त्रिचत्वारिंशोऽध्यायः अथातो हृद्रोगप्रतिषेधं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of the disease of the heart (Hridroga Pratisedha ). 1
Etiology and Nomenclature of Heart Diseases
भोजनैः ॥ २ ॥ वेगाघातोष्णरूक्षान्नैरतिमात्रोपसेवितः विरुद्धाध्यशनाजीर्णैरसात्म्यैश्चापि दूषयित्वा रसं दोषा विगुणा हृदयं गताः । कुर्वन्ति हृदये बाधां हृद्रोगं तं प्रचक्षते ॥ ३ चतुर्विधः स दोषैश्च क्रिमिभिश्च पृथक् पृथक् । लक्षणं तस्य वक्ष्यामि चिकित्सितमनन्तरम् ॥ ४ ॥ ३ ॥
Etiology and Nomenclature – The deranged Dosas of the body, aggravated by such causes as voluntary repression of any natural urging (of stool, urine, etc 😉 external blow or hurt, use of extremely dry (Ruksa) and heat-making articles of fare in inordinate quantities or of such articles as are indigestable or incompatible in combination or uncongenial to the system as well as taking food before digestion, contaminate the bodily Rasa (lymph chyle) and find lodgement in the heart, producing the characteristic pain in the organ, which is known as Hrdroga (the disease of the heart). The disease may be divided into five distinct types, of which four are Dosa-origined, (viz.— Vataja, Pittaja, Kaphaja, Sannipatika) and the fifth is due to the presence of worms (Krmi). The different symptoms should be first described and then the medical treatment there of. 2-4.
Specific Symptoms of heart diseases
आयम्यते मारुतजे हृदयं तुद्यते तथा । निर्मथ्यते दीर्यते च स्फोट्यते पाट्यतेऽपि च ॥ ५ ॥ तृष्णोषादाहचोषाः स्युः पैत्तिके हृदयक्लमः | धूमायनञ्च मूर्च्छा च स्वेदः शोषो मुखस्य च ॥६॥ गौरवं कफसंस्रावोऽरुचिः स्तम्भोऽग्निमार्दवम् । माधुर्यमपि चाऽऽस्यस्य बलासावतते हृदि ॥ ७ ॥
Specific Symptoms — In the Vataja type, a pain is felt in the region of the heart which seems as if being drawn and crushed, pierced and cracked, pricked and split. Thirst with a burning sensation, agonyfeeling and a sucking pain in the heart, epileptic fit, perspiration, fumy eructation and dryness of the mouth, are the symptoms which characterise the Pittaja type. A sense of heaviness in the chest, secretion of mucus (from the nose and the mouth), and aversion to food, feeling of numbness (in th body), dulness of digestive fire and a sweet taste in the mouth are the features which mark the Kaphaj type of the heart disease. 5-7.
उत्क्लेश: ष्ठीवनं तोदः शूलो हल्लासकस्तमः । अरुचिः श्यावनेत्रत्वं शोषश्च क्रिमिजे भबेत् ॥ ८ ॥
Krimija Hrdroga — Nausea, salivation (spitting), piercing and cutting.pain (in the heart ), dark vision, an aversion to food, a dull brown hue of the eyes, as well as emaciation of the body (D.R. swelling) are the indications which point to the presence of worms (Krmija Hrdroga) as the exciting factor of the disease. 8.
भ्रमक्लमौ सादशोषौ ज्ञेयास्तेषामुपद्रवाः । क्रिमिजे क्रिमिजातीनां श्लैष्मिकाणाञ्च ये मताः ॥ ९ ॥
Supervening symptoms – Vertigo and a sense of exhaustion attended with a feeling of physical lassitude and emaciation of the body exhibit themselves as the distressing concomitants in all the cases, while the supervening symptoms of Kaphaja worms exhibit themselves in case of Krmija Hrdroga also. 9.
Treatment of the Vataja Hrdroga
वातोपसृष्टे हृदये वामयेत् स्निग्धमातुरम् । द्विपञ्चमूलक्काथेन सस्नेहलवणेन तु ॥ १० ॥ पिप्पल्येला वचा हिङ्ग यवभस्मानि सैन्धवम् । सौवर्चलमथो शुण्ठीमजमोदाञ्च चूर्णितम् ॥ ११॥ फलधान्याम्लकौलत्थ-दधिमद्यासवादिभिः । पाययेत विशुद्धञ्च स्नेहेनान्यतमेन वा ॥ १२ ॥ भोजयेज्जीर्णशाल्यन्नं जाङ्गलैः सघृतै रसैः । वातघ्नसिद्धं तैलञ्च दद्याद् बस्तिं प्रमाणतः ॥ १३ ॥
Medical treatment of the Vataja Type — In a case of the Vataja type, the patient should be first treated with a Sneha and then made to vomit (out the contents of his stomach) with a draught of the decoction of Dasa-mula mixed with salt and a Sneha. After being purged he should be made to take a pulverised compound consisting of Pippali, ela, Vaca, Hingu, Yava-Kshara, Saindhava-salt, Sauvarcala, Sunthi and Ajamoda through the medium of the juice of (acid) fruits, fermented rice-boilings, decoction of Kulattha, curd, wine, asava or with any kind of Sneha. The patient should be made to have his meal of matured Sali rice, with the soup of any Jangala meat cooked with clarified butter. Oil duly cooked with the Vayu subduing drugs should be applied as a Basti in an adequate, quantity in the case. 10-13.
Treatment of the Pittaja Hrdroga
श्रीपर्णीमधुकक्षौद्र-सितोत्पलजलैर्वमेत् । पित्तोपसृष्टे हृदये सेवेत मधुरैः शृतम् ॥ १४॥ घृतं कषायांश्चोद्दिष्टान् पित्तज्वरविनाशनान् । तृप्तस्य च रसैर्मुख्यैर्मधुरैः सघृतैर्भिषक् । सक्षौद्रं वितरेद् बस्तौ तैलं मधुकसाधितम् ॥ १५ ॥
Treatment of Pittaja type— In a case of Pittaja-Hrdroga, vomiting should be induced with the decoction of Sri-parni-fruit, Yastimadhu and Utpala ( D. R. — treacle) mixed with honey and sugar. Clarified butter duly cooked with the drugs of the Madhura group, as well as the decoction efficacious in Pittaja fever, should be internally administered. The food of the patient should be prescribed with the soup of the flesh of the principal animals of the Jangala group cooked with clarified butter, and he should then be treated with a Basti, charged with honey and oil duly cooked with Yasti-madhu. 14-15.
Treatment of the Kaphaja Hrdroga
वचानिम्बकषायाभ्यां वान्तं हृदि कफात्मके। चूर्णन्तु पाययेतोक्तं वातजे भोजयेच्च तम् । फलादिमथ मुस्तादिं त्रिफलां वा पिबेन्नरः ॥ १६ ॥ श्यामात्रिवृत्कल्कयुतं घृतं वाऽपि विरेचनम् । बलातैलैर्विदध्याच्च बस्तिं बस्तिविशारदः ॥ १७ ॥
Treatment of Kaphaja Type – In the Kaphaja type of the disease, vomiting should be induced with the decoction of Vaca or of Nimba and the pulverised medicinal compound prescribed for the Vataja type, should be adminstered. The patient should also be advised to take clarified butter with his food. A decoction of Tri-phala or of the drugs of the Phaladi (Madana-phaladi- Sutra, Ch. XXXIX) or the Mustadi (Sutra Ch. XXXVIII) group, should be prescribed for internal use, or the patient should be purged with clarified butter mixed with powdered syama (Vrddha-daraka) and Trivrit. A physician skilled in the art of applying Basti should prescribe a Basti charged with Balaoil under the circumstances. 16-17.
Treatment of the Krimija Hrdroga
क्रिमिहद्रोगिणं स्निग्धं भोजयेत् पिशितौदनम् । दक्षा वा पललोपेतं त्र्यहं पश्चाद् विरेचयेत् ॥ १८ ॥ सुगन्धिभिः सलवणैर्योगैः साजाजिशर्करैः । विडङ्गगाढं धान्याम्लं पाययेताप्यनन्तरम् ॥ १९ ॥ हृदयस्था: पतन्त्येवमधस्तात् क्रिमयो नृणाम् । यवान्नं वितरेच्चास्य सविडङ्गमतः परम् ॥ २० ॥
Treatment of Krimija type — In the type (Krmija) characterised by the persence of worms, the patient should be first treated with a Sneha. A meat-diet with curd or (fried and) powdered sesamun should then be given to the patient for three days in succession after which he should be purged with the compound of Ajaji and sugar mixed with the salt predominting¹ purgative preparation (see-Sutra, XLIV.) and mixed with the scented drugs (mentioned in the Sutra-Sthana, ch. XLIV). An adequate quantity of fermented-rice boilings (Dhanymla) with a profuse quantity of Vidanga should then be internally administered, whereby the worms would be dislodged from the hearts (and expelled through the lower orfices of the body). A diet consisting of cooked barley grains saturated with powdered Vidanga should then be given to the patient. 18-20.
1. Some read “Su-pala-lair-jogaih” in place of ‘Salava-nair-jogaih.’ If would mean that the compound should be mixed with fried and powdered sesamum.
इति सश्रुत संहितायामुत्तरतन्त्रे हृदोगप्रतिषेधव्याख्यानाम faracaiffeiseara: 11 83 11
Thus ends the forty-third chapter of the Uttara Tantra in the Susruta Samhita which treats of the (symptoms and) treatment of Hydroga.