The Sūtrasthāna briefly supplied the foundations for knowing causes, signs, and treatment; the later sections expand them. Nidānasthāna begins because it states the causes and features of diseases relevant to surgery. Vāta disorders, such as ākṣepaka, are discussed first because vāta is considered foremost among the doṣas. Here nidāna includes both cause and defining signs. The commentary says this opening formula should be understood after the later phrase 'the best of physicians spoke,' because students who have neither approached nor requested instruction from a teacher are not entitled to the exposition.
धन्वन्तरिं धर्मभृतां वरिष्ठममृतोद्भवम् |
चरणावुपसङ्गृह्य सुश्रुतः परिपृच्छति ||३||
वायोः प्रकृतिभूतस्य व्यापन्नस्य च कोपनैः |
स्थानं कर्म च रोगांश्च वद मे वदतां वर ||४||
Meaning of the śloka
Sushruta respectfully takes the feet of Dhanvantari, foremost among the upholders of dharma and born with amṛta, and asks: 'Best of teachers, tell me the locations, functions, and diseases of vāyu in its normal state and when disturbed, together with the factors that provoke it.'
The commentary identifies Dhanvantari as the speaker and explains the respectful gesture as falling at his feet. Normal vāyu is that which remains in its natural condition; disturbed vāyu is altered. Provoking factors are substances, qualities, and activities similar to vāyu. The normal locations include the pelvis and rectum, whereas disturbed vāyu can occupy the whole body. Its functions are both general and specific, and its diseases include hiccup, dyspnea, and others. Some read bhūpate instead of kopanaiḥ, making it an address to Dhanvantari, and some read vadasva for vada me. Some omit 'function' and read 'location and division of diseases' instead.
Key terms
prakRutibhUta vAyu (prakṛtibhūta vāyu)
Vāyu remaining in its normal state.
vyApanna vAyu (vyāpanna vāyu)
Vāyu that has become disturbed or altered.
kopana
A substance, quality, or action held to provoke vāyu.
तस्य तद्वचनं श्रुत्वा प्राब्रवीद्भिषजां वरः |
स्वयम्भूरेष भगवान् वायुरित्यभिशब्दितः ||५||
स्वातन्त्र्यान्नित्यभावाच्च सर्वगत्वात्तथैव च |
सर्वेषामेव सर्वात्मा सर्वलोकनमस्कृतः ||६||
स्थित्युत्पत्तिविनाशेषु भूतानामेष कारणम् |
अव्यक्तो व्यक्तकर्मा च रूक्षः शीतो लघुः खरः ||७||
तिर्यग्गो द्विगुणश्चैव रजोबहुल एव च |
अचिन्त्यवीर्यो दोषाणां नेता रोगसमूहराट् ||८||
आशुकारी मुहुश्चारी पक्वाधानगुदालयः |९|
Meaning of the śloka
Dhanvantari replies that vāyu is called self-existent and revered: independent, eternal, all-pervading, and the inner principle of all beings. It is the cause of their maintenance, arising, and dissolution. Though itself unseen, its actions are manifest. It is dry, cool, light, rough, moves transversely, possesses two perceptible qualities, and is especially associated with rajas. Its power is said to be inconceivable; it directs the doṣas and stands foremost among causes of disease. It acts rapidly, moves repeatedly, and resides in the pakvādhāna and rectum.
The commentary gives independence, eternality, and all-pervasiveness as reasons for calling vāyu self-existent, adding subtlety through the conjunction. Its being the self of all is interpreted as pervading stationary and moving beings as cause and effect; another reading calls it the cause of every purpose. 'Maintenance' means life. Vāyu is invisible but known through evident action. Coolness belongs to uncombined vāyu, while in combination it may be hot. Its two qualities are sound and touch, and rajas predominates although all three guṇas are present. Its proposed powers include organizing bodily wastes and structures, moving doṣa, dhātu, and mala, and sustaining the earth externally. 'Leader of the doṣas' usually means their mover, though some say vāyu directs even vāyu. The compound rogasamūharāṭ is interpreted as shining or foremost among disease-causing factors rather than literally as king, to avoid conflict with a later phrase. Rapid action refers to quickly causing grave outcomes. Some read 'teacher of physicians' instead of 'best of physicians.'
Key terms
svayambhU (svayambhū)
Self-existent in the commentary's cosmological account.
avyakta
Unmanifest or not directly visible.
vyaktakarman (vyakta-karman)
Having actions that are manifest or observable.
rajovahula (rajo-bahula)
Characterized by predominance of rajas.
pakvAdhAna (pakvādhāna)
The lower digestive or fecal-holding region named as a seat of vāyu.
देहे विचरतस्तस्य लक्षणानि निबोध मे ||९||
दोषधात्वग्निसमतां सम्प्राप्तिं विषयेषु च |
क्रियाणामानुलोम्यं च करोत्यकुपितोऽनिलः ||१०||
(इन्द्रियार्थोपसम्प्राप्तिं दोषधात्वग्न्यवैकृतम्|
क्रियाणामानुलोम्यं च कुर्याद्वायुरदूषितः ||१०||) |
Meaning of the śloka
Learn the signs of vāyu as it moves through the body. When not aggravated, it maintains balance among doṣas, dhātus, and agni, enables contact with sensory objects, and allows bodily, verbal, and mental activities to proceed in their proper direction. An alternate recension says that undisturbed vāyu enables the senses to reach their objects, keeps doṣa, dhātu, and agni unaltered, and supports orderly activity.
The commentary says an omitted 'and so forth' after dhātu includes mala and upadhātu; alternatively, dhātu itself may include them because they help sustain the body. Sensory objects are sound, touch, form, taste, and smell. Activities are those of body, speech, and mind, and anulomya means enabling their proper movement. Gayadāsa reads the alternate verse beginning indriyārthopasamprāpti, which the commentator says was not written out fully for fear of excessive length.
Key terms
doShadhAtvagnisamatA (doṣa-dhātv-agni-samatā)
Balance of doṣas, tissues, and digestive/metabolic fire in the classical framework.
indriyArtha (indriyārtha)
An object of a sense: sound, touch, form, taste, or smell.
Anulomya (ānulomya)
Orderly or properly directed functioning.
upadhAtu (upadhātu)
A subsidiary tissue category included by the commentary.
Just as agni, though one, is divided fivefold by name, location, function, and disorder, vāyu too is one but divided fivefold by its names, locations, functions, and disorders.
Having described vāyu generally as a cause of health, the commentary introduces its five forms according to bodily site, each with distinct normal functions and diseases. It compares them with the five forms of pitta-agni—pācaka, rañjaka, ālocaka, bhrājaka, and sādhaka—distinguished by name, site, action, and disorder. Some instead take the analogy from the five external ritual fires: gārhapatya, āhavanīya, dakṣiṇāgni, āvasathya, and sabhya; Gayadāsa does not accept that interpretation.
Key terms
pa~jcadhA (pañcadhā)
Divided into five forms.
pAcaka (pācaka)
The digestive form of pitta-agni used in the comparison.
The five forms of vāyu are prāṇa, udāna, samāna, vyāna, and apāna. When each remains in its proper state and location, they sustain the embodied person.
The commentary says the verse supplies the names of vāyu. Here 'remaining in their locations' is interpreted as remaining in equilibrium, and 'sustain' means uphold the body.
Key terms
prANa (prāṇa)
One of the five functional forms of vāyu.
udAna (udāna)
The upward-associated form of vāyu.
samAna (samāna)
The digestive-associated form of vāyu.
vyAna (vyāna)
The body-pervading circulatory and movement-associated form.
apAna (apāna)
The downward-moving eliminative and reproductive-associated form.
यो वायुर्वक्त्रसञ्चारी स प्राणो नाम देहधृक् |
सोऽन्नं प्रवेशयत्यन्तः प्राणांश्चाप्यवलम्बते ||१३||
प्रायशः कुरुते दुष्टो हिक्काश्वासादिकान् गदान् |१४|
Meaning of the śloka
The vāyu that moves through the mouth is called prāṇa and sustains the body. It carries food inward and supports the vital functions. When disturbed, it commonly produces disorders such as hiccup and dyspnea.
Movement through the mouth is only an identifying indication; the head, chest, throat, and nose are also locations of prāṇa. It brings food inside to maintain the body. One explanation says it engages agni and other vital factors in their activities. Gayadāsa instead says that supporting the vital factors means supporting the heart that serves as their foundation, thereby sustaining life; a quoted teaching uses a tethered horse as an image for prāṇa departing at death and drawing the other vāyus with it. 'Such as dyspnea' also includes rhinitis, voice disturbance, and cough.
Key terms
prANa (prāṇa)
The form of vāyu associated here with intake, vital support, and the upper body.
dehadhRuk (deha-dhṛk)
Sustaining or upholding the body.
avalambana
Support, interpreted either functionally or as support of the heart.
shvAsa (śvāsa)
A classical disorder characterized by troubled breathing.
उदानो नाम यस्तूर्ध्वमुपैति पवनोत्तमः ||१४||
तेन भाषितगीतादिविशेषोऽभिप्रवर्तते |
ऊर्ध्वजत्रुगतान् रोगान् करोति च विशेषतः ||१५||
Meaning of the śloka
The foremost vāyu that moves upward is called udāna. Through it, distinct forms of speech, song, and related actions proceed. When disturbed, it especially causes disorders above the clavicular region.
The commentary presents udāna's normal identity and functions and the diseases of its disturbed state. Although not stated in the verse, its locations include the navel, chest, and throat. 'Speech, song, and so forth' also includes exhalation. Some read viṣayaḥ, 'the domain proceeds,' instead of viśeṣaḥ, 'the distinct form proceeds.' Disorders above the clavicle involve the eyes, mouth, nose, ears, and head; the conjunction also includes cough and other conditions.
Key terms
udAna (udāna)
The upward-moving form of vāyu associated with voice and exhalation.
Samāna moves through the region where food is being digested and remains associated with digestive fire. It digests food and separates the products arising from that digestion. When disturbed, it causes disorders such as gulma, weakened digestive activity, and diarrhea.
The commentary derives āmapakvāśaya as the receptacle where undigested food becomes digested. Some read 'assisting agni' instead of 'associated with agni,' with essentially the same meaning. Samāna is said to digest by kindling agni, like a cook. It separates digestion's products into rasa, doṣa, urine, and feces.
Key terms
samAna (samāna)
The form of vāyu associated with digestion and separation of digestive products.
AmapakvAshaya (āma-pakvāśaya)
The digestive receptacle where undigested food becomes cooked.
Vyāna moves throughout the entire body and drives the circulation of rasa. It also promotes sweating and the flow of blood and produces five kinds of bodily movement. When aggravated, it generally causes diseases affecting the whole body.
The commentary understands an implicit 'and so forth,' so vyāna moves rasa and other bodily materials. Its five movements are extension, contraction, bending, elevation, and transverse movement. Others instead enumerate locomotion, extension, lifting, closing the eyes, and opening them. Whole-body disorders include fever, diarrhea, raktapitta, and others.
Key terms
vyAna (vyāna)
The body-pervading form of vāyu associated with transport and movement.
Apāna resides in the pakvādhāna and, at the proper time, draws feces, urine, semen, the fetus, and menstrual blood downward. When aggravated, it causes severe disorders centered in the bladder and rectal region.
The commentary identifies pakvādhāna with the pakvāśaya. Disorders located in the bladder include urinary stones and related conditions, while disorders of the rectal region include fistula-in-ano and others.
Key terms
apAna (apāna)
The downward-moving form of vāyu associated with elimination and reproduction.
pakvAdhAna (pakvādhāna)
The lower digestive receptacle, glossed as pakvāśaya.
basti
The bladder region.
bhagandara
A classical fistula-in-ano disease category.
Adhikarana ૧૨ (૨૦) · Śloka ૨૦
શુક્રદોષપ્રમેહાસ્તુ વ્યાનાપાનપ્રકોપજાઃ ||૨૦||
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शुक्रदोषप्रमेहास्तु व्यानापानप्रकोपजाः ||२०||
Meaning of the śloka
Disorders of śukra and prameha are said to arise from aggravation of both vyāna and apāna.
The verse gives examples of the effects of two disturbed vāyus acting together. Because śukra is considered distributed throughout the body, and because prameha arises from rasa and other affected materials throughout the body, vyāna is involved. Because both manifest through the penile outlet, apāna is also involved.
Key terms
shukradoSha (śukra-doṣa)
A classical disorder involving reproductive material.
prameha
A classical group of urinary and metabolic disorders.
vyAnApAnaprakopa (vyānāpāna-prakopa)
Simultaneous aggravation of vyāna and apāna.
Adhikarana ૧૩ (૨૧) · Śloka ૨૧
યુગપત્ કુપિતાશ્ચાપિ દેહં ભિન્દ્યુરસંશયમ્ |૨૧|
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युगपत् कुपिताश्चापि देहं भिन्द्युरसंशयम् |२१|
Meaning of the śloka
If all five forms become aggravated at the same time, they are said without doubt to destroy the body.
The commentary takes yugapat to mean simultaneously and interprets 'break the body' as destruction or death of the body, presenting this as the fixed outcome of simultaneous aggravation of all five vāyus.
Key terms
yugapat prakopa
Simultaneous aggravation of all five forms.
dehabheda (deha-bheda)
Literally breaking the body, interpreted here as bodily destruction or death.
The text next describes disorders caused when aggravated vāyu occupies different locations. In the stomach it causes vomiting and related disorders, confusion, fainting, thirst, constriction in the cardiac region, and pain in the flanks. In the lower intestinal region it causes intestinal sounds, pain at the navel, difficult passage of urine and feces, abdominal distension, and pain around the sacral region. When lodged in the sensory organs beginning with the ear, it causes loss of their functions.
The commentary says disturbed vāyu produces many conditions according to its location. 'Vomiting and others' may include pain, stiffness or pricking in the flank, abdomen, and heart region, or upward-moving raktapitta and related conditions. Moha is impairment short of complete loss of mind, while mūrcchā is loss of consciousness. Antrakūja is indistinct intestinal sound. The conjunction adds retention of flatus, feces, and urine and pain in the legs, thighs, sacrum, flanks, and back. Some read śūlānāhau instead of śūlaṃ nābhau and interpret ānāha as a surrounding sense of binding in the pakvāśaya, distinct from another type described elsewhere. The sensory losses are inability to hear, smell, see, taste, or feel touch.
Key terms
AmAshaya (āmāśaya)
The stomach or upper digestive receptacle.
pakvAshaya (pakvāśaya)
The lower intestinal or digested-food receptacle.
antrakUja (antra-kūja)
Indistinct rumbling or sound in the intestines.
AnAha (ānāha)
Abdominal obstruction or distension, with a variant interpretation here.
वैवर्ण्यं स्फुरणं रौक्ष्यं सुप्तिं चुमुचुमायनम् |
त्वक्स्थो निस्तोदनं कुर्यात् त्वग्भेदं परिपोटनम् ||२५||
व्रणांश्च रक्तगो, ग्रन्थीन् सशूलान् मांससंश्रितः |
तथा मेदःश्रितः कुर्याद्ग्रन्थीन्मन्दरुजोऽव्रणान् ||२६||
कुर्यात् सिरागतः शूलं सिराकुञ्चनपूरणम् |
स्नायुप्राप्तः स्तम्भकम्पौ शूलमाक्षेपणं तथा ||२७||
हन्ति सन्धिगतः सन्धीन् शूलशोफौ करोति च |
अस्थिशोषं प्रभेदं च कुर्याच्छूलं च तच्छ्रितः ||२८||
तथा मज्जगते रुक् च न कदाचित् प्रशाम्यति |
अप्रवृत्तिः प्रवृत्तिर्वा विकृता शुक्रगेऽनिले ||२९||
Meaning of the śloka
According to its tissue or structure, disturbed vāyu produces different signs. In skin or rasa it causes discoloration, twitching, dryness, numbness, tingling, pricking, splitting, and peeling. In blood it causes wounds; in muscle, painful nodules; and in medas, mildly painful nodules without ulceration. In vessels it produces pain, contraction, or fullness; in sinews, stiffness, tremor, pain, and spasmodic movement. In joints it damages movement and causes pain and swelling. In bone it causes wasting, splitting, and pain; in marrow, pain that never subsides. In śukra it causes absent or abnormal discharge.
The commentary treats vāyu in skin as vāyu in rasa. Supti is loss of touch sensation, and cumucumāyana is a mustard-paste-like tingling pain. Some omit the phrase about wounds in blood, but the commentator retains it because Gayadāsa accepts it. Muscle-associated nodules are painful, whereas those in medas lack wounds and have little pain. Vessel contraction is the condition popularly described as crooked vessels. Stambha means immobilization and ākṣepaṇa means involuntary movement. Joint involvement prevents contraction and extension. By analogy with bone wasting, marrow involvement also causes marrow wasting. Abnormal śukra discharge may be excessively rapid, delayed, clotted, discolored, or otherwise altered.
Key terms
supti
Numbness or loss of touch sensation.
cumucumAyana (cumucumāyana)
A tingling or prickling sensation compared to mustard paste.
Vāyu may proceed successively through the hands, feet, head, and bodily tissues, or it may spread throughout the entire body and become all-pervading in a person.
The commentary says vāyu initially confined to one limb or one tissue may, if neglected, become distributed through all limbs or all tissues. The syntax places the alternative particle with 'all-pervading': vāyu may move successively through the hands, feet, and head, just as it may spread through the whole body; similarly, it may move successively through the tissues or become present in them all.
Key terms
ekA~ggagata (ekāṅga-gata)
Located in a single limb or bodily part.
ekadhAtugata (eka-dhātu-gata)
Located in one tissue category.
sarvagata (sarva-gata)
Spread throughout the whole body or all tissues.
Adhikarana ૧૭ (૩૧) · Śloka ૩૧
સ્તમ્ભનાક્ષેપણસ્વાપશોફશૂલાનિ સર્વગઃ |૩૧|
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स्तम्भनाक्षेपणस्वापशोफशूलानि सर्वगः |३१|
Meaning of the śloka
When vāyu has spread throughout the body, it causes stiffness, spasmodic movement, numbness, swelling, and pain.
The commentary identifies these as the signs of vāyu affecting all the limbs and says that body-wide vāyu produces stiffness and the other listed manifestations throughout the body.
The commentary explains 'mixed' as associated with pitta and the other doṣas. Obstruction of vāyu by pitta or another doṣa is inferred from seeing that doṣa's intrinsic qualities and effects—for example heat and burning indicate pitta, because vāyu alone is considered cool and cannot produce burning without pitta.
Key terms
sammishra (sammiśra)
Mixed or combined with another doṣa.
AvaraNa (āvaraṇa)
Obstruction or covering of vāyu by another factor.
dAha (dāha)
Burning sensation, taken here as evidence of pitta involvement.
Adhikarana ૧૯ (૩૨) · Śloka ૩૨
કુર્યાદવયવપ્રાપ્તો મારુતસ્ત્વમિતાન્ ગદાન્ |૩૨|
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कुर्यादवयवप्राप्तो मारुतस्त्वमितान् गदान् |३२|
Meaning of the śloka
When māruta reaches individual parts of the body, it can produce innumerable disorders.
When vāyu is associated with pitta, burning, heat, and fainting may occur. When that vāyu is covered by kapha, coldness, swelling, and heaviness occur. When associated with blood, there may be needle-like pricking, intolerance of touch, numbness, and other pitta-type changes. If prāṇa vāyu is covered by pitta, vomiting and burning arise; if covered by kapha, weakness, fatigue, drowsiness, and altered colour arise. Pitta joined with udāna produces fainting, burning, dizziness, and exhaustion; kapha covering udāna produces absence of sweating, horripilation, weak digestive fire, coldness, and stiffness. Pitta joined with samāna produces sweating, burning, heat, and fainting; kapha covering it produces stool and urine rich in kapha and horripilation. Pitta joined with apāna produces burning, heat, and uterine bleeding; kapha covering it produces heaviness of the lower body. Pitta covering vyāna produces burning, limb-throwing movements, and exhaustion; kapha covering vyāna produces heaviness of all limbs, stiffness of bone-joints, and arrested movement.
The commentary expands the earlier statement that mixed causes produce mixed symptoms and explains āvaraṇa patterns. Burning is compared with fire injury, and santāpa with exposure to intense environmental heat. Needle-like pain, touch intolerance, dryness, and loss of touch perception describe blood-associated vāta. Sadana means bodily fatigue; klama is fatigue without exertion; harṣa means horripilation. ‘Kapha-rich stool and urine’ means stool and urine containing abundant śleṣman. Asṛgdara is specified as a condition of women. Asthi-parvan means the joints between bones, and ceṣṭā includes walking and other movements.
Key terms
AvaraNa (āvaraṇa)
Covering or obstruction of one functional principle by another in classical pathology.
(प्रायशः सुकुमाराणां मिथ्याऽऽहारविहारिणाम् |
रोगाध्वप्रमदामद्यव्यायामैश्चातिपीडनात् ||४०||
ऋतुसात्म्यविपर्यासात् स्नेहादीनां च विभ्रमात् |
अव्यवाये तथा स्थूले वातरक्तं प्रकुप्यति ) ||४१||
Meaning of the śloka
Vātarakta is said to become aggravated especially in delicate persons who follow unsuitable food and activity, who are excessively strained by illness, travel, sexual activity, alcohol, or exercise, who act contrary to seasonal suitability or misuse oleation and related measures, and in inactive or stout persons.
After describing vāta covered by blood that is not itself aggravated, the commentary introduces causes for vātarakta produced when aggravated blood obstructs vāta. Sukumāra refers to a delicate person. Mithyā-vihāra means inappropriate actions of body, speech, and mind; adhvan is travel; vyāyāma is exertion-producing activity; vibhrama means performing oleation and similar measures incorrectly; and avyavāya is abstention from sexual activity. Some authorities omit this whole passage through ‘vātarakta becomes aggravated’ because it appears again in the treatment section.
Key terms
vAtarakta (vātarakta)
A classical disorder explained through interaction of vāta and aggravated blood.
mithyAhAravihAra (mithyāhāra-vihāra)
Inappropriate diet and bodily, verbal, or mental activity.
RutusAtmyaviparyAsa (ṛtu-sātmya-viparyāsa)
Conduct contrary to what is considered suitable for the season.
Travel on elephants, horses, camels, or other comparable exertions, together with vāta-provoking causes, is said to aggravate vāyu. Frequent use of sharp, hot, sour, alkaline, leafy, and similar foods, heat exposure, and related causes quickly vitiates blood. The affected blood blocks the rapidly moving pathway of vāyu; vāyu, greatly aggravated by that obstruction, further vitiates the increased blood. Because vāyu predominates in their association, the condition is called vātarakta. Similarly, pitta or kapha may become mixed with vitiated blood.
The commentary presents the classical pathogenesis. ‘Other’ causes include load carrying; vāyu’s own causes include foods producing burning and similar effects. Vitiated blood obstructs the path of quickly moving vāyu. The resulting, highly aggravated vāyu then affects the excessively increased blood. Tat-prābalya is interpreted as predominance of vāta and relative weakness of blood, though some understand it as the combined predominance of both vāta and blood. The closing lines similarly refer to vitiated pitta or kapha mixed with vitiated blood.
Key terms
samprApti (samprāpti)
The classical account of how the disorder develops.
mArgarodha (mārga-rodha)
Obstruction of vāyu’s pathway by affected blood.
vAtarakta (vātarakta)
The disorder named for the association and stated predominance of vāta with blood.
tatprAbalya (tat-prābalya)
Predominance interpreted either as vāta alone or as both vāta and blood.
When vāta predominates in vātarakta, the feet are intolerant of touch and have pricking, splitting pain, dryness, and numbness. When pitta and blood predominate, the feet show intense burning, marked heat, soft red swelling. When kapha affects the blood, the feet itch and are pale or white, cold, swollen, enlarged, and stiff. When all factors affect the blood, each displays its own features in the feet.
The commentary gives distinguishing signs according to the predominant doṣa. Sparśodvigna means that the feet cannot tolerate touch; praśoṣa is dryness and svāpa is loss of touch sensation. These characterize vāta-predominant vātarakta. In the next group, pitta and blood are especially strong within vāta-blood disease; rakta-śopha is red-coloured swelling. In the kapha pattern, the feet are itchy and pīna means enlarged or thick. When all are affected, their respective signs appear together.
Key terms
sparshodvigna (sparśodvigna)
Unable to tolerate touch.
svApa (svāpa)
Loss or diminution of touch sensation.
raktashopha (rakta-śopha)
Red-coloured swelling.
doShaprAbalya (doṣa-prābalya)
Predominance of a doṣa used to distinguish symptom patterns.
As preliminary signs, the feet may be lax, sweaty, cold, or show their opposites—hardness, absence of sweat, and heat—together with altered colour, pricking pain, numbness, heaviness, and burning.
The commentary identifies these as prodromal signs of vātarakta and supplies ‘the feet’ as the subject. Saviparyaya means that the opposite signs may also occur: hardness instead of laxity, lack of sweating instead of sweating, and heat instead of coldness. Oṣa means burning. Some authorities omit this prodromal passage here because it is read in the treatment section.
Key terms
prAgrUpa (prāgrūpa)
A preliminary or prodromal sign before the disease is fully expressed.
The commentary describes vātarakta as initially limited to the feet and later following other body parts. Mūla is interpreted as the sole. The comparison says that rat poison first takes hold at its point of origin and, once aggravated, subsequently travels throughout the body.
Key terms
pAdayormUla (pādayor mūla)
The soles or basal part of the feet.
anusarpati
Spreads progressively into other parts.
AkhorviSha (ākhor viṣa)
Rat poison, used as a historical simile for spread from a point of origin.
Vātarakta that has fissured as far as the knees, has broken open and discharges, or is accompanied by complications such as loss of vitality and wasting of flesh is regarded as incurable. A case arising a year earlier is regarded as manageable but not fully curable.
The commentary explains fissuring to the knees as splitting or eruption extending up to that level, prabhinna as ruptured, and prasruta as having discharge. The complications include those described as unavoidable, beginning with loss of vitality and flesh; the word ‘and others’ also includes deformity of the fingers or toes and arbuda-like growths. Fissuring to the knee is attributed to vāta predominance, while rupture and discharge to that level are attributed to predominance of pitta and blood; both are classified as incurable.
Key terms
AjAnusphuTita (ājānu-sphuṭita)
Fissured or erupted as far as the knee.
prabhinna-prasruta
Broken open and accompanied by discharge.
asAdhya (asādhya)
Classified as incurable in the historical prognosis.
yApya (yāpya)
Considered controllable or manageable rather than curable.
When greatly aggravated māruta enters all the dhamanīs, its recurrent movement repeatedly throws or convulses the body. Because of that repeated bodily movement, the condition is called ākṣepaka.
The commentary introduces ākṣepaka after vātarakta. Dhamanīs are glossed as nāḍīs; abhyeti means pervades, and ākṣipati means moves or throws. Muhuścara describes vāyu as repeatedly moving and thereby causing recurrent convulsions. Some read bahiścara, ‘moving outward’, but Gayadāsa rejects this reading. This is the general definition of ākṣepaka.
Key terms
AkShepaka (ākṣepaka)
A classical syndrome named for repeated involuntary throwing or convulsive movement of the body.
dhamanI (dhamanī)
A bodily channel, glossed here as nāḍī.
muhushcara (muhuścara)
Moving repeatedly; a variant reads bahiścara, moving outward.
An ākṣepaka that causes a person to fall intermittently is called apatānaka. When vāyu joined with kapha remains strongly in all those dhamanīs, it stiffens the body like a staff; this difficult condition is daṇḍāpatānaka, with severe jaw locking and difficulty taking food. A person who bends like a bow has dhanustambha. When forceful anila affects the network of snāyus associated with the toes, ankles, abdomen, heart, chest, and throat, the eyes and jaw become fixed, the side appears bent, and kapha is vomited; inward bowing is called antarāyāma. When located in the outer snāyu network, it produces outward bowing, bāhyāyāma. Cases with breaking or severe involvement of the chest, waist, and thighs are called incurable. Ākṣepaka is also classified as associated with kapha and pitta, caused by vāyu alone, or caused by trauma.
The commentary distinguishes forms of ākṣepaka. Apatānaka generally means intermittent falling; Gayadāsa elsewhere explains it as a state in which a person falls, sees darkness, or loses awareness, caused by vāyu with kapha acting through the heart and mind. Apatānaka has three forms: daṇḍāpatānaka, antarāyāma, and bahirāyāma. Daṇḍāpatānaka is difficult to cure; jaw locking may also occur in other vāta disorders. Dhanustambha names antarāyāma. The listed locations include toes, the ankle joint above the heel, abdomen, heart, chest, and throat. Outer snāyus are placed along the soles, calves, waist, back, and posterior neck. Bāhyāyāma is incurable only when the chest, waist, or thighs are described as broken; a new case without that feature may be treated. One classification counts kapha-associated, pitta-associated, pure-vāta, and traumatic forms. Jejjaṭa instead counts the first three bowing syndromes plus trauma; Gayī rejects this because miscarriage and other causes yield additional categories. Brahmadeva counts apatānaka, mixed-doṣa ākṣepaka, pure ākṣepaka, and traumatic ākṣepaka.
Key terms
apatAnaka (apatānaka)
A classical ākṣepaka syndrome marked by intermittent falling or loss of awareness.
daNDApatAnaka (daṇḍāpatānaka)
A form with staff-like rigidity and often severe jaw locking.
antarAyAma (antarāyāma)
A form with inward bow-like bending.
bAhyAyAma (bāhyāyāma)
A form with outward bow-like bending.
snAyupratAna (snāyu-pratāna)
An extended network of snāyus implicated in the described postures.
Adhikarana ૨૯ (૫૯) · Śloka ૫૯
ગર્ભપાતનિમિત્તશ્ચ શોણિતાતિસ્રવાચ્ચ યઃ |
અભિઘાતનિમિત્તશ્ચ ન સિધ્યત્યપતાનકઃ ||૫૯||
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गर्भपातनिमित्तश्च शोणितातिस्रवाच्च यः |
अभिघातनिमित्तश्च न सिध्यत्यपतानकः ||५९||
Meaning of the śloka
Apatānaka arising from miscarriage, excessive bleeding, or trauma is said not to be curable.
The commentary classifies these three causes as externally arising and incurable. It adds that if recovery occurs exceptionally through favourable fortune, disability remains.
Key terms
garbhapAtanimitta (garbha-pāta-nimitta)
Arising in connection with miscarriage or pregnancy loss.
When highly aggravated mātariśvan enters the upward-, downward-, and transverse-going dhamanīs of one half of the body, it loosens the joint-bindings and disables that side; physicians call this pakṣāghāta. The entire half of the body becomes functionally impaired and has diminished sensation or consciousness; the person may fall or lose life under the affliction of anila.
The commentary explains that vāyu occupies the upward, downward, and transverse channels of one bodily half, loosens its joint-bindings, and strikes or disables that half. Akarmaṇya is interpreted as having only slight capacity for action, and acetana as having little sensation or awareness. It reads the final outcomes conditionally: functional incapacity causes falling, while loss of consciousness is associated with loss of life.
Key terms
pakShAghAta (pakṣāghāta)
A classical syndrome involving loss of function in one half of the body.
dhamanI (dhamanī)
Channels described as running upward, downward, and transversely.
sandhibandha (sandhi-bandha)
The binding or support of joints, said here to be loosened.
akarmaNya-acetana (akarmaṇya-acetana)
Functionally impaired and having reduced sensation or awareness.
Pakṣāghāta caused by vāta alone is regarded as extremely difficult to cure; when associated with another doṣa it is described as curable; when caused by depletion it is incurable.
The commentary explains śuddha vāta as vāta not mixed with kapha or another doṣa, and ‘associated with another’ as joined with a different doṣa. The verse classifies prognosis according to these causes.
Key terms
shuddhavAta (śuddha-vāta)
Vāta acting alone, without association with kapha or another doṣa.
When aggravated vāyu rises from its place, it presses upon the heart, head, and temples, throws and bends the limbs, and the person may close the eyes, become motionless or fixed-eyed, make a cooing sound, cease breathing, breathe only with difficulty, and lose consciousness. When the heart is released the person becomes normal; when it is covered, the person loses awareness. This is known as apatantraka, caused by vāta associated with kapha.
The commentary describes apatantraka. It identifies the heart as the downward-facing lotus-bud-shaped organ, the temples as the regions above the ends of the eyebrows between ears and forehead, and the limbs as hands, feet, and other parts. Ākṣipet means throws down. Kūjati means making a pigeon-like sound; alternatively the person exhales or breathes with difficulty. Some authorities omit apatantraka as a separate condition because they regard apatantraka and apatānaka as identical.
Key terms
apatantraka
A classical episodic syndrome involving collapse, abnormal movement, breathing, and awareness.
sha~gkha (śaṅkha)
The temple region of the head.
kUjati (kūjati)
Makes a pigeon-like sound according to the commentary.
दिवास्वप्नासनस्थानविवृताध्वनिरीक्षणैः |
मन्यास्तम्भं प्रकुरुते स एव श्लेष्मणाऽऽवृतः ||६७||
Meaning of the śloka
That same vāyu, covered by śleṣman, is said to produce manyāstambha through daytime sleep, prolonged sitting or standing, and looking along a path with the neck turned.
The commentary defines āsana as sitting and sthāna as remaining upright. Vivṛtādhva-nirīkṣaṇa means looking along a path while turned or twisted. Some regard manyāstambha as a prodromal sign of apatānaka.
Key terms
manyAstambha (manyāstambha)
Stiffness of the neck region in this classical category.
In pregnancy, after childbirth, childhood, old age, depletion, or loss of blood—and also after excessively loud speaking, chewing hard substances, laughing, yawning, carrying an uneven load, or lying awkwardly—anila affecting the joints of the head, nose, lips, chin, forehead, and eyes is said to cause ardita. One half of the face becomes crooked and the neck may turn; the head shakes, speech is obstructed, and the eyes and related structures become abnormal. Pain occurs in the neck, chin, and teeth on the affected side. Preceding signs include horripilation, tremor, a clouded eye, upward movement of vāyu, numbness and pricking of the skin, and stiffness of the neck and jaw. Specialists call this disorder ardita.
The commentary explains sūtikā as a woman who has recently given birth and vyāharataḥ as producing voice. It parses the cause as an uneven load or an uneven sleeping posture; another reading has viṣamocchvasana, irregular breathing. Ardayitvā means causing pain, and apavartate means becoming crooked. Vāk-saṅga is failure of speech to emerge; ‘eyes and others’ includes the eyebrows, cheeks, and related structures. The neck and other parts become crooked on the affected side. Cibuka is the lower part of the oral cavity. The preliminary signs are said to arise before the full disorder; āvila means clouded or impure, upward vāyu requires an understood verb ‘spreads’, and skin svāpa is loss of touch sensation.
Key terms
ardita
A classical syndrome of unilateral facial distortion with associated neurologic signs.
vAksa~gga (vāk-saṅga)
Obstruction or failure of speech to emerge.
manyAhanugraha (manyā-hanu-graha)
Stiffness or restriction of the neck and jaw.
viShamashayana (viṣama-śayana)
An awkward or uneven sleeping posture; a variant reads irregular breathing.
pUrvarUpa (pūrvarūpa)
A sign said to precede the fully expressed disorder.
क्षीणस्यानिमिषाक्षस्य प्रसक्तं सक्तभाषिणः |
न सिध्यत्यर्दितं बाढं त्रिवर्षं वेपनस्य च ||७३||
Meaning of the śloka
Ardita is said not to be curable when the person is depleted, cannot blink because the eyes are fixed, has continuously obstructed or indistinct speech, has had the condition for three years, or has marked tremor.
The commentary glosses animiṣākṣa as fixed-eyed. Prasakta means continuous, and sakta-bhāṣin means speaking with difficulty and indistinct words. Another reading is prasaktāvyakta-bhāṣin, with prasakta understood as intensely fixed or persistent. Trivarṣa means lasting beyond three years, though others use the three-year qualification for a case with discharge from the nose, eyes, and mouth. Vepana means being prone to trembling. The earlier line listing pregnant, postpartum, young, old, depleted, and blood-depleted persons is omitted by Jejjaṭa and other teachers; this commentator includes it because many physicians read it.
Key terms
animiShAkSha (animiṣākṣa)
Having fixed eyes or inability to blink.
saktabhAShin (sakta-bhāṣin)
Having obstructed, difficult, or indistinct speech.
trivarSha (trivarṣa)
A three-year duration, alternatively linked to a discharging presentation.
When the kandara extending in relation to the heel and toes is afflicted by anila and restricts extension of the leg, the condition is called gridhrasi.
The commentary defines gridhrasi by restriction of leg extension. Parshni is the lower rear part of the ankle, and pratyanguli refers to the toes; together these indicate two major tendinous structures situated above and below. Kandara is a large snayu, and the leg is described as extending from the ankle to the groin. Gridhrasi is popularly called ranghini and may arise from vata alone or from vata with kapha. Unlike khanjana-vata, it has marked pain. A variant reads parshnim pratyangulinam in the accusative, but still identifies two kandaras, one directed toward the heel and one associated with the toes.
Key terms
gRudhrasI (gridhrasi)
A classical vata disorder marked here by painful restriction of leg extension.
kaNDarA (kandara)
A large tendinous or ligament-like structure, described as a major snayu.
sakthikShepa (sakthikshepa)
Extension or outward movement of the leg.
pArShNi (parshni)
The lower rear portion of the ankle or heel region.
When the kandaras related to the palm and fingers and those at the back of the arm are affected, loss of arm function results; this is called vishvachi.
The commentary presents vishvachi as resembling gridhrasi but occurring in one arm. Tala indicates the inner kandara of the hand, while bahuprishtha indicates the outer kandara. Although the verse uses the dual 'arms' in a general sense, the disorder may occur in either individual arm. The earlier phrase 'afflicted by anila' is understood here as well. The conjunction also gathers the unspoken alternative name khalli for gridhrasi and vishvachi. Another grammatical reading takes talam in the accusative, again yielding two kandaras: one directed toward the palm and one on the back of the arm.
Key terms
vishvAcI (vishvachi)
A classical disorder causing impairment of arm function.
bAhukarmakShaya (bahukarmakshaya)
Reduction or loss of functional movement of the arm.
tala
The palm or inner aspect of the hand in this explanation.
khallI (khalli)
An alternative name gathered by the commentary for gridhrasi and vishvachi.
A large, intensely painful swelling in the knee region, described as arising from vata and shonita and resembling a jackal's head, is known as kroshṭukashirsha.
The commentary identifies kroshṭukashirsha as a very painful, bulky swelling in the middle of the knee, shaped like a jackal's head. Its preferred explanation understands vatashonitaja as produced jointly by vata and blood, rather than caused by the named disease vatarakta. Others reject that derivation and interpret it as arising from vatarakta, treating the disease itself as the cause. The name literally places 'head' after kroshṭuka.
Key terms
kroShTukashira (kroshtukashirsha)
A classical painful knee swelling likened to a jackal's head.
vAtashoNitaja (vatashonitaja)
Interpreted either as arising from vata and blood or, alternatively, from vatarakta.
When vayu situated in the waist affects a kandara of one leg, the person's gait becomes impaired and the condition is called khanja. When both legs are completely disabled, the person is described as pangu.
The commentary distinguishes khanja from pangu. In khanja the kandara is affected only to a degree, producing an abnormal gait. Pangu denotes complete obstruction of movement from simultaneous impairment of both legs; 'both' is interpreted this way to avoid redundancy.
Key terms
kha~jja (khanja)
A classical category of impaired gait associated here with one leg.
pa~ggu (pangu)
A classical category of complete impairment of movement involving both legs.
The commentary distinguishes kalayakhanja from khanja by trembling at the very start of walking or taking a step. Muktasandhiprabandhana is explained as looseness of the structures binding the joints.
Key terms
kalAyakha~jja (kalayakhanja)
A classical gait disorder characterized by trembling at initiation of walking.
The commentary explains that the foot has been set down on an uneven surface. The location indicated by the uncertain reading khudu(la)ka is taken as the joint between the foot and lower leg. Others read the condition as situated at the heel.
Key terms
vAtakaNTaka (vatakantaka)
A classical painful disorder of the foot or ankle region.
viShamasthAna (vishamasthana)
An uneven place or surface.
khuDu(la)ka
A textually uncertain anatomical term interpreted as the foot-lower-leg joint.
हृष्यतश्चरणौ यस्य भवतश्च प्रसुप्तवत् |
पादहर्षः स विज्ञेयः कफवातप्रकोपजः ||८१||
Meaning of the śloka
When a person's feet experience a tingling, internally cold sensation and become as though asleep, the condition is called padaharsha and is attributed to aggravated kapha and vata.
The commentary explains harsha as a distinctive sensation resembling horripilation and producing an internal feeling of cold. 'As though asleep' means that touch is not properly perceived, giving a numb sensation.
Key terms
pAdaharSha (padaharsha)
A classical condition involving tingling, cold sensation, and numbness of the feet.
harSha (harsha)
A sensation resembling horripilation, described here as internally cold.
Vayu located in the shoulder region dries the structure binding the shoulder and contracts the siras there; it thereby produces the condition called avabahuka.
The commentary discusses amsashosha and avabahuka. Amsadesha is the area around the shoulder, and amsa is the head of the arm. Amsabandhana is interpreted as shleshma. After saying this binding is dried, the commentary supplies the implied clause that this produces the disease amsashosha. Vayu remaining in the same shoulder region then produces avabahuka.
Key terms
avabAhuka (avabahuka)
A classical disorder of the shoulder and arm.
aMsashoSha (amsashosha)
A classical condition understood from the implied clause as drying or wasting at the shoulder.
aMsabandhana (amsabandhana)
The binding structure of the shoulder, interpreted by the commentary as shleshma.
sirA Aku~jcana (sira akunchana)
Contraction of the vessels or channels described in the shoulder region.
The commentary explains shuddha as vayu acting alone. The word api is understood to include obstruction by rakta and pitta as further possibilities. Although this disease is also taught in Shalakya, it is included here because authorities of the older tradition accepted it in this context.
Key terms
bAdhirya (badhirya)
Deafness or loss of hearing.
shabdavaha srotas
The channel understood to carry sound.
AvRuti (avriti)
Obstruction or covering.
shuddha vAyu (shuddha vayu)
Vayu acting alone, without the stated association.
When anila causes a splitting-like sensation through the jaw, temples, head, and neck and produces pain in the ears, the condition is called karnashula.
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કર્ણશૂલમાહ- હનુશઙ્ખેત્યાદિ||૮૪||
Meaning of the commentary
The commentary simply introduces this verse as the description of karnashula and adds no further interpretation.
Vayu associated with kapha is said to obstruct the sound-carrying dhamanis and thereby make a person unable to perform speech normally, producing absence of speech, nasal speech, or indistinct and faltering speech.
The commentary presents this as a vata disorder affecting the tongue. Avritya means obstructing. Muka denotes absence of speech, minmina denotes nasalized speech, and gadgada denotes indistinct speech.
Key terms
shabdavAhinI dhamanI (shabdavahini dhamani)
A channel described as carrying sound or speech.
mUka (muka)
Without speech in the commentary's classification.
minmiNa (minmina)
Having nasalized speech.
gadgada
Having indistinct or faltering speech.
akriyaka
Unable to perform the relevant function, here normal speech activity.
Pain arising from the repositories of feces and urine and moving downward as though splitting the rectal and genital regions is called tuni. The same pain, when arising from the rectal-genital region and spreading upward in the reverse direction toward the pakvashaya in attacks, is called pratituni.
The commentary explains the splitting description as pain that feels as though it divides the rectal and genital regions. Pratilomavisarpini means beginning below and travelling upward. Vegaih refers to repeated attacks of pain that subside naturally between episodes. Some instead read 'driven in the reverse direction.'
Key terms
tUnI (tuni)
A classical pain pattern travelling downward from the fecal and urinary repositories.
pratitUnI (pratituni)
The reverse pain pattern travelling upward toward the pakvashaya.
pratilomavisarpiNI (pratilomavisarpini)
Spreading upward in a direction contrary to the normal course.
A markedly distended abdomen with internal movement or rumbling and extremely severe pain, arising from obstruction of vata, is called the grave condition adhmanam.
The commentary explains atopa as movement or rumbling, so satopa means accompanied by it. Udara here specifically denotes the pakvashaya. Ghora means distressing or difficult to bear.
Key terms
AdhmAna (adhmana)
A classical condition of severe painful distension.
ATopa (atopa)
Internal movement or rumbling.
vAtanirodha (vatanirodha)
Obstruction of vata.
pakvAshaya (pakvashaya)
The lower digestive repository identified here by udara.
A similar distension arising from the amashaya, but sparing the flanks and heart region, is called pratyadhmana and is attributed to vayu obstructed by kapha.
The commentary says this is a form of adhmanam arising in the amashaya, defined as the region between the navel and breasts. Because that location might suggest involvement of the heart and flanks, the verse explicitly excludes those regions. Vyakulita is explained as obstructed.
Key terms
pratyAdhmAna (pratyadhmana)
A classical distension arising in the amashaya while sparing the heart and flanks.
AmAshaya (amashaya)
The upper digestive repository, located here between the navel and breasts.
A dense, raised, elongated abdominal mass resembling an ashthila and obstructing the outward passage of flatus, feces, and urine is known as vatashthila. When this mass is painful, obstructs flatus, feces, and urine, and arises transversely in the abdomen, it is called pratyashthila.
The commentary records two explanations of ashthila: some call it a long, rounded stone found in the northern region, while others call it a long, rounded iron vessel used by leatherworkers. Ghana means compact and ayata means long. The external pathways named are those of flatus, feces, and urine. Another reading adds that the mass arises below the navel and may be movable or immovable. Pratyashthila differs from vatashthila by arising transversely. Some insert urustambha after this passage, but the commentator rejects that placement because it is taught later in treatment and is not accepted by the compilers.
Key terms
vAtAShThIlA (vatashtila)
A classical elongated abdominal mass obstructing elimination.
pratyaShThIlA (pratyashtila)
A painful obstructive mass distinguished by transverse orientation.
aShThIlA (ashthila)
Compared either to a long rounded stone or a leatherworker's long rounded iron vessel.
bahirmArga (bahirmarga)
The outward pathways of flatus, feces, and urine.
tiryagutthita
Arising or oriented transversely.
Adhikarana પુષ્પિકા · Śloka ૧
ઇતિ સુશ્રુતસંહિતાયાં નિદાનસ્થાને વાતવ્યાધિનિદાનં નામ પ્રથમોઽધ્યાયઃ ||૧||
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इति सुश्रुतसंहितायां निदानस्थाने वातव्याधिनिदानं नाम प्रथमोऽध्यायः ||१||
Meaning of the śloka
Thus ends the first chapter of the Nidanasthana in the Sushruta Samhita, entitled Vātavyādhinidāna, the diagnosis of disorders attributed to vata.
The commentary colophon states that the first chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.
vAtavyAdhinidAna (Vatavyadhinidana)
Diagnosis or description of disorders attributed to vata.