Chapter CLVII - The Nidanam of Dysentry

Dhanvantari said:—Hear me now, O Sushruta, discourse on the Nidanam of Atisara (dysentery) and Grahini (Lienteric diarrhœa.) The three morbific principles of the body such as the Vayu, Pittam, and Kapham, as well as their combinations and fright and grief may be set down as the exciting factors of Attsara, which admits of being divided into six different types. Drinking of large quantities of water, ingestion of dry food, or of inordinate quantities of lard, oil, butter, or cakes, and excessive indulgence in cups may be likewise set down as the exciting causes of the disease. The bodily Vayu (nerve force), disturbed on account of either day-sleep, keeping of late hours, presence of worms in the intestines, and voluntary repression of any natural urging of the body, etc., takes lodgment in the intestines and impairs the digestive function, causing a rush of blood to the nether regions of the body. The Vayu by continuing in the intestines with the feces and ingested food, serves to liquify the stool and give rise to the disease which is called Atisara. A breaking pain in the rectum, abdomen and cardiac region, together with a sense of lassitude and constipation of the bowels are the premonitory symptoms of Atisara. Distension of the abdomen, together with indigestion, scanty ejections of the contents of the stomach without any sound or report, frothy turbid stool, or constant passing of knotty, slimy feces, and a burning, cutting pain about the anus mark the Vataja-type of Atisara. Fever is absent in this type of Atisara. The anus is constricted, or the patient suffers from prolapsus ani (and?) together with dyspnœa and horripilation. Constant passing of yellow, black, yellowish, greenish or blood-coloured, fetid smelling stool, together with thirst, epileptic fits, and a burning sensation in the body mark the Pittaja-type. An aching, burning pain in the region of the anus, together with constant passings of thick, slimy, scanty stool, characterises the Kaphaja-type of Atisara. All the above-said symptoms together with nausea, vomiting, a sense of heaviness about the. anus and in the abdomen, and horripilation are the characteristics of the Sannipatika-type. The patient loses all consciousness in this type, and thinks what he has done as undone.

The bodily Vayu enraged through the effect of fright upon the mind liquifies the stool which is immediately passed out in hot or warm jets. In the Vata-Paittika-type symptoms respectively described under the Vataja and Pittaja-types of Atisara are combinedly exhibited. The specific symptoms of Atisara brought about through the action of grief are identical with those described under the fright-born type.

The disease admits of being further grouped under two hroad subdivisions such as, the Sama (with mucous) and Nirama (without mucous). In the first named type (Sama) the stool emits a very fetid smell, and nausea with distension of the abdomen, and suppression of urine are also present. A case exhibiting symptoms other than the foregoing ones should be included within the Nirama group. A marked predominence of the deranged Kapham in the body during the term of Atisara leads to death. A case of Atisara neglected at the outset may run into one of Grahini (Lienteric diarrhœa). Ingestion of a large quantity of articles, that impair the digestive function, brings about either Ama or Nirama type of fever. Incarceration of undigested food in the stomach is sure to be followed by an attack of Atisara of the Sama-type. The disease is so named from the fact of one’s passing large (Ati) quanties of stool during its attack. This disease naturally and invariably proves fatal. A case of Amatisara usually follows from indigestion and on account of the incarceration of undigested fecal matter in the intestines. A case of old and persistent Atisara runs into one of Grahini, which may be divided into four different types such as, Vataja-Grahini, Pittaja-Grahini, Kaphaja-Grahini, and Sannipatika-Grahini. A sense of lassidude in the limbs and constant emission of flatus together with salivation, and a distaste in the mouth, thirst, vertigo, repugnance for food, colic, vomiting, and buzzing in the ears are the.general indications of Grahini. Weakness and emaciation of the body, hot eructations, dyspepsia fever, epiliptic fits, a sensation of numbness in the head and cardiae region, œdematous swelling of the extremities, drowsiness, parchedness of the palate, darkness of vision, noise in the ears, pain (crams) in the neck, thighs, sides and inguinal regions, and cholera are the symptoms, which are found to supervene. All these symptoms are aggravated in a weak patient, thirst and hunger being specially and oppressively increased.

The abdomen gets distended close upon the completion of digestion, and the patient finds a little relief immediately after eating. Palpitation of the heart, with pain in the cardiac region and kindred complaints, internal glands (gulmas) rectal hæmorrhoids, splenic enlargement, Chlorosis and loss of consciousness should be regarded as the distressing and supervening troubles in a case of Vataja-Grahini. The stool is frequent, and either loose, hard or frothy and is passed with loud report, causing pain about the anus as well as cough and dyspnœa. In the Pittaja-type, the stool is either yellowish, or bluish yellow. Acid eructions, with a burning sensation in the heart and throat, repugnance for food, and an unquenchable thirst are the further characteristics of this type of Grahini. Painful motions of the bowels, difficulty of digestion, vomiting, reprugnance for food, burning sensation in the mouth, salivation, cough, nausea, catarrh, distension and heaviness of the abdomen, sweet eructations, lassitude, and horripilation are the specific features of the Kaphaja-type. The patient passes thick stool charged with mucous. All the abovesaid symptoms are exhibited in the Sannipatika-type. Epilepsy, stone in the bladder, Leprosy, Gonorrhœa, Ascites, fistula in ano, hæmorrhoids, and Grahini should be regarded as great maladies (Maha Roga) and cures in these cases are extremely difficult.