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Indian Medicine (Medicin), translated by C. G. Kashikar c12: V. Internal Diseases And Their Treatment

Indian Medicine (Medicin), translated by C. G. Kashikar c12

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V. Internal Diseases And Their Treatment

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§ 50. Children's Diseases¹ :— Even the Vedic medicine² contains information about children's medicine. Thus an incantation against worms in children is found in AV 5.23, cf. Kausika sūtra 29.22 f. where the lower end of a mortar-pestle (musala) is heated on fire and then passed to and fro three times on the palate of the child seated on the mother's lap to ward off the worms. The fourteenth chapter of the second medical work of the Bower MS deals exclusively with the treatment of children's diseases (kumārabhṛtya) and contains recipes for various kinds of diarrhoea, vomiting, constipation, worms, jaundice, throat-diseases, skin-diseases, being possessed by a male or female demon, fever, cough etc. Jīvaka cited therein ( 2.1081, cf. Hoernle's remark ) as an authority was a contemporary of Buddha and is called the "physician of children" ( komārabhacca )

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The later medical works attribute the usual children's diseases ( bālaroga, bālāmaya ) readily to the influence of the mother's milk. Thus except to the diseases of the suckling baby mentioned in § 43 the harmful effect of the mother's milk is divided also according to the principle of tridoṣas. Defective milk causes an inflammation of the eyelids ( kukūṇaka—Suppuration of the membrane of the new-born-Hirschberg ) in which the eye itches and frequently drops water and the child rubs the forehead, eye-borders and the nose, cannot look in the Sun, is not able to open the eyelids. If the child drinks milk of a pregnant mother, it suffers from cough, indigestion, vomiting, faintness, weakness, nausea, giddiness, and swelling of intestines. This is called pārigarbhika or paribhava ( MN 425; AS 2.1.173; Vang 889 ).

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A further source of diseases of childhood is the teething. Thus according to AS 6.1.179 f.; AHr 6.2.26 ff., diseases of every kind and on the entire body, particularly fever, headache, thirst, giddiness, dimsightedness, inflammation of the eye, ulcer on the eyelids, vomiting, cough, difficult breathing, diarrhoea and erysipelas are caused thereby. The teeth appear in the eighth month or later if the child is healthy, otherwise at the end of the fourth month. If the children suffer from pains caused by teething in too early an age, they cannot develop normally. The treatment consists of emetics and other medicines which, however, are to be given in very small dose. A child suffering from teething should not generally be subjected to severe cure, since the ailing appearances disappear by themselves when the teeth appear.

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The derangements of doṣas are also responsible for the origination of many children's diseases. Thus the disease of the palate tālu-kaṇṭaka is caused by the derangement of kapha in the flesh of the palate (soft palate). The symptoms are an (external) sinking in of the palate region, (internal) sinking of the palate, dislike of mother's breast, pain in swallowing, diarrhoea, thirst, pain in the eyes, throat and the mouth, inability to hold the neck (head) upwards and vomiting. From the derangement of three doṣas is caused a difficult form of erysipelas (visarpa), which is called mahāpadma. In general, all diseases of the grown-up, right from fever, particularly the minor diseases (kṣudraroga, cf. § 67, MN 426; Vang 889; Bhāv 2.4.208) attack the children also.

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Children's diseases are, however, particularly attributed to demoniac influences, perhaps because the innocent childhood is held especially accessible to such influences, and because the suddenness with which the severe illness appears and disappears in children cannot be explained otherwise. The demon jambha, who attacks the children, is Vedic and for his aversion the children are taken to mother's breast (AV 7.10. cf. Kauśika sūtra 32.1). Naigameya, Naigameṣa, partly a deity imparting birth of sons and the exchange of children in the womb, partly a demon making the children ill, is also Vedic. It also appears in ancient sculptures and has the head of a goat (later a ram's head) and is considered as the symbol of lewdness suited to the God of creation'. In the child attacked by Naigameṣa there appear flatulence, convulsions of the hands, feet and the mouth, froth in the mouth, thirst, tightening of fists, diarrhoea, hoarseness, discoloration, pains in the body, rattling in the throat, vomiting, cough, hiccup, sleeplessness, biting the lips, crookedness, looking upwards, violent delirium, unconsciousness, smelling of the flesh or fat, fever, tumour in one eye and other symptoms (AHr 6.3.12-14; AS 6.3.188; Su 6.27.16; MN 429). General signs of demoniac possession are the following: The child suddenly shrinks, becomes frightful and cries, it bites itself with teeth and also bites its nurse,

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looks upwards, bites its teeth together, groans, yawns, moves eyebrows, teeth and the lips, often spits out froth, becomes lean, does not sleep at night, has swollen eyes, suffers from diarrhoea and hoarseness, smells like flesh and blood, does not eat as before, does not take to breast ( MN 427; AHr 6.3.4-8; AS 6.3.187; Bhāv 2.4.197 ). The symptoms are fever and continuous crying (AS, AHr). Suśruta mentions nine *grahas*— four male and five female (*pūtanā*) which are also mentioned in MN, Vang and Bhāv. Cakradatta 406-12 speaks of twelve female fiends which he calles *mātṛkā* and which attack the child and make it ill from the 1st till the 12th day, month or year. AS 6.3.187; AHr 6.3.1-3 likewise distinguish twelve demons (*graha*), seven of which are female and the rest male. The *grahas* requested Skanda to procure livelihood for them; he turned to Śiva who advised them to attack the children in the houses in which the gods, fathers and guests, Brāhmaṇs and teachers are not honoured, no sacrifice is offered, broken dishes are used for food and in general the religious customs and rules of purity are not observed. They would thus get good livelihood and honour. Therefore such children whose nurses are dirty, or they themselves are unclean, or who cry at the time of morning and evening prayers, or who are angry, frightful or in a bad mood, or are alone in vacant places, are tormented by the *grahas* in sleep or even in awakened condition by all kinds of spirits. The *grahas* then enter the bodies of the children where they can be perceived only with the eye of science. For they can take any form they like and are invisible for ordinary mortals. The voluntary offences of the nurse or the mother also lead to the attack of the *grahas* ( AS 1. c.; Su 6.37; 6.27.6 ). For driving out the *grahas* medicines, baths, fumigation and the like and special sacrifices connected with the invocations of individual *grahas* are recommended besides anointing. Thus an oblation is offered to *Naigameṣa* with an invocation which calls upon " the famous god who has the sight of a goat, can take any shape that he likes " to guard the child ( Su 6.36.11 ).

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(1) Cf. Joachim, *Die Diätetik und die Krankheiten des kindlichen Alters bei den alten Indern*, Arch. fur Kinderheilkunde 12, 174-253 (1891). (2) Cf. Bloomfield, Grund. II, Ib, 61 f. (3) Cf. Winternitz, *nejamesa, naigamesa, nemeso*, JRAS 1895, 149 ff.; Buhler, *Specimens of Jaina Sculptures from Mathura*, EI 2, 314-8.

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§ 51. Fever :- At present about two-third of the death roll in India is, according to the statistical proofs, attributed to fever¹. In medical works also it is considered as the king of all diseases. In AV also the disease *takman* which corresponds to the later *jvara* "fever" is the most dreadful disease². In medicine the disease fever in human beings is considered as equal to the worst condition appearing in animals and nature such as madness in dogs, hollowness of trees, salt-desertness of soil and is frequently interwoven in myths. Thus it is said to have originated from Śiva's wrath-fire which became the frightful three-headed demon Virabhadra who disturbed the sacrifice of Dakṣa and even killed him and then harrassed the whole world in the form of fever with its companions nausea, joint-pains, headache, giddiness, fatigue, thirst, heat etc. ( AS 3.1.256; Su 6.39.8-14; Car 6.3.15-25; AHr 3.2.1 f.; Harita 264, 134 ). The wrath-fire (*kopāgni*, *roṣāgni*) reminds us of the heat in fever, just as in Vedic medicine *takman* is connected with the fire-god (*agni*)³.

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Fever exists when there is simultaneous occurance of symptoms, namely absence of perspiration, heat and pain in all limbs ( Su 6.39. 13 ff. ). The general causes of fever are : improper use of fomenting and other remedies, wounds of various kinds, other diseases, the ripening ( of tumours and the like ), fatigue, infirmity, indigestion, poison, the smell of (certain) plants and flowers, grief, evil influence of stars or seasons, sorcery or malediction, clouded mind or possession and in the case of women difficult delivery or injuries during the confinement or the first milk-secretion in the breasts ( l. c. 19-22 ). The tridoṣas of the body are deranged by such causes and are led astray so that the internal heat comes out rashly and the water element is retained. Therefore, a feverish man has a hot body and no sweat ( Su l. c. 22 f. ). There are eight different kinds of fever, seven of which are due to the derangement of one or more doṣas, and the eighth due to wounds and other external causes (Car 2.1.14; Su 6.39. 15-18; AS 3.2.260 f.; AHr 3.2.3 ). The common signs of an onset of fever are : fatigue, uneasiness, discoloration, bad taste in mouth, water in the eyes, heaviness and tearing in the limbs, want of appetite, nausea, sleepiness, yawning, laziness, tardiness, neglect of work, short breathing, alternative desire and dislike for sweet food, desire for warm, sour, salt and pungent things, excessive thirst, unstableness in walking, aversion to good advice, trembling, giddiness, delirium etc.

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At the approach of these signs and at the beginning of fever, light food or fasts are recommended, because the fever takes its origin in the stomach. Decoctions, ointments, fomenting remedy, plaster, bath, emetic, purgative, nasal remedy, fumigation etc. are then to be applied according to the condition. At the outbreak of fever the symptoms change according to its kind. Thus the fever proceeding from deranged vāta is characterized by the following signs : disproportionate coming and staying of the temperature and pain in different parts of body, numbness and stiffness of the feet, cramp in the calf of the leg, the joints as if torn, pain in the hips, pricking in the chest, the bones—particularly in the back as if cut down, violent pain in the arms, shoulders and temples, inability of the jaws to chew, noise in the ear, bad astringent taste in the mouth, yawning, dryness of the mouth, throat, palate and skin, thirst, constipation and hard stools, flatulence, dry cough etc. Symptoms of the fever caused by pitta : simultaneous coming and increasing of feverish appearances on the whole body, particularly during digestion, by midday and midnight or in the autumn, inflammation in the nose, mouth, throat, lips and palate, bitter taste in mouth, heavy temperature, thirst and desire for cold, yellow colour of nails, eyes, face, urine, faeces and the skin (jaundice) etc. Symptoms of the fever caused by kapha : simultaneous occurrence of fever-symptoms on the whole body, particularly after eating, before midday, in the first half of the night or in spring, a feeling of heaviness in the body, loss of appetite, nausea, excessive sleepiness and dullness, cold, salivation, cough and heavy breathing, sweet taste in the mouth, feeling of slight chill and desire for warmth, white colour of nails, eyes, face, urine, faeces and the skin, urticarial rash on the body, subdued pain, stiffness etc. ( Car 2.1.15-22; Su 6.39.25-34; AS 3.2.261 f.; AHr 3.2.6-22; MN 30 ff. ).

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Particularly dangerous is the fever caused by the derangement of all dosas (samnipātajvara) which, if coming in quite a pronounced form, is either incurable or curable with difficulty, and even if cured it leaves behind some permanent defect. On the 7th, 10th or 12th day this fever assumes a dangerous character whereupon it either disappears or leads to death. General symptoms : sudden change of heat and cold, pain in the bones, joints and head, the eyes drop water and are dim, irritated and crazy, the ears are ringing and painful, the throat is as if covered with thorns, there is sleepiness, senselessness, delirium, cough, difficult breathing, nausea, giddiness, the border of the tongue is of a burnt colour and the tongue is rough to touch, there is looseness of limbs, spitting of blood and pitta mixed with phlegm, shaking of head, thirst, want of sleep, beating of heart, seldom and sparing secretion of sweat, urine and faeces, feebleness of limbs, continual noise in the throat, dark-red pustules and eruption, dumbness, inflammation of the passages, heaviness of the abdomen, slow digestion, madness, irrelevant speech, black teeth, excessive sleepiness by day, sleeplessness by night, excessive perspiration or no perspiration, constipation or frequent (but insufficient) stools, loss of strength, hoarseness etc. There is thirteen kinds of this fever the nomenclature of which varies and is differently reckoned and described. The *abhinyāsajvara* is commonly known in which eyes and ears do not function, smell and touch also disappear, the patient groans, speaks little or remains dumb, helpless, sleepy, and lies breathing heavily, delirious, desires no food, the tongue is stiff, the throat is dry, sweat, urine and faeces are stopped, the eyes drop and so on. Closely connected with this is *hataujas* or *hṛtaujas* characterized by complete loss of strength. At the termination of *sannipātajvara* a swelling appears on the "ear-root" which can easily become fatal (*Car* 6.3.101 ff.; *Su* 6.39.35 ff.; *AS* 3.2; *AHr* 3.2.27 ff.; *MN* 34 ff.; *Bhav* 2.1.70 ff.; *Vang* 34 ff. ).

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The eighth kind of fever which proceeds from external causes (*āgantujvara*) can arise not only out of wounds and hurts of every kind but is also caused by strong excitation, particularly love, grief, fear or anger, possession, enchantment or malediction, the smell of poisonous plants or flowers, swoon, headache, trembling, vomiting, sneezing and other causes. It is also caused by poisoning, the symptoms of which consist of swoon, diarrhoea, black colour of mouth, heat and palpitation of heart etc. (*Car* 6.3.109-126; *AS* 3.2.263; *AHr* 3.2.38-45; *Bhav* 2.1.103-6; *MN* 40 f. ).

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The intermittent fever (*viṣamajvara*) forms a further variety of fever which is divided into five subsections : [1] *samtata* :- lasts for 7, 10 or 12 days, but in certain cases takes a still longer duration. This fever especially affects the chyle (*rasa*) or chyle and blood, generally all elements of the body and urine and faeces. [2] *satata* :- affects the blood and comes twice in course of day and night, i.e. once by day and once by night, or twice by day and twice by night (Arunadatta). [3] anyedyuṣka [Quotient fever] :- affects the flesh and comes at any time once within twentyfour hours. [4] tṛtīyaka [Tertian fever] :- affects the fat and repeats at interval of a day. In this fever there is pain in the head, upper coccyx or back according to the deranged doṣa. [5] cāturthaka [Quartan fever] :- affects the marrow and the bones whereby there is pain either in bones or in the head, and repeats every fourth day or lasts for two days as caturthaviparyaya while the first and the fourth days are free from fever. This fever is especially dangerous. The ‘hectic fever’ (*pralepaka*) which appears in Suśruta as corresponding to the *saṃtata* of other authors is very scarcely curable. It also appears as a peculiar type of intermittent fever. It makes the limbs hot and heavy and results in the death of consumptives. Related to this is *vātabalāsaka*. Balāsa and fever come together already in the Vedic medicine, and by these chiefly malaria seems to have been characterized (Car 6.3.52-81; Su 6.39.51-58; AS 3.2.264 f.; AHr 3.2.56-74; MN 42 ff.; Bhāv 2.1.107-141; Vang 51 f.).

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The fever is called "bodily" (*śārīra*) or "mental" (*mānasa* : typhus ?) according as it first affects the body or the mind. It is called "internal" (*antarvega*) if there is severe internal heat, "external" (*bahirvega*) if there is excessive heat in the skin. Cold fever is called *śitajvara*. The fever is "natural" (*prākṛta*) if it comes in rainy season, in autumn or in spring and is caused by the doṣas belonging to these seasons. It is "unnatural" (*vaikṛta*) if it comes at other times or does not proceed from the corresponding doṣas. It is called "unripe" (*āma, sāma*) in the following symptoms : salivation, nausea, fatigue, sleepiness, bad taste in the mouth, loss of appetite, passing of plenty urine, stiffness, constipation or undigested stools, acute fever with delirium etc. The signs of "ripening" fever (*pacyamānasya*) are : excessive chilliness, thirst, delirium, breathlessness, giddiness, laxity, and nausea. The fever may be considered as "resolved" (*nirāma*) by the following signs : hunger, lightness of limbs, relaxing of the fever, completion of period of first seven days. There is also another division of fever based on three different stages : navajvara, taruṇajvara upto 7 days, madhyajvara upto 14 days, jīrṇa or purāṇajvara of or less than 21 days. To the seven elements of the body correspond the seven kinds of fever residing in them. The fever residing in marrow or bones is dangerous, that residing in sperm which is characterized by erections and loss of sperm is fatal (Car 6.3.32-51; AS 3.2.263 f.; AHr 3.2.46-56; MN 48 ff.; Bhav 2.1.120-2).

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The identification of the above descriptions with the modern fevers in India presents difficulties¹, yet the intermittent fever and the remittent fever especially coming after the rainy season and having devastating effects as well as the pneumonic (*pralepaka*) and the wound-fever (*āgantu-jvara*) can easily be identified.

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Even though the Vedic medicine advises the surrender of the hot fever to the cold frog and the tying of a green-striped frog under the patient's bed, it also advises the application of *kuṣṭha*—a plant also used later as a remedy for fever². The Bower MS contains numerous recipes for fever, and the effect of *harītakī* (*Terminalia chebula*) as remedy against the intermittent fever is praised therein (2.939). The later literature is also full of recipes for every kind of fever, yet the application of dietetic remedy is particularly recommended. In the first stage upto the 7th day (according to others upto the 10th day) from the beginning of the fever, the patient should generally eat nothing or only thin decoctions (*yavāgū*) and the like in small quantity. Ordinary water should not be denied to him, yet he should, as a rule, take only boiled and warm water, as the cold water increases the fever and medicines have also a bad effect in this stage. In fever which comes immediately after meal, an emetic is first to be given. In general, the rule is to prescribe fast in the beginning, then promotion of digestion by corresponding diet, lastly medicines and purgatives after the fever has gone down. In mild fever medicines may immediately be given. In intermittent fever both purgative and emetic should be given. Bleeding should be resorted to in every kind of fever only if all other remedies have proved futile. Fever should be understood to have ceased if the head and body have become light; fatigue, deafening and heat have disappeared, the mouth has inflamed, the head itches, there is perspiration, appetite and sneezing. Even then the patient must avoid exercise, sexual intercourse, bath, taking a walk and wind-draught until he has fully recovered his strength (Car 6.3.136-342; Su 6.39.83-299; AHr 4.1; AS 4.1; Bhav 2.1.7-125; Vr 1.25 ff.).

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(1) Baines, *General Report on the Census of India 1891* (London 1893), 62. (2) Cf. Grohmann, *Indische Studien*, 9, 381 ff.; Bloomfield, l. c. 59 f. (3) Bloomfield l. c. 60. (4) Cf. Chevers, *A Commentary on the Diseases of India* (London 1886), 80, 263; G. Dacunha, *Dengue* (Bombay 1872); Baines, l. c. 62 f. (5) Bloomfield, l. c.

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§ 52. Diarrhoea, Dysentary and Cholera :—The common designation of diarrhoea, *atisāra* (cf. Vedie *āsrāva*) which, even at present, is a frequent cause of death in Bengal (*morbus Bengalensis*) is etymologically so explained that the water-element in the body which is driven out by the deranged *vāta*, extinguishes the digestive fire, is mixed with faeces, loosens the same and flows excessively (*ativa sarati*, Su 6.40.4 = MN 65; cf. AHr 3.8.3 f. = AS 3.8.279 ). The following are the causes of such derangement : food that is pungent, heavy, excessively fat, dry, hot, liquid or cold, unsuitable to each other (like milk and fish ) or injurious, if one eats too much or before digestion or drinks too much or drinks spoilt water or spirituous drink, poisoning, anxiety, grief, bathing for a long time, suppression of natural excretions, worms, haemorrhoids etc. Its signs are : pricking pain in heart, navel, anus, lower abdomen and the intestines, fatigue in the limbs, suppression of wind passing downwards, constipation, flatulence and indigestion. Further symptoms vary according to the kind of diarrhoea of which six kinds are commonly distinguished : 1. On account of the deranged *vāta* the stools are brown (MN) or dark (Su ), sparing but frequent, phlegmatic, frothy, hard, noisy and painful, the urine is retained, there is restlessness in the intestines, hips and thighs are indolent, the rectum is prolapsed. 2. If deranged by *pitta*, the stools are yellow, green, watery, thin, bad smelling, hot, and are under pressure, the patient also suffers from thirst, fainting, fits, heat and perspiration in the body, fever and inflammation of the anus. 3. In the case of the derangement of *kapha* the stools are white, sticky, covered with phlegm, tough, slow, noiseless, frequent, cold, the patient is weary and sleepy, is without hunger, does not know when he has had a stool, the stomach, the anus and the bladder are heavy. 4. In the derangement of *tridoṣas* the stools are of different kinds (Su, MN, AHr ), e. g. having the colour of whey, ghee, marrow, oil, fat or milk, or clear as water, or quite blue, red or black, smelling like carcass, pus or raw fish (Car). This form is particularly dangerous i. e. incurable. 5. If the cause is grief accompanied by insufficient feeding, the heat caused by the tears enters the bowels and disturbs the blood which then comes out with or without faeces. This kind is also scarcely curable. 6a. In indigestion (*āma*, *āmājīrṇa*) the tridoṣas trouble the intestines and cause painful stools of manifoldly different colours (Su, MN). 6 b. The vāta is deranged by agony and causes quick, warm, watery and liquid stools. According to another division dysentary is to be divided as unripe or acute (*āma*) and ripe or chronic (*pakva*), similar to fever (Car 6. 19.4-16; Su 6.40.1-18; AS 3.8.279 f.; AHr 3.8.1-14; MN 64 ff.).

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The *atisāra* is incurable if the stools are of abnormal quality e. g. having the colour of ghee, oil, fat, marrow, milk, whey and honey and if the patient suffers from thirst, heat, giddiness, dyspnoea, hiccup, pain in the sides and bones, speaking astray and other bad symptoms (Su 6.40.19-21; MN 70). The diarrhoea accompanied by fever is called *jvarātisāra*.

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Diarrhoea with blood (*raktātisāra*) is caused by excessive use of food promoting pitta and occurs in the diarrhoea caused by pitta (MN 71 = Bhāv 2.1.138). Another form of diarrhoea which can also cause bleeding (dysentary), is *pravāhikā* ('flowing') caused by unsuitable diet. The diet promotes vāta which then drives downwards and out of the anus the collected phlegm mixed with faeces (Su 6.40.138 f = MN 72). The diarrhoea accompanied by vomiting is called *chardyatisāra*.

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Closely connected with *atisāra* is *grahaṇī* or *grahaṇīroga*, *grahaṇīgada*—a kind of dysentary or chronic diarrhoea. *Grahaṇī* really means an organ above the navel, the seat of digestive fire that takes the undigested food and returns it in digested condition. If the *grahaṇī* is deranged by weakness of this fire, it sends out the food undigested (Car 6.15.54). Among its causes the neglected *atisāra* is particularly mentioned. In all cases the digestion is abnormal, stools are sometimes fluid, sometimes dry, thin, undigested, noisy, frothy, many times blue and yellow, or mostly phlegmatic, painful etc. Other less constant symptoms are: heart-burn, bad taste in the mouth, pain in the sides, thighs, chest, throat, vomiting diarrhoea, wasting, heat, fever and so forth. According to AS, AHr the difference between *atisāra* and *grahaṇī* is that the former disappears quickly, the latter gradually. The *grahaṇī*, moreover, lasts long and is also counted among the "major diseases" (Car 6.15.55-68; Su 6.40.166-177;

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AS 3.8.180 f.; AHr 3.8.15-30; MN 74-78). A particularly bad form of grahaṇī is saṃgrahagrahaṇī. It is characterized by noise in the intestines, inertia, feebleness and fatigue. The stools are fluid or solid, sparing or plenty, oily, with pain in the anus, undigested, sticky, noisy, a little painful, occur daily or once in 10 days, 15 days or in one month. The disease is aggravated by day and there is amelioration at night (MN 78 = Bhāv 2.1.155 = Vang 127 f.). The incurable variety of grahaṇī is known as "Scoop-wheel" (ghaṭiyantra) with numbness of both sides of the body, colic and splashing discharge as in pouring out of a bucket (Bhāv 2.1.156).

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The disease viṣūcikā, viṣūcī, is perhaps to be included among these, although it is dealt with in the medical works together with alasaka and similar conditions (cf. § 53). According to Wise, Dutt, Hoernle and AHr, viṣūcikā is "the cholera in its sporadic form"; yet there are other conceptions also¹. It is Vedic and appears in the Vājasaneya Saṃhitā as the result of too much use of Soma. In medicine also it is attributed to immoderateness. In other literature also mention of this disease is not rare. Thus in Rājatarangiṇī (edn. Stein) 8.88 it is mentioned as an example of a fatal and devastating disease. Car 2.3 mentions viṣūcikā along with alasaka while dealing with the epidemiology. The name viṣūcikā ("in both the directions" i. e. from mouth and anus) is to be derived from the evacuation from above and below. The Medical works, however, trace it to sūcī ('needle') because in this disease the vāta pricks the limbs as if with needles. Symptoms : Swooning faint, diarrhoea, vomiting, thirst, colic, giddiness, crookedness of hands and feet (being the meaning of the word udeṣṭana according to the commentators), yawning, heat, change of colour of the skin, trembling, pain in the heart, and severe headache. The following five are the bad and fatal complications : Sleeplessness, uneasiness, trembling, retention of urine and senselessness. If the teeth, nails and the lips become blackish, consciousness is gone, there is severe vomiting, the eyes sink, the voice becomes feeble, all joints become loose, then the patient dies (Su 6.56. 3-11; MN 65 f.; Bhāv 2.2.24 f.; Vang 196). Khallī i. e. gouty pain in hands and feet (= udeṣṭana) is mentioned as a common accompaniment; similarly pramilaka—drowsiness of eyes and pipāsā—thirst are also mentioned as accompaniments (Vr 6.60-62 along with comm.). The simultaneous occurrence of diarrhoea and vomiting is, however, considered as a special characteristic (Car 3.2.12-13).

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The treatment of diarrhoea should commence with fasts. In acute diarrhoea ( *āmātisāra* ) suppressive remedy should not be given immediately, since many diseases such as jaundice, enlargement of spleen, tympanitis, flatulence, *grahaṇī*, swelling of the belly, haemorrhoids, fever etc. arise out of untimely supression. If the patient is thirsty, he should be given water in which certain astringent medical stuffs are boiled; if he is very much hungry, light food should be given. For acute diarrhoea a large number of astringents, like *Bel* fruit (*bilva*), Devdār wood (*devadāru*) etc. are recommended. Still more constipative remedies are recommended for chronic diarrhoea, then also various enemata and so forth. In lingering diarrhoea milk boiled with three times quantity of water works like ambrosia. For *praṇāhikā* similar remedies, particularly milk with different additions are recommended. In diarrhoea washings and baths, heavy or fatty food and physical exercise and heat should be avoided. If urine passes without faeces, wind passes ( from the anus ), if there is good appetite and the intestines are light, then the disease is regarded as cured. In *grahaṇī* buttermilk is specially recommended. Other numerous recipes are partly similar to those for *atisāra*. Things evoking hunger, constipating and promoting digestion are generally given ( Car 6.19.17 ff.; 6.15.69 ff.; Su 6.40,25-137; 140-162; 178-181; AS 4.11-12; AHr 4.9-10; Vr 3.4 ). The Bower MS contains many prescriptions for these diseases. Later authors recommend mercury and opium.

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In curable cases one should brand both the heels of the person suffering from *viṣūcikā* and warm ( his body ); a sharp emetic should further be given to him; when the diet is digested he should fast and take digestive and purgative medicines. When the body has become pure and swooning faint and diarrhoea have disappeared, strenghtening enemeta and various medicines should be given ( Su 6.56.12 f. ). An ointment is also prescribed for *viṣūcikā* itself or for the pains in the eyes and head caused thereby, a lukewarm smearing for gouty pains in the hands and feet and for colic, an emetic, enemeta etc. for the " dreadful *viṣūcikā* " in general, branding the heels for very old *viṣūci*, which acts for bringing about the consciousness (? Vr 6.58 ff.). Similarly Vang 197-199, where salt water is recommended as emetic and hot pot for warming; and the pains in the *marman* are compared with the condition of one who has drunk poison; cf. also Bhāv 2.2. 26 ff. where pills and juices with Borax etc. are prescribed.

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¹ Cf. Semmelink, *Geschiedenis der Cholera in Oost Indie* (Utrecht, 1885, pp. 494) with Prof. Kern's translation of Su 6.56 and Car 3.2 on Visucika; the same author, *Histoire du Cholera* (ibid. 1885, p. 169).

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§ 53. Additional Diseases of Digestion :— Four kinds of digestion (fire) are enumerated already in the Bower MS 1.50 ff. : weak (*manda*), excessive (*tīkṣṇa*), irregular (*viṣama*), regular (*sama*). Similar statement is found in Su 1.35.24 where the ailments proceeding from these are also given : irregular (digestive) fire sometimes digests the food, sometimes causes flatulence, colic, constipation, diarrhoea, heaviness in abdomen, noise in the bowels, dysentary and causes vāta-diseases. Excessive digestion quickly digests even plentiful diet and causes dryness, burn and heat in the throat, in the palate and on the lips, as well as diseases of pitta. Weak digestion slowly digests even a small amount of diet and causes swelling of the body, heaviness in the head, cough, dyspnoea, salivation, vomiting, gout and diseases of kapha. Weakness of digestion (*agnimāndya*) is also considered as a particular ailing condition for which Vr 6.12, for instance, prescribed a pill consisting of *Asafoetida* (*hingu*), the three myrobalans (*triphalā*) and other substances and the Bower MS already knows a powder that gives 100 years' life (2.43-55).

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Closely connected with *agnimāndya* is *ajīrṇa* "indigestion" which is caused by excessive water-drinking, irregular meals, suppression (of hunger, impulse for stool or urine and other natural movements) and irregular sleep. Even light diet is not digested in *ajīrṇa* (MN 93). General signs : dizziness, stupifaction, distended abdomen, retention of wind, constipation or diarrhoea (ibid.). According to the deranged doṣa three forms— *āma*, *viṣṭabdha* and *vidagdha* are distinguished. *Āma* comes from kapha and causes heaviness, nausea, swelling of the cheeks and eyelids and eructation from the stomach immediately after meal. *Viṣṭabdha*, from vāta, causes colic, flatulence, manifold vāta-ailments, constipation of stools and wind, stiffness, numbness and pain in limbs. *Vidagdha*, from pitta, causes giddiness, thirst, swooning faint, manifold pains, sour eructation from stomach, sweat and heat (MN 91-93; Su 6.56.3). *Ajīrṇa* can lead to senselessness, delirium, vomiting, nausea, faintness, giddiness and even death. The following diseases are also considered as arising from *ajīrṇa* :— [1] *visūcī* (cholera nostras, cf. § 52), [2] *alasaka* (" tympany, flatulence ") characterized by inflation and tension of the abdomen, noise in intestines, obstinate constipation, thirst and eructation, colic and trembling and giddiness, [3] *vilambikā* (" constipation ") a condition scarcely curable yet without pain in which the food neither goes upwards nor downwards (Su 6.56.3-9; MN 94-96; Vang 185, 196 f.; Bhāv 2.2.24 f.). Various kinds of pepper, *Asafoetida*, dry ginger, *sauvarcala*-salt, cinnamon etc. appear as ingredients in the powders, pills etc. prescribed in the Bower MS 2.58 ff. for *ajīrṇa* and allied ailments. So also in later prescriptions. In all cases of *ajīrṇa* it is good to smear the belly with Asafoetida, pepper, ginger and stone-salt and sleep by day (Vang 186). For the treatment of *alasaka* and *vilambikā* similar rules as for *viṣūcikā* (Vang 199) are given, and so the Bower MS 2.80-84 already describes the preparation of a " Citron-pill " (*mātuluṅgagulikā*) which is equally applicable for *viṣūcikā* and *alasaka*.

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The colic (*śūla*), a frequent disease even in upper classes¹ in Bengal of today, does not appear in the old pathology (Car, Su, AS, AHr) as an independent disease, although it is frequently mentioned along with other diseases such as constipation, diarrhoea and the like, or as a symptom. In wider sense, pricking pains of every kind are to be understood by *śūla*, " spear ", especially " spear of Śiva " as e. g. *pārśvaśūla*- " pain in sides ", *hṛdi śūlāni*- " pain in the heart " (Bower MS 2.79). Frequently, however, it has a narrower meaning- " colic or violent pain arising from the bowels or stomach ", just as *parikartana*, *parikartikā* generally means " cutting ". According to MN 195-198 there are eight kinds of *śūla*: seven from the derangement of the *doṣas*, individually, in pair or united, and one from indigestion (*āma*). " Digestion-colic " (*pariṇāmaśūla*) and " colic of food and drink " (*annadravaśūla*) also belong to this. The complaints which give rise to these conditions are due mostly to different mistakes in the diet. *Pariṇāmaśūla* is caused during digestion. The accompanying signs in *vāta* are: flatulence, tympanitis, constipation, retention of urine, bad taste and trembling. Oily and hot medicines give relief to the patient suffering from this disease. In *pitta*: thirst, heat, bad taste, perspiration, deterioration by use of pungent, sour or salt things, amelioration by use of cold things. In *kapha*: vomiting, nausea, numbness, light but persistent pain. Relief is obtained by use of pungent and bitter things. In *annadravaśūla*, which arises during or after digestion, it makes no difference whether one eats wholesome or unwholesome food, eats or observes fast or regulates diet. Only emetic is helpful in this condition ( MN 1. c.; Vang 441 f.; Bhāv 2.3.1 f. ). Emetic, fasting, perspiration, remedies promoting digestion, suppository, cauteries and pills are recommended for curing śūla ( Vr 26.1 = Vang 442 = Cakra 180 ). Hemādri also mentions a ceremony in which a golden and silver spear (śūla) is presented to a sacrificial priest, and the challenge is given to the spear to cure the śūla in the belly, sides or the back ( caturvargacintāmaṇi, 1.755-757 ).

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One who cannot taste the food put in mouth suffers from arocaka. If one shows disinclination at the thought of food or when one sees or hears of it, then it is bhaktadveṣa (nausea). If one has no desire for food, it is abhaktacchanda (Bhoja in citations). Enemeta, purgative and emetic are prescribed respectively for arocaka arising from vāta, pitta and kapha. For arocaka arising from mental excitement, cheering-up is recommended ( Vr 14.3 = Cakra 117 ). Worse than arocaka is vomiting (chardi) which is related to it (Car 6.20; Su 6.49; AS 4.8; AHr 4.6; cf. MN 137 ff. ). Vomiting is caused by food that is too fluid or oily, disagreeable or saltish, by untimely or too plentiful or unwholesome eating, through fatigue, exhaustion, excitement, indigestion, worms, eating too hastily, objects causing nausea and in the case of women at the beginning of pregnancy. There are in general five kinds of vomiting with the accompanying signs : pain in the chest and sides, in the head and the navel; dryness of the mouth, swooning faint, deafening of the ears, giddiness, faintness, thirst, fever, sweet taste in the mouth, heat, colic, indigestion etc. The case is hopeless if the wind goes upwards stopping the canals which drive out of the body the excrements, sweat, urine and water, the vomit smells like or looks like faeces or urine and the patient is vexed by thirst, breathlessness, hiccup and pain (MN). The treatment, as a rule, commences with fasts, then follow the emetics if the patient is strong and has uninterrupted severe vomitings, and then a purgative. The diet recommended is as follows.— food that is dry, light and agreeable, juice of grapes or sugar and other juices, very cold water, fragrance, various powders, decoctions, licking substances etc.,

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The constipation already mentioned above as vilambikā is discussed in detail under the further conception of udāvarta, i. e.

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cessation or retention of natural excretions and necessities like winds, faeces, urine, sperm, watering from the eyes, sneezing, eructation, vomiting, sperm, hunger and thirst etc. ( Car 6.26.3-8; Su 6.55; MN 199-201; Vang 464-471; Bhāv 2.3.12-18 ). All these kinds of *udāvarta* are considered as causes of diseases. Thus the suppression of stools leads to flatulence, *śūla*, pain in the body, constipation, ascending of the wind or faecal vomiting. Closely connected or identical with this is the condition of *ānāha*. Accompanying signs in undigested faeces are : thirst, cold, heat in the head, pain in the belly, heaviness, a feeling of fullness in the chest, ceasing of eructation. If the excrements are digested, there follow stiffness in the hips and the back, constipation and retention of urine, colic, loss of consciousness, faecal vomiting and the signs of *alasaka* (see above). The suppression of wind going out of the anus leads, according to MN, Vang, Bhāv. to vāta-diseases, according to Su 6.55.7 f. to still worse results like colic, difficult breathing, headache, cough and sneezing, excretion of phlegm and bile and even faecal vomiting. The constipation is to be cured with suppository, enemata, purgative pills, powders and decoctions in ghee, also with perspiring remedies, smearings, baths, purging food etc. ( Car; Su; Vang; Bhāv; l. c.; Vr 28 f.; Cakra 185-188 ).

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By *amlapitta* according to Dutt (*nidāna* 181 note), dyspepsia with vomiting or diarrhoea, also blood-spitting, ( perhaps by cancer ), heat-burning and catarrh of the stomach are indicated. The older pathology ( cf. AHr 3.5.42 ) scarcely knows this disease; according to MN 307-9 the physician knows its existence by indigestion, giddiness, nausea, pungent or sour eructation, heaviness, burning in the chest and throat and loss of appetite. If it goes downwards, it rouses thirst, heat, loss of consciousness, dizziness, nausea, jaundice etc. If it goes upwards, there is vomiting, in which the vomit is green, yellow, blue, black, reddish or blood-coloured, very sour, phlegmatic etc. The physician should first give an emetic, then a mild purgative, which are followed by smearing with oil and a clyster ( Vr 53.1 = Cakra 304, cf. Vang 681-688 ).

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(1) Cf. Chevers, *Diseases of India*, 550, 591.

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§ 54. Swelling of Abdomen :- The purely external symptom of a partial or general swelling of the abdomen or the belly gives rise to the group of various diseased conditions like *gulma* and *udara*.

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By gulma is meant a round, growthlike swelling hardness in the intestines between the heart and the navel. It is either firm or movable. Generally five kinds of gulma are distinguished which are known from the following symptoms : frequent eructation, constipation, a feeling of saturation, noise and unrest in the intestines, flatulence, weak digestion, retention of urine and the wind, going up of the wind. According to Caraka the vāta deranged by injurious or excessive food etc. causes pain in the heart, bladder, sides and the navel and even growths (swellings) of different kinds in vātagulma. The growth is sometimes larger, sometimes smaller, ails sometimes severely, sometimes only a little, by virtue of the activity of the wind it is felt as if ants crawl on the body, the patient has the feeling as if he were pricked severely with a needle or a nail, gets fever in the evening, his mouth becomes dry, his breathing is difficult, his hair bristle, the spleen swells, he suffers from flatulence, unrest in bowels, indigestion, pain in the limbs, in the head and in the temple; his skin, nails, eyes and mouth, his urine and stools become dark-brown etc. When caused by pitta the tumour burns and is weak and sensitive to pressure; skin, nails etc. becomes green-yellow, the patient suffers from fever, diarrhoea etc. When caused by kapha the tumour is firm and hard; the skin, nails etc. become white, the patient suffers from cold fever, gout in the joints, cough and sneezing, consumption etc. In the case of all doṣas an incurable combination of all symptoms occurs. A gulma which is particularly greater, pervading the whole body or is spherical like a tortoise is also incurable. Raktagulma occurs in women only as a result of retained amenorrhoea, particularly after an abortion or child-birth and is easily misunderstood for pregnancy by the ignorant. The symptoms of the first four gulmas partly appear to be connected with hyperamia of liver and spleen, partly with enlargement of the belly and tumour in the belly, partly with floating kidney, floating spleen and similar conditions. The enlargement of spleen (plīhā) appears also as a particular disease. The treatment of gulma is to be directed especially towards the removal of the deranged vāta; so nutritional and perspiring remedies are to be applied, then mild purgative, enemata, lemon-juice and other juices of sour, salt and sweet taste, ghee with various additions etc. are to be given (MN 202-208; Car 2.3; 6.5; Su 6.42; AS 4.16; AHr 4.14; Vr 30; Vang 471-487; Bhāv 2.3.19.).

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Ailments similar to the first four gulmas fall partly under the conception of udara. Persons particularly suffering from weak digestion (*mandāgni*) are attacked by udara in which the saturated dosas penetrate between the skin and the flesh and severely blow up the belly as a result of unsuitable diet and other injurious causes. There are eight kinds of udara with the following signs: loss of appetite, sweet taste, oily and fat-containing food is slowly digested, one does not perceive whether the digestion is complete or not, does not endure oversaturation, the feet are swollen, the bladder ails, one becomes void of strength and breathes heavily even with small exertions, the faeces are retained, the belly is blown up even by light and sparing diet, veins appear on it and the wrinkles disappear and so on. Further common symptoms are: flatulence, inability to walk, feebleness, weak digestion, swelling of hands and feet, giddiness in limbs, constipation and retention of urine, heat, looseness and getting lean. 1-4. The special symptoms of the first three udaras which are derived from the dosas are distinguished chiefly (cf. gulma) by dark, yellow or white colour of the skin and veins on the belly. In the derangement of all dosas the patient becomes pale, lean and suffers from thirst. The derangement of all dosas can also be caused by poison or by an incantation of love consisting of food mixed with nails, hair, urine, faeces or menstrual blood of women. 5. plīhodara.

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This is caused by prolapse and enlargement of spleen which becomes hard as stone and pushed like the back of a tortoise and fills the left side of the belly with violent troubles. Similar symptoms on the right side are called yakṛddālyudara. 6. baddhaguda. This is caused by constipating food or by hair or stone in the food. The symptom is that the faeces accumulate in the anus and come out only in small quantity with troubles. There is also thirst, heat etc. and formation of a swelling between the navel and the heart. 7. parisrāvyudara or chirodara. This is caused by fish-bones, bones, wood, grass and other foreign bodies (*śalya*) in the food which wound the intestines and cause a flow of fluid from the anus with faeces and a swelling below the navel, with indigestion and other troubles. 8. udakodara, dakodara, jalodara. This is caused by untimely drinking of cold water. The belly is severely pushed as if filled with water so that it is felt and heard as a filled water-leatherbag. There is thirst, loss of appetite, prolapse and pain in the anus, feebleness, cough, breathlessness, swelling on the feet, etc. This is the ascitis coming already in the Vedas as thrown on the sinners by Varuna, the god of waters. It comes also in Manu 8.82 as "the fetters of Varuna" with which he fastens the perjurers. In other *udara*s also water can be produced and then they, as a rule, are incurable. Congenital *udara* is similarly incurable.

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In *baddhaguda* and *chidrodara* the patient dies mostly after 14 days. Of the remaining *udara*s, those caused by *vāta*, *pitta*, *kapha*, spleen, all *dosa*s and water are in succession more dangerous than the former. Fatal symptoms are the encroachment of the disease complicating all the vital spots in the body, the skin gets wet and thin, there is pain in the sides, loss of strength, swollen eyes, diarrhoea and vomiting etc. If the light remedies are ineffective, then, in the case of *udara* caused by all *dosa*s, the patient should be given poison mixed with drink or food, or in a fruit in which an excited serpent has bitten. For this, however, the physician must secure permission of the friends, relatives or wife of the patient, or of the Brāhmaṇas or the king or the *guru*. In the case of *baddhaguda* or *chidrodara* the surgeon should, after obtaining permission, take an incision (laparotomy) in the belly with a correspondingly big knife, four *angula*s below the navel on the left side, should open the intestines four *angula*s broad and pull them out. He should then examine them, remove the hair, faeces, stone etc. stuck inside. In *chidrodara* he should likewise take out the foreign bodies, wipe off the excretion, and should cause black ants to bite the wounded place whereupon he should pull off their bodies, the heads being stuck inside.

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Thereupon he should smear the bowels with honey and butter, lay them again in their place and sew up the external wound of the belly (Car, Su, AS, AHr). In *dakodara* the surgeon should, of course with permission, take an incision on the patient while friends have held him fast and have covered his body with cloth upto the arm-pits, on the left side, four *angula*s below the naval with *vrīhimukha* (trocar), as deep as the broad part of the thumb, then place inside a tube of tin or other material or a quill and tap the water of dropsy, not at one sitting lest it may cause thirst, fever and other complications, but gradually within 16 days. The wound should be rubbed with oil and salt and bandaged and a cloth should be covered around the body. The diet should be limited to milk for six months and eating should be resumed after an year (Car 6.13; Su 2.7; 4.14; AS 3.12; 4.17; AHr 3.12; 4.15; MN 236-242; Bhav 2.3.78-86; Vang 535-561).

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§ 55. Worm-Diseases :— The worms which play a prominent role as provoking disease in the European folk-medicine¹, especially in children's diseases, appear already in the Vedic medicine in different forms, not only as worms in the intestines, but also in the head, eyes, teeth and the nose². The later medicine also knows worms in the eyes, teeth, ears, head, heart and those of other kinds. According to MN 97 f. (= Vang 200 f.; Bhāv 2.2.37 ) there are 20 kinds of external and internal worms. The former originate from the faeces or sweat on the skin (comm. ). They resemble the sesame ( tila ) in size, form and colour, reside in the hair and the clothes, are either many-footed and are called lice ( yūkā ) or quite small, with the name likhyā and cause either a red eruption or itching boils. According to Car 3.7.10 ( cf. 1.19.3 : viṃśatiḥ krimijātayaḥ ) there are two kinds of external kṛmis, namely yūkā and pipīlikās. They stay in hair, beard, eye-lashes and on clothes.

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The internal worms arise from the faeces, phlegm or blood as a result of various defects in the diet, want of movement, sleep by day, warmth and the like. Their existence is known by fever, pale colour of the skin, colic, pain in the chest, giddiness, exhaustion, dizziness, loss of appetite and diarrhoea. Of the internal worms, seven according to Su and only five according to Car, MN, originate from faeces. According to Suśruta they are white and small, others are broad and provided with tails, the gaṇḍūpada are red and long, and throng towards the anus. According to MN, they are broad or round, thin or thick, dark, yellow, white or black. According to Caraka some are partly tiny, round, white, like long threads of wool, some are large, round, dark-coloured, blue, green or yellow. They arise in the bowels and cause colic, indigestion, diarrhoea, constipation, salivation, loss of appetite, thinness, weakness, goose-skin, pale skin-colour, itching in the anus when they go below. If they have become large and climb into the stomach, they cause eructation and breathing that smell like faeces. From phlegm, according to Suśruta, are caused six kinds of worms with the names darbhapuṣpa, cipiṭa, pipīlikā, etc. According to MN, Car, they are seven with the names antrāda ( devouring the intestines ), udarāveṣṭa or udarāda ( choking or devouring the stomach, tapeworm according to Wilson and Bohtlingk-Roth ), hṛdayāda ( heart-eater ), mahāguda ( longtailed ), curu, darbhakusuma, ( Darbha flower ). They are produced in the stomach and crawl in all directions, are hairy or have hair on the head, possessing tails, with dark-coloured rings, like a long stalk of corn or thread or an earthworm or similar to fleshy muscle (?) thin, long or tiny, white or copper-coloured etc., devour the marrow, lick the eyes, disturb the palate and the ears, cause nausea, salivation, indigestion, loss of appetite, loss of consciousness, vomiting, fever, thinness, sneezing, cold, headache, pain in the chest etc. From the blood are caused seven (according to Car, MN, six) :- 1-3. kesaromanakhāda (devourer of the hair on the head and on the body and nails), 4. dantāda (teeth-eaters that cause decay), 5. kikkisa, 6. kuṣṭhaja (arising from skin-diseases), 7. parisarpa (a kind of leprosy). This is according to Suśruta. Caraka and MN have partly other names like romadepa (destroyer of hair-roots), audumbara or udumbara (exciting a skin-disease). These kṛmis originating in blood are found in the blood-canals, are quite tiny (so one cannot see them partly on account of their smallness), red like copper, round and without feet. According to Su they are bloody, black, sticky, broad, they cause most of the blood-diseases, and are invisible. In Suśruta's opinion both the hair-destroyers are incurable. According to Car they devour the skin, veins, sinews, flesh and the cartilage when they have attained a large size (Car 1.19.3; 3.7.11; Su 6.54.1-19; MN l.c.). The question whether the tapeworm is mentioned by the name udarāveṣṭa or by some other name in what has preceded, is difficult to decide. Individual passages seem to prove the same; so also the earth-wormlike belly-worm and the thin, slender oxyurids (white, small, thronging towards the anus, causing itching in the anus etc.) are clearly distinguished." As remedy for worms viḍaṅga (Embelic Ribes)⁴ is mentioned very frequently. For lice, smearing with quicksilver (rasendra) etc. is recommended (Su 6.54. 20 f.; AS 4.22; AHr 4.20; Bhāv 2.2.39 f.; Vang 202-205; Vr 7).

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