Kritya denotes treatable conditions, divided into those easily treated and those treated with difficulty. Akritya denotes conditions regarded as incurable, divided into those that can be maintained and those for which treatment should be declined. Thus the two terms cover the complete prognostic classification.
Key terms
kRtya (kritya)
A condition considered treatable, whether easily or with difficulty.
akRtya (akritya)
A condition considered incurable, either maintainable or to be declined.
yApya (yapya)
An incurable condition regarded as capable of being maintained or managed.
pratyAkhyeya (pratyakhyeya)
A condition for which treatment is to be declined in the source's prognostic scheme.
Wounds are easy to treat in people who are youthful, firmly built, vigorous and mentally steady. When all four qualities occur in one person, the wounds are easiest to treat. In the young, wounds heal quickly because the tissues are fresh. In the firmly built, stable and abundant flesh protects vessels, ligaments and related structures from the instrument. Vigorous people do not readily become exhausted through pain, trauma, dietary restriction and similar factors. Mentally steady people are not distressed even by severe procedures. For these reasons their wounds are considered easiest to treat.
As wound shape, smell, colour and other features affect prognosis, qualities of the patient also do so. Youthful means young. Firmly built indicates concealed or well-protected joints, vessels and ligaments and therefore a compact, proportionate body. Vigorous means possessing strength, and mentally steady means remaining unconfused even in adversity. The conjunction includes other desirable patient qualities stated in the chapter on approaching the patient. Some read self-controlled as a fifth quality, meaning mastery of the senses. With one favourable quality a wound is easy to treat, with two or three progressively easier, and with four easiest. The wording also highlights that all qualities are difficult to find together. Fresh means newly developed tissue, stable means unmoving flesh, and exhaustion here means bodily slackness or debility. The source does not preserve the explanatory reason for the optional fifth quality, so the commentator does not supply it.
Key terms
sattvavat
Possessing mental steadiness and remaining unconfused during adversity or severe procedures.
prANavat (pranavat)
Possessing bodily vigour or strength in this prognostic description.
Adhikarana 3 (4) · Śloka 4
ta ēva viparītaguṇā vr̥ddhakr̥śālpaprāṇabhīruṣu draṣṭavyāḥ ||4||
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त एव विपरीतगुणा वृद्धकृशाल्पप्राणभीरुषु द्रष्टव्याः ||४||
Meaning of the śloka
The opposite qualities are to be recognised in people who are old, emaciated, weak or fearful, whose wounds are correspondingly difficult to treat.
Absence of one favourable quality makes treatment difficult, absence of two or three makes it progressively more difficult, and absence of all four makes it most difficult. Some read lack of self-control as a fifth adverse quality. In that reading, the conjunction also includes absence of other desirable patient qualities stated elsewhere.
Key terms
kRucchrasAdhya (kricchrasadhya)
Treatable only with difficulty in the source's prognostic classification.
Wounds situated on the buttocks, anus, genital region, forehead, cheeks, lips, back, external ear, scrotum, abdomen, root of the neck, or inside the mouth are considered easy to heal.
After prognosis based on qualities of the patient, the text classifies treatability according to the body part involved. Sphik denotes the two buttocks, payu the rectal or anal region, prajanana the private or genital region, ganda the cheeks, phalakosha the scrotum, and jatru the root of the neck.
Key terms
sukharopaNIya (sukharopaniya)
Considered easy to heal within the source's site-based prognosis.
Wounds involving the eye, tooth, nose, outer corner of the eye, ear, navel, digestive region, perineal seam, hip, flank, abdomen, chest, armpit, breast or joint are difficult to treat. So are wounds carrying frothy pus, blood or air, wounds containing a foreign body, lower-body wounds that drain upward, wounds at the hairline or near a nail, wounds at vital points, wounds involving the lower-leg bone, and fistula-in-ano with an internal opening or involving the perineal seam and pelvic bone. Wounds heal with difficulty in people affected by kushtha, chronic poison, wasting, or madhumeha, and when new wounds arise within an existing wound.
Apanga is the outer end of the eyebrow. Nitamba is the posterior hip, vakshas the chest, and sandhibhaga a joint region. The term carrying applies separately to froth, pus, blood and air. Antahshalya means a foreign body lodged within. A lower-region wound is called upward-draining when its opening faces upward. Romanta is the hair margin, upanakha the area near a nail, and janghasthi the bone between ankle and knee. The internal opening of bhagandara lies within the anal region. Kutakasthi is identified as part of the pelvic bone and is locally called mayurasthi. Others read involvement of the urinary passage instead of involvement of kutakasthi. Vishajushta refers specifically to a person affected by residual or chronic poison.
Key terms
dushcikitsya
Difficult to treat because of wound site, drainage, retained foreign body or associated condition.
antaHshalya (antahshalya)
A foreign body retained within a wound.
bhagandara
Fistula-in-ano, here especially difficult when internally opening or involving specified adjacent structures.
अवपाटिकानिरुद्धप्रकशसन्निरुद्धगुदजठराणि, ग्रन्थिक्षतक्रिमयः प्रतिश्यायजाः कोष्ठजाश्च त्वग्दोषिणां प्रमेहिणां वा ये परिक्षतेषु दृश्यन्ते, शर्करा सिकतामेहो वातकुण्डलिकाऽष्ठीला दन्तशर्करोपकुशः कण्ठशालूकं निष्कोषणदूषिताश्च दन्तवेष्टा विसर्पास्थिक्षतोरःक्षतव्रणग्रन्थिप्रभृतयश्च याप्याः ||८||
Meaning of the śloka
Wounds arising with avapatika, niruddhaprakasha, sanniruddhaguda, abdominal disorders, granthi-associated lesions with worms, worms arising from pratishyaya or from internal cavities, worms seen in injuries of people with skin disorders or prameha, and wounds associated with sharkara, sikatameha, vatakundalika, ashthila, dental calculus, upakusha, kanthashaluka, corrupted gums from toxic tooth-polishing material, visarpa, bone injury, chest injury, wound nodules and similar conditions are classed as maintainable.
After the two treatable divisions, the text presents the maintainable division of incurable conditions. The phrase granthi-kshata-krimayah means worms occurring in a lesion marked by a nodule. Worms are also connected with pratishyaya and internal cavities, and can appear in injuries when skin disorder or prameha is present. Sharkara is explained as a urinary stone broken by vata. Sikatameha is a particular urinary disorder, while vatakundalika and ashthila are particular forms of urinary obstruction. Nishkoshana is described as a poisonous sharpening or polishing implement used by people who colour the teeth; gums damaged by the toxic tooth stick used for sharpening are intended. Variant readings are nishcakshana and nishkarshana, with the same interpreted sense. The classification applies to wounds produced by the conditions beginning with avapatika and to wounds occurring when the later-listed diseases are present.
Key terms
yApya (yapya)
An incurable condition considered maintainable through ongoing management in the source's scheme.
vAtakuNDalikA (vatakundalika)
A named type of urinary obstruction in the commentary.
aShThIlA (ashthila)
Another named type of urinary obstruction in the commentary.
साध्या याप्यत्वमायान्ति याप्याश्चासाध्यतां तथा |
घ्नन्ति प्राणानसाध्यास्तु नराणामक्रियावताम् ||९||
Meaning of the śloka
Curable conditions may become maintainable, and maintainable conditions may become incurable. Incurable conditions destroy the lives of people who receive no treatment.
The prognostic classes previously described are not absolutely fixed as curable or maintainable, because treatment can change their course. An incurable condition is explained as one that may take life after an interval, while in the absence of treatment it may take life immediately. Akriyavat includes both those without treatment and those receiving treatment contrary to what is required.
Key terms
yApya (yapya)
A condition that can be maintained or controlled but is not eradicated.
akriyAvatAm (akriyavatam)
Those receiving no treatment or treatment contrary to the required method.
A condition should be known as maintainable when treatment alone sustains the patient and the patient quickly declines when treatment stops. Properly applied treatment supports a person with a maintainable disease as a well-positioned prop supports a house about to fall.
These verses define a yapya condition. Treatment in such a case preserves life but does not eradicate the disease at its root. Prapta means treatment applied by the physician, and viskambha means a supporting post or prop.
Key terms
yApanIyam (yapaniyam)
A disease state in which continued treatment sustains the patient without removing the root condition.
viShkambhaH (vishkambhah)
A supporting post, used as the simile for properly applied maintenance treatment.
अत ऊर्ध्वमसाध्यान् वक्ष्यामः- मांसपिण्डवदुद्गताः प्रसेकिनोऽन्तःपूयवेदनावन्तोऽश्वापानवदुद्वृत्तौष्ठाः , केचित् कठिना गोशृङ्गवदुद्गतमृदुमांसप्ररोहाः, अपरे दुष्टरुधिरास्राविणस्तनुशीतपिच्छिलास्राविणो वा मध्योन्नताः, केचिदवसन्नशुषिरपर्यन्ताः शणतूलवत् स्नायुजालवन्तो दुर्दर्शनाः, वसामेदोमज्जमस्तुलुङ्गस्राविणश्च दोषसमुत्थाः, पीतासितमूत्रपुरीषवातवाहिनश्च कोष्ठस्थाः, त एवोभयतोभागव्रणमुखेषु पूयरक्तनिर्वाहिणः, (क्षीणमांसानां च ) सर्वतोगतयश्चाणुमुखा मांसबुद्बुदवन्तः, सशब्दवातवाहिनश्च शिरःकण्ठस्थाः, क्षीणमांसानां च पूयरक्तनिर्वाहिणोऽरोचकाविपाककासश्वासोपद्रवयुक्ताः, भिन्ने वा शिरःकपाले यत्र मस्तुलुङ्गदर्शनं त्रिदोषलिङ्गप्रादुर्भावः कासश्वासौ वा यस्येति ||१२||
Meaning of the śloka
The text next describes wounds classed as incurable. These include wounds rising like a lump of flesh, discharging profusely, containing internal pus and pain, or having raised margins like the opening of a mare's genital tract; some with hard, horn-like elevations and soft fleshy sprouts; others discharging vitiated blood or a thin, cold, slimy fluid and raised in the center; some depressed with hollow margins and a network of ligaments like fibers of hemp; and wounds of doshic origin discharging muscle fat, adipose tissue, marrow or brain substance. Cavity wounds that carry yellow or black urine, feces or flatus, and those same cavity wounds discharging pus and blood through wound openings toward both the anal and oral routes, are also included. Wounds that extend through all tissues, have minute openings and flesh-like bubbles; wounds of the head and throat passing flatus with sound; wounds in people depleted of flesh that discharge pus and blood and are complicated by loss of appetite, impaired digestion, cough and difficult breathing; and a fractured skull in which brain substance is visible, signs of all three doshas appear, or cough and difficult breathing occur are likewise classed as incurable.
Prasekin means having abundant discharge. Raised wound margins are compared to the opening of a mare's genital tract. A wound with a depressed, hollow margin ends in a low-lying cavity. Muscle fat is the expressed essence of flesh, and brain substance is described as resembling half-melted ghee. The statement about doshic origin excludes wounds caused by external injury, because externally caused wounds may heal even when they have such discharge. The text then moves from doshic wounds to wounds situated in the body cavity. 'Those same' means those cavity wounds, and openings on both sides refers to carrying pus and blood through wound pathways toward both anus and mouth. It then separately lists incurable wounds extending through all wound tissues, those in the head and throat, those occurring in persons depleted of flesh, and those associated with a fractured skull.
Key terms
prasekinaH (prasekinah)
Wounds producing abundant discharge.
mastulu~ggam (mastulungam)
Brain substance, described by the commentary as resembling half-melted ghee.
doShasamutthAH (doshasamutthah)
Arising from doshas rather than from external trauma, a distinction material to the stated prognosis.
A wound discharging muscle fat, adipose tissue, marrow or brain substance may heal when caused by external injury, but does not heal when it arises from doshas.
A disorder arising in a non-vital body region and apart from major vessels, joints and bones, yet continuing to spread through the tissues, is a sign of incurability.
This passage explains how even wounds not included in the preceding list become incurable when they reach a particular state. The location is neither a vital point nor close to one, and desa means a body part, specifically the skin in this explanation. The commentator supplies an omitted inclusive term after vessels, joints and bones, thereby also excluding ligaments and arteries. Others take the vessel reference to mean absence of a large vessel specifically. Vikara here means the wound, which, despite treatment, advances everywhere and pervades all tissues. Thus, even when a wound arises at a favorable site and is treated by a good physician, spread through all tissues is taken to indicate a disease attributed in the source to prior action. Others extend vikara to disorders such as kushtha, vatarakta and wasting.
Key terms
anuparyeti
Continues to spread and pervade the tissues despite treatment.
amarmopahite deshe
In a body region neither at nor close to a vital point.
Adhikarana 12 (15-16) · Śloka 16
kramēṇōpacayaṁ prāpya ; dhātūnanugataḥ śanaiḥ |
na śakya unmūlayituṁ vr̥ddhō vr̥kṣa ivāmayaḥ ||15||
sa sthiratvānmahattvācca dhātvanukramaṇēna ca |
nihantyauṣadhavīryāṇi mantrān duṣṭagrahō yathā ||16||
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क्रमेणोपचयं प्राप्य ; धातूननुगतः शनैः |
न शक्य उन्मूलयितुं वृद्धो वृक्ष इवामयः ||१५||
स स्थिरत्वान्महत्त्वाच्च धात्वनुक्रमणेन च |
निहन्त्यौषधवीर्याणि मन्त्रान् दुष्टग्रहो यथा ||१६||
Meaning of the śloka
A disease that gradually increases and slowly follows the sequence of tissues cannot be uprooted once fully grown, just as a mature tree cannot easily be uprooted. Because it is firmly established, extensive and has advanced successively through the tissues, it defeats the potency of medicines as a malevolent graha is said to defeat mantras.
After stating that some diseases are incurable from their onset, these verses explain that another disease, initially curable, can become incurable through neglect. The neglected disease does not subside even under medicines whose effects are otherwise observable. Its firmness results from abundant doshas in a person following unsuitable conduct. Some diseases may defeat medicines from the outset even without neglect because of their magnitude. Such magnitude is understood through powerful causes, distinctive development attributed to prior action, and disease patterns such as abdominal disorders. The conjunction also includes inherent nature as the reason medicines fail in conditions such as rohini and valayamukha. Sequential penetration of tissues applies to kushtha and similar diseases. The malevolent graha comparison refers to conditions such as skanda and apasmara within the source's historical framework.
Key terms
dhAtvanukramaNena (dhatvanukramanena)
By advancing successively through the bodily tissues.
auShadhavIryANi nihanti (aushadhaviryani nihanti)
Defeats or renders ineffective the potency attributed to medicines.
अतो यो विपरीतः स्यात् सुखसाध्यः स उच्यते |
अबद्धमूलः क्षुपको यद्वदुत्पाटने सुखः ||१७||
Meaning of the śloka
A wound having qualities opposite to the difficult conditions just described is said to be easily curable, just as a young shrub whose root has not become fixed is easy to uproot.
A wound is easily curable when it is not situated in a marma, blood vessel, ligament, joint, bone or dhamani and does not spread around these structures. Kshupaka means a very young tree or shrub.
Key terms
sukhasAdhyaH (sukhasadhyah)
Readily or easily amenable to treatment according to the stated prognosis.
A wound not affected by the three doshas, with slightly dark lips, small granulations, an even surface, no abnormal pain and no discharge is called clean.
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idānīṁ vraṇasya śuddhilakṣaṇamāha- tribhirdōṣairanākrānta ityādi| dōṣaśabdō'tra dōṣakāryēṣu vraṇākr̥tigandhavarṇasrāvavēdanāsu vartatē, kāryē kāraṇōpacārāt; yathā- ghr̥tamāyuriti ; tairdōṣākr̥tigandhādibhiranākrāntaḥ| ‘tribhirdvandvaiḥ’ ityanyē paṭhanti; tē tu dvandvaśabdamabhivyaktau varṇayanti, tēna dōṣatrayābhivyaktibhirākr̥tyādibhiranākrānta iti sa ēvārthaḥ| anyē tu śītōṣṇaṁ, mr̥dukaṭhinaṁ saṁvr̥tavivr̥tamiti dvandvatrayaṁ manyantē| aparē tu ‘dvandvāni dōṣāḥ, tē cātra vātādayaḥ,tairanākrānta’ iti vyākhyānayanti| śyāvauṣṭha iti kiñcitkr̥ṣṇapāṇḍuḥ, prasīdacchōṇitatvāt; anyē śyāvauṣṭhatāṁ kaṣāyapariṣēkābhyaṅgādikr̥tāṁ vadanti| piḍakāḥ yasya santi sa piḍakī, piḍakā vraṇauṣṭhē'ṇumāṁsāṅkurāḥ| ‘apiḍakī’ ityanyē paṭhanti, tatra na vidyantē piḍakā asyēti| samaḥ samatalaḥ| avēdana iti na vidyatē vātādīnāṁ tōdādivēdanā yasya sa avēdanaḥ, sāmānyaśuddhavraṇavēdanā tu vidyata ēva, yēna surūḍhē vakṣyati- ‘aśūnamarujaṁ vraṇam’ iti||18||
Meaning of the commentary
Dosha here denotes its effects in wound shape, smell, colour, discharge and pain. A variant reads 'three pairs.' Some explain this as three manifest doshic groupings and thus retain the same sense; others understand three pairs as cold-hot, soft-hard and closed-open; still others take the pairs simply as the doshas. Shyava lips are slightly dark and pale because blood has become clear; others attribute this colour to astringent irrigation or massage. Pidaki means having minute flesh sprouts on the wound margin, but another reading has apidaki, without such sprouts. Sama means level. Avedana excludes abnormal doshic pains such as pricking, though ordinary pain of a clean wound may remain.
Key terms
shuddha vraNaH (shuddha vranah)
A clean wound lacking the stated signs of doshic disturbance.
A wound whose interior resembles a pigeon's pale-grey colour, is free from moisture, firm and bears thin skin-like flakes should be recognized as healing.
The colour is pale grey, and firm means hard. Chipitika indicates carmaceli, the dry, fine, white skin that forms as the wound dries and then peels away. Another reading has apitikavanta.
Key terms
carmacelI (carmaceli)
A fine, dry, whitish skin-like layer that forms and peels as a wound dries.
A wound is declared properly healed when its track and margins have healed, it has no nodule, swelling or pain, matches the colour of the skin and is level with the surrounding surface.
Rudhavartman means that the wound path or wound substance has healed. Agranthi excludes elevation from swelling. Tvaksavarna means the same colour as the skin. Samatala means even like the surface of the palm or tongue. Others say a compound concerning skin and nodule excludes raised swelling, while samatala excludes a depression below the surface.
Some read this verse on complications of a healed wound at the end of the chapter. The commentary says no established commentator accepts it, judges it non-authoritative and says it should not be read.