The Diagnosis of Heart Disease, Thirst, and Amlapitta

Verse 1 (garuda.1.154.1)

धन्वन्तरिरुवाच । हृद्रोगादिनिदानं ते वक्ष्येऽहं सुश्रुताधुना । कृमिहृद्रोगलिङ्गैश्च स्मृताः पञ्च तु हृद्गताः

dhanvantariruvāca hṛdrogādinidānaṁ te vakṣye'haṁ suśrutādhunā kṛmihṛdrogaliṅgaiśca smṛtāḥ pañca tu hṛdgatāḥ

Dhanvantari said: O Sushruta, I shall now declare to you the diagnosis of heart disease and related conditions. Along with the signs of worm-caused heart disease, five types located in the heart are remembered.

Verse 2 (garuda.1.154.2)

वातेन शून्यातात्यर्थं भुज्यते रोरुदीति च । भिद्यते शुष्यते स्तब्धं हृदयं शून्यता भ्रमः

vātena śūnyātātyarthaṁ bhujyate rorudīti ca bhidyate śuṣyate stabdhaṁ hṛdayaṁ śūnyatā bhramaḥ

From Vata: the heart feels as if it were being gnawed excessively, and the patient cries out; the heart feels as if breaking, drying, and stiffening; there is a sense of emptiness and giddiness —

Verse 3 (garuda.1.154.3)

अकस्माद्दीनता शोको भयं शब्देऽसैष्णुता । वेपथुर्वेपनान्मोहः श्वासरोधोऽल्पनिद्रता

akasmāddīnatā śoko bhayaṁ śabde'saiṣṇutā vepathurvepanānmohaḥ śvāsarodho'lpanidratā

causeless despondency, grief, fear, intolerance of sound, trembling, confusion arising from the trembling, obstructed breath, and reduced sleep.

Verse 4 (garuda.1.154.4)

पित्तात्तृष्णा श्रमो दाहो स्वेदोऽम्लकफजः क्रमः । छर्दनं ह्यम्लपित्तस्य धूमकल्पितको ज्वरः

pittāttṛṣṇā śramo dāho svedo'mlakaphajaḥ kramaḥ chardanaṁ hyamlapittasya dhūmakalpitako jvaraḥ

From Pitta: thirst, fatigue, burning, and sweating, followed in turn by sourness and phlegm; there is vomiting characteristic of Amlapitta, sour-bile disorder, a smoky sensation, and fever —

Verse 5 (garuda.1.154.5)

श्लेष्मणा हृदयं स्तब्धं भारिकं साश्मगर्भवत् । कासास्थिसादनिष्ठीवनिद्रालस्यारुचिज्वराः

śleṣmaṇā hṛdayaṁ stabdhaṁ bhārikaṁ sāśmagarbhavat kāsāsthisādaniṣṭhīvanidrālasyārucijvarāḥ

From Kapha: the heart feels stiff and heavy, as if filled with stone; there are cough, weakness of the bones, spitting, drowsiness, lassitude, loss of appetite, and fever.

Verse 6 (garuda.1.154.6)

हृद्रोगे हि त्रिभिर्देषैः कृमिभिः श्यावनेत्रता । तमः प्रवेशो हृल्लासः शोथः कण्डूः कफस्त्रुतिः

hṛdroge hi tribhirdeṣaiḥ kṛmibhiḥ śyāvanetratā tamaḥ praveśo hṛllāsaḥ śothaḥ kaṇḍūḥ kaphastrutiḥ

In heart disease from all three humors together, and from worms, there is a dark-bluish discoloration of the eyes, spells of darkness before the eyes, nausea, swelling, itching, and discharge of phlegm —

Verse 7 (garuda.1.154.7)

हृदयं सततं चात्र क्रकचेनेव दीर्यते । चिकित्सदामयं (रं) घोरं तच्छीघ्रं शीघ्रमारिणम्

hṛdayaṁ satataṁ cātra krakaceneva dīryate cikitsadāmayaṁ (raṁ) ghoraṁ tacchīghraṁ śīghramāriṇam

and the heart, continuously, feels as if being sawed by a saw. This terrible disease should be treated quickly, for it is swiftly fatal.

Verse 8 (garuda.1.154.8)

वातात्पित्तात्कफात्तृष्णा सन्निपाताद्बलक्षयः । षष्ठी स्यादुपसर्गाच्च वातपित्ते च कारणम्

vātātpittātkaphāttṛṣṇā sannipātādbalakṣayaḥ ṣaṣṭhī syādupasargācca vātapitte ca kāraṇam

Thirst arises from Vata, from Pitta, from Kapha, and from sannipata bringing loss of strength; a sixth type arises from complications; its cause lies in Vata and Pitta —

Verse 9 (garuda.1.154.9)

सर्वेषु तत्प्रकोपो हि सम्यग्धातुप्रशोषणात् । सर्वदेहभ्रामोत्कम्पतापहृद्दाहमोहकृत्

sarveṣu tatprakopo hi samyagdhātupraśoṣaṇāt sarvadehabhrāmotkampatāpahṛddāhamohakṛt

in all types, its aggravation occurs through the thorough drying of the bodily tissues; it produces giddiness throughout the body, trembling, heat, burning of the heart, and confusion.

Verse 10 (garuda.1.154.10)

जिह्वामूलगलक्लोमतालुतोयवहाः शिराः । संशोष्य तृष्णा जायन्ते तासां सामान्यलक्षणम्

jihvāmūlagalaklomatālutoyavahāḥ śirāḥ saṁśoṣya tṛṣṇā jāyante tāsāṁ sāmānyalakṣaṇam

By drying up the water-carrying vessels at the root of the tongue, in the throat, the lungs, and the palate, the various thirsts arise; their common signs are —

Verse 11 (garuda.1.154.11)

मुखशोषो जलातृप्तिरन्नद्वेषः स्वरक्षयः । कण्ठोष्ठतालुकार्कश्याज्जिह्वानिष्क्रमणे क्लमः

mukhaśoṣo jalātṛptirannadveṣaḥ svarakṣayaḥ kaṇṭhoṣṭhatālukārkaśyājjihvāniṣkramaṇe klamaḥ

dryness of the mouth, insatiable craving even for water, aversion to food, loss of voice, and, due to roughness of the throat, lips, and palate, exhaustion when putting out the tongue —

Verse 12 (garuda.1.154.12)

प्रलापश्चित्तविभ्रंशो ह्युद्गराढ्यस्तथामयः । मारुतात्क्षामतादैन्यं शङ्खभे (तो) दः शिरौभ्रमः

pralāpaścittavibhraṁśo hyudgarāḍhyastathāmayaḥ mārutātkṣāmatādainyaṁ śaṅkhabhe (to) daḥ śiraubhramaḥ

delirium, and derangement of the mind, together with a condition of excessive belching. From Vata: emaciation, wretchedness, a splitting pain in the temples, and giddiness of the head —

Verse 13 (garuda.1.154.13)

गन्धाज्ञानास्यवैरस्यश्रुतिनिद्राबलक्षयाः । शीताम्लफेनवृद्धिश्च पित्तान्मूर्छास्यतिक्तता

gandhājñānāsyavairasyaśrutinidrābalakṣayāḥ śītāmlaphenavṛddhiśca pittānmūrchāsyatiktatā

loss of the sense of smell, a bad taste in the mouth, and decline of hearing, sleep, and strength; and it worsens with cold, sour, and frothy things — this is thirst from Vata. From Pitta: fainting, and bitterness in the mouth —

Verse 14 (garuda.1.154.14)

रक्तेक्षणत्वं सततं शोषो दाहोऽतिधूमकः । कफो रसाद्विकुपितस्तोयवाहिषु मारुतः

raktekṣaṇatvaṁ satataṁ śoṣo dāho'tidhūmakaḥ kapho rasādvikupitastoyavāhiṣu mārutaḥ

constant redness of the eyes, dryness, burning, and an intense smoky sensation — this is thirst from Pitta. When kapha, aggravated from rasa, together with Vata in the water-carrying channels —

Verse 15 (garuda.1.154.15)

स्रोतस्तु सकफं तेन पङ्कवच्छोष्यते ततः । शूकैरिवाचितः कण्ठो निद्रा मधुरवक्रता

srotastu sakaphaṁ tena paṅkavacchoṣyate tataḥ śūkairivācitaḥ kaṇṭho nidrā madhuravakratā

fills the channel with kapha and dries it up like mud; the throat feels as if filled with sharp husks; there is drowsiness, and a sweet taste in the mouth —

Verse 16 (garuda.1.154.16)

आध्मानं शिरसो जाड्यं स्तैमित्यच्छर्द्यरोचकम् । आलस्यमविपाकञ्च यः स स्यात्सर्वलक्षणः

ādhmānaṁ śiraso jāḍyaṁ staimityacchardyarocakam ālasyamavipākañca yaḥ sa syātsarvalakṣaṇaḥ

abdominal distension, dullness of the head, heaviness, vomiting, and loss of appetite; lassitude and indigestion — this is thirst from Kapha, and the type showing all these signs together is the tridoshic sannipata form.

Verse 17 (garuda.1.154.17)

आमोद्भवाच्च रक्तस्य संरोधाद्वातपित्तता । उष्णाक्रान्तस्य सहसा शीताम्भो भजतस्तृषा

āmodbhavācca raktasya saṁrodhādvātapittatā uṣṇākrāntasya sahasā śītāmbho bhajatastṛṣā

From the formation of undigested toxin and obstruction of the blood arises the Vata-Pitta type of thirst; the thirst of one overcome by heat who suddenly resorts to cold water —

Verse 18 (garuda.1.154.18)

उष्णादूर्ध्वं गतः कोष्ठं कुर्याद्वै पित्तजैवसा । या च पानातिपानोत्था तीक्ष्णाग्रे स्नेहपाकजा

uṣṇādūrdhvaṁ gataḥ koṣṭhaṁ kuryādvai pittajaivasā yā ca pānātipānotthā tīkṣṇāgre snehapākajā

arises when heat rises from the abdomen upward, producing the Pitta-caused thirst. And the thirst that arises from excessive drinking, sharp at first, born of the improper digestion of unctuous substances —

Verse 19 (garuda.1.154.19)

स्निग्धकट्वम्ललवणभोजनेन कफोद्भवा । तृष्णारसक्षयोक्तेन लक्षणेन क्षयात्मिका

snigdhakaṭvamlalavaṇabhojanena kaphodbhavā tṛṣṇārasakṣayoktena lakṣaṇena kṣayātmikā

and that which arises from unctuous, pungent, sour, and salty food is Kapha-caused; and that which shows the signs of a wasted rasa tissue is the wasting-type thirst —

Verse 20 (garuda.1.154.20)

शोषमोहज्वराद्यन्यदीर्घरोगोपसर्गतः । या तृष्णा जायते तीव्रा सोपसर्गात्मिका स्मृता

śoṣamohajvarādyanyadīrgharogopasargataḥ yā tṛṣṇā jāyate tīvrā sopasargātmikā smṛtā

and the intense thirst that arises as a complication of other long-standing diseases such as consumption, delirium, and fever is called the complication-based thirst.