The morning sun shines on the hermitage in Kashi. A soft wind moves through the neem trees. Four patients wait outside Sushruta’s Gurukula. Ketana, Ananda, and Bhadraka stand beside him, ready to learn.
The First: The Envenomed Man
A young man lies half-conscious on a reed mat. His eyelids droop, his pupils are fixed, and his limbs hang loose. His breathing is shallow, and his voice is faint and broken.
Attendant: He was bitten on the foot by a snake while gathering firewood near the river. Soon after, there was swelling around the site. He complained of burning. Soon his vision blurred, his eyelids fell, and now he cannot lift his head or breathe well.
Ketana: His leg is swollen. The skin around the bite is dark and moist. His pulse is weak but steady.
Ananda: His voice fades, but he seems to understand our words.
Sushruta: The venom spreads quickly through the body. The limbs lose strength, the eyelids droop, speech becomes unclear, and breathing slows. Tie a band above the bite to delay the poison’s rise. Wash the wound with cool water. Apply a paste of haridrā (Curcuma longa) and sārivā (Hemidesmus indicus) on the site. Give warm water mixed with honey and powdered vacā (Acorus calamus) to ease breathing. Rub the limbs with ghee and saindhava salt to restore warmth and movement. Keep him sitting upright and calm until his breath steadies.
Ananda: So this is viṣa, poisoning?
Sushruta: Yes. Serpent venom acts fast. It stills the body but leaves the mind awake for some time. Most people die as it attacks the very essence that guards life.
The Second: An Intoxicated Man
A man sits leaning against the wall, laughing and muttering by turns. His breath smells of wine. His eyes are red and his hands tremble.
Attendant: He drinks every day. Today he drank much more than usual. He does not listen to anyone. He depends completely on wine. His family is worried, and all his earnings go toward drink.
Ananda: His tongue is dry, and his words are unclear.
Ketana: His thoughts wander. He stumbles when he walks and cannot keep balance.
Sushruta: How is his deterioration different from the first man’s?
Bhadraka: The first man’s decline was sudden; but this man is losing his health slowly because of his habit.
Sushruta: Yes. Wine dulls the senses. When wine rules the mind, memory and judgment weaken.
Ketana: How should we treat him?
Sushruta: Do not stop the drink all at once. Sudden withdrawal troubles the body and clouds awareness further. Give small, measured amounts of clear, mild wine under supervision to steady him. Then reduce the amount a little each day until the craving weakens.
Ketana: And after that?
Sushruta: When thirst troubles him, give water boiled with dhātrī (Phyllanthus emblica), harītakī (Terminalia chebula), and yashtimadhu (Glycyrrhiza glabra). Offer thin, sour rice gruel with salt and pippalī (Piper longum) to rouse appetite. Rub his limbs with warm sesame oil to ease tremor and stiffness. When his thoughts clear, feed him light soup of mudga (green gram) and yava (barley) with ghee to restore strength. Guide him to live with discipline, walk in the open air at dawn, and spend time with calm people.
The Third and Fourth: The Two Cousins with fever and eruptions
Two boys, cousins from the same family, lie with fever and eruptions over their bodies.
Attendant: Both boys fell ill four days ago. The fever came first, followed by red eruptions on the chest and face that soon spread. The first boy’s fever is easing. The blisters on his body have started to dry and form light crusts. He drinks water easily and asks for food. His voice is clear.
(After a brief pause)
But the second boy is not improving. His fever is still high, and the eruptions are darker and filled with fluid. He breathes fast and speaks in confusion. Since childhood, another vaidya said he had Sahaja Prameha—he is thin, eats much, feels thirsty often, and tires quickly.
Bhadraka: The disease is the same, yet one is recovering while the other worsens.
Ananda: Their age, gender, food, water, and home are the same. Why does one recover while the other suffers?
Sushruta: That is what you must think about. Bathe both with water cooled using candana (Santalum album) and uśīra (Vetiveria zizanioides). Give them thin rice gruel with parpaṭa (Fumaria parviflora) and musta (Cyperus rotundus) to lower fever. For the boy with Prameha, add guḍūcī (Tinospora cordifolia) and triphala—a blend of harītakī (Terminalia chebula), bibhitaka (Terminalia bellirica), and āmalakī (Phyllanthus emblica).
The Discussion
Sushruta: Except for the cousin who is recovering, what is common to the others?
Ketana: In all three, strength and clarity are lost. Their voices weaken, their bodies grow tired, and they cannot act as before.
Ananda: The first man was struck suddenly by poison. The second has developed weakness slowly because of his drinking habit. The third cousin grows weaker as the fever continues.
Sushruta: Though their diseases differ, each loses the same inner power that keeps the body steady and the mind clear. The man bitten by the serpent lost it suddenly. The drunkard loses it little by little. The sick boy cannot defend himself because that power was weak from the beginning.
Bhadraka: Master, all three lose the same strength, yet in different ways. The body grows weak, and the mind dulls. Is there one thing that gives both physical strength and mental stability?
Sushruta: Yes. Our teachers called that essence Ojas; the power that guards life and holds the body together. When Ojas declines, the body weakens, the voice fades, the breath shortens, and the mind grows dull. When it is full, a person is calm, steady, and strong.
Bhadraka: Master, is that why the boy with Sahaja Prameha isn’t recovering?
Sushruta: Yes, in Sahaja Prameha, the body is weak from birth. The tissues that are essential, do not build up properly. Because of this, Ojas, which is formed from well-nourished tissues, remains weak. When such a person falls ill, there is little reserve to defend life.
Ketana: So the poisoned man’s Ojas was destroyed suddenly, the drunkard’s declined slowly, and the sick boy’s was weak from the start.
Sushruta: Yes. When it is steady, illness is mild; when it is lost, life itself is lost.
Bhadraka: But the three patients are not equally sick. Why does the same Ojas fail in different ways?
Sushruta: Because Ojas weakens in stages. Our teachers describe three such stages: Visramsa – displacement or instability, Vyāpat – derangement or distortion), and Kṣaya – depletion or loss.
Ketana: How do we recognise these in a living person?
Sushruta: In Visramsa, Ojas is displaced but not destroyed. This is seen in the man weakened by drink. He staggers, his voice trembles, and his thoughts wander, yet some strength remains.
Ananda: And in Vyāpat?
Sushruta: Its quality becomes disturbed. The body grows weak, colour fades, and the mind is confused. This is the boy with Prameha and fever. His Ojas is disturbed but not lost.
Bhadraka: And Kṣaya?
Sushruta: In Kṣaya, the essence itself is exhausted. Breath becomes shallow, limbs grow cold, and the heart sinks. The man bitten by the cobra lies in that state. The lamp of life grows dim.
Bhadraka: So these are not three kinds of Ojas but three degrees of its loss.
Sushruta: Exactly. They show how the fortress of life collapses—first the inner bricks weaken, then the walls shake, and finally the foundation fails. The wise physician must see the danger early and protect what remains.
Bhadraka: I think I understand. The two cousins have the same disease, yet one recovers and the other fails. This is puzzling. Ojas explains why that is so.
Ketana: Poison and wine both harm body and mind, but one acts fast and the other slow. The stages of Ojas derangement explain that as well.
Sushruta: Correct. Ojas not only explains outcomes but also helps predict them. When a person with Prameha falls ill, recovery is often slower because Ojas is weak. This is consistent with clinical observation.
Bhadraka: Then when we propose such an entity, it must both explain and predict what we see, even if we cannot see the thing itself.
Sushruta: Well said. You cannot see Ojas in a dead body, but you can know it by its effects in the living. In the future, with careful observation and record-keeping, we may understand it better. So watch closely, think clearly, and learn from every patient.
The river murmurs beyond the trees. The four patients rest in silence—each a living lesson on the unseen essence that sustains life.
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