Vol.63 , No.3(2015)204森口 眞衣「『スシュルタサンヒター』における疾病概念とトリ・ドーシャ説」

The Japanese Association of Indian and Buddhist Studies

NII-Electronic Library Service

The JapaneseAssociation of Indian and Buddhist Studies

Jburnal

_of1}idian

andBucftthist

Studies

Vbl.

63,

No.

3,

March

2015

(89)

The

Concept

ofDiseases

and

the

tri-dosa

Theory

in

the

Sus'rutasamhitd

.

MoRiGucHi

Mai

For

ancient

human

who _{relied on}

hunting

it

_was

thought

_that

_poor

health

_{was caused}

pri-marily

by

external

iajury.

When

humans

began

settling

into

farming-based

societies,

con-tact

with others

increased,

and

infection

began

to

spread more readily.

Western

medicine, which

has

its

origin

in

Greek

medicine, created

the

"four cardinal

humors"

theory,

and

the

theory

eventually

became

commonplace.

However,

with

the

invention

of

the

microscope

in

the

16th

century,

it

was revealed

that

disease

was caused

by

_pathological

change at

the

cel-lular

level.

This

discovery

spurred

the

development

of cytopathology,

leading

to

the

mod-ern viewpoint

investigating

_pathology

based

on clinical observation ofthe affbcted organ.

In

the

Indian

rnedical system,

the

theory

ofhumors,

known

as

the

tri-dosa

theory,

is

con-sidered a

fundamental

basis

ofpathology

in

a manner similar

to

the

Greek

medical system,

and

disease

concept

in

medical

textbooks

have

been

described

based

on

the

tri-dosa

theory.

However,

this

is

not so at

least

in

the

SbiSrutasamhita

(

=

SS)

.

One

portion

of

this

Nepalese

manuscript

(within

the

Uirtaratantra

of

SS

=

Ut)

, omits explanation of

the

disease

using

the

tri-dosa

theory,

in

contrast

to

current editions.

This

change was recently raised

by

an-other

investigator.

i)

Should

SS

be

described

using

the

tri-dosa

theory?

In

the

Indian

medical system, what will

the

relationship

be

between

the

tri-dosa

theory

and

the

theory

of

disease?

The

_present

articleexamines

the

incorporation

of

the

tri-dosa

theory

in

the

Si2trasthana

(

=

Ss)

,

Mdana-sthdna

(

=

Ns)

, and

Ut,

and

potential

concems raised

by

each.

2)

Su-trastha-na

Ss

provides

an

introduction

to

Indian

medicine.

Section

1.1

(veda-utpatti)

and

1.24

(vyadhisamuddeSiva)

of

the

text

_provide

definitions

and

classifications

of

the

disease

(vyadhi).

Disease

is

initially

defined

as "what

gives

pain"

and

is

classified

into

four

types

as

fo11ows:

Accidental

(agantu):

external

iajury

Physical

(S5rira)

:eating and

drinking,

tnLdosa,

blood

-1183-The Japanese Association of Indian and Buddhist Studies

The JapaneseAssociation ofIndian andBuddhistStudies

(90)

The

Concept

ofDiseases and

the

tri-dbsa

Theory

in

the

ShrSrtttasarphith

(M.

MoRiGuci{i)

Mental

(mAnasa)

:

disorder

of

feeling

Natural

(svabhavika)

:starvation,

death

from

old age, sleep

In

1.24,

diseases

are roughly categorized according

to

whether surgical or medical

treat-ment

is

_possible.

Pain

is

also

defined

in

1.1

and classified

into

seven

types

and

lew

lank

classifications.

<[[Ype

ofpain>

(A)

adhyatmika

(B)adhibhautika

(C)

5dhidaivika

<Seven

disease

_types>

(1)

adibala

_pravptta

(2)

janmabala

pravptta

(3)

dosabala

_pravTtta

(4)

sarpghatabalapravrtta

(5)

kalabalapravptta

(6)

daivabala

_pravptta

(7)

svabhavabala

_pravptta

Generally,

in

the

medical

diagnosis

which

_present-day

we

know,

the

cause

are classified

into

the

external causes and

the

internal

cause.

Diseases

with external causes

are

influenced

by

the

external environment

including

social, scientific, nutritional,

physi-cal, and

biological

factors.

Diseases

attributed

internal

causes occur

due

to

_pathological

changes

in

the

body

exclusive of

the

external environment such as

_genetic

disease,

meta-bolic

disease,

aging, and others.

ln

the

classification scheme

described

in

Ss,

iajury,

weather, and magical events

(an

an-cient medical

cause)

are

considered

external causes.

However,

the

tri-dbsa

theory

is

only one component of

this

classification scheme and

is

categorized a

_physical

factor.

Therefbre,

the

tri-dosa

theory

does

not address

the

underlying etiology.

Ai)ida-nastha-na

Ns

advocates

the

cause of

diseases

(

== _nidana)

in

the

_chapter

title,

which raises

the

_question

ofwhere

it

places

the

tri-dosa

theory.

This

sth5na comprises

16

-1184-<Low

lank

classification>

(1.1)

matna

(1.2)

pitnia

(2.1

)

rasakpta-klrta

(2.2)

dauhrdapacara-kpta

(3.1)

Sarira

(3.2)

manasa

(4.1)

Sastra-krta

(4.2)

vyala-k#a

(5.1)

vyEpannal:tu-klta

(5.2)

avyapannartu-krta

(6.1)

athavarpa-kyta

(62)

upasargaja

(7.1)

kalaja

(7.2)

akAlaja of

diseases

The Japanese Association of Indian and Buddhist Studies

NII-Electronic Library Service

The JapaneseAssociation of Indian and BuddhistStudies

The

Concept

ofDiseases and

the

tri-dofa

Theory

in

the

SuSrutasamphitb

(M,

MoklGucHi)

(91)

seetions,

but

it

is

only

2.1

(vEtavyadhi)

that

described

the

tri-dosa

theory

as acore

compo-nent of

the

etiology. "Ihe tri-dosa

theory

is

also

included

in

2.2

(arga),2.3

(aSmari),2.4

(bhagandara),2.7

(udara),2.9

(vidradhi),

2.10

(visarpa-nfidi-stanaroga),2.11

(granthi-apaci-arbuda-galagapda) _,

2.12

(v!ddhi-upadamSa-Slipada),

and

2.16

(mukha-roga),

and

is

included

among

the

different

factors

in

each.

2.5

(kustha),2.6

(prameha),2.13

(ksu-draroga)

, and

2.14

(SUkadosa),

discuss

components

in

the

core etiology outside ofthe

tri-dosa

theory.

About

the

division

where

it

accepted

the

situation of a

fbrm

of

lesion,

the

sharp

_pain,

the

clinical

features

of

the

affected

_part

by

the

form

observation

including

the

progress

that

tri-dbsa

used, and

it

is

usage of only as a name,

besides.

2.8

(mUdliagarbha-)

and

2.15

(bhagna-)

describe

fetal

abnormalities

ofposition

caused

by

_poor

environment

of

the

_pregnant

mether and skeleta1 andjoint abnormalities and

does

not

include

the

tri-dosa

theory

as an etiology.

Overall,

the

tri-dbsa

theory

is

de-emphasized

as a

disease

classification and

is

among

the

least

considered etiologies

in

Ns.

Only

a

few

sections

in

the text

described

specific

diseases

using

the

tri-dbsa

theory

alone.

Uttaratantra

Ut

includes

several major

differences

in

constructions of

the

first

half

(6.1-6.37)

and

the

second

(6.39-6.66)

halves

ofthe

text

as

fo11ows.

<Pattern

A:

first

halg

6.1-6.37>

The

_pathology

and

disease

treatments

are

listed

in

sepa-rate sections.

The

_pathology

is

described

first,

and

its

corresponding

treatments

are

de-scribed

in

the

fbllowing

sections.

[salakya:

6.1-6.26]

[kaumarabhrtya:

6.27-6.37]

Of

these,

only

6.9-6.12,

6.1-6.7:

ocular

disease

6.8-6.19:

treatments

ofocular

disease

6.20:

aural

disease

6.21

:

treatments

ofaural

disease

6.22:

nasal

disease

6.23:

treatments

ofnasal

disease

6.25:

cranial

disease

6.26:

treatments

ofcranial

disease

6.27:

characteristics ofthe nine

_grahas

6.28-6.36:

individual

descriptions

of

the

nine

_g

6.37:

origin

of

the

_grahas

rahas

which

discuss

the

treatment

ofocular

disease,

bases

the

-The Japanese Association of Indian and Buddhist Studies

The JapaneseAssociation of Indian and Buddhist Studies

(92)The

Concept

of

Diseases

and

the

tri-dosa

Theory

in

the

StiSrutasapthita

(M.

MoRiGucHi)

nation of

the

disease

_pathology

on

the

tri-dosa

theory

to

any significant extent.

Etiologies

originating

from

the

blood

and

those

from

individual

doFa,

known

as vata,

_pitta,

and

kapha

are

described

in

these

sections.

Many

sections

describe

etiologies outside of

the

dbsa

theory

in

a manner similar

to

Ns,

although

tri-doFa

is

used

for

classification name

in

other

sec-tions.

<Pattern

B:

latter

halg

6.39-6.66>

Each

sections

discusses

all

infbrmation

concerning one

specific

disease.

The

_pathology

is

described

in

the

first

half

of each section, and treatments are

discussed

in

the

latter

halfof

the

section.

[kayacikitsE:

6.39-6.59,

6.383)]

6.39-6.42:

the

_general

symptoms

6.43-6.47:

circulatory

disease

6.48-6.53

+

6.24:

respiratory

disease

6.54-6.59

+

6.38:

digestive,

urinary, and

_genital

disease

[bhUtavidya:

6.60-6.62]

6.60:

_graha

diseases

ofadults

6.61:

unmada

disease

6.62:

epilepsy

[explanation

of

technical

terms:

6.63-6.66]

6.63:

types

of

tastes

6.64:

health

regimen

6.65:

technical

terms

6.66:

categories of

dosas

Only

6.45

(raktapitta),

which

discusses

hemorrhage,

includes

the

so-called

theory

of

cardinal

humors.

The

theory

is

also

described

in

corijunction with vata

in

6.5e

(hikkE),

6.51

(Svasa),6.52

(kasa).

These

sections

do

not

include

the

term

tri-dbsa

in

their

titles,

but

they

describe

hiccups,

bronchial

asthma, and cough as conditions

typified

by

a

kind

of

"wind"

raging

in

the

body.

The

name

tri-doFa

is

used

in

some

low-level

disease

classifica-tions

as

in

other sections.

These

observations suggest

that

there

are

the

seetions of

Ut

that

incorporate

the

tri-dosa

theory

within

the

disease

etiology,

though

these

descriptions

encompass only a small

_poF

tion

ofthe

text

overall.

Most

sections employ

the

names of

the

disease

subtypes.

1bei-dbsa

Theory

in

the

Sus'rutusapthha

Based

on

the

above observations,

the

rela-tionship

between

the

concept of

disease

and

tri-dosa

theory

in

SS

became

is

clearly one

that

_partially

incorporates

the

ancient

theory

in

the

names

fbrming

the

lower

disease

classi-fication

and

partially

as a core component of

disease

etiology.

Thus,

the

tri-dosa

theory,

in

-1186-The Japanese Association of Indian and Buddhist Studies

NII-Electronic Library Service

The JapaneseAssociation of Indian and Buddhist Studies

The

Concept

of

Diseases

and

the

tri-dosa

Theory

in

the

SuSrutasamphita-

(M.

MoRiGucHi)

(93)

SS

at

least,

is

not used

to

explain common

disease

etiologies

in

all cases.

Will

the

tri-dosa

theory

be

introduced

later?

Or,

will

this

theory,

which

_previously

fbrmed

the

fbundation

of

disease

etiology,

be

readopted within

the

classification names?

There

is

a need

fbr

the

field

to

further

examine

the

numerous classification

_{possibilities.}

Problem

of

the

Section

Placement

in

s'ntdkya

The

section organization

differs

be-tween

the

current editions of

Ut

and

the

Nepalese

manuscripts. 4)

The

location

of

the

sec-tion

within

the

Salakya

(

= sk) 5)

is

examined as an example.

As

previously

mentioned,

the

Ut

has

a characteristic structure

in

which sections

in

the

first

halfpart

ofthe

text,

describe

disease

_pathology

and

sections

in

the

latter

half

discuss

their

respective

treatments.

_ever,

_this

6)

organization

_generates

several

_problems

as

fo11ows.

<6.13

and

6.14>

The

opening

6.1-6.19

discuss

ocular

disease.

The

_pathologies

are

ex-plained

and

the

specific

diseases

are

listed

in

6.1-6.7,

and

their

treatment

is

discussed

in

6.8-6.19.

The

forrner

sections are

titled

according

to

the

specific

disease.

In

contrast,

titles

in

the

latter

section are

based

on etiology and

therapy

rather

than

the

disease.

Thus

the

titles

used

in

the

sections may

be

inconsistent.

In

the

current editions,

the

surgical

treatment

of

ocular

disease

is

described

in

multiple

6.13

(lekhyaroga)

and

6.14

(bhedyaroga).

Howeyer,

in

the

Nepalese

manuscripts,

infor-mation

in

section

6.14

is

included

in

6.13.7)

These

were originally one section,

but

6.14

(bhedyayoga)

which

discuss

manual surgical

techniques

was

latter

isolated

into

an

inde-pendent

section

fbr

an undetermined reason and recorded

in

later

editions.

<6.24>

In

the

latter

half

of sk, each section

begins

with an explanation of

the

disease

pa-thology,

which

is

fbllowed

by

infbrmation

on

treatment.

However,

this

structure

is

not

fu11y

maintained

in

the

current editions ofthe

text.

Unlike

most of

the

text,

which combines

the

specific etiologies and

treatments

into

one section

_per

organ

(6.20-6.21,

6.22-6.23,

6.25-6.26),

6.24

(pratiSyaya

_prati$edha)

discusses

the

treatment

of nasal

inflammation

inde-pendently

from

section

6.23,

which

discussed

the

treatment

ofnasal

disease

in

_general.

6.20:

kamagataroga-vljfiahiya

6.21

:

karpagataroga-pratisedha

6.22:

nisEgataroga-vijfizaniya

6.23:

nasEgataroga-pratisedha

6.24:

pratiSyfiya-pratisedha

6.25:

siroroga-vijfianiya

-1187-The Japanese Association of Indian and Buddhist Studies

The JapaneseAssociation of Indian and Buddhist Studies

(94)The

Concept

ofDiseases and thetri-dosa

Theory

in

the

SuSnitasamhita

(M.

MoRiGucH[)

6.26:

siroroga-pratisedha

6.24

describes

one ofthe

treatments

fbr

a specific

disease

known

as "pratiSyaya"

(nasal

infiammation)

.

Is

this

treatment

section

independent

from

6.23

similar

to

6.14

above?

The

Nepalese

manuscripts organize

the

sections as

fbllows.

Notably

6.24

is

not

included.

6.20:

kanLagataroga-vljfianiya

6.21:

kan

agataroga-pratisedha

6.22:

ghrarpagataroga-vijfianiya

6.23:

_{ghrarpagata(roga)}

8)-prati$edha

6.2s:

siro(gata)

9)roga-vijfianiya

6.26:

siro

(gata)

roga-prati$edha

The

immediate

questions

is

where

did

6.24

_go?

The

Process

_How

the

Medical

Book

Is

_Concluded

6.24

discuss

nasal

infiamma-tion,

which

has

a

_pattern

B

construction.

Therefbre,

this

section should

be

_placed

in

the

lat-ter

halfof

Ut,

which

discuss

constitution, rather

than

in

the

first

halfofthe

text.

In

the

latter

half

of

the

Nepalese

Ut,

6.24

is

_placed

in

the

latter

halfofthe

text

as expected.

6.48:

tr$rpZ-pratisedha

(morbid

thirst)

6.49:

chardi-pratisedha

(vomiting)

6.50:

hikkE-prati$edha

(hiccups)

6.51:

Svasa-pratisedha

(respiratory

disorders)

6.52:

kasa-pratisedha

(cough)

6.53:

svarabheda-pratisedha

(hoarseness)

6,24;

pratiSyEyana-pratisedha

(catamrh)

These

sections

describe

respiratory

disease.

Nasal

inflammation

was

initially

categorized

with respiratory

disease

but

was

later

considered a

type

of nasal

disease

in

sk

fbr

an

un-known

reason assuming

that

6.24

was

_placed

here

in

the

Nepalese

manuscripts.

The

section

may

haye

been

moved

to

the

_position

that

seemed

to

become

independent

by

the

treatments

ofdiseases of

the

nose.

For

6.14

and

6.24,

what underlies

the

decisions

two

reposition sections

fiJom

their

initial

positions

in

the

Nepalese

manuscripts and

their

_present

_positions

in

the

current editions?

We

can assume

that

there

are numerous reasons,

including

the

decision

to

edit

the

manu-script as a medical

textbook

and

the

subsequent advances

in

treatments.

An

effective meth-od

is

needed

to

examine

the

original structure of

SS

in

order

to

clarify

the

_process

of

its

-1188-The Japanese Association of Indian and Buddhist Studies

NII-Electronic Library Service

The JapaneseAssociation of Indian and Buddhist Studies

The

Concept

ofDiseases and thetri-dosa

Theory

in

the

SuSrutasapahita

(M.

MoRiGucHi)

(95)

tablishment.

1

)

The

same

_presentation

also

dea]t

with

the

differences

in

chapter arrangernents ef

the

Uttaratantra

between

the

editions and

the

Nepalese

manuscripts that will

be

discussed

later

in

thisanicle.

Kengo

Harimoto,

"More

_Observations

on

the

Old

Nepalese

Manuscripts

of the

Shrsirutasamhith"

(oral

presen-tationofthe

20th

congress of

the

Association

fbr

the

Study

ofthe

History

ofIndian

Thought,

the

Uni-versity of

Tbkyo,

December

2013)

.

2

)

The

sarirasthana,

whch

describes

_physical

anatomy and the

Cildtsiisthdna,

which

discusses

treat-ments are excluded

from

the

_present

analysis.

This

article

investigates

the

contents asthe

_pathological

theory.

The

IQiipasthana

classifies

_poisons

that

are

known

to

cause

disease.

The

classification scheme

in

these

texts

employs

the

tri-dosa

theory

very

little.

However,

a

few

sections

do

discuss

the

_potential

internal

tri-dosa or

blood

to

intensify

disease

associated with specific

_poisQns.

The

association

be-tween

dosa

and

the

_poison

is

seldom explored

in

the

entireKbiipasthdna.

3

)

6.38

should not

be

_placed

in

the

first

halfofUt

based

on theovera11 structure

described

in

this

ar-ticle.

See

5).

4

₎

See

1)

.

For

more

information

on

the

Nepalese

maniscripts, see

Harimoto

[2014]

.

5

)

Moriguchi

[2014]

examined the current

_piacement

of

6.38

atthe end ofthe

kauma-rabhrtya

in

Ut

from

the

beginning

of the textadjacent to

the

titleand tableof contents.

6.38

discuss

female

_genita1

disease

and

has

_pattern

B

constitutien.

The

_present

article

insists

on sequentially the

_possibility

that the

Iast

_part

ofkdyaciketsa

included

was the original

_placement

of6.38 according tothestmcture

in

the

Nepalese

manuscripts.

It

is

thought that

6.38

was moved

to

haumarabhrtya

by

some

kind

of

intention

in

editing afterwards.

6)

See

1).

7

)

KL

acc.

622

(NGMPP

C

80-7)

fo1.

164v4

!

NGMPP

B

29-9

t

Uttara

16r.

NGMPP

B

29-19

re-starts

folio

number at

the

beginning

of

the

Ut.

Due

to

the

difference

between

the

current editions and

theolder manuscripts, more

detailed

examination

is

necessary.

8

)

There

was a

difference

in

the manuscripts

in

thesection name, which was titled"ghrarpagata"

in

KL

acc.

622

(NGMPP

C

80-7)

foI.

173r2

and "ghrarpagataroga"

in

NGMPP

B

29-9

fo1.

Uttara

32.

9

₎

This

is

entit]ed"siroroga"

_in

_KL

acc.

622

(NGMPP

C

80-7)

fo1.

173v4

and "sirogataroga"

_in

NGMPP

B

29-9

fo1.

Uttara

33.

6.26

is

also similar.

<Abbreviation

and

References>

SS

Susiratasa,?2hita-

ofSusiruta,

with the

Mbantlhasangraha

Commentary

ofDalhanacharya.

Edited

by

Jadavii

Trikurriji

Acharya.

Bombay:

published

by

Turkdram

Jfivaj-i,

proprietor

ofthe

Sagar

Press,

1915;

SuSrutah,

Stitranida-naSariracikitsakaipottarahaipitadyurvedoh.

Edited

by

JivEnandavidyas5garabhattEcErya.

Calcutta,

1899.

Harimoto

Kengo

_[2014]

:"Nepa;ese

Manuscripts

of

the

Susirutasamhita."

lvdbgaku

Borooo-saku

kytz

EPR\Mty\-M

[Journal

oflndian andBuddhist studies]

62

(3),

_pp.

1087-1093.

Moriguchi

Mai

_ptP

_firk

_[2008]

:"`Igakusho'

toshiteno

SZtshurutasanhita-':

Dent6teki

kOsei

ni

taisu-

-1189-The Japanese Association of Indian and Buddhist Studies

The 　Japanese 　Association 　of 工ndian and _Buddhist 二_St二udies

（

96

）

The

　

Concept

　efDiseases 　and 　

the

　tri

−

do5a

　

Theory

　

in

　

the

　

SuSrutasagehitd

（

M

．

　

MoR

［GucH1

）

　　

ru　

kent6

”

「医学 書」

と し_{て の}

『

_{ス シ}ュ ル タ サ ン ヒ タ

ー

』

_：

伝 統 的構 成

に

対 す

る

検 討 匚

A

　me

−

　　

thodological

　examination 　of　

the

　

SuSrutas

α

pthita

：

As

　a皿 edical　

book

］

．

Indo

　

tetsugaku

　

BuklP

，

Ogaku

　　

印度哲 学 仏教 学 ［

Hokkaido

　

jouma

】of　

lndological

　and　

Buddhist

　stUdies

］23 ，

　

pp

．

246−264 ．

Moriguchi

　

Ma

三

［

2014 ］

：“

The

　

Ciinical

　

Viewpoint

　

in

　

the

　

Structure

　of　the　

SuSirutasarphita

．

”

Indogaku

　　

Bukkyo

’

_gaku

　

kenkyti印 度学 仏教 学研 究 匚

Journal

　_of 　

lndian

　_and 　Buddhist 　_studies

］62 （

3）

，　

pp ．

　　

1094−

llOO

．

（

This

　research 　

is

　supported 　

by

　

the

　

Grant

−

in

−

Aid

　

for

　

Scientific

　

Research

（

C

）24501240

　

from

　

JSPS ．

）

〈

Key

　words

＞

　Ayurveda

，

　

SuSirutasamhitdi

_，

　_concept 　ofdiseases

，

　

Nepalese

　_manuscript

　　

　　

　

　　

　　

　　

　　

　　

　　

　　

　　

　　

　　

　　

　　

　

　

（

Associate

　

Professor，

　

Japan

　

Health

　

Care

　

College，

　

PhD

）