२४. व्याधिसमुद्देशीयाध्यायः

Name: Sushruta Samhita
Author: Sushruta

Devanagari IAST (Roman)Telugu Tamil Malayalam Kannada Gujarati Bengali Gurmukhi

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Adhikarana १ (१-२) · Śloka २

अथातो व्याधिसमुद्देशीयमध्यायं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the chapter giving a concise classification of diseases will be explained, as taught by Bhagavan Dhanvantari.

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व्याधिसमुद्देशीयमित्यादि| व्याधीनां समासेनोद्देशः कथनं, तदधिकृत्य कृतोऽध्यायो व्याधिसमुद्देशीयः, व्याधिसङ्क्षेपोद्देशीय इत्यर्थः||१-२||

Meaning of the commentary

Vyadhisamuddeshiya means a chapter composed to state diseases briefly or to provide a concise outline of them.

Key terms

vyAdhisamuddesha (vyadhisamuddesha): A concise statement, outline or classification of diseases.

Adhikarana २ (३) · Śloka ३

द्विविधास्तु व्याधयः- शस्त्रसाध्याः, स्नेहादिक्रियासाध्याश्च | तत्र शस्त्रसाध्येषु स्नेहादिक्रिया न प्रतिषिध्यते, स्नेहादिक्रियासाध्येषु शस्त्रकर्म न क्रियते ||३||

Meaning of the śloka

Diseases are of two kinds: those treated by surgical instruments and those treated by measures beginning with oleation. Measures such as oleation are not prohibited in diseases requiring surgery, but surgical procedures are not performed in diseases treatable by oleation and related measures.

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शस्त्रसाध्यत्वेन स्नेहादिसाध्यत्वेन च व्याधीनां द्वैविध्यं दर्शयन्नाह,- द्विविधा इत्यादि| शस्त्रसाध्या इति छेद्यादिप्रकारेण; स्नेहादिक्रियासाध्या इति अत्रादिशब्देन स्वेदनवमनविरेचनादयः| तत्रेति तयोर्मध्ये| शस्त्रसाध्येषु अष्टविधशस्त्रकर्मीयोक्तेषु भगन्दरग्रन्थिप्रभृतिषु||३||

Meaning of the commentary

The first class is treated through excision and the other types of operative procedure. In the second class, the inclusive ending after oleation covers fomentation, emesis, purgation and similar measures. The surgically treated group includes bhagandara, granthi and other disorders described under the eight kinds of surgical procedure. Supportive oleation and related measures may still be used in that group.

Key terms

shastrasAdhya (shastrasadhya): A disease classified as requiring treatment with a surgical instrument or operative procedure.
snehAdikriyAsAdhya (snehadikriyasadhya): A disease treated by non-operative measures beginning with oleation and including procedures such as fomentation, emesis and purgation.

Adhikarana ३ (४) · Śloka ४

अस्मिन् पुनः शास्त्रे सर्वतन्त्रसामान्यात् सर्वेषां व्याधीनां यथास्थूलमवरोधः क्रियते | प्रागभिहितं ‘तद्दुःखसंयोगा व्याधय’ (सू. अ. १) इति | तच्च दुःखं त्रिविधम्- आध्यात्मिकम्, आधिभौतिकम्, आधिदैविकमिति | तत्तु सप्तविधे व्याधावुपनिपतति | ते पुनः सप्तविधा व्याधयः; तद्यथा- आदिबलप्रवृत्ताः, जन्मबलप्रवृत्ताः, दोषबलप्रवृत्ताः, सङ्घातबलप्रवृत्ताः, कालबलप्रवृत्ताः, दैवबलप्रवृत्ताः, स्वभावबलप्रवृत्ता इति ||४||

Meaning of the śloka

Because this treatise shares common ground with all branches, it includes all diseases in broad outline. Disease was previously defined as conjunction with suffering. That suffering is threefold: adhyatmika, adhibhautika and adhidaivika. These occur within a sevenfold classification of disease: arising from primordial or hereditary force, birth-related force, dosha force, traumatic conjunction, time, divine or unseen force, and inherent nature.

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शल्यतन्त्रत्वादस्य तन्त्रस्य शस्त्रक्रियैवार्हति न स्नेहादिक्रियेत्याशङ्क्योभयक्रियाधिकारं दर्शयन्नाह- अस्मिन्नित्यादि| अस्मिन्निति सौश्रुते शल्यतन्त्रे| पुनःशब्दोऽत्र एवार्थे| सर्वतन्त्रसामान्यादिति शालाक्यादीनां सामान्यात् तुल्यत्वात्| यथास्थूलमिति स्थूलदृष्ट्या, न सूक्ष्मदृष्ट्येत्यर्थः| एतेन ये सनामका व्याधयस्तेषामवरोधः, निर्नामकानां पुनर्लक्षणद्वारेण, अवरोधः सङ्ग्रहः| कः पुनरयं व्याधिरित्याह- प्रागभिहितमित्यादि| तदिति तयोः शरीरशरीरिणोः; ‘शरीरमनसोः’ इति केचित्| तच्च दुःखं त्रिविधमिति चकारान्न केवलं त्रिविधं सप्तविधं च| आत्मशब्देन समनस्कं शरीरमुच्यते| तत्र वातपित्तकफोत्थाः शरीरभवा आध्यात्मिकाः, तथा रजस्तमोभवाश्च; आत्मन्यधि अध्यात्मं, तत्र भवमाध्यात्मिकम्| भूतानि प्राणिनः, भूतेष्वधिकृत्य यद्वर्तते तदाधिभौतिकम्| देवाः सुराः सुरयोनयश्च, देवेष्वधिकृत्य यद्वर्तते तदाधिदैविकम्| तदेव त्रिविधं दुःखं भेदान्तरहेतुभिर्बहुप्रकारभूते व्याधौ समवैतीत्याह- तदित्यादि|- तदिति त्रिविधं दुःखम्| उपनिपतति मध्ये निपतति| ते पुनरिति ते त्रिविधा व्याधयः पुनः सप्तविधा भवन्तीत्यर्थः||४||

Meaning of the commentary

Although this is a surgical treatise, it has authority over both operative and measures such as oleation because it shares subject matter with branches such as Shalakya. Its inclusion of diseases is broad rather than minutely exhaustive. Named diseases are included by name, while unnamed ones are included through their signs. In the earlier definition, conjunction with suffering can refer to body and embodied self; some instead read body and mind. The conjunction in the present passage indicates that suffering is both threefold and, through another basis of division, sevenfold. Atman here means the body together with mind. Adhyatmika suffering arises in that embodied complex, including bodily conditions from vata, pitta and kapha and mental conditions from rajas and tamas. Adhibhautika concerns living beings, while adhidaivika concerns deities, divine classes or forces. The same threefold suffering falls within diseases made various by the causal bases of the sevenfold scheme.

Key terms

AdhyAtmika (adhyatmika): Suffering arising within the body-mind complex, including bodily and mental sources in this commentary.
Adhibhautika (adhibhautika): Suffering connected with other living beings.
Adhidaivika (adhidaivika): Suffering connected with divine, unseen or superhuman agencies in the source's classification.

Adhikarana ४ (५) · Śloka ५

तत्र, आदिबलप्रवृत्ता ये शुक्रशोणितदोषान्वयाः कुष्ठार्शःप्रभृतयः; तेऽपि द्विविधाः- मातृजाः, पितृजाश्च | जन्मबलप्रवृत्ता ये मातुरपचारात् पङ्गुजात्यन्धबधिरमूकमिन्मिनवामनप्रभृतयो जायन्ते; तेऽपि द्विविधाः रसकृताः, दौहृदापचारकृताश्च | दोषबलप्रवृत्ता ये आतङ्कसमुत्पन्ना मिथ्याहाराचारकृताश्च; तेऽपि द्विविधाः आमाशयसमुत्थाः , पक्वाशयसमुत्थाश्च; पुनश्च द्विविधाः- शारीरा, मानसाश्च | त एते आध्यात्मिकाः ||५||

Meaning of the śloka

Diseases arising from primordial or hereditary force are those linked to defects in semen or menstrual blood, such as kushtha and arshas; they are divided into maternal and paternal types. Diseases arising from birth-related force develop through improper conduct of the mother and include congenital lameness, blindness, deafness, muteness, nasal speech, and extreme shortness; they are divided into those caused through rasa and those caused by disregard of dauhrida. Diseases arising through dosha force develop from another disease or from improper diet and conduct. They are divided into those arising from amashaya and those from pakvashaya, and again into bodily and mental types. These three disease classes are adhyatmika.

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तेषां सप्तविधव्याधीनां क्रमेण लक्षणान्याह- तत्र आदिबलप्रवृत्ता इत्यादि| तत्र तेषु मध्ये| आदिबलप्रवृत्ता दुष्टशुक्रशोणितबलजाताः| के ते इत्याह- ये शुक्रशोणितदोषान्वया इति; शुक्रशोणितस्थितवातादिदोषजनिताः| तानेव नामतो दर्शयति- कुष्ठार्शःप्रभृतय इति| प्रभृतिग्रहणान्मेहक्षयादयः| मातृजा इति मातुः शोणितजाः, पितृजाश्चेति पितुः शुक्रजाः| द्वितीयं व्याधिभेदं दर्शयन्नाह- जन्मबलप्रवृत्ता इत्यादि| जन्मबलप्रवृत्ता इति शुक्रशोणितदुष्टिं विनाऽपि मातुरपचारबलजाताः; अपचार इति दुष्टाहाराचारावपचारः| मूका अवाचः, मिन्मिनाः सानुनासिकाः, वामना अत्यन्तह्रस्वशरीराः| दौहृदापचारकृताश्चेति गर्भानुभावान्मातुश्चतुर्थादिमासेष्विन्द्रियार्थप्रार्थना ‘दौहृदम्’ इत्याचक्षते; तस्यापचारस्तु दौहृदमेवापमानितम्, अपमानितमलब्धं गर्भस्याहितं वा| अत्र ‘मूकमिन्मिनवामनप्रभृतयो जायन्ते’ इत्यस्याग्रे केचित् ‘भुञ्जते’ इत्यादि पाठं पठन्ति, स च पूर्णो न दृश्यते निबन्धेष्विति न लिखितः| तृतीयं व्याधिभेदं निर्दिशन्नाह- दोषेत्यादि| दोषा वातादयो रजस्तमसी च, बलं शक्तिः, प्रवृत्ता जाताः| के पुनस्त इत्याह- ये आतङ्कसमुत्पन्ना इति| आतङ्का रोगाः; यथा- प्रतिश्यायात् कासः, कासात् क्षय इत्यादि| एते आध्यात्मिका इति एते आदिबलप्रवृत्ता जन्मबलप्रवृत्ता दोषबलप्रवृत्तास्त्रय आध्यात्मिकाः; शरीरस्थवातादिरजःप्रभृतिदोषजनितत्वात्||५||

Meaning of the commentary

Adibalapravritta diseases arise through the force of vitiated semen or blood, specifically through vata and other doshas located in them. The inclusive ending after kushtha and arshas covers meha, wasting and other conditions. Maternal forms arise from the mother's blood and paternal forms from the father's semen. Janmabalapravritta diseases can arise through the mother's unsuitable food and conduct even without a defect in semen or blood. Muka means unable to speak, minmina nasal in speech, and vamana extremely short in bodily stature. Dauhrida is the mother's desire for sense objects from about the fourth month onward, attributed to the influence of the fetus. Its disregard means insulting or denying the desire, failing to obtain the desired thing, or providing something harmful to the fetus. Some manuscripts add words after the congenital list, but the complete passage is unavailable in the commentarial sources and is therefore not reproduced. In doshabalapravritta disease, dosha includes vata, pitta and kapha as well as rajas and tamas. Disease can produce another disease, as pratishyaya may lead to cough and cough to wasting. The first three of the seven classes are called adhyatmika because they arise through bodily doshas and mental factors such as rajas.

Key terms

AdibalapravRtta (adibalapravritta): Arising through hereditary or primordial force associated in the source with defects in parental reproductive substances.
janmabalapravRtta (janmabalapravritta): Arising through birth-related force, attributed here to the mother's diet, conduct or disregard of dauhrida.
doShabalapravRtta (doshabalapravritta): Arising through the force of bodily or mental doshas, improper regimen, or progression from another disease.
dauhRda (dauhrida): A pregnant mother's desire for particular sense objects, explained as influenced by the fetus.

Adhikarana ५ (६) · Śloka ६

सङ्घातबलप्रवृत्ता य आगन्तवो दुर्बलस्य बलवद्विग्रहात्; तेऽपि द्विविधाः- शस्त्रकृता, व्यालकृताश्च | एते आधिभौतिकाः ||६||

Meaning of the śloka

Diseases arising through the force of collision are external in origin, such as those produced when a weaker person fights a stronger one. They are of two kinds: caused by weapons and caused by wild animals. These are classified as adhibhautika.

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चतुर्थं व्याधिभेदं निर्दिशन्नाह- सङ्घातेत्यादि| सङ्घातबलप्रवृत्ता इति प्रहारशक्तिजाताः| के पुनस्त इत्याह- य आगन्तव इत्यादि| व्यालकृता इति व्याला दुष्टव्याघ्रादयः| एते आधिभौतिका इति एते पूर्वोक्ता आगन्तवः; आधिभौतिकत्वं भूतेषु प्राणिष्वधिकृतत्वात्||६||

Meaning of the commentary

This passage states the fourth division of disease. Arising through the force of collision means produced by the power of a blow. Wild animals include dangerous tigers and similar creatures. The previously described externally originating disorders are called adhibhautika because their causes operate among living beings.

Key terms

sa~gghAtabalapravRuttAH (sanghatabalapravrttah): Arising from the force of impact or the power of a blow.
AdhibhautikAH (adhibhautikah): The source's category for externally caused disorders operating through living beings.

Adhikarana ६ (७) · Śloka ७

कालबलप्रवृत्ता ये शीतोष्णवातवर्षातपप्रभृतिनिमित्ताः; तेऽपि द्विविधाः- व्यापन्नर्तुकृताः, अव्यापन्नर्तुकृताश्च | दैवबलप्रवृता ये देवद्रोहादभिशप्तका अथर्वणकृता उपसर्गजाश्च; तेऽपि द्विविधाः- विद्युदशनिकृताः, पिशाचादिकृताश्च; पुनश्च द्विविधाः- संसर्गजा , आकस्मिकाश्च | स्वभावबलप्रवृत्ता ये क्षुत्पिपासाजरामृत्युनिद्राप्रभृतयः; तेऽपि द्विविधाः- कालजा, अकालजाश्च; तत्र परिरक्षणकृताः कालजाः, अपरिरक्षणकृता अकालजाः | एते आधिदैविकाः | अत्र सर्वव्याध्यवरोधः ||७||

Meaning of the śloka

Time-force disorders arise from causes such as cold, heat, wind, rain and sunlight. They are of two kinds: produced by a deranged season and produced by a season that is not deranged. Divine-force disorders are described as arising from offense against deities, curses, Atharvan rites and upasarga. They are divided into those caused by lightning or thunderbolt and those caused by pishacas and similar beings; they are also divided into those produced through contact and those occurring suddenly. Natural-force conditions include hunger, thirst, aging, death and sleep. They are timely or untimely: those that occur despite protective effort are timely, and those arising through lack of protection are untimely. These are classed as adhidaivika. All diseases are included within the categories stated here.

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पञ्चमं व्याधिभेदं निर्दिशन्नाह- कालबलप्रवृत्ता इत्यादि| कालः शीतोष्णवर्षलक्षणः षडृतुकः| के पुनस्त इत्याह- शीतोष्णवातवर्षातपप्रभृतिनिमित्ताः; ते पुनर्जाड्यदाहकम्पादयः, तथा व्रणज्वराश्च| अत्र व्यापन्नर्तुकृतानां पूर्वोद्धृतान्नपानौषधिभिरुपचारः, यथास्वं च व्याधिविहितं भेषजम् ऋतुव्यापत्प्रशमनं च, दैवव्यपाश्रयं च होमादि; अव्यापन्नर्तुकृतानां पुनर्यथादोषं यथारोगमेवोपचारः| षष्ठं व्याधिभेदं निर्दिशन्नाह- दैवबलप्रवृत्ता इत्यादि| दैवबलप्रवृत्ता इति देवशक्तिजाता इत्यर्थः| के पुनस्त इत्याह- ये देवद्रोहादित्यादि| देवगोगुरुसिद्धानां द्रोहात्| अभिशप्तका इति ऋषीणामाक्रोशजाः| आथर्वणकृता अथर्ववेदप्रणीताभिचारिकमन्त्रैः कृता मारणात्मका व्याधयः| उपसर्गजा इति उपसृज्यन्त इत्युपसर्गाः पीडितजनसमीपोत्पन्ना ज्वरादयः| विद्युदशनिकृता इति लताकारा तिर्यक्पतन्ती वह्निरूपा विद्युत्, मुशलवदधःपतनशीलो मारणात्मकोऽशनिः| संसर्गजा इति देवादिद्रोहकजनसम्पर्कजा इत्यर्थः| आकस्मिका इति विनैव संसर्गं प्राक्तनकर्मपीडितत्वेन जाता इत्यर्थः| उपसर्गजसंसर्गजयोरयं विशेषः- उपसर्गजा ज्वरादिरोगपीडितजनसम्पर्काद्भवन्ति; संसर्गजाश्च देवादिद्रोहकजनसम्पर्काद्भवन्ति| ‘देवद्रोहाभिशप्तका’ इत्यत्र केचित् ‘उपसर्गाभिशापाभिचाराभिषङ्गजा’ इति पठन्ति, स चाभावान्न लिखितः| सप्तमं व्याधिभेदं दर्शयन्नाह- स्वभावबलप्रवृत्ता इत्यादि| स्वभावबलप्रवृत्ता इति प्रकृतिशक्तिजाता इत्यर्थः| के पुनस्त इत्याह- क्षुत्पिपासेत्यादि| कालजा इति ये समये प्राप्ता भवन्ति| अकालजा असमये जाता इत्यर्थः| तत्र कालजाकालजयोर्हेतुभेदेन भेद इति दर्शयति- तत्र परिरक्षणकृता इत्यादि| परिरक्षणं रक्षाप्रयत्नः, तस्मिन्नपि परिरक्षणे ये भवन्ति ते कालजाः; अत एव कालकृतानां नोपचारोऽस्ति याप्यतैवास्ति भोजनपानरसायनादिभिः, आत्यन्तिकप्रतीकारो वा स्वभावव्याधिचिकित्सितोक्तरसायनविधिना| अपरिरक्षणकृता इति अपरिरक्षणं रक्षणेऽप्रयत्नः, तस्मिन् ये भवन्ति ते अकालकृताः| तेषां च यथादोषं यथारोगं च प्रतीकारः| एते आधिदैविका इति एते क्षुत्पिपासादयो दैवमधिकृत्य भवन्तीत्याधिदैविकाः| केचित् “एत आधिदैविकाः” इत्यमुं पाठं न पठन्ति| तेषां मते स्वभावबलप्रवृत्ताः क्षुत्पिपासादय आध्यात्मिकमध्ये निपतन्ति| तत्र तेष्वेव सप्तसु व्याधिभेदेषु सर्वव्याध्युपरोधं दर्शयन्नाह- अत्र सर्वव्याध्युपरोध इति| अत्रेति अत्रोक्तसप्तविधव्याधौ, उपरोधः सङ्ग्रहः||७||

Meaning of the commentary

This passage gives the fifth, sixth and seventh divisions of disease. Time is the six-season cycle characterized by cold, heat and rain. Its disorders include stiffness, burning and trembling, as well as wounds and fever. The commentary assigns deranged-season disorders treatment with previously collected food, drink and medicines, measures appropriate to the disease and seasonal disturbance, and historical rites such as homa; disorders arising in a normal season are treated according to dosha and disease. Divine-force disorders are said to arise from divine power. Their causes include offense against deities, cows, teachers and siddhas; curses by sages; destructive rites using Atharvan mantras; and upasarga disorders such as fever arising near an afflicted person. Lightning is described as transverse, vine-like fire, while ashani falls downward like a pestle and is lethal. Contact-produced disease here means contact with someone who has offended deities or similar beings, whereas upasarga means contact with a person afflicted by fever or another disease. Sudden disease is explained through the source's doctrine of prior action without contact. Some witnesses read a different sequence involving upasarga, curses, ritual acts and abhishanga, but the commentator omits it because the reading was unavailable. Natural-force conditions arise from the power of nature. Timely means occurring at the expected time despite protective effort; the commentary regards such conditions as maintainable with food, drink, rasayana and related measures, or potentially addressed through the rasayana method taught for natural disease. Untimely means arising through failure to protect and is addressed according to dosha and disease. Some omit the statement classing these conditions as adhidaivika and instead place hunger, thirst and the other natural conditions under adhyatmika. The seven disease divisions together are said to encompass all diseases.

Key terms

kAlabalapravRuttAH (kalabalapravrttah): Disorders attributed to the force of time, season or weather.
daivabalapravRuttAH (daivabalapravrttah): Disorders attributed by the source to divine or supernatural force.
svabhAvabalapravRuttAH (svabhavabalapravrttah): Conditions attributed to the force of nature, including hunger, thirst, aging, death and sleep.

Adhikarana ७ (८) · Śloka ८

सर्वेषां च व्याधीनां वातपित्तश्लेष्माण एव मूलं; तल्लिङ्गत्वाद्दृष्टफलत्वादागमाच्च | यथा हि कृत्स्नं विकारजातं विश्वरूपेणावस्थितं सत्त्वरजस्तमांसि न व्यतिरिच्यन्ते, एवमेव कृत्स्नं विकारजातं विश्वरूपेणावस्थितमव्यतिरिच्य वातपित्तश्लेष्माणो वर्तन्ते | दोषधातुमलसंसर्गादायतनविशेषान्निमित्ततश्चैषां विकल्पः | दोषदूषितेष्वत्यर्थं धातुषु सञ्ज्ञा- रसजोऽयं, शोणितजोऽयं, मांसजोऽयं, मेदोजोऽयं, अस्थिजोऽयं मज्जजोऽयं, शुक्रजोऽयं व्याधिरिति ||८||

Meaning of the śloka

Vata, pitta and kapha are the root of all diseases, because diseases bear their signs, because the effects of dosha-directed treatment are observed, and because authoritative teaching states it. Just as the entire range of transformations that constitutes the world does not exist apart from sattva, rajas and tamas, the entire range of diseases likewise does not occur apart from vata, pitta and kapha. Diseases differ through the combinations of doshas with tissues and wastes, through differences in their sites, and through their causes. When a tissue is greatly affected by doshas, the disorder is named after that tissue as rasa-born, blood-born, flesh-born, fat-born, bone-born, marrow-born or shukra-born.

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कथं पुनः सर्वव्याध्युपरोध इत्याह- सर्वेषां च व्याधीनामित्यादि| मूलमिति कारणमित्यर्थः| तल्लिङ्गत्वादिति वातादिलिङ्गत्वात्| लिङ्गं तु वातादीनां रौक्ष्याल्पस्नेहादयः, तथा तोददाहकण्ड्वादीनि कार्याणि च| दृष्टफलत्वादिति वातादिहरौषधैर्वातादिव्याधेरुपशमनदर्शनात्| आगमाच्च सविंशत्येकादशशतनां व्याधीनां कार्यभूतानां वातपित्तश्लेष्माणो हि कारणम्| यथाहि कृत्स्नमित्यादि| विकारजातमिति विकारसमूहं; विकाराश्चात्र त्रयोविंशतिर्महदाद्याः| विश्वरूपेणावस्थितमिति जगद्रूपेण व्याप्य स्थितमित्यर्थः| न व्यतिरिच्यन्त इति न पृथग्भवन्तीत्यर्थः| एवमेव कृत्स्नं विकारजातमित्यादि विकारजातमिति रोगसमूहम्| अव्यतिरिच्येति अपरित्यज्येत्यर्थः| एतेन ताल्लिङ्गत्वादित्यादिना अनुमानप्रत्यक्षागमोपमानानि चत्वारि प्रमाणान्युक्तानि| ननु, दोषत्रयात् कथमादिबलप्रवृत्तादयोऽनेके व्याधय इत्याह- दोषेत्यादि| दोषधातुमलसंसर्गादिति संसर्गः संयोगः; तद्यथा- वातादिदोषरसधातुसंसर्गाज्ज्वरादयो रसाधिष्ठानाः,वातादिदोषरसधातुपुरीषमलसंसर्गादतीसारादयः, वातादिदोषरसादिदूष्यमूत्रमलसंसर्गाद्विंशतिर्मोहाः, तथा वातादिदोषरक्तधातुसंसर्गाद्वातरक्तरक्तपित्तविद्रधिरक्तगुल्मादयः| आयतनविशेषादिति आयतनानि स्थानानि, तेषां विशेषो भेद इत्यर्थः; तद्यथा- सप्तस्वायतनेषु पञ्चषष्टिर्मुखरोगाः, चक्षुरिन्द्रियायतनेषु षट्सप्ततिर्नेत्ररोगाः, निमित्ततश्चेति निमित्तानि वातादयः; तद्यथा- प्रत्येकं वातादिज्वरास्त्रयः, सान्निपातिक एकः, द्वन्द्वजास्त्रयः, आगन्तुश्चाष्टमः; एवमन्यदपि निमित्ततो व्याधीनां नानात्वं ज्ञेयम्| एषामिति व्याधीनां, विकल्पो भेदः नानात्वमित्यर्थः| दूष्यजन्मसञ्ज्ञा लक्षणया भवतीति दर्शयन्नाह- दोषदूषितेष्वत्यर्थमित्यादि| दोषैरेव दूषितेषु धातुष्वत्यर्थं दोषजेषु विकारेषु रसजादिसञ्ज्ञा; यथा- घृतदग्धस्तैलदग्धस्ताम्रदग्धो लोहदग्ध इति| अत्र घृतादिशब्देन घृतादिस्थो वह्निर्लक्ष्यते, एवं रसादिजो व्याधिरित्यत्र रसादिस्थितवातादिदोषा लक्ष्यन्ते||८||

Meaning of the commentary

The passage explains how the preceding categories include all disease. Root means cause. Diseases show doshic signs such as dryness or reduced unctuousness and effects such as pricking pain, burning and itching. Their doshic basis is also inferred when medicines directed against a dosha calm the corresponding disease, and is supported by authoritative teaching that vata, pitta and kapha cause the stated diseases. In the comparison, the twenty-three transformations beginning with mahat pervade the form of the world without existing separately from sattva, rajas and tamas; similarly, the collection of diseases does not abandon the three doshas. The commentary sees inference, perception, authoritative testimony and analogy represented by these arguments. Variety arises when doshas combine with tissues and wastes: examples include fever based in rasa, diarrhea involving rasa and feces, prameha involving rasa and urine, and vatarakta, raktapitta, abscess and blood-gulma involving blood. Variety also arises from location, such as the many diseases of the mouth and eye, and from causes, as in the doshic, combined and external varieties of fever. Naming a disorder rasa-born or after another tissue is figurative: it denotes doshas situated in and severely affecting that tissue, just as 'burned by ghee' refers to fire situated in ghee rather than ghee itself as the burning agent.

Key terms

mUlam (mulam): The causal root, here assigned to vata, pitta and kapha for all diseases.
doShadhAtumalasaMsargAt (doshadhatumalasamsargat): Through combinations of doshas with tissues and bodily wastes, one basis for disease diversity.
rasajaH (rasajah): Called rasa-born by figuratively naming the disorder after the tissue severely affected by doshas.

Adhikarana ८ (९) · Śloka ९

तत्र, अन्नाश्रद्धारोचकाविपाकाङ्गमर्दज्वरहृल्लासतृप्तिगौरवहृत्पाण्डुरोगमार्गोपरोधकार्श्यवैरस्याङ्गसादाकालजवलीपलितदर्शनप्रभृतयो रसदोषजा विकाराः; कुष्ठविसर्पपिडकामशकनीलिकातिलकालकन्यच्छव्यङ्गेन्द्रलुप्तप्लीहविद्रधिगुल्मवातशोणितार्शोऽर्बुदाङ्गमर्दासृग्दररक्तपित्तप्रभृतयो रक्तदोषजाः , गुदमुखमेढ्रपाकाश्च; अधिमांसार्बुदार्शोऽधिजिह्वोपजिह्वोपकुशगलशुण्डिकालजीमांससङ्घातौष्ठप्रकोपगलगण्डगण्डमालाप्रभृतयो मांसदोषजाः; ग्रन्थिवृद्धिगलगण्डार्बुदमेदोजौष्ठप्रकोपमधुमेहातिस्थौल्यातिस्वेदप्रभृतयो मेदोदोषजाः; अध्यस्थ्यधिदन्तास्थितोदशूलकुनखप्रभृतयोऽस्थिदोषजाः; तमोदर्शनमूर्च्छाभ्रमपर्वस्थूलमूलारुर्जन्मनेत्राभिष्यन्दप्रभृतयो मज्जदोषजाः; क्लैब्याप्रहर्षशुक्राश्मरीशुक्रमेहशुक्रदोषादयश्च तद्दोषाः; त्वग्दोषाः सङ्गोऽतिप्रवृत्तिरयथाप्रवृत्तिर्वा मलायतनदोषाः; इन्द्रियाणामप्रवृत्तिरयथाप्रवृत्तिर्वेन्द्रियायतनदोषाः; इत्येष समास उक्तः; विस्तरं निमित्तानि चैषां प्रतिरोगं वक्ष्यामः ||९||

Meaning of the śloka

Disorders attributed to impaired rasa include lack of desire for food, loss of appetite, impaired digestion, bodily aching, fever, nausea, satiety, heaviness, cardiac pallor disorder, obstruction of pathways, emaciation, altered taste, weakness of the limbs, premature wrinkles and graying, and similar conditions. Blood-related disorders include kushtha, visarpa, pidaka, mashaka, nilika, tilakalaka, nyaccha, vyanga, indralupta, splenic disease, abscess, gulma, vatarakta, piles, arbuda, bodily aching, abnormal uterine bleeding, raktapitta, and suppuration of the anus, mouth and penis. Flesh-related disorders include adhimamsa, arbuda, piles, adhijihva, upajihva, upakusha, galashundika, alaji, mamsasanghata, swelling of the lips, galaganda, gandamala and similar disorders. Fat-related disorders include granthi, vrddhi, galaganda, arbuda, fat-related lip swelling, madhumeha, excessive corpulence and excessive sweating. Bone-related disorders include extra bones, extra teeth, pricking pain and pain in bones, kunakha and similar conditions. Marrow-related disorders include seeing darkness, fainting, dizziness, thick-rooted ulcers arising at joints, eye discharge and similar conditions. Shukra-related disorders include klaibya, absence of sexual desire, shukra stone, shukrameha and other shukra disorders. Skin disorders include kushtha. Obstruction, excessive flow or improper flow are disorders of waste outlets. Failure or improper functioning of the senses are disorders of sensory sites. This is a concise account; the details and causes will be stated disease by disease.

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चिकित्साविशेषविज्ञानार्थं सुखसाध्यत्वादिकर्मबोधार्थं च प्रत्येकं रसादिधातुविकारान् दर्शयितुमाह- तत्रान्नाश्रद्धारोचकेत्यादि| अन्नाश्रद्धा अन्नविद्वेषः| अङ्गमर्द इति वेदनाविशेषः ‘स्फुटनिका’ इति लोके| हृल्लासो हृदयोत्क्लेदोऽसकृत्ष्ठीवनम्| अङ्गसाद इति अङ्गानामनुत्साहः| रसदोषजा इति दोषदूषितरसजाताः| रसजानभिधाय रक्तजानभिधातुमाह- कुष्ठेत्यादि| रक्तजानुक्त्वा मांसजानाह- अधिमांसेत्यादि| मांससङ्घात इति मांसतानो नाम मुखरोगेषु; ‘मांसोच्छ्रायः सामान्य एव’ इत्यन्ये| मांसजान् कथयित्वा मेदोजानाह- ग्रन्थीत्यादि| मेदोजानुक्त्वाऽस्थिजानाह- अध्यस्थ्यधिदन्तेत्यादि| अध्यस्थीनि अधिकास्थीनीत्यर्थः| अधिदन्ता इति अधिका दन्ता इत्यर्थः| तोदशूलाभ्यां सहास्थिशब्दः प्रत्येकं सम्बध्यते| अस्थिदोषानभिधाय मज्जजानाह- तमोदर्शनेत्यादि|- तमोदर्शनम् अन्धकारदर्शनम्| मूर्च्छा चेतनाच्युतिः| भ्रमः चक्रारूढस्येव| पूर्वस्थूलमूलारुर्जन्मेति स्थूलमूलानामरुषां व्रणानां पर्वसु जन्मेत्यर्थः | अन्ये त्वत्र ‘पर्वगौरवस्थूलमूलारुर्जन्म’ इति पठन्ति| मज्जदोषानभिधाय शुक्रदोषान् दर्शयति- क्लैब्याप्रहर्षेत्यादि|- क्लैब्यमिति षण्ढतेत्यर्थः| अप्रहर्ष इति स्त्रीविषयेऽनभिलाषः| तद्दोषा इति शुक्रदोषा इत्यर्थः| शुक्रजानुक्त्वा मलायतनदोषानाह- त्वग्दोषा इत्यादि| त्वग्दोषाः कुष्ठानि| कर्णनासामुखाक्षिमलायतनेष्वन्येषु च प्रजननाद्यपत्यपथेष्वप्रवृत्तिः ‘सङ्ग’ उच्यते| मलायतनदोषानभिधायेन्द्रियायतनदोषानाह- इन्द्रियाणामप्रवृत्तिरित्यादि| समासः सङ्क्षेपः| दोषधातुमलसंसर्गादिति यत् प्रागुक्तं व्याधिनानात्वकारणं, तथाऽऽयतनविशेषादिति यद्द्वितीयं व्याधिनानात्वकारणमुक्तम्, एतद्द्वयमपि सङ्क्षेपेणाभिधाय निमित्ततश्चेति यदुक्तं तृतीयं व्याधिनानात्वकारणं तदभिधातुमाह- विस्तरमित्यादि| निमित्तानि वातादयः तत्कारणानि बलवद्विग्रहादीनि मिथ्याप्रयुक्तानि स्नेहादीनि च; ज्वरे तद्यथा कामज्वरः क्रोधज्वरो मृत्पाण्डुरोग इत्यादि; तथाऽतीसारे ‘गुर्वतिस्निग्धरूक्षोष्णद्रवस्थूलातिशीतलैः’ (उ. त. अ. ४०) इत्यादि प्रतिरोगं निर्दिष्टानि| प्रतिरोगं वक्ष्याम इति रोगे रोगे वक्ष्यामः||९||

Meaning of the commentary

The tissue-based disorders are listed to distinguish treatment and understand relative ease of cure. Lack of desire for food means aversion to food. Angamarda is a particular kind of pain popularly called sphutanika. Hrllasa is cardiac queasiness with repeated spitting, and angasada is lack of vigor in the limbs. A rasa-related disorder is one produced from rasa affected by doshas. After rasa, the passage successively lists disorders of blood, flesh, fat, bone, marrow and shukra. Mamsasanghata is a mouth disease called mamsatana; others take it simply as a general elevation of flesh. Adhyasthi and adhidanta mean extra bones and teeth, and the word bone applies separately to pricking and aching pain. Seeing darkness is visual obscuration; murccha is loss of consciousness; and bhrama is a sensation like being mounted on something rotating. The main marrow reading describes thick-rooted ulcers arising at joints. Others read heaviness at the joints followed by thick-rooted ulcers. Klaibya is impotence, and apraharsa is absence of desire toward women in the commentary's wording. Following the shukra list, the passage turns to skin, waste outlets and sensory sites. Sanga is non-flow or obstruction in the ears, nose, mouth, eyes, reproductive passages and other channels. The passage concisely covers disease diversity due to dosha-tissue-waste combinations and differences of site; the promised detailed account addresses the third basis, causes, including doshas and factors such as conflict with stronger persons or misapplied oleation. These will be stated for each disease.

Key terms

rasadoShajAH vikArAH (rasadoshajah vikarah): Disorders attributed to rasa affected by doshas.
malAyatanadoShAH (malayatanadoshah): Disorders of bodily waste outlets, expressed as obstruction, excess flow or improper flow.
indriyAyatanadoShAH (indriyayatanadoshah): Failure or improper functioning associated with the sensory sites.

Adhikarana ९ (१०) · Śloka १०

भवति चात्र- कुपितानां हि दोषाणां शरीरे परिधावताम् | यत्र सङ्गः खवैगुण्याद्व्याधिस्तत्रोपजायते ||१०||

Meaning of the śloka

As aggravated doshas move throughout the body, disease arises wherever they become obstructed because of abnormality in a channel or space.

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वातादीनां शरीरे प्रसरतां स्थानसंश्रयस्य व्याधिनानात्वकारणस्य हेतुं दर्शयन्नाह- कुपितानामित्यादि| खवैगुण्यात् स्रोतोवैगुण्यादित्यर्थः||१०||

Meaning of the commentary

The verse explains the cause of sthanasamshraya, the localization that accounts for the variety of diseases produced as vata and the other doshas spread. Khavaigunya means abnormality or vulnerability of a srotas.

Key terms

khavaiguNyAt (khavaigunyat): Because of abnormality or vulnerability in a bodily channel or space.

Adhikarana १० (११) · Śloka ११

भूयोऽत्र जिज्ञास्यं, किं वातादीनां ज्वरादीनां च नित्यः संश्लेषः परिच्छेदो वा? इति; यदि नित्यः संश्लेषः स्यात्तर्हि नित्यातुराः सर्व एव प्राणिनः स्युः; अथाप्यन्यथा वातादीनां ज्वरादीनां च, ‘अन्यत्र वर्तमानानामन्यत्र लिङ्गं न भवति’ इति कृत्वा यदुच्यते वातादयो ज्वरादीनां मूलानीति तन्न | अत्रोच्यते- दोषान् प्रत्याख्याय ज्वरादयो न भवन्ति; अथ च न (नित्यः) सम्बन्धः; यथाहि विद्युद्वाताशनिवर्षाण्याकाशं प्रत्याख्याय न भवन्ति, सत्यप्याकाशे कदाचिन्न भवन्ति, अथ च निमित्ततस्तत एवोत्पत्तिरिति; तरङ्गबुद्बुदादयश्चोदकविशेषाः एव; वातादीनां ज्वरादीनां च नाप्येवं संश्लेषो न परिच्छेदः शाश्वतिकः, अथ च निमित्तत एवोत्पत्तिरिति ||११||

Meaning of the śloka

A further question is whether doshas such as vata and diseases such as fever are permanently joined or entirely separate. If permanently joined, every living being would always be ill. If wholly separate, a sign belonging in one could not appear in the other, so the claim that doshas are the roots of fever and other diseases would fail. The answer is that fever and other diseases do not arise apart from doshas, yet their relation is not permanent. Lightning, wind, thunderbolts and rain do not arise apart from the sky or cloud, but they are not always present when it is present; they arise from it when the required causes assemble. Waves and bubbles likewise are particular forms of water. In the same way, doshas and diseases are neither eternally inseparable nor eternally separate; disease arises from doshas when the necessary conditions occur.

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प्रतिपाद्य व्याधीनां दोषाणां च कार्यकारणसम्बन्धं पुनरन्यथा जिज्ञास्यमाह- भूय इत्यादि|- भूयःशब्दः पुनरर्थे| जिज्ञास्यं ज्ञातुमभिलषणीयम्| एतेनैतदुक्तं भवति- प्राक्किल व्याधीनां वातादिमूलत्वं जिज्ञासितम्, अत्रान्यत् पुनरपि ज्ञातुमेष्टव्यमित्यर्थः; अन्ये भूयो बहुतरमिति व्याख्यानयन्ति| केचित् ‘भूयोऽत्र जिज्ञास्यते’ इति पठन्ति| नित्यः संश्लेष इति सर्वदा अपृथक्त्वं, यथा- सूर्यातपयोश्चन्द्रज्योत्स्नयोः पावकोष्णत्वयोरिति| परिच्छेदो विश्लेषः पृथक्त्वं; यथा- पटकुविन्दकयोर्घटकुम्भकारयोः कुण्डलसुवर्णकारयोरित्यादि| अथाप्यन्यथेति कोऽर्थः? अनित्यः संश्लेषः| पूर्वपक्षमाशङ्क्य समाधानमाह- अत्रोच्यत इत्यादि| प्रत्याख्यायेति परित्यज्येत्यर्थः| ननु, यदि दोषान् परित्यज्य ज्वरादयो न भवन्ति, तर्हि सम्बन्धोऽस्तीत्याशङ्कानिराकरणायाह- अथ च न सम्बन्ध इति|- ‘सर्वदा’ इति शेषः| कथं न सर्वदा सम्बन्ध इत्यत्र दृष्टान्तमाह- विद्युद्वातेत्यादि| आकाशशब्देनाकाशस्थो मेघ उच्यते; सत्यप्याकाश इति विद्यमानेऽपि जलद इत्यर्थः| निमित्तत इति सामग्रीत इत्यर्थः| तत एवेति तस्याः सामग्र्या एवेत्यर्थः| अपरदृष्टान्तमाह- तरङ्गबुद्बुदादय इति| तरङ्गः जललहरी| शाश्वतिक इति नित्य इत्यर्थः||११||

Meaning of the commentary

The passage further examines the cause-and-effect relation between dosha and disease. Bhuyas means again, though others take it as 'more extensively'; a variant reads 'is further investigated.' Permanent conjunction is inseparability like sunlight from the sun, moonlight from the moon or heat from fire. Separation is like cloth and weaver, pot and potter, or ornament and goldsmith. Pratyakhyaya means leaving aside. Here akasha refers to a cloud in the sky, and nimitta means the assembled causal conditions. The wave-and-bubble example shows effects as particular states of their material cause.

Key terms

nityaH saMshleShaH (nityah samshleshah): Permanent and inseparable conjunction of cause and effect.
paricchedaH (paricchedah): Complete distinction or separateness between dosha and disease.

Adhikarana ११ (१२) · Śloka १२

भवति चात्र- विकारपरिमाणं च सङ्ख्या चैषां पृथक् पृथक् | विस्तरेणोत्तरे तन्त्रे सर्वाबाधाश्च वक्ष्यते ||१२||

Meaning of the śloka

The extent of disorders, their separate numerical classifications, and all diseases will be explained in detail in the Uttara Tantra.

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‘विस्तरं निमित्तानि चैषां प्रतिरोगं वक्ष्याम’ इति यदुक्तं प्राक् तत् प्रतिपादयन्नाह- विकारपरिमाणं चेत्यादि| विकारपरिमाणं चेति इयं समुदायसङ्ख्या, तथा च ‘व्याधीनां तु सहस्रं यच्छतं विंशतिरेव च’- (उ. तं. अ. ६६) इत्युत्तरे तन्त्रे वक्ष्यते| सङ्ख्या चैषां पृथक् पृथगिति इयमवयवसङ्ख्या; तथा च- षडर्शांसि, चतस्रोऽश्मर्यः, अष्टादश कुष्ठानीति निदानस्थाने वक्ष्यते| सर्वाबाधाश्च वक्ष्यत इति ज्वरातीसारशोषादयः| चकारोऽत्र भिन्नक्रमे| तेन विकारपरिमाणं च सर्वाबाधाश्चोत्तरे तन्त्रे वक्ष्यत इति सम्बध्यते; न पुनः ‘उत्तरे तन्त्रे’ इति ‘सङ्ख्या चैषां पृथक् पृथग्’ इत्यत्र सम्बध्यते| अन्ये तु व्याख्यानयन्ति “ विकारा ज्वरादीनामुपद्रवरूपतया तृट्छर्दिप्रभृतयः, तत्परिमाणमधिकमध्यहीनभेदेन विकारपरिमाणम्; ‘अष्टौ ज्वराः, षडतीसाराः’ इत्यादि सङ्ख्या च पृथक् पृथक्; सर्वाबाधाश्च शारीरमानसा इति; सर्वमेतदुत्तरे तन्त्रे वक्ष्यते व्याख्यास्यत्याचार्यः” इति||१२||

Meaning of the commentary

One explanation takes vikara-parimana as the collective total, later stated as one thousand one hundred and twenty diseases, while separate enumeration means counts such as six types of piles, four urinary stones and eighteen kushthas, taught in the Nidanasthana. All diseases includes fever, diarrhea, shosha and others. By construing the conjunction out of sequence, the collective extent and all diseases are assigned to the Uttara Tantra, while the separate counts are not necessarily assigned there. Another interpretation takes vikara to mean complications of fever and other diseases, such as thirst and vomiting, and parimana as their greater, moderate or lesser degree; separate counts are examples such as eight fevers and six diarrheas; all diseases are bodily and mental; and all these topics are said to be explained in the Uttara Tantra.

Key terms

vikAraparimANam (vikaraparimanam): Interpreted either as the total number of disorders or as the degree of complications associated with individual diseases.

Adhikarana पुष्पिका · Śloka २४

इति सुश्रुतसंहितायां सूत्रस्थाने व्याधिसमुद्देशीयो नाम चतुर्विंशोऽध्यायः ||२४||

Meaning of the śloka

Thus ends the twenty-fourth chapter, called Vyadhisamuddeshiya, in the Sutrasthana of the Sushruta Samhita.

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इति श्रीडल्ह(ह्ल)णविरचितायां सुश्रुतव्याख्यायां निबन्धसङ्ग्रहाख्यायां सूत्रस्थाने चतुर्विंशतितमोऽध्यायः||२४||

Meaning of the commentary

Thus ends the twenty-fourth chapter in the Sutrasthana of the Nibandhasangraha commentary on Sushruta, composed by Shri Dalhana.

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