A History of Indian Medical Literature v1.c10: Chapter 3
A History of Indian Medical Literature v1.c10
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Chapter 3
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Chapter one, called rasavimāna,¹ deals with: the subjects of the Vimānasthāna (1.3); the roles of the tastes in substances and of the doṣas in disorders (vikāra); the connections between tastes and doṣas; the analysis of the roles played by tastes and doṣas in complex substances and disorders, in which their effects agree with their properties and actions (1.4–9); cases, where this analysis cannot be carried out, because the effects disagree with the properties and actions of the tastes and doṣas involved; substances and disorders of this type exhibit a specific action proper to aggregates (samudāyaprabhāva), due to their being vikṛtiviṣamasamaveta; this specific action (prabhāva) is of various types: rasa-, dravya-, doṣa- and vikāraprabhāva; these concepts are discussed and many examples are given (1.10–18);² sātmya (individual suitability), a concept linked to prabhāva (1.19–20);³ the eight factors involved in diet (āhāravidhi-viśeṣāyatana): the nature (prakṛti, svabhāva) of an article of food or a drug, its processing (karaṇa, abhisamskāra),⁴ the combination (samyoga) of substances, their quantity (rāśi), place (deśa),⁵ and time (kāla), rules concerning diet (upayogasamsthā), and the consumer (upayoktar) (1.21–22);⁶ rules concerning diet (1.23–25).
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Chapter two, called trividhakukṣīya, is concerned with: the appropriate quantities of articles of diet (2.3–7); the causes of corruption of āma;⁷ the diseases resulting from this corruption: visūcikā,⁸ alasaka,⁹ daṇḍālasaka and āmaviṣa;¹⁰ their pathogenesis, symptoms and treatment (2.8–14);¹¹ the āmāśaya, lying between navel and nipples, as the place where the food is digested (2.15–18).
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Chapter three, called janapadoddhvamsanīya,¹² records the teachings of Punarvasu Ātreya during a stay in Kāmpilya, the capital of Pāñcāla, concerning epidemic diseases (janapadoddhvamsana).¹³
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These diseases are due to derangements (vaiguṇya) of air, water, country and season.¹⁴ Preventive measures are described. Deviations from the dharma are the basic cause of epidemics (3.3–20), and, further, war, attacks by rākṣasas and afflictions caused by curses (3.21–23).
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The characteristics of human beings during the Kṛta- and Tretāyuga are discussed, and the decrease of the life span (āyus) during the four ages (yuga) of the world (3.24–27).¹⁵
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Ātreya expounds his views on the life span, which is determined (niyata) or undetermined (aniyata), and dependent on the relative strength of daiva (i.e., one’s deeds in previous lives) and puruṣakāra (one’s deeds in the present life) (3.29–36);¹⁶ he also explains the causes of timely and untimely death (kāla- and akālamṛtyu) (3.38).¹⁷
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The subjects of the last part of the chapter are: the prescription of hot water to patients suffering from fever (3.39–41);¹⁸ the treatment of diseases by means of measures which are contrary to their aetiology (nidānaviparīta) (3.42); the three types of depleting treatment (apatarpaṇa): laṅghana (reducing measures), laṅghanapācana (a combination of reducing and digestive measures) and doṣavasecana (the expulsion of doṣas), to be applied in patients with doṣas of little, moderate and great strength respectively (3.43–45).
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Chapter four, called trividharogavijñānīya, discusses the three sources of knowledge about diseases: āptopadeśa (the teachings of authoritative persons), pratyakṣa (perception) and anumāna (inference) (4.3).¹⁹ These concepts are defined. Inference is explained as tarka (reasoning), supported by yukti (4.4).²⁰ Āptopadeśa has to come first, followed by pratyakṣa and anumāna. The topics included in āptopadeśa are listed (4.6). Examples of pratyakṣa and anumāna are given (4.7). Inference procures knowledge about the state of the digestive fire (agni), a patient’s strength (bala), his sense organs and manas, his vijñāna,²¹ rajas,²² and moha,²³ his tendency to experience anger (krodha), grief (śoka), joy (harṣa), satisfaction (prīti), and fear (bhaya), his equanimity (dhairya), stability (avasthāna), faith (śraddhā),²⁴ intelligence (medhā), alertness of mind (samjñā),²⁵ memory (smṛti),²⁶ modesty (hrī), mode of conduct (śīla), dislikes (dveṣa), unreliability (upadhi), reliability (dhṛti), submissiveness (vaśyatā), etc. (4.8).
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The chapter ends with verses giving a summary of the contents.
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Chapter five, called srotasām vimānam, is about the channels (srotas) in the human body,²⁷ which transport constituents (dhātu) subject to physiological transformations (pariṇāma). These constituents are: prāṇa (vital breath), udaka (water), anna (digested food), rasa (nutrient fluid), rakta (blood), māṃsa (muscular tissue), medas (fatty tissue), asthi (bone tissue), majjā (bone-marrow), śukra (semen), mūtra (urine), purīṣa (faeces), and sveda (sweat) (5.3–7).
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The several groups of vessels are described.
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The vessels carrying prāṇa²⁸ have their origin in the heart (hṛdaya) and the mahāsrotas,²⁹ those carrying udaka³⁰ in the root of the palate (tālamūla) and the kloman,³¹ those carrying anna in the āmāśaya (receptacle of undigested food) and the left side of the chest (pārśva), those carrying rasa in the heart and the ten vessels called dhamanī,³² those carrying rakta in the liver (yakṛt) and spleen (plīhan), those carrying māṃsa in the snāyus (cords) and skin (tvac), those carrying medas in the vṛkkas (kidneys) and vapāvahana (omentum maius),³³ those carrying asthi³⁴ in the medas and buttocks (jaghana), those carrying majjā in the bones and joints, those carrying śukra in the testicles (vṛṣaṇa) and penis (śephas).
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The signs indicating that the vessels transporting prāṇa, udaka and anna are corrupted (praduṣṭa) are indicated;³⁵ the signs pointing to corruption of the other groups of vessels are the same as those of the transported constituents when corrupted and are therefore already described.³⁶
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The vessels carrying mūtra have their origin in the bladder (basti) and groins (vaṅkṣaṇa), those carrying purīṣa in the pakvāśaya (receptacle of digested food) and sthūlaguda (rectum),37 those carrying sveda in the medas and hair follicles (lomakūpa); the signs of corruption of the last three groups of vessels are described (5.8).
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The names of the visible and invisible spaces (avakāśa) for the dhātus are enumerated. The connections between corruption of the vessels (srotas), dhātus and doṣas are explained (5.9). The causes of corruption of the mentioned groups of vessels are dealt with (5.10–22), followed by some general statements on the vessels and the treatment of their corruption (5.23–28).
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Chapter six, called rogānīkam vimānam, is devoted to various ways of classifying diseases; additional subjects are the bodily fire (agni) and the constitutions (prakṛti).
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Dual groups (anīka) of diseases mentioned are those which are curable (sādhya) and incurable (asādhya), mild (mṛdu) and severe (dāruṇa),38 bodily and mental, endogenous (nija) and exogenous (āgantu), arising from the āmāśaya and from the pakvāśaya.39 The various ways in which diseases may be classified are discussed (6.3–4).
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The two psychic (mānasa) doṣas, rajas and tamas, and the three somatic ones, taken together, produce all the innumerable diseases; their exciting factors are the same: asātmyendriyārthasaṃyoga, prajñāparādha and pariṇāma; rajas and tamas are always associated (niyata anubandha), because rajas impels tamas, which cannot move independently; the psychic and somatic doṣas sometimes associate, working together; an example is the association between lust (kāma) and fever (6.5–9).
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Somatic doṣas in one and the same location (adhiṣṭhāna) give rise to combinations, called saṃnipāta when all three cooperate, and saṃsarga when two of them are linked to each other (6.10). Doṣas are called primary (anubandhya) when they are independent (svatantra), secondary (anubandha) when otherwise;40 saṃnipāta and saṃsarga are combinations of primary doṣas (6.11).
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The bodily fire (agni) is of four types: tīkṣṇa (intense), manda (sluggish), sama (balanced), and viṣama (irregular); it is dependent on the habitual state of the doṣas in the organism; balance of the doṣas gives rise to a balanced fire, predominance of vāta, pitta or kapha to an irregular, intense or sluggish fire respectively (6.12).41
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The theory that each human being is endowed with a constitution (prakṛti) dominated by one of the three doṣas, because a perfect equilibrium is never habitually present,42 is rejected with the argument that health (ārogya) is identical with such an equilibrium, also called prakṛti. Persons described as having a vātala, pittala or śleṣmala constitution should therefore be regarded as suffering from a disorder. The characteristics of persons considered to be vātala, pittala and śleṣmala are described, together with appropriate treatments (6.13–18).43
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Chapter seven, called vyādhitarūpīyam vimānam, begins with an exposition on the avoidance of diagnostic errors, easily made by inexperienced physicians. Those, only acquainted with part of the medical science, are deluded by the appearance (rūpa) of the patient (vyādhita), mistaking a severe disease (guruvyādhi) for a mild one (laghuvyādhi) and a mild disease for a severe one (7.3–7).
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The remaining part of the chapter is devoted to parasites (krimi), the disorders caused by them and the treatment of these disorders 44 (7.8–27). 45
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Twenty kinds of parasites are described; two kinds arising from external impure matter (bāhyamala): yūkā and pipīlikā; six kinds arising from blood: keśāda, lomāda, lomadvīpa, saurasā, auḍumbara, jantumātar; seven kinds arising from kapha: antrāda, udarāda, hṛdayacara, curu, darbhapuṣpa, saugandhika; five kinds arising from faecal matter: kakeruka, makeruka, leliha, saśūlaka, sausurāda. 46
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Chapter eight, called rogabhiṣagjitīya, deals with the study of āyurveda, the selection of a teacher, the method of studying, the method of teaching, and the initiation of a student (8.3–14). 47
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Discussions (sambhāṣā) among physicians constitute the next subject. 48 These discussions are either friendly (samdhāya- or anulomasambhāṣā)49 or hostile (vigṛhyasambhāṣā); 50 the opponent (para) is superior (pravara), inferior (pratyavara) or equal (sama); the assembly (pariṣad) is learned (jñānavatī) or ignorant (mūḍhā), friendly (suhṛtpariṣad), neutral (udāsīnapariṣad) or prejudiced (pratiniviṣṭapariṣad) (8.15–26). 51
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A long series of terms pertaining to learned discussions are given (8.27), defined and illustrated by means of examples (8.28–66). 52
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These terms are: vāda (debate), of a positive (jalpa) or critical (vitaṇḍā) nature; 53 dravya, guṇa, karman, sāmānya, viśeṣa, samavāya, terms already discussed in the Ślokasthāna; 54 pratijñā (thesis); 55 sthāpanā (justification) 56 by means of hetu (reason), dṛṣṭānta (corroborative instance), upanaya (correlation) and nigamana (establishment of the thesis); 57 pratiṣthāpanā (justification of a counter-thesis); 58 hetu (reason), 59 i.e., the means of obtaining knowledge (upalabdhikāraṇa), consisting of pratyakṣa (perception), anumāna (inference), aitihya (tradition) 60 and aupamya (analogy); 61 dṛṣṭānta; 62 upanaya 63 and nigamana; 64 uttara (rejoinder); 65 siddhānta (conclusive theoretical statement), divided into sarvatantra- (generally acknowledged), pratitantra- (restrictedly valid), adhikaraṇa- (implied) 66 and abhyupagamasiddhānta (hypothetical statement); 67 śabda (words), divided into dṛṣṭārtha (based on observable facts), adṛṣṭārtha (based on unobservable entities), satya (consistent) and anṛta (inconsistent); 68 pratyakṣa, 69 anumāna, 70 aitihya, 71 aupamya; 72 saṃśaya (doubt); 73 prayojana (purpose); 74 savyabhicāra (uncertain statement, making allowance for exceptions); 75 jijñāsā (enquiry); 76 vyavasāya (decision); 77 arthaprāpti (implied meaning); 78 saṃbhava (source); 79 anuyojya (questionable statement); 80 ananuyojya (unquestionable statement); 81 anuyoga (questioning about scriptural evidence); 82 pratyanuyoga (counter-questioning); 83 vākyadoṣa 84 (flaws in speech), of five types: nyūna (deficient), 85 adhika (superfluous), 86 anarthaka (meaningless), 87 apārthaka (incoherent), 88 and viruddha (incongruous); 89 vākyapraśamsā (commendable speech); 90 chala (deceptive speech); 91 ahetu (fallacious reasoning), 92 which is of three types: prakaraṇasama (relating to the topic), saṃśayasama (relating to doubt) and varṇyasama (relating to the object); 93 atītakāla (a statement deviating from the proper temporal order); 94 upālambha (a statement pointing out defects in causal reasoning); 95 parihāra (refutation of upālambha); 96 pratijñāhāni (abandonment of the original thesis);97 abhyanujñā (acceptance of an allegation, but turning to the opponent);98 hetvantara (fallacy of the reason adduced);99 arthāntara (an irrelevant statement);100 nigrahasthāna (reasons of defeat).101
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Some general rules regarding debates among physicians conclude this section (8.67).
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Ten concepts which a physician should be acquainted with before proceeding to action are discussed: kāraṇa (the agent), karaṇa (the instrument necessary for an agent to bring about an effort), kāryayoni (the material cause by the modification of which an effect is produced), kārya (that which is kept in view by the agent before making an effort), kāryaphala (the aim intended by the agent), anubandha (the good or bad effect which leaves its impact on the agent after making an effort), deśa (the location of an action), kāla (the process of temporal changes), pravṛtti (the effort leading to the production of an effect),102 upāya (the special aptitudes of agent, instrument and material cause which make the effect possible) (8.68–79).103
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These concepts introduce a section on types of examination (parīkṣā) and discussions regarding this point (8.80–82). Two types of examination are mentioned: pratyakṣa and anumāna, or three, if upadeśa (= āptopadeśa) is included (8.83).104
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The ten concepts, consisting of kāraṇa, etc, are explained in their application to medicine (8.84–151). The kāraṇa is the physician (8.86), the karaṇa the remedy (8.87), the kāryayoni the imbalance of the dhātus (dhātuvaiṣamya), which leads to the emergence of a disorder (vikārāgama) (8.88), the kārya the equilibrium (sāmya) of the dhātus (9.89), kāryaphala welfare (sukha) (8.90), anubandha the preservation of one’s life span (āyus) (8.91).
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Deśa has two meanings: the type of country in which a patient lives and the kind of soil on which a medicinal plant grows,105 and the patient (ātura) himself (8.92–93).
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A patient should be examined with reference to his prakṛti (constitution), vikṛti (pathology), sāra (predominance of the dhātus),106 saṃhanana (compactness of the parts of the body), pramāṇa (measurements), sātmya (suitability), sattva (mental condition), āhāraśakti (power of intake and digestion of food), vyāyāmaśakti (power of physical exercise) and vayas (age) (8.94).
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The factors determining the type of prakṛti are described. The types distinguished are śleṣmala (with a predominance of kapha), pittala (with a predominance of pitta), vātala (with a predominance of vāta), saṃsṛṣṭa (with a predominance of two doṣas),107 and samadhātu (with balance of the doṣas) (8.95).
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The properties of the doṣas108 and the constitutional characteristics of those with predominance of one of them are described. The characteristics of those in whose constitution two doṣas predominate and of those who are samadhātu can easily be deduced (8.96–100).109
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The pathology of a patient is severe, moderate or mild, dependent on the strength of cause, doṣa, dūṣya (corrupted constituent of the body), place, time, symptoms, and the interplay of these factors (8.101).
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Eight types of sāra are described, in which respectively the elements tvac (skin),110 rakta (blood),111 māṃsa (muscular tissue),112 medas (fatty tissue),113 asthi (osseous tissue),114 majjā (bone marrow),115 śukra (semen)116 and sattva (mental faculties)
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predominate. Some persons are endowed with all these sāras in combination, others are asāra. The importance of the determination of a patient's sāra is emphasized (8.102–115).¹¹⁷ Samhanana, also called samhati and samyojana, is briefly discussed (8.116).¹¹⁸
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The norm for the measurements of numerous parts of the body is given;¹¹⁹ the unit of these measurements is the breadth of one's own finger, called an aṅgula (8.117).¹²⁰ The parts of the body mentioned are: the two pādas (feet), jaṅghās (lower legs), jānus (knees), ūrus (thighs), and vṛṣaṇas (testicles), the śepha(s) (penis), bhaga (vulva), kaṭī (waist), bastiśiras, and udara (abdomen), the two pārśvas (sides of the chest), the stanāntara (part between the nipples), stanaparyanta (circumference of the nipples), uras (chest), and hṛdaya (apex of the heart),¹²¹ the two skandhas (shoulders), aṃsas (shoulder blades), prabāhus (upper arms),¹²² prāpānis (lower arms),¹²³ hastas (hands), and kakṣas (armpits), the trika (sacral region), pṛṣṭha (back), śirodharā (neck), ānana (face), āsya (mouth), cibuka (chin), oṣṭhas (lips), karṇas (ears), akṣimadhya (part between the eyes), nāsikā (nose), lalāṭa (forehead), and śiras (head).
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Sātmya is succinctly dealt with (8.118).¹²⁴ Sattva is, according to its strength, of three types: superior (pravara), medium (madhya) and inferior (avara);¹²⁵ persons of the first category are the same as those called sattvasāra (8.119). Āhāraśakti and vyāyāmaśakti are defined (8.120–121).
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Three stages of the life cycle are described: bāla, up to sixteen years, dominated by kapha, and extending to the age of thirty years; madhya, dominated by pitta, up to sixty years; jīrṇa, dominated by vāta, up to one hundred years, the maximum life span in the present age of the world (8.122).¹²⁶
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Prakṛti, etc., vikṛti excepted, may be present in three degrees; the strength of the doṣas in a pathological condition (vikṛti) and of a medicament is of three degrees too (8.123). The characteristics determining the life span will be described in the Indriyasthāna and the jātīsūtrīya chapter¹²⁷ (8.124).
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The divisions of time are dealt with, followed by physiological changes during the three main seasons (hemanta, grīṣma, varṣāḥ) and their consequences for therapy (8.125–127).¹²⁸ The condition of the patient (āturāvasthā) is, with respect to the period of time, kāla or akāla (8.128).
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Pravṛtti and upāya, the last two of the ten concepts, are briefly discussed (8.129–130).
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The types of examination dealt with in the foregoing find their application (prayojana) in a decision on the course of therapeutic action (pratipatti) (8.132). The way to arrive at a decision when symptoms in favour of a particular line of treatment co-exist with symptoms prohibiting this is discussed (8.134). Indications and contra-indications for treatment with emetics, etc., will be dealt with in the Siddhisthāna (8.133).
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Medicinal substances and preparations useful as emetics and purgatives are listed (8.135–136).¹²⁹
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Drugs used in āsthāpana (non-oleaginous enema) are, due to their large number, divided into six groups (skandha), according to the predominance of one particular taste. The items comprising these groups are enumerated;¹³⁰ directions for the ways of preparation are added (8.137–146).
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A wise physician should omit a drug, if he considers it to be unsuitable, or add one, even if not listed, if it is useful (8.149).
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Drugs to be employed in anuvāsana (oleaginous enema) are discussed, in particular the fatty substances in this type of enema (8.150). Drugs useful in śirovirecana (evacuation of the head) are enumerated (8.151).
Linked texts (1)
- Carakasaṃhitā — Agniveśa (Āyurveda) & Caraka, Sanskrit