आतुरोपक्रमणीयाध्यायः
अथात आतुरोपक्रमणीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
"Now, I shall explain the chapter on 'The Management of Patients."
"As spoken by the revered Dhanvantari."
This marks the beginning of a new chapter in the Sushruta Samhita, focusing on the guidelines and procedures for managing patients effectively.
आतुरमुपक्रममाणेन भिषजाऽऽयुरादावेव परीक्षितव्यं ; सत्यायुषि व्याध्यृत्वग्निवयोदेहबलसत्त्वसात्म्यप्रकृतिभेषजदेशान् परीक्षेत ||३||
"When commencing the treatment of a patient, the physician should first assess the patient's lifespan. If the lifespan is deemed long, the physician should examine the disease, the strength of the digestive fire, age, body, physical strength, mental strength, suitability, natural constitution, medicines, and the environment."
This Shloka emphasizes the comprehensive assessment required by a physician before starting the treatment, ensuring all relevant factors are considered.
तत्र महापाणिपादपार्श्वपृष्ठस्तनाग्रदशनवदनस्कन्धललाटं
दीर्घाङ्गुलिपर्वोच्छ्वासप्रेक्षणबाहुं, विस्तीर्णभ्रूस्तनान्तरोरस्कं ह्रस्वजङ्घामेढ्रग्रीवं, गम्भीरसत्त्वस्वरनाभिम् , अनुच्चैर्बद्धस्तनम्, उपचितमहारोमशकर्णं, पश्चान्मस्तिष्कं, स्नातानुलिप्तं मूर्धानुपूर्व्या विशुष्यमाणशरीरं पश्चाच्च विशुष्यमाणहृदयं पुरुषं जानीयाद्दीर्घायुः खल्वयमिति |
तमेकान्तेनोपक्रमेत् |
एभिर्लक्षणैर्विपरी तैरल्पायुः; मिश्रैर्मध्यमायुरिति ||४||
"A person with large hands, feet, sides, back, chest, teeth, face, shoulders, and forehead, long fingers and joints, deep breaths, wide eyes, and long arms, broad eyebrows, wide-chested, short calves, genitals, and neck, deep voice and navel, and well-developed chest, covered with thick hair and ears, having a head well-proportioned to the body, such a person should be considered long-lived. Such a person should be treated wholeheartedly. With opposite characteristics, a person should be considered short-lived; with mixed characteristics, of medium lifespan."
This Shloka describes the physical characteristics associated with a long-lived individual, emphasizing the importance of recognizing these traits for appropriate treatment.
भवन्ति चात्र |
गूढसन्धिसिरास्नायुः संहताङ्गः स्थिरेन्द्रियः |
उत्तरोत्तरसुक्षेत्रो यः स दीर्घायुरुच्यते ||५||
गर्भात् प्रभृत्यरोगो यः शनैः समुपचीयते |
शरीरज्ञानविज्ञानैः स दीर्घायुः समासतः ||६||
"Here it is stated: One with well-formed joints, veins, and ligaments, compact body, and stable senses, who comes from a lineage of progressively better lands, is considered long-lived. From birth onwards, one who is free from disease and gradually accumulates knowledge and understanding of the body, is generally considered long-lived."
These Shlokas emphasize the physical characteristics and lineage associated with a long-lived individual, as well as the importance of health and knowledge in determining lifespan.
मध्यमस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे |
अधस्तादक्षयोर्यस्य लेखाः स्युर्व्यक्तमायताः ||७||
द्वे वा तिस्रोऽधिका वाऽपि पादौ कर्णौ च मांसलौ |
नासाग्रमूर्ध्वं च भवेदूर्ध्वं लेखाश्च पृष्ठतः ||८||
यस्य स्युस्तस्य परममायुर्भवति सप्ततिः |९|
"For understanding medium lifespan, listen to me further: One whose lines below the little finger are clear and elongated, or two or three lines, or even more, with fleshy feet and ears, whose nose tip is upward, and lines on the back are upward, that person's maximum lifespan is seventy years."
These Shlokas describe the characteristics associated with a medium lifespan, focusing on the lines on the hands and body, as well as physical features.
जघन्यस्यायुषो ज्ञानमत ऊर्ध्वं निबोध मे ||९||
हस्वानि यस्य पर्वाणि सुमहच्चापि मेहनम् |
तथोरस्यवलीढानि न च स्यात्पृष्ठमायतम् ||१०||
ऊर्ध्वं च श्रवणौ स्थानान्नासा चोच्चा शरीरिणः |
हसतो जल्पतो वाऽपि दन्तमांसं प्रदृश्यते |
प्रेक्षते यश्च विभ्रान्तं स जीवेत्पञ्चविंशतिम् ||११||
"For understanding a short lifespan, listen to me further: One whose joints are small, and whose genitals are large, with folds on the chest and no lines on the back, whose ears are high, and whose nose is high, and whose gums are visible when laughing or talking, and who looks confused, will live for twenty-five years."
These Shlokas describe the characteristics associated with a short lifespan, focusing on physical features and behavioral traits.
अथ पुनरायुषो विज्ञानार्थमङ्गप्रत्यङ्गप्रमाणसारानुपदेक्ष्यामः |
तत्राङ्गान्यन्तराधिसक्थिबाहुशिरांसि, तदवयवाः प्रत्यङ्गानीति |
तत्र, स्वैरङ्गुलैः पादाङ्गुष्ठप्रदेशिन्यौ द्व्यङ्गुलायते ; प्रदेशिन्यास्तु मध्यमानामिकाकनिष्ठिका यथोत्तरं पञ्चमभागहीनाः; चतुरङ्गुलायते पञ्चाङ्गुलविस्तृते प्रपदपादतले; पञ्चचतुरङ्गुलायतविस्तृता पार्ष्णिः; चतुर्दशाङ्गुलायतः पादः; चतुर्दशाङ्गुलपरिणाहानि पादगुल्फजङ्घाजानुमध्यानि; अष्टादशाङ्गुला जङ्घा, जानूपरिष्टाच्च द्वात्रिंशदङ्गुलम्, एते पञ्चाशत्; जङ्घायामसमावूरू; द्व्यङ्गुलानि वृषणचिबुकदशननासापुटभागकर्णमूलभ्रूनयनान्तराणि; चतुरङ्गुलानि मेहनवदनान्तरनासाकर्णललाटग्रीवोच्छ्रायदृष्ट्यन्तराणि; द्वादशाङ्गुलानि भगविस्तारमेहननाभिहृदयग्रीवास्तनान्तरमुखायाममणिबन्धप्रकोष्ठस्थौल्यानि; इन्द्रबस्तिपरिणाहांसपीठकूर्परान्तरायामः षोडशाङ्गुलः; चतुर्विंशत्यङ्गुलो हस्तः; द्वात्रिंशदङ्गुलपरिमाणौ भुजौ; द्वात्रिंशत्परिणाहावूरू; मणिबन्धकूर्परान्तरं षोडशाङ्गुलं; तलं षट्चतुरङ्गुलायामविस्तारम्; अङ्गुष्ठमूलप्रदेशिनीश्रवणापाङ्गान्तरमध्यमाङ्गुल्यौ पञ्चाङ्गुले; अर्धपञ्चाङ्गुले प्रदेशिन्यनामिके; सार्धत्र्यङ्गुलौ कनिष्ठाङ्गुष्ठौ; चतुर्विंशतिविस्तारपरिणाहं मुखग्रीवं; त्रिभागाङ्गुलविस्तारा नासापुटमर्यादा; नयनत्रिभागपरिणाहा तारका; नवमस्तारकांशो दृष्टिः; केशान्तमस्तकान्तरमेकादशाङ्गुलं; मस्तकादवटुकेशान्तो दशाङ्गुलः; कर्णावट्वन्तरं चतुर्दशाङ्गुलं; पुरुषोरःप्रमाणविस्तीर्णा स्त्रीश्रोणिः; अष्टादशाङ्गुलविस्तारमुरः; तत्प्रमाणा पुरुषस्य कटी; सविंशमङ्गुलशतं पुरुषायाम इति ||१२||
"Now, to understand the science of lifespan, I will describe the measurements of body parts. The body parts include the inner thighs, arms, head, and their corresponding segments. For example, with one's own fingers, the big toe and the index finger measure two fingers' breadth; From the index finger to the middle, ring, and little fingers, each is progressively shorter by one-fifth. The sole of the foot measures four fingers in breadth and five in length. The heel measures four fingers in width and fourteen in length. The middle of the foot measures fourteen fingers in circumference. The calf measures eighteen fingers in length and thirty-two fingers from the knee up, making fifty fingers in total. The thighs are equal to the length of the calves. Two fingers measure the scrotum, chin, teeth, nostrils, ears, and eyebrows. Four fingers measure the genitals, the distance between the eyes, nose, ears, forehead, and neck. Twelve fingers measure the width of the hips, genitals, navel, heart, and chest. Sixteen fingers measure the circumference of the shoulders, abdomen, head, and chest. Twenty-four fingers measure the length of the arms. Thirty-two fingers measure the length of the arms and the circumference of the thighs. Sixteen fingers measure the distance between the wrist and elbow. The palm measures six fingers in length and four fingers in width. Five fingers measure the thumb, index finger, and middle finger. Three and a half fingers measure the ring finger and little finger. Twenty-four fingers measure the length of the neck. Three fingers measure the width of the nostrils. The pupil measures one-third of the eye. Eleven fingers measure the distance from the hairline to the top of the head. Ten fingers measure the distance from the top of the head to the hairline. Fourteen fingers measure the width between the ears. A woman's hips are the same width as a man's chest. Eighteen fingers measure the width of the chest. This is the measurement of the human body according to Sushruta Samhita."
These Shlokas provide detailed measurements of different body parts, offering a comprehensive understanding of the human body's proportions and dimensions.
भवन्ति चात्र श्लोकाः |
पञ्चविंशे ततो वर्षे पुमान् नारी तु षोडशे |
समत्वागतवीर्यौ तौ जानीयात् कुशलो भिषक् ||१३||
"Here are some verses: In the twenty-fifth year for a man, and in the sixteenth year for a woman, they reach the equilibrium of strength and vitality; a skilled physician knows this."
This Shloka emphasizes the ages at which men and women are considered to have reached their peak strength and vitality, highlighting the importance of recognizing these stages for effective medical practice.
देहः स्वैरङ्गुलैरेष यथावदनुकीर्तितः |१४|
"The body has been described accurately using one's own fingers as a unit of measurement."
This Shloka emphasizes the use of one's own fingers as a standard unit of measurement to describe the proportions and dimensions of the body accurately.
युक्तः प्रमाणेनानेन पुमान् वा यदि वाऽङ्गना ||१४||
दीर्घमायुरवाप्नोति वित्तं च महदृच्छति |
मध्यमं मध्यमैरायुर्वित्तं हीनैस्तथाऽवरम् ||१५||
"A man or woman whose body measures according to these proportions, will achieve a long life and great wealth. One with medium measurements will have a medium lifespan and moderate wealth, and one with inferior measurements will have a short lifespan and less wealth."
These Shlokas emphasize the correlation between body proportions and lifespan, as well as the impact on wealth and prosperity.
अथ सारान् वक्ष्यामः- स्मृतिभक्तिप्रज्ञाशौचशौर्योपेतं कल्याणाभिनिवेशं सत्त्वसारं विद्यात्; स्निग्धसंहतश्वेतास्थिदन्तनखं बहुलकामप्रजं शुक्रेण; अकृशमुत्तमबलं स्निग्धगम्भीरस्वरं सौभाग्योपपन्नं महानेत्रं च मज्ज्ञा; महाशिरःस्कन्धं दृढदन्तहन्वस्थिनखमस्थिभिः; स्निग्धमूत्रस्वेदस्वरं बृहच्छरीरमायासासहिष्णुं मेदसा; अच्छिद्रगात्रं गूढास्थिसन्धिं मांसोपचितं च मांसेन; स्निग्धताम्रनखनयनतालुजिह्वौष्ठपाणिपादतलं रक्तेन; सुप्रसन्नमृदुत्वग्रोमाणं त्वक्सारं विद्यादिति |
एषां पूर्वं पूर्वं प्रधानमायुःसौभाग्ययोरिति ||१६||
"Now, I will describe the essence: One endowed with memory, devotion, intelligence, purity, bravery, and a tendency toward good deeds is considered to have sattva (essence of the mind). Someone with smooth, compact, white bones, teeth, and nails, and many offspring is considered to have shukra (essence of semen). One who is not thin, has excellent strength, a smooth, deep voice, good fortune, and large eyes is considered to have majja (essence of marrow). Someone with a large head and shoulders, strong teeth, jawbones, and nails, is considered to have asthi (essence of bones). One with smooth urine, sweat, and voice, a large body, and endurance is considered to have meda (essence of fat). One with a flawless body, well-formed joints, and well-built muscles is considered to have mamsa (essence of flesh). One with smooth, reddish nails, eyes, palate, tongue, lips, and soles of the hands and feet is considered to have rakta (essence of blood). One with clear and soft skin and hair is considered to have tvak (essence of skin). The earlier the qualities mentioned, the more important they are for longevity and prosperity."
These Shlokas emphasize the different essences (saras) that contribute to a person's overall health and well-being, highlighting the importance of various qualities and characteristics.
विशेषतोऽङ्गप्रत्यङ्गप्रमाणादथ सारतः |
परीक्ष्यायुः सुनिपुणो भिषक् सिध्यति कर्मसु ||१७||
"By carefully examining the measurements of body parts and the essence, a skilled physician can accurately determine the lifespan and succeed in medical practice."
This Shloka emphasizes the importance of thorough examination and understanding of body measurements and essences for a successful and accurate medical practice.
व्याधिविशेषास्तु प्रागभिहिताः; सर्व एवैते त्रिविधाः- साध्या, याप्याः, प्रत्याख्येयाश्च |
तत्रैतान् भूयस्त्रिधा परीक्षेत- किमयमौपसर्गिकः, प्राक्केवलः, अन्यलक्षण इति |
तत्र, औपसर्गिको नाम यः पूर्वोत्पन्नं व्याधिं जघन्यकालजातो व्याधिरुपसृजति, स तन्मूल एवोपद्रवसञ्ज्ञः;
प्राक्केवलो नाम यः प्रागेवोत्पन्नो व्याधिरपूर्वरूपोऽनुपद्रवश्च; अन्यलक्षणो नाम यो भविष्यद्व्याधिख्यापकः, स पूर्वरूपसञ्ज्ञः |
तत्र, सोपद्रवमन्योन्याविरोधेनोपक्रमेत, बलवन्तमुपद्रवं वा; प्राक्केवलं यथास्वं प्रतिकुर्वीत; अन्यलक्षणे त्वादिव्याधौ प्रयतेत ||१८||
"The types of diseases have been previously mentioned; they are all of three types: curable, controllable, and incurable. They should be further examined in three ways: whether they are caused by complications, initially alone, or by other symptoms. A disease caused by complications is one that arises as an additional condition after a primary disease; it is known as an accompanying complication. A disease that arises initially without prior symptoms or complications is called primary. A disease that indicates the presence of future illness is known as a precursor. One should treat a disease with complications considering mutual non-interference, prioritizing the stronger complication. A primary disease should be treated according to its nature. For precursors, treatment should be aimed at preventing the future illness."
These Shlokas provide a detailed classification of diseases and guidelines on how to approach their treatment based on their nature and onset.
भवति चात्र |
नास्ति रोगो विना दोषैर्यस्मात्तस्माद्विचक्षणः |
अनुक्तमपि दोषाणां लिङ्गैर्व्याधिमुपाचरेत् ||१९||
"Here it is stated: There is no disease without the doshas; therefore, a wise physician, even without explicit instructions, should treat diseases based on the symptoms of the doshas."
This Shloka highlights the importance of understanding the role of doshas (biological energies) in diseases and emphasizes the need for a physician to treat diseases based on the symptoms of the doshas, even if specific instructions are not provided.
प्रागभिहिता ऋतवः ||२०||
"The seasons have been previously mentioned."
This Shloka refers to the prior discussion of the seasons (ṛutus) in the text.
शीते शीतप्रतीकारमुष्णे चोष्णनिवारणम् |
कृत्वा कुर्यात् क्रियां प्राप्तां क्रियाकालं न हापयेत् ||२१||
"In the cold, one should take measures against the cold, and in the heat, measures against the heat. Having done this, one should perform the necessary actions, never missing the appropriate time for treatment."
This Shloka emphasizes the importance of adapting to seasonal changes and ensuring that the appropriate measures are taken to counteract the effects of extreme weather, while also highlighting the necessity of timely treatment.
अप्राप्ते वा क्रियाकाले प्राप्ते वा न कृता क्रिया |
क्रिया हीनाऽतिरिक्ता वा साध्येष्वपि न सिध्यति ||२२||
"If the appropriate time for treatment is missed, or if treatment is not performed at the right time, and if the treatment is inadequate or excessive, even curable diseases will not be successfully treated."
This Shloka emphasizes the importance of timely and appropriately administered treatment for the successful cure of diseases, highlighting that any deviation from this can hinder the healing process.
या ह्युदीर्णं शमयति नान्यं व्याधिं करोति च |
सा क्रिया, न तु या व्याधिं हरत्यन्यमुदीरयेत् ||२३||
"That treatment which alleviates the aggravated disease without causing another disease is considered effective, not the one which removes one disease but gives rise to another."
This Shloka underscores the importance of effective treatment that addresses the primary illness without introducing new complications.
प्रागभिहितोऽग्निरन्नस्य पाचकः |
स चतुर्विधो भवति- दोषानभिपन्न एकः, विक्रियामापन्नस्त्रिविधो भवति- विषमो वातेन, तीक्ष्णः पित्तेन, मन्दः श्लेष्मणा, चतुर्थः समः सर्वसाम्यादिति |
तत्र, यो यथाकालमुपयुक्तमन्नं सम्यक् पचति स समः, समैर्दोषैः; यः कदाचित् सम्यक् पचति, कदाचिदाध्मानशूलोदावर्तातिसारजठरगौरवान्त्रकूजनप्रवाहणानि कृत्वा, स विषमः; यः प्रभूतमप्युपयुक्तमन्नमाशु पचति स तीक्ष्णः, स एवाभिवर्धमानोऽत्यग्निरित्याभाष्यते, स मुहुर्मुहुः प्रभूतमप्युपयुक्तमन्नमाशुतरं पचति, पाकान्ते च गलताल्वोष्ठशोषदाहसन्तापाञ्जनयति; यस्त्वल्पमप्युपयुक्तमुदरशिरोगौरवकासश्वासप्रसेकच्छर्दिगात्रसदनानि कृत्वा महता कालेन पचति, स मन्दः ||२४||
"The digestive fire responsible for the digestion of food has been previously mentioned. It is of four types: one that is balanced with the doshas and three that are imbalanced. The imbalanced types are: Vishama (irregular) due to Vata, Tikshna (intense) due to Pitta, and Manda (slow) due to Kapha. The fourth type is Sama (balanced) when all doshas are in equilibrium. The Sama type properly digests food at the right time. The Vishama type sometimes digests food properly and sometimes causes issues like bloating, pain, and other digestive troubles. The Tikshna type rapidly digests even large quantities of food, but can lead to symptoms like dryness, burning, and heat. The Manda type, on the other hand, takes a long time to digest even small amounts of food, causing symptoms like heaviness, headache, cough, shortness of breath, nausea, and fatigue."
These Shlokas describe the different types of digestive fire (Agni) and their effects on the digestion process and overall health, emphasizing the importance of balanced digestion for well-being.
विषमो वातजान् रोगांस्तीक्ष्णः पित्तनिमित्तजान् |
करोत्यग्निस्तथा मन्दो विकारान् कफसम्भवान् ||२५||
"The Vishama (irregular) Agni creates diseases caused by Vata, the Tikshna (intense) Agni causes diseases due to Pitta, and the Manda (slow) Agni leads to diseases originating from Kapha."
This Shloka explains the connection between the different types of imbalanced digestive fire (Agni) and the diseases caused by the doshas Vata, Pitta, and Kapha, highlighting the importance of maintaining a balanced digestive fire for overall health.
तत्र, समे परिरक्षणं कुर्वीत; विषमे स्निग्धाम्ललवणैः क्रियाविशेषैः प्रतिकुर्वीत; तीक्ष्णे मधुरस्निग्धशीतैर्विरेकैश्च; एवमेवात्यग्नौ, विशेषेण माहिषैश्च क्षीरदधिसर्पिर्भिः; मन्दे कटुतिक्तकषायैर्वमनैश्च ||२६||
"In the case of Sama (balanced) Agni, one should focus on maintaining it. For Vishama (irregular) Agni, treat it with special measures like unctuous, sour, and salty substances. For Tikshna (intense) Agni, use sweet, unctuous, and cooling substances, and purgatives. Similarly, for Ati Agni (extremely intense), use special measures including buffalo milk, curd, and ghee. For Manda (slow) Agni, use pungent, bitter, astringent substances, and emetics."
This Shloka provides specific treatment guidelines for different types of digestive fire (Agni), emphasizing the importance of appropriate measures to restore balance and ensure effective digestion.
जाठरो भगवानग्निरीश्वरोऽन्नस्य पाचकः |
सौक्ष्म्याद्रसानाददानो विवेक्तुं नैव शक्यते ||२७||
"The stomach's fire, known as the divine Agni, is the lord responsible for digesting food. Due to its subtle nature, it cannot be distinctly perceived while it assimilates the essences."
This Shloka highlights the importance of the digestive fire (Agni) in the stomach, which plays a crucial role in the digestion and assimilation of nutrients from food, despite its subtle and imperceptible nature.
प्राणापानसमानैस्तु सर्वतः पवनैस्त्रिभिः |
ध्मायते पाल्यते चापि स्वां स्वां गतिमवस्थितैः ||२८||
"The Agni is fanned and maintained by the three vital winds—Prana, Apana, and Samana— each performing its own specific function."
This Shloka highlights the role of the three vital winds (Prana, Apana, and Samana) in maintaining the digestive fire (Agni) and ensuring proper digestion and bodily functions.
वयस्तु त्रिविधं- बाल्यं, मध्यं, वृद्धमिति |
तत्रोनषोडशवर्षीया बालाः |
ते त्रिविधाः- क्षीरपाः, क्षीरान्नादा, अन्नादा इति |
तेषु संवत्सरपराः क्षीरपाः, द्विसंवत्सरपराः क्षीरान्नादाः, परतोऽन्नादा इति |
षोडशसप्तत्योरन्तरे मध्यं वयः |
तस्य विकल्पो- वृद्धिः, यौवनं, सम्पूर्णता, परिहाणिरिति |
तत्र, आविंशतेर्वृद्धिः, आत्रिंशतो यौवनम्, आचत्वारिंशतः सर्वधात्विन्द्रियबलवीर्यसम्पूर्णता, अत ऊर्ध्वमीषत्परिहाणिर्यावत् सप्ततिरिति |
सप्ततेरूर्ध्वं क्षीयमाणधात्विन्द्रियबलवीर्योत्साहमहन्यहनि वलीपलितखालित्यजुष्टं कासश्वासप्रभृतिभिरुपद्रवैरभिभूयमानं सर्वक्रियास्वसमर्थं जीर्णागारमिवाभिवृष्टमवसीदन्तं वृद्धमाचक्षते ||२९||
"Ages are classified into three stages: childhood, middle age, and old age. Children are up to sixteen years old. They are further classified into three stages: those who drink milk, those who eat both milk and food, and those who eat only food. Those up to one year old are milk-drinkers, those up to two years old consume both milk and food, and beyond that, they eat only food. Middle age ranges from sixteen to seventy years. It is further subdivided into growth, youth, completeness, and decline. Growth is until twenty, youth until thirty, fullness of strength and vitality until forty, and slight decline until seventy. After seventy, with diminishing strength, vitality, and enthusiasm, affected daily by wrinkles, gray hair, baldness, and conditions like cough and breathing difficulties, unable to perform all activities, one is considered old, like a worn-out building deteriorating day by day."
These Shlokas provide a detailed classification of the stages of life and their characteristics, emphasizing the changes that occur with age and the associated impacts on health and vitality.
तत्रोत्तरोत्तरासु वयोवस्थासूत्तरोत्तरा भेषजमात्राविशेषा भवन्ति, ऋते च परिहाणेः; तत्राद्यापेक्षया प्रतिकुर्वीत ||३०||
"In the successive stages of life, the dosage of medicine should be adjusted accordingly, except during decline; hence, treatment should be given based on the earlier stage."
This Shloka emphasizes the importance of adjusting the dosage of medicines according to the different stages of life, except during the period of decline, where the dosage should be based on the earlier stage of life.
भवन्ति चात्र-
बाले विवर्धते श्लेष्मा मध्यमे पित्तमेव तु |
भूयिष्ठं वर्धते वायुर्वृद्धे तद्वीक्ष्य योजयेत् ||३१||
"Here it is stated: In childhood, Kapha increases, in middle age, Pitta increases, and in old age, Vata predominantly increases; treatment should be administered accordingly."
This Shloka highlights the natural dominance of different doshas at various stages of life and emphasizes the importance of tailoring treatments based on the predominant dosha at each stage.
अग्निक्षारविरेकैस्तु बालवृद्धौ विवर्जयेत् |
तत्साध्येषु विकारेषु मृद्वीं कुर्यात् क्रियां शनैः ||३२||
"For children and the elderly, avoid treatments involving fire, alkali, and strong purgatives. In treatable conditions, use mild treatments gently."
This Shloka emphasizes the importance of avoiding harsh treatments like fire, alkali, and strong purgatives for vulnerable groups like children and the elderly. Instead, it suggests using gentle and mild treatments for their conditions.
देहः स्थूलः, कृशो, मध्य, इति प्रागुपदिष्टः ||३३||
"The body is classified as stout, thin, or of medium build, as mentioned earlier."
This Shloka refers to the previous classification of body types, emphasizing the different physical builds and their characteristics.
कर्शयेद्बृंहयेच्चापि सदा स्थूलकृशौ नरौ |
रक्षणं चैव मध्यस्य कुर्वीत सततं भिषक् ||३४||
"A physician should always aim to reduce the weight of a stout person and nourish a thin person, and constantly maintain the health of a person of medium build."
This Shloka highlights the tailored approach a physician should take in managing the health of individuals with different body types, focusing on weight reduction for the stout, nourishment for the thin, and maintenance for those of medium build.
बलमभिहितगुणं; दौर्बल्यं तु स्वभावदोषजरादिभिरवेक्षितव्यम् |
यस्माद्बलवतः सर्वक्रियाप्रवृत्तिस्तस्माद्बलमेव प्रधानमधिकरणानाम् ||३५||
"Strength has been discussed with its qualities; weakness, however, should be considered due to inherent nature, doshas, old age, etc. Because all actions depend on strength, it is the primary factor in bodily functions."
This Shloka emphasizes the importance of strength in maintaining bodily functions and highlights the various factors that contribute to weakness, such as inherent nature, imbalances in doshas, and aging.
केचित् कृशाः प्राणवन्तः स्थूलाश्चाल्पबला नराः |
तस्मात् स्थिरत्वं व्यायामैर्बलं वैद्यः प्रतर्कयेत् ||३६||
"Some thin individuals are healthy and strong, while some stout individuals are weak. Therefore, a physician should assess strength based on stability and exercise."
This Shloka highlights the importance of not judging health and strength solely based on body size. It emphasizes the need for a physician to evaluate strength through stability and exercise rather than appearance alone.
सत्त्वं तु व्यसनाभ्युदयक्रियादिस्थानेष्वविक्लवकरम् ||३७||
सत्त्ववान् सहते सर्वं संस्तभ्यात्मानमात्मना |
राजसः स्तभ्यमानोऽन्यैः सहते नैव तामसः ||३८||
"Sattva (essence of the mind) remains unwavering in situations of distress and prosperity. A person with sattva endures everything, stabilizing themselves with their own inner strength. A person with rajas (passion) can be stabilized by others, but a person with tamas (ignorance) cannot endure at all."
These Shlokas highlight the different qualities of the mind (Sattva, Rajas, and Tamas) and their influence on a person's ability to endure various situations, emphasizing the importance of inner strength and stability.
सात्म्यानि तु देशकालजात्यृतुरोगव्यायामोदकदिवास्वप्नरसप्रभृतीनि प्रकृतिविरुद्धान्यपि यान्यबाधकराणि भवन्ति ||३९||
यो रसः कल्पते यस्य सुखायैव निषेवितः |
व्यायामजातमन्यद्वा तत् सात्म्यमिति निर्दिशेत् ||४०||
"Adaptations are based on factors such as place, time, race, season, disease, exercise, water, day sleep, and food taste. Even things that are contrary to nature can become non-harmful. The taste or exercise that suits someone and brings happiness is called Satmya (adaptation)."
These Shlokas emphasize the importance of adaptability in various aspects of life, highlighting that even things that are initially contrary to one's nature can become non-harmful through adaptation. They also stress the significance of identifying what suits an individual and brings them happiness, referring to it as Satmya.
प्रकृतिं भेषजं चोपरिष्टाद्वक्ष्यामः ||४१||
"Next, I will describe the nature (Prakriti) and the medicines (Bhesaja)."
This Shloka introduces the upcoming discussion on the nature of individuals and the appropriate medicines, highlighting the importance of understanding both for effective treatment.
देशस्त्वानूपो जाङ्गलः साधारण इति |
तत्र, बहूदकनिम्नोन्नतनदीवर्षगहनो मृदुशीतानिलो बहुमहापर्वतवृक्षो मृदुसुकुमारोपचितशरीरमनुष्यप्रायः कफवातरोगभूयिष्ठश्चानूपः; आकाशसमः प्रविरलाल्पकण्टकिवृक्षप्रायोऽल्पवर्षप्रस्रवणोदपानोदकप्राय उष्णदारुणवातः प्रविरलाल्पशैलः स्थिरकृशशरीरमनुष्यप्रायो वातपित्तरोगभूयिष्ठश्च जाङ्गलः; उभयदेशलक्षणः साधारण इति ||४२||
"Regions are classified into Anupa (marshy), Jangala (desert), and Sadharana (mixed). Anupa is characterized by abundant water, low and high grounds, rivers, rainforests, mild cool winds, large mountains, and trees. People here have soft, tender, and well-built bodies and are mostly prone to Kapha and Vata disorders. Jangala is flat, with sparse and thorny trees, low rainfall, few springs, and water sources. It has hot, harsh winds and few mountains. People here have stable, lean bodies and are mostly prone to Vata and Pitta disorders. Sadharana has characteristics of both Anupa and Jangala."
These Shlokas describe the characteristics of different regions and their impact on the health of their inhabitants, emphasizing the relationship between the environment and the prevalence of certain disorders.
भवन्ति चात्र-
समाः साधारणे यस्माच्छीतवर्षोष्ममारुताः |
दोषाणां समता जन्तोस्तस्मात्साधारणो मतः ||४३||
"Here it is stated: In the mixed region (Sadharana), the cold, rain, heat, and wind are balanced. Therefore, the doshas are also balanced in people, which is why it is considered a mixed region."
This Shloka explains the balance of climatic conditions in the Sadharana region and how this balance influences the doshas in the inhabitants, making it a mixed region.
न तथा बलवन्तः स्युर्जलजा वा स्थलाहृताः |
स्वदेशे निचिता दोषा अन्यस्मिन् कोपमागताः ||४४||
उचिते वर्तमानस्य नास्ति देशकृतं भयम् |
आहारस्वप्नचेष्टादौ तद्देशस्य गुणे सति ||४५||
"Those who are either aquatic or land-based do not thrive as well when taken away from their natural habitat. The doshas accumulated in one's own country may become aggravated in another. One who lives in a suitable place has no fear of the region's climate. Proper diet, sleep, and activities, in accordance with the qualities of that place, support their well-being."
These Shlokas emphasize the importance of living in a suitable environment and following appropriate dietary, sleep, and activity practices to maintain health and well-being. They also highlight the potential impact of moving to a different region on the balance of doshas.
देशप्रकृतिसात्म्यर्तुविपरीतोऽचिरोत्थितः |
सम्पत्तौ भिषगादीनां बलसत्त्वायुषां तथा ||४६||
केवलः समदेहाग्नेः सुखसाध्यतमो गदः |
अतोऽन्यथा त्वसाध्यः स्यात्कृच्छ्रो व्यामिश्रलक्षणः ||४७||
"If a disease arises suddenly, contrary to the nature of the place, constitution, or season, considering the strength, essence, and lifespan of the physician and others, it is easiest to treat if the body and digestive fire are balanced. Otherwise, it may become difficult to treat and present mixed symptoms."
These Shlokas emphasize the importance of balanced body and digestive fire (Agni) for easier treatment of diseases and highlight the challenges of treating diseases that arise contrary to natural factors and with mixed symptoms.
क्रियायास्तु गुणालाभे क्रियामन्यां प्रयोजयेत् |
पूर्वस्यां शान्तवेगायां न क्रियासङ्करो हितः ||४८||
"When the desired effect of a treatment is achieved, another treatment should be used. It is not beneficial to combine treatments while the previous one is still active."
This Shloka emphasizes the importance of sequential treatment and avoiding the combination of multiple treatments until the effect of the previous one has subsided.
गुणालाभेऽपि सपदि यदि सैव क्रिया हिता |
कर्तव्यैव तदा व्याधिः कृच्छ्रसाध्यतमो यदि ||४९||
"Even if the desired effect of the treatment is achieved, if the same treatment is beneficial immediately, it should be continued when the disease is very difficult to treat."
This Shloka emphasizes that when a disease is particularly challenging to treat, the treatment that has proven beneficial should be continued even if the desired effect has already been achieved.
य एवमेनं विधिमेकरूपं बिभर्ति कालादिवशेन धीमान् |
स मृत्युपाशाञ्जगतो गदौघाञ्छिनत्ति भैषज्यपरश्वधेन ||५०||
"He who wisely follows this method regularly, as per the time and season, cuts off the bonds of death and the multitude of diseases with the axe of medicine."
This Shloka emphasizes the importance of adhering to the proper methods and treatments according to time and season, highlighting that doing so can effectively combat diseases and extend life.
इति सुश्रुतसंहितायां सूत्रस्थाने आतुरोपक्रमणीयो नाम पञ्चत्रिंशोऽध्यायः ||३५||
"Thus ends the thirty-fifth chapter named 'The Management of Patients' in the Sutra Sthana of the Sushruta Samhita."
This concludes the chapter, summarizing the comprehensive guidelines and wisdom shared for the effective management and treatment of patients.