Long pepper treatment (pippali-vardhamana)

Pippali/Long pepper

Pippali/Long pepper

Pippalī-vardhamāna is a kind of treatment in which (pippalī) long pepper corns are taken in increasing and decreasing quantity.

This treatment is excellent for detoxing body and also for mental health and wellbeing.

These benefits of this treatment have long been recognised:

  • The Caraka Saṃhitā is one of the classical texts of Ayurveda, it is dated to between the first and second century CE. In this text, pippalī-vardhamāna is described as a rejuvenation therapy which is nourishing and a promoter of a long life and a healthy mind.

  • The Bower Manuscript is an ancient Buddhist text, also dated to around the second century CE. In this text, various healing potions, similar and sometimes identical to those of the classical Ayurvedic texts, are described. The Bower Manuscript also mentions pippalī-vardhamāna and describes it as suitable in the treatment of mental health problems.

Our Clinical Practice: Buddhist Ayurvedic Counselling and Psychiatry (BACP; Galmangoda, 2015)

Mental health problems represent the largest single cause of disability and sickness absence in England and accounted for 70 million sick days in 2007. One in four adults experience at least one diagnosable mental health problem in any given year, mental health problems have been estimated to cost the UK economy around £105 billion a year, and people with mental illness die on average 15-20 years earlier than those without, often from avoidable causes.

Developing and implementing new and better interventions for mental health and wellbeing is a top priority. Mindfulness-based, compassion-focused and other Buddhist-derived interventions (BDIs) for mental health are increasingly adopted, and some individuals prefer mindfulness-based interventions that more closely resemble a traditional Buddhist approach.

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP; Galmangoda, 2015)

Buddhist Āyurvedic Counselling and Psychiatry (BĀCP; Galmangoda, 2015) is a new subject in the area of Buddhist Studies, developed in Sri Lanka over the past decade, and its practice has been recognized and valued by the World Health Organisation (p.15, WHO, 2009; p.39, WHO, 2012).

Whilst BĀCP theory remains grounded in premodern Buddhist and Āyurvedic texts, Manasa Ayurveda is now introducing BĀCP in England as a newly developing intervention for mental health and wellbeing.

Theory & treatment methods

According to BĀCP theory, mental health problems are defined in terms of affected mental functions. In particular (but not exclusively) functions relating to intellectual discriminative function (buddhi) and the capacity for memory and mindfulness (smṛti).

Mental health problems have many causes and conditions including both physical and mental factors. The symptoms according to premodern Buddhist and Āyurvedic texts have some agreement with those recognized within the ICD-10/DSM-5.

In BĀCP, indicated treatment plans are established and interventions targeted through case formulation based on assessment which draws upon specific theoretical constructs (e.g. tridoṣa, triguṇa, triakuśalamūla, khandhas). Treatment methods in BĀCP include traditional Āyurvedic physical therapies, behaviour and situation change (e.g. through diet and lifestyle counselling), and methods for developing concentration and insight into reality (through a more personally tailored approach to mindfulness and meditation training).


Although currently there appear to be no published Randomised Controlled Trials (RCTs) on BĀCP protocols, some small scale RCTs have been conducted (mostly in India) on Āyurvedic treatment methods for mental health (included within BĀCP).

To establish the evidence base, RCTs are required on specific treatment methods, but importantly also on BĀCP protocols. In addition, alongside service user feedback, in England consistent use of standard clinical outcome measures in routine clinical practice (e.g. the CORE-OM; Evans et al., 2000) will enable practice-based evidence to be gathered.


Manasa Ayurveda has modelled a process for the delivery of BĀCP in England using a treatment protocol originally developed in collaboration with international experts in Sri Lanka. Current BĀCP clinical practice in England is based on this protocol and mental health service users in England (from a range of ethnic, cultural and religious backgrounds) have given positive feedback on their experience of BĀCP. Further protocol development by Manasa Ayurveda (based on clinical practice in England) continues.

Psychosis and the Three Refuges

The following article on 'Psychosis and the Three Refuges' is, for the most part, an account of recovery from periods of 'psychosis' in relation to a Buddhist practice. It was originally published in The Middle Way: Journal of the Buddhist Society.

The Three Refuges are also known as the Three Jewels

The Three Refuges are also known as the Three Jewels


Psychosis sounds scary. It is the name of a 2010 horror film based on a serial killer who “unleashes his blood lust”. The first thing people often ask, when I tell them I work with people who have psychosis is: “aren’t you scared?” So what can psychosis have to do with the Three Refuges (the Buddha, Dharma and Sangha)?   


In psychiatry psychosis is sometimes used as a synonym for ‘severe mental disorder’ and according to the mental health charity, Mind, there is actually more chance of being killed by lightning than by someone with a mental illness.  Most narrowly defined, psychosis is simply the presence of delusions and/or hallucinations. 

Delusions, as understood in psychiatry, are beliefs that are clearly false and that indicate an abnormality in the affected person's content of thought. Hallucinations in psychosis are often auditory, hearing voices is a well known example. They can also be visual, and some people with psychosis experience strong smells or have sensations on or under the skin when nothing is actually there as far as other people are concerned. 

Whilst some of us may have a greater predisposition, all of us can potentially experience psychosis. The British Psychological Society (2000) has estimated that around 10-15% of the general population experience what could be described as psychotic phenomena, and most are neither distressed, nor seek help. Studies have shown that all sorts of beliefs Western psychiatry might see as delusions (including beliefs in magic, aliens, telepathy and spiritualist beliefs) are actually extremely common in the general population (Peters et al. 1999). 

Psychosis may be triggered by many things including stress, traumatic life events, drug use or even Buddhist practice. Buddhism traditionally that such experiences can arise in the practice of zazen. The Japanese term makyo, roughly “diabolic phenomenon” from “ma” (akuma), “devil” and kyo, “phenomenon, objective world” is used to describe such hallucinatory or delusional experiences in this practice. VanderKoor (1997) describes the example of Sara, who on a Buddhist meditation retreat had intense makyo. Following the retreat she was hospitalized and received antipsychotic medication.

Although I have a specific qualification in interventions for psychosis and around 7 years experience in working with others with these experiences, my most direct understanding comes not from training, work or study, but from personal first-hand experience of psychosis both within and without the mental health system. 

My first experience of psychosis, when eighteen, was thought by psychiatrists to have been a reaction to stress and bereavement. In 1996 I began reading books on religion and Zen and believed that I was making a 'breakthrough'. My presentation quickly led to a psychiatric hospital admission. The following are extracts from my personal health records of the time: 

...he is acutely psychotic, with paranoid delusions... hospital treatment is the only option...
— Record of receipt of medical recommendation(s) and formal admission to hospital
...it became necessary... for police to handcuff him and force him into the ambulance where he was strapped to a stretcher...
— Mental Health Act 1983 Social Circumstances Report 

In hospital I was further restrained and heavily medicated with antipsychotic injections by force. Fortunately the admission was brief and once discharged I stopped all medication after about 6 weeks. Since then over a number of years, at times of stress, I experienced brief psychotic symptoms. I chose not to disclose these symptoms to medical professionals at the time and navigated my way through, getting on with my life without subsequent compulsory psychiatric hospitalisations or forced injections.

During 1999-2000, whilst at university, I had a period of experiencing what a nurse described as “anxiety attacks”. The nurse recommended abdominal breathing. This worked for me and reminded me of the Zen books I had read over the previous few years, so I decided to try the practice of zazen (seated meditation). Later in 2002 I formally became a lay Buddhist at a Jukai ceremony and now consider the Three Refuges as vital to my personal recovery. 

The Three Refuges are the Buddha (meaning both the historical Buddha and the Eternal Buddha Nature), the Dharma (the teaching of the Buddha and of our own Buddha Nature), and the Sangha (those who follow the Buddha and those who seek, long for and know the Eternal) (Schomberg, 1996).

The Three Refuges

The Buddha

Mindfulness was originally integrated into Western healthcare in the late 1970s by Kabat-Zinn; he describes mindfulness as: “paying attention in a particular way: on purpose, in the present moment and non-judgementally” (Kabat-Zinn, 1994 p.4). In healthcare the importance of presenting mindfulness as secular and distinct from Buddhism is frequently emphasised; psychologists now often present mindfulness as something from psychology or something that Kabat-Zinn ‘came up with’. In fact he was a student of Zen Master Seung Sahn (Streitfeld, 1991) and recent healthcare treatments such as Dialectical Behaviour Therapy (DBT; Linehan et al., 1991; Linehan et al., 1993) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al, 2002) also have a basis in adaptations of Buddhist teachings (Welch et al., 2006; Gilpin, 2006). The Dalai Lama has stated: 

...what we are trying to do here is to see, among the age old meditative practices, aspects which can be adapted into the domain of health...
— The Dalai Lama (2005)

Studies are now beginning to support the use of Mindfulness practices drawn from Buddhism in the clinical treatment of psychosis (Abba, et al, 2006; Bach and Hayes, 2002; Chadwick, 2006; Gaudiano and Herbert, 2006). Paul Chadwick (2005; 2006), for example, is a clinical psychologist who has drawn on the teachings of Ajahn Sumedho (1992) and now advocates relating mindfully to unpleasant psychotic sensations; with a clear, open and gentle awareness of whatever is present. 

Daishin Morgan, Abbot of Throssel Hole Buddhist Abbey in England, sees the therapeutic and enlightenment aims of meditation as on one continuum. He reminds us that whilst it is good to see some of the benefits of Buddhist practice made available to those who might not otherwise find them, the fundamental aim of Buddhist practice goes much further (Morgan, 2004). 

Koshin Schomberg (1996a), Abbot of North Cascades Buddhist Priory in the USA, teaches that, in Buddhist training, difficulty in accepting the full religious implications of meditation can be an obstacle: Buddhism is a religion, and requires us to have real faith. This faith is not a matter of professed creed or belief. It is the faith that there is That which is a true Refuge and that we can find this Refuge through meditation and training. 

In my own life, this practice is more than just a technique for changing my relationship to unpleasant experiences; zazen is directly taking Refuge in the Buddha. 

The Dharma

Whilst I was in hospital with psychosis, I was convinced that the world and all that relates to it had ceased to exist – nothing was real. All that remained was an illusion, placed there by the devil to keep me bonded to false reality and ultimately in hell. I also believed that various people including my family were in fact this devil in disguise attempting to keep me in bondage.  

After looking at a landscape painting on the hospital wall for some time, I had a sudden belief that it was a window into the true reality beyond the devil’s illusion – a window into heaven. In order to show trust in God, I stood upright and allowed myself to fall backwards hoping to land in the heavenly reality shown in the painting. As I allowed myself to fall backwards my head hit the edge of a table. I lay on the floor, my head now bleeding. “Look at the blood” said the nursing staff around me, “What blood?” I answered, defying what I believed were the devil’s attempts to bind me.

Knowing what is real and what is not can be especially difficult when experiencing psychosis. For me, taking Refuge in the Dharma, the Buddhist teachings (which reject both extremes of eternalism and nihilism), provides a source of stability and confidence. In particular the teaching of the Buddhist precepts; beginning with “Cease from evil”, provides an anchor in the midst of the changing conditions of daily life, and an essential guide to action no matter what may happen (or appear to happen). Even within psychosis the Dharma, and in particular the teaching of the precepts, provides an anchor.      

The Sangha

Buddhism is more than mindfulness with bells, gongs and incense, but it is no cure for psychosis. At the completion of my final exams at university I had been practicing zazen for a while, but nevertheless became psychotic again, believing that I was being spied on by government agents: 

When I was out I noticed that someone looked at me and touched their ear. This was a message that they had an ear piece and were listening to me. In a pub, believing I was being listened to by government agents, I began reading from my passport; hoping this would help give me protection:

Her Britannic Majesty’s Secretary of State requests and requires in the name of Her Majesty all those whom it may concern to allow the bearer to pass freely without let or hindrance, and to afford the bearer such assistance and protection as may be necessary

As I read this I looked across the pub and could see that a woman was touching her ear looking at me and smiling. I then knew that she could hear me through an ear piece and was a spy. There was also a television on in the pub, the news was on and I could see that there was a riot in another part of the country. This riot was connected to the things that were happening to me and it became clear that I was now on a secret government mission. The woman’s smile was a signal that I would indeed have "assistance and protection as may be necessary" on this mission...

Around this time I had a number of other unusual experiences and then decided that it may be beneficial to practice zazen (something I had not done for a while). So I sat down in my room, but attempting to practice whilst in this psychotic state was like getting hit by a mental tsunami. For a moment I saw just how incredibly unsettled my mind was and this was very disturbing. This disturbance inspired me to check out my recent experiences, with a Buddhist Monk in a local Zen temple. My intention was to ask the Monk what his opinion was of these beliefs and experiences. On my way to the temple I had various further experiences such as receiving messages from inanimate objects. I also felt elated and believed that this could be a spiritual experience. I intended to share all this with the monk in the temple. 

When I entered the temple I was invited to join meditation. We first read a scripture together but when it was time to move I stayed put. I was then told that meditation was over and was offered a cup of tea. 

Responding to my unusual perceptions and experiences, I began to act in a chaotic way in the temple, and was eventually asked to leave. On my way out I explained that I had come to find out if the monk thought I should see a psychiatrist and he said that he thought I should. Being advised by the monk to see a psychiatrist challenged my psychotic beliefs and helped to bring me back down to earth.  Fortunately this challenge gave me enough insight to move in the direction of recovery without actually seeking medication or hospitalisation at the time. In the next few weeks, having completed my exams, I attended my graduation ceremony and returned to my parents’ home for a while. 

For many, in the face of an unsatisfactory mental health system, it can be tempting to seek alternatives in Buddhism. Taking Refuge in the Sangha means trusting in and seeking the advice of those who follow the Buddha. Over 2000 years before Florence Nightingale, who is seen as the founder of the nursing profession, Buddhist teachings set forth the qualities of a good nurse in the Anguttara Nikaya. The Buddha stated: "Whoever, O monks, would nurse me, he should nurse the sick" and Buddhism has begun to enrich contemporary Western nursing. 

Even so, Buddhist centres which are not set up as treatment clinics or hospitals cannot be expected to function as such and in relation to psychosis the most essential role of the Sangha may indeed be to continue pointing those in need in the direction of professional healthcare providers.    

Psychosis and the Three Refuges

In reality, unlike the movies, psychosis is not about “unleashing blood lust”, in fact sometimes it is not scary at all, but it can be deeply disturbing for both those who directly experience it and their families. One does not need to be a Buddhist to practice mindfulness, and it may be helpful to people in getting grounded and letting go of disturbing sensations or thoughts; however, Buddhism goes much deeper and I believe that not only mindfulness, but the Buddha, Dharma and Sangha have been essential to my staying well after psychosis.  

Finally, the Three Refuges do not offer a miracle cure for psychosis which can be rolled out through the healthcare system in a secularised form. There are perhaps as many routes to recovery as there are people.

Aldridge, M.A. (2011) Psychosis and the three treasures, The Middle Way: Journal of the Buddhist Society, 86:3

The Foundations of Mindfulness

Mindfulness has become a ‘billion-dollar business’ in the West (Wiecznsner, 2016). Growing research indicates that as a cognitive therapy, it works, and Western mental health professionals have begun to use and evaluate its efficacy as a clinical intervention for people with psychosis. The connection of mindfulness with Buddhism has occasionally been acknowledged in this context, but traditional Buddhist approaches to mental health and healing have, for the most part, been ignored in the West, perhaps dismissed as among the “trappings” of Buddhism.

As a result there are now growing concerns over the rapidity at which ‘mindfulness’ has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains. As stated by Huxter (2007) on this matter:

Attempts to reinvent the wheel, without reference to earlier models are, perhaps a retrograde step
— Huxter, 2007

Sri Lanka has been a centre of Buddhist scholarship and learning since the introduction of Buddhism in the third century BCE and historically Buddhism and traditional medicine, particularly Āyurveda, in Sri Lanka have been closely related (Liyanaratne, 1995).

Whilst attending the sick, the Buddha explained the satipatthanas (four establishings of mindfulness) (SN.36.7,8) and when the Venerable Anuruddha was gravely ill he explained that through his practice of the satipatthanas: “...arisen bodily painful feelings do not persist obsessing my mind” (SN.52.10).

The satipatthanas (four foundations (or establishings) of mindfulness) forms an important part of our therapeutic programmes. The Satipattana Sutta and Maha Satipattana Suta are the most ancient known discourses on the practice of mindfulness.

The Satipattanas form the basis of our approach to 'cognitive therapy' which is an important part of our Manasa Ayurveda therapy programmes.

In the recording here, Ven. Dr Omalape Sobhita Maha Thero is chanting the Maha Satipatthana Sutta (the Buddha's discourse on the four foundations of mindfulness). 

The recitation of this Sutta is traditionally offered to those who are suffering from physical or mental health problems...

Ayurvedic Spiritual Therapies: Resources for Health and Healing

Manasa Ayurveda therapies include daivavyapāsraya which is often described as 'spiritual therapies'. Ayurveda is not bound to any religion and is not itself part of religion so its recommendations for health through spiritual practice can benefit those of any or no faith. For example, for Muslims, such an approach may centre around the Quran, whilst Christians can find sources of inspiration for healing within the Bible : 

قُلْ هُوَ لِلَّذِينَ آمَنُوا هُدًى وَشِفَاء

And declare (O Muhammad) that [the Quran] is a guidance and healing for the believers
— al-Fussilat, 41:44
My son, attend to my words; incline thine ear unto my sayings. Let them not depart from thine eyes; keep them in the midst of thine heart. For they are life unto those that find them, and health to all their flesh.
— Proverbs 4:20-22

The Āyurvedic classical text, the Aṣṭāñga Hṛdayam was written by Vāgbhata, an Āyurvedic doctor who happened to be a convert to Buddhism. This foundational classic Ayurvedic text advises the use of specific mantras and dhāraṇīs (recitations) mentioning ‘Avalokita’ and ‘Natha’, referring to the Bodhisattva Avalokiteśvara, and Acala-Natha (Achalanatha; Lord Immovable) (AH.Utt.V.49-51).

Acalanatha is especially efficient in removing all kinds of obstacles which lie in the way of one’s undertaking, religious or otherwise. His other title is “the great destroyer of hindrances”. The Pali suttas make reference to the Buddha’s ‘unshakable’ liberation and being ‘steadfast’ (e.g. AN.6.45; AN.3.84; AN.3.103; MN.I.357). To further inspire and illustrate this quality of immovability, imagery was used in an early sutta of ‘the pillar in the king's frontier fortress’, with a ‘deep base… securely planted, immobile and unshakable’ (AN.7.67). Use of imagery to represent the quality of immovability seen within the early Nikayas may have provided the basis for the adoption of iconography now associated with Acalanatha, and which is described in the Maha-Vairocana-Abhisambodhi Tantra:

…He holds a sword and a noose, his plaited hair hangs from the left of his head, he is well adorned and one of his eyes squints. He abides amidst his own light, wrathfully seated upon a rock. His face is creased with anger, and he has a robust youthful form
— MVA.II.40

To embody the qualities of Achalanatha, the Maha-Vairocana-Abhisambodhi Tantra advises mental recitation of the mantra of Acalanatha and use of His mudra (as well as other ritual practices) (MVA.XI.85). The Ayurvedic Aṣṭāñga Hṛdayam also mentions the therapeutic use of dhāraṇīs invoking 'Natha' and the popularity of Achalanatha has spread internationally. The video below, made in England, includes contemporary English versions of dhāraṇīs calling upon Achalanatha. 

The Origins of Ayurveda – Myths & History

This article discusses the premodern interactions between Buddhist and Ayurvedic traditions and formed part of an MA thesis entitled: Developing Buddhist Ayurvedic Counselling and Psychiatry for mental health service provision in England (Copyright belongs to the author). 

Kasyapa Buddha: principal teacher of Ayurveda?

Kasyapa Buddha: principal teacher of Ayurveda?

It is widely accepted that Ayurveda came into existence long before the emergence of the historical Buddha and that the evidence for this can be found in Vedic literature, in particular the Atharvaveda, which, with a devotion to the removal of disease, was the principal source of medicine during the Vedic period of Indian medicine (p.118, Sharma, 1992; pp.1,14 Zysk, 1992).

Brahmanist-inclined traditionalists assert the continuity from Veda to Ayurveda; Ayurveda being seen as a timeless upanga or upaveda of the Atharvaveda. However, there is actually no mention of the word ‘Ayurveda’ in the Atharvaveda and the question has been raised as to whether Ayurveda really existed at the time of the creation of the Atharvaveda (p.12, Haldar, 1977). Wujastyk (1998, 2003) has argued that the Atharvaveda, does not form an obvious precursor to classical Ayurveda; the medical material within Vedic literature being ‘…remarkable, more for its differences from classical Ayurveda than for its similarities…’ (p.xxix, Wujastyk, 1998, 2003).

According to classical Ayurvedic texts themselves, the origin of Ayurveda is traced through a lineage of divine, semi-divine, and venerable transmitters; Hindu divinities being the ultimate fountains from which medical knowledge has issued: 

'Bharadvaja, the ascetic of eminence, desirous of long life, having known (about Indra) approached Indra - the lord of immortals and protector of the devotees. Daksa got the Ayurveda as propounded by Brahma; from the former, the Asvins got it in its entirety and Indra got the whole of it from the Asvins; so as directed by sages, Bharadvaja approached Indra (CS.Su.I.4-5).

Such proclamations are not, however, universally accepted as the final word on the question of the origins of Ayurveda. According to Wujastyk (1998; 2003) such claims within Ayurvedic texts are not evidence for Vedic medical history, but rather evidence of a bid by medical authors for social acceptance and religious sanction. The argument of Zysk (1991) is that such origin myths are likely to have been superimposed on previously existing material in an intellectual endeavour to render a fundamentally heterodox science orthodox; to establish a body of knowledge as brahmanic through applying a ‘veneer’ of Hindu mythology that was told and retold in later Ayurvedic classics such as the Astangha Hridaya (AH) (p.5;8;117-8, Zysk, 1991):

'Brahman, remembering Ayurveda (the science of life) taught it to Prajapati, he (Prajapati) in turn taught it to Asvin twins, they taught it to Agnivesa and others and they (agnivesa and other disciples) composed treatise, each one seperately' (AH.Su.Su.I.2-3).

Despite the narrative of divine lineage presented within these origin myths, according to Zysk’s analysis, Indian medicine was not a product of an orthodox brahmanic intellectual tradition. The brahmanic hierarchy may have denegrated medical practitioners, excluding them from orthodox ritual because of their pollution through contact with impure people (pp.4-5, Zysk, 1991) and from the perspective of social and religious history, it is not within brahmanic orthodoxy, but early Buddhist literature, that clear evidence of the foundations of Ayurveda can be identified:

‘...the very earliest reference in Indian literature to a form of medicine that is unmistakably a forerunner of ayurveda is found in the teachings of the Buddha... As far as we know, it was not yet called ayurveda, but the basic concepts were the same as those that later formed the foundations of ayurveda...' (p.31, Wujastyk, 2003).

Early Buddhist literature (which describes health as the ‘highest gain’; Dp.XV.204), directly references known illnesses and treatments of the time and adopts technical terms such as ‘dhatu’ which may have been borrowed from respected contemporaneous medical traditions (p.246, Larson, 1987; p.42, Mitra,1985). Sik (2016) investigated ancient Indian medicine according to various versions of the chapter on medicine in the extant Vinaya Piṭakas. Illnesses examined in these texts include:

‘…autumnal disease, wind diseases, disorders of humours or elements, fever, gastrointestinal disturbances, headache, jaundice, snakebite, poisoning, ocular diseases, itchy lesions, carbuncles, wounds, other skin problems, perineal diseases, foot ailments, and insanity…' (Sik, 2016).

Liyanaratne (1999) has claimed that the Girimanandasutta of the Anguttara Nikaya precedes the earliest Ayurvedic treatises by five or six centuries (p.72, Liyanaratne, 1999). It describes forty-eight forms of disease according to their location, type, cause and nature. The Brahmajala and Samannaphala suttas of the Digha Nikaya are among the earliest authenticated Buddhist texts (p.65, Liyanaratne, 1999). They enumerate livelihoods (jivaka) which include a range of medical therapies prescribed within Ayurvedic treatises. In these suttas the therapies are described as ‘brutish arts’ and distained as means of wrong livelihood; however, in the Vinaya the practice of some of these therapies is explicitly allowed.

Natthukamma (Skt. nasya – nasal therapy) and sirovirecana (a specific form of nasya) distained as means of wrong livelihood in the Brahmajala and Samannaphala Suttas, are permitted according to the Vinaya: “I allow, monks, (medical) treatment through the nose” (Vin.I.204). Clearly any distain is towards the prospect of Buddhist monks receiving remuneration for the provision of those services, not the therapeutic interventions themselves (p.27, Zysk, 1992). In fact, of all the occupations during the time of the Buddha, the medical profession appears to have been valued the most by the Buddhists as in full keeping with the principle of right livelihood (samma ajiva) (p.228, Dharmasiri, 1997; p.118, Sharma). Medicine was always a significant part of Buddhism throughout the development of the religion (p.70, Zysk, 1992), and where prompted by compassion combined with charity, involvement with the practice of nursing or medicine was not distained by the Buddha, but is actively encouraged (p.17, Liyanaratne, 1999):

“Monks, you have not a mother, you have not a father who might tend you. If you, monks, do not tend one another, then who is there who will tend you? Whoever, monks, would tend me, he should tend the sick' (Vin.I.302).

It can also be observed that the Brahmajala Sutta explicitly mentions that sramanas as well as Brahmins were engaging in the practice of these therapies (natthukamma (Skt. nasya – nasal therapy) etc.). Consequently, Vedic influences (such as specific knowledge and healing approaches originating in the Atharvaveda) may have become more connected with some early medical traditions than others. This appears to be supported by the fact that whilst Susruta mentioned three hundred bones in the human body, both adherents of the Vedas and Cakara's school held them to be three hundred and sixty (p.13, Haldar, 1977). Whatever the remaining early Vedic influences within the various medical traditions, it appears likely that the earliest Ayurvedic practitioners operated among the sramanas, outside brahmanic restrictions:

‘…Unaffected by brahmanic strictures and taboos, these sramanic physicians developed an empirically based medical epistemology and accumulated medical lore from different healing traditions in ancient India. Ideally suited to the Buddha's key teaching of the Middle Way, this medical information was codified in the early Buddhist monastic rules, which gave rise to a tradition of Buddhist monastic medicine during the centuries following the founder's death' (p.117-8, Zysk, 1992).

Pandey (2015) emphasised that the traditional medicine in Buddhist India was ‘undoubtedly the forerunner of Ayruveda of today’ (p.472, Pandey et al, 2015), Laiyanaratne (1999) has recognised that the development of Ayurveda took place principally in a ‘Buddhist matrix’ with the Sangha playing a major role (p.xi, Laiyanaratne, 1999) and Dharmasiri (1997) has emphasized that ‘…Ayurveda medicine itself is primarily of Buddhist origin with substantial Buddhist contributions throughout its history...' (p.209, Dharmasiri, 1997). Both the AH and Astangha Samgraha acknowledge the contribution of the Buddha to medicine in their opening verses by paying homage to the Buddha both explicitly (in the AS) and surreptitiously (in the AH):

'Obeisances to the Buddha, who by the power of knowledge and spells has subdued the mighty serpent called citta (mind)…

…I bow my head in reverence to that One (rare, unique) physician, who has dispelled from this world, quickly, all the rogas (diseases) commencing with raga (desire, lust) etc...’ (AS.Su.I.1).

‘Obeisances be, to that Apurva vaidya (unique/unparallelled/rare physician) who has destroyed, without any residue, (all) the diseases like raga (passion/desire) etc…’ (AH.Su.I.1).

From the time of the earliest suttas, the Buddhist tradition has emphasised that it is ultimately not Brahma, but the Buddhas who are true source of knowledge and wisdom (DN.I.222), and in these texts, Buddha is recognised as ‘the principal teacher of medicine’ (p.8, Zysk, 1992). In Buddhist Sri Lanka and Tibet the Brahmanist mythological lineage through which the origin of Ayurveda is traced has been maintained but with variations which explicitly emphasise the Buddha as source. According to Tibetan tradition, the Buddha Kasyapa (see image above) is firmly identified as the principal teacher of medicine (p.49, Dash, 1976; p.47, Clifford, 1984), and in the Vaidyalankara, an Ayurvedic text written in Sri Lanka, it is explained that the historical Buddha made Ayurveda clear, by getting Jivaka to learn it (Jivaka was the Buddha’s own physician, but is not mentioned in Brahminist Indian tradition concerning the origin of Ayurveda) (pp.395-6, Liyanaratne, 1999).

On this basis, the early Buddhist sangha ‘soon became the principal vehicle for the preservation, advancement, and transmission of Indian medical lore' (p.38, Zysk, 1992), and Zysk (1992) suggested that ‘Buddhist monastic medicine represents the earliest extant codification of medical doctrines...’ (p.84, Zysk, 1992); however, early Buddhist texts do not possess the word ‘Ayurveda’. Instead, the word 'tikiccha' is used (pp.131-3, Narayana & Lavekar, 2005). The names of three Vedas, i.e. Rgveda, Yajurveda and Samaveda are occasionally referred to in Buddhist canonical works, but there is also no mention of the word ‘Ayurveda’ in these, or the Atharvaveda. The Chandogya Upanisad also does not include the term Ayurveda, but it does mention bhutavidya (which became a branch of Ayurveda), which is also mentioned in the Buddhist Digha Nikaya (DN.I.2.I). On this basis, it seems unlikely that the term ‘Ayurveda’ was deliberately excluded or displaced in early Buddhist suttas. As stated by Wujastyk (2003), although the teachings of the Buddha refer to a form a medicine that is ‘unmistakably a forerunner of Ayurveda… As far as we know, it was not yet called ayurveda’ (p.31, Wujastyk, 2012).

Buddhist India contributed much to the spread of Ayurveda through the support of King Asoka (ca. 269-232 B.C.E.) who was an enormously influential convert to Buddhism:

'Asoka, Beloved of the Gods, issues the following proclamation: For more than two and a half years, I have been a lay disciple [upasaka] of the Buddha. More than a year ago, I visited the Samgha [the Buddhist religious orders], and since then I have been energetic in my efforts...’ (Maski Rock Edict).

Ayurveda was taken to all those countries where Asoka sent his Buddhist missionaries. It spread to Sri Lanka, China, Southeast Asian countries, Tibet, central Asia and beyond (p.168, Varier, 2005). The second rock edict of King Asoka (ca. 269-232 B.C.E.) at Girnar proclaims that everywhere in the kingdom medical treatment was to be provided to both humans and animals:

'...Medicinal herbs, suitable for men and animals, have been imported and planted wherever they were not previously available. Also, where roots and fruits were lacking they have been imported and planted. Wells have been dug and trees planted along the roads for men and animals' (Rock Edict II).

But despite Asoka’s support for medical treatment, he is also reported to have called for reprimanding those who wrongly handle surgery (p.168, Varier, 2005). It is possible that this was a consequence of potentially harmful surgery being undertaken for profit where safer and less invasive (but also less profitable), treatments were available; however, Varier (2005) has claimed that these reprimands along with the ‘Buddhists aversion in experimenting surgery in animals’ were detrimental to the practice of surgery (p.168, Varier, 2005). Dash and Kashyap (1987) made similar criticism by claiming that Buddhists ‘prohibited the practice of surgery among several other professions’ and thereby gave a ‘death blow to the medical practitioners’ (p.ix, Dash & Kashyap, 1987). A case recorded in the Vinaya, where a monk got a fistula operated by a surgeon called Akasagotta might appear to support a Buddhist rejection of surgery:

‘“Monks, one should not have lancing done within a distance of two finger-breadths of the private parts nor a clyster-treatment. Whoever should have either of these things done, there is a grave offence”’ (Vin.1.216).

But as Talim (2009) argued, it is ‘not proper’ to ascribe the decline of traditional surgery and medicine in India to Buddhism (p.93, Talim, 2009). The ‘rejection of surgery’ by the Buddha seen in the Vinaya (Vin.1.216), was of a specific surgical procedure, made in a specific context in which the lancing of an ulcer by Ākāsagotta, a monk who was a surgeon before joining the Sangha, was a failure, and the patient suffered. Surgery requires ongoing practice and a monk cannot play with the life of other monks on the basis of his previous experience (p.92, Talim, 2009). The Buddha made clear: “The skin, monks, is tender at the private parts, a wound is hard to heal, a knife hard to guide” (Vin.1.216). Jivaka was also a disciple of the Buddha who was a surgeon, but unlike Ākāsagotta, remained a householder. He maintained his surgical practice but was never advised by Buddha to discard surgery (p.92, Talim, 2009). Barring the example given above from the Vinaya, the Buddha had not objected to surgery and certainly never discouraged surgeons who were householders. A positive and intimate familiarity with surgery and the training of surgeons within Buddhist circles is evidenced within the Visudhimagga (Vis.136):

'Again, when a surgeon’s pupils are being trained in the use of the scalpel on a lotus leaf in a dish of water, one who is too clever applies the scalpel hurriedly and either cuts the lotus leaf in two or pushes it under the water, and another who is not clever enough does not even dare to touch it with the scalpel for fear of cutting it in two or pushing it under; but one who is clever shows the scalpel stroke on it by means of a balanced effort, and being good at his craft he is rewarded on such occasions' (Vis.136).

With the rise of Mahayana Buddhism, medical study (chikitsa-vidya) became one of the five sciences (vidya) for bodhisattvas, either monk or lay, to acquire for healing the sick, and medicine had become identified as one of the means (upaya) to liberation (p.67, Zysk, 1992). Eventually, many Mahayana monastreries in East Asia operated clinics, dispensed medicines and ran medical institutions and colleges (p.22, Zysk, 1992). The symbiotic relationship between what are now known as Buddhism and Ayurveda facilitated the spread of Buddhism in India, led to the teaching of medicine in the large Indian conglomerate monasteries, and assisted the acceptance of Buddhism in other parts of Asia (p.6, Zysk, 1992). 

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The photograph in this post is by Gerd Eichmann - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9401488


This article on the premodern interactions between Buddhist and Ayurvedic traditions is an extract from an MA thesis entitled: Developing Buddhist Āyurvedic Counselling and Psychiatry (BĀCP) for mental health service provision in England.