Sushruta Samhita, volume 2: Nidanasthana

by Kaviraj Kunja Lal Bhishagratna | 1911 | 37,609 words

This current book, the Nidana-sthana (english translation), is the second part of this voluminous medical work. It deals with diseases: their prognosis, their cause, their symptoms and their pathogenesis (development of the disease). The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can poss...

Chapter XIII - Diagnosis of minor diseases

Now we shall discourse on the Nidana of Kshudraroga (diseases which are known by the general name of minor ailments). 1.

These diseases are generally divided into forty-four distinct varieties or types such as:

  1. Ajagallika,
  2. Yavaprakshya,
  3. Andhalaji,
  4. Vivrita,
  5. Kachapika,
  6. Valmika,
  7. Indravriddha,
  8. Panasika,
  9. Pashana-garddabha,
  10. Jala-garddabha,
  11. Kaksha,
  12. Vishphota,
  13. Agni-rohini,
  14. Chippa,
  15. Kunakha,
  16. Anushaye,
  17. Vidarika,
  18. Sarkara-Arbuda,
  19. Pama,
  20. Vicharchika,
  21. Rakasa,
  22. Padadarika,
  23. Kadara,
  24. Alasa,
  25. Indralupta,
  26. Darunaka,
  27. Arunshika,
  28. Palita,
  29. Mashurika,
  30. Yauvana-pidaka,
  31. Padmini-kantaka,
  32. Yatumani,
  33. Mashaka,
  34. Carmakila,
  35. Tilakalaka,
  36. Nyaccha,
  37. Vyanga,
  38. Parivartika,
  39. Avapatika,
  40. Niruddha-prakasha,
  41. Niruddha-guda,
  42. Ahiputana,
  43. Vrishana-kaccu,
  44. and Guda-bhransha.[1] 2.

 

Metrical Texts:—

The species of pimples or eruptions which are shaped like the Mudga pulse and are glossy, knotty and painless is called Ajagallika. They are of the same colour (as the surrounding skin) and their origin is usually ascribed to the action of the deranged Kapha and Vayu. The disease is peculiar to infants.[2]

Yavaprakshya:—The eruptions which are 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 Kapha.

Andhalaji:—The dense, raised, slender-topped eruptions which appear in circular patches and exude a slight pus are called Andhalaji. They are due to the action of the deranged Vayu and Kapha.

Vivrita:—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 Pitta. 3–6.

Kaccapika:—

A group of five or six hard, elevated, nodular eruptions (Granthis), arranged in the shape of a tortoise (which may appear on the surface of any part of the body), are called Kaccapika. They are due to the action of the deranged Kapha and Vayu.

Valmika:—The knotty undurated eruptions (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 mucopurulent discharges appear around the aforesaid eruptions (Granthis). The disease is due to the action of the deranged Kapha, Pitta and Vayu. 7—8.

Indravriddha:—

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 Indravriddha by the physicians. The disease is caused by the action of the deranged Vayu and Pitta.

Pauasika:—Eruptions (Pidaka) of a sort of extremely painful pustules all over the back or the ears which resemble the Kumuda bulb in shape, are called Panasika. They are due to the action of the deranged Kapha and Vayu.

Pashana-Grarddabha:—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 Kapha 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[3] The disease results from the deranged Pitta.

Kaksha:—The disease characterised by the eruptions of black and painful vesicles (Shphota) on the back, sides, and on the region about the arm-pits, is called Kaksha. The disease is likewise attributed to the action of the aggravated Pitta.

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 Vishphotaka. The disease is the effect of vitiated blood and Pitta. 9—14.

Agni-Rohini[4]:—Vesicles (Shphota) having the appearance of burns and cropping up about the waist (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 (Vayu, Pitta and Kapha). It is incurable and ends in the death of the patient either on the seventh[5], tenth or fifteenth day (of its first appearance). 15.

Chippa:—

The deranged Vayu and Pitta vitiating the flesh of the finger-nails, give rise to a disease which is characterised by pain, burning and suppuration. The disease called Chippa, is also denominated Upanakha and Kshataroga.

Kunakha:—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 Kulina.

Anusayi:—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 Kapha.

Vidarika:—A round reddish swelling rising either on the auxiliary or inguinal regions in the shape of a gourd (Vidarikanda) is known as Vidarika. The disease is due to the concerted action of the deranged Vayu, Pitta and Kapha and is characterised by symptoms peculiar to each of them. 16–19.

Sharkararbuda:—

The deranged Vayu and Kapha having recourse to and affecting the flesh, veins (Shira), 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 (Sharkara) known accordingly as Sharkararbuda. A fetid secretion of varied colour is secreted from the veins (Shira) 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 Kushtha (Chapter. V.). 20—21.

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 Padadarika.

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 exudation, is called Alasa. 22—25.

Indralupta:—

The deranged Vayu and Pitta having recourse to the roots of the hairs bring about their gradual falling off, while the deranged blood and Kapha of the locality fill up those pores or holes, thus barring their fresh growth and recrudescence. The disease is called Indralupta,[5] Rujya or Khalitya (Alopecia).

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 Darunaka. The disease is due to the action of the deranged Kapha and Vayu.

Arunshika:—Ulcers (Arunshi) attended 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 Kapha (of the locality) are called Arunshika.

Palita:—The heat and Pitta of the body having recourse to the region of the head owing to overwork, fatigue, and excessive grief or anger, tend to make the hair prematurely grey, and such silvering of the hair (before the natural period of senile decay) is called Palita.

Masurika (variola):—The yellow or copper-coloured pustules or eruptions attended with pain, fever and burning and appearing all over the body, on (the skin of) the face and inside the cavity of the mouth, are called Masurika.

Yauvana-pidaka —(Mukhadushika):—The pimples like the thorns of a Shalmali tree, which are found on the face of young men through the deranged condition of the blood, Vayu and Kapha, are called Yauvana- pidaka or pimples of youth.

Padmini-Kantaka:—The circular, greyish patches or rash-like eruptions 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 Kapha.

Yatu mani (mole):—The reddish, glossy, circular, and painless, congenital marks (Sahaja) 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 Pitta. 26—33.

Mashaka (Lichen):—

The hard, painless, black and elevated eruptions on the body (skin) resembling the Masha pulse in shape, caused by the aggravated condition of the bodily Vayu are called Mashaka.

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, Pitta and Kapha.[7]

Nyaccha:—The congenital, painless, circular, white or brown (Syava) patches on the skin, which are found to be restricted to a small or comparatively diffused area of the skin, are called Nyaccha.

Carmakila (hypertrophy of the skin):—The causes and symptoms of the disease known as Carmakila have been already described (under the head of the Arsha-Nidana).

Vyanga:—The Vayu being aggravated through wrath and overfatiguing physical exercise, and surcharged with Pitta, 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.[8] 34–38.

The Parivartika:—

The vital Vayu (Vyana) aggravated by such causes as excessive massage (masturbation), 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 sometimes suppurates. When the knotty growth becomes hard and is accompanied by itching, then it is caused by the aggravated Kapha. 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 hymen 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-prakasha:—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 Niruddha-prakasha which is due to the deranged Vayu and is marked by pain (in the glans penis). 39-41.

Niruddhaguda:—

The Vayu (Apana) obstructed by the repression of a natural urging towards defecation stuffs the rectum, thus producing constriction of its passage and consequent difficulty of defecation. This dreadful disease is known as Niruddha- guda (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 consequent on the neglect in cleansing that part. The eruptions which are the effects of the deranged blood and Kapha soon assume an Eczematous character and exude a purulent discharge on account of constant scratching. The Eczema (Vrana) soon spreads, and coalesces and proves very obstinate in the end. The disease is called Ahiputana.

Vrishana-kaccu:—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-kaccu and is due to the aggravated condition of the Kapha and blood.

Guda-Bhransha:—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-Bhransha or prolapsus ani. 42—45.

 

Thus ends the thirteenth Chapter of the Nidana Sthana in the Sushruta Samhita which treats of the Nidana of minor ailments.

Footnotes and references:

1.

Brahmadeva comprising Garddavika, Irvellika, Gandkapidika and Tilakalaka in the list reads it as consisting of thirty-four different species. Jejjata does not hold the four forms of disease commencing with Garddavika, etc. as included within the list. Gayadasa, finding them included in all the recensions reads Garddabhika, etc. as included within the list of Kshudra Roga, and Pama etc. as included within the list of Kshudra Kushtha.

2.

They afflict certain infants—Dallana.

3.

The circular raised spots studded with vesicles are called Gardda- bha. They are reddish and painful and produced by the. action of Vayu and Pitta. Gayadasa reads it so.

4.

Dallana quotes from another Tantra that the morbific principles in men, aggravated through the action of the enraged and augmented Pitta and blood, give rise to vesicles (blisters) like red-hot charcoal by breaking open the flesh at the waist, attended with extreme pain, high fever and an insufferable burning sensation which,if not properly remedied, bring on death 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 of Vahni-Rohini due to the action of the deranged Kapha proves fatal within a fortnight, that due to the deranged Pitta, within ten days, and that due to the deranged Vayu, within a week.

5.

The patient dies on the seventh day in a case of disease marked by the dominant Vayu, on the tenth day in a case marked by the dominant Pitta and on the fifteenth day in a case of dominant deranged Kapha.

6.

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 Pitta being deranged and bringing on this disease.

7.

According to certain authorities it is due to the absorption of blood by Vayu and Pitta.

8.

According to others the spot goes by the name of Nilika, if it is black-coloured and appears anywhere other than on the face.

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