The commentary says that after the chapter on hṛdroga, beginning pāṇḍuroga is fitting because of the similarity of number (order) and because the treatment of hṛdroga from sharp, sour and pungent causes leads to it. Two 'ādi' words are understood to be omitted, so 'pāṇḍu-ādi diseases'. The first ādi includes mixtures of black and yellow colours; the second includes kāmalā and the like. Others take only one ādi as omitted, since all are called pāṇḍuroga because of the predominance of pale colour, and include kāmalā by that ādi. Others include kāmalā and the rest even without an ādi word, as they are included within pāṇḍuroga.
Key terms
pāṇḍuroga
A classical disorder marked by pallor.
kāmalā
A classical disorder with yellowish discolouration, treated here as related to pāṇḍuroga.
In one who indulges in sexual excess, sour and salty things, alcohol, clay, daytime sleep and excessively sharp things, the doṣas spoil the blood and produce paleness in the skin.
The commentary gives cause and pathogenesis of pāṇḍuroga: the spoiled doṣas of a person who uses these spoil the blood and produce pallor in the skin. Vyavāya is sexual activity, said to aggravate all doṣas; others say it aggravates vāta and pitta, since it is listed along with lifting loads and anger. Sour and salty aggravate pitta and kapha. Clay aggravates all doṣas because of its varieties, quoting: 'astringent (clay) aggravates vāta, saline pitta, sweet kapha; taken with dryness it makes the rasa dry'. Daytime sleep aggravates all three; sharp things aggravate pitta. The cause is thus stated as suits each; 'having spoiled the blood' onward is the pathogenesis. The 'ādi' is omitted after 'excessively sharp' and includes pastes, milk, māṣa, sesame and the like. Some read a different verse, 'clay, wine, fish, meat, sharp foods, ground flour, milk, daytime sleep, sesame, sugarcane, māṣa', and again include vyavāya and the rest by an omitted ādi. Others read 'atīvarūkṣam' (very dry) for 'atīva tīkṣṇam'.
The commentary states the number. 'Eightfold-halved' means fourfold: three from the doṣas separately and one from all together. The word 'at once' indicates simultaneous aggravation of the three doṣas. Although another tantra teaches a fifth kind, the clay type (mṛjja), here that is included in the tridoṣaja type, and the kāmalā and others to be described are synonyms of pāṇḍuroga; so here there are four only. Some read 'pāṇḍvāmayas tv aṣṭavidhaḥ' (eightfold): three from doṣas separately, one from all together, one from clay-eating, two kāmalās, and one halīmaka. They quote another tantra: 'by vāta, pitta, kapha, tridoṣa and clay-eating; two kāmalās and halīmaka: thus pāṇḍuroga is eightfold here'.
Key terms
aṣṭārdhavidha
Eight-halved, i.e. fourfold.
mṛdbhakṣaṇaja
Arising from eating clay.
halīmaka
A classical condition named in the eightfold scheme.
The commentary says that although the black and other colourings will be stated by doṣa, this disorder is named pāṇḍuroga because the pale colour predominates.
Cracking of the skin, spitting, sinking of the limbs, clay-eating, swelling around the eyes, yellowness of stool and urine, and indigestion will be its forerunners.
The commentary gives the premonitory signs of pāṇḍuroga. Tvaksphoṭa is splitting of the skin; ṣṭhīvana is spitting; though clay-eating is mentioned, the desire for eating clay is understood. Prekṣaṇa is the eye. Avipāka is indigestion of food. Puraḥsara means forerunner.
Key terms
pūrvarūpa (puraḥsara)
Forerunner or premonitory sign.
mṛdbhakṣaṇa
Eating clay, or the desire for it per the commentary.
That pāṇḍuroga is spoken of as kāmalā, āpānaki, kumbhāhvaya, lāgharaka and alasāhvaya. I shall describe its signs completely; know them as I state them in order.
The commentary gives synonyms of the same pāṇḍuroga. The disease is described by names such as kāmalā. 'Its' refers to the disease indicated by those synonyms. 'In order' means one after another. 'It' refers to the pāṇḍuroga.
One with black eyes, bound by black vessels, with black-coloured stool, urine, nails and face, joined with the other complications of it: one should determine such a person to have pāṇḍu from vāta.
The commentary gives the signs of vātika pāṇḍuroga. Black eyes means dark eyes; black stool, urine, nails and face; 'its complications' are those of vāta.
One with yellow eyes, bound by yellow vessels, with yellow-coloured stool, urine, nails and face, joined with the other complications of it: one should determine such a person to have pāṇḍu from pitta.
One with white eyes, bound by white vessels, with white-coloured stool, urine, nails and face, joined with the other complications of it: one should determine such a person to have pāṇḍu from kapha.
... वक्ष्यामि लिङ्गान्यथ कामलायाः |
यो ह्यामयान्ते सहसाऽन्नमम्लमद्यादपथ्यानि च तस्य पित्तम् ||१०||
करोति पाण्डुं वदनं विशेषात् पूर्वेरितौ तन्द्रिबलक्षयौ च |११|
Meaning of the śloka
... I shall now tell the signs of kāmalā. One who, after an illness, suddenly eats sour food, alcohol and unsuitable things: his pitta makes the face especially pale, and drowsiness and loss of strength, as stated before, occur.
The commentary raises an objection: if kāmalā is a synonym of pāṇḍuroga, why are separate signs stated? Answer: as vātika and other pāṇḍurogas each have their own distinction, so this does too; thus kāmalā and the like are distinct names for particular stages while remaining pāṇḍuroga. The statement of the cause of kāmalā is to help recognise it before it appears. 'After an illness' means after pāṇḍuroga or another disease; 'suddenly' means quickly. 'Sour food' means sour eating. 'Body' is supplied with 'pale'. 'As stated before' means drowsiness (tandrā) given in the Śārīrasthāna in the chapter on garbha-vyākaraṇa, and loss of strength in the Sūtrasthāna chapter on decrease and increase of doṣa. An objection on the word tandrā's derivation is answered by grammar. Others read 'tandrā, weakness, stated first', with the same sense; others read 'first-stated ones', meaning the specific signs of pāṇḍuroga. Some read 'yellow face' for 'pale face', which the commentators call non-authoritative.
The commentary states the variety of kāmalā. 'In it' means in the kumbha type. Parvabheda is pain in the joints. Kumbhasāhva is called kumbhakāmalā in another tantra.
The commentary says that the same kumbha-type, when joined with fever and the rest, is called lāgharaka and alasa; both names apply. Aṅgamarda is a special pain, or cracking per others. Others say that pāṇḍuroga itself, when joined with fever and the like, is called kumbhasāhva. Those of another tantra read a further stage of it called pānaki, quoting: 'heat, split stool, yellowness inside and out, paleness and eye disease indicate pānaki'.
The commentary says that when the kumbha type becomes green, yellow and dark-blue in colour, the knowers, meaning those who know Kāyacikitsā, call it halīmaka. Hari is green; nīla is dusky. Some read 'taṃ vātapittābhiparītaliṅgam' and explain it as having signs surrounded by vāta and pitta.
Key terms
halīmaka
A named advanced form with greenish-yellow-blue colour.
In these there are complications: distaste for food, thirst, vomiting, fever, headache, weak agni, swelling, difficulty in the throat, weakness, fainting, exhaustion and oppression of the heart.
The commentary gives the complications of pāṇḍuroga. Mūrdharuj is headache; abalatva is lack of strength. Whether pāṇḍuroga with complications is curable with difficulty or incurable should be known by stage.
Having judged the patient to be curable, oleated with ghṛta, he should be purified upward and downward, and then treated with preparations rich in honey and ghṛta and mixed with harītakī powder. Or he may drink ghṛta cooked with rajanī (haridrā), or that of triphalā or of tilvaka; or ghṛta prepared with purgative drugs, or purgative yogas with ghṛta.
The commentary says curability is known from the opposite of the signs of incurability and of ariṣṭa (fatal signs) described later. 'With ghṛta' means with ghṛtas such as kaṭvara-kalyāṇaka or mahātikta or pañcagavya, or with cow's ghṛta alone per others. Oleation with ghṛta alone is stated because these are pitta-predominant and blood-based conditions. Although upward cleansing is forbidden in pāṇḍuroga, mild emesis is to be given considering season, place, constitution, time and body, quoting another tantra. After emesis, the graded sequence with śāli rice and the like is followed and the yogas to be described are used to pacify the remaining doṣas. Only one yoga with iron powder, ghṛta, honey and harītakī is later stated, yet 'yogas' is plural because other formulas such as navāyasa are praised elsewhere. Ghṛta cooked with rajanī means with haridrā paste; traiphala with triphalā; tailvaka with tilvaka (paṭṭikā lodhra), or that stated in the vāta-disease chapter per others. Ghṛta prepared with trivṛt and the like, and purgative yogas from the purgation formulas, are drunk with ghṛta.
Half a pala of nikumbha cooked in (buffalo) urine may be drunk repeatedly, in the amount of half a kuḍava. Or jaggery cooked with abhayā may be eaten, or the decoction of āragvadha and similar may be drunk.
The commentary says further purgatives in pāṇḍuroga are given. Nikumbhā is dantī; half a pala of it is cooked in sixteen times buffalo urine, reduced to a quarter, and half a kuḍava (two palas) is drunk for purgation. Guḍa is a sugarcane product. 'Cooked with abhayā' means cooked with harītakī decoction, or per others jaggery with harītakī and similar; some read 'mixed with abhayā'. Since purgative yogas are stated repeatedly, purgation is known to be exceedingly beneficial in pāṇḍuroga.
A powder of iron dust, vyoṣa and viḍaṅga may be licked; or haridrā with triphalā, with ghṛta and honey; or the yogas described in other places in the treatise.
The commentary asks whether only the foregoing or other measures apply in pāṇḍuroga. Iron dust, vyoṣa and viḍaṅga powder is one yoga; haridrā with triphalā is a second. Ayorajas is iron powder; vyoṣa is trikaṭu; 'lick' is joined with 'with honey and ghṛta'. Haridrā means piṇḍa-haridrā, though some take it as dāruharidrā, with dāru omitted. 'Yogas described in other places' means navāyasa and others stated elsewhere.
The commentary says the cleansing prescribed in pāṇḍuroga should be done in small doses: repeatedly and little by little, because swelling arises. A variant reads 'when the doṣas are cleansed, well removed'; 'cleansed' means freed of the fault, and 'abhi' in 'abhinirhṛta' means properly, because excess is undesirable.
The commentary lists three yogas: āmalaka fruit juice with honey; sugarcane juice with honey; and mantha, a flour drink of the described kind ('barley flour anointed with ghṛta and mixed with cold water'), with honey. It cites another tantra: 'let him drink very cool manthas with ghṛta and honey, or juice of āmalaka or sugarcane with honey, eating wholesome food'. In another tantra for pāṇḍuroga, mantha means a special kind: 'in āmalaka juice, and in sugarcane juice, the pāṇḍu patient should drink very cool mantha with honey'.
The two bṛhatīs, rajanī, śukā, kākādanī, kākamācī, ādārī-bimbī with kadamba-flowered plants: having made a decoction, ghṛta is cooked in that decoction; it destroys pallor when used, or pippalī with milk according to agni.
The commentary says śukākhyā is carmakāra-vaṭa, or śukaśimbā per others; kākādanī is kākatinduka. Ādārī is a plant with flowers like vellantara, called 'āli' in common speech; bimbī is a vine like rāsnā with red fruit; Kārttikakuṇḍa explains ādārī-śimbī as 'auli'. Kadambapuṣpī is bhūmikadamba, or alambuṣā per others. These are made into a decoction, and ghṛta is cooked in it. Pippalī with milk is used according to the strength of agni.
The commentary says the decoction of yaṣṭīmadhu with honey is one yoga; the powder of yaṣṭīmadhu licked with honey is a second. Others read 'cūrṇaṃ lihed vā madhunā dvitīyam', with the same sense.
Iron powder with cow's urine and triphalā leaves, given for a long time, may be licked; likewise powder of coral, pearl, añjana and conch, or that made from gold and red ochre.
The commentary says the powder of triphalā leaves and iron powder are licked, mixed with cow's urine, over a long time. 'Leaves' rules out the stones. Others read 'cow-urine-soaked triphalā leaves', meaning triphalā soaked in cow's urine. Pravāla is coral; muktā is pearl; añjana is rasāñjana; 'likewise' means also with cow's urine over a long time. Powder of gold and red ochre is likewise licked with cow's urine. Others read 'cow-urine-drunk triphalā ground fine', licked with honey.
Goat dung (in the amount of a kuḍava), viḍa (salt), haridrā and the best of salts, each in a pala measure; this whole powder should be licked with honey by one on a wholesome diet.
The commentary says ājaśakṛt is she-goat dung, a kuḍava being four palas. Viḍa is a salt; lavaṇottama is saindhava. Each of viḍa and the rest is a pala. 'Whole' means all together.
A lick made of equal parts of maṇḍūra, iron, agni (citraka), viḍaṅga, pathyā, vyoṣa and tāpya (mineral), soaked in urine and mixed with honey, destroys severe pāṇḍuroga quickly.
The commentary says this is a most efficacious yoga in pāṇḍuroga. Maṇḍūra is a substance resembling iron slag. Agni is citraka; vyoṣa is trikaṭu. Each of the ingredients from maṇḍūra to vyoṣa is an equal share. Tāpya is a mineral called mākṣika. 'Soaked in urine' means kept in urine.
A pill of powder of bibhītaka, ayomala and nāgara, with sesame and the best jaggery, taken with buttermilk as the after-drink, destroys even severe pāṇḍurogas.
The commentary says this is another most efficacious yoga. Ayomala is iron-dross (siṅghāṇa). Sesame powder means black sesame; 'best jaggery' means jaggery in equal amount, not half. Kṣiṇoti means destroys. Although these two yogas are non-authoritative (anārṣa), they are read here because they are regarded as most efficacious and accepted by the commentator's teacher.
सौवर्चलं हिङ्गु किराततिक्तं कलायमात्राणि सुखाम्बुना वा |
मूर्वाहरिद्रामलकं च लिह्यात् स्थितं गवां सप्तदिनानि मूत्रे ||२५||
मूलं बलाचित्रकयोः पिबेद्वा पाण्ड्वामयार्तोऽक्षसमं हिताशी |
सुखाम्बुना वा लवणेन तुल्यं शिग्रोः फलं क्षीरभुजोपयोज्यम् ||२६||
Meaning of the śloka
Sauvarcala, hiṅgu and kirātatikta in kalāya-seed measure, or with lukewarm water; or mūrvā, haridrā and āmalaka soaked for seven days in cow's urine, may be licked. Or the patient of pāṇḍuroga, eating wholesome food, may drink the root of balā and citraka in akṣa measure, with lukewarm water, or śigru fruit with an equal amount of salt, taken by one living on milk.
The commentary says the plural 'in kalāya measure' shows each of sauvarcala and the rest is in kalāya-seed measure. 'Or with lukewarm water' means with slightly warm water, 'licked' supplied. Mūrvā, haridrā and āmalaka soaked for seven days in cow's urine are licked. Mūrvā is corasnāyu. Root paste of balā and citraka together, one karṣa, is drunk with urine or lukewarm water by one on wholesome food. Kārttikakuṇḍa reads 'drink' for the first line and, by the reasoning of the text, 'in which they stand' — so the urine in which mūrvā stood is drunk; a quoted line: 'haridrā, āmalaka, mūrvā soaked for seven days, cow's urine drunk destroys pāṇḍu and kāmalā'. Śigru fruit is śobhāñjana fruit; the salt is likewise in kalāya measure, since large quantities of salt, like hiṅgu, are not accepted. 'Milk-taker' means one eating milk as food.
One on wholesome food may drink the cooled decoction of the nyagrodha group with sugar and honey; or lick the powder of śālādi heartwood, or āmalaka fruit, with honey.
The commentary says the nyagrodha group is the nyagrodhādi gaṇa; 'decoction' means boiled in the sense of the decoction method. The powder of śāla heartwood and the like, or of āmalaka, is licked with honey.
विडङ्गमुस्तत्रिफलाजमोदपरूषकव्योषविनिर्दहन्यः |
चूर्णानि कृत्वा गुडशर्करे च तथैव सर्पिर्मधुनी शुभे च ||२८||
सम्भारमेतद्विपचेन्निधाय सारोदके सारवतो गणस्य |
जातं च लेह्यं मतिमान् विदित्वा निधापयेन्मोक्षकजे समुद्गे ||२९||
हन्त्येष लेहः खलु पाण्डुरोगं सशोथमुग्रामपि कामलां च |३०|
Meaning of the śloka
Powders of viḍaṅga, mustā, triphalā, ajamodā, parūṣaka, vyoṣa and citraka are made, with jaggery and sugar, and likewise clean ghṛta and honey. This mixture is cooked in the decoction of the sāravat group and, when it has become a lick, the wise physician should store it in a mokṣaka-wood casket. This lick destroys pāṇḍuroga, even with swelling, and severe kāmalā.
The commentary says the powders are put in the heartwood decoction of the sāravat group (śālasāra etc.), and the jaggery and sugar with ghṛta and honey are added and cooked together until it becomes a lick; it is stored in a casket made of mokṣaka wood. Vinirdahanī is citraka. The powders, sugar and jaggery are one quarter of the decoction, and the honey and ghṛta likewise. An objection: honey conflicts with heating; how is a lick cooked with honey? Answer: the conflict is in eating honey together with hot things, not in cooking; and another tantra says 'having cooked sugar with honey' and so on. Although this is general treatment for pāṇḍuroga, it should be applied according to the doṣa by varying its ingredients, quoting another tantra (Caraka Cikitsā 16): 'this treatment is stated for the pacification of pāṇḍuroga; the physician should vary it according to the strength of the doṣa: oily in vāta, bitter and cooling in pitta, pungent, dry and hot in kapha, mixed in sannipāta'.
Key terms
sāravat gaṇa (sāravatgaṇa)
The group of drugs used for heartwood decoction (śālasārādi).
The commentary says iron dross that has stayed a month in cow's urine, powdered in that same urine and mixed with rock salt, is drunk in kumbhakāmalā. Some read 'hiraṇyakiṭṭa' (gold dross) for 'lohakiṭṭa', which the commentators do not accept because gold is pure.
दग्ध्वाऽक्षकाष्ठैर्मलमायसं वा गोमूत्रनिर्वापितमष्टवारान् ||३२||
विचूर्ण्य लीढं मधुनाऽचिरेण कुम्भाह्वयं पाण्डुगदं निहन्यात् |
सिन्धूद्भवं वाऽग्निसमं च कृत्वा क्षिप्त्वा च मूत्रे सकृदेव तप्तम् ||३३||
लौहं च किट्टं बहुशश्च तप्त्वा निर्वाप्य मूत्रे बहुशस्तथैव |
एकीकृतं गोजलपिष्टमेतदैकध्यमावाप्य पचेदुखायाम् ||३४||
यथा न दह्येत तथा विशुष्कं चूर्णीकृतं पेयमुदश्विता तत् |
तक्रौदनाशी विजयेत रोगं पाण्डुं तथा दीपयतेऽनलं च ||३५||
Meaning of the śloka
Iron dross, burned with akṣa (bibhītaka) wood and quenched eight times in cow's urine, powdered and licked with honey, quickly destroys kumbhakāmalā and pāṇḍu disease. Or rock salt heated to fire-colour and quenched once in urine; and iron dross heated many times and quenched many times in urine. Both together, ground in cow's urine, are placed in a pot and cooked so that it does not burn, then dried, powdered and drunk with buttermilk; with buttermilk and rice as food, one overcomes the disease, pallor, and kindles agni.
The commentary says this is a most efficacious yoga in kumbhāhvaya. Sindhūdbhava is rock salt. 'Made fire-like' means heated to a fiery colour in a bibhītaka-wood fire. Iron dross is loha-siṅghāṇa. The two are mixed equally, ground in five times the quenching urine, placed in a covered pot so that steam does not escape and it does not burn, then dried, powdered and drunk with churned buttermilk; when digested, buttermilk with rice is eaten. The commentary states that this yoga, though not from the original Suśruta, is read here for the reason given above. In another tantra this formula is called bibhītakalavaṇa.
One with pāṇḍuroga may use jaggery-based ariṣṭas, honey and sugar (āsavas), urine-based āsavas and alkali-made ones; unctuous meat juices of jāṅgala animals with āmalaka or with jujube fruit; the yogas stated for swelling; and always śāli and barley.
The commentary says that, gathering all from another tantra such as abhayāriṣṭa, and food, this verse is given. Gauḍa ariṣṭas are abhayāriṣṭa and similar; 'honey' means madhvāsava, including lohāriṣṭa and others; 'sugar' means śarkarāsava; urine āsavas are those stated in the kuṣṭha chapter; alkali-made āsavas are those in the chapter on elephantiasis (ślīpada). Unctuous juices are meat juices of jāṅgala animals fried in sneha, prepared with āmalaka or jujube; the choice of alternatives is by suitability. The yogas for swelling are those such as with devadāru and ginger juice. Śāli means red śāli and the like.
Breathlessness, diarrhoea, distaste, cough, fainting, thirst, vomiting, pain, fever, swelling and burning, and likewise indigestion, change of voice and sinking, should be overcome according to each, after examining the relevant treatise.
The commentary gives treatment of the complications of pāṇḍuroga. 'According to each' means by the treatise of one's own treatment appropriate to each. Some read a different verse: 'thirst, fever, vomiting, diarrhoea, fainting, wasting, breathlessness, desire for no food; likewise indigestion, change of voice and sinking should be overcome properly after examining the treatise'. An objection: jvara with atisāra in one with pāṇḍu is later said incurable, so why extend their treatment here? Reply: when they are recent, the pāṇḍuroga patient is still treatable.
अन्तेषु शूनं परिहीनमध्यं म्लानं तथाऽन्तेषु च मध्यशूनम् |
गुदे च शेफस्यथ मुष्कशूनं प्रताम्यमानं च विसञ्ज्ञकल्पम् ||३९||
विवर्जयेत् पाण्डुकिनं यशोऽर्थी तथाऽतिसारज्वरपीडितं च ||४०||
Meaning of the śloka
One who is swollen at the extremities and thin in the middle, or wasted at the extremities and swollen in the middle; with swelling at the anus, penis or testes; who is fainting and nearly unconscious; the seeker of fame should abandon such a person with pāṇḍu, and likewise one troubled by diarrhoea and fever.
The commentary describes the pāṇḍuroga patient who is beyond treatment. 'At the extremities' means the hands, feet and face. Parihīnamadhya means thin in the body's middle; mlāna means emaciated. The swelling at the anus and the rest is stated to show that swelling there is a sign for abandoning even without wasting at the extremities. Śepha is the male organ. Muṣka-śūna is swelling of the scrotum. Pratāmyamāna means fainting; visaṃjñakalpa means nearly unconscious. Although fainting already implies unconsciousness, it is said separately to show it is especially incurable. One troubled by diarrhoea and fever means troubled by both. Although the treatment of pānakī and halīmaka is not stated, the treatment of pāṇḍuroga is to be applied to them too.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे पाण्डुरोगप्रतिषेधो नाम (षष्ठोऽध्यायः, आदितः) चतुश्चत्वारिंशत्तमोऽध्यायः ||४४||
Meaning of the śloka
Thus ends the chapter named Pāṇḍurogapratiṣedha, the forty-fourth chapter (the sixth from the beginning of this section), in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the forty-fourth chapter, named Pāṇḍurogapratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.