Concepts of Health and Disease (In early Buddhism)

In early Buddhism, the Buddha is often honoured as the “Unsurpassed Physician and Surgeon” (anuttaro bhisakko sallakatto) (Itivuttaka 101), who cures the suffering of sentient beings. His teaching, the dharma, is also regarded as the medicine for suffering, while the saṅgha members are regarded as attendants for the sick (Birnbaum 1989, 15).

In addition, the “Great Physician King” (Chinese: Da yiwang 大醫王)–another appellation–is described as having the skills which parallel the fundamental teaching of Buddhism, the Four Noble Truths (Saṃyukta Āgama (Saṃyukta Āgama), Taishō Tripiṭaka 99. 105a25-b10):^[1]

“There are four things, being accomplished, that the one named Great Physician King should [have] as a king’s possession, as a king’s duty. What are the four? One, knowing well the disease; two, knowing well the origin of the disease; three, knowing well the treatment of the disease; four, knowing well that after curing the disease, there will be no recurrence. How to comprehend ‘a good physician knows the disease well’? It means that the good physician knows well such and such various types of disease. This states how the ‘good physician knows the disease well.’ What [does it mean that] ‘a good physician knows well the origin of disease’? It means that the good physician knows well that this disease has arisen due to wind, this has arisen due to indigestion, this has arisen due to saliva, this has arisen due to many cold [conditions], this has arisen due to present matter, [and] this has arisen due to season.^[2] This states how the ‘good physician knows well the origin of disease.’ What [does it mean that] ‘a good physician knows well the treatment for disease’? It means that the good physician knows well the various diseases: this [disease] should be anointed with medicine, this should [be treated by] emesis, this should be purged, this should [be treated with] nasal douching, this should be fumigated, this should [be treated by] sweating–various treatments like these examples. This states how the ‘good physician knows well the treatment.’ What [does it mean that] ‘a good physician knows well the disease being cured and it will never occur in the future’? This means that the good physician relieves well the various diseases [and] causes them to be totally eliminated, [which] will never again arise in the future. This states how the ‘good physician knows well the treatment for disease [and the disease] will not recur.’”^[3]

Then, what has the Buddha, the Unsurpassed Physician and Surgeon, taught about health and disease? There is no clear definition of these two concepts in the sūtras or the Vinaya, though there is much discussion relating to them. The Pāli or Sanskrit term commonly used in early Buddhist literature for health is ārogya. There are, however, several terms denoting disease, illness or sickness, such as roga, ābādha, vyādhi, and ātanka, as well as the adjective term gilāna for sick or ill. Ārogya is an abstract noun of aroga (absence of illness), and roga is derived from the root ruj (to break, to afflict or hurt), according to the Pali-English Dictionary (s.v. “ārogya”, “roga”, and “rujati” respectively). Thus, roga is disease or illness, aroga is absence of illness/disease, and ārogya is the state of absence of illness/disease, i.e. health.

Illness is one of the eight types of suffering, as shown in the Dhammacakkappavattana Sutta (Discourse on Setting the Wheel of Dhamma in Motion) (Saṃyutta Nikāya V. 420-431).^[4] Suffering, according to the Four Noble Truths, is due to the arising of suffering (dukkhasamudaya). What is the arising of suffering? It is, as per the above-mentioned discourse, craving (taṇhā): craving for sensual desire (kāmataṇhā), craving for existence (bhava-taṇhā), and craving for non-existence (vibhava-taṇhā). As Rahula (1978, 29) explains: “It is this ‘thirst’, greed, craving, manifesting itself in various ways, that gives rise to all forms of suffering and the continuity of beings.” It is the craving–for anything delightful and pleasurable, whether it is form, sound, smell, taste, touch, or idea (Piyadassi 1987, 60)–that subsequently leads to clinging, becoming, birth, and suffering (such as ageing, death, etc.). However, according to Buddhism’s teaching on dependent arising (Pāli: paṭiccasamuppāda; Sanskrit: prātītyasamutpāda), the law of causality, every conditioned thing occurs depending on other factors.^[5] Craving should not be regarded as the “first” or “original” cause. It is itself conditioned by and dependent on other factors. As per the twelve-factored formula of dependent arising,^[6] the arising of craving depends on feeling, which in turn depends on contact and so on. In this formula, ignorance (Pāli: avijjā; Sanskrit: avidyā) is termed as the first factor. Hence this factor is considered as a very important one in causing all forms of suffering, including sickness. What is this ignorance that gives rise to suffering? It is the ignorance–the not-knowing–of the Four Noble Truths, of the principle of dependent arising, of the nature of the five aggregates of a being, and of the true nature of things as they are, i.e. impermanence, unsatisfactoriness, no-self-ness, and impurity. It is this ignorance that causes one to have moral defilements and unwholesome actions of body, speech, and mind (Piyadassi 1991, 142-143), which eventually result in suffering.^[7] But, again, ignorance should not be regarded as the first cause of suffering. It also is causally conditioned (Aṅguttara Nikāya V. 113).^[8]

Furthermore, a discourse in the Saṃyutta Nikāya (III. 228-229), while talking about the arising and cessation of suffering, states the relation of six sense-bases with disease as follows:

“Bhikkhus, the arising, continuation, production, and manifestation of the eye is the arising of suffering, the continuation of disease, the manifestation of aging-and-death. The arising, continuation, production, and manifestation of the ear … of the nose … of the tongue … of the body … of the mind is the arising of suffering, the continuation of disease, the manifestation of aging-and-death. The cessation, subsiding, and passing away of the eye … the mind is the cessation of suffering, the subsiding of disease, the passing away of aging-and-death” (Bodhi 2000, 1008).

A parallel (though more concise) version is found in the Chinese Saṃyukta Āgama (Taishō Tripiṭaka 99. 90c2629):

“If there is arising, staying, progressing, manifesting of the eye, then suffering arises, sickness stays, [and] ageing and death manifest. The same is said for the ear, the nose, the tongue, the body, [and] the mind. If there is ceasing, allaying, disappearing of the eye, arising of suffering then ceases, sickness then allays, [and] death then disappears. The same is said for the ear, the nose, the tongue, the body, [and] the mind.”^[9]

Herein, it can be noted that the occurrence of disease is dependent on the arising of the six sense-bases, while the disappearance of disease (and hence the state of health) is dependent on the cessation of the six sense-bases. There is no explanation in these two short discourses on how the arising/cessation of the six sense-bases relates to the occurrence/disappearance of illness. But it can easily be understood by taking into consideration the twelve-factored formula of dependent arising, as mentioned above. Depending on the six sense-bases, there arises contact, which in turn gives rise to feeling, craving, clinging, becoming, birth, and all sorts of suffering such as ageing, death, sorrow, etc. Conversely, without the six sense-bases, there is no arising of contact, and subsequently not of feeling, craving, clinging, becoming, birth, or other sufferings.

Therefore, according to Buddhist philosophy, sickness as a kind of suffering has its origin dependent on other factors, particularly ignorance and craving, as shown in the twelve-factored formula of dependent arising.^[10] It is noteworthy that suffering (including illness) is connected with psychological factors. This connotes that illness can be associated not only with physical elements but also with mental causes.^[11] Moreover, in accordance with the above discussion, it implies that one who wants cessation of suffering, as well as allaying of sickness, should follow the “way leading to cessation of suffering” (Pāli: magga;Sanskrit: mārga), which refers to the Noble Eightfold Path (Pāli: ariya aṭṭhangika magga; Sanskrit: āryāṣṭāṅgamārga). In order to have freedom from sickness (i.e. health), one should lead a lifestyle consistent with the doctrine of the Noble Eightfold Path.^[12] In brief, it means living with moral conduct (Pāli: sīla; Sanskrit: śīla), concentration (Pāli, Sanskrit: samādhi), and wisdom (Pāli: paññā;Sanskrit: prajñā). Moral conduct is for disciplining bodily and verbal behaviour, while concentration and wisdom are for cultivation of the mind. Hoping to be healthy, therefore, one has to take care of both body and mind, and not just one of them.

Apart from the above important perspective, there are other viewpoints on health and sickness found in Buddhist discourses. Life cannot be without suffering, and disease is part of life. Sickness is unavoidable. In a discourse (Aṅguttara Nikāya III. 54), this unavoidability of illness is stressed: “‘May what is subject to illness not fall ill!’: this is a situation that is unobtainable by an ascetic [or a brahmin, by a deva, Māra, or Brahmā,] or by anyone in the world” (Bodhi 2012, 674). A corresponding statement is also found in the Ekottara Āgama (Ekottara Āgama): “The thing subjecting to illness–[if one] wishes to make it not ill–this is not obtainable.”^[13] Thus, nobody can escape from sickness. This is an unavoidable phenomenon of life, according to Buddhism.

Disease is regarded as a “loss” and health as an “attainment”. In the Saṅgīti Sutta (Discourse on Chanting Together) of the Dīgha Nikāya, five types of loss (vyasana) and five types of attainment (sampadā) are listed, and among these are loss by disease (roga-vyasana) and attainment of health (ārogya-sampadā), respectively (III. 235).^[14] The commentary of this Sutta explains these two terms: “roga-vyasana [refers to that] disease exactly is a loss; ‘disease indeed ruins and destroys health’ is a loss,”^[15] and “ārogya-sampadā [refers to] the attainment of health;freedom from illness for a long time is a fulfilment.”^[16] In addition, there are four kinds of loss mentioned in the Raṭṭhapāla Sutta (Discourse on Raṭṭhapāla) of the Majjhima Nikāya, and loss through sickness (vyadhipārijuñña) is one of them, while the other three are loss through ageing, loss of wealth, and loss of relatives (II. 66-68). The loss is explained in this Sutta thus: “It is no longer easy for me to acquire unacquired [sic] wealth or to augment wealth already acquired” (Ñāṇamoli 2001, 685).^[17] Furthermore, health is also considered as one of the desirables. In the Aṅguttara Nikāya there is a discourse listing ten desirable things and health is one of them (V. 135-136).^[18] In the Āgamas, there are things frequently stated as unlikeable or undesirable while others as likeable or desirable. Amongst these things sickness is one of the undesirables while health is the opposite.^[19] For Buddhist practitioners, illness is undesirable, for it can interfere with spiritual practice and development, while health can be conducive for that. In a discourse of the Saṃyutta Nikāya, there is a case where a Buddhist monk, whose name is Assaji, was not able to attain meditative concentration due to his sickness (III. 124-126).^[20] Further, it is stated in the Ekottara Āgama that if a monk has chronic illness, he cannot have advancement in the present world; conversely, if he has little ailment, he can achieve success in the present world (Taishō Tripiṭaka 125. 771b17-c1). Being healthy and possessing a good digestion, as remarked in the Majjhima Nikāya (II. 95), is one of the five favourable factors for spiritual striving and attainment. ^[21] Herein, it can be understood that spiritual practice and accomplishment can be hindered by illness while health can be advantageous instead.^[22]

Health in Buddhism is highly valued as the uppermost gain in life. In the Dhammapada verse 204, it is emphasised: “Health is the highest gain” (ārogyaparamā labhā). The same phrase is found in the Māgandiya Sutta (Discourse to Māgandiya) of the Majjhima Nikāya (I. 501 ff.), though in a different verse.^[23] In the commentary on the Dhammapada, this phrase is explained thus: “There, ‘health is the highest’ means that the condition of health is the highest. For a sick one, indeed, even gains are being known just as losses. For a healthy one, all gains are truly obtained. Because of that, it is said: ‘health is the highest gain’.”^[24] The explanation given for this phrase in the commentary on the Majjhima Nikāya is: “With regard to the verse ‘health is the highest’, whatever gains of wealth, gains of fame, or gains of sons there are, health is the highest and uppermost of them. Therefore, there is no gain more superior. It is [the meaning of] ‘health is the highest gain’.”^[25] Hence in Buddhism we find a high praise of health. Moreover, health is even comparable to nirvāṇa (the state of emancipation with complete extinction of defilements). In both verses of the Dhammapada and the Māgandiya Sutta, health and nirvāṇa are both described as the “highest”–health being the highest gain and nirvāṇa the highest bliss (nibbānaṃ paramaṃ sukhaṃ). This may be understood from the doctrine of the Four Noble Truths. The third truth is the Truth of Cessation of Suffering (nirodha)–the cessation of all kinds of suffering, including illness. Nirodha, synonymous with nirvāṇa, thus can be regarded as “ultimate” health–the state of complete freedom from all kinds of sickness or suffering. This may be why health and nirvāṇa are comparable to each other in the discourses.^[26]

From what has been described above, it appears that Buddhism has a negative value for illness and a positive one for health. But this is not exactly so. Health, as mentioned, is regarded as gain and that which is likeable or desirable. However, it can also have an adverse effect. It can become a kind of “intoxication” (i.e. infatuation)–intoxication of health (ārogya-mada) (Dīgha Nikāya III. 220; Aṅguttara Nikāya I. 146).^[27] The Aṅguttara Nikāya explains why the intoxication of health can have a negative effect: “An uninstructed worldling, intoxicated with health, engages in misconduct by body, speech, and mind. With the breakup of the body, after death, he is reborn in the plane of misery, in a bad destination, in the lower world, in hell” (Bodhi 2012, 241). Hence, such intoxication can lead a person to doing misdeeds of body, speech and mind, and result in a miserable rebirth in the future life. Nonetheless, the intoxication of health can be eliminated or reduced by frequent contemplation of disease–“I am subject to illness; I am not exempt from illness” (Bodhi 2012, 686687)–as taught in the discourses (Aṅguttara Nikāya III. 72; Madhyama Āgama, Taishō Tripiṭaka 26. 608a3-8).^[28]

Likewise, illness is not necessarily negative. It can be the time for certain practices, according to early Buddhist teachings. Described in two successive discourses in the Saṃyukta Āgama, the sick elder monk, Anuruddha, by practising and abiding in the four establishments of mindfulness (Pāli: catu satipaṭṭhāna; Sanskrit: catuḥ smṛtyupasthāna), viz. mindfulness of body, mindfulness of feelings, mindfulness of mind, and mindfulness of phenomena, has his pain tolerated and relieved (Taishō Tripiṭaka 99. 140b26-c12, 140c13-24). ^[29] The seven factors of enlightenment (Pāli: satta bojjhaṅgā; Sanskrit: sapta bodhyanga)–mindfulness, investigation (of doctrine), energy, rapture, tranquillity, concentration, and equanimity–are often recited to sick people as protection (parittā) in the Theravāda tradition. In three consecutive discourses in the Saṃyutta Nikāya (V. 79-81), Mahākassapa, Mahāmoggallāna, and the Buddha, respectively, were sick. These seven factors of enlightenment were recited to them. After listening to these (and probably having meditated on them in the meantime), their illnesses were cured.^[30] In the Aṅguttara Nikāya (V. 108-112), a monk called Girimānanda was sick. The Buddha, through Ānanda, gave Girimānanda instructions on ten perceptions (saññā), viz. the perception of impermanence, the perception of selflessness, the perception of impurity, the perception of danger, the perception of abandoning, the perception of dispassion, the perception of cessation, the perception of not-having delight in the entire world, the perception of impermanence in all conditioned things, and the mindfulness of breathing. After hearing these ten (again, likely having contemplated and practised on these), Girimānanda immediately recovered. In the Aṅguttara Nikāya (III. 142-143), there are five things to be practised when sick: contemplation of the impurity of the body, perception of the loathsomeness of material food, perception of not-having delight in the entire world, perception of impermanence in all conditioned things, and perception of death. From the above descriptions, therefore, it can be learned that times of illness can be utilised for undertaking certain practices.

So, there are various viewpoints and nuances regarding health and disease in the early Buddhist scriptures, as mentioned above. However, when talking about health or disease in these sources, there is no specification of the kind of health–whether it is physical health or mental health.

It is expressed by the Buddha that there are two kinds of disease:

“Monks, there are these two diseases. What are the two? Bodily disease and mental disease.”^[31]

This, therefore, also means that there are two kinds of health–physical health and mental health. In this discourse of the Aṅguttara Nikāya, it is also stated that people can be physically healthy for a certain period of time (whether it is one year, two years, or even up to a hundred years), but those with just a moment of healthy mind are difficult to find except those who have destroyed their taints (āsava). This points out that, for ordinary people, nobody can avoid mental problem or distress even for a short while. In fact, many people suffer from mental illnesses. Herein, a question may be raised: does Buddhism advocate mind-body dualism as Descartes has claimed?^[32]

The answer is certainly no. Buddhism does not uphold the idea of mind-body dualism. One of the fundamental teachings in Buddhism is the doctrine of the five aggregates (Pāli: pañca khandha; Sanskrit: pañca skandha), that each individual is a combination of five aggregates. These five are: material (Pāli and Sanskrit: rūpa), feeling (Pāli and Sanskrit: vedanā), perception (Pāli: saññā; Sanskrit: saṃjñā), volitional formation (Pāli: saṅkhāra; Sanskrit: saṃskāra), and consciousness (Pāli: viññāṇa; Sanskrit: vijñāna). These five actually represent the psycho-physical complex of mind and body (or, in another expression, that of mentality and materiality), with rūpa corresponding to body/ materiality and the other four aggregates to mind/mentality. The five aggregates are “conditioned, interdependent, relative things and states,” and they operate “together in combination as a physio-psychological machine” (Rahula 1978, 26, 57). None of these aggregates can arise independently without the others. The material aggregate and the immaterial aggregates are not separable, and the five aggregates must coexist for an individual being.

There is another term in Buddhist doctrine highlighting this ideology of coexistence of mind and body (mentality and materiality), viz. nāma-rūpa. In this compound term, nāma comprises the four immaterial aggregates (of feeling, perception, volitional formation, and consciousness) and rūpa refers to the material aggregate, consisting of the great elements (earth, water, fire, and wind) and their dependent materials such as the five material sense-organs and their corresponding sense-objects, as well as mind-objects (Mahāniddesa II. 435; Saṃyutta Nikāya III. 59; Rahula 1978, 20). ^[33] Although the two components of the word is explained separately, as Karunaratne (2003, 128) pertinently describes, nāma and rūpa actually are “interdependent and that nāmarūpa is a designation given to the complex of mental and physical phenomena … The two are inseparable; they arise together, exist together, and perish together; they exist only in combination; in separation they are unable to exist … because neither of them possesses the power to exist alone. One exists only in dependence on the other.” Hence, nāma-rūpa, being a complex of mind and matter (i.e. physical body), can be referred to as an individuality (Pali-English Dictionary, s.v. “nāma”).

Based on the above discussions of the five aggregates and mentalitymateriality complex, Buddhism holds that mind and body are not independent phenomena; they interrelate and co-exist as one complex. Physical and mental states are “constantly interacting; they are not two totally separate spheres” (Harvey 1993, 29). Returning to our discussion on health and disease, Buddhism, therefore, recognises a close relationship between physical health and mental health. One kind of health cannot be achieved without another. Physical conditions can affect the mind. As mentioned earlier, the monk Assaji could not attain meditative concentration due to his sickness. Physical illness can interfere with mental cultivation and psychological wellbeing. Conversely, the psychological state can have an influence on the body. Taking the example of the sick monk Anuruddha, as stated earlier, the practice of the four establishments of mindfulness helped him tolerate and relieve his physical pain. Mind thus has an impact on body. Body and mind interact with each other, and can influence each other. Physical health and mental health therefore are mutually dependent. Both are significant for personal health as a whole, as well as for spiritual development.^[34]

Footnotes and references:

[1]:

Translations of the primary sources in this thesis are mine, unless stated otherwise. This translation has taken reference to the one provided by Anālayo in one of his articles (2011, 23-24).

The Chinese source is: “有四法成就，名曰大醫王者，所應王之具、王之分。何等為四？一者善知病，二者善知病源，三者善知病對治，四者善知治病已，當來更不動發。云何名良醫善知病？謂良醫善知如是如是種種病，是名良醫善知病。云何良醫善知病源？謂良醫善知此病因風起、癖陰起、涎唾起、眾冷起、因現事起、時節起，是名良醫善知病源。云何良醫善知病對治？謂良醫善知種種病，應塗藥、應吐、應下、應灌鼻、應熏、應取汗。如是比種種對治，是名良醫善知對治。云何良醫善知治病已，於未來世永不動發？謂良醫善治種 種病，令究竟除，於未來世永不復起，是名良醫善知治病，更不動發。”

A similar but shorter passage is found in the Saṃyukta Āgama (Alternative Translation) (Saṃyukta Āgama-AT) (Bieyi za’ahan jing 別譯雜阿含經, Taishō Tripiṭaka 100. 462c10-13). There is another discourse in the Chinese canon–Foshuo yiyu jing 佛說醫喻經 (Discourse on the Buddha’s Exposition of the Simile of Medicine) (Taishō Tripiṭaka 219. 802a15-b21)–which is similar to the above two discourses in the Saṃyukta Āgama and Saṃyukta Āgama-AT and has more elaborations.

[2]:

This list of causes resembles the one of eight aetiological factors that will be enumerated later in Section 3. 2.

[3]:

In the Pāli Nikāya, the parallel of this sūtra is not found. But association of the Four Noble Truths with medical ideas is found in the Visuddhimagga (Path of Purification): “The truth of suffering is like a disease, the truth of origin is like the cause of the disease, the truth of cessation is like the cure of the disease, and the truth of the path is like the medicine” (Ñāṇamoli 1991, 520).

[4]:

See p. 1 and footnote 1 of Chapter One of this thesis.

[5]:

The doctrine of dependent arising as expressed in the discourses (e.g. Saṃyutta Nikāya II. 28, 70; Majjhima Nikāya I. 262-264, III. 63) is: “Iti imasmiṃ sati idaṃ hoti imassuppādā idaṃ uppajjati; imasmiṃ asati idaṃ na hoti imassa nirodhā idaṃ nirujjhati.” English translation of this statement is: “Thus when this exists, that comes to be; with the arising of this, that arises. When this does not exist, that does not come to be; with the cessation of this, that ceases” (Bodhi 2000, 552). The Chinese version is: “此有故彼有，此生故彼生；此無故彼無，此滅故彼滅。” Another form of the doctrine of dependent arising is the twelve-factored formula, as shown in footnote 8 below.

[6]:

This twelve-factored formula of dependent arising is: Dependent on (i) ignorance, there arises (ii) volitional formations; dependent on volitional formations, there arises (iii) consciousness; in turn, there arise (iv) mentality-materiality, (v) six-fold sense-base, (vi) contact, (vii) feeling, (viii) craving, (ix) clinging, (x) becoming, (xi) birth, and (xii) ageing, death, sorrow etc. For an example of the primary source on this formula, see Saṃyutta Nikāya II. 20-21; Aṅguttara Nikāya I. 177.

[7]:

In relation to health and disease, we may consider ignorance as the not-knowing of what is good or bad for health, and craving as the thirst for something unhealthy to the body (and mind), such as smoking, high fat diet, lack of exercise, etc.

[8]:

Ignorance also depends on other factors for its arising. It is explained in the Aṅguttara Nikāya (V. 113) that ignorance requires five hindrances (pañca nīvaraṇā) (i.e. sense-desire, ill-will, sloth and torpor, restlessness and remorse, and sceptical doubt) as its nutriment. Jayatilleke (1966, 455) expounds thus: “the entertaining of false speculations about the past (pubbantānudiṭṭhi) or the future (aparantānudiṭṭhi) and the building of theories or views based on them, in contrast with the understanding of the nature of things, would constitute avijjā. The failure to grasp the theory of causation (paṭicca-samuppāda), with its emphasis on mutual dependence (idappaccayatā) and its difference from both determinism as well as indeterminism, would also constitute an important part of avijjā.”

[9]:

The Chinese passage is: “若眼生、住、轉出，則苦生、病住、老死出。耳、鼻、舌、身、意亦如是說。若眼滅、息、沒，苦生則滅，病則息，死則沒。耳、鼻、舌、身、意亦如是說。”

[10]:

This discussion on the arising of suffering, based on the principle of dependent arising, can be considered as the general Buddhist perspective on causation of illness. Specific aetiological factors on disease will be elaborated below.

[11]:

Mind-body relationship and its association with health/disease will be further elaborated later in this section.

[12]:

That is: right view (sammā-diṭṭhi), right thought (sammā-saṅkappa), right speech (sammā-vācā), right bodily action (sammā-kammanta), right livelihood (sammā-ājiva), right effort (sammāvāyāma), right mindfulness (sammā-sati), and right concentration (sammā-samādhi). The first two relate to wisdom, the following three to moral conduct, and the last three to concentration.

[13]:

Taishō Tripiṭaka 125. 697a16-17: “夫病之法欲使不病者，此不可得也”. A similar sentence is found in the same Āgama at Taishō Tripiṭaka 125. 679b17-18: “病法，欲使不病者，此不可得”.

[14]:

The other four types of loss or attainment relate to relatives, wealth, morality, and view.

[15]:

Dīgha Nikāya-Aṭṭhakathā III. 1028: “Rogo eva vyasanaṃ roga-vyasanaṃ. Rogo hi ārogyaṃ vyasati vināsetī yi vyasanaṃ.”

[16]:

Ibid: “Ārogyassa sampadā ārogya-sampadā. Pāripūrī dīgha-rattaṃ ārogatā.”

[17]:

The parallel of this sutta is found in the Madhyama Āgama (Madhyama Āgama), and the above-mentioned loss through sickness is found at Taishō Tripiṭaka 26. 626a23-28: “云何病衰？或有一人長病疾患，極重甚苦，彼作是念：「我長病疾患，極重甚苦，我實有欲，不能行欲... 」... 是為病衰。” My translation for this is: “What is decline by sickness? Perhaps there is a person who has chronic illness and severe pain. He has this thought: ‘I have chronic illness and severe pain. I actually have desire, [but] cannot carry out the desire...’... this is [the meaning of] decline by sickness.”

[18]:

The other nine desirable things are wealth, beauty, moral virtues, chastity, friends, much knowledge, wisdom, righteous qualities, and the heavens. This discourse also mentions the obstacles and supports for these ten things. In relation to health, doing what is beneficial or not can be an obstacle or support for health.

[19]:

For these statements on desirables or undesirables, see Saṃyukta Āgama-AT, Taishō Tripiṭaka 100. 397a10-13; Ekottara Āgama, Taishō Tripiṭaka 125. 608b16-c2, 637c9-21. In these discourses, the desirables are youth, health, life, and gathering with the beloved; the undesirables are ageing, sickness, death, and separation from the beloved.

[20]:

The parallel discourse in the Saṃyukta Āgama is found at Taishō Tripiṭaka 99. 267b5-c6.

[21]:

The other four are being faithful, honest, strenuous, and wise.

[22]:

As mentioned in the case of Assaji above, due to his sickness, he could not attain meditative concentration (samādhi). Without meditative concentration, it is difficult for one to develop insight meditation (Pāli: vipassanā;Sanskrit: vipaśyanā) which examines the true nature of phenomena (i.e. the nature of impermanence, unsatisfactoriness, non-selfness, and emptiness) and hence he/she is not able to destroy defilements/taints or to achieve liberation.

[23]:

The Chinese parallel discourse in the Madhyama Āgama is found at Taishō Tripiṭaka 26. 670a26 ff., and the Chinese translation for this phrase is “無病第一利”.

[24]:

Dhammapada-Aṭṭhakathā III. 267: “Tattha ārogyaparamā ti ārogyabhāvaparamā, rogino hi vijjamānāpi lābhā alābhā eva, arogassa sabbalābhā āgatā va honti, tena vuttaṃ: ārogyaparamā lābhā ti.”

[25]:

Majjhima Nikāya-Aṭṭhakathā III. 218: “Ārogyaparamā ti gāthāya ye keci dhanalābhā vā yasalābhā vā puttalābhā vā ārogyaṃ tesaṃ paramaṃ uttamaṃ n’ atthi tato uttaritaro lābho ti, ārogyaparamā lābhā.”

[26]:

In the Suttanipāta-Aṭṭhakathā, it explicitly says that “health is nibbāna” (ārogyan ti nibbānaṃ) (II. 507).

[27]:

In these two discourses, three forms of intoxication are listed: intoxication of health, intoxication of youth, and intoxication of life.

[28]:

Aṅguttara Nikāya III. 72: “vyādhidhammo’mhi vyādhiṃ anatīto”;Madhyama Āgama, Taishō Tripiṭaka 26. 608a5-6: “我自有病法，不離於病”.

[29]:

A shorter Pāli equivalent of these two discourses is found at Saṃyutta Nikāya V. 302.

[30]:

In the Āgama, there is only one discourse (instead of three) stating the recitation of the seven enlightenment factors for curing disease. The accounts of Mahākassapa and Mahāmoggallāna are missing. In the discourse of the Ekottara Āgama (Taishō Tripiṭaka 125. 731a26-b13), the monk Cunda was sick. He was visited by the Buddha, who asked Cunda to recite the seven enlightenment factors himself. After doing that, Cunda recovered from his sickness. This story differs from that given in the Saṃyutta Nikāya, where the Buddha was sick and it was Cunda who performed the recitation.

[31]:

Aṅguttara Nikāya II. 142-143: “Dve’me bhikkhave rogā. Katame dve? Kāyiko ca rogo cetasiko ca rogo.” There is no definition of bodily disease and mental disease in this short discourse or in commentaries. Bodily disease should refer to those diseases of the body, as listed in the Aṅguttara Nikāya and Madhyama Āgama (see p. 124125 below). Mental disease, on the basis of this discourse, should relate to taints (āsava) which include those of sense-desire (kāmāsava), existence (bhavāsava), ignorance (avijjāsava), and (wrong) views (diṭṭhāsava) (Pali-English Dictionary, s.v. “āsava”).

[32]:

This kind of question has sparked a lot of discussion in the field of philosophy. Many Buddhist scholars have also contributed their thoughts, e.g. Harvey (1993), Karunadasa (2012) and Lin (2013). It would be beyond the scope of this thesis to delve into their arguments. Here a general discussion will be conducted.

[33]:

The two components, nāma and rūpa, are given different meanings in other texts. For instance, in the Saṃyutta Nikāya (III. 86), rūpa is explained in terms of its nature of deformity by cold, heat, hunger, thirst, wind, sunburn, etc. Karunadasa (1989, 1) states that rūpa has four facets in early Pāli literature, viz. matter or materiality (rūpakkhandha), sphere of visibility (rūpāyatana), a plane in Buddhist cosmology (rūpdhātu, rūpaloka, or rūpavacara), and four stages of meditative concentration (rūpajjhāna). In the Saṃyutta Nikāya (II. 3-4) and the Majjhima Nikāya (I. 53), nāma is described consisting of five mental factors–feeling (vedanā), perception (saññā), volition (cetanā), contact (phassa), and attention (manasikāra). Furthermore, nāma-rūpa is a factor in the twelve-factored formula of dependent arising, where it has a reciprocal interaction with consciousness (viññāṇa) (Karunadasa 2012, 61).

Herein, viññāṇa is not included as a component of nāma.

[34]:

However, mind plays a more important role in Buddhism. The very first teaching of the Dhammapada (in verses 1 and 2) is: “Things have the mind as the leader, as the superior, [and] things are mind-made” (manopubbaṅgamā dhammā manoseṭṭhā manomayā). In addition, in the Saṃyutta Nikāya (I. 87), it says: “The world is led by the mind, [and] is dragged around by the mind” (cittena nīyati loko, cittena parikissati). Premasiri (2003, 5) points out that: “early Buddhism gives supreme importance to the mind in human living, and emphasizes the great human potential to develop and cultivate the mind with the objective of realizing the ultimate goal of complete liberation from suffering.”