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

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, Parisravi, Samvukavarta 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 Pidakas in their unsuppuratcd 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, arc the premonitor)- s\-mptoms of this disease. 2.

The ^ataponakah Type :— The Vayu, excited, condensed, and rendered motionless b)' 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 b\' 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, seems as if it is being thrashed with a rod, pierced

p. 32

with a sharp iiistriimcnt, 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 throu'^^h 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 b)- the V.i)u (^into the rectum) finds lod;4mcit 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. 5The ^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 Samvukavaitah. 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 Vayu (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 (V.'iyu^ 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 the

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34 THE SUSIIRUTA SAMIIITA. [Chap. IV.