Buddhist Healing: Methods and Mechanisms—A Madhyamaka-Oriented Investigation

Abstract

In Buddhist discourse, the path of healing often begins with awareness. Its crucial element, however, lies not in awareness alone, but in the direction toward which awareness is oriented and in the transformative process that follows from it. Ultimately, this process concerns how reality is understood. Madhyamaka thought takes cognition as its point of departure and emphasizes cognitive transformation as a means of reshaping the relationship between individuals and phenomena. Such transformation is not merely an exercise of psychological imagination; rather, it may bring about substantive changes in the structure of lived experience. Contemporary scientific research on psychological change, by contrast, largely relies on quantitative data and instrumental measurement, with its primary emphasis placed on neuroscience and psychology, whereas religious studies more commonly approaches such questions through textual interpretation and philosophical analysis. Each approach offers a distinct level of understanding. Nevertheless, the question of how religious thought may be translated into concrete and practically applicable methods remains in need of further exploration. Against this background, the present study takes healing as its central concern and examines, from within Buddhist theoretical frameworks, whether Buddhism may be understood as a mechanism of cognitive and existential transformation. Focusing on Chapter One of the Mūlamadhyamakakārikā, it argues that Nāgārjuna’s critique of arising is not merely an analysis of causality, but also a deconstruction of the linguistic and conceptual assumptions through which causality and existence are reified. By exposing both the limitations of language and the tendency to mistake conceptual constructions for reality itself, Nāgārjuna opens a therapeutic pathway through which rigid patterns of attachment, conflict, and suffering may be transformed. Furthermore, as individuals gradually loosen their reified assumptions about the self, others, and conflict through insight into emptiness, rigid boundaries between self and other, as well as between friend and enemy, may likewise be reconsidered. Such cognitive transformation may, in turn, provide a possible foundation for equanimity, compassion, and more inclusive forms of ethical engagement.

1. Introduction

In general, religion may be examined from multiple perspectives, including its doctrinal teachings, ritual practices, and institutional structures. For most people, however, the practical significance of religion is more directly reflected in how it responds to questions of life and death, fulfills human aspirations, interprets lived reality, and shapes an understanding of “truth.” Taken together, these dimensions suggest that religion possesses, to some extent, a healing function in human life. Buddhism likewise encompasses this dimension. However, the methods and mechanisms through which Buddhism may produce healing, despite its rich doctrinal and practical resources, warrant further theoretical clarification and development. Wei-min Tsai writes in his article “Religious Belief and Psychological Counseling: A Preliminary Comparison of Christianity and Buddhism”: “Religion itself possesses a significant counseling and therapeutic dimension. … The real issue that merits discussion is where religion should be situated within the counseling process, and how the counselor–client relationship can be appropriately maintained throughout that process.” (Tsai 2004, p. 61).1

This perspective represents one approach found in contemporary scholarship, in which religion is examined primarily within the professional framework of psychological counseling and its potential contribution to counseling practice. A related, though distinct, body of scholarship has explored healing through the encounter between Buddhism and psychotherapy. Part I of Buddhism and Psychotherapy: Across Cultures (Unno 2006, pp. 17–120), for example, brings together studies examining the resonances, tensions, and possibilities of integration between Buddhist practice and various psychotherapeutic perspectives. The contributions address such issues as the differing understandings of the self in Buddhist practice and psychotherapy, the psychological interpretation of Buddhism, the cultural assumptions involved in bringing Buddhist traditions into Western psychological frameworks (Safran 2006), and the possibilities and limitations of integrating Buddhist practice with psychotherapy. Importantly, some contributors also caution against reducing Buddhism to psychological categories or interpreting it primarily through Western therapeutic narratives. Taken together, these studies provide important perspectives on the relationship between Buddhism and psychotherapy, with particular attention to the possibilities and challenges that emerge when the two are brought into dialogue.

By contrast, if religion—particularly Buddhism—is taken as the primary point of departure for analysis, the focus of inquiry may be reoriented. The central question is not merely how religion may be incorporated into the counseling process, but how religion itself functions as a mechanism of cognitive and existential transformation, thereby redefining the nature of helping relationships. In other words, rather than limiting the discussion to the boundaries between counseling and religion or the ways in which the two may be integrated, it is more fruitful to examine where their theoretical foundations and practical aims complement one another, where they diverge, and where genuine tensions remain.

1.1. Conceptual Clarification

Before examining the methods and mechanisms of Buddhist healing, it is first necessary to clarify several closely related concepts that are often used interchangeably. Within the contexts of both religious studies and religious practice, healing is one of the most frequently invoked concepts. However, the relationship among healing, therapy, and counseling is far from self-evident. Whether these concepts differ in meaning, function, and scope, or whether they overlap and complement one another, requires further clarification.

In general, healing is understood as a process that promotes physical and psychological well-being. It is noteworthy that the Encyclopedia of Religion does not include a separate entry entitled “Healing,” but instead discusses the topic under “Healing and Medicine.”2 (Sullivan and Sered 2005, pp. 3808–16). This editorial arrangement suggests that, within the discourse of religious studies, healing and medical practice have frequently been understood within the same analytical framework.

However, religious healing encompasses a wide range of practices, including the use of sacred objects, prayer and meditation, confession, exorcism and purification rituals, as well as practices that induce trance and other altered states of consciousness. Among these diverse healing practices, one particularly important category is cognitive restructuring. Cognitive restructuring refers to “practices that encourage patients or other participants to view and understand the suffering they experience in new or healthier ways.” From this perspective, religious healing involves not merely the alleviation of symptoms or the restoration of physical health, but also a transformation of one’s interpretive framework, enabling individuals to reinterpret their circumstances and suffering within a broader religious and spiritual horizon (see Sullivan and Sered 2005, pp. 3811–13).

This cognitive dimension is of particular significance in the Buddhist tradition. Buddhist healing places greater emphasis on transforming an individual’s cognitive and existential condition through a reconstruction of the ways in which the self, reality, and experience are understood. Such a healing mechanism not only transforms one’s understanding of suffering, but also one’s relationship to it.

In religious studies, the term healing often carries spiritual or religious connotations, whereas therapy in contemporary usage generally has a stronger professional and clinical orientation, referring to a range of therapeutic or counseling interventions intended to improve or restore physical and psychological well-being. Religious healing may take a variety of forms, including practices involving rituals, sacred objects, sacred figures, and other forms of religious practice. At the same time, religious traditions may also involve processes of cognitive, psychological, and existential transformation through which individuals reinterpret themselves, their experiences, and the conditions of suffering. This dimension provides an important point of contact between religious healing and modern therapeutic concerns. Although the two have developed within different conceptual and institutional contexts, they need not be regarded as mutually exclusive; rather, they may illuminate different dimensions of human transformation and enter into meaningful dialogue.3

Indeed, some religious traditions contain practices and intellectual resources that may serve therapeutic functions or contribute to processes of cognitive and psychological transformation. Christianity, for example, has witnessed the gradual development of a relatively mature tradition of pastoral counseling4. This approach generally seeks to integrate modern psychological theories and methods with religious beliefs, theological perspectives, and pastoral practices, thereby providing not only general counseling services but also support for psychospiritual concerns. As Benner notes, pastoral counseling has long existed in a state of tension between the pastoral and the psychological. On the one hand, it seeks to avoid simply following prevailing trends in contemporary psychology; on the other, it does not disregard the contributions of modern therapeutic psychology. In this sense, pastoral counseling attempts to chart a middle course, preserving its distinctively pastoral character while remaining receptive to the professional insights of psychology (Benner 2003, pp. 13–14).

Accordingly, as a religious tradition with a rich doctrinal heritage and a strong emphasis on mental transformation and spiritual development, Buddhism possesses substantial theoretical resources and potential for the development of a model of religious healing. However, unlike Christianity, which has long cultivated institutionalized practices such as pastoral counseling, a systematic framework for understanding religious healing from a Buddhist perspective has yet to be fully developed. Nevertheless, Buddhist thought has already influenced modern psychotherapy in various ways, the most prominent example being Mindfulness-Based Stress Reduction (MBSR), which has attracted considerable attention in recent years. Although Jon Kabat-Zinn deliberately downplayed the religious character of the model in order to facilitate its integration into modern healthcare systems and the field of mental health, he also explicitly acknowledged Buddhist mindfulness and meditative traditions as important sources of its theory and practice (Kabat-Zinn 2003, 2011). In other words, once introduced into the medical system, the religious context was consciously deemphasized, while the practices themselves were reinterpreted as psychological and clinical interventions.

Although the ultimate aim of MBSR differs from the goal of liberation pursued in Buddhist mindfulness practice, its therapeutic effects in areas such as emotional regulation, cognitive transformation, and psychological well-being nevertheless demonstrate the considerable applicability of the Buddhist framework for overcoming afflictions and transforming the mind. This suggests that Buddhism is not lacking in healing resources; rather, it has yet to integrate its existing doctrines, contemplative practices, and spiritual practices into a systematic model of religious healing with both a coherent theoretical foundation and practical methods of application.5

It is evident that the concepts of spiritual healing, religious healing, counseling, and therapy both overlap to some extent and differ in their respective theoretical backgrounds and fields of application. Broadly speaking, spiritual healing has the broadest scope, while religious healing may be understood as one of its specific manifestations, as it is typically grounded in the doctrines and practices of particular religious traditions. By contrast, counseling and therapy are not core concepts originating within traditional religious discourse but are instead professional frameworks that have developed largely within the contexts of modern psychology and medicine. Accordingly, in terms of conceptual definition and scope of practice, counseling and therapy possess relatively well-defined meanings and professional boundaries. Although counseling and therapy are neither exclusive to religious healing nor dependent upon a religious context, they may nevertheless serve, within the areas where the two overlap, as important practical approaches and the theoretical resources through which religious healing is carried out. The distinctions proposed here are intended primarily to provide the conceptual framework for the present study rather than to offer a comprehensive definition of these concepts across different disciplinary contexts.

1.2. Religious Healing in Academic Discourse

A further question concerns how religious healing has been discussed as a subject of inquiry within religious studies. As noted above, the Encyclopedia of Religion discusses healing under the entry “Healing and Medicine” rather than providing a separate entry for “Healing.” This editorial arrangement may reflect a broader tendency to examine religious healing in close relation to medicine and healthcare. Consequently, when religious healing is incorporated into modern healthcare systems, an important question arises: must it conform to the norms of the medical system, such as scientific validation, objectivity, and demonstrable efficacy? A related orientation can be found in a substantial body of interdisciplinary scholarship on Buddhism and healing, in which Buddhist ideas and practices are examined through the conceptual and methodological frameworks of psychology, psychotherapy, cognitive science, and related fields. For example, Mruk and Hartzell’s (2003) Zen and Psychotherapy explores the relationship between Zen Buddhist practice and psychotherapy, while Welwood’s (2002) Toward a Psychology of Awakening brings Buddhist perspectives into dialogue with Western psychology and psychotherapy in addressing psychological and spiritual transformation. Similarly, the essays collected in Segall’s (2003) Encountering Buddhism: Western Psychology and Buddhist Teachings examine Buddhist teachings in relation to a range of Western psychological and psychotherapeutic perspectives. More recent studies continue this interdisciplinary orientation. Sys et al. (2024), for instance, examine Buddhist non-attachment in relation to the perspectives of secular and Buddhist-informed mental health practitioners, while Tormen and Mascarello (2025) reinterpret Buddhist wisdom and contemplative practices through the framework of cognitive models and “critical meta-awareness,” understood as the capacity to recognize cognitive constructions as constructions rather than as objective reality. Such studies have made important contributions to understanding the psychological and therapeutic implications of Buddhist thought and practice. At the same time, comparatively less attention has been devoted to examining healing from within Buddhist philosophical frameworks themselves—that is, to asking how Buddhist doctrines, philosophical analyses, and modes of reasoning may themselves function as mechanisms of cognitive and existential transformation.

Nevertheless, a further question may be raised: must religious healing be understood and explained exclusively within such a framework? For example, religious faith is often regarded as an important component of the healing process. Although it may not be possible to establish whether the sacred beings or objects in which believers place their faith actually exist or possess supernatural power, it is still possible to examine how such beliefs shape their understanding, experience, and action. Likewise, although Buddhist views such as the teaching that “all dharmas are empty” cannot be established as universally valid through empirical verification, we may still investigate how such a worldview transforms believers’ understanding and actions. If these beliefs do indeed exert an influence on human life, on what grounds should they be excluded from scholarly inquiry? Indeed, this is precisely the position adopted by the phenomenological approach in the study of religion. By placing religious truth claims, such as the existence of a “Supreme Being,” within brackets, researchers suspend judgment concerning their ontological validity and instead focus on how religious beliefs shape believers’ understanding, experience, and action.

For example, Koenig argues: “Nowhere do I claim that supernatural mechanisms are responsible for the relationship between religion/spirituality (R/S) and health. The pathways by which R/S influences physical health that researchers can study using the natural methods of science must be those that exist within nature—that is, psychological, social, behavioral, and genetic influences. Thus, this research says nothing about the existence of supernatural or transcendent forces (which is a matter of faith), but rather asks whether belief in such forces (and the behaviors that result from such beliefs) has an effect on health.” (Koenig 2012, p. 13) This perspective is further reflected in Koenig’s theoretical model of the relationship between religion, spirituality, and health.

In his article Religion, Spirituality, and Health: The Research and Clinical Implications, Harold G. Koenig proposes a theoretical model explaining how and why religion and spirituality may influence mental health. His discussion is based on a systematic review of quantitative studies published in peer-reviewed journals between 1872 and 2010 that were based on original empirical data. The review suggests that religion and spirituality are often associated with more positive psychological attitudes. For example, religious belief may provide resources for coping with stress, enhance a sense of meaning in life, reduce existential anxiety, and promote psychological well-being through religious communities and altruistic behavior, which provide social support. Furthermore, if mental health influences physical health, then religion and spirituality may also exert an indirect influence on physical health through psychological pathways.

Empirical approaches in medicine, psychology, and the social sciences have contributed significantly to understanding the relationships between religion, spirituality, and health by examining measurable outcomes, behavioral patterns, and other observable variables. The present study addresses a different but complementary question: how might transformation occur within the subjective experience of the religious practitioner? More specifically, the study turns to Buddhist philosophy to explore how changes in one’s cognitive framework may transform the ways in which suffering is understood and experienced. In the Madhyamaka context examined here, this process involves loosening reified understandings of persons, events, and things through the analysis of dependent arising and the absence of intrinsic nature. Such transformation is therefore not merely a change in one’s attitude toward suffering, but a reorientation of how one understands oneself, others, and lived experience. As reified understandings are loosened, the rigid distinction between self and other may also be weakened, thereby extending the significance of cognitive transformation beyond individual healing toward compassion and ethical transformation.

Accordingly, the present study does not begin with external observation or quantitative indicators. Instead, it returns to the worldview and interpretive framework provided by the religious tradition itself. On this basis, the study proposes an analytical model of religious healing, through which such experiences may be examined not only within their religious context but also within the discourse of contemporary scholarship. The central concern of this study is cognitive transformation. Taking the Buddhist doctrine of emptiness as an example, its significance need not presuppose a particular religious commitment but may instead be understood as a renewed understanding of the relationality and interdependence of phenomena. Such a transformation may, in turn, influence an individual’s psychological condition and way of engaging with the world.

Furthermore, contemporary research and practice increasingly demonstrate that Buddhist thought is no longer confined to the context of religious cultivation but has gradually become an important theoretical resource in psychology, neuroscience, and healthcare research. In such interdisciplinary engagement, Buddhist concepts and practices may themselves serve as the point of departure, while insights and methods from other disciplines provide additional perspectives through which their transformative and healing potential can be examined. For example, the Mind & Life Institute6 has long been dedicated to fostering interdisciplinary dialogue between Buddhist thought and modern science. Through its sustained support for pioneering research, it seeks to deepen our understanding of the nature of the human mind and to extend the resulting insights to broader social applications. Meanwhile, Cognitively-Based Compassion Training (CBCT),7 developed at Emory University, draws on the Indian–Tibetan Buddhist tradition of mind training (lojong) and integrates research from psychology, neuroscience, affective science, and evolutionary biology. It seeks to translate the core principles of Buddhist compassion practice into interventions applicable to education, healthcare, and mental health.

Furthermore, Healing Emotions, published by the Mind & Life Institute, offers an illustrative example of the relationship among emotion, cognition, and Buddhist practice. The book notes that some Tibetan Buddhist monastics with a profound understanding of Buddhist scriptures exhibited relatively few typical trauma-related responses even after prolonged confinement in extreme conditions such as concentration camps, and that their spiritual practice may even have been further deepened as a result (Goleman 2023, p. 118). Rather than explaining Buddhist practice primarily through a cognitive-scientific framework, this example points to a question central to the present study: how might Buddhist teachings and practices shape the ways in which individuals interpret and respond to suffering? From this perspective, religion not only provides a worldview through which life experiences are understood and interpreted but may also provide conceptual frameworks through which suffering and adversity are reinterpreted. Such reinterpretation may contribute to the reduction or transformation of negative emotions.

It is worth noting that this perspective also resonates to a considerable extent with contemporary research in neuroscience and cognitive psychology. Relevant studies suggest that even the most basic forms of sensory perception do not consist merely in the passive reception of external stimuli but are instead experiences constructed through judgment, interpretation, and meaning-making on the basis of existing cognitive frameworks. (see Goleman 2023, pp. 261–73)8 Accordingly, different cognitive patterns not only shape individuals’ understanding of the world but also influence their emotional responses, physiological states, and overall psychological and physical well-being. Cognitive-behavioral therapy (CBT), for example, emphasizes the role of cognition and cognitive change in therapeutic processes, with cognitive restructuring constituting an important method for identifying, evaluating, and modifying maladaptive beliefs and patterns of thought (Ezawa and Hollon 2023). From this perspective, investigating how Buddhism, on the basis of its own theoretical framework, facilitates the transformation of individual experience and healing through changes in worldview, cognitive patterns, and contemplative practice provides a point of dialogue with contemporary psychological approaches concerned with the relationship between cognition and human experience. Accordingly, approaching Buddhist healing as a process centered on cognitive transformation is not only theoretically well grounded but also methodologically justified.

2. Different Models of Cognitive Transformation: Psychology and Buddhism

Despite certain similarities, contemporary psychotherapy and Buddhism differ in several fundamental assumptions and ultimate aims. Although contemporary approaches to psychotherapy are highly diverse, they generally seek to alleviate psychological distress and improve individual functioning, adjustment, and well-being within the context of the present life. Many influential approaches emphasize self-understanding and the development of a coherent and integrated sense of self, while rarely extending their explanatory framework beyond the individual’s present lifetime. Moreover, in several therapeutic traditions, early life experiences and the family of origin are regarded as important contexts for understanding personality development and current emotional and relational patterns.

By contrast, Buddhism tends to understand an individual’s existential condition in terms of the continuity of karma and habitual dispositions, regarding the formation of personality and values as involving the accumulation of experiences across multiple lifetimes. Although Buddhism also recognizes the influence of various causal conditions, including the family environment, its theoretical focus is not confined to the course of a single lifetime.

Furthermore, Buddhist analysis of experience extends beyond descriptions of ordinary worldly phenomena to a more fundamental reflection on the structure of cognition itself: namely, how human beings come to take particular concepts for granted and, on that basis, construct their understanding of the world. At this level, the discussion has not yet entered the ultimate concerns of emptiness or liberation. Rather, it focuses on revealing the conditioned and constructed nature of cognition itself, thereby opening a theoretical space in which cognition may be transformed and cultivated.

The fundamental orientations of psychology and Buddhism indeed exhibit a certain degree of tension. Many psychological approaches take the self as their point of departure, emphasizing its importance in psychological development, personality integration, and adaptive functioning, while regarding the attainment of an integrated self as an important therapeutic goal. By contrast, the Buddhist doctrine of non-self (anātman) points toward a fundamental deconstruction of the substantiality of the self. Through profound insight into non-self, it becomes possible to loosen one’s attachment to a reified self, thereby creating an important opportunity for psychological liberation and personal transformation. The two traditions therefore differ significantly in their theoretical orientations. Related attempts to bring Buddhist thought into dialogue with Western psychology can be found in the work of Kaisa Puhakka and Robert Rosenbaum. Although both authors explore ways of loosening attachment to fixed perspectives, their approaches differ from that developed in the present study. Puhakka interprets the catuṣkoṭi primarily as an experiential and psychological process through which one moves beyond successive positions toward “no position,” whereas Rosenbaum employs the Zen metaphor of the mirror and its “fragments” to illustrate how attachment to particular perspectives and conceptualizations may result in a partial understanding of experience.9 The present study, by contrast, focuses more specifically on the operation of Madhyamaka dialectical reasoning itself: how assumptions of intrinsic existence are examined and shown to be contradictory or untenable, thereby loosening the reification of fixed cognitions and conceptual constructions. Importantly, this dialectical negation does not eliminate conceptual distinctions or conventional designations; rather, it reveals them as dependently arisen and empty of intrinsic existence while allowing them to retain their conventional functions.

Before proceeding further, it is useful to consider an important observation by Jack Engler in his article Being Somebody and Being Nobody: A Reexamination of the Understanding of Self in Psychoanalysis and Buddhism. Engler observes:

“Thingness is the most powerful, central, and consequential mental imputation that we can make, especially when we make it of the self: “The strong tendency to experience anything as independently existing … rather than any particular personal history is what most fundamentally predisposes one to experience suffering or impose it on others”…. This “unthinking attribution of inherency” to oneself and others is the lived ontology that underpins all other experiences of selfhood, including the modern psychological selves, and especially the partly conscious, partly unconscious representation of self as that singular, unique, separate “entity residing deep inside us.”

(Engler 2003, p. 88)10

Engler’s observation suggests that the emergence of suffering is closely related to the tendency to regard the self as an independently existing entity. This analysis also enters into an important dialogue with the Buddhist critique of attachment to the self.

The concern of Buddhism is not simply to deny the existence of the self but rather to liberate individuals from what would today be described as pathological beliefs or dysfunctional patterns of cognition. Accordingly, what Buddhism rejects is the deluded self—mistakenly regarded as possessing substantiality and inherent existence—rather than the conventional self, which exists only as a nominal designation for the purposes of reference and communication in everyday language and social interaction. Some early Western scholars interpreted the Buddhist doctrine of non-self as a complete negation of the self and even argued that it could lead to an evasion of ethical responsibility. Buddhism, however, does not deny the conventional use of the self as a designation in everyday language. Rather, its central concern is to loosen attachment to the self as a substantial entity, thereby revealing that the self is not a single, independent substance but a dynamic configuration constituted by multiple functional dimensions and continuously shaped by relationships and contextual conditions. Such cognitive transformation not only enables individuals to become liberated from dysfunctional self-understanding but also deepens their capacity to understand the circumstances and suffering of others, thereby giving rise to ethical practices grounded in compassion and care.

Furthermore, when Buddhism discusses emptiness, it does not speak of emptiness as an abstract entity in itself but rather emphasizes the emptiness of a particular phenomenon. In other words, emptiness does not exist independently of phenomena; without phenomena, emptiness itself could not be established. Accordingly, any analysis of non-self must first acknowledge the existence of a self as the basis of ordinary experience. Such a self, however, exists only as a nominal designation, provisionally established through the convergence of multiple causes and conditions, and therefore possesses no fixed or enduring substantiality.

From the Buddhist perspective, the most fully integrated state is not one in which the self is reinforced, but one in which the illusory nature of the self is recognized and deconstructed, thereby freeing individuals from the bondage of afflictions. By contrast, psychology preserves and, to some extent, strengthens the structure of the self, while acknowledging its functional significance and necessity within social norms and interpersonal relationships. In other words, what psychology understands as an integrated self refers to a state of integration achieved within a particular framework and context, whereas the ultimate aim of Buddhism is to penetrate all conceptual frameworks and categorical distinctions. The two traditions therefore differ significantly in both their theoretical orientations and their ultimate concerns.11 Precisely because Buddhism understands the self in a manner that differs in important respects from modern psychological frameworks, its primary concern extends beyond psychological adaptation to the transformation of one’s overall cognitive framework, thereby enabling a renewed understanding of the relationship between the individual and the world. As discussed above, various studies have explored the transformative and therapeutic dimensions of Buddhism through dialogue with psychology, psychotherapy, cognitive science, and related fields. However, comparatively less attention has been devoted to how Buddhist philosophical analysis itself—particularly its modes of reasoning—may function as a mechanism of cognitive transformation.

Accordingly, the following discussion approaches Buddhism not merely as an object of religious belief but as a systematic theoretical framework for understanding and transforming human experience. On this basis, the present study examines religious healing from within Buddhism’s own theoretical framework, taking the first chapter of the Mūlamadhyamakakārikā as its primary focus. It seeks to construct a Madhyamaka model of religious healing that balances theoretical rigor with practical application.

3. Buddhist Healing from the Perspective of the First Chapter of the Mūlamadhyamakakārikā

As the opening chapter of the Mūlamadhyamakakārikā, Chapter One provides a programmatic account of dependent arising and the absence of intrinsic existence, thereby establishing a fundamental framework for the arguments developed throughout the text. It is particularly relevant to the present study because the proposed healing model begins precisely by reconsidering seemingly fixed experiences of illness and suffering in terms of causes, conditions, and the absence of intrinsic nature.

The following discussion examines how Madhyamaka reasoning may function as a mechanism of cognitive transformation. Rather than treating the arguments of the first chapter merely as abstract philosophical analysis, I consider how its mode of deconstructive reasoning may be extended from arising and cessation to causal relations, conceptual construction, and lived experience. In this way, the discussion progressively illustrates how Madhyamaka analysis may acquire healing significance.

Nāgārjuna opens chapter one of the Mūlamadhyamakakārikā with the Eight Negations—no arising, no cessation; no permanence, no annihilation; no identity, no difference; no coming, no going. Through these, he systematically loosens and deconstructs the substantialist assumptions embedded in ordinary language and habitual patterns of thought, thereby opening the way for a critical reflection on language and conceptualization. Although Pingala’s commentary may at first appear somewhat elaborate, it provides valuable insight into the reasoning underlying Nāgārjuna’s deconstructive method. As he explains:

Moreover, the myriad things do not arise, and why? It is because of direct worldly perception. As we see with our worldly eyes, corn does not arise at the beginning of a kalpa, and why? Without the corn at the beginning of the kalpa there could be no corn now. If there were corn existing now apart from that at the beginning of the kalpa, there would have been an arising, but in fact this is not so, and therefore there is no arising.

Question: If there is no arising, then surely there must be ceasing? Reply: There is no ceasing, and the reason for this lies in direct worldly perception. As we see with our worldly eyes, the corn which was there at the beginning of the kalpa did not cease. If it had ceased there would be no corn now, but in fact there is corn, and therefore there is no ceasing.12

This passage aims to demonstrate that the arising of the myriad things should not be understood as possessing inherent existence. If there were truly an inherently existent arising, there would have to be some entity capable of arising independently, without relying on anything else. However, as confirmed by direct worldly perception, the corn now cannot exist apart from the corn at the beginning of a kalpa, indicating that all phenomena exist only through the continuity of causes and conditions. The corn now is the continuation of the preceding corn, just as a sprout arises through the continuity of its seed. If a sprout could arise without depending on a seed, it would arise inherently; yet such a situation does not occur. Therefore, arising is not inherently existent, and for this reason, it is said that there is “no arising”.

Conversely, if one were to admit an inherently existent ceasing, then once a phenomenon had ceased, it would have been completely extinguished and would no longer exist, making the subsequent arising of any further phenomenon impossible. However, as confirmed by direct worldly perception, the corn now still exists, indicating that no such definitive ceasing can be found. Therefore, ceasing is not inherently existent, and for this reason, it is said that there is “no ceasing.” Through this reductio argument based on direct worldly perception, it is shown that admitting inherently existent arising or ceasing would lead to conclusions that contradict experience. It therefore follows that all phenomena exist only through the continuity of causes and conditions, without inherently existent arising or ceasing.

The central point of this passage is not to deny the arising and ceasing observed in the ordinary world, but to show that people often understand “arising” and “ceasing” as events possessing fixed inherent existence. From the Madhyamaka perspective, all phenomena are merely processes of the continuity of causes and conditions; there is no independently existing “arising,” nor is there any definitive “ceasing.” What needs to be loosened is not the phenomena of arising and ceasing themselves, but the cognitive way in which they are understood as fixed, determinate, and unchangeable entities. As this mode of cognition is gradually loosened, one’s understanding of life experiences—including success and failure, gain and loss, and union and separation—also changes accordingly. This marks an important starting point for cognitive transformation in Madhyamaka. Such an argument is not confined to conceptual analysis; rather, by revealing the internal contradictions within existing cognitive frameworks, it loosens attachment to inherent existence, thereby facilitating cognitive transformation and opening up new possibilities for understanding lived experience.

The preceding discussion loosens the reified understanding of arising and ceasing. Yet even if arising and ceasing are no longer understood as possessing intrinsic nature, people may still continue to regard cause, condition, and effect as entities possessing fixed essences. Accordingly, the reductio argument developed in the first chapter of the Mūlamadhyamakakārikā does not end with the negation of arising and ceasing, but extends its critique to the very cause, condition, and effect that underlie the understanding of arising and ceasing. Although the two arguments differ in their immediate objects of analysis, they employ the same mode of reasoning, using reductio arguments to loosen attachment to intrinsic nature. Madhyamaka emphasizes dependent arising and emptiness, as expressed in the following verse: “The intrinsic nature of phenomena is not found within conditions; because intrinsic nature does not exist, other-nature likewise does not exist.”13 If phenomena arise in dependence upon causes and conditions, they cannot possess a fixed and unchanging intrinsic nature. Nevertheless, people continue to understand such conventional concepts as cause, condition, and effect as entities possessing intrinsic nature, thereby giving rise to various forms of attachment. Pingala’s Commentary on the first chapter likewise states:

“The sūtras teach the twelvefold dependent origination: because this exists, that exists. Yet this is not ultimately the case. Why? Because all phenomena arise from a multiplicity of conditions and therefore lack any fixed intrinsic nature. Since they lack a fixed intrinsic nature, they cannot be said to possess a determinate mode of existence. If no such mode of existence can be established, how can it be said that ‘because this exists, that exists’?”14

The point here is that although dependent origination constitutes one of the central teachings of Buddhism, to understand causes and conditions as entities possessing fixed intrinsic nature is itself to fall into attachment. Causes and conditions are not causes and conditions because they possess any determinate essence in themselves; rather, they are established only in dependence upon relations. To demonstrate this, Nāgārjuna develops a series of reductio arguments:

Does an effect arise from conditions, or does it arise from what are not conditions? Do conditions already contain the effect, or do they contain no effect at all?

A dharma from which an effect arises is designated a condition. But if the effect has not yet arisen, why should it not be called a non-condition?15

If the effect is already present within the condition, both existence and non-existence become untenable. If it is absent, for whom is the condition a condition? If it is already present, what need is there for a condition?

If the effect is not produced from what exists, nor from what does not exist, nor from what both exists and does not exist, on what basis can conditions be asserted?16

People generally hold a stable understanding of causal relations. For example, they often assume that studying diligently will necessarily lead to good academic performance. From the Madhyamaka perspective, however, if the effect has not yet arisen, how can the so-called cause be definitively identified as a cause? If the effect has already arisen, what necessity remains for the cause? A cause is therefore defined relationally rather than by any fixed intrinsic nature. Accordingly, before the effect is established, the so-called causal relation cannot be regarded as possessing intrinsic nature. Through this successive series of reductio arguments, the reified understanding of cause and condition is gradually undermined. This line of reasoning is not merely a formal logical exercise, but may further serve as a method for deconstructing ordinary experience, thereby constituting a possible healing mechanism. From the perspective that causality is without intrinsic nature, a “cause” should not be understood as a fixed and unchanging entity that determines its effect; rather, it is established in dependence upon multiple conditions. Correspondingly, an “effect” should not be understood as a predetermined and unalterable outcome. In other words, before an outcome has taken shape, numerous conditions and influences remain open to intervention and transformation. Human life, therefore, should not be understood as being completely constrained by predetermined structures, but rather as a field of continually unfolding possibilities.

For example, after being diagnosed with a serious illness, a person may conclude that life is no longer worth hoping for because a physician has given a poor prognosis. In such circumstances, thoughts such as “My condition will inevitably worsen” or “I will never be able to live a normal life again” are often taken as definitive descriptions of the future. From the Madhyamaka perspective on the absence of intrinsic nature in causality, however, before an outcome has actually come into being, there is no already determined and unalterable “effect.” The course of an illness continues to change in dependence upon numerous causes and conditions, including medical treatment, care, psychological state, and family support. Thus, Madhyamaka does not deny the existence of illness; rather, it loosens the cognitive tendency to understand future outcomes as predetermined entities, enabling individuals to no longer remain completely constrained by pessimistic expectations.

It thus becomes evident that causal relations do not possess intrinsic nature, but arise only through mutual dependence within a network of conditions. When people become attached to a causal framework in which “the past is fixed and the future is already determined,” they are likely to fall into a fatalistic way of understanding, making it difficult to open themselves to new possibilities. The central significance of the Mūlamadhyamakakārikā lies precisely in employing such reductio arguments to dismantle the reified attachment to seemingly fixed phenomena and to loosen the deterministic understanding of causality.

As discussed above, Madhyamaka demonstrates that concepts such as cause, condition, and effect do not possess intrinsic nature by refuting the assumption that they are intrinsically established. Following the same line of reasoning, one may further ask whether other concepts can likewise be deconstructed through a similar approach. Human suffering often arises from reifying our understanding of people, events, and things, and from regarding the concepts formed on this basis as fixed and unchanging realities. In interpersonal interactions, this tendency is especially evident in our attachment to evaluations made by others. We may ask why a single remark from another person can exert such a profound influence on us, giving rise to sadness, anger, or joy. For example, when someone criticizes one’s hairstyle as “ugly,” we may further ask: What is beauty? What is ugliness? By what criteria are they determined? And by whom are those criteria established?

From the perspective of its constitution, language is nothing more than sound produced through the vibration of the vocal cords and the flow of air. How, then, can it possess such power? The key lies in how words themselves are understood. Consider the statement, “Your hairstyle is ugly.” Formally, it is merely a combination of linguistic symbols. Yet it gives rise to suffering because people reify both the words themselves and the associations attached to them, regarding them as possessing fixed meanings. Words do not possess an inherent capacity to harm; rather, their harmful force is constructed within a particular cognitive context. Moreover, people from different cultures and social contexts do not arrive at a single fixed interpretation of the same word, demonstrating that linguistic meaning is itself constructed rather than intrinsically established. What truly gives rise to suffering is not language itself, but the cognitive meaning that individuals construct from words. For example, one may interpret “He says that I am not good enough” as “I truly am not good enough,” or equate another person’s criticism with a diminution of one’s own worth. Words were originally intended as tools of communication. Yet, under such reified understanding, they are endowed with a significance that exceeds their communicative function, thereby shaping both emotion and cognition. This analysis does not deny language, value judgments, or emotions themselves. Rather, it shows that none of these possesses intrinsic nature; instead, they are constructed and established under particular causes and conditions.

Once such standards of beauty and ugliness can no longer be established as boundaries possessing intrinsic nature, it becomes evident that “beauty” and “ugliness” are merely concepts established in dependence upon particular conditions rather than fixed and unchanging entities. Through this process of deconstruction, the attachment originally generated by evaluative judgments is gradually loosened, thereby reducing the suffering that arises from them. From the Madhyamaka perspective, one may further ask: Do another person’s words arise from a fixed and unchanging essence of malice, or are they instead brought about through the convergence of multiple conditions? Their emotional state at that moment, personal pressures, understanding of the situation, habitual use of language, and even their past experiences may all jointly constitute the conditions from which their words arise. Viewed from this perspective, so-called “hurtful words” do not originate from an intrinsically existent act of harm, but are merely phenomena that temporarily arise through causes and conditions.

Accordingly, the suffering experienced by an individual often arises from two forms of attachment operating simultaneously. First, language is regarded as possessing fixed meanings, leading one to interpret another person’s criticism as an objectively true and unchanging evaluation. Second, another person’s words and actions are understood as arising from a deliberate and fixed intention to cause harm. From the perspective of the Mūlamadhyamakakārikā, however, neither language nor intention possesses intrinsic nature. Rather, both are established only under particular causes and conditions and therefore lack any fixed and unchanging essence.

Such an analysis is not intended to deny or suppress emotional experience, nor does it imply that one should not feel hurt. Rather, it seeks to deconstruct the assumption that the experience must necessarily be interpreted in a way that gives rise to hurt. The individual does not deny the experience of being hurt, but no longer understands that experience as the only and fixed reality. As the reified connections among language, evaluation, and self-identity are gradually loosened, new ways of understanding and responding likewise begin to emerge. This transformation of life brought about through cognitive loosening may be regarded as one of the central healing mechanisms of Madhyamaka. In other words, individuals’ responses to words do not originate from language itself but are gradually constructed through cognitive processing, whereby meaning is shaped by pre-existing concepts, lived experience, and self-identity. Despite its complexity, this reductio analysis aims to expose the structures of reification and self-entanglement underlying human cognition. Even without religious belief, one may employ this mode of analysis to loosen one’s attachment to established conceptual frameworks.

The Buddhist tradition commonly distinguishes between conventional truth (saṃvṛti-satya) and ultimate truth (paramārtha-satya), while emphasizing their interdependent relationship. When emptiness is regarded as something remote and unattainable, or is misunderstood as the negation of existence, Chapter 24 of the Mūlamadhyamakakārikā offers the well-known statement: “Without relying on conventional truth, the ultimate truth cannot be realized.”17 This passage shows that the patterns of ordinary worldly functioning and the systems of language encompassed by conventional truth, although not ultimate reality, nevertheless constitute the necessary conditions and practical foundation for realizing emptiness.

This point may be further clarified through Nāgārjuna’s account of dependent designation. In MMK 24.18, dependent arising, emptiness, and designation are brought into a close conceptual relationship: what arises dependently is empty and is established through dependent designation.18 From this perspective, the critique of intrinsic existence does not entail the rejection of language or conceptual designation at the conventional level. Rather, the problem lies in reifying what is dependently designated as if it possessed a fixed and intrinsic nature. Thus, the deconstruction of linguistic and conceptual reification discussed above should not be understood as a denial of language or conceptual thought, but as a loosening of attachment to the intrinsic reality attributed to them.

In other words, reflecting upon ordinary experience and the cognitive processes through which it is constituted is not opposed to the realization of emptiness; rather, it is itself an important pathway toward that realization. As one’s habitual cognitive framework is gradually dismantled, one is able to reconfigure one’s understanding of both oneself and the world, thereby opening the possibility of inner peace and existential transformation.

Furthermore, Chapter Fifteen of the Mūlamadhyamakakārikā states: “To affirm existence is to cling to permanence; to affirm non-existence is to cling to annihilation. Therefore, the wise should not cling to either existence or non-existence.”19 Here, “nonexistence” refers to the view that all things are ultimately annihilated. However, when Madhyamaka speaks of the emptiness of all phenomena, it is not referring to “nonexistence” as the conceptual opposite of “existence.” Once “nonexistence” is understood as an opposing concept, one has already fallen into one of the two extremes. If cessation were understood as an absolute and definitive end, phenomena could no longer arise. Yet, as ordinary experience shows, phenomena continue to arise through provisionally established causes and conditions. This teaching reminds us that healing is grounded not in the denial of lived experience, but in loosening the cognitive tendency to understand lived experience as fixed, determinate, and unchangeable. By avoiding the two extremes of believing either that one’s present condition has been permanently determined or that all hope for change has been lost, individuals are able to reinterpret their own experience and remain open to new possibilities in life.

Accordingly, even when the realization of emptiness is not taken as the immediate goal, loosening the reified attachment to ordinary concepts and relationships still possesses significant transformative value. Mindfulness-Based Stress Reduction (MBSR), for example, has largely set aside Buddhism’s ultimate soteriological aim of liberation. Nevertheless, by cultivating awareness of habitual cognitive and emotional patterns without automatically becoming absorbed in or governed by them, it continues to function as an effective contemporary therapeutic approach. Likewise, the transformative mechanism articulated by Madhyamaka may also operate within modern contexts, thereby demonstrating its potential applicability to contemporary human concerns. In this respect, although the present model is grounded in the Buddhist understanding of reality, it seeks to facilitate reflection on the nature of language as a means of loosening established cognitive structures, deconstructing reified patterns of thought, and opening further possibilities for both understanding and healing.

The healing significance of such cognitive transformation, however, is not limited to the individual’s interpretation of suffering. If reification also structures the ways in which the self and others are perceived, then loosening reified cognition may further transform the boundary between self and other. The following section therefore extends the discussion from the transformation of suffering to its ethical implications, particularly the reduction of self-centeredness and dualistic opposition and the cultivation of equanimity and compassion.

4. From Cognitive Transformation to Ethical Practice

Although faith in Buddhist teachings remains important within the Madhyamaka tradition, Madhyamaka is not grounded in faith alone. Rather, the analysis of experience and the transformation of cognition are among its important characteristics. It is precisely these features that give Madhyamaka therapeutic potential in the modern world, allowing its insights to be applied across a variety of contexts beyond traditional religious settings. At the same time, such transformation involves not only a renewed understanding of the relationship between the individual and suffering, but also gives rise to an ethical dimension by prompting individuals to reconsider how the boundaries between self and others, as well as between one’s own standpoint and the perspectives of others, are constructed.

When discussing ethical practice, one may first raise an important question: if Madhyamaka maintains that all phenomena are empty, how can any ethical claims be established? After all, transcending dualistic oppositions constitutes one of the central concerns of Madhyamaka, whereas ethical practice often involves value judgments and normative principles. At first glance, the two therefore appear to stand in a certain tension. Yet the emptiness revealed by Madhyamaka is not a negation of the conventional world; rather, it is a way of understanding ordinary experience and its modes of operation as they truly are. Precisely because all phenomena arise in dependence upon causes and conditions, they are neither absolute nothingness nor entities possessing fixed and unchanging intrinsic nature. Instead, they manifest provisionally through the coming together of causes and conditions, appearing within experience like dreams or illusions. Having shown how the deconstruction of language may loosen suffering, this section turns to the ethical implications of emptiness.

In everyday life, when another person’s values come into conflict with our own, we often tend to understand the situation through a dualistic framework of self and other, right and wrong, regarding the other person’s position as a threat to our own beliefs and values. From the perspective of dependent arising, however, such oppositional relationships are themselves not intrinsically established. The particular views and positions that people hold arise only provisionally through the convergence of numerous causes and conditions, including life experiences, personal upbringing, social circumstances, and value commitments. When a particular standpoint is regarded as an independently existing and fixed entity, opposition and conflict readily arise. Once it is understood instead as a provisional designation arising in dependence upon causes and conditions, those seemingly rigid boundaries gradually begin to dissolve. Such loosening does not entail abandoning judgment or denying differences. Rather, it means no longer reifying either one’s own standpoint or that of others. Once the distinction between self and other is no longer understood as an absolute and insurmountable boundary, it becomes possible to recognize that both are equally conditioned by numerous causes and conditions. What arises from this realization is not merely tolerance toward the views of others, but a form of compassion grounded in an understanding of dependent arising. For when others are no longer regarded as beings fundamentally opposed to oneself, their suffering and well-being, limitations, and circumstances likewise become incorporated into one’s own understanding. In this sense, the ethical concern of Madhyamaka lies not primarily in establishing a universal and fixed set of moral norms, but in transforming the way people understand themselves, others, and their own existential situation.20 As the boundaries once regarded as real and immutable are gradually loosened, individuals become able to move beyond rigid oppositional perspectives, thereby opening possibilities for understanding, dialogue, and coexistence.

Accordingly, Madhyamaka ethics does not begin by asking, “How ought one to act?” Rather, it first asks, “How does one understand oneself and others?” Once this mode of understanding is transformed, ethical practice is transformed accordingly. A similar understanding can also be found in Goodman and Thakchöe’s (2016, p. 16) discussion of Madhyamaka ethics. They observe that: “The realization of emptiness provides an epistemological foundation for the practice of equanimity. By loosening attachment to self-centered discrimination, loving-kindness, compassion, and sympathetic joy are no longer constrained by preference or prejudice, but are able to extend impartially to all sentient beings.” This suggests that emptiness is not an obstacle to ethics; rather, it constitutes one of its essential foundations. Accordingly, tolerance, compassion, reconciliation, and even nonviolent coexistence may all be understood as concrete expressions of the realization of dependent arising and emptiness within ordinary life. They also represent the further development of cognitive transformation from individual healing to interpersonal relationships and social life.

5. Conclusions

In conclusion, this study argues that the reductio arguments presented in the first chapter of the Mūlamadhyamakakārikā should not be understood merely as metaphysical or philosophical reasoning, but may further be understood as a mechanism of cognitive transformation. Whereas contemporary cognitive therapies primarily focus on modifying the cognitive content through which individuals interpret events, Madhyamaka extends this process of reflection to language, concepts, and naming themselves. What it deconstructs is not the events themselves, but the ways in which people, through language and conceptualization, understand the self, others, causality, arising and ceasing, and the various experiences of life as possessing fixed and unchanging intrinsic nature.21 For this reason, Madhyamaka offers not merely a reinterpretation of events, but a critical reflection on the very processes through which cognition is constructed. As individuals gradually loosen their reified understanding of language, concepts, and cognition, the setbacks, illness, and suffering they encounter in life do not thereby disappear. Their ways of understanding and responding to such experiences, however, may be fundamentally transformed. This process—from engaging with lived experience, through the loosening of its interpretation, to the realization of non-intrinsic nature—may be understood as a theoretically grounded path of transformation that offers a possible basis for practical application.

This study further argues that this mechanism of cognitive transformation not only accounts for the healing potential of Buddhism, but also constitutes an important theoretical foundation for Buddhist ethical practice. Although the central aim of Buddhism is the liberation from suffering, its concern extends beyond the alleviation of individual psychological distress. Rather, it seeks to transform the ways in which people understand themselves, others, and the world, thereby reconfiguring human relationships. Because Madhyamaka loosens reified understandings of self-centeredness and dualistic opposition, compassion, tolerance, reconciliation, and even nonviolent coexistence are not ethical demands imposed upon the doctrine of emptiness from without. Rather, they emerge naturally from an understanding of dependent arising and emptiness. As Carpenter (2016, p. 40) observes, the realization of emptiness does not diminish ethical development; instead, it enables individuals to continually revise their understanding of happiness and broaden their moral horizon, thereby deepening their motivation to pursue liberation. It thus becomes evident that, within Madhyamaka thought, healing and ethics are not separate domains, but are grounded in the same process of cognitive transformation.

To date, research on Buddhist healing has accumulated substantial findings across medicine, psychology, and neuroscience, particularly in areas such as mindfulness, stress reduction, and psychotherapy, where its practical value has been widely demonstrated. Nevertheless, if we are to understand more fully why Buddhist healing is possible, how its theoretical mechanism is constituted, and how its key concepts are grounded within Buddhist thought itself, it remains necessary to return to Buddhist theory as the basis of inquiry. Beginning with the first chapter of the Mūlamadhyamakakārikā, this study has proposed a model of Buddhist healing centered on cognitive transformation and characterized by the deconstruction of language and concepts. It is hoped that this model will provide a more comprehensive theoretical account of Buddhist healing while fostering deeper interdisciplinary dialogue between Buddhist thought and contemporary psychotherapy, spiritual care, and ethical studies. It is further hoped that future research will continue to develop theories of Buddhist healing from the perspectives of different Buddhist traditions and further explore their diverse applications within contemporary society.