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Sushruta SamhitaDosha Dhatu Mala Kshaya Vruddhi Vijnaniyaadhyaya - Sushruta Samhita Sutrasthana Chapter 15

Dosha Dhatu Mala Kshaya Vruddhi Vijnaniyaadhyaya – Sushruta Samhita Sutrasthana Chapter 15

पञ्चदशोऽध्यायः । अथातो दोषधातुमलक्षयवृद्धिविज्ञानीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥

Now we shall discribe the Chapter which treats of development and non-development of the humoral constituents of the body and excrements (Dosa-Dhatu-Mala-Ksaya-Vrddhi-Vijnaniyaadhyaya). 1

दोषधातुमलमूलं हि शरीरम् तस्मादेतेषां लक्षणमुच्यमानमुपधारय ॥२॥

Since the human body is constituted of humours, ( Dosas), excretions (Malas), and the fundamental principles (Dhatus) of blood, marrow, etc., hear me discourse on the features which are peculiar to each of them. 2

तत्र, प्रस्पन्दनोद्वहनपूरणविवेकधारणलक्षणो वायुः पञ्चधा प्रविभक्तः शरीरं धारयति ॥३॥

The Vayu. – The imparting of motion to the body (praspandana), the carrying of the sensations of the respective sense organs (Udvahana), the passing down of food to its proper receptacles (Purana), the separation of excretions from the assimilated food matter (Viveka), and the retention and evacuation of urine and semen, etc. (Dharana) should be ascribed to the functions of the five kindst of Vayu (nerve force) which support the body. 3

1. They are called Prana, Udana, Samana, Vyana and Apana.

रागपक्त्योजस्तेजोमेघोष्मकृत् पित्तं पञ्चधाप्रविभक्तमग्निकर्म्मणानुग्रहं करोति ॥४॥

The Pitta – Pigmentations of colouring (Ragakrt), the digestion of food and metabolism of tissues (Paktikrt), the vitalisation and nutrition of the protaplasmic cells (Ojahkrt), the origination and preservation of eye-sight (Tejah-Krt), the germination of heat and maintenance of the temperature of the body ( Usma- Krt), and the origination of the faculty of intellection (Medha- Krt) should be regarded as the functions of the five kinds’ of Pitta, which contribute to the preservation of the body through its thermogenetic potency (Agni Karma). 4

सन्धिसंश्लेषणस्नेहनरोपणपूरण- (बृंहणतर्पण) – बलस्थैर्य्यकृत् श्लेष्मा पञ्चधा प्रविभक्त उदककर्म्मणाऽनुग्रहं करोति ॥५॥

1 The slesma. – The function of the five kinds 2 of Slesma is to lubricate the interior of the joints (Sandhi-Samslesana) to contribute to the gloss of the body (Snehana), to aid in the formation of healthy granules in sores ( Ropana), to add to the size of the body (Purana), to build fresh tissues (Brinhana ), to impart a pleasant or soothing sensation to the body ( Tarpana), to increast its strength (Balakrt), and to give firmness to the limbs (Sthairyakrt), Thereby contributing to the welfare of the body by supplying it with its watery element. 5

रसस्तुष्टिं प्रीणनं रक्तपुष्टिञ्च करोति । रक्तं वर्णप्रसादं मांसपुष्टिं जीवयति च। मांसं शरीरपुष्टिं मेदसश्च । मेदः स्नेहस्वेदौ दृढत्वं पुष्टिमस्थनाञ्च । अस्थि देहधारणं मज्ज्ञः पुष्टिञ्च | मज्जा प्रीतिं स्नेहं बलं शुक्रपुष्टिं पूरणमस्थ्नाञ्च करोति । शुक्रं धैर्य्यं च्यवनं प्रीतिं देहबलं हर्ष बीजार्थञ्च ॥६॥

1. They are named as Ranjaka, Pacaka, Sadhaka (Medhakrt and Ojahkrt), Alocaka and Bhrajaka.

2. They are known as Slesaka, Kledaka, Bodhaka. Tarpaka, Avalambaka.

N.B. – The Vayu, Pitta, and Slesma, (Kapha), though ordinarily translated as wind, bile and phlegm, differ in their meaning from their usual English synonyms. We reserve the treatment of these subjects for a separate place in another part of the book when we shall have occasion do deal with the essentials of Ayurvedic Physiology.

The Rasa or the lymph chyle exercises a soothing effect upon the entire organism and tends to contribute to the increased formation of blood. The blood, in its turn, increases the healthful glow of the complexion, leads to the increased formation of flesh and muscles and maintains vitality in the organism. The flesh contributes towards the stoutness or rotundity of the limbs and occasions the formation of fatty matter in the system. The fat gives rise to the glossiness (formation of oily or albuminous matter) of the body and primarily contributes towards the firmness and growth of the bones. The bones, in their turn, support the body, and ocntribute to the formation of marrow. The marrow contributes towards the formation and increase of semen, and fills in the internal cavities of the bones, and forms the chief source of strength, amorous feelings and hilarity. The semen gives rise to valour and courageousness, makes a man amorously disposed towards the female sex, increases his strength and amativeness, is the sole impregnating principle in the male organism, and is possessed of the virtue of being quickly emitted. 6

पुरीषमुपस्तम्भं वाय्वग्निधारणञ्च । बस्तिपूरणविक्लेदकृन्मूत्रम् | स्वेदः क्लेदत्वक्सौकुमार्य्यकृत् ॥७॥

The excreta or the fecal matters of a man are in dispensably necessary for the preservation of the body. They contain the wind and digestion (being primarily connected with the movements of the bodily Vayu and the feeling of hunger). The urine fills the receptacle of the bladder, and is possessed of the property of washing or draining off the waste or refuse matter of the organism; whereas perspiration tends to moisten the skin. 7

रक्तलक्षणमार्त्तवं गर्भकृच्च । गर्भो गर्भलक्षणम् । स्तन्यं स्तनयोरापीनत्वजननं जीवनञ्चेति । तत्र विधिवत् परिरक्षणं कुर्वीत ॥८॥

The Artava (menstrual blood) is endued with the same properties as its arterial namesake, and is one of the essential factors in a woman which makes impregnation possible. The foetus or impregnated matter (Garbha) serves to make patent the features characteristic of pregnancy. The breast-milk in its turn tends to bring about an expansion of the mammae (of a woman, and maintains the life of her child (by supplying it with the necessary and nutritive element of food). These Vayu, etc. should be duly preserved in their normal condition. 8

अत ऊर्द्धमेषां क्षीणलक्षणं वक्ष्यामः । तत्र, वातक्षये मन्दचेष्टताऽल्पवाक्त्वमप्रहर्षो मूढसंज्ञता च पित्तक्षये मन्दोष्माग्निता निष्प्रभत्वञ्च । श्लेष्मक्षये रुक्षताऽन्तहि आमाशयेतरश्लेष्माशयशून्यता सन्धिशैथिल्यं तृष्णा दौर्बल्यं प्रजागरणञ्च । तत्र स्वयोनिवर्द्धनान्येव प्रतीकारः ॥९॥

Now we shall describe the symptoms which attend the loss or waste of any of the foregoing principles of the body.¹ The loss of the bodily Vayu (nerve-force) is followed by a state of languor, shortness of speech, uneasiness or absence of hilarity, and loss of consciousness. The loss of (Pitta) is marked by a dulness of complexion, diminution of the bodily heat and an impaired state of internal fire (digestive heat). The loss of phlegm (Kapha) is marked by dryness, a sensation of internal burning, a feeling of emptiness in the stomach and other cavities or chambers of the body, looseness of the joints (a feeling as if the joints were all broken), thirst, weakness, and insomnia. In such cases the medical treatment should consist of remedial agents which are capable of directly contributing to the growth or formation of the humour so lost or deteriorated. 9

रसक्षये हृत्पीडा कम्पः शून्यता तृष्णा च । शोणितक्षये त्वक्पारुष्यमम्लशीतप्रार्थना सिराशैथिल्यञ्च । मांसक्षये स्फिग्गण्डौष्ठोपस्थोरुवक्षः कक्षापिण्डिकोदरग्रीवाशुष्कता रौक्ष्यतोदौ गात्राणां सदनं धमनीशैथिल्यञ्च । मेदःक्षये प्लीहाभिवृद्धिः सन्धिशून्यता रौक्ष्यं मेदुरमांसप्रार्थना च। अस्थिक्षयेऽस्थिशूलं दन्तनखभङ्गो रौक्ष्यञ्च । मज्जक्षयेऽल्पशुक्रता पर्व्वभेदोऽस्थिनिस्तोदोऽस्थिशून्यता च । शुक्रक्षये मेदूवृषणवेदनाऽशक्तिमैथुने चिराद्वा वा प्रसेकः प्रसेके चाल्परक्तशुक्रदर्शनञ्च । तत्रापि स्वयोनिवर्द्धनद्रव्योपयोगः प्रतिकारः ॥ १० ॥

1. Such a loss or perceptible deterioration of any of them should be ascribed to the use of excessive cleansing or cathartic (Samsodhana) and pacifying (Samsamana) measures or to a repression of the natural urgings of the body, or to a course of violent or overfatiguing physical exercise, or to amorous excesses, or to the use of unwholesome and unsuitable food, or to grief, etc.

Similarly the loss of lymph chyle is marked by pain about the region of the heart, Angina Pectoris, with palpitation of the heart, a sensation of emptiness or gone-feeling in the viscus, and thirst. The loss of blood is attented with such symptoms as roughness of the skin, and a craving for acid food or drink. The patient longs to be in a cool place and asks for cool things, and the veins become loose and flabby. The loss of flesh is marked by emaciation of the buttocks, cheeks, lips, thighs, breasts, armpits,’ neck, and the calves of the legs. The arteries seem loose and flabby, and the body seems to be dry and inert, accompanied by an aching or gnawing pain in its members. The loss of fat is followed by such symptoms as the enlargement of the spleen, a sense of emptiness in the joints, and a peculiar dryness of the skin and a craving for cold and emollient meat. The degeneration of the bones is marked by an aching pain in the bones and bone-joints, a wasting of teeth and gums, and a general dryness of the body. Similarly, the loss or waste of marrow is characterised by the formation of a lesser quantity of semen, aching pain in the bones and breaking pain in the bone-joints which have become marrowless. The loss or waste of semen is marked by pain in the penis and the testes, and by incapacity for sexual intercourse. In such cases the emission of semen but rarely happens, and is then perceptibly deficient in its quantity, the emitted matter consisting of a small quantity of semen marked with shreds of blood. The medical treatment under the preceding circumstances should consist of remedies of such medicinal virtues as are found to directly and immediately contribute of the formation of the bodily principle (thus wasted or lost). 10

पुरीषक्षये हृदयपार्श्वपीडा सशब्दस्य च वायोरूर्ध्वगमनं कुक्षौ सञ्चरणञ्च । मूत्रक्षये बस्तितोदोऽल्पमूत्रता च । अत्रापि स्वयोनिवर्द्धनद्रव्योपयोगः । स्वेदक्षये स्तब्धरोमकूपता त्वक्शोष: स्पर्शवैगुण्यं स्वेदनाशञ्च, तत्राभ्यङ्गः स्वेदोपयोगश्च ॥११॥

The loss absence, suppression or scanty formation of fecal matter is attended with a sensation of pain at the sides and the region of the heart, and the upward coursing of (the incarcerated) wind or flatus, accompanied with a rumbling sound about the region of the

1. The armpits look thin, narrow and contracted.

liver and the intestines. Similarly, the loss, (absence or scanty formation) of urine is marked by an aching pain in the bladder, causing it dribble or to come out in thin and scanty jets. Here, as in the foregoing instances, the remedial agents should consist of drugs which directly contribute to the formation of urine. Similarly the waste, absence or scanty formation of perspiration is followed by such symptoms as numbness about the pores of the hair, and dryness of the epidermis (skin). The sense of touch is perceptibly affected, and perspiration is entirely stopped. The medical treatment in such a case consists in the application of medicated unguents, lubrications, diaphoretics, and adoption of measures (that tend to produce a copious perspiration). 11

आर्त्तवक्षये यथोचितकालादर्शनमल्पता वा योनिवेदना च । तत्र संशोधनमाग्नेयानाञ्च द्रव्याणां विधिवदुपयोगः । स्तन्यक्षये स्तनयोर्लानता स्तन्यासम्भवोऽल्पता वा । तत्र श्लेष्मवर्द्धनद्रव्योपयोगः । गर्भक्षये गर्भास्पन्दनमनुन्नतकुक्षिता च । तत्र प्राप्तबस्तिकालायाः क्षीरबस्तिप्रयोगो मेद्यान्नोपयोगश्चेति ॥१२॥

In the case of loss of waste of the catamenial flow, the menses do not appear at the appointed time or are scanty. The vagina seems stuffed and painful. The medical treatment in such cases consists in the adoption of alternative or cleansing measures, and in the administration of drugs of a heat-making (Agneya) potency or virtue. The loss or waste of breast-milk is characterised by a shrunken condition of the mammae, and suppression or scanty secretion of the fluid. The medica treatment in such cases lies in the administration of drugs which generate Kapha. The atrophy or wasting of the foetus in the womb (during the period of gestation) is marked by the absence of any movement in the uterus and the non-distended condition of the sides or walls of the abdomen. The treatment consists in the application of Ksira Bastis (enemas of medicated milk into the region of the uterus) in the eighth month of gestation, and prescribing courses of emollient fare for the patient (mother)¹ 12

अत ऊर्ध्वमतिवृद्धानां दोषधातुमलानां लक्षणं वक्ष्यामः । वृद्धिः पुनरेषां स्वयोनिवर्धनात्युपसेवनाद्भवति ।।१३।।

1. Several editions read invigorating diets, egg, etc.

Now we shall describe the symptoms which mark the excess (excessive accumulation in the body) of any of the fundamental humours, principles and excrements of the body. The quantities of these humours, principles and secretion, are abnormally increased through the use of substances that primarily contribute to their formation in the organism.¹ 13

तत्र, वातवृद्धौ त्वक्पारुष्यं कायं कार्यं गात्रस्फुरणमुष्णकामिता निद्रानाशोऽल्पबलत्वं गाढवर्च्चस्त्वञ्च । पित्तवृद्धौ पीतावभासता सन्तापः शीतकामित्वमल्पनिद्रता मूर्च्छा बलहानिरिन्द्रियदौर्बल्यं पीतविण्मूत्रनेत्रत्वञ्च । श्लेष्मवृद्धौ शौक्ल्यं शैत्यं स्थैर्य्यं गौरवमवसादस्तन्द्रा निद्रा सन्धिविश्लेषश्च ॥१४॥

An excess of Vayu in the body is marked by such symptoms as roughness of the skin, emaciation of the body, darkness of complexion (lit : blackness of hue), a little tremor or trembling of the limbs, longing for heat, or for hot things, insomnia, thickness or increased consistency of the fecal matter and decrease of bodily strength. (Similarly, an abnormal) increase of Pitta is characterised by a sallow complexion or a yellowish colour of the skin, a general burning sensation in the body as well as insomnia, a craving for cold contacts and cooling things, diminution of strength, weakness of the sense organs, fits of fainting and yellowness of the conjunctivae, stool and urine.

An excess of Kapha in the body is marked by such symptoms, as the whiteness, coldness and numbness of the body, heaviness of the limbs, a sense of drowsiness and langour, somnolence, and a feeling of looseness of the bone-joints. 14

रसोऽतिवृद्धो हृदयोत्क्लेदं प्रसेकञ्चापादयति । रक्तं रक्ताङ्गाक्षितां शिरापूर्णत्वञ्च । मांसं स्फिगूगण्डौष्ठोपस्थोरुबाहुजङ्घासु वृद्धिं गुरुगात्रताञ्च । मेदः स्निग्धाङ्गतामुदरपार्श्ववृद्धिं कासश्वासादीन् दौर्गन्ध्यञ्च । अस्थ्यध्यस्थीन्यघिदन्ताश्च । मज्जा सर्व्वाङ्गनेत्रगौरवम् च। शुक्रं शुक्राश्मरीमतिप्रादुर्भावञ्च ॥ १५ ॥

1. Several Editons read it as an additional text. 2. Several Editions read roughness of speech.

Similarly, an increased germination of lymph chyle (Rasa) in the body is manifest by such characteristics as, nausea, water-brash, and an increased flow of salivary secretion. A plethroa of blood in the system gives a reddish glow to the complexion and the white of the eyes, and imparts fullness to the veins. An increase of flesh is marked by the rotundity and fullness of the buttocks and the lips, as well as of the penis, arms, and the thighs, and an increased heaviness of the whole body. An excess of fat in the body imparts an oily gloss to the skin. the sides of the abdomen are increased in bulk, and the body emits a fetid smell, and the person is assailed with cough and dyspnoea. An excessive formation of bone (abnormal ossification) is attended with such symptoms as the cutting of additional teeth and the abnormal development of any of the bone-structures. An excessive formation of marrow gives rise to a heaviness of the eyes and to the members of the body. An excess of semen in the body is marked by an excessive flow of that fluid and gives rise to the formation of gravels (concretions) in the bladder which are known as Sukrasmari. 15

पुरीषमाटोपं कुक्षौ शूलञ्च । मूत्रं मूत्रवृद्धिं मुहुर्मुहुः प्रवृत्तिं बस्तितोदमाध्मानञ्च । स्वेदस्त्वचो दौर्गन्ध्यं कण्डूञ्च ॥ १६ ॥

An abnormal increase in the formation of fecal matter is attended with distension of the abdomen and colic pains in the lins and the intestines. An excessive formation of urine is manifest by constant urging for micturition and distension of the bladder, attended by a kind of gnawing or aching pain. Similarly, an increased secretion of perspiration is attended with an itching of the skin which emits a bad odour. 16

आर्त्तवमङ्गमर्द्दमतिप्रवृत्तिं दौर्गन्ध्यञ्च । स्तन्यं स्तनयोरापीनत्वं मुहुर्मुहुः प्रवृत्तिं तोदञ्च । गर्भो जठराभिवृद्धिं शोथञ्च ।।१७।।

An excess in the quantity of catamenial blood’ gives rise to an aching of the limbs and an excessive flow. So also an excess in the quantity of the breast-milk is attended with frequent secretions of that fluid, and with inflammation and pain inthe mammae. An

1. An abnormal flow tends to stimulate the voluptuous sensation of a woman to a considerable extent, and is followed by a sense of reactionary weakness. It emits a fetid smell and originates ovarian tumours.

excessive growth of the faetus in the uterus tends to abnormally swell the region of the abdomen, and is accompanied by anasarca, or dropsy, of the lower extremities (phlegmasia dolens). 17

तेषां यथास्वं संशोधनं क्षपणञ्चक्षयादविरुद्धैः क्रियाविशेषैः प्रतिकुर्वीत ॥१८॥

These abnormal excesses of the aforesaid humours and principles, etc. of the body should be checked or remedied with corrective (cleansing) or pacifying measures as would be indicated by their respective natures, so as not to reduce them to a smaller quantity than that in which they are found in the normal and healthy state of a body. 18

पूर्व्व: पूर्व्वोऽतिवृद्धत्वाद् वर्द्धयेद्धि परं परम् ।

तस्मादतिप्रवृद्धानां धातूनां ह्रासनं हितम् ।।१९।।

Metrical text: An increased quantity of a bodily principle gives rise to a similar increase in the quantity of one immediately succeeding it in the order of enumeration as stated above; and hence an increase in any of the fundamental principles of the body should be checked and reduced to its normal quantity. 19

बललक्षणं बलक्षयलक्षणञ्चात ऊर्द्ध वक्ष्यामः । तत्र रसादीनां शुक्रान्तानां धातूनां यत् परं तेजस्तत् खल्वोजस्तदेव बलमित्युच्यते स्वशास्त्रसिद्धान्तात् ॥२०॥

Now we shall describe the characteristic features of the strengthgiving principles of the body, as well as the symptoms that mark their loss or waste. The quintessence of all the fundamental principles of the body, starting with lymph chyle and ending with semen, is called the Ojas, which is identical with what is termed “Vital power.” This view of oneness of vitality with protoplasmic albumen has been adopted in the present work.¹ 20

1. The Sanskrit term “Ojas” has a variety of meanings. Primarily it means protoplasmic matter as found in cells (Bindus). Secondarily it means albumen as we shall describe later on in the chapters on etiology and therapeutics of Prameha. Several authorities hold a contrary view stating that Ojas (albumen) forms only one of the essentials of vitality and that the two are by no means identical.

तत्र बलेन स्थिरोपचितमांसता सर्व्वचेष्टास्वप्रतिघातः स्वरवर्णप्रसादो बाह्यानामाभ्यन्तराणाञ्च करणानामात्मकार्य्यप्रतिपत्तिर्भवति ॥२१॥

This Ojas (albumen) or strength- giving principle serves to impart a firm integrity to the flesh (and the muscles), exercises unbounded control over all acts of vitality, improves the voice and complexion, and helps both the external (operative) and the internal (intellectual) sense organs, in duly performing their natural functions. 21

भवन्ति चात्रओजः सोमात्मकं स्निग्धं शुक्लं शीतं स्थिरं सरम् । विविक्तं मृदु मृत्स्नञ्च प्राणायतनमुत्तमम् ।।२२।। देहः सावयवस्तेन व्याप्तो भवति देहिनः । तदभावाच्च शीर्य्यन्ते शरीराणि शरीरिणाम् ॥ २३ ॥

Authoritative verses on the subject: Ojas(allbumen being of a white colour belongs to the class of Somatmakam (cooling) substances. It is cooling, oleaginous, and firm (Sthira), contributes to the formation and growth of flesh, maintains its integrity or holds it firm, and is mobile or capable of moving about from one place to another within the organism. It is further soft and shiny, and is possessed of the most efficacious virtue and should be regarded as the most important element (seat) of vitality. The whole body with its limbs and members is permeated with Ojas, and a loss or diminution in its natural quantity leads to the gradual emaciation (and ultimate dissolution) of organism. 22-23

अभिघातात् क्षयात् कोपाच्छोकाद् ध्यानाच्छ्रमात् क्षुधः । ओजः संक्षीयते होभ्यो धातुग्रहणनिःसृतम् ।

तेज: समीरितं तस्माद् विसंसयति देहिनः । ॥ २४ ॥

A blow, a persistent wasting disease, anger, grief, cares and anxieties, fatigue and hunger, are the causes to which should be ascribed the wasting or disappearance of this strength-giving principle (albumen) of the body. The bodily albumen, through the agency of the above said causes, is wasted through the channels carrying the

1. Several editions read Rasa, meaning it to be possesed of a sweet taste.

different fundamental principles of the body. Albumen is transformed into strength which radiates from the heart. 24

तस्य विस्रंसो व्यापत् क्षय इति लिङ्गानि व्यापन्नस्य भवन्ति; सन्धिविश्लेषो गात्राणां सदनं दोषच्यवनं क्रियासन्निरोधश्च विसंसे, स्तब्धगुरुगात्रता वातशोफो वर्णभेदो ग्लानिस्तन्द्रा निद्रा च व्यापन्ने, मूर्च्छा मांसक्षयो मोहः प्रलापो मरणमिति च क्षये ॥ २५ ॥

A deranged or vitiated albumen (Ojas) is characterised firstly by its dislodgment fromits proper seat or locality (Visransa), secondly, by a change or modification of its native virtues in contact with the deranged humours or disordered organs (Vyapad) and thirdly, by wasting away (Ksaya). The first of the preceding properties (dislodgment) gives rise to such symptoms as looseness of the bonejoints, numbness of the limbs, dislodgment of the deranged humours from their respective receptacles and suppression of the (bodily and intellectual) functions. To the second of the foregoing properties, (change or modification of its natural virtue through contact with the deranged bodily humours etc.) should be ascribed such symptoms, as numbness and heaviness of the limbs, dropsy due to the action of the deranged bodily Vayu, discoloured or changed complexion, feeling of malaise, drowsiness and somnolence. The third property of the deranged albumen, ( loss or wasting), brings on fits of fainting, loss of flesh, stupor, delirium and ultimately death. 25

भवन्ति चात्रत्रयो दोषा बलस्योक्ता व्यापद्विसंसनक्षयाः । विश्लेषसादौ गात्राणां दोषविस्रंसनं श्रमः । अप्राचुर्य्य क्रियाणाञ्च बलविसंसलक्षणम् ||२६।। गुरुत्वं स्तब्धताऽङ्गेषु ग्लानिर्वर्णस्य भेदनम् । तन्द्रा निद्रा वातशोफो बलव्यापदि लक्षणम् ।। २७ ।। मूर्च्छा मांसक्षयो मोहः प्रलापोऽज्ञानमेव च। पूर्वोक्तानि च लिङ्गानि मरणञ्च बलक्षये ॥ २८ ॥

Authoritative verses on the subject: A deranged state of albumen is marked by the three abovesaid properties of dislodgment from its proper seat (Visransa); by a change of its natural virtues through contamination (Vyapad) and by wasting (Ksaya). The first of these properties Visransa); is characterised by looseness of the joints, by an inert state of the body, by a sense of fatigue, by a dislodgment of the deranged humours from their natural seats, and by a suppression of the bodily and intellectual functions. Numbness and heaviness of the limbs, malaise, a discoloured complexion, drowsiness, somnolence and dropsical swelling brought about by a deranged state of the bodily Vayu, should be considered as natural consequences of the Vyapad (change of the natural virtues of albumen through contamination). The loss or waste of Ojas (albumen) is marked by such symptoms as fits of fainting, emaciation of the body, bewilderment and distraction of the mind, delirium and loss of consciousness and ultimately death. 26-28

तत्र विसंसे व्यापन्ने च क्रियाविशेषैरविरुद्धैर्बलमाप्याययेत् । मूढसंज्ञम् इतरन्तु वर्ज्जयेत् ।।२९ ।। (तेजोऽप्याग्नेयं क्रमशः पच्यमानानां धातूनामभिनिर्वृत्तमन्तरस्थं स्नेहजातं वसाख्यं स्त्रीणां विशेषतो भवति । तेन मार्द्दवसौकुमा- र्य्यमृद्वल्परोमतोत्साहद्दृष्टिस्थितिपक्तिकान्तिदीप्तयो भवन्ति । तत् कषायतिक्तशीतरुक्षविष्टम्भिवेगविघातव्यवायव्यायाम व्याधिकर्षणश्च विक्रियते) । तस्यापि पारुष्यवर्णभेदतोदनिष्प्रभत्वानि विस्रंसने भवन्ति । कार्य मन्दाग्निताधस्तिर्य्यक्च विच्युतिर्व्यापत्तौ । दृष्ट्यग्निबलहान्यनिलप्रकोपणानि क्षये। तत्रापि स्नेहपानाभ्यङ्गप्रदेहपरिषेकस्निग्धलघ्वन्नानि क्षये विदधीत) ।

The medical treatment in cases of dislodgment or flowing out ( external secretion) of albumen from its natural seat (Visransa), as well as in the event of it becoming contaminated by the vitiated principles of the body, should consist in improving its quantity by elixirs and remedies possessed of rejuvenating properties, tending to increase the quantity of such fluid (albumen) in the body. A patient who has lost all consciousness (owing to an excessive loss or waste of albumen) should be given up by a physician (as incurable). 29

The oily or albumious matter found within the components of the other fundamental principles (Dhatu) of the body (as metabolised by the internal heat and regularly metamorphosed into the succeeding ones) should be grouped under the head of fiery or thermogenetic (Agneya) substances. This fatty matter (Vasa) predominates in the female organism and produces its peculiar softness, beauty and pleasing shape, causes the growth of scanty but soft hair on its surface. It strengthens the eyesight and increases the energy of the body, improves its power of digestion and heightens its glow and complexion. Fat is deranged by such acts as, an abuse of astringent, bitter, cold, parchifying or Vistambhi (indigestible food which remains stuffed in the stomach) substances, a voluntary repression of the natural urging for evacutions of the body, by excessive sexual indulgence, and fatiguing physical exercise, or by the draining action of any particular disease.

An instance of dislodgment of fat from its proper seat or locality is attended by such symptoms as roughness of the skin, loss of the natural healthful glow of the body and a breaking or an aching pain in the limbs. Anaemia or a gradual emaciation of the body, impaired digestive function and a slanting or downward course of the deranged humours, mark the case where the bodily fat has undergone a change in its natural properties through any foul contamination. A case of loss or waste of the bodily fat is marked by such symptoms as, impaired digestive function, dulness of sight, decay of strength and aggravation of the bodily Vayu, and always ends in death.

The medical treatment in the latter case (loss of fat) should consist in the administration of oily or emollient drinks, use of medicated unguents or lubrications, Pradeha (plasters of oleaginous substances) and Pariseka (washes) and a diet comprising light, cooling and well-cooked articles of food.

दोषधातुमलक्षीणो बलक्षीणोऽपि वा नरः। स्वयोनिवर्द्धनं यत् तदन्नपानं प्रकाङ्क्षति । । ३० ।।

यद्यदाहारजातं हि क्षीणः प्रार्थयते नरः । तस्य तस्य स लाभे तु तं तं क्षयमपोहति ।। ३१ ।।

यस्य धातुक्षयाद् वायुः संज्ञां कर्म्म च नाशयेत् । प्रक्षीणञ्च बलं यस्य नासौ शक्यश्चिकित्सितुम् । ॥ ३२ ॥

Metrical texts: A person suffering from a wasting of any of the constituent humours or fundamental principles or excrements of the body, as well as one suffering from loss of Ojas (albumen) naturally craves for drink and food that tend to contribute directly to the formation of the matter (or bodily principle so lost or wasted. Conversely, the particular food or drink longed for by a person suffering from a loss or waste of any of the abovesaid fluids or principles, should be looked upon as possessed of a curative virtue in that particular case. Such a person devoid of consciousness and divested of his bodily and intellectual functions through a deranged state of the bodily Vayu (nerve-force) and extremely weak and enfeebled owing to the loss of the vital fluid should be regarded as past all cure. 30-32

रसनिमित्तमेव स्थौल्यं कार्यञ्च । तत्र श्लेष्मलाहारसेविनोऽध्यशनशीलस्याव्यायामिनो दिवास्वप्नरतस्य चाम एवान्नरसो मधुरतरश्च शरीरमनुक्रामन्नतिस्नेहान्मेदो जनयति, तदतिस्थौल्यमापादयति, तमतिस्थूलं क्षुद्रश्वासपिपासाक्षुत्स्व – प्नस्वेदगात्रदौर्गन्थ्यक्रथनगात्रसादगद्गदत्वानि क्षिप्रमेवाविशन्ति; सौकुमार्य्यान्मेदसः सर्व्वक्रियास्वसमर्थः, कफमेदोनिरुद्धमार्गत्वाच्वाल्पव्यवायो भवति, आवृतमार्गत्वादेव च शेषा धातवो नाप्यायन्तेऽत्यर्थमतोऽल्पप्राणो भवति । प्रमेहपिड़काज्वरभगन्दरविद्रधिवातविकाराणामन्यतमं प्राप्य पञ्चत्वमुपयाति । सर्व्व एव चास्य रोगा बलवन्तो भवन्त्यावृतमार्गत्वात् स्रोतसाम् । अतस्तस्योत्पत्तिहेतुं परिहरेत् ।। ३३ ।।

Etiology of Obesity : Obesity or loss of flesh (Karsya) should be ascribed to changes in the condition of the lymph chyle. The lymph chyle derived from the assimilated food of a person, who is habituated to a course of diet which tends to promote the quantity of the bodily Kapha or is in the habit of pampering his belly even when a previous meal has not been throughly digested, or who is addicted to a habit of sleeping in the day, or leading a sedentary life, or is averse to taking any sort of physical exercise, continues in an immature state and is transformed into a serum of sweet taste which moves about within the body, engendering the formation of fat which produces excessive stoutness. A person afflicted with obesity develops such symptoms as shortness of breath, thirst, ravenous appetite, excessive sleepiness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech. Owing to the softness of fat, a fatty person is unfitted for every kind of work. Capacity for sexual intercourse is diminished (in such a one), owing to the obstruction of the passage of semen by phlegm and fatty deposits; and the growth of thre rest of the root-principles of the body such as, lymph chyle, albumen, semen, etc., is considerably arrested owing to the deposit of fatty matter within the channels of the internal passages of the body, thus seriously affecting his bodily strength. An obese or excessively corpulent person is likely to be afflicted with any of the following diseases such as, urethral discharges, eruptions, boils, carbuncles, fever, fistula in ano, or with any of the diseases which are caused by a deranged state of the bodily Vayu; and such attacks are invariably found to terminate in death. Any disease in such a person is apt to develop into one of a violent and dangerous type owing to the obstruction of the internal channels with depostis of fat. Hence all things or conditions which foster the growth of abnormal fat should be carefully avoided. 33

उत्पन्ने तु शिलाजतुगुग्गुलुगोमूत्रत्रिफलालोहरजोरसाञ्जनमधुयवमुद्गकोरदूषकश्यामाकोद्दालकादीनां विरुक्षणच्छेदनीयानाञ्च द्रव्याणां विधिवदुपयोगो व्यायामो लेखनबस्त्युपयोगश्चेति ॥३४॥

Accordingly medicated compositions, consisting of such drugs and substances as Silajatu, Guggulu, Go-Mutra, Triphala, Loharaja, Kasanjana, Madhu, Yava, Mudga, Koradusaka, Syamaka and Uddalaka which are anti-fat in their properties, or of remedial agents possessing the efficacy of cleansing the internal channels, as well as enematas of liquefacient solutions technically known as Lekhana Bastis and physical exercise should be prescribed. 34

तत्र पुनर्वातलाहारसेविनोऽतिव्यायामव्यवायाध्ययनभयशोकध्यानरात्रिजागरणपिपासाक्षुत्कषायाल्पाशनप्रभृतिभिरुपशोषितो रसधातुः शरीरमननुक्रामन्नल्पत्वान्न प्रीणयति, तस्मादतिकाश्यं भवति । सोऽतिकृशः क्षुत्पिपासाशीतोष्णवातवर्षभारादानेष्वसहिष्णुर्वातरोगप्रायोऽल्पप्राणश्च क्रियासु भवति; श्वासकासशोषप्लीहोदराग्निसाद- गुल्मरक्तपित्तानामन्यतमं प्राप्य मरणमुपयाति । सर्व्व एव चास्य रोगा बलवन्तो भवन्त्यल्पप्राणत्वात् । अतस्तस्योत्पत्तिहेतुं परिहरेत् ।। ३५ ।।

Etiology of Karsya : Loss of flesh or a gradual emaciation of the body should be ascribed to the partaking of food in the composition of which, matter which aggravates the bodily Vayu largely or excessively enters, to over-fatiguing physical exercise, sexual excesses, over study, fright, grief or anxiety, to the keeping up of late hours, to unsatisfied hunger, insufficient food, and to astringent food which tends to dry up the lymph chyle. The chyle, thus parched up, moves about in the organism, but fails to impart to it the necessary nutritive element owing to its being insufficiently charged with it, thus, causing the body to grow extremely emaciated.

A patient suffering from extreme emaciation of the body fails to bear the inclemencies of weather and the variations of terrestrial heat, and becomes apathetic to all movements and does but imperfectly perform the functions of vitality, and is also incapable of enduring thirst or hunger. The bodily strength suffers a gradual diminution, and diseases, incidental to a deranged state of the bodily Vayu, make their appearance, and the patient has to meet his doom from any of the following diseases as asthma, cough, Sosa (phthisis), enlarged spleen or liver, abdominal dropsy, dyspepsia, abdominal glands and haemoptysis. Any disease appearing in such a patient develops into one a violent type owing to the loss or diminished condition of the bodily strength or protoplasm (Prana). Contrarily conditions or factors which produce obesity should be avoided. 35

उत्पन्ने तु पयस्याश्वगन्धाविदारिगन्धाशतावरीबलातिबलानागबलानां मधुराणामन्यासाञ्चौषधीनामुपयोगः, क्षीरदधिघृतमांसशालिषष्टिकयवगोधूमानाञ्च दिवास्वप्नब्रह्मचर्य्याव्यायामबृंहणबस्त्युपयोगश्चेति ॥३६॥

A case of patient obesity should be checked with a medicated compound, consisting of such drugs as, Payasya, Asvagandha, Vidarigandha, Satavari, Bala, Atibala, Nagabala and such other drugs of sweet taste. Diets consisting of thickened milk, clarified butter, curd, meat, boiled Sali rice, Sastika, wheat, barley, etc., should be prescribed in the case; and sleep in the day, sexual indulgence, physical exercise, etc., should be prohibited. Enematas of nutritive substances can be likewise given with advantage. 36

यः पुनरुभयसाधारणान्युपसेवेत तस्यान्नरसः शरीरमनुक्रामन् समान् धातूनुपचिनोति; समधातुत्वान्मध्यशरीरो भवति सर्व्वक्रियासु समर्थः, क्षुत्पिपासाशीतोष्णवातवर्षातपसहो बलवांश्च । स सततमनुपालयितव्य इति ॥३७॥

On the other hand, the lymph chyle of a man, who partakes of food belonging to both the abovesald classes, courses through his organism and strengthens the root-principles of his body, thus giving a middling or healthful rotundity to his limbs owing to its properties being equipoised. A man possessed of such a body is capable of all kinds of work and movement. He can fairly stand the inclemencies of weather and the keenness of hunger and thirst, and will gain in strength and energy. Care should be always taken to have such a well equipped body of moderate size. 37

भवन्ति चात्रअत्यन्तगर्हितावेतौ सदा स्थूलकृशौ नरौ । श्रेष्ठो मध्यशरीरस्तु कृशः स्थूलात् तु पूजितः । ।३८ ।।

दोषः प्रकुपितो धातून् क्षपयत्यात्मतेजसा । इद्धः स्वतेजसा वह्निरुखागतमिवोदकम् ॥ ३९ ॥

वैलक्षण्याच्छरीराणामस्थायित्वात् तथैव च दोषधातुमलानान्तु परिमाणं न विद्यते ॥४०॥

एषां समत्वं यच्चापि भिषग्भरवधार्य्यते । न तत् स्वास्थ्यागते शक्यं वक्तुमन्येन हेतुना । ॥४१॥

दोषादीनान्त्वसमतामनुमानेन लक्षयेत्। अप्रसन्नेन्द्रियं वीक्ष्य पुरुषं कुशलो भिषक् ॥ ४२ ॥

स्वस्थस्य रक्षणं कुर्य्यादस्वस्थस्य तु बुद्धिमान् । क्षपयेद्बृंहयेच्चापि दोषधातुमलान् भिषक् ।

तावद्द्यावदरोगः स्यादेतत् साम्यस्य लक्षणम्।।४३।।

Authoritative verses on the subject : Excessively corpulent and excessively lean persons are alike condemnable. A body which is neither too stout nor too lean, but strikes the mean as regards plumpness, is the best. A lean frame should have the preference to a stout one. The neraged or aggravated bodily humours dry up the fundamental principles of the body, such as the lymph chyle etc., just in the same way as a well-kindled fire will evaporate the water contained in a basin placed over it. Since (the temperament, constitution, size and the fundamental principles of) the body vary in different individuals; (and since the body, in its turn, undergoes such gradual transformations as infancy, youth and old age), and changes its state each moment, it is absolutely impossible to lay down the exact quantity of the deranged humours, excrements and fundamental principles (of lymph chyle, blood, semen, albumen, etc.) that may be found in the human organism. Hence it is necessary for a physican to ascertain their state of equilibrium (their continuance in normal state and quantity) at any particular time; and which should be pronounced only in cases where signs of perfect health would be visible. An experienced physician would naturally draw a contrary inference from the improper functions of the organs in an individual. An intelligent physician should preserve the state of health in a healthy individual, while he should increase or decrease the quantity of the bodily humours, vital fluids, or excrements in a sick patient according to the exigencies of the case until his health is perfectly restored. 38-43

समदोषः समाग्निश्र समधातुमलक्रियः ।

प्रसन्नात्मेन्द्रियमनाः स्वस्थ इत्यभिधीयते ।।४४ ।।

A person with an uniformly healthy digestion, and whose bodily humours are in a state of equilibrium, and in whom the fundamental vital fluids course in their normal state and quantity, accompanied by the normal processes of secretion, organic function, and intellection, is said to be a healthy person. 44

इति सुश्रुतसंहितायां सूत्रस्थाने दोषधातुमलक्षयवृद्धिविज्ञानीयो नाम पञ्चदशोऽध्यायः ॥१५॥

Thus ends the fifteenth Chapter of the Sutrasthana in the Susruta Samhita which treats of the Development and Non-development of the humoral constituents of the body.


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