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

A knotty stone-like tumour (Granthi) of consider- able density, whether fixed or mobile, and appearing below the umbilicus, and having an elevated shape which is always found to be extended in an upward direction, is called a VatabSthilSb, (which) as its name implies, is due to the action of the local deranged Vayu. The tumour, thus formed, obstructs the emission of flatus and impedes the evacuation of faeces. A tumour of similar shape,

Chap. I.] NIDANA STilANAM. I^

appearing laterally or across the region of the abdomen
(Jathara) and obstructing the passage of stool, urine
and flatus (Vata) is called a Pratyashthila'. 75 — ^6.

Thus ends the first Chapter of the Nidana Sthanam in the Subhruta Samhita, which treats of the Nidanam of the diseases of the nervous system.

CHAPTEE 11.

Now we shall discourse on the Nidanam of Ars'aS (Haemorrhoids}, i.

Haemorrhoids may be divided into six classes viz : —
(i) Vdtaja (due to the action of the deranged Vayu\
(ii) Pittaja (due to the action of deranged Pittam), (iii)
Kaphaja (due to the action of deranged Kapham), (iv)
Raktaja (due to the action of the vitiated blood), (v)
Samiipdtaja (due to the concerted action of the deranged
Vayu, Pittam and Kapham i and (vi) Sahaja (congenital).

PathoIOg^y : —The deranged Vayu, Pittam, etc. enraged by their specific aggravating causes, or by such acts or conduct as partaking of food composed of in- compatible substances, eating before the previous meal has been digested, inordinate sexual intercourse, sitting on the haunches, excessive riding, and the voluntary suppres- sion of any natural urging of the body, either severally or in combination of two or three Doshas, or vitiating the blood of a person, who observes no moderation in food and drink &c., become dislodged from their natural seats in the body [according to the law of Prasaranam (expansion and change of place by a deranged organic principle)] and are carried down through the large intestine (Pradhana Dhamani) into the descending colon and getting lodged therein, give rise to growths of polypi or fleshy condylomata, which are known as piles. These growths chiefly appear in persons suffering from impaired digestion (Agni), and gain in size through friction with the wearing apparel, weeds, wood, lumps of clay or stone, or by contact with cold water. 3.

The lower end of the large intestine, which passes into the flexure of the rectum and measures four and

Chap. II J NIDANA STHANAM. I9

a half fingers in length, is called the Gudam (lit —
the channel of fecal matter), the interior of which is
provided with three spiral grooves. Each of these grooves
or ring-like muscles lie a finger and a half apart, and
are respectively known as Pravdhini, Visarjani and
Samvarani, or the grooves of out-flow, defecation and
closure of the anus (sphincter ani), covering a space of
four fingers and having laterally an elevation of one
finger's width. 4.

Metrical Texts :— These grooves are like the involuted indentures of a conch shell, situated one above the other, coloured like the palate of an elephant. A part of the channel, half a finger's width in length as it is usually measured from the outer hairy orifice of the rectum, is called the anus (Gudoushtha). 5 — 6.

The first of the aforesaid grooves or rings lies about a finger's width apart from the orifice of the anus.

Premonitory Symptoms :~A non-relish

for food, a tardy and difficult digestion of food (brought into the stomach), acid eructations, a sense of weakness in the thighs, a rumbling sound in the intestines, emacia- tion of the body, frequent eructations, swellings around the eyes, a croaking sound in the intestines, cutting pain in the rectum (Guda), apparent indications of an attack of phthisis, jaundice, dysentery, cough, dyspnoea, vertigo, somnolence, excessive sleep, weakness of the organs (Indriya), are indications which predict the advent of this disease, and which become more marked with its progress. 7.

The Vataja Type :— Piles, due to the action
of the aggravated Vayu, arc non-exuding, rose-coloured,
and uneven in their surface. They resemble the Kadamba
flowers in structure and are either tubular or sharp-
pointed like a needle, sometimes assumino- the shape of

20 THE SUSHRUTA SAMHITA. [Chap. II.

the wild Tundikeri flower. The stool of a hsemorrhold
patient of this type becomes excessively hard, and can
be evacuated only in a sitting posture, with the greatest
pain and difficulty. An excruciating pain is experi-
enced in the regions of the waist, back, sides,
anus, umbilicus and the genitals. Symptoms peculiar
to Gulma, Ashthila, enlarged spleen and abdominal
dropsy add to the distress of the patient, whose skin,
nails, eyes, teeth, face, urine and stool also assume a
dark black colour. 8.

The Pittaja Type :— Piles, brought on through the action of the deranged Pittam, are slender, blue-topped, shifting in their nature, yellowish in their hue, or are coloured like shreds of liver, resembling in shape the tongue of the Suka bird. They are thick at middle, like barley grains, or resemble the mouth of leeches and secrete a sort of slimy exudation. The stool is marked with blood, and the patient complains of a painful, burning sensation (in the rectum) at the time of defecation. Fever, with a burning sensation and thirst, and epileptic fits, supervene. The skin, nails, eyes, face, teeth, stool, and urine of the patient assume • a yellow hue. 9.

The Kaphaja Type :— Piles, due to the action of the deranged Kapham, become white, are sunk about their roots, and are hard, round and glossy. They assume a greyish hue and resemble the teats of a cow or the stones of the Karira, or of a Panasa fruit. These piles do not burst, nor do they exude any sort of secretion. The patient feels an irresistible tendency to scratch the excrescences. The stools become copious in quantity and are charged with mucous (Sleshm^), resembling the washings of meat. Indigestion, fever with shivering (Sita-jvara), and heaviness of the head and oedema

Chap. II.] NIDANA STHANAM. 21

with a non-relish for food are the symptoms which be-
come manifest with the progress of the disease. The
skin, finger nails, eyes, teeth, face, sLool and urine of the
patient also assume a white colour. lO.

The Raktaja Type :- Piles (haemorrhoids),
having their origin in the vitiated condition of the blood
resemble the sprouts of the Vata tree in shape and are
of the colour of red coral, or the seeds (dark red)
of Gunja berry. They exhibit all the symptoms,
which are peculiar to the Pittaja type of this disease.
Pressed hard by the constricted fi-eces in their
passage through the anus, they suddenly give rise to a
hcxmorrhage of vitiated (venous) blood, and symptoms
characteristic of excessive bleeding are found to
supervene, il.

The Sannipata Type :- in a case of

haemorrhoids due to the concerted action of the
deranged Vayu, Pittam and Kapham, symptoms
characteristic of each of these types manifest themselves
in unison. 12.

The Congenital Type :— Congenital hemor- rhoids (Sahaja Arsas) are usually ascribed to defects in the semen and ovum of one's parents and should be medicinally treated with an eye to the special deranged Doshas involved in the case. The polypi (in this type) are hardly visible and are rough and yellowish, with their faces turned inward. They are extremely painful. A person suffering from this type of piles gets thinner and thinner every day and eats but very little. Large veins (Sird) appear on the surface of the body. The patient becomes irritable, the semen decreases in quantity, making the procreation of a small number of children possible only by him. The voice becomes feeble, the digestion is impaired, and disorders affecting the head

22 THE SUSIIRUTA SAMHITA. [ Chap. II.

nose, ears and eyes follow. A croaking sound is
heard in the intestines, attended with a rumbling in the
abdomen. All relish for food vanishes and the region
of the heart seems to be smeared with a kind of sticky
paste (of mucous), etc. 13.

Auhoritativc verse on the subject :—

A qualified physician should undertake the medical treat-
ment of haemorrhoids which occur cither about the
outer or the middle groove of the rectum, (in as much as
they prove amenable to medicine). A polypus, appear-
ing about the innermost ring or groove of the rectum,
should be treated without holding out any definite hope
of cure to the patient. 14.

Ling'ars'aS (Fig warts or condylomatous growths about the genitals): — The deranged and aggravated Vayu etc., finding lodgment in the genitals, vitiate the local iiesh and blood, giving rise to an itching sensa- tion in the affected localities. The parts become ulcerat- ed (through constant scratching) and the ulcers become studded with sprout-like vegetations offlesh(warts),which exude a kind of slimy, bloody discharge. These growths, or excrescences generally appear on the inner margin, or on the surface of the glans penis, in the form of soft, slender vegetations of skin, resembling the hairs of a small brush (Kurchaka). These vegetations ultimately tend to destroy the penis and the reproductive faculty of the patient.

Bhagars'aS :— The deranged Vayu etc. of the
body, lodged in the vaginal region of a woman, gives rise
to similar crops of soft polypi in the passage. They
may crop up isolated at the outset, and (by coalescing)
may assume the shape of a mushroom, or an umbrella,
secreting a flow of slimy, foul-smelling blood.

The deranged Vayu, etc. may further take an

Cbap. II.] MDANA STHANAM. ^3

upward course, and finding a lodgment In the ears, nose, mouth and eyes may produce similar warts in those localities. Warts, which crop up inside the cavities of the ears, may bring on earache, dumbness, and afoul dis- charge from those organs, while those (cysts) cropping up in the eyes will obstruct the movement of the eye-lids, giving rise to pain and a local secretion and ultimately destroy the eye-sight. Similarly, such growths in the nostrils produce catarrh, excessive sneezing, shortness of breath, headache, nasal speech and the complaint known as Futinasya. Such vegetations cropping up in and about the lips, palate or the larynx, tend to make the speech confused and indistinct. When appearing in the mouth, they impair the faculty of taste, and diseases which affect the cavity of the n^outh follow. The ex- cited Vyana Vayu, united with the aggravated Kapham, produces a kind of hard papillomatous growths on the skin (about the anus) which are called the Charmakilas (papillomata).* 15.

Authoritative verses on the subject :

— These Charmakilas may be attended with a kind of
pricking pain through an excess of the deranged Vdyu,
whereas those which have their origin in the deranged
Kapham (lymphatics) assume a knotty shape and be-
come of the same colour as the surrounding skin. On
the other hand, they become dry, black or white, and
extremely hard through an exuberance of the deranged
local blood and Fittam. 16.

The symptoms of polypi, appearing in the neighbour-
hood of the anus, have been described in full, while the
general characteristics of those, which are found to
crop up around the genitals, have been briefly discoursed

* According to others, Charmakilas may crop up on the skin of any part of the b dy.

^4 THE SUSMRUTA SAMHITA. [Chap. II.

upon. An intelligent physician should ponder over
the two groups of symptoms while engaged in treating
a case of piles. A case of piles exhibiting symptoms
peculiar to the two deranged Doshas is called the
Samsargajam. Six distinct types of bio-Doshaja piles
arc known in practice.* 17.

Prognosis :— A case of piles due to the con-
certed action of the three deranged Doshas of the body,
(with its characteristic symptoms) but partially develop-
ed, may be temporarily checked (Yapya). Cases, which
are of more than a year's standing, as well as those in
which the hciemorrhoids are due to the concerted action
of the two Doshas (Samsargaja), or are situated in the
middle groove of the rectum, may be cured but with
the greatest difficulty. Cases of the Sannipatika or
congenital (Sahaja) types . should be given up as
incurable. The Apana Vayu, in a person whose rectum
is overrun with such polypus growths, tries to pass out
through the anus, but is driven back upward, being
obstructed in its passage by the vegetations, and then
mixes with his Vyana Vayu, thus imparing (the five-
functioned) fire (Pittam) in his body. 18-19.

* Such as (i) the one due to the concerted action of the deranged Pittam and Kapham, (2) the one incidental to the simultaneous derange- ment of the Vayu and the Kapham, (3) the one brought about through the disordered condition of the Vayu and blood, (4) the one due to the combination of the deranged Pittam and Kapham, (5) the one produced by the concerted action of the deranged Pittam and blood, (6) the one which results from the combined action of the deranged Kapham and blood.

Thus ends the second Chapter of the Nidanasth^nam in the Sus'ruta Samhita which deals with the Nidanam of piles.