How did the Buddha die?

Ancient texts weave two stories about the Lord Buddha's death. Was it planned and willed by the Buddha, or was it food poisoning, or something else altogether? 

Parinirvana

The Mahaparinibbana Sutta,of Pali Tipitaka, is undoubtedly the most reliable source for details on the death of (BCE 563-483),the Lord Buddha.Mettanando posits that The sutta, paints two conflicting personalities of the Buddha,The first as of a miracle worker who could live until the end of the world,who determined the time of his own death .The other personality was that of an old man, who grumbled about his failing health and growing senility , who almost lost his life because of a severe pain during his last retreat at Vaisali , and who was forced to come to terms with his unexpected illness and death after consuming a special cuisine offered by his generous host.hence there appear to be two explanations of the Buddha's cause of death: One is that the Buddha died because his attendant, Ananda, failed to invite him to live on to the age of the world or even longer The other is that he died by a sudden illness which began after he ate what is known as "Sukaramaddava".

Binh Anson describes The last meal in details

The last meal offered to the Buddha was prepared by Cunda, the metalworker:

"... And Cunda, the metalworker, after the night had passed, had choice food, hard and soft, prepared in his abode, together with a quantity of sukara-maddava, ..."

".... And with the sukara-maddava prepared by him (Cunda), he served the Blessed One; and with the other food, hard and soft, he served the community of bikkhus."

"Thereafter, the Blessed One spoke to Cunda, saying: "Whatever, Cunda, is left over of the sukara-maddava, bury that in a pit. For I do not see in all this world, with its gods, Maras and Brahmas, among the host of ascetics and brhamins, gods and men, anyone who could eat it and entirely digest it except the Tathagata alone."

In the translation from the Pali script, "SUKARA-MADDAVA" was not translated in the English version, although Walshe translated it as "pig's delight" . However, the Vietnamese versions contain the words "na^'m" (mushroom) and "mo^.c nhi~" (edible black fungus). In some other books, the terms "pork meat, boar meat" were used.

According to many Pali scholars:

sukara: pig, boar maddava: delicate, well-liked, soft, tender

So, sukara-maddava may mean:

(1) the tender parts of a pig or boar
(2) what is enjoyed by pigs or boars, which may be referred to a mushroom or truffle, or a yam or tuber.

In some other commentaries, sukara-maddava was also mentioned as a "medicinal plant" in classic Indian medicine, or as "young bamboo shoots trampled by pigs".Though Binh Anson concurs with the meaning of "mushroom or truffle",

Anson describes the The last hours as mentioned in the suttas

"And soon after the Blessed One had eaten the meal provided by Cunda, a dire sickness fell upon him, even dysentery, and he suffered sharp and deadly pains. But the Blessed One endured them mindfully, clearly understanding and unperturbed.

" Then the blessed One spoke to the venerable Ananda, saying: "Come, Ananda, let us go to Kusinara."

He was thirsty and asked Ananda to get some water from a nearby stream of Hirannavati,which was quite muddy and murky However, when Ananda took the bowl to the stream, the water became clear, pure and pleasant.Then Buddha went to Mallas's sala grove, in the vicinity of Kusinara (Kushinagar), and asked Ananda to prepare a couch for him, between the twin sala trees, with the head to the north. 

kushinagar temple and ruins

According to Mettanado the latter version of Buddha’s personality sounds more realistic and accurate in describing a real life situation that happened in the Buddha's last days. As of the cause of Buddha’s death, instead of focusing on the nature of the special cuisine that the Buddha ate during his last meal as being the agent of his death. Mettanado’s approach is based on the description of the symptoms and signs given in the sutta, which modern medical knowledge can shed light on.

Mettanado’s Diagnosis

The sutta tells us that the Buddha felt ill immediately after eating the Sukaramaddava. Since we do not know anything about the nature of this food, it is difficult to name it as the direct cause of the Buddha's illness. But from the descriptions given, the onset of the illness was quick. While eating, he felt there was something wrong with the food and he suggested his host have the food buried. Soon afterward, he suffered severe stomach pain and passed blood from his rectum. We can reasonably assume that the illness started while he was having his meal, making him think there was something wrong with the unfamiliar delicacy. Out of his compassion for others, he had it buried. Was food poisoning the cause of the illness? Mettanado rules out food poisoning, which can be very acute, but would hardly cause diarrhea with blood.

Another possibility is chemical poisoning, which also has an immediate effect, Food poisoning with immediate intestinal bleeding could only have been caused by corrosive chemicals such as strong acids, but that should have caused bleeding in the upper intestinal tract, leading to vomiting blood. Peptic ulcer diseases can be excluded from the list of possible illnesses as well. In spite of the fact that their onset is immediate, similarly gastric ulcer is also ruled out.

Mesenteric infarction

A disease that matches the described symptoms-accompanied by acute abdominal pain and the passage of blood, commonly found among elderly people, and triggered by a meal-is mesenteric infarction, also known to us as abdominal angina. He had his second attack while he was eating the Sukaramaddava.

Mesenteric infarction is a disease commonly found among elderly people, caused by the obstruction of the main artery that supplies the middle section of the bowel-the small intestine-with blood. As the obstruction persists, the bowel is deprived of its blood supply, which subsequently leads to an infarction, or gangrene, of a section of the intestinal tract. This in turn results in a laceration of the intestinal wall, profuse bleeding into the intestinal tract, and then bloody diarrhea.

This condition matches the information given in the sutta. It is also confirmed later when the Buddha asked Ananda to fetch some water for him to drink, indicating intense thirst. As the story goes, Ananda refused, as he saw no source for clean water. He argued with the Buddha that the nearby stream had been muddied by a large caravan of carts. But the Buddha insisted he fetch water anyway.

A question arises at this point: Why did the Buddha not go to the water himself, instead of pressing his unwilling attendant to do so? The answer is simple. Buddha was suffering from shock caused by severe blood loss. He could no longer walk. Before passing away, the Buddha told Ananda that Cunda was not to be blamed and that his death was not caused by eating Sukaramaddava. 

Buddha statement is significant. The meal was not the direct cause of his death.the symptom was a repeat of an experience he'd had a few months earlier, the one which had almost killed him. Sukaramaddava, no matter the ingredients or how it was cooked, was not the direct cause of his sudden illness.late into the night,Buddha died during a second wave of septic shock. His illness stemmed from natural causes coupled with his age, just as it would for anyone else.

Conclusion Sukaramaddava, whatever its nature, was unlikely to have been the direct cause of his illness.Buddha did not die by food poisoning. Rather, it was the size of the meal, relatively too large for his already troubled digestive tract, that triggered the second attack of mesenteric infarction that brought an end to his life

Dr Mettanando Bhikkhu was a physician before entering the monk hood. He is currently based at Wat Raja Orasaram,Bangkok

Binh Anson is a Vietnamese Buddhist scholar