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Part I: For the Relief of Suffering

There are two ways in which diseases can arise in our bodies:

1. Physical causes: Physically caused diseases are those that come about through disorders in the five physical properties (dhātu)—

When these properties become upset or unbalanced, they provide one sort of opening for disease to arise, called dhātu-samuṭṭhāna.

2. Kammic causes: Kammic diseases are those that arise from kamma-citta, or acts of the mind, in which the mind becomes preoccupied with various upsetting or unwanted topics. As we think more and more of these things, our mental energy weakens, our mind gets upset or unbalanced, and ultimately disease can arise.

There are two ways of curing disease—but before treating our diseases, we should first examine ourselves to see how they came about so that we’ll be in a better position to cure them.

The two ways of curing disease are through—

1. Pharmaceutical medicines: medicines that are composed of various chemical ingredients that will bring the properties of our body back into balance so that our pain and diseases will lessen or go away.

2. Dhamma medicine: depending on ourselves to improve ourselves, turning our minds to topics that are good, skillful, and wise. For example, we may make a vow to do good in any number of ways, such as donating food to monks in such and such a manner, becoming ordained and observing precepts of such and such a sort, sponsoring the making of a Buddha image of such and such a variety, or saying our chants and meditating in such and such a way. In some cases, when a good intention arises in the heart and we feel happy and expansive, it gives energy to the heart and inner strength to the body, through which we can alleviate any diseases that have arisen.

Some additional food for thought for sick people and the doctors who treat them:

Our duty when we are sick is to examine ourselves to find out the causes of our disease. If we aren’t capable of knowing on our own, we should search out those who are and who will give us advice. For example, they may tell us that the kind of disease we have should be treated with pharmaceutical medicine. We should then contact a doctor so that he or she will have a chance to relieve our pain. Once we’ve received advice from the doctor, we have two duties:

We shouldn’t concern ourselves with whether we’ll recover or die. That’s the doctor’s responsibility. Our one responsibility is to look after our mind—to free our mind from the disease and to turn our thoughts to good and skillful topics so as to strengthen our morale as a way of helping the doctor who’s looking after our disease. When doctor and patient help each other in this way, neither will be a burden to the other. The doctor has freedom in treating our body; we have freedom in the area of the mind, and so we’ll have a chance to lessen our suffering. Even if we die, both we and the doctor will have been working to the full extent of our abilities, the doctor caring for our body while we care for the mind. Even if we die, we don’t lose; we’ll have our own inner goodness to take along with us.

So, when we treat our disease in this way, we can be said to have two types of medicine working for us: pharmaceutical medicines, which are the affair of the doctor; and dhamma medicine, which is our own affair. In this way, we and our doctor will be able to help each other in looking after the quality of our life.

These are the duties of sick people.

As for the duties of the doctor: As doctors, we should inform ourselves of the causes of disease. If we know that a particular disease comes from physical causes, we should prescribe the proper medicines. If we see that the disease comes from kammic causes, we should use other methods to improve our patient’s morale. For example, we can use a pleasing bedside manner or get the patient to feel well-disposed toward making merit, encouraging him or her to donate food to monks, to meditate or chant, to make a vow to ordain for a period of time, etc., all as a means of turning the patient’s thoughts in the proper direction. This is called dhamma-medicine.

In some cases, a disease that normally requires a great deal of medicine will disappear after using only a little medicine. Experienced doctors are sure to have met with cases like this. For example, a patient is seriously ill, but if we can find a way to console him and boost his morale, the symptoms—instead of worsening as they normally might—grow less severe; instead of dying today, the patient may live on into next week or next month. Some people, when they’ve stepped on a thorn, think that they’ve been bitten by a snake, and this can cause the pain to flare up immediately. Other people, when they’ve been bitten by a poisonous centipede, think that they’ve stepped on a thorn, and this can keep the poison of the centipede from causing much pain. If they then go to an experienced doctor who tells them that they’ve been bitten by a centipede, they can then become upset and the pain will flare up. Cases like this all offer proof for the role that kamma plays in causing disease.

The word “kamma” refers to two things—

1. Kamma vipāka, or the results of actions performed in the past that can affect the body in the present, upsetting the physical properties and giving rise to disease. Sometime even when we treat such diseases correctly in accordance with medical principles, they won’t go away. When the time comes for them to go, the patient may drink even just a gulp of lustral water and they disappear. This, partly, is a matter of the patient’s morale. This sort of disease is the result of old kamma. Sometimes the old kamma can spread to affect the mind, making the patient upset, and this in turn causes the physical disease to worsen. Sometimes the case is hopeless, but the patient recovers. Sometimes there’s hope, but the patient dies. In cases like this, we should conclude that the disease comes from old kamma. We’ll have to treat both the physical causes and the mental, kammic causes if we want to relieve the pain of the disease.

2. Sometimes diseases can arise from new acts of the mind. This is called kamma-citta. For example, when we feel extreme anger, hatred, love, or restlessness, the mind is agitated in full force and the defilements that enwrap it splash into the body, where they mix with the various properties of the body—in the blood, for instance, which then flows to the various parts of the body, causing weakness and fatigue. If blood of this sort stagnates in a particular part of the body, disease will arise right there. The mind becomes murky; the properties of the body are murky. At the very least, we’ll feel not up to par. If we don’t hurry to find a way to correct the situation, disease will arise.

Here we can make an analogy: The mind is like a fish in a pond. If a person stirs up the water with a stick, the fish will have to swim around in circles, and the mucus covering its body will slough off into the water. The water will become murky, the mud at the bottom of the pond will get stirred up, and the fish won’t be able to see. After a while the mucus from the fish will adhere to particles in the water, providing food for algae. As the algae multiply, the water will grow stale and unfit for use. In the same way, when mental defilements flare up in full strength, the power of such mental acts can spread to cause diseases in the body. If the properties in the body flare up at the same time as the mind, the disease will be hard to treat—or if it’s easy to treat, it will go away slowly.

Thus, kamma diseases in some cases arise first in the body and then spread to affect the mind. This is called kamma-vipāka. Sometimes they arise first in the mind and spread to affect the body. This is called kamma-citta. When a kamma disease arises and we know clearly whether it arises from the body or the mind, we should treat it with the two sorts of medicine mentioned above, which will provide effective means for relieving our suffering.

I myself have experienced the truth of these points, but to record my experiences in full would be a long, drawn-out affair. So I leave it to people of discernment to consider these things on their own.