Ashtanga Hridayam Nidanasthanam Chapter 15:  Vata Vyadhi Nidanam Adhyaya (Diagnosis of diseases of nervous system)  

The 15th chapter of Nidanasthanam of Ashtanga Hridayam is named as Vata Vyadhi Nidanam Adhyayah. This chapter deals with the explanation of ‘diagnosis of diseases of nervous system’.

The topics covered in this chapter include –

–       Normal and abnormal vata – cause for all the good and bad in the body
–       Authority of Vata
–       Pledge of what is to come in the chapter
–       Pathological increase of vata by decrease of tissues and enveloping of vata by other doshas in the channels
–       Vriddha Vata Karma – functions of aggravated vata
–       Vata Vyadhi occurring in sense organs
–       Symptoms of vata located in the tissues, veins, arteries, joints, tendons and all over the body
–       Akshepaka – convulsions
–       Apatantraka – Tetanus
–       Apatantraka – Tetanus
–       Antarayama – Exopthotonos
–       Bahirayama – Opisthotonos
–       Vranayama
–       Restoration of health after convulsions
–       Hanusramsa
–       Jihvasthambha
–       Ardita
–       Siragraha
–       Paksavadha
–       Dandaka
–       Apabahuka
–       Visvaci
–       Khanja Pangu
–       Kalayakhanja
–       Urusthambha
–       Krostukasirsaka
–       Vatakantaka
–       Gridhrasi
–       Khalli
–       Padaharsa
–       Padadaha

Pledge by the author(s)

अथातो वातव्याधि निदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘diagnosis of diseases of nervous system’. Thus pledge Atreya and other sages.

Normal and abnormal vata: Cause for all the good and bad in the body

सर्वार्थानर्थकरणे विश्वस्यास्यैककारणम् ।
अदुष्टदुष्टः पवनः शरीरस्य विशेषतः ॥ १ ॥
For all the good and bad of all world, unvitiated – normal and the vitiated – the abnormal Vata (air) respectively, is the only cause; especially so in the human body.

Authority of Vata

स विश्वकर्मा विश्वात्मा विश्वरूपः प्रजापतिः ।
स्रष्टा धाता विभुर्विष्णुः संहर्ता मृत्युरन्तकः ॥ २ ॥
तददुष्टौ प्रयत्नेन यतितव्यमतः सदा ।
Vata is the performer of all actions of the world the soul of all the creatures of the world Vata is the possessor of all forms, chief of all living being, the creator, supporter and controller of all; is omniscient, God destroyer, lord of death and death itself. Hence always, all efforts should be made to maintain Vata in uncontaminated state.

Pledge of what is to come in the chapter

तस्योक्तं दोषविज्ञाने कर्म प्राकृतवैकृतम् ॥ ३ ॥
समासाद्व्यासतो दोषभेदीये नाम धाम च ।
प्रत्येकं पञ्चधा चारो व्यापारश्चेह वैकृतम् ॥ ४ ॥
तस्योच्यते विभागेन सनिदानं सलक्षणम् ।
In doshaVijnana- chapter 11 of Sutrasthana, Vata’s normal and abnormal functions were described,in doshabhediya chapter of Sutrasthana, their description (of functions etc) in brief and detail, 5 types of Vata Dosha, their names, sites nature of movement and functions of each have been explained. Now it’s abnormalities will be describedalong with their causes and clinical features.

Pathological increase of vata by decrease of tissues and enveloping of vata by other doshas in the channels

धातुक्षयकरैर्वायुः कुप्यत्यतिनिषेवितैः ॥ ५ ॥
असङ्ख्यमपि सङ्ख्याय यदशीत्या पुरेरितम् |
चरन् स्रोतःसु रिक्तेषु भृशं तान्येव पूरयन् ।
तेभ्योऽन्यदोषपूर्णेभ्यः प्राप्य वाऽऽवरणं बली ॥ ६ ॥
Vayu gets aggravated due to over indulgence in things-foods, activities, that cause depletion of tissues. Though vata disorders are innumerable, only eighty of them that are common, have been enumerated previously. Bali (vata) then moves up in the empty channels-because of tissue depletion and also fills up these empty channels or by getting enveloped by the other doshas which have filled up the channels.

Notes: Aggravation of vata occurs in two ways viz-

a. occupying the empty channels caused by tissue depletion and producing increased functioning in the channels so occupied. Here, vata is the only dosha producing the effect, hence very powerful.

b. by getting enveloped/surrounded/ hindered by the other doshas which have accumulated in the channels and producing decreased or loss of functioning of the channels so affected. Here, vata is associated with any one or more of the other doshas, hence not very powerful.

Vriddha Vata Karma: Functions of aggravated vata

तत्र पक्वाशये क्रुद्धः शूलानाहान्त्रकूजनम् ।
मलरोधाश्मवर्ध्मार्शस्त्रिकपृष्ठकटीग्रहम् ॥ ७ ॥
करोत्यधरकाये च तांस्तान् कृच्छ्रानुपद्रवान् ।
Vata aggravated in the pakvasaya-large intestines gives rise to colic, flatulence,gurgling in the intestine,obstruction to movements of feces, urinary calculi,hernia, piles,catching type of pain in the upper part of the back, lower back and waistand other difficult diseases / complications concerned with the lower parts of the body.

Vriddha Vata Karma: Functions of aggravated vata

आमाशये तृड्वमथुश्वासकासविषूचिकाः ॥ ८ ॥
कण्ठोपरोधमुद्गारान् व्याधीनूर्ध्वं च नाभितः ।
Aggravated Vata in Amashaya causes thirst, vomiting, dyspnoea, cough, indigestion associated with simultaneous vomiting and diarrhea, obstruction of the throat, excessive belching and diseases in body parts above the umbilicus.

Vata Vyadhi occurring in sense organs

श्रोत्रादिष्विन्द्रियवधं
In the ear and other sense organs, it causes loss- or diminution of their sensory function.

Vata located in skin

त्वचि स्फुटनरूक्षते ॥ ९ ॥
In the skin, aggravated Vata causes and dryness;

Aggravated Vata Dosha in Rakta Dhatu: Blood tissue

रक्ते तीव्रा रुजः स्वापं तापं रागं विवर्णताम् ।
अरूंष्यन्नस्य विष्टम्भमरुचिं कृशतां भ्रमम् ॥ १० ॥
In the blood it gives rise to severe pain, loss of tactile sensation, increase of temperature, redness, discoloration, ulceration, stasis of undigested food in the alimentary tract for long period, loss of taste/ appetite, emaciation and dizziness.

Vata affecting Mamsa and Medas Tissue

मांसमेदोगतो ग्रन्थींस्तोदाढ्यान् कर्कशाञ्छ्रमम् ।
गुर्वङ्गं चातिरुक्स्तब्धं मुष्टिदण्डहतोपमम् ॥ ११ ॥ In the muscles and fat, it producestumors with severe pain and hardness,exertion,heaviness of the body, severe pain,rigidity, stiffness, and feeling as though being beaten with the fist or baton.

Vata afflicting Asthi Dhatu

अस्थिस्थः सक्थिसन्ध्यस्थिशूलं तीव्रं बलक्षयम् ।
In the bones Vata causes pain in the thighs, joints and bones, and profound loss of strength.

Vata afflicting Majja Dhatu

मज्जस्थोऽस्थिषु सौषिर्यमस्वप्नं सन्ततां रुजम् ॥ १२ ॥
In the marrow it produces hollowness of the bones, loss of sleep and constant pain.

Vata afflicting Shukra Dhatu

शुक्रस्य शीघ्रमुत्सर्गं सङ्गं विकृतिमेव वा ।
तद्वद्गर्भस्य शुक्रस्थः
In the Shukra Dhatu, Vata causes premature ejaculation, obstruction-non-ejaculation or abnormal ejaculation, so also of the fetus – premature, obstructed or abnormal delivery of the fetus.

Vata afflicting Sira: Blood vessels

सिरास्वाध्मानरिक्तते ॥ १३ ॥
तत्स्थः
In the blood vessels, Vata causes either their fullness or emptiness.

स्नावस्थितः कुर्याद्गृध्रस्यायामकुब्जताः ।
In the tendons it causes sciatica, tetanus, kyphosis / dwarfism.

Vata afflicting Sandhis: Sandhigata Vata

वातपूर्णदृतिस्पर्शं शोफं सन्धिगतोऽनिलः ॥ १४ ॥
प्रसारणाकुञ्चनयोः प्रवृत्तिं च सवेदनाम् ।
Localized in the bony joints Vata produces swelling resembling an inflated leather bag to touch, pain at the commencement of extending and flexing movements.

Vata afflicting all body parts

सर्वाङ्गसंश्रयस्तोदभेदस्फुरणभञ्जनम् ॥ १५ ॥
स्तम्भनाक्षेपणस्वापसन्ध्याकुञ्चनकम्पनम् ।
Spread all over the body, Vata produces pricking, splitting type of pain, throbbing, cutting type of pain, stiffness, convulsions, loss of tactile sensation, contractions of the joints tremors.

Akshepaka disorder: Convulsions

यदा तु धमनीः सर्वाः क्रुद्धोऽभ्येति मुहुर्मुहुः ॥ १६ ॥
तदाऽङ्गमाक्षिपत्येष व्याधिराक्षेपकः स्मृतः ।
When the aggravated vata invades all the dhamanis-arteries (nerves), then it produces repeated contractions of the body, especially of the extremities. This disease is known as Akshepaka – convulsion.

Apatantraka: Tetanus

अधः प्रतिहतो वायुर्व्रजन्नूर्ध्वं हृदाश्रिताः ॥ १७ ॥
नाडीः प्रविश्य हृदयं शिरः शङ्खौ च पीडयन् ।
आक्षिपेत् परितो गात्रं धनुर्वच्चास्य नामयेत् ॥ १८ ॥
कृच्छ्रादुच्छ्वसिति स्तब्धस्रस्तमीलितदृक् ततः ।
कपोत इव कूजेच्च निःसञ्ज्ञः सोऽपतन्त्रकः ॥ १९ ॥
स एव चापतानाख्यो मुक्ते तु मरुता हृदि ।
अश्नुवीत मुहुः स्वास्थ्यं मुहुरस्वास्थ्यमावृते ॥ २० ॥
Aggravated Vata getting obstructed in its downward movement, starts moving upwards, enters into the channels connected to the Hridaya- heart and brain and produces pain in the heart, head and the two temples, causes convulsions in the body and bends the body like a bow; the patient breaths with difficulty, patient’s eyes are static, motionless, drooping down and lids- half open, makes sound like a pigeon, and is unconscious. This disease is Apatantraka, it is also known as apatanaka also. When the heart- brain becomes free from Vata, the person obtains health-relief from convulsions momentarily and gets ill and convulsions appear again Vata is filled.

Apatantraka: Tetanus

गर्भपातसमुत्पन्नः शोणितातिस्रवोत्थितः ।
अभिघातसमुत्थश्च दुश्चिकित्स्यतमो हि सः ॥ २१ ॥
It -apatantraka is caused by abortion, it is also caused by heavy bleeding and trauma- injury to vital organs it is most difficult to treat.

Antarayama: Exopthotonus

मन्ये संस्तभ्य वातोऽन्तरायच्छन् धमनीर्यदा ।
व्याप्नोति सकलं देहं जत्रुरायम्यते तदा ॥ २२ ॥
अन्तर्धनुरिवाङ्गं च वेगैः स्तम्भं च नेत्रयोः ।
करोति जृम्भां दशनं दशनानां कफोद्वमम् ॥ २३ ॥
पार्श्वयोर्वेदनां वाक्यहनुपृष्ठशिरोग्रहम् ।
अन्तरायाम इत्येष
When vata gets inside the arteries/nerves present in the sides of the neck cause stiffness and then spreads to all the parts of the body, constricts the shoulders, makes the body bent inwards like a bow; produces bouts of convulsions, loss of movements of the eyes, causes excessive yawning, grinding of the teeth- rigidity of the jaws or lock jaw, vomiting of kapha- mucus, pain in the flanks, inability to speak, locked jaw and stiffness of back and head. This is antarayama – inward bending.

Bahirayama: Opisthotonos

बाह्यायामश्च तद्विधः ॥ २४ ॥
देहस्य बहिरायामात् पृष्ठतो नीयते शिरः ।
उरश्चोत्क्षिप्यते तत्र कन्धरा चावमृद्यते ॥ २५ ॥
दन्तेष्वास्ये च वैवर्ण्यं प्रस्वेदः स्रस्तगात्रता ।
बाह्यायामं धनुःष्कम्भं ब्रुवते वेगिनं च तम् ॥ २६ ॥
Similarly so is Bahirayama—outward bending when the body is bent outwards, with the head reaching the back, the chest protruding out, the neck extending the back, there is discoloration of the teeth and mouth, profuse sweating; debility of the body. This is called Bahyayama, Dhanusthambha and veginam – episodic.

Vranayama

व्रणं मर्माश्रितं प्राप्य समीरणसमीरणात् ।
व्यायच्छन्ति तनुं दोषाः सर्वामापादमस्तकम् ॥ २७ ॥
तृष्यतः पाण्डुगात्रस्य व्रणायामः स वर्जितः ।
The doshas get localized in wounds situated on vital spots, get aggravated by vata, and then spread all over the body from the feet to the head, under the influence of Vata Dosha, convulsions due to traumatic wounds or hemorrhage associated with thirst and pale discoloration of the body; this disease should be rejected.

Restoration of health after convulsions

गते वेगे भवेत् स्वास्थ्यं सर्वेष्वाक्षेपकेषु च ॥ २८ ॥
In all types of Aksepaka- convulsions, when the bouts pass off, the person obtains temporary wellbeing.

Notes:

Akshepaka is convulsions, in general, due to any cause, Apatantraka or apatanaka is Dhanusthambha-tetanus, Antarayama and bahirayama are its two kinds of manifestation.

Abortion- including miscarriage and abnormalities of delivery, profuse hemorrhage and trauma- injury due to any cause are some of the common causes, in addition to foods and activities which aggravate vata.

Hanusramsa

जिह्वातिलेखनाच्छुष्कभक्षणादभिघाततः ।
कुपितो हनुमूलस्थः स्रंसयित्वानिलो हनू ॥ २९ ॥
करोति विवृतास्यत्वमथवा संवृतास्यताम् ।
हनुस्रंसः स तेन स्यात् कृच्छ्राच्चर्वणभाषणम् ॥ ३० ॥
By excessive scraping of the tongue, eating dry foods, and by trauma- injury, vata localized at the lower jaw gets aggravated, and caused displacement of the lower jaw leading to the mouth being either kept open or closed, associated with difficulty for masticating and speaking; this disease is Hanusramsa.

Jihvasthambha

वाग्वाहिनीसिरासंस्थो जिह्वां स्तम्भयतेऽनिलः ।
जिह्वास्तम्भः स तेनान्नपानवाक्येष्वनीशता ॥ ३१ ॥
Vata gets localized in the veins in -near the vocal cords it causes loss of movement of the tongue leading to inability to swallow foods, water and to speak; this disease is Jihvasthambha.

Ardita

शिरसा भारहरणादतिहास्यप्रभाषणात् ।
उत्त्रासवक्त्रक्षवथोः खरकार्मुककर्षणात् ॥ ३२ ॥
विषमादुपधानाच्च कठिनानां च चर्वणात् ।
वायुर्विवृद्धस्तैस्तैश्च वातलैरूर्ध्वमास्थितः ॥ ३३ ॥
वक्रीकरोति वक्त्रार्धमुक्तं हसितमीक्षितम् ।
ततोऽस्य कम्पते मूर्धा वाक्सङ्गः स्तब्धनेत्रता ॥ ३४ ॥
दन्तचालः स्वरभ्रंशः श्रुतिहानिः क्षवग्रहः ।
गन्धाज्ञानं स्मृतेर्मोहस्त्रासः सुप्तस्य जायते ॥ ३५ ॥
निष्ठीवः पार्श्वतो यायादेकस्याक्ष्णो निमीलनम् ।
जत्रोरूर्ध्वं रुजा तीव्रा शरीरार्धेऽधरेऽपि वा ॥ ३६ ॥
तमाहुरर्दितं केचिदेकायाममथापरे ।
Due to carrying heavy load on the head, excessive laughing, speaking, exertion of the face- by acts such as sneezing, mimicking, others, making faces, histrionic feats etc., use of irregular-uneven, hard pillow while sleeping, chewing very hard materials causes aggravation of vata, by exposure to vata aggravating factors, which gets localized in the upper parts of the body and produces irregularities of half of the face; found specially during speaking, laughing and seeing, then his head begins to shake, associated with obstruction of speech, loss of movements of the eyes, shaking of the teeth, hoarseness of voice, deafness, obstruction of sneezing, loss of sense of smell, loss of memory, delusion, exhaustion during sleep, the spittle comes out from the sides of the mouth, one eye is closed, severe pain in the parts above the shoulders, pain in half of the body or lower parts of the body. This disease is called as Ardita – Facial palsy by some and as Ekayama by others.

Siragraha

रक्तमाश्रित्य पवनः कुर्यान् मूर्धधराः सिराः ॥ ३७ ॥
रूक्षाः सवेदनाः कृष्णाः सोऽसाध्यः स्यात्सिराग्रहः ।
Vata vitiates the blood, and gets localized in the veins of the head, makes them rough- hard, painful and black. This is Siragraha, which is incurable.

Pakshavadha

गृहीत्वार्धं तनोर्वायुः सिराः स्नायूर्विशोष्य च ॥ ३८ ॥
पक्षमन्यतरं हन्ति सन्धिबन्धान् विमोक्षयन् ।
कृत्स्नोऽर्धकायस्तस्य स्यादकर्मण्यो विचेतनः ॥ ३९ ॥
एकाङ्गरोगं तं केचिदन्ये पक्षवधं विदुः ।
सर्वाङ्गरोगं तद्वच्च सर्वकायाश्रितेऽनिले ॥ ४० ॥
शुद्धवातहतः पक्षः कृच्छ्रसाध्यतमो मतः ।
कृच्छ्रस्त्वन्येन संसृष्टो विवर्ज्यः क्षयहेतुकः ॥ ४१ ॥
Vata seizing half of the body, causes dryness of the veins and tendons, destroys – makes left or the right side of the body inactive, by loosening the joints. By this, half of the body becomes incapable of any function and insensible with loss of functions. This is called by some as Ekangaroga and by others as Pakshavadha. It is sarvangaroga since the entire body is invaded by anila- vata. Paksavadha caused by vata alone- without the association of pitta or kapha, is most difficult to cure, difficult when associated with others-doshas. The disease caused due to depletion of tissues is reject worthy, incurable.  

Dandaka

आमबद्धायनः कुर्यात् संस्थभ्याङ्गं कफान्वितः ।
असाध्यं हतसर्वेहं दण्डवद्दण्डकं मरुत् ॥ ४२ ॥
Vata, associated with kapha, invades all the channels of the body, which are filled with Ama, and makes the body stiff like a staff – log of wood, and in which all the activities of the body are destroyed, known as Dandaka is incurable.

Apabahuka

अंसमूलस्थितो वायुः सिराः सङ्कोच्य तत्रगाः ।
बाहुप्रस्पन्दितहरं जनयत्यवबाहुकम् ॥ ४३ ॥
Vayu-vata located at the root of the shoulders constricts the veins there, produces Apabahuka, which causes loss of movement of the arm.

Vishvachi

तलं प्रत्यङ्गुलीनां या कण्डरा बाहुपृष्ठतः ।
बाहुचेष्टापहरणी विश्वाची नाम सा स्मृता ॥ ४४ ॥
The disease which causes constriction of the tendons of the palms and fingers, over the back of the arm, leading to loss of function of the arm, is known by the name Vishvachi.

Khanja Pangu

वायुः कट्यां स्थितः सक्थ्नः कण्डरामाक्षिपेद्यदा ।
तदा खञ्जो भवेज्जन्तुः पङ्गुः सक्थ्नोर्द्वयोरपि ॥ ४५ ॥
Vayu localized in the waist / pelvis, causes constriction of the tendons of the thighs and gives rise to Khanja- lameness when one leg is affected and to Pangu- lameness when both the legs are affected.

Kalayakhanja

कम्पते गमनारम्भे खञ्जन्निव च याति यः ।
कलायखञ्जं तं विद्यान्मुक्तसन्धिप्रबन्धनम् ॥ ४६ ॥
The legs tremble at the commencement of walking, the patient walks by limping and the binding of the joints are loosened this condition is to be known as Kalayakhanja.

Urusthambha

शीतोष्णद्रवसंशुष्कगुरुस्निग्धैर्निषेवितैः ।
जीर्णाजीर्णे तथायाससङ्क्षोभस्वप्नजागरैः ॥ ४७ ॥
सश्लेष्ममेदःपवनमाममत्यर्थसञ्चितम् ।
अभिभूयेतरं दोषमूरू चेत्प्रतिपद्यते ॥ ४८ ॥
सक्थ्यस्थीनि प्रपूर्यान्तः श्लेष्मणा स्तिमितेन तत् ।
तदा स्कभ्नाति तेनोरू स्तब्धौ शीतावचेतनौ ॥ ४९ ॥
परकीयाविव गुरू स्यातामतिभृशव्यथौ ।
ध्यानाङ्गमर्दस्तैमित्यतन्द्राछर्द्यरुचिज्वरैः ॥ ५० ॥
संयुतौ पादसदनकृच्छ्रोद्धरणसुप्तिभिः ।
तमूरुस्तम्भमित्याहुराढ्यवातमथापरे ॥ ५१ ॥
Over indulgence in foods which are cold, hot, liquid, dry, heavy, unctuous, either cooked or uncooked; exertion, debility, irritation, excessive sleep or avoidance of sleep, etc., these causative factors bring about aggravation of vata associated with slesma (kapha), medas (fat tissue), and severe accumulation of Ama (undigested food metabolites), gets associated with other dosha (pitta) moves towards the thighs which fill up (accumulated in) the thigh bones which are made wet by the kapha, making the thigh stiff it becomes cold, numb and inactive. The patient feels as if the thigh belongs to someone else, the thigh becomes heavy, and is associated with severe pain, is greatly worried, has pain in body parts, feels as if his body is covered by a wet cloth, drowsiness, vomiting, tastelessness (anorexia), fever, associated with weakness of the feet, difficulty in lifting and loss of tactile sensation, this disease is designated as Urusthambha by some and as Adhyavata by some others.

Kroshtukashirshaka

वातशोणितजः शोफो जानुमध्ये महारुजः ।
ज्ञेयः क्रोष्टुकशीर्षश्च स्थूलः क्रोष्टुकशीर्षवत् ॥ ५२ ॥
A swelling in the middle of the knee arising from-aggravated vata and sonita- blood, highly painful, thick-big resembling the head of a jackal is known as Kroshtukashirshaka.

Vatakantaka

रुक् पादे विषमन्यस्ते श्रमाद्वा जायते यदा ।
वातेन गुल्फमाश्रित्य तमाहुर्वातकण्टकम् ॥ ५३ ॥
Vata getting localized in the ankle joint, either by placing the foot improperly while walking, or due to exertion of the feet produces pain in the ankles / heels. This is called as Vatakantaka.

Gridhrasi

पार्ष्णिं प्रत्यङ्गुलीनां या कण्डरा मारुतार्दिता ।
सक्थ्युत्क्षेपं निगृह्णाति गृध्रसीं तां प्रचक्षते ॥ ५४ ॥
Tendons of the feet getting vitiated by Vata, cause pain moving towards the heel / ankles or the toes and makes the lifting of the thigh up very difficult; this is called as Gridhrasi.

Khalli

विश्वाची गृध्रसी चोक्ता खल्लिस्तीव्ररुजान्विते ।
Vishvachi and grdhrasi when accompanied with severe pain are called as Khalli.

Padaharsha

हृष्येते चरणौ यस्य भवेतां च प्रसुप्तवत् ॥ ५५ ॥
पादहर्षः स विज्ञेयः कफमारुतकोपजः ।
The feet having tingling pains and needling sensation and seem to be sleeping – with loss of tactile sensation, is Padaharsha arising from aggravation of Kapha and Vata.

Padadaha

पादयोः कुरुते दाहं पित्तासृक्सहितोऽनिलः ॥ ५६ ॥
विशेषतश्चङ्क्रमिते पाददाहं तमादिशेत् ॥ ५६अब् ॥
Vata associated with pitta and Asrk-blood, produces burning sensation in the feet-soles in persons who walk more. This is known as Padadaha.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने वातव्याधिनिदानं नाम पञ्चदशोऽध्याय:।।१५॥
Thus ends the chapter Vatavyadhi Nidana-the fifteenth in Nidanasthana of Astangahrdayasamhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagup.