BUD DHISM

AND
HEALING
Byo" from Hobogirin

Mark Tatz

UNIVERSITY
PRESSOF
AMERICA

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Contents
Pr e f a c e page v

Sy no p s i s 1

Par t One Analogies and Parables 9

1. The Four Truths 9
2 . The Buddha, King of Physicians 14
3. Poisoned Arrows 15
4. Buddhism, a New Medicine 17
5. Monastic Discipline Compared to Medicine 18
6. The Body as a Patient 18
7 . Cataracts 20

Par t Two Sickness and Holiness 21

8. Illnesses of the Buddha 22
9. Illnesses of Bodhisattvas 26

Par t Three Sickness and Healing in the Monastic Discipline

(Lesser Vehicle) 31
10. Nurses 31
11. Th e Medical Prof ession Int erdict to Clergy 35

Part Four Healing a n d Compassion (Greater Vehicle) 43

12. Bodhisattva Physicians 44
13. Healing and Missionary Activity 50
In China 50
In Japan 52
14. Works of Medical Assistanc e 54
Monastic Hospitals 54
Works to Bene fit th e Laity 56 In India 56
In Cey l on 57 In Cambodi a 57 In Chi na 57 I n Japan 60

Par t Five Theories, Practices , and Medical Authorities 65

15. Pathogenesis 65
Three Humors and Three Defilements 69
Four Humors 71
Humors and Elements 73
16. Classification of Illnesses 77
17. Th erapeutics 82
Religious Therapeutics 83
Magical Therapeutics 87
Properly Medical Th erapeuti cs 89
18. Buddhism and Indian Medicine 92
19. Buddhism and Sino-Japanese Medicine 94

Abbreviations and Bibliography 99

iii
iv
GPreface
De v i s i n g a c urriculum for a seminar on t he relationship
o f Buddh ism to medici ne and h e a l ing , I h a v e fou nd no
be t t e r treatment t han t hat given t he s ubj ect i n the year
1 9 3 7 by Paul Demi e vi l l e . Newer scholarship, to be sure,
h as el uc idated the source s h e relied u p o n , an d some of
i t i s in dicate d in the a n notatio n b e l o w. A new field of
Tibetan Medici ne has been opened and to some extent e x-
p l o re d . But the approach made by that lat e sinologis t
a nd scholar of Buddhism, aided by Jean F illiozat in
i n d o l o g i c a l matt ers , r emains without p e er for mast er y
a n d comprehensiv en ess .

The a rticle by Demievil le c ome s from Fascicul e 3

o f the Fr anco -Japanes e Hobogi r i n proje ct , an " e n c y c l o p e -
d i c dictionary of Buddhism , " b ased chi ef l y on t he Chi-
nese buddhist canon and J a p a n e s e scholarship ( s e e
Bibliography b el ow ) of which he was edito r-in-c hi ef.
It is e n t i t l e d byo , meaning "il ln ess" ( San s k r i t vyadhi,
r aga, abadha, etc.), or "i ll" (gZana ). " Byo" make s re fe -
rence to other arti cles of t h e diction ary , thus abbr e -
v i a t i n g many of its discussions , and I hav e expanded it
upon o c cas ion from t h o s e sour c es .

Hobogiri n u s e s Sanskrit and Pali s o u r ce s as well a s

Sino-Japanes e. Bein g myse l f a South and Ce nt r a l Asi a n -
ist with no training in East As ian lan gu a g es, I supp ly
t i t l e s and e qu i v a len t s in Sanskrit wher e possibl e,
rat her than i n Chines e. Chin es e graphs , as print ed i n
Hobogiri n are not r eproduced. Transcriptions of th e
graphs a r e altered in accordanc e wit h t h e Wade -Gil es
sy stem pr evail i ng in English-l anguage scholars hi p. I
beg the reader's i ndulge nce of any errors that resu lt.

This project has been sponsored with a grant-in -aid

by t h e Kern Fou n d a t i o n as par t o f its on-going support
of t h e Ca l i f o r n ia Inst itute o f In tegral Studi es. I am
g rateful to the Found ation and to Ra lph Metz ne r, De an
of the I nstitute, f or t heir e n couragement. Thanks also
t o Hu b e r t Durt, pr es ent editor-in-chi e f of the I nsti tut
du Hobogirin (E. F.E .O. ) f o r h i s endorsement of th e e ndeavor.

Mark Tat z

v
vi
Synopsis
Illness, along with birth, old age and death, is one of
e i gh t aspects of suffering enumerated by the MadhYaJ7lagaJ7la
Sil t r a and by Sar-va.s t Lvada scholasticism (see Mhv 2235,
Dzsi 3:213-14) . In addition, it is often counted among
the torments of the twelfth causal link tni.dana), the
lamentable termination of each cycle of human life as
Buddhism conceives it. Illness is a matter of physical
suffering; it imposes the experience of suffering upon
us in the most palpable and immediate way.

Now the Buddha seeks to deliver us from all suffer-

ing . And to that end he calls upon us, first of all,
to ascertain the fact of suffering to be an ineluctable
reali ty (satya) . He insists tbat we admit this, and
acquiesce to it with the "patience" (k?anti) that is one
of the cardinal virtues or "perfections" (paraJ7lita) of
the aspirant to awakening .

"All is suffering": this is the first of the Noble

Truths of the Buddha (arya-satya) -the Truth of Suffering.
The subsequent three, grounded upon it, teach deliver-
ance from that suffering. The second corresponds to
the cause of suffering, to its Formation; the third is
that of deliverance itself, of Stopping; the fourth
points out the Path to stopping. Diagnosis, etiology ,
recovery, therapeutics-these four principles that sum-
marize all of medicine can be substituted for the bud-
dhist Four Truths in a natural and straightforward
transposition.

If we face !,;;: uffering in its aspect of illness,

then the one who saves us from it--the Buddha--takes
the form of a physician. The analogy is glaring, and
it is to be found spotlighted in a text of the Safnyukta-
gaJ7la (though lacking in the Pali recension of scrip-
tures) . With luck it may be taken much further, for
it echoes the spirit that inspires Buddha's whole doc -
trine . Does it then follow that the truth of suffering
is the very heart of his teaching? "All is suffering"-
the physician's point of view, the prejudice of a
doctor!

At all times and in all climes, medicine and reli-

gion have been bound by affinities that may alter in
nature, but subsist nonetheless in one form or another.

1
Wh e n re l igion pres ents itsel f a s a method of hea lth, the
p a r all e li s m is comple t e and e xp o s i t o r s los e n o opportu-
n i ty t o g l o r y in it in order to impress upon the multi -
t u des , wi t h a thous and patent an alog ies eas i l y acces -
s i b l e to a l l, the ideal the y offer to th em. Me d ic i ne
t he n ap p e a r s as a sort of reduced image of re l i g iou s
t he r a p e u t i c s , applicable to the physical domain alone,
o r as r e l i g i o n on a h uma n scale : " The world ly physician
knows n ot t he radical remedies, tho se which heal birth,
old a ge, sick ness and deat h .. . He o n ly tends to t he four
corporea l e l eme nt s whereas t he Buddha , t he supreme
p hysi cian , t e nds t o the si x e l e me n t s and the ei gh teen
planes (dhii tiu), healing the defilements (k l eea ) , making an
e n d to all sufferin g a n d deliv erin g from birth and de ath
forev er . .. "

Th e questi on o f wheth er Buddhism has borrowed t he

four truths from medi cin e is not without in terest. As
it h a p p e n s , t he medi c al li t er a tur e of India does not
transmit to us any f ormula pr e cis ely like it. But medi-
cine could itself have borrowed f r om Buddh ism in any
case , inasmuch as the ana logy is ap t and profou nd.

Th e t exts cited in P a r t One of this article will

give a sense of the medical "parables" that abound i n
a ll genr e of buddhi st litera ture . The Buddha i s the
" k i n g o f physicians". He e xtr acts poison ed arrows-
g r e e d , h atred and delusion . He r esembles a new phys i-
c i a n who h as come to supplant in competent practitioners-
the mast ers of "heretical" d o ctrines . Sent ien t b eings
are his p atients ; the Doctrine-or better y et , the monas-
tic dis cipli ne-is h is medi cine ; the Community is hi s
n ursi ng c o r p s . Because a ll sentie nt beings, at l e a s t
i nasmuch a s the y h a v e no t a ttained d e l i v e r a n c e , ar e
i nva lids , a l l i s s u f fering . Th e b ody itself, wit h its
a pertures like p u r ul en t woun d s , i s mai n t ai n e d in he al t h
a nd life on ly t hanks to t he care lavish ed upon it ; i ll -
ness is its no r ma l s tate , and health is de fin ed b y a
negative term , "th e abs ence of illness" ((irogyaJ, that
also s erves as an epi thet f o r nirv a~a . (L i k e wis e , f o r
Pascal , " i l l ne s s is t h e natural st a t e of Chr i s t ians . . . " )

§ Here a problem a r ises: What h ap p ens wh en del iverance

has b e en r e alized? Sin ce i l l ne ss is o n e o f t he fo r ms
of sufferin g, c a n the saints-and t he Bu d d h a hims el f--
still b e subje c t t o i t on c e t he y h a v e e x hauste d th e e f -
f ects o f t he bad deeds t hat p ro duce s uff eri ng? Th e
Lesser Veh i cle answers that t h e y are f r e e from unwh ole-
somen ess of the mind, but n o t t ha t o f th e b ody .' In
West ern te r ms, the sou l has b e e n save d , b ut t he f le s h

2
ye t suffers : "Physicians will not heal thee, for thou
s h a l t die in the end . It is I [Jesus Christ] who heal
t h e body and render it immortal. Suffer the c o r p o r e a l
fe t t e r s a n d servitude: I shall deliver the e only from
t he spiritual for now " (Pas cal, Peneeee, e d. As t ie 3 : 2 6 7 ) .
Th e physical sufferings of th e saint are not a l l due t o
pas t d eeds , to those p ast misdeeds whose r etribution has
be e n compl etely dis char ged f o r him . Th e y a re exp l a i n e d
by pres ent causes- ad v entitious, external o r phy si ologi -
c a l- t h a t somehow es cape the mechanism of moral c ausali-
ty .

This interpretation is open to f a c i le obj ec tions

(Medi ce , CU1'a t e i pswn! J The Greater Vehicle superimposes
upon it a more subtl e one : Certainly , the Buddha and the
bodhisattvas are subje ct to su ffer ing-but only in their
" b i r t h body" , in their c arnal hypostases. Th e i r glo -
r i o us and transcendent "essential body" (dha imakii ua ) ,
incorruptible l i k e a diamond , is untouched by illness.
Al t e r n a t i v e l y , he simulates illness as a simp l e "means"
(up aya J o r art ifice of his compassion in order to lead
suff ering se ntie nt beings to health-an "opportunistic "
procedure through which he reassures and converts bewil-
dered sentient beings by sharing in their miseries. In
"absolute trut h", t h e illness have n o mor e r eali ty tha n
a n y illusory phantasma gori a o f our worldly e xp e r ienc e :
they are pure "emptiness " ($imyataJ , as the Miidhy amika
dialectic delights to demonstrate .

This doctrine is taught b y the VimaZakirtini r desa in

picturesque dialogues , rich in sparklin g paradoxes-the
t r u e "myst ery " of illn ess unfolding 'at the bedside of an
infirm bodhisat t v a.

§ Su ch are the prin cipa l probl ems that illness r aises

from t h e doctrinal point of v i e w . It remains to b e seen
wh a t probl ems Buddhism has had in practice, in the
cou r s e of its history and in the various countries in
which it is implant ed , in regard t o illness and healin g .

Allusions to illnes s a b o un d in the mon astic disci-

pline (vinaya J of the Less e r Vehi cle . Some affe c t i o n s
prevent a dmi s s i o n t o the c o mmu n i t y; some on t h e other
hand furnish grounds for exemptions from t h e c o de.

All t he disciplinary codes req uire in principl e a

section devoted to medicaments. But do not b e deceived
by this : medicaments that form part of the equipment
(pari I? kiu-a J of monks are intended only for th em . Monks
are st rictly forbidd en to g i ve them to pious laity or to

3
a ny other s ufferin g se nt ie nt be i ng . Uni v ers al k i n d ne s s
is not part of th e Lesse r Veh icle, a t least in it s prac-
tical forms, a n d the v i n aya forma l ly p rohib its c lergy
t he study a nd p r a c ti c e of med icine-cons i de ri ng it a
lucrati ve p rofes s ion un worth y of "ch i l dren of th e
Bu d dha" .

Mo nk s a n d nu n s may of co urse acqui r e cer tai n e le-

ment ary sorts of l e arning in matt ers o f ph a rm acy and
die t et i cs . They mus t in fa ct nurs e thems el v es -mo r e
pre cis ely, they mus t "gu a r d" each other- i f t hey should
fa l l i ll , becau se they h ave n o o ther f amil y t han t hat o f
t he Buddh a . Only a conf re re, moreover, h a s t he p r op e r
a u t h or ity to secure for a si c k monk the re l ig io us ass is-
tan c e- r e ci t atio n of th e Do c t r i n e , religio us i nstruct io n
a n d mo r al exho rtation- th at is of co nt inui ng importance
t o the min d a n d which may bri ng about p hysica l r e c o v e r y
a s we l l . Th es e min istrat ions , howeve r, are n o mo r e th a n
plain n u r s in g . Fo r a p rope rly medi c a l consu ltation on e
must cal l upon l a y pro f ess i on al s . Th e t rad it io nal model
is Jivak a , ille gi timat e s cion of t he r o y al h ous e of Ma-
gadha , r e gular physi cian to Bimbas a r a a nd his court a n d
t o Buddha a n d hi s comm u n i ty . At t he most , ce r t ai n Vin a-
y a authori z e cl ergy to practi c e t he r a peu t ics of magi c,
but eve n i n such cases t he c har ms th at a re r ecit ed to
heal l a i t y come from sacre d text s, and o ne ref u ses a ny
fe e t he p a t i en ts ma y o ffe r. Or e l se o ne ma y a dmi ni ster
a s eda t i v e among monks , f or examp le, whe n t he c a se i s
urgent and med ici ne i s l a ckin g , but such t reatme nt
s ho uld be a dmi n i stered in s e c r e t , unknown to th e general
publi c.

Th e v i naya 's very insis t en c e s h ows how st ro ng t he

t emp t a ti on mus t b e amon g monk s - and e v en more s o, among
nuns- t o practice medi cine . A r elatively l at e tr e a tis e
on di s c iplin e , th e Samanbapaeadi.ka , g o e s so far a s to
insti tut e a n art ful cas ui s t ry permi tt i ng c le rgy , by
c u n n i ng evas i o n s, to tre a t " pat ro ns" agai n st sub s t a n t i al
remunerat ion without b r e ak ing t he rul e .

One can s en s e a n i n f l ue nce of t he Greater Vehicle

in t hat text, fo r its e t hic con t rasts with that of t he
Le s s er Vehic le on this po int, as on many others . The
bodhisattva, a sai nt of t h e laity, min gl e s wit h t he
wor ld; the re h e can c ult ivate giving in particular--
amo ng the car d ina l perfec tions, always pl ac ed at t he
h e ad of t he list , a wit nes s to h i s un i v e r s a l compas s io n.

Compass i o n i s n ot mani f e s t o n t he spirit ual pl an e

a lone: g uar dia n of b o d i es as wel l as of s o u l s , th e
bo dhisattva s t u dies a nd practi c e s medicin e as o ne of t he
4
f i v e secu lar sciences (vidyaJ recommended by the Mahayana
to its adepts. The disciplinary c o d e s of the new church
rev e r s e those of strict monastic Buddhism, prescribin g
at many turns the obligation to care for, to treat medi-
c a l l y , to shelter a ll sentient beings there may be.
Young Sudhana, an aspirant to awakenin g makin g a "tour
of India" in quest of reli gious teachin gs, takes a
c o u r s e of medicine under the saintly drug gi s t Samanta-
netra, himself a disciple of Ma fij u s r i . Jalav ah ana like-
wise, in the Sunarnaprabhdea , is taught medical do ctrin e by
his father Jalimdhara.
I
§ Indian medicin e accompanied Buddhism i n the course of
its expansion into neighboring countri es. In Japan
above al l the new religion was accepted , at around th e
y e a r 600, essentially as a therapeutic. Vows of physi-
c a l healing are present at the beginnings of art , archi-
t e c t u r e and epigraphy--in short, at the beginnin gs o f
all buddhist culture in Japan-and among the hosts o f
buddhas and bodhisattvas there are two great h ealers ,
the b uddha Bhaisajyaguru, "master of medicaments", and
the bodhisattva'Avalokitesvara, whom the first be lievers
preferred to worship.

In Ceylon, Cambodia , China and Japan , the spirit

of charit y that Buddhism introduc ed was translated into
c o n c r e t e benefits who were in need. Emperors, kin gs
and princes founded hospitals, subsidi z ed asylums, and
organized the distribution of remedies. These institu-
t ions of kindness, however, do not survive the periodic
bursts of enthusiasm. Th e y disappear altogether in the
decline of Buddhism, and to th e e x t e n t that kindness is
tending to be reorganized among the buddhists of East
Asia, it is in fact a result of christian influence.

What were the concrete manifestat ions in India it-

self of the compassion so ardently attested in the
literature of the Greater Vehicle? We are not aware of
any. All we reap are one ambiguous phrase among the
inscriptions of Asoka upon the solicitude he b estows ,
in his empire, upon men and animals , and some literary
a llusions to charitable works founded by certain kings
or incumbent upon bodhisattvas . Perhaps Indi a, mother
of dogmas and moral codes , has bequeathed to others the
trouble of making them thrive in the ,field of vile
materiality. The myth of Soma , the incarnation of a
bodhisattva, who gives his gigantic body to sick sen-
tient beings to dismemb er and consume as a inexhaustible
panacea, is an example of that tendency to unr eality
that contributed to diverting Buddhism from down-to-

5
 nr h Il lIp ll. 'I II. 1 n .

II n umh« I ' or t e x t s of the Chines e canon bearing on

I II I' d I" " I t.h io ry and practice ar e translated or described
III 1111 I l l S L p art o f this ar t i c le. That abstra ct, along
wi t h Lhe d ate s of the 'Chin e s e ve rs i o n s , may furnish
: I) J ' l a l i s t s some b en chm a r k s fo r t he h i story of hindu
lII 'd i c i n e. The te xts cannot be st u d i e d and e xploited
her e . But e v e n a s ummary e x a mi n a t i o n r eveals that on
man y poin ts the me di c al t r a d i t i o n attested in buddhist
lit erature diver g e s f r o m t ha t of t h e Ayurveda- the clas-
si cal canon of In d i an med ic i n e - a s known from treatises
of uncertain d a t e who s e s ub s t r a te is certainly highest
antiquity bu t who s e pres e n t recensions are no o lder
than tho s e of t h e e a r l i e s t Chines e buddhist t exts .

Th e div erg e nce i s e s pe c i a l ly acute in r e g ard to

do c t r in e s o f pat h ogen e s i s , In b o th classes o f document
t h e o r ig i n of il l ne s s is a s c r i b e d to a dis equilibrium
of e lemen t s (s o l i d, moist , hot , e tc. ) that constitute
t he b ody . But the Ayurveda distinguishes, amon g five
n o rm a l c o r p o r e a l el ements, three "peccant " (doe a) e l eme n t s
t hat a re g i v e n sp e cial nam es, whereas in most' buddhist
t ex ts t h is te r n a r y g r o up of patho gen ic e l eme n t s is
ec l i p s e d by a quat ernary g r o up -- f o u r physi cal e leme n ts
desi g n a te d by their norma l names, Upon this l att er
g r o u p rests the classifi c ation o f illnesses , whi ch is
like wise q ua t e r n a r y . Is this merely an adaptation of
medi cal doct rin e to th e particular theory of el ements
that developed in Buddhism? Or shou ld other causes -
perhaps ext ~rnal to India--be adduced to explain this
anomaly of buddhist ~ r a d i t i o n ? This is a question that
c a n only b e e xamin ed in c o n t ext o f doctrines be aring on
the e l e me n t s (mahabhfitaJ in buddhi s t c o s mo l ogy and physio-
lo gy; to a n s we r it exc ee d s the s c ope of this ar ti cle.

§ He aling pr a cti c es may be distributed under th r e e

headings , f o l l owi ng \an eminently suitabl e buddhi st
cl as sification : religious therapeutics ( g ood works, and
pra ctices of worship, expiation, medita t i on, e tc . ) ,
mag i cal therapeuti cs (mantr as, in cant a ti on s, e s o t e r i c
r i tual), and medi c al th er ap euti c s p r op e r ( d i e t e ti cs,
ph armacy, surgery, etc. ) The lin e s d ema r c a tin g thes e
t h ree fields a r e n ot at a l l dist in c t. Wh er e do " r e l i -
gi ous " ther apeuti cs stop? All o f Bu d dhis m is a s i n g le
ther apeuti c. From the earliest s t ra ta of tex t s , a
healin g value is at times as cribed t o med i tation con-
centrated upon arti cles o f fa i t h, to t e a ching, to the
r eci tation of sa cred t e x t s; a d o c t r i nal f o r mu l a (for
e x ample , th e st a t ement of t h e se ve n l im b s of awakenin g
6
ac c o r d i n g to the Ekottar agamd) may function as a healing
i n c a n t a t i o n . Pious works also contribute to the main-
te n a n c e of health, since physical ills'may b e due to
p r e v i o u s deeds; the Greater Vehicle promises "absence
o f illness" to those who cultivate the p er f e ctions.
The discipline of meditation (dhy ana , ch ' an, zen) combines
mental exercises with techniques of bre athing , "eve n as
s mok e is both fire a n d wood "; t h i s doubl e hy g i en e ,
p hy s i c a l and mental, assures the health o f t he body
t o ge t h e r with that of the mind: it is a ge n re of the ra-
pe u t i c that Chinese buddhists stress with p leas u re ,
mi n g l i ng their explan ations with concepts a n d terms
drawn from Taoism.

Ma g i c a l therap eutics, mentioned and sometimes

a u t h o r i z e d as far back as the old disciplinary s chool ,
b e comes later a speciality o f the tantri c s chool. We
wi l l take note of the principal works of the Chinese
can o n devoted to this subject. -

Surgery is chi efly represented in buddhist litera-

ture by the outlandish "tales of the sick" of Jivaka,
to which the marvelous operations of Hua T'o , the Chi-
nese physician who died in A.D . 220, bear such a resem-
blance as to seem no more than a legendary echo. We
will briefly examine, in this regard, the recipro cal
influences between India and China in the fi eld of medi-
c i n e that have been exerted with buddhists as interme-
diary; outside of pharmacopoeia, the balance seems near-
ly even.

This article h as be en reviewed in manus cript by Dr .

Filliozat, presently the f o remo s t western expert in
Indian medicine and its history. His obs ervations have
been priceless; s everal are bracketed b elow with his
name appended to them. 1

1. (Footnotes are those of the translator.) See Filliozat 1949

(a later publication) in the Bibliography below.

7
I II
i

8
Part One: Analogies and Parables

1. The Four Truths

Samyukt agama T 99: 15:105a-b [Gu ~ab ha d ra version, A .D.435 -
44 3 , accor ding to Bskd 7 :61 base d u p on a r e c e n s i o n of
the Sarvaa t Lva.da school; l a c k i ng i n the Pa1i Nikayas ; f or
t h e Sk t text , c ited by Yasom itra in his comme ntary to
t h e Ak , see 6: 121 n . 4 : t his text u s e s t he term dbadha ,
wh ich does no t seem to h a v e t he special s e n s e of
"i l l nes s", but s i g ni fi es "torment" i n genera l; see also
Ar u n a d a.t t a o n Va gbhat a , A?tangahrdaya, Ni.danasbhdna 1: 2;
Saundar ananda 16 : 41 s h ows v yadhi J : 2

A sutra de livered by the Bu d d h a . . . "He is named a

great ki ng of p hys icians who h a s realized th ese four
qualitie s (dharma) : (1 ) to clea rly know illness- i . e . , the
differe n t sor ts of il l n e s s [abadha- kusa Z,a J (d i a gno s i s) ;
(2 ) to c lear ly k now the orig in of i l l n e s s -whe t h e r du e
to wind, or to p h legm [ v a r . " i n d ige s t ion" ( ? ), h e r e= Sk t
e l.eeman , second of the "peccant humors ", see be1owJ , or t o
sa livary secretio ns [here=Skt pitta "bi le ", the third
"peccant humo r " J , to various sorts of cold , to persona l
karma, t o t he s e a s on [abadha-samutthana -kusaZ,aJ ( eti olo gy );
(3 ) to clear l y know the cou ntermeasur es t o illness :
ointments, expe ctorants or emeti cs, e vac u a n t s (purga -
tives) , i n ha lants (cp . Mahavagga 6: 13; Jol ly , Medicin par .
1 17,3 f umi gations , sudorifics t eu eda? ) [abadha-praha~ ­
kusa Z,a J ( t h e r a p e u t i c s ) ; (4) to cl ear ly know how t o treat
i l lness i n s uc h a way t hat having been treat ed, the re
will be no d an g e r of r el ap s e [aba dhasya-ayatyam-anutpada -
kusaZ,aJ ( d e f i n i t i v e h e al in g a nd prevention) . ..

" In the same way the Thus Come One , th e Worthy, t he

fully perfected Buddha-the great kin g of physi ci ans--
realizes fo ur virt ues t hanks to which h e h e als the il l-
n e s s e s o f sen tie nt b ein gs . That i s to say, he knows
t he fo u r Nob le Tru ths: (1) of s uffe ri n g (duh kha) ; ( 2)
o f the f o r ma t i o n of suffering (s amudaya ); (3) of t h e
stopping of sufferi n g tni.rodha ) ; (4) of the path to that

2. Asva g ho s a , Saundarananda 16 :4 1 ( tr. John ston ): " The r e f o r e i n

the first Tr u t h think of s u f f e r i ng as diseas e, in t h e second of
the f ault s a s the cause of disease , i n the t h i r d o f t he destruc -
t i on of s uffering as good health and in t he fourt h of the p a t h a s
the medicine ."
3 . Se e a lso the En g. t r . of this wo r k , Biblio graphy b elow.

9
 s t o p pi ng (marga ) . Th e mu n dane p hys ician d o e s n ot tru ly
know , a s t he y r e al ly are (ya thiibhutaJTI ) , t he rad ica l (fun -
d amenta l ) c o u n t e r me a s u r e s --n ame l y , th e rad ica l c o unter-
me a s ure t o birth [ th e e leventh causal linkJ , a n d t hat
to o l d a g e , to i llness, to deat h , to sorrow , to l ame n -
t at ion , to p a in , to tri b u lation [ a nd ot he r mi s eri e s
res u l t i ng f rom b i r th t ha t co nstit ute t he twe l ft h causa l
link.J"4

A re vision of this t e x t transl a te d at th e end of

the tenth cent u ry forms a n i ndepe nde nt s utra i n t h e
Chi nese canon ent i t l e d Sut r a of t he Nedi eal. Comparis on T
2 19.5 Th i s work e n u n c i a t e s four med ical prin ciples t hat
differ s l ightly from the above : "( 1) to know that for
e a c h illness one must use a corresponding medici ne;
(2) to k now the ori gin of an il ln ess and the medic ine
to be emp loyed ac cording to t hat origin; (3) the il l ness
h a v ing b een produc ed , to know its healin g and elimina-
tio n ; (4) to know h ow t o destroy the source of t he
i llness to prevent any relapse.
II'II A mor e el a borate rece nsion i s in c l uded in T 100 : 1 3 :
!i
462c-463a, a n ano nymous v ers i o n o f th e SamyuktagaJTIa
att rib uted to th e Ch 'i n dy nasty (A. D. 350-43 1)6 whi ch
arose, accor d i ng to indications marke d at Bs dk 7:62 ,
from the Kasyap iya s choo l, a relative ly lat e branch of
the Sarvastivada s e ct. To the c omp a r i s o n with t he f o u r
truths this recension a d d s a versified expans ion [to b e
f o u n d in part at T 99:45:332 cJ:

" ... Just as th e Th us Come One, t he Worthy, the

ful l y perf e c te d Buddh a--th e good p hys ician wit hout
e qu a l --e x t r a c t s four sorts of po isone d ar row fr om sen -
tie nt beings [s e e Ak l o c . cit.: bhi sak sa Zya paharta; Siksa-
saJTIuccaya and ch. 3 b el owJ . . . Th en t he v e n e r abl e Va g i§;a
was i n t hat a s semb ly [Pal i Van gi s a , t he n ame of a monk
who ex celled in composi ng stan zas; in particu lar, it i s
related of h im t hat o nce h e was ill and the Buddha,
called b y the n u r s e , came to pay h i m a visit ; S~uktagaJTIa
T 99: 36: 259 c -260c, cp . Samuuiita- rrikii ua 1 : 192 and Mahiiva s tu
1: 165J... He sa id o f h i ms el f that he h a d c omp o s e d a
e u l ogy of t h e comparison of t he four poisone d a rrows.
He rose f r om his s eat, palms joi ned , and utt ered these

4. Th e twelv e l inks (nidana) o f d e p end e n t o r ig i na t ion (pr a t l t ya-

samutpada) trac e the p r oces s of life , d eath and r ebirth; se e
Rob i n son and Jo hnson 1977 : 31- 34 .
5. Skt titl e Bhisa jupamana-s utra ; K 1446 .
6 . According to K, during the thr e e Ch ' i n dynastie s, A.D. 352-431.

10
s t anz as :

"'And now I take refuge in the Buddha, compassion-

at e to s enti ent b eings , r evered a s supr eme a n d pr emier,
wh o understands how t o extract poison ed ar rows ! Ther e
a re f o u r s orts o f mundane physi cian , cap ab le o f h ealin g
fo u r s o r t s of malady respecti v ely : (1) t h ose of the
bo dy, (2) thos e o f childr en, (3) t h o se o f t he eye s, and
(4) those of poisoned arrows .

"' ( I ) [=3 abo ve] The Thus Come One sur p ass es mun-
dan e physi ci ans i n op thamol o gy be c aus e he unders tands
h ow t o cut of f the catar act (trimi r a) o f i gnor an c e wit h
t h e iron of wisdom . (2) [=1 above] As f o r maladi e s o f
the body, h e doe s not h eal o n l y t he f o u r el emen ts [cor-
poreal elements of medical doctrine, see ch. 15 below]
a s does the mundane p h y s ic i a n ; h e takes cl e ar and com-
plet e ac cou n t of th e s i x e lemen t s [dhat u , o f the hum an
being ac co r d i ng to b u d dh i s t do c trine : ear th, wat er ,
f i re, a i r , s pace , and c o nscio us nes s ] a n d o f the e ight -
een el ements [es t abl i shed b y buddhist ep i stemo l ogy :
or g a ns , obj ects , cons ciousn esses , e tc . ] (3) [ =4 a b o ve ]
By me ans of th e doctrine h e can t r e at the most grave
ma l a dy of th e b ody--th e t hree d e f ilemen ts [t he th r ee
f u n dame ntal passions , se e c h. 15 b elo w]. ( 4 ) ~2 ~ve]
An d he u nderst ands h ow to tre at c h i l d i s h i mb e c i l i t y as
we l l [ i. e . , t he i gno r an c e of " j uve n ile " s e cular p e rs on s ,
pr'thagjana ] . That is why I pay homage to the g re a t mas te r
Gaut ama!

"'The kin g of ph y sici an s n a med Ka ru [Skt ?] h as

g ive n man y d e c o c tions a n d me d ic i nal h erbs to man kind ;
a n d t he re a re a lso t he l e arn ed * Ba k k u la [B a hula , Vahu l a ?
Bakkula was f o remo st among the dis cipl es o f t h e Bu d dha
in f ree dom from illn ess, b e caus e he h ad o f f ered , not
lon g b efore , th e e xce l l e n t drug myroba l an t o th e c om-
muni ty of Buddh a Vip a s yin , T l25:3 :557 c , l26 :83l c ; c p o
T 26: 8:475 c , 199:l94b-c , Tt l509: 22:2 23 c, Tt 154 5 :181 :
9 0 8b ], *Ca mp e y ya, a n d Jiva k a. Th e s e f our k i ngs of
phy si cians a re cap a b le o f h e alin g all i l l nesses ; but
where as th eir tr eatmen ts are unquesti onably conduciv e
to h ealin g, the illn esses they h eal thus are subj ect
to r e cidivism . Furth ermor e, th ey nev er pr e v en t d e ath.
The p e erl ess phy s ici an , th e Thus Come One , rids those
h e t r eat s from de fil e ment [ fr om t h e passions ] . He
g u i des them t o t he t erminati on o f su f f erin g , a n d
deli v ers th em d e finiti v ely f r om b irth and death so th at
they will n ever again have to submit to su fferin g . ..
And now, 0 sages (T 99: 0 physi cians) joined in this
g r e a t a s semb ly , l et you all a dmi n i s te r, wi th all you r
hearts , th e ambrosial drug o f immort al ity (T 99 : th e
11
drug th at is the doctrine of ambrosia)! And may all
peopl e agree to believe in the supreme guardian of the
eyes, in the healer of the body, in the extractor of
poisone d arrows, in the unequalled physician! '"

§ Compare the Mahaparinirvii1')a-sutra T 375 : 5: 631c where the

stat e of healing is assimilated to nirvana defined as
th e a b s e n c e of all hurt . Nirvana has ai ready been com-
pared to the absence of i l l n e s s (arogya) in a gnomic
s tanza of the Madhyamagama, T 26: 38: 672b [=Ma jjhima-nikaya
1 :510, MagandiyaJ,a text that compares the sensual secu-
larist to a patient, a n d the ignorant to a blind man .
See also Tt 1558: 13 (Ak 4: 34) .

§ The Safnyuktiigama a g a i n defines the four truths in medi-

cal terms during an enumeration of the cognitions (jnana)
bearing upon the truths that characterize the Noble Dis-
ciples endowed with erudit ion, T 99:l4 :9 4c [this pas-
sage also lacking in the PaliversionJ: "These noble
ones cognize, in a manner conforming to reality: (1)
illness in its three aspects of desire, becoming(bhava)
and ignorance; (2) the formation of illness in its as-
pect of the formation of ignorance; (3) the stopping of
illness in its aspect of the stopping of ignorance; (4)
the path to the stopping of illness in its aspect of
the eightfold path . And they likewise cognize, confor-
ming to reality, suffering, its formation , its stopping,
the path to its stopping . . . "

§ In his History of Buddhism in India (1 :367) Kern, not famil-

iar with the abovementioned texts, cites a commentary
to the Yoqaeictva in which he finds four religious truths
compared-as in Buddhism--with four medical truths:
»oqaveainearahetiu , iirogya=mok?a, bhaisajya=mok!!opiiya . The commen-
tary cited by Kern is the Bhasya attributed to Vyisa .
This work seems to date from around the sixth century
A.D. and may have borrowed the medical comparison from
Buddhism . But Dr. Filliozat (JA 1934:1:302) has ob-
served that Kern is premature in interpreting the doc-
trine of four truths in Buddhism (and in Yoga) as a
literal borrowing from medicine; the four categories
compr isin g diagnosis, etiology, therapeutics, and heal-
ing are not in fact found in the technic al literature
of Indian medicine .

One might object that Asanga , in a chapter of the

Yoqacarabhiani-sbae bra (Tt 1579: 1 5 : 365a) d evoted to the five
secular sciences (vi dyiisthiina ) a dmi t t e d by greater-vehicle
Buddhism), mentions th es e same prin ciples , styling
12
them strict ly medical and not drawing any parallel to
the four Nob le Tru t h s . In this text medical science
(cikitsa J is defined in between internal science (adhyatmaJ
a n d logic (hetuJ . Medicine comprises, a ccording to his
definition, four abilities concerning , r espective ly:
(1) the characteristics of the illness, (2) its cause,
(3) t h e i llness h a v i n g arisen, its destruction, and
( 4) the means by which the illness , having been des-
troyed, wi l l be prevented from re-arising. (Th e Skt
formula of the four medical truths corresponding to
that of t he Yogacara bhWni-sai t ra i s to be found in the
Bodhi sattvabhWni ed. Wogi hara 96 [ =T 1 48 1: 3: 903a J ; it is
nearly identical to the formula cited by Yasomitra in
his Vyakhya to the Ak; cp , "Synopsis " above .)

There is no doubt, however, that these texts are

only s h owi n g a ref lection o f t he influen ce exerci s ed
by b uddhist doctrine upon whatever medical system that
buddhists admit from th e period (or, in the mi lieu) in
which the Greater Vehicle authorizes an d commends the
study of medicine ( f o r b i dd e n to c lergy , as will be seen
below, by the monastic discipli ne of the Le s s e r Vehicle).

We wil l see furt her on that in pathogenic matters

as we ll buddhist authors seem t o deviate from t he c l a s -
si ca l formulations of ayur vedi c tradition a n d tend to
n e gl e c t , in explaining t he origin of illness, the pure-
ly medical co nception of "t hree humor s " in favor of
that of "four el ements" whi ch would b e fam iliar to all
buddhists. This gives no cause f o r postulatin g that
the theory o f f o u r e lements might be a borr owing from .\
me d i c i ne . In the same way, if th e doctrine of "four
t ru th s " lends itse lf to e x a c t t ransposi ti on i n t o me d i -
cal terms, one can still not be certain in concludin g
that it is i t s el f a mere transfer of a med ical f o r mu l a -
tion. And one must r ecognize that our documents on th e
tradition of Ayu rveda--documents in which this formula
d o e s no t figure--are do ub t l e s s i n their p r e s en t state
posterior to the Sainyuktagama, i f not to Asv a g hos a ts aundara-
nanda J , Asanga and Vasuvarman , authors who also prov ide
the celeb rated compar ison (see above and ch .16 below) .

§ At any e ve n t , t h is s tr iki ng a nalogy s hows at what

poin t the Buddha--or, the inventor or invent ors of t he
formu la of the four tr uths, if one pre fers to f o l l ow
Kern to the end and see t h e Buddha as ·me r e l y a myth--
fe lt an a f fi n i t y with h e a l e r s of t he b ody and conc eived
o f h i s do c t r i n e as a th e r a p e u t i c. On e will al s o observe
t h a t i n most of the abovementioned t e x t s t he fou rth
medica l term (correspon d ing to the path to the stopping
13
of suffering) does not concern, as one might anticipate,
the means to heal illness after having recognized its
nature (first term=suffering) and its causes (second
term=formation), but is defined as the means to prevent
relapse after healing. The therapeutic proper is coun-
ted as the third term (=stopping). This contains a
nuance doubtless to be explained by the doctrine of the
path. But in a t re atise of Sarvastivada scholasticism
devoted specifically to the four truths, Tt 1647:1:379c,
the path is better assimilated to medication as treat-
ment for illness : (1) suffer ing=illness, (2) formation=
cause of illness, (3) stopping=absence of illness , and
(4) path=medicament for the treatment of illness. The
same correspondences are found in Paramartha's version
of the Ak, Tt 1559: 266b, and at Baundax-ananda 16: 4 1.

2. The GfJuddha, King of Physicians

Vaidyaraja, ·" k i n g of physicians" (or, "of medicine"),
"medicine-king", is a frequent epithet of buddhas in
general (and, by extension, of bodhisattvas as well),
especially of Buddha Bhasajyaguru, "master of medica-
ments", whose "fundamental resolve" (mula-prani.dhana)
was to be healer of the sick . 7

T 276:384c : " Th e Buddha is a king of physicians

who discerns the marks of illnesses and knows the na-
ture of medicaments . He gives medicaments suited to
the illnesses so that sentient beings take them gladly ."

T 159 :8:330b : "Just as a great king of physicians

gives medications suited to illnesses, so the bodhisat-
tvas preach and convert suited to what is fitting [for
sentient beingsJ ."

Ibidem 328c: "Just as the panacea aqada 8 can heal

7. See Birnbaum 1979 . Other refs . on vaidyaraja , etc. Mpps 1:17

n.; also Msv Skt 2N42-49, a discussion of medicine by which
the Buddha converts Jivaka .
8 . Hobogirin 18b : "Skt, Pa1i agada 'remedy '. Ttt 2128 :21 & 25
give the exact etymology , 'non-illness ' ; and add a fanciful deri-
vation, a ' e x te nd e d , all' + gata 'depart '--which is to s a y that
all illnesses disappear--or agada 'priceless' . Ibidem 26 trans-
late's Japanese fushiyaku 'remedy of immortality'. Eog 2 trans-
lates mubyo ' wi t ho u t illness ' . Gog 24 translates ganyaku 'pill' .
The word assumes a mystical value in the title of several sections
of T 1092 [Amoghapasakalparaja--tr.J (33 , 43, 45, 48). The agada
serves as a compari son in various sutras to exalt the word of the

14
a l l illness, but after healing the medicament is aban-
done d just as the illness is--and for it to be adminis-
t ered in the absenc e o f illness would c a us e one to fall
ill again--thus the medi cament ' emptin ess' (su nya t a) i s
pre s c r i b e d unt il t h e i llness 'belief in b e comin g ' (bhava)
has been e l i mi n a t e d; attachment to emp tiness is an ill-
ne s s just a s at tachm ent t o becomin g is , a n d t hose wh o
pos s e s s g n os i s (j na na )will makes thems e lve s ill i n
taki ng it a s a medi cament .. . "

A similar c omp a r i s o n is f ou n d in th e Nii qaeena - eida-a

T 1640 ( =MiZi no-apanha 43, BEFEO 24 :119-20) wi th respe c t to
wis dom or g n o s i s (but emptiness is also mentioned).
Se e also La Va llee Poussin in MCB 2 : 32 .

1 'Poisoned '1lrrows
MahCiparini r va1Jfl.- sut r a T 375: 5: 631c: "It is like a man who suffers
f r om havin g been s truck by poi s oned ar r ows; h e e n c o u n -
t ers a good phys ician who remo v es the arrows f r om him
and appli es wonde rful medicaments , ending his suffering
a n d procuring p eac e and we l l - be i ng fo r him. And this
ph ysi cian t he n tr avels through t own s and v i l lage s,
go i ng whereve r h e fi n d s p ain a n d wo u n ds to he al . In
t he same wa y , th e f u l ly p er f e c t ed Buddh a is a g r e a t
king of physici ans. He s e es the s uf fer i ng s enti ent
b eings o f J ambudvipa--beings who under go g r e a t suff er-
ing s across measureless numbers of aeons, being struc k
by the poisoned arrows that are the thre e [fundamental J
pass ions: g r e e d, h atred, a n d error [ =the "thre e d efil e-
ments" , s ee c h . 15 be lowJ. He te ach es them t h i s medi-
c a me n t th at is t he ambrosi al doc trine o f the gr e ater-
vehi cle slitras--whereupon , having h eal ed them, h e b e-
tak es himself wherever th ere ar e wounded who hav e been
struck b y the poisoned ar rows o f the p assions , a n d h e
r eveals hims elf to them a s the Bu d dh a in orde r t o heal
them . . . "

The simile of poison ed arrows is routine; see the

e a r l y Sainyuk tagama cited in ch. 1 a b o v e. The Madhyamagama
T 26 :4 :442-3 [ =Majj hi ma- ni kaya no. 101 , th e Devadaha J des-
c r i be s th e successi ve su f f erings cau se d b y medical
treatment of a wo u n d due to a poison ed arrow , suff erin gs

Buddha, which hea l s a ll the pas sions, T 27 9 [Avatamsaka-sutra--

tr . J 13 & pas sim, 376: 6 etc . I n Japan, t he J odo sect comp a r e s i t
with t he n embutsu (Shn s ) . Tt t 2125 (tr. Taka ku s ll 1 27 ) : Aga da is
the fifth sec t ion of med ical s c ie nc e (ayurveda) , d ealing wi t h
antidote s."
15
of wh ich t he p ati e nt h as a clear aware nes s : he di sti n-
gu i s hes a nd h as a c lear mindfuln ess o f t h e suf f erin g
cau sed by t he wou nd it self , t hose brough t on b y ~ he
physi ci an in op enin g the wou nd wi th a k n ife, i n s earch -
ing o ut the point of t h e a r row, i n e x tr a c tin g i t , i n
a pp lyi ng t h e dress in g , and s o fo rt h . In t he same wa y ,
t h e b u ddhist is aware o f su f f ering, h e keeps trac k o f
its actua l phases a n d is cau s al e v o l u t ion; h e r e f use s
to bl indly accept--a s does t he h ete rodo x Ni r g r a n t ha--a
mechanical inevi t a b i lity o f d e eds (kar ma) .

Ib i d . 60:804-5 [ =Maj j hi ma-ni kaya no . 63, the Ma Zunkya ;

a n o t her, indepen d en t Ch i nese tran sl a t ion T 94 ]: If t he
Buddha i s wa ry of q uest i ons re lat i ng to the pe r manence
of the wor l d, to t he i nfi n ite , etc., i t is to t h e e n d
o f avo i ding wh a t would h ap p en t o a man struck by a
poison e d a r r ow who i nte rrogat e d hi s p hysician as t o hi s
n a me , hi s c l a s s, e tc., o n t he d i r e c ti on t he a r row t ook,
on the b ow , etc. --he wou l d di e b e f o re al lowi ng hims el f
to be h e al ed.

Mahapr ajiiaparamita- sastra Tt 15 09 : 1 : 58 c: 9 " All s entient

beings are defil ed by the il ln e sses o f t he f etters [sam-
yojana=pas s i ons ] . No o ne in th e cou r s e of b e ginningl ess
samsara has ever b e e n able to h ea l the s e illn esses ,
eve r b adl y unde rstood by b ad h et erodox mast ers . Now I
have appe ared in the wor l d li k e t h e g reat k i ng o f p hys i -
c i a n s, a n d I hav e compos e d th e med i camen t o f do ctr ine ,
and y ou s hould t ake i t. Tha t i s why I e n u nciate th e
Prajiiaparamita-sutra! "
Ibid. 22: 22 4 a : 10 " Th e Buddha is li k e th e king of
phys i c i ans, (2) the Do ctrin e is like the good medica -
ment , a n d (3) th e Communit y is like th e nurs e [1- 3 : t he
Thre e J ewels]; (4) I must submit to th e medication
presc r ibed by th e Buddha [i . e . , the Doctrin e." Cp o
Susrut a , Sutras thana 34 : 1 5 : "The p h y s ic ian, the pat i en t,
the remedy, and t he nurse : th es e a re the (f o u r ) l e g s
o f medi cin e that e n a b le one t o rea l i ze (med i cati v e)
work . "--Dr. Fillio z a t]

Ibid . 8 5: 6 57b : " Fo r h e alin g t he pati en t (1) o ne

n e e d s: a phy s i c i a n (2) , medi c in al h erb s ( 3 ) , and a

9 . Trans l a t e d a nd up date d a ccord ing to Lamott e, Mpps 1 :17-1 8 .

10 . Ibid. 3: 1393; s e e a lso t he pas sag e f rom Ak & vyakhya i bid. n .
1. Se e a lso ibid . 1407 : "The Buddha i s lik e a ki ng o f p hys ic i a ns ,
the Doctrine i s l i k e a good medi c ament , the Commu n ity is l i ke a
s i c k - nu r se , a nd mor ali t y is like s u bmi s s i o n to a me d i cal r e gimen ."

16
nurse (4) ; so the bodhis attva (l) , in order t o destroy
t he p a s sions , must (2) vow to wo r s h i p the Buddh a , ( 3)
p l a n t who l e s ome roo t s , a nd ( 4) f req u e n t who l e s ome
fr i e n d s . "

4. Buddhism, A New §VIedicine

Mihaparini P7Ja:r!"l- sut ra T 37 4: 2 : 3 78- 7 9: A fool i sh k i ng pays-
a n d ve ry dearly-a stupid phy si cian who t re ats a l l i l l -
ne s se s wit h a lacteous r e gi men , wi t h o u t knowing the
o r i g i n of illnesses and wi t hou t a n y expl an a ti on for t he
c u r a t i v e val ue of milk . Another physici an a r riv es; he
is wi se a n d knows t h e e igh t med ica l techniques (se e c h .
17, " Prope r l y Medi cal .. . " below) . Received wi t h s corn
by the o l d e r physi ci an , the new one defers and solicits
his teachings . Th e older on e r eplies that h e will
te a c h him medicine only i f he remains forty- ei ght y ear s
i n his s ervice . Ushered into the presence of the king ,
t he new doctor expounds to him the true principl es o f
medicine. The elder is dismissed. The good physician
f orb i d s the people, under penalty of decapitation , to
use milk as a medicament. But the king hims el f is
stri cken by an illness th at requires, acco rding to the
diagnostics of the physi cian , pr ecisely a milk tr eat-
ment. He e xplains t o the king th at milk, an injuriou s
medicin e in general, is non ethel ess indi cat ed in ce r -
t a i n c a se s . The cows , how e ver, should be r aised a nd
nourished according t o ce r tai n rul es t h a t he shows in
detail-here is a d is tin c tion of which the form er
physici an was unaware . The k ing is heale d th anks to
t hat g o o d milk , a n d authorizes hi s peopl e to t re at
themse l ve s with milk. Startl ed by this a p p aren t c o n-
tradiction , the p eopl e b alk. Th e king e xplain s what
can and what cannot b e r elieved b y that me d i c i ne.
Pati ents then put themselves t o drinking goo d mi l k and
al l are healed .

In the same way , t he Buddha is a g r e at k i ng of

physi cians wh o has a pp e ared i n the wor l d to subjugate
a l l het e rodox physi ci ans . Some would t e a ch the un condi-
t i onal nonexistence o f the self (iitman ) ; th e Buddha a l s o
preache s non-self ( a niitm an) , but with the aim o f s ub d u i ng
s enti ent b eings-out o f opportunism . In c e rt a i n cir-
c ums tan c e s he teaches the e x i s t e n c e of a c e r tai n sel f
th at is different from what the secular imagine .

§ See also Yogacar ahhflmi-sa stra Tt 1579: 46 : 545b where the

audit ors of the buddhas who accep t the initi al and
e asi e r predication o f the do ctrine with c o n v i ct i o n and

17
 I'CJ I' V O I' b u t s h ow t hemse 1ves in capabl e of ac qui esc ing t o
Il i gh c r a n d g r a du a l l y pro found int erpret ations taught by
t he bu ddh a s as o ne ri se s in the Greater Vehicle , are
compare d to p atients who receive with f aith th e medica-
ment prescri be d for a first illness but are seized b y
doubt when t he phy si cian c ou n s e l s th em, be c ause o f a
furt her i l l n e s s o f another sort, to renoun c e the medi-
c a me n t that has h ealed t h e m and a d op t anoth er in its
place.
S. Monastic Discipline
Compared to Medicine
Prefatory stanzas o f the Dharmaguptaka-vinaya T 1428 : 1 :
567c [bracketed explications follow the Japan ese trans-
lation Kyik J: "The dis cipline o f e thi cs is . .. like a p h y s -
i cian who exami n e s all illness es ... I f th e illness is
curable he calls for medicaments; if it i s in curabl e he
leaves them aside [on th e abandonment o f incur abl es,
pres c rib ed in India as in Gree ce , s e e F illioz a tJA 1935 :
1 :56 n .l ; see a case in China c h. 1 3, " Chi n a " b el owJ, as
is sa id in the Olaeei.c of Medicine [on the c l a s s if i c a t i on
o f illnesses into curabl e and incurable se e J olly ,
Medicin 48; also c h. 10 ( endin g) b elowJ. Four things
are in curable [the misdeeds of defe a tl, thirt e en are
curable [suspension~misdeedsJ; for the others [the dis-
ciplinary c o d e J requires no remedy [thes e are all mis-
deeds e xpiated by d is closure , regret , etc.J "

Ibid. 568a: "Just a s one prepares medicaments t o

e l i mi n a t e harm , and just as the p ati ent is healed and
b e c omes heal th y, p e acef u l, a n d joyous when the y are
admini st er ed , so one who is mindful in gu a r d i ng morality
shuns all harmful pra cti ces, eliminat es th e passion s ,
ob tains calm and e n ters nir van a .

6. The Body as a Patient

The buddhist considers h is body to b e a n invalid whom
h e b e ars a dut y to care f or--whence, f or example, the
c omparis on of t h e nine c orporeal o ri fi c e s ( e y e s , e ars,
nostr i l s ,lnouth , a nd l ower a pert ure s ) wit h n in e wou n d s.
Thus a typi c al te xt , s e le c te d f r om the MahCiparinirvcroa-
sidra T 3 7 5: 30: 741 c: "An inv alid , coati ng h is wou n d wi t h
a wa s h of b u t t er , wi l l ( 1 ) wrap it wit h a g a r me n t , (2)
apply the wa s h to draw o u t t he f oule d b l oo d , ( 3)
sprinkle the woun d wi th a n h erb t o h e a l i t, a n d ( 4)
t ake r e fu g e f rom bad weather indoo rs . In the s ame way

18
 t h e bodhisattva, the gr eat hero (mahaeat.tva) c o n s i d e r s
h is body to be a wound, and so he (1) covers it with
rob e s , (2) begs food and drink in proportion to the pus
tha t flows out of his nine orifices (dviira "doors" or
oro iae "flows, purulences"), (3) accepts lodgings to
pro t e c t himself from wind and rain, and (4) searches
o u t herbs when the four defilements [the four "peccant
humo r s " , see ch. 15 below] stir in him . Not in order
t o live a long l i f e, but with regard for the path to
a wa k e n i n g the bodhisattva great hero accepts these four
s o r t s of offering [robes , food, lodging, and medica-
ments: the four resources or requi~ites of a monk].
He tells himself : If I do not accept these, my body
wi l l grow worn-out; it will cease to be firm and will
n o longer endure pain; ceasing to bear pain , it will be
u n a b l e to cultivate wholesome factors ... "

The same unfolding , but a propos of the monk of

t h e Lesser Vehicle, is found in the Niigasena-sutra T 1670
(BEFEO 24=MiZinda).

The typically buddhist medical conception is

e x p r e s s l y asserted in the Mpps, i n s p i r i n g this compari-
son: Illness is the normal state of the human body ;
health or life a~e only maintained by medical attention .
Tt 1509: 10: l3lb: 1.1: "The body is never without i l l n e s s ,
be c a u s e it is an assemblage of four great elements
(mahabhicia) that are naturally [since " a l l is suffering"]
a t variance and contending with one another . An ulcer
i s never without pain; it can be ameliorated but not
cured by a medicinal unguent. The same is true for the
human body : always ill, it demands constant attention;
with care it can live, deprived of care it will die ."

A sutra cited in a manual compiled by Kumarajiva

a t the beginning of the fifth century, T 616 :2 :294b ,
reads : "That is why sentient beings of the ten direc-
tions possess bodies--it is exclusively to undergo
pain . That is why it is born . .. If there were neither
body nor mind, then old age, illness , death , and to r-
ments would have nothing upon which to fasten. In the
same way, a bad wind can overthrow a great tree, but
were it not for the tree the wind would have nothing
to pull down."

11. Ibid . 1 : 5 8 4.

19
l Cataracts
Opaci ties that disturb eyesight (timiraJ-more precisely,
cataracts--that were operated upon in India by means of
a metallic lancet (salii kii; see ch . 17 , "Properly Medical. .
.. " below), is a classical term of comparison. Someone
stricken by it is assimilated to the ignoramus whom the
Buddha heals. His warped vision is assimilated, in
scholastic philosophy , to the differentiating imagina-
tion (iri kal.pa) that causes relative characteristics, etc. ,
to appear--like optical illusions, spots , hairs or the
like. (S ee below ibid.; Lamotte, "Notes bouddhiques" in
Ac. R. de Belgique 1935 :301.)

See also the parable in the Lotus sl1tra of the good

doctor and the man who is blind from birth (Burnouf
82f). The Skt text t wice mentions the three humors,
and the Chinese of course counts four.

20
Part Two: ~ickness and Holiness
Acco r d i n g to the Nagasena-sutra T 1670 (=Milinda 44-45, BEFEO
24 : 120-21 ) , the saints [the arhats, who no longer have to
tak e rebirthJ remain subject to physical pain but not
to mental suffering (that has to do with mental events,
cai. tasika ) .

See also the Mpps Tt 1509 : 23: 229c-230a. "Question:

There are saints who are free from attachment but none-
theless undergo sufferings. Thus Sariputra suffered
illnesses of wind (vata) and of heat [here="bile"J,
Pilindavatsa suffered from bad eyes, and Lavanabhadrika
from hemorrhoides. 12 How can you say that they had no
sufferings?"

"Response: There are two sorts of suffering: physi-

cal suffering and mental suffering. Because of the
power of their wisdom (prajiUibalaJ, holy persons have no
more mental sufferings such as unhappiness, envy, and
ill will. But they have received a body made of the
four great elements because of their deeds in past
lives, and so they have physical pain such as old age
and illness, hunger and thirst, heat and cold . ..

"When an ordinary person (prthagjanaJ experiences

pain, his thinking engenders a torment of unhappiness,
stimulated by the habit (anusaua) of resentment (prati-
ghaJ .• • In pleasureable experiences he is stimulated by
the habit of sensual pleasure (raganusayaJ;in experiences

12 . Ibid. 1439-41. See 1439 n .2 : "According to the various ver-

sions of vinaya, sariputra suffered from kayadaha ' f e v e r ' (Pali
Vinaya 1:214), from a malady of wind (Dharmag;ptaka T 1428:42:
867b .29-c .19), of hot blood (Sarvastivada T 1435:26:190c.24-191a.
8), of dhatuvaisamya 'imbalance of the humors ' (Msv Skt 3 :1 :239-
240 :22) ,of wind·and hot blood (Msv Ch T 1440:4 :528c .18-25) . He
nursed himself with fibers (bisaJ and roots of the lotus (mulali-
kaJ, with lotus milk (bhisakslraJ, or with a porridge of wheat or
wheat hearts. On another oc~asion he suffered from abdominal wind
(udaravataJ and healed himself with garlic (lasuna); see Pali
Vinaya 2: 1 40 .
Mpps ibid. n.3 : "On the bad eyes of Pilindavatsa see p. 121
above . The fact is , this arhat collected maladies : migraines
(slsabhitapaJ , affections of wind (vatabhadaJ, rheumatic limbs
(angavata), articular rheumatisms (pabbavataJ, etc . ; see Pali
Vinaya 1 :204:6 . .
On Lava~abhadrika see ibid . n .4 .

21
neither pleasureable nor painful he is stimulated by
the habit of ignorance [or errorJ (avidyCinusayaJ .13 When an
ordinary person experiences pain he undergoes the suffer-
ing of the three defilements internally , while external -
ly he undergoes heat or cold, the whip or the stick,
etc.--as though a person with internal fever were also
being burned outside .

" As is said in siitra : 14 'When an ordinary person

loses a beloved object , his body and mind both undergo
a suffering, as though he were pierced by two arrows.
The nobles (CiryaJdo not have the suffering of unhappi-
ness ; they have only the physical pain and not the
other. I

§ This was previously the subject of a predication

addressed by the Buddha and by Sariputra to a feeble
old man, Nakula[p itrJ , i n the SamyuktCigama T 99:5 :33a-b
[=Samyutta-nikCiya 3:2fJ and the Ekottar Cigama T 125 :6 :573a-
b: "Ignorant secular persons , uninstructed [ in buddhist
doctrineJ, without understanding matter (rupaJ ,take it
for I and mine ; they become attached to it and are
destroyed or impaired [that is to say, they are over-
taken by evil or by physical degenerationJ ; in turn
their thinking, t h e i r consciousness (citta-vijiiCinaJ is
shaken [by that physical impairment , Skt anuvartoJ; they
then meet with physical and mental torment. But for
the nobles, the learned disciples, the impairment of
matter is not accompanied by that shaking of the mind;
they are only subject t6 physical suffering ."

8. GJllnesses of the Buddha

That the buddha Sakyamuni was subject to illness, no
buddhist would think to doubt . Not only did he die of
an indigestion [of pork or of truffles : see Waley, MCB

13. Mpps 3 :1441 n .1 : "The bad habits of sensual desire, resentment

and ignorance frequently form an integral grouping (Majjhima 3:
285, Samyutta 4:205), but they also occur in lists of six (Ak 5:2)
and of seven anusaya (Dlgha 3 :254 , 282; Samyutta 5 :60, Anguttara
4:9 . :
14 . Ibid. n .2: "From the ~alyatvena-siitra T 99:17:119c .28-120b.14 .
See also Sallattena-sutta of the Sainyutta, 4 :207-10 ." Full pas-
sage of Pali ver sion given with tr . ibid . "Th e s ame r easoning is
repeated in the Milinda; see also Demieville at BEFEO 14 :120-21 &
Milinda ed , 44 , tr. Horner 1 : 61 . "

22
1 : 34 3- 54 ] 15 - du r i ng the course of his career his
he a l t h was often jeopardized. The brahman Devahi ta had
t o treat him for a backache caused by a perturbation of
wi nd [ e i t he r t he e lement or the "humor"] , Sainyukto.gama T
99 : 44: 319b, T 100 : 5 : 407b [ = Sainyutta-nikaya 1:175]. The
p hy s i c i a n Jivaka had to prepare for h im such medicaments
a s are t aken by u ni v e r s al monarchs (ca krauartri n) , Mahiso.saka-
vinaya T 14 21 : 20:1 34a. St r icke n by a d i s t u r b a n c e of
win d, he cons umed in o ne day t hir ty- t wo ounces o f a
dr ug prepared fro m butter by Jivaka. Devadatta wished
to t a ke as much, but he could not digest s uch a quanti -
t y ; the Buddha healed him of h is indigestion by p lacing
h i s hand to the top of his he ad-upon which Devadatta
de c l a r e d to him , in a thankful manner, that he would
i nde e d make an excellent physician , but t hat if he
s hou l d lower his sights to the study of medicine , it
wou l d be because h is other science [ r el i g i o us doct rine]
wa s not a c c e p t e d by t he world , T 202:3:366a-b [ an a l a-
gous episode Msv T 1450 :14 :174c , where De va d a t t a goes so
f a r as to deny that his heali ng was due to the Buddh~.16
Wounded in the foot by a n acacia thorn , the Bud dha was
hea le d by Dasabala Kasyapa T 203 [ tr. Chavannes,Cinq
Cent s Contes 3 :7 8 ]. 17 Amo ng the "nine torments" ( o r "acts
o f violence" ) 18 that he u n de r go e s , most are malad ies-
f o r example, Npps Tt 1 50 9 : 9 : 1 21 c : He is wounded i n the
b i g toe by Devadatta, who wishes to crush him by push-
i ng a boulder down upon him [ s i lO.; t he very rock is
s hown to pi lgrims at Vulture 's Peak, see Chavannes,
Re ligi eux emineniie 155; Wa t t e r s, Records 2:152]; he is
pricked in the foot ; he ~ets a headache when Ki ng
Virugabha massacres the Sakyas ; etc .. . [See also Ak
4 : 1 22 n .2.]

Th i s poses the question of whet her t he Bud dha re -

ma ins s ubject to t he retri b u tion of p a s t deeds a f t e r he
has attained awakening . Two sorts o f malady are i n ef -

15. The latest theory is that the culprit was a mushr oom; see
Wasson, JAOS 102:591-603.
16. "Butter " {gh f t a } may represent a textual corruption of t he
actual medicine. Msv Skt 2:47:7-14 indicates a pur gat i ve (for
gas t r oent er i t i s ) compounded of t hi rty- t wo utpala f lo wers that the
Buddha snuffs {ghrata}. The Chinese ver si on of the upayak a us al ya -
sutr a, par . 147, indicates a medicine ca l led utpalahastagandha
(in t r ansl i t eration) .
17. Accordi ng t o Mpps 1: 51 0, t he Buddha was wal king i n a wood ;
ref s. i bid. 508n ., Upayaka usalya-s utra par. 139f.
18. Mp ps "Retribut io ns of misdeeds" (apa tti -vi pa ka ; 1: 507- ·17);
Upayaka usalya-sutr a "ka rmic connections " (k arma- s aint a t i ; par .
128- 75). Simi lar l ists Apadana, Msv, etc. Mpps i bi d .
23
feet distinguished by the Mpps Tt 1509:8:119c [cited at
greater length in ch . 16 belowJ: (1) maladies that
strike as the retribution for deeds performed in past
lives, and (2) those representing the effect of an exci-
tation in the present life [of the three humorsJ--of
cold [="phlegm"J, of heat [ ="bile"J, or of wind.

The first of these two categories, classified in

Indian medicine under the name of kaxmaia "born of
deeds" (Jolly, Medicin 48; Dasgupta , Hi s tory of Indian Philo-
sophy 2:402f; Filliozat, JA 1934:2:125f) is bound up
with a religious or ethical conception of pathogenesis--
the cause of illnesses, just as of other present evils,
being attributed to past misdeeds. The M~karmavib hanga
(ed. Levi iii-iv) enumerates the varied deeds that pre-
cipitate the "many maladies" or the "few maladies" .
See also the Saddharmasmr tyupas t hiina- s ut r a T 721 :9:47c,
where congenital and incurable illnesses in an infant
are explained as the residue of bad deeds that subsists,
at the time of its birth among human beings, in a sen-
tient beings who has departed from hell to arrive at
the human condition.

The notion that illness is caused by previous

deeds is attested as early as the S~uktagama T 99:35:
252c-253a, T 100: 11: 452b-c [=Sainyutta-nikaya 4: 230-31J ,
where the tirthika Sivaka (Pali Sivaka) interrogates the
Buddha on the following doctrine : All human sensations
[pain, etc .J are caused by previous deeds ; therefore
someone who has exhausted [the effect ofJ his past
deeds, and does not commit new deeds, escapes from
causes and conditions and need no longer under go any
suffering. But this doctrine is expressly condemned
by the Buddha, who shows that one must distinguish be-
tween (1) sufferings of a worldly sort--inescapable in
this world--that are caused [T 100: in the present
existenceJ by wind, phlegm, and bile [these are the
"three humors", see ch .15 belowJ or by a combination
of these three [Pali eannipiitiika ; T 100 e xplains the hu-
mors as the increase or diminution of the four ele-
mentsJ , or by accidents, the seasons, etc . . . [an exten-
ded enumeration of occasions for physical sufferin g;
to this enumeration the Pali text adds, without further
explanation, "the maturation of deeds", as .in other
listings of the causes of maladies, for e xample
Anguttara-nikaya 5: 110; but here the insertion c o n t r a d i c t s
the very point of lihe textJ; and (2) mental suffering:
unhappiness, having for causes and conditions the ob-
sessions [~passionsJ of greed, hatred, drowsiness,
agitation and doubt.

24
Th e Agama does not expressly deduce from this that the
Bu dd h a is only subject to maladies resulting from cur-
r e n t physical circumstances. But the latter part of
t h e Pali Milindapaiiha (p . 1 34 ) unpacks this canonical text
a n d quite neatly delivers from it the conclusion that
t h e sufferings of the Buddha are not at all the effect
o f h~s previous deeds. Such does not seem to have been
t h e opinion of the Sarvast ivada school of the Lesser
Veh i c l e , however . According to the Ne» T 1448 (tr .
Ch a v a n ne s , Cinq Cents Contiee 2:424), if the Buddha suffers
fr om backache, it is because he has in a previous exis-
te n c e broken the spine of a wrestler . (Here again the
Msv is in disagreement with the abhidharma of the school;
t h e Kosa , Tt 1558 :15 :83a [Ak 4 :127] declares in fact that
f o r saints the disequilibrium of elements--the cause of
i l l n e s s --i s never a retribution for deeds.)

The story of the wrestler is also cited in two

o p u s c u l e s of the Lesser Vehicle translated into Chinese
c a 300 A.D .--T 197:167 and T 199:202 19 [the latter
wo r k is related to the Pali Apadana, see Bekd 3 : 226]-
amo n g other avadanas that justify , by his past deeds,
t h e troubles to which the Buddha has to submit in the
c ou r s e of his present career (in T 197 these troubles
a r e numbered ten and are closely analagous to the "nine
t o r me n t s " of the Mpps, see above).

With the tendency to attribute a more or less

supramundane nature to the Buddha, other explanations
of these maladies are observed to appear . The doctrine
o f phyQstases, or multiple bodies, offers one such
e x p l a n a t i o n that was adopted by all the schools of the
Greater Ve h Lc Le . Even the Vibhdsa Tt 1545 : 46 : 392b [tr .
LVP in MCB 1: 3] teaches that only the Body of Birth i~
s u b j e c t to suffering and to illness, the Essential Body
(dharmakayaF be i.ng exempt from them . The same doctrine
is found in the MahO:paY'inirva-r:a-sutra: 20

"There are two sorts of body of the Thus Come One:

t h e B6dy 6f Birth and the Essential Body . The Body of
Birth is the created body of means (*upa.ya-nirma1')akO:yaJ.
It is subject to birth , to old age, to illness, and to
death; it admits of various sizes, of various colors,
of being one thing or another, student or graduate
(saik;;a-asaiksaJ.. . The Essential Body is permanence, joy,
self, purity; it is forever detached from birth, from
old age, from illness, and from death; it is neither
black nor white, neither student nor graduate; it is
permanent in duration and unchanging whether it appears
in the world as a Buddha or not ."

25
 The Mpps Tt 1509: 9: 121-22 assigns to the "nine
torments" t .he characteristic epithet "retributions for
misdeeds" (Cipatti-vipakaJ, stipulating immediately that
they touch only the Body of Birth , not the Essential
Body: that the Buddha gives himself the appearance of
undergoing them is to be styled a simple means (upayaJ. 2 1
And this sastm refers to the VimaZakirtinirdesa-sut m , the
most topical of authorities in that the protagonist is
an infirm laic; an entire chapter is dedicated to "the
question of illness" (T 475:2 & comm. Ttt 1775 :5; Eng.
tr . Izumi , EB 3:3) .

9. Gfllnesses of Bodhisattvas
The f'ramewor-k of that siitra is well known: a manner of
epopee in dialogue or theological mystery play. Vimala
has been popularized by the art of East Asia as a figure
laid up on his sickbed. Versified versions of the chap-
ter on his illness in vernacular Chinese have been re-
covered from Tun Huang (Lo Chen-yil, Tun huang ling shih ;
see Yin k 'oin BuZZ. Nat. Res. Inst . Phi/l , Ac . Sinica
2: 1, and in Ch'ing hua chou k'an 37: 1-10. And in our own
day the celebrated actor Mei Lan-fang has drown one of
his most popular pieces from the sutra of Vimalakirti.

The siitra opens with a predication by the Buddha

at Amrapali's garden in Vaisali. The wealthy househol-
der Vimalakirti is not among the auditors (ch.1). This
is because he has manifested an illness, which is noth-
ing however but a means [T 475:1:539bJ: To each of the
laity who comes to pay a visit, he teaches the distinc-
tion between "this body"-impermanent , weak, suffering,
subject to 101 maladies [the commentary mentions 404 of
them, see belowJ-and the body of the Buddha, the
Essential Body (ch.2).

The Buddha wishes for his part to dispatch one of

I I his disciples to the side of the patient to bring him
news. But Sariputra, Maha-Maudgalyayana, Maha-Kasyapa,
Subhutt and others excuse themselves on the grounds
that they are unworthy (ch.3). Finally Manjusri ac-
cepts; he betakes himself to Vimalakirti and questions
him on his illness (ch.5 , T 475:2): 22

"Can you bear this illness any longer? Is it res-

ponding to treatment? Is it not worsening? The Lord
is concerned and has sent me to bring news of you .
What is the cause of this illness, 0 Laic? How long
ago did it arise? When will it disappear?"

26
 "My illness is born from craving (trsnii) , itself due
l.o igno r a n c e. I am ill because all sentient beings are
I ll ; when the illnesses of all sentient beings have been
u l i mi n a t e d , mine also will be .. . Bodhisattvas enter the
r o u n d of birth and death for the sake [of the welfareJ
o J s e n t i e n t beings; and where birth and death is found
t he r e is illness as well . . . Just as parents will fall
il l when an only son is sick, but will be healed if
t he i r son is healed, so the bodhisattva, who love sen -
tie n t beings like a son, are ill if sentient beings are
11 1 , healed if they are healed ."

"What is the cause of this illness?"

"For bodhisattvas, illness is produced by reason
o f great compassion . .. "
"What are its characteristics?"
"My illness is formless, it is not visible."
"Is it associated with the body or the mind?"
"It is associated neither with the body-because
i t lacks characteristics-nor with the mind, because
t h e mind is like an illusion ."
"Which of the four great elements-earth, water,
fi r e , wind-bears your illness?"
"It is not an illness of the element of earth, nor
i s it separate from it. The same is true of the other
t hr e e elements . Rather, the maladies of sentient beings
ar e produced by the four elements and I am ill because
t h e y are."

"How should a bodhisattva comfort a sick bodhi-

sat t va ?"
"By teaching him the impermanence of the body but
no t renunciation of the body, the suffering of the body
bu t not expectation of nirvana, the self-lessness of
t h e body but charging him to guide sentient beings , the
emp t i n e s s of the body but not absolute calm [comm .:
nirvana=cessationJ, repentance of past misdeeds but
wi t ho u t teaching him that the misdeeds pertain [irrevo-
c a b l y J to the past [comm . : misdeeds are neither eternal
no r irreparable ; they exist only in the present effects
a n d can be dispelled by repentanceJ. He exhorts him to
use his own illness to sympathize with the sickness of
o t h e r s ... to heal everyone's illnesses as though he were
the king of physicians ... "

19. T 197 was tr . at A.D. 194-99, and T 199 at A .D . 303 (K).

20 . This pas se.qe , T 374 :34, cited from Hoooqirin 178 .
21 . Mpps 1:507, 513.
22 . Tr. Lamotte 1976:4 :117-25 .

27
 "And how, 0 Laic, does a sick bodhisattva subdue
his own mind?"
" By making the following reflections: My present
illness is born from false conceptions, from errors,
and from the passions of my past lives; there is nothing
in it of a real phenomenon (dhaxma) , Who therefore under-
goes illness? In fact there is a combination of four
great elements that are labelled a body, but these ele-
ments have no sovereign beginning, hence the body is
self-less. Now illness is due exclusively to attach-
ment toa self . .. My illness has neither reality nor
existence and such is also the case for the illnesses
of sentient be ings. And if in the course of such in-
spection (vipasyanaJ the bodhisattva produces the great
compassion with a view of craving in regard to sentient
beings, he must eliminate it in himself . Because the
bodhisattva should produce great compassion while cut-
ting off all adventitious passion (agantuka-klesaJ .. . "

(Commentary by Kumarajiva: 23"The 'great compassion

with a view of craving' is defined as compassion pro-
duced by desire-attachment [raga] born from looking at
sentient beings without having yet fathomed the true
characteristics.")

The theme of illness "simulated" by saints is also

taken up in a sutra cited by Kumarajiva in his commen-
tary to the Vimalakirtinirdesa; see S. Levi, JA 1927:2:117 .
For the story of the cow who gives her milk to the sick
Buddha see Ecke-Demieville, Twin Pagodas of Zayton 51 .

And the theme plays an important role in the T'ien-

taisect founded by Chih-i . In his great work Ttt 1911 :
8 :A-B :106-111c, Chih-i devotes many pages to a "survey
(vipasyana J of illness" [see also ch .16 below]. He dis-
II tinguishes (106a) real illnesses proper to sentient
beings to be found--in regard to health--in a state of
cause , from opportunistic illnesses proper to those
such as Vimalakirti and the Buddha who are in a state
of effect . Only the former can be attributed to an
actual perturbation of the four elements of the Body of
Birth--the perturbation being a retribution of deeds.
And Chih-i unpacks the text of the Vk strt r a at length;
he says for e x a mp l e (110c-111a): "By the survey of empti-
ness (or of the Middle Way .. . ) the bodhisattva who is
ill tames his mind ; the mind being tamed, the real
illness is healed . Then by compassion the opportunistic
illness arises in him : the bodhisattva produces the

23. Inserted here from Hobogirin 13a .

28
bu d d h a - f i e l d s (ksetraJ and particularized people: he
c on s i d e r s these people as an only child whom he com-
fo r t s with his own illness , even as parents of an only
c h i l d who is ill fall ill themselves . . . "

This simile of the Ra t naktrt a T 310 :108 :604b expresses

bh e same idea : 24 "Son of the family: By analogy, a
p h y s i c i a n who is educated in pacifying all illnesses,
wh i l e free from illness himself, will taste strong
medicine in front of sentient beings who are ill--and
he will praise it, he will sing its praises . The pa-
t i e n t s , seeing this, will drink the harsh medicine and
p a r t a k e of it, whereby they will be freed from their
i l l ne s s e s . In the same way, son of the family, the
Thus Come One, the great king of physicians, is freed
f r om all the illnesses of defilement; he has attained
f r e e d om from obstacles to all doctrine . Yet he dis-
p l a y s kaI'l71a, saying, 'This is the fruition of this
wh o l e s ome or unwholesome deed .' He displays illness
t h i nk i ng that sentient beings should fear and tremble
a t obstructions caused by past deeds and purify their
a c t s of body, speech and mind."

Here we have a response to the objection Nedioe ,

cur a te ipsum to which adversaries of Buddhism often
r e c u r . See also the invective addressed by Vimalaklrti,
in another passage of his sutra, to Ananda when on one
occasion the latter begged milk for the Buddha, acknow-
ledging forthrightly that the Lord was stricken by an
i n d i s p o s i t i o n , T475 :1 :542a [the bracketed additions are
a t t e s t e d by Tt 1509:9 :122b]: 25

"Wait, Ananda! Enough of such language! The body

of the Thus Come One is a diamantine body .. . Do not
slander it! Let no such strange and boorish sentiments
be heard by strangers . .. For if heterodox brahmanists
should hark to them, they would not be loath to say:
How is it that this master [the Buddha] can heal all
maladies but his own? . . [And if in future monks who
are ill should approach the laity for broth or medici-
nal herbs, the laity responding to them : How can you
heal others, who cannot heal yourselfs?--the monks will
be able to reply: But our great master himself was sub-
j ect to illness ... T"

See also the Ava.t arhs aka T 278:5:429a: the scholar is

24. Upayaka usalya ("Skill in Means") siitra par.131"; a lso tr.

Mpps 1:511n . Retr . here according to Tib versions.
25 . Mpps 1 516. Also tr. Lamotte 1976:81-82 & n .

29
 compared to a physician who is learned but ;incapable of
healing himself. On the other hand. the Rabnameqha--eicbra
T 660:2:289a says, "By analogy, a physician who excel ls
in therapeutics by needles (saUikiiJ cannot operate upon
the cataracts of the blind if he becomes blind himself.
So the bodhisattva whose mind is blinded by ignorance
cannot cut through the veil of worldliness with the
needle of ignorance ."

II

30
Part Three: Sickness and Healing
in the Monastic Discipline (Lesser Vehicle)
The treatises of monastic discipline (vinayaJ abound in
me d i c a l injunctions and prohibitions . In order to be
a d mi tted to the community (eainqha) one must be f r ee from
c e r t a i n serious illnesses, the listing of whi ch varied
b y text. Five are generally denoted [Pali Vin aya, Maha-
vaggcl :39 ; Dharmaguptaka T ~428:34:808c; see also Wieger ,
Bouddhi sme chinois 1:197, 205 . The Mahisasaka T 1421 :~7:116a
e nume r a t e s seven , the MahasaIilghika T 1425:24 :42Oc e xpands
t h e list. 26

10. 8Vurses
On c e they have been received and o r d a i n e d , monks have
t h e duty to heal one another--more precisely, they must ·
t e n d their confreres as sick-nurses. The fact is that
t he y have no relatives who could occupy themselves with
t h o s e among them who fall ill. Moreover , only a monk
e n j o y s the competence n e eded to a d mi n i s t e r spiritual
re l i e f : recitation or predication of the doctrine ,
e n c o u r a g e me n t s to detachment , to patien ce and so for th
t h a t have the greatest import to a sick monk . In a
ser i e s of su t r a s of the Sainyukt agama (see c h L?" ,i

" Re l i g i o u s ... " below), one sees the sick-nurse sometimes

directing predications to his con frere, sometimes trans-
mitting to him e x h o r t a t i o n s of the ancients (K~ama
nursed by Dasa[kaJ , T 99:5 :29c) , sometimes calling the
Bu d d h a himself to the sickbed (Vagisa nursed by[Japa-
n es eJ Furinni, ibid. 36:259c). To have a sick-nurse
o t h e r than a monk i s considered a last re course , becaus e
t h i s reli gious relief is not limit ed to a merely moral
v a l u e--i t often results in the patient' s corporeal
healing . So in the Ekot taragama (ch .~7 below) Cunda,
nursed by simple brahmani sts , r emains in curable until
the arrival o f the Buddha , who sav e s him b y making him
invoke the aids to awakening.

The Pali term for "sick-nurse" is giUmupat thana

(Skt glanopast hanaJ. 1 it. " t o stand before a pat"ien t . II

Dharmaguptaka-vinaya T 1428:~:86lb-c (this is unques-

26. Msv also e xp a nd s the list ; s ee Banerjee 1957 :1 21.

3~
 tionably the text to which the Mpps refers at Tt 1509:8:
119c-120a) : 27 The Buddha comes upon a sick monk , uncared
for and wallowing in his own excrement, who acknowledges
that he himself has never "nursed" his s ick confreres in
the past . "0 monks," says the Buddha, " i f you do not
nurse one another , whoever will nurse you? " He himself
raises up the patient , bathes him, washes and dries his
clothes, throws out the rotted straw that served him as
a a litter, cleans his bed, pargets it , arranges fresh
grass and a robe, and lays the patient covered by anoth-
er robe upon it .

"Anyone who wishes to make offerings to me," he

then declares, " l e t him make offerings to the sick ! "

Next , he enacts the following p rescripts: The care

to be given to a monk who is ill devolves upon his own
preceptor (upadhyayaJ or his own teacher (cwaryaJ, to a
preceptor or teacher of the same rank as the patient,
to his disciples or , in the absence of any of the pre-
ceeding, to any monks who may volunteer or be delegated
in rotation by the community . Finally, in the absence
of monks, others are admissable--nuns, nun-probationers,
male or female novices, laymen or laywomen--to assume
the nu rsing of a monk to the extent bhat they can do so
and with the proviso that women must refrain from
touching the patient .

A parallel text, the MahasCringhika-vinaya T 1425:28 :455a-

457b develops these prescripts at length: "0 monks !" says
the Buddha. "You have belonged to different classes and
families, believers or nonbelievers, and have all left
your families to belong to a single class, that of monks
who are sons of Sakya . You all cultivate the same rule
of celibacy (brahmacaryaJ.. If you do not care for your-
II selves by yourselves, whoever will care for you? .. If
a monk is ill, he is to be healed by his preceptor or
by a preceptor of the same rank, or by his cell-mate
neighbor, or by the monks of neighboring cells, or by
the community . To fail in this duty will be a 'trans-
gression' tat-ieara) type of misdeed . .. " 28

This text is cited in the collection Tt 2127:3:300a ,

which interpolates a note that Hsuan Tsang saw, north-
east of Raj agrha , the stupa commemorating the care
given by the Buddha to the sick monk .

27 . Mpps 1 :496-97 .
28 . Social "untouchability" was evidently a reason for the reluc-
tance of this monks to nurse his sick fellows.

32
 See also in the Udana-oarqa T 211, cited in the c011<!:lc-
Lio n Ttt 2122:95 :895c-896a, the tale of the sick and
ne gl e c t e d monk whom the Buddha bathed "with his adaman-
t i.ne hand" in the land of [Jap] Kendai: "That is why the
Iludd h a manifests himself in this world-precisely for
Lhe poor , the destitute, the orphaned , the lonely, and
Lhe aged ."

The MilZasarvi'istivi'ida-vinaya T 1451 :17 :283b enjoins the

pai n t i n g, in wards where sick [monks] are nursed, of
tma g e s of the Thus Come One himself nursing a patient.
fin d Msv T 1442:28:782b-c declares that all monks, whatever
the i r grade in the conventual hierarchy may be, are
>ha r g e d to nurse their sick confreres; several seats
a r e to be laid close by the patient so that sick-nurses
do not make themselves ridiculous by removing their
p r i v a t e seats as they leave the scene!

The MahiisOinghika-vinaya T 1425 :28:456a-457b [cited in

br i e f by Ttt 2122: 95 :985a, 1804 :3D:143b] stipulates detailed
o b l i g a t i o n s that constitute the doctrine (or method) of
nur s i n g sick monks : If some monks journey with merchants
i n an uninhabited region and one of them should fall
il l , the others may not abandon him; they are to bear
hi s baggage and support him. If he cannot walk, they
a r e to procure a vehicle or a beast of burden for him
a n d go to seek help from monks or laics of the nearest
vi l l a g e. If the patient should die, they are to take
c a r e of his corpse . The same obligations apply to sick
nuns, save that monks may not touch her.

The text continues : Monks of extraordinary quali-

t i e s (gu~a) [who are patients in the monastery] have the
r i g h t to special regard . They are not to be installed
i n a small or remote cell, but in a cell that is well
in sight, and thei r disciples shall sit with them with-
o u t respite, keeping the cell in a good state of tidi -
ness and entertaining callers . Lay callers should be
ad d r e s s e d with predications-for example , this word of
the Lord:

"To keep vigil with a sick monk is like keeping

vigil with me."

One among the attendants will see to the door and

another to the patient, intoning doctrine to him .

A monk of lesser quality will be cared for, on the

other hand, in his own place-out of sight, so that
people will know nothing of his death.

33
 If the patient has a prec eptor , a teacher, or some
disciples , it devolves upon them to nurse him--if not,
to the c ommu n i t y as a whole , which will delegate to him
one , two , or three nurses. If the patient possesses
medicaments, they will be given h im--if not , the commu-
nity will supply them. I f the c ommu n i t y has none , and
the patient possesses robes or bowls o f value, these
objects will be bartered for medicaments; if the patient
should refuse this 'o u t of stinginess, he should be
denounced to the community and one should endeavor to
persuade him . Or l astly , one should beg medicamen t s
for him. And if on e obtains nothing for him , he should
be given at least the best nourishment to be found in
the community sto r es or to be begged in villages, t o
which the sick-nurse may betake himself in person, armed
with two bowls.

The Ekot taxaqama T 125 :24: 680c [=Anguttara NikO.ya 5: 124}

enumerates five incompeten cies of a si ck-nurse: (1) He
does not know good medicaments ; (2) he gives proof of
laziness and lacks zeal; (3) he gives way to annoyance
or drowsiness; (4) he nurses the patient only out of
greed for nourishment [and such personal profifl; (5) he
does nothing in the way of offering doctrine [teachings,
etc.] and does not converse with him. Su ch a sick-nurse
fail? to accomplish healing.

Ibidem 680b [=Anguttar a Nika ya 5 :23]: f i v e faults of a

patient that impede healing: (1) He is not sel ective in
what he eats and drinks; (2) he does not nourish himself
at the proper times; (3) he does not consent to take
medicaments; (4) he abandons himself to melancholy, to
merr iment, or to annoyance; (5) he is pitiless toward
the sick-nurse.

These enumerations are also found in vinaya texts ,

but somewhat modi fied. Dharmaguptaka-vinaya T 1428:41:861c:
A patient difficult to tend : (1) wishes to eat what he
should not eat and refuses to take medicaments ; (2)
speaks untruthfully to his si ck-nurse, though he may be
tending him with all his heart; (3) does not walk or
remain still as he ought; (4) is incapable of bearing
pain ; (5) or bears it but makes nothin g of it when
asked. There follows an identical enumeration , save the
fifth term : (5) the patient shows himself incapable of
sitting still and holding his breath.

Mahasafnghika-vinaya T 1425:28:457a: Five faults of a

patient who is difficult to nurse: (1) He shows himself
incapable of taking medicaments and foods suitable to

34
h i s illness; (2) he disobeys the sick-nurse; (3) he does
no t make allowance for aggravation or amelioration of his
i l l n e s s ; (4) he does not bear the pain; (5) he is guilty
of laziness and lack of intelligence. Five faults that
r e n d e r one unfit to be a sick-nurse: (1) incapacity, be-
c a u s e of excessive disgust, to carry out vessels of ex -
c r eme n t ; (2) incapacity to beg medicaments and foods
s u i t a b l e for the illness on behalf of the patient ; (3)
i n c a p a c i t y to preach doctrine to him at every instant;
( 4) expectation [of personal profit]; (5) being sparing
of labor . All these negative enumerations have their
p o s i t i v e counterparts appended .

The Dharmaguptaka-vinaya T 1428 :41 :862b introduces the

la s t of these enumerations in context of donations to
the nurse. Any monk who has cared for one of his con-
f r e r e s has in effect, if the patient should come to die,
a sort of right of inheritance upon the robes, bowl ,
se a t , tube for needles, and other possessions of the de-
ce a s e d. But the inheritance would be considered as a
d o n a t i o n assigned to the nurse by the local community,
t o which in principle the possessions of all deceased
monks revert, and it would be accompanied by strict
f o r ma l i t i e s that the Dharmaguptaka-vinaya codifies in
detail. Sick-nurses have no right to that donation if
t hey have shown (1) incapacity in dietetic matters; (2)
disgust for the excrements and spittle of the patient ;
(3) an uncharitable, mercenary attitude; (4) incompe-
tence in the preparation of broths and medicaments and
(5) in teaching doctrine to the patient.

Ibidem 58: 998a-b: The sick-nurse is one of three

c o n d i t i o n s for effective cure--along with appropriate
f o o d (regimen , diet) and medicaments suited to the ill-
ness (specifics; gUinapratyayabhai;;ajya, Mhv 5893). There is
a classification of illnesses according to degree of
curability: (1) those fatal notwithstanding the speci-
fics, regimen , and sick-nurse ; (2) those mild even in
the absence of those three aids; and (3) those for which
successful healing depends upon them . So also Mahisasaka-
vinaya T 1421 :5:32c .
11. The Medical Profe~§ion
Interdict to Clergy
The abovementioned texts presuppose certain dietetic and
pharmaceutical knowledge of the clergy. But this is not
a matter of medicine proper. As a matter of fact, medi-
cine was taken for a worldly science in the relatively
ancient period represented by the great disciplinary
codes of the various schools of the Lesser Vehicle, and
35
 study of it was not recommended to clergy. According to
the traditional biography of Sakyamuni that is authori-
tative for all buddhists, the early physician of the
Buddha and his community was a laic, Jivaka , an illegi-
timate scion of the royal family of "Ma g a d h a and the
physician appointed to the king of that country, Bimba-
sara. At his request the Buddha refused to admit to the
order candidates stricken by (five, etc .) grave illnes-
ses . A number of candidates, in fact, sought ordination
only for the purpose of being treated by him and tended
by monastic sick-nurses . And as a (quintuple, etc .)
epidemic raged, Jivaka treated the king, his court (or,
his wives), and the buddhist community at the same time--
he along being insufficient to the task [Pali Vinaya,
Mahiivagga 1: 39, Mahisasaka T 1421 :17: il6a; Mahasful:ghika T 1425 :
24:420b-c; Dharmaguptaka T 1428:34:808c; etc .J

The treatises of monastic discipline show us the

clergy consulting secular physicians frequently. The
Mahiisa:mghika-vinaya T 1425 :32 :486c, for example , in context
of the interdiction against drinking human blood, men-
tions the case of a monk suffering from a "yellow" mala-
dy [i. e., either a malady due to the "humor" called
"yellow" (bile, pitta), or a "yellow sickness", panduroqa;
see Filliozat, JA 1934:2:137 J, for which the physician had
prescribed that remedy. The Msv T 1451:35 :382a enjoins
disciples to deliver their master to a physician when
he is ill, describing to him the circumstances of the
illness and consulting Thim on the mode of treatment they
are to procure and prepare by themselves. See also the
case of the monk operated upon for a fistula by the sur-
geon Atrigotra [ch.17, "Properly Medical . .. " belowJ.

The discipline even presents formal interdictions

to practicing medicine . Among sutras, the early Dirghii-
II qama Tl:13:84b, 14:89c counts medicine (spells, needle
surgery, herbal medicines) among technical trades that
other religieux (sramaV-a-brahmarya) practice to exploit the
liberality of believers , but which the Buddha forbids
his community . The latter of these texts corresponds to
the Pali BrahmajaZa-sutta (Di.qha Nikaya1:1:27) , which expands
the list of the parts of medicine .

In the treatises of monastic discipline, this

interdiction seems to apply to nuns more than to monks
(but this anomaly may be only apparent, and based upon
insufficient research). Mahiisafnghika-vinaya T 1425:38:531a-b
[eighty-second transgression, patayantikaJ : The Buddha is
in Kausambi. The nun Chanda's Mother-who excels in
knowing the treatment of illnesses-betakes he~self to

36
 ki n g s , ministers , and laity with medicaments made of
r o o t s , of leaves, and of f r-u i t s , She treats affections
o f pregnancy, of eyes, of expectoration, making laryn~
g e a l fumigations and nasal instillations, employing
ne e d l e and knife followed by medicaments such as oint-
ments. She receives appreciable offerings from patients .
Th e other nuns blame her, saying that these are the
p r a c t i c e s of a physician and entirely unfit for an or -
da i n e d religieuse. Mahaprajapati reports the case to
t h e Buddha. He decrees that henceforth it is forbidden
fo r nuns to earn their livelihood pract~cing medicine,
u n d e r pain of committing a transgression--medicine being
def i n e d as the treatment of illnesses by means of roots,
le av e s , fruits, and medical incantations [magic] bear-
i n g upon poisons, serpents, etc ., upon fire, upon the
s t a r s , upon the constellations, upon the sun and the
mo o n , etc . [upon maladies due to astral influences,
Se e for example Msv T 145l:12:257a; SarduZakarnavadJina 29 T
1300 :2 :409 , 1301:417£]. At the most, nuns may give verbal
c ou n s e l upon methods of treatment . Monks who earn
t h e i r livelihood as physicians will be guilty of a minor
infraction (ea-at-ieax-a) ,

The following article [transgression no. 83] for-

bids even the verbal practice of therapeutics as author-
ized by the preceding article: There i s a transgress~on
for nuns in giving "(medical) prescriptions" to '·'S B C U ,..
La r " or "heterodox" patients . By "secular" (grhin?J one
must understand "not ordained"; but "heterodox"
(t'irthika? J ordained into a non-buddhist religious order;
and by "medical prescriptions", incantations bearing
upon serpents, poisons, etc ., upon fire, upon the stars
and so forth.

In the Mahisasaka-vinaya T 1421:14: 94c-95a, medicine is

interdict to nuns as a worldly profession [transgres-
sion no. 144 for nuns] chiefly to avoid scandalizing
the public : Some nuns recited the prescriptions or
methods of the "Siitra of the Treatment of Maladies";
and some laics blamed them for studying nothing but
medical arts while neglecting their religious vocation:
they recited them in preference to buddhist siitrasl
Informed of this circumstance, the Buddha decided that
recitation of such prescriptions will constitute a
transgression-misdeed for nuns, and a simple misdeed
tduekata) for nun-probationers . But those who recite
them' for their own illnesses, out of charity, or under
threat of violence will not be at fault.

29 , Also known as the Matangi-sutra (K),

37
 The following article [no . 145J forbids teaching
those prescriptions to someone else. The next [no. 146J
declares nuns to be guilty of transgression, and nun-
probationers and novices of misdeed, if they make treat-
ment of maladies a profession. In fact, nuns did not
desist--even at night--from compounding, cooking , and
powdering herbal medicines, which earned them the fol-
lowing criticism from the lay side : "They are like
physicians or physicians' disciples. Instead of expos-
ing themselves to that worldly activity, let them search
out the path to healing the illness of birth and death!"

Finally, article no. 147 condemns medical teaching

equally, on the grounds that each time the laics came
to request them for a predication of doctrine,the nuns
replied : "This is how one treats all illnesses, of heat
[ =bileJ, of cold [ =phlegmJ, of wind ...II

The Dharmaguptaka-vinaya T 1428:30:774c-775a transgres-

sion no. 169 for nuns and the Sarvastivada-vinaya T 1435:
'I 1!1!l i
46:337b proscribe magical techniques and worldly arts
[the "bestial arts " of the Pali Bh-ikkuni-nribhanqa, trans-
::11
1'1' gressions no . 49 & 50; see also Di-gha-nikiiya 1:9fJ. Nuns
"
who study these are guilty of transgression; nun~
probationers and male and female novices of misdeed.
Exempted however is the study of incantations bearing
upon gastric worms [T 1435 : gastric painsJ, upon indi.,..
gestions, or even upon poisons--but on condition" that
they have recourse to these spells only for their own
"I I
I safekeeping , not to turn a profit.

The Msv T 1451:25:327c authorizes monks who are com-

petent in medicine to administer sedatives, at least,
to their confreres, in cases where those confreres are
stricken by acute pain and no physician is at had for
emergency relief. This treatment should be effected in
secret, without the knowledge of laics; the monk who
publicly administered a medicament to another monks
II"
would render himself guilty of a misdeed.

The same vinaya (ibid.) on the other hand permits

physician monks to give pharmaceutical and dietetic
advice to laics who come to consult them.

The Smrtyupasthana T 721:48:285c-286c counts medicine

among the thirteen sorts of activity injurious for
monks. It is a source of greed, envy, etc.; physicians
desire only that there be many who are ill ... The test
of a true shramana is to heal sentient beings of the
three passions--not of the three corporeal humors (daea.) ,

38
which last onl y as lon g as the body last s.

On th e issue of monks a dv is i ng l ait y , o ne finds in

t he Samant apdsiidikii Tt 1462 :1l :753a-c a mos t c ur iou s c a s ui s-
t r y . This re l a t ive ly l at e t r e ati s e of d isc i p li ne s t ill
c o n d emn s th e practi c e of medi cin e , fo r mall y : a ny monk
wh o expo ses h imse l f t o i t c ommit s a mi sde e d (as t he Bud-
d h a d e c ided in c o n nec t ion with monks who tau g ht abo r -
t i o n a r y pr actices to a n adult erous wh oman, a nd who p r o-
vo k e d the death of ano the r woman in pres c r i b ing for he r
a b ad medi c ament a g ainst st e rility). But i f medici ne
t hu s d e fin ed is a misdeed , t here is no t r an s g r essi on for
t h e c lergy in con f e c tin g medicin es for monk s , nun s , nun-
probat i o ne r s, or mal e or fe male novic es-whe ther u tili-
z i n g ph armaceutical subs t an c es that the pati en t s pos-
se s s themse lves , o r g i v i ng t o them those th at th e y do
not poss ess.

Th ere are fift e en ·t ypes o f laic , acco rd in g t o this

tex t , to whom a monk may give medicines or for whom h e
may c onf ect them: (1) his f a th er , (2) his moth e r , (3)
t he i r domestics, (4) domestics of the community (Pali
veyyiivaca ka [ra J , paid laics in the service of th e c le r g y ) ,
(5) "yellow leaves" (Pal i pandupal.aea, a t erm d esign atirig-
doubtl ess by anal ogy with a d ead leaf that breaks off a
t ree- yo u n g peopl e of . goo d fami ly who are c a n di d a te s for
or d i n a t i o n , not y e t ordained but residing in mon asteries
wh e re th e y render minor s ervi c es to the cl er g y), (6 -7)
hi s bro thers, both e l d er a n d y oun g er , (8-9) his s i&ers ,
( 10 - 1 5 ) v a r i o u s un cl es a n d aunts.

Th e monk e v en h as t he ri gh t t o in trodu c e his f ather

o r mother into t he mon as t e r y i f t hey · a re poor, in o rder
t o care f or t h e m. He s ho u l d lik e wise con fect medi c a-
me n t s f o r the p a ti en t s o f his p rece p t or who are ill i n
the mon a st e r y .

Th e cas e of patro ns wh o ar e ill o c c a sion s a n es -

peci all y cunning c as u i stry . Clergy h a v e i n pri nc ip le
no ri ght to prepare medi camen t s fo r th ei r pat r o ns or
t o mak e a g i f t of th em [for t h is wou l d c o nsti t u te a
sort of repayme n t f or don a ti on s r e ceived fr om t he pat-
ro ns , whereas donations to t he commu n i ty should b e e n -
tirely gr a t i s J . Medi c al advi c e ought likewis e be r e-
fus ed if the patrons themselves c ome to r eques t i t on
p ersonal grounds-for e xampl e, saying to him : "My
mother is stricken by such or su ch an illness. Wh at
treatment , which medi caments would you advise for her?"
But if the request is f o r mu l a t e d impersonally-"Someone
being ill , ... "-the monks may accede to it.

39
 Alternatively, one may have recourse to the follow-
ing " me a n s " (upaya): The monk is consulted by a patron,
but does not answer hi m dire ctly . While yet in the pat-
ron's presence he addresses the following question to
another monk: "The monk so-and-so is stricken by such-
and-such an affection . Whi ch medicaments does he re-
qu ire?" The response to this will inform the patron
indirectly.

This procedure was used by the elder (thera) Maha-

paduma to convey therapeutic information to the king of
Ceylon Vasabha's wife . This turned out so well that she
sent the monk various gifts as thanks for his interven-
tion . Mahapaduma recognized that the gifts represented
the "share" [of honoraria] that would be paid to a
physician, but he congratulated himself for having been
useful to a sentient being without committing any
misdeed .. .

The Samanbapaeiidikii then authorizes monks to betake

themselves to sick laics who invite them to come to re-
cite incantations [of curative magic]. But they should
instead recit e to them--in the guise of incantations--
the iitalJiitiya [D'igha Nikaya 32], or preach doctrine to them,
or confer lay precepts upon them . ..

[The Dharmaguptaka-vinaya T 1435:43:877a-b , in a passage

that is unfortunately somewhat obscure , deals with the
, :
case of a sick laic who was "nursed" by monks in the
I monastery itself, and who died there.]

All this subtle casuistry points up the fact that

as a new spirit, doubtless influenced by the Greater
Vehicle, forced its way into the habitat of the Lesser
Vehicle, monks allowed themselves more and more to be
won over to the study and practice of medicine and sought,
by a thousand subterfuges to circumvent the old disci-
plinary prohibitions .

It is a long way, in fact, to these vinaya texts

from the agama accounts in which the Buddha , or Ananda
or Sariputra, when they paid visits to sick laics , res-
tricted thems elves to discourses of an exclusively
religious character . They would demand of them news of
their health according to a formula of sanctified civili-
ty and then preach patience, the observan c e of ethics,
faith that releases from all cares , detachment from the
sensory world, the impermanence of conditio ned things,
and so forth [to Ana.t hap i nd i.ka , Sainyuktagama T 99:37:269b-
270a=Sainyutta Nikaya 5:385f, Madhyamagama T 26:6:485f=Majjhima
Nikaya no . 143; to Dharmadinna, Sainyuktagama ibid . 270a=Sainyutta
40
Nikiiya 5:406f; to Dighayus, Samyuk ti'igama ibid . 270a-b=Safnyutta
Ni kiiya 5:344f ; etc .

Hobogirin will de al in other pl a c e s wit h t h e numer-

o u s prescriptions of t h e d is ciplin a r y co des b e aring upon
med ica me n t s as one of the four r e I iances (nisraya ) of
mon k s. 30 Vin aya also ascribes an impo r t an t r o le t o hot
ba t h s in the medi cal hygience of mon k s ( in gener a l , a
mat t er of vapor baths)--the institution of wh ic h i s
attr i b u t e d to J i v a k a.

Fina lly, the disc ipline stipulat es certai n f o o d

e x e mp t i o n s for sick monks . That is why--to c i te an
ext r e me case--the Pali v inaya authorizes th e r a w bl ood
a n d fl esh (o f a pig) as med icaments (Mahiivagga 6 :10) . Th e
Samantapaeadi.kii Tt 1462:15 :778c specifies that it can n o t in
any circumstance be a matter of human blood ; the
Mahaeamghi ka-vi naya T 1425 : 32 :486c-487a likewise pros cribes the
c o n s u mp t i o n o f human blood , but authorizes o intmen ts of
horse-blood. That human bl ood and marrow have ac tuall y
been used in therapeutics seems to be attested by
a c c o u n t s a c c o r d i n g to which the Buddha , in his previous
e x i s t e n c e s , gave his blood and h is marrow to the sick
[for example , the co llections Ttt 2121: 10: 163b-c, 2122 :95 :
985b ; also Mev see Lalou, JA 1925 :2 :336; see also ch .12 below] .

30 . Only the article Chinkiyaku , excremential medicine, has been

published; see Hobogirin 4 (1967) 329a-335b .

41
42
Part Four: GJIealing and Compassion
(Gteater Vehicle)
We have just seen that in the monastic discipline of the .,
Le s s e r Vehicle, the practice of medicine is not only not
re c o mme n d e d to clergy--it is forbidden them. Further-
more , monks are authorized to study medicin e f o r their
own benefit i n an emergency, but they must b ewar e of
usi n g it to the advantage o f laics or secul ar p ersons.
The altruistic inspiration of the Great er Vehi cl e is
d iametrical ly opposed to that stra it and jealousl y cle-
r i c a l spirit of the Less er Vehicle in this domain as in
o t he r s .

The bodhisattva--who may be lay or monastic--should

c u l t i v a t e the perfections (paramita), one of which is the
p e r f e c t i o n of giving. He should vow unbiased compassion
f o r all sentient beings . His obligation to heal the
s i c k , whoever they may be, is expressly stipulated in
t h e disciplinary codes that the Greater Vehicle tries to
present as part and parc el of the Lesser Vehicle. 3 1
The ninth of the "mi nor pre c epts" of the Brahmuiiila-eictva
go e s as follows , T 1484:2:1005c :

"Watching over anyone who is ill, the son of the

Buddha [i.e . , a recipient of bodhisattva ordination]
should always care for him as he would car e for the
Buddha himself; among the eight fields (ksetra) of feli-
c i ty , the first consists of looking af ter' those who are
ill . Thus the son of the Buddha will nurse to health
his father or mother , his master, monks or si ck disci -
pIes ... And the bodhisattva who, out of malic e or hate ,
fails t o seek to save t he sick i n monasteries , towns,
d e s e r t s , or in mountains, forests , and highways, makes
himself guilty of a 'minor mis deed causing blemish . '"

The commentaries , Ttt 1812 :2 :591b and 1813:5:639a, spe-

c i f y that by the enumeration "his father or mother . . . "
one must understand "all senti ent beings " . On the
" eight fields of felicity " the commentari es disagree ;
this is probably an allusion to the Sut ra of the Fields of
Fe lici t y T 683 :777b which e nume r a t e s seven , of wh ich one
cons ists of " tre ating patients by p erforming ceas eless
giving of medicine and herbs ."

31. Obligation to heal the sick is also a part of independent pre-

sentations of bodhi sattva precepts, for examp le the Bodhisattva-
bhumi , "Chapter on Ethics" (TV 17d) •

43
 12. Bod4i~attva Physiciall~
Bodhisattvasought no t in fact~content themselves with
assisting the suff ering mass es as simple sick-nurses.
The study of medicin e--prohibit ed in the Lesser Vehicle
as a pro fessional and e x t r a - c le r i c a l line of e ndeavor--
is admitted and p r es cribed in the Gr e a t e r Vehicle.
Along with logic, grammar, etc., it was in t he seventh
century made part o f the c urri culum at the "un iversity "
of Na Lan da [Ttt 2053 : 3:237b; Beal , Life of Hiuen Tsiang 112] .
Medicin e can ser v e a s a 1 ibera t i ve means (upaya ); it is
. one of th e fi v e pro f ane s ci enc es (vidya) that bodhisat-
tvas a re deemed to ac q u i r e [e. g . in BodhisattvabhiAmi T 1581:
3:904c; Yogacarabhiimi Tt 1579 :15: 336a] .

Th e b odhisattv a is not a physician in a merely

spiritual or met aphor i cal s ense. Cert ainly , he has
made a v ow to heal s entient b eings from myftal ill -
nesses as well, as indicated by the Mpps :

"Th e master o f medicine (bhai?ajyaguru) heal s all

illnesses . If a patient ups e t by a demon seizes a
knife and insults the physician , fai ling to distinguish
f r i e n d fr o m foe , the physician--because h e understands
demoniac maladies--s e eks only to heal his patient ; he
has no hatred fo r him. The same is true for t he bodhi -
sattva : Whe n a s entien t being torments or insu lts him ,
he knows that the sentient being is sick with the pas-
sion o f aversion and that he is demented by rage; the
bodhisattva heals him by a l i b e r a t i v e means (upaya)
wi thout r esponding with anger towards him" [Tt 1509: 14 :
167c-168a; see a lso Ch I eng- kuan, Ta fang kuang go hua yen
ching eu Ttt 1735:27, corn p . A.D. 784 -87 ].

But the h e a l t h of t he body co n ditions that of t he

mind (mens sana in corpore sano ); hence t he bodhisattva
never negl ects corporeal healing (unus medicue animarum e t
eoxrporum; s e e Saint Ignati us of Antioch, "Epistle to the
Ephesians " 7 :2) . This is detail ed in a highly exp lic it
passage of the Gal'yjavyuha T 293:11 :710-12 (tr. A.D . 795 -98;
the medical e xposition l a c k i n g in earlier r ecensions ,
T 278 :49 :707b--708c, tr . ca A.D. 420 , and T 279 :46:354b-355a,
tr. A.D. 695-99) :

In the course of a journey in quest of teachi ngs,

the youth Su dha na pays a v isit to a (sixteent h ) sp iri -
t u al friend n ame d Samantanetra who is establishe d in

3 2 , Mpps 2 :899 .

44
b u s i n e s s as a druggist at Saman t amukha i n a land of t he
sou t h called Vetramulaka. Sam ant anetra s ay s that he
has learn ed medicine , as well as "t he es sent ial pre s-
c r i p t i o n s o f a ll fr a gr an Ges", from th e bo d h isat t va
Man j u s r i . He couns els Sudhan a to st u d y medi cine .
Su d h a n a objects: Why t each medi c ine--a secular art--to
some o n e who has c o me to question yo u on t he bodhisattva
c a r e e r ? Behold the response of the drug gis t :

"Know this, excellent man! For th e bodhisattva who

is teach in g himself to cultivat e awakening , the greatest
o b s t a c le is illness . When s en tient beings hav e si ck
bodies , their minds c a n no t b e a t p eace ; ho w t h e n c a n
t h e y cul tivat e the perfections? Th e bodhisatt va who
wou l d cultivate a wakening should first of a l l h eal ill -
n esses of the body . .. He should first minist e r to t he
k i n g of the land , because upon . kings r ests the pe a c e
a n d prosper ity of all se n t i e nt beings .. . Then he should
t e n d all sentient beings and heal them of all corpor e al]
s uf f e r i n g . On ly then should h e preach do ctrine to sub-
due their minds .. . "

And the druggist teaches an entire c o u r s e of med i-

c i n e for Sudhana's use [see c h. 1 6 below] .

A c hap t e r of the Buuarnaprabhiiea con tains a similar

course in medicine g ive n in ve r se form by a merchant
(s relJthin) conversant in medicine , J a lirhdh ara , to his
s o n Jalavahana (the Buddha in a previous e xis tence) ,
who is e n a b le d to he al to population of the c o u n t r y
f r om a n epidemic Vyiidhi-prasamana-parivarta 17: 160-67 of
the Skt text ed. Nan j o - I z umi ; c h. 20 of th e Chinese s y n-
cretic rec ension , T 664 :7 :384-95 . 33

The upiisakasU a- sut r a T 1488:5 (Chapter on Giving,

l060c-1061a), a sort of mahayanist exp ansion (tr . ca 426
A.D .) of a text o f th e ag ama s ( Sujata-sutra rvr . T 99 :33=
D'igOO Ni kiiya no. 31 , SingiiZovada ), promulgat es v arious pr ecepts
for the e d i f ic a t io n o f bodhi s at t v a s bo th h ouseholder and
r e l i g ieux . The foll owin g a re no t abl e :

"A bodhisattva who is poor a n d possesses nothing t o

g i v e will study man tras and v ar i ou s t e chniques of medi-
cine; he wi l l seek t o obtain mone y, infus ions, and medi-
c i n a l herbs to give to those who are in need of them ; h e
will care for the sick with all his heart , nourishing
them and treating them medi call y, exhorting the wealthy

33. Ch.16 i n Nobe l & Emmerick, see Bibliog. s.V. S uv . be l ow; and
Nobel 1951.
45
 to prepare medicaments, pills, powders, and infusions
for them. Having acquired a deep knowledge of medicine,
he will travel everywhere to care for the sick, examin-
ing their affections according to the rules of medicine
and treating them after having determined the seat of
them. He will clearly know the means, having no dis-
taste for any impurity, clearly discerning the aggrava-
tion or diminution of th e illness and prescribing
appropriate diets or medic ations .. . If he knows the
patient to be doomed , h e will not say so to him, but
exhort him to take refuge in the Three Jewels, to think
of the Buddha, the Doctrine, and the Community, to prac-
tice making offerings--explaining to him that his ill-
ness is due to evil c ommi t t e d in previous existences,
and that he should be mindful of it as a painful retri-
bution and make confession . And if the patient should
be provoked at these words and abuse him with harsh
speech, he will not respond at all, but not abandon the
patient either . He will take care not to exact grati -
tUde; he will continue to watch the patient after the
ii : healing for fear of relapse , and when he ascertains
that health has been completely restored he will rejoice
in his heart, but demand no recognition as recompense . . .
If a patient who has been healed should make him a gift
he will accept it only to make it a gift to the poor .
Someone who knows how to tend, to care for, and to
treat those who are ill in that way is a great patron
who truly aspires to the supreme path to awakening . ..

"And the sage who aspires to awakening will study

medicine even if he is r ich . He will build houses for
the keeping of patients provided with all that patients
need: drink and nourishment, infusions and herbs, of
which he gives .. . [There follows a long enumeration of
beneficent works: excavation of wells, afforestration,
redirection of streams, construction of hostelries fur-
nished for travellers, of bridges, etc .J .. . He is called
a pure donor; and of the two sorts of bodhisattva--
householder and religieux--it is easier for ,t h e former
than for the latter to be a pure donor . . . "

§ Miraculous cures are often effected, in the literature

of the Lesser vehicle (i'igama and vi naya ) , when the Buddha
simply lays his hand upon the head or the wound of a
patient . By c o n t a c t with that sacred palm adorned with
the wheel of a thousand spokes symbolizing his sovereign
power, a fluid of health and healing is released [for
example,Msv T1450:14 :174c cited ch.8 aboveJ. Mayaher-
self, when pregnant with the bodhisattva, h eals the sick
by laying her right hand upon t h e i r heads; Lalitavistara

46
 II
II

6: 71=T 187 :2:551b. The Greater Vehicle takes up this theme I; I

a propos of bodhisattvas, expounding it with a charac-
t e r i s t i c a l l y effusive imagination in order to a b u t upon
t h e myth of a sort of communal sacrifice--the bodhisat -
t v a vowing his curative body to be a p astur e for those
wh o suffer.

VimaZakirti-nirdesa T 475 :2 34 "The bodhisattva posses-

s i n g confidence (vaisaradya) can manifest i n an instant
the form, the voice , the thought of any senti ent being.
He becomes old, ill, dead ; he frolics in phantasmagoria
f o r the sake of the maturation of sentient beings .. . He
t u r n s into moon , sun, Sakra, Brahma, the lords of the
world, water, fire , earth, wind . If there is an epide-
mic, he becomes medic ine so that sentient beings be
nursed to health by it, liberated, saved, healed; if
t h e r e is a famine , he becomes drink and nourishment . .. "

Karmavibhanga (ed. Levi 2), the jataka of Sarvau:;;adha,

" Al l - Re me d y ": For him there is nothing that may not be a
remedy ; all that he takes and gives becomes a remedy .. . "

UpasakasiZa-sutra T 1488:2:1042a : In a previous existence

t h e Buddha , suffering from hunger, uttered a vow thanks
to which he obtained the body of a great fish; and with
his body he fed starved sentient beings . . . In another
lifetime when he was ill he uttered a vow to receive a
body [like] a "tree of medicine"; all those who were
ill--in seeing him , in smelling him or in touching him,
or in consuming his skin , his blood , his flesh, his
bone, or his marrow--were healed of all illness . A bo-
dhisattva, a great hero who knows how to endure such
sufferings without regressing is a true bodhisattva . . . .

According to the sut r a T 553 Lt r , Chavannes, Cinq

Cents Contes 3 :355], the "king of trees of medicine " is a
tree whose wood permits one to see the vital organs in-
side the human body. The Avatamsaka (cit ed Bdjt 1752c)
describes it as a great tree whose root, trunk, branches,
and leaves heal patients who smell or touch them; it
compares the tree to the body of bodhisattvas impregna-
ted with great compassion . The same comparison is made
in theMahaparinirvar.;a-sutra T 375 :30:804a:

"Just as the king of medicinal trees heals all the

sick who may take the root, trunk, branches , leaves,
flowers, fruits, or bark, so the bodhisattva frames the
following vow: May anyone who hears my voice, touches

34 . Citation filled out from Hebogirin 139b .

47
my body, or imbibes my blood, flesh , bone, or marrow,
be healed of all illnesses! When sentient beings eat
my flesh, may they be unable to give rise to any bad
idea, as though they were eating the flesh of their own
child! May I heal all and then preach the doctrine to
them! . .. Though he may be yet defiled, a bodhisattva who
endures such corporeal suffering with a mind without re-
gression, resolute, irreversible, will indubitably ob~
tain the mind without regression and accomplish
awakening .... "

On the medicine tree see also Tt 1578, tr. LVP as

"Le Joyau dans la Main," I1CB 2:137. See also the myth of
the medicinal tree in the mahayanist appendix of the
Yoqacarabhioni: translated by Dha rrnar-a.ks a , T 606:7:230b : 35
Recently the tree suddenly appeared in the atmosphere,
covering the entire universe with its branches. Its
emanations destroyed those of all poisonous plants; it
made the universe grow and prosper; all good people were
at peace; the highlands were reduced, the low were ele-
vated; there rained a sweet shower of jewels, all the
world was in a state of joy ...

The Pi taputr-aeamaqama of the Ra t nakirt a collection

tells--in jataka style--the myth of Soma, a curative
body who gives himself as pasture for the sick. This
myth certainly captures a buddhist echo of vedic tra-
ditions bearing upon soma, the "king of plants"--and in
particular the king of medicinal plants--from whom is
extracted a liquor that is sacred to brahmans, beverage
of the gods, elixir of youth and panacea of humanity.36
T 310:48:280b-282c (Bodhisattvapipaka-sutra):

"The bodhisattvas, the great heroes, should conceive

of all sentient beings as patients, ceaselessly burned
and tormented by the three fiery passions of greed,
hatred, and confusion. They should apply this ointment-
panacea (aqada) 37 of the good doctrine to them ... They
They should by the strength of their vow obtain a body
that will be a good medicine to heal sentient beings of
that threefold illness. The Buddha was born not long

35 . Tt 1578 has been reconstructed by N. Aiyaswami Sastri as Kara-

talaratna; Skt, Eng summary in Visva-bharati Annals 2(1949) . See
Demieville, "La Yogacarabhiimi de Sangharaki?a" in BEFEO 44 :2 :339-
434, p . 434.
36 . Dern i.ev i.Ll.e would surely wish to refer at this point to the
proposed identification of soma with the "entheogenic" mushroom
amanita muscaria; see Wasson 1968 .
37 . For a linguistic discussion see Hobogirin s.v. akada.
48
a go in the shape of a Devandra-Sakra named Wonderful
Ey e. At the time a fierce epidemic broke out in Jambu
Co n t i n e n t ; physicians proved impotent against it.
Al e r t e d by his sight and by his divine eyes, this Won-
de r f u l Eye metamorphosed into the body of a great being
n a me d Soma, and appeared on earth not far from the town
of Kuru. He offered himself as a gift to the sick.
They dismembered and cut up The gigantic body, which
no n e t h e l e s s underwent no diminution, and all were
healed by consuming his flesh . The sentient beings
wished then to show their gratitude to the great body;
he resumed the shape of a Devendra-Sakra and addressed
to them a teaching to convert them to Buddhism . In the
same way the Dharma-body of the bodhisattvas, the great
heroes, is indestructible like adamant; they actualize
destructible bodies only to convert destructible sen-
tient beings . .. "

Ibidem 283b: "Jivaka, the great king of physicians,

manufactured--by compounding drugs--the beautiful figure
of a woman, devoid of thought and discernment but capa-
ble of moving, of going and coming, of pausing seated or
lying, [an automaton]; Jivaka 'showed' her to patients
who came to consult him--to nobles, kings, princes,
ministers, merchants, and kinglets--and these patients
were healed by 'holding' the artificial woman for a
moment and putting their bodies in [sexual] 'contact'
with her. In the same way, [terrestrial] bodhisattvas,
the great heroes, actualize the Dharma-body and heal
all sentient beings who touch them from the illness of
the three passions ... "

See also the Tathagatacintyaguhyanirdesa s ec t 'Lon of

the Ra t un aktl t a , T 310:8:45c, for a similar story of a
beautiful young man, an automaton compounded by J1vaka
out of medicinal herbs: in contemplating him, in "sing-
ing and playing" with him, in examining his beautiful
appearance, the patients of Jivaka obtain healing,
pacification, and absence of desire; in the same way,
the bodhisattvas, the great heroes, actualize bodies in
order to procure love and pleasure for sentient beings--
men or women--whom the three passions torment to excess:
thus they calm their desires and guide them to calm
meditation and to discipline.

[Cp . in medicine (Bu s r-u t a , Kal.paethana 1:16) and in

literature (Kathiisarit-sagara 19:82 etc.) the "poison girl"
vi?akanya whose body, impregnated with poison, kills
whoever touches it--Dr. Filliozat.

[Cp o also the tale of the Greek physician in the

49
Thousand and One Nights who heals a king of Persia by con-
tact with a ball made of drugsJ

Among bodhisattva healers singled out for worship

by believers, the principal is Avalokitesvara (Jap . Kan-
non) . Under the name of Lokesvara he presided over Ang-
kor of the curative waters , and in Ceylon played the
role of patron of hospitals--devolving, in Cambodia,
into "master of medicaments ", the Buddha Bha~ajyaguru
(BEFEO 23:405) . This latter seems to have more or less
supplanted Avalokitesvara as the healing divinity of the
Sino-Japanese wor ld. His attr ibute is a medicine chest
[but the flask of Kannon seems not to have the same
endJ, or--in Tibetan tradition--a branch of myrobalan.
Two bodhisattvas are associated with him: Bhaisajyaraja
and Bhai$ajyasamudgata, who were in past lives'distrib-
utors of drugs to the community of the monk Candragarbha;
in this context he is the physician Buddha in person .
In Tibet and Mongolia the most widely distributed trea-
tise of medicine is a fourfold tantra (the Rgyud bzhi)
preached by Bha.Laa j yagur-u (Filliozat,JA1934:1:304) , 38

13. CJIeali1l$ and Mi§§ionary Activity

Medicine being recommended in the Greater Vehicle as a
means of conversion , many were the missionaries of Bud-
dhism who--though having in view the spiritual health
of unbelievers--presented themselves abroad as healers
of the body . Only a few examples borrowed from the
history of Chinese and Japanese Buddhism will be cited
here .

IN CHINA

Indian literature (Tt 201 :7; tr . Huber , SutraZarhkara 213f)

preserves the memory of a monk of Tak$aSlla named Gho~a
who was summoned to China by a blind prince who had
heard reports of him by merchants arrived from Taksa-
sila . This monk restored sight to the Chinese prince
by bathing his eyes with tears shed by auditors of his
instruction upon the "medicament" of the doctrine of
the twelve causal links.

Even the Parthian An Shih-kao, the earliest trans-

lator of buddhist texts in China (latter half of the

38. On the cults of Bhaisajyaraja, etc. in East Asia see Birnbaum

1979 . On the Rgyud bzhi' (with partial translation) see Rechung
1973.

50
s e c o n d century A.D.) is considered to have known medical
s c i e n c e , Ttt 2059 :1 :323a (on his translation of medical
texts see ch .15, "Four Humors" below) .

The Chinese hagiography ibid. 9:388 (a work of A.D .

519) reports that a century and a half later, at about
A.D. 300, a semi-divine personage bearing the very name
of Jivaka arrived at Lo-yang by way of Cambodia, Tankin,
and Canton. Before returning to the West by way of the
shifting sands he made numerous miraculous cures in
China. For example, at the capital he healed a civil
servant, whose legs were twisted and paralyzed, by
sprinkling him with pure water with a willow branch and
reciting incantations.

In the same era (A.D . 310-49) the Kuchean Fo-t'u-

teng gained renown at Lo-yang as a physician and thauma-
turge . He conquered an epidemic and he uttered-on the
subject of an illness of the crown prince of the impe-
rial house of Chao-a prognosis that proved to be more
apt than those of all other physicians, Chinese and
foreign : Ttt 2059 :9 :383c-384c (on this personage see also
Pelliot , TP 1912:419-22). One of his disciples, the hindu
Chu Fo-t f iao [*Buddhadeva-trJ likewise practiced medicine;
some sick women were brought to him: ibid. 387c .

In the fourth century a religieux who was probably

Chinese, Yli Fa-k f a i., passed for being versed in medtcfna. .
he had taken Jivaka as his patron, but he effected cures
by the Chinese procedures of acupuncture and examination
of pulses . In 361 Emperor Mo-ti of the Tsing summoned
him for a consultation. He diagnosed the illness as
hopeless and refused to treat the sovereign henceforth
[on abandonment of incurables, see above]; so highly
regarded was his competence that the Empress wished to
have him arrested for his refusal . On one occasion,
someone asked him why he busied himself with medicine .
His response is significant: "In cultivating the six
perfections as a struggle against illnesses due to the
four Maras a religious treatment of mental maladies ,
and in tending to the nine pulses as nursing affections
of wind and cold [physical maladies], there is profit
for myself and profit for others. Why should I not
then be permitted?" After his death a renowned man of
letters stated that he had "propagated religion by his
technical talents" -that is to say, by the practice of
medicine: Ttt 1059:4: 350a-b .

The buddhist chronicle Ttt 2035:40: 373c turns up other

recoveries, obtained in the year 720 at Ch'ang-an
during an epidemic by a Kashgarian "king of physicians"

51
known as "the old master Wei" , who was taken for an ema-
nation of the bodhisattva Bhaisajyaraja. An encyclo-
pedia, Ttt 2122: 95: 987c-989c, mentions some fiftee n cures
effected in China, from the Tsin to the T'ang, by
buddhists or buddhist procedures.

IN JAPAN

Physicians came from Korea, along wit h t he leading

elements of continental civilization. Chinese medicine
fo un d its way in directly, towards the end of the sixth
ce ntury . In t hat era Prince Shotoku is supposed to h a v e
fo unded some institutions of medical assistance at Osaka;
we wil l examine this supposit ion be low. Th a t these i n-
stitut i ons d a t e back so far is dubious in the extreme ;
it would not be inappropriate, however, to stress t hat
J a p a n e s e of the court as of t he general popu lation
formed a somewhat medical conception of Buddhism at t he
time of its introduction: the re lig ion was accepted in
Japan essentially because of its therapeutic elements .

The constructi on i n 607 of the famous Horyuji near

Nara had for pr i ncip le cause a vow made by Emperor YOrnei
i n 5 8 6 . Bei ng gravely il l at t he time, he pledged t hat
i f he were hea led he would found a temple for a nd vene-
rate a statue of Buddha Bh ai~ajyaguru. His sister and
h e r son--Empress Suiko and the you ng Sh o t o k u--c a r r i e d
out that vow in 607, as is attested by the inscription
engrave d on that date u p o n the a ureole of the renowned
g ilt -bronze Bhaisajyaguru. of Horyuj i (text of the in -
scription at Dainihonkinsekishi 1 :20).

Originally t hat statue occupied the central p lace i n

the principal sanctuary of Horyuji; later a statue of
Buddha Sakya was s ubstituted for it, flanked by two
bodhisattvas that tradition ident ifies--a characterist ic
survival--with the med ical bodhisattvas B hai~ajyaraja
and Bhaisajyasamudgata. Th i s latter triad was estab -
li she d in 623, l i k e wi s e to restore the health of Prince
Sh6toku and his spouse (see Maitre, " Dne inscript i on
j aponaise de I' a n 623" in Etudes Asiatiques 2).

There are thus vows of corporeal h e a li n g to be

found at the very origin of t he buddh ist art and epig-
raphy of Japan . The great sanctuary dedicated to
Bha isajyaguru--the Yakushiji near Horyuj i --also harks
b a c k · t o a vow, made by Emperor Temmu dur i n g a n il lness
of his spouse in A.D . 680 (Nihongi 14, tr. Aston 348). In
720 Empress Gensh6 caused the sutra of Bha isajyaguru t o
be recited in forty -eight temp les in or der to s a v e t he

52
life of one of her ministers, and in 745 Emperor Shomu ,
i l l himself , order ed statues to b e cast of t he healing
b u d d h a and his siitra to be r e cit ed a n d c o p ie d (Shokun i -
hongi 8, 16, etc.)

The most widely diffused t e xt s of this e r a were the

s ii t r a s of Bhaisajyaguru and Vimalakirti, a n d they were
r e a d and copied chief ly for the purposes o f h ealing and
preventing illness (see also the e s s a y of Prof . Matsu-
moto, "Le Bouddhisme de I' ere 'I'empyo" in Bukky os hi r on ,
Kyoto 1929: 316f). Recit ation of the Chapter on Illness of
t he VimaZak'irtini r de sa wa s a ri t e obs erved annually at
Kofukuji o f Nara up to the nineteenth cen tury--a custom
d a t i n g back to the healing of a minister of the Empr ess
Saimei at whose bedside a Korean nun had the chapt er
re a d in 656 (De Visser, Ancient Buddhism in Japan, Paris
1928:9-10) .

Beside these curative exer cises of a re ligious sor t,

the buddhist clergy also practi ced medicine proper. In
A.D. 754 the Chines e religieux Chi en-chen arrived at
Nara bringing more than a thousand pounds of scents and
medicaments f r o m China (Takakusu in BEFEO 28 :450). He was
versed in pharmacology , and successfully treated an
illness o f Empress Komy6 (ibid. 36) . The renown of this
healing monk--although stricken by blindn ess, he r ecog-
n ized drugs by thei r odor--remains great in Japan .

At the same t i me Emperor ShOmu , stricken b y a

mortal illness, sought in a dis tan t provinc e a monk
we l l - k n o wn f o r his t al ents as a si ck-nurse ; this monk
t ended him so well that the sovereign would no t summon
any other ph ysician . He was s e conded by 126 other
monastic nurses; as a r eward; t h e i r famili es were exe mp -
t ed from all taxes and corv~e after the death of Shomu
(Shokunihongi 19, decreed on the twenty-fourth day of the
fifth moon of the eighth year Tempyoshoho , A.D . 756) .
Here, the influenc e of China is e v i d e n t : Unde r HsUan-
tsung of the T'ang ( A.D . 712-55), an imp erial prince
was taken i ll; the court physi cians e n d e a v o r e d in vain
to heal him but only a buddhist monk suc ceeded ; he r e-
ce ive d in reward a red robe and a "net of fish " --very
g r a n d honorific dis tinctions (Ttt 2126:3:248c).

53
 Wor1(§ of Medical Assistance
MONASTIC HOSPITALS

In conformity with the spirit of the Lesser Vehicle,

the early codes of discipline did not provide for any
charitable institutions within monasteries for the bene-
fit of lay patients. No special installation seems to
have been anticipated even for the clergy, outside of
stores for drugs (Pali kappi.uabhioni., Mahiivagga 6:34:5; I-
tsing mentions them at Ttt2125:4:230c, see Takakusu,
Record 192). Monk patients were treated in ordinary cells,
as most of the vinay texts that have been cited above
make clear; only the Vinaya of the Millasarvastivada
school mentions a special hall for sick monks (Msv T
1451:17:283a-b). In the Pali Nikiiyas it is a matter of a
giUina-saUi "hall of patients" where the Buddha visits
several monks [see PTSD: Anguttara 3:142, lacking in Chi-
I, : nese; Safnyutta 4:210=T 99:37:268bJ. The Chinese translators
have so misunderstood this term that they have not even
translated the word giZana (Skt gZana): they give the faulty
transcription garirei; and as to the word saUi, they
render it with Mdo, "hall of teaching"! [T 99 loc. cit. J

The "Illustrated Monograph of the Jetavana Vihara

of Sravasti" Ttt 1899:2, a work by Tao-hsiian written in
A.D. 667, reports (893b-c) that the Jetavana monastery
included a hall containing a collection of all the me-
dical prescriptions of the universe along with a mirac-
ulous hand bell--the work of Jivaka--whose sound would
heal monks from the third fruition of holiness onward
who might hear it. Jetavana also included (ibid. 894a-b)
an edifice commemorating the illnesses of the Buddha
and the treatments given him by Jivaka and by Ananda,
a store of drugs for the use of secular as well as
monastic patients, and a place where they were lodged.
But the testimony of this "Monograph" is worthless;
Tao-hsiian drafted the text (in April of 667, some months
before his death) in part according to some previous
Chinese documents but chiefly, as he himself acknow-
ledged in boasting of it (see ibid. 883a, 895b-c; also
Ttt 2061:14:791a), according to miraculous revelations
that he received from a divinity. Probably this work
was intended, at least in part, to justify innovations
that the author was permitted to make in constructing
the famous ordination platform (to which he had already
devoted another book, Ttt 1892) in the outskirts of
Ch'ang-an at the beginning of the same year. Besides,

54
al~ the later works of that author denote a morbid
spiritualism (see Peri at BEFEO 16 :3:45f).

Be that as it may, the "Monograph of Jetavana

Vihara"-a monastery that Tao-hsuan makes in any event
a Mahayana establishment-does not s eem to furnish cre-
dible information 'on the monasteries of India or even
on those of China in his day. As I-tsing suggests in
Ttt 2066:1 (Chavannes , ReZigieux emi.nent:e 91), the "models"
by which the author claims to have been inspired must
be purely imaginary.

In his commentary (drafted A.D . 626 -30) to the

Dharmaquptaka-irinaija Ttt 1804:3D:144a,
the same Tao-hsuan
describes a place called "the court of impermanence"
in the north-west corner of Jetavana, "right-side out
where light disappears", to which dying patients were
transported so that they would be withdrawn from the
thoughts of attachment to life that would be provoked
in them by seeing, in their own cells, their robes,
bowls, and other personal effects. There stood in that
hall a gilded statue-turned toward the west-whose
right hand was raised and whose left held a silken ban-
ner of five colors trailing to the ground . The dying
monk was set behind that statue and made to hold in his
left hand the end of the banner . The Buddha Amitabha-
represented by the statue-was supposed to lead him to
the pure land, and during the death throes the sick-
nurse would burn incense, scatter flowers, and recite
appropriate texts [an encyclopedia , Ttt 2122:95:987a,
cites this entire passage-attributing it, doubtless in
error, to Ttt 1899 of Tao-hsuanJ.

No institution of that sort is mentioned in the

vinayas of the Lesser Vehicle, but as a plainly mahaya-
nist custom is at issue, it is possible that such local
mortuaries really existed in the monasteries of India
belonging to the Greater Vehicle. Doubtless they exis-
ted in China as well; a work of the eleventh century,
Ttt 2127:3:306b, makes reference to the aforementioned
text of Tao-hstian, adding in a note that up to the
eleventh century these halls intended for dying monks
received other names: the "hall of nirvana" " the "hall
of the prolongation of life", and so forth . In modern
Chinese monasteries, places reserved for patients are
still called "halls of nirvana", and during the death
throes one recites the SUtra of Impermanence T 801 (see De
Groot, Code du Mahayana en Chine 131). In Japan it is the
second designation, "hall of the prolongation of life",
that survives in the convents of the Zen school (see
Suzuki, The Training of the Zen Monk, Kyoto 1934 : 34).
55
 WORKS TO BENEFIT THE LAITY

In India. In li g ht of the sp i rit o f bene vol en c e th a t a n i -

ma tes the lit er a ture o f the Gr e a t er Ve h i cle, th er e can -
not be the sh adow o f a doub t that mahay anist Ind ia pro-
duced wo r k s o f a s s i s t ance or ki ndne s s f or l ay pat i ent s .
But Indian tradit ion, with i ts s corn for c o nc re te reali-
ti es , l e a v es us no t a s hre d of ev i de nc e o f the a cti vity
of the c hu rc h o f t he Gr e at e r Vehi c l e in th at doma in .
An d the do cum en ts are decept ive b eside s .

The Upaeakaei. la-eicta-a (ci t ed c h . 12 above) r e c ommen d s

to we alth y bodhis a t tvas that th ey establish f re e cl i nics .

A j at aka c o l lecte d in Ttt 2121:10 :54a shows u s a kin g

who gov erned h is p e opl e with love (maitriJ and who t e n ded
patients who we re poor or widowed dur ing t h e c o ur se of
monthl y t ours o f insp e ct ion , distributin g drugs and pap .
When h e took part in the hunt, h e h ad c h a r i o ts f ollow
him b earing c l o t h i ng and medi c amen ts.
II
I Epigr aphy informs us that Emperor As oka a r r a n g e d
to have h uma n b ein gs and animal s tre ated (medically? )
th roughout hi s e mp i re s i mu lt a neo us ly. Se cond Rock
Edict (S enart 1:73-74): " Ki ng Pi yadas i, b eloved o f the
go d s, h ad medi cine of t wo sorts mad e--medicine for hu-
man beings and medi c ine for a nimals (doe eilcioha kata
manuea eikioha ca paeuei kioha ), Senart interpr ets the term
aikiaha (Skt aikitsa "me d i cine") [ a t erm that might a lso
si gnify , in the contex t , simpl y " t he d e ed o f think ing
(with solici tude), o f tak i ng c a.r.e!' : see Pali eikicohatii:
"he thinks of" , as o p po se d t o tri lci cc hat i: " he c a r e s f or
medi cal ly"; t h e roo t is -rei.t: "to think" -Dr . Fil liozat]
in the sens e of distr ibution of medi c aments : "He d is-
tr i b u tes r emedi es of t wo sorts . .. " That int erpret ati on
s e ems t o .be corroborat ed by Sinhalese tradit ion : the
Samari iapaeiidika Tt 1462 :2 :682a s ee also Pali t e xt ed . Olden-
b erg, Vinaya Pi.i oka 3 :306 r e por t s in f a ct the foll owing
e p i s o d e f ound also in the Dipavafnsa and Mahavafnsa (Geiger ,
Dipavafnsa und Mahavafnsa 126) : The monk Kuntiputta Tissa ,
g r a ve ly ill, begs fo r medi c ament s , but o b t a i n s no thin g
save a pin ch o f ghi Aft er h e di es, Asoka s et s up me d i -
cal depots for monks at ea ch of t h e fo u r g a te s o f his
c i ty (Pal i pokkhar ani: " l o t u s pond"=in this c o n te x t a store
e xcava t e d in t he ground [ ?]) ; their p r ov i s io n of medi-
came nt s is assu red b y t he dail y r e v enue of t went y mil -
lion co i n s yi elded t o the king by the four t ho u san d
i n n s (Pali sabha ) ' s i t uat e d n ear to t he f o u r gat e s of
Pat a L f.pu t r a .

56
 In the seventh cen tury Hsuan-tsang saw as y l u ms all
o ve r India , called pU1J-yasaUi o r dharmaedlii where f o o d a n d
me d ic i nes were distribu t ed t o ind i g ents (Wat t er s , Tr a ve l s
1 :288, 328; 2 :286 ; see also R. M0j>cfe rji , Loca l Government: in
Anci en t India, Oxford 1920 :275f).

I n Ceyl on as we ll, where the Gre a t e r and Les s e r Vehic les

c o e x i s t e d f o r a long time , t he lo c al c hronicle repea te d -
l y me nti ons royal f ounda t i ons on b ehalf of t he s ick .
Th e mid- fou rth centur y Kin g Buddhadasa , whose name
see ms maha yanist (s e e Kern, His toir e du Bouddhi.eme, Fre nch
t r . 2 : 416 n.l) created s ala r i ed positions for phys ic ian s
a n d ve t e r i n a r ie s, and buil t a sy l u ms; a wor k o n med i c in e
is e ve n a t t r i b u t e d to him (JollY , Medi ci n, par. 14 ) .

[An e x a mp l e of a hospital i n brahmani c al Indi a i s

fo u n d a t Tirumukkudal (Chingl eput district) ; a Tamil
i n s c ri p t i o n of t he'el ev enth cen t u r y A .D . describes its
mainten ance. See K.V. Subramanya Ayyar, "The Tirumuk-
k u da l I nscript ion of Viraraj e n d r a " in Epigraphi a I ndica
21 (Jan.1932):220-5Q--Dr. Filliozat.J

In Cambodi a, the of t-repl i c at ed st ele of Say-fang (on the

middle Mekhong ) details the o r ga n i z a t i o n of a roy al
hospital fo unded i n A.D. 1186 (Finot,BEFEO 3 :1 8- 33). At
t h a t dat e there exist ed in th e Khmer kingdom no f e wer
t h a n 102 e s t a b li s h me n t s of t he type (Coe de s ibid. 6: 48 ) .
Pur ely mahayanist in inspir ation , they wer e plac ed under
t he invocation of Buddh a Bha i saj yaguru. Th e s e "hous e s
o f h ealth" (arogyasa l a ) were open to the four c as tes . At
Say-f a ng r esident p e rsonn el comprised 2 physi ci ans , 22
g ua r d i a n s and attendants , e tc. ( se e ibid . 15:2:110)-m:>re
than 30 e mp l oye e s in all--assi s t ed b y 66 non-r e sident
emp l oye e s , b esides re l ig i o u s o ffi ciants. P ati ent s we r e
f ed gratis , and t h r ice ye a r ly the y r ecei v ed c lo t hi ng,
p rov i s i o n s , and medi caments e numer a t e d in d e tail b y the
ins crip tions of Say -fan g ( s e e als o P. Cordi e r ibi d . 3 :466).

Ano ther ins crip ti on o f t he s a me d at e at Ta-prohm

near Angkor fi xes the annual budg e t of t he who le hospi-
t a l syst em (Coode s ibid. 6:80- 81) : 17,000 measures o f ri c e
f o r p at i ents , 1 , 6 0 0 ro b e s , et c.

In China . Appare nt l y, prebuddhi s t Ch i n a had c er tai n in -

stitutions of assistan ce t o the sick analagou s to thos e
o f o ur own pagan antiquity. If the chou-L i. is t o b e b e -
liev ed--that mo r e or less utopian code for th e adminis-
tration of a nc ient rit es--th e vario us me d i c a l spe cial-
ists to b e fo und u nde r the c o n t r o l of t he mast er physi-

57
c i a n had to busy t hemse l ve s not only wi th c o u r t a n d a d -
ministra t ive p ersonne l , but with the gene ral populac e
a s we l l. (The int erpret ati on o f Biot , Le Tcheou-Li: 1: 92 &
95 , i s b a s ed o n T ' a n g com ment ar ie s a n d s e ems mi stake n .)

The Spr i ng and Autumn Annals (Lu s hi h ch tun ch 'iu) 9 :2 shows

us a king of a n t iqu i t y having hims elf followed, when he
d e par t s, b y a c h a r io t b ear in g f o od that h e distr ibut es
to indi gent p ati en ts. But f ar f rom bein g mov e d b y com-
pas s i o n like th e Indi an ki ng o f t he jat aka c i t e d a b ove ,
this Chin ese k i ng aims o nly at winnin g the favor of t he
p eopl e in orde r t o dr a g th em o f f t o war.

Th e Kuan - t zu provide s fo r a n administra ti on i n the

c a pita l of th e fe u da l st at es c ha r ged to c a re f o r , to
hosp i t alize, a n d to f e ed indig ents stri cken wit h c h ro n i c
infirmiti es--deafn ess , b lindne ss, mutism , l ameness,
h eipl egia , e tc .--u n t i l th e y ar e heal ed. Anothe r f u n c -
tion ar y--a s o r t o f a t te n dant -vi s ito r --s hou l d make rounds
t o ask af te r p a ti en t s of all age s . But t he Kuan- t zu t h a t
we h a v e tod ay, a wor k of pure ly ut opian c h a rac te r, i s
larg ely apo cryp h a l and thi s pas s age ma y be a lat e addi-
tion und e r buddhi s t in fl u en ce.

§ Onl y und er t he b arbarian No rt he r n Wei d yn ast y, c o nve r -

ted to the n e w r eli gion, d o es o ne see th e ap p ear an c e o f
gen u i n e wor ks of pu b l ic assistance i n Ch i n a. The initia-
tor o f the ce leb ra t e d rupe s tral sanctuaries of Yun-kang,
T 'an- yao--named a dmi n i st ra t or of c lergy at a bou t A. D .
46 0--organ ize d r e s e r v e s of cerea l s o u t of d on ations made
t o t he buddhis t c hur c h by fam i l ies of t he f a it h f u l .
Th e s e r es e rve s we r e t o b e dis t ribu t e d t o th e popul a c e
in cas e of famin e ; th e y ar e what wa s r e f err ed t o as
"sa JiJg h a gra i n" ( Wei-s hu 114 , tr. BEFEO 25 :451 n .2 ; s ee a l so
Ware at TP 1933 :147 ).

In t ha t b u d d h i s t ins ti tu tion on e ma y p e rhap s di s-

ce r n th e remote ori g i n of t h e " gran ari e s of c h a r i t y "--
e s t ab li s hed b y Su i r u ler s in A.D. 585 a n d still main-
tai ned under t he T 'an g--in wh ic h r e s erv e s of g ra i n,
formed b y cont r ibut i o ns (or prete stat io ns ! ) o f t he
peo p le , were accu mu late d in pre vi s i on o f f a mine ( Sui- shu
24: 6b- 7a, 46: 3a- b; see al so Balaz s at Mitt. Sem, Or. Sp» ,
1932 :67) .

39 . Th is l a s t i tem, append ed by t h e author to t h e end o f t he f a s-

c icu le, may b e t akento qualif y h i s s t r i ctures on t h eory versus
p r a c t i c e in India , a s it p rov i d es mor e than textua l e v i de nce for
"maha ya n i.s t " s o cial institu tions .

58
 While Buddhism fl ourished in t he T 'ang e r a, medi c al
a s s i s t a n c e to indi g ent p atients wa s o r gan i z ed . The Em-
p r e s s Wu , as famous fo r e xcess i n h er poli tics a n d pri-
va t e life as for h er buddhist f erv or , be t we en t h e y ears
70 1 a n d 705 created a lay c ommi s s a r i a t ch a r g ed with ad-
mi n i s t e r i n g , in the n ame of th e stat e, th e hospi tals
t ha t were then found annexed to buddhist mon a s t eries.
Th e budget of these hospitals was assured b y th e pro-
c e e d s of special lands, belonging to the cl er gy, called
" fields of c omp a s s i o n " (p ei: t t i en), This term, which has
had a long career throu ghout the Far EAst up t o mod ern
t i me s , must c o n t a i n a pun upon t 'ien "field, ri c e paddy "
whi c h may also be unde rstood as an e qu i v a len t of Skt
keetn-a "field [of felicity]. "

In 717 the confu c ianist minister Sun-chun g , s can-

da l i z e d that such patronage should be accorded b y th e
s t a t e to buddhist institutions, implored Empe ror Hsuan-
t s u n g to suppress tha t c o mmi s s a r iat . He recalled in
t ha t regard Confucius' c o n d e mna t i o n of his disciple Tzu-
l u when the latter wished to donate his fortune to f e ed
t he needy of the land of Wei (T'ang hui yao 49:9a). But
Hsuan -tsung did not he ed the remonstrance; i n the year
74 4 he even d ecreed that beggars of the capit al be hos-
p i t a l i z e d at state expens e in the buddhist hospitals
( i b i d . and T'ung-chien 214) . 40

In A.D. 750-53 the Ch i nes e monk Chien-chen (b efor e h e

re p a i r e d to J a p a n; s e e c h . 1 3, " I n J apan" abo v e) manag ed
a " f i e l d o f compassion" f o r th e si ck at Yang- chou on th e
l owe r Blue River , as well as on e of the c u l t ic fields
(ch inq t t ien ) whose proc eeds wer e e a r ma r k e d for worship-
i.e . , for the maint en an c e-of th e Three J ewels : Buddha ,
Doc t r i n e , and Communit y BEFEO 28:471 .

At the time of th e g r e a t pros cription o f Buddhism

i n 845, the cl ergy was s eculari z ed a n d all it s goods
c o n f i s c a ted . Th e minist er Li Te-yu, who had directed
t he proscription but r e cognized-in an adv ersarial
light-the good points o f Buddhism , propos ed that the
s t a t e r e cover the h o spit als of t he " f ie l ds of compas-
s i o n" for its own profi t. But as tha t nam e smelled too
mu c h of Buddhism, th e y would h en c efo rth be c a l le d simpl y
" h o s p i t a l s". Li Te-yu caused th ere t o be chos en, from
amo ng the subalterns o f the administration and the el -
ders of the two capitals , the gr e at prefe ctu r es , and the
important market towns, a person of acknowl ed ged morali-
ty to attend to each of these hospitals in p lace of the

40 . These and other incidents discus sed Ch ' e n 1973,2 97-301.

59
 s e cul a r i z ed monks . For the i r maint en an ce he e a r mar ke d
produ c e of th e fi elds con fi s cated fr om t he chur ch , aug-
ment ed in c e r ta i n c a s e s b y p e cuniar y subventions b y th e
stat e (T rang hui yao l oco cit . ; s e e also De Groot, Sec tar i ani sm
and Re Zigious Pers ecution in China 69) .
The hospi tals thus s u rv ive d the c risis of 8 45 and
wer e r ecovered b y t he cl e r gy a f t e r the r estoration of
Buddhism in subs equent yea rs. In 867 Emperor I -tsung,
recovering from a grave illn ess, "thought to be father
and moth er to indi g ent p a tients. " He sent two pie c es
of s ilk t o ea ch in v alid over s event y year s of age, wh e -
th er l a y or mon a s t i c , and di stributed ri c e to hospi tals
of the p r ef ectur e s and sub-pr ef ectures . He furth ermore
ch arg ed lo cal a ut ho r i t ie s to choose comp et ent buddhist
monks , who woul d .b e c h a nge d e ve r y .t h r e e ye a r s, t o direct
th e hospita ls. The mon etar y e q u i v a le nt o f presents re -
ceiv ed b y t he Empero r on t he o ccasion of his r e covery
would b e portion ed a mo ng thes e hospi t als, which would
a vail themselv es o f it f or dis tribution to indi gents as
I ric e, and as medi c aments i n c as e s of e pi d e mi c (Trang ta
I I
I chao Zi ng chi 10:13b) .
11

I n Japan. Instituti ons of chari t a b l e assistance are wel l

known to h ist orian s of Buddhism: res embling buddhist
basili ades, 41 the y pass fo r h aving been found ed around
the year 593 a t Shit ennOj i of Na n iwa (pr esent-day Osaka)
by th e i mperial princ e ShO t oku Taishi. What does not
s e em t o have b e en pointed out until now is that these
institutions , like all those r esusci t a t ed by Japanese
c ivili zation at that t i me , we r e imitations of China.
The similarit y o f t erms us ed to design at e them in Japan
to tho s e noticed above from T 'ang China l eaves no doubt
i n that regard. True, the da t e at whi ch Sh6toku i s
d e eme d to h a v e founded Sh itenn6j i correspon d s to the
reign o f t he Sui in China (A.D . 589-617), a n d we h a v e
n o e v i d e n c e b earin g on the existe nce of buddhist h o s p i -
tals in China under that dynasty. Nevertheless, it is
not unr easo nabl e t o s uppos e that these hospita ls--as
with so man y other buddhis t i n stitu tions o f the T 'ang--
da t e back to the Sui. Even mor e i mp o r t a n t l y , the attri-
bu tion t o Sh6toku of the Shitenn6ji institut ions o f
charit y app ears to b e suspe ct. The bio g r a ph i es of t h a t
prin ce, e n c u mbe re d with l e g ends , h a v e not y e t b een sub-
mitt ed to a s eriou s critique. Th e e x ist ence of thes e
est ablishme nts is not what is dubious ; it is t h e da te

41. " Ba s i l i a d e s ": after Sa int Basi l (ca A. D. 33 0- 79) , a father of

Gre ek monasticism who founded hostels and ho spitals at the out-
skirts of Caesarea.
60
 t ha t tradition assigns them. The official history has
not h i n g on them; the first documents to mention t hem are
po s t e r i o r by several centuries to Sh6toku: these are the
sho tokutoiehidenru aku tDnbe 12: 18a-19a), a work that (accordi ng
to Bekd 5:531) d a t e s only from 917, and th e Shitennoji -
mishui nnengi (Dnbz 118 :58a-b , 64a), which pass es for having
been drafted by Sh6 t o k u h i ms e l f shortly aft er the foun -
d i n g of Shitenno j i in 595, b ut the manuscript tradition
of which dates b a c k no ear lier than t he year 1004 (Bskd
4 :204 ) .

According to these tex ts--the first of which claims

to cite t he second--the Shitenn6ji c omp r i s e d, at the
t i me of its foundation--or of its transfer to Naniwa
(Osaka) --in A.D. 593, the following four es tablishments :
(1) an estab lishment called the "cultic field" (keidehin) ,
in the central sanctuary of which a gi lt-bronze statu e
of Avalokitesvara the Savior (kuz ekannon J was venerated--
the stat ue having come from Paik-tjye i in Korea ( i n the
pseudo - manuscript of Sh6toku, the importation of the
stat ue is treate d as prophecy). The t hree other estab-
lishme nts are f o und outside t he preci ncts of that sanc-
t u a r y : they are (2) a pharmacopoeia (seyakuinJ whe re
medic i nal p lants were cultivated and d rug s prepared for
distribution to all; (3) a ho s p i t a l (r yoby8 y8inJ in which
all patients lacking resources, both male and female ,
were treated and fed ; monastic patients tended one ano-
ther unti l they were h ealed; and (4) an asylum , called
t h e estab l ishment of the "field of compassion" (hi dehinJ
whe re indig ents, orphans , hermits , and loners were lod-
ged a nd fed on a daily basis; when t hey were in good
healt h they cou ld be charged with various sor ts of work
in t he four establishments.

Th e upkeep of these establishments was assured b y

the s t ate with a revenue of six thousand trusses of rice
furn ished by the provinces of Settsu and Kawachi ( a d j a -
cent t o Osaka) .

§ If the date of the Shitenn6ji ins t itutions is far

from certain , the e xist en ce o f similar institutions in
the Nara period is well attest ed ( A.D. 710-84, the apo-
g e e of the T'ang in China). Th e buddhis t c h r o n i c l e
(Genkoshakusho 22 , in Dnbz 101:398a; othe r sour c es Bdnp 258)
mentions the fou ndations of a dispensary (s eyakuinJ and
a n asyl um of the "f ield of compassion" (hidehinJ at Kofu-
ku ji of Nara u n d e r the reign of Empress Gensho in A.D.
724.
In A.D . 730, near the time when China saw the Em-
peror Hsuan -tsung sanction state protection to buddhist
61
 hos pi t al s, we se e in Japan t he Empress K6my6 , spouse of
Shomu, f o u n d a dispensary (s eyakuin) that was d ependent
administratively on her hous e , and t he provision o f
drugs to wh ich was assured b y purchases e ff ecte d y e a r l y
in t h e various provin c e s b y t he lords and nobles; they
had to deduct the sum o f t hese purchases fr om th e re v e -
nues of their appanag e s (Shokunihongi 10 , fou r th mo o n of
t h e se c o n d y e a r Temp y6 ; K6my6 a l s o found ed a n a s ylum,
hidehin, see ibid. 22 , unde r t he si xth moon of the fourth
y e a r Tempy6h6ji). Th e r e we h a v e an imperi al , lay insti-
tution, the functi onin g o f wh i c h is known to u s b y a
do cument of Shos6in , the s t o r e ho us e for timber a n nexe d
t o Todai ji of Nara . In tha t storehouse the Emperor's
personal goods wer e deposited after his dea th . At that
time (A.D . 756) the th en dowager Empress K6my6 dedicated
the structure to th e " gre at buddha" of Todaiji (Vairo-
cana, Da inici ). Among the goods deposited are t we n t y -
o n e chests of medicaments of sixty c lassificat ions; t he
i nv e n t o r y--d r a wn up the s ame day as the donation--is
preserved i n Sh6s6in, a s are a goo d number of the me di-
II! II caments t hemse lves. These latter h a v e been stud i ed and
'I identified by Dr . K. Dohi, Professor of Dermatology at
I: t he I mperial Un i v e r s i t y of To k y o , who devot ed h is lei-
s ure h o u r s to the study of F a r Ea st e r n medicine ("Medi-
cine in Ancie nt J a p an " i n Young East 2 :5-6, OCt.-Nov . 1926) ;
t hey furn ish an authentic account of Sino-Japanes e
p harmacopeia of the era .

The inventory manus c ript (edited for example in

Ono Zent aro , ShOsoin no ehi ori , T6kyo 1920, app. 65-71)
stipu-
lates that the medi caments may be d o n a t e d to patients
who need t hem : pati ents should address a request to the
bureau of e cclesiastical administration (s ago) One of
these requests is pres e r ved in Sh6soin as a manuscript
dated 759 : the dispensa r y founded by Empress K6myo so li -
cits, with this docume n t , the gift of one hundred pounds
of cinnamo n , a medicament of which t h e dispensary is i n
short supply and which cannot be found for purch a se; the
request i s signed by a lay name, wh ich demonstrates that
t he dispensary is officially independent from the church .

Other dispensari es were, h owe v e r , att a ched to monas -

teries. I n 757 Empress Kok en, daughter of Shomu and
K6my6 , made the perpetual do nation of a ri c e field of
one hundredcho to t h e dispensary of Yamashinadera (ano -
t her n ame of K6fukuji of Nara; see above)--"for the care
of t he il l and the poor ," says the t e x t o f t h e e d i c t.
The sovereign wi she d by t h a t whole s ome de ed to acquire
merit for h e rs e l f and f o r sentient b e i n g s: " Ma y the
me di c in a l t r e e of the te n bodies [ s e e ch.12 aboveJs hel-
ter this worl d of dust and destroy forever the torme nts
62
o f illn ess]" (Slwkunihongi 20, twelfth moon of the first
ye a r Tempyohoji).

In 760 the same empress sent two chests of sundry

medicaments and a jar of h o n e y to e a c h o f the five
monasteries [of Nar a I (ibid. 22, fourth moon of the
f o u r t h year Tempyohoji).

An inventory of the g o o d s of H6ryuj i, drawn up in

74 7, mentions an asylum, hi dehin in t h a t monast ery (see
a l s o Ueda Shinjo in Mis s hugaku hO no .152 , March 1926 :119).

According to tradition (Moch 1088c) , Empress Komyo

had bathing rooms constructed in which she personally
cared for a thousand lepers, sucking the pus from their
sores.

§ The official institutions of assistance t o the ill

and the poor were c o n t i nue d when the capital was trans -
ferred from Nara to Heian (Kyoto; for what follows see
Ueda , loco cit. 122f). In A.D . 842 Heian contained t wo
asylums (hi.deirin) - one in the east and another in the
west of the city-where rice was distribut ed to the
hungry and orphans were reared. The history also men-
tions , at A.D. 825, 860, and 881 , a stat e dispensary.
These establishmen ts were ext a n t a t the be ginning of
the t e n t h century. Sin c e t he n ins titutions of c h a r i -
table assistance s e em to have b een neglected by the
state; private initiative makes sporadic attempts to
remedy t he situation, but it is only in modern times
that one again finds in Japan-and in China as well-
buddhist organizations of beneficence.

63
II II

64
Part Five: Theories, Practices, and
<:/\1edica1 <:.Authorities
15. Pathogenesis
Al l thro ug h b uddhist l i t e r atu r e one f inds a t heory ex-
p lai ni ng t he o r ig in of illn es s e s as a dera ngement or
d isequ ilibr i um of fou r el ements (Skt, Pa l i mahabhut a o r
dhatu ) th at make u p the hum an bo d y, n a me l y : (1 ) t he s olid
e lement, o r Eart h (Sk t prthivi ) ; (2 ) the wet e l e men t , or
Water (ap); ( 3 ) t he ho t e lement, or F ire (t ejas ); a n d
(4) t he mobile elemen t , or Wi nd (veda, viiyu) . Whe n o ne
o r mo r e o f t hese e lemen ts unde r go es a n abnormal a ugmen-
t a t i o n o r dim inut ion, th e r e o c curs a rup tur e of th e i r
harmony fr o m whi ch illnes s r esult s. Gen e rall y , it i s
sa id t hat 101 s o r t s of i l lnes s c o r res po n d to each of
the f o ur e lement s , makin g a grand t o ta l of 4 04 il l nesses.

Th at the ory g r e w so prevale n t in buddhist Indi a

th a t when a dis ciple sa l u ted his ma st e r in t h e morn in g
h e h a d to ask o f him : "Are y o ur e l e men t s at p eace?"
Thi s f ormu la is p re scr i be d b y the Msv T 1451 :35 :38 2a , a nd
the Chi nese p ilgrim I- ts in g h e a rd i t in t h e mo nasteries
o f Indi a e ve n at th e en d of t h e s eve nt h c e n t u ry (Ttt
2125 :3:222a; tr . Takakusu , Rec ord 116). In Chin a and in
J a pan the exp r e s s io n " dera ngemen t of th e f our element s"
(ehddai.fucho ) fo r " i l l nes s" h a s re mai ne d i n common us a g e
( for ex amp le , in ep is to lar y style) up t o th e pr e s en t
d ay. Tho se who e mp loy i t h av e , a s o fte n as not ( a n d
e s p e c i a l ly in Chin a) lost a l l s e nse of its p re cise
meaning a n d i t s buddhi s t o rigi n.

To that t h eory i s add e d--or somet im es s u bstit u te d--

t hat o f the t h r ee "peccant humo r s " (trido?a) : the humo r
of wind (viit a, viiyu), th e humor of ph l egm (sZe?man, Pali
eemha; Skt al s o kapha ) , a n d the humor of bil e ( Skt, P a li
pitta ) .
The word doea i s l it er al l y " f a u l t , de f ect, d et e rio-
rat i on, disturban c e" ; it is properl y app licab le only t o
e l e men t s th at are "pe c cant"--deter i ora t ed, v ici at ed,
f a ctor s of illne s s. Bu t i n the t e chni c al lite r ature of
Ind i an medi cin e , wh e re the pat ho logical poin t of v i e w
n a t ura l ly p r edomin at es , th e no tion o f doea , " d i s t u r -
ban c e ", f r equently b e c omes a simp l e s ynonym f o r dhatu ,
which strictly spe akin g designat es th e physical e leme n t s
in t h e i r normal stat e.

[In ayurved ic t r adition t he e l eme nts are inv ariably

65
 numbered five: earth , water , fire, wi nd , and space. Two
of these five--earth an d space--are inert; the ot her
thre e--wi nd, fire , and water--ar e active. Whe n th e a c-
tiv ity of the l a t t e r s et is n ormal, ther e is h e a l t h ;
whe n it is dist urbed--t hat is to say , wh en one or two
of them or even al l t hree together are fo u nd i n excess
o r i n deficiency, t here is i l l n e s s . Whi le a state of
heal th prev a ils t h ey behav e as t he t hr ee pri ncipal el e-
men t s of t he b o dy, the dhatu , whe n th ey are exci te d t hey
be come t he e lements of dist urbance, t he dosa. Bu t as a
p er s on becomes con c er ned wit h them chief ly whe n t hey are
excited, t hey are c h i e f l y r ef erred to as dOsa rather t han
as dhatu; a n d it e ve n comes abo ut t hat one al lows onese lf
to be drawn int o r e f erring to them as dosa even in cas es
where , acting in a normal manner , t hey actually f u nctio n
a s dhat u--fJr . Fi 11 i o z a t . ]

I n buddhist t e xts , on th e ot her hand--at l e a s t in

Far Easter n tradi ti on--the tridOsa play a minor rol e .
One would search the Chi nes e cano n in vain for a clear
Iii i
a n d exp l icit definition of th em, wher eas the f o u r cor-
por e a l elements ar e def i ned a n d explicated, as p a th o-
ge n ic princ i p les, i n varied texts f rom the agama on -
war ds. The ternary grou p of t r i dosa may perh aps conform
to t he three gU1Ja of t he Sarhk hy a (see Jolly , Medici n 19 ;
Fi11iozat , Revue Phi.loe , Nov.-Dec. 1933 :412, 423 n . 2) . A qua-
ternary classification of il ln esses fou nde d upon the
pat ho logy of the four mahabhiita; however , better corres-
ponds to p hysio logi cal a nd cosmo log ical i d e a s fami liar
to all buddh ists.

The t heory of t r i do?a seems n e v e r to h a v e been well

understood i n China. Ev e n tu a ll y . i t fe ll i nto comp lete
o b livion--doubtless un d e r the influ e n c e , of o ne t hing,
of the i nd igen ou s pat h o l ogy foun de d on a t heo ry of ele-
men ts ( wo od , fire, eart h , me t al , a n d wa t er) . Neve r th e-
l es s , t he wa veri ng be t ween a patho logy of " t h r e e humo r s "
and one of " f our e lement s " does no t appear to b e a Chi -
nese fact alo ne; i t ma y b e fo l lowed in texts n a t i v e to
India , as we s h a ll see b y citatio ns assembled be low .

[The b udd hist t heory of four e lements , a ll four

p a t h o g e ni c , o ffers ana logies wit h t he medical i d e a s of
t he Greeks that are so s t r i kin g t hat on e may wonder if
t hey do not r e f l e c t a h e l l e n i c i nflue n c e . See for ex-
a mpl e t he i de as expoun de d by Plato i n a passage of the
Timaeus -Dr. F .] 42

4 2 . Th e presuppo s i t io n that c ommon c o ncepts n e c e s s aril y f lowed

f rom Greece t o I ndia i s of c o urse o u tdated .

66
 Th e text s wi l l attes t at tempts to r e c on cile the t wo
p a t ho l o g i e s t h at a re somewha t c l umsy, because they car ry
t h e numb e r of " h umors" to fo ur o r b e c aus e t hey claim-in
c o n f o r mi t y to t he ayurve d i c system-t hat o ne o f th e f o u r
e l e me n t s i s n e v e r a p ri n cipl e o f i lln e s s a nd canno t
t h e r e f o r e corres po nd to a " h umor" , etc. Th e p i l g r i m 1-
t s i n g , a t abo u t th e yea r 700, expou n ds a th e or y of fo u r
" h umo rs " or morbid st at es ac c ordin g to a medi cal t ext
a t t r i b u t e d to the Buddha hims el f, and to hi s e x p o s it ion
he appends the commend t h a t acco r d i n g t o t he " v e r nacu l a r "
o r " l a y " no s ology [ o f IndiaJ , th e s e humo r s a re r edu c ibl e
to t hree: wind, b i le , a n d p hlegm (Ttt 2125: 3:224a , Record
130 ) . By "vernacular" or "l ay", I - t sing ev i d e nt ly unde r-
s t a n d s t he ext r a -bu dd h is t med i cin e t hen c u rre nt in Ind i a;
it appe a r s t herefore that in hi s er a buddh i s t s h ad take n
note of a di v er g en c e betwee n t heir own d o c t rin e of pat h -
ology a nd t hat of b r ahmanical phy si cian s , a n d had c la i med
a f o u r -rooted p a thogenes i s as t he ir own . (The Gr e a t e r
Vehic le t he n a ut ho r ize d the s t ud y o f medic i ne .)

Th e s t ud y o f Indi an medi c al t he o r y t h roug h Chin e s e

d o c ument s is r e n d ere d e s p e c i a l l y d iffi cult b y t he impr e-
ci s e t ermin ology o f Ch i ne s e t r an sl ations. In thos e
bear i ng upon th e t hree humor s i n p a rti cul a r , t h e Chin e s e
ve r sio ns b et ray co nsi ste n t cl u msiness. Sometime s the
names are r endere d in Chi nese acco r d i ng to t he n arrow
se nse of the Sans k ri t terms, whi l e o n ot her occ a s io ns
t hey c orre spon d to a broade r se nse, or agai n t he Ch i nese
t r a n slat io ns may b e borrowe d fr om t he vocab u lary of Ch i -
n e s e med i c ine . Witness t he diff er i ng t ran s lat io ns a d du -
ced in t he tex t s cited i n t he c o u rse of t he p r esent
art ic le : ( 1.) wi nd:fU " wi n d " , ki " b re a t h, pneum a "; (2)
p h l e gm: tan "phl e gm" , t ahin "phl e gmati c a f f ec t t on l Pl '! ,
in " we t, cold , e tc. p ri nc i p le ", r ei " c o l d", sui " wa ter "
[this humor c o r res po n ds t o t he li q u i d e lemen t J , hai
"lungs" [ on th is lo c ali zation see the f o l lowi n g sect i onJ ;
(3) bi l e : s en " sa l iva ( or mucus) " , senda "sal i va- s pi t tle",
tan " gal l", netsu " heat" bil e is t he humor of fi re ,
8 " ye l low h e a t " ( e . g . T 665:9:447-48 ) .

[On the corresponde nce of f e v e r a nd ye l low s e e also

V. Henr y , La Magie dans l 'Inde antique 182f ; Atharvav eda 1: 25:1-2
re fe r s t o feve r a s " go d o f ye l low", haritasya deva--Dr . F .J

Th e t rans l a ti on "humor , phl e gm , a n d b il e" a r e t hem-

s el ves a do p te d h ere a s nothi n g more t ha n pur el y c onv en-
t i o n a l e qu i va l e n t s . Th e word " hu mo r ", a s us ed in Euro-
pean med i c in e sin c e Galen, d esi gn ates liquids repres en-
t ing four e leme n t s in the hum an body that are not found
there t hemse l v e s : bl o od (repr es ent ing a ir) , p h l e gm (wa-
t er) , bil e (fire) , and black bil e ( e arth). In principl e,
67
 therefore, t he word o nly f i t s one of the do ea : th e
sle sman, wh o s e dhiitu i s wat er, the only li quid among the
tridosa (from the r o o t ..(slis "ad he re, stick" : th is is the
vis c ous doea ; see a l s o Fiiliozat , Rev. philos .Nov . -Dec .
1933:415n .) Furthermore, i n orde r to b etter e xpress the
nuan c e of doea on e must add to " humo r " a n epithet such
as "peccant". We d e em i t po s s i b le h er e , for l a c k of
a nything better, t o us e the translation "humor"-as is
current in works o f Orient al ism-for the sake o f seman -
tic reson ances th at the word e v o k e s now adays in the
West . The word " h u mo r" has in fact developed in a man -
ner somewhat the oppo s i t e t o th e Skt word do~a , a n d
"humor" h as c o me to i mp ly a morbid or "pec c ant" humor .

" Bi le " is u s e d h ere fo r pitta, the doea o f fire .

The te r m i s vindi c a t e d i f on e take s a cco u nt of the
Greek t heo ry a c c or d in g to wh ich the humo r of bil e is
deri v ed f rom t he elemen t f i r e. But in t he ancient
text s of India b e arin g upon doea , pitta n ev er desi gnat es
the liqui d that f ills the biliary vesi cl e.
Ii

§ Chinese terminolo gy for the four elements i s wel l

establish ed. For their distribution amon g t he vario us
organs, p arts, and func t ions of the body in detail, s ee
for examp le biadhuamdqama T 26 : 7 : 464c -466 c ( = Majjhima
Niki.iya 28 , t he Mahiihatthapadopama ); Ratnakicta T 310:73 :414f ;
Yogaca rabhilmi Tt 1579 :27:430f.

Th e e leme n t s a r e called "internal " (adhyiitmikaJ t o

distin guish them fr om t h e "ex ter n a l " (biihyaJ element s
tha t mak e up the outer world (bhiujana-Loka ) ; there is a
c l o se c orrespondenc e betwe en mi crocosm and macro cosm.

Here briefly , a s a specimen , is the distr ibution

of internal e lemen ts acco rding to the Ratmakicia T 310:16:
73:414bf, the Pitiiputrasamiigama [ for the bracketed Skt t erms
see LVP , Ak 1:22-23J. (1) The eart h e lement : all in the
h uma n bod y t h a t is " solidity " or " hardness" [k haraJ -
hair , nails , teeth , birthmarks , skin, flesh , muscles -
nerves , bon e and marrow, spl e en , kidn e y s , lungs (var.
belly), s mall and lar ge i nt estines, fe c es , b l a d de r,
membran e , brain, e t c . (2) Th e wa ter el ement: all that
is " wa te r" or " mo is t n e s,s"[sneha J , t h a t whi ch has th e
nature or the subs tantiality o f water or moistness-
tears , sw e at , mucus , saliva , pus, blood , ulcerations ,
fat, marrow, milk, f a l l (var . phlegm), and urine .
(3 ) Th e fire element : a ll that is "fire" o r "heat"
[u~~aJ, that wh i c h has the nature or char a cteristic of
fire or h eat . This e l e me n t has t he fun ction of ass ur-
i n g d i gestio n , and i t s dim inution or exh austio n brings

68
on illness or death. Furthermore, fire can dry up water"
a nd water can extinguish fire . (4) The wind element : all
that is "wind" or "quickness" (motility) [il'ar.zaJ, that
which has the substantiality or the name of wind or quick-
ness . There are winds that reside in the four limbs and
in the stomach; there are winds that circulate through
the five parts of the body (?panca-mandp}aka, Mhv 9278). in
the "minor limbs", and throughout th'e gr ea t and small
limbs; and there are expiration and inspiration--in sum,
all that circulates in the body,
[Vedic and brahmanical literature knows five winds
or breaths (Pl'C!;/}/X) ; see Filliozat, article cited above
421f. But the list .t he r e differs from these ,J
An augmentation, or abnormal accumulation of these
winds has the effect of dessicating the water element
and diminishing the fire element, which deprives the
body of moisture and heat and provokes grave disorders.
The other two buddhist elements are defined as fol-
lows: (5) the space element, represented in the human
body by all that is empty, cavity, interstice; and (6)
the element of consciousness (vijnana), which is not di-
vided into internal and external. These two elements
play no role in pathology .

THREE HUMORS AND THREE DEFILEMENTS

For the purposes of monastic discipline, the Saxroaet-ioada-
vinayaT 1435:13 :96a founds its definition of illness upon
the theory of three humors: Monks stricken by an impul-
sion (hateu, pvakopa ) or a superabundance (sei [the usual
term in Chinese medicineJ, saincaya or adhikatva) of wind,
of cold [ =phlegmJ or of heat [ =bileJ, are exempt from
certain alimentary prohibitions, inasmuch as they are
"sick" . All others would be considered "non-sick" ,
The complete formula of the tl'idosa does not seem
to be attested in the Pali Vinaya (see ' Maha.v a gga 6 :1 & 7,
8:1 :30, etc .), but i t is found in the Ni kay a.s . The
Ekottal'agama T 125 :12:604a-b (cited Ttt 2122: 95:986b), in a
passage lacking in the Pali, discusses the tl'idosa or
"three great affections" t eandaikan) : (1) affections of
wind, curable by butter (so, nauani ia) and by foods of
butter; (2) affections of phlegm (tan), curable by honey
and by foods of honey; and (3) affections of cold (l'ei=
bile), curable by oil and by foods of oil. These cor-
poreal affections are compared to the three moral
affections [or three unwholesome roots =three fundamen-
69
t al passi onsJ: (1) gree d, c ur a b le b y the impur e a n d b y
medi t a tion upon t he impur e ; (2) i l l will , c u rab le b y
fr ie n d l i nes s and b y medi t a ti on upon fri endl ine s s ; a nd
(3) wro ng vi ew , c u rab le b y knowl edge a n d b y medi ta t i o n
u p on t he c a u s a l links.

Th at compar is o n h a s b e come c l a ssic. One f inds it ,

fo r examp le, in t h e MahiipannirvC:.1J(l- s ut ra , a wor k i n whic h
compar iso n s drawn from me di c ine abo und (T 374: 25 :511b,
375 :23:575b ) : (1) i ll nesses of wi n d ar e to be tr e at ed by
but t e r (soyuJ ; (2) t hose of heat [ =bil eJ b y s ugar (s eki -
mai eu, " granu l a ted ho ney": on this d e si gn ation f or c r ys -
tallize d c a ne sug a r see Laufer, Si no-Ir anica 376) ; a n d
(3 ) t hose o f water [=phl e gmJ by g i nge r in fu si o ns .
Like wi s e , (1) gree d is to be tre at e d b y con temp latio n
of c orpse s ; (2) i l l wi l l b y con temp lat ion of fr ie n d l i -
n e ss ; a n d (3) e rror by t hat of t he c a us a l link s .

See also a short agama t r an slat ed i n the seco n d

cent ury A.D .,T150 :882a : (1) win d, c u rab le by oil [this
the r ap euti c is th at of th e v inay a: Mahiivagga 6 :14 , T 1 421:
22 :147bJ; (2) h eat [=bil eJ , c u r a b le by butt er; a nd (3)
co l d [=phlegmJ , c u r a b le by h on ey. Se e a lso Mpps Tt 1509:
1 :60a , d etailing th e t h ree so r ts of app ropri a t e di et . 43

Th e no solo g y of t he "t hree humo rs " h a ving b e en in

Bu dd h ism suppl ant ed--a t l e a s t i n the F ar East--by tha t
of t he f our el e men t s , t he Chi nese r e tain of t ha t com-
p ari s on o n ly the epit het t ridOsa a s appli ed to t he th r e e
f u n damenta l d ef il emen t s or passi o n s; the medi c a l import
o f t he e p i t he t event ua lly disappeared. Ev e n in P al i
trad it i o n t he re i s often a co nf usi o n between dos a=Skt
doea " humo r", and dOsa=Skt due ea " h at re d " (= ill wi l l, o ne
of the thr e e p a s sio ns) . An d the Ak Tt 155 8:15 (LVP 4 :1-28 )
d efin e s a d eed b orn of h a t r e d (dvesa J as a corr up t ion
(da ea) [On the equ ivalence of dOlla ' wi t h k l.ee a "p a ssi on "
see E .n. Johns t on at JRAS 1930:862 , 873 , a nd Sau ndarananda
t r . 7 9 n . 3 7 .J In Chi ne se tr adi tion the expressio n tri-
doea i s r endered b y eandoku "t he t hree poi s ons " ( f or

4 3 . Mpps 1: 33 - 34: "The r e a re doctr ine s that ex ist as r emedie s but

do not ex ist as true i n themse lves . Herbs and fo ods that a re ho t,
oil y , v i nega ry , and sal t a r e a r emedy f or illne s s e s o f wind , bu t
are no t a r emedy f or o t her il lne s s e s. Herb s and f o od s that are
co ld, s weet , bitter , and sou r are a r eme d y for illne s s e s of fir e,
but ar e not a remedy fo r o ther illne s se s . Herbs a nd foo d s t hat
are v i nega r y, bitter, and hot are a remedy for c h i l ls , but are not
a r emedy for o t her illne s s e s. So it goes for the Buddha ~ s doc-
trine , to remedy illne s s e s of thought . Cultivation of the r epul-
s ive i s a good remedy f o r t h e illne ss of attachme nt, but not for
the illnes s o f hate . .. "

70
e x a mp l e , in the epithet tii-idoeapaha, meeeandoku, at Mhv 71).
Doku "poison", whence "calamity, misfortune", seems to
have in Chinese medicine the sense of "infection"; but
as far back as the sixth century that medical nuance
escaped the Chinese commentators, who r eferred to the
defilements to explicate the term "three poisons" (see
for example ch.7 above), comparing them to venemous
serpents (Ttt 1851:5:565a, 1925:IA:667c). [On th e other
hand, in the tenth century Kog 2, cited Bdj t 614, glosses
"three poisons" with ken, the vernacular graph for
"fault, defect"-and an accurate translation of Skt
doea , J

§ Another classical comparison was bound to contr ibute

to the interpretation of tridosa as "three poisons": the
comparison of the four corporeal elements with four
venemous serpents placed in the same basket (the body) .
That very prevalent methaphor (for example, T 205:1 :503a)
is found in the SoJnyuktagama T 99:43:313b-c [=Sofnyutta Nikaya
35:~97, vol. 5, p .~76, the Asivisa; see also Ekot tardqama T 125:
23 :670aJ, in which the four elements appear, but only in
the Chinese text as pathogenic principles: "for they
cause death if they enter into conflict."

FOUR HUMORS

At the same time , the SoJnyuktagama ibid. 35 :252c [=Sofnyutta

Nikaya 4:230-31, see ch.8 aboveJ mentions the treidoea thus :
(~) wind, (2) phlegm, and (3) saliva [=bileJ (eenda, the
Pali has pitta), plus (4) the "combined" (Pali eanni.pat-ika )
do 9a--that is to say, the combination of the first three
as a cause of illness . Another Chinese version of the
last text, T 100 :11:452b, explains these four sorts of
affection (of wind , etc .) as abnormal augmentation or
diminution of the four elements.

That theory of four humors-wind , phlegm, bile,

and the combination of the three-is attested in some
passages of the Anguttara Nikaya (2 :87, 5 :110) that are
lacking in the Chinese . They are to be found in the
Mahiisalnghika-vinaya T 1425:10 :316a DOl illnesses of wind,
curable by oil or fat; 10~ of heat, curable by butter;
101 of water, curable by honey; and 101 combined, cur-
able by the above three medicamentsJ ; in the Smrty-
upaethana-eictxa T 72~:8:41b DOl illnesses of wind, ·1 0 1 of
"yellow" (cp.Mhv 4022, which translates pitta "bile" as
obyo "the yellow sickness") 101 of cold [=phlegmJ, and
~01 combinedJ; in the Prajfiaparamita texts , for example
T 220:331:695c, 351:277c [illnesses of wind , of heat (bile),
if phlegm , and combinedJ, Mpps 1509:59 :478b [404 illnesses

71
du e to t he se f our humors] ; a nd fin al l y in t he Suva~ ­
pr abhaea T 664 :7 :395a [ t r . A. D. 597 , b ut fo r th i s p a s s a g e
re produc i ng th e tr. of A. D. 4 14- 42 1, T 663 :3 :351-352] .

Thi s las t sutra, whic h dates f rom Kusana times (S .

Le vi at JA 1934:1 : lf ), permits a c o mpar t son o]' Ch i n es e
i

equ i va lent s wit h t he ori g inal Sanskrit t e rms ( ed .Nanj6-

I zumi 163 - 65) . 44 Its noso lo gical th e ory is as fo l lows:

I llne s s i s d ue to "augm e ntat i o n o r d im inut io n "

( pari varta , l i t . "s ubversion") of the f ou r elements t hat
form t he body ' s or gans, from wh ich r e sul t s : (1) i l l nes -
s e s of wind (f u, veda), (2) those o f h e a t ( net eu, pi tta
"b i le"), ( 3) t hos e of t he lungs, du e t o an e x c ess of
water (s ui, s ZeEfman or kapha "ph legm" ), a n d (4 ) t hose
re s ulti ng f r o m a comb i natio n of t he p r e c e ed i n g ( t8bun,
eannipata '; .

[The t r a n s latio n of s Ze?man b y " l u ngs ", i n thi s

fift h -cent u ry versio n, i s remi n i sce n t o f t he Gr e ek
l o c alization of phl e gm in t he lungs. Fo r Susruta
( Sutras thana 21:6-7) , the seats of e l eeman a r e t he stomach ,
th e c he s t , th e h ead , th e t hr oat, ~nd the joi nts--Dr . F .]

Th e f i r s t pr edomin a t e in s ummer, the secon d in

a ut umn , t h e th i r d in spr i ng, a n d the fo urt h i n wi nte r .
[ Same s easonal dis tr i bu ti o n at Susrut a, Sut r as t hiina 6:39 ;
see a l so " Pat h ogenes is" above . ]

Thi s exp osi tio n i s f o l lowed b y di e t e t i c a n d phar -

ma c eu t i c al pres cr ip t i on s .

§ A work e nt it led (i n tra ns literat i o n) Yogiiciirabhiimi

s hou l d be d ated at about t he same era . I t s a ut hor i s
gi ve n a s S amg ha ra k~a , on e of the t e a che r s of Kan i 9ka,
and i t ta ke s u p medic ine a t man y poin t s. 4 5 One v e rsio n
o f t h is text, T 607 :235a, i s attributed to An Shi h-kao
(ca A.D . 14 7-70 ); i t e n umerates 4 04 illn e s s e s : 101 o f
wi nd , 101 o f co l d, 1 01 of h e a t , a n d 101 combi nations .
Ano t her ve r s i o n , T 606 :1: 188c , 209b , g ives t he same e nu mera-
tio n , but at t ri b u te s t he cause o f e ac h group of 101 ill -
n esse s to au gmen t a t i on o r d im inution of each of t he fo u r
e leme nts : wat er , 101 il l nesses o f co ld [=ph l e gm] ; fire,
101 illn ess es o f h e a t [=b il e] ; wind , 101 i l lnesses o f
wind; a n d earth , 1 0 1 illn es s es of all sorts . Thi s s e c-
o n d v ersion , whose st yl e and t erminol o g y h a v e a mo st
arc haic charact er, is o we d t o Dharma r ak ~ a ( A.D. 284),

44 . Al so ed . Nobel 177-80;:. see al so p. 45 & n . abov e .

4 5 . Text discuss ed, s ummar ized b y Demi evi l le , re f.p .48 n.35 above.
72
a translator of Indo-Scythian (Yueh-chih) origin; it
men t i o n s the names of physicians and of many te xts or
f o r mu l a s related to various branches of medi cine:
opht hal mo l o g y , he aring, wounds, podiatry , d emonic affec-
t i o n s , etc .

HUMORS AND ELEMENTS

In all these texts there are obvious efforts to recon-

c i l e the formula of three humors with that of four ele-
men t s . The Vibhasa Tt 1545 :190: 953a and the Koea Tt 1558: 10 :
5Gb (=LVP, Ak 3:136) both deal with the co rrespondences
b e t we e n the t.x-idoea ("three internal calami ties") and
the four elements--but they come to different solutions.

The "calamities" (peccant humors) of (1) wind , (2)

heat [bile ], and (3) phlegm are produced, respectively,
when the elements (1) wind (2) fire , and (3) water in-
c rease to excess. Then a rupture (cheda) of vi tal joints
(marma) occurs , bringing on death. For example, when
water increases to the point of overflowing the whol e
body, it results in the muscles-nerves rotting, and in
the joints being broken up , which leads to death . In
the case of fire, the joints are corroded; in the case
of wind, they are ground into bits by its violent breath.
The muscles-nerves depend upon the element earth, but
earth itself--according to t h e Kosa --h a s no power to
cause a dOFfa or death. To explain this exception, the
Kosadeclares that there are only three and not four
internal "calamities" (doea) just as there are only
three external "calamities" [i.e ., the cosmic inunda-
tion, conflagration , and hurricane that destroy the
world at the close of an eon] (kaZpa:, on the parallelism
between external and int ernal elements, see "Pathogene-
sis" above).

The Vibhasa , however , cites the opinion of c ert ain

authors who make the e a r t h element a source of death:
they dec lare that if this element increases, the inter-
stices and cavities of the body are choked, which brings
on--as above--the br eaking up of the joints .

The (native Chinese) commentary to the Kotsa Ttt 1821:

10:184c adds that the trido sa correspond to a division of
the body into three regions: (1) the region of phlegm
above the heart, (2) that of heat [=bile] between the
heart and the novel , and ( 3) that of wind below the_
navel. This distribution is attested in India by Vag-
bha t a (Jolly , Mediein 40 ) and also in a Tamil work cited
by P. Pariadassou, Medieine traditioneZle de Lt Inde ,
Pondicherry 1934:2 :26-27. Chinese JIjedi,cineacknowledges
73
 an analagous divison of the human body into three super-
imposed regions.

So we see that Sarvastivada scholasticism, in order

to explain the relationship between the three humors and
the four elements, does not bring the number of humors
to four by adding to the three their own "combination",
but escapes by denying any morbific power to the solid
element: disturbances of the muscles-nerves (which de-
pend upon that element) have their source in the other
three elements. And if there are only three human doea,
it is because there are but three cosmic calamities .
This reasoning conforms perfectly to ayurvedic doctrine,
which recognizes only three dO?a and whose physiology
is tied strictly to cosmological ideas (see Filliozat ,
Rev. philos. Nov.-Dec. 1933:413f) .
Once again the authors of the Vibhasa and the Koba
show themselves to be exact and informed scholars, well
abreast of the science of their times. But their theory
HII
I
seems to have had scarcely any success among their co-
religionists. We have seen, in fact, that the "solid
element" is considered by the majority of buddhist
authors to be quite capable of causing illness, on the
same grounds as the other three elements. The Mpps it-
self, as has been shown above (Tt 1509: 59: 478b) , reduces
the 404 illnesses to disturbances of the four humors :
wind, bile, phlegm, and the combi nation of the three .
But a completely different explanation is given them
in the preceding chapter, Tt 1509:58:469c : The 404 ill-
nesses are due to encroachment of the four elements
upon one another; the elements of water and wind pro-
duce 202 illnesses (dosaJ of aold [phlegmJ, those of
earth and fire produce 202 illnesses of heat [bileJ.

A brief sutra on hot baths, whose translation is

attributed to An Shih-kao (A .D. 147-70) but ought in
reality to be attributed to Dharmaraksa (A.D. 265-313,
see notice in Kyik) , T 701 :802a, ·specifies that hot baths
"appease the four elements" and heal illnesses of wind
[the wind elementJ, rheumatismal affections due to~­
ness [the water e l.emerrt I, "icy water" [the earth ele-
ment?J, and "hot breath" [the fire elementJ.

Another very ancient text, whose translation is

attributed to Chih-yao and dated to the close of the
second century [K: A.D. 185- t r . J , T 608:236c-237a, enu-
merates four corporeal illnesses due, respectively, to
excess of earth, water, fire, and wind (with four men-
t~l illnesses due to excess of wrong view, ill will,

74
sensuality, and doubt; four respiratory affections, and
so forth), and adds therapeutic precriptions.

The VimaZakirti-nirdesa and its commentary (T 475:544,

Ttt 1775:2:342a) also explain the 404 illn esses as dise-
quilibrium of the four elements.

§ The Sutra of Medicine, Delivered by the Buddha T 793, a brief

work whose first part is purely medical , was translated
i n the second quarter of the third century by an Indian,
Chu Lu-yen, in collaboration with a Chinese of Indo-
Scythian origin, Chih-yueh . 4 6 According to Ttt 2154:2:
487c , which refers to a (lost) catalogue of the sixth
century , this text is only an abridged extract from a
great sutra. In fact, it does lack the ordinary sutra
framework, and the work opens with an un-prefaced defi-
nition of the 404 illnesses :

These are reduced to illnesses of the four elements,

which by their augmentation produce, respectively, (1)
wind [a disturbance or dosa said to beJ "of breath"; (2)
fire, of heat; (3) water, of cold; and (4) earth, of
force. There follows a curious localization of elements
in the body : Earth depends upon the body, water upon the
mouth, fire upon the eye, and wind upon the ear; if
there is an insufficiency of fire and an excess of cold
i.e. ,[waterJ, eyesight will be dimmed .

Then seasonal predominance of each of the elements

(in the human body) is denoted thus : In springtime,
there is predominance of cold [=waterJ; in summer, of
wind ; in autumn, of heat [=fireJ; and in winter, of
wind and cold . Prescription of postures (lying down,
etc.) correspond to this, as well as alimentary regimens
to be observed in the various months of the year.

The text then e nu me r a t e s ten causes of illness:

(1) remaining a long time seated without eating; (2)
eating without rendering [i . e ., to take another meal
without having digested the prededing--constipationJ;
(3) sadness; (4) stress; (5) debauchery ; (6) anger;
and (7-10) repression [wilful retentionJof excrements
and winds. Then it enumerates nine causes of premature
death [four arising from alimentation; see ch .16 belowJ,
six grounds for abstention from meat, and five trans-
gressions that result from overeating . The ending deals

46. T 793 has been studied by Satiranjan Sen, with a translation

illumined by notes drawn from Susruta, in Visva-bharati Annals
1 (1945)

75
 with moral questions .

In this sutra, therefore, we have four distinct

humors, each corresponding to one of the e lements .
But the Chinese translation leaves the Sanskrit names
of the humors poorly identified. Now these names are
given us by I-ts ing, who in Ttt 2125 :224a [Record 131J
ci tes a SU1;m of Medicine , Delivered by the Buddha- a sfit r a
apparently identical to our T 793 . I-tsing, who doubt-
less had access to a Sanskr it recension of that text,
cites the elements and the humors in exactly the reverse
order of T 793:

"( 1) Increase of earth produces a heaviness of body ;

called guru " h e a v y " IT 793: "a disturbance of force" J;
(2) that of water produces an abnormal accumulation of
tears and saliva called *kapha or el.eeman "phlegm" (pro-
posed in Record 131n .; these terms do not in themselves
correspond to the Chinese *sho or ancient Chinese *siep,
but the sense of the Chinese-"water" and " c o l d " - t o be
lilll found further on for kapha leaves no doubt that phlegm
is here at issue) [T 793 : "a disturbance of wind" J; (3)
increase of fire produces a violent fever in the head
and chest called pitta "bile" IT 793: "a disturbance of
heat" J; and (4) that of wind produces a violent preci-
pitance of breath, called vata "wind" [T 793: "a dis-
turbance of wind" 1

These glosses, it will be noted , shed light on the

way in which T 793 (above) localizes the elements: earth
in the body, water in the mouth, and so forth. I-tsing
strives then to identify these illnesses using the ter-
minology of Chinese medicine. Then he mentions, as we
have seen above ("Pathogenesis"), the classical tx-idoea
of the "vulgate" medicine [of IndiaJ-which takes no'
account, he says, of affections due to the earth ele-
ment [see in fact Vibhasa, Koea, etc. cited in "Four
Humors" aboveJ. Afterwards he launches into somewhat
obscure dietetic and therapeutic considerations. Our
pilgrim plumes . himself on medical attainments: he has
studied medicine recently, he says in the same place
(223; Record 128), but has renounced it because it is not
a "correct" profession [for a morik L We will never
adequately ascertain whether the therapeutic methods
that he recommends are drawn from India or from China .

76
16. Classification of 11lneS~s
Nosological classifications gen erally , in buddhist tra-
dition , r e s t upon the theory of four e leme n t s --a n d not,
as in brahmanical literature (Jolly, Medi cin 46) upon that
of three humors. The total of 404 illn e ss es (101 per
element) attested in Sanskrit sources (fo r e x a mp le,
Bodhicaryavatara 2 :55) is the norm in Chin es e do cuments . 47
[The figure 101 is met with in vinay a : for e xample, the
101 sorts of disc iplinary act (eccles iastical formality)
are counted at T 1438, T 1441:7:610c-611b, and T 1453. The
ayurveda counts 101 sorts of surgical inst rument.] But
other classifications are also found, of which some have
been indicated above (e .g. ch .5, 10).

The Sastra of the Four Truths (Catu~satya-sastra Tt 1647:1 :

382c-383a), a treatise of Vasuvarman founded upon works
by Katyayana and Buddhamitra of the Sarvastivada school,
deals (1) with illness, (2) with its definition , (3)
with its " affair"--i.e ., with its effect (?vastu) , (4)
with its condition, and (5) with its sufferings . A
summary of that passage:

(1) Illness is either (1 .1) corporeal , or (1.2)

mental, each of the two categories being (11 .1) of
internal origin, or (11 .2) of external origin . (11.1)
There is corporeal illness of internal origin (lit.,
"produced in having the internal as condition") when
corporeal elements develop in an unbalanced or mutually
adverse manner; there is absence of illness (arogya)
when they are found in a state of balance (eamatid ) : In
illness, the elements occur in mutual opposition by
their self-nature (eoabhava) ; they are like venemous ser-
pents . (11.2) Illnesses of external origin are caused
by external constraints or shocks . All thes e corporeal
illnesses are differentiated into various g enre , of
which the sum total is 404 . They may be differentiated
nominally (i.e., "leprosy", "furunculosis ", etc .) or
differentiated etiologically (illn esses having for
cause [hetu] phlegm, wind, or bile ["gall"], or a combi-
nation of the three--the four humors acting either in
isolation, or in two's, in three's, o r in four's), or
differentiated by locale (head, eyes, ears , throat, etc .)

(12.1-2) Mental illnesses have for cause illusions

or wrong views conditioned by internal or external ob-
jects . They are differentiated nominally as greed , ill

47. So Vk tr. Lamotte 1976:36, other refs . ibid . n .26 .

77
 will, pride, etc.; etiologically, they differ in that
they are caused by [illusions bearing upon objects that
haveJ pure, impure, etc ~ characteristics; by locale,
they differ [according to whether those objects come
under one or another amongJ the six sense-doors ((iyatana)-
form, sound, etc.

(2) Definition of illness : it is the tormentor of

the body .
(3) Its "affair" : [corporealJ pain and [mentalJ
sadness .
(4) The condition for illness : imbalance of the
elements.
(5) Illness admits of varieties of suffering: feel-
ings (iiedana) of [physicalJ pain, inability to function,
etc . ..

§ The Mpps (attributed to Nagarjuna), Ttt 1509:8:1l9c, gives

a similar classificat ion: 48 "There are two sorts of
malady. (1) One contracts all sorts of malady in ret-
IIII ribut ion for deeds committed in previous existences
(karmaja, seech. 8 above). (2) One likewise contracts
all sorts of malady in the present existence in conse-
quence of a surge of cold, heat, or wind [the three
humorsJ. Maladies of the present existence are of two
sorts : (a) internal maladies-derangement of the five
viscera, coagulation, maladies due to the stars, and
the like; and (b) external maladies-being crushed by
a chariot, falling from a horse, being wounded by wea-
pons, and other accidents of that sort."

See also ibid. 10 :131b-c 49 on external maladies

(cold and heat, hunger and thirst, wounds and falls,
etc.) versus the internal (the 404, due to defective
eating and/or hygience posture ).

Classification into corporeal and mental illnesses

is regular in Pr a.j fiapa r arm t a texts T 220:331 :695c, 451:277c-
288a, Mpps Tt 1509: 10: 13lc. There are four corporeal ill-
nesses: wind, heat [=bileJ, phlegm, combined, etc. ;
four mental : greed, ill will, . wrong view, pride , (and
other defilements, fetters , involvements, etc .)

The Mpps Tt 1509:59:478b provides a classification of

mental maladies, of which there are 84 thousand : 21
thousand of greed, 21 thousand of ill will, 21 thousand
of wrong view, and 21 thousand combined. But t h i s

48 . Citation expanded from Lamotte, tr . , Mpps 1:494 .

49. Mpps 1 :584-85.
78
classification h as nothing to do with med icine ; it is
merely a metaphorical int erpret at ion b as ed upon t h e com-
par ison of the p assions with t he fo ur - times - l 0 l so rts o f
malady--fo rming the sum total of 84 t ho us a n d that is
usual for the d ef i l ements Lcp . Dzsi 3 :292 J.

The Ga1Jrjavyuha T 29 3: 11 : 71 1a has a class ifi cation to be

met wi th in Susruta as well (Jolly 4 7) : (1) corp oreal
[ sal'il'a J maladies : wind, yellow , bil e, h e a t , e tc .; (2)
mental [manasaJ maladi es : madness, ment al d iso rder s , e tc . ;
(3) adventitious [extern al, agantuka J : wounds , s t r e ss,
et c . ; and (4) natural or congenital [ sv ab havika; th e Ch i -
nese has kuu, which must correspond to eaha.ia, a te r m e m-
ployed by medical treatises posterior t o Susrut aJ :
hunger and thirst, heat and cold, pain and pl easur e ,
sadness and joy, etc . All these maladies , numbe r ing
404 , are due to imbalance of the f our elements--l0 l p e r
element .

In a subsequent passage, the Ga1JrJavyuha adds to the

four natures of the body that correspond to the fou r
elements--(l) the solid (for examp le, the 360 bon es;
this number provided by Susruta, Jolly 43), (2) the
moist , (3) the hot, a n d (4) themobile--a fifth n atu re,
space, a nature of th e body (the ana tom ical inte rstices
or vascular syst em) that c or res p o n d s to the fifth el e-
ment, space .

That work (ibid . 711b) divides the ye a r into si x

seasons . Illness es of phlegm are produced during the
springtime and the snow s easons, those of wind dur ing
the heat and the r a i n s , and thos e of " ye l l o w- h e a t "
[=bile J du ring th e autumn and the co Ird Psee a h. 15 aboveJ.

Finally (ibid . 711c) , mental illnesses--or, th e

passions--are subdi vided into : (1) gre ed , curable by
meditation on t he r epulsive ; (2) ill will, cur able by
meditation on l ove; (3) false vi ew , c u r a b l e by teach ing
on the divers e c h a r ac te r i s t ic s of ph enomen a; and ( 4)
combined , curabl e by med it a tion on th e r epulsive and on
love .

The Di l'ghagama T 1:6 :41c e nu merates the last nine

maladies that will r emain under th e Do ctrine of t he
future buddha Mai treya, when human b eings wi ll l ive f or
eighty thousand y ears : (1) cold, (2) h eat , ( 3) hunge r ,
(4) thirst, (5) bowel movement , (6) urine , (7) sens e-
desire, (8) gluttony, a n d (9) old age . See t he similar
list Tt 1644 :9 :217a, lacking thi rst a n d glut tony ; cor r es -
pond ing lists of the Nadhuamaqama T 26 :15 :70b and D'i gha

.79
 Nikiiya are also shorter .

An enumeration of nine causes of violent or pre-

mature death--i .e. , death that arrives unexpectedly,
before the exhaustion of normal longevity , ayus-- is
found in a short text whose translation is attributed
to An Shih-kao , T 150A:SSo-SS1, 150B: (1) untimely alimen-
tation (for example , eating when full); (2) immoderate
alimentation; (3) unaccustomed alimentation (for exam-
ple , eating foods to which one is unac cumstomed in a
strange country, out of season); (4) indigestion (throw-
ing up f90d one has not digested, instead of eliminating
it with an emetic); (5) impeding "the warmth" (not defe-
cating or urinating and being the worse for it; restrain-
ing eructations, expectorations, sneezes, and the lower
winds); (6) violation of the precepts (murder, theft,
adultery, lying , or taking alcohol, which lead to death
by capital execution , imprisonment and starvation, an
enemy's revenge, or hypochondria due to hatred and re-
morse); (7) bad company; (S) entering a locality at an
"l inopportune time (at a time of battle, of official
harshness, etc.); and (9) not avoid ing the inevitable
(for example, a raging elephant, horse or bull, etc .)

Analagous lists, with variants, are found in the

MahiisOinghika-vinaya T 1425 :2S:457a; MahapaY'iniY'va~-sutra T 374:
26 :51Sc; Bhai?ajyaguru-sutra T 449-451; and the Sutra of the
Buddha on MedicineT 793 (ch .15, "Humors and Elements" above) .

§ The Chinese exegete Chih-i,at the end of the sixth

century, gave in Ttt 1911:SA:l06a-l07c a highly elaborate
classification of illnesses in which certain elements
were borrowed from Chinese medicine . The c lassifica-
tion can be summarized thus:

At the outset, the author distinguishes "real ill-

nesses" from "opportunistic illnesses" . TLe latter are
no more than means (upayaJ affected for the edification
of ordinary persons or laics [see also ch.9 above].
Real illnesses belong to the body of rebirth; they are
retributions for deeds and obstruct cultivation of the
noble path . They are classified (semeiologically) ac-
cording to syndromes (so, marks or signs) disclosed to
the physician by his examination of sounds and forms
(i .e ., a u d i b l e and visible symptoms) and by pulses .
For example, the examination of pulses [this is strictly
Chinese] permits the physician to di agnose an illness
of one or another among the five viscera; if the pulse
is "abundant and straight", there is an illness of the
liver, and so forth . Somatological examination permits

so
him to at t r i b u t e an i lln e ss to o n e or a no t he r among t he
fo u r e lemen t s , or to o n e o r a no t he r a mong t he vi scera;
f o r examp le, if t he body i s sore, he avy, h a rd , knott ed ,
dry , r heumat i s ma l, a n d gau nt, i t i s the symptom of a n
affec t ion o f the solid e lement ( earth ) , a nd so fort h .
I f t he f a ce is wan but the l i mb s l a ck p e r s p ir a ti on ,
t here is a disturb anc e of th e liver, etc .

Etio lo gical c lass ifica t ion of mal a d i e s is sixfo ld :

(1) illne ss e s due to d iscord a mon g the f our e l e me n t s:
( 1. 1 ) Whe n e x t e rnal h e a t r ein f o r c es c orpor e al fi r e a n d
t he y overpower water , ther e i s the illn e s s o f f ire.
(1 .2) Whe n ext e r na l c o l d augmen t s the e lement water a n d
t hey injur e the e lemen t f ire , t here is th e il l ness of
wat e r . (1 . 3) Wh en exter nal wi n d augments pn eum a ( k i ),
wh i ch blows over th e fire, ag i ta t i n g the wa t e r , t here
i s t he illness of wind. An d (1. 4) th er e i s a c o mb i n e d
illn ess when the e lemen t eart h is injured by a n a ugmen-
t ation of the other th r e e e lemen t s , or whe n a [so li d =
e ar t h ] part of the body a ugmen t s and inju r e s t he o t her
t h ree e leme nt s. Th e fo ur e lemen t s are c ompare d t o s er-
pent s of differe nt sp e ci e s [plac ed in th e s ame b asket],
to e nemy owls perched on th e s ame branch, t o p y thon s
bur rowing with rats i n t he s ame whole, to four ne i gh-
b oring nat ions in a stat e of war , and so f or th .

(2) Illness e s due to a limen t a ry d isturb an c e s : for

examp le, f i re is au gmen t ed b y g i nge r, c in n a mon, a n d
acr i d matt er ; wat e r is in c r e a s ed b y sugar , hone y , and
s wJ e t a n d c o l d mat t e r ; wi n d i s in crdas ed b y p e a rs ;
ea~t h i s i nc rea sed b y fat; e t c .

( 3) Illn es s es due to d i s o rde rs in med itationa l

exerc ise (eaz en- fueeteu) : certa i n irr e gul a r h abi t s or
p r a ct i c e s in t he cou rse of medit at ion a l exercise may be
injurious --re s pir a t o r y di s orde r s , e tc .

( 4) De moni a c il lne s s e s (ki byo) du e to t he i n trus io n

o f d emons in t o t he fo ur e leme n ts or in t o t h e five vi s -
ce ra: the ex i s te nce of th ese d e mon s is p rove n b y t he
su c c es s ful cures b y exorc ists in cases wher e norma l
medi cine is ineff e c ti v e .

(5) Maladies o f Mara (mab uo') t hat a ttack t he mi nd,

wher e a s t h e " d emo ni ac" mal ad i e s in jure o n ly t he bo dy.
Mor e s p e ci fica lly , p erver s e t ho u g h t s and no ti on s come
to di sturb a practitioner's mind in the cours e of i n -
sight meditatio n (vi pa§yana ) , c ausing him to lo s e th e
goo d qualities that h e has a cqu ire d .

81
 (6) Maladies due to deeds committed in previous
existences or in t h e present life--maladies of the five
facu lties {indriyaJ correspond to the five basic unwhole-
some deeds {akusaZaniJ; (6.1) maladies of the eye and li-
ver to murder, (6.2) maladies of the mouth and heart to
alcoholism, (6.3) maladies of the ears and genitals to
sensuality, (6.4) maladies of the tongue and spleen to
lying, and (6.5) maladies of the nose and lungs to theft.

lZ "Ihempeutics
In that treatise (Ttt 1911A:l07c-l09), the Chinese author Chih -
i stipulates that one must choose a mong the various me-
thods of therapeutics according to the genre of the ill-
ness being treated. (1-2) Illnesses whose origins are
elemental and alimentary are treated by prescriptions
and by medicines. (3) Illnesses due to meditational
disorders are treated by renewed practice in medita-
tio n--by mindfulness of breathing and by insight me d i -
tation. (4 -5) Demoniac illnesses, and those of Mara,
are treated by insight exercises and by incantations
{dharar:iJ. (6) Illnesses due to past deeds are treated
internally by insight and externally by confession
(confession, repentance, expiatory practices, and the
like) .

Implicit in that classification is a judicious

analysis of three modes of therape utic that is easy
to discern i n buddhist documents generally: ( 1) the
religious type of therapeutic, which ma y be (1 .1 ) ex-
ter nal, i nvolving practices of confessio n , or ( 1 . 2)
i nter nal, involving menta l tec hni ques, conce ntration,
insight, and the like, or (1.3 ) b o th external a nd in-
ternal, involving the breathing exercises associated
with psychic exercises; (2) the ma g i c a l type of t hera-
peutic involving incantatio ns, exorcisms, etc.; a nd
( 3 ) properly me dical therapeutics--drugs, dietetics,
surgery and so fort h .

The three-fold classification is proposed by t he

Buddha himself in a passage of t he Uddnaoarqa T 211:2 :579a-
b : A h ou s e ho l d e r of Sravas ti name d Sudatta, who has hi m-
self converted and " e n t e r e d the s tream", invites t he
Buddha to look in on o ne of his frie nds, K6shi (Suctana?) ,
who believes neither in Buddhism n o r i n Medicine. This
friend, sick to the point of d e a t h , refuses any me d i c a l
treatment, declaring t hat he has always devoted his acts
of worship to the sun and the moon and practiced loyalty
to his sovereign and filial devotion to his father and
his ancestors. These observances, he says, should suf -
fice: when in nee d he fasts with reverence a n d calls

82
 upon hi s protectors for assistance ; h e wil l ha ve nothing
to do wit h medicaments, need l es, cauter i es , and ' the like .

The Buddha reminds him that t here ar e thr ee caus es

of premature death (see above) : (1) not treating an ill -
ness , (2) t r e a ti n g it imprudently, and (3) o b s t i n a c y and
intractab i lity on the part of the pati ent. Th ere are
also t h r ee the rapeutics : (1) medicaments, f or illnesses
due to "cold " o r "heat " among the fo ur e lements; (2)
[recitatio n , as inc a n t a t i o n s , of] b u ddhist texts, for
d e mo n i a c i l l n e s s e s ; and (3) wors hip of s aint s and d ei -
t ies, works of c harity, and destruction of t he a g gre -
g a t e s (e kandhae ) by wisdom.

REL IGIOUS THERAPEUTI CS

The boundaries t hat separate t h e s e severa l therapeuti cs

are far from ne at; on e crosses from o ne to the other by
i mperceptible t ransitions that may h~ve esc ap ed the ob-
servation a n d the awareness of the a ncie nt b uddhists.
I n t he agama, f o r exampl e, we see the monk Kgema (Pa li
Khema) be h e al ed of a grave i ll ness by t he conviction--
ob ta ined af ter a n extended d i a l o gue wi th t h e e lders of
t he commu n i ty--t hat n o "self" (iitman) exists amo ng t he
five aggregates ( Safrryuk t iigcuna T 99:5 :29c=Sainyutta Nikiiya 5 :89f).
Anurudd ha like wi s e s u cceeds in beari ng his i l l ness with
patience, a nd in h e al i n g h ims elf of i t i n the end , by
~ f i x i n g h i s min d upon the f o u r pi llars of min d fu ln e s s
( srrcrt yupas t hiina ) , i bid . 20:140b-c=Sainy ut ta Nikiiya 5:302 . The
laic Dharmad i n na (Pali Dhammadi n na) hea ls h i ms e l f b y
the same means, as h e exp l a i ns afterward to Anu r u dd ha ,
ibid . 27:270c-271a=Safrryut t a Nikaya 5 :406f.

In ot her cases, t eaching doctr i ne " i n ex t remis"

procures for the pati e n t (wi thou t preve ntin g his d eath)
a sort of physica l tra nsfi guration at the momen t of dy-
i ng. Th e pat ient disp lays an animated cont entment ; his
face c l e a r s ; h i s skin be comes fr es h and b ri gh t. He has
broken the five lower bonds by h e a r ing t h e doctrine
preached by t he Budd ha; h i s mi nd is delivered from all
outf lows; h e obtai ns parinirvana i n the fearl essn ess of
doctrine ( Phagguna at Sainyuktagcund ibi d . 37 :266c-267b=Anguttara
Nikiiya 6 :56; Assaji at ibid. 267b-c=Safrryutta Ni kiiya 3:124f ; Gitiina
at i bid . 267c- 268a=Safrryutta Nikiiya 4 :46f; see a lso ibid .268a-b) .

"A correc t thou g h t , a correc t unde r st an d in g , in-

sight into the body , co n tro l of wo rldly greed ... e nable
o ne to va nqu i s h s u fferi ng " --so the Buddh a i nst r ucts
monks who are ill (Sainyuk t ii gcuna ibi d. 268b -269 a=Sainyutta
Nikiiya 4 :210f, t he GeZanna).
83
 The texts affirm the curative value of religious
conviction, of contemplating buddhist doctrines and of
teaching them. (Within Christianity, compare the text
of James 5 : 14-invoked by adepts of "Christian Science"-
on the double "corporeal and spiritual" healing owed to
"prayers of faith" recited over patients by "elders of
the church".)

But according to the Ekottaragama T 125:33:731a-b,

teaching does not suffice: the patient should recite
sacred formulae himself. Here we have the monk Cunda,
stricken by a grave affection, finding himself alone.
The Buddha, informed by his divine ear, pays him a visit
with an assembly of monks. He asks him first of all if
he feels himself well enough to receive his teachings.
Cunda answers that his illness has been getting only
worse, although he has no lack of any medicine; but
then , his nurses are not monks, they are simple brahma-
nists [hence laics and incapable of preaching to him or
reciting doctrine with proper authority] . The Buddha
invites him then to recite the names of the seven aids
to awakening to him. Cunda begins by invoking them
three times for himself; he thus recovers his strength
somewhat and recites them directed to the Buddha, im-
mediately obtaining complete healing. He then extols
the doctrine of the seven aids to awakening as the best
of medicines . That eulogy is immediately sanctioned
and corroborated by the Buddha before the assembled
monks .
Here is evident a transition to magical therapeu-
tics: a sacred text, a doctrinal formula becomes a
curative spell. [The corresonding Pali sutta, Samyutta
Nikaya 5:81, presents significant divergences: everything
concerning the invocation of the formula is suppressed ;
it is the Buddha who is ill , and Cunda heals him with a
banal predication of the aids to awakening.]

The Ratnakllta T 310: 43: 250b (Bodlrieat.tniap-i.iaka-eidira)

promises four sorts of freedom from malady w;ogyaJ to
the bodhisattva who practices the perfection of morality:
(1) he will be exempt from chronic illnesses ; (2) he
will not be thin or sickly, his limbs will be fresh and
robust; (3) he will never lack the requisites of life;
and (4) he will escape the violence of kings, brigands,
evil-doers, and the like.

In Prajfiaparamita literature, exercise of the per-

fection of wisdom immunizes against all mental sadness,
all c o r p o r e a l pain, the 404 maladies of eyes, ears,
nose, tongue, trunk, limbs, and joints that are due to

84
c o n f l ict s of the four e lemen t s T 220 :454:295a , 519 :695a,
etc. Or r ather , the s tud y of th a t wi s d om secu res the
b odh isattva a gainst a l on g ser ies o f infi rm i ti e s: blind-
ness , de a fn ess , mut eness , etc. T 220 :552 : 846c , etc. [On
these two c o mmo np lace s of t he PW texts seeDzsi 1:706 .]

Techni ques o f medi t a ti on , wh ich remain of a re l i -

g i o u s o rde r b ecaus e of their mys t ica l goals , par take at
t he s a me t i me of medi cine: t hey hav e a doub le p hysic a l
a n d spi ritu al as p e c t, "as s moke i s woo d a nd fire toget h -
e r ." Med it a t i o n a l insi ght , Ch i h - i te l l s u s (see above ),
serves to count eract i l l nes ses of t he b ody t hat are due
to d emo ni ac pos s e ssion and ment a l affe cti ons provoked
by Mi r a. Pr a c t iced d e f e c ti v el y, however , medi t a ti on may
i t s el f occasion morbid d i s tu rban c e , and for th e s e di s-
tu rb an c es meditation a g ain i s t he only r eme d y.

In a p assage in wh ich te r ms and ideas that a re b o th

buddhist and taoist (or tao ist i n origin, but sin c e b e-
c ome t he common ground of Ch ine se medicin e) a re c u r i o us -
ly mingl ed, Chih-i (l oc . c it. 108a-109b) enumerat e s s i x
vari e ti es of meditation al t he r a p e u t i c:

(~) Practices of qu i etude: fixing the mind on on e

or another point of th e body--e sp e cially, upon th e navel ,
from which a l l respi r at i on i s s u e s [ via the mou th] a n d
t o whi ch it r e t u r n s in e n te r i ng [ via t he no s e], and
whic h t he a u t h o r iden ti fi e s wit h th e " f ie l d o f ci n nabar"
(t andenJ of Ch i ne se ph ysiol o g y , t he 2!-inch regio n b e-
n e a th th e navel that i s de fin ed as the "sea of br eath"
(ki kai J.
(2) Th e t h e r a peut ic o f " b re at h" (kiJ : t here a r e s i x
ma n ner s of breathin g th ank s t o wh ich one may t re a t each
mal ady of the humor s , t he viscera , e t c.

(3) Th e re s pirato ry t herapeu tic (eo ku ) t hat par t ak e s

o f p hys ic a l and men tal t og e t h e r , just as smoke i s woo d
and f ire tog ether .

( 4-5) Ex clusi v el y menta l t herapeut ics: med i t a tion

o n im a ginary ideas (k es8J a nd d i r e ct ment al insight
( kaniii n) •
(6) Ma g i c , mantr a s , a nd p roced ure s t o treat c orp o -
r e al d isturbances (mal adi e s of n e ck , t eeth , etc . ) th a t
c o n s t ra i n or elici t med it ati on .

§ Med i t a tional tec hnique s pl ay an important ro l e in

Chines e Buddhism by reaso n of th eir resembl an c e to a n a -
l a gous practices in Taoi sm . I-tsing Ttt 2125: 3 :224b

85
 (Record 133) cites instances of Chinese buddhists who
master illness by taming their breath and by practicing
meditation. He insists upon the curative value of fas-
ting, which procures healing without the need for re-
course to medical procedures cauteries, drugs, examina-
tion of pulses, etc.; fasting will suffice to calm the
three disturbed humors, and thanks to it "any man can
become his own Jivaka." In this I-tsing reunites with
the taoist conception; until almost the year A.D. 200,
taoists reproached buddhists for resorting to medicine
to heal themselves of illness: according to them, one
lives long "by living upon air" (Mou-tzu, tr. Pelliot,
TP 19: 319-30) .

A peculiar sutra translated at A.D . 455 from an

original of Indian provenance via Khotan, the Secret
Method for Treating Maladies of Meditation T 620 (see colophon
at 342b), teaches under twelve headings therapeutic pro-
cedures recommended to practitioners of meditation.
The work abounds in very intriguing medical information.
rl Behold the titles of the dozen chapters: (1) seventy-
two procedures to counteract mental disorders [according
to one gloss, this chapter would be an extract of a
recension of the Safnyuktagama; despite the title, medicine
proper holds an important place in it; the figure 404
recurs constantly: 404 maladies, 404 verses, etc.J;
(2) therapeutics for morbid disturbances caused by con-
cupiscence; (4) for ulcers provoked by excessive and
obsessive lust for lucre; (5) for infractions of mora-
lity; (6) for melomania (excessive love of music); (8)
for the need to urinate caused by a superabundance of
the element water (while in the water concentration
[samadhiJ); (9) for cephalalgy, for ophthalmia, and for
deafness due to the element fire (while in the fire
concentration); ~10) for fright and for "loss of mind"
provoked by inauspicious matters revealed while in the
earth concentration; and (12) for various disturbances
caused by demons that attach themselves to beginners
in meditation and impede them from realizing concentra-
tion [this last part is presented as a sutra addressed
to AnandaJ .

Chinese tradition attributes to Bodhidharma, pat-

riarch of the Ch'an sect, a treatise of respiratory
and gymnastic technique called I chin ching; it is sup-
posed to have been studied by the monks of Tao-lin-ssu,
a temple in Ho-nan where Bodhidharma is deemed to have
practiced the famous "wall gazing". That temple has
lent its name to a famous school of boxing in China;
see Pelliot, TP 1923 :252-55 . [Boxing has always had a
semi-religious character is China; the "boxers" of 1900
86
fo rm ed a se cret so ci et y s p r u ng from the " he re t ic a l "
White Lotus sect of buddh i st o r ig i n. J

MAGICAL THERAPEUTI CS

Seve r a l amo ng t h e v i naya co des (see c h.11 above ) t hat

proh ibit c le r g y th e st u dy of magic a l a r t s already make
an except io n for med i c al in c an t a tion s. Tr an sl a t ed in-
can ta t ions that comb a t illne s s in ge ne ra l, or o ne or
a no t he r p a rticul ar malady, a b o u n d in the Chi nese cano n .
A numb er o f th ese text s fo r m autonomou s works . An ear-
ly set of th em is c o ns i dere d to hav e b e en t ra ns lated a t
t he e n d of the fourth ce nt ury b y a reli gi eux of we ster n
ori gin n amed T 'an-wu-Ian ; it c onsists of an in c an t a tion
f o r medi caments; incan t a tion s a g ainst poi sons , c l i mat ic
mal adi es , i n f a n t i l e aff e c ti ons , t o o t hac he , and e ye a il-
ments; a divine incant a t ion of the king of phy si cians
*Vi r o c a na (Vairocana ?); and so f o r t h .

Th e l ist of i nc ant at i ons translated by T' an-wu-Ian

i s dr awn from a catalo gue o f A.D. 597 (Ttt 2034 :7:70b; s ee
also th e c a t a l o g u e Ttt 2154: 3:504a, 14:634a). A p r evious
cata l ogue, however (A.D. 515 , Ttt 2145:4 :31b-c) , c las se s a l l
the s e t e xts among anonymous tra n s l a t i o n s. A few o f
th es e bri ef works h av e c o me down to us; the Ch i nese e d i -
ti ons of the canon c lass some of th em as anon ymous , some
a s t ra n s l a t i o n s b y T' an-wu- I an . Th ese a re in c ant a ti ons
tran s cribed or t ransl a t e d i nto Ch i ne s e and f ramed b y a
br i e f lit erar y desi gn--homa g e to t he Th ree J ewel s ,
directi ons for usin g th e in c an t a tions , e tc . : T 1326 Sutra
to Enchant Tooth [ache J [ this in c ant a t ion a ims a t exorc i z i ng
a king o f wo rms--hi s n ame " a n d h abi t at indi c a t ed--who
c o me s t o lod g e himsel f in t he ~ee t h and t h u s p r ov o ke
p ain; c p . T 1336:5:609a , i n whi ch t h e name o f t he wo rm
diff ers; o ne should rec ite t he incantation o nce wi t h
the mou t h f u l l of pur e wa t er , th en s even ti mes afte r
havin g spit out the wa t e r; a simi lar text is T 1336:8:
62GbJ; T 1328 Sutra to Enc hant CMaladies ofJ the Eyes; T 1329
Sutra t o Enchant CMaladies of J Infants.

Near the beginning of t he e igh t h c e n t u ry , I-tsing

translat ed a Sutra of Healing Hemorrhoids (Arsa-prasamana -
eicbra T 1325 , Tib Gzhan ' br um i-ab tu shi bar byed pa ' i mdo cp.
Okan no.213 , 645 ; Ttib no .621 , 1020), d e aling with the arsas--
cp. Lat in ulcus--of h eat [=b il eJ, phlegm, the thr e e hu-
mors c o mb i ne d , blood, the b ell y , the nose, t he t e eth,
et c .; it is apparently a matt er of ulcers .

No t long after, Amoghvajr a translated a Sut ra of

the I ncant at ion that Destro ys all Maladie s (Sarvarogaprasamana-

87
 dhdrani. T 1323, an enumeration of maladies), and a Sidra of
the I ncant at i on that Puri fies all Eye Ailments (Cak?upvisodhana-
vidya T 1324, cp . Otani Kanjur Cat .105. An episode of T
203 translated by Chavannes at Cinq Cents Contes 3 :70 makes
allusion to this sutra and the formula contained in it) .

Among works translat ed around A .D . 1000 by Fa-hsien

we find an ophthalmic sl1tra T 1380, similar to T 1324 , and
T 1330, a sutra of pediatri cs p u t in the mouth of Ravana
(a demon become patron of pediatrics much as the ogress
Hariti has become patroness of children ; on that work,
widely diffused through all of As ia, and on the recen-
sions in Tibetan, Tamil, Khmer, and Arabic, see Fillio-
zat, "Le Kums.r a.t an t r a de Ravaria" in JA 1935 :1 , and Cahiers
de La Soc . As . 4[1936J) . 50 .

To these few autonomous works one might add all

the therapeutic incantations inserted into tantric
literature (for example, T 1336 translated in the first
ha lf of the sixth century, or T 1059-60 translated in
~ the middle of the seventh)~1 This is a genre that the
authors of apocryphal sutras in China also cultivated;
some specimens of their lucubrations have been recovered
at Tun-huang: the Sittra f or Deliverance from Illness Ttt 2865 ,
the Sittra for the Protection of Life and Deliverance of Men from
Illness, Su ffering, and Danger Ttt 2878. These two texts have
been condemned by Chinese authorities (see Msyu 2 :194-
230)-but as apocrypha, not as medica l incant at ions;
curative magic was perfectly acceptable to the Chinese
church and was never excluded from canonical collections
as being magic . See also, among the mss.of Tun-huang
preserved at the Bibliotheque Nationale of Paris, no .
2637 and 2703 of the Fonds Pelliot: the S:utra, Spoken by
the Buddha, on Interrupted Cuisine, texts buddhist in format
but purely taoist in inspiration that teach a method
and some herbs for healing oneself of all illness and
living long without "terrestrial cuisine"-i.e ., eating
nothing but "celestial perfumes " . These texts are pre-
ceded by other recipes enlarded with "Sanskrit cuisine".

In Japan, the Code of Taiho (ed. Ryoshl1ge-shakugi ,

Tokyo 1931 :7B:191-92) , that regulated the offical status
of buddhist clergy at the beginning of the eighth cen-
tury, enjoined the defrocking of monks and nuns who
yielded to divination or to healing illnesses by " mi n o r
procedures" (ehodir-« according to the commentaries, the
employment of charms and other "left-handed" procedures)

50 . See also Bagchi 1940 .

51. T 1059 has been translated by Sen; ref . p. 75 n . 46 above.

88
or 'by magic arts (Jujut s u ) , Ne v e r th el ess , th e t e xt adds
that use o f therapeuti c in can t a ti ons " cons ist en t with
buddhist do c trine " r emains per missib le t o t hem. An im-
p e ri al de cre e of A.D. 717 r ati fi es t hese ru lin gs , a d d -
in g that monks a n d nuns may wa i t upon pat ients o n l y wi t h
t he p e rmissi on of ecc les i as t ical a ut ho rities (Shokunihongi
7 , fo u rt h moon of th e f i r s t yea r Yoro ) .

PROPERLY MEDI CAL THERAPEUTICS

Th e e ight sect i o n s (alrpi nga) of medi cin e, or ayur-vada ,

as e nu mer ate d in the c lass i c a l treati ses of I ndi a
(J oll y , Medi ci n 13) , a re men tioned a t man y t ur ns--but
wit ho ut be i ng defined--in t he Mahapar i ni rvii1Ja- s ut ra (T 375:
2 :617c, 660c-661b, 23: 755b ) .

[T 375 :9 :660c-661b n ames th e f o l Lo wi n g type s of med i-

c ati on: e met ics , ointments, nasal sprays , fumi gations,
washes , pills , powders, i n can tations, antitoxic med i ca-
ments (ant itoxic ointments sm e ared upon f oot- gear to
eliminat e venoms), medicaments to drive away demons,
and so forth .]

A commentary to the Mahaparinir viina-sut r a dating f rom

A.D . 509 (Ttt 1763 :23 :469a) pre s en ts th'ese "eight medical
t echniqu es" as the follo win g li st (cp. Ttt 1767:6:73a ,
wher e the order of the e ight diff ers): (1) t h e r a p e u t ic
o f the body (kiiyaci ki t siiJ; (2) o p h t h a l mo l o g y (may corr es-
pond t o Sk t siiUikya, a t erm d esi gnating t h e "mino r sur-
ge r y " of the needl e , prima rily p erformed upon e y es ,
ears , e tc. ); ( 3) t r a u mato logy ("therap eutic of wounds"
saZya, ma jor surgery) ; ( 4) p ediatri cs (kawniirabhrtya) ;
(5) d emonolo gy (" th er a p euti c o f in auspiciousness " bhicta-
vidyii) ; (6) to xi c olog y (aqadatianima l ; (7) e mbryo l ogy
( " therap euti c of the fet us"); and (8) astrol o g y. Th e s e
las t two it ems di f f e r i n I ndi an li sts ; at t he e n d o f
the s e v e nt h c entur y I- t sin g , i n Ttt 2125 : 3:223b-c (Record
127) re p laces th em wit h cl ass ica l te rm s : ( 7 ) prescrip-
tions f o r prolongin g li f e (ras iiyana " elixirs" , or jarii "o l d
age") ; and (8) " s t i mu lat i ng viri l ity ( vaji karana " a p hro -
di siacs "). Ttt 1763 adds t hat each of thes e e igh t s e c-
t ions ge ner at e s t wo thous and stanzas (giit ha ) or
"pr escriptions".

§ Ophthalmology , and in p ar ti cul ar the op er a tion upon

catar a ct s with a metall i c n e edle (saZiikii) , is the obj e ct
of con st a n t a llusions in buddh ist texts; see ch.6, 9
abo ve. [Operation upon c a t a ract s dates neithe r f rom
t he Hindus nor from the Gre eks : i t is mentioned in th e

89
 Code of Hammurabi par. 215-20-Dr . F .J52

A ritual of symbolic operation upon cataracts with

the saZaka is described in Skt in a tantric text preser-
ved, along with a commentary , in Old Javanese; see K.
Wulff, San Hyang Kamahiujanan Mantranaya, Copenhagen 1935 :24; H.
von Glasenapp, OLZ 1936, col. 486 .

In Tantrism, one of the symbolic rites that accom-

panies the ceremony of initiation or initiatory unction
(abhi.eeka) is inspired by that operation. The master holds
. before the initiate a wand
of metal (or more precisely
of gold) called in Japanese
kombei (on the various Chi-
nese graphics see Ttt 2128:25:
469c; the Tib version of T 848
gives qeer gyi t/hur , "wand of
gold), addressing to him a
stanza that the Vairocana-
eictra T 848:2 :12a cites in
Chinese translation and its
commentary Ttt 1796:9 gives
in Sanskrit transliterated.
With that stanza the master
declares to the initiate
that the Buddha, the "k ing
of physicians" {vaidya-rajaJ
clears away (apa + ni» J his
"membrane" of ignorance
{ajiianaJ . The Skt term for
Kombei. Wands for symbolic "membrane" is pataZa; this
operation upon cataracts . word designates the four
(One by two pcints or two by wrappers or transparent
one point .) surroundings of the eye, of
which the four,th-the crys-
talline-is the seat of opacities (ei "vei'l, shade";
Skt timira "obscurity ") that constitutes the cataract
i'Il proper . The same terms are found in a simile made in
the Mahiiparinirva1Ja-sutra (T 374:8:411c).

The Yai.rooanaeicbra commentary describes the surgical

wand (Skt transcription saZaki) as a small vajra about
4 to 5 inches long, thin around the middle , with two
rounded and smoothed points that physicians smear with
medicaments and insert into each of the two eyes [two
wands with single points are also employed, one for

52. See also HobOgirin 5 :454b.

90
each eye; see the figure above] . Another tantric text,
the Tattvasaingraha (T 866:4:252a) specifies that in the sym-
bolic ritual the master uses it to rub the eyes of the
initiate . At Mdjt 740 one will find pic tures of these
ritual lancets as they are utili zed i n Jap an for tantric
initiations ; the type dates back to spe c im ents i mp o r t e d
from China in the ninth century . A Chin es e author of
the Ch'an school alludes to these instruments in giving
the title Vajra Wand to a brief but renown ed tre atise on
the nature of awakening in inanimate be ings (Ttt 1932).

§ Greater surgery is chiefly a matter of Jivaka and his

six cures. Here we must content ourselves with noting
laparotomy and trepanation, described in a sutra that
is considered to have been trans lated by An Shih-kao
between 148 and 170 A. D. , T 553 (tr. Chavannes, Cinq Cents
Contes 3 no.499; cp , T 554). This su t r a is connected to the
Dharmaguptaka-vinaya (T 1428:40: 852b-c) , in which the operation
of trepanning, anesthetized by drunkenness, constitutes
the third of six cures effectuated by Jivaka. He has
the patient imbibe salted foods to make him thirst, sa-
turates him with a lcohol, and ties him to his bed sur-
rounded by relatives whom Jivaka has gathered to assist
him in the operation . He cuts through the sincipital
bone, extracts f r om. it some worms that he shows to the
family, refills the head with butter and honey , and
sews up the cranium . Laparotomy, the fourth cure of
' J i v a k a (ibid. 852c-853a) , consists of cutting open the
patient's abdomen, unravelling his intestines, and then
sewing up his skin smeared with medicinal herbs.

The same incidents appe ar in the Pali Vinaya (MahZi-

vagga 8:1:18 , 22) and in the Msv, which nonetheless does
not mention laparotomy (Kanjur , tr . Schiefner-Ralston ,
Tib . TaZes 75f, a passage apparently lacking in the Chinese
version of that vinaya) .

Cutting a fistula in the anus (Jivaka's second

operation in the Dharmaguptaka-vinaya) is proscribed for
clergy as inconvenient and dangerous in most of the
disciplinary codes: MahZivagga 6:22 (the operator is the
physician "Akasagotta), Sarvastivada T 1435:26 :187a-b; a
physician named Atrigotra, cpo Atri , Atreya as names
of Jivaka's teacher), Mah'isasaka T 1421 :22:147c (authorizes
incision for other absesses), and Dharmaguptaka T 1428:42:
871a (likewise forbids incision of fistulae of armpits,
and indicates other procedures for treatment) .

§ Embryology forms the subject of two sections of the

91
 Ra tnakiita, T 310 no.13 & 14 ;53"ee Pelliot, JA 1914 :2 :125 and
Lal ou , ibid. 1927:2:240. An e a r l ier v e rsion , T 317,: of the
f ir s t of t hese t ex ts concludes wi t h an e xtract of the
Safnyuktiigama (T 99: 2: 7c-8a=Safnyutta Nikiiya 22, 59 , Paiica); i t ha s
b e en ve r y indif f erentl y r ende r ed in to Ge rm an b y Dr.
Htibot ter: "D i e Sutra [s i c] tib er Empfan gnis und Embry olo-
g ie", Mitt. d. D. Ges. f. Nat. - u V. - k Os tasiens 26c (1932). The
f o r me r tex t, T 310 :13 , i s found in the Msv T 1451:11-12 .
Mo re str ictl y medical is t he Sut ra of GynecoZogy, Taught by
t he Rishi Kiisyapa to his a p p re n t ice Jivaka , hims el f d esi g-
na t ed here as a ri shi . Thi s bri ef t re at ise p re cr ibes
medic ations f or eac h of t h e t en (or t welve) month s of
pre gnan c y; s a v e the n ame of Ji vak a there is a b s o l u t e ly
no thing buddhist e i t h e r i n f o r m or in subst ance .

§ Vin a y a lit er atu re is so r i ch in t h e r a p e u t i c r eferen c e s

of a l l sorts that it would b e impossibl e to g i v e them
all h ere ( for exa mp le , T 1421 :22 :147 , 1428:42:870-871 , e t c .;
for pharma copoeia see t h e fort hco mi n g R8b8girin article
" Ya k u " ). Pl e as e r ef e r , h owever , to citations and re-
fer en c es given passim i n t he present articl e .

18. CJ3uddhism and Indian Medicine

I am a l s o unabl e to exp l o r e h ere a t any l ength the rol e
play ed by buddh ist s i n the d evelopment o f Indian medi-
cine. !i ore over , th er e seems little likelihood that a
tru l y buddhis t medicin e was ever o p p o sed to ayurvedic
me d i c i ne: one should not los e sight of the interdiction
p ronounced by the Le ss er Vehi cle upon medical studi es.
Nothing in Indi a warran ts a di stinction b etwe en a "mo-
n as ti c medicine" and t he medical tradition prop er such
as his tori ans of medi cin e make in the Chris ti an West,
f or exa mp le in the e ra of t he b arbarian invasions of
Italy . When in A.D. 5 1 9 the Ch i n e se ambass ador Sung
i Yun fell ill in U99iyari a , a c o u n t r y whos e k in g and
popul ation were buddhist, i t wa s a brahman wh o h eal ed
'II him wi th hi s incantations (Chav annes , BEFEO 3 :413) . The
a t t r i b u t i o n t o Na g ar j u na o f medical texts (uttaratantra,
supplement o f Sus ru t a ; above all t he Yoqasataka; see
Filliozat, BuZZ. Soc . F. Rist. Med. Jan . 1934: 33-34 a n d JA
1934:1 :305) h as no more v alue than the attri-
bution of works o f various other gen r e that buddhist--
or e v e n ext r a - b u d d h i s t --t r a d i ti o n sets under the commo-
dious and p resti gious name of that patron of Tantrism.
The p hy s ic ian par e xcell ence of buddhist literatur e,
Jivaka , hims e lf had Atri[-Pin gala] as his mast er

53. T 310:13 : Garbhavakranta-nirdesa; T 3 1 0 : 1 4 : Anandagar bhav a -

kranta-nirdesa (K).
92
(T 1428: 39 : 841b; s e e a ls o r efs. a bove a n d Chavann es , Ci nq
Cents Contes 3 : 334). At ri or At r e y a i s the n ame o f a ri shi
a n d riv a l o f Dhanva t a ri the f oun d er o f ayurve da .

Ca raka, the au thor of a c lass ica l t reatise on medi-

cine , is co n s ide r e d b y buddhis ts to have been physician
to Kan Lak a ( the a vada.na T 203:8 :484b, tr. Chava nn e s , Cinq
Cent s Contes 3 : 85; the traditional history Tt 2058 :5:316c , t r.
Levi atJA 1896 :2:481 , s e e also R .F .G . Mull er in JRAS 1932 :
803f). But that does not prove that he wa s buddhist, a n d
in fact the trea ti s e at tribut ed to him s e ems t o be in-
s p i r e d by brahmani ca l ideas (Wint erni t z , Geeoh, Ind. Litt .
3 :546 ) . Prof . Ui, who has studi ed a c h a p ter of Caraka's
t re a t i s e d e v oted t o lo gic (Indo Tetsagaku no Kenkyu 2 :425-71;
the same c h a p t e r h as bee n tr a n s lated int o Eng l i s h in
Das gupta Hist. Ind. PhiZ . 2 ) , seek s in that author a pre-
c u r s e r of buddhist l o gi c , prior t o Na g a r j u n a (and to
the NyayasutI'a ); but t he a rguments h e adduc es are highl y
d ebatabl e.

Another c e l e brate d medical author, Va gbhata, h ad

f o r mast e r a certain Av alokita, a n d Dr . Cordi er has
a t t e mp t e d to establish (JA 1901 :2) the buddhist char ac-
t er of the writings att r i b u te d to him . Va gbh ata, how-
e v e r , a l s o invoke s th e ris h i so n o f Atri at t h e be gin-
ning o f hi s A?t angahr daya- sainhi t a, a n d Dr . Fil lio z at di s -
put es Cord ier ' s op ini on (JA 1934 :1 : 303 n. l) . 54

Th e q ue st io n of what i nf l ue nce Ch i na may h ave exer -

te d upon Indi an me di cine h a s yet to b e st u d ied . I-t sing ,
at Ttt 2125 : 3 :224c (Record 136 ) d e v o t e s hims el f , a propos
of medi cine , t o a p ro ud e u logy o f Ch i ne se civ i l iz at i o n:
Ch i n a, t he "co n t i ne nt of ' go ds" , is parti cularl y ri ch in
ve g e t a l a n d min eral d ru g s of al l s orts ; t he plant o f
longevity i s f o u n d o n ly in Chin a. But a bove a l l, h e
says, it i s in the a rts of the n e edle (acupuncture), of
c a u t e r izat ion (mo xa) , and of t he exa mi nat io n of pu l s es
that Ch in a p r e va il s ove r all o f J ambudvip a [ a te r m that
to I-tsing seems t o d enot e the who le o f Ind i an c i v i l i za-
t i onJ .
Hsii an- t sang , a t Ttt 2087:2: 876c ( Watt e r s , TI'avels 2 :
155), c o u nts t he ( me t alli c ) n e e d l e a nd mo xa o n the o n e
h and , and vege tal a n d " s t on e" dr ugs o n t he o th er hand ,
as being a mo n g t h e p roced ures of Indian medi cine along
with in cantations o r pra ctice s o f exo rc i s m. Th e term
"stone " designates , in principl e , a n a cupunc ture n e edl e

54. Verse 1 of the Skt & Tib texts s a l u t es the Buddha; see Vogel
1965:45-4 6 . The questions discussed ibid., Introduction .

93
of stone, b u t t he expression "vegetal and stone drugs "
(yakus hi) is used to d e signat e medication in ge ner a l.

As it happens, the a rt of acupuncture does not

seem to have been introduced i n t o Indi a at all , and
onl y in error does Ch a va n nes, for exampl e (Ci nq Cent s
Contes passim) transl ate t he word shin" (me tal l i c) n e edl e"
a s "acupuncture " when i t a p pe a r s in Chinese v ersions of
buddhist texts : th e word t here r enders t he Skt sal-aka,
a term d esignatin g th e n e edl es of Indi an " mi n o r sur gery " .
India does not know mo x a e it he r (cauterization wit h t h e
a r t e mi sia leaf) . 55

As to the e x a mi na t ion of pulses , which we ma y es-

t e em, along with I-t sin g , a s the third--and most impor-
tan t--characteristi c of Ch i nese medi ci n e : the practice
i s not attested in India , i t s eems, unti l a r el atively
rece n t da te. In an y case, it is no t at issue in clas -
sical ayurveda. Joll y (Medi ci n 23) has found mention of
it only in sources o f t he Muslim era, and is in clined
to vi ew it as a borrowin g fr om t he Arabs or the Per-
sians . More recently , Dr. Filliozat has noted the
ex a mi n a t i o n o f puls es in a Tib etan treatis e tr anslated
from Sanskrit in the e igh t h cent ury, and proposes a
Ch i ne se common sour ce ( J A 1934:1 :307); admitt edly , t he
doct rin e of pulses is th e r e a dap t e d to Indian medi cal
i d e a s and to the the ory of taridoea , In T 553 (Chav annes,
Cinq Cents Cont es 3 : 333 , 345) t he a p pare n t me n t i o n o f ex a -
min a tion of puls es i s n o mor e than a fan c y o f t he Chi -
n ese translator; one does no t e no u nter it in t e x t s
r el at ed to th e Vin ayas .

l~ Buddhism ~ 8ino.f!apane§e Medicine

We have al r eady t a k en cogn izance o f the pr es e r v ation in
common dis course, d own to our own d a y , of t he buddhist
"imbalan ce of th e fo ur e leme n t s" formula to desi gnat e
an unhealthy cond ition. The t heo ry of four e leme nt s
a n d 404 illness e s was a do p ted b y a writ e r of t h e e igh t h
cen t ur y , Sun Ssu-miao ( A.D . 601 ?-82), in his great
tre atise of medicine e nt it led Prescriptions of Great VaZue
(Ch ' i en chin yao f ang, e d ite d in the taoist can o n under a
l ong er t i t l e ; on t he work s e e Pelliot , BEFEO 9 :435).

Sun Ssu-miao was a n ec lect i c author, c o n ver san t

with the philosophi es o f t h e diverse Chin e s e s chools--

55 . On Ch i nese a cupun c t u r e and moxa see Lu & Needham 1 98 0 . On

I nd i a n medic i ne see Ro§ u 197 8 and bib1 i og. ibid .

94
chiefly with Taoism , but he was interested in Buddhism as
well; a c o n temp orar y e ve n nickn amed him "a n e w Vimala-
kirt i" ( Chi u T 'ang shu 191: 4a-b) . Th e Prescriptions i s fund a-
mentally taoist on t he whole, but it b ear s in ce r t a i n
passages a buddhis t imprint--chi efl y , i n th e spirit
that animates i t and in t he sty l e . To b e a g o o d physi-
c ian, he s ays in the introduction ( ed. Taoi s t Canon 1 :
1b-2b), it will not suf fice to b e ve r s e d in c o n f u c i a n
and taoist li terature: No o n e who has not re a d buddhist
books will e x p e r i e nce love, compassion, and the joy o f
renunciation. One will no t know when approaching pa-
tients how to form the vow to convey suc cour t o all
animate b ein gs in all their su f f e rings , with out distin c -
t i o n of rank , fortun e, age , b e aut y, friend ship or inti-
macy, nation ality ( Chines e or barbarian) , or intell i-
ge n c e. One will not s ucc e e d in considering a l l pati en t s,
wi t h evenmindedness, as one's mos t dear fri ends .

In medi cal matters proper, Sun Ssu-mi ao appears to

have borrowed only the t h e o r y o f four elemen ts from Bud -
dhism, and even that he lays out (ibid. 9b-10a) in a form
adapted to Chinese th eories and t erminology:

"The human b o d y , " he says, r ef erring expressly to

buddhist t e xts, " i s a c o mb i n at i o n o f earth , water , fir e ,
and wind . When th e 'breath' ( ef fluvium , ener gy) of fir e
is troubl ed , the entire body c omes t o burn ; when it i s
t he 'br eath' of wind , the whol e b ody stif f ens and the
p o re s ge t c h o ke d; whe n i t is t he ' bre a t h ' . of water , t he
body sw ells, t h e [r esp ir a tory] bre ath ·is ' full' , pant i ng,
and thi ck ; and if it is the ' b r e a t h ' of e a r t h , the four
limbs s tay i n ert. I f fi r e is suppressed , t he bo d y ~s
co l d; if wind ii impeded , the b r eath is int errupted; if
water is exhau st e d , t h e re is no more blood ; and if ear t h
is disp ers ed, the body exp l o d e s. If the fou r 'breaths'
unite their v irtues, the fou r ~ s o u l s ' are placid and
harmonious; but if o ne of the 'br e a ths ' is tro ub l e d
e v en a lit tle , 101 i llness es wil l b e produ c ed , a n d i f
the four ' s o u l s ' a r e s h a ke n, 4 04 i l l nesse s will o c cur
at the s ame t i me. "

Foll owing t hat accou nt o f t he doc trine of four

e l eme n t s , Sun Ssu-miao posts guard ag a i ns t applications
th at mi ght b e inf err ed from i t by fa i l i ng to take
a ccount of the good prin cipl e s o f Ch i n e s e medicine:

" Fo o l i s h physi ci ans ," he s a ys , "who would treat

these illness es without taking a c count of the ideas of
blood vess els [i.e ., without takin g the pulses], will
provoke conflicts among the f iv e e leme n t s [o f Chines e
medicine : wa t er , wood , fire , eart h, and met al] in t h e
95
[five] viscera. It will be as though they have poured
oil upon fire!"

Another chapter of the Prescriptions (82:7b) is devo-

ted to maladies that can be treated by "appeasement of
the mind and regulation of the breath" (a technique of
Ch'an). The author erects in this regard a classifica-
tion of illnesses that is again a compromise between
the Indian system of four elements or four humors and
the Chinese system of five viscera. He distributes
these illnesses among four categories: rheumatic affec-
tions due to cold, disturbances of breath, pernicious
winds, and infections due to heat. But all these mala-
dies, he adds, are linked to the viscera. Each of the
five viscera has 81 illnesses--illnesses of cold, of
heat, of wind , and of breath. So multiplying 81 by 5
one obtains an [approximate] total of 404 illnesses .

[A long-lost Tr eat ise of the Five Visc era has been

recovered as a fragment from Central Asia by the Prus-
sian expedition. Although attributed to Jlvaka, it is
apparently a purely Chinese work. See Kuroda in Shina-
gaku 7:4 (1935) 121f.]

Finally, we observe that Sun Ssu-miao describes

Indian procedures of massage in detail, stipulating
that they are a brahmanical custom (82:lf).

§ From T'ang China the buddhist theory of four elements

and 404 illnesses passed to Japan, where one finds it
attested in the most ancient treatise of medicine that
now survives, the I ehimpo of Tamba Yasuyori composed in
A. D . 982. (See Fuj ikawa, Japanese Medi c i ne co LI . Clio
Medica, New York 1934:14).

In China itself that theory was introduced into

medical literature even prior to Sun Ssu-miao. The
taoist writer T'ao Hung-ching (A.D. 452-536) had in
fact drawn up "101 medical prescriptions " to complete
the great collection composed under the title of Chou
hou f ang by the famous alchemist and physician Ko Hung,
author of the Pao p 'u tzu (beginning of the fourth cen-
tury). T'ao Hung-ching is proved to have been a taoist ,
but as with most taoists of his time he studied Buddhism,
and it is reported of him that following a prophecy re-
ceived in a dream of the Buddha, he took a bodhisattva
name and made the vow of five precepts (Liang shu 51:6a,
Nan shih 76:5b). [One of his works contains a taoist p la-
giarism of the Sidra of Forty-Two Sections; see the study
by Mr. Hou Che analyzed in Bibliographie Bouddhique 7.]

96
 The p r e s c r i p t i o n s added by T 'ao Hung-ching to t hose
of Ko Hung have been lost sin c e the seventh century ( Sui
shu 34:13a) , b ut the preface , dated at A.D. 500 , is pre-
served i n the Taois t Canon (at the beginning of the
Pree cr-iptrione of Ko Hung). T' ao Hung- chin g there indicates
the motives that indu c ed him to fix the number (and the
title) of his prescriptions at ~O~. On th e one h a nd , he
days , it was i n remembrance of a writer of th e third
century who composed ~O~ poems to e x h o r t --as though at
the thrust of a needle (a doub le -entendr e wi th t he acu-
puncture needle) --a d isso lute prince to reform himself
of his excesses; but also it was by allusion " t o the
~O~ illn esses of the four e leme nts deal t with in bud-
dh i s t books."

One can go even further back a nd wonder whether

there are not echoes of the story of J1vaka and h i s
c ures (T 553-54, translated ca A. D. ~4 7- 70 ) in the semi -
l e g e n d a r y b i o g r a ph y of t he famous phy s i c i a n Hua T'o
(+A.D . 220 ). The o ldest rece n si o n of hi s biography i s
t hat of the Wei ehih, da ting f rom t h e en d of the t hird
ce nt ury [Dr . Hiibot t e r has g iven, in Mitt. d. D. Gee, f .
Naiiuxr-u , Yo l.kerk , Ostasiens 21A (1927) , t he s k e t ch of a trans-
l a ti o n of the texts beari ng o n Hua T'o accordi ng to t he
T'u shu chi ch/enq e ncyc lopedia; the b i o g r a ph y in t he Hou
Han shu (112B ) is l a t e r than that of t he Wei dhih J . 56

I n t he b iography ( Wei chili 29:1a ) we see Hua T ' 0 exe-

c uting laparotomy wi th h ashish anesthesia , re section of
t he intest i nes , washin g, sutur e of the abdomen, applica-
tion of ointments , and massage; i t s s imilarities to the
fou rt h cure of Jivaka ( ch .17 , "Properly Med ical" above)
are inescapable . A "privat e biography" of Hua T'o that
is cited by t he Wei chih (ibid. 3a) reports further t hat h e
opened t he abdomen t o f a p atient and e xcis ed ha lf of
t he sp leen, just as Ji vaka had operated upon the liver
(Chavannes, Cinq Cents Contes 3:343) .

One of the c u re s o f Hua T' 0 ( Wei chih 1b-2a) is that

of a command i ng offi c er st ri cken by an illness that
c o u l d be c ured onl y by a vi ol ent fit of anger; Hua T ' o
arranged for t he pati ent to be incens ed to t he po int at
which h e would pursue and slay hi m: at t he height of
his rage, h e s pit black blood--and was healed. St ill,
Hua T'o e n ded by being slain by a d i s s a t i s f i e d patient,
t h e Emperor Ts ' a o Ts ' a o . Th ese two episodes are remi -
nisce nt o f J ivaka pursued by a s usp icious king rendered

56 . Th e Wei c h i h o f ChIen Sho u, A. D. 233 - 9 7 (Ch ' en 1964 : 483n. )

97
furiou s by a congenit al poisoning (fourth cure in T 553) .

Mr. Ch 'e n Yin-k'o h a s point ed out t hese a n a l o g i e s

in Tsing hua heueli pao 6:1 (1930) 17-20 . He tr i es t o expl a i n
the very name of Hua T' o (whi ch does not a p p e a r t o b e
pure ly Ch i n e s e) as a n aphere ti ctranslit eration of the
Sk t agada " p a n a cea". 57 Th at exp l a n a t i o n is d ifficult to
acce p t, but the r appo r t betwee n the lengends o f Hua T'o
a n d Jiv a k a merits c o ns i de ra t i o n inasmuch as a l l the
surger y o f Hua T'o st ands o ut as e xceptional in t h e
his to r y o f Ch i n e se medi ci n e --e v en t h e an ci ent a ut h o r s
of Chin a r e sisted a dmitt i ng i ts histori ci ty .

[In the Tamil cou nt ry likewise, the l e gend o f the

ph ysici an Teraiya--he ext r a c ted a frog from the brain
of a patient--is no thing bu t a succedaneum f o r that of
Jivak a ; s ee Filliozat, Bull. Soc. Fr . Hist. Med.Jan .1934: 39-40. J

Admi ttedly , the His tory of t he Pr i or Han men tion s dis-

se c t io n of cadavers as ear ly as year el ev en o f th e
Christ ian Era (Han shu 119B:15a). But i f the usurper Wang
Mang ordered that diss ection--nearly unique in t h e an-
nals of Chi nese me d i c i n e--i t was with a vi ew o f measur-
ing and weighing th e vis cera and identifying the system
of b loo d vessels--that is t o say, to v erify experimen-
t ally the Chinese t h e o r ies of anatomy and phys iology.
I t is not a matter o f sur gery.

Then again , the Wei chih c o n t a i n s other borrowin gs

f r om the folklor e of Indi a. One f inds th ere, transfor-
med into a purely Chines e histori cal episode , t h e bud -
dhist (T 203, tr . Ch avann e s , Cinq Cent s Contes 3 :5) a n d jaina
(S. Le vi , Sir J.J. Modi Commemoration Yol.ume ) tal e of the
we igh i n g of the e le p h a n t in a boat (s ee Chavannes, loco
cit . n .L : the source is Wei chih 20: 1b) . This stor y i ll u s -
trat es an observation of empir ical physics , and it also
a t tes t s t he influence of Indian science in China during
the Thr e e Kingdom period . Whe n in A .D . 519 a Chinese
ambas s ador vaunted t he medi c al g e n i u s of Hua T 'o to the
k i n g o f U<;l<;liyana (Chavannes , BEFEO 3 : 409) h e c er t a in l y
r ende red , unsuspectin gl y and quite involunt aril y , an
ind irect homage to th e s ci ent i fic superi ority o f India .
The wonde rful l egends t h a t Ch inese traditi on attributes
to Hua T'o are prob abl y no mor e t h a n a legendary ech o of
Indian s urge r y th at has com e t o China b y the intermedia-
ry o f Buddhism but o f which Ch i n e s e medi cin e has not
known how to put to pr a cti cal use . Wh er e as Ch i n a ap-
pli ed itself profitably to the school of Ind i a in

57. See p. 14, n .8 above .

98
ph il o soph y , lin gui s t i cs , a nd a st r o n omy, in t h e re a l m of
medi cin e it s e e ms to have gotte n no mo r e t ha n s ome theo-
reti cal formulas a n d f abul ou s a ne c dotes.

<:.Abbreviations & GBibliographr

N.B. As a biblio gr aphy, t h i s listing i s n o t intended t o
be comp l ete . All works cit ed in th e not e s are docum en -
ted h ere --as are th e translator's abb r ev i ations--but
thos e c i ted i n th e t ext g en er a lly r emain t he re with the
a uthor 's document a tion , only supplemen t ed when po s sibl e
by Sanskrit or Ch i nese titl es . Works from t he Ch i nese
canon ar e c i t e d a s K or T ; f r o m t h e Pali in t he PTS
editions . Non- canoni c al works in Chin ese a nd J ap an es e
are o f t en abbreviat ed (Bdj t etc . ); documen t ation of
t h e se ma y be found in Hobogirin supplemen t s t o Fas ci cul es _
1 and 3.

Ak. Va subandhu , · Abhi.dharmakoea, T 1558. Tr . L. d e La

Vall e e Poussin. Paris -Louv ain, 1923f.
Asvagho s a , Baundarananda , Tr. E. H. Joh nson. Lahore, 1928.
Re p r . Delhi : Moti lal , 1975.
Bagchi, P.C. "N ew Mat erials for the Study of the Kumara-
tan tra of Rava n a " in Indian Culture 7 (1940) :269-86 .
Birnbaum, Raoul. The Healing Buddha. Bou l der: Sh ambhal a , 1979.
BEFEO . Bulletin de l 'Eaole franqaise d 'Extreme-Orient.
Ch' e n, Kenn eth K. S . 1964. Buddhism in China. Princeton :
Prin ceton Univer s i t y Pr e ss .
-- 1973 . The Chinese Transformation of Buddhism . ibid .
EB. Eas tern Buddhi s t.
Filliozat , Jean. La Doat rine alas sique de la Mediai ne indienne,
ses Ori gines et s es Para l.e l.Le e qx-ece, Pari s 1949 .
GiZgit Manusaripts. Ed . N. Dut t . Sr inag a r 194 2f .
HobOgirin: Diationnaire enayaZopedique du Bouddhisme d'apres les
eourcee ahinoises et japonaises. Tokyo : Maiso n Fran co-
Japonais e , 1929f . F as ci cul e An nexe : Tab les du Taisho
Issaikyo . 1931, 1979 ( rev . )
IHQ . Indian Hietoz-ical: Quarterly.
JA. Journal Asiatique.
JAOS. Journal of t he Ameriaan Oriental Soaeity.
Jolly , Juliu s. Medi ain. Strassburg: Trubn er , 1901. Tr. w .
not es by C. G. Kashikar a s Indian Medicine. Poona: by
th e t r anslato r, 1951 .

99
JRAS. Journal of t he Royal Asiatic Socie ty.
K. Lancaster, L. The Korean Buddhis t Canon. Berkel ey: U . of Cal.
Press, 1979.
Kern Hendrik . His tory of Buddhism in Indi a. Tr . from Dutch by
G. Huet as Hist oire du bouddhi.eme dans l 'I nde. Paris :
Leroux, 1901-3 .
Lamotte, E., tr. L 'Ens eignement de Vimalak'irti (Vimalak'irti-
nivdeea) , Tr . by Sara Boin as The Teaching of Vimalak'irti .
PTS 1976.
Lu Gwei-djen & Joseph Needham. Celes tial Lance t s . New York:
Cambridge U. Press , 1980 .
MCB. Melange s Chinois et Bouddhiquee ,
Mpp s. T 1509. Tr. by E . Lamott e as LeTmitede laGmnde
Vertu de Sages se de Nagarjuna (MahapmjnaparamitasastmJ .
Louvain: Inst itut Orientalist e, 1949f.
Ms v . Miilasarvastivada-vinaya. Skt ed . in Gilgit Manuscripts 3 .
Nj. Nanjo, Bunyo. A Ca t a l ogue of the Chinese Translation of the
Buddhist Tripii;aka. Oxford, 1883.
Nobel, J. "Ein alter medizinis cher Sanskrit-Text und
seine Deutung." Supplement to JAGS 11(1951).
PTS. Pali Text So c~ ety , London.
Rechung Rinpoche Jampal Kunzang . Ti bet an Medicine Repr.
Berkeley: U. of California Pr ess , 1973 .
Robinson , Richard H. & Johnson , Willard L. The Buddhist
Re l i gi on. 2nd ed . Encino , Cal.: Dickenson , 1977.
Ro§u, Arion . Conce ptions Psychologiques dans Lee Tex tes Medicaux
Indi ens . Paris : Institut de Civilisation Indienne ,1978 .
Suv. Buuarnp ra bhdeot t ama-eictira , Skt . ed. J . Nobel, Leip zig
1937. Tib ed. J. Nobel , Leiden-Stutt gard 1944, 1950
(Wor t er buch Tibe t isch-Deutsch-Sanskrit . Tr. by R.E. Emmerick as
The Siit ra of Go l den Li ght. London : Lu zak, 1970 .
T. Taish6 e d . of t he Chinese canon with supplements
TaishO Ieeaikuo . T : works c o n s idered th e dir ect word of
th e Buddha. Tt: works at t ributed to Indian (and
Serindian) authors. Ttt: works of Ch i ne s e (or Korean)
origin. See also H8b8girin Suppl. to fas c .1 , 4; and
Eaec : Annexe .
TP. T'oung Pao.
TV. Candragomin, Twent y Vers es on t he Bodhisattva Vow
(Bodhisattvasamvara-vimsaka) .
Upayakausa l ya-siitra. Ci t e d by sec. nos. Ed. , tr. forthcoming
by Tat z.
100
Va gbha~a. See Vo g el.
Vk. VimaZakirti-nirdesa . S e e Lamo t t e.
Vogel , Cl aus . " Va gbh a.t a I s Astangahrdayasafnhita". AbhandZungen
fUr die Kunde des MorgenZande s ' ' 3 7 : 2( 1965) .
Wasson, R . Gorden. Soma : Divi ne Mushroom of I mmor t alit y . Th e
Hague : Mouto n, 1968.

101