Curing Illness

Root Text: A practitioner settling the mind to cultivate the path may find that the four great elements fall ill, because the very effort of contemplation stirs the breath and, in turn, stirs an underlying illness into activity; or, at times, one is simply unable to properly regulate body, mind, and breath together, violating some rule inwardly or outwardly, and illness results from this. As for the method of sitting in meditation: if one applies the mind well, the four hundred and four illnesses are naturally cured of themselves; if one applies the mind wrongly, the four hundred and four illnesses arise because of it. This is why, whether for one's own practice or for guiding others, one must skillfully recognize the source of illness, and skillfully know the inward methods for treating illness while seated — for once illness has actually taken hold, it is not merely an obstruction to practicing the path, but a genuine risk to one's very life.

Commentary: Calming and insight comprises ten chapters in all; the eight above are now complete, and this ninth explains curing illness. This body of the five aggregates that we sentient beings carry is made up of the four great elements, and to have a body at all is to have the potential for illness — for these four "serpents" differ in nature, water and fire opposed to each other, an owl and a kite forced to share the same roost, a python and a rat forced to share the same den.

Illness, however, divides into the expedient and the actual. Actual illness belongs to the causal stage; expedient illness belongs to the fruit stage. "Expedient" means a skillful device — as when the layman Vimalakīrti lay ill in Vaiśālī, using his own illness as an occasion to teach... All of this is expedient illness... An illness of this expedient kind is not what this chapter addresses. What this chapter addresses is precisely the illness that arises from one's own karmically-produced body, the four "serpents" acting up and encroaching upon one another.

Should the body fall into a prolonged illness, this is a great obstruction to dhyāna-concentration — a body long afflicted with illness loses the very merit one was cultivating, and gives rise to boundless offense besides. A sūtra says: "breaking the floating raft, dismantling the very bridge, falsely losing correct mindfulness" — this is precisely the meaning here... For reasons of this kind, one must counter this demon of illness. One should know that no dharma arises on its own — it always relies on some condition to arise. From what, then, does this demon of illness actually arise? It is not without its own causes and conditions: a practitioner settling the mind to cultivate the path may fall ill because the four great elements have fallen out of balance, or because of immoderate eating and drinking, or because one was, at some point during dhyāna-concentration, unable to skillfully regulate body, mind, and breath together, or because one grew careless in guarding the mind and a spirit found its opening, or because of a demon's own doing, or because of karmic retribution giving rise to various afflictions...

The practice of sitting in meditation depends, above all, on how the mind is applied — applied well, it yields measureless benefit; applied poorly, it gives rise to many faults instead. This body, made up of the four great elements, falls into a hundred and one illnesses should even one element fall out of balance, and four hundred and four illnesses should all four fall out of balance; applying the mind carefully, every illness is naturally cured of itself, while applying it wrongly gives rise to every kind of affliction because of it. This is why anyone who hopes to accomplish the virtue of benefiting both self and other, seeking the path above and transforming beings below, must skillfully recognize the root source of illness — and must further know the inward methods for treating illness while seated, so that, knowing the illness, one can recognize the proper remedy and apply it accordingly. Otherwise, a person cultivating the path alone, dwelling by themselves in a thatched hut deep in the mountains and valleys, has, should illness suddenly strike, no method at all for treating it — not only obstructing one's own practice along the path, but placing one's very life in real danger. Yet for a merely minor, passing ailment, taking medicine is not strictly necessary either, since the body has its own power of resistance — just as a wealthy person, prone to illness, often makes it worse by overmedicating, while a person of modest means, less prone to illness, more easily recovers precisely by relying on the body's own natural resistance without medicating at all.

Root Text: Explaining the method of treating illness now has two aspects: first, recognizing the mark of illness arising; second, the method for treating illness. As for recognizing the mark of illness arising: illness arises through many paths, but briefly falls into two kinds. The first is the mark of imbalance among the four great elements. If the earth element increases, one develops swelling, hardness, and heaviness, the body withered and gaunt — a hundred and one such afflictions arise. If the water element increases, one develops phlegm and distended bloating, indigestion, abdominal pain and diarrhea — a hundred and one such afflictions arise. If the fire element increases, one develops chills and high fever, pain throughout every joint, foul breath, and blocked urination or bowel movements — a hundred and one such afflictions arise. If the wind element increases, the body feels hollow and unsteady, trembling and aching, the lungs congested and the abdomen bloated, retching and labored breathing — a hundred and one such afflictions arise. Hence a sūtra says: one element out of balance gives rise to a hundred and one illnesses; all four out of balance, and four hundred and four illnesses arise together at once. Each of the four elements' own illnesses carries its own particular mark, to be observed both while seated and in dreams.

Commentary: What follows below now divides into sections to explain this. First, explaining the mark of imbalance among the four great elements: our own body is made up of earth, water, fire, and wind, and should any one of these increase or decrease, illness results — hence the four elements must, without exception, be kept in balance. If the earth element increases relative to the other three, the body grows heavy and burdened, hard, knotted, and aching, withered, jaundiced, and gaunt — a hundred and one such afflictions arise; this is the mark of the earth element's own illness, and the marks of the other three elements' imbalance follow the text in just the same way.

Overwork without rest, exerting oneself while carrying a heavy load, constant exposure to cold and heat — outward heat aiding the fire element, and the fire element growing strong while the water element's own strength diminishes, is an increase of the fire-illness; outward cold aiding the water element, harming the fire element, is the water-illness; outward wind aiding the qi, the qi fanning the fire, the fire stirring the water, is the mark of the wind-illness. Should water, fire, and wind together increase and harm the earth element, this is called the "equal-portion illness"; should the body itself increase and harm water, fire, and wind, this too is an equal-portion illness belonging to earth. Once the four elements are thrown into disorder, every kind of affliction competes to arise — hence the sūtra says: one element out of balance gives rise to a hundred and one illnesses; should all four fall entirely out of balance, four hundred and four illnesses arise together at once. Whenever afflictions of this kind arise, each carries its own particular mark, to be observed both while seated and in dreams — observing where this demon of illness has actually come from, first seeking to know the root source of the illness, and only then applying various methods to counter it accordingly.

Root Text: The second is the mark of illness arising from the five organs. Illness arising from the heart: the body alternating between cold and hot, headache, dry mouth, and the like, since the heart governs the mouth. Illness arising from the lungs: the body bloated and full, aching in all four limbs, a stifled feeling in the chest, a blocked nose, and the like, since the lungs govern the nose. Illness arising from the liver: little joy in the mind, melancholy and unhappiness, sorrowful brooding and anger, headache, dim eyesight and confusion, and the like, since the liver governs the eyes. Illness arising from the spleen: a roaming rash across the face and body, chronic itching and pain, loss of taste in food and drink, and the like, since the spleen governs the tongue. Illness arising from the kidneys: a choked, blocked throat, abdominal bloating, deafness, and the like, since the kidneys govern the ears. Illness arising from the five organs is extremely varied, each with its own particular mark, to be recognized by observing both while seated and in dreams.

Commentary: This second part explains the mark of illness arising from the five organs... To recognize the mark of illness in the five organs, one must be familiar with the method of pulse-diagnosis before illness can actually be treated. A skilled physician knows the four elements: the finest physician diagnoses by listening to the voice, a middling physician by observing complexion, and a lesser physician by feeling the pulse — but for one applying effort in practice, precise medical skill is not required, only a general working knowledge...

As for how the mutual conquest among the five phases gives rise to illness in the five organs, this is explained in the root text, but one must understand the correspondence between the five phases, the five organs, and the five faculties: the east, wood, its color green, belongs to the liver, governing the eyes; the south, fire, its color red, belongs to the heart, governing the tongue; the west, metal, its color white, belongs to the lungs, governing the nose; the north, water, its color black, belongs to the kidneys, governing the ears; the center, earth, its color yellow, belongs to the spleen, governing the body as a whole...

One must further know the marks of illness in the six spirits: a tendency toward dullness and confusion means the liver lacks its own spirit; frequent forgetfulness means the heart lacks its own spirit; frequent dread and fits of madness mean the lungs lack their own spirit; a tendency toward sorrowful laughter means the kidneys lack their own resolve; frequent confusion means the spleen lacks its own intention; frequent melancholy dejection means the yin lacks its own essence — these explain the marks of illness among the six spirits. One should know that illnesses arising from the five organs and six viscera are extremely numerous, too many to list individually, yet each carries its own particular mark, to be recognized by a practitioner observing both while seated and in dreams.

Root Text: As explained, illnesses of the four elements and five organs arise through many causes and take numerous marks, more than can be told in full. A practitioner who wishes to cultivate the dharma-gate of calming and insight, should illness happen to arise, should skillfully understand its cause. These two kinds of illness both arise through causes both outward and inward. If it is from outward injury by cold, wind, or heat, or from indigestion, and illness arises from these two sources, one should know it to be caused outwardly. If it is from unregulated application of the mind, deviant contemplative practice, or, when a state of concentration arises, not knowing how to properly take it up or set it aside, and illness arises from these two sources, this is the mark of illness caused inwardly. Further, there are three distinct causes for the arising of illness: first, illness from imbalance in the four elements and five organs, as explained above; second, illness caused by ghosts and spirits; third, illness from karmic retribution. Illnesses of this kind, treated as soon as they first arise, are very easily cured — but should they persist over a long time, the illness becomes established, the body weakened and the illness deeply knotted, difficult to cure.

Commentary: "As explained" here carries forward what came before into what follows... Within the Buddhadharma there is also the study of the five sciences — grammar, arts and crafts, medicine, logic, and inner wisdom — and so there is indeed a place for the study of medicine as one of these... Though the Buddhadharma is not itself worldly, it is never separate from worldly awareness either, and so it borrows worldly medical skill to treat sentient beings' own bodily illness, just as the Tathāgata's own teaching serves as the Dharma-medicine treating sentient beings' own inward afflictions of the mind. One should recognize the various illnesses of sentient beings, skillfully understanding their own causes and conditions — when a state of concentration arises, taking it up where taking it up is fitting, setting it aside where setting it aside is fitting; failing to know which, illness in the two sources of the four elements and five organs results — this is the mark of illness caused inwardly.

Commentary: Second, explaining illness caused by ghosts and spirits. One should know that an illness of the four elements and five organs is not a ghost-illness, and a ghost-illness is not an illness of the four elements and five organs. If one claims ghost-illness does not exist, then how is it that deviant shamans, treating illness entirely through spirit-methods, sometimes succeed in curing it? If one claims illness of the four elements does not exist, then how is it that physicians, treating illness entirely through medicinal decoctions, sometimes succeed in curing it? This is enough to prove that ghost-and-spirit illness genuinely exists.

Long ago, Śāriputra, on Vulture Peak, entered the vajra samādhi. At that time two spirits passed by overhead — one named Kāla, the other Upakāla. Seeing Śāriputra seated in the lotus posture, deep in concentration, from a distance, the spirit Kāla said to his companion: "I am now capable of striking this monk's head with my fist." Upakāla replied: "Do not think of striking this monk's head — for this monk is the World-Honored One's own disciple, foremost in wisdom and intelligence." Kāla insisted, two or three times: "I am fully capable of striking this monk's head." The good spirit said: "If you will not heed my words, then stay here — I am leaving you." The evil spirit asked: "Are you afraid of this monk?" The good spirit answered: "I truly am afraid of him — should you strike this monk with your hand, the earth itself would split in two, a violent storm of wind and rain would follow, the earth would quake, the heavenly beings would be terrified, and the Four Heavenly Kings would take notice — we ourselves would then have no safe place left to dwell." The evil spirit did not heed this, and the good spirit departed. The evil spirit then went and struck Śāriputra's head — at that moment heaven and earth shook violently, a fierce storm of wind and rain broke out on every side, and the earth split in two; the evil spirit's entire body fell straight into hell.

Śāriputra then rose from samādhi, straightened his robe, and went to the World-Honored One at the Bamboo Grove, bowing at his feet and sitting to one side. The Buddha asked him: "Is your body free of illness now?" He answered: "My body is, in itself, free of affliction — only my head aches somewhat." The World-Honored One then told him: "The spirit Kāla struck your head with his hand — had that same spirit's hand struck Mount Sumeru itself, it would have split in two. Fortunate that you had entered the vajra samādhi, relying on this very samādhi's own spiritual power, you suffered no real harm — otherwise the danger would have been extreme indeed." This story comes from the Ekottara Āgama, told there in great detail — from this we know that disturbance caused by ghosts and spirits is genuinely able to produce illness.

Third, illness from karmic retribution: this may arise entirely from karma accumulated in a past life, or from breaking the precepts in this present life, stirring dormant karmic offense from a past life into activity as illness. Illness produced by karmic force corresponds to the five faculties according to the specific offense committed: the karma of killing produces illness of the liver and eyes; the karma of drinking alcohol produces illness of the heart and mouth; the karma of sexual misconduct produces illness of the kidneys and ears; the karma of false speech produces illness of the spleen and tongue; the karma of stealing produces illness of the lungs and nose; and breaking all five precepts together brings illness across all five organs and faculties at once. Once the karmic retribution is exhausted, the illness is cured.

One must further know that strictly upholding the precepts in this present life can itself stir dormant karma from a past life into activity as illness — if a grave offense would, by rights, call for suffering in hell, and is instead repaid lightly, in the human realm, through a mere headache, this too is a form of illness tied to karma being resolved and dissolved. One should know that illnesses of this kind — caused by ghosts and spirits, by karmic retribution, or by demons — are, if treated as soon as they first arise, very easily cured; but should they persist over a long time, the illness becomes as firmly rooted as a tree, very difficult indeed to uproot.

Root Text: Second, explaining the method of treating illness: understanding deeply the source from which the illness arose, one applies a method to treat it accordingly. The methods for treating illness are many, but, stated essentially, they do not exceed the two skillful means of calming and insight. What is treating the mark of illness through calming? One teacher says: simply settle the mind, fixed on the location of the illness, and this alone is able to cure it. Why is this? Because the mind is the very master of this present life's own karmic fruit — just as, wherever a king goes, a band of thieves scatters and flees. Another teacher says: one inch below the navel is called the elixir field; if one is able to fix the mind there, guarding it without scattering, in time much can be cured this way. Another teacher says: constantly fix the mind at the soles of the feet, whether walking, standing, sleeping, or lying down, and this alone is able to cure illness. Why is this? Because people, their four elements out of balance, fall prey to many afflictions precisely because the mind and consciousness are drawn upward — and so the four elements fall out of balance; settling the mind downward instead, the four elements naturally come into balance, and every illness is thereby removed! Another teacher says: simply knowing that every dharma is empty, with nothing there at all, not grasping at the mark of the illness, letting the mind settle into stillness — much can be cured this way. Why is this? Because it is precisely the mind's own recollection and imagination that stirs the four elements into activity, giving rise to illness in the first place; once the mind is stilled into harmonious contentment, every illness is cured. Hence the Vimalakīrti Sūtra says: "What is the root of illness? It is attachment to objects." "How does one sever this attachment to objects? By the mind attaining nothing at all." Explanations of this kind, using calming to treat the mark of illness, are numerous — from this we know that skillfully cultivating calming is able to cure every illness.

Commentary: This second part lets a practitioner know the method for treating illness... If illness comes from overwork or diet, medicine is what is needed to treat it; if it comes from unregulated seated meditation, one must still treat it through skillfully regulating breath and contemplation in meditation itself, not through medicine; if it is an illness caused by a ghost or demon, one must overcome it through the power of contemplative practice together with the power of the Great Compassion Mantra; if it is illness from karmic retribution, one should apply the power of contemplative practice inwardly, together with earnest, sincere repentance outwardly, before it can actually be cured...

The methods for treating illness explained across the sūtras, vinaya, and treatises are measureless in number, but, stated essentially, do not exceed the two skillful means of calming and insight — for calming and insight are themselves the very medicine that cures every illness, in truth the great dhāraṇī that holds every remedy for every disease within it...

A certain great worthy said: one inch below the navel is called the elixir field... A practitioner able to fix the mind here, guarding it without letting it scatter, can, in time, cure much this way — for the elixir field is itself an ocean of vital energy, able to dissolve and absorb every illness; fixing the mind here brings the breath into harmony, and illness is thereby cured...

Another teacher said: "Constantly fixing the mind at the soles of the feet is able to cure illness." Every affliction we suffer arises from the four elements falling out of balance, and the four elements fall out of balance entirely because the mind and consciousness are drawn upward — mind drives wind, wind stirs fire, fire melts water, water moistens the body — so that the upper portion of the body is regulated while the lower portion falls into disorder, and every kind of affliction bursts forth as a result. If the mind is instead directed downward, it is like blowing a flame downward — food and drink digest properly, the five organs fall into accord, and the four elements likewise come into balance...

Now, we who expound the path and discuss its teachings, spreading the Buddhadharma — why should we need any secret medical knowledge at all? Because, in wishing to resolve birth-and-death and realize the fruit of buddhahood in the present, one must rely on this very illusory body of the four elements to actually cultivate the path — without this body, one cannot cultivate the path at all; this is what is meant by "borrowing the illusory to cultivate the true" — hence the four elements must be kept in harmony...

Hence another teacher said: "Simply know that every dharma is empty, with nothing there at all." Fully understanding that whatever has a mark at all is entirely illusory, that every dharma, without exception, is markless — settling the mind into stillness in this way, not grasping at the mark of the illness, much can be cured this way... The Vimalakīrti Sūtra says: "What is the root of illness? It is attachment to objects." Because of clinging, one becomes attached to objects; because of this attachment, something is grasped; and where something is grasped, illness follows. If one wishes to attain a mind that grasps nothing at all, one must sever this attachment to objects — and to sever this attachment, giving rise to no clinging at all matters more than anything else. How does one sever this attachment to objects? By the mind attaining nothing at all. The Second Patriarch said: "Searching for the mind, it cannot ultimately be found." The Śūraṅgama Sūtra's own sevenfold search for the mind — neither inside, outside, nor in between, until the mind clings to nothing at all — these are all proof of severing this very attachment to objects.

Root Text: Next, explaining treating illness through insight. One teacher says: simply contemplating the mind's own thought and using the six kinds of breath to treat illness — this is treating illness through insight. What are the six kinds of breath? Chuī, hū, xī, hē, xū, and sì. These six kinds of breath are all produced through the lips and mouth, skillfully applied by the mind's own intention, adjusted as needed, used subtly and continuously. A verse says:
"The heart matches hē, the kidneys chuī; the spleen uses hū, the lungs sì — the sages all know this. When heat gathers in the liver, xū arrives; wherever the triple burner is blocked, simply say xī."

Commentary: This next part explains treating illness through insight. As explained above, treating illness through calming does not follow one single method; treating illness through insight-contemplation is likewise measureless in its methods. One teacher says: "Simply contemplating the mind's own thought and using the six kinds of breath to treat illness is able to cure it" — meaning observing the subject rather than the object...

To treat the five organs, the breath should be released through the teeth, lips, and tongue, skillfully guided entirely by the mind's own intention, adjusted as needed, never coarse or forceful, but continuous, fine, and subtly applied. One should know that these six kinds of breath carry the very greatest power, able to treat every serious illness of the four elements and five organs. If the body is cold, use chuī, as in blowing on a fire; if hot, use hū, as in exhaling a cool breeze; for pain throughout every joint, use xī... this can also treat wind-illness; for a vexed, distended feeling with rising qi, use hē; for chronic phlegm, use xū; for bodily fatigue and exhaustion, use sì. Matched to the five organs: xū treats the liver, hē treats the heart, hū treats the spleen, sì treats the lungs, and chuī treats the kidneys. The six kinds of breath can also all treat a single organ: coldness within that organ calls for chuī, heat calls for hū, pain calls for xī, vexation calls for hē, phlegm calls for xū, and fatigue calls for sì...

To apply this method: exhale cold air out through the mouth, then slowly draw warm air in through the nose, calmly and gently, taking care never to force it — at the start of a single sitting, this should be done seven times, and only then should one settle the mind; after settling the mind briefly, apply the breath again — this is the meaning of using breath to treat illness...

The "triple burner" refers to the triple viscera — the pathway of food and drink, and the very beginning and end of the body's own vital energy... But this kind of effortful countermeasure is only a beginner's expedient method within Buddhist teaching for treating illness, not the actual method of genuine practice — it is a matter of some absurdity that non-Buddhist practitioners have taken this and generated their own separate views from it, falsely treating it as some secret, wondrous treasure!

Root Text: Another teacher says: if one is able to skillfully apply contemplative visualization to work through twelve kinds of breath, this is able to cure every illness. The rising breath, the sinking breath, the filling breath, the scorching breath, the growing breath, the dissolving breath, the warming breath, the cooling breath, the piercing breath, the sustaining breath, the harmonizing breath, and the replenishing breath. These twelve kinds of breath all arise from the mind's own contemplative visualization. Briefly, their respective remedies: the rising breath treats heaviness; the sinking breath treats a hollow, unsteady feeling; the filling breath treats emaciation; the scorching breath treats swelling and bloating; the growing breath treats weakness and depletion; the dissolving breath treats excess; the warming breath treats cold; the cooling breath treats heat; the piercing breath treats blockage; the sustaining breath treats trembling; the harmonizing breath generally treats disharmony among the four elements; and the replenishing breath restores the four elements' own depletion. Skillfully applying these breaths, one can treat every kind of illness across the board — the details can be worked out by the same reasoning.

Commentary: The six kinds of breath used to treat illness above come, in fact, from within this same twelfth-breath method; this second part now explains how breath is able to counter every illness. "Breath" here means the breath through the nose, differing from what was explained before. The physical body and mind depend on each other, breath expressing this relationship — just as firewood and its smoke depend on each other: observing whether the smoke is clear or murky tells one whether the wood is dry; observing whether the breath is strong or weak tells one whether the body is healthy or ill...

These twelve kinds of breath must be distinguished from the six kinds of breath explained earlier, since the method of application differs entirely between the two: these twelve kinds of breath carry with them, in addition, an element of contemplative visualization... "Dependent breath" means breath arising in dependence on the mind — as when, in a moment of anger or desire, the breath becomes forceful and pronounced; this is called dependent breath. The earlier six kinds of breath carry visualization alongside "resultant breath"; these twelve kinds of breath carry visualization alongside "dependent breath" — hence the two differ. What was explained earlier concerned illness of the five organs tied to the five colors; this twelfth method treats illness tied to the organs directly, hence "dependent breath" is used to treat it. When applying any of these twelve kinds of breath, each must be accompanied by its own corresponding visualization in the mind, carried through to completion, and one must, above all, know the root source of the illness in detail... This is why a practitioner, when applying any of these breaths, must never apply the wrong one by mistake — knowing the illness and recognizing the proper remedy, prescribing according to the illness, matters more than anything else.

Root Text: Another teacher says: skillfully applying contemplative visualization is able to cure every illness — as when a person suffering from cold visualizes the fire-element rising within the body, and is thereby able to cure the cold. This is explained at length among the seventy-two secret methods for treating illness in the Saṃyukta Āgama.

Commentary: Among the breath-methods above, visualization was already combined with them to some degree; here the focus turns entirely to contemplative visualization alone as the remedy. Once there was a person suffering from a fatal wound, who sought out a skilled physician for treatment. The physician said: "This wound is not, in fact, serious — but I fear the small boil on your arm carries a real risk to your life, and matters far more; you should attend to it closely." The patient then fixed his mind single-mindedly on the small boil, no longer attending to the grave wound at all — and in time the grave wound healed completely. This was accomplished entirely through treating illness by visualization, produced by mind alone...

The Saṃyukta Āgama explains, at length, seventy-two secret methods for treating illness, each and every one of them a skillful means of mind-contemplation applied as treatment. One should know that secret methods of this kind are each suited to a particular occasion; a few are briefly recounted here for reference. The first is the method of "swallowing the snake": the Āgama's first version says: "It is like a person eating food who swallows the reflection of a snake, and believes they have swallowed an actual snake." Because of clinging to this thought from moment to moment, illness results. When another person asks about it, recognizing that the illness arose from swallowing this reflected image of a snake, one secretly places a dead snake in the patient's own basin and announces that the snake has come out — and the illness is cured at once. A snake painted on a wall, its reflection appearing in a wine cup, produces the very same effect.

The Āgama further says: "In the kingdom of Śrāvastī there was an elder named Chenju, whose household included a maidservant of extremely plain appearance... She happened to go out into the wilderness, where she found a spring with a tree growing beside it; on the tree hung the body of a beautiful woman who had hanged herself, its reflection appearing in the spring's own water. The maidservant, seeing this reflection, mistook it for her own reflection, not realizing there was an actual woman's corpse hanging in the tree above, which she had failed to notice. Because of this she grew angry at her employer, thinking to herself: 'Being as beautiful as this...' — and, smashing her water jar, she returned home, sat silently in a curtained seat within the hall, and would not speak a word. Her employer, thinking she had gone mad, questioned her, and she answered with the story as just described... Her employer, already knowing that a dead woman's body hung near that spring, sent the maidservant back to the spring, where she saw the dead woman's own reflection in the water, and realized that this fine appearance had never truly been her own reflection at all. From this her mind was unraveled and her understanding became clear, and she felt deep shame."

This is a case of illness arising from seeing a reflection, likewise cured by illuminating that same reflection. Every one of the seventy-two secret methods for treating illness in the Āgama follows this same pattern. This same contemplative visualization underlies every dhyāna practice as well — whether the nine contemplations, the eight liberations, the ten totalities, the sixteen excellent practices, or the various forms of refining and steeping contemplation — all of them rely on this same visualizing contemplation! This is why the ancients spoke of gazing at a plum tree to quench thirst, or imagining sand as food to relieve hunger — both instances of the benefit gained through visualizing contemplation.

Root Text: Another teacher says: simply using calming and insight to examine the body closely, one finds no illness within the four elements that can ultimately be found, and no illness within the mind that can ultimately be found — and every illness resolves of itself. Explanations of this kind, using insight to treat illness, differ in their application, but, skillfully grasping their underlying intent, every one of them is able to cure illness. One should know that if a person can skillfully grasp the underlying intent of calming and insight, there is no illness these two methods cannot cure. But people of the present age have shallow, dull faculties, and mostly fail to succeed in this kind of contemplative visualization, so it is not widely transmitted in the world today. Nor should one, in place of this, take up breath-cultivation techniques or grain-abstinence practices instead, for fear of giving rise to deviant views. Medicines of mineral, plant, or herbal origin, suited to the illness in question, may certainly be taken as well.

Commentary: Our own body of the four great elements is a temporary aggregation of the outward four elements — without the outward four elements, there could be no inward four elements at all. Now, when the inward four elements give rise to illness, one must examine one's own physical body closely, investigating minutely: where, exactly, does this illness actually reside? If the earth element itself is ill, then the outward mountains, rivers, and earth should equally be ill... yet mountains, rivers, and earth, and every fire and lamp-flame, have never once been observed to fall ill. Investigating this closely, seeking the four elements' own illness, there is, at root, no mark of illness there at all — and once the outward illness is found not to exist, one further investigates the mark of illness within one's own mind, turning to observe one's own mind, finding it ultimately unfindable — if the mind itself cannot even be found, how much less the illness supposedly afflicting it?

Just as Great Master Nanyue, reciting the Lotus Sūtra within a mountain cave, suffered from a swollen, paralyzing illness, his four limbs too heavy to rise — the master then directly contemplated the very source of the mind, investigating that illness arises from karma, karma arises from delusion, and, exhausting this deluded mind, found it ultimately unfindable; investigating further the source of his own four elements' illness, this too could not be found — who, then, is being afflicted by this illness at all, and who is there to actually suffer it? Contemplating in this way, the illness was cured of itself!

The various teachers above, though each explaining treating illness through insight in their own different way, all point to the same underlying intent — grasping this intent, whatever effort one applies, every illness can be cured; this is what is meant by "grasping the meaning and forgetting the words used to express it."

...Calming and insight together are exactly like a universal medicine, curing every illness without exception — but in this present age, the Dharma already in its final decline, sentient beings' own faculties are shallow and dull; having been deluded since time immemorial, committing boundless offenses at every turn, when they attempt to cultivate calming and insight, their own coarse mind and violent energy prevent any real effort from succeeding at all. From ancient times to the present, those who have cultivated the visualization of the six breaths and twelve breaths have gained real benefit only rarely, and so this method is not widely transmitted in the world today. We, with our own fragile, perishable bodies, subject to unpredictable decline, may reasonably borrow this method to treat illness, so that the body is at ease and the path preserved — there is no fault in this. But should one seek fame and reputation through it, stirring up worldly attention, this is itself a demonic delusion, to be abandoned at once. For what matters most within the Buddhadharma is purity of view and understanding — one must never let the slightest deviant thought take hold in the mind. Should illness of the four elements arise, one should use the effort of calming and insight to counter it; and should one's own power on the path prove too weak for this, treating it with mineral, plant, or herbal medicine is likewise acceptable. Hence it is said: medicine suited to the illness in question may certainly be taken.

Root Text: If it is a ghost-illness, one should apply mantras together with a strengthened mind to help treat it. If it is illness from karmic retribution, one must cultivate merit and repentance, and the affliction will be dissolved. Should a practitioner genuinely grasp even one of these two methods for treating illness, one is thereby able to help both oneself and others — how much more so if one masters both fully! Should one understand neither at all, illness, once it arises, has no remedy — not only abandoning correct practice but risking real danger to one's very life. How, then, could one presume to practice, let alone teach others! This is why anyone who wishes to cultivate calming and insight must skillfully understand these inward methods for treating illness. The methods are not just one, and grasping their true meaning depends on the person — how could this ever be fully conveyed through mere writing alone!

Commentary: What has been explained above concerns illness of the four elements and five organs, treated through calming and insight together with mineral, plant, and herbal remedies, able to be cured this way. If it is ghost-and-spirit illness, one should apply courageous diligence, a firm and resolute mind, together with the power of mantras — the Great Compassion Mantra, the Śūraṅgama Mantra, the mantra for rebirth in the Pure Land, the thirty-six-beast mantra, and others — to help treat it, and it can be cured. If it is illness resulting from karma accumulated in a past life, one must broadly cultivate offerings before the Buddha — incense, flowers, garlands, and every kind of offering — or, before a good spiritual friend, offer the four requisites of clothing, food and drink, bedding, and medicine; cultivating merit outwardly in this way, and, inwardly, with earnest, sincere devotion, bowing and repenting the karma of a past life — the affliction will naturally be dissolved!

...One should know that if a practitioner genuinely grasps even one of these two methods of treating illness, applying it correctly, one is thereby equipped not only for one's own practice but for helping others as well. Grasping even one method already accomplishes this much — how much more so if one masters both fully! But if one has no understanding at all of either method, when illness arises there is nothing to be done, and it becomes very difficult to treat — not only abandoning correct practice, but risking the loss of one's very life...

This is why anyone cultivating calming and insight must, without fail, come to understand these inward methods for treating illness. Yet the methods are extraordinarily numerous, and grasping their true meaning depends on the person — how could this ever be fully conveyed through mere writing? For writing is only the dregs left over; grasping the true meaning lies in one's own mind, not in the notion that mere writing itself can cure illness!

Root Text: Further, applying the mind to treat illness while seated requires, in addition, ten supporting habits, every one of them beneficial. The ten are: faith, application, diligence, dwelling constantly within the object, distinguishing the illness's own cause, skillful means, sustained practice, knowing what to take up and what to set aside, maintaining protection, and recognizing what should be kept private. What is faith? Believing that this method is certainly able to cure illness. What is application? Applying it constantly, at all times. What is diligence? Applying it single-mindedly, without pause, until a cure is actually achieved. What is dwelling within the object? Keeping the mind fixed, thought after thought, in accordance with the method, without straying to any other object. What is distinguishing the illness's own cause? As already explained above. What is skillful means? Skillfully accomplishing the exhalation, inhalation, mental application, and visualization involved, never losing what is fitting to the occasion. What is sustained practice? If the method brings no immediate benefit, not counting the days or months, but continuing to practice it without ever abandoning it. What is knowing what to take up and what to set aside? Knowing that where it brings benefit, one applies it diligently, and where it brings harm, one sets it aside, subtly adjusting one's approach accordingly. What is maintaining protection? Skillfully recognizing and avoiding any conflicting circumstance that would violate the treatment. What is recognizing what should be kept private? Not speaking of any benefit gained to others, and, before any harm has occurred, giving rise to no doubt or slander about the method. Relying on these ten habits, whatever is treated will certainly show real effect, not in vain.

Commentary: Further, if one applies the mind to treat illness while seated, one still requires, in addition, these ten habits, which are certain to bring real, positive results. Faith, application, and so on through recognizing what should be kept private.

What is faith? Believing, without a single thought of doubt, that this method is certainly able to cure illness — just as a leper believes blood to be milk, or one who venerates a camel's bone as a true relic; the great ocean of the Buddhadharma is entered through faith, and crossed through wisdom — this shows clearly how much faith matters. Application means applying the method constantly, at all times — believing in it but never applying it brings no benefit to oneself, exactly like holding a sharp sword but never drawing it against a bandit, only inviting harm instead; failing to apply the method is just the same.

Diligence means applying it single-mindedly through the first, middle, and last watches of the night, morning and evening alike, without pause, until an actual cure is achieved — just as drilling for fire, if paused partway through, never actually produces fire; failing to be diligent is just the same. Dwelling within the object means constantly applying the method of treatment, thought after thought remaining fixed on the object, without wavering — exactly like a cat stalking a mouse. Distinguishing the illness's own cause is as explained above — failing to recognize the illness and applying treatment at random, mismatched to the actual condition, brings no benefit at all.

Skillful means refers to the exhalation, inhalation, mental application, and visualization, accomplished skillfully, never losing what is fitting to the occasion — just as a lute-player must adjust the tension of the strings, turning the pegs this way and that, the fingers pressing lightly or firmly, before the tone comes properly into tune; skillful means is just the same. Sustained practice means that if a practitioner applies the method without seeing any benefit for a long time, one should, without counting the days or months, continue practicing it without ever abandoning it — one who cultivates the path and applies real effort must sustain this same constancy of mind, practicing continuously without pause, exactly as the ancients applied effort day and night alike, never once outside this constant effort, until, in time, success naturally follows — hence it is said, "the path cannot be departed from even for a moment; what can be departed from is not the path" — treating illness is just the same.

Knowing what to take up and what to set aside means that one applying effort must possess the discerning eye of the Dharma, taking up what should be taken up and setting aside what should be set aside, without the slightest forcing of the issue — setting something aside as readily as discarding hemp upon finding gold instead — subtly adjusting one's own approach as needed; we ordinary beings, our minds coarse and our energy unruly the whole day through, idle thought flowing without pause, are unable to gain any real benefit from the Buddhadharma this way, and so must turn what is coarse into what is fine, gathering our attention back into the mind, before we can truly accord with the path.

Maintaining protection means skillfully recognizing and avoiding whatever taboo or conflicting circumstance might arise — in movement, food and drink, and every one of the four bodily postures, skillfully nourishing and protecting oneself, never allowing any violation that would work against one's own progress on the path. Recognizing what should be kept private means not speaking of any benefit gained to others, and, before any harm has occurred, giving rise to no doubt or slander — as it is said, only the fish in the water itself knows whether it is warm or cold; whether one has genuinely attained the path or not is something only oneself can truly know. One often sees eminent monks and great virtuous teachers who, precisely in order to nurture their own progress on the path, seek neither fame nor material gain, deliberately concealing their own virtues and revealing their own faults instead, dwelling contentedly in poverty and holding fast to the path, or suddenly departing ten thousand miles away, wandering like a cloud to some other place entirely — all of this is precisely the meaning of maintaining this kind of protective privacy.

Should a practitioner applying effort be able to rely on these ten habits, applying every one of the treatments described above, real effect is certain to follow without any doubt — I can personally guarantee this to be true, never in vain. This concludes the great chapter on treating illness through calming and insight.