The Sushruta Samhita — trans. Bhishagratna

t^hap. III.

stomach-f- (Amasaya) into the bladder keeping it filled with this important fluid of the body, just as a newpitcher, immersed up to its neck in a vessel full of water, is filled by transudation through its lateral pores. 14.

In the same way the Vayu, Kapham and Pittam are carried into the bladder (through their respective ducts or channels), and in unison with the retained urine, give rise to the formation of stone, on account of the slimy character of the deposit produced. Stone is formed in the same way in the bladder as sediments are ultimately deposited from clear and transparent water at the bottom of a new pitcher which contains it. As the wind and lightning jointly condense the rainwater into hailstones, so the bodily Vayu and Pittam (heat) jointly contribute to the condensation of the Kapham in the bladder and transform it into stone.

The Vayu in the bladder, coursing in its natural downward direction, helps the full and complete emission of urine ; while coursing in a contrary direction, it gives rise to various forms of maladies such as, Prameha, strangury, as well as seminal disorders ; in short, it produces any urinary trouble to which the bladder may be subjected. 15.

t From the kidneys.

Thus ends the third Chapter of the Nidana Sthanam in the Sushruta
Samhita which treats of the Nidanam of urinary calculi.

CHAPTER IV.

Now we shall discourse on the Nidatnam of Bhag^- ancla.ram (fistula m ano and fistular ulcers), i.

The deranged Vayu, Pittam, Kaphah and Sannipatah (a simultaneous derangement of the three bodily Doshas) and extraneous causes (such as a blow etc.) give rise to the types of Bhagandaram known as Sataponaka, Ushtragriva, Parisrdvi, Samvukdvarta and Unmargi. The disease is so named from the fact that it bursts the rectum, the perineum, the bladder and the place adjoning to them (thus setting up a mutual communication between them). The pustules, which appear in this regions are called as Pidakds in their unsuppurated stage, while they are called Bhagandaram when they are in a stage of suppuration. A pain about the sacral bone and an itching about the anus, accompanied by a swelling and burning sensation, are the premonitory symptoms of this disease. 2.

The ^ataponakah Type :— The Vayu,

A pain about the sacral bone and an itching about the anus, accompanied by a swelling and burning sensation, are the premonitory symptoms of this disease. 2.

The ^ataponakah Type :— The Vayu, excited, condensed, and rendered motionless by a course of unwholesome food, gives rise to a pustule within one or two fingers' length from the rectum (anal region, — Guda), by vitiating the flesh (areolar tissue) and blood (of the locality). It assumes a vermilion colour and is characterised by a variety of pricking, piercing pain. If neglected at the outset, the pustule runs into suppuration. Owing to its vicinity to the bladder, the abscess or the suppurated pustule exudes a kind of slimy secretion and becomes covered with hundreds of small sieve-like holes, through which a constant frothy discharge is secreted in large quantities. The ulcer, thus formed, seerns as if it is being thrashed with a rod, piercedp. 32 with a sharp instrument, cut with a knife, and pricked by needles. The region of the anus cracks and bursts, and jets of urine, fecal matter, flatus (Vata) and semen are emitted through these sieve-like holes. This type of fistula is called Sataponakah (Sieve-like fistula in ano). 3.

The Ushtra-grivah Type: -The enraged

Pittam, carried down by the Vayu (into the rectum) finds lodgmeit therein, and there gives rise to a small, raised, red pustule, which resembles the neck of a camel in shape, and is characterised by a varied kind of pain, such as sucking etc. The pustule, not medicinally treated at the beginning, runs into suppuration. The incidental ulcer seems as if it is being burnt with fire or alkali, and emits a hot, fetid discharge. Jets of urine, flatus (Vata), fecal matter and semen flow out of the ulcer in the event of it not being healed up with proper medicinal remedies. This type is called Ushtragrivah. 4.

The Parisravi Type: —The enraged Kaphah, carried down by the Vayu (into the rectum) and lodged therein, gives rise to a white, hard, itching pustule in that locality, characterised by a variety of itching pains, etc. If neglected at the outset, it soon runs into suppuration. The incidental ulcer becomes hard and swollen, marked by excessive itching , and a constant secretion of slimy fluid. Jets of urine, fecal matter, flatus and semen are emitted through the ulcer in the event of it not being well cared for at the outset. This type is called Parisravi. 5.

Jets of urine, fecal matter, flatus and semen are emitted through the ulcer in the event of it not being well cared for at the outset. This type is called Parisravi. 5.

The ^amvukavartah Type :— The enraged Vayu, in conjunction with the aggravated Pittam and Kapham, is carried down, and finds lodgment (in the region of the rectum), giving rise to a pustule of the size of the first toe, and characterised by a piercing

Chap. IV.] NIDANA STHANAM. 33

pain, and burning, itching sensations etc. Such a pustule, neglected at the outset, speedily suppurates, and the incidental ulcer exudes secretions of diverse colours, characterised by a kind of whirling pain, which revolves about, in the direction of the involuted indentures (within the grooves of the rectum) such as are found within the body of a river or fresh water mollusc. This is called Samvukavartah. 6.

The Unmargi Type :— Particles of bones, eaten with (cooked) meat by an imprudent, greedy, gluttonous person, may be carried down with the hard and constipated stool by the Apana Vdyu (into the rectum), thus scratching or abrading the margin of the anus, or burrowing into the rectum in the event of their being evacuated in improper directions through (transverse or horizontal postures). The scratch or abrasion is soon transformed into a fetid and putrid ulcer, infested with worms and parasites, as a plot of miry ground will soon swarm with a spontaneous germination of similar parasites. These worms and parasites eat away the sides of, or largely burrow into, the region of the anus, and jets of urine, fecal matter, and flatus (VayuJ are found to gush out of these holes. This type of Bhagandaram is called Unmargi. 7.

Authoritative verses on the subject:— A pustule, appearing about the region of the anus and characterised by a slight pain and swelling, and spontaneously subsiding, should be regarded as a simple pustule, which is of a quite different nature from a fistula in ano, which has contrary features {i.e., invariably found to be attended with a violent pain and swelling etc., and takes a long time to heal). A Fistula-pustule crops up within a space of two fingers' width of the Pdyu proper (distal end of thep. 5p. 34 rectum), is sunk at its root, and attended with pain and febrile symptoms. Pain, itching and burning sensations are experienced about the anus after a ride in a carriage, or after defecation. The anus becomes swollen, and the waist painful in the premonitory stages of Bhagandaram. 8—9.