अथातो विशिखानुप्रवेशनीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter which treats of the essential qualifications of physician before he formally enters his profession (Visikhanupravesaniya adhyaya). 1
अधिगततन्त्रेणोपासिततन्त्रार्थेन दृष्टकर्मणा कृतयोग्येन शास्त्रं निगदता राजानुज्ञातेन नीचनखरोम्णा शुचिना शुक्लवस्त्रपरिहितेन छत्रवता दण्डहस्तेन सोपानत्केनानुद्धतवेशेन सुमनसा कल्याणाभिव्याहारेणाकुहकेन बन्धुभूतेन भूतानां सुसहायवता वैद्येन विशिऽखानुप्रवेष्टव्या ॥२॥
A physician having throughly studied the Science of medicine, and fully pondered on and verified the truths he has assimilated, both by observation and practice, and having attained to that stage of (lucid) knowledge, which would enable him to make a clear exposition of the science (whenever necessary) should open his medical carreer (commence practising) with the permission of the king of his country. He should be cleanly in his habits and well shaved, and should not allow his nails to grow. He should wear white garments, put on a pair of shoes, carry a stick and an umbrella in his hands, and walk about with a mild and benignant look as a friend of all created beings, ready to help all, and frank and friendly in his talk and demeanour, and never allowing the full control of his reason or intellectual powers to be in any way disturbed or interfered with. 2
ततो दूतनिमित्तशकुनमङ्गलानुलोम्येनातुरगृहमभिगम्योपविश्यातुरमभिपश्येत, स्पृशेत् पृच्छेच्च । त्रिभिरेतैर्विज्ञानोपायै रोगाः प्रायशो वेदितव्या इत्येके | तत्तु न सम्यक् षड्विधो हि रोगाणां विज्ञानोपायः, तद्यथा- पञ्चभिः श्रोत्रादिभिः प्रश्नेन चेति ॥३॥
A physician, having met with a messenger of happy augury, or having been encouraged on his journey by the notes of auspicious birds or sights, should go to the house of his patient. [Then, having entered the sick room], the physician should view the body of his patient, touch it with, his own hands, and enquire (about his complaint). Several authorities hold that these three, (inspection, touch and questioning) largely form the means of our ascertaining the nature of a disease. But that is not correct, inasmuch as the five senseorgans of hearing, sight, etc. and oral enquiry materially contribute to a better diagnosis. 3
तत्र श्रोत्रेन्द्रियविज्ञेया विशेषा रोगेषु व्रणास्रावविज्ञानीयादिषु वक्ष्यन्ते- ‘तत्र सफेनं रक्तमीरयन्ननिलः सशब्दो निर्गच्छति’ इत्येवमादयः । स्पर्शनन्द्रियविज्ञेयाः शीतोष्णश्लक्ष्णकर्कशमृदुकठिनत्वादयः स्पर्शविशेषा ज्वरशोथादिषु । चक्षुरिन्द्रियविज्ञेयाः शरीरोपचयापचयायुर्लक्षणबलवर्णविकारादयः । रसनेन्द्रियविज्ञेयाः प्रमेहादिषु रसविशेषाः । घ्राणेन्द्रियविज्ञेया अरिष्टलिङ्गादिषु व्रणानामव्रणानाञ्च गन्धविशेषाः । प्रश्नेन च विजानीयाद् देशं कालं जातिं सात्म्यमातङ्कसमुत्पत्तिं वेदनासमुच्छ्रायं बलं दीप्ताग्नितां वातमूत्रपुरीषाणां प्रवृत्त्यप्रवृत्ती कालप्रकर्षादींश्च विशेषान्। आत्मसदृशेषु विज्ञानाभ्युपायेषु तत्स्थानीयैर्जानीयात् ॥४॥
Diseases, which are to be diagnosed with the help of the organ of hearing, will be fully treated, later on, in the Chapter on VranaSrava (secretions from an ulcer). The wind (Vayu), making the blood ebullient, forces it up with a distinctly audible report and thus affects the sense of hearing. But this will be dealt with later on in the abovesaid chapter. The heat and coldness of the body, or the gloss, roughness, hardness, or softness of the skin of the affected part as in fever, or in an oedematous swelling of the body, are perceptible by the sense of touch. Fullness or emaciation of the body (cachexia), state and indications of vitality, strength, complexion, etc. are perceived by the sense of sight. secretions or discharges (from the inflamed mucous membrane of the urethra) in Prameha etc., should be tested wtih the organ of taste. The characteristic smell emitted by an ulcer in its critical stage (Arista) should be determined with the help of the organ of smell.
While such facts as the itme or season (of the first appearance) or the disease, the caste which the patient belongs to, and things or measures which tend to bring about a manifest amelioration of the disease, or prove comfortable to the patient (Satmya) as well as the cause of the disease, the aggravation of pain, the strength of the patient, and his state of digestion and appetite, the emission of stool, urine and flatus, or their stoppage, and the maturity of the disease as regards time, should be specifically ascertained by directly interrogating the patient (or those subjects). Though the abovesaid five organs of sense, like the three fundamental vital humours, help us to make the correct diagnosis of a disease, still the objects locally perceived by these senses should not be left out of account in ascertaining its specific nature. 4
मिथ्या दृष्टा विकारा हि दुराख्यातास्तथैव च । तथा दुष्परिमृष्टाश्च मोहयेयुश्चिकित्सकम् ॥५॥
Authoritative verse on the sbuject: A disease wrongly observed or incorrectlydescribed, or wrongly diagnosed, is sure to mislead a physician. 5
एवमभिसमीक्ष्य साध्यान् साधयेत्, याप्यान् यापयेत्, साध्यान्नैवोपक्रमेत्। परिसंवत्सरोत्थितांश्च विकारान् प्रायशो वर्ज्जयेत् ॥६॥
तत्र साध्या अपि व्याधयः प्रायेणैषां दुश्चिकित्स्यतमा भवन्ति । तद्यथा – श्रोत्रियनृपतिस्त्रीबालवृद्धभीरुराजसेवककितवदुर्बलवैद्य
1. The sweet, or any other taste of the discharges should be inferred from the fact of their being or not being swarmed with hosts of ants or flies. etc.
विदग्ध-व्याधिगोपकदरिद्रकृपण- क्रोधवतामनात्मवतामनाथानाञ्च; एवं निरूप्य चिकित्सां कुर्व्वन् धर्म्मार्थकामयशांसि प्राप्नोति ॥७॥
Having made these observations the physician will try to cure diseases that are curable, adopt palliative measures in cases where palliation is the only remedy that can be offered, and give up a case which is beyond all medical treatment, and mostly those which are of more than a year’s standing. Diseases affecting a Brahmana well versed in the Vedas, or a king, or a woman, or an infant, or an old man, or a timid person, or a man in the royal service, or a cunning man, or a man who pretends to possess a knowledge of the science of medicine, or a man who conceals his disease, or a man of an excessively irascible temperament, or a man who has no control over his senses, or a man in extremely indigent circumstances of life or without any one to take care of him, are apt to run into an incurable type though appearing in a common or curable form at the outset. The physician, who practises his art with a regard to these facts, acquires piety, wealth, fame and all wished for objects in life. 6-7
स्त्रीभिः सहास्यां संवासं परिहासञ्च वर्ज्जयेत् । दत्तञ्च ताभ्यो नादेयमन्नादन्यद्भिषग्वरैः ।।८।।
Authoritative verse on the subject: A physician should abjure the company of women, nor should he speak in private to them or joke with them. A physician is forbidden to take anything but cooked rice from the hands of a woman. 8
इति सुश्रुतसंहितायां सूत्रस्थाने विशिखानुप्रवेशनीयो नाम दशमोऽध्यायः ॥१०॥
Thus ends the tenth Chapter of the Sutrasthana in the Susruta Samhita which treats of the essential qualification of a physician.