An English Translation of the Sushruta Samhita, Vol. II — trans. Kaviraj Kunja Lal Bhishagratna (1911)

Four types of Akshepaka are usually recognised in practice such as, the (i) one incidental to the concerted action of the enraged bodily Vayu and Kapham (2), the one brought about through the union of the enraged Vayu with the deranged Pittam, (3), the one due to the single action of the agitated Vayu (4) and the one due to any external injury or blow ( Abhighataja).* An attack of Apatankah due to excessive haemorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour), or which is incidental to an external blow or injury (traumatic), should be regarded as incurable, 51 — 52.

* Brahma Deva designated the four types of the disease, as Apatanakah, Samsrishta Akshepakab, simple Akshepakah and the Abhighataja (traumatic).

,12 THi; SUSHRUTA SAMHITA. [Chap. I.

The disease, in which the extremely agitated Vayu affects the nerve chains (Dhamanis) which spread either in the left or in the right side of the body, whether in the upward, downward, or lateral direction, making them lax and vigourlcss, and in which the joints of the other side of the bod\- become useless and inoperative, is called Pakshag-hata (Hemiplegia) by eminent physicians. The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility, but who retains his consciousness so long as there remains the least vestige of vitality in the affected part, suddenly falls down and expires. 53 — 54.

Prognosis:— A case of Pakshaghata (Hemiplegia), brought about through the single action of the enraged or agitated Va\u of the bod\', can be cured only with the greatest care and difficulty. A case of the same disease, engendered by the aggravated Vayu in conjunction with the deranged Pittam or Kapham, proves amenable to medicine (Sadhya). It becomes incurable when caused through the waste of the root principles (Dhatu) of the body. 55.

Apatantrakah (Convulsions) :— The Vayu, aggravated (by its specifically exciting factors and principles) and dislodged from its natural .seat or receptacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples. It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.

Symptoms : — The patient lies with his eyes closely shut, or stares with a sort of fixed or vacant gaze, the eyes remaining fixed or immovable. The patient loses all perception, and groans. Respiration becomes difficult, or symptoms of temporary asphyxiaChap, I.] NIDANA STHANAM. . 1$ and unconsciousness set in. Consciousness and a normal condition of the organism return with the passage of the enraged Va\-u from the heart, while on the other hand the patient relapses into unconsciousness simultaneously with the envelopment of the heart with that enraged and Kapha-^aturated Vayu. This disease is called Apatantrakah and is ascribed to the action of the enraged Vayu surcharged with the deranged Kaphani. 56.

lYIanyastambha:— The local Vayu. agitated through such causes as sleep in the da\- time, reclining with the neck on an uneven place or pillow, gazing upward for a considerable length of time, or looking aside in a contorted way, and enveloped in the deranged Kapham, gives rise to the disease known as Manyastambha (wr\- neck or torticollis). 57.

Arditam (Facial Paralysis): — *Prcgnant women, mothers immediately after parturition (Sutika), infants, uld and enfeebled persons arc most prone to fall \'ictims to this disease*. It has been also known to result from excessive haemorrhage or loss of blood. The local Vaj^u, extremely enraged or aggravated by continuous talking in an extremely loud voice, chewing of hard substances, loud laughter, }-awning, carrving extremely heav\- loads, and lying down in an uneven position on the ground, finds lodgment in the regions of the head, nose, upper lip, chin, forehead and the joints (inner cornea) of the eye, and produces the disease called Arditam by distorting the face.

Symptoms: — The neck and half of the face longitudi- tally suffer distortion and are bent. The head shak'" ■ the power of articulating speech is lost, and the eyes arc distorted into a variety of shapes. The portions of the neck and the chin, as well as the teeth on the affected side become painful.

* Tlij portion of the text included within asteribks has been rejected by Jtjjal icharyya as spurious.

14 THE SUSHRUTA SAMillTA. [Chap. I.

Premonitory Symptoms :— The disease