Sushruta Samhita Uttara Tantra Chapter 66 (Dosha Bheda Vikalpa): The Last Question, and How the Samhita Ends

📖 23 min read · Classical Ayurveda texts · Sushruta Samhita series

Where Dosha Bheda Vikalpa Sits: The Last Chapter of the Sushruta Samhita

If you have searched for Sushruta Samhita Uttara Tantra Chapter 66 and want the short answer first: it is the chapter called Dosha Bheda Vikalpa Adhyaya, it deals with the different modifications and combinations of the three doshas, and it is the final chapter of the entire Sushruta Samhita. After it there is a colophon and nothing else. The line that ends the chapter also ends the book: “Here ends the Uttara-Tantra.”

The Uttara Tantra is the sixth and last of the Samhita’s six books, and by some distance the strangest. The five books before it are recognisably a surgeon’s curriculum. The Uttara Tantra is where Sushruta puts everything the surgical books deliberately set aside — the eye and the ear and the nose, the diseases of infancy, fever, and then a long run of internal medicine that most readers never reach. We have written about that neglected second half in our guide to Sushruta’s twenty-six chapters of Kaya Chikitsa.

What almost nobody notices is how the book actually ends. The last four chapters of the Uttara Tantra are not about any disease at all. Chapter 63 counts the combinations of the six rasas. Chapter 64 defines health. Chapter 65 — which we covered in our guide to the thirty-two tantra yuktis — teaches you how to read a technical text. And chapter 66 counts the combinations of the three doshas and then stops.

A book that spent five volumes on wounds, instruments, poisons and fevers ends on definitions, enumeration and reading method. That is not an accident of manuscript order. It is a claim about what a physician actually needs when the case in front of him does not match anything in the book.

Sushruta’s Last Question to Divodasa

The Sushruta Samhita is written as a dialogue. Sushruta, described in this chapter as “the son of Visvamitra”, puts questions to Divodasa — the king of Kashi, identified in the tradition with Dhanvantari. The chapter introduces him one last time in the formal manner the text reserves for him: “the high-minded Divodasa, well-versed in all the eight divisions of Ayurveda, with intellect sharp and as deep as an ocean, as it were, and with all the difficulties in the meanings of the Shastras fully solved.”

Then comes the question. In Kaviraj Kunja Lal Bhishagratna’s 1916 English translation — the version quoted throughout this article, published in Calcutta as Volume III of his three-volume Sushruta Samhita — it reads:

It is worth pausing on what kind of question that is. It is not a question about a patient. It is not a question about a substance, a season or a procedure. It is a bookkeeping question — Sushruta is asking his teacher to reconcile a number the text has already used with the method that produces it. The last thing the student of the Sushruta Samhita wants to know is whether the arithmetic holds.

The response is recorded with unusual warmth. “On hearing his word the great sage and king (Divodasa) with all his difficulties solved was greatly pleased and thus narrated the true conditions to Sushruta.” The teacher is pleased by an accounting question. It is the last emotion the book records.

Taken two at a time, and each pair can stand more than one way.

The Closing Census: Sixteen Substrata, Eleven Pranas, and a Count of Dravyas

Before Divodasa gets to the arithmetic he does something that reads, on the last page of a long book, almost like closing a ledger. In four compact verses he states the totals of the entire science.

He begins with what holds a body together: “The three Doshas, the (seven) Dhatus, feces and urine — these, in their normal state, hold together the corporeal frame in conjunction with the six Rasas necessary (for the constitution).” That single sentence names the tridosha, the seven dhatus, the malas and the six rasas — four of the great lists of Ayurveda — and it names them as things that hold together, not as things that go wrong. On the last page, the doshas are introduced as structural before they are introduced as pathological.

Then the census proper:

Notice the shape of that table. Two of the five entries are back-references — the substances and the gunas are flagged as already explained. Divodasa is not teaching here. He is reciting an inventory, the way you might read out the closing balance of an account you have kept for years. The Uttara Tantra is about to end, and the text is stating what it takes itself to have covered.

The figure of one thousand one hundred and twenty is the one modern readers stumble over, because the Samhitas do not agree on it and the number varies with how you choose to subdivide. It is best read as what it is in context: a claim about completeness, made at the point where a book closes. The point is not that a physician memorises eleven hundred and twenty entries. The point is that the field has an edge, and the next four verses are about what happens when a case falls outside it.

Dosha Bheda Vikalpa: How Divodasa Divides the Count

Now the arithmetic. This is the passage the chapter is named for, and it is short enough to quote almost whole. Divodasa takes the three doshas and asks in how many distinguishable states they can stand.

Three, nine, thirteen. The text then gives the subtotal itself: “thus making twenty-five in all with the aggravated Doshas.”

The first two figures are easy to follow and the text expects you to follow them. Three is one raised dosha with the other two normal — vata alone, pitta alone, kapha alone. Nine is what you get when two are raised at once: there are three possible pairs, and each pair can be raised evenly or with either member dominant, which is three states per pair.

Thirteen is the interesting one, because the text simply asserts it. It does not show its working. All three are raised, “both equally and unequally” — one case where they rise together in equal measure, and the remaining twelve where they rise in unequal proportion to one another. Later commentators reconstruct those twelve from the ways three quantities can be ranked against each other when none is left out. The chapter itself does not argue the point. It gives the number and moves on, in the manner of a text that expects the reader to have arrived here with the tridosha framework already in hand.

Counted once as risen and once as fallen. The arithmetic doubles.

Vriddhi and Kshaya: Why Sushruta Counts the Same Set Twice

Here is the move that separates this chapter from a merely clerical exercise, and it takes one sentence.

The twenty-five states of vriddhi — increase — are matched, one for one, by twenty-five states of kshaya, decrease. That gives fifty. Then twelve more for the cases where one dosha has risen while another has fallen at the same time. Fifty and twelve is sixty-two, and the chapter says so.

That symmetry is doing real conceptual work, and it is easy to miss because it is stated so briefly. A great deal of popular writing about Ayurveda presents a dosha as something that can only be too much. Sushruta’s last chapter spends half its arithmetic insisting that a dosha can equally be too little, and that a state of deficiency is exactly as distinguishable, exactly as countable, and exactly as much a subject of the science as a state of excess. Twenty-five and twenty-five. The text gives them equal weight by giving them equal numbers.

The twelve mixed states are the subtlest entry in the table — one dosha up while another is down. They are the reason the whole scheme cannot be collapsed into a single axis running from “low” to “high”. Vagbhata makes the same two-sided point in his own way, and we have written about it in our guide to Doshopakramaniya Adhyaya in the Ashtanga Hridaya.

Sixty-Two or Sixty-Three? The Footnote the Translator Could Not Skip

Read Sushruta’s question again and you will find a snag in it. He says “it has already been said that there are sixty-two varieties of the Doshas” — but where was it said? Bhishagratna, translating in 1916, chases the reference and finds that it does not quite land. His footnote is one of the most useful sentences in the volume:

That is the whole resolution, and it is elegant. The earlier chapter counted sixty-three states. This chapter counts sixty-two. The difference is exactly one state: the one in which all three are normal.

And in that one state, the translator points out, they are not doshas at all. They are dhatus — the word the text uses for them when they are behaving. Dosha is a word that already carries fault in it; a vayu that is doing its job is not a fault. So a chapter that sets out to count the modifications of the doshas cannot include the state in which there is no modification and nothing that deserves the name.

This is worth sitting with, because it is the kind of thing a classical text does casually and a modern reader can walk straight past. Health, in the arithmetic of the last chapter of the Sushruta Samhita, is not one item among sixty-three. It is the item that the vocabulary of disease cannot name. You reach it by subtraction.

Vagbhata arrives at a strikingly similar place from a different direction in Ashtanga Hridaya, Sutrasthana, Chapter 12, where the equilibrium state is numbered after the states of derangement rather than among them. We have covered his treatment separately in our guide to Doshabhediya Adhyaya, which is the place to go for Vagbhata’s version of this count; the two texts reach the same figure by visibly different routes, and reading them side by side is more instructive than reading either alone.

The instruments, set out separately, before anything is combined.

Rasa Bheda Vikalpa: The Twin Chapter That Counts the Instruments

The chapter title Dosha Bheda Vikalpa has a twin three chapters earlier, and the pairing is deliberate enough that the names rhyme. Uttara Tantra Chapter 63 is Rasa Bheda Vikalpa Adhyaya — the different combinations of the six rasas. Same construction, different noun.

Chapter 63 works through the six tastes exhaustively, and unlike chapter 66 it shows every step. The tally it builds is this:

Chapter 63 does not merely give those subtotals — it lists the members. Every one of the fifteen pairs is spelled out, then all twenty triples, then the fifteen quadruples. It is the most patient piece of enumeration in the Uttara Tantra, and reading it is a good corrective to the idea that classical Ayurveda dealt only in aphorism.

Its opening verse also solves a puzzle that has bothered readers of the Samhita for a long time. Chapter 21 of the Sutra Sthana had given fifteen combinations of the doshas. Chapter 63 says that figure was incomplete, that the doshas may be manifest separately (avidagdha) or combined with one another (vidagdha), and that “the combinations of the Doshas with one another already spoken of should be considered by an intelligent person to be sixty-three in all (and not fifteen only).”

A text that was careless would have quietly harmonised those figures. The Sushruta Samhita leaves all three standing, in three different places, and lets a later reader do the reconciling — which is precisely the skill chapter 65 spends its length teaching. The tantra yuktis include devices for exactly this situation: for a statement that appears to contradict another, for a meaning that must be supplied by the reader, for a rule stated in one place and qualified in another.

“Innumerable”: The Verse That Undoes the Table It Just Built

Verse 9 arrives immediately after the total, and it is the most surprising sentence in the chapter.

The chapter has just spent its entire length producing a closed, exact figure. One verse later it says that in practice the figure does not close. The sixty-two are the distinguishable kinds of derangement; the actual states a body can be in, once degree and combination are allowed to vary continuously, are beyond counting.

This is not the text losing its nerve. It is the text drawing a boundary around its own method, and it does so at the only moment where such a boundary really matters — on the last page, after the last table, with nothing following it that could soften the admission.

And then, having said the enumeration is not enough, the chapter says what to do instead. The verse continues: the physician is to work with “the different combinations of the (six different) Rasas after properly diagnosing the disease with a due regard to the aggravation of the different Doshas and without going into any further details.”

Read that last clause slowly, because it is a genuine instruction and an unusual one: without going into any further details. Having built a table, the text warns against extending it. The answer to an innumerable set of states is not a larger classification. It is a smaller working vocabulary — six rasas, three doshas, and the judgement to match them.

The instrument at rest. The last verse of the book is about who lifts it.

Karta, Karana, Karya: The Physician as Doer, the Rasas as Instruments

Verse 10 is the last teaching of the Sushruta Samhita, and it changes register completely. Up to this point the chapter has been counting. Now it does grammar.

Four roles, assigned in one sentence:

Put beside the arithmetic that precedes it, this verse is doing something quite deliberate. The sixty-two combinations are a map of the cause column, and the sixty-three rasa combinations of chapter 63 are a map of the instrument column. Both columns are enumerable, and the text has just enumerated them.

The doer is not enumerable. There is no table of physicians, no list of judgements, no scheme for the column that actually decides which instrument meets which cause. That is why the chapter can say the combinations are innumerable without contradicting itself: the innumerable part was never supposed to live in a table. It lives in the person holding the instrument.

The closing clause is the shortest definition of illness in the book. “The opposite hereof is want of health.” Not a substance, not an invasion, not a punishment — simply the same arrangement running the other way.

Svastha Vritta Adhyaya: Health Defined Three Chapters Earlier

Verse 10 can name health as the effect without pausing to explain it, because chapter 64 has already done the work. Svastha Vritta Adhyaya — the chapter on the rules of health — opens with as clean a definition as the classical literature offers:

Two halves, joined by as well as. The first half is the physiological ledger — doshas, agni, malas, dhatus, each in its normal condition. The second half is prasanna, serenity, and it covers the body, the mind and the senses together. Neither half is optional. A body whose ledger balances but whose mind is not serene does not meet the definition.

The same verse then states the purpose of the entire discipline: “the primary object of medical treatment is to maintain this healthy state in its normal equilibrium”, and notes that this too was said before, in the Sutra Sthana. Maintenance, not repair, is named as the first object — on the same page that begins a long seasonal regimen.

Chapter 64 goes on to lay out conduct and diet season by season, beginning with varsha, the rainy season. It is the Uttara Tantra’s own ritucharya, and readers who want that material developed at length will find it in our guides to Ritucharya in the Ashtanga Hridaya and to Charaka Samhita, Sutra Sthana, Chapter 6. Dalhana, the great commentator on Sushruta, adds a note to this very verse recording that some read kriya separately, as the organic functions such as sleep and waking — a reminder that even the definition of health was still being argued over centuries later.

The state that drops out of a count of what can go wrong.

“Here Ends the Uttara Tantra”: How the Sushruta Samhita Closes

Two verses remain. The first is the book taking stock of itself:

What is striking is what the book praises itself for. Not its surgery, not its instruments, not its pharmacy. It claims credit for “the order of the words and their meanings” and for making “hidden meanings” plain. The Uttara Tantra, on its own account, is a book about how to understand a book — which is exactly what chapter 65 spent thirty-two technical devices establishing, and exactly what chapter 66 has just demonstrated by reconciling two different counts of the same three doshas.

Then the final verse, and it is a promise rather than an argument: “Persons reading, according to the rules laid down, this treatise together with the Uttara-Tantra coming from (the mouth of) Brahma himself, are not abandoned by their wished for objects, that is to say, they are sure to obtain them. This word of Brahma is perfectly true.”

Note the condition attached: according to the rules laid down. Even the closing benediction is qualified by method. The promise is not made to a person who owns the book. It is made to a person who reads it the way chapter 65 said to.

And then the colophon, in the plainest possible words: “Thus ends the sixty-sixth chapter of the Uttara-Tantra in the Sushruta-Samhita which is called the different combinations of the different Doshas. Here ends the Uttara-Tantra.”

The Same Count in Ashtanga Hridaya and Charaka Samhita

The sixty-two is not unique to Sushruta, and comparing the three great texts on this one point is a good way to see how differently they are built.

Placement tells you a great deal. Vagbhata puts the count near the front, because in the Ashtanga Hridaya it is scaffolding — you need it before you can read anything that follows. Sushruta puts it at the very end, where it functions as a summary and a limit rather than a foundation. Charaka, whose organisation we have mapped in our complete guide to the Charaka Samhita, largely declines the tabular approach.

The rasa side of the ledger has a similar spread. Sushruta enumerates the sixty-three combinations exhaustively; Charaka’s treatment of taste sits inside a broader pharmacological framework of rasa, guna, virya and vipaka, which we cover in our guide to Dravyaguna in the Charaka Samhita.

The Uttara Tantra, Chapter by Chapter

Because chapter 66 is best understood as an ending, it helps to see what it is the ending of. The Uttara Tantra runs to sixty-six chapters and falls into five clear movements. The table below follows the contents of Bhishagratna’s Volume III, and links the chapters we have already written about in detail.

Roughly two-thirds of the Uttara Tantra is shalakya and kaumarabhritya — the specialities that use fine instruments above the collarbone, and the medicine of children. It is the section of the Samhita that most contradicts the popular picture of Sushruta as a purely surgical author, a point we develop in our overview of the Sushruta Samhita as an ancient surgical text.

Reading Uttara Tantra 66 With Modern Eyes — and What We Leave Out

Two habits make this chapter easier to read honestly.

Separate the observation from the scheme. The observation in chapter 66 is that derangement is two-sided — that a functional principle can be deficient as well as excessive, and that both are worth naming. That is a durable and rather sophisticated idea. The scheme is the specific figure of sixty-two, which depends entirely on choices the text makes about what counts as a distinguishable state. The observation survives translation across two thousand years. The figure is an artefact of the method, and the text more or less admits as much when it revises fifteen to sixty-three and then to sixty-two.

Read the numbers as claims about scope, not as data. One thousand one hundred and twenty diseases and five hundred and seventy-three substances are the totals of a closed curriculum. They tell you what the book believes it has covered. They are not measurements, and reading them as measurements produces the sort of confident nonsense that gives classical scholarship a bad name.

One last thing worth saying plainly, because the chapter invites the misreading. The sixty-two combinations are a scholarly classification inside an ancient text. They are not a self-assessment instrument, and nothing in this article is a method for working out your own state. Divodasa hands the whole business to a trained physician in verse 10, and the reason he gives is the one in verse 9: the real set is innumerable, and no table replaces a person who has been taught to look.

Kalpana: Three Classical Forms on an Ordinary Shelf

There is no product in this chapter. What there is, in verse 10, is a distinction between an instrument and the person using it — and in the classical pharmacy an instrument always arrives in a form. Kalpana is the Samhitas’ word for that: the preparation a substance is delivered in. Our shelf has three ordinary daily-care items whose form carries one of those classical names. That is the whole of the connection, and we would rather state it narrowly than dress it up.

These are everyday personal-care items for teeth, hair and skin. Nothing below is a claim of any kind about any of them.

And the column we have to leave empty. The instruments verse 10 actually names are the six rasas — tastes, taken internally, under a physician’s direction. There is nothing on our shelf that belongs in that column, and there should not be. Everything above is something you put on the outside of a body. The chapter’s own instrument column is not ours to fill.

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