Chapter XLIV - Symptoms and Treatment of Jaundice (Pandu-roga)

Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of Jaundice, etc. (Pandu-roga Pratishedha). 1.

Etiology and Nomenclature:—

The deranged bodily Doshas of a person addicted to sexual excesses^[1] or to eating clay or salts or articles of keen potency and of acid or saline taste or to strong liquors in excessive quantities or to sleeping in the day, contaminate the blood and produce a yellowish (Pandu) colour of the skin. This is known as Pandu-roga and is divided into four distinct types^[2] according as they are severally originated through the action of the deranged Vata, Pitta, or Kapha, the fourth being the one incidental to their concerted action. The disease has got the name of Pandu-roga from the fact that a deep yellow (Pandu) colour is imparted to the skin of the patient suffering therefrom. 2

Premonitory symptoms:—

Cracking of the skin, salivation (spitting) a sense of lassitude in the limbs, (desire for) eating clay, swelling of the eyelids, yellow colour of stool and urine, and indigestion are the premonitory symptoms which usher in an attack of Pandu-roga. The diseases known as Kamala-Palaki-Pandu (popularly called Kamala), Kumbha-Kamala, Lagharaka and Alasa (otherwise known as Halimaka) are all included within Jaundice (Pamdu-roga), the characteristic symptoms of which are fully enumerated in succession below. 3-4.

Specific Symptoms:—

A black colour of the eyes and of the skin marked by the prominent appearance of black-coloured vein (on the surface), black colour of the stool and of the urine, blackness of the face and of the finger-nails as well as other symptoms characteristic of the deranged bodily Vayu are manifested in the Vataja type of Pandu. Yellowness of the eyes and of the skin marked by the appearance of veins (Shira) of the same colour (on its surface), yellowness of the stool and of the urine, yellowness of the face and fingernails and other specific symptoms of the deranged Pitta, mark the Pittaja type of the disease. Whiteness of the eyes and of the skin, marked by the appearance of veins of the same colour (on its surface), whiteness of the stool and urine, whiteness of the face and of the finger-nails and other specific symptoms of the deranged Kapha mark a case of the Kaphaja type of the disease. All the preceding symptoms are exhibited in a case of the Sannipata type. Now I shall describe the symptoms which mark the disease known as Kamala. 5–8.

The Pitta of a patient suffering from any disease not radically cured gets deranged by the use of any acid, or unwholesome food or drink, and imparts a (deep) yellow tint to his complexion and produces physical weakness as well as all the specific symptoms (of Pandu-roga) described above. This disease is known as Kamala. When it is accompanied by a general swelling (edema) of the body and a crushing pain in the joints, is called Kumbha-Kamala, which, when it developes in its course such symptoms as fever, aching pain in the limbs, vertigo, physical langour, drowsiness and emaciation comes to be known as Lagharaka. This, in its turn, when marked by an excessive preponderance of the deranged Vayu and Pitta is called Alasa, otherwise known as Halimaka, by those who arc conversant with its nature. 9–12.

Supervening Symptoms:—

Aversion to food, thirst, vomiting, fever, headache, dulness of appetite, swelling about the neck, weakness, epileptic fits, exhaustion and a pain in the region of the heart are included their distressing concomitants. 13.

General Treatment:—

Having ascertained the curable nature of an attack of Pandu-roga, the patient should be treated with clarified butter^[3]. He should then be purged and vomited with the compounds containing powdered Haritaki mixed with a copious quantity of honey and clarified butter. Clarified butter duly cooked with turmeric or the one known as Traiphala-Ghrita^[4] as well as the one known as Tailvaka-Ghrita^[5] may also be used for the purpose. Drugs possessed of purgative properties should also be taken in combination with clarified butter (or clarified butter duly cooked with purgative drugs should be prescribed). Half a Pala (four Tolas) of Nikumbha duly cooked in an adequate quantity (eight Palas) of the urine of a she-buffalo should be daily used. Similarly half a Kudava measure of treacle mixed (D. R. duly cooked) with pulverised Haritaki should be taken by the patient. A decoction of the drugs of the Aragvadhadi group, may be likewise prescribed for internal use. Powdered (dead) iron mixed with pulverised Vyosha and Vidanga, or powdered Haridra^[6] and Tri-phala should be licked up with honey and clarified butter.^[7] Any other medicinal compound mentioned anywhere as remedial to Gulma should also be administered. 14.

The aggravated Doshas should be gradually eliminated from the system in as much as an quick and excessive elimination of the Doshas under the circumstances might produce swelling in the patient. Either the expresed juice of Dhatri or of sugar-cane, or a Mantha^[8] should be taken with honey by a patient and he should take wholesome diet. 15-16.

Clarified butter duly cooked with the Kalka and decoction of the two kinds of Vrihati, Rajani, Shukakhya (Shuka-shimbi), Kakadani, Kakamachi, Adari-vimbi and Kadamba-pushpi (Bhumi-Kadamba) should be taken as a remedy for Pandu-roga. Pippali- powder dissolved in milk should also be taken according to the condition of the appetite. The use of a decoction of Yashti-madhu, or of powdered Yashti-madhu mixed with honey would likewise prove efficacious. Powdered leaves of Tri-phala and powdered (dead) iron should be frequently taken as an electuary in combination with cow’s urine. A compound composed of powdered coral, pearl, antimony and conch-shell, or powdered Giri-mrittika (ferrugnious earth) should be similarly used by the patient. 17–18.

A compound consisting of half a seer of powdered goat’s dung together with a Pala weight of each of the drugs known as Vit -salt, Haridra and Saindhava- salt, should be licked with honey by a patient living on wholesome diet. A compound of Mandure (iron-rust), Agni (Citraka), Vidanga, Pathya, Tri-katu all taken in equal parts with Tapya (Svarna-makshika) equal to their combined weight should be duly soaked in cow’s urine and formed into a lambative with the addition of honey, the same being prescribed for an immediate cure of a serious type of Pandu-roga. 19–20.

Vibhitaka, Mandura (iron-rust), Nagara and Tila should be pounded together and made into a paste with the addition of a profuse quantity of treacle. Pills prepared from this compound should be administered through the medium of Takra whereby a violent attack of jaundice would be defeated. Pills of the Kalaya weight of each of Sauvarchala, Hingu and Kirata-tikta pasted together, should be taken with tepid water. As an alternative, a lambative compound of Murva, Haridra and Amahika pounded together and alternately dried and soaked in cow’s urine for a week, should be given to be licked by the patient. 21–22.

A patient suffering from Pandu-roga should observe a proper regimen of diet and take two-Tola-weight of the compound of the powders of Vala and Citraka (with cow’s urine or tepid water). The compound of Saindhava salt and powdered Shigru- seeds taken in equal parts should be taken with tepid water, followed by a meal of cocked rice with milk. The decoction of the drugs of the Nyagrodhadi group should be taken, when cold, with honey and sugar followed by a proper regimen of diet. Powders of the drugs included within the Shala-saradi group or of Amalaka should be formed into a lambative with the addition of honey and given to be licked by the patient. 23-26.

The pulverised compound of Vidanga, Must a, Tri-phala, Ajamoda, Parushaka, Vyosha and Citraka as well as clarified butter, honey, sugar and treacle should be duly cooked in the decoction of the drugs of the Shala-saradi group till reduced to the consistency of a lambative. It should then be taken down and preserved inside a covered vessel prepared of Mokshaka (Mushkaka). This lambative proves curative in cases of Pandu attended with a general edema as well as in cases of the violent types of Kamala. 27.

Treatment of Kamala, etc:—

Tribhandi (Trivrit) taken with sugar as well as Gavakshi or Shunthi taken with treacle, is beneficial to a patient suffering from an attack of Kamala. Clarified butter duly cooked with Kaleya -wood and mixed with turmeric as an after-throw is also efficacious. In the alternative the patient should take Srotanjana and Shilajcitu with cow’s urine in a case of Kumbha-Kamala. Mandura (rust of iron) kept immerged in cow’s urine should be likewise taken with Saindhava- salt continually for a month. Mandura should be burnt in the fire of Vibhitaka- wood and cooled with cow’s urine. The process should be repeated eight times in succession. The iron-rust thus tempered should be subsequently reduced to powders. Licked with honey it would act as a speedy cure in cases of Kumbha-Kamala. 28–30.

Saindhava-salt once made red-hot by heating (in the fire of Vibhitaka- wood) should be cooled in cow’s urine. Iron-rust (Mandura) should be successively heated in fire and cooled with cow’s urine as directed above, the process being repeated many times. The two substances (Saindhava and iron-rust) thus prepared, (taken in equal parts) and made into a paste with (five times of) cow’s urine, should be cooked on an oven, care being taken to guard against their ignition. When dried, the compound should be reduced to powder and taken with Udashvit (a kind of Takra). The medicine acts as a good appetiser and proves curative in cases of Pandu. The patient using it should take his diet with Takra after the assimilation of the medicine. Clarified butter duly cooked with the expressed juice of Draksha, Guduci and Amalaki proves curative in cases of Lagharaka 31.

Articles Of Diet:—

Arishtas and Asavas prepared with treacle or with honey or with sugar or with cow’s urine or with Kshara (alkali) as well as the essence of meat of any Jangala animal saturated with clarified butter and mixed with the expressed juice of Amalaka or of Kola should be prescribed and meals of cooked barley grains or of Shali rice and the preparations prescribed in cases of swelling (Shopha) should be daily taken by a patient suffering from an attack of Pandu-roga. 32.

Treatment of supervening Symptoms:—

The supervening symptoms such as difficulty of breathing, diarrhea, aversion to food, cough, epileptic fits, thirst, vomiting, colic pain, fever, swelling (Shopha), burning sensation in the body, indigestion, hoarseness, lassitude, etc. should be remedied on the principles laid down in the Shastras with due regard to the nature and intensity of the deranged bodily Doshas, severally lying at their roots. 33.

Prognosis:—

If a patient afflicted with Pandu have an edematious swelling of the extremities with an emaciation of the abdominal region and vice versa or if he have a swelling of the scrotum or of the genitals or about the anus or if he be suffering from fever or diarrhea or be lying in a sub-comatose state, he should be given up and should not be attended by a physician caring anything for his fame. 34.

 

Thus ends the forty-fourth chapter of the Uttara-Tantra in the Sushruta Samhita which deals with the (symptoms and) medical treatment of Pandu-roga.

Footnotes and references:

[1]:

Mādhava in his Nidāna reads “Vyāyāma” (physical exercise) in the place of “Vyavāya” “sexual enjoyment.” Charaka, however, includes both “Vyavāyā” and Vyāyāma” in the long list of the causes of Pāndu-roga.

[2]:

A variant reads that Pāndu-roga is of eight kinds. In that case the four different varieties of Pāndu, separately mentioned below should be added to the four kinds mentioned here. Charaka says that Pāndu-roga is of five different types:—by separating and adding the one due to the eating of clay to the four kinds enumerated here.

[3]:

Some say that the Sneha used should be the Kalyānaka-Ghrita (Ch. LXII.). Others says that simply matured clarified butter should be used.

[4]:

Traiphala-Ghrita may mean either the Ghrita duly cooked with Tri-phalā or the one known as Traiphala-Ghrita mentioned in.

[5]:

Similarly Tailvaka-Ghrita may mean the Ghrita of that name mentioned in Chap. V. Chikitsita-sthāna or the one duly cooked with Tilvaka.

[6]:

Here we have followed Dallana in the text. Some take H aridrā to mean Dāru-Haridrā.

[7]:

According to Charaka’s recipe, however, we find that the two compounds here have been combined into one and there we find the definite mention of Dārvi (Dāru-haridrā). In our practice also we follow Charaka in this case.

[8]:

Mantha is prepared by mixing powdered grains of barley with clarified butter and a copious quantity bf water. Some commentators, however, on the authority of other medical works, are of opinion that in cases of Pāndu (jaundice) the word “Mantha” is technically used for the preparation of the powdered grains of barley mixed with the expressed juice of Āmalaki and of sugar-cane and with honey.