Maha-Kushtha Chikitsa in the Sushruta Samhita: Chikitsa Sthana 10, the Chapter That Calls Itself a Seed

इस लेख को हिंदी में पढ़ें: महाकुष्ठ चिकित्सा: सुश्रुत संहिता चिकित्सा स्थान 10, जो ख़ुद को बीज कहता है

📖 27 min read · Sushruta Samhita, Chikitsa Sthana 10, read in Bhishagratna's English (Volume II, printed pages 362–371) and in the Sanskrit

Maha-Kushtha Chikitsa: What Sushruta's Chikitsa Sthana 10 Is, and How We Read It

The Sushruta Samhita gives kushtha two chapters in its book of therapy. Chapter 9, which we read on our page about kushtha chikitsa in Chikitsa Sthana 9, takes kushtha in general: causes, five stages, rules for food and conduct, a long list of preparations, and closing verses addressed to the patient. Chapter 10, the subject of this page, is the maha-kushtha-chikitsitam, the chapter on the great kushthas. Bhishagratna opens it in one line: Now we shall discourse on the medical treatment of major cutaneous affections (Maha-Kushtha). In his Volume II it runs from printed page 362 to printed page 371.

It is the shorter of the two chapters and the more single-minded. The Sanskrit text on Wikisource numbers it in sixteen verses: two of opening formula, one verse naming the recipients (verse 3), twelve verses of method (4 to 15) and one closing verse (16). Bhishagratna numbers nineteen paragraphs, because he splits some of the long prose verses. Where we quote him we give his paragraph as well.

Almost every line of the twelve verses of method is a preparation: what goes in, how much, in which vessel, for how long, at what hour of the day. Several of the conditions named beside them 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 frame: the verse at each end, the refrains that make each method repeatable, the names of the forms, the hundred-year formulas, the footnotes, and the places where the English and the Sanskrit part company. Read that way, the chapter is a lesson in how to multiply one method, and it says so in its last line.

What Maha Means in Maha-Kushtha

Maha means great. Monier-Williams, the standard Sanskrit-English dictionary, glosses the compound maha-kushtha as severe cutaneous eruption and as the name of seven forms of it, citing Sushruta. Bhishagratna's footnote to the chapter's first line gives two readings in two sentences: Kushtha which affects the deeper tissues and fundamental principles of the body is called Mahá-Kushtha. And: Gayi interprets the term "Mahá-Kushtha" as signifying those seven types of Kushtha which cannot be attributed to any detectable cause.

The first sentence defines "great" by depth: the kushtha that has gone below the skin. The second defines it by a count, the seven great kinds that Sushruta's diagnostic chapter lists at Nidana Sthana 5.5: तत्र सप्त महाकुष्ठानि एकादश क्षुद्रकुष्ठानि, "of these, seven are great kushthas and eleven are minor ones". The seven are named and described on our page about kushtha in the Sushruta Samhita's Nidana Sthana, so we do not repeat them here.

One oddity in that verse is worth a sentence. Among the eleven minor kinds it also lists one called maha-kushtha: स्थूलारुषकं महाकुष्ठमेककुष्ठं, "sthularushaka, maha-kushtha, eka-kushtha". So the same word names a group of seven and a single member of the other group. The title of chapter 10 means the group: Bhishagratna's "major cutaneous affections" says so, and so do both readings in his note.

Chapter 9 had already pointed here. At the fourth of its five stages (Chikitsa Sthana 9.6), after cleansing and other measures, it tells the physician to take up a row of methods, and the row ends with the words खदिरासनायस्कृतिविधानमासेवेत, "let him take up the methods (vidhana) of khadira, of asana and of ayaskriti". A footnote on Bhishagratna's printed page 348 sends the reader forward: those khadira and ayaskriti methods are in the chapter on maha-kushtha. Chapter 10's thirteenth verse then opens with the promised word, अतः खदिरविधानमुपदेक्ष्यामः, "now we shall teach the khadira-vidhana". One rung earlier, the same stage paragraph of chapter 9 had named रिष्टमन्थप्राशाः, arishtas, manthas and things to be swallowed; chapter 10 is where the arishta and the mantha are set out. Our reading: chapter 10 works as the back of the book for chapter 9's deeper stages.

Agrya-Mati and Buddhiman: Prose Between Two Verses

Most of chapter 10 is prose. Only two passages are verse, one at each end, and Bhishagratna marks both: the first as Metrical Text, the last as Memorable Verse. They are in different metres. Verse 3 runs in long lines of eleven syllables a quarter; verse 16 is a plain shloka of eight syllables a quarter.

Both verses are about the physician's mind. The first calls him agrya-mati. Monier-Williams gives agrya as foremost, topmost, principal, best, and also as intent, closely attentive. The last calls him buddhiman, the one with understanding. Bhishagratna renders both with the same three words, An intelligent physician.

Our reading: the twelve verses of method sit inside a frame that hands them to a trained mind, and neither framing verse speaks to the person who would receive anything. That is the opposite of chapter 9, whose last verb has the patient as its subject. Chapter 9 ends with the person; chapter 10 begins and ends with the physician.

Verse 3: Five Recipients, One of Them Defined by a Wish

Verse 3 names those for whom the chapter's methods are meant in five locative plurals, each ending in -eshu or -su, "in" or "for":

• kushtheshu, for the kushthas, the chapter's own subject;
• meheshu, for the mehas, the group that Sushruta's next three chapters (Chikitsa 11 to 13) take up under the name prameha;
• kaphamayeshu, for illnesses of kapha;
• sarvanga-shopheshu, for swellings of the whole body, with the adjective darunesu, "severe", beside them;
• krishatvam icchatsu medureshu, for the fat who wish for thinness.

The last is the odd one out. Four recipients are named by what they have. The fifth is named by what they want: icchatsu is the present participle of the verb "to wish", in the locative plural, so the phrase means "among the fat, those wishing for leanness". Medura is simply fat in Monier-Williams, who cites Sushruta for it. Bhishagratna keeps the wish in his English: inordinately corpulent persons, he writes, wishing to reduce. In a verse otherwise made of conditions, it is the one recipient defined by a want.

Look also at where the adjective sits. Darunesu, "severe", stands in the first line next to the swellings. Bhishagratna moves it to the head of the list and attaches it to kushtha: virulent types of Kushtha. In a list of locative plurals the adjective can go with the swellings alone or with all five, and the Sanskrit does not decide. The English does, and it chooses the kushthas, which suits the chapter's title.

Santarpana: The Same Family in Charaka Sutrasthana 23

Why these five together? Sushruta does not say. Charaka has a chapter that comes close to an answer. His Sutrasthana 23, the Santarpaniya, is about the disorders that follow over-nourishment (santarpana), which it traces to rich, sweet, heavy food, new grain, a dislike of exercise, day sleep, and too much time in beds and on seats. Its pivot line is Sutrasthana 23.5: रोगास्तस्योपजायन्ते सन्तर्पणनिमित्तजाः, "in him arise illnesses born of over-nourishment".

The list that follows, in verses 23.5 to 23.7, names a long row of conditions. Four of the five recipients of Sushruta's verse 3 have a counterpart in it: prameha for meha, the kushthas, atisthaulya (excessive bulk) for the fat, and shopha for the swellings. The fifth, illnesses of kapha, is a category rather than an item. Pandu, which turns up in two of chapter 10's outcome lines, is in Charaka's list too, as pandvamaya. Charaka's chapter even uses two of Sushruta's forms by name, arishta (23.17) and mantha (23.18), among its own measures.

Our reading, flagged as ours: chapter 10 is a chapter about excess. Its recipients are the people the classical texts thought of as carrying too much, and the plant groups it draws on, as the next section shows, are described in Sushruta's own catalogue with words for drying and reducing. Charaka's word for the answer to over-nourishment is apatarpana, and Sushruta's next chapter uses the same word. We are not saying the two authors read each other; the texts simply share a way of grouping these conditions.

Shala-Saradi, Aragvadhadi, Nyagrodhadi: Three Gana from Sutrasthana 38

Chapter 10 rarely names a single plant without at once naming a group (gana). Its groups come from Sushruta's own Sutrasthana 38, the Dravya-sangrahaniya, which opens by counting them: समासेन सप्तत्रिंशद्द्रव्यगणा भवन्ति, "in brief there are thirty-seven groups of substances" (Sutrasthana 38.3). Each group is named after its first member plus -adi, "and the rest": Shala-saradi is "shala-sara and the rest". Chapter 10 uses three of them again and again, Shala-saradi, Aragvadhadi and Nyagrodhadi, and a fourth, Pippalyadi, in one verse.

In Sutrasthana 38 each group ends with a line that says what the group is for. Set beside chapter 10's opening verse, the three lines explain the choice of groups:

The Shala-saradi line ends with the words kapha-medo-vishoshana, "drying up kapha and fat", which is the reducing idea of the last section in Sushruta's own vocabulary. The Nyagrodhadi group is the surprise: only one of its words, medas, meets verse 3, yet chapter 10 names it beside the other two in six verses.

Two smaller notes. Verse 12 calls the Aragvadhadi group by another name, Arevatadi, and Bhishagratna's English prints both: Nyagrodhádi or Árevatádi (Áragvadhádi) group. And the chapter spells its first group two ways, salasara with an s in verse 4 and shalasara with sh everywhere else; Monier-Williams notes that the tree's name is also written sāla. We give the members of no group: they are the ingredients the chapter is built from.

Evam: Ten Verses That Widen Themselves

Here is the chapter's real design. Of the twelve verses of method (4 to 15), ten carry a line that turns the one method just given into a rule for many. The lines come in three shapes.

• Seven say evam, "in the same way", and name other groups. Verse 9 ends: एवं शालसारादौ न्यग्रोधादावारग्वधादौ च लेहान् कारयेत्, "in the same way, in the Shala-saradi, the Nyagrodhadi and the Aragvadhadi, let him make lehas". Verses 6, 7, 8 and 9 repeat all three group names in the same words; verse 10 swaps the part of the plant (the fruits of one group, the flowers of another); verse 12 uses the name Arevatadi; and verse 4's evam eva, "in just the same way", repeats its drink with other groups.
• Three state a rule for a whole class with sarva, "all". एष सर्वमन्थकल्पः, "this is the method for every mantha" (verse 4); एतेन सर्वलौहेष्वयस्कृतयो व्याख्याताः, "by this the ayaskritis in all metals are explained" (verse 11); एष एव सर्ववृक्षसारेषु कल्पः, "this same method holds for the heartwood of every tree" (verse 13).
• One borrows a method for other grains. Wheat and venu-yava are to be used yava-vidhanena, "by the barley method" (verse 5).

That makes eleven widening lines in ten verses, since verse 4 has two. Only verses 14 and 15 have no such line. Bhishagratna's English keeps the shape: This is the method of preparing all kinds of Manthas.

Our reading: the chapter is written the way a modern reader would write a template, one worked example and then the slots that can be filled differently. Sanskrit has a word for thinking of that kind, and it is the word the last verse uses. Bija is "seed", and Monier-Williams also gives bija-ganita, the old Indian name of algebra, as calculation of primary causes, analysis, algebra. We do not suggest that the chapter's author was thinking of algebra. The point is only that the same word could stand for a starting point from which many answers grow.

One carved block, one motif, many prints: the shape of the chapter's evam lines, which turn one method into a rule for many.

The Chapter, Verse by Verse

The whole chapter in sixteen rows, with Bhishagratna's paragraph numbers in brackets. No row says what goes into anything.

The colophon follows: इति सुश्रुतसंहितायां चिकित्सास्थाने महाकुष्ठचिकित्सितं नाम दशमोऽध्यायः, "thus, in the Sushruta Samhita, in the Chikitsa Sthana, the tenth chapter, called maha-kushtha-chikitsitam".

Mantha, Arishta, Asava, Avaleha, Churna: What the Names Say

The forms have names that still sound familiar in India, and each name is a small description.

Mantha. From the verb manth, to stir or churn, the root of the churning stick. Monier-Williams: a drink in which other ingredients are mixed by stirring, most often made with parched barley-meal. Chapter 10's mantha starts from saktu, the roasted barley flour still sold as sattu.

Arishta. The word is a-rishta, and the dictionary's first sense is unhurt. In Sushruta it is also a fermented preparation. The same word has a darker sense: the neuter arishta is a natural phenomenon boding approaching death, and Sushruta uses it that way himself at Sutrasthana 32.7, where the physician who understands एतान्यरिष्टरूपाणि, "these forms of arishta", is the one a king esteems. One word for a preparation and for an omen.

Asava. Monier-Williams lists decoction and juice among its senses. In chapter 10 an asava is made arishta-kalpena, by the arishta method, so the second form is defined by the first.

Avaleha, or leha. From ava-lih, to lick: licking, lapping. Bhishagratna's English word is an old one, lambatives.

Churna. Powder or flour. Monier-Williams also gives churna as a kind of easy prose, a term of poetics; the chapter itself, as it happens, is mostly prose.

Kalpa and vidhana. The two words the chapter uses for its methods, four times each. Kalpa is a sacred precept, law, rule, ordinance, the same word that names the Kalpa Sthana. Vidhana is order, measure, disposition, arrangement, regulation, rule, precept, method, manner, and in Sushruta also medical prescription or regulation, diet.

Sushruta had promised these chapters long before. His Sutrasthana 45, the chapter on liquids, says चिकित्सितेषु वक्ष्यन्तेऽरिष्टा, "the arishtas will be described in the chapters of therapy", and then hands the judging of them to the physician: बुद्ध्या यथास्वं संस्कारमवेक्ष्य कुशलो भिषक्, "the skilled physician, by his understanding, looking at how each is prepared" (Sutrasthana 45.197 to 45.198). Buddhya, by understanding, is the same idea as the buddhiman of chapter 10's last verse.

Yavaka: Barley in Eight Shapes

Verse 5 is the one verse of the twelve that is plain food. It names yavaka, barley foods, in eight shapes and an "and so on": धानोलुम्बककुल्माषापूपपूर्णकोशोत्कारिकाशष्कुलिका and kunavi.

• Dhana. Monier-Williams: fried barley or rice or any grain fried and reduced to powder.
• Ulumbaka. Not in the dictionary under this form. Bhishagratna prints a different word, Lunchaka.
• Kulmasha. half-ripe barley, and also sour gruel.
• Apupa. cake of flour, meal, a word the dictionary traces back to the Rigveda.
• Purnakosha. "Full-sheathed". The dictionary knows the word only as the name of a plant. We can only guess from the name that it was a filled pastry.
• Utkarika. Monier-Williams knows it only as a poultice, citing Sushruta. Here it is a food; our guess is a thick cooked mass of flour, which is what a poultice also is.
• Shashkulika. a large round cake cooked in oil, and, in the same entry, the orifice of the ear, auditory passage, presumably for the round shape.
• Kunavi. The dictionary has N. of a plant (?), question mark included.

Bhishagratna's list has nine names for the Sanskrit's eight: Dhána, Lunchaka, Kulmásha, Apupa, Purnakosa, Utkáriká, Sashkuliká, Kunári and Konáli. His footnotes show where the extra name came from. One reports another reading: Gayadása reads Chitrá (a kind of soup) before "Utkáriká." The other explains the ninth: Dallana does not read "Konáli" but says that some read "Konáliká" in place of "Kunári" both of which are synonyms. We have, however, both the terms in our text. His printed text kept a reading and its synonym side by side.

Then comes the substitution rule, which turns even the food paragraph into a template: यवविधानेन गोधूमवेणुयवानुपयुञ्जीत, "by the barley method let him use wheat (godhuma) and venu-yava". We give these as words and food history. The chapter offers them to its recipients as part of a regimen; we offer them to no one.

Barley as food, in four of its shapes: grain, flour, flatbread and a round cake fried in oil. Verse 5 names eight.

Ayas and Loha: Iron, Red Metal and a Bracket

Two of the twelve verses (11 and 12) concern ayaskriti, which Monier-Williams defines as a medical preparation of iron, citing Sushruta. The word is ayas plus kriti, "iron-work". Ayas is one of the oldest metal words in the language: the dictionary gives iron, metal from the Rigveda and sets beside it Latin aes and German Eisen.

The chapter's other metal word is loha, and its dictionary entry is a small history. It probably comes from a root meaning to be red, so its first sense is red metal, copper; only later does it mean iron (either crude or wrought) or steel or gold or any metal. Verse 11's method opens with tikshna-loha, "sharp metal", which Bhishagratna translates as steel, and ends with a rule for all metals: एतेन सर्वलौहेष्वयस्कृतयो व्याख्याताः. His English adds a bracket that the Sanskrit does not have: all kinds of Loha (zinc, copper, lead and gold). The four metals are his.

The three iron preparations rise by name: ayaskriti in verse 11, then aushadha-ayaskriti and mahaushadha-ayaskriti in verse 12, "iron-work", "medicine iron-work" and "great-medicine iron-work". The word maha, which opened the chapter's title, returns at the top of its strongest preparation. We give none of the steps, and a later section says why, beyond the law.

Ayas and loha: a rusted iron bar and a lump of copper. Loha first meant the red metal and only later any metal at all.

Khadira and Sara: The Tree and the Heartwood

One tree runs through the chapter. Khadira is named thirteen times in seven of the sixteen verses, and verse 13 belongs to it. Monier-Williams identifies it as Acacia Catechu, a tree having very hard wood, known by the name Khayar (the khair of Hindi), and finds its name as far back as the Rigveda.

Its partner word is sara. The dictionary: the core or pith or solid interior of anything, and also firmness, strength. In a tree the sara is the heartwood, the dark, dense core inside the paler sapwood. Chapter 10 is a heartwood chapter. Its first group carries the word in its own name (shala-sara); verse 9 works from heartwoods; and verse 13 widens the khadira method to every tree, which Bhishagratna renders as the essential parts (Sára) of all other medicinal trees.

Verse 13 opens by keeping chapter 9's promise: अतः खदिरविधानमुपदेक्ष्यामः, "now we shall teach the khadira method". What follows is a way of drawing the tree's own juice down into a vessel set at its root, with the help of fire. We leave every step of it in the book. For the diet and conduct that go with it, the verse points to a method set out in another chapter, and that chapter's method ends with a near twin of this chapter's formula: शतायुर्भवति, "he becomes one with a life of a hundred years" (Chikitsa Sthana 6.17).

Sara is the heartwood, the dense dark core inside the pale outer wood, and the chapter keeps returning to it.

Varsha-Shatam: A Hundred Rains, Autumns or Summers

Four of the twelve verses of method contain a hundred-year phrase. In the Sanskrit:

• verse 11: वर्षशतं जीवति, "he lives a hundred years", and then तुलायां तुलायां वर्षशतमुत्कर्षः, "measure by measure, a hundred years more";
• verse 12: वर्षशतायुश्चानया पुरुषो भवति, "by this a man becomes one with a hundred-year life";
• verse 13: शतं वर्षाणामायुषोऽभिवृद्धिर्भवति, "there is an increase of life of a hundred years";
• verse 15: वर्षशतायुररोगो भवति, "he becomes one with a hundred-year life, without illness".

That is five hundred-year phrases in four verses. The word for year here is varsha, and Monier-Williams gives its history in a single entry: first rain, raining, in the plural the rains, then a year (commonly applied to age). A life was counted in rainy seasons.

The hymns of the Rigveda counted it in autumns. Sharad is autumn and, used poetically, a year, and the dictionary's word for a person granted a hundred years, shatayus, "attaining the age of a hundred years", is found as early as the Atharvaveda. Bhishagratna, writing in English, counts in a third season: enables him to live a hundred summers in verse 13 (his paragraph 15), and witness a hundred summers (on earth) in verse 15 (his paragraph 18). Rains in the Sanskrit, autumns in the hymns, summers in the translation: three seasons for one year.

Read as arithmetic, verse 11 promises centuries, one more for every further measure. Read as a sentence, the hundred-year life is the old way of saying a full life, and it closes these methods the way a stated fruit closes a ritual text. Our reading: these lines belong to the genre of the promise (phalashruti), not to observation. They are not claims anyone should rely on, and under the 1954 Act nobody may advertise them as one.

Varsha, the word for year in the chapter's hundred-year lines, first meant rain: a life counted in rainy seasons.

Asadhyam Sadhayati: A Pun the English Lost

Verse 12 says of the middle iron preparation: एषौषधायस्कृतिरसाध्यं कुष्ठं प्रमेहं वा साधयति. Word for word: "this aushadha-ayaskriti makes the not-to-be-accomplished kushtha or prameha accomplished". Asadhya and sadhayati come from the same root, sadh, to accomplish, once with a negative prefix and once as a causative verb. Monier-Williams gives asadhya first as not to be effected or completed.

Bhishagratna's English: it cures even the incurable types of Kushtha. The pun is gone, and the word "even" has no word under it in our Sanskrit; there is no api.

The sentence also sits awkwardly beside chapter 9. There, at the fifth stage, the instruction to the physician was पञ्चमं नैवोपक्रमेत्, "he should not take up the fifth at all" (Chikitsa Sthana 9.6). Two chapters apart, the same book declines one case and promises to accomplish the unaccomplishable. Our reading: the refusal is an instruction and the promise is a formula, and the two are different kinds of sentence. Neither is a statement anyone should act on today.

Bhishagratna's English Against the Sanskrit

Kaviraj Kunja Lal Bhishagratna's translation is still the English most readers meet. In this chapter it differs from the Wikisource Sanskrit in nine places worth knowing:

• The numbering. Nineteen paragraphs for sixteen verses. He prints verse 5 as paragraph "4 5." and verse 11 as "11-12.", splits verse 12 across two paragraphs and verse 13 across three.
• Verse 3. Darunesu moves from the swellings to the kushthas.
• Verse 11. A bracket names four metals that the Sanskrit's "all metals" does not list.
• Verse 12. The pun asadhyam sadhayati becomes cures even the incurable.
• Verse 13. A hundred varsha, a hundred rains, becomes "a hundred summers".
• Verse 14. सर्वकुष्ठैर्विमुच्यत इति, "he is released from all kushthas", becomes a radical cure of any type of Kushtha.
• Verse 15. सर्वकुष्ठैर्विमुक्तः शुद्धतनुः स्मृतिमान् वर्षशतायुररोगो भवति, "released from all kushthas, pure of body, with full memory, of a hundred-year life, without illness", becomes a speedy recovery from all types of Kushtha and enable the patient to witness a hundred summers (on earth) in the full enjoyment of sound health and intellect. "Speedy", "witness", "on earth" and "full enjoyment" are his. Monier-Williams gives smritimat as having recollection or full consciousness.
• Verse 16. Bijena anena, "with this seed", becomes with the aforesaid drugs and in the manner described above.
• Verse 16 again. The Sanskrit names seven forms; his list has six: Surás, Asavas, Arishtas, Lehas (lambatives), powders and Ayaskritis. The mantha has dropped out.

The pattern is worth stating plainly. Where the English differs, it is usually more of a promise than the Sanskrit (verses 12 to 15) and less of a method (verse 16). Bhishagratna was writing for physicians, not for an advertising code. The point is only that the English should not be read as the text.

Jejjata, Gayadasa and Dallana: Twelve Footnotes

Bhishagratna's ten pages for this chapter carry twelve footnotes, on six of them (printed pages 362, 363, 364, 365, 367 and 370). They are the trace of a much older argument. Three commentators are named: Jejjata, Gayadasa and Dallana. Dallana, the latest of the three, is named in five notes; Gayadasa in four, and the "Gayi" of the note on the title is most likely the same man; Jejjata once. Two further voices are an unnamed group and the editor, who signs "Ed." twice. The unnamed group gets one sentence: Old and experienced physicians explain "Svarasam" to be the decoction as well.

What they argue about falls into four kinds:

• Which words belong in the text. Gayadasa's extra soup before utkarika; the reading Konalika for Kunari; and whether one tree belongs in one list, which Gayadasa leaves out.
• What a word means. Maha, in the note on the title; svarasa, the fresh juice, which one note widens; and pani-tala, word for word "the palm of the hand", which Dallana weighs as either a fixed weight or a palmful.
• How much. Several notes are about quantities, among them one that sets a figure of Jejjata's against Gayadasa's refusal to support it. We give none of them.
• What else goes in, and how. Others add an item or explain a step. We give none of them either.

Monier-Williams records both sides of two of these arguments. Svarasa is own (unadulterated) juice or essence and also a partic. astringent juice or decoction; pani-tala is both the palm of the hand and a fixed weight. A dictionary finished in the nineteenth century still carries the commentators' quarrel.

The best line in the notes is the editor's, after Dallana's weighing of pani-tala: It should be observed, however, that the difference in the two interpretations is ultimately immaterial. An editor stepping in to close an argument many centuries old in one sentence. Whether he was right we cannot say here, because the quantity in question is one we do not print.

Bijena Anena: The Last Verse Calls the Chapter a Seed

The last line of the chapter is सहस्रशोऽपि कुर्वीत बीजेनानेन बुद्धिमान्: the intelligent one may make them even by the thousand, with this seed. Sahasrashas is by thousands. Bija is seed (of plants), and in the same entry the germ or origin of any composition, as of a poem or the plot of a play.

The chapter calls itself a seed, and its form bears the word out: one worked example per form, then the line that widens it, in ten verses of twelve. Bhishagratna's closing line keeps the occasion but not the image: Thus ends the tenth Chapter of Chikitsita Sthánam in the Sus'ruta Samhitá which deals with the medical treatment of Mahá-Kushtha.

A seed also needs soil, and the chapter leans on the rest of the book for everything it does not say: four groups from Sutrasthana 38; one base that Bhishagratna traces to the chapter on stone (our page on Ashmari Chikitsa, Chikitsa Sthana 7 reads that chapter); a regimen from Chikitsa 6; the standard way of cooking fats (sneha-paka-vidhana); a vessel "already prepared" (prak-krita-samskara); and a step "as stated" (yathoktam) elsewhere. Even the order of the book's therapy chapters, which follows a list of the hardest conditions in Sutrasthana 33, is part of that soil; our page on Bhagandara Chikitsa, Chikitsa Sthana 8 shows how it works.

Our reading: the seed verse explains why no recipe from this chapter belongs in a kitchen. It was written for an agrya-mati, a mind trained in the whole book, who could see which slot to fill and why. Lifted out alone, a single preparation is not what the chapter teaches. What it teaches is a way of thinking: one method, many forms, and a physician's judgement at both ends.

Why the Metal Methods Stay in the Book

The law is one reason. The other is safety. Metal preparations are the part of the tradition where the modern record is most worrying. In 2008 the Journal of the American Medical Association published a study by Robert Saper and colleagues of 193 Ayurvedic medicines bought online. Its conclusion: One-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic. Medicines of the metal-and-mineral tradition (rasa shastra) did worse, 40.6 per cent against 17.1 per cent, and the study found that every product with metals in it exceeded at least one standard for acceptable daily intake.

Chapter 10's iron-work is not the lead and mercury of later rasa shastra. The lesson carries all the same: a metal preparation made at home from an old text, untested, is a risk with nothing to set against it. Metals in medicine belong to licensed manufacture and to a physician who can test and watch, and that is where this chapter's three ayaskritis stay.

What This Page Leaves Out

Every preparation in the chapter: every ingredient, amount, vessel, fire, timing and step for all of the forms in verses 4 to 15, including the three iron preparations and the khadira methods. The members of every plant group. The diet and conduct the chapter attaches to its methods. The outcome lines in full: where we quote the hundred-year formulas and the asadhya sentence, it is to show how they are built, not what they claim. The commentators' notes on quantities and on what goes into a method.

And one category, named here once so that it is clear why the rest stays in the book. The chapter's outcome lines name conditions that correspond to seven entries on the Act's schedule of fifty-four: leprosy, diabetes, obesity, dropsy, insanity, epilepsy and tuberculosis. No medicine may be advertised for any of them, and this page advertises nothing for any of them.

What We Could Not Settle

• What the note means by Gayi's seven kinds that cannot be attributed to any detectable cause; Sushruta's own verse on the seven gives them no such clause.
• Whether darunesu in verse 3 goes with the swellings alone, as its place suggests, or with the whole list, as Bhishagratna's "virulent types of Kushtha" assumes.
• Which readings lie behind Bhishagratna's "Lunchaka" (our text: ulumbaka) and his "Kunári and Konáli" (our text: kunavi).
• What utkarika and purnakosha were as foods, when the dictionary knows one as a poultice and the other as a plant.
• Whether the two spellings of the first group (salasara in verse 4, shalasara elsewhere) mean more than the accepted variant the dictionary records.
• Whether the "Gayi" of the note on the title is Gayadasa, as the other notes suggest.

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