We will now expound the chapter called as Rogabhediya-classification of discases; thus said atreya and other great sages.
अथातो रोगभेदीयमध्यायं व्याख्यास्यामः । इति हस्माहुरात्रेयादयो महर्षयः ।
Rogabheda – classification of diseases
सप्तविधाः खलु रोगा भवन्ति। सहगर्भजातपीडाकालप्रभावस्वभावजाः। ते तु पृथद्विविधाः । तत्र सहजाः शुक्रार्तवदोषान्वयाः कुष्ठार्शोमेहादयः । पितृजा मातृजाश्च । गर्भजा जनन्यभिचा रात् कौब्जपाङ्गल्यपैङ्गल्यकिलासादयोऽन्नरसजा दौहृदविमाननजाश्च । जातजा: स्वापचारात् सन्तर्पणजा अपतर्पणजाश्च । पीडाकृताः क्षतभङ्गप्रहारक्रोधशोकभयादयः शारीरमानसाश्च । कालजा: शीतादिकृता ज्वरादयो व्यापन्नजा असंरक्षणजाश्च । प्रभावजा देवगुरूल्लङ्गनशापा थर्वणादिकृता ज्वरादयः पिशाचादयश्च | स्वभावजाः क्षुत्पिपासाजराय: का अकालजाश्च। तत्र कालजा रक्षणकृताः अरक्षणजा अकालजाः। त एते समासत: पुनर्द्विविधा भवन्ति । प्रत्युत्पन्नकर्मजाः पूर्वकर्मजाश्च। तत्र रोगोत्पत्तिं प्रति प्रत्युत्पन्नं कर्म यदनेनैव शरीरेण दृष्टमदृष्टञ्चोद्दिश्याऽप्तोपदिष्टानां विहितानां प्रतिषिद्धानाममननुष्ठानमनुष्ठानं वा । जन्मान्तरातीतेन तु पूर्वम्। तत्तु पुनर्दैवाख्यमुक्तञ्च नियतानियतभेदेन प्राक् । तस्माद् दृष्टहेतवः प्रत्युत्पन्नकर्मजाः । विपरीता दैवजन्मान: अल्पनिदाना महारुजाश्चोभयात्मकाः ॥१॥
तत्र यथास्वं प्रतिपक्षशीलनात् पूर्वेषां रोगाणामुपशमः। सत्येव विपक्षशीलनेऽनिष्टकर्मक्षयात् दैविकानाम् । दोषकर्मक्षयादन्येषाम् । अन्ये पुनः प्रत्युत्पन्नं कर्म परकृतमपि वर्णयन्ति। तच्च पराभिसंस्कारमाचक्षते । एवञ्चाहुः यदि स्वयं कृतादेवकर्मणः कार्यनिवृत्तिः स्यात् । न दृष्टपुरूषान्तरकृतात् । किमिति विद्वानपि पराचरितयोरुपकारापकारयोः सुखदुखानुरोधा त्तोषरोषौ प्रतिकर्तच्यचित्तं वा प्रतिपद्यते । एवमेते व्याधयो द्धिविधाः सन्तः त्रिविधा जायन्ते। ततश्च दोषवन्तो भूयः सप्तविधाः ॥२॥
Diseases are of seven kinds; such as, Sahaja, Garbhaja, Jataja, Pidaja, Kalaja, Prabhavaja and Svabhavaja; each one is of two kinds.
Sahaja (born with, inherited, heriditary) are due to abnormalities of Sukra (male seed) and arthava (female seed). For example, leprosy (and other skin diseases), haemorrhoids, diabetes etc. They are (of two kinds): (a) pitrja (paternal) and (b) matrja (maternal).
Grabhaja (congenital) are those caused by the improper activities of the mother, such as hunchback, lameness, brown (tawny) eyes (cornea), leucoderma and other due to (a) Annarasaja (food) and (b) due to douhrda vimananaja (not satisfying the longings of the pregnant woman),
Jataja (acquired) are those caused by ones own improper food; (a) santarpanaja (by over-nourishment / over-feeding) and (b) by apatarpanaja (undernourishment underfeeding).
Pidaja (traumatic) are those caused by injury from weapons like wounds, fractures, blows, anger, grief, fear, etc. (a) sarira (somatic) and (b) manasika (psychic / mental).
Kalaja (seasonal, climatic) caused by cold, heat etc., such as fevers and other diseases. They are due to (a) Vyapannja (abnormal nature of seasons) and (b) asamraksanaja (inadequate or no protection).
Prabhavaja (influencial, providential) caused by (a) curse of gods and godly men, violation of tradition, Atharvanic rites (sorcery, witchcraft) such as fevers and (b) possession by pisaca (goblins) and other evil spirits.
Svabhavaja (natural) such as hunger, thirst, oldage etc., either of (a) kalaja (appropriate time) or (b) akalaja (of inappropriate time, premature); those of proper time are produced even after protection (care) whereas that of improper time (premature) are due to lack of protection (carelessness).
All the above diseases are again of two kinds viz. (a) pratyutpanna karmaja: those caused by activities of the present life and (b) purva karmaja-those caused
by activities of the previous lives. Activities of the present life are either seen or unseen (known or unknown) either in the form of not following the regimen prescribed by the learned or indulging in activities contrary to the ones prescribed. Activities of the past lives, previously named as Daiva, (in chapter 9) are of two kinds-de-finite (specific, special) and indefinite (unspecific, casual, general).
Hence, all seen (known or understood) causes are those of the present life; the opposite (unseen causes) are those of Daiva providential, divine) origin; those causes which are trivial (mild, insignificant, weak) in nature but cause dreadful diseases-are a mixture of both (activities of the present life and past lives). (1)
The diseases due to actions of the present life will get relieved by the use of opposite (foods, drugs or activities possessing qualities or effects opposite of the doshas or diseases). The diseases caused by providence (actions of past lives) will be relieved only after the effect of such actions comes to an end, in spite of the use of opposites. The rest by the diminution of both effects.
Some other authorities describe the action of the present life as : (the effect of) actions of others, which is also known as parabhisamskara (developed or conceived by others). They argue that if all the effects are accepted as due to ones own action, then there will be nothing like effects of actions of enemies at all. Why should a person though a scholar do many acts to please another person and get benefit and happiness from him or displease him by his acts and get evils and misery from him?
Diseases though of two kinds broadly, as above, are in fact, of three kinds and further those caused by the doshas are of seven kinds. (2)
Notes: Parabhisamskara literally means concieved or developed by others and refers to evil acts such as sorcery, witchcraft etc., which were very common in ancient times. Persons though scrupulous in their food and activities still became victims of diseases by the effect of such evil acts developed and transferrd by the enemies. So even such harmful acts of others should be taken as causes of diseases and included under activities of the present life. So the cause of diseases become three, viz., acts of previous lives, ones own acts of the present life and acts of others during the present life. All these diseases are again due to the distrubances in the doshas only are counted as seven; viz.,
three by each one of the three doshas separately, three by the combination of any two doshas and one from the combination of all the three doshas together.
सकलोऽपि चायं रोगसमुहः प्रतिकारवानायुर्वेदविहितमुपदेशमपेक्षते । यास्मान्नियतहेतुकोऽप्यामयः सम्यक् भिषगादेशानुष्ठानादुपात्तायुस्संस्कारापरिक्षिये जातोपि वा सह्यवेदनतां प्रतिपद्यते । अनुपक्रम्यमाणस्तु सर्व एव प्रायशो भिनत्यकाण्डे । स्वयमपि च दैवान्निदानाल्पतया वा निवर्तमानष्षोडशगुणसमुदित क्रियोपलम्भादाशुतरमपरिक्लिष्टस्य चाऽपगच्छति। अनियतफलदायिनि तु दैवे हिताभ्यासरतस्याऽवकाशमेव न लभते व्याधिः । तस्मान्नकस्याञ्चिदवस्थायामात्मवान् हिताहितयोः तुल्यदर्शी स्यात् । त्रिविधाश्च पुनर्व्याधयो मृदुमध्याऽधिमात्रभेदेन । तत्राल्पलक्षणा मृदवो मध्यलक्षणा मध्याः सम्पूर्णलक्षणास्त्वधि मात्राः । ते पुनः सुखसाध्यादिविशेषेण चतुर्विधाः प्रागुपदिष्टाः | सुबहुशोऽपिच भिद्यमाना व्याधयो निजागन्तुतां न व्यभिचरन्ति ॥ ३ ॥ *
All these categories of diseases are amenable to treatment and so have been enunciated within the tenets of Ayurveda. Even though diseases have a definite (known) cause and can be cured by the removal of that cause still they can be tolerated (without much suffering) by following the advice of the physician, till the period of one’s life comes to an end. By not following such advice, life may end up prematurely. Though some diseases get cured automatically, either due to being born of trivial causes or by the effect of providence, they can get cured more quickly and without any difficulty, if they get the support of the sixteen good qualities of therapeutics. Though the effects of providence (action of past lives) are of indefinite nature, the diseases do not get any chance at all, to develop in persons who follow the regimen of healthy living. So a wise man should not, at any stage, consider the healthy and unhealthy things as similar (as of one and the same effect)
Further, the diseases are again of three kinds-the mild, the moderate and the severe; those which have very few symptoms are mild, those having moderate number of symptoms are moderate and those which develop all the symptoms fully are severe. They ( diseases) are also of four kinds such as easily curable etc. as described earlier (in chapter 3). (3)
Notes: All diseases are to be treated by one or other method; Ayurveda has enunciated all such methods, and so following the advice of this science is absolutely necessary. Though it is seen that some diseases get cured on their own accord without any treatment, it does not happen in all diseases always. Diseases can be either prevented or can be tolerated without much suffering if good treatment is available. The sixteen qualities of treatment are the ideal qualities of the four limbs of treatment: the physician, drug, attendant and patient.
तत्र निजास्तु दोषोत्थाः । तेषु पूर्वं वातादयो वैषम्यमापद्यन्ते ततो व्यथताऽभिनिर्वर्तते । बाह्यहेतुजास्त्वागन्तवः तेषु प्रहारेण व्यथा पूर्वमुपजायते ततो दोषवैषम्यम् । दोषवैषम्येणैव च बहुरूपारूगनुबध्यते प्रवर्द्धते च । एवञ्च कृत्वा न दोषव्यतिरेकेण रोगानुबन्धः केवलं पौर्वापर्ये विशेषः । तस्मादेकाकारा एवरोगा रुक्सामान्यात् । असंख्यभेदा वा प्रत्येकं समुत्थानस्थान संस्थानवर्णनामवेदनाप्रभावोपक्रमविशेषात्, ते यथास्थूलं यथास्वमेवोपदेक्ष्यन्ते। असंख्येयत्वाच्च दोषलिङ्गैरेव रोगानुपक्रमं च विभजेत् ॥४॥ )
Though of many such categories, they ( diseases) will not be apart from being either Nija (organic, endogenous, internal) or agantu ( traumatic, exogenous, external ). Nija diseases (organic) are of doshas which become abnormal first and painful symptoms develop later. Agantu diseases (traumatic) are due to external causes: in them the painful symptoms develop first due to assult (blow) etc. and the doshas become abnormal later. Different kinds of diseases manifest and also increase due to abnormalities of the doshas. So there is no disease without abnormal doshas. The only difference being its presence either in the beginning or later. Hence all the diseases are of one kind only because of pain (misery, unhappiness ) being common in all. They become innumerable depending upon the causes, location, features, colour, nomenclature, suffering (feelings), effect, and mode of treatment. These will be de scribed in brief at appropriate places, as they are innumerable and are to be treated depending only upon the symptoms produced by the dossas. (4)
Dosha Sarvaroga Karanam – doshas the causes of all diseases
दोषा एव हि सर्वरोगैककारणम् । यथैव शकुनिः सर्वतः परिपतन् दिवसं स्वां च्छायां नाऽतिवर्तते । यथा वा कृत्स्त्रं विकारजातं वैश्वरूप्येण व्यवस्थितं गुणत्रयमप्यतिरिच्य न वर्तते । तथैवेदमपि कृत्स्नं विकारजातं दोषत्रयमिति । यथा च विद्युद्धर्षादयो नभसि भवन्ति न त्ववश्यंनिमित्ततस्त्ववश्यमपि। तरङ्गबुद्बुदादद्यश्चाम्भसि तथा दोषेषु रोगाः ॥५॥
Dosha alone are the causes for all diseases. just as a bird which flies all over the place throughout the day and still cannot be without its shadow or just as all the myriads of things in the universe cannot be without the effects of the three gunas ( satwa, rajas and tamas), so also, all the diseases canot be without the three doshas.
Just as the thunderbolt, rain etc., occur in the sky, but not without a powerful cause (in other words only with a powerful or essential cause) or just as waves, bubbles etc. occur in water ( of the sea), so also the diseases (occur only with abnormal) dosha. (5)
Notes: Ayurveda gives primacy only to the doshas among the different causes of disease. There can be no disease without abnormal doshas. The example of thunderbolt, rain, waves, bubbles etc., is to indicate the relationship between the cause and effect. Thunderbolts and others manifest from the sky but do not happen at all times. Another important cause is necessary to produce them and that is the wind. This wind becomes the efficient cause. Only when the wind becomes very active and brings the accumulation of clouds, there will be thunderbolts and rain. This analogy as applied to disease manifestation can be explained thus; diseases arise in the dhatus (tissues) of the body; they manifest only when the abnormal doshas vitiate the dhatus. So, for the disease, the doshas are Nimitta karana (Powerful and efficient cause), the dhatus are Samavayikarana (inherent cause), the various foods and activities which bring about abnormality of the doshas are sahakari karanas, exciting, helpful, supportive causes.
Trividha karana – three kinds of causes
त्रिविधन्तु निमित्तमेषामसात्म्येन्द्रियार्थसंयोगः प्रज्ञापराधः परिणामश्च । ते पुनः प्रत्येकमतियो गाऽयोगमिथ्यायोगभेदात् त्रिधा भिद्यन्ते । तत्र यथास्वं चक्षुरादीन्द्रियाणां रूपादिभिरर्थैरतिसं सर्गोऽतियोगः । अल्पशो नैव वा संसर्गस्त्वयोगः । सूक्ष्मातिदूरान्तिकस्थातिभास्वत् भैरवाप्रियविकृतादिदर्शनम् । द्धिष्टात्युच्चपरुषभीषणादिश्रवणम् । पूत्यमेध्यातितीक्ष्णोग्र प्रतिकूलाद्याघ्नाणम् । स्वभावादिभिराहारकल्पनाविशेषायतनैरपथ्यानां रसानामभ्यवहारः तथा स्नानादीनां शीतोष्णादीनञ्च स्पृश्यानामयथावदुपसेवनमशुचिभूताभिघातविषवातादिसंस्पर्शश्च मिथ्यायोगः ॥६॥
For the doshas ( to become abnormal) there are three causes, viz.,
(a) Asatmyendriartha samyoga-improper correlation of sense organs with their objects,
(b) Prajnaparadha-willful transgression of modes of conduct and
(c) Parinamachange (time, season); each of them is again of three kinds; viz., atiyoga (excessive), ayoga (inadequate) and mithyayoga (perverse); just as seeing objects for a very longtime, is excess use of the organ of seeing; similarly for the other sense organs with their objects is atiyoga (excessive correlation); seeing objects for a very short time or not using the eye at all for seeing is ayoga (inadequate or absence of correlation; (similarly for the other sense organs). Seeing objecs which are small, very far away, very near, unsteady, very bright, terrific, unpleasant and unnatural; hearing sounds which are hated (disliked) very loud, very rough and very fearful; smells such as putifying (decomposing) foul, very penetrating, very acute (powerful intense, strong) and repelling; ingestion of foods which are not having the natural taste, not prepared properly and those which are not suitable for health improper indulgence in bathing (massaging and other acts), use of cold and heat, improper way to touching, holding etc., of objects, touching thing which are dirty (impure), assault by other living beings (big or minute), injury, poisonous air (gas) etc., all these are mithyayoga (perverse correlation) of the senses (respectively)
कायवाङ्मनोभेदेन तु त्रिविधमप्यहितं कर्म प्रज्ञापराधः । तत्र कायादिकर्मणोऽतिप्रवृत्तिरतियोगः । अल्पशो नैव वा प्रवृत्तिरयोगः वेगोदीरणधारणविषमाङ्गचेष्टनस्खलनकण्डूयनप्रहारप्राणायामादि । तथा क्षुत्पिपासाऽर्धभुक्तभाषणादि । भयशोकेर्ष्यामात्सर्यादि । दशविधं चाऽकुशलं कर्म यथास्वं मिथ्यायोगः ।
All the three kinds of unhealthy actions-those of the body, speech and mindconstitute Prajnaparadha (willful transgresion). Too much of indulgence in such action is excessive activity; very little or no indulgence at all, is inadequate activity; untimely initiation of the bodily urges, withholding them when not to, unnatural postures and movements; falling, scratching, beating, controlling the breath and such other activities of the body; speaking while hungry, while thirsty and in the middle of eating and such other action of speech; emotions like fear, grief, greed, jealosy, and the ten sinful acts all these constitue perverse activities of the body, speech and mind respectively (6).
Notes : The ten sinful acts are himsa ( torture ), steya ( stealing ) anyathakama (unlawful sex), paisunya (columny, backbiting, slanderous speech) Parusa vacana (harsh, abusive speech) anrtavacana ( falsehood, untrue speech) sambhinnalpa (irrelevant speech), vyapada (thinking of doing bad to others), abhidya (thinking of robbing away the property of others) drigviparyaya (doubting, disbelieving or finding fault with the words of elders and scriptures).
परिणामः काल उच्यते । सोऽपि शीतोष्णवर्षभेदात्त्रिध| तंत्राऽतिमात्रस्वलक्षणः कालोऽतियोगः । हीनस्वलक्षणस्त्वयोगः | विपरीतो मिथ्यायागः | त एतेतियोगादयः सामान्यतोऽनुपशयलक्षणाः । सर्वो वा प्रज्ञापराध एवाऽयं यदेषामविवर्जनम् । अर्थकर्मकालाः पुनः सम्यंग्योगेनोपशयात् भूयिष्ठं स्वास्थ्यहेतवः । तत्राऽपि रसवर्ज्या विषया यथायथमिन्द्रियं बाधन्तेऽनुगृह्णन्ति च । शेषा रसकर्मकालास्तु सर्वं देह | अपि च ॥७॥
Parinama (change) is known as time (season), it is of three kinds, cold, hot and rainy; occurrence of these qualities in severe degree in the season is excess manifestation; occurrence in very mild degree is inadequate manifestation; occurrence of unusual features is perverse manifestation.
All these three combination (associations, union ) – excessive, inadequate and perverse are all generally unsuited or harmful for health. All these, together known as Prajnaparadha are to be avoided. The proper combination of Artha ( perceptions), Karma (activities) and Kala ( seasons) being generally good lead to health. Among these, the artha (perceptions) except that of the taste, cause either bad or good to their respective sense organs only; whereas taste perception, activities (of the body mind and speech) and the seasons (cause harm or good) to the whole body (7).
सर्वभावानां भावाभावौ नान्तरेण योगातियोगादीन् व्यवस्तेत् । सर्वेषां पुनर्विकाराणां निदानदोषदृष्याविशेषेभ्यो भावाभावविशेषा भवन्ति । यदा ह्येते त्रयो निदानादिविशेषात् नाऽन्योन्यमनुबध्ध्रन्तीषद्वानुबध्रन्त्यबला वा न तदाऽभिनिर्वर्त्तन्ते व्याधर्यीश्चराद्वाऽभिनिर्वर्त्तन्ते तनवो वा भवन्त्यसम्पूर्णलिङ्गा वा । विपर्यये तु विपरीताः ॥८॥
Further on;
Existence or non-excistence of all the things (of the universe) is not apart fromproper, excessive, inadequate and improper combinations respectively. In the context of all the diseases, the Nidana (cause), doshas and the dusyas (dhatus and malas) are the (causative) factors; the proper and improper combination of these are causes for differentiation of diseases; when these three factors either do not combine with one another, cobmine very little or loosely (weak combination) then the diseases do not manifest, manifest after a long time or manifest midly with incomplete (very few) symptoms. The opposites (of their combination) produces the opposite effect. (8)
Notes :- The above statement can be made clear from the following table :
Combination of Causative factors Nidana, Dosha and Dusya Nature of manifestation of disease 1. Absence no manifestation 2. Weak Late, mild and/or with few symptoms (incomplete). 3 Strong quick, powerful and with all symptoms (complete).
Rogamarga – pathways of diseases
त्रतश्च रोगाणां मार्गा बाह्यमध्याभ्यन्तराः तत्र बाह्यो रक्तादिधातवस्त्वक् च । स पुनः शाखाख्याः गण्डपिटकालज्यपचीचर्मकीलार्बुदाधिमांसमशव्यङ्गादयो बहिर्भागाश्च शोफार्शोगुल्मवीसर्पविद्रध्यादयः । मध्यो मूर्द्धहृदयबस्त्यादीनि मर्माण्यस्थिसन्धयः । तत्रोपनिवद्धाश्चस्त्राय्वायुसिराकण्डारादयः तदाश्रयाः । पक्षवधग्रहापतानकार्दितराजयक्ष्मास्थिसन्धिशूलगुदभ्रंशादयो मूर्द्धादेरोगाश्च । आभ्यन्तरो महास्त्रोतः शरीरमध्यं महानिम्नमामपक्का शयाश्रयः कोष्ठोऽन्तरिति पर्यायाः तदाश्रयाज्वारातीसारछर्घलसकविषूचिकाश्वासकासहिध्माऽनाहोदरप्लीहादयोऽन्ताः, गाश्च विसर्पशोफार्शोविद्रधिगुल्मादयः ॥ ९ ॥
Rogamaragas (pathway, seat, locale, channel of diseases) are three; Bahya (exterior), Madhyama (middle) and Abhyantara (interior);
Rakta and other dhatus (tissues) and the skin form the exterior pathway; This is also known as Sakha. Enlargment of glands, pustles, tubercles, warts, malignant growths, muscular fumors, eruption, discoloured patches and other skin disease, dropsy, haemorrhoids, abdominal tumors, visarpa (herpes), abscesses and such others arise (and dwell) in this external pathway.
Middle pathway comprises of the head, heart, urinary bladder and other marmas (vital organs) and joints of bones inclusive of their appendages such as tendons, veins, aponuroses etc.; hemiplegia, paraplegia, tetanus, facial palsy, pulmonary tuberculosis, pain, ( diseases) of the bones and joints, prolapse of the rectum and all diseases of the head arise (and dwell) in this middle pathway.
Interior pathway, also known as Mahasrotas, the centre of the body and the great pit, consists of the amasaya and pakwasaya (intestines) and kostha; fever, diarrhoea, vomitting, alasaka (stasis of food in the abdomen for long time without digestion), visucika (disease charactorised by concurrent vomitting and diarrhoea) dyspnoea, cough, hiccup, distention and enlargement of the abdomen, enlargement of spleen and other diseases originating from inside, visarpa, (herpes) swelling, haemorrhoids, abscesses, internal tumors and such others arise from (or dwell in this internal pathway. (9)
Swatantra Paratantra Roga – primary and secondary diseases
ते च रोगाः स्वप्रधाना च भवन्त्यन्यपरिवारा वा क्रमादनुबन्ध्यनुबन्धाख्याः । तत्राऽऽद्याः स्वतन्त्राः स्पष्टाकृतयो यथास्वं समुत्थानोपशयाश्च । इतरे तु तद्धिपरीताः तद्वच्च दोषा अपि । तत्रान्यपरिवारा व्याधयो द्विविधाः । पुरोगामिनोनुगामिनश्च । तेष्वाद्याः पूर्वरूपसंज्ञाः । उपद्रवास्त्वितरे । तान्यथायथमेव वक्ष्यमाणानुपलक्षयेत् । प्रधानप्रशमे च प्रशमो भवति तेषामनुपशाम्यतो वा पश्चात्तानुपक्रमेत् । त्वरितं वा बलवन्तमुपद्रवं प्रधानाविराधेन । सहि पीडाकरतरो भवति व्याधिपरिक्लिष्टदेहत्वात् प्रमेहपिटकादिवत् । तथाऽन्यः प्रधान एव रोगोऽन्यस्य प्रधानस्य हेतुः भवति । यथा ज्वरो रक्तपित्तस्य रक्तपित्तं वा ज्वरस्य । तौ श्वासस्य । प्लीहा जठरस्य । तच्छवयथोः । अर्शांसि गुल्मोदरातीसारग्रहणीनां । प्रतिश्यायः कासज्वरयोः । तौ क्षयस्य । क्षयः शोषस्य | एकश्चाऽपचारो निमित्तमेकस्य व्याधे: बहूनां च तथा बहवः तद्धदेकं लिङ्गम् । एवमेव प्रशमेऽभ्युपायः तथा स एवाऽन्यस्य प्रकोपे । तस्मात्तानवहितः सम्यगागमादिभिः परीक्षेत ॥१०॥
These diseases manifest either as the chief one or as retinue (associate, accompanying) of another disease; known respectively as Anubandhya (leader, primary, chief) and Anubandha (follower, secondary, associate, retinue). The former is independent and has specific, well defined features (signs and symptoms), cause and diagnosis; the latter is its opposite (clinical features, causes and diagnosis being unsepecific and indefinite). Similarly also the doshas (are of two kinds, anubandhya and anubandha),.
Diseases which are secondary are (again) of two kinds; Purogami (manifesting first) and Anugami (manifesting later); the former is known as purvarupa (premonitory/prodromal features) and the latter as upadrava (associate features, complications). These will have to be recognised in praticular contexts. They (secondry diseases) generally subside (disappear) with the cure of the primary diseases but when they do not subside they should be treated after the treatment of powerful (and dangerous) they should be attended to immediately without opposing (provoking) the primary disease; because such complication cause severe troubles to the body which has become weak already by the disease, as seen in the case of diabetic carbuncles:
Further, one pimary disease may become the primary (powerful) cause for another disease. For example, fever causes bleeding disease, or bleeding disease causes fever; both together may cause dyspnoea; splenic enlargement causes abdominal enlargement, which in turn may cause drospy; haemorrhoids may cause tumor and enargement of abdomen, diarrhoea and duodenal disease; nasal catarrh may cause cough and fevers, these two become the cause for consumption; consumption for emaciation etc, etc.
One improper act (error, fault) might become the cause of one particular disease or of many diseases; likewise appearance of one symptom denotes any one particular disease and also many diseases; treatment of one disease may mitigate it but might also (at the same time) cause aggravation of the other diseases.
So, knowing all these, the physician should carefully examine (determine) each one, in the light of the science and other methods. (10)
Roga – Rogi pariksa – examination of the disease
तत्रागमतो रोगमेमेवं प्रकोपणमेवं योनिमेवमधिष्ठानमेवमात्मानमेवं वेदनमेवं रूपशब्द – गन्धरस स्पर्शमेवं पूर्वरूपमेवमुपद्रवमेवं वृद्धिस्थानक्षयान्वितमेवमुदर्कमेवं नामानम् । तस्मिन्नियं प्रतीका रस्य प्रवृत्तिः अन्यथा निवृत्तिः । प्रत्यक्षतस्त्वाऽऽतुरस्य यथावमिन्द्रियैर्वर्णसंस्थनप्रमाणोपचय छायाविण्मूत्र छर्दिताधिक्यामान्त्रकूजनमङ्गल्यादिषुसन्धिषु स्फुटनं देहशकृद्व्रणादिगन्धं सुप्तशीतोष्णस्तम्भनसंस्पन्दश्लक्ष्णखरस्पर्शञ्च । प्रकृतिविकृतियुक्तमास्यरसन्तु प्रश्नेन तथा सुच्छर्दनदुच्छर्दनत्वं मृदुकुरकोष्ठतां स्वप्रदर्शनमभिप्रायं जन्मामयप्रवृत्तिनक्षत्रद्विष्टेष्टसुखदुः खानि च । तथा वयः प्रत्यक्षेण च । अनुमानतस्तु यूकापसर्पणेन शरीरवैरस्यम् । मक्षिकोपसर्पणेन शरीरमाधुर्यम् । तथाऽग्निं जरणशक्त्या | बलं व्यायामशक्तया। गूढलिङ्गं व्याधिमुपशयाऽनुपश्यतः । दोषप्रमाणमपचारविशेषेणायुषः क्षयं रिष्टैः । प्रकृति सत्वसारसा त्म्यबलाननुशीलनेनेति । भवति चात्र ॥ ११ ॥ –
With the knowledge of the science, every disease is to be determined in respect of its exciting cause, cheif cause, location, features ( symptoms) in respect of appearance (sight), sound, smell, taste and touch; prodromal symptoms, complications, aggravtion ( exacerbation) normalcy and mitigation, sequellae, specific nomenclature, the method to be adopted (treatment) and not to be adopted for its cure. Such an examination being done with due intention.
Rogi pariksa – examination of the patient
Next, the patient is to be examined by Pratyaksa (sensory perception) through all the sense organs of the physician to determine the colour, shape, size, growth, shade, increase of the quality of feces, urine and vomited material; gurgling noise of the intestines, crackling sounds in the joints such others; loss of tactile sensation, feeling of heat and cold, stiffness, throbbings, smoothness and coarseness of touch. The normal and abnormal taste in the mouth, satisfactory, or unsatisfactory bouts of vomiting, softness or hardness of bowel movements, nature and opinions of dreams, the stellar constellation at the time of his (patient) birth and at the time of onset of the disease, the things he hates, things he likes, his comforts and discomforts etc. are to be examined by interrogation; his age by both questioning and observation.
By Anumana (inference) the following are to be examined :
Bad taste of the body is to be inferred from lice deserting it, the sweetness of the body by the swarming of flies to it; similarly his digestive capacity by his ability of digestion, his strenth by his sbility to work; determination of a doubtful disease by noting the good or bad effects of diognostic tests, the strength of the doshas by indulgence in bad regimen, decrease of duration of life by observing the fatal sings, body constitution, mental standard, excellence of one or all the tissues, habituations (accustoms) and strength by long observation. ( 11 )
Some more verses here :
ज्ञानबुद्धिप्रदीपेन यो नाऽविशति योगिवत् । आतुरस्याऽन्तरात्मानं न स रोगांश्चिकित्सति ॥ १२ ॥
He (the physician) who does not enter into soul of the patient (understand him thoroughly) in the light of his knowledge and experience, will not be able to treat the disease of the patient (effectively). (12)
द्वाविमौ व्याधितौ व्याधिस्वरुपस्याप्रकाशकौ । तद्यथैको गुरुव्याधिः सत्वदेहबलाश्रयात् ॥१३॥ लघुव्याधिवदाभाति लघुव्याधिरतोन्यथा । बाह्यावयवमात्रेण तयोर्मुह्यति बालिशः ॥१४॥ ततोल्पमल्पवीर्यं वा विपरीतमतोऽथवा । पथ्यंविपर्यये युञ्जन् प्राणान् मुष्णाति रोगिणाम् ॥१५॥
There are two kinds of patients who do not exhibit the symptoms of the diseases properly; the first kind, who though afflicted with a severe disease appear as having a mild disease because of good stamina of his mind and body; the second kind, who is the opposite of the first (who appears as having a major disease though actually having a mild disease due to poor stamina of his mind and body). An inexperienced physician gets confused in diagnosis by superficial observation of the symptoms of both these types of patients, prescribes food, drugs and other treatment which are either very mild or very powerful to them respectively and takes away their life thereby (13-15)
ज्ञानांशेन न हि ज्ञानं कृत्स्त्रे ज्ञेये प्रवर्तते । बुभुत्सेत भिषक् तस्मात् तत्वं तन्त्रानुशीलनात् ॥१६॥ अभियुक्तस्तु सततं सर्वमालोच्य सर्वथा । न जातु स्खलति प्राज्ञो विषमेपि क्रियापथे ॥१७॥
By knowing a part the knowledge of the whole cannot be obtained. Hence the physician desirous of full knowledge should study science (scientific literature) constantly and understand the principles.
The intellegent person who performs all his functions with careful consideration, does not stumble (err, commit mistake) even at unusual (abnormal) situations. (16-17)
आगन्तुरन्वेति निजं विकारं निजस्तथाऽगन्तुमतिप्रवृद्धः । तत्रानुबन्धं प्रकृतिञ्च सम्यक् ज्ञात्वा ततः कर्म समारभेत् ॥ १८ ॥
An organic disease greatly aggravated might appear as a traumatic disease or a traumatic disease greatly aggravated may appear as an organic. In such conditions appropriate treatment should be adopted after determining their associations (organic, causes, symptoms etc.) and real nature. (18)
।। इति द्वाविंशोऽध्यायः ॥
Thus ends the twenty-second chapter.
