Life in the Womb: Conception and Gestation in Buddhist Scripture and Classical Indian Medical Literature
Robert Kritzer
The first Noble Truth of Buddhism asserts that all is suffering. In this context, the word “all” means all conditioned things, that is to say, all worldly things. Hence anything that perpetuates the cycle of rebirth in this world can be considered antithetical to liberation and subject to condemnation.
A number of Buddhist sūtras, meditation manuals, and doctrinal texts, probably written before the third century, describe in various degrees of completeness the stages between one lifetime and the next. Th e process of rebirth begins at the moment of death in one life, continues through the intermediate existence or antarābhava, the moment of conception, and the period of gestation, and culminates in the moment of birth in the next life. Among the Buddhist texts that take up the topic, the Garbhāvā krāntisūtra presents the most detailed description of conception and gestation.
Little has been written about this fascinating sūtra. In this chapter, I compare its accounts of the crucial moment of conception and the period of gestation with accounts in Indian medical literature, particularly the Carakasam․hitā. On the one hand, there are many similarities, which may be the result of mutual infl uence between the Buddhist sūtra and the medical texts as well as possible borrowing from a now-lost common source. On the other hand, there are also considerable differences, which can be explained at least in part by the fact that the sūtra and the medical texts have different purposes.
Th is is an expanded version of the 2006 Numata Lecture at McGill University, a transcript of which is being published in ARC: Th e Journal of the Faculty of Religious Studies, McGill University. I am indebted to Professor Elizabeth Kenney for her invaluable criticism and suggestions.
Before examining the Garbhāvakrāntisūtra, I will start out by briefl y discussing some non-Buddhist Indian religious texts that include descriptions of the rebirth process so that the special features of the sūtra will stand out in contrast. Th e texts that I mention are not particularly old; in fact, they are all probably more recent than the sūtra. But we cannot conclude that they are based on the sūtra. It is more likely that they borrow from the same common sources as the sūtra and the medical literature.
Rebirth Accounts in Non-Buddhist Religious Texts
In stories of the Buddha’s birth, the Buddha, unlike ordinary people, is said to be born in a state of complete purity, unblemished by the messy fluids that normally characterize birth. Furthermore, he causes his mother none of the usual discomforts of pregnancy and childbirth, and he emerges from her side rather than be born in the conventional way. As a result, he completely avoids the “suffering at birth” ( janmaduh․kha) and is able to remain conscious for the entire period of conception, gestation, and birth.1 Uniquely, the Buddha remembers all his past lives and embarks upon his last birth confident that he will achieve enlightenment.
Th e experience of ordinary people is quite diff erent. Because of the oppressive environment of the womb and the narrowness of the vagina, they lose consciousness when they are born and, with it, all memory of their past lives. As a result, they are doomed to ignorance and to continued suff ering in sam․sāra. A number of nonBuddhist texts, summarized by Hara, describe how the fetus is folded and distorted in the womb, how it is tormented by contact with the food the mother consumes and with her feces and urine, how it is squeezed unbearably by the vagina, and how it is shocked unconscious when it touches the outside air.2 Other texts go into some detail regarding the development of the fetus in the womb. According to the Agnipurān․a, the soul ( jīva), aft er entering the womb, fi rst becomes kalala (liquid in consistency). In the second month, it becomes ghana (a solid mass). In the third month, the limbs develop; in the fourth, bones, skin, and fl esh. In the fi ft h month, body hair appears. In the sixth, consciousness develops. In the seventh month, the fetus experiences suff ering. Its body is covered with the placenta, and its hands are folded on its forehead. If it is female, it is positioned on the left , if male, on the right, and it faces its mother’s back. If it is neuter,3 it is positioned in the middle of the belly. The fetus knows without doubt in whose
1. Th e Indian religious literature on the rebirth process has been explored by Hara Minoru, who is especially interested in the notion of janmaduh․kha. Th is literally means “suff ering at birth” but can also be loosely applied to the period immediately before birth. See M. Hara, “Shō ku,” in Hotoke no Kenkyū: Tamaki Kōshirō Hakushi Kanrekikinenronshū (Tokyo: Shunjūsha, 1977), 667–83; M. Hara, “A Note on the Buddha’s Birth Story,” in Indianisme et Bouddhisme: Mélanges off erts à Mgr Étienne Lamotte (Louvain, Belgium: Université Catholique du Louvain, 1980), 143–57. See also Sasson’s chapter in this volume.
2. M. Hara, “Note on the Buddha’s Birth Story,” 146–51.
3. Th e Sanskrit word here is klīva (“neuter”). In other texts, the word napum․saka is used, probably suggesting an intermediate gender rather than a lack of sex organs (S. Smets, “Le développement embryonnaire selon la Jaiminīyasam․hitā du Brahmān․․dapurān․a: Étude sur l’intertextualité,” Studia Asiatica 4–5 [2003–2004]: 313–330).
womb it is. Furthermore, it knows its past lives since it was fi rst born as a human, and it experiences darkness and great pain. Also in the seventh month, the fetus obtains nourishment consumed by its mother. In the eighth and ninth months, it is greatly affl icted, receiving pain when the mother has sex or is very active and being ill when she is ill. A moment seems like a hundred years; the fetus is tortured by its karma, and it wishfully vows, “Brahman, freed from the womb, [I] will achieve knowledge of liberation.” Th e fetus is fi nally turned head downward by the birthwind and goes out, being pressed by the restraint of the vagina, and, for the fi rst month of life outside the womb, it is pained by the mere touch of a hand.
Th e Garbhopanis․ad also gives a brief, month-by-month description: During the first month, the fetus passes through the stages of kalala, budbuda (bubblelike), and pin․․da (a roundish lump), becoming solid by the end of the first month. By the end of two months, the head has developed; aft er three months, the feet; four, the ankles, belly, and hips; fi ve, the back; six, the mouth, nose, eyes, and ears. In the seventh month, the fetus is joined with the soul ( jīva). In the eighth month, it is complete in its parts, the sex and certain birth defects are determined, and the senses and consciousness can operate. In the ninth month, it is complete in all its qualities and knowledge, and it remembers its past births and its good and bad karma. Aft er this, the fetus contemplates the suffering of repeated births and deaths and resolves to study Sām․ khya and Yoga in order to achieve emancipation, but when it is born, it forgets its rebirths and karma.5
Another account is found in a Jaina text, the Tandulaveyāliya.6 Th is work consists of groups of verses separated by prose passages, and there are some minor differences between the verses and the prose. According to the prose account, in the first month, the fetus weighs three-quarters of a pala (about 75 grams). In the second month, it is called pesī, which is described as being ghana, or solid. In the third month, two-heartedness (dohala) develops. Th is is the condition in which the fetus influences the mother, who develops inexplicable whims. In the fourth month, the fetus causes the mother’s body to swell up. In the fifth month, five lumps, namely the hands, feet, and head, develop. In the sixth month, bile and blood accumulate. In the seventh month, the fetus develops seven hundred veins, fi ve hundred muscles, nine arteries, and 35 million pores. The fetus is complete in the eighth month, and birth takes place in the ninth.7
These accounts display some differences, as can be seen in the accompanying table. One thing we notice in comparing these three texts is that there is little agreement regarding the precise terms assigned to each of the earliest stages of the fetus, although similar words appear in all texts, such as kalala and ghana. However, the most striking difference among the texts is that the description in the Tandulaveyāliya, the shortest of the three, does not refer to the subjective experience
4. Agnipurān․a 3: 398.19–27. Hara, “Shōku,” 673. Manmatha Nāth Dutt Shastri, Agni Purān․am (Varanasi: Chowkhamba Sanskrit Series Offi ce, 1967), 2: 1288–1289.
5. Garbha-Upanisad (Garbhopanisad). Available at www.sub.uni-goettingen.de/ebene_1/fi indolo/gretil/1_sanskr/ 1_veda/4_upa/garbhupu.htm.
6. I am grateful to Professor Nalini Balbir for bringing this text to my attention.
7. Tandulaveyāliya: 5.6–12.
table 5.1. A Comparison of the Development of the Fetus in the Agnipurā․na, Garbhopani․sad, and Tandulaveyāliya [[[Jaina]]] Month Agnipurān․a Garbhopanis․ad Tandulaveyāliya [[[Jaina]]]
1 soul enters the womb, becomes kalala kalala, bubuda, pin․d․a; becomes solid (kat․hina) verse prose kalala, abuya, weight: pesī, ghan․a 3/4 pala 2 becomes solid ( ghana) head develops becomes pesī, which is solid ( ghan․a)
3 limbs develop feet develop two-heartedness (dohala) develops
4 bones, skin, fl esh develop ankles, belly, hips develop the mother’s body swells up
5 body hair appears back develops hands, feet, and head develop
6 consciousness appears mouth, nose, eyes, ears develop bile and blood accumulate
7 fetus experiences suff ering, knows its career fetus is joined with soul 700 veins, 500 muscles, nine arteries, 35 million pores develop
8 receives pain from mother’s activities, vows to attain liberation aft er birth complete in all parts, consciousness can operate fetus is completed
9 head turned downward by the birth-wind, pressed by the vagina, experiences pain aft er birth complete in all qualities, remembers past births and karma, resolves to achieve emancipation, forgets past births and karma upon being born birth takes place of the fetus. However, the group of verses that are found at the end of the fi rst section of the text elaborates on the suff ering of birth in a way similar to the other texts.8 Th us, although the month-by-month account in the Tandulaveyāliya is more neutral and, as we shall see, closer to accounts found in the medical texts, it is put to use in the same way as those of the other religious texts in emphasizing the ills of sam․sāra and encouraging the pursuit of liberation.
The most dramatic religious account of the rebirth process, however, is found in the Buddhist Garbhāvakrāntisūtra. Although it shares many features with the non Buddhist texts mentioned here, it is far richer in medical or pseudo-medical detail, and, especially in the later version, it is far more insistent on its religious message, intent upon illustrating the first Buddhist Noble Truth of suffering in every stage of the rebirth process.
8. Ibid., 18–21 (6.23–30). 9. C. Caillat. “Sur les doctrines médicales dans le Tandulaveyāliya 1. Enseignements d’embryologie,” Indologica Taurinensia 2 (1974): 51.
Next, I will analyze the descriptions of conception, gestation, and childbirth in the Sūtra in comparison with corresponding material from the Carakasam․hitā to show how the Buddhist and medical traditions draw on a common store of information about the facts of life for their very diff erent purposes. First, I will briefl y introduce these two texts.
The Garbhāvakrāntisūtra
The Garbhāvakrāntisūtra is a rather long sūtra that includes an account of the mechanism of rebirth. The account begins before conception, when the being about to be reborn is in the intermediate state (antarābhava). The text is best known for its week-by-week description of the development of the fetus, but it also details the ills to which the newly born being is subject.
Th ere are several extant versions of the sūtra. Th e earliest is a translation by Dharmaraks․a titled Pao-t’ai ching (Taishō edition, Buddhist canon [T.], 317), dated 281 or 303. A translation by Bodhiruci titled Fo wei a-nan shuo ch’u-t’ai hui (T. 310 n. 13), dated 703–713, is found in the Ratnakūt․asūtra. I-ching also translated the sūtra, and his translation (dated 710) can be found in two different places, in the Ratnakūt․asūtra (T. 310 n. 14), titled Fo shuo ju-t’ai-tsang hui), and in the Mūlasarvāstivādavinayaks․udrakavastu, titled Ju-mu-t’ai ching (T. 1451: 251a14–262a19). I-ching’s version is much longer than Dharmaraks․a’s or Bodhiruci’s.
It consists of three parts:
(1) an account of the instruction of Nanda;
(2) an account of conception and gestation that generally corresponds with Bodhiruci’s version, followed by various teachings related to suffering and how to overcome it;
(3) an account of Nanda’s previous lives. There is no extant Sanskrit for the portion of the Mūlasarvāstivādavinaya in which the sūtra is found, but there is a ninth-century Tibetan translation. Th e other Tibetan translations of the sūtra are from the Chinese translations, not from a Sanskrit original.
The Carakasam․hitā
The Carakasam․hitā is the earliest of the Indian medical texts that Kenneth Zysk calls “the classical compilations,” which also include the Suśrutasam․hitā, the As․․tān˙gahr․dayasam․hitā, and the As․․tān˙gasam․graha. As is the case with Indian Buddhist texts, it is difficult to establish the dates of Indian medical texts. According to Zysk, the Carakasam․hitā and the Suśrutasam․hitā probably date from a few centuries before or after the beginning of the common era,10 whereas the As․․tān˙gahr․dayasam․hitā and the As․․tān˙gasam․graha are from around the seventh century, with the As․․tān˙gahr․dayasam․hitā probably being slightly older.11
10. K. G. Zysk, “Mythology and the Brāhman․ization of Indian Medicine: Transforming Heterodoxy into Orthodoxy,” in Categorization and Interpretation, ed. Folke Josephson (Göteborg, Sweden: Meijerbergs institut för svensk etymologisk forskning, Göteborg universitet, 1999), 125. 11. Ibid., 139.
Clearly, the authors of Indian medical texts share a certain pool of knowledge with authors of religious texts, both Buddhist and non-Buddhist. I am primarily concerned with the diff erent emphases and the uses to which this knowledge is put in the Garbhāvakrāntisūtra, which includes the most prominent Buddhist treatment of the subject of conception and gestation, and the Carakasam․hitā, which I have chosen as a representative of the classical medical tradition.
Since both the Garbhāvakrāntisūtra and the Carakasam․hitā presuppose a belief in rebirth related to, if not directly resulting from, karma, it is not surprising that their accounts of conception are generally quite similar. According to both texts, the mother must be at the proper time of her menstrual cycle, and her reproductive organs must be healthy. Naturally, the father and mother must have sex. Finally, the entity that will be reborn as the new baby must be present in the form of the intermediate being (antarābhava) at the time of intercourse; this is crucial if moral continuity is to be preserved from one lifetime to the next.
Not surprisingly, given the different purposes of the two texts, there are also some differences. Th e Garbhāvakrāntisūtra specifies that the parents must have a “defi led thought,” that is to say, a lustful thought. Th is reflects the Buddhist conviction that desire, because it leads to rebirth, is essentially defi ling and is, as the second Noble Truth implies, the cause of suffering. Like the non-Buddhist religious texts discussed above, the Garbhāvakrāntisūtra describes the rebirth process in detail, not as a disinterested explanation of the facts of life, but for the sake of arousing or confirming disgust in sam․sāra. Its audience was probably the meditating monk.
Th e Carakasam․hitā, on the other hand, is not addressed to monks, and it passes no moral judgment on socially acceptable sexual activity. Rather, its aim is to encourage a successful pregnancy and a healthy birth. In addition to instructions regarding the best position for intercourse, the sensibilities of both partners are taken into account. Th e couple is recommended to wear white clothes and garlands, to have pleasant dispositions, and to have sexual desire for one another.
They should be stimulated, ready for intercourse, and well fed, and their bed should be sweet smelling and comfortable. For a week aft er intercourse, the woman is to be pampered with various soothing and nutritious drinks, all white in color, and all of her surroundings should be white. She should have a large white bull or a decorated horse to look at, morning and evening. She should be told pleasant stories and look upon men and women of agreeable form, speech, and behavior as well as other pleasant sense-objects. Far from evoking disgust, these passages emphasize 12. Garbhāvakrāntisūtra (T. 1451: 253a23–26; Peking 120a6–7; Derge 249.3–4; not discussed in T. 317); Carakasam․hitā 4.3.3 (1: 419).
the pleasantness of the process, and the frequent mention of the color white suggests purity, not defilement.13 Th e other obvious difference is that the Garbhāvakrāntisūtra refers to the about to-be-reborn being as antarābhava, or intermediate being. Th e Carakasam․hitā, on the other hand, calls it the “soul” ( jīva), the same word that is used in the Brahmanical and Jaina texts mentioned earlier. Despite the difference in terminology, the Garbhāvakrāntisūtra and the Carakasam․hitā agree that something in addition to the material contributions of the father and mother is required for conception to occur. Th us, in both these systems, which take rebirth for granted, a conscious entity accompanied by previously accumulated karma seems to be necessary for the mixture of semen and blood to become animated.
After the explanation of the conditions for entering the womb, the Mūlasarvāstivādavinaya version of the Garbhāvakrāntisūtra (but not the version translated by Dharmaraksa) describes some features of the antarābhava. Th e Carakasam․hitā similarly includes a description of the jīva as it is being reborn. Next, the Garbhāvakrāntisūtra discusses the arrival of a woman’s period of fertility each month and explains the connection between a woman’s condition and the duration of her period of fertility.
Some women take three days to become fertile, others five days or half a month or a month, while others become fertile only aft er a long time depending on conditions. If a woman does not have much power, if she undergoes a lot of suffering and misfortune, if she is ugly, or if she does not have pleasant food and drink, her period of fertility, even though it arrives, will quickly stop, just as water, when it is sprinkled on parched earth, quickly dries up. If she is powerful, always receives pleasure, has an elegant appearance, and gets pleasant food and drink, her period of fertility does not quickly stop, just as water, when it is sprinkled on moist earth, does not quickly dry up. While a number of other medical texts have various views regarding the duration of the period of fertility, the Carakasam․hitā seems to be silent about this.
Th e Garbhāvakrāntisūtra then enumerates the reasons why a woman might fail to conceive.15 If the seed of either the mother or father is not emitted, or if either partner is impure, conception will not occur. Next follows a long list of graphically described “faults” of the vagina that can prevent conception from occurring. Th e fi rst three are diseases caused by imbalances in the three humors, wind, bile, and phlegm. In their sections on gynecology, the medical texts similarly classify the diseases of the vagina according to the three humors.
Other faults mentioned by the sūtra include diseases characterized by obstruction due to blood and, perhaps, fat, conditions such as being overweight or applying medicine, and a disease that resembles an ant’s waist (perhaps by making the vagina very narrow at some point). Still other faults are identifi ed by the appearance of the vagina: like a camel’s mouth, like a tree with many roots, like a plough
13. Carakasam․hitā 4.8.5–4.89 (1: 462–64). 14. Garbhāvakrāntisūtra (T. 1451: 253b6–13; Peking 120b2–8; Derge 249.7–250.6; not discussed in T. 317). 15. Garbhāvakrāntisūtra (T. 1451: 253b13–27; Peking 120b8–121a9; Derge 250.6–251.7; T. 317: 886a13–b3).
head, like a cart, like a cane stalk, like a tree leaf, like the hair on barley. Furthermore, the uterus may be too deep at the bottom or too deep at the top. It may bleed or drip water. It may be always open, like a crow’s mouth. Its dimensions may be uneven in all directions. It may have raised and depressed areas. Finally, it may harbor worms that eat putrefied filth.
Although a few of these conditions may correspond more or less closely with the diseases of the vagina described in the medical texts, most of them do not. Th e medical texts formally name the disorders and explain their causes and symptoms. Th e sūtra, on the other hand, generally goes no further than the fanciful similes listed above.
The language used to describe these “faults” resembles that used in a description of the vagina in a passage found later in the sūtra: “that hole, which is a wound on the body that has arisen from the maturation of past karma, very nauseating like a toilet, foul-smelling, a dungeon, heaped up with filth, home of many thousands of types of worms, always dripping, continually in need of being cleaned, vile, always putrid with semen, blood, fi lth, and pus, thoroughly putrefied, slimy, covered with a perforated skin, frightful to behold.”
This is the language of two traditional Buddhist meditations, the meditation on unpleasant things and the meditation on the body, both of which are intended to arouse feelings of disgust and thereby remove attachment to the body.
Aft er enumerating the faults of the vagina, the sūtra states that if the parents are exalted and the antarābhava is low, or vice versa, conception cannot occur. Th ere is no further explanation, but the meaning seems to be that an antarābhava will not be reborn in a family whose karma is strikingly different from its own. Furthermore, even if the parents and the antarābhava are all exalted or are all low, conception still will not occur if the parents have not amassed the appropriate karma to have a child, or if the antarābhava has not amassed the appropriate karma to be born to the parents, and thus the antarābhava does not have the appropriate thought of hatred toward the father and lust toward the mother or lust toward the father and hatred toward the mother.
The medical texts do not subscribe to this Buddhist oedipal theory. Instead, sex differences are explained by the predominance of semen or blood in the fetus; the jīva, unlike the antarābhava, has no gender. However, the Carakasam․hitā shares the same general model of the necessary conditions for conception, and it devotes a chapter to a defense of the Sage Ātreya’s position that the fetus is produced by a combination of factors: father, mother, self, suitability, nutrients, and mind. If any of these is not present, conception will not take place.
This notion that a number of different causes need to come together for conception to occur seems quite similar to the Buddhist account. Furthermore, the Carakasamhitā specifically mentions the importance of the parents’ karma in producing the fetus. It also attributes to the jīva a number of factors, including birth in a certain species and a given life span,18 both of which Buddhist texts consider to be the result of karma.
16. R. Kritzer, “Childbirth and the Mother’s Body in the Abhidharmakośabhās․ya and Related Texts,” in Indo tetsugaku bukkyō shisō ron shū: Mikogami Eshō kyōju shōju kinen ronshū (Kyoto: Nagatabunshodō, 2004), 1089.
The sūtra next explains how the antarābhava enters the womb. If the mother’s uterus is clean, the antarābhava is present, the faults mentioned above are absent, and the parents and the antarābhava all have the appropriate karma, then conception can take place. First, the antarābhava has the misguided thoughts of lust for the parent of the opposite sex and hatred for the parent of the same sex mentioned above. Next, it has the false idea that it is very cold, that there is wind, rain, clouds, and fog, and that it hears the sound of a great, clamoring crowd. Thereupon, according to its past karma, the antarābhava imagines that it is escaping into one of ten types of shelters, ranging from very elegant to very primitive. With one of these mistaken notions, it thus enters the womb.19 Since the medical texts are not concerned with the spiritual development of the jīva, it is not surprising that no corresponding passages can be found in them.
Finally, before the week-by-week account of the fetus, the sūtra contains an elaborate description of the composition of the earliest stage of the new life, the kalala.20 Th is is said to be neither the same as nor different from the semen and blood of the parents; rather, the body of the kalala is formed on the basis of the semen and blood but with the cooperation of various causes and conditions. Th ere follows a long series of similes, all of which stress that the material elements of the new being arise because of the confluence of causes and conditions.
These elements are the necessary constituents of the embryo, and their functions are described: earth contributes hardness; water, wetness; fi re, hotness; and wind, fluidity. If there is earth without water, the kalala will dry up and fall apart, like a handful of dryflour or ashes. In similar fashion, the sūtra describes what will happen if various combinations of the other elements are absent. It is only because of past karma that the elements are able to perform their functions and that the embryo can grow properly.
Th e same subject is treated in the Carakasam․hitā, where the embryo is defined as the combination of the semen, blood, and self in the womb; this is further analyzed in terms of the elements, which are said to be the base of consciousness and to produce the various parts and features of the body.21
The large number of similes in the Garbhāvakrāntisūtra and the imagery employed are quite different from the matter-of-fact discussion in the Carakasam․hitā of the same biological phenomena and causal principles. Although it would be misleading to say that the Carakasam․hitā is totally unconcerned with religion or philosophy, its section on embryology consists largely of what Mitchell Weiss has described as “detailed directives for promoting fertility and the birth of a healthy, intelligent male child” and a presentation of the medical knowledge on which these directives are based.
Th e sūtra, on the other hand, appears to be an extended meditation on one aspect of the first Noble Truth of suffering (duh․khasatya), namely the suffering
19. Garbhāvakrāntisūtra (T. 1451: 253b28–c9; Peking 121a9–122a1; Derge 251.7–253.4; T. 317: 886b3–10). 20. Garbhāvakrāntisūtra (T. 1451: 253c10–254a22; Peking 122a1–124a4; Derge 253.4–257.6; T. 317: 886b11–887a14). 21. Carakasam․hitā 4.4.5–12 (1: 428–40). 22. M. G. Weiss, “Caraka Sam․hitā on the Doctrine of Karma,” in Karma and Rebirth in Classical Indian Traditions, ed. W. Doniger O’Flaherty (Berkeley: University of California Press, 1980), 97.
of birth, and the summary of the first part of the sūtra, before the week-by-week account of gestation, declares that the essential nature of the birth process is suffering:
Nanda, I do not extol the production of a new existence even a little bit; nor do I extol the production of a new existence for even a moment. Why? Th e production of a new existence is suffering. For example, even a little [bit of ] vomit stinks. In the same way, Nanda, the production of a new existence, even a little bit, even for a moment, is suffering. Therefore, Nanda, whatever comprises birth, [namely] the arising of matter, its subsistence, its growth, and its emergence, the arising, subsistence, growth, and emergence of feeling, conceptualization, conditioning forces, and consciousness, [all that] is suffering. Subsistence is illness. Growth is old age and death. Therefore, Nanda, what contentment is there for one who is in the mother’s womb wishing for existence?
Gestation
To the best of my knowledge, the Garbhāvakrāntisūtra is the first text that mentions each week of the development of the fetus. In Tibet, however, week-by-week accounts are standard in medical texts, notably in the Rgyud bźi, although there are differences in the total number of weeks as well as in the sequence of development. Most scholarly interest in the account in the sūtra focuses on Tibetan medicine and Tibetan Buddhism, for which the sūtra is a source. In the following, however, I am more interested in the sūtra itself and its relationship to the Indian medical tradition.
I now compare the accounts of gestation in the Garbhāvakrāntisūtra and in the Carakasam․hitā. I should note at the outset that the sūtra account is considerably longer and more detailed than that in the Carakasam․hitā.
Month 1
First of all, the sūtra, in its description of each of the first four weeks, stresses the suffering of the embryo, which is said to lie in filth, like a lump. The sense organs and consciousness are all in the same place, as if in a pot, and the embryo is very hot and in great pain. Each week the sūtra designates the embryo by one of the terms that we have seen used in the non-Buddhist religious texts: kalala, arbuda, peśī, ghana.
Th e Carakasam․hitā, in contrast to the sūtra, does not use such terms for the stages of the embryo, nor does it dwell on the embryo’s suff ering. Furthermore, during the first month the sūtra envisions a faster development of the fetus than does
23. Garbhāvakrāntisūtra (T. 1451: 254a22–29; Peking 124a4–7; Derge 257.6–258.2; T. 317: 887a15–20).
the Carakasam․hitā. By week four of the sūtra account, the embryo has hardened to the extent that it can be likened to distinct objects, such as a metal cylinder or a shoe last, whereas according to the Carakasam․hitā, it is still semi-liquid and shapeless.
However, perhaps the most striking difference between the sūtra and the various Indian medical accounts is the winds that feature in the sūtra descriptions of almost all of the first thirty weeks and in the thirty-eighth week. Although “bodily winds” are an important feature of Indian medical theory, winds are generally absent from the accounts of the development of the fetus.
The Carakasam․hitā, as far as I can tell, does not mention any winds that provoke changes in the fetus. It is true that, according to the Suśrutasam․hitā, wind (vāyu) is instrumental in causing the male to discharge semen, the jīva to enter the uterus, and the menstrual blood, aft er it has collected for a month, to move to the opening of the vagina, but these are not directly related to fetal development. Vāyu is also mentioned regarding the production of various body parts and functions, but always in connection with the other humors, and in these cases, the winds are not differentiated or named, as in the sūtra. In one verse, the blowing of wind (māruta) is said to cause the growth of the fetus. However, the wind is not named, nor is any specific developmental feature identified.
Th e manifold winds of the sūtra, each with its imaginative name, do not seem to be derived from the Indian medical tradition of the time. However, they do seem to have been absorbed from the sūtra into the Tibetan medical system, where they are found in many texts, although not in the Rgyud bźi. For now, the question of the winds’ origin must remain unanswered.
Month 2
Again, the embryo is developing faster in the sūtra’s account than in the Carakasam․hitā version. In the sūtra, the limbs appear gradually during this month, impelled by the sequence of winds. For each week, a botanical simile is provided to describe the function of the winds in producing the various features. For example, in week six a wind causes the fetus to manifest its elbows and knees, just as spring rain falling on edible plants produces branches. During this month, the outline of the body seems to take shape, but its contents—bones, blood, organs, and skin— will not appear until later.
In the Carakasam․hitā, on the other hand, there is no differentiation of body parts; the embryo is simply a congealed mass. Th e term ghana is used at this point as a general description of the embryo at this stage, whereas the terms peśī and arbuda refer respectively to female and neuter embryos. A third term, pin․․da, is introduced to designate the male embryo. These terms do not refer to separate stages of the fetus here.25
24. Ibid. (T. 1451: 254b2–17; Peking 124a7–125a5; Derge 258.2–260.1; T. 317: 887a21–b13); Carakasam․hitā 4.4.9 (1: 429–30). 25. Gārbhāvakrāntisūtra (T. 1451: 254b18–c1; Peking 125a5–b8; Derge 260.1–261.4; T. 317: 887b14–c1); Carakasam․hitā
In the ninth week, according to the sūtra, a wind causes the fetus to manifest the signs of the nine orifices (eyes, ears, etc.). In the tenth week, one wind makes the fetus firm, while another one expands the womb. In the eleventh week, a wind causes the fetus to be penetrated by nine holes, presumably the same nine mentioned before, which it then enlarges as the mother moves. In the twelfth week, intestines and joints are produced by another wind. The process of filling in the outline of the body has begun.
Th e sūtra describes a more gradual process than does the Carakasam․hitā, which states that the sense organs and the parts of the body are all formed at once. Th is may be in part ascribable to the fact that a week-by-week account will naturally seem more gradual than a month-by-month one. However, the use of the word “all at once” ( yaugapadyena) in the Carakasam․hitā leaves no doubt that sometime in the third month the featureless embryo suddenly gains the features that make it recognizable as an incipient human being. On the other hand, it is important to note that both accounts are at odds with the Western medical belief in “preformation,” prominent in the seventeenth century, according to which the fetus was “preformed, a fully fashioned though tiny adult that simply grew in size.”
Th e Carakasam․hitā says that feelings (vedanā) appear at the same time, the fetus becomes animated, and its influence on its mother, which is called “two heartedness” (dvaihr․dayya, equivalent to dohala), commences. However, in the sūtra two-heartedness is not mentioned, nor are feelings. Th e sūtra describes only external physical features in this month.
Month 4
In its account of the fourth month, the sūtra includes many interesting details. In week thirteen, the fetus is said to be hungry and thirsty, and it receives nourishment through its navel from the food consumed by the mother. In weeks fourteen and fifteen, winds produce large numbers of sinews and blood vessels. In week sixteen, a wind, which is said to result from karma, establishes the eyes, ears, nostrils, mouth, throat, and heart in their proper places and makes digestion and respiration possible, just as a potter takes a lump of clay, puts it on his wheel, and shapes it into a vessel.
Similar details are not included in the month-by-month account in the Carakasam․hitā, which simply says that the fetus becomes thick and the mother feels heavy. In fact, aft er the third month, the text hardly describes any developmental details and focuses more on the pregnant woman and her interaction with the fetus.
26. K. Newman, Fetal Positions: Individualism, Science, Visuality (Stanford, Calif.: Stanford University Press, 1996), 33. 27. Gārbhāvakrāntisūtra (T. 1451: 254c2–18; Peking 125b8–126b1; Derge 261.4–262.6; T. 317: 887c2–24); Carakasam․hitā 4.4.11–15 (1: 430–31). 28. Gārbhāvakrāntisūtra (T. 1451: 254c19–255a14; Peking 126b1–127b2; Derge 262.6–265.1; T. 317: 887c25–888b3); Carakasam․hitā 4.4.20 (1: 432).
Month 5
In the seventeenth week, according to the sūtra, a wind first cleanses and arranges the digestive and respiratory systems, as well as the parts of the body with which, in the nineteenth week, the sense organs will be associated. The simile is drawn to a skillful person cleaning a dirty mirror with a cloth. In the eighteenth week, another wind purifies the six bases (the meaning of which is unclear), “as when the sun and the moon are obscured by a great cloud, and a strong wind arises and disperses the cloud.” In the twentieth week, still another wind causes the bones to be produced and arranges them, just as a sculptor shapes a sculpture.
According to the Carakasam․hitā, in the fifth month flesh and blood appear, and the mother becomes thin. Th e sūtra, however, assigns these developments to the sixth month and as usual does not worry about the mother’s condition.
Month 6
According to the sūtra, following the production of flesh and blood, skin is produced and then “brightened” in the sixth month. In the description of the twenty first week, another interesting simile is made: a wind makes flesh grow on the body just as when a plasterer spreads mud on a wall. As for the Carakasam․hitā, it states that strength and complexion develop in the fetus, while the mother loses strength and complexion.
Th ere seems to be some agreement here if we can assume that the production and brightening of skin correspond to developing complexion. As in the previous month, the Carakasam․hitā envisions the fetus’s development at the expense of the mother. This aspect is totally absent from the sūtra although it would seem to be a good basis for meditation on suffering: the condition of the fetus improves at its mother’s expense.
Month 7
In its description of the seventh month, the sūtra portrays the fetus as nearing completion. Its blood and flesh become increasingly moist, and hair, body hair, and fingernails appear. But the striking feature here is the sudden introduction, in the account of the twenty-seventh week, of a discussion of the karma of the fetus (this is found in all versions of the sūtra so there can be no question of its being a later interpolation). If the fetus has done bad things in a previous life, it will receive various bad results: its attributes will all be the opposite of what is desirable in the world into which it will be reborn; it will have various disabilities, such as deafness, and even its relatives will hate it. If the fetus has done good things in a previous life, the opposite will happen.
29. Gārbhāvakrāntisūtra (T. 1451: 255a15–b9; Peking 127b2–128b1; Derge 265.1–267.1; T. 317: 888b4–c2); Carakasam․hitā 4.44.21 (1: 433). 30. Gārbhāvakrāntisūtra (T. 1451: 255b10–18; Peking 128b1–5; Derge 267.1–5; T. 317: 888c3–15); Carakasam․hitā 4.4.22 (1: 433). 86 Furthermore, in the description of the twenty-seventh week, it is said that if the fetus is male, he will squat on the mother’s right side, his hands covering his face, facing his mother’s back. If the fetus is female, she will squat on the mother’s left side, her hands covering her face, facing her mother’s belly. Th e fetus is situated between the stomach and the intestines, the contents of which respectively press down on and poke up at the fetus, causing pain. When the mother eats too much or too little, it causes pain, as does food that is too oily or too dry, too cold or too hot, salty or bland, bitter or acidic, sweet or hot.
The various actions of the mother, such as having sex and walking fast, all cause pain. Nanda, the interlocutor of the sūtra, is then reminded of the various sufferings that humans experience in the womb and exhorted to avoid the endless sea of sufferings of sam․sāra.
Also, in the twenty-eighth week, eight mistaken ideas are said to arise in the fetus: a house, a vehicle, a park, a tower, a grove, a seat, a river, a pond. Th ere is no further explanation, but it seems as though these are mistaken notions because the fetus thinks it is dwelling in one of these places rather than in the place where it really is, namely its mother’s womb.
According to the Carakasam․hitā, the fetus develops in every respect, and the mother becomes generally exhausted. Th e details of growth enumerated in the sūtra are left unspecified. Like the sūtra, the Carakasam․hitā ascribes a role to karma in both embryology and disease, a topic explored by Weiss. However, Weiss points out that in many passages, particularly those with practical applications, the influence of karma is rather downplayed (106–107). In its month-by-month account of gestation, the Carakasam․hitā explains the two-heartedness of the third month as resulting from past karma and mentions the self (with which karma is associated) as one of the factors in determining sex, but it does not associate karma with the further development of the fetus. Nor does it claim, as the sūtra does at a later point, that karma causes defects that lead to the premature death of the fetus.
Month 8
According to the sūtra, winds apply the finishing touches to the external features of the fetus, and the effects of karma on its appearance are mentioned. This is a continuation of the development in the twenty-seventh week, when the effects of karma on the fetus are first mentioned. The Carakasam․hitā still focuses on the relationship between mother and fetus, both physical and mental. It says that they exchange ojas (vital fluid), as a result of which their moods can be unstable.32
Months 9–10
During the thirty-first through thirty-fifth weeks, according to the sūtra, the fetus gradually grows and reaches its full size and complete development. In the
31. Gārbhāvakrāntisūtra (T. 1451: 255b19–256a5; Peking 128b5–130b1; Derge 267.5–271.2; T. 317: 888c16–889b6); Carakasam․hitā 4.4.23 (1: 433). 32. Gārbhāvakrāntisūtra (T. 1451: 256a6–14; Peking 139b1–8; Derge 271.2–272.1; T. 317: 889b7–21); Carakasam․hitā 4.4.24 (1: 433).
thirty-sixth week, it becomes unhappy inside its mother’s belly, and in the thirty seventh week, it has three unmistaken notions, of uncleanliness, a bad smell, and darkness. This seems to be in contrast to the mistaken notions in the twenty-eighth week: now it realizes how unpleasant the womb is and presumably is ready to come out. Finally, in the thirty-eighth week, a wind directs the fetus toward the vagina, and another wind, compelled by the force of karma, turns the fetus so that its head is pointing downward ready for birth.33
Th e Carakasamhitā simply states that these are the months of childbirth, and it mentions elsewhere that the fetus turns over so that it can be born headfi rst.34 Again the sūtra invokes the agency of winds, this time to move the fetus into position for birth, whereas the Carakasam․hitā does not. As we have seen above, at least one other religious text, the Agnipurān․a, also mentions a wind that turns the fetus over into position to be born headfirst. It appears as though all the accounts have finally converged at this point.
Conclusion
The Garbhāvakrāntisūtra and the Carakasam․hitā share an epigenetic model of fetal development unlike the preformationist one common in seventeenth- and eighteenth-century Europe.
They do not imagine that a homunculus is implanted in the womb at conception and needs only to bide its time and grow in size during the nine or ten months of gestation. Rather, they describe a process in which the material contribution of the two parents, once animated by the antarābhava or the soul, develops gradually, its various parts becoming differentiated and growing month by month.
The Carakasam․hitā is rather terse in its account and goes into few details, giving the impression of an abrupt development, with the sense organs and body parts all being formed at once in the third month, the flesh and blood developing in the fifth, and the fetus growing and gaining strength in the remaining months. The sūtra, on the other hand, goes into far greater detail.
It gives the impression that in the earlier months the outline of the fetus is being sketched in. As time goes by, the contents—the internal organs—appear, and the structure of the fetus is literally fleshed out. Finally, the most external parts of the body, the hair and nails, become completely visible as the fetus attains its full size.
It is perhaps surprising how similar these two ancient accounts are to modern medical descriptions of gestation. One major difference is that development, generally speaking, occurs earlier according to modern medicine, with many things happening during the first month, whereas in the Indian accounts the fetus is little more than a lump or an even more shapeless blob. Th is may be explained by the available technology: there was obviously no ultrasound technology in ancient India, nor were there scanning electron microscopes for conducting meaningful
33. Gārbhāvakrāntisūtra (T. 1451: 256a13–b9; Peking 130b7–131b3; Derge 272.1–273.4; T. 317: 889b21–c6); Carakasam․hitā
4.4.25 (1: 433).
34. Carakasam․hitā 4.6.24 (1: 452).
dissection. From the second month, however, the account in the Buddhist sūtra seems to move along similarly to that of modern medicine, although oft en perhaps a month behind. Of course, the details diff er, and the sūtra is not as sophisticated.
Nevertheless, the epigenetic model is the same.
Th is is not to say that the sūtra is scientific. The winds it mentions are mythical and magical, corresponding to nothing in medicine, either ancient Indian or modern Western. Th e account of gestation occurs in the context of a sermon on the suffering inherent in rebirth, and the emotion elicited by the physiological details is neither scientific detachment nor wonder at the miracle of life. We are reminded of the filth in which the fetus grows and the pain that it experiences, at both the embryonic stage and in the seventh month, when it is fully capable of appreciating its predicament.
In the Buddhist meditation on the body, the practitioner is explicitly told that the enumeration of the hairs, sinews, guts, bones, etc., is for the “direction of attention to repulsiveness.” In this sūtra, Nanda is not meditating, but the message that he is hearing is that the body, beginning from the porridge-like liquid in the hot, filthy pot-like womb, is an unsatisfactory, suffering mess, consisting of vast numbers of components, formed and arranged by oft en grotesquely named winds.
Th is contrasts strikingly with the neutral description found in the medical literature. However, perhaps the same imaginative prowess that the unknown author or authors of the Buddhist sūtra employ to disgust the listener with the rebirth process enabled them to visualize more completely than the medical texts, and surprisingly accurately, the development of life in the womb.
Finally, it must be emphasized that in the Garbhāvakrāntisūtra, the embryo and the womb are viewed totally negatively. Elsewhere in Buddhist literature, the womb comes to have positive connotations, as in the doctrine of Tathāgatagarbha, where the “womb of the Tathāgatas” refers to the inherent potential in all beings to become Buddhas.
In Tantric texts, as Frances Garrett points out, spiritual development is likened to the development of the embryo.35 But this sūtra is clearly an example of what Alan Sponberg refers to as ascetic misogyny in early Buddhist literature.36 Here the womb, as well as the vagina and the woman to whom they belong, are all considered to be agents of sam․sāra.
And as the Buddha tells Nanda in the account of the twenty-seventh week: if even in good rebirths, one is born in such an unclean and awful place and suffers so much pain, how much worse will it be in bad destinies such as those of hungry ghosts, animals, and hell-beings? Th e only way out is to give up the pursuit of pleasure so that one can eventually escape the suffering that begins in the womb in every lifetime.
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