The Nidanam of Chlorosis ||162||

1-2Dhanvantari said: -Hear me, O Susruta, now discourse on the Nidanam of chlorosis (Pandu), Oedema and Anasarca (Sotha). The morbific principles of Vayu and Kapha, in combination with the Pittam extremely aggra-vated through their respective aggravating factors, are carried upward in the region of the heart, the deranged and aggravated Vayu supplies the motive power in these instances, and the aggravated Pittam, through the channels of the ten Dhamanis (nerves) which branch out from that locality, spreads all through the organism.
3The deranged Pittam vitiates the Kapham, blood, skin, and flesh of the body, imparting a varied hue to its skin.
4As the colour of the skin largely becomes yellow (Pandu) like turmeric in this disease, it is called Pandu Roga Jaundice.
5In the Amaja type of Jaundice, the fundamental principles of the body become lighter and considerably lose their consistency. The patient suffers from a marked anemia, the functions of the sense organs are impaired, the limbs become loose and flabby, the quantity of fat is diminished in the body, and the bones are deprived of their substance.
6The limbs get thinner and thinner every day, a clammy perspiration is felt in the region of the heart, a burning and aching sensation is experienced both in the conjunctiva and sockets of the eyes, and the mouth becomes filled with saliva.
7Thirst is conspicuously absent. The patient cannot bear the least cold, and abhors all cold things, and a persistent fever of equal intensity, attended with dyspnea earache, vertigo, vanishings of sight, impaired digestion and horripilation on the skin of the head are found to supervene.
8-9The disease admits of being grouped under five subheads according as it is engendered through the several, or concerted action of the morbific principles of the body. A peculiar type of chlorosis is caused by eating earth, and the premonitory stage of all types of Jaundice develops such symptoms as, perspiration about the region of the heart, dryness of the skin with a repugnance for food, yellowness and scantiness of urine, or absence of perspiration. The Vataja type of Chlorosis is marked by lassitude of the body, a stupour like that of a drunkard, and an excruciating pain in the limbs.
10The veins, fingernails, feces, urine, and conjunctive assume a black colour, or look dry and coloured like vermilion, and oedematous swelling of the limbs and dryness of the feces and of the mouth and the nostrils are the symptoms which further characterize this type of the disease.
11In the Pittaja type the veins become either yellow or greenish coloured, and fever with thirst, fainting, vanishings of sight, heat, and emaciation of the body with a bitter taste in the mouth and longing for cold things are found to supervene.
12-13Diarrhoea, acid risings, a burning sensation in the body, clamminess of the cardiac region, somnolence, a saline taste in the mouth, cough, and vomiting are the features which mark the Kaphaja type of Jaundice, which is very distressing in its effect. The expectorated mucous in this disease acquires a pungent or sweetish taste either through a preponderance of the deranged Vayu or Pittam.
14The deranged phlegm vitiates the fundamental principles of fat etc., of the body, and produces a condition of parchedness in the organism which results in hemorrhage. The deranged Kapha, as before described, obstructs the internal vessels of the body, and thereby produces its general emaciation.
15In Jaundice, the face of the patient gets thinner, the scrotum and the muscles of the calves and abdomen are withered up, and the patient passes stool, which is mixed with blood and mucous, and contains hosts of little intestinal worms.
16An injudicious use of extremely Pitta generating food by Jaundice-patient is followed by an attack of Kamala (Chlorosis). The deranged and aggravated Pittam, in the disease, coming out of its seat in the abdominal vacity, scorches up the flesh and the blood.
17The urine, eyes, skin, face and feces of the patient assume a yellow colour, and thirst, and indigestion with a burning sensation in the body are found to supervene. The patient lies like a bloated toad, weak in all his limbs and organs.
18The unassimilated Pittam, in this disease gives rise to a kind of general anasarca, which, being neglected, may run into a case of Kumbha Kamala.
19-20The undigested bile produces greenness of complexion, the deranged Vayu and Pittam give rise to vertigo, and thirst, and a low fever with fondness for female company, somnolence, extreme lassitude, and impaired digestion are the symptoms which mark the premonitory stage of Halimaka.
21-22I have already, told you, O Susruta, that Shotha is one of the most dreadful diseases, now hear me discourse on the Nidanam of that disease. The deranged Vayu, by driving the deranged Kapham (phlegm), Pittam and blood to the external vessels of the body, make them incarcerated. in the local skin and flesh, giving rise to a raised and compact swelling which is called a Shotha.
23The disease may be divided into nine different types according to the difference of the morbific principle acting as. its exciting factor, inclusive of those which are of extraneous origin, or are caused by ardent sexual passion.
24The last named kinds of Sotham extends all over the body. The swellings may be divided into three classes according as they are extended raised and pointed, or knotty and concurrent in shape.
25The several action of the deranged Vayu, Pittam and Kapham may be set down as the exciting casues of all fortes of swellings, and they are often found to invade persons emaciated with disease, over work, or fasting.
26-29Ingestion of inordinate quantities of pot herbs, or of extremely cooling, saline, acid or alkaline articles of fare, drinking of large quantities of water, and excessive sleep or wakefulness may likewise serve to bring on an attack of Sotha. Suppression of any natural urging of body, ingestion of dry meat, or of heavy and indigestible articles of fare, or excessive riding are the factors which tend to obstruct the orifices of the vessels of the body, thus causing the appearance of an oedematous swelling about the locality of obstruction, dyspnea, cough, dysentery, hemorrhoids, ascites, · leucorrhoea, fever, tympanites, vomiting and hiccough may be manifest as supervening, distressing. symptoms in a case of oedema. The morbific principles of the deranged Vayu, Pittam and Kapham, finding lodgment in the upper, middle, or lower part of the body, or in the urinary bladder, may give rise to an oedematous swelling about the seat of their lodgment, while spreading all through the organism they tray give rise to a general anasarca. An increased temperature of the body, heaviness of the limbs, and a kind of breaking, expanding pain in the veins are the symptoms which mark the premonitory stage of oedema.
30-31In the Vataja (nervous) type of oedema, the swelling is found to be shifting in its character. It assumes a blackish or reddish colour and is felt rough to the touch. The hairs about the base of the swelling become rough, and the patient complains of a breaking pain about the temporal bones or in the urinary bladder, pelvis and the intestines, and suffers badly from insomnia. The swelling is speedy in its growth and even· in its formation, and perceptively yields to pressure, entirely, disappearing after massage.
32After the application of a mustard plaster to it, a sort of tingling sensation is experienced inside the swelling, which increases in size during the night and markedly subsides during the day.
33In the Pittaja type, the swelling assumes a black, red or yellow colour, and is marked by a burning sensation in its inside; the swelling does not readily subside, and an intolerable burning sensation of the body indicates its advent.
34Fever with thirst and a burning sensation in the skin, perspiration, vertigo, stupor, and loose motions of the bowels are its distressing concomitants. The swelling emits a peculiar fetid smell, yields of pressure, and is felt soft to the touch.
35In the Kaphaja type, the swelling assumes a grey colour and becomes cold, glossy, firm and hard-skinned. An itching sensation is experienced in its inside, and somnolence, aching pain and impaired digestion are the symptoms which manifest themselves with the progress of this type of the disease.
36An oedematous swelling may appear as the effect of a stroke, blow, cut, or wound, or as the outcome of an exposure to cold winds, or see breezes, or that of being rubbed with a Kapikacchu berry or with the juice of Bhalliitaka.
37It may also appear in the body of a person after a long pedestrian journey. All these kinds of swelling are marked by extreme heat, and exhibit symptoms peculiar to the Pittaia type.
38-39Similarly, the touch of a venomous reptile, or that of its excretions, or a bite by a venomous animal, or an exposure to a breeze blowing over poisonous trees, smelling of dusts and pollens of poisonous flowers are the factors which may likewise produce swellings of the body. These swellings are soft and shifting, and usually appear about the lower part of the body.
40A swelling of recent origin, unattended with any of the distressing symptoms, tray be easily cured, while one of the onnosite kind should be regarded as incurable.