The Diagnosis of Piles (Arsha)

Verse 1 (garuda.1.156.1)

धन्वन्तरिरुवाच । अथार्शसां निदानं च व्याख्यास्यमि च सुश्रुत ! । सर्वदा प्राणिनां मांसे कीलकाः प्रभवन्ति ये

dhanvantariruvāca athārśasāṁ nidānaṁ ca vyākhyāsyami ca suśruta ! sarvadā prāṇināṁ māṁse kīlakāḥ prabhavanti ye

Dhanvantari said: Now I shall explain the diagnosis of Arsha, piles, O Sushruta. The fleshy protrusions, like stakes, that always arise in the flesh of living beings —

Verse 2 (garuda.1.156.2)

अर्शांसि तस्मादुच्यन्ते गुदमार्गनिरोधनात् । दोषस्त्वङ्मांसमेदांसि सन्दूष्य विविधाकृतीन्

arśāṁsi tasmāducyante gudamārganirodhanāt doṣastvaṅmāṁsamedāṁsi sandūṣya vividhākṛtīn

are, because they obstruct the anal passage, called Arsha. The vitiated humor, corrupting the skin, flesh, and fat, produces various forms —

Verse 3 (garuda.1.156.3)

मांसांकुरानपानादौ कुर्वन्त्यर्शांसि ताञ्जगुः । सहजन्मान्तरोत्थेन भेदो द्वेधा समासतः

māṁsāṁkurānapānādau kurvantyarśāṁsi tāñjaguḥ sahajanmāntarotthena bhedo dvedhā samāsataḥ

of fleshy sprouts in the anal region, which are called Arsha. In summary, they are of two kinds: congenital, present from birth, and acquired at another time.

Verse 4 (garuda.1.156.4)

शुष्काग्रावाविभेदाश्च गुदस्थानानुसंश्रयाः । अर्धपञ्चाङ्गुलिस्तस्मिंस्तिस्रोऽघ्यर्धाङ्गुलिस्थिताः

śuṣkāgrāvāvibhedāśca gudasthānānusaṁśrayāḥ ardhapañcāṅgulistasmiṁstisro'ghyardhāṅgulisthitāḥ

They are dry-tipped or moist, lodged at various points around the anus; within a space of four and a half fingers, three kinds are located, each at one and a half fingers —

Verse 5 (garuda.1.156.5)

बाल्यप्रवाहिणी तासामन्त्रमध्ये विसर्जिनी । बाह्यासंवरणे तस्या गुदादौ बहिरङ्गुले

bālyapravāhiṇī tāsāmantramadhye visarjinī bāhyāsaṁvaraṇe tasyā gudādau bahiraṅgule

of these, 'Balya' discharges from within, 'Visarjini' is in the middle of the intestine, and the outer restraining type is located one finger outside the anal opening —

Verse 6 (garuda.1.156.6)

सार्धाङ्गुलप्रमाणेन रोमाण्यत्र ततः परम् । तत्र हेतुः सहोत्थानां बाल्ये बीजोपतप्तता

sārdhāṅgulapramāṇena romāṇyatra tataḥ param tatra hetuḥ sahotthānāṁ bālye bījopataptatā

at one and a half fingers, hair grows there, and beyond it as well. The cause of the congenital type is the affliction of the parents' reproductive seed in childhood —

Verse 7 (garuda.1.156.7)

अर्शसां बीजसृष्टिस्तु मातापित्रपचारतः । देवतानां प्रकोपे हि सान्निपातस्य चान्यतः

arśasāṁ bījasṛṣṭistu mātāpitrapacārataḥ devatānāṁ prakope hi sānnipātasya cānyataḥ

the seed-origin of piles comes from the improper conduct of the parents, or from the anger of deities, or from sannipata, all three humors together, or from other causes.

Verse 8 (garuda.1.156.8)

असाध्या एवमाख्याताः सर्वे रोगाः कुलोद्भवाः । सहजानि विशेषेण रूक्षदुर्दर्शनानि तु

asādhyā evamākhyātāḥ sarve rogāḥ kulodbhavāḥ sahajāni viśeṣeṇa rūkṣadurdarśanāni tu

In this way, all hereditary diseases are declared incurable. The congenital piles in particular are dry and unsightly —

Verse 9 (garuda.1.156.9)

अन्तर्मुखानि पाण्डूनि दारुणोपद्रवाणि च । योज्यानि च पृथोग्दोषसंसर्गनिचयात्स्वतः

antarmukhāni pāṇḍūni dāruṇopadravāṇi ca yojyāni ca pṛthogdoṣasaṁsarganicayātsvataḥ

turned inward, pale in color, and productive of severe complications; they should be classified according to the accumulation of the individual and combined humors.

Verse 10 (garuda.1.156.10)

शुष्काणि वातश्लेष्मभ्यामार्द्राणि त्वस्य पित्ततः । दोषप्रकोपहेतुस्तु प्रागुक्तेवस्त्रसादिनि

śuṣkāṇi vātaśleṣmabhyāmārdrāṇi tvasya pittataḥ doṣaprakopahetustu prāguktevastrasādini

They are dry when caused by Vata and Kapha, and moist when caused by Pitta. The cause of humoral aggravation is as previously described, along with excessive wearing of clothes and the like —

Verse 11 (garuda.1.156.11)

अग्नौ मलेऽतिनिचिते पुनश्चायं (ति) व्यवायतः । पानसंक्षोभविषमकठिनक्षुद्रकाशनात्

agnau male'tinicite punaścāyaṁ (ti) vyavāyataḥ pānasaṁkṣobhaviṣamakaṭhinakṣudrakāśanāt

weak digestive fire, excessive accumulation of stool, and also from excessive sexual activity; from disturbance in drinking, and from irregular, hard, or scanty food —

Verse 12 (garuda.1.156.12)

बस्तिनेत्रगलौष्ठोत्थतलभेदादिघट्टनात् । भृशशीताम्बुसंस्पर्शप्रततातिप्रवाहणात्

bastinetragalauṣṭhotthatalabhedādighaṭṭanāt bhṛśaśītāmbusaṁsparśapratatātipravāhaṇāt

from friction or cracking of the bladder, eyes, throat, lips, and soles of the feet; from contact with excessively cold water, and from prolonged, excessive straining —

Verse 13 (garuda.1.156.13)

गतमूत्रशकृद्वेगधारणात्तदुदीरणात् । जुगुप्सातीसारमेव ग्रहणी सोऽप्युपद्रवः

gatamūtraśakṛdvegadhāraṇāttadudīraṇāt jugupsātīsārameva grahaṇī so'pyupadravaḥ

from suppressing the urges for urine and stool, and from forcing them out; from disgust-induced diarrhea; and Grahani, malabsorption disease, is also its complication —

Verse 14 (garuda.1.156.14)

कर्षणाद्विषमादेश्चचेष्टाभ्यो योषितां पुनः । आमगर्भप्रपतनाद्गर्भवृद्धिप्रपीडनात्

karṣaṇādviṣamādeścaceṣṭābhyo yoṣitāṁ punaḥ āmagarbhaprapatanādgarbhavṛddhiprapīḍanāt

from excessive exertion and irregular activities; and, in women, from the loss of an immature fetus, and also from the pressure of a growing full-term fetus —

Verse 15 (garuda.1.156.15)

ईदृशैश्चापरैर्वायुरपानः कुपितो मले । पायोर्वलीषु सद्रवृत्तिभास्वन्निः पूर्णमूर्तिषु

īdṛśaiścāparairvāyurapānaḥ kupito male pāyorvalīṣu sadravṛttibhāsvanniḥ pūrṇamūrtiṣu

from these and other such causes, the Apana-vayu becomes aggravated in the stool and produces, in the folds of the anus, protrusions that are moist, round, glistening, and full in shape —

Verse 16 (garuda.1.156.16)

जायन्तेर्ऽशांसितु तत्पूर्वं लक्षणं वह्निमन्दता । विष्टम्भः सास्थिसदनं पिण्डि (ष्ट) कोद्वेष्टनं भ्रमः

jāyanter'śāṁsitu tatpūrvaṁ lakṣaṇaṁ vahnimandatā viṣṭambhaḥ sāsthisadanaṁ piṇḍi (ṣṭa) kodveṣṭanaṁ bhramaḥ

these piles thus arise. Its premonitory signs are: weakness of digestive fire, constipation with weakness in the bones, cramping of the calves, and giddiness —

Verse 17 (garuda.1.156.17)

सान्द्रोत्थोनेत्रयोः शोथः शकृद्भवेदोऽथ वा ग्रहः । मारुतः पुरतो मूढः प्रायो नाभेरधश्चरन्

sāndrotthonetrayoḥ śothaḥ śakṛdbhavedo'tha vā grahaḥ mārutaḥ purato mūḍhaḥ prāyo nābheradhaścaran

dense swelling around the eyes, and either normal or obstructed passage of stool; Vata, confused, moving mostly downward from the navel —

Verse 18 (garuda.1.156.18)

सरक्तः परिकृन्तंश्च कृच्छ्रादाकुञ्चति श्वसन् । अन्त्रकूजनमाटोपः क्षारितोद्गारभूरिता

saraktaḥ parikṛntaṁśca kṛcchrādākuñcati śvasan antrakūjanamāṭopaḥ kṣāritodgārabhūritā

produces bloody, cutting pain, and the patient contracts, breathing with difficulty; there is rumbling of the intestines, distension, and frequent acidic belching —

Verse 19 (garuda.1.156.19)

प्रभूतमूत्रमल्पा विडश्रद्धा धूम्रकोष्ठकः । शिरः पृष्ठोरसां शूलमालस्यं भिन्नवर्चसम्

prabhūtamūtramalpā viḍaśraddhā dhūmrakoṣṭhakaḥ śiraḥ pṛṣṭhorasāṁ śūlamālasyaṁ bhinnavarcasam

excessive urination, scanty stool, loss of appetite, a smoky sensation in the abdomen; pain in the head, back, and chest, lassitude, and irregular stool —

Verse 20 (garuda.1.156.20)

इन्द्रियार्थेषु लौल्यं च क्रोधो दुः खोपचारतः । आशङ्का ग्रहणी शोथः पाण्डुगुल्मोदरेषु च

indriyārtheṣu laulyaṁ ca krodho duḥ khopacārataḥ āśaṅkā grahaṇī śothaḥ pāṇḍugulmodareṣu ca

restlessness toward sense-objects, and anger arising from harsh treatment; apprehension, and the risk of Grahani, swelling, anemia, abdominal tumors, and ascites —

Verse 21 (garuda.1.156.21)

एतान्येव विवर्धन्ते जातेष्वहतनामसु । निवर्तमानो मानो हि तैरधोमार्गरोधतः

etānyeva vivardhante jāteṣvahatanāmasu nivartamāno māno hi tairadhomārgarodhataḥ

once piles have arisen, all these increase further. When Vata's natural downward path is blocked by them, it turns back and —

Verse 22 (garuda.1.156.22)

क्षोभयेदनिलानन्यान् सर्वेन्द्रियशरीगान् । तथा मूत्रशकृत्पित्तकफान्वायुश्च शोषयन्

kṣobhayedanilānanyān sarvendriyaśarīgān tathā mūtraśakṛtpittakaphānvāyuśca śoṣayan

agitates the other winds pervading all the senses of the body; and, drying up urine, stool, Pitta, and Kapha —

Verse 23 (garuda.1.156.23)

मुष्णात्यग्निं ततः सर्वे भवन्ति प्रायशोर्ऽशसः । कृशो भृशं हतोत्साहो दीनः क्षामोऽथ निष्प्रभः

muṣṇātyagniṁ tataḥ sarve bhavanti prāyaśor'śasaḥ kṛśo bhṛśaṁ hatotsāho dīnaḥ kṣāmo'tha niṣprabhaḥ

it steals away the digestive fire; thereafter, most patients with piles show all these signs. The patient becomes greatly emaciated, without vigor, wretched, thin, and lusterless —

Verse 24 (garuda.1.156.24)

असारी विगतच्छायो जन्तुदग्ध इवद्रुम । कृच्छ्रैरुग्रद्रवैर्ग्रस्तो यक्ष्मोक्तैर्मर्मपीडनैः

asārī vigatacchāyo jantudagdha ivadruma kṛcchrairugradravairgrasto yakṣmoktairmarmapīḍanaiḥ

without strength, robbed of luster, like a tree consumed by insects; afflicted with the severe, acute sufferings and vital-point pains described under consumption —

Verse 25 (garuda.1.156.25)

तथा काशपिपासास्यवैरस्यश्वासपीनसैः । क्लमाङ्गभङ्गवमथुक्षवथुश्वयथुज्वरैः

tathā kāśapipāsāsyavairasyaśvāsapīnasaiḥ klamāṅgabhaṅgavamathukṣavathuśvayathujvaraiḥ

and with cough, thirst, a bad taste in the mouth, breathlessness, and catarrh; with exhaustion, aching limbs, vomiting, sneezing, swelling, and fever —

Verse 26 (garuda.1.156.26)

क्लैब्यबाधिर्यस्तैमित्यशर्करापरिपीडितः । क्षामो भिन्नस्वरो ध्यायन्मुहुः ष्ठीवन्नरोचकी

klaibyabādhiryastaimityaśarkarāparipīḍitaḥ kṣāmo bhinnasvaro dhyāyanmuhuḥ ṣṭhīvannarocakī

afflicted with impotence, deafness, numbness, and urinary gravel; emaciated, with a broken voice, constantly brooding, spitting, and without appetite —

Verse 27 (garuda.1.156.27)

सर्वपर्वास्थिहृन्नाभीपायुवङ्क्षणशूलवान् । गुदेनस्त्रवता पित्तं बलाकोदरसन्निभम्

sarvaparvāsthihṛnnābhīpāyuvaṅkṣaṇaśūlavān gudenastravatā pittaṁ balākodarasannibham

suffering pain in every joint, bone, the heart, navel, anus, and groin; and, from the anus, a discharge resembling the color of a crane's belly —

Verse 28 (garuda.1.156.28)

विशुष्कं चैव मुक्ताग्रं पक्वामं चान्तरान्तरम् । पाण्डुपित्तं हरिद्राक्तं पिच्छिलं चोपवेश्यते

viśuṣkaṁ caiva muktāgraṁ pakvāmaṁ cāntarāntaram pāṇḍupittaṁ haridrāktaṁ picchilaṁ copaveśyate

dry with a loosened tip, alternately digested and undigested; pale-bilious, turmeric-tinged, slimy stool is passed — this is the Vata type.

Verse 29 (garuda.1.156.29)

गुदाङ्कुरा बह्वनिलाः शुष्काश्चिमचिमान्विताः । पीनाङ्गारारुणाः स्तब्धा विषमाः परुषाकराः

gudāṅkurā bahvanilāḥ śuṣkāścimacimānvitāḥ pīnāṅgārāruṇāḥ stabdhā viṣamāḥ paruṣākarāḥ

The anal sprouts, predominant with Vata, are dry and accompanied by a tingling, burning sensation; dark-reddish like glowing embers, hard, irregular, and rough —

Verse 30 (garuda.1.156.30)

मिथो विसदृश वक्रास्तीक्ष्णा विस्फुटि(रि) ताननाः । शिम्बीखर्जृरकर्कन्धूकार्पासफलसन्निभाः

mitho visadṛśa vakrāstīkṣṇā visphuṭi(ri) tānanāḥ śimbīkharjṛrakarkandhūkārpāsaphalasannibhāḥ

mutually dissimilar, curved, sharp, and fissured; resembling in shape a bean-pod, a date, a jujube fruit, or a cotton-boll —

Verse 31 (garuda.1.156.31)

केचित्कदम्बपुष्पाभाः केचित्सिद्धार्थकोपमाः । शिरः पार्श्वांसजङ्घोरुवङ्क्षणाद्यधिकव्यथाः

kecitkadambapuṣpābhāḥ kecitsiddhārthakopamāḥ śiraḥ pārśvāṁsajaṅghoruvaṅkṣaṇādyadhikavyathāḥ

some resembling kadamba flowers, others like mustard seeds; causing severe pain in the head, sides, shoulders, thighs, groin, and the like —

Verse 32 (garuda.1.156.32)

क्षवथूद्गारविष्टम्भहृद्गहारोचकप्रदाः । कासश्वासाग्निवैषम्यकर्णनादभ्रमावहाः

kṣavathūdgāraviṣṭambhahṛdgahārocakapradāḥ kāsaśvāsāgnivaiṣamyakarṇanādabhramāvahāḥ

producing sneezing, belching, constipation, heaviness of the heart, and loss of appetite; bringing on cough, breathlessness, irregular digestion, ringing in the ears, and giddiness —

Verse 33 (garuda.1.156.33)

तैरार्तो ग्रथितं स्तोकं सशब्दं सप्रवाहिकम् । रुक्फेनपिच्छानुगतं विबद्धमुपवेश्यते

tairārto grathitaṁ stokaṁ saśabdaṁ sapravāhikam rukphenapicchānugataṁ vibaddhamupaveśyate

afflicted by these, the patient passes stool in small, knotted amounts, with sound, with straining, mixed with pain, froth, and mucus, in a constipated state.

Verse 34 (garuda.1.156.34)

कृष्णत्वग्बद्धविण्मूत्रनेत्रवक्त्रश्च जायते । गुल्मप्लीहोदराष्ठीलासंभवस्तस्य चैव हि

kṛṣṇatvagbaddhaviṇmūtranetravaktraśca jāyate gulmaplīhodarāṣṭhīlāsaṁbhavastasya caiva hi

The skin turns dark, stool and urine become obstructed, and the eyes and face become discolored; and there arise in him abdominal tumors, an enlarged spleen, ascites, and hard lumps.

Verse 35 (garuda.1.156.35)

पित्तोत्तरा नीलमुखा रक्तपीतासितप्रभाः । तन्वग्रस्त्राविणो विश्रास्तनवो मृदवः श्लथाः

pittottarā nīlamukhā raktapītāsitaprabhāḥ tanvagrastrāviṇo viśrāstanavo mṛdavaḥ ślathāḥ

The Pitta-predominant piles have a bluish tip and a reddish-yellow-black hue; thin at the tip, discharging, drooping, soft, and loose —

Verse 36 (garuda.1.156.36)

शुकजिह्वा यकृत्खण्डजलौकावक्त्रसन्निभाः । दाहशो (ष) कज्वरस्वेदतृण्मूर्छारुचिमोहदाः

śukajihvā yakṛtkhaṇḍajalaukāvaktrasannibhāḥ dāhaśo (ṣa) kajvarasvedatṛṇmūrchārucimohadāḥ

resembling a parrot's tongue, a piece of liver, or a leech's mouth; producing burning, grief, fever, sweating, thirst, fainting, loss of appetite, and confusion —

Verse 37 (garuda.1.156.37)

सोष्माणो द्रवनीलोष्णपीतरक्तामवर्चसः । यवमध्या हरित्पीतहारिद्रत्वङ्नखादयः

soṣmāṇo dravanīloṣṇapītaraktāmavarcasaḥ yavamadhyā haritpītahāridratvaṅnakhādayaḥ

warm to the touch, with liquid, bluish, hot, yellow, or blood-mixed undigested stool; barley-grain-shaped at the center, with greenish-yellow, turmeric-colored skin and nails — this is the Pitta type.

Verse 38 (garuda.1.156.38)

श्लेष्मोल्बणा महामूला घना मन्दरुजः सिताः । उत्सन्नोपचितस्निग्धस्तब्धवृत्तगुरुस्थिराः

śleṣmolbaṇā mahāmūlā ghanā mandarujaḥ sitāḥ utsannopacitasnigdhastabdhavṛttagurusthirāḥ

The Kapha-predominant piles have large bases, are dense, cause little pain, and are white; raised, thick, oily, firm, round, heavy, and stable —

Verse 39 (garuda.1.156.39)

पिच्छिलाः स्तिमिताः श्लक्ष्णाः कण्ड्वाढ्याः स्पर्शनप्रियाः । करीरपनसास्थ्याभास्तथा गोस्तनसन्निभाः

picchilāḥ stimitāḥ ślakṣṇāḥ kaṇḍvāḍhyāḥ sparśanapriyāḥ karīrapanasāsthyābhāstathā gostanasannibhāḥ

slimy, moist, smooth, intensely itchy, and pleasant to the touch; resembling the seed of the karira plant or a jackfruit seed, and also resembling a cow's udder —

Verse 40 (garuda.1.156.40)

वङ्क्षणानाहिनः पुयुबस्तिनाभिविकर्तनाः । सकाशश्वासहृल्लासप्रसेकारुचिपीनसाः

vaṅkṣaṇānāhinaḥ puyubastinābhivikartanāḥ sakāśaśvāsahṛllāsaprasekārucipīnasāḥ

causing distension in the groin, and pus-like cutting pain at the bladder and navel; accompanied by cough, breathlessness, nausea, salivation, loss of appetite, and catarrh —

Verse 41 (garuda.1.156.41)

महकृच्छ्रशिरोजाड्यशिशिरक्षारकारिणः । क्लैब्याग्निमार्दवच्छर्द्यतीसारादिविकारदाः

mahakṛcchraśirojāḍyaśiśirakṣārakāriṇaḥ klaibyāgnimārdavacchardyatīsārādivikāradāḥ

causing great distress, dullness of the head, and worsening with cold, alkaline substances; producing impotence, weakness of digestion, vomiting, diarrhea, and similar disorders —

Verse 42 (garuda.1.156.42)

वसाभसकफप्राज्यपुरीषासृक्प्रवाहिकाः । न स्त्रवन्ति न भिद्यन्ते पाण्डुस्निग्धत्वगादयः

vasābhasakaphaprājyapurīṣāsṛkpravāhikāḥ na stravanti na bhidyante pāṇḍusnigdhatvagādayaḥ

discharging fatty, watery, phlegm-mixed, copious blood-tinged stool with straining; they do not bleed and do not rupture; the skin becomes pale and oily — this is the Kapha type.

Verse 43 (garuda.1.156.43)

संसृष्टलिङ्गत्संसर्गनिचयात्सर्वलक्षणाः । रक्तोल्बणा गुदे कीलाः पीताकृतिसमन्विताः

saṁsṛṣṭaliṅgatsaṁsarganicayātsarvalakṣaṇāḥ raktolbaṇā gude kīlāḥ pītākṛtisamanvitāḥ

When the humors combine, the signs likewise combine, appearing according to their accumulated mixture. The blood-predominant anal protrusions have a yellowish form —

Verse 44 (garuda.1.156.44)

वटप्रसेहसदृशाः गुञ्जाविद्रुमसन्निभाः । तेऽत्यर्थं दुष्टमुष्णं च गाढविष्टंभपीडिताः

vaṭaprasehasadṛśāḥ guñjāvidrumasannibhāḥ te'tyarthaṁ duṣṭamuṣṇaṁ ca gāḍhaviṣṭaṁbhapīḍitāḥ

resembling a banyan-tree bud, or a gunja seed, or coral; extremely afflicted with corruption, heat, and severe constipation, they —

Verse 45 (garuda.1.156.45)

स्त्रवन्ति सहसा रक्तं तस्य चातिप्रवृत्तितः । केकाभः पीड्यते दुः खैः शोणितक्षयसम्भवैः

stravanti sahasā raktaṁ tasya cātipravṛttitaḥ kekābhaḥ pīḍyate duḥ khaiḥ śoṇitakṣayasambhavaiḥ

suddenly discharge blood; and from its excessive flow, the patient, groaning like a peacock's cry, is afflicted with sufferings arising from loss of blood —

Verse 46 (garuda.1.156.46)

हीनवर्णबलोत्साहो हतौजाः कलुषेन्द्रियः । मुद्गकोद्रवजंबीरकरीरचणकादिभिः

hīnavarṇabalotsāho hataujāḥ kaluṣendriyaḥ mudgakodravajaṁbīrakarīracaṇakādibhiḥ

his complexion, strength, and vigor diminished, his vital essence destroyed, his senses clouded. From mung beans, kodrava grain, citron, karira, chickpea, and the like —

Verse 47 (garuda.1.156.47)

रूक्षैः संग्राहिभिर्वायुर्विट्स्थाने कुपितो बली । अधोवहानि स्रोतांसि संरुध्याधः प्रशोषयन्

rūkṣaiḥ saṁgrāhibhirvāyurviṭsthāne kupito balī adhovahāni srotāṁsi saṁrudhyādhaḥ praśoṣayan

which are dry and constipating, the strong Vata becomes aggravated in the site of the stool, obstructing the downward-flowing channels and drying them —

Verse 48 (garuda.1.156.48)

पुरीषं वातविष्णूत्रसंगं कुर्वीत दारुणम्? । तेन तीव्रा रुजा कोष्ठपृष्ठहृत्पार्श्वगा भवेत्

purīṣaṁ vātaviṣṇūtrasaṁgaṁ kurvīta dāruṇam? tena tīvrā rujā koṣṭhapṛṣṭhahṛtpārśvagā bhavet

it produces a terrible retention of stool, wind, and urine; from this, severe pain arises in the abdomen, back, heart, and sides.

Verse 49 (garuda.1.156.49)

आध्मानमुदरे विष्ठा हृल्लासपरिकर्तने । बस्तौ च सुतरां शूलो गण्डश्वयथुसंभवः

ādhmānamudare viṣṭhā hṛllāsaparikartane bastau ca sutarāṁ śūlo gaṇḍaśvayathusaṁbhavaḥ

there is abdominal distension, retained stool, nausea, and cutting pain; and, especially in the bladder, severe pain along with the arising of lumps and swellings —

Verse 50 (garuda.1.156.50)

पवनस्योर्ध्वगामित्वात्ततश्छर्द्यरुचिज्वराः । हृद्रोगग्रहणीदोषमूत्रसंगप्रवाहिकाः

pavanasyordhvagāmitvāttataśchardyarucijvarāḥ hṛdrogagrahaṇīdoṣamūtrasaṁgapravāhikāḥ

because Vata is forced upward, vomiting, loss of appetite, and fever occur; heart disease, Grahani-disorder, urinary retention, and straining diarrhea —

Verse 51 (garuda.1.156.51)

बाधिर्यातिशिरः श्वासशिरोरुक्काशपीनसाः? । मनोविकारस्तृट्श्वासपित्तगुल्मोदरादयः

bādhiryātiśiraḥ śvāsaśirorukkāśapīnasāḥ? manovikārastṛṭśvāsapittagulmodarādayaḥ

deafness, severe headache, breathlessness, headache, cough, and catarrh; mental disorder, thirst, breathlessness, biliousness, abdominal tumors, ascites, and the like —

Verse 52 (garuda.1.156.52)

एते च वातजा रोगा जायन्ते भृशदारुणाः । दुर्नामामृत्यूदावर्तपरमोऽयमुपद्रवः

ete ca vātajā rogā jāyante bhṛśadāruṇāḥ durnāmāmṛtyūdāvartaparamo'yamupadravaḥ

all these Vata-caused diseases arise in an exceedingly severe form. Durnama, the obstinate variety of piles, and Udavarta are the most severe complications —

Verse 53 (garuda.1.156.53)

वाताभिभूतकोष्ठानां तैर्विनापि विजायते । सहजानि तु दोषाणि यानि चाभ्यन्तरे वलौ

vātābhibhūtakoṣṭhānāṁ tairvināpi vijāyate sahajāni tu doṣāṇi yāni cābhyantare valau

which can afflict those whose abdomen is overwhelmed by Vata even without these specific causes. Congenital disorders located deep within the inner fold —

Verse 54 (garuda.1.156.54)

स्थितानि तान्यसाध्यानि याप्यन्तेऽग्निबलादिभिः । द्वन्द्वजानि द्वितीयायां वला यान्याश्रितानि च

sthitāni tānyasādhyāni yāpyante'gnibalādibhiḥ dvandvajāni dvitīyāyāṁ valā yānyāśritāni ca

are incurable; they can only be managed through strengthening the digestive fire and similar measures. Those caused by two combined humors, located in the second fold —

Verse 55 (garuda.1.156.55)

कृच्छ्रसाध्यानि तान्याहुः परिसंवत्सराणि च । बाह्यायां तु वलौ जातान्येकदोषोल्बणानि च

kṛcchrasādhyāni tānyāhuḥ parisaṁvatsarāṇi ca bāhyāyāṁ tu valau jātānyekadoṣolbaṇāni ca

are said to be curable, though with difficulty, over about a year. But piles arising in the outer fold, predominantly caused by a single humor —

Verse 56 (garuda.1.156.56)

अर्शांसि सुखसाध्यानि न चिरोत्पत्तिकानि च । मेढ्रादिष्वपि वक्ष्यन्ते यथास्वं नाभिजानि तु

arśāṁsi sukhasādhyāni na cirotpattikāni ca meḍhrādiṣvapi vakṣyante yathāsvaṁ nābhijāni tu

are easily curable, and are not of long standing. Piles arising on the male organ and elsewhere, as well as near the navel, will likewise be described.

Verse 57 (garuda.1.156.57)

गण्डूपदस्य रूपाणि पिच्छिलानि मृदूनि च । व्यानो गृहीत्वा श्लेष्माणं करोत्यर्शस्त्वचो बहिः

gaṇḍūpadasya rūpāṇi picchilāni mṛdūni ca vyāno gṛhītvā śleṣmāṇaṁ karotyarśastvaco bahiḥ

The Gandupada type has the appearance of earthworms, slimy and soft. Vyana-vayu, seizing kapha, produces piles outside the skin —

Verse 58 (garuda.1.156.58)

कीलोपमं स्थिरखरं चर्मकीलं च तद्विदुः । वातेन तोदः पारुष्यं पित्तादसितवक्त्रता

kīlopamaṁ sthirakharaṁ carmakīlaṁ ca tadviduḥ vātena todaḥ pāruṣyaṁ pittādasitavaktratā

which is firm and rough like a peg — this they call Charmakila, a skin-tag. From Vata: pricking pain and roughness; from Pitta: a dark mouth-color —

Verse 59 (garuda.1.156.59)

श्लेष्मणः स्निग्धता तस्य ग्रथितत्वं सवर्णता । अर्शसां प्रशमे यत्नमाशु कुर्वीत बुद्धिमान् । तान्याशु हि गदन्धा (कार्) य्य कुर्युर्बद्धगुदोदरम्

śleṣmaṇaḥ snigdhatā tasya grathitatvaṁ savarṇatā arśasāṁ praśame yatnamāśu kurvīta buddhimān tānyāśu hi gadandhā (kār) yya kuryurbaddhagudodaram

from Kapha: unctuousness, a knotted texture, and matching natural skin-color. A wise person should make prompt effort to pacify piles; if neglected, they swiftly bring about a disease that blocks the anus and abdomen.