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Sushruta SamhitaNidana SthanaVatavyadhi Nidana - diseases of the nervous system - Sushruta Samhita Nidanasthana...

Vatavyadhi Nidana – diseases of the nervous system – Sushruta Samhita Nidanasthana Chapter 1

प्रथमोऽध्यायः । अथातो वातव्याधिनिदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥

Now we shall discourse on the Vatavyadhi (diseases of the nervous system) Nidanam. 1

धन्वन्तरिं धर्मभृतां वरिष्ठममृतोद्भवम् । परिपृच्छति ।। २ ।।

चरणावुपसंगृह्य सुश्रुतः वायोः प्रकृति भूतस्य व्यापन्नस्य च कोपनैः। स्थानं कर्म च रोगांश्च वद मे वदतां वर ? ।। ३ ।।

Metrical Text: Having clasped the feet of the holy Dhanvantari, who had arisen out of the primordial ocean with the pitcher of ambrosia on his head, and who was the foremost of all knowers of truth. Susruta interrogated him as follows : “Tell me, O thou, the foremost of discoursers, all about the different locations and functions of the bodily Vayu (nerve force), both in its normal and agitated conditions, (as well as when it changes its natural seat through a concourse of

1. The term Nidana. usually translated as Pathology, is meant to include factors, which fall within the respective provinces of Pathology, Aetiology, Symptomology and Pathognomy as well. For the meaning and functions of Vayu see Introduction Vol. I. pp. xli-xliii. disturbing or aggravating causes). Instruct me on the nature of distempers, which result from its deranged condition.” 2-3

तस्य तद् वचनं श्रुत्वा प्राब्रवीद् भिषजां वरः । स्वयंभूरेष भगवान् स्वातन्त्र्यान्नित्यभावाच्च वायुरित्यभिशब्दितः ।। ४ ।।

सर्वगत्वात् तथैव च । सर्वेषामेव सर्वात्मा सर्वलोकनमस्कृतः ।। ५ ।।

स्थित्युत्पत्तिविनाशेषु भूतानामेष कारणम् । अव्यक्तो व्यक्तकर्मा च रूक्षः शीतो लघुः खरः ।। ६ ।।

तिर्यग्गो द्विगुणश्चैव रजोबहुल एव च। अचिन्त्यवीर्यो दोषाणां नेता रोगसमूहराट् । आशुकारी मुहुश्चारी पक्वाधानगुदालयः ॥ ७॥

The holy Dhanvantari, the greatest of all healers, having listened to the foregoing words of Susruta, replied as follows: This vital Vayu (nerve force), which courses through the body, is self-begotten in its origin, and is regarded as indentical with the divine energy of eternal life (God), inasmuch as it is unconditional and absolute in its actions and effects, eternal and self-origined, and is subtle and all-pervading (like the sky and the atoms). It is the primary factor, which determines the principle of cause and effect in all forms of created things, whether mobile or immobile. It is so called (Vayu) from the fact of its coursing (skr. Va– to move) throughout the universe. It determines the growth. origin and disintegration of all animated organisms, and as such, it receives the homage of all created beings. Although invisible in itself, yet its works are patent or manifest, It is cold, light, mobile, dry and piercing and follows a oblique course. It is characterised by the two attributes (proper-sensibles or Gunas) of sound and touch. It abounds in the fundamental quality of Rajas (principle of cohesion and action), is of inconveivable prowess, propels all the deranged or obstructing principles (Dosas) in the organism, (or in other words, is primarily concerned with the deranged principles of the body which are pathogenic in their actions). It is instantaneous in its action, and radiates or courses through the organism in constant currents. It has its primary field of action in the intestinal tract ( Pakvadhana) and the rectum (Guda). In its deranged state, it is the principal factor, which, (in combination with the deranged Pitta and Kapha), lies at the root of all diseases, and is accordingly termed the king of diseases ( Rogarat). 4-7

देहे विचरतस्तस्य लक्षणानि निबोध मे ॥ ८॥

दोषधात्वग्निसमतां सम्प्राप्तिं विषयेषु च। क्रियाणामानुलोम्यञ्च करोत्यकुपितोऽनिलः ।। ९ ।।

यथाग्निः पञ्चधा भिन्नो नामस्थानात्मकर्मभिः । भिन्नोऽनिलस्तथा ह्येको नामस्थानक्रियामयैः ।। १० ।।

प्राणोदानौ समानश्च व्यानश्चापान एव च। स्थानस्था मारुताः पञ्च यापयन्ति शरीरिणम् ।। ११ ।।

The action of Vayu in its normal State: Now, hear me describing the symptoms, which mark the Vayu, as it courses through the organism. The Vayu in its normal or undisturbed condition, maintains a state of equilibrium between the different Dosas and the root principles of the body ( Dhatu); it further tends to maintain uniform state in the metabolism of the body, (protoplasmic, Agni¹ and helps the organs of sense-perception in discharging their specific functions. The bodily Vayu, like the Pitta in the organism, is grouped under five different subheads according to the difference in its functions and locations, and is classified as the Prana, udana, Samana, Vyana and Apana². These five classes of Vayu, located in their specific regions, contribute towards the integration and maintenance of the body. 8-11

वायुर्यो वक्त्रसंचारी स प्राणो नाम देहधृक् । प्रवेशयत्यन्तः प्राणांश्चाप्यवलम्बते ।

सोऽन्नं प्रायशः कुरुते दुष्टो हिक्काश्वासादिकान् गदान् ।। १२ । ।

The Prana Vayu: The Vayu, that courses in (governs) the cavity of the mouth,³ is called the Prana, its functions being to force down

1. See Introduction Vol. I. pp. L-LI Mahamahopadhyaya Dvarka Natha Kaviratna interprets this Agni as digestive heat (Jatharagni).

2. The Prana Vayu is identical with the energy of the nerve centre in the medulla; the Udana with that of the one which is situated in the speech centre. The Samana is same as the energy of the epigastric plexus, the Udana is same as the energy of the Motor-Sensory Nerves, and the Apana is identical with the force of the Hypogastric plexus.

3. The field of its action includes the regions of the heart, throat, head and the nose.

the food into the cavity of the stomach, and to assist the different vitalising principles of the body (such as the internal heat or fire etc.) in discharging their functions in life, and to contribute to the general sustenance of the body. A deranged condition of this particular kind of Vayu (Prana) is usually followed by hic-cough, dyspnoea and other kindred distempers. 12

उदानो नाम यस्तूर्ध्वमुपैति पवनोत्तमः । तेन भाषितगीतादिविशेषोऽभिप्रवर्त्तते । ऊर्ध्वजत्रुगतान् रोगान् करोति च विशेषतः ।। १३ ।।

The Udana Vayu: The most important of the vital Vayus, which courses (sends its vibrations ) upward, is called the Udana. It produces speech, song, etc. In its deranged state it brings on diseases which are specifically confined to regions lying above the clavicles. 13

आमपक्वाशयचर: समानो वह्निसङ्गतः । सोऽन्नं पचति तज्जांश्च विशेषान् विविनक्ति हि । गुल्माग्निसंङ्गातीसार-प्रभृतीन् कुरुते गदान् ।। १४ ।।

The Samana Vayu: The Samana Vayu courses in (governs) the stomach (Amasaya) and in the region of intestines (Pakvasaya). Its functions consist in digesting the chyme brought down into the intestines in unison with the digestive ferment (Agni), and especially in disintegrating its essence from its refuse or excreted matter. A deranged or aggravated condition of the Samana Vayu causes dysentery, Gulma and impaired digestion, etc. 14

रससंवहनोद्यतः। कृत्स्नदेहचरो व्यानो स्वेदासकस्रावणो वापि पञ्चधा चेष्टयत्यपि । क्रुद्धश्च कुरुते रोगान् प्रायशः सर्व्वदेहगान् ।। १५ ।।

The Vyana Vayu: The Vayu known as the Vyana courses (acts) through the whole organism, and its functions consist in sending the lymph chyle etc. all through the body and in helping the out-flow of blood (Asrk) and perspiration. Five kinds of muscular movements’ are ascribed to the action of the Vyana Vayu, a deranged condition of

1. Such as expansion, flexion, lowering down and lifting up or lateral thrusting of any part of the body. which is generally attended with diseases which are not confined to any particular region, member, or organ of the body, but are found to affect the whole organism (such as, fever, etc.). 15

पक्वाधानालयोऽपानः काले कर्षति चाप्यधः । समीरणः शकृन्मूत्रंशुक्रगर्भार्तवावानिचः ।

कुद्धश्चकुरुते रोगान् घोरान् बस्तिगुदाश्रयान् ।। १६ ।।

शुक्रदोषप्रमेहास्तु व्यानापानप्रकोपजाः । युगपत् कुपिताश्चापि देहं भिन्धुरसंशयम् ।। १७ ।।

The Apana Vayu : The Vayu known as the Apana acts in the lower region of the intestines (Pakvadhana). Its functions consist in bearing down the foetus and the faeces and in evacuating the urine, semen and catamenial blood. An eraged condition of this Vayu tends to bring on serious diseases, which are peculiar to the urinary bladder and the distal portion of the large intestine (Guda). An aggravated condition of both the Vyana and Apana Vayus may produce Prameha and disorders of the seminal fluid, while a simultaneous excitement of the five vital Vayus leads to a sure and speedy termination of life. 16-17

अत ऊर्ध्वं प्रवक्ष्यामि नानास्थानान्तराश्रितः । बहुश: कुपितो वायुर्विकारान् कुरुते हि यान् ।। १८ ।।

वायुरामाशये क्रुद्धश्छर्घादीन् कुरुते गदान् । मोहं मूर्च्छा पिपासाञ्च हृद्ग्रहं पार्श्ववेदनाम् ।। १९ ।।

पक्वाशयस्थोऽन्त्रकूजं शूलं नाभौ करोति च। कृच्छमूत्रपुरीषत्वमानाहं त्रिकवेदनाम्।। २० ।।

श्रोत्रादिष्विन्द्रियवधं कुर्यात् क्रुद्धः समीरणः ।। २१ ।।

वैवर्ण्य स्फुरणं रौक्ष्यं सुप्तिं चुमुचुमायनम् । त्वक्स्थो निस्तोदनं कुर्यात् त्वग्भेदं परिपोटनम् ।। २२ ।।

व्रणांश्च रक्तगो, ग्रन्थीन् सशूलान् मांससंश्रितः । तथा मेदः श्रितः कुर्याद् ग्रन्थीन् मन्दरुजोऽव्रणान् ।

कुर्यात् सिरागतः शूलं सिराकुञ्चनपूरणम् ।। २३ ।।

स्नायुप्राप्तः स्तम्भकम्पौ शूलमाक्षेपणं तथा ॥ २४ ॥

हन्ति सन्धिगतः सन्धीन् शूलशोफौ करोति च ॥ २५ ॥

अस्थिशोषञ्च भेदञ्च कुर्याच्छूलञ्च तच्छ्रितः ॥ २६ ॥

तथा मज्जगते रुक् च न कदाचित् प्रशाम्यति ॥ २७ ॥ अप्रवृत्तिः प्रवृत्तिर्वा विकृतिः (ता) शुक्रगेऽनिले । ॥ २८ ॥

Now we shall describe the nature of diseases, brought about by the localization of the variously aggravated Vayus in the different parts of the body. In the cavity of the stomach (Amasaya) the deranged or aggravated Vayu gives rise to vomiting, vertigo, epileptic fits, thirst and pain at the sides (Parsva Sula) and about the region of the heart (Hrdgraha). In the intestines (Pakvasaya) the enraged or disturbed Vayu gives rise to a rumbling in the intestines, a piercing pain about the region of the umbilicus, scanty and painful urination and stool, or their entire suppression (Anaha), and pain about the region of the coccyx (Trika). Similarly, incarcerated in the sense-organs, such as the ears, etc. it tends to deprive them of their respective faculties. In the skin (lymph chyle) it produces a discolouring of the complexion, parchedness and twitching in the skin, and causes a complete local anaesthesia, giving rise to a tingling, piercing pain in the skin, which spontaneously bursts, or becomes marked with cracks and fissures. Similarly, the aggravated Vayu interfering with the principle of blood gives rise to ulcers. In the flesh, it produces painful nodes and tumours (Granthi), while in the principle of fat it brings on almost painless tumours (Granthi) unattended with any kind of ulcer. Incarcerated in the veins & c. (Sira) it produces a stiffening or painful contraction, or a varicose or neuralgic condition; in a ligament (Snayu), it produces numbness (anaesthesia), palsy, aching pain and convulsive jerks; in a long joint, it tends to deprive it of its contractibility and produces a painful inflammatory swelling (about the affected part) in the bones it produces a wasting (atrophy) or the bones which crack and begin to spontaneously burst, attended with the characteristic bone-ache. Again in that important principle of life, the marrow, it tends to dry it up and produces a sort of pain, extending all over the body which knows no respite or abatement. Similarly, in the principle of semen it tends to produce a scanty, defective, or excessive emission of that vital fluid, or a complete stoppage thereof. 18-28

हस्तपादशिरोधातूंस्तथा संञ्चरति क्रमात् । व्याप्नुयाद् वाऽखिलं देहं वायुः सर्वगतो नृणाम् ।। २९ ।

स्तम्भनाक्षेपणस्वापशोफशूलानि सर्वगः । स्थानेषूक्तेषु मिश्रश्च संमिश्राः कुरुते रुजः ।। ३० ।।

कुर्यादवयवप्राप्तो मारुतस्त्वमितान् गदान् ।। ३१ ।।

The Vayu, thus disturbed and agitated, affects in succession the lower and the upper extremities of the body, and the head, or extends all over the body and deranges all its root-principles (Dhatu). The symptoms, which mark such conditions of the body, are numbness (paralysis), convulsive contortions of the limbs (aksepa), anaesthesia, and various kinds of pain (sula), and swelling (Sopha) of the body. The deranged Vayu, having entered the natural seats of the Pitta or Kapha, develops symptoms, which are peculiar to either of them, and gives rise to numerous diseases. 29-31

दाहसन्तापमूर्च्छाः स्युर्वायौ पित्तसमन्विते ।। ३२।। शैत्यशोफगुरुत्वानि तस्मिन्नेव कफावृते ।। ३३ ।।

सूचीभिरिव निस्तोदः स्पर्शद्वेषः प्रसुप्तता । शेषा: पित्तविकाराः स्युर्मारुते शोणितान्विते । ॥ ३४ ॥

The symptoms, which characterise the union of the deranged Vayu with the Pitta (in its particular seat) are a burning sensation, heat, thirst, and loss of consciousness, in addition to the symptoms of the Vataja disease so generated in that particular part of the body, while a similar unison with the Kapha develops coldness, swelling and heaviness (of the affected part). The disturbed or agitated Vayu in unison with the principle of blood gives rise to a sort of pricking pain (pins and needles in the affected locality), which can not bear the least touch, or is marked by complete anaesthesia, and symptoms, peculiar to the deranged Pitta, follow in its train. 32-34

प्राणे पित्तावृतेछर्दिर्दाहश्चैवोपजायतै ।। ३५ ।। दौर्बल्यं सदनं तन्द्रावैवर्ण्यञ्च कफावृते ।। ३६ ।।

उदाने पित्तसंयुक्ते मूर्च्छादाहभ्रमक्लमाः ।। ३७ ।। अस्वेदहर्षो मन्दाग्निः शीतस्तम्भौ कफावृते ॥ ३८ ॥

Vomiting, and a burning sensation, etc. in the body, mark the instance when the Prana Vayu is surcharged (Avrta) with the Pitta; while weakness, lassitude, somnolence and a general discolouring of the complexion (D. R.–loss of taste) characterise a case when it is surcharged with the deranged Kapha. A burning sensation in the body, loss of consciousness or epileptic fits, and a sense of giddiness (vertigo) and physical languor are the indications, which distinguish a case of the Udana Vayu being surcharged with the Pitta; while a stoppage or absence of perspiration, appearance of goose-flesh on the skin, impaired digestion, coldness and numbness of the affected part characterise a case of the same being surcharged with the Kapha. 35-38

समाने पित्तसंयुक्ते स्वेददाहौष्ण्यमूर्च्छनम् ।। ३९ ।। कफाधिकञ्च विण्मूत्रं रोमहर्षः कफावृते ।। ४० ।।

Copious flow of perspiration, heat with a burning sensation in the body, and epileptic fits indicate a case when the Samana Vayu has become united with the pitta; while a copious flow of stool and urine. and an excess of mucous secretion (Kapha) from the nose fluent coryza) etc. and horripilation mark a case. where it has become saturated with the Kapha. 39-40

अपाने पित्तसंयुक्ते दाहौष्णये स्यादसग्दरम् ।। ४१ ।। अधःकाय गुरुत्वञ्च तस्मिन्नेव कफावृते ।। ४२ । ।

Heat and a burning sensation in the affected part and a profuse menorrhagia mark a case when the Apana Vayu becomes-surcharged with the Pitta, whereas a sense of heaviness in the lower limbs characterises a case when it becomes overcharged with the Kapha. 41-42

व्याने पित्तावृते दाहो गात्रविक्षेपणं क्लमः ।। ४३ ।।

गुरूणि सर्वगात्राणि स्तम्भनञ्चास्थिपर्वणाम् । लिङ्गं कफावृते व्याने चेष्टास्तम्भस्तथैव च ॥ ४४ ॥

[ Symptoms such as ] burning and jerking in the limbs, and a sense of physical languor become manifest in the event of the Vyana Vayu being surcharged with the Pitta, while a general heaviness of the limbs, stiffness of numbness of the bone-joints, and an incapability of locomotion indicate the fact of its being surcharged with the Kapha. 43-44

प्रायशः सुकुमाराणां मिथ्याहारविहारिणाम् । रोगाध्वप्रमदामद्यव्यायः मैश्चातिपीडनात् ऋतुसात्म्यविपर्यासात् स्नेहादीनाञ्च विभ्रमात् ।

अव्यवाये तथा स्थूले वातरक्तं प्रकुप्यति ॥ ४५ ॥

The Nidana of Vata Rakta A faulty diet and regimen, excessive sexual intercourse, inordinate physical exercise, drinking large quantities of wine, in a particular season of the year which is improper to it, use of articles of food which are not congenial to one’s own temperament and an improper or baneful use of such oleaginous substances (as oil, clarified butter etc.) are the factors, which vitiate in common the blood and Pitta of a person. The foregoing causes especially tend to vitiate or agitate the Vayu and blood in persons of delicate constitutions. or in corpulent persons, or in those who observe a form of perfect continence. 45

हस्त्यश्वोष्ट्रैर्गच्छतोऽन्यैश्च वायुः कोपं यातः कारणैः सेवितैः स्वैः । तीक्ष्णोष्णाम्लक्षारशाकदिभेज्यैः सन्तापाद्यैर्भूयसा सेवितैश्च ।। ४६ ॥

क्षिप्रं रक्तं दुष्टिमायाति तच्च वायोर्मार्ग संरुणद्धचाशु यातः । क्रुद्धोऽत्यर्थ मार्गरोधात् स वायुरत्युद्रिक्तं दूषयेद्रक्तमाशु ॥ ४७ ।।

तत् संपृक्तं वायुना दूषितेन तत्प्राबल्यादुच्यते वातरक्तम् ॥ ४८ । ।

The vital Vayu becomes enraged or agitated by excessive riding on horses. camels or elephants, or through the lifting or carrying of great weights, etc.. or by an inordinate indulgence in things which are possessed of the specific virtue of enraging or aggravating that vital principle. On the other hand, an over-indulgence in such articles of food as are heat-making in their potency, or a surfeit of edibles largely composed of sharp, acid or alkaline substances, as well as a large consumption of potherbs etc., or an exposure to heat tends to vitiate the blood of the organism, and which on account of such contamination, tends to speedily obstruct the passage of the fleet-coursing Vayu. The Vayu, thus impeded in its course, becomes more and more agitated each moment, and is prone to speedily agitate the blood in a similar way. The antecedence of the term “Vata” or “Vayu” in the nomenclature of the disease (Vata-Rakta) is owing to the precedence accorded to the action of the deranged Vayu in bringing about the malady, although it effects this in concert with the vitiated blood of the organism. 46-48

तद्वत् पित्तं दूषितेनासृजातं श्लेष्मादुष्टो दूषितेनासृजाऽऽक्त ।। ४९ ॥

स्पर्शोद्विग्नौ तोदभेदप्रशोषस्वापोपेतौ वातरक्तेन पादौ । पित्तासगृभ्यामुग्रदाहौ भवेतामत्यर्थोष्णौ रक्तशोफौ मृदू च ।

कण्डूमन्तौ श्वेतशीतौ श्वेतशीतौ सशोफौ पीनस्तब्धौ श्लेष्मदुष्टे तु रक्ते ।।५० ।।

सर्वैर्दुष्टे शोणिते चापि दोषाः स्वं स्वं रूपं पादयोर्दर्शयन्ति ।। ५१ ।।

Similarly, the disease brought about by the agitated Pitta, in conjunction with the vitiated or agitated blood, is called the PittaRakta, while the one incidental to the combination of the deranged Kapha with the vitiated blood is called Kapha-Rakta. In a case of VataRakta, the legs, or the lower extremities can not bear the least touch (Hyperaesthesia) and a sort of pricking, piercing pain ( pins and needles) is experienced in those regions. The legs become withered or atrophied and lose all sensibility to touch. In a case of Pitta-Rakta, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Rakta, the legs become swollen and numbed. The swelling assumes a whitish hue and feels cold to the touch, and is accompanied by excessive itching. In the Sannipatika or Tridosaja form of Dusta-Rakta, the legs exhibit symptoms, which are resepctively peculiar to all the three preceding types. 49-51

प्राग्रूपे शिथिलौ स्विन्नौ शीतलौ सविपर्ययौ । वैवर्ण्यतोदसुप्तत्वगुरुत्वौषसमन्वितौ ।। ५२।।

पादयोर्मूलमास्थाय आखोर्विषमिव क्रुद्धं तदेहमनुसर्पति ।। ५३ ।। कदाचिद्धस्तयोरपि ।

Premonitory Symptoms : In the incubative stage of the disease the legs perspire and become cold and flabby, or (on the contrary), the local perspiration is stopped and the legs become hot and hard. Moreover, a pricking pain is experienced in the affected parts which are marked by complete anaesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in either from the lower extremities, or in some cases, first affects the upper ones and gradually extends all over the body like an enraged rat-poison. 52-53

आजानुस्फुटितं यच्च प्रभिन्नं प्रस्तुतं च यत् । उपद्रवैश्च यज्जुष्टं प्राणमांसक्षयादिभिः ।

शोणितं तदसाध्यं स्याद्याप्यं संवत्सरोत्थितम् ॥ ५४॥

Prognosis: The form of the disease in which the skin of the part lying between the instep and the knee-joint becomes abraded or spontaneously bursts open, exuding pus and blood, attended with loss of strength (Prana) and flesh, should be regarded as incurable; while a case of one year’s standing admits only of palliative measures. 54

यदा तु धमनीः सर्वाः कुपितोऽभ्येति मारुतः। तदाक्षिपत्याशु मुहुर्मुहुर्देहं मुहुश्चरः ।

मुहुर्मुहुस्तदाक्षेपादाक्षेपक इति स्मृतः ॥ ५५ ॥

सोऽपतानकसंज्ञो यः पातयत्यन्तराऽन्तरा । कफान्वितो भृशं वायुस्तास्वेव यदि तिष्ठति ।। ५६ ।।

स दण्डवत् स्तम्भयति कृच्छ्रो दण्डापतानकः । हनुग्रहस्तदाऽत्यर्थं सोऽन्नं कृच्छ्रान्निषेवते ।। ५७ ॥

The enraged or agitated Vayu, while coursing swiftly through the Dhamanis (nerves) of the body, shakes it in quick succession, and a disease, (exhibiting such) symptoms as shaking or convulsive jerks), is originated which is called Aksepaka¹ (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called Apatanaka (Epilepsy without convulsions). The aggravated or agitated Vayu charged with an abnormal quantity of Kapha, sometimes affects and stuffs the entire nervous system, and gives rise to a form of disease, which is called Dandapatanaka² (Epilepsy with convulsions), inasmuch as it deprives the body of its power of movement and flexibility, making it stiff and rigid like a rod (Danda).

The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty, its characteristic symptom being a paralysis of the jaw-bone, which makes deglutition extremely difficult. 55-57

1. The patient suffers from vanishings (tamyate) and loss of consciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named. — Gayadasa

2. Jejjata holds that the enraged Vayu, in unison with the deranged Kapha, gives rise to another kind of convulsions (Aksepaka) which he has denominated as Danda-patanakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pitta and Kapha. Several authorities aver that there are four distinct types of Aksepaka, such as Danda-patanaka, Antarayam, vahirayam and Aksepaka of traumatic (Abhighataja) origin.

।। ५८।। धनुस्तुल्यं नमेद्यस्तु स धनुःस्तम्भसंज्ञकः ।

अङ्गुलीगुल्फजठरहृवक्षोगलसंश्रितः स्नायुप्रतानमनिलो यदाऽक्षिपति वेगवान् । विष्टब्धाक्षः स्तब्धहनुर्भग्नपार्वः कफं वमन् ।। ५९ ।।

अभ्यन्तरं धनुरिव यदा नमति मानवः । तदा सोऽभ्यन्तरायामं कुरुते मारुतो बली ।। ६० ।।

बाह्यस्नायुप्रतानस्थो बाह्यायामं करोति च। तमसाध्यं बुधाः प्राहुर्वक्षः कटचूरुभञ्जनम् ।। ६१ ।।

The disease in which the enraged Vayu bends the body like a bow is called Dhanustambha (Tetanus). The disease admits of being divided into two distinct types accordingly as the body of the patient is curved internally (Antarayama, lit :- inwardly or forwardly extended, emprosthotonos), or externally (Vahirayama.lit:- extended or bent on the back, resting on his heels and occiput– Opisthotonos). When the extremely enraged and powerful bodily Vayu (nerve-force). accumulated in the regions of the fingers, insteps. abdomen. chest. heart and throat, forcibly draws in the local ligaments (Snayu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarayama Dhanustambha. The movements of the eyes become impossible, which become fixed in their sockets; the jaw-bones become locked, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapha). These are the features which mark the first type (Antarayama Dhanustambha). On the contrary, when the same enraged Vayu. centred or lodged in ligaments which traverse the posterior side of the body, contracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease is called Vahirayama, and should be looked upon as beyond the pale of all medicinal treatment. 58-61

कफपित्तान्वितो वायुर्वायुरेव च केवलः । कुर्यादाक्षेपकं त्वन्यं चतुर्थमभिघातजम् ।। ६२ ।।

गर्भपातनिमित्तश्च शोणितातिस्रवाच्च यः । अभिघातनिमित्तश्च न सिध्यत्यपतानकः ।। ६३ ।।

Four types of Aksepaka are usually recognised in practice such as, the (1) one incidental to the concerted action of the enraged bodily Vayu and Kapha (2), the one brought about through the union of the enraged Vayu with the deranged Pitta (3), the one due to the single action of the agitated Vayu (4) and the one due to any external injury or blow (Abhighataja).¹ An attack of Apatanakah due to excessive haemorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour) or which is incidental to an external blow or injury (traumatic), should be regarded as incurable. 62-63

अधोगमाः सतिर्यग्गा धमनीरूर्ध्वदेहगाः । यदा प्रकुपितोऽत्यर्थं मातरिश्वा प्रपद्यते ॥ ६४ ॥

तदाऽन्यतरपक्षस्य सन्धिबन्धान् विमोक्षयन् । हन्ति पक्षं तमाहुर्हि पक्षाघातं भिषग्वराः ।। ६५ ।।

यस्य कृत्स्नं शरीरार्धमकर्मण्यमचेतनम् । ततः पतत्यसून् वाऽपि जहात्यनिलपीडितः ।। ६६ ।।

The disease, in which the extremely agitated Vayu affects the nerve chains (Dhamanis) which spread either in the upward, downward, or lateral direction, making them lax and vigourless, and in which the joints of the other side of the body become useless and inoperative, is called Paksaghata (Hemiplegia) by eminent physicians. The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility. suddenly falls down and expires. 64-66

शुद्धवातहतं पक्षं कृच्छ्रसाध्यतमं विदुः । साध्यमन्येन संसृष्टमसाध्यं क्षयहेतुकम् ॥ ६७ ॥

Prognosis: A case of Paksaghata (Hemiplegia), brought about through the single action of the enraged or agitated Vayu of the body, can be cured only with the greatest care and difficulty. A case of the same disease, engendered by the aggravated Vayu in conjunction with the deranged Pitta or Kapha proves amenable to medicine (Sadhya). It becomes incurable when caused through the waste of the root principles (Dhatu) of the body. 67

1. Brahma Deva designated the four types of the disease, as Apatanakah, Samsrsta Aksepakah, simple Aksepakah and the Abhighataja (traumatic).

वायुरूर्ध्वं व्रजेत् स्थानात् कुपितो हृदयं शिरः । शङ्खौ च पीडयत्यङ्गान्याक्षिपेन्नमयेच्च सः ॥ ६८ ।।

निमीलिताक्षो निश्चेष्ट: स्तब्धाक्षो वाऽपि कूजति । निरुच्छ्वासोऽथवा कृच्छ्रादुच्छ्वस्यान्नष्टचेतनः ।। ६९ ।।

स्वस्थ: स्याद्धृदये मुक्ते ह्यावृते च प्रमुह्यति । कफान्वितेन वातेन ज्ञेय एषोऽपतन्त्रकः ॥ ७० ॥ ।।

Apatantrakah ( Convulsions ): The Vayu aggravated (by its specifically exciting factors and principles) and dislodged from its natural seat or receptacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples. It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.

Symptoms: The patient lies with his eyes closely shut, or stares with a sort of fixed or vacant gaze. the eyes remaining fixed or immovable. The patient loses all perception. and groans Respiration becomes difficult, or symptoms of temporary asphyxia and unconsciousness set in. Consciousness and a normal condition of the organism return with the passage of the enraged Vayu from the heart, while on the other hand the patient relapses into unconsciousness simultaneously with the envelopment of the heart with that enraged and Kapha-saturated Vayu. This disease is called apatantrakah and is ascribed to the action of the enraged Vayu surcharged with the deranged Kapha. 68-70

दिवास्वप्नासन (म) स्थानविवृताध्वनिरीक्षणैः ।

मन्यास्तम्भं प्रकुरुते स एव श्लेष्मणाऽऽवृतः ।। ७१ ।।

Manyastambha: The local Vayu. agitated through such causes as sleep in the day time, reclining with the neck on an uneven place or pillow, gazing upward for a considerable length of time, or looking aside in a contorted way, and enveloped in the deranged Kapha, gives rise to the disease known as Manyastambha (wry neck or torticollis). 71

गर्भिणीसूतिकाबालवृद्धक्षीणेष्वसृक्क्षये उच्चैर्व्याहरतोऽत्यर्थं खादतः कठिनानि वा ।। ७२ ।।

हसतो जृम्भतो भाराद् विषमाच्छयनादपि । शिरोनासौष्ठचिबुकललाटेक्षणसन्धिगः ।। ७३ ।।

अर्दयित्वाऽनिलो वक्त्रमर्दितं जनयत्यतः । वक्रीभवति वक्त्रार्धं ग्रीवा चाप्यपवर्तते ॥ ७४ ॥

शिरश्चलति वाक्सङ्गो नेत्रादीनाञ्च वैकृतम् । ग्रीवाचिबुकदन्तानां तस्मिन् पार्श्वे तु वेदना ।। ७५ ।।

यस्याग्रजो रोमहर्षो वेपथुर्नेत्रमाविलम् । वायुरूर्ध्वं त्वचि स्वापस्तोदो मन्याहनुग्रहः। तमर्दितमिति प्राहुर्व्याधिं व्याधिविशारदाः ।। ७६ ।।

क्षीणस्यानिमिषाक्षस्य प्रसक्ताव्यक्तभाषिणः । न सिध्यत्यर्दितं बा (गा) ढं त्रिवर्षं वेपनस्य च ॥ ७७ ॥

Ardita (Facial Paralysis) : ‘Pregnant women, mothers immediately after parturition (Sutika), infants, old and enfeebled persons are most prone to fall victims to this disease. It has been also known to result from excessive haemorrhage or loss of blood. The local Vayu, extremely enraged or aggravated by continous talking in an extremely loud voice, chewing of hard substances, loud laughter, yawning, carrying extremely, heavy loads, and lying down in an uneven position on the ground, finds lodgment in the regions of the head, nose, upper lip, chin, forehead and the joints (inner cornea) of the eye, and produces the disease called Ardita by distorting the face.

Symptoms: The neck and half of the face longitudinally suffer distortion and are bent. The head shakes; the power of articulating speech is lost, and the eyes are distorted into a variety of shapes. The portions of the neck and the chin, as well as the teeth on the affected side become painful.

Premonitory Symptoms : The diseases generally commences with shivering, horripilation, cloudiness of vision, upcoursing of the bodily Vayu and anaesthesia, a pricking pain in the affected locality, numbness or paralysis of the jaw-bone, or of the cervical muscles of the neck. Physicians conversant with the Aetiology of diseases, call it Ardita (Facial paralysis).

Prognosis: A case of Arditam, appearing in an extremely enfeebled or emaciated patient, or exhibiting such symptoms as a

1. The portion of the text included within asterisks has been rejected by Jajjatacarya as spurious.

सु० नि० स्था०

winkless vision, inarticulate speech which hardly seems to come out of the throat, excessive palsy of the face, as well as the one of more than three year’s standing should be deemed as incurable. 72-77

पाष्णिप्रत्यङ्गुलीनान्तु कण्डरा याऽनिलार्दिता । सक्थ्नः क्षेपं निगृह्णीयाद् गृध्रसीति हि सा स्मृता ।। ७८ ॥

Grdhrasi ( Sciatica ) : The disease in which the two great nerve trunks (Kandara), which emanating from below the lower extremity of the thigh reach down to the bottom of the insteps and toes, and become stuffed or pressed with the enraged Vayu, thus depriving the lower extremities of their power of locomotion, is called Grdhrasi. 78

तल प्रत्यङ्गुलीनान्तु कण्डरा बाहुपृष्ठतः । बाह्वोः कर्मक्षयकरी विश्वाचीति हि सा स्मृता ।। ७९ ।।

Visvachi : (Erbe’s paralysis or Bracial neuralgia): The disease in which the enraged Vayu affecting the nerve-trunks (Kandara) which run to the tips of fingers from behind the roots of the upper arms, making them incapable of movement and depriving them of their power of flexion or expansion is called Visvaci.¹ 79

वातशोणितजः शोफो जानुमध्ये महारुजः । शिरः क्रोष्टुकपूर्वन्तु स्थूलः क्रोष्टुकमूर्धवत् ।। ८० ॥

Krostukasirsa (Synovitis of the knee-joints): An extremely painful swelling in the knee-joints, which is originated through the concerted action of the deranged Vayu and the vitiated blood is called Krostukasirsa from the fact of its resembling the head of a jackal (Krostuka) in shape. 80

वायुः कटयां स्थितः सक्थ्नः कण्डरामाक्षिपेद्यदा । खञ्जस्तदा भवेज्जन्तुः, पङ्गः सक्थ्नोर्द्वयोधात् ।। ८१ । ।

प्रक्रामन् वेपते यस्तु खञ्जन्निव च गच्छति। विद्यान्मुक्तसन्धिप्रबन्धनम् ।। ८२ ।। कलायखञ्जं तं

Khanja (Lameness): The disease proceeds from the drawing up of the nerve trunks (Kandara) of a leg by the deranged Vayu lying

1. When the aforesaid nerve of a single arm is affected the disease is restricted to it alone, while it attacks the both when both their nerves are affected.

about the region of the waist. When both the legs are similarly affected, the patient is called Pangu. He, whose legs tremble before starting for a walk and who afterwards manages to go on limping is called KalayaKhanja one in whom the bone-joints become loose. 81-82

न्यस्ते तु विषमे पादे रुजः कुर्यात् स्मीरणः । वातकण्टक इत्येष विज्ञेयः खड्डुकाश्रितः ।। ८३ ।।

पादयोः कुरुते दाहं पित्तासृक्सहितोऽनिलः । विशेषतश्चंक्रमणात् पाददाहं तमादिशेत् ॥ ८४ ॥

हृष्यतश्चरणौ यस्य भवतश्च प्रसुप्तवत् । पादहर्षः स विज्ञेयः कफवातप्रकोपजः ॥ ८५ ॥

अंसदेशस्थितो वायुःशोषयित्वांऽसबन्धनम् । सिरास्त्वाकुञ्च्य तत्रस्थो जनयत्यवबाहुकम् ।। ८६ ।।

Vata Kantaka : The local Vayu enraged by making a false step on an uneven ground, finds lodgment in the region of the ankle (Khudaka, instep according to others), thus giving rise to a disease which is called Vata Kantaka. The burning sensation in the soles of the feet caused by the enraged local Vayu, in conjunction with the deranged Pitta and blood, is called Pada-daha, which is generally seen to afflict persons of pedestrian habits. When the legs are deprived of all sensibility of touch, and a sort of tingling pain is experienced in them it is termed Padaharsa, which is due to the deranged action of the Vayu and Kapha. The disease in which the enraged local Vayu dries up the normal Kapha lying about the shoulder joints is called Ansasosaka. The form in which the aggravated local Vayu contracts the nerves of the arms is called Avabahukal 83-87

यदा शब्दवहं स्रोतो वायुरावृत्य तिष्ठति । शुद्धः श्लेष्मान्वितो वाऽपि बधिर्यं तेन जायते ।। ८७ ।।

Badhirya (deafness): The disease occurs only when the deranged Vayu, either singly or surcharged with the Kapha stuffs the soundcarrying channels (Srota) of the ears. 87

हनुशङ्खशिरोग्रीवं यस्य भिन्दन्निवानिलः । कर्णयोः कुरुते शूलं कर्णशूलं तदुच्यते ।। ८८ ।। icell

1. The Ansa-sosa is due to the single action of the enraged Vayu, while Avabahuka is due to the concerted action of the deranged Vayu and Kapha.

आवृत्य सकफो वायुर्धमनी: शब्दवाहिनीः । नरान् करोत्यक्रियकान् मूकमिन्मिणगद्गदान् ।। ८९ ।।

Karna Sula : The disease in which the deranged Vayu causing a piercing pain in the regions of the cheekbones, head, temples and neck, gives rise to a sort of aching pain in the tympanum, is called Karna-sula (otitis). The local Vayu, deranged and saturated with the Kapha stuffing the nerves (Dhamani) which conduct the sound of speech, produces complete (in some cases partial) loss of the power of speech–e.g. Muka (dumbness, Minmina (nasal voice) and Gad-gada (indistinct speech). 88-89

अधो या वेदना याति वर्चोमूत्राशयोत्थिता । भिन्दतीव गुदोपस्थं सा तूणीत्युपदिश्यते ।। ९० ।।

गुदोपस्थोत्थिता सैव प्रतिलोमविसर्पिणी । वेगैः पक्वाशयं याति प्रतितूणी तु सा स्मृताः ।। ९१ ।।

साटोपमत्युग्ररुजमाध्मातमुदरं भृशम् । आध्मानमिति जानीयाद् घोरं वातनिरोधजम् ।। ९२ । ।

विमुक्तपार्श्वहृदयं तदेवामाशयोत्थितम् । प्रत्याध्मानं विजानीयात् कफव्याकुलितानिलम् ।। ९३ ।।

A sort of pain, which (rising from the bowels or the urinary bladder and ranging downward) gives rise to a bursting sensation in the regions of the anus and the gentials, is called Tuni. whereas the one, rising upward from the preceding parts and extending up to the region of the intestines, is called Prati-tuni. A distension of the abdomen (Udara), attended with the incarceration of flatus (Vayu) and an intense pain and rumbling in its inside, is called adhmana (Tympanitis). When it first affects the stomach (Amasaya) and is unattended with an oppressive feeling about the heart and pain at the sides it is called Pratyadhmana. The Vayu saturated with the deranged Kapha cause the preceding type of distemper. 90-93

नाभेरधस्तात् सञ्चारी यदि वाचलः । अष्ठीलावद् घनो ग्रन्थिरूध्वमायत उन्नतः । वाताष्ठीलां विजानीयाद् बहिर्मार्गावरोधिनीम् ।। ९४ ।।एनामेव रुजायुक्तां वातविण्मूत्ररोधिनीम् । प्रत्यष्ठीलामिति वदेज्जठरे तिर्यगुत्थिताम् ।। ९५ ।।

A knotty stone-like tumour (Granthi) of considerable 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 Vatasthila, ( 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, appearing laterally or across the region of the abdomen (Jathara) and obstructing the passage of stool, urine and flatus ( Vata ) is called a Pratyasthila. 94-95

इति सुश्रुतसंहितायां निदानस्थाने वातव्याधिनिदानं नाम प्रथमोऽध्यायः ।। १ ।।

Thus ends the first Chapter of the Nidana Sthana in the Susruta Samhita, which treats of the Nidana of the diseases of the nervous system.


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