Mathomathis would like present an article on Life in the Womb: Conception and Gestation in Buddhist Scripture and Classical Indian Medical Literature By Author: Robert Kritzer. Before proceeding further, make sure to complete the previous article: Life in the Womb | The Garbhavakrantisutra

The Garbhāvakrāntisūtra is the first text that mentions each week of the development of the fetus. In Tibet, however, week-by-week accounts are standard in medical texts, notably in the Rgyud bźi, although there are differences in the total number of weeks as well as in the sequence of development. Most scholarly interest in the account in the sūtra focuses on Tibetan medicine and Tibetan Buddhism, for which the sūtra is a source. In the following, however, author is more interested in the sūtra itself and its relationship to the Indian medical tradition. Author compare’s the accounts of gestation in the Garbhāvakrāntisūtra and in the Carakasamhitā.

Month 1:- First of all, the sūtra, in its description of each of the first four weeks, stresses the suffering of the embryo, which is said to lie in filth, like a lump. The sense organs and consciousness are all in the same place, as if in a pot, and the embryo is very hot and in great pain. Each week the sūtra designates the embryo by one of the terms that we have seen used in the non-Buddhist religious texts: kalala, arbuda, peśī, ghana. The Carakasamhitā, in contrast to the sūtra, does not use such terms for the stages of the embryo, nor does it dwell on the embryo’s suffering. Furthermore, during the first month the sūtra envisions a faster development of the fetus than does the Carakasamhitā. By week four of the sūtra account, the embryo has hardened to the extent that it can be likened to distinct objects, such as a metal cylinder or a shoe last, whereas according to the Carakasamhitā, it is still semi-liquid and shapeless. However, perhaps the most striking difference between the sūtra and the various Indian medical accounts is the winds that feature in the sūtra descriptions of almost all of the first thirty weeks and in the thirty-eighth week. Although “bodily winds” are an important feature of Indian medical theory, winds are generally absent from the accounts of the development of the fetus. The Carakasamhitā does not mention any winds that provoke changes in the fetus. It is true that, according to the Suśrutasamhitā, wind (vāyu) is instrumental in causing the male to discharge semen, the jīva to enter the uterus, and the menstrual blood, after it has collected for a month, to move to the opening of the vagina, but these are not directly related to fetal development. Vāyu is also mentioned regarding the production of various body parts and functions, but always in connection with the other humors, and in these cases, the winds are not differentiated or named, as in the sūtra. In one verse, the blowing of wind (māruta) is said to cause the growth of the fetus. However, the wind is not named, nor is any specific developmental feature identified. The manifold winds of the sūtra, each with its imaginative name, do not seem to be derived from the Indian medical tradition of the time. However, they do seem to have been absorbed from the sūtra into the Tibetan medical system, where they are found in many texts, although not in the Rgyud bźi. For now, the question of the winds’ origin must remain unanswered.

Month 2:-  Again, the embryo is developing faster in the sūtra’s account than in the Carakasamhitā version. In the sūtra, the limbs appear gradually during this month, impelled by the sequence of winds. For each week, a botanical simile is provided to describe the function of the winds in producing the various features. For example, in week six a wind causes the fetus to manifest its elbows and knees, just as spring rain falling on edible plants produces branches. During this month, the outline of the body seems to take shape, but its contents—bones, blood, organs, and skin— will not appear until later. In the Carakasamhitā, on the other hand, there is no differentiation of body parts; the embryo is simply a congealed mass. The term ghana is used at this point as a general description of the embryo at this stage, whereas the terms peśī and arbuda refer respectively to female and neuter embryos. A third term, pinda, is introduced to designate the male embryo. These terms do not refer to separate stages of the fetus here.

Month 3:- In the ninth week, according to the sūtra, a wind causes the fetus to manifest the signs of the nine orifices (eyes, ears, etc.). In the tenth week, one wind makes the fetus firm, while another one expands the womb. In the eleventh week, a wind causes the fetus to be penetrated by nine holes, presumably the same nine mentioned before, which it then enlarges as the mother moves. In the twelfth week, intestines and joints are produced by another wind. The process of filling in the outline of the body has begun. The sūtra describes a more gradual process than does the Carakasamhitā, which states that the sense organs and the parts of the body are all formed at once. This may be in part ascribable to the fact that a week-by-week account will naturally seem more gradual than a month-by-month one. However, the use of the word “all at once” (yaugapadyena) in the Carakasamhitā leaves no doubt that sometime in the third month the featureless embryo suddenly gains the features that make it recognizable as an incipient human being. On the other hand, it is important to note that both accounts are at odds with the Western medical belief in “preformation,” prominent in the seventeenth century, according to which the fetus was “preformed, a fully fashioned though tiny adult that simply grew in size.” The Carakasamhitā says that feelings (vedanā) appear at the same time, the fetus becomes animated, and its influence on its mother, which is called “twoheartedness” (dvaihrdayya, equivalent to dohala), commences. However, in the sūtra two-heartedness is not mentioned, nor are feelings. The sūtra describes only external physical features in this month.

Month 4:- In its account of the fourth month, the sūtra includes many interesting details. In week thirteen, the fetus is said to be hungry and thirsty, and it receives nourishment through its navel from the food consumed by the mother. In weeks fourteen and fifteen, winds produce large numbers of sinews and blood vessels. In week sixteen, a wind, which is said to result from karma, establishes the eyes, ears, nostrils, mouth, throat, and heart in their proper places and makes digestion and respiration possible, just as a potter takes a lump of clay, puts it on his wheel, and shapes it into a vessel. Similar details are not included in the month-by-month account in the Carakasamhitā, which simply says that the fetus becomes thick and the mother feels heavy. In fact, after the third month, the text hardly describes any developmental details and focuses more on the pregnant woman and her interaction with the fetus.

Month 5:- In the seventeenth week, according to the sūtra, a wind first cleanses and arranges the digestive and respiratory systems, as well as the parts of the body with which, in the nineteenth week, the sense organs will be associated. The simile is drawn to a skillful person cleaning a dirty mirror with a cloth. In the eighteenth week, another wind purifies the six bases (the meaning of which is unclear), “as when the sun and the moon are obscured by a great cloud, and a strong wind arises and disperses the cloud.” In the twentieth week, still another wind causes the bones to be produced and arranges them, just as a sculptor shapes a sculpture. According to the Carakasamhitā, in the fifth month flesh and blood appear, and the mother becomes thin. The sūtra, however, assigns these developments to the sixth month and as usual does not worry about the mother’s condition.

Month 6:- According to the sūtra, following the production of flesh and blood, skin is produced and then “brightened” in the sixth month. In the description of the twentyfirst week, another interesting simile is made: a wind makes flesh grow on the body just as when a plasterer spreads mud on a wall. As for the Carakasamhitā, it states that strength and complexion develop in the fetus, while the mother loses strength and complexion. There seems to be some agreement here if we can assume that the production and brightening of skin correspond to developing complexion. As in the previous month, the Carakasamhitā envisions the fetus’s development at the expense of the mother. This aspect is totally absent from the sūtra although it would seem to be a good basis for meditation on suffering: the condition of the fetus improves at its mother’s expense.

Month 7:- In its description of the seventh month, the sūtra portrays the fetus as nearing completion. Its blood and flesh become increasingly moist, and hair, body hair, and fingernails appear. But the striking feature here is the sudden introduction, in the account of the twenty-seventh week, of a discussion of the karma of the fetus (this is found in all versions of the sūtra so there can be no question of its being a later interpolation). If the fetus has done bad things in a previous life, it will receive various bad results: its attributes will all be the opposite of what is desirable in the world into which it will be reborn; it will have various disabilities, such as deafness, and even its relatives will hate it. If the fetus has done good things in a previous life, the opposite will happen.

Furthermore, in the description of the twenty-seventh week, it is said that if the fetus is male, he will squat on the mother’s right side, his hands covering his face, facing his mother’s back. If the fetus is female, she will squat on the mother’s left side, her hands covering her face, facing her mother’s belly. The fetus is situated between the stomach and the intestines, the contents of which respectively press down on and poke up at the fetus, causing pain. When the mother eats too much or too little, it causes pain, as does food that is too oily or too dry, too cold or too hot, salty or bland, bitter or acidic, sweet or hot. The various actions of the mother, such as having sex and walking fast, all cause pain. Nanda, the interlocutor of the sūtra, is then reminded of the various sufferings that humans experience in the womb and exhorted to avoid the endless sea of sufferings of samsāra. Also, in the twenty-eighth week, eight mistaken ideas are said to arise in the fetus: a house, a vehicle, a park, a tower, a grove, a seat, a river, a pond. There is no further explanation, but it seems as though these are mistaken notions because the fetus thinks it is dwelling in one of these places rather than in the place where it really is, namely its mother’s womb. According to the Carakasamhitā, the fetus develops in every respect, and the mother becomes generally exhausted. The details of growth enumerated in the sūtra are left unspecified. Like the sūtra, the Carakasamhitā ascribes a role to karma in both embryology and disease, a topic explored by Weiss. However, Weiss points out that in many passages, particularly those with practical applications, the influence of karma is rather downplayed. In its month-by-month account of gestation, the Carakasamhitā explains the two-heartedness of the third month as resulting from past karma and mentions the self (with which karma is associated) as one of the factors in determining sex, but it does not associate karma with the further development of the fetus. Nor does it claim, as the sūtra does at a later point, that karma causes defects that lead to the premature death of the fetus.

Month 8:- According to the sūtra, winds apply the finishing touches to the external features of the fetus, and the effects of karma on its appearance are mentioned. This is a continuation of the development in the twenty-seventh week, when the effects of karma on the fetus are first mentioned. The Carakasamhitā still focuses on the relationship between mother and fetus, both physical and mental. It says that they exchange ojas (vital fluid), as a result of which their moods can be unstable.

Months 9–10:- During the thirty-first through thirty-fifth weeks, according to the sūtra, the fetus gradually grows and reaches its full size and complete development. In the thirty-sixth week, it becomes unhappy inside its mother’s belly, and in the thirtyseventh week, it has three unmistaken notions, of uncleanliness, a bad smell, and darkness. This seems to be in contrast to the mistaken notions in the twenty-eighth week: now it realizes how unpleasant the womb is and presumably is ready to come out. Finally, in the thirty-eighth week, a wind directs the fetus toward the vagina, and another wind, compelled by the force of karma, turns the fetus so that its head is pointing downward ready for birth. The Carakasamhitā simply states that these are the months of childbirth, and it mentions elsewhere that the fetus turns over so that it can be born headfirst. Again the sūtra invokes the agency of winds, this time to move the fetus into position for birth, whereas the Carakasamhitā does not. As we have seen above, at least one other religious text, the Agnipurāna, also mentions a wind that turns the fetus over into position to be born headfirst. It appears as though all the accounts have finally converged at this point.

Author’s Conclusion:- The Garbhāvakrāntisūtra and the Carakasamhitā share an epigenetic model of fetal development unlike the preformationist one common in seventeenth- and eighteenth-century Europe. They do not imagine that a homunculus is implanted in the womb at conception and needs only to bide its time and grow in size during the nine or ten months of gestation. Rather, they describe a process in which the material contribution of the two parents, once animated by the antarābhava or the soul, develops gradually, its various parts becoming differentiated and growing month by month. The Carakasamhitā is rather terse in its account and goes into few details, giving the impression of an abrupt development, with the sense organs and body parts all being formed at once in the third month, the flesh and blood developing in the fifth, and the fetus growing and gaining strength in the remaining months. The sūtra, on the other hand, goes into far greater detail. It gives the impression that in the earlier months the outline of the fetus is being sketched in. As time goes by, the contents—the internal organs—appear, and the structure of the fetus is literally fleshed out. Finally, the most external parts of the body, the hair and nails, become completely visible as the fetus attains its full size. It is perhaps surprising how similar these two ancient accounts are to modern medical descriptions of gestation. One major difference is that development, generally speaking, occurs earlier according to modern medicine, with many things happening during the first month, whereas in the Indian accounts the fetus is little more than a lump or an even more shapeless blob.

This may be explained by the available technology: there was obviously no ultrasound technology in ancient India, nor were there scanning electron microscopes for conducting meaningful dissection. From the second month, however, the account in the Buddhist sūtra seems to move along similarly to that of modern medicine, although often perhaps a month behind. Of course, the details differ, and the sūtra is not as sophisticated. Nevertheless, the epigenetic model is the same. This is not to say that the sūtra is scientific. Th e winds it mentions are mythical and magical, corresponding to nothing in medicine, either ancient Indian or modern Western. The account of gestation occurs in the context of a sermon on the suffering inherent in rebirth, and the emotion elicited by the physiological details is neither scientific detachment nor wonder at the miracle of life. We are reminded of the filth in which the fetus grows and the pain that it experiences, at both the embryonic stage and in the seventh month, when it is fully capable of appreciating its predicament. In the Buddhist meditation on the body, the practitioner is explicitly told that the enumeration of the hairs, sinews, guts, bones, etc., is for the “direction of attention to repulsiveness.” In this sūtra, Nanda is not meditating, but the message that he is hearing is that the body, beginning from the porridge-like liquid in the hot, filthy pot-like womb, is an unsatisfactory, suffering mess, consisting of vast numbers of components, formed and arranged by oft en grotesquely named winds. This contrasts strikingly with the neutral description found in the medical literature. However, perhaps the same imaginative prowess that the unknown author or authors of the Buddhist sūtra employ to disgust the listener with the rebirth process enabled them to visualize more completely than the medical texts, and surprisingly accurately, the development of life in the womb.

Finally, it must be emphasized that in the Garbhāvakrāntisūtra, the embryo and the womb are viewed totally negatively. Elsewhere in Buddhist literature, the womb comes to have positive connotations, as in the doctrine of Tathāgatagarbha, where the “womb of the Tathāgatas” refers to the inherent potential in all beings to become Buddhas. In Tantric texts, as Frances Garrett points out, spiritual development is likened to the development of the embryo. But this sūtra is clearly an example of what Alan Sponberg refers to as ascetic misogyny in early Buddhist literature. Here the womb, as well as the vagina and the woman to whom they belong, are all considered to be agents of samsāra. And as the Buddha tells Nanda in the account of the twenty-seventh week: if even in good rebirths, one is born in such an unclean and awful place and suffers so much pain, how much worse will it be in bad destinies such as those of hungry ghosts, animals, and hell-beings? The only way out is to give up the pursuit of pleasure so that one can eventually escape the suffering that begins in the womb in every lifetime.