Ashtangasamgraha 22
English (machine translation) 22
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22.1
Now we shall explain the chapter on the classification of diseases. Thus spoke the great sages led by Ātreya.
Diseases are indeed of seven kinds:
congenital, hereditary, born after birth, caused by trauma, caused by time, caused by superhuman power, and natural.
They, in turn, are each of two kinds.
Among them, congenital diseases originate from defects in the semen and menstrual fluid,
such as dermatosis, hemorrhoids, and urinary disorders;
and they are paternal and maternal.
Hereditary diseases arise from the mother's improper conduct, such as hunchback, lameness, squint, and leukoderma; and they arise from the nutrient fluid of food and from thwarting longings during pregnancy.
Diseases born after birth arise from one's own misconduct, and they arise from over-nourishment and under-nourishment.
Diseases caused by trauma are wounds, fractures, blows, anger, grief, fear, and the like; and they are physical and mental.
Diseases caused by time are produced by cold and the like, such as fevers; and they arise from seasonal abnormalities and from lack of protection.
Diseases caused by superhuman power are fevers and the like produced by transgressing gods and elders, curses, Atharvan sorcery, and so forth, as well as possession by piśācas and the like.
Natural diseases are hunger, thirst, aging, and the like; and they are timely and untimely.
Among them, timely ones are conditioned by self-protection;
untimely ones arise from lack of self-protection.
In brief, these very [diseases] are again of two kinds:
arising from present action and arising from past action.
Among them, in regard to the arising of disease, present action is that which, having a visible or invisible outcome, is non-performance of what is prescribed or performance of what is prohibited by the teachings of authoritative teachers, carried out by this very body.
Past [action], however, is that done in a previous lifetime.
That, in turn, is called fate, and it was explained earlier according to the distinction of predetermined and indeterminate.
Therefore, those with visible causes arise from present action;
those contrary to these arise from fate; and those with minor etiology but great pain partake of both nature[s].
Thus spoke the great sages led by Ātreya.
Thus spoke the great sages led by Ātreya.
22.2
Among them, by cultivating the appropriate counter-measure according to each case, the former diseases are pacified.
Diseases caused by fate are alleviated, even while cultivating counter-measures, upon the exhaustion of undesirable karma;
others, upon the exhaustion of both doṣas and karma.
Others, furthermore, describe present action as also done by another,
and they designate that as manipulation by another.
And they say this: if the accomplishment of an effect were not from action done by oneself,
nor from what is done by another visible person,
why would even a wise man, following pleasure and pain caused by favors and injuries done by others, experience satisfaction and anger, or a mind resolved on retaliation?
Thus these diseases, being of two kinds, become of three kinds;
and then, possessing doṣas, they are further of seven kinds.
Therefore, one should strive to pacify leukoderma as one would a blazing house.
22.3
And this entire group of diseases, being amenable to remedy, requires the instructions prescribed by Āyurveda.
For even a disease with an inevitable cause, through the proper execution of a physician's instruction, when the accumulated lifespan-impressions have not been exhausted, or even when it has arisen, attains tolerability of pain.
Untreated, however, almost every [disease] strikes prematurely.
Even when subsiding spontaneously due to fate or due to the smallness of the etiology, it departs more quickly and without torment for one who obtains treatment endowed with the sixteen factors.
When fate yields an indeterminate result, disease finds no opening at all for one devoted to the habitual practice of wholesome things.
Therefore, in no condition should a self-controlled person view wholesome and unwholesome as equal.
Furthermore, diseases are of three kinds by way of the distinction of mild, moderate, and severe.
Among them, those with few symptoms are mild, those with moderate symptoms are moderate, and those with complete symptoms are severe.
They, in turn, have been taught earlier as fourfold according to the distinction of easily curable and the like.
And even when divided into many kinds, diseases do not deviate from being endogenous and exogenous.
A hundred palas of each, but three āḍhakas of varā;
with that steam and with tubular sudation, one should foment the person well-anointed,
or with leaves of bilva, barley, kola, kulattha, māṣa, arka, and śigru boiled together with meat of wetland animals.
22.4
Among them, endogenous [diseases] arise from the doṣas.
In them, vāta and the others first undergo imbalance, and from that pain is produced.
Exogenous [diseases], however, arise from external causes; in them, pain is first produced by an assault, and from that doṣa-imbalance [arises].
And through doṣa-imbalance alone, multiform pain persists and increases.
And taking this into account, there is no continuance of disease apart from the doṣas; the only distinction lies in the sequence.
Therefore, diseases are of a single form because of the generality of pain;
or they are of countless varieties, because of the non-distinction of each [with regard to] origin, site, form, color, name, sensation, superhuman influence, and ripening.
They will be taught in detail according to each, as far as the broad categories [permit].
And because of their innumerability, one should classify diseases and treatment by the signs of the doṣas alone.
Together with the two niśās, ten palas; having ground [them], one should throw [them] into the decoction of these,
or prepared with eight times milk and the paste of jīvaka, madhuka, kuṣṭha, maṇḍūkī, devadāru, and mahauṣadha.
22.5
For the doṣas alone are the cause of all diseases.
Just as a bird flying about everywhere all day long does not outrun its own shadow,
or just as the entire assemblage of modifications, established in its manifold forms, does not transcend the three qualities,
just so this entire assemblage of modifications does not transcend the triad of doṣas.
And just as lightning, rain, and the like occur in the sky—not necessarily, yet necessarily due to an operative cause—
and waves, bubbles, and the like occur in water, so do diseases in the doṣas.
Śyāmā, kirāta, the three pungents, and five āḍhakas there of the five bovine products,
or with boar lard cooked with the paste of madhuka, kṣīrakākolī, māṣa, and śatāvarī, all-fragrant water, and milk.
22.6
The causes of these [diseases] are threefold: unwholesome conjunction with sense objects, errors of judgment, and the transformation [of time]. These in turn are individually divided into three kinds based on the distinctions of excessive conjunction, non-conjunction, and improper conjunction.
Among them, excessive contact of the sense organs—the eye and so forth—with their respective objects—form and so forth—is excessive conjunction.
Contact in small measure or no contact at all is non-conjunction.
Looking at things that are subtle, extremely distant, exceedingly close, excessively bright, terrifying, unpleasing, abnormal, and the like;
listening to hateful, excessively loud, harsh, terrifying, and similar [sounds];
smelling putrid, unwholesome, excessively sharp, pungent, offensive, and similar [odors];
consuming tastes that are unwholesome by nature or on account of specific factors in the preparation of food, improper engagement with bathing and the like and with tactile sensations like cold and heat, and contact with impure substances, spirits, trauma, poison, wind, and so forth is improper conjunction.
[It is not] vitiligo alone, [but also] chronic lymphadenitis, worms, cough, and leprosy;
or with monitor-lizard fat cooked with jatamansi, kuṣṭha, medā, sarala, surabhi, madhuka, and milk.
22.7
Unwholesome action, though threefold according to the division into body, speech, and mind, is error of judgment.
Among them, excessive activity of the body and so forth is excessive conjunction.
Activity in small measure or no activity at all is non-conjunction.
Forcing natural urges, suppressing them, moving the limbs unevenly, stumbling, scratching, striking, breath-control, and the like;
likewise speaking while hungry, thirsty, or halfway through eating, and the like;
fear, grief, jealousy, envy, and the like;
and the ten kinds of unwholesome action—each according to its sphere—constitute improper conjunction.
Transformation is said to be time.
That also is threefold, based on the distinction between cold, heat, and rain.
Among these, time with excessively pronounced seasonal characteristics is excessive conjunction.
[Time] with deficient seasonal characteristics is non-conjunction.
[Time with characteristics] contrary [to the season] is improper conjunction.
These—excessive conjunction and the rest—are generally characterized as unwholesome.
Or all of this is indeed error of judgment, insofar as there is failure to avoid them.
Sense objects, actions, and times, when properly conjoined, are mainly the causes of health because of their wholesomeness.
Even there, the objects of the senses, with the exception of taste, afflict or support their respective sense organs;
whereas the rest—taste, action, and time—affect the entire body.
Furthermore:
Goiter, abdominal swelling, cervical adenitis, tumors, swelling, urinary disorders, and diseases of the throat;
or oil prepared with a paste of madhuka and kṣīrakākolī, four parts of drumstick, the smaller five roots, and castor-leaf juice, along with eight parts of milk.
22.8
One should determine the presence or absence of all states not apart from proper conjunction, excessive conjunction, and the rest.
Moreover, the specific presence or absence of all disorders arises from the particular combination of etiology, doṣas, and susceptible tissues.
For when these three do not combine with one another, or combine only slightly, or are weak, due to the particularities of the etiology and so forth, then diseases do not manifest, or they manifest late, or they are mild, or their symptoms are incomplete.
In the opposite case, however, the results are contrary.
22.9
The pathways of diseases are three: external, middle, and internal. Among them, the external consists of the bodily tissues beginning with blood, and the skin.
This is also called the branch.
Resting in it are cervical lumps, pustules, boils, scrofula, warts, tumors, muscular excrescences, freckles, melasma, and the like, as well as external swellings, hemorrhoids, abdominal swellings, erysipelas, abscesses, and the like.
The middle consists of the vital spots—the head, heart, bladder, and so forth—and the joints of bones,
and connected to them are the ligaments, vessels, tendons, and the like. Resting in it are
paralysis, rigidity, convulsion, facial palsy, consumption, pain in bones and joints, prolapse of the rectum, and the like, as well as diseases of the head and other parts.
The internal pathway is the great channel, the center of the body, the great cavity, the seat of the stomach and intestines; ‘belly’ and ‘interior’ are its synonyms. Resting in it are fever, diarrhea, vomiting, sluggish digestion, choleraic diarrhea, dyspnea, cough, hiccups, flatulence, abdominal enlargements, splenic disorders, and the like, as well as internal erysipelas, swellings, hemorrhoids, abscesses, abdominal swellings, and the like.
In leukoderma, a purgative is foremost; the juice of malayū with jaggery is recommended.
22.10
These diseases are either primary in themselves or accompanied by others, known respectively as the primary and secondary.
Among them, the former are independent, clear in appearance, and possess their own respective etiologies and therapeutic exploratory tests.
The others are the opposite; and the doṣas are likewise.
Among these, diseases accompanied by others are of two kinds:
preceding and following.
Among them, the former are termed premonitory symptoms,
and the others are complications.
One should observe them as they will be described in their respective places.
When the primary disease is pacified, their pacification also occurs; or if they do not subside, one should treat them afterward;
or one may promptly treat a strong complication without conflicting with the primary disease.
For that [complication] causes greater suffering because the body is already afflicted by the disease, as in the case of diabetic carbuncles and the like.
Likewise, another primary disease becomes the cause of yet another primary disease:
as fever [is the cause] of a bleeding disorder, or a bleeding disorder of fever;
both of them of dyspnea;
enlargement of the spleen of abdominal enlargement;
that [abdominal enlargement] of edema;
hemorrhoids of abdominal swellings, abdominal enlargements, diarrhea, and impaired digestion;
catarrh of cough and fever;
both of them of phthisis;
and phthisis of wasting.
A single misconduct can be the cause of a single disease or of many; likewise, many [misconducts may cause] a single symptom.
In the same way, an expedient for pacification [of one disease] may itself cause the provocation of another.
Therefore, being attentive, one should examine them thoroughly by means of authoritative tradition and other methods.
And after being purged, one who is thirsty should take gruel for three days.
Then, the oil that drips as it is heated immediately relieves earache.
22.11
There, from authoritative tradition, [one should examine] the disease: having such-and-such an aggravating cause, such-and-such an origin, such-and-such a seat, such-and-such a nature, such-and-such pain, such-and-such appearance, sound, smell, taste, and touch, such-and-such a premonitory symptom, such-and-such a complication, accompanied by such-and-such increase, steady state, or decrease, having such-and-such a sequel, and having such-and-such a name;
in that [disease] this is the application of remedy, or otherwise its withdrawal.
By direct perception, however, [one should examine] the patient through the respective senses: color, shape, measurement, complexion, luster, feces, urine, excessive vomiting, rumbling of the bowels, cracking in the joints of the fingers and so forth, smell of the body, feces, and color, and touch that is numb, cold, hot, rigid, throbbing, smooth, or rough;
and by interrogation [one should ascertain] the taste in the mouth as normal or abnormal, likewise whether vomiting is easy or difficult, softness or hardness of the bowels, dreams, intentions, birth, onset of disease, constellation, dislikes, likes, pleasure, and pain;
likewise age by direct perception;
and by inference: body distastefulness through lice creeping away;
body sweetness through flies gathering;
likewise digestive fire through digestive capacity;
strength through capacity for exercise;
a disease of hidden symptoms through therapeutic exploratory tests and adverse responses;
the measure of doṣas through the specifics of indiscretion;
exhaustion of lifespan through prognostic signs;
and constitution, mental strength, bodily essence, habituation, and strength through continual observation.
And here it is said:
When the blisters have erupted, he should drink [it] every morning for a fortnight.
22.12
He who does not enter, like an adept of yoga, into the inner self of the patient
with the lamp of intellect and understanding does not cure diseases.
Or [he should take] alkali of palāśa according to strength, mixed with molasses.
22.13
These two patients do not manifest the true nature of their disease:
namely, one with a severe disease, relying on the strength of his mind and body,
should drink [it] with a decoction of the roots of kalitaru, kṛtamāla, and madanaphala;
one should apply a poultice prepared with all grains, fats, and cow's milk onto the ear covered with castor leaves for the purpose of sudation,
and repeatedly tube-sudations and bolus-sudations;
and one should carry out the procedure for vāta-diseases, catarrh, and facial paralysis, along with evacuating enemas and unctuous enemas.
22.14
appears like one with a mild disease; and the one with a mild disease is contrary to that;
with respect to these two, a fool is confused merely by external signs.
And when [the meal] is digested, eating kodrava steeped in buttermilk, this regimen is for three nights for the eruption of blisters.
22.15
Therefore, administering little [medicine], or [medicine of] little potency, or contrary to this,
or unwholesome instead of wholesome, he robs the patients of life.
He may smear [it] as desired; for pain, an application of ointment made of conch columella with water should be employed;
then, when he has been oleated, one should purge him;
one should administer breast milk processed with grapes and liquorice as ear-drops,
or honey,
or ghee processed with paste of liquorice and padmaka in breast milk;
or priyāla oil cooked with sugar, liquorice, dates, and raisins, along with milk and sugarcane juice, destroys pain and burning through inunction, nasal drops, and ear-drops.
22.16
Indeed, knowledge does not operate upon the entire knowable [subject] through a fraction of knowledge;
therefore, the physician should desire to know the reality from continual study of the treatise.
A pill equal to a jujube, containing half a part of poison, is an excellent paste pacifying leukoderma and skin diseases;
and one should administer it as before.
22.17
The wise one, however, who is constantly diligent, having examined everything in every way,
never stumbles, even on an uneven path of therapeutic action.
After a fortnight, this should be drunk by the patient with leukoderma, and the procedure prescribed for skin diseases should be performed for him;
and one should foment him;
likewise nasal drops of milk and ghee, and anointing of the head;
if there is still no relief even so, then purgation again.
22.18
An extrinsic [disorder] follows an intrinsic disorder, and an intrinsic one that is greatly aggravated likewise follows an extrinsic one;
there, having correctly recognized the secondary and the primary, he should then begin the treatment.
And he should drink milk boiled with bījaka after that for the destruction of leukoderma;
then one should have him inhale sharp medicinal smoke.
22.18_1
Thus ends the twenty-second chapter.
Commentaries (1)
- Śaśilekhā — Indu, Sanskrit
Linked texts (1)
- Aṣṭāṅgasaṃgraha — Vāgbhaṭa, Sanskrit