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tudyamānaṁ sa hr̥dayaṁ sūcībhiriva manyatē|  

tudyamānaṁ sa hr̥dayaṁ sūcībhiriva manyatē|  

chidyamānaṁ yathā śastrairjātakaṇḍūṁ mahārujam||39||  

chidyamānaṁ yathā śastrairjātakaṇḍūṁ mahārujam||39||  

hr̥drōgaṁ krimijaṁ tvētairliṅgairbuddhvā sudāruṇam|  

hr̥drōgaṁ krimijaṁ tvētairliṅgairbuddhvā sudāruṇam|  

tvarēta jētuṁ taṁ vidvān vikāraṁ śīghrakāriṇam||40||

tvarēta jētuṁ taṁ vidvān vikāraṁ śīghrakāriṇam||40||

tudyamAnaM sa hRudayaM sUcIbhiriva manyate|  

tudyamAnaM sa hRudayaM sUcIbhiriva manyate|  

chidyamAnaM yathA shastrairjAtakaNDUM mahArujam||39||  

chidyamAnaM yathA shastrairjAtakaNDUM mahArujam||39||  

hRudrogaM krimijaM tvetairli~ggairbuddhvA sudAruNam|  

hRudrogaM krimijaM tvetairli~ggairbuddhvA sudAruNam|  

tvareta jetuM taM vidvAn vikAraM shIghrakAriNam||40||  

tvareta jetuM taM vidvAn vikAraM shIghrakAriNam||40||  

The patient of krimija hridroga feels severe pain in the precordial region and complains of itching, as if the heart is being pricked and pierced with needles or cut open by weapons. Krimija hridroga is a very grave heart condition and may lead to immediate death. Therefore it should be promptly diagnosed and managed (39-40).

 

Sixty two permutations and combinations of samsarga and tridosha:

The patient of ''krimija hridroga'' feels severe pain in the precordial region and complains of itching, as if the heart is being pricked and pierced with needles or cut open by weapons. ''Krimija hridroga'' is a very grave heart condition and may lead to immediate death. Therefore it should be promptly diagnosed and managed [39-40]

(I). Thirteen types of sannipata:

==== Sixty two permutations and combinations of ''samsarga'' and ''tridosha'' ====

 

===== (I). Thirteen types of ''sannipata'' =====

 

द्व्युल्बणैकोल्बणैः षट् स्युर्हीनमध्याधिकैश्च षट्|  

द्व्युल्बणैकोल्बणैः षट् स्युर्हीनमध्याधिकैश्च षट्|  

समैश्चैको विकारास्ते सन्निपातास्त्रयोदश||४१||  

समैश्चैको विकारास्ते सन्निपातास्त्रयोदश||४१||  

dvyulbaṇaikōlbaṇaiḥ ṣaṭ syurhīnamadhyādhikaiśca ṣaṭ|  

dvyulbaṇaikōlbaṇaiḥ ṣaṭ syurhīnamadhyādhikaiśca ṣaṭ|  

samaiścaikō vikārāstē sannipātāstrayōdaśa||41||  

samaiścaikō vikārāstē sannipātāstrayōdaśa||41||  

dvyulbaNaikolbaNaiH ShaT syurhInamadhyAdhikaishca ShaT|  

dvyulbaNaikolbaNaiH ShaT syurhInamadhyAdhikaishca ShaT|  

samaishcaiko vikArAste sannipAtAstrayodasha||41||  

samaishcaiko vikArAste sannipAtAstrayodasha||41||  

There are 13 conditions of sannipata of dosha (combination of all three dosha), Out of these, three conditions are with a dominance of two doshas (other one dosha comparatively less increased), three conditions are with dominance of only one dosha (others two dosha comparatively less increased), six conditions with diminished, moderate and dominant doshas, and one condition with equal aggravation of all three doshas. (41).

There are 13 conditions of ''sannipata'' of ''dosha'' (combination of all three ''dosha''), out of these, three conditions are with a dominance of two ''doshas'' (other one ''dosha'' comparatively less increased), three conditions are with dominance of only one ''dosha'' (others two ''dosha'' comparatively less increased), six conditions with diminished, moderate and dominant ''doshas'', and one condition with equal aggravation of all three ''doshas'' [41]

(II). Nine types of samsarga:

 

===== (II). Nine types of ''samsarga'' =====

 

संसर्गे नव षट् तेभ्य एकवृद्ध्या समैस्त्रयः|  

संसर्गे नव षट् तेभ्य एकवृद्ध्या समैस्त्रयः|  

पृथक् त्रयश्च तैर्वृद्धैर्व्याधयः पञ्चविंशतिः||४२||  

पृथक् त्रयश्च तैर्वृद्धैर्व्याधयः पञ्चविंशतिः||४२||  

saṁsargē nava ṣaṭ tēbhya  ēkavr̥ddhyā samaistrayaḥ|  

saṁsargē nava ṣaṭ tēbhya  ēkavr̥ddhyā samaistrayaḥ|  

pr̥thak trayaśca tairvr̥ddhairvyādhayaḥ pañcaviṁśatiḥ||42||  

pr̥thak trayaśca tairvr̥ddhairvyādhayaḥ pañcaviṁśatiḥ||42||  

saMsarge nava ShaT tebhya [1] ekavRuddhyA samaistrayaH|  

saMsarge nava ShaT tebhya [1] ekavRuddhyA samaistrayaH|  

pRuthak trayashca tairvRuddhairvyAdhayaH pa~jcaviMshatiH||42||  

pRuthak trayashca tairvRuddhairvyAdhayaH pa~jcaviMshatiH||42||  

यथा वृद्धैस्तथा क्षीणैर्दोषेः स्युः पञ्चविंशतिः|  

यथा वृद्धैस्तथा क्षीणैर्दोषेः स्युः पञ्चविंशतिः|  

yathā vr̥ddhaistathā kṣīṇairdōṣēḥ syuḥ pañcaviṁśatiḥ|  

yathā vr̥ddhaistathā kṣīṇairdōṣēḥ syuḥ pañcaviṁśatiḥ|  

yathA vRuddhaistathA kShINairdoSheH syuH pa~jcaviMshatiH|  

yathA vRuddhaistathA kShINairdoSheH syuH pa~jcaviMshatiH|  

Similar to the combinations of increased dosha mentioned above, there are 25 conditions of kshina (decreased) dosha (42½).

Similar to the combinations of increased ''dosha'' mentioned above, there are 25 conditions of ''kshina'' (decreased) ''dosha'' [42½]

IV. Twelve sannipāta of normal, increased and decreased doṣha:

 

वृद्धिक्षयकृतश्चान्यो विकल्प उपदेक्ष्यते||४३||                                                                                   वृद्धिरेकस्य समता चैकस्यैकस्य सङ्क्षयः|  

===== (IV). Twelve ''sannipata'' of normal, increased and decreased ''dosha'' =====

 

वृद्धिक्षयकृतश्चान्यो विकल्प उपदेक्ष्यते||४३||

वृद्धिरेकस्य समता चैकस्यैकस्य सङ्क्षयः|  

द्वन्द्ववृद्धिः क्षयश्चैकस्यैकवृद्धिर्द्वयोः क्षयः  ||४४||  

द्वन्द्ववृद्धिः क्षयश्चैकस्यैकवृद्धिर्द्वयोः क्षयः  ||४४||  

vr̥ddhikṣayakr̥taścānyō vikalpa upadēkṣyatē||43||  

vr̥ddhikṣayakr̥taścānyō vikalpa upadēkṣyatē||43||  

vr̥ddhirēkasya samatā caikasyaikasya saṅkṣayaḥ|  

vr̥ddhirēkasya samatā caikasyaikasya saṅkṣayaḥ|  

dvandvavr̥ddhiḥ kṣayaścaikasyaikavr̥ddhirdvayōḥ kṣayaḥ ||44||  

dvandvavr̥ddhiḥ kṣayaścaikasyaikavr̥ddhirdvayōḥ kṣayaḥ ||44||  

 

vRuddhikShayakRutashcAnyo vikalpa upadekShyate||43||  

vRuddhikShayakRutashcAnyo vikalpa upadekShyate||43||  

vRuddhirekasya samatA caikasyaikasya sa~gkShayaH|  

vRuddhirekasya samatA caikasyaikasya sa~gkShayaH|  

dvandvavRuddhiH kShayashcaikasyaikavRuddhirdvayoH kShayaH [2] ||44||

dvandvavRuddhiH kShayashcaikasyaikavRuddhirdvayoH kShayaH [2] ||44||

There is another form of sannipata where the doshas are present in normal, decreased or increased combinations, and such cases are of 12 types there. Out of these, six conditions are where one dosha is increased, the second is normal and the third is decreased. In three types of combinations, two dosha are increased and the third decreased. Finally, there are three types of combinations where one dosha is increased and the other two are decreased. (43-44).  

 

There is another form of ''sannipata'' where the ''doshas'' are present in normal, decreased or increased combinations, and such cases are of 12 types there. Out of these, six conditions are where one ''dosha'' is increased, the second is normal and the third is decreased. In three types of combinations, two ''dosha'' are increased and the third decreased. Finally, there are three types of combinations where one ''dosha'' is increased and the other two are decreased. [43-44]  

    

    

Twelve types of irregular (vishama) sannipata [combination of dosha]

==== Twelve types of irregular (''vishama'') ''sannipata'' (combination of dosha) ====

1. Normal pitta, decreased kapha and increased vata sannipata:

 

===== 1. Normal ''pitta'', decreased ''kapha'' and increased ''vata sannipata'' =====

 

प्रकृतिस्थं यदा पित्तं मारुतः श्लेष्मणः क्षये|  

प्रकृतिस्थं यदा पित्तं मारुतः श्लेष्मणः क्षये|  

स्थानादादाय गात्रेषु यत्र यत्र विसर्पति||४५||  

स्थानादादाय गात्रेषु यत्र यत्र विसर्पति||४५||

तदा भेदश्च दाहश्च तत्र तत्रानवस्थितः|  

तदा भेदश्च दाहश्च तत्र तत्रानवस्थितः|  

गात्रदेशे भवत्यस्य श्रमो दौर्बल्यमेव च||४६||  

गात्रदेशे भवत्यस्य श्रमो दौर्बल्यमेव च||४६||  

prakr̥tisthaṁ yadā pittaṁ mārutaḥ ślēṣmaṇaḥ kṣayē|  

prakr̥tisthaṁ yadā pittaṁ mārutaḥ ślēṣmaṇaḥ kṣayē|  

sthānādādāya gātrēṣu yatra yatra visarpati||45||  

sthānādādāya gātrēṣu yatra yatra visarpati||45||  

tadā bhēdaśca dāhaśca tatra tatrānavasthitaḥ|  

tadā bhēdaśca dāhaśca tatra tatrānavasthitaḥ|  

gātradēśē bhavatyasya śramō daurbalyamēva ca||46||  

gātradēśē bhavatyasya śramō daurbalyamēva ca||46||  

prakRutisthaM yadA pittaM mArutaH shleShmaNaH kShaye|  

prakRutisthaM yadA pittaM mArutaH shleShmaNaH kShaye|  

sthAnAdAdAya gAtreShu yatra yatra visarpati||45||  

sthAnAdAdAya gAtreShu yatra yatra visarpati||45||  

tadA bhedashca dAhashca tatra tatrAnavasthitaH|  

tadA bhedashca dAhashca tatra tatrAnavasthitaH|  

gAtradeshe bhavatyasya shramo daurbalyameva ca||46||  

gAtradeshe bhavatyasya shramo daurbalyameva ca||46||