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Indian Medicine (Medicin), translated by C. G. Kashikar c10: III. Theoretical Conceptions

Indian Medicine (Medicin), translated by C. G. Kashikar c10

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III. Theoretical Conceptions

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§ 33. The Tridosas :— The principle of three doṣas ( dhātus ) of human body goes like a red thread through the whole of medicine. The three doṣas are : wind ( vāyu, vāta, māruta, anila, samīraṇa ), bile ( pitta ) and phlegm ( ślesman, kapha ). The disease or being ill is defined as the derangement of the doṣas and health as their normal condition or balance ( AHr 1.1.20). Without kapha, pitta and vāta as well as blood the body cannot exist, they always sustain it ( Su. 1.21.3). The usual name doṣa "defect" shows that doṣas deranged or existing in excess are to be properly treated. The name dhātu characterises them as the elements of the body. Vāta is dry, cold, light, delicate, moving, clear and raw, pitta is greasy, hot, sharp, fluid and acrid, kapha is heavy, cold, mild, oily, sweet, stable and phlegmatic. By substances ( medicines and articles of food ) of opposite qualities they are neutralised and cured ( Car 1.1.61 ). Vāta prevails in advanced age, pitta prevails in the middle age and kapha prevails in childhood. Similar condition concerning the prevalance of the doṣas exists also with regard to the end, middle and beginning respectively of the day, the night and the digestion ( AS 1.1; AHr 1.1.8 ). The doṣas pervade and occupy the whole body, yet vāta has its chief place below the navel, pitta between the heart and navel, and kapha above the heart ( l. c. ). Vāta is divided into five kinds : 1.

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udāna, in throat, goes upwards and causes the speech, music etc., and by its derangement those diseases particularly occur which have their place above the collar-bone ( in throat and head ). 2. prāṇa, in heart, causes breath coming from the mouth that leads the food inside, and causes inward breath; by its derangement hiccup, asthma and similar diseases occur. 3. samāna, in stomach and intestines, digests the food by the digestive fire and analyses it into its elements ( chyle, excreta, urine etc. ); if deranged it causes weakness of digestion, diarrhoea and swelling of the body. 4. apāna, in lower body, drives the faeces, urine, sperm, menses and the foetus below and if deranged causes the dangerous diseases of the bladder, anus, sperm as well as diabetes. 5. vyāna, in the whole body, causes the division of fluids, the flow of sweat and blood, and the moving, opening and closing of the eyes etc. According to AS, AHr, Bhāv, the bodily functions of movement, filling with food, retention of secretions etc. rest on vyāna, while according to Suśruta ( Dallana ) these functions are distributed among the five kinds of vāyu. The diseases catching hold of the whole body are caused by the derangement of vyāna. By simultaneous derangement of the five vāyus, man is no more ( Bhāv. ). There are five kinds of pitta : 1. pācaka, paktikṛt, between the stomach and intestines, causes the digestion and secretion of chyle, urine and excreta. 2.

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rañjaka, rāgakṛt, in the liver and spleen or in stomach, colours the chyle and turns it into blood. 3. sādhaka, in heart, causes sight, determination and memory. 4. ālocaka, in the eyes, causes faculty of seeing. 5. bhrājaka, in the skin, gives glaze to skin and absorbs ointment. There are five kinds of śleṣman : 1. kledaka, in stomach, moistens the food and the other places of phlegm in the body. 2. avalambaka, in the heart, causes firmness of limbs. 3. rasana, bodhaka, in tongue, brings about the taste. 4. snehana, tarpaka, in head, oils and refreshes all sense-organs. 5. śleṣana, in the joints, makes the joints flexible ( AS 1.20; AHr 1.12; Bhāv 1.1.28 ff; Su. 1.15 ). By certain signs one can know as to which of the three doṣas prevails in the body. Thus men with predominance of vāta are inclined to waking, are voracious, atheists, addicted to music, joke, hunting and fight, having lust for sweet, sour, sharp and hot food and drink, very talkative, unstable, thievish, disaffectionate, not having many children, thin, tall, having weak, stagnant, trembling or rough voice, miserable etc. Men with predominance of bile are bold, proud, civilized, clean, intelligent, prudent, not loved by women and not of loving nature; they eat sweet, astringent, sharp and cold things; dream of lightning, fire and the like; are tended to perspiration, bad smelling, have brown hair (on the head) and little hair on the body, become prematurely grey etc.

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Men with predominance of kapha are intelligent, trustworthy, faithful, truthful, do not utter any disgrace, are patient, grateful, eat pungent, astringent, hot and dry things but only in small quantity, dream of ponds covered with blooming lotuses and clouds, have many sperms and many sons and servants, long arms, a full and broad breast, high forehead, thick and dark hair etc. ( Su. 3.4; AS 2.8; AHr 2.3 ). Increase or decrease of normal doṣas evokes ailing appearances ( Su. 1.15 ). It depends particularly on diet; thus sour food increases pitta, sweet food kapha and pungent food the vāta ( Car 1.27.3 ).

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According to another opinion which already comes in the Bower MS, blood is also a doṣa and so there are four doṣas. The blood is also often considered as exciter of disease¹. This conception is important, because it reminds us of the Greek humoral pathology. On the other hand, vātikāra, vātikṛta² comes already in the Atharvaveda, vātagulmin in Viṣṇu 46.27; so that at least the vāta belongs to the Vedic medicine. If the rite described e.g. in Kausika sūtra 26.1 is considered as directed against vāta, pitta and kapha as informed by the commentator, the old tradition may be proved to be still earlier. The old Buddhistic medicine also knows the three doṣas. Cf. §§ 14-16.

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(1) Cf. Hoernle, Bower MS, 1.93; ZDMG 53, 379. (2) Cf. Bloomfield, SBE 42, 246, 483, 516 ff.

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§ 34. The Seven Basic Elements:— The blood belongs to the seven basic elements (dhātu) of human body: rasa-chyle, rakta-blood, māṃsa-flesh, medas-fat, asthi-bone, majjā-marrow, śukra-sperm.

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1. rasa— Juice, chyle, has its place in heart and originates from properly digested food as a transparent extract of extreme fineness. From the heart it flows through the 24 tubes (dhamanīs), 10 going upwards, 10 going downwards and 4 horizontal; feeds day by day the whole body, makes grow, maintains, supports and animates it by an invisible power. At the end of five days rasa is transferred into rakta and then successively into the other basic elements of the body and thus requires a month in order to become sperm or, in the case of women, ovum (Su. 1.14). Rasa gives good mood and feeds the blood. Burnt on account of the weakness of digestion, it becomes pungent or sour and provokes many diseases (Bhāv 1.1.37). 2. rakta—red fluid, blood, originates from rasa when the same reaches the liver and spleen and there becomes red by the heating effect of pitta. Normal blood is red like the Coccinelle, not thick nor faded (Su. 1.14). Its colour is also compared with that of ruby, lac-dye, Guñjā-seed and refined gold (Car 1.24). The inference from certain expressions particularly in Bhāv that blood-circulation was known to Indians already before Harvey¹ (1619 A. D.) seems very doubtful. Spoiled by the doṣas individually, by pair or collectively, blood becomes frothy, black, blue, yellow, green, flowing slow or fast, not desired by ants and flies, oily, thick or thin, bad smelling etc. One must then proceed for blood-letting. From spoilt blood various diseases are caused, e.g. inflammation in the mouth, nose and eyes, swelling of the body, erysipelas, abscess, haematuria, nettlerash, dysmenorrhea, madness, leprosy, indigestion, irritability etc. (Car. Su. 1.c.). 3. māṃsa—flesh is blood digested by the natural fire which is condensed by the wind. Muscles—pesī, are a part of flesh ( Bhāv 1.1.38). 4. medas—fat is flesh digested by the natural fire and has its chief place in the belly, therefore in fatty people the belly is protruding (1.c.40). 5. asthi—bones are fat digested by the natural fire and dried by the wind. They form the kernel of the body and remain after the decay of the skin and flesh and sustain still longer (1.c.). For particulars see § 35. 6. majjā—marrow is a tough juice of bones digested by the natural fire which separates like perspiration (1.c. 42). 7. śukra—the generative element originates from marrow and has its chief place nearby the bladder and is also present all over the body.

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§ 35. Anatomy :— The outlines of anatomy of human body apparently formed a locus communis of Sanskrit literature¹. Thus the osteology in Caraka on one side and the law-books of Viṣṇu (96,55 ff.) and Yājñavalkya (3.84 ff.) on the other side is nearly identical, as the following survey shows :—

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By decrease and increase of the basic elements of the body deteriorating changes occur in the same. Thus there occur heart-disease, trembling, a feeling of emptiness and thirst by the decrease of rasa, and nausea and salivation by increase of the same. By decrease of śukra there is pain in the penis and testicles, impotency or slowness in the emmision of sperm and blood is mixed with the sperm. Sperm-stone and excessive sperm-effusion are caused by its over-abundance (Su. 1.15).

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The quintessence of all the seven elements is called ojas—vitality or bala—power and as a result of the same external and internal organs fulfil their functions. Ojas is oily, white, cold, soft etc. and pervades the whole body. It is demolished by injuries, grief, exhaustion, hunger and the like. There are three grades of the derangement of ojas; the worst stage leads to death. (Su. 1.15).

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(1) Sir Bhagawat Sinhjee, Aryan Medical Science, pp. 93 ff. Hoernle (Su. p. 89) considers the substitution of the variant anudhavato "running through" for older anusarato "going through" (Su. 1.14.1) as a result of the knowledge of blood-circulation in India. However, it cannot be said that Indian authors meant thereby the recurrent movement of blood.

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| Name or place of Bones | Number of Bones | |
| | Caraka 4.7 | Visnu, Yajñavalkya. |
| Teeth | 32 | 32 |
| Roots of teeth | 32 | 32 |
| Nails | 20 | 20 |
| Hands and feet | 20 | 20 |
| Fingers and toes | 60 | 60 |
| Heels | 2 | 2 |
| In the lower part of the palm | 2 | |
| Hand-joints | 4 ( v.1.2 ) | |
| Foot-ankle | 4 | 4 |
| Elbow | 4 | 4 |
| Lower part of the thigh | 4 | 4 |
| Knee | 2 | 2 |
| Bend of the knee ( Pelvis ? ) | 2 | 2 |
| Upper part of the thigh | 2 | 2 |
| Arms and shoulders | 2 | 2 |
| In the lower part of the temple | 2 | 2 |
| Palate | 2 | 2 |
| Hips | 2 | 2 |
| Pubic-bone | 1 | 1 |
| Upper Coccyx | 1 | |
| Lower Coccyx | 1 | |
| Back | 35 ( v. 1.45 ) | 45 |
| Neck | 15 | 15 |
| Clavicle | 2 | 2 |
| Chin | 1 | 1 |
| Lower jaw-bone | 2 | 2 |
| Forehead | 2 | 2 |
| Eyes | 2 | 2 |
| Cheeks | 2 | 2 |
| Cartilage of the nose | | 1 |
| Nasal bones | 3 | |
| Ribs and spine | 72 | 72 |
| Temples | 2 | 2 |
| Head | 4 | 4 |
| Breast | 17 | 17 |
| | 360 | 360 |

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AS 2.5, AHr 2.3 also distinguish 360 bones. In Su. 3.5 there are 300 only, yet the figure 360 was known to him. The whole body is further divided into six chief parts (*aṅga*) : arms, legs, trunk and head. As sub-sections (*pratyaṅga*) are mentioned cranium, belly, back, navel, forehead, nose, ears, eyes, fingers and others. According to Caraka they are 56. There are 6 (or 7) skin-layers in which originate the various diseases like erysipelas, tumours, abscesses, leprosy etc. that go more or less deep. The five sense-organs, viz. the skin, tongue, nose, eyes and the ears correspond to the five sense-functions : feeling, taste, smell, sight and hearing. Besides there are five active organs : hands, feet, anus, genital and the tongue. There are 7 reservoirs (*āśaya, ādhāra*) or hollow entrails in which air, bile, phlegm, blood, undigested food, digested food and urine are contained. Women have besides the eighth for the foetus, called *garbhāśaya*. The internal organs (*koṣṭhāṅga*) are 15 according to Caraka (and Viṣṇu, Yājñ. ), viz. heart, lungs, liver, spleen, bladder, stomach, rectum etc. The seven basic elements (cf. § 34) are separated from each other by the 7 *kalās* which consist of a fluid extract from the basic elements (*dhātu-sāra*) which is compared with the substance of wood. The *kalās* contain or surround, according to their names, flesh, blood, fat, phlegm, faeces, bile and sperm. The second *kalā* which contains blood is found, according to Suśruta, in flesh, particularly in the arteries, spleen and liver, wherefore blood flows out in wounds of flesh just as milk-juice flows out from a tree containing such juice. The nine openings (*srotas, kha, chhidra*) are the mouth, nostrils, ears, eyes, anus and urinary canal. In the case of women there are in addition the breast and vagina. The ten chief places of life (*prāṇāyatana, jīvitadhāman*) are head, neck, heart, navel, anus, bladder, *ojas* (vitality), sperm, blood, temples and the tongue ( AS. AHr, Viṣṇu, Yājñ. ). The quantities of fluid parts are given in *añjalis* "handful"; thus the body contains 10 *añjali* water, 5 *añjali* bile etc. The seven basic elements (*dhātu*) create seven excretas (*mala*), viz. phlegm, bile, secretions of ears, nose etc., perspiration, nails and hair, eye-dirt and fatness of skin. *Mala* has another and more general meaning. Thus Manu 5.135 distinguishes 12 *malas* : fatty secretion of skin, sperm, blood, marrow ( brain ), urine, faeces, nasal phlegm, dirt in ear, phlegm, tears, eye-dirt and sweat. According to Bhāv., the *malas* are innumerable like the hair and pores ( Car 4.7; Su. 3.4 f.; AS 2.5; AHr 2.3; Bhāv 1.1. 55 f. ).

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The joints (*sandhi*) are exhaustively described. According to Suśruta, they are 210 : 68 in the extremities, 59 in the trunk and 83 above the neck. The joints in the extremities, jaw and hip are movable, the remaining are immovable. To these joints on the bones are added the innumerable ones in muscles, sinews, nerves and arteries. The number of *snāyus* (sinews and nerves, literally ‘bindings’) is 900 : 600 in the extremities, 230 in the trunk and 70 above the neck. There are 500 muscles (*peśī*) : 400 in the extremities, 66 in the trunk and 34 above the neck. Women have 20 more : 10 in breast which develop only after puberty, 4 in vagina, 3 in uterus and 3 for the propagation of semen and blood. The 700 vessels (*sirā*) starting from the navel moisten the body, just as a garden is watered by water-trenches. Mention is made of 10 basic vessels (*mūlasirā*) in the heart which lead *ojas* through the whole body (AS), and also of 72000 tubes (*nāḍī*) which start from the heart (Yājñ). One hundred and seventy five vessels contain wind, and an equal number of them contains bile, phlegm and blood. The wind-vessels are reddish and are full of wind, the bile-vessels are hot and blue, the phlegm-vessels are cold, whitish and immovable, the blood-vessels are red and lukewarm. In blood-letting certain vessels are to be avoided. The 24 (according to Car, Viṣṇu, Yājñ. 200) reeds (*dhamanī*, i. e. vessels and nerves) start likewise from the navel, yet it is denoted as an error to consider them simply as a sub-section of *sirā*. Ten *dhamanīs*, going upwards, cause the five sense-functions, viz. the breathing in and breathing out, yawning, sneezing, laughing and speaking. Ten going downwards, conduct downwards the wind, urine and faeces, sperm and ovum, and four, running circular through the body with innumerable branches in the whole body, throw out perspiration. According to Car, Viṣṇu, Yājñ, there are 3956000 (2900956) *sirās* and *dhamanīs*. The *srotas* are another kind of canals of which there are two each for the breath, food, water, chyle, blood, flesh, fat, urine, faeces, sperm and ovum. Important for the physician’s practice are the 107 *marman* i. e. dangerous points in flesh, arteries, sinews, bones and joints, the places of which are sufficiently described. They are also divided from the view-point as to whether wounds are forthwith fatal, or bring death only after some time or are fatal after extracting an arrow or similar foreign matter, or only cause lameness or pain. To the first class of *marman* belongs the heart which is the seat of three *guṇas* and of spiritual activity (Su. 3.6.30; AHr 2.4.13; Aruṇadatta). There are 16 sinews (*kandarā*)

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which end in nails, 16 networks (*jāla*), 6 fibrous aponcurosis (*kūrca*) on the hands, feet and in the neck, the 4 cords (*rajju*) in the spinal cord, and 7 sutures (*sevani*, 5 in head, one each on the tongue and on the penis). These must be avoided in operations. There are also 14 “bone-groups” with the corresponding “dividing lines” (*sīmanta*, Car 4.7; Su 3. 5–9; AS 3. 5–7; AHr 2.3 f.; Bhāv 1.c.)

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One third of the eye consists of the black part (*kṛṣṇamaṇḍala*) the seeing organ (*dṛṣṭi*— the pupil or lense ) occupies one seventh of the black part. The eye contains 5 circles, viz. the eyelashes, eyelids, the white part (*śveta*), the black part and the *dṛṣṭi* (pupil). There are six joining places (*sandhi*), viz. between the eyelashes and eyelids, between the eyelids and the white, between the white and the black, between the black and *dṛṣṭi*, on the eye-star (*kanīnakā*) and on external eye-angle. There are further two membranes (*paṭala*) on the eyelids, and four on the eye; one of these four is connected in fact with the transparent substance (*tejojala*) and these four are affected by the frightful disease *timira* (Cataract). Their diameter carries altogether a fifth of *dṛṣṭi* (Su 6.1; AS 3.5).

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(1) A musical-work, *Sangītaratnākara* of the middle age also contains a comprehensive representation of embryology and anatomy which intimately agrees with Su and Car. (R. Simon). Cf. *Sangītaratnākara* (ASS 1897) I, pp. 14 ff. On the *Amarakośa* see Weber, (2nd edn) p. 286; on the *Upaniṣads*, cf. § 14, *Indische Litteratur*.

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§ 36. Dissection :— Some sort of dissection is mentioned only in Su 3.5. A surgeon who desires to obtain a definite knowledge of human body, should properly clean a body in order to learn to know the position of the organs. The dead body to be selected for this purpose should be of a man with complete limbs, who did not die of poison or of a protracted disease (on account of the morbid changes of the body resulting thereby-Ḍallaṇa), or was of over age. Having removed all excremental matter from the entrails, the body should be placed in a cage fast tied (so that it may not flow off by the current -Ḍallaṇa) in not a rapid current after wrapping it with rush or bast or Kuśa grass or hemp (so that it may not be devoured by fish and other animals in water-Ḍallaṇa) in a covered place (where it would be safe from the attacks of birds of prey-Ḍallaṇa). There the body should be allowed to decompose. When, after seven days, it is thoroughly

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decomposed, it should be taken out and very slowly scrubbed with a whisk made of khas (*uśīra*) or hair or bamboo gradually and the internal and external parts (which have become visible), beginning with the skin, should be fully examined with the eye. One cannot see the soul with physical eyes, but with the eye of knowledge and penance. Since this procedure is recommended only to the surgeon, the anatomical knowledge thus received may not obviously be considered as necessary for the treatment of cases other than the surgical ones.

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§ 37. Philosophy and Cosmology :— The philosophy of medical authors is essentially that of the Sāṃkhya system¹, as is evident from the fact that Punarvasu (Car 1.13.3) imparts his instructions to the followers of this philosophy (*sāṃkhya*) who surrounded him. So also Su 3.1 denotes the "anexpanded" (*avyakta*) which consists of three *guṇas* : *sattva*, *rajas* and *tamas*, as the creative element of the whole world. From *avyakta*, "the great" (*mahān*) originates, and from this "the inspirer of I" (*ahaṃkāra*) in three forms : *vaikārika*, *taijasa* and *bhūtādi*. From the first form of *ahaṃkāra* the eleven senses (*indriya*) are created; they are (1) the five senses of perception : hearing, feeling, sight, taste and smell, (2) the five active senses : speech, catch and hold, procreation, evacuation and walking, the respective organs for these senses and (3) the internal sense (*manas*). From the third form of *ahaṃkāra* are created the five *tanmātra* ("only this") i. e. the basic elements of the sound, feeling, colour, taste and smell and from these the gross elements (*bhūta*) : vacuum², wind, fire, water and earth. Thus there are 24 principles (*tattva*). Of these *avyakta*, *mahān*, *ahaṃkāra* and the five *tanmātra* are the eight basic forms (*prakṛti*), the remaining 16 are the products (*vikāra*). In opposition to the 24 irrational *tattvas*, there is the 25th endowed with intelligence (*cetayitṛ*); it is the soul (*puruṣa*). Like the basic element or the matter (*prakṛti*) the soul is also without beginning and end, eternal and omnipresent. While, however, the matter is uniform and non-intelligent, consists of three *guṇas*, propagates itself and does not remain neutral, there is a variety of souls who are endowed with intelligence, are immaterial (*aguṇa*), unproductive and neutral. Car 4.1 speaks of the soul as the *cetanādhātu* who is named as *puruṣa* and consists of the 24 above elements. The *puruṣa* is without beginning and eternal, the designations *ātman*, *kṣetrajña*, *vibhu*, *sūkṣin* are also applied to Him. If there were no *puruṣa*, there would neither be light nor darkness, neither truth nor untruth, no Veda, no good or bad deeds, neither pleasure nor pain, neither birth nor death, neither bond nor release. At the dissolution of the world (*pralaya*) a counterformation takes place also in the case of the *puruṣa*, the folded becomes unfolded and vice versa. After death the expressions of the soul's activity, viz. pleasure and pain, comprehension and recollection etc. cease, the body becomes like an empty house and devoid of consciousness after the removal of the soul. Caraka holds similar view with Suśruta in respect of *avyakta*, *buddhi* (*mahān*), *ahaṃkāra*, five *tanmātra*, five senses of perception and five of activity, *manas*, five gross elements (*khādīni*) and the 16 *vikāras*. In 4.5 Caraka speaks of the redemption and the means therefor. According to Car 4.6, the body is the product of five gross elements (*mahābhūta*, see above) under the guidance of the soul. If the balance of the elements is disturbed, the body suffers or expires. Decrease or increase of individual elements occurs by unsuitable or suitable diet and the like. In 1.8 the relation of the senses to the soul or inner sense, *manas*, also called *sattva* or *cetas*, is exhaustively discussed. The senses can take hold of their respective objects only by the direction of the soul. The way in which the spirit or character of every individual man is formed, depends upon as to which of the three *guṇas* (*sattva*, *rajas*, *tamas*) is dominant in him. Compare also § 41.

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The principle of three *guṇas*, the *prakṛti* and the 25 *tattvas* is presented in detail in Bhāv 1.1.9 ff.

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The organic world is usually divided into four classes: *svedaja* or *ūṣmaja*—originating from heat (insects), *aṇḍaja*—originating from egg (birds, serpents etc.), *udbhijja*—originating from a shoot (plants), *jarāyuja*—originating from a womb (men etc.). This division need not necessarily start from the Sāṃkhya philosophy¹.

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(1) Cf. Garbe, *Die Sāṃkhya Philosophie*, (Leipzig 1894), *Sāṃkhya und Yoga* (Strassburg 1896, Grundr. III. 4). To the proofs exhaustively given therein (44 ff. and §§ 10-15) about the works influenced to a great extent by this system may be added the medical text-books as well. (2) Cf. Bohtlingk, *Die fünf Elemente der Inder und Griechen* (Ber. d. Sachs. Ges. d. Wiss. 1900). (3) cf. e. g. Deussen, *System des Vedanta*, p. 259.

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§ 38. Pathology :— Since illness is the result of the derangement of the tridoṣas (§ 33), it gives a hint to divide from this viewpoint all the diseases which are 1120 according to Su 6.66.8 and are innumerable according to Car 3.6.5. Thus Car 1.20 counts 80 diseases proceeding from vāta, 40 from pitta and 20 from kapha, and remarks that these ailments are really speaking innumerable. To these are added the diseases that are accidental or due to external causes (āgantu) as a fourth group, viz. those caused by scratching, biting, tumbling, acts of violence, possession, enchantment, malediction, strokes, captivating, pricking, choking, squeezing, knitting, burning wounds, weapon, lightning stroke or demoniac influence. As general characteristics of vāta-diseases Caraka mentions dislocation, trembling, unrest, pain in limbs, redness of skin, astringent taste in mouth, deafness and dumbness, crookedness of limbs, lameness etc. Symptoms of pitta-diseases according to him are burning, heat, inflammation, perspiration, moistness, rotten ulcers, redness, bad smell and taste, and decolorization. Symptoms of kapha-diseases are white colour of the skin, cold, itch, stiffness, tumour, heaviness, numbness, moistness, sweet taste, slowness etc. These general symptoms undergo modifications corresponding to the individual diseases, as will be evident from their descriptions. According to Car 3.6 two doṣas in different combinations or all three doṣas can also be responsible for the origination of a disease (saṃsarga and sannipāta) which then becomes prominent in the description of the disease. The worst diseases have their origin in sannipāta which is a combination of three doṣas. Car 1.11 calls the diseases caused by the doṣas as nija, those proceeding from demons, poisoning, wind, fire, strokes and the like (cf. above) as the second group (āgantu) and the mental excitements and mental worries as the third group (mānasa). Similarly there are four groups according to Su 1.1 : āgantu i. e. proceeding from wounds, śārīra i. e. abnormal increase or decrease of vāta, pitta or kapha or blood proceeding from food or drink, mānasa i. e. anger, grief, anxiety, pleasure and other mental excitements, svābhāvika (natural) i. e. hunger, thirst, oldage, death and sleep. Inherent diseases (sahaja) like inherent blindness are also included elsewhere (Bhāv 1.1.15) among the svābhāvika which (as well as the mānasa) cannot properly be called diseases. The classification in AS 1.1, AHr 1.1 is more logical. They distinguish only two groups, nija and āgantu, with the additional remark that they have their place either in body or in mind. Aruṇadatta remarks here that in *nija* the derangement of *doṣa* occurs first and then the disease, while in *āgantu* the derangement of *doṣa* is secondary and that by mental diseases swoon, apoplexy, madness, possession, epilepsy and similar conditions are to be understood.

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The derangement of the balance of *doṣas* is caused chiefly by unsuited diet, yet other conditions are also responsible for it. Thus *vāta* is deranged also by fight with strong people, excess in movements, in sexual intercourse or in study, tumbling, running, pressure, wounds, fasts, bath, swimming, keeping awake at night, carrying heavy load, riding on an elephant or horse, driving or walking and suppression of natural needs. *Pitta* is deranged by anger, grief, anxiety, exertion, fast, indigestion and sexual extravagance. *Kapha* is deranged also by sleep by day, want of activity and inertia. Besides, the seasons and daily changes of time and the various stages of digestion also influence the *doṣas*, as e. g. the *kapha* is deranged particularly in winter and spring, in the morning and evening and immediately after the meal. The derangement of *doṣa* is compared with the fermenting process. The *vāta* gives impetus and drives the *doṣas* around in the body in which they cause various pains and troubles according to the place of their appearance (Su 1.21). The therapy is aimed at allaying or suppression (*praśamana*) of the only or chiefly deranged *doṣa*.

c10.24

The same pathological effect as that of the *tridoṣas* is attributed to the blood as well, cf. § 33. According to Su 1.21 derangements of blood are caused by the derangement of *pitta* and by frequent use of liquid, oily and heavy food, sleep by day, anger, fire, sunheat, fatigue, wounds, indigestion, unharmonious or excessively eaten food and the like; similarly Car 1.24. Fifteen kinds of derangements occur according to Su 1.c.15 from the derangements of the *tridoṣas* and the blood, individually or in various combinations. According to Car 1.24.4 all the diseases that are curable in themselves and which resist the application of remedies that are cold and hot, oily and dry, and similar other remedies, are caused by deranged blood (*raktaja*). The derangements of other six *dhātus* (Cf. § 34) also cause analogous effects. Thus spoiled *rasa* brings about loss of appetite, gout, fever, impotency, thinness and other diseased conditions; spoiled flesh brings about swelling of gums, tumour, goitre etc.; spoiled fat brings about abnormal height or abnormal dwarfishness, abnormal fatness or abnormal leanness etc.; spoiled bones bring about exostosis, caries, various diseases of teeth etc.; spoiled marrow brings about swoon, giddiness, pain in joints etc.; spoiled sperm brings about impotency or infirmity of children or miscarriage etc. (Car 1.28; Su 1.24). Similarly various stages of many diseases, e. g. kuṣṭha (§ 68), are explained by their place in various dhātus.

c10.25

Along with his above fourfold division, Su 1.24 mentions also another division of diseases in 7 classes : ādibalapravṛtta—proceeding from procreation, i. e. from spoiled sperm and ovum, thus inherited from father and mother; e. g. skin-diseases and piles. 2. janmabalapravṛtta— proceeding from the birth, i. e. in the womb by defective conduct of pregnancy, like lameness, inherent blindness, dumbness and deafness, speaking through the nose, dwarfishness and the like. 3. doṣabalapravṛtta— proceeding from the doṣas, in fact originating either in intestines or in stomach, either in body or in mind. 4. saṃghātabalapravṛtta—proceeding from wounds, i.e. caused either by weapon or by beasts. 5. kālabalapravṛtta—originated from the seasons, i. e. brought about by cold, heat, wind, rain and the like. 6. daivabalapravṛtta— caused by the divine will, i. e. effected on account of an insult of a divine being, effected by imprecation, incantation from the Atharvaveda or by contagion (Ḍallaṇa). The effects of lightning are also reckoned herein. 7. svabhāvabalapravṛtta— natural, i.e. hunger, thirst and the like (see above). Suśruta, however, expressly adds that vāta, pitta and kapha form the root of all diseases.

c10.26

According to the grade of their dangerousness, the diseases are divided into three kinds : curable (sādhya), only mitigating (yāpya) and incurable (pratyākhyeya, anupakrama, asādhya). Reference is always made to this division in the description of diseases. Chronic diseases are understood by yāpya; these may be temporarily checked by suitable medicine or remedies, but cannot be cured. In Caraka, therefore, they form a section of incurable diseases. On the other hand, the curable diseases are divided by him into those that are curable easily and those that are curable with difficulty (Su 1.35.18; Car 1.10. 7-10; AHr 1.1.30-32). To the difficult diseases belong the surgical cases (śastrādisādhana, AHr 1.1.32). Su 1.24.3, therefore, remarks that in surgical cases the application of medical remedies is not inadmissible, on the other hand in the cases of diseases curable by medical remedies operation is not to be resorted to.

c10.27

From the standpoint of the principle of rebirth, those diseases are considered as *karmaja*, i.e. proceeding from the misdeeds in a previous birth, for which there appears no visible cause and which resist the usual curing methods. One must try to cure them by penance (*prāyaścitta*). Where serious ailments arise out of trivial causes, it is due to a combined effect of the *doṣas* and previous misdeeds (AHr 1.12. 57 ff.; Bhāv 1.1.126 ).

c10.28

The study of a disease in the beginning stage is called *prāgrūpa*, *pūrvalakṣaṇa*, the characteristic symptoms are called *lakṣaṇa*, complications are called *upasarga*, *aupasargika*.

c10.29

Epidemic diseases (*maraka*, *janapadoddhvaṃsa*) proceed particularly from continuous draught, excessive rainfall and similar calamities which are sent by gods as punishment for sins, or from the evaporation of poisonous plants, the influence of stars etc. As a measure of relief the infected region should be abandoned or the epidemic should be subdued by expiating ceremonies etc. (Car 3.3; Su 1.6).

c10.30

The simplest and most natural classification is that which is based on the place of the disease in the body (*rogamārga*) : 1. The external diseases (*bāhyaroga*) i. e. skin-diseases, haemorrhoids, tumours etc. 2. Diseases of inner organs, e.g. vomiting, diarrhoea, cough, fever and the like and 3. those of the middle organs, e. g. consumption, hemiplegia, headache etc. (Car 1.11.48 f.; AHr 1.12.44 ff.) Of the eight subjects of medicine (Su 1.1) the second is related to the diseases of ears, eyes and other parts above the clavicle, the third to the diseases of the whole body, like fever, diarrhoea, madness etc. Besides, the possession by demons, children's diseases and poisoning form part of this subject.

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