Hunger is the supreme disease, conditioned formations are the supreme suffering. Having known this as it is, nibbana is the supreme happiness.

Jighacchāparamā rogā — hunger is the supreme disease: jighacchā is hunger. The most fundamental disease of the body is the constant need for food. As long as there is a body, there will be hunger — the most basic dependency.

Saṅkhāraparamā dukkhā — conditioned formations are the supreme suffering: saṅkhāra are conditioned formations — everything compounded, everything constructed, everything dependent on conditions. Their impermanent and conditioned nature is the ultimate source of dukkha.

Etaṃ ñatvā yathābhūtaṃ — having known this as it is: yathābhūtaṃ is “as it really is” — direct, non-conceptual vision of the nature of reality. This knowledge is not intellectual but experiential.

Nibbānaṃ paramaṃ sukhaṃ — nibbana is the supreme happiness: the definitive conclusion. If saṅkhāra are suffering, what is beyond them — nibbāna, the unconditioned — is supreme happiness. This is one of the clearest and most direct statements in the entire Pāli canon.