Health and Sickness of Body and Mind: Selections from the Yogācāra-bhūmi

The passages translated in this chapter illustrate ways that Asaṅga incorporated medical knowledge into his largest work, the Yogācāra- bhūmi, a foundational scripture for the Yogācāra school (pronounced “yoga- chara”).1 Asaṅga and his half brother Vasubandhu are credited with founding Yogācāra in the fourth century. As one of the two forms of Mahāyāna that was practiced in India (the other is Madhyamaka), it focused on mental development and cleansing the mind of distorted understandings of real ity.

The Yogācāra- bhūmi details seventeen contextual experiential domains called bhūmi.2 The se lections here draw from diff er ent bhūmis, each showcasing distinctive ways that the Yogācāra- bhūmi applies medical knowledge. The fi rst and longest passage is from the second bhūmi, the “mentalizing domain” (mano- bhūmi),3 and moves from psychosomatic interplay to the medical and hygienic activities aff ecting life and death. This excerpt uses medicine as a source of ethical guidelines.4 The second se lection, a very short excerpt from the tenth bhūmi on “ways of acquiring and learning the teachings” (śrutamāyībhūmi), provides a terse overview of the science of medicine. The third passage, found in the same bhūmi but in the section on epistemology, occurs as part of the explanation of the defi nition of perception.5 Intriguingly, it uses the example of an expert physician selecting appropriate medicine to explain the nonconceptualizing nature of a moment of perception. The fi nal se lection from the thirteenth bhūmi, the domain of the “Hearers” 6 (i.e., theories and practices of non- Mahāyāna Buddhists), lists repulsive impurities

6. Health and Sickness of Body and Mind Se lections from the Yogācāra- bhūmi dan lusthaus 66103_1Pa_02_salg17994_text.indd 49 1/5/17 4:22 AM 50 doctrinal considerations

within the body. Off ering an anatomical and medical overview of the components of the body, this list includes hair, internal organs, bodily fl uids, and excreta, framed by a well- known disdain for the body by non- Mahāyāna Buddhists.

Asaṅga assumes his audience is familiar with basic medical theory and terminology as understood in India at that time. Terms such as doṣa and dhātu7 appear, and the reader is expected to know what they are, what they do, which other bodily components and operations are associated with them, and so on. Asaṅga’s pre sen ta tion of medical material is similar but not identical to defi nitions and discussions in the extant early Indian medical lit er a ture, such as the Compendium of Caraka, the Compendium of Suśruta, and Vāgbhaṭa’s texts.8 Some recensions of the fi rst two prob ably predate the Yogācāra- bhūmi, whereas Vāgbhaṭa’s texts— which largely superseded them in clinical practice if not hoary authority— came later.9

Just as a modern author might consult current medical, neurophysical, psychobiological, anatomical, and other scientifi c fi elds to deepen or contextualize Buddhist ideas, Asaṅga draws on the medical understanding of his day to understand how the mind and body work, and what implications that holds for Buddhist practice. Far from rejecting a scientifi c or even materialist approach, Asaṅga embraces these as essential ele ments for a Buddhist understanding of life and cultivation. Health is necessary for a productive life conducive to advancing on the Path.

The fi rst passage starts just as Asaṅga begins to expose the psychosomatic nature of the mentalizing domain. Asaṅga asks how “intoxication”10 occurs. He replies by listing the sorts of things, such as ingestion of substances or disease, that can cause that sort of alteration of one’s mental condition. Then, with a word seeming to derive from the word for “intoxication,” he asks how “insanity”11 occurs. He then lists several causes for this more extreme type of mental alteration, causes that might be physical (e.g., an

imbalance of one’s dhātus, or a blow to the head), or mental (by- products of bad habits), or a mixture of physical and mental factors (e.g., emotional or physical trauma). The Yogācāra- bhūmi then proceeds through vari ous types of alterations of consciousness, such as sleepiness, waking up, becoming light- headed, and so on, explaining each according to the types of things that cause it, until reaching “ dying.” Most of those items are treated as signifi cant symptomatic conditions in Indian medical treatises. For instance, texts such as the Compendium of Caraka devote entire chapters to “insanity” and its causes and treatments. As mentioned above, Asaṅga’s descriptions, while not identical to extant medical treatises, are very similarly arranged. We do not know which medical sources he specifi cally drew upon.

The discussion in the Yogācāra- bhūmi on the pro cess of dying greatly infl uenced later Buddhists, becoming, for instance, a foundational source for Tibetan understandings of death and dying. For example, the Yogācāra- bhūmi describes the retreat of consciousness from the dying body as draining either from the head or feet toward the heart, from which it leaves the body. This forms the basis for the Tibetan practice of tukdam (thugs dam), which is still very much a part of Tibetan belief. This practice involves the notion that highly developed prac ti tion ers nearing death can enter a meditation that slows the dying pro cess, so that the brink of death is extended for days and even weeks or more. 66103_1Pa_02_salg17994_text.indd 50 1/5/17 4:22 AM health and sickness of body and mind 51

Meanwhile, the body is virtually devoid of vital signs (no pulse, breath, etc.), heat in the heart region is supposedly maintained, and the body neither putrefi es nor emits any unpleasant odors until death has fully occurred, and consciousness has exited from the heart.12

The second passage parses the science of medicine into four aspects that are implicitly aligned with the Four Noble Truths (see parallel in chapter􀂬17). This passage comes from the contextual domain on ways to acquire and learn (śrutamāyī- bhūmi). This section of the Yogācāra- bhūmi deals with the fi ve “sciences” (vidyā) Buddhists were encouraged to study, one of which is medicine (cikitsā). Below is the fi rst Western translation of this section, which is exceptionally short.

The third passage, on perception, is signifi cant for several reasons. The Yogācārabhūmi is one of the earliest Buddhist texts to propose a detailed theory of the instruments of knowledge.13 The two most impor tant Buddhist epistemological theorists, Dignāga and Dharmakīrti,14 were Yogācāras. This passage exhibits some aspects that might surprise scholars of Buddhist epistemology. The defi nition of perception is presented in negative, i.e., exclusionary language, an early if unnoticed example of apoha (literally “exclusion”) theory.15 Second, the extract here deals with how perception pertains only to what is grasped of an object by the senses, not to any conceptual frames one might interpose or superimpose. This exclusion of conceptualization was further developed by Dignāga16 and subsequent Buddhist epistemologists.17 Asaṅga’s example of a physician putting aside considerations of prior learning and anticipations of outcome when immediately perceiving and identifying the proper medicine indicates that for him, perception is not devoid of discernment, but rather removes extraneous considerations from clouding or infl uencing how and what one perceives.

The fi nal passage lists bodily components considered impure and thus repulsive. These body parts are key objects of contemplation in a set of practices known as “meditations on impurity” (Skt. aśubha- bhāvanā), which are said to assist prac ti tion ers in overcoming attachment to the body’s beauty and sensual pleasures. Similar lists are found in other Buddhist texts. There are major discrepancies between the Sanskrit, Chinese, and Tibetan versions of this passage,18 which would require a monograph to sort out, so I have opted to translate only the Sanskrit, with occasional mention of the others in notes.

further reading

Kragh, Ulrich Timm, ed. 2013. The Foundation for Yoga Prac ti tion ers: The Buddhist Yogācārabhūmi Treatise and Its Adaptation in India, East Asia, and Tibet. Cambridge, Mass.: Harvard University Press.

Lusthaus, Dan. 2011. “Philosophy, Medicine, Science and Bound aries.” In After Appropriation: Intercultural Explorations in Philosophy and Religion, ed. Morny Joy, 159–92. Calgary: University of Calgary Press.

Sharma, P.􀂬V. 1993. Ṣoḍasangahrdayam: Essentials of Ayurveda. Delhi: Motilal Banarsidass. 66103_1Pa_02_salg17994_text.indd 51 1/5/17 4:22 AM 52 doctrinal considerations

1. Psychosomatics, Hygiene, Life and Death,

from the “Mentalizing Domain”19 What causes intoxication? Due to a weak constitution, or not being used to drinking, or overly potent intoxicants, or consuming excessive amounts, one becomes drunken and confused.

What causes insanity? It can be brought about due to prior activities, an imbalance or disorientation of one’s dhātus, physical or emotional trauma, the striking of a vital point, or possession by spirits.

What causes sleepiness? It may be based on a weak constitution, or due to fatigue and exhaustion because of doṣas, or due to heaviness from eating, or due to dullness in attention and mental focus, or due to taking respite from all sorts of activities [i.e., relaxing because one feels secure], or due to drowsiness from repeated meditative practice, or being overcome by something extraneous, such as seizures or tremors, or by spells, or by medicines, or by a daemonic power (prabhāveṇa) that produces disorientation, dullness, sleepiness.

What causes awakening? Having been invigorated by sleep, one is no longer overcome by fatigue. Or because of having something to do, one sets a time [to wake up]. Or being pulled away from a dream by something else [such as a loud noise], one wakes.

What brings about light- headedness? An imbalance of vāta and pitta, or being struck, or by purging, as in expelling blood due to dysentery, or due to overexertion until one faints.

What is emerging from light- headedness? Having been light- headed, one comes out of it.

What brings about action (karma) of body and speech? Because of what one knows prior to acting, which gives rise to a desire [to do or say something], one produces the activities in accord with those prior activities [i.e., habits]. The arising of bodily and linguistic karma derives from this.

How does one become detached from desire? By successfully detaching from the root of desire, by according with the [good] teachings acquired from others, by staying far away from obstacles, and by the application of correct practice, one is without errant thoughts, and so is able to detach from desire. . . . 20 What causes dying? Due to [reaching] the limit of one’s life􀂬span, one arrives at death. Furthermore, there are three types of [ dying]: (1) due to having exhausted one’s life􀂬span; (2) due to exhausting previous karma; (3) due to failing

to avoid imbalances. Moreover, you should know that there are timely and untimely deaths, and there is dying with a wholesome mind, or an unwholesome mind, or a karmically neutral mind. What is “death due to having exhausted one’s life􀂬span”? That is dying as soon as one has experienced the completion of the sum of one’s life􀂬span. This is called a timely death. What is “death due to exhausting previous karma”? That is when one’s inherited [karma] runs out. What is death due to failing to avoid imbalances? As the World Honored One said: 66103_1Pa_02_salg17994_text.indd 52 1/5/17 4:22 AM health and sickness of body and mind 53

“ There are nine causes and conditions for dying even though one has not exhausted one’s [full] life􀂬span.”

What are these nine causes of premature death?21 They are

1. eating improper amounts, 2. eating improper foods, 3. eating before having digested the previous meal, 4. undigested food (āma) that one is unable to expel,22 5. retention of fully digested food, 6. not being near a doctor or herbs [when ill], 7. not knowing what is harmful or benefi cial for yourself, 8–9. overindulgence in unchaste activities at improper times and in improper amounts.

These are called untimely deaths.

What is “ dying with a wholesome mind”? When about to die, one either recollects on one’s own prior wholesome deeds [i.e., karma] that one had previously practiced, or others remind him [by reciting, etc.]. The dying person remembers previous activities in which he engaged with wholesome [ mental qualities] such as faith, and so on,23 and sees those reenacted before him. At that time, whether a coarse or subtle thought should occur, the wholesome mind will neutralize it, and one remains in a mental condition that is only karmically neutral. Why? At the time of death, one is no longer able to remember those habitual wholesome [thoughts], nor can others cause one to remember them anymore.

What is “ dying with an unwholesome mind”? When one is about to die, one recollects on one’s own the unwholesome things one has repeatedly done, or one is reminded of them by others. At that time, unwholesome thoughts of greed, hatred, and delusion all pres ent themselves, until the crude and subtle thoughts [dissipate], as was explained in the case of the wholesome mind.

Moreover, when a wholesome mind dies, death is blissful. When that one is about to die, no extreme pain oppresses the body. When an unwholesome mind dies, death is painful and vexatious. When that one is about to die, serious pain oppresses the body. Again, when a wholesome mind dies, it does not see confusing forms. When an unwholesome mind dies, it sees confusing, disorienting forms. What is “ dying with a karmically neutral mind”? This refers [ either] to someone whose actions [have been both] wholesome and unwholesome [so that they neutralize each other] or to someone who was inactive. When about to die, such a person is unable to remember [ either type] and there are no other memories. The moment of death for one with “neither a wholesome mind nor an unwholesome mind” is neither blissful nor painful.

Again, when a person who has acted in a wholesome or unwholesome way is about to die, he will naturally, on his own, remember prior repeated wholesome or unwholesome things he did, or others may remind him. At that time, his mind 66103_1Pa_02_salg17994_text.indd 53 1/5/17 4:22 AM

54 doctrinal considerations

will tend to register those of his repeated habits that were most dominant, while the rest are entirely forgotten.

If he had already repeatedly cultivated equanimity,24 then at the time [of dying], that will be the fi rst thing he remembers, or he will be reminded by others. That [calmness] will not be cut off , so no other type of thoughts arise. There are those whose death is caused by two types of dominant forces, namely, the dominant force of attachment to plea sure and erroneous mental proliferation,25 and the dominant force caused by pure and impure karma. Once the fruits of prior karma have been exhausted, should one do something unwholesome, that will dominate at the time of death. One will experience undesirable eff ects from the prior unwholesome acts previously performed— such

as seeing innumerable horrifi cally mutilated, monstrous images mutating,26 as if in a nightmare. The Bhagavan explained the basis of such images, saying: “If you previously engaged in bad, unwholesome activities, then once [your karma] has reached maturity, when you die, it will be like the shadows [descending] on the mountain peaks at the end of the day, [at fi rst only] the cliff s are covered, then everywhere is covered, and [fi nally, every thing is] utterly covered [with darkness].”

You should know that just so does a person journey from light into darkness. If previous unwholesome karmic fruit is exhausted and one cultivates wholesome ways, contrary to the previous example, you should know that this is like a person journeying from darkness to light.

The diff erence between these two is that when [a wholesome mind] is about to die, it is like in a dream seeing innumerable types of nonmonstrous images mutating, so one can expect a corresponding [ wholesome] birth.

If, as in the earlier example, you are one who performs unwholesome actions, then because you see these images of monstrous mutations, sweat will fl ow, your hair will stand on end, your hands and feet will thrash uncontrollably, you will lose control of your bowels and bladder, you will fl ail wildly at the empty air, your eyes will roll upward, and you will froth at the mouth. Then you will have a birth corresponding to these monsters.

For one who has performed [only] mediocre unwholesome karma, at the time of dying, images of monstrous mutations may or may not occur. When sentient beings are about to die, but before they have fallen into a coma, the self- love that they have cultivated for a long time appears. Because of its power, one says [with alarm], “I will cease to exist!” This causes love for his body; from this one creates the recompense of a new life. At the moment of the passing of

the previous fruit to the coming of the future fruit, self- love again reappears. At [this transition point . . . ], if, by repeatedly investigating and searching, and by the power of wisdom, one can control and not be attached [to the self and the body], just as a strong warrior is able to control and suppress a frail weakling in a wrestling match, [then the reappearance of self- love can be suppressed]. You should know that the princi ple of the Middle Way is like this. Should the fruit not return, at this time, self- love does not reappear. 66103_1Pa_02_salg17994_text.indd 54 1/5/17 4:22 AM health and sickness of body and mind 55

Furthermore, the dissolution of limbs and joints occurs in all the realms in which sentient beings are born, except in the heavens and hells. . . . He who dies a pure and liberated death is called one who tamed death. He who dies an impure and unliberated death, is said to be one who has not tamed death. Furthermore, when one who has performed unwholesome karma is about to die, his consciousness withdraws from the upper portion [of the body]. A cold sensation begins in the upper portion and gradually withdraws [downward] until reaching the heart. When those who have performed wholesome karma [are dying], their consciousness withdraws from the lower part [of the body]. A cold sensation begins in the lower portion and gradually withdraws [upward] until reaching the heart. You should know that it is only from the heart that consciousness subsequently withdraws [from the body], which is followed by a cold sensation pervading [the entire body.]

2. The Science of Medicine, from the

“Domain of Ways to Acquire and Learn”27 Of what does medical knowledge28 consist? You should know that generally there are four aspects, which are skill concerning symptoms of illness, skill concerning the causes of illness, skill at eliminating an illness that has arisen, and skill at preventing an illness that has been eliminated from arising again.29 In this way, [ these four] skills can be extensively analyzed, as should be known from the sūtras.30 We have explained medical knowledge.

3. Perception Neither Reminisces

nor Anticipates, from the “Domain of Ways to Acquire and Learn”31

What is perception? It is what is not imperceptible, neither a prior nor a future consideration, and nonerroneous, undistorted. . . . 32 What is perception that is neither a prior nor a future consideration? It is twofold: (1) just grasping a senseobject immediately apprehended as its basis; (2) apprehending a sense- fi eld as a basis for establishing a sense- object.

“Just grasping a sense- object immediately apprehended as its basis” means when the sense- object that is the basis of the grasping causes [a perception] of just that to arise. This is like when a good doctor selecting a prescribed medicine, [perceiving that] the herbs’ color, fragrance, taste, and texture are all perfect, [thereby perceives that] it will be greatly eff ective.33 This is the virtuosity of [medical] skill. One should know that this medicine’s color, fragrance, taste, and texture are the basis on which is brought about the apprehension of just that which is grasped. That the medicine has great effi cacy and potency, while the sickness has not yet been cured, is called an ex pec tant thought [i.e., an inference aimed at the future]. 66103_1Pa_02_salg17994_text.indd 55 1/5/17 4:22 AM 56 doctrinal considerations

Once the illness is cured, it is called “already thought about.” It is the same with what is called the sense- object that is the basis for bringing about the apprehension of just that which is grasped [in perception].34 4. Repulsive Impurities of the Body, from the “Hearer’s Domain”35

What are the inner repulsive impurities?36 The impurities in the body are

1. head hair, 2. body hair, 3. nails, 4. teeth, 5. specks of dirt, 6. stains (or taints), 7. skin, 8. fl esh, 9. bones, 10. muscles/tendons, 11. blood vessels, 12. kidneys, 13. heart, 14. spleen,37 15. lungs, 16. large intestine, 17. small intestine, 18. undigested food in the upper torso,38 19. digested food in the lower torso,39 20. liver, 21. excrement, 22. tears, 23. sweat, 24. nasal mucous, 25. greasy fat, 26. marrow,40 27. watery humor in the body, lymph,41 28. urinary, semen- producing system,42 29. bodily fat,43 30. pitta, 31. śleṣmā, 32. pus, 33. blood, 34. brain, 66103_1Pa_02_salg17994_text.indd 56 1/5/17 4:22 AM health and sickness of body and mind 57

35. membrane of the brain,

36. urine.

notes

1. The Yogācāra- bhūmi, written and compiled by Asaṅga, prob ably in the second half of the fourth century, is a large text currently only available in full in Chinese and Tibetan, with most of the fi rst half available in Sanskrit. China reportedly possesses a full Sanskrit version of the complete text, but so far, that has not been made available to scholars. The fi rst half of the Yogācāra- bhūmi elaborately details seventeen bhūmis, the practices associated with each, etc., and the second half consists of comments on and elaborations extrapolated from the fi rst half. For a detailed summary of the seventeen bhūmis, see Kragh 2013. For an overview of the vari ous Sanskrit, Chinese, and Tibetan editions, modern translations, and secondary studies, broken down section by section, see Delhey 2013.

2. Bhūmi, literally, “ground, earth,” is a fi eld that circumscribes a range of attitudes, orientations, activities, and ways of organ izing and interacting with surroundings; it is the context that shapes how a par tic u lar domain is experienced. The Yogācāra- bhūmi describes seventeen bhūmis that pro gress from bodily sensation (fi rst bhūmi) to mental factors (second bhūmi), to methods, meditations, ethics, and so on, to increase knowledge and understanding, and advance on the path to becoming a Buddha (fi fteenth bhūmi) and, ultimately, two types of nirvāṇa (bhūmis sixteen and seventeen). While some translate it as “stage” or “level,” it means more than that in this text, where each bhūmi is treated as an environment with its own structure, orientation, and raison d’être, and the sequence of bhūmis does not always follow a neat progression.

3. On the transition from the “sensory domain” to the “mentalizing domain,” see Lusthaus 2013.

4. Portions of this passage were translated previously in Lusthaus 2013, but the translation here has been revised.

5. Perception (pratyakṣa- pramāṇa) is one of the means of knowledge accepted by Asaṅga. In the Yogācāra- bhūmi, logical inference (anumāna) and authoritative teachings (āgama) are the others.

6. The śrāvaka- bhūmi (Hearer’s Domain) is an elaborate, valuable compendium of the theories and practices of non- Mahāyāna Buddhists.

7. In medical contexts, the term dhātu􀂬refers to seven basic bodily constituents that are key factors of health or sickness. See the glossary.

8. The Caraka- saṃhitā is considered the oldest complete surviving Indian medical text. Possibly preserving material from the third century b.c.e., it was initially redacted by Caraka in the fi rst century c.e., and comes down to us in redactions compiled sometime around the sixth century c.e. The Suśruta- saṃhitā is the next oldest medical text (dating to perhaps the second or third century c.e.); it has a special focus on surgery. There are multiple En glish translations of both works (see, e.g., partial translations in Wujastyk 2003).

9. Vāgbhaṭa, the author of foundational medical texts, is believed to have been a Buddhist. The two main works attributed to him are Aṣṭāṅga- saṅgraha and Aṣṭāṅga- hṛdaya- saṃhitā, 66103_1Pa_02_salg17994_text.indd 57 1/5/17 4:22 AM 58 doctrinal considerations

though some scholars doubt both works were by the same author. On Vāgbhaṭa, with selected translations, see Wujastyk 2003.

10. Intoxication (Skt. mada).

11. Insanity (Skt. unmāda).

12. On tukdam, see http:// www . rigpawiki . org / index . php ? title = Tukdam. On Chogye Trichen Rinpoche’s passing, see also http:// blazing - splendor . blogspot . com / 2007 / 02 / chogye - trichen - rinpoches - passing . html. On Kyabje Tenga Rinpoche’s tukdam, see http:// www . benchen . org / en / tenga - rinpoche / parinirvana / 239 - simply - amazing . html; on Kyabje Trülshik Rinpoche’s tukdam, http:// gentlevoice . org / content / 2011 / 09 / passing - kyabje - trulshig - rinpoche / . The Dalai Lama has had scientists monitoring vital signs, EKGs, and EEGs during the tukdam of Tibetan luminaries, such as Ganden Tripa’s tukdam, http:// www . youtube . com / user / gyalwarinpoche ? v = gO7RQi55asY&lr = 1. (All websites last accessed 29 Sept. 2016.) 13. After Yogācāra- bhūmi, Buddhists increasingly devoted their eff orts to epistemology (hetuvidyā), and theories of the instruments of knowledge (pramāṇa).

14. Dignāga (fi fth century) and Dharmakīrti (seventh century) not only dramatically changed the trajectory of Buddhist philosophy in India and Tibet but altered how non- Buddhist Indian philosophy developed as well. Scholars readily acknowledged Dignāga’s indebtedness to Vasubandhu, Asaṅga’s half brother, but most continue to overlook Asaṅga’s infl uence on both of them.

15. Apoha is a uniquely Buddhist approach to language, which, to avoid reifying metaphysical universal classes, purports that things are properly named by what they are not, i.e., what they exclude. Thus, instead of saying “X is a cow,” one says “X is not not- a- cow,” which signals that the term “cow” is a conventional designation for perceived similarities between discrete particulars (individual cows) based on conceptual distinctions rather than metaphysical essence (universal “cowness” pervading individual cows). Many interpretations and implications of apoha theory have been proff ered over the centuries, and scholars are still disputing how best to understand it. See, for instance, Siderits, Tillemans, and Chakrabarti 2011.

16. This foreshadows Dignāga’s famous notion that perception is devoid of any conceptualization (kalpanā- aphoḍha).

17. Asaṅga also defi nes perception as nonerroneous (avibhrānta), something omitted by Dignāga but reinserted into the defi nition of perception by Dharmakīrti, though in a very diff er ent manner than Asaṅga pres ents it. Scholars have seen Dharmakīrti’s move as a “deviation” from Dignāga rather than as a return to Asaṅga’s roots (cf. Franco 1986). 18. For instance, while the Chinese alone mentions gallbladder—an impor tant organ in Chinese medicine— neither the Sanskrit nor Tibetan list it, possibly because apparently Indian medicine did not discuss gallbladders until centuries after the Yogācāra- bhūmi was written.

19. Sanskrit: Bhattacharya 1957: 13, 15–18. Chinese: T. no.􀂬1579, 30: 280c28–282a12.

20. I omit the descriptions of backsliding from having detached from desire, cutting off benefi cial roots, and progressively developing benefi cial roots, and move directly into the discussion of death and life.

21. See also chapter􀂬3§3.2.

22. In Indian medical theory, āma, which means “raw,” refers to food being pro cessed in digestion. This occurs not only in what modern anatomy identifi es as the digestive track but 66103_1Pa_02_salg17994_text.indd 58 1/5/17 4:22 AM health and sickness of body and mind 59

also in vari ous additional places in the upper body. Āma that accumulates or fails to process fully can cause a variety of illnesses. Medical texts off er elaborate explanations of how all sorts of illnesses ensue when the digestive pro cess does not work properly, including fatal outcomes.

23. “Faith” usually heads the list of wholesome mental states in āgamic and abhidharma lists. 24. “Equanimity” (sama) is a calmness based on equalizing things. This equanimity is stressed in Yogācāra practice, the point here being that one accustomed to this practice will be able to assume a calm, un perturbed demeanor even while dying since that mental frame will be familiar— like second nature— recognizing the “sameness” of life and death. 25. Buddhists identify “erroneous mental proliferation” (prapañca) as a core mental prob lem signifying not only the proliferation of ideas and mistaken notions but the anx i eties and compulsions driving us to infuse our surroundings with unreal fi ctions that we take for real ity.

26. “Innumerable horrifi cally mutilated, monstrous images mutating” is an attempt to capture some of the range of anekavikṛta (lit., “a multitude of mutilated and deformed” images), but implying a frightening array of nightmarish apparitions. 27. Śrutamāyī- bhūmi. Sanskrit: Śrāvakabhūmi Study Group 2007: 304–5. Chinese: T no.􀂬1579, 30: 356a8–11.

28. The Sanskrit has cikitsā, i.e., “medicine,” whereas Xuanzang, for clarity, renders cikitsā here as yifang ming, lit., “fi eld of knowledge of medical methods,” the ming indicating that this is one of the fi ve vidyā- s, or fi elds of knowledge covered in this bhūmi.

29. Note that these four aspects allude to the Four Noble Truths: suff ering (symptom), cause of suff ering (diagnosis), suff ering can be eliminated (prognosis), and the way to eliminate suff ering (treatment plan), though the fourth aspect is modifi ed (cf. chapter􀂬17§2). 30. The reference to sūtras is unclear. If he is referring to standard Buddhist sūtras, perhaps he has in mind those sūtras which explic itly deal with medical knowledge, or perhaps he is being more allegorical and considering all sūtras to be expressions of the Buddha as doctor and healer, off ering cures through the Four Noble Truths. Sūtra could also be an allusion to the verses of medical texts, Buddhist and non- Buddhist alike.

31. Śrutamāyī- bhūmi. Sanskrit: Wayman 1999: 14–15; Yaita 1992: 517/3.26, 518–19/3.262–2621. Chinese: T no.􀂬1579, 30: 357a15–16, 357b12–19.

32. The Sanskrit terms are “not imperceptible” (aviparokṣa), “not a prior nor a future consideration” (anabhyūhitam anabhyūhyam), and “nonerroneous, undistorted” (avibhrāntaṃ). Each begins with the negative prefi x a- /an- , meaning “not.” Perception is defi ned by what it is not. Xuanzang’s Chinese translation literally reads: “Perception is threefold: (1) not seeing what is not pres ent, (2) neither thought already nor ex pec tant thought, (3) not deluded about the perceptual fi eld.” The example of the physician is part of the explanation for the middle two terms, “not a prior nor a future consideration.”

33. On Āyurveda, Dominik Wujastik (2009) writes: “Several thousand plants were known for their medicinal values, and described in terms of a pharmacological typology based on fl avours (six types), potency (usually two: hot and cold), post- digestive fl avourings (usually three), and pragmatic effi cacy (used when the eff ect of a medicine is not adequately defi ned by the earlier categories). This typology formed a system of interlocking correspondences and antipathies with the system of humours and other physiological categories as expressed through the vocabulary of pathology.” 66103_1Pa_02_salg17994_text.indd 59 1/5/17 4:22 AM 60 doctrinal considerations

34. The point is that when perceiving the herbs, the doctor only discerns the colors, fragrances, etc., and even while recognizing that they are “perfect” and thus effi cacious, he concerns himself not with what will be, nor what has been, nor will have been. Perception is seeing things as they actually are.

35. Śrāvaka- bhūmi. Sanskrit: Shukla 1973: 203; Śrāvakabhūmi Study Group 2007: 58. Chinese: T 30, no.􀂬1579, 30: 428c24–28.

36. The extant Sanskrit has pratyaśubhatādhyātmam upādāya, but Sakuma (1990, 2: 94n573) and Deleanu (2006, 1: 71n60) both correctly suggest that pratyaśubhatā should be emended to pūtyaśubhatā, which better fi ts the context and the Chinese and Tibetan versions. I thank Robert Kritzer for bringing this to my attention. The śrāvaka- bhūmi follows the “inner” repulsive impurities with a list of “external” repulsive impurities (types of corpses, etc.). Xuanzang glosses “inner” as “in the body,” indicating that the diff erence is what is found within or on one’s own body, as opposed to things outside one’s body.

37. “Spleen” (plīhakam). The Tibetan doesn’t mention spleen, and some versions of the Chinese list “spleen” as the twenty- second item, not the fourteenth (though some Chinese texts have a character similar in appearance to “spleen” that means “buttocks or thighs”). 38. Āmāśayam. On āma, see note 21 above. See also the fourth and fi fth items in the list of nine causes of premature death above.

39. Pakvāśayam. Once the digesting food is fully pro cessed, it is pakva (lit., “matured”) and is expelled from the lower torso; should it fail to be expelled (constipation, etc.), illness can result. Xuanzang translates the āma and pakva terms as “raw storage” and “pro cessed storage.” The Tibetan version uses terms meaning “stomach” and “ruminating stomach,” as if humans had two stomachs, the second one with cuds.

40. Vasā. 41. Lasīkā.

42. Majjā. The corresponding Chinese here is “kidneys.” Chinese medicine sees kidneys, the urinary tract, and reproductive fl uids as part of the same system. Tibetan medicine has a similar view. 43. Medaḥ.