Buddhist Medicine: Global Traditions

Buddhist Medicine in Early India and Central Asia

Ayurveda has tended to overshadow all other forms of medicine in Indian historiography. Rather than consisting of a single dominant medical system, however, medicine in India was a heterogeneous body of knowledge represented by a diversity of oral and textual traditions. Received Buddhist and Ayurvedic texts available today represent two distinct syntheses of the large range of ideas about the body, disease, and healing that were circulating widely in Indian society. In fact, while they developed via oral tradition over a roughly contemporary span of time, scholars think that the writing down of the Buddhist texts most likely predates the maturation of the main Ayurvedic treatises (Carakasaṃhitā and Suśrutasaṃhitā) by a few centuries.

Although never its primary concern, the Pāli Buddhist Canon (first committed to writing in first century BCE Sri Lanka) contains a great amount of material pertinent to the history of Indian medicine. Medical ideas appearing in the Pāli Canon bear obvious similarities to the Greek doctrines of Elements and Humors in the Hippocratic Corpus, and may have arrived in India during the conquests of Alexander the Great in the fourth century BCE. The doctrines of the Four Elements (Earth, Water, Fire, and Wind) and the associated pathogenic forces (Bile, Wind, and Phlegm) found in Pāli texts became foundational to both Buddhist and Ayurvedic medicine, although each tradition would interpret these doctrines in unique ways.

There is every indication that medicine was practiced among the Indian monastic communities. The monastic codes, or Vinaya, of the various Indian Buddhist schools contain guidelines and narrative descriptions of medical procedures such as herbal and mineral treatments, dietary regulation, and even surgery. Additionally, the accounts of Chinese pilgrims tell us that medicine was an important part of the training of monks at the great monastic "universities" such as Nalanda, and that monastics from all over Asia came to study in the seventh and eighth centuries.

In addition to the Pāli sources, numerous relevant texts and fragments have been discovered in Central Asian archaeological sites written in Sanskrit and in local languages. While not necessarily patently "Buddhist" compositions, these manuscripts are illustrative of the diversity of medical thought circulating in Buddhist circles. Important medical manuscripts recovered in Central Asia include the Bower manuscript, the Weber Manuscript, the Bhelasaṃhitā, Jīvakapustaka, Siddhasāra, and Yogaśataka. Additional textual fragments with relevant medical content have been found at monastic sites across Central Asia.

Buddhist Medicine in East Asia

The spread of Buddhism to East Asia in the first millennium CE included the transmission of a significant amount of medical material. Influential aspects of Buddhist medicine included doctrines such as the Four Elements and doṣa, Indian and Southeast Asian pharmaceuticals, Buddhist medical deities (including their hagiographies, rituals, and iconography), medical spaces such as dispensaries and hospices within monastic complexes, the ideal of the monk as wondrous healer, and several core medical metaphors that structured Buddhist medical thought in East Asia.

By the sixth to ninth centuries, Buddhist medicine had become influential among both the common people and the elite medical officials associated with the imperial court. Buddhist medical ideas appear in the writings of the most famous Chinese physicians from this period (such as Sun Simiao), Buddhist healing rites were organized and patronized by rulers and elites across China, and monastic hospitals and other medical charities were important parts of every day life in Chinese cities.

Buddhist medical ideas and institutions were introduced to Korea and Japan via Chinese Buddhism as well. By the eighth century, monastic dispensaries, hospices, and asylums were operational, and propitation of Buddhist medical deities such as the Medicine Buddha (Skt. Bhaiṣajyaguru; Ch. Yaoshifo 藥師佛; Jp. Yakushi 薬師; Kr. Yaksabul 약사불) constituted a major part of Buddhist ritual practice across East Asia.

The Taishō Tripitaka, chief among the East Asian collections of Buddhist texts, includes important medical texts in a variety of genres:

•References to Buddhist doctrine in writings by classical physicians
•Foreign items in materia medica texts
•Buddhist medical treatises
•Vinaya texts
•Texts on healing deities
•Ritual manuals
•Dhāraṇī texts
•Meditation manuals
•Hagiographies
•Travelogues
•Lists of texts now no longer extant are included in imperial bibliographies

(Individual texts are discussed in my forthcoming books.)

Living Traditions in Asia

While Buddhist medical deities and rituals remained important in East Asia, core Indian medical doctrines largely did not prevail over the long term. Likewise, Indian medicine explicitly associated with Buddhism lost favor in India, replaced by an Ayurvedic tradition associated with Hinduism. Buddhist medicine remains vitally important, however, in many other parts of Asia today. Here I will mention only two examples, Tibet and Thailand.

Among the regional traditions, Tibetan medicine is perhaps the richest in terms of its textual tradition. The most influential Tibetan medical treatise is the compilation known as the Four Tantras (rgyud-bzhi). Developed between the seventh and twelfth centuries, this text synthesized Buddhist and secular Indian medical material, self-consciously integrating this with ideas from the indigenous Tibetan Bōn tradition, as well as with Chinese, Central Asian, Persian, and even Greco-Roman medicine. The Tibetan Tripitaka also contains translations of twenty-two Indian medical writings, many of which are now no longer extant in Sanskrit. These treatises cover topics as varied as internal medicine, pediatrics, gynecology and obstetrics, toxicology, surgery, pharmacology, alchemy, and veterinary medicine.

Traditional Thai medicine has a much more recent textual history, as few Siamese medical writings are extant that predate the 1830s. However, the modern edition of the Thai medical canon, the Study of Medicine (phaetthayasat songkhro), compiled in the nineteenth century, contains numerous texts that, while of uncertain provenance, suggest important continuities with Indian doctrines. This material gives the reader the distinct impression that it originated in multiple geographical and cultural contexts and entered Thailand over the course of many centuries. Some of the sources of Thai medical knowledge certainly included the Pāli Canon and Ayurvedic treatises; however, a significant portion seems to reflect traditions originating in India but not attested in extant Indian sources.

Sri Lankan, Khmer, and other Southeast Asian medical traditions are similarly diverse sources on a wide range of Indian medical knowledge transmitted to the region largely via Buddhism.

Buddhist Medicine as a Transnational Phenomenon

There are important discrepancies among the traditions discussed above on the details of even the most basic doctrines. Even within the same tradition, for example, some texts hold that there are four Great Elements (Earth, Water, Fire, Wind), while others assert there are five (adding Space) or six (adding Consciousness). Most texts throughout the Buddhist world hold there are three doṣa (Wind, Bile, and Phlegm), but some recognize Blood or Dark Phlegm as a fourth. Other authors insist the number is three but, in practice, treat Blood as functionally equivalent to a doṣa. Texts differ in how they divide up medicinal foods by flavors (options range from three to ten categories), and how the flavors correlate with particular therapeutic effects on the Elements. Finally, texts diverge in how they understand the Elements to be specifically affected by the fluctuations of the seasons, personal regimen, environmental factors, and specific pharmaceutical interventions. Such differences reflect both diversity in the Indian transmission of medicine, as well as the localization of received knowledge in different parts of Asia.

Taken as a whole, however, the received texts, archaeologically recovered manuscripts, and contemporary medical traditions discussed here tell us in no uncertain terms that Indian medical doctrines and practices circulated widely and were highly influential throughout Asia, and that Buddhism played a major role in their dissemination and acceptance across the region.

Discussion of cognitive neuroscience of mindfulness by Philippe Goldin.

Buddhist Medicine and Modernity

As Buddhism is now spreading Westward, the association between Buddhism and medicine has once again been front and center in Buddhist crosscultural exchange. Scientific research into the mental and physical benefits of Buddhist meditation has been enthusiastically undertaken under the aegis of organizations such as the Mind & Life Institute, as well as by individual researchers in psychology, psychiatry, neurology, and other disciplines. Medical studies listed in the PubMed database have demonstrated the benefits of meditation, notably including the reduction of stress, addiction, and depression, the increase in memory and attention, the slowing of the aging process, and the increase in one's general sense of wellbeing. Many of the popular writings on Buddhism available at bookstores and online in the English language mention such benefits among the chief reasons for taking up Buddhist practice.

As Buddhism is translated into scientific language to increase its appeal to modern audiences, these new ways of talking about the tradition are now playing a role in how Asian practitioners see Buddhism as well. As always, translation into a new language and conceptual world brings both gains and losses. The process of "modernization" represents yet another example of the ease with which Buddhist ideas are translated into new cultural and social contexts, as well as the willingness of Buddhist leaders, authors, and practitioners to emphasize the practical benefits of Buddhism in accessible terms in order to gain legitimacy and attract converts. Of course, it also underscores how central the alleviation of all forms of suffering — especially the suffering of illness — remains to the Buddhist tradition as a whole, and how ecumenical Buddhists are in their embrace of this mission.