Chapter I - Diagnosis of diseases of nervous system

Now we shall discourse on the Vata-vyadhi-nidana^[1] (diseases of the nervous system) .

Metrical text:—

Having clasped the feet of the holy Dhanvantari, who had arisen out of the primordial ocean with the pitcher of ambrosia on his head, and who was the foremost of all knowers of truth, Sushruta interrogated him as follows:—“Tell me, O thou, the foremost of discoursers, all about the different locations and functions of the bodily Vayu (nerve force), both in its normal and agitated conditions, (as well as when it changes its natural seat through a concourse of disturbing or aggravating causes). Instruct me on the nature of distempers, which result from its deranged condition.” 2.

The holy Dhanvantari, the greatest of all healers, having listened to the foregoing words of Sushruta, replied as follows:—This vital Vayu (nerve force), which courses through the body, is self-begotten in its origin, and is regarded as identical with the divine energy of eternal life (God), inasmuch as it is unconditional and absolute in its actions and effects, eternal and self-origined, and is subtile and all-pervading (like the sky and the atoms). It is the primary factor, which determines the principle of cause and effect in all forms of created things, whether mobile or immobile. It is so called (Vayu) from the fact of its coursing (skr. Va—to move) throughout the universe. It determines the growth, origin and disintegration of all animated organisms, and as such, it receives the homage of all created beings. Although invisible in itself, yet its works are patent or manifest. It is cold, light, mobile, dry and piercing, and follows a transverse course. It is characterised by the two attributes (proper-sensibles or Gunas) of sound and touch. It abounds in the fundamental quality of Rajas (principle of cohesion and action), is of inconceivable prowess, propels all the deranged or obstructing prinicples (Doshas) in the organism, (or in other words, is primarily concerned with the deranged principles of the body which are pathogenic in their actions). It is instantaneous in its action, and radiates or courses through the organism in constant currents. It has its primary field of action in the intestinal tract (Pakvadhana) and the rectum (Guda). In its deranged state, it is the principal factor, which, (in combination with the deranged Pitta and Kapha), lies at the root of all diseases, and is accordingly termed the king of diseases (Rogarat). 3.

The action of Vayu in its normal State:—

Now, hear me describe the symptoms, which mark the Vayu, as it courses through the organism. The Vayu, in its normal or undisturbed condition, maintains a state of equilibrium between the different Doshas and the root principles of the body (Dhatu); it further tends to maintain uniform state in the metabolism of the body, (protoplasmic, Agni^[2]) and helps the organs of sense-perception in discharging their specific functions. The bodily Vayu, like the Pitta in the organism, is grouped under five different subheads according to the difference in its functions and locations, and is classified as the Prana, Udana, Samana, Vyana and Apana.^[3] These five classes of Vayu, located in their specific regions, contribute towards the integration and maintenance of the body. 4—6

The Prana Vayu:—

The Vayu, that courses in (governs) the cavity of the mouth,^[4] is called the Prana, its function being to force down the food into the cavity of the stomach, and to assist the different vitalising principles of the body (such as the internal heat or fire etc.) in discharging their functions in life, and to contribute to the general sustenance of the body. A deranged condition of this particular kind of Vayu (Prana) is usually followed by hiccough, dyspnea and other kindred distempers. 7.

The Udana Vayu:—

The most important of the vital Vayus, which courses (sends its vibrations) upward, is called the Udana. It produces speech, song, etc. In its deranged state it brings on diseases which are specifically confined to regions lying above the clavicles. 8.

The Samana Vayu:—

The Samana Vayu courses in (governs) the stomach (Amashaya) and in the region of intestines (Pakvashaya). Its functions consist in digesting the chyme brought down into the intestines in unison with the digestive ferment (Agni), and especially in disintegrating its essence from its refuse or excreted matter. A deranged or aggravated condition of the Samana Vayu causes dysentery, Gulma, and impaired digestion, etc. 9.

The Vyana Vayu:—

The Vayu known as the Vyana courses (acts) through the whole organism, and its functions consist in sending the lymph chyle, etc. all through the body and in helping the out-flow of blood (Asrik) and perspiration. Five kinds of muscular movements^[5] are ascribed to the action of the Vyana Vayu, a deranged condition of which is generally attended with diseases which are not confined to any particular region, member, or organ of the body, but are found to affect the whole organism (such as, fever, etc). 10.

The Apana Vayu:—

The Vayu known as the Apana acts in the lower region of the intestines (Pakvadhana). Its functions consist in bearing down the fetus and the feces and in evacuating the urine, semen and catamenial blood. An enraged condition of this Vayu tends to bring on serious diseases, which are peculiar to the urinary bladder and the distal portion of the large intestine (Guda). An aggravated condition of both the Vyana and Apana Vayus may produce Prameha and disorders of the seminal fluid, while a simultaneous excitement of the five vital Vayus leads to a sure and speedy termination of life. 11–12.

Now we shall describe the nature of diseases, brought about by the localization of the variously aggravated Vayus in the different parts of the body.—In the cavity of the stomach (amashaya) the deranged or aggravated Vayu gives rise to vomiting, vertigo, epileptic fits, thirst and pain at the sides (Parshva Sula) and about the region of the heart (Hridgraha). In the intestines (Pakvashaya) the enraged or disturbed Vayu gives rise to a rumbling in the intestines, a piercing pain about the region of the umbilicus, scanty and painful urination and stool, or their entire suppression (anaha), and pain about the region of the coccyx (Trika). 13—15. Similarly, incarcerated in the sense-organs, such as the ears, etc. it tends to deprive them of their respective faculties. In the skin (lymph chyle) it produces a discolouring of the complexion, parchedness and twitching in the skin, and causes a complete local anesthesia, giving rise to a tingling, piercing pain in the skin, which spontaneously bursts, or becomes marked with cracks and fissures. Similarly, the aggravated Vayu interfering with the principle of blood gives rise to ulcers. In the flesh, it produces painful nodes and tumours (Granthi), while in the principle of fat it brings on almost painless tumours (Granthi) unattended with any kind of ulcer. Incarcerated in the veins etc. (Shira) it produces a stiffening or painful contraction, or a varicose or neuralgic condition; in a ligament (Snayu), it produces numbness (anesthesia), palsy, aching pain and convulsive jerks; in a long joint, it tends to deprive it of its contractibility and produces a painful inflammatory swelling (about the affected part). In the bones it produces a wasting (atrophy) of the bones which crack and begin to spontaneously burst, attended with the characteristic bone-ache. Again in that important principle of life, the marrow, it tends to dry it up and produces a sort of pain, extending all over the body which knows no respite or abatement. Similarly, in the principle of semen it tends to produce a scanty, defective, or excessive emission of that vital fluid, or a complete stoppage thereof. 16—23.

The Vayu, thus disturbed and agitated, affects in succession the lower and the upper extremities of the body, and the head, or extends all over the body and deranges all its root-principles (Dhatu). The symptoms, which mark such conditions of the body, are numbness (paralysis), convulsive contortions of the limbs (Akshepa), anesthesia, and various kinds of pain (Shula), and swelling (Shopha) of the body. The deranged Vayu, having entered the natural seats of the Pitta or Kapha, develops symptoms, which are peculiar to either of them, and gives rise to numerous diseases. 24—25.

The symptoms, which characterise the union of the deranged Vayu with the Pitta (in its particular seat) are a burning sensation, heat, thirst, and loss of consciousness, in addition to the symptoms of the Vataja disease so generated in that particular part of the body, while a similar unison with the Kapha develops coldness, swelling and heaviness (of the affected part). The disturbed or agitated Vayu in unison with the principle of blood gives rise to a sort of pricking pain (pins and needles in the affected locality), which can not bear the least touch, or is marked by complete anesthesia, and symptoms, peculiar to the deranged Pitta, follow in its train. 26—28.

Vomiting, and a burning sensation, etc. in the body, mark the instance when the Prana Vayu is surcharged (Avrita) with the Pitta; while weakness, lassitude, somnolence and a general discolouring of the complexion (D. R.,—loss of taste) characterise a case when it is surcharged with the deranged Kapha. A burning sensation in the body, loss of consciousness or epileptic fits, and a sense of giddiness (vertigo) and physical languor are the indications, which distinguish a case of the Udana Vayu being surcharged with the Pitta; while a stoppage or absence of perspiration, appearance of goose-flesh on the skin, impaired digestion, coldness and numbness of the affected part characterise a case of the same being surcharged with the Kapha. 29—32.

Copious flow of perspiration, heat with a burning sensation in the body, and epileptic fits indicate a case when the Samana Vayu has become united with the Pitta; while a copious flow of stool and urine, and an excess of mucous secretion (Kapha) from the nose (fluent coryza) etc. and horripilation mark a case, where it has become saturated with the Kapha. 33—34.

Heat and a burning sensation in the affected part and a profuse menorrhagia mark a case when the Apana Vayu becomes surcharged with the Pitta, whereas a sense of heaviness in the lower limbs characterises a case when it becomes overcharged with the Kapha. 35—36.

[Symptoms such as,] burning and jerking in the limbs, and a sense of physical languor become manifest in the event of the Vyana Vayu being surcharged with the Pitta, while a general heaviness of the limbs, stiffness or numbness of the bone-joints, and an incapability of locomotion indicate the fact of its being surcharged with the Kapha. 37—38.

The Nidana of Vata Rakta:—

An over-indulgence in grief, excessive sexual intercourse, inordinate physical exercise, drinking large quantities of wine, observance of a regimen of diet and conduct in a particular season of the year which is improper to it, use of articles of food which are not congenial to one’s own temperament and an improper or baneful use of such oleaginous substances (as oil, clarified butter etc.) are the factors, which vitiate in common the blood and Pitta of a person. The foregoing causes especially tend to vitiate or agitate the Vayu and blood in persons of delicate constitutions, or in corpulent persons, or in those who observe a form of perfect continence. 39.

The vital Vayu becomes enraged or agitated by excessive riding on horses, camels or elephants, or through the lifting or carrying of great weights, etc., or by an inordinate indulgence in things which are possessed of the specific virtue of enraging or aggravating that vital principle. On the other hand, an over-indulgence in such articles of food as are heat-making in their potency, or a surfeit of edibles largely composed of sharp, acid or alkaline substances, as well as a large consumption of potherbs etc., or an exposure to heat tends to vitiate the blood of the organism, and which, on account of such contamination, tends to speedily obstruct the passage of the fleet-coursing Vayu. The Vayu, thus impeded in its course, becomes more and more agitated each moment, and is prone to speedily agitate the blood in a similar way. The antecedence of the term “Vata” or “Vayu” in the nomenclature of the disease (Vata-Rakta) is owing to the precedence accorded to the action of the deranged Vayu in bringing about the malady, although it effects this in concert with the vitiated blood of the organism. 40.

Similarly, the disease brought about by the agitated Pitta, in conjunction with the vitiated or agitated blood, is called the Pitta-Rakta, while the one incidental to the combination of the deranged Kapha with the vitiated blood is called Kapha-Rakta. In a case of Vata-Rakta, the legs, or the lower extremities can not bear the least touch (Hyperesthesia) and a sort of pricking, piercing pain (pins and needles) is experienced in those regions. The legs become withered or atrophied and lose all sensibility to touch. In a case of Pitta Rakta, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Rakta, the legs become swollen and numbed. The swelling assumes a whitish hue and feels cold to the touch, and is accompanied by excessive itching. In the Sannipatika or Tridoshaja form of Dushta-Rakfcam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding types. 41—43.

Premonitory Symptoms:—

In the incubative stage of the disease the legs perspire and become cold and flabby, or (on the contrary), the local perspiration is stopped and the legs become hot and hard. Moreover, a pricking pain is experienced in the affected parts which are marked by complete anesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in either from the lower extremities, or in some cases, first affects the upper ones and gradually extends all over the body like an enraged rat-poison.

Prognosis:—

Theform of the disease inwhichthe skin of the part lying between the instep and the knee-joint becomes abraded or spontaneously bursts open, exuding pus and blood, attended with loss of strength (Prana) and flesh, curvature of the fingers, and eruptions of nodules, should be regarded as incurable; while a case of one year’s standing admits only of palliative measures. 44.

The enraged or agitated Vayu, while coursing swiftly through the Dhamanis (nerves) of the body, shakes it in quick succession, and a disease, (exhibiting such symptoms as shaking or convulsive jerks), is originated which is called Akshepaka^[6] (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called Apatanaka (Epilepsy without convulsions). The aggravated or agitated Vayu, charged with an abnormal quantity of Kapha, sometimes affects and stuffs the entire nervous system, and gives rise to a form cf disease, which is called Dandapatanaka^[7] (Epilepsy with convulsions), inasmuch as it deprives the body of its power of movement and flexibility, making it stiff and rigid like a rod (Danda). 45—46.

The disease but rarely yields to medicine and, is cured in rare instances only with the greatest difficulty; its characteristic symptom being a paralysis of the jawbone, which makes deglutition extremely difficult. The disease in which the enraged Vayu bends the body like a bow is called Dhanushtambha (Tetanus). The disease admits of being divided into two distinct types accordingly as the body of the patient is curved internally (Antarayama, lit:—inwardly or forwardly extended, emprosthotonos), or externally (Vahirayama, lit:—extended or bent on the back, resting on his heels and occiput—Opisthotonos). When the extremely enraged and powerful bodily Vayu (nerve-force), accumulated in the regions of the fingers, insteps, abdomen, chest, heart and throat, forcibly draws in the local ligaments (Snayu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antarayama Dhanushtambha. The movements of the eyes become impossible, which become fixed in their sockets; the jaw-bones become paralysed, the sides are broken, and the patient ejects (at intervals quantities of) slimy mucous (Kapha). These are the features which mark the first type (Antarayama Dhanushtambha). On the contrary, when the same enraged Vayu, centred or lodged in ligaments which traverse the posterior side of the body, attracts them violently, the body is naturally bent backward. The patient experiences a sort of breaking pain at the chest, waist and thighs, (which are ultimately broken). The disease is called Vahirayama, and should be looked upon as beyond the pale of all medicinal treatment. 47—50.

Four types of Akshepaka are usually recognised in practice such as, the

1. one incidental to the concerted action of the enraged bodily Vayu and Kapha,
2. the one brought about through the union of the enraged Vayu with the deranged Pitta,
3. the one due to the single action of the agitated Vayu,
4. and the one due to any external injury or blow (Abhighataja).^[8]

An attack of Apatankah due to excessive hemorrhage, or following closely upon an abortion or miscarriage at pregnancy (difficult labour), or which is incidental to an external blow or injury (traumatic), should be regarded as incurable. 51—52.

The disease, in which the extremely agitated Vayu affects the nerve chains (Dhamanis) which spread either in the left or in the right side of the body, whether in the upward, downward, or lateral direction, making them lax and vigourless, and in which the joints of the other side of the body become useless and inoperative, is called Pakshaghata (Hemiplegia) by eminent physicians. The patient, the whole or half of whose body has become (almost) inoperative and lost all sensibility, but who retains his consciousness so long as there remains the least vestige of vitality in the affected part, suddenly falls down and expires. 53—54.

Prognosis:—

A case of Pakshaghata (Hemiplegia), brought about through the single action of the enraged or agitated Vayu of the body, can be cured only with the greatest care and difficulty. A case of the same disease, engendered by the aggravated Vayu in conjunction with the deranged Pitta or Kapha, proves amenable to medicine (Sadhya). It becomes incurable wheji caused through the waste of the root principles (Dhatu) of the body. 55.

Apatantrakah (Convulsions):—

The Vayu, aggravated (by its specifically exciting factors and principles) and dislodged from its natural seat or receptacle in the body in consequence thereof, courses upwards and finds lodgment in the regions of the head, heart and temples. It presses upon those parts and gives rise to convulsive movements of hands and legs, or at times bends them down.

Symptoms:—

The patient lies with his eyes closely shut, or stares with a sort of fixed or vacant gaze, the eyes remaining fixed or immovable. The patient loses all perception, and groans. Respiration becomes difficult, or symptoms of temporary asphyxia and unconsciousness set in. Consciousness and a normal condition of the organism return with the passage of the enraged Vayu from the heart, while on the other hand the patient relapses into unconsciousness simultaneously with the envelopment of the heart with that enraged and Kapha-saturated Vayu. This disease is called Apatantrakah and is ascribed to the action of the enraged Vayu surcharged with the deranged Kapha. 56.

Manyastambha:—

The local Vayu, agitated through such causes as sleep in the day time, reclining with the neck on an uneven place or pillow, gazing upward for a considerable length of time, or looking aside in a contorted way, and enveloped in the deranged Kapha, gives rise to the disease known as Manya- stambha (wry neck or torticollis). 57.

Ardita (Facial Paralysis):—*

Pregnant women, mothers immediately after parturition (Sutika), infants, old and enfeebled persons are most prone to fall victims to this disease^[9]. It has been also known to result from excessive hemorrhage or loss of blood. The local Vayu, extremely enraged or aggravated by continuous talking in an extremely loud voice, chewing of hard substances, loud laughter, yawning, carrying extremely heavy loads, and lying down in an uneven position on the ground, finds lodgment in the regions of the head, nose, upper lip, chin, forehead and the joints (inner cornea) of the eye, and produces the disease called Ardita by distorting the face.

Symptoms:—

The neck and half of the face longitudinally suffer distortion and are bent. The head shakes; the power of articulating speech is lost, and the eyes are distorted into a variety of shapes. The portions of the neck and the chin, as well as the teeth on the affected side become painful.

Premonitory Symptoms:—

The disease generally commences with shivering, horripilation, cloudiness of vision, upcoursing of the bodily Vayu and anesthesia, a pricking pain in the affected locality, numbness or paralysis of the jaw-bone, or of the cervical muscles of the neck. Physicians, conversant with the Ætiology of diseases, call it Ardita (Facial paralysis).

Prognosis:—

A case of Ardita, appearing in an extremely enfeebled or emaciated patient, or exhibiting such symptoms as a winkless vision, inarticulate speech which hardly seems to come out of the throat, excessive palsy of the face, as well as the one of more than three years’ standing, should be deemed as incurable. 58.

Gridhrashi (Sciatica):—

The disease in which the two great nerve-trunks (Kandara), which emanating from below the lower extremity of the thigh reach down to the bottom of the insteps and toes, and become stuffed or pressed with the enraged Vayu, thus depriving the lower extremities of their power of locomotion, is called Gridhras'i. 59.

Vishvaci (Erbe’s paralysis or Bracialneuralgia):—

The disease in which the enraged Vayu affecting the nerve-trunks (Kandara) which run to the tips of fingers from behind the roots of the upper arms, making them incapable of movement and depriving them of their (??)ower of flexion or expansion is called Vishvaci^[10] 60.

Kroshtukashirsha (Synovitis of the knee- joints(?)):—

An extrimely painful swelling in the knee-joints, which is originated through the concerted action of the deranged Vayu and the vitiated blood is called Kroshtukashirsha from the fact of its resembling the head of a jackal (Kroshtuka) in shape. 61.

Khanja (Lameness):—

The disease proceeds from the drawing up of the nerve trunks (Kandara) of a leg by the deranged Vayu lying about the region of the waist. When both the legs are similarly affected, the patient is called a Pangu. He, whose legs tremble before starting for a walk and who afterwards manages to go on limping is called a Kalaya Khanja one in whom the bone-joints become loose. 62—63.

Vata Kantaka:—

The local Vayu, enraged by making a false step on an uneven ground, finds lodgment in the region of the ankle (Khudaka, instep according to others), thus giving rise to a disease which is called Vata Kantaka. The burning sensation in the soles of the feet caused by the enraged local Vayu, in conjunction with the deranged Pitta and blood, is called Pada-daha, which is generally seen to afflict persons of pedestrian habits. When the legs are deprived of all sensibility of touch, and a sort of tingling pain is experienced in them it is termed Padaharsha, which is due to the deranged action of the Vayu and Kapha. The disease in which the enraged local Vayu dries up the normal Kapha lying about the shoulder- joints is called Ansa-shoshaka. The form in which the aggravated local Vayu contracts the nerves of the arms is called Avavahuka^[11]. 64—67.

Vadhiryayam (deafness):—

The disease occurs only when the deranged Vayu, either singly or surcharged with the Kapha, stuffs the sound-carrying channels (Srota) of the ears. 68.

Karna Shula:—

The disease in which the deranged Vayu causing a piercing pain in the regions of the cheekbones, head, temples and neck, gives rise to a sort of aching pain in the tympanum, is called Karna- shula (otitis). The local Vayu, deranged and saturated with the Kapha stuffing the nerves (Dhamani) which conduct of the sound of speech, produces complete (in some cases partial) loss of the power of speech—eg. Muka (dumbness. Minmina (nasal voice) and Gad-gada (indistinct speech). 69—70

A sort of pain, which (rising from the bowels or the urinary bladder and ranging downward) gives rise to a bursting sensation in the regions of the anus and the genitals, is called Tuni, whereas the one, rising upward from the preceding parts and extending up to the region of the intestines, is called Prati-tuni. A distension of the abdomen (Udara), attended with the incarceration of flatus (Vayu) and an intense pain and rumbling in its inside, is called Adhmana (Tympanites). When it first affects the stomach (Amasaya) and is unattended with an oppressive feeling about the heart and pain at the sides it is called Pratyadhmana. The Vayu saturated with the deranged Kapha causes the preceding type of distemper. 71—74.

A knotty stone-like tumour (Granthi) of considerable density, whether fixed or mobile, and appearing below the umbilicus, and having an elevated shape which is always found to be extended in an upward direction, is called a Vatasthila, (which) as its name implies, is due to the action of the local deranged Vayu. The tumour, thus formed, obstructs the emission of flatus and impedes the evacuation of feces. A tumour of similar shape, appearing laterally or across the region of the abdomen (Jathara) and obstructing the passage of stool, urine and flatus (Vata) is called a Pratyashthila. 75—76.

 

Thus ends the first Chapter of the Nidana Sthana in the Sushruta Samhita, which treats of the Nidana of the diseases of the nervous system.

Footnotes and references:

[1]:

The term Nidana, usually translated as Pathology, is meant to include factors, which fall within the respective provinces of Pathology, Ætiology, Symptomology and Pathognomy as well. For the meaning and functions of Vayu see Introduction vol. I. pp. xli.—xlii.

[2]:

See Introduction Vol. I. p.p. XLVIII—XLIX Mahamahopadhyaya Dvarka Natha Kaviratna interprets this Agni as digestive heat (Jaiharagni).

[3]:

The Prana Vayu is identical with the energy of the nerve centre in the medulla; the Udana with that of the one which is situated in the speech centre. The Samana is same as the energy of the epigastric plexus, the Udana is same as the energy of the Motor-Sensory Nerves, and the Apana is identical with the force of the Hypogastric plexus.

[4]:

The field of its action includes the regions of the heart, throat, head and the nose.

[5]:

Such as expansion, flexion, lowering down and lifting up or lateral thrusting of any part of the body.

[6]:

The patient suffers from vanishings (tamyati) and loss of consciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named—Gayadasa.

[7]:

Jejjada holds that the enraged Vayu, in unison with the deranged Kapha, gives rise to another kind of convulsions (Akshepaka) which he has denominated as Danda-patanakh which, exhibits such symptoms as coldness, swelling and heaviness of the body on account of its being brought about by a concerted action of the deranged Pitta and Kapha. Several authorities aver that there are four distinct types of Akshepakah, such as Danda-patanakh, Antarayamah, Vahirayamah, and Akshepakh of traumatic (Abhighataja) origin.

[8]:

Brahma Deva designated the four types of the disease, as Apatanakah, Samsrishta Akshepakah, simple Akshepakah and the Abhighataja (traumatic).

[9]:

The portion of the text included within asterisks has been reject by Jejjadacaryya as spurious.

[10]:

When the aforesaid nerve of a single arm is affected the disease is (?)cted to it alone, while it attacks the both when both their nerves are

[11]:

The Ansa-shosha is due to the single action of the enraged Vayu, while Ava-vahuka is due to the concerted action of the deranged Vayu and Kapha.