A Handbook for the Relief of Suffering
Ajaan Lee Dhammadharo
(Phra Suddhidhammaransi Gambhiramedhacariya)
Translated from the Thai by
Copyright © 1995
Metta Forest Monastery
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Lee composed the following three short essays when he was hospitalized in late
1959, shortly over a year before his death. The style of presentation -- outlines
that are just barely fleshed out -- is typical of his later writings. He seems
to have intended that the essays be given to hospital patients, as food for thought
for them to ponder while undergoing treatment. Although the presentation is ecumenical,
the basic points are straight Buddhism. The explanation of the two types of disease
in the first essay follows one of the central insights of the Buddha's Awakening:
the realization that events in the present are conditioned both by past kamma
(intentional actions) and by present kamma. The four principles of human values
presented in the second essay correspond to the four agatis, or types of prejudice
that the Buddha warned against: prejudice based on (1) likes and desires, (2)
dislikes and anger, (3) delusion, and (4) fear.
The third essay, "The
Buddhist Way," is a brief outline of the Buddha's teachings based on the
synopsis of the Ovada Patimokkha, a discourse the Buddha gave at the beginning
of his career to 1,250 arahant disciples before sending them out to spread the
teaching; and on an analysis of one of the basic Buddhist concepts, that of sankhara,
which means force, fashioning, or compounded thing. In its form, the analysis
of two types of sankharas -- those on the level of the world and those on the
level of the Dhamma -- is original with Ajaan Lee and is based on a Thai reading
of two Pali compounds: sankhara-loka and sankhara-dhamma. From the point of view
of Pali grammar, sankhara- functions as the adjective in each of these compounds:
the first compound refers to the world of compounded things, the second refers
to compounded things as phenomena in and of themselves. The two compounds were
taken over straight into Thai, but because Thai places its adjectives after the
nouns they modify, Ajaan Lee has interpreted loka (world) and dhamma (phenomena)
as adjectives modifying sankhara, and thus he arrives at his own novel interpretation
of the terms. His understanding of the aggregate of consciousness, the fifth aggregate,
is also interesting in that it differs from most scholarly interpretations. Otherwise,
the content of his analysis is standard, and the points he makes form a convenient
synopsis of Pali Buddhist teachings.
For the Relief of Suffering
There are two ways in which diseases can arise in our bodies:
2. Kammic causes (kamma-samutthana).
causes: Physically caused diseases are those that come about through disorders
in the five physical properties (dhatu) --
a. Earth: the solid parts of the
body, such as bones, muscles, skin, etc.
b. Water: the liquid parts, such
as saliva, mucus, blood, etc.
c. Fire: the warmth in the body.
forces that move back and forth through the body, such as the breath.
the empty spaces that lie throughout the body, through which the various elements
of the body mingle and interact. These include such things as the ear canal, the
nasal passages, the mouth, the pores of the skin, etc.
When these properties
become upset or unbalanced, they provide one sort of opening for disease to arise,
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, worthwhile, 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.
additional food for thought for sick people and the doctors who treat them:
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:
1. Follow the doctor's
2. Give the doctor complete freedom to treat us as he or she
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 thus 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.
Thus, 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.
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 vipaka, 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. Sometimes 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.
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-vipaka. 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.
"Freedom from disease is the greatest good fortune."
pañca-mare jine natho
araham buddho itipi
so bhagava namamiham
"Having defeated the five forms of temptation
mainstay (the Buddha) attained the ultimate self-awakening.
He is worthy, awakened,
and thus blessed. I pay him homage."
Chant this every day when you are
sick in bed.
Everyone in the world wants
justice. To give the world justice, we all -- no matter what race or nationality
we belong to -- need to have human values in our hearts. Human values are not
a creed or a religion. When people are born into the world, they want justice
by their very nature. Sometimes they receive it, sometimes they don't. This is
because there are times when they let inhuman values interfere with human values.
When this is the case, these inhuman values prevent them from receiving the justice
For this reason I would like to point out a way that will help
people throughout the world keep their minds in line with human values. Even if
we may have lapses from time to time, we'll still be doing well as long as we
can maintain long intervals between the lapses.
1. Have a sense of moderation
in your likes and loves for people and objects. Don't let yourself get carried
away to the point of infatuation, causing your behavior with regard to people
and objects to go out of bounds. To stumble in this way can -- on the level of
your conduct -- hurt your reputation. On the level of your mind, it can cause
you to be deluded and deceived. The results you reap will be sorrow afflicting
your heart, all from lacking the human value of moderation.
2. In your interaction
with people and objects, don't let yourself get carried away with anger. Even
if people behave in ways that are disagreeable, or if the objects that come your
way aren't what you had hoped for, you should still stop to consider whether those
people have at least some good to them, and whether those objects may be of at
least some use to you. When you can keep your mind in check in this way, you'll
loosen yourself from the grip of anger and displeasure, so that thoughts of good
will can arise within you instead. The result will be that those people will become
your friends and allies; the objects you get will be able to serve you in other
ways. For instance, suppose you want a chisel but you get a nail. This means that
your hopes aren't fulfilled, but even so the nail can be of use to you in other
ways in the future.
In addition, thoughts of good will can foster long-lasting
composure and peace of mind. This, then is a human value that should underlie
our dealings with one another throughout the world.
3. Be upright and straightforward
in all your dealings, behaving toward people behind their backs the same way you
would behave to their faces. Even when confronted with frightening intimidation,
you should make your heart audacious to the proper degree. Too much audacity can
cause harm, and the same holds true for being too timid. For example, if you let
yourself become intimidated in your business dealings, your business will suffer.
If you're too reckless or audacious, that too can lead to missteps in your work.
Thus you should have a sense of moderation and proportion so that your relationships
with people and the various objects in the world will run properly. Only then
will you count as having human values.
4. Whatever you do in thought, word,
or deed, dealing with people or objects in the world, you should first examine
your motivations. Only if they're sound and reasonable should you listen to them
and act in line with them. This will keep you from coming under the sway of delusion.
You have to be endowed with the human values of circumspect mindfulness and reasonable
discernment. Those who can behave in this way will have friends no matter what
social grouping they join. They'll bring about the growth and development of the
various objects they deal with, and will bring progress to themselves and to society
at large -- which is something that each and every one of us desires.
world we live in has been here since long before any of us were born. Even our
creeds and religions all gradually came into being long after the world did. The
history of the human world is that sometimes the world is advanced in both material
and spiritual terms, leading to welfare for all; sometimes humanity is so degenerate
in both material and spiritual terms that it practically sinks into the belly
of the sea. Sometimes the spiritual side is advanced, with people living in peace
and security, while the material side is undeveloped.
When human beings have
human values in their hearts, material progress can bring happiness and well-being
to all. When people lack human values -- when they trample human values underfoot
by going overboard in exercising their power and influence -- material progress
can destroy the peace and well-being of human beings throughout the world. There
is a basic truth that when people are bad, even good material objects can cause
harm to people at large; if people are moral and just, even harmful objects can
When all the people in the world establish themselves firmly
in human values, then it's as if we were all friends and relatives. If people
don't have human values in their hearts, even families fall apart, friends become
enemies -- and when relationships on the small scale are like this, war on the
large scale will be unavoidable. How will we be able to escape it?
in the world should develop human values so that we can all view one another as
friends, expressing in our behavior an attitude of good will and kindness for
the sake of justice and fairness in the world.
The points I have made so far
are principles of nature common to the entire world. Even people who adhere to
different religions should assist one another. We should remember our common humanity
and help one another on the human level. The Buddha praised those who help others
on the basis of common humanity; and as for other religions, I myself have met
with a number of Roman Catholics and Protestants who, when they've come to our
country, seem to be well-mannered, well-educated, and possessed of strong human
values. For example, some of them have helped donate money to build temples and
monasteries. This has made me curious as to what their religion was, and when
I asked them, they said that they were Christian. It struck me then that their
hearts had human values in full measure, which is why they have progressed far
As for the teachings of Buddhism, there is one point where the Buddha
taught that when we deal with people outside of the religion, we should give thought
to our common humanity and not make religion an obstacle. Otherwise, it will cause
When this is the case, people who are well-versed in human values can
fit perfectly into any society and can create strong bonds of friendship with
Thus I ask all who read this to consider the matter using their
The Buddhist Way
What follows is a discussion
of the Buddhist way, a way discovered by a human being whom large numbers of people
have respected and praised as being a worthy person who has shown us the way as
well. When we study his teachings, we are free to believe them or not, as we see
fit; the man who discovered them never laid down any rules coercing us in any
When a group of people sees that a doctrine can lead them to become good
and they give that doctrine their respect and adherence, it is said to be their
religion. As for the religion or doctrine of the Buddha, it can be summarized
in three points.
1. We should refrain from doing anything at all in thought,
word, or deed that would be evil or destructive, that would cause suffering to
ourselves or to others. Even if we find ourselves already doing such things, we
should make an effort to stop.
2. We should develop within ourselves all qualities
that we know to be good and virtuous, maintaining the virtues we already have
-- this is called arakkha-sampada -- and constantly aiming at developing the virtues
we haven't yet been able to acquire.
3. Whatever activities we may engage
in, we should do so with purity of heart. We should make our hearts pure and clean.
If we can't keep them that way constantly, we're still doing well if we can make
them pure from time to time.
All three of these points are the aims of the
The Buddha taught in line with the true nature of the
world. He said, "Khaya-vaya-dhamma sankhara, appamadena sampadetha,"
which means, "All sankharas, once they have arisen, decay by their very nature.
Don't be heedless or complacent. Be thoroughly mindful and completely alert, and
you will attain peace and security."
What this means is this: All things
that appear in the world arising from actions (kamma) are called sankharas --
formations, fashionings, compounded things. Sankharas, by their nature, or of
two sorts -- sankharas on the level of the world and sankharas on the level of
1. "Sankharas on the level of the world" refers to the
eight ways of the world: status, fortune, praise, and pleasure, which are things
to which we all aspire but -- sankharas being what they are, unstable and inconstant
-- results of another sort may interfere: Having had status, we may lose it. Having
had fortune, we may lose it. Having been praised, we may be criticized. Having
tasted the pleasure that come from material wealth, we may become needy and destitute,
afflicted with suffering and pain. Therefore the Buddha taught us not to be so
heedless as to be deluded by these things. If we can't keep this point in mind,
we're sure to suffer.
2. "Sankharas on the level of the Dhamma"
refers to the properties (dhatu), aggregates (khandha), and sense media (ayatana)
that lie within us and that result from unawareness and the sankharas concocted
by the mind giving rise to dhamma-sankharas on the outer level.
The properties that are fashioned into sankhara of the level of the Dhamma are
(1) The solid or dense components of the body, such as bones, muscle,
and skin, are called the earth property.
(2) The liquid aspect, such as the
blood, permeating throughout all parts of the body, is called the water property.
(3) The forces, such as the in-and-out breath, that flow through the body
are called the wind property.
(4) The aspect that gives warmth to all the
parts of the body is called the fire property.
(5) The empty spaces in the
body, where the other properties can move, enter, and leave, the passages that
permit air to enter and leave, and allow us to move -- such as the ear canal,
the nasal passages, and mouth, all the way to the pores -- are called the space
(6) These various aspects of the body, if there's no consciousness
overseeing them, are like a dead flashlight battery that can no longer produce
the power to give rise to brightness or movement. As long as consciousness is
in charge, it can cause the various qualities and parts of the body to be of use
to living beings. Good and evil, merit and demerit can arise only if consciousness
is giving the orders. Thus, good and evil come ultimately from awareness itself.
This is called the property of consciousness.
All six of these properties
are one class of sankharas on the level of the Dhamma.
b. Khandha: The various
categories of things that we experience are called the five aggregates --
Form: All visible sense data, both within us and without, are called the aggregate
(2) Feeling: the feelings of pleasure, pain, and neither pleasure
nor pain that result when consciousness and sense data come into contact with
one another are called the aggregate of feeling.
(3) Perception: The act of
labeling and identifying people and things, both within and without, is called
the aggregate of perception.
(4) Formations: The thoughts and mental constructs
that arise from the mind -- good, bad, right, wrong, in line with the common nature
of all thinking -- are called the aggregate of formations.
Distinct awareness in terms of conventional suppositions -- for example, when
the eye sees a visual object, the ear hears a sound, a smell comes to the nose,
a taste comes to the tongue, a tactile sensation comes to the body, or an idea
arises in the intellect -- being clearly aware through any of the senses that,
"This is good, that's bad, this is subtle, that's fine": To be able
to know in this way is called the aggregate of consciousness.
All five of
these aggregates come down to body and mind. They are sankharas on the level of
the Dhamma that arise from unawareness.
c. Ayatana: This term literally means
the "base" or "medium" of all good and evil. Altogether there
are six sense media: the senses of vision, hearing, smell, taste, feeling, and
All of these things are sankharas on the level of the Dhamma. They
arise as a result of unawareness, i.e., knowledge that doesn't penetrate into
Thus, we have sankharas on the level of the world and sankharas
on the level of the Dhamma. The Buddha taught that all of these sankharas are
undependable, fleeting, and unstable. They appear, remain for a moment, and then
disband. Then they appear again, going around in circles. This is inconstancy
and stress. Whether they're good or bad, all sankharas have to behave in this
way. We can't force them to obey our wishes. Thus the Buddha taught that they're
not-self. Once we've developed precise powers of discernment, we'll be able gradually
to loosen our attachments to these sankharas. And once we've stabilized our minds
to the point of Right Concentration, clear cognitive skill will arise within us.
We'll clearly see the truth of sankharas on the level of the world and on the
level of the Dhamma, and will shed them from our hearts. Our hearts will then
gain release from all sankharas and attain the noblest happiness as taught by
the Buddha, independent of all physical and mental objects.
discussion of these two topics has been brief, it can comprehend all aspects of
the Buddha's teachings.
To summarize: Heedfulness. Watchfulness. Non-complacency.
Don't place your trust in any of these sankharas. Try to develop within yourself
whatever virtues should be acquired and attained. That's what it means not to