In a case of haemorrhoids due to the concerted action of the deranged Váyu, Pittam and Kapham, symptoms characteristic of each of these types manifest themselves in unison. 12.
Congenital haemorrhoids (Sahaja Ars'as) are usually ascribed to defects in the semen and ovum of one's parents and should be medicinally treated with an eye to the special deranged Doshas involved in the case. The polypi (in this type) are hardly visible and are rough and yellowish, with their faces turned inward. They are extremely painful. A person suffering from this type of piles gets thinner and thinner every day and cats but very little. Large veins (Sirá) appear on the surface of the body. The patient becomes irritable, the semen decreases in quantity, making the procreation of a small number of children possible only by him. The voice becomes feeble, the digestion is impaired, and disorders affecting the head nose, ears and eyes follow. A croaking sound is heard in the intestines, attended with a rumbling in the abdomen. All relish for food vanishes and the region of the heart seems to be smeared with a kind of sticky paste (of mucous), etc. 13.
A qualified physician should undertake the medical treatment of haemorrhoids which occur either about the outer or the middle groove of the rectum, (in as much as they prove amenable to medicine). A polypus, appearing about the innermost ring or groove of the rectum, should be treated without holding out any definite hope of cure to the patient. 14.
The deranged and aggravated Váyu etc., finding lodgment in the genitals, vitiate the local flesh and blood, giving rise to an itching sensation in the affected localities. The parts become ulcerated (through constant scratching) and the ulcers become studded with sprout-like vegetations of flesh(warts),which exude a kind of slimy, bloody discharge. These growths, or excrescences generally appear on the inner margin, or on the surface of the glans penis, in the form of soft, slender vegetations of skin, resembling the hairs of a small brush (Kurchaka). These vegetations ultimately tend to destroy the penis and the reproductive faculty of the patient.
The deranged Váyu etc. of the body, lodged in the vaginal region of a woman, gives rise to similar crops of soft polypi in the passage. They may crop up isolated at the outset, and (by coalescing) may assume the shape of a mushroom or an umbrella, secreting a flow of slimy, foul-smelling blood.
The deranged Váyu. etc. may further take an upward course, and finding a lodgment in the ears, nose, mouth and eyes may produce similar warts in those localities. Warts, which crop up inside the cavities of the ears, may bring on earache, dumbness, and afoul discharge from those organs, while those (cysts) cropping up in the eyes will obstruct the movement of the eye-lids, giving rise to pain and a local secretion and ultimately destroy the eye-sight. Similarly, such growths in the nostrils produce catarrh, excessive sneezing, shortness of breath, headache, nasal speech and the complaint known as Putinasya. Such vegetations cropping up in and about the lips, palate or the larynx,tend to make the speech confused and indistinct. When appearing in the mouth they impair the faculty of taste, and diseases which affect the cavity of the mouth follow. The excited Vyána Váyu, united with the aggravated Kapham, produces a kind of hard papillomatous growths on the skin (about the anus) which arc called the Charmakilas (papillomata). * 15.
These Charmakilas may be attended with a kind of pricking pain through an excess of the deranged Váyu, whereas those which have their origin in the deranged Kapham (lymphatics) assume a knotty shape and become of the same colour as the surrounding skin. On the other hand, they become dry, black or white, and extremely hard through an exuberance of the deranged local blood and Pittam. 16.
The symptoms of polypi, appearing in the neighbourhood of the anus, have been described in full, while the general characteristics of those, which arc found to crop up around the genitals, have been briefly discoursed upon. An intelligent physician should ponder over the two groups of symptoms while engaged in treating a case of piles. A case of piles exhibiting symptoms peculiar to the two deranged Doshas is called the Samsargajam. Six distinct types of bio-Doshaja piles are known in practice * 17.
* According to others, Charmakilas may crop up on the skin of any part of the b dy.
Prognosis: - A case of piles due to the concerted action of the three deranged Doshas of the body, (with its characteristic symptoms) but partially develop-edj may be temporarily checked (Yápya). Cases, which are of more than a year's standing, as well as those in which the haemorrhoids are due to the concerted action of the two Doshas (Samsargaja), or are situated in the middle groove of the rectum, may be cured but with the greatest difficulty. Cases of the Sannipatika or congenital (Sahaja) types should be given up incurable. The Apána Váyu, in a person whose rectum is overrun with such polypus growths, tries to pass out through the anus, but is driven back upward, being obstructed in its passage by the vegetations, and then mixes with his Vyána Váyu, thus imparing (the five-functioned) fire (Pittam) in his body. 18-19.
* Such as (1) the one due to the concerted action of the deranged Pittam and Kapham, (2) the one incidental to the simultaneous derangement of the Váyu and the Kapham, (3) the one brought about through the disordered condition of the Váyu and blood, (4) the one due to the combination of the deranged Pittam and Kapham, (5) the one produced by the concerted action of the deranged Pittam and blood, (6) the one which results from the combined action of the deranged Kapham and blood.
Thus ends the second Chapter of the Nidanaslhanam in the Sus'ruta Samhita which deals with the Nidanam of piles.