चतुर्विंशोऽध्यायः । अथातो व्याधिसमुद्देशीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥१॥
Now we shall discourse on the Chapter, which deals with the classification of diseases according to their specific nature (VyadhiSamuddesiya-adhyaya). 1
द्विविधा व्याधयःशस्त्रसाध्याः स्नेहादिक्रियासाध्याश्च । तत्र शस्त्रसाध्येषु स्नेहादिक्रिया न प्रतिषिध्यते । स्नेहादिक्रियासाध्येषु शस्त्रकर्म्म न क्रियते । अस्मिन् पुनः शास्त्रे सर्व्वतन्त्रसामान्यात् सर्व्वेषां व्याधीनां यथास्थूलमवरोधः क्रियते ॥ २ ॥
Diseases may be grouped under two broad subdivisions, such as Surgical, and Medical, that is those that yield to the administration of purgatives, emetics, oils, diaphoretics, and unguents.
The use or administration of medicated oils and unguents, etc., is not prohibited in a surgical disease, while a case, which is exclusively medicinal in its character, does not admit of the adoption of any surgical remedy. Only a general outline of the nature and symptoms of all diseases will be found to have been briefly laid down in the present work. This work includes within its scope subject matters which have been fully dealt with in other books (having only a general bearing upon all the several branches of the science of medicine). 2
प्रागभिहितं तद्दुःखसंयोगा व्याधय इति । तच्च दुःखं त्रिविधम्आ ध्यात्मिकमाधिभौतिककमाधिदैविकमिति॥३॥
तत् तु सप्तविधे व्याधावुपनिपतति । ते पुनः सप्तविधा व्याधयः; तद्यथा-आदिबलप्रवृत्ताः, जन्मबलप्रवृत्ताः, दोषबलप्रवृत्ताः, सङ्घातबलप्रवृत्ताः, कालबलप्रवृत्ता, दैवबलप्रवृत्ताः, स्वभावबलप्रवृत्ता इति ॥४॥
It has been stated before that anything that afflicts either the body or the living personality-self, or both, is called disease. This pain or affliction may be eithe. physical¹ in its character (Adhyatmika), or due to any disturbance in the physical environments of a man (Adhibhautika), or to the acts of God (Adhidaivika) etc. This threefold pain may be ultimately transformed into any of the seven kinds of diseases such as, the Adi-bala-pravrtta, Janma-bala-pravrtta, Dosabala-pravrtta Samghata.bala-pravrtta, Kala-bala-pravitta, Daiva-balapravrtta and Svabhava-bala-pravrtta. 3-4
तत्रादिबलप्रवृत्ता ये शुक्रशोणितदोषान्वयाः कुष्ठार्शः प्रभृतयः; तेऽपिद्विविधाःमातृजाः, पितृजाश्च । जन्मबलप्रवृत्ता ये मातुरपचारात् पङ्गुजात्यन्धबधिरमूकमिन्मिनवामनप्रभृतयो जायन्ते; तेऽपि द्विविधा रसकृताः, दोहृदापचारकृताश्च । दोषबलप्रवृत्ता ये आतङ्कसमुत्पन्ना मिथ्याहाराचारभवाश्च; तेऽपि द्विविधाः- आमाशयसमुत्थाः, पक्वाशयमुत्थाश्च, पुनश्च द्विविधाः – शारीरा, मानसाश्च । एते आध्यात्मिकाः ॥५॥
Adi-bala-pravrtta: The disease termed adi-bala-pravrtta is ascribed to any inherent defect in the semen or the ovum of one’s parent, which forms one of the original and primary factors of “being” and includes leprosy ( Kustha), hemorrhoids, phthisis, etc. This type may be divided into two sub divisions, according as the disease is generated by the deranged paternal or maternal factor at the time of incubation.
Janma-bala-pravrtta: The Congenital or the Janma balapravrtta type usually follows such causes as an improper conduct on the part of the mother during the period of gestation, etc., and embraces such defects or maladies as (congenital) blindness, deafness,
1. Cenain commentators interpret the term “Atman”in “Adhyatmika” to mean body only, and accordingly designate all phenomena that may be manifest in the body as Adhyatmika.
dumbness, nasal-voice, and such monstrous aberrations of nature as congenital cretinism, and the births of dwarfs and pigmies. This type, in its turn, admits of two sub-divisions, according as the disease is due to the action of the deranged lymph-chyle (Rasa-krta), or to an ungratified desire of the mother during gestation, or to her gratification of any improper longing or conduct during pregnancy (Dauhrdya).
Dosa-bala-pravrtta : The Dosa-bala-pravrtta (idiopathic) type is due to the action of any of the fundamental bodily humours deranged by an improper diet, or resulting from the dynamical energies of the mind, such as ( Rajas and Tamas, etc.). This type may be classified under two sub-heads, according as the disease is found to have its origin in the Amasaya (stomach) or in the Pakvasaya (intestines), and each of these again-may be further divided into two main subdivisions such as the physical and the mental. The three preceding kinds of diseases include within their category disorders which are called mental or psychical (Adhyatmika). 5
सङ्घातबलप्रवृत्ता ये आगन्तवो दुर्बलस्य बलवद्विग्रहात्; तेऽपि द्विविधाः – शस्त्रकृता, व्यालकृताश्च । एते आधिभौतिकाः ॥६॥
Samghata-bala-Pravrtta : The Traumatic type ( Sanghatabala-pravrtta) includes diseases that are caused by an external blow or are due to wrestling with an antagonist of superior strength. They may be sub-divided into minor divisions, according as the disease is due to an external wound, or to the bite from any fierce beast or poisonous reptile, etc. These types belong to the Adhibhautika type, i.e. (brought about by physical causes. 6
कालबलप्रवृत्ता ये शीतोष्णवातवर्षाप्रभृतिनिमित्ताः। तेऽपि द्विविधाःव्यापनर्त्तुकृताः, अव्यापनर्त्तुकृताश्च । दैवबलप्रवृत्ता ये देवद्रोहादभिशप्तका आथर्व्वणकृता उपसर्गजाश्च; तेऽपि द्विविधाःविद्युदशनिकृताः, पिशाचादिकृताच, पुनच द्विविधाः- संसर्गजा, आकस्मिकाश्च। स्वभावबलप्रवृत्ताः क्षुत्पिपासाजरामृत्युनिद्राप्रभृतयः; तेऽपि द्विविधाःकालकृता, अकालकृताश्च । तत्र परिरक्षणकृताः कालकृताः, अपरिरक्षणकृता अकालकृताः । एते आधिदैविकाः । अत्र सर्व्वव्यांध्यवरोधः ॥७॥
Kala-bala-pravrtta: The Periodical type (Kala-bala-pravrtta) includes diseases that are brought about by the variation of atmospheric heat or humidity with the change of the seasons, and admits of being grouped under two different sub-heads, according as the seasons, which usher these changes in, exhibit natural or contrary features.
Daiva-bala-pravrtta : The Providential (Daiva-bala-pravrtta) type includes diseases that are the embodiments of curses, divine wrath or displeasure, or are brought about through the mystic potencies of charms and spells, as described in the Atharva-Veda. This type may be divided into two minor divisions according as the disease is due to such acts of God as when a man is struck by lightning, etc., or to the malignant influences of demons and monsters, and these may be further grouped under two main sub-heads, according as the disease assumes a contagious character (epidemic), or is purely accidental, and restricts itself to isolated cases (sporadic).
Svabhava-bala-pravrtta: The Natural or the Spontaneous (Svabhava-bala-pravrtta) type includes such natural organic phenomena as, decrepitude, death,’ hunger, thirst, sleep, etc. These phenomena are either Kalakrta (timely) or Akalakrta (untimely). They are called Kalakrta when they occur at the proper time in persons who strictly observe the rules of health, and Akalakrta, when they appear at the improper time (morbid or premature) as the effect of unhealthy living. These diseases belong to the Providential or Adhi-daivika type.² Thus we have classified diseases into their several types. 7
सर्व्वेषाञ्च व्याधीनां वातपित्तश्लेष्माण एव मूलम् तल्लिङ्गत्वाद् दृष्टफलत्वादागमाच्च । यथा हि कृत्स्नं विकारजातं विश्वरूपेणावस्थितं सत्त्वरजस्तमांसि न व्यतिरिच्यन्ते, एवमेव कृत्स्नं विकारजातं विश्वरूपेणावस्थितमव्यतिरिच्य वातपित्तश्लेष्माणो वर्त्तन्ते । दोषधातुमलसंसर्गायतनविशेषान्निमित्ततश्चैषां विकल्पा भवन्ति । दोषदूषितेष्वत्यर्थं धातुषु संज्ञा क्रियते – रसजोऽयं, शोणितजोऽयं, मांसजोऽयं, मेदोजोऽयं,
1. According to certain authorities “Death” may also mean death of tissues.
2. Several authorities on the other hand include such diseases as thirst, hunger, etc., within the Adhyatmika class inasmuch as they are but the indications of the want of certain vital principles in the body and appear in the mental plane (Adhyatmika) only as longings for water, food, etc.
अस्थिजोऽयं, मज्जजोऽयं, शुक्रजोऽयं, व्याधिरिति ॥८॥
The deranged bodily humours such as, Vayu, Pitta and Kapha should be looked upon as the primary sources of all diseases, inasmuch as symptoms characteristic of each of them may be detected in the case of a disease of whatsoever type, (which usually abates with their corresponding subsidence), and also because the Sastras have ascribed to them the fatherhood of all maladies that assail the human frame.
As the three qualities of Sattva, Rajas and Tamas¹ are inherent in, and inseparable from, all the phenomenal appearances in the universe which are, in reality, but modifications of their own qualities, so the three fundamental bodily humours underlie at the root of, and run through, the course of all known forms of bodily distemper.
The deranged bodily humours (Dosa) in contact with the different elements, (Dhatu) and excrements (Mala) of the body, together with the difference of their locations and pathological effects, give rise to the different forms of disease.²
The nomenclature of disease depends upon where the affection of the several elementary principles of the body by the deranged bodily humours lies, and which is accordingly styled as it is seated in the lymph-chyle, or in the blood or the flesh, or it is in fat, bone, or in the semen. 8
तत्रान्नाश्रद्धारोचकाविपाकाङ्गमईज्वरइल्लास-तृप्तिगौरवहृत्पाण्डुरोग-मार्गोपरोध कार्यवैरस्याङ्गसादाकालजवलिपलितदर्शनप्रभृतयो रसदोषजा विकाराः ।।९।।
Rasaja Distempers: Distempers such as aversion to, and loss of relish for food, indigestion, aching in the limbs, fever, nausea and a sense of repletion even without food, heaviness of the limbs, diseases affecting the heart, jaundice, construction of any internal passage of the body (Margoparodha), emaciation of the body
1. The Sattva: Illuminating or psychic principle. Rajas: Principle of Action and Co-hesion. Tamas: Principle of Nescience or Illusion.
2. This answers the question, “How can the deranged bodily humours bring about a disease of the Adi-bala-type-a disease which is specifically due to the derangement of the innate and primary factors of life.” ( cachexia), bad taste in the mouth, weak feelings in the limbs, premature whiteness and falling off of the hair, and symptoms indicative of senile decay, should be regarded as having their seat in the deranged lymph-chyle (Rasa). 9
कुष्ठविसर्पपिडकामशकनीलिकातिलकालकन्यच्छव्यङ्गेन्द्रलुप्तप्लीहविद्रधिगुल्मवातशोणितार्शोऽर्बुदाङ्गमर्दासग्दररक्तपित्तप्रभृतयो रक्तदोषजा गुदमुखमेढ्रपाकाश्च ।।१०।।
Raktaja Diseases: Maladies such as Kustha (cutaneous affections in general), Visarpa (erysipelas), Pidaka (pustular eruptions), Masaka, Nilika, Tilakalaka (specks), Nyachha (tans), Vyanga (stains), Indralupta (alopecia), enlarged-spleen, Vidradhi (abscess), Gulma (abdominal glands), Vata-sonita ( a kind of leprosy ), Arsa (piles), Arbuda (tumours), aching of the limbs, menorrhagia, haemoptysis, etc. as well as suppuration in the regions of the anus and the penis should be deemed as having their origin in the blood (Raktaja) contaminated by the deranged bodily humours. 10
Mansaja-Diseases: Similarly Adhi-mansa, Arvbda, Arsa, Adhijihva, Upa-jihva, Upakusa, Gala-sundika, Alaji Mansa-sanghata (condylomatous growth), Ostha-prakopa, Gala-ganda, Ganda-mala (scrofula), etc. should be regarded as diseases having their seat in the flesh, vitiated by the deranged bodily humours. 11
ग्रन्थिवृद्धिगलगण्डार्बुदमेदोजोष्ठप्रकोपमधुमेहातिस्थौल्यातिस्वेदप्रभृतयो मेदोदोषजाः ।। १२ ।।
Medaja-Distempers: Diseases, such as Granthi, Vrddhi, Galaganda, Arbuda, and Ostha-prakopa are due to the action of the deranged fat. Madhu-meha (diabetes), obesity and abnormal diaphoresis, etc. should be regarded as having their origin in the humour deranged fat of the body. 12
Asthija-Disease: Adhyasthi, Adhi-danta, Asthi-toda, Asthisula and Ku-nakha, etc. are the diseases which should be regarded as the outcome of the deranged bodily humours affecting the bones. 13 तमोदर्शनमूर्च्छाभ्रमपर्व्वस्थूलमूलारुर्जन्मनेत्राभिष्यन्दप्रभृतयो मज्जदोषजाः ।।१४।।
Majjadosaja Diseases: The vanishing of sight, epilepsy, vertigo, conjunctivities and the appearance of a broad-based ulcer about the Parvasthanam and a sense of heaviness in the thighs and knee-joints should be regarded as having their seat in the deranged marrow. 14
क्लैव्याप्रहर्षशुक्राश्मरीशुक्रमेहशुक्रदोषादयश्च तद्दोषजाः । ॥ १५ ॥
sukra-dosaja : Diseases such as, impotency, entire aversion to sexual intercourse, sukrasmari (seminal concretions), Spermatorrhoea, and other seminal affections, should be regarded as having their seat in the deranged semen. 15
त्वग्दोषाः सङ्गोऽतिप्रवृत्तिरयथाप्रवृत्तिर्वा मलायतनदोषाः । इन्द्रियाणामप्रवृत्तिरयथाप्रवृत्तिर्वेन्द्रियायतनदोषाः । इत्येवं समास उक्तः, विस्तरं निमित्तानि चैषां प्रतिरोगं वक्ष्यामः ॥१६॥
Cutaneous affections, constipation or looseness of the bowels, and diseases impeding or arresting the proper functions of the senseorgans or in any way bringing about their aberrations, should be regarded as respectively located in the receptacle of the faeces and the sense organs.
Thus we have briefly enumerated the names of diseases, the specific nature and symptoms of which will be fully discussed later on under their respective heads. 16
भवति चात्र । कुपितानां हि दोषाणां शरीरे परिधावताम् । यत्र सङ्गः, खवैगुण्याद् व्याधिस्तत्रोपजायते ।।१७।।
Authoritative verse on the Subject: The deranged and aggravated humours, freely coursing through the body, give rise to a disease at the place in which they are incarcerated owing to an obstruction in their natural passage. 17
भूयोऽत्र जिज्ञास्यम्- किं वातादीनां ज्वरादीनाश्च नित्यः संश्लेष: परिच्छेदो वा इति ? यदि नित्यः संश्लेष: स्यात् तर्हि नित्यातुराः सर्व्व एव प्राणिनः स्युः; अथाप्यन्यथा वातादीनां ज्वरादीनाञ्चान्यत्र वर्त्तमानानामन्यत्र लिङ्गं न भवतीति कृत्वा यदुच्यते वातादयो ज्वरादीनां मूलानीति, तन्न ।।१८।।
Now it may be again asked, whether the relation of a disease, such as fever, etc. with the deranged bodily humours is constant and inseparable, or otherwise. All human beings would be in danger of perpetually falling ill in the event of the said connection (relation) being constant and unseparable; but in case of their separate existence, it is but natural that their characteristic symptoms should separately manifest themselves instead of being simultaneously present with fever, etc. as they are found to be in reality. And accordingly the theory, that diseases (such as, fever, etc.) and the deranged bodily humours have a separate existence and are not prima facie intimately co-related with one another falls to the ground. On the other hand, the assumption of their separate existence invalidates the incontestable conclusion, that diseases such as, fever, etc. are fathered by the deranged humours of the body. 18
अत्रोच्यते-दोषान् प्रत्याख्याय ज्वरादयो न भवन्ति, अथ च न नित्यः सम्बन्धः;-यथा हि विद्युद्वाताशनिवर्षाण्याकाशं प्रत्याख्याय न भवन्ति, सत्यप्याकाशे कदाचिन्न भवन्ति, अथ च निमित्ततस्तत एवोत्पत्तिरिति । तरङ्गबुद्बुदादयश्चोदकविशेषा एव । वातादीनां ज्वरादीनाश्च नाप्येवं संश्लेषो न परिच्छेदः शाश्वतिकः अथ च निमित्तत एवोत्पत्तिरिति ॥९१॥
Hence it may be safely asserted that no disease can occur without the direct mediation or intervention of the deranged bodily humours. Yet the connection (relation) which exists between the two is neither constant nor separable. As the physical phenomena of lightning, storm, thunder and rain can not happen independently of the sky (cloud); and yet they sometimes do or do not occur with the presence of a cloud; again as bubbles, though in reality but the modifications of the underlying water, do not swell up on its surface at all times, so the connection between a disease and the bodily humours is neither universally separable or inseparable. 19
भवति चात्र विकारपरिमाणञ्च सङ्ख्या चैषां पृथक् पृथक् । विस्तरेणोत्तरे तन्त्रे सर्व्वाबाधाश्च वक्ष्यते ।।२०।।
Authoritative verse on the subject: We shall describe the nature, intensity and quality of diseases with their complications and give the number of their different types. Diseases [omitted to be mentioned in the chapter on Nidana (aetiology)] will be found fully dealt with in the supplementary part of the present work (Uttaratantra). 20
इति सुश्रुतसंहितायां सूत्रस्थाने व्याथिसमुद्देशीयो नाम चतुर्विंशोऽध्यायः ॥२४॥
Thus ends the twenty-fourth Chapter of the Sutrasthana in the Susruta Samhita which treats of the classification of diseases according to their specific nature.