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336 Speculations in the Medical Schools (CH. pitta occasions digestion; śleşman is strength and vitality, and vāyu is the source of all activities and the life of all living beings; but in the abnormal state pitta produces many diseases; śleşman is the dirt of the system and the cause of many troubles, and vāta also produces many diseases and ultimately death. The places (sthānāni) at which the affections of vāta, pitta and kapha are mostly found are thus described by Caraka: of vāta the bladder, rectum, waist and the bones of the leg, but the smaller intestine (pakvāśaya) is its particular place of affection; of pitta sweat, blood and the stomach, of which the last is the most important; of śleşman the chest, head, neck, the joints, stomach and fat, of which the chest is the most important. There are eighty affections of vāta, forty of pitta and twenty of śleşmant. But in each of these various affections of vāta, pitta and śleşman the special features and characteristics of the corresponding dośas are found. Thus Caraka in I. 20. 12–23 describes certain symptoms as leading to a diagnosis of the disease as being due to the disturbance of rāta, pitta or kapha. But a question may arise as to what may consistently with this view be considered to be the nature of vāyu, pitta and kapha. Are they only hypothetical entities, standing as symbols of a number of symptoms without any real existence? In such an interpretation reality would belong to the symptoms, and the agents of morbidity, or the dușas, would only be convenient symbols for collecting certain groups of these symptoms under one name. Wherever there is one particular set of symptoms, it is to be considered that there is disturbance of vāyu; wherever there is another set of symptoms, there is disturbance of pitta, and so
third stage is called prasāra. At this stage there is something like a fermentation of the dosas (pary'uşita-kinvodaka-pişta-samavāya iva). This is moved about by vāyu, which though inanimate, is the cause of all motor activities. When a large quantity of water accumulates at any place, it breaks the embankment and flows down and joins on its way with other streams and flows on all sides; so the dosas also flow, sometimes alone, sometimes two conjointly, and sometimes all together. In the whole body, in the half of it, or in whatever part the fermented dosas spread, there the symptoms of diseases are showered down, as it were, like water from the clouds (doso vikāram nabhasi meghavat tatra varsati). When one dosa, e.g. vāyu, spreads itself in the natural place of another dosa, e.g. pitta, the remedy of the latter will remove the former (vāyoh pitta-sthānagatasya pittavat pratīkāraḥ). The difference between prakopa and prasāra is thus described by Dalhaņa: just as when butter is first stirred up, it moves a Jittle; this slight movement is like prakopa; but, when it is continuously and violently stirred to flow out, in froths and foams, it may then be called prasāra (Susruta-samhitā, 1. 21. 18-32). The fourth stage is when the pūrva-rūpa is seen, and the fifth stage is the stage of rūpa or vyādhi (disease) (ibid. 38, 39).
i Caraka-samhitā, 1. 20. II.
