156 - Diseases 

Dhanvantari said: 

1-3. O Sushruta, I shall explain the pathology of Arshas (Piles) ailments. Among the condylomatous (pinlike) growths in the flesh those that obstruct the anus are called Arshas. The deranged humour defiling the skin, flesh and the fat makes many shoots of flesh of diverse shapes in the region of the rectum. They are called Arshas (Piles). In brief, they are of two types sahaja (congenital) and Anantarottha (postnatal). 

4. The passage of the rectum is five and a half Angulas long. There, dry stone-like lumps three and a half angulas long grow. 

5-6. Blood vessels passing through the entrails come to these lumps and split open. Hence, within an angula from without, bleeding occurs in the region of these condylomatous growths. Hair about one and a half angulas in length grow beyond them. In the congenital type of piles, the cause is the discomfort of the child in the womb. 

7. The creation of the seeds of piles is due to the misdeeds of the parents. Curse of gods also may be the cause. In the piles due to the combined action of the doshas it is the food taken in that creates the seeds. 

8. All ailments congenital in nature are incurable. The piles of congenital type are rough, ugly looking, pointing inward and pale, yellow in colour. The disorders brought about by them are dreadful. 

9. Piles are of six types when caused by doshas after the birth. The three different doshas severally or their combinations in twos make up the six varieties. The dry piles are due to Vayu and Kapha and the wet ones due to Pitta. 

10. When more and more faces accumulate in the gastric fire that reduces the food taken before into faeces, if the person indulges in excessive sexual intercourse the doshas become aggravated. 

11-14. The Apana Vayu (genito-urinary illiac nerve force) becomes aggravated due to various such causes as: drinking in a fitful state, taking in hard indigestible foodstuffs, frequent rubbing of the belly, eyes and throat with the palms, contact with very chill water, continuous riding for a long time, suppression of natural urges and evacuating them with difficulty, dysentery, constipation, pulling things and in woman miscarriage and painful labour. 

15-16. When the Apana becomes excited the faeces get obstructed in the flexus of the rectum and condylomatous growths occur on their knotty joints. Its indications are low gastric function, obstruction to the removal of ordure, pain in the bones and calves of the legs, vertigo, burning sensation in the eyes, intumascence and either loose motions or constipation. 

17. Obstructed from the front, the wind moves about below the umbilicus and when the patient breathes with difficulty it comes out with blood. 

18. A rumbling sound in the entrails, eructation, profuse belching of saline stuff, excessive urination, scanty faeces, non-inclination to take food, vertigo, sour taste in the mouth. 

19. Pain in the head, back and chest, lassitude, yearning for sensuous pleasures, anger due to frustration or neglect of service by others are also observed. 

20. Sometimes the symptoms give rise to the suspicion of other ailments such as diarrhoea, wasting disease, jaundice, enlargement of the spleen and dropsy. All these diseases increase when piles begin to grow. 

21. When the Apana returns, it is obstructed by these growths and so it aggravates other vital airs moving among the sense organs and parts of the whole body. 

22. Then it produces a parched condition in the seats of Pitta, Kapha, urine and faeces and obstructs The gastric fire. Then usually all the piles grow. 

23. The patient becomes lean, his enthusiasm and jolly spirit vanishes; he becomes dejected, emaciated, pallid in face, and appears like a worm-eaten tree, sapless and devoid of shade. 

24-25. All the disorders mentioned in Yakshma (Pulmonary consumption) distress him. They give rise to acute pain in the vulnerable joints, Cough, excessive thirst, dryness in the mouth, dyspnea, chatarrh, lassitude, aching pain in the limbs, nausea, sneezing, intumescence, fever, debility, deafness, rigidity and the disease gravel-all these torment him. 

26. Completely emaciated, with voice broken, he sinks into a trance and frequently spits. He does not show any inclination to take food. He has pain in all joints, bones, chest, navel, anus and the thigh joints. A kind of bilious matter begins to ooze out of the anus. It resembles water with which meat has been washed.

27. Some of these piles are dry but others are found to suppurate and burst; they are caused by Pitta and are of the colour of turmeric. 

28. These piles generated by aggravated Vayu are dry and rough. They are faded, reddish or brownish in colour and uneven. 

29. They are of unequal sizes and shapes, curved, sharp-pointed with their external ends cracked and severed. They resemble the fruits of Bimba Kharjura¹, Karkandhu² and Karpasaa³ seed.

1. Phoenix dactylifer or p. acaulis (Refer GVDB p. 131).

2. Zizyphus nummularia.

3. Glossypium barbadens.

30. Some of them resemble Kadamba flowers, and some those of the white mustard. Acute pain in the head, sides, shoulders, calves, thighs, thigh joints, etc. is felt. 

31. Sneezing, eructation, obstruction to the removal of ordure, catching pain in the heart and non-relish for food, cough, dryspnea, impaired function of the digestive system, ringing noise in the ears and vertigo are further symptoms. 

32. A patient distressed with these disorders passes stools with great difficulty. It is scanty. A loud sound is produced while evacuating the slimy frothy stuff. 

33. The skin, nail, faeces, urine, eyes and face are black in colour. Chronic enlargement of the spleen, drooping and globular tumours (Ashthila) occur.

34. The condylomatous growths of piles due to the derangement of Pitta are bluish in colour at the opening and red, yellow and black otherwise. They exude bloody, watery stuff through their small tips. They smell like raw meat. They are soft to the touch and hang loosely. 

35. Some of them resemble the tongue of a parrot, split liver or the mouth of a leech. Burning sensation, fever and perspiration, thirst, epileptic fits, non-relish for food and loss of sense are the symptoms at the time of suppuration. 

36. The faeces are hot, liquid in form, bluish, reddish and yellow in colour and undigested. The piles are thick in the middle like barley grain. The skin, nail etc are green or yellow in colour. 

37. If Kapha be the cause the piles are deep rooted, thick, less painful, white in colour, of decaying appearance, glossy, globular in shape and unyielding. 

38. Lubricious, rigid, smooth and mild they produce an itching sensation and the patient finds it pleasant to handle them and scratch them. Some of them are like the bamboo shoots or the seed of the jack fruit or the teat of a cow. 

39. There is catching pain at the thigh joints, rectum, bladder and navel. Dyspnea, cough, disquietude in the cardiac region, salivatiou non-relish of food and chatarrh are the symptoms. 

40. Strangury (difficulty in passing urine), sluggishness of head, shivering chilliness are experienced, Impotency, impaired gastric function, vomiting and all the disorders in undigested state are also found in the patient. 

41. The faeces come out in profusion. They have the colour of suet. They contain mucous kapha matter. The piles do not crack nor do they bleed. Skin, etc., have grey colour and are glossy, 

42. In the piles caused by the combined action of all doshas all the symptoms can be observed. If they are caused by the impurity of blood such symptoms as are in the Pittaja type can be observed. 

43. They resemble the shoots of Vata or Gunja berries or coral. The faeces are hard and hot and contaminated. 

44. If the motions are many the blood gushes out suddenly. The skin of the patient is like that of a frog. He suffers all disorders due to the deficiency of blood. 

45-47. The patient loses the colour of his complexion, strength and mental gaiety. His vitality is impaired. His sense organs do not function properly. By taking hard foodstuffs dehydrating the faeces, like Mudga¹, Kodrava², Jambira³, bamboo shoots, Bengal gram, etc., the wind becomes aggravated in the region of the rectum and obstructs the ducts flowing down and dries up the waste matter.

1. Phaseolus radiatus.

2. Paspalum screbiculatum.

3. An Allium species (Refer GVDB. p. 164).

48. It absorbs the moisture of faeces and urine and makes them thick with disastrous consequences. As a result of it acute pain in the viscera, back, cardiac region and the sides results. 

49. Tympanites, Ascites, accumulation of faeces, colic, pain in the bladder and intumescence in the cheeks are likely to follow. 

50. The deranged Vayu taking an upward course causes vomiting, non-relish for food and fever. Palpitation of the heart, diarrhoea, suppression of urine and dysentery are also caused 

51. Deafness, dyspnea, acute headache, consumption, chatarrh, faecal disorder, thirst, enlargement of the spleen dropsy, etc., follow. 

52. All these caused by the derangement of Vayu are terrific. Piles bring about even death. 

53. Piles grow in the rectum of those persons whose viscera are attacked by Vayu even without the exciting factors. The congenital piles as well as those that grow in the inner grove of the rectum are incurable. If the digestive power is maintained palliation is the only alternative. 

54. Growths of condylomatous nature caused by any two of the doshas in combination and those in the second flexus are incurable if left untreated for a year. 

55. Those piles that grow in the external groove as well as those caused by a single dosha can be easily cured if they are of recent origin. 

56. Condylomatous growths are said to grow on the penis, etc., as well as in the navel too. They are like the Gandupada (the pillow footed worm or Earthworm) and are lubricious and soft. 

57. The wind Vyana in combination with Kapha brings about growth of piles on the outer skin like nails rough to the touch and firm. They are called Charmakila. 

58. The roughness and piercing nature of the piles is due to Vayu; the blackness at the top is due to Pitta; and their glossiness, knotty nature and colouration are due to Kapha.

59. An intelligent man must exert himself in quelling the piles quickly. Otherwise, they may lead to graver disorders and asitis.