अथातो महारोगाध्यायं व्याख्यास्यामः ॥ १ ॥ इति ह स्माह भगवानात्रेयः ॥ २ ॥
Now we shall pound the “Major Chapter on the (Enumeration of) Diseases.” [ 1-2 ] Thus said Lord Atreya
In the previous chapter, the diseases manifested due to the vitiation of vata, pitta and kapha in general have been enumerated. The present chapter, however, represents enumeration of specific diseases caused by vata, pitta or kapha.
General classifications of diseases
चत्वारो रोगा भवन्ति – आगन्तुवातपित्तश्लेष्मनिमित्ताः; तेषां चतुर्णामपि रोगाणां रोगत्वमेकविधं भवति, रुक्सामान्यात् ; द्विविधा पुनः प्रकृतिरेषाम्, आगन्तु निजविभागात्, द्विविधं चैषामधिष्ठानं, मनःशरीरविशेषात्; विकाराः पुनरपरिसंख्येयाः, प्रकृत्यधिष्ठानलिङ्गायतनविकल्प विशेष परिसंख्येयत्वात् ॥ ३ ॥
There are four types of diseases viz., exogenous, vaitka, paittika and slaismika. Pain being common to all, diseases are (ultimately) of one type. They are again of two types depending on their nature, that is exogenous and endogenous. They are again of two types somatic and psychic-depending on the sites of their manifestation viz., body and mind. Diseases are in fact innumerable inasmuch as the immediate causes, (dhatus afflicted, signs and symptoms), distant causes like improper diet and regimen ), and permutation and combination of various fractions of doshas are innumerable. [3]
Exogenous diseases have already been described in the chapter on “Three types of Swellings” (Sutra 18). They are again being explained here in order to specify their signs and symptoms. Mind and body as the sites of manifestation of diseases are common to both viz., exogenous and endogenous diseases. Mental diseases include diseases like passion, etc. They all come under the category of exogenous diseases. By permutation and combination, the three doshas and seven dhatus may form innumerable entities. It is only the diseases that are most commonly manifested, are described in the texts.
General aetiological factors
मुखानि तु खल्वागन्तोर्न खदशनपतनाभिचाराभिशापाभिषाङ्गाभिघातव्यधबन्धनवेष्टनपीडनरज्जुदहनशस्त्राशनिभूतोपसर्गादीनि, निजस्य तु मुखं वातपित्तश्लेष्मणां वैषम्यम् ॥ ४॥
The exogenous diseases are caused by nails, teeth, fall, spell, curse, psychic afflictions including demoniac seizure, assault, piercing, bandage, rapping, application of pressure, binding by rope, fire, weapon, thunderbolt, demoniac seizure, natural calamities, etc. Endogenous diseases on the other hand are caused by the disturbance in the equilibrium of vata, pitta and kapha. [ 4 ]
Four aetiological factors, basis of all diseases
द्वयोस्तु खल्वागन्तुनिजयोः प्रेरणमसात्म्येन्द्रियार्थसंयोगः, प्रशापराधः, परिणामश्चेति ॥ ५ ॥
Unwholesome contacts between the sense organs and their objects, intellectual blasphemy and effects of time constitute the common causative factors for both the exogenous and endogenous types of diseases. [5]
सर्वेऽपि तु खल्वेतेऽभिप्रवृद्धाश्चत्वारो रोगाः परस्परमनुबध्नन्ति, न चान्योन्येन सह सन्देहमापद्यन्ते ॥ ६ ॥
All these four types of diseases when aggravated do share the symptoms of each other. Even then, the distinetive features of each one of them are too clearly manifested to allow any confusion. [ 6]
Role of doshas in the pathogenesis of exogenous and endogenous diseases
आगन्तुर्हि व्यथापूर्व समुत्पन्नो जघन्यं वातपित्तश्लेष्मणां वैषम्यमापादयति; निजे तु वातपित्तश्लेष्माणः पूर्व वैषम्यमापद्यन्ते जघन्यं व्यथामभिनिर्वर्तयन्ति ॥७॥
The exogenous diseases begin with pain and then they bring about the disturbance in the equilibrium of doshas. The endogenous diseases on the other hand begin with the disturbance in the equilibrium of doshas and then bring about pain. [7]
Physiological sites of doshas in the body
तेषां नायाणामपि दोषाणां शरीरे स्थानविभाग उपदेक्ष्यते; तद्यथा-बस्तिः पुरीषाधानं कटिः सक्थिनी पादावस्थीनि पक्काशयश्च घातस्थानानि, तत्रापि पक्काशयो विशेषेण वातस्थानं;
स्वेदो रसो लसीका रुधिरमामाशयश्च पित्तस्थानानि, तत्राप्यामाशयो विशेषेण पित्तस्थानम् ;
उरः शिरो ग्रीवा पर्वाण्यामाशयो मेदश्च श्लेष्मस्थानानि, तत्राप्युरो विशेषेण श्लेष्मस्थानम् ॥ ८ ॥
The important sites of location of these three doshas are as below :
Urinary bladder, rectum, waist, thighs, legs, bones and color are the sites of vata; amongst them colon is the most important site.
Sweat, rasa, lasika (lymph ), rakta and small intestine ( lower part of amasaya ) are the sites of pitta; amongst them, small intestine (lower part of amasaya is the most important site.
Chest, head, neck, joint, stomach ( upper part of amasaya ) and fat are the sites of slesma; amongst them chest is the most important site. [8]
Vata in fact is divided into various categories like pruna, etc., with its different sites for each division-cf. Chikitsa 28: 6-11. The sites mentioned in the above passage are, however, those where the vitiation of vata generally manifests itself and the diseases caused by the vitiation of vata in these places are difficult to cure. So if vata is controlled in these sites, all types of vatika diseases can be prevented.
Types of diseases caused by different doshas
सर्वशरीरचरास्तु वातपित्तश्लेष्माणः सर्वस्मिञ्छरीरे कुपिताकुपिताः शुभा शुभानि कुर्वन्ति – प्रकृतिभूताः शुभान्युपचयबलवर्णप्रसादादीनि, अशुभानि पुनर्विकृतिमापन्ना विकारसंज्ञकानि ॥ ९ ॥
तत्र विकाराः सामान्यजाः, नानात्मजाश्च । तत्र सामान्यजाः पूर्वमष्टोदरीये व्याख्याताः नानात्मजांस्त्विहाध्यायेऽनुव्याख्यास्यामः । तद्यथा-अशीतिर्वात विकाराः चत्वारिंशत् पित्तविकाराः, विंशतिः श्लेष्मविकाराः ॥ १० ॥
The entire body is in fact the abode of all the three doshas viz., vata, pitta and kapha and as such these doshas bring about good and bad results according as they are in normal and abnormal states respectively. When in a normal state, they bring about good results like growth, strength, complexion, happiness, etc. When, in an abnormal state, they, cause various types of diseases. [ 9 ]
Endogenous diseases again are of two types viz., diseases caused by vata, pitta and kapha in general and the specific diseases caused by the vitiation of the vata, pitta and kapha. Diseases of the former type have been explained in the preceding chapter and those of the latter type are being explained in the present chapter. Diseases caused by vata are of eighty types, those by pitta of forty types and those by kapha of twenty types. [ 10 ]
Eighty diseases caused by vata:
तत्रादौ वातविकाराननुव्याख्यास्यामः । तद्यथा-नखभेदश्ध, विपादिका च, पादशूलं च, पादभ्रंशश्च, पादसुप्तता च, वातखुडुता च, गुल्फग्रहश्च, पिण्डिकोद्वेष्टनं च, गृध्रसी च, जानुभेदश्व, जानुविश्लेषश्च, ऊरुस्तम्भश्च, ऊरुसादव, पाङ्गुल्यं च, गुदभ्रंशश्च, गुदार्तिश्च, वृषणाक्षेपश्च, शेफस्तम्भश्च, वङ्खणांनाहश्च, श्रोणिभेदश्च, विड्भेदश्च, उदावर्तश्च, खञ्जत्वं च, कुब्जत्वं च, वामनत्वं च, त्रिकग्रहश्च पृष्ठग्रहध, पाश्र्वावमर्दश्य, उदरावेष्टश्च, हृन्मोहश्च, हृद्रवश्ध, वक्षउद्धर्पश्च, वक्षउपरोधश्च, वक्षस्तोदश्च, बाहुशोषश्च, ग्रीवास्तम्भच, मन्यास्तम्भश्च, कण्ठोड्वंसश्च, हनुभेदश्च, ओष्ठभेदश्च, अक्षिभेदश्व, दन्तभेदश्च, दन्तशैथिल्यं च, मूकत्वं च, वाक्सङ्गश्च, कषायास्यता च, मुखशोषश्च, अरसज्ञता च, घ्राणनाशश्च, कर्णशूलं च, अशब्दश्रवणं च, उच्चैःश्रुतिश्च, बाधिर्य च, वर्त्मस्तम्भश्च, वर्त्मसङ्कोचश्च, तिमिरंच, अक्षिशूलं च, अक्षिव्युदासश्च, श्रृव्युदासश्च, शङ्खभेदश्च, ललाटभेदश्य, शिरोहक च, केशभूमिस्फुटनं च, अर्दितं च, एकाङ्गरोगश्च, सर्वाङ्गरोगश्च, पक्षवधश्च, आक्षेपकश्च, दण्डकश्च, तमश्च, भ्रमश्च, वेपथुश्च, जृम्भा च, हिक्का च, विषादश्च, अतिप्रलापश्च, रौक्ष्यं च, पारुष्यं च, श्यावारुणावभासता च, अस्वप्नश्च, अनवस्थितचित्तत्वं च; इत्यशीतिर्वातधिकारा वातविकाराणामपरिसंख्येयानामाविष्कृततमा व्याख्याताः ॥ ११ ॥
To begin with we shall explain the diseases caused by vata. Even though, such diseases are innumerable, the following eighty diseases are the most commonly manifested ones :
Actually eighty one diseases are enumerated; there appears to be wrong interpolation.
1. nakhabheda ( cracking of nails ), 2. vipadika ( cracking of feet), 3. padasula (pain in foot 4. padabhrainsa ( foot drop ), 5. padasuptata ( numbness of foot), 6. vatakhuddata ( club foot ), 7. gulphagraha ( stiff ankle ), 8. pindikodvestana ( cramps in the calf ), 9. grdhrasi (sciatica ), 10. janubheda ( genu varum ), 11. januvislesa ( genu valgum ), 12. urustambha ( stiffness of thigh ), 13. urusada (pain in the thigh ) 14. pangulya (paraplegia) 15. gudabhramsa ( prolapse rectum) 16. gudarti (tenasmus ) 17. vrsanaksepa ( pain in scrotum) 18. sephastambha ( stiffness of penis) 19. vanksananaha ( tension of groin) 20. sronibheda (pain around the pelvic girdle ) 21. vidbheda (diarrhoea) 22. udavarta (misperistalsis) 23. khanjatva (lameness) 24. kubjatva (kyphosis) 25. vamanatva (dwarfism ) 26. trikagraha (arthritis of sacroillac joint) 27. prsthagraha ( stiffness of back) 28. parsvavamarda ( pain in chest ) 29. udaravesta (griping pain in abdomen) 30. hrnmoha (brady cardia) 31. hrddrava ( tachycardia) 32. vaksa-uddharssa ( rubbing pain in chest ) 33. vaksa-uparodha (impairment of thorasic movement) 34. vaksastoda (stabbing pain in chest ) 35. bahusosa (atrophy of arm) 36. grivastambha ( stiffness of the neck) 37. manyastambha ( torticollis) 38. kanthoddhvamsa ( hoarseness of voice) 39. hanubheda (pain in jaw ) 40. osthabheda (pain in lip) 41. aksibheda (pain in eye) 42. dantabheda (toothache) 43. dantasaithilya (looseness of tooth ) 44. mukatva (aphasia) 45. vaksanga (lalling speech) 46. kasayasyata ( astringent taste in mouth) 47. mukhasosa (dryness of the mouth) 48. arasajnata (ageusia ) 49. ghrananasa (anosmia ) 50. karnasula (ear ache) 51 asabdasravana (tinitus) 52. uccaihsruti ( hard of hearing ) 53. badhirya (deafness ) 54. vartmastambha (ptosis of eye lid) 55. vartmasamkoca (entropion) 56. timira ( amaurosis) 57. aksisula (pinching pain in eye) 58. aksivyudasa (ptosis of eye ball ) 59. bhruvyudasa (ptosis of eye brow) 60. Sankhabheda ( pain in temporal region) 61. lalatabheda (pain in frontal region) 62. siroruk (headache) 63. kesabhumisphutana ( dandruff ) 64. ardita (facial paralysis) 65. ekangaroga (monoplegia ) 66. sarvangaroga ( polyplegia ) 67. paksavadha (hemiplegia ) 68. aksepaka ( clonic convulsion) 69. dandaka (tonic convulsion) 70. tama (fainting) 71. bhrama (giddiness) 72. vepathu ( tremor) 73. jrmbha (yawning) 74. hikka ( hiccup) 75. visada (asthenia) 76. atipralapa (delirium ) 77. rauksya ( dryness) 78. parusya (hardness) 79. syavarunavadhasata (dusky red appearance) 80. asvapna (sleeplessness ) 81. anavasthitacittatva (unstable mentality ). [9-11]
Endogenous diseases of the general type (samunyaja) are caused by the combination of two or more doshas. The endogenous diseases of the specific type (nanatmaja=na+anatmaja=atmaja) are on the other hand, caused by only one of the doshas without being combined with any other dosha. Even if some of the vatika type of diseases are caused by other doshas besides vata, it is the vata which is actually responsible for the transmission or otherwise of the vitiated doshas to a specific organ of the body as it has been said “kapha, pitta and dhatus, left to themselves are immobile in nature. Wherever, they are carried by the vata, they cause diseases as the cloud carried by the wind causes rain in a particular area.
In the above passage pain in foot, eye and ear are enumerated as diseases caused by the vata inasmuch as they are the most commonly manifested types of pain of the vatika type. Pain in other parts of the body, for example, hand, foot, etc., are in fact also included under the innumerable-varieties of vatika diseases.
Pathophysiology of vatika diseases
सर्वेष्वपि खल्वेतेषु वातविकारेषूक्तेष्वन्येषु चानुक्तेषु वायोरिदमात्मरूपम परिणामि कर्मणश्च स्वलक्षणं यदुपलभ्य तवयवं वा विमुक्तसन्देहा वातविकारमेवाध्यवस्यन्ति कुशलाः; तद्यथा- रौक्ष्यं शैत्यं लाघवं वैशद्यं गतिरमूर्तत्वमनवस्थितत्वं चेति वायोरात्मरूपाणिः एवंविधत्वाच्च वायोः कर्मणः स्वलक्षणमिदमस्य भवतिः तं तं शरीरावयवमाविशतः; तद्यथा— संसभ्रंसव्याससङ्गभेदलादहर्षतर्षकम्पवर्तचालतोदव्यथाचेष्टादीनि, तथा खरपरुषविशदसुषिरारुणवर्णकषायविरलमुखत्वशोषशूलसुप्तिसङ्कोचनस्तम्भनखञ्जतादीनि च वायोः कर्माणि तैरन्वितं वातविकारमेवाध्यवस्येत् ॥ १२ ॥
In all the vatika type of diseases enumerated or implied, the inherent natural qualities and actions of vata are quite obviously manifested wholly or partially and as such it is not difficult for a competent physician to correctly diagnose the vatika type of diseases; for example, roughness, coolness, lightness non-sliminess, movement, shapelessness, unstability-these are the inherent qualities of vata
The natural action of vata moving from one part of the body to the other are looseness, dislocation, expansion, obstruction, separation, depression, excitation, thirst, trembl. ing, circular movement, motion, piercing pain, aching pain, action, etc. coarseness, harshness, non-sliminess, porousness, reddishness, astringent taste and tastelessness in the mouth, wasting, pain, numbness, contraction, rigidity and lameness, etc.-these are the actions that help a competent physician to diagnose the vatika type diseases. [ 12 ]
Even though the vata is devoid of any taste or complexion, it brings about certain taste or complexion due to its specific action.
General principles of treatment of vatika diseases
तं मधुराम्ललवणस्निग्धोष्णैरुपक्रमैरुपक्रमेत, कर्मभोजनाभ्यङ्गोत्सादनपरिषेकादिभिर्वातहरैर्मात्रां स्नेहस्वेदास्थापनानुवासननस्त:कालं च प्रमाणीकृत्य; तत्रास्था पनानुवासनं तु खलु सर्वत्रोपक्रमेभ्यो वाते प्रधानतमं मन्यते भिषजः, तद्धयादित एव पक्काशयमनुप्रविश्य केवलं वैकारिकं वातमूलं छिनत्ति; तत्रावर्जितेऽपि वाते शरीरान्तर्गताः वातविकाराः प्रशान्तिमापद्यन्ते, यथा वनस्पतेर्मूले छिन्ने स्कन्धशाखाप्ररोहकुसुमफलपलाशादीनां नियतो विनाशस्तद्वत् ॥ १३ ॥
The vitiated vata should be treated by drugs having sweet sour and saline taste and unctuous and hot qualities and by such devices as oleation, fomentation, asthapana and anuvasana types of enema, inhalation, diet, massage, unction, affusionwhich should all contain materials having anti-vatika properties. This is of course to be done with due regard to the doshage and the season. Of all the devices stated above, the asthapana and anuvasana types of enema or the treatment par excellence for the cure of vatika diseases because immediately after entering the colon, they strike at the very root of the vitiated vata and when it is overcome in the colon, even the entire vitiated vata dwelling in other parts of the body is automatically alleviated. This can be likened to the cutting of the root of a tree which results in the automatic destruction of the trunk, branches, sprouts, flowers, fruits, leaves, etc. [ 13]
Forty specific diseases of pitta
पित्तविकारांश्चत्वारिंशतमत ऊर्ध्वमनुव्याख्यास्यामः- ओषश्च, प्लोषश्च, दाहश्च, दवथुश्च, धूमकश्च, अम्लकश्च, विदाहश्च, अन्तर्दाहश्च, अंसदाहश्च, ऊष्माधिक्यं च, अतिस्वेदश्च (अङ्गस्वेदश्च ), अङ्गगन्धश्च, अङ्गावदरणं च, शोणितक्लेदश्च, मांसक्लेदश्च, त्वग्दाद्दश्च, ( मांसदाहश्च, ), त्वगवदरणं च, चर्मदलनं च, रक्तकोठश्च, रक्तविस्फोटश्च, रक्तपित्तं च रक्तमण्डलानि च, हरितत्वं च, हारिद्रत्वं च, नीलिका च, कक्षा ( क्ष्या ) च, कामला च, तिक्तास्यता च, लोहितगन्धास्यता च, पूतिमुखता च, तृष्णाधिक्यं च, अतृप्तिश्च, आस्यविपाकश्च, गलपाकश्च, अक्षिपाकश्च, गुदपाकश्च, मेढ़पाकश्च, जीवादानं च, तमःप्रवेशश्च, हरितहारिद्रनेत्रसूत्रवर्चस्त्वं च इति चत्वारिंशत्पित्तविकाराः पित्त विकाराणामपरिसंख्येयानामाविष्कृततमा व्याख्याताः ॥ १४ ॥
Now we shall explain the forty varieties of diseases due to the vitiation of pitta. Even though the diseases due to the vitiation of pitta are innumerable, the following are the forty varieties which are most commonly manifested.
1. osa ( heating ) 2. plosa ( scorching ) 3. daha (burning) 4. davathu (boiling ) 5. dhumaka (fuming) 6. amlaka (acid eructation) 7. vidaha (pyrosis)
8. antardaha (burning sensation inside the body) 9. amsadaha (burning sensation in shoulder) 10. usmadhikya ( excessive temperature) 11. atisveda (excessive sweating ) 12. angagandha (foetid odour of the body) 13. angavadarana ( cracking pain in the body) 14. Sonitakleda (sloughing of the blood) 15. mamsakleda (sloughing of the muscle ) 16. tvagdaha (burning sensation in the skin) 17. tvagavadarana ( cracking of the skin) 18. carmadalana ( itching of the skin) 19. raktakostha (urticaria) 20. raktavisphota (red vesicle ) 21. raktapitta ( bleeding tendency) 22. raktamandala (red wheals) 23. haritatva (greenishness) 24. haridratva (yellowishness) 25. nilika (blue moles) 26. kaksa (herpes) 27. kamala (jaundice ) 28. tiktasyata (bitter taste in mouth) 29. lohitagandhasyata (smell of blood from the mouth ) 30. putimukhata (foetid odour of mouth) 31. trsnadhikya (excessive thirst) 32. atrpti (non-satisfaction ) 33. asyavipaka (stomatitis) 34. galapaka (pharyngitis) 35. aksipaka ( conjunctivitis) 36. gudapaka (proctitis) 37. medhrapaka (inflammation of the penis) 38. juadana (haemorrhage) 39. tamahpravesa (fainting) 40. haritaharidra netra mutra varcastva (greenish & yellowish colouration of eyes, urine & faeces ) [ 14 ]
Pathophysiology of paittikka diseases
सर्वेष्वपि खल्वेतेषु पित्तविकारेषूक्तेष्वन्येषु चानुक्तेषु पित्तस्येदमात्मरूपमपरिणामि कर्मणश्च स्वलक्षणं, यदुपलभ्य तदवयवं वा विमुक्तसंदेहाः पित्तविकारमेवाध्यवस्यन्ति कुशलाः; तद्यथा— औष्ण्यं तैक्ष्ण्यं द्रवत्वमनतिस्नेहो वर्णश्च शुक्लारुणवर्जो गन्धश्च विस्रो रसौ च कटुकाम्लौ सरत्वं च पित्तस्यात्मरूपाणि; एवंविधत्वाच पित्तस्य कर्मणः स्वलक्षणमिदमस्य भवति तं तं शरीरावयवमाविशतः; तद्यथा- दाहौष्ण्य पाकस्वेद क्लेद कोथकण्डूस्रावरागायथास्वं च गन्धवर्णरसाभिनिर्वर्तनं पित्तस्य कर्माणि; तैरन्वितं पित्तविकारमेवाध्यवस्येत् ॥ १५ ॥
In all the paittika type of diseases enumerated or implied, the inherent natural qualities and actions of pitta are quite obviously maifested wholly or partially and as such it is not difficult for a competent physician to correctly diagnose the paittika type of diseases. The inherent natural qualities of pitta are heat, sharpness, liquidity, slight unctuousness, all colours except white and red, fishy smell, acrid and sour tastes and fluidity.
The natural actions of pitta moving from one part of the body to the other are burning sensation, heat, suppuration, pers – piration, sloughing, putrifaction, itching, discharge, redness, and the exhibition of its inherent smell, colour and taste-these are the actions that help a competent physician to diagnose paittika type of diseases.
General principles of treatment for paittika diseases
तं मधुरतिक्तकषायशीतैरुपक्रमैरुपक्रमेत स्नेहविरेकप्रदेहपरिषेकाभ्यङ्गादिभिः पित्तहरैर्मात्रां कालं च प्रमाणीकृत्य; विरेचनं तु सर्वोपक्रमेभ्यः पित्ते प्रधानतमं मन्यन्ते भिषजः; तड्यादित एवामाशयमनुप्रविश्य केवलं वैकारिकं पित्तमूलमपकर्षति, तत्रावजिते पित्तेऽपि शरीरान्तर्गताः पित्तविकाराः प्रशान्तिमापद्यन्ते, यथाऽझौ व्यपोढे केवलमझिगृहं शीतीभवति तद्वत् ॥ १६ ॥
This should be treated by drugs having sweet, bitter, astringent and cooling qualities and such devices as oleation, purgation, unction, affusion, massage, etc., which should all contain material having anti-paittika properties. This is of course to be done with due regard to the doshage and season. Of all the devices stated above, the purgation is the treatment par excellence for curing the paittika diseases because immediately after it is administered, it eliminates the vitiated pitta from its very root. When it is overcome in the amasaya (small intestine ), it alleviates the entire vitiated pitta dwelling in other parts of the body. This can be likened to a hot chamber being cooled by removing the fire from inside it. [16]
Twenty types of kaphaja diseases
श्लेष्मविकारांश्च विंशतिमत ऊर्ध्वं व्याख्यास्यामः; तद्यथा- तृप्तिश्च, तन्द्रा च, निद्राधिक्यं च, स्तैमित्यं च, गुरुगात्रता च, आलस्यं च, मुखमाधुर्य च, मुखस्रावञ्च, श्लेष्मोद्भिरणं च, मलस्याधिक्यं च, वलासकश्च, अपक्तिश्च, हृदयोपलेपश्च, कण्ठोपलेपश्च, धमनीप्रति (वि) चयश्च, गलगण्डश्च, अतिस्थौल्यं च, शीताग्निता च, उदर्दश्च, श्वेतावभासता च, श्वेतमूत्रनेत्रवर्चस्त्वं चः इति विंशतिः श्लेष्मविकाराः लेष्मविकाराणामपरिसंख्येयानामाविष्कृततमा व्याख्याता भवन्ति ॥ १७ ॥
Now we shall explain the twenty varieties of diseases due to the vitiation of kapha. Even though, the diseases due to the vitiation of kapha are innumerable; the following are the twenty varieties which are most commonly manifested.
1. trpti ( anorexia nervosa ) 2. tandra ( drowsiness )
3. nidradhikya ( excessive sleep )
4. staimitya ( timidness )
5. gurugatrata ( heaviness of the body ) 6. alasya ( laziness)
7. mukhamadhurya ( sweet taste in mouth )
8 mukhasrava ( salivation )
9. slesmodgirana ( mucus expectoration )
10. maladhikya ( excessive excretion of excreta )
11. balasaka ( loss of strength )
12. apakti ( indigestion )
13. hrdayopalepa ( phlegm adhered in vicinity of heart)
14. kanthopalepa ( phlegm adhered to throat )
15. dhamanipraticaya (hardening of vessals )
16. galaganda ( goiter ) 17. atisthaulya (obesitey )
18. sitagnita (suppression of digestive power )
19. udarda ( urticaria )
20. Svetavabhasata ( pallor
21. Svetamutranetravarcastva ( whiteness of urine, eye and faces ) [ 17 ]
Pathophysiology of kaphaja diseases
सर्वेष्वपि खल्वेतेषु श्लेष्मविकारेषुक्तेष्वन्येषु चानुक्तेषु श्लेष्मण इदमात्म रूपमपरिणामि कर्मणश्च स्वलक्षणं यदुपलभ्य तदवयवं वा विमुक्तसंदेहाः श्लेष्मविकार मेवाध्यवस्यन्ति कुशलाः; तद्यथा-स्नेहशैत्यशौक्लयगौरव माधुर्यस्थैर्य पैच्छिल्यमात्नर्यानि श्लेष्मण आत्मरूपाणि; एवंविधत्वाच्च श्लेष्मणः कर्मणः स्वलक्षणमिदमस्य भवति तं तं शरीरावयवमाविशतः; तद्यथा-श्वैत्यशैत्यकण्डस्थैर्यगौरवस्नेहसुतिक्लेदोपदेहबन्धमाधुर्यचिरकारित्वानि श्लेष्मणः कर्माणि; तैरन्वितं श्लेष्मविकारमेवाध्यवस्येत् ॥ १८ ॥
In all the slaismika type of diseases enumerated or implied, the inherent natural qualities and actions of kapha are quite obviously manifested fully or partly and as such it is not difficult for a competent physician to correctly diagnose the slaismika type of diseases. Unctuousness, coolness, whiteness, heaviness, sweetness, steadiness, sliminess and viscocity —these are the inherent qualities of kapha.
The natural actions of kapha moving from one part of the body to the other are whiteness, coolness, itching, stability, heaviness, unctuousness, numbness, stickiness, upadeha ( act of being covered with bodily excreta ), obstruction, sweetness and delay in manifestation-these are the actions that help a competent physician to diagonse diseases caused by kapha. [18]
Numbness is ascribed as the action of both kapha and vata-in the former due to inaction, in the latter due to loss of sensation.
General principles of treatment for kaphaja diseases
तं कटुकतिक्तकषायतीक्ष्णोष्णरूक्षैरुपक्र मैरुपक्रमेत स्वेदवमनशिरोविरेचनव्यायामादिभिः श्लेष्महरैर्मात्रां कालं च प्रमाणीकृत्य; चमनं तु सर्वोपक्रमेभ्यः श्लेष्मणि प्रधानतमं मन्यन्ते भिषजः, तद्ध्यादित एवामाशयमनुप्रविश्योरोगतं केवलं वैकारिकं श्लेष्ममूलमूर्ध्वमुत्क्षिपति, तत्रावजिते श्लेष्मण्यपि शरीरान्तर्गताः श्लेष्मविकाराः प्रशान्तिमापद्यन्ते, यथा भिन्ने केदारसेतौ शालियवषष्टिकादीन्यनभिव्यन्यमानान्यम्भसा प्रशोषमापद्यन्ते तद्वदिति ॥ १९ ॥
They diseases due to vitiated kapha) should be treated with drugs having pungent, bitter, astringent, sharp, hot and unctuous qualities and by such therapies like fomentation, emesis, elimination of doshas from the head, exercise, etc., which should all contain materials having anti-slaismika properties. This is of course to be done with due regard to the doshage and season. Of all the devices stated above, emetic therapy is the treatment par excellence for the cure of diseases due to kapha because immediately after entering the stomach, it strikes at the very root cause of the vitiation of kapha and when it is overcome in the stomach, even the entire vitiated kapha dwelling in other parts of the body is automatically alleviated. This can be likened to the withering away of paddy, barly, etc., for want of barrier of the cornfield ( full of water ) being broken. [19] As sites of maifestation of Kapha, both chest and stomach are equally important as stated in the above passage and passage 8/ante.
Importance of diagnosis in treatment
भवन्ति चाषरोगमादौ परीक्षेत ततोऽनन्तरमौषधम् । ततः कर्म भिषक् पश्चाज्ज्ञानपूर्व समाचरेत् ॥ २० ॥ यस्तु रोगमविज्ञाय कर्माण्यारभते भिषक् । अप्यौषधविधानशस्तस्य रोग विशेषज्ञः देशकालप्रमाणशस्वस्थ सिद्धिर्यदृच्छया ॥ २१ ॥ सर्वभैषज्यकोविदः । सिद्धिरसंशयम् ॥ २२ ॥ यस्तु
Thus it is said :
A physician should first of all diagnose the disease and then he should select proper medicine. Thereafter, he should ad. minister the therapy applying the knowledge of the science of medicine (he had already gained ). A physician who initiates treatment without proper diagnosis of the disease can accomplish the desired object only by chance ( that is to say he cannot be sure of his success); the fact that he is well-acquainted with the knowledge of application of medicine does not necessarily guarantee his success. On the other hand, the physician who is well-versed in diagnosing diseases, who is proficient in the ad. ministration of medicines and who knows about the doshage of the therapy that varies from place to place and season to season, is sure to accomplish the desired object. [ 20-22] तत्र श्लोकाः
संग्रहः प्रकृतिर्देशो विकारमुख मीरणम् । भसन्देहोऽनुबन्धश्च रोगाणां संप्रकाशितः ॥ २३ ॥ दोषस्थानानि रोगाणां गणा नानात्मजाश्च ये। रूपं पृथक् च दोषाणां कर्म चापरिणामि यत् ॥ २४ ॥ पृथक्त्वेन च दोषाणां निर्दिष्टाः समुपक्रमाः । सम्यादति रोगाणामध्याये तत्त्वदर्शिना ॥ २५ ॥
To sum up :
In the major chapter on diseases, the enlightened sage has fully dealt with the following subjects: classification, nature, sites of manifestation, specific and general causative factors, interchangeability and specific identity of diseases, sites of doshas, enumeration of specific diseases due to doshas, invariable signs and actions of doshas separately alongwith their treatment. [ 23-25 ]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने aerturearat ara fazitsearer: 11 20 11 समाप्तो रोगचतुष्कः. ।। ५ ।।
Thus ends the twentieth “Major Chapter on Disease” of the Sutra section of Agnivesa’s work as redacted by Charaka. [20] Thus ends the “Quadrate on diseases”
