Chapter CLVI - The Nidanam of Hæmorrhoids

Dhanvantari said:—O Sushruta, I shall now discourse on the Nidanam of Hæmorrhoids. Fleshy condylomatous growths are found to frequently crop up on the body. Polypi, that appear in the region of the rectum obstructing its orfice, are called Arshas (Hæmorrhoids). The enraged and aggravated morbific principles of the body such as, the deranged Vayu, Pittam, etc., give rise to these growths of diverse shape in the anal region by vitiating the local skin, fat (adipose tissue) and flesh, which the learned call Hæmorrhoids. These growths may be divided into two classes such as, the congenital and post-natal ones. They are either dry, bleeding or jagged, and are situated in the region of the rectum. The passage of the rectum measures five fingers’ widths and a half in length, and hæmorrhoids are found to appear within the length of three fìngers’-widths and a half from the external office of the anus. Bleeding occurs from the veins which run through these internal piles or hæmorrhoids, while the external ones are found to be situated in the region of the anus within the length of a finger’s-width of its external orfice. Another kind of polypi crop up in the region about a finger and a half distant from the anus, aronnd the outskirt of which the hairs grow.

The congenital hæmorrhoids are attributed to injudicious conducts of its parents during the period of gestation and the bodily discomfort of the child during its inter-uterine life. The Sannipatika form of hæmorrhoids owes its origin to the concerted action of the deranged morbific principles of the body, and to the curse of gods as well. Congenital piles, like any other congenital disease, are incurable, and they are dry, ugly-looking, pointing inward, of a pale (yellowish) colour, and are attended with all the dreadful supervening symptoms. Hæmorrhoids may be divided into six different forms, viz., those which are severally due to the action of the deranged Vayu, Pittam, or Kapham, of Vayu and Pittam, of Vayu and Kapham, of Pittam and Kapham, and of Vayu, Pittam, and Kapham combined.

The polypi, which are due to the action of the deranged Vayu and Kapham, are dry, while those which owe their origin to the concerted action of the Vayu and Pittam, are moist and exuding. The factors, which tend to aggravate the morbific principles of the body in this disease, have been described before, and likewise, impaired digestion, accumulation of feces in the intestines, and sexual excesses may be set down as conditions which help the growth of these polypi. Similar vegetations of polypous growths may appear in the throat, eyes, bladder, uterus, lips, etc., through a pressure, or friction, or rubbing of those localities with fingers, or with any other hard substance, or through the agency of a small cough, or choking cough during a drink. Constant contact of extremely cold water, long and frequent rides, voluntary repression of any urging toward micturition or defecation, violent straining at the time of bearing down the stool, or of passing water, daily ingestion of loathsome food, lienteric diarrhœa, fasting, pulls that involve a heavy, strain on the muscles, acts that involve a heavy strain on the female organs of generation, and miscarriage are factors which tend to enrage the Apana Vayu (Genito-urinary and illiac nerve force) of the organism. The feces lie incarcerated in the grooves (flexus) of the rectum owing to the disordered condition of this angry Apana, giving rise to a sort of congestion in those localities which help the vegetation of hæmorrhoids.

The symptoms, which mark the preliminary stage of this, disease, fare impaired digestive capacity, loss of appetite, distension of the abdomen, aching pain in the loins and calves of the legs, vertigo, a burning sensation in the eyes, oedema, and loose motions, or constipation, of the bowels. The wind incarcerated about and below the umbilicus, is passed with the greatest difficulty, and, attended with loud reports, and bleeding.

The aggravated Vayu, by producing a parched condition of the intestines, gall and urinary bladders, gives rise to all kinds of hæmorrhoid growths. The patient gradually becomes, thinner and more dejected. The complexion becomes pale and sallow; the strength of the body is markedly diminished; and; the whole organism becomes sapless as a worm-eaten, tree. The pain in the regions of the Marmas specifically described under Yakshma is found to supervene with cough, thirst, dyspnœa, lassitude, vomiting, œdema, fever, deafness, and a disagreeable taste in the mouth. An aching pain in, the limbs, anus, groins, umbilicus, and the region of the heart may be also present. The patient constantly spits and evinces no desire for food, and remains drowsy all day long. A kind of bilious discharge, resembling washing, of meat, is secreted from the rectum.

In some cases the vegetations remain dry, while in others they are found to suppurate and burst. In the type due to. the action of the deranged Pittam, they become yellow, suppurate, spontaneously burst, and bleed. In the type due to the action of the enraged Vayu, the polypi are marked by their small growth and absence of any secretion. They are found to be rough, uneven, sharp-pointed, hard, and of a reddish or brownish colour, with their external ends, cracked and severed, resembling a Vimba, Karkandu, Kharjura, or Karpasa seed in, shape. Some of them grow in the shape of Kadamva flowers, while others are found to resemble mustard seeds in size and shape. An excruciating pain in the head, sides, shoulders, thighs and inguinal regions, salivation, eructation, distension of the abdomen, cough, dyspnœa, vertigo, noise in the ears, impaired digestion with a catching pain in the heart, and an extreme nonrelish for food are the symptoms, which mark the Vayu-origined type of hæmorrhoids. The patient in this type passes hard, knotty, slimy, stool with loud flatus and much straining. The skin, nails, feces, urine, eyes and face of of the patient assume a black (dep blue) hue, and splenic (splenio?) dropsy, internal glands (Gulma) and mucous tumours make their appearance with the progress of the disease. In the Pittaja type, the heads of the polypi assume a blackish, bluish, or yellowish red colour. They are felt soft to the touch, emit afleshy smell, and secrete a thin bloody discharge from their elongated ends. Some of them are either like the tongues of parrots, or resemble the mouths of leeches in shape, or are shaped like the liver. A burning sensation of the body together with suppuration of the growths, perspiration, epileptic fits and an extreme repugnance for food are the symptoms which are found to supervene. The patient passes a kind, of hard undigested feces which are coloured green, yellow, or bloody at intervals. The polypi are thick at the middle like barley corns, and the skin, nails, feces, urine, eyes, etc., of the patient assume a yellow color in this type of the disease. In the Shleshmaja type, the hæmorrhoid growths are thick and flat at their base and are found to vegetate over a considerable area around the anus. They are white, slightly painful, glossy, unyielding, firm, smooth, globular in shape, and are felt soft to the touch. An itching sensation is invariably experienced in the affected region, and the patient feels an irresistible desire to constantly handle the growths, which seem heavy and as if enshrouded with a wet compress, resembling either the Kantaki seeds, bamboo sprouts, or the teats of a cow in shape. The patient complains of a catching, binding pain in the inguinal regions, and of a drawiug (drawing?) pain either in the bladder, rectum, or in the umbilical region. Cough, dyspnœa, nausea, vomiting, catarrh, repugnance for food, strangury, heaviness of the head, rigour, fever, increased sexual desire, mucous dysentery, dulness of appetite, and urethral and urinary disorders are the symptoms which are likewise found to supervene. In this type the patient passes stool in large quantities with much straining. The stool is found to be largely charged with thick, lard-like mucous, and the polypi are marked by the absence of bleeding or of any kind of slimy discharge. They look grey and glossy, and do not burst or crack even under the pressure of hard feces. The type of hæmorrhoids, which owes its origin to the concerted action of the deranged Vayu, Pittam, and Kapham, exhibits symptoms which are respectively peculiar to the three kinds described above. Hæmorrhoids, which result from a cotaminated (contaminated?) (lit: enraged) condition of the blood, resemble Gunja berries, or coral or Vata sprouts in shape and colour, and are attended with all the symptoms specifically described under the Pittaja type. The polypi, under the pressure of hard stool, violently bleed in this type, and in consequence of such copious hæmorrhages the complexion of the patient becomes pale and yellowish like the skin of a yellow frog, not to speak of hosts of other distempers which result from the loss of blood. The patient gets thinner and feebler every day. The complexion becomes pale and sallow, the organs fail to perform their proper functions, and the spirit becomes gloomy and dejected. The Vayu enraged and aggravated through the ingestion of gram, mudga, bamboo sprouts and such like stuff, takes lodgment in the region of the rectum, and obstructs the downward passage of the body by absorbing moisture from the urine and stool, which becomes extremely hard in consequence. Thus incarcerated in the system they give rise to an excruciating pain in the sides, abdomen, back, and sacral and cardiac regions, bringing on tympanitis, ascites, salivation, colic in the urinary bladder, œdematous swelling of the cheeks, and an obstinate constipation of the bowels with the progress of the disease. The deranged Vayu, if happens to take an upward direction in the system, in this disease, produces vomiting, repugnance for food, fever, palpitation of the heart and kindred complaints, diarrhœa, dysentery, suppression of urine, deafness, dyspnœa cough, coryza, fecal disorders, thirst, internal glands (gulmas), cephalagia and a violent obstinate headache, etc., which are usually attributed to its aggravation and disturbance. Asthma or any other form of dyspnœa, and entire suppression of the stool and urine with tympanitis are the distressing symptoms, which are usually found to supervene, causing death of the patient in unfavourable instances. Even in the absence of foregoing exciting factors, rectal hæmorrhoids may grow from quite idiopathic causes in persons whose abdominal chamber has been invaded by the deranged and incarcerated Vayu of the body. The congenital form of the disease, as well as the one in which the polypi are found to vegetate upon the inner groove of the rectum soon becomes incurable. Palliation is the only treatment possible in these cases in the event of the digestive faculty of the patient being sound and unimpaired. A case of hæmorrhoids in which the polypi vegetate on the second groove of the rectum may lapse into an incurable one in the event of their not being remedied within the first year of their growth or appearance, A case of hæmorrhoids in which the polypi are of recent growth are are found to vegetate on the outer or external groove of the tectum, and in which only a single morbific principle of the body serves as the exciting factor, may yield to medical treatment. Polypi; Which are fotind to crop up on the generative organs (condylomatous growths), or On the region of the umbilicus, are slimy and felt soft to the touch like the mouth of an earth-worm. The deranged Vyana Vayu of the system, by forcing out the deranged Kapham through the skin, gives rise to a kind of pappilatous growths on the surface of the body which are called Charmakilas, which are firm and rough to the touch. In the Vataja type of Charmakilas; a piercing pain is felt in the growths; in the Pittaja type they are found to be black capped, while in the Kaphaja type they become glossy, concurrent, and of the same colour with the surrounding skirt. An intelligent person should resort to good medical treatment from the very first appearance of this disease in his organism, in as much as a little delay or neglect might bring in a host of other rectal disorders and ascitis.