A few centuries before the rise of Buddhism in India, healing was seen and practised in a more religious and even magical way. This was mainly because illness and other misfortunes were generally believed to be caused by magical powers, such as evil spirits. Hence, ancient Indians chanted various incantations and repeated prayers in order to overcome such maladies. The beginning of medical theory and practice can be traced back to the Indian ascetic movements, and namely, Buddhism. We know that Buddhism developed in India 2500 years ago. The revolutionary teaching spread to the rest of the world in waves. The first of those, known as Theravada, spread to Southeast Asia. Mahayana, or “the Big Vehicle” advanced to China, Tibet, Korea, Japan, and Mongolia. With the Buddhist doctrine there emerged a new type of medical practice. Healing, after all, is at the very core of Buddhist tradition. The Buddha said: “Both in the past and now, I set forth only this: suffering and the end of suffering.”[1] The goal of eliminating human suffering, as well as compassion and hope, are in the centre of Buddhist beliefs. When we think of the transmission of knowledge it is important to take into account a number of factors. Most importantly, the construction and movement of knowledge should always be studied in the relevant context. When Buddhism moved to the East or to the West, some of its characteristics would inevitably be lost or misunderstood. The experience and influence of Buddhist teachings were bound to be received differently from culture to culture, depending on individual indigenous beliefs and traditions.

Buddhism is considered to be essential for the transmission of knowledge and ideas along the Silk Road. Religious and philosophical ideas, as well as economy, material culture etc. were among the aspects of Buddhist influence. Buddhism was transmitted along the Silk Road through trade and commerce, but also emigration and religious missions, as well as brides who brought with them various texts to their new homes. The first Indian refugees who moved to China brought their script and technologies, but also their faith and all it represented.[2] Meyer writes that missionaries spread not only the teachings of the “Enlightened One”, but also the various sciences related to Buddhism.[3] Along with Buddhist texts and practices, Indian medical knowledge also travelled along the Silk Road. Buddhism is one of earliest examples of intercultural exchange and spread widely during the first millennium AD. This movement was very well documented, with thousands of manuscripts surviving till today. Healing always had a central place in Buddhist doctrine. Hagiographies filled with Buddhist monks who had the knowledge of healing represented the Boddhisatva ideal of healing the sick and other acts of compassion. Meyer suggests that the healing played an important part in the diffusion of Buddhism throughout Asia, bringing Indian medical practices all to way to the Far East and being an important part behind the diffusion of Buddhist knowledge and the wide spread and conversion from existing doctrines.[4] There is evidence that the early Buddhist monasteries had what was called a “sick room”, which later might have expanded to more formal medical establishments. At first, Buddhist monks were predominantly concerned with the healing of their fellow monks, but later on they started helping the laity.[5] It is certain that medicine’s close ties with Buddhism cannot be overlooked. It could be argued that before Buddhism there was not an official theoretical medical doctrine in India: healing was performed through ritual and ancient Indians had very basic understanding of anatomy and the use of a number of herbs. The wandering ascetics began collecting medical knowledge that, in turn, became the traditional Indian medical doctrine Ayurveda. This suggests that medicine is indeed very strongly connected with Buddhism and medical knowledge spread along with the Buddhist philosophy. Primary sources such as the Sutra of the Master of Medicines Buddha indicate how important healing was for the early Buddhists. Bhaisajyaguru, the Medicine Buddha, was a key figure in Buddhist belief. In the Sutra of the Master of Medicine it is indicated that the devotee should have faith in Bhaisajyaguru, but also trust in their own “will power”. The sutra provides promise of protection against disease and other personal misfortunes. In Japan, people began worshipping the Medicine Master Buddha as soon as Buddhism reached the country. Medicine plays a major part in Japan’s accumulation of the new doctrine. Belief in the deity is still strong today with practices including praying and touching a statue of the Medicine Buddha where they feel an ailment believing that it has healing properties. Salguero argues that a number of such Buddhist medical texts reached Japan and Korea from China, thus forming the foundations of Buddhist medical practice across the whole of East Asia.[6]

Medicine is considered to be one of the five Buddhist fields of knowledge, along with logic, grammar, and the arts. It could be argued that the visual arts are extremely important for the circulation of Buddhist ideas. After all, art is universal, and we have numerous evidence of how important visual art was in the transmission of Buddhism and its ideas. Examples include medical paintings, found in abundance in various sites on the Silk Road, as well as thousands of medical manuscripts translated in different Silk Road languages. Some examples include Niya, Kucha, and Dunhuang, which are all important stops on the Silk Road. The Library cave in Dunhuang was a monastic storehouse filled with documents in various Eurasian languages, including texts on medicine. Dunhuang was also an important pilgrimage centre. The Buddhist scrolls and wall murals found there date from 5th century to early 11th century. This would indicate that the Buddhist librarians were collecting Buddhist texts during the whole second half of the first millennium and translating them into Chinese from Sanskrit and Tibetan, as well as Khotanese, Uighur, and Sogdian. This suggests the magnificent scope of the popularity of Buddhism along Eurasia.[7] The 5th century Buddhist monk Sengyou wrote, “with translation there is transmission; without translation there is but obscurity.”[8] This belief must have been held by the rest of the Buddhist monks living along the Silk Road, because the work and attention put into the translation of thousand of documents, is wholly monumental. Salguero introduces the term Buddhist medicine to mean a “collection of ideas and practices that originated in the Indo-European context but was modified and expanded as a result of cross-cultural interactions during the vigorous geographical expansion of Buddhism”.[9] Of course, similarly to the transmission of religious beliefs and material culture, the interpretation and local reception of Buddhist, as well as medical, practices differed widely in the different places they reached. China had an already established local medical tradition, as opposed to, for example, Tibet, where the influence from India was seen as much greater. Similarly, the way Buddhism was assimilated in Japan in Korea was a different experience altogether, as the Japanese and Koreans were influenced by the Chinese adaptation of the new philosophy. The traditions of Buddhist medical knowledge were transmitted along the Eurasian trade routes via sea and land, fusing with the existing medical traditions and forming new doctrines of medicine. The same could be said about diffusion of philosophical doctrine. For example, in China, Buddhism was gaining more and more followers for various reasons, including the fact that the new doctrine dealt with matters such as death and the afterlife, which were left unanswered by the local Confucianism. The 9th century philosopher Li Ao wrote a medical text, in which he proposed to reform the Confucianism doctrine. This was because more and more Chinese were beginning to follow Buddhism. Li Ao believed that there were significant questions that Confucianism failed to answer, and even ask: it gave priority to morality and neglected nature or metaphysics. Buddhism was offering forgiveness and mercy; and those were among the ideas that attracted Chinese followers.[10] There were many different ideas that Buddhism revolutionised, especially on ethical questions, such as Karma, or the belief that not everything is predestined, and humans have influence over their fate.

Chinese pilgrims played a significant part in the cultural exchange between India and China. An interesting primary source for the study of transmission of Buddhist medicine to China and beyond is the 7th century Chinese pilgrim Yijing’s eyewitness account on monastic medicine and hygiene in an Indian monastery. Disappointed with the way Chinese monks were conducting themselves, Yijing wrote a commentary explaining the practices of medicine as they were performed in India, the very land where Buddhism originated, and hence the ultimate authority concerning all Buddhist practices. Yijing emphasises the importance of learning Sanskrit, “the original language of the scriptures”[11], in order to avoid misinterpretation when studying Chinese translations. Yijing signifies the importance of prevention of illness, instead of simply focusing on treatment once one falls ill. He talks about the significance of fasting in India and explains what is the correct way of ingesting medicines according to the laws there. A number of Buddhist medical ideas that stayed the same during the transmission from India, and many that changed, or disappeared altogether. The idea of the three poisons: desire, hatred, and ignorance (or delusion) is significant for medicine, because it was believed that they were the cause of any imbalances in the body and the source of all illness. Buddhists believe that everything is linked and interdependent. This idea of the three poisons is connected to the Indian notion of dosas, or wind, bile, and phlegm. The word dosa is sometimes incorrectly translated as humour, but literally means fault. The belief that the dosas exist in everybody’s body, but when they are out of balance, illnesses are caused, came from India and is held in both China and Tibet. Before Buddhism spread to China, there was no mention of such notions, judging by the lack of it in The Yellow Emperor’s Classic of Medicine. However, by 5th century AD Chinese medical sources explain disease as the imbalance of heat, coolness, wetness, or dryness and suggest which foods to ingest in order to restore the balance in the body. [12]

Tibet was another place, which was highly influenced by the spread of Buddhism along the Silk Road. Unlike China, Tibetans adopted the new doctrine much later. The Tibetan medical practice was significantly, but not exclusively, influenced by Buddhist theories. It is interesting to note that many documents, one being a commentary on the Noose of Methods Mantra, were written on paper, but in the style of Indian manuscripts written on palm leaf. This is an example of Buddhist knowledge traveling, influencing, but being adapted to local practices. Other significant sources of influence on Tibetan medical theory are the Chinese and Greco-Arab traditions. Mystical diagrams, symbolism, and magic formulas hold an important place in Tibetan medical practice, which is richly filled with incantations, magical spells, divinatory rituals, etc.[13] To use the documents found in Dunhuang as an example again, it is clear that the period of Tibetan occupation saw the buildings of many new caves, imperial patronage and even greater effort to copy and circulate Buddhist materials. Of course, it is highly important, as with every primary source, to first look at the historical context in which these texts were written, and then translated. One example comes from Sangye Gyatso’s 17th century Mirror of Beryl. Gyatso compiled an extensive history of the origins and practices of Tibetan medicine. One of the stories, which is thought to date from 7c AD states that three doctors were invited to Tibet- one from India, one from China, and one from the West (Galenos). This was supposed to represent the foreign influences on Tibetan medicine, with a considerable attention given to Western impact, as Galenos was presented to have stayed in Lhasa in the story. However, while there is no doubt that Tibetan medicine was heavily influenced by both Indian and Chinese practices, it would be sensible to consider Galen’s presence as a later addition, due to the fascination with ancient Greek culture and medicine during the 16-17th centuries.

Recent years have seen Buddhism gain a wider recognition in the West due to its peaceful and accessible philosophy. In addition, we see an ever-increasing popularity of practices such as meditation and yoga. Meditation has a principle place in the practice of Buddhism and is exercised in order to discipline the mind. Meditation is beginning to be taken seriously by the elite biomedicine practitioners. One example is mindfulness-based stress reduction, which is used to help in anxiety disorders, depression, chronic pain, etc. This is a new science but results can already confirm what Buddhism has taught for centuries: that our thoughts are responsible for our mental, as well as physical, wellbeing.

The spread of Buddhist teachings and practices from India to China during the first centuries of the first millennium marked the beginning of global cross-cultural exchange. With Buddhism travelled knowledge and technologies that would change the course of Asian and World history. It cannot be denied that medicine was one of the most significant fields of information that was shared during the course of this exchange. Medical knowledge traveling from India to the East Asia was received differently from different cultures and different regions, depending on the indigenous beliefs and practices, thus creating unique variations of Buddhist medicine, or simply morphing into altogether different systems and traditions. Despite the fact that cultures such as China already had established complex ideas of knowledge and medicine, they were forever changed with the spread of Buddhist philosophy. Along with practical medical theory, Buddhism provided unfamiliar concepts such as afterlife, karma, rebirth, all important to a person’s understanding of life and the idea of preventing illness, rather than simply treating it. Compassion and the struggle of ending suffering became central in Eastern thought and medicine and revolutionised the way that one looked after their body, as well as mind.