- •Introduction
- •Biographical Sketch of Cakrapāṇidatta
- •Social and political background of Cakrapāṇidatta
- •Religious persuasion of Cakrapāṇidatta
- •Works Attributed To Cakrapāṇidatta
- •Cakradatta
- •Dravyaguṇasaṃgraha
- •Vyagradaridraśubhaṃkara
- •Bhānumatiṭīkā
- •Vyādhikṣamatva
- •Viruddha
- •Table - 4 Cakrapāṇidatta’s Comments on Anatomical Terms
- •Table - 5 Comments on Symptoms
- •Table - 6 Definitions or Paribhāṣas
Table - 5 Comments on Symptoms
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Pūrvarūpa
Cakrapāṇidatta explains the term lakṣaṇa in the definition of pūrvarūpa distinguishes it from the nidāna as both are indicative of future diseases363. Just as the cloud indicative of future rain; the pūrvarūpa are indicative of forthcoming diseases, so the argument that pūrvarūpa is indicative of a non-existent entity does not hold ground. Further it is stated elsewhere that pūrvarūpa manifests during the sthānasamsrayāvastha,364 By prefixing pūrva to the synonyms of rūpa, one can obtain the synonyms of pūrvarupa. 365 Cakrapāṇidatta classifies pūrvarūpas in to two types first group includes the not well manifested real symptoms of the disease, which is invariably related to doshadhusyasammurchana (morbid interaction between morbific factors and corruptible elements of the body). The second type is the group of symptoms other than former group of actual well manifested symptoms of the disease which does not have any relation with doṣas or dūṣyas and their interaction, for example the hostility to children in jvara. Such prodromes not necessarily continue to exist even during the rūpa stage and are confirmed to the stage of prodrome. If it continues to exist beyond the prodromal stage they are indicative of bad prognosis366. Cakrapāṇidatta accepts the notion of sāmānya and viśīṣṭapūrvarūpa. There will not be any narration about special prodrome (viśeṣa pūrvarūpa) in all the cases. He explains that special or viśiṣṭapūrvarūpa are elaborated in the treatises only in the conditions where it appears367. Cakrapāṇidatta favours the definition of Vāgbhāṭa of pūrvarūpas368.The riṣṭa is considered as the pūrva rūpa of maraṇa or death369.
Rūpa
Cakrapāṇidatta considers rūpa as well manifested symptoms of ailments; a part from the specific symptoms of diseases, the specific states or avasthas, upadravas are also included under rūpas370. Cakrapāṇidatta recommends the reads to understand the exact meaning connoted to various symptoms from the words of patients. Here rendering shows affinities with Śabarabhāṣya371.
Upaśaya
Upaśaya is the well being attained by the administration of remedial measures is upaśaya. The appropriate use of therapeutic measures, foods, regimens which are opposites in nature to the cause of the illness and to the illness itself providing the result that is contrary to cause of illness and to illness and thus leading to well-being is known as upaśaya (therapeutic diagnosis of the illness) 372.Since upaśaya utilises treatment for diagnosis, all synonyms of cikitsā will be applicable to upaśaya373.Upaśaya helps in the diagnosis of illness having hidden or minute signs and symptoms and not in the acknowledgement of illness with clear prodromes, signs, symptoms and cause. Upaśaya is utilised only in the case of diseases with ill defined signs and symptoms. In case of well defined signs and symptoms, one must not make use of it and must rely on the rūpa or līṅga374.
Classification of Upasaya
Hetuviparīthauṣadhaṃ Remedial measures contrary to the cause of the disease are the characteristic feature of this group. It is observed in the treatises that diseases caused by cold substances will be cured by the administration of hot substances and viceversa. For example, śitajvara (fever produced by cold substances having coldness as its main manifestation) is alleviated by the administration of decoction prepared from dry Zingiber officinale or śunṭhi. Hetuviparītānna: The administration of diet contrary to the cause of the illness. The administration of rasoudhana i.e. rice boiled in meat broth will alleviate vātajvara or fever produced by vāta excited by exhaustion. Hetuviparīta vihara: The administration of regimen contrary to the cause of the illness; keeping awake at night when there is an excitation of kapha caused by day sleep. Vyadhiviparitauṣadhaī: Remedial measures contrary to the disease, for example pāṭha (Cissampleouspariera or Cycleapeltata) is given as a bowel binding agent in atisāra (diarrhoea).Vyādhiviparītannaī: The administration of diet contrary to the illness; intake of masūra or lentils as bowel binding agents (sthambhana) in atisārā. Vyādhiviparītavihara: This class makes use of administration of regimen contrary to the disease. The strained evacuation of bowel (causing the downward pressure of abdomen) i.e. pravāhaṇa in udavartha (which is characterised by pratilomagati of vāta (retrograde movement of vāta) resulting in a spectrum of diseases ranging from simple constipation, leads to mental disturbances, it also includes conditions like heart ailments and severe acute neurological manifestations.). Hetuvyadhiviparītaushadha: The making use of remedial measures contrary to the cause of the disease and disease itself is characteristic of this group. The daśamūla kvātha (decoction prepared out of these ten herbal roots) will act against both vāta and the śopha (inflammation) when administered in a patient having śopha produced by vata. Hetuvyadhiviparītānna: The administration of diet contrary to the cause of the illness as well against the illness itself forms the salient aspect of this division. The use of hot gruel (yavāgu) in jvara caused by cold is attributed .The gruel by its very nature is antipyretic and hotness will act against the coldness of the nidāna. Hetuvyadhiviparītavihāra: The administration of regime contrary to the cause of the illness as well against the illness; in the treatment of tandra or lassitude caused by the sleep during day time which by it very nature is unctuous and caused an aggravation of the same attribute in the body, remaining awake (as a part of treatment) during night will increase roughness in the body and will pacify the lassitude. Hetuviparītarthakāri Ouṣadha: The viparītārthakāri are those medicines, therapies, food or a regime which seems to be similar to that of the causative factor or disease but brings in alleviation of hetu or vyādhi. For example, the application of hot poultice (which will aggravates the pitta) in an inflamed sore which is having a pre-eminence of pitta, instead of excitation of pitta it will alleviate the inflammation. Hetuviparītarthakāri anna: Intake of vidāhiāhāra (foodstuff which brings about the alternation of normal functioning of pitta) in a pacyamānavṛaṇa (sore in the process of maturation) will pacify the condition is an example for hetuviparitarthakari anna. Hetuviparītārthakāri vihāra: The example for hetuviparītārthakāri vihāra, the act of terrorising or trasana will cause the excitation of vāta. The very act will pacify the excited vata in an insane patient (unmāda) having the pre-eminence of vāta. Vyadhiviparītārthakāri ouṣadha: The example for this class is the usage of emetic drug, madana (Randiadumetorium.Lam) in the treatment of vomiting. Vyadhiviparītārthakāri anna: In take of milk (which is a laxative) in the treatment of diarrhoea is an example for the class of vyadhiviparītārthakāri anna.
Vyadhiviparītārthakārivihāra: The tickling of the throat in order to induce vomiting in the case of vomiting is an example for vyadhiviparītārthakāri vihara.Hetuvyadhiviparītārthakāri Ouṣadha: Selective use of poison for the treatment of poisoned states is an example for this group. The application of ointment made out of agaru (Aquilariaagallocha. Roxb.) As remedy for the burns caused by the fire. Here both the disease as well as the causative factors is hot and the medicine applied is also hot in nature. Hetuvyadhiviparītārthakārianna: Intake of an alcoholic beverage in the treatment of intoxication (madathyaya) resulted from the excessive consumption of alcoholic beverages is an example. Hetuvyadhiviparītārthakāri vihāra: Mūḍhavāta (vāta in retrograde movement will cause great discomfort to the patient) which is resultant of excessive physical exercise is alleviated by doing an exercise in the form of swimming375.
We see all the illustrations of eighteen divisions of upaśaya and explanations seen in Āyurvedadīpikā are included in later commentaries like Madhukośa. It is also interesting to note the absence of explanations about the working of hetuviparītastartakāri means in Āyurvedadīpikā, where Vijyarakṣita gives a detailed explanation on this topic in Madhukośa.
The anupasaya is characterised by results that are produced by remedial measures, food and regimes that results in the aggravation of the disease state. In short it is inadequate treatment of the illness and is included under nidāna or hetu.376
Saṃprāpti
Saṃprāpti is enumerated as the last member of the five fold scheme of source of knowing a disease due to its relatively inferior role in diagnosis.377Prof.G.J.Meulenbeld also noted this special stand taken by Cakrapāṇidatta i.e., the attribution of a relative inferior status for saṃprāpti among the pañcalakṣaṇanidāna. The reason cited for construing an inferior status for the saṃprāpti among the sources confirming the disease, is that it varies from person to person (even if inflicted by similar type of disease). Hence only the general concept of saṃprāpti is enumerated in the treatises without taking into account of the possible individual variations. The enumeration of general saṃprāpti is to avoid the shortcoming from non enumeration of saṃprāpti. Such individual variations are not considered useful by Cakrapāṇidatta378. Though Āyurvedadīpikā refers to opposing views regarding the saṃprāpti, it is not employing the term doṣaitikartavyatārūpa saṃprāptī and vyādhijamnarupasaṃprāpti for explaining these two schools of thoughts on saṃprāpti379. It is very interesting to note that Cakrapāṇidatta who uses the term itikartavyata twice in the commentary380 is not using it in connection with the definition of saṃprāpti. Cakrapāṇidatta notes that there is a school of thought which favours the concept of saṃprāpti as that which is responsible final manifestation of the illness. As per this concept of saṃprāpti, unlike the nidāna etc, it is not indicative of the illness which is not yet manifested but of the fully manifested one.381 But others disagree with this view of saṃprāpti as an indicator of mere emanation of the illness, without considering the subtle nuances of disease genesis. They cite that even the nidāna, pūrvarūpa etc, are also indicative of non-manifested diseases and it is not mandatory that diseases should diagnosed only in its fully manifested state. Therefore this school defines saṃprāpti as the genesis of disease characterised by the way in which it is manifested by the underlying doṣa - vyādhijanakadoṣa vyāpāraviśeṣayuktaṃ- that is, the genesis of a particular illness is by a specific cause resulting in a definite vitiation of the doṣas in accordance to the strength of the cause, leading to a particular pattern of corruption in the body, expressing its specific characteristics. To cover this aspect of saṃprāpti, it has been given the synonym āgati, which signifies the specific action of a causative factor, along with full pattern, up to the full-blown manifestation of the disease. Thus saṃprāpati construed in this manner will be helpful in comprehending the subtler aspects specific for each disease processes. For example in the case of jvara, the saṃprāpti highlights the involvement of āmāśaya, inhibition of āgni, and vitiation of rasa before its manifestation.382
Cakrapāṇidatta further explains the specific character of vitiating the āmāśaya etc, should not be attributed to saṃprāpti, it is the essential qualities of the nidānas of jvara, but it is only comprehended through saṃprāpti. Inorder to highlight its utility for highlighting the above mentioned specific caharacteristics of nidāna, saṃprāpti has been separately mentioned in the śāstra. Though pūrvarūpa and rūpa are signs of a disease, they are mentioned separately in list of meaning of diagnosis to stress the fact that former provides the information about unmanifested state of the illness and later confirms a disease in its complete manifestation. By adopting Vāgbhaṭa’s definition for saṃprāpti, Cakrapāṇidatta places him in nearer to the second school of thought i.e., doṣetikartvyatārūpasaṃprāpti.
Through this statement Āyurvedadīpikā not only fails to justify the statement which grants a relatively inferior status for saṃprāpti in the sources confirming disease and seems to fall in to a circle of self contradiction .
Further he tries to place saṃprāpti in nidāna, and tries to substantiate it by placing the view of some scholars who considers the narration sa yadā prakupitaḥ383 etc as specific actions of nidānas and have nothing to do with saṃprāpti. Here also we can clearly notice the lack of clarity and inconsistency in explaining the concept of saṃprāpti in Āyurvedadīpikā. Nīlameghā explains samprapti in the context of yogatantrayukti, construed from the other four means of acknowledging (both associated and dissociated) the illness .It is the samprapti, that which provides the exact characteristics of the illness and guides the very course of therapeutic procedures. Owing these two reasons, saṃprāpti is placed as the last member in the list of five means of confirming the illness. The knowledge obtained from other means of confirming illness will lack in tendering the exact characteristics of an illness and that is provided by the saṃprāpti384.
The five fold divisions of saṃprāpti (onset of an illness) are based on conditional factors viz., saṃkhyā (number or enumeration), vikalpa (discrimination), prādhānya (ascendancy), bala (degree of intensity), and kāla (time). The vidhi (mode) is added to this list that is otherwise understood under the narration of saṃkhyā. Since this enumeration of divisions of saṃprāpti helps in treatment, it is acceptable to have such divisions incorporated in the treatise385. Sankhyasaṃprapāti: This only covers the divisions of a disease as enumerated in the aṣtaudarīyādhyāya of sūtrasthāna386. Vidhisaṃprāpti: The saṃprāpti is further grouped on the basis of vidhi or mode of presentation of illness. The mode conveys the distinction within a class where as the number conveys the differences in two or more different classes.Vikalpa saṃprāpti: The vitiating factors will not necessarily cause equal degree of aggravation to all attributes of doṣa involved. Therefore a careful analysis of each attribute of doṣas vitiated as well as the number of doṣas involved is done for the perfect comprehension of the manifested disease. The vitiation will vary from one cause to another as well as it is delimited by the strength of the cause. Pradhanya saṃprāpti: The prādhānya saṃprāpti provides the degree of comparison between the vitiated doṣas. If all the three doṣas are involved ,the degree of vitiation is indicated by the superlative term tama and if two out of three are excited then it is expressed by the term tara. In the case of a disease, the prādhānya saṃprāpti is expressive of the relative independence or dependence of each disease. The independent disease is predominant and dependent disease is non-dominant. Balakālasaṃprāpti: The balakālasaṃprāpti is explained as that which gives the complete picture of disease with relation to variations in seasons, diunurnal variations, and variation related to digestion of the food. Āyurvedadīpikā reports that some scholars are interpreting the term vidhi here as actions of past life.
Cakrapāṇidatta views that as the saṃprāpti and its divisions are common to all disease it is explained in general and the specifics about nidāna,pūrvarūpa,rūpa,and upaśaya varies from case to case Its details to specific diseases are seaparately elaborated in the treatise.387
While commenting on rogamārgas the nomenclature śākha or bāhyarogamārga is used for communication as well as to highlight the peripheral nature. The term tvak also connotes the rasadhātu associated with it. The term rasa as such is not used because it has been associated with hṛdaya and which is associated with the koṣṭha.The same is the case of raktadhātu, it should also go to the madhyamarogamārga, since its main loci are yakṛt and plīha, which indeed are again associated with the koṣṭha388.
Cikitsā
Nirantarapada ṭikā confirms the fact that only rasāyana and vājīkaraṇa chapters own the four sub sections389. The current chapter is positioned as fourth in the format of four quarters of the rasāyana, the topic expounded in this quarter i.e. the act of primary preaching of Āyurvedic tenets.390 Due to the pre-eminent nature of this section the tenets implied here must be understood in the beginning of the pedagogical activity391. Tacitly the pre-eminence of the topic is implied irrespective of its order of placement, though the section actually forms one of the four quarters of rasāyanādhyāya392. By illation Cakrapāṇidatta puts this section as the conclusion of this chapter393.(verses 1-2) The two fold division of division of r̥iṣis or inspired sages : yāyāvara and śālīnāḥ394.The later group is having a fixed abode and the former is devoid of any such fixed settlement and they consumed fruits, roots395. Cakrapāṇidatta construes this classification as the one based on their activity396. The appellation r̥iṣi demarcate the yāyāvaras from vagrant mendicants397. This shows that yāyāvarar̥iṣis are forest dwellers any longer and their luxurious mode of living made them less auspicious and more susceptible to diseases398. Jejjaṭa explains the term ‘kalpanīyapātāḥ’, the term is not found in the present edited version of Carakasaṃhitā and is noted commented upon by Cakrapāṇidatta399. Instead of Cakrapāṇidatta’s reading ‘nātikalyāśca’ Jejjaṭa favours the version ‘nātikalyāṇāśca’400. Term ‘itikartavyatā’, is commented by Cakrapāṇidatta as operation or vyāpāraḥ (of their respective function/profession) and is not rendered in Nirantarapada401. The qualifying term ‘śivaṃ’ for Himālayās, according to Jejjaṭa indicative of north part of it402.The usage of synonyms to address/qualify Lord Indra is interpreted as an act of reverence by both the ṭīkāras403. The transmission of Āyurveda is meant for the welfare of people to turn in their unadvised life pattern to the tenets of Āyurveda. Cakrapāṇidatta’s commentary closely follows Jejjaṭa’s rendering404. Jejjaṭa reads the continuity and purity of Āyurveda tradition from the narration of lineage of gurus. He also lauds the role of the guru in pedagogical system. We can find analogous passages in Āyurvedadīpīka405 (1/ 2, 3). Cakrapāṇidatta explains the term ‘atha’ as ‘adhikāra’ (reference or relation)406.Āyurvedadīpīka explains the fresh instruction of Āyurveda tenets is only a refresher of sages who had lost their acuity and agility in their rusty life407. Nirantarapada gives a contrary explanation to this view408.As per Jejjaṭa account, the additional narration about the original propagation of Āyurveda is out of care and compassion for the ailing humanity, so that its precepts will help the course of humanity.409Jejjaṭa extols indrokta rasāyanas and due to its usefulness he ratifies their narration to a greater degree410.Nirantarapadakara in this context interprets the word atha as thereafter411. The ten drugs explained in this section are having the same procedure of administration412. There is very conspicuous absence of any specific exegesis on this topic in Āyurvedadīpikā. As per the Nirantarapada, sages had discerned the medicinal properties of these rare drugs vowing to their penance and virtuous nature413. Jejjaṭa tries to camouflage the mysterious nature of the celestial drugs414. Cakrapṇi too acknowledges this rarity and the inscrutability of these celestial rasāyana drugs415. Cakrapāṇidatta tries to explain the archaic terms (of celestial plants) on the basis of hearsay reports416.Based on the traditional narrations that even accomplished sages falling to the lust, these celestial drugs should be taken only by sages who had won their senses417.Guided by the traditional notion Jejjaṭa is of the opinion that these specific potentiating drugs must reversed exclusively for pious sages418.
The potency of drug is not universal, and hence many therapeutic uses of drugs are highly selective and many a times they are not be easily generalisable. In order to discern these exceptionable conditions one must follow the authoritative scriptures rather than speculations. One must exercise extreme caution while discerning as any fallacy may end in jeopardy419. This explanation is not seen Ayurvedadīpika. The use of pippalī along with lavaṇa and kṣāra is restricted, but here in 1/3/32 it recommended an exceptional one (utsarvgavidhi). More over the pippalī is recommended here in a ‘rasāyanavidhi’ so it will not harm the person as it is given in combination with other dravyās420. Carakapāṇidatta follows Jejjaṭa’s explanation regarding the rationale of pippalī rasāyanavidhi421. Jejjaṭa uses the choices of number of pippalī in the text as a clue for construing the alternate schemes of administration of pippalī and further accounts an alternate scheme of pippalī administration: three or four or six or nine or eleven pippalis, based on the doṣāvastha (state of factors involved)422.Cakrapāṇidatta too follows this interpretation423. The enumeration of administration of pippalī in five, eight etc is one mode and the other mode is administration of the three pippalis processed in kiṃśuka or palāśa kṣāra and ghr̥ta or ghee before food. Cakrapāṇidatta ṭīkā lacks this description424. Reason for the listing out various time and mode of administration of pippalī as per Jejjaṭa is to suit the need of various doṣic combinations425. Jejjaṭa quotes another authority to explain the vātavalāsaka jvara426. (verse 32- 36). Jejjaṭa seems to read ‘cūrṇīkr̥tā’ in the verse 39 as śītīkr̥tā427. Cakrapāṇidatta also refers to existence of such a variant428. The quantity of kṣīra or milk should be either increased or decreased in proportion to that of pippalī429. Jejjaṭa finds parlance with ‘śilājatu rasāyanavidhi’ and the pippalī rasāyana explained here430, as both of them have the best, moderate and inferior doses and modes of administration. Cakrapāṇidatta does not describe the quantitative aspect of milk.He counts the number of days required for best mode of administration of pippalī i.e. nineteen days for the consuming thousand pippalis. The convention of giving moderate dose of increase with six pippalis is attributed to predecessors by Cakrapāṇidatta, any such reference is conspicuously absent in Nirantarapada commentary431.(verse 37- 39). The commentary on verses 40-47 Jejjaṭa counts all the four rasayana prayogas of triphalā and all the four should be given for one year. Cakrapāṇidatta clarifies the usage of term ‘suvarṇa’ in the text give special emphasis for gold among the metals and should be conjoined with triphalā to achieve rasayanā properties432 (verses 41-47). The verse 1/4/48-49 explains the general therapeutic qualities of śilājatu. The only varieties of śilājatu are explained in Carakasaṃhita where are Suśrutā(chapter ) ascribes six types of śilājatu. According Jejjaṭa, while analysing a text one must devote oneself to that particular text and not to opinions expressed in any other treatises, which Cakrapāṇidatta too agrees on433.While enumerating the therapeutic properties of various types of śilājatu, qualities śitā and uṣṇa are assigned. This attribution does not refer to absolute state but a reference to these qualities in moderation434. Cakrapāṇidatta following the foot steps of Jejjaṭa explains that in śita or uṣṇa vīrya is not found in absolute preponderance or predominance in these varieties of śilājatu 435. So in suvarṇasambhavaśilājatu, there will be a preponderance of madhura rasa and by the usage satiktaṃ it signifies its atyantahintvaṃ or only in extreme subordination. In this way one must explain the properties of other śilājatu varieties436.The reference regarding combination involving variant elements based on observance can display slight variation and they cannot be comprehended under one head437. (Verses48-49) Cakrapāṇidatta also explains this variant in pharmacological properties of various categories of śilājatu as a case of exception438. Cakrapāṇidatta elucidate the term suvarṇaśilājatu is not concomitant with gold it should be comprehended as the śilājatu from the source site as that of gold439. Cakrapāṇidatta explains technical terms like mr̥tsnaṃ and acchaṃ, which are not in Nirantarapada440. (verses:55-61). The plural usage – śilājatuprayogeṣu- refers to multiplicity in the genera and the processing of śilājatu441. Ayurvedadīpika also interprets this term in acquiesce with Jejjaṭa442. The proscription of kulatthā is construed by some physicians as life long exclusion of kulatthā and other deemed as a total ban of it for the whole life.443
There physicians who consider the prohibition until the objective of therapy is reached. Jejjaṭa considers the proscription for a time span of one year as it is time span need to get the body strengthened.444He also highlights necessity of this ban445. Jejjaṭa gives variant reading to the verse ‘na so’sti rogo bhuvi sādhyarūpaḥ śilāhvayaṃ yanna jayetprasahya.’446Jejjaṭa reports ‘sadhyarūpa’ is construed by some physicians to connote ‘sāmānyjarogas’.447 Cakrapāṇidatta’s commentary is silent on these issues. The ṭīkā ends by highlighting diachotomic nature of śilājatu i.e. preventive and remedial powers.448Āyurvedadīpikā also ends in the chapter by expressing same idea in a sketchy manner.449
Cakrapāṇidatta explains three forms of treatment schedules. They are nidānavarjana or avoidance of the causative factors of diseases, samana or pacification of doṣas by means other than the elimination therapies, and śodhana or elimination therapies.450 Additional explanations of ṣaḍvidhopakramas are available in Āyurvedadīpikā. In rūkṣaṇa therapy, the predominating quality will be rūkṣā where as in laṅghana it will be laghu; moreover laṅghana can be performed even without the help of dravyas and is not possible in the case of virūkṣaṇa. Hence one should not equate these two different therapies.451 In laṅghana, all the śodhana therapies expect anuvāsana are included. The exclusion of anuvāsana from laṅghana is due to its bṛṃhaṇa (nourishing) nature.452 Pācana works either by clearing the factors working antagonistic to digestive fire or by strengthening its functional capacity; these are having predominance of agni and vāyu mahabhūtas. 453
The chapter which enumerates the treatment of jvara is termed as jvaracikitsā; here Āyurvedadīpikā clearly follows Nirantarapada vyākhyā.454Āyurvedadīpikā clarifies that here the term jvara also connotes the general sense of disease; this interpretation is also found in Nirantarapadavyākhyā.455Nirantarapadavyākhyā in this context explains how and when one must clarify the doubts with one’s preceptor and this is also reflected in Cakrapāṇidatta’s commentary 456 Āyurvedadīpikā explains dehendriyamanastāpi, the qualification of javara as the unique feature of jvara. Some diseases only afflict body, others inflict mind, and some afflictions target specifically the sense organs457. Jejjaṭa also explains in the same way, he also reports an alternate interpretation, which takes the terms deha, and indriya as one compound term, explain it as sparśnendriya.458 Nirantarapadavyākhyā clarifies that this query is not a śiṣyasūtra and this is not seen in the corresponding Āyurvedadīpikā.459 Āyurvedadīpikā quotes mythological narration that portrays jvara as a creature having three legs and three heads is also found in Nirantarapadavyākhyā.460Nirantarapadavyākhyā explains the nature of jvara in two planes one upapattikṛta - resulted by śārīrika and mānasikadoṣas and svābhavikī, which associated with pañcatva or death.461 Cakrapāṇidatta and Jejjaṭa subscribe the traditional mythological concept that links fury of Lord Rudra primordial manifestation of jvara462. While explaining the term prabhāva in javara prabhāva, Cakrapāṇidatta clarifies that it is the special power of related to special conditions or power limited to specific conditions463. Jejjaṭa also explains this term as extraordinary power464.
Āyurvedadīpikā reports the alternate view which holds that doṣas are the causative factors of jvara, in this case the role of causative factors like rūkṣa etc are inferred from their effect on the excitement of doṣas.465 The alternate view seems to be of Nirantarapadavyākhyā.466 While commenting on the vidhi bhedas or modes of jvara, Āyurvedadīpikā refutes the opinion of two different schools of thought467. Though jvara affects both mind and body, their separate narration is intended to emphasis the need for different treatment protocol for mānasikajvara and śārīrikajvaras468. Nirantarapadavyākhyā reports a variant related to the verses explaining antardāha and comments that on the basis of explanations found in other. Āyurvedadīpikā is not cognizing the existence of such a problem.469Āyurvedadīpikā explains that though the upadravas of jvara are not explicitly mentioned in the treatise one must understand it from its general narration. Alternatively, they can be the ten complications explained in other treatises. The alternate opinion can also be seen in Nirantarapadavyākhyā.470The manifestation of disease depends on the course of the saṃprāpti. This idea is very explicitly mentioned in Nirantarapadavyākhyā and is concisely quoted in the Āyurvedadīpikā.471While explaining the prognosis of vātādi jvaras; Āyurvedadīpikā takes pralap, bhrama, and śvasa as common set symptoms to three types of jvaras. Accordingly vātajvara will result in death in seven days, pittajvara in ten and twelve days kaphajvara. Āyurvedadīpikā refers to Nirantarapadavyākhyā interpretation which considers the three symptoms separately for three doṣas. So pralāpa and vātajvara will result in seven days, similarly paittikajvara with bhrama in ten days and death within twelve days in the case of kaphajajvara with svāsa. Both the commentaries agree on the fact that there can be exceptions for this time limit. Āyurvedadīpikā explains gambhira as antarvegajvara or dhātusthajvara472. The second opinion refers to Nirantarapadavyākhyā473.About the prognosis of vātika jvara with respect to kāla or temporal factor Āyurvedadīpikā is that all vātajajvaras (in varṣakāla) are difficult to cure so it is vaikṛta in that sense. Alternatively vātajvara in varṣakāla is prākṛta but it is kṛcchrasādhyaḥ, where as in vasanta and śaradṛtus it is sukhasādhya and prākṛta; more it is in line with Vāgbhaṭa474.Nirantarapadavyākhyā lacks these discussions. While commenting on satatajvara, Āyurvedadīpikā carries the same allusions of Nirantarapadavyākhyā.475 Āyurvedadīpikā refers a number of pāṭhabhedas to satatādijvaras476. The seats of these jvara are explained as three doṣas, sapta dhātus, mūtraṃ, and malas.477 Cakrapāṇidatta clarifies that the description found in other treatises are different from the one which are elaborated in the treatise478. According to the view of Āyurvedadīpikā, satatajvara is resulted by the involvement of three doṣas479. The sāmprapti will determine the influence the effects of kāla, pṛkṛti a dūṣyas in satatādijvaras and this narration is not seen in Nirantarapadavyākhyā480. Āyurvedadīpikā refers to pāṭhabhedas regarding the texts explaining the ṭṛtiyaka and caturthakajvaras, the corresponding Nirantarapadavyākhyā is not explicitly referring to these variants481. Like the gṛdhras,i there is no paittika caturthakajvara482. Here Jejjaṭa makes an interesting view about expressed by Harīta; he boldly states that all preceptors are not equal to the status of Agniveśa. As the case of Āyurvedadīpikā he also explains the involvement of pitta as anubandha483. So does Nirantarapadavyākhyā .Āyurvedadīpikā also includes saṃtata is a viṣamajvara484. Cakrapāṇidatta refers to school which considers only of jvaras as viṣamajvara; here the school of Kharanāda excludes satata from the list. Some others only grant tṛtiyaka and caturthaka the status of viṣamajvara485. He also prefers this classification486.Nirantarapadavyākhyā quotes a difference of opinion about caturthavaviparyaya’s interpretation put forward by Śivasaindhava and Āṣāḍhavarma; he leaves that point to discretion of vṛddhavaidyas487. This point is not seen in Āyurvedadīpikā. Cakrapāṇidatta points out the importance of manas in determining the nature of viṣamajvara488. Both Āyurvedadīpikā and Nirantarapadavyākhyā explain that the symptoms explained in sannipātajvara outside the symptoms of vātadijvaras are generated by the vikṛtiviṣamasamavāyārbhaṃ. In this connection Nirantarapadavyākhyā reproduces the symptom of koṭha (from Bhāluki) and tantra from another anonymous treatise. In Āyurvedadīpikā also we find reproduction of koṭha lakṣaṇa489.
In āgantujvaras the vitiation of rakta predominates and maṃsa and other dhātus are only slightly vitiated.490 In the case of āgantujvara, the Kāśmiri recension reckons viṣaja as a separate type of abhiṣaṅgajvara and adds separate verses for explaining it. Whereas there are other recessions which does not contains these verses but still accept the viṣajajvara as an abhiṣaṅgajajvara. There was still another sect of scholars, who does not deem the viṣajvara as an abhiṣaṅgajajvara; instead they regarded it as doṣajajvara predominated by pitta.491 The symptoms like kṣudā etc., will be appear as a result of doṣapāka irrespective of the time factor of eight days492. In the context of jvara, the term laṅgana refers to fasting493. The term kṣaya related to jvara is interpreted in two different ways, one the jvara caused by the kṣaya of dhātus and two the jvara related to rājayakṣma494. Laṅghana is contraindicated in the anilajvara; it should be understood as nirāmānila. Alternatively, the vātakopa attributed to the underlaying dhātukṣaya.495 In the case of āvṛtavāyu usually it will be associated with āma, owing to its āvārakadharma; there one must judiciously apply the laṅghana or fasting496. The conditions like kāmajvaras are having association with vāta in their subsequent stages and therefore laṅghana is contraindicated497.
Both Cakrapāṇidatta and Nirantarapadavyākhyā agree that the role of agni in the genesis of vātaśleṣmajvara, here it is agni involved is in the form of bhutāgnis498.
The symptoms like kṣudā etc., will be appear as a result of doṣapāka irrespective of the time factor of eight days499. In the context of jvara, the term laṅgana refers to fasting500. The term kṣaya related to jvara is interpreted in two different ways, one the jvara caused by the kṣaya of dhātus and the other, the jvara related to rājayakṣma501. Laṅghana is contraindicated in the anilajvara; it should be understood as nirāmānila. Alternatively the vātakopa is attributed to the underlying dhātukṣaya.502 Āvṛtavāyu usually will be associated with āma, owing to its āvārakadharma. Here one must judiciously apply the laṅghana or fasting503. The conditions like kāmajvaras are having association with vāta in their subsequent stages and therefore laṅghana is contraindicated504. The usage of kaṣāya in jvara after eight days is intended for pācana of apakvadoṣas505. The emesis is done for doṣas concentrated at āmāśaya. Since it’s in an excited state by itself and is located in the koṣṭha, there is no need for mobilization of doṣas by snehana and svedana (even if done only in a mild form)506. In the case of jīrṇajvara, if one wants to perform vamana, it must be preceded by snehana and svedana507. Sāmadoṣas are in a state of stagnation and are in association with the dhātus508.
Āyurvedadīpikā explains that the contraindication of yavāgu in Hārita is with respect to ativṛddhaśleṣma or highly excited morbid kapha, some other commentators are of the view that this contraindication is for person having a state of pitta and kapha prakṛtis, an obvious reference to Nirantarapadavyākhyā509. Cakrapāṇidatta observes that the ṣadrātravidhi is not practiced in all jvaras in his place510. Quoting Hariścandra Āyurvedadīpikā explains that lājapeya is indicated in kāphāvastha511.
Cakrapāṇidatta sees no contradiction between various treatises regarding the timing for the administration of kaṣaya512. Āyurvedadīpikā quotes the alternate view regarding the contrindication on kaṣaya for jvara; according one school of thought, even in the seventh day kaṣaya prepared out of kaṣayarasadravyas is contraindicated513. If kapha predominates and agni is optimum, one must administer yūṣā and in case of preponderance of vāta and if patient is weak one must go for rasas514. In vātapitta predominant condition, administration of sarpi is indicated and this does not permit its use in anuvāsana and abhyaṅga. This interpretation of Āyurvedadīpikā is based on the term pāna in the text515. Cakrapāṇidatta explains that in baddhadoṣa one must administer gokṣīra and in pracyutadoṣa the choice is chāgakṣīra516. Āyurvedadīpikā interprets the term purāṇa in connection with administration of anuvāsana in jvara as atyarthapurāṇa i.e., extreme chronicity517. In Dāhajvara, if one anoints any paste, according to Suśruta’s interpretation, it must be very thin518. The state where ghṛta is administered in jvara is predominated by rūkṣata; owing to the special nature of the disease. This is seen in the jīrṇāvasta or chronic state of jvara519. The condition is explained as the state of jvara where sneha part of pitta is lost as result of laṅghana. Others explain it as the condition associated kapha has become rūkṣa and ghṛta can be applied. Another explanation is that body after administration of kaṣaya had turned to rūkṣa and that is the time for the administration of ghṛta. Last explanation is also seen in Kharanādasaṃhita and in commentaries of Bhāsadatta, Svāmidāsa, Āṣāḍhavarma, Brahmadeva and others and Āyurvedadīpikā find it difficult to ignore this view520. This view is also quoted in Nirantarapadavyākhyā. The kaṣāyas explained here can be also administered in form of ghṛtas, so scholars explain it as administration of kaṣāyas with ghṛta as an adjuvant.521 Cakrapāṇidatta hints about a possible contraindication of nagnisveda in jvara522.The verse narrating punarāvarttakajvara are not part of the Cakrapāṇidatta’s text, he explains it as Kāśmirapāṭha523.
Cakrapāṇī, commenting on the verse, explains that the varied clincal status of the pitta itself is termed as lohitapitta4. A triad of causes have been mentioned to substantiate this notion of pitta attaining this status: its combination with rakta, the corruption of rakta by it and the similarity of pitta with blood in smell and colour.5 Cakrapāṇi splits up this as the three definition of raktapitta: the pitta associated with rakta is rakta pitta ; the condition where rakta is vitiated by pitta is raktapitta; and, the pitta assuming the nature similar to rakta is raktapitta.6
In raktapitta the movement of pittā towards rakta is resultant of its special saṃprāpti524. The fluid part of the dhātu i.e., rakta will transcend to other dhātus and augment the disease process525. Āyurvedadīpikā explains that in paittikaraktapitta, in the viśeṣasaṃprāpati, there is no involvement of other doṣas. Cakrapāṇidatta refutes the attribution of doṣic status to raktapitta on the basis of its movement. Cakrapāṇidatta is very categorical in denying any special status for such association of doṣa and these associations are also not considered for determining the prognostic status 526.Since the upward movement is predominated by kapha and downward by vāta, some scholars are of the opinion that there is no possibility of a paittikaraktapitta. A few others are of the opinion that paittikaraktapitta is resulted when the excited pitta from other parts of the body comes in contact with raktapitta527 Koradūṣā and gaṇḍīra act as causative factors only in combination with other similar constituents528. The medicines indicated for raktapitta must be understood from a holistic perspective and not from the individual properties529. The Āyurvedadīpikā reports the kāmalahara property of formulation āṭarūṣakamṛdvikādi530.
Gulma refers to lump in body resulted from conglomeration of doṣas531. Some are of the opinion that five specific seats attributed to gulma is not applicable for raktagulma as its seat is garbhāśaya532. For others, garbhāṣya is covered under the seat pārśva.533 The term nicaya refers to sannipāta resulted from vikṛtiviṣamasamavāyārambha534. The saṃsargadoṣāvastha in gulma is not resulted from vikṛtiviṣamasamavāya, so from the individual narration itself we can construe the dvandavjagulmas; therefore no separate narration of dvandajagulmas is given535. Some scholars are of the opinion that gulma resulted from prakṛtisamasamāvāyārambha are curable536. Āyurvedadīpikā also clarifies that raktagulma can be seen even after ten months537. In gulma both anuvāsana and nirūhaṇa are administered538. The virecana must not be tīvaravirecana as it can aggravate the already excited vāta539. Cakrapāṇidatta clarifies that there is no difference of opinion between the treatises of Caraka and Suśruta in context of indicating raktamokṣaṇa and explaining also pāka of gulma; only difference one can see is the usage of different terms for explanation540. Cakrapāṇidatta explains the term mūḍha as saṃmūrcchana of extreme interaction with each other resulted by the āvaraṇa541. Some explain Ci.5.102-104 differently. According to them, taila is administered with cūrṇas like nīlinīcūrṇa and according them the trayūṣaṇādyaghṛta is also administered with nīlinīcūrṇa542.
In the genesis of prameha, kapha having excessive drava quality and not otherwise will result in prameha543. The term bahvabaddhaṃ is explained as asaṃhataṃ, i.e., unbound or un-connected. The bahutva and abaddhatva can be seen in medas, māṃsa, majjā and vasā. Rest of the dhātus will be having only bahutva544.
Though the number of pramehapiṭaka explained in the compendium of Suśruta exceeds that of Carakasaṃhitā does not contradicts each other, In Caraka considering the relative importance only seven piṭakas are explained545.
In the context of kuṣṭhacikitsā, Cakrapāṇidatta is inclined towards ālepana546. In case of taila, for external application some physicians prefers sarṣapataila and for internal use tilataila is generally preferred547. There are similar doṣas and dūṣyas involved in the saṃprāpti of kuṣṭha and visarpa. However, in visarpa we can see a dominant involvement of rakta and visarpaṇaśīla or the morbid factors are set in fast motion. The dominance of rakta can cause increase in pain in visarpa compared to that of kuṣṭha. Even some physicians are of the view that compared to kuṣṭha; in visarpa the combined role of seven factors is not always necessary548. The viṣeṣaduṣṭi of doṣas is explained in connection with kuṣṭha549.
The sneha refers to śukra and ojas550. In the case of rājayakṣmā, manifestation of ekādaśarūpas is considered as full manifestation, ṣadrupa and trirūpa rājayakṣma are partial manifestation of the disease.551 Āyurvedadīpikā clarifies that though some authorities consider rājayakṣma as a single entity, owing to difference in line of treatment the fourfold classification of śoṣa must be appreciated here552. Cakrapāṇidatta explains the three lakṣaṇas are the salient features of all types of rājayakṣmā but is not explicitly explained in Caraka and it can be any three symptoms of yakṣmā. Where as some scholars explain it as aṃsapārśvābhitāpa etc553. Others consider aṃsaparśva etc as the feature of jvara in rājayakṣmaroigi554. Aruci is reckoned as prakṛtisamasamavāyārbdha disease555. The narration yakṣmiṇaṃ saptakaṃ balaṃ is explained on the basis of reference from some anonymous text which reads hikka in thegroup of seven symptoms. Āyurvedadīpikā clarifies that though hikka is not in the symptoms of yakṣma, it must be understood as a complication556. Āyurvedadīpikā classifies praseka into two, svatantra and parādhīna; the former is having a dominance of kapha and later is having a predominance of vāta. The same classification is extended to the case of chardi too.557
Āyurvedadīpikā reveals the existence of practice of bhūtavidaya during this period558. The unmāda curing effect of māṃsa, which considered as a causative factor of unmāda is attributed to adṛṣṭa559. Some scholars is of the opinion that the usage of māmsa in the case of nijonmāda is not accepted by Āyurvedadīpikā560. Like the gulma, the apsmāra is also reckoned by some physicians as prakṛtisamasamavāya.561 Cakrapāṇidatta metions about the scholars like Bhīmadanta explaining the textual matter, which elaborates āgantvapasmāra separately. If accepted, the sankhya saṃprāpti of apsamāra will have to be altered562. Keeping in line with the tradition of Bengal, Cakrapāṇidatta expresses reservation in accepting the narration of atattvābhiniveśa as an independent disease, which is accepted by the physicians of Kāśmira and Sindhudeśa.563
Cakrapāṇidatta explains that the principles of treatment of mānasavyādhis can also be employed in treating the śārīrikavyādhis564. Cakrapāṇidatta explains the term daiva by providing two options namely, fruits of previous action and gods or divine agencies.565 Daivavyapāśrayacikitsā is considered as the one which provides quick relief and is indicated in acute diseases.566
Regarding the disease kṣatakṣīṇa, some physicians consider it as two conditions namely kṣatha and kṣaya. When kṣatakṣīṇa is considered as a single entity, it is attributed to the diminution of śukra and ojas. Cakrapāṇidatta is in favour of those who consider it as a single disease entity and says only its manifestations are in two different ways. This narration helps to conceive the treatment protocol in the pūrvarūpa stage.567
The kaphaśopha is more prominent during night because kleda increases during night due to sedentary state and śtrotas are blocked during the night time. The śopha that affects the śiras is explained as upaśīrṣaka by Āyurvedadīpikā.568 Cakrapāṇidatta explains the treatments of bhagandara are not elaborated here as it involves surgical methods569.
Udara is said to be resulted from agnidoṣa, Āyurvedadīpikā explain it as agnimāndya570. Āyurvedadīpikā gives two causes for plīha, one is due to over excretion and other resulted from the vitiation of rakta571. Āyurvedadīpikā explains the term sopasthambha in Ci.13.174 as āvaraṇa.572
Takraproyoga in arśas is expounded in detail; morning takra alone is taken; if the state of agni of the patient remains as atyarthamṛdu or functioning is extremely low it can be taken even in evening too. If the function of Agni is in moderation, in the evening, the administration of takra is modified by adding lajasaktu. Then if the agni improves the diet can be shifted to yuṣa with takra. Maximum period for the administration of takra is one month. The administration of takra must be reduced in the same way it was increased. During the decrease one must not reduce the quantity of food intake.573
The grahaṇidoṣa also includes the agnidoṣas but they are not viśeṣagrahaṇi diseases; In atisāra is not included in grahaṇī as there is no elimination undigested matter and its saṃprāpti is also different574. Cakrapāṇidatta refers to amlapitta575. Āyurvedadīpikā explains the ingridents of caturamla and pañcāmla576. The śirovirecana recommended in the tridoṣajagrahaṇi is done only if there is a prepounderance of kapha577. In the context of agnimāndya, the term sneha only connotes ghṛta578.
Cakrapāṇidatta stresses the colour changes associated with paṇḍu 579. Kāmala and halīmaka are considered as varieties of paṇḍu580. The paṇḍu resulted from the consumption of earth explained in Suśruta is included here in the sannipātajapaṇḍu581. Lack of sārata in paṇdu is the cause for gaurava or lethargy582. The diminution of ojas means the loss of quality of raktadhātu583. Cakrapāṇidatta categorically explains that the change in raktadhātu is kṣaya and not vṛḍḍhi584. Cakrapāṇidatta reports that Harita includes kāmala etc in the pāṇḍu itself. Like the pramehapiḍaka, kāmala etc can also manifest independently. Āyurvedadīpikā explains that the koṣāśākhāśritakāmala which is having a doṣic predominance of pitta will invariably be preceded by pāṇḍuroga. Whereas some physicians are of the opinion that kāmala associated with śākha with lesser involvement of pitta can manifest independently. Kumbhakāmila refers to a condition associated to koṣāṭāśritakāmila; here the term kumbha refers to koṣṭha. Halīmaka is termed as alasa and lāghava in other treatises585. Āyurvedadīpikā is not in favour of granting it an independent status for halīmaka. According to Āyurvedadīpikā, it is a state of kāmala which shows a bhinnavarcatvaṃ as a special feature586.
In relation to hikka, some scholars explain kṣudraśvāsa as udānavāyu587. Physicians are divided on the issue of prognosis of mahāhikka; some are of the view that it is curable588. Tamaka is said to be increased by tamas; here Āyurvedadīpikā seems to be in state of confusion; adhakāra or darkness and tamoguṇa are choices given. The klinnakāya is interpreted as vṛddha or oldage589. In svāsacikitsā where the doṣic involvement is mild one can have dhūma or fumigation even without vamana.590 Some scholars are of the opinion that it is samanacikitsā advocated is in relation to aśuddhapuruṣa, bṛṃhaṇa refers to śuddhapuruṣas. Some explains that by śamana itself we get bṛṃhaṇa591.
Kṣayakāsa means the kāsa associated to rājayakṣma and dhātukṣāya. Kṣatakāsa implies the kāsa related kṣata and pūrvarūpa of uraḥkṣata592. Cakrapāṇidatta explains the etymology of kāsa593. Kṣayakāsa is the sannipāta variety of kāsa or else since kāsa is resulted from prakṛtisamasamavāya, there is no need for separate narration of sannipātakāsa.594 Āyurvedadīpikā reports that in the context of chardicikitsā, some are of the opinion the śaṃśodhana means virecana. Āyurvedadīpikā clarifies the meaning of visarpa by furnishing its etymology.595 Apacī is equated with granthi visarpa.596 Āyurvedadīpikā explains in case, where the disease is from a strong doṣic origin, simultaneously its complications may also appear597. Cakrapāṇidatta explains it by enumerating its etymology598. Āyurvedadīpikā takes the āmaja and annaja tṛṣṇas explained in Suśruta in āmaja and kṣataja in upasargātmikatṛṣṇa599. Āyurvedadīpikā takes ambukāmitvaṃ as the svalakṣaṇa or salient feature of tṛṣṇa600. Cakrapāṇidatta says that the viṣacikitsā being a separate specialized field only a very condensed description is seen in the treatise601. The commentary also indicates that the knowledge of poison healing is more prevalent and systematic with tribes602. Āyurvedadīpikā classifies gara or artificial poison: as the one resulted from the combination of non toxic materials and the other is product combination of toxic substances. The former is termed as garaṃ and later is called as kṛtrimaviṣa.603Āyurvedadīpikā relies more on Suśruta while explaining this topic. Throughout the commentary on vṛṇacikistā Āyurvedadīpikā tries to reconcile with Suśruta604 the mūtrāghāta explained in sūtrasthāna is enumerated in trimarmīyackitsā as mūtrakṛcchra. These are different from the mūtraghāta explained in trimarmīyasiddhi. In mūtrakṛcchra we find kṛcchrata in dominant way and in mūtrāghata there will be mūtraśoṣaṇa or pratighāta in a dominant. In contrast with this treatise in Suśruta the difference is very explicit605. Āyurvedadīpikā reveals that the there is no uniformity in the text followed in this section of Carakasaṃhitā. Some physicians are not recording mukharoga as a separate section and it is studied along the mukharogas.606 Āyurvedadīpikā says that twenty eight karṇarogas explained in śālākya are included in four types narrated here. Difference in the number of disease of eye is explained in Āyurvedadīpikā607. Āyurvedadīpikā views the āma responsible for the genesis of ūrusthambha is rasaseṣa608.
Āyurvedadīpikā gives two shades of meanings according to one version vāta itself is the disease i.e., vāta eva vyādhiḥ. The aggravated vāyu itself after afflicting the dūṣyas pervades the body as whole or part depending on the causative factor; resulting in disease. The second version means diseases caused by vāyu. By implication doṣas and dūṣyas are vitiated by excited vāta resulting in the manifestation of diseases. Though other diseases like jvara are also produced by vāta they are excluded from the list of vātavyādhi as these diseases are also resulted by other two doṣas. The diseases resulted by the āvaraṇa of pitta and kapha are mentioned here because such manifestations are not possible without the involvement of vāta. Even though nānatmajavyādhis of pitta and kapha are also mentioned in the text like the vāta; the treatise maker is not giving same status as that of vāta. So special treatment protocol is envisaged only for vāta.609 Āyurvedadīpikā says that the importance of vāta is further established by the fact that only the subdivisions of vāta have been explained in the text610. The vāta aggravation in relation to asthi and majja are given the same line of treatment but two conditions are separately ascertained by their distinctive features611.
Though ardita is a condition where affliction affects only one half of the body but as far as the auditory organs are concerned both organs are affected due the specific nature of the disease612. The difference between ardhāṅgaroga and ardita is that the affliction by ardita is only temporary where as ekāṅga roga’s effect is permanent613. Cakrapāṇidatta equates manyāstamba with antarāyāma.He further says that in other texts manyāsthamba is considered as the pūrvarūpa of antarāyāma614. Āyurvedadīpikā explains that bahirāyāma is resulted by vāta aggravated in both snāyu and śira615. Āyurvedadīpikā identifies two types of hanugraha one where the mouth remains constantly open and the other where it remains constantly closed.616 Cakrapāṇidatta differentiates daṇḍākṣepaka from daṇḍaka.617 Vāta kapha gṛdhrasī will be associated with tandra.618 Term mala is interpreted as association of kapha and pitta by some scholars (also quoted by Jejjaṭa); Āyurvedadīpikā dismisses this view .As per his interpretation sadoṣatvat refers to faculty treatments for vāta.619 Though the symptoms of vitiation of vāta in relation to nābhi are not explained it must be inferred from the symptoms like pain etc in that region.620 In the case of ardita the treatment line contains the term tarpaṇa Cakrapāṇidatta seems to not sure with its implications. He gives two options one is nasal drops having santarpaṇa qualities or general treatments and regimens having saṃtarpaṇa nature.621In the āvaraṇa of vāyu, the āvārya is weaker will lose its functions to the stronger āvāraka. If āvārya is stronger than the āvāraka then there is an increase in the function of the former, and decreases in the functions of the latter. According to some scholars, the decrease of the functions of the āvārya; increase in the functions of the āvaraka happens to the general rule.622
In the case of vātarakta the synonyms khuḍa refers to the involvement of sandhis and vātabalaśa refers to the excited state of rakta resulted from the āvaraṇa of vāta.623 The joints are reckoned as the specific seat of this disease.624 Āyurvedadīpikā reconciles the contradictory views about uttāna and gambhīra varieties of vātarakta. Just like the case of kuṣṭha, Suśruta takes it as the two stages as same disease. In the beginning the vātarakta manifests as uttāna and later on it becomes gaṃbhira by afflicting all dhātus. This is a general notion and change according to individual conditions. Caraka never stated that the uttāna variety will remain as such throughout its course and it can become gambhīra as postulated by Suśruta. Hence according to Caraka, vātarākta originates as uttāna and turns to gambhīra in the course of time and it can also manifests directly as gaṃbhīra. Thus in reality there is no contradiction between the two treatises.625 The two varieties are further classified on the basis of doṣic status, Kharanāda refers to thirty six varieties and commentators who preceded Cakrapāṇidatta gives forty five types, but Āyurvedadīpikā is not subscribing to these subtler classifications due to lack of clinical utility.626 Āyurvedadīpikā reports that some scholars consider that vātarakta is asādhya when it is associated with meha627. Āyurvedadīpikā explains that in the uttānavātarakta the rakta plays a significant role but its role is considerably less significant in gambhīravātarakta.628
Cakrapāṇidatta’s commits on Pañcakarma
Cakrapāṇidatta is not giving specific comments regarding the dosage or mātra of anupāna for sneha administration. According to Āyurvedadīpikā, the dosage of the drug can be fixed according the efficacy of drug or according to the kalpana or the pharmaceutical process involved. Another alternative for fixing the dosage of anupāna is the following of set conventions laid down by the traditional physicians or vṛddhavaidyavyavahāra629.
Though abhyaṅga is performed by pure sneha it is not designated under vicāraṇasnehana because of the fact that the sneha administered is not subjected to jaṭharāgnivyāpāra630.
Regarding the mātra of snehapāna Āyurvedadīpikā refers to a school of thought who explains the term ahorātra as a day where the day is short and night is longer than the day631. Again Āyurvedadīpikā explains that the uttamamātra of sneha is only saṃśamana and madhyamamātra must be used for saṃśodhana632
The time limit described for doing snehana in the form of seven days or three days is applicable for snehana other than sadhyasnehapāna. Alteratively one must understand that sadhyasnehana will bring forthn snehana in three days633.
Āyurvedadīpikā very well explains how the koṣṭha functions under the influence of various doṣic states. In vāta dominant condition i.e., krūrakoṣṭha vāta will counteract the saraguṇa of drugs like guḍa or jiggery, where as in mṛdukoṣṭha, predominated by pitta, there is no counter acting force in the form of vāta and kapha, which may cause sthambhana, thus producing a very smooth virecana.634 Āyurvedadīpikā reveals the system of giving ghṛta by physicians even in the āmāvastā. He attributes the action of tiktadidravyas processed in ghṛta for getting desired results even in the āmāvastha. He recommends absolute abstinence from non processed sneha during the āmāvastha. He also extends this contraindication to cases of taila etc. The example cited here indicates that in the mind of Cakrapāṇidatta there was less clarity regarding the procedural details of snehapāna, especially in the sāmāvasthā.635The svedana is beneficial for the diseases resulted from vātakapha, vāta and kapha in uncombined state. Even though the conditions like udara are resulted from vātakapha, they are not curable by svedana.636 On the basis of sthāna the nature of svedana is modified, in the case of āmaśayagatavāta, first of all rūkṣasvedana is done and is followed by snigdhasvedana and in the case of kapha in pakvāśaya, snigdhasvedana is done followed by rukṣasvedana.637
By the very nature of raktapitta, svedana is contraindicated and it is mentioned in the list of disease state where svedana is contraindicated to emphasis the fact that even if a person afflicted with raktapitta is afflicted by any other disease by vātakapha, there also svedana is not done. The contraindication is so absolute, that svedana is not even performed as a pūrvakarma of pañcakarma therapies in them638. Āyurvedadīpikā explains that the nomenclature of various methods of svedana is derived from the long standing tradition of Āyurveda, some of the terms may carry a specific meaning from its derivation and other may not have any connection with its derivation.639This principle of naming is reiterated while commenting on term related to kuṣṭha in nidānasthāna640. The ayoga or inadequate administration and atiyoga or over administration is resulted from the treatment by pseudo physician or vaidyamāni. Cakrapāṇidatta raises the query why the system maker is silent about the third incorrect form of therapy i.e., mithyayoga or false administration. Āyurvedadīpikā explains that a pseudo physician can commit all three kinds of errors namely ayoga, atiyoga, and mithyāyoga. The last one is understood from ayoga itself. The mithyayoga is separately narrated only in those conditions where it is different from ayoga, and its separate narration provides sense for the readers. They are separately mentioned in the case of sense objects like sound etc., because mithyāyoga of śabda or sound etc., is to be avoided by all possible means for the maintenance of positive health641.
Since snehana is done before performing vamana and it is the best alleviator of the chief doṣa i.e., vāta, the chapter enumerating details of snehana is first enumerated in the text.642 The administration of sneha or unctuous substance alone is called acchapāna643 and its usage mixed with other substances is termed as vicāraṇa.644 The terms are derived from the convention followed by traditional physicians.645The taila from an etymological sense means seasmum oil but by conventional meaning it means any oils from plant sources (sthāvarasnehaṃ)646. Ghṛta is regarded as the unctuous substance of par- excellence owing to its capacity to imbibe qualities of substances added to it with out loosing its own qualities. Even substances having antagonistic qualities to that of ghṛta are also taken up by it without loosing its salient qualities. Some times the secondary qualities of ghṛta may be superceded by the qualities of substances added but it will never loose its primary quality i.e., sneha or unctuousness. Some scholars are of the opinion that saṃskārānuvartanaṃ is carrying over of qualities added to sneha by loosing its own properties. This is not true in the case of ghṛta and is only applicable for taila647.
Vasā and majjā are administered in climatic condition which are neither too hot nor too cold and in doṣic status of moderate range. The anupāna given with it will be also anuṣṇaśita so as to suit the properties of vasā and majjā. Thus the ideal time for administration of vasā and majjā is the month of Vaiṣākha or Mādhavamāsa. Though it is moderate in nature, the month Caitra is not preferred owing to the kapha predomination, which makes it unsuitable for the administration of sneha648.
The specific seasons enumerated for the administration of sneha or unctuous substance is not applicable for patients suffering from acute diseases649.
While explaining the time for administration of sneha, Cakrapāṇidatta quotes the view of certain scholars who explains the term vātādhika as kevalavāta and śleṣmādhika as vātaśleṣmika and pittaśleṣmika conditions650.
Cakrapāṇidatta defines avapīḍakasneha as bahumātraprayoga or administration of sneha in maximum quality.651Avapīḍaka method of taking medicated oil involves the intake of sneha first and taking food thereafter. It is termed avapīdana since the food exerts the pressure or pīḍana on the medicine.652
The sequence of doing pañcakarma (for healthy individual to negate the accumulation doṣas resulted by temporal factors) will begin either with vamana or śirovirecana. In normal case it follows the sequence where vamana is done first, after the purification of head by śirovirecana; followed by virecana, and then vasti.653 But its can be altered according to the conditions of doṣic accumulation.654 Āyurvedadīpikā explicitly states that purificatory therapies are done only on basis of doṣic status and not on the basis of an ordained sequence655. Pañcakarma is performed for eliminating the doṣas which are in a state of prominence or pradhānāvasthaprāptadoṣa and had shed its līnāvastha or attached state with dhātus. This state is indicative of performing pañcakarma. This state can occur naturally or doṣas can be brought to this state by the performance of preparatory processes or purvakarmas in the form of snehana and svedana. The later is optional and can be performed from a minimal degree to maximium depending on the state of doṣas involved656. The pañcakarmas to their multifacted specific action (bahvitikartavyatāyogidoṣa nirharaṇa śakti) eliminate the augumented doṣas657. Āyurvedadīpikā refers to an anonymous school of thought with in Āyurveda who instead of pañcakarma preferred saptakarma by taking in to account the two preparatory processes in the form of svedana and snehana658. Since they lack the bahvitikartavyatāyogidoṣa nirharaṇa śakti or the specific capacity to eliminate the doṣas they are not included in the group of elimination therapies. Thus the number remains unchanged and only pañcakarma or five elimination procedures. Since anuvāsana does the elimination of purīṣa and pakvāśayagatavāta, it is also considered as an elimination therapy, even though its action is limited when compared to other śodhanakarmas. The uttaravasti is included in snehavasti. Cakrapāṇidatta explains that the term pañcakarma is yogarūḍi or derivative conventional (mode in which etymological and customary significances are partly retained like the word paṅkaja) and its does not cover the procedures like sneha, svedana, niṣṭīvana etc659. Similiarly the system maker has used the term virecana to refer vamana and virecana so other elimination procedures like śirovirecana will come under the purview of this technical term virecana660. But in one instance he even draws the sense of nirūhavasti from the term virecana661.Pañcakarma processes are supposed to be administered with atmost caution i.e., with out any complications662. The first narration of nirūha in the sequence of procedures viewed as its relative importance; the medicines prescribed for nirūha are utilised for anuvāsana too. The effect of anuvāsana on respective doṣas can be achieved by processing the sneha with suitable drugs663. The vamana purifies the doṣas excited and located (upasthita) in the ūrdhvāmaśaya or upper portion of āmāśaya and the virechana eliminates the vitiated doṣas from the lower part of āmāśaya. The term doṣa is used in sense of excited doṣas situated in the pakvāśaya, which is ready to be get elemented by nirūha.664 Madana and trivṛt are explained first to highlight their importance in the respective śodhana modes.665
The narrations of yavagu etc are mentioned as remedial measures for countering any complications resulted from the pañcakarma666. The narration of pañcakolasiddhayavāgu is for enhancing the agni, which is diminished due to pañcakarma procedures667. Since snehana is done before performing vamana and it is the best alleviator of the chief doṣa i.e., vāta, the chapter enumerating details of snehana is first enumerated in the text668. The administration of sneha or unctuous substance alone is called acchapāna669 and its usage mixed with other substances is termed as vicāraṇa670. The terms are derived from the convention followed by traditional physicians.671The taila from an etymological sense means seasmum oil but by conventional meaning it means any oils from plant sources (sthāvarasnehaṃ)672. Ghṛta is regarded as the unctuous substance of par-excellence owing to its capacity to imbibe qualities of substances added to it with out loosing its own qualities. Even qualities of substances having antagonistic to that of ghṛta are also taken up by it without loosing its salient qualities. Some times the secondary qualities of ghṛta may be super ceded by the qualities of substances added but it will never loose its primary quality i.e., sneha or unctuousness. Some scholars are of the opinion that saṃskārānuvartanaṃ is carrying of qualities added to sneha by loosing its own properties. This is not true in the case of ghṛta and is only applicable for taila673.
Vasā and majjā are administered in climatic condition which are neither too hot nor too cold and in doṣic status of moderate range. The anupāna given with will be also anuṣṇaśita so as to suit the properties of vasā and majjā. Thus the ideal time for administration of vasā and majjā is the month of Vaiṣākha or Mādhavamāsa. Though its is moderate in nature the month Caitra is not preferred owing to the kapha predomination, which makes unsuitable for the administration of sneha.674
The specific seasons enumerated for the administration of sneha or unctuous substance is not applicable for patients suffering from acute diseases675. While explaining the time for administration of sneha, Cakrapāṇidatta quotes the view of certain scholars who explains the term vātādhika as kevalavāta and śleṣmādhika as vātaśleṣmika and pittaśleṣmika conditions.676
According to Āyurvedadīpikā due to the vastness of the topic i.e., vasti is not explained in the sūtrasthana.677 Siddhi refers to the management of the complications manifested due to improper administration of vamanādi therapeutic procedures; another interpretation of siddhi defines it as the proper administration of the therapeutic procedures as well as management of its complications. The group of chapters that deals with these topics is siddhisthāna.678 Though cikitsāsthāna also deals dispersedly with the related subject matter, the term is limited to the siddhisthāna by the principle of yogārūḍhī. The time range of snehana from three to seven days is in conditions where the ideal dose of sneha can be stipulated according to the koṣṭha i.e. snehana is advocated for three days in mṛdukoṣṭha; for seven days in krūrakoṣṭha; and for five days in madhyama koṣṭha. It is in these conditions that the snehana turns sātmya if administered beyond the stipulated time. If otherwise, the person may not develop sātmya even after seven days; in such conditions, a gap is given in between the process of snehana, and can later be continued with greater quantity of sneha.679 In pradhānaśuddhi the peya, vilepī, akṛta-kṛta yūṣa and akṛta-kṛtarasa are administered for three āhārakāla each .i.e., in the first three annakāla following the śodhana, peyā is given; vilepī is given for the next three annakāla; anna with kṛta and akṛta yūṣa is given for the next three āhārakāla; in the last three āhārakāla kṛta and akṛta rasa should be given. Thus from the evening of vamanādi therapy, the peyādi krama extends for twelve āhārakālas, for seven days. Similarly the peyādikrama is carried out for two and one āhārakāla in madhyama śodhana respectively. When peyādikrama is advocated for one āhārakāla in avaraśuddhi, no time division is available for kṛta and akṛta yūṣa and rasa. Cakrapāṇidatta opines that in this condition the slightly processed (stokasaṃskāreṇa) yūṣa and rasa should be administered at respective āhārakāla.680 Cakrapāṇidatta quotes from other text the quantity reckoned to one prastha in the context of vamana, virecana and śoṇitamokṣaṇa, which accounts to thirteen and a half pala (generally prastha accounts to sixteen palas).681 Four types of indications for proper vamana and virecana (śuddhi) are mentioned viz., āntikī, vaigikī, mānikī and laiṅgikī. Cakrapāṇidatta refutes the four types of indications and accepts only laiṅgika śuddhi.682 The rasasaṃsarjana karma mentioned after peyādikrama under the context of uttaravasticikitsā should be administered after the peyādikrama following all the therapeutic procedures prior to commencement of normal food. After nirūhavasti, the anuvāsana might be administered for deserved (anuvāsanārha) on the same evening. Here anuvāsanārha indicates that it should not be done in conditions of āma and in mandāgni.683 Anuvāsa should be administered at daytime in śisira and vasanta ṛtu, and at night in śarat and grīṣma. Cakrapāṇidatta suggests that here day should be considered as the daytime nearing the night and night is considered as the nighttime nearing day.684 Though anuvāsana is not indicated in kaphapitta conditions its indications in these doṣic states points to the diseases of kaphapitta which are associated with vāta.685 Though nirūha is contraindicated after the administration of virecana and vice versa, it should be understood that the contraindication is applicable only to the period immediately after the procedure. In order to oppose their administration by three or four days that it has been mentioned that the virecana or nirūha has to be done seven days following either of the procedures. This norm advocates the administration of nirūha following anuvsana on ninth day. This opposes the administration of the vasti immediately after the saṃsarjana krama in which case the rule shall be applicable only for pravaraśuddhi, while in avaraśuddhi the saṃsarjana krama ends on third day; this norm is to refute the administration of vasti on fourth, fifth or sixth day according to the completion of saṃsarjana karma. 686 For anuvāsana, taila is the ideal choice, though some even consider ghṛta.687 The karma, kāla and yogavasti refer to set of vastis, which reckons to thirty, sixteen and eight in number. The kālavasti is explained to be half in number to that of karmavasti; here the half does not exactly accounts to fifteen, but to sixteen in number. In karmādi vastis, the nirūha is given in the form of yāpanavasti, thus they do not create vātakṣobha. These names of karma etc., for set of thirty etc., vastis are used as saṃjñā just like that of yamaka, mahā and acchapāna. 688 The contraindication of vastis in pairs is with respect to (sneha) anuvāsana, but it can be given in pairs as part of nirūha.689 The pañcakarmīyasiddhi deals with the factors that guide the indication and contraindications of pañcakarma.690 Owing to its all pervasiveness caused by the subtle nature of sneha, the anuvāsana is administered in the evening, after the consumption of food. Anuvāsana is good for treating bhaktānabhinandana but it is contraindicated in arocaka. This seems contradictory to each other having similar causation for either condition. Cakrapāṇidatta rules out any contradiction in this opinion. Bhaktānabhinandana is mere disinclination towards food which is caused by vātadoṣa alone. Arocaka is aversion towards food due to many causes. The utility of anuvāsana is seen only in kevalavāta condition, thus its indication in bhaktānabhinandana and its contraindication in arocaka.691 In chapter vastisūtrīya siddhi, deals with the practices of various types of vasti according to the tradition and condition is vastisūtrīya siddhi.692 Caraka suggests starting the āsthāpana during śuklapakṣa; Cakrapāṇidatta quotes the opinion of Hārīta who suggests starting of āsthāpana in kṛṣṇapakṣa, as it is at this time that asurā and all rogas originate.693 During the procedure of the vasti, the head of the patient is either placed level or slightly depressed, which is decided according the patient’s need; i.e., if the waist region of the patient is very obese then the head is positioned in level position, while in patients with lean waist the head is kept in slightly depressed position.694 The patient is made to lie in left lateral position while administering vasti, as the grahaṇī and guda will be directed in its anatomical position in this posture. In the anatomical position the administered vasti gets ideally pervaded due to proper upaśleṣaṇa, the gudavalīs gets flattened, by which the administered vasti reaches the destined areas easily.695 The vasti cures the diseases lodged in sites of pitta and kapha by its potency. Though the procedure is not an ideal treatment for pitta and kapha, it is advocated in vātānubandha and vātāvaraka conditions.696In persons who indulge in rūkṣa regularly, have good agni, practices exercise regularly and in diseases of vāta, the anuvāsana should be administered daily, as the sneha gets digested quickly, in conditions otherwise the sneha administered needs three days or more to get digested. In the later condition the sneha that is smeared to the pakvāśaya should be digested by the agni dissipated from the jāṭharāgni to the pakvāśaya.697The snehavasti vyāpat is described prior to the topic of vamana virecana vyāpat owing to its greater clinical importance.698At the end of saṃśodhana karma, saṃśamanīya sneha has to be administered in order to cure the exhaustion caused by the purificatory measures.699 The sneha virecana in atisnigdha persons will not be able to eliminate even the mobilized doṣas due to the excess quantity of sneha, and as a result the doṣas gets further submerged into the srotas, thus rūkṣa virecana is advocated in such conditions.700 In madyapa and vātapaittika conditions, tarpaṇādikrama is advocated instead of peyadikrama following the śōdhana cikitsā in which case peyā is replaced by svaccha tarpaṇā and vilepī by Ghana tarpaṇa.701 The ten vyāpats of vamana and virecana are grouped under atiyoga and ayoga categories i.e., the ādhmāna, srāva, hṛdgraha, aṅgagraha, upadrava and klama are caused due to ayoga. Parikartikā and jīvādāna are atiyogajanya. Vibhraṃśa is of three types: gudabhraṃśa, saṃjñābhraṃśa and the bhraṃśa characterized by the symptoms like kaṇḍū etc. Out of these the first two viz., gudabhraṃśa, saṃjñābhraṃśa are caused by atiyoga and rest is caused by ayoga. In vamana and virecana there is no mithyāyoga: as the propulsion of doṣas is of four types: atipravṛtti, asamyakpravṛtti, apravṛtti and alpapravṛtti. The apravṛtti and alpapravṛtti comes under ayoga; the pratilomapravṛtti (propulsion of doṣas in opposite direction) is also considered as the insufficient propulsion of doṣas in the proper channel, which is also considered as ayoga.702In vamanavyāpat parikartana is not considered, Cakrapāṇi datta quotes the opinion of Suśruta that in vamana vyāpat kaṇṭha karṣaṇa replaces parikartana and kaphapraseka replaces parisrāva.703 Here the vasti refers only to nirūha, thus the chapter deals with the vyāpath of nirūhavasti.704
Vasti is an important treatment for the diseases afflicting the three marmas. Thus after explaining the vyāpat of vasti, the areas of the indications of vasti has been described. The treatment of vastivyāpat have been described in the previous chapters, the trimarmaja vyādhis also manifest due to the vyapat of vasti, thus the description of its treatment are dealt in this chapter.705 The ten dhamanīs attached to the hṛdaya are the dhamanīs that carry ojas.706 The prāṇāpānau is described as inspiration ad expiration.707 Apatantraka has been classified into two types by Cakrapāṇidatta: vātāt and kaphāt: that which is characterized by loss of consciousness is termed as apatantraka of kapha origin; the apatantraka caused by vāyu is termed as apatānaka.708 The uttaravasti is named so as it is administered from the uttara mārga or because it has greater effect.709