EAS MA Thesis - University of Toronto T-Space · literature in which the Buddha himself was a central figure. [11] The Mahavastu (भहािस्तु), which was composed some

EAS MA Thesis

The Buddhalakshana (बुद्धलक्षणानि)

By

Oleg Daniel Bendz

A thesis submitted in conformity with the requirements for the degree of Master of Arts

in the Department of East Asian Studies

University of Toronto

© Copyright by Oleg Daniel Bendz 2010

2010-02-22

Supervisor: Professor S. Sandahl

ii

The BuddhalakSana (बुद्धलक्षणानि) Oleg Daniel Bendz

Master of Arts Department of East Asian Studies

University of Toronto 2010

Abstract:

The physical representation of the Buddha (Siddhartha Gautama) is characterized by some

thirty-two uncommon attributes that are described in the Lalitavistara as the marks of a great man. The

origin of these attributes, whether they are actual physical observations, of symbolic origin or a combination

is unclear. In various art forms depicting the Buddha, he is usually shown with some but not all of these

attributes. We have examined the origin of these physical attributes, by considering what is known of

similarly described physical variations in humans (both congenital and acquired) and by examining the

Sanskrit medical texts, such as the Sushruta-Samhita and the Charaka-Samhita, for descriptions of these

and similar attributes.

It is plausible that the observation of most of these thirty-two uncommon physical attributes might

well have been accumulated over centuries as a result of contact by observers with various afflicted

persons. It is kept in mind that the Buddha is described as physically well endowed and healthy, while the

occurrence of the physical attributes themselves are sought in disorders. The concept of the physical

marks of a great man, having been formulated in an earlier period, is applied to the image of the Buddha

himself.

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Acknowledgements:

This academic undertaking, like any other, is built on the efforts and accomplishments of

innumerable individuals, whose work creates a base of experience and knowledge from which we benefit

and in turn build upon.

Our gratitude should in the greatest part be expressed to Professor Stella Sandahl for her attentive

guidance, kind suggestions and patient instruction. Over the last several years, I have benefitted greatly

from her expertise in numerous areas of Sanskrit language and Indian culture. Her helpful encouragement

and advice made it possible for me to undertake this study.

A note of thanks should also be directed at a number of participants at the Fourteenth International

Sanskrit Symposium in Kyoto in September, 2009 for their helpful suggestions for this study.

Finally, I should like to express my gratitude to the East Asian Studies Department of the University

of Toronto for allowing me to pursue my studies in Sanskrit.

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Table of Contents: Introduction

Buddha's physical representation in art

Perspectives from early Indian medical literature

Medical discussion

Regrouping the 32 marks

Occurrence of the 32 marks

Accounting for the 32 marks in Buddha

Plausibility and conclusions

Footnotes

General references

Medical references

Tables

Table 1. The thirty-two superior marks

Table 2. The eighty secondary marks

Table 3. Physical qualities of children associated with health and a long life, from the

carakasaMhitA.

Appendixes

Appendix A. Sources of the marks of the great man (भहाऩुरुषरऺणानन)

Appendix B. Harvard-Kyoto encoding and the Sanskrit alphabet

Appendix C. A description of some medical terminology

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Introduction:

The physical representation of the Buddha is characterized by thirty-two uncommon, exceptional

attributes that are described in the Lalitavistara (रलरतविस्तय्) and other texts as the marks of a great man

(भहाऩुरुषरऺणानन). A number of early Buddhist texts describing and enumerating these attributes are listed

in Appendix A; the thirty-two major marks and eighty secondary marks are enumerated in Tables 1 and 2.

When applied to bodhisattvas and the Buddha himself, these marks are often referred to as the

buddhalakshanas (फुद्धरऺणानन). The origin of these attributes, whether they are actual physical

observations, of symbolic origin or a combination is unclear. In various art forms depicting the Buddha, he

is usually shown with some but not all of these attributes. We should like to look into the origin of these

physical attributes, by considering what is known of similarly described physical variations in humans (both

congenital and acquired) and by examining the Sanskrit medical texts, such as the suZrutasaMhitA

(सुशु्रतसंहहता) and the carakasaMhitA (चयकसंहहता), for descriptions of these and similar attributes.

We expect to be able to determine the plausibility of his physical variations based on current data

available for congenital abnormalities, such as connective tissue disorders (Ehlers-Danlos and Marfan's

syndrome) to explain his skeletal features (his long reach, long digits and legs, pedal deformity), and

acquired physical changes as with endocrinopathies, as one might see with acromegaly (large tongue and

jaw) and Cushing's syndrome (interscapular hump, soft skin, hair growth quality). We should like to keep

in mind that an explanation for these physical attributes are being sought in disorders, while the Buddha is

described as physically well-endowed and healthy and is believed to have lived to beyond eighty years of

age. By examining some early Sanskrit medical sources, such as the carakasaMhitA, we hope to come to

understand early Indian concepts of how qualities are inherited (including congenital variations) and the

associations suggested by various physical attributes. This should allow us to acquire some insights into

the significance of some of the thirty-two marks.

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Buddha's physical representation in art:

Historically, in the early centuries of Buddhism, there is a conspicuous absence of his bodily

representation and image. In early Buddhism, before the new era (first century CE), even in the time of

Ashoka, Buddha is not represented in human form, but by symbols, such as motifs of the stupa, the

dharmacakra (significantly, the wheel), and the asana (आसन-) under the bodhi-tree. [1-3] Originally places

of memorial worship containing the ashes or remains of the Buddha, the caitya (चैत्म:) soon became

widespread across India. To further the extent of these, Ashoka even had the original ashes of the Buddha

unearthed and relocated all over India, yielding caityas in the form of stupas (स्तूऩा्) in many locations.

Furthermore, in later centuries, revered monks and ascetics had stupas erected in their memorial, too.

While Buddha was well revered during his lifetime, it was in first five centuries after his death that he was

worshipped by his symbols -- the stupa (स्तूऩ्), representing his parinirvana (ऩरयननिााण), the tree (चैत्म-िृऺ ्),

representing his enlightenment, the wheel (धभा-चक्र्) -- his first sermon at RSipatana-mRgadAva

(ऋवषऩतनभगृदाि), a forest near Benares [4-6].

The earliest images of the Buddha were produced in Gandhara (गन्धाय) and Mathura (भथुया), which

were ruled by the Kushans (कुषण-), (50 - 250 CE). [7] The cultural environment of the Kushans afforded a

most varied human experience and furnished a setting in which social and cultural innovation would be

likeliest to occur and enjoy the greatest support and propagation. That Buddhism was well established

among the Kushans is evidenced by numerous Buddhist stupas and monuments of that period, as well as

literary works -- such as the Gandhari Dharmapada, written in a north-western middle Indo-aryan prakrit,

whose text is considerably consistent with the Pali and Patna dharmapadas. [8, 9]

The appearance of the image of the Buddha himself represents an innovation, a new idea.

Images of the Buddha "cannot help but include creation and artificiality, because they do not portray the

historical Buddha, but try to represent the ideal body to be owned by the Buddha." [10a] Agrawala relates

3

that during the reign of the great Kushan ruler, Kanishka (कननष्क्), various pantheons found their

representation on coins; these included Zoroastrian deities and brahminical deities like Shiva (लिि). To

represent Buddhism, Buddha would be represented, not just by symbols, but in human form. Accordingly,

with Kanishka's authority, the need of worshippers to see Buddha in physical form was realized through his

representation as "the Mahāpurusha whose body was radiant with 32 marks (द्िात्रिंत-भहाऩुरुष-रऺणानन)."

[10b] Nevertheless, once an image of the physical Buddha had been produced, as stated at the outset, an

irreversible process began that either affected the value of or entirely replaced the earlier symbolism.

In order for the first artist to have produced an image of the Buddha, he would have needed a source,

presumably a literary one, to have some idea of the image to produce. This is not to say that art always

follows literature or that art serves only to illustrate literature. Instead one should appreciate the well

developed medium of oral tradition, repetition and recital that was prevalent in India as well as written

literature in which the Buddha himself was a central figure. [11] The Mahavastu (भहािस्तु), which was

composed some time in the second century BCE, but expanded in the fourth century CE and later [12],

contains repeated accounts of Buddha's appearance as well as four accounts of his birth. In these

accounts, the thirty-two physical attributes of a great man are repeated, occasionally with minor variation.

The Lalitavistara, too, describes the thirty-two physical attributes of the great man, but is regarded, more so

than the Mahavastu, as a most sacred text. Both works describe eighty, mainly physical, secondary

characteristics, as well. The other texts serving as sources of the mahApuruSalakSaNani -- namely,

abhidharmadIpa, abhisamayAlaMkArAlokA prajJaparamitavyakhya (containing aSTasAhsrikA

prajJApAramitA), dIgha nikAya, mahAyAnasUtrasaMgraha, majjhima nikAya (see Appendix A) -- display a

remarkable consistency in the enumaration and in the wording of their enumeration of the thirty-two major

and eighty minor marks of the great man. These marks (रऺण) of a great man (भहाऩुरुष or चक्रिनतान)् are

believed not to be the invention of the Buddhists, but were assumed by them and applied to the Buddha.

(13) These works, as well as similar oral accounts would have provided the artist with the necessary

conceptual material to produce an image.

While the Buddha and the bodhisattvas are described as having the marks (रऺणानन) of the great

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man, the literature suggests that these attributes predate the Buddha himself and that Buddhism inherited

ideas and cultural traditions from pre-existing common Indian tradition. [10b, 12, 13] Coomaraswamy

states: "Thus the Buddhist had taken over at an early period from non-Buddhist sources a conception of

the Buddha as mahāpuruşa or cakravartin. The lakşaņas were certainly not the invention of Buddhists, but

were taken over by them and applied to the person of the Master. In other words, a definite idea of the

Buddha's appearance existed before the time of actual representations; nor did this idea differ from that

which a Hindu would have had of the appearance of such a god as Vişņu, likewise a mahāpuruşa." [13]

There is a time limit to how far back the ideas go that contributed to the conceptualization of the

mahApuruSa. Many of the human physiologic concepts revealed in the carakasaMhitA likely evolved after

the Vedic period. Meulenbeld, discussing the three doshas (दोष-), declares: "In my opinion, the doctrine of

the three doşas is of post-Vedic origin. At the time when the sam ̩hita ̄s of caraka and suśruta assumed their

present shape, it had definitely begun to dominate Ayurvedic theory." [14] While such physiologic ideas

are evolving after the Vedic period, so do the extraordinary attributes of the mahApuruSa.

5

Perspectives from early Indian medical literature:

Among the oldest available medical references is the carakasaMhitA (चयकसहंहता) (CS). The time

of the composition of the carakasaMhitA, as is the case with many instances of early Indian culture, is

difficult to determine. But the evolution of the carakasaMhitA by referencing the works of Atreya (आरमे्),

AgniveZa (अग्ननिेि्), Caraka (चयक्) and DRDhabala (दृढफर्) -- can be estimated as before the time of

Panini (ऩाणणनन), since AgniveZa is mentioned in more than one of Panini’s sUtras. Since in the

carakasaMhitA, the concepts of Ayurveda (आमुिेद, the science of life) are developed on the basis of the

Atharvaveda, the time limits for the evolution of these ideas and physiologic concepts are considered to be

between the time of the Atharvaveda and the time of Panini. Caraka (an individual or a group) refined and

elaborated the works of AgniveZa, becoming the bhASyakAra (बाष्मकाय) of agniveZa's work, much as

pataJjali (ऩतञ्जलर) for the aSTAdhyAyI (अष्टाध्मामी) of pANini, an analogy mentioned by P.V. Sharma in his

introduction to his edition of the carakasaMhitA (see General References).

In the Atharvaveda (or AtharvAGgirasaH अथिााङ्गगयस्), which contains magic formulas for the

healing of disease -- atharvan, "holy magic bringing happiness" -- and curses against enemies and

evildoers -- aGgiras, "hostile or black magic" -- we see the formulation of an interactive structure between

the healer and the unwell. Various illnesses are described specifically, such as consumption

(tuberculosis) (verse 1687ff), and tumors and outgrowths of the neck and shoulders (verses 1365, 1367).

In addition to magic incantations, the Atharvaveda, to address various illnesses, recommends foods,

medicines, rainwater and sunlight, of which the latter are echoed in the carakasaMhitA and later Indian

medical literature.

The carakasaMhitA represents a valuable resource for understanding the extant concepts in India

surrounding human physiology, reproduction, body image, the source of health and etiology of illness.

Some of the other medical sources examined, such as the suZrutasaMhitA (सुशु्रतसंहहता) and the

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bhelasaMhitA (बेरसंहहता), did not offer additional unique material that might contribute to our study. We

used the recently (2008) republished edition of the carakasaMhitA by Priyavrat Sharma (see General

References). As engaging as it might be to proceed along an elaboration on these works, we shall restrict

ourselves to what might be relevant to this discussion.

The idea of rebirth and transmigration is expressed as an established truth, based on the

perception of early sages (CS, vol 1, part 1, chap 11, verse 29) and the individual produced at birth is a final

product of well-defined factors that are enumerated and elaborated upon in the carakasaMhitA. The

embryo produced at conception is the product of the mother, the father and the eternal "self." The qualities

of the offspring that are particularly maternal are the skin, blood, navel, heart and internal organs, while

those that are particularly paternal are the head, facial and body hairs, nails, teeth, bones veins, ligaments

and semen. (CS, vol 1, part 4, chap 3, verse 6-7) However, the third essential determinant is the eternal

self, the source of life (जीि-), producing these qualities of the offspring: life span, self knowledge, mind,

sense organs, respiration, voice, complexion, moods (happiness, misery, desire-aversion), consciousness,

intellect, memory, ego and will. (CS, vol 1, part 4, chap 3, verse 10). The attributes of the eternal self (jIva,

the source of life) are described so (CS, vol 1, part 4, chap 3, verse 8):

आत्भजश्चाम ंगबा् ।

गबाात्भा ह्मन्तयात्भा म्, त ंजीि इत्माचऺत ेिाश्ितभरुजभजयभभयभऺमभबेद्मभच्छेद्मभरोड्म ंविश्िरूऩ ं

विश्िकभााणभव्मक्तभनाहदभननभननधनभऺयभवऩ।

"The embryo is also produced of the self.

"The soul of the embryo, the internal soul, is known as "Ji ̄va," the life force or personal soul.

"It is perpetual, free of decay, old age, death, illness, disruption, perforation, and excision.

"It has multiple forms and actions.

"It is invisible, has no beginning, ending or degeneration."

7

Any unusual features in the physical characteristics of the offspring are viewed as the product of a

number of factors. Clearly, the occurrence of unusual physical features did not go by unnoticed. To

illustrate, let us cite the following (CS, vol 1, part 4, chap 2, verse 29):

फीजात्भकभाािमकारदोषभैतैसु्तथाऽऽहाजविहायदोषै् ।

कुिाग्न्त दोषा विविधानन दषु्टा् ससं्थानिणेग्न्िमिकृैतानन॥

"From defects in seed (sperm), the self, past deeds, the uterus, time and from faults in the behavior and

eating habits of the mother, the damaged harmful elements (दोषा्) produce various distortions of body

shape, complexion, and organs of sense."

Once the child is born it possesses characteristics resulting from these forces.

The carakasaMhitA enumerates approximately thirty qualities of children associated with health

and a long life, of which fourteen are among the thirty-two mahApuruSa lakSanas and several are among

the secondary marks. Please see Table 3. These include the following (with references to the marks of a

great man (भहाऩुरुषरऺणानन) from Tables 1 and 2 in parentheses):

discrete, smooth, deep-rooted black hair (# 2, 21);

broad, even, forehead (# 3);

eyebrows disjoined, even compact and large (# 4, 5);

big mouth, well-set teeth (#8);

tongue broad and long, smooth, thin, normal color (#12);

voice profound, not shallow, sweet, echoing, deeply risen and patient (#10);

large jaw (# 13);

expanded, well-developed chest (# 19, 20);

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hidden xiphoid and vertebral column (#14, 16);

distant breasts (# 20, broad chest);

arms, legs and fingers round, developed and long (# 18, 25, 26);

hands and feet big and developed (# 27);

nails stable, round, unctous, coppery, high and tortoise-shaped, (secondary # 1-3);

thighs tapering downwards, round and well-developed, (# 24);

shanks neither too corpulent not too thin resembling that of a deer's foot (# 25), with hidden

blood vessels, bones and joints (secondary # 7, 8);

feet possessing the above features and tortoise-shaped (# 27, 28).

What is remarkable is that the selection of qualities deemed to be significant are similar in both

enumerations. This is in addition to a fair degree of agreement in the quality of many of the characteristics.

9

Medical discussion:

Let us consider these physical qualities-- "thirty-two marks of a great man" (द्िात्रिता

भहाऩुरुषरऺणानन) --from a medical perspective reflecting on their plausibility and accounting for them with

described medical conditions where feasible. Many of these features can be shown to occur in various

disorders and states of illness. This would provide a basis for their actual observation in real individuals at

various times. Notwithstanding, one considering these anomalies should keep in mind that they are

applied to the Buddha and bodhisattvas as physical enhancements, as marks of greatness, not disordered

abnormality.

Regrouping the thirty-two marks.

Concisely put, the thirty-two qualities in the Lalitavistara address the static physical features of

Buddha's connective tissue structures (hair, skin, teeth, skeletal structure, even voice), excepting only

several entries. Let us regroup the thirty-two marks as enumerated in Table 1.

Hair is described as:

(#1) either curly or in the shape of a turban (उष्णीषिीषा् ) or even a bony protuberance;

(#2) turned to the right, shiny, dark black and curly

(लबन्नाञ्जनभमूयकराऩालबनीरिग्लरतप्रदद्नमणािताकेि्);

(#4) growing as an area of whitish, silvery cotton-wooly hair between his eyebrows (ऊणाा भहायाज

सिााथालसद्िस्म कुभायस्म भ्रुनोसाध्मे जाता हहभयजतप्रकािा "a wooly outgrowth between the eyebrows, with snow or

silver flakes");

(#5) having eyelashes like a cow (गऩऺभनेर्);

(#21) hairs growing singly (एकैकयोभा);

10

(#22) turning to the right at their ends (ऊधााग्रालबप्रदक्षऺणाितायोभा्).

Teeth are described as:

(#7) being forty in number (सभचत्िारयिंद्धन्त्);

(#8) so closely set as not to have interspaces (अवियरदन्त्);

(#9) perfectly white (िुक्रदन्त्).

His skeletal, bony structure:

(#1) the quality of having a crown-like protuberance of his head (उष्णीषिीषा् )

(#3) he has a large, even forehead (सभविऩुररराट्);

(#13) he has the jaw of a lion (लसहंहनु्);

(#14) he has perfectly rounded shoulders (सुसंितृ्तस्कन्ध्);

(#16) he has a large protuberance on or between his shoulder blades (गचतान्तयांस्);

(#18) standing without bending, his hand reaches his knee (ग्स्थतो ऽनिनतप्ररम्फफाहु्);

(#19) the front of his body (chest) resembles that of a lion (लसहंऩूिााधाकाम्);

(#20) he is thin and tall, like a tree (न्मग्रधऩरयभण्डर् (भहायाज सिााथालसद्ध् कुभाय्));

(#24) he has perfectly round thighs (सुवििनतातोरु्);

(#25) he has the legs of the king of gazelles, an antelope (एणेमभगृयाजजङ्ग्);

(#26) long fingers (दीघााङ्गुलर्); (#27) feet with elevated or pronounced heels (आमतऩाग्ष्णाऩाद्);

(#28) standing flat, flat-footed or pes planus (उत्सङ्घऩाद्);

(#32) there is symmetry, allowing him to stand firmly on both feet on the ground (सुप्रनतग्ष्ितसभऩातौ).

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There is some overlap in categorizing these descriptions, that is, some pertain to both bony-skeletal

structures as well as the skin and subcutaneous tissues.

Skin is described as:

(#15) having seven protuberances (सप्तोत्सद्), located on both hands, feet, shoulders and on one

arm;

(#16) the rounding of both shoulders from behind producing an interscapular protuberance was

mentioned under skeletal features;

(#17) the skin is of good (or gold) color or lustre (सूक्ष्भसुिणािणाच्छवि्);

(#29) his hands and feet are soft and delicate (भदृतुरुणहस्तऩाद्);

(#30) the digits of his hands and feet are marked by webs (जाराङ्गुलरहस्तऩाद्).

He has the voice (#10 ब्रह्भस्िय्) of a bird, be it a crow, sparrow, etc., reflecting his laryngeal (cartilaginous)

structure or vocal cords.

His tongue is wide and thin (#12 प्रबूततनुग्जह्ि्), and is capable of a superior range of tastes (#11

यसयसाग्रिान)्.

His genitals are concealed or retracted into a pelvic structure (#23 कोिोऩगतिग्स्तगुह्म्).

The color of his eyes (#6) is described as being either black or blackish-blue (अलबनारनेर्).

Finally, defying any physiologic category, the soles of both feet (#31) are relatively meticulously described

12

as possessing two (one each) brilliant white wheels, with a thousand stripes (rays, spokes) with one rim and

center: ((दीघााङ्गुलरय) अध् कभतरमो् (भहायाज सिााथालसद्धस्म कुभायस्म) चके्र जात ेगचरे (अगचाष्भती प्रबस्िये लसत)े सहस्राये

सनेलभके सनालबके।).

Given the above, it can be said that--besides being a great teacher and spiritual leader--Buddha

possessed a physical appearance -- an accumulation of special physical qualities -- that was different from

most any other known person. While the literature is rife with interpretations as to the purpose and higher

functioning of all these qualities, including even Agrawala's highly interpretive enumeration of Buddha's

qualities, our focus is on considering the physical quality itself, its plausibility and potential etiologies.

Occurrence of the thirty-two marks.

Let us consider the settings in which these physical peculiarities might occur. In other words, we

should like to review a number of pathological conditions, that is, states of illness, in which these

abnormalities might actually be observed. The constellation of skeletal features--including, his long reach,

long digits, long legs, pedal deformity, large jaw--dermal features--including his pigmentation (with black

eyes), webbing of digits, seven prominences, interscapular hump and rounded shoulders, soft skin--glossal

dysmorphism, apparent gonadal underdevelopment, and hair growth quality, location--all suggest either a

congenital etiology that may be one or a combination of congenital connective tissue disorders, gonadal

dysgenesis with alteration of skeletal phenotype, or endocrinopathy. It brings to mind acquired pituitary

disorders (all endocrinopathies) such as acromegaly [15], caused by a growth hormone elaborating

neoplasm of the anterior pituitary, which is associated with soft-tissue enlargement (90%), bony

enlargement of the face (90%), oily skin and skin tags (70%), neuromuscular dysfunction and myopathy

(50%), and other features, such as enlarged tongue.

Let us outline the characteristics of a number of categories of congenital syndromes. Given the

preponderance of skin and skeletal items, one should perhaps commence by considering the inherited

connective tissue disorders [16] as a category. Perhaps the two commonest and most relevant groups of

disorders would be Ehlers-Danlos syndrome--characterized by articular hypermobility and hyperextensible

13

skin in a number of its subclasses--and Marfan's syndrome, a group of congenital disorders (either inherited

or arising spontaneously) with charactersitic musculoskeletal features. Marfan's syndrome (MFS), a

member of a large family of fibrillinopathies [17], is characterized by long, thin extremities (# 20, 25) in

association with arachnodactily (long digits, # 26). Also persons with MFS present with an upper body (top

of the head to the pubic ramus) to lower body ratio that is less that two standard deviations from the norm for

a given population, thereat, with long arms and fingers, facilitating the touching of the knees when upright

(#18). In addition, MFS is characterized by protrusion of the chest (pectus carinatum, item #19) as a result

of rib overgrowth, a high-arched palate, high pedal arches and pes planus (flat footedness, #28 and #32).

Connective tissue defects may also affect cartilage, affecting his voice (#10), and skin with resultant

hyperextensibility and webbing (#30). There are numerous other features of MFS, such as ocular and

cardiovascular problems, that are not immediately relevant to our discussion of the Buddha's physical

qualities.

Generally speaking the entire category of congenital or heritable connective tissue disorders are

characterized by considerable variability in phenotypic expression of the connective tissue defect. One

need only review, for instance, the varied expression of defects seen in Ehlers-Danlos syndrome, with its

hallmarks of skin hyperextensibility and joint hypermobility, to be convinced [16, 18]. Note that more that

twenty genes encode the protein products that produce over eleven types of collagen, and the biosynthesis

of collagen is complex--consisting of cellular protein synthesis, intracellular modification throught the Golgi

apparatus by glycosylation, postsythetic modification (limited proteolysis), formation and stabilization into

fibrillar structures, followed by exocytosis and further extracellular packaging of the protein product, and

final formation of complex extracellular structural protein matrices. It is appreciated that the full phenotypic

expression of mutations in any of the collagens--resulting from alteration of one (or more) components in

such a multicomponent matrix--is still not known for most of these disorders. That is, the full extent as well

as various subtleties of these abnormalities and the final clinical picture is difficult to predict or unknown.

Added to this is that these genetic connective tissue defects are not only inherited but are observed to occur

by spontaneous, new mutations. In Marfan's syndrome, for instance, eighty percent of documented cases

are inherited from a parent, while some twenty percent represent de novo new mutations, with no evidence

in the biological parents.

14

It ought to be emphasized that while Marfan's syndrome, Ehlers-Danlos syndrome, cutis laxa and

osteogenesis imperfecta are clinically the commonest syndromes, the compendious reference produced by

Winter and Baraitser enumerates some two thousand conditions characterized by multiple congenital

anomalies--listed by disease and then by presenting clinical abnormality--albeit many of them rare and

many of them resulting in devastating physiologic and neurologic compromise. The medical field of

heritable connective tissue disorders experienced its initial significant development in the years after the

war (1950's and later), with the recognition of osteogenesis imperfecta and the Marfan syndrome and then

the Ehlers-Danlos syndrome and Pseudoxanthoma elasticum. Earlier prewar medical accounts were

descriptive with designations such as "gargoylism" for the Hurler syndrome. It was with the development

of our understanding of metabolic pathways (and their defects), the biochemistry of connective tissue

(collagen, elastin, etc.) and genetic principles that today's concepts were able to evolve sufficiently to allow

the grouping and formulation of diagnostic criteria of these abnormalities. [19] Given the spontaneous

mutational potential and our relatively recent ability to begin to understand these conditions genetically and

biochemically, all of this is but the tip of a vast iceberg.

Let us very briefly consider item #1, describing the protuberance of his head. Its nature remains

unclear; that is, whether it is just hair, hair in the shape of a turban, or a protuberance caused by the skull or

its contents remains unclear. The newborn infant has two fontanelles, a diamond-shaped anterior

fontanelle at the junction of the coronal and sagittal sutures--generally closing by 18 mo--and a posterior

fontanelle between the intersection of the occipital and parietal bones--generally closing by 8 wks. Since a

bulging fontanelle indicates increased intracranial pressure caused by serious medical neurologic

conditions, like intracranial bleeding, meningitis-encephalitis, hydrocephalus, etc., this is an unlikely cause

of the protuberance described in item #1. Craniosynostosis [20], referring to premature closure of the

cranial sutures, results in the development of various skull deformities caused by large bony ridges. For

instance, scaphocephaly, the commonest and generally not causing any neurologic problems, results from

premature sagittal suture closure--producing a broad forehead (item #3) and prominent occiput (item #1).

(Parenthetically, this causes cephalopelvic disproportion and resultant dystocia during labor.) The head in

scaphocephaly remains bilaterally symmetric. In principle, premature closure of but one suture does not

result in serious neurologic deficit. Notwithstanding, a group of heritable disorders caused by fibroblast

15

growth factor recepter gene defects, known as "craniosynostosis syndromes and skeletal dysplasias" have

been described and are characterized by significant skeletal and skull deformities with anticipated

significant pathological consequences. [21]

The few acquired conditions known to enhance skeletal developement do so by the elaboration of

growth hormone. These are disorders of the anterior pituitary whose clinical manifestation is so gradual as

not to be suspected for many years, causing a substantial delay in diagnosis. As mentioned above,

acromegaly is associated with soft-tissue enlargement (90%), bony enlargement of the face (90%) (#3, 13),

oily skin and skin tags (70%) (#15), and neuromuscular dysfunction and myopathy (50%). Acromegaly is

also associated with an enlarged tongue [22]. The negative clinical effects of increased growth hormone

are also very gradual and initially very subtle, consisting of carbohydrate intolerance (diabetes),

degenerative joint disease, cardiomegaly, and visual field disturbances. The disorder can take several

decades to run its course and produce significant morbidity and mortality.

Another acquired endocrinopathy worthy of consideration is Cushing's syndrome, or

hypercortisolism--of which one cause is an anterior pituitary neoplasm (Cushing's disease) elaborating

ACTH (adenocorticotropic hormone)--resulting in varous symptoms, but physically producing hypertension,

supraclavicular fat pads (#14), a buffalo hump (interscapular protubertance, #16), facial plethora, hirsutism

(abnormal hair growth, #4), purple striae (conceivably perceived as spokes of a wheel?, #31), proximal

muscle weakness--i.e., wasting of pelvic and shoulder girdle muscles (perhaps producing #24, round

thighs). Thinning of skin is observed (#29). Furthermore, while generalized bronze-colored

hyperpigmentation (item # 17) is characteristic of Addison's disease (hypocortisolism), it has been

observed in Cushing's disesase [23], and is results in both settings from the stimulation of melanin

production by ACTH and alpha-MSH. This condition is also not rare and tends to be underdiagnosed in its

early stages.

Without attention being brought to his genitals in #23, that they are retracted into his pelvis, it would

be difficult to suggest male hypogonadism, either congenital or acquired, as worthy of consideration here.

This retraction of his genitalia might easily represent his restraint or modesty and not be a physical

abnormality. [24] Attention is nonetheless brought to this by its enumeration as one of the thirty-two marks.

There is an entire family of disorders characterized by androgen deficiency--whose signs consist of: 1) soft,

16

smooth skin; 2) loss of body hair; 3) a diminution in prostate and testis size. Klinefelter's syndrome, an

example of congenital hypogonadism characteristically results in small testes, infertility, long legs with

resultant tall stature and gynecomastia. [25] This and other congenital disorders of sexual differentiation,

however, frequently but not invariably produce boys with learning disabilities and social malajustment.

Acquired hypogonadotropic hypogonadisms, an example of an acquired condition, is often caused by the

presence of a pituitary tumor--such as a tumor producing ACTH or growth hormone--that indirectly

adversely affects gonadotropin release. Once again, a very prolonged delay in diagnosis (and

underestimation of prevalence) characterizes this family of disorders.

One might accordingly appreciate that most of the thirty-two marks are observed in persons

suffering from various states of illness. And observers, be they physicians or religious practitioners,

would have had the occasion to enumerate and interpret these variations in appearance.

Accounting for the thirty-two marks in Buddha.

A much more difficult undertaking is to account for these in the person of the Buddha. A fact that

deserves emphasis and reiteration is that Buddha was healthy, lived to the age of eighty and is described as

magnificent and beautiful in form. Furthermore, while many of these abnormalities may be "explainable"

by one or another disorder, it might be kept in mind that Buddha, if at all, had only one--or possibly, but less

probably, only two--conditions to explain these phenotypic oddities. If one is interested in formulating a

diagnosis, ascribing to him three such conditions would diminish that diagnostic likelihood by yet another

order of magnitude. That is, he could not simultaneously have suffered from a dozen congenital metabolic

disorders. It should be appreciated that formulating a diagnosis on such an incomplete inventory of

physical observations might be unrealistic, since there is a gaping absence of much information that is

routinely acquired when assessing someone so afflicted. It might also be appreciated that--with the

exception of a number of congenital disorders of gonadal dysgenesis, connective tissue disorder or

endocrinopathy, which bring their owner both immediate and delayed physiologic burden--the vast majority

of congenital metabolic disorders are characterized by severe and often catastrophic limitation of

functioning, neurologic impairment and disastrously reduced life expentancy. The best diagnostic

17

candidates are therefore those disorders characterized by the least interference with physiologic

functioning, at least in the initial stages. Finally, considering item #31, describing with care and in relative

detail the wheels on his feet, and item #7, attributing to him forty teeth, it might be kept in mind that the

possibility remains that these physical attributes might have been given Buddha by his well-intentioned

biographers in order to ascribe to him physical attributes complementing his unique and higher emotional,

spiritual and intellectual level of functioning.

Let us outline some fundamental considerations in formulating such a diagnosis. Any basic

textbook of medicine contains a discussion of this [26], and the potential exists here for a very lengthy

discussion of how to make a medical diagnosis. Nevertheless, a reasonable progression of consideration

would be as follows:

1) Firstly and before all else, the reliability of the observations must be considered. Are we being

told what was actually physically seen or given an interpretation of what was seen? The completeness of

the observations is important.

2) Secondly, given a solid and reliable observation, its relevance to making a diagnostic effort must

be weighed. It should be combined with other reliable findings to produce groupings of findings (potentially

recognize a syndrome).

3) One should consider a finding or a grouping of findings and enumerate reasonable causes,

taking into account the subject's age, sex, geography, the prevalence of each diagnostic candidate and the

etiologic category of the illness--congenital, acquired, etc.

4) Then one takes the given findings and examines their sensitivity and specificity for each

diagnostic consideration, as well as the predictive value for any particular illness. To be more modern, one

might even employ available computerized statistical prediction models based on Bayes' theorem to

enhance predictive accuracy.

5) An assiduous search for additional information--conventionally taking the form of diagnostic

testing, but in this case gathering observations of the subject from other sources--should be made, and

each new observation should be cycled through the above steps, taking particular care with ensuring the

reliability of the information, and assessing whether it represents a distinct observational effort or whether it

represents an interpreted reiteration.

18

Despite the limited observations made of the physical person of Buddha, but still accounting for as

many of the observations as possible, let us advance a a diagnostic hypothesis by no means for the

purpose of making any conclusions but for the sake of illustrating how such an exercise can be made to

account for his observed physical peculiarities. The presence of congenital Marfan's syndrome (MFS) and

the presence of an acquired benign pituitary tumor elaborating either adenocorticotropic hormone (ACTH)

or growth hormone (GH) with secondary acquired hypogonadism may be advanced to explain many of the

observations made of the physical person of Buddha. Referring to the above discussion, MFS would

address the items, 10, 18-20, 25-28, 30, 32. Scaphocephaly might account for the shape of the head and

occipital protuberance. A benign ACTH producing tumor would address the items, 4, 14, 16, 17, 24, 29, and

possibly 31--and GH, 3, 12, 13, 15, 30--with secondary hypogonadism from the local effects of the tumor

producing 23 and 29. This leaves only his teeth (#7-9) and some features of his hair unaddressed. The

above remains consistent with arguably the most reliable quality and medical characteristic of Buddha, that

is, preservation of his neurologic, cognitive and emotional functioning.

In the case of our subject--द्िात्रिता फुद्धरऺणानन "thirty two marks of Buddha"--we have proceeded

with this discussion accepting these thirty-two physical observations as a basis for further diagnostic

consideration. With our current and still growing understanding of congenital deformities,

endocrinopathies and other disorders, it is with great difficulty that one can accomodate all these

possibilities in a single individual while in addition preserving a reasonable life expectancy and sufficient

health and well-being to allow a meaningful functional capacity.

19

Plausibility and Conclusions:

Over the course of time the thirty-two marks, be it individually or in combinations, are likely to have

been observed in real living persons. The individuals possessing them would have been for the most part

unwell, but others would have been functional and able to live with a relatively preserved life expectancy.

Indeed the attributes are characteristic of endocrinopathies, connective tissue disorders and syndromes of

gonadal dysgenesis whose diagnosis even today is often delayed because of their gradual onset and

relative sparing of physiologic function.

Importantly, there is no time limit to these observations. They might well have been accumulated

over centuries as a result of contact by observers with various persons so afflicted. The nature of the

observers might have been either religious or physician practitioners that would have gathered, collected

and recorded their experiences.

How these physical abnormalities were interpreted becomes a matter of even greater conjecture.

Depending on the subject they might have been viewed either as defects or as compensatory blessings.

Eventually, though, some of these attributes made their way to formulating the physical characteristics of

the mahApuruSa (भहाऩुरुष्), the ultimate man.

20

Footnotes Please see References section for complete source identification. 1. Tanaka p.4. 2. Coomaraswamy. The origin of the Buddha image p.1 3. Nariman p.26 4. Foucher p.15 5. Nariman p.26 6. Coomaraswamy p.8 7. Basham p.367 8. Brancaccio p.61. 9. Brough, John. The gandhari dharmapada. Motilal Banarsidass, Delhi, 1962. 10a.Tanaka p.92 10b. Agrawala p. 238 11. Nariman p.26 12. Nariman p.18 13. Coomaraswamy p.29 14. Meulenbeld, G. J. The constraints of theory in the evolution of nosological classifications: a study

on the position of blood in Indian medicine. In Medical Literature from India, Sri Lanka and Tibet. (G.Jan Meulenbeld ed.) E.J.Brill, Leiden, 1991. see p.91.

15. MKSAP XV (2009), American College of Physicians, (Patrick Alguire ed.) Endocrinology and Metabolism. Philadelphia, 2009.

16. Harrison's chap 351 17. Schruijver, I. in Cassidy et al. chap 13 p. 207 18. Nelson's chap 649 p.2207 and Scriver chap 115 p. 2824 19. McKusick, Victor A. Heritable disorders of connective tissue: a personal account of the origins,

evolution, validation and expansion of a concept. pp. 13-18. In Royce, Peter M. and Beat Steinman (eds.). (2002) Connective tissue and its heritable disorders: molecular, genetic and medical aspects. 2nd edition. Wiley-Liss, New York.

20. Nelson's chap 585 p.1992. 21. Francomano, Clair A. and M.Muenke. Craniosynostosis syndromes and skeletal dysplasias caused

by mutations in fibroblast growth factor receptor genes. pp. 961-991. In Royce, Peter M. and Beat Steinman (eds.). (2002) Connective tissue and its heritable disorders: molecular, genetic and medical aspects. 2nd edition. Wiley-Liss, New York.

22. Harrison's chap 31, p. 198 23. Harrison's chap 57, p. 322 24. Powers, pp.13, 23 25. Harrison's chap 338, p.2173 26. Harrison's chap 3, p. 8

21

General References

AbhidharmadIpa (अलबधभादीऩ) with VibhASAprabhAvRtti (विबाषाप्रबािगृ्त्त. Jaini, Padmanabh S. (ed.) Kashi Prasad Jayaswal Research Institute, Patna, 1977.

Abhisamayalamkara'aloka Prajnaparamitavyakhya (अलबसभमारंकायारोका प्रऻाऩायलभताव्माख्मा), the work of Haribhadra. Unrai Wogihara (ed.) The Toyo Bunko, Tokyo, 1977 [1932]. (sanskrit text)

Agrawala, Vasudeva S. Indian art: A history of Indian Art from the earliest times up to the third century A.D. (2 vols) Prithivi Prakashan, Varanasi. 1965.

Astasahasrika Prajnaparamita (अष्टसाहलस्रका प्रऻाऩायलभता). Edward Conze (transl.) Asiatic Society, Calcutta,1958.

The Atharvaveda: Sanskrit text with English translation. (transl. by Devi Chand), Munshiram Manoharlal Pub., New Delhi, 2007.

Basham, A.L. The wonder that was India: a survey of the culture of the Indian sub-continent before the coming of the Muslims. MacMillan, New York, 1954.

Brancaccio, Pia and Kurt Behrendt (eds.) Gandharan Buddhism: archeology, art, texts. UBC Press, Vancouver, 2006.

Brough, John. The Gandhari Dharmapada. Motilal Banarsidass, Delhi, 1962. Burnouf, M.E. Le Lotus de la Bonne Loi. (traduit du sanscrit) L'Imprimerie Nationale, Paris, 1852 et Adrien

Maisonneuve, Paris, 1973.

Caraka-Sam ̩hita ̄ (4 vols), Priyavrat Sharma (ed.) Text with English transl. Chaukhambha Orientalia,

Varanasi, Delhi, 2008. (reprint edition) Coomaraswamy, Ananda, K. The origin of the Buddha image. Munshiram Manoharial Pub., New Delhi,

2001. Dayal, Har. The Bodhisattva Doctrine in Buddhist Sanskrit literature. Motilal Banarsidass, Delhi, 1970.

[London, 1932]. Digha Nikaya editions:

The Di ̄gha Nika ̄ya. Rhys Davids, T.W. and J.E.Carpenter (eds.), London Pali Text Society,

Colombo, Ceylon, 1974. (in Pali)

The Di ̄gha Nika ̄ya. Rhys Davids, J.Estlin (ed.), London Pali Text Society, Colombo, Ceylon, 1960.

(in Pali) Dialogues of the Buddha. 5th ed. Translated from the Pali of the DIgha NikAya by T.W.and

C.A.F.Rhys Davids, Pali Text Society, Luzac & Co., London, 1965-6. Foucher, A. The Beginnings of Buddhist Art. Paul Geuthner, Paris, 1918. Grunwedel, Albert. Buddhist art in India. (J.Burgess (ed.); A.Gibson (transl.)), Bernard Quaritch, London,

1901. Lalita-vistara. Vaidya, P.L. (ed.) Buddhist Sanskrit Texts -- No. 1. Mithila Institute, Darbhanga, 1958. Lefmann, S. Lalita Vistara: Leben und Lehre des Çâkya-Buddha. Halle, Verlag des Buchhandlung des

Waisenhauses, 1902. (2 volumes)

Mahavastu (भहािस्तु) editions: Mahavastu-Avadana. Emile Senart (ed.). 3 vols. Paris. 1882-1897. online text:

http://www.sub.uni-goettingen.de/ebene_1/fiindolo/gretil/1_sanskr/4_rellit/buddh/mhvastuu.htm The Mahavastu. 3 vols. Engl. transl. J.J.Jones.(1949) The Pali Text Society, 1987. Mahayana-sutra-samgraha. P.L.Vaidya (ed.) Buddhist Sanskrit Texts No.17. Mithila Institute,

Darbhanga, 1961. Majjhima Nikaya editions:

The Majjhima-nika ̄ya. Robert Chalmers (ed.), London Pali Text Society, Oxford University Press,

1951.

Majjhima-nika ̄ya, V.Trenckner, R.Chalmers and Mrs.Rhys Davids (eds.) Pali Text Society,

London, 1888-1925 4 vols (unavailable to us) Meulenbeld, G. Jan. A History of Indian Medical Literature. Egbert Forsten--Groningen, 1999.

22

Meulenbeld, G. J. The constraints of theory in the evolution of nosological classifications: a study on the position of blood in Indian medicine. In Medical Literature from India, Sri Lanka and Tibet. (G.Jan Meulenbeld ed.) E.J.Brill, Leiden, 1991.

Nariman, J.K. Literary history of Sanskrit Buddhism. Motilal Banarsidass, Delhi, 1992. Powers, John. A Bull of a Man: images of masculinity, sex, and the body in Indian Buddhism. Harvard

Univ.Press, Cambridge, MA, 2009.

Samtani, N.H. Arthaviniścaya-sūtra and its commentary. Jayaswal Research Inst., Patna, 1971.

Sharma, Priyavrat (ed.) Caraka-Sam ̩hita ̄ (4 vols). Text with English transl. Chaukhambha Orientalia,

Varanasi, Delhi, 2008. (reprint edition) Tanaka, Kanoko. Absence of the Buddha image in early Buddhist art. D.K.Printworld, New Delhi, 1998. Medical References: Cassidy, S. and J.Allenson. (eds.) (2005) Management of Genetic Syndromes. Wiley-Liss, 2005. ISBN

0-471-31286-X Harrison's principles of internal medicine (15th ed.) (2001) (eds. E. Braunwald et.al.) McGraw-Hill. ISBN

0-07-913686-9 MKSAP XV (2009), American College of Physicians, (Patrick Alguire ed.) Endocrinology and Metabolism.

Philadelphia, 2009. Nelson's textbook of pediatrics. (17th ed.) (2004) (eds. R.Behrman et .al). Saunders. ISBN 0-7216-9556-6 Royce, Peter M. and Beat Steinman (eds.). (2002) Connective tissue and its heritable disorders:

molecular, genetic and medical aspects. 2nd edition. Wiley-Liss, New York. Scriver, Charles et.al. (ed.) (2000) The metabolic and molecular basis of inherited disease. Eighth edition.

(4 vols) McGraw-Hill. Winter, Robin M. and Michael Baraitser. (1991) Multiple congenital anomalies: a diagnostic compendium.

Chapman and Hall Medical. ISBN 0-412-29130-4 and 0-442-31316-0

23

Tables 1 & 2. Table 1. The Thirty-two Superior Marks: Lefmann, S. Lalita Vistara: Leben und Lehre des Çâkya-Buddha. Halle, Verlag des Buchhandlung des Waisenhauses, 1902. (thirty-two superior marks, pp.105-106) Burnouf, M.E. Le Lotus de la Bonne Loi. (traduit du sanscrit) L'Imprimerie Nationale, Paris, 1852 et Adrien Maisonneuve, Paris, 1973.

1. उष्णीष- िीषा- there is a protuberance on the crown of the head (उष्णीष-) 2. लबन्नाञ्जन- भमूयकराऩालबनीर- िग्लरत- प्रदद्नमणािता- केि् the hair is glossy black, curled to the right (in the shape of a turban?)

3. सभ- विऩुर- रराट् the forehead is broad and even

4. ऊणाा (भहायाज सिााथालसद्िस्म कुभायस्म) भ्रुनोसाध्मे जाता हहभयजतप्रकािा between the eyebrows is a wave of hair (ऊणाा) 5. गोऩ- ऺभनेर् the eyelashes are like those of a bull 6. अलबनीर- नेर् the eyes are black and brilliant 7. सभ- चत्िारयिंद्धन्त् he has forty teeth, all of the same size 8. अवियर- दन्त् the teeth are contiguous, close together 9. िुक्र- दन्त् the teeth are white

10. ब्रह्भस्ियो (भहायाज सिााथालसद्ध् कुभाय्) he has the voice of Brahma, a crow or a sparrow

11. यसयसाग्रिान ् he has a refined sense of taste, a superiority in tasting flavors

12. प्रबूततन-ु ग्जह्ि् his tongue is wide and thin

13. लसहं- हनु् he has the jaw of a lion

14. सुसंितृ्त- स्कन्ध् his shoulders are perfectly rounded

15. सप्तोत्सद् as are his seven protuberances, his extremities, shoulders, arms

16. गचतान्तयांस् the space between the shoulders is full or has a hump

17. सूक्ष्भ- सुिणा- िणा- च्छवि्

24

his skin is golden

18. ग्स्थतो ऽनिनत- प्ररम्फ- फाहु् when upright, his hands reach his knees

19. लसहं- ऩूिााधाकाम् the front of his body is like that of a lion

20. न्मग्रध- ऩरयभण्डर् his chest has the width of a nyagrodha tree

21. एकैकयोभा his hairs grow one by one

22. ऊधााग्रालबप्रदक्षऺणािता- योभा् his hairs turn to the right at their ends

23. कोिोऩगतिग्स्तगुह्म् his genitals are drawn up

24. सुवििनतातोरु् his thighs are perfectly round

25. एणेमभगृयाज- जङ्ग् he has legs like the king of antelopes

26. दीघााङ्गुलर् his fingers are long

27. आमत- ऩाग्ष्णा- ऩाद् the feet have pronounced, extended heels

28. उत्सङ्घऩाद् standing horizontally, even with his feet, flat-footed

29. भदृ-ु तरुण- हस्त- ऩाद् hands and feet are delicate and slender

30. जाराङ्गुलर- हस्तऩाद् the digits of his hands and feet are marked by nets and webs

31. (दीघााङ्गुलरय) अध् कभतरमो् चके्र जाते गचर े(अगचाष्भती प्रबस्िये लसते) सहस्राये सनेलभके सनालबके

on the soles of both feet are two bright brilliant white wheels, with a thousand rays or spokes.

32. सुप्रनतग्ष्ितसभऩातौ both feet are equal, even and are placed flat and firmly on the ground

25

Table 2. The Eighty Secondary Marks: Enumeration after Grunwedel (pp. 158-162)

तुङ्गनखश्च भहायाज सिााथालसद्ध् कुभाय्। 1. prominent nails

ताम्रनखश्च ग्स्ननधनखश्च ितृ्ताङ्गुलरश्च अनुऩूिागचराङ्गुलरश्च गूढलियश्च गूढगुलपश्च घनसंगधश्च अविषभसभऩादश्च आमतऩाग्ष्णाश्च भहायाज सिााथालसद्ध् कुभाय्। 2. dark, coppery nails 3. smooth nails 4-6) round, regular and long fingers 7-8) hidden [bony] prominences and ankles 9) solid joints 10) the feet are identical 11) pronounced heels

ग्स्ननधऩाणणरेखश्च तुलमऩाणणरेखश्च गम्बीयऩाणणरेखश्च अग्जह्भऩाणणरेखश्च अनुऩूिाऩाणणरेखश्च त्फम्फोष्टश्च नोच्चिचनिब्दश्च भदृतुरुणताम्रजह्िश्च गजगजातालबस्तननतभेघस्ियभधयुभञ्जघोषश्च ऩरयऩूणाव्मञ्जनश्च भहायाज सिााथालसद्ध् कुभाय्। 12-16) the lines of the hands are smooth, and are the same in quality and number, deep, straight, regular 17) round lips 18) the sound of his speech is not coarse 19) the tongue is soft, tender, dark or coppery colored 20) sweet, pleasant voice as clear as thunder or the sound of an elephant 21) full and well-developed limbs

प्ररम्फफाहुश्च िुगचगारिस्तुसंऩन्नश्च भदृगुारश्च वििारगारश्च अदीनगारश्च अनुऩिोन्नतगारश्च सुसभाहहतगारश्च सुविबक्तगारश्च ऩथृवुिऩुरसुऩरयऩूणाजानुभण्डरश्च ितृ्तगारश्च भहायाज सिााथालसद्ध् कुभाय्। 22) long arms 23-29) limbs are radiant, bright and perfectly developed; graceful, large and powerful, majestic, well built, well proportioned 30) knees are broad, wide and full 31) rounded limbs

सुऩरयभषृ्टगारश्च अग्जह्भिषृबगारश्च अनुऩूिागारश्च गम्बीयनालबश्च अजीह्भनालबश्च अनुऩूिानालबश्च िुच्माचायश्च ऋषबित्सभन्तप्रासाहदकश्च ऩयभसुवििुद्धविनतलभयारोकसभन्तप्रबश्च नागविरग्म्फतगनतश्च भहायाज सिााथालसद्ध् कुभाय्। 32-33) graceful, straight, powerful, well-ordered limbs 34-35) navel is deep and regular (not crooked) 36-37) exemplary behavior; the most entirely kind and amiable disposition 38) his radiance is the most virtuous, brightening all and seeing in the greatest darkness 39) he moves cautiously like an elephant

26

लसहंविक्रान्तगनतश्च ऋषबविक्रान्तगनतश्च हंसविक्रान्तगनतश्च अलबप्रदक्षऺणाितागनतश्च नतृ्तकुक्षऺश्च भषृ्टकुक्षऺश्च अग्जह्भकुक्षऺश्च चाऩोदयश्च व्मऩगतछन्ददोषनीरकारकादषु्टियीयश्च ितृ्तदंष्रश्च भहायाज सिााथालसद्ध् कुभाय्। 40-43) when he goes, he strides like a lion, a bull, a goose, and tends to the right 44-47) his belly is round, smooth and straight, like a bow 48) his body is pleasing, free of all defects, unspoiled by black spots 49) the eye teeth are round

तीक्ष्णदंष्रश्च अनुऩूिादंष्रश्च तुङ्गनासश्च िुगचनमनश्च विभरनमनश्च प्रहलसतनमनश्च अमतनमनश्च वििारनमनश्च नीरकुिरमदरसदृिनमनश्च सहहतबूश्च भहायाज सिााथालसद्ध् कुभाय्। 49-51) the eye teeth are round, sharp and regular 52) the nose is prominent 53-63) the eyes are bright, clear, cheerful, far-gazing, wide, and dark, resembling the dark-blue flower of the water lily (lotus)

गचरबूश्च अलसतबूश्च संगतबूश्च अनऩूिाबूश्च ऩीनगण्डश्च अविषभगण्डश्च व्मऩगतगण्डदोषश्च अनुऩहतकु्रष्टश्च सुविहदतेग्न्िमश्च सुऩरयऩूणेग्न्िमश्च भहायाज सिााथालसद्ध् कुभाय्। 64-67) his cheeks are full, equal, free of defects and not deformed by anger 68-69) he has a perfect understanding of and power over his senses

संगतसुखरराटश्च ऩरयऩूणोत्तभाङ्गश्च अलसतकेिश्च सहहतकेिश्च (ससंगतकेिश्च) सुयलबकेिश्च अऩरुषकेिश्च अनाकुरकेिश्च अनुऩूिाकेिश्च सुकुग्ञ्चतकेिश्च श्रीित्सस्िग्स्तकनन्द्माितािधाभानसंस्थानकेिश्च भहायाज सिााथालसद्ध् कुभाय्। 70) forehead [and face] emanating happiness 71) the most perfect body (head?) 72-79) the hair is black, held together well, well arranged, smooth, orderly, nicely curled 80) the hair is arranged resembling auspicious diagrams, srivatsa (a cruciform flower), svastika (a cross with its limbs bent at right angles), nandyavarta (diagram of happiness), vardhamana (a mystical figure or diagram). (These symbols are generally drawn as variations of geometric crosses inside of a circle or wheel.)

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Table 3.

Physical qualities of children associated with health and a long life, as enumerated in the चरकसंहिता, chapter 4 (शारीरस्थािम)् verse 51.

The text and translation (with modification) has been taken from: Caraka-SaMhitA (4 vols), Priyavrat

Sharma (ed.) Text with english transl. Chaukhambha Orientalia, Varanasi, Delhi, 2008. (reprint edition)

Qualities coinciding or similar to the the marks of a great man (भहाऩुरुषरऺणानन) from Tables 1 and 2 are referred to in parentheses.

तरभेान्मामष्भता ंकुभायाणां रऺणानन बिग्न्त। There, these qualities are those of children of health and long life.

एकैकजा भदृिोऽलऩा् ग्स्ननधा् सफुद्धभरू् कृष्णा् केिा् प्रिस्मन्त।े discrete, soft, sparse, smooth, deep-rooted black hair are expressed (# 2, 21)

ग्स्थया फहरा त्िक्। firm and thick skin

प्रकृत्माऽनतसऩंन्नभीषत्प्रभाणानतितृ्तभनरुूऩभातऩरोऩभ ंलिय्। व्मढंू दृढं सभ ंसलुिष्टिङ्खसनध्मधू्िाव्मञ्जनसऩंन्नभऩुगचत ंिलरभभधाचिााकृनत रराटभ।् naturally well-endowed, slightly bigger in size, proportionate and umbrella-like head, broad, firm, even, united well with the temples, endowed with upper superior signs (three

transverse lines), corpulent, wrinkled half-moon shaped forehead (# 3)

फहरौ विऩरुसभऩीटौ सभौ नीचैिृाद्धौ ऩषृ्ितोऽिनतौ सलुिष्िकणाऩरूकौ भहाग्च्छिौ कणौ। thick ears with large and even flaps, elongated downwards depressed at the back, having

compact tragus and big meatus

ईषत्प्ररग्म्फन्मािसगंत ेसभे सहंत ेभहत्मौ भ्रिुौ। eyebrows slightly hanging downwards, disjoined, even compact and large (# 4, 5)

सभे सभहहतदिाने व्मक्तबागविबागे फरिती तजेसोऩऩन्ने स्िङ्गाऩाङ्ग ेचऺुषी। eyes equal having concentrated vision, with clear divisions, strong, lustrous and having

beautiful front and corners

ऋज्िी भहोच््िासा ििंसऩंन्नेषदिनताग्रा नालसका। nose straight with large nostrils, well-ridged and slightly depressed at the tip

भहदृजुसनुनविष्िदन्तभास्मभ।् big mouth, well-set teeth (#8)

आमाभविस्तायोऩऩन्ना श्रऺणा तन्िी प्रकृनतिणामकु्ता ग्जह्िा। tongue broad and long, smooth, thin, normal color (#12)

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श्रक्ष्णं मकु्तोऩचमभषू्भोऩऩन्न ंयक्त ंतार।ु palate smooth, hot and red,

भहानदीन् ग्स्ननधोऽननुादी गम्बीयसभतु्थो धीय् स्िह्। voice profound, not poor, sweet, echoing, deeply risen and patient (#10)

नानतस्थूरौ नातकृिौ विस्तायोऩऩन्नािास्मप्रच्छादनौ यक्तािोष्िौ। red lips not too thick or thin, having proper breadth

भहत्मौ हन।ू large jaw (# 13)

ितृ्ता नानतभहतो गग्रिा। round, but not too large a neck

व्मढूभऩुगचतभयु्। expanded, well-developed chest (# 19, 20)

गढंू जर ुऩषृ्िििंश्च। hidden xiphoid and vertebral column (#14, 16)

विप्रकृष्टानतयौ स्तनौ। distant breasts (# 20, broad chest)

असऩंानतनी ग्स्थये ऩाश्िे। unbending and stable sides

ितृ्तऩरयऩणूाामतौ फहू सग्क्थनी अङ्गरुमश्च। arms, legs and fingers round, developed and long (# 18, 25, 26)

भहदऩुगचत ंऩाणणऩादभ।् hands and feet big and developed (# 27)

ग्स्थया ितृ्ता् ग्स्ननधास्ताम्नास्तङु्गा् कूभाकाया् कयजा्। nails stable, round, unctous, coppery, high and tortoise-shaped, (secondary # 1-3)

प्रदऺीणािताा सोत्सङ्गा च नालब्। navel whirled clockwise and deep,

उयग्स्रबागहीना सभा सभऩुगचतभांसां कटी। waist 1/3 less than chest in breadth, even,, having well-developed muscles

ितृ्तौ ग्स्थयोऩगचतभांसौ नात्मनु्नतौ नात्मिनतौ ग्स्पचौ। buttocks round, with firm well-developed muscles, not too elevated

अनऩुिू ंनतृ्तािऩुचममकु्तािरूू।

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thighs tapering downwards, round and well-developed, (# 24)

नात्मऩूगचत ेनात्मऩगचत ेएणणऩदे प्रगढूलसयाग्स्थसन्धी जङ्घे। legs neither too corpulent not too thin resembling that of a deer's foot (# 25) with hidden blood vessels, bones and joints (secondary, # 7, 8)

नात्मऩुगचतौ नात्मऩगचतौ गलुपौ। ankles neither too corpulent nor too thin

ऩिूोऩहदष्टगणुौ ऩादौ कूभााकायौ। feet possessing the above features and tortoise-shaped (# 27, 28)

प्रकुनतमकु्तानन िातभरूऩयुीषगहु्मानन तथा स्िप्तजागयणा मासग्स्भतरूहदतस्तननुनहणआनन। मज्ि ककग्ञ्चदन्मदप्मनकु्तभग्स्त ऩदवऩ सिा प्रकुनतसऩंन्नलभष्टभ।् normal functioning of flatus, urine, stool, sex organs and also sleep, vigil, exertion, smiling,

weeping and suckling as normal indicate a long life span

विऩरयत ंऩनुयननष्टभ।् contrary features are undesirable for a long life

इनत दीघाामरुाऺ णनन। so the features of the long-living person are explained

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Appendix A. Sources of the Marks of the Great Man (भहाऩुरुषरऺणानन) 1. The text of the Lalita Vistara in which the 32 attributes and 80 secondary attributes are described: Lefmann, S. Lalita Vistara: Leben und Lehre des Çâkya-Buddha. Halle, Verlag des Buchhandlung des Waisenhauses, 1902. (2 volumes) see pp. 105-106. Lalita-vistara. Vaidya, P.L. (ed.) Buddhist Sanskrit Texts -- No. 1. Mithila Institute, Darbhanga, 1958. see Chapter 7. JanmaparivartaH saptama. pp.57-82, specifically pp.74-76. 2. Other enumerations (and discussions) of the marks of a great man:

a) AbhidharmadIpa (अलबधभादीऩ) with VibhASAprabhAvRtti (विबाषाप्रबािगृ्त्त). Jaini, Padmanabh S. (ed.) Kashi Prasad Jayaswal Research Institute, Patna, 1977.

see Chapter 4, Part 4, verse 227 pp.187-192

b) Abhisamayalamkara'aloka Prajnaparamitavyakhya (अलबसभमारंकायारोका प्रऻाऩायलभताव्माख्मा), the work of Haribhadra. Unrai Wogihara (ed.) The Toyo Bunko, Tokyo, 1977 [1932]. (Sanskrit text) see (in the edition of U.Wogihara) pp. 918-922. Chapter XXIX. Anugama-parivartaH. Section, DharmakAyAdhikAraH The same text is also found in this more commonly cited work, that was unavailable to us: AbhisamayAlaGkArAloka of Haribhadra published along with aSTasAhasrikA prajJApArmitA, Ed. P.L.Vaidya, Darbhanga, 1960. pp.537ff. (Main title: aSTasAhsrikA prajJApAramitA) c) Dayal, Har. The Bodhisattva Doctrine in Buddhist Sanskrit literature. Motilal Banarsidass, Delhi, 1970.

[London, 1932]. see Chap. VII. The last life and enlightenment. pp.300-305 d) the Digha Nikaya:

The Di ̄gha Nika ̄ya. Rhys Davids, T.W. and J.E.Carpenter (eds.), London Pali Text Society,

Colombo, Ceylon, 1974. (in Pali)

The Di ̄gha Nika ̄ya. Rhys Davids, J.Estlin (ed.), London Pali Text Society, Colombo, Ceylon, 1960.

(in Pali) Dialogues of the Buddha. 5th ed. Translated from the Pali of the DIgha NikAya by T.W.and C.A.F.Rhys Davids, Pali Text Society, Luzac & Co., London, 1965-6. see vol 2, chap 14, part 1, verse 32 and vol 3, chap 30, part 1, verses 142-145. e) Edgerton, Franklin. Buddhist Hybrid Sanskrit Grammar and Dictionary. (2vols) Munshiram

Manoharlal Pub., New Delhi. 2004. see Vol 2. Dictionary pp.458-460 (dictionary entry for lakSaNa-)

f) Mahavastu (भहािस्तु): Mahavastu-Avadana. Emile Senart (ed.). 3 vols. Paris. 1882-1897. online text:

http://www.sub.uni-goettingen.de/ebene_1/fiindolo/gretil/1_sanskr/4_rellit/buddh/mhvastuu.htm The Mahavastu. 3 vols. Engl. transl. J.J.Jones.(1949) The Pali Text Society, 1987. see Vol 1, verses 226-227; Vol 2, verses 29-30, 43-44

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g) Mahayana-sutra-samgraha. P.L.Vaidya (ed.) Buddhist Sanskrit Texts No.17. Mithila Institute, Darbhanga, 1961.

see pp. 329-39. h) the Majjhima Nikaya:

The Majjhima-nika ̄ya. Robert Chalmers (ed.), London Pali Text Society, Oxford University Press,

1951. BL1411.M33T74.1948 see Chap. 91. BrahmAyusuttam PaThamam. Vol 2 pp. 137-139. (The same text can also be found in this more commonly cited work, that was unavailable to us:

Majjhima-nika ̄ya. V.Trenckner, R.Chalmers and Mrs.Rhys Davids (eds.) Pali Text

Society, London, 1888-1925 4 vols)

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Appendix B. Harvard-Kyoto encoding and the Sanskrit alphabet

In our essay we make use of the Harvard-Kyoto encoding (HKe) system for sanskrit. This (HKe) system of representation makes use of nothing more than the latin alphabet and punctuation. This ensures machine readability of any sanskrit text without requiring any additional computer fonts and entirely obviates the need for diacritics.

On the other hand, HKe enjoys the harsh criticism of traditional sanskritists and scholars of indo-aryan languages, who by far prefer the devanagari, or even the brahmi and kharosthi, representation and the conventional system of romanization with diacritics which all indologists accept and agree upon. The conventional system of romanization requires either the installation of additional fonts or the remapping of diacritic characters that potentially makes any computer generated text presently unreadable by another operating system.

Allow us to provide this historical perspective. Even the earliest represenations of sanksrit and prakrit make use of at least two alphabet systems, the brahmi and the kharosthi. Then, over the subsequent centuries, each indo-aryan and dravidian language group develops its very own representation system for sanskrit using its own alphabet -- be it an NIA system derived from the brahmi script, like Hindi, Bengali, Gujarati, etc. or a dravidian system, like Malayalam, Telegu, Tamil, Kannada, etc. So by the eighteenth century, sanskrit is represented throughout India, Nepal, Pakistan, and south-east Asia by a very large variety of local alphabets. Then, it is only with the English occupation of India and the advent of printing presses that one system is selected, specifically, for the purposes of printing and the mass production and dissemination of sanskrit texts. And that system is devanagari, a slight variant of the Hindi alphabet. Accordingly, even the devanagari representation of sanskrit comes to enjoy widespread use as a result of a technological need.

This sentiment, of course, runs against the grain of any sanskritist's preference and what has become conventional represesentation in indology. But provided that orthographic and phonological information is not lost in translation the HKe is indeed viable.

HKe is close to the conventional romanization of sanskrit. It takes advantage of the absence of capitalization in sanskrit, there being no distinction between capital and small letters. Admittedly, some of the sanskrit sounds and letters are represented in HKe by truly awkward and bizarre latin capitals and the

long 'i' (i ̄, इ) is readily confused with the consonant 'l' (l, ल्).

In this section we enumerate, for reference, the sanskrit alphabet in traditional sequence along with the phonological equivalent, the conventional romanized form and the HKe form, used in our essay. Nagari phonologic value Romanized HKe

ऄ [a] a a

अ [a:] ā A

आ [i] i i

इ [i:] i ̄ I

ई [u] u u

उ [u:] ū U

ऊ [ r ̩ ] r ̩ R

ॠ [ r ̩:] r ̩̄ RR or Y

लृ [ l ̩] l ̩ L

ए [e:] e e

ऐ [a:j] ai ai

ओ [o:] o o

औ [a:w] au au

anusvara [v ̃] [+nas] m̩ M

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visarga [h] or [x] h̩ H

The anusvara is represented by a dot over the vowel (तं, taM), the visarga appears as a colon (तः, taH).

The consonants are shown without virama ( क = 'ka'; क् = 'k'), which indicates the absence of any following

'a' or other vowel.

क [k] k k

ख [kʰ] kh kh

ग [g] g g

घ [gʰ] gh gh

ङ [ŋ] ń G

च [tʃ] c c

छ [tʃʰ] ch ch

ज [ʤ] j j

झ [ʤʰ] jh jh

ञ [ɲ] ñ J

ट [ʈ] t̩ T

ठ [ʈʰ] t̩h Th

ड [ɖ] d̩ D

ढ [ɖʰ] d̩h Dh

ण [ɳ] ņ N

त [t] t t

थ [tʰ] th th

द [d] d d

ध [dʰ] dh dh

न [n] n n

प [p] p p

फ [pʰ] ph ph

ब [b] b b

भ [bʰ] bh bh

म [m] m m

य [j] y y

र [r] r r

ल [l] l l

व [w] v v

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श [ɕ] ś Z

ष [ʂ] ş S

स [s] s s

ह [h] h h

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Appendix C. A description of some medical terminology. Let us describe some of the terms used by way of a brief discussion. Since most of the thirty-two marks describe attributes relating to connective tissue structures (hair, skin, teeth, skeletal structure, and voice), most attention will be paid to this system. A system refers to a physiologic grouping of bodily tissues and processes sharing a similar physiology (or

anatomy). Examples of systems include: cardiovascular -- referring to the heart and circulation; hematologic -- referring to tissues and processes relating to the bone marrow; connective tissue -- referring to structural and supporting tissues, such as bone, cartilage,

skin, hair, nails, teeth, ligaments, supporting tissues (holding in place) of many organs and blood vessels;

endocrine -- referring to organs producing hormones and hormonally mediated processes. An inherited disorder refers to any disorder, abnormality present at the time of birth, genetically acquired,

that are manifested variably at birth or much later. These can be metabolic disorders, structural deformities or other conditions.

Since not all genes are expressed, the phenotype (of an individual) is the final physical and physiologic form of the individual that is produced by genes that are expressed. If a gene codes for an abnormality, its expression would be a dysmorphism. For instance, the term, arachnodactily, refers to elongated, "spider-like" digits.

An acquired disorder refers to any disorder, condition that is not inherited at birth, but develops at any

point later in life. Disorders are understood by their unhealthy, damaging processes, or pathophysiology. Systems involved

in such processes exhibit pathology. In the case of the endocrine system, it is termed an endocrinopathy, a disorder of muscle is a myopathy. Developmental (congenital) disorders (or dysfunction) are often termed dysgenesis.

The endocrine system, in simple terms, can be understood as a hierarchy of hormonally mediated

processes. The activity level of end organs -- such as the adrenal gland, the thyroid, reproductive organs -- is controlled by the central nervous system and secondarily by the pituitary gland (situated in the sella turcica and attached to the inferior part of the brain), which produces regulatory hormones that affect the activity of end organs. The pituitary gland can be viewed as a "master gland" of the endocrine system. (The anterior pituitary produces somatotropin (growth hormone), prolactin, corticotropin (adrenal system), thyrotropin (thyroid system) and finally both luteinizing hormone (LH) and follicle-stimulating hormone (reproductive system). The posterior pituitary, an extension of the central nervous system, produces two hormones, oxytocin and arginine vasopressin.). Disorders of the pituitary, while causing structural damage around the gland, can be manifested as either increased or diminished activity of one or many of these regulatory hormones. So, hypocortisolism refers to inadequate functioning of the adrenal system, hyperthyroidism refers to excessive functioning of the thyroid, hypogonadism -- inadequate functioning of the reproductive system, and so on. When these deficiencies are caused by the pituitary they would be referred to as hypocorticotropic hypocortisolism (from inadequate corticotropin), hypogonadotropic hypogonadism (from inadequate LH and FSH), and so on.

In our text we refer to craniosynostosis, which represents premature closure of the cranial sutures

(edges of the skull bones that become "sewn" together during infant growth), resulting in the development of various skull deformities caused by large bony ridges. When a baby is born normally, the sutures of the skull are not closed, allowing for some flexible passage during birth. The bony sutures close quite variably later in life by around the end of the first year. But in the

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infrequent event of premature closure, skull defomity results from growth of the skull in different directions. The terminology is elaborate -- such as the term, scaphocephaly, the commonest form of premature closure -- but the underlying phenomenon is simple, as described.

Syndomes of gonadal dysgenesis represent a family of inherited endocrinopathies in which disorders of

sexual differentiation and skeletal and dermal structure occur as a result of chromosomal aberrations, exemplified by Kleinfelter's syndrome (occurring in 1 in 500 males), in which the common karyotype is either 47, XXY or a mosaic 46, XY/47, XXY.

By grammatical convention in the medical literature, the various syndromes, such as Marfan's syndrome

are usually referred to without the possessive form, that is, the Marfan syndrome.

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