The Diagnosis of Dysentery (Atisara) and Grahani

Verse 1 (garuda.1.157.1)

धन्वन्तरिरुवाच । अतीसारग्रहण्योश्च निदानं वच्मि सुश्रुत । दोषैर्व्यस्तैः समस्तैश्च भयाच्छोकाच्च षड्विधः

dhanvantariruvāca atīsāragrahaṇyośca nidānaṁ vacmi suśruta doṣairvyastaiḥ samastaiśca bhayācchokācca ṣaḍvidhaḥ

Dhanvantari said: O Sushruta, I shall tell the diagnosis of Atisara, diarrhea and dysentery, and Grahani, malabsorption. It is sixfold: from the separate humors, from all combined, from fear, and from grief.

Verse 2 (garuda.1.157.2)

अतीसारः स सुतरां जायतेऽत्यम्बुपानतः । विशुष्कान्नवसास्नेहतिलपिष्टविरूढकैः

atīsāraḥ sa sutarāṁ jāyate'tyambupānataḥ viśuṣkānnavasāsnehatilapiṣṭavirūḍhakaiḥ

This Atisara arises especially from drinking excessive water; also from overly dry food, from fat, oily substances, sesame, flour paste, and sprouted grains —

Verse 3 (garuda.1.157.3)

मद्यरूक्षातिमात्रादिरसातिस्नेहविभ्रमात् । कृमिघोषविरोधाच्च तद्विधेः कुपितानिलः

madyarūkṣātimātrādirasātisnehavibhramāt kṛmighoṣavirodhācca tadvidheḥ kupitānilaḥ

from liquor, excessively dry foods and the like, from disturbance caused by excessive oiliness in food, and from worms and mutually incompatible foods — Vata, thus aggravated —

Verse 4 (garuda.1.157.4)

विस्त्रंसयत्यधोवातं हत्वा तेनैव चानलम् । व्यापार्यान्नशकृत्कोष्ठपुरीषद्रवतादयः

vistraṁsayatyadhovātaṁ hatvā tenaiva cānalam vyāpāryānnaśakṛtkoṣṭhapurīṣadravatādayaḥ

loosens the Apana-vayu, and by that very process destroys the digestive fire; it disturbs the food, stool, and abdomen, causing the stool to become liquid and the like —

Verse 5 (garuda.1.157.5)

प्रकल्पतेऽतीसारस्य लक्षणं तस्य भाविनः । भेदो हृद्गुदकोष्ठेषु गात्रस्वेदो मलग्रहः

prakalpate'tīsārasya lakṣaṇaṁ tasya bhāvinaḥ bhedo hṛdgudakoṣṭheṣu gātrasvedo malagrahaḥ

this brings about Atisara. Its premonitory signs are: pain in the heart, anus, and abdomen, sweating of the body, and retention of stool —

Verse 6 (garuda.1.157.6)

आध्मानमविपाकश्च तत्र वातेन विज्वरम् । अल्पाल्पं शब्दशून्याढ्यं विरु (ब)द्धमुपवेश्यते

ādhmānamavipākaśca tatra vātena vijvaram alpālpaṁ śabdaśūnyāḍhyaṁ viru (ba)ddhamupaveśyate

distension, and indigestion. There, in the Vata type, without fever, stool is passed in small quantities, sometimes without sound and sometimes with much sound, in an obstructed manner —

Verse 7 (garuda.1.157.7)

रूक्षं सफेनमच्छं च गृहीतं व मुहुर्मुहुः । तथादग्धगदाभासं पिच्छिलं परिकर्तयन्

rūkṣaṁ saphenamacchaṁ ca gṛhītaṁ va muhurmuhuḥ tathādagdhagadābhāsaṁ picchilaṁ parikartayan

dry, frothy, and clear, or repeatedly retained; and appearing as if undigested, slimy, and causing cutting pain —

Verse 8 (garuda.1.157.8)

सशुष्कभ्रष्टपायुश्च हृष्टरोमा विनिश्वसन् । पित्तेन पीतमशितं हारिद्रं शाद्वलप्रभम्

saśuṣkabhraṣṭapāyuśca hṛṣṭaromā viniśvasan pittena pītamaśitaṁ hāridraṁ śādvalaprabham

with a dry, prolapsed anus, horripilation, and deep sighing. In the Pitta type, the stool is yellow, turmeric-hued, or the color of green grass —

Verse 9 (garuda.1.157.9)

सरक्तमतिदुर्गन्धं तृण्मूर्छास्वेददाहवान् । सशूलपायुसन्तापपाकवाञ्छ्लेष्मणा घनम्

saraktamatidurgandhaṁ tṛṇmūrchāsvedadāhavān saśūlapāyusantāpapākavāñchleṣmaṇā ghanam

blood-mixed, extremely foul-smelling, accompanied by thirst, fainting, sweating, and burning; with pain and burning in the anus and a ripening-like sensation. In the Kapha type, the stool is thick —

Verse 10 (garuda.1.157.10)

पिच्छिलं तत्रानुसारमल्पाल्पं सप्रवाहिकम् । सरोमहर्पः सेक्लेशो गुरुबस्तिगुदोदरः

picchilaṁ tatrānusāramalpālpaṁ sapravāhikam saromaharpaḥ sekleśo gurubastigudodaraḥ

slimy, passed in small amounts with each urge, with straining; accompanied by horripilation and distress, with heaviness in the bladder, anus, and abdomen —

Verse 11 (garuda.1.157.11)

कृतेऽप्यकृतसङ्गश्च सर्वात्मा सर्वलक्षणः । भयेन क्षुभिते चित्ते शायिते द्रावयेत्स (च्छ) कृत्

kṛte'pyakṛtasaṅgaśca sarvātmā sarvalakṣaṇaḥ bhayena kṣubhite citte śāyite drāvayetsa (ccha) kṛt

and, even after passing stool, a sense of incomplete evacuation remains. The type from all three humors together shows all these signs at once. When the mind is agitated by fear while the person lies down, the stool may become liquid at once —

Verse 12 (garuda.1.157.12)

वायुस्ततो निवार्येत क्षिप्रमुष्णं द्रवं प्लवम् । वातपित्ते समं लिङ्गमाहुस्तद्वच्च शोकतः

vāyustato nivāryeta kṣipramuṣṇaṁ dravaṁ plavam vātapitte samaṁ liṅgamāhustadvacca śokataḥ

Vata should then be quickly checked with hot, liquid, floating remedies. The signs of the fear-caused type are said to resemble those of Vata-Pitta, and likewise for the grief-caused type.

Verse 13 (garuda.1.157.13)

अतीसारः समासेन द्वेधा सामो निरामकः । सासृग्जातं रसद्रोगो गौरवादप्सु मुञ्चति? । शकृद्दुर्गन्धमाटोपविष्टम्भार्तिप्रसेकिनः

atīsāraḥ samāsena dvedhā sāmo nirāmakaḥ sāsṛgjātaṁ rasadrogo gauravādapsu muñcati? śakṛddurgandhamāṭopaviṣṭambhārtiprasekinaḥ

In summary, Atisara is of two kinds: with ama, undigested toxin, and without it. The ama-type stool sinks in water because of its heaviness; the stool is foul-smelling, with distension, obstruction, pain, and salivation —

Verse 14 (garuda.1.157.14)

विपरीतो निरामस्तु कफात्कोऽपि न मज्जति । अतीसारेषु यो नाति यत्नवान् ग्रहणीगदः

viparīto nirāmastu kaphātko'pi na majjati atīsāreṣu yo nāti yatnavān grahaṇīgadaḥ

the opposite, the nirama type, does not sink in water at all. Among these cases of Atisara, when sufficient care is not taken, the disease Grahani arises.

Verse 15 (garuda.1.157.15)

तस्य स्यादग्निनिर्वाणकार्यैरत्यर्थसञ्चितैः । सामं शकृन्निरामं वा जीर्णं येनातिसार्यते

tasya syādagninirvāṇakāryairatyarthasañcitaiḥ sāmaṁ śakṛnnirāmaṁ vā jīrṇaṁ yenātisāryate

This occurs through the extinguishing of the digestive fire by causes accumulated in excess; stool with or without ama, digested or not, is repeatedly passed in this way —

Verse 16 (garuda.1.157.16)

सोऽतिसारोऽतिसरणा दाशुकारीः स्वभावतः । सामंशीर्णमजीर्णेन जीर्णे पक्वं तु नैव च

so'tisāro'tisaraṇā dāśukārīḥ svabhāvataḥ sāmaṁśīrṇamajīrṇena jīrṇe pakvaṁ tu naiva ca

and this Atisara, through its own recurrence, by its nature quickly gives rise to Grahani. The stool carries ama when the food is undigested, but properly should not do so once digestion is complete —

Verse 17 (garuda.1.157.17)

चिरकृद्ग्रहणीदोषः सञ्चयांश्चोपवेशयेत् । अकस्माद्वारसुर्वेधमकस्मात्सन्धिनीमुहुः? । स चतुर्धा पृथग्दोषैः सन्निपाताच्च जायते

cirakṛdgrahaṇīdoṣaḥ sañcayāṁścopaveśayet akasmādvārasurvedhamakasmātsandhinīmuhuḥ? sa caturdhā pṛthagdoṣaiḥ sannipātācca jāyate

the long-standing Grahani-disorder gives rise to further accumulations; sometimes with sudden severe pain, sometimes recurring suddenly and repeatedly. It is fourfold, arising from the separate humors or from sannipata.

Verse 18 (garuda.1.157.18)

प्राग्रूपाङ्गस्य सदनं चिरात्पवन अल्पकः । प्रसेको वक्त्रवैरस्यमरुचिस्तृट्श्रमोभ्रमः

prāgrūpāṅgasya sadanaṁ cirātpavana alpakaḥ praseko vaktravairasyamarucistṛṭśramobhramaḥ

Its premonitory signs are: weakness of the limbs, and, after a long time, slight passage of flatus; salivation, a bad taste in the mouth, loss of appetite, thirst, fatigue, and giddiness —

Verse 19 (garuda.1.157.19)

आब (न) द्धोदरता छर्दिः कर्णकेऽप्यनुकूजकम् । सामान्यलक्षणं कार्श्यं वमक स्तमको ज्वरः

āba (na) ddhodaratā chardiḥ karṇake'pyanukūjakam sāmānyalakṣaṇaṁ kārśyaṁ vamaka stamako jvaraḥ

obstruction in the abdomen, vomiting, and even a ringing sound in the ears. Its common signs are: emaciation, a tendency to vomit, obstructive breathing, and fever.

Verse 20 (garuda.1.157.20)

मूर्छा शिरोरुविष्टम्भः श्वयथुः करपादयोः । तन्द्रानिलात्तालुशोषस्तिमिरं कर्णयोः स्वनः

mūrchā śiroruviṣṭambhaḥ śvayathuḥ karapādayoḥ tandrānilāttāluśoṣastimiraṁ karṇayoḥ svanaḥ

Fainting, headache with obstruction, swelling of the hands and feet, and drowsiness occur from Vata, along with dryness of the palate, dimness of vision, and ringing in the ears —

Verse 21 (garuda.1.157.21)

पार्श्वोरुवङ्क्षणग्रीवारुजा तीक्ष्णविषूचिका । रुग्णेषु वृद्धिः सर्वषु क्षुत्तृष्णापरिहर्त्रिका

pārśvoruvaṅkṣaṇagrīvārujā tīkṣṇaviṣūcikā rugṇeṣu vṛddhiḥ sarvaṣu kṣuttṛṣṇāparihartrikā

pain in the sides, thighs, groin, and neck, and a severe cholera-like disturbance. All these afflictions worsen further, and hunger and thirst become erratic —

Verse 22 (garuda.1.157.22)

जीर्णेजीर्यति चाध्मानं भुक्ते स्वास्थ्यं समश्नुते । वाताद्धृद्रोगगुल्मार्शःप्लीहपाण्डुरशङ्किताः

jīrṇejīryati cādhmānaṁ bhukte svāsthyaṁ samaśnute vātāddhṛdrogagulmārśaḥplīhapāṇḍuraśaṅkitāḥ

there is distension both after digestion and after eating, yet a sense of relief comes while eating. In Vata-caused Grahani, there is suspicion of heart disease, abdominal tumors, piles, an enlarged spleen, and anemia —

Verse 23 (garuda.1.157.23)

चिराद्दुः खं द्रवं शुष्कं तुन्दारं शब्दफेनवत् । पुनः पुनः सृजेद्वर्चं पायुरुच्छ्वासकासवान्

cirādduḥ khaṁ dravaṁ śuṣkaṁ tundāraṁ śabdaphenavat punaḥ punaḥ sṛjedvarcaṁ pāyurucchvāsakāsavān

after a long time, with pain, liquid or dry stool, distending the belly, comes out with sound and froth; the patient passes stool repeatedly, and the anus is accompanied by breathlessness and coughing.

Verse 24 (garuda.1.157.24)

पीतेन पीतनीलाभं पीताभं सृजति द्रवम् । पूत्यम्लोद्गारहृत्कण्ठदाहारुचितृडर्दितः

pītena pītanīlābhaṁ pītābhaṁ sṛjati dravam pūtyamlodgārahṛtkaṇṭhadāhārucitṛḍarditaḥ

In Pitta-caused Grahani, a yellowish-blue or yellow liquid stool is passed, and the patient is afflicted with foul, sour belching, burning of the heart and throat, loss of appetite, and thirst —

Verse 25 (garuda.1.157.25)

श्लेष्मणा पच्यते दुःखे मनश्छर्दिररोचकः । आस्योपदाहनिष्ठीवकासहृल्लासपीनसाः

śleṣmaṇā pacyate duḥkhe manaśchardirarocakaḥ āsyopadāhaniṣṭhīvakāsahṛllāsapīnasāḥ

In Kapha-caused Grahani, digestion occurs painfully, the mind grows troubled, with vomiting and loss of appetite; there is burning in the mouth, spitting, cough, nausea, and catarrh —

Verse 26 (garuda.1.157.26)

हृदयं मन्यते स्त्यानमुदरं स्तिमितं गुरु । उद्गारो दुष्टमधुरः सदनं सप्रहर्षणम्

hṛdayaṁ manyate styānamudaraṁ stimitaṁ guru udgāro duṣṭamadhuraḥ sadanaṁ sapraharṣaṇam

the heart feels thick and congested, and the abdomen heavy and sluggish; belching is corrupted and sweetish, accompanied by weakness and horripilation —

Verse 27 (garuda.1.157.27)

सम्भिन्नश्लेष्मसंश्लिष्टगुरुचाम्लैः (वर्चः) प्रवर्तचम् । अकृशस्यापि दौर्बल्यं सर्वजे सर्वदर्शनम्

sambhinnaśleṣmasaṁśliṣṭagurucāmlaiḥ (varcaḥ) pravartacam akṛśasyāpi daurbalyaṁ sarvaje sarvadarśanam

stool mixed with broken phlegm, heavy and sour, is passed; weakness persists even in one who is not thin. In the type from all three humors together, all these signs appear at once.

Verse 28 (garuda.1.157.28)

विभागेऽङ्गस्य ये प्रोक्ता पिपासाद्यास्त्रयो मलाः । तेऽप्यस्य ग्रहणीदोषाः समन्तेष्वस्ति कारणम्

vibhāge'ṅgasya ye proktā pipāsādyāstrayo malāḥ te'pyasya grahaṇīdoṣāḥ samanteṣvasti kāraṇam

The three excretions beginning with thirst, described earlier in relation to the body's division, are also present throughout as causes of this Grahani-disorder.

Verse 29 (garuda.1.157.29)

वातव्याध्यश्मरीकुष्ठमेहोदरभगन्दरम् । अर्शांसि ग्रहणीत्यष्टौ महारोगाः सुदुस्तराः

vātavyādhyaśmarīkuṣṭhamehodarabhagandaram arśāṁsi grahaṇītyaṣṭau mahārogāḥ sudustarāḥ

Vata-disease, kidney stones, skin disease, urinary disorders, ascites, fistula, piles, and Grahani — these eight are declared to be the great diseases, exceedingly difficult to overcome.