The Sushruta Samhita — trans. Bhishagratna

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.

Prognosis : — Almost all the types of this disease (Fistula in anoj yield to medicine after a prolonged course of treatment, and are hard to cure, except the Sannipatah and traumatic ones, which are incurable. 10.

Thus ends ihe fourth Chapter of the Nidana Sthanam in the Sushrula
Samhila, which treats of the Nidanam of Fistula in ano (Bhagandaram).

CHAPTER V.

Now we shall discourse on the Nidatnam of Kushtham (cutaneous affections in general), i.

Improper diet or conduct; especially ingestion of improper, unwholesome, indigestible, or incongenial food ; physical exercise or sexual intercourse immediately after partaking of any oleaginous substance, or after vomiting ; constant use of milk in combination with the meat of any domestic, aquatic or amphibious animal ; a cold water bath after an exposure to heat ; and repression of any natural urging for vomiting etc. are the factors which tend to derange and aggravate the fundamental principle of Vayu in a person. The enraged or aggravated Vayu, in combination with the agitated Pittam and Kapham, enters into the vessels or ducts fSira), which transversely spread over the surface of the body. Thus the enraged Vayu deposits the Pittam and Kapham on the skin through the medium of their channels and spreads them over the entire surface of the body. The regions of the skin in which the aforesaid morbific diatheses are deposited become marked with circular rings or patches. The morbific diatheses (Doshas), thus lodged in the skin, continue to aggravate, and having been neglected at the outset, tend to enter into the deeper tissues and thus contaminate the fundamental principles (Dhatus) of the body. 2.

Premonitory Symptoms : — A roughness

of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anaethesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premonitory stages of Kushtham. 3.

p. 36

3.

p. 36

Classification :— [Diseases, falling under the group of Kushtham, may be divided into two broad subdivisions], viz.,— Mahdktishthas (major) and Kshudra {minor) Kushthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all. The Mahakushthas are classified as, Aruna, Audumvara,Rishya-Jihva, Kapala, Kakanaka, Pundarika, and Dadru. The minor or Kshudra-kushthas (Lichen and Dermatitis) are Sthularushkam, Mahakushtham, Ekakushtham, Charmadalam, Visarpah, Parisarpah, Sidhma, Vicharchika, Kitima, Pama, and Rakasa. All the types of Kushtham, whether major or minor, involve the action of the deranged Vdyu, Pittam or Kapham, and are connected with the presence of parasites in those localities * The preponderance of any particular morbific diathesis (Dosha) in any case of Kushtham should be looked upon as its originating cause. The type, known as Aruna Kushtha, is due to the action of the preponderant Vayu ; Audumvara, together with Rishya-Jihva, Kapala and Kakanaka, to a preponderance of the deranged Pittam ; while Pundarika and Dadru owe their origin to an excess of the deranged Kapham. These types of major or minor Kushthas are successively more extensive in their action and more incurable on account of their respectively invading a greater number of the bodily elements (Dhatus). 4 — 6.

Mahakushthas :— Aruna-kushtha owes its origin to an exuberance of the deranged Vayu. It is slightly vermilion-coloured, thin and spreading in its

* Certain authorities hold that, all types of Kushtham (cutaneous affections) to be of parasitic origin. The Garuda Puranani avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous Sif^eclions—A'iishtAaika'heiavoniafy'dk shlemshajd v6hyasambhavdli, Ch. CLXIXV. 4.

Chap, v.] KlDANA STHAKAM. 37

The Garuda Puranani avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous Sif^eclions—A'iishtAaika'heiavoniafy'dk shlemshajd v6hyasambhavdli, Ch. CLXIXV. 4.

Chap, v.] KlDANA STHAKAM. 37

nature. A sort of pricking, piercing pain (is experienced in the affected locality) which loses all sensibility to the touch. The type known as Audumbara is coloured and shaped like a ripe or mature Audumbara fruit and has its origin in the deranged Pittam. The type called Rishyajihva is rough and resembles the tongue of a Rishya (Deer) in shape and colour. The type known as Kapaila (Macula cserula^) resembles a black (deep blue) Kharpara ( baked clay ). The Katkanaka type is characterised by a dark red and black colour like the seed of the Guiija berry. A sort of sucking and burning pain is experienced in the affected locality in all the four preceding types of the disease which are the outcome of the deranged Pittam. The whole diseased surface seems as if burning with fire, and emitting hot fumes. They are speedy in their origin and rapidly suppurate and break. All these types soon become infested with parasites. These are the general features of these forms of Kushthas. 7.

Pundarika:— The patches resemble the petals of a (full blown) lotus flower in colour, and Dadru (Ringworm) assumes the colour ffaint blue) of an Atasi flower, or of copper. They are spreading in their nature and are found to be overspread with pustules. Both the Dadru and Pundarika types are raised, circular, and characterised by itching and take a considerable time to be fully patent. These are the general characteristics of Dadru and Pundarika. 8.

Kshudra Kushthas :— We shall now describe (the features of the diseases known as) Kshudraknshthas (M. Text):— The type known as Sthula'rushka appears about the joints. It is extremely thick at its base, is cured with the greatest difficulty, and is strewn over with hard pustules (Arungshi). In the type known

3^ THE SUSHRUTA SAMHITA. [Chap. V.