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The foundations of Chinese medicine had already been laid by the time the Indian religion of Buddhism arrived in China during the Hàn period (probably in the first century C.E.). At first sight, Buddhism’s direct influence on Chinese medicine therefore appears almost negligible, limited to the incorporation of individual drugs into the Chinese materia medica or isolated comments on cataract surgery.

Aspects of traditional Indian medicine such as the humoral system of Ayurvedic medicine or invasive surgery that were at odds with indigenous ideas failed to leave the permanent impression that we might expect. This difference was even more pronounced in the realm of basic attitudes and values. Although often considered as part of the Oriental tradition, Buddhism stems from an Indo-European background and is in many aspects much closer to the European mindset than to indigenous Chinese ideas.

Because of their fundamental differences, it took several centuries for Buddhism to become Chinese and for China to become Buddhist. This two-way process of cross-fertilization was not without conflict but ultimately led to the enrichment of both traditions. This is evident, on the one hand, in the rise of religious Daoism and Neo-Confucianism as indigenous responses to the Buddhist metaphysical challenge, and, on the other hand, in the growth of Chinese Buddhist schools like Chán (禅, more commonly known by its Japanese name Zen) and Tiantai (天台 or Tendai in Japanese).

Buddhism has held a lasting influence over the general Chinese population to this day. On the Chinese mainland, 16% of the population identifies as Buddhist, while in Taiwan the figure is as high as 35%. The reasons for this popularity probably lie in the attraction of the doctrines of karma, which provide rewards after death for good conduct in this life. Despite its continuing popularity, Buddhism has had substantially less influence over the development of Chinese medicine than indigenous doctrines.

The Four Noble Truths, Samsara, and Karma

Perhaps the greatest conflict between indigenous Chinese ideas and Buddhist values is found in the attitude towards the body and the material realm in general. To summarize Buddhist doctrine in the briefest way possible, let us recall the Four Noble Truths as they were reportedly taught by the historical Buddha Śakyamuni in the sixth century BCE:

1. Misery and pain: This life of a physical existence in a material body is suffering.

2. Craving and attachment: Suffering is caused by desire, namely the fact that it is human nature to cling to things, to expect permanence, and to become attached to things, people, or even to the idea of finding enlightenment.

3. Extinction: An end to suffering exists and is found in the liberation from the physical realm. This is called nirvana, which cannot be described concretely in language, but is comparable to the blowing out of a candle.

4. Salvation: There exists a path to the end of suffering: the eightfold path, which prescribes a life of morality, mental concentration, and intellectual clarity.

These teachings are rooted in some generally held Indian beliefs that were initially quite contrary to Chinese indigenous attitudes, namely the concepts of samsara and karma: Buddhism sees humans as caught in a wheel of rebirth that binds us perennially to the realm of samsara. Upon death, we are propelled from one level of existence to another by our karma, the accumulated force of our conscious actions in this and past lifetimes. Like a bank account of deposits and debits, the balance of our good and bad actions determines the level of our next rebirth, ranging from numerous hells and the realm of hungry ghosts to the animal or human realms or the heavens inhabited by gods and demi-gods.

Body, Mind, and Matter

Buddhism’s otherworldly focus obviously contrasted sharply with the Confucian concern with social order and hierarchies on the one hand, and the Daoist embrace of a material existence in this world on the other. Particularly relevant in the context of medicine, the human body can serve as the perfect example to demonstrate these differences.

In Buddhism, the body is seen as circumstantial to the ultimate goal of release from the material realm. Unlike other Indian religious teachers, the Buddha did not recommend the ascetic approach of mortifying the body in order to conquer it. Instead, he recommended a middle path of keeping the body healthy and functioning without paying undue attention to it. This would enable one to focus fully on overcoming suffering and liberating oneself from desire by spiritual means like meditation and prayer.

In China, this negative view of the body and of the material world in general caused outrage and consternation because the body was, from the Confucian perspective, the property of one’s ancestors. The highest duty of filial piety was procreation and the production of male heirs for the continuation of the family line. The Buddhist practice of monasticism, the act of leaving one’s family to join a community of believers, appeared as the ultimate expression of disrespect. Furthermore, implicit in the Confucian ancestor worship is that people remain people after they have died. The possibility suggested by Buddhism that the wheel of samsara could turn a person into a lesser creature in the next life was not a prospect early Confucians would have relished.

From the Daoist perspective, the body was an aspect of the divine Dào and a site of its transformations, as well as an alchemical raw material to be cultivated and remolded into an immortal vehicle in which one was to enjoy a world of limitless bliss. The cultivation of the physical body was therefore an integral part of the search for unity with the Dào.

The separation of mind and body or spirit and matter that Buddhist teachings implied was a concept utterly foreign to Chinese culture. However, one important point of contact between Buddhist and indigenous notions was the focus both traditions placed on moderating desires and avoiding the harmful effects of excessive emotions. It is therefore most probable that Buddhism in this instance reinforced already extant Chinese ideas.

Buddhism and Medicine

Buddhism’s attitude towards medicine is more complex than the above-noted rejection of the material realm might suggest at first sight. Metaphorically speaking, the Buddha likened himself to a physician who administers his teachings like medicine to his patients, namely ordinary human beings suffering from the diseases of attachment, desire, and delusion. The cornerstones of Buddhist doctrine, the Four Noble Truths, were often explained in the medical terminology of diagnosis, etiology, and therapy. In practice, however, the Buddhist ideal implied a single-handed focus on spiritual pursuits. Most medical advice prescribed in Buddhist literature consisted of a combination of prayer and meditation.

Nevertheless, the Buddha also realized that to concentrate on the mind, the body had to be kept healthy. Moreover, the immediate goal of all Buddhist teachings is the deliverance from suffering, be it physical, mental, or spiritual. Compassion is an essential Buddhist virtue, as it implies the ability to overcome one’s personal desires and extend one’s love to all sentient beings. Practicing good deeds allows ordinary human beings to accumulate good karma and therefore assure themselves a better rebirth in the next lifetime.

In this context, the practice of medicine is one of the most tangible ways in which one human being can improve another human being’s wellbeing. Monastic institutions and individual Buddhist proselytizers realized this and frequently engaged in medical activities, with the additional benefit of not only healing people’s bodies but coincidentally winning their minds as well. In addition, the doctrine of reincarnation, through the possibility of rebirth in the animal realm, encouraged a respectful and compassionate attitude towards all sentient beings. Therefore, it encouraged the development of veterinary medicine as an act of caring towards those less fortunate than oneself for having been reincarnated as a less than human creature.

Buddhism and the West

Buddhism began to acquire a great following in the West in the latter part of the 20th century, no doubt because it appeals more strongly than Western faiths to people with a modern world view. While Christianity’s creationism, anthropocentrism (animals have no soul) and belief in miracles such as the virgin birth came to appear primitive and naïve to those educated in science, Buddhist cosmology, which describes the world in terms of a hierarchy of beings (animals and humans) that can be seen as similar to that of modern science and which emphasizes the natural causality of suffering in moral issues, is more acceptable to people with a scientific world view. Free of the dogmatism and proselytization of Christianity, it responds to the needs of a culturally pluralistic world. Furthermore, the Buddhist advocation of vegetarianism based on the moral objection to violence against any sentient beings, not just humans, finds resonance in modern nutritional and ecological ideas. Medical and environmental experts now tell us that we can be as healthy, if not healthier, by eating less or no meat and that pressure on the biosphere could be relieved by the elimination of animal farming.

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