Buddhist Medicine in India
Summary and Keywords
The Pāli Tripiṭaka demonstrates that Indian Buddhists were familiar not only with the classical Āyurveda of the late Vedic period but also with the Atharvaveda and with the oldest passages that precede the redaction of the Āyurvedic Saṃhitās. The Nikāyas, Pāli Vinaya, and certain noncanonical Pāli sources contain the earliest accounts of Buddhist knowledge of diseases, medicinal substances, dietary guidelines, herbal and surgical treatments, and illnesses specific to the life and practices of a bhikkhu, the most common of which were gastrointestinal ailments, digestive problems, piles, and skin-related diseases. These sources also offer the information on medical training, infirmaries, and caregivers. Knowledge of medicine in Pāli literature is a combination of popular and folk medicine and classical Āyurveda. In all of Indian Buddhist traditions, the knowledge of preventing illnesses, preserving good health, and securing longevity is closely related to the Buddhist conception of the preciousness and rarity of human life, and the importance of health for Buddhist practice is emphasized. The ultimate medicine is said to be the Buddha Dharma and the ultimate physician the Buddha. In the Pāli Vinaya Piṭaka, the Buddha himself acts as a physician, making a diagnosis and prescribing a treatment, although he himself at times succumbed to illness and physical pain. The Indian Mahāyana and Vajrayāna traditions also recognized the Medicine Buddha (Bhaiṣajyaguru), Amitābha, Āyurbuddha, and various Bodhisattvas as healers and designed the devotional, ritual, and meditational practices related to these celestial physicians. Another healer who is given attention in many Buddhist sources as early as the Pāli Vinaya is Jīvaka, “the king of physicians,” known for his superb diagnostic and surgical skills.
Different classifications of diseases, ranging from 35 and 49 to 404, are given in various Pāli and Sanskrit sources. While certain Pāli noncanonical sources contain mutually differing lists of the eight causes of illness, including karma, some Sanskrit sources, like Garbhāvakrānti Sūtra, speak of 80,000 bodily worms as causes of human illnesses. All major Indian Buddhist traditions equally recognized various malicious entities as external causes of illness and offer diverse methods of healing the afflictions caused by these entities.
In the Indian Buddhist tantric tradition, according to which only embodied human beings can practice tantra, the importance of maintaining health and ensuring a long life become of paramount importance. Since various yogic tantric practices are most intimately related to subtle physiological and prāṇic systems, the physiological aspects of illness are examined as well as, medicinal formulas, and medical treatments that accord with Āyurveda. But tantras and tantric-medical treatises also pay great attention to the preparations and usages of alchemical substances, knowledge of the drawings of yantras and maṇḍalas, ritual performances, astrological divinations, and applications of protective and healing mantras and dhāraṇīs as regular therapeutic methods. In this regard, the medical training of a tantric healer covered multifaceted aspects of tantric knowledge.
The earliest records of Buddhist medicine in India can be found in the Pāli canonical and noncanonical sources that shed some light on the Buddhist understanding of health and illness, and on medical treatments utilized in early Buddhist monastic communities. Sanskrit literature of the early and later centuries of the Common Era as well as epigraphic evidence of the 3rd and 4th centuries, which record the names of various wealthy physicians and their family members who made meritorious gifts to the saṅgha, also provide valuable information on the close relations of the Buddhist tradition and its monastic institutions to medicine and affluent lay physicians.1 Buddhist medicine in India also had a close connection to the classics of Indian Āyurveda, such as the Suśruta and Caraka Saṃhitās. The mentions of celebrated expounders of Indian Āyurveda in Buddhist literature, in addition to the names of other medical specialists, is evidence of the familiarity of Buddhist physicians with the Āyurvedic medical system.2
From its inception, the Buddhist tradition in India considered the preservation of health to be of great importance. Although it focused primarily on mental training and transformation, it did not neglect physical health. In the Magandīya Sutta, the Buddha Śākyamuni himself pointed out the difficulty of achieving the final goal of nirvāṇa with an impaired body. On several occasions recorded in the Pāli canon, the Buddha expressed his view of health as a person’s greatest possession and considered it as one of the ten things desirable in the world but difficult to obtain. Similarly, in the Dhammapada (ch. 15, v. 204), health is said to be “the highest gain” (ārogyaparamā lābhā).3 In the Aṅguttara Nikāya (III.30), one’s resistance to illness and one’s good digestion are said to be among the five factors that facilitate the monk’s effort in Buddhist practice. In the same text, the Buddha counsels monks to reflect in this way: “I am now seldomly ill or afflicted; I possess an even digestion that is neither too cool nor too hot but moderate and suitable for striving. But there will come a time when illness assails this body. Now when one is ill, overcome by illness, it is not easy to attend to the Buddha’s teaching; it is not easy to resort to remote lodgings in forests and in jungle groves.”4 A person’s perpetual vulnerability to illness is indicated as a consequence of the person’s embodiment. In the “Khandhasaṃyutta” section of the Saṃyutta Nikāya (III.1), the aged householder Nakulapitā is reminded that it would be foolish for any embodied being to claim to be healthy even for a moment.5 Similarly, in the Sanskrit Garbhāvakrāntisūtra, dated to the early centuries ce, the Buddha speaks of the body’s susceptibility to illness in this way: “Nanda, this body becomes an illness; it becomes a tumor; it becomes a thorn.”6
In several suttas of the Dīgha and Anguttara Nikāyas, the Buddha asserts that everyone, whether a woman or a man, a householder or a śrāmaṇa, should often reflect in this way: “I am subject to illness; I am not exempt from illness.” The given reason for this way of thinking is to counteract one’s infatuation with one’s own health (ārogyamada). Those infatuated with their health are said to be prone to engage in bodily, verbal, and mental misconduct, but if they often reflect upon their vulnerability to sickness, that infatuation diminishes or completely vanishes.7 In the Aṅguttara Nikāya, the Buddha’s advice is to avoid unwholesome lifestyles and non-beneficial things, which obstruct health.8 In another passage of the same Nikāya, while explaining the difference between physical and mental illnesses, the Buddha admits that there are those who claim to enjoy physical health for even up to one hundred and more years; and at the same time, he emphasizes that with the exception of those who are free from mental defilements (āssava), it is difficult to find people in the world who can claim to enjoy mental health even for a moment.9
The emphasis on maintaining and restoring physical health was also given great importance in the later Indic Mahāyāna tradition, which saw the prolonged life of an altruistic Bodhisattva as profitable for suffering beings. In the context of the yogic Vajrayāna practices, the preservation of health and the body became of paramount importance. This is made explicit in the statement given in the Kālacakratantra (ch. 2), in which the tantric adept is instructed to preserve his body for the sake of attaining siddhis, since in the absence of the body, neither siddhis nor supreme bliss is attainable in this life.10
The Buddha Śākyamuni as a Physician and the Dharma as Medicine
In the Questions of King Milinda (Milindapañha), Nāgasena speaks of the Buddha Dharma as a casket of ambrosial medicine that heals all the diseases of sin. It is said to surpass all of the most powerful medicines in the world, including the antidotes to poison, since it liberates a person from disease, old age, and death, as well as from sins, desires, and karma.11 In that respect, in the Milindapañha and in the Sela Sutta of the Mahāvagga section of the Sutta Nipāta, the Buddha is quoted referring to himself as the “supreme physician,” as an “incomparable physician,” and as the unexcelled surgeon (sallakatto anutaro).12 In addition to Pāli sources, one finds references to the Buddha as physician and to his Dharma as medicine in later Sanskrit sources. In the Abhidharmakośabhāṣya (ch. 6), the Buddha is referred to as a physician, the Dharma as a remedy, and the Saṅgha as a patient.13 In the same text (ch. 5), the Buddha is also called “the great physician” (mahāvaidya).14 A similar reference is found in the Saddharmapuṇḍarīka Mahāyāna Sūtra (ch. 15, v. 21).
The Mahāvagga section of the Pāli Vinaya Piṭaka describes events in which the Buddha himself acted as a physician, miraculously curing a person or prescribing various treatments and medicines to sick monks. In the Aṅguttara Nikāya, one reads about Venerable Girimānanda, who, inflicted by a grave illness, fully recovered while listening to a discourse on ten perceptions presented to him by Ānanda on the Buddha’s advice. The ten perceptions that were said to immediately cure Venerable Girimānanda pertain to insight into some of the main Buddhist principles and meditative practices: impermanence, no-self, the foulness of the body, bodily dangers, the abandoning of sensual desires, renunciation, disenchantment with the world, the impermanence of all formations, and mindfulness of breathing.15 In the Saṃyutta Nikāya we find other examples of sick monks recovering from illnesses after receiving teachings on the Buddha Dharma and an occasion in which the Buddha Śākyamuni himself, having become very sick during his stay in Rājagaha, asked the Venerable Mahācunda to recite the seven factors of awakening (bodhi-pakkhiyā dhammā). It is said that after listening to Mahācunda’s recitation of the factors of awakening and approving Mahācunda’s words, the Buddha recovered from his illness.16
Although free from mental defilements, the Buddha himself experienced physical ailments and sought medical help. In the Mahāvagga section of the Saṃyutta Nikāya, we learn about the Buddha becoming seriously ill and experiencing terrible pains bordering on death while he was residing in Vesālī during the rainy season. The text tells us that despite the severity of those pains, he endured them mindfully and without becoming distressed. He was able to suppress his illness, revitalize his body, and fully recover, as he thought that it would be inappropriate for him to leave for parinibbāna without having first addressed his saṅgha.17 In another passage of the Saṃyutta Nikāya, one encounters Venerable Anuruddha, who also, while gravely ill, endured bodily pains with mental calm. When asked by other monks how it is that his painful bodily sensations do not preoccupy his mind, Anuruddha reveals that this is due to his mind being well established in the four applications of mindfulness (satyupasthāna).18 In the same Nikāya, we read about the layman Anāthapiṇḍaka, one of the chief lay followers of the Buddha and a great supporter of the saṅgha, who, having fallen gravely ill, fully recovered after hearing Sāriputta’s words of consolation, which validated Anāthapiṇḍaka’s faith in the Three Jewels and his right view and conduct.19 In another instance, the Buddha instructs a sick lay practitioner named Mahānāma on how a lay devotee should console a sick lay devotee with a fourfold consolation, which resembles that given by Sāriputta to the sick Anāthapiṇḍaka in that it confirms the sick person’s faith in the Three Jewels and his unbroken virtues. After the sick lay follower is consoled, he should be asked whether he has abandoned his anxiety about his parents, wife, and children, and his pleasures and desire for heaven. If he expresses his anxiety about any of these, he should be reminded of the inevitability of death and the futility of anxiety.20
The Medicine Buddha, Bhaiṣajyaguru
In India, the earliest idea of a divine healer goes back to the Ṛgveda, which eulogizes certain deities, such as Aśvins, Varuṇa, Rudra, and Dhvanvantari, for their healing powers. The Ṛgveda also speaks of the six Vedic sages (ṛṣis) renowned as healers, whose names, together with Dhvanvatari, are also mentioned in the Milindapañha and in the Jātakas. In the Bhaiṣajyavaidūryaprabharāja Mahāyāna Sūtra, dedicated to the Medicine Buddha, who presides over the Buddha-field (buddhakṣetra) of the eastern direction, called Vaidūryanirbhāsa, we learn of his previous twelve aspirations (praṇidhāna) to cure diseases, change females into males, dispel the fears of sentient beings, provide them with food/ clothing/ protection, and lead them to his Buddha-field and to enlightenment.21 His body marked with the thirty-two major and eighty minor marks of the Great Man is said to be thoroughly pure like a cat eye’s gem (vaidūrya). The light of his body, which outshines the light of the sun and the moon, illuminates his entire world system, enabling people to move freely at night. Similar to the Vedic god Dhvanvanatri, he holds a vessel with ambrosia (amṛta) in his hand. Those who worship him and recite his name are promised to beget sons, revive the dying, and acquire wealth. In his Buddha-field there is no suffering, nor are there women.
The Mahāyāna scriptures also speak of celestial Medicine Bodhisattvas. Two such Bodhisattvas are the brothers Bhaiṣajyarāja and Bhaiṣajyasamudgata, who are mentioned in the earliest segment of the Saddharmapuṇḍarīka Mahāyāna Sūtra. According to the Saddharmapuṇḍarīka Sūtra (ch. 3), in one of his previous births, the elder of the two brothers, the Bodhisattva Bhaiṣajyarāja, wrapped his body with divine garments, bathed in oil, and burned himself out of his devotion to the Buddha and the Saddharmapuṇḍarīka Sūtra. In consequence, his body went on blazing for twelve thousand years, illuminating the worlds.
In the Kāraṇḍavyūha, I.15, we encounter the Bodhisattva Bhaiṣajyasena in a vast assembly of Bodhisattvas, listening to the Buddha’s teachings, and in the Saṃghātasūtra Dharmaparyāya appears the Bodhisattva Mahāsattva Bhaiṣajyasena, who speaks of himself in these words:
- I am the medicine of sentient beings.
- The best of all medicine,
- that I will teach you—
- that pacifies all the sicknesses
- that has infected sentient beings.22
In addition to Bhaiṣajyaguru and the aforementioned Bodhisattvas, Āyurbuddha and Amitāyus Buddha held a central place in granting longevity and protecting the life of a pregnant woman and an infant. The Āyuḥsādhana, Āyurbuddhānusmṛti, Āyurvardhanīvidhi, and other practice texts related to these two Buddhas contain descriptions of worshiping these two Buddhas and performing various rites and sādhanas for ensuring one’s longevity.
Medicine in the Pāli Vinaya Piṭaka
In the sixth Khandaka of the Mahāvagga, which is dedicated to medicine and medical treatments permissible for sick monks, and in the Cullavagga of the Vinaya Piṭaka, one learns of the therapeutic methods and medicinal substances prescribed by the Buddha for the variety of illnesses to which members of the early Buddhist saṅgha succumbed.23 Each medical case is presented in a particular formulaic way: after the Buddha himself notices or is told by someone of a medical condition of an individual monk or of a group of monks, he gives a religious discourse prior to offering his medical advice to the sick. In contrast, when rebuking monks for preparing medicine or treating the sick at an inappropriate time or in an inappropriate manner, his rebuke precedes his religious discourse. Several examples given in the Pāli Vinaya show that in some cases, the Buddha’s initial medical advice failed to bring the desired result for the disease-stricken monks, in which cases he would offer different medical advice that would bring the desired result. The text does not explain for what reason the Buddha’s initial advice failed. There is mention of neither the possible role of a monk’s karma in unsuccessful treatment nor the Buddha’s lack of the knowledge of healing.
Numerous examples of disease-stricken monks in the Pāli Vinaya suggest that digestive disorders and gastrointestinal problems were the most common ailments of monks and even of the Buddha himself. In the Mahāvagga, one learns of the Buddha becoming troubled with abdominal wind on more than one occasion and finding relief from a tekaṭula gruel made with tila seeds, rice, and beans, and prepared in the form of a drink.24 A significant number of medicinal substances and treatments prescribed in the Mahāvagga pertain to restoring a healthy digestive system. The five most common types of medicine (pañcabhesajjāni) for gastrointestinal ailments, which were also used as ingredients in certain other medicines for other types of ailments, were ghee (sappi), fresh butter (navanīta), oil (tela), honey (madhu), and molasses (phāṇīa).25 We learn of sick monks who vomited and became emaciated and yellow in complexion due to suffering from the disease of a “hot season,” and being treated with these five medicines on the Buddha’s advice. These five substances were also well known for their medicinal properties among the laity, as seen in the story of Venerable Pilindavaccha, who was rewarded with large quantities of ghee, butter, oil, and molasses by local people for his miracle of transforming the king Bimbisāra’s residence into a golden palace and thereby saving the lives of a local family of gate keepers. However, as the supply of medicine became abundant, Pilindavaccha had it distributed among the attending monks; and as their vessels and bags became filled with medicine, rats scattered it all over vihāras. The medicine hoarding monks became the objects of resentment and ridicule in local communities. Hearing about this, the Buddha prohibited that this kind of medicine be stored for longer than a week.26 In the case of a man who suffered from poor digestion, the ingestion of raw meat was recommended. When a person suffers from indigestion or dysentery, dry, raw meat were to be set on fire. The ashes that fall down from that meat contain an alkaline ingredient that was deemed beneficial as medicine.27
Various substances often used as flavor-enhancing spices in cooking were prohibited for healthy monks but allowed as a digestive aids for the sick. These include roots such as turmeric, ginger, orris root (rhizoma iridis), ativisa (Aconitum heterophyllum), the root of black hellebore (helleborus nigum), and the like, which could be prepared as soft, hard, or pulverized. Moreover, astringent decoctions and astringent roots, medicinal leafs, various types of pepper and myrobalans, fruits, different kinds of gums, and salts were all used for digestive problems.28 In the case of a monk who was troubled by abdominal wind, the usage of decoctions made of oil mixed with strong liquor was prescribed. However, when certain monks poured too much liquor into the oil decoction and became intoxicated, the Buddha no longer permitted that it be used as a drink. However, he allowed its external application as an ointment. For treatments of gastrointestinal sickness that required fatty substances, the fat from animals such as a bear, fish, alligator, pig, or donkey was permitted, but only if prepared and used at the right time. Preparing and consuming animal fat at the wrong time was regarded as a wrong action that results in the monastic dukkaṭa offense. Furthermore, any type of surgical treatment of the anal area within a distance of two inches around the anus, such as the lancing of anal fistulas and the like, was prohibited on the grounds that the skin of that area is thin and hard to treat, and a knife difficult to guide. Any such surgery was declared by the Buddha to be a monastic thulaccaya offense.29
Skin diseases such as scabs, boils, itches, smelly discharges, and the like, and various types of fever were also frequent health problems experienced by monks, and were treated with various medicines. For example, to a senior monk named Belaṭṭhasīsa, who was suffering from thick, oozing scabs that were sticking to his robes, the Buddha prescribed chunam as medicine; and to those having healthy skin he allowed the use of dry dung and clay as a preventive treatment. We also learn of Venerable Sāriputta being relieved of fever by the edible stalks of lotuses, after Mahā Moggallana, seeing Sāriputta in Jetavana grove suffering from fever for some time, departed to Lake Mandākinī, where a nāga of the lake provided him with the stalks of lotuses that pacified Sāriputta’s fever.30
In the case of an occular diseases, the use of eye ointments, such as black collyrium, rasa ointment, sota ointment, yellow ochre (geruka), and soot taken from the flame of a lamp (kapalla), were prescribed together with perfumes made of different kinds of sandalwood and fragrant flowers. Sweating by the use of herbs and hot baths mixed with medicinal herbs was prescribed for rheumatism. Larger ārāmas contained pools for such use, which were enclosed with fences made of brick, stone, or wood for the sake of privacy and donated to monks. Mustard powder and fumigation were used for sores. Oils were used for blisters on the feet and for wounds, while dung, urine, ashes, and clay were prescribed for snakebites.
The Pāli Vinaya also contains examples of various Buddhist lay devotees who procured medicine and assisted sick monks. One such lay devotee was a woman named Suppiyā, who, we are told, having gone to the monks’ ārāma, went around from vihāra to vihāra, from one monastic cell to another, asking the resident monks who among them was sick and in need of what.31
Dietary and Pharmaceutical Treatments of Digestive Problems in Pāli and Sanskrit Sources
Among all physical ailments, a poorly functioning digestive system seems to be of most concern in Pāli suttas and in noncanonical sources. As in the Vinaya, here too good digestion is to be maintained with appropriate dietary habits and is to be restored with a proper diet. Moderation in the consumption of food and drink was seen as indispensable for good health and vitality. In the Saṃyutta Nikāya, the Buddha tells this to king Pasenadi of Kosala, who was huffing and puffing after eating a bucket-size portion of rice and curries:
- When a man is always mindful,
- Knowing moderation in the food he eats,
- His ailments then diminish:
- He ages slowly, guarding his life.32
In the Bhaddāli Sutta of the Majjhima Nikāya, the Buddha gives these reasons for his good health: “Monks, I eat at a single session. By so doing, I am free from illness and affliction, and I enjoy health, strength, and a comfortable abiding.” He further instructs monks to do the same for the sake of health, strength, and comfort.33 In the Kīṭāgiri Sutta of the same Nikāya, the Buddha informs the monks in Kāsi who ate their meals at different times, in the evening, the morning, and during the day, “Monks, I abstain from eating at night. By so doing I am free from illness and affliction, and I enjoy health, strength, and a comfortable abiding.”34 In the Aṅguttara Nikāya, he expounds the five types of health benefits of eating rice porridge, one of which is a healthy digestive system. Rice porridge is said to still hunger, dispel thirst, settle wind, clean out the bladder, and promote the digestion of the remnants of undigested food.35 In the Bodhirājakumāra and Kaṇṇakatthala Suttas, faith in the Buddha’s enlightenment is given as another cause of a healthy digestive system. There, the Buddha informs a young prince and the king of Kosala, respectively, that a monk who has faith in the Tathāgata’s enlightenment becomes free from illness, has good digestion that is neither too cool nor too hot, and is able to endure the strain of practice.36
In the case of dysentery, a mixture of milk, honey, oil, and sugar was recommended.37 In the Sumangalavilāsinī, different kinds of gruels and drinks that function as purgatives are suggested to those suffering from constipation: rice gruel, a gruel of mung, a gruel to which a small amount of oil is added, milk, and a decoction of the ashes of non-husked rice.38 In the Dīgha Nikāya we find other types of purgatives, those for the lower part of the body, those for the upper part of the body, and those for the head.39 From the Aṅguttara Nikāya we learn that purgatives were also given as a preventive medicine to control the excess of wind, bile, and phlegm in the body.
Seasonal Diets and Illnesses
In the “Chapter on Healing and Illnesses” of the Suvarṇaprabhāsottama Sūtra, a physician by the name of Jatiṃdhara, fully versed in the eight branches of medicine, instructs his son Jalavāhana on the relation between the seasons and illnesses. Food and drink must be consumed in accordance with the six seasons. As the sense faculties and bodily elements change during the change of seasons, various illnesses arise. Illnesses caused by the excess of wind arise during the rainy season, disturbances of bile take place in autumn, disturbance of phlegm occur during the hot season, and the imbalance of the combination of the three humors occurs in winter. Food, drink, and medicine must be administered in accordance with the time, humoral disorder, and person. Thus, fatty, warm, salty, and sour tastes should be administered during the rainy season; in autumn, fatty, sweet, and cold tastes; and in summer, rough, warm, and bitter tastes. Excess of phlegm occurs as soon as one has eaten, excess of bile occurs during digestion, and excess of wind springs up as soon as one has digested. A strengthening medicine is for the imbalance of wind, a purgative for bile disorder, an emetic for phlegm disorder, and a medicine consisting of the three qualities is for imbalances in the combination of the three humors.40
The Buddhist medical manuscript from Gandhara known as the Bower Manuscript, named after Hamilton Bower, a lieutenant in the British Army who purchased it in 1888, contains an entire chapter dedicated to the medicinal benefits, including digestive ones, of the uses of garlic, and recipes for the preparation of foods with garlic, including the preparation of garlic with various kinds of meat. Brahmins who have traditionally been prohibited from eating garlic are advised to consume milk or milk products from cows that were fed garlic.
Surgery in Pāli Sources
The Jātaka story of the Buddha’s previous birth as a king of Sivi (XV.499) describes the surgical transplant of an eyeball performed on the king Sivikumāra by the surgeon Sīvaka. The surgeon Sīvaka is said to have brushed the king’s eye with a strong powder three times until the eyeball moved from the socket and dangled from the tendon. As the blood was trickling from the king’s eye socket, Sīvaka took the eyeball with his left hand and cut the tendon with a knife in his right hand. Having done so, he placed the eyeball into the empty socket of a blind brāhmaṇa, who was none other than the god Indra in disguise.41
In the Asilakkhaṇa Jātaka (I.126) we encounter a surgeon who performed a rhino-plastic surgery by affixing an artificial tip to the nose of a brāhmaṇa of Benares, who tested a sword made for the king of Benares by a certain smith. When the brāhmaṇa pulled out the sword from a sheath that contained some finely ground pepper and sniffed it, the pepper went up his nose and made him sneeze so violently that he slit his nose with the edge of the sword. On the king’s request, a surgeon fitted the brāhmaṇa’s nose with a false tip that was painted to look like a real nose.42
The Mahāvagga (VIII.1–36) of the Vinaya Piṭaka informs us about a surgery performed by Jīvaka, a personal physician of Bimbisāra, the king of Magadha, and also the Buddha Śākyamuni’s personal physician, on a merchant of Rājagaha, who suffered from head ailments caused by worms. Some of the merchant’s previous physicians, who could not see both worms that caused the merchant’s headaches, had prognosticated that he would die in five days, while others had prognosticated that he would die within seven days. After questioning the sick merchant, Jīvaka tied him to his bed and performed surgery by cutting through the skin, drawing apart the flesh on the each side of the merchant’s head, and pulling out the two worms, one small and one big, which were about to enter his brain within five or seven days. Jīvaka closed the wounds, stitched the skin, and anointed it with salve. We also learn of Jīvaka performing an intestinal surgery on a son of a merchant of Benares, who suffered from entangled intestines caused due to the game of tumbling, which resulted in his inability to digest any food or drink and in constipation, emaciation, and a yellow complexion. Jīvaka ordered people out of the room, drew a curtain, tied the patient to a pillar, placed his wife in front of him, and then cut through the skin of the belly, drew the twisted intestines out and disentangled them, put the intestines back into the right position, stitched the skin together, and anointed it with salve. In another instance, we read about Jīvaka curing the king Seniya, who suffered from a fistula that stained his garment with blood, for which reason he was not able to appear in public. Due to that, he also experienced sadness, since the women of his court ridiculed him, saying that the king was having his monthly periods and would give birth. Jīvaka applied a layer of ointment of the king’s fistula and removed it in one stroke with an instrument called a “nail instrument.” In the Sattigumba Jātaka, when Devadatta threw a stone, and a splinter struck and injured the Buddha’s foot, Jīvaka made his foot well.43 The Cullahaṃsa Jātaka tells the same story, but in somewhat different version: Jīvaka heals the Buddha’s foot by opening the foot with a knife, letting out bad blood, removing the extra flesh, and anointing the wound.44
We also find descriptions of other types of surgical procedures in Pāli sources, such as surgery on boils, abscesses, knotty boils, wounds, wounds from a poisonous arrow, and hydroceles. Instead of surgery on hydroceles, the Buddha suggested that a cotton wick or a bamboo tube smeared with oil or an alkaline substance be placed into the rectum of the patient. Pāli literature also sheds light on the different surgical instruments used for various types of surgical interventions, among which are five different types of needles, five types of scissors, twelve types of piercing instruments, cutting instruments, tongs, forceps, small sticks, and so on. In the commentary on the Cullavaga section of the Vinaya Piṭaka, it is said that a physician who ignoring the cause of illness, immediately takes up a surgical instrument is not a skillful physician.
Classification of Illnesses in Pāli and Sanskrit Sources
Various Buddhist Pāli and Sanskrit sources, contain different classifications of illnesses. Illnesses are most commonly classified into two general categories: physical illnesses and mental illnesses. The Mahāniddesa of the Khudaka Nikāya lists thirty-five diseases, some of which are diseases of the individual sense faculties.45 According to the Sutta Nipāta, in ancient times humans suffered from only three types of illness: desire (icchā), hunger (anasana), and senility (jarā), but due to the slaughter of animals, these three types of illness proliferated into ninety-eight types of diseases.46 In the Aṅguttara Nikāya, we find a classification of illnesses into forty-nine types narrated in the story of Girimānanda. Some of them are diseases of the eye, internal ear, nose, tongue, body, head, external ear, mouth, and teeth; cough, asthma, catarrh, pyrexia, fever, stomach ache, fainting, dysentery, grips, cholera, leprosy boils, eczema, tuberculosis, epilepsy, ringworm, itches, scabs, chickenpox, scabies, hemorrhage, diabetes, hemorrhoids, cancer, and fistulas; illnesses originating from one of the three humors or from their combination, and illnesses caused by the change of climate, by careless behavior, by assault, and as a result of karma.47
In the Garbhāvakrānti, the Buddha mentions four hundred and four illnesses, which he groups into four categories: 101 illnesses related to wind disorder, 101 illnesses related to bile disorder, 101 illnesses related to phlegm disorder, and 101 illnesses related to an imbalance in the combination of the three humors.48 Another passage of the same sūtra tells of the Buddhist tradition’s familiarity with forty-nine physical illnesses, which to some degree differ from those mentioned in the Aṅguttara Nikāya: diseases of the head, eye, ear, nose, teeth, throat, and heart, colds, abscesses, itches, leg sores, leprosy, swellings, eruptions, white leprosy, epilepsy, carbuncles, elephantiasis, fistulas, dropsy, hiccups, vomiting, fissures, diarrhea, contagious fever, intermittent fever, cough, shortness of breath, desiccation, hunger, jaundice, swelling, fat disease, bile disease, erysipelas, fever, daily fever, every-other-day fever, every-third-day fever, every-fourth-day fever, constant fever, fever in the limbs or ribs or heart, and ache in the limbs, in the ribs, in the heart, and in the collar bone.49
Etiology of Illnesses in Pāli and Sanskrit Sources
According to the Cakkavatisīhanāda Sutta of the Dīgha Nikāya, the gradual deterioration of the lifespan from a time of prosperity to the last days of the kali-yuga is a consequence of unethical living: of greed, stealing, lying, killing, and so on.50 In the Milindapañha, when speaking about untimely death, Nāgasena lists eight causes of illness and death: an excess of wind, an excess of bile, an excess of phlegm, the unfavorable combination of these three humors (dosa), changes in temperature, inequality of protection, medical treatment, and karma. Death caused by karma is said to be the only timely death.51 In another passage, Nāgasena gives a somewhat different list of the eight causes of illness: excesses of wind or bile or phlegm, an imbalance of their combination, changes in temperature, inequality of protection, external agency, and karma. According to him, not all diseases are caused by karma, because if this were the case, individual illnesses would lack distinct characteristics by which they can be differentiated from one another. For instance, a disturbance of the wind humor is brought about under the influence of one of these ten factors: cold, heat, hunger, thirst, overeating, standing for a long time, overexertion, walking too fast, medical treatment, and karma. Imbalances of the bile humor are caused by cold, heat, or wrong food, and disturbances of phlegm by cold, heat, food, and drink. One cannot say that all illnesses are caused by karma because, apart from karma, all other causes of disease occur in the present life. A disturbance of one of the three humors or of their combination manifests as an illness with distinctive characteristics that distinguish it from illnesses caused by other factors. Illnesses that arise as the result of karma are said to be fewer in number than those that arise from other causes.52 With regard to the Buddha Śākyamuni, Nāgasena assures King Milinda that the Buddha’s physical pain was never a result of his karma or of an attack through some karmic adversity. Instead, it resulted from the other six aforementioned causes of illness, which could not deprive him of his life.53 Also, in the Saṃyutta Nikāya (IV.230) we find the idea that all of one’s painful experiences are due to karma being refuted. The list of types of illness given there corresponds to the previously mentioned eight causes of illness: diseases originating from the disturbance of one of the three humors, from the imbalance of their combination, due to the change of seasons, due to careless behavior, due to assault, and due to karma.54 However, in the Cūḷākammavibhanga Sutta of the Majjhima Nikāya, we read that those who abstain from injuring beings with the hand, clod, stick, or knife will possess health in the next life, whereas those who injure beings in the aforementioned ways will be reborn sick.55 Thus, a connection between a person’s previous actions and sickness is made clear here. In the much later Pāli Abhidhamma work, Abhidhammatthavibhāvinī, a commentary on Anuruddha’s Compendium of the Topics of Abhidhamma (Abhidhammatthasaṅgaha, the 11th–12th centuries), Sumaṅgala speaks of a “destructive” karma, which interferes with the causes of disease or with the balance of the three humors and thereby obstructs the prolonged activity of a result of another, wholesome karma. He also informs us of a different view, according to which it is an “obstructive” type of karma that brings together the conditions for many diseases and thus interferes with the results of wholesome karmas.56
In the Garbhāvakrāntisūtra, a different etiology of diseases is given. There the Buddha speaks of 80,000 types of worms that arise in the body a week after one is born. Here we also find a detailed list of the names of those worms and their specific locations in different parts of the body. Feeding on the body day after day throughout one’s life, they afflict, torment, weaken, and sicken the body. Therefore the body experiences mental illness, exhaustion, and torment, which even physicians do not know how to cure. Moreover, thirty-two malevolent graha demons come to the person, causing insanity and other forms of suffering.57
Diseases Caused by Nonhuman Agents in Pāli Sources
In the Mahāvagga section of the Vinaya Piṭaka, a monk is inflicted by illness caused by a nonhuman entity and is unable to recover despite all the care received from his teacher and his superior. While under the influence of spirit possession, he went to a place where pigs were slaughtered, and he consumed their raw flesh and blood. As the result of this, his illness diminished. The Buddha, having learned this, allowed for the use of raw flesh and blood when a disease is caused by nonhumans.58 For recovery from a disease inflicted by a nonhuman entity, the Samantapasādikā recommends a medicine consisting of the seven ingredients (sattavidha-odissaṃ)—flowers of Bassilia latifolia, plantain, date, mango, breadfruit, jackfruit, and tamarind—which a patient can take for seven days at any time.59 In another instance, at a time of famine when monks ate serpents, the serpent king Supassa, having approached the Buddha, warns him of the possible revenge of serpents antagonistic to the Buddha Dharma that could harm monks on any occasion.60
Medical Training and Divisions of Medical Knowledge in Pāli and Sanskrit Sources
The Milindapañha tells of the ways in which someone became an apprentice to a physician and what kind of training the apprentice had to undergo in order to become a skillful physician or surgeon. After acquiring a teacher through payment or through service, the apprentice was trained in holding the lancet, in cutting, marking, and piercing with it, in extracting darts, in cleaning and drying wounds, in the application of ointments, and in the administration of various emetics and enemas.61 When speaking of the past great teachers of medicine who were well versed in medical knowledge, Nāgasena mentions the four types of medical knowledge: the knowledge of the onset of disease and its cause, of the nature and progress of disease, of its cure and treatment, and of cured and uncured disease.62
In the Mūlasarvāstivāda Vinaya, the Buddha lists the four areas in which a physician should be skilled: disease, the symptoms of disease, the removal of an arisen disease, and the prevention of a disease’s reoccurrence after it has been removed.63
While medical services were valued in early Buddhism, they were not considered the proper livelihood for monks. In the Brahmajāla Sutta of the Dīgha Nikāya, we are told that for śrāmaṇas who live on the donations of their lay devotees, making a living by practicing medicine in the form of administering emetics, purges, expectorants, or ointments for the ear or eye or nose, performing surgeries, practicing pediatrics, and using balms to counteract the side effects of previous medicine are base arts and wrong means of livelihood.64 A similar view is also presented in the Pāli Vinaya.
Similarly, the Mūlasarvāstivāda Vinaya allows for monks competent in medicine to administer sedatives to their lay donors only in the case of emergency, when a physician is unavailable, or in secrecy, without the knowledge of the laity. A monk who would administer medicine to his donor publicly would be guilty of a misdeed. However, the Vinaya permits physician monks to administer medicines and to give dietary advice to lay people who seek their consultation.65
A Physician and the “King of Medicine”
In Pāli literature, the medical profession is listed as one of twenty-one professions, and three types of healers are mentioned: a physician (bhisaka), a surgeon (sallakatta), and an exorcist (bhūtavejja).66
In the Pāli tradition, Jīvaka, referred to as a “king of medicine,” stands out as the paradigmatic example of a superb physician. He sees medicinal properties in everything he can find in his natural environment, he respects medicinal substances, he cures chronic illnesses that other physicians cannot, and he shows ingenuity. We read in the Mahāvagga of the Vinaya Piṭaka that while still a student of medicine in Takkasilā (Taxila), Jīvaka was asked by a physician under whom he studied to take a spade and examine a distance of a yojana on every side of Taxila and to bring him whatever he saw as devoid of medicinal properties. Having returned empty handed, Jīvaka reported that he could not find anything lacking medicinal properties.67 As a skilled physician, he successfully treated a laywoman who suffered for seven years from migraines by administering a handful of ghee boiled with various medicines through her nose and out her mouth; he also cured the king Pajjota of Ujjeni from jaundice despite all the previous treatments that the king had received from other physicians who had failed. Jīvaka offered him a drink of boiled ghee. But since the king had an aversion to ghee, Jīvaka boiled the ghee with various medicines to give it the color, smell, and taste of an astringent medicine, which acted as a laxative. Moreover, when on one occasion the Buddha became ill due to a disturbance of the three humors and requested a purgative from Jīvaka, Jīvaka recommended that Ānanda rub the Buddha’s body with fat for a few days. After Ānanda did so, Jīvaka thought that it may not be appropriate to give a strong purgative to the Buddha, and therefore he mixed three handfuls of blue lotuses with various medicines and offered them to the Buddha, which were to purge him thirty times. Quickly realizing that the purgative he gave would purge the Buddha’s body only twenty-nine times, he advised the Buddha to take a warm bath that would purge him one more time and to abstain from liquid foods. In this way, we are told, he fully restored the Buddha’s health.68
In contrast to the Mahāvagga, in the Mūlasarvāstivāda Vinaya, after receiving the title of the “king of physicians” for the third time and prior to becoming a follower of the Buddha, Jīvaka came across as an arrogant man, claiming, “There is no doctor whatsoever who is equal to me. [Just as] I am the foremost among physicians of the body, so too is the Blessed One foremost among physicians of the mind.”69 The Buddha, having noticed Jīvaka’s arrogance and his inability to grasp certain truths because of it, showed him the Himālayas and introduced him to numerous medicinal plants, demonstrating the superiority of his knowledge of medicine to that of Jīvaka. Lauding Jīvaka as the one endowed with the four qualities of a physician, who is worthy of a king and suitable to be a king’s physician, the Buddha instructs Jīvaka in the Four Noble Truths and makes him his follower.70
Patients, Caregivers, and Infirmaries
In the Aṅguttara Nikāya, the Buddha speaks of three types of patients: (1) a patient who does not recover from his illness whether or not he or she is given the appropriate food and medicine, (2) a patient who recovers from his illness whether or not he or she receives the appropriate food and medicine, and (3) a patient who recovers only when he or she receives the appropriate food and medicine and has a qualified caregiver. The Buddha further asserts that since there are patients who recover when they are provided with suitable food and medicine, and with a qualified caregiver, therefore other patients must also be assisted in this way.71 In the same Nikāya, the five types of difficult patients and the five types of easy patients are described. A difficult patient is one who does what is harmful, who does not observe moderation in what is beneficial to his health, who does not take his medicine, who does not accurately disclose his symptoms, and who does not report whether his condition is getting better or worse or remains unchanged. In contrast, an easy patient is the one who, in each case, does the opposite of the aforementioned difficult patient. An easy patient also patiently endures painful and harrowing bodily pains, which deplete his vitality.72
As for caregivers, an unqualified caregiver is said to be a person who does not know how to prepare medicines, who does not recognize what is beneficial and harmful and hence offers to the patient that which is harmful, who attends to the patient for the sake of material reward and not out of loving kindness, who feels disgust at having to remove the patient’s bodily fluids (feces, urine, vomit, and spittle), and who is unable to encourage, inspire, instruct, or gladden the patient with a Dharma talk. In contrast, a qualified caregiver is a knowledgeable person who acts out of loving kindness and in the ways contrary to those of a bad caregiver.73
The story of a monk with dysentery in the Kucchivikavatthu of the Vinaya tells of the Buddha Śākyamuni coming across a monk sick with dysentery and lying in his own urine and excrement. Together with his attendant Ānanda, the Buddha proceeds to bathe him. He asks the sick monk and later the community of monks why no one has helped the sick monk. The explanation is that since the sick monk did not do anything for others, no one did anything for him. Thereafter the Buddha addresses the monks, telling them, “If you do not tend to one another, who then will tend to you? Whoever would tend to me, he should tend to the sick . . . If he has a preceptor (upajjhāya), the preceptor should attend to him until he recovers. If he has a teacher (ācāriya) or a fellow student, they should attend to him until he recovers. And if he does not have any of these, the saṅgha should attend to him, and whoever does not so will be guilty of dukkaṭa.”74
In the commentary on the Mahāvagga section of the Vinaya Piṭaka, monks are instructed to assist a sick monk in five ways: to serve the sick monk food, to give him medicine, to serve food to the person who looks after a sick monk, to inquire about the sick monk’s health, and, if needed, to serve him and his attendant personally.75 A sick monk is exempted from receiving exhortation and from the prohibition against eating food at the wrong time, he can have a meal as often as he feels hungry, he is carried on the shoulders of other monks, and he is allowed to eat a ball of honey after his meal. According to the Cullavagga, a sick monk is permitted to use an umbrella, to use a stick if he cannot walk, to tie a string to his begging bowl and wear it on his shoulder, and to wear sandals. If he has fallen on the ground due to weakness he should not be asked to get up, he should be given a good bed, he is allowed to use a scrubber if suffering from scabs, he is permitted to eat garlic for abdominal aches, and so on. According to the Samantapasādikā, one suffering from a fistula or a similar disease that involves oozing of blood should be given a chamber pot; a monk suffering from excess of phlegm should be given a spitting box; a leper who stains a sitting place should be moved to a leafy cottage, but if a sick monk does not stain a sitting place, he can be given a bed; and monks undergoing a purgative treatment, a nasal wash, or other similar treatment must be provided with a comfortable seat and sleeping accommodations.76
Indian Buddhist scriptures give us scarce but valuable information about the nurseries that housed the sick. One was a house of the sick (gilaṇasāla), where sick monks dwelled; another was a house of the destitute (anāthasālā), where criminals who were punished with mutilation of the limbs, nose, ears, and other bodily parts lay destitute, with pus and blood trickling from wounds covered with flies and worms. According to the Vibhanga Aṭṭhakathā, those in a house of the destitute also suffered mentally, experiencing great sadness when seeing the cheerful and colorfully dressed passersby.77 The Sumangalavilāsinī speaks of compassionate people who provided medicine and bandages for those in a house of the destitute.78 Reference to such houses in Vesali and Rājagaha are found in a number of Pāli commentarial texts.
Medicine in Indian Vajrayāna Buddhism
In addition to Buddhist tantras, a number of medical treatises, such as the Yogaśataka Jīvasūtra, Avabheṣakalpa, Āryarājanāmavaṭīkā, Āryamūlakośamahauṣadhāvalī, Rasaratnākāra, and Kakṣapuṭa, which are traditionally attributed to a certain Nāgārjuna, serve as useful sources for the study of the medical knowledge and practices of the later phase of Buddhism in India. Buddhist tantric literature deals with human physiology and the physiological aspects of illness, medicinal formulas, and medical treatments that accord with Āyurveda. But it also informs us of the preparations and usages of alchemical substances, drawings of yantras and maṇḍalas, ritual performances, astrological divinations, and applications of protective and healing mantras as additional therapeutic methods. Although the usage of dhāraṇīs and mantras for healing purposes was also prescribed in some Mahāyāna treatises, in the Buddhist tantric tradition, they became more profusely applied. Likewise, alchemy and rites of healing were in practice by the time of the emergence of Buddhist tantras. The Buddhist tantric preoccupation with the preservation of a yogī’s body facilitated the development of yogic methods of rejuvenation, which included various yogic techniques of the manipulation of vital energies (prāṇas), the ingestion of life-giving essences extracted from various substances, the ingestion of tonics and elixirs prepared through alchemical processes, and rituals of longevity. According to the Buddhist tradition in general, the optimal lifespan of the individual is said to be one hundred years.
The Kālacakratantra (11th century ce), paying close attention to the correspondences between the body and the cosmos explains the process of bodily deterioration that takes place over the course of one hundred years in this way: the bodily elements undergo a process of maturation that lasts ninety-six years and ten and a half months. For the first thirty-two years and three and a half months, the vital energies (prāṇa) in the body are dominated by the quality of sattva (luminosity, intelligibility); for the next thirty-two years and three and a half months, the vital energies are dominated by the quality of rajas (activity, passion); and for the last thirty-two years and three and a half months, the vital energies are dominated by the quality of tamas (darkness, inertia). Over the course of the remaining three years, three fortnights, and three days, the vital energies gradually cease circulating, as the bodily cakras begin to collapse. In this way, the vital energies leave the bodily elements, causing their sequential dissolution that results in death. This division of the human lifespan of ninety-six years and ten and a half months is said to correspond to the length of time it takes the eight planets to move through the circle and half of the twenty-seven constellations (nakṣatra).79 As the planets govern certain zodiacal houses as their respective fields, they also preside over the elements carried by the vital energies that circulate through the left and right sides of the body. All physical and mental ailments are ultimately brought into existence by the power of time that is of the nature of death. From the moment of conception in the womb, time, in the form of malefic lunar days, assembles in the joints, knuckles, and other parts of the body due to the efficacy of the elements, and it seizes the person in its merciless grip.
In this tantric system, the elemental nature and medicinal qualities of medicinal plants depend on the time of year in which certain medicinal plants grow and on the geographical areas in which particular medicinal substances are found. Moreover, seasons and geographical areas, in turn, correspond to the nature of particular constellations, planetary positions, and the time of their influence on specific regions of the earth.
The second chapter of the Kālacakratantra, the “Chapter on the Individual,” contains a long section on medicine, which concerns itself with a variety of illnesses, their causes, and methods of healing that a tantric adept should know.80 Among various means of the prevention and cure of diseases are offering rites, mantra recitations, drawing of yantras and maṇḍalas, and the initiation of a patient into the maṇḍala. All of these are prescribed for dealing with illnesses caused by malevolent entities, and for poisonous snakebites. We find here a detailed list of various types of evil spirits and the illnesses that they cause. Some of them are yakṣas, grahas, rākṣasas, piśācas, and evil nāgas, who take delight in human blood, as well as ḍākinīs, rūpikās, vampire ghouls who feed themselves in cemeteries (kumbhāṇḍa), land protectors (ksetrapāla), gaṇapatis, pretas, goblins, the lords of ḍākinīs who cause epilepsy, and mātṛkās who seize infants. When appeased with prayers and offerings, they can grant well-being. However, they are not able to ward off death when the symptoms of irrevocable death appear. Therefore, the rites of pacification of these entities should not be performed at that time. Moreover, carrying on the body gems of various colors is considered to be a protection from the aforementioned types of malefic entities. For instance, a gem of the color red, made of substances dominated by the fire element, is believed to prevent evil spirits form possessing a person’s body, while a gem made of substances in which the space element is dominant is believed to ward off the casting of an evil eye.81 At other times, certain herbal medications empowered by mantras are administered to those possessed by malevolent spirits to alleviate the symptoms of their illness. For example, when a pregnant woman suffers from sharp uterine pains caused by malevolent spirits, she is to be given pounded kuṣṭha, uśīra, kaseru grass, tagara, blue waterlily (keśara), and the filament of a lotus with cold water, all of which are consecrated by mantras and vajras.
Tantric medicinal mantras are of three general types: protective mantras, supplicatory mantras, and consecratory mantras. In many instances, one mantra performs multiple functions. For instance, in treatments of malignant diseases characterized by fever and joint pains, the single mantra “oṃ phre vajra” is said to simultaneously empower medicinal ingredients and to protect the patient’s cakras in the body.82 One also finds here references to haṭha-yoga, to various yogic postures, and to breathing techniques as therapeutic methods. The vajra posture (vajrāsana) is recommended for the elimination of backache, the head-stand posture (śīrṣāsana) for phlegm-related illness, and the vase technique of breathing (kumbhaka) for the alleviation of abdominal ailments, leprosy, and other similar diseases. A patient afflicted by leprosy is advised to practice the kumbhaka for a period of six months, in which he should retain seminal fluid during sexual intercourse.83
Methods of treatment are chosen based on the symptoms of a disease, the occasions of its occurrence, and the knowledge of its cause. For example, bodily convulsions, sharp ocular pains, a yellowish complexion of the face, arms or legs, a distinctively yellow color of the urine, fever, vomiting, emaciation, and fainting are seen as symptomatic of a disease afflicted upon small children by cruel spirits. In that case, the sick child must be treated with ritual oblation in the maṇḍala. A sick child afflicted by graha demons must be bathed in the five ambrosias (amṛta): water, milk, sour milk, ghee, honey, molasses, and fragrant water that have been kept in seven unbaked vessels.84
In the case of illnesses caused by other factors, such as disequilibrium of the three humors, external factors, poor hygiene, inadequate diet, and the like, applications of different medicinal herbs are recommended. For instance, the application of slightly warmed akṣobhya in the mouth is prescribed for an infection of the mouth; anointing the neck with karkoṭī, lāṅgalī, and indrī is recommended for the inflammation of the glands in the neck, and so on. Dietary therapy, hydrotherapy, massage, nasal inhalations, fumigation, anointing with oils, and consumption of medicaments are also included in the Kālacakratantra’s therapeutics. Medicinal substances are chosen and prescribed according to their tastes arising from the elements that constitute them. Each among the five elements and its corresponding taste have their unique, individual efficaciousness. For example, a medicinal substance with a bitter taste, combined with three myrobalans (kaṭuka), is said to obliterate disorders of phlegm. Therefore, goat’s milk, which has a somewhat bitter taste, when combined with the three myrobalans, is prescribed to those suffering from phlegm-related disorders. Sweet and astringent substances are said to eliminate bile disorders, thus buffalo-cow’s milk is given to those suffering from bile-related illnesses; camel’s milk, combined with rock salt, becomes alkaline and thereby can cure wind-related disorders. For the treatment of boils, pustules, and similar skin disorders, fumigation with ghee and sea salt wrapped in a cloth and anointing with the sap of the arka plant are recommended. For infections of the ear and eye, warm urine is to be applied in the ear and cold urine in the eye. A person suffering from sunstroke must be treated with a decoction made of medicinal herbs, powder, and leaves.
Although the intimate connection between the mind and body has been recognized in Indian Buddhism in general, it was given great significance in Indian Buddhist tantras, which contain detailed and intricate accounts of the mutual effects of the body and mind. This is reflected not only in the prescribed Varjayāna religious practices but also in the medical ones. Therefore, practices such as meditation and visualization of tantric deities are often prescribed to yogīs as healing practices that accompany the administering of medicine. A yogī suffering from throat cancer is advised to abide in meditative concentration (samādhi) in order to pacify severe pain. The procedure is described in this way: while practicing prāṇāyāma, he is to visualize in his heart chakra Viśvamātā, the consort of Kālacakra, appearing as a stainless moon, seated in the vajra posture, having one face and two arms, with her hands in the wish-granting gesture and holding a lotus.85
Review of the Literature
In comparison to the number of works written on Hindu Āyurveda, literature on Indian Buddhist medicine is remarkably meager. One reason is that Hindu Āyurveda is still in practice. Buddhist medicine that is studied and practiced today in India is primarily Tibetan medicine, which has its roots in Indian Buddhist Āyurveda. Another reason is that many original Sanskrit works that are a valuable resource for the study of Indian Buddhist medicine are no longer extant in Sanskrit but preserved in Tibetan and Chinese translations. So far, there has not been a single, comprehensive, scholarly work on Indian Buddhist medicine produced. The available works tend to focus on a specific subject matter, on particular Buddhist text, or on texts composed within a specific period in the history of Buddhism in India. Secondary sources on Indian Buddhist medicine primarily comprise short articles, small sections within survey volumes, and a very small number of books, most of which are published in India. Moreover, so far, the focus has been on the information provided in Pāli sources and rarely on Sanskrit texts. To my knowledge, Zysk’s Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery dedicates one chapter to Buddhist medicine in India in his partial examination of the evolution of classical Indian medicine, and dedicates two chapters to a discussion the materia medica and narratives of treatments in the context of early Buddhist monastic medicine, based on Pāli literature. Kritzer’s Garbhāvakāntisūtra: The Sūtra on the Entry into the Womb is a study and translation from Tibetan of the original Indian Mahāyāna text, which describes the conception, gestation, birth, and sufferings of a newborn child. Although a religious text, the Garbhāvakāntisūtra contains certain sections on medical knowledge of embryology, human anatomy, gynecology, and obstetrics. One finds here how medical knowledge of the mentioned areas is utilized to bring the reader to the realization of the First Noble Truth of suffering and to instigate one’s desire for a renunciation of the world and escape from cyclic existence. In his article “Life in the Womb: Conception and Gestation in Buddhist Scripture and Classical Indian Medical Literature,” Kritzer offers a brief comparative analysis of the views on conception expounded in select Hindu and Jaina religious texts, the Garbhāvakrāntisūtra and the Carakasaṃhitā. In this article he points out not only the main differences among the various theories of conception but also a similarity between these two texts, which take an epigenetic model of fetal development. In the Science of Medicine and Surgery in Buddhist India, Talim gives an overview of various types of medicine, including contraceptives, and diseases mentioned in Pāli and Sanskrit sources. The most interesting sections in this book are those describing surgical procedures for eleven types of illnesses, seventy-one surgical instruments, and accompanying illustrations of surgical instruments. In the “The Buddhist Tantric Medicine in the Kālacakratantra,” Wallace addresses theoretical foundations and syncretistic features characteristic of Indian Buddhist tantric medicine as expounded in the Kālacakratantra. In “A Convergence of Medical and Astro-Sciences in Indian Tantric Buddhism: A Case of the Kālacakratantra,” Wallace shows medical applications of astrology in this Indian Buddhist tantra and the merging of these two disciplines of Buddhist knowledge. The Kālacakratantra: The Chapter on the Individual together with the Vimalaprabhā, translated by Wallace, contains the rich information on the Buddhist tantric understanding of the subtle body, physiology, embryology, anatomy, and therapeutics.
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The Dhammapada. Translated by John Ross Carter and Mahinda Palihawadana. New York: Oxford University Press, 1988.Find this resource:
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Garbhāvakrāntisūtra: The Sūtra on Entry into the Womb. Translated by Robert Kritzer. Studia Philologica Buddhica 31. Tokyo: International Institute of Buddhist Studies, 2014.Find this resource:
The Jātaka or Stories of the Buddha’s Former Births, vol. 1. Translated by Robert Chalmers. Cambridge, UK: Cambridge University Press, 1895.Find this resource:
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(1.) For the content of inscriptions, see Keishō Tsukamoto, Indo bukkyō himei no kenkyū, part 1 (Tokyo: Sanhibo Busshorin, 1996), 523; James Burgess, Report on Buddhist Cave Temples and Their Inscriptions: Being Part of the Result of the Fourth, Fifth, and Sixth Seasons’ Operations of the Archeological Survey of Western India: 1876–77, 1877–78, 1878–79 (Varanasi: Indological Book House, 1964), 84, no. 5, plate XLIV; and H. Lüders, “A List of Brahmī Inscriptions from the Earliest Times to About A.D. 400 with the Exception of Those of Aśoka., in Epigraphica Indica and Record of the Archaeological Survey of India, 10: Appendix: 1–212 137.1191 (Calcutta: British India, 1909).
(2.) For instance, the names of Dhanvantari (a teacher of the Suśruta Saṃhitā), of his disciples Vetaraṇi and Bhoja, Aṅgirasa (who is mentioned in the Caraka Saṃhitā), Nārada (who is referenced in the Caraka Saṃhitā), and so on.
(3.) The Dhammapada, trans. John Ross Carter and Mahinda Palihawadana (Oxford: Oxford University Press, 1987), chap. 15, v. 204: 257.
(4.) The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Boston: Wisdom Publications, 2012), 681, 711, 742, 749.
(5.) The Connected Discourses of the Buddha: A New Translation of the Saṃyutta Nikāya, vol. 1, trans. Bhikkhu Bodhi (Boston: Wisdom Publications, 2000), 853.
(6.) Garbhāvakrāntisūtra: The Sūtra on Entry into the Womb, ed. Robert Kritzer, Studia Philologica Buddhica Series 31 (Tokyo: International Institute for Buddhist Studies, 2014), 87.
(7.) The Long Discourses of the Buddha: A Translation of the Dīgha Nikāya, trans. Maurice Walshe (Boston: Wisdom Publications, 1995), 486; and The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Boston: Wisdom Publications, 2012), 686–687.
(8.) The Numerical Discourses of the Buddha: An Anthology of Suttas from the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Walnut Creek, CA: AltaMira, 1999), 135; and The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Boston: Wisdom Publications, 2012), 1429.
(9.) The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Boston: Wisdom Publications, 2012), 522.
(10.) Vimalaprabhāṭīkā of Kalki Śrī Puṇḍarīka on Śrī Laghukālacakratantrarāja by Śrī Mañjuśrī, vol. 1, ed. Jagannatha Upadhyaya. Bibliotheca Indo-Tibetica Series 11 (Sarnath, Varanasis: Central Institute of Higher Tibetan Studies, 1896), chap. 2, v. 107, lines a–b, 228.
(11.) The Questions of King Milinda, vol. 2, trans. Thomas William Rhys Davids. The Sacred Books of the East 36, (1963), IV.5.8: 8, IV.5.10: 10, IV.6.26: 65, V.11: 218, V.12: 219.
(12.) The Sutta-Nipāta, trans. H. Saddhatissa (London: Curzon, 1985), 66.
(13.) Abhidharmakośabhāṣyam of Vasubandhu, vol. 3, trans. Louis de la Vallèe Poussin. (Berkeley, CA: Asian Humanities, 1991), 1033. The Poussin version is in French; the English version was translated by Le M. Pruden.
(14.) Saddharmapuṇḍarīka Sūtra, ed. P. L. Vaidya (Darbhanga: Mithila Institute, 1960), 93.
(15.) The Numerical Discourses of the Buddha: An Anthology of Suttas from the Aṅguttara Nikāya, trans. Bhikkhu Bodhi (Walnut Creek, CA: AltaMira, 1999), 251–253.
(16.) The Connected Discourses of the Buddha, vol. 2, 1582.
(17.) The Connected Discourses of the Buddha, vol. 2, 1636.
(18.) The Connected Discourses of the Buddha, vol. 2, 1757–1758.
(19.) The Connected Discourses of the Buddha, vol. 2, 1816–1820.
(20.) The Connected Discourses of the Buddha, vol. 2, 1834–1836.
(21.) The sūtra is of uncertain date. Its earliest references are found in the Śatasāhasrikāprajñāpāramitā Sūtra and in the Mañjuśrīmūlakalpa.
(23.) Vinaya Texts, part 2, trans. Thomas William Rhys Davids and Herman Oldenberg (Delhi: Motilal Banarsidass, 1982), VI.1.2–VI.40.3: 41–145.
(24.) In the example given in Vinaya Texts, part 2, VI.1.2–VI.17: 68–69, the Buddha rebukes Ānanda for keeping the ingredients for a gruel and cooking it indoors of his own accord and instructs the monks, saying, “Whatever is kept indoors, O Monks, or cooked indoors, or cooked of your own accord, is not be eaten.” But at the time of food shortages, he gave permission to monks to ignore this prohibition.
(25.) In the Bhaiṣjyavastu section of the Sarvastivāda Vinaya, III.1.3, fresh butter is replaced by sugar molasses (śarkarā), and the five medicines are collectively called “saptāhikāni,” or “allowed for the period of seven days.”
(26.) Vinaya Texts, part 2, VI.1.2–VI.14: 55–61.
(27.) Mahāvagga, vol. 1, ed. Jagadīśa Kāśyapa, Nālandā Devanāgarī Pāli Series (Bihar, India: Pāli Publication Board, 1959), 234–235.
(28.) The mentioned astringent substances are nimba (Azadirachta Indica), kuṭaga (Wrightia anti-dysenterica), pakkava (a type of a creeper), nattamāla (Pongania Glabra), etc. Salts include sea salt, black salt, rock salt, red salt.
(29.) Vinaya Texts, part 2, VI.1.2–VI.22: 78–80.
(30.) Vinaya Texts, part 2, VI.1.2–VI.20: 76–77.
(31.) Vinaya Texts, part 2, VI.1.2–VI.23: 80–81.
(32.) The Connected Discourses of the Buddha, vol. 1, 176.
(33.) The Middle Length Discourses of the Buddha: A Translation of the Majjhima Nikāya, trans. Bhikkhu Ñānamoli and Bhikkhu Bodhi (Boston: Wisdom Publications, 2001), 542.
(34.) The Middle Length Discourses of the Buddha, 577–578.
(35.) The Numerical Discourses of the Buddha: An Anthology of Suttas from the Aṅguttara Nikāya, 821–822.
(36.) The Middle Length Discourses of the Buddha, 707, 736.
(37.) The Majjhima Nikāya, vol. 1, ed. V. Treckner (Oxford: Pali Text Society, 2000), 378.
(38.) Buddhaghosa, Sumangalavilāsinī Dīghanikāya-aṭṭakathā, vol. 2, ed. Mahesh Tiwari (Nalanda: Nalanda Mahavihara, 1975), 215.
(39.) Dīgha Nikāya, vol. 1, ed. Thomas William Rhys Davids (Oxford: Pali Text Society, 1950), 61.
(40.) The Sūtra of Golden Light (Suvarṇaprabhāsottamasūtra), trans. R. E. Emmerick (Oxford: Pali Text Society, 2004), 75–80.
(41.) The Jātaka or Stories of the Buddha’s Former Births, vol. 4, trans. W. H. D. Rouse, ed. E. B. Cowell (Cambridge, UK: Cambridge University Press, 1901), 250–256.
(42.) The Jātaka or Stories of the Buddha’s Former Births, vol. 1, trans. Robert Chalmers, ed. E. B. Cowell (Cambridge, UK: Cambridge University Press, 1895), 277–280.
(43.) The Jātaka or Stories of the Buddha’s Former Births, vol. 4, 267–270.
(44.) The Jātaka or Stories of the Buddha’s Former Births, vol. 5, trans. H. T. Frances, ed. E. B. Cowell (Cambridge, UK: Cambridge University Press, 1905), 175–185.
(45.) Niddesa I. Mahāniddesa, vol. 1, ed. H. Milford (London: Pali Text Society, 1916), 13.
(46.) The Sutta-Nipāta, 34, v. 311.
(47.) The Numerical Discourses of the Buddha: An Anthology of Suttas from the Aṅguttara Nikāya, 1412–1413.
(48.) Garbhāvakrāntisūtra: The Sūtra on Entry into the Womb, 86.
(49.) Garbhāvakrāntisūtra: The Sūtra on Entry into the Womb, 86.
(50.) The Long Discourses of the Buddha: A Translation of the Dīgha Nikāya, 395–405.
(51.) The Questions of King Milinda, part 2, IV.8.41: 164, IV.8.44: 168.
(52.) The Questions of King Milinda, part 1, IV.1.62–63: 191–192.
(53.) The Questions of King Milinda, part 1, IV.1.66: 193–194.
(54.) The Connected Discourses of the Buddha, vol. 2, 1279.
(55.) The Middle Length Discourses of the Buddha, 1054.
(56.) Summary of the Topics of Abhidhamma (Abhidhammatthasaṅgaha) by Anuruddha and the Exposition of the Topics of Abhidhamma (Abhidhammatthavibhāvanī) by Sumaṅgala Being a Commentary to Summary of the Topics of Abhidhamma, trans. R. P. Wijeratne and Rupert Gethin, Sacred Books of the Buddhists 50 (Oxford: Pali Text Society, 2002), 173–174.
(57.) Garbhāvakrāntisūtra, trans. Robert Kritzer, Studia Philologica Buddhica 31 (Tokyo: International Institute of Buddhist Studies, 2014), 75–80.
(58.) Vinaya Texts, part 2, VI.1.2–VI.10: 49.
(59.) Meena Talim, Science of Medicine and Surgery in Buddhist India (Delhi: Buddhist World, 2009), 65, 58–59.
(60.) Vinaya Texts, part 2, VI.1.2–VI.23: 86.
(61.) The Questions of King Milinda, part 2, VI.12: 255.
(62.) The Questions of King Milinda, part 2, IV.7.20: 109.
(63.) Nalinaksha Dutt, ed., Gilgit Manuscripts (Srinagar-Kashimir: Calcutta Oriental, 1942), III.2: 45.3.
(64.) The Long Discourses of the Buddha: A Translation of the Dīgha Nikāya, 73. See also Dialogues of the Buddha, vol. 1, 25.
(65.) Paul Demièville, Buddhism and Healing: Demiville’s Article “Byo” from Höbögirin (1937), trans. Mark Tatz (Lanham, MD: University Press of America, 1985), 38.
(66.) The Milindapañha, Being Dialogues between King Milinda and the Buddhist Sage Nāgasena, ed. V. Trenckner (London: Williams and Norgate, 1880), I.45. See also Jyotir Mitra, A Critical Appraisal of Āyurvedic Material in Buddhist Literature with Special Reference to Tripiṭaka (Varanasi: Jyotiralok Prakashan, 1985), 25.
(67.) Vinaya Texts, part 1, VIII.1.7: 175.
(68.) Vinaya Texts, part 1, 8–33: 175–193.
(69.) Dutt, III.2: 43.
(70.) Dutt, III. 44.19–45.2.
(71.) The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, 217.
(72.) The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, 741–742.
(73.) The Numerical Discourses of the Buddha: A Translation of the Aṅguttara Nikāya, 741–742.
(74.) Vinaya Texts, part 2, VIII.26: 240–243.
(75.) Buddhaghosa, Vinayapiṭake Paccitīya Mahāvagga-Aṭṭhakathā (Igatapuri: Vipaśyanā Viśodhana Vinyāsa, 1998), 56.
(76.) Buddhaghosa, Samantapasādikā-nāma Aṭṭhakathā, vol. 3, ed. Nathmala Ṭāṭiyā (Nalanda: Nava Nālandā Mahāvihāra, 1965), 1306.
(77.) Buddhaghosa, Abhidhammapiṭake Sammohavinodinī-nāma Vibhanga-aṭṭhakathā, Dhammagiri-Pāli-Ganthamālā 126 (Igatapuri: Vipassanā Research Institute, 1998), 98.
(78.) Buddhaghosa, Sumangalavilāsinī: Dīghanikāya-aṭṭakathā, vol. 1, ed. Mahesh Tiwari (Nālandā: Nava Nālandā Mahāvihāra, 1974), 222.
(79.) Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, ed. Jagannatha Upadhyaya (Sarnath, Varanasi: Central Institute of Higher Tibetan Studies, 1986), chap. 1, vv. 65, 108–109, lists the moon, the sun, Mars, Jupiter, Venus, Mercury, Saturn, and Ketu as eight planets.
(80.) Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, vv. 228–255.
(81.) Vimalaprabhāṭīkā of Kalkin Śrīpuṇḍarīka on Śrīlaghukālacakratantrarāja by Śrīmañjuśrīyaśas, vol. 3, ed. Vrajavallabh Dwivedi and S. S. Bahulkar, Rare Buddhist Texts Research Project (Sarnath, Varanasi: Central Institute of Higher Tibetan Studies, 1994), chap. 5, vv. 187, 128; and The Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, vv. 154–160, vv. 253–255.
(82.) Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, vv. 129: 237.
(83.) Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, vv. 129, 127, 122: 233, 237–238.
(84.) The Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, vv. 159, 146, and 152: 254–255, 249, 252.
(85.) The Vimalaprabhāṭīkā of the Kalkī Śrī Puṇḍarīka of Śrī Laghukālacakratantrarāja by Śrī Maṇjuśrīyaśa, vol. 1, chap. 2, 128: 237.