Chapter CLXX - The Nidanam of diseases of the nose

Now hear me, O Sushruta, discourse on the Nidanam of the diseases of the nose. In the disease known as Pinasa or Apinasa the nostrils (passages of the nose) seem to be stuffed with the Vayu-dried Kaphah, and the patient complains of warm vapours escaping out of his nostrils. The faculties of smell and taste are affected in this disease, which, like nasal catarrh (Pratisyaya) should be attributed to the action of the deranged Vayu and Kaphah. The disease in which the Vayu aggravated through the several actions of the Pittam, Kaphah and blood, and finding lodgment in the larynx and the root of the palate, is emitted with a fetid smell through the nostrils is called Putinasyam (fetid-nose) by the wise. The disease in which the deranged Pittam, lodged in the nose, gives rise to inflammation and crops of pustular eruptions in the nostrils, or in which the nostrils alternately become dry and moist (with a mucous discharge) is called Nasapaka. The disease in which blood-mixed pus is discharged from the nostrils through actions of the morbific principles of the body, or through the effect of any blow or injury on the forehead, is called Puya-raktam. The disease in which the deranged and aggravated Vayu, by taking recourse to the Sringataka Marma in the nose, is expelled with mucous through the nostrils, is called Kshavathu (sneezing). Ingestion of irritating articles of fare (such as mustard, etc.,) smell of any strong-smelling or irritating substance, looking at the sun, tickling of the septum of the nostrils with a thread, etc., are the factors which may likewise produce sneezing. The disease in which thick mucous, previously accumulated in the head, is liquefied and acquires a saline taste on account of being exposed to the heat of the deranged Pittam, and is emitted through the nostrils, is called Bhransakam. In the disease known as Diptam the patient complains of an intolerable burning sensation in the nose and thinks as if hot fumes are escaping out of his nostrils. The disease in which the deranged Vayu and Kaphah tend to choke up the passages of the nostrils, is called Pratinaha. The disease in which a thick or thin, white or yellow mucous is discharged from the nostrils, is called Nasasrava (fluent coryza). The disease in which the natural moisture of the mucous membrane of the passages of the nose, absorbed through the action of the deranged Vayu, and heated (parchified) through the action of the deranged Pittam, produces difficulty of breathing is called Nasa-shosa. In the acute or immature stage of Pinasam (nasal catarrh) the patient suffers from heaviness of the head and feels a repugnance for all kinds of food. The voice becomes weak, and the discharge (from the nostrils) thin and constant. The mature stage of the disease is marked by all these symptoms with the exception that sound becomes clear and pronounciation of words more distinct and the mucous discharges from the nostrils are thickened and remain stuck to the walls of the nostrils. The disease known as Pratishyaya admits of being grouped under two heads such as Sadya (brought on the very day the exciting factors are present) and that which is brought oil after the accumulation and aggravation of the morbific principles lying at the root of the disease. Voluntary repression of any natural urging of the body and indigestion, vapours and particles of dust getting into the nostrils, excessive talking or irascibility, unnatural seasons, night-keeping, day-sleep, use of extremely cold water, exposure to frost or mist, coition, weeping, and any thing, that engenders heat in the head, are the factors which tend to thicken the mucous in the head. The Vayu, enraged and aggravated in consequence, instantaneously brings on Sadya Pratishyaya.

The different morbific principles of the body, gradually accumulating in the head, and by being aggravated by their respective exciting factors, bring on the second form of Prastishyaya. Sneezing, heaviness of, or a numbed feeling in, the head, aching of the limbs, horripilation, feeling as if hot fumes escaping out of the nostrils, burning in the palate, lachrymation and running at the eyes are the symptoms which mark the premonitory stage of this disease. In the Vataja type of Pratishyaya, the nostrils seem choked or stuffed and a discharge of mucous flows out from the nostrils, the lips, palate and throat seem dry or parched, a pricking pain is felt in the regions of the temples, sneezing becomes constant and the voice hoarse or week, and a vapid taste is felt in the mouth. In the Pittaja type of Pratishyaya a flow of hot or yellowish mucous is discharged from the nostrils, the complexion becomes pale and sallow, the patient begins to lose flesh and complains of heat in the body and feels as if hot fumes are escaping out of his nostrils. In the Kaphaja type of Pratishyaya there is a profuse discharge of grey mucous from the nostrils. The eyes and complexion of the patient become white. There is a tight feeling around the head and the patient complains of an itching sensation in the lips and throat, and about the palate.

Cases of Pratishyaya, whether mature (Pakka) or immature (Apakka), which know many relapses after being spontaneously subsided, and in which the specific symptoms of the three several Doshas manifest themselves in unison, should be regarded as of a Sannipatika origin. The type of Pratishyaya in which there is a fetid smell in the breath and the patient loses the faculty of smell, and in which the apertures of the nose seem dry or moist, stuffed or dilated at intervals, is called Dushta (bad) Pratishyaya (catarrh). Cases of this type of nasal catarrh are extremely hard to cure. In the type known as Rakta-Pratishyaya the nose bleeds, the eyes assume a bloody or blood-shot aspect, the breath exhales a fetid smell, the faculty of smell is lost or impaired, and the patient suffers from a pain about the chest. Neglected or not properly remedied at the outset, all cases of nasal catarrh may run into those of Dushta Pratishyaya type, which are extremely hard to cure, or prove irremedible in certain instances. Small parasites are found to germinate in the mucous discharge in Dushta Pratishyaya (Rakta-Pratishyaya according to others) which serve to produce symptoms which ordinarily characterise cases of shiroroga (diseases of the head, Cephalagia). Discharges of thick mucous which are the specific features of chronic cases of Pratishyaya may bring on blindness, deafness, loss of smell, impairment of the digestive faculty, cough, and a host of other diseases of the eyes. Seven forms of tumours, four kinds of œdematous swellings, four kinds of polypous growths and four types of Hæmorrhage (Rakta Pittam) are found to invade the nose in addition to diseases described above.