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, clari-fied butter etc.) arc the factors, which vitiate in common the blood and Pittam of a person. The foregeoing causes especially tend to vitiate or agitate the Váyu and blood in persons of delicate constitutions, or in corpulent persons, or in those who observe a form of perfect continence. 39.
The vital Váyu becomes enraged or agitated by exces-sive 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 Váyu. The Váyu, 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 "Váta" or "Váyu" in the nomenclature of the disease (Váta-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 Pittam. in conjunction with the vitiated or agitated blood, is called the Pitta-Raktam. while the one incidental to the combination of the deranged Kapham with the vitiated blood is called Kapha-Raktam. In a case of Váta-Raktam. 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 Raktam, the legs become extremely red, hot, soft and swollen, characterised by a sort of indescribable burning sensation. In a case of Kapha-Raktam, 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-Raktam, the legs exhibit symptoms, which are respectively peculiar to all the three preceding types. 41 - 43.
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 arc marked by complete anaesthesia, heaviness, or heat, and discolouring of the skin. The disease creeps in cither 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.
The form of the disease in which the 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 Prána) 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 Váyu, 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 * (spasms, convulsions). The form of the disease, in which the patient falls to the ground, at intervals, is called Apatánaka (Epilepsy without convulsions). The aggravated or agitated Vayu, charged with an abnormal quantity of Kapham, sometimes affects and stuffs the entire nervous system, and gives rise to a form of disease, which is called Dandá-patánakam † (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 Váyu 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 (Antaráyáma, lit: - inwardly or forwardly extended, emprosthotonos), or externally (Vahiráyáma, 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 (Snáyu), the body becomes contracted and bent forward, bringing about a curvature of the inner trunk. The disease in this form is called Antaráyáma 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 (Kapham). These are the features which mark the first type (Antarayáma Dhanushtambha). On the contrary, when the same enraged Váyu, 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 Vahiráyáma, and should be looked upon as beyond the pale of all medicinal treatment. 47 - 50.
* The patient suffers from vanishings (tamyate) and loss of consciousness through the instrumentality of the enraged and aggravated Vayu, hence the disease is so named - Gayadása.
† Jejjada holds that the enraged Vayu, in unison with the deranged Kapham, 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 Pittam and Kapham. Several authorities aver that there are four distinct types of Akshepakah, such as Danda-patanakh, Antarayamah, Vahirayamah, and Akshepakh of traumatic (Abhighataja) origin.
Four types of Akshepaka are usually recognised in practice such as, the (1) one incidental to the concerted action of the enraged bodily Váyu and Kapham (2), the one brought about through the union of the enraged Váyu with the deranged Pittam, (3), the one due to the single action of the agitated Váyu (4) and the one due to any external injury or blow (Abhighátaja). * An attack of Apatánkah due to excessive haemorrhage, 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.
* Brahma Deva designated the four types of the disease, as Apatanakah, Samsrishta Akshepakah, simple Akshepakah and the Abhighataja (traumatic).
The disease, in which the extremely agitated Váyu 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 Pakshágháta (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.
A case of Pakshágháta (Hemiplegia), brought about through the single action of the enraged or agitated Váyu of the body, can be cured only with the greatest care and difficulty. A case of the same disease, engendered by the aggravated Váyu in conjunction with the deranged Pittam or Kapham, proves amenable to medicine (Sádhya). It becomes incurable when caused through the waste of the root principles (Dhátu) of the body. 55.