Garudapurana 1.156

The glorious Garuḍa Mahāpurāṇa — 156.
Dhanvantari said: / Now I shall explain the etiology of piles (arśas), O Suśruta! / The pegs that constantly arise in the flesh of living beings,

are called piles (arśas) because they obstruct the anal passage. / The doṣas, vitiating the skin, flesh, and fat, produce diverse forms of

fleshy sprouts in the anus and other parts; they call these piles. / Briefly, their division is twofold: congenital and arising in later life.

The varieties are dry and exuding, residing in the region of the rectum. / It measures four and a half finger-breadths; in it are three [folds], each situated at one and a half finger-breadths.

Among them, the inner is pravāhiṇī, in the middle of the bowel is visarjinī, / and the outer is saṃvaraṇī, at the anus, extending outward by a finger-breadth;

at a measure of one and a half finger-breadths further on are the hairs. / The cause of the congenital ones is the affliction of the seed in childhood;

the creation of the seed of piles is from the misconduct of mother and father, / from the wrath of deities, or from the combination of doṣas in another manner.

All hereditary diseases are declared to be incurable. / The congenital ones, in particular, are rough and unsightly,

turned inward, pale, and accompanied by severe complications. / They are also to be classified individually from the single doṣas, their combination, and their gathering.

The dry ones are from vāta and kapha, while the moist ones are from blood and pitta. / The cause of the aggravation of the doṣas is as stated before in [the chapter on] wasting and other diseases:

when the digestive fire is impaired and wastes are excessively accumulated; also from excessive sexual intercourse; / from agitation caused by drinking, and eating irregular, hard, or meager food;

from trauma caused by the enema nozzle, ulceration of the throat or lips, and splitting of the palms or soles; / from contact with extremely cold water, and constant excessive straining;

from suppressing or forcefully expelling the urges of passing urine and feces; / disgust, diarrhea, and grahaṇī are also complications of it;

from emaciation, irregular exertion, and the like; in women, furthermore, / from miscarriage of an immature fetus, and pressure from the growth of the fetus.

By these and other such causes, the apāna vāyu, aggravated in the fecal matter / and in the folds of the anus, having moisture and circular shape, swelling into full forms,

piles are born. Their premonitory symptoms are: weakness of the digestive fire, / flatulence, debility of the bones, cramps in the calves, and dizziness;

thick swelling arising in the eyes, looseness or retention of stool, / wind moving downward confounded, usually wandering below the navel;

with blood, cutting pain, contracting with difficulty while panting, / rumbling in the intestines, abdominal distension, and abundant sour or caustic belching;

abundant urine, scanty stool, lack of appetite, a smoky sensation in the gut, / pain in the head, back, and chest, laziness, and loose feces;

longing for sensory objects, anger from slight provocation, / suspicion, grahaṇī, swelling, anemia, abdominal tumors, and dropsy.

These very symptoms increase when [the piles] are formed under their specific names; / for the wind, turning back due to the obstruction of the downward path caused by them,

agitates the other winds going to all the sense organs and the body, / and the wind, drying up urine, feces, pitta, and kapha,

steals the digestive fire; then all [kinds of] piles generally develop. / The patient becomes exceedingly emaciated, dispirited, dejected, weak, and lusterless,

destitute of strength, bereft of complexion, like a tree consumed by pests; / seized by painful and severe complications, and torment of the vital parts as described in consumption;

likewise with cough, thirst, bad taste in the mouth, asthma, chronic rhinitis, / fatigue, aching of the limbs, vomiting, sneezing, swelling, and fevers;

afflicted with impotence, deafness, numbness, and urinary gravel, / emaciated, with a broken voice, brooding, spitting repeatedly, and lacking all relish.

suffering from sharp pain in all joints, bones, heart, navel, anus, and groins; / through the rectum dripping bile resembling a heron's belly,

dried up, discharged at the tip, alternately cooked and raw, / pale yellow, smeared with turmeric, and slimy is evacuated.

Anal polyps having an excess of wind are dry, tingling, / reddish-brown like glowing coals, rigid, irregular, and rough in shape;

dissimilar to each other, crooked, sharp, with cracked mouths, / resembling beans, dates, wild jujubes, or cotton fruits;

some resemble kadamba flowers, some are like mustard seeds; / causing severe distress in the head, flanks, shoulders, calves, thighs, groins, and elsewhere;

causing sneezing, eructation, constipation, cardiac distress, and anorexia, / bringing on cough, dyspnoea, irregular digestive fire, ringing in the ears, and dizziness.

Afflicted by them, a person passes knotty, scanty, noisy stool with tenesmus, / accompanied by pain, froth, and slime, [passed] with obstruction.

His skin, eyes, and mouth become black, and urine and stool are obstructed; / moreover, abdominal tumours, spleen disorders, and stone-like swellings arise in him.

Those dominated by bile have blue tips, with red, yellow, and black lustres; / their discharges flow from slender tips, they smell like raw meat, and are thin, soft, and flaccid;

resembling parrot tongues, pieces of liver, or leech mouths; / causing burning, emaciation, fever, perspiration, thirst, fainting, anorexia, and confusion;

they are accompanied by heat; the faeces are liquid, blue, hot, yellow, red, and undigested; / they are barley-shaped in the middle, and the skin, nails, and other parts become green, yellow, and turmeric-coloured.

Those dominated by phlegm have deep roots, are dense, cause dull pain, and are white; / elevated, fleshy, unctuous, rigid, round, heavy, and firm;

slimy, motionless, smooth, very itchy, pleasant to the touch; / resembling karīra sprouts, jackfruit seeds, or cow udders;

causing fullness in the groins, cutting pain in the anus, bladder, and navel; / accompanied by cough, dyspnoea, nausea, excessive salivation, anorexia, and chronic catarrh;

causing great dysuria, heaviness in the head, chilliness, and alkaline discharges; / producing impotence, dullness of digestion, vomiting, diarrhoea, and other disorders;

accompanied by tenesmus and copious stool mixed with fat-like matter, phlegm, and blood; / they do not bleed or burst; the skin and other parts are pale and oily.

From combinations [of two doshas] arise combined symptoms; from all three combined, all signs are present. / Blood-dominated piles in the rectum have the shape of bile-type piles,

resemble banyan sprouts, and look like guñjā berries or corals. / Afflicted by tight constipation, they suddenly bleed

excessive, vitiated, and hot blood; and from its excessive flow, / looking like a peacock, he is afflicted by miseries arising from blood loss;

diminished in complexion, strength, and enthusiasm, his vitality destroyed, his senses clouded. / By mung beans, kodo millet, citron, karīra, chickpeas, and the like,

which are dry and astringent, wind is aggravated in the seat of stool and becomes strong; / blocking the downward-moving channels and drying up below,

it produces severe retention of wind, stool, and urine; / thereby, intense pain arises in the abdomen, back, heart, and flanks;

distension in the abdomen, retained faeces, nausea, cutting pain, / especially severe colic in the bladder, and swelling of the cheeks occur.

Because wind moves upward, there arise vomiting, anorexia, fever, / heart disease, disorders of the duodenum, urinary retention, and tenesmus;

deafness, severe head pain, dyspnoea, headache, cough, and chronic catarrh; / mental disturbance, thirst, breathlessness, bilious abdominal tumours, and other disorders.

These highly dreadful diseases caused by wind arise; / udāvarta is the most grave complication, an enemy of longevity, [caused by] piles.

In those whose bellies are overwhelmed by wind, it arises even without them. / But those piles that are congenital, and those situated on the innermost fold,

are incurable; they are palliated by digestive strength and the like. / Those born of two doshas, and those situated on the second fold,

are said to be curable with difficulty, as are those lasting over a full year; / but those arisen on the outer fold, aggravated by only a single dosha,

are easily curable piles, if not of long standing. / They will also be described on the penis and other parts according to their characteristics; but those born at the navel

have the form of earthworms, slimy and soft. / Vyāna wind, seizing phlegm, produces piles on the exterior of the skin,

peg-like, firm, and rough; they know it as a cutaneous wart. / By wind there is piercing pain and roughness; from bile there is a blackish tip;

from phlegm there is unctuousness, knottiness, and same colour as the skin. / An intelligent person should quickly make an effort for the relief of piles; / for, quickly causing disease, they may cause intestinal obstruction.

Thus in the glorious Garuḍa Mahāpurāṇa, in the first section called the first part, in the section on Conduct, the one hundred and fifty-sixth chapter, named “Diagnosis of Piles”.