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

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.

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

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

CHAPTER V.

Now we shall discourse on the Nidanam 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 Fittam and Kapham, enters into the vessels or ducts (Sira), which transversely spread over the surface of the bod)'. 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.

36 THE SUSIIKUTA SAMllITA. [Chap. V.

Classification :— [Diseases, falling under the group of Kushth;iin, may be divided into two broad subdivisions], viz., — Mahdkushthas (major) and Kshudra (minor) Kushthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all. The Mahakushthas arc classified as, Aruna, Audumvara,Rishya-Jihva, Kapala, Kakanaka, Pundarika, and Dadru. The minor or Kshudra-kushthas (Lichen and Dermatitis) are Sthularushkam, Mahakushtham, Kkakushtham, Charmadalam, Visarpah, Parisarpah, Sidhma, Vicharchika, Kitima, Pamd, and RakasA. All the types of Kushtham, whether major or minor, involve the action of the deranged Vayu, Pittam or Kapham, and are connected with the presence of parasites in those localities.* The preponderance of any particular morbific diathesis (Dosha) in an\' 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.

IVIahakushthas :— Aruna-kushtha owes its

origin to an exuberance of the deranged Vayu. It is slightly vermilion-coloured, thin and spreading in its