The Nidanam of Dysentry ||157||

1Dhanvantari said: -Hear me now, O Susruta, discourse on the Nidinam of Atisara (dysentery) and Grahini (Lienteric diarrhoea) The three morbific principles of the body such as the Vayu, Pittam, and Kapham, as well as their combinations and fright and grief may be set down as the exciting factors of Atisara, which admits of being divided into six different types.
2Drinking of large quantities of water, ingestion of dry food, or of inordinate quantities of lard, oil, butter, or cakes, and excessive indulgence in cups may be likewise set down as the exciting causes of the disease.
3The bodily Vayu (nerve force), disturbed on account of either day-sleep, keeping of late hours, presence of worms in the intestines, and voluntary repression of any natural urging of the body, etc., takes lodgment in the intestines and impairs the digestive function, causing a rush of blood to the nether regions of the body.
4-5aThe Vayu by continuing in the intestines with the feces and ingested food, serves to liquify the stool and give rise to the disease which is called Atisara.
5b-7A breaking pain in the rectum, abdomen and cardiac region, together with a sense of lassitude and constipation of the bowels are the premonitory symptoms of Atisara. Distension of the abdomen, together with indigestion, scanty ejection of the contents of the stomach without any sound or report, frothy turbid stool, or constant passing of knotty, slimy feces, and a booming, cutting pain about the anus mark the Vitaja-type of Atisara.
8-9Fever is absent in this type of Atisara. The anus is. constricted, or the patient suffers from prolapsus ani together with dyspnea and horripilation. Constant passing of yellow, black, yellowish, greenish or blood-coloured, fetid smelling stool, together with thirst, epileptic fits, and a burning sensation in the body mark the Pittajatype.
10-11An aching, burning pain in the region of the anus, together with constant passing’s of thick, slimy, scanty stool, characterizes the Kaphaja type of Atisara. All the above said symptoms together with nausea, vomiting, a sense of heaviness about the anus and in the abdomen, and horripilation are the characteristics of the Saimipatika-type. The patient loses all consciousness in this type and thinks what he has done as undone. The bodily Vayu enraged through the effect of fright upon the mind liquifies the stool which is immediately passed out in hot or warm jets.
12In the Vata-Paittika-type symptoms respectively described under the Vataja and Pittaja-types of Atisara are combinedly exlubited. The specific symptoms of Atisara brought about through the action of grief are identical with those described under the fright-born type.
13The disease admits of being -further grouped under two broad subdivision such as, the Sama (with mucous) and Nirama (without mucous). In the first named type (Sama). the stool emits a very fetid smell, and nausea with distension of the abdomen, and suppression of urine are also present.
14-15A case exhibiting symptoms others the foregoing ones should be included within the Nirama group. A marked predominance of the deranged Kapham in the body during the term of Atisira leads to death. A case of Attsara neglected at the outset may run into one of Graini (Lienteric diarrhoea). Ingestion of a large quantity of articles, that impure the digestive function, brings about either Ama or Nirama type of fever.
16-17Incarceration of undigested food in the stomach is sure to be followed by an atack of Atisara of the Sama-type. The disease is so named from the fact of one’s passing large (Ati) quantities of stool during its attack. This disease naturally and invariably proves fatal. A case of Amatisara usually follows from indigestion and on account of the incarceration of a digested fecal matter in the intestines. A case of old and persistent Atisara runs into one of Grahini which may be divided into four different types such. Vataja-Grahini. Pitaja-Grahini, Kaphaja-Grahini. and Sannipatika-Grahini.
18-21A sense of lassitude in the limbs and constant emission of – flatus together with salivativa. and a distaste in the mouth thirst, vertigo, repugnance for food, colic, vomiting, and buzzing in the ears are the general indications of Grahini. Weakness and emaciation of the body, hot eructation’s, dyspepsia fever, epileptic fits, a sensation of numbness in the head and cardiac region, edematous swelling of the extremities, drowsiness, parchedness of the palate, darkness of vision, noise in the ears, pain (crams) in the neck, thighs, sides and inguinal regions, and cholera are the symptoms, which are found to supervene. All these symptoms are aggravated in a weak patient, thirst and hunger being specially and oppressively increased.
22-23The abdomen gets distended close upon the completion of digestion, and the patient finds a little relief immediately after eating. Palpitation of the heart, with pain in the cardiac region and kindred complaints, internal glands (gulmas) rectal hemorrhoids, splenic enlargement, Chlorosis and loss of consciousness should be regarded as the distressing and supervening troubles in a case of Vataja-Grahini.
24-25The stool is frequent, and either loose, hard or frothy and is passed with loud report, causing pain about the anus as well as cough and dyspnea. In the Pittaja-type, the stool is either yellowish, or bluish yellow.
26Acid eruptions, with a burning sensation in the heart and throat, repugnance for food and an upuenchable thirst are the further characteristics of this type of Grahini.
27Painful motions of the bowels, difficulty of digestion, vomiting, reprugnance for food, burning sensation in the mouth, salivation, cough, nausea, catarrh, distension and heaviness of the abdomen, sweet eructations, lassitude, and horripilation are the specific features of the Kaphaja type.
28The patient passes thick stool charged with mucous All the abovesaid symptoms are exhibited in the Sannipatika type.
29Epilepsy, stone in the bladder, Leprosy, Gonorrhea, Ascites, fistula in ano, hemorrhoids, and Grahini should be regarded as great malades (Maha Roga) and cures in these cases are extremely difficult.