Chapter CLXXXIV - The Nidanam of Vomiting

Now hear me, O Sushruta, discourse on the Nidanam of Chhardi-Roga (vomiting). The enraged and aggravated Vayu, Pittam and Kaphah, as well as their concerted action, and the sight or smell of obnoxous (obnoxious?) things are the factors, which tend to produce vomiting, which may be grouped under five subheads according to the difference of its exciting factors. Drinking of inordinately large quantities of fluid, ingestion of excessive quantities of emolient food, or of offensive, unwholesome, unaccustomed, or incongenial articles of fare, hasty eating, excessive physical labour, anxiety, indigestion, worms in the intestines, pregnancy and kindred conditions of the body are the factors which tend to set the morbific principles of the deranged Vayu, Pittam and Kaphah in motion, which, in their turn, are violently expelled through the mouth, producing a sort of breaking pain in the joints. The aggravated Vayu leads to the opening of the diaphragm of the chest, which makes the expulsion of the contents of the stomach through the mouth possible. This disease is called Chhardi (vomiting).

Nausea, suppression of eructations, water brash, and an extreme repugnance for food or drink are the symptoms, which are exhibited immediately previous to an act of vomiting. In the form of vomiting due to the action of the deranged Vayu, pain at the chest and the sides, dryness of the mouth, aching pain in the head and about the umbilicus, cough, hoarseness, and a pricking pain in the body are the symptoms, which manifest themselves.

In the Pittaja form of vomiting thirst with epileptic fits, dryness of the mouth, heat in the head and eyes, vertigo and vanishing of sight are the symptoms, which manifest themselves. A kind of yellow, green, or reddish black, hot matter, which leaves a bitter taste in the mouth, is ejected and the patient complains of a burning sensation in the throat at the time of vomiting. Somnolence with a sweet taste in the mouth, water brash and a sense of repletion, drowsiness and a distaste for food and a feeling of heaviness of the limbs form the characteristic traits of the Kaphaja type of vomiting (Emisis). A thick, glossy, sweet and white coloured matter is belched out in this type, attended with horripilation. This type of vomiting is the least painful of all other types. Colic, indigestion with a repugnance for food, thirst, dyspnœa with a burning sensation in the body and epileptic fits are the symptoms, which are prominently exhibited in the Sannipatika form of vomiting, and the patient constantly belches out a hot, thick, blue or red-coloured matter with a saline taste. The accumulated bile and mucous in the stomach of the patient, as well as the other waste matters of the organism, vitiated by the deranged and aggravated Vayu, are carried up and violently ejected through the mouth, when the enraged and aggravated bodily Vayu, by obstructing the ducts of stool, urine and perspiration etc., abnormally courses in an upward direction within the organism. The ejected matter smells of stool and urine owing to the obstruction of the intestines and urinary ducts by the deranged Vayu. Thirst, dyspnœa, and hic-cough are soon found to supervene and death comes and speedily closes the scene.

Vomitings severally induced by the sight or smell of an obnoxous object, as well as those due to uterine irritation as in pregnancy, or to the presence of worms, or of accumulated mucous in the intestines, should be all regarded as of a traumatic origin, the symptoms indicating the predominance of any particular morbific diathesis (such as the deranged Vayu, etc.,) in the system should lay down the course of medical treatment to be adopted in each case. There is a persistent nausea with an intolerable colic in the type of vomiting due to the existence of worms in the intestines, and symptoms peculiar to a case of Hrid-roga of a parasitic origin are likewise found to supervene. Extreme prostration, and the colour of the ejected matter resembling that of the crest of a peacock’s plume, as well as the fact of its being marked with shreds of blood or pus are symptoms which point to an unfavourable prognosis in vomiting.

Now hear me, O Sushruta, discourse on the Nidanam of the burning sensation in the body (Daha). The heat of the Pittam, augmented through the abuse of wine, lies pent up in the blood and bile, and is afterwards thrown up to the surface-layer of the bodily skin, causing an intolerable burning sensation therein which is known as “wine’s-burning.” Blood, which courses through the whole organism, being conjested in the head, produces a kind of burning sensation in the body, attended with thirst and a copper-coloured complexion. The eyes assume a blood-shot aspect, an ironlike smell is emitted from the mouth and the patient feels as if being surrounded with a circle of blazing fire. All other symptoms of bilious fever become patent in this type of burning in which the same course of medical treatment should be followed as laid down in connection with bilious fever. Unappeased thirsts, by bringing about a diminution of the watery parts of the bodily constituents through the agency of the augmented Pittam, produce a kind of burning sensation both in the surface of the body and its inside in which the lips, throat, and palate seem as if parched up and the patient shakes and protrudes his tongue. Accumulation of blood in any of the chambers or cavities of the body (such as the the thorax) in consequence of a deep-seated sword-cut, or arrow-wound gives rise to a kind of intolerable burning sensation in the body in which all the symptoms of the type due to the congestion of blood are found to supervene. A loss of any of the fundamental principles of the body is followed by a burning sensation in the body which brings on epiliptic fits, thirst, aphonia, and stupour, which, if not speedily remedied, may terminate in death. A blow on any of the vulnerable Marmas of the body, such as the heart, bladder, head, etc., may bring on an intolerable burning sensation in the body which defies all medicinal remedies. A wise physician should not take in hand the medical treatment of a patient, who complains of a burning sensation in the body when it is felt cold to the touch.