Trimarma in the Charaka Samhita: Hridaya, Shiras and Basti, the Three Roots of the Body

इस लेख को हिंदी में पढ़ें: चरक संहिता में त्रिमर्म: हृदय, सिर और बस्ति, शरीर के तीन मूल

📖 27 min read · Charaka Samhita, Siddhi Sthana 9 and Sutrasthana 17.3–40, read in Van Loon's handbook (Volume II, printed pages 670 to 683) and in the Sanskrit

Trimarma: Charaka's Three Roots of the Body

Trimarma means "the three marmas". A marma is a vital point, a place where an injury does more harm than the same blow would do elsewhere. Charaka counts a hundred and seven of them, and in Siddhi Sthana 9, the chapter called Trimarmiya Siddhi, he ranks three above all the rest: hridaya, the heart; basti, the bladder; and shiras, the head. His reason fits in two words, tan-mulatvat sharirasya: because the body has them for its root. When a root goes, what grows from it goes too.

What makes the chapter worth reading slowly is the next sentence, which gives each root a picture. The heart is a hub with its spokes. The head is the sun with its rays. The basti is the sea that all rivers reach. Then the whole body becomes a sky, filled with light from these three. Few passages in the Charaka Samhita are so plainly built to be remembered.

Below we read that chapter (verses 3 to 87, as far as Van Loon's handbook prints it) with the head and heart verses of Sutrasthana 17, comparing the Sanskrit with two English versions and with Sushruta and Vagbhata. Where the chapter turns to medicines and procedures, we stop.

Two Chapters in One Section: Sutrasthana 17 and Siddhi Sthana 9

Gabriel Van Loon's Charaka Samhita: Handbook on Ayurveda rearranges the text by subject. Its second volume gathers the disease chapters, and one section, opening on printed page 670, is headed The 3 Vital Organs (Heart, Head and Urinary System). It joins three chapters from three parts of the Samhita: verses 3 to 40 of Sutrasthana 17 (pages 671 to 674), Siddhi Sthana 9 from verse 3 to verse 87 (pages 675 to 683), and then Chikitsa Sthana 26, the Trimarmiya Chikitsa, which begins halfway down page 683 and is left for another day.

For the Sanskrit we used the CSRTSDC edition (Charaka Samhita Research, Training and Skill Development Centre), which prints each verse with its own English, and the Wikisource text of the Siddhi Sthana. The two English versions often disagree; several finds below sit in the gaps.

The chapters' closing lines (colophons) tell their own story. Sutrasthana 17 ends:

Sutrasthana 17, colophon
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने कियन्तःशिरसीयो नाम सप्तदशोऽध्यायः
ity agnivesha-krite tantre charaka-pratisamskrite shloka-sthane kiyantahshirasiyo nama saptadasho 'dhyayah

"In the treatise made by Agnivesha and revised by Charaka", it says, calling the Sutrasthana by its other name, Shloka-sthana. Siddhi Sthana 9 closes differently: charaka-pratisamskrite 'prapte dridhabala-sampurite, revised by Charaka, but in a part that was "not obtained" and was completed by Dridhabala. In the same edition Chikitsa 26 closes the same way. So both chapters named after the three marmas carry Dridhabala's name, and the Siddhi chapter says plainly that it fills a gap in the other: verse 11 promises, in the CSRTSDC English, some of the diseases related to marma that have not been described in the chapter Trimarmiya Chikitsa.

Saptottaram Marma-Shatam: 107 Marmas, Counted but Not Seen

Siddhi Sthana 9.3, first words
सप्तोत्तरं मर्मशतमस्मिञ्छरीरे स्कन्धशाखासमाश्रितमग्निवेश
saptottaram marma-shatam asmin sharire skandha-shakha-samashritam agnivesha

"A hundred and seven marmas, Agnivesha, rest in this body, on the trunk (skandha) and the limbs (shakha)." When any one of them is hurt, the verse goes on, the pain is greater than elsewhere, and Van Loon gives the reason as because of the specific attachment of consciousness to them. Then comes a ranking. The trunk's marmas weigh more (gariyamsi, literally "heavier") than the limbs', because the limbs hang on the trunk: in Van Loon's words, the latter are dependent on the former. And among the trunk's marmas, the heart, the bladder and the head weigh most, because the body has them for its root.

The number comes from Charaka's count of the body, Sharira Sthana 7. Its verse 13 says that what has been listed so far can be seen and pointed out. Verse 14 begins:

Sharira Sthana 7.14
अनिर्देश्यमतः परं तर्क्यमेव
anirdeshyam atah param tarkyam eva "beyond this, it cannot be pointed out; it can only be reasoned"

It then lists, among other things, nine hundred sinews, seven hundred vessels, two hundred dhamanis, four hundred muscles, सप्तोत्तरं मर्मशतं (the hundred and seven marmas) and two hundred joints. By Charaka's own account, the number that opens Siddhi 9 belongs to the part of anatomy that is reasoned, not seen. Chikitsa 26.3 points back to the same list (sharira-sankhyam adhikritya, "with reference to the count of the body") before it names the three. For the count itself, region by region, see our page on marma sharira in the Bhavaprakasha, where the heart and the bladder share a class with the navel.

Hridaya: Ten Dhamanis and the Hub of a Wheel

Siddhi Sthana 9.4, the heart
तत्र हृदये दश धमन्यः प्राणापानौ मनो बुद्धिश्चेतना महाभूतानि च नाभ्यामरा इव प्रतिष्ठितानि
tatra hridaye dasha dhamanyah pranapanau mano buddhish chetana mahabhutani cha nabhyam ara iva pratishthitani

"In the heart are set the ten dhamanis, prana and apana, the mind, the intellect, consciousness and the great elements, like spokes in a hub." Seven kinds of thing: vessels, the two breaths, mind (manas), intellect (buddhi), consciousness (chetana) and the five great elements (mahabhuta) the body is made of. This heart holds far more than blood: it is where the body's vessels and the mind are fixed to one centre.

The image hangs on one word. Nabhi is the navel, and Monier-Williams also gives the nave of a wheel: the hub, the solid centre into which the spokes (ara) are set. Van Loon writes as spokes in the hub; the CSRTSDC English has just like spokes to the axle in the center of a wheel. Both keep the picture. A hub holds every spoke at once; take it out and nothing stays in place, which is what verse 5 says of all three marmas.

Shiras, the Uttamanga: the Senses and the Sun's Rays

Siddhi Sthana 9.4, the head
शिरसि इन्द्रियाणि इन्द्रियप्राणवहानि च स्रोतांसि सूर्यमिव गभस्तयः संश्रितानि
shirasi indriyani indriya-prana-vahani cha srotamsi suryam iva gabhastayah samshritani

"In the head rest the senses and the channels that carry the senses and prana, as rays rest in the sun." Gabhasti is a ray of light, sunbeam (Monier-Williams). Van Loon's bracket sends the rays outward, as rays in the sun [as sun-rays emanate from the sun], and the CSRTSDC English has the radiating spicules of the rays of sunlight. The verb in the Sanskrit, samshrita, looks the other way: the dictionary gives leaning against, clinging to and situated or being in. Our reading, flagged: the verse pictures the senses held in the head as rays are held in the sun, and leaves the shining-out to the reader.

Sutrasthana 17.12, one of the best-known lines in the Samhita, had already said why the head ranks so high:

Sutrasthana 17.12
प्राणाः प्राणभृतां यत्र श्रिताः सर्वेन्द्रियाणि च । यदुत्तमाङ्गमाङ्गानां शिरस्तदभिधीयते
pranah pranabhritam yatra shritah sarvendriyani cha, yad uttamangam anganam shiras tad abhidhiyate

"Where the pranas of living beings rest, and all the senses, that which is the highest of the limbs, is called the head." Van Loon splits it into two plain definitions: That where the vital breath of living beings is located and also all the sense organs. and That which is the best of all organs. Uttamanga, in Monier-Williams the highest or chief part of the body, the head, is still a common Sanskrit word for it. Look at the verb, too: shritah, from the same root as Siddhi 9's samshrita. Two chapters from two hands, Charaka's and Dridhabala's, say the same thing about the head with the same verb root.

A low sun behind trees, its light fanning out through the mist: Siddhi Sthana 9.4 says the senses rest in the head as rays rest in the sun.

Basti: the Sea That Takes In Every River

Siddhi Sthana 9.4, the basti
मूत्रधारोऽम्बुवहानां सर्वस्रोतसामुदधिरिवापगानां प्रतिष्ठा
mutra-dharo 'mbu-vahanam sarva-srotasam udadhir iva-apaganam pratishtha

The verse places the basti low in the pelvis and says what it is: the holder of urine (mutra-dhara), and the base (pratishtha) of all the water-carrying channels (ambu-vaha srotas), as the ocean is of rivers. Van Loon: just as the sea is the receptacle of all the rivers. The picture is of collection. Every stream ends here.

Then the sentence closes on the body as a whole:

Siddhi Sthana 9.4, last words
गगनमिव दिनकरकरैर्व्याप्तमिदं शरीरम्
gaganam iva dinakara-karair vyaptam idam shariram

"By many channels rooted in these three, called marmas, this body is pervaded, as the sky is by the rays of the day-maker." Dinakara, "making day or light", is the sun. So one long sentence holds two suns: the head as the sun with its rays, and the body as a sky lit through. Van Loon: the body is pervaded like the sky by the sun rays.

One more thing about the word basti. Monier-Williams gives vasti (also written basti) as the bladder, and also as an injection-syringe made of bladder or the injection itself. The procedure Ayurveda calls basti is named after the animal bladder its bag was made from. Keep that in mind: verse 7 uses both senses in one breath.

A river reaching the sea at first light. Charaka calls the basti the base of all the water-carrying channels, as the ocean is of rivers.

Ashraya and Ashrita: Why Breaking One Breaks the Body

Siddhi Sthana 9.5
आश्रयनाशादाश्रितस्यापि विनाशः
ashraya-nashad ashritasyapi vinashah "when the support is destroyed, what rests on it is destroyed too"

Verse 5 draws the conclusion. If even one of the three is broken (bheda), the body breaks quickly, because the support (ashraya) carries what rests on it (ashrita). Van Loon: By breaking of any of the above 3 the body is broken quickly because by destruction of substratum the dependent is also destroyed. A lesser hurt (upaghata) brings on graver illness. Hence these should be protected particularly from external injury as well as the doshas (internal factors).

Two dangers, then: a blow from outside and the doshas from within. Verse 6 takes the first; verses 7 to 10 take the second, vata above all.

A small thing for close readers: Charaka keeps no fixed order for the three. Verse 3 has heart, bladder, head (hrid-vasti-shiramsi); verses 4 and 9 have heart, head, bladder; Chikitsa 26.3 has bladder, heart, head. None of these verses ranks one of the three above the others.

Abhighata: What Each of the Three Shows When Struck

Verse 6 lists what follows a blow (abhighata) to each marma. We give the shape of the lists, not every item; several are serious conditions in their own right.

The heart's list has eleven entries (twelve if one compound is split). It begins with breath, strength and the throat: cough, breathlessness, loss of strength, a dry throat, a dry mouth and palate. It ends with the mind: delirious talk and, in Van Loon's English, vacantness of mind. The head's list is the longest, seventeen entries, almost all of the neck, the face, the eyes and speech: a stiff neck, rolling eyes, muteness, a stammer, drooping eyelids, yawning, drooling, loss of voice. The bladder's eight are retentions and pains of the lower body: wind, urine and stool held back, pain in the groin and the bladder, stiffness from the navel to the hips.

Two entries appear in both of the first two lists: cough (kasa) and breathlessness (shvasa). Our reading, flagged: the verse counts the breath as something either root can lose.

One word in the heart's list shows how far two translations can drift. Klomakarshana is "a drawing of the kloma". Monier-Williams gives kloman as the right lung. Van Loon keeps the organ: traction of kloma. The CSRTSDC English turns it into a sensation: klomakarshana (a form of severe chest pain). One version names a part of the body; the other names a feeling.

The verse ends by sending the reader on: the signs of the three when troubled by the doshas are told, with their care, in the Chikitsa Sthana. Van Loon's handbook adds (Ch. 2) here. Our reading, flagged: a misprint for 26. The chapter meant is the Trimarmiya Chikitsa, which verse 11 names and whose first verse the handbook itself prints seven pages later.

Anila, the Root of Prana: Why Vata Comes First

Siddhi Sthana 9.7
अनिलो हि पित्तकफसमुदीरणे हेतुः प्राणमूलं च
anilo hi pitta-kapha-samudirane hetuh prana-mulam cha

Of the doshas, verse 7 says, the three marmas must be guarded from vata (anila, "wind") above all, and it gives two reasons. Vata is what stirs up pitta and kapha, and it is the root of prana. Van Loon: V is the cause of aggravation of P and K and is also the root cause of vital breath.

Then the verse names its preferred protection, and the double sense of basti comes into play. Vata yields most to basti, the procedure. In Van Loon's English: Hence there is no other therapy equal to enema for protecting the vital parts. The bladder is one of the three marmas, and the procedure named after a bladder is the chapter's chief way of guarding all three.

We report this as the text's position and go no further: basti is a physician's procedure, and the formulas the verse and verse 8 go on to give stay in the book.

Marma Paripalana: Charaka's Three-Part Rule

Siddhi Sthana 9.9 and 9.10
हृदये मूर्ध्नि बस्तौ च नृणां प्राणाः प्रतिष्ठिताः
hridaye murdhni bastau cha nrinam pranah pratishthitah (verse 9, first half)
आबाधवर्जनं नित्यं स्वस्थवृत्तानुवर्तनम् । उत्पन्नार्तिविघातश्च मर्मणां परिपालनम्
abadha-varjanam nityam svastha-vrittanuvartanam, utpannarti-vighatash cha marmanam paripalanam (verse 10)

The chapter's prose part ends in two verses. The first: "In the heart, the head and the basti of human beings the pranas are established; so one should always take care to guard them." The second says what guarding is: abadha-varjana, keeping clear of what harms, always; svastha-vritta-anuvartana, following the conduct of the healthy; and utpannarti-vighata, checking a trouble once it has arisen. Van Loon: The protection of vital parts consists of avoidance of impending factors, observance of the code of conduct for the healthy and remedy of disorders if arisen.

Notice the proportions. Of the three parts, only the last needs a physician. The first two are a way of living: avoid what hurts, and keep the daily and seasonal routine the Samhita lays out for people who are well. Two verses after setting basti above every other protection, the chapter's own summary puts everyday conduct first.

Ordinary things for an ordinary morning. Two of the three parts of Charaka's rule for guarding the marmas are everyday conduct.

Sandharana: One Everyday Habit, Named in Eight Places

Read the causes in these verses side by side and one stands out because it is so ordinary: holding back a natural urge (vega), called sandharana, vega-nigraha or dharana. It opens the causes of head disease in Sutrasthana 17, and it keeps coming back in Siddhi 9.

Eight places: five in causes of head trouble, counting the tears, and three among the thirteen disorders of urine. The heart's verses in Sutrasthana 17 do not name it. Sutrasthana 17.10 even names both sides of the same habit, rodanad bashpa-nigrahat, from weeping and from holding back tears; Van Loon has weeping, suppression of tears. By our count no other single cause appears in as many places.

The rule against holding back urges has its own chapters in the classics. Our page on vegadharana in the Ashtanga Hridaya reads Vagbhata's version, with its thirteen urges. If there is one thing to carry away from the chapters on the three roots of the body, it is this: the cause Charaka repeats, across the head and the bladder, is a daily habit.

Kiyantah Shirasi: Five Shiroroga and Five Hridroga

Sutrasthana 17.3
कियन्तः शिरसि प्रोक्ता रोगा हृदि च देहिनाम्
kiyantah shirasi prokta roga hridi cha dehinam "how many diseases are told of the head, and of the heart, in embodied beings?"

Sutrasthana 17 takes its name, Kiyantahshirasiya, from its first words: "how many ... in the head". Agnivesha asks how many diseases of the head and the heart there are, how many from the doshas' proportions, how many kinds of wasting (kshaya) and boils (pidaka), and how many courses (gati) the doshas take. Atreya answers with numbers:

Sutrasthana 17.6
दृष्टाः पञ्च शिरोरोगाः पञ्चैव हृदयामयाः
drishtah pancha shiro-rogah panchaiva hridayamayah "five diseases of the head are seen, and just five of the heart"

then sixty-two from the doshas' proportions, eighteen kinds of wasting, seven boils and three courses. Van Loon's handbook keeps only the head and the heart here, verses 3 to 40. The rest of the chapter, on ojas, the sixty-two and the three courses, is read on our Charaka Samhita Part 17 page, and we do not repeat it.

The five of each are built the same way: one for each dosha, one for all three together, and one from krimi, worms or small organisms. The CSRTSDC English introduces the five As mentioned in Ashtodariya Adhyaya, the chapter of the Sutrasthana that lists diseases by number (Sutrasthana 19), so the five is a summary count, not a census. Verses 13 and 14 show as much: before giving the five, they name other troubles of the head, among them pain in half the head (ardhavabhedaka), a cold in the head (pratishyaya), giddiness and a shaking head (shirasah kampa), and other such diseases of the head. Two of those come back in Siddhi 9 as named disorders.

Prag-Vata, Purva-Vata, Puro-Vata: an East Wind or a Wind in the Face?

Sutrasthana 17.8 to 17.10 lists the causes of head disease in one long breath. Split the compounds one way and there are twenty-four, among them holding back urges, sleeping by day, staying up at night, loud talk, frost or dew (avashyaya), the prag-vata, unsuitable smells, dust, smoke, cold and sun, heavy, sour and green foods, too much cold water, a blow to the head, ama (undigested matter), weeping and holding back tears, the coming of the clouds, a troubled mind, and the wrong place or season.

The prag-vata is the interesting one. It is "the wind from prak", and prak faces two ways. Monier-Williams gives pranc as directed forwards or towards, being in front, facing, opposite and also as turned eastward, eastern, easterly. In Sanskrit the words for "in front" are also the words for "east". So the English versions split. Van Loon writes easterly wind. The CSRTSDC English writes exposure to wind from the front.

Then the same edition, translating Siddhi 9.74 on ardhavabhedaka, meets a different word for the same wind, purva-vata, and this time writes easterly breeze. Purva is again both: being before or in front, and eastern. Vagbhata, listing the causes of head disease in Ashtanga Hridaya, Uttara Sthana 23.1, uses a third word, पुरो-वात (puro-vata), from puras: in front, in advance, forward, and in or from or towards the east. Three words, one wind, and each can be read either way. The word beside it wobbles too: avashyaya is exposure to frost in one CSRTSDC chapter and dew/snow in the other, while Van Loon has "dew" both times.

Our reading, flagged: "the east wind" is the likelier sense, since the classics give each direction's wind its own qualities (Sushruta's east wind is read on our page on the eight winds in the Bhavaprakasha). But "a wind in the face" is not bad Sanskrit, and a reader of one CSRTSDC chapter would never guess that the other speaks of the east.

A morning wind at an open window. One English version of prag-vata says a wind from the east, another a wind from the front.

Tapati or Patati: Vagbhata Copies Charaka's Vata Headache

The vata kind of head disease (vataja shiroroga) gets the fullest description of the five (verses 16 to 21). The temples ache sharply, the nape feels split, the ears ring, the eyes feel as if pulled out, the head seems to spin and come loose at its joints, and its veins throb. As a sign, warmth and oil are said to ease it (upashaya).

Vagbhata knew these lines. Ashtanga Hridaya, Uttara Sthana 23.4 to 23.6 repeats them almost word for word, and one pair of syllables has changed places:

Charaka, Sutrasthana 17.19 (CSRTSDC)
सभ्रूमध्यं ललाटं च तपतीवातिवेदनम्
sa-bhru-madhyam lalatam cha tapativativedanam "the forehead and the space between the brows, as if burning, in great pain"

Vagbhata, Uttara Sthana 23.4
भ्रुवोर् मध्यं ललाटं च पततीवाति-वेदनम्
bhruvor madhyam lalatam cha patativati-vedanam "the space between the brows and the forehead, as if falling, in great pain"

Tapati, it burns; patati, it falls. The same two syllables, swapped. Both English versions of Charaka read a burn: Van Loon has burning sensation and excessive pain, the CSRTSDC excessive heat and pain in forehead. We cannot tell from two printed texts which reading is older, or whether a copyist's slip made one from the other. The lines around it run in step: ghurnativa shirah sarvam sandhibhya iva muchyate, "the whole head seems to spin, as if coming loose at the joints", stands the same in both.

Pitta, Kapha, All Three and Krimi: the Rest of the Five

The other four are shorter. Pitta's (verses 22 and 23) comes from pungent, sour, salty and alkaline things, anger, sun and fire: the head and eyes burn, cold is welcome, with thirst, giddiness and sweat. Kapha's (24 and 25) comes from a life of comfort, too much sleep and heavy, oily meals: a dull ache, a head that feels numb, cold and heavy, with drowsiness (tandra) and no appetite. The kind from all three (26) adds them up: pain, giddiness and trembling from vata, burning and thirst from pitta, heaviness and drowsiness from kapha.

The fifth, krimija, comes from too much sesame, milk and jaggery, eating before the last meal is digested, and spoiled or mixed-up food, in someone whose doshas are already high. Moisture builds in the blood, kapha and flesh, and then:

Sutrasthana 17.28
ततः शिरसि सङ्क्लेदात् क्रिमयः पापकर्मणः
tatah shirasi sankledat krimayah papa-karmanah

"Then, from the moisture in the head, the krimi of the papa-karman ...". Monier-Williams gives papakarman as an ill-doer, criminal, sinner. Read as a genitive, the phrase means "the worms of the wrongdoer", and the moral word belongs to the sufferer. Van Loon reads it as describing the worms themselves: the trouble-creating organisms cause head disease with loathsome symptoms. The CSRTSDC English leaves the word out: wherein parasites are produced. Our reading, flagged: the grammar allows both, and the heart's verses, as the section after next shows, use a plainer moral word that allows only one.

Hridroga: Five Heart Diseases, Two Englishes

The heart's five (verses 30 to 40) follow the head's plan. Vata's comes from grief, fasting, exercise, and dry, rough or too little food. Pitta's from hot, sour, salty, alkaline and pungent food, eating before digestion, anger and the sun. Kapha's from eating too much, heavy and oily food and, in Van Loon's words, little mental and physical work and indulgence in sleep.

That kapha line has a twin. The Sanskrit is achintanam achestanam, "not thinking, not moving", which the CSRTSDC English renders as a worry-free and sedentary lifestyle. In Siddhi 9.21 the opposite, chintana (excessive thinking) in the same edition, is a cause of tandra, a heaviness that settles on the heart. Too little thinking and too much both appear, and in both verses the dosha at work is kapha.

The signs of vata's heart disease are where the translations part most. The line is short:

Sutrasthana 17.31
वेपथुर्वेष्टनं स्तम्भः प्रमोहः शून्यता दरः
vepathur veshtanam stambhah pramohah shunyata darah

Van Loon renders the six words plainly: Trembling, stiffness, fainting, vacant look, tearing pain, with “cramps” [angina?] for veshtana, his own question mark included. The CSRTSDC English maps the same six onto a cardiologist's vocabulary: extra systole/ fibrillation, cardiac cramps, pauses in cardiac beats, stupor, sensation of emptiness in the cardiac region, and murmur ( dara ). The dictionary sides with the plain words. Monier-Williams gives vepathu as quivering, trembling, tremor, and dara as fear and, from the root "to split", cleaving, breaking; nothing like a murmur. Our reading, flagged: the modern terms are interpretations laid over the Sanskrit, not translations of it.

A Bracketed Half-Line, and a Harder Word

After the kind from all three doshas, the CSRTSDC text prints a half-verse inside round brackets and numbers it 35½:

Sutrasthana 17.35½ (in brackets)
हृद्रोगः कष्टदः कष्टसाध्य उक्तो महर्षिभिः
hridrogah kashtadah kashta-sadhya ukto maharshibhih "heart disease is called by the great sages troublesome and hard to manage"

The Sanskrit says "heart disease", with no qualifier. Van Loon reads it that way, under his own heading Prognosis of Heart Disease: The great sages consider heart disease to be troublesome and hardly curable. The CSRTSDC English ties it to the kind just described: ( tridoshaja hridroga is considered a most troublesome disease by great sages). One half-line, two scopes: all heart disease, or only the kind from all three doshas. The handbook also numbers it differently, as verse 37.

The next verses (36 to 38) bring in a second moral word, and this one leaves no grammatical way out. Krimi arise in the heart, they say, in one who already has the kind from all three doshas and still keeps eating sesame, milk and jaggery: yo duratma nishevate, "the duratman who indulges". Monier-Williams gives duratman as evil-natured, wicked, bad. Van Loon keeps the edge: The evil-natured person who takes sesamum, milk, jaggery etc. The CSRTSDC English softens it to An unfortunate person. Verse 38 then calls the same person upahatatman, one whose self is struck down. Here the old text passes judgement on the patient; one of its modern translators chose not to.

Ten, Eleven, Ten: Three Texts Count the Head's Diseases

Siddhi 9 returns to the head at verse 70 with a modest line, atah shiro-vikaranam kashchid bhedah pravakshyate, "now some varieties of head disorder will be told". It names five: shankhaka at the temples, ardhavabhedaka in half the head, suryavarta, anantavata and shirah-kampa, the shaking head. With the five of Sutrasthana 17, Charaka names ten.

Sushruta counts eleven. His Uttara Tantra 25 adds the sun, the endless wind, the half-head and the temple to seven kinds by cause, and announces the total:

Sushruta, Uttara Tantra 25.4
सूर्यावर्तानन्तवातार्धावभेदकशङ्खकैः । एकादशप्रकारस्य लक्षणं संप्रवक्ष्यते
suryavartanantavatardhavabhedaka-shankhakaih, ekadasha-prakarasya lakshanam sampravakshyate "with suryavarta, anantavata, ardhavabhedaka and shankhaka, the signs of the eleven kinds will be told"

Vagbhata closes his list in Ashtanga Hridaya, Uttara Sthana 23.20 with सूर्यावर्तः स इत्य् उक्ता दश रोगाः शिरो-गताः (suryavartah sa ity ukta dasha rogah shiro-gatah, "that is suryavarta; so the ten diseases seated in the head are told") and then adds nine more of the skull (kapala).

Twelve kinds in all, eight shared by the three texts. Sushruta alone has the kind from wasting. Charaka has no separate blood kind, since for him the blood of the head is spoiled in head disease generally (Sutrasthana 17.11), but he shares anantavata with Sushruta and the shaking head with Vagbhata. So Charaka's ten and Vagbhata's ten are not the same ten. Our page on Sushruta's eleven head diseases reads his chapter in full.

Suryavarta: a Headache on the Sun's Clock, Three Ways

Suryavarta is "sun-turning": avarta is turning, winding, turning round, revolving. All three texts describe a head pain that rises with the sun. They disagree on nearly everything else.

Charaka (Siddhi 9.79 to 81) gives a cause and a mechanism. Holding back urges, eating before digestion and the like spoil the blood and vata, and these spoil the mastishka, the brain matter. After sunrise the sun's heat makes it seep, the pain grows with the day, and then:

Siddhi Sthana 9.81
दिनक्षये ततः स्त्याने मस्तिष्के सम्प्रशाम्यति
dina-kshaye tatah styane mastishke samprashamyati "at the day's end, the mastishka having thickened, it subsides"

Van Loon's English: the brain matter is gradually liquefied after sunrise due to heat of the sun-rays ... at the end of the day when the brain matter is solidified.

Sushruta (Uttara Tantra 25.11 to 25.13) gives no mechanism. The pain in the eyes and brows comes on slowly from sunrise and विवर्धते चांशुमता सहैव (vivardhate chamshumata sahaiva), "grows along with the sun", turning back as the sun turns. Sometimes cold eases it, sometimes warmth. He calls it bhaskaravarta (bhaskara, "making light", is another name for the sun), says it comes from all three doshas, and calls it the most troublesome of all.

Vagbhata (Uttara Sthana 23.18 and 23.19) moves the clock. Vata bound up with pitta brings a throbbing pain that rises with the sunrise, आ-मध्याह्नं विवर्धिष्णुः (a-madhyahnam vivardhishnuh), "growing until midday", worse in someone hungry, and easing after that. Neither cold nor warmth helps reliably.

Three texts, three clocks: until the day ends, along with the sun, until noon. Only Charaka says why.

A courtyard at noon, the post's shadow at its shortest. In Vagbhata, suryavarta grows until midday; in Charaka it lasts until the day ends.

Tandra and Apatantraka: What the Siddhi Adds to the Heart

Between its protective rule and the head disorders, Siddhi 9 adds two disorders that reach the heart. In apatantraka (verses 12 to 15), vata rises to the heart and then the head, bends the body like a bow and clouds the mind, and the person, in the verse's own image, coos like a dove (kapota). This severe condition caused by V is said by some as apatanaka, Van Loon adds for its variant.

Verses 21 to 24 describe tandra, a stupor: from sweet, oily and heavy food, overthinking, exertion, grief and long illness, kapha, driven by vata, settles over the heart and covers knowing (jnana); the CSRTSDC English says it obscures the process of jnana. Its signs are an unease in the heart, heaviness of speech, movement and the senses, and a mind and intellect that will not clear.

Trayodasha Mutra-Dosha: Thirteen Names, Not Described

Siddhi Sthana 9.26
त्रयोदशैते मूत्रस्य दोषास्ताँल्लिङ्गतः शृणु
trayodashaite mutrasya doshas tamllingatah shrinu "these are the thirteen disorders of urine; hear them by their signs"

Verses 25 and 26 name thirteen disorders of urine, and verses 27 to 49 describe them: mutraukasada, mutrajathara, mutrakrichchhra, mutrotsanga, mutrasankshaya, mutratita, vatashthila, vatabasti, ushnavata, vatakundalika, mutragranthi, vidvighata and bastikundala. Vata is in the name of four of them and appears in twelve of the thirteen descriptions; only mutratita is described without it.

We give the names and stop. The descriptions go into the urinary and genital organs in detail, and nothing in them helps a reader with a symptom. Three of the thirteen, as the table above shows, begin with holding back urine: mutrajathara, mutratita and vatabasti. Pain or difficulty passing urine needs a doctor, not a verse.

What We Leave in the Book

Much of Siddhi 9 is medicine, and we have left all of that part where it is:

• verse 8: preparations for each of the three marmas when troubled by vata;
• verses 16 to 20 and verse 24: the management of apatantraka and tandra;
• verses 27 to 49: the thirteen disorders of urine, beyond their names, with their care;
• verses 50 to 69: a procedure for physicians, its instrument and its use;
• verses 73, 77–78, 81–83, 86 and 87: what is done for the five head disorders;
• Sutrasthana 17.40: the line on acting quickly in the krimi kind of heart disease.

From verse 88 the chapter turns to nasal therapy (nasya), ending with two summary verses (118 and 119 in the Wikisource text); the handbook does not reprint that part here, and neither do we. Two causes in Sutrasthana 17.8 and a few entries in the lists of Siddhi 9.6 are left out by count, not named. No quantity of anything appears on this page.

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