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

A preponderance of the deranged Vayu in a case of Kushtham (leprosy) is indicated by a contraction of the skin, local anaesthesia, a copious flow of perspiration, swelling, and piercing or cutting pain in the affected part, together with a deformity of the limbs and hoarseness. Similarly, an excess of the deranged Pittam in a case of Kushtham, should be presumed from the suppuration of the affected part, from the breaking of the local skin, from the falling off of the fingers, from the sinking of the nose and ears, from the redness of the eyes and from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapham, in a case of Kushtham, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and Kakanam, which are due to the germinal defect of the patient, are incurable, inasmuch as they involve (according to Dallana) the concerted action of the three simultaneously deranged Doshas from the very outset. 1 3 .

Memorial verses :-~As a tree, full grown in the
course of time, has driven its roots, which derive their
nourishment from the rain water, deeper and deeper
into the successive strata of the soil, so this disease
(Kushtham), first affecting and confining itself to the
upper layers of the skin, will invade the deeper tissues
and organs etc. of the patient, if unchecked until al-
most all the fundamental principles or elements Dhdtus
are attacked by its virus in the course of time. 14.

Chap, v.] NibANA STHANAM. 4t

The symptoms of a case of Kushtham confined only to the serous (Tvaka) fluid of the skin are the loss of the perception of touch, a scanty perspiration, itching and dis- coloration and roughness of the affected part. The symp- toms which manifest themselves when the disease is con- fined to the blood are complete anaesthesia, horripilation, absence of perspiration, itching and excessive accumu- lation of pus in the affected parts. The symptoms of Kushtham affecting only the flesh are thickness of the patches, dryness of the mouth, roughness and hardness of the patches which become covered with pustular eruptions and vesicles, and an excruciating pricking pain in, and numbness of, the affected part. The symptoms of (Kushtham) invading the principle of fat only are a fetid smell and an excessive accumulation of pus in the affected part and a breaking of the skin, exposing deep gashing wounds which soon become infested with para- sites. The body seems as if covered with a plaster. Symptoms of (Kushtham) affecting only the bones and the marrow are a sinking (lit: breaking) of the nose, a redness of the eyes, loss of voice and the germination of parasites in the incidental ulcers. Symptoms of the disease restricting itself only to the principle of semen are a crippled state of the hands and distortion of the limbs, loss of the power of locomotion, spreading of ulcers and all the other symptoms peculiar to the pre- ceding types of the disease. 15 — 20.

A child, which is the offspring of the contaminated
semen and ovum of its parents afflicted with Kushtham,
should be likewise regarded as a Kushthi. 21.

Prognosis: — A case of Kushtham appearing
in a person of prudence and discretion and confined
only to the serum (Tvaka), flesh and blood of his orga-
nism should be regarded as curable. A palliative treat-

42 THE SUSHRUTA SAMHlTA. [Chap. V.

ment is the only remedy in cases where the disease is
found to invade the principle of fat ; whereas a case
where the poison is found to have penetrated into
any of the remaining organic principles should be given
up as incurable. 22,

Wise men hold that, for killing a Brahmana, or a wo- man, or one of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. The disease reattacks a man even in his next rebirth in the event of his dying with it. Uncured Kushtham (leprosy) is the most painful, and most troublesome of all diseases. 23 — 24.

A Kushthi (leper), getting rid of this foul malady by
observing the proper regimen of diet and conduct and
by practising expiatory penances and by resorting to
proper medicinal measures, gets an elevated status after
death. 25.

Kushtham (Leprosy) is a highly contagious disease ; the contagion being usually communicated through sexual intercourse with a leper (Kushthi), or by his touch or breath, or through partaking of the same bed, and eating and drinking out of the same vessel with him, or through using the wearing apparel, unguents and garlands of flowers previously used by a person afflicted with this dreadful disease. Kushtham (Leprosy), fever, pulmonaiy consumption, ophthalmia and other Aupasar- gika disease (incidental to the influences of malignant planets or due to the effects of impious deeds) are communicated from one person to another. 26.

Thus ends the fifih Chipter of the Nidanaslhanam in the Sushruta Samhila which treats of the Nidanam of cutaneous affections (Kushtham).

CHAPTEE VI.

Now we shall discourse on the Nidanam of Pra- meha (diseases of the urinary tracts), i.

It may be prognosticated that an idle man, who
indulges in day sleep, or follows sedentary pursuits or
is in the habit of taking sweet liquids, or cold and
fat-making or emollient food, will ere long fall an easy
victim to this disease. 2.

Pathology : —The bodily principles of Vdyu,
Pittam and Kaphah of such a person get mixed with
improperly formed chyle of the organism. Thus deranged,
they carry down through the urinary ducts the de-
ranged fat, etc.* of the body and find lodgment at the
mouth (neck) of the bladder, whence they are emitted
through the urethra -t", causing diseases, known by the
(generic) name of Prameha. 3

Premonitory symptoms: -A burning sensation in the palms of the hands and of the soles of the feet, a heaviness of the body, coldness or sliminess of the skin and limbs, sweetness and whiteness of the urine, somnolence, lassitude, thirst, a bad-smelling breath, a shortness of breath, slimy mucous deposit on the tongue, palate, pharyx and teeth, clotted hair and an in- ordinate growth of the finger and toe nails are the indications which mark the advent of the disease. 4.

General Characteristics:— A copious flow

of cloudy or turbid urine characterises all the types of
the disease, which, together with the abscesses and
eruptions (Pidaka) which mark its sequel, should be

* The particle "cha" in the text denotes other virus or morbific matter. Dallana.

t Remain incarcerated therein according to others.

44 THE SUSHRUTA SAMHITA. [Chap. VI.

regarded as involving the concerted action of the de- ranged Doshas (Vayu, Pittam and Kaphah). 5.

The Kaphaja Types : —Cases of Prameha,
which are caused by an exuberance of the deranged
Kapham, may be grouped under ten subheads such as,
Udaka-meha, Ikshu-meha, Sura-meJia, Sikata-meha, S'a-
nai-meha, Lavana-meha, Pishta-meha, Scindra-meha, S'uk-
ra-meha and Phena-meha. The ten aforesaid types are
curable, inasmuch as the medicines which tend to remedy
the deranged Kapham (Dosha), the cause of the disease,
prove also remedial to the other principles of the body
(flesh, marrow, blood, semen etc.) deranged (Dushya)
from the same causes. 6.

The Pittaja Types : — The types, which are
brought about through an exuberance of the deranged
Pittam, are named as Nila-meha, Haridrd-meha, Amla-
meha, KsJiara-meha, ManjisJitha-ineha^ and S'onita-meha,
Palliation is all that can be effected in these types,
inasmuch as the medicines which tend to correct the de-
ranged Pittam, which has brought on the disease, fail
to exert similar virtues on the organic principles
(Dushyas) deranged by it. 7.

The Vataja Types :— The types of Prameha
which are produced by an aggravated condition of
the bodily Vayu are divided into four subgroups, such as
Sarpi-ineha, Vasd-meha, Kshoudra-meha and Hasti-ineha.
These should be regarded as most incurable inasmuch as
no kind of medicine can restore the fleet-coursing, deep
diving {ie. invading the bones and the marrow) Vayu,
which at the same time also augments the Pittam, to its
normal state and thus advances (unchecked) in its work
of disintegration. 8.

The deranged Kaphah, in conjunction with the (morbid) Pittam, Vayu and fat, gives rise to all Kaphaja

Chap. VI. NIDANA STHANAM. 45

types of Prameha. The deranged Pittam, in conjunc-
tion with the deranged Vayu, blood, fat and Kapham,
produces the Pittaja ones ; while the deranged Vayu, in
unison with the deranged Kapham, Pittam, fat, marrow
and Vasa (myosin), engenders the types of Vataja
Prameha. 9.

Symptoms of Kaphaja IVIehas : -The

urine* of a person suffering from an attack of Udaka-
meha becomes white and water-like and is passed without
the least pain. In a case of Ikshumeha the urine
resembles the expressed juice of sugarcane. It has the
colour of wine in a case of Surameha. The urine in a
case of Sikatameha is passed with pain and is found
to leave a sediment of extremely fine and sand-like
concretions {Sikatas). In a case of Sanaimeha the
urine gushes out at intervals in jets and is charged
with a slimy mucous (kaphah). The urine in a case of
Lavauameha becomes limpid (non-viscid) and acquires
a saline taste. There is horripilation at the time of
micturition in a case of Pishtameha (Chyluria), the
urine resembling a stream of water, charged with a
solution of pasted rice (Pishtam).

In a case of Sandrameha, the urine becomes
thick and turbid, while in a case of Sukrameha
the urine resembles semen (or the urine is found to
be charged with semen : — Madhaba). In a case of

* Tl e Sanskrit term Meha literally means to micturate. The verbal noun Mehanam signifies utination as well as the act of passing any morbid urethral secretion. Hence the urine in most of these cases denotes the fact of its being charged with pus or any other morbid secretion of the urinary oigans such as Ojah (albumen), marrow, etc., which imparts tluir characteristic colours to the fluid, —a fact which determines the nomen- clature of the disease and forms the keynote of its diagnosis in the Ayurveda.— Ed.

46 THE SUSHRUTA SAMHITA. [Chap. I.

Phenamelia the patient passes frothy urine in broken jets. lo.

Symptoms of Pittaja Mehas :— Now we

shall describe the characteristic features of the types of Prameha, which are due to the action of the deranged Pittam. The urine in a case of Nilameha becomes frothy, transparent and bluish. The urine in a case of Haridrameha becomes deep yellow like turmeric (Haridra) and is passed with a burning pain. The urine in a case of Amlameha acquires an acid taste and smell. The urine in a case of Kshairameha* resembles an alkaline solution filtered (through a piece of linen). The urine in a case of MaDJisthameha resembles the washing of the Manjistha, while in a case of Raktameha, the urine is found to be of blood-colour ^or charged with blood - Madhava). 1 1 .

Symptoms of Vataja-IVIehas :— Now we

shall describe the characteristics of the different types of
Prameha, which are due to an exuberance of the
deranged Vayu. In a case of Sarpimeha, the urine
looks like a stream of clarified butter, while in one of
Vasatmeha it resembles the washings of Vasa. In a case
of Kshaudrameha, the urine looks like honey and
acquires a sweet taste. In one of Hastimsha, the
patient passes a copious quantity of urine, like an
excited elephant, at a time, and in one unbroken stream,
(the organ becoming steady immediately after the act
of micturition). I2.

Supervening" symptoms :— The fact of

the urine being assailed by a swarm of flies, lassitude, growth of flesh (obesity), catarrh, looseness of the limbs, a

* The urine acquires a distinct alkaline taste, smell, colour and touch. (Madhaba Nidanam).

f Charaka has included it within Kshaudra Meha and Madhu Me a.

Chap. VI.] NIDANA STHANAM. 47

non-relish for food, Indigestion, expectoration of mucous, vomiting, excessive sleep, cough and laboured breathing (Svasa) are the supervening traits (Upadrava) of the Kaphaja Prameha. A piercing pain in the testes, a pricking (veda) pain in the bladder, a shooting pain (Tuda) in the penis, a griping pain at the heart, acid eructations, fever, dysentery, a non-relish for food, vomiting, a sensation as if the entire body is emitting fumes, a burning sensation in the skin, thirst, epileptic fits, insomnia, jaundice (Pandu) and a yellow colour of the stool and urine are the supervening symptoms which mark the Pittaja types of Prameha. An oppressive feeling at the heart (Hridgraha), eager longings for foods of all tastes, insomnia, numbness of the body, fits of shivering, colic pain and constipation of the bowels are the supervening symptoms, which specifically mark the Vataja types. Thus we have described the nature of the twenty different types of Meha with their supervening evils as well. 13-16.