Sushruta Samhita, volume 1: Sutrasthana
by Kaviraj Kunja Lal Bhishagratna | 1907 | 148,756 words
This current book, the Sutra-sthana (english translation), is the first part of this voluminous medical work. It contains a large summary of the knowledge envelopig the medical aspects of Ayurveda. Descriptions of diseases, various diets and drugs, the duties of a surgeon, surgical procedures, medical training; these are only some of the numerous s...
Chapter XXI - Questions concerning wounds
Now we shall discuss the Chapter which investigates the nature of bodily humours, as exciting causes of ulcers (Vrana-prashna-adhyaya).
The Vayu, Pitta and Shleshma should be considered as the primary and the most essential factors in the constitution of human organism. These fundamental and vital humours, occupying respectively the lower, middle, and upper parts of the body, maintain its integrity. The human body is supported by the three fundamental humours in the same way as a dwelling house is propped up by three supporting poles or stays; from which fact, the body is called the three-supported one (Tristhuna) by certain authorities. A deranged condition of these three fundamental humours may bring about its dissolution or death, while on their continuance in a normal state depends the vitality of the organism. These three humours, in combination with a fourth, the principle of blood, determine the origin, preservation, and dissolution of animated organism and permeate it with their respective properties till the moment of death.
Authoritative verse on the subject:—
There can be no organism without Vayu, Pitta, Kapha and blood, which are necessary to constantly maintain its integrity. The terms Vata (Vayu), Pitta and Shleshma (Kapha) are respectively derived from the roots ‘Va’, to move or smell, ‘Tapa,’ to burn or to heat, and “Shlisha,” to embrace, with the suffix ‘Ta’ thereto added.
Seats of the bodily humours:—
Now we shall describe the locations of the foregoing vital humours. The Vayu may be briefly described as located in the regions of the pelvis (Shroni), and the rectum (Guda). The Pitta has its seat in the region between the stomach (amashaya) and the intestines (Pakvashaya) which is above the pelvis and the rectum and below the umbilicus, while the Kapha is ensconced within the cavity of the stomach (amashaya).
Now we shall divide the locations of each of the vital humours into five parts:—The five localities of the Vayu will be described under the head of Vata-Vyadhis (nervous diseases), while those of Pitta are the liver and the spleen, the heart, the pupils of the eyes, the skin and the intestines (Pakvashaya). The Kapha is located in the region of the breast, the throat, the head, the joints and the stomach (amashaya). The foregoing regions are the seats of the vital humours in their normal state.
The vital humours (Vayu, Pitta and Kapha) maintain the integrity of the animated organism by creating, assimilating and diffusing strength in the same way as the moon, the sun, and the winds maintain the integrity of the terrestrial globe.
Now it may be asked whether the Pitta is identical with the elemental fire, or is it something other than that? The question may be answered by stating that the Pitta is the same as fire. Since such symptoms, as a burning sensation, digestion (boiling, and all other characteristics of fire can never exhibit themselves in the human body without the intervention of Pitta. Pitta therefore is called internal fire.
Consequently, an enfeebled action of Pitta is remedied by the administration of drugs and substances which are akin to the elemental fire in their attributes, while an abnormal or excessive action (secretion) of Pitta is subdued by cooling measures as an overkindled fire is subdued by moisture. There is no other fire (heat making factor) in the organism than Pitta.
By the ordination of fate or necessity (unfathomable natural cause), the Pitta, located in the region between the stomach (Amashaya) and the intestines (Pakvashaya), helps the digestion of the four kinds of food such as drink and edibles etc.) partaken of by a living subject, and purges off the residue or impure morbiferous matter in the shape of urine and excreta after the completion of the process. Even thus located, it keeps up the temperature in its other distant locations (skin, etc.) in virtue of its native heat-giving attribute. Hence this Pitta is called the Pachakagni (digestive fire or heat) in an animated organism.
The function of the Pitta, which has its seats in the liver and the spleen, consists in imparting its characteristic pigment (Ragakrit) to the lymph-chyle and is hence known as Ranjakagni (lit:—dyeing fire or pigment bile.)
The Pitta seated in the heart is denominated as the Sadhakagni performing or operating heat or fire; inasmuch as its action is to bring about the fruition or realisation of one’s desires.
The Pitta, which is located in the pupils of the eyes, is called the Alochakagni (the Pitta or fire of sight) as its office is to catch the image of any external object presented to the eyes.
The Pitta, which has its seat in the skin, is called the Bhrajakagni (illuminating or irradiating heat) inasmuch as it absorbs the substances used in the shape of unguents, lubrications, etc. and irradiates the glow of one’s natural complexion.
The Pitta is a keen, sharp and warm liquid, of a blue colour (in its normal state), or yellowish (in its deranged condition). It emits a kind of fleshy smell and is possessed of a pungent taste which is transformed into an acid one when deranged or vitiated.
Seats of Shleshma (Kapha):—
Now we shall describe the locations of Kapha. The stomach (Amashaya), which is the seat of Kapha, occupies the same position as regards its location to that of Pitta as the sun holds in relation to that of the moon. And since the stomach (amashaya) is situated above the pancreas (Pittashaya), and is endowed with a property (cooling) contrary to the primary virtue (heating) of Pitta, and, since the heat emitted by the receptacle of Pitta is naturally radiated in an upward direction, the four kinds of food, brought in to the stomach (Amashaya), are boiled and transformed into a soft placid mass (chyme), like rice boiled in a bowl full of water placed over a burning oven. The food, thus brought down into the stomach, is easily moistened, disintegrated and digested by coming into contact with the oily secretions of the stomach (amashaya).
The Kapha is originated through the sweet, slimy, watery, exudating character of the food brought into the stomach (amashaya); and hence the Kapha becomes endued with similar attributes.
The Kapha, even though principally located in the stomach, permeates its four other distant localities with its peculiar watery or humid essence in virtue of its inherent attributes.
The Kapha, located in the region of the chest, protects the joints of the arms, the neck and the sternum, and enables the heart to perform its natural functions with the help of the lymph-chyle derived from the assimilated food and its own intrinsic potency.
The Kapha, situated in the throat and at the root of the palate, lends its aid to the perception of tastes by maintaining the moist or humid character of the tongue.
The Kapha, situated in the head, cools and bathes the different sense organs with its own humid essence, in virtue of its natural humid attributes.
The Kapha, situated in the joints, keeps them firmly united, protects their articulation and opposes their separation and disunion.
The Kapha is white, heavy, oily, slimy and cool. In its normal state, it is possessed of a sweet taste, which is followed by a saline one in its reactionary transformation (chemical reaction) when deranged or vitiated.
Seats of blood:—
The seats of blood are in the liver and the spleen, as stated before, whence it helps its other receptacles to serve their proper functions.
The blood is red, oily or glossy, a little warm, and is possessed of an attribute similar to something of a sweet taste. It is heavy, and it emits a fleshy smell and resembles the Pitta in its reactionary process, or in other words, those factors, which derange the Pitta, vitiate the blood as well.
These are the locations of the deranged humours, which are respectively accumulated in them on account of the aforesaid causes. The deranged humours exhibit such symptoms as, fullness and stuffedness of the abdomen, or of any of the viscera (due to the action of the deranged Vayu); yellowness of the affected part (due to the action of the deranged Pitta, and diminution of the bodily heat, heaviness of the limbs, and a sense of languor (due to the action of the diseased Kapha), and a natural repugnance for causes (factors) which lead to their respective aggravations or accumulations. The medical treatment should be commenced as soon as the symptoms, peculiar to their accumulation, would become manifest.
Humours and their aggravations:—
Now we shall enumerate the causes which agitate and (aggravate) the deranged humours. The bodily Vayu is aggravated by such factors (conduct, practices and diet, etc.) as, wrestling with a wrestler of superior strength, violent gymnastic exercises, sexual excesses, excessive study, a headlong plunge into water or a leap from an inordinate height, running, a violent pressing blow, leaping over a ditch, a bounding gait, swimming, keeping of late hours, carrying of heavy loads, excessive riding, walking a long distance and the partaking of a food into the composition of which pungent, astringent, bitter, light or parchifying articles, or substances of cool potency, largely enter. Diets consisting of dried pot-herbs, Vallura, Varaka, Uddalaka, Kara-dusha, Shyamaka, Nivara, Mudga, Masura, adhaki, Harenu, Kalaya, and Nishpava tend to aggravate the bodily Vayu.
Fasting, unequal or irregular meals, over-eating, voluntary suppression of urine, semen, and tears, or of the mucous secretions from the nose as in a fluent coryza, a forced stoppage of defecation, eructation or sneezing are the factors, which may be set down as the aggravating causes of the bodily Vayu.
The bodily Vayu is naturally aggravated in a cold, cloudy or windy day, in winter, during the rains, in the morning and evening and especially at the close of digestion.
Symptoms of aggravated Pitta:—
The Pitta is aggravated by anger, grief, fear, fatigue, fasting, acid transformation (reaction) of the assimilated food, or deficient gastric digestion, unnatural sexual indulgence, partaking of a food consisting of pungent, acid or saline, keen, heat making or light substances, as well as of those whose digestion is followed by a reactionary acidity. It is aggravated by the use of sesamum oil, or of sesamum paste. Kulattha, Sarshapa, atashi, the pot-herbs known as Haritaka, fish, the flesh of a Godha or a goat or mutton may lead to its aggravation, if taken injudiciously.
Similarly, the use of curd, whey, Kurchika, (inspissated milk), Sauviraka, different kinds of wine, Amla-phala (sour fruits), or Katvara (curd mixed with oil) and excessive exposure to the sun, may be followed by the same consequences.
In addition to all these, the Pitta is spontaneously and abnormally aggravated in summer, in autumn, at noon, at mid-night and during the process of digestion, as well as by the partaking of hot or warm substances.
Symptoms of the deranged Kapha:—
The deranged Kapha is aggravated by sleep in the day time, or by the following of lazy or sedentary habits. The partaking of food, composed of substances which are heavy, slimy, sweet, acid or saline in their taste, or of one consisting of substances which increase the mucous secretions from the fissures of the body, may be likewise set down as aggravating factors. The use of food grains, which are called the Hayanaka, the Yavaka, the Naishadha, the Itcata, the Masha, the Mahamasha, the Godhuma, the Tilam, or of rice cakes may lead to its aggravation. Curd, milk, the Krishara, the Payasha (sweetened rice porridge), the various preparations of cane-sugar are things which produce the same result. The flesh of beasts and birds that are aquatic in their habits or live in swampy lands, as well as lard, have the same effect, if used as food. The use of bulbs and lotus stems or of Kasheruka, Shringataka, Madhura-phala, Valli-phala as well as eating before digestion or the partaking of food consisting of both wholesome and unwholesome substances may aggravate this bodily humour.
The Kapha is naturally and spontaneously aggravated in the morning and evening, in Hemanta, and specially in Spring, and just after a meal. Likewise, it is aggravated by the use of cold food or drink, etc.
Symptoms of the aggravated blood:—
[Owing to a natural similarity between blood and the Pitta, and through a natural affinity between their attributes], causes, which tend to aggravate the deranged Pitta, tend to aggravate or agitate the blood as well. Moreover, frequent meals or repeated use of food, into the composition of which cool, liquid and heavy substances largely enter, are followed by a disturbed or aggravated condition of the blood. Sleep in the day time, anger, exposure to the glare of the sun or fire, over-fatiguing labour, an external blow, ingestion of indigestible or incompatible substances, and eating before the full digestion of a previous meal, may as well be set down as causes which tend to aggravate blood.
As the bodily humours are never aggravated independently of the blood, their aggravation goes together with a disturbed or agitated condition of the blood. The aggravated condition of the humours gives rise to pain and moves the wind Vayu) in the bowels; it further occasions acid eructations, thirst, burning sensations, aversion to food, vomiting and nausea. Any of these symptoms should be regarded as the second occasion which calls for medical aid.
Expansion of the deranged humours:—
Now we shall describe the expansion (Prasara) of the deranged humours. The deranged humours, aggravated by the above mentioned causes, expand and overflow the limits of their respective localities in the same manner as, cakes, soaked in any ferment or enzyme and kept standing over night, ferment and rise through the acquisition of new and unseen attributes. The Vayu, which is possessed of locomotion or extreme mobility, should be looked upon as the cause of their expansion or over-flowing. The Vayu, though an inanimate thing, in reality is possessed of the quality of “Rajas” (creative or cohesive energy), and the quality of the Rajas is the only essential or motive principle in the universe.
As a vast and mighty expanse of water, which has been divided into two expanses by a dam or barrier, will sweep away the latter and unite again to form one sheet of water; so the deranged humours, sometimes singly, sometimes in combination with two or all of their species, or in unison with blood, expand and over-run the organism in all directions. As for example, the Vayu, the Pitta, the Kapha and the blood are singly expanded, whereas the bi-humoural expansions involve the simultaneous overflow of the two deranged humours, or of any deranged humour and blood, as the Vayu and Pitta, Vayu and Kapha, Vayu and blood, Pitta and blood, and Kapha and blood. The tri-humoural expansions, which involve the blood and any two of the deranged and enraged humours, may be classified as the expansion, of (1) the Vayu, Pitta and blood, (2) the expansion of the Vayu, Kapha and blood, (3) the expansion of Pitta, Kapha and blood, (4) the expansion of Vayu, Pitta and Kapha, (5) the expansion of Pitta, Kapha and blood, the different types of expansion numbering fifteen in all.
The aggravated, or the abnormally irritated deranged humours, whether permeating the whole or half of the system or restricted to any particular part or member of the body, give rise to disease in the place of their incarceration, like rain clouds pouring down in the quarter of the sky where they are formed. The deranged humours, not excessively (slightly) aggravated, lie inoperative coating the internal passages (Margas) of the body and thus bring about a fresh disease, if subsequently agitated by any disturbing causes.
The deranged and aggravated Vayu, having moved into any specific seat of Pitta, should be medicinally treated as a case of Pittaja aggravation. Similarly, the deranged and aggravated Pitta, or Kapha, changing their respective places with each other, should be medicinally treated as the humour in whose location it is found. The Vayu, thus aggravated and expanded, tends to deviate from its right passage and gives rise to a swelling or distention of the abdomen, accompanied by a rumbling sound in the intestines. The Pitta, under the similar condition, gives rise to heat, and a sort of sucking, burning pain in the affected part, together with a sensation of radiation or evaporation of heat from its surface. The Kapha, under the circumstance, would usher in a complete aversion to food, inertness of the limbs, vomiting and impaired digestion. The preceding symptoms, caused by the aggravation and expansion of the bodily humours, should be the third occasion for medical treatment
Now we shall enumerate the names of the peculiar diseases, which are originated by the deranged and expanded humours, incarcerated in the different parts of the body. These humours, confined in the abdomen, give rise to Gulma (abdominal glands) tumours, internal abscesses (Vidradhi), abdominal dropsy, impaired digestion in the bowels, constipation (anaha), cholera (Visuchika) and dysentery.
Lodged in the bladder, these humours usher in Prameha (morbid urethral discharges), Ashman (stone in the bladder), Mutrakricchra (stricture of the urethra) and Mutraghata (retention, of urine), and diseases affecting the renal secretion, etc. Restricted to the penis they tend to bring in syphilis, Nirudha-prakasha (phymosis and the local inflammatory diseases known as the Shuka-dosha, etc.
Similarly, lodged in the region of the anus, these deranged and expanded humours beget fistula in ano, Hemorrhoids and polypus growths about that locality. Confined in the region of the scrotum, they give rise to hydrocele and other types of scrotal tumours, etc. Restricted to the region above the clavicles, these humours originate diseases peculiar to that locality, while erysipelas, cutaneous affections (Kushtha) and other minor diseases supervene, when they restrict themselves to the flesh and the skin (lymph-chyle) and blood. Affecting only the fat, these humours tend to originate Granthi (Aneurism), Apachi (scrofula), Arvuda (tumour), Galaganda (goitre) and Alaji (inflammation of the eye at the edge of the cornea).
Lodged in the lower extremities, they bring on elephantisis, Vata-Rakta (a kind of leprosy), Vata-Kan taka, etc. Permeating the whole organism, they give rise to such diseases as fever, Sarvangaroga, etc. which invade the entire system.
The aggravated and expanded humours, thus firmly ensconced in the different parts of the body, exhibit the premonitory symptoms of diseases which will be fully dealt with under their respective heads. The manifestation of these premonitory symptoms should be considered as the fourth occasion for medical treatment.
Now we shall deal with the full development or manifestation of a disease. The full manifestation of a disease, such as a swelling, tumour, aneurism (Granthi), Vidradhi (abscess) and erysipelas (Visarpa) etc., fever or dysentery, signifies the complete development of the characteristic symptoms, which should be regarded as the fifth occasion for medical treatment.
The sixth occasion for the calling in of medical aid should be considered to have arisen when a swelling (abscess, tumour, etc.) would burst and exhibit the characteristic symptoms of an open ulcer. A persistent lingering or continuance of a fever or dysentery, etc., should be considered as marking, or forming one of its particular stages, and which may run into one of an incurable type, if neglected or not sufficiently cared for at the outset.
Authoritative verse on the subject:—
The physician, who fully knows about the accumulation (Sancaya), disturbance or aggravation (Prakopa), expansion (Prasara), and differentiating traits of the deranged humours (Bheda), and is well conversant with the specific localities in which they are respectively confined in the course of their expansion (Sthana-samshrayam), and with the symptoms which they respectively exhibit in connection with the incidental disease (Vyakti), is alone worthy of that epithet.
The deranged humours, checked or subdued in their accumulating stage, fail to exhibit any further or subsequent development, but, if left unremedied, they gain in strength and intensity in the course of their further development. The humours, deranged either singly, or in couples, or in a triple combination as regards one or two of their virtues, push on, follow and blend with humours similarly deranged as regards their qualities and combinative numbers.
The medical treatment in a case, where two or all (three) of the deranged humours are involved, consists in conquering the strongest one in the combination, but so as not to enrage or aggravate the minor or the weaker humours in the group and specially so in a case of Sannipata.24
A concourse of deranged humours, affecting and appearing in a particular part of the body, is called a boil or an ulcer (Vrana) which is derived from the root “Vri” to cover and is so called from the fact of its covering a particular part of the body or from its leaving a cicatrix which remains the whole life-time of the patient.
Thus ends the twenty-first chapter of the Sutrasthana in the Sushruta Samhita which treats of investigation into the nature ot the humours giving rise to an ulcer.
Footnotes and references:
From this should be inferred that motion and smell are the natural attributes of the vital Vayu, heat and burning are those of Pitta, and union and integration are those of Kapha.
The moon laves the earth and imparts to it the vitalising principle with her own ambrosial light. The sun draws off the moisture in virtue of his own attractive force, and the Vayu distributes the heat and moisture over its surface.
The analogy is based on the heating (and metabolic) actions of Pitta, and does not extend to its liquid secretion (bile). But since the former attributes permeate in its entirety, it is designated the Internal fire.
Additional text:—Reaching down and confined in the bone-systems of the body, they produce Vidradhi (abscesses), Anushayi, ete.