Bhesajjakkhandhaka (Chapter on Medicine)

by Hin-tak Sik | 2016 | 121,742 words

This study deals with the ancient Indian Medicine (Ayurveda) in Early Buddhist Literature and studies the Bhesajjakkhandhaka and the Parallels in other Vinaya Canons. The word Bhesajja means “medicine” and is the sixth chapter of the Khandhaka, which represents the second book of the Pali Vinaya Pitaka. Other works consulted include the Bhaisajya-s...

Internal Medicine (e): Gastrointestinal Disturbances

Only a few accounts of digestive tract problems are found in the Chapters on Medicine. The remedies involved were chiefly fluids, especially alkaline ones.

The records are as follows:

Theravāda:—“At that time a certain monk was having indigestion. ‘I allow, monks, to make [him] drink an alkaline food.’”[1]

Dharmaguptaka:—“At that time the Buddha was in Śrāvastī. There was a monk [afflicted with] vomiting and diarrhoea.... The Buddha said: ‘[I] allow [you] to cook well the whole barley grains or whole rice grains. Do not cause [the grains] to break. [Then] filter the fluid for drinking.’”[2]

“Then there was a monk afflicted with vomiting. There was a need of fine soft hairs. The Buddha said: ‘[I] allow, after burning [them], the ashes are mixed with water; [the fluid] is [then] filtered and is accepted for drinking.’”[3]

“At that time there was a monk with vomiting and diarrhoea. [He] caused a person in Śrāvastī to cook porridge [for him].”[4]

The above records reveal the gastrointestinal problems of indigestion, vomiting, and diarrhoea. These will be discussed one by one here. The Samantapāsādikā gives explanations on indigestion and its cure:

“‘One having indigestion’ is one having perished digestion. The meaning is: the excrement gets out with difficulty. ‘Alkaline food’ is: having burnt the dry boiled rice, the alkaline water is flowed forth from those ashes.”[5]

In the Pāli source, the word for indigestion is duṭṭhagahaṇika, which is a compound term in relation to gahaṇī (Sanskrit: grahaṇī). Gahaṇī/grahaṇī is regarded as an organ responsible for digestion (Pali-English Dictionary, s.v. “gahaṇī”; A Sanskrit-English Dictionary, s.v. “grahaṇī”), and disorder of it causes indigestion. Modern Āyurvedic scholars render it as the duodenum (translators’ notes to Caraka Saṃhitā Cikitsāsthāna 15. 1-2; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 8. 15). There are four types of digestive disorders in Āyurveda: three by each of the three humours and one by the combination of all humours (Caraka Saṃhitā Cikitsāsthāna 15. 58; Suśruta Saṃhitā Uttarasthāna 40. 171; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 8. 19). Because of their respective aggravating factors (such as unsuitable diets, activities, behaviours), humours are aggravated. This causes suppression of the digestive fire and thus the food consumed is not digested easily (Caraka Saṃhitā Cikitsāsthāna 15. 59-72). The usual treatments involve fasting and/or light diets, measures to alleviate or eliminate the aggravated humours (such as emesis and purgation), and medicines to stimulate digestive power (such as medicated gruel, medicated ghee, decoctions, buttermilk, alchoholic drinks, and so on) (Caraka Saṃhitā Cikitsāsthāna 15. 82-198; Suśruta Saṃhitā Uttarasthāna 40. 178-182; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 10). Alkaline substances are frequently employed in medicinal recipes to enhance digestive power (Caraka Saṃhitā Cikitsāsthāna 15. 171-194; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 10. 56-65).

There are five types of vomiting (chardi) in Āyurveda: three due to each of the humours, one to the combination of the humours, and one to other causes such as contact with unwanted objects or sights, pregnancy, worms and so on (Caraka Saṃhitā Cikitsāsthāna 20. 6; Suśruta Saṃhitā Uttarasthāna 49. 8-12). The humours, being aggravated by their causative factors, afflict the vital organs in the upper part of the body. This leads to an upward movement of the humours localised in the stomach giving rise to vomiting (Caraka Saṃhitā Cikitsāsthāna 20. 7-18; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 6. 1). The approach of treatment for vomiting is similar to that for digestive disorder mentioned above: fasting; emesis and purgation (to eliminate aggravated humours); suitable foods and drinks (gradually from light to heavy), such as soups, gruels, ghee, milk, and so on, which may be prepared wih medicines; psychological measures (such as consolation for contact with loathesome objects/sights); and cures for worms (Caraka Saṃhitā Cikitsāsthāna 20. 20-47; Suśruta Saṃhitā Uttarasthāna 49. 15-35; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 6. 1-24).[6]

Diarrhoea (atīsāra) is of six types in Āyurveda: three caused by each humour, one by the combination of all humours, one by fear, and one by grief (Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 8. 1). Aggravated humours, due to their causative factors, reduce the digestive fire, reach the colon, liquefy the stools, and give rise to diarrhoea. Fear and grief cause diarrhoea via the aggravation of wind humour (Caraka Saṃhitā Cikitsāsthāna 19. 5-9, 11-12; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 8. 1-4, 12-13). General approaches of treatment include fasting followed by gradual increase of diet from light to heavy food; allowance of evacuation without inhibiting it for the purpose of elimination of the aggravated humours, which may even be helped by use of emetics and purgatives; stimulation of digestive power by drugs such as medicinal decoctions; and psychological means for relieving fear and grief (Caraka Saṃhitā Cikitsāsthāna 19. 12-19; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 9. 2-25). Gruel is commonly used for treating diarrhoea because it is a light diet, removes thirst, and stimulates appetite (Suśruta Saṃhitā Uttarasthāna 40. 158).

The Pāli term duṭṭha-gahaṇika should be etymologically related to the Latin word dys-pepsia. The latter is rendered as bad digestion or indigestion, and it is a term commonly used by clinicians. However, both indigestion and dyspepsia are inexact terms and are interpreted in different ways by physicians and patients. Both terms usually refer to a multitude of upper abdominal symptoms including heartburn, acid regurgitation, epigastric pain or discomfort, belching, abdominal bloating, early satiation, postprandial fullness, nausea, and vomiting. Some patients may also include other symptoms such as constipation and presence of undigested food in stools (Lindsay, Langmead, and Preston 2012, 229;Oustamanolakis and Tack 2012, 175; Talley, Phung, and Kalantar 2001, 1294). In modern medicine, dyspepsia can be divided into two groups: organic and functional. For organic dyspepsia, underlying organic diseases can be identified, such as peptic ulcer, gastrooesophageal reflux, gastric or oesophageal cancer, and so on. For functional dyspepsia, no structural or biochemical abnormalities can be found and the pathogenesis remains uncertain. Functional dyspepsia represents the majority of cases with dyspepsia (Oustamanolakis and Tack 2012, 175-176; Talley, Phung, and Kalantar 2001, 1294-1295). Management of dyspeptic cases include investigations to identify any organic causes; reassurance and explanation to the patients; change of lifestyle and diet (such as reducing intake of alcohol, coffee, fatty food, etc., and cessation of smoking); withdrawal of certain drugs (such as aspirin, non-steroidal anti-inflammatory drugs); use of drugs (such as H2-receptor antagonists, protonpump inhibitors, prokinetic agents, antidepressants, etc.);eradication of Helicobacter pylori infection; behavioural therapy, psychotherapy, and so on (Oustamanolakis and Tack 2012, 182-184; Talley, Phung, and Kalantar 2001, 12961297).

Vomiting, being controlled by the vomiting centre in the brainstem and stimulated by various causes, is “a reflex composed of the coordinated series of motor and autonomic responses that results in the forceful expulsion of gastric contents through the mouth” (Getto, Zeserspm, and Breyer 2011, 211). It can occur in many gastrointestinal and non-gastrointestinal disorders, and is often preceded by nausea (“a feeling of wanting to vomit”) and retching (“a strong involuntary unproductive effort to vomit associated with abdominal muscle contraction but without expulsion of gastric contents through the mouth”) (Lindsay, Langmead, and Preston 2012, 230). Vomiting is mostly mild and self-limiting, and requires no treatment. But it can lead to complications such as dehydration, electrolyte disturbance, aspiration, oesophageal rupture, and bleeding. Management of vomiting involves treatment of any cause, correction of complications (such as replacement of fluid and electrolytes orally or intravenously), and utilisation of anti-emetic drugs (Getto, Zeserspm, and Breyer 2011, 212; McQuaid 2012, 550-551).

There is no exact definition for diarrhoea in modern medicine. It is usually considered as “a change in normal bowel movements with the passage of 3 or more stools per day or at least 200 g of stool per day” (Getto, Zeserspm, and Breyer 2011, 215). Diarrhoea is classified as acute or chronic. Acute diarrhoea is of sudden onset, usually short-lived, and lasting for less than two weeks; chronic diarrhoea lasts more than four weeks (McQuaid 2012, 557-562). There are many causes of diarrhoea including infections (bacterial, viral, fungal, and parasites), non-infective conditions (such as inflammatory bowel disease, colonic cancer, malabsorption, etc.), endocrine causes (e.g. thyrotoxicosis), and factitious diarrhoea (e.g. purgative abuse, dilutional diarrhoea) (Lindsay, Langmead, and Preston 2012, 293, table 6. 22). Diarrhoea is usually treated with fluid and electrolyte replacement, avoidance of some foods and drinks (such as high fibre foods, fats, dairy products, caffeine, alcohol, etc.), consumption of soft and easily digestible food, use of antidiarrhoeal drugs, administration of antimicrobial agents (depending on the infection), and arrangement of diagnostic tests and even hospital admission for patients with prolonged/severe diarrhoea to determine the cause (and hence the treatment) (Lindsay, Langmead, and Preston 2012, 292-293; McQuaid 2012, 558-559, 562).

In summary, cases of digestive tract problems are found in the Chapters on Medicine. In these, sick monks are presented with indigestion, vomiting, and/or diarrhoea. They were chiefly treated by alkaline substances, fluids, and light diet (like porridge). In Āyurveda, there is a more detailed information on various gastrointestinal disorders, including those mentioned in the Chapters on Medicine. Treatments given in the Āyurvedic texts for these conditions are more diverse and complex. In modern medicine, these above problems are regarded only as symptoms, which can occur in many gastrointestinal and non-gastrointestinal diseases. Treatments would direct at correcting underlying causes (if diagnosed), relieving such symptoms, and managing any complications.

Footnotes and references:


Theravāda Vinaya Piṭaka I. 206: “tena kho pana samayena aññataro bhikkhu duṭṭhagahaṇiko hoti. anujānāmi bhikkhave āmisakhāraṃ pāyetun ti.”


Taishō Tripiṭaka 1428. 867a12-14: “爾時佛在舍衛國。有比丘吐下...佛言:「聽以完全麥、若完全稻穀煮令熟,勿使破,漉汁飲。」”


Taishō Tripiṭaka 1428. 870c6-7: “時有比丘患吐,須細軟髮,佛言:「聽燒已末之水和漉受飲之。」”


Taishō Tripiṭaka 1428. 874c8: “爾時有吐下比丘,使舍衛城中人煮粥。”


Samantapāsādikā V. 1092: “duṭṭhagahaṇiko’ti vipannagahaṇiko. kicchena uccāro nikkhamatī’ti attho.

āmisakhāran ti sukkhodanaṃ jhāpetvā tāya chārikāya paggharitakhārodakaṃ.”


The use of filtered fluid obtained from burnt ashes of soft hair for treating vomiting as mentioned in the Dharmaguptaka Bhaiṣajyaskandhaka finds no similarity in the Āyurvedic texts. Such use may be due to the alkalinity of ashes, which has stimulating effect on digestive power according to Āyurveda.

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