Sutra Sthana Chapter 11.The Three Desires of Life and important triads
|Section/Chapter||Sutra Sthana Chapter 11|
|Preceding Chapter||Mahachatushpada Adhyaya|
|Succeeding Chapter||Vatakalakaliya Adhyaya|
|Other Sections||Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Chikitsa Sthana, Kalpa Sthana, Siddhi Sthana|
|Translator and commentator||Tiwari P.|
|Reviewer||Panja A., Godatwar P.|
|Date of publication||December 17, 2018|
Keywords: Eshanas, desires, pramanas, means of knowledge, pariksha, trayo upastambhas, trividha bala, triyo roga ayatana, trividha rogas, trayo rogamargas, trividha bhisahaja, trividha aushadha, triads of pillars of life, disease pathways, types of diseases, physician types, therapeutics, modalities.
- 1 Introduction
- 2 Sanskrit text, Transliteration and English Translation
- 2.1 Three Desires
- 2.2 Pratyaksha (Direct perception) and Apratyaksha(Unknown)
- 2.3 Views regarding Paranirmana (soul as the Creator of the Universe)
- 2.4 Yadrichha or free will (power which is responsible for sudden occurrence of events in universe)
- 2.5 Four-fold examination
- 2.6 Important Triads
- 2.6.1 Three Supporting Pillars of Life
- 2.6.2 Three Types of Bala (strength)
- 2.6.3 Three Ayatana (causes of diseases)
- 2.6.4 Three Causes of Diseases
- 2.6.5 Three Types of Diseases
- 2.6.6 Three Disease Pathways
- 2.6.7 Three Types of Physicians
- 2.6.8 Three Kinds of Treatment Modalities
- 2.6.9 Three Types of Therapies
- 2.7 Process of identification of diseased state
- 2.8 Summary
- 3 Tattva Vimarsha (Fundamental Principles)
- 4 Vidhi Vimarsha (Applied Inferences)
- 4.1 Importance of Three
- 4.2 Categories of three mentioned in Vedanta
- 4.3 Why is kamaeshana not included as a desire to be pursued?
- 4.4 The Cause of Birth
- 4.5 Four Pariksha and their clinical significance
- 4.6 Aptopdesha: Clinical Significance [Cha.Sa.Vimana Sthana 4/6]
- 4.7 Pratyaksha
- 4.8 Clinical application
- 4.9 Anumana (estimation, or analysis)
- 4.10 Clinical Application
- 4.11 Yukti
- 4.12 Three Upasthambhas
- 4.13 Three types of bala (strength, immunity)
- 4.14 Three ayatanas (causes of diseases)
- 4.15 Three classes of roga (diseases)
- 4.16 Three rogamarga (pathways of disease manifestation)
- 4.17 Three bhishaga (physicians)
- 4.18 Three aushadha (therapies)
- 5 References
Longevity is the desire of most human beings - to lead a healthy and long life. There is also desire for wealth - to enjoy all the worldly pleasures and also spend on spiritual rituals. The process of birth and rebirth is a karmic cycle and the quality of an individual’s afterlife and the remaining part of his present life depends upon the good and bad deeds done in the life. As a result of good deeds, we can enjoy material (or heavenly) pleasures and lead healthy lives.
Prior chapters dealt with maintainence of health and cure for diseases. The aim of a healthy life is for attainment of happiness/ bliss in this world and the world after death. The chapter begins with a description about three basic desires of human life, which should be fulfilled during one’s lifetime - longevity, material comforts, and a blissful after-life. Charak has stated about the methods and means to fulfill these eshanas, or desires: The desire for longevity Pranaeshanacan be achieved by following a healthy lifestyle. The desire for earning Dhanaeshana may be fulfilled by adopting appropriate and ethical means of livelihood. A wealthy person is respected by the society, therefore earning is essential for maintaining health as well as to perform various spiritual rituals to fulfill the third desire, i.e. Parlokeshaeshana, to get happiness in the next world after death. The third desire is vague, since there are no means to perceive life after death for an individual. On this subject, there are two schools of thoughts - astik, or theism (belief in a supernatural power responsible for creation of the world), and atheism (belief that there is no God or believing only objects or experiences that can be perceived). Different opinions about creation are explained according to different schools of thought. It is concluded that there is existence of many things in this universe even though they are not directly perceptible, so their existence cannot be denied, and therefore the theory of reincarnation cannot be denied unless proven otherwise.
The four pariksha or fourfold methods for getting correct knowledge are explained viz. aptopadesha (authoritative/scriptural testimony), pratyaksha(direct observation by senses), anumana(inference) by guessing, and yukti(reasoning) by applying intelligence. These four methods are defined vividly and their importance in establishing the theory of reincarnation is explained. Afterwards, the factors in maintenance of good health are described. Three supporting pillars of life or upastambhas are food (ahara), sleep (swapna) and celibacy (bramhacharya). By following these well regulated lifestyle factors, the body is bestowed with strength, increasing the three forms of strength, immunity(bala) – constitutional strength, immunity(sahaja), seasonal strength, immunity (kalaja) and acquired immunity(yuktikrita). Various diseases may arise if there is stress, unhealthy lifestyle, or through the effects of unhealthy season over the mind and the body. Further this chapter briefly describes three basic causes of diseases, three disease pathways, three types of treatments and therapies, three categories of physicians based on their qualities.
Sanskrit text, Transliteration and English Translation
इति ह स्माह भगवानात्रेयः||२||
iti ha smāha bhagavānātrēyaḥ||2||
iti ha smAha bhagavAnAtreyaH||2||
Now we shall expound the chapter "Tistraishaniya" (Three Desires of Life and important triads). Thus said Lord Atreya. [1-2]
इह खलु पुरुषेणानुपहतसत्त्वबुद्धिपौरुषपराक्रमेण हितमिह चामुष्मिंश्च लोके समनुपश्यता तिस्र एषणाः पर्येष्टव्या भवन्ति| तद्यथा- प्राणैषणा, धनैषणा, परलोकैषणेति||३||
iha khalu puruṣēṇānupahatasattvabuddhipauruṣaparākramēṇa hitamiha cāmuṣmiṁśca lōkēsamanupaśyatā tisra ēṣaṇāḥ paryēṣṭavyā bhavanti| tadyathā- prāṇaiṣaṇā, dhanaiṣaṇā, paralōkaiṣaṇēti||3||
iha khalu puruSheNAnupahatasattvabuddhipauruShaparAkrameNa hitamiha cAmuShmiMshca lokesamanupashyatA tisra eShaNAH paryeShTavyA bhavanti| tadyathA- prANaiShaNA, dhanaiShaNA, paralokaiShaNeti||3||
A person having sound mind, intellect, physical strength, energy and psychological strength, one who is desirous of attaining benefits in this world and the other world (after death), should try to fulfill three desires. These desires are- desire for (long and healthy) life, desire for wealth (livelihood), and desire for a blissful life in the other world (after death). 
Desire for Life
आसां तु खल्वेषणानां प्राणैषणां तावत् पूर्वतरमापद्येत| कस्मात्? प्राणपरित्यागे हि सर्वत्यागः| तस्यानुपालनं- स्वस्थस्य स्वस्थवृत्तानुवृत्तिः, आतुरस्य विकारप्रशमनेऽप्रमादः,तदुभयमेतदुक्तं वक्ष्यते च;तद्यथोक्तमनुवर्तमानः प्राणानुपालनाद्दीर्घमायुरवाप्नोतीति प्रथमैषणा व्याख्याता भवति||४||
āsāṁ tu khalvēṣaṇānāṁ prāṇaiṣaṇāṁ tāvat pūrvataramāpadyēta| kasmāt? prāṇaparityāgē hi sarvatyāgaḥ| tasyānupālanaṁ- svasthasya svasthavr̥ttānuvr̥ttiḥ, āturasya vikārapraśamanē'pramādaḥ,tadubhayamētaduktaṁ vakṣyatē ca; tadyathōktamanuvartamānaḥ prāṇānupālanāddīrghamāyuravāpnōtītiprathamaiṣaṇā vyākhyātā bhavati||4||
AsAM tu khalveShaNAnAM prANaiShaNAM tAvat pUrvataramApadyeta| kasmAt? prANaparityAge hi sarvatyAgaH| tasyAnupAlanaM- svasthasya svasthavRuttAnuvRuttiH, Aturasya vikAraprashamane~apramAdaH,tadubhayametaduktaM vakShyate ca; tadyathoktamanuvartamAnaHprANAnupAlanAddIrghamAyuravApnotIti prathamaiShaNA vyAkhyAtA bhavati||4||
Of these three desires, the most important one is the desire for life. Why? Because with the end of life, everything comes to an end. To fulfill this desire, a healthy person should follow a healthy regimen or lifestyle and a diseased person should try to get relief from the diseased state. The methods of health management and modes of treatment of diseases have been described in the preceding chapters and will be discussed further in the coming chapters. Thus, the first desire for life is explained. 
Desire for Wealth
अथ द्वितीयां धनैषणामापद्येत, प्राणेभ्यो ह्यनन्तरं धनमेव पर्येष्टव्यं भवति ; न ह्यतः पापात् पापीयोऽस्तियदनुपकरणस्य दीर्घमायुः, तस्मादुपकरणानि पर्येष्टुं यतेत| तत्रोपकरणोपायाननुव्याख्यास्यामः; तद्यथा कृषिपाशुपाल्यवाणिज्यराजोपसेवादीनि, यानि चान्यान्यपि सतामविगर्हितानि कर्माणि वृत्तिपुष्टिकराणि विद्यात्तान्यारभेत कर्तुं; तथा कुर्वन् दीर्घजीवितं जीवत्यनवमतः पुरुषो भवति | इति द्वितीया धनैषणा व्याख्याता भवति||५
atha dvitīyāṁ dhanaiṣaṇamāpadyēta, prāṇēbhyō hyanantaraṁ dhanamēva paryēṣṭavyaṁ bhavati ; nahyataḥ pāpāt pāpīyō'sti yadanupakaraṇasya dīrghamāyuḥ, tasmādupakaraṇāni paryēṣṭuṁ yatēta| tatrōpakaraṇōpāyānanuvyākhyāsyāmaḥ; tadyathā- kr̥ṣipāśupālyavāṇijyarājōpasēvādīni, yāni cānyānyapisatāmavigarhitāni karmāṇi vr̥ttipuṣṭikarāṇi vidyāttānyārabhēta kartuṁ; tathā kurvan dīrghajīvitaṁjīvatyanavamataḥ puruṣō bhavati | iti dvitīyā dhanaiṣaṇā vyākhyātā bhavati||5||
atha dvitIyAM dhanaiShaNamApadyeta, prANebhyo hyanantaraM dhanameva paryeShTavyaM bhavati ;na hyataH pApAt pApIyo~asti yadanupakaraNasya dIrghamAyuH, tasmAdupakaraNAni paryeShTuMyateta| tatropakaraNopAyAnanuvyAkhyAsyAmaH; tadyathA- kRuShipAshupAlyavANijyarAjopasevAdIni, yAnicAnyAnyapi satAmavigarhitAni karmANi vRuttipuShTikarANi vidyAttAnyArabheta kartuM; tathA kurvandIrghajIvitaM jIvatyanavamataH puruSho bhavati | iti dvitIyA dhanaiShaNA vyAkhyAtA bhavati||5||
The second desire is for wealth because during life one has to try to earn wealth or seek a livelihood. There is no sin greater than a person living life without (ethically or using fair means) seeking a livelihood. That is why one should try to earn livelihood by fair methods. The means for earning a virtuous livelihood are agriculture, dairy farming, business or trade, and services (government jobs), etc. Besides these, any other mode that is not sinful should be employed to earn a livelihood. By choosing such (respectable) occupations one can live a long life and earn respect and goodwill in the society. Thus, the second desire for wealth is explained. 
Desire of other world after death
अथ तृतीयां परलोकैषणामापद्येत| संशयश्चात्र, कथं? भविष्याम इतश्च्युता न वेति; कुतः पुनः संशय इति, उच्यते- सन्ति ह्येके प्रत्यक्षपराः परोक्षत्वात् पुनर्भवस्यनास्तिक्यमाश्रिताः, सन्ति चागमप्रत्ययादेव पुनर्भवमिच्छन्ति; श्रुतिभेदाच्च- ‘मातरं पितरं चैके मन्यन्ते जन्मकारणम् | स्वभावं परनिर्माणं यदृच्छां चापरे जनाः’ || इति | अतः संशयः- किं नु खल्वस्ति पुनर्भवो न वेति||६||
atha tr̥tīyāṁ paralōkaiṣaṇāmāpadyēta| saṁśayaścātra, kathaṁ? bhaviṣyāma itaścyutā navēti; kutaḥ punaḥ saṁśaya iti, ucyatē- santi hyēkēpratyakṣaparāḥ parōkṣatvāt punarbhavasya nāstikyamāśritāḥ, santi cāgamapratyayādēvapunarbhavamicchanti; śrutibhēdācca- ‘mātaraṁ pitaraṁ caikē manyantē janmakāraṇam | svabhāvaṁ paranirmāṇaṁ yadr̥cchāṁ cāparē janāḥ’ || iti | ataḥ saṁśayaḥ- kiṁ nu khalvasti punarbhavō na vēti||6||
atha tRutIyAM paralokaiShaNAmApadyeta| saMshayashcAtra, kathaM? bhaviShyAma itashcyutA naveti; kutaH punaH saMshaya iti, ucyate- santi hyekepratyakShaparAH parokShatvAt punarbhavasya nAstikyamAshritAH, santi cAgamapratyayAdevapunarbhavamicchanti; shrutibhedAcca- ‘mAtaraM pitaraM caike manyante janmakAraNam | svabhAvaM paranirmANaM yadRucchAM cApare janAH’ || iti | ataH saMshayaH- kiM nu khalvasti punarbhavo na veti||6||
The third desire is the aspiration for a virtuous life in the other world (life after death. There is some skepticism regarding this desire). What happens after death? Does rebirth occur? Why are there doubts regarding reincarnation? Lord Atreya says that there are people who believe in perceptible things and do not believe in imperceptible things. Acharyas (teachers) who have faith in the shastras believe in the theory of reincarnation even when they have not perceived or experienced it. But there is skepticism because of differences in opinion. Among the “believing” acharyas, some attribute the role of ‘parents or ancestors’, some on swabhava(personality or nature of the individual), some on the role of the paranirman (impersonal soul), while some on yadruchha ( free will or external powers responsible for sudden occurrences of events in the universe) in the process of reincarnation. Because of so many opinions and schools of thought, there is skepticism with regards to the theory of reincarnation, whether it exists or not. 
Pratyaksha (Direct perception) and Apratyaksha(Unknown)
तत्र बुद्धिमान्नास्तिक्यबुद्धिं जह्याद्विचिकित्सां च| कस्मात्? प्रत्यक्षं ह्यल्पम्; अनल्पमप्रत्यक्षमस्ति, यदागमानुमानयुक्तिभिरुपलभ्यते; यैरेव तावदिन्द्रियैः प्रत्यक्षमुपलभ्यते,तान्येव सन्ति चाप्रत्यक्षाणि||७||
tatra buddhimānnāstikyabuddhiṁ jahyādvicikitsāṁ ca| kasmāt? pratyakṣaṁ hyalpam; analpamapratyakṣamasti, yadāgamānumānayuktibhirupalabhyatē; yairēvatāvadindriyaiḥ pratyakṣamupalabhyatē, tānyēva santi cāpratyakṣāṇi||7||
tatra buddhimAnnAstikyabuddhiM jahyAdvicikitsAM ca| kasmAt? pratyakShaM hyalpam; analpamapratyakShamasti, yadAgamAnumAnayuktibhirupalabhyate;yaireva tAvadindriyaiH pratyakShamupalabhyate, tAnyeva santi cApratyakShANi||7||
It is for intellectuals to discard the heterodox view pertaining reincarnation, and quell any doubts associated with it. Knowledge regarding this theory can only be acquired through the scriptures, inference and reasoning, because the scope of perception is very limited (and our sense organs have limited powers to perceive) and there is a vast, uncharted area of knowledge. 
Hindrances in direct perception
सतां च रूपाणामतिसन्निकर्षादतिविप्रकर्षादावरणात् करणदौर्बल्यान्मनो|नवस्थानात् समानाभिहारादभिभवादतिसौक्ष्म्याच्चप्रत्यक्षानुपलब्धिः; तस्मादपरीक्षितमेतदुच्यते- प्रत्यक्षमेवास्ति, नान्यदस्तीति||८||
satāṁ ca rūpāṇāmatisannikarṣādativiprakarṣādāvaraṇāt karaṇadaurbalyānmanōnavasthānātsamānābhihārādabhibhavādatisaukṣmyācca pratyakṣānupalabdhiḥ; tasmādaparīkṣitamētaducyatē-pratyakṣamēvāsti, nānyadastīti||8||
satAM ca rUpANAmatisannikarShAdativiprakarShAdAvaraNAt karaNadaurbalyAnmanonavasthAnAtsamAnAbhihArAdabhibhavAdatisaukShmyAcca pratyakShAnupalabdhiH; tasmAdaparIkShitametaducyate-pratyakShamevAsti, nAnyadastIti||8||
Various types of objects are not visible to the naked eye if they are too close or too far, or there is any hindrance, or the sense organs are not functioning properly, or there is a lack of concentration of mind, or similar objects are placed near it, or if it has been over-shadowed, or if the items are microscopic. In all these cases, direct knowledge cannot be obtained by the sense organs. That is why it is not fair to assume that an object does not exist just because our sense organs are unable to perceive it. 
श्रुतयश्चैता न कारणं, युक्तिविरोधात्| आत्मा मातुः पितुर्वा यः सोऽपत्यं यदि सञ्चरेत्| द्विविधं सञ्चरेदात्मा सर्वोवाऽवयवेन वा||९||
सर्वश्चेत् सञ्चरेन्मातुः पितुर्वा मरणं भवेत्| निरन्तरं, नावयवः कश्चित्सूक्ष्मस्य चात्मनः||१०||
śrutayaścaitā na kāraṇaṁ, yuktivirōdhāt| ātmā mātuḥ piturvā yaḥ sō'patyaṁ yadi sañcarēt| dvividhaṁ sañcarēdātmā sarvōvā'vayavēna vā||9||
sarvaścēt sañcarēnmātuḥ piturvā maraṇaṁ bhavēt| nirantaraṁ, nāvayavaḥ kaścitsūkṣmasya cātmanaḥ||10||
shrutayashcaitA na kAraNaM, yuktivirodhAt| AtmA mAtuH piturvA yaH so~apatyaM yadi sa~jcaret| dvividhaM sa~jcaredAtmA sarvovA~avayavena vA||9||
sarvashcet sa~jcarenmAtuH piturvA maraNaM bhavet| nirantaraM, nAvayavaH kashcitsUkShmasya cAtmanaH||10||
Shrutis (scriptures) are not very clear about the idea of reincarnation since there are various differences in opinion regarding it. For instance, there is a view that if the soul of either the mother or the father is transferred into the child, then does the child embodies the soul of the parent completely or is it only part of the parent’s soul? If the soul of the mother or the father is present in body of child then if either of them should die, partial transformation of soul is not possible. Because the soul does not have any structure and it is very subtle. [9-10]
बुद्धिर्मनश्च निर्णीते यथैवात्मा तथैव ते| येषां चैषा मतिस्तेषां योनिर्नास्ति चतुर्विधा||११||
buddhirmanaśca nirṇītē yathaivātmā tathaiva tē| yēṣāṁ caiṣā matistēṣāṁ yōnirnāsti caturvidhā||11||
buddhirmanashca nirNIte yathaivAtmA tathaiva te| yeShAM caiShA matisteShAM yonirnAsti caturvidhA||11||
In the same manner, if it is proven that mind and intellect are like the soul, these cannot be sole cause of birth. Those who accept the theory of mind and intellect of parents as sole factor of birth then the four categories of species (yonis-jarayuja (born out of amnion), andaja (born out of egg), swedaja (born out of sweat) and udabhija (born by breaking open the earth)) will not be possible. 
विद्यात् स्वाभाविकं षण्णां धातूनां यत् स्वलक्षणम्| संयोगे च वियोगे च तेषां कर्मैव कारणम्||१२||
vidyāt svābhāvikaṁ ṣaṇṇāṁ dhātūnāṁ yat svalakṣaṇam| saṁyōgē ca viyōgē ca tēṣāṁ karmaiva kāraṇam||12||
vidyAt svAbhAvikaM ShaNNAM dhAtUnAM yat svalakShaNam| saMyoge ca viyoge ca teShAM karmaiva kAraNam||12||
The natural theory of birth is that the six dhatus (five basic elements- prithvi, apa, tejas, vayu, akasha and the atman (soul)) possess specific qualities, and that the combination and separation of these basic elements, conditioned by the actions of the atman, determines the qualities of the individual at birth. 
Views regarding Paranirmana (soul as the Creator of the Universe)
अनादेश्चेतनाधातोर्नेष्यते परनिर्मितिः| पर आत्मा स चेद्धेतुरिष्टोऽस्तु परनिर्मितिः||१३||
anādēścētanādhātōrnēṣyatē paranirmitiḥ| para ātmā sa cēddhēturiṣṭō'stu paranirmitiḥ||13||
anAdeshcetanAdhAtorneShyate paranirmitiH| para AtmA sa ceddheturiShTo~astu paranirmitiH||13||
Consciousness is without any beginning or end, and being eternal it cannot be created by any other thing. Creation by something else refers to the creation of the body by the absolute atman (the supreme consciousness or the supreme soul), and is an acceptable view for the proponents of the theory of reincarnation. 
Yadrichha or free will (power which is responsible for sudden occurrence of events in universe)
न परीक्षा न परीक्ष्यं न कर्ता कारणं न च| न देवा नर्षयः सिद्धाः कर्म कर्मफलं न च||१४||
नास्तिकस्यास्ति नैवात्मा यदृच्छोपहतात्मनः| पातकेभ्यः परं चैतत् पातकं नास्तिकग्रहः||१५||
na parīkṣā na parīkṣyaṁ na kartā kāraṇaṁ na ca| na dēvā narṣayaḥ siddhāḥ karma karmaphalaṁ na ca||14||
nāstikasyāsti naivātmā yadr̥cchōpahatātmanaḥ| pātakēbhyaḥ paraṁ caitat pātakaṁ nāstikagrahaḥ||15||
na parIkShA na parIkShyaM na kartA kAraNaM na ca| na devA narShayaH siddhAH karma karmaphalaM na ca||14||
nAstikasyAsti naivAtmA yadRucchopahatAtmanaH| pAtakebhyaH paraM caitat pAtakaM nAstikagrahaH||15||
Those who are atheists or nihilists do not believe in the theory of creation. As per this view, there is no existence of soul and no examination is warranted to prove its existence. They do not believe that there is any doer or divine cause for the existence of anything. For these people, there is no existence of God, sages, siddhas, and therefore, they do not believe in concepts such as karma (action) and karmaphala (results of the action). Thus, nihilism constitutes the worst sin in this world. [14-15]
तस्मान्मतिं विमुच्यैताममार्गप्रसृतां बुधः| सतां बुद्धिप्रदीपेन पश्येत्सर्वं यथातथम्||१६||
tasmānmatiṁ vimucyaitāmamārgaprasr̥tāṁ budhaḥ| satāṁ buddhipradīpēna paśyētsarvaṁ yathātatham||16||
tasmAnmatiM vimucyaitAmamArgaprasRutAM budhaH| satAM buddhipradIpena pashyetsarvaM yathAtatham||16||
An intelligent person should get rid of such nihilistic thoughts and should see the world through the light of the lamp of wisdom shown by wise men. 
द्विविधमेव खलु सर्वं सच्चासच्च; तस्य चतुर्विधा परीक्षा- आप्तोपदेशः, प्रत्यक्षम्, अनुमानं, युक्तिश्चेति||१७||
dvividhamēva khalu sarvaṁ saccāsacca; tasya caturvidhā parīkṣā- āptōpadēśaḥ, pratyakṣam, anumānaṁ,yuktiścēti||17||
dvividhameva khalu sarvaM saccAsacca; tasya caturvidhA parIkShA- AptopadeshaH, pratyakSham,anumAnaM, yuktishceti||17||
All the worldly objects can be divided into two categories, truth (or existence) and false (or non-existence). There are four methods of examination- scriptures or texts (words of persons with superior intellect, or sages), direct perception (direct observance), inference and reasoning. 
आप्तास्तावत्- रजस्तमोभ्यां निर्मुक्तास्तपोज्ञानबलेन ये| येषां त्रिकालममलं ज्ञानमव्याहतं सदा||१८||
आप्ताः शिष्टा विबुद्धास्ते तेषां वाक्यमसंशयम्| सत्यं, वक्ष्यन्ति ते कस्मादसत्यं नीरजस्तमाः ||१९||
āptāstāvat- rajastamōbhyāṁ nirmuktāstapōjñānabalēna yē| yēṣāṁ trikālamamalaṁ jñānamavyāhataṁ sadā||18||
āptāḥ śiṣṭā vibuddhāstē tēṣāṁ vākyamasaṁśayam| satyaṁ, vakṣyanti tē kasmādasatyaṁ nīrajastamāḥ ||19||
AptAstAvat- rajastamobhyAM nirmuktAstapoj~jAnabalena ye| yeShAM trikAlamamalaM j~jAnamavyAhataM sadA||18||
AptAH shiShTA vibuddhAste teShAM vAkyamasaMshayam| satyaM, vakShyanti te kasmAdasatyaM nIrajastamAH ||19||
Those who are enlightened and knowledgeable are absolutely free from rajas and tamas (psychological doshas). By virtue of this, they possess knowledge of trikala (past, present and future) and are known as authorities (aptas). They are also known as the wise and the enlightened (vibuddha) persons. Their words are considered absolute truth without any doubt. As they are free from rajas and tamas, how could they tell lie? [18-19]
Knowledge by Direct Perception
आत्मेन्द्रियमनोर्थानां सन्निकर्षात् प्रवर्तते| व्यक्ता तदात्वे या बुद्धिः प्रत्यक्षं स निरुच्यते||२०||
ātmēndriyamanōrthānāṁ sannikarṣāt pravartatē| vyaktā tadātvē yā buddhiḥ pratyakṣaṁ sa nirucyatē||20||
AtmendriyamanorthAnAM sannikarShAt pravartate| vyaktA tadAtve yA buddhiH pratyakShaM sa nirucyate||20||
Knowledge gained by the proximity of soul, sense faculties, mind with the object of study or observation is known as perception or direct observation (pratyaksha). 
प्रत्यक्षपूर्वं त्रिविधं त्रिकालं चानुमीयते| वह्निर्निगूढो धूमेन मैथुनं गर्भदर्शनात्||२१||
एवं व्यवस्यन्त्यतीतं बीजात् फलमनागतम्| दृष्ट्वा बीजात् फलं जातमिहैव सदृशं बुधाः||२२||
pratyakṣapūrvaṁ trividhaṁ trikālaṁ cānumīyatē| vahnirnigūḍhō dhūmēna maithunaṁ garbhadarśanāt||21||
ēvaṁ vyavasyantyatītaṁ bījāt phalamanāgatam| dr̥ṣṭvā bījāt phalaṁ jātamihaiva sadr̥śaṁ budhāḥ||22||
pratyakShapUrvaM trividhaM trikAlaM cAnumIyate| vahnirnigUDho dhUmena maithunaM garbhadarshanAt||21||
evaM vyavasyantyatItaM bIjAt phalamanAgatam| dRuShTvA bIjAt phalaM jAtamihaiva sadRushaM budhAH||22||
Inference is preceded by perception and is of three types- past, present and future. For example: fire is inferred from the coming smoke and sexual intercourse from pregnancy - these are inferences drawn from the present and the past respectively. By looking at a seed, one can infer about the species or genus of the plant or tree and the kind of fruits it would bear. This inference is drawn on the basis of repeated, empirical observation of the plant’s (or tree’s) lifecycle and is an example of inferring (or predicting) the future. [21-22]
जलकर्षणबीजर्तुसंयोगात् सस्यसम्भवः| युक्तिः षड्धातुसंयोगाद्गर्भाणां सम्भवस्तथा||२३||
मथ्यमन्थन(क)मन्थानसंयोगादग्निसम्भवः| युक्तियुक्ता चतुष्पादसम्पद्व्याधिनिबर्हणी||२४||
jalakarṣaṇabījartusaṁyōgāt sasyasambhavaḥ| yuktiḥ ṣaḍdhātusaṁyōgādgarbhāṇāṁ sambhavastathā||23||
mathyamanthana(ka)manthānasaṁyōgādagnisambhavaḥ| yuktiyuktā catuṣpādasampadvyādhinibarhaṇī||24||
jalakarShaNabIjartusaMyogAt sasyasambhavaH| yuktiH ShaDdhAtusaMyogAdgarbhANAM sambhavastathA||23||
mathyamanthana(ka)manthAnasaMyogAdagnisambhavaH| yuktiyuktA catuShpAdasampadvyAdhinibarhaNI||24||
Water, ploughed piece of land, seeds and the season in which particular seeds are sown, when combined together, result in a crop. Similarly, combination of six factors (pancha mahabhuta and atman) is responsible for formation of a fetus in the uterus. Fire is produced by lower-fire-drill, upper-fire drill and the act of drilling or churning done by a person. In a similar manner, the treatment of disease is possible by applying the fourfold therapeutics measures (The vaidya, medicines, paramedical staff, and the patient). [23-24]
बुद्धिः पश्यति या भावान् बहुकारणयोगजान्| युक्तिस्त्रिकाला सा ज्ञेया त्रिवर्गः साध्यते यया||२५||
buddhiḥ paśyati yā bhāvān bahukāraṇayōgajān| yuktistrikālā sā jñēyā trivargaḥ sādhyatē yayā||25||
buddhiH pashyati yA bhAvAn bahukAraNayogajAn| yuktistrikAlA sA j~jeyA trivargaH sAdhyate yayA||25||
The intellect perceives things by combination of multiple factors, valid for past, present and future is termed as yukti (reasoning). This is helpful in fulfilling three basic objects of human life (dharma, i.e. duties, wealth, desire). 
Importance and applications of four-fold Examination
एषा परीक्षा नास्त्यन्या यया सर्वं परीक्ष्यते| परीक्ष्यं सदसच्चैवं तया चास्ति पुनर्भवः||२६||
ēṣā parīkṣā nāstyanyā yayā sarvaṁ parīkṣyatē| parīkṣyaṁ sadasaccaivaṁ tayā cāsti punarbhavaḥ||26||
eShA parIkShA nAstyanyA yayA sarvaM parIkShyate| parIkShyaM sadasaccaivaM tayA cAsti punarbhavaH||26||
This is how the four fold examination helps in establishing the existence and non-existence of things. This examination can prove the theory of rebirth. 
तत्राप्तागमस्तावद्वेदः, यश्चान्योऽपि कश्चिद्वेदार्थादविपरीतः परीक्षकैः प्रणीतः शिष्टानुमतो लोकानुग्रहप्रवृत्तःशास्त्रवादः, स चाऽऽप्तागमः; आप्तागमादुपलभ्यतेदानतपोयज्ञसत्याहिंसाब्रह्मचर्याण्यभ्युदयनिःश्रेयसकराणीति||२७||
tatrāptāgamastāvadvēdaḥ  , yaścānyō'pi kaścidvēdārthādaviparītaḥ parīkṣakaiḥ praṇītaḥ śiṣṭānumatōlōkānugrahapravr̥ttaḥ śāstravādaḥ, sa cāptāgamaḥ;āptāgamādupalabhyatēdānatapōyajñasatyāhiṁsābrahmacaryāṇyabhyudayaniḥśrēyasakarāṇīti||27||
tatrAptAgamastAvadvedaH  , yashcAnyo~api kashcidvedArthAdaviparItaH parIkShakaiH praNItaHshiShTAnumato lokAnugrahapravRuttaH shAstravAdaH, sa cA~a~aptAgamaH;AptAgamAdupalabhyatedAnatapoyaj~jasatyAhiMsAbrahmacaryANyabhyudayaniHshreyasakarANIti||27||
Scriptural testimony are the Vedas or other scripts which agree with the Vedas, other scripts do not oppose the theories of Vedas rather support them. They are composed by the help of four fold examinations, enunciated by the experts, approved by the trustworthy persons and having the capability of bringing happiness to the world. These scriptural sources of knowledge are the words of the authorities. This goal of scriptures can be fulfilled by donation, penance, performing rituals (offerings to sacred fire), truthfulness, nonviolence and bramacharya (control of senses/ celibecy) by doing these one's upliftment and liberation is possible. 
न चानतिवृत्तसत्त्वदोषाणामदोषैरपुनर्भवो धर्मद्वारेषूपदिश्यते||२८||
na cānativr̥ttasattvadōṣāṇāmadōṣairapunarbhavō dharmadvārēṣūpadiśyatē||28||
na cAnativRuttasattvadoShANAmadoShairapunarbhavo dharmadvAreShUpadishyate||28||
Persons those who have not been able to free themselves from rajas and tamas (psychological doshas), for them advice given by the learned sages in religious literatures is that they cannot attain salvation. 
धर्मद्वारावहितैश्च व्यपगतभयरागद्वेषलोभमोहमानैर्ब्रह्मपरैराप्तैः कर्मविद्भिरनुपहतसत्त्वबुद्धिप्रचारैः पूर्वैःपूर्वतरैर्महर्षिभिर्दिव्यचक्षुभिर्दृष्ट्वोपदिष्टः पुनर्भव इति व्यवस्येदेवम् ||२९||
dharmadvārāvahitaiśca vyapagatabhayarāgadvēṣalōbhamōhamānairbrahmaparairāptaiḥkarmavidbhiranupahatasattvabuddhipracāraiḥ pūrvaiḥpūrvatarairmaharṣibhirdivyacakṣubhirdr̥ṣṭvōpadiṣṭaḥ punarbhava iti vyavasyēdēvam ||29||
dharmadvArAvahitaishca vyapagatabhayarAgadveShalobhamohamAnairbrahmaparairAptaiHkarmavidbhiranupahatasattvabuddhipracAraiH pUrvaiHpUrvatarairmaharShibhirdivyacakShubhirdRuShTvopadiShTaH punarbhava iti vyavasyedevam ||29||
The people who follow the path of dharma (eternal duty), they are devoid of fear, attachment, hatred, greed, confusion, vanity and all their mental defects are vanished, they have great knowledge. Their mind and intellect are functioning forever, such ancient and most ancient sages with their divine sight after careful observation has enunciated the theory of rebirth. Everyone should think over this and there should be no doubt. 
प्रत्यक्षमपि चोपलभ्यते- मातापित्रोर्विसदृशान्यपत्यानि, तुल्यसम्भवानां वर्णस्वराकृतिसत्त्वबुद्धिभाग्यविशेषाः,प्रवरावरकुलजन्म, दास्यैश्वर्यं, सुखासुखमायुः, आयुषो वैषम्यम्, इह कृतस्यावाप्तिः, अशिक्षितानां चरुदितस्तनपानहासत्रासादीनां प्रवृत्तिः, लक्षणोत्पत्तिः, कर्मसादृश्ये फलविशेषः, मेधा क्वचित् क्वचित् कर्मण्यमेधा,जातिस्मरणम्- इहागमनमितश्च्युतानामिति , समदर्शने प्रियाप्रियत्वम्||३०||
pratyakṣamapi cōpalabhyatē- mātāpitrōrvisadr̥śānyapatyāni, tulyasambhavānāṁvarṇasvarākr̥tisattvabuddhibhāgyaviśēṣāḥ, pravarāvarakulajanma, dāsyaiśvaryaṁ, sukhāsukhamāyuḥ,āyuṣō vaiṣamyam, iha kr̥tasyāvāptiḥ, aśikṣitānāṁ ca ruditastanapānahāsatrāsādīnāṁ pravr̥ttiḥ,lakṣaṇōtpattiḥ, karmasādr̥śyē phalaviśēṣaḥ, mēdhā kvacit kvacit karmaṇyamēdhā, jātismaraṇam-ihāgamanamitaścyutānāmiti , samadarśanē priyāpriyatvam||30||
pratyakShamapi copalabhyate- mAtApitrorvisadRushAnyapatyAni, tulyasambhavAnAMvarNasvarAkRutisattvabuddhibhAgyavisheShAH, pravarAvarakulajanma, dAsyaishvaryaM,sukhAsukhamAyuH, AyuSho vaiShamyam, iha kRutasyAvAptiH, ashikShitAnAM caruditastanapAnahAsatrAsAdInAM pravRuttiH, lakShaNotpattiH, karmasAdRushye phalavisheShaH,medhA kvacit kvacit karmaNyamedhA, jAtismaraNam- ihAgamanamitashcyutAnAmiti , samadarshanepriyApriyatvam||30||
Observation proves theory of rebirth: To establish the theory of rebirth observation may be helpful, for example dissimilar children born to their parents, parents may be same but their children differ in various manners like complexion, voice, structure, mind, intellect and fate. Birth in high class or lower class, slavery or lordship, happy or miserable life, difference in lifespan, getting different result of the deeds done in this life, without any training actions like crying, sucking breast, laughing, fear etc. (in new born), appearance of signs over body indicating good or bad fortune, actions being the same results are different, preservation of memory sometimes memory loss, memory of previous life in some persons, appearance being the same but some have liking some have disliking for the same things, all these prove the theory of rebirth. 
अत एवानुमीयते- यत्- स्वकृतमपरिहार्यमविनाशि पौर्वदेहिकं दैवसञ्ज्ञकमानुबन्धिकं कर्म, तस्यैतत् फलम्;इतश्चान्यद्भविष्यतीति; फलद्बीजमनुमीयते, फलं च बीजात्||३१||
ata ēvānumīyatē- yat- svakr̥tamaparihāryamavināśi paurvadēhikaṁ daivasañjñakamānubandhikaṁkarma, tasyaitat phalam; itaścānyadbhaviṣyatīti; phaladbījamanumīyatē, phalaṁ ca bījāt||31||
ata evAnumIyate- yat- svakRutamaparihAryamavinAshi paurvadehikaM daivasa~jj~jakamAnubandhikaMkarma, tasyaitat phalam; itashcAnyadbhaviShyatIti; phaladbIjamanumIyate, phalaM ca bIjAt||31||
Inference supporting rebirth theory: Inference can be drawn that the action done in previous life is unavoidable, eternal and have continuity is known as fate. The results of which are enjoyable in this life and the actions done in this life will bring its results in next life. As seed comes from fruit and fruit from seed, this process is going on forever. 
युक्तिश्चैषा- षड्धातुसमुदयाद्गर्भजन्म, कर्तृकरणसंयोगात् क्रिया; कृतस्य कर्मणः फलं नाकृतस्य, नाङ्कुरोत्पत्तिरबीजात्;कर्मसदृशं फलं, नान्यस्माद्बीजादन्यस्योत्पत्तिः; इति युक्तिः||३२||
yuktiścaiṣā- ṣaḍdhātusamudayādgarbhajanma, kartr̥karaṇasaṁyōgāt kriyā; kr̥tasya karmaṇaḥ phalaṁnākr̥tasya, nāṅkurōtpattirabījāt; karmasadr̥śaṁ phalaṁ, nānyasmādbījādanyasyōtpattiḥ; iti yuktiḥ||32||
yuktishcaiShA- ShaDdhAtusamudayAdgarbhajanma, kartRukaraNasaMyogAt kriyA; kRutasya karmaNaHphalaM nAkRutasya, nA~gkurotpattirabIjAt; karmasadRushaM phalaM, nAnyasmAdbIjAdanyasyotpattiH; itiyuktiH||32||
Reasoning supporting rebirth: the garbha (embryo) is formed by the combination of six dhatus (pancha mahabhutas and atman). Doer and the instrument when do come together results in manifestation of action. The results which we get are because of the actions done, no results if no action done. The germination occurs because of seed, the result always corresponds to the action, and seed cannot bring out heterogeneous product. This is reasoning. 
एवं प्रमाणैश्चतुर्भिरुपदिष्टे पुनर्भवे धर्मद्वारेष्ववधीयेत; तद्यथा- गुरुशुश्रूषायामध्ययने व्रतचर्यायां दारक्रियायामपत्योत्पादनेभृत्यभरणेऽतिथिपूजायां दानेऽनभिध्यायां तपस्यनसूयायां देहवाङ्मानसे कर्मण्यक्लिष्टे देहेन्द्रियमनोर्थबुद्ध्यात्मपरीक्षायांमनःसमाधाविति; यानि चान्यान्यप्येवंविधानि कर्माणि सतामविगर्हितानि स्वर्ग्याणि वृत्तिपुष्टिकराणि विद्यात्तान्यारभेतकर्तुं; तथा कुर्वन्निह चैव यशो लभते प्रेत्य च स्वर्गम्| इति तृतीया परलोकैषणा व्याख्याता भवति||३३||
ēvaṁ pramāṇaiścaturbhirupadiṣṭē punarbhavē dharmadvārēṣvavadhīyēta; tadyathā-guruśuśrūṣāyāmadhyayanē vratacaryāyāṁ dārakriyāyāmapatyōtpādanē bhr̥tyabharaṇē'tithipūjāyāṁdānē'nabhidhyāyāṁ tapasyanasūyāyāṁ dēhavāṅmānasē karmaṇyakliṣṭēdēhēndriyamanōrthabuddhyātmaparīkṣāyāṁ manaḥsamādhāviti; yāni cānyānyapyēvaṁvidhāni karmāṇisatāmavigarhitāni svargyāṇi vr̥ttipuṣṭikarāṇi vidyāttānyārabhēta kartuṁ; tathā kurvanniha caiva yaśōlabhatē prētya ca svargam| iti tr̥tīyā paralōkaiṣaṇā vyākhyātā bhavati||33||
evaM pramANaishcaturbhirupadiShTe punarbhave dharmadvAreShvavadhIyeta; tadyathA-gurushushrUShAyAmadhyayane vratacaryAyAM dArakriyAyAmapatyotpAdanebhRutyabharaNe~atithipUjAyAM dAne~anabhidhyAyAM tapasyanasUyAyAM dehavA~gmAnasekarmaNyakliShTe dehendriyamanorthabuddhyAtmaparIkShAyAM manaHsamAdhAviti; yAnicAnyAnyapyevaMvidhAni karmANi satAmavigarhitAni svargyANi vRuttipuShTikarANi vidyAttAnyArabhetakartuM; tathA kurvanniha caiva yasho labhate pretya ca svargam| iti tRutIyA paralokaiShaNA vyAkhyAtA bhavati||33||
All the four means of knowledge (scriptures, observation, inference & reasoning) help in establishing the rebirth theory, one should concentrate mind on the path of eternal duty. Paths are to give service to the preachers/teachers/elders, studies, performing spiritual acts, marriage, producing children, maintenance of servants, giving respect to the guests, giving donations, no greed for others money, penance, avoid jealousy, performing acts which do not affect physical, verbally and mind, introspection of body, sensual faculties, mind, intellect and self and meditation are included. Similar acts recommended by virtuous persons which are conducive for doing well in life, and attainment of heaven after death, means of livelihood should be done. By doing such acts one gains fame and attains heaven after death. Thus, the third basic desire is explained. 
अथ खलु त्रय उपस्तम्भाः, त्रिविधं बलं, त्रीण्यायतनानि, त्रयो रोगाः, त्रयो रोगमार्गाः, त्रिविधा भिषजः, त्रिविधमौषधमिति||३४||
atha khalu traya upastambhāḥ, trividhaṁ balaṁ, trīṇyāyatanāni, trayō rōgāḥ, trayō rōgamārgāḥ, trividhābhiṣajaḥ, trividhamauṣadhamiti||34||
atha khalu traya upastambhAH, trividhaM balaM, trINyAyatanAni, trayo rogAH, trayo rogamArgAH, trividhAbhiShajaH, trividhamauShadhamiti||34||
There are three supporting pillars of life, three types of strength, three types of causes of diseases, three types of diseases, three systems for disease manifestation, three types of physicians, three types of therapies. 
Three Supporting Pillars of Life
त्रय उपस्तम्भा इति- आहारः, स्वप्नो, ब्रह्मचर्यमिति; एभिस्त्रिभिर्युक्तियुक्तैरुपस्तब्धमुपस्तम्भैः शरीरंबलवर्णोपचयोपचितमनुवर्तते यावदायुःसंस्कारात् संस्कारमहितमनुपसेवमानस्य , य इहैवोपदेक्ष्यते||३५||
traya upastambhā iti- āhāraḥ, svapnō, brahmacaryamiti;ēbhistribhiryuktiyuktairupastabdhamupastambhaiḥ śarīraṁ balavarṇōpacayōpacitamanuvartatēyāvadāyuḥsaṁskārāt saṁskāramahitamanupasēvamānasya , ya ihaivōpadēkṣyatē||35||
traya upastambhA iti- AhAraH, svapno, brahmacaryamiti;ebhistribhiryuktiyuktairupastabdhamupastambhaiH sharIraM balavarNopacayopacitamanuvartateyAvadAyuHsaMskArAt saMskAramahitamanupasevamAnasya , ya ihaivopadekShyate||35||
Three supporting pillars of life: Ahara (food), nidra (sleep) and observance of bramhacharya ( celibacy/control of senses). By the wisdom of well regulated support of these three pillars one can get body with strength, good complexion and proper growth and this continues throughout life, provided person does not get involved in regimens which are detrimental for health, these are discussed in this chapter. 
Three Types of Bala (strength)
त्रिविधं बलमिति- सहजं, कालजं, युक्तिकृतं च| सहजं यच्छरीरसत्त्वयोः प्राकृतं, कालकृतमृतुविभागजं वयःकृतं च, युक्तिकृतं पुनस्तद्यदाहारचेष्टायोगजम्||३६||
trividhaṁ balamiti- sahajaṁ, kālajaṁ, yuktikr̥taṁ ca| sahajaṁ yaccharīrasattvayōḥ prākr̥taṁ, kālakr̥tamr̥tuvibhāgajaṁ vayaḥkr̥taṁ ca, yuktikr̥taṁpunastadyadāhāracēṣṭāyōgajam||36||
trividhaM balamiti- sahajaM, kAlajaM, yuktikRutaM ca| sahajaM yaccharIrasattvayoH prAkRutaM, kAlakRutamRutuvibhAgajaM vayaHkRutaM ca, yuktikRutaMpunastadyadAhAraceShTAyogajam||36||
Sahaja (hereditary, since birth), kalaja (seasonal or periodic), and yuktikrita (acquired).
Sahaja bala is present in body and mind since birth or naturally. Kalakrita bala is according to the seasonal variations and age of the person. Yukti krita bala or acquired strength is based on the combination of the dietetic and the other regimens followed by the person. 
Three Ayatana (causes of diseases)
त्रीण्यायतनानीति- अर्थानां कर्मणः कालस्य चातियोगायोगमिथ्यायोगाः| तत्रातिप्रभावतां दृश्यानामतिमात्रं दर्शनमतियोगः, सर्वशोऽदर्शनमयोगः,अतिश्लिष्टातिविप्रकृष्टरौद्रभैरवाद्भुतद्विष्टबीभत्सनविकृतवित्रासनादिरूपदर्शनं मिथ्यायोगः;तथाऽतिमात्रस्तनितपटहोत्क्रुष्टादीनां शब्दानामतिमात्रं श्रवणमतियोगः, सर्वशोऽश्रवणमयोगः,परुषेष्टविनाशोपघातप्रधर्षणभीषणादिशब्दश्रवणं मिथ्यायोगः; तथाऽतितीक्ष्णोग्राभिष्यन्दिनां गन्धानामतिमात्रंघ्राणमतियोगः, सर्वशोऽघ्राणमयोगः, पूतिद्विष्टामेध्यक्लिन्नविषपवनकुणपगन्धादिघ्राणं मिथ्यायोगः; तथारसानामत्यादानमतियोगः, सर्वशोऽनादानमयोगः, मिथ्यायोगो राशिवर्ज्येष्वाहारविधिविशेषायतनेषूपदेक्ष्यते;तथाऽतिशीतोष्णानां स्पृश्यानां स्नानाभ्यङ्गोत्सादनादीनां चात्युपसेवनमतियोगः, सर्वशोऽनुपसेवनमयोगः, स्नानादीनांशीतोष्णादीनां च स्पृश्यानामनानुपूर्व्योपसेवनं विषमस्थानाभिघाताशुचिभूतसंस्पर्शादयश्चेति मिथ्यायोगः||३७||
trīṇyāyatanānīti- arthānāṁ karmaṇaḥ kālasya cātiyōgāyōgamithyāyōgāḥ| tatrātiprabhāvatāṁ dr̥śyānāmatimātraṁ darśanamatiyōgaḥ, sarvaśō'darśanamayōgaḥ,atiśliṣṭātiviprakr̥ṣṭaraudrabhairavādbhutadviṣṭabībhatsanavikr̥tavitrāsanādirūpadarśanaṁ mithyāyōgaḥ; tathā'timātrastanitapaṭahōtkruṣṭādīnāṁ śabdānāmatimātraṁ śravaṇamatiyōgaḥ,sarvaśō'śravaṇamayōgaḥ, paruṣēṣṭavināśōpaghātapradharṣaṇabhīṣaṇādiśabdaśravaṇaṁ mithyāyōgaḥ;tathā'titīkṣṇōgrābhiṣyandināṁ gandhānāmatimātraṁ ghrāṇamatiyōgaḥ, sarvaśō'ghrāṇamayōgaḥ,pūtidviṣṭāmēdhyaklinnaviṣapavanakuṇapagandhādighrāṇaṁ mithyāyōgaḥ; tathārasānāmatyādānamatiyōgaḥ, sarvaśō'nādānamayōgaḥ, mithyāyōgōrāśivarjyēṣvāhāravidhiviśēṣāyatanēṣūpadēkṣyatē; tathā'tiśītōṣṇānāṁ spr̥śyānāṁsnānābhyaṅgōtsādanādīnāṁ cātyupasēvanamatiyōgaḥ, sarvaśō'nupasēvanamayōgaḥ, snānādīnāṁśītōṣṇādīnāṁ ca spr̥śyānāmanānupūrvyōpasēvanaṁ viṣamasthānābhighātāśucibhūtasaṁsparśādayaścētimithyāyōgaḥ||37||
trINyAyatanAnIti- arthAnAM karmaNaH kAlasya cAtiyogAyogamithyAyogAH| tatrAtiprabhAvatAM dRushyAnAmatimAtraM darshanamatiyogaH, sarvasho~adarshanamayogaH,atishliShTAtiviprakRuShTaraudrabhairavAdbhutadviShTabIbhatsanavikRutavitrAsanAdirUpadarshanaM mithyAyogaH; tathA~atimAtrastanitapaTahotkruShTAdInAM shabdAnAmatimAtraMshravaNamatiyogaH, sarvasho~ashravaNamayogaH,paruSheShTavinAshopaghAtapradharShaNabhIShaNAdishabdashravaNaM mithyAyogaH;tathA~atitIkShNogrAbhiShyandinAM gandhAnAmatimAtraM ghrANamatiyogaH,sarvasho~aghrANamayogaH, pUtidviShTAmedhyaklinnaviShapavanakuNapagandhAdighrANaMmithyAyogaH; tathA rasAnAmatyAdAnamatiyogaH, sarvasho~anAdAnamayogaH, mithyAyogorAshivarjyeShvAhAravidhivisheShAyataneShUpadekShyate; tathA~atishItoShNAnAM spRushyAnAMsnAnAbhya~ggotsAdanAdInAM cAtyupasevanamatiyogaH, sarvasho~anupasevanamayogaH,snAnAdInAM shItoShNAdInAM ca spRushyAnAmanAnupUrvyopasevanaMviShamasthAnAbhighAtAshucibhUtasaMsparshAdayashceti mithyAyogaH||37||
Atiyoga (excessive utilisation), ayoga (non-utilisation) and mithyayoga (wrong utilisation) of artha (objects of senses), karma (actions) and kala (time) are three causes of diseases. Examples are
- Atiyoga of sense of vision is excessive gazing at highly illuminous things,
- Ayoga of sense of vision is to not look at anything
- Mithyayoga of the sense of vision would be looking at things which are too close or too far, looking at awful, terrifying or surprising, contemptuous, frightful or deformed and alarming things is wrong utilization. Likewise, to hear loud noise coming out of thunder bolt, kettle drum, loud cries etc. are the examples of excessive utilization of sense of hearing, not hearing anything at all is non-utilization, hearing harsh words, news about death of near and dear or about loss of wealth, assaulting, insulting and terrifying sounds is wrong utilization of sense of hearing. Smelling of sharp, acute and intoxicating odors is excessive utilization of sense of olfaction, not to smell is non-utilization. Smelling of putrid, unpleasant, dirty, putrefied and cadaverous smell and poisonous gas is wrong utilization of sense of smell.
Similarly, excessive intake of various substances with different tastes is over utilization of gustatory sense, not to use the sense is its non-utilization, and intake of things not considering the factors for utility of food mentioned in Vimana Sthana except rashi is the wrong utilization of gustatory senses.
Excessive cold or hot water bath, excessive massage, unction etc. constitutes overuse of tactile senses, not to use at all is non-utilization, touch of uneven places, trauma, dirty objects, bhuta-sansparsha (microscopic organisms causing diseases) is the wrong utilization of tactile senses. 
Three Causes of Diseases
तत्रैकं स्पर्शनमिन्द्रियाणामिन्द्रियव्यापकं , चेतः- समवायि, स्पर्शनव्याप्तेर्व्यापकमपि च चेतः; तस्मात् सर्वेन्द्रियाणांव्यापकस्पर्शकृतो यो भावविशेषः, सोऽयमनुपशयात् पञ्चविधस्त्रिविधविकल्पो भवत्यसात्म्येन्द्रियार्थसंयोगः; सात्म्यार्थोह्युपशयार्थः||३८||
tatraikaṁ sparśanamindriyāṇāmindriyavyāpakaṁ , cētaḥ- samavāyi, sparśanavyāptērvyāpakamapi cacētaḥ; tasmāt sarvēndriyāṇāṁ vyāpakasparśakr̥tō yō bhāvaviśēṣaḥ, sō'yamanupaśayātpañcavidhastrividhavikalpō bhavatyasātmyēndriyārthasaṁyōgaḥ; sātmyārthō hyupaśayārthaḥ||38||
tatraikaM sparshanamindriyANAmindriyavyApakaM , cetaH- samavAyi, sparshanavyAptervyApakamapica cetaH; tasmAt sarvendriyANAM vyApakasparshakRuto yo bhAvavisheShaH, so~ayamanupashayAtpa~jcavidhastrividhavikalpo bhavatyasAtmyendriyArthasaMyogaH; sAtmyArtho hyupashayArthaH||38||
The sense of touch is present/pervades in all the senses, it is associated with mind. The mind is pervaded in sense of touch, the latter in turn in all senses. The anupashaya (unwholesome objects) of sensual faculties are divided into five types further sub divided into three each (non-utilization, over utilization, wrong utilization). This is known as asatmyendriyatha samyoga. The favorable reaction of the senses is satmya (adaptation/wholesome conjunction of senses with their object). ||38||
Prajnaparadha (intellectual defects)
कर्म वाङ्मनःशरीरप्रवृत्तिः| तत्र वाङ्मनःशरीरातिप्रवृत्तिरतियोगः; सर्वशोऽप्रवृत्तिरयोगः;वेगधारणोदीरणविषमस्खलनपतनाङ्गप्रणिधानाङ्गप्रदूषणप्रहारमर्दनप्राणोपरोधसङ्क्लेशनादिः शारीरो मिथ्यायोगः,सूचकानृताकालकलहाप्रियाबद्धानुपचारपरुषवचनादिर्वाङ्मिथ्यायोगः, भयशोकक्रोधलोभमोहमानेर्ष्यामिथ्यादर्शनादिर्मानसोमिथ्यायोगः||३९||
karma vāṅmanaḥśarīrapravr̥ttiḥ| tatra vāṅmanaḥśarīrātipravr̥ttiratiyōgaḥ; sarvaśō'pravr̥ttirayōgaḥ;vēgadhāraṇōdīraṇaviṣamaskhalanapatanāṅgapraṇidhānāṅgapradūṣaṇaprahāramardanaprāṇōparōdhasaṅklēśanādiḥśārīrō mithyāyōgaḥ, sūcakānr̥tākālakalahāpriyābaddhānupacāraparuṣavacanādirvāṅmithyāyōgaḥ,bhayaśōkakrōdhalōbhamōhamānērṣyāmithyādarśanādirmānasō mithyāyōgaḥ||39||
karma vA~gmanaHsharIrapravRuttiH| tatra vA~gmanaHsharIrAtipravRuttiratiyogaH; sarvasho~apravRuttirayogaH;vegadhAraNodIraNaviShamaskhalanapatanA~ggapraNidhAnA~ggapradUShaNaprahAramardanaprANoparodhasa~gkleshanAdiHshArIro mithyAyogaH, sUcakAnRutAkAlakalahApriyAbaddhAnupacAraparuShavacanAdirvA~gmithyAyogaH,bhayashokakrodhalobhamohamAnerShyAmithyAdarshanAdirmAnaso mithyAyogaH||39||
Action includes verbal, mental and body (physical) activities. The atiyoga (excess action) includes speech, mind and body activities in excessive manner and their complete inactivity is ayoga (non-utilisation). Suppression of natural urges, their forceful manifestation, slipping from uneven places, excessive walking, falling, keeping body parts in improper posture, keeping body parts unhygienic, body assault, excessive massage, excess holding of breath and giving all kind of torture to body are the examples of wrong utilization of body activities. Backbiting, lying, unnecessary quarrels, unpleasant talks, irrelevant and unpleasant and harsh talks are the examples of wrong utilization of speech. Fear, grief, anger, greed, confusion, proud, envy and misconceptions are wrong utilization of mind. 
सङ्ग्रहेण चातियोगायोगवर्जं कर्म वाङ्मनःशरीरजमहितमनुपदिष्टं यत्तच्च मिथ्यायोगं विद्यात्||४०||
saṅgrahēṇa cātiyōgāyōgavarjaṁ karma vāṅmanaḥśarīrajamahitamanupadiṣṭaṁ yattacca mithyāyōgaṁvidyāt||40||
sa~ggraheNa cAtiyogAyogavarjaM karma vA~gmanaHsharIrajamahitamanupadiShTaM yattaccamithyAyogaM vidyAt||40||
In brief, actions which are not included in over utilization and non-utilization related to actions of speech, mind and body and which are harmful even though not mentioned comes under wrong utilization of acts of speech, mind and body. 
इति त्रिविधविकल्पं त्रिविधमेव कर्म प्रज्ञापराध इति व्यवस्येत्||४१|
iti trividhavikalpaṁ trividhamēva karma prajñāparādha iti vyavasyēt||41||
iti trividhavikalpaM trividhameva karma praj~jAparAdha iti vyavasyet||41||
Three types of vikalpa (atiyoga, ayoga and mithyayoga) and three actions (speech, mind and body) comes under category of deeds done of prajnaparadha (intellectual defects). ||41||
Kala or Parinama (time)
शीतोष्णवर्षलक्षणाः पुनर्हेमन्तग्रीष्मवर्षाः संवत्सरः, स कालः| तत्रातिमात्रस्वलक्षणः कालः कालातियोगः, हीनस्वलक्षणः (कालः) कालायोगः, यथास्वलक्षणविपरीतलक्षणस्तु (कालः)कालमिथ्यायोगः| कालः पुनः परिणाम उच्यते||४२||
śītōṣṇavarṣalakṣaṇāḥ punarhēmantagrīṣmavarṣāḥ saṁvatsaraḥ, sa kālaḥ| tatrātimātrasvalakṣaṇaḥ kālaḥ kālātiyōgaḥ, hīnasvalakṣaṇaḥ (kālaḥ) kālāyōgaḥ,yathāsvalakṣaṇaviparītalakṣaṇastu (kālaḥ) kālamithyāyōgaḥ| kālaḥ punaḥ pariṇāma ucyatē||42||
shItoShNavarShalakShaNAH punarhemantagrIShmavarShAH saMvatsaraH, sa kAlaH| tatrAtimAtrasvalakShaNaH kAlaH kAlAtiyogaH, hInasvalakShaNaH (kAlaH) kAlAyogaH,yathAsvalakShaNaviparItalakShaNastu (kAlaH) kAlamithyAyogaH| kAlaH punaH pariNAma ucyate||42||
Time span of a year is divided into sheeta (winter season), ushna (summer season) and rainy season. Which is further divided into six seasons namely hemanta- shishira (winter), vasanta- grishma (summer), varsha-sharada (rains). The manifestation of particular season in excess be regarded as kala atiyoga (excessive utilization), if season manifests in lesser measure, termed as ayoga (non-utilization). On the other hand, if manifestation of the season is contrary with normal, this is mithyayoga (wrong utilization) of the kala (season). 
इत्यसात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति त्रयस्त्रिविधविकल्पा हेतवो विकाराणां; समयोगयुक्तास्तु प्रकृतिहेतवोभवन्ति||४३||
ityasātmyēndriyārthasaṁyōgaḥ, prajñāparādhaḥ, pariṇāmaścēti trayastrividhavikalpā hētavō vikārāṇāṁ;samayōgayuktāstu prakr̥tihētavō bhavanti||43||
ityasAtmyendriyArthasaMyogaH, praj~jAparAdhaH, pariNAmashceti trayastrividhavikalpA hetavovikArANAM; samayogayuktAstu prakRutihetavo bhavanti||43||
The asatmyaindriyarthsamyoga (unwholesome union) of the sense organs with their objects, prajnaparadha (intellectual defect) and parinama (seasonal effects) along with three types (atiyoga, ayoga and mithyayoga) are the three causes of diseases.
Samyoga (proper utilization) of sense organs, actions and time are beneficial for maintenance of health. 
सर्वेषामेव भावानां भावाभावौ नान्तरेण योगायोगातियोगमिथ्यायोगान् समुपलभ्येते; यथास्वयुक्त्यपेक्षिणौ हि भावाभावौ||४४||
sarvēṣāmēva bhāvānāṁ bhāvābhāvau nāntarēṇa yōgāyōgātiyōgamithyāyōgān samupalabhyētē;yathāsvayuktyapēkṣiṇau hi bhāvābhāvau||44||
sarveShAmeva bhAvAnAM bhAvAbhAvau nAntareNa yogAyogAtiyogamithyAyogAn samupalabhyete;yathAsvayuktyapekShiNau hi bhAvAbhAvau||44||
All the objects in this universe have bhava (presence) and abhava (absence) which can be recognized by their yoga (proper maintenance), ayoga (non utilization), atiyoga (excessive utilization) and mithyayoga (improper utilization). Because bhava needs yukti (reasoning) for recognition but abhava does not depend on yukti. 
Three Types of Diseases
त्रयो रोगा इति- निजागन्तुमानसाः| तत्र निजः शारीरदोषसमुत्थः, आगन्तुर्भूतविषवाय्वग्निसम्प्रहारादिसमुत्थः, मानसः पुनरिष्टस्यलाभाल्लाभाच्चानिष्टस्योपजायते||४५||
trayō rōgā iti- nijāgantumānasāḥ| tatra nijaḥ śārīradōṣasamutthaḥ, āganturbhūtaviṣavāyvagnisamprahārādisamutthaḥ, mānasaḥpunariṣṭasya lābhāllābhāccāniṣṭasyōpajāyatē||45||
trayo rogA iti- nijAgantumAnasAH| tatra nijaH shArIradoShasamutthaH, AganturbhUtaviShavAyvagnisamprahArAdisamutthaH, mAnasaHpunariShTasya lAbhAllAbhAccAniShTasyopajAyate||45||
There are three types of diseases – Nija (endogenous), agantuja (exogenous) and manasa (psychological). Nija vyadhi (endogenous diseases) are caused by vitiation of body doshas (vata, pitta and kapha). Agantuja (exogenous diseases) are caused bhuta (invisible organisms), poisonous substances, wind, fire and trauma. Manasa (psychological diseases) are caused by conflict between not getting the desired things and getting non desired things. 
तत्र बुद्धिमता मानसव्याधिपरीतेनापि सता बुद्ध्या हिताहितमवेक्ष्यावेक्ष्य धर्मार्थकामानामहितानामनुपसेवने हितानांचोपसेवने प्रयतितव्यं, न ह्यन्तरेण लोके त्रयमेतन्मानसं किञ्चिन्निष्पद्यते सुखं वा दुःखं वा; तस्मादेतच्चानुष्ठेयं-तद्विद्यानां चोपसेवने प्रयतितव्यम्, आत्मदेशकुलकालबलशक्तिज्ञाने यथावच्चेति||४६||
tatra buddhimatā mānasavyādhiparītēnāpi satā buddhyā hitāhitamavēkṣyāvēkṣyadharmārthakāmānāmahitānāmanupasēvanē hitānāṁ cōpasēvanē prayatitavyaṁ, na hyantarēṇa lōkētrayamētanmānasaṁ kiñcinniṣpadyatē sukhaṁ vā duḥkhaṁ vā; tasmādētaccānuṣṭhēyaṁ- tadvidyānāṁ cōpasēvanē prayatitavyam, ātmadēśakulakālabalaśaktijñānē yathāvaccēti||46||
tatra buddhimatA mAnasavyAdhiparItenApi satA buddhyA hitAhitamavekShyAvekShyadharmArthakAmAnAmahitAnAmanupasevane hitAnAM copasevane prayatitavyaM, na hyantareNa loketrayametanmAnasaM ki~jcinniShpadyate sukhaM vA duHkhaM vA; tasmAdetaccAnuShTheyaM-tadvidyAnAM copasevane prayatitavyam, AtmadeshakulakAlabalashaktij~jAne yathAvacceti||46||
A wise person even if suffering from psychological disease should consider carefully what is beneficial and what is harmful for health. One should discard the harmful or unwholesome regimens and do the beneficial work regarding the dharma (virtue), artha (wealth) and kama (desire). In this world happiness or sorrow cannot occur without these three. That is why one should try to indulge in doing beneficial work and discard the harmful one. One should serve the intellect. Also, try to acquire knowledge about atman(self), desha (place), kala(time), bala(strength), shakti(potential/capacity). 
भवति चात्र- मानसं प्रति भैषज्यं त्रिवर्गस्यान्ववेक्षणम्| तद्विद्यसेवा विज्ञानमात्मादीनां च सर्वशः||४७||
bhavati cātra- mānasaṁ prati bhaiṣajyaṁ trivargasyānvavēkṣaṇam| tadvidyasēvā vijñānamātmādīnāṁ ca sarvaśaḥ||47||
bhavati cAtra- mAnasaM prati bhaiShajyaM trivargasyAnvavekShaNam| tadvidyasevA vij~jAnamAtmAdInAM ca sarvashaH||47||
Thus, it is said that the treatment of psychological diseases is- to follow the conduct related to dharma (virtue), artha (wealth) and kama (desire). To do service of persons who are having knowledge of psychological diseases and follow their instructions. To obtain the knowledge about self etc. 
Three Disease Pathways
त्रयो रोगमार्गा इति- शाखा, मर्मास्थिसन्धयः, कोष्ठश्च| तत्र शाखा रक्तादयो धातवस्त्वक् च, स बाह्यो रोगमार्गः; मर्माणि पुनर्बस्तिहृदयमूर्धादीनि,अस्थिसन्धयोऽस्थिसंयोगास्तत्रोपनिबद्धाश्च स्नायुकण्डराः , स मध्यमो रोगमार्गः; कोष्ठः पुनरुच्यते महास्रोतः शरीरमध्यंमहानिम्नमामपक्वाशयश्चेति पर्यायशब्दैस्तन्त्रे, स रोगमार्ग आभ्यन्तरः||४८||
trayō rōgamārgā iti- śākhā, marmāsthisandhayaḥ, kōṣṭhaśca| tatra śākhā raktādayō dhātavastvak ca, sa bāhyō rōgamārgaḥ; marmāṇi punarbastihr̥dayamūrdhādīni,asthisandhayō'sthisaṁyōgāstatrōpanibaddhāśca snāyukaṇḍarāḥ , sa madhyamō rōgamārgaḥ; kōṣṭhaḥpunarucyatē mahāsrōtaḥ śarīramadhyaṁ mahānimnamāmapakvāśayaścēti paryāyaśabdaistantrē, sarōgamārga ābhyantaraḥ||48||
trayo rogamArgA iti- shAkhA, marmAsthisandhayaH, koShThashca| tatra shAkhA raktAdayo dhAtavastvak ca, sa bAhyo rogamArgaH; marmANipunarbastihRudayamUrdhAdIni, asthisandhayo~asthisaMyogAstatropanibaddhAshca snAyukaNDarAH ,sa madhyamo rogamArgaH; koShThaH punarucyate mahAsrotaH sharIramadhyaMmahAnimnamAmapakvAshayashceti paryAyashabdaistantre, sa rogamArga AbhyantaraH||48||
There are three pathways of disease manifestation- shakha (peripheral path), marmasthisandhi (vital organs & bone joints) and koshtha (digestive system). The shakha includes tissue elements like blood and skin etc.; this is considered as bahya rogamarga (external path for disease manifestation). Marmas (vital organs) are basti (urinary bladder), hridaya(heart), murdha (head) etc. bones, joints, ligaments and tendons, is considered as madhyama rogamarga (middle pathway for manifestation of disease). Koshtha (digestive system) is known as Mahastrotas (great channel) it is sharira madhya (central body part), mahanimna (greater lower part), ama-pakwashaya (stomach and intestines), this is abhyantara rogamarga (internal pathway for disease manifestation). 
तत्र, गण्डपिडकालज्यपचीचर्मकीलाधिमांसमषककुष्ठव्यङ्गादयो विकारा बहिर्मार्गजाश्च विसर्पश्वयथुगुल्मार्शोविद्रध्यादयःशाखानुसारिणो भवन्ति रोगाः; पक्षवधग्रहापतानकार्दितशोषराजयक्ष्मास्थिसन्धिशूलगुदभ्रंशादयः शिरोहृद्बस्तिरोगादयश्चमध्यममार्गानुसारिणो भवन्ति रोगाः; ज्वरातीसारच्छर्द्यलसकविसूचिकाकासश्वासहिक्कानाहोदरप्लीहादयोऽन्तर्मार्गजाश्चविसर्पश्वयथुगुल्मार्शोविद्रध्यादयः कोष्ठानुसारिणो भवन्ति रोगाः||४९||
tatra, gaṇḍapiḍakālajyapacīcarmakīlādhimāṁsamaṣakakuṣṭhavyaṅgādayō vikārā bahirmārgajāścavisarpaśvayathugulmārśōvidradhyādayaḥ śākhānusāriṇō bhavanti rōgāḥ;pakṣavadhagrahāpatānakārditaśōṣarājayakṣmāsthisandhiśūlagudabhraṁśādayaḥśirōhr̥dbastirōgādayaśca madhyamamārgānusāriṇō bhavanti rōgāḥ;jvarātīsāracchardyalasakavisūcikākāsaśvāsahikkānāhōdaraplīhādayō'ntarmārgajāścavisarpaśvayathugulmārśōvidradhyādayaḥ kōṣṭhānusāriṇō bhavanti rōgāḥ||49||
tatra, gaNDapiDakAlajyapacIcarmakIlAdhimAMsamaShakakuShThavya~ggAdayo vikArAbahirmArgajAshca visarpashvayathugulmArshovidradhyAdayaH shAkhAnusAriNo bhavanti rogAH;pakShavadhagrahApatAnakArditashoSharAjayakShmAsthisandhishUlagudabhraMshAdayaHshirohRudbastirogAdayashca madhyamamArgAnusAriNo bhavanti rogAH;jvarAtIsAracchardyalasakavisUcikAkAsashvAsahikkAnAhodaraplIhAdayo~antarmArgajAshcavisarpashvayathugulmArshovidradhyAdayaH koShThAnusAriNo bhavanti rogAH||49||
Diseases like ganda (goiter), pidaka (pustule), alaji (boil), apache (scrofula), charmakeela (skin warts), adhimamsa (muscular new growth), mashak (moles), kushtha (skin disorders), vyanga (blemishes), also the external variety of visarpa (skin disease/ swelling quickly spreads), shvayathu (edema), gulma (abdominal lumps), arsha (piles), and vidradhi (abscess) are the diseases of shakha (external route).
Pakshavadha (hemiplegia), graha (stiffness), apatanaka (convulsion disorder), ardita (facial palsy), sosha (cachexia), rajayakshma (tuberculosis), asthisandhishula (pain in bone joints), gudabhramsha (prolapsed rectum), and diseases of head, heart and urinary bladder are the diseases of middle pathway for disease manifestation.
Jwara (fever), atisara (diarrhea), chhardi (vomiting), alasaka (sluggish intestines/ paralytic ileus), visuchika (cholera), kasa (cough), shwasa (dyspnoea), hikka (hiccups), anaha (obstructed flatulence), udara ( abdominal disorders), pliha roga (diseases of spleen), internal visarpa (skin disease/ swelling which quickly spreads), shvayathu (internal swelling), gulma (abdominal lumps), arsha (internal piles), and vidradhi (internal abscess) are the diseases of internal pathway for disease manifestation. 
Three Types of Physicians
त्रिविधा भिषज इति- भिषक्छद्मचराः सन्ति सन्त्येके सिद्धसाधिताः| सन्ति वैद्यगुणैर्युक्तास्त्रिविधा भिषजो भुवि||५०||
वैद्यभाण्डौषधैः पुस्तैः पल्लवैरवलोकनैः| लभन्ते ये भिषक्शब्दमज्ञास्ते प्रतिरूपकाः||५१||
श्रीयशोज्ञानसिद्धानां व्यपदेशादतद्विधाः| वैद्यशब्दं लभन्ते ये ज्ञेयास्ते सिद्धसाधिताः||५२||
प्रयोगज्ञानविज्ञानसिद्धिसिद्धाः सुखप्रदाः| जीविताभिसरास्ते स्युर्वैद्यत्वं तेष्ववस्थितमिति||५३||
trividhā bhiṣaja iti- bhiṣakchadmacarāḥ santi santyēkē siddhasādhitāḥ| santi vaidyaguṇairyuktāstrividhā bhiṣajō bhuvi||50||
vaidyabhāṇḍauṣadhaiḥ pustaiḥ pallavairavalōkanaiḥ| labhantē yē bhiṣakśabdamajñāstē pratirūpakāḥ||51||
śrīyaśōjñānasiddhānāṁ vyapadēśādatadvidhāḥ| vaidyaśabdaṁ labhantē yē jñēyāstē siddhasādhitāḥ||52||
prayōgajñānavijñānasiddhisiddhāḥ sukhapradāḥ| jīvitābhisarāstē syurvaidyatvaṁ tēṣvavasthitamiti||53||
trividhA bhiShaja iti- bhiShakchadmacarAH santi santyeke siddhasAdhitAH| santi vaidyaguNairyuktAstrividhA bhiShajo bhuvi||50||
vaidyabhANDauShadhaiH pustaiH pallavairavalokanaiH| labhante ye bhiShakshabdamaj~jAste pratirUpakAH||51||
shrIyashoj~jAnasiddhAnAM vyapadeshAdatadvidhAH| vaidyashabdaM labhante ye j~jeyAste siddhasAdhitAH||52||
prayogaj~jAnavij~jAnasiddhisiddhAH sukhapradAH| jIvitAbhisarAste syurvaidyatvaM teShvavasthitamiti||53||
There are three types of bhishag (physicians):
- bhishag chhadmachara (pseudo physicians/impostor),
- siddhasadhit (feigned/pretender physicians), and
- vaidya guna yukta / jivitabhisara (true/genuine physicians with essential qualities) found in this world.
Those who carry equipments, medicines, books, green herbs and dress up like vaidyas are ignorant of medical science, fool others and are just fake vaidya or quacks.
A person who poses like a wealthy, famous, knowledgeable and siddha (expert) person, but in reality is not like so, belongs to the category of feigned physicians.
Practical use of various therapies and the deep knowledge of Ayurveda science, having insight, famous, successful, capable of giving happiness to the patients are Jivitabhisara (saviour of life), the qualities of genuine physician. [50-53]
Three Kinds of Treatment Modalities
त्रिविधमौषधमिति- दैवव्यपाश्रयं, युक्तिव्यपाश्रयं, सत्त्वावजयश्च| तत्र दैवव्यपाश्रयं- मन्त्रौषधिमणिमङ्गलबल्युपहारहोमनियमप्रायश्चित्तोपवासस्वस्त्ययनप्रणिपातगमनादि,युक्तिव्यपाश्रयं- पुनराहारौषधद्रव्याणां योजना, सत्त्वावजयः- पुनरहितेभ्योऽर्थेभ्यो मनोनिग्रहः||५४||
trividhamauṣadhamiti- daivavyapāśrayaṁ, yuktivyapāśrayaṁ, sattvāvajayaśca| tatra daivavyapāśrayaṁ-mantrauṣadhimaṇimaṅgalabalyupahārahōmaniyamaprāyaścittōpavāsasvastyayanapraṇipātagamanādi,yuktivyapāśrayaṁ- punarā hārauṣadhadravyāṇāṁ yōjanā, sattvāvajayaḥ- punarahitēbhyō'rthēbhyōmanōnigrahaḥ||54||
trividhamauShadhamiti- daivavyapAshrayaM, yuktivyapAshrayaM, sattvAvajayashca| tatra daivavyapAshrayaM-mantrauShadhimaNima~ggalabalyupahArahomaniyamaprAyashcittopavAsasvastyayanapraNipAtagamanAdi,yuktivyapAshrayaM- punarAhArauShadhadravyANAM yojanA, sattvAvajayaH- punarahitebhyo~arthebhyomanonigrahaH||54||
There are three kinds of treatment modalities- Daivavyapashraya (divine or spiritual therapy), yuktivyapashraya (therapy based on reasoning) and satwavajaya (psychotherapy). Daivavyapashraya includes mantra chanting, medicine, wearing gems, auspicious offerings, oblations, gifts, offerings to sacred fire, following spiritual rules, atonement, fasting, chanting of auspicious hymns, obeisance to gods, visit to holy places, etc. Yuktivyapashyraya includes proper dietetic regimen, medicine planning. Sattvavajaya is withdrawal of mind from harmful objects. 
Three Types of Therapies
शरीरदोषप्रकोपे खलु शरीरमेवाश्रित्य प्रायशस्त्रिविधमौषधमिच्छन्ति- अन्तःपरिमार्जनं, बहिःपरिमार्जनं, शस्त्रप्रणिधानं चेति| तत्रान्तःपरिमार्जनं यदन्तःशरीरमनुप्रविश्यौषधमाहारजातव्याधीन् प्रमार्ष्टि,यत्पुनर्बहिःस्पर्शमाश्रित्याभ्यङ्गस्वेदप्रदेहपरिषेकोन्मर्दनाद्यैरामयान् प्रमार्ष्टि तद्बहिःपरिमार्जनं, शस्त्रप्रणिधानंपुनश्छेदनभेदनव्यधनदारणलेखनोत्पाटनप्रच्छनसीवनैषणक्षारजलौकसश्चेति||५५||
śarīradōṣaprakōpē khalu śarīramēvāśritya prāyaśastrividhamauṣadhamicchanti- antaḥparimārjanaṁ,bahiḥparimārjanaṁ, śastrapraṇidhānaṁ cēti| tatrāntaḥparimārjanaṁ yadantaḥśarīramanupraviśyauṣadhamāhārajātavyādhīn pramārṣṭi,yatpunarbahiḥsparśamāśrityābhyaṅgasvēdapradēhapariṣēkōnmardanādyairāmayān pramārṣṭitadbahiḥparimārjanaṁ, śastrapraṇidhānaṁpunaśchēdanabhēdanavyadhanadāraṇalēkhanōtpāṭanapracchanasīvanaiṣaṇakṣārajalaukasaścēti||55||
sharIradoShaprakope khalu sharIramevAshritya prAyashastrividhamauShadhamicchanti- antaHparimArjanaM,bahiHparimArjanaM, shastrapraNidhAnaM ceti| tatrAntaHparimArjanaM yadantaHsharIramanupravishyauShadhamAhArajAtavyAdhIn pramArShTi,yatpunarbahiHsparshamAshrityAbhya~ggasvedapradehapariShekonmardanAdyairAmayAn pramArShTitadbahiHparimArjanaM, shastrapraNidhAnaMpunashchedanabhedanavyadhanadAraNalekhanotpATanapracchanasIvanaiShaNakShArajalaukasashceti||55||
Bodily doshas (vata, pitta, kapha) vitiation leads to manifestation of disease, three types of therapies are necessary to be applied to the body:
- Antahaparimarjana (internal cleansing),
- Bahiparimarjana (external cleansing), and
- Shastrapranidhana (surgical procedures).
Antahaparimarjana (internal cleansing) treatment mode introduces drugs inside body for the treatment of diseases caused by improper diet etc. Bahiparimarjana (external cleansing) is done over the skin by the application of massage, sudation, unction, affusion, applying external pressure and kneading over affected body part externally. Shastrapranidhana (surgical procedures) includes excision, incision, puncturing, rupturing, scraping, uprooting, rubbing superficially with rough surface, suturing, probing, application of alkalis and leeches. 
Process of identification of diseased state
प्राज्ञो रोगे समुत्पन्ने बाह्येनाभ्यन्तरेण वा| कर्मणा लभते शर्म शस्त्रोपक्रमणेन वा||५६||
बालस्तु खलु मोहाद्वा प्रमादाद्वा न बुध्यते| उत्पद्यमानं प्रथमं रोगं शत्रुमिवाबुधः||५७||
अणुर्हि प्रथमं भूत्वा रोगः पश्चाद्विवर्धते| स जातमूलो मुष्णाति बलमायुश्च दुर्मतेः||५८||
न मूढो लभते सञ्ज्ञां तावद्यावन्न पीड्यते| पीडितस्तु मतिं पश्चात् कुरुते व्याधिनिग्रहे||५९||
अथ पुत्रांश्च दारांश्च ज्ञातींश्चाहूय भाषते| सर्वस्वेनापि मे कश्चिद्भिषगानीयतामिति||६०||
तथाविधं च कः शक्तो दुर्बलं व्याधिपीडितम्| कृशं क्षीणेन्द्रियं दीनं परित्रातुं गतायुषम्||६१||
स त्रातारमनासाद्य बालस्त्यजति जीवितम्| गोधा लाङ्गूलबद्धेवाकृष्यमाणा बलीयसा||६२||
तस्मात् प्रागेव रोगेभ्यो रोगेषु तरुणेषु वा| भेषजैः प्रतिकुर्वीत य इच्छेत् सुखमात्मनः||६३||
prājñō rōgē samutpannē bāhyēnābhyantarēṇa vā| karmaṇā labhatē śarma śastrōpakramaṇēna vā||56||
bālastu khalu mōhādvā pramādādvā na budhyatē| utpadyamānaṁ prathamaṁ rōgaṁ śatrumivābudhaḥ||57||
aṇurhi prathamaṁ bhūtvā rōgaḥ paścādvivardhatē| sa jātamūlō muṣṇāti balamāyuśca durmatēḥ||58||
na mūḍhō labhatē sañjñāṁ tāvadyāvanna pīḍyatē| pīḍitastu matiṁ paścāt kurutē vyādhinigrahē||59||
atha putrāṁśca dārāṁśca jñātīṁścāhūya bhāṣatē| sarvasvēnāpi mē kaścidbhiṣagānīyatāmiti||60||
tathāvidhaṁ ca kaḥ śaktō durbalaṁ vyādhipīḍitam| kr̥śaṁ kṣīṇēndriyaṁ dīnaṁ paritrātuṁ gatāyuṣam||61||
sa trātāramanāsādya bālastyajati jīvitam| gōdhā lāṅgūlabaddhēvākr̥ṣyamāṇā balīyasā||62|| tasmāt prāgēva rōgēbhyō rōgēṣu taruṇēṣu vā| bhēṣajaiḥ pratikurvīta ya icchēt sukhamātmanaḥ||63||
prAj~jo roge samutpanne bAhyenAbhyantareNa vA| karmaNA labhate sharma shastropakramaNena vA||56||
bAlastu khalu mohAdvA pramAdAdvA na budhyate| utpadyamAnaM prathamaM rogaM shatrumivAbudhaH||57||
aNurhi prathamaM bhUtvA rogaH pashcAdvivardhate| sa jAtamUlo muShNAti balamAyushca durmateH||58||
na mUDho labhate sa~jj~jAM tAvadyAvanna pIDyate| pIDitastu matiM pashcAt kurute vyAdhinigrahe||59||
atha putrAMshca dArAMshca j~jAtIMshcAhUya bhAShate| sarvasvenApi me kashcidbhiShagAnIyatAmiti||60||
tathAvidhaM ca kaH shakto durbalaM vyAdhipIDitam| kRushaM kShINendriyaM dInaM paritrAtuM gatAyuSham||61||
sa trAtAramanAsAdya bAlastyajati jIvitam| godhA lA~ggUlabaddhevAkRuShyamANA balIyasA||62||
tasmAt prAgeva rogebhyo rogeShu taruNeShu vA| bheShajaiH pratikurvIta ya icchet sukhamAtmanaH||63||
A wise person when gets disease, by the administration of external and internal cleansing or surgical therapy regains health. Fools because of ignorance or lack of awareness, neglects the disease just like fool is not aware about his enemy. In early stage disease is in insignificant stage but as time passes it grows. Thereafter it becomes deep rooted and takes away the strength and life of affected person. The fools are never conscious about any abnormality till it affects seriously and when becomes seriously ill then only thinks about eradication of disease. After this calls his children, wife and relatives and requests them to call physician and says, “I am ready to give all my earnings”. But who can save person with lack of strength, weak, sick, emaciated, wretched, about to die and has developed organ failure. Failing to find saviour (good physician), fool loses his life just like an iguana dies when its tail tied with rope pulled by a strong person. That is the reason a person who is desirous of his well being, should try to get rid of disease in early stage (before complete manifestation) by getting treated with appropriate therapies. [56-63]
एषणाः समुपस्तम्भा बलं कारणमामयाः| तिस्रैषणीये मार्गाश्च भिषजो भेषजानि च||६४||
त्रित्वेनाष्टौ समुद्दिष्टाः कृष्णात्रेयेण धीमता| भावा, भावेष्वसक्तेन येषु सर्वं प्रतिष्ठितम्||६५||
tatra ślōkau- ēṣaṇāḥ samupastambhā balaṁ kāraṇamāmayāḥ| tisraiṣaṇīyē mārgāśca bhiṣajō bhēṣajāni ca||64|| tritvēnāṣṭau samuddiṣṭāḥ kr̥ṣṇātrēyēṇa dhīmatā| bhāvā, bhāvēṣvasaktēna yēṣu sarvaṁ pratiṣṭhitam||65||
tatra shlokau- eShaNAH samupastambhA balaM kAraNamAmayAH| tisraiShaNIye mArgAshca bhiShajo bheShajAni ca||64|| tritvenAShTau samuddiShTAH kRuShNAtreyeNa dhImatA| bhAvA, bhAveShvasaktena yeShu sarvaM pratiShThitam||65||
Basic desires/pursuits (pranaeshana, dhanaeshana and paralokaeshana), supporting pillars (ahara, swapna and brahmacharya), three folds strength (sahaja, kalaja and yuktikrita), causes of disease (asatmya indriyartha samyoga, pragnyaparadha and parinama), diseases (nija, agantu and manasa), pathways for manifestation of disease (shakha, marma asthi sandhi and koshtha), physicians (pseudo physician, feigned physician and genuine physician), therapies (daivavyapashraya, yuktivyapasharaya and sattvavjaya) or antahparimarjana (internal cleansing), bahiparimarjana (external cleansing), shastrapranidhana (surgical procedures), triads of eight factors described in this chapter by wise sage Krishna Atreya. Everything is (virtue, wealth and desire) all are dependent on these eight factors. [64-65]
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने तिस्रैषणीयो नामैकादशोऽध्यायः||११||
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē ślōkasthānē tisraiṣaṇīyō nāmaikādaśō'dhyāyaḥ||11||
ityagniveshakRute tantre carakapratisaMskRute shlokasthAne tisraiShaNIyonAmaikAdasho~adhyAyaH||11||
Thus ends the work by Agnivesha, redacted by Charak of Sutra Sthana eleventh chapter on “Three desires of life”. 
Tattva Vimarsha (Fundamental Principles)
- Three basic desires to be fulfilled are: Desire for life (Praneshana), desire for wealth or livelihood (Dhaneshana)), desire for the other world or after death (Paralokeshana). 
- There is very limited scope for direct perception of everything. The scope of indirect knowledge is very vast. 
- Consciousness is without any beginning. Being eternal, it cannot be created by any other thing. Creation of body by the absolute atman (supreme soul) is acceptable view. 
- All the worldly objects can be divided into two categories, truth/existence and false/non-existence. There are four methods of examination- scripts or texts (words of persons with high intellect or sages), direct perception (direct observance), inference and reasoning. 
- Apta (authority), who are enlightened and knowledgeable are absolutely free from the rajas and tamas (psychological doshas). [18-19]
- The interconnection of soul, sense objects, mind and intellect is very important for knowledge by direct perception. 
- Reasoning shall be based on decision made by intellect based upon combination of multiple factors, valid for past, present and future. 
- Rebirth theory can be proved based on the scriptural evidences, perception, inference and reasoning.
- Treatment of psychological diseases includes, following the conduct related to dharma (virtue/eternal duty), artha (wealth) and kama (desire), by receiving guidance from experts with knowledge of psychological diseases and follow their instructions, and obtaining the knowledge about self. 
- Three important types of treatment modalities are, divine or spiritual therapy (daivavyapashraya), therapy based on reasoning (yuktivyapashraya) and psychotherapy (sattvavajaya). Daivavyapasharaya includes mantra chanting, medicine, wearing gems, auspicious offerings, oblations, gifts, offerings to sacred fire, following spiritual rules, atonement, fasting, chanting of auspicious hymns, obeisance to gods, visit to holy places, etc. Yuktivyapashyraya includes proper dietetic regimen, medicine planning. Sattvavajaya is withdrawal of mind from harmful objects. 
The zest of the various important topics discussed in this chapter is as follows.
Table 1: Three types of various factors:
|Three Aeshanas (desires)||1.Pranaeshana ( desire for life)|
2.Dhanaeshana(desire for wealth)
3.Paralokeshana (desire for other world after death)
|Four parikshas (methods to get knowledge)||1.Aptopdesha (authorative testimony)|
2.Pratkysha (direct observation)
|Three upasthambha (supporting pillars of life)||1.Ahara(diet)|
|Three types of bala (strength)||1.Sahaja (natural)|
|Three ayatanas (causes of diseases)||1.Asatmyaindriyarthasamyoga(atiyoga, ayoga, mithyayoga)|
2.Pragnyaparadha (intellectual defects)
|Three rogas(diseases)||1.Nija (endogenous)|
|Three rogamargas (routes for disease manifestation)||1.Shakha (bahya-periphery)|
2.MarmaAsthisandhi (madhyam-vital organs &bones joints &ligaments-tendons)
3.Koshtha (abhyantara- gastrointestinal tract & central part)
|Three bhishaja (physicians)||1.Chhadmachara (pseudophysician or quack)|
2.Siddhasadhit (feigned physician)
3.Jivitabhisara (genuine physician)
|Three aushadha (therapies)||1.Daivayapshraya (spiritual therapy)|
2.Yuktivyapasharaya (therapy based on reasoning)
1.Anta parimarjana (internal purification)
2.Bahirparimarjan (external purification)
3.Shastrapranidhan (surgical procedures)
Vidhi Vimarsha (Applied Inferences)
Human being is most intelligent of all the living beings on this earth. After satisfying the basic needs for living i.e. food, clothing, shelter etc. humans tried to find out the reason behind their birth and what are the goals to be achieved in this life. The results of the search lead to the origin of ‘Philosophy’ to find the answer and to find solutions to the worldly sorrows. Animals eat, drink, reproduce and die, but humans are not like animals, they live in society, they have various duties to perform. To set the moral, social duties and also code of conduct to live in society, religion was developed, all the things exist in this world are respected, energies were worshiped and given extreme importance, many ancient scriptures were written which taught the way of leading life.
The desires in human life were recognized and the modes to fulfillment were determined. The present chapter describes about three basic pursuits of life; these are to live long, to earn wealth and attainment of happiness in next world. Longevity can be achieved by following healthy lifestyle, desire for earning may be fulfilled by adopting appropriate and rightful means of livelihood, various spiritual acts and good deeds for the society are to be performed to fulfill the third desire to get happiness in after life. The main tattva of this chapter are the three desires and rest of the tattvas are mentioned to support for achievement of these desires.
To maintain health, triad of "supporting pillars (upasthambha) are advised. If the upasthambhas are properly followed then one is bestowed with good physical strength, the triad of balas (strength) is mentioned. If someone is exposed to etiolgical factors of disease (nidana sevana, disease is likely to occur. these factors are again of three types. Diseases manifest by three routes, to treat a disease competent physician is necessary. Three types of physicians are described. A good physician treats the disease by various therapies, which are of three types. When the body doshas get vitiated and cause diseases, then, three types of therapies can be done to cure those diseases is explained. In this manner every factor described in this chapter is interrelated with each other.
Importance of Three
The concept of the Triad or Trinity can be found throughout the world in all dimensions of life and been in use across civilizations and cultures since time immemorial. It can be understood as a key to the integrity and interdependence of all existence. The ideas of concepts of three can found in philosophy, mathematics, physics, etc. in ancient as well as modern times.
In Hinduism, the number three has great importance in religious studies as well as in rituals and various vedic texts since the number symbolizes the Holy Trinity of Brahma, Vishnu, and Shiva (or Mahesh) and their associated powers (also considered the universal order) of creation, preservation, and destruction respectively. From the viewpoint of creation, one is God, the second is prakriti, and together they manifest the rest of the creation. The Triad or Trinity also symbolizes the unity of body, mind and spirit. The concept of "three" or "triad" is referenced very frequently across cultures and traditions , and the various triads described in vedic texts include:
- Three qualities or guna of mind: Sattva, rajas and tamas
- Three layers of nature: Light, fire, and darkness
- Three states of being: Inherent, transcendent, and the absolute
- Three divisions of time: Past, present, and future
- Three periods of day: Morning, noon, and evening
- Three worlds: Bhuh (earth), bhuvah (atmosphere), and swahah (heaven)
- Three phases of life: Childhood, adulthood, and old age
- Three paths of self-realization: Jnana (path of knowledge), bhakti (path of love or devotion), and karma (path of action)
- Types of breath: Puraka (inhalation), kumbhaka (retention), and rechaka (exhalation)
- Three steps of Vishnu in Vamanavatar (or in his Vamana incarnation)
- Three syllables of AUM, the sacred vedic symbol representing three states of consciousness, possessing three hidden sounds that represent the primordial sound waves that predated the creation of the universe. A detailed study of Aum( ) is available in the Mandukya Upanishad
- Three duties of the Brahmin: Worship of the deity, study of the vedas, and the giving of charity
- Triple control: thoughts, words, and deed
- Three lines of sacred ash worn by shaivites (or the followers of Shiva) on their foreheads
Categories of three mentioned in Vedanta
- Three types of Shariras or bodies: Sthula-sharira (gross physical body), sukshma or linga-sharira (subtle body), karana-sharira (causal body).
- The threefold nature of atman or brahman: Sat (Truth/Existence), chit (Consciousness), ananda (bliss).
- Three granthis or knots of the heart: Avidya (ignorance), kama (desire), and karma (action).
- Three defects of the jiva are: Mala (impurities), vikshepa (distraction), avarana (veil of ignorance).
- Three gunas or qualities of prakriti: Sattva (purity), rajas (activity), tamas (darkness).
- Three types of karmas: Sanchita (accumulated), prarabdha (originated), agami (future).
- Bhedas or differences are three: Svagata (individual), svajatiya (in own society), dvijatiya (different society).
- Three Tapas: Adhidaivika, adhibhautika, adhyatmika
- Three prasthanas or the regulated texts of vedanta: Upanishads (shruti), Brahmasutras (nyaya), Bhagavad-Gita (smriti).
- Three eshanas or desires: Daraishana (desire for wife), putraishana (desire for son), vittaishana (desire for wealth).
- Three fold vikshepa-shakti: Kriyashakti (will to act), ichhashakti (will power), jnanashakti (power of knowledge)
- Three satta or existence is of varieties: Paramarthika (absolutely real), vyavaharika (phenomenal), pratibhasika (apparent or illusory).
- Three fold nature of the cosmic (samashti) person (ishvara): Virat, hiranyagarbha, ishvara.
- Three fold nature of the individual (Vyasmi) person (jiva): Vishva, taijasa, prajna.
In geometry, two straight lines cannot possibly enclose any space or form a plane figure. Neither can two plane surfaces form a solid. Three lines are necessary to form a plain figure, and three dimensions of length, breadth, and height, are necessary to form a solid (a cube, for instance). Three, therefore, stands for that which is solid, real, substantial, complete, and entire. 
Brihadaranyaka Upanishad (B. U. 4/4/22) states three eshanas or desires of a person from a social context: Putraeshana (desire to have son), vittaeshana (to earn) and lokaeshana(recognition by society). Vedic traditions are patriarchal, where the first desire of a married person is to have a son. The son gets the family name and the tradition passes down through all future generations. The son is also supposed to do all the religious rituals after the death of a person. Ancient societies were primarily agrarian and relied on physical strength, which necessitated the presence of male children in a family. Thus, the desire for son could be justified.
The second desire is to earn, since wealth is required to maintain a healthy lifestyle, perform spiritual rituals, as well as give alms – an important aspect of vedic traditions. A wealthy person is respected in society. The third desire is lokaeshana, or the desire for recognition in society. To get respect and happiness in this world, one should follow societal traditions and rules laid down for the self and for one’s conduct within the community, maintaining harmony with others, including with animals and the environment. One has to follow the path of eternal duty to keep pace with the rest of the world.
In Vedanta, eshanas or desires are three: Daraishana (desire for wife), putraishana (desire for son), and vittaishana (desire for wealth). As societies evolved, the institution of marriage was created, with the primary purpose of formalizing the union of man and woman. To further the growth of societies, a desire to get an ideal wife who could manage homes and give birth to healthy and able children became an important objective of any household. After the development of religious consciousness, marriage was not only became a social need but also an eternal duty of every individual. In Hinduism, marriage is regarded as a religious sacrament in which a man and a woman are bound with permanent relationship for physical, social, and spiritual purposes of dharma, procreation and sexual pleasure. When the theory regarding “three debts” evolved- first to god, second to sages and saints, and third to ancestors – the institution of marriage gained even greater importance and sanctity, since it was through marriage, through the process of jointly raising the family in accordance with moral and ethical principles, that one could repay the “debt to ancestors”. Marriage is regarded as a sacrifice, per vedic traditions, and a person who does not marry is said to be “one without sacrifice.” Taittiriya Brahmana says, “Person who does not have wife is without sacrifice.” A married life is considered essential for the growth of an individual’s personality. Upanishad had established the ashram theory that institutionalized four ashrams or phases in an individual’s life, to be followed in a sequential manner:
- Bramhacharya (life as a celibate student),
- Grahastha (life as a married person and fulfilling all social and moral responsibilities expected of a householder),
- Vanaprastha (transitory phase to a life of spirituality, involving renunciation of material comfort (artha) and physical desires (kama)) and finally,
- Sanyasa (phase of pursuing spiritual goals through abandonment of social connections to family and other institutions. During the Smriti phase of Vedic history, the ashram system was believed to have been divinely ordained, and it was thought to have been a sacred duty of every person to respect it. Smritis highly praise the life of a grahastha, regarding it as central to the whole social structure. In this phase, the society, in general, supported the three ashrams by means of knowledge, food and money.
The institution of marriage is integral to the grahastha ashram, since progeny helped grow the society and also further traditions and moral values (e.g., sharing one’s resources with the family (or families) and contributing to social rituals within one’s community). Marriages were also a means to forge relationships between families, towns, and kingdoms – and therefore did not mean relationships for mere fulfilment of sexual desires.  As mentioned, since the growth of a family represented the growth of a community, a society, and a way of life, most scriptures and spiritual texts have emphasized upon the critical role of family, and therefore, the desire for a wife. The second desire is for son and the third desire is to earn a livelihood.
As per the Bhela Samhita  (Sutra 15), the three objectives are pranaeshana, dhanaeshana and dharmaeshana (performing religious acts). The first two desires are same as mentioned by Charak, while third dharmeshana is to follow the duties of individual towards one’s self, family, society, and realm, etc. abide by the moral and ethical traditions laid down in the scriptures, and maintain harmony between self and the society and environment, in general.
Why is kamaeshana not included as a desire to be pursued?
Chakrapani raised a question, “Why is kamaeshana not mentioned?”. However, he goes on to give an explanation to this exclusion himself, writing that kamaeshana can be considered as an implicit activity in one’s pursuit of pranaeshana and dhanaeshana. Since a person instinctively indulges in kama, there is no need to explain it separately. [Chakrapani on Cha.Sa.Sutra Sthana 11/3] After knowing the goals for fulfilment of eshanas, the question of reincarnation arises which is discussed after a detailed description of eshanas.
The Cause of Birth
Charak asks whether life exists after death or not. Some support the idea of rebirth or reincarnation on the basis of scriptures but others do not. If the cause of birth is only attributed to parents, it is accepting only that which is perceptible. If only swabhava (natural trait or instinct) is considered as a reason (which does not sound to be a compelling reason), it is denying the existence of God. Paranirmana is accepted as the cause for birth, since it considers the existence of God, and if yadrichcha (supernatural power) is the only reason attributed to birth, then it supports the theory of supernatural power but does not support the existence of God.
Four Pariksha and their clinical significance
The theory of reincarnation is explained by means of fourfold parikshas (examinations)- aptopadesha, pratkysha, anumana and yukti. These are considered to be the correct means of getting information regarding an individual’s birth and therefore, play a significant role in the diagnosis of diseases and deciding the course of treatment to be employed. In Vimana Sthana, Charak considers the first three types of pariksha, i.e., aptopdesha, pratyaksha and anumana as acceptable means of examination. One should first examine the patient with the help of all the parikshas and then diagnose the disease. One should acquire knowledge systematically through "aptopadesha" followed by pratyakhsha and anumana. Use of all the three types of examination is recommended, and not any one of them alone. [Cha.Sa.Vimana Sthana 4/5-1]
Aptopdesha: Clinical Significance [Cha.Sa.Vimana Sthana 4/6]
Every disease should be studied carefully, with the help of the texts, from the standpoint of:
- Prakopana-hetu (etiological factors of the disease)
- Yoni-doshas involved.????
- Utthana- mode of manifestation
- Atman-nature of disease (seriousness or acuteness)
- Adhisthana-Location in organs of body & mind
- Vedana-Type of pain
- Shabda, sparsha, rupa, rasa, gandha- Association with specific sounds, touch, colour, taste or smell
- Vriddhi, sthana and kshaya-Symptoms of aggravation, normalcy and alleviations
- Nama- Names of diseases
- Yoga-Concomitants / prescribed medicines
- Pratikara, pravritti and nivritti- Prescriptions and prohibitions in the treatment.
Pratyaksha or direct perception / observation is the knowledge gained by the union of (coming together) of atman, indriya (sense organs), manas (mind) and the indriyarthas (objects). [Cha.Sa.Sutra Sthana 11/20]
A Clinician desirous to gain knowledge about the disease by this examination should use his own sense organs, except his gustatory organ. [Cha.Sa.Vimana Sthana 4/7]
Shrota Pratyaksha (auscultation / percussion)
Modern technological advancements like stethoscope, ultrasound etc.have significantly improved the methods of clinical diagnosis. Following methods are still helpful in certain situations:
- Antrakujana- gurgling sound from intestines.
- Sandhisphutana anguliparvana- cracking sounds in joints, including small joints.
- Swaravishesha-voice of the patient
- Shariropagata shabda-specific sounds of patient, like coughing, hiccup etc.
For percussion of the body parts one must use both the palms. On the basis of the sound created by percussion, conclusions can be drawn. For example, on percussion of the abdomen, if a tympanic note is heard, then it could be attributed to gas in the intestines and if a dull note is heard, it may be due to collection of fluid in the abdominal cavity.
Similarly, auscultation of thorax could be employed to examine pulmonary sounds and cardiac sounds, auscultation of abdomen for peristalsis, bruits, etc.
Darshan pratyaksha (visual inspection)
Visual inspection can be employed to draw some inference on the nature of various elements, such as edema, cyanosis, petechiae, skin lesions, abnormal movements, deformities, using the following cues:
- Varna (colour, complexion, or lustre), sansthana (shape), and pramana (measurements),
- Normal and abnormal appearance of body and organs,
- Whatever else not mentioned here but could be visually observed.
Rasapariksha (gustation-by inference)
“Tastes” of various factors in the body be ascertained by inference and not by direct observation:
- “Taste” of the mouth of a patient: By interrogation
- Impairment of “taste” of an individual: could be inferred by the behavior of parasites like lice (if instead of getting drawn to a person, they get repelled by it), or if someone attracts flies or ants (implying “sweet taste” emanated by the patient)
- Bleeding from the body: doubts about the nature of blood can be resolved by giving it to dog and crow. Its intake indicates its purity and rejection indicates that the blood is vitiated by pitta dosha and the patient is suffering from raktapitta.
- Similarly other tastes can be inferred.
Nowadays various laboratory tests are available to diagnose this, such as blood glucose etc.
The physician should be able to smell normal and abnormal smells of the entire body of patient by olfactory sense organ.
Various types of odor are recognizable from the breath. The odor of alcohol, and odor of diabetic ketoacidosis have been described as ‘sweet and sickly’. The odor in condition of uraemia is ‘ammonical or fishy,’ and hepatic failure is ‘mousy’. Halitosis is common in patients with poor dental hygiene and associated with chronic gingivitis. In suppurative conditions of lungs, breath may have putrid odor.
Sparshana Pariksha (palpation)
The physician has to touch the patient by his hand and do examination of normal and abnormal area. Care should be taken, however, to ensure that the physician’s hand should not be too warm or cold. Also, palpation should be performed very gently. The examination done by this method helps in assessing rise of body temperature, palpation of pulse, any tenderness, guarding, rigidity, swelling, lump or growth, lymphadenopathy, palpation of organs to reveal organomegally, size of organ palpable, surface, borders, consistency, bruits etc.
Anumana (estimation, or analysis)
The scope of perception has limitations and there are many ailments that cannot be perceived using sensory organs. Such imperceptible ailments can be diagnosed using agama (texts), anumana (inference) and yukti (reasoning). [Cha.Sa.Sutra Sthana 11/7] Anumana depends on prior knowledge acquired through pratyaksha (direct observation) and yukti (logical reasoning) and is applicable when the patient is aware of ailments suffered in the past (medical history) that can aid in drawing inferences about his current afflictions. It can also be defined as new information or inference drawn on the basis of applying one’s intelligence on information drawn through pratyaksha. It can be of three types:
- Inferring the effect from cause (future knowledge): For example, by observing the seed one can have knowledge of the fruit it will bear.
- Inferring the cause from effect (past knowledge): For example, by looking at pregnancy one can have the past knowledge of sexual intercourse.
- General inference (present knowledge): For example, by seeing smoke one can have knowledge of fire.
Since there are many things that cannot be perceived using sensory organs alone, anumana or the power to deduce or infer is an important and effective tool that a physician may employ. Charak has enumerated the following factors to be observed by inference:
- Agni (digestive fire), from the power of digestion
- Bala (strength), from capacity for exercise.
- Condition of senses- from their capacity to perceive the respective objects
- Existence of mind- from the perception of specific objects even in the presence of all other senses along with their respective objects.
- Knowledge of things from proper reaction to it.
- Rajoguna, from attachment to women
- Moha, from lack of understanding
- Anger, from revengeful disposition
- Grief, by sorrowful disposition
- Joy, by happiness
- Pleasure, from satisfaction (reflected by the appearance of face and eyes)
- Fear, from apprehension
- Courage, from strength of mind even when one is in dangerous situation
- Energy of an individual, from initiative in such actions which are normally difficult to perform.
- Stability of mind from the avoidance of any mistake.
- Desire from request.
- Intelligence from power of comprehension of scriptures etc.
- Recognition from recollection of the name
- Memory from power of remembrance.
- Modesty from bashfulness
- Liking from habitual intake
- Disliking from no inclination for something
- Deception from subsequent manifestations –individual pertaining to be well wisher but actually having evil intentions
- Courage from firmness
- Obedience from compliance with orders
- Age, liking, adaptation, disease, cause of disease from stage of life, habitat, conduciveness, symptoms, pain respectively.
- Disease in latent phase can be diagnosed by therapies which would alleviate or aggravate the symptoms of disease.
- Vitiation of doshas from the quantity of provocating factors
- Approaching death from prognostic signs
- Prosperity from initiation of useful work
- Sattavika mind from absence of impairment
- Similarly, condition of grahani (intestines), dreams, desires, likes- dislikes, happiness (or unhappiness), etc can be known by interrogation of the patient.
Yukti, or reasoning [Ch Su 11/25], is the fourth pariksha. The intellect perceives things as an outcome of a combination of various factors by employing yukti. Trivarga or dharma, artha and kama can be achieved by yukti.
- Harvest–due to combination of water, tilling operation, seeds and season.
- By combining of panchamahabhuta and chetana, garbha is formed (or conceived).
- Treatment is possible by the combination of chatushpada.
Yukti is especially important in the process of planning the course of treatment of a disease. The knowledge of hetu, doshas vitiated, strotas involved, type of strotas dushti, stage of disease manifestation etc. will help the physician to decide the treatment modalities.
The maintenance of healthy life is dependent on the lifestyle followed, hence the factors which are mandatory for sustenance of life are mentioned next.
The three upasthambhas or supporting pillars of body mentioned in this chapter are ahara (diet), swapna (sleep) and brahmacharya (celibacy). As diet is critical for the sustenance of life, it is the first of the three, followed by sleep and brahmacharya. Importance of a healthy and wholesome diet (in Sutra Sthana , Chapter 27), various classification of dietary items (in Sutra Sthana, Chapter 25), wholesome and unwholesome diets (in Sutra Sthana, Chapter 25), the quantity of diet to be taken and the significance of a balanced diet (in Sutra Sthana, Chapter 5,) eight factors responsible for digestion of food and ahara vidhi vidhana (rules for diet described in Vimana Sthana Chapter 1), ahara parinamkara bhavas (factors affecting diet digestion mentioned in Sharira Sthana chapter 6), the dietary regimen according to different seasons (in Sutra Sthana Chapter 6) and the description of incompatible foods (in Sutra Sthana chapter 26).
The physiology of sleep, effects, and indications – contraindications of day sleep, effects of night awakening, methods and measures to induce good sleep, causes of insomnia, classification of sleep etc. are discussed in detail in Sutra Sthana Chapter 21.
Semen is considered as one of the factors useful in promoting strength and self- control, increasing pleasure, as well as increasing awareness in celibates of the importance of abstinence (from sex), leading to salvation. [Cha.Sa.Sutra Sthana 30/15] Shukra kshaya (depletion of shukra) is considered as a causative factor for pratiloma kshaya(emaciation), which in turn may cause rajayakshama, hence it has to be preserved. [Cha. Sa.Nidana Sthana 6/8]
When the appropriate use of these upasthambhas is practiced by an individual, he will be bestowed with excellence of strength. Hence, the next topic discussed is about bala or strength.
Three types of bala (strength, immunity)
Strength is of three types i.e. sahaja (constitutional), kalaja (temporal) and yuktikrita (acquired):
- Sahaja bala: It is an inherent characteristic property of an individual and is present since birth. It can be attributed to an equilibrium state of doshas and does not require any extraneous factor for its improvement.
- Kalaja bala: It is dependent on seasonal variations and age of the person. Weakness prevails in adanakala (depleting strength-summer season), gaining of strength progressively is observed in visarga kala (increasing strength-winter season) and in middle of these two seasons, strength is moderate and this form of bala peaks during one’s middle age.
- Yuktikrita: Acquired strength or immunity is attained by healthy practices related to diet like ghee, meat, milk etc. and activities such as proper rest, exercise etc. It can also be improved by the use of rejuvenation therapies.
In Ayurvedic texts word bala is used as a synonym of ojas and also for immunity (vyadhikshamatava). Charak has considered normal kapha as bala. Sahaja bala can be considered as innate immunity while yuktikrita bala can be considered as acquired immunity that can be achieved by various methods like good quality diet, exercise, vaccination etc.
The assessment of sharirik bala (physical strength) is done by anumana (inference) by analyzing the capacity of an individual to do physical exercise (or his endurance). [Cha.Sa.Vimana Sthana 4/8]
With the knowledge of strength and the factors useful in maintaining it, one can achieve better strength for leading a healthy and long life. But if strength is not good and one indulges in activities or dietary practices that weaken one’s strength or immunity, then the individual may get afflicted with diseases.
Three ayatanas (causes of diseases)
Three causes of nija (bodily) diseases are- asatmya indriyartha samyoga (atiyoga, ayoga, mithyayoga) (unwholesome contact of sense organs with objects), pragnyaparadha (intellectual blasphemy) and parinama (consequence). The three causes of all the somatic and psychological diseases are mithyayoga, ayoga and atiyoga of kala (time), buddhi (intellect) and indriyartha (objects of senses). [Cha.Sa.Sutra Sthana 1/54]
Desires are the root cause of all the miseries of life, and therefore, elimination of desires leads to eradication of all miseries. Just as a silkworm spins its thread around itself causing its own death, similarly, an ignorant person, bound to worldly miseries of his own creation, remains unhappy all his life. (Cha.Sa.Sharira Sthana 1/95] Impairment of intellect (dhi"), patience ("dhruti), memory (smriti) and variations of natural seasons, advent of actions and unwholesome contact with the objects of senses are the causative factors of miseries (diseases). [Cha.Sa.Sharira Sthana 1/98] The details may be referred to in Sharira Sthana chapter 1.
Pragnaparadha (intellectual defects)
This includes forcible stimulation of natural urges. For example, excessive straining at passing stool may cause prolapsed rectum or rectal bleeding. Delay in treatment will aggravate the disease and complications may arise which may even cause death of the patient. Malice, vanity, fear, anger, greed, and ignorance may lead to psychological disorders.
Ailment caused by the variations of time or season. For example: diseases caused by the vitiation of vata dosha manifest during the final stage of digestion of food (afternoon and post midnight), and diseases caused by vitiated kapha dosha manifest during time of intake of food, forenoon and pre-mid night and those caused by the vitiation of pitta dosha manifest during initial stage of digestion, noon and midnight. The vitiation of three doshas during the three different stages of life are responsible for manifestation of diseases- kaphaja diseases during young age, pittaja diseases during the middle age and vataja diseases during old age. [Cha.Sa.Sharira Sthana 1/111-112]
Atiyoga or mithyayoga
Diseases are caused due to unwholesome contact with senses. For example: atiyoga of the hearing, caused by exposure to excessively loud sounds, rough noise, terrifying noise, etc. may lead to hearing impairment. Atiyoga or mithyayoga of the eyes could be caused due to excessive exposure to bright light, or working for long hours in front of computers, etc., could lead to blindness. Atiyoga of sense of touch may result in diseases ranging from mild burns due to touching excessively hot objects, to amputation of limbs or death due to frostbite (when exposed to extreme cold), etc. Specific examples of mithyayoga of touch mentioned in the text include vishyukta vayu sparsha, or exposure to toxic, poisonous vapors or air that could cause burns.
Three classes of roga (diseases)
Classification of diseases helps in the process of diagnosis and the subsequent courses of treatment selected. In this particular chapter, diseases are classified by its underlying cause: nija (endogenous cause), agantuja (exogenous cause), and manas (psychological). Sharira (body) and manas (mind) are the ashraya (refuge, or home) of the diseases. [Cha.Sa.Sutra Sthana 1/55] Apart from this classification, diseases are classified in various other ways. For instance, in the preceding chapter, diseases have been classified broadly as sadhya (curable) and asadhya (incurable). The sadhya diseases have been further classified into sukha sadhya (easily curable) and kriccha sadhya (curable with difficulty), while the asadhya have been classified into yapya (palliable) and anupakrama (non-treatable). Sadhya vyadhis have also been classified into alpa upaya sadhya (curable with mild treatment), madhya upaya sadhya (curable with moderate treatment) and utkristta upaya sadhya (curable with aggressive treatment modalities).
The Charak Samhita also provides classifications and counts of diseases by the organs afflicted or their causative factors. For example, in Sutra Sthana Chapter 19 (Astodariyadhyaya), a count of all disease systems has been provided (that were known at that time), grouped by organs afflicted. These 48 diseases have been grouped into 8 types of udara rogas, 8 types of mutraghata, 7 kushthas, 7 pidikas, 6 atisara, 5 gulma, 5 kasa, 5 swasa, etc. Similarly, in Sutra Sthana Chapter 20, 4 types of diseases are mentioned according to the causative factor- agantuja (exogenous), vataja, pittaja and kaphaja. Nanatmaja vikaras of vata are of 80 types; those of pitta are of 40 types; and kapha are of 20 types.
In Vimana Sthana Chapter 6, Dasharoganikadhyaya, diseases are classified by their prabhava (effect) into 10 types, by curability into two types (sadhya (curable) and asadhya (incurable)), by their bala (strength) of vyadhi (disease) into two types (mridu (mild) and daruna (severe)), by their adhisthana (location) into two types (manasika (psychic) and sharirik (somatic)), according to cause into nija (endogenous) and agantuja ( exogenous), according to ashaya bheda (organ of origin) into amashaya samuttha (originating from stomach) and pakwasaya samuttha (originating from large intestines).
WHO  has done the classification of diseases in a systemic manner, it is defined as a system of categories to which morbid entities are assigned according to established criteria- International Classification of diseases (ICD). The purpose of this is to permit the systematic recording analysis, interpretation and comparison of mortality and morbidity data collection in different countries or areas and at different times. It is used to translate diagnosis of disease and other health problems from words into alphanumeric code, which permits easy storage, easy retrieval and analysis of data. The details can be obtained from: The International Classification of Diseases–ICD-10 (WHO Publications).
After gaining the knowledge about the classification of diseases, the routes of manifestation and the nomenclature of diseases must be known, hence the routes of disease manifestation are described.
Three rogamarga (pathways of disease manifestation)
In the process of sthana samshraya doshas after circulating all over the body, get accumulated in dushyas in particular strotas, next step is dosha- dushya sammurchhana, doshas vitiate the dushyas and first produce premonitory symptoms. The manifestation of symptoms of disease follows a route depending upon the movement of vitiated doshas inside the body and the involvement of strotas. Ayurveda considers three rogamargas or rogayatana/ routes for manifestation of diseases - shakha (bahya rogamarga: twachha and raktadi dhatus - periphery), marma asthisandhi (madhyam rogamarga: Vital organs, bones, joints & ligaments-tendons), kostha (abhyantara rogamarga: Gastrointestinal tract and central part of body). The diseases manifesting in particular rogamarga is also described.
Charkapani has commented that three rogamarga include marma asthi sandhi as one route, shakha nomenculature is given for the practical purpose, as the dhatus here are like the branches of tree. Twachha denotes here the rasa dhatu which is present in twachha(skin), directly it is not stated as rasa, as it is different from the rasa dhatu present in hridaya (heart). The vitiation of rasa residing in hridaya is considered in kostha, also the vitiated rakta dhatu which is present in yakrita (liver) and pleeha (spleen). Ama sthana – amashaya (stomach), agni sthana (site of agni- pancreas), site of digested food –pakwashaya (terminal ileum and large intestine), mutrashaya (urinary bladder), rudhir sthana (yakrita-liver, pleeha- spleen), hridaya (heart), unduka (caecum), phuphhupus (lungs) are considered as part of kostha (Su.Chi.2). Asthi sandhi stands for the joints and the tendons and ligaments. The description of rogamarga helps in knowing the prognosis of diseases. [Chakrapani on Cha.Sa.Sutra Sthana 11/48]
Sutra Sthana Chapter 28 has explained the causes responsible for the movement of doshas from kostha to shakha. Due to strenuous exercise, hyperfunctioning of agni (digestive power), non-observance of wholesome regimen and the pressure of vitiated vata dosha causes movement of doshas from kostha to shakhas, they remain there till further aggravation. If already in stage of aggravation, then only they produce disease. [Cha.Sa.Sutra Sthana 28/31-32] The factors responsible for the movement of doshas from shakha to kostha are also mentioned, aggravation of doshas, increase in their fluidity, paka (suppuration), by the removal of the obstruction at the entrance of the channels and reduced pressure of vata dosha. This knowledge helps in planning the treatment for the vitiated doshas accumulated in particular rogamarga.
In contemporary medical science the symptoms of the diseases are mentioned according to involvement of the systems. For eg: diseases produced in respiratory tract are bronchitis, pneumonia, bronchiectasis, bronchial asthma etc. the presenting features of which are cough, expectoration, chest pain, dyspnoea etc.
When an individual gets ill, there is need of a physician therefore the qualities of physician are described to choose a good knowledgeable physician for better treatment.
Three bhishaga (physicians)
Three types of physicians are mentioned- Chhadmachara (Pseudophysician or Quack), siddhasadhit (feigned physician) and jivitabhisara (genuine physician). In the ancient times, there were people practicing medicine without appropriate knowledge about the science, Charak has mentioned the qualities of a physician to whom we should rely upon for treatment and to keep away from the quacks and the dangers of getting treated from them, even losing a life.
Sutra Sthana Chapter 1 (Deerghanjiviteeya Adhyaya), verse 124 states the qualities of good physician as, ‘one who examines the patient and in consonance with habitat, time, individual variations, applies appropriate medicine is best physician’. The medicine which can cure disease is best medicine and the physician who can give relief to the patients of their ailments is best physician. The wise person who aspires to be physician should acquire the qualities of physician, knowledge of science and also the practical knowledge of the diseases and medicine, to become life saver.
The physician with good memory, having adequate knowledge of hetu (causes of disease), proper reasoning, self control and having presence of mind by combination of various drugs can practice medicine. In Sutra Sthana Chapter 9, Khuddakachatushpada Adhyaya, four aspects of therapeutics- physician, medicament, attendant and the patient are described. The physician occupies the most important place; the qualities of physician are excellence in medical knowledge, having extensive practical experience, expertise and purity. The physician engaged in acquiring the knowledge of medical science, understanding its practical interpretation, implementation in clinical practice and the appropriate knowledge of therapies is often termed asPranabhisara Vaidya or a life saviour physician. The physician who possesses six qualities – knowledge, critical approach, insight to other sciences, good memory, promptness and perseverance can never become unsuccessful in treatment. The one with knowledge, intellect, concentration, practical experience, constant practice of treatment modalities, success in treatment and has practiced with experienced teachers deserves to be called as ‘good physician’. The physician should be friendly, sympathetic towards patients, show concern towards patients who can be cured and should have detachment towards those who are heading death.
Dasha pranayatana or the ten important resorts of life are two temples, three vital organs (head, heart and bladder), throat, blood, semen, ojas and rectum. The physician who has knowledge of these resorts, senses, knowledge of science similar to Ayurveda (all medical fields), reason of consciousness- soul, causes of diseases and recovery from diseases is known as “Saviour of life”. Those who are born in noble families, who have deep knowledge of science, who are skillful in preparing medicines, who have vast practical experience of treating patients medically and surgically, who are hygienic, self controlled, well equipped, sense organs functioning normally, well acquainted with the symptoms of disease and the prakriti of patient and having the knowledge of the etiological factors of diseases are the saviors of life of patients. Two types of physicians are described by Charak in Sutra Sthana Chapter 29 - pranabhisara vaidya (savior of life) and rogabhisara vaidya (bad physician/votaries of diseases), the qualities of these may be referred to Sutra Sthana chapter 30, “pallavaghrahita vidya” the physicians with superficial knowledge and their qualities are described (verse 72- 77).
In present context the utility of this is for selecting doctor for treatment, the qualification of the physician, validity of his medical degree and medical registration, clinical and surgical skills of the physician and the surgeon to whom approaching for treatment. If these things are not checked and the person who is doing treatment is not well qualified, then there is fear of losing money without getting cured and also of losing life.
After description about the treating physician, three types of therapies are described.
Three aushadha (therapies)
Three types of therapies are mentioned: daivavyapashraya (spiritual therapy), yuktivyapasharaya (therapy based on reasoning) and satvavajaya (psychotherapy). In Sutra Sthana Chapter 1, verse 58, the treatment modalities for somatic diseases is daivavyapasharaya and for psychological diseases is satvavajaya:
This is the treatment for diseases arising due to purva janmakruta papa karma (sins of past life) or karmaja vyadhis (karmic ailments). This type of treatment was done in the Rigvedic period in majority and yuktivyapasharaya was neglected. The observance of yama (ahimsa(non violence), satya (truth), astaya(not to steal), bramhacharya(control over sexual desire),and aparigraha (accumulation of prosperities)) and niyama (shaucha (cleanliness), santosha (satisfaction), tapas (conquest of all desires), swadhyaya (self-study), ishwara pranidhana (surrender to God)) is also part of this treatment. This form of treatment includes chanting mantras, wearing amulets on body, wearing gems, precious stones etc. performing auspicious rituals, offerings to God, oblations, homa, following niyama, prayachhitta, upavasa, svastyayana, pranipata and going to holy places.
The effects of various modalities mentioned above also have scientific validation. The religious traditions all over the world believe in healing through prayer. The healing powers of prayer have been examined in triple-blind, randomized controlled trials, Cha et al. studied 219 consecutive womens with infertility, aged between 26-46 years, who undergone in vitro fertilization embryo transfer in Seoul, South Korea. These women were randomized into distant prayer and control groups. Distant prayers were conducted by prayer groups in the USA, Canada and Australia. It was found that the women who had been prayed for had nearly twice as high a pregnancy rate as those who had not been prayed for (50 vs. 26%; P <0.005). Furthermore, the women who had been prayed for showed a higher implantation rate than those who had not been prayed for (16.3 vs. 8%; P <0.001). Finally, the benefits of prayer were independent of clinical or laboratory providers and clinical variables. The study showed that distant prayer facilitates implantation and pregnancy rate in women undergoing IVF-ET. Study done on the effect of chanting Gayatri mantra , aim was to evaluate the effects of Gayatri Mantra (GM) chanting on attention as measured by digit-letter substitution task (DLST). Subjects consisted of 60 school students included (boys = 30 and girls = 30) in the age between the range of 12-14 years, who were trained for chanting Gayatri Mantra for 5 days The present study, showed that recitation of Gayatri Mantra improves attention.
Old fire ritual conducted in the remote village in Kerala has shown a positive impact on the atmosphere, soil and other environment effects, according to scientists monitoring the yajna. The yajna seems to have accelerated the process of germination of seeds and also the microbial presence in air, water and soil in and around the region of the fire ritual is vastly diminished. The fire ball that was formed during the ritual had a particular wavelength with an unusually high intensity similar to what is observed in typical laser beams at about 3,870 degree centigrade. It may be possible to have stimulated emission at this wavelength (700 nm) and gain from plasma recombination.
In ancient times, every home had a sacred grove, for performing yajna concerning about nature. In the current context – but preserving sacred groves, whether in one’s home or outside in public spaces, will definitely benefit the environment that is getting degraded by global warming. Vedic knowledge, applied during current times in the right context, will benefit us not only personally but for the entire community.
Wearing gems is an age old practice and, per Vedic texts, can play a significant role in influencing human health,  Dr. Robert Frost revealed that gems have remedial properties, by wearing appropriate gems reduces pain, helps in allergies, improves coordination and even improves muscle strength.
This is the therapy done by the planned use of drugs, foods and regimen for the treatment of diseases caused by vitiation of bodily doshas. This is widely practiced and is further classified into three types: Antahaparimarjana (internal purification), Bahirparimarjana (external purification) and Shastrapranidhana (surgical therapy). Antahaparimarjana is administered for the diseases of kostha also for the diseases of shakha to losen the vitiated doshas from shakha and bring them into kostha, internal medications are prescribed oral drugs, vamana, virechana, basti, uttara basti, shirovirechana etc. Bahirparimarjana is the treatment for the diseases of shakha, also bahaya snehana- swedana or purvakarma is done for loosening the vitiated doshas from the shakhas and bring them into kostha for elimination. It is also done for skin disorders application of snehana, swedana, lepa, ointment, dusting powders and unctions etc. details of various formulations for skin disorders are well discussed in Sutra Sthana, Chapter 3 (Aragvadhiya Adhyaya). Shastrapranidhana, even though not mentioned in detail in Charak, is the treatment modality for various diseases not cured by medicinal treatment, for the diseases of exogenous factors like trauma, fractures also for diseases like arsha, arbuda, granthi etc. The various causes of the diseases are reasoned out and suitable means and methods are designed to cure, based on fundamental principles of Ayurveda viz. Pancha mahabhuta, tridosha, samanya visesha etc. The path of pathogenesis is broken by the administration of appropriate medicines and by advising suitable diets and regimens. These methods include both internal and external application of medication.
In internal treatment category have two types of procedures viz., samsodhana and samsamana:
- Samsodhana: This is mainly used in Panchakarma which received a very important place in the treatment of both psychological as well as physical diseases. “Purify, pacify and remove the cause” is the master formula for the treatment and the purifying procedures are collectively called Panchakarma.
- Samsamana: These procedures include internal medication to pacify the diseases.
In Sutra Sthana Chapter 22, six types of therapies are mentioned viz langhana (to reduce), brimhana (to nourish), rukshana (to dry), snehana (to oleate), swedana (to fomentate) and sthambhana (astringent).
Sattvavajaya, or Psychotherapy, is one of the three principal categories of the approach to the patients care as described in Ayurvedic classics. In principle, sattvavajaya is applicable in varying forms in all kinds of diseases but it is essentially indicated in mental diseases.
Charak was the first scholar to give the name sattvavajaya, his definition gives lot of scope for expansion of the Sanskrit phrase sattvavajayah punah ahitebhyo manonigraha. This definition gives emphasis on three words i.e. ahita, artha and manonigraha. 
The word Ahita conveys that something is unwholesome. Artha is wide variety of objects that can be perceived by sense organs. Each indriya (sense apparatus) has its own artha or the object that it can perceive. Similarly, sattva which is considered as ubhayendriya any thing that can be perceived by sattva can also be included in this category. In sattvavajaya, it is to consider mano arthas though it may not be objectionable to include, panchendriarthas, because ultimately sattva (mind) materializes the perception of the objects through indriyas (senses).
Asatmyendriyartha samyoga (unwholesome contact of indriyarthas) is regarded as one of the principal causes of diseases. The avoidance of over utilization, non utilization and wrong utilization, (hina mithyatiyoga) of chintya, vicharya, uhaya, dhyeya and samkalpa should help in the cure of psychiatric disorders. The word mano nigraha means control of mind this can both be subjective and objective. ‘Self control of mind’ is difficult task and needs a perfect combination of desire, determination and dedication.
Dimensions of Sattvavajaya 
- Trivarga anveksana: The therapy of mental disorders is done by following the trivargas i.e. the dharma, artha and kama (virtue, wealth and pleasure). The person with mental aliment should be made to remain in touch with the experts of treating mental illnesses and to know about atma (self), desha (place), kala (time), shakti (strength) and capacity properly.
- Psycho-supportive Techniques: Charak has described several psychological supportive techniques, under the category of sattvavajaya chikitsa. He advocates aswasana (reassurance and explanation), suhritvakya (guidance and suggestion), dharmartha vakya (education of individual and family), ishta vinashana (verbal shock), adbhuta darshana (showing extra ordinary things), tadana (physical shock), trasana (mental shock), santwana (rehabilitation,reassurance, or consolation), which are also known as psychological intervention.
- Promotion of jnayana (cognition): The methods for improving jnayana (cognition) and its components like dhi (intellect), dhrti (controlling power) and smrti (recollection/ memory) are part of sattavavajaya chikitsa. Some important techniques / steps in promoting jnana are- recognizing and correcting negative automatic thoughts, teaching reattribution techniques, increasing objectivity in perspectives, keeping spiritual understanding of life, identifying and testing maladaptive assumption, and decentering and it may also include such behavioural techniques as activity scheduling, homework assignments, graded task assignment, behavioural rehearsal, role playing and diversion techniques and teaching problem solving skills
- Promotion of vijnayana- It is mentioned in the scriptures and texts about the activities of the physical world, social and personal conducts, knowledge of the activities and interrelationship of body and mind, dietary rules, rules to be followed in disease state. The promotion of vijnana in context to sattvavajya includes the development and uses of behavioral techniques for treating psychosomatic and psychiatric disease. This relieves the patient's apprehensions and calms his disturbed mind.
- Promotion of samadhi like state (yogic psychotherapy): Samadhi is the ultimate stage in the practice of yoga, which is a state of unwavering concentration. Promoting samadhi in a diseased state is trying to minimize the mental fluctuations, reduce the waverings ultimately leading to focused and tranquilized mind. It is achieved through the application of various yogic techniques.
- Pratyatma chikitsa (individual psychotherapy): Each and every individual is having different body constitution (deha prakriti), mental constitution (manas prakriti), desha (habitat), kala (time), vaya (age), pratyatma jeevana vritta (Individual life situations). Therefore, every individual patient should be dealt as a separate individual and treatment decisions should be taken after considering all the above factors. Term purusampurusam viksaya (Ch. Su. 1/124) is used to emphasize the individualistic therapy in treatment of diseases in general and psychological problems in particular.
- Pratidvanda chikitsa (Replacement of Emotions): Replacement of emotions by opposite emotions (viz. kama for krodha) is one of the approaches of sattvavajaya in Ayurveda. In the case of mental disorders resulting from an excess of desires, grief, delight, envy or greed, should be calmed down by bringing the influence of opposite emotions to bear on the prevailing one and neutralize it. [Cha.Sa.Chikitsa Sthana 9/86]
- Aswasana (reassurance): Reassurance relieves fears, it boosts self confidence and promotes hope in a patient. The nature of the disease should be explained to the patients freely and frankly, so that the patient develops insight into the disease.
IX. Suhrit vakya (friendly advice and guidance): The patient’s relatives, well wishers, friends should give advice to the patient. The focus is given on fundamental matters as budgeting, personal hygiene and nutrition. Efforts are made to persuade the person to give up the unhealthy habits and replace them with healthy ones. The physician should explain the fundamental nature of the disturbance, importance of changed attitudes and positive thinking based on an improved philosophy of life.
- Ishta Vinashana (Changing the thought process): This is a method of verbal psychological shock therapy which includes changing the situation and environment of the patient. The information is given to patient, which can change the internal thought process and activities which helps to bring back the normalcy in patient's behaviour. They should also be rehabilitated at their level of intelligence and stamina.
- Psychoshock therapy (mano ksobha chikitsa): Psychoshock therapy has been described elaborately in Ayurveda. This important method of treatment has also been considered under Sattvavajaya chikitsa. For managing acute episodes of mental ailments, Ayurveda describes a number of methods of psychoshock therapy to restore the patient's psyche. Intimidation or threatening (trasana) terrorization, coaxing, exhilaration (harsana), gratification, frightening and astonishing (vismapana) are the causes of forgetfulness (vismarana) and are the main ways to change the ideas and bring back the mind to its original state from delusionary and psychotic state.
Thus the Chapter on “Three Desires” has been explained.
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