Healing Through Letting Go: On the Maturation of a Certain Conception of Medicine in Indian Buddhism

Abstract

“Illness itself is emptiness”, says Vīmalakīrti, in a statement that appears to reflect on the nature of sickness and disease. However, Vimalakīrti’s approach of non-duality may not satisfy the rising interest in Buddhist medicine, for which philosophical ideas of emptiness seem too far removed from practical interventions with real people’s pain. Nevertheless, there may be more in Vimalakīrti’s ideas than mere sophistry, and the vision he expresses can connect to realistic practices of healing. In this article, I pursue one potent formulaic passage that appears in a number of early discourses preserved in Pāli (but not in Chinese), in order to examine some of the earlier antecedents of the idea that illness is a mental construction, and that the mind can contribute to recovery. The early discourses provide a more sober definition of the position expressed by Vimalakīrti, by showing how a variety of practitioners let go of their illness, through a change in attitude that was informed by Buddhist insight. With this these texts highlight an understanding regarding the powers of the mind over matter, which traces physical events to their mental apprehension. Not only monks, but also householders, can heal through letting go of the the inner causes that contribute to the disease. While such an understanding need not be generalized as a comprehensive statement on Buddhist medicine, it helps us understand the views and cogency of Buddhist doctrine in this context.

“Illness itself is emptiness”, says Vīmalakīrti, within a sequence of arguments on non-duality.1 Non-duality is the heart of the philosophical teaching of the dazzling Vimalakīrti-nirdeśa (VkN),2 a classic and in some ways representative early Mahāyāna scripture in the way it weaves together a variety of philosophical notions, without deciding whether it inclines to any particular brand of scholastic Buddhist philosophy: ideas of emptiness and of the powers of the mind, suspicion of verbal designation, together with its valorization when it reveals the view of the Mahāyāna,3 blend with magical performances by the Buddha or his followers’, thereby attesting to reality’s completely phantasmagoric nature, fully dependent on its conceptualization, perception, and mental construction. This is the magic of words and vision, generated through the inspired eloquence (pratibhāṇa) of the realized Buddhist adept, who controls reality by knowing its utter lack of objectivity.4 Illness here is a mere stratagem,5 and healing no more real than any other illusion, remaining a change in understanding that dispenses with the illusion of illness. Much like suffering, which in Mahāyāna rhetoric is empty of inherent nature,6 so is illness. When emptiness has been internalized into every pore of this illusory, bodily existence, illness will spontaneously vanish.

Can we take this approach as one that seriously relates to medicine? Would the idea that sickness is emptiness have any power to heal? Is this position more than a pretentious, even condescending, smack in the face of real people’s veritable pain? In recent years, there has been a growing interest in Buddhist medicine, which aimed to go beyond the idealized philosophical and doctrinal conceptions one finds in the texts and to examine concrete practices of treatment and healing in Buddhist societies (Salguero 2014, 2017, 2019, 2022; Gyatso 2015; Triplett 2020). The field of Buddhist studies seems to be calling for a more realistic assessment of Buddhist medical practices, which would not remain content with the fairytale-truths of the VkN. Nevertheless, it may still be true that the attitudes revealed by the VkN have more healing potency in them than mere word-play and aesthetic impact. Although the philosophical positions of the Mahāyāna can be taken seriously in the pursuit after the nature of reality and of physical existence,7 we need not go so far. Here, a more modest and reasonable insight is available, which is that the positions adopted by the VkN emerge from a understanding regarding the powers of the mind and its ability to generate healing through a change in mental attitude. Simply, good “placebos” are hard to come by,8 and ones that are ingrained in dominant cultural and religious paradigms would have an advantage in generating processes of healing. The effort of this article is thus to better understand what these mental healing powers might be like and why they were thought to be effective in their own historical contexts, while remaining open to the possibility that they touch upon real potentials of mind and reality. That is to say, when science is able to explain just how matter and mind relate to each other and co-exist in the same ontological domain, the powers of the mind may be granted more respect than they command today.

My effort is thus to advance the understanding of the doctrinal positions of Buddhism with respect to healing, and to see how Vimalakīrti’s claim that “illness is emptiness” came into being. Salguero (2017, p. xxi), in his introduction to a volume within a series of game-changing publications regarding the practices of Buddhist medicine, makes the intriguing statement that “mainstream Buddhist doctrine seeks to mitigate the suffering of illness by stressing the illusory nature of the human body, the nonexistence of the separate self, and the possibility of radical transcendence of Buddhist practice”.9 Here, I aim to refine this statement in a number of ways. First, I will suggest that although ideas of the healing powers of the mind are deeply ingrained in Buddhism, the idea of the body, and reality more generally, as an illusion, grew and intensified with time (Shulman 2008), while the earlier canonical antecedents of this notion are much more subtle. The full-fledged position of the VkN thus emerged from a method of philosophizing that can be thought to make psychological sense, and one that does not rely on the notion of illusion. Simply, early Buddhism identifies the potential of the mind to both generate and alleviate sickness, so that a change in attitude can be helpful in allowing one to heal. This means, in turn, that the Buddhist practices that contribute to healing are not so much those involved in “radical transcendence”, but rather ones of radical immanence, that is, in improved pathways of heart and mind. Finally, while these ideas can be seen to relate broadly to notions of selflessness, the latter need not be over-emphasized in interpreting the healing powers of the consciousness, as healing would be necessary also for people, including advanced practitioners and affiliated laymen, who have not yet reached such a realization. Moreover, ideas of selflessness may again be finer than the manner in which they are normally constructed in modern scholarship,10 so that, again, the working powers of Buddhist insight need not be seen as something that is beyond the world, but as related to improved ways of being within it. Working with Collins (2020, esp. ch. 2), who draws on Hadot and Foucault, we may suggest that Buddhist practices, or “technologies of the self”, are pregnant with healing potential, so that cultivation of Buddhist insight is a positive endeavor, and not just one that negates the conceptual construct of the self.

That is, for early Buddhism, and despite certain available interpretations, the notion of selflessness does not mean that all is lost. The middle-way position avoids both eternalism (sassta), the existence of a permanent self that retains its identity over time, and annihilation (uccheda), which denies continuity and moral desert. Even without an agentive Self, individuals still experience the fruits of their karma and are ethically responsible. They are also still very much alive, at least as conditioned and changing streams of experience. Indeed, early Buddhist practice, for both laypeople and monastics, takes the fact of experience very seriously, so much so that one is encouraged to cultivate the mind and change the structures of experience for the better, perhaps most distinctly by attenuating attachment to a permanent personal Self. When ideas of selflessness mature in the Mahāyāna, as in the VkN, and when the notion of selflessness becomes comprehensive emptiness, a position like Vimalakīrti’s that illness is emptiness, and therefore an illusion, becomes feasible. The notion that nothing is real; however, or that everything is mere fantastic play, does not reflect the early Buddhism approach to reality, even if it does catch some of its more extreme potential philosophical implications.

Elsewhere, Salguero (2022, p. 17) suggests that “Illness lies at the very foundation of the story Buddhism tells about itself”, referring to the Buddha’s choice to pursue the religious path after facing the realities of old age, sickness, and death. The four noble truths are also commonly presented as being based on a medical model, according to which desire gives rise to suffering (e.g., Gethin 1998, pp. 63–64; Triplett 2020, p. 44). In a certain sense, my discussion will be designed to bring out some of the powers behind this idea, showing how in the early Buddhist discourses, the understanding is developed that pain—severe sickness included—arises through grasping, and that such realities can be altered once the mental causes that give rise to them are treated. This does not mean, however, that grasping is necessarily seen as the one and only cause of illness in early Buddhism, and the degree to which sickness is mind-dependent can vary. However, in the sources we will analyze, it seems that at least in certain situations, deep control of the mind, relaxation of grasping and anxiety, and evocation of positive mental potencies, can help one heal even in the face of severe illness in which one may be even close to death. This idea is then intensified to reach its full-blown expression in the VkN, which suggests that even the subtlest forms of mental construction are themselves painful, and that these densify into seemingly objective realities such as sickness. In both cases, sickness is not distinct from the mind and depends on its causal roles.

The discussion will proceed as follows. First, I will shortly examine the mature conception of the emptiness of illness presented in the VkN. Then, we will search for its earlier origins in early Buddhist teachings, and specifically in the discourses that contain one formula on emergence from sickness in the Pāli Nikāyas, allowingus to identify this sequence of development.

1. Sickness, or Emptiness, in the Vimalakīrti-Nirdeśa

A key feature of the VkN is that it sees magical performances as evidence for the illusory nature of reality.11 The text speaks of non-duality in a plethora of contexts, but ultimately in order to suggest that reality is in no way distinct from the manner in which it is known and constructed in perception.12 While the performative and literary nature of the text suggests that these ideas are no less an aesthetic feeling than a philosophical argument,13 so long as we wish to explore the text as one that makes a statement in the context of Buddhist medicine, its argument must be defined. Roughly, the point is that sickness, much like anything else, is nothing more than a mental construction. It has reality only so long as one considers it real, and so long as the mental conditioning that has brought it into being remains intact. Reality, the text pleads again and again, is completely malleable and responds directly to the commands of the master who knows emptiness. In fact, Vimalakīrti manifests an illness in order to provide an occasion to speak eloquently, that is, through pratibhāṇa, about the lack of duality. There is, in fact, no body, as there is no matter, no mind, nothing objective or subjective, no inner and outer, no sickness and healing. Understanding this, and relying on upāya-kauśalya, a master like Vimalakīrti can pretend to be sick, so that people who inquire into his health may hear him speak of such ideas.

Lamotte ([1994] 1976, p. vi) succinctly described the philosophy of the VkN almost half a century ago—

“For Vimalakirti mind objects, from the most concrete to the most abstract, arise from false imagination (abhūta-parikalpa); false imaginations rest on a total baselessness (apratiṣṭhāna), and this itself, in turn, has no root (VI, §6). From this it results that things, with no exception whatever, are, in the etymological sense of the word, acintya ‘not to be thought of’, and it is within this radical inconceivability that they lead to sameness (samatā) or, to be more exact, non-duality (advaya)”.

Here, we will focus on one sequence in chapter 4 that leads up to the statement with which we opened that “Illness is itself Emptiness”, aiming to see how the text understands sickness. Thus, Vimalakīrti argues in Section 4.11—

“[A] bodhisattva who is ill should train his mind to reflect in the following manner: This illness has arisen due to the effects of past deeds resulting from misperceiving things that are not true; it has arisen due to defilements resulting from imagining things that are not real. From the point of view of ultimate truth, moreover, one cannot apprehend any real thing here which has this illness”.14

The non-dualistic philosophy of the Vimalakīrti, like most non-dual philosophies, must play a double game of affirmation and negation—on the one hand, anything that has arisen is unreal; on the other hand, it has somehow arisen. Here, the concern is with illness (vyādhi), which is explained to result from past karma, which itself “results from misperceiving things that are not true”. In fact, the point made by the text here is more specific, as the compound the text employs explains that the illness has arisen (samutthito) from the manifestation (samutthāna) of karma that results from mistaken perception (asadviparyāsa)15 with respect to an earlier limit (pūrvānta; to read—pūrvāntāsadviparyāsa-karma-samutthāna-samutthito). This means that the arising of the misperception, is one that perceives a moment of arising. Pūrvānta—earlier limit, the opposite of a later limit—aparānta, is well-known already from early texts like the Brahmajāla-sutta as referring to a mistaken assumption that something arises ex nihilo, so that it is completely new to the world as an entity that is distinguished from its causes and conditions. While in earlier texts the focus is more on personal existence, in the Mahāyāna, the term is generalized to speak of any object or event. Here, the statement leads us to the perplexing understanding that the manifestation of karma is an event of non-arising, since any distinction between earlier stages of a thing and its conditioning would be an imputation of an earlier limit (and, in effect, a later limit, a view of destruction, uccheda, to the conditions).16 Again, the world play is tantalizing, and seems unphilosophical and self-contradictory, but is designed to explain that the arising is only an event of perception, which itself appears, but has no objective reality to it. Furthermore, this act of arising, which is real as an illusion, is also the result of defilements (kleśa) that derive from and are based on conceptual construction (parikalpa).17 “Ultimately”, Vimalakīrti concludes this statement, “there is no thing (dharma) for whom this illness can be perceived”.

The text now continues to dwell on its complicated message, aware at the same time that there is a physical body that is at least seemingly sick, but that any sickness is a mental construction. Explaining the ending of the last quote, which raises the idea of selflessness by suggesting that there is no owner of the illness, Vimalakīrti provides a more realistic explanation of the nature of the body, defining it as one that arises from the four great elements. At the same time, they have no owner—

This body consists of the four elements, and these elements have no master, nor any one that sets them in motion, because this body lacks a self. The so-called ‘illness’ cannot be apprehended from the point of view of ultimate truth, except as a result of obsession with self. Let us remain then unobsessed with the self and fully cognizant of the roots of illness. Having thus dispensed with the idea of a self, we should entertain the idea of dharmas. This body is a collection of dharmas. It’s only dharmas arising when they arise, only dharmas ceasing when they cease. But those dharmas are not aware of each other nor do they know one another. As they arise they do not think, “We are arising,’ as they cease they do not think, ‘We are ceasing.’18

This section begins in a realistic vein, saying that “the body consists of the four great elements”. Yet because it is such an accumulation, a physical form (samucchraya) that is not constituted by itself, Mahāyāna insight takes it to be a mere conceptual construction, a product of words and mental imputation. As we see in a similar sequence in chapter 2, the concrete description of the body as impermanent, feeble, and ailing quickly leads to the notion that it is “like a magical illusion, arising from misperception; like a dream, appearing other than it is”.19 This recommends that this imputation does not take place in empty space, so to speak, but is a mental construction of something that has at least a degree of reality. There is no owner (svāmin), no gravitational center, no true agent to this complex. One should be “fully cognizant of the roots of illness”, Vimalakīrti says, meaning that what holds such material elements together is a mental construction that takes itself as real. The body is, in a way, a “real illusion”.20

The end of this passage moves to a different kind of argument, as if what seems like a body is only a series or combination of more basic units of dharmas, which have no agency and mechanistically combine to become what appear to our mistaken perception as things or selves. This idea is problematic, however, as a Buddhist view of the kind advocated by the VkN would not want to rely on the understanding that such basic units are ultimately real, as is attributed to Abhidharma systems.21 Thus, Vimalakīrti says that one should make an effort to understand that “Even this idea of dharmas is a misperception as well, and misperception is a serious illness. I ought to be free of illness and I must make an effort to eliminate illness”. Vimalakīrti is thus suggesting that there are no ultimately substantial units that analysis can rely on, and that such a reliance is itself an illness, i.e., the illness that takes illness to be objectively real. Moving to a sequence on non-duality, Vimalakīrti asks—

What then is the elimination of illness? It is the elimination of me and mine. And what is the elimination of me and mine? It is the cessation of duality. What then is the cessation of duality? It is non-involvement with oneself and what is external to one’s self. What then is non-involvement with oneself and what is external to one’s self? It is being unmoved and undisturbed because of sameness. And what is sameness? It is the sameness of final release together with the sameness of the self. Why? Both of these are empty, the self and final release. What are they empty of? They are empty as verbal designations. Both of them are not ultimately real, the self and final release. Seeing things as the same, he should not take illness as one thing as emptiness as another. Illness is itself emptiness”.

(Gomez and Harrison 2022, pp. 53–54)

Vimalakīrti is eager to deconstruct any duality we may conceive of. Here, he focuses on that between self and other, or self and objectivity, represented by the classic denial of I and mine. There is thus no internal and external, and all becomes equal, a mere verbal designation. The final emptiness is the crucial one, between illness and emptiness. It, too, is a mere mental construction, which comes into manifestation due to the mistake of mental construction itself. It is the reality of the unreal, and as such, one can cause it to vanish if one ceases to construct it in this way.

These are powerful ideas, and a strong case could be made for them philosophically. However, for the way we conceive of sickness and health in a modern episteme, this seems fantastic. I thus suggest that we examine what, in this view, is faithful to the earlier Buddhist tradition, as this can be accessed through the discourses preserved in Pāli.22 Within this strand of the tradition, we seldom find any resonance with the extreme metaphysics of non-duality.23 Indeed, the philosophical tone of this tradition is more realistic and less inclined to see reality as an illusion.24 Nonetheless, we can identify interesting antecedents of the views advocated by Vimalakīrti.

2. Sick Monks and Their Powers of Healing

My approach will be to take one particularly potent and expressive formula on healing that is preserved in the Pāli Nikāyas, and examine it in its different manifestations.25 This method of studying the texts relies on the methodological approach of “The Play of Formulas”, which takes oral formulas as a key to understanding the early Buddhist textual tradition (Shulman 2021). These formulas provide dense articulations of insight, which can be carefully unpacked in order to understand the ideology and world view of early Buddhism.26 The idea is that formulas were used creatively—at times in storytelling, preaching events, or other performances, in other contexts in recitation of passages or of full discourses for study or for merit27—so that the texts we find in the Tipiṭaka today are ones that became canonical with time, through complex processes we do not yet fully understand, which eventually incorporated writing (Collins 1990). The practices of textual composition and transmission that this understanding helps us to perceive, according to which texts are not recordings of events but creative expression and exegesis within traditional models, reflect some of the literary and performative contexts that were also part of the transition to the literature and thought world of early Mahāyāna. This dynamic literary perspective thus helps us situate the philosophical developments that are our main focus, and which inform us of conceptions of medicine and healing, within their broader textual context, so that the two come to reflect each other. Further attention to these literary details is provided in Appendix A.

In the present case, the analysis will focus on what can be identified as the main statement in the Pāli Nikāyas on spontaneous healing—emerging from sickness through a subjective letting go of it—which I will suggest anticipates the position of the VkN. The texts in which this formula appears are mostly well-known, and one of them has received a fair amount of attention. However, the key statement of the formula has not been defined clearly enough.

The paradigmatic textual example for the formula on spontaneous healing appears in two short discourses from the Bojjhaṅga-saṃyutta, chapter two of Book V of the Saṃyutta-nikāya. In the first of these texts, the Buddha hears that Mahākassapa is gravely ill and suffering (ābādhiko dukkhito bāḷhagilāno); the second text is an exact replica of this one, only that the sick monk is Mahāmoggalāna. I take these texts, and the other ones that will be discussed below, as idealized presentations of the theme of spontaneous healing, rather than as attempts to convey historical events. The Buddha thus arrives to visit the sick monk and asks him through the “sickness inquiry formula”:

“Are you enduring? Are you holding out? Are the painful feelings you experience receding, rather than increasing, so that their complete recession is apparent, not their increase?”

kacci te khamanīyaṃ kacci yāpanīyaṃ; kacci te dukkhā vedanā paṭikkamanti no abhikkamanti patikomsānaṃ paññāyati no abhikkamo’ti28

To this, the monk replies, in accord with the formulaic structure of this exchange—

“I am not enduring, sir, not holding out; my intense, painful feelings are on the rise, not receding, so that their complete increase is apparent, not their recession”.

na me bhante khamanīyaṃ na yāpanīyaṃ; baḷhā me dukkhā vedanā abhikkamanti no paṭikkamanti abhikkamosānaṃ paññāyati no paṭikkamo’ti

This formulaic exchange appears over a dozen times in the Nikāyas, with further related texts scattered in the different canonical collections.29 It is used to structure a thematic sequence in which the Buddha or one of his leading disciples goes to visit a sick monk or householder, usually on the latter’s deathbed.30 He then inquires about the sick person’s health, only to learn that his condition is deteriorating, so that heprovides a teaching that helps the sick man recover, or that allows him to die a good Buddhist death. The occasion that the text is depicting is thus that Kasspa is gravely ill, maybe even in a life-threatening situation, and that he receives a visit from the Buddha, the ultimate doctor who has penetrated the secrets of human pain, and who has thereby become an embodiment of cosmic truth and blessing. The fact that this text is used as a paritta—and was probably even designed as a paritta to begin with—a text for protective chanting, reminds us that the words are considered to carry a mantric quality, and that they are imbued with a thick religious significance, which itself derives from the unique power that the words of the fully realized being are thought to be pervaded by.31 As Salguero (2022, p. 28) says of the Buddha’s healing powers—“the Buddha usually does not resort to conventional medicines or procedures… More typically, it is his glance, his touch, his fragrance, his ability to summon protective spirits, the transformative power of his wisdom, or other such wondrous factors that heal the patient”.

In the simplified formulaic sequence of the sickness-inquiry formula, the Buddha (or the monk inquiring) now provides a teaching, which initiates a rapid recovery. In the present case, he recites the formula on the seven factors of awakening (bojjhaṅga)—

“There are, Kassapa, these seven factors of awakening which have been well-taught by me, [so that when they are] cultivated and developed, lead to understanding (abhiñña), awakening (sambodha), utter calm (nibbāna).32 Which seven?

The awakening factor of mindfulness, indeed, oh Kassapa, has been well-taught by me, [so that when it is] cultivated and developed, it leads to understanding (abhiñña), awakening (sambodha), utter calm (nibbāna). The awakening factor of analysis (of events, dhammavicaya)… of energy (vīriya)… of bliss (pīti)… of tranquility (passaddhi)… of meditative concentration (samādhi)… The awakening factor of equanimity (upekkhā) has been well-taught by me, [so that when it is] cultivated and developed, it leads to understanding, awakening, utter calm.33”

This is an extremely potent sequence of liberative understandings, qualities, and potentials of the mind, which relates to the entrance into samādhi states that in other collections can be defined as jhāna.34 Commenting on this passage, Anālayo (2017, p. 13) speaks of “the healing potential of these mental qualities”. Since this recitation helps heal these two advanced students, followed by the Buddha himself healing from illness in the following discourse, thanks to the recitation of this same passage by the monk Cunda, Anālayo suggests that “In all of these cases, it seems that the recitation helps the diseased person to recollect the qualities that led to his awakening. Such reliving of the condition of the mind at the time of awakening apparently has such a strong effect that the body emerges from its sick condition”. The force of the healing thus lies, for Anālayo, in the experience of awakening that these monks underwent, so bringing its qualities to mind is curative. “Whatever may be the last word on the psycho-physical dynamics involved”, he concludes, “there can be little doubt that this is a depiction of employing purely mental means to affect a physical healing process”.35

Anālayo’s focus is on the relation between the qualities encapsulated in the seven limbs of enlightenment and the events of awakening. However, as we will see, similar healing effects are said to take place also for monks and householders who clearly did not reach awakening. In these cases, the emphasis seems to be on the understanding with which Anālayo ends his statement—“that this is a depiction of employing purely mental means to affect a physical healing process”. As Salguero (2022, p. 31) says, “The account of the healing powers of hearing the Awakening Factors certainly suggests that mental agitation was thought to be closely linked to physical illness and that positive mental states were thought to be able to reverse the condition”. This understanding can be advanced by viewing the main formula with which the text itself explains the process of healing experienced by Mahākassapa and Mahāmoggalāna:

This is what the Bhagavān said. Venerable Mahākassapa was pleased and delighted in the Bhagavān’s words. And the Venerable Mahākassapa rose from that sickness, as that sickness of Venerable Mahākassapa was thereby let go of.

SN V.80.15–18: idam avoca bhagavā. attamano āyasmā mahākassapa bhagavato bhāsitaṃ abhinandi. vuṭṭhahi cāyasmā mahākassapo tamhā ābādhā tathā pahīno36 cāyasmato mahākassapassa so ābādho ahosī ti.

Hitherto, the philosophy expressed by this passage has not been appreciated well enough, since translators normally miss the subtlety of the statement that Mahākassapa and Mahāmoggalāna let go of their illness.37 The text could also be interpreted more lightly as a statement that the illness was “eliminated”, pahīna, but since pahīna is a past participle of pajahati—“to give up, renounce, forsake, abandon, eliminate, let go, get rid of”,38 the idea seems to be that the illness was subjectively and probably even consciously released, abandoned and done away with. In fact, the genitive in āyasmato mahākassapassa could even be read to mean that the illness was let go of by Mahākassapa. In my interpretation, the idea related by the formula is therefore that the illness was, to begin with, upheld by modes of grasping and subjective determination, which can potentially be undone. Illness, in this view, is not a plain objective, material condition that cannot be affected by the mind, but rather one that is dependent on it. In the idealized setting of the discourse—a creative textual statement on the potential powers of the subjective mental states—the idea is that an advanced disciple can alter the nature of physical illness through a change in attitude, even when he is about to die.39

Notice that here, in a manner that is quite distinct from Vimalakīrti, the Buddha does not tell Mahākassapa that his sickness is unreal, or that his understanding of sickness relies on a duality of sickness of health, self and dharmas, self and liberation, or matter and mind. The sickness, rather, seems to be acknowledged as a real-life condition, which would reflect the way it is experienced by regular human beings. At the same time, the idea expressed through the formula is that sickness, as an objective and material reality that occurs in a real “physical body made from the four great elements, coming into being from mother and father, supported by rice and gruel” (kāyo rūpī cārumahābhūtiko mātāpettikasambhavo odanakummāsupacayo),40 is conditioned, and can be controlled, by the mind. If one is able to alter the underlying subjective attitudes, one can heal.

The question is now what caused these students to let go, and thereby heal from their intense sickness. In the present text, we find (a) the Buddha himself, (b) reciting, (c) the formulaic sequence of the seven factors of enlightenment. Furthermore, the recitation is directed (d) to very advanced students who are apparently familiar with the practices described. We may ask if it is the teaching itself that produced the effect, the Buddha’s inspiring presence, or perhaps the recitation of such potent words and ideas through the physical voice of a living Buddha. Must the practitioners who hear the recitation be so advanced, perhaps even liberated as Anālayo suggests? Are all these factors necessary, is one of them the dominant one, or is transformation produced in their interrelation?

This discourse may lead us to believe that it is the sequence of the seven factors itself that holds the key to this effective healing. The practices included in the list form together a comprehensive movement along the advanced stages of the Buddhist path. Without entering into an intricate discussion,41 the items on this list include vipassana-oriented practices of mindfulness and “analysis of phenomena”, which lead into samādhi-oriented qualities like pīti, samādhi, and upekkhā. The latter, final element on the list of equanimity is especially significant as a powerful expression of Buddhist insight, which blends together ethical, meditative, and philosophical aspects of the path. Specifically, upekkhā appears as a central aspect of some of the most advanced meditative states, included in this sequence of the 7 limbs of enlightenment, in the final state among the four Brahma-vihāra meditations, and as a defining feature of the 4th jhāna. Steering well away from any question of how these theories of meditation relate to each other and if anyone of them is more “original” than the others, for the present discussion it suffices to notice that the idea of upekkhā, which here relates a fully embodied reality that has been realized in the practitioner’s mind, would serve as an elegant demonstration of the mental quality of letting go that the Buddha directs his student’s mind to. Kassapa and Moggalāna would both be advanced practitioners for whom such a quality has been cultivated and developed (bhāvitā bahulīkatā), so that the recitation directs them to experience the mental state, and not only to think of it in a theoretical manner. The practice is so effective that the Buddha has Mahā-Cunda recite the bojjhaṅgas for him when he himself is sick in the following discourse, thereby facilitating his own recovery.42

However, when we examine another appearance of this formula on spontaneous healing from the Aṅguttara Nikāya, we see that spontaneous healing does not depend on the seven limbs of enlightenment. Here, the Venerable Ānanda informs the Buddha that the monk Girimānanda is very sick.43 The Buddha instructs Ānanda to recite a series of ten perceptions (saññā) to the sick monk, so that he may recover. The Buddha recites the sequence himself, with formulaic definitions for perceptions of impermanence, selflessness, filth, danger, relinquishing, dispassion, cessation, finding no joy in all worlds, having no desire toward all conditioned things, and mindfulness of breathing (aniccasaññā, anattasaññā, asubhasaññā, ādīnavasaññā, pahānasaññā, virāgasaññā, nirodhasaññā, sabbaloke anabhiratasaññā, sabbasaṅkhāresu anicchāsaññā, ānāpānassati).44 Ānanda then proceeds to visit Girimānanda, recites the list of perceptions, and Girimānanda “rose from that illness, as that sickness of Venerable Girimānanda was thereby let go of”. This resolution implies that neither the presence of the Buddha, nor the formula on the seven limbs of enlightenment (or the practices behind it), are necessary for this kind of spontaneous healing.

The sequence of the ten perceptions is in itself a remarkably powerful, condensed articulation of Buddhist teachings, which contains many well-known formulaic elements that join to present the full analytic vision of early Buddhism. In this sequence, central Buddhist ideas are carefully defined with prevalent formulas, as when impermanence is described through a perception of the rising and falling of the five aggregates; selflessness through seeing the senses and their object as devoid of self; filth (asubha) through the reflection on the 32 bodily elements that is found in the Sati-paṭṭhāna-sutta; or both dispassion (virāga) and cessation (nirodha) are defined with the same intriguing formula on nibbāna that “this is peaceful, this is subtle, that which is the quieting of all formations, the letting go of all material sustenance, the cessation of thirst, dispassion/cessation, nibbāna” (etaṃ santaṃ etaṃ paṇītaṃ yadidaṃ sabbasaṅkhārasamatho sabbūpadhippaṭinissaggo taṇhākkhayo virāgo nibbāna’nti).45

It thus becomes clear that what produces the healing in the cases we have examined is not any one of these teachings, but rather, their impact on the mind. It is probably the practitioners’ advanced state of mental cultivation that allows them to let go in this way, while it could very well be that Girimānanda was a practitioner more oriented to vipassanā-style analytic practice, while Mahākassapa and Mahāmoggallāna were practitioners more devoted to samādhi. Thus, the Buddha tailored the formula that was being recited to each student’s particular trainings, which was itself probably attuned to their natural psychological inclinations. Potentially, the Buddha could have caused other students to heal through other parts of his well-taught (svākkhāto) dharma, but these have not been preserved in the textual record.

Since it is Ānanda that recites the sequence of the ten perceptions to Girimānanda, rather than the Buddha, it is also evident that it is not necessary for the Buddha himself to recite the formulas in order for healing to take place. Rather, healing ensues from the direct impact of the teaching on the minds of disciples, which helps them reach the mental state of letting go. Two points seem clear: First, that the Buddha’s teachings, perhaps even his eloquently defined, formulaic, oral encapsulations of the teaching, can be healing. And at the same time, that sickness was, to begin with, dependent on the mind, not objectively present as a state the monks cannot influence, but malleable and responsive to the way it is conceived.

3. Spontaneous Healing of Laymen

The next appearance of the formula on healing by letting go is surprising. It appears in the Book of 6s of the Aṅguttara Nikāya,46 and the person who undergoes the healing is a householder, while his recovery occurs without him receiving any direct Buddhist teaching. This event will help us pinpoint the message of this specific textual trope.

Nakulapitā—the father of Nakula—is dying. His wife, Nakulamātā—Nakula’s mother—is concerned that he will die with an unquiet mind, worried (sāpekho), as such a death would be not only painful (dukkha), but has been said to be contemptible by the Buddha.47 Nakulamātā’s care for her husband and their close relationship is attested in another discourse in the Aṅguttara,48 while in the Book of 1s the teacher defines them as the most trustworthy among his students (or perhaps the ones with greatest trust in him; aggaṃ vissāsakānaṃ/vissāsikānaṃ).49 This last quote is picked up by the commentary to the Saṃyutta-nikāya, which opens its third Book with a rich discourse in which Nakulapitā requests instruction from the Buddha before he dies.50 This reference in the Aṭṭhakathā suggests that there were more stories circulating about this couple as exemplars of Buddhist faith than are included in the surviving textual record. That we are dealing with a particular literary representation that once had wider appeal is also suggested by the inclusion of this couple in the list of students who are the best among this or that quality in Book 1 of the Aṅguttara, which is evidently meant to facilitate the recollection of further stories. In fact, the commentary to Aṅguttara 4.55 tells us that Nakulapitā was the Buddha’s father, grandfather, and “small-father” (cūḷa-pitā, apparently meaning paternal-uncle) for five hundred rebirths each, the same being true for Nakulamātā, who was his mother, grandmother, and “small-mother” (cūḷa-mātā). For this reason, “upon their first sight of the Buddha [in this lifetime], they experienced care for a son [saying] ‘hello sweetie’, much like the care of a cow for her young calf. Seeing him for the first time, they [thus] became stream-enterers”.51 In the discourse itself (Aṅguttara 4.55), their special status is highlighted as the Buddha comes to visit the couple, to hear both husband and wife each disclose their utter faithfulness to the other and express their will to continue together in future lives. The Buddha explains that if such an outcome is desired, they must share the same morality, faith, generosity, and understanding, concluding his exposition with a verse. We see again that much like the construction of the paritta texts with Mahākassapa and Mahāmoggalāna,52 these are exemplary figures that suit the role of the ideal householders, who now can heal from sickness by letting go. We again observe the high literary quality of such texts and their idealized storytelling.53

Nakulapitā and Nakulamātā are thus thick characters, and their exchange when the father of the household is about to die is exemplary of attitudes that householders should adopt. The true heroine of the story here is the wife, who is able to produce a sense of assurance in Nakulapitā, which would have allowed him to die in peace, but is so forceful that he rises from his illness by letting go. In this case, the positive state of mind produced by her questioning is enough to heal him.

As this is the Aṅguttara Book of 6s, Nakulamātā must calm her beloved husband’s heart in six ways. The first, quite naturally, is his worry about her ability to sustain the household, which she appeases by reminding him of her dexterity in weaving cotton and knitting wool. If he is worried that she will go to the house of another, she reminds him of her 16 years of sexual abstinence, even as a householder. If he is concerned that after he dies, she will not want to go see the Buddha, she assures him that she will want to see him even more. If he worries that she will not keep her Buddhist ethics (sīla, she says that she is among the women who ardently do so, and suggests that he question the Buddha about this directly, as he should for another worry, whether she can reach inner, calm states of mind (labhinī ajjhattaṃ cetosamathassa). Finally, if he has any doubt in her complete faith in the Buddha, the Buddha would vouch for her in this case as well. Then, we are told that—

“On account of that admonition by the householder Nakulamātā, that sickness of the householder Nakulapitā subsided. And the householder Nakulapitā rose from that sickness, as that sickness of the householder Nakulapitā was thereby let go of”.54

This discourse with the householder heroes Nakulapitā and Nakulamāta helps us penetrate the logic of this textual cycle. In order to experience spontaneous healing, first, it is best to be a highly devoted person, whether a householder or a monk. Such a person does not need to hear the direct words of the Buddha, although trust in the Buddha is surely of great value in generating healthy, curative states of mind. One also does not necessarily need to hear a dense encapsulation of doctrine chanted by the Buddha or one of his prime disciples. In fact, the healing vision here is not only one produced by Buddhist philosophy or meditative technique, although these will obviously be helpful as well. One does not even need to be a monk in order to reach the deep transformation of the mind that allows one to overcome sickness. However, a change of heart can cause one to abandon illness, an option open to householders and monks alike.

4. Summary

The understandings of non-duality advocated by Vimalakīrti and his ideas on illusion and emptiness, are generally alien to the early Buddhist notion of reality. However, we can identify an intriguing antecedent of this position and its bold assertion that sickness is a mere mental construction in texts where Buddhist disciples heal from illness through a spontaneous process of letting go. In the Saṃyutta-nikāya the Buddha recites the formula on the seven limbs of enlightenment (bojjhaṅga) to Mahākassapa and Mahāmoggalāna, who are gravely ill, so that they quit the illness and heal. Even though the Buddha also heals in the same way in another text, it seems that the cure does not result from a recitation of the formula on the bojjhaṅgas, since in another text, the monk Girimānanda is said to heal by hearing a series of powerful Buddhist philosophical formulations. It is also not the chanting of Buddhist texts or the Buddha’s presence that produces the impact, as it is Ānanda who recites to Giramānanda, while the householder Nakulapitā, who was on the verge of death, heals when his wife helps him reach a state of complete trust in her and in her ability to take care of herself and of their household, both physically and spiritually. This last example allows us to pinpoint the focus of this doctrine—physical health is dependent upon the mind, and sickness is maintained by grasping; when one reaches a truly equanimous mental state, health is made accessible. Vimalakīrti’s position may take this mode of thinking a step further, framing the early Buddhist thought on the powers of the mind within a metaphysic of non-duality.55

Salguero (2022, p. 31) questions whether early Buddhism developed “a coherent viewpoint on health and healing”, suggesting that monks “would not have thought of themselves as medical specialists”. While monks may not have necessarily been medicine men, and despite the recurrent prohibition against monks acting as medical specialists, it does appear that the Buddhist path of practice crystallized a compelling statement on the healing potentials of consciousness, which could be made to generate health and well-being in face of adverse conditioning so long as mental construction of the event quit negative attitudes. The idealized settings of the texts may not offer a fine-grained analysis of how change is effected through letting go, but they do recommend that mental apprehension is part of what produces and maintains disease, and that such conditions can potentially be altered, if only one develops the right state of mind.