During the Buddha’s lifetime he was given numerous epithets in recognition of his outstanding qualities. Some of these include the Happy One, Teacher of Gods and Humans, Lord of Creatures, King of Truth, Teacher, etc. One of the most interesting of these epithets, found in several places in the Tipitaka, is the Supreme Physician (anuttaro bhisakko, It.101). It is usually thought that this refers to the Buddha’s ability to soothe and ultimately heal the afflictions of saṃsāra – birth, death and rebirth, greed, hatred and delusion. Certainly, this is how many people during his lifetime thought of it. For example, the brahman Piṅgiyānī said: “Just as a skilled physician might quickly cure someone ailing, sick and seriously ill, whenever one hears the different aspects of the good Gotama’s Dhamma, grief, sorrow, suffering, lamentation and despair disappear” (A.III,238).
The Paramatajotikā put it like this: “The Buddha is like a skilled physician in that he is able to heal the sickness of the defilements.” While these and similar comparisons are legitimate, they are only part of the reason the Buddha was equated with and praised as a skilled and compassionate physician. He also had interesting, insightful and practical things to say about doctoring and nursing, sickness, health, and healing in the conventional sense. With primitive sanitary arrangements and large numbers of people living in close proximity to each other, particularly in cities, sicknesses of all kinds were a part of everyday life in the Buddha’s India. Some of those mentioned in the Tipitaka include jaundice, fever, ulcers, cough, hay fever, diabetes, literally ‘honey urine’ (madhumehika), and leprosy. There is a description of the monk Kokāila having boils or pustules (phoṭa) break out all over his body which gradually became bigger until they ruptured, discharging pus and blood, and causing him to die (Sn.p.124-5). This is a good description of smallpox. The Buddha mentioned a man “whose testicles were like pots” (S. II, 258) which is a common symptom of filariasis, a condition caused by a roundworm transmitted by several species of mosquitos. Another manifestation of this condition is elephantiasis (sīpada) which causes the legs to become grotesquely swollen (Vin.I,91).
The ancients were aware of sicknesses that run in families (bandhukaroga), chronic illnesses (anusāyuka) and epidemics, or what the Carakasaṃhitā referred to as “the destruction of whole districts” (janapada uddhvaṃsa). What might be one of the few mentions in the Tipitaka of such occurrences was when Ānanda informed the Buddha that a monk, a nun and ten lay disciples had recently died in Nādikā, one of the outer suburbs of Vesālī (D.II,91-92). The Jātaka mentions a family afflicted by a disease known as snake-wind sickness (ahivātaka) and despairing that there was little hope of survival, the mother urged her son to knock a hole in the wall of the house and crawl out, thereby avoiding the malevolent disease-causing spirit haunting the threshold and giving him at least a chance to survive (Ja.II,79). A later text says snake-wind sickness was one of two afflictions caused by evil spirits and would sometimes affect whole districts, while the second, maṇḍalaka, would kill the whole family of the person it first struck (Mv.I,253). Some modern scholars have theorized that this affliction might have been malaria. That the Buddha had at least five synonyms for sickness (roga, ābādha, vyādhi, ātanka, gilāna) and that he was able to list nearly fifty diseases and infirmities (S.V,421) suggests that good health was not common during his time. In fact, the Buddha opined that it would be rare, even impossible, for someone to get through life without being affected by at least some sickness (AIII,54).
Contrary to popular misconception, the Buddha did not claim that all physical conditions, including injury and illnesses, were necessarily caused by past kamma, He mentioned at least eight causes of sickness of which only one was kamma; the others being a disorder in the bile (pitta), in the phlegm (semha), in the wind (vāta), a disorder due to a combination of all three (sannipāta), seasonal changes (utuparināma), carelessness (visamaparihāra) and external events (opakkamika) such as accidents and natural disasters (S.IV,230-231). On other occasions he mentioned that improper diet and overeating can likewise make one ill. Significantly, he did not include evil spirits as a cause of diseases.
The Buddha recognized two types of illness, physical and psychological, saying that while it might be possible to find someone who had never been sick in body, only those who had attained Awakening (bodhi) could be said to be truly psychologically healthy (A.II,143). However, here we will focus on the first of these types of illness.
The Buddha defined health (ārogya) as “having well-being and good digestion, not over-cold or over-hot, and balanced so as to be capable of activity,” (A.III,103; M.II,437). He encouraged his disciples to cherish their health and take steps to maintain it and lauded good health as a real blessing (sampadā), as something desirable (kanta), a great gain (paramā lābhā), and a wonderful opportunity to practice the Dhamma (A.III,103; 135; V,134; Dhp.204; D.III,235). He acknowledged that it would certainly be possible to live by the Dhamma despite being sick and with the resolution: “Though my body is sick my mind shall not be sick” but being healthy would make it many times easier (S.III,1; A.III,103).
As disease and sickness with non-kammic causes can respond to medical intervention the Buddha saw the physician’s role as a vital one. He said, “Indeed, those who care for the sick are of great benefit [to others] (api ca gilānupaṭṭhākā bahūpakārā, Vin.I,303). Consequently, his Dhamma is replete with information pertaining to the treatment of the sick. Because the Tipitaka predates the separation and specialization of the medical profession as presented in early Ayurvedic treatises such as the Suśrutasaṃhitā and the Caraka-Saṃhitā, it rarely makes a distinction between the physician or doctor (bhisakka, tikicchaka or vejja) and the nurse (gilanupaṭṭhaka). During the Buddha’s time the doctor probably performed all the functions in the sick room, including that of nursing the patient. So, the Buddha offered this advice to the physician/nurse:
Possessing five qualities, one who nurses the sick is fit to do so. What are the five? He can prepare the medicine. He knows what is good and what is not. What is good he offers, and what is not he does not. He nurses the sick out of love, not out of hope for gain. He is unmoved by excrement, urine, vomit and spittle. And from time to time, he can instruct, delight, inspire and uplift the sick with talk on Dhamma (A.III,1440).
Of the five points mentioned here the first concern the physician’s responsibility to be fully trained in and skillful in the administration of drugs, given that some drugs can be dangerous if not prescribed properly. The second point is perhaps equivalent to the Hippocratic Oath’s third and fourth stipulation; that the physician shall never do anything to harm a patient, even if asked to do so. The third point counsels the physician to have a benevolent attitude to patients and put their welfare above personal gain. The fourth point reminds the physician that at times it might be necessary to deal with the loathsome aspects of the human body and that he or she should do this with detachment, both for his or her own mental balance and so as not to embarrass or humiliate the patient. The fifth and final stipulation is a recognition of the fact that spiritual counselling and comfort can have a part to play in healing and that the physician or caregiver needs to have at least some abilities in this area.
The Buddha made it a rule that his monks should not practice medicine, although as mentioned above, they were expected to look after their fellows when sick, and this may have sometimes required going beyond just nursing to diagnosing the affliction and dispensing the appropriate medicine (D.I,11).Why would the Buddha have forbidden his monks doing something that is so often associated with compassion and kindness? The answer lies in the purpose and goal of the monastic life: to realize Awakening and to teach others how to realize it. Beyond this, they were discouraged from getting involved in worldly pursuits. Monks or nuns who practiced medicine would soon find themselves being often called upon for their services and have little time for doing what they became monastics for. Nonetheless, in later centuries it was common for monks to serve as doctors, but this was a departure from the Buddha’s original vision for the monastic life.
The Buddha recognized that even the most experienced physician could not cure every affliction (A.V,219) and therefore that different patients would have different prognosis. He observed:
There are these three types of patients to be found in the world. There is the patient who, whether he obtains the proper diet, medicines and nursing, will not recover from his illness. Then there is the patient who, whether he obtains the proper diet, medicines, and nursing, will recover from his sickness anyway. Lastly, there is the patient who will recover from his illness only if he gets the proper diet, medicines and nursing. It is for this last type of patient that proper diet, medicine and nursing should be prescribed, but the others should be looked after also (A.I,120-121).
Apart from being an astute and clear-eyed observation, these recommendations contain something of major importance; the Buddha’s last point. Suśruta, the father of Indian medicine, advised the physician not to treat a patient who is likely to die so as to avoid being blamed for their death. In contrast, the Buddha said patients should be treated and nursed even if they were going to die. This is probably the earliest inkling of what today is called palliative care. While the ethical principles Suśruta taught were of a high order, on this point the Buddha was superior and ahead of his time.
The Buddha was aware that while medical intervention is crucial for the restoration of health, the patient’s attitude and behavior also has a part to play and he had something to say about this too.
Possessed of five qualities, a sick person is of much help to himself. What five? He knows what medicine is good for him. He knows the right measure in his treatment; he takes the medicine as prescribed. He describes his illness to the nurse who cares for him out of kindness, saying, ‘It comes like this.’ ‘It goes like this.’ ‘When it is there, it is like this. And he endures the various pains of the sickness (A.III,143).
Once again, this is practical, common sense advice and suggests that the patient should have some role to play in the healing process.
The Buddha did not just talk about ministering to the sick, on one occasion he did just that. Once he and Ānanda washed and comforted a monk who had been neglected by his fellow monks and left lying in his own excrement; a horrible and humiliating condition to be in. Having looked after this monk the Buddha called the other monks together and in measured but firm words scolded them for their neglect of one of their fellows and ended by saying, “If you would minister to me, minister the sick” (Yo bhikkhave maṃ upaṭṭaheyya so gilānaṃ upaṭṭhahissati, Vin.I,142; 301-2). And he didn’t limit this encouragement to monastics, but to lay disciples as well. For instance, he said that an employer must look after his underlings when they are sick (gilānupaṭṭhānena, D.III,191) and the mistress of a house should carefully monitor the strengths and weakness of servants and workers when they were ill (gilānakānañ ca balābalaṃ, A.III,38).
Recent research has shown that regular visits by loved ones and friends to hospital patients are a crucial component in their recovery. It is not surprising therefore to find that the Buddha always found the time to visit his monastic and lay disciples when they were ill (e.g. A.III,142;379; S.III,119-120; IV,210; V, 80-81;344-355). During such visits he would inquire about how the patient was feeling and express concern for their welfare. “I hope you are managing and getting better. I hope there are signs that the discomfort is declining and not increasing” (S.V,245). Inspired by this, monks and nuns followed his example. Hearing that the monk Channa was critically ill, Sāriputta went to check on him only to find that he was in such pain that he was seriously thinking of killing himself. Shocked by this Sāriputta exclaimed, “Don’t kill yourself Channa. Live! I want you to live. If you don’t have suitable food I will get it for you. If you don’t have the right medicine, I will get it for you. If you don’t have proper care I will take care of you. Do not kill yourself. Live! I want you to live” (M.III,264).
Because of the seriousness of the situation Sāriputta responded with more than just his presence and expressions of sympathy—he undertook to provide Channa with practical help. As for his lay disciples, the Buddha instructed them how to console their sick fellow disciples to lessen any fear or anxiety they might have (S.V,408-409). When it seemed that Nakulamātā’s condition might be terminal, his wife assured him that she would be able to manage alone, thus easing his worry about her fate as a widow should he die (A.III,295). Later, when Nakulapitā recovered, he recounted to the Buddha how his wife had so lovingly nursed him through his sickness. The Buddha told him how blessed he was to have a wife “with compassion for you, desiring your welfare, to counsel and mentor you” (A.III,295-298).
It is hard to know what influence the Buddha’s exhortation and example had on medical care in India and the lands where Buddhism spread because of the many gaps in the records. But we do know that the Buddha’s words were long remembered and often referred to in later Buddhist texts. An important Mahāyāna work translated into Chinese in the 3rd century and still popular in China, the Brahmajāla Sūtra, paraphrases his words about caring for the sick: “If a disciple of the Buddha sees anyone who is sick, he should provide for that person’s needs as if he were making an offering to the Buddha.” The 6th century Chinese physician Sun Simiao was so famous he came to be identified with Bhaiṣajyaguru, the Medicine Buddha of Mahāyāna. In his influential Beiji qianjin yaofang he explained the attitude physicians should maintain towards those who came to them for help:
If someone needs help because they are ill or because they are in some way afflicted, a great physician should take no account to status, wealth, or age; he should not bother whether the sick person is beautiful or ugly, an enemy or a friend, Chinese or a foreigner, or finally, whether he is learned or ignorant. He should regard everyone as equal and act towards everyone as he would himself. Desiring nothing for himself, disregarding all obstacles and not thinking of himself, he will be able to save a life out of compassion.
Centuries later the author of the Saddhammopāyana, a Sri Lankan work from the 12th century, wrote something similar:
Nursing the sick was much praised by the Great Compassionate One and is it a wonder that he would do so? For the Sage sees the welfare of others as his own and thus, that he should act as a benefactor is no surprise. This is why attending to the sick has been praised by the Buddha. One practicing great virtue should have loving concern for others.
As for hospitals, when the Chinese pilgrim Faxian was in India in the 5th century, he wrote this of the Buddhists of Pāṭaliputra:
The nobles and householders of the country have established hospitals within the city to which the poor, the destitute, cripples and the sick of all districts come. They are freely given help. Physicians diagnose their diseases and prescribe for them the correct food, drink, medicine and treatment that will restore their health. When they are cured they depart whenever they like.
Ruins of ancient hospitals have been found throughout Sri Lanka. One attached to the monastery of Mahintale for example, was founded in the 9th century and had thirty-one rooms built around a courtyard in which there was a shrine. Excavations revealed a medicinal bath, jars for storing medicines, grindstones for grinding them and surgical instruments.
When religion meets illness the miraculous is sometimes close by, particularly if the illness is chronic or is judged incurable. Some of history’s great religious personalities are credited with having healed physical ailments through divine power. Whether or not such claims are true is difficult to say. Certainly, the claims of modern faith healers have all too often proved to have been exaggerated or fraudulent—contemporary high-profile ‘televangelists’ in the United States being an example of this. And more than a century of careful scientific study of faith healing has so far produced very little evidence of its validity.
This raises the question of whether the Buddha had miraculous healing powers and that he healed people with them. As mentioned above, he frequently visited those who were sick and it is reported that some of them recovered sometime afterwards. Given that sound scientific research shows that patients spend less time in hospitals when visited by loved ones and friends, this is hardly surprising. But the four Nikāyas do not mention how soon after a visit from the Buddha a patient recovered; nor is there any suggestion that their recovery was somehow miraculous. This tells us something interesting about early Buddhism’s understanding of causes and cures of disease and something about the general character of his Dhamma as well.