The ten different types of Pidaka (abscess, carbun- cles, pimples, pustules etc.) are found to crop up on the bodies of patients, suffering from Prameha, and abounding in fat and Vasa, and whose fundamental principles have been affected by the simultaneous derangement of the Vayu, Pittam and Kapham. They are named as Siravikat, Sarshapika, Kachchapika; Jaiini, Vinat^, Putrini, Masurika, Alaji, Vids^rika and Vidradhikab. \7 -
IVIctrical Texts : — An abscess which is raised
at the margin and dipped in its centre, so as to resemble
an Indian saucer in its shape is called Saravik^. Pimp-
les or pustules of the shape and size of white mustard
seeds are called Sarshapikat. An abscess, resembling
(the back of) a tortoise in shape and attended with a
burning sensation, is called Kachchapika by the wise.
48 THE SUSHRUTA SAMHITA. [C^i^P- ^^»
An abscess studded with slender vegetations of flesh and attended with an intolerable burning sensation is called Jg^lini. A large blue-coloured abscess (carbuncle) appearing on the back or the abdomen, and exuding a slimy secretion and attended with a deep-seated pain is called Vinatat A thin and extensive abscess (studded withslender pustules —D.R.) is called Putrini. Pimples to the size of lentil seeds are called Masurika. A dreadful abscess which is of a red and white colour, studded over with blisters or exuding vesicles is called Alaji. A hard and round abscess as large as a (full-grown) gourd is called Vidai'ikat. An abscess of the Vidradhi type is called Vidradhika (carbuncle) by the wise. An incidental abscess in a case of Prameha should be regarded as having its origin in the same morbific principle (Dosha) as that which has produced the disease (Prameha) 18-28.
Prognosis : — A Pidaka,or an abscess, appearing
about the region of the heart, anus, head, shoulder, back
or at any of the vital joints (Marma) of the body, and
attended with other supervening symptoms producing
extreme prostration [impaired digestion — D." R.] in
the patient should be abandoned as incurable. In
a case of Vataja meha, the deranged Vayu presses
all the fundamental principles out of the body through
the urethra and rages rampant in the lower part of the
body, united with the deranged fat, marrow and Vasa.
Hence a case of Vataja meha, (or its accompanying
abscess), is held as incurable. 29-30.
A person in whom the premonitory symptoms (Pur-
varupam of Prameha) have appeared and who passes
a little larger quantity of urine than usual, should be
considered as already afflicted with it. A person
afflicted with all or half of the premonitory symptoms
of the disease and passing a copious quantity of urine
Chap. VI. NIDANA STHANAM.
should be considered as one suffering from an attack ofPrameha. 31 — 32.
A Prameha patient afflicted with deep-seated absces- ses and other distressing symptoms, which are usually found to supervene in the disease, should be pronounc- ed as suffering from Madhumeha and adjudged incurable. A Madhumeha patient seeks a halting place while walk- ing, wants a place to sit on while halting, lies down if he finds a sitting place, and sleeps if he lies down. 33 — 34.
As five mixed colours such as grey, brown, Kapila
(bluish yellow), Kapota (blackish grey), Mechaka
(light-green) may be produced by combination of the
five primary colours in definite proportions (such as
white, green, black, yellow and red), so a diversity of
causes, through the relative preponderance of the parti-
cular kinds of food, and of the deranged Doshas, root
principles (Dhatu) and excretions of the body (Mala),
may be attributed to the origin of Prameha. 35.
IVIemorial verses :— All types of Prameha,
not properly treated and attended to at the outset,
may ultimately develop into those of Madhumeha
types, which are incurable. 36
For English equivalents of the different types of Prameha compare : — Cystitis (Acute Infective) — Frequent, painful micturition, small quantity of urine voided with pain and urgency. Urine — slightly acid or alkaline in reaction, cloudy, containing blood corpuscles. Cystitis (Chronic Infective) — Great and frequent pain, in the lumbar region, rigor. Urine — thick, offensive and alkaline, containing ropy mucous and blood. Cystitis (Non- Infective) — Symptoms like those of acute inflammatory type. Urine- acid and cloudy with mucous. Blood is generally present in considerable quantity. Neuralgia of the bladder, compare Albuminuria, Albumosuria, Hoemoglobinuria, Hoematuria, Peptonuria, Pyuria, Spermatorrhoea and Diabetes, Proteuria and Polyuria.
Thus ends the sixth Chapter of the Nidana Sthanam in the Sushruta Samhit^, which treats of the Nidanam of Prameha.
Qs
CHAPTER YII.
Now we shall discourse on the Nidainam of Udara
(dropsy with an abnormal condition of the abdomen), i.
Metrical Text :— The royal sage Dhanvan-
tari, the foremost of all pious men who equalled
in splendour and glory the lord of the celestials, thus
blissfully discoursed on the Niddnam of Udara to
Susruta, the son of the holy Vis'vamitra, who devoutly
approached him for that purpose. 2.
Classification : — This disease may be divided
into eight different types, of which four are produced
by the several actions of the three deranged Doshas of
the body and their concerted action as well. Of the re-
maining types, two being known as Plihodara (including
Yakritodara), and Vaddha-Gudodara (tympanites due to
the constriction of the anus), the seventh Agantuka
(traumatic or of extraneous origin), and the eighth
Dakodara (Ascites proper). 3.
Predisposing Causes :— The deranged
Doshas of a person of extremely impaired digestion,
addicted to the habit of taking unwholesome food, or
of eating dry, putrid food, or of violating the rules of
conduct to be observed in connection with oleaginous
measures etc.,* are aggravated and find lodgment in the
abdomen. Thus appearing in the shape of an abdomi-
nal tumour (Gulma), they give rise to this dreadful disease,
attended with all its characteristic symptoms. The lymph
chyle formed out of the assimilated food getj vitiated,
and, impelled by the aggravated Vdyu, it percolates
* These include purgative, erpitic, A'stha'panam and Anuva'sapann p(iej^su|re§,
th«p. VII.] NIDANA STHANAM. Jt
through the peritoneum in the same manner as a quantity of oil or clarified butter kept in. a new, earthen pot will transude through the pores of its sides. It thus gradually distends the skin (Tvak) of the abdomen. The process becomes general all through the abdominal region and the disease (Udara) is produced in consequence. 4 — 5.
Premonitory sypmtoms :— The precursory
symptoms of the disease are loss of strength, complexion
and appetite, emaciation of the muscles of the abdomen,
appearance of veins on its surface, acid reaction of food
closely following upon its digestion (Viddha\ pain
in the bladder, and swelling of the lower extremities.
The patient cannot ascertain whether his meal has been
digested or not. 6.
The Vataja, Pittaja, and Kaphaja
Types : — A case of Udara in which the abdomen en- larges on its sides and posterior part, and is over- spread with nets of black veins should be ascribed to the action of the deranged Vdyu. A pain (Sula), suppression of the stool and urine (Andha) and a cutting and piercing pain and flatulent rumbling in the intestines are the symp- toms which likewise characterise this Va'taja form of Udara. A sucking pain in the abdomen, thirst, fever with a burning sensation, yellow colour of the swollen skin of the abdomen, on the surface of which yellow veins appear, yellow colour of the eyes, nails, face, stool and urine and the rapid increase of the dropsical swelling, are the characteristics of the Pittaja Udara. In a case of Kaphaja type the dropsical swelling is cold to the touch and becomes overspread with white-coloured, veins. The abdomen seems heavy , hard, glossy and is extreme- ly distended. The swelling slowly increases, and the finger- nails and face of the patient become white, and he complains of a general lassitude. 7 — 9.
52 THE SUSHRDTA SAMHITA. tChap. VIl.
The TridOShaja Type :— Evil-natured wo- men (with a view to win the affections of their husbands or lovers sometimes) mix with their food and drink such refuse matters of their bodies as nails, hair, faeces, urine, catamenial blood etc. (which are supposed to be possessed of talismanic virtues). The three Doshas of the body, vitia- ted by such food or drink, or through imbibing any sort of chemical poison (Gara) administered by one's enemy, or by taking poisonous waters, or Dushi-Visha (slow poison whose active properties have been destroyed by fire or any antipoisonous medicine), will vitiate the blood and give rise to a kind of dreadful dropsical swelling of the abdomen, marked by the specific symptoms of each of them The disease is aggravated in cold and cloudy days and a burning sensation is felt (in the inside of the abdomen\ The patient becomes pale, yellow and emaciated, and is afflicted with thirst and dryness in the mouth, and loses consciousness at short intervals. This disease is also known as the dreadful Dushyodaram. lo. Plihodaram. — (Spleen with dropsy of the abdo- men) : — -Now hear me describe the symptoms of Pliho- daram. The blood and the Kapham of a person, derang- ed and aggravated through the ingestion of phlegma- gogic food, or of those which is followed by an acid digestionary reaction (Viddha), often enlarge the spleen, (which gives rise to a swelling of the abdomen). This disease is called Plihodara by the experts. Plihodaram protrudes on theleft sideof the abdomen, its characteristic symptoms being lassitude, low fever, impaired digestion, loss of strength, jaundice, weakness, and other distress- ing symptoms peculiar to the deranged Pittam and Kapham. A similar enlargement of the liver through similar causes on the right side of the abdomen is called Jakriddfitly udarani. 1 1 — 1 2.
Chap. Vll.] NIDANA SfHAJSTAM. ^3
Vaddha-gUdOdaram* :— The fecal matter,
mixed with the deranged Vayu, Pittam etc. of the
body, lies stuffed in the rectum of a person whose in-
testines have been stuffed with slimy food (as pot herbs)
or with stones and hair (enteritis). They give rise to
a sort of abdominal dropsy by swelling the part between
the heart and the umbilicus which is called Vaddha
Gudodaram. Scanty stools are evacuated with the great-
est pain and difficulty and the patient vomits a pe-
culiar kind of matter with a distinctly fecal smell
(scyabalous ?). 13.
Parisravi-Udaram : — Now hear me describe
the causes and symptoms of the type of Udaram which
is called Parisratvi-udaram. Thorny or sharp-pointed
substances (such as fish-bones etc.), carried down with
the food in a slanting way from the stomach into the
abdomen, sometimes scratch or burrow into the intes-
tines. Causes other than the preceding ones, (such as
a long yawn or over-eating etc.) may contribute to the
perforation of the intestines, giving rise to a copious
flow of a watery exudation which constantly oozes out
of the anus and to a distension of the lower part of the
abdomen situated below the , umbilicus. This is called
Parisravy udaram which is marked by a cutting pain and
a burning sensation. 14.
Dakodaram : — Now hear me describe the causes and symptoms of the type known as Dakodaram (ascites). The drinking of cold water immediately after the application of an Aunvdsanam or Asthapanam enema, or closely following upon the exhibition of any purgative or emetic medicine, or just after the taking of a medicated oil or clarified butter, etc. tends to derange
* Dropsical swelling of the abdomen with tympanites due to the cons- triction of the rectum known as intestinal obstruction.
54 THE SUSHRUTA SAMHITA. ' [Chap. VII.
the water-carrying channels of the body. The same result
may be produced by the drinkmg of oil, etc. in inordi-
nate quantities The water, by percolating or transud-
ing through the walls of these channels, as before des-
cribed, inordinately enlarges the abdomen, which be-
comes glossy on the surface and is full of water, being
rounded about the umbilicus and raised like a full-
bloated water-drum. The simile is complete as it
fluctuates under pressure, oscillates, and makes a pecu-
liar sound like a water-drum under percussion. 15.
Distension of the stomach, incapacity of locomotion,
weakness, impaired digestion, cedematous swelling of
the limbs, a general sense of lassitude and looseness in
the limbs, suppression of flatus and stool, and a burning
sensation and thirst are among the general characteris-
tics of the disease in its various forms. 16.
Prognosis : — All cases of Udaram after the lapse of considerable time develop into those of ascites, and a case arriving at such a stage should be given up as incurable. 16 — 17.
Thus ends the seventh Chapter of the Nidana Slhanam in the Sub'ruta Samhita which treats of the Nidanam of Udaram.
CHAPTER Vm.
Now we shall discourse on the Nidanam of
IVlUClhagarbham (false presentations and difficult
labour), i.
