The Sushruta Samhita — trans. Bhishagratna

5 — 6.

The first of the aforesaid grooves or rings lies about a finger's width apart from the orifice of the anus.

Premonitory Symptoms :~A non-relish

for food, a tardy and difficult digestion of food (brought into the stomach), acid eructations, a sense of weakness in the thighs, a rumbling sound in the intestines, emaciation of the body, frequent eructations, swellings around the eyes, a croaking sound in the intestines, cutting pain in the rectum (Guda), apparent indications of an attack of phthisis, jaundice, dysentery, cough, dyspnoea, vertigo, somnolence, excessive sleep, weakness of the organs (Indriya), are indications which predict the advent of this disease, and which become more marked with its progress. 7.

The Vataja Type :— Piles, due to the action of the aggravated Vayu, arc non-exuding, rose-coloured, and uneven in their surface. They resemble the Kadamba flowers in structure and are either tubular or sharppointed like a needle, sometimes assumino- the shape ofp. 20 the wild Tundikeri flower. The stool of a hsemorrhold patient of this type becomes excessively hard, and can be evacuated only in a sitting posture, with the greatest pain and difficulty. An excruciating pain is experienced in the regions of the waist, back, sides, anus, umbilicus and the genitals. Symptoms peculiar to Gulma, Ashthila, enlarged spleen and abdominal dropsy add to the distress of the patient, whose skin, nails, eyes, teeth, face, urine and stool also assume a dark black colour. 8.

The Pittaja Type :— Piles, brought on through the action of the deranged Pittam, are slender, blue-topped, shifting in their nature, yellowish in their hue, or are coloured like shreds of liver, resembling in shape the tongue of the Suka bird. They are thick at middle, like barley grains, or resemble the mouth of leeches and secrete a sort of slimy exudation. The stool is marked with blood, and the patient complains of a painful, burning sensation (in the rectum) at the time of defecation. Fever, with a burning sensation and thirst, and epileptic fits, supervene. The skin, nails, eyes, face, teeth, stool, and urine of the patient assume • a yellow hue. 9.

Fever, with a burning sensation and thirst, and epileptic fits, supervene. The skin, nails, eyes, face, teeth, stool, and urine of the patient assume • a yellow hue. 9.

The Kaphaja Type :— Piles, due to the action of the deranged Kapham, become white, are sunk about their roots, and are hard, round and glossy. They assume a greyish hue and resemble the teats of a cow or the stones of the Karira, or of a Panasa fruit. These piles do not burst, nor do they exude any sort of secretion. The patient feels an irresistible tendency to scratch the excrescences. The stools become copious in quantity and are charged with mucous (Sleshm^), resembling the washings of meat. Indigestion, fever with shivering (Sita-jvara), and heaviness of the head and oedema

Chap. II.] NIDANA STHANAM. 21

with a non-relish for food are the symptoms which become manifest with the progress of the disease. The skin, finger nails, eyes, teeth, face, sLool and urine of the patient also assume a white colour. lO.

The Raktaja Type :- Piles (haemorrhoids), having their origin in the vitiated condition of the blood resemble the sprouts of the Vata tree in shape and are of the colour of red coral, or the seeds (dark red) of Gunja berry. They exhibit all the symptoms, which are peculiar to the Pittaja type of this disease. Pressed hard by the constricted fi-eces in their passage through the anus, they suddenly give rise to a hcxmorrhage of vitiated (venous) blood, and symptoms characteristic of excessive bleeding are found to supervene, il.

The Sannipata Type :- in a case of haemorrhoids due to the concerted action of the deranged Vayu, Pittam and Kapham, symptoms characteristic of each of these types manifest themselves in unison. 12.

The Congenital Type :— Congenital hemorrhoids (Sahaja Arsas) are usually ascribed to defects in the semen and ovum of one's parents and should be medicinally treated with an eye to the special deranged Doshas involved in the case. The polypi (in this type) are hardly visible and are rough and yellowish, with their faces turned inward. They are extremely painful. A person suffering from this type of piles gets thinner and thinner every day and eats but very little. Large veins (Sird) appear on the surface of the body. The patient becomes irritable, the semen decreases in quantity, making the procreation of a small number of children possible only by him. The voice becomes feeble, the digestion is impaired, and disorders affecting the head

22 THE SUSIIRUTA SAMHITA. [ Chap. II.

The voice becomes feeble, the digestion is impaired, and disorders affecting the head

22 THE SUSIIRUTA SAMHITA. [ Chap. II.

nose, ears and eyes follow. A croaking sound is heard in the intestines, attended with a rumbling in the abdomen. All relish for food vanishes and the region of the heart seems to be smeared with a kind of sticky paste (of mucous), etc. 13.

Auhoritativc verse on the subject :—

A qualified physician should undertake the medical treatment of haemorrhoids which occur cither about the outer or the middle groove of the rectum, (in as much as they prove amenable to medicine). A polypus, appearing about the innermost ring or groove of the rectum, should be treated without holding out any definite hope of cure to the patient. 14.

Ling'ars'aS (Fig warts or condylomatous growths about the genitals): — The deranged and aggravated Vayu etc., finding lodgment in the genitals, vitiate the local iiesh and blood, giving rise to an itching sensation in the affected localities. The parts become ulcerated (through constant scratching) and the ulcers become studded with sprout-like vegetations offlesh(warts),which exude a kind of slimy, bloody discharge. These growths, or excrescences generally appear on the inner margin, or on the surface of the glans penis, in the form of soft, slender vegetations of skin, resembling the hairs of a small brush (Kurchaka). These vegetations ultimately tend to destroy the penis and the reproductive faculty of the patient.

Bhagars'aS :— The deranged Vayu etc. of the body, lodged in the vaginal region of a woman, gives rise to similar crops of soft polypi in the passage. They may crop up isolated at the outset, and (by coalescing) may assume the shape of a mushroom, or an umbrella, secreting a flow of slimy, foul-smelling blood.

The deranged Vayu, etc. may further take an

Cbap. II.] MDANA STHANAM. ^3