Ashtodariya Adhyaya

Ashtodariya Adhyaya
Section/Chapter	Sutra Sthana Chapter 19
Tetrad/Sub-section	Roga Chatushka
Preceding Chapter	Trishothiya
Succeeding Chapter	Maharoga
Other Sections	Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana

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(Sutra Sthana Chapter 19, Chapter on the Numerical Classification of Diseases)

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.

Keywords: kapha, nija, pitta, sannipattika, vikara, vata, numerical classification of diseases.

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.

Sanskrit text, Transliteration and English Translation

अथातोऽष्टोदरीयमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō'ṣṭōdarīyamadhyāyaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto~aShTodarIyamadhyAyaM vyAkhyAsyAmaH||1||

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

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 murchcha (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 of 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 of 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 of 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 of 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 of 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 nijastathāgantumapi 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.