The Sushruta Samhita — trans. Bhishagratna

The foregoing causes especially tend to vitiate or agitate the Vayu and blood in persons of delicate constitutions, or in corpulent persons, or in those who observe a form of perfect continence. 39.

The vital Vayu becomes enraged or agitated by excessive riding on horses, camels or elephants, or through the lifting or carrying of great weights, etc., or by an inordinate indulgence in things which are possessed of the specific virtue of enraging or aggravating that vital principle. On the other hand, an over-indulgence in such articles of food as are heat-making in their potency, or a surfeit of edibles largely composed of sharp, acid or alkaline substances, as well as a large consumption of potherbs etc., or an exposure to heat tends to vitiate the blood of the organism, and which, on account of such contamination, tends to speedily obstruct the passage of the fleet-coursing Vayu. The Vayu, thus impeded in its course, Ibecomes more and more agitated each moment, and is prone to speedily agitate the blood in a similar way. The antecedence of the term "Vata" or "Va}^u" in the nomenclature of the disease (Vata-Rakta) is owing to the precedence accorded to the action of the deranged Vayu in bringing about the malady, although it effects this In concert with the vitiated blood of the organism. 40.

Similarly, the disease brought about by the agitated Pittam, in conjunction with the vitiated or agitated blood, is called the Pitta- Raktam, while the one incidental to the combination of the deranged Kapham with the vitiated blood is called Kapha-E/aktam. In a case of Vata-Raktam, the legs, or the lower extremities canp. 9 not bear the least touch (Hyperaesthesia) and a sort of pricking, piercing pain (pins and needles) is experienced in those regions. The legs become withered or atrophied and lose all sensibility to touch. In a case of Pitta Rakt am, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Raktam, the legs become swollen and numbed. The swelling assumes a whitish hue and feels cold to the touch, and is accompanied by excessive itching. In the Sannipatika or Tridoshaja form of Dushta-Rakfcam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding types. 41 — 43.

In the Sannipatika or Tridoshaja form of Dushta-Rakfcam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding types. 41 — 43.

Premonitory Symptoms : —In the incubative stage of the disease the legs perspire and become cold and flabby, or (on the contrary\ the local perspiration is stopped and the legs become hot and hard. Moreover, a pricking pain is experienced in the affected parts which are marked by complete anaesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in either from the lower extremities, or in some cases, first affects the upper ones and gradually extends all over the body like an enraged rat-poison.

Prognosis : — The form of the disease in which the skin of the part lying between the instep and the kneejoint becomes abraded or spontaneously bursts open, exuding pus and blood, attended with loss of strength (Prana) and flesh, curvature of the fingers, and eruptions of nodules, should be regarded as incurable ; while a case of one year's standing admits only of palliative measures. 44.

The enraged or agitated Vayu, while coursing swiftly through the Dhamanis (nerve.s) of the body, shakes it in quick succession, and a disease, (exhibiting suchp. 10 symptoms as shaking or convulsive jerks), is originated which is called Akshepaka* (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called ApataLnaka (Epilepsy without convulsions). The aggravated or agitated Vayu, charged with an abnormal quantity of Kapham, sometimes affects and stuffs the entire nervous system, and gives rise to a form of disease, which is called DandaipataiaakaTnt (Epilepsy with convulsions), inasmuch as it deprives the body of its power of movement and flexibility, making it stiff and rigid like a rod (Danda). 45 — 46.

45 — 46.

The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty ; its characteristic symptom being a paralysis of the jawbone, which makes deglutition extremely difficult. The disease in which the enraged Vayu bends the body like a bow is called Dhanushtambha (Tetanus). The disease admiits of being divided into two distinct types accordingly as the body of the patient is curved internally (Antaraiyama, lit:— inwardly or forwardly extended, emprosthotonos), or externally (Vahirakyatma, lit : — extended or bent on the back, resting on his heels and occiput — Opisthotonos). When the extremely enraged and powerful bodily Vayu (nerve-force), accumulated in

* The patient suffers from vanishings (idniyale) and loss of consciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named — Gayaddsa.

t Jejjada holds that the enraged Vayu, in unison with the deranged Kapham, gives rise to another kind of convulsions (Akshepaka) which he has denominated as Danda-patanakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pittam and Kapham. Several authorities aver that there are four distinct types of Akshepakah, such as Danda-patanakh, Anlarayamah, Vahirayamah, and Akshepakh of traumatic (Abhighataja) origin.

Chap. I.] NIDANA STHANAM. II

the regions of the fingers, Insteps, abdomen, chest, heart and throat, forcibly draws in the local ligaments (Snayu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarayatma Dhanushtambha. The movements of the eyes become impossible, which become fixed in their sockets ; the jaw-bones become paralysed, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapham). These are the features which mark the first type (Antarayama Dhanushtambha). On the contrary, when the same enraged Vayu, centred or lodged In ligaments which traverse the posterior side of the body, attracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease Is called Vahiratyatma, and should be looked upon as beyond the pale of all medicinal treatment. 47 — 50.