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1
AN ENGLISH TRANSLATION
I OF
THE SUSHRUTA SAMHITA
Vol. II.
NIDANA-STHANA TO KALPA-STHANA.
AN ENGLISH TRANSLATION
OK
THE SUSHRUTA SAMHITA
A FULL AND COMPREHENSIVE INTRODUCTION, ADDITIONAL TEXTS,
DIFFERENT READINGS, NOTES, COMPARATIVE VIEWS,
INDEX, GLOSSARY AND PLATES
IN THREE VOLUMES
KDITKD liY
KAVIRAJ KUNJALAL BHISHAGRATNA, M.R.A.S.
Vol. II.
NIDANA-STIIANA, S'ARIRA.STIIANA, CIIIKITSITA- STIIANA AND KALAl-A-STIIANA.
CALCUTTA ; PUBLISHED BY THE AUTHOR,
NO. 10, KASHI GHOSE'S LANE
1911
AH Rights Reserved.
•,sr Ti, i-fui ^-ook-Supplyini Agency. Poo/ia.
rulNTliD UY M. UHATTACIIARYYA, AT J HE BUAKAT MllllR TRESS, 25, ROY UAUAN STREET, CALCUTTA.
1907 V. 2- PREFAGE.
It is with mingled feelings of pain and pleasure that we now place before the public the Second Volume of our English Translation of the Susruta Samhita, The arduous task of com- piling a connected and succint history of any part whatever, of the ancient Hindu System of Medicine — requires greater leisure and more extensive reading than we can lay any pre- tension to. Years of patient study and constant discourse with our sainted preceptor the late lamented Mahamahopadhyaya Kaviraj Dwaraka Nath Sen, Kaviratna, that refulgent link of the golden chain of the Dhanvantaric succession, have enabled us, however, to grasp the leading facts, and during the last few years we have worked continuously, in moments snatched from the practice of an anxious profession that knows no respite, to arrange these facts in their present form. It breaks our heart to record the sad departure of our venerable Acharyya from this sublunary sphere to a land "from whose bourne no traveller e'er returns.'*
It is hardly necessary for us to reply to those critics who, through their ignorance of the original
( 2 )
Sanskrit works, persist in describing Ayurveda as an empirical system destitute of Anatomy, Physiology or Pathology in any scientific sense.
It behoves us, however, in this preface to meet some of the charges which have been brought aofainst us.
Exception has been taken to our not includ- ing in the opening stanza the usual invocation to the Supreme Self (for a successful completion of the work) although it has found its way into almost all the printed editions of the work extant.
Now the stanza referred to finds no place in the various manuscript copies of the original work which are in our possession, or on which we have been able to lay our hands. The work was first put into print by the late Dr. Madhu- sudan Gupta and we believe that it was only in this printed edition that the benedictory address in question appeared for the first time, and that it has since crept, by the process of circulation, into subsequent printed editions.
In this opinion we are supported by the fact, that in noneof the various commentaries and anno- tations on the Susruta Samhita is any mention made of the line in question, whereas, had it been the opening stanza of the original work, it would certainly have received at least a passing notice at the hands of the commentators, however easy or simple it might have been. Further, were it composed by Susruta himself, it would not have
( 3 )
been in the form in which we find it in the printed editions. The ancient sages used invariably the auspicious expression "^^Tc?*. " or " girtrr '' and the Hke. when commencing a work and never invoked any particular deity for a happy termination of their undertaking.* These are the reasons which have led us to omit the passage in our present translation.
Another objection raised by a certain section of the community is that we should not have at all undertaken to translate the work into the English language. Their contention is that the Ayurveda, being an integral portion of the Eternal Vedas, should, on no account, be rendered into a Mlechchha Bhdshd and thus made accessible to the public at large, irrespective of caste or creed.
Such an objection, at this time of the day, is, to say the least, most puerile ! Truth is truth, and latitudes and longitudes are not its boundary lines. The \^edas themselves have been trans- lated into many European languages. To keep the truths promulgated by our ancient sages con- fined within the coterie of the privileged classes and thus to deprive the educated public of the
* Thus :~
'a) "^tWf f;^#f^^?i^-«iTa sgi^nMRT:''— Charaka Samhita. (/') ''^^mt \^ "^^Tsjmw!' — Kanada Vaiseshika Sulra {c) "^^Tm ^^frsT^l"— Vedanta Sutra.
( 4 )
benefit of such truths would certainly be a sacrilege. In i^iving preference to English as the nicdiiini of translation we have been actuated by more reasons than one.
It cannot be gainsaid that Iinglish has now become almost the lin^^ua franca of the world, and to disseminate the ancient wisdom of India throu(£hout the world, we could not have selected a medium better than the English language.
Besides this, we have been actuated by the hope of drawing the direct attention of our be- nign Government to the scientific value of our system of Medicine by the adoption of such a procedure.
Here we must not stop without expressing our sincere and hearty thanks to our learned and valued friends Kaviraj Jogindranath Sen, M.A., Vidyabhusana, Kaviraj Jnanendranath Sen, B.A., Kaviratna and Professor Satyendranath Sen, M. A., Vidyavagisa, who have rendered us material help in the publication of this volume. We must freely admit that but for the active and continued co-operation of the above-named gentlemen we could not have brought out this volume so promptly and successfully. Our thanks are also duo to Dr. S. Sanyal, B.Sc, L.M.S. for his kind h'elp, to Dr. S. N. Goswami, B.A.. L.M.S. for his kindly supplying us with materials for writing the Introduction, and to our readers for their kind encouragement.
( 5 )
In conclusion, we implore our readers to excuse the errors of omission and commission which are inevitable in the execution of such a huge work, more especially when the author is encumbered with the responsible duties of his profession involving, as they do, the life and death of persons entrusted to his care.
10, Kashi Ghoshe's Lane,
Calcutta. \ KlNIA LaL BlIISHAGRATNA.
Novemberi igii. '
INTRODUCTION.
In the introduction of the first volume of our translation
of the Susruta-Samhita we have attempt-
Ayurveda is not ed to place before the public a correct an Encyclopaedia ,_,,_,. , t- .
of ancient medical interpretation of Vayu, Fitta and Kapha,
tise on Biilogy^"^^^' ^^^ ^^^^"^^^ so-called humours of the body* and it is a great pleasure to us, that our pronouncement has been very kindly accepted. In the introduction of the present volume we would draw the attention of the readers to the fact that Ayurveda is not at all an encyclopsedic work, — an Encyclopcedia of the Indian
* Berdoe says : — "What is known as the Humoral Pathology formed the most essential part of the system of the Dogmatics. Humoral Pathology explains all diseases as caused by the mixture of the four cardinal humouri, viz., the blood, bile, mucus or phlegm and water. Hip- pocrates first leaned towards it, but it was Plato who developed it. The stomach is the common source of all these humours. When diseases develop, they attract humours. The source of the bile is the liver, of the mucus the head, of the water the spleen. Bile causes catarrhs and rheu- matism, dropsy depends on the spleen."
Be it observe! that among the humours of Hippncrates there is no place for Vala although in point of fact both his Physiology and Patho- logy are to be traced to the "Tri-dhatu" of Ayurveda. The secret of this anomaly is that the theory of Vata was found to be a complicated one and Hipprocates, not being able to comprehend its original import, left it out and cautiously introduced, in its stead, his own theory of "water". Sowe find "Humoral Pathology is not of Indian origin ; neither it is the same which the Indian Rishis of Rigveda developed under the name of Tridhatu." It is simply an imitation of Susruta who introduced blood ( 'itf^ff^'^'; ) ^s ^^^ fourth factor in the genesis of diseases. But the bor- rower, in his interpretation of Susruta, had made a mess of it. He retain- ed blood, but substituted "water" in place of Vata, the most important of the three, for reasons best known to him,
il INTRODUCTION.
system of Medicine in all its departments, but it is the Science of Life entire.
Though it is customary and convenient to group apart such phenomena as are termed mental and such of them as are exhibited by rnen in society, under the heads of Psycho- logy and Sociology, yet it must be allowed that there are no absolute demarcations in Nature, corresponding to them, and so in the entire Science of Life, psychology and sociology are inseparably linked with Anatomy and Physiology, nay, more, with Pathology and Hygiene and above all with Treatment. In short the Biological Sciences must deal with whatever phenomena are manifested by living matter in whatever condition it is placed. Life in health ( %rgrq: ) as well as Life in disease ( ^'.WW- )> therefore, fall within the scope of Biology— even life exhibited by man in Society ( f%fnf%cf ) is not exempted from it.
i{TT^ era ^W^pf^: ^ ^=^% II '^T^, ^*^IT, m ^<5ITg I
In calling Ayurveda, therefore, the entire Science of Life,
. J ., we are not guided by any prejudice
entire Science of of our own, but we rely solely on
^ ®' facts and figures, and these, when
closely studied, will lead any one to arrive at the same
conclusion, not unlike our own and to interpret Ayurveda
as a collection of Biological Sciences in all departments.
In the firsl place, for the guidance of our readers, we will
mention that the name Ayurveda itself is a strong evidence
in favour of its being called the Science Negative Eviden- ^« y -ir o ji n r
ces thereof :— 01 Life. Secondly, we will refer to
1. The Name it- ^j^g arrangement of the subject-matter self. " , , ■'
in the Sarira-sthana which is popu- larly belived to be the anatomical portion of the book, as
tending to the same conclusion. In XL The arrange- ,. . , . .,., .,
ment of the sub- this section, chapters on Midwifery
ject-matters. ^nd Management of Infants follow
close to the heels of those on Anatomy and Physiology, and
INTRODUCTION. iii
these latter again are immediately preceded by chapters on Psychology. This intermixture is certainly an anomaly and can in no wise be satisfactorily explained unless we have to look upon these as general truths of Biology, elucidated by the Introduction of special truths exclu- sively collected from the science of medicine — ftrwjnl^^ *im^ ^F^cnf'T I To call it Descriptive Anatomy or Physiology, in the modern sense of the term is simply ridiculous. The absence of any reference to brain and
ti^lnatomyTnd 'P^"'^ ^°''^' ^° P"""^^' ^"^ ^^^'^' '" Physiology in the a book of Anatomy and Physiology is
Ithlnaitself?-"'^^' unpardonable and in the Sarira-sthana we feel this absence almost to despon- dency. Moreover, in western medical science, Grey's Ana tony and Kirke's Physiology, for instance, in their bulk exceeds, each, more than a thousand of pages and to present to the public, under the same name less than half a dozen of pages, as the result of Indian wisdom, is certainly a very miserable contrast — a contrast that is calculated to inspire no admiration, but, on the contrary, to generate in scientific minds an universal apathy, at least an apathy towards all that is connected with the system of Indian Medicine. In order to save our venerable Rishis from this disastrous plight, we announce here foremost of all, that our beloved Science of Ayurveda is by no means an Encyclopaedic work, but distinctly possesses every characteristic ^^Positive Eviden- ^^^^ ^^^^^ ^j^^ Science of Biology.
I The definition The very name Ayurvada indicates ofAyus. . • • ,, .
Same as Life as that it is actually a science of Ayus
blrVspen^er'"' ^^''" ^""^ ^^^ ""^'^ ^^^' ^' "^^^ here in the same sense as Mr. Herbert Spencer understands by his remarkable definition of Life.
In his masterly classification Mr. Herbert Spencer has in his Biology, given, indeed, the first place to Anatomy and Physiology, but still it is divested of any elaborate chapters dealing with the subjects.
B
IV INTRODUCTION.
In the science of Life a short reference to the structures of the body or its functions is quite sufficient to illustrate its principles, and if we fail to find therein any discourse on the descriptive Anatomy and Physiology, we still consider that there is nothing amiss.
But unfortunately the fate of Ayurveda is otherwise. Though the very name indicates that it is Biology pure and simple, still it is denounced for its dificiencies in Anatomy and Physiology, and doomed for ever.
Sanskrit words are notorious for their confusion of meanings, but, as regards Ayurveda there exists no difference of opinion, at least, so far as the first word is concerned. Ayus is /iyus everywhere in Ayurveda and it is the only fault our venerable Rishis may be reasonably charged with, that they did not put themselves into any great trouble to explain Ayus, but, on the contrary, unlike scientific men, misspent their energy to ascertain the significance of the insignificant portion of Ayurveda, that is the meanings of the root ''Fida" in the light of Grammar.
The scientific ear, ever unsatisfied with these grammati- cal eruditions, has ultimately thrust an Encyclopaedic value upon what is properly speaking, a book of Biology. Of course, there is a marked difference between the two. An ordinary treatise on Biology deals with the general truths of life, and does not represent, by way of illustrations, all its special truths, nor their practical sides, but so far as Ayurveda is concerned, the general truths of Biology are thrown into the background and the special truths, gleaned exclusively from the science of medicine, are given great prominence (fir'SfJllR^ ^^1^ ^■'^fsifilf'T ), so much so, that it is now regarded as a system of Medicine and Surgery which has neither Biology, nor Anatomy, nor Physiology, nor Pathology — but is a systematised Empiricism or Quackery. This is certainly a great misfortune. Apart from the name, the arrangement of the subject, to which we have just referred, at least, in the section of Sarira-sthana (the falsely so-called Anatomy of
INTRODUCTION. V
the Hindus),— is a direct contradiction to its bieng considered
as an Encyclopaedic work. The existence of the chapters on
midwifery and management of infants in the same, following
immediately the chapters on Anatomy, serves as a strong
additional evidence thereof. It is an anomaly no doubt,
that Midwifery has been offered a place in the section of
Anatomy, but the confusion does not Reasons for in cor- . . ,, t j j -r i ^ ^
porating Midwifery g^^ ^^ ^'' confounded, if we are led to
into this Anatomi- believe that the science of generation cal seccion-
of a superior race (if we are at all
permitted to use the term) forms, indeed, an important depart- ment of Practical Biology.
From whatever standpoint we look to the question, we find there are grounds to lead any one to pronounce in our favour and to come to the conclusion at which we now venture to arrive. Besides these two important facts,
we now cite the following passage as
Internal evidence- , • . , • j • r r
a strong internal evidence in favour of
our view. Maharshi Punarvasu, after giving us a short table
of the principal structures of the human body, remarks that
even this reference is considered by many as superfluous,
Reasons for omit- ^'^ ^^^ g'"^""^' '^^' '" acquaintance ting Descriptive with the molecular construction of an organism is quite suflScient to help us as a reliable guide to treatment.
The passage referred to is quoted below : —
Now we ask the reader if this is not a sufificient evidence, proving to the hilt, that Ayurveda is nothing but Biology and that we run no risk of committing a grave omission if the chapter on Anatomy is wholesale dispensed with from Ayurveda. For the improvement of this awkward position — that in the section of Anatomy there should be no Anatomy — the entire credit is due to Susruta, as he has very wisely made the suggestion, that a knowledge of the anatomical structures of the body is of great value, at least so far as it
VI INTRODUCTION.
helps the Surgeons and the Surgeons only in their operations.* But so far as Biology is concerned with medicine, Susruta does not forget to lay particular stress on the knowledge of the molecular construction of the body. The following memorable passages actually preached by this renowned Surgeon, some three hundred centuries ago, still stands as a model from which modern Science, even in its present ad- vancement, can draw inspirations. He says : —
1. ST 31,^ ^^qr ?^' t% fl^ff^ f%->^: I
^^rTMT ^'f^^NTgiT^^ri f^: II
2. fT«iTf%:¥3!a Tii^ ^=srT si^^ ^^ctt i siteflifgT 'Jft ^PRiJr ?^^s^^f^?i: ii iif?r^ f^ ^. 1^ ^re??^^ ??ftfi I
?f?TrefT¥^^?i ^^] TlTTf%qtf ?T II
That is, the protean work of the protoplasm in which the
great Self resides cannot be detected by the body's eye ; to
know its work, mind's eye is necessary, along with the body's
eye. For acquiring efficiency in Surgery alone, the dissection
* Susruta recommends dissection on dead human bodies and suggests that it is only required of those who will practise surgery and that students of medicine can do without it. Herophilus practised dissection on living bodies and with the object of practising medicine suceessfuUy, but it soon fell into disrepute and did not at all influence the art of Medicine, He was condemmed even by his own pupil Philinus of cos who declared that all the Anatomy his vivisecting master had taught him had not helped him in the least in the cure of his patients. Such indeed was the fate of vivisection for which Europe now takes pride.
But Susruta's, Avagharshana is now considered by many as the only perfect mode of dissection ever known. It is with the help of this method of dissection that the layers of epidermis and dermis could be discovered and blood-vessels with their minute branches could be counted to be as many as thirty millions. Not only this, but also in the opinion of several European savants, Susruta still stands as a model of surgery and European surgery has borrowed many things from Susruta and has yet many things to learn.
INTRODUCTION. Vil
of dead body (not of living body as proclaimed by Herophilus), nay, the Avagharshana which brings into view
The knowledge ^^^ ^^^^""^ ^^ ^^^ epidermis and the
of the Molecular dermis, the number and branches of
Construction of the ., , . , , ,• u j
body is all that is blood-vessels and nerves that he embed-
wanted. ^^^ j^^ muscles, etc , is only necessary.
Professor Michael Foster's remarks in his article on Physiology in the Encyclopedia Britannica, to all appearnces, are just in the same line, if not identical with our extract, when he says "that the problem of Physiology, in the future, is largely concerned in arriving by experiment and infer- ence, by the mind's eye, and not by the body's eye alone, assisted, as that may be, by lenses yet to be introduced at a knowledge of the molecular construction of the protean protoplasm ; of the laws according to which it is built up and the laws according to which it breaks down ; for these laws when ascertained will clear up the mysteries of the protean work which the protoplasm does."
In short the knowledge of the molecular construction of the body is just the thing with which Biology is concerned, and such is the unanimous verdict both in the East as well as in the West, in the most ancient and in the most modern Sciences of the world. Now, if the 'knowledge of the molecular construction of the protoplasm, of the laws according to which it is built up, and the laws according to which it breaks down,' is all that is necessary for an accurate knowledge of Anatomy and Physiology, our Ayurveda is pre-eminently the Science we want.
The following extracts, from Charaka Samhita, are cited here to prove that we are quite justified in our contention.
That is, the body is composed of molecules and these are said to be numberless, because no body can count them up.
Vlll INTRODUCTION.
By their union, they build up the body, and this union is governed by three Laws, viz., the Laws of Vayu, Karma and Swabhava (which are almost equivalent to the three Biological Laws, i e.^ the law of heredity, (he law of external relations and the law of molecular motion caused by Ethereal vibrations compared with which nerve-impulses — akin to electric force, — are grosser and coarser shocks). So far we think we have proved that Ayurveda, as a Biology is not defective, if it contains no descriptive Anatomy and Physiology — descriptive in the same sense as Grey's Anatomy or Kirke's Physiology is. Its Histiology is molecular; its Pathology is molecular ; its Physiology is molecular. Molecular in every sense is
the Biology of the Hindus, virtually speaking, Ayurveda is our Science of Life, and we will presently shew that Life and Ayus are identical.
The continuous adjustment of molecules, their successive breaking down and building up within an organised living body, without destroying its identity, is the definition of /iyus as suggested by Maharshi Punarvasu.
He says : —
In another place the same definition is repeated with a slight modification and in this he enumerates %TTrgetf^:,
(consciousness) as the most distinctive of'Ayu. ■^®^^^*^°° characteristic of ^j'w^. According to this
definition, 3iTlTf^^rc9T<?T#qt^: and %PTTg- ?f%: re'er to an organised living body ; f'M^; and ^g^^?: are identical with processes of breaking down and building up of the organism without destroying its identity. The idea of continuous adjustment is included also in these two words. So we find, the definition ofAyus, as sugessted by Punarvasu,
includes more than what is proposed in
The same as Life. ,, tt u . o > j /- • • r ^ y
Mr. Herbert Spencer sdefinition q\ Life.
The words >sitT and ^t%fTiT, as explained by the great annotator
Chakrapani, represent two more distinct phases of Life, the
INTRODUCTION. IX
first bearing upon the existence in the system of a preven- tive factor of putrefaction, the second More compre- • .^- . .l . . .u ..
hensive than Life pointing to the agent or agents that
as defined by Mr. adjust the internal relations by deli- Herbert Spencer. ,• . , cate touches, which professor Michael
Foster speaks of as "continuously passing from protoplasm to
protoplasm and compared with which the nervous impulses
^ . , , , (which are perhaps electrical in nature)
Prof. ^ Michael ^ , , . ,, xt
Foster on the The- are grosser and coarser shocks. Now ory of Sensation. ,. ^^-^ ^^^^ epithet, viz., "^f^ci/' as ex- plained by Chakrapani — "#^?rf?T m'JTR >?K2j1%"— furnishes us with a clue to determine what Ayus ( '^rq: ) actually means. Our Sacred Upanishads now come for-
the^pJnfshad? °^ ^''^^^ ^° ^^^ ^^^^^^ ^"^ ^^'^ "^' '" '^^ ^^^^ place, "'?rrq: UTIj:," ie , Ayu and Prana
are one and the same principle. In the second place, "?i: rto;
^ ^:", i.e , Prana and Vayu are identical. In the third place,
"^ x^ xm\t ^grr^r^TyRi:", i.e., Vdyu is not unlike Ether.
In the fourth place, "w jr\^ ^j^fig", i.e., the primitive fluid
yaccording to Lord Kelvin) is divided into two parts, viz., one
without motion, another endued with motion. In the fifth
place, "4j4f*lrt^l«tit^', '.e., everything in this world are
waves of this Ether endued with motion. In the sixth place,
"^igrN ^"^'." "^T^ ft^, RTO: m%g". i e., Vdyu is the universal
store of energy ; in the Physical world it is known by the
name of Vayu ; in the Living world it is called under a
different name and that name is Prana (v{]w.)
From the above short table we come to know that the
agent that adjusts the internal relations to external relations,
is Ayus and that Ayus is Life, and that Life is a motion of the
great etherial fluid which is known in Sanskrit as "?^' and that
"^T?j" is the sum of all the various The same as pri- . u- ^ ■ ^ ^ u- ^ • i
mitive fluid as de- energies— biological and abiological—
fined by Lord which under the name of heat, light,
Kelvin. , . . . '
electricity or consciousness, etc, manifest
themselves both in the Physical as well as in the Metaphysical
X INTRODUCTION.
world, and that Prana (vciw.) is another name of the same force that, in acting on an aggregated living body, divides itself into five distinct forces, viz., Prdna, A/>dna, Samdna, Uddna, and Vydna, and subserves the functions of correlation ( ^rg: ) and sustentation ( fqrt ) and controls oxidation (^^t). So Prana continuously helps to adjust, like the main-spring of a watch, the internal relations to the external relations. We are indebted to the master mind of Sankara for his able exposi- tion of the functions of this main-spring,
vJ^u and^EthS. °^ ^^^^ '^' °^ ^^® etherial vibrations {sfj^w.) as transformed into the vital force in an organised body. We quote below what he says about it in his celeberated commentary on the Vedanta Darsana.
ot'^vlyu 'in'ufa"' "n^: «w ^m wm ^ ^^ =T,sft ^- tion on a living ,^^ , ^c^^w ^'^ w^w^ <?t T fw<i^ i aggregate.
That is the primitive fluid that is endued with motion in its evolution of Life gets knotted into five divisions, viz , Prdna, Apdna, Samdna, Uddna and Vydna, and this acting on any aggregated living matter is called Prana. So what we call Prana is not the Vayu itself, but a particular mode of its motion. Hence the question of identity and non-identity is a matter of choice. Shortly speaking, this is the Biology of the Hindus. This too is the sum and substance into which (as a department of Biology), Physiology unfolds itself.
This too evidently serves as the line of Biology forms the demarcation between ^urg: and ^:WTi:i iM^^Tlevetpta fen,: -d •^^.. From this too as so much col- Health and Disease, Hygiene and lateral branches. ^^^^^^^^t, Psychology and Sociology
have all their origin and start. In fact, Biology forms the basis upon which the great edifice of the Indian Medical Science, as
a collateral branch, has been developed.
Conclusion. rpj^^ general truths of Biology ae all
there in the Ayurveda ; but the special truths from medicine
INTRODUCTION. Xi
have been given so great a prominence that the real character of the book has been over-shadowed and it has been trans- formed into a Science of Medicine.
*******
With a view to convey to the minds of our readers an idea of the different branches of the Medical Science which developed as a'coUateral branch of this great Science of Life, we would here touch upon a few of them in passing.
Magnetism had formed its way into the therapeutics of
the ancient Hindus and animal magne-
Magnetism. ,. ^ . , .• j •
tism was very extensively practised in
India long before they were recognised by Mesmer in Germany
and subsequently by John EUiotson in England.
The Indian writers on Medical Science of the good
old days have described in length the
Hydropathy. ,• • , r ,
medicinal properties of the waters of
the principal rivers, lakes, water-falls and mineral springs of the country that were known at the time and their respec- tive curative powers as applied to various ailments that human flesh is heir to. This goes a long way to establish the fact that Hydropathy was known in India long before it was even dreamt of in the Western world.
The ancient Hindu sages from time immemorial had been cognizant of the benefits of massage and shampooing and taken to practising them. Whereas, it is but of late that the advantages of these methods have begun to be appreciated by the Western Medical School and it no longer hesitates to acknowledge them as efificacious therapeutic agents.
The Science of begetting healthy and beautiful children,
which is just beginning to receive atten- Genesiology. ...
tion in other countries was not un- known to the ancient Hindus, and Manu in his Mdnava- dharma-Sdstra has laid down special injunctions which still form an integral part of the doniestic life of the orthodox section of the community. As a matter of fact, they knew
C
Xli INtRODUCtlON.
that mental impressions of the parents at the time of con ception exercise a great influence over the future destiny of the child in embryo.
Thus we read in the Sastras : — "A woman, though at a distance, conceives a child of the shape of the person she loves ardently and thinks of at the time. Just as a tree that grows is not different from the parent tree whether we plant a branch or sow a seed, so the main features of the child partake of the features of its father, though there might be slight changes due to the soil."
The subtle soul co-operates with the Manas (the mind) ; the mind co-operates with the senses ; the senses perceive objects ; all this takes place in little or no time. The above is the connection between the soul and objects around us. What is there which the mind cannot comprehend ? There- fore, wherever the mind enters, the soul follows it.
"The soul being subtle, whenever it enters another soul, requires some time and an effort of the mind to know the latter. The soul, which intensely meditates on an object, assumes the shape of that object.'' etc, etc.
In a book entitled Bhoja-Prabandha being a collection
of the anecdotes realating to the reign
Anaesthetics. ^^ ^^^.^^ p, ..^^ ^^ Pandita Ballala
there is narrated the detail of an interesting surgical opera- tion which had been performed on the Raja, who was suf- fering from an excruciating pain in the head. All the medical aid obtaining at the same time was availed of, but in vain and his condition became quite critical when two brother physicians accidentally arrived in Dhar, who were duly called in. These physicians, after carefully examining the patient, held that unless surgically treated no relief could possibly be afforded to the Royal patient. Accordingly they administered an anaesthetic called Sammohini with
* Vide—'B^xh.h& Mihit's Brihat Samhita Book, II. Chapter Ixxv- Verses 1-3.
INTRODUCTION. Xlll
a view to render him insensible and, when completely under the influence of the drug, they trephined his skull, removed the malignant portion of the brain, the actual seat of the complaint, closed and stitched up the opening and applied a healing balm to the wound. Then they adminis- tered a restoration known as Sanjivani to the patient, who, thereupon, regained consciousness and felt quite at ease. This incident (as narrated by Thakur Saheb of Gondal in his Short History of Aryan Medical Science) goes to prove that the attendant physician of Buddha, is likewise recorded to have practised cranial surgery writh the greatest success. Instances of successful cases of abdominal section are also not rare. Thus it will appear that the ancient Indians knew and successfully practised surgical operations which are regarded now-a-days as the greatest triumphs of modern surgery. The purpose of chloroform in the palmy days of yore was used to be served by Sammohini, but there is hardly a drug known to modern Pharmacopseias, corresponding whith Sanjivani which certainly lessens the chances of deaths that at present sometimes occur under ancesthetics.
Let them, who allege that the Hindu system of the heal- ing Art is unscientific, now pause and reflect ere they make such an unwarranted and irresponsible assertion. How can a system which contains so accurate an account of the unions of bones and ligaments, anastomoses of nerves, veins and arteries, etc , and which assures the world of trie existence of three crores and a half of veins and arteries in the human body giving facts and figures thereof with such mathe- matical precision, be regarded as being unscientific ?
It is certainly an undeniable fact that one of the colossal
achievements of modern Western Medical Science is its
Anatomy; but the point at issue is whether the process of
laying open the structures of the body
TJi QCflpt".! nn
with the lancets, is at all a satisfactory method. For, is it not a fact that the finest and the
XIV INTRODUCTION.
minutest arteries of the skin are never disclosed, if the scalpel is used so recklessly to remove the skin all at once and not allowed to go deeper into the muscles to expose the minute branches of blood vessels and nerves that may happe i to lie embedded therein ? But, on the contrary, look at the process promulgated by Susruta for demonstrating practical Anatomy ! Its originality and perfection beats hollow all the known methods, although it was discovered in almost the pre-historic age. The process prescribed by the Hindu system is as follows : — Cover a dead body with Kusa grass and place it at the edge of the water of a rivulet. After three days take it out carefully, and gradually take off the succsesive layers of the epidermis and dermis and of the muscles beneath by gently and lightly rubbing it over with a soft brush. Thus the smallest and the thinnest arteries, which have by this time swelled and obtained a distinct existence are made palpable everywhere even to the minutest.
The process is termed, as we have pointed before, Ava- gharshana by Susruta. The Western method might be an easier and a more off-hand one, but by no means precise. Though the merit of discovering this mode Avagharshana. ^f dissection is due to Susruta, we are all blind to it and call Hippocrates the father of Medicine ! It is generally believed that with a view to further his researclies and perfect his knowledge, it is Hippocrates who inaugurated the system of dissection of dead human bodies and he did the work secretly. Credulous people may lend a willing ear to such assertions but the fact is, that it was not till a century later that Hirophilus openly resorted to dissection of human bodies and thereby earned an undying fame in Europe, obliterating Susruta's name for ever, though, virtually speaking, he (Susruta) was the pioneer of dissection and figured in the world more than a millenium before the advent of Hippocrates and over eleven centuries prior to the age of Herophilus.
INTRODUCTION. XV
It would not, perhaps, be out of place here to mention that Dr. A. F. R. Hoernle, M. A , F. R. S , C. I. E., Ph. D., in his recent publication on Hindu Osteology, has proved it to the hilt, how systematic, scientific, unerring and exact were the researches of the ancient Hindus and what a mine of resplendent truths lay imbedded in them ! We, in our Intro- duction of the first volume of this work, have tried to prove how very superb, salutary and supremely happy was the theory of Vayu, Pitta, and Kapha promulgated by Susruta. There we have incidentally mentioned that the Science of Embryo- logy was not unknown to the Hindu sages. In the present volume we mean to prove to a point that the main principles promulgated in the Anatomy, the Physiology and the Patho- logy of Susruta yield in no way to the principles en those subjects included by the modern Western Scientists and investigators. On the other hand, we boldly afifirm that in the theories propounded by Susruta some two thousand years back there lies a fund of truths which might well throw a flood of light on the field of labour of the modern scientific men of the West. For is it not a fact that the theories of Vamatia (causing to eject the contents of the stomach by mouth), Virechatia (causing the evacuation of the intestines), JVasya (causing to inhale through the nose), Anuvdsana and Asthd- pana which, in ancient India, had earned the appellation of Pancha-Karma, and had gained universal prevalence, and were extensively practised by oriental physicians from time im- memcrial, have, of late, been hailed by the medical authorities of the day as the most approved and commended mode of treatment.
Sceptics who care nor to examine and weigh solid facts, bluntly allege that the Ayurvedic system is not based upon experiment and observation — the key-stone of all true Science, and such being the case its Anatomy, Physio- logy, Pathology and Therapeutics are all erroneous. The suggestion, cruel and baseless as it is, originally emanated from an eminent Indian pliysician who has earned an un-
XVI INTRODUCTION^
enviable reputation by writing a Treatise on Hindu Materia Medica. He says : — "It (the Ayurvedic system) is built not so much upon experiment and observation as upon an erroneous system of Pathology and Therapeutics.' But such an expression would not stand the light of day. Indeed none but the ancient Hindu sages did set a high value on experiment and observation, and where they did not claim some occult knowledge or intuition, it is upon these two that they mainly based all their knowledge.
The Materia Medica of the Hindus is really a marvel. Its description of the properties of drugs belonging to the animal, vegetable and mineral kingdoms, and of the articles of food essential to the maintenance of health and strength, its selection of the specific dietaries and elimination of what are prohibited in particular ailments are every day being found correct. The European preparations of Indian drugs and diets are corroborative evidence thereof. The theory adopted by the ancient Hindus as the basis of their investiga- tion is that every substance, whether regitable or animal, possesses five properties namely, — Rasa, Guna, Viryya, Vipaka and Prabhava which lenses alone cannot reveal, nor the body's eye after observation and experiment made upon rats and rabbits. And those who have opportunities of studying and practising both the Eastern and Western Medical Science assert that the ancient Medical Science of the Hindus once reached the highest standard of excellence and perfection in Materia Medica, Therapeutics and Hygiene and was simply unrivalled and unapproachable, as it blended Philosophy with Science— the mind's eye with the body's eye.
A dispassionate examination of these facts (and such as can be multiplied to any extent), will convince an impartial reader that Ayurveda, as we find it described in Charaka Samhita and Susruta Samhita, if approached in a spirit of fairness and enquiry, might reveal the germs of not a few of the marvellous achievement of the present age in the domain of Medical Science and afford to the assiduous
INTRODUCTION. XVll
Student a vast scope and varied materials for comparision between the Eastern and the Western systems, and render material help in improving upon the one with the aid of the other, and this to the benefit of the suffering humanity at large.
Lastly it is our prayer, that if Western Medical Science was ever anywise, directly or indirectly, benefited by the ancient Medical Science of the Hindus, it is but meet and fair that the former should come forward to render all possible aid to her parent Science, and that as it is almost dying now for want of aid and succour we look hopefully to our present benign Government in whose power lies the means of its complete regeneration.
PLATE No. I.
Vital points (Marmas) in the arm Vital points (^latmab) in the arm
(inner side).
(outer side).
"J" indicates the points recognised in Juijutsu.
See Chapter VI, S'atira-S'lhana.
y '
PLATK No n.
Vital points (Marmas) in the leg Vital points (Marmas) in the back
(outer side). of the thigh and the leg.
"J" indicates the points recognised in Juijutsu.
^ee Chapter VI, S'arira-Sthina^
CONTENTS.
NIDANA STHANA.
(Section on Pathology).
CHAPTPR I.
Diseases of the Nervous System, etc :— The action of the Vdyti
in its normal state.— The Prana Va'yu— The Udana Vayu— The Samana Vayu — The Vyana Vayu — The Apana Vayu. — Descriptions of the nature of the diseases — When they are localised in the different parts of the system. — Pathology of Vaita-rakta — Its premonitory symptoms — Its prognosis. — Spasms — Convulsions — Epilepsy without Convulsions — Epilepsy with Convulsions. — Hemiplegia — Its Prognosis. — Wry-neck or Torticollis. — Facial Paralysis — Its Premonitory Symptoms — Its Prognosis. — Sciatica. — Erb's Paralysis. — Synovitis of the Knee-joints. — Lameness. — Vata-Kantaka. — Pada-Daha — Pada-Harsha. — Ams'a-s'oshaka. — Ear-ache. — Deafness. — Nasal voice. — Indistinct Speech. — Tuni — Prati-tuni. — Tympanites. — Vata- shthila. — Pratyashthila. ... ... ... Pages i — 17.
CHAPTER II.
Haemorrhoids:— Classifications— Patholog)-— Premonitory Symptoms, — Vataja Type — Pittaja Type — Kaphaja Type — Raktaja Type — Sannipdlaja Type — Congenital Type. — Figwarts or condylomatous growths about the genitals. — Prognosis. ... ... ... ... 18 — 24.
CHAPTER in.
Urinary Calculii*. — General .Etiology. — Premonitory Symptoms. — Leading Indications. — S'leshmaja As'mari — Pittaja As'mari — Vataja As'mari. — Seminal Concretions. — Supervening Symptoms. — Situation of the Blad- der.— How stones are formed in the Bladder. ... ... 25 — 30.
CHAPTER IV.
Fistula-in-ano and Fistular Ulcers :— Classifications— rremonilory Symptoms. — Derivation of the term Bhagandara. — Vataja Type — I'itlaja Type — Kaphaja Type — Sannipatika Type — Traumatic Type — S'ala-ponaka Type — Ushtra-griva Type — I'arisravi Type — S'ambukavarta Tppe — Un- niargi Type. — Fistulous Pustules. — Prognosis. ... ... 31 — 34.
CHAPTER V.
Cutaneous Affections in general :— Premonitory Symptoms— /Ktiology — Clasbitkat ions. — - Aruna-Kushtha — Audumbara — Rishya-jihva — Kapdla Kushtha (Macula). — Kakanaka — Pundarika — Dadru (ring-worm) — Sthul^rushka — Eka-Kushtha (Ichthyosis)— Charma-dala (Hypertrophy of the skin) — \'isarpa-Kushtha — Parisarpa-Kushtha — Sidhma — Vicharchika (Psoriasis) — Vipadika — Kitima (Keloid) — Pa'ma (Eczema) — Kachchhu — Rakasa (Dry Erythema) — Kil^sa. — Congenital cause of Kushtha. — Prognosis. — Mow Kushtha becomes contageous. — Some other contagious diseases enumerated. ... ... ... ... 35 — 42.
CHAPTER VI.
Diseases of the Urinary tracts :—Patholog)— Premonitory Symp- toms.— General characteristics. — Kaphaja Type — Pittaja Type — Vataja Type. — Names and Symptoms of Kaphaja Meha — Sura-meha — Lavana- meha — Pishta-meha — Sandra-meha — S'ukra-meha. — Names and Symptoms of Pittaja Meha — Nila-Meha — Haiidra-meha — Amla-meha — Kshara-Meha — INIanjishtha-meha — Kakta-meha. — Names and Symptoms of Vataja Meha — Sarpir-meha — Vasa-meha — Kshaudra-meha — Hasti-meha. — Supervening Symptoms. — Kaphaja Types — Pittaja Types — Vataja Types. — Abscesses. — Carbuncles. — Pimples. — Pustules, etc., due to Prameha. — Prognosis. — Symptoms of Madhu-lNIeha. ... ... ... ... ^-j — 49.
CHAPTER VII.
Dropsy with an abnormal condition of the abdomen:— Classifications.— Predisposing causes. — Premonitory Symptoms. — Vataja, Pittaja and Kaphaja Types —Tridoshaja Type. — Enlargement of the Spleen and the Liver with dropsy of the Abdomen. — Vaddha-gudodara — Parisravi-Udara. — Jalodara (Ascites).— General Characterstics of Dropsy. — Prognosis. 50 — 54.
Ill
CHAPTER VIII. False Presentations and Difficult Labour -.—Causes.— Definition.
— Classifications and Symptoms. — Abortion. — Miscarriage. — Prognosis.
Caesarian Section. ■•■ ••• ••. 55— 60.
CHAPTER IX
Vidradhi (Abscess, etc.) '. — Definition and Classification — Vataja, Pittaja and Elaphaja Types — Sannipatika Type — Traumatic Type — Raktaja Type — Incurable type of External Abscess.— Internal Abscesses — Their localities. — Differentiating diagnosis of Gulma and Vidradhi. — Incurable Type . ... ... ... ... ... 61—66.
CHAPTER X. Erysipelas, Sinus and Diseases affecting the mammary glands
of women : — Definition of Erysipelas — Vataja, Pittaja and Kaphaja Types —.Sannipatika Type— Kshataja Type.— Prognosis.— Nadi-Vrana (Sinus). — Classification — Vataja, Kaphaja and Pittaja Types — Dvandvaja and Tri-doshaja Types— S'alyaja Type.— Stanaroga.— Breast-milk— Its character — Its normal and abnormal traits. — StanaA'idradhi (Inflammation of mammary glands). ... ... ... ... 67 — 71.
CHAPTER XI.
G-lands, Scrofula, Tumours and Goitre :— Dosha-origened Glands
— Sirija gland (aneurysm or Varicose Veins). — Apachi (Scrofula, etc-) — Its symptoms. — Tumour — Its symptoms — Blood-origined Tumour. — Mdmsa- Ar\uda. — Prognosis. — Adhyarvuda. — Dvirarvuda. — Cause of its not being suppurated.— D.-finition of Goitre— Its specific Symptoms — Vataja Goitre — Kaphaja Goitre — Medoja Goitre. — Prognosis.— General shape of Goitre.— ... ... ... ... ... 73—78.
CHAPTER Xn. Hydrocele, Hernia, Scrotal Tumours, Upadams'a (disease of the
genital organ) and Elephantiasis:— Classification of Vriddhi — Definition and Premonitory Symptoms of Vriddhi. — Symptoms of Dosha-origined Vriddhi.— Medoja Vriddhi — Raktaja Vriddhi— Hydrocele. — Inguinal
IV
Hernia.— Upadams'a — Symptoms of different Dosha-origined types of Upadams'a. — Raktaja Upadams'a. — Definition of Elephantiasis. — Causes and Symptoms of different l<:inds of Elephantiasis. — Prognosis of Elephan- tiasis.— Localisation of Elephantiasis. ... ... ... 79 — 84.
CHAPTER XIII. Diseases known by the general name of Kshudra-Roga (minor
ailments): — The Names and Symptoms of the diseases included therein. — Ajagallika — Yava-prakhya — Andhalaji — Vivrita — Kachchhapika — Valmika — Indra-vriddha — Panasikd — Pashana-Gardabha — Jala-Gavddabha — Kak- shl — Vishphota — Agni-Rohini — Chippa — Kunakha— Anus'ayi — Vidarika — S'arkararbuda — Pama — Vicharchikd — Rakasa — Pdda-darika — Kadara — Alasa — Indra-lupta (Alopecia) — Darunaka — Arumshika — Palita — Masurika etc. — Tila-kalaka — Nyachchha — Charma-kila — Vyanga — Parivartika — Ava- patika — Niruddha-Prakas'a— Niruddha-guda — Ahi-putana — Vrishana- kachchhu— Guda-Bhrams'a. ... ... ... 85 — 93.
CHAPTER XIV.
Suka-dosha: — Its classification. — Symptoms of different Types. — Progonsis. ... ... ... ... ... 94 — 96.
CHAPTER XV.
Fracture and Dislocation, etc :— Th.ir Causes.— General features of Sandhi-mukta (Dislocation). — Diagnostic Symptons of Dislocation. — Different kinds of Kanda-bhagna (Fracture) — General symptoms of Kanda- bhagna. — Curable and incurable Types. ... ... ... 97 — loo-
CHAPTER XVI.
Mukha-Roga (Diseases which affect the cavity of the mouth in general): — General Classification and Localisation. — Di.st.ases of the lips. — Dosha-origined Types. — Raktaja Type — Mangsaja Type — Medoja Type — Diseases of the roots of the teeth.— Their Names and specific Symp- toms.—Danta-Nsidi (Sinus at the root of a tooth).— Diseases of the tooth proper. — Their Names and specific Symptoms. — Diseases of the tongue — Their Names and specific Symptoms. — Diseases of the Palate— Their Names and specific Symptoms.— Diseases of the Throat and Larnyx
— Their Names and specific Symptoms. — The different Kinds and Symp- toms of Rohini.— Diseases in the entire cavity. ... ... loi — in.
End of the contents of Sutra-sthana-
SAPxlRA STHANA.
(Section on Anatomy).
CHAl TER I.
The Science of Being in General :— The Twenty-four Tattwas or first Principles. — The Puru.sha or the Primordial Being or the Self-conscious Reality. — The Prakriti or the External Nature personified or the non- conscious Eternity— Traits of Commonalty and Diversity. — Comparison of the Philosophy of A'yurveda with that of Samkhya as well as with the other branches of Philosophy. — Prakriti and Purusha how understood in the A'yurveda — Different kinds of Ma}ias (mind). — The five Primary Elements of Creation — Their specific function — Their mutual co-operation in creation. ... ... ... ... ... in. — I2i.
CHAPTER II. Purification of Semen and Cataminal fluid etc. :~Derange-
ment of Semen.— Specific treatment. — Derangement of Cataminal fluid. — Specific treatment. — Traits of pure and healthy Semen and Cataminal fluid. — Menorrhagia. — Amenorrhcea. — Their treatment. — Regimen to be ob- served during Menses. — Conduct of husband during the period. — Prohibited period. —Conception — Subsequent Conduct. — Causes of different Colours in the child. — About twins — Causes of the child being of Defective Organ —Fecundation without sexual intercourse — Causes of Deformity in the child — State of the Foetus — Its activity while in the womb. ... 122—133,
CHAPTER III.
Pregnancy, etc. : — Combination of Self with the Impregnated Matter. — Factors which determine Sex. — Period and Signs of Menstruation. — Signs of Pregnancy.— Prohibited conducts during Gestation. — Develop-
VI
mcnt of the FoeUis. — Longings and its effects during pregnancy.— Develop- ment of the Foetus from {\v2 Sixth to the Eighth month.— Time of Delivery. — Different opinions on the formation of the Foetal body. — The solution^ Factors respectively supplied by the Paternal and Maternal Elements, etc. — External Signs of Male, Female and Twin conception. ... 134—143.
CHAPTER IV. The development of Factors in the womb as well as the
Factors which contribute to the growths of its different bo;lily organs and principles :— Different folds of skin over the foetus. — The definition of Kalas and their varieiies. — Seat of the semen. — Why and how semen is discharged. — Placenta. — Formation of different limbs and organs of the Foetal body. — Sleep and its effect. — Heart and its action. — Effects of day- sleep. — Somnolence. — Effect of -Sleep on an Enciente woman. — Gnawing. —The temperaments. — Symptoms of Vataja, Pittaja and Kafaja tempera- ments - Symptoms of Dvandvaja and Sannnipalika temperaments.— Sattvika, Rajasika and Tiimasika features. ... ... ... 1 44 — 158.
CHAPTER V. The Anatomy of the Human body :— Definition of foetus.—
Enumeration of the dfferent Limbs and Membeis of body. — Their Numbers — The Cavities or Viscera. — Channels. — Kandara. — ^Jala or Plexuses. — Kurcha or Cluster. — Sevani or Sutures. — Asthi-Sanghata. — Simanta. — Bones of the four Extremeties. — Bones of the Trunk. — Bones above the Cavicles — Different kinds of Bones and their situation — Sandhi or Joints. — Joints of the four Extremities. — Sandhis of the Koshtha and Clavicles. — Their forms, distinctions and locations. — The Snayu or Ligaments. — Their Number and Situations. — Muscles. — Muscles in the extremities in the Koshtha — Of the Head and Neck. — Extra Muscles in Women. — The Vaginal Canal — The Uterus — The Womb. — Superiority of Surgery — Preparations of dead body — Mode of dissection. ... .., 15c — 172.
CHAPTER VI.
The Marmas or Vital parts of the body:— Classifications of
Marmas — Their different Numbers. — Their Locations. — Their Names and Distributions. — The different Heads of Marmas. — Qualitative Classes. — Different opinions on Marmas. — Marmas of the Extremities. — Marmas of the Thorax, etc. — Marmas in the Back. — Marmas in the Clavicular region. — Their specific Symptoms wh;n injured. ... ... 173 — 190.
VI 1
CHAPTER VII.
The Description and Classification of Sira or the Vascular System: — Their Numbers and action. — Names and Classification of the principal Siras. — Their specific Locations. — The Pitta, Kapha, Vayu and Rakta-carrying Siras. — •Specific Colours of Sir^s. — The specific Siras not to be punctured. — Siras of the four Extremeties, Trunk and the region above the Clavicles and their roots. ... ... ... 191 — 197.
CHAPTER VIII.
The method of Venesection : — Persons unfit for Venesection :— Preliminary Rules. — The Jantra-Vidhi or how the patient should be placed in cases of Venesection. — Venesection in the E.vtremeties. — Venesection on the different parts of the body. — Proper and Defective Venesection — Classi- fication and definition of Defective Venesection. ... ... 198 — 208.
CHAPTER IX. The Description of the Arteries, Nerves and Ducts -.—Region
and Number of Dhamanis. — Functions of the up-coursing Dhamanis. — Functions of the down-coursing Dhamanis. - Functions of the lateral cours- ing Dhamanis.— The Situation of the Srotas and the specific Symptoms when pierceil at the roots. ... ... ... 209 — 215.
CHAPTER X. Nursing and Management, etc of Pregnant Women from the
day of conception till parturition :^ General rules.— Especial Regimen during the period of Gestation.— Sign of imminent Parturition— Effects of premature Urging — Preliminary Measures. —Post-parturient Measures.— Natal Rites. —Diet for Children.— Treatment of the Mother— Makkalla pain and its treatment. — Management of the Child. — Lactation. — Selection of Wet-nurses. — Examination, etc. of Breast-milk. — Treatment of Wet-nurses. — Infantile Diseases and their Diagonosis — Treatment of Infants.— I ifant- ile Elixirs. — Nursing of child. — Symptoms when malignant stars, etc. strike the child.— Eductation and Marriage. — Defective Pregnancy— Its Symptoms and Medical treatment. — Miscarriage — Its treatment. — Manage-, ment of Pregnancy and special Recipe for Pregnant Women according to c months of Gestation. ... ... •■■ .. 216 — 238.
End of the contents of ^arira Sthana.
VIII
CniKlTSITA STUANA.
(Section on Therapeutics).
CHAPTER I.
The two kinds of inflamed Ulcers:— The Causes, Symptoms and Classification of Ulcers. — Mioiwlliic antl Traumatic ulcers. — General and specific Symptoms. —Symptoms of different Dosha-origined ulcers. — Symp- toms of Blool-origined ulcers. — Symptoms of Suddh% Vrana. — Therapeu- tics.— The sixty different Factors of medical trcatmcnl of ulcers. — Upadrava or the Supervening Symptoms of ulcers. ... ... 269—264.
CHAPTER II. The medicil tr3itm3nt of Traumitic Wounds or Sores :—
Dirfjronl Shapjs an 1 Clasiificati mis of Sores. — Their dcfinilions — Their specific Symptoms — Their treatment. — Treatment of Cuts or Incised Wounds. — Treatment of Excised Wounds. — Treatment of Viscera when perforated. — Subsequent treatment. — Treatment of Diabetic Ulcers. — Treatment of Ulcers due to Kushtha or malignant Ulcers. ... 265 — 278.
CHAPTER III. The medical treatment of Fractures and Dislocations :—
Symptoms of incurable fractures. — Bandage, — Diet. — Defective Bandaging — Washing. — Prrgnosis. — Treatment of fractures in particular lir.ibs. — Gandha-Taila. — Suppuration of fractured Bones — Symptoms of Complete union of fractured Joints. ... ... ... 279 — 288.
CHAPTER IV. The medical treatment of Vata-VysCdhi or Nervous disorders :
— Nervous affection of the A'mas'aya — Nervous afifections of the Pakvas'aya — S'alvana-upanaha. — General Measures beneficial to Vata-Vyadhi. — The Tilvaka-Ghrita. — The Anu-Taila. — The S'ata-paka and Sahasra-paka Taila, — The Patra-lavana. — The Kanda or Sneha-lavana. — The Kalyanaka- lavana. ••. ... ... ... ... 289 — 296.
IX
CHAPTER V.
The medical treatment of Maha-Vata-Vyadlii :— Causes of Vata-Rakta. — Its definition — Premonitory symptoms — Specific features of Vata-Rakta — Prognosis. — Preliminary remedial measures. — Plasters etc — Treatment of Vata-Rakta with a preponderance of different Doshas. — The five Pradehas — Guda-Haritaki and Pippali-Vardhamana Yogas. — Diet. — Regimen of conduct. — The Medical Treatment of Apatanaka. — Traivrita Ghrita. — Treatment of Pakshaghata. — Treatment of Manya-stambha. — Treatment of Apatantraka. — Treatment of Ardita. — Kshira-Taila. — Tympanites etc. — Hingvadi-vati. — Symptoms and Treatment of Uru- stambha. — Therapeutic properties of Guggulu. ... ... 297 — 315,
CHAPTER VI. The medical treatment of Ars'as (Haemorrhoids) :— General
remedial measures. — Application of Kshara (.\lkali). — Symptoms of satisfactory, excessive and defective Cauterisation. — Diet — Rectal Speculum. — Plasters. — Treatment of Internal piles. — Dantyarishta. — Abhayarishta. — Bhallataka-yoga. — Other forms of Bhallataka-yoga. — Regimen of diet and conduct. ... ... ... ... ... 316-328,
CHAPTER VII. The medical treatment of As'mari (Urinary Calculus, etc) ;—
Different modes of treatment in As'mari. — Treatment of Vataja, Pittaja and Kaphaja As'mari. — Alkaline treatments. — Modes of Surgical operations. — Prognosis. — Lithotomic operations. — Post-surgical measures. — Surgical treatment in Seminal Concretions. — Diet. — Parts to be guarded in Litho- tomic operations. ... ... ... ... 329-337.
CHAPTER VHl. The medical treatment of Bhagandara (Fistula-in-ano, etc) :—
Classification. — General treatment. —Specific measures. — Different Forms and Names of incision.— Treatment of Ushtra-griva. — Treatment of Parisravi. — Bhagandara in infants — Treatment. — Treatment of traumatic type.— Treatment of Tri-doshaja type.— Syandana Taila. — Description of instrument. — Regimen of diet. ... ... ... 338-345.
X
CHAPTER IX. The medical treatment of Kushtha (Cutaneous Affections in
general); — Pathology. — Conduct of diet and regimen. — Regulation of diet and conduct. — Preliminary treatment. — Treatment of Doshaja types. — Maha-tikta Ghrita. — Tikta-Sarpih. — Medicinal plasters. — Alkaline treat- ment.— Treatment of S'vitra. — Nila-Ghrita. — Maha-nila Ghrita. — Treatment by Bleeding, Emetics and Purgatives. — Vajraka Taila. — Mahd-Vajraka Taila. — Treatment liy Khadira. — Diet. ... ... ... 346-361.
CHAPTER X. The medical treatment of Maha-Kushtha (Major Cutaneous
Affections). — Mantha-Kalpas. — Diet. — Medicated Arishtas, Asavas, Suras (Wine) and Powders. — Medicinal Ayas-kriti. — Aushadha Ayas-krili. — Mahaushadha Ayas-kriti. -^Khadira preparations. ...Khadira-Sara pre- parations. ... ... ... .... ... 362-371.
CHAPTER XI. The medical treatment of Prameha (Diseases of the Urinary
tracts): — Two-fold Classifications, Causes and .Symptoms. — Forbidden articles of food and drink. — Articles of diet. — Preliminary treatment. — The five medicinal remedies. — Specific treatment of Kaphaja Meha — .Specific treatment of Pittaja Meha. — Specific treatment of Vataja Meha. —Palli- ative measures — Medicinal Arishtas, Asavas, Yavagus, etc. — Mode of treat- ing a poor Prameha-patient. .. . ... ... ... 372-378.
CHAPTER XII. The medical treatment of Prameha-Pidaka (the Abscesses or
Eruptions which mark the sequel of a case of Prameha) : — Curable cases of Prameha-Pidaka. — Treatment. — Dhanvantara-Ghrita. — Fomentations for- bidden in cases of Madhu-meha. — S'ala-saradi Avaleha. —Navayasa Churna. — Loharishta. — Traits of cure. ... ... ... 379-385.
CHAPTER XIII.
The medical treatment of Madhu-meha :— S'ila-jatu— Its origin, properties and use.— The Mdkshika-Kalpa. — The Tuvaraka-Kalpa. 286-391.
XI
CHAPTER XIV.
The medical treatment of Udara (Dropsy with an abnormal condition of the Abdomen) : — Symptoms of curable and incurable types. — Diet of articles forbidden. — Treatment of Vataja, Pittaja and Kaphaja types. — Treatment of Dushyodara. — Genera] treatment of Udara. — Haritaki Ghrita. — Maha-vriksha Ghrita. — Chavya Ghrita. — Anaha-Vartis. —Treat- ment of Plihodara. — Shat-palaka Ghrita. — Treatment by Venesection. — Treatment of Baddha-Gudodara. — Treatment of Parisravi Udara.— Treat- ment of Udakodara. — Treatment by tapping. — Diet. .., 392-403.
CHAPTER XV.
The medical treatment of Mudha-Garbha (Difikult and mal- presentation of the Foetus and Difficult Labour) : — Varieties of Mudha- Garbha. — Incantations. — Postures of the Fcetus. — Operations involving destruction of the Foetus. — Craniotomy. — After-measures. — Diet and regi- men ofconduct. — The Bala Taila. — The Bala-Kalps. ... 404-411.
CHAPTER XVI. The medical treatment of Vidradhi (Abscesses) and Tumours:—
Classifications. — Tieatment of Vataja, Pittaja and Kaphaja Vidradhi.^ Karanjadya Ghrita. — Treatment of traumatic and blood-origined types. — Treatment of internal Vidradhi. — Treatment of Vidradhi. — Treatment of Majja-jata Vidradhi. ... ... ... ... 412-417.
CHAPTER XVII. The medical treatment of Erysipelas etc., Sinus and Diseases
of the Mammary Glands •.—Classifications of curable and incurable types of Visarpa (Erysipelas)— Treatment of Vataja and Pittaja Visarpa. — Gauryadi Ghrita. — Treatment of Kaphaja Visarpa. — Treatment of Nadi- Vrana (Sinus). — Treatment of Vataja, Pittaja, Kaphaja and S'alyaja Nidi (Sinus). — Alkaline treatment— Treatment by Plug-stick — Bhallatakadya Taila — Treatment of Stana-Roga — Purification of breast-milk — Surgical treatment of Stana-Roga. ... ... ... ... 418-426.
CHAPTER XVIII.
The medical treatment of Granthi (Glandular Swellings), Apachi (Scarvi), Arvuda (Tumour) and Gala-ganda (Goitre) :— General
Xll
Iroatnicnl of GrantM — Trcaliiicnt of Vataja, I'itlaja, Kaiihaja and Mcdoja (Iranlhi. — Medical treatment of ApacM- — Surgical treatment of Apachi. — Arvuda — Treatment of \'al:ija, I'ittaja, Kaphaja and Medoja types of Arvmla (Tumour). — Gala-ganda— Treatment of Vataja, Kaphaja and Medoja types of Gala-ganda (Ooitre). ... ... ... 427-438.
CHAPTER XIX.
Ihe medical treatment of Vriddhi (Hernia, Hydrocele. Scrotal Tumour, etc.), Upadams'a (Disca.sts of the (Jenital Organ) and Slipada (Elephantiasis) :— Treatment of Vataja, Pittaja, Kaktaja, Kaphaja, Medoja and Mutraja Vriddhi. — Treatment of Antra- Vriddhi. — Treat- ment of Upadams'a — (jeneral treatment — Treatment of Vdtaja, I'ittaja, Kai)haja, Tridoshaja and Kaktaja types of Upadams'a. — Treatment of Slipada — General treatment — Treatment of Vataja, Pittaja and Kaphaja types of S'lipada — Alkaline remedies. ... ... ... 439 — 449.
CHAPTER XX
The medical treatment of KshudraRoga (Minor Ailments) :—
Treatment of Aja-gallika and Vava-prakhya. — Treatment of Vivrita, etc. — Treatment of S'arkararvuda, etc. — Treatment of Pada-dari, etc. — Treat- ment of Alasa and Kadara. — Treatment of Baldness and Alopecia, etc. — Treatment of Darunaka, etc. — Treatment of Jatu-mani, etc — Treatment of Yuvana-pidaka — Treatment of the Retroflexion of the Prepuce. — Treatment of the Constriction or Stricture of the Urethra — Its surgical treatment. — Treatment of the Stricture of the Anus, etc. — Treatment of Valmika, Ahi- putana and the Prolapsus of the Anus. ... ... 450-458.
CHAPTER XXI. The medical treatment of the Sores on the Penis produced
by the Suka : — The specific treatment of the different types of S'uka- dosha — General treatment. — Prognosis. ... ... ... 459-461.
CHAPTER XXII.
The medical treatment of the Aifections of the Mouth :—
Treatment of Vataja, Pittaja, Kaphaja and Mfdoja types of Oshtha-
2Cm
kopa — Treatment of the diseases of the Danta-mula. — Treatment of Danta-Veshta etc. — Paridara — S'aushira — U pakus'a — Danta- Vaidarbha — Adhimamsa. — Treatment of Danta-nadi. — Treatment of the diseases cf the different types of Tooth proper. — Treatment of Tongue-diseaseS — Treatment of V'ataja, Pittaja and Kaphaja types of tongue-diseases — Treatment of the ditTerent types of Talu-gata diseases — Treatment of Throat-diseases. — Treatment of Vataja, Pittaja, Kaphaja and Raktaja types of Rohini. — Treatment of the different types of the Sarva-sara Mukha-Roga. — Incurable types of Mukha-Roga. ... ... 462-474.
CHAPTER XXIII. The medical treatment of Sopha (Swellings).— Ckissifications of
general S'opha — Its causes. — The specific symptoms of Dosha-origined typosof S'opha. — Symptom of Vishaja S'opha — Complications — Prognosis. — The .Special treatment of the different types of S'opha. — General remedies. —Diet. ... ... ... ... ... 475-477-
CHAPTER XXIV. The Rules of Hygiene and the Prophilactic Measures :—
Tooth-brushing — Cases where tooth-brushing is forbidden. — Eye arid Mouth- washing. — Colly rium. — S'iro'bhyanga. — Combing. — Anointing. — Parisheka. — Affusion. — Effu.sion. — Anointments. — Prohibitions of Anointments, etc. — Physical E.Kcrcise. — Rubbing and Friction. — Massage. — Bathing. — Prohibi- tion of Bathing. — Anulepana. — A'lepa. — Food. — Pravata and Nivata. — Sleep — General Rules of Conduct. — Rules for Drinking Water, etc. — Curd (Dadhi) — When and llovv to be taken. — Women unfit to visit. — Evil Effects of the foregoing Abuses. « ... ... 4S0-502.
CHAPTER XXV.
The medical treatment of a Variety of Diseases :— Diseases of the Ear-lobes — Classification — Causes and Symptoms — General treatment — Specific treatment. — Treatment of Palita.— Treatment of Vyanga, etc.
503-504-
XIV
CHAPTER XXVI.
The medical treatment for inc>?v: .4ng the Strength and the
Virilg Power of weak persons : — Definition of Vaji-Karana — Means of V.-iji-karana. — Causes and Syniplonis of the six Forms of Sexual incapacity. — Incurable types. — Remedies — Utkdrika — Pupalika. — Cakes etc. 510-514.
CHAPTER XXVII. The Recipes and Modes of using Elixirs and Rejuvenators ••—
The Human Organism — Which will make it invulnerable to the inroads of any Disease and Decay. — Time of using Kasayana. — Rasayana for Mental and Physical maladies. — V'idanga-Rasayana — Vidanga-kalpa — Kas'marya- kalpa. — Bala-kalpa, — Ati-bala, Naga-bala, Vidari and S'atJivari-kalpa. — Varahi-kalpa — Use of S'ana (-seeds). ... ... ... 515-521.
CHAPTER XXVni.
The Elixirs and Remedial Agents which tend to improve the Memory and invigorate the Mental Faculties as well as to increase the Duration of Human Life : — S'vetavalguja- Rasayana — Krishnavalguja- Rasayana — Manduka-parni-Rasayana — Biahmi-Rasayana — Brahmi-Ghrita — Vacha-Rasayana — S'ala-paka-Vacha-Ghrita. — Measures for prolonging life. — Uses of Gold. ... ... ... ... 522-523.
CHAPTER XXIX.
The Restorative and the Constructive Agents which arrest
innate morbific tendencies and decays : — Classifications of Soma. — Mode of using the Soma. — Regimen of Diet and Conduct after taking Soma. — Its Therapeutic efifects. — Distinctive features of the Soma-plants — Their des- criptions—Their Habitats. ... ... ... ... 530-538.
CHAPTPR XXX.
The Tonic Remedies which remove Mental and Physical Distress : — Persons unfit for the use of Rasayna. — Names of the healing drugs. — The Mode of their use. — Regimen of Diet and Conduct — Dosage — Therapeutic effects. — Differentiating traits. — Mode of Culling the above drugs. — Their Habitats. — The common Habitat of all the Oshadhis.
539-545-
XV
CHAPTER XXXI.
The medicinal uses of Sneha, etc, : — Classifications of Sneha — Description of Sneha — The specific uses. — Measures of drugs. — The Kashaya-paka-Kalpa — The Sneha-paka-Kalpa. — Alternative methods. — Application of Sneha according to specific Dosha and Season. — Degrees of Cooking a Sneha — Distinctive traits of the complete cooking of a Sneha. — Process of Internal Use of Sneha — The Specific Uses of Clarified butter — The Dosage. — Evil Effects of over-dosage — Sadyah-Sneha. — Forbidden cases of Sneha-pana. — Good Eff"ects of Sneha-pana. ... ... 546-557.
CHAPTER XXXU. The medical treatment by measures of Sveda (Fomentations,
Diaphoretic measures etc. ): — Classifications of Sveda. — Its Specific Appli- cations.— Effects of Sveda. — Prohibited cases of Sveda. — Symptoms of per- fect and imperfect Sveda. — Measures to be followed after Sveda. 558-564.
CHAPrER xxxni.
The Distresses which prove amenable to the use of Purga- tives and Emetics :— Importance of Purgatives and Emetics. — Mode of application of Emetics. — Symptoms of excessive, satisfactory and deficient Emetics. — Effects of satisfactory Emetics. — Cases where Emesis is forbid- den.— Cases where Emesis is recommended. — Mode of administering Purgatives. — Classifications of Koshtha. —Diet. — Benefits of proper Purga- tion.— Persons who should not be purged. — Persons who should be purged. — Necessity of applying Sneha before I the administration of Purgative or Emetic. ... ... ... ... ... 565-5S9-
CHAPTER XXXIV.
The treatment of the Disorders resulting from an Injudici- ous Use of Emetics or Purgatives ;— Their Classes.— Causes and treat- ment.— Evils of an Unpurged Residue of a Purgative or Emetic. — Evils of a Digested Purgative, etc. — Evils of insufficient or excessive expulsion of the Doshas. — Flatulent Colic. — Partial and Deficient Medication (Ayoga). — Over-drugging with purgatives, etc. (Ati-yoga). — Haemorrhage due to excessive Vomiting or excessive Purging (Jivadana). — ^Jiva-s'onita, how to be known. — Flatulent distention of the Abdomen (Adhmana). — Cutting
XVI
pain in the Anus, etc. — Dysenteric stools (Parisniva). — Diarrhoea (Pravahii-:a). — Overwhi.-lming the heart. — Retention (Vibandha) of flatus, stool and urine. ... ... ... ... 577 — 589.
CHAPTER XXXV.
The Dimensions and Classifications of a Netra and a Vasti with, their therapentic applications -.—The importance of Vasti- Karma. — The application of Vasti in different diseases. — Dimensions of the Pipe. — Materials of the Pipe. — Construction of the Vasti. — Classifications of the Vasti. — Nomenclature of the Vasti. — Application of Niruha-Vasti and Asthapana-Vasti. — Their therapeutic Effects — The different Defects of a Vasti. ... ... ... ... ... 590 — 598
CHAPTER XXXVI.
The medical treatment of the mishaps which are consequent on the Injudicious Application of the Pipe and the Vasti :—
Remedies for the injudicious application of the Pipe. — 'Disorders resulting from a defective Vasti (bladder) and its contents. — Disorders resulting from the defective Position of the Patient. — Remedies for the Complications of the defective position of Niruha-Vasti and Sneha- Vasti. — Intervals for the application of Purgative, Emetic, Asthapana-Vasti and Anuvasana- Vasli. ... ... ... ... ... 599 — 607.
CHAPPER XXXVII. The treatment with Anuvasana-Vasti and Uttara-Vasti:— The
Process of Annvdsana-Vasti — The process of preparing several medicated Oils and Snehas. — Proper time for the application of Sneha-Vasti. — The mode of applying a Sneha-Vasti. — Symptoms of insufficient, excessive, and satisfactory application of Anuvasana-Vasti. — Diet after the application of a Vasti. — The Successive Actions of a Vasti. — Distresses from Injudicious Application of Sneha-Vasti. — Specific Symptoms — Their remedies. — Uttara- Vastis — Dimensions of the Pipe of the Vasti for a Male and for a Female patient. — Mode of application. — Vaginal Uttara-Vasti. — Diseases amenable to Uttara-Vasti. ... ... ... ... 608 — 626,
XVll
CHAPTER XXXVIII. The mode of applsring, as well as the treatment with a
Nirudha-Vasti : — The mode of Preparing a Vasti. — The mode of Apply- ing a Vasti. — Symptoms of a satisfactory application of a Vasti. — Subsequent treatment and Diet — Drugs to b2 uS2d in a Niruha-Vasti. — The Formula of a Niruha-Vasti. — The process of preparation. — The Dvadasa-Prasriii. — Classifications of Vastis according to the range of their therapeutic appli- cations.— Corrective Vastis. — Lekhana-Vasti. — Vaji-Karana-Vasti. — Vrim- hana-Vasti. — Pichchhila-Vasti. — Grahi-Vasti. — Sneha-Vasti. — Utkles'ana- Vasti. — Dosha-hara-Vasti. — Soothing Vasti. — Yukta-ratha-Vasti.— Siddha- Vasti. — Mustadika- Vasti. — Variations in the composition of Vastis in cases of persons of different Temperaments. — Nomenclature of different Vastis and .their Specific Uses. ... ... ... 637 — 646.
CHAPTER XXXIX.
The treatment of distressing Symptoms which are manifest- ed in a patient : — The quantity of diet to be taken after the exhibition of a Niruha-Vasti. — Internal application of Sneha after Blood-letting. — Preparations of different diets. — Diet to be taken according to the Dosha and to the Strength of the patient. — Regimen of conduct. — Articles of diet.
647—652.
CHAPTER XL. The treatment which consists in employing the Dhuma
(Fumes), Nasya (Snufis) and Kavala (Gargles) ;— Classifications of Dhuma — Materials of different Dhuma-Varti. — Formation of the Pipe used in Dhuma-Pana — Mode of inhalation of different Dhumas— Prohibitive cases — Time of Dhuma-pana (Smoking) — The therapeutic effects of Dhuma- Pana— Mode of Smoking.— Snuffs and Errhines (Nasya)— The Nomen- clature of the term "Nasya" — Classifications of Nasya — S'iro-Virechana — Its application — Dosage of Sneha-Nasya — Effects of proper, excessive and defi- cient application of a Sneha-Nasya — Avapida-Nasya — Forbidden cases. — Prati-marsha Nasya when to be used— Its effects. — Specific use of Sneha- Nasya. — Kavala-graha (Gargles) — Classification — Mode of application — Their us js— Kavala and Gandusha distinguished — How long Kavala should be retained — Symptoms of satisfactory, deficient and excessive Gargling. — Prati-sarana — Its classification and effects. ... 653 — 671.
End of the Contents of the Chikitsita Sthana.
KALrASTUANA.
(Section on Toxicology).
CHAPTER I.
The mode of Preserving Food and Drink from the effects of
Poison : — The ncccbsary quahficaiions of a SupcrintLndent of the Royal KiUlicn — The necessary features of a Royal Kitchen. — Characteristic features of a Poisoner. — Indications of poisoned food and drink, etc. — General treatment. — The mode of preparing Soup, etc. ... ... 673 — 684.
CHAPTER II.
The Indications (Effects, Nature and Operations) of Sthavara Poisons : — Sthavara I'oison — Its source. — Names of the different V^egetable and Mineral poisons. — Effects of poison on the Human organism. — Effects of Bulb-poisons — Specific properties and actions of Bulb-poisons — Definition of Dushi-visha — Symptoms of weak and slow poisoning — Derivative meaning of Dushi-visha — Symptoms of the different stages of Sthavara Poisoning — The medical treatment. — Koshatakyadi-Vavagu — Ajeya-Ghrita — Vishari Agada. — Treatment of the supervening Symptoms of Poisoning. — Prognosis. ... ... ••• ••• ••• 685 — 694.
CHAPTER III. The Subject of (the nature, virtue, etc. of) Animal Poisons : —
Different locations— Characteristic features and purifications o) poisoned Water. — Poisons in the Atmosphere and its purification. — Mythological origin of Poison. — Properties of Poison — Nature and Location of Snake- poison — General treatment of poisoning — Symptoms of taking poison internally. — Fatal bites. — Prognosis. ... ... ... 695 — 702.
CHAPTER IV.
The Specific Features of the Poison of a Snake-bite ;— Clasifica- tions of Snakes — Classifications of Snake-bites — Their specific Symptoms — Characteristic features of the different species of Snakes. — Features of the different Castes amongst Snakes. — Particular Habits of the different kinds of Snakes. — Names of the different species of Darvi-kara Snakes — Names of
XIX
ihe different species of Mandali Snakes — Names of the different species of Rajiman Snakes — Names of the different species of Nirvisha Snakes — Names and Origin of the different species of Vaikaranja Snakes — Sub-families of the Vaikaranja Snakes. — Characteristic features of Male and Female Snakes — Features of iheir bites — General and specific symptoms of a bite by a Darvi- kara Snake —Specific symptoms of a bite by a Mandali Snake — Specific symptoms of a bite by a Rajiman Snake — Specific symptoms of bites by Snakes of different Sexes and Ages, etc. — Symptoms of the different stages of poisoning from the bites of a Daivi-kara Snake — Different stages of poisoning from the bite of a Mandali Snake — Different stages of poisoning from the bites of a Rajiman Snake. — -The Vegdnlara (or the intervening) Stages. — Different Stages of poisoning in cases of Lower Animals. — Different stages of poisoning in cases of Birds, ... ... 703 — 714.
CHAPTER V.
The medical treatment of Snake bites :— General treatment of Snake-bites. — Mantras (Incantations) — Blood-letting in Snake-bites — Specific treatement of the bitJ by a Hooded (Darvi-kara) Snake, a Mandail Snake and a Rajiman Snake. — Contra-indication to blood-letting in cases of Snake-bites. — Dosage of CoUyrium, etc., to be resorted to in cases of different Beasts and Birds. — General dosage of medicines in cases of Snake- bites— Specific treatment of poisoning according to the Physical Symp'oms — Specific treatment of the different Supervening Symptoms. — Remedy for the aggravated Doshas due to Poison — Medical treatment of persons made unconscious from the effects of a Fall or Suspended Animation. — Symptoms of wounds from Poisoned Darts, etc. — Treatment of a Poisoned Wound — Recipe of different Agadas — Mahagada — Ajitagada — Tarkshya'gada — Risha- bhdgada — Sanjivana Agada — Darvi-kara Rajila-visha-hara-Agada — Man- dali-visha hara Agada— Vams'a-tvagadi Agada— Pancha-s'irisha Agada — Sarva-Kamika Agada — Ekasara Agada. ... ... 71c 727.
CHAPTER VI.
Cases of Rat-poisoning : — Different Varieties of I\.ats— General Symptoms of Kat-poisoning— Specific symptoms and treatment of Rat- poisoning — General treatment. — Causes of Rabies— Symptoms of Hydro- phobia— Prognosis.— Symptoms of Jala-trasa— Its treatment — Treatment of bites by rabid-dogs — Treatment of teeth and nail-scratching. 728 — 736.
XX
CHAPTER VII.
Treatment with ths Sounds of a (medicated) Drum, etc, possessed of Anti-venomous Virtues : — Kshaiagada— Its Uses and Thirapjiilic ElTecls — Kaly.inaka-Gliri'a— Ainrita-Ghrita — Mahd-sugandhi AgacU — ^Rules of Diet and Conduct. — Symptoms of Elimination of Poison.
737—741.
CHAPTER VIII. On insects, ie-, the measures, etc. to be adopted in cases of
Insect-bites, etc^ ■ — The Germination and Classification of Insects — Insects of Vataja, I'iltaja, Kaphaja and .Sannipatika temperaments.— Symptoms of their Bites — The Kanabha class of Insects — The Gaudheyaka class of Insects — S'ala-padi — Manduka (Frogs) — Pipilika (Ants) — Makshiki (Stinging Flies) — Mas'akas (Mosquitoes). — Incurable classes — Treatment of a bite by strong and acute-poisoned Insects — Recipes of Remedies in different cases. — Origin and Classification of Scorpions — Specific trails and characteristics of Mild-poisoned Scorpions, Madhya-visha Scorpions and Tikshna-visha Scorpions — Treatment of Scorpion-bites.— Spider-bites. — Development of Luta-poison — Its Potency — Location. — Characteristics of ^ Poison according to its seat in the body of a Spider — Mythological Account of the Origin of Luta- — The different names of Spiders and the general Symptoms of their Bodies — Specific Symptoms of Spider-bites and their Treatment — General Remedies — Specific symptoms of the Incurable cases of Spider-bites — Their treatment. — Surgical Treatment — Treatment of Ulcers incidental to the Bites by Insects or Snakes. ... ... 742 — 762.
End of the Contents of the Kalpa Sthana-
THE
SUSHRUTA SAMHITA
NIDANA STHANAM.
rMAPTER I.
Now wc shall discourse on the Vatavyadhi-
(discascs of the nervous system) Nidaaam*.
IVIctrical text: — HavinL; clasped the feet of the holy Dhanvantari, who had arisen out of the primordial ocean with the pitcher of ambrosia on his head, and who was the foremost of all knowers of truth, Sus'hruta interrogated him as follows : — "Tell me.O thou, the foremost of discoursers, all about the different locations and functions of the bodily Vayu (nerve force), both in its normal and agitated conditions, (as well as when it changes its natural seat through a concourse of disturbing or aggravating causes). Instruct mc on the nature of distempers, which result from its deranged condition." 2.
The holy Dhanvantari, the greatest of all healers, having listened to the foregoing words of Sus'hruta, replied as follows: — This vital Vayu (nerve force), which courses through the body, is self-begotten in its origin, and
* The term Nidanam, usually translated as Pathology, is meant to include factors, which fall within the respective provinces of Pathology, .Etiology, Symptomology and Pathognomy as well. For the meaning and functions of Vayu see Introduction vol. I. pp. xli. — xlii.
2 tliK SUSIIKUTA SAMUITA, t<^''ai'- 1-
is regarded as identical with the divine energy of eternal life (God), inasmuch as it is unconditional and absolute in its actions and effects, eternal and self-origined, and is subtile and all-pervading (like the sky and the atoms). It is the primary factor, which determines the principle of cause and effect in all forms of created things, whether mobile or immobile. It is so called (Vciyu) from the fact of its coursing (skr. Va — to move) throughout the universe. It determines the growth, origin and disintegration of all animated organisms, and as such, it receives the homage of all created brings. Although invisible in itself, yet its works are patent or manifest. It is cold, light, mobile, dry and piercing, and follows a transverse course. It is characterised by the two attributes (propcr-sensiblcs or Gunas) of sound and touch. It abounds in the fundamental quality of Rajas (principle of cohesion and action), is of inconceivable prowess, propels all the deranged or obstructing prinicples (Doshas) in the organism, (or in other words, is primarily concerned with the deranged principles of the body which are pathogenic in their actions). It is instantaneous in its action, and radiates or courses through the organ- ism in constant currents. It has its primary field of action in the intestinal tract (Pakvadhana) and the rectum (Guda). In its deranged state, it is the principal factor, which, (in combination w^ith the deranged Pittam and Kapham\ lies at the root of all diseases, and is accordingly termed the king of diseases (Rogarat). 3.
The action of Vayu in its normal
State:— Now, hear me describe the symptoms, which mark the Vayu, as it courses through the organism. The Vayu, in its normal or undisturbed condition, main- tains a state of equilibrium between the different Doshas and the root principles of the body (Dhatu) ; it further
Chap. I.] NIDAXA STIIAX.nr. 3
tends to maintain uniform state in the metabolism of the body, (protoplasmic, Agni*) and helps the organs of sense-perception in discharging their specific functions. The bodily Vayu, like the Pittam in the organism, is grouped under five different subheads according to the difference in its functions and locations, and is classified as the Prana, Udana. Samana, V}-ana and Apana.-j* These five classes of Va\-u, located in their specific regions, contribute towards the integration and main- tenance of the bod}'. 4 — 6
The Prana Vayu : — The Va}-u. that courses in (governs)the cavity of the mouth. ^ is called the Prana. its function being to force down the food into the cavity of the stomach, and to assist the different vitalising principles of the bod}- (such as the internal heat or fire etc ) in dis- charging their functions in life, and to contribute to the general sustenance of the body. A deranged condition of this particular kind of Vayu (Prana) is usually followed by hic-cough,d}'spncca and other kindred distempers. 7.
The Udana Vayu : —The most important of the vital Va}'us, which courses (sends its vibrations) upward, is called the Udana. It produces speech, song, etc. In its deranged state it brings on diseases which are speci- fically confined to regions lying above the clavicles. 8,
The Samana Vayu :— The Samana Vayu courses in (governs) the stomach (Amashaya) and in the
* See Inlroduction Vol. I. p.p. XLVIII — XLIX Mahamahopadhyaya Dvatka Natha Kaviratna interprets this Agni as digestive heat {Jalhardoni).
t The Prana Vayu is identical with the energy of the nerve centre in the medulla ; the Udana vilh that of the one which is situated in the speech centre. The Samana is same as the energy of the epigastric plexus, the Udar.a is same as the energy of the Motor-Sensory Nerves, and the Apana is iden'.ical with the force of the Hypogastric ple.xus.
% The field of its ac'ion includes the regions of the heart, throat, head and the nose.
^ TIIK SUSIFRUTA SAMIIITA. tChap. I.
rc:jion of intestines (Pakvashaya). Its functions consist in cli<'cstin<^- the chyme brought down into the intestines in unison with the digestive ferment (Agni), and especially in disintcorating its essence from its refuse or excreted matter. A deranged or aggravated condition of the Samana Vayu causes dyscntcr\-, Gulma, and impaired digestion, etc. 9.
The Vyana Vayu : —The Va\-u known as the Vyana courses (.acts) through the whole organism, and its functions consist in sending the lymph chyle etc. all through the body and in helping the out-flow of blood (Asrik^ and perspiration. Five kinds of muscular move- ments* are ascribed to the action of the Vyana VAyu, a deranged condition of which is generally attended with diseases which arc not confined to any particular region, member, or organ of the bod>-, but are found to affect the whole organism (such as, fever, etc). 10.
The A pan a Vayu : — The Vayu known as the Apana ads in the lower region of the intestines (Pakvadhana). Its functions consist in bearing down the Retus and the fitces and in evacuating the urine, semen and catamenial blood. An enraged condition of this Vayu tends to bring on .serious diseases, which are peculiar to the urinary bladder and the distal portion of the large intestine (Guda). An aggravated condition of both the Vyana and Apana Vaj-us may produce Prameha and disorders of the seminal fluid, while a simultaneous excitement of the five vital Vayus leads to a sure and speedy termination of life. 11-12.
Now we shall describe the nature of diseases, brought
about by the localization of the variously aggravated
Vayus in the different parts of the body.— In the cavity
* Such as expansion, flexion, lowering do v.'n and lifiing up or lateral
thrusting of any part of the body.
Chap. I.] NIDANA STIIANAM. 5
of the stomach (Amt'ishaya) the deranged or aggra- vated Vayu gives rise to vomiting, vertigo, epileptic fits, thirst and pain at the sides (ParsVa Sula) and about the region of the heart (Hridgraha). In the intestines (Pakvashaya) the enraged or disturbed Vayu gives rise to a rumbling in the intestines, a piercing pain about the region of the umbilicus, scant}' and painful urination and stool, or their entire suppression (Anaha), and pain about the region of the coccyx (Trika). 13 — 15. Similar- ly, incarcerated in the sense-organs, such as the ears, etc. it tends to deprive them of their respective faculties. In the skin (lymph ch>le) it produces a discolouring of the complexion, parchedness and twitching in the skin, and causes a complete local anaesthesia, giving rise to a tingling, piercing pain in the skin, which spontane- ously bursts, or becomes marked with cracks and fissures. Similarh', the aggravated Vayu interfering witli the principle of b'ood gives rise to ulcers. In the flesh, it produces painful nodes and tumours (Granthi), while in the principle of fal it brings on almost painless tumours (Granthi) unattended with an\' kind of ulcer. Incar- cerated in the veins Sec. (Sira) it produces a stiffening or painful contraction, or a varicose or neuralgic condition ; in a ligament (Snayu).it produces numbness (anaisthesia), pals\-, aching pain and convulsive jerks ; in a long joint, it tends to deprive it of its contractibility and produces a painful inflammatory swelling (about the affected part). In the bones it produces a wasting (atroph)') of the bones which crack and begin to spontaneously burst, attended with the characteristic bone-ache. Again in that important principle of life, the marrow, it tends to dr}' it up and produces a sort of pain, extending all over the body which knows no respite or abatement. Similarly, in the principle of semen it tends to produce a scanty,
6 Till'. SUSIIIiUTA SAMIIITA. [Chap. I.
defective, or excessive emission of that vital fluid, or a complete stoppage thereof, 16—23.
The Vayii, thus disturbed and agitated, affects in succession the lower and the upper extremities of the bod\', and the head, or extends all over the body and deranges all its root-principles (Uhatu). The symptoms, which mark such conditions of the bods', are numbness (paral)-sis), convulsive ccmtortions of thclimbs (Akshepa), ana^'sthcsia, and various kinds of pain (Sula), and swelling (S'opha) of the bod\-. The deranged Vayu, having enter- ed the natural seats of the Pittam or Kapham, develops symptoms, which are peculiar to either of them, and gives rise to numerous diseases. 24 — 25.
The symptoms, which characterise the union of the deranged Vayu with the Pittam (in its particular seat) are a burning sensation, heat, thirst, and loss of conscious- ness, in addition to the symptoms of the Vataja disease so generated in that particular part of the body, while a similar unison with the Kapham develops coldness, swelling and heaviness (of the affected part). The disturbed or agitated Vayu in unison with the principle of blood gives rise to a sort of pricking pain (pins and needles in the affected locality), which can not bear the least touch, or is marked by complete anaesthesia, and symptoms, peculiar to the deranged Pittam, follow in its train. 26 — 28.
Vomiting, and a burning sensation, etc. in the body, mark the instance when the Prana Vayu is surcharged (Avrita) with the Pittam ; while weakness, lassitude, somnolence and a general discolouring of the com- plexion ( D. R., — loss of taste) characterise a case when it is surcharged with the deranged Kapham A burning sensation in the body, loss of consciousness or epileptic fits, and a .sense of giddiness (vertigo) and
Chap. I.] ^■ID.\NA STIlAXAM. 7
physical languor are the indications, which distinguish a case of the Udana Vayu being surcharged with the Pittam ; while a stoppage or absence of perspiration, appearance of goose-flesh on the skin, impaired diges- tion, coldness and numbness of the affected part characterise a case of the same being surcharged with the Kapham. 29—32.
Copious flow of perspiration, heat with a burning sensation in the body, and epileptic fits indicate a case when the Samana Vav'u has become united with the Pittam ; while a copious flow of stool and urine, and an excess of mucous secretion (Kapham) from the nose (fluent coryza) etc. and horripilation mark a case, where it has become saturated with the Kapham. 33 — 34.
Heat and a burning sensation in the affected part and a profuse mcnorrhagia mark a case when the Apana Vayu becomes surcharged with the Pittam, where- as a sense of heaviness in the lower limbs characterises a case when it becomes overcharged with the Kapham.
0 5 — y^'
[Symptoms such as,] burning and jerking in the limbs, and a sense of ph}'sical languor become manifest in the event of the Vyana Va}-u being surcharged with the Pittam, while a general heaviness of the limbs, stiff- ness or numbness of the bone-joints, and an incapability of locomotion indicate the fact of its being surcharged with the Kapham. 37 — 38.
The Nidanam of Vata Raktam : —
An over-indulgence in grief, excessive sexual inter- course, inordinate physical exercise, drinking large quantities of wine, observance of a regimen of diet and conduct in a particular season of the year which is im- proper to it, use of articles of food which are not con- genial to one's own temperament and an improper or
.S Tin: srsiIKI'lA SAMIIITA, [CUp. I.
baneful use of such ()Ua;4iii()U^ substances (as <jil, clari- fied buLLer etc.) are the factors, w hich vitiate in common the blood and Pittam of a person. The foregoing causes cspcciall\' tend to \itiate or agitate the Vayu and blood in persons of delicate constitutions, or in corpulent persons, or in those who (observe a form of perfect continence. 39.
The \ital Va} u becomes enraged or agitated by exces- sive riding on horses, camels or elephants, or through the lifting or carrying of great weights, etc., or by an in- ordinate indulgence in things which are possessed of the specific virtue of enraging or aggra\ating that \ ital principle. On the other hand, an over-indulgence in such articles of food as arc heat-making in their potency. or a surfeit of edibles largeh' composed of sharp, acid or alkaline substances, as well as a large consumption of potherbs etc., or an exposure to heat tends to vitiate the blood of the organism, and which, on account of such contamination, tends to speedily obstruct the pas.sagc of the fleet-coursing Vayu. The \';i\u. thus impeded in its course, Ibecomcs more and more agitated each moment, and is prone to speedily agitate the blood in a similar way. The antecedence of the term "Vata" or "Va)-u" in the nomenclature of the disease (Vata-Rakta)is owing to the precedence accorded to the action of the deranged Vayu in bringing about the malady, although it effects this in concert with the vitiated blood of the organism. 40.
Similarl}', the disease brought about by the agitated Pittam. in conjunction with the vitiated or agitated blood, is called the Pitta- Raktam. while the one incidental to the combination of the deranged Kapham with the vitiated blood is called Kapha-Raktam. In a case of Vata-Raktam. the legs, or the lower extremities can
Chap. I.] NIDANA STHANAM. 9
not bear the least touch (Hypcrsesthesia) and a sort of pricking, piercing pain (pins and needles) is experienced in those regions. The legs become withered or atrophied and lose all sensibility to touch. In a case of Pitta Raktam, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Raktam, the legs become swollen and numbed. The swelling assumes a whitish hue and feels cold to the touch, and is accompanied by excessive itching. In the Sannipatika or Tridoshaja form of Dushta-Raktam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding t\-pcs. 41 — 43.
Premonitory Symptoms: —In the incuba- tive stage of the disease the legs perspire and become cold and flabby, or (on the contrary*, the local perspira- tion is stopped and the legs become hot and hard. More- over, a pricking pain is experienced in the affected parts which are marked by complete anaesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in either from the lowc extremities, or in some cases, first affects the upper ones and gradually extends all over the bod\' like an enraged rat-poison.
Prognosis : — -Theform of the disease inwhichthe skin of the part lying between the instep and the knee- joint becomes abraded or spontaneous!)- bursts open, exuding pus and blood, attended with loss of strength (Pr^na) and flesh, curvature of the fingers, and eruptions of nodules, should be regarded as incurable; while a case of one year's standing admits only of palliative measures. 44.
The enraged or agitated Vayu, while coursing swiftly through the Dhamanis (nerves) of the body, shakes it in quick succession, and a disease, (exhibiting such
10 THE SUSHRUTA SAMHITA. tChap. I.
symptoms as shaking or convulsive jerks), is originated which is called Akshepaka* (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called Apatanaka (Epilepsy without convulsions). The aggravated or agitated Vayu, charged with an abnormal quantity of Kapham, some- times affects and stuffs the entire nervous system, and gives rise to a form of disease, which is called Dandai- patataakamt (Epilepsy with convulsions), inasmuch as it deprives the body of its power of movement and flexibility, making it stiff and rigid like a rod (Danda). 45 — 46.
The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty ; its characteristic symptom being a paralysis of the jaw- bone, which makes deglutition extremely difficult. The disease in which the enraged Vayu bends the body like a bow is called Dhanushtambha (Tetanus). The disease admiits of being divided into two distinct types accord- ingly as the body of the patient is curved internally (Antarstyama, lit :— inwardly or foi-wardly extended, emprosthotonos), or externally (VahirJiyaima, lit : — ex- tended or bent on the back, resting on his heels and occiput — Opisthotonos). When the extremely enraged and powerful bodily Vayu (nerve-force), accumulated in
* The patient suffers from vanishings {iamyale) and loss of con- sciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named — Gayaddsa,
t Jejjada holds that the enraged Vayu, in unison with the deranged Kapham, gives rise to another kind of convulsions (Akshepaka) which he has denominated as Danda-patanakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pittam and Kapham. Several authorities aver that there are four distinct types of Akshepakah, such as Danda-patanakh, Antarayamah, Vahirayamah, and Akshepakh of traumatic (Abhighataja) origin.
Chap. I.] NIDANA STHANAM. II
the regions of the fingers, insteps, abdomen, chest, heart and throat, forcibly draws in the local ligaments (Snayu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarayama Dhanushtambha. The movements of the eyes become impossible, which become fixed in their sockets ; the jaw-bones become paralysed, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapham). These are the features which mark the first type (Antarayama Dhanushtambha). On the contrary, when the same enraged Vayu, centred or lodged in ligaments which traverse the posterior side of the body, attracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease is called Vahirayama, and should be looked upon as beyond the pale of all medicinal treatment. 47 — 50.
Four types of Akshepaka are usually recognised in practice such as, the (i) one incidental to the concerted action of the enraged bodily Vayu and Kapham (2), the one brought about through the union of the enraged Vayu with the deranged Pittam, (3), the one due to the single action of the agitated Vayu (4) and the one due to any external injury or blow ( Abhighataja).* An attack of Apatankah due to excessive haemorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour), or which is incidental to an external blow or injury (traumatic), should be regarded as incurable, 51 — 52.
* Brahma Deva designated the four types of the disease, as Apatanakah, Samsrishta Akshepakab, simple Akshepakah and the Abhighataja (traumatic).
,12 THi; SUSHRUTA SAMHITA. [Chap. I.
The disease, in which the extremely agitated Vayu affects the nerve chains (Dhamanis) which spread either in the left or in the right side of the body, whether in the upward, downward, or lateral direction, making them lax and vigourlcss, and in which the joints of the other side of the bod\- become useless and inoperative, is called Pakshag-hata (Hemiplegia) by eminent physicians. The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility, but who retains his consciousness so long as there remains the least vestige of vitality in the affected part, suddenly falls down and expires. 53 — 54.
Prognosis:— A case of Pakshaghata (Hemi- plegia), brought about through the single action of the enraged or agitated Va\u of the bod\', can be cured only with the greatest care and difficulty. A case of the same disease, engendered by the aggravated Vayu in conjunction with the deranged Pittam or Kapham, proves amenable to medicine (Sadhya). It becomes in- curable when caused through the waste of the root prin- ciples (Dhatu) of the body. 55.
Apatantrakah (Convulsions) :— The Vayu, aggravated (by its specifically exciting factors and principles) and dislodged from its natural .seat or recep- tacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples. It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.
Symptoms : — The patient lies with his eyes closely shut, or stares with a sort of fixed or vacant gaze, the eyes remaining fixed or immovable. The patient loses all perception, and groans. Respiration becomes difficult, or symptoms of temporary asphyxia
Chap, I.] NIDANA STHANAM. . 1$
and unconsciousness set in. Consciousness and a normal condition of the organism return with the passage of the enraged Va\-u from the heart, while on the other hand the patient relapses into unconsciousness simultaneously with the envelopment of the heart with that enraged and Kapha-^aturated Vayu. This disease is called Apatantrakah and is ascribed to the action of the enraged Vayu surcharged with the deranged Kaphani. 56.
lYIanyastambha:— The local Vayu. agitated through such causes as sleep in the da\- time, reclining with the neck on an uneven place or pillow, gazing upward for a considerable length of time, or looking aside in a contorted way, and enveloped in the deranged Kapham, gives rise to the disease known as Manya- stambha (wr\- neck or torticollis). 57.
Arditam (Facial Paralysis): — *Prcgnant women, mothers immediately after parturition (Sutika), infants, uld and enfeebled persons arc most prone to fall \'ictims to this disease*. It has been also known to result from excessive haemorrhage or loss of blood. The local Vaj^u, extremely enraged or aggravated by continuous talking in an extremely loud voice, chewing of hard substances, loud laughter, }-awning, carrving extremely heav\- loads, and lying down in an uneven position on the ground, finds lodgment in the regions of the head, nose, upper lip, chin, forehead and the joints (inner cornea) of the eye, and produces the disease called Arditam by distorting the face.
Symptoms: — The neck and half of the face longitudi- tally suffer distortion and are bent. The head shak'" ■ the power of articulating speech is lost, and the
* Tlij portion of the text included within asteribks has been rejected by Jtjjal icharyya as spurious.
14 THE SUSHRUTA SAMillTA. [Chap. I.
eyes arc distorted into a variety of shapes. The portions of the neck and the chin, as well as the teeth on the affected side become painful.
Premonitory Symptoms :— The disease
generally commences with .shi\ urin'^^, horripilation, cloudiness of visicMi, iipcoursing of the bodily Vdyu and an.nesthesia, a pricking pain in the affected locality, numbness or paralysis of the jaw-bone, or of the cervical muscles of the neck, Ph)sicians, conversant with the i^tiology of diseases, call it Arditam (Facial paralysis). Prognosis : — A case of Arditam, appearing in an ex- tremely enfeebled or emaciated patient, or exhibiting such symptoms as a winkless vision, inarticulate speech which hardly seems to come out of the throat, excessive palsy of the face, as well as the one of more than three years' standing, should be deemed as incurable. 58.
Gridhras'i (Sciatica): — The disease in which the two great nerve-trunks (Kandara), which emanating from below the lower extremity of the thigh reach down to the bottom of the insteps and toes, and become stuffed or pressed with the enraged Vayu, thus depriving the lower extremities of their power of locomotion, is called Gridhras'i. 59.
ViS'vachi (Erbe's paralysis or Bracial neuralgia): — The disease in which the enraged Vayu affecting the nerve-trunks (Kandara) which run to the tips of fingers from behind the roots of the upper arms, making them incapable of movement and depriving them of their power of flexion or expansion is called Vis'vachi* 60.
KrOShtukas'irsha (Synovitis of the knee- joints): — An extrimely painful swelling in the knee-
* When the aforesaid nerve of a sirgle arm is aflecld the disease is restricted to it alone, while it attacks the both when both their nerves are affected.
Chap. I.] NIDANA STHANAM. 15
joints, which is originated through the concerted action of the deranged Vayu and the vitiated blood is called Kroshtukas'irsha from the fact of its resembling the head of a jackal (Kroshtuka) in shape. 6i.
Khan ja (Lameness): — -The disease proceeds from the drawing up of the nerve trunks (Kandara) of a leg by the deranged Vayu lying about the region of the waist. When both the legs are similarly affected, the patient is called a Pangu. He, whose legs tremble before starting for a walk and who afterwards manages to go on limping is called a Kalaya Khanja one in whom the bone-joints become loose. 62 — 63.
Vata Kantaka : —The local Vayu, enraged by making a false step on an uneven ground, finds lodg- ment in the region of the ankle (Khudaka, instep according to others), thus giving rise to a disease which is called Vata Kantaka. The burning sensation in the soles of the feet caused by the enraged local Vayu, in conjunction with the deranged Pittam and blood, is called Pada-daha, which is generally seen to afflict persons of pedestrian habits. When the legs are deprived of all sensibility of touch, and a sort of tingling pain is experienced in them it is termed Padaharsha, which is due to the deranged action of the Vayu and Kapham. The disease in which the enraged local Va}'u dries up the normal Kapham lying about the shoulder- joints is called Ansa-shoshaka. The form in which the aggravated local Vayu contracts the nerves of the arms is called Avavahuka*. 64—67.
Vad hiry ay am (deafness) : —The disease occurs only when the deranged Vayu, either singly or sur-
* The Ansa-shosha is due to the single action of the enraged Vayu, while Ava-vahuka is due to the concerted action of the deranged Vayu and Kapharo.
1 6 THESUSHRUTA SAMIIITA. [Chap. I.
charged with the Kapham, stuffs the sound -carrying channels (Srota) of the cars. 68.
Kama S'ulam:— The disease in which the deranged Vayu causing a piercing pain in the regions of the cheekbones, head, temples and neck, gives rise to a sort of aching pain in the tympanum, is called Karna- s'ulam (otitis). The local Vc-'iyu, deranged and saturated with the Kapham stuffing the nerves (Dhamani) which conduct of the sound of speech, produces complete (in some cases partial) loss of the power of speech — e }^. Muka (dumbness , Mimnina (nasal voice) and Gad-g-ada (indistinct speech). 69—70
A sort of pain, which (rising from the bowels or the urinary bladder and ranging downward) gives rise to a bursting sensation in the regions of the anus and the genitals, is called Tuui, whereas the one, rising upward from the preceding parts and extending up to the region of the intestines, is called Prati-tuni. A distension of the abdomen (Udara), attended with the incarceration of flatus (Vayu) and an intense pain and rumbling in its inside, is called Adhmanam (Tympanites). When it first affects the stomach f Amasaya) and is unattended with an oppressive feeling about the heart and pain at the sides'" it is called Pratyadhmauam. The Va>-u saturated with the deranged Kapham causes the preceding t\-pe of distemper. 71 — 74.
A knotty stone-like tumour (Granthi) of consider- able density, whether fixed or mobile, and appearing below the umbilicus, and having an elevated shape which is always found to be extended in an upward direction, is called a Vatasthila, (which) as its name implies, is due to the action of the local deranged Vayu. The tumour, thus formed, obstructs the emission of flatus and impedes the evacuation of faeces. A tumour of similar shape.
Chap. I.] NIDANA STIIANAM. 1 7
appearing laterally or across the region of the abdomen (Jathara) and obstructing the passage of stool, urine and flatus (Vata) is called a Pratyashthila. 75 — y^.
Thus ends the fir=t Chapter of the Niciana Slhanam in the Sujhruta Samhita, which treats of the Nidanam of the diseases of the nervous system.
('llAPTiHJ II.
Now wc sliall discourse on the Nidanam of Ars'aS (Hiemorrhoids'. i.
ll.einorrhoids may be divided into six classes vi:: : — (i) Vdtnjii (due to the action of the deranged Vayu\ (ii) Pittiijn (flue to the action of deranged Pittam), (iii) Kaphaja (due to the action of deranged Kapham), (iv) Raktaja (due to the action of the vitiated blood), (v) Sannipdtaja (due to the concerted action of the deranged Vayu, I'ittani and Kai)hami and (vi) Sahaja (congenital).
Pathology : —The deranged Vayu, Pittam, etc. enraged by their specific aggravating causes, or by such acts or conduct as partaking of food composed cjf in- compatible substances, eating before the previous meal has been digested, inordinate sexual intercourse, sitting on the haunches, excessive riding, and the voluntary suppres- sion of any natural urging of the body, cither severally or in combination of two or three Doshas, or vitiating the blood of a person, who observes no moderation in food and drink &c., become dislodged from their natural seats in the body [according to the law of Prasaranam (expansion and change of place by a deranged organic principle)] and arc carried down through the large intestine (Pradhana Dhamani) into the descending colon and getting lodged therein, give rise to growths of polypi or fleshy condylomata, which are known as piles. These growths chiefly appear in persons suffering from impaired digestion (Agni), and gain in size through friction with the wearing apparel, weeds, wood, lumps of clay or stone, or by contact with cold water. 3.
The lower end of the large intestine, which passes into the flexure of the rectum and measures four and
Chap. II ] NIDAXA STHANAM. I9
a half fingers in length, is called the Gudam (lit — the channel of fecal matterj, the interior of which is provided with three spiral grooves. Each of these grooves or ring-like muscles lie a finger and a half apart, and arc respectively known as Pravahini, Visarjani and Samvarani, or the grooves of out-flow, defecation and closure of the anus (sphincter ani), covering a space of four fingers and having lateral!)- an elevation of one finger's width. 4
IVIetrlcal Texts :— These grooves arc like the involuted indentures of a conch shell, situated one above the other, coloured like the palate of an elephant. A part of the channel, half a finger's width in length as it is usuall)- measured from the outer hair\- orifice of the rectum, is called the anus (Gudoushtha). 5 — 6.
The first of the aforesaid grooves or rings lies about a finger's ^^■^dth apart from the orifice of the anus.
Premonitory Symptoms:— A non-relish
for food, a tardy and difficult digestion of food (brought into the stomach), acid eructations, a sense of weakness in the thighs, a rumbling .sound in the intestines, emacia- tion of the body, frequent eructations, .swellings around the eyes, a croaking sound in the intestines, cutting pain in the rectum (Guda), apparent indications of an attack of phthisis, jaundice, dy.sentery, cough, dy.spnoea, vertigo, somnolence, excessive sleep, weakness of the organs (Indriya), are indications which predict the advent of this disease, and which become more marked M ith its progress. 7.
The Vataja Type :— riles, due to the action of the aggravated Vayu, are non-exuding, rose-coloured, and uneven in their surface. They resemble the Kadamba flowers in structure and are either tubular or sharp- pointed like a needle, sometimes assuming the shape of
20 THE SUSIIRUTA SAMIIITA. [Chap. II.
the wild Tundikeri flower. The stool of a haemorrhoid patient of this type becomes excessively hard, and can be evacuated only in a sitting posture, with the greatest pain and difficulty. An excruciating pain is experi- enced in the regions of the waist, back, sides, anus, umbilicus and the genitals. Symptoms peculiar to Gulma, Ashthila, enlarged spleen and abdominal dropsy add to the distress of the patient, whose skin, nails, eyes, teeth, face, urine and stool also assume a dark black colour. 8.
The Pittaja Type :— Piles, brought on through the action of the deranged Pittam, are slender, blue-topped, shifting in their nature, yellowish in their hue, or are coloured like shreds of liver, resembling in shape the tongue of the Suka bird. They are thick at middle, like barley grains, or resemble the mouth of leeches and secrete a sort of slimy exudation. The stool is marked with blood, and the patient complains of a painful, burning sensation (in the rectum) at the time of defecation. Fever, with a burning sensation and thirst, and epileptic fits, supervene. The skin, nails, eyes, face, teeth, stool, and urine of the patient assume a yellow hue. 9.
The Kaphaja Type :— Piles, due to the action of the deranged Kapham, become white, are sunk about their roots, and are hard, round and glossy. They assume a greyish hue and resemble the teats of a cow or the stones of the Karira, or of a Panasa fruit. These piles donot burst, nor dothey exude any sort of secretion. The patient feels an irresistible tendency to scratch the excrescences. The stools become copious in quantity and :riC charged with mucous (Sleshma), resembling the washings of meat. Indigestion, fever with shivering (Sita-jvara), and heaviness of the head and cedema
Chap. II.] NIDANA STIIAXAM. 21
with a non-i'clish for food are the s\-mptom.s which be- come manifest with the progress of the disease. The skin, finger nails, eyes, teeth, face, stool and urine of the patient also assume a white colour. lO.
The Raktaja Type : -Piles (haemorrhoids), having their origin in the vitiated condition of the blood resemble the sprouts of the Vata tree in shape and are of the colour of red coral, or the seeds (dark red) of Gunja berry. They exhibit all the symptoms, which are peculiar to the Pittaja t}-pe of this disease. Pressed hard by the constricted fyeces in their passage through the anus, they suddenly give rise to a haemorrhage of vitiated (venous) blood, and symptoms characteristic of excessive bleeding are found to supervene, ii.
The Sannipata Type: -In a case of
haemorrhoids due to the concerted action of the deranged Vayu, Pittam and Kapham, s>'mptoms characteristic of each of these types manifest themselves in unison. 12.
The Congenital Type :— Congenital hysmor- rhoids (Saliaja Ars'as) arc usually ascribed to defects in the semen and ovum of one's parents and should be medicinally treated with an eye to the special deranged Doshas involved in the case. The polypi (in this type) are hardly visible and are rough and yellowish, with their faces turned inward. They are extreme!}' painful. A person suffering from this type of piles gets thinner and thinner cveiy day and eats but very little. Large veins (Sira) appear on the surface of the body. The patient becomes irritable, the semen decreases in quantity, making the procreation of a small number of children possible only by him. The voice becomes feeble, the digestion is impaired, and disorders affecting the head
22 THE SUSIIRUTA SAMllITA. [Chap II.
nose, cars and eyes follow. A cr(^akin^ sound is heard in the intestines, attended with a rumbling in the abdomen. All relish for food vanishes and the region of the heart seems to be smeared with a kind of sticky paste (of mucous), etc. 13.
Auhoritativc verse on the subject : —
A qualified physician should undertake the medical treat- ment of haemorrhoids which occur cither about the outer or the middle groove of the rectum, (in as much as they prove amenable to medicine). A pol)'pus, appear- ing about the innermost ring or groove of the rectum, should be treated without holding out any definite hope of cure to the patient. 14.
Lingars'as (Fig warts or cond\-lomatous growths about the genitals): — The deranged and aggravated Vayu etc., finding lodgment in the genitals, vitiate the local flesh and blood, giving rise to an itching sensa- tion in the affected localities. The parts become ulcerat- ed (through constant scratching) and the ulcers become studded with sprout-like vegetations offlesh(warts),which exude a kind of slimy, bloody discharge. These growths, or excrescences generally appear on the inner margin, or on the surface of the glans penis, in the form of soft, slender vegetations of skin, resembling the hairs of a small brush (Kurchaka). These vegetations ultimately tend to destroy the penis and the reproductive faculty of the patient.
Bhagars'as : — The deranged Vayu etc. of the body, lodged in the vaginal region of a woman, gives rise to similar crops of soft polypi in the passage. They may crop up isolated at the outset, and (by coalescing) may assume the shape of a mushroom, or an umbrella, secreting a flow of slimy, foul-smelling blood.
The deranged Vayu. etc. ma\' further take an
Cliap. II.] MDAXA STHAXAM. 23
upward course, and finding a lodgment in the ears, nose, mouth and eyes may produce similar warts in those localities. Warts, which crop up inside the cavities of the ears, may bring on earache, dumbness, and afoul dis- charge from those organs, while those (c}-sts) cropping up in the eyes will obstruct the movement of the e}'e-lids, giving rise to pain and a local secretion and ultimateh' destroy the eye-sight. Similarh", such growths in the nostrils produce catarrh, excessive sneezing, shortness of breath, headache, nasal speech and the complaint known as rutinas)-a. Such vegetations cropping up in and about the lips, palate or the lar\nx,tcnd to make the speech confused and indistinct. When appearing in the mouth, they impair the faculty of taste, and diseases which affect the cavit\' of the mouth follow. The ex- cited V\-ana Va}-u, united with the aggravated Kapham, produces a kind of hard papillomatous growths on the skin (about the anus) which are called the Charmakilas ( papillomata).* i 5.
Authoritative verses on the subject :
— These Charmakilas may be attended with a kind of pricking pain through an excess of the deranged Vayu, whereas those which have their origin in the deranged Kapham (lymphatics) assume a knott}' shape and be- come of the same colour as the surrounding skin. On the other hand, they become dr}', black or white, and extremely hard through an exuberance of the deranged local blood and Pittam. 16.
The symptoms of polypi, appearing in the neighbour- hood of the anus, have been described in full, while the general characteristics of those, which are found to crop up around the genitals, have been briefly discoursed
* Accordini; to others, Charmakilas may crop up on the skin of any part of the b dy.
24 TIIK SUSHRl'TA SAMIIITA. [Clis].. ll.
upon. An intelligent physician should ponder over the two groups of symptoms while engaged in treating a case of piles. A case of piles exhibiting symptoms peculiar to the two deranged Doshas is called the Samsargajam. Six distinct types of bio-Doshaja piles are known in practice.* ly.
Prognosis : — A case of piles due to the con- certed action of the three deranged Doshas of the body, (with its characteristic symptoms) but partially develop- ed, may be temporarily checked (Ydpya). Cases, which arc of more than a year's standing, as well as those in which the h;rmorrhoids are due to the concerted action of the two Doshas (Samsargaja), or are situated in the middle groove of the rectum, may be cured but with the greatest difficulty. Cases of the Sannipatika or congenital (Sahaja) t)i)es should be given up as incurable. The Apana Vayu, in a person whose rectum is overrun with such polypus growths, tries to pass out through the anus, but is driven back upward, being obstructed in its passage by the vegetations, and then mixes with his V}-ana Vayu, thus imparing (the five- functioned) fire (Pittam) in his body. 18-19.
* Such as (l) the one due to the concerted action of the deranged Pittam and Kapham, (2) the one incidental to the simultaneous derange- ment of the Vayu and the Kapham, (3) the one brought about through the disordered condition of the Vayu and blood, (4) the one due lo the combination of the deranged Pittam and Kapham, (5) the one produced by the concerted action of the deranged Pittam and blood, (6) the one which results from the combined action of the deranged Kapham and blood.
Thus ends the second Chapter of the Xidanasthanam in the Sus'ruta Samhita which deals with the Nidanam of piles.
CHAPTER III.
Now we shall discourse on the Nidanam of As'- ma.ri (urinary calculi), i.
The disease admits of being divided into four several types, such as the Vataja, the Pittaja, the Kaphaja and the Sukraja (Seminal) concretions. An exuberance or preponderance of the deranged Kapham should be under- stood as the underlying cause of all invasions of this disease. 2.
General aBtioIOgy :--The Kaphah of a man, who neglects to cleanse (Sams'odhana) the internal channels of his organism, or is in the habit of taking unwholesome food, enraged and aggravated by its own exciting causes, is carried into the urinary bladder. Here it becomes saturated with the urine, and gives rise to the formation of concretions or gravels in its cavity. 3.
Premonitory Symptoms :— An aching pain in the bladder, with a non-relish for food, difficulty in urination, an excruciating pain in the scrotum, penis, and the neck of the bladder, febrile symptoms, physical lassitude, and a goat-like smell in the urine arc the symptoms, which indicate the formation of gravel in the bladder. 4.
IVIetrical Text ;— The deranged Doshas involv- ed in a particular case respectively impart their specific colour to the urine, and determine the character of the accompanying pain. The urine becomes thick, turbid, and vitiated with the action of the aggravated Doshas, and micturition becomes extremely painful. 5.
Leading^ Indications :— A sort of excru- ciating pain is experienced either about the umbilicus, or in the bladder, or at the median rape of the
4
26 THE SUSHRUTA SAMIIITA. [Chap, III.
perineum, or about the penis, during micturition when •Tavel is fcnmin;^ in the bladder. The urine is stopped at intervals in its out-flow, or becomes charged with blood, or flows out twisted and scattered like spray, leaving a sediment of clear, sand}', red or yellow particles of stone, which resembles a Gomedha gem in colour. Moreover a pain is experienced in the bladder at the time of running or jumping or in swimming, or while ridin'4 <>n hnrsL'back, or after a long journey. 6.
The ^ICShmas'mari : — Stone or gravel, ori- ginated through the action of the deranged Kapham, saturated with an excessive quantity of that Dosha by the constant ingestion of phlegm-generating (Sle.sh- mala) substances, increases in size at the lower orifice of the bladder and ultimately obstructs the passage of the urine. The pressure and recoil of that incarcerated fluid on the walls of the urinar)' badder gives rise to a kind of crushing, bursting, pricking pain in that organ, which becomes cold and heavy. A Kapha-origined stone or gravel is white and glossy, attains to a large size, to that of a hen's egg, and has the colour of the Madhuka flower. This t\'pe is called S'lcshmas'mari. 7.
The Pittaja As'mari :— The Kapham
charged (dried) with the deranged Pittam becomes hard (condensed) and large in the aforesaid way, and lying at the mouth of the bladder obstructs the passage of the urine. The bladder, on account of the flowing back of the obstructed urine into its cavity, seems as if it has been exposed to the heat of an adjacent fire, boiling with the energy of an alkaline solution. A kind of sucking, drawing and burning pain is experienced in the organ. This type of As'mari is further marked by symptoms which characterise Ushna-vata (stricture). The concretion is found to be of a reddish, yellowish
Chap. III.] NIDANA STHANAM. 2^
black colour like the stone of the Bhallataka fruit, or it is coloured like honey. This type is called Pittaja As'mari. 8.
The Vatas'mari :— The deranged Kapham (mucus) inordinately saturated with the bodily Vayu, acquires hardness and gains in dimensions, and these l\-ing at the mouth of the bladder obstructs the passage of the urine. The incarcerated fluid causes extreme pain in the organ. The patient constantly under severe pain gnashes his teeth or presses his umbilical region, or rubs his penis, or fingers his rectum (Pd\-u) and loudly screams. A burning sensation is experienced in the penis, and urination, belching and defecation become difficult and painful.* The concretions in this type of As'mari are found to be of a dusk\- colour, rough, uneven in shape, hard, facetted and nodular like a Kadamva flower. This type is called Vdtds'mari. 9.
Infants are more susceptible to an attack of any of the three preceding t>'pes of As'mari, inasmuch as they are fond of day sleep or of food composed of both whole- some and unwholesome ingredients, and arc in the habit of eating before the digestion of a previous meal, or of taking heavy, sweet, emollient and demulcent food. In children the bladder is of diminished size and poor in muscular structure. These facts contribute to the easy possibility of the organ being grappled (with a surgical instrument) and of the stone being extracted with the greatest ease in cases of infantile As'mari. i-o.
The ^'ukras'mari : — Sukras'maris or seminal concretions arc usually formed in adults owing to the germination of semen in their organisms, A sudden or abrupt stoppage of a sexual act, or excessive coition tends to dislodge the semen from its natural receptacle * Stool and urine can be voided only with the greatest str.-iining.
28 THE SUSHRUTA SAMHITA [Chap. III.
in the body. The fluid thus dislodged, but not emitted, finds a wrong passage. The Vayu gathers up the fluid (semen), thus led astray, and deposits it (in a round or oval shape) at a place lying about the junction of the penis and the scrotum and dries up the humidity with which it is charged. The matter, thus formed, condensed, and hardened, is called the seminal stone (Sukrds'mari), which then obstructs the passage of the urine, giving rise to pain in the bladder, painful micturition, and swelling of the scrotum. The stone vanishes under pressure in its seat*, ii — 12.
Authoritative verses on the sub- ject : — Concretions, sands and sediments found to be deposited in the urine in a case of Bhashma-meha are but the modifications, or attendant symptoms of a case of stone in the bladder (As'mari). The same group of symptoms and the same kind of pain are exhibited and experienced in a case of gravel {S'ar^ard) as in a case of stone (As'mari) in the bladder. The local VAyu coursing in its natural direction helps the dis- charge of calculi (As'mari) with the urine in the event of they being extremely attenuated in structure. Particles of a stone broken by the Vayu are called urinary calculi {S'arkard). A pain about the cardiac region, a sense of weakness and lassitude in the thighs, a griping pain in the regions of the spleen and liver (Kukshi-s'ula), a shivering sensation, thirst, hiccough or eructations, darkness or sallowne's of complexion, weakness, emaciation with a non-relish for food and
• We can not but contemplate with admiration the fact that Sushruta was aware of the formation of seminal or spermatic concretions in the seminal vesicles through degenerative changes of spermatozoa and other secretions and their subsequent calcification as lately discovered by the savants of the 'West. — Translator
Chap. III.] NIDANA STHANAM. 29
impaired digestion are the symptoms which are manifest in a gravel-patient. A gravel {S'arkard) obstructed at the mouth of the urinary channel is detected by the following indications : — via., weakness, lassitude, emaciation, cachectic condition of the body, pain over the hepatic region (Kukshi-s'ula), a non-relish for food, sallowness of complexion, hot and high coloured urine, thirst, pressing pain at the cardiac region and vomiting. 13.
The bladder is situated in the pelvic cavity, sur- rounded on its different sides by the back, loin (Kati), umbilicus, scrotum, rectum (Guda), groins and penis. This organ is provided with a single aperture or opening and lies with its mouth downward, covered with nets of nerves (Sira) and ligaments (Snayu), in the shape of a gourd. The organ is extremely thin in structure ; and thus situated within the pelvic cavity, it is connected, through its mouth or external orifice, with the rectum, the penis, and the testes. It is also known by the name of Maladhara (the receptacle of impure matter) and forms (one of) the primar^^^ seats of vital energy (Prana)*. The urinary ducts (ureters) pass close by the large intestines (Pakvas'aya) and constantly replenish the bladder and keep it moist with that waste product of the system in the same manner as rivers carry their contributions of water into the ocean. These passages or ducts (which are two) are found to take their origin from hundreds of branches (or mouths tiibuli uriniferi), which are not visible to the naked eyes, on account of their extremely attenuated structures and carry, whether in a state of sleep or wakening, the urine from below the region of the
• The text has Frdndyalanam, which means that an injury to the urinary bladder may be attended with fatal result.
30 THE SUSHRUTA SAMHITA. [Chaj). III.
stomachf (Amasaya) into the bladder keeping- it filled with this important fluid of the body, just as a new pitcher, immersed up to it;? neck in a vessel full of water, is filled by transudation through its lateral pores. 14.
In the same way the Vayu, Kapham and Pittam are carried into the bladder (through their respective ducts or channels), and in unison with the retained urine, give rise to the formation of stone, on account of the slimy character of the deposit produced. Stone is formed in the same way in the bladder as sediments are ultimately deposited from clear and transparent water at the bottom of a new pitcher which contains it. As the wind and lightning jointly condense the rainwater into hailstones, so the bodily V^iyu and Pittam (heat) jointly contribute to the condensation of the Kapham in the bladder and transform it into stone.
The Vayu in the bladder, coursing in its natural downward direction, helps the full and complete emission of urine ; while coursing in a contrary direction, it gives rise to various forms of maladies such as, Prameha, strangury, as well as seminal disorders ; in short, it produces any urinary trouble to which the bladder ma\- be subjected, i 5.
t From the kidneys.
Thus ends the third Chapter of the Nidana Sthanam in the Sushruta Samhita which treats of the Nidanani of urinary calculi.
CHAPTER IV.
Now \vc shall discourse on the Nidanam of Bhag"- a.ncla.ra.m t, fistula in ano and fistular ulcers), i.
The deranged Vayu, Pittam, Kaphah and Sannipatah (a simultaneous derangement of the three bodily Doshas) and extraneous causes (such as a blow etc.) give rise to the types of Bhagandaram known as Sataponaka, Ushtragriva, Parisravi, Samvukavarta and Unmargi. The disease is so named from the fact that it bursts the rectum, the perineum, the bladder and the place adjoning to them (thus setting up a mutual communica- tion between them). The pustules, which appear in this regions are called as Pidakas in their unsuppuratcd stage, while they are called Bhagandaram when they are in a stage of suppuration. A pain about the sacral bone and an itching about the anus, accompanied by a swelling and burning sensation, arc the premonitor)- s\-mptoms of this disease. 2.
The ^ataponakah Type :— The Vayu,
excited, condensed, and rendered motionless b)' a course of unwholesome food, gives rise to a pustule within one or two fingers' length from the rectum (anal region, — Guda), by vitiating the flesh (areolar tissue) and blood (of the locality). It assumes a vermilion colour and is characterised b\' a variety of pricking, piercing pain. If neglected at the outset, the pustule runs into suppuration. Owing to its vicinity to the bladder, the abscess or the suppurated pustule exudes a kind of slimy secretion and becomes covered with hundreds of small sieve-like holes, through which a constant frothy discharge is secreted in large quantities. The ulcer, thus formed, seems as if it is being thrashed with a rod, pierced
32 THE SUSHRUTA SAMHITA. fChap. IV,
with a sharp iiistriimcnt, cut with a knife, and pricked by needles. The region of the anus cracks and bursts, and jets of urine, fecal matter, flatus (Vata) and semen are emitted throu'^^h these sieve-like holes. This type of fistula is called Sataponakah (Sieve-like fistula in ano). 3.
The Ushtra-grivah Type:— The enraged
Pittam, carried down b)- the V.i)u (^into the rectum) finds lod;4mcit therein, and there gives rise to a small, raised, red pustule, which resembles the neck of a camel in shape, and is characterised by a varied kind of pain, such as sucking etc. The pustule, not medicinally treated at the beginning, runs into suppuration. The incidental ulcer seems as if it is being burnt with fire or alkali, and emits a hot, fetid discharge. Jets of urine, flatus (Vata), fecal matter and semen flow out of the ulcer in the event of it not being healed up with proper medicinal remedies. This type is called Ushtragrivah. 4.
The Parisravi Type : —The enraged Kaphah, carried down by the Vayu (into the rectum) and lodged therein, gives rise to a white, hard, itching pustule in that locality, characterised by a variety of itching pains, etc. If neglected at the outset, it soon runs into suppura- tion. The incidental ulcer becomes hard and swollen, marked by excessive itching and a constant secretion of slimy fluid. Jets of urine, fecal matter, flatus and semen are emitted through the ulcer in the event of it not being well cared for at the outset. This type is called Parisravi. 5-
The ^amvukavartah Type :— The en- raged Vayu, in conjunction with the aggravated Pittam and Kapham, is carried down, and finds lodgment (in the region of the rectum), giving rise to a pustule of the size of the first toe, and characterised by a piercing
Chap. IV.] NIDANA STHANAM. 33
pain, and burning, itching sensations etc. Such a pustule, neglected at the outset, speedily suppurates, and the incidental ulcer exudes secretions of diverse colours, characterised by a kind of whirling pain, which revolves about, in the direction of the involuted indentures (within the grooves of the rectum) such as are found within the body of a river or fresh water mollusc. This is called Samvukavaitah. 6.
The Unmargi Type :— Particles of bones, eaten with (cooked ) meat by an imprudent, greedy, glut- tonous person, may be carried down with the hard and constipated stool by the Apana Vayu (into the rectum), thus scratching or abrading the margin of the anus, or burrowing into the rectum in the event of their being evacuated in improper directions through (transverse or horizontal postures). The scratch or abrasion is soon transformed into a fetid and putrid ulcer, infested with worms and parasites, as a plot of miry ground will soon swarm with a spontaneous germination of similar parasites. These worms and parasites eat away the sides of, or largely burrow into, the region of the anus, and jets of urine, fecal matter, and flatus (V.'iyu^ are found to gush out of these holes. This type of Bhagandaram is called Unmargi. 7.
Authoritative verses on the sub- ject:— A pustule, appearing about the region of the anus and characterised by a slight pain and swelling, and spontaneously subsiding, should be regarded as a simple pustule, which is of a quite different nature from a fistula in ano, which has contrary features ^i.e., invariably found to be attended with a violent pain and swelling etc., and takes a long time to heal). A Fistula-pustule crops up within a space of two fingers' width of the Pdyu proper (distal end of the
.5
34 THE SUSIIRUTA SAMIIITA. [Chap. IV.
rectum), is sunk at its root, and attended with pain and febrile symptoms. Pain, itching and burning sensations are experienced about the anus after a ride in a carriage, or after defecation. The anus becomes swollen, and the waist painful in the premonitory stages of Bhagandaram. 8 — 9.
Prognosis : — Almost all the types of this disease (Fistula in ano) yield to medicine after a prolonged course of treatment, and arc hard to cure, except the Sannipatah and traumatic ones, which are incurable. lo.
Thus ends ihe fourth Chapter of the Nidana .Sthanam in the Sushrula Samhila, which treats of the Nidanani of Fistula in ano (Bhagandaram).
CHAPTER V.
Now we shall discourse on the Nidanam of Kush- tham (cutaneous affections in general), i.
Improper diet or conduct; especially ingestion of improper, unwholesome, indigestible, or inconge- nial food ; physical exercise or sexual intercourse immediately after partaking of any oleaginous subs- tance, or after vomiting ; constant use of milk in com- bination with the meat of any domestic, aquatic or amphibious animal ; a cold water bath after an exposure to heat ; and repression of any natural urging for vomiting etc. are the factors which tend to derange and aggravate the fundamental principle of Vayu in a person. The enraged or aggravated Vayu, in combina- tion with the agitated Fittam and Kapham, enters into the vessels or ducts (Sira), which transversely spread over the surface of the bod)'. Thus the enraged Vayu deposits the Pittam and Kapham on the skin through the medium of their channels and spreads them over the entire surface of the body. The regions of the skin in which the aforesaid morbific diatheses are deposited become marked with circular rings or patches. The mor- bific diatheses (Doshas), thus lodged in the skin, continue to aggravate, and having been neglected at the outset, tend to enter into the deeper tissues and thus contaminate the fundamental principles (Dhatus) of the body. 2.
Premonitory Symptoms : — A roughness
of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anaethesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premoni- tory stages of Kushtham. 3.
36 THE SUSIIKUTA SAMllITA. [Chap. V.
Classification :— [Diseases, falling under the group of Kushth;iin, may be divided into two broad subdivisions], viz., — Mahdkushthas (major) and Kshudra (minor) Kushthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all. The Mahakushthas arc classified as, Aruna, Audumvara,Rishya-Jihva, Kapala, Kakanaka, Pundarika, and Dadru. The minor or Kshudra-kushthas (Lichen and Dermatitis) are Sthularushkam, Mahakushtham, Kka- kushtham, Charmadalam, Visarpah, Parisarpah, Sidhma, Vicharchika, Kitima, Pamd, and RakasA. All the types of Kushtham, whether major or minor, involve the action of the deranged Vayu, Pittam or Kapham, and are con- nected with the presence of parasites in those localities.* The preponderance of any particular morbific diathesis (Dosha) in an\' case of Kushtham should be looked upon as its originating cause. The type, known as Aruna Kushtha, is due to the action of the preponderant Vayu ; Audumvara, together with Rishya-Jihva, Kapala and Kakanaka, to a preponderance of the deranged Pittam ; while Pundarika and Dadru owe their origin to an excess of the deranged Kapham. These types of major or minor Kushthas are successively more extensive in their action and more incurable on account of their respectively invading a greater number of the bodily elements (Dhatus). 4 — 6.
IVIahakushthas :— Aruna-kushtha owes its
origin to an exuberance of the deranged Vayu. It is slightly vermilion-coloured, thin and spreading in its
* Certain authorities hold that, all types of Kushtham (cutaneous affections) to be of parasitic origin. The Garuda Puranam avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous affections — Kushthaika-hetavontarjdh shlemshajd vdhya sambhavdh. Ch. CLXIXV. 4.
Chap, v.] NIDANA STHANAM. 37
nature. A sort of pricking, piercing pain (is experienced in the affected locality) which loses all sensibility to the touch. The type known as Audumbara is coloured and shaped like a ripe or mature Audumbara fruit and has its origin in the deranged Pittam. The t>'pc called Rishyajihva is rough and resembles the tongue of a Rish\a (Deer) in shape and colour. The type known as Kapala (Macula caerulae) resembles a black (deep blue) Kharpara ( baked clay ). The Kakanaka type is characterised by a dark red and black colour like the seed of the Gutija berry. A sort of sucking and burning pain is experienced in the affected locality in all the four preceding types of the disease which are the outcome of the deranged Pittam. The whole diseased surface seems as if burning with fire, and emitting hot fumes. They are speedy in their origin and rapidl)' suppurate and break. All these types soon become infested with parasites. These are the general features of these forms of Kushthas. 7.
Pundarika: —The patches resemble the petals of a (full blown) lotus flower in colour, and Dadru (Ringworm) assumes the colour ffaint blue) of an Atasi flower, or of copper. They are spreading in their nature and are found to be overspread with pustules. Both the Dadru and Pundarika t\'pes are raised, circular, and characterised by itching and take a considerable time to be fully patent. These are the general charac- teristics of Dadru and Pundarika. 8.
Kshudra Kushthas :— We shall now des- cribe (the features of the diseases known as) Kshudra- kushthas (M.Text): — The type known as Sthularushka appears about the joints. It is extremely thick at its base, is cured with the greatest difficulty, and is strewn over with hard pustules (Arungshi). In the type known
38 THE SUSHKUTA SAMHITA. [ Chap. V.
as of Mahakushtham the skin contracts, and with the bursting" of the skin (a piercing pain is felt in the affec- ted part), which loses all sensibility to the touch, accom- panied by a general sense of lassitude in the limbs. In the Ekakushtham (Ichthyosis) type the skin assumes a reddish black colour. It is incurable. In the form known as Charmadalam (Hypertrophy of the skin> a burning, sucking, drawing pain is experienced in the palms of the hands and in the soles of the feet which become cha- racterised with an itchmg sensation. The disease, which affects in succession the (organic principles ofj skin, blood and flesh, and speedily extends all over the body, like Erysipelas, and is attended with a burning sensation fVidaha), restlessness, suppuration and a piercing pain and loss of consciousness (epileptic fits), is called Visarpa Kuslltliam. The form in which a number of exuding pustules gradually extend over the surface of the body is called Parisarpa Kushtham. The type of the disease which is white and thin, and is characterised by itching and docs not create any disturbance (in the patient), is called Sidhma (Maculae atrophicae). This form is generally found to restrict itself to the upper part of the body. Vicharchika (^Psoriasis) is characterised by excessive pain and itching and gives rise to extremel)' dry crack-like marks on the bod\' [hands and feet]. The same form of malady attended with pain, burning and itching, and restricting itself solely to the lower extremities, is called Vipadika. The type in which the eruptions exude (a kind of slimy secretion) and which arc circular, thick, excessively itching, glossy and black-coloured is called Kitima (Keloid tumours). Small pustules or pimples characterised by an itching, burning secretion and appearing on the surface of the body are called Fama (Eczema). The preceding kinds of pimples attended
Chap. V ] NIDAxVA STHAXAM. 39
with burning vesicles, are called Kacliclius and are found to be chiefly confined to the legs, hands and buttocks. A sort of dry and non-exuding pimples characterised by excessive itching and appearing all over the body, is called Rakasa (dry Erythema). 9-10.
The forms known as Sthularushka, Sidhma, Rakasa, Mahakushtham and Ekakushtham should be considered as offspring of the deranged Kapham. Parisarpa-kush- tham alone is due to the action of the deranged Vayu, while the remaining types (of minor Kushtham) owe their origin to the action of the deranged Pittam. 11.
Kilasam : — The disease known as Kilasam is but another form of Kushtham. It may be divided into three types according as it is brought about through the action of the deranged Vayu, Pittam or Kapham. The difference between Kildsam and Kushtham is that the former confines itself only to the Tvaka (the skin)and is marked by the absence of an}' secretion.* A case of Kilasam caused by the action of the deranged Vayu is circular, vermilion-coloured and rough to the touch. The affected part when rubbed peals off" scales of morbid skin. A case of Kilasam, due to the action of the deranged Pittam, is marked by eruptions, resembling the petals of a lotus flower (^in shape and colour), and are attended with an extrcmcl)- burning sensation. In the type originated through the action of the deranged Kapham, the affected part (skin) assumes a glossy, white colour, becomes thick and is marked by an itching sensation. The form in which the eruptions or patches extend and become confluent, inxading even the soles of the feet,
• A case of Kushtham has its primary ?eat in the blood and skin (of tlie patient), in which it lies confined during the period of incubation, after which it attacks the skin and secretes the characteristic secretion of the deranijed Dosha involved in it.
40
TUF. SUSIIRUTA SAMIIITA. [Chap. V,
the palms of the hands and the region of the anus, and in which the local hairs assume a red colour should be regarded as incurable. A case of Kilasham, which is the outcome of a burn (cicatrix) should be likewise con- sidered as incurable. 12.
A preponderance of the deranged Vayu in a case of Kushtham (leprosy) is indicated by a contraction of the skin, local ana."sthesia, a copious flow of perspiration, swelling, and piercing or cutting pain in the affected part, together with a deformity of the limbs and hoarseness. Similarly, an excess of the deranged Pittam in a case of Kushtham, should be presumed from the suppuration of the affected part, from the breaking of the local skin, from the falling off of the fingers, from the sinking of the nose and ears, from the redness of the eyes and from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapham, in a case of Kushtham, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and KAkanam, which are due to the germinal defect of the patient, are incurable, inasmuch as they involve (according to Dallana) the concerted action of the three simultaneously deranged Doshas from the very outset. 1 3 .
Memorial verses :— As a tree, full grown in the course of time, has driven its roots, which derive their nourishment from the rain water, deeper and deeper into the successive strata of the soil, so this disease (Kushtham), first affecting and confining itself to the upper layers of the skin, will invade the deeper tissues and organs etc. of the patient, if unchecked until al- most all the fundamental principles or elements Dhatus are attacked by its virus in the course of time. 14.
Chap, v.] NIDANA STHANAM. 4I
The symptoms of a case of Kushtbam confined only to the serous (Tvaka) fluid of the skin are the loss of the perception of touch, a scanty perspiration, itching and dis- coloration and roughness of the affected part. The symp- toms which manifest themselves when the disease is con- fined to the blood are complete anaesthesia, horripilation, absence of perspiration, itching and excessive accumu- lation of pus in the affected parts, The symptoms of Kushtham affecting only the flesh arc thickness of the patches, dryness of the mouth, roughness and hardness of the patches which become covered with pustular eruptions and vesicles, and an excruciating pricking pain in, and numbness of, the affected part. The symptoms of (Kushtham) invading the principle of fat only are a fetid smell and an excessive accumulation of pus in the affected part and a breaking of the skin, exposing deep gashing wounds which soon become infested with para- sites. The bod)' seems as if covered with a plaster. Symptoms of (Kushtham) affecting only the bones and the marrow are a sinking (lit : breaking) of the nose, a redness of the eyes, loss of voice and the germination of parasites in the incidental ulcers. Symptoms of the disease restricting itself only to the principle of semen arc a crippled state of the hands and distortion of the limbs, loss of the power of locomotion, spreading of ulcers and all the other symptoms peculiar to the pre- ceding types of the disease. 15— -20.
A child, which is the offspring of the contaminated semen and ovum of its parents afflicted with Kushtham, should be likewise regarded as a Kushthi. 21.
Prognosis: — A case of Kushtham appearing in a person of prudence and discretion and confined only to the serum (Tvaka), flesh and blood of his orga- nism should be regarded as curable. A palliative treat-
6
42
THE SUSIIKUTA SAMIIITA. [Chap. V.
mcnt is the only remedy in cases where the disease is found to invade the principle of fat ; whereas a case where the poison is found to have penetrated into any of the remaining organic principles should be given up as incurable. 22.
Wise men hold that, for killing a 13rahmana, or a wo- man, or (jne of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. The disease reattacki a man even in his next rebirth in the event of his dying with it. Uncurcd Kushtham (leprosy) U the most painful, and most troublesomeof all diseases. 23 — 24.
A Kushthi (leper), getting rid of this foul malady by observing the proper regimen of diet and conduct and by practising expiatory penances and by resorting to proper medicinal measures, gets an elevated status after death. 25.
Kushtham (Leprosy) is a highly contagious disease ; the contagion being usually communicated through sexual intercourse with a leper (Kushthi), or by his touch or breath, or through partaking of the same bed, and eating and drinking out of the same vessel with him, or through using the wearing apparel, unguents and garlands of flowers previously used by a person afflicted with this dreadful disease. Kushtham (Leprosy), fev'er, pulmonaiy consumption, ophthalmia and other Aupasar- gika disease (incidental to the influences of malignant planets or due to the effects of impious deeds) are conimunicated from one person to another. 26.
Thus enJs the fifih Chapter of the Nidanasihanam in the Sushruta Sainhila which treats of the Nidanam of cutaneous afTections (Kushtham).
CHAPTER VI.
Now we shall discourse on the Nidanam of Pra- mcha (diseases of the urinary tracts), r.
It may be prognosticated that an idle man, who indulges in day sleep, or follows sedentary pursuits or is in the habit of taking sweet liquids, or cold and fat-making or emollient food, will ere long fall an easy victim to this disease. 2.
Pathology : —The bodily principles of Vc4\-u, Pittam and Kaphah of such a person get mixed with improperly formed chyle of the organism. Thus deranged, they carry down through the urinary ducts the de- ranged fat, etc.* of the bod)' and find lodgment at the mouth (neck) of the bladder, whence they are emitted through the urethra-j*, causing diseases, known by the (generic) name of Pramsha. 3
Premonitory symptoms :-A burning
sensation in the palms of the hands and of the soles of the feet, a heaviness of the body, coldness or sliminess of the skin and limbs, sweetness and whiteness of the urine, somnolence, lassitude, thirst, a bad-smelling breath, a shortness of breath, slimy mucous deposit on the tongue, palate, phar\-x and teeth, clotted hair and an in- ordinate growth of the finger and toe nails are the indications which mark the advent of the disease. 4.
General Characteristics:— A copious flow
of cloudy or turbid urine characterises all the types of the disease, which, together with the abscesses and eruptions (Pidaka) which mark its sequel, should be
• The particle "cha" in the text denotes other virus or morLific matter. Uallana. • t Remain incarcerated then in acc^rJirg to others.
44 THE SUSHRUTA SAMHITA. [Chap. VI.
regarded as involving the concerted action of the de- ranged Doshas (VAyu, Pittam and Kaphah). 5.
The Kaphaja Types :— Cases of Prameha, which are caused by an exuberance of the deranged Kapham, may be grouped under ten subheads such as, Udaka-meha, Iksliu-nieha, Siird-meka, Sikatd-meha, S'a- nai-meha, Lavana-meha, Pislita-tneha, Sdndra-meha, S'uk- ra-meha and PJiena-7ncJia. The ten aforesaid types are curable, inasmuch as the medicines which tend to remedy the deranged Kapham (Dosha), the cause of the disease, prove also remedial to the other principles of the body (flesh, marrow, blood, semen etc) deranged (Dushya) from the same causes. 6.
The Pittaja Types : —The types, which are brought about through an exuberance of the deranged Pittam, are named as Nila-rneJia, Haridrd-meha, Amla- meha, KsJidra-meha, Ma?ijishthd-ineha, and S' onita-meha. Palliation is all that can be effected in these types, inasmuch as the medicines which tend to correct the de- ranged Pittam, which has brought on the disease, fail to exert similar virtues on the organic principles (Dushyas) deranged by it. 7.
The Vataja Types :— The types of Prameha which are produced by an aggravated condition of the bodily Vayu are divided into four subgroups, such as Sarpi-nieJia, Vasd-meJia^ Kshoudra-mcha and Hasti-7neha. These should be regarded as most incurable inasmuch as no kind of medicine can restore the fleet-coursing, deep diving [ie. invading the bones and the marrow) Vayu, which at the same time also augments the Pittam, to its normal state and thus advances (unchecked) in its work of disintegration. 8.
The deranged Kaphah, in conjunction with the (morbid) Pittam, Vayu and fat, gives rise to all Kaphaja
^h^P- VI. i^IDANA ST li AN AM.
4S
types of Prameha. The deranged Pittam, in conjunc- tion with the deranged Vayii, blood, fat and Kapham, produces the Pittaja ones ; while the deranged Vayu, in unison with the deranged Kapham, Pittam, fat, marrow and Vasa (myosin), engenders the types of Vataja Prameha. 9.
Symptoms Of Kaphaja IVIchas : -The
urine* of a person suffering from an attack of Udaka- meha becomes white and water-like and is passed without the least pain. In a case of Ikshnmeha the urine resembles the expressed juice of sugarcane. It has the colour of wine in a case of Surameha. The urine in a case of Sikatamsha is passed with pain and is found to leave a sediment of extremely fine and sand-like concretions (Si/catas). In a case of Sanaimeha the urine gushes out at intervals in jets and is charged with a slimy mucous (kaphah). The urine in a case of Lavauamelia becomes limpid (non-viscid) and acquires a saline taste. There is horripilation at the time of micturition in a case of Pishtameha (Chyluria), the urine resembling a stream of water, charged with a solution of pasted rice (Pishtam).
In a case of Sandra,meha, the urine becomes thick and turbid, while in a case of Sukrameha the urine resembles semen (or the urine is found to be charged with semen :— Madhaba). In a case of
* Tl e Sanskiit term Meha literally means to micturate. The verbal noun Mehanam signifies urination as well as the act of passing any morbid urethral fecretion. Hence the urine in most of these cases denotts the fact of its being charged wiih pus or any other morbid secretion of the urinary oigans such as Oj.ih (albumen), marrow, etc., which imparts thiir characteristic colours to the fluid, —a fact which determines the nomen- clature of the disease and forms the keynote of its diagnosis in the Ayurveda. — Ed.
46 THE SUS[IRUTA SAMIIITA. [Chap. I.
Phenamelia the patient passes frothy urine in broken jets. lO.
Symptoms of Pittaja IVIchas:— Now wc
.shall describe the characteristic features of the types of Pramcha, which arc due to the action of the deran<^cd Pittam, The urine in a case of Nilameha becomes froth}', transparent and bluish. The urine in a case of Haridramaha becomes deep yellow like turmeric (Haridra) and is passed with a burning pain. The urine in a case of Amlameha acquires an acid taste and smell. The urine in a case of Ksharameha* resembles an alkaline solution filtered (through a piece of linen). The urine in a case of MaDJisthameha resembles the washing of the Manjisthd, while in a case of Raktameha, the urine is found to be of blood-colour or charged with blood - ]\I;idha\a). 1 1 .
Symptoms of Vataja-IVIehas :— Now we
shall describe the characteristics o{ the different types of Pramcha, which are due to an exuberance of the deranged VayLi- ^'i ^>- case of Saipimeha, the urine looks like a stream of clarified butter, while in one of Vasameha it resembles the washings of Vasa. In a case of Kshaudramelia, the urine looks like honey and acquires a sweet taste. In one of Hastimeha, the patient passes a copious quantity of urine, like an excited elephant, at a time, and in one unbroken stream, (the organ becoming steady immediately after the act of micturition). I3.
Supervening symptoms :— The fact of
the urine being assailed b)- a swarm of flies, lassitude, growth of flesh (obesity), catarrh, looseness of the limbs, a
* The urine acquires a distinct alkaline taste, smell, colour and touch. (Madhaba Nidanain).
t Charaka has included it within Kshaudra Meha and Madhu Me a. -
Chap. VI.] NIDANA STHAXAM. 47
non-relish for food, indigestion, expectoration of mucous, vomiting, excessive sleep, cough and laboured breathing (Svasa) are the supervening traits (Upadrava) of the Kapbaja Prameha. A piercing pain in the testes, a pricking (vcda) pain in the bladder, a shooting pain (Tuda) in the penis, a griping pain at the heart, acid eructations, fever, dysentery, a non-relish for food, vomiting, a sensation as if the entire body is emitting fumes, a burning sensation in the skin, thirst, epileptic fits, insomnia, jaundice (Pandu) and a )ellow colour of the stool and urine arc the supervening symptoms which mark the Pittaja types of Prameha. An oppressive feeling at the heart (Hridgraha), eager longings for foods of all tastes, insomnia, numbness of the body, fits of shivering, colic pain and constipation of the bowels are the supervening symptoms, which specifically mark the Vataja types. Thus we have described the nature of the twenty different types of Meha with their supervening evils as well. 13-16.
The ten different types of Pidaka (abscess, carbun- cles, pimples, pustules etc.) arc found to crop up on the bodies of patients, suffering from Prameha, and abounding in fat and Vasa, and whose fundamental principles have been affected b\- the simultaneous derangement of the Vayu, Pittam and Kapham. They are named as Siravika, Sarshapika, Kachchapika, Jalini, Vinata, Putrini, Masurika, Alaji, Vidarikal and Vidradhika i/- lYletrical Texts :— An abscess which is raised at the margin and dipped in its centre, so as to resemble an Indian saucer in its shape is called Saravika. Pimp- les or pustules of the shape and size of white mustard seeds are called Sarshapika'. An abscess, resembling (the back of) a tortoise in shape and attended with a burning sensation, is called Kachchapika by the wise.
48 THE SDSHRUTA SAMHITA. [Chap. VI.
An abscess studded with slender vegetations of flesh and attended with an intolerable burning sensation is called Js^liiii. A large blue-coloured abscess (carbuncle) appearing on the back or the abdomen, and exuding a slimy secretion and attended with a deep-seated pain is called Vinata A thin and extensive abscess (studded withslender pustules — D.R.) is called Putrini. Pimples to the size of lentil seeds are called Masurika. A dreadful abscess which is of a red and white colour, studded over with blisters or exuding vesicles is called Alaji. A hard and round abscess as large as a (full-grown) gourd is called Vidsirika'. An abscess of the Vidradhi type is called Vidradhika (carbuncle) b)' the wise. An incidental abscess in a case of Prameha should be regarded as having its origin in the same morbific principle (Dosha) as that which has produced the disease (Prameha) 18-28.
Prognosis : — A Pidaka,or an abscess, appearing about the region of the heart, anus, head, shoulder, back or at any of the vital joints (Marma) of the body, and attended with other supervening symptoms producing extrom:; prostration [impaired digestion — D. R.] in the patient should be abandoned as incurable. In a case of Vataja mcha, the deranged Vayu presses all the fundamental principles out of the body through the urethra and rages rampant in the lower part of the body, united with the deranged fat, marrow and Vasa. llcncc a case of Vataja mcha, (or its accompanying abscess), is held as incurable. 29-30.
A person in whom the premonitory symptoms (Pur- varupam of Prameha) have appeared and who passes a little larger quantity of urine than usual, should be considered as already afflicted with it. A person afflicted with all or half of the premonitory symptoms of the disease and passing a copious quantity of urine
Chap- VI. NIDANA STHANAM.
49
should be considered as one suffering from an attack of Prameha. 31 — 32.
A Prameha patient afflicted with deep-seated absces- ses and other distressing symptoms, which are usually found to supervene in the disease, should be pronounc- ed as suffering from Madhumeha and adjudged incurable. A Madhumeha patient seeks a halting place while walk- ing, wants a place to sit on while halting, lies down if he finds a sitting place, and sleeps if he lies down. ^^ — 34.
As five mixed colours such as grey, brown, Kapila (bluish yellow), Kapota (blackish grey), Mechaka (light-green) may be produced by combination of the five primary colours in definite proportions (such as white, green, black, yellow and red), so a diversity of causes, through the relative preponderance of the parti- cular kinds of food, and of the deranged Doshas, root principles (Dhatu) and excretions of the body (Mala), may be attributed to the origin of Prameha. 35.
IVIemorial verses :— All types of Prameha, not properly treated and attended to at the outset, may ultimately develop into those of Madhumeha types, which are incurable. 36
For English equivalents of the different types of Prameha compare : — Cystitis (Acute Infective) — Frequent, painful micturition, small quantity of urine voided with pain and urgency. Urine — slightly acid or alkaline in reaction, cloudy, containing blood corpuscles. Cystitis (Chronic Infective) — Great and frequent pain, in the lumbar region, rigor. Urine — thick, offensive and alkaline, containing ropy mucous and blood. Cystitis (Non- Infective) — Symptoms like those of acute inflammatory type. Urine- acid and cloudy with mucous. Blood is generally present in considerable quantity. Neuralgia of the bladder, compare Albuminuria, Albumosuria, Hoemoglobinuria, Hcematuria, Peptonuria, Pyuria, Spermatorrhoea and Diabetes, Proteuria and Polyuria.
Thus ends the sixth Chapter of the Nidana Sthanam in the Sushruta Samhita, which treats of the Nidanam of Prameha.
CHAPTER YII.
Now wc shall discourse on the Nidanam of Udara
(dropsy with an abnormal condition of the abdomen), i.
IVIctrical Text : — The royal sage Dhanvan- tari, the foremost of all pious men who equalled in splendour and glory the lord of the celestials, thus blissfully discoursed on the Nidanam of Udara to Sus'ruta, the son of the holy Vis'vamitra, who devoutly approached him for that purpose. 2.
Classification : — This disease may be divided into eight different types, of which four are produced by the several actions of the three deranged Doshas of the body and their concerted action as well. Of the re- maining types, two being known as Plihodara (including Yakritodara), and Vaddha-Gudodara (tympanites due to the constriction of the anus), the seventh Agantuka (traumatic or of extraneous origin), and the eighth Dakodara (Ascites proper). 3.
Predisposing Causes :— The deranged
Doshas of a person of extremely impaired digestion, addicted to the habit of taking unwholesome food, or of eating dry, putrid food, or of violating the rules of conduct to be observed in connection with oleaginous measures etc.,* are aggravated and find lodgment in the abdomen. Thus appearing in the shape of an abdomi-
, nal tumour (Gulma), they give rise to this dreadful disease, attended with all its characteristic symptoms. The lymph chyle formed out of the assimilated food gets vitiated,
•and, impelled by the aggravated Vayu, it percolates
* These include purgative, emitic, A'stha'panam and Anuva'sanatu mesisures.
Chtp. VII.] NIDANA STHANAM. 5'r:
through the peritoneum in the same manner as a quantity of oil or clarified butter kept in a new earthen pot will- transude through the pores of its sides. It thus gradually distends the skin (Tvak) of the abdomen. The process becomes general all through the abdominal region and" the disease (Udara) is produced in consequence. 4—5.
Premonitory sypmtoms :— The precursory
S}'mptoms of the disease are loss of strength, complexion and appetite, emaciation of the muscles of the abdomen, appearance of veins on its surface, acid reaction of food closely following upon its digestion (Vidaha\ pain in the bladder, and swelling of the lower extremities. The patient cannot ascertain whether his meal has been digested or not. 6.
The Vataja, Pittaja, and Kaphaja
Types : — -A case of Udara in which the abdomen en- larges on its sides and posterior part, and is over- spread with nets of black veins should be ascribed to the action of the deranged Vayu. A pain (Sula), suppression of the stool and urine (Anaha) and a cutting and piercino- pain and flatulent rumbling in the intestines are the symp- toms which likewise characterise this Va'taja form of Udara. A sucking pain in the abdomen, thirst, fever with a burning sensation, yellow colour of the swollen skin of the abdomen, on the surface of which yellow veins appear, yellow colour of the eyes, nails, face, stool and urine and the rapid increase of the dropsical swelling, are the characteristics of the Pittaja Udara. In a case of Kaphaja type the dropsical swelling is cold to the touch and becomes overspread with white-coloured veins. The abdomen seems heavy , hard, glossy and is extreme- ly distended. The swelling slowly increases, -and the finger- nails and face of the patient become white, and he complains of a general lassitude, y—.g. \
52 THE SUSHRUTA SAMlliTA. IChap. VII.
The TridOShaja Type :— Evil-naturcd wo- men (with a view to win the affections of their husbands or lovers sometimes) mix with their food and drink such refuse matters of their bodies as nails, hair, faeces, urine, catamenial blood etc. (which are supposed to be possessed of talismanic virtues). The three Doshas of the body, vitia- ted by such food or drink, or through imbibing any sort of chemical poison (Gara) administered by one's enemy, or by taking poisonous waters, or Uushi-Visha (slow poison whose active properties have been destroyed by fire or any antipoisonous medicine), will vitiate the blood and give rise to a kind of dreadful dropsical swelling of the abdomen, marked by the specific symptoms of each of them The disease is aggravated in cold and cloudy days and a burning sensation is felt (in the inside of the abdomen). The patient becomes pale, yellow and emaciated, and is afflicted with thirst and dryness in the mouth, and loses consciousness at short intervals. This disease is also known as the dreadful Dnshyodaram. lo. Plihodaram. — (Spleen with dropsy of the abdo- men) : — Now hear me describe the symptoms of Pliho- daram. The blood and the Kapham of a person, derang- ed and aggravated through the ingestion of phlegma- gogic food, or of those which is followed by an acid digestionary reaction (Viddha), often enlarge the spleen, (which gives rise to a swelling of the abdomen). This disease is called Plihodara by the experts. Plihodaram protrudes on the left side of the abdomen, its characteristic symptoms being lassitude, low fever, impaired digestion, loss of strength, jaundice, weakness, and other distress- ing symptoms peculiar to the deranged Pittam and Kapham. A similar enlargement of the liver through similar causes on the right side of the abdomen is called Jakriddailyudarain. ii — 1 2.
Chap. VII.] N I DANA STHANAM.' 53
Vaddha-gudodaram* :— The fecal matter,
mixed with the deranged Vayu, Pittam etc. of the body, lies stuffed in the rectum of a person whose in- testines have been stuffed with slimy food (as pot herbs) or with stones and hair (enteritis). They give rise to a sort of abdominal dropsy by swelling the part between the heart and the umbilicus which is called Vaddha Gudodaram. Scanty stools are evacuated with the great- est pain and difficulty and the patient vomits a pe- culiar kind of matter with a distinctly fecal smell (scyabalous ?). 13.
Parisravi-Udaram :— Now hear me describe the causes and symptoms of the type of Udaram which is called Parisravi-udaram. Thorny or sharp-pointed substances (such as fish-bones etc.), carried down with the food in a slanting way from the stomach into the abdomen, sometimes scratch or burrow into the intes- tines. Causes other than the preceding ones, (such as a long yawn or over-eating etc.) may contribute to the perforation of the intestines, giving rise to a copious flow of a watery exudation which constantly oozes out of the anus and to a distension of the lower part of the abdomen situated below the umbilicus. This is called Parisravyudaram which is marked by a cutting pain and a burning sensation. 14.
Dakodaram : — Now hear me describe the causes and symptoms of the type known as Dakodaram (ascites\ The drinking of cold water immediately after the application of an Aunvasanam or Asthapanam enema, or closely following upon the exhibition of any purgative or emetic medicine, or just after the taking of a medicated oil or clarified butter, etc. tends to derange
* Dropsical swelling of the abdomen with tympanites due to the cons- triction of the rectum known as intestinal obstruction.
§4' THE SUSHRUTA SAMHITA. ' [Chap. VII.
the water-carrying channels of the body. The same result may be produced by the drinking of oil, etc. in inordi- nate quantities The water, b)- percolating or transud- ing through the walls of these channels, as before des- cribed, inordinately enlarges the abdomen, which be- comes glossy on the surface and is full of water, being rounded about the umbilicus and raised like a full- bloated water-drum. The simile is complete as it fluctuates under pressure, oscillates, and makes a pecu- liar sound like a water-drum under percussion. 15.
Distension of the stomach, incapacity of locomotion, weakness, impaired digestion, cedematous swelling of the limbs, a general sense of lassitude and looseness in the limbs, suppression of flatus and stool, and a burning sensation and thirst are among the general characteris- tics of the disease in its various forms. 16.
Prognosis : — All cases of Udaram after the lapse of considerable time develop into those of ascites, and a case arriving at such a stage should be given up as incurable. 16 — 17.
Thus ends the seventh Chapter of the Xidana Sihanam in the Sub'rut* Sanihitd which treats of the Nidanam of Udaram.
CHAPTER Vm.
Now we shall discourse on the Nidanam of IVIUClhag'ai*bham (false presentations and difficult labour), i .
Causes of lYIudha-garbham : -Sexual
intercourse during pregnancy, riding on horseback, etc., or in any sort of conveyance, a long walk, a false step, a fall, pressure on the womb, running, a blow, sitting or lying down on an uneven ground, or in an uneven posture, fasting, voluntary repression of any natural urging of the body, partaking of extremely bitter, pungent, parchifying articles, eating in inordinate quan- tities of Sakas and alkaline substances, dysentery (Atisara), use of emetics or purgatives, swinging in a swing or hammock, indigestion, and use of medicines which induce the labour pain or bring about abortions, and such like causes tend to expel the faetus from its fixture. These causes tend to sever the child from the uterine wall with its placental attachment owing to a kind of Abhighatam (uterine contraction) just as a blow tends to sever a fruit from its pedicel. 2.
Definition :^The faetus, thus severed and dislodged from its seat, excites peristalsis not only in the uterus, but induces a sort of constant, spasmodic contraction of the intestinal cavities (Koshthas), pro- ducing pain in the liver, spleen, etc. The Apana Vayu, thus obstructed through the spasmodic contraction of her abdomen, produces any of the following symp- toms, viz. a sort of spasmodic pain in the sides, or in the neck of the bladder, or in the pelvic cavity, or in the abdomen, or in the vagina, or Anaha (tymp- anites with obstruction, etc.) or retention of urine,
56 THE SUSHRUTA SAMHITA. [Chap. VIII.
and destroys the faetus, if immature, attended with bleeding. In case the faetus continues to develop and is brought in an inverted posture at the entrance to the vaginal canal, and is impacted at that place, or if the Apana Vdyu gets disordered and conse- quently cannot help the expulsion of the same, such an obstructed faetus is called Mudha garbhah. 3. Classification and Symptoms: -Cases
of Aludha-garbha may be roughly divided into four different classes such as, the Kilah, the Pratikhurah, the Vijakah and the Parighah. The sort of false presentation in which the child comes with its hands, legs and head turned upward and w^ith its back firmly obstructed at the entrance to the vagina, like a stake or a kila, is called Kilah. The sort of presentation, in which the hands, feet and head of the child come out, with its body impacted at the entrance to the vagina, is called Prathikhurah- The type in which only a single hand and the head of the child come out (with the rest of its body obstructed at the same place), is called the Vijakah. The type in which the child remains obstructing the head of the passage in a horizontal position, like a bolt, is called the Parighah. Certain authorities aver that, these are the only four kinds of Mudhagarbha. But we can not subscribe to the opinion (which recognises only four kinds of false presentations), inasmuch as the deranged Vayu (Apana) can present the faetus in various different postures at the head of the vaginal canal. Sometimes, the two thighs of the child are first presented, and sometimes it comes with a single leg flexed up. Sometimes the child comes with its body, bent double, and thighs drawn up, so that only breech is obliquely presented. Sornetimes the child is presented, impacted at the head
Chap. VIII.] NIDANA STHANAM.
57
of the passage with its chest, or sides, or back. Some- times the child is presented with its arm around its head, resting on the side, and the hand coming out first. Sometimes only the two hands are first presented, the head leaning on one side; sometimes the two hands, legs and the head of the child, the rest of the body being impacted at the exit in a doubled up posture. Some- times one leg is presented, the other thigh bsing impacted at the passage (Payu). I have briefly described these eight sorts of presentation of which the last two are irremediable. The rest should be given up as hopeless if these are attended with the following compli- cations viz., deranged sense- perception of the mother, convulsions, displacement or contraction of the repro- ductive organ (yoni) a peculiar pain like the after-pain of child birth, cough, difficult respiration, or vertigo. 4.
Memorial verses :— /^s a fruit, fully matured, is naturally severed from its pedicel and falls to the ground and not otherwise, so the cord, which binds the foetus to its maternal part, is severed in course of time, and the child comes out of the uterus ( into this world of action ). On the other hand, as a fruit, worm-eaten or shaken by the wind or a blow, untimely falls to the ground, so will a fcetus be expelled out of its mother's womb, before its time. For four months after the date of fecundation, the faetus remains in a liquid state, and hence its destruction or coming out of the womb goes by the name of abortion. In the course of the fifth and sixth months the limbs of the foetus gain in firmness and density, and hence, its coming out at such a time is called miscarriage. 5-7.
PrOgTIOSiS ; — The enceinte who violently tosses her head in agony (at the time of parturition) and the surface of whose body becomes cold, compelling
3
58 THK SUSHRUTA SAMHITA [Chap. VIII.
her to forego all natural modesty, and whose sides and abdomen arc covered with nets of large blue- coloured veins, invariabl)' dies with the dead child locked in her W(jmb, The death of the frjetus in the womb may be ascertained by the absence of movements of the ftetus (in the womb) or of an)- pain of child-birth, by a brown or yellow complexion of the cnccinta, cade- verous smell in her breath, and colic pain in the abdomen and its distension owingto the continuance of the swollen and decomposed child in the womb. 8-9.
The death of a child in the womb may result from some emotional disturbance of its mother, (such as caused by bereavement or by loss of fortune during pregnancy) ; while an external blow or injury (to the womb) or an\' serious disease of the mother may also produce the like result. A child, moving in the womb of a dead mother, who had just expired (from convulsions etc.) during parturition at term, like a goat (Vast/imAra) should be removed immediately by the Surgeon from the womb (by Caesarean Section) ;* as a delay in extract- ing the child ma\- leads to its death 10-: i.
* Csecsarean Section means incision of the uterus through the abdomi- nal walls and extrication of the foetus therefrom. Operation like this upon a dead subject requires no skill of a surgeon. Any one can do it without the help of any anilomical knowledge. In modern times, when the mother's life is in peril, and the expulsion of the foetus becomes nearly impossible, by the natural passage, owing to an existenee of deformity either in the parturient canal or in the forms and structures of the foetus, to save both mother and child this operation is principally undertaken.
The eviJence of similar attempts, in ancient India, is found recorded in passages like what we have just translated and that the operation was practised on living subjects, there is not the least doubt about it. This custom is still preserved in Central Africa, and it is possible that the Egyp- tians like Hindu philosophy and religion learnt this also from the Hindus. "Felkin," says "Baas in his History of Medicine p. 70 "saw a case of the Csesarean operation in Central Africa performed by a man. At one stroke
Chap. VIII.] XIDAXA STHANAM. ^0
Additional Text :— The bladder is ruptured, the dead child lies like a weight upon the placenta and is pressed upward on the spleen, liver and gall bladder. The mother shivers and is oppressed with tremor, dryness of the tongue, dyspnrea and perspiration. She complains of a cadaverous smell in her breath and stands in danger of imminent death. By these symptoms a physician shall know the death of the child in the womb. This portion is partly recognised by Brahmadeva and is totally rejected by Jejjadacharya as spurious.
an incision was made through both the abdominal walls and the uterus. The opening in the latter organ was then enlarged, the haemorrhage checked by the actual cautery, and the child removed. While an assis- tant compressed the abdomen, the operator then removed the placenta. The bleeding from the abdominal walls was then checked. No sutures were placed on the walls of the uterus but the abdominal parietes were fastened together by seven figure-of-eight sutures, formed with polished iron needles and threads of bark. The wound was then dressed with a paste prepared from various roots, the woman placed quietly upon her abdomen, in order to favour perfect drainage, and the task of the African Spencer Wells was finished. It appears that the patient was first rendered half unconscious with banana wine. One hour after the operation the patient was doing well. And her temperature never rose above loi F. nor her pulse above io8. On the eleventh day the wound was completely healed, and the woman apparently as well as usual."
When we read this evidence of Felkin, we are reminded of the opera- tive steps as described in our own ancient book of Surgery from which modern surgeons have been able to borrow the operation of rhinoplasty. It is a great pity that while in Africa the same practice is still retained intact, we in India by spurious attempts and disgraceful contortions, subs- titutions of false readings and dismal knowledge of grammar and rhetoric try to prove in the face of strong evidence that in ancient India Cesarean Section was at'empted only on cases where one "might not perspire."
If we take r2fqiliqi: in the sense of "a woman whose life is in great danger" and not exactly in the sense of "a woman who is dead" as recom- mended by Dalian and Arundutla (and which might have been the meaning if instead of f^qg a word like sjiiqn had been used in the text), we find at once that Weber's remark in his History of Indian Literature p. 270 "that in Surgery they (the Hindus) attained to high proficiency" is not based on the solitary evidence of rhinoplasty alone.
In performing obstetric operations with success examples like this are not rare. If the two diflTerent readings ^^ITI^ ^"<^ <?f%51'C betaken con- jointly into consideration we are impressed with the idea that in ancient
6o THE SUSriRUTA SAMHITA. CChap. VIII.
India Cicsarean operations were very frequently undertaken in cases of puerperal eclampsia, where the molher had been in the deplorable condi- tion of a goat sufTerin}^ from cramps and convulsions as well as in cases of an accidental death not unlike that which fell to the lot of the poor molher of him in whose nnme the operation is called. q^ = goat»in = destroyer (Sec Monier William's Dictionary) hence a goat-destroyer = a tiger or wolf) or in cases where the presence of deformity in the parturient canal or of maUormalion of the foetus prevented the natural delivery of a living child. The incision is not to be made anywhere else but exactly in the place where Kelkin saw the illiterate Negro successfully apply his knife, the selection of !(f^' ({{^^ as suggested by some commentators being a tempest on a tea pot especially when the subject is beyond the grave. In a living subject the selection of a proper site for the o,"eration is of course very commendable. Hence we venture to suggest that extraction of the living foetus from the womb by making incision through this part of the pelvis was also attempted later on. We extract here the two dififerent readings and leave our readers to judge whether we are correct to draw the above inferences. — Ed.
^r«fi^ ^^^^\^\: f,fg : H^^e^ qf? oi5?i«i% ori: ai^.^ qij^sc^^^-
r^?'^ I Bagabhala S'arira S'.hanam. ch. II. slo. 53.
^ft^^\K U^^w. ffg: v^^'H gf? ?i?igiii5^^*i% « m^fqc^;*?-
Thus ends the eighth Chapter of the Nidana Sthanam in the Sus'ruta Samhitd, which treats of Niddnam of difficult labour and false presenta- tions.
CHAPTER IX.
Now \vc shall discourse on the Nidanam of Vidradhi (abscess etc.). I.
The blessed Dhanvantari, the honoured of the gods, who for the promulgation of the knowledge of the Ayurveda and for administering proper medicines (to the sick), took his birth at Kasi, (Benares) as a king, thus fully discoursed on the symptoms of Vidradhi (abscess etc.) to his disciple, Sus'ruta. 2.
Definition and classification :— The
extremely deranged and aggravated Vayu, Pittam and Kapham, resorting to the bone and vitiating the Tvaka ( skin ), blood, flesh, and fat of a person (with their own specific properties), gradually give rise to a deep-seated, painful, round or extended swelling which is called Vidradhi by the wise. The disease admits of being divided into six types such as the Vataj'a t>-pe, the Pittaja type, the Kaphaja t\'pe, the Sannipatika type, the Kshataja type (traumatic), and the Asrija i^which has its seat in the vitiated blood). Now we shall describe their specific symptoms. 3-4,
The Vsttaja Type : — This abscess assumes a black Or vermilion coKnir, is felt rough to the touch and is characterised by a sort of excruciating pain. The growth and suppuration of the abscess are brought about in a variety of forms (owing to the variable and irregular action of the deranged Vayu inolvcd in these cases). 5.
The Pittaja Type : — This abscess assumes a blackish }clIow colour or one like that of a ripe Audum- vara fruit. It is attended with fever and a burning sensation, and is of rapid growth and suppuration. 6.
62 NIDANA STHANAM. Chap. IX.]
The Kaphaja Type:— This abscess is shaped like an Indian saucer (s'arava) and seems cold to the touch. It assumes a light yellow colour and is character- ised by numbness, itching and little pain. The growth and suppuration of this abscess is very slow. The secretions from a Vataja abscess are thin, those from a Pittaja type are yellow, while the exudations from a Kaphaja abscess arc white. J.
The Sannipatika Type:— An abscess of
the Sannipatika type is of varied colour, and is attended with a varied sort of pain (sucking, drawing, turning etc.) and exudes secretions of various colours (white, yellow, etc.). It is little raised or elevated at its top, large and irregular in its shape and does not uniformly suppurate in all its parts. 8,
Agantuja or Kshataja Type :-~The local
or inherent heat of an ulcer, (caused by a blow or a dirt) in a person, addicted to unwholesome regimen, is augmented and conducted by the deranged Vayu and vitiates the blood and Pittam, thus giving rise to a kind of abscess which is known as the Agantuja Vidradhi (traumatic abscess). Symptoms of the Pittaja type like- wise mark this type of abscess and fever, thirst and a burning sensation attend it from the very beginning. 9.
The Raktaja Type: — This abscess assumes a black or tawny colour, covered with a large number of black vesicles, and fever and an intolerable burning and pain attended with all the symptoms peculiar to the Pittaja type, mark the present form of the disease. It is called Raktaja Vidradhi. Of external Vidradhis or abscesses, those of the Sannipatika type should be regarded as incurable. 10 — 1 1.
Antara-Vidradhi ;— Now we shall describe the characteristic features of internal abscesses (Antara-
[Chap. IX. THE SUSHRUTA SAMHITA . 63
Vidradhi). The Vdyu, Pittam and Kaphah of the body, deranged through eating heav}-, incompatible and in- congenial (to the physical temperament of the eater) articles of food or of dr\-, putrid and decomposed sub- stances, or by excessive coition and fatiguing physical exercise, or by voluntary repression of any natural urging of the body or through the eating of food which is followed b\' an acid reaction, either severally or collectively give rise to a tumour-like (Gulma), raised, or elevated abscess in the interior of the organism, which is often felt to be shaped like an ant-hill. 12-13.
Localities: — They are generally found to be seated at the mouth (neck) of the bladder, or about the umbilicus, or in the sides, or in the Kukshi (inguinal regions), or on the Vrikkas, or on the liver, or in the heart, or on the Kloma, or on the spleen, or in the rectum. Their general characteristics are identical with those of the several types of external abscess. The symptoms of their suppurated or unsuppurated stages should be determined in the light of the chapter on Amapakvaishanyiam (Ch XVII Sutra.). 14-15.
Their specific symptoms : -Now hear
me describe the symptom.s which specifically mark these internal abscesses according to their seats in the differ- ent regions of the organism. An abscess appearing in the restum (Guda) is marked by the suppression of the flatus (Vata). Seated in the bladder, it gives rise to difficulty of urination and scantiness of urine. Appearing about the umbilicus it produces a distressing hic-cough and a rumbling sound (Atopa) in the intes- tines. Seated in either of the sides (Kukshi) it tends to aggravate inordinately the vayu of the body. Appear- ing in the inguinal region it gives rise to an extreme catching pain at the back and waist. Seated in either
64 NIDANA STHANAM [Chap. IX.
of the Vrikkas it brings about a contraction of the sides. Appearing on the spleen, it produces symptoms of difficult and obstructed respiration. Seated on the heart it gives rise to an excruciating and piercing pain within its cavity and a drawing pain (Graha) extending all over the body (D. R. — cough). Seated in the Liver its characteristic indications are thirst and difficult breathing (D. R. — hic-cough) whereas a sort of unquen- chable thirst is the symptom which marks its seat on the Kloma. 16-17.
Prognosis : — An abscess appearing on any vital part (Marma) of the organism, whether large or small in size, suppurated or unsuppurated, should be deemed' as extremely hard to cure. Discharge from an abscess formed in the region of the organism above the umbilicus and (spontaneously bursting), will flow out through the mouth whereas similar secretions from down the umbilical region of (the abdomen), naturally find an outlet through the fissure of the anus. The case •in which the secretions (pus etc.) find a down- ward channel and outlet may end in recovery of the patient, whereas the one in which the secretions take an upward course invariably proves fatal. An incision made by surgeon from the outside into an internal abscess, other than the one situated on the heart, or on the bladder or on the umbilicus may occasionally, prove successful, but the one, seated on any of the preceding vulnerable visceras (heart, bladder etc.) of the body and surgically opened invariably ends in death. 18-19.
A woman, who has miscarried or has been even safely delivered of a child at term, may be afflicted with a dreadful abscess in the event of her taking injudi- cious and unhwholcsome food after parturition. The abscess in such a case, which is attended with extreme
Chap. IX.] NIDANA STHANAM. 65
hyper-pyrexia (Da hajvara) should be considered as having had its origin to the vitiated blood (Raktaja Vidradhi) accumulated in the organism. The abscess, which appears in the Kukshi (in the iliac region) of a safely delivered woman owing to the presence of the unexpelled blood-clots in those regions after child- birth, should be also diagnosed as a case of Raktaja abscess. The unexpelled blood is called Makkalla. Such an abscess, if not absorbed in the course of a week, is sure to suppurate. 20 - 21.
Differentiating diag^nosis of Gulma and Vidradhi* :— Now I shall discuss the features
which distinguish a Gulma (internal tumour; from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration ? 22— 23. The answer is that a Gulma (^internal tumour', though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity
* A Gulma according !o Sus'nm does not supjniraU', bnl ihc term "Api" (also) contemplates instances in which a Guln.a may suppurate as in the case where it has got its basis in the dernnged flesh etc. of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestionnry acid reaction, colic pain, insomnia with !tver and a non-relish for food and a sense of oppression, etc. are the symp- toms which indicate that suppuration has set in a Gulmn, and he advises that it (Gulma) should be treated with poultices, etc.
ee THE SUSHRUTA SAMHITA. [Chap. IX.
of the body etc. without any fixed root of its own. Hence, it is that a Gulma (internal tumour) does not suppurate at all. Suppuration sets in in an abscess only because it largely contains flesh and blood unlike a Gulma (internal tumour) which is not formed of any such organic matter, and depends only on the aggravated Doshas giving birth to it. Hence, a Gulma does not suppurate at all. 24.
Incurable Types : — A case of an internal abscess suppurating about the heart, bladder or umbilicus as well as one of the Tridosha type (appearing in any part of the organism) should be given up as in- curable. The abscess in which the marrow suppurates (generally) becomes fatal. The suppurating process in an internal abscess, which generally affects the under- lying bone, is sometimes found to affect the marrow. The suppurated marrow, failing to find an outlet on account of the compactness of the local flesh and bone, produces a sort of burning sensation in the locality which consumes the body like a blazing fire. The disease confined to the bone, like a piercing dirt, torments the patient for a considerable length of time. An incision (made into the affected bone) is followed by the secretion of a fat-like, glossy, white, cold and thick pus. Men, learned in the knowledge of the Medicinal Sastras, designate such an abscess as an Asthighata-Vidradhi (abscess of the bone) which involves all the three kinds of deranged Doshas, and is attended with various kinds of pain w hich mark them respectively. 25-26.
Thu'^ rnrls th' ninili Chapler of the Nidanasthanam in ihe Sii^'mta Siimliiid which treats o(the celiology of absccs.?.
CHAPTER X.
Now we shall discourse on the Nidanam of Visar-
pa (erysipelas), Nadi (sinus) and Stana-roga
(diseases affecting the mammae of a womanl i.
Definition of Visarpa :— The deranged and aggravated Doshas, (Vayu, Pittam and Kapham) having recourse to, and affecting the Tvaka (Skin), flesh and blood, speedily give rise to a sort of shifting, elevated swelling ( Sotha) marked by the characteristic symptoms of any of them involved in the case. This swelling tends to extend all over the body. The disease is called Visarpa from the fact of its extending or swiftly shifting character (Skr. srip —to go, to extend). 2.
The Vataja Type :— The swelling (Sotha) is soft and rough and assumes a black colour attended with an aching pain in the limbs and a cutting or piercing pain (in the affected locality). It is further marked b}' (all the usual! symptoms of the Vatika fever. A case of this type in which uneven flame coloured \esicles or bulbs appear on the affected part through the extreme vitiation (of the Vayu and Pittam) should be given up as incurable. 3.
The Pittaja and Kaphaja Types : - The
Pittaja Visarpa (erysipelas) rapidly extends (over the body, attended with severe fever, a burning sensation, suppuration and cracking (of the skin . A large number of vesicles appears on the spot which as- sume a blood-red colour. A case of this t}'pe, characterised by the destruction of the local flesh and veins owing to the excessively aggravated condition of the deranged Doshas (Kaphha and Pittam) and a
68 Tin: SUSllKUTA SAMIIITA. [Chap. X.
coll}'rium-likc black colour (of the swelling), should be regarded as incurable. The Kaphaja Visarpa extends slowly and the process of suppuration is tardy. The affected part becomes white, glossy and swollen, and is marked by a slight \n\.\n and excessive itching. 4-5.
The Sannipatika Type : -The Visarpa of
the Tridoshaja type is deep-seated and the affected part assumes all colours and is attended with all sorts of piin which are peculiar to the three aforesaid types The local flesh and veins arc destroyed in the suppurating stage (jf this disease and hence, it shouldbc looked upon as incurable 6.
The Kshataja Type (Erysipelas due to a wound or an ulccri:— The Pittam of a person with a temperament marked by the extreme aggravation of all the three Doshas, in conjunction with the blood, resorts to a wound* in his body and immediately gives rise to Erysipelas (Sopha— lit rash) which assumes a reddish- brown colour, with high fever with a burning sensation, and suppuration in its train, and it is found to be covered with black vesicles to the size of Kulattha pulse. 7.
Prognosis ;— The Vataja, Pittaja and Kaphaja Visarpas are curable ; the Sannipatika and Khataja ones being incurable. The symptoms, which indicate an unfavourable prognosis in a case of Vataja or Pittaja Erysipelas, have been described before Those, which attack the vital parts (Marmas) of the body, can be cured only with the greatest difficulty.f 8.
• Or through the extreme augmentation of all the three doshas in the ulcer (Sadyah kshata-Vrana) according to others.
+ Golden coljured (yellow) Erysipelas due to the action of the (deranged) Tillam is incurable (PiKatrni A'anchana-vapuscha ia hA na sydhyei.).—D. K.
Chap. X.] NIDANA STHANAM. 69
The Nadi-Vrana :— The pus of an abscess or swelling burrows into the affected part if a person neglects it in its fully suppurated stage, dubious of its being so conditioned, or not, or even neglects to open a fully suppurated abscess. An abscess or swelling is called a Gati Vrana owing to an excessive infiltration of pus, and it is also called a Kadi-vrana owing to the presence of a large number of recesses or cavities in its inside There arc five different types of Nddi-vrana (sinuses) such as the Vataja, Pittaja Kaphaja, Tridoshaja and Sah'aja. 9—10.
The Vataja, Kaphaja and Pittaja
Types:— The Vataja Siiius is rough and short- mouthed, characterised by an aching pain (in its inside) It exudes a sort of frothy secretion which becomes greater at night and is attended with an aching pain. Thirst, lassitude, heat and a piercing pain(in the affected locality) arc the usual accompaniments of the Pittaja types. Fever is present from the beginning and the Sinus exudes a large quantity of hot and yellow coloured secretion which is more by day than by night. The Kaphaja Sinus becomes hard and is characterised by itching and a slight pain (numbed ?). It is found to secrete a copious quantit>' of thick, shiny, white-coloured pus which becomes greater at night, it -13.
Dvandaja and Tridoshaja Types : —
A case of Nadi-Vrana involving the concerted action of any two of the deranged Doshas (Vayu, Pittam and Kapham) and exhibiting symptoms peculiar to both, is called a Dvandaja* one. There are three
• Gayadasa docs nol read the symploms of Dvi-doshaja {i.e., due 10 iwo morbific principles) types of sinus a g vtn in the text which he has rejected as spurious
70 THE SUSHRUTA SAMHITA. [Chap. X.
types of this class of disease, {such as the Vata-pittaja. Vata-kaphaja and Pitta-kaphaja) A case of Natdi- vrana, exhibiting symptoms of the three aforesaid types, and attended with fever and a burning sensation, diffi- cult breathing, dryness of the mouth and syncope, is called Tridoshaja. An attack of this type should be regarded as dreadful and fatal, casting around the gloom of death. 14-T5.
The ^alyaja Nadi-Vrana :— A foreign
matter (such as dirt, bone, splinter etc.), lodged within the body and invisible to the eye, tends to burst open the skin, etc, of the locality along its channel of inser- tion and gives rise to a type of Sinus. It is character- ised by a constant pain, and suddenly and rapidly exudes a sort of hot, blood-tinged, agitated, frothy secre- tion. This type is called Salyaja. 16.
ThcStana-Roga: — These may be divided into as many types as the aforesaid Nadi-Vrana and are caused by the same exciting factors as the last named malady. The milk-carrying ducts remain closed in the breast of- a nullipera thus barring the possibility of the descent of the Doshas through them and of an attack of any disease at that part of the body. On the contrary, such ducts in the breast of a piimipara open and expand of their own accord, thus making the advent of diseases possible that are peculiar to the mamma. 17-19
The breast-milk : -The sweet essence of the Rasa (lymph chyle) drawn from the digested food courses through the whole body and is ultimately con- centrated in the breast of a mother or a woman (big with child) which is called milk. 2o.
Its character :— The breast milk, like semen, lies hidden and invisible in the organism, though
Chap. X ] NIDANA STHANAM. 7I
permeating it in a subtle or essential form. The charac- teristic features of the breast-milk bear analogy to those of semen. The breast milk is secreted, and flows out at I he touch, sight or thought of the child in the same manner as the semen is dislodged and emitted at the sight, touch or recollection etc. of a beloved woman. As the strong and unclouded affections of a man arc the cause of the emission of semen, so the fondest love of a mother for her children brings about the secre- tion of her breast-milk Both semen and breast-milk are the product of the essence of digested food, this essence being converted into milk in women. 21 — 22.
Its abnormal and normal Traits: —
The milk of a mother vitiated by the deranged Vayu of her system has an astringent taste and floats on water The milk of a mother vitiated b}-- the deranged Pittam has an acid and pungent taste and becomes marked with a yellow hue,* if left to float on water. The milk of a mother vitiated by the deranged Kapham is thick and slimy and sinks in water. The milk of a mother vitiated by the concerted and simultaneous derangement of the three Doshas of the body is marked by the combination of all the preceding symptoms. An external blow or hurt too (Abhighata) sometimes pro- duces vitiation of the mother's milk. 23.
The milk (of a mother), which instantly mixes with water., tastes sweet and retains its natural greyish tint, should be regarded as pure. 24.
The bodily Doshas liaving recourse to the breasts of a woman whether filled v^'ith milk or not and vitiating the local flesh and blood give rise to mammary diseases,
* The paitick- ''Chn"' in the lext ir.c-icaffMhnI the colour mny turn blue or pink in some cases.
72 THE SUSHRUTA SAMHITA. [Chap. X.
(Stana-roga). All the types of abscess (Vidradhi) excepting the one called the Raktaja out of the six types described before are found to attack the mammae, and their symptoms should be understood as identical with those of external abscesses. 25.
Thus ends the tenth Chapter of the Niflanam Sthanam in the Sus'rula Samhila w ich treats of the oetiology and symptoms of Erysipelas, Sinus and mammary abscesses.
CHAPTER XI.
Now we shall discourse on the Nid^nam of Granthi (Glands etc.), Apachi (Scrofula etc.), Arvudi (Tumours) and Galaganda (Goitre), i.
The deranged and unusually aggravated Vayu etc. (Pittam and Kapham), by vitiating the flesh, blood and fat mixed with the Kapham (of any part of the or- ganism), give rise to the formation of round, knotty, elevated swellings which are called Granthi (Glandular inflammation). 2.
The Dosha-Origincd Types :— The swell- ing (Sopha) of the Vataja type seems as if it were drawn into and elevated or as if severed or pricked with a needle, cleft in two or drawn asunder or as if cut in two or pierced. The knotty growth assumes a black colour, and is rough and elongated like a bladder. On bursting a granthi of this type exudes clear bright red blood. The Pittaja Granthi is characterised by heat and an excessive burning sensation (in its inside). A pain, like that of being boiled by an alkali or by fire, is felt in the inside. The knotty formation assumes a red or yellowish colour and exudes a flow of extremely hot blood on bursting. The Kaphaja Granthi is slightly discoloured and cold to the touch. It is characterised by a slight pain and excessive itching, and feels hard and compact as a stone It is slow or tardy in its growth and exudes a secretion of thick white-coloured pus when it bursts. 3-5.
The lYIedaJa Type :— The fat origined Gran- thi is large and glossy and gains or loses in size with the gain or loss of flesh by the patient. It is marked
10
74 THE SUSHRUTA SAMHITA. [Chap. XI.
by a little pain and an excessive itching sensation and exudes a secretion of fat resembling clarified butter or a gruel, in colour and consistency, made of the levigated paste of sesamum on bursting. 6.
^ira-Granthi — (aneurism or varicose veins) : — The bodily Vayu in weak and enfeebled persons, de- ranged by over-fatiguing physical exercises, straining or exertion or by pressure, presses on, contracts, dries or draws up the ramifications of veins (Sira) or arteries (of the affected locality), and speedily gives rise to a raised knotty formation which is called a Sird-Granthi, In the event of its being shifting and slightly painful, it can be cured only with the greatest difficulty. Whereas a case in which the knotty formation is pain- less, fixed, large and situated at any of the vital parts of the body (Marmas), should be deemed incurable * 7.
Apachi — (Scrofula etc.) : — The augmented and accumulated fat and Kapham give rise to string of hard glossy, painless, nodular, or elongated granthi (swellings) about the joints of the jawbones, at the waist, joint, about the tendons of the neck, about the throat or about the region of the arm-pits. These glands (Granthis) re- sembling the stones of the Amalaka fruit or the spawn of fish in shape or like some other shape, are of the same colour as the surrounding skin ; and a string or a large crop of such glandular knots, gradually growing is called Apachif on account of the extensive nature of their growth. 8-9.
* In several editions an additional line is to be found running as men well conversant with syirplonis (of Gtavihis) recognise a type of Granthi due 10 the action of the deranged flesh and blood, which exhibits symp- trms idenlical with those of a tumour {Afansjtasrayavi charvttda laskhanena tiilyani hi drish/amath lakshanajanih). But Jejjata has rejected it as of questionable authority.
t These glandular formations appear about the root of the penis, about ihe sides, in the arm-pits and about the throat and the tendons of the neck.
Chap. XI.] NIDANA STHANAM. 75
These knotty formations are characterised by itching and a slight pain. Some of them spontaneous!}- burst exuding secretions while others are observed to vanish and re-appear (in succession). Such vanishings, re- appearances, or fresh formations continue for a consider- able time. The disease undoubtedly owes its origin to the deranged fat and Kapham, and may only be made amenable (to medicine) with the greatest difficulty lasting for years at a time. lo.
ArVUda— (tumour etc.) : — The large vegetation of flesh which appears at any part of the body, becomes slightly painful, rounded, immovable and deep-seated, and has its root sunk considerably deep in the affected part, and which is due to the vitiation of the flesh and blood by the deranged and aggravated Doshas (Vayu, Pittam and Kapham) is called an Arvuda (tumour) by the learned physicians*. The growth of an Arvuda is often found to be slow, and it seldom suppurates. The characteristic symptoms of an Arvuda which owes its origin to the deranged condition of the Vayu, Pittam, Kapham, flesh or fat, are respectively identical with those, which mark the cases of Granthis, brought about by the same deranged principles of the body. 1 1 .
Raktaja— Arvuda :— The deranged Doshas (Vayu, Pittam and Kaphamo contracting, compressing
They resemble spawns of fish in shape and size and are due (o the action of the deranged Vayu, Pittam and Kapham. The appearance ol such glands in the upper part of the body should be ailribuied lo the action of the deranged and aggravated \^ayu. They are ixtrenicly hard lo cuie in as much as their growth (foruiation) involves the concmed aciion of the morbific principles (Doshas) of the body. — Bhoja-
Charaka, who designates this disease as Gandamala, describes its location in regions about the jawbones alone,
* That they having recourse to the flesh, produce deep-s(attd vegetations (of flesh) is the reading adopted by Gayadasa and others.
76 THK SUSflRUTA SAMIIITA. [Chap. XI.
and drawing the vessels (^Sira) and blood (of the affec- ted part^, raise a slightly suppurated and exuding tumour which is covered with small warts and fleshy tubercles and is called a Raktarvuda. This tumour is rapid in its growth and exudes a constant flow of (vitiated) blood. The complexion of the patient owing to depletive actions and other concomitant evils of haemorrhage becomes pale and yellow. The type should be considered incurable on account of its having its origin in the blood.* 12 — 13.
IVIanS^rvuda : — The flesh of any part of the body hurt by an external blow etc. (hurting it with a log of wood — DR.) and vitiated in consequence, gives rise to a sort of swelling (tumour) which is called Mdnsarvuda, which originates through the action of the deranged Vayu. It is glossy, painless, non-sup- purating, hard as a stone, immobile, and of the same colour as the surrounding skin. Such a tumour appearing in a person addicted to meat diet becomes deep seated owing to the consequent vitiation of the bodily flesh and soon lapses into one of an incurable type. 14.
ProgTIOSiS : — Even of the aforesaid curable types (such as the Vataja, ctc.^ the following types of Arvudam (tumours) should be likewise regarded as incur- able, those which appear in the cavity of a Srota chan- nel or an artery , or any vulnerable joint of the body and are characterised by any sort of secretion and also im- movable, should be deemed incurable. An ir\rvudam (tumour) cropping up on one existing from before is
* Although all types of Arvuda have their origin in the deranged flesh and blood, i)reponderant action of the deranged blood is ^'ound in Raktd- arvuda, while a dominant action of the deranged flesh marks the Mdnsdrvuda type.
Chap. XI. NIDANA STHANAM. TJ
called Adhyarvudam, which should be likewise deemed as incurable. A couple of contiguous Arvudam (^tumours) cropping up simultaneously or one after another is called Dviarvudam, which should be held as equally incurable i^with one of the foregoing types). An Arvuda (^tumour) of whatsoever type, never suppurates owing to the exuberance of the deranged Kapham and fat as well as in consequence of the immobility, condensation and compactness of the deranged Doshas (Vayu, Pittam and Kapham involved in the case, or out of a specific trait of its own nature. 15-16.
Definition of Calaganda (Goitre;: -The
deranged and aggravated Va}'u in combination with the deranged and augmented Kapham and fat of the loca- lity affects the two tendons of tne neck (Manyas) and gradually gives rise to a swelling about that part of the neck characterised by the specific symptoms of the deranged Doshas (Vayu or Kapham) and principles in- volved in the case. The swelling is called Galganda (Goitre). 17.
Symptoms of the Dosha-origined
Types : — The swelling or tumour in the Vataja goitre is characterised by a pricking pain (in its inside) marked by the appearance of blue or dark coloured veins S'ird) on its surface. It assumes a \crmilion or tawny brown hue. The goitre becomes united with the local fat in course of time, and gains in size, giving rise to a sense of burning in the throat, or is characterised by the absence of any pain at all. A Vataja goitre is rough to the touch, slow in its growth, and never or but rarely suppurates. A sense of dryness in the throat and the palate as well as a bad taste in the mouth likewise marks this type. The swelling in the Kaphaja Type assumes a large shape and becomes hard, firm, cold
78 THE SUSHRUTA SAMHITA. [Chap. XI.
and of the same colour (white). There is but slight pain and the patient feels an irresistible inclination to scratch the part. It is slow in its progress and suppuration is rare and tardy. A sweet taste is felt in the mouth and the throat and the palate seem as if smeared with a sort of sticky mucous. i<S-2o.
Symptoms of the IVIedaJa Type:—
The swelling is glossy, soft (heavy — D.R) and pale- coloured. It emits a fetid smell and is characterised by excessive itching and an absence of pain. It is short at its root and hangs down from the neck in the shape of a pumpkin (Aldvu), gradually gaining its full rotundity at the top. The size of the goitre is proportionate to the growth or loss of flesh of the body. The face of the patient looks as if it has been anointed with oil and a peculiar rumbling sound is constantly heard in the throat. 21.
Prognosis : - A case of goitre attended vvith difficult respiration, a softening of the whole bod}-, weakness, a nonrelish for food, loss of voice as well as the one which is more than of a year's standing should be abandoned by the physician as incurable, 22.
IVIetrical Text : — A pendent swelling whether large or small and occurring about the region of the throat and resembling the scrotum in shape is called a Gala-Ganda. 23.
Thus ends the eleventh Chapter of the Nidana Sthanam in the Snsruta Samhita which treats of the Nidanam of Granlhi, Scrofula, etc.
CHAPTER XII
Now we shall discourse on the Nidanamof Vriddhi (hydrocele, hernia, scrotal tumours etc), Upadatisa. (disease of the genital organ, and ^Ifpada vele- phantiasis). i .
Classes : -There are seven different types of Vriddhi such as the Vataja, Pittaja, Kaphaja, Raktaja, Medaja, Mutraja and the Antra-vriddhi. Of these both the Mutraja-vriddhi (h\-drocele or extra vagation of the urine), and Antra-vriddhi types, though owing their ori- gin to the deranged condition of the bodily Vayu, have been so named after the organic matters or anatomical parts (urine, iliac colon etc.) involved in them. 2.
Definition and Premonitory symp- toms : — Any of the deranged Doshas (Vayu, Pittam. etc i lying in the nether regions of the body may resort to the spermatic cords (Dhamani) and give rise to a swelling and inflammation of Phalacosha (scrotal sac) which is called Vriddhi (scrotal tumour etc.). A pain in the bladder, scrotum, penis and the waist (Kati) incarceration of the Vayu and the swelling of the scrotum, are the premonitory symptoms of the disease. 3 — 4.
The Dosha-origined Types :— The type
in which the scrotum becomes distended with Vayu like an inflated air-drum, marked by roughness of (its surface) and the presence of a varied sort of Vataja pain (in its interior) without any apparent cause is called Vataja Vriddhi. The swollen scrotum, of the Pittaja Vriddhi, assumes the colour of a ripe
8o THE SUSHRUTA SAMHITA. [Ch*p. XII.
Audumvara fruit and is attended with fever, a burning sensation and heat in the affected part. It is of a marked rapid growth and speedy suppuration (of the scrotum). The swollen organ in the Kaphaja Vriddhi becomes hard and cold to the touch accompanied by- little pain, and itching (in the affected part'. In the Raktaja type the swollen scrotum is covered over with black vesicles, all other symptoms of the type being identical with those of the Pittaja one. In the Medaja type the swollen scrotum looks like a ripe Tdla fruit and becomes soft, glossy and slightly painful. The patient feels a constant inclination to scratch the part. The Mutr.iji- vriddhi (hydrocele) owes its origin to a habit of voluntary retention of urine, its characteristic symptoms being softness and fluctuation on the surface of the swollen scrotum like a skin-bladder filled with water, painful urination, pain in the testes and swelling of the scrotum. 5.
Antra-vriddhi (Inguinal hernia):— The local Vayu enraged and unusually aggravated by lifting a great load, wrestling with a .stronger person, violent physical strain or a fall from a tree and such like physical labour doubles up a part of the small intestine and presses it down into the inguinal regions lying there strangulated in the form of a knot (Granthi) which is known as Antra-vriddhi (inguinal hernia). The part not properly attended to at the outset descends into the scrotum which becomes ultimately elongated and intensely swollen and looks like an inflated air-bladder. It (hernia) ascends upwards under pressure, making a peculiar sound, (gurgling) ; while let free it comes down and again gives rise to the swelling of the scrotum. This disease is called Antra-vriddhi and is incurable. 6.
Chap. XII.] NIDANA STHANAM. Si
TheUpadansam: —An inflammatory swelling of the genital, whether ulcerated or not is called Upadans'a*. The disease owes its origin to the action of the local Doshas, aggravated by promiscuous and excessive sexual intercourse, or by entire absti- nence in sexual matter ; or by visiting a woman, who had observed a vow of lifelong continence or one who has not long known a man, or one in her menses or one with an extremely narrow or spacious vulva, or with rough or harsh or large pubic hairs ; or by going unto a woman whose partturient canal is studded with hairs along its entire length ; or by visiting a woman not amorously disposed towards the visitor and vice versa ; or by know- ing a woman who washes her private parts with foul water or neglects the cleanliness of those parts, or suffers from any of the vaginal diseases, or one whose vagina is naturally foul ; or by going unto a woman in any of the natural fissures of her body other than the organ of copulation (Vi yoni) ; or by pricking the genital with finger nails, or biting it with the teeth, or through poison- ous contact, or through practice of getting the (penis abnormally elongated by pricking the) bristles of a water parasite {Suka) into its body ; or by practising
* Upadans'a is not syphilis whole to whole. Certain types of Upadans'a such as the Raklaja and S^nnipdtika types which entail the destruction of the organs concerned exhibit certain symptoms which are common to syphilis as well. The secondary eruptions and tertiary symptoms of syphilis are not mentioned by ihe A') urvedic Rishis who used to treat it only with vegetable medicines and this fact intimates the probability that the secondary and tertiary symptoms of syphilis might not arise by their efficient and able treatment from the very beginning, preventing the absorption of the poison into the system. The practice of ablution, so common among the Hindus, might be taken into consideration as one of the important preventive factors. Maharshi Caaraka has comprised it within the chapter on 'Senile Impotency'. — Ed.
II
82 THE SUSHRUTA SAMHITA. [Chap. Xtt.
masturbation, or any unnatural offence with female quadrupeds ; or by washing the genitals with filthy or poisonous water ; or through neglect to wash the parts after coition, or voluntary suppression of a natural flow of semen or urine or through any hurt or pressure on the organ etc. The inflammation of the genital thus engendered is called Upadans'a. The disease admits of bsin^ divided into five distinct types, such as, the Vataja, Pittaja, Kaphaja, Tridoshaja and the Raktaja. 7—8.
The symptoms of different Types:—
The roughness of the genitals, the bursting or cracking of the integuments of the penis and prepuce etc., numb- ness and swelling of the affected part which is perceived rough to the touch and the presence of a varied sort of pain peculiar to the deranged Vayu are the characteristic indications of the Vataja type. In the Pittaja type fever sets in (from the very beginning), the penis becomes swollen and assumes the colour of a ripe Indian fig (reddish-yellow), attended with a sort of intolerable burning sensation The process of suppuration is rapid and a variety of pain peculiar to the deranged Pittam, (distinguishes it from the other forms of the disease). The penis becomes swollen, hard and glossy in the Kaphaja type marked by itching and a variety of pain characteristic of the deranged Kapham. In the blood-origined type (Raktaja) the organ bleeds heavily and is covered with the eruptions of large black vesicles. Fever, thirst, (Sosha), burning sensations and other characteristic symptoms of the deranged Pittam are also present. Palliation is all that can be occasionally effected in these cases. Symptoms specifically betraying to each of the Vataja, Pittaja and Kaphaja t}-pes concurrently manifest themselves in the Sannipatika t>T3e of Upa-
Chap. XII.] NIDANA STHANAM. " 83
dansa. The organ cracks, the ulcers or cancers become infested with parasites and death comes in to put a stop to the suffering of its wretched victim. 9 —13.
^lipadam (Elephantiasis) :- The disease in which the deranged Vayu, Pittam and Kapham, taking a down- ward course, are lodged in the thighs, knee-joints, legs and the inguinal regions and spread to the feet in course of time and gradually give rise to a swelling therein, is called Slipadam. There are three types of Slipada severally due to the actions of the deranged Vayu, Pittam and Kapham. 14— 15.
The symptoms of the different
Types: — The swollen parts assume a black colour in the Vataja type and are felt rough and uneven to the touch. A sort of spasmodic pain without any apparent reason is felt (at intervals in the seat of the disease), which largely begins to crack or burst. The Pittaja type is characterised by a little softness and yellowish hue (of the diseased localities) and often attended with fever, and a burning sensation. In the Kaphaja type the affected localities become white, glossy, slightly painful, heavy, contain large nodules (Granthis) and are studded over with crops of papillae. 16.
Prognosis : — A case of elephantiasis of a year's growth as well as the one which is characterised by excessive swelling (of the affected parts), exudation and vegetation of knotty excrescences resembling the sum- mits of an ant-hill should be given up as incur- able. 17.
Memorable Verses :— A preponderance of the deranged Kapham marks the three types of the disease, in as much as, the heaviness and largeness (of the swelling) can not be brought about by any other factor than Kapham. The disease is peculiar to countries
84 THE SUSHRUTA SAMHITA. tChap. XII.
in which large quantities of old rain-water remain stagnant during the greater part (lit.- all seasons) of the year making them damp and humid in all seasons. 18-91
The disease is usually found to be confined to the legs and hands of men but cases are on record in which it has extended to the ear, nose, lips and the regions of the eyes. (Penis — Madhaba-Nidjinam). 20.
Thus ends ihe twelfth Chapter of the Nidanastbanam in the Sus'ruta Samhila which treats of the Nidanam of scrotal tumours, hernia, Upa- dans'am and elephansiasis.
CHAPTER XIII.
Now we shall discourse on the Nidanam of Kshudrarogam (diseases which are known by the general name of minor ailments), i.
These diseases are generally divided into forty- four distinct varieties or types such as ; — Ajagallika, Yavaprakshya, Andhdlaji, Vivrita, Kachchapika, Valmika, Indravriddha, Panasiki, Pashana-garddabha, Jala-garddabha, Kaksha, Vishphota, Agni-rohini, Chippam. Kunakha, Anus'aye, Vidarika, Sarkara- Arbudam, Pamd,, Vicharchika. Rakasa, Pd,dadarika, Kadara, Alasa, Indralupta, Darunaka, Arunshika, Palitam, Mas'urika, Yauvana-pidaka, Padmini-kantaka, Yatumani, Mas'aka, Charmakila,Tilakalaka, Nyachchya, Vyanga, Parivartika, Avapatika, Niruddha-prakas'a, Niruddha-guda, Ahiputanam, Vrishana-kachchu, and Guda-bhrans'a * 2,
Metrical Texts : -The species of pimples or eruptions which are shaped like the Mudga pulse and are glossy, knotty and painless is called Ajagallikai. They are of the same colour (as the surrounding skin) and their origin is usually ascribed to the action of the deranged Kapham and Vayu. The disease is peculiar to infants,-]- Yatvaiprakshya^ : — The eruptions
* Brahmadeva comprising Garddavika, h-vfUika, GandhapidikA and Tilakdlaka in the list reads it as consisting of thirty-four different species. Jejjata does not hold the four forms of disease commencing wiih Gardda- vika, etc. as included within the list. Gayadasa, finding them included in all the recensions reads 6'arfWo3A/-fa', etc. as included within the list of Kshudra Roga, and Pama etc. as included within the list of Kshudra Kushtham.
t They afflict certain infants — Dallana.
86 THE SUSHRUTA SAMHITA. [Chap. XIII.
which arc shaped like the barley-corns, extremely hard, thick at the middle, knotty and affect (lit — confined to) the flesh are called Yavaprakshya. They are due to the action of the deranged Vayu and Kapham. Andhjilaji : — The dense, raised, slender-topped eruptions which appear in circular patches and exude a slight pus are called Andhdlaji. They are due to the action of the deranged Vdyu and Kapham. Vivritai: — Pustules or eruptions, which are coloured like a ripe fig. fruit and are flat-topped and appear in circular patches with an intolerable burning sensation, are called Vivrita They are due to the action of the deranged Pittam. 3 6.
Kachchapika :— A group of five or six hard, elevated, nodular eruptions (Granthis), arranged in the shape of a tortoise (which may appear on the sur- face of any part of the body), are called Kachchapikd. They are due to the action of the deranged Kapham and Vdyu. Valmika : — The knotty undurated erup- tions (Granthis) which gradually appear on the soles, palms, joints, neck and on the regions above clavicles and resemble an ant-hill in shape, slowly gaining in size are called Valmika Ulcers attended with pricking pain, burning, itching sensations and exuding mucopu- rulent discharges appear around the aforesaid eruptions (Granthis). The disease is due to the action of the deranged Kapham, Pittam and Vaiyu. 7 — 8.
I ndravr idd h2t :— Pimples or eruptions ^Pidaka) arising (on the surface of the body), arranged in the same circular array as marks the distribution of the seed (sacks) in a lotus flower are called Indravriddhai by the physicians. The disease is caused by the action of the deranged Vdyu and Pittam. Panasika :— Eruptions (Pidaka) of a sort of extremely painful pustules all over the back or the ears which resemble the
Chap. XIII.] NIDANA STHANAM. 8^
Kumuda bulb in shape, are called Panasika. They are due to the action of the deranged Kapham and Vayu. Pashana-Garddabha :— A slightly painful and non-shifting hard swelling, which appears on the joint of the jawbones, (Hanu-sandhi; is called Pashana- Garddabha. The disease is the effect of the deranged Kapham and Vayu. Jala-Garddabha : — A thin and superficial swelling, which like erysipelas is of a shifting or progressive character and is further attended with fever and a burning sensation and which is but rarely found to suppurate, is called Jala-Garddabha.* The disease results from the deranged Pittam. Kaksha ■ — The disease characterised by the eruptions of black and painful vesicles ;^ShphotaJ on the back, sides, and on the region about the arm-pits, is called Kakshd. The disease is likewise attributed to the action of the aggravated Pittam. Vishphotaka — The disease in which eruptions of burnlike vesicles (Shphota) crop up on the whole surface of the body, or on that of any particular locality, attended with fever, is called Vish- photaka. The disease is the effect of vitiated blood and Pittam. 9 — 14.
Agni-Rohinif ;— Vesicles (Shphota) having the appearance of burns and cropping up about the waist
* The circular raised spots studded with vesicles are called Gardda- bha. They are reddish and painful and produced by ihe action of Vayu and Piitaui. Gayadasa reads it so.
+ Dallana quotes from another Tantram that the morbific principles in men, aggravated through the action of the enraged and augmented Pittam and blood, give rise to vesicles (blisters) like red-hot charcoal by breaking open the flesh at the waibt, attended with extreme pain, high fever and an insufferable burning sensation which, if not properly remedied, bring on diath within a fortnight, or ten days of their first appearance. These (vesicles) are called Vahni- Rohini. And again from another work he cites that a case oiVahni ■ Kohini due to the action of the deranged-
88 THE SUSHRUTA SAMHITA. [Chap. XIII.
(KakshA) by bursting the local flesh, and which is attended with fever and a sensation as if a blazing fire is burning in the inside (of the affected part), are called Agni-Rohini. The disease is caused by the concerted action of the three deranged Doshas .;Vdyu, Pittam and Kapham). It is incurable and ends in the death of the patient either on the seventh*, tenth or fifteenth day (of its first appearance . 15.
Chippam : — ^Thc deranged Vdyu and Pittam vitiating the flesh of the finger-nails, give rise to a disease which is characterised by pain, burning and suppuration. The disease called Chippam, is also denominated Upanakha and Kshataroga. Kuna- kham : — The nails of fingers becoming rough, dry, black, and injured through the action of the Doshas enraged through the effect of a blow, are called Kunakha (bad nails). It is also called Kulviam. Aiiusayi :— A small swelling (on the surface of the body) which is of the same colour (as the surrounding skin), but is deep-seated, and suppurates in its deeper strata, is called Anusayi by the physicians. The disease is the effect of the deranged Kapham. Vidarika : — A round reddish swelling rising either on the auxiliary or inguinal regions in the shape of a gourd ( Viddrikandd) is known as Vidarika. The disease is due to the concerted action of the deranged Vayu, Pittam and Kapham and is characterised by symptoms peculiar to each of them. 16-19,
Kapham proves faial within a fortnight, that due to the deranged Pillatn, wiihin ten days, and that due to the deranged Vayu, within a week.
* The patient dies on the seventh day in a case of disease marked by the dominant Vdyu, on the tenth day in a case marked by the dominant Pittam and on the fifteenih day in a case of dominant deranged Kapham.
Chap. XIII.] NIDANA STHANAM. 89
^arkararbudam :— The deranged Vayu and Kapham having recourse to and affecting the flesh, veins (Sira), ligaments (Snayu) and fat give rise to a sort of cyst (Granthi) which when it bursts exudes a copious secretion in its nature somewhat like honey, clarified butter or Vasa. The aforesaid Vayu, when aggravated through excessive secretion, dries and gathers the flesh up again in the shape of (a large number of) gravel-like concretions (Sarkara) known accordingly as Sarkararbu- dam. A fetid secretion of varied colour is secreted from the veins (Sira) in these Granthis which are sometimes found to bleed suddenly. The three varieties of the skin disease called Pama (Eczema), Vicharchika (Psoriasis) and Rakasa have already been discussed under the head of Kushtham (Chapter. V.). 20 - 2 r.
Padadarika :— The soles and feet of a person of extremely pedestrian habits become dry (and lose their natural serous moisture). The local Vayu thus aggravated gives rise to peculiar painful cracks (Dari in the affected parts) which are called Pada- darika. Kadara : — The knotty (Granthi), a painful, hard growth raised at the middle or sunk at the sides, which exudes a secretion and resembles an Indian plum (Kola — in shape), and appearing at the soles (palms according to — Bhoja) of a person as an outcome of the vitiated condition of the local blood and fat produced by the deranged Doshas incidental to the pricking of a thorn etc. or of gravel is called a Kadara (corns). Alasa : — An affection, caused by contact of poisonous mire and appearing between the toes, which is characterised by pains, burning, itching and exuda- tion, is called Alasa. 22 — 25.
Indralupta:— The deranged Vayu and Pittam having recourse to the roots of the hairs bring about their
12
$0 THE SUSHRUTA SAMHITA. [Chap, Xlll.
gradual falling off, while the deranged blood and Kapham of the locality fill up those pores or holes, thus barring their fresh growth and recrudescence. The disease is called Indralupta,* Rujya or Khatlitya (Alo- pecia). Darunaka:— The disease in which the hairy parts of the body (roots of hairs) become hard, dry and characterised by an itching sensation is called Diiru- naka. The disease is due to the action of the deranged Kapham and Vayu. Arunshika : — Ulcers (A runshi) at- tended with mucopurulent discharges and furnished with a number of mouths or outlets and appearing on the scalps of men as the result of the action of local parasites and of the deranged blood and Kapham (of the locality) are called Arunshik^. Palitam : — The heat and Pittam of the body having recourse to the region of the head owing to overwork, fatigue, and ex- cessive grief or anger, tend to make the hair prema- turely grey, and .such silvering of the hair ibefore the natural period of senile decay) is called Palitam. Masurika (variola) : — The yellow or copper-coloured , pustules or eruptions attended with pain, fever and burn- ing and appearing all over the body, on (^the skin of,) the face and inside the cavity of the mouth, are called Masurikl Yauvana-pidakai— (Mukhadushikski : — The pimples like the thorns of a Salmali tree, which arefound on the face of young men through the deranged condition of the blood, Vayu and Kapham, are called Yauvana- pidaka or pimples of youth. Padmini-Kantaka : — The circular, greyish patches or rash-like eruptions
* Women are generally proof against this disease owing to their delicate constitution and to their being subjected to the monthly discharge of vitiated blood and at the same time to their undergoing no physical exercise, and hence there is little chance of the bodily Pittam being deranged and bringing on this disease.
Chap. XIII.] NIDANA STHANAM. 9I
studded over with thorny papilla of the skin resembling the thorns on the stem of the lotus marked by itching are called Padmini-kantaka. The disease is due to the deranged condition of the Vayu and Kapham. Yatu- mani (mole) : — The reddish, glossy, circular, and pain- less, congenital marks CSahajam) or moles on the body not more elevated (than the surrounding skin) are called Yatumani. The disease is due to the deranged condition of the blood and Fittam. 26—33.
IVIasaka (Lichen) : -The hard, painless, black and elevated eruptions on the body (skin) re- sembling the Masha pulse in shape, caused by the aggravated condition of the bodily Vayu are called Mas'aka Tilakalaka: — The black painless spots on the skin about the size of a sesamum seed and level with the skin are called Tilakalaka. This disease is caused through the aggravated condition of the Vayu, Fittam ana Kapham .-f Nyachcham : — The congenital, painless, circular, white or brown (Sydva) patches on the skin, which arc found to be restricted to a small or comparatively diffused area of the skin, are called Nyachcham. Charmakila (hypertrophy of the skin) : — The causes and symptoms of the disease known as Charmakila have been already described (under the head of the Ars'a-Nidanam). Vyang'a : — The Vdyu being aggravated through wrath and over- fatiguing physical exercise, and surcharged with Fittam, and suddenly appearing on the face of a person, causes thin, circular, painless and brown-coloured patches or stains. They are known by the name of Vyanga * 34-38.
* According to certain authorities it is due to the absorption of blood by Vayu and Pitlam.
+ According to others the spot goes by the name of iV//j/iaw, if it is black-coloured and appears anywhere other than on the face.
92 THE SUSHRUTA SAMHITA. [Chap. XIII.
The Parivartika :— The vital Vayu (Vydna) aggravated by such causes as excessive massage (mastur- bation), pressure, or local trauma, attacks the integuments of the penis (prepuce) which being thus affected by the deranged Vayu forms into a knot-like structure and hangs down from the glans penis. The disease known as Parivartika or Phymosis is due to the action of the deranged Vayu aggravated by any extraneous factor. It is marked by pain and burning sensation; and some- times suppurates. When the knotty growth becomes hard and is accompanied by itching, then it is caused by the aggravated Kapham. 39.
Avapatika : — When the integuments of the prepuce is abnormally and forcibly turned back by such causes as coition under excitement, with a girl (before menstruation and before the rupture of the h}'men and consequently with a narrow external orifice of the vagina) or masturbation or pressure or a blow on the penis, or a voluntary retention of a flow of semen or forcible opening of the prepuce, the disease is called Avapatika or paraphymosis. Niruddha-prakas'a : — The prepuce affected by the deranged Vayu entirely covers up the glans penis and thus obstructs and covers up the orifice of the urethra. In cases of partial obstruction a thin jet of urine is emitted with a slight pain. In cases of complete closing the emission of urine is stopped without causing any crack or fissure in the glans penis in consequence. The disease is called Xiruddha-prakas'a which is due to the deranged Vayu and is marked by pain (in the glans pcnis\ 39-41.
Niruddhaguda :— The Vayu (Apana) obstruct- ed by the repression of a natural urging towards de- fecation stuffs the rectum, thus producing constriction of its passage and consequent difficulty of defeca-
Chap. XIII.] NIDAKA STHANAM. 93
tion. This dreadful disease is known as Niruddha- gudam (stricture of the rectum) which is extremely difficult to cure. Ahiputana . — A sort of itch-like eruptions appearing about the anus of a child owing to a deposit of urine, perspiration, feces etc conse- quent on the neglect in cleansing that part. The eruptions which are the effects of the deranged blood and Kapham soon assume an Eczematous character and exude a purulent discharge on account of constant scratching. The Eczema (Vranaj soon spreads, and coalesces and proves very obstinate in the end. The disease is called Ahiputana. Vrishana-kachchu : — When the filthy matter, deposited in the scrotal integuments of a person who is negligent in washing the parts or in the habit of taking daily ablutions, is moistend by the local perspiration, it gives rise to an itching sensation in the skin of the scrotum, which is speedily turned into running Eczema by constant scratching of the parts. The disease is called Vrishana-kachchu and is due to the aggravated condition of the Kapham and blood. Guda-Bhransa : — A prolapse or falling out of the anus (due to the Vayu) in a weak and lean patient through straining, urging or flow of stool as in dysentery is called Guda-Bhrans'a or prolapsus ani. 42 — 45.
Thus ends the thirteenth Chapter of the Nidana Sthanam in the Sus'ruta Samhita which treats of the Nidanani of minor ailments.
CHAPTER XIV.
Now we shall discourse on the Nidanam of the disease known as SukadOSha. i.
Any of the eighteen different types of the disease may affect the genital (penis) of a man who foolishly resorts to the practice of getting it abnormally elongated and swollen by plastering it with Suka (a kind of irritating water insect) and not in the usual officinal way.
Classification : — Diseases, which result from such malpractices, are knonwn as, — Sarshapika, Ashthi- Hka, Grathitam, Kumbhika, Alaji, Mriditam, Sammudha- pidaka, Avamantha, Pushkarika, Spars'ahani, Uttam^, Satoponaka, Tvakapaka, Sonitarvudam, Mansarvudam, Mdnsapaka. Vidradhi and Tilakalak. 2.
IVIetrical Texts :— The tiny herpetic eruptions (Pidaka) which resemble the seeds of white mustard in shape and size, (and are found to crop up on the male organ of generation) on account of a deranged condition of the blood and Kapham, as the result of an injudicious application of Suka plasters are called Sarshapika by the wise. Eruptions of hard stone-like pimples, (Pidaka) irregular at their sides or edges and which are caused by the aggravation of the local Vayu by the use of a plaster of the poisonous Suka, are called Ashthilika. The knotty Granthis (nodules) on the penis owing to its being frequently stuffed with the bristles of a Suka insect are called Grathitam. This type is caused by the deranged action of the Kapham, A black wart resembling the stone or seed of a jambolin fruit in shape is called Kumbhika(. This type is due to the deranged condition of the blood and Pittam. 3 — 5.
Chap. XIV.] KIDANA STHANAM. 95
An Alaji (incidental to an injudicious application of Suka on the penis) exhibits symptoms, which are identical with those manifested by a case of Alaji in Prameha (Ch. vi). A wart (papilloma) attended with swelling of the part and caused by the aggravated Vayu on the hard and inflamed penis causing pressure (on the urethra) is called Mriditam. The pustule or eruption appearing on the penis on account of its being extremely pressed by the hand i^for the insertion of the hairs of the Suka) in its dorsum is called Sammudha- pidaka. (^It is the outcome of the aggravated Vayu*). A large number of elongated pustules on the penis (in- cidental to an application of Suka to the partj which burst at the middle, causing pain and shivering, is called Avamantha (epithelioma*. 6 — lo.
The Pushkarika type of the disease is marked by the eruptions of small pimples around the principal one The type has its origin in the deranged condition of the blood and Pittam, and is so called from the part of the excrescenses being arranged in rings or circles like the petals of a lotus flower in shape. A complete anes- thesia (of the affected organ) owing to the vitiated blood by the injudicious application of a Suka is called Spars'a- haklli- Pustules appearing on the penis through the vitiation of the local blood and Pittam by such con- stant applications are called Uttama. A suppuration of the prepuce under the circumstance is called Tvakapakh. There is fever with a burning sensation in the affected organ. The disease is due to the vitiated condition of the blood and Pittam. ii — 15.
The type of the disease in which the penis is marked by the eruption of black vesicles and is covered over with a large number of red pimples or pustules with
According to Dallana it is due to the action of Vayu and blood.
96 THE SUSIIRUTA SAMHITA. [Chap. XIV.
an excruciating pain in the ulcerated region of the organ is called SonitaLrvudam. The vegetation of a fleshy tumour on the penis (incidental to a blow on the organ to alleviate the pain of inserting the hairs of the Suka insect into its body), is called Mainsairvudam. A sup- puration as well as sloughing of the penis attended with different kinds of pain which severally mark the de- ranged Vayu, Pittam and Kapham is called Matnsa- pSLka. This type is caused by the concerted action of the deranged Vayu, Pittam and Kapham. 15-18.
The specific symptoms of a Tridoshaja Vidradhi as described before (Chap.ix.) mark the one which affects the penis (owing to an injudicious application of the highly poisonous irritant Suka to the organs) The disease is called Vidradhi. A process of general sup- puration and sloughing of the organ marks the type which is produced by the application of a black Suka or one of a variegated coloured insect of the same species. The type is called Tilakailaka, and should be regarded as Tridoshaja one. 19-21.
Prognosis: — Of the above enumerated malig- nant diseases of the penis, those known as Mansarvuda, Mansapaka, Vidradhi and Tilakalak shoulda be deemed as incurable. 22.
Thus ends the fourteenth Chapter of the Nidana Sthanam in the Sus'ruta Samhita which treats of Nidanam of different types of S'ukadohsa.
CHAPTER XV.
Now we shall discourse on the Nidanam of Bhag"- na.m (fractures and dislocations etc. of bones), i
Various kinds of fracture may be caused from a variety of causes, such as by a fall, pressure, blow, violent jerking or by the bites of ferocious beasts etc. These cases may be grouped under the two main sub- divisions such as Sandhi-Muktam (dislocation) and KsLnda-Bhagnam (fracture of a kanda). 2.
Cases of Sandhi-muktam (dislocation) maybe divided into six different types, such as the UtplisJitam, Vis'- lishtam, Vivartitam, AdhaJi-Kshiptam, Ati-ksJiiptam and Tiryak-kshiptam. 3
General features of a dislocation :—
Incapability of extension, flexion, movement, circum- duction and rotation (immobility, considered in respect of the natural movements of the joint), of the dislocated limb, which becomes extremely painful and cannot bear the least touch. These are said to be the general symptoms of a dislocation. 4.
Diagnostic symptoms of a disloca- tion : — In case of a friction of a joint by two articular extremeties (Utplishtam) a swelling is found to appear on either side of the articulation attended with a variety of pain at night. A little swelling accompanied by a constant pain and disordered function of the dislocated joint, marks the case of simple-looseness (Vislishtam) of the articulation ; while pain and unevenness of the joint owing to the displacement of the connected bones distinguish a case of Vivartitam (lateral displacement). An excruciating pain, and looseness of the dislocated
13
98 THE SUSHRUTA SAMHITA. [Chap. XV.
bone arc the symptoms which characterise a case in which a dislodged bone is seen to drop or hang down from its joint (Adhah-kshiptam). In a case of abnor- mal projection (Ati-kshiptam\ the dislocated bone is removed away from its joint which becomes extremely painful. A case of oblique dislocation (Tiryak-kshiptam) is marked by the projection or displacement of the bone on one side accompanied by a sort of intolerable pain. 5.
Different kinds of Kanda Bhag-
nam : — Now we shall describe the Kdnda-Bhagnam (fracture etc.)- Fractures may be divided into twelve different kinds which are known as, Karkatakam, As'va- karnam.Churnitam,Pichchitam,Asthi-chchalitam, Kdnda- bhagnam, Majjagatam, Atipdtitam, Vakram, Chchinnam, Pdtitam and Sphutitam. 6.
General symptoms of Kanda-bhag-
nam : — A violent swelling (about the seat of fracture) with throbbings or pulsations, abnormality in the position (of the fractured limb), which cannot bear the least touch, crepitus under pressure, a looseness or dropping of the limb, the presence of a variety of pain and a sense of discomfort in all positions are the indications which generally mark all kinds of fracture (Kanda-bhagnam). 7. Diagnostic symptoms :— The case where a fractured bone, pressed or bent down at its tvvo articular extremities, bulges out at the middle so as to resemble the shape of a knot (Granthi), is called Karkatam. The case where the fractured bone projects upward like the ear of a horse is called As'vakarnam. The fractured bone is found to be shattered into fragments in a case of the Chumitam or comminuted kind which can be detected both by palpation and crepitation. A smashed condition of the fractured bone marks a
Chap, XV.] NIDANA STHANAM. 99
case of the PicUoMtim kind which is often found to be marked by a great swelling. The case where the covering or skin of the bone (periosteum) is cast or splintered off is called the Asthi-chchalUtatn. The case where the completely broken or severed bone? are found to project through the local skin, is called Killda- bhag^nam (compound). The case where a fragment of the fractured or broken bone is found to pierce into the bone and dig out the marrow, is called JVEljjaaugatam, (Impacted fracture). The case where the fractured bone droops or hangs down is called Ati-patitam. The case where the unloosened bone (from its position) is bent down in the form of an arch is called Vakram The case where only one articular extremity of the bone is severed is called Chhinnan. The case where the bone is slightly fractured and pierced with a large number of holes, is called Patitam, an excruciating pain being the leading indication. The case where the bone largely cracked and swollen becomes painful as if stuffed with the bristles of a Suka insect is called Sphutitam (Green- stick fracture). Of the several kinds of fracture, cures are effected with extreme difficulty in a case of the Churnitam, Chhinnam, Ati-pdtitam or Majjanugatam kind. A casa of displacement or laxation occurring in a child or in an old or weak patient or in one suffer- ing from asthma (Svasa) or from any cutaneous affec- tion (Kushtha^ or Kshata-Kshina disease is difficult to cure. 8.
Memorable verses : —The following cases
are to b3 given up a^ h^p^leis — ;y/.3. fracture of the pelvic bone (or of bones that are of this description, wherever they may be situated) ; dislocation of the pelvic joints ; compound fracture of the thigh bone or of the flat bones) ; fracture into small pieces of the
lOO THE SUSHRUTA SAMHITA. [Chap. XV\
frontal bone or its dislocation ; simple fracture of the breast-bones, back-bone and temporal and cranial bones. If the dislocations and fractures be improperly set from the outset (Adito)* or if the union be anyhow disturbed there is no hope for recovery. 9— ii.
If fractures happen at any time of the first three stages of adalt life which has been described before (vide Sutrasthana Chap. XXXV.) and if they are set up by an able surgeon they have a great chance of being united. 12.
A bending of a gristle or cartilage (Taruna) is called its fracture. A Nalaka (long bone) bone is usually found to be severed. A Kapatla bone is found to be cracked, while a Ruchakaf (tooth) is found to be splintered off. 13.
* The word A.ii/o may be taken inlo the sense of congenital mal- formation which is beyond remedy.
t The presence of the particle 'cha' denotes Valya-asthi-
Thus ends the fifteenth Chapter of the Nidana Sthanam in the Sus'ruta amhita which treats of the Nidanam of dislocations and fractures.
CHAPTER XVI.
Now wc shall discourse on the Nidanam of Mukharog^am (diseases which afifect the cavity of the mouth in general), r.
General Classifications:— Sixty five* dif- ferent forms of mouth disease are known in practice. They are found to attack seven different localities viz. the lips, the gums of the teeth, tongue, palate, throat and the entire cavity ; of these eight are peculiar to the lips ; fifteen, to the roots of the teeth; eight to the teeth; five to the tongue ; nine to the palate ; seventeen to the throat; and three to the entire cavity. 2 — 3.
Diseases of the lips :— The eight forms which affect the lips, are either Vataja, Pittaja, Kaphaja, Sanni- patika, Raktaja, Mans'aja, Medaja or Abhighataja (Traumatic). 4.
The Vataja Type :— The lips become dry, rough,numbed, black, extremely painful and the affected part seems as if it were smashed and pulled out or cracked by the action of the aggravated Vjiyu. In the Pittaja type — the lips become blue or yellow-coloured and studded with (a large number of small) mustard- seed-like eruptions, which suppurate and exude a puru- lent discharge attended with a burning sensation (in the locality). In the Kaphaja type — the affected lips are covered with small eruptions, which are of the same colour as the surrounding part, and become slimy, heavy or thick, cold and swollen. Pain is ab.sent in this type and the patient feels an irresistible inclination to scratch the parts. In the Sannipaitaja type, the lips change
* According to others sixty-seven — but Dalian does not support this.
102 THE SUSHRUTA SAMHITA. [Chap. XVI.
colour, becoming black, yellow, or ash-colourcd (white) at intervals and are found to be studded with various sorts of eruptions. 5—8,
The Raktaja type : —(Produced by the vitiated condition of the blood) the affected lips look as red as blood and profusely bleed and crops of date coloured (chocolatecoloured) eruptions appear on their surface. In the Ma^usaja type (due to the vitiated condition of the local flesh), the lips become heavy, thick and gathered up in the form of a lump of flesh. The angles of the mouth become infested with parasites which germi- nate and spread themselves in the affected parts. In the Medaja(fat-origined; type the lips become numbed, soft, heavy and marked by an itching sensation. The skin of the inflamed surface becomes glossy and looks like the surface layer of clarified butter exuding a thin crystal-like (transparent) watery discharge. In the Abhighataja (Traumatic) type, the lips become red, knotty and marked by an itching sensation and seem as if .pierced into or cut open with an axe and (become cracked and fissured). 9 — 12.
Disease of the roots of the teeth ;—
Diseases which are peculiar to the roots of the teeth, are known as Sitada, Danta-pupputaka, Danta-veshtaka, Saushira, Maha-Saushira, Paridara, Upakus'a, Danta- vaidarbha, Vardhana, Adhimansa and the five sorts of NAdi (sinus). 13.
Sitada (Scurvy); — The gums of the teeth suddenly bleed and become putrified, black, slimy and emit a fetid smell. They become soft and gradually slough off. The disease has its origin in the deranged condition of the local blood and Kapham. Danta pupputaka (crum boil):— The disease in which the roots of two or three teeth at a time is marked by a violent swelling and
Chap. XVI.] NIDANA STHANAM. 1 03
pain is called Danta-pupputaka. The disease is due to the vitiated condition of the blood and Kapham. Danta-veshtaka: — The teeth become loose in the gums, which exude a discharge of blood and pus. This disease is due to the vitiated blood of the locality. SausMra: — The disease in which an itching painful swelling appears about the gums attended with copious flow of saliva is called Saushira (Alveolar abscess). It is caused by the deranged blood and Kapham of the locality. Mahai- Sausliira: — The disease in which the teeth become loose, the palate marked by sinuses or fissures, the gums putri- fied, and the whole cavity of the mouth inflamed, is called Mahas'aushira, the outcome of the concerted action of the deranged Doshas of the body. 14 — 18.
Paridara. : — The disease in which the gums be- come putrificd, wear off and bleed is called Paridara (bleeding gums\ The disease has its origin in the deranged condition of the blood, Kapham and Pittam. Upakus'a:— The disease in which the gums become marked by a burning sensation and suppuration and the teeth become loose and shaky (in their gums) in consequence and bleed at the least shaking, is called Upakus'a, There is a slight pain, and the entire cavity of the mouth becomes swollen and emits a fetid smell ; this disease is due to the vitiated condition of the blood and Pittam 19.
Danta-Vaidarbha :— The disease which is consequent upon the friction of the gums marked by the appearance of a violent swelling about the portion (so rubbed and in which) the teeth become loose and can be moved about, is called Danta-vaidarbha which is due to an extraneous cause such as a blow etc Vardhana : — the disease which is marked by the advent of an additional tooth (the last molar) through the action
104 THE SUSHRUTA SAMHITA. [Chap. XVI.
of the deranged Vayu with a specific excruciating pain of its own, is called Vardhana or eruption of the Wisdom tooth. The pain subsides with the cutting of the tooth. AdhimaLDsa :— The disease in which a violent and extremely painful tumour appears about the root of the tooth, and is situated in the farthest end of the cavity of the cheek-bone accompanied by a copious flow of saliva is called Adhimansa or Epulis, It is due to the deranged Kapham, The five sorts of Na'di (sinus) which affect the roots of the teeth (are either Vataja, Pittaja, Kaphaja, Sannipataja or Abhighataja), their symptoms being respectively identical with those of the types of Ncidi-vrana. 20 - 24.
Diseases to the teeth proper:— Diseases
which are restricted to the teeth proper are named as, D^lana, Krimi-dantaka,Danta harsha,Bhanjaka,Sarkara, Kapalika, Syava-dantaka and Hanu-moksha. 25.
Dalana : — The disease in which the teeth seem as if being cleft asunder with a violent pain is called Dalana or toothache, the origin of which is ascribed to the action of the aggravated state of the bodily Vayu. Krimi-dantaka : — The disease in which the teeth are eaten into by worms, is called Krimi-dantaka (caries\ The teeth become loose and perforated by black holes accompanied by a copious flow of saliva. The appear- ance of an extremely diffused swelling (about the roots of decayed teeth) with a sudden aggravation of the accom- panying pain without any apparent cause is also one of its specific features. Danta-harsha : — The disease in which the teeth cannot bear the heat, cold or touch is called Danta-harsha. It is due to the deranged condi- tion of Vayu. Bhanjaka : — The disease in which the face is distorted, the teeth break, and the accompanying pain is severe, is called Bhanjaka (degeneration of the
Chap. XV7 ] NIDANA STHANAM. I05
teeth\ The disease is due to the deranged condition of the Vayu and Kapham. Sarkaia : — The disease, in which sordes, formed on the teeth and hardened (by the action of the deranged Vayu), lie in a crystallised form at the roots of the teeth, is called Sarkara (Tartar), Such deposits tend to destroy the healthy growth and functions of the teeth. Kapalika : — The disease in which the preceding crystallised deposits get cemented together and aftenvards separate from the teeth taking away a part of their coating (enamel) is called Kapalika (calcareous deposit) which naturalh' makes an erosion into and destroys the teeth Syava-dantaka : — The disease, in which the teeth variously scorched by the action of the deranged Pittam assumes a blackish or blue colour, is named as Syava-dantaka (black teeth). Hanu-mokslia '■ — The disease in which the \'ayu aggravated (by such causes, as by loud talking, chewing of hard substances, or immoderate yawning) produces the dislocation of the jawbones is called Hanu-moksha It is identical with Ardditam as regards its symptoms. 26 -33.
Diseases of the tongue :— The five Kinds
of diseases which affect the organ of taste are the
three sorts of Kantakas due to the three deranged
Doshas (Vataja Pittaja and Kaphaja), Alasa and Upa-jihvika. 34.
The three Kantaks :— In the Vataja Kan-
taka type the tongue becomes cracked, loses the sense of taste and becomes rough like a teak leaf (giving the organ a warty appearance). In the Pitta ja Kantakaform the tongue is coloured yellow and studded over with furred blood-coloured papillae with the burning sensation (of the Pittam in them). In the Kaphaja Kantaka type the tongue becomes heavy, thick and grown over with vegetation of slender fleshy warts in the
H
I06 THE SUSHRUTA SAMHITA. [Cliap. XVI.
shape o{ S'dlinali thorns Alasa : —The severe inflam- maiory swelling about the under surface of the tongue is called Alasa, which if allowed to grow on unchecked gives rise to numbness and immobility of the organ and tends to a process of rapid suppuration at its base. The disease is caused by the deranged blood and Kapham. The Upa-jihva : -The disease in which a (cystic) swelling shaped like the tip of the tongue appears about the under-surface of that organ by raising it a little is called Upa-jihvika (Ranula). The accom- panying symptoms are salivation, burning and itching sensations in the affected organ ; these are due to the deranged Kapham and blood (of the locality). 35 — T)7.
Disease of the palate : — Diseases which are peculiar to the part of the palate are named Gala-s'undika, Tundikeri. Adhrusha, Mansa-kachchapa, Arvuda, Mansa- sanghata, Talu-s'osha and Talu-paka. 38.
Gala-SUndika : — The diffused and elongated sw^elling, caused by the deranged blood and Kapham, which first appears about the root of the palate and goes on extending till it looks like an inflated skin- bladder is called Gala-s'undika (tonsilitis) by physicians. Thirst, cough, difficult breathing are the indications of the disease. Tundikeri : — A thick swelling resembling the fruit of the Tundikoi ^^Xdini in shape and appearing about the root of the palate attended with a burning, piercing or pricking pain and suppuration is called Tundikeri (abscess of the tonsil). Adhrusha : — A red, numbed swelling appearing about the same region, as the effect of the vitiated blood of the locality, attended with severe fever and pain, is known by the name of Adhrusha, Mansa-kachchapa:— A brownish and slightly painful swelling somewhat shaped like the back of a tortoise (and appearing about the region of the soft
Chap. XVI.] NIDANA STHANAM. I07
palate^ is called M^nsa-kachchhapa. The disease is slow in its growth or development and is due to the deranged Kapham. Arvuda : — A swelling shaped like the petal of the lotus lih' and appearing in the region of the soft palate as an outcome of the aggravated con- dition of the local blood is called Arvudam. The swelling is identical with the Raktarvuda described before. Macsa-Sangliata :~ A vegetation of morbid flesh at the edge or extremit}' of the soft palate through the action of the deranged Kapham is called Mansa-Sanghata. It is painless. Talu-pnpputa : — A painless permanent swelling to the shape of the Kola fruit (plum") caused by the deranged fat and Kapham at the region of the soft palate is called Talu-pupputa. Talu-sosha :— The disease of the soft palate in which the patient feels a sort of parched sensation with dyspncea and a severe piercing pain in the affected part is called Talu-sosha, which has its origin in the aggravated condition of the bodily Vayu acting in concert with the deranged Pitlam. Talu-paka — The disease in which the deranged Pittam sets up a very severe suppurative process in the soft palate is called Talu-paka. 39-47-
The diseases of the throat and
larynx : — The diseases peculiar to the throat and the larynx are seventeen in number and are known as the five types of Rohini, Kantha-Saluka, Adhijihva, Valaya. Valasa, Eka-vrinda, Vrinda, Sataghni, Gilayu, Gala-vidradhi, Galaugha, Svaraghna, Mansatana, and Vidari. 48.
General features of Rohinis :— The
aggravated Vayu, Pittam, Kapham, either severall}' or ni combination, or blood may affect the mucous of the throat and give rise to vegetations of fleshy papillae.
I08 THE SUSIIRUTA SAMHITA. [Chap. XVI.
which gradually obstruct the channel of the throat and bring on death. The disease is called Rohini (Diphtheria"). 49.
The Vataja Rohini: -A vegetation of ex- tremely painful fleshy Ankuras (nodules), crops up all over the tongue which tend to obstruct the passage of the throat and are usually accompanied by other distressing symptoms characteristic of the deranged Vayu. Pittaja- Rohini : — The Ankuras (nodules) in the present type are marked by speedy growth and suppuration, and are accompanied by a burning sensation and high fever, Kaphaja Rohini : —The Ankuras (nodules) become heavy, hard and characterised by slow suppuration gradually obstructing the passage of the throat. 50-52.
The Sannjpatika Type :— Suppuration
takes place in the deeper strata of the membrane ac- companied by all the dangerous symptoms peculiar to I the three aforesaid types of the disease. It is rarely amenable to treatment Riktaji Typ8 : -Symptoms characteristic of the Pittaja type of the disease are present and the fleshy outgrowth formed in the throat, is found to be covered with small vesicles. This type is incurable.* 53~54
Kantha-^'alukam : —The disease in which a hard rough nodular growth (Granthi) in the shape of a plum-stone crops up in the throat, which seems as if it has been stuffed with the bristle of a S'uka insect or been pricked by thorns is called Kantha-Salukam. The disease is due to the action of the deranged Kapham. It is amenable to surgical treatment only. Adhijiliva : — ■ A small swelling like the tip of the tongue caused by the
* The reading Sadhya (curable) which is to be met with in the several printed editions of Madhab's Nidanam in lieu of the reading Asadhya (incurable) is not to our mind correct.
Chap. XVI.] NIDANA STHANAM. I09
deranged blood and Kapham over the root of the tongue is called Adhijihva, which should be given up as soon as suppuration sets in. Valaya :- A circular or ring-shaped raised swelling obstructing or closing up the upper end of the oesophagus (structure of oesophagus) is called Valaya. It cannot be cured and hence should be given up. It is due to the deranged action of the Kapham in the locality. Valsisa : —The disease in which the unusually aggravated Vayu and Kapham give rise to a swelling in the throat, which is extremely painful and causes a difficulty of respiration, ultimately producing symptoms of complete asphyxia is called Valasa by learned physicians and is vcr\' difficult to cure. 55 — 58.
Eka-vrinda and Vrinda*:— The disease in
which a circular, raised, heavy and slightly soft swelling appears in the throat attended with itching, a slightly burning sensation and a slight suppuration is called Eka-vrinda. The disease is due to the effect of vitiated blood and Kapham. The disease in which a round elevated swelling attended with high fever and a slightly burning sensation is formed in the throat through the aggravated condition of the blood and Pittam is called Vrinda. A piercing pain in the swelling points to its Vataja origin. 59 — 60.
^ataghni : — The disease in which, through the concerted action of the deranged Vayu, Pittam and Kapham, a hard throat obstructing Varti fjagged mem- brane; edged like a Sataghni-f and densely beset with fleshy excrescences is formed along the inner lining of
* The diseases of the throat are 17 in number. Taking Vrinda as a separate disease they amount to 18 ; but Vrinda, affecting similar place and being similar in appearance with but a slight distinction of symptoms, is only a particular state of Ek£-vtinda, and not a separate disease.
+ Salaghni is a kind of weapon used in ancient warfare.
iro THE .-^USIIRUTA SAMHITA [Chap. XVI.
that pipe is denominated as Sataghni. Various kinds of pains, (characteristics of each of the deranged Vayu, Pittam and Kapham) are present in this type which should be necessarily considered as irremediable. 6i.
Gllayu : -— The disease in which the aggravated Kapham and blood give rise to a hard and slightly painful (D. R extremely painfull glandular swelling in the thrvmt to the slzz of the stone of the Amalaka fruit is called Gilayu. A sensation as if a morsel or bolus of food is stuck in the throat is experienced which by its very nature is a surgical case. 62.
Gala-Vidradhi: — Thediscasein whichan exten- sive swelling occurs along the whole inner lining of the throat, owing to the concerted action of the deranged V^yu, Pittam and Kapham is called Gala-vidradhi which exhibits all the features present in a Vidradhi of the Sanipatika type, Galaugha : — The disease in which a large swelling occurs in the throat so as to completely obstruct the passage of any solid or liquid food and also that of Udana-vayu (choking the pharynx, larynx and the mouth of the esophagus), attended with a high fever is called Galaugha, the origin of which should be as- cribed to the action of the deranged blood and Kapham. Svaraghua: -The disease in which the patient faints owing to the choking of the larynx by the deranged Kapham which is marked by stertorous breathing, hoarse- ness, dryness and paralysed condition of the throat is called Svaraghna which has its origin in the deranged Vayu. 63 — 65.
IVIanSatana : — The disease in which a pendent, spreading and extremely painful swelling appears in the throat which gradually obstructs the pipe is called Mansatana. It invariably proves fatal and is caused by the deranged Vayu, Pittam and Kapham 66
Chap. XVI.] XIDANA STIIANAM. til
ViCiari : -The disease in which a copper-coloured swelling occurs in the throat, marked by a pricking and burning sensation, and the flesh of the throat gets putrefied and sloughs off (and emits a fetid smell) is called Vidari. The disease is of a Pittaja origin and is found to attack that side of the throat on which the patient is in the habit of lying. 67.
The disease in the entire cavity: —
Cases which are found to invade the entire cavity of the mouth (without being restricted to any particular part thereof) may be either due to Vataja, Pittaja, Kaphaja or Raktaja type and are known by the general name — SaVra-Sara. 68.
In the Vataja type the entire cavity of the mouth is studded with vesicles attended with a pricking sensation in their inside. In the Pittaja type a large number of small yellow or red-coloured vesicles attended with a burning sensation crops up on the entire (mucous membrane lining the cavity of the mouth. In the Kaphaja variety a similar crop of slightly painful, itching vesicles of the same colour as the skin (is found on the entire inner surface of the mouth.) The blood-origined itaktaja type is nothing but a modification of the Pittaja one (giving rise to similar symptoms) ; it is also by others called Mukha-paka. 69-72.
Thus ends the sixteenth Chapter of the Nidana Sthanani in the Sui'ruta Samhita which treats of the Nidanam of the diseases of the mouth.
Here ends the Nidana Sthanam.
THE
SUSRUTA SAMHITA
S'ARIRA STHANAM.
(Section on Anatomy). : 0 :
CHAPTER I.
Now we shall discourse on the S^riram which treats of the science of Being in general (Sarva-Bhuta
Chlnta ^ariram). i.
The latent (lit : unmanifest) supreme nature (Prakriti) is the progenitor of all created things She is self- begotten and connotes the three fundamental or primary virtues of Sattva, Rajas and Tamas. She is imaged or embodied in the eightfold categories of Avyakta (un- manifest), Mahan (intellection), Ahamkara (Egoism) and the five Tanmdtras or elementals (proper sensibles) and is the sole and primary factor in working out the evo- lution of the universe. The one absolute and original nature is the fundamental stone house of materials out of which the bodies of all self-conscious (Karma-Purusha) working agents (agents who come into being through the dynamical energy of their acts or Karmas) have been evolved in the same manner as all water, whether con- fined in a tank or a reservoir, or coursing free through the channels of streams and of mighty rivers, have been welled up from the one and shoreless primordial ocean. 2.
Out of that latent unmanifest (Avyakta) or original nature (impregnated by the atoms or elemental units of
15
114 THE SUSIIRUTA SAMHITA. [Chap. I.
consciousness or Purushas) Intellection or Mahdn has been evolved, and out of MahAn egoism. This Mahdn or intellection should be likewise considered as partaking of the three fundamental attributes (Sattva, Rajas, and Tamas) of the latent (Avyakta) or original nature.* Ahamkara or egoism in its turn may be grouped under three subheads as the Vaikdrika Taijasa (operative) or Rdjasika, and Bhutadi (illusive or Tamasika). 3.
The eleven organs of cognition, communication or sense perception have emanated from the co-operation of the aforesaid Vaikarika Ahamkara with the Taijasa or Rajasa. They are the ears, skin, eyes, tongue, nose, speech, hands, genitals, anus, feet and the mind (Manah), Of these foregoing organs the first five are intellectual or sense organs (Vuddhi Indriya) ; the next five being operative (Karma-Indriya\ The mind (Manah) par- takes of the character of both the intellectual and operative organs alike. 4-5.
The five Tanmatras or elementals (or the five proper sensibles of hearing, touch, sight, taste, and smell) charac- terised by the Nescience, etc. have been evolved out of the Bhutadi etc. (or Tamasa Ahamkara) concerted with the Taijasa Ahamkara through the instrumentality of the Vaikarikam. The gross or perceptible modifications of these five Tanmatras are sound, touch, taste, sight and smell. From the combination of the aforesaid five Tanmatras (Bhutadi) taken one at a time, have succes- sively emanated the five gross matters of space such as
* Sattva, Rajas and Tamas : — Adhesion, cohesion and disintegration in the Physical plane ; affection, love and hate in the moral ; emancipa- tion, spiritual affinity and sin in the Psychic.
Simply phenomenal or the simple outcome of the phenomenal evolution without being by other specific attributes of matter and hence Sattvika or jlluir.inating or qi'asi-spiritual,
Chap. I.] SARIRA STHANAM. 115
ether, air, heat, (fire,) fluid (water), and earth (solid). These twenty four categories combinedly form what is technically known as the twenty four elements (Tattvas). Thus we have discoursed on the twenty four fundamental principles (Chaturvins'ati-tattvam). 6.
Hearing, touch, sight, taste and smell respectively form the subjects of the five intellectual (Vuddhi) organs of man, whereas the faculty of speech, handling, pleasure, ejections or evacutation, locomotion successively belong to the (remaining) five operative (Karma-Indriya) ones. The original nature (Avyakta), Mahan* (intellec- tion). Egoism (Ahamkara),the five sensibles (Tanmatras), and the five gross material principles in their nascent stage in evolution form what is included within the eight categories of Nature (Prakriti), the remaining sixteen categories being her modifications (Vikara). The objects of intellection (Mahan) and Egoism (Ahamkara) as well as of the sense organs of knowledge and actions are the material principles (Adibhautika) though they are spiri- tual in themselves and in their nature.
The tutelary god of intellection (Buddhi) is Brahma. The god Is'vara is the presiding deity of the sense of egoism (Ahamkara) ; the moon god is that of the mind (Manah) ; the quarters of the heaven, of the ears ; the wind god is that of the skin ; the sun is that of the eyes ; the water is that of the taste ; the earth is that of the smell ; the fire is that of the speech ; Indra is that of the hands ; Vishnu is that of the legs ; Mitra is that of the anus and Prajapati is that of the organs of generations. 7.
* Mahan, Ahamkara and the five Tanmatras, though but modifications of the original Nature in themselves, have been included within the category of Nature (Prakriti) in asmuch as they form the immediately prior or antecedent conditions of the evolution of the phenomenal universe.
Il6 THE SUSHRUTA SAMHITA. [Chap. I,
All the aforesaid (twenty-four) categories or elementals (Chaturvins'ati-Tanmdtras) are devoid of consciousness. Similarly the modifications of the primal cause of Prakriti such as the Mahat etc. are all bereft of consciousness in as much as the cause itself, the Avyakta or the original nature is devoid of it. The Purusha or the self-conscious subjectivity, enters into the primal cause (Mula-Prakriti or original Nature) and its necessary effect (the evolved out phenomena) and makes them endued with his own essence or self-consciousness. The preceptors and holy sages explain the proposition by an analogy that as the milk in the breast of a mother, though unconscious in itself, originates and flows out for the growth and sustenance of her child ; (as the semen in the organism of an adult male though devoid of consciousness, flows out during an act of sexual intercourse) ; so these twenty-four primary' material principles (elementals), though unconscious in themselves, tend to contribute towards the making of the self-conscious self or the universal individual (the aggregate of limited or condi- tional selves) for the purpose of working out his final liberation or emancipation i.e., attainment of the stage of pure consciousness or perfect knowledge. 8.
Now we shall describe the tracts which the Purusha (subjective or self-conscious reality) and Prakriti or nature (passive non-conscious eternity) pass in com- mon as well as those wherein they differ from each other. 9.
Traits of commonalty :— Both the Purusha and Prakriti are eternal realities, both of them are un- manifest, disembodied, without a beginning or origin, eternal, without a second, all — pervading and omni- present.
Chap. I.] SARIRA STHANAM. tl7
Traits of diversity :— Of the Pumsha and the Prakriti, only the latter is non-conscious and possesses the three fundamental qualities of Sattva, Rajas and Tamas. Prakriti performs the function of the seed or in otherwords she lies inherent as the seed or the primary cause in the latter phenomenal evolution of the Mahat etc. and contributes the maternal element in the conception, development and birth of the primordial cosmic matter (phenomenal universe\ fecundated by the Purusha (self-conscious subjectivity) in its different stages of evolution. These stages are called Mahat, Ahamkara etc. ; and Prakriti is not indif- ferent, as the Purusha is to the pleasures and misery of life. But the Purusha (units or atoms of consciousness), devoid of the threefold virtues of Sattva etc. are non- concerning hence non-producing and bereft of the seed- attributes of lying inherent in all as the primary cause of evolution. They are mere witnesses to the joys and miseries of life, and do not participate in their enjoyment though imprisoned in the human or- ganism. 10
Since an effect is uniform in virtue to its producing cause, the evolutionised effects or products of the Pra- kriti such as the Mahat, Ahamkara etc. must needs par- take of the three fundamental qualities (Sattva, Rajas and Tamas) which are predicated of the Prakriti. In other words, these Mahat, Ahamkara, etc, are but the modifications of the three fundamental qualities of Sattva, Rajas and Tamas. Moreover, certain authorities hold that the Purushas are units of self-consciousness, possessed of the three aforesaid qualities owing to their antecedent conditions or causes (the gross material universe) being permeated with and characterised by them. II.
Il8 THE SUSHRUTA SAMHITA. [Chap. I.
IVIetrical Text (Vaidyakc.) :— It Is asserted in the Ayurveda that it is only the gross-sighted ones and men capable of observing only the superficial appearances, who confound eternal order or se- quence of things and events (Svabhaba), God (Is'varaV* Time (Kala), sudden and unlooked for appearances of the phenomena (Yadrichchha), Necessity (Niyati) and transformation (Parinama) with the original Nature (Prakriti). The five different forms of matter (such as Ether etc) are nothing but the modifications or trans- formed states of the original nature and are characterised by the three universal qualities of Sattva, Rajas and Tamas, and all created things, whether mobile or im- mobile, should be considered as alike exponented by the same. In the Science of medicine the cause of a disease is the one sole aim to be achieved by means of administering proper medicinal remedies (matter), and hence the properties of matter are the only fit subject to be dealt with in a book on pharmacy. And further, because the immediately prior cause of the human organism is a proper and congenial admixture of the sperm and ovum (matter), the sense organs are the resultants of phenomenal — evolution of matter, and the objects of sense perception are equally material or phenomenal in their nature. 12 —14,
IVIemorable verse : -A man by a particular organ of his body perceives the same matter which forms the proper object of that sense organ in as much as the perceiving sense organ and the perceived sensible are produced by the same material cause. The matter,
* The second factor according to Sankhya, in the order of cosmic evolution, which as the seed of the universe, was hid in the burning disc of the central, primordial Sun, out of which the different solar systems have come into being.
Chap. I.] SARIRA STHANAM. Up
which specifically forms the object of a particular sense organ, cannot be perceived by the other. We see a flower with the eyes and not with the nose. 15.
The Science of medicine does not lay down that the self-conscious Selves (Kshctrajna) are all pervading, but on the contrary it asserts that they are real and eternal and are born in the planes of divine, human or animal existence according to their good or evil deeds in life. The existence of these self-conscious entities can be ascertained duly by inference inasmuch as they are extremely subtle in their essence. The self-conscious self is possessed of infinite consciousness, is real and eternally subject to the process of being evolved out into a finite, organic individual through the dynamics of the combined sperm and ovum. The view is further corroborated by a dictum of the Sruti which holds that Parusha (individual) is nothing but a combination of a self-conscious self and the five kinds of matter (Maha- bhutas) formed into an organic body. This Purusha or individual, which is called Individual of action (Karma- Purusha), falls within the scope of the science and art of medicine.* 16 — 17.
* Here lies the difference between Sankhya and Ayurveda. While the former discourses on in material character of the soul, the latter com- mences to discuss on the questions how the material environment in which the soul is said to inhabit is evolved, and how the inclusion of the spiiilual within the material organism is effected.
Hence Sus'ruta's Physiology, like that of Charaka, is in the strictest sense of the word molecular and his science of life is an attempt at explanation of consciousness from the materialistic standpoint, which agrees with the views of modern westein science. Intellect according to Sus'ruta is material and belongs to the same category which the Sankhya system of philosophy in its explanation of evolution enumerates originr.lly as seven. The soul, according to Sus'ruta, is an independent existence and is often associated with what is called life. Where there is life, there is a soul, and it is not everywhere the same. The soul in Sus'ruta is individual
I20 THE SUSHRUTA SAMHITA. [Chap. I.
The attributes of an organic indi- vidual : — Longing for pleasure, shunning of pain, enemity, energetic undertaking of work, respiration (Prana\ emission of flatus (Apana), closing and opening of the eytfids, intellect (Vuddhi), sentiment (Manah), deliberation, discretion, memory, knowledge of art, perseverance, sensation and perception, are the attributes of an organic individual. i8.
Distinctive features of the different classes of mental temperaments :— An
absence of all killing or hostile propensities, a judicious regimen of diet, forbearance, truthfulness, piety, a belief in God, spiritual knowledge, intellect, a good retentive memory, comprehension, and the doing of good deeds irrespective of consequences, are the qualities which grace the mind of a person of a Satttvika temperament. Feeling of much pain and misery, a roving spirit, non- comprehension, vanity, untruthfulness, nonclemency, pride, an over winning confidence in one's own excel- lence, lust, anger and hilarity are the attributes which mark a mind of the Rajashika cast. Despondency, stupidity, disbelief in the existence of God, impiety, stupification . and perversity of intellect, lethargy in action and sleepiness are the qualities which mark a mind of a TatmasMka stamp. 19,
The distinctive traits of the five material of Elements of the world :—
The properties of Akas'a (ether) are sound, the sense of •hearing, porosity and differentia evolution of the veins, ligaments etc. into their characterised species (Viviktatd.)
tifsi'T g^^; ^"^ takes cognisance of sorrow, disease and death by its union with the body ( q< JTfliJ^ aflft ^J^Wfq: ^^^ ?gi'^% )• Hence the living frame together with the soul that ia said to inhabit it forms the subject-matter of Ayurvedic medical treatment. Ed.
Chap. I] SARIRA STHANAM. 121
The properties Vatyu (ethcriii) are touch, the skin, all functional activities of the organism, throbbing of the whole body (Spandana) and lightness. The properties of Teji (fire or heat) are form, the eyes, colours, heat, illumination, digestion, anger, generation of instanta- neous energy and valour. The properties of Apa (water or liquid) arc taste, the tongue, fluidity, heaviness, cold- ness, olioginousncss and semen. The properties or modifications of Pritllivi (the earth matter or solid) are smell, the nose, embodiment and heaviness, 20.
Of these the ether or Akasa abounds in attributes of the Sattvika stamp, the Vayu or etherin in Rajashika, the Teja in Sattvika and Rajashika, the water in Sattvika and Tamashika and the earth in Tamasha attributes. 21.
There are IVIemorable Verses : —These
qualities are found tu characterise and enter into the suc- cessive elements in the order of their enumeration. The specific attributes of these elements are manifest in the substances v\^hich are respectively originated from them. The term Prakrit! or original nature connotes the eight categories (of Avyakta, Mahan, Ahamkara, and the five Tanmatras) and the rest of the twenty four fundamental principles are its modifications. The Purusha forms the twenty fifth principle. These twenty five fundamental prin- ciples of cosmogony have been dealt with in the present treatise ^Salya-Tantram) as well as in the other treatise (Salaky-Tantram and Sdnkhya Philosophy). 22 — 23.
Thus ends the first Chapter of the S'arira Sihanan in the Sus'ruta Samhiia which deals with the science of Being in general.
16
CHAPTER 11.
Now \vc shall discourse on the Sariiam \\liic!ii treats of the purification of semen and cataminal
fluid etc. (^ukra-^onita-^uddhirnama ^ariram). i.
A man is incapable ol begetting children, whose seminal fluid, affected by the aggravated Vdyu, Pittam or Kapham, emits a cadaverous smell, or has acquired a clotted or shreddy character or which looks like putrid pus, or has become thin, or smells like urine or stool, 2.
Deranged Semen : — Semen vitiated by the deranged Vayu acquires a (reddish-black) colour and gives rise to a pain (piercing and cutting etc.) which characterises the Vayu (at the time of being emitted). Similarly semen deranged by the Pittam gets a (yellowish or bluish etc.) colour and produces the specific pain (burning and sucking etc.) of the deranged Pittam (at the time of emission). Semen vitiated by the action of the deranged Kapham has a (white) colour and pro- duces the pain (itching sensation etc.) peculiar to the deranged Kapham (at the time of its outflow). The semen vitiated by blood is tinged with a bloody hue, produces all kinds of pain peculiar to the deranged Sonita (Pittam). The semen smells like a putrid corpse and is emitted in large quantities. The shreddy or clotted character of the fluid (Grautliila) should be ascribed to the action of the deranged Vayu and Kapham. If vitiated by the action of the deranged Pittam and Kapham it looks like putrid pus (Puti- puya). Thin semen is caused by the deranged Vayu and
Chap. II.] SARIRA STHANAM. 1 23
Pittam as described before. A concerted action of the deranged Vayu, Pittam, and Kapham causes the semen to smell like urine or fecal matter. Of these, the cadaverously smelling, shreddy and clotted, putrid pus- like and thinned semen can be remedied and corrected only with the greatest difficulty ; while the one, having the smell of stool or urine, should be regarded as beyond cure. The remaining kinds are curable. 3,
Deranged Artavam :— The catamenial fluid ( Artavam) of a woman vitiated by the deranged V^yu, Pittam, Kapham, or blood, either severally or in combination of two or more Doshas should be likewise considered as unfit for the purpose of fecundation. Vitiated catamenial fluid exhibits the characteristic colour and pain of the deranged Doshas or blood (underlying at its roots). Of the several kinds (of vitiated catamenial fluids) those which smell like a putrid corpse or fetid pus, or which is clotted, or is thin, or emits the smell of urine or fecal matter, should be deemed as being beyond remedy, the rest being amenable. 4.
lYIemorable Verses :— The first three types
of seminal derangements or defects should be corrected by an intelligent physican with an application of medicated oil etc. iSneha-karma), diaphoric measures etc* or uretheral injections ^Uttara-vasti\ A medi- cated Ghrita prepared with a (decoction and Kalka of) DJiataki flowers, Khadira, Dddima and Arjiina barks should be given to drink to a man whose semen em:ts a cadaverous smell (Kunapa\ As an alter- native, a medicated Ghrita prepared with (a decoction and levigated paste or Kalka of) the drugs forming the S'dlasdrddi group should be given to him. In a case of
* The word " A:U" in ihe text includes emelicSj purgatives, Anuva- sanam and Asthapanam measures according to their specific Doshas.
124 THE SUSHRUTA SAMHITA. [Chap II.
clotted and shreddy semen (Granthi), the patient should be made to drink a medicated Ghrita prepared with a (decoction and Kalka of) S'athi, or with an alcaline solu- tion prepared from the ashes of the burnt P aids' ha wood. In the case of a pus-like appearance of the fluid the patient should be treated with the medicated Ghrita prepared with (a decoction and Kalka of) the drugs included within the groups of Paruskakddi and Vatddi (Nyagrodhadij Ganas. In a case of thin semen, measures laid down under the same head before, as well as those to be hereafter described should be resorted to. Similarly a medicated Ghrita, prepared with (a de- coction and Kalka ofj Chitrakk roots. Ushira roots and Hincru, should be drunk in a case of the semen smelling like urine or fecal matter. In all cases of seminal disorders as well as in menstrual anomalies, Uttara- Vssti (uretheral or vaginal injection) should be made after having recourse to the application of medicated oil etc. (Sneha-karma , purgatives, emetics, Asthapana and Anuvasana measures. 5 — 12
Treatment of deranged Artava:— In
all the four cases when the catamenial blood would be found to be vitiated (by the deranged Vayu, Pittam, Kaphah or Sonita), the preliminary remedial measures of the application of oil etc, purgatives etc. (Pancha-karma) should be first employed and then the following measures should be undertaken viz. application of Kalka, (levigated paste of drugs), Ficliu (medicated plugs— pecharies etc/), Pathya (diet) and Achamana (washes with decoctions) as described under the treat- ment of Gyontiecological cases etc. Appearance of clots of blood (Granthi) in place of the healthy men- strual fluid would indicate, decoction or a pulverised compound of Path^, Trushuna and Vrikshaka (Kutaja).
Chap. II.] NIDANA STIIANAM. 12$
A decoction o^ B/ia:^ras'rlj'a,vr' and Chandaiiani is indica- ted in the case when the menstrual fluid would smell like fetid pus, or contain marrow. The remedies described under the head of seminal disorders, should be likewise prescribed in cases of menstrual anomalies caused by the action of the deranged Vayu, Pittam and Kaphah according to the requirements of each individual case under treatment. Sali-rice, barley, wine and meat with cholagogue properties should be deemed as a wholesome diet in these cases. 13 — 16.
Traits of pure and healthy semen and menstrual blood : — Semen which is
transparent like crystal, fluid, glossy, sweet and emits the smell of honey ; or like oil or honey in appearance according to others, should be considered as healthy. The catamenial blood (Artava) which is red like the blood of a hare, or the washings of shellac and leaves no stains on cloths (which ma}' be washed off" by simply soaking them in water) should be considered as health}-. 17—18.
Asrig'dara (Menorrhagia) :— An abnormal or excessive discharge of the menstrual blood (Artava), or its long persistence even after the wonted time, or its appearance at a premature or unnatural period (as well as contrarit}' in its colour or properties) is called Asrig'dara. All types of the disease (Asrigdara) arc attended with an aching in the limbs and a painful flow (of the catamenial fluid). In case of exce.ssive hcemorrhage '^from the uterus), symptoms such as weak- ness, vertigo, loss of consciousness, darkness of vis'on, or difficult breathing, thirst, burning (sensation of the bod}'), delirium, palour, somnolence and other Vataja
* Blndrab'riyam is S'richandanain according to Dallana or white Sandal wood according Gayadasa.
126 THE SUSriRUTA SAMFHTA. [Chap. II.
troubles (convulsion, hysteria etc.) may set in. A physician should treat a case of Asrigdara with measures and remedies as laid down under the head of Rakta-pittam (hoemorrhage) in a case when the patient is young (of sixteen year.s), careful in her diet, and the disease unattended with .severe complica- tions. 19 — 21.
Amcnorrhoe : —In a case of suppression of menstruation ( Ainenorrhoe) caused by the obstruction of the deranged Doshas (Vayu and Kapham) in the passage, the patient should be advised to take fish, Kulaitha pulse, Masha pulse, Kanjikam fermented sour gru 4 etc.), Tila, wine (Sura), cow's urine, whey, half diluted Takm, curd and S^ukfam for her diet. The .symptoms and treatment of thin and scanty menstrua- tion have been described before. Still in such a case measures laid down for the treatment of Nashta-Rakta (amenorrhce) ma}' be adopted. Under a course of treatment described as before, the semen or the cata- msnial blood of a person would be resorted to their healthy and normal condition. 22 — -23.
A woman with (healthy) catamenial flow should forego the bed of her husband during the first three days of her uncleanness, as well as day sleep and coUyrium. She shall not shed tears nor bathe, nor smear her person (with sandal paste etc.), nor anoint her bod}% nor pare her nail, nor run, nor indulge in loud and excessive laughter and talk, nor should she hear loud noise, nor comb her hair, nor expose herself to droughts^ nor do any fatiguing work at all ; because if a woman sleeps in the day time (during the first three days of her period) her child of subsequent conception becomes sleepy or somnolent. The woman who applies collyrium along her eyelids (during those days\ gives
Chap. II.] SARIRA STHANAM. 1 27
birth to a blind child ; by shedding tears (during her period) a woman gives birth to a child of defective eye- sight ; by bathing or smearing her body (with sandal paste etc.) a miserable one ; by anointing her body a leper (Kushthi) ; by paring her, nails a child with bad nails ; by running a restless one ; by indulging in ex- cessive laughter, a child with brown (S)ava) teeth or palate or tongue ; by excessive talking a garrulous child or one of incoherent speech ; by hearing loud sounds, a deaf child ; by combing her hair, a bald one ; whereas by exposure to the wind or by doing fatiguing work (during the first three days of her period) she gives birth to an insane child Cconceived immediately after it). Hence these acts (^day sleep etc) are to be avoided. 24.
Regimen to be observed in her
menses : —A woman in her menses should lie down on a matress made of Kus'a blades (during the first three days of her uncleanness), should take her food from, her own blended palms or from earthen sauces, or from tray." made of leaves. She shonld live on a course of Habishya diet and forswear during the time, even the sight of her husband. After this period, on the fourth da)- she should take a ceremonial ablution, put on a new (untorn) garment and ornaments and then visit her husband after having uttered the words of necessary benediction. 25. Metrical Text :— A child conceived after the period resembles the man whom she first sees after ablution on the fourth day of her menses ; hence she should see none but her husband* at that time (so that the child may resemble his father). After that the priest shall perform the rites (Garbhadhana ceremony),
In the case of the hu&band being abscn- at the time, sh^ should look at the suD.
128. THE SUSHRUTA SAMHITA. [Chap. II.
to help the conception of a male child and after the ceremony a wise husband should observe the following rules of conduct, 26 — 27.
Conduct of Husband :— A husbaud wish- ing to beget a son by his wife, should not visit her bed for a month (before the day of the next flow). Then on the fourth day of her uncleanness, he should anoint or lubricate his body with Ghrita, should partake of a food in the afternoon or evening composed of boiled S'dli rice, milk and clarified butter, and then visit the bed of his wife The wife also, in her tern, should observe a similar vow of sexual abstinence (Brahma-charini ) for a month before that day on which she should anoint or lubricate her body with oil, partake of food largely composed of oil and MasJia pulse, and then meet her husband at night. The husband then having uttered the appro- priate Veda Mantras and having awakened confidence in the wife, should go unto her on the fourth, sixth, eighth, tenth or on the twelfth night of her menses for the progenation of a male child. 28.
IVIctrical Text ;— A vislc to the wife on any of these nights leads to the continual increase of the wealth, progeny, and the duration of the husband's life. On the other h?i,nd, a visit to one's wife on the fifth, seventh, ninth, or eleventh da)^ of her flow leads to the conception of a female child The thirteenth and the remaining days (till the next cour.se) are condemned as regards intercourse. 29 —30
Prohibited Period etc. :— A going unto
one's wife on the first day of her monthly course tends to shorten one's life and a child born of the act dies imme- diately after its delivery. The same result is produced l>y a visit on the second day, or the child dies lying-in loom i.e. ten days of its biith ; A visit on the third day
Chap. II.] SARIRA STHANAM. 1 29
leads to the child's being deformed and short-lived. A child which is the fruit of a visit on the fourth day lives long, will be well developed and remain in the full vigour of health. The semen cast in the womb of a woman during the continuance of her monthly flow does not become fruitful because it is carried back and flows out in the same manneras a thing thrown into a stream does not go against but is carried away with the current. Hence a husband should foreswear the company of his wife during the first three days of her un cleanness, when she also should observe a vow of sexual abstinence ; the husband should not visit his wife within the month after the twelfth day of her menses). 31.
After the impregnation on any of these nights, three or four drops (of the expressed juice) of any of the following drugs such as Lakshand, Vata-S'iinga! , S'ahadevd or Vis'vadevd, mixed with milk should be poured into the right nostril of the enceinte for the conception of a male child and care should be taken that she does not spit it away. 32.
Metrical Text :— A co-ordination of ihe four factors of menstrual period (Ritu), healthy womb (Kshetra), nutrient liquid i.e. chyle of digested food (Ambu), healthy semen (Vija) and the proper observance of the rules is necessary for the conception and develop- ment of a healthy child just as the proper season (Ritu), good soil (Kshetra), water (containing nutrient matter) and vigorous seeds (Vija) together with proper care, help the germination of strong and undiseased sprouts. A child which is the fruit of such conception is destined to be beautiful, of vigorous health, generous, long-lived, virtuous, attached to the good of its parents and capable of discharging its parental obliga- tions. 33.
17
130 THE SUSHRUTA SAMHITA. [Chap, II.
Causes of different colours of the
Child:— The ficiy principle (Tejadliatu) of the
organism, which is the originator of all colours of the skin (complexion), happening to mix largely with the watery principle of the body at the time of conception, serves to make the child a fair complexioned one (Gaiira-varna) ; mixed with a large quantity of the earth principle (Kshiti) of the body, it makes the chiid a dark complexioned one (Krishna-varna). In combi- nation with a large quantity of earth and ethereal principles of the organism, it imparts a dusky (Krishna- s'yama) complexion (^to the full developed fcetus). A similar combination of watery and ethereal principles serves to make the child dusky yellow (Gaura-s'yama). Others on the contrary aver that the complexion of the child is determined by the colours of the food taken by its mother during the period of gestation. 34.
A child is born blind in the failure of the fiery principle (Teja-dhatu) of the organism in reaching the region of its still undeveloped eyes (part — where the eyes would be) ; so also a penetration by the same (Teja-dhatu) into its blood accounts for the blood-shot eyes of the child. Entered into the Pittam it makes the child a yellow-pupiled one (Pingalaksha). Entered into its bodily Kapham it makes it a white-eyed body and mixed with its bodily Vayu, a child of defective eyesight. 35.
IVIemorable verses:— As a lump of con*
densed clarified butter melts and expands if placed by the side of a fire, so the ovum (Artava) of a woman is dis- lodged and glides away in contact with an adult male*
* Sub'iula's theory is that ovulation occurs about the same lime as uienstfuation and rather initiates the latter, and the shed ova are washed out Nviili the menstrual flow, hence there is a possibility of conception on
Chap. II,] SARIRA STHANAM. 131
A seed divided into two by the deranged Vayii within the (cavity of the) uterus (Kukshi) gives rise to the birth of twins, conditioned by the good or evil deeds of their prior existence * A child born of scanty paternal sperm becomes att Asekya and feels no sexual desire (erection) without previously (sucking the genitals and) drinking the semen of another man. A child begotten in a sordid vagina is called a Sougandhika, whose organ does not respond to the sexual desire without smelling the genitals of others. The man who first be- comes a passive member of an act of sodomy and then again commits sodomy with the woman (he visits) is called a Kumbhika (or Guda-yoni and is included within the category of a Kliva). ^,6 — 40.
The man who cannot copulate with a woman without previously seeing the sexual intercourse of another couple is called Irshaka. A child born of an act of fecund- ation foolishly or ignorantly effected during the menses of its mother by its progenitor by holding her on his bosom during the act is called a Shauda and invariably exhibits effeminate traits in his character. A daughter born of a woman riding on her husband during the act of sexual intercourse will develop masculine traits in her character. 41 — 43.
connexion during the period of flow. But when the menstruation stops of itself by the end of the third day, it also indicates that ovulation has ceased and no ovum is left to be fertilized, hence the question arises how can there be conception then on connexion on the fourth day and thereafter ? The explanation (as in the following verse) is that the ovulating organ though quiescent at the time is again stimulated to activity by intercourse with a male and new ova are shed which are ready to be fertilized by the semen. — Ed.
• Gayi interprets the term "Dharmelara" to mean evil deeds (other than good) and quotes verses from S'rutis, S'mritis and Tantras on ex- piations of sin in support of his view.
T?2 THE SUSHRUTA SAMHITA [Chap. II.
Semen is developed in the four types of Kliva known as Asekya, Sougandhika, Kumbhika and Irshaka, whereas a Shanda is devoid of that fluid (Sukra). The semen carrying ducts of an Asekya etc. are ex- panded by the drinking of the semen as above described which helps the erection of his reproductive organ. 44-45
The conduct and character of a child and its incli- nation to particular dietary are determined by those of its parents during the act of fecundation. A boneless (/. e. with cartilaginous bones) monstrosity is the outcome of the sexual act in which both the parties are female and their Sukra (sexual secretion) unite some how or other in the womb of one of them. Fecundation may take place in the womb of a woman, dreaming of sexual intercourse in the night of her menstrual ablution. The local Vayu carries the dislodged ovum into the uterus and exhibits symptoms of pregnancy, which develop month after month till the full period of gestation. The offspring of such a conception is a Kalala (a thin bone- less jelly-like mass) on account of the absence of the paternal elements* in its development. Such monstro- sities as serpents, scorpions, or gourd shaped fcetus delivered from the womb of a woman should be ascribed as the effects of deadly sins. 46-49.
The child of a mother whose wishes are not honoured and gratified during pregnancy stands in danger of being born palmless, hunchbacked, lame, dumb or nasal voiced through the deranged condition of the Vayu of its mother's body. The malformation of a child in the womb; should be ascribed to the atheism of its parents, or to the effects of their misdeeds in a prior existence, or
* Hair, beard, nails, leeth, arteries, veins, ligaments and semen are called paternal elements inasmuch as these are said to be inherited by the child irom its father
Chap. II.] SARIRA STHANAM. 133
to the aggravated condition of the Vayu, Pittam and Kapham. 50 — 5r.
A fcetus in uterus does not excrete faeces or urine, owing to the scantiness of the fecal matter, etc , in its intestines and also to the obstruction and consequently lessened admission of the Vayu into its lower bowels. A child in the womb does not cry inasmuch as its mouth remains covered with the sheath of the placenta i.e.fcetalinemhrams (Yarau) and its throat is stuffed with Kapham. The processes of respiration, sleeping and movement of the foetus in the womb are effected through those of its mother. 52 — 53.
The adjustment of the different limbs and organs of the body of a child in the womb at their proper places, the non-development of hair on its palms and soles and the subsequent cutting and falling off of its teeth are spontaneously effected according to the laws of nature after the model of its own species. An honest, pious, erudite man, who has acquired a vast knowledge of the Sastras in his prior existence, becomes largely possessed of mental traits of the Sattvika stamp in this life too and also remembers his prior births (Jatismara). Acts similar to those, which a man performs in a prior existence, overtake him also in the next. Similarly the traits and the temperament which he had developed in a previous existence are likewise sure to be patent in the next. 54 — 55.
Thus ends ihe second Chapter of the S'arira Sthanam in the Sus'ruta Samhita which treats of the purification of sperm and ovum.
CHAPTER III.
Now we shall discourse on the Sariram which treats of
pregnancy, etc. (Garbha Vakranti Sariram .i.
The male reproductive clement (Sukra) is endowed with Soma-guna (i.e , thermolytic properties) the female element Artava) presents the opposite property and is therefore Agni-guna (i e., thermogcnetic properties). The principles of earth, water, fire, air and ether are also present in men in their subtile forms and contribute to the formation of the material parts by their molecular adjustment in the way of supplying nutrition and in way of the adding to their bulk. 2.
Combination of Self with the im- pregnated matter :— The local Vayu (nerve- force) heightens or aggravates the heat generated b}' the friction of the sexual organs in an act of copula- tion. The Vayu and heat thus aggravated tend to dis- lodge the semen from its sac or receptacle in a man which enters into the uterus of a woman through the vaginal canal and there it mixes with the ovum (Artavam) dislodged and secreted by similar causes. The combined ovum and semen are subsequently con- fined in the uterus (Garbhas'aya). After that, He who is known by the epithet; of Self-conscious, impressioner (creator of sensations and perceptions), toucher, smeller, seer, hearer, taster, Self or Ego, creator, wanderer, wit- ness, ordainer, speaker, though eternal, unmanifested and incomprehensible in his real nature, takes hold of the five subtile or essential material principles contributed by the united impregnating matter, assumes a subtile .shape throughout, marked by the three fundamental
Chap. Ill] SARIRA STHANAM. 135
qualities of Sattva, Rajas and Tamas, and led away by the Vayu, lies confined in the uterus to be subsequently evolved out in the shape of a god, animal, or monster, as determined by his acts in the former existence. 3.
Factors which determine sex :— The
birth of a male-child marks the preponderance of semen over the ovum (in its conception) ; the birth of a daughter shows the preponderance of the maternal ele- ment. A child of no-sex (hermaphrodite) is the product when ovum and sperm are equal (in their quality and quantity). The first twelve nights after the cessation of the flow should be deemed as the proper period for conception, as being the time during which the ova are secreted. Certain authorities hold that there are women who never menstruate to all appearances 4 — 5.
Memorable verses :— The face of a woman (lit : a woman of undetected menstruation) becomes full and lively. A moist and clumsy deposit is found on the body, face, teeth and gums. She feels a desire for sexual intercourse and speaks sweet words. Her eyes, hair, and belly droop down. A sort of distinct throbbing is felt m her aims, thighs, mamma;, umbilicus, perineum and buttocks. Her sexual desire grows intense and prominent, and its gratification gives her utmost joy and pleasure. These symptoms will at once indicate that a woman has menstruated (inter- nally). 6.
Just as the petals of a full blown lotus flower are gathered up during ths night, so the uterus (Yoni) of a woman is folded up {i. e., os of the uterus is closed) after the lapse of the menstrual period {ie. fifteen days from the date of the flow). The menstrual flow, accumulated in the course of a month, is led in time by the local Vayu through its specific duct (Dhamani) into the mouth of
136 THE SUSIIRUTA SAMIIITA. L^hap. Ill,
the uterus (Yonij whence it flows out odourless and blackish. 7.
Period of IVIcnstruation :— The process
(menstruation) commences at the twelfth year, flowing once in every month, and continues till the fiftieth* year when it disappears with the sensible decay of the body. 8
A visiti* to one's wife on even days during the cata- menial period (twelve days in all from the cessation of the flow) leads to the conception of a male child while an intercourse on odd days results in the birth of a daughter. Hence a man, seeking a male-issue, should approach his wife for the purpose in a clean body and with a quiet and calm spirit on an even date. 9.
A sense of fatigue and physical languor, thirst, lassitude and weariness in the thighs, suppression of the flow of semen and menstrual secretion (Sukra and Sonita) out of the uterus (Yoni), and throbbing in the organ Cafter coition) are symptoms of a recent fecun- dation. lO.
Signs of Pregnancy- (M T. :— A black
rash (areola) around the nipples of the mammae, the rising appearance of a row of hair (as far as the umbilicus), contractions of the eye-wings, sudden vomitings, nausea which does not abate even on smelling perfumes, water-
* Some are of opinion that the menstruation continues up to the sixtieth year.
t According to Videha, menstrual secretion flows less on even days, hence a son is born if the sexual intercourse be made on those days ; whereas menstrual secretion becomes more on odd days, so a daughter is born if the intercourse be made on odd days.
According to Bhoja, a son is born from intercourse on even days and a daughter is born from that on odd days. The birth of a male issue is due to the preponderance of semen virile and that of a female sex is due lo the preponderance of menstrual secretion. If both the secretions be equal (in quality and quantity) a hermaphrodite is issued.
Chap. III.] SARIRA STHANAM. I37
brash, and a sense of general lassitude are the indications of pregnancy, ri.
Prohibited conducts during gesta- tion : — Immediately on the ascertainment of her pregnancy, a woman should avoid all kinds of physical labour, sexual intercourse, fasting, causes of emaciation of the body, day-sleep, keeping of late hours, indulgence in grief, fright, journey by carriage or in any kind of conveyance, sitting on her haunches, excessive appli- cation of Sneha-karmas etc., and venesection at an improper time {i.e , after the eighth month of gestation), and voluntary retention of any natural urging of the body. 12.
IVIetrical Text :— The child in the womb feels pain in the same part of its body as the one in which its mother feels any ; whether this (pain) may be from an injury or through the effect of any deranged morbific principle (Dosha) of her organism. 13.
Development of the Foetus:— in the first
mouth of gestation a gelatinous substance is only formed (in the womb) ; the molecules of the primary elements (Mahabhuta — air, fire, earth, water, and ether) being acted upon by cold (Kapham), heat (Pittam) and air (Vayu or nerve-force) are condensed in the second month. A lump-like appearance (of that confused matter) indicates the male-sex (of the embryo). An elongated-like shape of the matter denotes that the foetus belong to the opposite sex ; whereas its tumour- like shape (like a Salmali-bud) predicts the absence of any sex (/ e. a hermaphrodite). In the third month, five lump-like protuberances appear at the places where the five organs —namely the two hands, two legs and the head — would be and the minor limbs and members of the body are formed in the shape of extremely small
138 THE SUSHRUTA SAMIIITA. [Chap. III.
papillae. In the fourth month all the limbs and organs (of the body of the embryo) become more potent and the foetus is endowed with consciousness owing to the formation of viscus of the heart. As heart is the seat of consciousness, so as the heart becomes potent, it is endowed with consciousness and hence it expresses its desire for things of taste, smell etc. (through the longings of its mother). The enciente is called double- hearted (Dauhrida) at the time, whose wishes and desires — not being honoured and gratified — lead to the birth of a paralysed, hump-backed, crooked-armed, lame, dwarfed, defect-eyed, and a blind child. Hence the desires of the enciente should be gratified, which would ensure the birth of a strong, vigorous and long- lived son. 14.
Memorable Verses :— A physician should
cause the longings of a pregnant woman (Dauhrida) to be gratified inasmuch as such gratifications would alleviate the discomforts of gestation ; her desires being fulfilled ensure the birth of a strong, long-lived, and virtuous son. A non-fulfilment of her desires during pregnancy, proves injurious both to her child and her ownself. A non-gratification of any sensual enjoy- ment by its mother '.Dauhrida) during gestation tends to painfully affect the particular sense-organ of the child.
Longings and its effects during
pregnancy : — An enciente longing for a royal interview during her gestation (fourth month) gives birth of a child, who is sure to be rich and to hold a high position in life Her longing for fine silks, clothes, ornaments etc. indicates the birth of a beauti- ful child of aesthetic taste. The birth of a pious and self-controlled child is indicated by its mother's longing
Chap. III.] SARIRA STHAN-AM.
139
for a viiit to a hermitage. The desire of a pregnant woman to see a divine image or an idol, predicts the birth of a child in her womb who would grace the council of an august assembly in life. Similarly, a desire to see a savage animal on the part of a pregnant woman signifies the presence of a child of savage and cruel temperament in her womb. A desire for the flesh of a Godha indicates the presence of a sleepy, drowsy person in her womb who would be tenaciously fond of good things in life. Similarly a longing for beef on the part of the mother (during gestation) indicates the birth of a strong and vigorous child capable of sustaining any amount of fatigue and physical pain A longing for buffalo-meat of the mother indicates the birth of a hairy, valiant and red-eyed child (in her wombj; a longing for boar-flesh indicates the birth of a drowsy child though valiant ; a longing for venison indicates that of an energetic, determined and sylvan-habited child ; a longing for Srimara-meat indicates that of a distracted person ; a longing for the flesh of Tittira bird indicates that of a child of timid disposition ; whereas a desire on the part of an enciente for the flesh of any particular animal indicates that the child in the womb would be of such stature and would develop such traits of character in life as are peculiar to that animal. The desires of a woman during her pregnancy are determined by ordained fate and effects of the acts of the child in its prior existence (that are to be happened during the present life). 15.
Development of the Foetus :— In the
fifth mouth the fcetus is endowed with mind (IVIanah^ and wakes up from the sleep of its sub-conscious exis- tence. In the sixth month cognition (Buddhi) cornes in. In the seventh month all the limbs and members
140 THE SUSHRUTA SAMHITA. [Chap. III.
of its body are more markedly developed. The Ojo- dhdtu (in the heart of the foetus) does not remain silent in the eighth month * A child born at that time (eighth month) dies for want of Ojo-dhdtu soon after its birth, a fact which may be equally ascribed to the agency of the malignant monsters Hence (in the eighth month of gestation) offerings of meat should be made to the demons and monsters (for the safe continuance of the child). The parturition takes place either in the ninth, tenth, eleventh or twelfth month of conception, otherwise something wrong with the foetus should be appre- hended. i6.
The umbilical chord (Nadi) of the foetus is found to be attached to the cavity of the vein or artery of its maternal part through which the essence of lymph-chyle (Rasa) produced from the assimilated food of the mother, enters into its organism and fastens its growth and development, (a fact which may be understood from the analogy of percolation or transudation of blood). Immediately after the completion of the process of fecundation, the vessels (Dhamani) of its maternal body which carry the lymph-chyle (Rasa) and run laterally and longitudinally in all directions through it, tend to foster the foetus with their own tiansudation all through its continuance in the womb. 17.
Different opinions on the formation
of the foetal body :-Saiinaka says that
probably the head of the foetus is first developed
since head is the only organ that makes the functions
of all other organs possible. Kritaviryya says, it is
the heart that is first developed siiace heart is the seat
of Manah and Buddhi (mind and intellect). The son of
* Sometimes it passes from the body of the child to that of the mother and vice vtna.
Chap. III.] SARIRA STHANAM. 14!
Paras'ara says that the development of the umbilical re- gion of foetus must necessarily precede (that of any other part of its body) inasmuch as it is through umbilical chord that an embryo draws its substance from mother's body. Mat:ka,udeya says that the hands and feet of a foetus are first te be developed since they are the only means of movements in the womb. Sabhuti Gautama says that the development of the trunk is the earliest in point of time since all other limbs and organs lie solder- ed to and imbedded in that part of the body. But all these are not really the fact. Dhanvantari holds that the development of all the parts of the body of an embryo goes on simultaneously ; and they can not be perceived or detected in their earlier stages of development in the womb owing to their extremely attenuated size like a mango fruit or sprouts of bamboo. As the stone, marrow, pith etc. of a ripe and matured mango-fruit or the sprouts of bamboo, cannot be separately perceived in the earlier stage of their growth but are quite distin- guishable in the course of their development, likewise in the early stage of pregnancy the limbs and organs of the body (foetus) are not perceptible for their extremely attenuated stage but become potent (and therefore they are distinctly perceived) in the course of time for their development. 18.
Factors respectively supplied by the paternal and maternal elements :-Now
we shall describe the parts and principles of the body of a fcetus which are respectively contributed by the paternal element, maternal factor, the serum (Rasaja),the soul (Atmaja), the natural (Sattvaja) and the innate physiological conditions (Satmyaja). The hairs of the head and body, beard and moustaches, bones, nails, teeth, veins (Sira), nerves, arteries (Dhamani),
142 THE SUSHRUTA SAMHITA. [Chap. III.
semen and all the steady and hard substances (in the organism of a child) arc contributed by the paternal element in the conception Pitraja ; whereas flesh, blood, fat, marrow, heart, umbilicus, liver, spleen, intestines, anus (Guda) and all other soft matters in the body owe their origin to the maternal element (Mdtrija) ; strength, complexion, growth, rotundity and decay of the body are due to the serum (Rasaja). The sensual organs, conciousness, knowledge, wisdom, duration of life (longivity), pleasure and pain etc. are the outcome of the spiritual element in man (Atmaja). We shall describe the Sattvaja features of the body in the next chapter. Valour, healthfulncss, strength, glow and memory are the products of a child naturally born with physiological conditions of the parents (Satmyaja). 19.
Signs of male and female concep-
tion : — An cncicnte, in whose right mammaethe milk is first detected, who first lifts up her right leg at the time of locomotion, whose right eye looks larger, or who evinces a longing largely for things of masculine names, dreams of having received lotus flowers (red and white), Utpala, Kumuda. Amrataka, or flowers of such masculine denomination in her sleep, or the glow of whose face becomes brighter during pregnancy, may be expected to give birth to a male child ; whereas the birth of a daughter or a female child should be pre-assumed from the contriety of the foregoing indi- cations. An enciente whose sides become raised and the forepart of whose abdomen is found to bulge out will give birth to a sex-less (hermaphrodite) child. An enciente, the middle part of whose abdomen becomes sunk or divided in the middle like a leather-bag, will give birth to a twin. 20.
Chap. Ill-] SARIRA STHANAM. I43
lYIemorable verses :— Those women who are devout in their worship of the gods and the Brahmins and cherish a clean soul in a clean body during pregnancy are sure to be blest with good, virtuous and generous children ; whereas a contrary conduct during the period is sure to be attended with contrary fruits. The development of the limbs and the members etc. of a foetus in the womb is natural and spontaneous, and the qualities and conditions which mark these organs are determined by the acts of the child which are anterior to its genesis and wcrri done in its prior existence. 21-22.
Thus ends the third Chapter of the S'arira Sihanam in the Su 'ruta Samhila which treats of the generation and pregnancy.
CHAPTER IV.
Now we shall discourse on the Sdriram which treats of the devclopiTient of a foetus in the womb, as well as of the factors which contribute to the growth of its different bodily organs and principles ^Garbha-
Vyakaranam-aariram). r.
The Fittam (fiery or thermogenic) and Sleshma (lunar principles of the body, the bodily Vayu, the three primary qualities of Sattva, Rajas, and Tamas (adhesion, cohesion and disintegration), the five sense organs, and the Self (Karma-Purusha) are the preserver of the life (Pranah) of the Foetus, 2.
Folds of Skin : —Seven folds or layers of cover- ing (Tvaka — skin) are formed and deposited on the rapidly transforming product of the combination of (semen) Sukra and Sonita (fertilized ovum) which have been thus charged with the individual Soul or Self in the same manner as layers (of cream) are formed and deposited on the surface of (boiling) milk. Of these the first fold or layer is called Avabhaisini (reflecting) as it serves to reflect all colours and is cap- able of being tinged with the hues of all the five mate- rial principles of the body. The thickness of this fold measures eighteen-twentieth of a Vrihi* (rice grain) and it is the seat of skin diseases, such as Sidhma, Padma-
* The complexion of a person is due to this first layer ; and as the colour of an opaque body is due to the rays that are reflected from its surface, this layer is rightly named Avabbas'ini or reflecting layer.
** The text runs "Vriherashtadashabhaga," which means eighteen (or so mr.ny) parts of a Vrihi ; and Dalian comments that "Vrihi" stands for a measure equal to the twentieth division of a Vrihi or rice grain.
Chap. IV.] SARIRA STHANAM. I45
kantaka etc. The second fold (from the surface) is called Lohita ; it measures a sixteen-twentieth of a Vrihi and is the seat of such (cutaneous affections; as Tilakalaka, Nyachcha and Vyanga etc. The third fold or layer is called Sv^ta^, which measures in thick- ness, a twelve-twentieth of a Vrihi, and forms the seat of such diseases as Ajagalli, Charmadala, and Mas'aka etc. The fourth fold or layer is called Taimr^ measuring an eight-twentieth of a Vrihi and forms the seat of such diseases as the various kinds of Kilasa and Kushtha etc. The fifth fold or la\-cr is called Vedini, measuring in thickness a five-twentieth of a Vrihi and forms the seat of Kushtha, Visarpa, etc. The sixth fold or layer is called Rohiui, which is of equal thickness as a Vrihi (grain), and is the seat of Granthi, Apachi, Arvuda, Slipada and Gala-ganda etc. The seventh fold or layer is called Mansa-dhara' twice a Vrihi in thickness and is the seat of l^hagandara, Vidradhi, and Ars'a etc. These dimensions should be understood to hold good of the skin of the fleshy parts of the body, and not of the skin on the forehead, or about the tips of the fingers, inasmuch as there is a surgical dictum to the effect that an incision as deep as the thickness of the thumb may be made into the region of the abdomen with the help of a Vrihi-mukha (instrument). 3
The Kalas too number seven in all and are situated at the extreme borders (forming encasement and support) of the different fundamental principles (Dhatus) of the organism. 4.
Memorable Verses : — x^s the duramen or core of a piece of wood or stem becomes exposed to view by cutting into it, so the root principles (Dbattus) of the body may be seen by removing the successive la}ers or
19
146 THE SUSHRUTA SAMHITA. Chap. IV.]
tissues of its flesh. These Kalds are extensively supplied with Sndyus (fibrous tissues), bathed in mucous, and encased in a membranous covering. 5-6.
IVIansacIhara-Kala:- Of these Kalds.the first is named Maasadhara (^fascia), in the contained flesh (bodily substance of the Kala) of the Sira (veins), Snayu (fibrous tissues), Dhamani (arteries) and other Srotas (channels) are found to spread and branch out. 7.
IVIcmorable Verse : — As the roots and stems of a lotus plant respectively situated in the ooze and water (of a tank), do simultaneously grow and expand, so the veins etc. situated in the flesh, grow and ramify. 8.
Raktadhara- Kala : -The second KaU is
called Rakta-dhara (Vascular tissue of the blood vessels etc.X The blood is contained in these inside the flesh and specially in the veins (Sira) and in such viscera of the body as the liver and spleen. 9.
Memorable Verse:— As a plant containing latex in its tissues, when injured or pricked, exudes milky juice, so blood oozes out instantaneously on the flesh of the body (supplied with the Raktadhard-kala) being injured. 10.
IVIedadhara-Kala :— The third Kald is called Medadharat (adipose tissue). Meda (fat) is present (chiefly) in the abdomen of all animals, as well as in the cartila- ges (small bones). The fatty substance present in large bones is called Majjai (marrow). 11.
IVIemorable Verse :— Marrow is found inside large bones, whereas a substance similar in appearance and found inside other bony structures (cartilages i should be considered as Meda, mixed with blood. The fats, present in purely muscular structures, go by the name of Vassi (muscle-fat). 12-13.
[Chap. IV. SARIRA STHANAM.
147
^leshmadharaC-Kala :— The fourth KaU is called Sieshmsidharai (Synovial tissues) and is present about all the bone-joints of animals. 14.
IVIemOrable Verse : -As a wheel easily turns upon a well greased axle, so the joints moistened by the mucous (Sleshma) contained in these sacs admit of easy movements, i'.
Purishadhara-Kala :— The fifth kala is
called Purishadhara and being situated in the Kostha (abdomen) serves to separate the faecal refuse in the (Pakvds'aya) lower gut (from other ingested matters). 16.
IVI em Orable Verse :— This Kald extends about the liver, upper and lower intestines and other abdominal viscera and keeps the foeces in the lower intestines (Un- dukam) separate and hence is called MaladharA-kald 17.
Pittadhara-Kala:— The sixth Kala is called Pittaphara-kala ; it holds (the chyme derived from) the four kinds of solid and liquid foods (in the Pitta-sthanam or biliary region) propelled from the stomach (Amas'aya or Grahani-Nadi) and on its way to the (Pakas'aya) intestines (for the proper action of the digestive juices upon it) 18.
IVIemorable Verse :— The four kinds of food,
viz. those that are chewed, swallowed, drunk, or licked, and brought into the intestines (Kostha) of a man, are digested in proper time through the heating agency (action") of the Pittam 19.
^Ukradhara-Kala :— The seventh KalA is called Sikradhiia (semen-bearing), which extends throughout the entire body of all living creatures. 20,
IVIemorable Verse : -The physician should
know that like fat (Sarpi) in the milk, or sugar in the expressed juice of sugar-cane, the (seat of) semen is co- extensive with the whole organism of a man (or animal).
148 THE SUSHRUTA SAMHITA. tChap. IV.
The semen passes through the ducts situated about two fingers' breadth on either side (vas deferens) and just below the neck of the bladder and finally flows out through the canal. The semen of a man during an act of sexual intercourse with a female . under exhilaration comes down from all parts of his body owing to the extreme excitement (engendered by the act). 21-33.
The orifices of the Artava— carrying channels (vessels of the uterine mucosa) of a pregnant woman are ob- structed by the foetus during pregnancy and hence there is no show of menses (during gestation). The menstrual blood thus obstructed in its downward course ascends upwards ; a part of it accumulates and goes to the formation of placenta ( Apara\ while the rest ascends higher up and reaches the breasts ; this is the reason why the breasts of a pregnant woman become full and plump. 24.
The spleen and liver of the foetus are formed out of blood ; the lungs are made of the froth of the blood ; and the Unduka or faecal receptacle, of the refuge matter (Mala) of the blood. 25,
IVIetrical Texts :— The intestines (Antra), the bladder (Vasti), and the anus (Guda) of the foetus are formed out of the essence of the blood and Kapham, baked by the Pittam into which Vayu enters as well. As fire fed by draughts of air refines the dregs of cfolden ore and transforms it into pure metal, so blood and Kapham acted upon by the heat of the Pittam are transformed into the shape of the intestines etc. in the abdomen. The tongue is made of the essence of the flesh, blood and Kapham. The Vayu, com- bined with heat (Pittam) in adequate proportion, rends through the internal channels into the flesh and trans- forms them into muscles (Pes'i\ The Vayu, by taking off
Chap. IV.] SARIRA STHANAM. 149
the oily principles of fat (Meda). transforms them into (Sira- and ^fibrous tissues) Snaiyu.the underbaked (Mridu) ones being converted into the Sira and the overbaked (Kshara) ones into the Snayu. The internal cavities (.As'ayas) of the body mark the spots or regions where the Vayu had constantly stayed in its embryo stage. 26-29. The kidneys (Vrikkas* are made out of the essence of the blood and fat. The testes are formed out of the essence of the blood, flesh, Kapham and fat. The heart is formed out of the essence of blood and Kapham ; and the vessels (Dhamanis) carrying the vital principles of the body are attached to it (heart). The spleen and the lungs are situated below and beneath the heart on the left side, and the liver and Kloma (Pancreas ?) below and beneath it (heart) on the right. The heart is the special seat of consciousness (Chetana) in all creatures. Sleep sets in when this viscus heart) of a person becomes enveloped by the effects of the Tamas (principles of illusion or nescience). 30-31.
IVIcmorabIC Verse :— The heart which is of the shape of a lotus bud hangs with its apex downward, folding itself up during sleep and expanding with the return of wakening or consciousness. 32.
Sleep and its virtues ; — Sleep is the illu- sive energy of God ^lit. -the all-pervading deity) and naturally has its sway over all created beings. The kind of sleep which sets in when the sensation-carrying channels (Snayu) of the body are choked by Sleshma, which abounds in the quality of Tamas, is known as Tamasi-nidra. It is this sleep which produces uncon- sciousness at the time of dissolution or death. A man of Tamisika-tempsrament sleeps both in the day and night ; one of the Rsijasika-teiiiperament sleeps either in the day or in the night ; while sleep never visits the
I50 THE SUSIIRUTA SAMHITA. Chap. IV.]
eyelids of a man of Sattvika-temperament before mid- night. Persons with enfeebled Kapham and aggra- vated Vayu, or suffering from bodily and mental troubles, get little sleep, and if at all, their sleep is of the Vaika- rika or delirious type {ie. much disturbed)*. 33-34.
Memorable Verses : — O Sus'ruta ! the heart is
said to h?. the primary seat of consciousness (Chetana) in the animated beings. Sleep overcomes a man whenever the heart is enveloped in the illusive effects of Tamas. Sleep is the offspring of Tamas and it is the quality of Sattvam that brings on awakening. This is the funda- mental law of Nature. The self-conscious individuality (Self), ensconced in the material frame of man which is composed of the five material elements, recollects through the agency of the mind (Manah), which abounds in the quality of Rajas, the renaissance of his by-gone existences, and wakens up in his psychic plane the pic- tures of good or evil deeds done by him therein. Dreams are but the embodiment of these recollections, The self or Jivatmat, though he sleeps not himself, is said to be sleeping, whenever the sense organs are over- powered by the illusive energy of Tamas. 35.
Day sleep is forbidden in all seasons of the year, except in summer and in the case of infants, old men, and persons enfeebled by sexual excesses, or in Kshata- kshina diseases and in case of habitual tipplers. A sleep in the day may be enjoyed after the fatigue of a long journey, riding, or physical labour, or on an empty stomach. It may be allowed as well to men suffering from the loss of fat, Kapham or blood, to those of
* Such persons may get sleep only, when being tired and exhausted they case to think of thf-ir affairs,
G f. Charaka :— When the active self of a person, tired in body and rnind, loses tovich with his worldly affairs, sleep comes to him.
Chap. IV,] SARIRA STHANAM. 151
scanty perspiration, or of dry or parched constitution ; and also to those who have been sufifering from indi- gestion and who may sleep for a Muhurta (48 minutes) in the day time. Those who have kept late hours in the night may sleep in the day for half the time they have watched in the night (and no more). Day sleep is the outcome of perverted nature and all the Doshas of the body are aggravated by a sleep in the day, bringing on many a troublesome complaints such as couL,h, asthma, catarrh,heaviness of the body, aching or lassitude in the limbs, fever, loss of appetite etc. On the other hand, the keeping of late hours in the night develops symptoms (Upadrava) which are peculiar to the deranged Vayu and Pittam, ^6.
lYIcmorable Verses:— Hence, one should not
sleep in the day, nor keep late hours. Having known both these acts to be injurious, the wise should observe moderation in sleep. A conformity to the preceding rule of conduct is rewarded with health, good humour, strength, healthful complexion, virility and beauty, a frame which is neither too fat nor too thin, and a long life of a hundred years). A day sleep may not prove injurious to those who are habituated to it and conversely keeping late hours at night may not tell upon the health of those to whom it is customary, 37-39.
An aggravated condition of the bodily Vayu or Pittam, an aggrieved state of the mind, loss of vital fluid, and a hurt or an injury may bring on insomnia, the remedy being the adoption of measures antagonistic to those which destroy sleep. The following measures are useful in cases of sleeplessness -such as anointing the body, rubbing of oil on the head, soft massages of the body (with cleansing paste) and shampooing ; a diet consisting of cakes and pastiy made up of S'dli-rice and
152 THE SUSHRUTA SAMHITA. Chap. IV.]
wheat prepared with sugar or other derivatives of sugar- cane, sweet or soothing articles with milk or meat juice or flesh of animals of the Biskira or Viles'aya class, and eating of grapes, sugar and sugar-cane at night, are beneficial (in such cases) ; so also a soft and pleasant bed, and easy and convenient seats and means of loco- motion. Hence, a wise physician should advise those and similar other measures to allay insomnia. 40-41.
Excessive sleep should be remedied by emetics, Sans'odhana measures, fastings, bleeding, and works which tend to disturb the mental equanimity of man. Keeping up at night is beneficial to persons afflicted with obesity, poison or the deranged Kapham ; so also a nap in the day is beneficial to people troubled with hiccough, colic pain, dysentery, indigestion, or thirst. 42-43.
Somnolence or Drowsiness etc. :— In
this kind of light sleep, or in the i)roliminary stage of sleep, the sense organs- are overpowered and remain only partially cognisant of their respective objects and all (subjective and objective) symptoms of a sleepy person such as, yawning, sense off atigue and heaviness ol the limbs, present themselves in succession ; these are the special features of Tandra. One (prolonged) inha- ling of the air through a widely open mouth and subsequent exhaling with the contraction of the limbs and tearful eyes are (all together) called Jrimbha or yawning.
A sense of fatigue without any physical labour which comes upon a person unaccompanied by hurried res- piration is called Klama. It obstructs the proper functions of the senses as also the workings of the active organs.* An inordinate love of pleasure and a great aversion to pain, attended with an apath}' to all sorts of
* Hand, leg,