Vranaprashna can mean a chapter containing questions concerning wounds. In one explanation, vrana here denotes vata and the other doshas because they cause wounds, so the questions concern those factors. Others derive the title as a question based on a wound, with grammatical elision. The chapter accordingly discusses the number, particular characteristics and actions of vata and the other causes of wounds, as well as the derivation and other features of the wound itself.
Key terms
vraNaprashna (vranaprashna)
Questions concerning wounds and, by causal extension in the commentary, the doshas that initiate them.
Vata, pitta and kapha are causes in the formation of the body. When undisturbed and situated respectively in the lower, middle and upper regions, they support the body like three pillars supporting a house; therefore some call the body three-pillared. When disturbed, those same factors cause destruction. Thus the body remains associated with these three, together with blood as a fourth, in its formation, maintenance and dissolution.
The undisturbed doshas assist semen, menstrual blood and related factors in generating the body. Their lower, middle and upper placement corresponds respectively to vata, pitta and kapha. Some teachers consequently use the designation three-pillared. When altered from their natural state, the same doshas become causes of bodily destruction; another reading includes the word also with dissolution. Blood is then introduced as a fourth factor because of its prominence as a substrate in the initiation of wounds. This is identified as one doctrinal view. Accordingly, the commentary notes two accounts of wound maturation: one assigns the process to the doshas alone, while another assigns it to the doshas together with blood. Avirahita means continually associated.
Key terms
tristhUNa (tristhuna)
Three-pillared, comparing the body's support by vata, pitta and kapha to a house supported by three posts.
This verse restates the second view that includes blood. Kapha is named first rather than following the usual vata-first order because the body is described as having its root above and branches below, and kapha occupies the upper region. The point is not only that the body cannot arise without kapha and the others, but also that their undisturbed forms sustain it. Some teachers add an introductory phrase identifying this as a summary verse of the preceding prose.
The verbal root va conveys movement and scent, tap conveys heating, and shlish conveys embracing or joining. With the prescribed derivative suffixes, these yield the forms vata, pitta and shleshma.
These etymologies present characteristics useful in treatment. Vata is derived from the root va in the senses of movement and scent, with the suffix tan, thereby indicating movement as its nature. Pitta is derived from tap, to heat, through the stated grammatical transformations, indicating its inherent heating characteristic. Shleshma is derived from shlish, to embrace or join, with the suffix manin and vowel strengthening, indicating its function of joining structures such as the joints.
Key terms
vAta (vata)
Derived here from a root conveying movement and scent, emphasizing movement.
pitta
Derived here from a root meaning to heat, emphasizing its heating character.
shleShma (shleshma)
Derived here from a root meaning to embrace or join, emphasizing cohesion.
The locations of the doshas are next stated in summary. Vata is based in the pelvis and rectum. Above these and below the navel is the pakvashaya. Pitta occupies the region between pakvashaya and amashaya, while amashaya is the location of kapha.
Some read their locations in place of dosha locations, with the same sense. This is a summary; the chapter on vata disorders additionally names the navel region, heart, throat, whole body and joints as vata sites. Shroni means the pelvic or waist region. The pitta site is summarized as the interval between pakvashaya and amashaya; a fuller list also includes liver, spleen, heart, vision, skin and sense faculties. Amashaya is the place where eaten and drunk substances are processed and is described in a cited definition as the region between navel and breasts. A fuller list of kapha sites also includes chest, head, throat and joints.
Key terms
pakvAshaya (pakvashaya)
The lower digestive receptacle described as above the pelvis and rectum and below the navel.
AmAshaya (amashaya)
The receptacle where consumed food and drink undergo processing, identified as a principal kapha site.
These locations are further divided fivefold. The locations of vata will be stated in the Nidana section on vata disorders. Pitta occupies the liver, spleen, heart, vision, skin and the place previously stated. Kapha occupies the chest, head, throat, root of the tongue, joints and the place previously stated. These are the locations of the doshas when they are undisturbed.
After the principal locations, subsidiary sites are made explicit. The five pitta sites are presented with the previously stated location counted in the scheme. The liver is described as a dark segment, the spleen as a mass of flesh on the left side, the heart as a downward-facing lotus bud, and the visual structure as lentil-sized within the dark pupil. The conjunction also includes sites named in other works, such as lasika, described as fluid issuing from flesh heated by pitta. For kapha, the chest is the interval between the breasts and the earlier site is amashaya. The conjunction can additionally include medas as stated elsewhere. These are chiefly the sites of doshas in their natural, unaggravated condition.
Just as the moon, sun and wind sustain the world respectively through release, taking up and dispersal, kapha, pitta and vata sustain the body through corresponding actions.
The correspondence is sequential: the moon, sun and wind act through release, taking up and varied dispersal, while kapha, pitta and vata perform analogous functions in the body. Release means production or bestowal of strength, taking up means taking away strength, and dispersal means driving cold, heat and other conditions in various ways.
Key terms
visarga-AdAna-vikShepa (visarga-adana-vikshepa)
Release, taking up and dispersal, aligned respectively with kapha, pitta and vata in the analogy.
A question arises whether agni exists apart from pitta or whether pitta itself is agni. The response says that no agni separate from pitta is observed. Because pitta has a fiery nature and acts in burning, digestion and related processes, it is figuratively called inner agni. When its fiery quality is diminished, substances with similar qualities are used; when it is excessively increased, cooling measures are used. Observation, inference and authoritative teaching are therefore cited for the view that no separate agni exists apart from pitta.
The opening can concern the distinction or identity between pitta and agni. Others connect it with the preceding description of taking up and ask whether that action belongs to pitta or agni. Burning includes heat, digestion includes processing food, and the inclusive ending covers colouring, seeing and similar functions. Calling pitta inner agni is figurative usage based on resemblance. Similar substances means those resembling fire through heat and sharpness; others say agniguna means bodily heat and then understand similarity as resemblance to pitta. Cooling treatment in excessive increase also supports the identification, while agama means the Ayurvedic textual tradition. The commentary then raises contrary evidence: ghee and goat milk can calm pitta while stimulating agni; fish and similar foods can increase pitta without kindling agni; daytime sleep can aggravate pitta while diminishing agni; and other passages separately classify agni and dosha. It concludes that Sushruta and other authorities actually accept agni as distinct from pitta, citing statements that distinguish bodily heat from pitta and that contrast liquid, unctuous, downward-moving pitta with fire. The apparent identity in this passage is taught so that agni can be treated through pitta endowed with taste, potency and other qualities, since fire abstracted from such qualities cannot itself be directly treated.
Key terms
antaragni
Inner fire, applied figuratively to pitta in this passage because of its fiery actions.
Through a particular unseen cause, pitta situated between pakvashaya and amashaya digests four kinds of food and drink and separates doshas, rasa, urine and feces. Remaining there, by its own power it supports the other pitta locations and the body through fiery action; there it is called Pacaka agni. Pitta in the liver and spleen is called Ranjaka agni and is said to give colour to rasa. Pitta in the heart is called Sadhaka agni and accomplishes desired aims. Pitta in vision is called Alocaka agni and apprehends visible form. Pitta in the skin is called Bhrajaka agni; it processes substances used in massage, pouring, immersion and topical application, and manifests bodily complexions.
The unseen cause is explained as karma from a former life. The central pitta location is the navel region. The four food forms are eaten, drunk, licked and chewed. Vivecayati means separating dosha, rasa, urine and feces. Some read food-rasa, urine and feces, while others read vata, urine and feces. Pacaka supports the other pitta sites and the body. Sadhaka is connected with achieving dharma, wealth, desire and liberation because it removes kapha and tamas from the heart and clarifies the mind's capacity. Alocaka means that which enables seeing. Bhrajaka is placed in the outer skin called Avabhasini. It processes the substances that serve as instruments of massage and the other procedures. It manifests the five-element complexions such as blue, and the conjunction also includes bodily radiance. A cited distinction says complexion is seen nearby and overlays colour, whereas radiance shines from afar and reveals colour.
Key terms
pAcaka (pacaka)
The pitta function associated with digestion, separation and support of other pitta sites.
ra~jjaka (ranjaka)
The pitta function in liver and spleen said to impart colour to rasa.
sAdhaka (sadhaka)
The heart-based pitta function associated with accomplishing intended aims.
Alocaka (alocaka)
The visual pitta function associated with apprehending visible form.
bhrAjaka (bhrajaka)
The skin-based pitta function associated with processing external applications and manifesting complexion.
Sharpness is compared with mustard and black pepper. Puti means having a raw or foul smell. Pitta is blue when associated with ama and yellow when free from ama. In its normal state it is pungent. When changed through contrary digestion it becomes sour. Others say it tastes sour when mixed with vidagdha indigestion, while some take vidagdha pitta as the particular disease called amlapitta. Some manuscripts read flowing in place of liquid.
Key terms
vidagdha pitta
Altered pitta described as sour, with alternative interpretations recorded in the commentary.
अत ऊर्ध्वं श्लेष्मस्थानान्यनुव्याख्यास्यामः |
तत्र, आमाशयः पित्ताशयस्योपरिष्टात् तत्प्रत्यनीकत्वादूर्ध्वगतित्वात्तेजसः, चन्द्र इव आदित्यस्य , चतुर्विधस्याहारस्याधारः; स च तत्रौदकैर्गुणैराहारः प्रक्लिन्नो भिन्नसङ्घातः सुखजरो भवति ||१२||
Meaning of the śloka
The locations of kapha are next explained in the same sequence. Amashaya lies above the pitta receptacle because it is opposed to pitta and because fire moves upward, just as the moon stands in relation to the sun. It is the receptacle of the four kinds of food. There, watery qualities moisten the food and loosen its compact mass, making it easy to digest.
This begins with amashaya, the first of the five kapha locations. Its position above the pitta site is explained by opposition: if the watery receptacle were beside or below it, water's downward movement would leave fire unopposed and fire would burn the body. The moon-sun comparison offers an analogy for the same relationship. The four food forms are eaten, drunk, licked and chewed. Their being processed supports an inference that amashaya lies above the pitta site, since upward-moving fire could not otherwise act upon them in the stated way. Drava and other watery qualities break up the food mass, while unctuousness moistens it, so it undergoes transformation easily.
Key terms
audaka guNa (audaka guna)
Watery qualities such as fluidity and unctuousness that moisten and loosen food in amashaya.
Sweetness, sliminess and moistening belong to the food. The two conjunctions include further unmentioned qualities such as fluidity and unctuousness. Sambhavati here means that kapha becomes aggravated or manifest, not that it is newly created from nonexistence, because kapha is said to originate from rasa dhatu.
Key terms
sambhavati
Here interpreted as becoming aggravated or manifest, rather than arising for the first time.
Kapha remaining in amashaya supports the other kapha locations and the body through water-like functions by its own power. In the chest it supports the trika and, together with food-derived rasa, sustains the heart. At the root of the tongue and in the throat, because the tongue faculty has a watery nature, it enables proper recognition of taste. In the head, through lubrication and nourishment, it supports the sense faculties. In the joints, through cohesion of all joints, it supports their function.
Water-like functions include moistening, filling and related actions. The trika is described as the junction of the head and two arms. Sustaining the heart means enabling its own functional capacity. The sense faculties supported by head-based kapha are hearing, touch, vision, taste and smell. Lubrication and nourishment may be read as two functions or as nourishment through unctuousness. Others explain sneha specifically as the marrow of the head, whose nourishment is the relevant function. Kapha in the joints supports them through their mutual cohesion.
Key terms
trika
The junction described by the commentary as connecting the head and the two arms.
udakakarma
Water-like actions of kapha, including moistening and filling.
These characteristics are stated so kapha can be recognized and treated. The conjunction after cold also includes qualities such as softness and stability. Avidagdha is primarily explained as uncooked and sweet in taste, while vidagdha is cooked and salty. Others explain avidagdha as kapha in its normal, unvitiated state and vidagdha as kapha in an altered, vitiated state; another possibility is that it becomes salty through the cooking of digested food.
Key terms
avidagdhaH (avidagdhah)
Uncooked or untransformed kapha; alternatively, kapha in its normal unvitiated state.
vidagdhaH (vidagdhah)
Kapha transformed by cooking or heat; alternatively, kapha in an altered, vitiated state.
After discussing the doshas according to the first doctrine, this passage states the seat of blood intended by the doctrine that counts blood as a fourth factor alongside the three doshas. The earlier statement occurs in the section describing blood.
Key terms
shoNitasthAnam (shonitasthanam)
The principal seat of blood, identified here as the liver and spleen.
भवति चात्र- अनुष्णशीतं मधुरं स्निग्धं रक्तं च वर्णतः |
शोणितं गुरु विस्रं स्याद्विदाहश्चास्य पित्तवत् ||१७||
Meaning of the śloka
Blood is neither hot nor cold, is sweet and unctuous, red in color, heavy and visra in odor. It undergoes burning or irritating transformation in the same manner as pitta.
These inherent characteristics are given for understanding the causes, signs and treatment of blood disorders. Neither hot nor cold means of an intermediate character. Visra means having a raw or fleshy odor. Blood undergoes vidaha through the same substances and in the same manner as pitta.
Key terms
anuShNashItam (anushnashitam)
Neither hot nor cold, interpreted as intermediate in thermal character.
These are the sites of the doshas, and the doshas accumulate in them. The causes of accumulation were stated earlier. Signs of accumulated doshas are rigidity and fullness of the abdomen, a yellowish appearance, mildly increased warmth of the limbs, heaviness, laziness, and aversion to the causes of accumulation. This is the first opportunity for treatment.
The causes of accumulation were described earlier in the chapter on seasonal conduct. Accumulation is increase in the form of compact gathering, whereas aggravation is increase in the form of liquefaction. Read in sequence, rigidity and fullness of the abdomen are signs of vata accumulation; yellowish appearance and mild warmth are signs of pitta; and heaviness and laziness are signs of kapha. Some take all these signs generally as applying to every accumulated dosha. Aversion to the cause of accumulation is a general sign for all three. Some witnesses omit that sentence. Some teachers next read a verse beginning 'increase of the doshas in their own sites' to define accumulation and aggravation, but the complete verse was unavailable and therefore was not written out. This stage is called the first kriyakala, the earliest opportunity for therapeutic action.
Key terms
cayaH (cayah)
Accumulation, defined as an increase having the form of compact gathering.
prathamaH kriyAkAlaH (prathamah kriyakalah)
The first recognized opportunity for therapeutic action.
Vata becomes aggravated through conflict with stronger persons; excessive exercise, sexual activity and study; falls, running, crushing pressure, blows, fasting, repeated jumping, swimming, night waking, carrying loads, and excessive travel by elephant, horse, chariot or on foot; through pungent, astringent, bitter, dry, light and cold-potency foods; dried vegetables, dried meat, varaka, uddalaka, koradusha, shyamaka, nivara, mudga, masura, adhaki, harenu, kalaya and nishpava; through not eating, irregular eating or eating before prior food is digested; and through suppressing urges for flatus, urine, feces, semen, vomiting, sneezing, belching, tears and similar urges.
Conflict with stronger persons includes hand-to-hand combat with wrestlers and others. 'Excessive' applies to exercise, sexual activity and study. Abhighata is a blow from a staff or similar object. Langhana means crossing a pit or similar obstacle with a leap, plavana moving by repeated jumps, and pratarana crossing rivers by swimming with the arms. Excessive travel applies separately to elephant, horse, chariot and walking. Vallura is dried meat; varaka is varatika, a minor grain; uddalaka is wild kodrava; nivara is prastika, a red-awned grain popularly called ulaji; adhaki is tuvari; harenu is round kalaya; kalaya is triputaka; and nishpava is rajashimbi. Anashana includes scant eating and fasting. Irregular eating means excessive, insufficient or untimely food, while adhyashana means eating in the presence of undigested food. Suppression applies separately to each natural urge; kshavathu means sneezing and bashpa means tears. The inclusive ending also covers suppression of hunger and other urges.
Key terms
viShamAshanam (vishamashanam)
Irregular eating, including excessive, insufficient or untimely food.
adhyashanam
Eating while previously consumed food remains undigested.
स शीताभ्रप्रवातेषु घर्मान्ते च विशेषतः |
प्रत्यूषस्यपराह्णे तु जीर्णेऽन्ने च प्रकुप्यति ||२०||
Meaning of the śloka
Vata becomes especially aggravated in cold conditions, cloudy weather, strong wind and at the end of the hot season; at dawn, in the afternoon, and after food has been digested.
The passage separately states temporal causes of vata aggravation. Cold means the cold season, cloudy means a time marked by clouds, strong wind means weather with intense wind, and the end of the hot season means the rainy season. Dawn and afternoon are its times within the day, while after digestion is the time relative to eating.
Ayasa is bodily strain. Vidagdha means a burning or irritating state produced by swelling, passion, food or other causes. Vidahi describes food that provokes sour belching, burning, thirst and similar effects and digests with difficulty. The green-vegetable group is defined by a quoted list including kuthera, shigru, surasa, sumukha, suri, bhustrina, cukraka and cukrika. The curd specified is unctuous cow curd. Kurcika is clotted buttermilk and mastu is the watery part of curd. Sauvira is either a fermentation made from dehusked barley and trivrit or another sour grain fermentation. Sura preparations include flour-based varieties. Sour fruits include amrataka. Katvara is primarily non-unctuous curd. Others define it as very sour kanjika, the lower portion of that liquid, buttermilk that has become very sour, or buttermilk produced from unctuous curd. The inclusive ending covers cukra and related substances.
Key terms
vidAhi (vidahi)
Food described as provoking sour belching, burning and thirst and reaching digestion with difficulty.
kaTvaram (katvaram)
Primarily non-unctuous curd, with several alternative identifications involving sour fermented liquids or buttermilk.
तदुष्णैरुष्णकाले च घनान्ते च विशेषतः |
मध्याह्ने चार्धरात्रे च जीर्यत्यन्ने च कुप्यति ||२२||
Meaning of the śloka
Pitta becomes aggravated by hot things, during hot weather, and especially at the end of the cloudy season; at midday, at midnight, and while food is being digested.
Heat here is heat produced by the sun or similar sources. Hot weather means summer, and the end of the cloudy season means autumn. Midday and midnight are the daily periods of aggravation, while the digestion of food gives the time relative to eating. Jaijjhata declares the inclusion of grief and fear among pitta-aggravating factors non-authoritative because those factors aggravate vata. Other compilers did not reject that reading, so the present commentator retains it.
Abhishyandi describes something that produces excessive moisture in doshas, tissues, wastes and channels. Hayanaka, also called ghotakapuccha, is a type of shali rice. Yavaka is an awned grain with rice-like kernels shaped like barley. Naishadha is a grain called koraka, and itkata is khaggali. Flour here is rice flour. Krishara is gruel of sesame, rice and masha; payasa is rice cooked in milk. Bisa is lotus root, popularly called bisanda; mrinala is the thick sprouting shoot arising from lotus root; and shrngataka is a three-spined aquatic plant. Sweet fruits include tala and coconut. Vine fruits include alabu and similar fruits; others identify them as kushmanda and related fruits.
Key terms
abhiShyandi (abhishyandi)
Described as producing excessive moisture in doshas, tissues, wastes and bodily channels.
स शीतैः शीतकाले च वसन्ते च विशेषतः |
पूर्वाह्णे च प्रदोषे च भुक्तमात्रे प्रकुप्यति ||२४||
Meaning of the śloka
Kapha becomes aggravated by cold substances, in cold weather, and especially in spring; during the earlier part of the day, at the beginning of night, and immediately after eating.
Blood becomes aggravated by the same factors that aggravate pitta and, in particular, through repeated use of liquid, unctuous and heavy foods; daytime sleep, anger, fire, sunlight, exertion, injury, indigestion, incompatible foods, eating before previous food is digested, and similar factors.
Under the second doctrine, blood is the fourth factor alongside the three doshas, so the text states its causes of aggravation separately. Pitta-aggravating factors also aggravate blood because pitta and blood are similar. The following list supplies causes especially relevant to blood. Abhikshna means repeatedly; the omitted verb 'used' is to be understood with the foods.
Blood is not aggravated independently but always in dependence on a dosha. Thus blood affected by vata becomes aggravated at the time of vata aggravation, and blood affected by pitta or kapha follows the respective time of pitta or kapha.
Key terms
yathAdoSham (yathadosham)
According to the particular dosha on which the blood's aggravation depends.
From aggravation of the doshas arise pricking pain and movement within the abdomen, sour eructation, thirst, pervasive burning, aversion to food and unsettled nausea in the cardiac region. This is the second opportunity for treatment.
The first two signs, abdominal pricking and movement, belong to vata; movement means wandering of vata in the abdomen. Sour eructation, thirst and pervasive burning belong to pitta. Some divide aparidaha differently, understanding the negative prefix in the sense of slightness and interpreting it as mild burning. Aversion to food and hrdayotkleda belong to kapha; hrdayotkleda means nausea or queasiness. This stage is the second kriyakala, the second opportunity for therapeutic action.
Key terms
sa~jcaraNam (sancaranam)
Movement or wandering of vata within the abdomen.
hRudayotkledaH (hrdayotkledah)
Nausea or unsettled queasiness felt in the cardiac region.
dvitIyaH kriyAkAlaH (dvitiyah kriyakalah)
The second recognized opportunity for therapeutic action.
Next, prasara is described. When the doshas are aggravated by the stated disturbances, their combined increase resembles the swelling mixture of ferment, water and flour. Vayu, because it possesses movement and is dominated by rajas, drives their spread, since rajas sets things in motion. Like a great accumulation of water breaking a barrier, mixing with other water and rushing everywhere, doshas spread singly, in pairs, in groups, or with blood. The text enumerates fifteen patterns: vata, pitta, kapha or blood alone; each pairing of these; each three-member combination containing blood; the three doshas together; and all three doshas with blood.
Prasara is a particular further state of aggravation. The provoking factors may be those already stated, such as forceful struggle, or signs such as movement and pricking in the koshta. Ferment is the starter for sura, flour is rice flour, and their conjunction illustrates mutually penetrating qualities and combined increase. Vayu alone propels the doshas because of its mobility and abundance of rajas. Breaking the setu means breaking an embankment. The list classifies spread by every stated combination.
Key terms
prasaraH (prasarah)
Spread of aggravated doshas from their prior location, driven by vayu.
In whichever entire limb, half, or smaller part a dosha becomes intensely aggravated, it produces disorder there like a cloud raining in the sky. A dosha that is not greatly aggravated may remain latent in the pathways; when unopposed, it later encounters a cause and becomes aggravated.
Anga here includes the head, arms and legs; an avayava is a smaller part such as the chin or foot. A dosha that has spread may not immediately cause disease when its aggravation is slight. Lina means lodged in one place, and nishpratyanika means without a counteracting measure.
Key terms
lInaH (linah)
Latent or lodged at a particular site without yet producing overt disorder.
तत्र वायोः पित्तस्थानगतस्य पित्तवत् प्रतीकारः, पित्तस्य च कफस्थानगतस्य कफवत्, कफस्य च वातस्थानगतस्य वातवत् ; एष क्रियाविभागः ||३१||
Meaning of the śloka
Vata that has entered the site of pitta is treated as pitta; pitta in the site of kapha is treated as kapha; and kapha in the site of vata is treated as vata. This is the stated division of treatment.
Signs of spreading aggravated vata are movement along abnormal paths and atopa. Signs of pitta are localized burning, a sucking type of painful burning, diffuse heat and a sensation like smoke rising. Signs of kapha are loss of appetite, indigestion, bodily lassitude and vomiting. This is the third opportunity for treatment.
Calling the doshas aggravated in the context of prasara shows that prasara is a special degree of prakopa. Prakopa is compared to the first movement of solid ghee being heated, while prasara resembles foam rising and moving elsewhere when it is boiled intensely. Vimarga is a path other than vayu's normal path; atopa is abdominal disturbance preceded by pain. Osha is localized burning, chosha feels as if the part is being sucked, and dhumayana feels like smoke being emitted. Some omit osha and chosha and read only burning and dhumayana. Some omit indigestion and bodily lassitude and read only anorexia and vomiting. Up to prasara, treatment concerns the doshas; afterward it concerns disease.
Key terms
ATopaH (atopah)
Abdominal disturbance or agitation preceded by pain.
Next, sthanasamshraya is described. Aggravated doshas reach particular body regions and generate corresponding diseases. In the abdomen they cause gulma, vidradhi, udara, obstruction of agni, anaha, visuchika, diarrhea and related disorders; in the bladder, prameha, urinary stone, urinary retention and urinary disorders; in the penis, niruddhaprakasha, upadamsha and shuka disorders; in the anus, bhagandara and piles; in the testes, vriddhi; above the clavicles, disorders of that region; in skin, muscle and blood, minor disorders, kushtha and visarpa; in medas, granthi, apachi, arbuda, galaganda and alaji; in bone, vidradhi, anushayi and related disorders; in the feet, elephantiasis, vatarakta and vatakantaka; and throughout the body, fever and systemic disorders. When doshas become firmly lodged, prodromal signs appear; these will be described for each disease. The prodromal stage is the fourth opportunity for treatment.
Sthanasamshraya is arrest of spread where channel abnormality causes doshas to lodge. Sannivesha means firm establishment. The inclusive lists add disorders such as pravahika and vilambika. Jatru is the root of the neck. In the skin-muscle-blood sequence, 'skin' is intended to denote rasa. The bone-disease passage is considered appropriate after medas but is not fully written because it is absent from the sutra. Diseases of doshas lodged in majja and shukra are omitted because they are few and occasional. Systemic disease may mean generalized vata disease or prameha, pandu, shosha and others. The subtle stage lacks a separate sign; its evidence is emergence of the disease's prodrome, which must be taught disease by disease. Another reading says 'while prodromal signs are present.' Treatment here addresses both dosha and affected tissue.
Key terms
sthAnasaMshrayaH (sthanasamshrayah)
Localization of spreading doshas at a vulnerable site, where prodromal disease signs begin.
Next comes manifestation of disease: the signs of swelling, arbuda, granthi, vidradhi, visarpa, fever, diarrhea and related disorders become fully evident. This is the fifth opportunity for treatment.
Vyakti is the fully manifest form by which disease is recognized. Fully evident signs are the defining characteristics of the disease class: aggregation of dosha in skin and muscle for swelling and related lesions, heat for fever, flowing for diarrhea, and filling or distension for udara. Treatment at this stage directly opposes the disease.
Key terms
vyaktiH (vyaktih)
Full clinical manifestation in which the defining signs of a disease become evident.
When these swellings and related lesions rupture and become wounds, the sixth opportunity for treatment has arrived. In fever, diarrhea and similar diseases, this stage is marked by prolonged persistence. Without treatment at this stage, they become incurable.
This is bheda, the differentiated or complicated stage. Avadirna means split or ruptured, so swelling and related lesions acquire the state of a wound. For fever and similar disease classes, prolonged duration is given as the differentiating feature. Others say bheda instead means differentiation by signs of vata and other subtypes, while prolonged duration describes the result of failing to treat earlier stages. Earlier stages still leave later opportunities; after this final stage no later opportunity remains, hence the warning about incurability.
Key terms
bhedaH (bhedah)
The sixth stage, involving rupture, complication, chronicity, or differentiation into disease subtypes.
Earlier intervention requires fewer measures, while later stages require more. Removal means shodhana when doshas are abundant, fasting and pachana when moderate, and shamana when slight.
The verse distinguishes the principal dosha from the secondary accompanying dosha for treatment. One explanation takes bhava as inherent qualities such as dryness, heat and unctuousness: the dosha displaying all its qualities is principal and overt, while one aggravated through fewer qualities follows it; treating the principal is expected to calm the secondary. When all doshas are fully aggravated, each is principal in equal sannipata, where pitta is treated first. Other authorities define bhavas as diet, activity, place and time; others as taste, quality, virya and vipaka; Harichandra and other Caraka commentators as substance, quality and action. A variant reads bhagaih, parts or qualities, and prescribes opposing whichever one, two, three or all component qualities are aggravated. Samsarga is conjunction of two doshas. It may be prakriti-sama-samaveta, where combined qualities are naturally similar, as vata and pitta share a drying tendency, or vikriti-vishama-samaveta, where they oppose one another, as hot pitta joins cold kapha.
Key terms
anubandhya
The principal, fully expressed dosha to which a secondary dosha is attached.
anubandha
The secondary accompanying dosha, expressed through fewer of its qualities.
Gariyan means the heavier or more severe dosha. Treatment must not aggravate the others. Passages directing that pitta be treated first in combined fever and in fever or diarrhea concern equal sannipata, rather than the twelve unequal forms, so they do not contradict this rule.
Adhikarana ૩૮ (૪૦) · Śloka ૪૦
વૃણોતિ યસ્માદ્રૂઢેઽપિ વ્રણવસ્તુ ન નશ્યતિ |
આદેહધારણાત્તસ્માદ્વ્રણ ઇત્યુચ્યતે બુધૈઃ ||૪૦||
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वृणोति यस्माद्रूढेऽपि व्रणवस्तु न नश्यति |
आदेहधारणात्तस्माद्व्रण इत्युच्यते बुधैः ||४०||
Meaning of the śloka
Because it covers the part, and because the mark or substance of a wound does not disappear even after healing but remains as long as the body endures, knowledgeable people call it vrana.
One derivation explains vrana from its covering the affected part. Alternatively, the wound mark remains even after healing, throughout life, and this persistence accounts for the name.
Key terms
vraNaH (vranah)
A wound, explained either as covering a part or as leaving a lasting mark after healing.