not bear the least touch (Hyperaesthesia) and a sort of pricking, piercing pain (pins and needles) is experienced in those regions. The legs become withered or atrophied and lose all sensibility to touch. In a case of Pitta Rakt am, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Raktam, the legs become swollen and numbed. The swelling assumes a whitish hue and feels cold to the touch, and is accompanied by excessive itching. In the Sannipatika or Tridoshaja form of Dushta-Rakfcam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding types. 41 — 43.
Premonitory Symptoms : —In the incuba- tive stage of the disease the legs perspire and become cold and flabby, or (on the contrary\ the local perspira- tion is stopped and the legs become hot and hard. More- over, a pricking pain is experienced in the affected parts which are marked by complete anaesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in either from the lower extremities, or in some cases, first affects the upper ones and gradually extends all over the body like an enraged rat-poison.
Prognosis : — The form of the disease in which the
skin of the part lying between the instep and the knee-
joint becomes abraded or spontaneously bursts open,
exuding pus and blood, attended with loss of strength
(Prana) and flesh, curvature of the fingers, and eruptions
of nodules, should be regarded as incurable ; while a
case of one year's standing admits only of palliative
measures. 44.
The enraged or agitated Vayu, while coursing swiftly
through the Dhamanis (nerve.s) of the body, shakes it in
quick succession, and a disease, (exhibiting such
10 THE SUSHRUTA SAMHITA. [Chap. I.
symptoms as shaking or convulsive jerks), is originated
which is called Akshepaka* (spasms, convulsions). The
form of the disease, in which the patient falls to the
ground, at intervals, is called ApataLnaka (Epilepsy
without convulsions). The aggravated or agitated Vayu,
charged with an abnormal quantity of Kapham, some-
times affects and stuffs the entire nervous system, and
gives rise to a form of disease, which is called Dandai-
pataiaakaTnt (Epilepsy with convulsions), inasmuch as it
deprives the body of its power of movement and flexibility,
making it stiff and rigid like a rod (Danda). 45 — 46.
The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty ; its characteristic symptom being a paralysis of the jaw- bone, which makes deglutition extremely difficult. The disease in which the enraged Vayu bends the body like a bow is called Dhanushtambha (Tetanus). The disease admiits of being divided into two distinct types accord- ingly as the body of the patient is curved internally (Antaraiyama, lit:— inwardly or forwardly extended, emprosthotonos), or externally (Vahirakyatma, lit : — ex- tended or bent on the back, resting on his heels and occiput — Opisthotonos). When the extremely enraged and powerful bodily Vayu (nerve-force), accumulated in
* The patient suffers from vanishings (idniyale) and loss of con- sciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named — Gayaddsa.
t Jejjada holds that the enraged Vayu, in unison with the deranged Kapham, gives rise to another kind of convulsions (Akshepaka) which he has denominated as Danda-patanakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pittam and Kapham. Several authorities aver that there are four distinct types of Akshepakah, such as Danda-patanakh, Anlarayamah, Vahirayamah, and Akshepakh of traumatic (Abhighataja) origin.
Chap. I.] NIDANA STHANAM. II
the regions of the fingers, Insteps, abdomen, chest, heart and throat, forcibly draws in the local ligaments (Snayu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarayatma Dhanushtambha. The movements of the eyes become impossible, which become fixed in their sockets ; the jaw-bones become paralysed, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapham). These are the features which mark the first type (Antarayama Dhanushtambha). On the contrary, when the same enraged Vayu, centred or lodged In ligaments which traverse the posterior side of the body, attracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease Is called Vahiratyatma, and should be looked upon as beyond the pale of all medicinal treatment. 47 — 50.
Four types of Akshepaka are usually- recognised
in practice such as, the (i) one incidental to the
concerted action of the enraged bodily Vayu and
Kapham (2), the one brought about through the union
of the enraged Vayu with the deranged Pittam, (3),
the one due to the single action of the agitated Vayu
(4) and the one due to any external injuiy or blow
(Abhighataja).* An attack of Apatdnkah due to excessive
haemorrhage, or following closely upon an abortion or
miscarriage at pregnancy (difficult labour), or which is
Incidental to an external blow or injury (traumatic),
should be regarded as Incurable. 51 — 52.
* Brahma Deva designated the four types of the disease, as Apatanakah, Samsrishta Akshepakah, simple Akshepakah and the Abhighataja (traumatic).
il;2 THE SUSHRUTA SAMHITA. [Chap. I.
The disease, in which the extremely agitated Vayu affects the nerve chains (Dhamanis) which spread either in the left or in the right side of the body, whether in the upward, downward, or lateral direction, making them lax and vigourless, and in which the joints of the other side of the body become useless and inoperative, is called Pakshfiighstta (Hemiplegia) by eminent physicians. The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility, but who retains his consciousness so long as there remains the least vestige of vitality in the affected part, suddenly falls down and expires. 53 — 54.
ProgTIOSis:— -A case of Pakshaghata (Hemi-
plegia), brought about through the single action of the
enraged or agitated Vayu of the body, can be cured
only with the greatest care and difficulty. A case of
the same disease, engendered by the aggravated Vayu
in conjunction with the deranged Pittam or Kapham,
proves amenable to medicine (Sadhya). It becomes in-
curable when caused through the waste of the root prin-
ciples (Dhatu) of the body. 55.
Apatantrakah (Convulsions) :— The Vayu, aggravated (by its specifically exciting factors and principles) and dislodged from its natural seat or recep- tacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples. It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.
Symptoms :— The patient lies with his eyes
closely shut, or stares with a sort of fixed or vacant
gaze, the eyes remaining fixed or immovable. The
patient loses all perception, and groans. Respiration
becomes difficult, or symptoms of temporary asphyxia
Chap. I.] NIDANA STHANAM. 1 3
and unconsciousness set In. Consciousness and a normal
condition of the organism return with the passage
of the enraged Vayu from the heart, while on the
other hand the patient relapses into unconsciousness
simultaneously with the envelopment of the heart with
that enraged and Kapha-e^aturated Vayu. This disease
is called Apatantrakah and is ascribed to the action
of the enraged Vayu surcharged with the deranged
Kapham. 56.
IVIanyastambha:— The local Vayu, agitated
through such causes as sleep in the day time, reclining
with the neck on an uneven place or pillow, gazing
upward for a considerable length of time, or looking
aside in a contorted way, and enveloped in the deranged
Kapham, gives rise to the disease known as Manya-
stambha (wry neck or torticollis). 57.
Arditam (Facial Paralysis) :~*P regnant women,
mothers immediately after parturition (Sutika), infants,
old and enfeebled persons are most prone to fall victims
to this disease*. It has been also known to result from
excessive haemorrhage or loss of blood. The local Vayu,
extremely enraged or aggravated by continuous talking
in an extremely loud voice, chewing of hard substances,
loud laughter, yawning, carrying extremely heavy loads,
and lying down in an uneven position on the ground,
finds lodgment in the regions of the head, nose, upper lip,
chin, forehead and the joints (inner cornea) of the eye,
and produces the disease called Arditam by distorting
the face.
Symptoms : —The neck and half of the face
longitudinally suffer distortion and are bent. The head
shakes ; the power of articulating speech is lost, and th^.
* The portion of the text included within asterisks has been reject by Jejjadacharyya as spurious.
14 THE SUSHRUTA SAMHITA. [Chap. I.
eyes are distorted Into a variety of shapes. The portions
of the neck and the chin, as well as the teeth on the
affected side become painful.
Premonitory Symptoms :— The disease
generally commences with shivering, horripilation, cloudiness of vision, upcoursing of the bodily Vayu and anaesthesia, a pricking pain in the affected locality, numbness or paralysis of the jaw-bone, or of the cervical muscles of the neck. Physicians, conversant with the Etiology of diseases, call it Arditam (Facial paralysis). Prognosis :— A case of Arditam, appearing in an ex- tremely enfeebled or emaciated patient, or exhibiting such symptoms as a winkless vision, inarticulate speech which hardly seems to come out of the throat, excessive palsy of the face, as well as the one of more than three years' standing, should be deemed as incurable. 58.
Gridhras'i (Sciatica): — The disease in which the
two great nerve-trunks (Kandara), which emanating from
below the lower extremity of the thigh reach down to
the bottom of the insteps and toes, and become stuffed or
pressed with the enraged Vayu, thus depriving the lower
extremities of their power of locomotion, is called
Gridhras'i. 59.
ViS'vachi (Erbe's paralysis or Bracial neuralgia):—
The disease in which the enraged Vayu affecting the
nerve-trunks (Kandara) which run to the tips of fingers
behind the roots of the upper arms, making them
[capable of movement and depriving them of their
)wer of flexion or expansion is called Vis'vachi* 60.
KrOShtukaS'irsha (Synovitis of the knee- Ints) : — An extrimely painful swelling in the knee- When the aforesaid nerve of a sirgle arm is afTecld the disease is :ted to it alone, while it attacks the both when both their nerves are
Chap. I.] NIDANA STHANAM. 1$
joints, which is originated through the concerted action
of the deranged Vayu and the vitiated blood is called
Kroshtukas'irsha from the fact of its resembling the
head of a jackal (Kroshtuka) in shape. 6i,
Khan ja (Lameness): — The disease proceeds from
the drawing up of the nerve trunks (Kandara) of a leg
by the deranged Vayu lying about the region of the
waist. When both the legs are similarly affected, the
patient is called a Pangu. He, whose legs tremble before
starting for a walk and who afterwards manages to go
on limping is called a Kalaya Khanja one in whom the
bone-joints become loose. 62 — 6^.
Vata Kantaka : -The local Vdyu, enraged by
making a false step on an uneven ground, finds lodg-
ment in the region of the ankle (Khudaka, instep
according to others), thus giving rise to a disease
which is called Vata Kantaka. The burning sensation
in the soles of the feet caused by the enraged local
Vayu, in conjunction with the deranged Pittam and
blood, is called Pada-daha, which is generally seen to
afflict persons of pedestrian habits. When the legs are
deprived of all sensibility of touch, and a sort of tingling
pain is experienced in them it is termed Padaharsha,
which is due to the deranged action of the Vayu and
Kapham. The disease in which the enraged local Vayu
dries up the normal Kapham lying about the shoulder-
joints is called Ansa-s'hoshaka. The form in which the
aggravated local Viiyu contracts the nerves of the arms
is called Avavahuka*. 64—67.
Vad hiry ay am (deafness) :— The disease occurs only when the deranged Vayu, either singly or sur-
* The Ansa-shosha is due to the single action of the enraged Vayu, while Ava-vahuka is due to the concerted action of the deranged Vayu and Kapharo,
1 6 THE SUSHRUTA SAMHITA. [Chap. L
charged with the Kapham, stuffs the sound-carrymg channels (Srota) of the ears. 68.
Kama S'ulam:— The disease in which the
deranged Vayu causing a piercing pain in the regions of
the cheekbones, head, temples and neck, gives rise to a
sort of aching pain in the tympanum, is called Karna-
s'ulam (otitis). The local Vayu, deranged and saturated
with the Kapham stuffing the nerves (Dhamani) which
conduct of the sound of speech, produces complete (in
some cases partial) loss of the power of speech — eg.
Muka (dumbness , Minmina (nasal voice) and Gad-gada
(indistinct speech). 69 — 70
A sort of pain, which (rising from the bowels or the
urinary bladder and ranging downward) gives rise to
a bursting sensation in the regions of the anus and the
genitals, is called Tuni, whereas the one, rising upward
from the preceding parts and extending up to the region
of the intestines, is called Prati-tuni. A distension
of the abdomen (Udara), attended with the incarceration
of flatus (Vayu) and an intense pain and rumbling in its
inside, is called Adhmsinam (Tympanites). When it first
affects the stomach fAmasaya) and is unattended with an
oppressive feeling about the heart and pain at the sides'
it is called Praty^dhmaiinam. The Vayu saturated with
the deranged Kapham causes the preceding type of
distemper. 71—74.
