Chapter CLIV - The Nidanam of heart disease

Dhanvantari said:—O Sushruta, now I shall discourse on the Nidanam of Hridroga^[1] which admits of being grouped under five sub-heads according as the deranged Vayu, Pittam and Kapham, either severally or concertedly lie at the root of the disease, or as any parasitic growth in the heart serves as its exciting factor. In the type due to the action of the deranged Vayu, the patient complains of a vacuum in his heart, which seems dry, numbed, and as if being broken or turn asunder. He cannot bear the least sound or noise, and is frightened, or feels dejected, or indulges in grief without any apparent reason. Insomnia becomes markedly patent, and the patient suffers from difficult breathing, shivers, and lapses into fits of unconsciousness. The bilious type develops such symptoms as thirst, fatigue with a burning sensation in the body, perspiration, acid eructations, vomiting of acid or bilious matter, fever and darkness of vision. The symptoms, which manifest themselves in the type due to the action of the deranged Kapham, are a sensation of numbness in the heart, impairment of digestive faculty, distaste in the mouth, cough, pain in the bones, expectoration of mucous, somnolence, and fever with a non-relish for food. The type, which is due to the concerted action of the deranged Vayu, Pittam and Kapham, exhibits symtoms which are peculiar to the form which are respectively brought about by each of these morbific principles. A blackish (dull) yellow colour (brownish) of the conjunctiva accompanied by vertigo, nausea, waterbrash, cedema, expectoration of mucous, and an itching sensation in the limbs form the specific indications of the type of Hridroga which is of a parasitic origin. The patient feels as if his heart is being sawed with a sharp-toothed saw. The medical treatment of a case of any of these types of Hridroga should be commenced almost simultaneously with the manifestation of any of its specific indications, inasmuch as it is often found to run into one of the incurable types, and speedily runs its course, terminating fatally in most instances. The sixth form or type of Hridroga is fouud(?) to result as a supervening symptom of any other preexisting distemper in which any of the vital principles of the organism, such as, blood, lymph-chyle, albumen, etc., has suffered an abnormal loss or diminution. In almost all the types of Hridroga, there occurs a loss of any of the abovesaid vital principles of the body in consequence of which both the Vayu and Pittam are enraged. Hence an abnormal derangement of the Vayu and Pittam, causing spasmodic jerks in all the limbs, rigour, palpitation of, and a burning sensation in, the heart, and fits of unconscious should be looked for in all the types described above. The water-crying vessels, which traverse the throat, palate, lungs and the root of the tougue (tongue?), become dry and parched up, giving rise to a short of unquenchable thirst which is common to all the forms of Hridroga. An unquenchable thirst attended with dryness of the mouth (the patient craving for more water each time), loss of voice, roughness of the throat, lips and palate, difficulty in protruding the tongue, delirium, mental aberrations and loud eructations, are the further characteristics of this disease. Prostration, dejection of spirit and vertigo with a breaking pain in the temples, loss of smell, dulness of hearing, and insomnia with a vapid taste in the mouth, are the symptoms which are developed through the action of the deranged Vayu in Hridroga. A little increase of reactionary acidity in the stomach after digestion accompanied by a bitter taste in the mouth, redness of the eyes, a burning sensation in the body, dryness of, and a feeling as if fumes are escaping through, the skin, and fainting are the symptoms which should be specifically attributed to the action of the deranged Pittam in the present disease. In the Kshayaja type the aggravated Kaphah chokes up the passages of Vayu in the heart, and the sticky mucous accumulated in those vessels absorbs heat, like thickened slime. Somnolence, and a sensation as if the lining membrane of the throat has been studded with the bristles of a Shuka insect, together with a sweetish taste in the mouth, are the symptoms which should be attributed to the action of the deranged Kapham in this disease. A sensation of heaviness and numbness in the head, vomiting, lassitude, indigestion with a non-relish for food, and tympanites, are the symptoms, which should be attributed to the concerted action of the deranged Vaiyu, Pittam and Kapham in a case of Hridroga. Owing to the obstructed course of blood and generation of mucous in the system in this disease, both the deranged Vayu and Pittam are inordinately aggravated, and for this the patient, though suffering from an intense heat in the body, is suddenly seized with a rigour which shakes him to the very bones.

The type of Hridroga, which is caused by the Pittam being obstructed in the thorax through the agency of thirst, should be regarded as of a bilious origin. Similarly, a kind of aching pain is felt in the heart through drinking large quantities of water inasmuch as heavy drinks naturally dissolve the albuminous constituents of the body and help their digestion in the usual way. The kind of thirst, which is generated through taking acid, saline or emolient things, should be regarded as caused by the deranged Kapham. The kind of thirst which follows from the loss of lymph-chyle (any vital organic principle) is but an indication of wasting or consumption. The thirst, which is experienced during a paroxysm of fever or in consumption, should be regarded as a mere supervening symptom.