The Diagnosis of Pandu (Anemia/Jaundice) and Shotha (Swelling)

Verse 1 (garuda.1.162.1)

श्रीगरुडमहापुराणम् १६२ धन्वन्तरिरुवाच । पाण्डुशोथनिदानञ्च शृणु सुश्रत वच्मि ते । पित्तप्रधानाः कुपिता यथोक्तैः कोपनैर्मलाः

śrīgaruḍamahāpurāṇam 162 dhanvantariruvāca pāṇḍuśothanidānañca śṛṇu suśrata vacmi te pittapradhānāḥ kupitā yathoktaiḥ kopanairmalāḥ

Dhanvantari said: O Sushruta, now hear the causes of pandu (anemia/jaundice) and shotha (swelling); I shall tell you. The wastes, chiefly of the nature of pitta, become provoked by the causes already stated —

Verse 2 (garuda.1.162.2)

नत्रानिलेन बलिना क्षिप्ताक्षिप्तं यदि स्थितम् । धमनीर्दशमीः प्राप्य व्याप्नुवन्सकलां तनुम्

natrānilena balinā kṣiptākṣiptaṁ yadi sthitam dhamanīrdaśamīḥ prāpya vyāpnuvansakalāṁ tanum

— carried there by the powerful wind, whether propelled forth or lying still, it reaches the ten great vessels and pervades the entire body.

Verse 3 (garuda.1.162.3)

त्वगसृक्छ्लेष्ममांसानि प्रदूष्यन्रसमाश्रितम् । त्वङ्मांसयोस्तु कुरुते त्वचि वर्णान् पृथग्विधान्

tvagasṛkchleṣmamāṁsāni pradūṣyanrasamāśritam tvaṅmāṁsayostu kurute tvaci varṇān pṛthagvidhān

Corrupting the skin, blood, phlegm, and flesh, and lodging in the rasa (plasma), it produces on the skin and flesh various different discolorations.

Verse 4 (garuda.1.162.4)

स्वयं हरिद्रा हारिद्रं पाण्डुत्वं तेषु चाधिकम् । यातोऽयं प्रहतेदुग्रः स रोगस्तेन गौरवम्

svayaṁ haridrā hāridraṁ pāṇḍutvaṁ teṣu cādhikam yāto'yaṁ prahatedugraḥ sa rogastena gauravam

The skin itself turns turmeric-yellow, a yellowish pallor predominating among the discolorations; when this severe disease has thus advanced, heaviness of the body results.

Verse 5 (garuda.1.162.5)

धातूनां स्पर्शशैथिल्यमामजश्च गुणक्षयः । ततोऽल्परक्तमेदोऽस्थिनिः सारः स्याच्छ्लथेन्द्रियः

dhātūnāṁ sparśaśaithilyamāmajaśca guṇakṣayaḥ tato'lparaktamedo'sthiniḥ sāraḥ syācchlathendriyaḥ

There is a looseness to the touch in the bodily tissues, and their qualities decay from undigested matter (ama); thence blood, fat, and bone become deficient in essence, and the sense-organs grow feeble.

Verse 6 (garuda.1.162.6)

शीर्यमाणैरिवाङ्गैस्तु द्रवता हृदयेन च । शूलोक्षिकूटवदने स्तैमित्यं तत्र लालया

śīryamāṇairivāṅgaistu dravatā hṛdayena ca śūlokṣikūṭavadane staimityaṁ tatra lālayā

The limbs feel as though wasting away, and there is a sensation of looseness at the heart; there is pain in the eyes, temples, and face, and a heaviness there from excess saliva.

Verse 7 (garuda.1.162.7)

हीनतृट्शिशिरद्वेषी शीर्णलोभो हतानलः । मन्दशक्तिर्ज्वरी श्वासी कर्णशूली तथा भ्रमी

hīnatṛṭśiśiradveṣī śīrṇalobho hatānalaḥ mandaśaktirjvarī śvāsī karṇaśūlī tathā bhramī

Thirst diminishes, there is aversion to cold, the appetite fades, and the digestive fire is destroyed; the patient grows weak, feverish, breathless, has earache, and giddiness.

Verse 8 (garuda.1.162.8)

स पञ्चधा पृथग्दोषैः समस्तैर्मृत्तिकादनात् । प्राग्रूपमस्य हृदयस्पन्दनं रूक्षता त्वचि

sa pañcadhā pṛthagdoṣaiḥ samastairmṛttikādanāt prāgrūpamasya hṛdayaspandanaṁ rūkṣatā tvaci

This disease, pandu, is of five kinds — by the several doshas separately, by all together, and by the eating of clay. Its premonitory signs are throbbing at the heart and roughness of the skin.

Verse 9 (garuda.1.162.9)

अरुचिः पीतमूत्रत्वं स्वेदाभावोऽल्पमृत्रता । मेदः समानिलात्तत्र गाढरुक्क्लेदगात्रता

aruciḥ pītamūtratvaṁ svedābhāvo'lpamṛtratā medaḥ samānilāttatra gāḍharukkledagātratā

Loss of appetite, yellowness of urine, absence of sweating, and scanty urination occur. In the type arising from wind combined with fat/kapha, there is intense pain and moistness of the limbs.

Verse 10 (garuda.1.162.10)

कृष्णेक्षणं कृष्णशिरानखविण्मूत्रनेत्रता । शोथो नासास्यवैरस्यं विट्शोषः पार्श्वमूर्छना

kṛṣṇekṣaṇaṁ kṛṣṇaśirānakhaviṇmūtranetratā śotho nāsāsyavairasyaṁ viṭśoṣaḥ pārśvamūrchanā

The eyes turn dark; the veins, nails, stool, urine, and eyes all take on a dark hue; there is swelling, an unpleasant taste in nose and mouth, dryness of stool, and fainting felt in the sides.

Verse 11 (garuda.1.162.11)

पित्ते हरितपित्ताभः शिरादिषु ज्वरस्तमः । तृट्शोषमूर्छादौर्गन्ध्यं शीतेच्छा कटुवक्रता

pitte haritapittābhaḥ śirādiṣu jvarastamaḥ tṛṭśoṣamūrchādaurgandhyaṁ śītecchā kaṭuvakratā

In the pittaja type, the complexion turns greenish-bilious, darkness spreads over the veins and the like, and fever sets in; there is thirst, wasting, fainting, foul odour, a craving for cold, and a bitter, harsh taste in the mouth.

Verse 12 (garuda.1.162.12)

विड्भेदश्चाम्लको दाहः कफाच्च हृदयार्द्रता । तन्द्रा लवणवक्रत्वं रोमहर्षः स्वरक्षयः

viḍbhedaścāmlako dāhaḥ kaphācca hṛdayārdratā tandrā lavaṇavakratvaṁ romaharṣaḥ svarakṣayaḥ

The stool becomes loose with a sour smell, and there is burning; from kapha there arises moistness at the heart, drowsiness, a salty, distorted taste, horripilation, and loss of voice.

Verse 13 (garuda.1.162.13)

काशश्छर्दिश्च निचयान्नष्टलिङ्गोऽतिदुः सहः । उत्कृष्टेनिलपित्ताभ्या कटुर्वा मधुरः कफः

kāśaśchardiśca nicayānnaṣṭaliṅgo'tiduḥ sahaḥ utkṛṣṭenilapittābhyā kaṭurvā madhuraḥ kaphaḥ

There is also cough and vomiting. In the type born of the accumulation of all three doshas, the signs are indistinct and it is extremely hard to bear; kapha, overpowered by aggravated vata and pitta, may taste pungent or sweet.

Verse 14 (garuda.1.162.14)

दूषयित्वा वसादींश्च रौक्ष्याद्रक्तविमोक्षणम् । स्रोतसां संक्षयं कुर्यादनुरुध्य च पूर्ववत्

dūṣayitvā vasādīṁśca raukṣyādraktavimokṣaṇam srotasāṁ saṁkṣayaṁ kuryādanurudhya ca pūrvavat

Having corrupted the fat and the rest, through dryness there is a loss of blood, and, taking hold as before, it brings about the wasting of the body's channels.

Verse 15 (garuda.1.162.15)

पाण्डुरोगेक्षयेजाते नाभिपादास्यमेहनम् । पुरीषं कृमिवन्मुञ्चेद्भिन्नं सास्त्रं कफान्वितम्

pāṇḍurogekṣayejāte nābhipādāsyamehanam purīṣaṁ kṛmivanmuñcedbhinnaṁ sāstraṁ kaphānvitam

When wasting sets in due to pandu roga, swelling appears at the navel, feet, mouth, and genitals; the stool passes out broken up like worms, mixed with blood and phlegm.

Verse 16 (garuda.1.162.16)

यः पित्तरोगी सेवेत पित्तलं तस्य कामलम् । कोष्ठशा खोद्गतं पित्तं दग्ध्वासृङ्मांसमाहरेत्

yaḥ pittarogī seveta pittalaṁ tasya kāmalam koṣṭhaśā khodgataṁ pittaṁ dagdhvāsṛṅmāṁsamāharet

If one already afflicted with a pitta disorder indulges in pitta-aggravating food, kamala (jaundice) results in him; the pitta rising up from the trunk and limbs burns and consumes the blood and flesh.

Verse 17 (garuda.1.162.17)

हारिद्रमूत्रनेत्रत्वं मुखं रक्तं शकृत्तथा । दाही विपाकतृष्णावान् भेकाभो दुर्बलेन्द्रियः

hāridramūtranetratvaṁ mukhaṁ raktaṁ śakṛttathā dāhī vipākatṛṣṇāvān bhekābho durbalendriyaḥ

The urine and eyes turn turmeric-yellow, the mouth and stool become reddish; the patient burns, has disturbed digestion, is thirsty, takes on a frog-like greenish-pale colour, and his senses grow weak.

Verse 18 (garuda.1.162.18)

भवेत्पित्तानुगः शोथः पाण्डुरोगावृतस्य च । उपेक्षया च शोथाद्याः सकृच्छ्राः कुम्भकामलाः

bhavetpittānugaḥ śothaḥ pāṇḍurogāvṛtasya ca upekṣayā ca śothādyāḥ sakṛcchrāḥ kumbhakāmalāḥ

In one overtaken by pandu roga, swelling of the pitta type follows; and through neglect, this swelling and its associated signs turn into the severe, hard-to-cure kumbhakamala.

Verse 19 (garuda.1.162.19)

हरितश्यामपित्तत्वे पाण्डुरोगो यदा भवेत् । वातपित्ते भ्रमस्तृष्णा स्त्रीषु हर्षो मृदुज्वरः

haritaśyāmapittatve pāṇḍurogo yadā bhavet vātapitte bhramastṛṣṇā strīṣu harṣo mṛdujvaraḥ

When pandu roga arises with pitta turned a greenish-black hue, and with both vata and pitta provoked, there is giddiness, thirst, an unusual excitement toward women, and a low-grade fever.

Verse 20 (garuda.1.162.20)

तन्द्रा वा चानलभ्रंशस्तं वदन्ति हलीमकम् । आलस्यञ्चातिभवति तेषां पूर्वमुपद्रवः

tandrā vā cānalabhraṁśastaṁ vadanti halīmakam ālasyañcātibhavati teṣāṁ pūrvamupadravaḥ

There is also drowsiness and loss of digestive fire — this they call halimaka. Excessive lassitude is the complication that precedes all these conditions.

Verse 21 (garuda.1.162.21)

शोथः प्रधानः कथितः स एवातो निगद्यते । पित्तरक्तकफान्वायुर्दुष्टो दुष्टान्बहिः शिराः

śothaḥ pradhānaḥ kathitaḥ sa evāto nigadyate pittaraktakaphānvāyurduṣṭo duṣṭānbahiḥ śirāḥ

Having spoken of shotha as the principal topic, that very subject is now further explained. The provoked wind, carrying the vitiated pitta, blood, and kapha, drives outward into the veins —

Verse 22 (garuda.1.162.22)

नीत्वा रुद्धगतिस्तैर्हि कुर्यात्त्वङ्मांससंश्रयम् । उत्सेधं संहतं शोथं तमाहुर्निचयादतः

nītvā ruddhagatistairhi kuryāttvaṅmāṁsasaṁśrayam utsedhaṁ saṁhataṁ śothaṁ tamāhurnicayādataḥ

— and, its own movement thereby obstructed by them, it settles into the skin and flesh; the raised, compact swelling thus formed from this accumulation is called shotha.

Verse 23 (garuda.1.162.23)

सर्वहेतुविशषैस्तु रूपभेदान्नवात्मकम् । दोषैः पृथग्विधैः सर्वैरभिघाताद्विषादपि

sarvahetuviśaṣaistu rūpabhedānnavātmakam doṣaiḥ pṛthagvidhaiḥ sarvairabhighātādviṣādapi

According to all its specific causes and by the differences in its manifestation, it is of nine kinds — from the several doshas separately, from all combined, from injury, and from poison as well.

Verse 24 (garuda.1.162.24)

तदेव नीयमानन्तु सर्वाङ्गे कामजम्भवेत् । पृथून्नताग्रग्रथितैर्विशेषैश्च त्रिधा विदुः

tadeva nīyamānantu sarvāṅge kāmajambhavet pṛthūnnatāgragrathitairviśeṣaiśca tridhā viduḥ

When that same swelling spreads over the entire body, it is termed 'kama-ja'; and by its particular features — broad, raised-tipped, or knotted — it is known to be of three further kinds.

Verse 25 (garuda.1.162.25)

सामान्यहेतुः शोथानां दोषजातो विशेषतः । व्याधिः कर्मोपवासादिक्षीणस्य भवति द्रुतम्

sāmānyahetuḥ śothānāṁ doṣajāto viśeṣataḥ vyādhiḥ karmopavāsādikṣīṇasya bhavati drutam

The general cause of swellings arises specifically from the doshas; in one weakened by disease, by strenuous exertion, and by fasting and the like, it arises quickly.

Verse 26 (garuda.1.162.26)

अतिमात्रं यदासेवेद्गुरुमत्यन्तशीतलम् । लवणक्षारतीक्ष्णाम्लशाकाम्बुस्वप्नजागरम्

atimātraṁ yadāsevedgurumatyantaśītalam lavaṇakṣāratīkṣṇāmlaśākāmbusvapnajāgaram

One who indulges to excess in food that is heavy, extremely cold, salty, alkaline, pungent, or sour, in unsuitable vegetables and water, and in excessive sleeping or waking —

Verse 27 (garuda.1.162.27)

रोधो वेगस्य वल्लूरमजीर्णश्रममैथुनम् । पच्यते मार्गगमनं यानेन क्षोभिणापि वा

rodho vegasya vallūramajīrṇaśramamaithunam pacyate mārgagamanaṁ yānena kṣobhiṇāpi vā

— and who suppresses natural urges, eats dried meat, eats before digestion, over-exerts, indulges in intercourse, and travels far on a jolting vehicle —

Verse 28 (garuda.1.162.28)

श्वासकासातिसारार्शोजठरप्रदरज्वराः । विष्टम्भालस्यकच्छर्दिहिक्कापाण्डुविसर्पकम्

śvāsakāsātisārārśojaṭharapradarajvarāḥ viṣṭambhālasyakacchardihikkāpāṇḍuvisarpakam

— such a person develops breathlessness, cough, diarrhoea, piles, abdominal disease, uterine bleeding, fevers, constipation, lassitude, vomiting, hiccup, pandu, and visarpa (a spreading skin eruption) —

Verse 29 (garuda.1.162.29)

ऊर्ध्वशोथमधो बस्तौ मध्ये कुर्वन्ति मध्यगाः । सर्वाङ्गगः सर्वगतः प्रत्यप्रत्यगेति तदाश्रयः

ūrdhvaśothamadho bastau madhye kurvanti madhyagāḥ sarvāṅgagaḥ sarvagataḥ pratyapratyageti tadāśrayaḥ

— and these causes, situated above, below at the bladder-region, or in the middle, produce swelling accordingly; this swelling may be confined to one limb, spread over the whole body, or pervade it entirely — such is its range of location.

Verse 30 (garuda.1.162.30)

तत्पूर्वरूपं क्षवथुः शिरायामङ्गगौरवम् । वाताच्छोथश्चलो रूक्षः खररोमारुणोऽसितः

tatpūrvarūpaṁ kṣavathuḥ śirāyāmaṅgagauravam vātācchothaścalo rūkṣaḥ khararomāruṇo'sitaḥ

Its premonitory signs are sneezing, stiffness of the veins, and heaviness of the body. Swelling arising from vata is mobile, dry, rough with hair standing on end, and reddish-black in colour.

Verse 31 (garuda.1.162.31)

शङ्खबस्त्यन्त्रशोफर्तिमेदोभेदाः प्रसुप्तिता । वातोत्तानः क्लमः शीघ्रमुन्नमेत्पीडितां तनुम्

śaṅkhabastyantraśophartimedobhedāḥ prasuptitā vātottānaḥ klamaḥ śīghramunnametpīḍitāṁ tanum

There is swelling and pain in the temples, bladder, and intestines, disorders of fat, and numbness; the vataja swelling is superficial, and fatigue quickly makes the afflicted body rise into it.

Verse 32 (garuda.1.162.32)

सिग्धस्तु मर्दनैः शाम्येद्रात्रावल्पो दिवा महान् । त्वक्सर्षपविलिप्ते च तस्मिंश्चिमिचिमायते

sigdhastu mardanaiḥ śāmyedrātrāvalpo divā mahān tvaksarṣapavilipte ca tasmiṁścimicimāyate

When unctuous, it subsides with massage; it is slight at night and pronounced by day; and when the skin is smeared with mustard paste, it produces a tingling sensation.

Verse 33 (garuda.1.162.33)

पीतरक्तासिंताभासः पित्तजातश्च शोषकृत् । शीघ्रं नासौ वा प्रशमेन्मध्ये प्राग्दहते तनुम्

pītaraktāsiṁtābhāsaḥ pittajātaśca śoṣakṛt śīghraṁ nāsau vā praśamenmadhye prāgdahate tanum

The pitta-born swelling has a yellow-red-black hue and causes wasting of the body; it either subsides quickly or does not, but before that it burns the body.

Verse 34 (garuda.1.162.34)

सतृट्दाहज्वरस्वेदो भ्रमक्लोदमदभ्रमाः । साभिलाषी शकृद्भेदो गन्धः स्पर्शसहो मृदुः

satṛṭdāhajvarasvedo bhramaklodamadabhramāḥ sābhilāṣī śakṛdbhedo gandhaḥ sparśasaho mṛduḥ

It is accompanied by thirst, burning, fever, and sweating, along with giddiness, moistness, and an intoxication-like confusion; there is craving for coolness, loose stool, foul odour; it tolerates touch and is soft.

Verse 35 (garuda.1.162.35)

कण्डूमान्पाण्डुरोमा त्वक्कठिनः शीतलो गुरुः । स्निग्धःश्लक्ष्णः स्थिरः शूलो निद्राच्छर्द्यग्निमान्द्यकृत्

kaṇḍūmānpāṇḍuromā tvakkaṭhinaḥ śītalo guruḥ snigdhaḥślakṣṇaḥ sthiraḥ śūlo nidrācchardyagnimāndyakṛt

In the kaphaja swelling there is itching, the body-hair turns pale, and the skin becomes hard, cold, and heavy; it is unctuous, smooth, fixed, and painful, and it brings on excessive sleep, vomiting, and weak digestion.

Verse 36 (garuda.1.162.36)

आघातेन च शस्त्रादिच्छेदभेदक्षतादिभिः । हिमानिलैर्दध्यनिलैर्भल्लातकपिकच्छजैः

āghātena ca śastrādicchedabhedakṣatādibhiḥ himānilairdadhyanilairbhallātakapikacchajaiḥ

From injury, from cutting, piercing, or wounding by weapons and the like, from exposure to intense cold and wind, from curds combined with wind-provoking substances, and from contact with bhallataka (marking-nut) or kapikacchu (cowhage) —

Verse 37 (garuda.1.162.37)

रसैः शुष्कैश्च संस्पर्शाच्छ्वयथुः स्याद्विसर्पवान् । भृशोष्मा लोहिताभासः प्रायशः पित्तलक्षणः

rasaiḥ śuṣkaiśca saṁsparśācchvayathuḥ syādvisarpavān bhṛśoṣmā lohitābhāsaḥ prāyaśaḥ pittalakṣaṇaḥ

— and from contact with certain saps and dried substances too, swelling arises which may be accompanied by visarpa; it is intensely hot and red in colour, and generally bears the marks of pitta.

Verse 38 (garuda.1.162.38)

विषजः सविषप्राणिपरिसर्पणमूत्रणात् । दंष्ट्रादन्तनखाघातादविषप्राणिनामपि

viṣajaḥ saviṣaprāṇiparisarpaṇamūtraṇāt daṁṣṭrādantanakhāghātādaviṣaprāṇināmapi

Poison-born swelling arises from a venomous creature crawling over the body or urinating upon it, and it may also arise from the bite, claw, or fang of even a non-venomous creature.

Verse 39 (garuda.1.162.39)

विण्मूत्रशुक्रोपहतमलवद्वस्तुसंङ्करात् । विषवृक्षानिलस्पर्शाद्गरयोगावचूर्णनात्

viṇmūtraśukropahatamalavadvastusaṁṅkarāt viṣavṛkṣānilasparśādgarayogāvacūrṇanāt

It also arises from contact with objects fouled by stool, urine, or semen, from exposure to wind blown from a poisonous tree, and from being smeared or dusted with a compounded poison (gara).

Verse 40 (garuda.1.162.40)

मृदुश्चलोऽवलम्बी च शीघ्रो दाहरुजाकरः । नवोऽनुपद्रवः शोथः साध्योऽसाध्यः पुरेरितः

mṛduścalo'valambī ca śīghro dāharujākaraḥ navo'nupadravaḥ śothaḥ sādhyo'sādhyaḥ pureritaḥ

The swelling that is soft, mobile, and pendulous, quick to cause burning and pain, recent in origin, and free from complications, is curable; the opposite kind, as described earlier, is incurable.