A COMPARATIVE STUDY ON SAMPRAPTI OF GRAHANI

DEPARTMENT OF AYURVEDA SAMHITA AND SIDDHANTA

1. 1 SEMINAR PRESENTATION ON COMPARATIVE STUDY ON SAMPRAPTI OF GRAHANI WSR TO BRUHATTRAYI

2. PRESENTER Dr.ASWATHI.T.P 1 st YEAR PG SCHOLAR DEPARTMENT OF PG STUDIES IN AYURVEDA SAMHITHA & SIDDHANTA GOVERNMENT AYURVEDA MEDICAL COLLEGE , MYSURU UNDER THE GUIDANCE OF DR. SHREEVATHSA PROFESSOR & HEAD DEPARTMENT OF PG STUDIES IN AYURVEDA SAMHITHA & SIDDHANTA. GOVERNMENT AYURVEDA MEDICAL COLLEGE , MYSURU 2

3. CONTENTS 1.INTRODUCTION NIDANA PANCHAKA GRAHANI 2.REFERENCES FROM SAMHITAS 3.GRAHANI NIRUKTI 4.UNIQUENESS OF GRAHANI AS PER CHARAKA SAMHITA 5.GRAHANI SWARUPA 6.GRAHANI NIDANA 7.GRAHANI PURVA RUPA 3

4. 8.GRAHANI BHEDA 9.GRAHANI SAMPRAPTI 10.SAMPRAPTI GHATAKA 11.DISCUSSION ON GRAHNI NIDANA SAMPRAPTI GHATAKA CONCLUSION 4

5. INTRODUCTION भिषजा प्राक् परीक्ष्यैवं विकाराणां स्वलक्षणम्| पश्चात्कर्मसमारम्भः कार्यः साध्येषु धीमता|| (CH.SU.10/21) A wise physician should examine the distinctive features of the disease first and then start the management only of the curable disease to get success in practice. In order to facilitate better understanding , to ease the process of diagnosis & management of disease Nidana panchakas are utilized. 5

6. NIDANA PANCHAKA तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः| (Ch.Ni.1/6) NIDANA Knowledge of nidana helps in- Avoiding it to prvent disease progression( Nidana parivarjana ) Planing treatment. Speculation of outcomes viz, dosha that is going to get vitiate, Nature of disease that is going to be produced. Disease diagnosis. Disease prevention. 6

7. POORVA ROOPA Helps in- Diagnosing the disease early and to check the disease process at the earliest. To intervene disease progress to further stages. Knowing the prognosis of disease. RUPA Gives the precise information about the vitiation of dosha . Indicates the site of actual pathology in body. Helps in accurate diagnosis, prognosis and treatment 7

8. UPASHAYA It provides the diagnostic aid for disease which are otherwise difficult to diagnose. This creates a clearly outlined path in the selection of aushadha , ahara and vihara that mitigate the lakshanas of vyadhi . The concept of upashaya can be practically applied to advice the rogi about Pathya & Apathya in specific disease. 8

9. SAMPRAPTI It is the process of evolution of disease. Samprapti of a disease gives an exact idea pertaining to various factors that cause dosha prakopa , how the doshas travel through different sites for setting up the disease process, and the dhatus they affect which in turn leads to disease manifestation. Samprapti vighatana being the ultimate method to eradicate the disease, the compilation and comparison of the same becomes significant. 9

10. INTRODUCTION TO GRAHANI The avayava pradhana vyadhi in which grahani gets vitiated functionally & structurally, with the impairment of agni is called as grahani roga . The key site of Agni and Site of occurrence of the disease Grahani roga is organ grahani . It is a tridoshatmaka vyadhi,which is included in Ashtamahagada (Acharya Vagbhata ). It is hard to diagnose and difficult to cure ( Sudustara ). Grahani and Agni are having Adhara – Adheya sambandha . 10

11. REFERENCES FROM BRUHATTRAYIS Charaka Samhita – Chikitsa sthana-15 th chapter Susruta Samhita-Uttara tantra-40 th chapter Astanga Samgraha-Nidana sthana-8 th chapter Astanga Samgraha - Chikitsa sthana-12 th chapter Astanga hridaya-Nidana sthana-8 th chapter Astanga hridaya - Chikitsa sthana-10 th chapter 11

12. GRAHANI NIRUKTI ACCORDING TO KALPADRUMA Grahani is अग्न्यधिष्ठाननाडी | ACCORDING VACHASPATYAM पित्तधराख्ये कलाभेदे | 12

13. ACCORDING TO MONIER -WILLIAMS GRAHANI- Is an imaginary organ supposed to lie between the stomach and the intestines (the small intestines or that part of the alimentary canal where the bile assists digestion and from which vital warms is said to be diffused. 13

14. UNIQUENESS OF GRAHANI DOSHA CHIKITSITA ADHYAYA OF CHARAKA SAMHITA In the 15th chapter of Charaka Samhita chikitsa sthana - Grahani dosha chikitsa the basic physiology of digestion, metabolism and assimilation along with factors influencing the same is discussed. The concept of agni and its vaishamya is dealt in detail here. Which form the key to understand many related concepts in Ayurveda. An overview of the chapter can be given as follows- 14

15. AGNI 15

16. DAHANA PRAKRIYA 16

17. AJEERNA 17

18. GRAHANI VARNANA 18

19. GRAHANI SWARUPA 19

20. Charakas view अग्न्यधिष्ठानमन्नस्य ग्रहणाद्ग्रहणी मता| नाभेरुपर्यह्यग्निबलेनोपष्टब्धोपबृंहिता अपक्वं धारत्यन्नं पक्वं सृजति पार्श्वतः| दुर्बलाग्निबला दुष्टा त्वाममेव विमुञ्चति|| (Ch.chi.15/53-55) Grahani is the seat of agni and is called so because of its power to restrain the downward movement of food . It is situated above umbilical region and is supported and nourished by the power of agni . Grahani holds the food till it digested and releases it from the side after it is digested. 20

21. When it get deranged due to weak digestive fire it releases the ingested material even in unripe condition. Grahani dosha is often caused by Arshas , therefore it is described after Arshas chikitsa . अन्नमादानकर्मा तु प्राणः कोष्ठं प्रकर्षति| तद्द्रवैर्भिन्नसङ्घातं स्नेहेन मृदुतां गतम्||६|| समानेनावधूतोऽग्निरुदर्यः [१] पवनोद्वहः| काले भुक्तं समं सम्यक् पचत्यायुर्विवृद्धये||७|| एवं रसमलायान्नमाशयस्थमधः स्थितः| पचत्यग्निर्यथा स्थाल्यामोदनायाम्बुतण्डुलम्||८|| (Ch.chi.15/6-8) 21

22. PRANA VATA brings ingested food to koshta Dravamsha does the BHEDANA OF ANNA SAMGHATA This get MRIDUTWA by SNEHAMSHA SAMANA VATA does AGNI DEEPANA PACHANA of KALA BHUKTA & SAMA BHUKTA ANNA 22

23. The process of digestion by agni in the gut is comparable to the process of cooking of the raw recipe kept in an earthen vessel . 23

24. SUSRUTAS VIEW Grahani is- Pittadhara kala which was described as 6 th kala. Situated between pakwashaya and amashaya . षष्ठी पित्तधरा नाम या कला परिकीर्तिता | पक्वामाशयमध्यस्था ग्रहणी सा प्रकीर्तिता (Su.U.40/169) 24

25. ग्रहण्या बलमग्निर्हि स चापि ग्रहणीं श्रितः | तस्मात् सन्दूषिते वह्नौ ग्रहणी सम्प्रदुष्यति || (Su.U.40/170) Strength of Grahani is agni and that agni resides in grahani . When agni is vitiated grahani also become vitiated Grahani dosha is described along with Atisara prakarana,as it lead to Grahani dosha if it is not properly managed. 25

26. GRAHANI DOSHA NIDANA ACCORDING TO CHARAKA SAMHITA यो हि भुङ्क्ते विधिं त्याक्त्वा ग्रहणीदोषजान् गदान्| स लौल्याल्लभते शीघ्रं, वक्ष्यन्तेऽतः परं तु ते|| (Ch.chi.15/40) In the causation of grahani ahara vidhi has important role . अभोजनादजीर्णातिभोजनाद्विषमाशनात्| असात्म्यगुरुशीतातिरूक्षसन्दुष्टभोजनात्||४२|| विरेकवमनस्नेहविभ्रमाद्व्याधिकर्षणात्| देशकालर्तुवैषम्याद्वेगानां च विधारणात्||४३|| दुष्यत्यग्निः ,(Ch.chi.15/42) 26

27. Nidana Aharaja Anya nidana Viharaja Nidanas can be classified as follows- 27

28. AHARAJA VIHARAJA ANYA NIDANAS Abhojanat Ajeerna - atibhojanat Vishamashanat Asatmya bhojana Guru- Sheeta - Atirooksha bhojana Samdushta bhojana Vireka,Vamana , sneha - vibhrama Vega dharana Vyadhikarshana Desha-kala- ritu vaishamya 28

29. IMPORTANCE OF JATHARAGNI Jatharagni is responsible for digestion and assimilation of food. Aggravation and diminution of jatharagni results in the aggravation and diminution of bhutagni and dhatwagni . If a person takes food without following appropriate procedure, then he quickly succumbs to disease caused by the vitiation of grahani .(Duodenum and the and upper part of the small intestine.) 29

30. ACCORDING TO SUSRUTA दुष्यति ग्रहणी जन्तोरग्निसादनहेतुभिः || अतिसारे निवृत्तेऽपि मन्दाग्नेरहिताशिनः | भूयः सन्दूषितो वह्निर्ग्रहणीमभिदूषयेत् (Su.U.40/166) Agni dushtikara nidanas leads to grahani dushti . Indulgence in apathya ahara and vihara immediately after recovery from atisara by a person having poor digestive fire will lead to Grahani dosha . 30

31. ASHTANGA HRIDAYA अतीसारेषु यो नातियत्नवान् ग्रहणीगदः||१५|| तस्य स्यादग्निविध्वंसकरैरन्यस्य सेवितैः| (Ah.Ni.8/15) Grahani is the structure that playas major role in ahara pachana . When it is deranged to an extent in which the functioning is hampered the condition is referred as Grahani gada . The two factors leading to the pathology are- The patient of diarrhoea who does not try much to cured of it becomes affected by disorders of grahani . 2.Also even others who indulge in things food and activities which destroy the agni . 31

32. CHARAKA SUSRUTA VAGBHATA Trishna Alasyam Bala kshayam Vidaha Chira anna paka Kaya gauravam Trishna Alasyam Balakshayam Vidaha Klama Aruchi Kasa Karna kshweda Antra koojana Trishna Sadanam Chira anna paka , amlaka klama Aruchi Praseka Vaktravairasyam Karna kshweda Antra koojana Brama Anadha - udarata Chardi POORVA ROOPA 32

33. तृष्णारोचकवैरस्यप्रसेकतमकान्वितः||५३|| शूनपादकरः सास्थिपर्वरुक् छर्दनं ज्वरः| लोहामगन्धिस्तिक्ताम्ल उद्गारश्चास्य जायते|| (Ch.ch.15/53) Trushna - excess thirst Arochaka -anorexia Vairasya - distaste in mouth Praseka -excessive Tamaka shwasa -asthma RUPA-SAMANYA CHARAKA 33

34. Parvaruk -pain in small joints Chardi -vomiting Jwara -fever Udgara - having metallic, ama ganda and with tikata - amla rasa 34

35. SUSRUTA अथ जाते भवेज्जन्तुः शूनपादकरः कृशः | पर्वरुग्लौल्यतृट्छर्दिज्वरारोचकदाहवान् ||१७४|| उद्गिरेच्छुक्ततिक्ताम्ललोहधूमामगन्धिकम् | प्रसेकमुखवैरस्यतमकारुचिपीडितः || (Su.U.40/174) Swelling in legs and arms,emaciation , joint pain, greediness towards all the tastes, thirst, vomiting, fever, loss of taste burning sensation in side,vomitus whicha are like vinegar, bitter and sour,smelling like iron and smoke, suffers from more salivation, bad taste in the mouth, asthma &anorexia. 35

36. PRATYATMA LAKSHANA OF GRAHANI एकशः सर्वशश्चैव दोषैरत्यर्थमुच्छ्रितैः | सा दुष्टा बहुशो भुक्तमाममेव विमुञ्चति ||१७१|| पक्वं वा सरुजं पूति मुहुर्बद्धं मुहुर्द्रवम् |(Su.U.40/171) Doshas together or individually vitiates grahani . Thus excessively vitiated grahani releases the ingested food either in ama or in pakwa state, accompanied with – features SARUJA PUTI MUHUR BADHAM MUHURDRAVAM 36

37. VAGBHATA सामान्यं लक्षणं कार्श्यं धूमकस्तमको ज्वरः| मूर्च्छा शिरोरुग्विष्टम्भः श्वयथुः करपादयोः|| (Ah.8/21) Its general symptoms are emaciation, feeling of hot fumes coming out from the mouth, tamaka , fever, fainting, head ache, stasis of undigested food in the stomach and swelling of the hands and feet. 37

38. GRAHANI ROGA BHEDA All the Bruhat – trayis explained Chaturvidha Grahani dosha . VATAJA GRAHANI CHARAKA PITTAJA GRAHANI SUSRUTA KAPHAJA GRAHANI VAGBHATA SANNIPATAJA GRAHANI 4 TYPES 38

39. 39 VATAJA GRAHANI NIDANA AHARAJA KATU TIKTA KASHAYA RUKSHA SHEETALA BHOJANA PRAMITASHANA VIHARAJA ATYADHWA VEGA NIGRAHA ATI MAIDHUNA

40. 40 PITTAJA GRAHANI NIDANA KATU VIDAHI AMLA KSHARA AJEERNA BHOJANA

41. KAPHAJA GRAHANI NIDANA AHARAJA GURU SNIGDA SHEETA ATI-BHOJANA BHUKTA MATRA SWAPNA 41

42. GRAHANI RUPA( Vishesha ) In general the manifestations of grahani can be classified as follows : ABDOMINAL SYMPTOMS NATURE OF STOOL SPECIFIC CHARACTER GENERALISED SYMPTOMS GRAHANI 42

43. VATAJA GRAHANI PITTAJA GRAHANI KAPHAJA GRAHANI ABDOMINAL SYMPTOMS Food digest with difficulty,shukta paka , visuchika --------- Food digest with difficulty NATURE OF STOOL Passes stool with difficulty,froathy , undigested, repeatedly Watery, undigested, bluish-yellowish or yellow in colour Stool not well formed,broken , heavy ,mixed with ama and mucous 43

44. GENERALISED SYMPTOMS Ruoghness in body, dryness in throat, and mouth, hunger,thirst,blurred-vision,tinnitus,pain in thigh, chest etc Emaciation , weakness,cough,dyspnoea Indigestion,anorexia , thirst,foetid and sour eructation,burning sensation in the cardiac region and throat,gudaparshwa-udara-mastaka daha Nusea,vomiting , anorexia,sliminess and sweetishness of mouth,cough,rhinitis , sweetish eructations with foul smell,general -debility, lack of desire towards- woman,weakness & lassitude SPECIFIC CHARACTERS Flatulence after and during digestion Foetid and sour eructation Heaviness and stillness of abdomen 44 CONT….

45. SALIENT FEATURES OF DOSHAJA GRAHANI Acharyas states that Vataja grahani leads to suspicion of diseases like vata hridroga , gulma , arsha and pandu . Acharya Susruta opined that the colour of nails, faeces,urine , eyes and face will be in accordance with dosha . 45

46. SAMPRAPTHI OF GRAHANI DOSHA दुर्बलो विदहत्यन्नं तद्यात्यूर्ध्वमधोऽपि वा||५१|| अधस्तु पक्वमामं वा प्रवृत्तं ग्रहणीगदः| उच्यते सर्वमेवान्नं प्रायो ह्यस्य विदह्यते||५२|| अतिसृष्टं विबद्धं वा द्रवं तदुपदिश्यते | ( Ch.chi.15/51 ) 46

47. SAMPRAPTHI OF GRAHANI ROGA NIDANA SEVANA MANDATA OF AGNI VIDAGDATA OF ANNA RASA(Partial digestion) VIDAGDA ANNA RASA ENTER INTO CIRCULATION MOVES UPWARDS AND DOWNWARDS IN GI TRACT WHILE DOWNWARD MOVEMENT GRAHANI DOSHA IS MANIFESTED with PRATYATMA LAKSHANAS AS- ATISRUSHTA VIBADHA DRAVA 47

48. CONCEPT OF AMA AND AJEERNA Vitiated agni is unable to digest even the light food. When this agnidushti progress apaka of anna happens. And the partially digested anna gets shuktata (amla bhava), which on due course act as ghora anna visha also termed as ama visha . Which again progress into the condition called ajeerna . तस्य लिङ्गमजीर्णस्य विष्टम्भः सदनं तथा| शिरसो रुक् च मूर्च्छा च भ्रमः पृष्ठकटिग्रहः||४५|| जृम्भाऽङ्गमर्दस्तृष्णा च ज्वरश्छर्दिः प्रवाहणम्| अरोचकोऽविपाकश्च, घोरमन्नविषं च तत्|| (Ch.chi.15/45) 48

49. When the Ajeerna avastha associated with doshas it shows corresponding features- Vata samsrushta - vata roga Pitta-Amla pitta, daha , trushna,mughamaya Kapha-Yakhma , peenasa , prameha When it affects dhatu respective symptoms will be developed. 49

50. SAMPRAPTI GHATAKA OFGRAHANI DOSHA Nidana - Aharaja , Viharaja & anya nidanas . Dosha - Pitta pradahana Tridosha Dushya -Rasa Agni- Jatharagni - Mandya Ama- Amavisha formation at GIT level Srotas-Rasavaha srotas , Annavaha srotas , Purishavaha srotas Srotodushti -Sanga, Atipravruthi , Vimarga gamana Uthbhava Sthana - Amashaya Rogamarga-Abhyantara Vyadhi swabhava - Chirakari Adhishtana - Grahani 50

51. 51 DISCUSSION DISCUSSION ON GRAHANI SWAROOPA All the Bruhat-trayis have the opinion that Grahani is the adhishtana for agni . Grahani and Agni are having Adhara – Adheya sambandha (Mutually supportive).Any derangement that occurs in Grahani will reflect in agni and vice versa. Charaka considers nabhi upari pradesha as Grahani sthana . Susruta describes Grahani as pittadhara kala-situated between pakwashaya and amashaya .

52. 52 DISCUSSION ON GRAHANI DOSHA NIDANA All the bruhat trayis opines that agni dushti is the root cause for Grahani dosha . Charaka elaborates the factors leading to agni dushti wheras Susruta and Vagbhata used the term Agnividhamsaka ,& agni sadana hetus respectively. While discussing agrya dravyas Charaka states Ajeerna adhyashana as agrya for grahani dooshana Acharya Susruta and Vagbhata described it as nidanarthakara roga of atisara .

53. 53 Abhojanat- vata dushti,sara vidhamana Ajeerna bhojana-Sarvadosha prakopa , agni dushti , samvrutha sroto mugha , pratilomata of vata , hamperded vega pravruthi , dhatu dushti Pureesha vaha sroto dushti Atibhojana - Cause tridosha dushti,Annavaha srotodushti,Rasa vaha sroto dushti . Vishamashana-Tridosha dushti Asatmya bhojana -Will affect the well being of individual. Guru bhojana -Rasa vaha srotodushti

54. 54 Sheeta bhojana - Agni will not be stimulated, hamper digestion,vata gati will be affected, cause kapha dushti Rsa vaha sroto dushti Atirooksha bhojana -Agni will not be stimulated, hamper digestion,vata gati will be affected Samdushta bhojana - Tridosha dushti

55. 55 VIHARAJA Vibhrama from- Vireka,Vamana , Sneha Vegadharana-Vata dushti , Pureesha vaha sroto dushti ANYA NIDANAS Desha kala ritu vaishamya - tridosha dushti Vyadhi karshana -

56. 56 DISCUSSION ON SAMPRAPTI GHATAKA DOSHA- Tridosha Vata mainly involved is Samana vata समानोऽग्निसमीपस्थः कोष्ठो चरति सर्वतः| अन्नं गृह्णाति पचति विवेचयति मुञ्चति| (Ah.su.12/8) Agni sameepastha Grahani sthana Anna grahana - अपक्वमामाशये धारयतीत्यर्थः | Pachana - अग्निसन्धुक्षणाद्भक्तकार इव | (Ah.su.12/8,Sarvanga Sundara Commentary) Vivechana - संहतमन्नं पाकाय विभजते |(Ah.su.12/8,Sarvanga Sundara Commentary) Munchana - शकृन्मूत्रादिरूपमधः | (Ah.su.12/8,Sarvanga Sundara Commentary) Agni dushti leads to the vitiation of samana vata which takes part role in manifestation of Grahani dosha .

57. 57 Pitta --------------------तत्र पक्वामाशयमध्यगम्| पञ्चभूतात्मकत्वेऽपि यत्तैजसगुणोदयात्||१०|| त्यक्तद्रवत्वं पाकादिकर्मणाऽनलशब्दितम्| पचत्यन्नं विभजते सारकिट्टौ पृथक् तथा||११|| तत्रस्थमेव पित्तानां शेषाणामप्यनुग्रहम्| करोति बलदानेन पाचकं नाम तत्स्मृतम्|| (Ah.su.12/10) Anna pachana , sara-kitta vibhajana , are the functions attributed to pachaka pitta, the abnormality of which may lead to Grahani dushti

58. 58 KAPHA ---------------------------यस्त्वामाशयसंस्थितः||१६|| क्लेदकः सोऽन्नसङ्घातक्लेदनात्---- (Ah.su.12/16) ANNA SAMGHATA KLEDANA- Which signifies the role of kledaka kapha in anna pachana . DUSHYA Rasa dushti .

59. 59 SROTAS The role of anna vaha srotas in the manifestation of grahani roga is direct and significant. ANNAVAHA SROTO MOOLA अन्नवहानां स्रोतसामामाशयो मूलं वामं च पार्श्वं ,( Ch.vi.5/8) ANNA VAHA SROTO DUSHTI KARANA अतिमात्रस्य चाकाले चाहितस्य च भोजनात्| अन्नवाहीनि दुष्यन्ति वैगुण्यात् पावकस्य च||१२| (Ch.vi.5/)

60. 60 RASA VAHA SROTAS Agni nasha is one among the rasapradoshaja lakshana , which is the key factor for Grahani roga . DUSHTI KARANA गुरुशीतमतिस्निग्धमतिमात्रं समश्नताम्| रसवाहीनि दुष्यन्ति चिन्त्यानां चातिचिन्तनात् (Ch.vi.5/13)

61. RASA DAHATU PRADOSHAJA ROGA अश्रद्धा चारुचिश्चास्यवैरस्यमरसज्ञता| हृल्लासो गौरवं तन्द्रा साङ्गमर्दो ज्वरस्तमः [२३] ||९|| पाण्डुत्वं स्रोतसां रोधः क्लैब्यं सादः कृशाङ्गता| नाशोऽग्नेरयथाकालं वलयः पलितानि च||१०|| रसप्रदोषजा रोगा,...| (Ch.Su.28/10) PUREESHA VAHA SROTAS सन्धारणादत्यशनादजीर्णाध्यशनात्तथा| वर्चोवाहीनि दुष्यन्ति दुर्बलाग्नेः कृशस्य च|| (Ch.vi.5/12) 61

62. 62 CONCLUSION Grahani is an avayava pradhana vyadhi where agni dushti plays a major role. The adhara-adheya sambandha of agni and grahani is forms the key factor in understanding the disease. Acharya Charaka considered it as a Swatantra vyadhi while Susruta and Vagbhata considered it as nidanarthaka roga of atisara . Charaka used term “ Grahani dosha chikitisitam ” to emphasise the scope of expansion of the prakarana as grahani dosha and grahani - asrita rogas . Knowledge of the disease Grahani forms the base for understanding various concepts in Ayurveda viz,agni,ama,ajeerna,ahara pachana , shareera poshana etc

63. 63 REFERENCES Acharya YT,2019,Ayurvedadipika Commentary of Sri Chakrapanidatta on Charaka Samhita of Agnivesha,Chikitsa stana , Grahanidosha Chikitisitam,15 th chapter,Varanasi,Chaukhamba Orientalia,2015 Acharya JT,2021,Nibandasamgraha Commentary of Sri Dalhanacharya on Susruta SamhitaUttara tantra,Atisara pratishedham,40 th chapter, Varanasi,Chaukhamba Orientalia,2021 Acharya Dr.Anna Moreswara Kunte,2019, Sarvanga sundara ( Arunadatta )& Ayurveda rasayana ( Hemadri ) Commentary on Astanga Hrudaya Nidana Sthana,Atisara Grahani roga Nidana,8 th chapter, Varanasi,Chaukhamba Orientalia,2019

64. SUGGESTIONS 64