10. viśikhānupravēśanīyādhyāyaḥ

Meaning of the commentary

Vishikha here means the path of professional practice, or karmamarga. The chapter is called Vishikhanupraveshaniya because it deals with entering that path.

Meaning of the commentary

The commentary explains the qualifications for entering practice. Studying the tantra means reading the treatise; learning its meaning means studying its interpretation beside a teacher. Observed procedures include cutting and the other operations, and sneha and the other therapeutic procedures. Practical training means repeated practice of the actions. Expounding the teaching in its wording and meaning, in the prescribed manner, indicates continued command of the text. Alternative readings say 'expounding the meaning of the teaching' or 'expounding the treatises.' Royal permission should follow examination: the king must protect the people, and neglect allows impostors resembling physicians to move through the country and trouble the public. The discussion then turns from knowledge and skill to outward appearance. Trimmed nails promote cleanliness and ease of work. Trimmed hair is associated with neat simplicity; others explain that it avoids trouble in the kitchen. Cleanliness here means external cleanliness, such as bathing, because outward appearance is being discussed; inner purity is covered by a good disposition. White clothing is for auspiciousness, or for cleanliness and simplicity. An umbrella offers protection from sun, dust, rain, snakes and similar hazards; a supporting staff prevents stumbling, and footwear protects against thorns and the like. Unostentatious dress means the dress of respectable people and excludes unsuitable bodily presentation. Others explain it as avoiding showiness in varied clothes, body colours, garlands, ointments and elaborate ornaments. A good mind possesses qualities such as freedom from cruelty; despondency is considered undesirable when setting out. Auspicious speech is intended to win the goodwill of all. Freedom from deception restrains body, speech and mind: a kuhaka is a deceiver lacking scriptural learning who nevertheless inspires great trust. Others understand akuhaka as someone who does not seek to astonish through pretentious appearance or behaviour. Good assistants matter because a physician visiting the inner household may incur blame through an assistant's fault; assistants also provide personal protection and patient care. Finally, an objection asks how the physician can be a friend to living beings when fresh blood from living creatures is prescribed. The commentator accepts the point but argues that a practice prescribed by the teaching is not blameworthy, comparing it with killing an animal in a prescribed sacrificial rite.

Meaning of the commentary

A duta is a person who comes to summon the physician or ask a question. Nimitta denotes a favourable sign, such as a fragrant breeze. Shakuna includes particular birds and favourable utterances; mangala includes auspicious objects such as a svastika and a full vessel. Their being in accord means that they are favourable. The three methods mentioned are observation, touch and questioning. The particle hi expresses the reason for the stated correction. 'Beginning with hearing' includes the senses associated with skin, eyes, tongue and nose as well as hearing.

Meaning of the commentary

The commentary connects the audible features with the later discussions of wound discharge. Bodily increase means stoutness, decrease means thinness, and strength in the visual list means enthusiasm or vigour. It raises an objection concerning taste: physicians infer sweetness and other tastes in prameha from flies, ants and similar creatures gathering, so how is this knowledge obtained through taste? Its answer is that the taste faculty meant here belongs to the ants and other creatures, not to the physician. Odours of both wounded and unwounded persons are understood through smell. Desha has three environmental divisions: jangala, anupa and sadharana. Jati here denotes the historical social groups beginning with Brahmanas. Kala is either regularly recurring time, represented by the seasons, or time relating to a particular state: stages such as childhood in a healthy person, and stages such as the onset of fever in someone ill. Satmya is whatever, through being used, brings comfort to that person. It concerns either activity, divided into bodily, verbal and mental activity, or food, divided according to the six tastes. The origin of illness means its cause, such as conflict with a stronger person. The development of pain concerns the emergence of pricking and other pains associated with the doshas. Strength here is capacity known through exertion. Inquiry into digestive fire asks whether it is balanced, irregular or weak. The mention of flatus, urine and stool is understood to include other discharges, such as menstrual discharge and downward raktapitta. Duration asks how long the illness has been present; the wording also includes matters such as pus issuing from a private part. Other interpreters read the compound 'deshakalajatisatmyam' and connect satmya separately with locality, time and social group. They explain suitability to locality in terms of qualities opposite to those of the three environments. Another reading is 'deshakalajatam', joining 'arisen' separately to place and time. Here place includes both geographical environment and the patient's body: in which environment did the dosha accumulate or become aggravated, and where did illness arise? Within the patient, the inquiry concerns the affected part, such as the throat, and whether it is a site of shleshma or pitta. The final instruction is explained through signs corresponding to vata, pitta and shleshma and the six means of knowledge: hearing, touch, sight, taste, smell and questioning. In a vata-associated wound, audible escape of air with froth and blood is known by hearing; roughness and dryness by touch; colours like ash, pigeon or bone by sight; pungent or parched-grain-like odours by smell; astringency by taste; and pricking, splitting or cutting pains by questioning. In pitta-associated swelling or wounds, heat is known by touch, blue or yellow colour by sight, pungent or sour taste by taste, a sharp atasi-like odour by smell, and the various burning or scorching pains by questioning. In shleshma-associated conditions, unctuousness and sliminess are known by touch, whiteness by sight, sweetness by taste, a raw-flesh-like odour by smell, and itching or heaviness by questioning. A discerning physician can thus recognise diseases through dosha signs even when their names have not been specified in Ayurveda. The Panjikakara preserves a different textual arrangement: only three kinds of examination, beginning with inspection. After the verse beginning 'mithyadrishta vikara hi', he reads a verse directing a physician seeking success to examine diseases rationally through all means of knowledge, beginning with inspection. He argues that the additional word 'pramanas' includes smell, taste and sound, and criticises readings that explicitly enumerate six kinds of examination here. He also omits the final sentence beginning 'atmasadrisheshu'. These are presented as a distinct commentator's reading and disagreement.

Meaning of the commentary

Curable conditions are divided into those easy to cure and those difficult to cure. Incurable conditions are divided into yapya, which can be maintained under management, and pratyakhyeya, for which treatment is to be declined. The conditions lasting beyond a year are explained as those remaining very strong through all the seasons. The commentator reasons that, if only one dosha caused them, the season that pacifies that dosha would bring relief or reduction. When this does not occur, involvement of all three doshas is inferred, and the text advises against undertaking them. An alternative explanation is that, over a year, the condition usually becomes incurable by proceeding successively through the dhatus. 'Generally' means in most cases, not invariably. The commentary therefore recognises exceptions: certain conditions such as raktagulma may be fit for treatment even after a year, and it states that ardita is curable within a period of three years.

Meaning of the commentary

The patient's disorders are incorrectly observed when they have not been properly seen, inaccurately described when the patient has not reported them as they are, and inadequately examined when they have not been properly assessed. Such conditions can confuse the physician. The commentary therefore advises against undertaking diseases that remain unrecognised in this way.

Meaning of the commentary

The commentator gives a reason for each category in the passage. In a person devoted to maintaining Vedic observances, daily bathing and similar activities may aggravate the disease. A ruler may act as he pleases because of his independence; others instead explain the difficulty as inability to tolerate procedures because of a delicate constitution. Women are described as suppressing natural urges and concealing disorders of the private parts out of modesty. Children and older people are said to allow only limited procedures because they are unsuitable for measures such as virechana; an alternative explanation groups children, older people and women together as having delicate bodies that cannot tolerate medicines. A fearful person cannot endure procedures because of limited mental fortitude. A royal servant is dependent on the ruler. A gambler is constrained by addiction. Weak people present difficulties similar to children and older people. A person with a superficial grasp of medicine who considers himself a physician acts contrary to instructions out of pride. Someone who conceals disease does not disclose it. Poor people lack medicines because they lack resources; miserly people do not obtain medicines because of greed. Anger is said to aggravate disease. A person without self-restraint follows unsuitable habits; the term means someone who has not mastered the senses. Those without support lack attendants and are alone.

Meaning of the commentary

The commentator understands this rule in the setting of a physician entering the inner household or women's quarters during practice: it limits opportunities for faults arising from carelessness. Sahasya is explained as remaining in the same place, samvasa as living in a neighbouring residence, and parihasa as joking. Food is explained to include food and drink, which may be accepted because they sustain one's livelihood. Anything permitted by the king may, however, be accepted. Some read samvada, conversation, instead of samvasa, residence.

Meaning of the commentary

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