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The Classical Doctrine of Indian Medicine: Its Origins and its Greek Parallels c12.s3: Susruta, Nidanasthana, I

The Classical Doctrine of Indian Medicine: Its Origins and its Greek Parallels c12.s3

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Susruta, Nidanasthana, I

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¹ This text has been established following the texts mentioned hereunder: Madhusūdangupta, Calcutta, 1835 (M.). Jivananda Vidyasagara, 3rd. edn. Calcutta, 1889 (J.). Kālīprasanna Kavīsekhara, Calcutta, 1898, in Bengali script (K.) with the commentary of Dalhaṇa (DK.) and Bengali translation; Yādavaśarman (Jadavji Trikamji), 2nd. edn. Bombay, 1931 (Y.) with the commentary of Dalhaṇa (DY.). The commentary of Dalhaṇa (D.), the Nibandhasaṃgraha, is quoted following the preceding editions as also the separate edition of Jivananda Vidyasagara. 3rd. edn., Calcutta, 1891 (DJ.). The Nyāyacandrikā of Gayadāsa has been preferred and for the same the MSS. of the Cordier Collection, copied from the MSS. of Bikaner Library (No. 1762) by Umeshcandra Gupta, Bibl. Nat. Sanskrit, 1177, p. 1-37 (G.) G. gives variations noted here as G. var. A number of the explanations of Dalhaṇa are taken from Gayadāsa; that is why the latter, an early commentator, has been followed before Dalhaṇa. The verses are numbered only in J. and Y., Y. adding a second phrase after the first one of introduction, his numbering thus differs by one from that of J. In K. the numbering is by group of the verses of the beginning.

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[1] We will now explain the etiology of the diseases of the wind.² [2] Suśruta questioned Dhanvantari, the best of those who supported the Order, born with ambrosia¹, after having saluted his feet. [3] “O, the best among those who talk, tell me the localisation, the function and the ills of the wind in a natural state and disturbed by excitants”. [4] Having heard his discourse, the best of the doctors replied: *General Theory of the Wind*: “The Being existing by himself, that Blessed one is, it is said, the wind. [5] Since it depends only on itself, existed perpetually and also because it goes everywhere, it is for all the objects the universal soul to whom the entire world renders homage.² [6] It is he, the efficient cause of the beings³, in their conservation, their birth and their destruction. Not manifest but with its action manifest⁴, it is sharp, cold, bitter.⁵ [7] It goes horizontally, has two properties⁶, and lots of passion.⁷ Its power is inconceivable, it is the conductor of the elements of troubles⁸, it shines among the multitude of ills.⁹ [8] It acts promptly, circulates constantly. It has its seat in the intestines and in the rectum. Teach me its characteristics when it circulates in the body. [9] Normal Functions of the Wind in the Body: When it is not excited, the wind ensures the equilibrium of impurities, of the organic elements and of fire, the entering into contact (the sensation) in the domains (of the faculties)¹ and the normal occurrence of various activities. [10] Just as fire is divided into five as regards names, as regards seats and its own functions, similarly is the wind divided, which has only one denomination, one localisation and one activity.³ [11] The breath of the front and the breath on high, the concentrated breath, the diffused breath and the breath below are the five winds which, when they keep their places, keep the corporeal being going. [12] The wind which circulates in the body is called the breath of the front, prāṇa⁴, it sustains the body, makes nourishment enter inside and supports the breaths.⁵

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² Y. adds: thus says the blessed Dhanvantari.

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¹ Reference to the legend which places the birth of Dhanvantari incarnated here in the king Divodāsa, in the churning of the ocean which also produced ambrosia.

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² J., Var. of Cordier . . . the ancients have rendered homage.

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³ Or “of the elements”. G. justifiably makes a *rapprochement* between Car., *Sūtr.*, XII, 8e (above) and leaves the choice between the two interpretations of—*bhūta*, “beings” or “elements” (p. 8, 1.13: *bhūtānām prāṇinām mahābhūtānām vā caturnām*).

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⁴ D. *avyakto’ dṛśyamūrtih | vyaktakarmā prakaṭakriyah*: “*avyakta*, of invisible form, *vyaktakarmā*, of manifest action”.

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⁵ cf. Car., *Sūtr.*, XII, 4 and 7, which is reproduced by G., by reading; —*rūkṣaḥ śīto laghuḥ sūkṣma calo viśadaḥ karaiti*, “bitter, cold, light, subtle, mobile, inconsistent, sharp”.

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⁶ G., p. 10, 1.4, DY.: *dviguṇa iti śabdasparṣaguṇaḥ*, “has two properties”=has as properties sound and touch (that is to say, those of being heard and felt). DJ. and DK.: *śitasparśa*, “the cold and the touch” (bad reading).

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⁷ This refers to the property “passion” (*rajoguṇa*) which the Sāṃkhya recognises in Nature as a specially active property. The expression amounts to saying. “it has lots of activity”, cf., *Śatapatha-brāh.*, VIII, 7,2,10: *dviguṇo bahulataraḥ* (in an entirely different context).

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⁸ Of the impurities of the body or of the three elements of trouble, but in this last case it should be admitted with those who stand for this interpretation, that it is its own conductor because it is one of those three (G. and D.).

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⁹ One could simply translate: “it is the king of the multitude of ills” in accordance with the Bengali version (*vyādhigaṇera rājā*) but G. and D. do not accept that *rāt* be taken here as a synonym of *rājan*. (G., p. 11, 1. 1: *nāyaṃ rāṭśabdo rāja [Corr.—’ja] paryāyaḥ;—DY.: na tu [DJ. & and DK. have by mistake nanu] rāṭśabdo rājaparyāyaḥ; G. explains: rogasamūhe rājati, D.: rājate śobhate*.

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¹ G.: "the entering into contact with the objects of faculties, the disorganisation of faculties, of the organic elements and of fire", that is to say, on one side it closes the circuit on sensation, makes the feeling subject attain the objects falling under the control of sensorial faculties and on the other that it is the antagonist or the regulator of the disturbing elements of the organism.

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² G. and D. specify that it refers to five forms of the fire in the body and enumerate them. They add that it does not refer, as desire some, to five ritual fires.

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³ The suffix *maya* here possesses an abstractive value, cf., *vānmaya*, "oratorial art", exactly "that which consists of words" (L. Renou, *Grammaire Sanskrite*, Sect. 201). However G. and D. understand: *kriyā-āmayaiḥ kriyānnapācanādikayā āmayenāmlapākādinā*, "as regards function, i.e., the cooking of nourishment, etc.; as regards disease, that is to say, the acidity, the maturing (excessive combustion), etc." The Bengali translation, seems justifiably, not to follow them (*sei prakāra eka vāyuī nāma sthāna o kriyā*, "similarly the wind, one, as regards names, seats and actions"). The English translation of K.L. Bhishagratna, Calcutta, 1911, Vol. II, p. 3, is too free to judge the interpretation on which it is based. The Latin translator, Fr. Hessler, Erlangen, 1844, Vol. I, p. 169, has understood it as G. and D.

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⁴ G. p. 13, l. 11, notes that "in another book, the breath of the front is said to be seated in the heart; the breath of the front is in the heart, the breath below in the rectum, the concentrated breath goes in the centre of the umbilic, the breath on high is situated in the region of the throat, the diffused breath goes in all the limbs and the articulations. cf., in fact, *Yogacūḍāmanyupaniṣad*, 23-24, with some difference.

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⁵ Others than him or simply "Life" which is a usual sense of *prāṇaḥ*. G. p. 13, l. 14: *prāṇāvalambana-vacanena tu hṛdayāvalambanamuktam | prāṇānām viśeṣeṇa hṛdayarmasthititvāt*, "by the expression, support of the heart, because the breaths have their seat principally in the vulnerable point of the heart". G. developes thereafter this interpretation, D. takes up a part of this development. Both of them add a quotation *yathā saindhavo'śvaḥ śaṅkumutpātya dhāvati tadvat prāṇa* (G. adds *anilo*). "Just as a horse of Sind runs off having uprooted its peg, similarly the breath (G. the breath of the front) arrested, escapes at the time of death tearing off all the winds". In D. this quotation is introduced.

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[13] Troubled, it produced principally affections such as hiccough and panting. The one called the breath on high, superior wind, goes upwards. [14] By means thereof opens out that which has the characteristic of being said, sung, etc...¹ It produces specially the ills which come above the clavicles. [15] The one that circulates in the receptacles of the uncooked and of the cooked², the concentrated breath (samāna), in concert with the fire³, cooks the nourishment and separates the particular substances which are found to be produced thereby. [16] It produces ills such as the tumours, the weakening of the (digestive) fire⁴, diarrhoeaes, etc. The one which circulates in the entire body, the diffused breath (vyāna) acts to bring in its wake the organic sap, [17] and makes perspiration and blood flow and causes the occurring of the gestures of five types⁵ and excited, it provokes chiefly the ills which traverse the entire body. [18] The one that has for seat the receptacle of the cooked (the intestines), the breath below (apāna), it is this wind which, at a convenient moment, brings in its wake the excreta, the urines, the sperm, the embryos and the menses downwards. [19] Excited, it provokes the terrible ills which stay in the bladder and the rectum; but the troubles of the sperm and the urinary ills are produced by the excitation of the diffused breath and of the breath below (associated). [20-21] And, all together, excited, they (the five winds) tear the body undoubtedly.

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¹ G., D. variant: the domain of that which is said, sung, etc.

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² The stomach and the intestines.

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³ Var.: with the help of the fire.

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⁴ Var.: the tumours, the diarrhoeaes where there is association with fire.

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⁵ G. and D.: extension, contraction, flexion, recovery, lateropulsion or according to others reported by D.: march, extension, recovery, opening of the eyes and closing of the eyes.

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I am going to explain below the disturbances provoked by the wind when strongly excited, seated in different places. The wind excited in the receptacles of the uncooked (the stomach) provokes ills such as vomitings, etc.

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by *yaduktaṃ śrutau*, “it is said in the Veda”; in G. by *yaduktaṃ suśrute*, “it is said in Suśruta”. Cordier in a note in his hand on the MSS. of G. supposes it to refer to an older edition of Suśruta because it is not the practice of the commentator to thus denote the text commented upon by him. But the good reading must be *śrutau* as the quotation is an approximative reproduction of the *Bṛh.-up.*, VI, 1,13.

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[22] Bewilderment, swoonings, thirst, the gripping of the heart, the point of the side. The one that has its seat in the receptacle of the cooked (the intestines) provokes the noise of the entrails and the sharp pain (colic) in the nombril.¹ [23] Dysuria and constipation, the intestinal occlusion, the suffering at the trifurcation (of the trunk and of the hips). Excited, the wind can produce the death of faculties (sensorial and active) in the ear, etc. [24] That which is found in the skin can provoke bad tint, the quivering, abruptness, sleep (tegumentary insensibility), cooking, pricking, chapping, desquamation. [25] That which has arrived in the blood can provoke ulcers, that which has its seat in the flesh can provoke painful nodosities,—similarly the one that has its seat in the fat can provoke new ulcerous indolent nodosities. [26] That which has attained the vessels can produce lancinating pain, contraction and the plenitude of vessels. That which has attained the tendons can provoke paralysis and shaking, lancinating pain as also convulsion. [27] That which has reached the joints renders them painful and swollen and can provoke the drying of the bones and their fissuration as also lancinating pain, the one that has its seat in them. [28] And when it has attained the marrow, the illness never gets calm; when the wind has attained the sperm, there is an absence of production or there is troubled production. [29] The wind which goes everywhere, covers successively the constitutive elements of the hands, the feet, the head and can attack the entire body of men. [30] The one that goes everywhere provokes paralysis, convulsions, sleep (anaesthesia), swelling and lancinating pains, and mixed (with other elements causing trouble) in the seats that are said to be those of complex ills. [31] The wind that has reached the limbs can provoke innumerable ills. There can be inflammation, heating and swooning when the wind is associated with bile. [32] Cold, swelling and heaviness, when it is enveloped in phlegm.

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¹ Var.: the sharp pain and the intestinal occlusion.

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Pricking as by needles, horror of touch (hyperaesthesia) [33] and other disturbances of the bile can occur when the wind is associated with blood. When the breath of the front is enveloped in bile, vomiting takes place and inflammation.

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appears. [34] When it is enveloped in phlegm, there appear weakness, depression, lassitude and bad mien. When the wind of high is associated with bile: swooning, inflammation, dizziness, lassitude. [35] Absence of transpiration and horripilation, diminished (internal) fire, cold and impotence, when it is enveloped in phlegm.

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[36] When the concentrated breath is associated with bile, sudation, inflation, burning and swooning. And when it is enveloped in phlegm, excess of phlegm, excreta and urines, horripilation. When the breath of below is associated with bile, there can occur inflammation and burning and (in women) flux of the blood.

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[37] When it is enveloped in phlegm, heaviness in the lower part of the body. When the diffused blood is enveloped in bile, convulsions, lassitude. [38] All the limbs are heavy and there is the stiffness of the points of bones, (such is) the symptomatology (liṅga) when the diffused breath is enveloped in phlegm and there is also the paralysis of movements. [39]¹ Generally, in delicate persons, in those who take undue amounts of nourishment and live beyond measure, because of excessive fatigue due to women, due to spirituous drinks and exercises which are the paths of ills², [40] following a deviation in the regimen of the seasons and irregular use of fatty bodies, etc., the windy blood gets excited in those who are chaste as also in the corpulent ones. [41] The one who goes with elephants, horses, camels and others, has his wind excited because of the habitual causes (of excitation), because of nourishment of vegetables, etc. pungent, hot, acid and caustic edibles as also because of heatings, etc. (becoming) too habitual. [42] Rapidly the blood gets corrupted and blocks the path of the wind. This wind, immediately rendered violently excited by the blocking of its route, can immediately trouble the blood a great deal. [43] The latter, mixed with the wind, disturbed by its predominance, is called “Windy Blood”. Similarly bile mixed with disturbed blood, disturbed phlegm mixed with disturbed blood. [44] Fearing the touch, suffering from pricking pain and drying up, from sleep (anaesthesia), are the feet because of the windy blood. Because of bile and blood they have a violent inflammation, are extremely hot, have red swelling and are smooth. [45] They are pruriginous, white and cold, swollen, inflated and impotent when the blood is disturbed by phlegm. And the ailments, when the blood is disturbed by all, make manifest in the feet, their individual aspects. [46] As premonitory symptoms, they are soft, perspiring, cold (or) possess opposite characteristics, have a bad colour, a pricking pain, sleep (anaesthesia), heaviness, heat. [47] When it (the blood) has reached the sole of the feet, sometimes also the palm of the hands, like rat-poison¹, it infiltrates the body. [48] When it has spread up to the knees, and when it is an effusion, being fragmented (that is to say, in the form of spread-out spots, petechiae) and when it is accompanied by complications like those of the weakening of the breath and of the flesh, [49] blood can become incurable (or) curable after several years. But when excited wind invades all the vessels, [50] then by a sudden attack it causes lively convulsions all over the body occurring at all moments, and as this convulsion is caused at all times, it is traditionally called "convulsor" (*ākṣepaka*), [51] is called "tension-producer" (*apātānaka*)², the one which makes descend (*pātayati*), by intervals, if the wind associated with phlegm violently occupies the (vessels). [52] The one which makes it hard like a stick is serious, that is the "tension-producer like a stick" (*daṇḍapātānaka*, upright tetanus). When it seizes the jaws very strongly (trismus) use of nourishment becomes difficult. [53] The one that makes the body bend like a bow draws its name from the hardness of the bow (*dhanuḥstambha*). It has its seat in the fingers, in ankles, abdomen, heart, chest and throat. [54] When the wind, impetuous, causes the convulsive expansion of the tendons, (the patient) has his eyes fixed, the jaw rigid, the side twisted (pleurothotonos), and (he) vomits phlegm. [55] When the man is bent like a bow inwards, then the wind, powerful, provokes its "contraction inwards" (emprosthotonos), [56] and if the tendons of outside¹ are found in the expansions it provokes the "outward contraction" (opisthotonos). The experts call incurable the one that causes the chest, the hips and the thighs to incurvate.

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¹ 39 and 40 probably interpolated.

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² Var.: following the affliction.

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¹ D.: poison of *Ficus glomerata* which is in reality the name of a skin-disease (*audumbara*, Suśr., Nid., V, 3), but the rat-poison, thought to be contained in its sperm, is well-known to Suśruta as giving rise to extended accidents, Kalp., VI, 5-7, which describes exactly the swellings, eruptions, fevers, panting, weakness, etc. caused by the corruption of blood.

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² This word depends on *tan*, "to extend", and not on *pat*, "to fall"; hence the etymology proposed here is fallacious. The diseases in question are the different forms of tetanus whose "convulsion-causing" wind provokes spasms. The names of *ākṣepaka*, *apātānaka* are the epithets of the wind as tetanus-causing functions but easily become names with morbid forms provoked by the latter; in that case these words are used for *ākṣepaka-roga*, *apātānaka-roga*, etc. It has been believed that *apātānaka* denoted epilepsy (Suśr., trnsln. of K.L. Bhishagratna) undoubtedly because of the indication that there is a fall but epilepsy is well-known and is described elsewhere as *apasmāra* and the mention of falls, which are not the characteristics of tetanus (whose access, in any case, is incompatible with the standing position), seem to be due to the care shown for etymology; the rest of the piece refers clearly to tetanus and to the diverse forms of tetanic accidents.

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¹ D.: "the tendons of outside are those which have their seat in the soles of the feet, in fleshy mass (calf of leg, etc.), in the posterior parts of hips, of the back and of the neck". These are the muscles whose contraction causes opisthotonos.

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[57] The wind associated with phlegm and bile and even the wind alone can produce the "convulsion-producer" (*ākṣepaka*) and another, the fourth is born of the traumatisms.² [58] The "tension-producer" which has abortion for its cause, or which occurs because of haemorrhage, or which has the traumatisms as cause, is not cured. [59] When the wind, excessively excited, attains the vessels going downwards along with those going horizontally and those which go high in the body, [60] then, releasing the links of articulations on one side, it injures the side and the best of practitioners call him "affected on the side" (hemiplegia). [61] The one who is tormented by the wind and whose entire half-body is paralysed and insensible, (he) falls³ and even loses life. [62] It is known that the side injured by pure wind⁴ is the most difficult to cure, the curable is that which is in relation with another (element of trouble), and the incurable is that which brings atrophy in its wake. [63] The wind excited can climb from its seat to the heart and the head, it torments the temples and can cause convulsions in limbs and can also bend them. [64] With eyes closed, without any movement, or with eyes fixed, one whimpers, without breath, or one can breathe with difficulty, with consciousness abolished. [65] One can be in one's normal state when the heart is freed and one swoons when it is enveloped (in the wind) by the wind accompanied by phlegm, one should know it to be *apatantraka*.¹ [66] As against sleeping during daytime, in one posture², in one position, of one look in an abnormal sense³ the one that is enveloped in phlegm provokes torticolis (*manyāstambha*). [67] In pregnant women, in parturition, in children, old men and the weak⁴, in the case of the diminution of blood, the one who cries aloud and masticates hard objects too much, [68] laughs, yawns, and due to weight, due even to an unequal level⁵, going to the head, the nose, the lips, the chin, the forehead, the junctions of the eyes⁶, [69] the wind torments the visage and engenders thereafter facial paralysis (*ardita*). Half of the face becomes twisted and even the neck gets twisted, [70] the head deviates, there is liming of speech (Aphasia) derangement of the eyes, etc. and suffering on the same side of the neck in the chin and in the teeth. [71] The one who has horripilation in the beginning, trembling, eye-trouble, wind going up, sleep (anaesthesia) and pain in the skin, seizing of the muscular mass of the neck and of the jaws, the experts in diseases call his (trouble) the disease "*ardita*".⁷ [72] The one who is weakened, whose eyes do not blink, whose speech is continually limy¹, his ardita is not cured assuredly as also if he is three years old and of the one who trembles. [73] The tendon of the heel and that of the toe which is tormented by the wind can retain the extension of the thigh; this is what is called “sciatica” (grdhrasī). [74] The tendon of the palm and of the fingers, in the back in the region of the arm, diminishes the function of the arms; this is what is known as “brachial paralysis” (viśvācī). [75] The swelling in the centre of knee, due to the wind and to the blood, very painful is the “jackal’s head”², massive like the shout of the jackal. [76] When the wind happens to sit in the hips and causes the tendon of the thigh to convulse³, then the man can become lame and, following the death of the two thighs, become paraplegical (paṅgu). [77] The one whose legs shake while walking and who walks like a lame person, one should know him as the “lame because of sinewy fasciculia” (kalaya-khañja), whose ligaments of articulations are loose. [78] When the foot is placed in an irregular manner, the wind can produce pains; it should be known that it is the “thorn of the wind” (vātakaṇṭaka) which has its seat in the ankle.

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² There are three types of "convulsion-producers" due respectively to wind, to wind associated with phlegm and with wind associated with bile, a fourth type is of traumatic origin. This last form, where the coming in of the disease is apparently due to traumatism, is distinguished from tetanus seeming to be spontaneous, which were considered as pertaining to medical pathology, even in modern times before it was known that D. lists various classifications of tetanus in four types.

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³ Var.: following the same.

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⁴ Alone, without the intervention of the phlegm and of bile.

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¹ According to Y. (note): "hysteria". The design suits well enough the convulsions and the "hysterical" coma, but also the manifestations with an organic substratum such as can provoke a number of neurological affections, meningeal haemorrhages, etc.

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² Specially of a posture in sitting position. Var.: of an irregular position.

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³ Var.: of an upward glance.

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⁴ The first half of the verse is rejected by Jejjhata and others.

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⁵ Var.: of unequal respiration.

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⁶ Lines of junction between the brows and the lids, the eye-lids and the white, etc. (Suśr., *Utt.*, I, 14). In fact, in facial paralysis there is a complete displacement of the eye-lids in relation to the eye.

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⁷ Here it does not refer merely to facial paralysis, but rather to facial neuralgia with trophic troubles (troubles of the eye), or to serious facial paralysis with lagophthalmia (absence of blinking indicated in verse 72), secondary contractions and neurological troubles associated together (paralysis with hemiplegia and aphasia).

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¹ Var.: whose speech is limy and indistinct.

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² Literally: “head” but preceded by jackal, that is to say that its name is formed of śiraḥ, “head”, preceded by kroṣṭhuka, “jackal”, therefore, kroṣṭhukáśiraḥ, “head of the jackal”.

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³ According to G.: “convulses a little”. Here it refers in fact not to violent contractions but to paraplegia or spasmodic monoplegia.

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[79] The wind associated with bile and blood provokes inflammation in the feet and specially following a walk: it is called “inflammation of the feet” (pādadāha, acrodyny). [80] The one whose feet have horripilation and are as if asleep⁴, it should be known that he has the horripilation of the feet (pādaharṣa) born of the excitation of the phlegm and of the wind. [81] The wind which, having its seat in the region of the shoulder, after having dried up the articulation⁵ and bent the tendons, stays there, engenders the “arm below” (avabāhuka). [82] Where the wind stays filling the vectorial canal of speech⁶, whether pure or associated with phlegm, deafness (bādhirya), is produced because of it. [83] The one in whom the wind provokes a shooting pain in the ears as if cutting the jaws, temples, head and the neck, he is said to have the "shooting pain of the ears" (*karṇaśūla*). [84] The wind with phlegm having filled the vectorial canals of speech, renders men inactive, dumb, speaking through the nose, or makes them stammerers. [85] The suffering that goes downwards, arriving in the receptacles of the faeces and of the urines, as if cutting the rectum and the genital organs, is known as the "quiver"¹ (*tūnī*). [86] The suffering which, arrived in the rectum and in the genital organs, winding the wrong way, occurs with paroxysms in the receptacle of the cooked (in the intestines) is called "contrary quiver" (*pratitūnī*). [87] The abdomen with rumbling, the seat of extremely violent pains, strongly swollen: one should know that to be "distension" (*ādhmāna*), terrible due to the stoppage of the wind. [88] When the side and the heart are untrammeled and when it reaches the receptacle of the undigested (stomach) it should be known as the "contrary distension", where the wind is filled with phlegm.

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⁴ Var.: and can be put to sleep.

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⁵ Literally: “that which has a link”. Var.: the link of the shoulder.

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⁶ Literally: “of the words”.

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¹ Pain as if due to a quiver full of arrows. Similarly the "shooting pain", *śūla*, is the pain caused by a blow of the lance.

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[89] One should know that a nodule, firm like seed-stone, enlarged upwards, elevated, is a "seed-stone of the wind" (*vātāṣṭhilā*), blocking the external outlets. [90] One should say that the one accompanied by pains, blocking the winds, the faeces and the urines, developed horizontally in the abdomen is the "seed-stone in the contrary direction" (*pratyaṣṭhilā*).

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