How relevant is the Chapter on Medicine (Bhesajjakkhandhaka) to the life of a modern bhikkhu(ni)?

Textual Scholarship
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The Vinaya rules contain an elaborate chapter that addresses the use of medicinal treatments, nutritional guidelines, plant and animal-based apothecary, as well as permissions and allowances of appropriate instruments, methodologies and disease management.

This chapter focuses on providing a set of suttas that reference the occasions when a monk may have succumbed to an illness and its appropriate treatment as advised by the physicians and approved by Gautama Buddha.

After careful examination of this chapter on medicine, one will easily notice that most of the medical references or provisions for treatment mirror the medical knowledge compounded in the three principles works of Ayurvedic medicine compiled by Caraka, Susruta and Vagbhata. This means that the Vedic knowledge of medicine, combined with the shramanic practice of surgery, herbal medicine and preventative methodology of Ayurveda, made its way into the regulation of health amid the sangha from the earliest of days.

An account of Venerable Pilindavaccha illustrates that the medical traditions employed during the beginning stages of the Sangha formation were directly related to the Ayurvedic principles of Tridosha (wind disease is understood as an imbalance of the Vata dosha) and also that the ascetic Gautama looked to the medical specialists of the day to advise the appropriate measures for treatment, as long as they did not contradict the Vinaya rules being established at the time (the allowances are not prescribed treatments, but mere confirmations of the appropriate guidelines, seen as skillful means): “At that time the Venerable Pilindavaccha had a wind disease. The physicians said thus: ‘Oil should be cooked.’ [The Exalted One said:] ‘I allow, monks, an oil decoction.’

This leads us to understand that the medical knowledge employed for the delineation of the Chapter on Medicine in the Pali Vinaya Pitaka takes its provenance from an existing medical practice that was well-established prior to the formation of the Sangha. The same is echoed in the similarities and correspondences between some of the basic teachings on the four great elements in Buddhism and the five great elements in Ayurveda.

It is difficult to imagine that the information contained in the Vinaya rules in relation to disease management, and the other references to great elements, would be somehow inferior to the other topics taught and expounded upon in the Dhamma. A serious student of the Dhamma would have to weight this out in equal measure and consideration, as the core teachings of Buddhism deserve. Albeit, the medical chapter is not the primary focus of the Vinaya Pitaka, and speaks more precisely to the organization of health and healthcare among the Sangha – it is hardly a trove of forgotten ancient tricks that have little relevance to the nature of our physical and psychological existence today.

With the advance of modern bio-medicine, the monasteries are becoming more and more reliant on allopathic medicine as it advances & permeates the very fabric of our daily lives. In Sri Lanka, Ayurvedic hospitals are still maintaining a strong presence, and some, but not many are dedicated to treating the bhikkhus. Sri Lanka occupies a particular tier in ancient Buddhist Ayurvedic hospitals, where not only the medical treatments, or the meditation practice, but even the architecture is designed to impact the patient with healing properties.

Today, the Chapter on Medicine receives little attention from the scholars of the Buddhist lore, but the topic of health has remained just as prevalent in addressing our ability to practice and comprehend the more profound teachings in Buddhism. The Chapter on Medicine acquaints us with the overall approach of compassionate treatment that is so fundamental to Buddhist ethics. Perhaps, in taking a closer look at how we are to address our ills through the Ayurvedic lens of Buddhist medicine, we may discover that our tasks are simple, our challenges are surmountable and our goals are achievable.

In giving the stamp of approval to the medicines that must be consumed within seven days, the Bhesajjakkhandhaka states: “These five medicines, namely, ghee, fresh butter, oil, honey, [and] molasses; [these] medicines indeed are considered as medicines for the world, and they serve as food, and [each of them] is not perceived as coarse food.” The direct link which is drawn between food and medicine in this statement is profound and fundamental to understanding the key aspects of how it is in our nature to cling to food (fuel) for sustenance rather than consuming it within the framework of medicinal benefit.

Historically, we may cast some doubts on whether or not any of the information in the Chapter on Medicine was approved or recommended by the Teacher himself. Perhaps, we may speculate that these accounts were included at a later day under the guise of permissions and allowances as to not create unnecessary disputes among the Sangha. But, that which appears to be historically traceable is that ancient Indian medical knowledge was employed and revised by the Buddhist physicians to yield an extensive library of Ayurvedic literature which mirrors the foundational Buddhist teachings on the nature of existence.

How relevant is the information contained in the Chapter on Medicine to the life of bhikkhus and bhikkhunis today? Does it offer any practical guidance or greater understanding of the conditions that underpin our existence? Does it illuminate our practice or benefit our discipline in any way?

How relevant is the Chapter on Medicine to the life of a modern bhikkhu or bhikkhuni?

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Dear Iviscum
welcome to the forum and thanks for the interesting question.
Could you give the reference to where this chapter is from…

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Thank you for the warm welcome :pray:, the references are taken from: Theravāda Vinayapiṭaka : Khandhaka (Mahāvagga) : Chapter 6. Medicine (Bhesajja). A reputable English translation was first done by I.B. Horner

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The medical knowledge was quite vast back then, we can take several hints from other sources as well. Take for instance the story of Ven. Cakkhupala. To cure the eyes, drops were instructed to be place in the nose while lying down. It was said to be a single dose cure, but the venerable refused to lie down and lost his eyes. (It is the first story of the Dhammapada commentary, Buddhist Legends). Today know that the eyes and the nose are connected. In fact, if you use those green Vietnamese eye drops, you can taste it. I believe Ven Cakkhupala’s doctor would have cured the disease under normal circumstances, but others cannot believe. However, due to his past kamma of causing blindness to someone who cheated him, perhaps nothing could cure him. Lastly, we must understand the power of kamma for sickness and cure. Not only that, the power of the mind was stronger back then lending to a stronger placebo affect.

There was a urine therapy book that once said something like.

Placebos can only get %15 to 20% maximum, however, those who are willing to drink their own urine might have stronger mental power and determination to increase that percentage.

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Thank you, Venerable Subhuti :pray: You have added some great points to this discussion.

The Chapter on Medicine mentions the use of Putrid Medicine in the following manner, from various references:

Bhesajjakkhandhaka: “I allow him to drink chebulic myrobalan soaked in cattle urine.“

Dharmaguptaka: “At that time the [Buddha] The five monks then rose from [their] seats, went toward and bowed down to the Buddha’s feet, [and] stayed at one side. [They] informed the Buddha: ‘What [medicine] should be used?’ The Buddha said: ‘[I] allow using the putrid medicine. A sick monk with a reason should use [it] till the end of one’s life.’”

Mahāsāṃghika: “A monk was sick. The physician said: ‘[You] should consume urine.’”

Theravāda:—“At that time a certain monk was bitten by a snake. [The monks] informed this matter to the Exalted One. ‘I allow, monks, to give the four great foul things: faeces, urine, ashes, [and] clay.’”

There is some debate among the scholars whether historically urino-theraphy was of animal or human provenance, the different translations seem to point into either of directions. The use of fermented cow’s urine is still valid in contemporary Ayurveda.

Interestingly, in Sri Lanka, the archeological finds of highly decorated urinal stones have lead to further debate on the possibility of this practice, but some scholars insist that the urinal stones may have been incorporated into an elaborate meditation practice due to the location of some of these stones within the paved pathways of walking meditation within the ancient monastery complexes of some stricter sects.

The placebo effect of drinking urine (in some transliterations referred to as “foul” or “putrid”) and the strength of one’s mind is an interesting suggestion, in a sense the strengthening of the placebo effect would certainly be related to the ability of one’s mind to foresee a clear path to self-healing.

Generally speaking, the prescriptions and medical methodology enumerated in the regulations of monastic life, points at a very elaborate medical practice and a profound understanding of the connections between the health of the body and the strength of the mind.

For example, a very common feature of the ancient monastic hospital architecture in Sri Lanka are the “janthaghara” facilities that would be equivalent to a modern day sauna, meant to administer a “svedana” sweating therapy to the monks who were in need of deep detoxification and body purification, a common procedure still employed in the preparatory stages of the Ayurvedic pancakarma therapy.

Another artifact of the ancient hospitals in Lanka are the large stone baths that can be easily seen at the Medirigiriya complex. These would have served either for oil baths or decoction soaking baths for deep nourishment and rejuvenation therapies administered through the skin, the largest human organ.

Stone inscriptions at the ancient hospital sites in Sri Lanka indicate extensive patronage of the Buddhist hospital facilities, suggesting that ancient Buddhist Lanka may have been the most sophisticated hospital system in the ancient world, with advanced care facilities and waste water sewage systems, with advanced filtration found under the very urinal stones mentioned above.

More so, the treatment and care facilities were carefully arranged as to not disturb the main occupation of the monks, and great attention was paid to designing an environment that was conducive to meditation even to the patients that occupied the hospital rooms which all faced into a courtyard with a statue of the Buddha in the center. The ancient monasteries in Sri Lanka in particular had the unique design of a “boulder garden” that developed out of a profound understanding of how human nature is undeniably linked to nature in general.

The height of this development culminated some time around the 11-13th centuries of our era, with the hospital located in Polonnaruwa, where excavation revealed a trove of surgical and other medical instruments that are housed and on display at the Pollonaruwa archaeological museum.

The uninterrupted development of the Buddhist civilization in ancient and pre-medieval Sri Lanka points at the spectacular feat that a Buddhist civilization can achieve in healthcare that is rooted in Buddhist ethics and compassionate care.

It is only with the beginning of the colonial era that Buddhist medical practice began to decline, first with the Dutch and Portuguese interventions, and then a complete ban on Ayurvedic practice by the British, who saw this traditional knowledge as an existential threat to their advancement.

I believe that today the medical systems in the monasteries are only a shell of their past glory, and very scarce knowledge remains among the practitioners to maintain a self-sufficiency for their healthcare needs. This can be changed if the Ayurvedic principles are returned to the general study among the practicing monastics. The monasteries can once again become the sites of a flourishing medical practice that is rooted in the wholesome principles of a balanced lifestyle.

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It is highly relevant, but only for bhikkhus, as there are no any legal bhikkhunis any more in Theravada lineage. We can say it is relevant to ten-precept-nuns and lay Buddhists as well.

The Blessed One has praised using simple (but effective) medicine like putrid urine even in Suttas. Still there are monks who prefer medicine like puti mutta, haritaki and triphala over other medicines, even though the number is very low. Even in modern days, forest monks in Sri Lanka and Burma prefer Ayurvedic and Natural medicine over Western medicine.

There are many advantages of using the medicine recommended in Bhesajjakkhandaka or similar types of medicine like Ayurvedic.

  • Easy to obtain and cheap
  • Simple and supportive for maintaining simplicity which is a great virtue praised by the Teacher
  • Absence of (or negligible) side effects
  • Supportive for balancing humors (especially reduction of heat) which greatly contribute to maintain mental calmness
  • Provision of Iongtime health benefits which are unbelievable by an average person
  • Recommended restrictions of diet and lifestyle (by such doctors) encourage sense-restraint which is a great virtue in Buddhism
  • Supportive to Brahmacariya lifestyle and Dhutanga practices like eating only one meal

If my memory is correct, Caraka says that the best medicine is ghee, the best eating practice is eating only one meal a day, and the best lifestyle is Brahmacari life. All those go well with Sramana religions like Buddhism.

It is true, but it is affected by other factors as well.

Main factor is the domination of Western medicine. The advancement of Western culture highly influences the attitude of general public towards Ayurvedic medicine. First exposure of modern monks before they ordain, is the public attitude.

Another factor is the relative difficulty of finding Ayurvedic medicine or simple medicines like fermented cow urine in modern society.

Lack of knowledge about the benefits of such medicine is another factor. Organized and extensive programs of instructing and promoting might be needed to address the issue.

Anyway, it is a great merit that supporting the monks through such ways. May your expectations be fulfilled nearly in the future!

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Thank you @ekocare :pray:, I appreciate your reply on the merits of Ayurvedic medicine within the monastic organization of healthcare. You have pointed out some key components about the simplicity, accessibility and benefits of many basic Ayurvedic recommendations that can be easily adopted across the vast majority of monasteries to benefit anyone entering the order and perhaps looking for some effective solutions in managing their basic nutritional and healthcare needs in accordance with their constitution.

If you think about it, according to the Vinaya rules, all medicine or medical care that falls outside of the “allowed” references, would technically be considered an offense. According to this logic, allopathic medicine and certainly some surgical procedures would fall outside the allowed realm of Buddhist medicine. There is an account when the Teacher gave a clear instruction about surgery: “Having scolded intensely [and] given a dhamma talk, [the Exalted One] addressed the monks: ‘Monks, surgical operation or enema should not be caused to be performed [at] the vicinity of two finger-breadths of the private parts. Whoever would cause [them] to be done, there is a grave offence.’” This is related to the Ayurvedic knowledge of the vital points which are to be completely avoided in surgery, as advised by Susruta. Not only is operating on the vital points a grave offense, it is potentially dangerous to the life of the individual and will at the least create an irregularity in the srotas (channels) in the body, possibly inhibiting the ability of a monk to progress on their path successfully.

The monasteries have probably dealt with this dilemma of allopathic medicine and surgery in one way or another, but the question really remains whether or not those recommendations were much more profound in knowledge than contemporary scientific methods and may have prevented certain harmful effects from unwholesome medical practice— which should be included under the larger umbrella of medical malpractice in general.

I agree with you that time and effort should be dedicated to the development of basic courses in Ayurveda as part of a basic curriculum for all monastics. I also agree with you that the same efforts should be dedicated to spreading this knowledge into the lay communities, and I can attest that Ayurvedic dietary and nutrition principles, as well as the general understanding of doshic constitutions are being adapted into the overall wellness movement that is taking place both in the East and in the West. General public is adopting the wholistic lifestyle step-by-step, which is very encouraging, but I believe that the monastic communities can benefit faster and in greater amount from these teachings, because their lifestyle is already oriented at following a spiritual discipline.

If you don’t mind me asking you a few more questions about the inner workings of healthcare within the monastic communities that you are familiar with, and which employ Ayurvedic healing methods:

  1. Are the Ayurvedic treatments performed on location of the monastery, or do the bhikkhus visit the Ayurvedic hospitals outside the monasteries? Do they need to travel to these hospitals for treatment? Does an Ayurvedic physician make regular visits to the monastery?

  2. Among the medical recommendations advised in the Vinaya Pitaka on root medicine, leaves, fruits, the seven-day tonics (“These five medicines, namely, ghee, fresh butter, oil, honey, [and] molasses“), — how many are in current regular use among the bhikkhus? Are the bhikkhus allowed to make their own medicinal preparations? Do they grow any of the plants/trees at the monastery grounds, or do they forage in the forests? Do they have an in-house apothecary or do they rely on the prescriptions that need to be fulfilled by an outside Ayurvedic pharmacy?

  3. How much of the daily nutrition and food preparation is done in accordance with the Tridoshic principles of Ayurveda? Are the alms that are collected considered separately from the foods prepared in the common kitchen? How much can a bhikkhu follow an appropriate diet for their individual constitution, and how does the schedule for meals reflect the Ayurvedic recommendations, along with the Vinaya rules for proper food taken at the proper time?

I hope that you don’t mind me posing so many questions :pray: I would be very grateful for some additional information that you can share on this topic from your knowledge.

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Here is a timestamped YouTube bookmark on my talk about putrid urine along with a story of how I used it on my body during a meditation retreat in Myanmar. We also often eat fruits soaked in this urine and stored for 3 months at paauk.

Please note: we are not so fond of comparison of EBT texts here at ClassicalTheravada. Please only mention the Theravada texts. Comparison of traditions is more suitable for SuttaCentral.

Please note: we are not so fond of comparison of EBT texts here at ClassicalTheravada. Please only mention the Theravada texts. Comparison of traditions is more suitable for SuttaCentral.

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I’m mostly familiar with the few forest monasteries than the modern village and city temples. Ayurvedic medicine is relatively more famous in forest monasteries, specially in strict Vinaya monasteries.

Both. I have seen Ayurvedic consultations are performed in some well-known forest monasteries once a year by Ayurvedic doctors in the area, but this happens only when a faithful Buddhist medical officer leads his subordinate officers. Oil massage, steam bath kind of treatments are performed maybe once a six months, if a lay devotee sponsors. Sometimes there can be seen a mini store of simple Ayurvedic and Western medicine inside the monastery.

All of the above happens only in the well-known forest or meditation monasteries since the attention is receieved less by the other monasteries.

Most of the time monks go to famous hereditary Sinhala-medicine doctors or Ayurvedic doctors, outside the monastery, if they have a considerable disease.

Generally forest monks prefer Ayurvedic medicine and they use simple medicines like triphala and herbal drinks regularly along with panca-bhesajja mentioned in Vinaya. But they are moderate in their opinion and use Western medicine as well, in serious diseases and surgeries.

I don’t think the monks in average modern temples use those medicine regularly though they also prefer Ayurvedic medicine.

Yes. Most of the time monks visit Ayurvedic hospitals if they want to stay some days at the hospital for regular treatments (to have regular treatments for bone or joint problems, to have regular kasayas and massages in severe diseases). Other times they prefer visiting famous Sinhala or Ayurvedic private doctors, since they are thought to be better than normal doctors in Ayurvedic hospitals. If there is a famous doctor in the hospital or the disease is not severe, then the monks (and lay people as well) visit Ayurvedic hospitals.

Generally doesn’t. But it seem to be happened if two conditions are met: the monastery should be a famous meditation center with many monks and the chief physician in the nearest hospital should be a faithful Buddhist.

In small monasteris the monks either get the help of a lay devotee who is also an Ayurvedic professional, or they visit an Ayurvedic doctor.

All those are in regular use in forest monasteries, even though the demand has been started to slightly decline since a decade. Butter seems overpowering ghee little by little while tea and beverages seem overpowering herbal tonics, among the modern young monks. But the decline is higher in average village temples.

They do, but most of the time it is done by lay people or samanera monks, to avoid breaking Vinaya rules by cutting plants and lighting fire.

Sometimes very few number of plants are grown but it doesn’t cover at least the basic needs because haritaki, amalaki kind of medicines are hardly grown. Monks hardly forage in the forests but lay supporters do if they were asked.

Only the big meditation monasteries have an drugstore and it also doesn’t have all types of medicine. Other monasteries particularly the average forest monasteries might have a inorderly collection of offered basic medicines like herbal drinks, Paspanguwa, some oils and churnas …etc. but not much. So they go to Ayurvedic pharmacies or ask lay devotees to supply medicine in a considerable disease condition.

Unless lay people were informed by monks, the food offered would be rich in oil and spices. Monks generally don’t like to order laypeople regarding food since it is prohibited by Vinaya and looked down by lay people as well.

Generally the food is healthy in forest monasteries while average in temples. Forest monks pay attention to tridoshic principles. In the forest monasteries, the lay representatives of the monastery (kappiyas) inform lay supporters to give healthy food.

The food offered at the temples or at the ceremonies in lay houses by dayakas (official lay supporters) tend to be more rich and oily but carefully prepared than the regular meals of lay people.

Regarding the forest monasteries (in larger monasteries lay supporters come to stay one night and cook there and offer), the food offered at the monastery is healthier than the food collected by pindapata (alms round) in the village. But there are only very few number of pindapata monks.

Not much attention is paid to the healthiness of pindapata food because the pindapata-monks have other regular healthy practices such as walking long distances daily to collect food, doing physical chores and eating only one meal for the day most of the time.

Generally the serious (old type) meditation practitioners don’t have a habit of thinking about food too much, since they are required to contemplate on the repulsiveness of food. They only care about avoiding unhealthy food in consecutive meals. They consider over-thinking about health is also a hindrance to the practice.

Still there are many monks in forest monasteries who care about the healthiness of the food, sometimes on behalf of other monks, and they inform kappiyas (lay persons in monastery) about what is better to be offered (less oily, less spicy, less junk, and less naturally-hot food). Then they inform lay donators. But in the city temples, relatively less attention is paid to the healthiness (oiliness, etc.) of food, even though the monks are better than lay people in this regard.

More green food items like different types of eatable leaves and rice-gruel made of leave extract (kola kenda) are used particularly in forest monasteries. Some consider salty rice-gruel (lunu kenda) is the best which prepares the stomach before having the morning meal. And the naturally-hot items like tomatoes, wheat, prawns, are eaten less in monasteries and more cold items are preferred.

In terms of having timely meals, forest tradition’s monks and Vinaya monks are the best while less strict monks and modern village and city monks are better than the lay people.

According to the Suttas and Vinaya, the best eating practice that contribute to the physical and mental health is eating only one meal. Next best is refraining from afternoon meals. The blessed one says it contributes to the health, strength and comfortable life.

Actually what distance people from good eating practices are the “mental defilements”. The greediness and need for quick results distance people from both Ayurveda and Buddhism.

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Thank you :pray:, I will definitely take a listen to the link that you’ve shared from your talk on putrid urine, and revert back if I have further questions here. Noted on the mentions of non-Theravada texts :+1:

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Thank you so much @ekocare , for such detailed responses, they are very illuminating and inspire hope in my heart :smiling_face_with_three_hearts:

The practical aspects of the medical and nutritional practices within the forest monasteries are quite impressive in my view, even though the challenges of adequate healthcare and healthy foods are quite understandable.

I understand that for the purposes of a fruitful discussion, we will have to consider the forest monasteries that receive support for such practices, as well as meet the two conditions that you’ve established: 1. monastery is a famous meditation center; 2. chief physician is a faithful Buddhist.

Can you elaborate on what is meant by a “faithful Buddhist physician” here – a medical doctor who is know to be a devout Buddhist, or a medical physician who is trained in the medical regulations in accordance with Buddhist ethics? Do the bhikkhus advise the physician on certain allowances or is the physician specialized in the Vinaya rules?

Actually, if a bhikkhu receives some treatment every 6 months or so, this is pretty good.

I am aware about the general restraint in nutrition (both quantity and timing) within the monastic regulations, I wasn’t however aware that "over-thinking’ about health is something that is equally advised against (do you mean in the hypochondriac way?). I can see how over-thinking in general is contradictory to the practice, I suppose that over-thinking about health is somewhat of a gray area, but it would make sense that this should be the area of preoccupation and expertise of the physician, and not the monk.

Following up on my earlier questions, may I ask perhaps on a more personal level in your experience – has the lifestyle supported by these practices noticeably improved your health or the health of those around you? Have you noticed any impact from the meditation practice and purification practices that there 's been a positive benefit to your state of health, vitality, overall ease in the body? Perhaps, some simple seasonal chronic occurrences have gone away (sinuses, headaches, skin conditions?). Or, perhaps you have noticed that the nutritional regimen of one-meal-per-day has resulted in better digestive health or weight regulation? What have you experienced personally as a positive physical change in adjusting to the monastic lifestyle? Would you say that you have seen a general improvement in your immune response?

If some or all of these questions are too personal, please forgive me for asking!!! My interest is primarily altruistic in nature and my intentions are to correlate the practical experiences to the textual study of the Vinaya as concerned by the specific chapter on medicine. I thank you for your consideration with much regard :pray: :pray: :pray:

On the philosophical aspects of our discussion, I equally agree with you that the mental defilements are a major hindrance in our ability to simplify our lay lifestyles and eating habits as well. In my study courses in Sri Lanka, I had the wonderful fortune to study with a professor who has designed a program where Ayurvedic medical practice is understood in direct relationship with the Buddhist philosophy. We spoke about the Abhiddhamic analysis in equal measure and alongside the Tridoshic principles. This is not done in most Buddhist universities or Ayurvedic schools when the two fields of study are undertaken separately.

For example, the 3 unwholesome roots in Buddhism are likened to the 3 doshas in the following manner:

  1. Greed – Kapha (due to its slow and sticky nature)
  2. Hatred - Pitta (due to its hot and easily aggravated nature)
  3. Delusion - Vata (due to its mobile and unstable nature)

At the same time, we know from Ayurveda that doshas can be in balance or out of balance, therefore a balanced dosha will result in its equivalent wholesome characteristic:

  1. Wisdom (a wise Kapha is nourishing and enduring, not prone to diseases)
  2. Intelligence (an intelligent Pitta is responsive and effective in its benefit to others)
  3. Reflection (a contemplative Vata is creative and visionary)

In some ways, understanding the correlations between the Buddhist teaching and the Ayurvedic practice can be a practical means of illustrating or managing the same concepts in their different expressions, where “nama” can be addresses via “rupa” just as much as “rupa” can been understood via “nama”.

Do you find the intersection of both these disciplines to be useful, or do you believe that the Buddhist methodology takes care of both “the physical” and “the psychological” health by default?

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A devout Buddhist. Otherwise he will not come to the monastery regularly, as there is no gain for him. At least the doctors don’t get the habitual respect received from lay people, from monks. Unless the doctor being a devout Buddhist, he would not see enough benefits to spend his time and effort regularly.

The situation can be different if there is a government pressure (a rule for doctors to visit schools or monasteries) or a benefit from the government (like the allowance for the rich men to escape from tax if they have spend something for a monastery or as a social service). But as far as I know there is no any government pressure or benefit for Ayurvedic doctors.

However, Ayurvedic doctors are still better than Allopathic doctors in their respect towards monks.

Generally the monks hardly discuss Vinaya matters with lay people unless in an unavoidable case. And the physician hardly knows them as well.

I have seen it only in very few big forest monasteries. This is also done mostly by a faithful richman who come with two or three medical servants from a massage/pancakarma hotel.

I think it is not in the texts but in the opinions of serious practitioners, because constant over-care about trivial health matters considered to be a form of protectiveness arisen from desire for body. But it is mostly an advice regarding forest practice.

Generally such a person can’t regularly consume pindapata food (that are not always supportive for health or not always prepared under good hygienic conditions), live under trees or in forests (being exposed to rain, cold, mosquitoes, insects and snakes), live in areas far away from good hospitals, …etc.

At the same time under-thinking about the health is considered as a bad practice by monks because physical health is a necessary condition for mental health. Mostly the under-thinking is considered to be caused by greediness and ignorance.

I would comment about the people and monks that I know. These practices have noticeably improved their health. Most of them have stable and comfortable physical conditions and calmer mental conditions compared to their past.

By samatha meditation some seasonal occurrences of some diseases have been minimized in some people and monks that I know. Mostly the ease in the body and the strength of mind have been increased.

Steam bath and massages has helped many monks to increase overall ease in the body (as they say), specially if they are not slim or suffering from diabetes, cholesterol, etc.

In two or three big forest monasteries that I know, there is a ‘Janthaghara’ (as in the texts) where monks can have a steam bath even without any medical servant.

Only very few monks in the Buddhist countries practice it because it is a Dhutanga practice and not a compulsory Vinaya rule. As I have observed their digestive health, weight regulation, mental ease and eligibility for meditation have been increased.

While there are relationships, there are differences as well.

  • Ayurveda is about physical health while Buddhism is about mental health. (The word ‘arogya’ in “Arogya parama labha” is defined in Buddhism as ‘mental health’)

  • Ayurveda is an art of living while Buddhism is an art of disappearing. (Lokiya vs Lokuttara)

Buddhism doesn’t focus on creating a comprehensive medical discipline. It’s goal is to help people liberating from rebirth.

At the same time Buddhism allows monks to use medicine mentioned in Vinaya or compliant medicine (as we suppose Ayurveda, Siddha or suchlike) as long as they live, since the physical health is vital for mental stability which is the base for insight practice.

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Dear @ekocare, I am so grateful for your responses which have illuminated many areas that have remained obscure in my mind for some years of study and research in relation to these practices.

Actually, your answers have inspired me to consider to find ways to create a special fund that can support more regular Ayurvedic treatments for the monasteries. I know that you mentioned that this occurs only on occasion and only in very few big forest monasteries.

Can you let me know, which of the monasteries still use the Janthaghara? in Sri Lanka?

I am very happy to hear that you have equally noticed the benefits from these treatments in the overall health and purification of the body and mind. Equally, i am happy to hear from you that there is a confirmation of the Dhutanga practice being an effective form of digestive health and weight regulation. These are logical outcomes, but in today day and age, it is still a joyful realization that mental ease and eligibility for meditation can be increased via such simple adjustments. I have noticed it in myself, although I am a lay practitioner, that the climate of Sri Lanka is very conducive to the Dhutanga-like practice. Although, not in the exact form, but my personal experience has been that the very environment of the island is supportive of not having meals in the afternoon and evenings, and I have gone for many days with simply a light papaya snack in the afternoon. I have observed that mental clarity and general immune responses spring up during such dietary regimen.

I don’t mean to compare these in exact or equal measure to a monastic lifestyle, but simply to confirm that even in lay lifestyle similar changes bring about immediately noticeable benefits, thus a logical conclusion would be that there is common ground in the establishment of such practices across communities that put a wholesome existence at the forefront.

I appreciate your drawing the distinctions here, because I completely agree with you that the goal of Ayurveda is somewhat more noticeably concerned with physical purification, or perhaps its methodology takes the route of addressing general imbalances through the physical manipulation of matter.

At the same time, it is not easy to dismiss the more subtle practices and connections that drive the Ayurvedic practice, which has demonstrated a very thorough understanding of the mental and spiritual realms, and ways in which they are interconnected with the physical realm.

I suppose that the “nama-rupa” interconnectedness cannot truly function without the subtler realms being as contingent on the material realms. I suppose that as long as the physical body exists (and I’ve heard commentary that even thought forms are believed to be at least in some part of material nature) – we cannot really circumvent the “body dilemma.” In some cases, I truly wonder how much of mental purification is contingent on bodily purification, and whether or not a heavily “intoxed” body (let’s say as a result of greed or anger or delusion, or all three, and the habits that form out of that) – how much of mental purification can truly be performed without addressing the physical problem of the body as a storage and accumulation devise of all the vices. Perhaps, a very small number of individuals are able to overcome this dilemma and go straight to the source of the mind?

Ayurveda does have an extensive discipline in mental health as much as Buddhism has paid attention to solving the question of “the disappearing art.” It is a high art indeed, and its merits cannot be begged, to me it seems that it is more of a distinction of focus, rather than omission. Both disciplines acknowledge the importance of the “form”-“non-from” co-existence, but perhaps have taken a slightly different approach or methodology to resolving the ultimate question.

I agree that Ayurveda does not place its aim with liberation from rebirth, I would consider this as a key distinction. But, perhaps Ayurveda might agree with the following statement: “If, as a result of one’s physical and mental purification, one may achieve a healthy holy life, thus ending the cycle of their rebirth, so be it!”

I recently read a post on another Buddhism-related platform where someone questioned whether or not liberation from rebirth can be equated to suicide. In my view, a question such as this is either aimed at being provocative, or points at a lack of understanding of the core teachings in Buddhism, starting with the Four Noble Truths. In the second case, one would have to really ponder upon the significance of not being able to see the distinction between “the ending of suffering” in Buddhist term and of suicide. In my opinion, view of suicide as an end to anything is just as intensely linked to craving of rebirth, basically a mass delusion.

I wanted to return to the topic that is being discussed in this particular conversation – can you elaborate on how you understand the under-thinking to be caused by greediness and ignorance. I can see that underthinking can be equated in a general sense to ignorance, as in “the lack of thinking/reflecting,” but I’m not sure how to interpret the under-thinking (and maybe we can stay on the subject of health, for added clarity) – how would greediness be a form of under-thinking the health matters?

Finally, I would like to ask your opinion, because you have an extensive knowledge of the subject – what do you consider to be helpful in establishing a more regular support for health in the monasteries? What would be advisable in seeking some funds for regular Ayurvedic procedures for the monks and nuns? Do you have some suggestions on what you believe would be an effective way to support the monks in their endeavors via proper attention to their general health?

Also, may I ask you, if you happen to have some knowledge of this – are the monks still commonly affected by the “autumnal disease” as they were in the past, as described in the Vinaya manuscripts? If so, what is this disease referred to today? Does it have some modern bio-medical term?

Thank you once again for all your contributions to this discussion, as I’ve stated before and happily repeat myself, your answers inspire me and bring hope back to the center of my heart :heart: :pray: :pray: :pray:

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I meant the greed overpowers the thinking. Even if a person already knows the consequences of bad eating practices, he can’t reflect them successfully when an higher greed arises.

The Commentary says it is a Pitta disorder arises in Autumn.

sāradikena ābādhenāti saradakāle uppannena pittābādhena, tasmiñhi kāle vassodakenapi tementi, kaddamampi maddanti, antarantarā ātapopi kharo hoti, tena tesaṃ pittaṃ koṭṭhabbhantaragataṃ hoti.

By the autumnal disease, by the bile-related disease that arises in the autumn season, for at that time, they are drenched even by the rainwater, they even trample on the mud, and in between, the heat of the sun also becomes harsh, because of that, their bile enters inside the stomach. (Chatgpt translation)

The Vimativinodani sub-commentary describes it as follows.

pittaṃ koṭṭhabbhantaragataṃ hotīti bahisarīre byāpetvā ṭhitaṃ abaddhapittaṃ koṭṭhabbhantaragataṃ hoti, tena pittaṃ kupitaṃ hotīti adhippāyo.

Bile enters inside the stomach, the unbound bile that was spread throughout the outer body enters inside the stomach, by that, the bile becomes agitated—this is the intended meaning.

So some monks that I know think it as Gastritis. But I’m not sure what the consensus among scholars is.

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I see, it certainly makes sense that Greed would have an over-powering effect for some individuals especially in the food consumption aspect, which would have certain consequences for health. Greed is one of the more complex unwholesome roots, and it has a direct relationship to sustenance of the body, but I would suspect that on the mental level it reflects a state of deep dissatisfaction and desire for over-compensation through accumulation.

Thank you for this, I will look into this a little further on the Ayurvedic side. I believe that the Fall/Autumn season is considered a Vata-vitiation season, whereas Summer and the high temperatures are often seen as Pitta-aggravating seasons. But, there is a definite link between the two because a vitiated Vata can cause Pitta to rise. Gastritis seems to fit as a reference, will need to look through the Ayurvedic literature to see if the two align.

Provided this description for the external conditions that cause “the bile to enter inside the stomach,” - Do you know if these symptoms are still a common occurrence for the forest dwelling monks, or does the rains retreat diminish these symptoms?

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Could this be the reason for why the above comparison is not done seriously in most Buddhist universities?

Visuddhimagga:

Exposition on the Types of Characters:

Now, regarding the phrase “suitable to one’s character,” there are six types of characters: lustful, hateful, deluded, faithful, intelligent, and speculative.
…
What is the cause of these characters (cariya)? How is it to be known that “this person has lustful tendencies, and this person has tendencies towards anger or other dispositions?” What is suitable for a person with each type of character?

Therein, some say that these three characters arise from past habits (pubbāciṇṇa) and from the predominance of elements (dhātu) and humours (dosa). A person with a lustful disposition was often involved in good deeds and favorable actions in the past, or he may have been reborn here after falling from heaven. A person with an angry disposition was frequently involved in acts of cutting, killing, binding, or harboring resentment, or he may have been reborn here after falling from hell or the animal realm. A person with a deluded disposition was often involved in drinking intoxicants, lacking in learning and questioning, or he may have been reborn here after falling from the animal realm. Thus, these characters are said to arise from past habits.

Furthermore, a person is of a deluded disposition due to the predominance of the earth and water elements. A person with an angry disposition has the predominance of the other two elements. A person with a lustful disposition has a balance of all elements.

Among humours, a person with an excess of phlegm has a lustful disposition. A person with an excess of wind has a deluded disposition. A person with an excess of phlegm may also have a deluded disposition, while a person with an excess of wind may have a lustful disposition. Thus, they are said to arise from elements and humours.

However, because not all beings who were frequently involved in good deeds and favorable actions in the past or who have been reborn here after falling from heaven have a lustful disposition, and not all others are disposed to anger or delusion, and because there is no definite rule of excess for the elements as mentioned, and because only lust and delusion have been described in humour section, and this is contradictory, and also because there is no cause given for other dispositions such as faith, therefore, all of this is an undefined statement.

Visuddhimagga-ṭīkā:

**“Some” refers to the Elder Upatissa. It is stated in the Path of Freedom (Vimuttimagga) … **

The Vimuttimagga is considered to be a text of the Abhayagiri sect by modern scholars. And I think there are multiple such kind of opinions in Vimuttimaga that has been rejected by Visuddhimagga.

Then the Visuddhimagga explains the causes given by ancient Atthakathacariyas for describing character-types.

The decision here, according to the opinion of the commentarial teachers, is as follows: it is said in the explanation of predominance (Dhammasaṅgaṇī Aṭṭhakathā, 498): “These beings, due to the influence of past causes, are predominantly greedy, hateful, or deluded, or predominantly free from greed, hatred, or delusion.

For instance, at the moment of forming kamma, if greed is strong while non-greed is weak, and non-hatred and non-delusion are strong while hatred and delusion are weak, then the weak non-greed cannot overcome greed. However, the strong non-hatred and non-delusion can overcome hatred and delusion. Thus, being reborn through the connection of this kamma, the person becomes greedy, pleasant-natured, free from anger, and wise, with diamond-like knowledge.

Similarly, if, at the moment of forming kamma, greed and hatred are strong while non-greed and non-hatred are weak, but non-delusion is strong while delusion is weak, then the person becomes both greedy and hateful, yet also wise, with diamond-like knowledge, like the Elder Dattābhaya.

If, at the moment of forming kamma, greed, hatred, and delusion are all strong, while the opposite qualities are weak, the person becomes greedy, hateful, and dull, though virtuous and free from anger, like the Elder Bākulatthera.

Likewise, if all three unwholesome roots—greed, hatred, and delusion—are strong at the moment of forming kamma, while their opposites are weak, the person becomes exceedingly greedy, hateful, and deluded.

If, at the moment of forming kamma, non-greed, hatred, and delusion are strong while the opposites are weak, the person becomes non-greedy, with few defilements, remaining undisturbed even when seeing celestial objects, but hateful and dull-witted.

If, at the moment of forming kamma, non-greed, non-hatred, and delusion are strong while the opposites are weak, the person becomes non-greedy, free from anger, virtuous, yet dull-witted.

Similarly, if, at the moment of forming kamma, non-greed, hatred, and non-delusion are strong while the opposites are weak, the person becomes non-greedy and wise, but hateful and prone to anger.

Finally, if, at the moment of forming kamma, all three non-greed, non-hatred, and non-delusion are strong, while the opposites are weak, the person becomes non-greedy, free from anger, and wise, like the Elder Mahāsaṅgharakkhita.

”In this context, one who is described as “greedy” refers to the lustful character. Those who are hateful and dull refer to the hateful and deluded characters. The wise one refers to the intelligent character. Those who are free from greed and hatred, and are naturally pleasant, refer to the faithful character. Similarly, one reborn due to kamma dominated by non-delusion is of an intelligent character, and one dominated by strong faith is of a faithful character. One born due to kamma associated with speculative thoughts, like sensual thoughts, is of a speculative character. Therefore, kamma associated with one or more of greed, etc., serves as the cause of the different characters.

What do you think?

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These are definitely interesting references, and can be schematically arranged, as they yield many varieties of personalities.

My gravitation is toward arranging these combinations via an Ayurvedic methodology rooted in the elements, simply because using the terms Greed, Hatred, Delusion and their wholesome opposites is slightly less precise in technicality. Also, when Ayurvedic physicians deal with particular imbalances, they tend to have less of a “personality” approach, and more neutrally address these through the elements and humors, although of course their mental equivalents are just as valid.

This would be denoted as Kapha :arrow_up:Pitta :arrow_up:Vata :arrow_down:

Ayurveda insists that the psycho-physical characteristics of the person, or their dosha, is passed onto the person via their parents at the time of conception. It is true that we inherit many physical and psychological characteristics from our parents via our genetics. For example, a person may have the skin organ the same as their fathers, hair as their mothers, teeth as their maternal father, and toes as their paternal father, etc. All these manifest physically through an undeniable resemblance or even a complete copy. At the same time, the same person may possess the naivety and delusional mind attributes of their mother, while a calm and rational mind of their father. It is very difficult to pinpoint the exact genetic make-up that creates the physical characteristics and also influence the mental ones.

This is interesting, because it points at Greed, or Lustfulness – or in more fundamental terms known as Attachment – being the more difficult defilement to overcome. I believe that this is due to rebirth being closely linked with craving, therefore attachment is rudimentary even to a personality that has overcome Greed or Lustfulness in their proper terms, but is still dealing with a level of Attachment to life and rebirth on the most of rudimentary levels. Generally, a wise personality who has fully subdued Anger/Hatred and Delusion, is the more likely candidate to overcome Attachment due to their Wisdom and Goodwill.

K :arrow_up:P :arrow_down:V :arrow_down:

I can see how Buddhism and Visuddhimagga are moreso concerned with the personality aspect of this because it is more closely linked to the mind expression. But, if we agree that everything in the world that surrounds us, that is visible and sensible to us falls under the same fundamental elemental makeup, then dealing in personalities becomes rather complicated.

Let’s take plants, for example: many herbs have been profoundly understood through Ayurveda in terms of their Rasa (taste); Veerya (potency) and Vipaka (post-digestive effect) – all giving a specific result or vitiation of a dosha. In this sense, the plant itself is an expression of a dosha. Perhaps, we may not consider that the plant has any mind of sort, but we may consider that it still possesses some level of consciousness. More recent research reveals that plants are very complex beings and exhibit similar electrical and chemical intelligences that are indicative of some level of consciousness being present.

In addition to such characteristics as taste, potency and post-digestive effect, some plants or animal substances are known to have an unpredictive or unusual effect, a behavior that isn’t characteristic to other substances of similar elemental makeup. This further indicates that living substances (unique combinations of bio-molecules) exhibit bio-chemical behaviors beyond their conventional or expected model. It is as if a plant is able to overcome its own nature to produce something other than what it was originally intended to be.

All in all, we need not look to humans alone to understand that “rupa” and “nama” are also arbitrary terms because they respond in predictive model behavior only under conventional conditions – occasionally these conditions can be lifted to yield unconventional results.

Where does this phenomenon draw its origin is perhaps a speculative reasoning, but I would suggest that kamma has a play here because despite the physical attributes or mental characteristics that link us closely to our immediate relatives, we are still at times exhibiting characteristics that defy our familial behaviors. Equally, traumas or negative kamma accumulated in the past will make itself known despite the general goodwill and pleasant nature of the overall family. We bring our kammic imprints via the consciousness that incarnates into a psycho-physical genetic makeup. And, while a particular genetic makeup is required for a certain consciousness to incarnate, this makeup may not be sufficient or may be overstimulating for our kammically-influenced consciousness.

Basically, I believe that what I am saying is that our easily observable characteristics of personality may be just as much a result of a simple copy-paste genetic variety, as much as an expression of our consciousness and the accumulated kamma.

If the Theravada methodology accepts the notion of being able to eliminate all kamma (which renders kamma destructible), then this would indicate that the fundamental building blocks of kamma are more tangible in nature and can be addressed through a tangible methodology, which is what the path of purification seems to suggest. Vinnana plays an important role in the realization process because without the realization of the arbitrary nature of one’s own existence there cannot be a fundamental acceptance of complete detachment.