पञ्चत्रिंशोऽध्यायः अथात आतुरोपक्रमणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Chapter which deals with clinical observations (Aturopakramaniya adhyaya). 1
आतुरमुपक्रममाणेन भिषजायुरादावेव परीक्षितव्यम् । सत्यप्यायुषि व्याघ्यृत्वग्निवयोदेहबलसत्त्वसात्म्यप्रकृतिभेषजदेशान् परीक्षेत ॥२॥
A physician should first observe the vital condition (Ayu) of the patient before commencing the medical treatment. After that, the nature of the disease, the country and season of the year in which it has made its appearance, as well as the state of digestion, age, body, strength, disposition, habit, previous medicine, natural temperament and the power of endurance of the patient, etc. should be observed and carefully examined. 2
तत्र महापाणिपादपार्श्वपृष्ठस्तनाग्रदशनवदनस्कन्धललाटं दीर्घाङ्गुलिपर्वोच्छ्वासप्रेक्षणबाहुं, विस्तीर्णभ्रूस्तनान्तरोरस्कं, ह्रस्वजङ्घामेढ्रग्रीवं, गम्भीरसत्त्वस्वरनाभिमनुचैर्बद्धस्तनमुपचितमहारोमशकर्णं, पश्चान्मस्तिष्कं, स्नातानुलिप्तं मूर्द्धानुपूर्व्या विशुष्यमाणशरीरं पश्चाच्च विशुष्यमाणहृदयं पुरुषं जानीयाद् दीर्घायुः खल्वयमिति । तमेकान्तेनोपक्रमेत् । एभिर्लक्षणैर्विपरीतैरल्पायुर्मिश्रैर्मध्यमायुरिति ॥३॥
Characteristic features of a long lived man: Men, the dimensions of whose hands, legs, sides, back, nipples of the breast, teeth, face, shoulders and forehead exceed the average, as well as those whose eyes, arms, phalanges and fingers are longer than the ordinary ones should be regarded as going to live long. those who have broad chests, broad eye-brows with broader spaces intervening between the muscles of the breasts, and who take in deeper inspirations of breath, will be long lived. Those whose necks, thighs, and generative organs are shorter than those of the average type, or those whose voices and umbilical cavities are deep, and whose breasts are unraised and thick-set, and external ears broad, fleshy and hairy, with the occipital region fully developed and protruded, will enjoy a longer span of life. Men, on whose bodies sandal paste and similar preparations begin to dry up from the head downward, while those applied over the chest become absorbed later, should be looked upon as persons endowed with an uncommonly longer duration of life.
The medical treatment of such a patient may be unhesitatingly taken in hand by a physician. Persons, exhibiting bodily features other than those described above, should be looked upon as short-lived men, while those, who are possessed of features common to men of both the above mentioned types, should be considered as keeping the mean between them as regards longevity (Madhyamayuh). 3
गूढसन्धिशिरास्नायुः संहताङ्गः स्थिरेन्द्रियः । उत्तरोत्तरसुक्षेत्रो यः स दीर्घायुरुच्यते ।। गर्भात् प्रभृत्यरोगो यः शनैः समुपचीयते । शरीरज्ञानविज्ञानैः स दीर्घायुः समासतः ॥ ४ ॥
Authoritatives verses on the subject: A man, with deep-set bones, ligaments, and veins, and tough and thick-set limbs, and firm and unflinching sense organs, as well as one whose body gradually develops a more and more symmetrical shape, should be looked upon as a long-lived man. The man, who has not ailed for a single moment even from the day of his birth, and has been getting more and more strong-limbed every day through the cultivation of his inborn sense and a better knowledge of the laws of health, is sure to live to a good old age in the full enjoyment of his senses and intellect. 4
मध्यमस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे। अधस्तादक्षयोर्यस्य लेखाः स्युर्व्यक्तमायताः । द्वे वा तिम्रोऽधिका वापि पादौ कर्णौ च मांसलौ ।। नासाग्रमूर्ध्वंञ्च भवेदूर्ध्वं लेखाश्च पृष्ठतः। यस्य स्युस्तस्य परममायुर्भवति सप्ततिः । ॥ ५ ॥
Madhyamayuh: Now, hear me describe the bodily features of a man of a mean or average duration of life (Madhyamayuh). The man, the integuments of whose lower eyelids are marked with two or three well-marked and extended lines or furrows, and whose legs and external ears are thick and fleshy, and the tip of whose nose is turned a little upward, and who has up-pointed lines directly running through the middle of his back, is expected to live up to the ripe old age of seventy years, 5
जघन्यस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे। हूस्वानि यस्य पर्वाणि सुमहच्चापि मेहनम् ।। तथोरस्यवलीढानि न च स्यात् पृष्ठमायतम् । ऊर्ध्वं श्रवणौ स्थानान्नासा चोच्चा शरीरिणः ।। हसतो जल्पतो वापि दन्तमांसं प्रदृश्यते । प्रेक्षते यश्च विभ्रान्तं स जीवेत् पञ्चविंशतिम् ॥ ६ ॥
Specific traits of a short-lived man: Now, hear me describe the specific traits, which characterise the body of a short-lived man. A man with short phalanges of fingers a narrow back, and external ears abnormally raised up from their natural seats, and who is possessed of a large penis,a high nose, a breast covered with ringlets of curly hair, and who exposes the gums of his teeth, or whose eyes roll while talking or laughing, is not expected to see more than twenty-five summers. 6
अथ पुनरायुषो विज्ञानार्थमङ्गप्रत्यङ्गप्रमाणसारानुपदेक्ष्यामः । तत्राङ्गान्यन्तराधिसक्थिबाहुशिरांसि तदवयवाः प्रत्यङ्गानीति । तत्र स्वैरङ्गुलैः पादाङ्गुष्ठप्रदेशिन्यौ द्व्यङ्गुलायते । प्रदेशिन्यास्तु मध्यमानामिका कनिष्ठिका यथोत्तरं पञ्चमभागहीनाः । चतुरङ्गुलायते पञ्चाङ्गुलविस्तृते प्रपदपादतले। पञ्चचतुरङ्गुलायतविस्तृता पाणिः । चतुर्दशाङ्गुलयतः पादः। चतुर्द्दशाङ्गुलपरिणाहानि पादगुल्फजङ्घाजानुमध्यानि । अष्टादशाङ्गुला जङ्घा, जानूपरिष्टाच्च द्वात्रिंशदङ्गुलमेवं पञ्चाशत् । जङ्घायामसमावूरू ॥७॥
We shall now give the exact measures of the different limbs and members of the body for the better ascertainment of the duration of life a patient under investigation. The legs, the arms, and the head are called the limbs of the body, while their component parts are called the members (Avayavas). The great toe of a man, or the one next to it, measured with his own fingers should measure two fingers width in length, the lengths of the other toes (the third, fourth, and small ones) successively diminishing by a fifth part of that of his middle finger (Pradesini).
The fore-sole and the sole proper respectively should measure four fingers width in length and five fingers’ width in breadth. The heel of the foot (Parsni) should measure five fingers’ width in length and four fingers’ width in breadth. The foot itself should measure fourteen fingers’ width in length. The girth of the foot, as well as the circumference of the middle parts of thighs and knee-joints, respectively should measure fourteen fingers in width.
The part of the leg between the ankle and the knee-joint should measure eighteen fingers’ width in length, while the part between the joint of the waist and the knee-joint should measure thirty-two fingers’ width in length, the entire leg thus measuring fifty fingers’ width in all. The length of the thigh is the same as that of the part lying between the heel and the knee-joint (Jangha). 7
द्व्यङ्गलानि वृषणचिबुकदशननासापुटभागकर्णमूलनयनान्तराणि । चतुरङ्गुलानि मेहनवदनान्तरनासाकर्णललाटग्रीवोच्छ्रायदृष्ट्यन्तराणि। द्वादशाङ्गुलानि भगविस्तारमेहननाभिहृदयग्रीवास्तनान्तरमुखायाममणिबन्धप्रकोष्ठस्थौल्यानि । इन्द्रबस्तिपरिणाहांसपीठकूर्परान्तरायामः षोडशाङ्गुलः। चतुर्विंशत्यङ्गुलो हस्तः । द्वात्रिंशदङ्गुलपरिमाणौ भुजौ, द्वात्रिंशत्परिणाहावूरू। मणिबन्धकूर्परान्तरं षोडशाङ्गुलम्। तलं षट्चतुरङ्गुलायामविस्तारम् । अङ्गुष्ठमूलप्रदेशिनीश्रवणापाङ्गान्तरमध्यमाङ्गुल्यौ पञ्चाङ्गुले। सार्द्धचतुरङ्गुले प्रदेशिन्यनामिके। सार्द्धत्रचङ्गुलौ कनिष्ठाङ्गुष्ठौ ।।८।।
The scrotum, the chin, the (two rows of) teeth, the exterior line of the nostrils, the roots of the ears, and the intervening space between the eyes, should respectively measure two fingers’ width in length. The non-erected penis, the cavity of the mouth, the two rows of teeth, the nose, the height of the neck, the ears, and the forehead, and the space intervening between the pupils of the eyes measure four fingers’ width in length.
The entire length of the vaginal canal should measure twelve fingers’ width. The space lying between the penis and the umbilicus, as well as the one intervening between the chest and the upper end of the throat (lit: neck), like the one lying between the tips of the two nipples of the breast, should measure twelve fingers’ width in length. The length of the entire face should measure twelve fingers’ width. The girth round the wrist and the fore-arm of a man should measure twelve fingers.
The girth round the knee-joint is sixteen fingers’ width and the length between the wrist and the elbow should measure sixteen fingers’ width. The part of the arm between the elbow and the tip of the middle finger should measure twenty-four fingers’ width in all. The length of the entire arm measures thirty-two fingers’ width, and the girth round the thighs should measure thirty-two fingers’ width. The palm of the hand should measure six fingers’ width in length and four fingers’ width in breadth. The space between the bottom of the ball of the thumb to the root of the index finger, as well as the space between the root of the ears to the outer corner or angle of the eyes, should measure five fingers’ in length. The middle finger should measure five fingers’ width in length. The index and the ring-fingers respectively should measure four and a half fingers in length, the thumbs and the little fingers respectively measuring three and a half fingers. 8
चतुर्विंशतिविस्तारपरिणाहं मुखग्रीवम् । त्रिभागाङ्गुलिविस्तारा नासापुटमर्यादा । नयनत्रिभागपरिणाहा तारका | नवमस्तारकांशो दृष्टिः। केशान्तमस्तकान्तरमेकादशाङ्गुलम् । मस्तकादवटुकेशान्तो दशाङ्गुलः । कर्णाववन्तरं चतुर्दशाङ्गलम् । पुरुषोरः प्रमाणविस्तीर्णा स्त्री श्रोणिः। अष्टादशाङ्गुलविस्तीर्णमुरः । तत्प्रमाणा पुरुषस्य कटी। सविंशमङ्गुलशतं पुरुषायाम इति ॥ ९ ॥
The fissure of the mouth should measure four fingers in length. The girth round the neck should measure twenty fingers. Each of the cavities of the nostrils should measure one and three quarter parts of a finger in length. The region of the iris occupies a third part of the entire area of the cornea. The region of the pupil should measure a ninth part thereof.
The arch extending from the hairy extremity of the templar region to the middle point of the back of the head should measure eleven fingers. The distance between the middle of the head and the terminal point of the hairy portion of the neck should measure ten fingers in length. The girth of the neck measure from the back of one ear to that of the other should be fourteen fingers. The length of the pelvic region of a young woman measure from below the anterior side of the thigh joints should be found to be equal to the breadth of the chest (Vaksah) in a male subject ( twelve fingers).
The thigh of a woman should be eighteen fingers in breadth and equal to that of the waist of a man. The entire length of a male human body should be a hundred and twenty fingers. 9
भवन्ति चात्रपञ्चविंशे ततो वर्षे पुमान् नारी तु षोडशे । समत्वागतवीर्यौ तौ जानीयात् कुशलो भिषक् ।।१०।।
स्वैरङ्गलैरेष यथावदनुकीर्त्तितः ।। देहः युक्तः प्रमाणेनानेन पुमान् वा यदि वाङ्गना ।
दीर्घमायुरवाप्नोति वित्त महदूच्छति । मध्यमं मध्यमैरायुर्वित्तं हीनैस्तथाऽवरम् ।।११।।
Authoritative verse on the subject: An intelligent physician should regard the organism of a man of twenty-five or of a woman of sixteen years of age, as fully developed (in respect of the maturity of the seven fundamental principles of the body such as, serum, blood, & c). The dimensions of the different limbs and members of the body, laid down above, should be understood as to have been measured by the standard of one’s (man’s or woman’s) own finger’s width, and a person, whose limbs and organs are found to correspond to the abovesaid measures, is sure to live to a good and hearty old age, as a necessary and befitting sequel to a happy and prosperous career in life. In the case of a partial correspondence of one’s limbs and organs to the above-said measures and proportions, a man should be regarded as having an average life and prosperity. A person whose limbs fall short of the abovesaid measures should be regarded as an indigent and short-lived person. 10-11
अथ सारान् वक्ष्यामः । स्मृतिभक्तिप्रज्ञाशौर्यशौचोपेतं कल्याणाभिनिवेशं सत्त्वसारं विद्यात् स्निग्धसंहतश्वेतास्थिदन्तनखं बहुलकामप्रजं शुक्रेण । अकृशमुत्तमबलं स्निग्धगम्भीरस्वरं सौभाग्योपपन्नं महानेत्रञ्च मज्ज्ञा। महाशिरः स्कन्धं दृढदन्तहन्वस्थिनखमस्थिभिः । स्निग्धमूत्रस्वेदस्वरं वृहच्छरीरम् आयासासहिष्णुं मेदसा । अच्छिद्रगात्रं गूढास्थिसन्धिं मांसोपचितञ्च मांसेन । स्निग्धताम्रनखनयनतालुजिह्वौष्ठपाणिपादतलं रक्तेन । सुप्रसन्नमृदुत्वग्रोमाणं त्वक्सारं विद्यादित्येषां पूर्वं पूर्व प्रधानमायुः सौभाग्ययोरिति॥ १२॥
Physical temperament (Sara): Now we shall describe the characteristic traits of the different preponderant principles (Sara) or temperaments of the human organism. A man, who is possessed of a good retentive memory, and is intelligent, valorous and cleanly in his habits, and whose mind is graced with such rare and excellent virtues as, purity of thought, and a fervent and unflinching devotion to gods and the reverend, and who exerts himself for the furtherance of the absolute good, should be regarded as a man of Satvasara (psychic or illumined) temperament.
A man with glossy, white and close-set bones, teeth, and nails and who has begotten a large family of children, and shows a marked amative tendency, should be looked upon as a man in whom the principle of semen decidedly preponderates. A man with a thin and sinewy body, and who exibits traits of excessive strength, and possesses a deep resonant voice, and a pair of large and handsom eyes, and who is successful in every walk of life, should be looked upon as one in whom the principle of marrow preponderates. A man with a large head, and a large pair of shoulders, and having firm teeth, bones, cheek-bones, and finger-nails, should be considered as one in whom the principle of bone preponderates.
A man with a large and bulky body, and who is capable of enduring a large amount of fatigue or physical exertion, and who naturally talks in a soft and melodious voice, and whose bodily secretions such as urine and perspiration are characterised by coldness should be regarded as one of a fatty temperament. A man with an erect and upright frame, and deep-set bones, and joints in thick layers of flesh, should be regarded as one in whom the principle of flesh predominates.
A man, whose finger nails, eyes, tongue, palate, lips, palms of hands and soles of feet are glossy, and tinged with a shade of red, should be looked upon as one in whom blood forms the essential and predominant principle. A man with a soft, smooth and pleasant skin and hair should be considered as one in whom serum (Tvak) forms the essential principle of the body. In respect of wordly success and longevity, men of each of the aforesaid types should be successively judged inferior to men belonging to the one preceding it in the above order of enumeration. 12
भवति चात्र विशेषतोऽङ्गप्रत्यङ्ग-प्रमाणादथसारतः।
परीक्ष्यायुः सुनिपुणो भिषक् सिध्यति कर्मसु ॥१३॥
Authoritative verse on the subject : A qualified physician should examine the duration of life in a patient with the help of the aforesaid measures of limbs and the essential bodily principles, before proceeding to take up his medical treatment, and his professional success hsould be decidedly increased thereby. 13
All the diseases, whose names have been specifically enumerated before, may be grouped under any of the three different heads as the curable, the suppressible (Yapya) and the incurable (lit: fit to be pronounced as hopeless). 14
तत्रैतान् भूयस्त्रिधा परीक्षेत किमसावौपसर्गिकः प्राक्केवलोऽन्यलक्षण हति ।
तत्रौपसर्गिको नाम यः पूर्वोत्पन्नं व्याधिं जघन्यकालजातो व्याधिरुपसृजति स तन्मूल एवोपद्रवसंज्ञः । प्राक्केवलो यः प्रागेवोत्पन्नो व्याधिरपूर्वरूपोऽनुपद्रवश्च । अन्यलक्षणो यो भविष्यद्व्याधिख्यापकः स पूर्वरूपसंज्ञः ॥१५॥
Each of these different types, in its turn, should be carefully observed so as to determine whether it is a primary or an independent disease, or merely an accessory or sympathetic one, or the premonitory indication of an incipient distemper in its incubative stage.
An aupasargika (sympathetic) disease is merely a symptom developed in the course of an original or primary malady, and which has its foundation in the very nature or component factors of the preexisting distemper. A disease, which manifests itself from the commencement of a case and is neither an accessory symptom, nor a premonitory indication of any other distemper, is called a Prakkevala (primary or original) one. A disease which indicates the advent of a future or impending malady is called a Purvarupa (premonitory stage or indication of a disease). 15
तत्र सोपद्रवमन्योन्याऽविरोधेनोपक्रमेत बलवन्तमुपद्रवं वा । प्राक्केवलं यथास्वं प्रतिकुर्वीत । अन्यलक्षणे त्वादिव्याधौ प्रयतेत ॥ १६ ॥
The medicial remedy to be administered in any particular case should be selected with an eye to the curative virtues of each of its components, so as not to clash with the nature (cause) of the disease and its accompanying symptoms, and to prove simultaneously soothing to both of them. On the contrary, a violent unfavourable symptom should be first attended to and checked in a case where it would be found to have grown stronger and more distressing or dangerous than the original malady in course of which it has been developed.
A primary or independent malady, unattended with any of the distressing or unfavourable symptoms, should be treated according to its indications and the nature of the deranged humours involved therein, while in an incubative disease the treatment should consist in subduing a premonitory symptom as soon as it would make itself manifest. 16
भवति चात्रनास्ति रोगो विना दोषैर्यस्मात् तस्माद् विचक्षणः । अनुक्तमपि दोषाणां लिङ्गैर्व्याधिमुपाचरेत् ।।१७।।
प्रागभिहिता ऋतवः ।। १८ ।।
Authoritative Verse on the subject : As there is not a single disease, which can make its appearance without the participation of any of the deranged bodily humours, a wise physician is enjoined to administer medicines according to the specific features of the deranged humours involved in a disease whose nature and treatment have not even been described in any book on medicine. The different seasons of the year have been described before. 17-18
शीते शीतप्रतीकारमुष्णे चोष्मनिवारणम् । कृत्वा कुर्यात् क्रियां प्राप्तां क्रियाकालं न हापयेत् ।।१९ ।।
अप्राप्ते वा क्रियाकाले प्राप्ते वा न कृता क्रिया | क्रिया हीनाऽतिरिक्ता वा साध्येष्वपि न सिध्यति ॥ २० ॥
या तूदीर्णं शमयति नान्यं व्याधिं करोति च। सा क्रिया, न तु या व्याधिं हरत्यन्यमुदीरयेत् ।। २१ ।।
Metrical Texts : In the cold season, a disease should be treated with measures and remedies endued with the virtue of destroying or warding off cold, while in summer the medicinal treatment should consist of measures and applications capable of allaying the heat. The medical treatment of a disease should be commenced just at the opportune moment, which should not be allowed to expire in vain under anycircumstances whatsoever. A course of medical treatment commenced at an inopportune moment, or not resorted to at the advent of its proper time, as well as over or insufficient medication, proves abortive even in a curable type of disease. The proper medical treatment (of a disease) is that which successfully copes with the malady under treatment, and arrests the recrudescence of a fresh one by way of sequel, and not that, which though subduing a particular distemper, is immediately followed by a new one. 19-21
प्रागभिहितोऽग्निरन्नस्य पाचकः । स चतुर्विधो भवति, दोषानभिपन्न एको विक्रियामापन्नस्त्रिविधो भवति । विषमो वातेन, तीक्ष्णः पित्तेन,
मन्दः श्लेष्मणा, चतुर्थः समः सर्वसाम्यादिति ॥ २२ ॥
It has been demonstrated before that the food of a man is digested only with the help of the digestive fire or heat (Pacakagni), which may be divided into four different kinds (states). One of these kinds is due to it not being in any way affected by the deranged humours of the body, while the other three are respectively ascribed to the fact of their becoming so deranged. The digestive fire or heat becomes irregular or fitful (Visamagni) through the action of the deranged Vayu becomes keen, through the action of the deranged Pitta, and dull or sluggish, through the action of the deranged Kapha. The fourth kind (Sama) continues in a state unaffected by any of the morbid humoural constituents of the body owing to their maintaining the normal equilibrium. 22
तत्र यो यथाकालमुपयुक्तमन्नं सम्यक् पचति स समः समैर्दोषैः । यः कदाचित् सम्यक् पचति कदाचिदाध्मानशूलोदावर्त्तातिसारजठरगौरवान्त्रकूजनप्रवाहणानि कृत्वा स विषमः । यः प्रभूतमप्युपयुक्तमन्नमाशु पचति स तीक्ष्णः स एवाभिवर्द्धमानोऽत्यग्निरित्याभाष्यते; स मुहुर्मुहुः प्रभूतमप्युपयुक्तमन्नमाशुतरं पचति, पाकान्ते च गलताल्वोष्ठशोषदाहसन्तापान् जनयति । यस्तु स्वल्पमप्युपयुक्तमुदरशिरोगौरवकासश्वासप्रसेकच्छर्द्दिगात्रसदनानि कृत्वा महता कालेन पचति स मन्दः ॥२३॥
Samagni and Visamagni: The digestive heat, which fully digests the ingested food at the proper time without the least irregularity, thus reflecting the continuance of the bodily humours in their normal state, is called Samagni. The digestive heat which is irregular in its action, and which sometimes helps the process of complete digestion, and produces distension of the abdomen, colic pain, constipation of the bowels, dysentery, ascites, heaviness of the limb rumbling in the intestines, and loose motions ( diarrhoea ) at other times, is called Visamagni.
Tiksnagni : The digestive heat, which helps the digestion of even a heavy meal within an incredibly short space of times, is called “Keen” (Tiksnagni) and which becoming abnormally augmented begets an excessive or voracious appetite (Atyagni), helps a glutton to digest his frequent meals, and produces a parched throat, palate and lips, heat and other discomforts.
Mandagni : The digestive fire or heat which causes the tardy digestion even of a scanty meal, and produces heaviness of the abdomen and head, cough, difficult breathing, water-brash, nausea, and weariness of the limbs simultaneously with the taking thereof, is called dull or sluggish (Mandagni). 23
विषमो वातजान् रोगांस्तीक्ष्णः पित्तनिमित्तजान् ।
करोत्यग्निस्तथा मन्दो विकारान् कफसम्भवान् ॥ २४ ॥
तत्र समे परिरक्षणं कुर्वीत, विषमे स्निधाम्ललवणैः क्रियाविशेषैः प्रतिकुर्वीत, तीक्ष्णे मधुरस्निग्धशीतैर्विरकैच, एवमेवात्यग्नौ विशेषेण माहियै क्षोरदीवसर्पिर्भिः मन्दे कटुतिक्तकषायैर्वमनैश्च परिरक्षण
Meirical Texts: The digestive fire of the Visama kind brings on diseases characterised by the derangement of the Vayu. A keen (Tiksna) digestive fire brings on bilious (Pittaja) affections, while a sluggish (Manda) fire gives rise to diseases marked by a deranged state of the Kapha. Endeavours should be made to keep the digestive fire of the Sama type (normal or regular appetite¹) in an unimpaired state. The one known as Visama (irregular) should be corrected by a diet consisting of emollient, acid or saline substances. In a case of abnormally keen digestive fire, the medical treatment should consist in prescribing purgatives and a diet in the composition of which sweet, cooling, and fatty or albuminous matters largely enter. The same treatment should be adopted in (Atyagni) as marked in cases of voracious appetite, and a diet consisting of buffalo-milk, or its curd (Dadhi) and liquid buffalo-butter should be prescribed for the patient in addition. Emetics should be administered in a case of dull or sluggish digestion (Mandagni) and the patient should be restricted to a diet consisting of articles of a pungent, astringent or bittertaste. 24-25
जाठरो भगवानग्निरीश्वरोऽन्नस्य पाचकः । सौक्ष्म्याद्रसानाददानो विवेक्तुं नैव शक्यते ॥ २६ ॥
1. There is a difference between “Agni” and “appetite”. Agni includes bile and pancreatic secretions, and hence indicates the state of ones digestion. Appetite, though not an unerring indicator of the process, is the effect of Agni.
प्राणापानसमानैस्तु सर्वतः पवनैस्त्रिभिः । ध्मायते पाल्यते चापि स्वे स्वे स्थाने व्यवस्थितैः ।। २७ ।।
Metrical Texts : The fire, that burns within a person, is godly in its subtle essence, and possesses the divine attributes of atom-like invisibility, weight-lessness, etc., and is the digestant of food. It takes up the lymph chyle of different tastes for the purpose of digestion, and is invisible owing to its extremely subtle essence. The three vital Vayus known as Prana, Apana and Samana, located in their own spheres within the organism, feed it and keep it burning. 26-27
वयस्तु त्रिविधं, बाल्यं मध्यं वृद्धमिति । तत्रोनषोडशवर्षीया बालास्तेऽपि त्रिविधा:-क्षीरपाः, क्षीरान्नादाः, अन्नादा इति । तेषु संवत्सरपरा: क्षीरपाः, द्विसंवत्सरपरा: क्षीरान्नादाः, परतोऽन्नादा इति । ॥ २८ ॥
The three stages of man may be roughly described as (1) infancy or childhood, (2) youth or middle age, and (3) old age or dotage. Childhood extends up to the sixteenth year of life, and children may be divided into three different classes, according as they are fed on milk, or on milk and boiled rice or on boiled rice alone. A child lives exclusively on milk up to the first year of its life, it is fed on milk and boiled rice (hard food) up to the second year, and is thenceforward nourished with boiled rice (hard food). 28
षोडशसप्तत्योरन्तरे मध्यं वयस्तस्य विकल्पो वृद्धिर्यौवनं सम्पूर्णता हानिरिति । तत्र आ विंशतेर्वृद्धिरात्रिंशतो यौवनमाचत्वारिंशतः सर्वधात्विन्द्रियबलवीर्यसम्पूर्णता । अत ऊर्ध्वमीषत्परिहाणिर्यावत् सप्ततिरिति । सप्ततेस्तूर्ध्वं क्षीणमाणधात्विन्द्रियबलवीर्योत्साहमहन्यहनि बलीपलितखालित्यजुष्टं कासश्वासप्रभृतिभिरुपद्रवैरभिभूयमानं सर्वक्रियास्वसमर्थं जीर्णागारमिवाभिवृष्टमवसीदन्तं वृद्धमाचक्षते ।। २९ ।।
The middle age of a man extends from the sixteenth to the seventieth year of his life, and exhibits the traits of growth, youth, arrest of development and decay. The process of growth or building goes on up to the twentieth year of life, when youth or the age of maturity sets in and holds sway over the body of a man up to the thirtieth year of his life, the strength, semen and all the organs and vital principles of the body attain (their) full maturity at the age of forty Thenceforth decay gradually sets in up to the seventieth year of life. After that the strength and energy of a man dwindle day by day. The organs and virility grow weak and suffer deterioration. The hair turns to a silvery white, the parched skin looks shrivelled and becomes impressed with marks of dotage (crow’s feet-marks). The skin hangs down and becomes flabby, the hair begins to fall off, and symptoms of alopecia mark the smooth, sheen and balded pate. The respiration becomes laboured and painful. The body, worn out like an old and dilapidated building, shakes with fits of distressing cough. Such a man is incapable of all acts, and does but imperfectly perform all bodily functions. He has grown old. 29
तत्रोत्तरोत्तरासु वयोऽवस्थासूत्तरोत्तरा भेषजमात्राविशेषा भवन्ति, ऋते च परिहाणेस्तत्राद्यापेक्षया प्रतिकुर्वीत ॥ ३०॥
The dose of medicine should be increased with the age of a patient till the age of decay, and reduced after the expiry of the seventieth year to the quantity (which is usually prescribed for an youth of sixteen). 30
बाले विवर्द्धते श्लेष्मा मध्यमे पित्तमेव तु। भूयिष्ठं वर्द्धते वायुर्वृद्धे तद्वीक्ष्य योजयेत् |॥ ३१ ॥
अग्निक्षारविरेकैस्तु बालवृद्धौ विवर्जयेत् । तत्साध्येषु विकारेषु मृद्वीं कुर्यात् क्रियां शनैः ॥ ३२ ॥
Authoritative verses on the Subject : Kapha is increased during the years of childhood and Pitta in middle age; while an increase of Vayu (nervous derangement) marks the closing years of life. The use of strong or drastic purgatives, and cauterisation are alike prohibited in cases of children and old men. They should be used only in weakened or modified forms if found indispensably necessary. 31-32
देहः स्थूलः कृशो मध्य इति प्रागुपदिष्टः । कर्शयेद् बृंहयेच्चापि सदा स्थूलकुशौ नरौ ॥
रक्षणञ्चैव मध्यस्य कुर्वीत सततं भिषक् ।। ३३ ।।
It has been stated before that the body of a person is either stout, thin or of an average (middling) bulk. A stout person should be reduced in bulk with depletive measures, while a physician should try to make a thin patient gain in flesh. A human body, which is neither too thin nor too stout, should be made to maintain its shapely rotundity. 33
बलमभिहितगुणं, दौर्बल्यन्तु स्वभावदोषजरादिभिरवेक्षितव्यम् । यस्माद् बलवतः सर्वक्रियाप्रवृत्तिस्तस्माद् बलमेव प्रधानमधिकरणानाम्॥३४॥
We have already discoursed on the strength of the body. Now in a particular case under treatment, it is primarily incumbent on the physician to enquire whether the patient is naturally weak, or has become so through a deranged condition of the bodily humours or old age. And since it is the strength of a patient which makes all remedial measures (such as cauterisation, etc.) possible, it should be regarded as the grandest auxiliary to a medical treatment of whatsoever natuure it may be. 34
केचित् कृशाः प्राणवन्तः स्थूलाञ्चाल्पबला नराः। तस्मात् स्थिरत्वं व्यायामैर्बलं वैद्यः प्रतर्कयेत् | ॥ ३५ ॥
सत्त्वन्तु व्यसनाभ्युदयक्रियादिस्थानेष्वविक्लवकरम् ।।३६ ।।
Metrical Texts: There are some men who are strong though thin; while others are weak, though stout; and accordingly a physician should determine the bodily strength of a patient by enquiring about the capacity of his physical endurance and labour. Sattva or fortitude denotes a kind of (stoic) indifference of one’s mind to sensations and sources of pleasure or pain. 35-36
सत्त्ववान् सहते सर्वं संस्तभ्यात्मानमात्मना । राजसः स्तभ्यमानोऽन्यैः, सहते नैव तामसः ।।३७ ।।
A man of strong fortituude (Sattvika temperament) is capable of enduring everything, or any amount of pain by repressing his mind with the help of his will or intellect. A man of a Rajasika turn of mind (strong, active, energetic) may be made to patiently submit to a course of painful medical treatment by means of persuasive counsels and the logic of the inevitable, whereas a man of a Tamasika temperament (a worldly cast of mind characterised by Nescience) is simply overwhelmed at the prospect of bodily pain. 37
प्रकृतिं भेषजञ्चोपरिष्टाद् वक्ष्यामः । सात्म्यानि तु देशकाल – जात्यृतुरोगव्यायामोदकदिवास्वप्नरसप्रभृतीनि प्रकृतिविरुद्धान्यपि यान्यबाघकराणि भवन्ति ॥३८॥
Later on, we shall have occasion to deal with the different types of physical treatment and of remedial agents in general. A particular country, or a season of the year, a particular disease or a peculiar mode of living, any particular kind of physical labour or exercise, or the specific properties of the water of any particular locality, or day sleep, or a juice of any particular taste, is or are said to be congenial (Satmya) to a man, or a man is said to be naturalised to these conditions and environments, when they fail to produce any injurious effect on his health, though naturally unwholesome to others. 38
यो रसः कल्पते यस्य सुखायैव निषेवितः ।
व्यायामजातमन्यद् वा तत् सात्म्यमिति निर्दिशेत् ॥ ३९ ॥
Metrical Texts: A thing of any taste whitsoever, or any kind of habit or physical exercise is said to be congenial to a man which, instead of in any way telling on his health, contributes to his positive pleasure and comfort. 39
देशस्त्वानूपो जाङ्गलः साधारण इति । तत्र बहूदकनिम्नोन्नतनदीवर्षगहनो मृदुशीतानिलो बहुमहापर्वतवृक्षो मृदुसुकुमारोपचितशरीरमनुष्यप्रायः कफवातरोगभूयिष्ठश्चानूपः । आकाशसमः प्रविरलाल्पकण्टकिवृक्षप्रायोऽल्पवर्षप्रस्रवणोदपानोदकप्राय दारुणवातः प्रविरलाल्पशैलः स्थिरकृशशरीरमनुष्यप्रायो वातपित्तरोगभूयिष्ठश्च जाङ्गलः । उभयदेशलक्षणः साधारण इति ॥४०॥ उष्ण
Features of Anupa country: A country may be classed either as an Anupa, Jangala or a Sadharana one, according to its distinctive physical features. An Anupa (watery or swampy) country contains a large number of pools, and is wooded and undulated with chains of lofty hills traversing its area, and which is impassable owing to its networks of rivers and sheets of accumulated rain-water rippling before the currents of the gentle, humid air. It is inhabited by a race of stout, shapely and soft-bodied men, susceptible of Vatala and Kaphaja diseases.
Features of Jangala and Sadharana countries: The country which presents a flat surface and whose dull monotony is enlivened here and there by scanty growths of thorny shrubs and the tops of a few isolated hills or knolls, and in which the waters from springs and wells, accumulated during the rains, become nearly drained, and strong gales of warm wind blow (during the greater part of the year) making its inhabitants, though thin, strong, tough, and sinewy in their frames, subject to attacks of diseases, is called Jangala. A country, which exhibits features common to both the aforesaid classes, is called Sadharana or ordinary. 40
समाः साधारणे यस्माच्छीतवर्षोष्ममारुताः । दोषाणां समता जन्तोस्तस्मात् साधारणो मतः । ॥ ४१ ।।
न तथा बलवन्तः स्युर्जलजा वा स्थलाहताः। स्वदेशे निचिता दोषा अन्यस्मिन् कोपमागताः ॥४२॥
उचिते वर्त्तमानस्य नास्ति देशकृतं भयम् । आहारस्वप्नचेष्टादौ तद्देशस्य गुणे देशप्रकृतिसात्म्यर्तुविपरीतोऽचिरोत्थितः सति ॥४३॥
सम्पत्तौ भिषगादीनां बलसत्त्वायुषां तथा ।। ४४ ।।
केवलः समदेहाग्नेः सुखसाध्यतमो गदः । अतोऽन्यथा त्वसाध्यः स्यात् कृच्छ्रो व्यामिश्रलक्षणः।।४५।।
Authoritative Verses on the Subject : A country derives the epithet of Sadharana from the ordinary character of its heat, cold and rainfall, and from the fact of the bodily humours maintaining their normal state of equilibrium within its confines. A disease originated in, and peculiar to a particular country fails to gain in intensity, if brought over to, and transplanted in a country of a different character. A man, who observes a regimen of diet and conduct soothing to the deranged bodily humours accumulated in the country he has come from, and aggravated and manifest in the shape of a disease in the country he has been living for the time being, need not apprehend any danger from the altered conditions of his new abode, for the fact of his not observing a regimen of diet and conduct regarded beneficial in consideration of the physical features of the latter place. A disease of recent growth or origin unattended with any distressing or unfavourable complications, and unsuited to the nature of the country’, the season of the year, the temperament, and the adopted or congenial or naturalised traits of the physique of a patient with a regular and unimpaired state of digestion (Samagni), and who exhibits traits of strength, fortitude and longevity and commands the co-operation of the four commendable factors of a course of medical tratment, readily yields to medicine.
A disease, which is marked by features other than those described above, should be regarded as incurable, while the one exhibiting traits common to both the abovesaid types, should be looked upon as extremely hard to cure. 41-45
क्रियायास्तु गुणालाभे क्रियामन्यां प्रयोजयेत् । पूर्वस्यां शान्तवेगायां न क्रियासङ्करो हितः । ॥ ४६ ।।
गुणालाभेऽपि सपदि यदि सैव क्रिया हिता। कर्त्तव्यैव तदा व्याधिः कृच्छ्रसाध्यतमो यदि ॥४७॥
य एवमेनं विधिमेकरूपं बिभर्त्ति कालादिवशेन धीमान् । स मृत्युपाशान् जगतो गदौघांश्छिनत्ति भैषज्यपरश्वधेन ।।४८ ॥
In the case of a former medicine proving abortive, a different one should not be resorted to as long as the effect of the first would last, inasmuch as a mixture or a confusion of medicinal remedies tends to produce a positively injurious effect. A medicine or any medicinal measure, failing to produce any tangible effect, may be repeated in quick succession in a difficult or dangerous disease, if it be empirically
1. As the development of a disease due to the deranged Kapha in a country of the Jangala type.
2. As the attack of a bilious distemper in forewinter, or of a Vataja malady in autumn, or of a Kaphaja affection in summer.
3. As the appearance of Kaphaja disease in a patient of bilious temperament.
4. As the appearance of a Kaphaja disease in a subject habituated to the use of viands of pungent taste.
found to be beneficial in the case under treatment. The intelligent physician, who, considering the nature of the season, etc. fully conforms to the abovesaid rules of medical treatment, conquers the bodily distempers and dispels the gloom of Death from the world with his medical skill. 46-48
इति सुश्रुतसंहितायां सूत्रस्थाने आतुरोपक्रमणीयो नाम पञ्चत्रिंशोऽध्यायः ॥ ३५ ॥
Thus ends the Thirty-fifth Chapter of Sutrasthana in the Susruta Samhita. which treats of clinical observation.