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

Types :~The V^fcaja SiEUS is rough and short- mouthed, characterised by an aching pain (in its inside). It exudes a sort of frothy secretion which becomes greater at night and is attended with an aching pain. Thirst, lassitude, heat and a piercing pain jn the affected locality) are the usual accompaniments of the Pittaja types. Fever is present from the beginning and the Sinus exudes a large quantity of hot and yellow coloured secretion which is more by day than by night. The Kaphaja Sinus becomes hard and is characterised by 'itching and a slight pain (numbed ?). It is found to secrete a copious quantity of thick, shiny, white-coloured pus which becomes greater at night. 11-13.

Dvandaja and Tridoshaja Types :—

A case of Nddi-Vrana involving the concerted action •of any two of the deranged Doshas (Vayu, Pittam

and Kapham) and exhibiting symptoms peculiar to • both, is called a Dvandaja* one. There are three

* Gayadasa does not read the symptoms of Dvi-doshaja (?.<;., due to two morbific principles) types of sinus a g ven in the text which he has rejected as spurious

70 THE SUSHRUTA SAMHITA^ [Chap. X.

types of this class of disease, (such as the Vata-pittaja,
Vhta-kaphaja and Pitta-kaphaja) A case of Na'di-
vrana, exhibiting symptoms of the three aforesaid types,
and attended with fever and a burning sensation, diffi-
cult breathing, dryness of the mouth and syncope, is
called Tridoshaja. An attack of this type should
be regarded as dreadful and fatal, casting around the
gloom of death. I4-I5-

The ^alyaja Nadi-Vrana :— A foreign

matter (such as dirt, bone, splinter etc.), lodged within the body and invisible to the eye, tends to burst open the skin, etc. of the locality along its channel of inser- tion and gives rise to a type of Sinus. It is character- ised by a constant pain, and suddenly and rapidly exudes a sort of hot, blood-tinged, agitated, frothy secre- tion. This type is called Salyaja. i6.

ThcStana-Roga: — These may be divided into
as many types as the aforesaid Nadi-Vrana and are
caused by the same exciting factors as the last named
malady. The milk-carrying ducts remain closed in the
breast of a nullipera thus barring the possibility of the
descent of the Doshas through them and of an attack
of any disease at that part of the body. On the
contrary, such ducts in the breast of a piimipara open
and expand of their own accord, thus making the
advent of diseases possible that are peculiar to the
mamma. I7-I9-

The breast-milk : -The sweet essence of the
Rasa (lymph chyle) drawn from the digested food
courses through the whole body and is ultimately con-
centrated in the breast of a mother or a woman (big
with child) which is called milk. 2o.

Its character :— The breast-milk, like semen, lies hidden and invisible in the organism, though

Chap. X ] NIDANA STHANAM. /r

permeating it in a subtle or essential form. The charac- teristic features of the breast-milk bear analogy to those of semen The breast milk is secreted, and flows out at the touch, sight or thought of the child in the same manner as the semen is dislodged and emitted at the sight, touch or recollection etc. of a beloved woman. As the strong and unclouded affections of a man are the cause of the emission of semen, so the fondest love of a mother for her children brings about the secre- tion of her breast-milk Both semen and breast-milk are the product of the essence of digested food, this essence being converted into milk in women. 21 — 22.

Its abnormal and normal Traits: —

The milk of a mother vitiated by the deranged Vayu
of her system has an astringent taste and floats on
water The milk of a mother vitiated by the deranged
Pittam has an acid and pungent taste and becomes
marked with a yellow hue,* if left to float on water. The
milk of a mother vitiated by the deranged Kapham
is thick and slimy and sinks in water. The milk of a
mother vitiated by the concerted and simultaneous
derangement of the three Doshas of the body is marked
by the combination of all the preceding symptoms. An
external blow or hurt too (Abhighata) sometimes pro-
duces vitiation of the mother's milk. 23.

The milk (of a mother), which instantly mixes with water, tastes sweet and retains its natural greyish tint,

should be regarded as pure. 24.

The bodily Do.shas having recourse to the breasts of

a woman whether filled with milk or not and vitiatinsf

the local flesh and blood give rise to mammary diseases,

* The particle 'Cha" in the text indicates that the colour may turn blue or pink in some cases.

72 THE SUSHRUTA SAMHITA. [Chap. X.

(Stana-roga). All the types of abscess (Vidradhi)
excepting the one called the Raktaja out of the six
types desciibed before are found to attack the mammae^
and their symptoms should be understood as identical
with those of external abscesses. 25.

Thus ends the tenth Chapter of the Nidaram Sthdnam in the Su&'ruta Samhit^ w ich treats of the oetiolcgy and symptoms of Erysipelas, vSinus and mammary abscesses.

Chapter Xl

Now we shall discourse on the Nid^nam of Granthi
(Glands etc.), Apachi (Scrofula etc.), Arvudi (Tumours)
and Gralagand a (Goitre), i.

The deranged and unusually aggravated Vayu etc.
(Pittam and Kapham), by vitiating the flesh, blood and
fat mixed with the Kapham (of any part of the or-
ganism), give rise to the formation of round, knotty,
elevated swellings which are called Granthi (Glandular
inflammation). 2.

The Dosha-Origined Types :— The swell-
ing (Sopha) of the Vaitatja type seems as if it were
drawn into and elevated or as if severed or pricked
with a needle, cleft in two or drawn asunder or as if
cut in two or pierced. The knotty growth assumes a
black colour, and is rough and elongated like a bladder.
On bursting a granthi of this type exudes clear bright
red blood. The Fittaja Granthi is characterised by
heat and an excessive burning sensation (in its inside).
A pain, like that of being boiled by an alkali or by
fire, is felt in the inside. The knotty formation assumes
a red or yellowish colour and exudes a flow of extremely
hot blood on bursting. The Kaphaja Granthi is slightly
discoloured and cold to the touch. It is characterised
by a slight pain and excessive itching, and feels hard
and compact as a stone. It is slow or tardy in its
growth and exudes a secretion of thick white-coloured
pus when it bursts. 3-5.

The Medaja Type :— The fat origined Gran-
thi is large and glossy and gains or loses in size with
the gain or loss of flesh by the patient. It is marked

74 THE SUSHRUTA SAMHItA. [Chap. Xt.

by a little pain and an excessive itching sensation and
exudes a secretion of fat resembling clarified butter or
a gruel, in colour and consistency, made of the levigated
paste of sesamum on bursting. 6.

Si ra-Granthi— (aneurism or varicose veins) : — The bodily Vayu in weak and enfeebled persons, de- ranged by over-fatiguing physical exercises, straining or exertion or by pressure, presses on, contracts, dries or draws up the ramifications of veins (Sira) or arteries (of the affected locality), and speedily gives rise to a raised knotty formation which is called a Sira-Granthi, In the event of its being shifting and slightly painful, it can be cured only with the greatest difficulty. Whereas a case in which the knotty formation is pain- less, fixed, large and situated at any of the vital parts of the body (Marmas), should be deemed incurable.* 7.

Apachi — (Scrofula etc.) : — The augmented and accumulated fat and Kapham give rise to string of hard glossy, painless, nodular, or elongated granthi (swellings) about the joints of the jawbones, at the waist, joint, about the tendons of the neck, about the throat or about the region of the arm-pits. These glands (Granthis) re- sembling the stones of the Amalaka fruit or the spawn of fish in shape or like some other shape, are of the same colour as the surrounding skin ; and a string or a large crop of such glandular knots, gradually growing is called Apachi-f- on account of the extensive nature of their growth. 8-9.

* In several editions an additional line is to be found running as men well conversant with symptoms (of Gtanthis) recognise a type of Granthi due to the action of the deranged flesh and blood, which exhibits symp- toms identical with those of a tumour {Mansjtasrayam chdrvuda laskhanena tulyam hi drish/awaih lakshanajunih). But Jejjata has rejected it as of questionable authority.

t These glandular formations appear about the root of the penis, about the sides, in the arm-pits and about the throat and the tendons of the neck.

Chap. XI.] NIDANA STHANAM. 75

These knotty formations are characterised by itching
and a slight pain. Some of them spontaneously burst
exuding secretions while others are observed to vanish
and re-appear (in succession). Such vanishings, re-
appearances, or fresh formations continue for a consider-
able time. The disease undoubtedly owes its origin to
the deranged fat and Kapham, and may only be made
amenable (to medicine) with the greatest difficulty
lasting for years at a time. lO.

ArVUda— (tumour etc.) : — The large vegetation
of flesh which appears at any part of the body, becomes
slightly painful, rounded, immovable and deep-seated,
and has its root sunk considerably deep in the affected
part, and which is due to the vitiation of the flesh
and blood by the deranged and aggravated Doshas
(Vayu, Pittam and Kapham) is called an Arvuda
(tumour) by the learned physicians*. The growth of
an Arvuda is often found to be slow, and it seldom
suppurates. The characteristic symptoms of an Arvuda
which owes its origin to the deranged condition of the
Vayu, Pittam, Kapham, flesh or fat, are respectively
identical with those, which mark the cases of Granthis,
brought about by the same deranged principles of the
body. II.

Raktaja— Arvuda :— The deranged Doshas (Vayu, Pittam and Kaphami) contracting, compressing

They resemble spawns of fish in shape and size and are due (o the action of the deranged Vayu, Pitiam and Kapham. The appearance ol such glands in the upper part of the body should be attributed to the aciicn of the deranged and aggravated Vayu. They are ixtremdy hard to cure inasmuch as their growth (formation) involves the concerted action of the morbific principles (Doshas) of the body. — Bhoja.

Charaka, who designates this disease as Gandatncild, describes its location in regions about the jawbones alone.

* That they having recourse lo the flesh, produce deep-seated vegetations (of flesh) is the reading adopted by Gayadasa and ot>iers.

76 THE SUSHRUTA SAM HIT A. [Chap. XI.

and drawing the vessels (Sira) and blood (of the affec-
ted partj, raise a slightly suppurated and exuding
tumour which is covered with small warts and fleshy
tubercles and is called a Raiktatrvuda. This tumour is
rapid in its growth and exudes a constant flow of
(vitiated) blood. The complexion of the patient owing
to depletive actions and other concomitant evils of
haemorrhage becomes pale and yellow. The type
should be considered incurable on account of its having
its origin in the blood.* 12 — 13.

IVIansarvuda :— The flesh of any part of the
body hurt by an external blow etc. (hurting it with a
log of wood — D.R.) and vitiated in consequence, gives
rise to a sort of swelling (tumour) which is called
Mdnsarvuda, which originates through the action of
the deranged Vdyu. It is glossy, painless, non-sup-
purating, hard as a stone, immobile, and of the same
colour as the surrounding skin. Such a tumour
appearing in a person addicted to meat diet becomes
deep seated owing to the consequent vitiation of the
bodily flesh and soon lapses into one of an incurable
type. 14.

ProgTIOSIS :— Even of the aforesaid curable
types (such as the Vataja, etc.^, the following types of
Arvudam (tumours) should be likewise regarded as incur-
able, those which appear in the cavity of a Srota chan-
nel or an artery , or any vulnerable joint of the body and
arc characterised by any sort of secretion and also im-
movable, should be deemed incurable. An Arvudam
(tumour) cropping up on one existing from before is

* Although all types of Arvuda have their origin in the deranged flesh and blood, i)reponderant action of the deranged blood is found in Raktd- arvuda^ while a dominant action of the deranged flesh marks the MAmArvuda type.

Chap. XI. NIDANA STIIANAM. TJ

called Adhyarvudam, which should be likewise deemed
as incurable. A couple of contiguous Arvudam (tumours)
cropping up simultaneously or one after another is called
Dviarvudam, which should be held as equally incurable
(with one of the foregoing types). An Arvuda (tumour)
of whatsoever type, never suppurates owing to the
exuberance of the deranged Kapham and fat as well
as in consequence of the immobility, condensation and
compactness of the deranged Doshas (Vayu, Pittam and
Kapham involved in the case, or out of a specific trait
of its own nature. 15-16.