अथातः कियन्तः शिरसीयमध्यायं व्याख्यास्यामः ॥ १ इति ह. स्माह भगवनात्रेयः ॥ २ ॥
We shall now expound the chapter on “The Enumeration of Diseases relating to the Head”— so said Lord Atreya.
The various aspects of the therapeutic processes have been explained in the previous four quadrates. The present quadrate relates to the enumeration of diseases which constitute the objects of such therapeutic processes. Evidently, representing as it does, the goal of the science of medicine, the treatment of diseases plays a predominant role there and so it has been dealt with first in the previous quadrate. The reason for giving priority to the exposition of treatment of diseases has also been explained in the first chapter. In the present quadrate relating to the enumeration of diseases, the first chapter represents the description of diseases relating to head and heart which are most important amongst all the organs including the vital parts of the body.
Contents of the chapter in question form :
कियन्तः शिरसि प्रोक्ता रोगा हृदि च देहिनाम् । कति चाप्यनिलादीनां रोगा मानविकल्पजाः ॥ ३ ॥ क्षयाः कति सामाख्याताः पिडकाः कति चानघ ! । गतिः कतिविधा चोक्ता दोषाणां दोषसूदन ! ॥ ४ ॥ हुताशवेशस्य वचस्तच्छ्रुत्वा गुरुरब्रवीत् । पृष्टवानसि यत् सौम्य ! तन्मे शृणु सविस्तरम् ॥ ५ ॥ दृष्टाः पञ्च शिरोरोगाः पञ्चैव हृदयामयाः । व्याधीनां द्व्यधिका षष्टिर्दोषमानविकल्पजा ॥ ६ ॥ दशाष्टौ च क्षयाः सप्त पिडका माधुमेहिकाः । दोषाणां त्रिविधा चोक्ता गतिर्विस्तरतः शृणु ॥ ७ ॥
Agnivesa asked: “What is the number of diseases relating to the head and the heart of the individuals? What are the diseases caused due to permutation and combination of doshas ? What are the signs and symptoms of the diminution of doshas, dhatus and malas? How many and what are the types of the pidakas ( carbuncles ) ? What are the courses of doshas ?” Lord Punarvasu replied, “I am answering all your questions in detail. Listen to me, O noble one ! Diseases relating to the head and heart each are five; diseases arising out ofthe permutation and combination of vata, etc. are sixty-two; there are eighteen conditions relating to the diminution of doshas, dhatus and malas; carbuncles due to madhumeha (diabetes) are of seven types; there are three courses of doshas. Now I would explain their details.”
Diminution, normalcy and aggravation these are the three aspects of doshas. Their permutation and combination depend on their relationship or otherwise with the other doshas.
The word “madhumeha” from which “madhumehikuh” has been derived stands for prameha or urinary diseases in general. As it will be said in verse 104 of this chapter, carbuncles are caused by the vitiation of medas (fat) even without any urinary disorder in general. If the term “madhumeha” were to denote only a particular type of prameha (urinary disorder) which normally causes carbuncles, the apt term to be used in this verse should have been “madhumeha” and not “prameha”. Again in the section on Treatment (Cikitsa 6:58), it will be said that the seven types of carbuncles from which the pramehins (victims of urinary disorder) suffer, have been separately enumerated. The treatment of carbuncles arising out of “madhumeha” has also been prescribed. This shows the word “madhumeha” occurring in the present context stands for “prameha”, that is urinary diseases in general and not madhumeha (diabetes mellitus) alone. Rather the term in question does not include “madhumeha” (diabetes mellitus) because it is regarded as incurable and there will be no question of prescribing any treatment therefore. Even, elswhere, this term is used to indicate urinary disorder in general and not diabetes mellitus alone as such. For example, it will be said (Iadriya 9:8 ) that. those suffering from gulma (abdominal tumour), madhumeha and consumption are incurable in the event of the diminution of strength and muscle tisue of the body. If the term “madhumeha” in this context were to denote diabetes mellitus (vaktia variety of prameha ), this disease being incurable in itself, the statement regarding the depedence of incurability on diminution of strength and muscle would be redundant. Susruta has also described these pidakas (carbuncles) to be complications of prameha (urinary disorder in general)-Cf. Susruta: Niduna 6:14.
The reason why the term “madhumeha” is used to indicate “prameha” that is urinary disorder in general is that in all types of such diseases there is sweetness in excess in the body; because of this sweetness the urine attracts ants and bees-cf. Niduna 4:47 and Astanga Hrdaya : Nidana: 10:21.
Aetiology of the diseases of the head
संधारणादिवास्वप्नाद्रात्रौ उच्चैर्भाष्यावश्यायात् प्राग्वाताद तिमैथुनात् ॥ ८ ॥ जागरणान्मदात् । ॥९॥ गन्धादसात्म्यादाघ्राताद्रजोधू महिमातपात् । गुर्वम्लहरितादानादतिशीताम्बुसेवनात् शिरोऽभिघाताहुष्टामाद्रोदनाद्वाष्पनिग्रहात् मेघागमान्मनस्तापादेशकालविपर्ययात् वातादयः प्रकुप्यन्ति शिरस्यत्रं च दुष्यति । ततः शिरसि जायन्ते रोगा विविधलक्षणाः ॥ ११ ॥ ।। १० ।। ।
By the suppression of natural urges, sleep during the day time, vigil during the night, intoxication, speaking aloud, exposure to frost and easterly wind, sexual indulgence, inhalation of undesirable smell, exposure to dust, smoke, snowfall and sun, intake of heavy and sour food, and rhizomes including tubers, etc. in excessive quanitity, excessive intake of cold water, injury to the head, vitiation of ama (a poduct of improper digestion and metabolism ) lamentation, suppression of tears, advent of cloud, anxiety and adopting regimen contrary to those prescribed for the locality and season, doshas like vata, etc., get aggravated resulting in the vitiation of raktadhatu in the head. This causes diseases with various symptoms in the head.
Definition of head : Another reading for the term ‘dustamat’ occurring in verse 10 is ‘usnamat’. If the latter reading is adopted, the interpretation would be that such diseases are caused by heat and ama. It may further be stated in this connection that in all types of diseases relating to the head, vitiation of raktadhatu is regarded as an invariable cause.
प्राणाः प्राणभृतां यत्र श्रिताः सर्वेन्द्रियाणि च । यदुत्तमाङ्गमङ्गानां शिरस्तदभिधीयते ॥ १२ ॥
In a living being, the head is the substratum of elan vital and all the sense faculties. So it occupies the first place amongest the vital organs of the body. [ 12 ]
अर्धावभेदको वा स्यात् सर्व वा रुज्यते शिरः । प्रतिश्यायमुखनासाक्षिकर्णरोगशिरोभ्रमाः अर्दितं शिरसः कम्पो गलमन्याहनुग्रहः । विविधाश्चापरे रोगा वातादिक्रिमिसंभवाः ॥ १४ ॥ ॥ १३ ॥
Diseases of the head
There might be pain only in half of the head or all over the head, or there might be coryza ( pratisyaya ), diseases of the mouth, nose, eyes and ears or there inight be a feeling of giddiness. There might as well be facial paralysis, trembling of the head; stiffness of the throat, sternomastoid muscle and jaw, and similar other diseases arising out of krmi (germ) and vata etc. [ 13–14]
Vatika disease of head
॥ १६ ॥ । ।। १७ ।। पृथग्दिष्टास्तु ये पञ्च संग्रहे परमर्षिभिः । शिरोगदांस्तान्छृणु मे यथा स्वैर्हेतु लक्षणैः ॥ १५ ॥ उच्चैर्भाष्यातिभाष्याभ्यां तीक्ष्णपानात् प्रजागारात् । शीतमारुतसंस्पर्शाद्व्यवायाद्वेगनिग्रहात् उपवासादमीघाताद्विरेकाद्वमनादति बाष्पशोकभयत्रासाद्वारमार्गातिकर्शनात् शिरोगताः सिरा वृद्धो वायुराविश्य कुप्यति । ततः शूलं महत्तस्य वातात् समुपजायते ॥ १८ ॥ निस्तुद्येते भृशं शङ्खौ घाटा संभिद्यते तथा । स भ्रूमध्यं ललाटं च तपतीवातिवेदनम् ॥ १९ ॥ वध्येते स्वनतः श्रोत्रे निष्कृष्येते इवाक्षिणी । घूर्णतीय शिरः सर्व संधिभ्य इव मुच्यते ॥ २० ॥ स्फुरत्यति सिराजालं स्तभ्यते च शिरोधरा । स्त्रिग्धोष्णमुपशेते च शिरोरोगेऽनिलात्मके ॥ २१ ॥
The five head diseases, as envisaged by the sages will be separately enumerated in the chapter on “Eight abdominal Diseases” ( sutra 19 ). I shall now explain their causes and symptoms. Listen to me :
By loud and excessive speech, pungent drinks, vigil, contact with cold wind, sexual indulgence, supperession of natural urges, excessive fasting, trauma, excessive purgation and vomiting, excessive weeping, grief, apprehension, carrying heavy load, walking for long distance and emaciation in excess, vata gets aggravated and having entered the vessels of the head, it gets further vitiated to cause excruciating pain in the head.
There is pain in the temporal region and cracking sensation in the nape. The head and the central part of eye brows have also excessive pain and burning sensation. There is pain and noise in the ears, there is a feeling as if eyes are coming out. There is giddiness, the joints are severed as it were, and there is excessive throbbing of the vein; the neck is stiffened. The patient gets relief by unctuous and warm regimen. This is vatika type of head disease. [ 15-21]
Even though the diseases pertainning to nose, etc. may also be included under head disease, still such diseases are not mentioned here. The diseases mentioned here are those which will be explained in the Astodariya chapter ( Sutra 19 ). Accordingly only the diseases of the head associated with pain are being explained here.
Paittika disease of head
कट्वम्ललवणक्षारमद्यक्रोधातपानलैः पित्तं शिरसि संदुष्टं शिरोरोगाय कल्पते ॥ २२ ॥
दह्येते रुज्यते तेन शिरः शीतं सुषूयते । दह्येते चक्षुषी तृष्णा भ्रमः स्वेदश्च जायते ॥ २३ ॥
By the intake of substances having acrid, sour and saline tastes, alkalies and alcohols, by anger, by exposure to sun and fire, the pitta dosha in the head gets vitiated and theraby produces head dieases resulting in burning and aching sensation in the head. The patient develops a liking for cold substance. There is burning sensation in the eyes and the patient is subjected to thirst, giddiness and perspiration in excess. [ 22-23 ]
आस्यासुखैः स्वप्नसुखैर्गुरु स्निग्धातिभोजनैः । श्लेष्मा शिरसि संदुष्टः शिरोरोगाय कल्पते ॥ २४ ॥
शिरो मन्दरुजं तेन सुप्तं स्तिमितभारिकम् । भवत्युत्पद्यते तन्द्रा तथाऽलस्यमरोचकः ॥ २५ ॥
By sedentary habits, sleep during the daytime (when it is not desirable ), excessive intake of heavy and unctuous food, the kapha of the head gets vitiated and causes head-disease. There is dull pain and numbness. The patient feels as if he is wet and is loaded with too heavy a burden; there is drowsiness laxiness and anorexia. [ 24-25]
Clinical features of Tridoshaja disease of head
वाताच्छ्रलं भ्रमः कम्पः पित्ताद्दाहो मदस्तृषा । कफागुरुत्वं तन्द्रा च शिरोरोगे त्रिदोषजे ॥ २६ ॥
In the event of head-diseases being caused by all the three doshas, there is pain, giddiness, shaking of the head due to morbid vata, burning sensation, intoxication and thirst due to morbid pitta, and heaviness and drowsiness due to morbid kapha. 
Krimija disease of head
तिलक्षीरगुडाजीर्णपूतिसङ्कीर्णभोजनात् क्लेदोऽसृक्कफमांसानां दोषलस्योपजायते ॥ २७ ॥
ततः शिरसि संक्केदात् क्रिमयः पापकर्मणः । जनयन्ति शिरोरोगं जाता वीभत्सलक्षणम् ॥ २८ ॥
व्यधच्छेदरुजाकण्डूशो फदौर्गत्यदुःखितम् क्रिमिरोगातुरं विद्यात् क्रिमीणां दर्शनेन च ॥ २९ ॥ ।
By the intake of tila ( Sesamum indicum Linn. ), sugar candy, heavy, putrified and unwholesome food (food of mutually contradictory qualities) a sort of stickiness is produced in the rakta, kapha, and mamsa due to the excessive vitiation of doshas. The stickiness in the head of the sinful patients results in the productin of pathogenic organisms causing thereby headdiseases associated with serious symptoms. There is stabbing and cutting pain, itching, swelling, foul smell (sense of discomfort) and the pathogenic organisms are at times visible. [ 27-29 ]
The diseases caused by these pathogenic organisms are very painful. It is only the sinful ones who suffer from such diseases.
Diseases of Heart
Vatika disease of heart
शोकोपवासव्यायाम रूक्षशुष्काल्पभोजनैः वायुरावित्र्य हृदयं वेपथुर्वेष्टनं स्तम्भः प्रमोहः हृदि वातातुरे रूपं जीर्णे जनयत्युत्तमां रुजम् ॥ ३० ॥ शून्यता दरः । चात्यर्थवेदना ॥ ३१ ॥
By grief, fasting, excessive exercise, intake of unctuous, dry and inadequate quantity of food, the vata gets vitiated and effects the heart resulting in excruciating pain, trembling, cramps, stiffness, unconsciousness, sensation of of emptiness, bewilderment and severe pain after the digestion of food. This is vatika type of heart disease. [ 30–31 ]
Paittika disease of heart
उष्णाम्ललवणक्षारकटुकाजीर्णभोजनैः मद्यक्रोधातपैश्चाशु हृदि पित्तं प्रकुप्यति ॥ ३२ ॥
हृद्दाहस्तितता वक्त्रे तिक्ताम्लोगिरणं क्लमः । तृष्णा मूर्च्छा भ्रमः स्वेदः पित्तहृद्रोगलक्षणम् ॥ ३३ ॥
By the in take of hot, sour, salty, alkaline, acidic and heavy food and by resorting to alcohol, anger and exposure to sun, the pitta located in the heart gets vitiated resulting in heart-burn, bitter taste in the mouth, eructations with bitter and sour taste, exhaustion, thirst, unconsciousness, giddiness and perspiration. This is the paittika type of heart-disease. [ 32-33 ]
Kaphaja disease of heart
अत्यादानं निद्रासुखं हृदयं कफहृद्रोगे तन्द्रारुचिपरीतस्य गुरुस्निग्धमचिन्तनमचेष्टनम् । कफहृद्रोगकारणम् ॥ ३४ ॥
सुप्तं स्तिमितभारिकम् । भवत्यक्ष्मावृतं यथा ॥ ३५ ॥ चाभ्यधिकं
Excessive intake of food, intake of heavy and unctuous food, inadequate mental exercise, sedentary habits and excessive sleep are the causes of slaismika type of heart diseases. The symptoms are bradycardia, stiffness and heaviness of the heart, drowsiness and anorexia. The patient feels as if he is loaded with a stone. This is slaismika type of heart disease. [ 34-35]
Tridoshaja heart disease
हेतुलक्षणसंसर्गादुच्यते सान्निपातिकः ।
Sannipatika type of heart disease is the one caused by the combined vitiation of all the three doshas. This can be diagnosed by the existence of the various signs and symptoms of all the three types of heart diseases.
( हृद्रोगः कष्टदः कष्टसाध्य उक्तो महर्षिभिः )
The samnipatika type of heart disease is very painful and difficult to cure.
Krimija disease of the heart
त्रिदोषजे तु हृद्रोगे यो दुरात्मा निषेवते ॥ ३६ ॥ तिलक्षीरगुडादीनि ग्रन्थिस्तस्योपजायते । रसश्चास्योपगच्छति ॥ ३७ ॥ मर्मैकदेशे संक्लेदं सर्पन्तो संकेदात् क्रिमयश्चास्य भवन्त्युपहृतात्मनः । मर्मैकदेशे ते जाताः भक्षयन्ति च ॥ ३८ ॥ तुद्यमानं स हृदयं सूचीभिरिव मन्यते । छिद्यमानं यथा शस्त्रैर्जातकण्डूं महारुजम् ॥ ३९ ॥ हृद्रोगं क्रिमिजं त्वेतैर्लिङ्गैर्बुद्ध्वा सुदारुणम् । त्वरेत जेतुं तं विद्वान् विकारं शीघ्रकारिणम् ॥ ४० ॥
In the event of the heart disease caused by the vitiation of all the three doshas, if one takes tila ( Sesamum indicum Linn. ), milk, sugar candy, etc. This causes nodules in the heart. Rasa becomes sticky in some parts of the heart. This stickiness produces pathogenic organisms (in a part of the heart of the patient). These organisms crawl and eat away ( the heart ). The patient feels as if his heart is being pierced by niddles or being cut into pieces by weapons; there is itching and painy in the heart. By these symptoms a wise physician should diagnose the heart disease as caused by the presence of pathogenic organisms. Considering the seriousness of this condition, he should expedite the treatment of this acute disease. [36-40]
Sixty-two types of combinations of doshas
द्वयुल्बणैकोल्बणैः षट् स्युनमध्याधिकैश्च षट् । समैको विकारास्ते सन्निपातास्त्रयोदश ॥ ४१ ॥ संसर्गे नव षट् तेभ्य एकवृद्ध्या समैत्रयः । पृथक् यश्च तैर्वृद्धैर्व्याधयः पञ्चविंशतिः ॥ ४२ ॥ यथा वृद्धैस्तथा क्षीणैर्दोषैः स्युः पञ्चविंशतिः । वृद्धिक्षयकृतश्चान्यो विकल्प उपदेक्ष्यते ॥ ४३ ।। वृद्धिरेकस्य समता चैकस्यैकस्य संक्षयः । द्वन्द्ववृद्धिः क्षयश्चैकस्यैकवृद्धिर्द्वयोः क्षयः ॥ ४४ ॥
Simultaneus aggravation of all the three doshas (Sannipata). is of thirteen types. They are as follows :
Two doshas aggravated in excess and the remaining one just aggravated
1. Vata and pitta aggravated in excess, and kapha just aggravated.
2. Pitta and kapha aggravated in excess, and vata just aggravated.
3. Khapha and vata aggravated in excess, and pitta just aggravated. (b) One dosha aggravated in excess and the remainining two just aggravated
4. Vata aggravated in excess, and pitta and kapha just aggravated.
5. Pitta aggravated in excess, and vata and kapha just aggravated.
6. Kapha aggravated in excess, and vata and pitta just aggravated.
Aggravation of doshas in progressive order
7. Vata aggravated, pitta more aggravated and kapha most aggravated.
8. Vata aggravated, kapha more aggravated and pitta most aggravated.
9. Pitta aggravated, kapha more agrgavated and vata most aggravated.
10. Pitta aggravated, vata more aggravated and kapha most aggravated.
11. Kapha aggravated, vata more aggravated and pitta most aggravated.
12. Kapha aggravated, pitta more aggravated and vata most agravated.
Aggravation of all three doshas in the same degree.
13. Vata, pitta and kapha aggravated in the same degree.
Simultaneous aggravation of any two doshas (samsarga) is of nine types as follows
Aggravation of one doshas in excess.
14. Pitta aggravated and vata more aggravated.
15. Pitta aggravated and kapha more aggravated.
16. Vata aggravated and kapha more aggravated.
17. Vata aggravated and pitta more aggravated.
18. Kapha aggravated and pitta more aggravated.
19. Kapha aggravated and vata more aggravated.
Aggravation of two doshas in same degree.
20. Vata and pitta aggravated in the same degree.
21. Pitta and kapha aggravated in the same degree.
22. Kapha and vata aggravated in the same degree.
Aggravation of only one dosha is of three types.
23. Vata aggravated.
24. Pitta aggravated.
25. Kapha aggravated.
The diminution of doshas like aggravation is al of twenty five types (aggravation and diminution are in total of fifty types.)
The twelve other alternant conditions of doshas depend on the aggravation and diminution taken together.
When one dosha is aggravated, the second dosha is in normal condition and the third dosha is in a state of diminution
51. Vata aggravated, pitta in normal condition and kapha in the state of diminution.
52. Pitta aggravated, kapha in normal condition and vata in state of diminution.
53. Kapha aggravated, pitta in normal condition and vata in the state of diminution.
54. Vata aggravated, kapha in the normal condition and pitta in the state of diminution.
55. Pitta aggravated, vata in the normal condition and kapha in the state of diminution.
56. Kapha aggravated, vata in the normal condition and pitta in the state of dminution.
When two doshas are aggravated and one dosha is in the state of diminution
57. Vata and pitta aggravated, and kapha in the state of diminution.
58. Pitta and kapha aggravated, and vata in the state of diminution.
59. Kapha and vata aggravated and pitta in the state of diminution.
When one dosha is aggravated and two are in a state diminution.
60. Vata aggravated, pitta and kapha in the state of diminution.
61. Pitta aggravated, vata and kapha in the state of diminution.
62. Kapha aggravated, vata and pitta in the state of diminution. [ 41-44]
Clinical features of different types of combination of doshas
विसर्पति ॥ ४५ ॥ तत्रानवस्थितः । प्रकृतिस्थं यदा पित्तं मारुतः श्लेष्मणः क्षये । स्थानादादाय गात्रेषु यत्र यत्र तदा भेदश्च दाहश्च तत्र गात्रदेशे भवत्यस्य अमो दौर्बल्यमेव च ॥ ४६ ॥ प्रकृतिस्थं कफं वायुः क्षीणे पित्ते यदा वली । कर्पेत् कुर्यात्तदा शूलं सशैत्यस्तम्भगौरवम् ॥ ४७ ॥ यदाऽनिलं प्रकृतिगं पित्तं कफपरिक्षये । संरुणद्धि तदा दाहः शूलं चास्योपजायते ॥ ४८ ॥ श्लेष्माणं हि समं पित्तं यदा वातपरिक्षये । सन्निरुन्ध्यात्तदा कुर्यात् सतन्द्रागौरवं ज्वरम् ॥ ४९ ॥ प्रवृद्धो हि यदा श्लेष्मा पित्ते क्षीणे समीरणम् । रुन्ध्यात्तदा प्रकुर्वीत शीतकं गौरवं रुजम् ॥ ५० ॥ समीरणे परिक्षीणे कफः पित्तं समत्वगम् । कुर्वीत सन्निरुन्धानो मृद्रग्नित्वं शिरोग्रहम् ॥ ५१ ॥ निद्रां तन्द्रां प्रलापं च हृदरोगं गात्रगौरवम् । नखादीनां च पीतत्वं ष्ठीवनं कफपित्तयोः ॥ ५२ ॥ हीनवातस्य तु श्लेष्मा पित्तेन सहितश्चरन् । करोत्यरोचकापाकौ सदनं गौरवं तथा ॥ ५३ ॥ हृल्लासमास्यस्रवणंं पाण्डुतां दूयनं मदम् । विरेकस्य च वैषम्यं वैषम्यमनलस्य च ॥ ५४ ॥ हीनपित्तस्य तु श्लेष्मा मारुतेनोपसंहितः । स्तम्भं शैत्यं च तोदं च जनयत्यनवस्थितम् ॥ ५५ ॥ गौरवं मृदुतामग्नेर्भक्ताश्रद्धां प्रवेपनम् । नखादीनां च शुक्लत्वं गात्रपारुष्यमेव च ॥ ५६ ।। मारुतस्तु कफे हीने पित्तं च कुपितं द्वयम् । करोति यानि लिङ्गानि शृणुतानि समासतः ॥ ५७ ॥ भ्रममुद्वेष्टनं तोदं दाहं स्फुटनवेपने । अङ्गमर्द परीशोषं दूयनं धूपनं तथा ।। ५८ ।। वातपित्तक्षये श्लेष्मा स्रोतांस्यपिदधभृशम् । चेष्टाप्रणाशं मूर्च्छा च वाक्सङ्गं च करोति हि ।। ५९ ।। वातश्लेष्मक्षये पित्त देहौजः संसयञ्चरेत् । ग्लानिमिन्द्रियदौर्बल्यं तृष्णां मूर्च्छा क्रियाक्षयम् ॥ ६० ॥ पित्तश्लेष्मक्षये वायुर्मर्माण्यतिनिपीडयन् । प्रणाशयति संज्ञां च वेपयत्यथवा नरम् ॥ ६१ ॥
When the kapha is in the state of diminution, the aggravated vata displaces the pitta in normal condition and carries it to different parts of the body, then wherever they move in the body, there is cracking and burning sensation which are not constant; there is also exhaustion and weakness all over the body.
when the pitta is in the state of diminution, the aggravated vata displaces the kapha in its normal condition causing thereby pain, coolness, stiffness and heaviness.
When khapha is in the state of diminution, the pitta obstructs the path of vata ( when latter is in its normal condition) causing thereby burning sensation and pain.
When vata is in the state of diminution and pitta in equilibrious state, the latter blocks the path of kapha causing thereby drowsiness, heaviness and fever.
When pitta is in the state of diminution, the aggravated kapha obstructs the channel of vata causing thereby coolness, heaviness and pain.
When vata is in the state of diminution, the kapha obstructs the path of pitta in normal condition causing thereby the weakness of the digestive power, stiffness of head, sleepiness, drowsiness, delirium, heart diseases, heaviness in the body, yellowness of the nails, etc. and expectoration of phlegm and bile.
When uata is in the state of diminution, the kapha moving together with pitta causes anorexia, indigestion, prostration, heaviness, nausea, salivation, anemia, burning sensation, intoxication, irregularity in purgation and digestion.
When pitta is in the state of diminution, the kapha together with vata causes an unstable stiffness, cold, pain, heaviness, weakness of digestive power, dislike for food, trembling, pallor of nails, etc. and roughness in the body.
When kapha is in the state of diminution, the uata and pitta aggravated together give rise to various signs and symptoms which are explained in brief below: Giddiness, pain, cramps, burning and cracking sensation, trembling, feeling of dryness, heating and steaming sensation.
When vata and pitta are in the state of diminution, the kapha obstructs the channels and gives rise to loss of activity, fainting and loss of speech.
When vata and kapha are in the state of diminution, the pitta while eliminating ojas in the body causes depression, weakness of senses, thirst, fainting and loss of action.
When pitta and kapha are in the state of diminution, the vata afflicts the vital organs, does away with consciousness and causes trembling in the patient.
These are the examples of the signs and symptoms produced by the twelve alternant conditions of doshas depending on the aggravation and diminution taken together.
When pitta is in its normal condition (- vide verses 45-46), how could there be a burning sensation? A dosha, in its natural state does never cause any ailment. Moreover, the vata is incapable of causing any burning sensation by itself. It may, however, be noted that even though pitta is in its normal condition, its displacement by the vata causes all sorts of complications attributable to pitta. So long as pitta is in its natural condition and located in its own place, there would certainly not arise any occasion for any disease being caused by it; but as the pitta of one place is added with the pitta of another place which latter is carried by vata, this certainly amounts to aggravation. The same principle applies to similar other symptoms. This can also be explained in another way when doshas, in normal condition, come in contact with those in the vitiated condition, the former also behaves like vitiated doshas; for example rakta, etc.
General features of vitiated doshas
दोषाः प्रवृद्धाः स्वं लिङ्गं दर्शयन्ति यथाबलम् । क्षीणा जहति लिङ्गं स्वं, समाः स्वं कर्म कुर्वते ॥ ६२ ॥
Doshas when aggravated manifest their signs and symptoms in accordance with the degree of aggravation; those in the state of diminution give up their normal signs and symptoms; and those in a state of equilibrium operate properly.
The signs and symptoms of aggravation, diminution and equlibrious states of the doshas are being explained in the present verse. Doshas in the state of aggravaiton manifest the signs and symptoms of their vitiation in accordance with the degree of aggravation. That is to say, excessive, moderate and slight aggravation of the doshas reflects itself in the form of excessiveness, mediocrity or triffleness of the signs and symptoms. Dasas, while in the state of diminution, cease to manifest even their normal signs and symptoms. As a matter of fact, doshas in the state of diminution do not vitiate other dhutus ( tissue elements) to cause diseases like jvara, etc., because they are themselves weak. They just represent a deviation from the normal state of doshas in the sense that they cease to manifest their normal signs and symptoms. Dossas in their equilibrious state operate properly.
These sixty-two permutations and combinations of doshas are only those which are most commonly manifested. There might be other types of dosha-combinations depending upon their permutation and combination in different ratios.
The question arises, how could there be different types of dosha combinations? It is not normally possible to combine two mutually contradictory elements. When two mutually contradictory elements combine, they generally destroy each other, e.g., fire and water. So due to their mutually contradictory qualities, vata etc. in combination with other doshas are bound to destroy themselves automatically. So combination, itself, of the doshas does not appear to be a reality. But this argument is not based on facts. A mutual contradiction between two objects is to be determined by their own action rather than the citing of other illustrations. We cannot say, for example, that as water and fire are in contradiction with each other they will not allow the combination of five mahabhutas; similarly sour taste is said to be caused by the domination of the combined qualities of jala and agni. This will also be not possible if the inferential contradistinction does not allow mutually contradictory elements to combine. Thus in the absence of similar examples, it is not. correct to refute the combination of doshas with mutually contradictory qualities.
It has been stated elsewhere that in the event of the combination of two objects having mutually contradictory qualities, the stronger one overpowers the weaker one and also that the distinctive feature of a. thing is responsible for the diminution of another substance when combined with it (Sutra 1 : 44). This statement would not stand valid if it is argued that there is no contradistinction between the doshas having mutually opposite qualities. But this statement applies only to cases other than doshas having specific properties. This statement does not apply to substances having specific properties, e. g., the attributes of nicuca (Artocarpus lakoocha Roxb.) aggravate all the three doshas due to their homologatory property but these attributes do not alleviate the doshas because of the specificity of their action, whereas sour taste of amalaka (Emblica officinalis Gaertn.) alleviates vata, its sweetness and coldness alleviate pitta, and its acrid and bitter tastes alleviate kapha. On the other hand, this sourness of nicuca being dominated by astringent taste and coldness, does not allevaiate vata; so also the sweetness and coldness being dominated by sourness do not alleviate pitta. Thus it is the specificity of doshas that plays an important role in bringing about their combination having mutually codtradictory properties. This specificity in the doshas is caused by their adrstas (invisible factors). Added to this are the adrstas of individuals capable of causing miseries. It is due to these adrstas that doshas combine together inspite of their mutually contradictory properties. As it will be said, “Inspite of their mutually contradictory qualities, doshas do not destroy each other because of their natural power of co-existence. Even the most dangerous poison in the body of the snake does not kill it.” -cf. Cikitsa 26: 293. This natural power of co-existence is not something which can occur any where. This exists only when it is pre-ordained. So one cannot say that as doshas do not destroy themselves, they will not destroy or vitiate even the rasa, rakta, etc.
If the doshas are homologous with the time, dhutu and bodily constitution, they cause the santata (continuous) type of fever which is incurable ( Cikitsu 3:55). If this view is accepted, the bodily constitution (prakrti) may have to be taken as something which might go in. contradistinction with doshas. The bodily constitution is nothing but a specific dosha, congenitally aggravated, (Sutra 7:40). So how could there be any contradistinction between one set of doshas that are responsible for the constitution of the body (that is prakrti) and the other set of doshas which are responsible for causing diseases ? This contradistinction can be explained like this: The contradistinction is nothing but something that does not favour the aggravation of the disease causing doshas. These da sas on the other hand get aggravated if they come across a homologous bodily constitution, i.e. prakrti. If doshas lose their strength to a very great extent and come across a heterologous bodily constitution there will be no aggravation strong enough to produce a disease. This, however, does not mean that a dosha is destroyed by a heterologous bodily. constitution. If vata is aggravated in excess, it may cause the diminution of kapha, but it does not impair the possibility of the combination of two or three doshas.
Signs (excreta) and symptoms of vitiation of dhatus (tissues) and malas
वातादीनां रसादीनां मलानामोजसस्तथा । क्षयास्तत्रानिलादीनामुक्तं घट्टते सहते हृदयं संक्षीणलक्षणम् ॥ ६३ ॥ शूल्यते । ताम्यति शब्द नोच्चैद्भवति स्वल्पचेष्टस्यापि रसक्षये ॥ ६४ ॥ परुषा स्फुटिता म्लाना त्वग्रक्षा रक्तसंक्षये । मांसक्षये विशेषेण स्फिग्ग्रीवोदरशुष्कता ॥ ६५ ॥ सन्धीनां स्फुटनं ग्लानिरक्ष्णोरायास एव च । लक्षणं मेदसि क्षीणे तनुत्वं चोदरस्य च ।। ६६ ।। केशलोमनखश्मश्रुद्विजप्रपतनं ज्ञेयमस्थिक्ष श्रमः । लिङ्गं सन्धिशैथिल्यमेव च ॥ ६७ ॥ शीर्यन्त इव चास्थीनि दुर्बलानि लघूनि च । प्रततं वातरोगीणि क्षीणे मज्जनि देहिनाम् ॥ ६८ ॥ दौर्बल्यं मुखशोषश्च पाण्डुत्वं सदनं श्रमः । कैव्यं शुक्राविसर्गश्च क्षीणशुक्रस्य लक्षणम् ॥ ६९ ।। क्षीणे शकृति चान्त्राणि पीडयन्निव मारुतः । रुक्षस्योन्नमयन् कुक्षि तिर्यगूर्ध्वं गच्छति ॥ ७० ॥ मूत्रक्षये मूत्रकृच्छ्रं मूत्रवैवर्ण्यमेव च । पिपासा बाधते चास्य मुखं च परिशुष्यति ॥ ७१ ॥ मलायनानि चान्यानि शून्यानि च लघूनि च । विशुष्काणि च लक्ष्यन्ते यथास्वं मलसंक्षये ॥ ७२ ॥
Diminution occurs in doshas ( vata, pitta and kapha ), dhatus (rasa, rakta, mainsa, medas, asthi, majja and sukra ), malas ( excreta of seven types ) and ojas ( ? ). Out of them signs and symptoms of diminution of doshas have already been explained.
It the case of diminution of rasa the patient becomes restless, he does not stand loud sounds; there is palpitation, cardiac pain, exhaustion even with the slightest exertion.
Signs and symptoms of diminution of rakta are: roughness, dryness and cracks in the skin and loss of its lusture.
In the event of the diminution of mamsa, there is emaciation, specially of the buttock, neck and abdomen.
In the event of the diminution of medas, there is cracking of the joints, lassitude of the eyes, exhaustion and thinness of the abdomen.
Signs and symptoms of the diminution of asthi are falling of hair, nails, hair of the beard including mustaches and teeth, exertion and looseness of joints.
The sign and symptoms of the diminution of majja (marrow) are thinness, weakness, and lightness of the bones, and the bones are always afflicted with the diseases due to vata.
In the event of diminution of sukra (semen) the patient suffers from weakness, dryness of mouth, pallor, lassitude, exertion, impotency and non-ejaculation of semen.
In the event of the diminution of faeces, the vata afflicts the intestines and due to the dryness caused thereby, the abdomen is swollen; the vata moves upwards and sidewards in it.
Diminution of urine causes dysurea, decoloration of the urine. thirst and dryness in the mouth.
The sings and symptoms of the diminution of other malas are the feeling of emptiness, lightness and dryness in the excretory organs.
Malas (excretas ) here include the faeces, urine and the excreta of the five sense organs like eyes tongue and skin including mucus membranes. Skin here, includes the hairfolicles (sweat glands) and genital organs (excreta like smegma etc. ). Jatukarna has also described these 18 types of ksayas ( diminutions).
Properties of ojas
बिभेति दुर्बलोऽभीक्ष्णं ध्यायति व्यथितेन्द्रियः । दुश्छायो दुर्मना रूक्षः क्षामश्चैवौजसः क्षये ॥ ७३ ॥ हृदि तिष्ठति यच्छुद्धं रक्तमीपत्सपीतकम् । ओजः शरीरे संख्यातं तन्नाशान्ना विनश्यति ॥ ७४ ॥ प्रथमं जायते ह्योजः शरीरेऽस्मिञ्छरीरिणाम् । सर्पिर्वर्ण मधुरसं लाजगन्धि प्रजायते ॥ ७५ ॥ ( भ्रमरैः फलपुष्पेभ्यो यथा संम्रियते मधु । तद्वदोजः स्वकर्मभ्यो गुणैः संम्रियते नृणाम् ॥ १ ॥ )
Signs and symptoms of the diminution of ojas is the complex, constant weaknesss, worry, affliction of sense organs with pain, loss of complexion, cheerlessness, roughness emaciation, fear and The one which dwells in the heart and is predominantly white, yellowish and reddish in colour is known as ojas of the body; if the ojas is destroyed, the human beings will also perish. The form in which the ojas is produced in the body of the human beings for the first time is of the colour of ghee; in taste it is like that of honey, in smell it is like that of fried paddy (laja ).
(As the bees collect honey from the fruits and flowers, so the ojas it maintains the body of human being by virtue of its properties and actions.
It is very difficult to comprehend the exact nature af ojas. By definition, ojas is said to be predominantly white, reddish and yellowish in colour. The ojas of superior quality is only of eight drops in quantity. The other type of ojas on the other hand is half an anjali* in quantity. This is the quantity of the slaismika type of ojas cf Surira 7: 15,
The ojas is of two types-the superior type and the other ordinary type. Heart is the dwelling place for the superior type of ojas. The vessels attached to the heart are the site of other ordinary type of ojas. As regards the first category of ojas, its volume is fixed. Any diminution in the volumes (that is eight drops) would amount to instantaneous death, Diminution is, however, possible in other type of ojas as it happens in the case of diabetes mellitus.
Ojas constitutes the essence of all the seven dhutus taken together. So there is no point in treating it the eighth dhutu-cf. Susruta Sutra 15: 19.
The eighteen varieties of diminution are just an illustration of the most commonly manifested types. There are many other varieties of diminution, viz., diminution of water, diminution of voice, etc. which are also intended to be included under diminution-cf. Vimana 5: 8.
Causes of emaciation
व्यायामोऽनशनं चिन्ता रूक्षाल्पप्रमिताशनम् । वातातपौ भयं शोको रूक्षपानं प्रजागरः ॥ ७६ ॥
कफशोणितशुक्राणां मलानां चातिवर्तनम् । कालो भूतोपघातश्च ज्ञातव्याः क्षयहेतवः ॥ ७७ ।।
*One anjali just represents the volume equal to that of two hand joined in the form of a cup. This is equal to two palas or eight tolas (approximatelty 96 cc. ). In the present context, however, the measurement of the volume is to be determined by the volume of ones own hand. Thus the actual measurement of ardhanjali, that is half an anjali, will vary from person to person.
The following are the causes of the diminution of dhatus: Physical exercise, fasting, anxiety, intake of ununctuous food and food in small quantity or habitual intake of food having one taste only, exposure to the wind and sun, fear, grief, intake of ununctuous drinks, vigil, excessive elimination of phlegm, blood, semen and other excreta, old age and period of adana (absorption) and demoniac seizures.
The factors stated above relate to the diminution of all the doshas except vata. The causes of the diminution of vata are inadequate thinking, day sleep, etc. The diminution of vata may be caused even by fasting because fasting is responsible for the lack of excreta and unless there are excreta, the required quantity of vata cannot be produced.
Aetiopathology of diabetes mellitus
गुरुस्निग्धाम्ललवणान्यतिमात्रं समश्नताम् । नवमनं च पानं च निद्रामास्यासुखानि च ॥ ७८ ॥ त्यक्तव्यायामचिन्तानां संशोधनमकुर्वताम् । लेष्मा पित्तं च मेदश्च मांसं चातिप्रवर्धते ॥ ७९ ॥ तैरावृतगतिर्वायुरोज आदाय गच्छति । यदा बस्ति तदा कृच्छ्रो मधुमेहः प्रवर्तते ॥ ८० ॥ स मारुतस्य पित्तस्य कफस्य च मुहुर्मुहुः । दर्शयत्याकृतिं गत्वा क्षयमाप्यायते पुनः ॥ ८१ । उपेक्षयाऽस्य जायन्ते पिडकाः सप्त दारुणाः । मांसलेष्ववकाशेषु मर्मस्वपि च संघिषु ॥ ८२ ॥
Tlıere is an excessive increase in kapha, pitta, medas ( adipose tissue) and mamsa ( muscle tissue) in the cases of those who take in excess, heavy unctuous food and food having sour and saline tastes, rice from newly harvested crop and fresh wine; those who sleep ( too much ), and have sedentary habits; those who have given up physical and mental exercises and also those who do not adopt elimination therapies.
The path of vata is obstructed thereby and so the vata to.gether with the ojas comes down to reach the basti ( urinary bladder including kidneys.) causing an obstinate type of disease called madhumeha ( diabetes mellitus ). In this disease, signs and symptoms pertaining to vata, pitta and kapha are manifested quite frequently-they vanish at times and appear again (in the more vehement form ). If neglected, this disease causes serious types of carbuncles in subcutaneous and muscular areas, vital parts and joints of the body.
Types of Carbuncles
शराविका कच्छपिका जालिनी सर्षपी तथा । अलजी विनताख्या च विद्रधी चेति सप्तमी ॥ ८३ ॥ अन्तोन्नता मध्यनिम्ना श्यावा क्लेदरुगन्विता । शराविका स्यात् पिडका शरावाकृतिसंस्थिता ॥ ८४ ॥ अवगाढार्तिनिस्तोदा महावास्तुपरिग्रहा। श्लक्ष्णा कच्छपपृष्ठाभा पिडका कच्छपी मता ॥ ८५ ॥ स्तब्धा सिराजालवती स्निग्धास्रावा महाशया । रुजानिस्तोदबहुला सूक्ष्मच्छिद्रा च जालिनी ॥ ८६ ।। पिडका नातिमहती क्षिप्रपाका महारुजा । सर्षपी सर्षपाभामिः पिडकाभिश्चिता भवेत् ॥ ८७ || दहति तृष्णामोहज्वरप्रदा । विसर्पत्यनिशं त्वचमुत्थाने दुःखाद्दहत्यग्निरिवालजी ॥ ८८ ॥ अवगाढरुजाक्लेदा पृष्ठे वाऽप्युदरेऽपि वा । महती विनता नीला पिडका विनता मता ॥ ८९ ॥
The seven types of carbuncles are saravika, kacchapika, jalini, sarsapi, alaji, vinata and vidradhi.
The saravika type of carbuncle elevated in the border and depressed in the centre, grey in colour and associated with slough and pains. Because of its appearance as a farava that is earthen saucer, it is known as saravika.
The kacchapika type of carbuncle is deep seated and painful combined with a splitting type of pain; it has very big base, it is smooth and resembling the back of tortoise.
The jalini type of carbuncle is hard; it has net-work of vessels in its surface; its discharge is sticky; it has a very big base; it is very painful with splitting type of pain and having subtle openings.
The carbuncle which is not very big, which suppurates quickly, which is very painful and associated with carbuncles of the size of mustard seeds is known as sarsapi.
Alaji type of carbuncle causes burning sensation during eruption; when fully manifested, it causes thirst, unconsciousness fever, it always spreads and is very painful due to burning sensation like fire.
The pain in vinata type of carbuncle is also deep-seated; it is associated with slough; it occurs either in the back or abdomen; it is big in size, blue in colour and having depression in the centre.
The seven varieties of pidakas (carbuncles ) as mentioned above are just by way of illustrating the most common types of such diseases. The possibility of other varieties is not therefore ruled out. In fact, in the Susruta, some other varieties have also been described.
External and internal abscesses
विद्रधि द्विविधामाहुर्वाह्यामाभ्यन्तरीं तथा । । वाह्या त्वक्स्नायुमांसोत्था कण्डराभा महारुजा ।। ९० ।। शीतकान्नविदा ह्युष्णरूक्षशुष्कातिभोजनात् विरुद्धाजीर्णसंक्लिष्टविषमासात्म्यभोजनात् व्या पन्नवहुमद्यत्वाद्वेगसंधारणाच्छ्रमात् जिह्मव्यायामशयनादतिभाराध्वमैथुनात् अन्तःशरीरे मांसासृगाविशन्ति यदा मलाः । तदा संजायते ग्रन्थिर्गम्भीरस्थः ।। ९२ ।। 1 सुदारुणः || ९३ ॥ ततः ॥ १५ ॥ हृदये क्लोसि यकृति प्लीहि कुक्षौ च वृक्कयोः । नाभ्यां वंक्षणयोर्वाऽपि वस्तौ वा तीव्रवेदनः ॥ ९४ ॥ दुष्टरक्तातिमात्रत्वात् स वै शीघ्रं विदह्यते । शीघ्रविदाहित्वाद्विद्रधीत्यभिधीयते व्यवच्छेद माना हशब्दस्फुरणसर्पणैः वातिकीं, पैत्तिकीं तृष्णादाहमोहमदज्वरैः ।। ९६ ।। जम्भोत्क्लेशा रुचिस्तम्भशीतकैः श्लैष्मिक विदुः । सर्वासु च महच्छ्रलं विद्रधीषूपजायते ।। ९७ ॥ शास्त्रैर्भिद्यत इव चोल्मुकैरिव दह्यते । विद्रधी व्यम्लता यातावृश्चिकैरिव दश्यते ।। ९८ ।। तनु रुक्षारुणं श्यावं फेनिलं वातविद्रधी । तिलमापकुलत्थोदसन्निभं पित्तविद्रधी ।। ९९ ॥ श्लैष्मिकी नवति श्वेतं पिच्छिलं बहलं बहु । लक्षणं सर्वमेवैतद्भजते सान्निपातिकी ।। १०० ।। ॥ ९१ ॥ ।
Abscess is of two types — the external and the internal. The external one arises out of the skin, ligaments and muscles. In shape and size it resembles tendons and it is exceedingly painful.
The internal abscess is caused by the excessive intake of food which is staled, irritant, hot, rough, dry of having mutu. ally contradictory qualities, undigestible, and which is doshaaggravating and unwholesome; by taking meals irregularly by taking excessivelly strong wines, suppression of natural urges, excessive physical exertion, physical exercise and sleep in wrong postures, carrying excessive load, walking long distance and excessive sexual intercourse. These factors are responsible for the affliction of mamsa and rakta dhatus of the interior of the body by the doshas, thereby causing deep-seated abscesses which are very painful. This causes excessive pain in heart, kloman, liver, spleen, sides of the abdomen kidney navel and sides of the lower abdomen or bladder. Due to an excessive vitiation of rakta, these abscesses get suppurated quickly. This is called ‘vidradhi’ because of vidaha (suppuration ).
Vidradhi (abscess) is of four types, viz. vatika, paittika, slaismika and samnipatika. The signs and symptoms of vatika type of vidradhi are piercing and cutting pain, giddiness, constipation, sounding and throbbing sensation, and spreading tendency; those of paittika type are thirst, burning sensation, unconsciousness, intoxication and fever, and those of the slaismika type are yawning, nausea, stiffness and cold. The samnipatika type of vidradhi is marked by excruciating pain.
In the event of the abscess being ripened the patient feels as if being assaulted by weapons, burnt by fire brands and being bitten by scorpions.
The discharge from the vatika type of vidradhi is thin, ununctuous, reddish, gray and foamy, that from the paittika type of vidradhi can be likened to the decoction of tila ( Sesamum indicum Linn.), masa ( Phaseolus radiatus Linn) and kulathha (Dolichos biflorus Linn.), and that of the slaismika type is white, slimy, thick and profuse. The discharge from the samnipatika type of vidradhi shares all these characteristics.
Prognosis of internal abscesses
अथासां विद्रधीनां साध्यासाध्यत्वविशेषज्ञानार्थं स्थानकृतं लिङ्गविशेषमुपदेक्ष्यामः – तत्र प्रधानमर्मजायां विद्रध्यां हृद्धट्टनतमकप्रमोहकासश्वासाः, क्लोमजायां पिपासामुखशोषगलग्रहाः, यकृज्जायां श्वासः, प्लीहजाया मुच्छ्वासोपरोधः, कुक्षिजायां कुक्षिपार्श्वान्तरांसशूलं, वृक्कजायां पृष्ठकटिग्रहः, नाभिजायां हिक्का, वंक्षणजायां सक्थिसादः, बस्तिजायां कृच्छ्रपूतिमूत्रवर्चस्त्वं चेति ॥ १०१ ।। पक्कप्रभिन्नासूर्ध्वजासु मुखात् स्रावः स्रवति, अधोजासु गुदात्, उभयतस्तु नामिजासु ॥ १०२ ॥ आसां हृन्नाभिवस्तिजाः परिपक्काः सान्निपातिकी च मरणायः शेषाः पुनः कुशलमाशुप्रतिकारिणं चिकित्सकमासाद्योपशाम्यन्ति । तस्मादचिरोत्थितां विद्रधीं शस्त्रसर्पविद्युदग्नितुल्यां स्नेहविरेचनैराश्वेवोपक्रमेत् सर्वशो गुल्मबच्चेति ॥ १०३ ॥
Now we shall explain the local signs and symptoms indicating the curability or otherwise of the various type of vidradhis (carbuncles and abscesses). If the disease occurs in the heart, there will be palpitation, fainting, unconsciousness, coughing and dyspnoea; if it is in kloman (?) there will be thirst, dryness in mouth and obstruction in throat; if it is in the liver, there will be dyspnoea; if in spleen, there will be obstruction to expiration; if in the sides of abdomen, there will be pain in both the sides of the abdomen, in the middle of the abdomen and in the shoulder (referred pain). In the event of abscess in the kidney, there will be stiffness in the back and waist. If the abscess is in the nabhi, this causes hiccup, if in the groin, this will impair the movement of the thighs; if it occurs in the urinary bladder, urine and stool will pass with difficulty and there will be putrification.
When ripened and ruptured, the discharge from the internal abscess in the upper portion of the body comes out through the mouth, whereas from the lower part of the body it comes out through the anus. When the abscess in the nabhi (?) region, ruptures, the discharge may come out through both mouth and anus.
The ripened abscess located in the heart, nabhi and urinary bladder and those of the samnipatika type are fatal. The other varieties of abscesses can be cured if treated immediately by a qualified physician. So, as soon as one is afflicted by abscess, he should immediately get himself treated by oleation and elimination therapies.
This disease is as dangerous as a weapon, snake, lightening and fire. The principle of treatment as mentioned for gulma should be adopted here.
The abscess located in the heart, nabhi (?) and urinary bladder are fatal only when ripened; the samni patika type of abscess is however fatal irrespective of its being ripened or otherwise. The abscess is likened to weapons, snakes, lightening and fire. it can piercc through vital organs like a weapon; it can immediately cause unconsciousness like snake bite and it can cause instantaneous death like lightening and fire.
Prognosis of carbuncles
भवन्ति चात्र – विना प्रमेहमप्येता जायन्ते दुष्टमेदसः । तावश्चैता न लक्ष्यन्ते यावद्वास्तुपरिग्रहः ।। १०४ ।। शराविका कच्छपिका जालिनी चेति दुःसहाः । जायन्ते ता ह्यतिवलाः प्रभूतम्लेष्ममेदसः ।। १०५ ।। सर्षपी चालजी चैव विनता विद्रधी च याः । साध्याः पित्तोल्बणास्तास्तु संभवन्त्यल्पमेदसः ।। १०६ ।। • मर्मस्वंसे गुदे पाण्योः स्तने सन्धिषु पादयोः । जायन्ते यस्य पिडिकाः स प्रमेही न जीवति ॥ १०७ ।।
Thus it is said :
Abscesses may occur due to the vitiation of medas even with. out the disease prameha ( that is diabetes mellitus ). They are, however, not visible until they take a definite shape and size.
Saravika, kacchapika and jalini types of carbuncles are intolerably painful and of very serious nature. They occur in such of the patients who have excessive kapha and medas.
Sarsapi, alaji, vinata and vidradhi types of carbuncles are on the other hand dominated by pitta and occur in the cases of such patients who have medas in less quantity. These are curable.
A diabetic patient who suffers from abscesses occuring in vital organs, shoulder, anus, hands, breasts, joints and feet seldom survive.
Complications of carbuncles
तथाऽन्याः पिडकाः सन्ति रक्तपीतासितारुणाः । पाण्डुराः पाण्डुवर्णाश्च मृद्व्यश्च कठिनाश्चान्याः स्थूलाः सूक्ष्मास्तथाऽपराः । मन्दवेगा महावेगाः भस्मामामेचकप्रभाः ।। ११८ ।। ब्रूयादुपचरेश्वाशु स्वल्पशूला महारुजः ॥ १०९ ॥ बुद्धवा मारुतादीनां यथास्वैर्हेतुलक्षणैः । प्रागुपद्रवदर्शनात् । ११० ।। तृट्श्वासमांससंकोथमोहहिक्कामदज्वराः वीसर्प मर्मसंरोधाः । पिडाकानामुपद्रवाः ॥ १११ ॥
There are other varieties of abscesses having red, yellow, black, reddish, grey, yellowish, white, unctuous black and ash colour. Some of them are soft, some are hard, some are of big size, some are of small size, some of them develop slowly, some of them develop quickly, some of them have dull pain and some of them have excruciating pain-they should be diagnosed as vatika etc. considering their aetiology, signs and symptoms it should be treated immediately, before any complication arises. The complications of an abscess are thirst, dyspnoea, sloughing unconsciousness, hiccup, toxaemia, fever, cellulitis and impediment of the functions of the vital organs. [ 108-111]
Different courses of doshas in the pathogenesis of diseases
क्षयः स्थानं च वृद्धिश्च दोषाणां त्रिविधा गतिः । ऊर्ध्वं चाधश्च तिर्यक्च विज्ञेया त्रिविधाऽपरा ॥ ११२ ॥ त्रिविधा चापरा कोष्ठशाखामर्मास्थिसन्धिषु । इत्युक्ता विधिभेदेन दोषाणां त्रिविधा गतिः ।। ११३ ।। चयप्रकोपप्रशमाः पित्तादीनां यथाक्रमम् । भवन्त्येकैकशः षट्सु कालेष्वभ्रागमादिषु ॥ ११४ ॥ गतिः कालकृता चेषा चयाद्या पुनरुच्यते ।
Diminution, normal state and aggravation these are the three conditions of doshas; the three more types are upward, downward and sideward movement of doshas. The doshas have another threefold movement according as they move in the kostha or alimentary tract, sakha or exterior dhatus and marmasthisandhi or vital organs, bones and joints. Thus, these are the threefold conditions of doshas.
Pitta and other doshas are accumulated, aggravated and alleviated respectively in the six seasons like rains, etc. This aspect of the doshas is stated to be seasonal in nature. [ 112-114]
Piita, vata and kapha are accumulated, and alleviated in the respective seasons as follows.
Table showing the State of doshas in various seasons
Vata Pitta Kapha Doshas States Accumulation Grisma (April to June ) Varsa (August to October) Hemanta (December to February) Aggravation Alleviation Pravrt ( June to August ) Sarat (October to December) Sarat (October to December ) Hemanta (December to February) Vasanta (February to April) Grisma ( April to June )
The above statement only shows the predominance of various aspects (accumulation etc.) of the doshas in the respective seasons. It does not, however, rule out the possibility of minor accumulation, aggravation, etc. of the doshas in the other seasons. So it is possible that there might be minor aggravation of kapha and pitta even in the pravrt season or such an aggravation of vata and pitta in the spring season.
Physiological and Pathological Concepts of doshas
गतिश्च द्विविधा दृष्टा प्राकृती वैकृती च या ॥ ११५ ।। पित्तादेवोष्मणः पक्तिर्नराणानुपजायते । तच्च पित्तं प्रकुपितं विकारान् कुरुते बहून् । ११६ ।। प्राकृतस्तु बलं श्लेष्मा विकृतो मल उच्यते । स चैवौजः स्मृतः काये स च पाप्मोपदिश्यते ॥ ११७ ॥ सर्वा हि चेष्टा वातेन स प्राणः प्राणिनां स्मृतः । तेनैव रोगा जायन्ते तेन चैवोपरुध्यते ॥ ११८ ॥ ।।
There are two aspects of the doshas, viz. natural and morbid. In the natural state, pitta helps in the digestion and metabolism of living beings. In its morbid state, it causes various diseases.
The kapha in its natural state promotes strength in the form of ojas. When in morbid condition, it takes the form of excreta and causes misery.
Similarly, vata in its natural state is responsible for all activities of the body. Vata, in fact constitutes the very life of living beings. When in morbid state, it causes diseases and death. [ 115-118 ]
Among the doshas, pitta plays a very important role in the maintenance of human life. That is why, it comes first in the list of doshas described above. Ojas of the second variety, that is apara ojas is indeed a direct product of kapha.
Preservation of health
नित्यं सन्निहितामित्रं समीक्ष्यात्मानमात्मवान् । परिचरेदिच्छेन्नायुरनित्वरम् ॥ ११९ नित्यं युक्तः
One desirous of ensured longevity for himself, should always make an attempt for his well-being as if surrounded by opponents ( for his health ). [ 119 ]
तत्र श्लोकौ — शिरोरोगाः सहृद्रोगा रोगा मानविकल्पजाः । क्षयाः सपिडकाश्चोक्ता दोषाणां गतिरेव च ॥ १२० ।। कियन्तः शिरसीयेऽस्मिन्नध्याये तत्त्वदर्शिना । ज्ञानार्थ भिषजां चैव प्रजानां च हितैषिणा || १२१ ॥
To sum up –
Head diseases, heart diseases, the states of doshas in different permutations and combinations, diminutions, abscesses, the course of movement of doshas have beeen explained by the sage in this chapter on “The Enumeration of Diseases relating to the Head”. The sage has done this with a view to enlightening the physicians about it as well as for the well-being of subjects. [ 120-21]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते लोकस्थाने कियन्तः शिरसीयो नाम सप्तदशोऽध्यायः ||१७||
Thus ends the seventeenth chapter on “The Enumeration of diseases relating to the Head of the Sutra section of Agnivesa’s work as redacted by Charaka.