The commentary asks why the number six is explicitly stated when the listed categories already total six. It answers that the number prevents additional types produced by pairs of doṣas from being counted separately. Although vāta and the other doṣas acting in the site of blood initiate the blood-associated form, it is conventionally called 'born of blood,' just as something burned by fire supported by ghee may be called 'ghee-burned.'
Key terms
ShaDarshAMsi (ṣaḍ-arśāṃsi)
The six classified forms of arśas.
shoNitajAni (śoṇita-jāni)
The form conventionally described as arising from blood.
In people lacking self-restraint, doṣas may be provoked singly, in pairs, together, or with blood by factors such as incompatible or excessive eating, excessive sexual activity, prolonged squatting, riding, and suppression of natural urges. Spreading through the principal channels and descending to the rectum, they are said to disturb the folds there and produce fleshy outgrowths, especially in those with weak digestive activity. Contact or injury from grass, wood, stone, clods, cloth, and similar objects, or contact with cold water, is also said to enlarge pre-existing swellings. These growths are called arśas.
The commentary supplies the etiological sequence: provoked doṣas produce fleshy growths. Anātmavat is glossed as a person whose senses are uncontrolled. Previously described provocations include struggle with stronger persons, anger, grief, daytime sleep, and others. The prefix in strīprasaṅga conveys extreme attachment or excess. Utkaṭukāsana is explained as squatting with the anus and heels in contact, popularly called ukuḍu, while pṛṣṭhayāna means travel on the back of a horse or similar animal. Suppression includes urges for flatus, feces, and urine. Viruddhāśana is extended to heavy, cold, channel-clogging, burning, unaccustomed, and improperly measured food. The doṣas spread as described earlier, enter the feces-carrying principal vessels, descend to the rectum, disturb its skin folds, and particularly in weak digestion form outgrowths. The final term is attributed to earlier teachers.
Key terms
viruddhAshana (viruddhāśana)
Eating regarded as incompatible or otherwise unsuitable in the classical framework.
adhyashana (adhyaśana)
Eating again before the preceding meal is digested or excessive superimposed eating.
utkaTukAsana (utkaṭukāsana)
A prolonged squatting posture with heels near the anal region, as explained here.
vegavidhAraNa (vega-vidhāraṇa)
Suppression of natural urges such as flatus, stool, or urine.
The rectum, attached to the large intestine, is described as four and a half aṅgulas long. Within it are three ring-like folds—pravāhaṇī, visarjanī, and saṃvaraṇī—arising at intervals of one and a half aṅgulas and together extending four aṅgulas. Each is transversely raised by one aṅgula. They lie one above another like the spiral of a conch and are compared in color to an elephant's palate. The anal lip is described as extending half an aṅgula inward from the end of the surrounding hair.
The commentary identifies sthūlāntra as the pelvic or rectal intestine commonly called gudāntra and interprets ardha-pañcāṅgula as four and a half aṅgulas. The folds are separated by one and a half aṅgulas. It reconstructs the two upper folds as each one and a half aṅgulas including its interval, the first fold as one aṅgula without an interval, and the anal lip as half an aṅgula. This supports the later statement that the first fold lies one aṅgula from the anal lip. Their names indicate functions: pravāhaṇī drives material onward, visarjanī releases it, and saṃvaraṇī closes or retains it. The anal-lip measurement begins at the margin of the ring of hair; one and a half barley grains are taken as half an aṅgula because an aṅgula is reckoned as three barley grains.
Key terms
guda
The rectal and anal region described in this passage.
pravAhaNI (pravāhaṇī)
The fold named for propelling contents onward.
visarjanI (visarjanī)
The fold named for expelling or releasing contents.
saMvaraNI (saṃvaraṇī)
The fold named for closing or retaining contents.
a~ggula (aṅgula)
A traditional finger-breadth unit whose exact modern value is not fixed here.
Adhikarana ૫ (૭) · Śloka ૭
પ્રથમા તુ ગુદૌષ્ઠાદઙ્ગુલમાત્રે ||૭||
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प्रथमा तु गुदौष्ठादङ्गुलमात्रे ||७||
Meaning of the śloka
The first rectal fold is situated one aṅgula from the anal lip.
Before arśas becomes manifest, the text lists reduced desire for food, difficult digestion, sour belching, burning, constipation or obstruction, thirst, weakness of the thighs, abdominal distension and sounds, weight loss, frequent belching, swelling around the eyes, intestinal rumbling, cutting pain in the anal region, concern that pāṇḍuroga, grahaṇī disorder, or wasting disease may be developing, cough, dyspnea, loss of strength, dizziness, drowsiness, sleep disturbance, and weakness of the senses.
The commentary says these are prodromal signs of a condition about to arise. Amlikā means sour eructation; sakthisadana is fatigue or weakness of the thighs, though some understand it as a splitting-like sensation; and āṭopa means abdominal inflation. Āśaṅkā means a suspected or indeterminate resemblance to pāṇḍuroga, grahaṇī disorder, and śoṣa. The verb 'arise' is supplied for cough, dyspnea, dizziness, drowsiness, sleep, and sensory weakness.
Key terms
pUrvarUpa (pūrvarūpa)
A prodromal sign appearing before a disease is fully manifest.
amlIkA (amlikā)
Sour belching or acid eructation.
viShTambha (viṣṭambha)
Obstruction or constipation in this context.
gudaparikartana (guda-parikartana)
A cutting type of pain in the anal region.
Asha~gkA (āśaṅkā)
Suspicion or uncertain resemblance to another disorder.
In the vāta-associated form, the growths are dry, reddish or variably colored, and uneven at the center. Their shapes are compared with kadamba flowers, tuṇḍikerī flowers or tubes, buds, and needle points. The affected person passes compact stool with pain and experiences pain in the waist, back, flanks, genital region, anus, and navel. Gulma, aṣṭhīlā, enlargement of the spleen, and abdominal disease are said to arise as complications. The person's skin, nails, eyes, teeth, mouth, urine, and feces become dark.
The commentary explains dry as non-discharging, aruṇa as slightly red, and varied color literally as having different colors. Viṣamamadhya is read as uneven, with depressed and raised centers. Some instead read viṣamadhyāma: uneven in relief and dark like a burned brick. One interpretation identifies tuṇḍikerī as wild cotton and compares the growth to its flower. Another reads a sequence comparing them with the mouth of a tuṇḍikerī tube, a flower bud, and a sewing needle; in that explanation tuṇḍikerī is bimbī. The patient is made to pass dense stool painfully. Gulma and the other listed disorders are presented as complications caused by this condition.
Key terms
vAtArshas (vātārśas)
The vāta-associated form of arśas.
parishuShka (pariśuṣka)
Very dry and, according to the commentary, non-discharging.
viShamamadhya (viṣama-madhya)
Having an uneven, raised-and-depressed center; a variant reads viṣamadhyāma.
tuNDikerI (tuṇḍikerī)
A plant identified alternatively as wild cotton or bimbī in the shape comparisons.
aShThIlA (aṣṭhīlā)
A classical hard abdominal or pelvic mass-like disorder.
Pitta-type arśas are described as thin, spreading growths with dark-blue tips and a yellow appearance. Their shapes are compared with liver, a parrot’s tongue, barley grains thick in the middle, or the curved mouth of a leech, and they are moist or discharging. The affected person passes stool with burning and blood and may develop fever, burning, thirst, and fainting. The skin, nails, eyes, teeth, mouth, urine, and stool are described as becoming yellow.
The commentary explains visarpin as tending to spread. Saṃsthāna means shape. ‘Barley-centred’ means thick in the middle and thin at the base and tip. Praklinna means moist and producing discharge.
Key terms
pittaja arshas (pittaja arśas)
Arśas classified as arising from predominance of pitta.
visarpin
Spreading or tending to extend.
yavamadhya (yava-madhya)
Barley-shaped: thick in the middle and thin at both ends.
श्लेष्मजानि श्वेतानि महामूलानि स्थिराणि वृत्तानि स्निग्धानि पाण्डूनि करीरपनसास्थिगोस्तनाकाराणि, न भिद्यन्ते न स्रवन्ति कण्डूबहुलानि च भवन्ति; तैरुपद्रुतः सश्लेष्माणमनल्पं मांसधावनप्रकाशमतिसार्यते, शोफशीतज्वरारोचकाविपाकशिरोगौरवाणि चास्य तन्निमित्तान्येव भवन्ति, शुक्लत्वङ्नखनयनदशनवदनमूत्रपुरीषश्च पुरुषो भवति ||१२||
Meaning of the śloka
Kapha-type arśas are described as pale or white, broad-based, firm, round, unctuous, and greyish. Their shapes are compared with karīra, jackfruit seed or fruit structures, and a cow’s teat. They do not split or discharge and are very itchy. The affected person passes a large quantity of stool containing mucus and resembling water in which meat has been washed. Associated features include swelling, fever with predominant coldness, lack of appetite, indigestion, and heaviness of the head; the skin, nails, eyes, teeth, mouth, urine, and stool are described as becoming pale or white.
The commentary glosses sthira as hard and pāṇḍu as greyish. Karīra is a tree growing extensively in arid regions. Panasa is jackfruit, known for its externally spiny fruit, and the lesion shape is compared with its fruit. Analpa means abundant. Śīta-jvara is fever in which coldness predominates.
Key terms
shleShmaja arshas (śleṣmaja arśas)
Arśas classified as arising from predominance of kapha.
mahAmUla (mahā-mūla)
Having a broad or large base.
pANDu (pāṇḍu)
Pale or greyish in this description.
mAMsadhAvanaprakAsha (māṃsa-dhāvana-prakāśa)
Resembling water used to wash meat, a simile for mucus-rich stool.
Blood-origin arśas resemble shoots of the banyan tree, coral, or the fruit of kākaṇantikā and also display pitta-type features. When compressed by hard, impacted stool, they suddenly discharge a large amount of severely affected blood. If bleeding becomes excessive, complications of major blood loss occur.
The commentary identifies the banyan shoot and coral comparisons. Kākaṇantikā is identified as guñjā, locally called cirihiṇṭikā, while others identify it as kākādanī. The conjunctive wording also includes unstated secondary signs of vāta and kapha. Complications of excessive blood loss include ākṣepaka and related conditions.
Key terms
raktaja arshas (raktaja arśas)
Arśas classified as arising from affected blood.
avagADhapurISha (avagāḍha-purīṣa)
Hard or impacted stool that compresses the growths.
shoNitAtiyoga (śoṇitātiyoga)
Excessive loss or discharge of blood.
kAkaNantikA (kākaṇantikā)
A plant-fruit comparison identified differently as guñjā or kākādanī.
Adhikarana ૧૨ (૧૪) · Śloka ૧૪
સન્નિપાતજાનિ સર્વદોષલક્ષણયુક્તાનિ ||૧૪||
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सन्निपातजानि सर्वदोषलक्षणयुक्तानि ||१४||
Meaning of the śloka
Sannipāta-type arśas possess features belonging to all the doṣas.
Jejjaṭa explains this as the presence of signs found among all types of arśas. Gayadāsa reads ‘sannipāta-born lesions have all signs’ and explains that they display the characteristic forms and actions of vāta, pitta, and kapha.
Key terms
sannipAtaja (sannipātaja)
Arising from the combined involvement of all three doṣas.
sarvadoShalakShaNa (sarva-doṣa-lakṣaṇa)
Signs associated with all the doṣas.
svabhAvakarma (svabhāva-karma)
The characteristic nature and actions attributed to each doṣa.
Congenital arśas are attributed to affected parental reproductive blood and semen, and their assessment or management is to be determined from the responsible doṣa. They are described as difficult to see, rough, greyish, severe, and inward-facing. The affected person is thin, eats little, has prominent veins, few offspring, diminished reproductive strength, a weak voice, irritability, weak digestion and vitality, and marked lethargy. The person is also described as having disorders of smell, head, eyes, nose, and hearing, and as continually troubled by intestinal sounds, gurgling, distension, a coated or burdened feeling in the heart region, poor appetite, and related symptoms.
The commentary distinguishes the cause of congenital lesions from doṣa-produced arśas. Only the portion of the reproductive seed forming the fetal anal region is said to be affected; if the whole seed were affected, conception could not occur. One interpretation of ‘prasādhana according to doṣa’ is diagnostic: determine the responsible doṣa through its signs, colour, pain, and form in the affected semen and blood. Another interpretation makes prasādhana treatment selected after examining doṣa signs. Durdarśana means difficult to visualize, like an internal abscess; pāṃsu means greyish, and dāruṇa means extremely distressing.
Key terms
sahaja arshas (sahaja arśas)
Arśas described as congenital or present from birth.
duShTashoNitashukra (duṣṭa-śoṇita-śukra)
Affected parental reproductive blood and semen in the classical etiological account.
prasAdhana (prasādhana)
Interpreted either as diagnostic ascertainment or as treatment according to the doṣa.
antar mukha (antar-mukha)
Facing or opening inward.
ATopa (āṭopa)
Abdominal gurgling or distension in this symptom list.
A skilled physician should treat arśas situated in the outer and middle folds. For lesions arising from the innermost fold, treatment should be undertaken only after explaining that the condition is regarded as incurable.
The commentary says this verse gives prognosis according to anatomical location. Antarvali means the innermost fold. Pratyākhyāya means first declaring or communicating that these arśas are considered incurable before proceeding with intervention.
Key terms
bAhyavali (bāhya-vali)
The outer anal fold in the text’s anatomical arrangement.
madhyavali (madhya-vali)
The middle anal fold.
antarvali (antar-vali)
The innermost anal fold.
pratyAkhyAya (pratyākhyāya)
After communicating the grave or historically incurable prognosis.
When aggravated doṣas settle in the penis, they affect flesh and blood and cause itching. Scratching creates a wound, from which abnormal fleshy sprouts arise that discharge sticky blood and bear fine, elongated projections, either on the glans or outer skin. These can damage the penis and impair reproductive or sexual function. When doṣas settle in the vagina, they produce delicate, foul-smelling, umbrella-shaped sprouts discharging sticky blood; these damage the vagina and affect menstruation. At the navel they produce delicate, foul-smelling, sticky sprouts compared with the mouth of an earthworm. The same doṣas moving upward can produce arśas in the ears, eyes, nose, and mouth. Ear lesions are associated with impaired hearing, pain, and foul discharge; eye lesions with eyelid obstruction, pain, discharge, and loss of vision; nasal lesions with severe rhinitis, repeated sneezing, difficult breathing, foul nasal discharge, nasal speech, and headache; and oral lesions in the throat, lips, or palate with broken or indistinct speech, loss of taste recognition, and other mouth disorders.
The commentary explains arśas outside the anal region. Abhiprapanna means that doṣas have taken residence. Kūrcakin lesions have clusters of fine, long projections; internally they occur on the glans and externally on the skin. Puṃstva includes semen and male sexual characteristics. In the vaginal and umbilical descriptions, the understood subject is again the doṣas, and karīra means sprouts. The same doṣas are then said to generate lesions in the ears, eyes, nose, and mouth. Vartman is the eyelid; kṣavathu is sneezing. In the oral group, ‘one of these places’ means the throat, lip, or palate where arśas have arisen.
The commentary identifies this as charmakila, an arshas situated in the skin. Bahih primarily means outside the lip of the anus; others say that it may also mean elsewhere on the body. Kilavat means shaped like a peg or spike.
Key terms
carmakIla (charmakila)
A firm, peg-like skin lesion classified here among arshas.
vyAna (vyana)
A subtype of vata described here as aggravated.
shleShman (shleshman)
Kapha, said here to be taken up by aggravated vyana.
kIlavat (kilavat)
Resembling a peg or spike.
bahiH (bahih)
Outside the anal margin in the main interpretation, or elsewhere according to another view.
In these charmakilas, piercing pain is attributed to maruta. Shleshma is associated with similarity of color and a nodular form. Dryness, dark coloration, smoothness, and pronounced hardness are described in relation to pitta and shonita. These are the distinguishing features of charmakila according to dosha involvement.
The commentary sets out dosha-specific signs of charmakila. Savarnatva is explained as having a color similar to shleshma, and granthitva as a nodular form. It assigns the features beginning with dryness to pitta and blood. Samudirnakharatva is explained as extreme hardness. The closing statement says these are signs distinguished according to vata and the other doshas. Some textual traditions omit this entire description of dosha signs in charmakila.
Key terms
nistoda
A piercing or pricking type of pain.
savarNatva (savarnatva)
Similarity of color, explained here in relation to shleshma.
granthitva
A knotted or nodular form.
raukShya (raukshya)
Dryness.
samudIrNakharatva (samudirnakharatva)
Pronounced roughness or, according to the commentary, extreme hardness.
The commentary extends earlier dosha-based features to arshas arising at sites such as the genitals. Apart from the specific vata and other dosha signs, the general features stated briefly are to be determined from the earlier detailed account. Sadhayet may mean either 'should know or determine' or 'should treat.' Gayadasa understands the instruction as consulting the earlier detailed signs of each dosha type of arshas. Others distinguish six types in the concise account and fifteen modes of spread in the detailed earlier account, from which the physician should make the determination.
Key terms
arshas
The classical lesion or disease category discussed in this chapter.
sAmAnyalakShaNa (samanyalakshana)
General features shared by the condition.
vyAsa (vyasa)
Detailed exposition.
sAdhayet (sadhayet)
May mean should determine or know, or alternatively should treat.
atidesha
Extension or application of an earlier rule to the present cases.
The commentary introduces samsarga within the sixfold discussion of arshas for the purpose of planning medicines. It lists six pairings: vata-pitta, vata-shleshma, pitta-shleshma, vata-shonita, pitta-shonita, and shleshma-shonita. Their signs are to be understood from the features of wound pain described in the Sutrasthana.
Key terms
saMsarga (samsarga)
Combined manifestation of signs belonging to two factors.
doShadvaya (doshadvaya)
A pair of doshas or causal factors.
ShaDvidha (shadvidha)
Sixfold.
vraNavedanAlakShaNa (vranavedanalakshana)
Features of wound pain used by the commentary to distinguish the combinations.
Arshas involving all three doshas but showing only slight signs, those arising from two doshas, and those situated in the second fold are described within the yapya category. Those persisting for about a year are said to be difficult to cure. Arshas arising from sannipata and those present from birth should be abandoned as unsuitable for curative treatment.
The commentary explains prognosis among arshas classified as manageable but persistent, difficult to cure, and incurable. Dvandvaja means arising from two doshas, and the commentator states that these too are yapya. Parisamvatsara means having remained for approximately a full year and is assigned to the difficult-to-cure group. Some begin an alternative reading at 'sannipatasamutthani,' but the complete version was unavailable and therefore was not recorded.
Key terms
yApya (yapya)
Manageable or controllable but not presented as readily curable in the classical prognosis.
When all the anal folds are affected by arshas, apana vayu is obstructed by them and cannot move outward. Joining with vyana, it is then said to weaken the person's digestive fire.
The commentary describes the serious consequence of arshas occupying all the folds. Durnama here means arshas. The obstructed apana becomes fixed and does not pass outward; after combining with vyana, it diminishes jyotis, interpreted as the fivefold agni. This complication is said to occur especially in congenital arshas.
Key terms
sarvavalI (sarvavali)
All of the anal folds.
durnAma (durnama)
A euphemistic designation for arshas.
apAna vAyu (apana vayu)
The form of vayu governing downward outward movement in the classical account.
vyAna (vyana)
A form of vayu said here to combine with obstructed apana.
jyotis
The fivefold digestive fire or agni in the commentary.
Adhikarana પુષ્પિકા · Śloka ૨
ઇતિ સુશ્રુતસંહિતાયાં નિદાનસ્થાનેઽર્શોનિદાનં નામ દ્વિતીયોઽધ્યાયઃ ||૨||
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इति सुश्रुतसंहितायां निदानस्थानेऽर्शोनिदानं नाम द्वितीयोऽध्यायः ||२||
Meaning of the śloka
Thus ends the second chapter of the Nidanasthana in the Sushruta Samhita, entitled Arshonidana, the diagnosis of arshas.
The commentary colophon states that the second chapter of the Nidanasthana is complete in Acharya Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
arshonidAna (Arshonidana)
The chapter on the causes and diagnostic description of arshas.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.