The Diagnosis of Vatarakta (Gout)

Verse 1 (garuda.1.167.1)

श्रीगरुडमहापुराणम् १६७ धन्वन्तरीरुवाच । वातरक्तनिदानं ते वक्ष्ये सुश्रुत तच्छृणु । विरुद्धाध्यशनक्रोधदिवास्वप्नप्रजागरैः

śrīgaruḍamahāpurāṇam 167 dhanvantarīruvāca vātaraktanidānaṁ te vakṣye suśruta tacchṛṇu viruddhādhyaśanakrodhadivāsvapnaprajāgaraiḥ

Dhanvantari said: O Sushruta, I shall now tell you the diagnosis of vatarakta (gout); listen to that. From incompatible food, overeating, anger, sleeping by day, and staying awake by night —

Verse 2 (garuda.1.167.2)

प्रायशः सुकुमाराणां मिथ्याहारविहारिणाम् । स्थूलानां सुखिनां चापि कुप्यते वातशोणितम्

prāyaśaḥ sukumārāṇāṁ mithyāhāravihāriṇām sthūlānāṁ sukhināṁ cāpi kupyate vātaśoṇitam

— generally in persons of delicate constitution who follow improper diet and regimen, and also in the obese and the comfort-loving, vatarakta becomes provoked.

Verse 3 (garuda.1.167.3)

अग्निघातादशुद्धेश्च नृणामसृजि दूषिते । वातलैः शीतलैर्वायुर्वृद्धः क्रुद्धो विमार्गगः

agnighātādaśuddheśca nṛṇāmasṛji dūṣite vātalaiḥ śītalairvāyurvṛddhaḥ kruddho vimārgagaḥ

From impairment of the digestive fire and from impurity, when a man's blood becomes corrupted, the wind, increased by wind-provoking and cold factors, becomes provoked and strays from its proper course —

Verse 4 (garuda.1.167.4)

तादृशैवासृजा रुद्धः प्राक्तदैव प्रदूषयेत् । तथा वातो गुदे पीडां बलासं वातशोणितम्

tādṛśaivāsṛjā ruddhaḥ prāktadaiva pradūṣayet tathā vāto gude pīḍāṁ balāsaṁ vātaśoṇitam

— obstructed by that very corrupted blood, it at once corrupts it further; thus the wind produces pain at the anus, a phlegm-like discharge, and vatarakta.

Verse 5 (garuda.1.167.5)

संस्तभ्य जनयेत्पूर्वं पश्चात्सर्वत्र धावति । विशेषाद्वमनाद्यैश्च प्रलम्बस्तस्य लक्षणम्

saṁstabhya janayetpūrvaṁ paścātsarvatra dhāvati viśeṣādvamanādyaiśca pralambastasya lakṣaṇam

It first fixes itself and produces the disease in one place, and afterward courses everywhere; especially when aggravated by vomiting and the like, a pendulous swelling is its sign.

Verse 6 (garuda.1.167.6)

भविष्यतः कुष्ठसमं तथा साम्बुदसंज्ञकम् । जानुजङ्घोरुकट्यंसहस्तपादाङ्गसन्धिषु

bhaviṣyataḥ kuṣṭhasamaṁ tathā sāmbudasaṁjñakam jānujaṅghorukaṭyaṁsahastapādāṅgasandhiṣu

This disease, as it develops, resembles kushtha and is also known by the name sambuda; in the knees, calves, thighs, waist, shoulders, hands, feet, and joints of the limbs —

Verse 7 (garuda.1.167.7)

कण्डूस्फुरणनिस्तोदभेदगौरवसुप्तताः । भूत्वा भूत्वा प्रशाम्यन्ति मुहुराविर्भवन्ति च

kaṇḍūsphuraṇanistodabhedagauravasuptatāḥ bhūtvā bhūtvā praśāmyanti muhurāvirbhavanti ca

— itching, throbbing, stinging pain, a tearing sensation, heaviness, and numbness arise again and again, subsiding and reappearing by turns.

Verse 8 (garuda.1.167.8)

पादयोर्मूलमास्थाय कदाचिद्धस्तयोरपि । आखोरिव विलं क्रुद्धः कृत्स्नं देहं बिधावति

pādayormūlamāsthāya kadāciddhastayorapi ākhoriva vilaṁ kruddhaḥ kṛtsnaṁ dehaṁ bidhāvati

Taking hold at the base of the feet, and sometimes of the hands too, the provoked disease runs through the whole body like a rat through its burrow.

Verse 9 (garuda.1.167.9)

त्वङ्मांसाश्रयमत्तानं तत्पूर्वं जायते ततः । कालान्तरेण गम्भीरं सर्वधातूनभिद्रवेत्

tvaṅmāṁsāśrayamattānaṁ tatpūrvaṁ jāyate tataḥ kālāntareṇa gambhīraṁ sarvadhātūnabhidravet

At first it lodges only superficially in the skin and flesh; but with the passage of time it penetrates deeper and invades all the bodily tissues.

Verse 10 (garuda.1.167.10)

कट्यादिसंयतस्थाने त्वक्ताम्रश्यावलोहिताः । श्वयथुर्ग्रथितः पाकः स वायुश्चास्थिमज्जसु

kaṭyādisaṁyatasthāne tvaktāmraśyāvalohitāḥ śvayathurgrathitaḥ pākaḥ sa vāyuścāsthimajjasu

At the fixed sites — the waist and the like — the skin turns coppery, dusky, or red; there is knotted swelling and suppuration, and that wind penetrates to the bones and marrow.

Verse 11 (garuda.1.167.11)

छिन्दन्निव चरत्यन्तश्चकीकुर्वंश्च वेगवान् । करोति खञ्जं पङ्गुं वा शरीरं सर्वतश्चरन्

chindanniva caratyantaścakīkurvaṁśca vegavān karoti khañjaṁ paṅguṁ vā śarīraṁ sarvataścaran

It moves within as though cutting, making a creaking sound, and courses forcefully; roaming through the whole body, it makes the person lame or utterly crippled.

Verse 12 (garuda.1.167.12)

वाताधिकेऽधिकं तत्र शूलस्फुरणभञ्जनम् । शोथस्य रौक्ष्यं कृष्णत्वं श्यावतावृद्धिहानयः

vātādhike'dhikaṁ tatra śūlasphuraṇabhañjanam śothasya raukṣyaṁ kṛṣṇatvaṁ śyāvatāvṛddhihānayaḥ

Where vata predominates, there is greater colic pain, throbbing, and a sense of breaking; the swelling is dry, blackish, dusky, and alternately increases and subsides.

Verse 13 (garuda.1.167.13)

धमन्यङ्गुलिसन्धीनां संकोचोङ्गग्रहो तिरुक् । शीतद्वेषानुपशयौ स्तम्भवेपथुसुप्तयः

dhamanyaṅgulisandhīnāṁ saṁkocoṅgagraho tiruk śītadveṣānupaśayau stambhavepathusuptayaḥ

There is contraction of the vessels and finger-joints, seizure of the limbs, and severe pain; aversion to cold, absence of relief from remedies, stiffness, trembling, and numbness.

Verse 14 (garuda.1.167.14)

रक्ते शोथोऽतिरुक्तोदस्ताम्राश्चिमिचिमायते । स्निग्धरूक्षैः समं नैति कण्डुक्लेदसमन्वितः

rakte śotho'tiruktodastāmrāścimicimāyate snigdharūkṣaiḥ samaṁ naiti kaṇḍukledasamanvitaḥ

In the type dominated by blood, the swelling causes intense pain and pricking, is coppery in colour, and tingles; it responds neither to unctuous nor to dry remedies equally, and is accompanied by itching and moisture.

Verse 15 (garuda.1.167.15)

पित्ते विदाहः संमोहः स्वादो मूर्छा मदस्तृषा । स्पर्शासहत्वं रुग्रावः शोषः पाको भृशोष्मता

pitte vidāhaḥ saṁmohaḥ svādo mūrchā madastṛṣā sparśāsahatvaṁ rugrāvaḥ śoṣaḥ pāko bhṛśoṣmatā

In the type dominated by pitta, there is burning, confusion, a strange taste, fainting, an intoxication-like delirium, and thirst; touch becomes unbearable, there is pain accompanied by sound, wasting, suppuration, and intense heat.

Verse 16 (garuda.1.167.16)

कफे स्तैमित्यगुरुता सुप्तिस्निग्धत्वशीतता । कण्डूर्मन्दा च रुग्द्बन्द्वं सर्वलिङ्गञ्च संकरात्

kaphe staimityagurutā suptisnigdhatvaśītatā kaṇḍūrmandā ca rugdbandvaṁ sarvaliṅgañca saṁkarāt

In the type dominated by kapha, there is heaviness, numbness, unctuousness, and coldness, along with mild itching and pain. Where two doshas combine, the signs of both appear; where all combine, all the signs appear together.

Verse 17 (garuda.1.167.17)

एकदोषञ्च संसाध्यं याप्यञ्चैव द्विदोषजम् । त्रिदोषजन्त्यजेदाशु रक्तपित्तं सुदारुणम्

ekadoṣañca saṁsādhyaṁ yāpyañcaiva dvidoṣajam tridoṣajantyajedāśu raktapittaṁ sudāruṇam

That arising from a single dosha is fully curable; that from two doshas is only manageable; that from all three should be abandoned at once — it is exceedingly dreadful, as grave as a hemorrhagic disorder.

Verse 18 (garuda.1.167.18)

रक्तमङ्गे निहन्त्याशु शाखासन्धिषु मारुतः । निवेश्यान्योन्यमावार्य वेदनाभिर्हरत्यसून्

raktamaṅge nihantyāśu śākhāsandhiṣu mārutaḥ niveśyānyonyamāvārya vedanābhirharatyasūn

It quickly destroys the blood in the limbs; the wind, lodging in the branches and joints and mutually obstructing them, takes away life through its pains.

Verse 19 (garuda.1.167.19)

वायौ पञ्चात्मके प्राणे रौक्ष्याच्चापल्यलङ्घनैः । अत्याहाराभिघाताच्च वेगोदीरणचारणैः

vāyau pañcātmake prāṇe raukṣyāccāpalyalaṅghanaiḥ atyāhārābhighātācca vegodīraṇacāraṇaiḥ

Now, of the fivefold wind: the prana sub-type — from dryness, restlessness, and fasting, from overeating and injury, and from suppressing the natural urges and excessive movement —

Verse 20 (garuda.1.167.20)

कुपितश्चक्षुरादीनामुपघातं प्रकल्पयेत् । पीनसो दाहतृट्कासश्वासादिश्चैव जायते

kupitaścakṣurādīnāmupaghātaṁ prakalpayet pīnaso dāhatṛṭkāsaśvāsādiścaiva jāyate

— when provoked, causes damage to the eyes and other sense-organs; catarrh, burning, thirst, cough, and breathlessness among other things arise from it.

Verse 21 (garuda.1.167.21)

कण्ठरोधोमलभ्रंशच्छर्द्यरोचकपीनसान् । कुर्याच्च गलगण्डदींस्तञ्जत्रुमूर्ध्वसंश्रयः

kaṇṭharodhomalabhraṁśacchardyarocakapīnasān kuryācca galagaṇḍadīṁstañjatrumūrdhvasaṁśrayaḥ

It produces obstruction of the throat, retention of stool, vomiting, loss of appetite, and catarrh; and, lodged above the collarbone, it produces goitre and similar conditions.

Verse 22 (garuda.1.167.22)

व्यानोऽतिगमनस्नानक्रीडाविषयचोष्टितैः । विरुद्धरूक्षभीहर्षविषादाद्यैश्च दूषितः

vyāno'tigamanasnānakrīḍāviṣayacoṣṭitaiḥ viruddharūkṣabhīharṣaviṣādādyaiśca dūṣitaḥ

Vyana vayu — corrupted by excessive walking, bathing, playing, indulgence in sensory pleasures, and by incompatible food, dryness, fear, excitement, and dejection —

Verse 23 (garuda.1.167.23)

पुंस्त्वोत्साहबलभ्रंशशोकचित्तप्लवज्वरान् । सर्वाकारादिनिस्तोदरोमहर्षं सुषुप्तताम्

puṁstvotsāhabalabhraṁśaśokacittaplavajvarān sarvākārādinistodaromaharṣaṁ suṣuptatām

— produces loss of virility, enthusiasm, and strength, grief, mental agitation, fever, pricking pain of every kind, horripilation, and excessive numbness.

Verse 24 (garuda.1.167.24)

कुष्ठं विसर्पमन्यच्च कुर्यात्सर्वाङ्गसादनम् । समानो विषमाजीर्णशीतसङ्कीर्णभोजनैः

kuṣṭhaṁ visarpamanyacca kuryātsarvāṅgasādanam samāno viṣamājīrṇaśītasaṅkīrṇabhojanaiḥ

It also produces kushtha, visarpa, and other conditions, together with exhaustion of the whole body. Samana vayu — from irregular, undigested, cold, and mixed food —

Verse 25 (garuda.1.167.25)

करोत्यकालशयनजागराद्यैश्च दूषितः । शूलगुल्मग्रहण्यादीन्यकृत्कामाश्रयान्गदान्

karotyakālaśayanajāgarādyaiśca dūṣitaḥ śūlagulmagrahaṇyādīnyakṛtkāmāśrayāngadān

— and when corrupted also by untimely sleeping and waking, produces colic, abdominal tumours, disorders like grahani (chronic diarrhoea), and diseases lodged in the liver.

Verse 26 (garuda.1.167.26)

अपानो रूक्षगुर्वन्नवेगाघातातिवाहनैः । यानपानसमुत्थानचङ्क्रमैश्चातिसेवितैः

apāno rūkṣagurvannavegāghātātivāhanaiḥ yānapānasamutthānacaṅkramaiścātisevitaiḥ

Apana vayu — provoked by dry and heavy food, the suppression and forcing of natural urges, excessive travel and vehicular journeys, over-drinking, rising suddenly, and excessive walking —

Verse 27 (garuda.1.167.27)

कुपितः कुरुते रोगान्कृत्स्नान् पक्वाशयाश्रयान् । मूत्रसुक्रप्रदोषार्शोगुदभ्रंशादिकान्बहून्

kupitaḥ kurute rogānkṛtsnān pakvāśayāśrayān mūtrasukrapradoṣārśogudabhraṁśādikānbahūn

— when provoked, produces all the diseases lodged in the large intestine, and many disorders such as corruption of urine and semen, piles, and prolapse of the rectum.

Verse 28 (garuda.1.167.28)

सर्वाङ्गमाततं सामं तन्द्रास्तैमित्यगौरवैः । स्निग्धत्वाद्बोध कालस्य शैत्यशोथाग्निहानयः

sarvāṅgamātataṁ sāmaṁ tandrāstaimityagauravaiḥ snigdhatvādbodha kālasya śaityaśothāgnihānayaḥ

When this disease, mixed with ama (undigested matter), spreads through the whole body, there is drowsiness, heaviness, and dullness; from its unctuous nature and the time of onset one can discern coldness, swelling, and loss of digestive fire.

Verse 29 (garuda.1.167.29)

कण्डूरूक्षातिनाशेन तद्विधोपशमेन च । मुक्तिं विद्यान्निरामं तं तन्द्रादीनां विपर्ययात्

kaṇḍūrūkṣātināśena tadvidhopaśamena ca muktiṁ vidyānnirāmaṁ taṁ tandrādīnāṁ viparyayāt

When itching and excessive dryness disappear and such symptoms subside, one should know the disease to be free of ama and moving toward cure; the same is understood from the reversal of drowsiness and the like.

Verse 30 (garuda.1.167.30)

वायोरावरणं वातो बहुभेदं प्रचक्षते । पित्तलिङ्गावृते दाहस्तृष्णा शूलं भ्रमस्तमः

vāyorāvaraṇaṁ vāto bahubhedaṁ pracakṣate pittaliṅgāvṛte dāhastṛṣṇā śūlaṁ bhramastamaḥ

The obstruction of one sub-type of vata by another factor is described as of many kinds. When obstructed by the signs of pitta, there is burning, thirst, colic pain, giddiness, and dimness of vision —

Verse 31 (garuda.1.167.31)

कटुकोष्णाम्ललवणैर्विदाहशीतकामता । शैत्यगौरवशूलाग्निकट्वाज्यपयसोऽधिकम्

kaṭukoṣṇāmlalavaṇairvidāhaśītakāmatā śaityagauravaśūlāgnikaṭvājyapayaso'dhikam

— pungent, hot, sour, and salty foods aggravate the burning, and there is a craving for coolness. When obstructed by kapha, there is coldness, heaviness, colic pain, weak digestion, and distress from excess pungent food, ghee, and milk —

Verse 32 (garuda.1.167.32)

लङ्घनायासरूक्षोष्णकामता च कफावृते । कफावृतेऽङ्गमर्दः स्याद्धृल्लासो गुरुतारुचिः

laṅghanāyāsarūkṣoṣṇakāmatā ca kaphāvṛte kaphāvṛte'ṅgamardaḥ syāddhṛllāso gurutāruciḥ

— and a craving for fasting, exertion, dryness, and heat. When obstructed by kapha, there is aching of the limbs, nausea, heaviness, and loss of appetite.

Verse 33 (garuda.1.167.33)

रक्तवृते सदाहार्तिस्तवङ्मांसाश्रयजा भृशम् । भवेत्सरागः श्वयथुर्जायन्ते मण्डलानि च

raktavṛte sadāhārtistavaṅmāṁsāśrayajā bhṛśam bhavetsarāgaḥ śvayathurjāyante maṇḍalāni ca

When obstructed by blood, there is intense burning distress, arising in the skin and flesh; the swelling carries redness, and circular patches (mandala) appear.

Verse 34 (garuda.1.167.34)

शोथो मांसेन कठिनो हृल्लासपिटिकास्तथा । हर्षः पिपीलिकानां च संचार इव जायते । चललग्रनो मृदुः शीतः शोथो गात्रेषु रोचकः

śotho māṁsena kaṭhino hṛllāsapiṭikāstathā harṣaḥ pipīlikānāṁ ca saṁcāra iva jāyate calalagrano mṛduḥ śītaḥ śotho gātreṣu rocakaḥ

When obstructed by flesh, the swelling is hard, with nausea and small blisters, and there is a tingling as though ants were crawling. When obstructed by fat, the swelling is mobile, deep-rooted, soft, and cold, and the limbs' appetite for food is affected.

Verse 35 (garuda.1.167.35)

आढ्यवात इव ज्ञेयः स कृच्छ्रो मेदसावतः । स्पर्श आच्छादितेत्युष्णशीतलश्च त्वनावृते । मज्जावृते तु विषमं जृम्भणं परिवेष्टनम्

āḍhyavāta iva jñeyaḥ sa kṛcchro medasāvataḥ sparśa ācchāditetyuṣṇaśītalaśca tvanāvṛte majjāvṛte tu viṣamaṁ jṛmbhaṇaṁ pariveṣṭanam

This form arising from fat should be known as resembling adhyavata (a severe gout), difficult to cure; to the touch it feels as though covered, and warm in some places, cool in others. When obstructed by marrow, there is irregular yawning and a sensation as though the body were tightly wrapped —

Verse 36 (garuda.1.167.36)

शूलञ्च पड्यिमानश्च पाणिभ्यां लभते सुखम् । शुक्रावृते तु शोथे वै चातिवेगो न विद्यते

śūlañca paḍyimānaśca pāṇibhyāṁ labhate sukham śukrāvṛte tu śothe vai cātivego na vidyate

— and colic pain also occurs; pressing with the hands brings relief. When obstructed by semen, there is swelling but not with excessive severity.

Verse 37 (garuda.1.167.37)

भुक्ते कुक्षौ रुजा जीर्णे निकृत्तिर्भवति ध्रुवम् । मूत्राप्रवृत्तिराध्मानं बस्तेर्मूत्रावृते भवेत्

bhukte kukṣau rujā jīrṇe nikṛttirbhavati dhruvam mūtrāpravṛttirādhmānaṁ bastermūtrāvṛte bhavet

After eating, there is pain in the flank, and once digested, a cutting pain certainly follows. When obstructed by urine, there is retention of urine and distension of the bladder.

Verse 38 (garuda.1.167.38)

छिद्रावृते विबन्धोऽथ स्वस्थानं परिकृन्त ति । पतत्याशु ज्वराक्रान्तो मूर्छां च लभते नरः

chidrāvṛte vibandho'tha svasthānaṁ parikṛnta ti patatyāśu jvarākrānto mūrchāṁ ca labhate naraḥ

When obstructed at the perforations of the channels, there is constipation, and the disease erodes its own site; the patient, quickly seized by fever, falls and faints.

Verse 39 (garuda.1.167.39)

सकृत्पीडितमन्येन दुष्टं शुक्रं चिरात्सृजेत् । सर्वधात्वावृते वायौ श्रोणिवङ्क्षणपृष्ठरुक्

sakṛtpīḍitamanyena duṣṭaṁ śukraṁ cirātsṛjet sarvadhātvāvṛte vāyau śroṇivaṅkṣaṇapṛṣṭharuk

The semen, once compressed by another obstructing element, becomes corrupted and is released only after a long time. When the wind is obstructed by all the tissues together, there is pain in the pelvis, groin, and back.

Verse 40 (garuda.1.167.40)

विलोमे मारुते चैव हृदयं परिपीड्यते । भ्रमो मूर्छा रुजा दाहः पित्तेन प्राण आवृते

vilome mārute caiva hṛdayaṁ paripīḍyate bhramo mūrchā rujā dāhaḥ pittena prāṇa āvṛte

When the wind moves against its natural course, the heart is severely afflicted; when prana is obstructed by pitta, there is giddiness, fainting, pain, and burning.

Verse 41 (garuda.1.167.41)

रुजा तन्द्रा स्वरभ्रंशो दाहो व्याने तु सर्वशः । क्रमों गचेष्टाभङ्गश्च सन्तापः सहवेदनः

rujā tandrā svarabhraṁśo dāho vyāne tu sarvaśaḥ kramoṁ gaceṣṭābhaṅgaśca santāpaḥ sahavedanaḥ

When vyana is obstructed, there is pain, drowsiness, loss of voice, and burning everywhere; there is also irregularity of gait, disruption of movement, distress, and continual pain.

Verse 42 (garuda.1.167.42)

समान ऊष्मोपहतिः सस्वेदोपरतिः सुतृट् । दाहश्च स्यादपाने तु मले हारिद्रवर्णता

samāna ūṣmopahatiḥ sasvedoparatiḥ sutṛṭ dāhaśca syādapāne tu male hāridravarṇatā

When samana is obstructed, there is loss of the digestive heat, cessation of sweating, and intense thirst. When apana is obstructed, there is burning, and the stool turns turmeric-yellow —

Verse 43 (garuda.1.167.43)

रजोवृद्धिस्तापनञ्च तथा चानाहमेहनम् । श्लेष्मणा प्रावृते प्राणे नादः स्नोतोऽवरोधनम्

rajovṛddhistāpanañca tathā cānāhamehanam śleṣmaṇā prāvṛte prāṇe nādaḥ snoto'varodhanam

— together with increased menstrual flow and burning, as well as distension and difficulty in urination. When prana is obstructed by kapha, there is a rattling sound and obstruction of the channels —

Verse 44 (garuda.1.167.44)

ष्ठीवनञ्चैव सस्वेदश्वासनिः श्वाससंग्रहः । उदाने गुरुगात्रत्वमरुचिर्वाक्स्वरग्रहः

ṣṭhīvanañcaiva sasvedaśvāsaniḥ śvāsasaṁgrahaḥ udāne gurugātratvamarucirvāksvaragrahaḥ

— spitting, sweating, and obstruction of both inhalation and exhalation. When udana is obstructed, there is heaviness of the limbs, loss of appetite, and impairment of voice and speech.

Verse 45 (garuda.1.167.45)

बलवर्णप्रणाशश्चा पाने पर्वास्थिसंग्रहः । गुरुताङ्गेषु सर्वेषु स्थूलत्वञ्चागतं भृशम्

balavarṇapraṇāśaścā pāne parvāsthisaṁgrahaḥ gurutāṅgeṣu sarveṣu sthūlatvañcāgataṁ bhṛśam

There is destruction of strength and complexion. When apana is obstructed, there is stiffness in the joints and bones, heaviness throughout all the limbs, and a sudden excessive stoutness.

Verse 46 (garuda.1.167.46)

समानेऽतिक्रियाज्ञत्वमस्वेदो मन्दवह्निता । अपाने सकलं मूत्रं शकृतः स्यात्प्रवर्तनम्

samāne'tikriyājñatvamasvedo mandavahnitā apāne sakalaṁ mūtraṁ śakṛtaḥ syātpravartanam

When samana is obstructed, there is inability to perform the normal digestive functions, absence of sweating, and weak digestive fire. When apana is obstructed, urine is entirely retained, and only the stool passes.

Verse 47 (garuda.1.167.47)

इति द्वाविंशतिविधं वातरक्तामयं विदुः । प्राणादयस्तथान्योऽन्यं समाक्रान्ता यथाक्रमम्

iti dvāviṁśatividhaṁ vātaraktāmayaṁ viduḥ prāṇādayastathānyo'nyaṁ samākrāntā yathākramam

Thus vatarakta is known to be of twenty-two kinds; in this manner, prana and the other four winds, in due order, obstruct one another.

Verse 48 (garuda.1.167.48)

सर्वेऽपि विंशतिविधं विद्यादावरणञ्च यत् । हृल्लासोच्छ्वाससंरोधः प्रतिश्यायः शिरोग्रहः

sarve'pi viṁśatividhaṁ vidyādāvaraṇañca yat hṛllāsocchvāsasaṁrodhaḥ pratiśyāyaḥ śirograhaḥ

All these together should be known as making twenty kinds of obstruction: there is nausea, obstruction of breathing, catarrh, and seizure of the head —

Verse 49 (garuda.1.167.49)

हृद्रोगो मुखशोषश्च प्राणेनापान आवृते । उदानेनावृते प्राणे भवेद्धै बलसंक्षयः

hṛdrogo mukhaśoṣaśca prāṇenāpāna āvṛte udānenāvṛte prāṇe bhaveddhai balasaṁkṣayaḥ

— heart disease and dryness of the mouth, when apana is obstructed by prana. When prana is obstructed by udana, there occurs a decline in strength.

Verse 50 (garuda.1.167.50)

विचारणेन विभजेत्सर्वमावरणं भिषक् । स्थानान्यपेक्ष्य वातानां वृर्धिहानिं च कर्मणाम्

vicāraṇena vibhajetsarvamāvaraṇaṁ bhiṣak sthānānyapekṣya vātānāṁ vṛrdhihāniṁ ca karmaṇām

The physician should carefully classify all these kinds of obstruction by examining the seats of the several winds and the increase or decrease of their functions.

Verse 51 (garuda.1.167.51)

प्राणादीनाञ्च पञ्चानां पित्तमावरणं मिथः । पित्तादीनामावसतिर्मिश्राणां मिश्रितैश्च तैः

prāṇādīnāñca pañcānāṁ pittamāvaraṇaṁ mithaḥ pittādīnāmāvasatirmiśrāṇāṁ miśritaiśca taiḥ

Pitta too may, in turn, obstruct each of the five winds beginning with prana; and the seats of pitta and the rest may likewise be obstructed by mixed combinations of these —

Verse 52 (garuda.1.167.52)

मिश्रैः पित्तादिभिस्तद्वन्मिश्राण्यपित्वनेकधा । तांल्लक्षयेदवहितो यथास्वं लक्षणोदयात्

miśraiḥ pittādibhistadvanmiśrāṇyapitvanekadhā tāṁllakṣayedavahito yathāsvaṁ lakṣaṇodayāt

— just as mixtures of pitta and the rest occur in many combined ways. The physician should carefully identify these by the arising of their own respective signs —

Verse 53 (garuda.1.167.53)

शनैः शनैश्चोपशयान्दृढानपि मुहुर्मुहुः । विशेषाज्जीवितं प्राण उदानो बलमुच्यते । स्यात्तयोः पीडनाद्धनिरायुषञ्च बलस्य च

śanaiḥ śanaiścopaśayāndṛḍhānapi muhurmuhuḥ viśeṣājjīvitaṁ prāṇa udāno balamucyate syāttayoḥ pīḍanāddhanirāyuṣañca balasya ca

— gradually, again and again, testing even firmly established remedies. Especially, prana is called life itself, and udana is called strength; the affliction of these two brings about the destruction of both life and strength.

Verse 54 (garuda.1.167.54)

आवृता वायवोऽज्ञाता ज्ञाता वा स्थानविच्युताः । प्रयत्नेनापि दुः साध्या भवेयुर्वानुपद्रवाः

āvṛtā vāyavo'jñātā jñātā vā sthānavicyutāḥ prayatnenāpi duḥ sādhyā bhaveyurvānupadravāḥ

Winds that are obstructed, whether recognized or unrecognized, and displaced from their proper seats, may — even with careful effort — prove hard to cure, or else remain free of complications.

Verse 55 (garuda.1.167.55)

विद्रधिप्लीहहृद्रोगगुल्माग्निसदनादयः । भवन्त्युपद्रवास्तेषामावृतानामुपेक्षया

vidradhiplīhahṛdrogagulmāgnisadanādayaḥ bhavantyupadravāsteṣāmāvṛtānāmupekṣayā

If neglected, these obstructions give rise to complications such as abscess, enlargement of the spleen, heart disease, abdominal tumour, and loss of digestive fire.

Verse 56 (garuda.1.167.56)

निदानं सुश्रुत ! मया आत्रेयोक्तं समीरितम् । सर्वरोगविवेकाय नराद्यायुः प्रवृद्धये

nidānaṁ suśruta ! mayā ātreyoktaṁ samīritam sarvarogavivekāya narādyāyuḥ pravṛddhaye

O Sushruta, this diagnosis, as taught by Atreya, I have thus declared to you, for the discernment of all diseases and for the increase of the lifespan of mankind and other beings.

Verse 57 (garuda.1.167.57)

एवं विज्ञाय रोगादींश्चिकित्सामथ वै चरेत् । त्रिफला सर्वरोगघ्नी मध्वाज्यगुडसंयुता

evaṁ vijñāya rogādīṁścikitsāmatha vai caret triphalā sarvarogaghnī madhvājyaguḍasaṁyutā

Having thus understood the diseases, one should then proceed with treatment. Triphala, taken with honey, ghee, and jaggery, destroys all diseases —

Verse 58 (garuda.1.167.58)

सव्योषा त्रिफला वापि सर्वरोगप्रमर्दिनी । शतावरीगुडूच्यग्निविडङ्गेन युताथवा

savyoṣā triphalā vāpi sarvarogapramardinī śatāvarīguḍūcyagniviḍaṅgena yutāthavā

— or triphala combined with the three pungent spices likewise crushes all diseases; or it may be combined with shatavari, guduchi, chitraka, and vidanga —

Verse 59 (garuda.1.167.59)

शतावरी गुडूच्यग्निः शुण्ठीमूषलिका बला । पुनर्नवा च बृहती निर्गुण्डी निम्बपत्रकम्

śatāvarī guḍūcyagniḥ śuṇṭhīmūṣalikā balā punarnavā ca bṛhatī nirguṇḍī nimbapatrakam

— shatavari, guduchi, chitraka, dry ginger, mushalika, bala, punarnava, brihati, nirgundi, and neem leaves —

Verse 60 (garuda.1.167.60)

भृङ्गराजश्चामलकं वासकस्तद्रसेन वा । भाविता त्रिफला सप्तवारमेखमथापिवा

bhṛṅgarājaścāmalakaṁ vāsakastadrasena vā bhāvitā triphalā saptavāramekhamathāpivā

— bhringaraja, amalaki, and vasaka: with the juice of these, triphala may be soaked and processed seven times, or even once.

Verse 61 (garuda.1.167.61)

पूर्वोक्तश्च यथालाभयुक्तैश्चूर्णञ्च मोदकः । वटिका घृततैलं वा कषायो शोषरोगनुत् । पलं पलार्धकं वापि कर्षं कर्षार्धमेव वा

pūrvoktaśca yathālābhayuktaiścūrṇañca modakaḥ vaṭikā ghṛtatailaṁ vā kaṣāyo śoṣaroganut palaṁ palārdhakaṁ vāpi karṣaṁ karṣārdhameva vā

Combined, as available, with the previously mentioned herbs, and taken as powder, sweet balls, pills, medicated ghee or oil, or decoction — this destroys the wasting disease (vatarakta); its dose should be one pala, half a pala, one karsha, or half a karsha.