त्रयस्त्रिंशोऽध्यायः अथातोऽवारणीयमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Chapter which treats of incurable diseases (Avaraniya-adhyaya). 1
उपद्रवैस्तु ये जुष्टा व्याधयो यान्त्यवार्य्यताम् । रसायनाद् विना वत्स ! तान् श्रृण्वेकमना मम ॥२॥
वातव्याधिः प्रमेहश्च कुष्ठमर्शो भगन्दरः। अश्मरी मूढगर्भश्च तथैवोदरमष्टमम् । अष्टावेते प्रकृत्यैव दुश्चिकित्स्या महागदाः ।। ३ ।।
तृष्णाशोषवमिज्वरः । पुनश्चैतैरुपद्रताः । प्राणमांसक्षयश्वास मूर्च्छातिसारहिक्काभिः वर्ज्जनीया विशेषेण भिषजा सिद्धिमिच्छता ॥ ४ ॥ शूनं सुप्तत्वचं भग्नं कम्पाध्माननिपीडितम् । नरं रुजार्त्तमन्तश्च वातव्याधिर्विनाशयेत् ।।५।
Metrical texts : Hear me describe, Oh child, the diseases which being attended with many a distressing and supervenient symptom, and being treated without rejuvenating and restorative medicines, speedily assume incurable character. The following eight diseases, viz:-Maha-Vata-vyadhi (paralysis or diseases affecting the nervous system in general), Prameha (morbid discharges from the urethra), Kustha, Arsa (piles) Bhagandara (fistula in ano), Asmari (stone in the bladder), Mudha-garbha (false presentations) and the eight kinds of Udari (abdominal dropsy) are, by their very nature, extremely hard to cure. A physician with any regard to professional success should abandon a patient laid up with any of the preceding diseases, marked by complications such as, emaciation of the body, loss of strength, dyspnoea, palpitation, wasting, vomiting, dysentery and hic-cough, fever and swoon. A case of Vatavyadhi developing symptoms, such as oedematous swelling, complete anesthesia of the affected part, breaking and palsy (shaking) of the affected limbs, distention of the abdomen, with aching and colic pain, usually ends in death. 2-5
यथोक्तोपद्रवाविष्टमतिप्रसुतमेव वा। पिडकापीडितं गाढं प्रमेहो हन्ति मानवम् ॥६॥
A case of Prameha, attended with indications as are to be found under the head of that disease, as well as an increased secretion of urine charged with semen, albumen, etc. and eruptions of specific abcesses (known as Saravika etc.) is sure to have a fatal termination. 6
प्रभिन्नं प्रस्रुताङ्गञ्च रक्तनेत्रं हतस्वरम् । पञ्चकर्म्मगुणातीतं कुष्ठं हन्तीह कुष्ठिनम् ॥७॥
तृष्णारोचकशूलार्त्तमतिप्रस्रुतशोणितम् शोफातीसारसंयुक्तमर्शोव्याधिर्विनाशयेत् । ।।८।।
A case of Kustha (leprosy) characterised by spontaneous bursting of the affected parts, hoarse voice, and blood-shot eyes, and not proving itself amenable to the five-fold appliances of emetics, purgatives, etc. (Panca-Karma), usually ends in death. A case of piles attended with thirst, aversion to food, colic pain, excessive haemorrhage, anasarca (Sopha) of the locality, and dysentery is soon relieved by death. 7-8
वातमूत्रपुरीषाणि क्रिमयः भगन्दरात् प्रसवन्ति यस्य तं प्रशूननाभिवृषणं रुद्धमूत्रं रुगन्वितम् । अश्मरी क्षपयत्याशु सिकताशर्करान्विता ।। १० ।। शुक्रमेव च । परिवर्ज्जयेत् ॥ ९ ॥
A patient suffering from an attack of fistula in ano, characterised by an emission of flatus (Vayu), urine, fecal matter, worms and semen through the ulcerated locality, should be given up as lost. A patient suffering from the presence of stone, gravel, or urinary concretions (Sarkara) in the bladder and attended with oedema of the scrotum and the umbilicus, retention of urine, and colic pain in that organ, is soon relieved of his pain by death. 9-10
गर्भकोषपरासङ्गो मक्कल्लो योनिसंवृतिः । हन्युः स्त्रियं मूढगर्भे यथोक्ताश्चाप्युपद्रवाः ।।११।।
In a case of false presentation (Mudhagarbha) an extreme constriction of the mouth of the uterus (or uteri), development of the peculiar pain of child-birth, which is known as Makkalla, tonic rigidity of the vagina, and situation of the placenta (Apara) at a wrong place ( false pregnancy) and other symptoms (convulsions, cough, dyspnoea, vertigo etc.) described in the Chapter on the Etiology of that disease, forebode the death of the parturient woman. 11
पार्श्वभङ्गान्नविद्वेष शोफातिसारपीडितम् । विरिक्तं पूर्य्यमाणञ्च वर्ज्जयेदुदरार्द्दितम् ।।१२।।
यस्ताम्यति विसंज्ञश्च शेते निपतितोऽपि वा। शीतार्द्दितोऽन्तरुष्णश्च ज्वरेण म्रियते नरः ।।१३।।
A patient suffering from abdominal dropsy (ascites) marked by pain at the sides, aversion to food, oedematous swelling of the limbs, dysentery and fresh accumulation of water even after he had been tapped, or evacuated with the exhibition of purgatives, should be given up as incurable. A case of fever in which the patient becomes restless and tosses about in the bed in an unconscious state, and lies extremely prostrate, or is incapable of sitting or of holding himself up in any other position and is besides afflicted with rigor through complaining of a burning sensation within, is sure to end in death. 12-13
यो हृष्टरोमा रक्ताक्षो हृदि सङ्घातशूलवान् । नित्यं वक्त्रेण चोच्छ्वस्यात् तं ज्वरो हन्ति मानवम् ।।१४।।
हिक्काश्वासपिपासार्त्तं मूढं विभ्रान्तलोचनम् । सन्ततोच्छ्वासिनं क्षीणं नरं क्षपयति ज्वरः ॥ १५ ॥
Similarly, a fever patient developing such symptoms as, the appearance of goose flesh on the skin, an aching gathered-up pain in the cardiac region, blood-shot or congested eyes, and breathing through the mouth should be deemed as already at the threshold of death. Similarly, a case of fever, attended with hic-cough, dyspnoea, thirst, fits of unconsciousness or fainting, and rolling of the eye-balls, proves fatal in a weak and emaciated patient, who is found to breathe hurriedly through the mouth. 14-15
आविलाक्षं प्रताम्यन्तं निद्रायुक्तमतीव च। क्षीणशोणितमांसञ्च नरं नाशयति ज्वरः ।। १६ ।।
श्वासशूलपिपासार्त्तं क्षीणं ज्वरनिपीडितम् । विशेषेण नरं वृद्धमतीसारो विनाशयेत् । । १७ ।।
A case of fever proves fatal in a patient, found to be restless or to lie inert in an unconscious (subcomatose) state with dull, clouded, or tearful eyes, or prostrate, somnolent and extremely emaciated. A fever patient and especially an old one extremely enfeebled and emaciated, readily succumbs to an attack of dysentery in which laboured respiration, colic and thirst supervene. 16-17
शुक्लाक्षमन्नद्वेष्टारमूद्धर्वश्वासनिपीडितम् । कृच्छ्रेण बहु मेहन्तं यक्ष्मा हन्तीह मानवम् ।।१८।।
श्वासशूलपिपासान्नविद्वेषग्रन्थिमूढताः भवन्ति दुर्बलत्वञ्च गुल्मिनो मृत्युमेष्यतः ।।१९।।
An attack of Phthisis (Yaksma) leads its victim to death in whom glossiness of the eyes, aversion to food, expiratory ( subclavicle) dyspnoea, difficult and up-drawn breathing (Urdhwa-Svasa), and painful and excessive micturition (diarrhoea according to others), manifest themselves. A patient suffering from an attack of Gulma (abdominal gland), and on the verge of death, exhibits such symptoms as laboured and painful respiration, colic pain, unquenchable thirst, aversion to food, loss of consciousness, anaemia, and the sudden obliteration of the Granthi (tumorous or glandular formation). 18-19
आध्मातं बद्धनिष्यन्दं छर्दिहिक्कातृडन्वितम् । रुजाश्वाससमाविष्टं पाण्डुदन्तनखो यश्च पाण्डुनेत्रश्च मानवः ।
पाण्डुसङ्घातदर्शी च पाण्डुरोगी विनश्यति ।। २१ ।। विद्रधिर्नाशयेन्नरम् ।।२०।।
A person laid up with an attack of Vidradhi (abscess) and exhibiting such fatal symptoms as distension of the abdomen, retention of urine, vomiting, hiccough, thirst, pain of a varied character (such as aching, excruciating, etc.) and dyspnoea, should be regarded as to have approached the goal of his life. A patient suffering from an attack of jaundice or chlorosis marked by yellowness of the teeth, nails, and of the conjunctivae, and seeing everything yellow, is not expected to long survive the occurrence of the attack. 20-21
लोहितं छर्द्दयेद् यश्च बहुशो लोहितेक्षणः । रक्तानाञ्च दिशां द्रष्टा रक्तपित्ती विनश्यति ॥ २२ ॥
अवाङ्मुखस्तून्मुखो वा क्षीणमांसबलो नरः । जागरिष्णुरसन्देहमुन्मादेन विनश्यति ।। २३ ।।
बहुशोऽपस्मरन्तन्तु प्रक्षीणं चलितभुवम् । नेत्राभ्याञ्च विकुर्व्वाणमपस्मारो विनाशयेत् ॥ २४ ॥
A person laid up with an attack of Haemoptysis, largely vomiting blood, and viewing everything red or blood-coloured with his bloodshot eyes, should be regarded as about to depart this life. A person, insane, extremely enfeebled and emaciated, and sitting up sleepless in the night, or with eyes constantly lifted upward or cast down, would be soon relieved of his earthly suffering. A case of Apasmara (epilepsy) proves fatal in a person, who is extremely emaciated, and whose eye-brows are constantly moving and whose eyes seem fixed in an unnatural (oblique) stare. 22-24
इति सुश्रुतसंहितायां सूत्रस्थानेऽवारणीयो नाम त्रयस्त्रिंशोऽध्यायः ॥३३॥
Thus ends the thirty-third Chapter of the Sutrasthana in the Susruta Samhita which treats of incurable diseases.
