Tetsunori Koizumi, Director

The Middle Path appears in the first discourse the Buddha delivered to the five bhikkhus in Benares after reaching enlightenment. In this discourse the Buddha told the five bhikkhus, with whom he used to train together in search of enlightenment, that the kind of extreme self-mortification practiced by them would not lead to salvation. The message the Buddha conveyed to them was that a middle path of avoiding the two extremes of self-indulgence on the one hand and self-mortification on the other is the path that leads to peace of mind, to wisdom, to enlightenment.

What is noteworthy is that the Middle Path of avoiding the two extremes of self-indulgence and self-mortification contains a holistic conception of health when interpreted in the context of the Buddha’s overall systems view of the world. In fact, the concept of health implied by the Middle Path can be interpreted as the state of “systemic balance” at the three levels of human existence—operational balance at the level of the human body as an aggregate of digestive, immune and other physiological systems, “organizational balance” at the level of the individual human being as a composite system of mental states and physical substances, and “orthogenetic balance” at the level of the global system defined as the space of interaction between humans and natural systems.

While not a physician by trade, the Buddha must have been well versed with the medical theory and practice of his time, judging from the way he presented the Four Noble Truths about the human condition in the world as if he were treating an illness. The Buddha starts off with the first truth about dukkha, or suffering, offering his diagnosis of what is wrong with the world, the fact that the world is full of suffering, including aging, disease, and death. The Buddha next offers his analysis of the cause of this illness of suffering, which, to him, comes from tanha, or craving. Having diagnosed an illness and discovered its cause, the next step for a physician would be to assess whether the illness can be cured. Thus, the Buddha presents his third truth, saying that this illness of suffering can indeed be cured. Finally, the Buddha offers a treatment program for this illness in his fourth truth, which is the Noble Eightfold Path.

The Noble Eightfold Path, which the Buddha presented as a concrete treatment program for the illness of suffering, spells out what the Middle Path means. To avoid the two extremes of self-indulgence and self-mortification entails, in the first place, that we take good care of our body: “To keep the body in good health is a duty, for otherwise we shall not be able to trim the lamp of wisdom, keep our mind strong and clear.”¹ To maintain the body in good health is important, the Buddha tells us, because that is the precondition for keeping the mind strong and clear so that we may see the light of enlightenment. The Buddha, then, goes on to spell out a concrete treatment program consisting of eight principles of right view, right thought, right speech, right action, right livelihood, right effort, right mindfulness and right concentration.

The Noble Eightfold path is indeed a comprehensive program, involving both mental and physical activities, where mental activities are represented by the four principles of right view, right thought, right aspiration and right mindfulness, and physical activities by the four principles of right speech, right behavior, right effort and right livelihood.² Dividing the eight principles into those which deal with the activities of the mind and those which deal with the activities of the body makes it clear that the Buddha the health scientist was concerned with the overall health of humans, that is, health interpreted holistically as a state of balance between reflection and action, between mind and body, in short, as a sate of systemic balance.

First, health can be defined as a state of “operational balance” in the operation of the human body as a system. To be more specific, the human body is an aggregate of digestive, immune and other physiological systems, which the Buddha was clearly aware of, judging from his detailed analysis of kaya, or body, in Mahasatipatthana Sutta. The Middle Path of maintaining balance between indulgence and mortification means that the human body is kept in good health in the sense of maintaining systemic balance in the operation of the body as a system.

Second, heath can be defined as a state of “organizational balance” in the human person as a composite system of mental states and physical substances. The Buddha had a systems view of man in that he saw man as an organism of many aggregates, consisting of the material form (the body) and the mental states as represented by perception, thought, mental formations and consciousness. Needless to say, we can expand on the Buddha’s conception of man by talking about the human body as an aggregate of cells, tissues, muscles, bones, organs and so on, and the human mind as an aggregate of emotions, feelings, sensations, and thoughts. What is important here is that both mental states and physical substances, both mind and body, must be kept in “systemic balance” in order to ensure the health of the human person as a composite system, as an organization, which is what the Noble Eightfold Path as a concrete embodiment of the Middle Path implies. To keep mental and physical activities in balance is important for our health because there is increasing evidence that our immune system, for example, is affected by our mental states.

Third, health can be defined as a state of “orthogenetic balance” in the natural environment. As the Buddha saw it very clearly, man is an open system in that he is in constant interaction with his environment, engaging in physical interaction with the use of his five senses and spiritual interaction with the use of his consciousness. The environment influences human health in many ways: light, gravity, physical stress such as temperature and noise, and psychological stress such as fear, tension and uncertainty. In turn, man influences the health of the environment through his consumption of food and other materials and production of goods and services from the use of raw materials found in the environment. Indeed, man can cause “stress” on the environment in the form of pollution, ozone deletion and other types of environmental degradation. In view of such mutual influence between the health of man and the health of the environment, it is clear that the holistic notion of health must contain the notion of “environmental health,” which can be represented by the concept of “orthogenetic balance.”

The Buddha presented the Middle Path—and the Noble Eightfold Path—as a concrete program for guiding his disciples and followers to enlightenment. The Noble Eightfold Path, in particular, spells out what the Middle Path entails as far as transforming the Buddha’s message into a concrete program of action. In the form of eight principles, the Noble Eightfold Path shows us how we need to maintain balance between mental and physical activities and between human and natural systems. It may be recalled that conceiving health as a state of balance is the common theme among Eastern philosophies, from Ayurveda to Yin-Yang theory. Coming out of this philosophical tradition of the East, it is not surprising that the Buddha had a notion of health that is holistically conceived in the context of his systems view of the world.

1. Carus, Paul, The Gospel of Buddha, Oxford: One World, 1994, p. 51.
2. Koizumi, Tetsunori, “The Noble Eightfold Path as a Prescription for Sustainable Living”, in How Much Is Enough? Buddhism, Consumerism, and the Human Environment, edited by Richard K. Payne, Somerville: Wisdom Publications, 2010.

 Tetsunori Koizumi, Director

“Mindfulness,” a word widely adopted as the English translation of the Pali word sati, has found applications in all sorts of areas in recent years such as business, education, health care, human development, personal transformation, politics, and relationships. The fact that “mindfulness” has been found to be useful in such varied areas of applications is not surprising, considering that sati was a key concept that captures the essence of the Buddha’s teachings. Not only does mindfulness appear as samma sati, or right mindfulness, as one of the eight factors in the Noble Eightfold Path in the Buddha’s first discourse on the Four Noble Truths, it also appears in his extensive discussions of satipatthana, which is usually translated as the Four Foundations (or Establishments) of Mindfulness.

By far the most comprehensive treatment of sati for Buddhist practitioners is to be found in Mahasatipatthana Sutta, or the Great Discourse on the Foundations of Mindfulness, which is sutta 22 in Digha Nikaya, known as Long Discourses in the Pali canon. This is truly a remarkable discourse in that the Buddha goes into such detail about what it means to practice sati, or mindfulness.

The importance the Buddha places on this sutta among his discourses is made clear immediately when he opens his discourse by saying that cattaro satipatthana, or the four foundations of mindfulness, is “the one and only way for the purification of beings, for the overcoming of sorrow and lamentation, for the extinguishing of suffering and grief, for walking on the path of truth, for the realization of nibbana.” The Buddha goes on to unveil what the four foundations of mindfulness are, saying: “Which four? Here, monks, a monk dwells ardent with awareness and constant thorough understanding of impermanence, observing body in body, having removed craving and aversion towards the world; … observing sensations in sensations, … observing mind in mind, … observing mental contents in mental contents …” Having unveiled that the four foundations of mindfulness are the contemplations of body, sensations (or feelings), mind and mental contents (or phenomena as objects of mind), the Buddha explains in great detail what each of the four foundations entails.

Contemplation of body consist of six parts: (1) anapana, or respiration, (2) iriyapatha, or postures, (3) sampajana, or constant thorough understanding of impermanence, (4) patikulamanasikara, or reflections on repulsiveness, (5) dhatumanasikara, or reflections on the material elements, (6) navasivathika, or nine charnel-ground observations. Of these, the first two on respiration and postures are well known among Buddhist practitioners of meditation today, for they are asked to be mindful about their breathing and posture when they meditate. So, too, is the fifth part about material elements as we are told about the four elements of earth, water, fire and air that constitute the body. The part on reflections on repulsiveness of the body serves to testify the amazing knowledge the Buddha had of human anatomy as he lists as many as 31, or 32 according to some interpreters, parts of the body which are patikula, or repulsive, from external parts such as hair, nails and skin, which are visible to the eye, to internal organs such as heart, kidneys, lung and stomach, which are invisible to the eye. The Buddha further includes such things as excrement, bile, phlegm, pus, blood, sweat, fat, tears, tallow, saliva, snot, synovial fluid, and urine among repulsive parts of the body. What is equally, if not more, amazing is his discussion of the nine conditions of the dead body in a cemetery, which we need to be mindful of, such as a corpse eaten by crows or vultures, a skeleton with flesh and blood connected by sinews, a fleshless skeleton smeared with blood connected by sinews, a skeleton detached from the flesh and blood connected by sinews, randomly connected bones scattered in all directions, the bones whitened like shells, the bones piled up a year old, the bone rotted away to a powder and a skeleton detached from the flesh and blood. The whole point about the Buddha’s detailed discussion of the repulsive aspects of the human body, dead or alive, is to draw our attention to the causes and conditions in which the human body comes into the world and passes away.

The thoroughness with which the Buddha discusses kaya, or the body, is repeated with respect to other three foundations of mindfulness: vedana, or sensations (feelings), citta, or mind, and dhamma, or mental contents (phenomena). The Buddha’s discussion of citta, or mind, where he talks about sixteen kinds of mind, starting from lustful and deluded minds to concentrated and liberated minds suggests that the Buddha was well informed about human physiology, but he had a penetrating insight into human psychology as well. In this sense, the Buddha was a complete physician of body and mind whose knowledge about human physiology and psychology is truly astonishing, considering the undeveloped state of medical sciences in the world in his day. It comes as no surprise, then, that the Buddha’s mindfulness practice regarding body and mind has come to be incorporated into modern medicine in the form of mind-body medicine.

The Buddha’s discourse on the four foundations of mindfulness ends with his discussion of dhamma, or mental objects, where he talks about the five hindrances, the five aggregates, the six sense bases and objects, and the seven factors of enlightenment, culminating in another thorough exposition of the Four Noble Truths. In a way, it is natural that the Buddha ends his discourse on the four foundations of mindfulness with another detailed exposition of the Four Noble Truths, which was the first discourse he gave to the five bhikkhus after enlightenment. The Buddha must have wanted to make sure that the whole pint about mindfulness practice in the four foundations of mindfulness is to develop insight into the realities of the world around us and thereby gain enlightenment, which he promises we would do not with years of practice but with just seven days of practice! This, certainly, is an encouraging message for us mindfulness practitioners.