Sushruta Samhita, volume 1: Sutrasthana

by Kaviraj Kunja Lal Bhishagratna | 1907 | 148,756 words

This current book, the Sutra-sthana (english translation), is the first part of this voluminous medical work. It contains a large summary of the knowledge envelopig the medical aspects of Ayurveda. Descriptions of diseases, various diets and drugs, the duties of a surgeon, surgical procedures, medical training; these are only some of the numerous s...

Chapter XV - Knowledge of doshas etc

Now we shall describe the Chapter which treats of development and non-development of the humoral constituents. of the body and excrements (Dosha-Dhatu-Mala-Kshaya-Vriddhi-Vijnaniya-adhyaya).

Since the human body is constituted of humours, (Doshas), excretions (Mala), and the fundamental principles (Dhatus) of blood, marrow, etc., hear me discourse on the features which are peculiar to each of them.

The Vayu:—

The imparting of motion to the body (Praspandana), the carrying of the sensations of the respective sense organs (Udvahana), the passing down of food to its proper receptacles (Purana), the separation of excretions from the assimilated food matter (Viveka), and the retention and evacuation of urine and semen, etc. (Dharana) should be ascribed to the functions of the five kinds[1] of Vayu (nerve force) which support the body.

The Pitta:—

Pigmentations or colouring (Ragakrit), the digestion of food and metabolism of tissues (Paktikrit), the vitalisation and nutrition of the protaplasmic cells (Ojakrit), the origination and preservation[2] of eye-sight (Teja-Krit), the germination of heat and maintenance of the temperature of the body (Ushma-Krit), and the origination of the faculty of intellection (Medha-Krit) should be regarded as the functions of the five kinds[3] of Pitta, which contribute to the preservation of the body through its thermogenetic potency (Agni-Karma).

The Shleshma:—

The function of the five kinds[4] of Shleshma is to lubricate the interior of the joints (Sandhi-Samshleshana), to contribute to the gloss of the body (Snehana), to aid in the formation of healthy granules in sores (Ropana), to add to the size of the body (Purana), to build fresh tissues (Vrimhana), to impart a pleasant or soothing sensation to the body (Tarpana), to increase its strength (Valakrit), and to give firmness to the limbs (Sthairya-krit), thereby contributing to the welfare of the body by supplying it with its watery element.

The Rasa or the lymph chyle exercises a soothing effect upon the entire organism and tends to contribute to the increased formation of blood. The blood, in its turn, increases the healthful glow of the complexion, leads to the increased formation of flesh and muscles and maintains vitality in the organism. The flesh contributes towards the stoutness or rotundity of the limbs and occasions the formation of fatty matter in the system. The fat gives rise to the glossiness (formation of oily or albuminous matter) of the body and primarily contributes towards the firmness and growth of the bones. The bones, in their turn, support the body, and contribute to the formation of marrow. The marrow contributes towards the formation and increase of semen, and fills in the internal cavities of the bones, and fonns the chief source of strength, amorous feelings and hilarity. The semen gives rise to valour and courageousness, makes a man amorously disposed towards the female sex, increases his strength and amativeness, is the sole impregnating principle in the male organism, and is possessed of the virtue of being quickly emitted.

The excreta or the fecal matters of a man are indispensably necessary for the preservation of the body. They contain the wind and digestion (being primarily connected with the movements of the bodily Vayu and the feeling of hunger). The urine fills the receptacle of the bladder, and is possessed of the property of washing or draining off the waste or refuse matter of the organism; whereas perspiration tends to moisten the skin.

The artava (menstrual blood) is endued with the same properties as its arterial namesake, and is one of the essential factors in a woman which makes impregnation possible. The fetus or impregnated matter (Garbha) serves to make patent the features characteristic of pregnancy. The breast-milk in its turn tends to bring about an expansion of the mamme (of a woman), and maintains the life of her child (by suppling it with the necessary and nutritive element of food). These Vayu, etc. should be duly preserved in their normal condition.

Now we shall describe the symptoms which attend the loss or waste of any of the foregoing principles of the body.[5]

The loss of the bodily Vayu (nerve-force) is followed by a state of languor, shortness of speech, uneasiness or absence of hilarity, and loss of consciousness. The loss of (Pitta) is marked by a dulness of complexion, diminution of the bodily heat and an impaired state of internal fire (digestive heat). The loss of phlegm (Kapha) is marked by dryness, a sensation of internal burning, a feeling of emptiness in the stomach and other cavities or chambers of the body, looseness of the joints (a feeling as if the joints were all broken), thirst, weakness, and insomnia. In such cases the medical treatment should consist of remedial agents which are capable of directly contributing to the growth or formation of the humour so lost or deteriorated.

Similarly the loss of lymph chyle is marked by pain about the region of the heart, Angina Pectoris, with palpitation of the heart, a sensation of emptiness or gone-feeling in the viscus, and thirst. The loss of blood is attended with such symptoms as roughness of the skin, and a craving for acid food or drink. The patient longs to be in a cool place and asks for cool things, and the veins become loose and flabby. The loss of flesh is marked by emaciation of the buttocks, cheeks, lips, thighs, breasts, armpits,[6] neck, and the calves of the legs. The arteries seem loose and flabby, and the body seems to be dry and inert, accompanied by an aching or gnawing pain in its members. The loss of fat is followed by such symptoms as the enlargement of the spleen, a sense of emptiness in the joints, and a peculiar dryness of the skin and a craving for cold and emollient meat. The degeneration of the bones is marked by an aching pain in the bones and bone-joints, a wasting of teeth and gums, and a general dryness of the body. Similarly, the loss or waste of marrow is characterised by the formation of a lesser quantity of semen, aching pain in the bones and breaking pain in the bone-joints which have become marrowless. The loss or waste of semen is marked by pain in the penis and the testes, and by incapacity for sexual intercourse. In such cases the emission of semen but rarely happens, and is then perceptibly deficient in its quantity, the emitted matter consisting of a small quantity of semen marked with shreds of blood. The medical treatment under the preceding circumstances should consist of remedies of such medicinal virtues as are found to directly and immediately contribute to the formation of the bodily principle (thus wasted or lost).

The loss absence, suppression or scanty formation of fecal matter is attended with a sensation of pain at the sides and the region of the heart, and the upward coursing of (the incarcerated) wind or flatus, accompanied with a rumbling sound about the region of the liver and the intestines. Similarly, the loss, (absence or scanty formation) of urine is marked by an aching pain in the bladder, causing it dribble or to come out in thin and scanty jets. Here, as in the foregoing instances, the remedial agents should consist of drugs which directly contribute to the formation of urine. Similarly the waste, absence or scanty formation of perspiration is followed by such symptoms as numbness about the pores of the hair, and dryness of the epidermis (skin). The sense of touch is perceptibly affected, and perspiration is entirely stopped. The medical treatment in such a case consists in the application of medicated unguents, lubrications, diaphoretics, and adoption of measures (that tend to produce a copious perspiration).

In the case of loss or waste of the catamenial flow, the menses do not appear at the appointed time or are scanty. The vagina seems stuffed and painful. The medical treatment in such cases consists in the adoption of alterative or cleansing measures, and in the administration of drugs of a heat-making (agneya) potency or virtue.

The loss or waste of breast-milk is characterised by a shrunken condition of the mamme, and suppression or scanty secretion of the fluid. The medical treatment in such cases lies in the administration of drugs which generate Kapha.

The atrophy or wasting of the fetus in the womb (during the period of gestation) is marked by the absence of any movement in the uterus and the non-distended condition of the sides or walls of the abdomen. The treatment consists in the application of Kshira Vastis enemas of medicated milk into the region of the uterus) in the eighth month of gestation, and prescribing courses of emollient fare for the patient mother)[7] Now we shall describe the symptoms which mark the excess (excessive accumulation in the body) of any of the fundamental humours, principles and excrements of the body.

The quantities of these humours, principles and secretion, are abnormally increased through the use of substances that primarily contribute to their formation in the organism.[8]

An excess of Vayu in the body is marked by such symptoms as roughness of the skin,[9] emaciation of the body, darkness of complexion (lit: blackness of hue), a little tremor or trembling of the limbs, longing for heat, or for hot things, insomnia, thickness or increased consistency of the fecal matter and decrease of bodily strength. (Similarly, an abnormal) increase of Pitta is characterised by a sallow complexion or a yellowish colour of the skin, a general burning sensation in the body as well as insomnia, a craving for cold contacts and cooling things, diminution of strength, weakness of the sense organs, fits of fainting and yellowness of the conjunctive, stool and urine.

An excess of Kapha in the body is marked by such symptoms, as the whiteness, coldness and numbness of the body, heaviness of the limbs, a sense of drowsiness and languor, somnolence, and a feeling of looseness of the bone-joints.

Similarly, an increased germination of lymph chyle (Rasa) in the body is manifest by such characteristics as, nausea, water-brash, and an increased flow of salivary secretion. A plethora of blood in the system gives a reddish glow to the complexion and the white of the eyes, and imparts fullness to the veins. An increase of flesh is marked by the rotundity and fullness of the buttocks and the lips, as well as of the penis, arms, and the thighs, and an increased heaviness of the whole body. An excess of fat in the body imparts an oily gloss to the skin. The sides of the abdomen are increased in bulk, and the body emits a fetid smell, and the person is assailed with cough and dyspnea. An excessive formation of bone (abnormal ossification) is attended with such symptoms as the cutting of additional teeth and the abnormal development of any of the bone-structures. An excessive formation of marrow gives rise to a heaviness of the eyes and to the members of the body.

An excess of semen in the body is marked by an excessive flow of that fluid and gives rise to the formation of gravels (concretions) in the bladder which are known as Shukrashmari. An abnormal increase in the formation of fecal matter is attended with distension of the abdomen and colic pains in the loins and the intestines. An excessive formation of urine is manifest by constant urging for micturition and distension of the bladder, attended by a kind of gnawing or aching pain.

Similarly, an increased secretion of perspiration is attended with an itching of the skin which emits a bad odour. An excess in the quantity of catamenial blood[10] gives rise to an aching of the limbs and an excessive flow. So also an excess in the quantity of the breast-milk is attended with frequent secretions of that fluid, and with inflammation and pain in the mamme. An excessive growth of the fetus in the uterus tends to abnormally swell.the region of the abdomen, and is accompanied by anasarca, or dropsy, of the lower extremities (phlegmasia dolens).

These abnormal excesses of the aforesaid humours and principles, etc. of the body should be checked or remedied with corrective (cleansing) or pacifying measures as would be indicated by their respective natures, so as not to reduce them to a smaller quantity than that in which they are found in the normal and healthy state of a body.

Metrical text:—

An increased quantity of a bodily principle gives rise to a similar increase in the quantity of one immediately succeeding it in the order of enumeration as stated above; aud hence an increase in any of the fundamental principles of the body should be checked and reduced to its normal quantity.

Now we shall describe the characteristic features of the strength-giving principles of the body, as well as the symptoms that mark their loss or waste. The quintessence of all the fundamental principles of the body, starting with lymph chyle and ending with semen, is called the Ojas, which is identical with what is termed “vital power.” This view of oneness of vitality with protoplasmic albumen has been adopted in the present work[11]

This Ojas (albumen) or strength-giving principle serves to impart a firm integrity to the flesh (and the muscles), exercises unbounded control over all acts of vitality, improves the voice and complexion, and helps both the external (operative) and the internal (intellectual) sense organs, in duly performing their natural functions.

Authoritative verses on the subject:—

Ojas (albumen) being of a white colour belongs to the class of Somatmaka (cooling) substances. It is cooling, oleaginous, and firm (Sthira), contributes to the formation and growth of flesh, maintains its integrity or holds it firm, and is mobile or capable of moving about from one place to another within the organism.[12] It is further soft and shiny, and is possessed of the most efficacious virtue and should be regarded as the most important element (seat) of vitality. The whole body with its limbs and members is permeated with Ojas, and a loss or diminution in its natural quantity leads to the gradual emaciation (and ultimate dissolution) of organism.

A blow, a persistent wasting disease, anger, grief, cares and anxieties, fatigue and hunger, are the causes to which should be ascribed the wasting or disappearance of this strength-giving principle (albumen) of the body. The bodily albumen, through the agency of the abovesaid causes, is wasted through the channels carrying the different fundamental principles of the body. Albumen is transformed into strength which radiates from the heart.

A deranged or vitiated albumen (Ojas) is characterised firstly by its dislodgment from its proper seat or locality (Visransha), secondly, by a change or modification of its native virtues in contact with the deranged humours or disordered organs (Vyapad) and thirdly, by wasting away (Kshaya).

The first of the preceding properties (dislodgment) gives rise to such symptoms as looseness of the bone-joints, numbness of the limbs, dislodgment of the deranged humours from their respective receptacles and suppression of the (bodily and intellectual) functions. To the second of the foregoing properties, (change or modification of its natural virtue through contact with the deranged bodily humours etc.) should be ascribed such symptoms, as numbness and heaviness of the limbs, dropsy due to the action of the deranged bodily Vayu, discoloured or changed complexion, feeling of malaise, drowsiness and somnolence. The third property of the deranged albumen, (loss or wasting), brings on fits of fainting, loss of flesh, stupor, delirium and ultimately death.

Authoritative verses on the subject:—

A deranged state of albumen is marked by the three abovesaid properties of dislodgment from its proper seat (Visransha); by a change of its natural virtues through contamination (Vyapad) and by wasting (Kshaya. The first of these properties (Visransha) is characterised by looseness of the joints, by an inert state of the body, by a sense of fatigue, by a dislodgment of the deranged humours from their natural seats, and by a suppression of the bodily and intellectual functions. Numbness and heaviness of the limbs, malaise, a discoloured complexion, drowsiness, somnolence and dropsical swelling brought about by a deranged state of the bodily Vayu, should be considered as natural consequences of the Vyapad (change of the natural virtues of albumen through contamination). The loss or waste of Ojah (albumen) is marked by such symptoms as fits of fainting, emaciation of the body, bewilderment and distraction of the mind, delirium and loss of consciousness and ultimately death.

The medical treatment in cases of dislodgment or flowing out external secretion! of albumen from its natural seat (Visransha), as well as in the event of it becoming contaminated by the vitiated principles of the body, should consist in improving its quantity by elixirs and remedies possessed of rejuvenating properties, tending to increase the quantity of such fluid (albumen in the body. A patient who has lost all consciousness owing to an excessive loss or waste of albumen) should be given up by a physician (as incurable).

The oily or albuminous matter found within the components of the other fundamental principles (Dhatu) of the body as metabolised by the internal heat and regularly metamorphosed into the succeeding ones) should be grouped under the head of fiery or thermogenetic (Agneya) substances. This fatty matter (Vasa) predominates in the female organism and produces its peculiar softness, beauty and pleasing shape, causes the growth of scanty but soft hair on its surface. It strengthens the eyesight and increases the energy of the body, improves its power of digestion and heightens its glow and complexion. Fat is deranged by such acts as, an abuse of astringent, bitter, cold, parchifying or Vistambhi (indigestible food which remains stuffed in the stomach) substances, a voluntary repression of the natural urging for evacutions of the body, by excessive sexual indulgence, and fatiguing physical exercise, or by the draining action of any particular disease.

An instance of dislodgment of fat from its proper seat or locality is attended by such symptoms as roughness of the skin, loss of the natural healthful glow of the body and a breaking or an aching pain in the limbs. Anemia or a gradual emaciation of the body, impaired digestive function and a slanting or downward course of the deranged humours, mark the case where the bodily fat has undergone a change in its natural properties through any foul contamination. A case of loss or waste of the bodily fat is marked by such symptoms as, impaired digestive function, dulness of sight, decay of strength and aggravation of the bodily Vayu, and always ends in death.

The medical treatment in the latter case (loss of fat) should consist in the administration of oily or emollient drinks, use of medicated unguents or lubrications, Pradeha (plasters of oleaginous substances) and Parisheka (washes) and a diet comprising light, cooling and well-cooked articles of food.

Metrical texts:—

A person suffering from a wasting of any of the constituent humours or fundamental principles or excrements of the body, as well as one suffering from loss of Ojah (albumen) naturally craves for drink and food that tend to contribute directly to the formation of the matter (or bodily principle) so lost or wasted. Conversely, the particular food or drink longed for by a person suffering from a loss or waste of any of the abovesaid fluids or principles, should be looked upon as possessed of a curative virtue in that particular case. Such a person devoid of consciousness and divested of his bodily and intellectual functions through a deranged state of the bodily Vayu nerve-force) and extremely weak and enfeebled owing to the loss of the vital fluid should be regarded as past all cure.

Etiology of Obesity:—

Obesity or loss of flesh (Karsha) should be ascribed to changes in the condition of the lymph chyle. The lymph chyle derived from the assimilated food of a person, who is habituated to a course of diet which tends to promote the quantity of the bodily Kapha or is in the habit of pampering his belly even when a previous meal has not been thoroughly digested, or who is addicted to a habit of sleeping in the day, or leading a sedentary life, or is averse to taking any sort of physical exercise, continues in an immature State and is transformed into a serum of sweet taste which moves about within the body, engendering the formation of fat which produces excessive stoutness. A person afflicted with obesity develops such symptoms as shortness of breath, thirst, ravenous appetite, excessive sleepiness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech. Owing to the softness of fat, a fatty person is unfitted for every kind of work. Capacity for sexual intercourse is diminished (in such a one), owing to the obstruction of the passage of semen by phlegm and fatty deposits; and the growth of the rest of the root-principles of the body such as, lymph chyle, albumen, semen, etc., is considerably arrested owing to the deposit of fatty matter within the channels of the internal passages of the body, thus seriously affecting his bodily strength. An obese or excessively corpulent person is likely to be afflicted with any of the following diseases such as, urethral discharges, eruptions, boils, carbuncles, fever, fistula in ano, or with any of the diseases which are caused by a deranged state of the bodily Vayu; and such attacks are invariably found to terminate in death. Any disease in such a person is apt to develop into one of a violent and dangerous type owing to the obstruction of the internal channels with deposits of fat. Hence all things or conditions which foster the growth of abnormal fat should be carefully avoided.

Accordingly medicated compositions, consisting of such drugs and substances as Shilajatu, Guggulu, Go-Mutram, Triphala, Loharaja, Rasanjana, Madhu, Yava, Mudga, Koradusha, Shyamaka and Uddalaka which are anti-fat in their properties, or of remedial agents possessing the efficacy of cleansing the internal channels, as well as enematas of liquefacient solutions technically known as Lekhana Vastis and physical exercise should be prescribed.

Etiology of Karshya:—

Loss of flesh or a gradual emaciation of the body should be ascribed to the partaking of food in the composition of which, matter which aggravates the bodily Vayu largely or excessively enters, to over-fatiguing physical exercise, sexual excesses, over study, fright, grief or anxiety, to the keeping up of late hours, to unsatisfied hunger, insufficient food, and to astringent food which tends to dry up the lymph chyle. The chyle, thus parched up, moves about in the organism, but fails to impart to it the necessary nutritive element owing to its being insufficiently charged with it, thus causing the body to grow extremely emaciated.

A patient suffering from extreme emaciation of the body fails to bear the inclemencies of weather and the variations of terrestrial heat, and becomes apathetic to all movements and does but imperfectly perform the functions of vitality, and is also incapable of enduring thirst or hunger. The bodily strength suffers a gradual diminution, and diseases, incidental to a deranged state of the bodily Vayu, make their appearance, and the patient has to meet his doom from any of the following diseases as asthma, cough, Shosha (phthisis), enlarged spleen or liver, abdominal dropsy, dyspepsia, abdominal glands and hemoptysis. Any disease appearing in such a patient develops into one of a violent type owing to the loss or diminished condition of the bodily strength or protoplasm (Prana).

Contrarily, conditions or factors which produce obesity should be avoided. A case of patent obesity should be checked with a medicated compound, consisting of such drugs as, Payasya, Ashvagandha, Vidari, Vidarigandha, Shatavari, Vala, Ativala, Nagavala and such other drugs of sweet taste. Diets consisting of thickened milk, clarified butter, curd, meat, boiled Shali rice, Yasthika, wheat, barley, etc., should be prescribed in the case; and sleep in the day, sexual indulgence, physical exercise, etc., should be prohibited. Enematas of nutritive substances can be likewise given with advantage.

On the other hand, the lymph chyle of a man, who partakes of food belonging to both the abovesaid classes, courses through his organism and strengthens the root-principles of his body, thus giving a middling or healthful rotundity to his limbs owing to its properties being equipoised. A man possessed of such a body is capable of all kinds of work and movement. He can fairly stand the inclemencies of weather and the keenness of hunger and thirst, and will gain in strength and energy. Care should be always taken to have such a well equipped body of moderate size.

Authoritative verses on the subject:—

Excessively corpulent and excessively lean persons are alike condemnable. A body which is neither too stout nor too lean, but strikes the mean as regards plumpness, is the best. A lean frame should have the preference to a stout one. The enraged or aggravated bodily humours dry up the fundamental principles of the body, such as the lymph chyle etc., just in the same way as a well-kindled fire will evaporate the water contained in a basin placed over it. Since (the temperament, constitution, size and the fundamental principles of) the body vary in different individuals; (and since the body, in its turn, undergoes such gradual transformations as infancy, youth and old age), and changes its state each moment, it is absolutely impossible to lay down the exact quantity of the deranged humours, excrements and fundamental principles (of lymph chyle, blood, semen, albumen, etc.) that may be found in the human organism. Hence it is necessary for a physician to ascertain their state of equilibrium (their continuance in normal state and quantity) at any particular time; and which should be pronounced only in cases where signs of perfect health would be visible. An experienced physician would naturally draw a contrary inference from the improper functions of the organs in an individual. A person with an uniformly healthy digestion, and whose bodily humours are in a state of equilibrium, and in whom the fundamental vital fluids course in their normal state and quantity, accompanied by the normal processes of secretion, organic function, and intellection, is said to be a healthy person.

An intelligent physician should preserve the state of health in a healthy individual, while he should increase or decrease the quantity of the bodily humours, vital fluids, or excrements in a sick patient according to the exigencies of the case until his health is perfectly restored.


Thus ends the fifteenth Chapter of the Sutrasthana in the Sushruta Samhita which treats of the Development and Non-development of the humoral constituents of the bodv.

Footnotes and references:


They are called Prana, Udana, Samana, Vyana and Apana.


N. B. —The Vayu, Pitta, and Shleshma, (Kapha), though ordinarily translated as wind, bile and phlegm, differ in their meaning from their usual English synonyms. We reserve the treatment of these subjects for a separate place in another part of the book when we shall have occasion to deal with the essentials of Ayurvedic Physiology—Tr.


They are named as Ranjaka, Pachaka, Sadhaka (Medhakrit and Ojakrit), Alochaka and Bhrajaka.


They are known as Shleshmaka, Kledaka, Vodhaka, Tarpaka, Avalamvaka.


Such a loss or perceptible deterioration of any of them should be ascribed to the use of excessive cleansing or cathartic (Samshodhana) and pacifying (Samshamana) measures, or to a repression of the natural urgings of the body, or to a course of violent or overfatiguing physical exercise, or to amorous excesses, or to the use of unwholesome and unsuitable food, or to, grief, etc.


The armpits look thin, narrow and contracted.


Several editions read invigorating diets, egg, etc.


Several Editions read it as an additional text.


Several Editions read roughness of speech.


An abnormal flow tends to stimulate the voluptuous sensation of a woman to a considerable extent, and is followed by a sense of reactionary weakness. It emits a fetid smell and originates ovarian tumours.


The Sanskrit term “Ojas” has a variety of meanings. Primarily it means protoplasmic matter as found in cells (Vindus). Secondarily it means albumen as we shall describe later on in the chapters on etiology and therapeutics of Prameha. Several authorities hold a contrary view stating that Ojas (albumen) forms only one of the essentials of vitality and that the two are by no means identical.


Several editions read Rasa, meaning it to be possessed of a sweet taste.

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