The central question

तदन्तरम् काशिपतिर्वामको वाक्यमर्थवित्॥

व्याजहारर्षिसमितिमुसृत्याभिवाद्य च॥५ ॥

किन्नु भोः पुरुषो यज्जस्तज्जास्तस्यामयाः स्मृताः॥

न वेत्युक्ते नरेन्द्रेण प्रोवाचर्षीन् पुनर्वसुः॥ ६ ॥

सर्व एवामितद्न्यानविद्न्यानच्छिन्नसंशयाः॥

भवन्तश्छेत्तुमर्हन्ति काशिराजस्य संशयम्॥७॥

Translation: Then King of Kashi, Vamak, who knew the meaning (of what he was talking) came forward to the committee, greeted them and asked "Dear All,  From what originates Purusha the same are the origins of his diseases. whether it is true or not ? "

When the King asked this Punarvasu said to all dignitories " All of you have dispelled your doubts with your infinite knowledge (of your own disciplines) as well as knowledge of other disciplines. (Therefore) You should dispell the doubt expressed by King of Kashi"

Commentary (Chakrapani) (Main Points) Vamak is the adjective to refer to specific person as there were many Kings of Kashi.

In one version Punarvasu says  " All of you have dispelled your doubts with your infinite knowledge (of your own disciplines) as well as knowledge of other disciplines. (Therefore) You should dispell the doubt in our mind expressed here by King of Kashi"

The main question : Do diseases originate from the same causes which are responsible for generation of Purusha? or Are causes of diseases different from those which produce Purusha?

Commentary (Vishnu): Kings of Kashi were renowned for their surgery, Guru of Sushrut was also King of Kashi named Divodas was considered as reincarnation of Lord Dhanwantari. King of Kashi is named here as Vamak  We do not know whether it is a nickname or given name. If it is a nickname then it is an interesting situation. Vamak means one who is master of Vaman the first of Panchakarma. Was he a physician expert in Vamana? Did he abandon his family tradition of surgeons to become a physician or was the tradition developed later? We really do not know. We need help from a historian here. 

Vidnyan is defined as knowledge of other disciplines (Charak Sutrasthan 10/21 Chakrapani commentary.

Other meaning of this term are 1 Specialization or specialized knowledge

2.Applied Knowledge

3.Knowledge of performing arts like Shilpashastra(Sculpture)

If we apply any meaning it distinguishes the assembly as multidisciplinary and superspecialists with profound applied knowledge. Those were not confined to their ivory towers. 

Most important point Iwant to highlight is the main question.   Do diseases originate from the same causes which are responsible for generation of Purusha? or Are causes of diseases different from those which produce Purusha? The discussion that follows is unanimous. Every participant is taking it as granted that diseases do originate from the same causes which are responsible for generation of Purusha. They are proposing different causes for origin of Purusha and then proceed to argue that same is the cause of diseases. Next person will show the exceptions and propose a new cause. Nobody is proposing a situation where origins of Purusha and those of disease do not match.

This focuses the notion that causes of diseases are internal or inherent in Purusha. External factors are not held responsible for origin of disease. Nobody is denying the role of external factors but these factors first have to affect the internal environment. Internal environment is produced along with Purusha. External causes may produce diseases but they are not sufficient. They may even not be necessary. (It is very difficult to find situations where external factors are entirely unnecessary.)

There is described a division of diseases as Nija and Agantu where cause is internal and external respectively. But in both cases after some initial period the course of disease depends mostly on internal factors.

यज्जः पुरुषीय अध्याय॥

पुरा प्रत्यक्षधर्माणम् भगवंतम् पुनर्वसुम्।

समेतानाम् महर्षीणाम् प्रादुरासीत् इयम् कथा।

आत्मेन्द्रियमनोर्थानाम् योऽयम् पुरुषसंज्नितः।

राशिः तस्यामयानाम् च प्रागुत्पत्तिविनिश्चये॥

Once upon a time many seers met Lord Punarvasu, who was embodiment of Dharma. Following discussion took place at that time about origins of Purusha, the complex of Soul, mind,senses and substrates;  and his Diseases.

Commentary (Chakrapani): This chapter is first in the quadruplet on Food and drinks. It follows the quadruplet on Yojana or Lines of treatment describing 6 therapies, as success or failure of treatments depends on proper or improper use of food and drinks. The first part of the chapter deals with causation of diseases in a person as a preamble to the question of properties of food and also to gain insights into the logic behind 6 lines of treatment. The chapter is called ‘Yat Jah Purusheeya’ as it centers on the question ‘From what a Purush is formed?’. Although the verse starts with ‘Purusho Yat jah’ the name emphasizes the question ‘Yat Jah?’ What is the origin?  

Embodiment of Dharma is due to highest quality of Tapas (performed by Lord Punarvasu).

The word Katha (which means story in common usage of the word) means posing questions to each other to gain insights. (we can call it symposium)

Purush is described here as the complex of Soul, mind, senses and substrates for senses. the discussion is about origin of this complex and origin of diseases.

Commentari (Vishnu): I agree with Chakrapani on most of the points but I beg to differ on the following.

1.      Connection with 6 lines of treatment (Upakrama) is very tenuous. The discussion that follows never touches the 6 upakramas. Only the principle ‘yajja: pu$Ya: tjja:tsya Aamayaa:’’Factors responsible for origin of a person are the same ones which are responsible for his diseases. The same phenomena create both;the person and his diseases’ gives us the rationale behind the 6 upakramas. A better argument for sequence of quadruplets i.e. Yojana followed by Ahar may be the fact that Ahar or diet is biggest modifying factor in both a. Disease process and b. outcome of interventions.

2.      The term ‘p`%yaxaQamaa-Nama\’ is interpreted by Chakrapani as embodiment of Dharma. I propose a different interpretation. In Sanskrit grammar conjugated words can be dissociated in many ways. Chakrapani is treating this term as Tatpurusha ‘p`%yaxama\ Qama- [va’  I propose a dissociation using ‘Bahuvrihi’ conjunction, i.e. ‘p`%yaxama\ Qama-: yasya sa:’ one who relies on direct observation. One for whom direct observation is Dharma or most important value. This description is more apt for a scientist like Punarvasu.

3.      Of course we must not forget that this Pratyaksha or direct perception includes ‘yaaOigak p`%yaxa’ or perception by a mind highly trained by Yoga. ( Kekule’s perception of cyclical nature of Benzene or Einstine’s perception of curvature of spacetime is on par with Yogik pratyaksha)

4.      I fully agree with Chakrapani that the reason of being Pratyakshadharma is Tapas or extremely concentrated and sustained effort.

5.      The most important point that I want to highlight is definition of Purusha. Here Purusha is defined as complex of Soul, mind, senses and substrates for senses. Elsewhere (Chapter 1) we get the definition of life as complex of body, senses, mind and soul. Why body has been left out in the definition here? Of course body is a part of substrates for senses and is not really excluded but it surely is relegated to a minor importance.  Why this should be so? Are we negating the role of body in the development & diseases? Is it because of the notion that ‘Body is the effect (phenotype) and not the cause’?

I offer this argument as virtually all the biomarkers, signs, symptoms and manifestations of the disease are the effects or outcomes and not really the Dravya (substance) of the disease. There is a big argument in Madhukosh commentary of Madhav Nidan about nature of diseases. Are they material substances or are they abstract entities? Dravya or Adravya? This is a very deep question worthy of consideration by molecular biologists.

There are 2 schools of thought in favor of each option. I belong to the school which states that diseases are material, even the mental diseases. But some say that Adhyatmik type of diseases are Adravya.

There may be a possibility of dual nature of disease. Some fine substance produced by conjugation of Dosha and Dooshya (Sammurchana) which may well be beyond the capability of senses (Atindriya) which may also act like adravya like software in a computer.

But on the whole what we observe, measure or modify with our treatments are the effects of phenomena which are deeply chained to the body. But while thinking about causes and origins we must leave the body behind and venture in the realm of perception.

If we keep this in mind the discussion which follows becomes easier to follow and we may get subtle and deep insights.

I will state now the theme of symposium once again

‘Symposium on origin of Purusha: a complex of Soul, mind, senses and substrates for senses; and origin of his diseases’