2. arśōnidānam

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Adhikarana 1 (1-2) · Śloka 2

athātō'rśasāṁ nidānaṁ vyākhyāsyāmaḥ ||1|| yathōvāca bhagavān dhanvantariḥ ||2||

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अथातोऽर्शसां निदानं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the diagnosis of arśas will be explained, as taught by the revered Dhanvantari.

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athētyādi| nidānaṁ hētulakṣaṇanirdēśaḥ||1-2||

Meaning of the commentary

The commentary explains nidāna here as the statement of causes and diagnostic features.

Key terms

arshas (arśas): A classical anorectal disease category, commonly associated with hemorrhoidal growths.
nidAna (nidāna): An account of causes and diagnostic signs.

Adhikarana 2 (3) · Śloka 3

ṣaḍarśāṁsi bhavanti vātapittakaphaśōṇitasannipātaiḥ sahajāni cēti ||3||

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षडर्शांसि भवन्ति वातपित्तकफशोणितसन्निपातैः सहजानि चेति ||३||

Meaning of the śloka

Arśas is classified into six types: those associated with vāta, pitta, kapha, blood, combined doṣas, and those present from birth.

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ṣaḍarśāṁsītyādi| nanu, vātapittakaphaśōṇitasannipātaiḥ sahajāni cētyanēnaiva ṣaṭsaṅkhyāyā labdhatvāt kathaṁ ṣaḍiti saṅkhyānirdēśaḥ? ucyatē- dvidōṣajanitārśōgaṇanāparihārārtham| yadyapi śōṇitādhiṣṭhānā vātādayō raktārśasāmārambhakāḥ, tathā'pyupacārāt ‘śōṇitajāni’ ityucyantē; yathā- ghr̥tādhiṣṭhānēnāgninā dagdhō ‘ghr̥tadagdha’ ityucyatē||3||

Meaning of the commentary

The commentary asks why the number six is explicitly stated when the listed categories already total six. It answers that the number prevents additional types produced by pairs of doṣas from being counted separately. Although vāta and the other doṣas acting in the site of blood initiate the blood-associated form, it is conventionally called 'born of blood,' just as something burned by fire supported by ghee may be called 'ghee-burned.'

Key terms

ShaDarshAMsi (ṣaḍ-arśāṃsi): The six classified forms of arśas.
shoNitajAni (śoṇita-jāni): The form conventionally described as arising from blood.
sannipAta (sannipāta): Combined involvement of all three doṣas.
sahaja: Present from birth or congenital.

Adhikarana 3 (4) · Śloka 4

tatrānātmavatāṁ yathōktaiḥ prakōpaṇairviruddhādhyaśanastrīprasaṅgōtkaṭukāsanapr̥ṣṭhayānavēgavidhāraṇādibhirviśēṣaiḥ prakupitā dōṣā ēkaśō dviśaḥ samastāḥ śōṇitasahitā vā yathōktaṁ prasr̥tāḥ pradhānadhamanīranuprapadyādhō gatvā gudamāgamya pradūṣya gudavalīrmāṁsaprarōhāñjanayanti viśēṣatō mandāgnēḥ, tathā tr̥ṇakāṣṭhōpalalōṣṭhavastrādibhiḥ śītōdakasaṁsparśanādvā kandāḥ parivr̥ddhimāsādayanti, tānyarśāṁsītyācakṣatē ||4||

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तत्रानात्मवतां यथोक्तैः प्रकोपणैर्विरुद्धाध्यशनस्त्रीप्रसङ्गोत्कटुकासनपृष्ठयानवेगविधारणादिभिर्विशेषैः प्रकुपिता दोषा एकशो द्विशः समस्ताः शोणितसहिता वा यथोक्तं प्रसृताः प्रधानधमनीरनुप्रपद्याधो गत्वा गुदमागम्य प्रदूष्य गुदवलीर्मांसप्ररोहाञ्जनयन्ति विशेषतो मन्दाग्नेः, तथा तृणकाष्ठोपललोष्ठवस्त्रादिभिः शीतोदकसंस्पर्शनाद्वा कन्दाः परिवृद्धिमासादयन्ति, तान्यर्शांसीत्याचक्षते ||४||

Meaning of the śloka

In people lacking self-restraint, doṣas may be provoked singly, in pairs, together, or with blood by factors such as incompatible or excessive eating, excessive sexual activity, prolonged squatting, riding, and suppression of natural urges. Spreading through the principal channels and descending to the rectum, they are said to disturb the folds there and produce fleshy outgrowths, especially in those with weak digestive activity. Contact or injury from grass, wood, stone, clods, cloth, and similar objects, or contact with cold water, is also said to enlarge pre-existing swellings. These growths are called arśas.

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arśasāṁ hētūn samprāpti ca darśayannāha- tatrētyādi| prakupitā dōṣā māṁsaprarōhāñjanayantīti sambandhaḥ| anātmavatām ajitēndriyāṇām| yathōktaiḥ prakōpaṇairbalavadvigrahādikrōdhaśōkādidivāsvapnādibhiḥ| viruddhaṁ bahudhā hitāhitīyōktam| strīprasaṅga ityatra praśabdēnātyantasaktiḥ pratipādyatē| ‘gudapārṣṇīsamāyōgaḥ prāhurutkaṭukāsanam’, ‘ukuḍu’ iti lōkē| aśvādīnāṁ pr̥ṣṭhēna gamanaṁ pr̥ṣṭhayānam| vēgavidhāraṇaśabdēna vātaviṇmūtrādīnāṁ vēgadhāraṇam| viruddhāśanaśabdēna guruśītābhiṣyandividāhyasātmyapramitāśanādīni gr̥hyantē| viśēṣairbhēdaiḥ| tēṣāṁ nidānamabhidhāya samprāptimāha- yathōktamityādi| prasr̥tā iti ‘kiṇvōdakapiṣṭasamavāya ivōdriktānāṁ prasarō bhavati’ (sū. 21) ityādikramēṇa prasr̥tāḥ| pradhānadhamanīḥ purīṣavāhinīḥ| anu paścāt, prapadya prāpya| gudavalīriti valistvaksaṅkōcaḥ| mandāgnērviśēṣatō'tiśayēna māṁsaprarōhāñjanayantīti sambandhaḥ| tathā tr̥ṇētyādi| parivr̥ddhimāsādayanti prāpnuvantītyarthaḥ| ācakṣata iti ‘pūrvācāryā’ ityadhyāhāraḥ||4||

Meaning of the commentary

The commentary supplies the etiological sequence: provoked doṣas produce fleshy growths. Anātmavat is glossed as a person whose senses are uncontrolled. Previously described provocations include struggle with stronger persons, anger, grief, daytime sleep, and others. The prefix in strīprasaṅga conveys extreme attachment or excess. Utkaṭukāsana is explained as squatting with the anus and heels in contact, popularly called ukuḍu, while pṛṣṭhayāna means travel on the back of a horse or similar animal. Suppression includes urges for flatus, feces, and urine. Viruddhāśana is extended to heavy, cold, channel-clogging, burning, unaccustomed, and improperly measured food. The doṣas spread as described earlier, enter the feces-carrying principal vessels, descend to the rectum, disturb its skin folds, and particularly in weak digestion form outgrowths. The final term is attributed to earlier teachers.

Key terms

viruddhAshana (viruddhāśana): Eating regarded as incompatible or otherwise unsuitable in the classical framework.
adhyashana (adhyaśana): Eating again before the preceding meal is digested or excessive superimposed eating.
utkaTukAsana (utkaṭukāsana): A prolonged squatting posture with heels near the anal region, as explained here.
vegavidhAraNa (vega-vidhāraṇa): Suppression of natural urges such as flatus, stool, or urine.
gudavalI (guda-valī): A fold of the anal canal in the text's anatomy.

Adhikarana 13 (15) · Śloka 15

sahajāni duṣṭaśōṇitaśukranimittāni, tēṣāṁ dōṣata ēva prasādhanaṁ karttavyam, viśēṣataścaitāni durdarśanāni paruṣāṇi pāṁsūni dāruṇānyantarmukhāni; tairupadrutaḥ kr̥śō'lpabhuk sirāsantatagātrō'lpaprajaḥ kṣīṇarētāḥ kṣāmasvaraḥ krōdhanō'lpāgniprāṇaḥ paramalasaśca, tathā ghrāṇaśirō'kṣināsāśravaṇarōgī, satatamantrakūjāṭōpahr̥dayōpalēpārōcakaprabhr̥tibhiḥ pīḍyatē ||15||

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सहजानि दुष्टशोणितशुक्रनिमित्तानि, तेषां दोषत एव प्रसाधनं कर्त्तव्यम्, विशेषतश्चैतानि दुर्दर्शनानि परुषाणि पांसूनि दारुणान्यन्तर्मुखानि; तैरुपद्रुतः कृशोऽल्पभुक् सिरासन्ततगात्रोऽल्पप्रजः क्षीणरेताः क्षामस्वरः क्रोधनोऽल्पाग्निप्राणः परमलसश्च, तथा घ्राणशिरोऽक्षिनासाश्रवणरोगी, सततमन्त्रकूजाटोपहृदयोपलेपारोचकप्रभृतिभिः पीड्यते ||१५||

Meaning of the śloka

Congenital arśas are attributed to affected parental reproductive blood and semen, and their assessment or management is to be determined from the responsible doṣa. They are described as difficult to see, rough, greyish, severe, and inward-facing. The affected person is thin, eats little, has prominent veins, few offspring, diminished reproductive strength, a weak voice, irritability, weak digestion and vitality, and marked lethargy. The person is also described as having disorders of smell, head, eyes, nose, and hearing, and as continually troubled by intestinal sounds, gurgling, distension, a coated or burdened feeling in the heart region, poor appetite, and related symptoms.

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śarīrēṇa saha jātānāmarśasāṁ dōṣēbhyō bhinnaṁ hētuṁ darśayannāha- sahajānītyādi| duṣṭaśōṇitaśukranimittānīti garbhagudārambhakamātraṁ bījaṁ duṣṭaṁ na sarvaṁ, sarvaduṣṭatvē hi prajōtpattirēva na syāt| ‘tēṣāṁ dōṣata ēva prasādhanaṁ kartavyamiti yēna dōṣēṇa yasya śukraśōṇitaṁ dūṣitaṁ bhavēttasya dōṣasya lakṣaṇavarṇavēdanākr̥tibhiḥ prasādhanaṁ vijñānam’ ityēkē; anyē tu ‘dōṣata iti dōṣaliṅgaṁ samīkṣya prasādhanaṁ cikitsā’ ityāhuḥ| durdarśanāni duḥkhēna dr̥śyantē, antarvidradhivadityarthaḥ| pāṁsūni dhūsarāṇi| dāruṇāni atiduḥkhakarāṇi||15||

Meaning of the commentary

The commentary distinguishes the cause of congenital lesions from doṣa-produced arśas. Only the portion of the reproductive seed forming the fetal anal region is said to be affected; if the whole seed were affected, conception could not occur. One interpretation of ‘prasādhana according to doṣa’ is diagnostic: determine the responsible doṣa through its signs, colour, pain, and form in the affected semen and blood. Another interpretation makes prasādhana treatment selected after examining doṣa signs. Durdarśana means difficult to visualize, like an internal abscess; pāṃsu means greyish, and dāruṇa means extremely distressing.

Key terms

sahaja arshas (sahaja arśas): Arśas described as congenital or present from birth.
duShTashoNitashukra (duṣṭa-śoṇita-śukra): Affected parental reproductive blood and semen in the classical etiological account.
prasAdhana (prasādhana): Interpreted either as diagnostic ascertainment or as treatment according to the doṣa.
antar mukha (antar-mukha): Facing or opening inward.
ATopa (āṭopa): Abdominal gurgling or distension in this symptom list.

Adhikarana 18 (21) · Śloka 21

arśasāṁ lakṣaṇaṁ vyāsāduktaṁ sāmānyatastu yat | tatsarvaṁ prāgvinirdiṣṭātsādhayēdbhiṣajāṁ varaḥ ||21||

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अर्शसां लक्षणं व्यासादुक्तं सामान्यतस्तु यत् | तत्सर्वं प्राग्विनिर्दिष्टात्साधयेद्भिषजां वरः ||२१||

Meaning of the śloka

The best physician should determine the general features of arshas described in detail by referring to what was set out previously.

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idānīṁ sarvēṣāmēva mēḍhrādijānāṁ vātādilakṣaṇamatidēśēna nirdiśannāha- arśasāmityādi| arśasāṁ mēḍhrādijānāṁ vātādidōṣalakṣaṇaṁ vinā yat saṅkṣēpatō lakṣaṇamuktaṁ tat sarvaṁ sādhayēt jānīyāt cikitsēdvā| kathamityāha- prāgvinirdiṣṭāditi; “prāk pūrvaṁ vyāsēna pratyēkaṁ vātādijārśōlakṣaṇamuktaṁ vīkṣyētyarthaḥ” iti gayadāsācāryaḥ; anyē tu “saṅkṣēpataḥ ṣōḍhā, vyāsatō vistarēṇa, prāgvinirdiṣṭāt pañcadaśadhā prasarāt sādhayēt” iti manyantē||21||

Meaning of the commentary

The commentary extends earlier dosha-based features to arshas arising at sites such as the genitals. Apart from the specific vata and other dosha signs, the general features stated briefly are to be determined from the earlier detailed account. Sadhayet may mean either 'should know or determine' or 'should treat.' Gayadasa understands the instruction as consulting the earlier detailed signs of each dosha type of arshas. Others distinguish six types in the concise account and fifteen modes of spread in the detailed earlier account, from which the physician should make the determination.

Key terms

arshas: The classical lesion or disease category discussed in this chapter.
sAmAnyalakShaNa (samanyalakshana): General features shared by the condition.
vyAsa (vyasa): Detailed exposition.
sAdhayet (sadhayet): May mean should determine or know, or alternatively should treat.
atidesha: Extension or application of an earlier rule to the present cases.

Adhikarana 21 (25-26) · Śloka 26

sarvāḥ syurvalayō yēṣāṁ durnāmabhirupadrutāḥ | taistu pratihatō vāyurapānaḥ sannivartatē ||25|| tatō vyānēna saṅgamya jyōtirmr̥dnāti dēhinām ||26||

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सर्वाः स्युर्वलयो येषां दुर्नामभिरुपद्रुताः | तैस्तु प्रतिहतो वायुरपानः सन्निवर्तते ||२५|| ततो व्यानेन सङ्गम्य ज्योतिर्मृद्नाति देहिनाम् ||२६||

Meaning of the śloka

When all the anal folds are affected by arshas, apana vayu is obstructed by them and cannot move outward. Joining with vyana, it is then said to weaken the person's digestive fire.

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sarvavalivyāpināmarśasāṁ pañcātmakasyāpyagnērmahānarthakaratvaṁ darśayannāha- sarvā ityādi| yēṣāṁ dēhinām| durnāmabhiḥ arśōbhiḥ| taistu arśōbhirityarthaḥ| apānō vāyuriti sambandhaḥ| sannivartatē sthitiṁ badhnāti na niḥsaratītyarthaḥ| saṅgamya militvā| jyōtiḥ pañcātmakamagniṁ, mr̥dnāti mandīkarōti| ayaṁ cōpadravaḥ, prāyēṇa sahajēṣvarśaḥsu jñēyaḥ||25-26||

Meaning of the commentary

The commentary describes the serious consequence of arshas occupying all the folds. Durnama here means arshas. The obstructed apana becomes fixed and does not pass outward; after combining with vyana, it diminishes jyotis, interpreted as the fivefold agni. This complication is said to occur especially in congenital arshas.

Key terms

sarvavalI (sarvavali): All of the anal folds.
durnAma (durnama): A euphemistic designation for arshas.
apAna vAyu (apana vayu): The form of vayu governing downward outward movement in the classical account.
vyAna (vyana): A form of vayu said here to combine with obstructed apana.
jyotis: The fivefold digestive fire or agni in the commentary.

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