Etiology And Nomenclature

The deranged Doshas of the body, aggravated by such causes as voluntary repression of any natural urging (of stool, urine, etc), external blow or hurt, use of extremely dry (Ruksha) and heat-making articles of fare in inordinate quantities or of such articles as are indigestable or are incompatible in combination or are uncongenial to the system as well as taking food before digestion, con-taminate the bodily Rasa (lymph chyle) and find lodgement in the heart, producing the characteristic pain in the organ, which is known as Hridroga (the disease of the heart). The disease may be divided into five distinct types, of which four are Dosha-origincd, {viz.- Vataja, Pittaja, Kaphaja, Sannipatika) and the fifth is due to the presence of worms (Krimi). The different symptoms should be first described and then the medical treatment thereof. 2-3.

Specific Symptoms

In the Vataja type, a pain is felt in the region of the heart which seems as if being drawn and crushed, pierced and cracked, pricked and split. Thirst with a burning sensation, a gone-feeling and a sucking pain in the heart, epileptic fit, perspiration, fumy eructation and dryness of the mouth, are the symptoms which characterise the Pittaja type. A sense of heaviness in the chest, secretion of mucus (horn the nose and the mouth), an aversion to food, feeling of numness (in the body), dulness of appetite and a sweet taste in the mouth are the features which mark the Kaphaja type of the heart-disease. 4-6.

Krimija Hridroga

Nausea, salivation (spitting), piercing and cutting pain (in the heart), dark vision, an aversion to food, a dull yellow hue of the eyes, as well as emaciation of the body (D. R. swelling) are the indications which point to the presence of worms (Krimija Hridroga) as the exciting factor of the disease. 7.

Supervening Symptoms

Vertigo and a sense of exhaustion attended with a feeling of physical lassitude and emaciation of the body exhibit themselves as the distressing concomitants in all the cases, while the supervening symptoms of Kaphaja worms exhibit themselves in case of Krimija Hridroga also. 8.

Medical Treatment Of The Vataja Type

In a case of the Vataja type, the patient should be first treated with a Sneha and then made to vomit (out the contents of his stomach) with a draught of the decoction of Dasa-mula mixed with salt and a Sneha. After being purged he should be made to take a pulverised compound consisting of Pippali, Ela, Vacha, Hingu, Yava-kshara, Saindhava-salt, Sauvarchala, S'uthin and Ajamoda through the medium of the juice of (acid) fruits, fermented rice-boilings, decoction of Kulattha, curd, wine, Asava or with any kind of Sneha. The patient should be made to have his meal of matured S'ali rice, with the soup of any Jangala meat cooked with clarified butter. Oil duly cooked with the Vayu-subduing drugs should be applied as a Vasti in an adequate quantity in the case. 9.

Treatment Of Pittaja Type

In a case of Pittaja-Hridroga, vomiting should be induced with the decoction of S'ri-pari-fruit, Yashti-madhu and Utpala (D. R. - treacle) mixed with honey and sugar. Clarified butter duly cooked with the drugs of the Madhura group, as well as the decoction efficacious in Pittaja-fever, should be internally administered. The food of the patient should be prescribed with the soup of the flesh of the principal animals of the Jangala group cooked with clarified butter, and he should then be treated with a Vasti, charged with honey and oil duly cooked with Yashti-madhu. 10.

Treatment Of Kaphaja Type

In the Kaphaja type of the disease, vomiting should be induced with the decoction of Vacha or of Nimba and the pulverised medicinal compound prescribed for the Vataja type; should be adminstered. The patient should also be advised to take clarified butter with his food. A decoction of Tri-phala or of the drugs of the Phaladi (Madana-phaladi - Sutra, Ch. XXXIX) or the Mustadi(Sutra, Ch. XXXVIII) group, should be prescribed for internal use, or the patient should be purged with clarified butter mixed with powdered S'yama (Vriddha-daraka) and Trivrit. A physician skilled in the art of applying Vasti should prescribe a Vasti charged with Vala-oil under the circumstances, II.

Treatment Of Krimija Type

In the type (Krimija) chiracteriscd by the persence of worms, the patient should be first treated with a Sneha. A meat-diet with curd or (fried and) powdered sesamun should then be given to the patient for three days in succession after which he should be purged with the compound of Ajaji and sugar mixed with the salt-predominating * purgative preparation (sec Sutra, XLIV.) and mixed with the scented drugs (mentioned in the Sutra-sthana, Ch. XLIV). An adequate quantity of fermented-rice boilings (Dhanyamla) with a profuse quantity of Vidanga should then be internally administered, whereby the worms would be dislodged from the hearts (and expelled through the lower orfices of the body). A diet consisting of cooked barley grains saturated with powdered Vidanga should then be given to the patient. I 2.

* Some read "Su-pala-lair-jogaih" in place of 'Salava-nair-jogaih'. It would mean that the compound .should be mixed with fried and powdered sesamum.

Thus ends the forly-third chapter of the Uttara Tantra in the Sus'ruta Samhita which treats of the (symptoms and) treatment of Ilridroga.