एकविंशोध्यायः । अथातो व्रणप्रश्नमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discuss the Chapter which investigates the nature of bodily humours, as exciting causes of ulcers (Vrana-prasnaadhyaya). 1
वातपित्तश्लेष्माण एव देहसम्भवहेतवः । तैरेवाव्यापन्नैरधोमध्योर्ध्वसन्निविष्टैः शरीरमिदं धार्यतेऽगारमिव स्थूणाभिस्तिसृभिरतश्च त्रिस्थूणमाहुरेके । त एव च व्यापन्नाः प्रलयहेतवः तदेभिरेव शोणितचतुर्थः सम्भवस्थितिप्रलयेष्वप्यविरहितं शरीरं भवति ।। २ ।।
The Vayu, Pitta and Slesma should be considered as the primary and the most essential factors in stitution of human organism. These fundamental and vital humours, occupying respectively the lower, middle, and upper parts of the body, maintain its integrity. The human body is supported by the three fundamental humours in the same way as a dwelling house is propped up by three supporting poles or stays; from which fact, the body is called the three supported one ( Tristhuna) by certain authorities. A deranged condition of these three fundamental humours may bring about its dissolution or death, while on their continuance in a normal state depends the vitality of the organism. These three humours, in combination with a fourth, the principle of blood, determine the origin, preservation, and dissolution of animated organism and permeate it with their respective properties till the moment of death. 3
भवति चात्र नर्त्ते देहः कफादस्ति न पित्तान्न च मारुतात् । शोणितादपि वा नित्यं देह एतैस्तु धार्यते ।। ३ ।।
‘तत्र ‘वा’ गतिगन्धनयोरिति धातुः, ‘तप्’ सन्तापे, ‘श्लिष्’ आलिङ्गने । एतेषां कृद्विहितैः प्रत्ययैर्वातः पित्तं श्लेष्मेति च रूपाणि भवन्ति ॥४॥
Authoritative verse on the subject: There can be no organism without Vayu, Pitta, Kapha and blood, which are necessary to constantly maintain its integrity. The terms Vata (Vayu ), Pitta and Slesma (Kapha) are respectively derived from the roots ‘Va’, to move or smell, ‘Tapa’, to burn or to heat, and “Slis”, to embrace, with the suffix ‘Ta’ thereto added. 3-4
दोषस्थानान्यत ऊर्द्ध वक्ष्यामः । तत्र समासेन वातः श्रोणीगुदसंश्रयः । तदुपर्यथो नाभे पक्वाशयः, पक्वामाशययोर्मध्यं पित्तस्य । आमाशय: श्लेष्मणः ॥५॥
Seats of the bodily humours: Now we shall describe the locations of the foregoing vital humours. The Vayu may be briefly described as located in the regions of the pelvis (Sroni), and the rectum (Guda). The Pittam has its seat in the region between the stomach (Amasaya) and the intestines (Pakvasaya) which is above the pelvis and the rectum and below the umbilicus, while the Kapha is ensconced within the cavity of the stomach (Amasaya). 6
अतः परं पञ्चधा विभज्यन्ते । तत्र वातस्य वातव्याधौ वक्ष्यामः । पित्तस्य यकृत्प्लीहानौ हृदयं दृष्टिस्त्वक् पूर्व्वोक्तञ्च । श्लेष्मणस्तूर: शिरः कण्ठसन्धय इति पूर्वोक्तञ्च । एतानि खलु दोषाणां स्थानान्यव्यापन्नानाम् ॥६॥
Now we shall divide the locations of each of the vital humours into five parts:- The five localities of the Vayu will be described under
1. From this should be inferred that motion and smell are the natural attributes of the vital Vayu, heat and burning are those of Pitta, and union and integration are those of Kapha.
the head of Vata-Vyadhis (nervous diseases), while those of Pitta are the liver and the spleen, the heart, the pupils of the eyes, the skin and the intestines (Pakvasaya). The Kapha is located in the region of the breast, the throat, the head, the joints and the stomach (Amasaya). The foregoing regions are the seats of the vital humours in their normal state. 6
विसर्गादानविक्षेपैः सोमसूर्य्यानिला यथा । धारयन्ति जगद्देहं कफपित्तानिलास्तथा ॥ ७ ॥
Metrical Texts : The vital humours (Vayu, Pitta and Kapha) maintain the integrity of the animated organism by creating, assimilating and diffusing strength in the same way as the moon, the sun, and the winds maintain the integrity of the terrestrial globe.¹7
तत्र जिज्ञास्यं, किं पित्तव्यतिरेकादन्योऽग्निः ? आहोस्वित् पित्तमेवाग्निरिति? अत्रोच्यते- न खलु पित्तव्यतिरेकादन्योऽग्निरुपलभ्यते, आग्नेयत्वात् पित्ते दहनपचनादिष्वभिवर्त्तमानेष्वग्निवदुपचारः क्रियतेऽन्तरग्निरिति । क्षीणे ह्यग्निगुणे तत्समानद्रव्योपयोगादतिरेकादतिप्रवृद्धे शीतक्रियोपयोगादागमाच्च पश्यामो न खलु पित्तव्यतिरेकादन्योऽग्निरिति॥८॥
The Pittam: Now it may be asked whether the Pitta is identical with the elemental fire, or is it something other than that? The question may be answered by stating that the Pitta is the same as fire. Since such symptoms, as a burning sensation, digestion (boiling, and all other characteristics of fire can never exhibit themselves in the human body without the intervention of Pitta. Pitta therefore is called internal fire. 2
Consequently, an enfeebled action of Pitta is remedied by the administration of drugs and substances which are akin to the elemental fire in their attributes, while an abnormal or excessive action (secretion)
1. The moon laves the earth and imparts to it the vitalising principle with her own ambrosial light. The sun draws off the moisture in virtue of his own attractive force, and the Vayu distributes the heat and moisture over its surface.
2. The analogy is based on the heating ( and metabolic) actions of Pitta and does not extend to its liquid secretion (bile). But since the former attributes permeate in its entirety, it is designated the Internal fire.
of Pitta is subdued by cooling measures as an over-kindled fire is subdued by moisture. There is no other fire (heat making factor) in the organism than Pitta. 8
तच्चाद्दृष्टहेतुकेन विशेषेण पक्वामाशयमध्यस्थं पित्तं चतुर्विधमन्नपानं पचति, विवेचयति च दोषरसमूत्रपुरीषाणि तत्रस्थमेव चात्मशक्तचा शेषाणां पित्तस्थानानां शरीरस्य चाग्निकर्म्मणाऽनुग्रहं करोति, तस्मिन् पाचकोऽग्निरिति संज्ञा ॥९॥
The Pacakagni By the ordination of fate or necessity (unfathomable natural cause) the Pitta, located in the region between the stomach (Amasaya) and the intestines ( Pakvasaya), helps the digestion of the four kinds of food (such as drink and edibles etc.) partaken of by a living subject, and purges off the residue or impure morbiferous matter in the shape of urine and excreta after the completion of the process. Even thus located, it keeps up the temperature in its other distant locations (skin, etc.) in virtue of its native heatgiving attribute. Hence this Pitta is called the Pacakagni (digestive fire or heat) in an animated organism. 9
यत् तु यकृत्प्लीह्रोः पित्तं तस्मिन् रञ्जकोऽग्निरितिसंज्ञा, स रसस्य रागकूदुक्तः ॥१०॥
The Ranjakagni : The function of the Pitta, which has its seats in the liver and the spleen, consists in imparting its characteristic pigment (Ragakrt) to the lymph-chyle and is hence known as Ranjakagni (lit :- dyeing fire or pigment bile). 10
यत् पित्तं हृदयसंस्थितं तस्मिन् साधकोऽग्निरितिसंज्ञा, सोऽभिप्रार्थितमनोरथकृदुक्तः ॥११॥
The Sadhakagni : The Pitta seated in the heart is denominated as the Sadhakagni (performing or operating heat or fire) inasmuch as its action is to bring about the fruition or realisation of one’s desires. 11
यद्दृष्टयां पित्तं तस्मिन्नालोचकोऽग्निरिति संज्ञा; स रूपग्रहणेअधिकृतः ॥१२॥
The Alocakagni : The Pitta, which is located in the pupils of the eyes, is called the Alocakagni (the Pitta or fire of sight) as its office
is to catch the image of any external object presented to the eyes. 12
यत् तु त्वचि पित्तं तस्मिन् भ्राजकोऽग्निरिति संज्ञा; सोऽभ्यङ्गपरिषेकावगाहावलेपनादीनां क्रियाद्रव्याणां पक्ता च्छायानाञ्च प्रकाशकः ॥१३॥
The Bhrajakagni: The Pitta, which has its seat in the skin, is called the Bhrajakagni (illuminating or irradiating heat) inasmuch as it absorbs the substances used in the shape of unguents, lubrications, etc. and irradiates the glow of one’s natural complexion. 13
पित्तं तीक्ष्णं द्रवं पूति नीलं पीतं तथैव च ।
उष्ण कटुरसञ्चैव विदग्धञ्चाम्लमेव च ।।१४।।
Metrical texts : The Pitta is a keen, sharp and warm liquid, of a blue colour (in its normal state), or yellowish (in its deranged condition). It emits a kind of fleshy smell and is possessed of a pungent taste which is transformed into an acid one when deranged or vitiated. 14
अत ऊर्व श्लेष्मस्थानान्यनुव्याख्यास्यामः । तत्रामाशयः पित्ताशयस्योपरिष्टात् तत्प्रत्यनीकत्वादूद्धर्व गतित्वात् तेजसञ्चन्द्र इवादित्यस्य; स चतुर्व्विधस्याहारास्याधारः । स च तत्रोदकैर्गुणैराहारः प्रक्लिन्नो भिन्नसङ्घातः सुखजरो भवति ॥१५॥
Seats of Slesma (Kapha): Now we shall describe the locations of Kapha. The stomach ( Amasaya), which is the seat of Kapha, occupies the same position as regards its location to that of Pitta as the sun holds in relation to that of the moon. And since the stomach (Amasaya) is situated above the pancreas (Pittasaya), and is endowed with a property (cooling) contrary to the primary virtue (heating) of Pitta, and, since the heat emitted by the receptacle of Pitta is naturally radiated in an upward direction, the four kinds of food, brought in to the stomach (Amasaya), are boiled and transformed into a soft placid mass (chyme), like rice boiled in a bowl full of water placed over a burning oven. The food, thus brought down into the stomach, is easily moistened, disintegrated and digested by coming into contact with the oily secretions of the stomach (Amasaya). 15
माधुर्यात्पिच्छिलत्वाच्च प्रक्लेदित्वात् तथैव च ।
आमाशये सम्भवति श्लेष्मा मधुरशीतलः ।।१६।।
Metrical Texts: The Kapha is originated through the sweet, slimy, watery, exudating character of the food brought into the stomach (Amasaya); and hence the Kapha becomes endued with similar attributes. 16
स तत्रस्थ एव स्वशक्तया शेषाणां श्लेष्मस्थानानां शरीरस्य चोदककर्म्मणानुग्रहं करोति । उरः स्थस्त्रिकसन्धारणमात्मवीर्येणान्नरस सहितेन हृदयावलम्बनं करोति । जिह्वामूलकण्ठस्थो जिह्वेन्द्रियस्य सौम्यत्वात् सम्यग्रसज्ञाने वर्त्तते । शिरस्थ: स्नेहसंतर्पणाधिकृतत्वादिन्द्रियाणामात्मवीर्येणानुग्रहं करोति । सन्धिस्थस्तु श्लेष्मा सर्व्वसन्धिसंश्लेषात् सर्व्वसन्ध्यनुग्रहं करोति ॥१७॥
The Kledaka: The Kapha, even though principally located in the stomach, permeates its four other distant localities with its peculiar watery or humid essence in virtue of its inherent attributes.
The Avalambaka: The Kapha, located in the region of the chest, protects the joints of the arms, the neck and the sternum, and enables the heart to perform its natural functions with the help of the lymph-chyle derived from the assimilated frood and its own intrinsic potency.
The Bodhaka: The Kapha, situated in the throat and at the root of the palate, lends its aid to the perception of tastes by maintaining the moist or humid character of the tongue.
The Tarpaka : The Kapha, situated in the head, cools and bathes the different sense organs with own humid essence, in virtue of its natural humid attributes.
The Slesmaka : The Kapha, situated in the joints, keeps them firmly united, protects their articulation and opposes their separation and disunion. 17
श्लेष्मा श्वेतो गुरुः स्निग्धः पिच्छिलः शीत एव च ।
मधुरस्त्वविदग्धः स्याद् विदग्धो लवणः स्मृतः ।।१८।।
Metrical Texts : The Kapha is white, heavy, oily slimy and cool. In its normal state, it is possessed of a sweet taste, which is followed by a saline one in its reactionary transformation (chemical reaction) when deranged or vitiated. 18
शोणितस्य स्थानं यकृत् – प्लीहानौ, तच्च प्रागभिहितम्; तत्रस्थमेव शेषाणां शोणितस्थानानामनुग्रहं करोति ॥१९॥
Seats of blood: The seats of blood are in the liver and the spleen, as stated before, whence it helps its other receptacles to serve their proper functions. 19
अनुष्णशीतं मधुरं स्निग्धं रक्तञ्च वर्णतः ।
शोणितं गुरु विस्रं स्याद् विदाहश्चास्य पित्तवत् ।। २० ।।
Metrical Texts : The blood is red, oily or glossy, a little warm, and is possessed of an attribute similar to something of a sweet taste. It is heavy, and it emits a fleshy smell and resembles the Pitta in its reactionary process, or in other words, those factors, which derange the Pitta, vitiate the blood as well. 20
एतानि खलु दोषस्थानानि, एषु सञ्चीयन्ते दोषाः । प्राक् सञ्चयहेतुरुक्तः । तत्र सञ्चितानां खलु दोषाणां स्तब्धपूर्णकोष्ठता पीतावभासता मन्दोष्मता चाङ्गानां गौरवमालस्यं चयकारणविद्वेषश्चेति लिङ्गानि भवन्ति । तत्र प्रथमः क्रियाकालः ॥ २१ ॥
These are the locations of the deranged humours, which are respectively accumulated in them on account of the aforesaid causes. The deranged humours exhibit such symptoms as, fullness and stuffedness of the abodomen, or of any of the viscera (due to the action of the deranged Vayu); yellowness of the affected part (due to the action of the deranged Pitta), and diminution of the bodily heat, heaviness of the limbs, and a sense of languor (due to the action of the diseased Kapha), and a natural repugnance for causes (factors) which lead to their respective aggravations or accumulations. The medical treatment should be commenced as soon as the symptoms, peculiar to their accumulation, would become manifest. 21
अत ऊर्ध्वं प्रकोपणानि वक्ष्यामः । तत्र बलवद्विग्रहातिव्यायामव्यवायाध्ययनप्रपतनप्रथावनवनप्रपीड़नाभिघातलङ्घनप्लवनतरणरात्रिजागरणभारहरणगजतुरङ्गरथपदातिचर्य्याकटुकषायतिक्तरूक्षलघुशीतवीर्य्यशुष्कशाकवल्लूरवरकोद्दालककोरदूषश्यामाकनीवारमुद्गमसूराढ़कीहरेणुकलायनिष्पावानशनविषमाशनाध्यशनवातमूत्रपुरीषशुक्रच्छर्द्दिक्षवथूद्गार-वाष्प वेगविघातादिभिर्विशेषैर्वायुः प्रकोपमापद्यते ॥ २२ ॥
Humours and their aggravations: Now we shall enumerate the causes which agitate and (aggravate) the deranged humours. The bodily Vayu is aggravated by such factors (conduct, practices and diet, etc.) as, wrestling with a wrestler of superior strength, violent gymnastic exercises, sexual excesses, excessive study, a headlong plunge into water or a leap from an inordinate height, running, a violent pressing blow, leaping over a ditch, a bounding gait, swimming, keeping of late hours, carrying of heavy loads, excessive riding, walking a long distance and the partaking of a food into the composition of which pungent, astringent, bitter, light or parchifying articles, or substances of cool potency, largely enter. Diets consisting of dried pot-herbs, Vallura, Varaka, Uddalaka, Koradusa, Syamaka, Nivara, Mudga, Masura, Adhaki, Harenu, Kalaya, and Nispava tend to aggravate the bodily Vayu.
Fasting, unequal or irregular meals, over-eating, voluntary suppression of unine, semen, and tears, or of the mucous secretions from the nose as in a fluent coryza, a forced stoppage of defecation, eructation or sneezing are the factors, which may be set down as the aggravating causes of the bodily Vayu. 22
स शीताभ्रप्रवातेषु घर्म्मान्ते च प्रत्यूषस्यपराहे तु जीर्णेऽन्ने च विशेषतः । प्रकुप्यति || २३॥
Metrical Text: The bodily Vayu is naturally aggravated in a cold, cloudy or windy day, in winter, during the rains, in the morning and evening and especially at the close of digestion. 23
क्रोधशोकभयायासोपवासविदग्धमैथुनोपगमन-कट्वम्ललवणतीक्ष्णोष्णलघुविदाहीतिलतैलपिण्याक-कुलत्थ -सर्षपातसीहरितकशाक गोधामत्स्याजाविकमांस दघितक्रकूर्च्चिकामस्तुसौवीरकसुराविकाराम्लफलकट्वरार्कप्रभृतिभिः पित्तं प्रकोपमापद्यते ॥ २४॥
Symptoms of aggravated Pitta : The Pitta is aggravated by anger, grief, fear, fatigue, fasting, acid transformation (reaction) of the assimilated food, or deficient gastric digestion, unnatural sexual indulgence, partaking of a food consisting of pungent, acid or saline, keen, heat making or light substances, as well as of those whose digestion is followed by a reactionary acidity. It is aggravated by the use of sesamum oil, or of sesamum paste. Kulattha, Sarsapa, Atasi, the pot-herbs known as Haritaka, fish, the flesh of a Godha or a goat or mutton may lead to its aggravation, if taken injudiciously.
Similarly, the use of curd, whey, Kurcika, (inspissated milk), Sauviraka, different kinds of wine, Amla-phala (sour fruits), or Katvara (curd mixed with oil) and excessive exposure to the sun, may be followed by the same consequences. 24
तदुष्णैरुष्णकाले च मेघान्ते च विशेषतः ।
मध्याह्ने चार्द्धरात्रे च जीर्य्यत्यन्ने च कुप्यति ॥ २५ ॥
Metrical Texts: In addition to all these, the Pitta is spontaneously and abnormally aggravated in summer, in autumn, at noon, at midnight and during the process of digestion, as well as by the partaking of hot or warm substances. 25
दिवास्वप्नाव्यायामालस्यमधुराम्ललवणस्निग्धगुरुपिच्छिलाभिष्यन्दिहायनकयवकनैषधेत्कटमाषमहामाषगोधूम-तिल-पिष्ट – विकृतिदधिदुग्धकुशरापायसेक्षु-विकारानूपौदकमांसवसाविसमृणालकशेरुकश्रृङ्गाटकमधुर वल्ली-फलसमशनाध्यशनप्रभृतिभिः श्लेष्मा प्रकोपमापद्यते ॥ २६ ॥
Symptoms of the deranged Kapha : The deranged Kapha is aggravated by sleep in the day time, or by the following of lazy or sedentary habits. The partaking of food, composed of substances which are heavy, slimy, sweet, acid or saline in their taste, or of one consisting of substances wich increase the mucous secretions from the fissures of the body, may be likewise set down as aggravating factors. The use of food grains, which are called the Hayanaka, the Yavaka (barley), the Naisadha, the Itkata, the Masa, the Mahamasa, the Godhuma (wheat), the Tila, or of rice cakes may lead to its aggravation. Curd, milk the Krsara, the Payasa (sweetened rice porridge), the various preparations of cane-sugar are things which produce the same result. The flesh of beasts and birds that are aquatic in their habits or live in swampy lands, as well as lard, have the same effect, if used as food. The use of bulbs and lotus stems or of Kaseruka, Srngataka, Madhura-phala, Valli-phala as well as eating before digestion or the partaking of food consisting of both wholesome and un-wholesome substances may aggravate this bodily humour. 26
स शीतैः शीतकाले च वसन्ते च विशेषतः । पूर्व्वाहे च प्रदोषे च भुक्तमात्रे च प्रकुप्यति।।२७।।
Metrical Texts: The Kapha is naturally and spontaneously aggravated in the morning and evening, in Hemanta, and specially in Spring, and just after a meal. Likewise, it is aggravated by the use of cold food or drink, etc. 27
पित्तप्रकोपणैरेव चाभीक्ष्णं द्रवस्निग्धगुरुभिश्चाहारैर्दिवास्वप्न-क्रोधानलातपश्रमाभिघाताजीर्णविरुद्धाध्यशनादिभिरसक् प्रकोपमापद्यते ॥२८॥
Symptoms of the aggravated blood: [Owing to a natural similarity between blood and the Pitta, and through a natural affinity between their attributes], causes, which tend to aggravate the deranged Pitta, tend to aggravate or agitate the blood as well. Moreover, frequent meals or repeated use of food, into the composition of which cool, liquid and heavy substances largely enter, are followed by a disturbed or aggravated condition of the blood. Sleep in the day time, anger, exposure to the glare of the sun or fire, over-fatiguing labour, an external blow, ingestion of indigestible or incompatible substances, and eating before the full digestion of a previous meal, may as well be set down as causes which tend to aggravate blood. 28
यस्माद्रक्तं विना दोषैर्न कदाचित् प्रकुप्यति । तस्मात् तस्य यथादोषं कालं विद्यात् प्रकोपणो ।।२९ ।। तेषां प्रकोपात् कोष्ठतोदसञ्चरणाम्लिकापिपासापरिदाहान्नद्वेषहृदयोत्क्लेदाश्च जायन्ते । तत्र द्वितीयः क्रियाकालः ॥ ३०॥
Metrical Texts: As the bodily humours are never aggravated independently of the blood, their aggravation goes together with a disturbed or agitated condition of the blood. The aggravated condition of the humours gives rise to pain and moves the wind (Vayu) in the bowels; it further occasions acid eructations, thirst, burning sensations, aversion to food, vomiting and nausea. Any of these symptoms should be regarded as the second occasion which calls for medical aid. 29-30
अत ऊर्ध्वं प्रसरं वक्ष्यामः । तेषामेभिरातङ्कविशेषैः प्रकुपितानां पर्युषितकिण्वोदकपिष्टसमवाय इवोद्रिक्तानां प्रसरो भवति, तेषां वायुर्गतिमत्त्वात् प्रसरणरहेतुः सत्यप्यचैतन्ये, स हि रजोभूयिष्ठो रजश्च प्रवर्त्तकं सर्व्वभावानाम् ॥३१॥
Expansion of the deranged humours: Now we shall describe the expansion (Prasara) of the deranged humours. The deranged humours, aggravated by the above mentioned causes, expand and overflow the limits of their respective localities in the same manner as, cakes, soaked in any ferment or enzyme and kept standing over night, ferment and rise through the acquisition of new and unseen attributes. The Vayu, which is possessed of locomotion or extreme mobility, should be looked upon as the cause of their expansion or over-flowing. The Vayu, though an inaminate thing, in reality is possessed of the quality of “Rajas” (creative or cohesive energy), and the quality of the Rajas is the only essential or motive principle in the universe. 31
यथा- महानुदकसञ्चयोऽतिवृद्धः सेतुमवदार्य्यापरेणोदकेन व्यामिश्रः सर्व्वत: प्रधावत्येवं दोषाः कदाचिदेकशो द्विशः समस्ताः शोणितसहिता वाउनेकधा प्रसरन्ति । तद्यथा- वातः, पित्तं, श्लेष्मा, शोणितम्, वातपित्ते, वातश्लेष्माणौ, पित्तश्लेष्माणौ, वातशोणिते, पित्तशोणिते, श्लेष्मशोणिते, वातपित्तशोणितानि, वातश्लेष्मशोणितानि, पित्तश्लेष्मशोणितानि, वातपित्तकफाः, वातपित्तकफशोणितानीत्येवं पञ्चदशधा प्रसरन्ति ॥ ३२॥
As a vast and mighty expanse of water, which has been divided into two expanses by a dam or barrier, will sweep away the latter and unite again to form one sheet of water; so the deranged humours, sometimes singly, sometimes in combination with two or all of their species, or in unison with blood, expand and over-run the organism in all directions. As for example, the Vayu, the Pitta, the Kapha and the blood are singly expanded, whereas the bi-humoural expansions involve the simultaneous overflow of the two deranged humours, or of any deranged humour and blood, as the Vayu and Pitta, Vayu and Kapha, Vayu and blood, Pitta and blood, and Kapha and blood. The tri-humoural expansions, which involve the blood and any two of the deranged and enraged humours, may be classified as the expansion, of (1) the Vayu, Pitta and blood (2) the expansion of the Vayu, Kapha and blood, (3) the expansion of Pitta, Kapha and blood, (4) the expansion of Vayu, Pitta and Kapha, (5) the expansion of Pitta, Kapha and blood, the different types of expansion numbering fifteen in all. 32 कृत्स्नेऽद्धेऽवयवे वाऽपि यत्राङ्गे कुपितो भृशम् ।
दोषो विकारं नभसि मेघवत् तत्र वर्षति ।। ३३ ।।
नात्यर्थं कुपितश्चापि लीनो मार्गेषु तिष्ठति । निष्प्रत्यनीकः कालेन हेतुमासाद्य कुप्यति ॥ ३४ ॥
Metrical Texts: The aggravated, or the abnormally irritated deranged humours, whether permeating the whole or half of the system or restricted to any particular part or member of the body, give rise to disease in the place of their incarceration, like rain clouds pouring down in the quarter of the sky where they are formed. The deranged humours, not excessively (slightly) aggravated, lie inoperative coating the internal passages (Margas) of the body and thus bring about a fresh disease, if subsequently agitated by any disturbing causes. 33-34
तत्र वायोः पित्तस्थानगतस्य पित्तवत् प्रतीकारः, पित्तस्य च कफस्थानगतस्य कफवत्, कफस्य च वातस्थानगतस्य वातवतूः एष क्रियाविभागः । एवं प्रकुपितानां प्रसरताञ्च वायोर्विमार्गगमनाटोपौ, ओषचोषपरिदाहधूमायनानि पित्तस्य, अरोचकाविपाकाङ्गसादाच्छर्द्दिश्चेति श्लेष्मणो लिङ्गानि भवन्ति । तत्र तृतीयः क्रियाकालः ॥ ३५॥
The deranged and aggravated Vayu, having moved into any specific seat of Pitta, should be medicinally treated as a case of Pittaja aggravation. Similarly, the deranged and aggravated Pitta, or Kapha, changing their respective places with each other, should be medicinally treated as the humour in whose location it is found. The Vayu, thus aggravated and expanded, tends to deviate from its right passage and gives rise to a swelling or distention of the abdomen, accompanied by a rumbling sound in the intestines. The Pitta, under the similar condition, gives rise to heat, and a sort of sucking, burning pain in the affected part, together with a sensation of radiation or evaporation of heat from its surface. The Kapha, under the circumstance, would usher in a complete aversion to food, inertness of the limbs, vomiting and impaired digestion. The preceding symptoms, caused by the aggravation and expansion of the bodily humours, should be the third
अत ऊर्ध्वं स्थानसंश्रयं वक्ष्यामः । एवं कुपितास्तांस्तान् शरीरप्रदेशानागत्य तांस्तान् व्याधीन् जनयन्ति । ते यदोदरसन्निवेशं कुर्व्वन्ति तदा गुल्मविद्रध्युदराग्निषङ्गानाहविसूचिकातिसारप्रभृतीन् जनयन्ति, बस्तिगताः प्रमेहाश्मरीमूत्राघातमूत्रदोषप्रभृतीन्, मेढ्रगता निरुद्धप्रकशोपदंशशूकदोषप्रभृतीन्, वृषणगता वृद्धीः । गुदगता भगन्दरार्श:प्रभृतीन्, ऊर्ध्वजत्रुगतास्तूर्ध्वजान्, त्वङ्मांसशोणितस्थाः क्षुद्ररोगान् कुष्ठानि विसपश्च, मेदोगता ग्रन्थ्यपच्यर्बुदगलगण्डालजीप्रभृतीन्, (अस्थिगता विद्रध्यनुशयीप्रभृतीन्), पादगताः श्लीपदवातशोणितवातकण्टकप्रभृतीन् । सर्व्वाङ्गगता ज्वरसर्व्वाङ्गरोगप्रभृतीन् ॥३६॥
Sthana-Samsraya: Now we shall enumerate the names of the peculiar diseases, which are originated by the deranged and expanded humours, incarcerated in the different parts of the body. These humours, confined in the abdomen, give rise to Gulma (abdominal glands) tumours, internal abscesses (Vidradhi), abdominal dropsy, impaired digestion in the bowels, constipation (Anaha), cholera (Visucika) and dysentery.
Lodged in the bladder, these humours usher in Prameha (morbid urethral discharges), Asmari (stone in the bladder) Mutrakncchhra (stricture of the urethra) and Mutraghata (retention of urine), and diseases affecting the renal secretion, etc. Restricted to the penis they tend to bring in syphilis, Niruddha-prakasa (phymosis) and the local inflammatory diseases known as the Suka-dosa, etc.
Similarly, lodged in the region of the anus, these deranged and expanded humours beget fistula in ano, haemorrhoids and polypus growths about that locality. Confined in the region of the scrotum, they give rise to hydrocele and other types of scrotal tumours, etc. Restricted to the region above the clavicles, these humours originate diseases peculiar to that locality, while erysipelas, cutaneous affections (Kustha) and other minor diseases supervene, when they restrict themselves to the flesh and the skin (lymphchyle) and blood. Affecting only the fat, these humours tend to originate Granthi (Aneurism), Apaci (scrofula), Arbuda (tumour), Galaganda (goitre) and Alaji (inflammation of the eye at the edge of the cornea Lodged in the lower extremities, they bring on elephantisis, Vata-Rakta (a kind of leprosy ), Vata-Kantaka, etc. Permeating the whole organism, they give rise to such diseases as fever, Sarvangaroga, etc. which invade the entire system. 36
तेषामेवमभिसन्निविष्टानां पूर्व्वरूपप्रादुर्भावः तं प्रतिरोगं वक्ष्यामः । तत्र पूर्व्वरूपगतेषु चतुर्थः क्रियाकालः ॥३७॥
The aggravated and expanded humours, thus firmly ensconced in the different parts of the body, exhibit the premonitory symptoms of diseases which will be fully dealt with under their respective heads. The manifestation of these premonitory symptoms should be considered as the fourth occasion for medical treatment. 37
अत ऊद्धर्वं व्याधिदर्शनं वक्ष्यामः- शोफार्बुदग्रन्थिविद्रधिविसर्पप्रभृतीनां प्रव्यक्तलक्षणता ज्वरातिसारप्रभृतीनाञ्च ।
तत्र पञ्चमः क्रियाकालः ॥३८॥
Disease-Its Development: Now we shall deal with the full development or manifestation of a disease. The full manifestation of a disease, such as a swelling, tumour, aneurism (Granthi), Vidradhi (abscess) and erysipelas (Visarpa) etc., fever or dysentery, signifies the complete development of the characteristic symptoms, which should be regarded as the fifth occasion for medical treatment. 38
अत ऊर्द्धमेतेषामवदीर्णानां व्रणभावमापन्नानां षष्ठः क्रियाकालः, ज्वरातिसारप्रभृतीनाञ्च दीर्घकालानुबन्धः । तत्राप्रतिक्रियमाणेऽसाध्यतामुपयान्ति ॥३९॥
The Sixth occasion for the calling in of medical aid should be considered to have arisen when a swelling (abscess, tumour, etc.) would burst and exhibit the characteristic symptoms of an open ulcer. A persistent lingering or continuance of a fever or dysentery, etc., should be considered as marking, or forming one of its particular stages, and which may run into one of an incurable type, if neglected or not sufficiently cared for at the outset. 39
1. Additional text: Reaching down and confined in the bone-systems of the body. they produce Vidradhi (abscesses), Anusayi, etc.
भवन्ति चात्रसञ्चयञ्च प्रकोपञ्च प्रसरं स्थानसंश्रयम् । व्यक्तिं भेदञ्च यो वेत्ति दोषाणां स भवेद् भिषक् ॥ ४० ॥
Authoritative verse on the subject: The physician, who fully knows about the accumulation (Sancaya), disturbance or aggravation (Prakopa), expansion (Prasara), and differentiating traits of the deranged humours (Bheda), and is well conversant with the specific localities in which they are respectively confined in the course of their expansion (Sthanasamsraya), and with the symptoms which they respectively exhibit in connection with the incidental disease (Vyakti), is alone worthy of that epithet. 40
सञ्चयेऽपहृता दोषा लभन्ते नोत्तरा गतीः । ते तूत्तरासु गतिषु भवन्ति बलवत्तराः ।।४१ ।।
सर्व्वर्भावैस्त्रिभिर्वाऽपि द्वाभ्यामेकेन वा पुनः । संसर्गे कुपितः क्रुद्धं दोषं दोषोऽनुधावति ।। ४२ ।।
The deranged humours, checked or subdued in their accumulating stage, fail to exhibit any further or subsequent development, but, if left unremedied, they gain in strength and intensity in the course of their further development. The humours, deranged either singly, or in couples, or in a triple combination as regards one or two of their virtues, push on, follow and blend with humours similarly deranged as regards their qualities and combinative numbers. 41-42
संसर्गे यो गरीयान् स्यादुपक्रम्यः स वै भवेत् । शेषदोषाविरोधेन सन्निपाते तथैव च ।।४३ ।।
The medical treatment in a case, where two or all (three) of the deranged humours are involved, consists in conquering the strongest one in the combination, but so as not to enrage or aggravate the minor or the weaker humours in the group and specially so in a case of Sannipata.’ 43
वृणोति यस्मादूढेऽपि व्रणवस्तु न नश्यति । आदेहधारणात् तस्माद् व्रण इत्युच्यते बुधैः ।।४४।।
1. The combination of any two of the bodily humours with the vitiated blood may likewise be interpreted to signify a Sannipatika (trihumoural) combination.
A concourse of deranged humours, affecting and appearing in a particular part of the body, is called a boil or an ulcer (Vrana) which is derived from the root “Vr” to cover and is so called from the fact of its covering a particular part of the body or from its leaving a cicatrix which remains the whole life-time of the patient. 44
इति सुश्रुतसंहितायां सूत्रस्थाने व्रणप्रश्नो नामैकविंशोऽध्यायः ॥२१॥
Thus ends the twenty-first chapter of the Sutrasthana in the Susruta Samhita which treats of investigation into the nature of the humours giving rise to an ulcer.