An English Translation of the Sushruta Samhita (Bhishagratna ed.)

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 suppura- tion. 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.

The ^amvukavartah Type :— The en-
raged 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, glut-
tonous 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 sub-
ject:— 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

34 THE SUSHRUTA SAMHITA. [Chap. IV.

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 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).

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

Improper diet or conduct; especially ingestion of improper, unwholesome, indigestible, or inconge- nial food ; physical exercise or sexual intercourse immediately after partaking of any oleaginous subs- tance, or after vomiting ; constant use of milk in com- bination 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 combina- tion 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 mor- bific 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 premoni- tory stages of Kushtham. 3.

36 THE SUSHRUTA SAMHITA. tChap. V.

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, Eka-
kushtham, 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 con-
nected 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

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 charac-
teristics of Dadru and Pundarika. 8.

Kshudra Kushthas :— We shall now des-
cribe (the features of the diseases known as) Kshudra-
knshthas (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.

as of Mahatkushtham the skin contracts, and with the bursting of the skin (a piercing pain is felt in the affec- ted part), which loses all sensibility to the touch, accom- panied by a general sense of lassitude in the limbs. In the Ekakushtham (Ichthyosis) type the skin assumes a reddish black colour. It is incurable. In the form known as Charmadalam (Hypertrophy of the skin) a burning, sucking, drawing pain is experienced in the palms of the hands and in the soles of the feet which become cha- racterised with an itching sensation. The disease, which affects in succession the (organic principles of) skin, blood and flesh, and speedily extends all over the body, like Erysipelas, and is attended with a burning sensation fVidaha), restlessness, suppuration and a piercing pain and loss of consciousness (epileptic fits), is called Visarpa Kushtham. The form in which a number of exuding pustules gradually extend over the surface of the body is called Parisarpa Kushtham. The type of the disease which is white and thin, and is characterised by itching and does not create any disturbance (in the patient), is called Sidhma (Maculae atrophicae). This form is generally found to restrict itself to the upper part of the body. Vicharchika (Psoriasis) is characterised by excessive pain and itching and gives rise to extremely dry crack-like marks on the body [hands and feet]. The same form of malady attended with pain, burning and itching, and restricting itself solely to the lower extremities, is called Vipatdikat. The type in which the eruptions exude (a kind of slimy secretion) and which are circular, thick, excessively itching, glossy and black-coloured is called Kitima (Keloid tumours). Small pustules or pimples characterised by an itching, burning secretion and appearing on the surface of the body are called Fakma (Eczema). The preceding kinds of pimples attended

Chap, v.] NIDANA STHANAM. 39

with burning vesicles, are called Kachchus and are
found to be chiefly confined to the legs, hands and
buttocks. A sort of dry and non-exuding pimples
characterised by excessive itching and appearing all
over the body, is called Rakasai (dry Erythema). 9-10.

The forms known as Sthularushka, Sidhma, Rakasa,
Mah^kushtham and Ekakushtham should be considered
as offspring of the deranged Kapham. Parisarpa-kush-
tham alone is due to the action of the deranged Vayu,
while the remaining types (of minor Kushtham) owe
their origin to the action of the deranged Pittam. ii.

Kilasam : — The disease known as Kilasam is but another form of Kushtham. It may be divided into three types according as it is brought about through the action of the deranged Vayu, Pittam or Kapham. The difference between Kilisam and Kushtham is that the former confines itself only to theTvaka (the skin)and is marked by the absence of any secretion.* A case of Kilasam caused by the action of the deranged Vdyu is circular, vermilion-coloured and rough to the touch. The affected part when rubbed peals off scales of morbid skin. A case of Kilasam, due to the action of the deranged Pittam, is marked by eruptions, resembling the petals of a lotus flower (in shape and colour), and are attended with an extremely burning sensation. In the type originated through the action of the deranged Kapham, the affected part (skin) assumes a glossy, white colour, becomes thick and is marked by an itching sensation. The form in which the eruptions or patches extend and become confluent, invading even the soles of the feet,

* A case of Kushtham has its primary seat ir\ the blood and skin (of the patient), in which it lies confined during the period of incubation, after which it attacks the skin and secretes the characteristic secretion of the deranged Dosha involved in it*

40 THE SUSHRUTA SAMHITA. [Chap. V.

the palms of the hands and the region of the anus, and in
which the local hairs assume a red colour should be
regarded as incurable. A case of Kilasham, which is
the outcome of a burn (cicatrix) should be likewise con-
sidered as incurable. 12.