Chapter XXIV - Knowledge of diseases

Now we shall discourse on the Chapter, which deals with the classification of diseases according to their specific nature (Vyadhi-Samuddheshiya-adhyaya).

Diseases may be grouped under two broad subdivisions, such as Surgical, and Medical, that is those that yield to the administration of purgatives, emetics, oils, diaphoretics, and unguents.

The use or administration of medicated oils and unguents, etc., is not prohibited in a surgical disease, while a case, which is exclusively medicinal in its character, does not admit of the adoption of any surgical remedy. Only a general outline of the nature and symptoms of all diseases will be found to have been briefly laid down in the present work. This work includes within its scope subject matters which have been fully dealt with in other books (having only a general bearing upon all the several branches of the science of medicine).

It has been stated before that anything that afflicts either the body or the living personality—self, or both, is called disease. This pain or affliction may be either physical^[1] in its character (Adhyat-mika), or due to any disturbance in the physical environments of a man (adhibhautika), or to the acts of God (adhidaivika) etc. This three-fold pain may be ultimately transformed into any of the seven kinds of diseases such as, the adi-vala-pravritta, Janma-vala-pravritta, Dosha-vala-pravritta, Sanghata-vala-pravritta, Kala-vala-pravritta, Daiva-vala-pravritta and Svabhava-vala-pravritta.

Adi-vala-pravritta:—

The disease termed Adi-vala-pravritta is ascribed to any inherent defect in the semen or the ovum of one’s parent, which forms one of the original and primary factors of “being” and includes leprosy (Kushtha), hemorrhoids, phthisis etc. This type may be divided into two sub divisions, according as the disease is generated by the deranged paternal or maternal factor at the time of incubation.

Janma-vala-pravritta:—

The Congenital or the Janma-vala-pravritta type usually follows such causes as an improper conduct on the part of the mother during the period of gestation, etc., and embraces such defects or maladies as (congenital) blindness, deafness, dumbness, nasal-voice, and such monstrous aberrations of nature as congenital cretinism, and the births of dwarfs and pigmies. This type, in its turn, admits of two sub-divisions, according as the disease is due to the action of the deranged lymph-chyle (Rasa-krita), or to an ungratified desire of the mother during gestation, or to her gratification of any improper longing or conduct during pregnancy (Dauhridyam).

Dosha-vala-pravritta:—

The Dosha-vala-pravritta (idiopathic) type is due to the action of any of the fundamental bodily humours deranged by an improper diet, or resulting from the dynamical energies of the mind, such as (Rajas and Tamas, etc). This type may be classified under two sub-heads, according as the disease is found to have its origin in the amashaya (stomach), or in the Pakvashaya (intestines), and each of these again may be further divided into two main sub-divisions such as the physical and the mental. The three preceding kinds of diseases include within their category disorders which are called mental or psychical (Adhyatmika).

Samghata-vala-Pravritta:—

The Traumatic type (Samghatha-vala-pravritta) includes diseases that are caused by an external blow or are due to wrestling with an antagonist of superior strength. They may be sub-divided into minor divisions, according as the disease is due to an external wound, or to the bite from any fierce beast or poisonous reptile, etc. These types belong to the adhi-bhautika type, i.e. (brought about by physical causes).

Kala-vala-pravritta:—

The Periodical type (Kala-vala-pravritta) includes diseases that are brought about by the variation of atmospheric heat or humidity with the change of the seasons, and admits of being grouped under two different sub-heads, according as the seasons, which usher these changes in, exhibit natural or contrary features.

Daiva-vala-pravritta:—

The Providential (Daiva-vala-pravritta) type includes diseases that are the embodiments of curses, divine wrath or displeasure, or are brought about through the mystic potencies of charms and spells, as described in the Atharva-Veda. This type may be divided into two minor divisions according as the disease is due to such acts of God as when a man is struck by lightning, etc., or to the malignant influences of demons and monsters, and these may be further grouped under two main sub-heads, according as the disease assumes a contagious character (epidemic), or is purely accidental, and restricts itself to isolated cases (sporadic).

Svabhava-vala-pravritta:—

The Natural or the Spontaneous (Svabhava-vala-pravritta) type includes such natural organic phenomena as, decrepitude, death,^[2] hunger, thirst, sleep, etc. These phenomena are either Kalakrita (timely) or Akalakrita (untimely). They are called Kalakrita when they occur at the proper time in persons who strictly observe the rules of health, and Akalakrita, when they appear at the improper time (morbid or premature) as the effects of unhealthy living. These diseases belong to the Providential or Adhi-daivika type^[3]. Thus we have classified diseases into their several types.

The deranged bodily humours such as, Vayu, Pitta and Kapha should be looked upon as the primary sources of all diseases, inasmuch as symptoms characteristic of each of them may be detected in the case of a disease of whatsoever type, (which usually abates with their corresponding subsidence), and also because the Shastras have ascribed to them the fatherhood of all maladies that assail the human frame.

As the three qualities of Sattva, Rajas and Tamas^[4] are inherent in, and inseparable from, all the phenomenal appearances in the universe which are, in reality, but modifications of their own qualities, so the three fundamental bodily humours underlie at the root of, and run through, the course of all known forms of bodily distemper.

The deranged bodily humours (Dosha) in contact with the different elements, (Dhathu) and excrements (Mala) of the body, together with the difference of their locations and pathological effects, give rise to the different forms of disease.^[5]

The nomenclature of a disease depends upon where the affection of the several elementary principles of the bod y by the deranged bodily humours lies, and which is accordingly styled as it is seated in the lymph-chyle, or in the blood or the flesh, or it is in fat, bone, or in the semen.

Rasaja Distempers:—

Distempers such as aversion to, and loss of relish for food, indigestion, aching in the limbs, fever, nausea and a sense of repletion even without food, heaviness of the limbs, diseases affecting the heart, jaundice, constriction of any internal passage of the body (Margo-parodha), emaciation of the body (cachexia), bad taste in the mouth, weak feelings in the limbs, premature whiteness and falling off of the hair, and symptoms indicative of senile decay, should be regarded as having their seat in the deranged lymph-chyle (Rasa).

Raktaja Diseases:—

Maladies such as Kushtha (cutaneous affections in general), Visarpa (erysipelas), Pidaka (pustular eruptions), Mashaka, Nilika, Tilakalaka (specks), Nachya (tans), Vyanga (stains), Indralupta (alopecia), enlarged-spleen, Vidradhi (abscess), Gulma (abdominal glands), Vata-shonita (a kind of leprosy), Arsha (piles), Arvuda (tumours), aching of the limbs, menorrhagia, hemoptysis, etc. as well as suppuration in the regions of the anus and the penis should be deemed as having their origin in the blood (Raktaja) contaminated by the deranged bodily humours.

Mansaja-Diseases:—

Similarly Adhi-mansa, Arvuda, Arsha, Adhi-jihva, Upa-jihva, Upakusha, Gala-sunthika, Alaji, Mansha-sanghata (condylomatous growth), Astha-prakopa, Gala-ganda, Ganda-mala (scrofula), etc. should be regarded as diseases having their seat in the flesh, vitiated by the deranged bodily humours.

Medaja-Distempers:—

Diseases, such as Granthi, Vriddhi, Gala-ganda, Arvuda, and Ostha-prakopa are due to the action of the deranged fat. Madhu-meha (diabetes), obesity and abnormal diaphoresis, etc. should be regarded as having their origin in the humour-deranged fat of the body.

Asthija-Disease:—

Adhyasthi, Adhi-danta, Asthi-toda, Asthi-shula and Ku-nakha, etc. are the diseases which should be regarded as the outcome of the deranged bodily humours affecting the bones.

Majjadoshaja Diseases:—

The vanishing of sight, epilepsy, vertigo, conjunctivitis and the appearance of a broad-based ulcer about the Parva-sthana and a sense of heaviness in the thighs and knee-joints should be regarded as having their seat in the deranged marrow.

Shukra-doshaja:—

Diseases such as, impotency, entire aversion to sexual intercourse, Shukrashmari (seminal concretions), Spermatorrhea, and other seminal affections, should be regarded as having their seat in the deranged semen.

Cutaneous affections, constipation or looseness of the bowels, and diseases impeding or arresting the proper functions of the sense-organs or in any way bringing about their aberrations, should be regarded as respectively located in the receptacle of the feces and the sense organs.

Thus we have briefly enumerated the names of diseases, the specific nature and symptoms of which will be fully discussed later on under their respective heads.

Authoritative verse on the Subject:—

The deranged and aggravated humours, freely coursing through the body, give rise to a disease at the place in which they are incarcerated owing to an obstruction in their natural passage.

Now it may be again asked, whether the relation of a disease, such as fever, etc. with the deranged bodily humours is constant and inseparable, or otherwise. All human beings would be in danger of perpetually falling ill in the event of the said connection relation being constant and unseparable; but in case of their separate existence, it is but natural that their characterstic symptoms should separately manifest themselves instead of being simultaneously present with fever, etc. as they are found to be in reality. And accordingly the theory, that diseases (such as, fever, etc.) and the deranged bodily humours have a separate existence, and are not prima facie intimately co-related with one another falls to the ground. On the other hand, the assumption of their separate existence invalidates the incontestable conclusion, that diseases such as, fever, etc. are fathered by the deranged humours of the body.

Hence it may be safely asserted that no disease can occur without the direct mediation or intervention of the deranged bodily humours. Yet the connection relation) which exists between the two is neither constant nor separable. As the physical phenomena of lightning, storm, thunder and rain can not happen independently of the sky (cloud); and yet they sometimes do or do not occur with the presence of a cloud; again as bubbles, though in reality but the modifications of the underlying water, do not swell up on its surface at all times, so the connection between a disease and the bodily humours is neither universally separable or inseparable.

Authoritative verse on the subject:—

We shall describe the nature, intensity and quality of diseases with their complications and give the number of their different types. Diseases [omitted to be mentioned in the chapter on Nidana (etiology)] will be found fully dealt with in the supplementary part of the present work (Uttara-tantra).

Thus ends the twenty-fourth Chapter of the Sutrasthana in the Sushruta Samhita which treats of the classification of diseases according to their specific nature.

Footnotes and references:

[1]:

Certain commentators interpret the term “Atman” in “Adhyatmika” to mean body only, and accordingly designate all phenomena that may be manifest in the body as Adhyatmika.

[2]:

According to certain authorities “Death” may also mean death of tissues.

[3]:

Several authorities on the other hand include such diseases as thirst, hunger etc., within the Adhyatmika class inasmuch as they are but the indications of the want of certain vital principles in the body and appear in the mental plane (Adhyatmika) only as longings for water, food, etc

[4]:

The Sattva Illuminating or psychic principle. Rajas:—Principle of Action and Co-hesion. Tanias: —Principle of Nescience or Illusion.

[5]:

This answers the question, “how can the deranged bodily humours bring about a disease of the Adhi-vala-type—a disease which is specifically due to the derangement of the innate and primary factors of life.”