Chapter 11 - The Etiological Factors of Disease

Caraka classifies all etiological factors of diseases generally into two types, i.e., (nija—endogenous) and (āgantu—exogenous) (Carakasaṃhitā Sūtrasthāna 18.4 and 6). Sushruta pursues the subject further into its metaphysical origins and declares in his treatise in keeping with the general concept in all branches of the science that disease is the occurrence of suffering (Suśrutasaṃhitā Sūtrasthāna 24.4).

That suffering is of three kinds (ādhyātmika, ādhibhautika and ādhidaivika).

1. Having its source in oneself,
2. Having its source in physical elements and creatures of the world, and
3. Having its source in natural and supernatural agencies.

This triad of etiological categories is in accordance with the Sankhya concept of the triad of the causes of all suffering Sushruta makes further subdivision from a practical point of view of this triad so as to make seven categories of disease in the light of their etiological factors.

They are thus:—

[Suśrutasaṃhitā Sūtrasthāna 24.4]

A Endogenous Category

[1. Ādibala-pravṛtta—Hereditary diseases. Inherited disease conditions from inherent defect in genesis of one’s parents. These are genetic etiological factors.]

[2. Janmabala-pravṛttā—Congenital disease. The disease conditions which result during the fetal period of life in the mother’s womb. These are congenital etiological factors.]

[3. Doṣabala-pravṛtta—Nutritional or metabolic diseases. It also includes

psychic and somatic conditions due to internal derangement of function or structures. These are the nutritional or metabolic etiological factors.]

B Exogenous Category

I. Adhibhautika:—

4. Samghatabala-pravritta—The group of diseases that are due to all kinds of trauma or injury from physical, chemical and biological sources. (Carakasaṃhitā Sūtrasthāna 18. 4)

II. Adhidaivika:

5. Kalabala-pravritta—Diseases resulting from abnormality of climate and season.

6. Daivabala-pravritta—Those of supernormal origin or nature such as pandemics, epidemics, emergent conditions due to atmospheric upheaval and such other dreadful disease-conditions difficult to explain ordinarily

7. Svabhavabala-pravritta—Natural conditions or disabilities characterizing human life such as hunger, thirst, sleep, fatigue, decay, senescence and death.

These types of conditions may act either as exciting factors or as predisposing factors (mudha or preraṇa). (Carakasaṃhitā Sūtrasthāna 20.4-5) and they may act either as immediate Sannikrishta (saṃnikṛṣṭa)or as remote causes Viprakrishta (viprakṛṣṭa). Those above-mentioned classifications are exhaustive and the entire varieties of etiological factors both biological and material are comprehended by them.