A History of Indian Medical Literature v1.c13.95

v1.c13.95

The subjects dealt with are: the classification of haemorrhoids into those present at birth (sahaja) and those developing at a later time (uttarakālaja); the substrate (āyatana) of those present at birth is the damaged (upatapta) bīja,³⁷⁰ responsible for the development of the ano-rectal folds (gudavali); damage to the bīja is in this case, as in all sahaja disorders, caused by faulty behaviour (apacāra) of the parents and transgressions during a previous existence; haemorrhoids are defined as a disorder characterized by an excess of muscular tissue (adhimāṃsavikāra) (14.5); the site (kṣetra) of all haemorrhoids is composed of the three ano-rectal folds (gudavali),³⁷¹ which occupy a space (avakāśa) measuring five fingers (aṅgula) and a half³⁷² and divide this space into three parts; some are of the opinion that growths called arśas are also found on the penis (śiśna), the female genitals (apathyapatha), in the pharynx (gala), on the palate, in the oral cavity (mukha), nose and ears, on the eyelids and the skin; these also consist of an excess of muscular tissue (adhimāṃsa), but only those arising from the ano-rectal folds are regarded as haemorrhoids in the present treatise; the substratum (adhisṭhāna) of all haemorrhoids consists of fatty tissue, muscular tissue and skin (14.6);³⁷³ the shapes and colours of sahaja haemorrhoids (14.7); their symptoms (14.8);³⁷⁴ the aetiology and pathogenesis of acquired haemorrhoids (14.9); their shapes (14.10); the symptoms of haemorrhoids brought about by vāta (4.11) and their aetiology (14.12–13);³⁷⁵ the symptoms and aetiology of haemorrhoids brought about by pitta (14.14 and 15–16), kapha (14.17 and 18–19), and a combination of two or three doṣas (14.20);³⁷⁶ the prodromes (14.21–22);³⁷⁷ haemorrhoids are always caused by all three doṣas, but designated after the predominant one (14.23); the excitation of the five kinds of vāta, of pitta, kapha, and of the three ano-rectal folds collectively leads to the appearance of haemorrhoids, a painful disorder, usually difficult to cure (14.24–25); the degrees of curability and their determining factors (14.26–32);³⁷⁸ treatment by means of excision (kartana), caustics (kṣāra) or cauterization (dāha), to be performed by experienced specialists, on account of the risks involved; the complications that may arise from these treatments (śastrakṣārāgnivibhrama); the hazardous character of the mentioned methods of treatment is the reason for describing easier ones, less painful and perilous (14.33–37);³⁷⁹ the classification of haemorrhoids into two categories: dry (śuṣka), with a predominance of vāta and kapha, and discharging (prasrāvin), with a predominance of blood and pitta (14.38); treatment of haemorrhoids (14.39–169);³⁸⁰ bleeding haemorrhoids, in which kapha or vāta is secondarily involved (as an anubandha) (14.170); the treatment of bleeding haemorrhoids (14.171–242);³⁸¹ the general treatment of haemorrhoids (14.243 and 246–248); the interdependence of haemorrhoids, diarrhoea and grahaṇī (14.244–245).