157 - Diseases

Dhanvantari said: 

1. O Sushruta, I shall explain the pathology of dysentery and diarrhoea. They are of six types, the doshas severally and in combination produce four varieties and fear and sorrow produce two types. 

2-3. Dysentery is usually caused by drinking too much of water. The Vayu becomes aggravated due to the injudicious intake of dry foods, fatty stuffs, fried things, gingelly seed cakes, shoots and germinated sprouts and inordinate quantities of wine, day-sleep, worms and suppression of natural urges for excretion. 

4. The aggravated Vayu causes the downward rush of the blood extinguishing the gastric fire. Then it permeates the inner chamber of food and faeces and liquefies the waste matter. 

5. The indication of its imminent onset is an acute pain in the chest, rectum and viscera, perspiration all over the body and constipation. 

6. Distention of the abdomen, indigestion and absence of sever are due to Vayu. The patient passes scanty faces without any sound but with constant interruptions. 

7. The waste matter is hard, turbid, frothy and knotty. A burning sensation in the fleshy region of the rectum is felt. The lubricious surface is cut up. There is a prolapse in the constricted anus. The patient gasps for breath and has horripilation all over the body. 

8-10. In the pittaja type diarrhoea the waste matter is yellow, black, turmeric coloured and grass coloured with blood mixed with it. It has a fetid smell. The patient has a burning sensation, excessive thirst and epileptic fits. If the cause is kapha there is an acute pain in the anus with burning sensation. The waste matter is thick, slimy and scanty in a continuous flow. If the three doshas in combination cause diarrhoea, all the symptoms and particularly horripilation, severe pain, and heaviness in bladder, belly and anus are observed. The patient loses sense and thinks what he has done as not done. 

11. If extreme fright agitates the mind the patient passes stool even as he lies down. The Vayu liquefies it and it passes out in warm jets. 

12. If extreme agony causes diarrhoea the symptoms are as in Vataja and Pittaja types. In brief, diarrhoea can be divided into two (1) Sama or with mucous and (2) Nirama or without mucous. 

13. In the Sama type the waste matter emits fetid smell. There is swelling, obstruction to the passage of ordure, and salivation. The opposite characteristics are observed in Nirama type. Due to Kapha none sinks. 

14. Atisara (diarrhoea) not given careful attention may lead to Grahani (acute dysentery) by taking in articles of food bringing about the quenching of gestric fire. 

15. Atisara is so called because there is plenty (Ati) of evacuation (Sara) of digested Sama or Nirama waste matter. Hence, it is very active and virulent naturally. If Sama is undigested it becomes shattered; if digested it does not become Pakva (fully ripe and digested). 

16. A chronic Atisara with the accumulations leads to Grahani disorder which is of four types, the three doshas severally and collectively being the cause. 

17-21. The general symptoms of the onset of Grahani are exhaustion of the limbs, purification of the body with delay (delayed evacuation), a little salivation, draught in the mouth, non-relish for food, thirst, vertigo, binding pain in the abdomen, vomiting and ringing in the ears. Some of these symptoms are also seen: -Weakness and emaciation of the body, acute Tamaka fever, epileptic fits, numbness in the head and thighs, intumescence in hands and feet, drowsiness, parchedness of the palate due to the action of the wind, darkness of vision, noisy echo in the ears, pain in the sides, thighs, thigh joints, neck, etc. and acute cholera. 

22. In weak patients the symptoms are very pronounced, hunger and thirst greatly oppressing them. There is inflation of belly during the process of digestion or on the completion of the same. After taking meal the patient gets some relief. 

23. In the Vataja type of Grahani the following indications can be seen. Palpitation of the heart, enlargement of the spleen, piles, jaundice, loss of sense, passing of either loose or hard lumpy dry waste matter with froth and loud report, gasping for breath and hiccough. The motion is frequent. 

24. In the Pittaja type of Grahani the waste matter is either yellow or bluish yellow and liquid in nature. Acid eruptions, burning sensation in the heart and throat, nonrelish for food and excessive thirst are also seen.. 

25-27. Difficulty in digestion, painful motion, vomiting, non-relish for food, burning sensation in the mouth, frequent spitting, cough, disquietude and chatarrh, sensation of bulkiness in the heart, distension and heaviness of abdomen, eructation with defiled sweetness, lassitude, horripilation, etc. are the specific features of the Kaphaja type. The waste matter is thick split up and charged with mucous matter. Even if the patient is not lean he feels weak. In the Sannipataja Grahani all the symptoms are observed. 

28-29. The first three types are very disorderly. All the symptoms mentioned before are observed in Grahani too. Eight ailments are called Maharogas (great illnesses). They are incurable. They are: -Rheumating gravel in urine (or stone in bladder), leprosy, epilepsy, dropsy, gonorrhoea, piles and Grahani.