15. dōṣadhātumalakṣayavr̥ddhivijñānīyādhyāyaḥ

Meaning of the commentary

Doshas begin with vata; dhatus include rasa and the upadhatus; wastes begin with faeces. Others supply an understood 'and so forth' after wastes, thereby including breast milk, artava, the embryo and related entities.

Meaning of the commentary

This explains why their depletion and increase must be discussed. Just as roots are central to a tree's arising, continued existence and destruction, vata and the other constituents have that foundational role for the body.

Meaning of the commentary

Balance, depletion and increase are known both through characteristic qualities and through actions. The qualities of vata, pitta and kapha are described elsewhere; the present account concerns actions. In one interpretation, bodily movement belongs to vyana; sustaining the objects of the senses to udana; filling with food to prana; separating rasa, urine and faeces to samana; and drawing out shukra, urine and similar substances at the proper urge, while retaining them otherwise, to apana. These are the five divisions. Others regard these actions as common to all five vayus: movement includes breathing, carrying means transporting doshas, dhatus and wastes, filling means bringing food-rasa and other materials to their respective sites, separation has the same meaning as before, and retention means supporting the bodily mechanism.

Meaning of the commentary

The verb 'produces' applies to each item. Ranjaka colours rasa; pachaka digests food; sadhaka produces ojas, described as soma-like and seated in the heart, and medha, the capacity to grasp a text. Alochaka produces tejas, here interpreted as sight; a quotation notes that tejas can denote sight or shukra. Bhrajaka in the skin produces bodily warmth. These are the five divisions, and their actions provide benefit to the body. Others interpret tejas as the skin's colour-revealing radiance and regard the listed actions as common to all forms of pitta.

Meaning of the commentary

Joint binding is restated to remove a possible doubt that it belongs to vyana merely because vyana moves through joints. Unctuousness follows kapha's unctuous nature; wound healing its saumya nature; bodily filling its abundance and substantial form. Strength means nourishment. Stability means firmness of the trika joints, or the capacity of kapha's sites to perform their functions. Its five divisions correspond to the amashaya, chest, head, throat and joints. Others give them the names shleshaka, kledaka, bodhaka, tarpaka and avalambaka. Some also include bodily growth, attributed to fluidity and substantiality, and satisfaction of the dhatus.

Meaning of the commentary

Dhairya means courage or bravery; the commentary associates its absence with kliba persons. Cyavana means rapid discharge. Priti means affection toward women; bodily strength consists in vigour and bodily development; harsha means sexual eagerness toward women. Shukra produces an embryo as a seed produces a sprout when season, field and other conditions are suitable. A variant preferred by the commentary's compilers says that rasa nourishes, blood sustains life, flesh covers, medas lubricates, bone supports and marrow fills bones. In that reading dhairyacyavana is taken as a compound meaning loss of composure in relation to women, rather than separate courage and emission. The other functions of shukra remain affection, bodily strength, sexual eagerness and the seed function.

Meaning of the commentary

Support means maintenance of the body. Some include nourishment among the functions of faeces, but the teachers do not; one teacher omits support. Basti means urinary bladder, and vikleda means moistness. Others read urine as arising from separation of the moisture in food and filling the bladder. Some simply read that sweat moistens.

Meaning of the commentary

The blood-like characteristics describe artava's nature, while producing the embryo describes its normal action. The conjunction also includes blood's life-sustaining action. Some add that artava is as previously described and unaltered: its stated resemblance to hare's blood or lac liquid is recalled, and unaltered means not affected by the eight dosha-related disturbances or by asrigdara. Such pure artava contributes to conception. The embryo produces pregnancy signs such as darkening of the breast tips. Breast fullness means fleshy fullness; the life sustained by milk is that of children, for whom women's milk is suited.

Meaning of the commentary

This concerns vata and the other constituents in their normal state. The method is the regimen for maintaining health; preservation means protecting them in every respect.

Meaning of the commentary

Some insert causes such as excessive cleansing or pacification, suppression of urges, unsuitable food, mental distress, exercise, fasting and excessive intercourse. The teachers find the insertion unnecessary because these mostly increase vata while depleting pitta and kapha, so causes must be understood according to applicability. Reduced activity means reduced bodily action; lack of gladness means dissatisfaction; impaired awareness means loss of correct understanding. The conjunction also includes loss of the depleted dosha's normal action and increased normal action of its opposite, here kapha; this principle applies to subsequent depletion descriptions. Loss of radiance means diminished lustre. The amashaya is where consumed food is digested; other kapha sites are chest, throat, head and joints. Naming the amashaya separately stresses its emptiness. Some also name the head separately because it is the seat of all senses.

Meaning of the commentary

One explanation specifies qualities such as coldness and dryness rather than indiscriminately using every substance that increases that dosha, since some would markedly provoke another dosha. A quoted rule uses cold and dry qualities for depleted vata rather than pungent substances, pungent and hot qualities for depleted pitta rather than salt and similar substances, and unctuous cold substances such as milk for depleted kapha. Others explain own source as the constituent's cause: vayu for vata, fire for pitta and water for kapha, so the corresponding increasing substances are intended. Others identify rasa as kapha's source and blood as pitta's source; since watery and fiery substances increase these, the intended meaning is considered equivalent.

Meaning of the commentary

Heart qualifies distress, trembling and emptiness; thirst means desire to drink water. A variant adds bodily wasting and understands emptiness as in the amashaya or mind. The earlier principle about loss of normal functions also applies. In blood depletion, sour things are desired to oppose increased vata, while cold things oppose increased tejas following loss of blood's fluidity. Others explain both desires through blood's agni-soma nature and the corresponding qualities of sour and cold. Reduced digestive fire and related signs described in the blood chapter are also included. The wasting term qualifies every listed flesh site; calves lie between knees and ankles. In medas depletion, dryness concerns skin and the desired meat is especially fatty. In bone depletion, dryness affects body, teeth and nails; their breaking is explained by their bony nature. In marrow depletion, joint pain and bone emptiness follow lack of filling. Delayed emission means that even when emission occurs it takes a long time. One account describes depleted shukra mixed with marrow as becoming slightly blood-coloured. Others read that aggravated vayu, following dhatu depletion, discharges blood mixed with a small amount of shukra. Penis and testes are specified as particular seats despite shukra being distributed throughout the body.

Meaning of the commentary

Increase may occur through the same substance, matching qualities or predominance of matching qualities. Examples given are blood through blood, flesh through flesh, medas through medas, bone through young bone, marrow through marrow and shukra through shukra. Fiery substances or those predominantly possessing fiery qualities illustrate the quality-based account for blood. Mention of substances also includes activities that increase the depleted dhatu. Verses then describe predominant elemental qualities: rasa is saumya because water predominates; blood has additional fire qualities; flesh earth qualities; medas water and earth; bone earth, air and fire; marrow and shukra soma; urine water and fire; faeces earth; artava fire; sweat and breast milk water. The embryo predominantly has earth qualities with small amounts of the others.

Meaning of the commentary

Kukshi means abdomen. The examples for depleted faeces are masha and kulmasha; those for depleted urine include sugarcane and trapusa. Impaired touch means diminished sensation. The conjunction also includes internal use of meats such as chicken and pig, described as promoting sweat.

Meaning of the commentary

These are presented as depletions of the upadhatus. The expected time for artava is glossed as a three-day discharge each month. Some understand purification generally; others specifically mean vamana, excluding virechana. The latter argue that virechana would reduce pitta and further reduce artava, whereas removing the saumya constituent through vamana permits the agneya constituent to increase and replenish artava. Agneya substances include sesame, masha, sura and shukta. Loss of breast fullness means lack of elevation. The milk-related measures are explained by breast milk's origin from rasa. The appropriate time for basti is glossed as the eighth month. Medya food means unctuous food. Others read 'medhyanda', interpreted as reproductive-strengthening eggs or testicular material, with goat and fish examples.

Meaning of the commentary

The connecting word includes exaggeration of each constituent's normal functions throughout these lists. Harsh speech means rough speaking; some omit it. Thinness means loss of flesh, darkening concerns the body, and reduced strength here means diminished enthusiasm. Pitta's slight unctuousness is invoked in explaining the mention of little sleep. Fainting obscures the power of all the faculties. Loss of strength here means loss of ojas, since heat can deplete it. Shleshma-associated whiteness and coldness concern the skin and other structures; stability here means stiffness of the limbs. Dejection is weariness of mind and body; drowsiness is a form of sleep. Excessive shleshma is said to produce separation of joints. A different reading instead describes close joining of joints and bones through increased kapha. Another manuscript reads 'adhyasthishlishtata'.

Meaning of the commentary

Hridayotkleda is explained as nausea; others understand vomiting. Praseka means salivary flow. The verb 'produces' continues through the subsequent lists up to the statement about garbha. Adhyasthi means extra bone, and adhidanta extra teeth; the connecting word also includes excessive growth of hair and nails. Excess manifestation of shukra means excessive discharge.

Meaning of the commentary

This describes excessive malas. Atopa is explained as distension; others interpret it as disturbance. The distension in the urine passage specifically concerns the bladder.

Meaning of the commentary

These are the excessive increases of upadhatus. Angamarda is a particular aching pain. The foul smell of artava is explained through its pitta nature, with a reference to a description of slight darkness and odour. Others read 'weakness' instead of 'foul smell'. The connecting word also includes raktagulma and related conditions.

Meaning of the commentary

Appropriate means belonging specifically to the affected constituent. Reduction here means pacification. The commentary refers to compatible measures taught in another treatise, quoting chinna, vishva and related materials for vayu, honey and triphala for pitta, and jaggery and fresh ginger for kapha, described as not acting adversely upon the doshas. Another reading says simply to reduce them through compatible specific measures. Those measures include purification, pacification, food and conduct.

Meaning of the commentary

Excessive dhatus cause harm themselves and can produce further harm through their relationships with preceding and subsequent dhatus. Reduction means removal of the excess. The forward sequence is illustrative rather than exhaustive: an increased later dhatu can also increase an earlier one, like a river dam causing flooding upstream. Likewise, depletion of a later dhatu can deplete an earlier one, and depletion of an earlier dhatu can deplete the next. Some readers place this verse after the verse beginning 'yasya dhatukshayad vayuh'.

Meaning of the commentary

Para means excellent. Tejas is interpreted by comparison with brilliance, or as ghee: just as ghee represents the fatty essence of milk, ojas represents the unctuous essence of all the dhatus. Others gloss it simply as the best essence. Calling ojas and bala identical serves their common treatment; the commentator nonetheless distinguishes them in actuality. Ojas, as the unctuous and nourishing essence of the dhatus, has form, taste, potency and other qualities. Bala is recognised through capacities such as carrying a load and does not itself have taste, potency or colour. Their distinction is also supported by the earlier statement naming strength, complexion and ojas separately among things sustained by food. In other treatises rasa may also be called ojas; some use ojas for jivashonita, and others for heat.

Meaning of the commentary

Firm, developed flesh is attributed to bala understood as the developed essence of all dhatus. Unimpeded bodily, verbal and mental activity concerns bala as functional capacity, such as carrying a load. Clarity of voice and complexion involves both senses. One interpretation calls the organs of action external and the organs of knowledge internal. Their functions are speech, grasping, walking, elimination and pleasure for speech, hands, feet, anus and genital organ; and perception of sound, touch, form, taste and smell for ear, skin, eye, tongue and nose. Pratipatti is explained as apprehending one's own function; others explain it as performing that function. Another interpretation includes all ten organs among the external faculties, and mind, intellect and related faculties among the internal, with ojas as the cause of strength.

Meaning of the commentary

These natural qualities are described for the treatment of ojas and strength. Soma-like means saumya, unctuous means possessing the quality of oiliness, and white is glossed as very white. The commentary compares a Charaka passage describing white, red and yellow aspects of ojas. It argues that this tradition also permits three colours through a reading identifying shukra with ojas and the colours already assigned to shukra. It rejects a separate additional dhatu for ojas, since that would produce eight dhatus: the unctuous product arising through the successive dhatus is compared to ghee present in milk. Some explicitly read shukra instead of shukla, a reading the commentary considers reasonable because the colours of shukra indicate those of ojas. Cool means cool in potency. Stable means stabilising bodily parts, while sara means spreading. Others read rasa and interpret it as sweet, the principal taste. Vivikta means possessing excellent qualities; others take it as fresh, implying replenishment through fresh food. Soft means tender, and mritsna means slimy. The connecting word includes unstated qualities such as heaviness. Ojas is called the foremost seat of the life-sustaining principles beginning with agni and soma. The earlier statements establish its role in maintenance; its absence explains bodily destruction. The supplied commentary ends by noting that the passage has not been written out in full because the reading was unavailable.

Meaning of the commentary

Dhatu-grahana is first explained as the channels that carry the dhatus, from which ojas emerges as their successive unctuous essence. Alternatively it means the heart, because the dhatu-carrying channels are based there, and ojas issues from it through their openings. Others directly interpret the heart as that which holds the dhatus. Tejas here means pitta, and 'agitated' is understood as propelled by vata. 'From there' means from the heart, and displacing means causing it to leave its seat.

Meaning of the commentary

These distinctions help determine treatability. Visramsa means displacement from its seat through injury and related causes. Vyapat means alteration through contact with disturbed doshas and dushyas. Kshaya means reduction below its proper amount through grief, mental preoccupation, depletion and similar causes. Some read an introductory phrase referring to signs in a disturbed state. Joint looseness means separation. Dosha displacement is first interpreted as vata and the others leaving their own sites; others mean displacement of ojas by doshas, and still others the passage of malas. Restriction concerns bodily, verbal and mental actions. An alternative grammatical reading makes this only slight restriction. The connecting word includes loss of the normal functions of strength in all three states. Stiffness means inability to bend parts such as the knees; altered colour differs from the person's usual complexion. Weariness is absence of cheerfulness; drowsiness is inability to engage with sensory objects. Fainting obstructs the faculties of knowledge, moha means mental confusion, and pralapa means disconnected speech.

Meaning of the commentary

The verses repeat the preceding prose. The three doshas here mean three altered states, not the three named bodily doshas. The previously mentioned signs are those of visramsa and vyapat.

Meaning of the commentary

The measures include rasayana and vajikarana, compatible with agni and other factors. Bala means strength and bodily development, and replenishing means increasing it. 'The other' means the depleted state; the person excluded is one who has lost consciousness, since confusion has already been mentioned earlier. Some students of Sushruta append a further passage on agneya tejas: it describes an internal fatty substance called vasa formed as the dhatus are successively processed, especially in women. It attributes softness, delicacy, soft sparse hair, enthusiasm, maintenance of sight, digestion, beauty and radiance to it. It lists astringent, bitter, heavy, cold, dry and obstructive things, restraint of urges, sexual activity, exercise and disease-related wasting as disturbing it. Its displacement is said to cause roughness, altered colour, pricking and loss of lustre; its impairment, thinness, weak agni and downward or lateral displacement; and its depletion, loss of sight, agni and strength, aggravated anila and death. Except in depletion, the appended passage proposes internal oleation, oil application, topical applications, pouring treatments and unctuous light food. The commentator explicitly rejects this appended reading because the nibandha authors do not accept it as authoritative. It is therefore preserved here as a rejected variant, not merged with the main teaching.

Meaning of the commentary

Increasing one's own source means increasing the factors that produce the depleted constituent. Food-group means the collection of foods. Some teachers omit the verse about obtaining desired food. Some students append a detailed list of cravings associated with depletion. For depleted vata they list barley, mudga, harenu, dry light foods and astringent, pungent and bitter tastes. For pitta: sesame, masha, kulattha, flour preparations, mastu, shukta, sour buttermilk and curd. For shleshma: buffalo, boar and goat meat, jaggery, heavy foods, milk, sleep and curd. For rasa: sugarcane, meat broth, mantha, honey, ghee, jaggery water, blood, meat and thin gruel. For rakta: meat cooked with blood, grapes, pomegranate, fat and salt. For mamsa: sour foods, preparations with curd, shadava preparations and meat of large carnivorous animals. For medas: meat cooked with fat, from domestic, marsh-dwelling and aquatic animals, particularly with kshara. For asthi the appended sequence mentions well-cooked broths and bone-in meat, followed by meat with marrow and bone fat; the placement of the latter clause is compact. For majja it mentions sweet-and-sour substances. For shukra it lists eggs of peacock, domestic fowl, hamsa and sarasa, followed by domestic, marsh-dwelling and aquatic animals. For stool: barley and yavaka foods, various greens, peacock meat and masha soup. For urine: thin gruel, sugarcane juice, milk, badara water with jaggery, trapusa and ervaruka. For sweat: oil application, massage, alcohol, lying and sitting sheltered from wind, and heavy coverings. For artava: pungent, sour, salty, heating and heavy fruits, greens and accompanying drinks. For garbha: prepared fetuses of deer, goats, sheep and boar, fat and spit-roasted preparations. For breast milk: sura, rice food, meat, cow milk, sugar, asava, curd and pleasing foods. These details are identified as additions read by some students. Some omit the final verse because they consider it already covered by the earlier exclusion of the depleted, unconscious person. Others retain it as a distinct statement applying to depletion of all dhatus.

Meaning of the commentary

The conjunction includes a moderate bodily build as another outcome of rasa. The commentary asks how one rasa can cause opposite outcomes and then explains the stated mechanisms. Adhyashana means repeatedly eating before digestion is complete; this can produce ama even with strong digestive fire. Although food has undergone transformation by jatharagni, rasa is called ama because it has not been processed by the tissue fires. Special food, unseen factors and obstruction by medas are said to cause nourishment to pass over two tissues and increase medas preferentially. Krathana is the rumbling sound in the throat during sleep; others define it as a sudden interruption of breathing. Gadgadatva means indistinct speech. The remaining tissues are bone and those following it. The vata disorders here arise from obstruction of its paths by medas. Avoiding causes is presented as prevention of future illness. Uddalaka is wild kodrava, with the inclusive ending also covering gavedhuka and similar substances. Virukshana means reducing medas and chedaniya clearing channels. Proper use accounts for the person, digestive fire, strength and dose. The commentary quotes a lekhana basti formula from the Chikitsasthana containing triphala decoction, cow urine, honey and kshara, with ushakadi additions. The conjunction also includes mild exercise and related measures, and Kankayana saktu.

Meaning of the commentary

Vata-promoting food is explained as excessively dry food. The qualification excessive applies separately to exercise and the following factors. The commentary also explains kshaya as tissue depletion. Depleted rasa has become excessively dry and scant; failure to nourish means providing only slight nourishment. Extreme leanness indicates absence of strength understood as bodily development. Limited capacity for bodily, verbal and mental activities indicates absence of strength understood as functional power. Shosha is identified as rajayakshma. Payasya is identified as arkapushpi, or alternatively kshirakakoli; vidarigandha is shaliparni. Other sweet drugs include riddhi, vriddhi and jivaka. The quoted brimhana basti uses a decoction of nourishing substances together with their paste, unctuous material and saindhava, churned with a khaja. The conjunction also implies that nourishing treatment should be light.

Meaning of the commentary

The balanced regimen is neither excessively unctuous nor excessively dry and supports health. Examples include shashtika and red shali rice, lavaka, dadima and tanduliyaka, along with habits such as not sleeping by day. Although capacity for all activities already implies strength, the explicit repetition of strength emphasises that this regimen reliably produces it. The moderate build is maintained by following the conduct prescribed for health.

Meaning of the commentary

Although both extremes have drawbacks, the commentary highlights greater drawbacks of corpulence and the merits of a moderate build. It explains the preference for leanness by the corpulent person's reduced capacity for activity or treatment and greater affliction by disease.

Meaning of the commentary

Although increase and decrease of dosha, dhatu and mala are discussed together, the commentary identifies the doshas as causes of tissue and mala depletion. Dosha means vata, pitta or kapha. Dhatu here can include normally balanced malas because they also support the body; alternatively the term indicates them by implication. Depletion means reduction from an increased or balanced state. Pitta acts through pungency and heat, vata through drying, and kapha through obstruction of channels. Atmatejas means its own power, iddha blazing, and ukha a pot.

Meaning of the commentary

The commentary explains why quantities in pala and similar units have not been specified. Bodies differ in constitution, tissue excellence, compactness and stature. Quantities also vary with recurring time and with stages of life. Daily examples include kapha accumulation in the morning and pitta at midday; seasonal examples include kapha in hemanta and vata in summer. Life-stage examples include increased kapha and little shukra in childhood, absence of menstrual flow and breast milk in young girls, increased pitta in youth and vata in old age. Particular quantities may be determined in a particular person or circumstance, but not universally.

Meaning of the commentary

The commentary poses the question of how balance can be known without numerical measures such as pala. These factors means doshas, dhatus and malas. Their balance is known through the condition of health.

Meaning of the commentary

Imbalance means increase or decrease; the inclusive expression covers dhatus and malas as well as doshas. The use of senses rather than merely body indicates both the physical seats of the senses and their capacities. Observation includes features such as colour. Some read knowing instead of observing.

Meaning of the commentary

After recognising imbalance as increase or decrease, the physician reduces what is increased and increases what is depleted. Recovery of health sets the limit for both reduction and nourishment, because health is the sign of balance. The commentary states that the full passage was not written out because it was unavailable.

Meaning of the commentary

The commentary asks how doshas can be balanced when daily, seasonal and life-stage changes continually occur, citing morning kapha, midday pitta, kapha accumulation in hemanta and aggravation in spring, and increased kapha in childhood. One answer is that small fluctuations do not warrant designation as imbalance, just as eating a single grain of rice may still be described as not eating. Others explain balance through seasonal health regimens and daily preventive practices such as tooth cleaning. Samadhatumalakriya means balanced functions of dhatus and malas. Some separate kriya and interpret it as activities such as sleep and waking. Atman is explained as the body; others take it as the embodied, action-associated self. The commentary notes that teachers discuss how that otherwise unchanging self is bound by bodily qualities and faults, but omits the extended account for brevity. The senses include physical seats and capacities, while mind is the inner faculty that assists them. Earlier teachers call a person so constituted healthy. A further question asks why agni and the other factors are stated separately if their balance follows from dosha balance. The response is that they need separate consideration and treatment: ghee and goat milk can reduce pitta while increasing agni. Madhava is quoted raising the same objection and replying that these factors are separately stated because they can differ where a dosha has become habitual; some people are naturally of such a kind, or the difference is not excessive enough to be harmful. The commentary also records a different order and reading of the preceding verses. Some place a half-verse about inferring balance, rather than imbalance, after the verse on bodily variation, then explain health as the effect from which balance is inferred. They next read the definition of health and then the instruction to protect the healthy and restore the unwell through reduction and nourishment.

Meaning of the commentary

Thus ends the fifteenth chapter, called Doshadhatumalakshayavriddhivijnaniya, in the Sutrasthana of the commentary on Sushruta named Nibandhasangraha, composed by Shri Dalhana.