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Line 1: − + − + − + − The preceding chapter provided details on diseases of the vital organs with signs of swellings. This Trishothiyadhyaya of Roga chatushka (tetrad on diseases) describes various kinds of swellings/distension as well as causative factors for endogenous and exogenous swellings/distensions, their locations in the body and their modes of treatment. Further, the pathophysiology of various diseases along with their specific diagnostic criteria have been described in the chapter. + − + − + − In the previous chapter, diseases of vital organs like head, heart, and the urinary system, signs of dhatu kshaya (depletion of dhatu) and pidika (papules) with signs of swellings were described. This chapter deals with the etiology and symptomatology of endogenous and exogenous as well as local and generalized swellings and distensions. The name of the chapter denotes three types of swellings but later in the text, these swellings are classified into various types based upon several etiopathological factors and location. This chapter is important from the standpoint of diagnostics as it describes the main causes of all diseases that can be endogenous (innate origin) and exogenous (external agents). Some of the causative factors that can trigger non-infectious and infectious inflammations include traumatic injuries, contact with poisonous plants, animals, insect bites, animal bites, frost bite, and burns. The body’s reaction to invading micro-organisms, in terms of vitiation of dosha, can be observed and appropriate course of action can be planned. + − Inflammation is an important pathology that includes tumor (swelling) as a cardinal sign. Further, classifications of shotha (swelling/distension) based on cause, predominance of dosha, and prognosis as per site of swelling are explained. Principles of identification of new diseases are also elucidated. The normal functions of dosha and their importance in disease conditions is emphasized. Thus, the chapter is fundamental in knowing disease. + − Adhyaya (The chapter)+ − अथातस्त्रिशोथीयमध्यायं व्याख्यास्यामः||१|| + + + + − athātastriśōthīyamadhyāyaṁ vyākhyāsyāmaḥ||1|| + − athAtastrishothIyamadhyAyaM vyAkhyAsyAmaH||1|| + − + − Now we will discuss the chapter on three types of shotha i.e. swellings. Thus, said Lord Atreya. [1-2]+ − Three types of shotha: + − + + + + + + + + + + + + + + + + + + + + − trayaḥ śōthā bhavanti vātapittaślēṣmanimittāḥ, tē punardvividhā nijāgantubhēdēna||3||+ − trayaH shothA bhavanti vAtapittashleShmanimittAH, te punardvividhA nijAgantubhedena||3||+ − There are three types of shothas (swelling) i.e. vataja, pittaja and kaphaja. Further, they can be classified into two i.e. nija (endogenous) and agantuja (exogenous). [3]+ − Causes of exogenous swelling:+ − तत्रागन्तवश्छेदनभेदनक्षणनभञ्जनपिच्छनोत्पेषणप्रहारवधबन्धनवेष्टनव्यधनपीडनादिभिर्वाभल्लातकपुष्पफलरसात्मगुप्ताशूकक्रिमिशूकाहितपत्रलतागुल्मसंस्पर्शनैर्वा स्वेदनपरिसर्पणावमूत्रणैर्वा विषिणांसविषप्राणिदंष्ट्रादन्तविषाणनखनिपातैर्वा सागरविषवातहिमदहनसंस्पर्शनैर्वा शोथाः समुपजायन्ते||४|| + + + + + + + + + − tatrāgantavaśchēdanabhēdanakṣaṇanabhañjanapicchanōtpēṣaṇaprahāravadhabandhanavēṣṭanavyadhanapīḍanādibhirvābhallātakapuṣpaphalarasātmaguptāśūkakrimiśūkāhitapatralatāgulmasaṁsparśanairvā svēdanaparisarpaṇāvamūtraṇairvāviṣiṇāṁ saviṣaprāṇidaṁṣṭrādantaviṣāṇanakhanipātairvā sāgaraviṣavātahimadahanasaṁsparśanairvā śōthāḥsamupajāyantē||4|| − tatrAgantavashchedanabhedanakShaNanabha~jjanapicchanotpeShaNaprahAravadhabandhanaveShTanavyadhanapIDanAdibhirvAbhallAtakapuShpaphalarasAtmaguptAshUkakrimishUkAhitapatralatAgulmasaMsparshanairvA svedanaparisarpaNAvamUtraNairvA viShiNAMsaviShaprANidaMShTrAdantaviShANanakhanipAtairvA sAgaraviShavAtahimadahanasaMsparshanairvA shothAH samupajAyante||4|| − Causes of agantuja shotha (exogenous swelling): Common etiological factors of agantuja shotha include chhedana (excision), bhedana (incision), kshanana (churning of bones), bhanjana (breaking), pichhana (excess squeezing), utprashana (grinding), prahaara (hitting), vadha (stroking), bandhan (binding), veshtana (twisting), vyadhana (piercing), peedana (pressing) etc. In addition to these traumas some other factors such as coming in contact with the juice of flowers or fruits of some plants such as bhallātaka (Semicarpus anacardium), atmagupta (Mucuna pruriens) or getting bitten or stung by certain insects or touching irritant leaves, climbers, shrubs, sweat or urine of poisonous animals or even coming in physical contact with them, or getting injured by their teeth, horns and nails, or exposure to marine or poisonous air, or exposure to excess cold or burns may also result in agantuja shotha. [4] − Diagnosis and treatment of exogenous swelling: − ते पुनर्यथास्वं हेतुव्यञ्जनैरादावुपलभ्यन्ते निजव्यञ्जनैकदेशविपरीतैः;बन्धमन्त्रागदप्रलेपप्रतापनिर्वापणादिभिश्चोपक्रमैरुपक्रम्यमाणाः प्रशान्तिमापद्यन्ते||५|| − tē punaryathāsvaṁ hētuvyañjanairādāvupalabhyantē nijavyañjanaikadēśaviparītaiḥ;bandhamantrāgadapralēpapratāpanirvāpaṇādibhiścōpakramairupakramyamāṇāḥpraśāntimāpadyantē||5|| − te punaryathAsvaM hetuvya~jjanairAdAvupalabhyante nijavya~jjanaikadeshaviparItaiH;bandhamantrAgadapralepapratApanirvApaNAdibhishcopakramairupakramyamANAH prashAntimApadyante||5|| − Exogenous swellings can be primarily identified by characteristic signs of injury and localization. After some time, they become similar to endogenous swellings [due to vitiation of dosha]. They are treated by bandage, mantra (holy chants), antidotes, local application of medicines, fomentation, cooling measures etc. [5] − General causes of endogenous swellings: − निजाः पुनः स्नेहस्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावत्प्रयोगान्मिथ्यासंसर्जनाद्वाछर्द्यलसकविसूचिकाश्वासकासातिसारशोषपाण्डुरोगोदरज्वरप्रदरभगन्दरार्शोविकारातिकर्शनैर्वा कुष्ठकण्डूपिडकादिभिर्वाछर्दिक्षवथूद्गारशुक्रवातमूत्रपुरीषवेगधारणैर्वा कर्मरोगोपवासाध्वकर्शितस्य वासहसाऽतिगुर्वम्ललवणपिष्टान्नफलशाकरागदधिहरितकमद्यमन्दकविरूढनवशूकशमीधान्यानूपौदक-पिशितोपयोगान्मृत्पङ्कलोष्टभक्षणाल्लवणातिभक्षणाद्गर्भसम्पीडनादामगर्भप्रपतनात् प्रजातानां चमिथ्योपचारादुदीर्णदोषत्वाच्च शोफाः प्रादुर्भवन्ति; इत्युक्तः सामान्यो हेतुः||६|| − nijāḥ punaḥ snēhasvēdavamanavirēcanāsthāpanānuvāsanaśirōvirēcanānāmayathāvatprayōgānmithyāsaṁsarjanādvāchardyalasakavisūcikāśvāsakāsātisāraśōṣapāṇḍurōgōdarajvarapradarabhagandarārśōvikārātikarśanairvākuṣṭhakaṇḍūpiḍakādibhirvā chardikṣavathūdgāraśukravātamūtrapurīṣavēgadhāraṇairvākarmarōgōpavāsādhvakarśitasya vāsahasā'tigurvamlalavaṇapiṣṭānnaphalaśākarāgadadhiharitakamadyamandakavirūḍhanavaśūkaśamīdhānyānūpaudaka-piśitōpayōgānmr̥tpaṅkalōṣṭabhakṣaṇāllavaṇātibhakṣaṇādgarbhasampīḍanādāmagarbhaprapatanāt prajātānāṁ camithyōpacārādudīrṇadōṣatvācca śōphāḥ prādurbhavanti; ityuktaḥ sāmānyō hētuḥ||6|| − nijAH punaH snehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAnmithyAsaMsarjanAdvAchardyalasakavisUcikAshvAsakAsAtisArashoShapANDurogodarajvarapradarabhagandarArshovikArAtikarshanairvA kuShThakaNDUpiDakAdibhirvAchardikShavathUdgArashukravAtamUtrapurIShavegadhAraNairvA karmarogopavAsAdhvakarshitasya vAsahasA~atigurvamlalavaNapiShTAnnaphalashAkarAgadadhiharitakamadyamandakavirUDhanavashUkashamIdhAnyAnUpaudaka-pishitopayogAnmRutpa~gkaloShTabhakShaNAllavaNAtibhakShaNAdgarbhasampIDanAdAmagarbhaprapatanAt prajAtAnAM ca mithyopacArAdudIrNadoShatvAccashophAH prAdurbhavanti; ityuktaH sAmAnyo hetuH||6|| − Nija shotha i.e. endogenous swelling could be caused due to any of the following factors: − Iatrogenic factors: Improper administration of snehana (oleation), swedana (sudation), vamana (therapeutic emesis), virechana (therapeutic purgation), asthapana basti (non-unctuous enema), anuvasana basti (unctuous enema), shirovirechana (nasal errhines) and/or samsarjana krama (dietetic regimen after purification therapy). − Complication of other diseases: It can also result as complication of chhardi (vomiting), alasaka (delayed and obstructive digestive process), visuchika (cholera), shwasa (dyspnoea), kasa (cough), atisara (diarrhea), shosha (tuberculosis or pthysis ), pandu roga (anemia), udara roga (abdominal diseases including ascitis), jwara (pyrexia), pradara (excessive vaginal discharge), bhagandara (fistula-in-ano), arsha (piles) excessive emaciation, skin disorders, worm infestation, peedika (boils) etc.. − Lifestyle: It may be due to suppression of natural urges like vomiting, sneezing, belching, ejaculation, flatus, micturition, defecation, excessive weakness caused by therapeutic purification procedures, chronic diseases, fasting, and excessive walking. − Dietary factors: Excess intake of too heavy diet, sour, salty, preparations of rice flour/maida/pastry, fruits, vegetables, raga preparations or pickles, curd, green salads, wine, unfermented curd, sprouted and new corn and cereals, consumption of meat of animals in marshy places or of acquatic animals such as certain types of fish, eating clay or pieces of earthen pots or bricks, or eating excessive salt (resulting in swelling). − Ante-natal and post-natal factors: Due to excessive pressure of gravid uterus, abortion, pre mature delivery and improper follow up of puerperal regimen, doshas get aggravated and produce shotha. [6] − Specific causes of swelling due to dosha dominance: − Swelling due to vata dominance: − अयं त्वत्र विशेषः- शीतरूक्षलघुविशदश्रमोपवासातिकर्शनक्षपणादिभिर्वायुः [१] प्रकुपितस्त्वङ्मांसशोणितादीन्यभिभूय शोफंजनयति; स क्षिप्रोत्थानप्रशमो भवति, तथा श्यामारुणवर्णः प्रकृतिवर्णो वा, चलः स्पन्दनः खरपरुषभिन्नत्वग्रोमा छिद्यत इवभिद्यत इव पीड्यत इव सूचीभिरिव तुद्यते पिपीलिकाभिरिव संसृप्यते सर्षपकल्कावलिप्त इव चिमिचिमायते सङ्कुच्यतआयम्यत इवेति वातशोथः (१); − ayaṁ tvatra viśēṣaḥ- śītarūkṣalaghuviśadaśramōpavāsātikarśanakṣapaṇādibhirvāyuḥ [1]prakupitastvaṅmāṁsaśōṇitādīnyabhibhūya śōphaṁ janayati; sa kṣiprōtthānapraśamō bhavati, tathāśyāmāruṇavarṇaḥ prakr̥tivarṇō vā, calaḥ spandanaḥ kharaparuṣabhinnatvagrōmā chidyata iva bhidyata ivapīḍyata iva sūcībhiriva tudyatē pipīlikābhiriva saṁsr̥pyatē sarṣapakalkāvalipta iva cimicimāyatē saṅkucyataāyamyata ivēti vātaśōthaḥ (1); − ayaM tvatra visheShaH- shItarUkShalaghuvishadashramopavAsAtikarshanakShapaNAdibhirvAyuH [1] prakupitastva~gmAMsashoNitAdInyabhibhUya shophaMjanayati; sa kShiprotthAnaprashamo bhavati, tathA shyAmAruNavarNaH prakRutivarNo vA, calaH spandanaH kharaparuShabhinnatvagromA chidyata iva bhidyata ivapIDyata iva sUcIbhiriva tudyate pipIlikAbhiriva saMsRupyate sarShapakalkAvalipta iva cimicimAyate sa~gkucyata Ayamyata iveti vAtashothaH (1); − vata gets vitiated due to excess intake of sheeta (cold things), ruksha (rough or low calorie), laghu (very light), vishada (non-slimy substance) diets, shrama (excessive exertion), upavasa (excessive fasting), ati-karshan (emaciation), and kshapana (wasting). This vitiated vata gets into and stays within twak (skin), mamsa (muscle tissue), along with rakta (blood) and produces shotha, i.e., swelling. This swelling increases as well as subsides quickly, black or reddish in color, fleeting, pulsating, with coarse skin, rough and broken hair. The person feels different types of pain sensation like chhidyati (excision), bhidyati (incision), suchibhiriva (piercing by needles/pricking), crawling of ants, irritation (as if pasted with mustard) and a feeling of contraction or expansion. These are some of the traits of swelling caused by vata. [1]+ + + + + + + + + + + + + + + + + + + + + + + − Swelling due to pitta dominance: + − उष्णतीक्ष्णकटुकक्षारलवणाम्लाजीर्णभोजनैरग्न्यातपप्रतापैश्च पित्तं प्रकुपितं त्वङ्मांसशोणितान्यभिभूय शोथं जनयति; सक्षिप्रोत्थानप्रशमो भवति, कृष्णपीतनीलताम्रावभास उष्णो मृदुः कपिलताम्ररोमा उष्यते दूयते धूप्यते ऊष्मायते स्विद्यतेक्लिद्यते न च स्पर्शमुष्णं च सुषूयत इति पित्तशोथः (२); + − uṣṇatīkṣṇakaṭukakṣāralavaṇāmlājīrṇabhōjanairagnyātapapratāpaiśca pittaṁ prakupitaṁtvaṅmāṁsaśōṇitānyabhibhūya śōthaṁ janayati; sa kṣiprōtthānapraśamō bhavati,kr̥ṣṇapītanīlatāmrāvabhāsa uṣṇō mr̥duḥ kapilatāmrarōmā uṣyatē dūyatē dhūpyatē ūṣmāyatē svidyatēklidyatē na ca sparśamuṣṇaṁ ca suṣūyata iti pittaśōthaḥ (2); + − uShNatIkShNakaTukakShAralavaNAmlAjIrNabhojanairagnyAtapapratApaishca pittaM prakupitaM tva~gmAMsashoNitAnyabhibhUya shothaM janayati; sakShiprotthAnaprashamo bhavati, kRuShNapItanIlatAmrAvabhAsa uShNo mRuduH kapilatAmraromA [2] uShyate dUyate dhUpyate UShmAyate svidyate klidyate na casparshamuShNaM ca suShUyata [3] iti pittashothaH (2); + + + + − pitta is vitiated due to excessive intake of hot, irritant, pungent, alkaline, salt, sour food, taking food when ailing from indigestion, or due to excessive exposure to heat and sunlight. This gets into the skin, muscle tissue, or blood and produces swelling. It also increases and subsides quickly. The affected part becomes blackish, yellow, bluish, copper-tinged, hot, or soft with brown and coppery hair. It gives a burning sensation of various forms and could be hot, sweaty, and moist. The affected region could be tender to touch and very sensitive to heat. These are the traits of swelling due to pitta dosha. [2]+ − Swelling due to kapha dominance: + − गुरुमधुरशीतस्निग्धैरतिस्वप्नाव्यायामादिभिश्च श्लेष्मा प्रकुपितस्त्वङ्मांसशोणितादीन्यभिभूय शोथं जनयति; सकृच्छ्रोत्थानप्रशमो भवति, पाण्डुश्वेतावभासो गुरुः स्निग्धः श्लक्ष्णः स्थिरः स्त्यानः शुक्लाग्ररोमा स्पर्शोष्णसहश्चेतिश्लेष्मशोथः (३); + − gurumadhuraśītasnigdhairatisvapnāvyāyāmādibhiśca ślēṣmā prakupitastvaṅmāṁsaśōṇitādīnyabhibhūyaśōthaṁ janayati; sa kr̥cchrōtthānapraśamō bhavati, pāṇḍuśvētāvabhāsō guruḥ snigdhaḥ ślakṣṇaḥ sthiraḥstyānaḥ śuklāgrarōmā sparśōṣṇasahaścēti ślēṣmaśōthaḥ (3); + − gurumadhurashItasnigdhairatisvapnAvyAyAmAdibhishca shleShmA prakupitastva~gmAMsashoNitAdInyabhibhUya shothaM janayati; sa kRucchrotthAnaprashamobhavati, pANDushvetAvabhAso guruH snigdhaH shlakShNaH sthiraH styAnaH shuklAgraromA sparshoShNasahashceti shleShmashothaH (3); + + + + + + + + − kapha is vitiated due to excessive use of heavy to digest, sweet, cold and unctuous food, excessive sleep, sedentary life, etc. Vitiated kapha inhabits the skin, muscle tissues, and blood, causing swelling. A kapha-induced swelling grows slowly and subsides with difficulty. Affected part becomes pale, whitish, heavy, unctuous, smooth, stable, thick, with white hair, tolerant of touch and heat This is the swelling caused due to kapha.+ − Different types due to involvement of more than one dosha:+ − यथास्वकारणाकृतिसंसर्गाद्द्विदोषजास्त्रयः शोथा भवन्ति; यथास्वकारणाकृतिसन्निपातात् सान्निपातिक एकः; एवं [४]सप्तविधो भेदः||७|| + − yathāsvakāraṇākr̥tisaṁsargāddvidōṣajāstrayaḥ śōthā bhavanti; yathāsvakāraṇākr̥tisannipātāt sānnipātikaēkaḥ; ēvaṁ [4] saptavidhō bhēdaḥ||7|| + − yathAsvakAraNAkRutisaMsargAddvidoShajAstrayaH shothA bhavanti; yathAsvakAraNAkRutisannipAtAt sAnnipAtika ekaH; evaM saptavidho bhedaH||7|| + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − Through the combination of the causes and symptoms of two doshas (dwidoshaja), three types of swelling occur. Similarly, a sannipatika shotha is caused by the combination of respective causes and symptoms of all three doshas. Thus swelling is of seven types. [7]+ − Various types of shotha and cardinal sign: − प्रकृतिभिस्ताभिस्ताभिर्भिद्यमानो द्विविधस्त्रिविधश्चतुर्विधः सप्तविधोऽष्टविधश्च शोथ उपलभ्यते, पुनश्चैक एवोत्सेधसामान्यात्||८|| − prakr̥tibhistābhistābhirbhidyamānō dvividhastrividhaścaturvidhaḥ saptavidhō'ṣṭavidhaśca śōthaupalabhyatē, punaścaika ēvōtsēdhasāmānyāt||8|| − prakRutibhistAbhistAbhirbhidyamAno [5] dvividhastrividhashcaturvidhaH saptavidho~aShTavidhashca shotha upalabhyate, punashcaika [6] evotsedhasAmAnyAt||8|| − On the basis of causative factors and classifications from different views, swelling may be of two, three, four, seven or eight types Again, there is only one type with common sign of ‘swelling’. [8] − Brief description of specific features: − भवन्ति चात्र- − शूयन्ते यस्य गात्राणि स्वपन्तीव रुजन्ति च| − पीडितान्युन्नमन्त्याशु वातशोथं तमादिशेत्||९|| − यश्चाप्यरुणवर्णाभः शोथो नक्तं प्रणश्यति| − स्नेहोष्णमर्दनाभ्यां च प्रणश्येत् स च वातिकः||१०|| − यः पिपासाज्वरार्तस्य दूयतेऽथ विदह्यते| − स्विद्यति क्लिद्यते गन्धी स पैत्तः स्वयथुः स्मृतः||११|| − यः पीतनेत्रवक्त्रत्वक् पूर्वं मध्यात् प्रशूयते| − तनुत्वक् चातिसारी च पित्तशोथः स उच्यते||१२|| − शीतः सक्तगतिर्यस्तु कण्डूमान् पाण्डुरेव च| − निपीडितो नोन्नमति श्वयथुः स कफात्मकः||१३|| − यस्य शस्त्रकुशच्छिन्नाच्छोणितं न प्रवर्तते| − कृच्छ्रेण पिच्छा स्रवति स चापि कफसम्भवः||१४|| − निदानाकृतिसंसर्गाच्छ्वयथुः स्याद्द्विदोषजः| − सर्वाकृतिः सन्निपाताच्छोथो व्यामिश्रहेतुजः||१५|| − bhavanti cātra- + − śūyantē yasya gātrāṇi svapantīva rujanti ca| − pīḍitānyunnamantyāśu vātaśōthaṁ tamādiśēt||9|| − yaścāpyaruṇavarṇābhaḥ śōthō naktaṁ praṇaśyati| − snēhōṣṇamardanābhyāṁ ca praṇaśyēt sa ca vātikaḥ||10|| − yaḥ pipāsājvarārtasya dūyatē'tha vidahyatē| − svidyati klidyatē gandhī sa paittaḥ svayathuḥ smr̥taḥ||11|| − yaḥ pītanētravaktratvak pūrvaṁ madhyāt praśūyatē| − tanutvak cātisārī ca pittaśōthaḥ sa ucyatē||12|| − śītaḥ saktagatiryastu kaṇḍūmān pāṇḍurēva ca| − nipīḍitō nōnnamati śvayathuḥ sa kaphātmakaḥ||13|| − yasya śastrakuśacchinnācchōṇitaṁ na pravartatē| − kr̥cchrēṇa picchā sravati sa cāpi kaphasambhavaḥ||14|| − nidānākr̥tisaṁsargācchvayathuḥ syāddvidōṣajaḥ| − sarvākr̥tiḥ sannipātācchōthō vyāmiśrahētujaḥ||15|| − bhavanti cAtra- − shUyante yasya gAtrANi svapantIva [1] rujanti ca| − pIDitAnyunnamantyAshu vAtashothaM tamAdishet||9|| − yashcApyaruNavarNAbhaH shotho naktaM praNashyati| − snehoShNamardanAbhyAM ca praNashyet sa ca vAtikaH||10|| − yaH pipAsAjvarArtasya dUyate~atha vidahyate| − svidyati klidyate gandhI sa paittaH svayathuH smRutaH||11|| − yaH pItanetravaktratvak [2] pUrvaM madhyAt prashUyate| − tanutvak cAtisArI ca pittashothaH sa ucyate||12|| − shItaH [3] saktagatiryastu kaNDUmAn pANDureva ca| − nipIDito nonnamati [4] shvayathuH sa kaphAtmakaH||13|| − yasya shastrakushacchinnAcchoNitaM [5] na pravartate| − kRucchreNa picchA sravati sa cApi kaphasambhavaH||14|| − nidAnAkRutisaMsargAcchvayathuH syAddvidoShajaH| − sarvAkRutiH sannipAtAcchotho vyAmishrahetujaH||15|| − Specific features of vataja, paittika and kaphaja swellings: − In the case of vataja swelling, affected body parts are swollen, and there is a feeling of numbness, pain, the swelling rebounds immediately after releasing pressure (pitting edema). It is reddish in color and subsides during night, by application of unctuous and hot massage. [9-10] − In the case of paittika or pittaja swelling, the patient suffers from excessive thirst and fever, and in the affected parts there is a sensation of burning, sweating, moisture and foul smell. Patients have yellow eyes, face and skin, thin skin, diarrhea and the ailment emanates from the middle of the body [abdomen and trunk]. [11-12] − In kaphaja swelling, the patient has cold, immobile, itchy, and pale swelling that does not rebound after pressure (solid edema). These swellings do not bleed on cutting with a sharp weapon or kusha grass but instead ooze a slimy discharge. [13-14] − As mentioned earlier, there is a combination of causes and symptoms of two doshas, called dwidoshaja. A sannipataja swelling, on the other hand, combines the causes and symptoms of all the three doshas. [15] − Prognosis: − यस्तु पादाभिनिर्वृत्तः शोथः सर्वाङ्गगो भवेत्| − जन्तोः स च सुकष्टः स्यात् प्रसृतः स्त्रीमुखाच्च यः||१६|| − यश्चापि गुह्यप्रभवः स्त्रिया वा पुरुषस्य वा| − स च कष्टतमो ज्ञेयो यस्य च स्युरुपद्रवाः||१७|| − yastu pādābhinirvr̥ttaḥ śōthaḥ sarvāṅgagō bhavēt| − jantōḥ sa ca sukaṣṭaḥ syāt prasr̥taḥ strīmukhācca yaḥ||16|| − yaścāpi guhyaprabhavaḥ striyā vā puruṣasya vā| − sa ca kaṣṭatamō jñēyō yasya ca syurupadravāḥ||17|| − yastu pAdAbhinirvRuttaH shothaH sarvA~ggago bhavet| − jantoH sa ca sukaShTaH syAt prasRutaH strImukhAcca yaH||16|| − yashcApi guhyaprabhavaH striyA vA puruShasya vA| − sa ca kaShTatamo j~jeyo yasya ca syurupadravAH||17|| − Prognosis of shotha: − A swelling that starts from the feet and spreads all over the body and which starts from the face in women can only be cured with difficulty. In men or women, swellings that emanate from the genitalia, as well as all complicated variants of edema are mostly difficult to cure. [16-17] − Complications of shotha: − छर्दिः श्वासोऽरुचिस्तृष्णा ज्वरोऽतीसार एव च| − सप्तकोऽयं सदौर्बल्यः शोफोपद्रवसङ्ग्रहः||१८|| − chardiḥ śvāsō'rucistr̥ṣṇā jvarō'tīsāra ēva ca| − saptakō'yaṁ sadaurbalyaḥ śōphōpadravasaṅgrahaḥ||18|| − chardiH shvAso~arucistRuShNA jvaro~atIsAra eva ca| − saptako~ayaM sadaurbalyaH shophopadravasa~ggrahaH||18|| − Vomiting, breathlessness, anorexia, excessive thirst, pyrexia, diarrhea and weakness - these are seven complications of shotha. [18] − Different types of swelling at specific sites: − Upajivhika: − यस्य श्लेष्मा प्रकुपितो जिह्वामूलेऽवतिष्ठते| − आशु सञ्जनयेच्छोथं जायतेऽस्योपजिह्विका||१९|| − yasya ślēṣmā prakupitō jihvāmūlē'vatiṣṭhatē| − āśu sañjanayēcchōthaṁ jāyatē'syōpajihvikā||19|| − yasya shleShmA prakupito jihvAmUle~avatiShThate| − Ashu sa~jjanayecchothaM [1] jAyate~asyopajihvikA||19|| − When the vitiated kapha emanates or begins from the root of the tongue and causes swelling suddenly, is called upajivhika (ranula or hypertrophied solitary lingual papilla). [19]+ − Galashundika: − यस्य श्लेष्मा प्रकुपितः काकले व्यवतिष्ठते| − आशु सञ्जनयेच्छोफं करोति गलशुण्डिकाम्||२०|| − yasya ślēṣmā prakupitaḥ kākalē vyavatiṣṭhatē| − āśu sañjanayēcchōphaṁ karōti galaśuṇḍikām||20|| − yasya shleShmA prakupitaH kAkale vyavatiShThate| − Ashu sa~jjanayecchophaM [2] karoti galashuNDikAm||20|| − The Vitiated kapha inhabits at uvula and produces swelling suddenly, that is called Galashundika(uvulitis). [20] − Galaganda: − यस्य श्लेष्मा प्रकुपितो गलबाह्येऽवतिष्ठते| − शनैः सञ्जनयेच्छोफं गलगण्डोऽस्य जायते||२१|| − yasya ślēṣmā prakupitō galabāhyē'vatiṣṭhatē| − śanaiḥ sañjanayēcchōphaṁ galagaṇḍō'sya jāyatē||21|| − yasya shleShmA prakupito galabAhye~avatiShThate| − shanaiH sa~jjanayecchophaM [3] galagaNDo~asya jAyate||21|| + − A swelling that is caused when a vitiated kapha affects the throat from the outside, and gradually produces swelling , is called galaganda (goitre). [21]+ − Galagraha: − यस्य श्लेष्मा प्रकुपितस्तिष्ठत्यन्तर्गले स्थिरः| − आशु सञ्जनयेच्छोफं जायतेऽस्य गलग्रहः||२२|| − yasya ślēṣmā prakupitastiṣṭhatyantargalē sthiraḥ| − āśu sañjanayēcchōphaṁ jāyatē'sya galagrahaḥ||22|| − yasya shleShmA prakupitastiShThatyantargale sthiraH| − Ashu sa~jjanayecchophaM [4] jAyate~asya galagrahaH||22|| − When the vitiated kapha, firmly located inside the throat causes swelling suddenly, it causes galagraha (pharyingitis). [22]+ − Visarpa:+ − यस्य पित्तं प्रकुपितं सरक्तं त्वचि सर्पति| + − शोफं सरागं जनयेद्विसर्पस्तस्य जायते||२३|| + − yasya pittaṁ prakupitaṁ saraktaṁ tvaci sarpati| + − śōphaṁ sarāgaṁ janayēdvisarpastasya jāyatē||23|| + − yasya pittaM prakupitaM saraktaM tvaci sarpati| + − shophaM sarAgaM janayedvisarpastasya [5] jAyate||23|| + + + + + + + + + + + + + + + + + − When a vitiated pitta (with rakta, or blood) spreads through the skin, it causes swelling with redness. Such a swelling is called visarpa i.e. erysipelas. [23]+ − Pidika: − यस्य पित्तं प्रकुपितं त्वचि रक्तेऽवतिष्ठते| − शोथं सरागं जनयेत् पिडका तस्य जायते||२४|| − yasya pittaṁ prakupitaṁ tvaci raktē'vatiṣṭhatē| − śōthaṁ sarāgaṁ janayēt piḍakā tasya jāyatē||24|| − yasya pittaM prakupitaM tvaci rakte~avatiShThate| − shothaM sarAgaM janayet [6] piDakA tasya jAyate||24|| − When the vitiated pitta is located within the skin and rakta, swelling and redness appears causing pidika i.e. boils or pustules. [24]+ − Tilaka-pipplava-vyanga-neelika: − यस्य प्रकुपितं पित्तं शोणितं प्राप्य शुष्यति| − तिलका पिप्लवो व्यङ्गा नीलिका तस्य जायते||२५|| − yasya prakupitaṁ pittaṁ śōṇitaṁ prāpya śuṣyati| − tilakā piplavō vyaṅgā nīlikā tasya jāyatē||25|| − yasya prakupitaM pittaM shoNitaM prApya shuShyati| − tilakA piplavo vya~ggA nIlikA tasya jAyate||25|| − − When the vitiated pitta goes into rakta and gets absorbed there where?, it causes tilaka (moles), piplu (port-wine marks), vyanga (blemish/spots), or nilika (blue-black moles). [25] − Shankhaka: − यस्य पित्तं प्रकुपितं शङ्खयोरवतिष्ठते| − श्वयथुः शङ्खको नाम दारुणस्तस्य जायते||२६|| − yasya pittaṁ prakupitaṁ śaṅkhayōravatiṣṭhatē| − śvayathuḥ śaṅkhakō nāma dāruṇastasya jāyatē||26|| − yasya pittaM prakupitaM sha~gkhayoravatiShThate| − shvayathuH sha~gkhako nAma dAruNastasya jAyate||26|| − When a vitiated pitta inhabits the temporal regions of the head, severe and fatal swellings known as shankhaka (saggital sinus thrombosis/ intracranial growth/ temporal arteritis) are caused. [26]+ − Karnamulika shotha (swelling at base of ears): − यस्य पित्तं प्रकुपितं कर्णमूलेऽवतिष्ठते| − ज्वरान्ते दुर्जयोऽन्ताय शोथस्तस्योपजायते||२७|| − yasya pittaṁ prakupitaṁ karṇamūlē'vatiṣṭhatē| − jvarāntē durjayō'ntāya śōthastasyōpajāyatē||27|| − yasya pittaM prakupitaM karNamUle~avatiShThate| − jvarAnte durjayo~antAya shothastasyopajAyate||27|| + − When the vitiated pitta is located at the base of ears, a severe, incurable and fatal swelling arises at the terminal stage of the fever. [27]+ − Pliha [splenomegaly]: − वातः प्लीहानमुद्धूय कुपितो यस्य तिष्ठति| − शनैः परितुदन् पार्श्वं प्लीहा तस्याभिवर्धते||२८|| − vātaḥ plīhānamuddhūya kupitō yasya tiṣṭhati| − śanaiḥ paritudan pārśvaṁ plīhā tasyābhivardhatē||28|| − vAtaH plIhAnamuddhUya kupito yasya tiShThati| − shanaiH paritudan [7] pArshvaM plIhA tasyAbhivardhate||28|| + − When the vitiated vata inhabits and elevates the spleen, it causes a gradual prickly pain in the sides, causing vliha vriddhi i.e. splenomegaly. [28]+ − Gulma [abdominal lumps]: − यस्य वायुः प्रकुपितो गुल्मस्थानेऽवतिष्ठते| − शोफं सशूलं जनयन् गुल्मस्तस्योपजायते||२९|| − yasya vāyuḥ prakupitō gulmasthānē'vatiṣṭhatē| − śōphaṁ saśūlaṁ janayan gulmastasyōpajāyatē||29|| − yasya vAyuH prakupito gulmasthAne~avatiShThate| − shophaM sashUlaM janayan gulmastasyopajAyate||29|| − When the vitiated vata inhabits in the abdominal region causing swelling and pain, it causes gulma. [29]+ − Vriddhi [scrotum enlargement]: − यस्य वायुः प्रकुपितः शोफशूलकरश्चरन्| − वङ्क्षणाद्वृषणौ याति वृद्धिस्तस्योपजायते||३०|| − yasya vāyuḥ prakupitaḥ śōphaśūlakaraścaran| − vaṅkṣaṇādvr̥ṣaṇau yāti vr̥ddhistasyōpajāyatē||30|| − yasya vAyuH prakupitaH shophashUlakarashcaran| − va~gkShaNAdvRuShaNau yAti vRuddhistasyopajAyate||30|| − When the vitiated vata moves from the groins to testicles causing swelling and pain, it causes vriddhi i.e. testicular swellings. [30] − Udara [abdominal diseases]: − यस्य वातः प्रकुपितस्त्वङ्मांसान्तरमाश्रितः| − शोथं सञ्जनयेत् कुक्षावुदरं तस्य जायते||३१|| − yasya vātaḥ prakupitastvaṅmāṁsāntaramāśritaḥ| − śōthaṁ sañjanayēt kukṣāvudaraṁ tasya jāyatē||31|| − yasya vAtaH prakupitastva~gmAMsAntaramAshritaH| − shothaM sa~jjanayet kukShAvudaraM tasya jAyate||31|| + + − When the vitiated vata located between the skin and muscles produces swelling in the abdomen, it is known as udara roga i.e. diseases of abdominal cavity. [31]+ − Anaha (obstruction in abdomen): − यस्य वातः प्रकुपितः कुक्षिमाश्रित्य तिष्ठति| − नाधो व्रजति नाप्यूर्ध्वमानाहस्तस्य जायते||३२|| − yasya vātaḥ prakupitaḥ kukṣimāśritya tiṣṭhati| − nādhō vrajati nāpyūrdhvamānāhastasya jāyatē||32|| − yasya vAtaH prakupitaH kukShimAshritya tiShThati| − nAdho vrajati nApyUrdhvamAnAhastasya jAyate||32|| − When the vitiated vata is stuck in the belly and moves neither upwards nor downwards (neither passed through flatus nor through belching), it causes aanaha (obstruction in abdomen). [32]+ − Tumors: − रोगाश्चोत्सेधसामान्यदधिमांसार्बुदादयः| − विशिष्टा नामरूपाभ्यां निर्देश्याः शोथसङ्ग्रहे||३३|| − rōgāścōtsēdhasāmānyadadhimāṁsārbudādayaḥ| − viśiṣṭā nāmarūpābhyāṁ nirdēśyāḥ śōthasaṅgrahē||33|| − rogAshcotsedhasAmAnyadadhimAMsArbudAdayaH| − vishiShTA nAmarUpAbhyAM nirdeshyAH shothasa~ggrahe||33|| − Various diseases with names and features such as adhimamsa (fleshy growth or extra growth of muscles), and arbuda (tumors) are included in the family of shotha due to the common appearance of swelling. [33]+ − Rohini (diphtheria): − वातपित्तकफा यस्य युगपत् कुपितास्त्रयः| − जिह्वामूलेऽवतिष्ठन्ते विदहन्तः समुच्छ्रिताः||३४|| − जनयन्ति भृशं शोथं वेदनाश्च पृथग्विधाः| − तं शीघ्रकारिणं रोगं रोहिणीति विनिर्दिशेत्||३५|| − त्रिरात्रं परमं तस्य जन्तोर्भवति जीवितम्| − कुशलेन त्वनुक्रान्तः क्षिप्रं सम्पद्यते सुखी||३६|| − vātapittakaphā yasya yugapat kupitāstrayaḥ| + − jihvāmūlē'vatiṣṭhantē vidahantaḥ samucchritāḥ||34|| − janayanti bhr̥śaṁ śōthaṁ vēdanāśca pr̥thagvidhāḥ| − taṁ śīghrakāriṇaṁ rōgaṁ rōhiṇīti vinirdiśēt||35|| − trirātraṁ paramaṁ tasya jantōrbhavati jīvitam| − kuśalēna tvanukrāntaḥ kṣipraṁ sampadyatē sukhī||36|| − vAtapittakaphA yasya yugapat kupitAstrayaH| − jihvAmUle~avatiShThante vidahantaH samucchritAH||34|| − janayanti bhRushaM shothaM vedanAshca pRuthagvidhAH| − taM shIghrakAriNaM rogaM rohiNIti vinirdishet||35|| − trirAtraM paramaM tasya jantorbhavati jIvitam| − kushalena tvanukrAntaH [8] kShipraM sampadyate sukhI||36|| − When all the three doshas get aggravated simultaneously and inhabit the base of the tongue, they cause severe burning sensation, acute/intense swelling and various types of pain. This fatal disease is known as rohini (diphtheria). If afflicted with this ailment and left untreated, the patient could die in three days. But if treated by an expert physician quickly, one can recover almost immediately. [34-36]+ − Prognosis of diseases: − सन्ति ह्येवंविधा रोगाः साध्या दारुणसम्मताः| − ये हन्युरनुपक्रान्ता मिथ्याचारेण वा पुनः||३७|| − साध्याश्चाप्यपरे सन्ति व्याधयो मृदुसम्मताः| − यत्नायत्नकृतं येषु कर्म सिध्यत्यसंशयम्||३८|| − असाध्याश्चापरे सन्ति व्याधयो याप्यसञ्ज्ञिताः| − सुसाध्वपि कृतं येषु कर्म यात्राकरं भवेत्||३९|| − सन्ति चाप्यपरे रोगा येषु कर्म न सिध्यति| − अपि यत्नकृतं बालैर्न तान् विद्वानुपाचरेत्||४०|| − साध्याश्चैवाप्यसाध्याश्च व्याधयो द्विविधाः स्मृताः| − मृदुदारुणभेदेन ते भवन्ति चतुर्विधाः||४१|| − santi hyēvaṁvidhā rōgāḥ sādhyā dāruṇasammatāḥ| − yē hanyuranupakrāntā mithyācārēṇa vā punaḥ||37|| − sādhyāścāpyaparē santi vyādhayō mr̥dusammatāḥ| − yatnāyatnakr̥taṁ yēṣu karma sidhyatyasaṁśayam||38|| − asādhyāścāparē santi vyādhayō yāpyasañjñitāḥ| − susādhvapi kr̥taṁ yēṣu karma yātrākaraṁ bhavēt||39|| − santi cāpyaparē rōgā yēṣu karma na sidhyati| − api yatnakr̥taṁ bālairna tān vidvānupācarēt||40|| − sādhyāścaivāpyasādhyāśca vyādhayō dvividhāḥ smr̥tāḥ| − mr̥dudāruṇabhēdēna tē bhavanti caturvidhāḥ||41|| − santi hyevaMvidhA rogAH sAdhyA dAruNasammatAH| − ye hanyuranupakrAntA mithyAcAreNa [10] vA punaH||37|| − sAdhyAshcApyapare [11] santi vyAdhayo mRudusammatAH| − yatnAyatnakRutaM yeShu karma sidhyatyasaMshayam||38|| − asAdhyAshcApare santi vyAdhayo yApyasa~jj~jitAH| − susAdhvapi kRutaM yeShu karma yAtrAkaraM bhavet||39|| − santi cApyapare rogA yeShu karma na sidhyati| − api yatnakRutaM bAlairna tAn vidvAnupAcaret||40|| − sAdhyAshcaivApyasAdhyAshca vyAdhayo dvividhAH smRutAH| − mRududAruNabhedena te bhavanti caturvidhAH||41|| − There are certain curable diseases that become fatal if improperly managed or not given adequate treatment. There are other curable diseases that are mild and get alleviated certainly with or without effort. There are incurable diseases, considered “palliable”, in which appropriate treatment enables the patient to move along. And finally, there are other incurable diseases that do not respond to any treatment. At times, ignorant physicians treat these enthusiastically. However, the wise should not treat them. Thus, diseases are primarily of two types: curable and incurable, and depending upon their severity and responsiveness to drugs, are further categorized into two sub-categories within each of these types. [37-41] − Criteria for classification of diseases: − त एवापरिसङ्ख्येया भिद्यमाना भवन्ति हि| − रुजावर्णसमुत्थानस्थानसंस्थाननामभिः ||४२|| − व्यवस्थाकरणं तेषां यथास्थूलेषु सङ्ग्रहः| − तथा प्रकृतिसामान्यं विकारेषूपदिश्यते||४३|| − ta ēvāparisaṅkhyēyā bhidyamānā bhavanti hi| − rujāvarṇasamutthānasthānasaṁsthānanāmabhiḥ ||42|| − vyavasthākaraṇaṁ tēṣāṁ yathāsthūlēṣu saṅgrahaḥ| − tathā prakr̥tisāmānyaṁ vikārēṣūpadiśyatē||43|| − ta evAparisa~gkhyeyA bhidyamAnA bhavanti hi| − rujAvarNasamutthAnasthAnasaMsthAnanAmabhiH [12] ||42|| − vyavasthAkaraNaM [13] teShAM yathAsthUleShu sa~ggrahaH| − tathA prakRutisAmAnyaM vikAreShUpadishyate||43|| − There are several diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. Their systematic classification has been attempted in the form of some gross disease families or classes. However, in other cases general principle may be followed. [42] − Identification of new diseases: − विकारनामाकुशलो न जिह्रीयात् कदाचन| − न हि सर्वविकाराणां नामतोऽस्ति ध्रुवा स्थितिः||४४|| − स एव कुपितो दोषः समुत्थानविशेषतः| − स्थानान्तरगतश्चैव जनयत्यामयान् बहून् ||४५|| − तस्माद्विकारप्रकृतीरधिष्ठानान्तराणि च| − समुत्थानविशेषांश्च बुद्ध्वा कर्म समाचरेत्||४६|| − यो ह्येतत्त्रितयं ज्ञात्वा कर्माण्यारभते भिषक्| − ज्ञानपूर्वं यथान्यायं स कर्मसु न मुह्यति||४७|| − vikāranāmākuśalō na jihrīyāt kadācana| − na hi sarvavikārāṇāṁ nāmatō'sti dhruvā sthitiḥ||44|| − sa ēva kupitō dōṣaḥ samutthānaviśēṣataḥ| − sthānāntaragataścaiva janayatyāmayān bahūn ||45|| − tasmādvikāraprakr̥tīradhiṣṭhānāntarāṇi ca| − samutthānaviśēṣāṁśca buddhvā karma samācarēt||46|| − yō hyētattritayaṁ jñātvā karmāṇyārabhatē bhiṣak| − jñānapūrvaṁ yathānyāyaṁ sa karmasu na muhyati||47|| − vikAranAmAkushalo na jihrIyAt kadAcana| − na hi sarvavikArANAM nAmato~asti dhruvA sthitiH||44|| − sa eva kupito doShaH samutthAnavisheShataH| − sthAnAntaragatashcaiva janayatyAmayAn bahUn [14] ||45|| − tasmAdvikAraprakRutIradhiShThAnAntarANi ca| − samutthAnavisheShAMshca buddhvA karma samAcaret||46|| − yo hyetattritayaM j~jAtvA karmANyArabhate bhiShak| − j~jAnapUrvaM yathAnyAyaM [15] sa karmasu na muhyati||47|| − One should not be ashamed of one’s inability to name a disease, since all disorders cannot be given standard names. There are innumerable diseases because the same vitiated dosha causes various disorders according to variations in etiology and location. Hence one should initiate any treatment after acquiring complete knowledge of the nature of the disease as well as its pathogenesis, location and etiological factors. The one who initiates the treatment after knowing all these things, rationally and according to prescribed procedure, does not get confused in actions. [44-47] − Discussion on dosha: − नित्याः प्राणभृतां देहे वातपित्तकफास्त्रयः| − विकृताः प्रकृतिस्था वा तान् बुभुत्सेत पण्डितः||४८|| − nityāḥ prāṇabhr̥tāṁ dēhē vātapittakaphāstrayaḥ| − vikr̥tāḥ prakr̥tisthā vā tān bubhutsēta paṇḍitaḥ||48|| − nityAH prANabhRutAM dehe vAtapittakaphAstrayaH| − vikRutAH prakRutisthA vA tAn bubhutseta paNDitaH||48|| − vata, pitta and kapha - these three doshas are always present in the body of all living beings. The learned should know about their normal or abnormal states. [48] − Functions of normal vata dosha: − उत्साहोच्छ्वासनिः श्वासचेष्टा धातुगतिः समा| − समो मोक्षो गतिमतां वायोः कर्माविकारजम्||४९|| − utsāhōcchvāsaniḥ śvāsacēṣṭā dhātugatiḥ samā| − samō mōkṣō gatimatāṁ vāyōḥ karmāvikārajam||49|| − utsAhocchvAsaniH shvAsaceShTA dhAtugatiH samA| − samo mokSho gatimatAM vAyoH karmAvikArajam||49|| − Enthusiasm, inspiration, expiration, movements, normal processing of dhatu (body tissues), and normal elimination of excreta are the normal functions of vayu (vata). [49] − Functions of normal pitta dosha: − दर्शनं पक्तिरूष्मा च क्षुत्तृष्णा देहमार्दवम्| − प्रभा प्रसादो मेधा च पित्तकर्माविकारजम्||५०|| − darśanaṁ paktirūṣmā ca kṣuttr̥ṣṇā dēhamārdavam| − prabhā prasādō mēdhā ca pittakarmāvikārajam||50|| − darshanaM paktirUShmA ca kShuttRuShNA dehamArdavam| − prabhA prasAdo medhA ca pittakarmAvikArajam||50|| − Vision, digestion, (production of) heat, hunger, thirst, softness in body, luster, serenity and intelligence are the normal functions of pitta. [50]+ − Functions of normal kapha dosha: − स्नेहो बन्धः स्थिरत्वं च गौरवं वृषता बलम्| − क्षमा धृतिरलोभश्च कफकर्माविकारजम्||५१|| − snēhō bandhaḥ sthiratvaṁ ca gauravaṁ vr̥ṣatā balam| − kṣamā dhr̥tiralōbhaśca kaphakarmāvikārajam||51|| − sneho bandhaH sthiratvaM ca gauravaM vRuShatA balam| − kShamA dhRutiralobhashca kaphakarmAvikArajam||51|| − Unctuousness, binding, firmness/stability, heaviness, virility, strength, forbearance, restraint and absence of greed are the properties of kapha. [51] − Diagnosis of abnormal state of dosha: − वाते पित्ते कफे चैव क्षीणे लक्षणमुच्यते| − कर्मणः प्राकृताद्धानिर्वृद्धिर्वाऽपि विरोधिनाम्||५२|| − vātē pittē kaphē caiva kṣīṇē lakṣaṇamucyatē| − karmaṇaḥ prākr̥tāddhānirvr̥ddhirvā'pi virōdhinām||52|| − vAte pitte kaphe caiva kShINe lakShaNamucyate| − karmaNaH prAkRutAddhAnirvRuddhirvA~api virodhinAm||52|| − Any decrease in vata, pitta and kapha is thus indicated by a decrease in their natural functions or increase in functions of opposite dosha. (this is indicated by the properties associated with any of these doshas for example, reduced unctuousness indicates a decrease in kapha, etc). [52]+ − दोषप्रकृतिवैशेष्यं नियतं वृद्धिलक्षणम्| − दोषाणां प्रकृतिर्हानिर्वृद्धिश्चैवं परीक्ष्यते||५३|| − dōṣaprakr̥tivaiśēṣyaṁ niyataṁ vr̥ddhilakṣaṇam| − dōṣāṇāṁ prakr̥tirhānirvr̥ddhiścaivaṁ parīkṣyatē||53|| − doShaprakRutivaisheShyaM niyataM vRuddhilakShaNam| − doShANAM prakRutirhAnirvRuddhishcaivaM parIkShyate||53|| − Conversely, any aggravation in dosha is indicated by an increase in their normal functions. Thus normalcy, decrease and aggravation of dosha are examined. [53] − तत्र श्लोकाः- − सङ्ख्यां निमित्तं रूपाणि शोथानां साध्यतां न च| − तेषां तेषां विकाराणां शोथांस्तांस्तांश्च पूर्वजान्||५४|| − विधिभेदं विकाराणां त्रिविधं बोध्यसङ्ग्रहम्| − प्राकृतं कर्म दोषाणां लक्षणं हानिवृद्धिषु||५५|| − वीतमोहरजोदोषलोभमानमदस्पृहः| − व्याख्यातवांस्त्रिशोथीये रोगाध्याये पुनर्वसुः||५६|| − tatra ślōkāḥ- − saṅkhyāṁ nimittaṁ rūpāṇi śōthānāṁ sādhyatāṁ na ca| − tēṣāṁ tēṣāṁ vikārāṇāṁ śōthāṁstāṁstāṁśca pūrvajān||54|| − vidhibhēdaṁ vikārāṇāṁ trividhaṁ bōdhyasaṅgraham| − prākr̥taṁ karma dōṣāṇāṁ lakṣaṇaṁ hānivr̥ddhiṣu||55|| − vītamōharajōdōṣalōbhamānamadaspr̥haḥ| − vyākhyātavāṁstriśōthīyē rōgādhyāyē punarvasuḥ||56|| − tatra shlokAH- − sa~gkhyAM nimittaM rUpANi shothAnAM sAdhyatAM na ca| − teShAM teShAM vikArANAM shothAMstAMstAMshca pUrvajAn||54|| − vidhibhedaM vikArANAM trividhaM bodhyasa~ggraham| − prAkRutaM karma doShANAM lakShaNaM hAnivRuddhiShu||55|| − vItamoharajodoShalobhamAnamadaspRuhaH| − vyAkhyAtavAMstrishothIye rogAdhyAye punarvasuH||56|| − Summary of the chapter:+ − Types, causes, symptoms and prognoses of swelling, of various diseases, types of diseases, definitions of the three doshas, normal functions and symptoms of decrease and aggravation of doshas - all these have been explained in this chapter on three types of swellings by Punarvasu , who is free from tamas and rajas qualities, doshas, greed, conceit, pride and ambition.[54-56] − Tattva Vimarsha: − • Shotha (swelling) is associated with tridosha and occurs due to endogenous and exogenous factors. − • The exogenous factors cause swelling first and then vitiate dosha. This leads to exogenous swellings getting transformed into endogenous swellings. − • Any treatment of swelling depends upon the causative factors and doshas associated with it. [5] − • Endogenous swelling can be caused by iatrogenic factors (e.g., poor administration of panchakarma), complications arising from other diseases, consumption of improper food articles (e.g., allergic reactions to nuts or grains), not following proper ante-natal/post-natal regimen, etc. [6] − • Etiological factors specific to each dosha are involved in the pathogenesis of swelling.[7] − • The prognosis of swelling depends upon the involvement of dosha, the affected part and location of dosha accumulation. [16-41] − • There are innumerable diseases classified on the basis of type of pain, appearance (color), etiology, site, symptoms and name. [42] − • All the diseases cannot be named with standard nomenclature. [44] − • For knowing and treating a new disease that has not been described in the text, the underlying dosha, its location, etiological factors, and the movement of dosha should be well identified. Then pathogenesis should become evident and rational treatment can be started. [45-47] − • Three doshas - vata, pitta and kapha - are always present in the body of living beings. The learned should know about their normal and vitiated states. [48] − • Enthusiasm, inspiration, expiration, movements, processing of dhatu (body tissues) and elimination of excreta are natural functions of of a normal vata.[49] − • Vision, digestion, heat production, hunger, thirst, softness in body, luster, serenity and intelligence are the natural functions of a normal pitta. [50] − • Unctuousness, binding, firmness/stability, heaviness (maintaining volume/mass), virility, strength, forbearance, restraint and absence of greed are the natural functions of of a normal kapha. [51] − • The decrease (or increase) of these doshas in a body can be best diagnosed by a decrease (or increase) in the functions mentioned above. The alternate method to examine the status is to check functions of other (opposite) dosha. Thus the status of dosha can be investigated based on their representative functions only.[52] − Vidhi Vimarsha: − Classification of shotha (swelling/ distension): − Depending on etiological factors diseases are grossly divided in to two categories. First one are nija (endogenous) diseases which are caused by endogenous factors i.e. the whole disease process starts within the body, although the provocation or aggravating factors may come from outside but the complete phenomenon of pathogenesis occurs inside body in a systematic way. According to Ayurvedic concepts full-fledged involvement of vata, pitta and kapha dosha is present here. The second type of swelling is known as agantuja (exogenous) in which the etiological factors are extraneous, which could be physical or environmental. Many times they bypass routine disease courses and causes disease in very short course of time. Conventional involvement of doshas take place later on i.e. after manifestation of disease. − In addition to the types of swellings mentioned by Charaka, Sushruta has added rakta as a separate type. [Su. Su. 17/4]. Sushruta has also emphasized on vishaja (caused due to poisons) as another type while mentioning treatment. [Su. Chi. 23/3]. Vagbhata has differentiated types based on causes of injuries (abhighataja) and contact with poisons (vishaja). Further he has mentioned two types of shotha on the basis of distribution in body i.e. sarvanga (generalized) and ekang (localized). According to its manifestation he has described three categories i.e. prathu (diffused spread), unnat (elevated) and grathit (nodular) [A.H. Ni. 13/22, 23]. On the basis of prognosis, Madhava has divided shotha into three i.e. urdhvagata (in upper part of body), madhyagata (in the middle part) and adhogata (in the lower part) [Ma.ni.-36/17]. These types are of clinical importance since they help understand the origin of the swelling and the pre-dominant dosha involved in it. [3] − Etiology of swelling: − The exogenous factors produce sudden swellings most of the time while endogenous swellings mostly occur gradually. Any type of trauma, direct or indirect, will produce a swelling first. Some plants contain allergens which may cause allergic reactions such as severe itching. Scorpion, wasp, honey bee, spider stings or their touch can cause inflammatory reaction including edema. Excessive cold air or prolonged contact with ice may cause frostbite like symptoms and swelling causes weakness of the affected organ resembling a paralytic disorder. [4] − In chikitsa sthanam, few other causes, such as the people who never do any physical activity, neither they adopt internal purification e.g. vamana, virechana etc., nor they take external purification by means of bath; may develop shotha (Ca.chi. 12/6). Some other etiological factors e.g. intake of kata-sharkara i.e. burned sugar and lime, practice of sexual intercourse during indigestion or travelling by vehicles with jerky movements may also produce shotha [Su. Chi. 23/4]. Few other causes of nija shotha described are sleeping during the day and working at night, and intake of dry and domestic animal meat in diet [A.H. Ni. 13/26]. During bio-purification procedures there is a loss of some body contents. When procedures are optimally performed then only unwanted materials are lost, but if the procedures are improperly administered, then certain amount of necessary body contents may also get removed which may result in many diseases. Besides, some nutrients may not get absorbed or metabolized properly. Due to these reasons deficiency of proteins, iron and other nutrients may occur causing edema in the long term. Similar pathology is found in many chronic disorders due to malnutrition, few of which are mentioned here. Violation of dietary rules is responsible for many shotha disorders. Eating of clay and pieces of earthen pots may cause worm infestations, thereby causing anemia or malnutrition, and in due course of time will result in edema2. Excessive use of salt will result in sodium retention and edema3. Lastly, recurrent abortions, miscarriages, intra-uterine death, and ante-natal problems may cause anemia and hypo-proteinaemia resulting in edema. − In conventional medicine many mechanisms have been described to explain edema. Among these, increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary permeability, sodium and water retention, and lymphatic obstruction4 are important. Above mechanisms can be studied in context of vataja, paittika and kaphaja types of shotha. [6] − Differential diagnosis of types of swelling: − Character/dosha vata dominance pitta dominance kapha dominance − Duration Quick onset and regression Quick onset and regression Slow onset and difficult regression − Appearance black or reddish blackish, yellow, bluish, coppery tinge pallor, whitish − Nature Fleeting/moving/pulsating, quickly regress when pressed Hot, tender Immobile, stable, doesn’t regress quickly when pressed − Skin and hair on affected part coarse, rough and broken Soft, thin with brown and coppery hair, perspiring and moist heavy, unctuous, smooth, stable, thick, with white hair. − Sensation at affected part Like excising, incising, piercing by needles/pricking], feeling of crawling ants, has irritating sensation as if pasted with mustard, contracts or expands burning sensations of various types, hot, intolerant to heat and touch tolerant of touch and heat − Time of increase & decrease Increases in day, reduces at night -- Increases at night, reduces in day − Pacifying Hot and unctuous massage -- -- − Types of shotha, location: − The appearance of vātaja shotha can be correlated with the increased hydrostatic pressure mechanism of edema. The features are similar to edema caused by cardiac diseases where congestion is a major cause of increased hydrostatic pressure in vessels5. Through the day, due to gravity, water goes down the body and gets retained in lower limbs causing edema in the evening hours. During night (i.e., at rest), the retained water redistributes and the edema subsides. Edema of cardiac origin is pitting in type, similar to vataja shotha. − Kaphaja shotha, on the other hand, could be due to hypoproteinaemia in liver diseases or due to proteinuria in renal diseases6. In renal edema, swelling is typically facial and manifests early in the morning. Sometimes these swellings are too hard, as found in cases of malignancies or tumors. The swellings of paittika/pittaja type are mostly inflammatory in nature. [9-15] − Distribution of shotha and prognosis: − kapha dosha are typically found in upper body parts, pitta in middle body parts and vata in lower body parts. Doshas situated in amashaya (stomach) cause shotha in the upper body, those situated in pakwashaya (large bowel) cause shotha in the middle body and those situated in malashaya (rectum) cause shotha in the lower body parts, whereas more than one dosha leads to shotha in the whole body [Su.chi.23/6]. Shotha in the middle body parts and generalized edema are difficult to cure. A shotha that has spread across half of the body is invariably fatal and a shotha that spreads upward from the lower parts (or from the top towards lower body parts) is incurable [Su.chi. 23/7-8]. Swellings of flanks, abdomen, throat and vital parts are incurable. Excessively bulky and rough swellings are also incurable. Swellings in children, old people and very weak patients are incurable (Ma.ni.-36/20). [16-17] − Complications: − Improper treatment or care of any existing edema-causing disease can lead to upadravas, or complications caused due to obstruction caused by accumulated fluid in the interstitial spaces leading to improper circulation. This hampers the normal movement of vata leading to various complications. − If we consider modern etiopathogenesis of edema, then it is clear that all the complications described here are consequences of either edema or its associated disease. For example, hypertension is an etiological factor for heart and renal failure which are common causes of edema. Sometimes, pulmonary edema develops due to many reasons resulting in dyspnea. Anorexia may be due to hepatic pathology itself or may be due to congestion (as in the case of congestive heart failure)7. Excessive thirst may be due to induced or spontaneous diuresis leading to dehydration. Pyrexia, diarrhea and weakness can develop because of associated infections or other systemic ailments. [18] − Various locations of shotha: − Sushruta described galashundi as kanthashundi, a condition indicated by breathlessness, coughing and thirst. He mentioned the role of rakta along with kapha in causing the condition. (Su.ni.-16/41). Visarpa is a kind of inflammatory swelling mostly caused due to infection. In the context of kshudra rogas (curable diseases), tilaka (mole) is black in color, similar to size of sesame seed, painless and is flat (Su.ni.-13/43). Similarly vyanga (pigmentation) as painless, fine, black color circles (Su.ni.-13/45,46). Same manifestation over the face or other body parts is called nilika (Su.ni.-13/46). In addition to pitta, Sushruta has mentioned involvement of vata, kapha and rakta in the affliction of shankhaka roga (saggital sinus thrombosis/intracranial growth/temporal arteritis) (Su.ut.-25/16-18). In Madhava Nidanam it is described as a very severe and fatal condition that, by causing blockages in the head and throat, can kill the patient in three days [Ma.ni.-60/15]. Karnamoola shotha (swelling at base of ear/parotitis) has been described as a complication of sannipataja jwara (Ca.chi.-3/287). Pliha vriddhi (splenomegaly) has been described as plīhodara (Ca.chi.-13/35-38). Sushruta has described plihodara, due to intake of irritant and slimy food items, as a cause for aggravation of rakta and kapha. Gulma is a very special disease class described in Ayurveda, because it is neither mentioned independently in modern medicine nor it can be correlated with any disease. The problems or symptoms described in reference to gulma are practically found in clinical practice therefore it should be considered exclusively(Ca.chi.-5 & ch.ni.-3). In Aanaha (distension of abdomen), not only is the movement of vata hampered but the vitiated vata also dries the stool. Therefore, the patient of aanaha complains of constipation along with flatulence. Two causes of aanaha are: impaired peristalsis of the stomach and that of the large bowel (Su.utt.-57/20-22). Vriddhi roga (hydrocele and hernia) has been described to be of seven types i.e. vataja, pittaja, kaphaja, raktaja, medoja, mutraja and antraja. (A.H.Ni.-11/21-31). The antraja vriddhi may be correlated with swelling of the hernia and is said to be incurable. Sushruta has described five types of rohini (diptheria) i.e. vataja, pittaja, kaphaja, raktaja and sannipataja (Su.ni.-16/47-50). − Upajihvika, galashundika, galagraha, rohini, are basically infectious disorders affecting the mouth and throat area. Galaganda closely resembles goitre which is caused due to thyroid disorders. Visarpa and pidika are caused due to skin infections, whereas tilaka, piplu, vyanga and nilika are the problems present in skin due melanin pigment disorders. Pliha vridhi or spleenomegaly is condition where spleen gets enlarged due to many reasons such as infections, hematological disorders, malignancies etc. Gulma, udara roga, aanaha are diseases mainly located and related to gastrointestinal tract, having main features of fullness or protuberance. Eight udara rogas described in Ayurveda are actually diseases present as protuberances in abdomen. But all udara rogas are not directly related to the gastrointestinal tract e.g. plihodara (splenomegaly), yakradaludara (hepatomegaly), and jalodara (ascites). Still their manifestation is similar to shotha i.e. swellings. Swelling at the roots of ears, commonly known as Karnamool shotha (Parotitis), is mostly due to viral infections. Vriddhi roga is a kind of hernia, i.e., inguinal, femoral, umbilical or incision hernia with visible swelling. Adhimansa (increased muscles bulk) and arbuda(tumor) are swellings associated with extra or new growth that could be benign or malignant. Rohini can be closely correlated with diphtheria which is caused by a bacterial infection i.e. Corynibacterium diphtheriae8. It can affect many sites in the body but most commonly the throat where if not treated properly may cause death due to suffocation or asphyxia. [19-36] − Dosha and disease: − Over the years, as a result of changes in lifestyle, multiple etiological factors, and decreased body resistance, new diseases are appearing. Therefore, naming all the diseases is a problem that all branches of medical sciences face. In modern medicine where the cause of a disease is not very clear, symptom-based or descriptive diagnosis is given to various conditions, e.g., APD (Acid Peptic Diseases) is the term given to problems having symptoms of hyperacidity, pain in the abdomen, indigestion etc. Similarly, NUD (Non Ulcer Dyspepsia) term is applied to the symptoms of indigestion without pain. CAD (Coronary Artery Disease), CHD (Congenital Heart Disease), CVA (Cerebro- Vascular Accidents), COPD (Chronic Obstructive Pulmonary Disease), HE (Hepatic-encephalopaty), Renal parenchymal disease, Coagulopathies, Myopathies, Neuropathies, etc. are a few other examples of grouping various ailments by their symptoms. In a similar manner, certain Ayurvedic conditions have been grouped into Twak vikara (skin disorders), Udara vikara, Mutra vikara, Mano vikara, vāta vikara, pitta vikara, kapha vikara etc. and an appropriate course of treatment is administered after understanding the possible etiopathogenesis. [44-47] − If we analyze doshas, then we observe that all solid and watery contents of our body are made up of kapha. Most enzymes, digestive functions and all warmth in body can be attributed to pitta. And all types of micro or macro-movements in our bodies are performed by vata. Therefore, our body and the associated constituents and life-processes could be attributed to the three doshas, along with body tissues (dhatus), and secretions (mala). In all circumstances, doshas, dhatus and malas play an important role and are considered as roots of the body [A.H.Ni. 11/1]. [48] − vata, pitta and kapha are further sub-categorized into five types of each. They all have their specific sites in the body and specific functions applicable to those sites. (Sha.Pu.Kh. 5/27-35). Specific sites of these doshas are mentioned in (Ca.Su. 20/8). [49-51] − Many functions and gunas of doshas are mostly interrelated (especially opposite to each other). For instance, vata and kapha properties are mostly opposite to pitta properties. Therefore, their functions increase or decrease in inverse relation to each other. [52] − Typical functions of aggravated dosha are described such as emaciation, blackening, willingness of warm things, tremors, flatulence, constipation, impaired body power, insomnia, incapability of grasping objects by sense organs, delirium, vertigo and lustlessness are functions or presentations of aggravated vata. Yellowish discoloration of stool, urine, nails and skin, reduction in appetite, thirst, burning and sleep are due to aggravated pitta, whereas anorexia, excessive salivation, laziness, heaviness, white discoloration of body, coldness and loss of muscle tone, increase in breathlessness, coughing and sleep are due to aggravated kapha [A.H.Su. 11/5-7]. [53] − References − 1. Charaka samhita ; Nidana sthana - 1/10 − 2. Charak samhita ; chikitsa sthanam –16/30 − 3. Pathology by Harsh mohan; chapter-5 page (66-67), 3rd edition − 4. Pathology by Harsh mohan; chapter-5 page (64-70), 3rd edition. − 5. Manual of practical medicine by R. Alagappan; chapter-3(page-159), 3rd edition. − 6. Manual of practical medicine by R. Alagappan, chapter-7 page-369-371, 3rd edition. − 7. Manual of practical medicine by R. Alagappan, chapter-3 page-159, 3rd edition. − 8. Textbook of microbiology – Orient Longman, chapter-26 page-23, 4th edition.
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[[Sutra Sthana]] 18. Trishothiyadhyaya
[[Sutra Sthana]] 19. Ashtodariya Adhyaya
[Chapter starting with three types of swellings]
[Chapter on numerical classification of diseases]
Abstract
Abstract
In continuation of the previous chapter, this chapter delves into classifications of various diseases. Diseases have been broadly classified here into two groups – one comprising of diseases manifesting as a result of involvement of two or more doshas (“Samanyaja Vyadhi”), while the other focusing on diseases caused due to a single dosha (“Nanatmaja Vyadhi”). Forty eight diseases have been enlisted with their types from diagnostic perspective in this chapter. The role of doshas in etiopathogenesis of the diseases, difference between the exogenous and endogenous diseases and their coexistence has also been described. In modern medicine, classification and knowledge of these diseases differs. Some diseases described in this chapter can be exactly correlated with diseases of modern medicine whereas some cannot be.
Key words: Swellings, endogenous causes, exogenous causes, shotha, nija-agantuja, generalized edema, localized edema,
Key words: kapha, nija, pitta, sannipattika, vikara, vata, numerical classification of diseases.
Introduction:
Introduction
Important principles of diseases in this section of the Roga Chatushka (tetrad on diseases) have been described. The preceding chapter provided a broader explanation for the cause of innumerable diseases due to dosha vitiation as well as variations in characteristics like pain, sign, etiology, site of origin, site of manifestation, symptoms and nomenclature. However, only the most important diseases, probably prevalent at that time, have been classified in view of prescribing treatment. Classification of these known diseases, based on characteristics provided above, and coupled with a few more variables such as prognosis, chronicity, treatment etc. have been done at various places within the Charaka Samhita. On critically analyzing, we find that the diseases have been classified into groups having as few as one to as many as eight diseases each. Three disease groups of twenty types each have been classified at the end. It has been observed that the listing of groups by diseases has been done in a descending order - from those having eight diseases to one - because there are no other groups that have greater than eight types of diseases within them, except for the three groups with twenty types. Hence, these outliers (with twenty types) have been enumerated at the end rather than in the beginning of the chapter. Even though there are eighteen types of obstinate skin diseases, only the seven most obstinate ones have been enumerated here.
As mentioned above, various modes of classification have been used to classify diseases in the Samhita - some diseases have been classified only according to doshas involved, such as apasmara (epilepsy), akshi roga (eye diseases), mukha roga (diseases of oral cavity), pratishyaya (rhinitis) etc. In some cases, apart from doshas, certain etiological factors have also been considered and nomenclature has been done accordingly e.g. in case of unmada, pandu roga, hridroga, chhardi, shosha, vrana etc. Some diseases have been classified taking into consideration only prominent clinical features, such as in the case of kushtha, kilasa, arsha, jwara, and aayama. In some cases, nomenclature is based on the site involved in pathogenesis, as in rakta pitta, kamala etc, while in some cases, severity has been the basis for classification e.g. vatarakta. We also find groups containing sub-classes or sub-groups of diseases. This hierarchical basis has been used while classifying the three disease families mentioned that have twenty types of diseases. Krimi are first classified into bahya, raktaja, shleshmaja and purishaja which are sub-classified into other diseases. Similarly, twenty types of pramehas are broadly classified into three groups on the basis of doshas and then subtypes are mentioned. Yoni vyapada (gynecological disorders) are broadly classified into diseases caused by dosha and diseases caused by amalgamation of doshas and dushyas, with further sub-classifications. Thus, it can be said that classification has not been restricted to a single hierarchic pattern but a hierarchical system for disease classification as well. Still, the classification of all known diseases is not complete using the above mentioned system. Need-based or contextual re-classification of various disease groups can be found in many places within the Samhita.
This lack of standardization or disease classification or nomenclature does warrant a need to frame some standards that are unanimously acceptable across the world. In fact, the need for standardizing disease classifications has been strongly aired by experts and this body of classification has been given the name of Ayurvedic Classification of Diseases (ACD). Moreover, considering the importance of traditional medicine, the World Health Organization (WHO) is also incorporating Traditional Medicine (TM) in ICD-11. WHO recently completed a survey among member nations and discovered that 82% of the world's population uses some form of TM.[2] To bring all countries onto one platform for health management requires the inclusion of TM in ICD.
To make this happen, immense efforts are required to develop adequate nomenclature and classification for Ayurvedic diseases. However, there are practical challenges associated with correlating all these diseases mentioned in Ayurveda with modern disease families. For example, certain diseases or disorders such as kushtha, pandu, prameha, gulma, etc. may not have an equivalent in modern medicine. Some do have a direct correlation with those found or classified today, such as bhagandara, kamala, baddhodara, chidrodara, tamaka shwasa etc.
The relationship between the doshas and endogenous diseases can be explained using the following analogy mentioned in this text: just as no bird (under the Sun) can fly without casting a shadow, no endogenous disease (caused by the disturbance of the equilibrium of dhatus) can occur without the vitiation of vata, pitta and kapha. The exogenous diseases may or may not be caused due to a vitiated dosha but so far as their treatment is concerned, doshas need not be factored in. There is also a mention of exogenous and endogenous diseases coexisting together. Endogenous diseases are, at times, followed by the exogenous ones and vice versa. While treating such conditions, one should start treatment on the basis of the secondary development and our understanding of the primary nature of the disease.
The chapter:
अथातोऽष्टोदरीयमध्यायं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
इति ह स्माह भगवानात्रेयः||२||
athātō'ṣṭōdarīyamadhyāyaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2||
iti ha smāha bhagavānātrēyaḥ||2||
athAto~aShTodarIyamadhyAyaM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
We shall now expound the chapter on “Eight abdominal diseases, thus said Lord Atreya (1-2)
Numerical classification of diseases:
त्रयः शोथा भवन्ति वातपित्तश्लेष्मनिमित्ताः, ते पुनर्द्विविधा निजागन्तुभेदेन||३||
अष्टावुदराणीति, अष्टौ मूत्राघाता: अष्टौ क्षीरदोषा:, अष्टौ रेतोदोषा: ,सप्त कुष्ठानीति,सप्त पिडका:,
सप्त विसर्पा:,षडतीसारा:, षडुदावर्ता:, पञ्च गुल्मा:, पञ्च प्लीहदोषा:, पञ्च कासा:, पञ्च श्वासा:, पञ्च हिक्का:, पञ्च तृष्णा:, पञ्च छर्दय:, पञ्च भक्तस्यानशनस्थानानि, पञ्च शिरोरोगा:, पञ्च हृद्रोगा:, पञ्च पाण्डुरोगा:, पञ्चोन्मादा:, चत्वारोऽपस्मारा:, चत्वारोऽक्षिरोगा:, चत्वारः कर्णरोगा:, चत्वारः प्रतिश्याया:, चत्वारो मुखरोगा:, चत्वारो ग्रहणीदोषा:, चत्वारो मदा:, चत्वारो मूर्च्छाया:, चत्वारः शोषा:, चत्वारि क्लैब्यानि:, त्रयः शोथा:, त्रीणि किलासानि, त्रिविधं लोहितपित्तम,
द्वौ ज्वरO, द्वौ व्रणO, द्वावायामO, द्वे गृध्रस्यO, द्वे कामले, द्विविधमामम, द्विविधं वातरक्तम, द्विविधान्यर्शांसी, एक ऊरुस्तम्भ:, एकः सन्न्यास:, एको महागद:, विंशतिः क्रिमिजातय:, विंशतिः प्रमेहा:, विंशतिर्योनिव्यापद: इति इति अष्ट्चत्वारिंशद्रोगधिकरणान्यस्मिन् संग्रहे समुद्दिष्टानि ||४||
There are eight types of udara roga (abdominal swellings), eight types of mutraghata (oliguria/anuria), eight types of ksheera dosha (disorders related to breast milk), eight types of reto dosha (disorders of semen), seven types of kushtha (skin disorders), seven types of pidaka (inflammatory swelling), seven types of visarpa (acute spreading inflammatory skin conditions like erysipelas ), six types of atisara (diarrhoeal diseases), six types of udavarta (abdominal diseases due to suppression of natural urges), five types of gulma (abdominal lumps/tumour), five types of pleeha dosha (disorders of spleen), five types of kasa (cough), five types of shwasa (dyspnoea), five types of hikka (hiccup), five types of trishna (thirst), five types of chhardi (vomiting), five types of bhaktasyanashanasthanani (anorexia), five types of shiroroga (diseases of head), five types of hridroga (diseases of heart), five types of panduroga (anaemia), five types of unmada (insanity), four types of apasmara (epilepsy), four types of akshiroga (disorders of eyes), four types of karna Roga (disorders of ear), four types of pratishyaya (rhinitis), four types of mukha roga (oral diseases/buccal diseases), four types of grahani roga (assimilation disorders/malabsorption disorders), four types of mada roga (intoxication), four types of murcha (fainting), four types of shosha (consumption/wasting disorders), four types of klaibya (sterility), three types of shopha (swellings), three types of kilasa (vitiligo), three types of rakta-pitta (coagulopathies), two types of jwara (fever), two types of vrana (wound), two types of aayama (abnormal posture of body due to severe muscular spasm), two types of gridhrasi (sciatica), two types of kamala (jaundice), two types of ama (disorders due to indigestion and metabolism), two types of vatarakta (gout), two types of arsha (piles), one type of urustambha (spastic paraplegia), one type of sanyasa (coma), one type of mahagada (Pshyconeurosis), twenty types of krimi roga (parasitic infestations), twenty types of prameha (urinary disorders which are characterized by abnormal and increased frequency of urine), and twenty types of yoni vyapad (gynaecological disorders). Thus, classifications of forty-eight diseases have been briefly described in this chapter. (3)
Types of diseases:
Diseases of eight types:
एतानि यथोद्देशमभिनिर्देक्ष्यामः-
अष्टावुदराणीति वातपित्तकफसन्निपातप्लीहबद्धच्छिद्रदकोदराणि, अष्टौ मूत्राघाता इतिवातपित्तकफसन्निपाताश्मरीशर्कराशुक्रशोणितजाः, अष्टौ क्षीरदोषा इति वैवर्ण्यं वैगन्ध्यं वैरस्यं पैच्छिल्यं फेनसङ्घातो रौक्ष्यंगौरवमतिस्नेहश्च, अष्टौ रेतोदोषा इति तनु शुष्कं फेनिलमश्वेतं पूत्यतिपिच्छलमन्यधातूपहितमवसादि च (१);
ētāni yathōddēśamabhinirdēkṣyāmaḥ-
aṣṭāvudarāṇīti vātapittakaphasannipātaplīhabaddhacchidradakōdarāṇi, aṣṭau mūtrāghātā itivātapittakaphasannipātāśmarīśarkarāśukraśōṇitajāḥ, aṣṭau kṣīradōṣā iti vaivarṇyaṁ vaigandhyaṁvairasyaṁ paicchilyaṁ phēnasaṅghātō raukṣyaṁ gauravamatisnēhaśca, aṣṭau rētōdōṣā iti tanu śuṣkaṁphēnilamaśvētaṁ pūtyatipicchalamanyadhātūpahitamavasādi ca (1);
etAni yathoddeshamabhinirdekShyAmaH-
aShTAvudarANIti vAtapittakaphasannipAtaplIhabaddhacchidradakodarANi, aShTau mUtrAghAtA iti vAtapittakaphasannipAtAshmarIsharkarAshukrashoNitajAH,aShTau kShIradoShA iti vaivarNyaM vaigandhyaM vairasyaM paicchilyaM phenasa~gghAto raukShyaM gauravamatisnehashca, aShTau retodoShA iti tanu shuShkaMphenilamashvetaM pUtyatipicchalamanyadhAtUpahitamavasAdi ca (1);
These diseases will be described in detail in the same order as enumerated earlier. Eight types of udara roga (abdominal swelling) are vatika, paittika, kaphaja, sannipataja, plihodara (due to splenic disorder), baddhodara (due to intestinal obstruction), chidrodara (due to intestinal perforation) and dakodara (ascites).
Eight types of mutraghatas (Oliguria/Anuria) are vatika, paittika, kaphaja, sannipatika, ashmarija (due to stone in urinary tract), sharkaraja (due to gravels in urinary tract), shukraja (due to spermolith) and shonitaja (due to hematoma).
Eight types of ksheera-dosha (disorders of breast milk) are vaivarnya (discoloration), vaignadhyam (altered smell), vairasyam (altered taste), paichichhilyam (sliminess), phenasamghata (excessive frothiness), raukshyam (absence of unctuousness), gauravam (heaviness in digestion/physical character) and atisneha (excessive unctuousness)
Eight types of reto dosha (disorders of semen) are tanu (increased liquidity/decreased liquefaction time), shuskam (less viscous/dry), phenilam (excessive frothiness), ashwetam (discoloration), puti (foul smelling), atipichichhilam (excessive sliminess), anyadhatupahitam (presence of tissue constituents) and avasadi (increased specific gravity) (1)
Diseases with seven types:
सप्त कुष्ठानीति कपालोदुम्बरमण्डलर्ष्यजिह्वपुण्डरीकसिध्मकाकणानि, सप्त पिडका इति शराविका कच्छपिका जालिनीसर्षप्यलजी विनता विद्रधी च, सप्त विसर्पा इति वातपित्तकफाग्निकर्दमकग्रन्थिसन्निपाताख्याः (२);
sapta kuṣṭhānīti kapālōdumbaramaṇḍalarṣyajihvapuṇḍarīkasidhmakākaṇāni, sapta piḍakā iti śarāvikākacchapikā jālinī sarṣapyalajī vinatā vidradhī ca, sapta visarpā itivātapittakaphāgnikardamakagranthisannipātākhyāḥ (2);
sapta kuShThAnIti kapAlodumbaramaNDalarShyajihvapuNDarIkasidhmakAkaNAni, sapta piDakA iti sharAvikA kacchapikA jAlinI sarShapyalajI vinatA vidradhI ca,sapta visarpA iti vAtapittakaphAgnikardamakagranthisannipAtAkhyAH (2);
Seven varieties of kushtha (obstinate skin diseases) are kapala, udumbara, mandala, rishyajihwa, pundarika, sidhma and kakanaka.
Seven types of pidakas (inflammatory swellings) are sharavika, kachhapika, jalini, sarshapi, alaji, vinata and vidradhi.
Seven types of visarpa (acute spreading inflammatory skin conditions) are vatika, paittika, kaphaja, sannipatika, agni, kardama and granthi. (2)
Diseases with six types:
षडतीसारा इति वातपित्तकफसन्निपातभयशोकजाः, षडुदावर्ता इति वातमूत्रपुरीषशुक्रच्छर्दिक्षवथुजाः (३);
ṣaḍatīsārā iti vātapittakaphasannipātabhayaśōkajāḥ, ṣaḍudāvartā itivātamūtrapurīṣaśukracchardikṣavathujāḥ (3);
ShaDatIsArA iti vAtapittakaphasannipAtabhayashokajAH, ShaDudAvartA iti vAtamUtrapurIShashukracchardikShavathujAH (3);
Six types of atisara (diarrhoeal disorders) are vatika, paittika, kaphaja, sannipatika, bhayaja (caused by fear) and shokaja (caused by grief.)
Six types of udavartas (abdominal diseases due to suppression of natural urges) are vataja (due to suppression of flatus), mutraja (due to suppression of urine), purishaja (due to suppression of feces), shukraja (Due to suppression of ejaculation of semen), chhardija (due to suppression of vomiting) and kshavathuja (due to suppression of sneezing). (3)
Diseases with five types:
पञ्च गुल्मा इति वातपित्तकफसन्निपातशोणितजाः, पञ्च प्लीहदोषा इति गुल्मैर्व्याख्याताः, पञ्च कासा इतिवातपित्तकफक्षतक्षयजाः, पञ्च श्वासा इति महोर्ध्वच्छिन्नतमकक्षुद्राः, पञ्च हिक्का इति महती गम्भीरा व्यपेता क्षुद्राऽन्नजाच, पञ्च तृष्णा इति वातपित्तामक्षयोपसर्गात्मिकाः, पञ्च छर्दय इति द्विष्टार्थसंयोगजा वातपित्तकफसन्निपातोद्रेकोत्थाश्च , पञ्च भक्तस्यानशनस्थानानीति वातपित्तकफसन्निपातद्वेषाः, पञ्च शिरोरोगा इति पूर्वोद्देशमभिसमस्यवातपित्तकफसन्निपातक्रिमिजाः, पञ्च हृद्रोगा इति शिरोरोगैर्व्याख्याताः, पञ्च पाण्डुरोगा इतिवातपित्तकफसन्निपातमृद्भक्षणजाः, पञ्चोन्मादा इति वातपित्तकफसन्निपातागन्तुनिमित्ताः (४);
pañca gulmā iti vātapittakaphasannipātaśōṇitajāḥ, pañca plīhadōṣā iti gulmairvyākhyātāḥ, pañca kāsā itivātapittakaphakṣatakṣayajāḥ, pañca śvāsā iti mahōrdhvacchinnatamakakṣudrāḥ, pañca hikkā iti mahatīgambhīrā vyapētā kṣudrā'nnajā ca, pañca tr̥ṣṇā iti vātapittāmakṣayōpasargātmikāḥ, pañca chardaya itidviṣṭārthasaṁyōgajā vātapittakaphasannipātōdrēkōtthāśca , pañca bhaktasyānaśanasthānānītivātapittakaphasannipātadvēṣāḥ, pañca śirōrōgā iti pūrvōddēśamabhisamasyavātapittakaphasannipātakrimijāḥ, pañca hr̥drōgā iti śirōrōgairvyākhyātāḥ, pañca pāṇḍurōgā itivātapittakaphasannipātamr̥dbhakṣaṇajāḥ, pañcōnmādā iti vātapittakaphasannipātāgantunimittāḥ (4);
pa~jca gulmA iti vAtapittakaphasannipAtashoNitajAH, pa~jca plIhadoShA iti gulmairvyAkhyAtAH, pa~jca kAsA iti vAtapittakaphakShatakShayajAH, pa~jca shvAsA itimahordhvacchinnatamakakShudrAH, pa~jca hikkA iti mahatI gambhIrA vyapetA kShudrA~annajA ca, pa~jca tRuShNA iti vAtapittAmakShayopasargAtmikAH, pa~jcachardaya iti dviShTArthasaMyogajA vAtapittakaphasannipAtodrekotthAshca [1] , pa~jca bhaktasyAnashanasthAnAnIti vAtapittakaphasannipAtadveShAH, pa~jcashirorogA iti pUrvoddeshamabhisamasya vAtapittakaphasannipAtakrimijAH, pa~jca hRudrogA iti shirorogairvyAkhyAtAH, pa~jca pANDurogA itivAtapittakaphasannipAtamRudbhakShaNajAH, pa~jconmAdA iti vAtapittakaphasannipAtAgantunimittAH (4);
Five types of gulmas (abdominal lump/tumour) are vataja, pittaja, kaphaja, sannipataja and raktaja. Five types of pleeha doshas (splenic disorders) are of the same type as those of gulma.
Five types of kasa (cough) are vataja, pittaja, kaphaja, kshataja (caused by internal injuries in respiratory tract) and kshayaja (caused by wasting).
Five types of shwasa (dyspnoea) are mahashwasa, urdhwashwasa, chhinna shwasa, tamaka shwasa and kshudra shwasa (dyspnoea due to exertion).
Five types of hikka (hiccup) are mahati, gambhira, vyapeta, kshudra and annaja.
Five types of trishna (thirst) are vataja, pittaja, amaja, kshayaja (due to wasting) and upsargaja (secondary to other diseases).
Five types of chhardi (vomiting) are vataja, pittaja, kaphaja, sannipataja and dwistarthsangyogaja (by coming in contact with obnoxious articles).
Five types of bhaktasyanasana (anorexia) are vataja, pittaja, kaphaja, sannipataja and dweshaja (repugnance)
Five types of shiroroga (disorders of head) are vataja, pittaja, kaphaja, sannipataja and krimija (due to parasitic infection).
Five varieties of hridroga (cardiac disorders) are same as disorders of head i.e. vataja, pittaja, kaphaja, sannipataja and krimija (due to parasitic infection).
Five types of pandu (anaemia) are vataja, pittaja, kaphaja, sannipataja and mridbhakshanaja (due to intake of clay).
Five types of unmada (insanity) are vataja, pittaja, kaphaja, sannipataja and aagantuja (due to exogenous causes). (4)
Diseases with four types:
चत्वारोऽपस्मारा इति वातपित्तकफसन्निपातनिमित्ताः, चत्वारोऽक्षिरोगाश्चत्वारः कर्णरोगाश्चत्वारः प्रतिश्यायाश्चत्वारोमुखरोगाश्चत्वारो ग्रहणीदोषाश्चत्वारो मदाश्चत्वारो मूर्च्छाया इत्यपस्मारैर्व्याख्याताः, चत्वारः शोषा इतिसाहससन्धारणक्षयविषमाशनजाः, चत्वारि क्लैब्यानीति बीजोपघाताद्ध्वजभङ्गाज्जरायाः शुक्रक्षयाच्च (५);
catvārō'pasmārā iti vātapittakaphasannipātanimittāḥ, catvārō'kṣirōgāścatvāraḥ karṇarōgāścatvāraḥpratiśyāyāścatvārō mukharōgāścatvārō grahaṇīdōṣāścatvārō madāścatvārō mūrcchāyāityapasmārairvyākhyātāḥ, catvāraḥ śōṣā iti sāhasasandhāraṇakṣayaviṣamāśanajāḥ, catvāri klaibyānītibījōpaghātāddhvajabhaṅgājjarāyāḥ śukrakṣayācca (5);
catvAro~apasmArA iti vAtapittakaphasannipAtanimittAH, catvAro~akShirogAshcatvAraH karNarogAshcatvAraH pratishyAyAshcatvAro mukharogAshcatvArograhaNIdoShAshcatvAro madAshcatvAro mUrcchAyA ityapasmArairvyAkhyAtAH, catvAraH shoShA iti sAhasasandhAraNakShayaviShamAshanajAH, catvAriklaibyAnIti bIjopaghAtAddhvajabha~ggAjjarAyAH shukrakShayAcca (5);
Four types of apasmara (epilepsy) are vataja, pittaja, kaphaja and sannipataja.
Four types of akshiroga (diseases of the eye), four types of karna roga (diseases of the ear), four types of pratishyaya (rhinitis), four types of mukha roga (oral disorders), four types of grahani roga (mal-absorption disorders), four types of mada roga (intoxication) and four types of murchcha (fainting) are same as that of apasmara (epilepsy) i.e. vataja, pittaja, kaphaja and sannipataja.
Four varieties of shosha (consumption/wasting) are sahasaja (over strain), sandharanaja (suppression of natural urges), kshayaja (wasting) and vishamashanaja (irregularities in diet).
Four types of klaibya (sterility) are beejopaghataja (affliction of sperm), dhwajabhangaja (atonia of genital organs/erectile dysfunction), jaraaja (senility) and shukrakshayaja (decreased production of sperm) (5)
Diseases with three types:
त्रयः शोथा इति वातपित्तश्लेष्मनिमित्ताः, त्रीणि किलासानीति रक्तताम्रशुक्लानि, त्रिविधं लोहितपित्तमितिऊर्ध्वभागमधोभागमुभयभागं च (६);
trayaḥ śōthā iti vātapittaślēṣmanimittāḥ, trīṇi kilāsānīti raktatāmraśuklāni, trividhaṁ lōhitapittamitiūrdhvabhāgamadhōbhāgamubhayabhāgaṁ ca (6);
trayaH shothA iti vAtapittashleShmanimittAH, trINi kilAsAnIti raktatAmrashuklAni, trividhaM lohitapittamiti UrdhvabhAgamadhobhAgamubhayabhAgaM ca (6);
Three types of shothas (swellings) are vataja, pittaja and kaphaja.
Three types of kilasas (vitiligo) are rakta (red), tamra (coppery) and shukla (white) coloured.
Three types of lohitatapittas (coagulopathies) are urdhabhagam (involving upper channels), adhobhagam (involving lower channels and ubhayabhagam (involving both channels). (6)
Diseases with two types:
द्वौ ज्वराविति उष्णाभिप्रायः शीतसमुत्थश्च शीताभिप्रायश्चोष्णसमुत्थः, द्वौ व्रणाविति निजश्चागन्तुजश्च, द्वावायामावितिबाह्यश्चाभ्यन्तरश्च, द्वे गृध्रस्याविति वाताद्वातकफाच्च, द्वे कामले इति कोष्ठाश्रया शाखाश्रया च, द्विविधमाममितिअलसको विसूचिका च, द्विविधं वातरक्तमिति गम्भीरमुत्तानं च, द्विविधान्यर्शांसीति शुष्काण्यार्द्राणि च (७);
dvau jvarāviti uṣṇābhiprāyaḥ śītasamutthaśca śītābhiprāyaścōṣṇasamutthaḥ, dvau vraṇāvitinijaścāgantujaśca, dvāvāyāmāviti bāhyaścābhyantaraśca, dvē gr̥dhrasyāviti vātādvātakaphācca, dvēkāmalē iti kōṣṭhāśrayā śākhāśrayā ca, dvividhamāmamiti alasakō visūcikā ca, dvividhaṁ vātaraktamitigambhīramuttānaṁ ca, dvividhānyarśāṁsīti śuṣkāṇyārdrāṇi ca (7);
dvau jvarAviti uShNAbhiprAyaH shItasamutthashca shItAbhiprAyashcoShNasamutthaH, dvau vraNAviti nijashcAgantujashca, dvAvAyAmAvitibAhyashcAbhyantarashca, dve gRudhrasyAviti vAtAdvAtakaphAcca, dve kAmale iti koShThAshrayA shAkhAshrayA ca, dvividhamAmamiti alasako visUcikA ca,dvividhaM vAtaraktamiti gambhIramuttAnaM ca, dvividhAnyarshAMsIti shuShkANyArdrANi ca (7);
Two types of jwara (fever) are ushnabhipraya shitasamuttha (fever arising from cold and patient has desire for hot substances) and shitabhipraya ushnasamuttha (fever arising from heat and patient has desire for cold substances).
Two types of vrana (wound) are nija (endogenous causes) and agantuja (exogenous causes).
Two types of aayama (abnormal posture of body due to severe muscular spasm) are bahya (opisthotonus) and abhayantara (emprosthotonus)
Two types of gridhrasi (sciatica) are vatika and vata-kaphaja.
Two types of kamala (jaundice) are koshthashraya (pre-hepatic & hepatic jaundice) and shakhashraya (Obstructive jaundice).
Two types of ama (disorders due to improper digestion and metabolism) are alasaka (intestinal torper) and visuchika (cholera/food poisoning).
Two types of vatarakta (Gout) are gambheera (deep) and uttana (superficial).
Two types of arsha (piles) are shushka (non bleeding masses) and aardra (bleeding masses). (7)
Diseases with one type:
एक ऊरुस्तम्भ इत्यामत्रिदोषसमुत्थः, एकः सन्न्यास इति त्रिदोषात्मको मनःशरीराधिष्ठानः, एको महागद इतिअतत्त्वाभिनिवेशः (८);
ēka ūrustambha ityāmatridōṣasamutthaḥ, ēkaḥ sannyāsa iti tridōṣātmakō manaḥśarīrādhiṣṭhānaḥ, ēkōmahāgada iti atattvābhinivēśaḥ (8);
eka Urustambha ityAmatridoShasamutthaH, ekaH sannyAsa iti tridoShAtmako manaHsharIrAdhiShThAnaH, eko mahAgada iti atattvAbhiniveshaH (8);
There is one urustambha (spastic paraplegia) which is caused by ama and all three doshas.
Sanyasa (coma) is also of one type that is caused by all three doshas and is psycho-somatic in nature.
Mahagada (major disease) is one and is due to atattvabhinivesha (mental and moral perversion). (8)
Diseases with twenty types:
विंशतिः क्रिमिजातय इति यूका पिपीलिकाश्चेति द्विविधा बहिर्मलजाः, केशादा लोमादा लोमद्वीपाः सौरसा औदुम्बराजन्तुमातरश्चेति षट् शोणितजाः, अन्त्रादा उदरावेष्टा हृदयादाश्चुरवो दर्भपुष्पाः सौगन्धिका महागुदाश्चेति सप्त कफजाः,ककेरुका मकेरुका लेलिहाः सशूलकाः सौसुरादाश्चेति पञ्च पुरीषजाः; विंशतिः प्रमेहा इत्युदकमेहश्चेक्षुबालिकारसमेहश्चसान्द्रमेहश्च सान्द्रप्रसादमेहश्च शुक्लमेहश्च शुक्रमेहश्च शीतमेहश्च शनैर्मेहश्च सिकतामेहश्च लालामेहश्चेति दशश्लेष्मनिमित्ताः, क्षारमेहश्च कालमेहश्च नीलमेहश्च लोहितमेहश्च मञ्जिष्ठामेहश्च हरिद्रामेहश्चेति षट् पित्तनिमित्ताः,वसामेहश्च मज्जामेहश्च हस्तिमेहश्च मधुमेहश्चेति चत्वारो वातनिमित्ताः, इति विंशतिः प्रमेहाः; विंशतिर्योनिव्यापद इतिवातिकी पैत्तिकी श्लेष्मिकी सान्निपातिकी चेति चतस्रो दोषजाः, दोषदूष्यसंसर्गप्रकृतिनिर्देशैरवशिष्टाः षोडश निर्दिश्यन्ते,तद्यथा-रक्तयोनिश्चारजस्का चाचरणा चातिचरणा च प्राक्चरणा चोपप्लुता च परिप्लुता चोदावर्तिनी च कर्णिनी च पुत्रघ्नीचान्तर्मुखी च सूचीमुखी च शुष्का च वामिनी च षण्ढयोनिश्च महायोनिश्चेति विंशतिर्योनिव्यापदो भवन्ति (९);
viṁśatiḥ krimijātaya iti yūkā pipīlikāścēti dvividhā bahirmalajāḥ, kēśādā lōmādā lōmadvīpāḥ saurasāaudumbarā jantumātaraścēti ṣaṭ śōṇitajāḥ, antrādā udarāvēṣṭā hr̥dayādāścuravō darbhapuṣpāḥsaugandhikā mahāgudāścēti sapta kaphajāḥ, kakērukā makērukā lēlihāḥ saśūlakāḥ sausurādāścēti pañcapurīṣajāḥ; viṁśatiḥ pramēhā ityudakamēhaścēkṣubālikārasamēhaśca sāndramēhaścasāndraprasādamēhaśca śuklamēhaśca śukramēhaśca śītamēhaśca śanairmēhaśca sikatāmēhaścalālāmēhaścēti daśa ślēṣmanimittāḥ, kṣāramēhaśca kālamēhaśca nīlamēhaśca lōhitamēhaścamañjiṣṭhāmēhaśca haridrāmēhaścēti ṣaṭ pittanimittāḥ, vasāmēhaśca majjāmēhaśca hastimēhaścamadhumēhaścēti catvārō vātanimittāḥ, iti viṁśatiḥ pramēhāḥ; viṁśatiryōnivyāpada iti vātikī paittikī ślēṣmikīsānnipātikī cēti catasrō dōṣajāḥ, dōṣadūṣyasaṁsargaprakr̥tinirdēśairavaśiṣṭāḥ ṣōḍaśa nirdiśyantē,tadyathā- raktayōniścārajaskā cācaraṇā cāticaraṇā ca prākcaraṇā cōpaplutā ca pariplutā cōdāvartinī cakarṇinī ca putraghnī cāntarmukhī ca sūcīmukhī ca śuṣkā ca vāminī ca ṣaṇḍhayōniśca mahāyōniścētiviṁśatiryōnivyāpadō bhavanti (9);
viMshatiH krimijAtaya iti yUkA pipIlikAshceti dvividhA bahirmalajAH, keshAdA lomAdA lomadvIpAH saurasA audumbarA jantumAtarashceti ShaT shoNitajAH, antrAdAudarAveShTA hRudayAdAshcuravo darbhapuShpAH saugandhikA mahAgudAshceti sapta kaphajAH, kakerukA makerukA lelihAH sashUlakAH sausurAdAshcetipa~jca purIShajAH; viMshatiH pramehA ityudakamehashcekShubAlikArasamehashca sAndramehashca sAndraprasAdamehashca shuklamehashca shukramehashcashItamehashca shanairmehashca sikatAmehashca lAlAmehashceti dasha shleShmanimittAH, kShAramehashca kAlamehashca nIlamehashca lohitamehashcama~jjiShThAmehashca haridrAmehashceti ShaT pittanimittAH, vasAmehashca majjAmehashca hastimehashca madhumehashceti catvAro vAtanimittAH, itiviMshatiH pramehAH; viMshatiryonivyApada iti vAtikI paittikI shleShmikI sAnnipAtikI ceti catasro doShajAH, doShadUShyasaMsargaprakRutinirdeshairavashiShTAHShoDasha nirdishyante, tadyathA- raktayonishcArajaskA cAcaraNA cAticaraNA ca prAkcaraNA copaplutA ca pariplutA codAvartinI ca karNinI ca putraghnIcAntarmukhI ca sUcImukhI ca shuShkA ca vAminI ca ShaNDhayonishca mahAyonishceti viMshatiryonivyApado bhavanti (9);
kevalashcAyamuddesho yathoddeshamabhinirdiShTo bhavati||4||
Twenty types of krimis (parasites) include yuka (lice) and pipilika (eggs of lice) on the body surface and produced from external impurities, six parasites in blood (kesada, lomada, lomadwipa, saurasa, audumbara and jantumatara). Seven parasites that live in kapha-specific body locations (antrada, udaraveshta, hridayada, churu, darbhapushpa, saugandhika and mahaguda), and five parasites originating from feces (kakeruka, makeruka, leliha, sashulaka and sausurada).
There are twenty types of pramehas (urinary disorders characterized by abnormal and increased frequency of urine) - udakameha (polyuria), ikshuvalikarasameha (glycosuria), sandrameha, sandraprasadameha, shuklameha, shukrameha, shitameha, shanairmeha, sikatameha and lalameha (ten diseases caused by kapha). Ksharameha, kalameha, nilameha, lohitameha, manjisthameha and haridrameha are six types caused by pitta. Finally, vasameha, majjameha, hastimeha and madhumeha are four types caused by vata..
There are twenty types of yoni vyapadas (gynaecological disorders). Of these, vatika, paittika, kaphaja and sannipataja are produced by vata, pitta, kapha and a combination of all the three doshas (tridosha) respectively. The remaining sixteen are caused through various permutations and combinations of dosha, dushya and other causative factors. These are raktayoni (menorrhagia), arajaska (amenorroea), acharana (colpitis mycotica), aticharana (chronic vaginitis), prakcharana (deflorative vaginitis), upapluta (secondary dysmenorrhoea), paripluta (acute vaginitis), udavartini (primary dysmenorrhoea), karinini (endo-cervitis), putraghini (abortive tendency), antarmukhi (inversion of uterus), suchimukhi (colpo stenosis), sushka (culpo xerosis), vamini (profluvium seminis), sandhyayoni (undeveloped female sex organs/pseudo-uterus) and mahayoni (prolapse of the uterus). These are twenty types of gynaecological disorders. (9)
Definite relation between dosha and disease:
सर्व एव निजा विकारा नान्यत्र वातपित्तकफेभ्यो निर्वर्तन्ते, यथाहि- शकुनिः सर्वं दिवसमपि परिपतन् स्वां छायां नातिवर्तते,तथा स्वधातुवैषम्यनिमित्ताः सर्वे विकारा वातपित्तकफान्नातिवर्तन्ते|
वातपित्तश्लेष्मणां पुनः स्थानसंस्थानप्रकृतिविशेषानभिसमीक्ष्य तदात्मकानपि च सर्वविकारां स्तानेवोपदिशन्तिबुद्धिमन्तः||५||
sarva ēva nijā vikārā nānyatra vātapittakaphēbhyō nirvartantē, yathāhi- śakuniḥ sarvaṁ divasamapiparipatan svāṁ chāyāṁ nātivartatē, tathā svadhātuvaiṣamyanimittāḥ sarvē vikārāvātapittakaphānnātivartantē|
vātapittaślēṣmaṇāṁ punaḥ sthānasaṁsthānaprakr̥tiviśēṣānabhisamīkṣya tadātmakānapi casarvavikārāṁ stānēvōpadiśanti buddhimantaḥ||5||
sarva eva nijA vikArA nAnyatra vAtapittakaphebhyo nirvartante, yathAhi- shakuniH sarvaM [1] divasamapi paripatan svAM chAyAM nAtivartate, tathAsvadhAtuvaiShamyanimittAH sarve vikArA vAtapittakaphAnnAtivartante|
vAtapittashleShmaNAM punaH sthAnasaMsthAnaprakRutivisheShAnabhisamIkShya [2] tadAtmakAnapi ca sarvavikArAM stAnevopadishanti buddhimantaH||5||
All the endogenous diseases occur invariably due to the vitiation of vata, pitta and kapha. As a bird cannot infringe upon its own shadow even by flying throughout the day, in the same way all the diseases are produced by disturbances in equilibrium in dhatu and cannot occur without vitiation of vata, pitta and kapha. By examining location, sign and symptoms, causes of vitiation of vata, pitta and kapha in any condition, the intelligent physician diagnose all diseases. (5)
Endogenous and exogenous diseases:
भवतश्चात्र-
स्वधातुवैषम्यनिमित्तजा ये विकारसङ्घा बहवः शरीरे|
न ते पृथक् पित्तकफानिलेभ्य आगन्तवस्त्वेव ततो विशिष्टाः||६||
bhavataścātra-
svadhātuvaiṣamyanimittajā yē vikārasaṅghā bahavaḥ śarīrē|
na tē pr̥thak pittakaphānilēbhya āgantavastvēva tatō viśiṣṭāḥ||6||
bhavatashcAtra-
svadhAtuvaiShamyanimittajA ye vikArasa~gghA bahavaH sharIre|
na te pRuthak pittakaphAnilebhya Agantavastveva tato vishiShTAH||6||
Disturbance in equilibrium of dhatus results in number of diseases and these are only due to pitta, kapha and vata i.e. they cannot be produced without involvement of these three doshas. Exogenous diseases are exception to this. (6)
Progression of endogenous and exogenous diseases:
आगन्तुरन्वेति निजं विकारं निजस्तथाऽऽगन्तुमपि प्रवृद्धः|
तत्रानुबन्धं प्रकृतिं च सम्यग् ज्ञात्वा ततः कर्म समारभेत||७||
āganturanvēti nijaṁ vikāraṁ nijastathā''gantumapi pravr̥ddhaḥ|
tatrānubandhaṁ prakr̥tiṁ ca samyag jñātvā tataḥ karma samārabhēta||7||
Aganturanveti nijaM vikAraM nijastathA~a~agantumapi pravRuddhaH|
tatrAnubandhaM prakRutiM ca samyag j~jAtvA tataH karma samArabheta||7||
Exogenous diseases may occur as secondary development after endogenous and similarly endogenous diseases may further progress as exogenous diseases. One should carefully analyze primary causes and secondary complications before starting treatment. (7)
Summary:
तत्र श्लोकौ-
विंशकाश्चैककाश्चैव त्रिकाश्चोक्तास्त्रयस्त्रयः|
द्विकाश्चाष्टौ, चतुष्काश्च दश, द्वादश पञ्चकाः||८||
चत्वारश्चाष्टका वर्गाः, षट्कौ द्वौ, सप्तकास्त्रयः|
अष्टोदरीये रोगाणां रोगाध्याये प्रकाशिताः||९||
tatra ślōkau-
viṁśakāścaikakāścaiva trikāścōktāstrayastrayaḥ|
dvikāścāṣṭau, catuṣkāśca daśa, dvādaśa pañcakāḥ||8||
catvāraścāṣṭakā vargāḥ, ṣaṭkau dvau, saptakāstrayaḥ|
aṣṭōdarīyē rōgāṇāṁ rōgādhyāyē prakāśitāḥ||9||
tatra shlokau-
viMshakAshcaikakAshcaiva trikAshcoktAstrayastrayaH|
dvikAshcAShTau, catuShkAshca dasha, dvAdasha pa~jcakAH||8||
catvArashcAShTakA vargAH, ShaTkau dvau, saptakAstrayaH|
aShTodarIye rogANAM rogAdhyAye prakAshitAH||9||
Summing up the contents- this chapter on “Numerical classification of diseases with eight types of abdominal diseases” lists down three diseases having twenty variants each, three diseases having one each, eight diseases having two each, ten diseases having four each, twelve diseases having five each, four diseases having eight each, two diseases having six each, and three diseases having seven variants each. (8-9)
Tattva Vimarsha:
• Numerical classification of diseases is important in practice for differential diagnosis and planning treatment.
• The diseases can be classified by dosha dominance, cardinal signs, clinical presentation, or location of dosha.
• Doshas are inevitable factors associated with the pathogenesis of every disease. A disease cannot occur without disequilibrium in the doshas.
• In due course of time, endogenous diseases make the patient vulnerable to exogenous diseases and vice versa.
Vidhi vimarsha:
- Classification of diseases, including abdominal ones, have been discussed in this chapter. Since diseases are innumerable, the classification is only restricted to diseases prevalent at that time. [Verse no. 1-2]
- In this chapter, diseases have been classified according to sankhya samprapti (by the number of variants of the disease), vidhi samprapti (i.e., by features or symptoms of the disease). [Verse 3, 4(1)]
- The common thing among these three diseases with seven varieties is that their manifestation site is skin but they vary in clinical features, severity, chronicity etc. Nomenclature of kushtha and pidaka is based mainly on clinical manifestation and in visarpa subtypes have been also mentioned according to doshas involved. [Verse no. 4(2)]
- Diseases are classified into six types on the basis of their etiological factors involved. During classifying atisara both physical and mental factors are considered while classification of udavarta is based on suppression of six important natural urges. [Verse no. 4(3)]
- In this verse 12 diseases have been mentioned which have 5 subtypes. If we analyze five subtypes of each disease we will find that in most of the cases four sub-types are vataja, pittaja, kaphaja and sannipataja. Fifth type varies in many of above mentioned diseases like in gulma & pleeha dosha - raktaja, in chhardi- dwistarthsangyogaja, in bhaktasyanasana - dweshaja, in shiroroga & hridroga - krimija, in pandu – mridbhakshanaja and in unmada – agantuja. Any cause other than dosha remarkably changes pathogenesis of disease so keeping this fact in mind, last subtypes have been separately mentioned and named. For the same reason in kasa, in place of sannipataja, kshataja & kshayaja kasa and in trishna in place of kaphaja - aamaja trishna have been mentioned. In shvasa division has been done on the basis of prominent symptoms and in hikka it is based on both symptoms and causative factors. [Verse no. 4(4)]
- In eight out of set of ten diseases mentioned, classification into subtypes has been based on involvement of soshas. shosha & klaibya pathogenesis and treatment varies with cause of the disease so they are classified on the basis of causative agent involved. [Verse no. 4(5)]
- The basis of classification is different in all the three above mentioned diseases. In shotha subtypes are classified on the basis dosha, in kilasa it is based on clinical features and in lohitapitta it is classified on the basis of site of manifestation. [Verse no. 4(6)]
- Diseases are classified into two types based on etiology, clinical features, severity etc. mainly aimed to properly understand pathogenesis as well as to plan treatment. [Verse no. 4(7)]
- Diseases with no subtypes have been mentioned. The above set includes possible variation of physical and mental causes. Urustambha occurs due to three doshas and ama, sanyasa is psycho-somatic in nature and in mahagada there is involvement of mental entities only. [Verse no. 4(8)]
- While describing diseases with large number of subtypes separate way of classification was used. All the mentioned diseases are first broadly classified in a group and then sub-types are mentioned. Krimi are first classified into bahya, raktaja, shleshmaja and purishaja and then among these four groups twenty types of krimi have been mentioned.( Cha.Vi.7) Twenty types of prameha are broadly classified in three groups on basis of doshas and then subtypes are mentioned, Similarly, yoni vyapada are broadly classified as diseases due to dosha and diseases due to amalgamation of dosha and dushyas and under second category 16 types of diseases have been mentioned. [Verse no. 4(9)]
- Importance of dosha in disease production has been mentioned. Equilibrium of dosha is important aspect of swasthaya or health and if doshas are vitiated they will lead to disease formation. Three important factors by which one can diagnose disease have been mentioned in the above verse. [Verse no. 5]
- It has been emphasized that there is separate category of disease (agantuja vyadhi) in which involvement of doshas may not be necessary. [Verse no. 6]
- It has been clarified that exogenous and endogenous diseases can coexist and at times endogenous diseases are followed by the exogenous ones and even the exogenous ones are followed by the endogenous one. So, while treating such type of conditions secondary development and the primary nature of the disease should be properly analyzed. [Verse no.7]
- With the advancement of scientific knowledge and technology mode of disease classification has changed a lot but the basic principles remain the same. At present, disease classification is based upon etiology, pathogenesis, clinical features etc. So, basis remains the same but due to enhancement in knowledge nomenclature has changed. [Verse no.3]
Udara roga:
Cardinal feature of udara roga is swelling in abdomen so all diseases having presentation with abdominal swelling/distension can be taken under common term ‘udara roga’. In general diseases of stomach and bowel can be included in it. [3][Madhukosh on M.Ni.35/1, Ch.Su.18/31]
So, udara rogas described in Ayurveda can be correlated with different intraabdominal conditions in which abdominal swelling/distension is prime feature eg. abdominal tumours, hepato/splenomegalies, intestinal obstruction, perforation, ascites etc. Subtypes of udara roga are named and described on the cause of swelling/distension. First four types are named after dosha involved. Description of ‘pleehodara’ in Chikitsa Sthana closely resembles with spleen enlargement. Pleeha refers to spleen so all conditions with predominant splenomegaly which cause visible abdominal swelling/distension can be taken by the term pleehodara. Baddha means obstruction so obstructive conditions leading to abdominal swelling/distension can be clubbed as baddhodara. Cause and symptoms closely resembles with that of intestinal obstruction so intestinal obstruction could be the possible modern correlate. Chidra refers to hole. In description of chidrodara it is clearly mentioned that intestine is injured which leads to exudation of material from intestine to abdominal cavity from the injured site. This condition closely resembles intestinal perforation. Udaka literally refers to water. Udakodara or jalodara is a condition in which fluid is accumulated in intestine. Based on resemblance in clinical features it can be correlated with ascites.
Mutraghata:
In mutraghata main symptom is either oliguria or enuria due to suppression of urine formation and obstructive uropathy. Vijayarakshita has mentioned difference between mutrakrichra and mutraghata. In mutrakrichra there is painful and frequent micturition [4] so it can be correlated with dysuria as in urinary tract infection. All conditions in which urinary output is low or absent can be interpreted as mutraghata.[ Ma.Ni.31/1, Dalhana on S.U.58/1, Chakrapaani on C.Chi.26/43-44]
Four types of mutraghata are classified according to dosha. Ashmari refers to stone. [5] So ashmarija mutraghata can be taken as obstruction of urine due to urolithiasis. In the same way based on the nomenclature sharkaraja mutraghata can be taken as condition with gravels in urinary tract, shukraja mutraghata as obstruction due to spermolith and shonitaja refers to blood clot and so it can be taken as hematuria due to tuberculosis, tumor, thrombosis, stone and trauma. .
Ksheera dosha: Ksheera literally means milk, disorders in which breast milk is vitiated can be taken under ksheera dosha. Eight types of ksheera dosha (pathological lactation) are mentioned according to change in physical characteristics of breast milk like color, smell, consistency etc.
Reto dosha :
Retas refers to sperm [6] so various clinical conditions in which sperm is vitiated can be denoted as common term reto-dosha (Sperm disorders) such as oligospermia, azoospermia and sperm dyskynesia. Sub classification of reto dosha has been done on any alteration in physical characteristic of retas with impaired spermatogenesis and impaired sperm emission. [Verse no. 4(1)]
Kushtha:
The disease in which discoloration or disfigurement of skin occurs comes under kushtha. Various dermatological disorders including leprosy are included under kushtha.[ A.H.Ni. 14/3, A.H.Ni. 14/4]
Pidaka:
Pidaka refers to conditions like boil and abscess. [7] These are the inflammatory swelling affecting diabetic or non diabetic immune compromised persons.
Visarpa:
Visarpa word literally refers to spreading, moving or gliding property. [8] It is acute disease which spreads quickly, so all acute inflammatory conditions like erysipelas, herpes, erythema multiforme and acute lymphadenitis can be called visarpa.[ Cha.Chi. 21/11, Chakrapaani on C.Chi. 21/11, Dalhana on S.Ni.10/3, Madhukosha Teeka on M.Ni.52/1]
It can be said that kushtha covers almost all dermatological disorders whereas pidakas are inflammatory swelling which occurs as complications of prameha but can occur in other conditions also. Visarpa is relatively serious condition and can be taken as acute spreading inflammatory skin conditions. [Verse no. 4(2)]
Atisara: All diarrheal diseases including acute, chronic, psychogenic, drug and diet induced, inflammatory and non-inflammatory diseases.
Udavarta:
Udavarta word refers to excretion [9] and is caused by suppression of natural urges due to which path of vata is obstructed resulting in hampering of normal functioning and movement of vata. [Madhukosha Teeka on M.Ni. 27/1] Conditions characterized by retention of feces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic movements in the body.
Gulma:
Gulma is a condition in which there is palpable mobile or immobile lump in abdomen, in shape and constantly increasing and decreasing in size. So, gulma can be taken as any abdominal lump which can be palpated. [ Cha. Ni. 3/7, Cha. Chi. 5/7]
Kasa: Kasa refers to a condition in which air is expelled from the lungs with a sudden explosive sound of cough. [10] Kasa includes all pathological conditions in which coughing is cardinal feature. [ Cha.Chi.18/8, Su.Utt.52/5]
Shvasa:
Shvasa word implies respiration. Shvasa vyadhi refers to pathological conditions in which there is difficulty in breathing. [11] Shvasa is a condition in which person breathes rapidly like a leather bag which inflates and deflates with speed. Shvasa refers to impaired cardiorespiratory function including systemic causes. [Madhukosha Teeka on M. Ni. 12.15]
Hikka:
Hikka is a disease in which hik hik sound is produced. It can be correlated with hiccup [12] and its pathological variation mentioned in Ayurvedic texts ranges from mild to severe life threatening conditions. [ Su.U. 50/6, Madhukosha on Ma.Ni. 12/3]
Trishna:
Trishna literally means thirst, a clinical entity in which patient suffers from excessive thirst not satisfied even after excessive water intake. [ A. U. 48/3 ]
Chhardi: In chhardi (vomiting), food and dosha are forcefully expelled out through mouth.
Arochaka:
Arochaka refers to a clinical condition in which person has loss of taste, appetite and aversion to food. [13]
Shiroroga and Hridroga:
‘Shira’ is head and ‘hridaya’ is heart. Shiro roga are diseases of head and related structures [14] and hridroga is cardiovascular diseases [15]
Pandu:
Pandu is pallor of skin[16] and mucosa and is consistent with anemia.
Unmada: Unmada is a syndrome with multiple manifestations and heterogeneous causes, including psychosis and mood disorders, It is characterized by perturbation / confusion (vibhrama) of mind (manas), intellect (buddhi), consciousness (sangyaa), knowledge (gyaana), memory (smriti), desire (bhakti), manner (sheela), behaviour (cheshtaa), conduct (aachaara). This is cardinal sign of unmada.
Apasmara:
Apasmara is a clinical condition with impaired memory, intellect and cognition, characterized by seizures and impaired consciousness, resembling epilepsy.
Akshi roga, karna roga and mukha roga :
Akshi Roga refers to ophthalmic disorders, karna roga to diseases of ear [18] and mukha roga as disorders of mouth.
Grahani :
Grahani is a group of diseases involving small intestine as in irritable bowel syndrome, inflammatory bowel diseases and all types of disorders of digestion and absorption.
Mada/Murchha:
Mada is acute state of confusion and delirium and murcha is deep loss of consciousness (syncope).
Shosha:
Shosha refers to phthisis, a progressive wasting or consumptive condition such as tuberculosis. It generally refers to depletion of dhatu and hence strength.
Klaibya: Klaibya denotes impotence.[22]
Shotha: Shotha is a condition with swelling/distension. [23]
Kilasa: Kilasa refers to depigmentation of skin as in leukoderma, vitiligo.
Rakta pitta: Disorder of bleeding[24]/coagulopathies.
Jwara : Jwara refers to fever.[25]
Vrana: Vrana (wound) is defined as any lesion in the body causing damage or destruction of the tissue which on healing may leave behind a scar permanently.
Aayama: Aayama refers to abnormal posture of body due to severe muscular spasm or dysotnia.
Gridhrasi: Gridhrasi refers to sciatica lumbosacral radiculopathy and lumbosacral plexopathy.
Kamala: Jaundice
Vatarakta: Gout, vasculitis
Arsha: Arsha refers to hemorrhoids and benign and malignant growth in ano-rectal region.
Urustambha: Urustambha, pelvic girdle myopathy and flaccid paraplegia is seen.
Sanyasa: Sanyasa is a state of unconsciousness in which a person lies in vegetative state and correlates with coma. [ Ch.Su.24/44-45]
Mahagada: Atattvabhinivesha is said to be Mahagada. It is a psychological disorder such as hypochondriasis and paranoia. [ Ch.Chi.10/60] [Verse no. 4(8)]
Krimi Roga: - Krimi refers to various parasitic infestation.
Prameha: Prameha is passage of excessive and turbid urine from many causes.
Yoni Vyapada: Yoni Vyapada refers to different conditions afflicting female genital organs. [27] Broadly it refers to various gynecological disorders. [Verse no. 4(9)]
- Exogenous causes are important cause of morbidity and mortality and so they are included in international classification of diseases. In separate chapter injury, poisoning & certain other consequences of external causes & external causes of morbidity and mortality have been mentioned in ICD-10. Exogenous causes were given importance in ancient times also and so their role in disease diagnosis and treatment has been emphasized in above verse. [Verse no. 7]
The classification of the diseases as mentioned above has been summarized in the table given below.
References
[1]. Manohar P R. Clinical diagnosis in Ayurveda: Challenges and solutions. Ancient Sci Life 2012;31:149-50
[2]. William Morris et al., Stacy Gomes, Marilyn Allen, Glob Adv Health Med. 2012 September; 1(4): 38–41
[3]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 184
[4]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 825
[5]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 114
[6]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 887
[7]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 625
[8]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1001
[9]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 185
[10]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 281
[11]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1106
[12]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1298
[13]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 88
[14]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1073
[15]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1302
[16]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 616
[17]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 53
[18]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 257
[19]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 372
[20]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 823
[21]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1092
[22]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 324
[23]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 1091
[24]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 861
[25]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 428
[26]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 934
[27]. Williams Monier, Sanskrit – English Dictionary, Motilal Varanasi Publications, Reprint- 1997, Page no 858
Glossary
udara (udara, उदर) - Generalized abdominal enlargement.
Mūtrāghātaat(mUtrAghAtAH ,मूत्राघात) - Anuria / Oliguria A disease characterized by anuria or oligouria due to obstruction to the flow of urine.
kṣīradōṣa (kShIradoSha ,क्षीरदोष ) - Vitiation of breast milk, they are classified into eight varieties.
rētōdōṣa (retodoSha ,रेतोदोष) - Seminal abnormalities The term signifies all kinds of seminal anomalies including its qualitative and quantitative disturbances.
kuṣṭha (kuShTha , कुष्ठ) - Multiple dermatological manifestation Chronic Dermatological diseases characterized by disfiguring and discoloration chronic non- suppurative skin disorders.
piḍakā (piDakA ,पिडका) - Mass, postules.
Visarpa (vIsarpa ,विसर्प) - The disease in which multiple and generalized eruptions over the skin are produced and having acute, fast spreading and lethal nature.
atīsāra (atIsAra,अतीसार) - Diarrhea A disease of large intestine having cardinal feature as excessive and frequent defecation of liquid or unformed stools.
udāvarta (udAvarta,उदावर्त) - Retention of feces, urine and flatus. Abnormal condition characterized by retention of feces, urine and flatus, associated with pain and leading to or caused by anti-peristaltic movements in the body.
gulma (gulma,गुल्म) - Lump in abdomen. A lump like formation occurring in the abdomen either mobile or static in nature, circular in shape and constantly increasing and decreasing in size.
plīha (plIha,प्लीह) - Spleen
kāsā (kAsa,कास) - Cough A disease characterized by excessive cough either dry or with mucous.
śvāsa (shvAsa,श्वास) - Dyspnoea due to respiratory disease. It is a respiratory disease marked by recurrent paroxysmal attacks of Shortness of breath, a subjective difficulty or distress in breathing, with or without wheezing due to obstruction in the respiratory airways.
hikkā (hikkA,हिक्का) – Hiccoughs. A disease characterized by production of peculiar sound like hic-hic by mouth.
tr̥ṣṇā (tRuShNA,तृष्णा) - Polydypsia The condition resembles to morbid thirst in which the person even after continuous water intake fails to quench his thirst.
chardi (chardi,छर्दि) - Vomiting A disease in which vomiting is the main symptom.
śirōrōga (shiroroga,शिरोरोग) - Headache and diseases of scalp. Disease conditions wherein headache is prominent feature. Totally there are eleven such conditions. In literature there are again mention of nine conditions affecting the scalp which are also considers among the diseases affecting the head.
hr̥drōga (hRudroga ,हृद्रोग) - Heart diseases. The functional and structural diseases of heart. E.g. Coronary heart disease, Cardiomyopathy etc.
pāṇḍurōga (pANDuroga ,पाण्डुरोग) - Pallor of body, Anemia The term literally means paleness of the skin and mucosa along with yellowish discoloration of urine and feces; marked by lack of blood, strength complexion, body fat and essence of the body tissues.
unmāda ( ,उन्माद) - Psychosis Pscycointellectual disorder in which cognition, memory and behavior gets altered.
(apasmAra,अपस्मार) - Seizures A neurological condition comprising episodes of fearful paroxysmal movements of the body which are produced by perversion of memory, intelligence and other mental functions along with loss of memory during the episode.
grahaṇī (grahaNI,ग्रहणी) - Chronic mal absorption syndrome A disease of small intestines which affects the digestive capacity of a person and thus leading to periodically alternative passage of unformed and formed stools often associated with undigested food particles.
mada ( mada,मद) - Slight intoxication The term signifies an abnormal condition where in the persons becomes out of his senses personified by uncanny activities or behavior.
mūrcchā (mUrcchA,मूर्च्छा) - Syncope A fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood.
śōṣa (shoSha,शोष) - A disease characterized by generalized emaciation.
klaibya (klaibya,क्लैब्य) - Erectile dysfunction, impotent A person’s persistent inability to perform sexual intercourse with the beloved, willing and submissive partner, though having persistent desire due to the lack of erection and if at all attempted ends into failure without ejaculation due to flaccidity of penis associated with breathlessness and perspiration.
śōtha (shotha,शोथ) – It is used synonymous to edema.
lōhitapitta (lohitapittaM,लोहितपित्त) - Hemorrhagic disorder A hemorrhagic disorder in which bleeding occurs through orifices of the body without any direct injury to the body tissues.
jvara ( jvara,ज्वर) - Pyrexia / fever A sense of non well being in senses, mind and body along with raised body temperature and associated by obstruction to the skin.
vraṇa (vraNa,व्रण) - Wound Lesions occurring due to loss of tissue.
āyāma (ayAma,आयाम) – It refers to a state of severe hyper extension or flexion resembling arch and in which there is spasticity in individual's head, neck and body.
gr̥dhrasī (gRudhrasI,गृध्रसी) - Sciatica A disease in which the person experiences radiating pain from low back to the toe leading to pain and difficulty to move the lower limbs, vulture like gait and restricted movements.
kāmalā (kAmalA,कामला) - Jaundice A disease originating due to increased pitta dosha , which may be a resultant of pittaja Paandu; wherein there is generalized yellowish discoloration of the body, and passing orange colored red urine and
normal colored stools.
āma (Ama,आम) - Form of Toxins It is used as a technical word for anything that exists in a state of incomplete transformation. It is mentioned in various contexts like a) In particular, it can refer to a toxic byproduct generated due to improper or incomplete digestion. b) Toxins that were produced at any stage of metabolism and that are circulating through the channels are also sometimes. c) The first stage of any disease is also frequently. d) Any substance which is present in its abnormal state and is unwanted in the body. It represents, in a gross sense, mere indigestion which begins in the stomach, to, in a finer sense, even a faulty enzymatic pathway that prevents or hampers a metabolic cycle or chain. It is a very important factor playing a pivotal role in the genesis of any disease. It is also important in determining the prognosis, drug selection and all other stages of therapy.
vātarakta (vAtarakta ,वातरक्त) - Gouty arthritis A disease manifested due to vitiation of väta and rakta and showing symptoms over small joints of hand and feet along with some dermatological manifestations and chronic in nature.
arśa (arsha,अर्श) - Hemorrhoids A disease characterized by formation of stake like muscular sprouts of various shapes in the anal region.
urustambha (Urustambha,उरुस्तम्भ) - Stiffness of thigh A disease characterized by partial loss of motor and sensory function of thigh region.
sanyāsa (sannyAsa,सन्यास) - Coma A state of profound unconsciousness where the person becomes like a log of wood which leads to death unless untreated; may be due to the action of an ingested toxic substance or of one formed in the body, to trauma, or to disease.
krimi (krimi,क्रिमि) - : Worm infestations. Diseases caused due to worm infestation.
prameha (prameha,प्रमेह) - : Diabetes The disease characterized by symptoms of frequent excessive and turbid urination.
yōnivyāpada (yonivyApada,र्योनिव्यापद) - Abnormalities of female reproductive organs. Disorders of female reproductive system with functional and structural abnormalities.