Diagnosis and Treatment of Diseases in Ayurveda (Set of 5 Volumes)

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Based on Todarananda Ayurveda Saukhyam, this series in nine volumes covers almost all the aspects of Ayurveda, including fundamentals principles, anatomy, physiology, hygiene and public health, examination of patients, diagnosis, prognosis and treatment of diseases, iatro- chemistry, materia medica and five specialised therapies, known as Panch Karma.

While volumes one and two deal with materia medica and basic principles of Ayurveda, respectively, volumes three to seven cover the diagnosis and treatment of different diseases. Five specialised therapies (Panch-Karma) and Rasa Sastra make part of volumes eight and nine respectively. Besides the original Sanskrit text, all the volumes contain its English translation, extensive glossary of technical terms, various indices, notes and references.

Vaidya Bhagwan Dash , holds graduate and post-graduate qualification in Ayurveda, in addition to Master's degree in Sanskrit and a Doctorate from University of Delhi.

In the course of over thirty years dedicate to research and practice of Ayurveda, Dr. Dash has attended several international conferences and seminars held in Brazil, Mexico and France. He was invited to deliver a course of lectures in Ayurveda at the Patrice Lumumba Friendship University, Moscow and the Australian School of Ayurveda at Adelite, South Australia.

Author of over twenty important publications covering different aspects of Ayurveda and Tibetan Medicine, he has to his credit an English translation and commentary of Caraka Samhita, the most authentic Ayurvedic classic.

Dr. Dash was Deputy Adviser in Ayurveda to the Government of India in the Ministry of Health and Family Welfare till 1981. He has also served the World Health Organisation as a consultant in Traditional Medicines.

Vaidya (Miss) Lalitesh Kashyap , obtained her Ayurvedic degree from the Ayurvedic and Unani Tibia College, Delhi and Ph.D from the K.S.D. Sanskrit University, Darbhanga. She has been actively engaged in Ayurvedic practice and research for the past twenty-five years. She has to her cred several published articles on Ayurvedic drugs, particularly those essential in the treatment of ladies and children. She worked as the Medical Superintendent of the Ayurvedic Hospital, under the Central Government Health Scheme.

From times immemorial man has been waging an incessant war against a host of diseases. The sages of the ages gone by are well- known to the scholars of ancient culture for their lore and learning regarding a variety of herbs and other media for curing various ailments.

Rudra (Siva) is the foremost Divine Physician. Invoking Him for general welfare, Grtsmada, a sage of yore, sang: "By the most salutary medicines given by thee, O Rudra, I would attain a hundred winters", and added, "Raise up our heroes with remedies. I ,ear of thee as the best physician of physicians". The deity is, thus; the pioneer of the system of medicine. He, being the lord of all learning, from Him was handed down, along with other branches of learning, the science of healing to man on this earth, who thenceforth not only preserved what was given to him, but also, on his part, propagated it by introducing new researches and experiments with the result that many a man of wisdom compiled literature on health and longevity. This traditional activity has been kept alive even today; and I am happy to mention the names of two scholars- Vaidya Bhagwan Dash and Vaidya Lalitesh Kashyap-c-who have recently augmented the store of Ayurvedic literature by their joint contribution. They have been working arduously on Raja Todara Malla's voluminous work entitled Ayurveda Saukhyam which means "Bliss through Ayurveda".

Ayurveda Saukhyam is encyclopedic in norm and form in as much as it has a total of ninety seven chapters. Each chapter is called a haria which means "joy". The present volume has four chapters embodying the XIH, XIV, XV and XVI chapters respectively. These four chapters dealing with (i) methods of diagnosis of diseases, (Ii) six therapies, (iii) administration of different types of pharmaceutical processes, and (iv) diagnosis and treatment of fever, have occupied a little less than eighteen hundred verses, which is really an enormous and demanding task to perform and too difficult to be achieved by those other than geniuses.

The language employed in the book is Sanskrit which is completely devoid of bombastic style. It is simple and natural, and the flow of expression is very vivid. A man of literature finds here in an anthology inasmuch as verses have been culled from more than seventy sources inclusive of persons and works. Apart from the renowned names, many lesser known authors and works have been cited. For instance, Nala, Vrnda, Vyadi, Bhoja, Bhela, Gopura, Bhaluki, Carpati, Dhurjati, Tottala, Jaijjata, Kharanada, Vrndaraka and Palakapya are persons; and Cikitsa-Kalika, Naksatra-malika, Srinivasu-Samhita, Mati-mukura, Cint amani, Rasa-raja- laksmi, Saivagama, Svacchandaiaktysgama, Slva-rahasya and Hara- mekhala are works quoted here, Which generally escape mention in the day-to-day parlance of the practitioners of Ayurveda. It is thus clear that this work contains a gist of researches and experiences of many men of erudition in the science of healing humanity.

It was the general practice in ancient India to write in verse. In the wake thereof, books on medicine and surgery also were mostly attempted likewise probably for the reason that verses are easy and interesting to learn and to remember. A student, having learnt this book by heart, can become a walking cyclopaedia of Ayurveda. The metre employed is mostly Anustun interspered, however, with some others like Upajati. Prose is used sparingly. Disturbance in the basic triad of pillars of the body (dosas), according to Ayurveda, is responsible for physical affliction which has its repercussions on the mind also. Similarly, any kind of mental agony tells upon the physique. Therefore, Ayurveda treats a person as one composite unit of body, mind and soul.

As there is no cure-ali or panacea for diseases, the men of wisdom have noted down I in their learned treatises manifold methods of treatment. Being essentially a pycho-physical entity, man needs for his welfare not only various material media such as herbs and minerals, but also some psychic therapy. Keeping this fundamental fact in mind, Todara malla has suggested in his book both medicines and esoteric formulae.

Classical Ayurveda is theist in theory and practice. Accordingly, the compilers of the present book begin with an invocation to Lord Ganapati, the Remover of all obstacles, and likewise refer to various deities at several places. One is advised, for instance, to worship Lord Siva, Surya, Visnu and others before taking the Mrtyunjaya Rasa. At another place, Caraka is quoted as suggesting that a person suffering from Visama jvara can get rid of the the disease by worshipping Siva, Parvan and their attendants. Similarly, a person who prays to Lord Visnu by repeating His Thousand epithets is relieved of all varieties of fever, as vouchsafed by Caraka, These are a few instances of Todara malia's attitude of devotion to the Supreme Being and other divinities.

The original work was entrusted to about six copyists. Such copying was then in vogue. Old manuscripts thus vary in readings, the variations being the result of either the carelessness or the ignorance of the scribes. Here they are edited to get the correct reading. Editing, which is decidedly a technical job, requires collection and collation; and the present work has been edited very efficiently on scientific lines.

The Sanskrit text has been rendered into English; and I am glad to observe that the translation has been very correct and accurate.

I must congratulate both the editors-cum-translators on bringing out this valuable work. Without their sincere endeavour over a long period, it was not possible for us, the medical practitioners in general and for the community of vaidyas in particular, to have this informative and instructive voluminous work of excellence.

I would surely like to recommend this work for scholars and students as well; hoping that it will be widely read and highly appreciated.

We have already placed before our esteemed readers the first two volumes of the Ayurveda Saukhyam in Todarananda an encyclopedic work consisting a total of ninety seven chapters. Our first volume dealing with the Materia Medica of Ayurveda is based on ten chapters. The second volume dealing with the Basic Principles of Ayurveda comprises six chapters. Four chapters dealing with the Diagnosis and Treatment of different types of fever and allied topics are included in this third volume of the series.

The first chapter of this volume deals with the Ayurvedic method of the examination of diseases. Unlike modern medicine, Ayurveda does not accept germs or invading organisms as the primary factors for the causation of diseases. They are treated as the secondary causes -the primary cause being the disturbance of the equilibrium of dosas, dhatus and malas. The term jvara is generally translated as fever. But there is a difference between these two terms. In the allopathic system of medicine, fever is not treated as a disease but only a symptom of another disease. On the other hand, the jvara of Ayurveda is a disease entity based on specific samprapti or pathogenesis. Readers are requested to keep this point in mind while going through this book. A disease, according to Ayurveda, is examined keeping in view the nidana (etiological factors), purva rupa (premonitory signs and spmptoms), rupa (actual signs and symptoms), upasaya (exploratory or homologatery therapies) and samprapti (pathogenesis). These five factors taken together are called panca nidana and without their proper appreciation, successful Ayurvedic treatment is next to impossible.

The second chapter deals with six categories of Ayurvedic therapies. As has been stated above, Ayurveda does not lay much emphasis upon the seed. It is the field which is of primary importance for the treatment of diseases. Germs or seeds may be there in the body. But, if the field or tissue elements of the body are barren or immune to them, then the germs will not be able to produce a disease. Therefore, the aim of Ayurvedic therapy is not to kill any germ but to make the tissues of the body immunised so that these germs wiII not be able to multiply and grow. This results in both prevention and cure of diseases. Based on this fundamental principle, in Ayurveda, therapies are classified into six categories in general. These six categories of therapies are often administered by permutation and combination because diseases are generally found in a mixed form.

The third chapter deals with the diagnoses and treatment of various types of jvara (fever) and their treatment in general. The use of opium was prevalent in this country when the work was composed-vide verse no. 288 of this chapter. Different types of diet and regimens prescribed and prohibited for this ailment are described in detail. Medicines become ineffective if the patient resorts to unwholesome diet and regimens. Therefore, in Ayurveda, a lot of emphasis is laid upon the use of correct diet and regimens.

The fourth chapter provides an exhaustive description of recipes for the cure of obstinate and otherwise incurable types of sannipata jvara, visama jrara, exogenic fever, relapsing fever and chronic fever. The recipes in this chapter are culled from different authentic classical works. Further, it has been claimed that all these recipes are traditionally known to be effective; and their effectiveness has been experienced by the author himself-vide verse no. 1398 of this chapter.

On the basis of Todara malia's Ayurveda saukhyam, the two volumes in this series-one on the Materia Medica of Ayurveda and the other on the Basic Principles of Ayurveda have already Men published. The chapters on the Diagnosis and Treatment of Diseases are to be published in the subsequent five volumes. This third volume deals solely with the Diagnosis and Treatment of the most important and common disease called jvara (fever). With a view to enabling the reader to appreciate the contents of these volumes, it is necessary to elucidate some of the fundamental concepts regarding diseases and their treatment in ayurveda.

Diseases in different Ages

According to Indian mythology, the period from the creation of the universe up to its dissolution is divided into four yugas or ages, viz., Satya, Treta, Dvapara and Kali. During the Satya yuga (the age of truthfulness), the mind of the individual was free from perversions like passion, anger, grief, attachment, false-hood and envy. The body of the individual at that time was not afflicted with malnutrition nor was he used to sophisticated living conditions. Therefore, man was relatively free from disease. In subsequent ages, viz., Treta yuga and Dvapara yuga, man became gradually exposed to adhyatmika, adhidaivika and adhibhautika types of miseries. Such miseries reached their apogee during Kali yuga which is prevailing at present.

Soul and its transmigration

Ayurveda believes in the existence of Soul (Jivatna) in the individual's' body which is a part of the universal Soul (Paramatma). This Soul is free from any kind of morbidity i.e. it is unaffected by either worldly pleasure or pain. It is Sat, Cit and Ananda. But because of its association with manas (mind), buddhi (intellect) and ahahkara (ego)-which, taken together, are called antah karana tma appears to get afflicted with pleasure and pain.

Ayurveda believes in the transmigration of the Soul along with four subtle elements and the mind from the person after his death to an embryo freshly conceived. This process continues till the attainment of nirvana or salvation. Therefore, the samskaras (impressions) of one life period continue during the subsequent rebirths. Some diseases occur as a result of evil or sinful acts. It is not necessary that the results of such sinful acts must necessarily mature during the same span of life. The results of the sinful acts of one life period may mature during the subsequent rebirths to produce a disease. This is called bhagya, and special rituals like mantra, japa and homo should be performed by the person to overcome such diseases.

Psycho-somatic Concept of Disease

Ayurveda believes in the unity of the body and the mind. Mental perversions affect the physical functions; and morbidity of the body affects the mental activities. A disease, therefore, is not exclusively psychic or physical. Since both physical and mental factors are responsible for the production of diseases, for their treatment also, some regimens including good conduct are prescribed along with appropriate drugs and diet. For the so-called psychic diseases side by side with psycho-therapy, appropriate medicines are also prescribed. For example, a person suffering from gastritis or gastric ulcer is asked to practice meditation and be free from worry and anxiety including anger or passion. Such prescriptions may appear quaint but they certainly 'help the patient to overcome his sufferings.

Treatment of Individual as a whoel

When a patient, suffering from the diseases of the eye or the ear, comes to a doctor's clinic, it is generally the eyes or the ears which are investigated and treated by the doctors. It is as if the eyes or the ears alone come to the doctor's clinic. But to an Ayurvedic physician it is not only the eyes and the ears that come but the whole individual. There is thus a subtle difference in approach to the problem of disease. The Ayurvedic physician while treating the afflicted organs, looks to the place of origin of the disease. Thus, he treats the ailment right from its root. If there is constipation, a mild purgative is administered. If there is congestion in the nose, inhalation therapy is administered. If there is over-exertion, the patient is advised to take rest. These are obviously not directly connected with the ailment for which the patient has come to be treated. But by correcting the incidental ailments, the disease is taken care of at its root to ensure that there is no relapse.

Emphasis on Positive Health

Ayurveda emphasises the maintenance of positive health and prevention of diseases in preference to their cure. For the prevention of the process of aging, maintenance of youthful vigour and for immunising the body against the attack of diseases, rasayana or rejuvenation therapies have been prescribed. In fact, this constitutes one of the specialised branches of Ayurveda. In different seasons, dosas of the body undergo some natural variations. To keep them in a state of equilibrium in the face of seasonal vagaries, different types of diet, drinks and regimens for different seasons have been prescribed. All these taken together are called rtu carya. Similarly, regimens have been prescribed for different parts of the day and night which are called dina carya and ratri carya respectively. For keeping the body free from disease, Ayurveda lays emphasis upon good conduct and behaviour on the part of the individual which is called acara rasayana or rejuvenation by good conduct.

Germ theory Ayurveda believes in making the tissue elements of the body resistant to the attacks of organisms in preference to destroying these organisms for the cure of diseases. Ayurveda does, no doubt, recognise different types of germs as causative factors of diseases.But they are considered as secondary factors, the primary factor being the disturbance in the equilibrium of dosas. Seeds germinate if they are placed on fertile soil in a congenial atmosphere. If seeds are placed on barren soil, not only do they not germinate, but also they lose their germinating power in the course of time and die out. Similarly, if there is equilibrium of dhatus and dosas, germs, howsoever virulent they may be, do not multiply but die a natural death.

To day, there is a growing awareness among the international community regarding the utility of traditional medicine. Ayurveda, because of its intrinsic potentialities and close association with the culture and tradition of the community has assumed a unique position in the medical and health care programmes of the developing and under-developed countries of south-east Asia. Its services are equally in demand in other developed countries.

In the past, ayurveda had crossed the political and geographical barriers. It pervaded and was adopted as indigenous medicine with different names in the countries of Asia. Cheapness, easy availability, absence of toxic side effects coupled with the presence of side benefits, and above all, the therapeutic potentiality coupled with rational fundamental principles account for its popularity among the people living both in rural as well as urban areas.

Apathy of the previous foreign rulers, antagonism of some of the so called intellectuals who are trained in foreign traditions, ignorance of the country's health planners and the lack of financial support from the administrators have all failed to divert the attention of the people from ayurveda to other systems of medicine. On the other hand, international bodies like the World Health Organisation are evincing keen interest and making sincere efforts to promote ayurveda, among others, by providing expert advice and financial assistance. It is therefore, essential to apprise the intellectuals of this country and abroad about the real merit of ayurveda in a language known to them and in a style understood by them. This is one of the primary objectives of undertaking this work on Ayurveda saukhyam of Tadarananda.

Already three volumes of this series have been published. The first volume comprised chapters on Materia Medica, the second volume on Basic Principles and the third volume on the Diagnosis and Treatment of fever. Because of limitations of space, the present volume, which is the fourth in the series comprises the description of the Diagnosis and Treatment of nine diseases only. The remaining diseases will be included in subsequent volumes.

As was explained in earlier volumes, this work has been collated and edited on the basis of six manuscripts some of which were incomplete. There are variations in the numbering of chapters in these manuscripts. This explains the discrepancy in the chapter-number quoted in the foot-note provided at the beginning of each chapter and in the colophon. Chapter numbers in each of these edited volumes are however, given seriatim and this should not be confused with the original chapter number of the manuscripts. As in other volumes, indexes and a glossary of technical terms are provided at the end of this-book.

The original manuscripts had many grammatical and syntactical errors in them. Corrections have been made only when such changes were supported by other manuscripts-and other authentic texts. It was kept in view that such changes should not alter the implications of terms. This is not a kavya simply to be enjoyed but a work with practical utility. Recipes are prescribed for saving the life of patients and changes in these recipes might be injurious to the health of the patient. Therefore, wherever such apprehensions were felt the incorrect words have been left as they were. These should be corrected in future with the help of better manuscripts of this work. This also explains the usage of some terms in this work which do not stand to be correct according to the rules prescribed in Panini's grammar.

We are extremely thankful to Kumari Kanchan Gupta and Shri Subhash Gupta who were of considerable help to us at each and every stage of the preparation of this work. We have no words to express our gratitude to the publisher who was a constant source of inspiration in this endeavour. May Lord Dhanvantari keep them healthy and happy.

We are fully aware of our limitations to undertake such a scholarly work. To quote Cakrapani Datta, the reputed commentator of Caraka Samhita:

Ayurveda or "the science of life" has been prevalent in India and its neighbouring countries since time immemorial. It has its unique concept of health. Generally, the term "health" is interpreted as "freedom from disease". According to ayurveda, health does not connote a negative approach of keeping the body free from diseases but a positive one of enjoying an uninterrupted sense of physical, mental and spiritual happiness. It is, therefore, not a "system of medicine" in the conventional sense but a "scierce of life", or better still, a "way of living."

The individual cannot live in isolation. To keep him healthy, it is necessary to make his surroundings, that is his family, his society and his country free from physical, mental and spiritual ailments. Therefore, ayurvedic prescriptions and prohibitions do not pertain to an individual alone but also to the society or the human beings as a whole.

Man should live for a minimum span of one hundred years. In his old age he should not suffer from senile changes in the body and the mind. He should not be deprived of the youthful vigour and sharpness of intellect. He should not be crippled physically. He should be able to see clearly, hear clearly, speak clearly and effectively participate in the activities of the society. To achieve this, efforts should be made right from the youth. Along with the nourishment of the body, there should be mental tranquility and spiritual purity.

Ayurveda has its unique method of identifying a disease and describing its diagnosis as well as treatment. Diseases are broadly classified into two categories, viz. nija or those caused by internal factors, and agantuja or those caused by external agents like injury and afflictions by evil spirits. Both these types of diseases involve aggravation of dosas. In the former category, dosas get aggravated in the beginning and diseases are manifested subsequently. In the latter category, injury etc., take place in the beginning and dosas get aggravated subsequently.

Disturbance in the equilibrium of dosas plays the most important role in the manifestation of a disease. It may be either increase in the quantity (dosa vddhi) or decrease in the quantity (dosa ksaya) of dosas. The former, that is the increase in the quantity of dosas is primarily responsible for the causation of a disease. The latter, that is the decrease in the quantity of dosas does not produce a disease directly. Signs and symptoms of dosa ksaya (decrease in the quantity of dosas) are no doubt described in ayurvedic texts. This only helps the physician to determine that another dosa which has opposite attributes has been aggravated.

Quantity apart, there may be a change in the quality of a dosa. All dosas have their specific attributes. Without any change in the quantity, if there is any change in the quality of the dosas, this is called dosa dusti or vitiation of dosas. This is also responsible for the causation of diseases. This ultimately leads to the aggravation of the dosas, Therefore, dosa vrddhi (aggravation of dosas) and dosa dusti (vitiation of dosas) are often used as synonyms.

Dosas circulate all over the body including the nails and hair. Even urine, feces and sweat which are on their way out of the body contain dosas. As a result of environmental changes, during different seasons, during different periods of the day and night, during different stages (ages) of life and during different periods of the intake and digestion of the food, one or other of the three dosas gets aggravated. To a limited extent, the body is capable of adapting to such minor changes in the equilibrium of dosas and no disease is produced. But when the limit is crossed' either by natural phenomena or by improper food, drinks and regimens or by psychic stress and strain, a disease is caused.

The body is composed of several categories of srotas or channels of circulation. Dosas as well as the mind (which latter is atomic in nature) move through all these channels of circulation. Movement of the mind is, however, limited to the body excluding' the nails and hair. But dosas move all over the body including the nails and hair. The aggravated or vitiated dosa while circulating in the body gets lodged in a particular spot which is weak or which is exposed to stress and strain. This is the beginning of the process of disease formation. The agnis or enzymes located in that spot get afflicted resulting in the impairment of their functions which includes digestion and metabolism. The tissue elements circulating in that channel, therefore, do not get properly meta-bolised and assimilated into the permanent tissues. They remain back in the channel. Such uncooked elements are called ama. As a result of the accumulation of this ama, the channel gets blocked which is called sroto rodha. The tissues comprising the channel suffer from starvation because of their inability to utilise the nutrient material circulating in the channel as a result of the impairment of the functions of agni or enzymes. This condition is called sroto dusti. Generally, sroto rodha or the obstruction to the channels of circulation and sroto dusti or the vitiation of the channels of circulation are interrelated inasmuch as one is caused by the other.

As a result of this obstruction or vitiation of the channels of circulation, the circulating fluid accumulates in excessive quantity in the proximal side. Because of positive pressure, it tries to find a new path to join the main stream. This results in the diversion of the route which is called vimarga gamana. The obstructed place of the channel gradually becomes hard and takes a nodular form which is called sira granthi. This place is called the udbhava sthana or the site of origin of the disease. Radical eradication of the disease involves correcting this "site of origin" which will be discussed later.

From this "site of origin" the fluid mixed with ama takes diverse routes. These are classified into three categories, viz. sakha (skin and channels of other tissue elements), kostha (viscera of the thorax and abdomen) and marmasthisandhi (vital organs, bones and joints). These diverse routes are collectively called marga. Knowledge of this has an important bearing upon the treatment of a diseases which will be discussed later.

We are exceedingly glad to present before our esteemed readers this 5th volume of Todarananda Ayurveda Saukhyam series. Details of the 97 chapters of this work are already furnished in pp 19-29 of the Introduction to the second volume in this series. The first volume contained ten chapters dealing with "Materia Medica of Ayurveda". The second volume included six chapters dealing with "Basic Principles of Ayurveda", "Diagnosis and Treatment of Diseases in Ayurveda" are planned to be published in volume Nos. 3-7. The third volume comprised one chapter dealing with the diagnosis and treatment of different types of jvara (fever). Nine chapters dealing with the diagnosis and treatment of atisara (diarrhoea), sangrahani (sprue syndrome), arsas (piles), agni mandya (suppression of the power of digestion), Krmi roga (parasitic infection), pandu (anemia), rakta pitta (a disease characterized by bleeding from different parts of the body), rajo yaksma (tuberculosis) and kasa (cough) were included in the fourth volume of this series. The present work which is the fifth volume in the series contains 14 chapters dealing with the diagnosis and treatment of hikka-svasa (hiccup and asthma), svara bheda (hoarseness of voice), arocaka (anorexia), chardi (vomiting), trsna (morbid thirst), murcha (fainting), daha (burning syndrome), madatyaya (alcoholism), unmada (insanity), apasmara (epilepsy), vata vyadhi (nervous disorders), vata rakta (gout), uru stambha (stiffness of thighs) and ama vella (rheumatism).

As has been reported in the prefatory matter to earlier volumes, this work is based on six different manuscripts. Almost all of them are replete with grammatical and syntactic errors. The nature of manuscripts and the style of collation, editing and translation followed for the volumes of this work, are already explained in earlier volumes and they need no further elucidation here.

Each volume of this series contains chapter nos. seriatum, But the chapter nos. of Ayurveda saukhya are different. In some manuscripts it is given in the beginning along with an invocation, and in others, it is given in the colophon. Verses of invocation, which were perhaps subsequently added, are so corrupt that we did not think it proper to include them in the text. These are given in the foot-notes along with the associated chapter nos. These chapter nos. vary in these two categories of manuscripts. This explains the discrepancy-in the chapter nos. given in the foot-note at the beginning and in the colophon of each chapter of this and earlier volumes.

Ayurveda saukhya, like other ancient ayurvedic works, was composed in Sanskrit (except occasional quotations in old Hindi). Presentation of this (so far unpublished) work simply by collating from six manuscripts and editing would have served very limited purpose. Intellectuals of this country, for the most part, are gradually drifting away from scholarship in Sanskrit. Besides, there are several scientists, physicians and orientalists in the West who are anxious to acquire knowledge about ayurveda. Most of them have no knowledge of Sanskrit. For them, it was felt necessary to provide an English translation of this text.

Translation is a hazardous job specially when it involves a highly technical work like this because the source material was originally composed nearly twenty five centuries ago-their mode of expression being quite different from those of the present age. However, we have tried to be as careful and accurate as possible. The translation could have much improved by trans- position of words and by outstretching their meanings. We have preferred accuracy, and sacrificed, whenever it was necessary, a good literary form to make it as true to the original as possible, and to reflect its correct meaning and implications.

In the volumes of this series, English translation of certain words like vayu, pitta and kapha are avoided, because these concepts being subtle and new to Western culture, exact equivalents are not available, and those in current use by some scholars, viz. wind, bile and phelgrn are totally misleading. Drugs used in the recipes for the treatment of various diseases, are for the most part botanically identifiable. But, the same drug so often repeats in these recipes that giving their botanical names against each in parenthesis would have made the reading extremely difficult. For those interested in their identity, botanical names are given in the appendix. Same was the motive behind avoiding metric equivalents of ayurvedic weights and measures; their nearest equivalents are given in another appendix along with other technical words. A deviation from this has been made while describing the signs and symptoms of diseases and therapeutic indications of recipes. For most of these terms nearest (if not the exact) equivalents in English are provided, and for others, which are very few in number, explanations have been included in the glossary of technical terms.

While describing some recipes, the exact quantity in which the ingredients are to be added and the methods of preparation are not mentioned. For such recipes, general rules prescribed for the purpose in standard ayurvedic texts are to be followed.

Ayurvedic recipes often contain metals like mercury, iron, copper, zinc, lead, gold and silver, minerals, gems, jewels and poisonous plants as weIl as animal products. Before adding to recipes, these are to be detoxicated and made assimilable. In some recipes, words indicating exact forms, viz. bhasma or suddha visa (purified aconite) are mentioned. For others, where such indications are not provided, it was presumed that the physicians are acquainted with such rules. Therefore, whether such descriptions are provided or not, invariably such metals, minerals, gems, jewels, poisonous vegetable drugs and animal products are to be purified (detoxicated) and reduced to assimilable forms like bhasma or pisti, and only thereafter, added to recipes. These should never be used in unprocessed and raw form. These pharmaceutical methods are described in standard texts on Rasa sastra.

A recipe is often described to be used in the treatment of many ailments. It is presumed that the physician has the basic knowledge of their dosage, duration of treatment, mode of administration and anupsna (vehicles) in which these are to be useful in different conditions. One should not start using these recipes in all conditions or sit on judgment over their therapeutic efficacy without the prior basic knowledge on these topics.

They vary so considerably that it is not possible to give all such variations under each and every recipe. Information on these items is provided in some recipes only to high-light their peculiarities.

These recipes are described to be manufactured in different ways and each category of preparation has a prescribed self-life (except metallic and alcoholic preparations which become more effective as they become older). These methods can also be changed to suit the requirements of physicians and patients. For example, a recipe prescribed to be prepared in the form of a tablet may also be made in the form of a powder and vice versa. But the tablet has a longer self-life in comparison to the powder, and some powders can't be made to a tablet form unless adhesive material, not mentioned in the recipe, is added. With the advancement of modern technology like air-tight packing, addition of preservatives. methods of preservation and mixing of inert binding material, it might be possible to change the prescribed self-life of recipes and their pharmaceutical processes. But one should be very careful before adopting such modifications and deviating from the methods prescribed in the text. Some of these techniques and preservatives, though considered safe for allopathic drugs may not be so for ayurvedic preparations because ayurvedic concepts of "drug- composition" and "drug-action" are distinct and different from allopathic system.

The above-mentioned points should also be kept in view while embarking upon any research project on ayurveda. There will be no two opinion to adopt scientific methods to evaluate the efficacy of ayurvedic drugs and recipes. But the laboratory techniques generally followed at present to assess the utility of allopathic drugs may not be appropriate for ayurveda unless these are suitably modified keeping in view the ayurvedic concepts of "drug-composition" and "drug-action".

In the preface to 'Basic Principles of Ayurveda' (Todarsnanda, Ayurveda Saukhyam series; no. II) we have already described the availability and difference in the arrangement as well as numbering of the chapters in the six manuscripts which we have consulted for the preparation of this work. Out of these six mss, chapters included in the present volume, are available only in five manuscripts excluding the third one. As we have discussed there, the invocation (which, for the most part, is erroneous) is available only in the mss. no. 6 and the colophon is lacking there. .The colophon, however, is available in the remaining four manuscripts. The arrangement of the chapters and the numbers thereof in the sixth ms. is entirely different from the remaining ones. Therefore, our readers will notice discrepancies in the numbers of chapters at the beginning (before the invocation) and also at the end (the colophon). The invocations are so full of errors that we preferred not to correct them and to leave them as such in the footnotes at the beginning of each chapter.

All our manuscripts have several grammatical and syntactical errors and these errors are found more and more, as we are going ahead, in subsequent volumes. We have of course, corrected some of these obvious errors in the text and the variant readings are given in the footnotes. This being a book of medical science, we are however, very careful not to temper with the text too much, lest it may give an erratic meaning to our readers and research workers. Therefore, our readers will find some errors left out in the text and draw their own judgement about the correct textual reading. In future, if we come across better manuscripts, then corrections would be carried out oil the basis of those mss. in subsequent editions.

In this book, for the convenience of readers, we have given chapter numbers seriatim. This is an editorial device and has nothing to do with the chapter numbers given in various mss. of this work.

In this volume, we are mostly dealing with surgical ailments In ancient India, Salya tantra or surgery was in practice and was treated as a specialised branch of ayurveda. There are many references to the practice of surgery in the VEDAS and PURANAS. Many surgical performances like transplantation of the head of a horse to the trunk of a human being and its subsequent replacement by human head, providing artificial limbs, connecting the head of Yajna to his trunk etc., are described in the Vedas. Similarly, in puranas we come across the transplantation of an elephant's head with the trunk of Ganesa. In Ramayana, there is the description of war-surgery. When Laksmana became unconscious being injured by a weapon, Susena, the surgeon, revived his consciousness by surgery and administration of a plant called sanjivani.

During the life time of Lord Buddha, there was a famous physician by the name Jtvaka. Because of his proficiency in the art and science of surgery, he was thrice crowned as the king of physicians and surgeons. He was an expert pediatrician and even excelled in brain surgery. He successfully performed major abdominal operations. There are several anecdotes about this Jivaka and his exploits in the Tibten literature.

Even in Bhoja prabandha (11 th century A.D.), we have the description of the King Bhoja's suffering from a serious type of headache. He was anesthetized by sammohana curna, his cranial bone was opened, the foreign body was removed, the bone was replaced, stitched and he was made to regain his conciousness by the use of another powder called sanjivani curna.

Whether these descriptions and anecdotes have to be believed or not is a different matter. But there is no doubt that several major surgical operations were in practice in ancient India and it reached the apogee of its development in the field of surgery during seventh century B.C.

The original texts of Agnivesa samhita, Susruta samhita and several other texts on surgery and treatment of diseases of eye ear, nose and throat are not available now because of historical reasons. What is available now is Caraka samhita and Susruta samhita, both in redacted and supplemented versions. Even in the, extant Caraka samhita, we have references to surgical performances, and for surgery, he has suggested patients to be referred to the practitioners of Dhanvantara school. The extant edition of Susruta samhita provides us an elaborate description of surgical equipments, methods and performances along with the description of ailments needing surgery. Description of rhinoplasty, Caesarean section provided in the text are the evidence of the high skill to which surgery developed in ancient India.

Unfortunately, Buddhism which was patronised by the rulers and subjects of India alike prohibited the practice of surgery among several other professions. This gave a death blow to the medical practitioners, They have to give relief to suffering humanity. When the religion prohibited them to practise surgery they made efforts to develop medicines for correcting these surgical ailments. These drugs and recipes are in successful practice in India and its neighbouring countries even today. Therefore, one often comes across patients of cancer, stone in urinary tract, stone in gall bladder, peptic ulcer, heart diseases and the like who were directed for surgery but successfully treated by medicines by the ayurvedic physicians of this country.

Regarding the English translation given In this volume, we would like to mention that in the 6th manuscript there are brief notes in Hindi to some of the difficult terms described in the text. Some of these interpretations, given in the note, are unconventional. However, we have followed them in our translation.

We are extremely thankful to Ku. Kanchan Gupta, M.A., M.Ed., who was of great help in each and every stage of the preparation of this work. We express our gratitude- to Shri Naurang Rai, the publisher who in spite of his pre occupation entertained the publication of this work for the welfare of the suffering humanity and encouraged us in each and every step of our endeavour. We will fail in our duty if we do not express our thanks to Shri Manjit Singh, the printer, for printing it expeditiously and for taking personal pains. Mr. Madhava Rao deserves our thanks for all the help he rendered in proof reading etc., of this book.

Both of us are extremely busy in our professional activities and we have very little free time to devote for this monumental work. The work is, therefore, done at midnight. If it proves beneficial to patients, physicians, teachers and research workers we will feel amply rewarded. At the end, we would like to quote the great poet Kalidasa who, in his monomental play' Abhijnana Sakuntalam', says: “I will not consider my efforts to be meritorious until and unless the wise readers (audience) for whom this work is meant, arc satisfied."

Disease is a reaction of the individual against the injustice done to his body and mind either by himself through his food, drinks and regimens, or because of extraneous factors like vagaries of nature ,injury and providential factors. To make him free from the disease, it is necessary to undo the inflicted injustice and to support his body and mind to overcome the damage already done. The patient nowadays is so scared of the disease that he wants to get rid of it instantaneously or at least as early as possible. Thus, he demands and is prescribed instantcure therapies. Both the body and mind of the individual have their own momentum towards recovery and these instant cure therapies cause unnatural acceleration of the natural mode- of recovery progress. These unnatural efforts do partially succeed to overcome the disease but the individual's own power for resisting the attacks of diseases, both the present and future ones, is reduced and tie succumbs to several side effects. These side effects of instant cure therapies have become so common and so dangerous that a specialised branch of modern medicine called Iatro-chemistry is now developed to handle them. If this vicious circle of disease, instant cure therapies to correct it, side effects coupled with low body immunity caused by the administration of such tehrapies and again treatment of these side reaction is not broken, then the individual will be eternally a patient and die unnatural death because of lack of money to finance the treatment of such recurring diseases and also because of the adverse reactions of these medicines, The remedy of this unfortunate situation lies in finding out a balanced but stable therapy which may even be slow acting, which should not produce side toxic effects, but give side benefits in the form of increasing the individual's power to resist the recurrence of such diseases. In this field ayurveda and ayurvedic therapies stand unparalleled. These therapies are not only based on sound principles to protect the natural body mechanisms but are also backed by centuries of experience behind them.

The present work is the seventh volume in Todarananda Ayurveda Saukhyam series (part of the Diagnosis and Treatment of Diseases in Ayurveda). It deals with the diagnosis and treatment of some such obstinate and otherwise incurable diseases like sinus, fistula-in-ano, syphilis, obstinate skin diseases including leprosy, erysipelas, chicken pox, small pox and diseases specific to head including eye, ear, nose, mouth and throat Against most of these diseases modem medicine has very little to offer except, strong antibiotics, chemotherapies, steroids and surgical intervention which, according to protagniots of this system themselves, are very risky and shrouded with side toxic effects. After all, there is no guarantee that these diseases will not recur after these are suppressed by these therapies. The side effects of these so called modem therapies are more painful than the disease itself. Ayurveda provides successful and sure treatment for such ailments. Such therapies, along-with diet and other regimens in respect of each of these ailments are described in this work.

Todaramalla, the author of this encyclopaedic work had the unique previlage to collect the most effective recipes for the treatment of these ailments. He had at his disposal the services of reputed scholars and libraries to compile and interprete textual material for the diagnosis and treatment of these diseases. Because of the wealth of material contained in it, this will be equally useful for Ayurvedic physicians, for doctors of Modem Medicine in this country as well as abroad and for research workers in the field of health and humanities.