Prameha Chikitsa in the Sushruta Samhita: Chikitsa Sthana 11, the Lean, the Stout and a Hundred Yojanas

इस लेख को हिंदी में पढ़ें: सुश्रुत संहिता में प्रमेह चिकित्सा: दुबला, स्थूल और सौ योजन की यात्रा

📖 27 min read · Sushruta Samhita, Chikitsa Sthana 11, read in Bhishagratna's translation (Volume II, printed pages 372 to 378) and in the Sanskrit

Prameha Chikitsa: What Sushruta's Chapter 11 Is About

Prameha chikitsa is the subject of the eleventh chapter of the Chikitsa Sthana of the Sushruta Samhita, the Prameha-chikitsitam. Prameha is the old name for a group of urinary disorders; Monier-Williams gives it simply as urinary disease. Chikitsa is the physician's work of care. Sushruta describes prameha in Nidana Sthana 6, and here, in the Chikitsa, he turns to what is done about it.

It is a short chapter: thirteen numbered lines in the Sanskrit, seven printed pages in Kunja Lal Bhishagratna's English. It counts two pramehas, draws the two kinds of person who have them, gives the physician's part, then speaks to people one by one. That last stretch is the most unusual in the chapter, and most of this page is about it.

We read the Sanskrit (the Wikisource text) beside Bhishagratna's translation and footnotes, the Monier-Williams dictionary, Charaka, Vagbhata and the Manusmriti. Where the chapter gives preparations, foods, procedures or promises, we stop and say so.

Thirteen Lines, Two Numberings: How the Chapter Runs

The Sanskrit text numbers its lines 1 to 13. Line 1 is the title, athatah prameha-chikitsitam vyakhyasyamah, "now we shall explain the care of prameha", and line 2 is the frame every chapter of the Samhita carries, yathovacha bhagavan dhanvantarih, "as the lord Dhanvantari said". Bhishagratna also numbers 1 to 13, but he counts the title as 1 and cuts the rest differently.

So both versions reach thirteen, but they count differently. Lines 1, 12 and 13 carry the same number and the same content in both. In between, Bhishagratna leaves out the Dhanvantari line, joins Sanskrit lines 3 and 4, and 7 and 8, runs line 10 into the start of 11, and splits line 9 in two and line 11 in three. The shape is clear either way: people, then the physician, then people again. The chapter before it is read on our page on Sushruta Chikitsa Sthana 10; the two after it return to prameha.

Dvau Pramehau: Two Pramehas, Not Two Causes

Chikitsa Sthana 11.3
द्वौ प्रमेहौ भवतः सहजोऽपथ्यनिमित्तश्च । तत्र सहजो मातृपितृबीजदोषकृतः अहिताहारजोऽपथ्यनिमित्तः
dvau pramehau bhavatah sahajo 'pathya-nimittash cha; tatra sahajo matri-pitri-bija-dosha-kritah, ahitahara-jo 'pathya-nimittah "There are two pramehas, the sahaja and the apathya-nimitta. Of these, the sahaja is made by a fault in the seed of mother and father; the one born of unsuitable food is the apathya-nimitta."

Bhishagratna's English begins: This disease may be ascribed to two causes, such as the congenital (Sahaja) and that attributable to the use of injudicious diet. The Sanskrit counts something else. It does not say two causes; it says dvau pramehau bhavatah, "there are two pramehas", each named by where it comes from. Our reading, flagged: the difference is small in sense, but Sushruta counts kinds of prameha, and the rest of the chapter keeps them apart as two different people.

Apathya, Monier-Williams says, is unwholesome as food or drink in particular complaints; nimitta is cause, motive, ground, reason. The verse then restates the name with a plainer word, ahitahara-ja, "born of ahita food", and ahita is unfit, improper: the second kind is named twice in one line.

Charaka's diagnosis chapter on the subject is read on our Charaka Samhita Part 34 page (Nidana Sthana 4).

Sahaja: Matri-Pitri-Bija-Dosha, a Fault in the Parents' Seed

The first kind is sahaja. Monier-Williams gives its plain sense first, born or produced together or at the same time as, and then the sense it has here: congenital, innate, hereditary, original, natural. Sushruta defines it in one compound, matri-pitri-bija-dosha-krita, "made by a fault (dosha) in the seed (bija) of mother and father". Bhishagratna: the first type is due to a defect in the seeds of one's parents.

Charaka says something close, near the end of his prameha chapter:

Charaka Samhita, Chikitsa Sthana 6.57
जातः प्रमेही मधुमेहिनो वा न साध्य उक्तः स हि बीजदोषात्
jatah pramehi madhumehino va na sadhya uktah sa hi bija-doshat "One born with prameha, or born of a madhumehi, is said not to be sadhya, for it comes from a fault of the seed."

The same two words, bija and dosha, stand at the root in both texts. The CSRTSDC English of Charaka's verse adds a modern word in brackets: because of the morbidity in their bija (genes). That bracket is the editors' gloss; the Sanskrit says seed, and we keep the old word.

One difference: Charaka adds a judgement about the outcome, na sadhya, "not to be accomplished". Sushruta's line names the kind and moves on to the body. Anyone who knows such trouble runs in their family has something useful to tell a doctor, who can test for it. An old verse cannot.

Apathya-Nimittaja: The Man of the Nidana Twin

Many of Sushruta's Chikitsa chapters have a twin in the Nidana Sthana. For prameha the twin is Nidana Sthana 6, and it opens with a portrait:

Nidana Sthana 6.3
दिवास्वप्नाव्यायामालस्यप्रसक्तं शीतस्निग्धमधुरमेद्यद्रवान्नपानसेविनं पुरुषं जानीयात् प्रमेही भविष्यतीति
diva-svapna-avyayama-alasya-prasaktam shita-snigdha-madhura-medya-drava-anna-pana-sevinam purusham janiyat pramehi bhavishyatiti "A man given to day-sleep, to no exercise and to idleness, who takes cold, unctuous, sweet, fattening and liquid food and drink: know that he will become a pramehi."

That is the man of the second prameha. Diff the two chapters and one thing stands out: the Nidana knows only this man. It says nothing of a prameha born with a person. The sahaja appears first in the Chikitsa, in its very first sentence about the disease. Day-sleep (diva-svapna) heads the list of habits; Charaka's view of when day-sleep suits is read on our page on nidra in Charaka Sutrasthana 21.

A verse near the Nidana's end follows a man with the gravest kind, madhumeha, as rest takes him over:

Nidana Sthana 6.25
स चापि गमनात् स्थानं स्थानादासनमिच्छति । आसनाद्वृणुते शय्यां शयनात् स्वप्नमिच्छति
sa chapi gamanat sthanam sthanad asanam ichchhati; asanad vrinute shayyam shayanat svapnam ichchhati "And from walking he wants to stand, from standing to sit; from the seat he chooses the bed, and from lying down he wants sleep."

A ladder, rung by rung, down from walking to sleep. Hold it in mind: the Chikitsa's last prose line sends people the other way, back onto the road.

Krisha and Sthula: Two Bodies, Two Habits (Shila)

Chikitsa Sthana 11.3, continued
तयोः पूर्वेणोपद्रुतः कृशो रूक्षोऽल्पाशी पिपासुर्भृशं परिसरणशीलश्च भवति उत्तरेण स्थूलो बह्वाशी स्निग्धः शय्यासनस्वप्नशीलः प्रायेणेति
tayoh purvenopadrutah krisho ruksho 'lpashi pipasur bhrisham parisarana-shilash cha bhavati; uttarena sthulo bahvashi snigdhah shayya-asana-svapna-shilah prayeneti "Struck by the first, a man is lean, dry, eats little, is very thirsty and given to moving about; by the second, he is stout, eats much, is sleek, and given to bed, seat and sleep, as a rule."

The two portraits are built as a set of pairs, and laid side by side they show their shape:

Three pairs line up exactly; thirst has no partner. Both lists end on the same word, shila, which Monier-Williams gives as habit, custom, usage, natural or acquired way of living or acting. The lean one is parisarana-shila, and parisarana is running or moving about. The stout one is shayya-asana-svapna-shila: shayya is a bed, couch, sofa, asana is sitting, sitting down, and svapna is sleep, sleeping, with a second sense the dictionary also records, sleeping too much, sloth, indolence. So the first kind is drawn with a habit of motion, the second with a habit of rest.

Bhishagratna's English keeps the pictures: emaciation and a dryness (of the body), diminished capacity of eating, too much thirst and restlessness for the first, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushions for the second. "Restlessness" for parisarana turns a habit of going about into a state of mind; the Sanskrit is about the feet.

A rope cot, a bolster and a cushioned stool. Sushruta draws the stout kind of person by three habits of rest: the bed, the seat and sleep.

Bed, seat and sleep are also the last three rungs of the Nidana's ladder in 6.25. Beds and seats in the daily routine are read on our page on sleeping on the floor.

Prayena: Sushruta's Own "As a Rule"

The last word of the sentence is easy to miss: prayena, which Monier-Williams gives as mostly, generally, as a rule. It stands after the stout man's habits, at the very end, and the grammar allows it to cover both portraits. Bhishagratna attaches it to the second kind only (which usually attend the latter type).

Either way, the word does honest work. Sushruta does not offer these pictures as a test: not every lean person with prameha was born with it. Our reading, flagged: prayena marks the portraits as typical, not defining, which is the right way to read any old description of a body: as a rule of thumb, never as a way to sort oneself or anyone else.

Anna-Pana and Apatarpana: Opposite Care for Opposite Bodies

Chikitsa Sthana 11.4
तत्र कृशमन्नपानप्रतिसंस्कृताभिः क्रियाभिश्चिकित्सेत स्थूलमपतर्पणयुक्ताभिः
tatra krisham anna-pana-pratisamskritabhih kriyabhish chikitset, sthulam apatarpana-yuktabhih "There, let him care for the lean one with measures made up of food and drink, the stout one with measures joined to apatarpana."

One line each, and they point in opposite directions. The verb is chikitset, from the same root as the chapter's name. Apatarpana, says Monier-Williams, is fasting (in sickness), the opposite of nourishing. Bhishagratna widens it in a bracket of his own: (fasting, physical exercise, depletory measures etc.). The brackets are his; the Sanskrit has the one word.

Charaka puts the same split at the head of his prameha care:

Charaka Samhita, Chikitsa Sthana 6.15
स्थूलः प्रमेही बलवानिहैकः कृशस्तथैकः परिदुर्बलश्च
sthulah pramehi balavan ihaikah, krishas tathaikah paridurbalash cha "Here one pramehi is stout and strong, and one is lean and very weak."

The CSRTSDC English calls the second group those who are emaciated and weak, and the verse gives them nourishment. Two verses later Charaka warns that depleting a pramehi too far brings troubles of its own, and his closing summary lists mehi dvividhah, "the pramehi of two kinds", and atikshapana-dosha, "the fault of depleting too much". Vagbhata repeats the warning in both his books.

The wider rule, that one body is lightened and another built up, has a whole chapter in Vagbhata, read on our page on Ashtanga Hridaya Sutrasthana 14. The chapter on prameha begins by refusing one rule for everybody. Nobody should fast or change their food because a verse says so; with any medical condition, or with regular medicine, that is a decision for a doctor.

Verses 5 to 10: The Physician's Part, Read for Its Shape

The middle of the chapter is the physician's, and we do not reproduce its contents. Its shape, though, says something. It runs from the general to the particular:

• verse 5: what all of them should avoid. It opens sarva eva cha parihareyuh, "and all of them should avoid", the one line in the chapter addressed to everybody at once;
• verse 6: what may be eaten;
• verse 7: cleansing first, tatradita eva, "there, at the very start";
• verse 8: five preparations said to serve all the mehas;
• verse 9: a preparation for each of the twenty kinds, and then measures for the four the Nidana ranks gravest;
• verse 10: further preparations and gruels.

The sequence runs all, all, first, all, each. Only then does the chapter return to persons. Bhishagratna's footnotes to these verses are a story of their own, told below.

Udaka-Mehin to Hasti-Mehin: Twenty Kinds, Named by the Person

Verse 9 walks through the twenty kinds of prameha in the Nidana's order: ten of kapha, six of pitta, four of vata. What is worth noticing is the grammar. The Chikitsa names the person, not the disease: udaka-mehinam, ikshu-mehinam and so on, forms of mehin, the one who has that meha. Monier-Williams gives mehin as voiding urine, making water, and in compounds suffering from a partic. urinary disease, with words of this very list as examples.

The descriptions of the twenty live in Nidana Sthana 6. One small difference between the twins: the Nidana's second kind is ikshuvalika, the Chikitsa's ikshu. Otherwise the order matches kind for kind; what the Chikitsa adds is a person at each step.

Asadhyeshv Api Yapanartham: The Four That Are Not Dropped

The Nidana sorts the twenty by outlook. Its verse 8 calls the ten of kapha sadhya, the six of pitta yapya, and the four of vata asadhyatamah, "most asadhya", mahatyayikatvat, because they carry the greatest danger. One might expect the Chikitsa to say nothing about those four. It does the opposite:

Chikitsa Sthana 11.9
अत ऊर्ध्वमसाध्येष्वपि योगान् यापनार्थं वक्ष्यामः
ata urdhvam asadhyeshv api yogan yapanartham vakshyamah "From here on we shall give measures even for the asadhya, for the sake of yapana."

Bhishagratna: Now we shall describe the palliative measures to be adopted even in cases of incurable types of the disease. The key word is yapana, which Monier-Williams gives as prolonging or supporting life, maintenance, support and causing time to pass away. The four kinds the Nidana ranks lowest are not dropped; they get measures of their own, and the word that justifies them is about time, not victory. The measures are withheld here. The sentence is not, because it shows that the physician's work does not stop where the outlook is poor.

Aushadha-Dveshin: The Rich Lord Who Hates Medicine

Chikitsa Sthana 11.11
महाधनमहिताहारमौषधद्वेषिणमीश्वरं वा
maha-dhanam ahitaharam aushadha-dveshinam ishvaram va "a man of great wealth who eats what does not suit him and hates medicine, or a lord"

After the physician's part, the chapter turns to people again, starting with the hardest kind of patient. Monier-Williams gives dveshin as hating, disliking, hostile, and ishvara as master, lord, prince, king. Bhishagratna: a rich or royal patient of injudicious conduct and refusing to take medicines.

The chapter's answer is craft, not reproach: a course hidden in drink and food (pana-bhojana). Its contents stay in the book, since they include drinks and a powder that nobody should take. One line can be shown, because it is about pleasure:

Chikitsa Sthana 11.11
अविरुद्धानि चास्मै पानभोजनान्युपहरेद्रसगन्धवन्ति च
aviruddhani chasmai pana-bhojanany upahared rasa-gandhavanti cha "and let him bring him drinks and foods that do not disagree, and that are full of taste and smell."

Bhishagratna: His food and drink should be fragrant and well flavoured. An old text knows that some patients will refuse, and writes a version for the one who will. It also knows that the version he will accept must taste good.

Pravriddha-Meha: Vyayama, Niyuddha and a Prince's Training Ground

Chikitsa Sthana 11.11, end
प्रवृद्धमेहास्तु व्यायामनियुद्धक्रीडागजतुरगरथपदातिचर्यापरिक्रमणान्यस्त्रोपास्त्रे वा सेवेरन्
pravriddha-mehas tu vyayama-niyuddha-krida-gaja-turaga-ratha-padati-charya-parikramanany astropastre va severan "But those whose meha has grown should take up exercise, close combat, games, going by elephant, horse, chariot and on foot, walking about, or arms and lesser arms."

The dictionary bears out what the list sounds like. Vyayama is exertion, manly effort, athletic or gymnastic exercise, with Monier-Williams' own examples of playing with heavy clubs and drawing a bow with a chain. Niyuddha is fighting (esp. with fists), pugilistic combat, close or personal struggle; krida is sport, play, pastime, amusement; padati is going or being on foot. Astra is a missile weapon, bolt, arrow and upastra a secondary or minor weapon.

Read straight after the rich lord, the list is a prince's day: the elephant, the horse, the chariot, the wrestling ground and the weapons. Bhishagratna: The practice of regular physical exercise, wrestling, active sports, riding on a horse or an elephant, long walks, pedestrial journeys, practising archery, casting of javelines, etc., should be resorted to in a case where the disease has made a decided advance. The chariot (ratha) is missing, and "the weapons" have become archery and javelins.

An empty akhara before anyone arrives. Verse 11 lists exercise, close combat and games for those whose meha has grown.

In the Ashtanga Sangraha, Vagbhata's longer work, the matching line changes one syllable:

Ashtanga Sangraha, Chikitsa Sthana 14.19
प्रवृद्धमेदाः प्रगाढव्यायामोद्वर्तनस्नानविलेपनानि
pravriddha-medah pragadha-vyayama ... "those whose medas has grown: strong exercise ..."

Sushruta has pravriddha-mehah, "whose meha has grown"; the Sangraha has pravriddha-medah, "whose medas has grown", and medas is fat, marrow, lymph in Monier-Williams, one of the body's seven tissues. One letter, ha against da. Our reading, flagged: we cannot tell from two printed texts which reading is older. Exercise in the daily routine, to half one's strength, is read on our page on vyayama in the Bhavaprakasha. How much exercise suits a given person is a question for that person's doctor.

Adhana, Abandhava: The Poor Man's Road

Chikitsa Sthana 11.12
अधनस्त्वबान्धवो वा पादत्राणातपत्रविरहितो भैक्ष्याशी ग्रामैकरात्रवासी मुनिरिव संयतात्मा योजनशतमधिकं वा गच्छेत्
adhanas tv abandhavo va padatrana-atapatra-virahito bhaikshyashi grama-eka-ratra-vasi munir iva samyatatma yojana-shatam adhikam va gachchhet "But the man without wealth, or without kin, with no footwear and no parasol, living on alms, staying one night in a village, self-restrained like a sage, should go a hundred yojanas or more."

Then the chapter turns from the palace to the road. Adhana is destitute of wealth; abandhava is having no relation or kindred, lone. Atapatra is a heat-protector, a large umbrella (of silk or leaves). Bhaiksha is living on alms, subsisting by charity; a muni is, among other senses, ascetic, monk, devotee, hermit, and samyata is self-controlled.

Bhishagratna: A poor and friendless patient should live on alms, lead a life of perfect continence like an ascetic, forego the use of shoes and umbrella and walk a hundred Yojanas or more on foot without staying for more than one night at a single village. Two of his choices tilt the Sanskrit. "Friendless" is narrower than abandhava, which is about kin. And "perfect continence" reads one special restraint into samyatatma, which in the dictionary is self-control in general. Our reading, flagged: the Sanskrit draws a man who has nobody, keeps nothing and controls himself like a sage, without singling out one appetite.

The road is given to the man who has nothing to lose by taking it. No one should copy it: walking far, and walking barefoot, are questions for a doctor first for anyone with a medical condition.

Yojana-Shatam: How Far Is a Hundred Yojanas?

A yojana is literally a yoking: Monier-Williams calls it a distance traversed in one harnessing or without unyoking, and then admits the sources disagree: sometimes regarded as equal to 4 or 5 English miles, more correctly four krosha or about 9 miles, by other calculations two and a half miles, and by some eight krosha.

Bhishagratna settles it in a footnote: A Yojana is equal to eight miles. On his figure a hundred yojanas is eight hundred miles, about 1,290 kilometres; on Monier-Williams' "about 9 miles", about 1,450 kilometres; even on the shortest reckoning, two and a half miles, about 400 kilometres. And the Sanskrit adds adhikam va, "or more". However the yojana is measured, the walk is long, and its rules are a wanderer's: alms for food, one night in each village (ekaratra, duration of one night), the simile of the muni. It is a way of life, not a stroll.

Padatra and Atapatra: The Same Author Praises Shoes and the Umbrella

The poor man walks without footwear and without a parasol, and Sushruta has a great deal of good to say about both. In Chikitsa Sthana 24, his chapter on the healthy person's day, he writes:

Sushruta, Chikitsa Sthana 24.72
सुखप्रचारमोजस्यं सदा पादत्रधारणम्
sukha-pracharam ojasyam sada padatra-dharanam "Always wearing footwear makes going easy and is good for ojas."

The next lines call always walking with unshod feet (padabhyam anupanadbhyam sada chankramanam) anarogyam anayushyam, "unhealthy, shortening life", and harmful to the eyes. Verse 76 praises the umbrella (chhatra-dharanam). Then comes a verse that could have been written about chapter 11:

Sushruta, Chikitsa Sthana 24.79
अध्वा वर्णकफस्थौल्यसौकुमार्यविनाशनः । अत्यध्वा विपरीतोऽस्माज्जरादौर्बल्यकृच्च सः
adhva varna-kapha-sthaulya-saukumarya-vinashanah; atyadhva viparito 'smaj jara-daurbalya-krich cha sah "The road wears away colour, kapha, stoutness and softness; too much road is the reverse of this, and brings on old age and weakness."

Verse 78 has just said that sitting (asya) builds up colour, kapha, stoutness and softness. So in Chikitsa 24 the same author calls the seat a maker of stoutness and the road its undoing, and warns that too much road brings old age and weakness. Chapter 11's hundred yojanas, barefoot and bareheaded, is a deliberate excess given to one kind of person. It is not advice for the healthy, and Sushruta's own daily-routine chapter says so.

Sandals and an umbrella left at the door. In Chikitsa 24 Sushruta praises both; in chapter 11 the poor man walks without them.

These verses follow the ones on washing the feet, read on our page on washing the feet in Sushruta Chikitsa Sthana 24.

Mahadhana: The Very Rich Man Sent to Live With the Deer

The next person in verse 12 is mahadhana, a man of great wealth, which Monier-Williams gives as having much money, rich, wealthy. He too is sent out of his house, to live on plain grains and forest fruits, and:

Chikitsa Sthana 11.12
मृगैः सह वसेत्
mrigaih saha vaset "he should live with the deer",
सततमनुव्रजेद्गाः
satatam anuvrajed gah "he should keep following the cows".

Mriga is a forest animal or wild beast, game of any kind, especially a deer, and Bhishagratna translates and live among the deer. Anuvraj is to go along, and the dictionary adds a pleasant detail: it is the word for following a departing guest, as a mark of respect. Bhishagratna: He should constantly follow the tracks of cows.

The lists differ: the Sanskrit names two grains and four fruits, Bhishagratna's English one grain and three fruits. One item of this man's regimen, about what he takes from the cows, stays in the book. The point does not depend on it: the man whose habit is the bed and the seat is moved into the open, to walk behind a herd all day.

Shilonchha, Bhaiksha and Krishi: Three Livelihoods from Manu 4.5

Chikitsa Sthana 11.12
ब्राह्मणो वा शिलोञ्छवृत्तिर्भूत्वा
brahmano va shilonchha-vrittir bhutva "or the Brahmin, having made gleaning his livelihood ..."

Shilonchha is a pair of words: Monier-Williams gives it as gleaning ears of corn, and as a pair, gleaning ears and picking up grains. Bhishagratna renders it A Brahman patient should live on the grain, spontaneously fallen from plants.

What the reapers leave behind. Shilonchha, living on fallen ears and grains, is the way of life the chapter gives its Brahmin.

The word belongs to the law books, which list the ways a householder may live:

Manusmriti 4.5
ऋतं उञ्छशिलं ज्ञेयं अमृतं स्यादयाचितम् । मृतं तु याचितं भैक्षं प्रमृतं कर्षणं स्मृतम्
ritam unchha-shilam jneyam amritam syad ayachitam; mritam tu yachitam bhaiksham pramritam karshanam smritam "Rita is to be known as gleaning; amrita is what comes unasked; mrita is begged alms; pramrita is said to be ploughing."

Monier-Williams cites this very verse under each word: unchhashila is the gleaning, gathering, Mn. iv, 5; mrita is begging, food or alms obtained by begging; pramrita is tillage, cultivation (as causing the death of many beings); karshana is ploughing, cultivating the ground, Mn. iv, 5.

Now set chapter 11 against it. The poor man lives on alms, bhaiksha. The Brahmin lives by gleaning, shilonchha. The other ploughs, krishet. Three of the chapter's ways of living are three of the livelihoods Manusmriti 4.5 names, and five verses later Manu uses the chapter's own compound, vartayamsh cha shilonchhabhyam, "and living by gleaning". Our reading, flagged: Sushruta draws on the law books' stock of words for ways of living and hands them out by station, labour fitted to a person's place as that world saw it.

Brahmaratham Uddharet or Upadharayet: Pull the Chariot, or Keep the Veda in Mind?

The Brahmin has a second task. The Wikisource text reads:

Chikitsa Sthana 11.12
ब्रह्मरथमुद्धरेत्
brahmaratham uddharet "he should draw the brahma-ratha".

Monier-Williams gives brahmaratha as the chariot or carriage of a Brāhman, and uddhri as to take out, draw out, bring or tear out, pull out. Read that way, the Brahmin is given physical work: pulling a cart.

Bhishagratna's English says two things at once: A Brahman patient should live on the grain, spontaneously fallen from plants, constantly study the Vedas and draw chariots occupied by Brahmanas. His footnote explains where the study comes from, citing Dallana's commentary: Some explain the phrase, which he prints as ब्रह्मरथमुपधारयेत्, to mean that he should retain in his memory (the teachings of) the Vedas.

So there are two readings of one verb. Uddharet, pull. Upadharayet, from upadhri, which in the causative means to hold in the mind, reflect or meditate on. With the first, the Brahmin hauls a carriage; with the second, he carries the Veda in his memory. Our reading, flagged: Bhishagratna's translation seems to keep both at once, the study from the commentary and the chariot from the text.

Itarah, "the Other": the Plough or a Well

Chikitsa Sthana 11.12
कृषेत् सततमितरः खनेद्वा कूपं
krishet satatam itarah, khaned va kupam "The other should plough without pause, or dig a well."

Itara is, in Monier-Williams' first sense, the other (of two), another, and in the plural the rest. The verb krish in this form is to draw or make furrows, plough, and a kupa is a pit well.

Bhishagratna writes: A patient belonging to the lower orders of society (Sudras, etc.) should be made to sink wells. Two things have changed. The Sanskrit names no class here, only "the other", and the plough is missing from the English, which keeps only the well. Our reading, flagged: itarah most naturally means everyone not yet named, so the chapter's last labour is open to anyone; the class label is the translator's.

A village well. The chapter's last labour goes to the other: plough the field, or dig a well.

The well changes from book to book: a well (kupa) in Sushruta, tanks (tadaga, a tank, pool) in Vagbhata's Ashtanga Sangraha, ponds (salilashaya, a pond, lake) in his Ashtanga Hridaya. A hole for one family's water grows into a reservoir for a village.

Krisham Tu Satatam Rakshet: The Lean One Is Always Protected

Verse 12 ends with four words that undo any idea that the chapter is simply about hardship:

Chikitsa Sthana 11.12, end
कृशं तु सततं रक्षेत्
krisham tu satatam rakshet "But the lean one he should always protect."

Raksh is to guard, watch, take care of, protect, save, preserve. Bhishagratna: the strength of a weak or emaciated patient should be preserved (with nutritive diets, etc.), the bracket again his own. Vagbhata keeps the rule in both books: the Sangraha says the lean one should be built up with things that do not disagree (krisham tv aviruddhair brimhayet), the Hridaya with medicines and foods that add neither fat nor urine.

So every version ends its list of hardships the same way. Whatever the poor man, the rich man, the Brahmin and the other are told to do, the lean one is kept out of it. The chapter that opened by splitting people into lean and stout closes its prose by returning to the lean: the strongest sign that its road and its labour were never meant for everyone.

Vagbhata's Two Versions: One Poor Man, Three Choices

Vagbhata retold this passage twice. In the Ashtanga Hridaya:

Ashtanga Hridaya, Chikitsa Sthana 12.36–37
अधनश्छत्रपादत्ररहितो मुनिवर्तनः । योजनानां शतं यायात्खनेद्वा सलिलाशयान्
adhanash chhatra-padatra-rahito muni-vartanah; yojananam shatam yayat khaned va salilashayan "The man without wealth, without umbrella and footwear, keeping a sage's way, should go a hundred yojanas, or dig ponds."

The next line keeps the cows, the one after it the lean. The Sangraha is fuller:

Ashtanga Sangraha, Chikitsa Sthana 14.20
अधनस्तु छत्रपादत्रविरहितो मुनिवृत्तिर्योजनशतमधिकं वा गच्छेत्
adhanas tu chhatra-padatra-virahito muni-vrittir yojana-shatam adhikam va gachchhet "But the man without wealth, without umbrella and footwear, living as a sage, should go a hundred yojanas or more."

Vagbhata folds four people into one: the poor man alone keeps the road, and the forest, the cows and the digging become his choices. What survives in every version is the walk, the missing footwear and parasol, the sage's way of life and the protection of the lean.

Charaka Chikitsa Sthana 6: Exercise Without the Road

Charaka's prameha chapter, the sixth of his Chikitsa Sthana, has movement too, but no road. Verse 50 opens with vyayama-yogair vividhaih:

Charaka Samhita, Chikitsa Sthana 6.50
व्यायामयोगैर्विविधैः
vyayama-yogair vividhaih "with many kinds of exercise ..."

and the chapter's closing summary lists vyayama-vidhir vividhah, "the many ways of exercise", among its subjects. The CSRTSDC English of that summary has two types of patients and disadvantages of excess depletion therapy near the top of the list.

What Charaka does not have is the social map: no walk of a hundred yojanas, no alms, no rich man among the deer, no gleaning Brahmin, no plough and no well. Charaka gives everyone exercise; Sushruta gives each kind of person a different labour.

Atandritah: The Closing Verse and Its Reader

The chapter ends with one verse, introduced as usual by bhavati chatra, "and here there is (a verse)". Its first half:

Chikitsa Sthana 11.13
अधनो वैद्यसन्देशादेवं कुर्वन्नतन्द्रितः
adhano vaidya-sandeshad evam kurvann atandritah "The man without wealth who does this on the physician's instruction, unwearied ..."

Three things are worth noticing. The verse speaks to the adhana, the poor man, not to the rich. It says "on the physician's instruction" (vaidya-sandeshat), not on his own initiative. And its last word is atandritah, from atandra, free from lassitude, alert, unwearied: the stout man of verse 3 was given to bed, seat and sleep, and the closing verse ends on the man without lassitude. Bhishagratna: A poor patient, carefully following these directions of his medical advisers without the least demur or delay.

The second half names a span of time and an outcome. As a promise about a scheduled condition it stays in the book, for the reason given below.

Thirteen Footnotes: Chakradatta, Dallana, Jejjata and Gayadasa

Bhishagratna's seven pages carry thirteen footnotes (1, 3, 3, 2, 1, 2 and 1 page by page). Some name an authority:

• Chakradatta, the later compendium of preparations: four footnotes;
• Charaka: two, both of which also name Chakradatta;
• Dallana, the commentator on Sushruta: three, including the brahma-ratha note;
• Jejjata and Gayadasa, two older commentators, in one footnote, disagreeing about one word;
• unattributed: five, among them the yojana and a variant reading.

The striking page is the third (printed page 374). Its three footnotes all concern the five preparations of verse 8, and all three end the same way. The first: The practice, however, is to follow the recipe of Chakradatta. The second: Chakradatta is more generally followed in the case. The third: Charaka, however, is quoted verbatim by Chakradatta and is followed in practical use. On one page, three footnotes in a row tell the reader that practice followed Chakradatta's wording rather than Sushruta's.

That is a small window onto how a classical text lives. Sushruta's lines were copied into Chakradatta's compendium, sometimes changed (an earlier footnote says one has been quoted by Chakradatta in his compilation), and the physicians of the translator's day reached for the later book. The Samhita was the source; the compendium was the working manual.

What We Leave in the Book

Prameha is often equated with diabetes, which is named, with obesity, in the schedule of India's Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954: one more reason a seller's website should not repeat a classical promise about either. Much of chapter 11 is medicine, and we have left all of that part where it is:

• verse 5: the list of things all of them should avoid;
• verse 6: the foods;
• verse 7: the cleansing procedures;
• verse 8: the five preparations and the line about what they do;
• verse 9: the preparations for each of the twenty kinds, and the measures for the four;
• verse 10: the further preparations and gruels;
• verse 11: the drinks, dishes and powder for the rich lord;
• verse 12: one item in the very rich man's regimen;
• verse 13: the second half of the closing verse;
• the substance of the footnotes on the preparations.

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