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Sushruta Samhita Chapter 33 Avaraniya Adhyaya


This article explains Sushruta Samhita Sutrasthana Chapter 33 “Avaraniya Adhyaya” – Incurable diseases.

Avaraniya Adhyaya

Incurable diseases

अथातोऽवारणीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound the chapter by name Avaraniya (Vyadhi) incurable diseases, as revealed by the venerable Dhanvantari.

उपद्रवैस्तु ये जुष्टा व्याधयो यान्त्यवार्यताम् |
रसायनाद्विना वत्स! तान् शृण्वेकमना मम ||३||

Diseases, which are associated with complications / secondary diseases become incurable except by the use of Rasayana (rejuvenation therapy). Hence, dear son, listen attentively to my words.
Read – Bad Prognosis Based On Premonitory Symptoms Of Disease – Purvarupiya Arishta

Mahagada

Dreadful diseases

 वातव्याधिः प्रमेहश्च कुष्ठमर्शो भगन्दरम् |
अश्मरी मूढगर्भश्च तथैवोदरमष्टमम् ||४||
अष्टावेते प्रकृत्यैव दुश्चिकित्स्या महागदाः |५|

 Below mentioned are the eight dreadful diseases –

  • Vata  Vyadhi (special diseases caused by vata, diseases of the nervous system),
  • Prameha (diabetes),
  • Kustha (leprosy),
  • Arshas (Hemorrhoids),
  • Bhagandara (fistula- in- ano),
  • Ashmari (urinary calculi),
  • Mudha garbha (foetal obstruction) and
  • Udara (enlargement of the abdomen)

Notes: Dalhana explains that the  greatness of  these diseases is because of causing death and being incurable. Charaka Samhita (Ind. 9/8-9) enumerates the diseases differently as ”Vatavyadhi”, Apasmara (epilepsy), Kustha (leprosy), Shopha (dropsy), Udara (abdominal disorders), Gulma (abdominal tumor), Madhumeha (diabetes mellitus) and Rajayakshma (pulmonary tuberculosis).

Complications, in the presence of which the diseases should be rejected

प्राणमांसक्षयः शोषस्तृष्णा च्छर्दिर्ज्वरस्तथा ||५||
अतीसारश्च मूर्च्छा च हिक्का श्वासस्तथैव च |
एतैरुपद्रवैर्जुष्टान् सर्वानेव विवर्जयेत् ||६||

Even all other diseases with the following complications / secondary diseases should be rejected (not treated). They are –

Life taking complications of Vata Vyadhi

शूनं सुप्तत्वचं भग्नं कम्पाध्माननिपीडितम् |
नरं रुजार्तमन्तश्च वातव्याधिर्विनाशयेत् ||७||

Vata Vyadhi (diseases of the nervous system) kills the patient when accompanied with complications such as oedema, loss of tactile sensation, fractures, tremors, flatulence and pain.

Fatal complications of Prameha

यथोक्तोपद्रवाविष्टमतिप्रस्रुतमेव वा |
पिडकापीडितं गाढं प्रमेहो हन्ति मानवम् ||८||

Prameha (diabetes) kills the person when associated with complications mentioned therein (Nidana sthana, chap13), too much urination, and troubled too much by eruptions.
Read – Charaka Prameha Nidana: 4th Chapter

Fatal complications of Kustha – leprosy / skin disorders

प्रभिन्नप्रस्रुताङ्गं च रक्तनेत्रं हतस्वरम् |
पञ्चकर्मगुणातीतं कुष्ठं हन्तीह कुष्ठिनम् ||९||

Kustha (leprosy) kills the patient when having complications such as tearing / splitting of the body parts, decaying and falling of body parts, reddish discoloration of the eyes,  loss of voice and the patient unsuitable for Panchakarma therapies (condition in which panchakarma therapies would not help the patient).
Read – Charaka Kushta Nidana: 5th chapter

Life threatening complications of Arshas – haemorrhoids

तृष्णारोचकशूलार्तमतिप्रस्रुतशोणितम् |
शोफातीसारसंयुक्तमर्शोव्याधिर्विनाशयेत् ||१०||

Arshas (haemorrhoids) kills the patient when accompanied with thirst, loss of taste, abdominal pain, copious bleeding, oedema and diarrhoea.

Life threatening complications of Bhagandara – fistula-in-ano

वातमूत्रपुरीषाणि क्रिमयः शुक्रमेव च |
भगन्दरात् प्रस्रवन्ति यस्य तं परिवर्जयेत् ||११||

Bhagandara (fistula- in-ano) should be refused when air (gas) / flatus, urine, faeces, worms and semen is seen coming out through the fistula.
Read – Fistula In Ano Ayurvedic Understanding And Effective Treatment

Fatal complications of ashmari – urinary calculus

प्रशूननाभिवृषणं रुद्धमूत्रं रुगन्वितम् |
अश्मरी क्षपयत्याशु सिकता शर्करान्विता ||१२||

Ashmari (urinary calculus) kills the patient soon when accompanied with profound swelling of the umbilicus (region of) and scrotum, obstruction of urination, severe pain and elimination of urinary gravel.

Life taking complications of Mudha Garbha – obstructed foetus

 गर्भकोषपरासङ्गो मक्कल्लो योनिसंवृतिः |
हन्यात् स्त्रियं मूढगर्भे यथोक्ताश्चाप्युपद्रवाः ||१३||
Mudha Garbha (obstructed foetus) kills the woman when accompanied with obstruction (closure) of the uterus, post- partum pain, constriction of the vagina and other complications mentioned therein (ch.8 Nidanasthan).
Read – Mudha Garbha – Obstructed Labor, Ayurveda Perspective

Lethal complications of Udara – abdominal enlargement

पार्श्वभङ्गान्नविद्वेषशोफातीसारपीडितम् |
विरिक्तं पूर्यमाणं च वर्जयेदुदरार्दितम् ||१४||

A patient of Udara (abdominal enlargement) should be refused when associated with complications such as splitting pain in the flanks, aversion to food, oedema, diarrhoea, abdomen being filled (with fluid) again even after purgation.

Fatal complications of Jwara – fever

यस्ताम्यति विसञ्ज्ञश्च शेते निपतितोऽपि वा |
शीतार्दितोऽन्तरुष्णश्च ज्वरेण म्रियते नरः ||१५||
यो हृष्टरोमा रक्ताक्षो हृदि सङ्घातशूलवान् |
नित्यं वक्त्रेण चोच्छ्वस्यात्तं ज्वरो हन्ति मानवम् ||१६||
हिक्काश्वासपिपासार्तं मूढं विभ्रान्तलोचनम् |
सन्ततोच्छ्वासिनं क्षीणं नरं क्षपयति ज्वरः ||१७||
आविलाक्षं प्रताम्यन्तं निद्रायुक्तमतीव च |
क्षीणशोणितमांसं च नरं नाशयति ज्वरः ||१८||

  • Jvara (fever) kills the patient who faints often, falls on the ground unconscious, suffers from cold externally (coldness on the surface of the body) and heat internally (increased heat inside the body).
  • Fever kills the patient of fever who has frequent horripilation, reddish eyes, pain in the heart as though (feels as if) hit by stone, always breathes through the mouth.
  • Fever will kill the patient who is suffering from hiccups, dyspnoea, severe thirst, unconsciousness, unsteady look, constant expirations and debility.
  • Fever would destroy (kill) a person whose eyes are turbid (dirty), who faints often, having very deep sleep, and diminution of blood and muscles.
    Read – Charaka – Jwara Chikitsa 3rd Chapter

Fatal complications of Atisara – diarrhoea

श्वासशूलपिपासार्तं क्षीणं ज्वरनिपीडितम् |
विशेषेण नरं वृद्धमतीसारो विनाशयेत् ||१९||

Atisara (diarrhoea) kills the patient when associated with dyspnoea, pain in the abdomen, severe thirst, emaciation, fever and especially so in older people.

Life threatening complications in Rajayaksma – pulmonary tuberculosis

शुक्लाक्षमन्नद्वेष्टारमूर्ध्वश्वासनिपीडितम् |
कृच्छ्रेण बहु मेहन्तं यक्ष्मा हन्तीह मानवम् ||२०||

Rajayaksma (pulmonary tuberculosis) kills the patients when accompanied with white coloured eyes (bright / lustrous eyes), aversion to food, prominent expiration and frequent urination.

Fatal complications in Gulma – abdominal tumour

श्वासशूलपिपासान्नविद्वेषग्रन्थिमूढताः |
भवन्ति दुर्बलत्वं च गुल्मिनो मृत्युमेष्यतः ||२१||

Gulma (abdominal tumour) kills the patient when accompanied with dyspnoea, pain in the abdomen (colic), severe thirst, aversion to food, absence of movement of the tumour and debility.
Read – Gulma- Abdominal Tumor- A Unique Disease In Ayurveda

Life threatening complications of Vidradhi – abscess

आध्मातं बद्धनिष्यन्दं छर्दिहिक्कातृडन्वितम् |
रुजाश्वाससमाविष्टं विद्रधिर्नाशयेन्नरम् ||२२||

Vidradhi (abscess) kills the patient when having symptoms such as distension (of the abscess), obstruction to flow of exudations (blood, pus etc), vomiting, hiccup, thirst, pain and dyspnoea.

Lethal complications of Pandu Roga – Anaemia

पाण्डुदन्तनखो यश्च पाण्डुनेत्रश्च मानवः |
पाण्डुसङ्घातदर्शी च पाण्डुरोगी विनश्यति ||२३|

The patient of Pandu Roga (anaemia) perishes when accompanied with whitish-yellow (pale) coloration of the teeth, nails and eyes and sees all things as yellowish white in colour.

Lethal Symptoms of Raktapitta – bleeding disorders

लोहितं छर्दयेद्यस्तु बहुशो लोहितेक्षणः |
रक्तानां च दिशां द्रष्टा रक्तपित्ती विनश्यति ||२४||

Raktapitta (bleeding disease) kills the patient who has vomiting of blood frequently, has red coloured eyes and sees the spaces around as red in colour.

Life threatening complications of Unmada – Insanity

अवाङ्मुखस्तून्मुखो वा क्षीणमांसबलो नरः |
जागरिष्णुरसन्देहमुन्मादेन विनश्यति ||२५||

Unmada (insanity) kills the patient who keeps his face always either looking down or up, has loss of muscles and strength and is awake always (does not sleep at all).
Read – Unmada-Insanity: Ayurvedic Understanding And Management

Fatal complications of Apasmara – epilepsy

बहुशोऽपस्मरन्तं तु प्रक्षीणं चलितभ्रुवम् |
नेत्राभ्यां च विकुर्वाणमपस्मारो विनाशयेत् ||२६||

Apasmara (epilepsy) kills the patient who faints very frequently, is emaciated greatly, has unsteady brows and makes abnormal movements of the eyeballs.

इति  श्रीसुश्रुतसंहितायां सूत्रस्थानेऽवारणीयो नाम त्रयस्त्रिंशत्तमोऽध्यायः ॥३३॥

Thus ends the Thirty third chapters by name Avaraniya in Sutra Sthana of Sushruta Samhita.

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