There are healing practices and rituals found across Buddhist traditions that reinforce the notion of the healing power of dharma. Dr. C. Pierce Salguero asks, what’s behind the Buddhist approach to healing and medicine? Is the healing power of dharma simply placebo or something more?

Buddhism has always highlighted the healing powers of the dharma. From the very beginning of the tradition, illness and healing have played a central role in narratives, metaphors, rituals, and other aspects of Buddhism worldwide. But, how should we understand the healing power of these practices? Are Buddhist approaches to health and medicine just placebo? 

Virtually all Buddhists will be familiar with the episode in the legend of Siddhartha Gautama’s life when the future Buddha slips out of his father’s palace. Coming across a sick man, he is shaken to his core by the inevitability of the suffering of illness. Later, sitting under the bodhi tree, Siddhartha discovers a path to the ultimate relief of all forms of suffering. For Buddhists ever since following in the Buddha’s footsteps often has meant learning to disidentify from the body and the separate self to be able to calmly and stoically face the travails of illness. At the same time, Buddhist tradition has never rejected engagement with more active or targeted forms of healing. In fact, the vast majority of Buddhists throughout history have fully embraced a wide range of healing practices and have seen them as compatible with, and even central to, the dharma.

These therapeutic practices have included certain herbal remedies, dietary practices, massage, and even surgery (ancient Buddhist texts mention both removal of cataracts and trephination). In addition, sacred texts in Pali, Sanskrit, Chinese, Tibetan, and other languages teach all sorts of meditations, visualizations, doctrinal reflections, and other contemplative practices that are said to directly heal diseases. The Buddhist healing repertoire also involves ritual practices such as sutra chanting, recitation of dharanis or mantras, creation of talismans and amulets, and various purification or karma-cleansing rites. It has been exceedingly popular for millennia for devotees to invoke particular deities such as the Medicine Buddha, Avalokiteshvara, Tara, and others in times of need. Blessings from enlightened beings are thought to be able to cure diseases instantaneously, but also can be stored in blessed objects that are later used to heal or strengthen patients, or to banish or protect against disease-causing spirits. 

This diverse array of Buddhist healing interventions are of more than historical interest. Nearly every Buddhist community around the world continues to find meaning and solace in such teachings and practices today and these therapies were utilized all over the world during the Covid-19 pandemic. Even the most secular Buddhists often cite the benefits of meditation practice for mental and physical health. For all of these reasons, it is common among Buddhists past and present to refer to the Buddha as “the Great Doctor” and the dharma as “the Great Medicine.”

Herbs, diet, massage, and surgery from Asian contexts have all been studied scientifically for over a century. More recently, a flurry of research on mindfulness and other meditations has demonstrated their benefits for both mind and body. However, to date, there has been very little research attempting to measure the effects of rituals. Can wearing a “binding thread” that attaches a monk’s blessings to your wrist, reciting the name of Amitabha Buddha in Sanskrit, or wearing a talisman to repel disease-causing spirits actually improve your health? Such questions have never gained much traction among modern researchers or others who are steeped in a scientific worldview. Among those who are unable to accept the existence of blessings or deities, such remedies are routinely dismissed as just placebo.

Buddhists have historically understood and embraced the placebo effect, and made it a central part of their approaches to healing.

Calling something a placebo is often meant to deny that it has any medical legitimacy. However, recent research suggests otherwise. Over 20 years ago Daniel E. Moerman (a medical anthropologist at the University of Michigan) argued that the placebo effect is mobilized by interactions between healers and their patients as well as by meaningful symbols and cultural cues. More recently, Alia Crum (an assistant professor of psychology at Stanford) has characterized the placebo effect as a natural capacity for a patient’s body to heal itself that is enhanced by a positive mindset and a supportive social context. Ted J. Kaptchuk (a clinical researcher at Harvard Medical School) has focused on understanding the nuances of the placebo effect. In one study, he found that sham pills have a healing effect even when the people taking them know they are fake. In another, he discovered that blue pills have a sedating effect and white pills work better for pain, even when both pills are completely inert. He also found that placebo interventions such as sham acupuncture that involve more complex procedures result in more benefit than those with less complexity. 

These recent trends in placebo research might be summarized as shifting away from controlling for the placebo effect to directly investigating how the placebo effect works and how to maximize it. However, despite some astonishingly promising preliminary results, this is still a new area of study. Modern scientific medicine is still a long way away from embracing the placebo effect and integrating it into clinical practice or physicians’ training in a systematic way. 

In contrast, I believe that Buddhists have historically understood and embraced the placebo effect, and made it a central part of their approaches to healing. Of course, traditional Buddhism doesn’t use the word “placebo,” but I do think that there are analogous concepts. 

In the first place, Buddhist healing rituals seem to me to be sophisticated traditional means of intentionally eliciting and maximizing the effect. Healers routinely administer herbal medicines, massages, and other more tangible therapies embedded within a richly orchestrated web of symbols and healer-patient interactions. For example, when I worked with traditional medicine healers in northern Thailand in the 1990s and 2000s, their herbal prescriptions were frequently prepared with blessed water, chanted over numerous times, and given to patients wrapped in a paper talisman. Healers spent time with each patient that visited, consulting and consoling and listening to their needs. There always was an altar with images of the Buddha, famed monks, and other spiritual helpers so that patients could lay offerings and say prayers on their way in and out of the consultation. Even these healers’ own demeanor and appearance — including their ceremonial clothing, mala beads, amulets, talismanic tattoos, and other accoutrements — all were intended to inspire confidence in patients that they were being magically protected. 

While some might be tempted to call the herbal part of a healer’s intervention the medicine and the rest the placebo, that would introduce a duality that runs against mainstream Buddhist doctrines. Most forms of Buddhism would deny that the mind and body are separable entities. Rather, the bodymind is seen as an interdependent whole. Interventions that may seem to an outside observer to be completely physical thus could be understood by a Buddhist to be operating at the mental level as well, and vice versa. In that light, it is completely unsurprising that a healer would employ the entire gamut of ritual interventions since the more the whole bodymind is involved in the therapy, the more effective it will be.

Mahayana Buddhism pushes this line of thinking even further. According to the doctrine of emptiness, both mind and body are ultimately devoid of any substantiality. It’s not like the body is “really real” while the mind is “just in your head” — both are mirage-like products of our habits of misunderstanding and reification. From this perspective, all interventions, whether physical or mental, “real” or “placebo,” can be seen to operate on the same level playing field. They are all simply skillful means that can help us to navigate the world of appearances and conventions. 

These traditional Buddhist versions of placebo theory don’t necessarily conflict with modern medicine. Rather, they point to the ways that even the most scientific and materially focused medical interventions are always working on both the body and mind inseparably. Every detail of every medical encounter — from how one is greeted upon entering the office, to the color of the paint on the walls, to the kind of plants in the waiting room, to what the doctor is wearing, to the amount of eye contact given during the consultation — influences the patient’s whole being and unconsciously affects the healing process. Some of these factors may be beneficial influences (i.e., inspiring the placebo effect), while others may, in fact, be harmful (the nocebo effect). 

Taking seriously Buddhist notions of interdependence and skillful means would mean intentionally ensuring that our doctors’ offices, hospitals, and other healing spaces are sending comfortable and supportive signals rather than harsh or dehumanizing ones. It would also mean recognizing that every medical intervention — pharmaceuticals, surgeries, vaccines, and everything in between — is always inescapably entangled with subjective mental and emotional factors.

Such detailed attention to how the environment and the interactions between patient and practitioner can support healing is precisely what is being highlighted in traditional Buddhist approaches. Writing off chanting, prayer, talismans, and other rituals as “just” placebo misses the point entirely. These practices skillfully immerse patients in a whole web of complex symbolism and multisensory stimuli in order to maximize the bodymind’s natural capacity to heal itself. They are manifestations of the healer’s compassion, and they inspire confidence in patients that they are surrounded by beneficial energies or entities. 

Perhaps such forces are objectively real and may someday be measurable by science. In the meantime, they can be recognized as critical parts of Buddhist healing precisely because they are placebos — just like every other medical intervention under the sun. And we can recognize Buddhist healing as a model for the highly sophisticated and skillful integration of placebo into healthcare.