Along with important input from Indian, Chinese, and Greek medicine, it should come as no surprise that Buddhism was a major influence on Traditional Tibetan Medicine (Sowa Rigpa). While the medical tradition asserts that it is a healing science for all - not just a modality for religious adherents - the Buddhist orientation towards empirical observation and rational thought offered a uniquely profound context for the evolution of Sowa Rigpa in Tibet. Many of the medically-oriented teachings of Buddhist philosophy are featured in the healing system, often explained in uniquely scientific terms, and Tibetan Medicine presents itself as a valuable tool for understanding the most salient techniques within the Buddhist tradition.
Unlike theistic schools of thought that gave rise to many of the world’s ancient healing systems, Buddhist philosophy offers a non-theistic, quasi-scientific basis for understanding phenomena. Tantric Buddhism, or Vajrayana, often refers to energetic and physiological systems of the body, and asserts that the inner body is a microcosmic manifestation of universal principles. The famous Hermetic adage from the Emerald Tablet, “As above, so below,” is echoed and elaborated upon in the Kalachakra Tantra (the Wheel of Time), which is one of the most famous Buddhist sources for medical and astrological knowledge. The Kalachakra repeats, “As in the outer, so in the body; as in the body, so in the other,” meaning that outer phenomena are reflected in our inner reality (and vice-versa), and that observation of the body and outer universe are essential for understanding the spiritual path. The “other,” in this case, refers to the mandala of the deity in tantric practice. Magical processes, such as those found in the Kalachakra literature, are not inversions or departures from universal laws, but powerful methods of engaging with them for inner development.
The Buddhist focus on consciousness and the mind pushed Tibetan Medicine to closely acknowledge the connections between psychological and physiological states, fostering a profound take on the mind-body connection. While it may not deal as directly with specific physiological ailments, Buddhism can itself be seen as a kind of healing discipline, even invoking traditional medical models to come to a universal diagnosis of sentient beings.
Siddhartha Gautama, the “historical Buddha” (also known as Shakyamuni), was the prince of an Indian kingdom sometime between the 8th-6th centuries BCE. He experienced an existential crisis upon discovering that his perfect palace life was a misrepresentation of the common human experience. He famously discovered that all beings experience the sufferings of sickness, ageing, and death – a radical realisation that propelled him to explore the root cause of suffering itself. After studying with Indian ascetics for a number of years, he decided to explore a hypothesis that extremity in practice does not bring about liberation from suffering. Engaging in the middle-way practices of calm abiding (shamatha) and insight (vipassana) meditation, he attained complete enlightenment and permanently transcended the endless cycle of suffering. He adopted the title Buddha, meaning “one who has woken up.”
The Buddha’s first teaching is widely known, taking place at Deer Park in Sarnath some months after his enlightenment. He taught on the Four Noble Truths, fundamental realisations about the nature and cessation of suffering. It is little known, however, that the structure he used for presenting these teachings was directly derived from medical theory. Vedic and Ayurvedic medicine had long following a standardised procedure for describing pathological states, which were clearly known to the Buddha. This fundamental structure is still used today in the breakdown of diagnosis, aetiology, prognosis, and treatment of disease. The Four Noble Truths follow this schema as follows:
Treatment: Eightfold “Therapies”
In this way, the “supreme physician” (an epithet of the Buddha) presented a systematic analysis of the root affliction common to all life. The diagnosis of suffering (dukkha in Pali or duk-ngel in Tibetan) indicates that the experience of misery itself is the root affliction plaguing all beings. While the symptoms of suffering vary by individual, the basic diagnosis is the same. This unveils an important truth regarding our mind’s orientation. We may perceive our sensory perceptions as being the windows into a concrete outer world, yet in reality our brain produces the entire array of phenomena that we associate with it. We are not afflicted by outer circumstances, but by the subjective experience of suffering. While the disease appears through many diverse symptoms, in order to effectively treat it we need to address the root.
Even if we experience a fleeting moment of bliss based on our apprehension of external stimuli, this is simply a symptom of suffering’s progression as a chronic disease. Suffering is in fact present in all experiences, if only due to the impermanent nature of joyful experiences. Every happy moment is tinged with despair - not because they are bad, but because we cling to them and always want more. The bliss of a loving relationship is actually a source of suffering, because impermanence dictates that separation or death will inevitably come to pass. Therefore, even joy is tinged with grief, as long as we haven’t managed our addiction to permanence.
The aetiological cause of suffering is described as attachment. Alternative translations include desire and clinging, but I think that addiction is the best term to use. An evocative designation, addiction covers the diverse range of the experiences described by the Buddha. We generally think of “addicts” as being shady illicit drug users on the fringe of society - uniquely unfortunate individuals who are often remote from our experience. Yet addiction pervades all of our activities as modern humans. Consumerism is based on addictive behaviours, and a staggering number of substances, psychological tricks, and dogmatic impositions are used to stoke the fire of consumption. Whether somebody is addicted to heroin, food, caffeine, online shopping, or sex, we all fall somewhere on the spectrum of addiction. Even if we avoid all pleasurable substances and materialism, we may become addicted to pleasure, serenity, or the lack of disease. We may experience a desire to attain physical fitness, an attachment to our gym routine, and attachment to our well-toned muscles. But because of the fundamental truth of impermanence, a disease, accident, or natural ageing will rob us of these pleasures over time. The accumulation of wealth may seem to be an effective treatment for our disease of suffering, but we can see that the accumulation of wealth is usually accompanied by an enduring desire for more money, attachment to our fortune, and fear of losing what we have accumulated. The wealth, fitness, and sex are not intrinsically bad - it's our addiction to them that gives rise to the experience of suffering.
On a more essential level, our addiction to an unrealistic view of reality is the most fundamental cause of suffering. According to Buddhism, the subjective “lens” of our experience is formed from karmic imprints, which are accumulated throughout our countless lifetimes. These karmic imprints produce a kind of “veil” over our conscious experience, charging sensations with polarities that differ wildly between different sentient individuals. If somebody spends their life in armed conflict, reducing other humans to targets and potential threats, then this produces distinct imprints on their conscious experience. It will impact the way they instinctually approach others, and their view of reality will be affected by their behaviour. From a Buddhist perspective, the effect of these imprints produced in life carry on after death, leading individuals to attract particular forms of rebirth. This is the true process of karma, not some divine system of discipline and retribution. Karma is not “bad things happen to bad people,” it’s a recognition that our reality is formed based on previous causes and conditions.
In modern terminology, we can think of these karmic imprints as data accumulated both through human genetic history and our previous lived experiences. We use evolutionary algorithms embedded in our DNA to construct our individual view of reality, supplemented by life experiences and memories accumulated since birth. We’re programmed to seek certain desirable traits in foods, other humans, climates, and sensations based on billions of years of genetic history. Very few of the decisions that we make are free from any kind of evolutionary component. Our own life experiences provide another layer of subjective illusion, with the past directly affecting our decisions in the present. We are dragged around by our genetic and subconscious motives like a fish on a hook, which is why so many seek emancipation from these imprints through inner development.
Tibetan Medicine offers an interesting mechanism for some of these imprints on the mind, and particularly in the brain, with its description of negative channels or tsa-ngen. They are described as channels that form based on habitual negative behaviours, which cause them to become increasingly instinctual for the individual. Personally, I tend to think of these as neural pathways formed in the brain, which are also produced by habitual behaviours and create the tendency to approach future experiences in similar ways. When our consciousness is conditioned by these negative pathways for a long time, this is believed to become more energetically ingrained in the consciousness of an individual. After death, this habituation propels our mind into new manifestations of life that most closely reflect our orientation.
Our karmic view is founded upon the fundamental delusion that we are intrinsically separate from the world around us. Because we produce reality based on the input of a specific set of sensory data, we erroneously conclude that we have an intrinsically individual “self” that is independent from the alien “other.” In reality, nothing about our bodies, minds, or personalities are permanent or independent. Our bodies are ever-changing conglomeration of molecules that completely reinvent themselves at least once per decade. Our memories are also ever-changing and contextualised within broader circles of influence, and our self-identity is very much a moving target. All organic matter is composed of impermanent cells, which are made up of molecules, which are made up of atoms, which are made up of subatomic particles almost entirely composed of empty space. As long as we cling to some kind of stable, enduring self, we will absolutely be let down.
The prognosis that the Buddha provides is encouraging. He tells us that the disease of suffering, although quite serious, is actually treatable! But like many conditions, a cure is entirely dependent on our ability to follow the treatment method perfectly. For some, treatment at this time is not possible. Even though mice are also diagnosed with suffering caused by addiction, we do not yet have methods for treating them effectively. They must wait until their existential experience allows for treatment (i.e. a human rebirth with beneficial conditions). Death itself is not a treatment, which may be a jarring realisation for avowed existentialists. We have no compelling reason to believe that the awareness at the root of our experience ceases after death. The data held in our brain will certainly fade, since it is tied to our physical neural network, but without understanding the nature of consciousness or awareness itself it is currently impossible to ascertain what happens to the mind after death via scientific means.
The treatment prescribed by the Buddha comprises of eight therapies. These are broken down into physical treatments, mental treatments, and treatments related to our verbal engagement with others. In classical Buddhist terminology, these comprise the Noble Eightfold Path of behaviours that foster enlightenment.
As for physical treatments of suffering, these include proper action, proper livelihood, and proper effort. Our actions should proactively seek to reduce suffering for ourselves and others, meaning that we do not engage in activities that bring harm. Our livelihood, the means by which we accumulate the necessities of survival, is directly related to our collective experience of suffering. If we make a living by killing others or causing environmental destruction, this will ultimately pull us deeper into the web of destruction. If we make our living helping others, then we can contribute to a much healthier society and overall well-being. Proper effort impacts our very capacity for agency in our own lives. If we remain passive in our pursuit of existential health, then we will be led about by manifold conditioning factors. This treatment method requires more than passive reception of magic spells and pills – it requires the patient to take an active role in their healing. It also requires us to exercise restraint, since it is easy to exacerbate our condition by engaging in unhealthy behaviours. In order to avoid this, we must exercise proper effort. In this way, the Buddha places our well-being squarely into our own hands. The Buddha is far closer to a physician than a god - he doesn’t inflict illness upon us as some kind of divine punishment, and he is not capable of removing it through magic or omnipotence. The most that he can do is offer us the treatment, and provide us with comfort and healing guidance along our therapeutic path.
The mental treatments for suffering include proper view, proper intention, proper mindfulness, and proper meditation. These are essential, because it is understood that mental states ultimately give rise to our perceived reality. If our minds are polluted with hatred, jealousy, or other afflictive states, then this will impact both our actions in the world and our perception of it. Proper view prescribes that we must work to become acquainted with a realistic view of reality. We are not told to learn about reality from a set of dogmatic laws, or to become deferential to the divine rule imposed by a creator. Rather, we should seek to understand the true essential nature of phenomena itself. In modern times, we can support traditional techniques with cutting-edge research in fields like quantum physics and neurochemistry. We know that phenomena is not solid, and that our perceptions are not objective. Our version of reality is entirely influenced by secondary conditions that are largely out of our control, therefore we have to question whether or not our conventional view of reality is based in reason or delusion. By recognising the quantum nature of phenomena, and the essential nature of Mind itself, we can heal our disease of suffering. If we can engage with our treatment method with the proper intention, namely an intention that is based in altruism and not deluded egocentricity, then this will also encourage our healing process. If we maintain mindful concentration and awareness of the state of our mind, then we can learn to control our physiological and energetic impulses. And if we engage with meditative practice, then we can ultimately cultivate the ability to investigate and control our mind, instead of being controlled by it.
Finally, our spoken relations with others are used as a medium for treatment, since a great degree of human suffering arises from the spoken word. Proper speech involves using our sophisticated verbal powers to ease the suffering of others. It is advised not to use language that “pierces the heart” of beings, causing them misery, but rather to use it in order to alleviate suffering and facilitate the experience of liberation. In this way, the Buddha connects our healing with the way we engage with our community. Not only should we seek not to kill or injure others – we should use our power to influence the minds of others to ease suffering. This, of course, does not mean that we cannot use fierce language to tackle injustice and inequality. If the intention is noble and the approach is skilful, then fierce compassion can be incredibly effective. But if our intention is to cause another being misery, then this is not an effective way to heal our suffering.
In essence, the Buddhist approach to spiritual practice can be broken down into three categories – the cultivation of mindfulness, the maintenance of ethical conduct, and the unveiling of primordial wisdom. Mindfulness, being the cultivation of concentration that allows us to deeply focus and analyse phenomena, gives us the ability to gain mastery over our experience. But while this is powerfully important, it is ethically neutral. Mindfulness can be used to foster liberation, but it can also be used to pull us deeper into suffering. Teaching an overworked businesswoman to use mindfulness in order to reduce stress (and work longer hours) is not an effective method for curing suffering. Ethical conduct is vital for understanding how to apply mindfulness in a productive and positive way. At its essence, ethical conduct can be analysed along the lines of impact on suffering, as well as the underlying intention of our behaviour. If an act causes suffering, is rooted in malevolent intention, and/or leads to the celebration of pain, this is defined as an ethically negative act. If our behaviour eliminates suffering, is rooted in altruism, and/or leads to celebration of altruistic activities, then this is ethically positive. The unveiling of primordial wisdom is the basis of both our applications of mindfulness and our analysis of ethical conduct. To acquaint and dissolve oneself into the luminous nature of primordial wisdom is the ultimate goal of Buddhism.