Varana means treatment or prevention. Diseases for which such warding is unavailable are called avarana. The chapter therefore concerns diseases classified as incurable.
Key terms
avAraNIya (avaraniya)
Not capable of being warded off or treated in the prognostic classification of this chapter.
Listen attentively, dear student, to the diseases that become impossible to ward off when accompanied by complications, except through rasayana according to the source.
An upadrava is a later-arising disease dependent on an earlier primary disease. The particle tu emphasizes that the preceding chapter described death through arishta signs, while this chapter concerns complications. Some read ca instead; on that reading, the diseases are accompanied by signs in the form of complications. Jushta means associated with. The commentary claims that rasayana can often make even an incurable disease treatable. Ekamanas means attentive. Some manuscripts read that the diseases go to incurability rather than become impossible to ward off.
Key terms
upadrava
A complication arising later and dependent upon an earlier primary disease.
rasAyana (rasayana)
A traditional rejuvenative intervention presented by the source as an exception to otherwise incurable prognosis.
The eight diseases are major vata disorder, prameha, kushtha, arshas, bhagandara, urinary stone, obstructed fetus, and abdominal disease. These eight are by their very nature difficult to treat and are called major diseases.
The primary diseases are listed before their later complications. Vata disorder here means a major vata disorder, with the word major understood though not written. Repeating the number eight emphasizes that all eight share the classification; the commentary mentions another explanation but omits it to avoid length. By nature means by their inherent character. They are called great diseases because the source regards them as capable of causing death and as incurable. A variant verse reads that these eight are great diseases and always difficult to cross or overcome.
Key terms
mahAgada (mahagada)
A major disease regarded in this source as especially difficult to treat and potentially fatal.
प्राणमांसक्षयः शोषस्तृष्णा च्छर्दिर्ज्वरस्तथा ||५||
अतीसारश्च मूर्च्छा च हिक्का श्वासस्तथैव च |
एतैरुपद्रवैर्जुष्टान् सर्वानेव विवर्जयेत् ||६||
Meaning of the śloka
A physician is instructed to avoid treating any of those diseases when accompanied by complications such as loss of vitality and flesh, wasting, thirst, vomiting, fever, diarrhea, fainting, hiccup and difficult breathing.
Loss of prana and flesh is explained as loss of energy and bodily development. The three conjunctions also include later-mentioned complications such as swelling and numbness of the skin. The plural construction is taken to indicate association with three complications. An alternative verse orders the complications differently and says that a physician seeking success should especially avoid such cases.
Key terms
prANamAMsakShaya (pranamamsakshaya)
Loss of vitality and flesh, explained as diminished energy and bodily development.
The source says that vata disorder destroys a person who is swollen, has numb skin, is broken or weakened, suffers tremor, distension and pressure, and is tormented by deep internal pain.
This begins the disease-specific adverse prognostic signs. The person is understood as having complications beginning with swelling. Numb skin means skin without sensation. Bhagna is explained as broken apart by vata. Internal pain means severe pain arising deep within. A variant reads a person possessing pain and distress, where pain includes pricking and related sensations and distress is glossed as shula.
The specified complications include approach of flies and related signs in kapha forms, descent or rupture involving the testes and related signs in pitta forms, and constriction of the heart and related signs in vata forms. Excessive flow means profuse urination. The pidakas include Sharavika, Kacchapika and other named eruptions. Gadha means present to a severe degree.
Key terms
pramehapiDakA (pramehapidaka)
Named eruptions associated with prameha, including Sharavika and Kacchapika in the commentary.
प्रभिन्नप्रस्रुताङ्गं च रक्तनेत्रं हतस्वरम् |
पञ्चकर्मगुणातीतं कुष्ठं हन्तीह कुष्ठिनम् ||९||
Meaning of the śloka
The source says that kushtha destroys a person whose limbs are broken open and discharging, whose eyes are red, whose voice is lost, and whose condition has gone beyond the benefit of the five kinds of therapeutic action.
Anga connects separately with broken open and discharging. Hatasvara means loss of voice. Some interpret the five actions as emesis and the other pancakarma measures and say they have failed to produce a result, but the commentator rejects this. The preferred explanation takes five as kushtha established in the fifth tissue, bone. The relevant actions include cleansing, pacification, oil application, guggulu, shilajatu and related measures; being beyond their benefit means bone-seated kushtha has gained no improvement from them. Others define the five actions as five groups of treatment: cleansing during prodromal signs, cleansing and application when rasa or skin is involved, and the respective treatments when blood, flesh and medas are involved.
Key terms
pa~jcakarmaguNAtIta (pancakarmagunatita)
Beyond the beneficial result of five therapeutic groupings, with competing explanations of what the five denotes.
The sentence connects arshas with destruction of a person who has complications beginning with thirst and loss of appetite and including the remaining listed features.
Key terms
arshas
A classical disease category whose grave complication signs are listed here; it is left untranslated to preserve its source scope.
Ashmari accompanied by a greatly swollen navel and testicles, urinary obstruction, pain, and gravel-like particles is said to destroy the person quickly.
The named complications accompany ashmari in the stated fatal prognosis. Ashu means quickly. Sikata means sand; the ashmari is accompanied by sharkara resembling grains of sand.
Key terms
ashmarI (ashmari)
The classical disease named in the passage, retained without modern diagnostic equivalence.
sikatAsharkarAnvitA (sikatasharkaranvita)
Accompanied by small concretions or particles resembling grains of sand.
In mudhagarbha, severe obstruction involving the uterus or fetus, makkalla, closure of the vaginal passage, and the complications previously described are said to destroy the woman.
The complications beginning with garbhakoshaparasanga are fatal in the presence of mudhagarbha. The main explanation takes the phrase as an extreme or principal obstruction of the uterus. Others understand parasanga as the fetus leaving its proper place and becoming obstructed elsewhere. Makkalla is the condition described in the account of pregnancy. The commentary notes that it may occur not only after delivery but also before delivery; retained and transforming blood may be termed makkalla when a fetus displaced from the uterus remains lodged at the vaginal opening. Yonisamvrti means contraction or closure of the vaginal passage. Previously described complications include convulsion, cough, difficult breathing and dizziness from the diagnosis of mudhagarbha. Some witnesses read 'would destroy a woman with mudhagarbha' rather than 'would destroy a woman in mudhagarbha.'
Key terms
mUDhagarbha (mudhagarbha)
The classical obstetric condition in which the listed complications occur, retained without modern equivalence.
garbhakoShaparAsa~ggaH (garbhakoshaparasangah)
Severe obstruction of the uterus, or alternatively obstruction of a fetus displaced from its normal position.
पार्श्वभङ्गान्नविद्वेषशोफातीसारपीडितम् |
विरिक्तं पूर्यमाणं च वर्जयेदुदरार्दितम् ||१४||
Meaning of the śloka
A person afflicted by udara should be declined when affected by splitting pain in the side, aversion to food, swelling and diarrhea, and when the abdomen repeatedly fills again after extensive purgation.
Parshvabhanga is a particular pain described as though the side were breaking. The prognosis concerns an udara-afflicted person who has been purged repeatedly with purgative substances but whose abdomen fills again.
Key terms
pArshvabha~ggaH (parshvabhangah)
A particular pain experienced as though the side were breaking.
viriktaM pUryamANam (viriktam puryamanam)
The abdomen filling again after repeated purgation in the source's prognosis.
The text assigns a fatal prognosis in fever to a person who repeatedly faints, lies unconscious or has collapsed, is cold externally and hot within; to one with horripilation, red eyes, compact or severe pain in the cardiac region, and constant open-mouth upward breathing; to an emaciated person afflicted by hiccup, difficult breathing, thirst, confusion, wandering eyes and continuous breathing; and to one with clouded, tear-filled eyes, repeated profound faintness, excessive sleep, and depletion of blood and flesh.
These verses describe internal-medicine diseases judged incurable through complications. Tamyati means repeatedly fainting. The person may lie without consciousness or be collapsed without consciousness. Cold affliction applies externally, while heat means internal burning. Hrshtaroma is raised body hair. Sanghatashula in the cardiac region is pain from a compact mass resembling ashthila; others simply interpret it as severe pain. Constant mouth breathing means breathing upward through the mouth at all times. Mudha means mentally confused, and vibhrantalocana means eyes moving abnormally. The commentary supplies that fever destroys such a person at that very moment. Avilaksha means eyes filled with tears like rice-gruel water, pratamyanta means entering profound faintness, and 'excessively' means day and night. The final prognosis applies to the entire cluster of clouded eyes and the other complications.
Key terms
hRudi sa~gghAtashUla (hrdi sanghatashula)
Pain in the cardiac region attributed to a compact ashthila-like mass, or more generally severe pain.
santatocchvAsinam (santatocchvasinam)
Breathing continuously without normal interruption.
AvilAkSham (avilaksham)
Having clouded eyes filled with tears, compared to rice-gruel water.
The word 'especially' qualifies old age: the same cluster may destroy a person who is not old, but is said to do so with still greater force in an older person. Some witnesses read 'an emaciated person afflicted by bimbishi' instead of 'an emaciated person afflicted by fever.' Bimbishi here denotes pravahika, supported by a cited statement that some learned authorities use bimbishi as another name for pravahika.
Key terms
atIsAraH (atisarah)
The classical disease named as fatal when accompanied by the stated complications.
bimbishI (bimbishi)
A variant reading identified by the commentary with pravahika.
Adhikarana ౧౫ (౨౦) · Śloka ౨౦
శుక్లాక్షమన్నద్వేష్టారమూర్ధ్వశ్వాసనిపీడితం |
కృచ్ఛ్రేణ బహు మేహంతం యక్ష్మా హంతీహ మానవం ||20||
Yakshma is said to destroy a person with white eyes, aversion to food, upward or difficult breathing, and frequent discharge of a large amount of waste only with difficulty.
Krcchrena means with difficulty, and bahu mehanta means discharging a large quantity. The commentary supplies mala, bodily waste, as the object. This indicates that an excessive portion of food is becoming waste; the resulting depletion of flesh and blood is then described as incurable. The fatal statement applies to a person with this feature together with white eyes and the other listed complications. 'Here' means in this treatise.
Key terms
yakShmA (yakshma)
The classical disease named in the passage, retained without a modern diagnostic equivalent.
श्वासशूलपिपासान्नविद्वेषग्रन्थिमूढताः |
भवन्ति दुर्बलत्वं च गुल्मिनो मृत्युमेष्यतः ||२१||
Meaning of the śloka
In a person with gulma who is approaching death, the text describes difficult breathing, colicky pain, thirst, aversion to food, inability to perceive the mass, and weakness.
Granthimudhata means that the gulma can no longer be perceived. These are presented as complications in a person with gulma who is proceeding toward death.
Key terms
granthimUDhatA (granthimudhata)
Failure to perceive the gulma mass, as explained by the commentary.
Baddhanishyanda may mean obstructed urine or an obstructed route for pus. Although vidradhi is not listed under internal medicine, it is included here after gulma because the stated complications render it incurable.
Key terms
baddhaniShyandam (baddhanishyandam)
Obstructed discharge, interpreted as retention of urine or blockage of the path of pus.
Pandu here is glossed as whiteness. Pallor of the teeth and nails is attributed to dosha in bone, while pallor of the eyes and seeing clusters of white objects in every direction are attributed to dosha in marrow.
Key terms
pANDusa~gghAtadarshI (pandusanghatadarshi)
Seeing clusters or masses of white objects in all directions.
Bahushas means repeatedly, and lohitekshana red-eyed. Red eyes and red perception are attributed, as in the preceding passage, to dosha in marrow. Instead of 'seeing the directions as red,' some read 'seeing red eructation,' explained either as blood appearing in an eructation or as seeing every object as blood-red. Others read 'seeing a red mass,' also explained as seeing everything red, while another reading is 'seeing red forms.'
Avanmukha means facing downward and unmukha upward. Strength here means initiative or energy. Jagarishnu means habitually wakeful. Another reading has 'turned downward or turned upward,' with the same meaning.
Key terms
utsAha (utsaha)
Initiative or functional energy, intended by bala in this commentary.
बहुशोऽपस्मरन्तं तु प्रक्षीणं चलितभ्रुवम् |
नेत्राभ्यां च विकुर्वाणमपस्मारो विनाशयेत् ||२६||
Meaning of the śloka
The text says apasmara destroys a severely depleted person who has frequent episodes, moving eyebrows and abnormal movements or appearance of both eyes.
Bahushas means many times, and apasmarantam a person experiencing repeated apasmara episodes. The understood noun after depleted is person. The eye phrase means making both eyes abnormal. The commentary states that all the listed complications of internal-medicine diseases are to be understood as incurable.