Prolonge d

infcchbus sale of body

5mrk ugTsAT:
CHAPTER VI

379T7: yTTufrarm aTETRITH: I1

gf ATE yTaT-T:I1
We shall now expound the chapter on the "Diagnosis of
Consumption.
Thus said Lord Atreya. [1-2]

Etiology of consumption:
faruHTRTH4fa u u
There are four (categories of) etiological factors of con-
sumption viz., (1) rash behaviour, (2) suppression of the natural
urges, (3) wasting and (4) irregular dieting. [3]
The emphasis laid here on the four fold classification of etiological
factors is intended to convey the sense that all the causative factors of
this disease are included under these four categories.
teue
Details of rash behaviour as
etiological factor: 3tfAETTATd

Tererda aTSTAIGHTEea, 3rfAyH aTSEATH zaafAuafa, 37f4ET

aT, 33ag ffacaraei faqyufaaT aT TTHTTHTTY 7raTfaATUT
cHUTT:&TUdIT:4HUiad argITATafkri: yeTUTHT:F-

TT
aTTEiTefa, Z: TUEA a a i a ST: ufAyaTag Tà, 7
forearafaga fTrdFiugr; Tm: auaret faufrar aTrT:

vifur grafa, vitfuTHATaT rqurea, uatd THUYT:

TEfua:f a:7 zuvdirdauzdauga: 7:
 78 CARAKASAMHIT [ CH.

yaf a
TRrsifrrnTAT:
ita f y6ufiag UT: hHgAII4
We shall now discuss "rash behaviour" as an ctiological
factor of consumption. When a weak person fights with a stron.
ger one or exerts with too big a bow or speaks too much, oor
carries too big a load or swims in water for a long distance or
resorts to forceful massage and application of pressure by-feet or
runs fast to cover a long distance or subjects himself to assault
or indulges in such other irregular regimens and physical exe
cises in excess, his chest gets injured due to such excesses. The
injured chest gets saturated with (vitiated) vta. The local väla
affects the kapha normally residing in the chest, vitiates pita and
moves upwards, downwards and sideways. The portion which
affects the joints of the body causes yawning, malaise and fever.
The portion which affects the m[aya (stomach including small
intestine), leads to anorexia and the disease of the chest (like
palpitation and cardiac pain). The portion which affects throat
causes kanthodhvamsa (irritation of the throat) and svarabheda
(hoarseness of voice). The portion which affects the channels
carrying the vital air (prna) leads to dyspnoea and cold. The
portion which affects the head causes damage to that part.
Thereafter, due to injury to the chest, irregular movement of
the väta and of the the patient suffers
irritation throat,
constant coughing. Due to continued coughing there is (further
from
injury to the chest and the patient spits blood. Due to blood
spitting, he becomes weak. These are the complications arising
out of rash behaviour of an individual. These emaciating com-
plications lead to cachexia by and by. So a wise person should
perform various activities with due regard to his own strength.
The body is sustained by strength and the individual
self) by the body.
(Empirical
Thus it is said
The individual enjoys the desired
fruit of his action only
when he is alive. Therefore, one
desirous of long life should
avoid rash behaviour. [4-5]
When a portion of the vitiated vâta
affects the
including the small intestine), it produces diseases ämaaya (stomach
the latter it of the chest because
adjecent to the former.
VI
NIDANASTHÄNA T 79

Details of suppressionm of natural

L acalT3 No tranuforma
on o
urges as
etiological factor RoLa
ieaTaafrfa Rakta-

vefua: frHYeATUT HEraiuurde a fagrfa; Fmsigrfayraur

Tdaeittraqafayiu vfaya ayus-afa, fmf giuqstuafa ar, 41E11
TE faufa, 3taraaya, auSHrSTaUHfa, fyrreruaa, 7T
LBiock
ehanna

ritHFuTn
We shall now explain
"suppression of natural urges"as the
etiological factor of consumption. When an individual sup-
presses the manifested urges for passing flatus, urine and stool
because of apprehension,
pre-occupation, bashfulness or hatred
in front of the king or master or
(while sitting) at the feet of the
preceptor or while gambling or attending meetings of gentle-
men or in the midst of women, while
or
travelling in high or low
vehicles, then vâta in his body gets
aggravated. This aggravated
vala carrying along with it the provoked pilta and kapha moves
upwards, downwards and sideways. Different portions of vala
enter into different parts of the body as described before
(in
para 4) and cause colic pain, diarrhoea, drying up of stool,
excessive pain in the sides of the chest, grinding pain in the
shoulder region, increased respiratory movement in the chest
and throat, damage to the head, coughing,
dyspnoea, fever,
hoarseness of voice and coryza. These emaciating
complications
lead to cachexia by and by. Therefore a wise person should
make special efforts not to suppress the manifested urges with
a view to sustaining his body. The body constitutes the root
cause of the well
being of the individual and the very produc-
tion of the body is dependant upon the individual self.
Thus it is said
7 Ca.Pt.Il
 80 CARAKA-SAMHIT
CH.
Leaving everything else, one should maintain the bocd.
For if there is no body, there is nothing that can be made avail
able to the individual. [6-7]
The term 'yogakemakara' means factors, the observance of whick
sustains the body. Non-suppression of manifested urges of
urine, tool
etc., help sustain the body. These somatic factors also regulate the
chic factors in their proper functioning. One should, first of all, trypsy
f
or
the
welfare of his own body in preference to others. It is with a
emphasising the paramount position of the self that the term 'ätmamak
view t
is used here. As body is the substratum of all
phenomena in living beings
so the individual should make efforts for the sustenance of his
own bodv
even is preference to his own mind and also the body of other
indivlduals the latter two can be attempted subsequently. One
cannot
have proper functioning of his own mind nor can he
help in the
welbeing of other individuals if his own body is handicapped.
The 'yogaksemakara' can be explained in a different way also,
term

yoga means the attainment of excellent strength as well as

camplexion
and 'ksema' indicates the
prevention of disease. Thus the non-suppres-
sion of natural urges,
according to this explanation, helps in the promo-
tion of strength and
complexion as well as pervention of diseases in the
individual.
The question arises whether in view of the
predominan
body in the sustenance of the elan vital, the individual
of the
self cancebe sub-
jected to a sub-ordinate position. The intention of the clause "zriuar
TeTyaf" is to refute this argument. The idea is that if the
body plays a
predominant role in the sustenance of the elan vital, the individual self
is the very root
cause of the
production of the body inasmuch as, but for
his past action and the resultant
enjoyability of happiness or misery, the
body would not have been produced.
Details of wasting
etiological factor:
as

: TTETAAHÍAtA agh
TeATEATRTH:-aqT YaatsterHis
Tafaarufragaat vafa, jatauaTHatefefirai qafayud, FT
a
TA4TTRET qafa, zaoupfarangrtseuTgrT aT vafa,(aa
a TaUTT 7aTuaHTUTQUT (R );
We shall
explain "Wasting' as an
Rasa residing in the heart of etiological
factor for co
Sumption. an individual
ished due to the gets dimin
following -
1.
afflication of the heart
grief and worries; of the individual, with excessive
2. afflication with jealousy,
anxiety, fear, anger etc.
 NIDANASTH 81
VI

3. intake of ununctuous diets and drinks by emaciated

individuals; and
4. intake of food in lesser quantity or fasting by persons
who are weak by nature.
Due to this diminution of rasa, the individual is afflicted
with consumption and if this condition is not neutralized, it
leads to the manifestation of tuberculosis in a manner to be
described later. (1)
Rasa which resides in the heart is of the posya (which is nourished,
as distinct from posaka which provides nourishment) type. Some others
interpret this as
ojas. The procedure through which this disease is mani-
fested is being explained in the next paragraph.
Loss of semen due to over-indulgence and its consequences:

HSTT: aHfi aafT a s f taf ufe : T

fAraria, T uitkHFY tTHTYETHTTR 7 eddsTa-
HTEATTRtuTtatrain,
TATS aTrgatao4rÜra e4-irqufay
furrai-iaT: Vfuri yATaufa, Tnarqr T: HTTUT
Ttfur yard araggaagqi 372T ETATwUAYadHl H :
fTfereitvat, zHYzA, : VTrirt zrdoaufayTa, aT: ahtuHT-

itfur, Tauft ruf, Faufa T, 3ragret

TRUTHfa, f9TT: YAuTUguraia uagrafa vruuT, FRT utsa

grafa, TfuraTHIET adrayusra, : 3uyiTuutta-

3HTETR TARHTH:
When an individual due to excessive attachment borne
outof excessive passion
indulges in sexual act in excess, his
semen is diminished due
indulgence. If his mind is not
to over
detached from after the diminution of semen, and
woman even
he is still determined to
indulge in sexual act, he will have no
ejaculation of semen during cohabitation because of his semen
having been already exhausted. During the
process of coitus,
 82 CARAKA-SAMHIT CH.
vata would enter the blood vessels of this individual leading
to
the ejaculation of blood; the blood being vitiated by väta, would
then enter the seminal channels because of the diminution c
semen. Due to the diminution of semen, and discharge of
there would be dryncse
blood, the joints would become loose,
and further weakness in the body and aggravation of väta. The
vitiated väta while spreading all over the body from where se
men is exhausted and aggravating kapha and pilla, would dry up
(reduces) muscle tissues and blood, eliminate kapha (phlegm)
and pilta (bile), produce pain in the sides of the chest and
grinding pain in the shoulders, irritate the throat, till up the
head with kapha after vitiating the latter. It would also produce
malaise, anorexia and indigestion after afflicting the joints. Due
to the vitiation of pitta and kapha and adoption of opposite
course, väta would then produce fever, cough, dyspnoea,
hoarseness of voice and coryza. Due to the injury in the chest
because of continued coughing the patient would spit blood.
Due to the loss of blood he would become weak. These emaci-
ating complications would thus lead to cachexia by and by.
Therefore a wise man should preserve semen with a view to
protecting his own body because it (semen) is the outcome par
excellence of the food taken.
Thus it is said
Semen is the outcome par excellence of food. One
should preserve his own semen because its diminution leads to
many discases and even death. [8-9]
Semen is treated as the outcome par excellence because it is the
most purified form. Diminution of other dhätus (tissue elements) may
also cause consumption but the
process of manifestion of the disease due
to the diminution of semen is
specially
mentioned here because of its
importance. Diminution of blood due to be the causative factor for tu-
berculosis.
Details of irregular dieting
eliological factor.
as

fauaryTH yiTTATaaafa zgm,

a4TTATH:-aT gu:
uTTTHRTar paerUTEaTRTÍNTyTaToituatTEEaTUyTa-

qgrATgdufa, aerzuat fayraur gituurai

aaTsUTafaHGAIAT
VI NIDANASTH 83

FRATATTHTT faqATYTATYTET aT:quE yuURait

zar ufayard arysTafd; fi aierH-Tete ; cT

uftrard frtat Torauiree T , aTEHSTETf ford
fArgtafa, itrureilZTR aguTdI Taà faqHTTitufearETT

uTTarauHHTETHTETqI go ll

We shall explain ihe "irregular dieting" as an etiological

factor for consumption. When an individual takes different
ypes of drinks and diets, viz. drinkables, eatables, chewables
and lickables without paying proper heed towards their nature,
mode of preparation, combination, quantity, locality, time,
diatetic rules and wholesomeness for the individual, then väla,
pitta and kapha in his body get imbalanced due to
this'irregularity. These imbalanced dosas spreads all over the
body and when they get localized in view of the obstruction to
the entrances of the channels of circulation, then whatever
food
is taken by the individual is mostly converted into stool and
urine rather than dhtus (tissue elements) of the body. The
afflicted individual is sustained by the retention of the stool.
Therefore, the fecal matter of individuals suffering from con-
sumption or others who are extremely emaciated or weak
should be retained. Dosas accumulated due to irregular dieting,
separately produce the following complications in the body,
already depleted, resultüng in further emaciation. Vala produces
colic pain, malaise, irritation in throat, pain in the sides of the
chest, grinding pain in the shoulders, hoarseness of voice and
coryza. Pitta causes fever, diarrhoea and burning sensation in-
side the body, and kapha causes coryza, heaviness of head, anor-
exia and coughing. Due to excessive coughing there is injury to
the chest (lungs) and the patient spits blood. Because of the
discharge of blood he becomes weak. Thus the three dosas accu-
mulated due to irregular dieting manifest the disease
Räjayaksm (tuberculosis). The emaciating complications lead
to cachexia by and by. Therefore, a wise person should take
84 CARAKA-SAMHIT CH.
such diets as are not unwholesome from the point of view o f
nature, mode of preparation, combination, quantuty, locality,
time, dietetic rules and the wholesomeness for the individual
who takes them.
Thus it is said
In view of the association of painful diseases with irregular
dieting, a wise person who has control over his senses should
take wholesome food in proper quantity and in proper time.
[10-11]
Nature, combination etc., of food articles will be described in
greater detail in Vimna 1:21-22. The utility of retaining fecal matter in
the body of a patient suffering from tuberculosis is further explained in
Cikitsã 8:88.

Nomenclature of disease:

Z4TUTHTEad fyys:; zEATET THTETETE: FTASIT TEATAS-

The four causative factors of consumption, when resorted

to, lead to the aggravation of vla, pilla and kapha. These aggra-
vated dosas deplete the body due to varieties of complications.
This condition is known as Rjayaksm (lit. king of diseases or
disease of the king) because of its most formidable nature
among all the diseases and also because according to the mytho-
logical story, it afflicted the moon who is the king of stars. [12]
The termn 'R jayaksmä is composed of two words, viz. r jan mean-
ing the king and yaksman meaning the disease. This term grammatically
can be interpreted in two ways, viz. the king among diseases and the
king's (of the moon who is the king of stars) disease. Both these inter-
pretations are illustrated in the above paragraph.

Premonitory symptoms: 1
TrHf ydraufr saf; TT-tagara:; gagniaui, YeTU
ge:, TuHTepa, 3RTTYOTT:, 3H arTH:, aruayfHarquaed-
qTeTqTguyruftayT
aarReHTEATRTT, TEaTiT, qruatraaru
Hraen, 342TT: TaYTeAT TfeaT, aaT HTUTfGaTAT, thTHdl,
frejfurra, zrvraaviaaT a r , za atzi zviauggE
VIl NIDANASTHÄNA 85

T : Pfkeryequr^TRUTPiAT afrtgurfirfr (vuydesurf

yaft ) R3 1
Its premonitory symptoms are (1) coryza, (2) frequent
sneezing, (3) excessive salivation, (4) sweet taste in the mouth,
(5) disinclination for food, (6) feeling of tiredness during the
meal time, (7) finding fault with such things as are without any
fault or with negligible fault specially that of utensils, water,
food soup, Cake, upadamaa (things which are chewed before tak
ing food), and caterers, (8) nausea after taking food, (9) vom-
iting even during the course of taking meals, (10) swelling of
the face and feet, (11) frequent inspection of hands, (12) exces-
sive whiteness of eyes, (13) enquiry about the measurement of
arms, (14) passionate attachment with women, (15) cruel dispo-
sition, (16) freightful appearance (discolouration and foul
smell) in his body, and (17) appearance of the following in
dreams:
(a) empty water reservoirs;
(b) deserted villages, towns, cities and countries;
(c) dried, burnt and denuded forests;
(d) coming into physical contact with chamelion, pea-
cocks, monkeys, parrots, serpents, crows, owls etc;
(e) riding over dogs, camels, donkeys and pigs or ve
hicles drawn by them;
( climbing over heaps of hair, bones, ash, chaff and fire
brands.
(These are the pre-monitory symptoms of consumption).
[13)
Pratisyaya (coryza) etc., mentioned here as the premonitory symp-
toms of consumption are mosthy produced due to the association of the
kapha in the disease. When väta plays the dominant role in the manifes-
tation of this disease, then its association with the kapha residing in the
chest produces such symptoms. It is due to the specific characteristics of
the locality (chest) that kapha gets vitiated here. Because of the domi-
nance of kapha in the pathogenesis of this disease (consumption or
5osaroga) some scholars name it as "Slemaroga".
The dream of the individual going to south while riding a camel
or a donkey, is a bad prognostic sign but in the dream which occurs as
a premonitory symptom of consumption there is no restriction of the
 86 CARAKA-SAMHIT
CH.
direction towards which the individual goes by riding a camel or donkes.
It is only in some diseases like tuberculosis or consumption and Insani key.
nity
that characteristic dreams form the premonitory symptoms. In othe
diseases like juara (fever) etc., where no such description is given in th
classics, dreams do not occur as premonition. The dream of the patien
the
taking wine with ghosts is indicative of impending death precededent
fever-cf. Indriya 5:9. But this is only a bad prognostic sign and does ne
constitute the premonitory symtoms of fever. not

Eleven symptoms of consumption : 0

377 35uaayTauTfUT T Ya, TuT-NTTR: ftquti
6TEH, TH:, Fania:, YTUUTYEi, TiTUagtai,
qTaarie4, 3YRT
Thereafter eleven symptoms of this disease are
mani-
fested. They are (1) heaviness of head,
(2) coughing, (3) dys-
pnoea, (4) hoarseness of voice, (5) vomiting of
phlegm, (6)
spitting of blood, (7) pain in the sides of the chest, (8) grinding
pain in the shoulder, (9) fever, (10) diarrhoea and (11) anore
xia. [14]
These eleven are manifested
symptoms only when the disease
rajayaksm (tuberculosis) is fully manifested. In the section on "Treat
ment' (Cikits 8:16-32) four groups of symptoms each
eleven symptoms are enumerated and
some of them are
group consisting
of
what are described in this different from
diction because the eleven
chapter. But this does not involve
any contra-
symptoms enumerated in the above
graph are by way of illustration only
and all para-
are not restricted to these eleven
symptoms of this condition
only.
Progmosis:

TZT :
TATHfteTurarHTANifUra arararaftg: tdrfu ziruferg aug
acarufat f HEEATTTare Fgengisu-
A
patient whose strength, muscle tissues and
not
undergone diminution, who is strong and in blood have
bad whose body
prognostic symptoms have not appeared is curable
all symptoms of the even i
disease-consumption-are
body. A strong and well nourished
manifested in his
disease and patient can resist both the
medicines weill; hence even if
all symptoms of the
disease are manifested in his body, still
having a few symptoms only i.e. he may be considered as
easily curable. [15]
VI NIDANASTHÄNA 87

In the above paragraph, after the

description of the non-diminu-
tion of strength (3TvfRetUrae) the patient is described to be strong (erAF).
This appears to be a repetition. But the latter term (eTT) stands for
congenital strength whereas the former term (Tuftefturaen) indicates ac
quired strength.
Signs of incurable :
Eaci aftefturacnieifurauoufy usTaTfgaft argfa rafty-

A patient even having a few symptoms of the disease and

without bad prognostic signs
is incurable (like the one having
all symptoms and manifested bad prognostic signs)., if he
weak and there is diminution of strength, muscle tissue and
blood, because he will be unable to resist the effect of the dis-
ease as well as the medicines. He should not be treated. Bad
prognostic signs may appear in such patients in no time and
even without any causative factor. [16]
The weak patient having diminished strength, muscle tissue and
blood is considered to be incurable (i. e. he will positively succumb to
death) even without any bad prognostic symptoms. But in Indriya 2:5, it
is mentioned that death is always preceded by bad prognostic symptoms.
Because of this, it is mentioned subsequently in this paragraph that bad
prognostic symptoms may appear in the patient at any moment, that too
without any causative factor. Further the incurability due to the diminu-
tion of strength and muscle tissue itself is indicative of bad prognosis.
Merits of royal physician:

To sum up
The physician who is well versed in the
etiology, symp-
tomatology and premonitory symptoms of consumption is verily
competent to be a 'Royal Physician'. [17]

Thus ends the sixth chapter on "Diagnosis of

Consump
tion" of the Section on the Diagnosis of Diseases
(NVidänasthäna)
of Agnivesas work as redacted by Caraka.

*****