A physician beginning treatment should first examine the patient's lifespan. When life remains, the physician should examine the disease, season, agni, age, bodily strength, mental strength, habituation, constitution, medicine and place.
Treatment is said to be undertaken for one with a long enough lifespan. Disease is assessed as treatable or incurable. Season is considered because agni, age-related condition and bodily strength depend on it. Agni includes strong and weak states, age includes childhood and later stages, and body strength includes lean, corpulent and related conditions. Sattva is mental quality, graded as superior and otherwise. Satmya is a taste such as sweet, or a practice such as exercise, habitually used by a person and conducive to comfort. Constitution includes vata and the other types. Medicine is examined because potency depends on dosha, habituation, constitution and related factors. Place includes dry-land and marshy regions. Some understand an omitted and related factors after place, adding medicine timing and other considerations.
Key terms
sAtmya (satmya)
A food quality or practice habituated to the person and conducive to comfort.
The source attributes long lifespan to a person with comparatively large hands, feet, flanks, back, nipple tips, teeth, face, shoulders and forehead; long finger joints, breathing, gaze and arms; broad eyebrows, space between the breasts and chest; short lower legs, genital organ and neck; depth of mind, voice and navel; slightly raised, compact breasts; well-developed, large, hairy ears; a posterior hair whorl or related cranial feature; and a body that, after bathing and anointing, dries successively from the head downward, with the heart region drying last. Such a person is to be treated confidently. Opposite signs indicate short lifespan and a mixture indicates intermediate lifespan.
Large and long each mean slightly exceeding the stated measurements; largeness includes breadth while length does not. Finger joints are the knuckles and prekshana means eyes. Broad applies to eyebrows, the interval between breasts and the chest. Deep sattva means abundance, a deep voice is unctuous and resonant, and a deep navel is recessed. The breasts are slightly raised and compact. The ears are fleshy, broad and hairy. Pashcanmastishka can mean a hair whorl behind the neck. Alternatives read side hair whorls near the crown; a posterior fatty cranial feature called ghritika; one compound describing fleshy, broad, hairy regions beside the ears; or kalamastaka. Drying in order means the head and body dry first and the heart last. Ekantena can mean treating with firm conviction or treating continuously. Some use a variant introductory wording for the opposite signs.
Key terms
dIrghAyuHlakShaNa (dirghayurlakshana)
Traditional bodily and behavioural signs interpreted as indicating long lifespan.
A person whose joints, vessels and ligaments are well concealed, whose limbs are compact and senses steady, and whose successive bodily regions are increasingly well formed is said to have long life. One who has been healthy from the womb onward and gradually develops in body, knowledge and practical understanding is also described in summary as long-lived.
Concealed means protected beneath the body, and compact limbs likewise means well covered. Steady senses can mean unmoving sensory organs; others take indriya as their bodily seats, excluding such signs as protruding or loose eyes. Successive good fields means each bodily region is better formed than the preceding one, beginning with feet and ankles and continuing through ten regions to the hairline and head. Bodily growth includes development of medas and related tissues. Jnana is understanding of principles and vijnana skill in activities such as art. An omitted and related qualities after vijnana includes auspicious attainments. A cited verse conversely says that a person who develops sexual signs, learning, body bulk, intelligence, wealth and fame too early will not live long.
Key terms
sukShetra (sukshetra)
A well-formed bodily region within the traditional sequence of ten body fields.
vij~jAna (vijnana)
Practical skill, illustrated by competence in arts and related activities.
Adhikarana ५ (७-८) · Śloka ९
मध्यमस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे |
अधस्तादक्षयोर्यस्य लेखाः स्युर्व्यक्तमायताः ||७||
द्वे वा तिस्रोऽधिका वाऽपि पादौ कर्णौ च मांसलौ |
नासाग्रमूर्ध्वं च भवेदूर्ध्वं लेखाश्च पृष्ठतः ||८||
यस्य स्युस्तस्य परममायुर्भवति सप्ततिः |९|
Meaning of the śloka
For intermediate lifespan, the source lists clearly elongated lines below the eyes, numbering two, three or more; fleshy feet and ears; an upward-turned nasal tip; and upward-running lines on the back. A person with these signs is assigned a maximum lifespan of seventy years.
Akshi is interpreted as the orbital bone, and lekha as lines or streaks. Some read below the hands instead of below the eyes.
Key terms
madhyamAyuH (madhyamayuh)
Intermediate lifespan in the source's threefold prognostic scheme.
Adhikarana ६ (९-११) · Śloka ११
जघन्यस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे ||९||
हस्वानि यस्य पर्वाणि सुमहच्चापि मेहनम् |
तथोरस्यवलीढानि न च स्यात्पृष्ठमायतम् ||१०||
ऊर्ध्वं च श्रवणौ स्थानान्नासा चोच्चा शरीरिणः |
हसतो जल्पतो वाऽपि दन्तमांसं प्रदृश्यते |
प्रेक्षते यश्च विभ्रान्तं स जीवेत्पञ्चविंशतिम् ||११||
Meaning of the śloka
For short lifespan, the source lists short joints, an exceptionally large genital organ, contrary whorls on the chest, a back that is not long, ears placed high, a raised nose, gums visible while laughing or speaking, and a confused gaze. Such a person is assigned a lifespan of twenty-five years.
Jaghanya means short or lowest. Mehana means the male genital organ. Avalidhani are opposing hair-whorl patterns on the chest. Some have a different reading at this phrase, but it is absent from the available commentary and is not reproduced. Vibhranta means markedly confused. Years is understood after twenty-five.
Key terms
jaghanyAyuH (jaghanyayuh)
Short or lowest lifespan in the source's prognostic scheme.
For further assessment of lifespan, the source gives traditional measurements of limbs and subparts in units of the person's own finger breadth. The great toe and second toe are two angulas long, and each succeeding toe is one-fifth shorter. The forefoot and sole are four angulas long and five broad; the heel is five long and four broad; and the foot is fourteen long. Circumferences at the foot, ankle, mid-calf and mid-knee are fourteen. The lower leg is eighteen long, and the distance above the knee to the hip is thirty-two, together making fifty; the thighs correspond in length to the lower legs. Two-angula measures are assigned to the testis, chin, teeth, outer nostril portions, ear root, eyebrows and interval between the eyes. Four-angula measures apply to the genital organ, opened mouth, nasal ridge, ear, forehead and neck height, and interval between the visual centres. Twelve-angula measures apply to the genital opening, intervals from genital organ to navel, navel to heart, heart to neck and between breasts, face length, and circumference of wrist and forearm. The mid-calf circumference and distance from shoulder head to elbow are sixteen. The hand from elbow to middle fingertip is twenty-four; the arms are thirty-two; the thighs have a circumference of thirty-two; and wrist to elbow is sixteen. The palm is six long and four broad. The interval from thumb root to index finger, ear opening to outer eye corner, and length of the middle finger are five. Index and ring fingers are four and a half, and little finger and thumb three and a half. Face and neck together are described through a twenty-four measure. The nostril boundary is one and one-third angulas; the pupil has one-third the eye's circumference, and the visual centre is one-ninth of the pupil. Hairline to crown is eleven, crown to the posterior hairline ten, and between the depressions behind the ears fourteen. A woman's pelvis equals a man's chest measure; the chest is eighteen broad, and a man's waist has that measure. Total male reach or height with arms raised is one hundred and twenty angulas.
Anga comprises trunk, two legs, two arms and head; pratyanga means their components. Sakthi extends from the hip joint to the toes. Measurements proceed from the great toe toward the crown and use the subject's own fingers, excluding the nail where stated. One-fifth of the toe is explained as half an angula. A variant gives forefoot breadth six and sole breadth five. Heel length and breadth are five and four. Some read thirteen rather than fourteen for circumferences, twenty-four rather than eighteen for lower-leg length, twenty rather than sixteen from shoulder to elbow, and eighteen rather than sixteen from wrist to elbow. The eighteen-angula thigh reading follows the statement that thigh length equals lower-leg length. The commentary provides detailed anatomical assignments for each compound, including separate outer nostril portions and the interval of the two eyes. Four angulas for the genital organ applies without its elevation to one traditional male type, and six with elevation. The twelve-angula genital-opening measure is attributed to a traditional female type cited from Kamashastra. Face length runs from chin to forehead. The earlier fourteen-angula calf circumference is located nearer the ankle, while the sixteen-angula Indrabasti circumference is nearer the knee. A hand here runs from elbow through the middle fingertip. Variant readings affect the finger pair beginning at thumb root, the combined face-neck clause, nostril width, and chest and neck widths. The visual measurements distinguish the black part of the eye, pupil and central visual area, with an attempted reconciliation of surgical and Shalakya measures. The female pelvis is the region below the hip joint and above the genital region. The commentary variously gives male chest as twelve or twenty-four in explaining the comparison, while the source later states an eighteen-angula chest for a woman and the same for a man's waist. The final one-hundred-twenty measure is for a man standing with arms raised.
Key terms
svA~ggula (svangula)
The person's own finger breadth used as the unit of proportional measurement.
a~gga-pratya~gga (anga-pratyanga)
Major body divisions and their component subparts.
indrabasti
The mid-calf region, specified here near the knee for a circumference measure.
A skilled physician is instructed to regard a man in his twenty-fifth year and a woman in her sixteenth as having reached bodily completeness and mature vigour.
The preceding measurements of features such as female pelvis and male chest are said to apply in youth rather than early age. At the stated ages, full bodily measure and vigour are considered established. Another quotation similarly assigns full strength and suitability for measurement to a man at twenty-five and a woman at sixteen, or at one-quarter of life. Samatvagata means completeness has been attained, and virya is complete through fullness of rasa and the other tissues. A variant reads samanvagatavirya, explained as strength and growth having properly arrived afterward.
Key terms
samatvAgatavIrya (samatvagatavirya)
Having reached bodily completeness and mature vigour in the source's age scheme.
Adhikarana ९ (१४) · Śloka १४
देहः स्वैरङ्गुलैरेष यथावदनुकीर्तितः |१४|
Meaning of the śloka
The body's measurements have been stated using the person's own finger breadths.
This clarifies that the preceding dimensions are expressed through the measured person's own angula unit and were stated according to the prescribed method.
Key terms
a~ggula (angula)
A proportional finger-breadth unit based on the individual being measured.
Adhikarana १० (१४-१५) · Śloka १५
युक्तः प्रमाणेनानेन पुमान् वा यदि वाऽङ्गना ||१४||
दीर्घमायुरवाप्नोति वित्तं च महदृच्छति |
मध्यमं मध्यमैरायुर्वित्तं हीनैस्तथाऽवरम् ||१५||
Meaning of the śloka
A man or woman conforming to these full measurements is said to obtain long life and great wealth. Intermediate signs correspond to intermediate lifespan and wealth, and deficient signs to lesser lifespan and wealth.
The passage states the proposed purpose of the measurements. Intermediate means possessing the middle-grade characteristics. Vitta means wealth, and avara means lesser. Hina refers to the deficient characteristics.
The tissue and mental essences are next described. Sattva essence is marked by memory, devotion, discernment, purity, courage and commitment to what is beneficial. Shukra essence is associated with unctuous, compact, white bones, teeth and nails, strong desire and many offspring. Majja essence is associated with a body that is not emaciated, excellent strength, an unctuous deep voice, good fortune and large eyes. Bone essence is associated with a large head and shoulders and firm teeth, jaw, bones and nails. Medas essence is associated with unctuous urine, sweat and voice, a large body and tolerance of exertion. Flesh essence is associated with an even body without depressions, well-covered bones and joints, and developed flesh. Blood essence is associated with unctuous copper-coloured nails, eyes, palate, tongue, lips, palms and soles. Skin essence is associated with exceptionally clear, soft skin and hair. Among these, each earlier essence is considered more important than the following one for lifespan and good fortune.
Memory is recollection, prajna understanding across past, present and future, courage freedom from despondency in action, and commitment to good means diligent orientation toward it. Sattva essence means abundance of sattva quality. For shukra, unctuous, compact and white each applies to bones, teeth and nails; many desires and many offspring are separately intended. Majja essence includes possession of good fortune. Large applies separately to head and shoulders in bone essence, and firm to teeth, jaw, bones and nails. Unctuous applies separately to urine, sweat and voice in medas essence; a large body is a strong build and tolerance of exertion means capacity for difficult activity. Flesh essence includes a body without depressions and concealed bone joints. Unctuous and copper-coloured each apply to all listed blood signs. Clear and soft apply to both skin and hair. Skin essence is interpreted as rasa essence because skin here denotes rasa situated in the skin. Earlier means each preceding essence in the list is considered superior for lifespan and saubhagya, meaning appearing attractive to everyone.
Key terms
sAra (sara)
The excellence or predominance of a mental quality or bodily tissue, inferred from traditional signs.
sattvasAra (sattvasara)
Excellence of mental qualities such as memory, discernment and courage.
tvaksAra (tvaksara)
Skin or rasa essence, associated here with clear, soft skin and hair.
A highly skilled physician who examines lifespan through the measurements of major and minor body parts and through the essences is said to succeed in treatment.
Viseshatah means distinguishing the measures and essences from one another. The physician also determines lifespan through contrary wound signs, messengers, chaya, bodily and natural alterations, complications and incurability, and then distinguishes superior, inferior and intermediate lifespan through features such as a large forehead. Sunipuna means exceptionally skilled. Some read generally rather than particularly, interpreting this as assessment in broad outline.
Adhikarana १३ (१८) · Śloka १८
व्याधिविशेषास्तु प्रागभिहिताः; सर्व एवैते त्रिविधाः- साध्या, याप्याः, प्रत्याख्येयाश्च |
तत्रैतान् भूयस्त्रिधा परीक्षेत- किमयमौपसर्गिकः, प्राक्केवलः, अन्यलक्षण इति |
तत्र, औपसर्गिको नाम यः पूर्वोत्पन्नं व्याधिं जघन्यकालजातो व्याधिरुपसृजति, स तन्मूल एवोपद्रवसञ्ज्ञः; प्राक्केवलो नाम यः प्रागेवोत्पन्नो व्याधिरपूर्वरूपोऽनुपद्रवश्च; अन्यलक्षणो नाम यो भविष्यद्व्याधिख्यापकः, स पूर्वरूपसञ्ज्ञः |
तत्र, सोपद्रवमन्योन्याविरोधेनोपक्रमेत, बलवन्तमुपद्रवं वा; प्राक्केवलं यथास्वं प्रतिकुर्वीत; अन्यलक्षणे त्वादिव्याधौ प्रयतेत ||१८||
Meaning of the śloka
Diseases described earlier are of three kinds: treatable, maintainable and to be declined. They should again be examined in three ways: as a complication, as a primary disease arising alone, or as a sign of another disease. A complication is a later disease that attaches to an earlier disease and arises from it. A primary solitary disease arises first without prodromal signs or complication. A sign of another disease announces a future disease and is called purvarupa. When a primary disease has a complication, treat both without conflict or first treat the stronger complication. Treat a solitary primary disease according to its own therapy. When prodromal signs occur, direct effort toward the disease that is beginning.
The earlier diseases are those described in the opening and disease-classification chapters. The conjunction after declined shows that even a declined case can sometimes be treated after warning, as cited for certain ear and mouth diseases. Aupasargika here means upadrava. Prakkevala lacks both prodrome and complication. Anyalakshana means a prodrome of a future disease. A later disease joins the earlier one and has it as its cause. It is the later disease itself, not merely simultaneous signs of the root disease, that is called a complication, although persistent signs can acquire that designation. The singular does not restrict a case to one complication; multiple later diseases can qualify. Upadrava and upasarga are synonymous. Examples of solitary diseases include mashaka, tilakalaka, nyaccha and vyanga, which arise by their nature without a prodrome. Treating without conflict means that measures for the root disease and complication do not oppose each other. If the complication is stronger it is treated first. In prodrome, according to its own treatment carries forward and effort is directed to the impending primary disease.
Key terms
aupasargika
A later complication arising from and attaching to a prior primary disease.
prAkkevala (prakkevala)
A primary disease arising alone, without prodromal signs or complications.
anyalakShaNa (anyalakshana)
A sign announcing another future disease, identified as purvarupa.
Because no disease exists without doshas, a discerning physician should treat even a disease not explicitly described by recognising the signs of the involved doshas.
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व्याधीनामानन्त्याद्दोषभेदेनानुक्तस्य व्याधेर्दोषव्यपेक्षाचिकित्सार्थं, तथा रोगकृतस्यापि रोगस्य चिकित्सामपि कर्तुं, न कार्यव्याधिमात्रस्य नापि तु हेतुव्याधिमात्रस्येति कथयन्नाह- नास्तीत्यादि| अनुक्तमपि व्याधिं दोषाणां लिङ्गैः कृत्वोपाचरेदिति सम्बन्धः||१९||
Meaning of the commentary
Diseases are innumerable. Therefore an unnamed disease is treated according to its dosha differentiation, and a disease caused by another disease is treated as well. Treatment should address neither only the resulting disease nor only the causal disease, but the relevant whole. The grammatical connection is that an unlisted disease is treated through the signs of the doshas.
Key terms
doShali~gga (doshalingga)
Signs indicating the dosha involvement used to guide treatment of an unnamed disease.
In cold weather, measures opposing cold should first be arranged; in hot weather, heat should first be checked. The indicated procedure should then be performed without allowing the proper time for action to pass.
The verse gives a special rule for an urgent disease occurring in a dissimilar season. Opposing cold means creating warmth, and preventing heat means creating coolness. Kriya includes procedures such as agnikarma when indicated. The proper opportunity must not be missed because delay is said to risk severe distress, failure and incurability, while time itself has great force. The commentary cites the example that medicine given while doshas remain ama may intensify fever. The conjunction also includes measures against rain. Others say rain is already included under cold because of its cooling character.
Key terms
kriyAkAlam (kriyakalam)
The proper opportunity or timing for the indicated therapeutic action.
Atyayika (atyayika)
Urgent, qualifying the disease situation discussed by the commentary.
Adhikarana १७ (२२) · Śloka २२
अप्राप्ते वा क्रियाकाले प्राप्ते वा न कृता क्रिया |
क्रिया हीनाऽतिरिक्ता वा साध्येष्वपि न सिध्यति ||२२||
Meaning of the śloka
A procedure performed before its proper time, omitted when the proper time has arrived, or applied in deficient or excessive measure does not succeed even in curable conditions.
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कीदृशी क्रिया न सिध्यतीत्याह- अप्राप्ते वेत्यादि| अप्राप्ते काले अनागते काले, क्रिया कृता साध्येष्वपि न सिध्यतीति सम्बन्धः| अनागते हि काले क्रिया कृता न सिध्यति, तथाच प्रागुक्तं- भेषजं ह्यामदोषस्येत्यादि| प्राप्ते वा न कृता क्रियेति अतीते काले क्रिया कृतेत्यर्थः; साऽपि साध्येष्वपि व्याधिषु न सिध्यति| यथा- जीर्णज्वरे क्षीरमांसरसस्नेहसाध्ये लङ्घनमिति| क्रिया हीनाऽतिरिक्ता वेति बहुदोषे हीना क्रियाऽकिञ्चित्करी, अल्पदोषे महती रोगिजीवितहरी रोगान्तकारिणी च| चकारान्मिथ्या क्रिया चानुक्ता समुच्चीयते; तद्यथा- शीतसाध्ये उष्णा, उष्णसाध्ये शीता चेति||२२||
Meaning of the commentary
An action performed before its time fails, as illustrated by medicine given before an ama state has resolved. Failure to act at the proper time means acting only after the opportunity has passed; the commentary gives fasting in an established fever that instead requires milk, meat broth and unctuous treatment. A deficient measure does nothing when doshas are abundant, while an excessive measure in slight dosha disturbance may take life or create another disease. The conjunction also includes wrong treatment, such as heat where cooling is indicated or cooling where heat is indicated.
Key terms
hInA (hina)
Deficient in measure relative to the condition.
atiriktA (atirikta)
Excessive in measure relative to the condition.
Adhikarana १८ (२३) · Śloka २३
या ह्युदीर्णं शमयति नान्यं व्याधिं करोति च |
सा क्रिया, न तु या व्याधिं हरत्यन्यमुदीरयेत् ||२३||
Meaning of the śloka
A true treatment is one that calms the aggravated condition without producing another disease. An intervention that removes one disease while provoking another is not considered proper treatment.
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क्रियाऽक्रिययोर्लक्षणमाह- येत्यादि| उदीर्णम् उत्कटम्| न तु या व्याधिं हरत्यन्यमुदीरयेदिति न पुनः सा क्रिया कथ्यते, या एकं व्याधिं हरत्यन्यं प्रकोपयतीत्यर्थः| यथा- कृशबृंहणेऽग्निसादमेहातीसारादयः, यथा वा स्थौल्यापकर्षणे मेहचिकित्सापतर्पणे च यक्ष्मवातरोगादयः||२३||
Meaning of the commentary
Udirna means markedly aggravated. The commentary illustrates improper intervention with nourishing a lean person in a way that produces weak digestive fire, prameha or diarrhea, and with reducing corpulence or under-nourishing prameha in a way that produces yakshma or vata disorders.
Key terms
kriyA (kriya)
Proper treatment, defined as calming the target disorder without provoking another.
Adhikarana १९ (२४) · Śloka २४
प्रागभिहितोऽग्निरन्नस्य पाचकः |
स चतुर्विधो भवति- दोषानभिपन्न एकः, विक्रियामापन्नस्त्रिविधो भवति- विषमो वातेन, तीक्ष्णः पित्तेन, मन्दः श्लेष्मणा, चतुर्थः समः सर्वसाम्यादिति |
तत्र, यो यथाकालमुपयुक्तमन्नं सम्यक् पचति स समः, समैर्दोषैः; यः कदाचित् सम्यक् पचति, कदाचिदाध्मानशूलोदावर्तातिसारजठरगौरवान्त्रकूजनप्रवाहणानि कृत्वा, स विषमः; यः प्रभूतमप्युपयुक्तमन्नमाशु पचति स तीक्ष्णः, स एवाभिवर्धमानोऽत्यग्निरित्याभाष्यते, स मुहुर्मुहुः प्रभूतमप्युपयुक्तमन्नमाशुतरं पचति, पाकान्ते च गलताल्वोष्ठशोषदाहसन्तापाञ्जनयति; यस्त्वल्पमप्युपयुक्तमुदरशिरोगौरवकासश्वासप्रसेकच्छर्दिगात्रसदनानि कृत्वा महता कालेन पचति, स मन्दः ||२४||
Meaning of the śloka
Agni, previously described as the digester of food, is fourfold. In its altered forms it is irregular through vata, sharp through pitta, and weak through kapha; the fourth is balanced through balance of all doshas. Balanced agni properly digests food taken at the right time. Irregular agni sometimes digests properly and sometimes does so only after producing distension, pain, udavarta, diarrhea, abdominal heaviness, intestinal sounds and straining. Sharp agni rapidly digests even abundant food; when it increases further it is called atyagni and repeatedly digests large amounts still more rapidly, followed by dryness, burning and heat of the throat, palate and lips. Weak agni takes a long time to digest even a small amount after producing heaviness of abdomen and head, cough, difficult breathing, salivation, vomiting and bodily fatigue.
The earlier reference to agni is in the wound discussion. Although agni is fivefold when divided as bhrajaka and the other forms, it is fourfold in the present functional classification. Dosha contact does not itself always mean pathological alteration, since people of vata and other constitutions may have dosha association without disease. Balanced agni is therefore stated first to place the normal condition before alteration. Vata sometimes leaves digestion undisturbed and sometimes disperses agni unevenly so food does not digest properly. Kujana is a gurgling sound and pravahana is straining. Sharp agni has three degrees: rapid digestion, neglected atyagni also called bhasmaka, and the still sharper neglected form that repeatedly digests food and causes dryness and heat after digestion. Some witnesses add a passage explaining pitta joined by vata, but it was unavailable and is not reproduced. Praseka is salivation and gatrasadana is fatigue of the limbs.
Key terms
samAgni (samagni)
Balanced digestive fire that digests appropriately timed food properly.
viShamAgni (vishamagni)
Irregular digestive fire associated with vata in this classification.
atyagni
An intensified form of sharp agni, also called bhasmaka in the commentary.
Balanced agni should be maintained. Irregular agni is addressed with unctuous, sour and salty measures; sharp agni with sweet, unctuous and cooling measures and purgation; atyagni in the same way, especially with buffalo milk, curd and ghee; and weak agni with pungent, bitter and astringent measures and emesis.
Maintenance means keeping balanced agni in that same state. 'In the same way' applies the sweet, unctuous and cooling measures together with purgation to atyagni.
The revered jatharagni, situated in the abdomen, governs and digests food. Because it is subtle while taking up tastes, it cannot be directly distinguished.
Jathara means abdomen and jathara agni is that which exists there. Bhagavan means possessing greatness, while ishvara is explained through the eight extraordinary powers beginning with anima. Agni is not visible because of subtlety but is known through its effects. An objection asks how an all-powerful agni can become weak. One answer attributes weakness and other faults to the person's prior action; another says agni depends on pitta, so its impairment arises from disruption of pitta rather than from agni itself. Agni takes up sweet and the other tastes for digestion and is inferred from the effect of food digestion rather than perceived directly.
Key terms
jAThara agni (jathara agni)
The subtle digestive fire situated in the abdomen in the passage's doctrine.
saukShmyAt (saukshmyat)
Because of subtlety, explaining why agni is inferred from effects rather than directly perceived.
As wind assists external fire, vayu assists jatharagni. 'From all sides' may mean in every direction. Others take it as distinguishing these three from all forms of vayu: prana and apana kindle the fire, while samana sustains it; vyana and udana do not perform these roles. Remaining in their own courses means that the three are unaltered and carry out their proper actions in their respective paths. Some witnesses add a passage beginning 'when agni is properly joined' to emphasize its primacy, but it was unavailable and is omitted.
Key terms
prANApAnasamAnaiH (pranapanasamanaih)
By prana, apana and samana, the three vayus assigned roles in kindling and sustaining jatharagni.
Age is threefold: childhood, middle age and old age. Those below sixteen are children, divided into milk-fed, milk-and-food-fed, and food-fed. Milk-fed extends through the first year, milk and food through the second, and food thereafter. Middle age extends from sixteen to seventy and comprises growth, youth, completeness and decline: growth through twenty, youth through thirty, fullness of tissues, senses, strength and virility through forty, and gradual decline thereafter until seventy. Beyond seventy, old age is described through daily decline of tissues, senses, strength, virility and vigor; wrinkles, gray hair and baldness; complications such as cough and difficult breathing; incapacity for activities; and sinking like an old house soaked by rain.
Below sixteen means through the fifteenth year. Milk-fed refers to breast milk, milk-and-food-fed to both milk and solid food, and food-fed to solid food alone beginning in the third year. An alternate childhood reading is mentioned but unavailable. Middle age lies between sixteen and seventy. Growth means bodily increase. Youth may mean the mixture of growth and completeness; others define it as the transformation characteristic of a young person. Completeness is the nourishment of fully grown parts. Some read the upper limit of decline as sixty rather than seventy. Virya here means semen, vali contraction of skin, palita whitening of hair, and khalitya baldness. Old age is compared to an old building drenched by rain and collapsing.
Key terms
vayaH (vayah)
Age, divided here into childhood, middle age and old age.
parihANiH (parihanih)
The stage of gradual decline within middle age.
Adhikarana २५ (३०) · Śloka ३०
तत्रोत्तरोत्तरासु वयोवस्थासूत्तरोत्तरा भेषजमात्राविशेषा भवन्ति, ऋते च परिहाणेः; तत्राद्यापेक्षया प्रतिकुर्वीत ||३०||
Meaning of the śloka
In successive stages of age, progressively greater medicine quantities are used, except during decline. In the stage of decline, treatment should be measured with reference to the earliest stage.
The purpose of knowing age is adjustment of medicine quantity. Successive stages from childhood through youth receive progressively larger measures, except after seventy. In decline, the quantity is compared with childhood, specifically that for a sixteen-year-old. The commentary cites another treatise: a newborn receives one raktika in the first month in a lickable preparation with honey, milk, sugar and ghee; the amount rises monthly through the first year, then by one masha yearly through sixteen, remains at the adult measure through seventy, and returns to a child-like measure thereafter. It also refers to dosage divisions elsewhere in this treatise. Some read 'with reference to the other stage' and interpret that other stage as growth, reaching the same sixteen-year comparison.
Key terms
bheShajamAtrA (bheshajamatra)
The quantity of medicine varied according to the age classification.
AdyApekShayA (adyapekshaya)
With reference to the earliest stage, interpreted as a childhood or sixteen-year measure.
Kapha predominates in childhood, pitta in middle age, and vayu most strongly in old age. Treatment should be planned after considering this.
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दोषचयादावपि वयोज्ञानफलं दर्शयन्नाह- बाले इत्यादि| भूयिष्ठं बहुतरम्| एतेन यथा बाले श्लेष्मा न तथा पित्तवातावित्यर्थः; एवं शेषयोरपि||३१||
Meaning of the commentary
Bhuyishtha means more abundant. Thus kapha is more prominent than pitta and vata in childhood, with corresponding predominance understood for pitta in middle age and vata in old age.
Key terms
bhUyiShTham (bhuyishtham)
Most abundant or predominant relative to the other doshas.
Fire treatment, alkali and purgation should be avoided in children and older people. In disorders considered treatable by these, a mild procedure should instead be performed gradually.
The passage gives age-specific modification of procedures. Even fire can be made mild by using gentle materials such as goat dung as its support. Alternatively, 'mild procedure' refers to incision or opening using the specific medicines prescribed for children, older people, those unable to tolerate treatment, the depleted, fearful persons, women and diseases over vital points. Alkali is made mild by omitting strong added ingredients, and purgation by basing it on mild substances such as caturangula. Shanaih means gently or slowly.
Key terms
mRudvIM kriyAm (mrdvim kriyam)
A mild form of the otherwise indicated procedure, performed gradually.
Adhikarana २८ (३३) · Śloka ३३
देहः स्थूलः, कृशो, मध्य, इति प्रागुपदिष्टः ||३३||
Meaning of the śloka
Body build, previously taught, is of three kinds: stout, lean and intermediate.
Strength has the qualities already described. Weakness should be assessed according to constitution, doshas, ageing and similar causes. Because a strong person can undertake every activity, strength is foremost among the factors supporting action.
Previously described strength refers back to the teaching on ojas. Constitutional weakness derives from parental reproductive factors, and weakness may also arise from doshas or old age. Another reading says strength is dependent on age and explains the stages as milk-fed, milk-and-food-fed, and food-fed. Pravritti means performance; a variant reads pratipatti with the same sense. Adhikarana means a basis of action.
Key terms
balam
Strength as the principal capacity supporting action.
Some lean people possess vitality, while some corpulent people have little strength. Therefore the physician should infer firmness and strength through capacity for exercise.
The verse distinguishes bodily development from functional power because the two do not always correspond. Exercise is used to assess strength in the sense of stability or endurance.
Sattva is the quality that prevents collapse during adversity, prosperity and required action. A sattvika person steadies the mind through personal understanding and endures everything; a rajasa person endures when supported by others; a tamasa person does not endure even with support.
Sattva is mental strength, opposed to rajas and tamas, and produces endurance of distress. Adversity means suffering and prosperity a cause of pleasure; sattva prevents dejection in the former and excessive elation in the latter. Sattva represents high mental strength, rajas moderate strength and tamas weakness. The sattvika person firms the mind through buddhi; the rajasa requires other people, while the tamasa cannot endure even then.
Key terms
sattvam
Mental strength expressed as steadiness and endurance.
Satmya includes habits involving region, time, community or species, season, disease, exercise, water, daytime sleep, tastes and similar factors that cause no distress even when contrary to ordinary nature. Whatever taste, exercise-derived practice or other habit consistently produces comfort for a person is called satmya.
Satmya is what produces comfort. Region may mean land or the patient's body; bodily compatibility may concern the whole, as sweet taste nourishing all tissues, or a part, as substances suited to eyes, hair or throat. Land compatibility also concerns whole regions or local peoples and their customary foods. Further classes include species, seasonal regimen, disease-specific use, bodily, verbal or mental exercise, all four forms of food implied by water, and daytime sleep together with waking. Some explicitly read rasa, taking water and taste to include milk, curd, ghee and other foods. 'Contrary to prakriti' may mean naturally contrary or contrary to one's doshic constitution. Another reading says 'when excessively used for comfort.'
Key terms
sAtmyam (satmyam)
A personally or contextually habituated factor that is tolerated and produces comfort.
Adhikarana ३४ (४१) · Śloka ४१
प्रकृतिं भेषजं चोपरिष्टाद्वक्ष्यामः ||४१||
Meaning of the śloka
Prakriti and medicines will be explained later.
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प्रकृतेर्भेषजस्य च क्व पुनः परीक्षेत्याह- प्रकृतिमित्यादि| प्रकृतिं शारीरे, भेषजं भूमिप्रविभागीये, आतुरोपक्रमणीयाध्यायादनन्तरं सूत्रस्थानसमाप्तिं यावद्भेषजपरीक्षैवेत्येके||४१||
Meaning of the commentary
Prakriti is examined in the Sharirasthana and medicines in the Bhumipravibhagiya chapter. Some say that everything from the end of this chapter to the close of the Sutrasthana is examination of medicine.
Land is anupa, jangala or sadharana. Anupa has abundant water, uneven low and high ground, rivers, rain and dense growth, soft cool wind, many large mountains and trees, generally soft, delicate, well-developed people, and predominance of kapha and vata disorders. Jangala is open and level like the sky, with sparse small thorny trees, little rain and little water in springs and wells, hot harsh wind, few small hills, generally firm lean people, and predominance of vata and pitta disorders. Sadharana combines characteristics of both.
The repeated 'abundant' applies to water through rain, and gahana means made dense by these. Akashasama means unobstructed, even land without depressions and elevations. The jangala description means sparse, few, mostly thorny trees and generally little water from rain, springs and wells.
The verse states the doshic implication of understanding the three land types.
Adhikarana ३७ (४४-४५) · Śloka ४५
न तथा बलवन्तः स्युर्जलजा वा स्थलाहृताः |
स्वदेशे निचिता दोषा अन्यस्मिन् कोपमागताः ||४४||
उचिते वर्तमानस्य नास्ति देशकृतं भयम् |
आहारस्वप्नचेष्टादौ तद्देशस्य गुणे सति ||४५||
Meaning of the śloka
Disorders arising in water-rich land are less powerful when taken to dry land. Doshas accumulated in their own region may become aggravated in another. One who follows a suitable regimen need not fear harm from region, provided food, sleep, activity and related conduct possess qualities appropriate to that region.
Examples from anupa include shlipada. Kapha accumulated in anupa may aggravate in jangala. Uchita means appropriate. Harm still occurs if conduct is unsuitable, as when someone with accumulated kapha continues daytime sleep in jangala. Even amid jangala dryness and heat, conduct should remain appropriate and possess qualities opposed to kapha.
A newly arisen disease opposite to the region, constitution, habituation and season is easiest to treat when physician and other supports, strength, sattva and lifespan are complete, the disease is caused by one dosha or lacks complications, and body and agni are balanced. With opposite features it is incurable; with mixed features it is difficult to treat.
Examples are kapha disease in jangala, kapha disease in pitta constitution, kapha disease in one habituated to pungent taste, and vata disease in autumn, pitta disease in winter or kapha disease in summer. Achirotthita means recent. Others say the negative construction allows even an old condition such as raktagulma to be treatable. Sampatti means completeness and applies also to strength, sattva and lifespan. Kevala means single-dosha or uncomplicated.
Key terms
vyAmishralakShaNaH (vyamishralakshanah)
Having a mixture of favourable and unfavourable prognostic features.
If one treatment produces no benefit, another should be used after the force of the first has subsided; mixing treatments together is not beneficial.
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क्रियाफलं यदा न दृश्यते तदाऽन्या क्रिया कर्तव्या; साऽपि विश्रम्य कालान्तरिता सती कर्तव्येति दर्शयन्नाह- क्रियाया इत्यादि| पञ्चरात्र्यन्तरिता षड्रात्र्यन्तरिता वाऽन्या क्रिया प्रयोक्तव्या| सङ्करो युगपद्द्वयोः प्रयोगः||४८||
Meaning of the commentary
When no result appears, another treatment is used only after a pause, stated as an interval of five or six nights. Sankara means simultaneous use of two treatments.
Adhikarana ४० (४९) · Śloka ४९
गुणालाभेऽपि सपदि यदि सैव क्रिया हिता |
कर्तव्यैव तदा व्याधिः कृच्छ्रसाध्यतमो यदि ||४९||
Meaning of the śloka
Even when benefit is not immediately obtained, if the same treatment remains suitable it should continue when the disease is especially difficult to treat.
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यस्यापि फलं न दृश्यते साऽपि सप्तरात्रं प्रकर्तव्येत्याह- गुणालाभ इत्यादि| सपदि शीघ्रं यदा पुनः कृच्छ्रसाध्यो व्याधिस्तदा गुणस्य क्रियाफलस्यालाभेऽपि हिता या क्रिया सैव प्रयोक्तव्या| अस्मिञ्छ्लोके पाठान्तरमस्ति, तच्चाभावान्न लिखितम्||४९||
Meaning of the commentary
The commentary says such a treatment may be continued for seven nights. Sapadi means quickly: when a difficult disease shows no result but the procedure remains appropriate, that same procedure is applied. The commentary notes another reading but does not provide it because it was unavailable.
The discerning physician who consistently maintains this method while adapting it to time and other factors cuts people free from the noose of death and masses of disease with the axe of medicine.
This is praise of the preceding method. Ekarupa means holding it without confusion, while kaladivashena means according to the power of time and other factors. Some omit the verse. Some teachers count six arishta chapters from Viparitaviparitavrana through Avaraniya; others include Aturopakramaniya as an arishta chapter. Elders direct that arishta chapters be recited outside the home, such as in a temple, from fear of obstacles.
Adhikarana पुष्पिका · Śloka ३५
इति सुश्रुतसंहितायां सूत्रस्थाने आतुरोपक्रमणीयो नाम पञ्चत्रिंशोऽध्यायः ||३५||
Meaning of the śloka
Thus ends the thirty-fifth chapter, called Aturopakramaniya, in the Sutrasthana of the Sushruta Samhita.