Two kinds of ailments (curable and incurable).

This sutra is about diseases and how to understand them. Vyádhi means a disease that is not yet full-blown, and rog is a disease that is full-blown. The full-blown disease can be perceived by the senses and involves physical symptoms. The phase before a disease becomes full-blown is very well-described in Ayurveda and is what is being discussed here, the experience of it is as a kind of suffering or anxiety, a worry. The word sadhya means controllable, manageable, curable, correctable, and its opposite is asadhya - incurable. From the perspective of curability of a disease, these are the two kinds - curable and incurable. We must know whether the disease is curable before we begin treatment. Just because one's back hurts does not mean that there is something a doctor has to do about it. People today are most interested in writing prescriptions immediately, they are sicker than the patients they are trying to cure. If we take the example of a marionette, all of the strings on it have to be attached for the puppet to work. We focus on the puppet and not the strings, but we should focus on the strings, and in this case, we are making the puppet do the dance of curing disease, and that happens if the puppet master knows how to pull the strings. The opportunities for cure are the strings. The Ayurvedic practitioner has to look at the strings, and his view of the puppet is from above, he does not see what the audience sees. We need to understand the concept of what is and is not curable, not give useless advice without understanding whether there is any point to it.

If a disease is curable (sadhya) with the aid of a medication, then it can be done. Another example is that of people who know how to ride elephants - they have a kind of tool they use to prod the elephant, which is enormous, and the elephant responds immediately even though the prod is so comparatively smaller. That is what a successful cure can be like for a curable disease. However, if a disease is raging and full-blown, and if the causes of it are constant, then it cannot be cured, it is like a bonfire of tires into which people keep bringing more and more tires. For example, a person whose work schedule causes problems for his liver, if he is unwilling to change his daily regime, has disease for which the cure is being ignored - the cure would be to change the sleep schedule, but the person refuses. There are two kinds of curable diseases: su-sádhyaḣ = easily curable and kṛččhra-sádhyaś = hard to cure. Just like we learn to ride a bike, first with training wheels and then without, we can distinguish which diseases can be cured easily and which will be hard to cure, more like training a lion than learning to ride a bicycle.

If a disease is incurable (sadhya) it also comes in two types:  yápyó is a conditioned disease, one for which there are medicines, procedures, such as dialysis for the kidneys - if you can perform the procedure for the rest of your life, the disease will not kill you. Upakramaḣ means that the incurable disease is uncompromising and there is no solution for it, it is useless to try to undertake a cure, it would be like trying to stop a building from falling down. For example, some people who are very addicted to methamphetamine cannot be helped and their lives end quickly.