Kushtha Chikitsa in the Sushruta Samhita: Chikitsa Sthana 9 on Papa-Roga, the Five Stages and Dallana's Doubts

इस लेख को हिंदी में पढ़ें: कुष्ठ चिकित्सा: सुश्रुत संहिता चिकित्सा स्थान 9, पापरोग और पाँच अवस्थाएँ

📖 27 min read · Sushruta Samhita, Chikitsa Sthana 9, read in Bhishagratna's English (Volume II, printed pages 346–361) and in the Sanskrit

Kushtha Chikitsa: What Sushruta's Chikitsa Sthana 9 Is, and How We Read It

The Sushruta Samhita discusses kushtha twice. The diagnostic book, Nidana Sthana, gives it chapter 5: causes, early signs, the eighteen kinds, the white patches called kilasa, and the seats in the body. We have read that chapter in full on our page about kushtha in the Sushruta Samhita's Nidana Sthana, and Charaka's diagnostic chapter on our page for Charaka Samhita, Nidana Sthana 5. The book of chikitsa then gives kushtha two chapters: chapter 9, on kushtha in general, and chapter 10, on the great kushthas (maha-kushtha). This page is about chapter 9.

Bhishagratna opens it like this: Now we shall discourse on the medical treatment of cutaneous affections in general (Kushtha). In his Volume II the chapter runs from printed page 346 to printed page 361. The order of these chapters is not random. Sushruta's Sutrasthana 33 names eight conditions as the hardest of all, and the Nidana Sthana and the Chikitsa Sthana take them up in one fixed order; our page on Bhagandara Chikitsa, Chikitsa Sthana 8 shows how. Kushtha is the fifth of the eight in that order, and chapter 9 follows straight on from chapter 8.

Most of chapter 9 is a list of preparations: medicated ghee, oils, pastes, washes and powders. Two modern conditions that fall under its words, leprosy and leucoderma (vitiligo), are on the schedule of the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954, which forbids advertising medicines for them. We are a shop, so the rule is simple: no preparation, ingredient list, amount or method from this chapter appears on this page.

What we read instead is the chapter's frame. Its words, its order, its causes, its stages, what it says about the patient, where it puts sin, where its own commentators doubt it, and how its English translation differs from its Sanskrit. For the Sanskrit we use the text of the chapter on Wikisource, which numbers the verses 1 to 72 (the first two verses are the opening formula). Bhishagratna's English numbers its paragraphs differently and stops at 38, so where we quote him we give his paragraph and printed page as well.

Kushtha, Tvag-dosha and Papa-roga: Three Names in One Chapter

The chapter uses three names for its subject, and each one points somewhere different.

Kushtha. The title word: verse 1 announces the kushtha-chikitsitam, and the closing line names the chapter the same way. It is not one disease. Bhishagratna's cutaneous affections in general is the honest English, and both of our Nidana pages show the range: seven great kinds and eleven minor ones in Sushruta, and the white patches as a related kind. Vagbhata gives the word a meaning in Ashtanga Hridaya, Nidana Sthana 14.4: कालेनोपेक्षितं यस्मात् सर्वं कुष्णाति तद् वपुः, "because, neglected over time, it kushnati the whole body", from a verb that means to tear or pull at. The person who has it is a kushthi, and that word matters in the last verse.

Tvag-dosha. Verse 3, the list of causes, does not say kushtha at all. Its subject is tvag-doshah, plural: "faults of the skin" (tvak, skin, and dosha, fault or disorder). Bhishagratna keeps the word in brackets: A cutaneous disease (Twag-dosha) originates through injudicious conduct of life. The skin itself has layers in Sushruta's anatomy; our page on Sapta Twacha, the seven layers of the skin reads that chapter.

Papa-roga. In verse 45, in the middle of a preparation we do not reproduce, the Sanskrit calls kushtha पापरोगस्य, "of the papa-roga", the disease of sin. Bhishagratna's English at that point says only "Kushtha". The Nidana chapter uses the same word in its verse 30, where it lists the sins. So the chapter's three names run from a medical class (kushtha), to a plain description (faults of the skin), to a moral label (disease of sin). The rest of this page follows all three.

Verse 3: The Causes, From Viruddha Food to Two Kinds of Karma

Chikitsa Sthana 9.3
विरुद्धाध्यशनासात्म्यवेगविघातैः स्नेहादीनां चायथारम्भैः पापक्रियया पुराकृतकर्मयोगाच्च त्वग्दोषा भवन्ति
viruddha-adhyashana-asatmya-vega-vighataih snehadinam cha ayatha-arambhaih papa-kriyaya pura-krita-karma-yogach cha tvag-dosha bhavanti

Read item by item, the verse lists seven causes:

1. viruddha: incompatible food, the foods that clash with one another;
2. adhyashana: eating again before the last meal is digested;
3. asatmya: what does not suit the person;
4. vega-vighata: holding back the body's natural urges;
5. snehadinam ayatha-arambhah: oils, ghee and the like (sneha), begun in the wrong way;
6. papa-kriya: a sinful act;
7. pura-krita-karma-yoga: the working of deeds done before.

The first five are about the body: what goes in, when, and what is held back. The last two are moral. Bhishagratna gives the first five carefully and then folds the last two into one sentence: It is attributed even to the dynamics of sinful acts done by a man in this or in some prior existence. The word "even" is his. The Sanskrit has no "even" and no "attributed": the two moral causes stand in the same sentence as the food, as causes of the same verb, bhavanti, "arise". That is the first thing to notice about this chapter. It does not keep sin for a separate paragraph.

The Nidana chapter does. Its own list of causes, at the opening of the chapter (paragraph 2 in Bhishagratna), is all food and conduct: improper food, exercise and other exertion straight after oily food or after vomiting, milk taken with meat, a cold bath after heat, a held-back urge to vomit. Sin comes only near the end of the Nidana chapter, in its verse 30, as something "they say" (prahuh). Our reading: the Chikitsa chapter moves sin from the edge of the Nidana into the opening list of causes.

Two of the seven causes come back one verse later, as rules. Incompatible food and eating before digestion are on the avoid-list of verse 4. Held-back urges have their own chapter in Charaka; the cause list here simply names them.

Ahara-Achara Vibhaga: The Avoid-List and the Old Grain (Verses 4 and 5)

Verse 5 ends with its own label: ity esha ahara-achara-vibhagah, "this is the division of food and conduct". The two verses are the chapter's daily rules for a tvag-doshi, the person with the skin fault.

What to avoid (verse 4). Meat, fat (vasa), milk, curd, oil, horse gram (kulattha), black gram (masha), nishpava beans, things made from sugarcane and from flour, sour things, incompatible food, eating before digestion, eating while food still lies undigested (ajirna), foods that cause burning (vidahi) and foods that clog the channels (abhishyandi), sleeping by day, and one more item that we leave in the book. Sleeping by day has a long history of its own; our page on nidra in the Charaka Samhita reads Charaka's rules about it.

One small difference with the English. The Sanskrit compound is ikshu-pishta-vikara: things made (vikara) from sugarcane (ikshu) and from flour or pounded grain (pishta). Bhishagratna gives preparations and modifications of sugarcane juice and nothing for the flour. A reader of the English alone would not know that flour-based foods are on the list.

What to eat (verse 5). The verse opens with grain, and with one word that is easy to miss: anavan, "not new". Old rice of the shali and shashtika kinds, barley (yava), wheat (godhuma) and three small grains (koradusha, shyamaka, uddalaka), all from an earlier harvest. Bhishagratna keeps the word: The old and matured grain. With the grain go soups of green gram (mudga) or pigeon pea (adhaki), and the verse allows the meat of dry-land animals, without fat, to a person used to meat. Verse 5 also names plants to cook into the soups and greens, the bitter group of the Sutrasthana, and three outside applications; they belong to the chapter's preparations, and we leave them out.

Verse 5 asks for grain that is anavan, not new: old rice, barley, wheat and small grains, with a soup of green gram.

Two things stand out. First, the plate is plain: old grain, a thin pulse soup, bitter greens. Second, the avoid-list overlaps the list of causes. Incompatible food and eating before digestion appear in both verses, which makes the rules read like the causes turned round. That pattern, a cause list answered by a rule list, is one to watch for in other chapters too.

Verse 6: Purvarupa, Tvak, Shonita, Mamsa, and Two Stages Without a Name

Verse 6 is the backbone of the chapter. It sets out what the physician does as the condition goes deeper, rung by rung.

Chikitsa Sthana 9.6 (opening and close)
तत्र पूर्वरूपेषूभयतः संशोधनमासेवेत … पञ्चमं नैवोपक्रमेत्
tatra purva-rupeshu ubhayatah samshodhanam aseveta … panchamam naiva upakramet

In order, the rungs are:

1. Purvarupa, the early signs: cleansing "from both ends" (ubhayatah samshodhana), that is, upward and downward.
2. Tvak-samprapta, reached the skin: applications.
3. Shonita-prapta, reached the blood: the same, plus internal measures and the letting of blood.
4. Mamsa-prapta, reached the flesh: all of that, plus three more kinds of preparation.
5. Chaturtha, the fourth: yapya, kept going rather than ended, and only for a certain kind of patient (the next section).
6. Panchama, the fifth: naiva upakramet, "he should not take it up at all".

Each rung keeps the measures of the rung above it and adds more: the blood's list holds the skin's measures, and the flesh's list holds the blood's. The deeper the condition, the longer the list, until the fifth, where there is no list.

Verse 6 runs like a stair: each stage keeps the measures of the one before and adds more, until the fifth, where the verse stops.

The fourth and the fifth have no names. The Sanskrit names the first three seats (skin, blood, flesh) and then simply counts: the fourth, the fifth. Bhishagratna fills the gap twice. A footnote supplies the fourth: The type of Kushtha affecting the principle of Medas (fat) is generally supposed to be sin-begotten. A bracket inside his main text supplies the fifth: The disease in its fifth form (is found to invade the bones and) should be given up as incurable. Fat and bones are the translator's additions, not words of this verse.

His names are reasonable, because the Nidana chapter names them. Nidana Sthana 5.22 to 5.27 describe the signs of kushtha seated in skin, blood, flesh, fat, bone and marrow, and the reproductive tissue (shukra): six seats. Then Nidana 5.29 gives the outcome:

Nidana Sthana 5.29
कुष्ठमात्मवतः साध्यं त्वग्रक्तपिशिताश्रितम् । मेदोगतं भवेद्याप्यमसाध्यमत उत्तरम्
kushtham atmavatah sadhyam tvag-rakta-pishita-ashritam, medo-gatam bhaved yapyam asadhyam ata uttaram
"Kushtha seated in skin, blood or flesh can be ended for the self-possessed; gone to the fat it is to be kept going; beyond that, it cannot be ended."

So the Nidana has six seats and three outcomes. The Chikitsa has five rungs and stops. Our reading: a book of measures needs only as many rungs as there are measures. After the fifth there is nothing to prescribe, so the Chikitsa does not count further.

"Do not begin" is not a verdict. The Nidana uses asadhya, "not to be accomplished", for the deep seats. The Chikitsa uses a different word for the fifth rung: naiva upakramet, from upakrama, the act of setting about a course of measures. It is an instruction to the physician, not a verdict on the patient. Bhishagratna's English turns it into a verdict (should be given up as incurable). The Sanskrit tells the physician what not to do and leaves the verdict to the Nidana.

Atmavan and Samvidhanavan: The Fourth Stage Depends on the Patient

Chikitsa Sthana 9.6 (the fourth rung)
चतुर्थकर्मगुणप्राप्तं याप्यमात्मवतः संविधानवतश्च
chaturtha-karma-guna-praptam yapyam atmavatah samvidhanavatash cha

The fourth rung is yapya, to be kept going, and the verse adds for whom: atmavatah samvidhanavatah cha, "for one who is self-possessed and who has the means". Two words. Atmavat is a person in command of himself. Samvidhanavat is a person with samvidhana: arrangements, provision, the means to carry out a plan.

Bhishagratna spends twenty-one words on those two: the fourth stage is purely contingent on the willingness and capacity of the patient to conform to a strict regimen of diet, conduct and dress. On our reading, his "willingness" is atmavat and his "capacity" is samvidhanavat. "Strict regimen of diet, conduct and dress" is his explanation; "dress" in particular is not in the verse.

The same word, atmavat, sits in the Nidana's verse 29 quoted above, but one rung higher. There, self-command is the condition for kushtha in skin, blood and flesh to be ended; Bhishagratna's English for it is a person of prudence and discretion. Here, in the Chikitsa, self-command is the condition for the fourth stage merely to be kept going. The deeper the condition, the more is asked of the patient for less.

The second word is the more surprising. Samvidhanavat admits that a long course of measures needs means: time, food, help, money. A text written for physicians says plainly that the outcome at the fourth stage depends partly on what the patient can afford to arrange. That is our reading of one word; his English softens it into "capacity".

Papa-Roga: Where Sushruta Puts Sin

Sin, or the idea of it, appears in the kushtha chapters of the Sushruta Samhita in five places. Three are in chapter 9 and two in its Nidana twin.

1. Chikitsa 9.3: papa-kriya and pura-krita-karma, a sinful act and deeds done before, in the list of causes (above).
2. Chikitsa 9.6: the compound for the fourth rung contains the word karma, and Bhishagratna reads it as sin: Palliation and temporary respite are all that can be offered in a case of the sin-begotten type, which is the fourth (in order of enumeration). How the compound should be divided is one of the things we could not settle.
3. Chikitsa 9.45: papa-roga, the disease of sin, as a name for kushtha in the middle of a preparation.
4. Nidana 5.30: the list of sins.
5. Nidana 5.31 to 5.32: rebirth, and the way out.

Nidana Sthana 5.30
ब्रह्मस्त्रीसज्जनवधपरस्वहरणादिभिः । कर्मभिः पापरोगस्य प्राहुः कुष्ठस्य संभवम्
brahma-stri-sajjana-vadha-parasva-haranadibhih karmabhih papa-rogasya prahuh kushthasya sambhavam
"By deeds such as killing a brahmin, a woman or a good person, or taking what belongs to another, they say kushtha, the disease of sin, comes about."

Bhishagratna (his paragraphs 23 to 24): Wise men hold that, for killing a Bráhmana, or a woman, or one of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. Three of his phrases are worth a look. "Sometimes" and "divine retribution" are not in the verse. And one of his own relations does not match sajjana, "a good person", in the text we read; it would match svajana, "one's own people", so his manuscript may have read differently.

Verse 31 adds: म्रियते यदि कुष्ठेन पुनर्जातेऽपि गच्छति, "if he dies of kushtha, it comes to him again when he is born again". Bhishagratna: The disease reattacks a man even in his next rebirth in the event of his dying with it. Verse 32 then gives the way out: the great course of food and conduct, chosen medicines, and tapas, austerity, which Bhishagratna renders by practising expiatory penances; the person freed from it gets an elevated status after death.

Put together, the Nidana makes kushtha a matter of this life and the next. The Chikitsa takes over the word papa-roga but, as the last section of this page shows, it ends somewhere else.

Charaka, Sushruta and Vagbhata on Sin and Kushtha

Sushruta is not alone. All three of the great texts put a moral cause beside the food causes of kushtha, and in each one the sin sits in the same list as the diet.

Charaka, Chikitsa Sthana 7.8, ends its long list of food and conduct with विप्रान् गुरून् धर्षयतां पापं कर्म च कुर्वताम्, "of those who insult brahmins and teachers and do sinful deeds". The CSRTSDC English of Charaka's chapter sums up verses 4 to 8 with the same pairing, ending on doing sinful acts. For the white patches Charaka has a verse of their own, Chikitsa 7.177: पापक्रिया पूर्वकृतं च कर्म हेतुः किलासस्य विरोधि चान्नम्, "sinful action and deeds done before are the cause of kilasa, and incompatible food". That phrase, a sinful act and deeds done before, is almost word for word Sushruta's verse 3.

Vagbhata, Ashtanga Hridaya, Nidana Sthana 14.1 to 2, is the most compact: wrong food and conduct, especially the incompatible, then slander of the good, killing and theft, then पाप्मभिः कर्मभिः सद्यः प्राक्तनैर्, "by sinful deeds, of now or of before". His sadyah and praktanaih, usually read as "of now" and "of before", are Sushruta's two moral causes again.

So the pattern is not one author's quirk. In all three, kushtha has a kitchen cause and a conscience cause, side by side. Our observation: in Charaka the moral list is longest for kilasa, the white patches, which is also the condition Sushruta's chapter gives the most verses to.

From Sin to Stigma: Reading These Lines Today

A text that calls a skin condition the disease of sin, says it returns in the next birth, and then (Nidana 5.33 to 5.34) says it passes from person to person by touch, breath, shared food, a shared bed, clothes, garlands and ointments, has given its readers every reason to keep the sick apart. Vagbhata says much the same in Ashtanga Hridaya, Nidana 14.41 to 14.42. People affected by leprosy have lived with the result, in India and elsewhere. The World Health Organization's fact sheet on leprosy says it plainly: persons affected by leprosy also face stigmatization and discrimination.

The same fact sheet answers the old contagion verse directly: The disease does not spread through casual contact (like shaking hands or hugging, sharing meals or sitting next to each other). For the white patches, which Bhishagratna's English once calls white leprosy, the NHS page on vitiligo says you cannot catch it from someone else who has it. Vitiligo and leprosy are different conditions, and neither is a judgement on anyone.

Sharing meals or sitting next to each other does not spread leprosy, the WHO fact sheet says, whatever the old contagion verse claimed.

How should a reader hold these verses, then? As history. They tell us how physicians many centuries ago explained a frightening, visible and slow condition with the tools they had: food, the body's own faults, and the moral order. They do not tell us anything true about a person with a skin condition today. We read them because they are in the text, and because knowing where a stigma came from is part of ending it.

Dadru and Shvitra: The Two Cases Verse 11 Sets Apart

Verses 3 to 10 are prose. Verse 11 is the first verse in metre, and it is a hinge:

Chikitsa Sthana 9.11 (second line)
वैशेषिकानतस्तूर्ध्वं दद्रूश्वित्रेषु मे शृणु
vaisheshikan atas tu urdhvam dadru-shvitreshu me shrinu
"From here on, hear from me the special ones for dadru and shvitra."

The first line of the verse closes the general part by counting what came before: seven applications, all named in verse 10. Then the speaker turns to two conditions that get their own measures, vaisheshika, "special". Bhishagratna's English: Now hear me deal with them. The "me" is the teacher of the whole book: verse 2 is the usual formula yathovacha bhagavan dhanvantarih, "as the revered Dhanvantari said".

Dadru, which Bhishagratna translates as ringworm, gets three verses (12 to 14). Shvitra, the white patches he calls leucoderma, gets far more: verses 15 to 29 are about it almost entirely, and it comes back in verses 38 to 40. Verse 15 names it beside pundarika, and verse 24 calls the condition kilasa, the Nidana's word. No other named condition in the chapter takes as many verses. That matches what the Nidana says about the white patches: they are kushtha's close relative and also something apart.

Everything in those verses is a preparation, and we leave all of it in the book. One general remark is fair to make: several of the shvitra verses use materials taken from animals, including wild ones. Read as history, they show what a physician of that age thought worth trying. Read as instructions, they would be harmful and, for some of the animals, against the law.

Arsha or Anarsha: Dallana's Doubts About Three Formulas

Bhishagratna's footnotes in this chapter name later scholars: Jejjata, Gayadasa and Dallana, who wrote commentaries on the Sushruta Samhita; Chakradatta, the compendium compiled by Chakrapani; Shivadasa, who wrote on Chakradatta; and Vagbhata, cited once as an authority. Most of the notes are about readings (one word for another inside a preparation, one oil for another). Two are about something bigger: whether a passage belongs to Sushruta at all.

The Sanskrit word for "belonging to the sage" is arsha (from rishi). Its opposite, anarsha, marks a passage that someone added later. On our page about Tantra Yukti, the thirty-two devices of the Sushruta Samhita we read the tools the old commentators used on a text; here is one of them at work.

1. Two medicated ghees, verses 29 to 38. Bhishagratna's note to his paragraph 21: Dallana, in his commentary, says that the two Ghritas (Nila and Mahá-Nila) seem to be spurious (Anárshá). But he has included them in his commentary as Jejjata and Gayadása have read and explained them before him.
2. One more ghee, verse 49. His note to paragraphs 29 to 30: Dallana says that the authorship of this remedy should not be attributed to Sus'ruta, inasmuch as Jejjata does not mention it in his commentary.

Bhishagratna adds a doubt of his own about verses 23 to 24 (his paragraph 17): The whole stanza seems to be of faulty construction. He then gives a different fourth line that Dallana reports, prefers it, and points out that it drops the word kilasa.

Dallana's test is plain in the first two notes: what his predecessors read and explained. If Jejjata and Gayadasa had both commented on a passage, he kept it even when he doubted it. If Jejjata was silent, the passage lost its claim to be Sushruta's. Authority, in other words, came from the chain of earlier readers.

What the metre shows (our observation). We counted the syllables of every verse in the Sanskrit. Verses 12 to 26 and 39 to 53 are in an eleven-syllable metre. Verses 27 to 38 are in the eight-syllable anushtubh, and that short stretch holds the two ghees Dallana doubts. It is tempting to see a later hand. But the stretch begins with two applications he does not doubt (verses 27 to 29), and verse 49, which he also doubts, sits in the eleven-syllable block. Metre alone settles nothing here. It only shows that the chapter is not all of one cloth.

Seventy-Two Verses, Thirty-Eight Paragraphs: How the Chapter Is Built

The Sanskrit chapter has three textures. Verses 1 to 10 are prose: the opening, the causes, the rules, the stages, the first measures. Verse 11 is the hinge in the common eight-syllable metre. From verse 12 to the end the chapter is verse, in long eleven-syllable stretches (12 to 26, 39 to 53) and in eight-syllable stretches (27 to 38, 54 to 72).

Bhishagratna's English turns the whole thing into 38 paragraphs, grouping several verses into one. He marks the turn at verse 11 with a heading of his own, "Metrical Text". His numbers also contain one small slip: after paragraphs 3 and 4, the paragraph on the stages is printed as "3-6", where the run of numbers needs 5 to 6. Anyone matching his English to the Sanskrit should count from the text, not from his numbers.

Two words do a lot of the chapter's work. Kushtha is the condition; kushthi is the person who has it. Verse 7 opens the first measures with the kushthi, verse 42 warns about him, and verse 72, the last, makes him the subject of the final sentence.

Durvanta, Durvirikta: The Warning About Half-Done Cleansing (Verses 41 to 43)

Near the middle of the chapter, after the shvitra verses, comes a warning about the cleansing procedures of the physician.

Chikitsa Sthana 9.42
दुर्वान्तो वा दुर्विरिक्तोऽपि वा स्यात् … निःसन्दिग्धं यात्यसाध्यत्वमाशु
durvanto va durvirikto 'pi va syat … nihsandigdham yaty asadhyatvam ashu

A kushthi who is badly made to vomit (durvanta) or badly purged (durvirikta), his body filled with stirred-up doshas, "without doubt goes quickly to the state that cannot be ended". Bhishagratna: the condition is sure to lapse into one of an incurable type. Hence, the verse ends, his doshas must be removed completely.

The principle is worth knowing even outside medicine: a procedure stopped halfway can leave things worse than no procedure. Verse 43 then sets a calendar for four repeating procedures. Those are a physician's measures in an ancient system, and we give neither the calendar nor the methods.

Kushthi Kushtham Apohati: The Patient in the Last Verses (70 to 72)

The chapter ends by speaking to the patient, and its last three verses are its best.

Verse 70 addresses the patient by his wish: दिदृक्षुरन्तं कुष्ठस्य, didrikshur antam kushthasya, "one who wants to see the end of kushtha". The rest of the verse names one substance to be used in every form; we leave it in the book. Bhishagratna turns the wish into desirous of being perfectly cured, which loses the picture of a person waiting to see an end.

Verse 71 is a mirror. Its first half: यथा हन्ति प्रवृद्धत्वात् कुष्ठमातुरमोजसा, "as kushtha, having grown, strikes down the patient with its force (ojas)". The second half answers with the same word, ojas, for the substance of verse 70. Bhishagratna renders the growth as the disease invading the successive strata of the human organism. The strata are his. The Sanskrit has one word, pravriddhatvat, "from having grown". He had used the same image for the Nidana's tree verse, where a tree's roots go deeper and deeper into the successive strata of the soil, though the Sanskrit there (अन्तर्भूमिं विगाहेत, "would plunge into the earth") has no strata either. The translator carried his own picture from one chapter to the other.

Hair and nails kept short: the first words of the chapter's last verse, which ends with the patient as the subject.

Verse 72 is the last word:

नीचरोमनखः श्रान्तो हिताश्यौषधतत्परः … कुष्ठी कुष्ठमपोहति
nicha-roma-nakhah shranto hitashy aushadha-tatparah … kushthi kushtham apohati

Hair and nails kept short (nicha-roma-nakha). Tired (shranta). Eating what is good for him (hitashi). Devoted to his medicines (aushadha-tatpara). Three things kept away from, which we leave in the book. And then the main clause: kushthi kushtham apohati, "the kushthi pushes the kushtha away".

Look at the grammar. The subject of the chapter's last verb is the patient. Not the physician, not a preparation, not the stars or the gods: the person with the condition, doing something to it. The words even mirror each other, kushthi kushtham, the one who has it and the thing he has. Bhishagratna's English turns the sentence round: With the strict observance of the above rules a Kushtha-patient may be expected to recover. In his version the patient is the object of an expectation. In the Sanskrit, the patient acts.

Two smaller points. Shranta means tired or worn out, and it describes a person who has exerted himself; Bhishagratna's light physical exercise gives the cause and adds "light", which the verse does not say. And the Nidana ends its moral passage with a passive verb: the person who mucyate, "is freed", reaches a good state after death. The Chikitsa ends with an active one, in this life.

Shranta means tired: the person of verse 72 has worn himself out, and Bhishagratna's English adds the word light.

The chapter began with a list in which sin and deeds from a past life stood beside food as causes. It ends with a person cutting his nails, working until he is tired, eating with care and keeping to his course. Our reading: whatever the old texts said about where kushtha came from, the Chikitsa's last line puts the person in charge of what happens next. That is a far better note to end on than the Nidana's talk of rebirth, and it is the chapter's own.

It is still a verse from an ancient medical system, not a promise. Nothing in it is a reason to delay seeing a doctor about any skin change.

Bhishagratna's English Against the Sanskrit: Eight Differences

Bhishagratna's translation is the English most readers meet, and it is a faithful one on the whole. These are the places in today's two chapters where his English and the Sanskrit part ways.

1. Chikitsa 9.3. Two moral causes (a sinful act; deeds done before) become one sentence with "even" and "attributed" added.
2. Chikitsa 9.4. Ikshu-pishta-vikara, things made from sugarcane and from flour, loses the flour.
3. Chikitsa 9.6. The fourth and fifth rungs are counted in the Sanskrit; the English names them, fat in a footnote and bones in a bracket.
4. Chikitsa 9.6. Naiva upakramet, "do not take it up", becomes given up as incurable.
5. Chikitsa 9.6. Two words for the patient, atmavat and samvidhanavat, become twenty-one, ending in diet, conduct and dress.
6. Chikitsa 9.45. Papa-roga, the disease of sin, becomes simply "Kushtha".
7. Chikitsa 9.71. Pravriddhatvat, "from having grown", becomes the disease invading the successive strata of the human organism.
8. Chikitsa 9.72. Kushthi kushtham apohati, the patient as subject, becomes a patient who may be expected to recover; shranta, tired, becomes light physical exercise.

One more, in the Nidana: at 5.30 the Sanskrit we read has sajjana, a good person, where his English has one of his own relations. None of this is a complaint about a translation made more than a century ago. It is a reminder to read the Sanskrit where the Sanskrit is short.

The Chapter, Part by Part

A map of all 72 verses, and what this page does with each part.

What This Page Leaves Out

Every preparation in the chapter: every ghee, oil, paste, wash, powder and drink, every ingredient list and every amount. The plants, the bitter group and the three outside applications of verse 5, one item of the avoid-list in verse 4, and three abstentions in verse 72. The calendar of verse 43 and every procedure the chapter names (cleansing from both ends, purging, the letting of blood, nasal measures), which are a physician's work in an ancient system and nothing to try. The substance of verses 70 and 71. Where the chapter attaches a time to an outcome, we do not repeat it.

What We Could Not Settle

• How to divide the compound chaturtha-karma-guna-praptam in verse 6, and whether karma there means sin, as Bhishagratna's "sin-begotten" assumes.
• Which manuscript reading lies behind Bhishagratna's "one of his own relations" at Nidana 5.30 (our text has sajjana).
• Whether the eight-syllable stretch of verses 27 to 38 is later than the verses around it. Dallana's doubts and the metre overlap only in part.
• Exactly which modern plants the herbs of verse 5 are; we leave them out in any case.
• How much of Bhishagratna's "strict regimen of diet, conduct and dress" comes from the commentaries he used, and how much is his own.

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