Sushruta Samhita Sutrasthana Chapter 24: Vyadhi Samuddesheeya Adhyaya (Knowledge of Diseases)

The 24th chapter of Sutrasthana of Sushruta Samhita is named as Vyadhi Samuddesheeya Adhyaya. This chapter deals with the Knowledge of Diseases.

अथातो व्याघिसमुद्देशीयमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥

Now, we will expound the chapter by name Vyadhi samuddesiya- knowledge of diseases in brief; as revealed by the venerable Dhanvantari.

Vyadhi Bheda: Kinds of diseases

द्विविधास्तु व्याघय:- शस्त्रसाध्याः, स्नेहादिक्रियासाध्याश्च । तत्र शस्त्रसाध्येषु स्नेहादिक्रिया न प्रतिषिध्यते, स्नेहादिक्रियासाध्येषु शस्त्रकर्म न क्रियते ॥३॥

Broadly, there are two kinds of diseases,

We also need to know that in shastrasadhya vyadhis i.e. diseases treatable by surgery – Snehana etc therapies can also be used i.e. they are not forbidden to be administered. On the other hand, in Snehadi Kriya Sadhya Vyadhis i.e. in diseases treatable by oleation etc., shastra vidhi i.e. surgical procedures are not done.

Trividha Dukha: Three kinds of miseries

अस्मिन् पुनः शास्त्रे सर्वन्त्रसामन्यत् सर्वेषां व्याधीनां यथास्थूलमवरोधः क्रियये। प्रागभिहितं ’तद्दुःखसंयोगा व्याधय’ (सू, अ, १) इति। तच्च दुःखं त्रिविधम् आध्यात्मिकम्, आधिभौतिकम्, आधिदैविकमिति । तत्तु सप्तविधे व्याधावुपनिपतति। ते पुनःसप्तविधि व्याधयः; तद्यथा- आदिबलप्रवृत्ताः, जन्मबलप्रवृत्ताः, दोषबलप्रवृत्ताः, संघातबलप्रवृत्ताः, कालबलप्रवृत्ता, दैवबलप्रवृत्ताह् स्वभावबलप्रवृत्ता इति॥४॥

Again in this surgical science all the diseases affecting the man have been briefly described since these diseases are common to all the other branches of Ayurveda (the diseases are the same in whichever branch they are explained).

Trividha Dukha

Earlier it was said that the diseases are nothing but ‘association of miseries’ (chapter 1). These miseries are of three types. They are –

These pains (miseries) manifest (affect human beings) in seven different kinds of diseases. They are –

Saptavidha Vyadhi – Below mentioned are the seven kinds of diseases derived from Adhyatmika and other types of Dukha mentioned above –

Ⅰ. Adhyatmika vyadhi: Diseases of one’s own (individual) body

तत्र, आदिबलप्रवृत्ता ये शुक्रशोणितदोषान्वयाः कुष्ठार्शः कुष्ठार्शःप्रभृतयः तेऽपि द्विवोधा:-

मातृजाः पितृजाश्च। जन्मबलप्रवृत्ता ये मातुरपचारात् पङ्गुजात्यन्धबधिरमूकमिन्मिनवाननप्रभृतयो जायन्ते तेऽपि द्विविधाः- रसकृताः. दौहृदापचारकृताश्च। दोषबलप्रवृत्ता ये आतङ्कसमुत्पन्ना मिथ्याहारचारकृताश्च; ते ऽपि द्विविधाः_ आमाशयसमित्थाः, पक्वाशयसमुत्थाश्च; पुनश्च द्विविधाः- शारिरा, मानसाश्च। त एते आध्यात्मिकाः ॥५॥

1. Adibala pravrtta vyadhi –

The diseases that are produced by the abnormalities of sukra (semen vis-à-vis sperm) and Sonita (menstrual blood a vis-a-vis ovum) are known as Adibala Pravrtta diseases.

Example – leprosy piles etc.

Types –

–        Matruja – maternal – derived from mother
–        Pitruja – paternal – derived from father

2. Janmabala Pravrtta vyadhi –

The diseases which are caused by improper conduct of the mother are known as Janmabala pravrtta diseases.

Example – All these diseases are produced by birth viz,

–        Lameness
–        Blindness
–        Deafness
–        Muteness
–        Nasal speech

Types –

–        Rasakrta – produced by rasa or essence of food which is being supplied to the embryo / fetus by mother
–        Dauhrda Apachara Krta – produced by non-fulfillment of ‘longings or cravings of pregnancy’

3. Doshabala Pravrtaa Vyadhhi –

Those diseases which are produced from improper food and activities are known as Dosabala pravrtta diseases.  

Types –

–        Amasaya samutta – diseases taking their origin in the stomach and small intestine
–        Pakvasaya samuttha – diseases taking their origin in the large intestine

Other type of classification –

–        Sarira – pertaining to / manifested in the body (somatic)
–        Manasa – pertaining to / manifested in the mind (psychic)

All the above said categories of diseases are considered as Adhyatmika Vyadhis which are related to one’s own self.

Ⅱ. Adhibhautika Vyadhi: Diseases due to external objects

संघातबलप्रवृत्ता य आगन्तवो दुर्बलस्य, बलवद्विग्रहत् ; तेऽपि द्विविधाः- शस्त्रकृता, व्यालकृताश्च। एते आधिभौतिकाः ॥६॥

4. Sanghata Bala Pravrtta Vyadhi –

The diseases which are caused due to external or accidental causes, like an assault caused by a strong person over the weaker one are called as Sanghata Bala Pravrtta Vyadhis.

Types –

–        Sastra Krta – caused by weapons (injury caused by weapons)
–        Vyala Krta – caused by wild animals (by their attack, bite, scratch etc.)

These diseases are called Adhibhautika Vyadhis since they are caused by external objects other than living beings / humans.

Ⅲ. Adhidaivika Vyadhi: Diseases caused by superhuman agencies-

 कालबलप्रवृत्ता ये शीतोष्णवातवर्षातपप्रभृतिनिमित्ताः ; तेऽपि द्विविधाः-व्यापन्नर्तुकृताः,अव्यापन्नर्तुकृताश्च । दैवबलप्रवृत्तां ये देवद्रोहादभिशप्तका अथर्वणकृता उपसर्गजाश्च। स्वभावबलप्रवृत्ता ये क्षुत्पिपासाजरामृत्युनिद्राप्रभृतयः;तेऽपि द्विविधाः- कालजा, अकालजश्च; तत्र परिरक्षणकृताः कालजाः,अपरिरक्षणकृता अकालजः । एते आधिदैविकाः। अत्र सर्वव्याध्यवरोधः ॥७॥

5. Kalabala pravrtta Vyadhis –

The diseases which are produced by kala (season) such as cold, heat, wind, rain, sunlight etc. are known as Kala bala pravratta diseases.

Types –

–        Vyapanna Rtu Krta – produced by abnormal seasons
–        Avyapanna Rtu Krta – produced by normal seasons

6. Daivabala pravrtta Vyadhis –

The diseases which are caused by the below mentioned are considered as Daivabala Pravrtta –

–        by abhishapa – curses of humiliated divine beings,
–        by Atharvana rites (sorcery, witchcraft etc) and
–        by upasarga – developing from proximity of contact with another diseased persons (contagious)

Other type of classification –

–        Vidyudasani Krta – those produced by lighting, thunderbolt etc.
–        Pisacadi Krta – those produced by demons like pisaca etc.

Also, other two kinds –

Samsargaja – diseases caused due to close contact or proximity with another person who is diseased (contagious diseases)

Akasmika – they are produced by accidentally or suddenly without a clue or notice – like epidemics

7. Svabhavabala Pravritta Vyadhis –

The diseases such as hunger, thirst, old age, death, sleep and such others are known as Svabhavabala pravritta diseases.

Types –

–        Kalaja – they appear at proper or usual time, even after protection or sufficient care or preventive measures have been taken
–        Akalaja – they appear untimely i.e. at improper time, too early or too late (premature or delayed manifestation), are caused when there is no (even without) protection, prevention or care

The above-mentioned categories of diseases are called as Adidaivika Vyadhis and are caused by superhuman entities.

Dosha Sarvavyadhi Karana: Doshas the causes of all diseases

सर्वेषां च व्याधीनां वातपित्तश्लेष्माण एव मूलं; तल्लिङ्गत्वादृष्टफलत्वादागमाच्च ।

यथा हि कृत्स्नं विकारजातं विश्चरूपेणावस्थितं सत्त्वरजस्तमांसि न व्यतिरिच्यन्ते, एवमेव कृत्स्नं विकारजातं विश्वरूपेणावस्थितमव्यतिरिच्य वातपित्तस्लेष्माणो वर्तन्ते। दोषधातुमलसंसर्गादायतनविशेषान्निमित्ततश्चैषां विकल्पः। दोषदूषितेष्वत्यर्थं धातुषु संज्ञा- रसजोऽयं शोणितजोऽयं मांसजिऽयं मेदोजोऽयं, अस्थिजोऽयं मज्जजोऽयं, शुक्रजोऽयं व्याधिरिति॥८॥

Vata, Pitta and Slesma (Kapha) only are the root causes for all the diseases. Below mentioned are the reasons –

1. Tat lingatvat – these doshas exhibit their features, the symptoms of these three doshas are found in the diseases

2. Drshta phalatvat – since the results of treating these three doshas are actually evident (seen, observed), i.e. when treatment is given to these diseases based on the dosha symptoms that they exhibit, results i.e. cure of those diseases will be observed and

3. Agamat cha – since these doshas and their role in causation of diseases and their responses to the treatments have been extensively explained in Ayurveda treatises.

Vata, pitta and kapha are present all over the body and they impart their influence everywhere in a state of balance as well as imbalance. The three Mahagunas are Sattva, Rajas and Tamas. They influence everything in the creation. The myriads of substances of this universe is not beyond the influence of these trigunas. Similarly, diseases cannot manifest without the touch and influence of doshas. The multitude of diseases that manifest in our lifetime cannot occur without the involvement of vata, pitta and kapha. The diseases are thus never beyond the touch of tridoshas.

Due to the combination of doshas, dhatus (tissues) and malas (excreta), different locations and due to involvement of various etiological factors, many kinds of diseases are caused. Due to the severe contamination / vitiation of tissues by doshas the diseases get different names such as (like telling) – this disease is rasaja (born from rasa tissue), this is sonitaja (produced by blood), this is mamsaja (produced by muscles), this is medoja (born from fat), this is asthija (born from bone), this is majjaja (born from bone marrow) and this is sukraja (born from semen). 

Dhatu Vikara Rogas: Diseases of each Dhatu

तत्र,अन्नाश्रद्धारोचकाविकाङ्गमर्दज्वरहृल्लासतृप्तिगौरवहृत्पाण्डुरोगमार्गूपरोदकार्श्यवैरस्याङ्गसादाकालजवलीपलितदर्शनप्रभृतयो रसदोषजा  विकाराः कुष्ठविसर्पपीडकामशकनीलिकातिलकालकन्यच्छव्यङ्गेन्द्रलुप्तप्लीहविद्रधिगुल्मवातशोणितार्शोऽर्बुदाङ्गमर्दासृग्दररक्तपित्तप्रभृतयो रक्तदोषजाः गुदमुखमेढ्रपाकाश्च; अधिमांसार्बुदार्शोऽधिजिह्वोपजिह्वोपकुशगल शुण्डिकालजीमांससंघातौष्ठप्रकोपगलगण्डण्डमलाप्रभृतयो मांसदोषजाः; ग्रन्थिवृद्धिगलगण्डार्बुदमेदोजौष्ठप्रकोपमधुमेहातिस्थौल्यातिस्वेदप्रभृतयो मेदोदोषजाः ; अध्यस्थ्यधिदन्तास्थितोदशूलकुनखप्रभृतयोऽस्थिदोषजाः; तमोदर्शनमूर्च्छाब्रमपर्वस्थूलमूलारुर्जन्मनेत्राभिष्यन्दन्प्रभृतयो मज्जदोषजाः ; मलायतनदोषाः; इन्द्रियाणामप्रवृत्तिरयथाप्रवृत्तिर्वेन्द्रियायतनदोषाः; इर्त्यषसमास उक्तः ; विस्तरं निमित्तानि चैषां प्रतिरोगं वक्ष्यामः ॥९॥

Rasadoshaja Vikara (diseases produced by vitiated rasa dhatu) – include –

–        lack of desire for food,
–        loss of taste,
–        improper digestion,
–        squeezing pain all over the body,
–        fever,
–        nausea,
–        feeling of contentment (abnormal),
–        feeling of heaviness of the  body,
–        diseases of the heart,
–        anemia,
–        obstruction of channels in the tissues,
–        emaciation,
–        bad taste  in the mouth,
–        debility of the body,
–        premature appearance of wrinkles of the skin,
–        grey hairs and others

Raktadoshaja Vikara (diseases produced by vitiated blood) – include –

–        leprosy (and some other diseases of the skin),
–        erysipelas,
–        eruptions,
–        moles on the skin, pigmented patches,
–        tilakalaka – black pinheads,
–        Nilika (back patch of the face)
–        Nyaccha (blue or white patch anywhere on the body)
–        Vyanga (blue / black patch on the face)
–        Indralupa (alopecia)
–        enlargement of spleen,
–        abscess,
–        abdominal  tumors,
–        gout,
–        piles,
–        malignant tumor,
–        squeezing pain in the body,
–        menorrhagia,
–        bleeding diseases and ulceration of the Anus, mouth and penis, etc

Mamsadosaja Vikara (diseases produced by vitiated muscles) – include –

–        excess growth of muscles,
–        malignant tumor,
–        hemorrhoids,
–        adhijihva (adenoids)
–        upajihva (salivary cyst),
–        upakusa (gingivitis),
–        galasundika (enlargement of uvula),
–        alaji (episclerities),
–        mamsa sanghata (tumor of the palate),
–        ostha prakopa (inflammation of the lips),
–        galaganda (goiter),
–        gandamala (scrofula) etc.

Medo Dosaja Vikara (diseases produced by vitiated fat tissue) – include –

–        tumors,
–        enlargement of scrotum (hernia),
–        galaganda (goiter),
–        gandamala (scrofula),
–        arbuda (malignant tumor),
–        enlargement of the lips by fat,
–        diabetes mellitus,
–        obesity,
–        profuse sweating etc. are

Asthi Dosaja Vikara (diseases due to vitiated bone tissue) – include –

–        extra growth of bones,
–        eruption of extra teeth,
–        pricking pain in bones,
–        bone pain,
–        bad nails (distorted shape, texture etc)

Majja Dosaja Vikara (diseases caused by vitiation of bone marrow) – include –

–        darkness before the eyes (transient blindness),
–        fainting,
–        giddiness,
–        increase of size of bony joints (small joints of fingers),
–        formation of ulcers on them (small joints of the fingers),
–        ophthalmia (conjunctivitis) etc

Sukra Dosaja Vikara (diseases produced by vitiation of semen) – include –

–        impotence,
–        absence of desire in sex,
–        seminal calculus,
–        spermatorrhoea and such others

Malayatana Dosha (diseases of seats of waste products) – include –

–        diseases of the skin,
–        decrease, increase or improper flow of wastes

Indriyayatana dosas (diseases of sense organs) – include – non-perception or improper perception (of sense organs).

In brief, this is a list of diseases. More details and causes of these diseases will be described as per context, in the description of each disease separately.

Vyadhi Utpatti Sthana: Place of origin of disease

कुपितानां हि दोषाणां शरीरे परिधावताम् ॥
यत्र सङ्गः खगैगुण्याद्व्चधिस्तत्रोपजायते॥१०॥

One verse here:-

The aggravated doshas keep circulating all over the body. When these doshas get obstructed and hence get stagnated due to the abnormality of the channels (in the tissues), the diseases get manifested at that place of dosha aggravation.

Dosha Vyadhi Sambandha: Relation between Doshas and disease:-

भृयोऽत्र जुज्ञास्यं, किं वातादीनां ज्वरादीनां च नित्यः संश्लेषः परिच्छेदो वा?इति ; यदि नित्यह् संश्लेषः स्यात्तार्हि नित्यातुराः सर्व एव प्रणिनः स्युः; अथाप्यन्य्हथ वातदीनां ज्वरादीनं  मूलानीति  तन्न। अत्रोच्यते-दोषान् प्रत्याख्याय  ज्वरादयो नभवन्ति;अब च न  नित्यः संबन्धः;यथाहि विद्युद्वाताशनिर्षाण्याकाशं प्रत्याख्याय न, भवन्ति, सत्यप्याकाशे कदाचित्र भवन्ति, अथ च  निमित्ततस्तत एवोत्पत्तिरितिः तरङ्गबुद्वुदायश्चोदकविशेषा एव, वातादीनां ज्वरादीनां च नाप्येवं संश्लेषो न परिच्छेदः शाच्छेद :, अथ च निमित्तत एवोत्पत्तिरिति ॥११॥

A great debatable point in this context is, is the relation between the doshas i.e. vata, pitta and kapha and the diseases i.e. jwara – fever etc, a permanent, ongoing and inseparable relationship or is it a temporary and separable relationship?

If a permanent relationship is considered between the doshas and diseases, then all the living beings in the world should become sick and diseased at once and at all the time. Since all living beings are not ill always it (relationship) should be otherwise. If the relationship between the doshas and the diseases is considered to be a permanent and long-standing one, due to the presence of vata etc doshas and fever etc diseases in different places, their symptoms cannot be manifested in a single (same) place because the features of something present at some place will not appear elsewhere. Therefore the vata etc doshas are not the root (causes) of jwara etc diseases.

Taking recourse to the dictum (mentioned above), we now say that fevers etc (diseases) will not occur without the (involvement of the) Doshas. The relationship between doshas and diseases is not permanent and constant. Just as lightning, wind, thunderbolt and rain cannot happen without the sky, and in spite of the sky being present at all times, these (lightning etc.) do not happen at all times. But when there is presence of existing causes and suitable time for their manifestation, they (lightning) would manifest in the same sky (and do not occur all time). Similarly, the water bubbles and the water waves do not get manifested elsewhere i.e. they are manifested in water only. The water bubbles and waves do not occur at all times in the water, they manifest at suitable times with suitable causes.

So, it can be concluded that the relation between the doshas and diseases is neither permanent association or permanent dissociation. The origin of these diseases occurs only due to an exciting cause such as improper foods and activities.

विकारपरिमाणं  च संख्या चैषां पृथक् पृथक् ॥
विस्तरेणोत्तरे तन्त्रे सर्वाबाधाश्च वक्ष्यते ॥१२॥

Another verse here:-

The details of all these diseases in relation to their quantity, nature, number etc. of abnormalities i.e., signs and symptoms shall be described separately in the last section of this treatise i.e. in Uttara Tantra section.

इति श्रीसुश्रुतसंहितायां सूत्रस्थाने व्यधिस मुद्देशीयो नाम चतुर्विंशोध्यायः ॥२४॥

Thus ends the Twenty fourth chapter by name Vyadhi Samuddesiya in Sutra Sthana of Susrutha samhita.