Sushruta Samhita Sutrasthana Chapter 33: Avaraniya Adhyaya (Incurable Diseases)

The 33rd chapter of Sutrasthana of Sushruta Samhita is named as Avaraniya Adhyaya. This chapter deals with Incurable Diseases.

अथातोऽवारणीयमध्यायं व्याख्यास्यामः ॥१॥
यथोवाच भगवान 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॥             

All those diseases which are associated with complications would become incurable but would be curable by administration of Rasayanas only. Therefore, dear son, listen to my words with utmost attention.

Mahagada: Dreadful diseases

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

 Below mentioned are the eight dreadful diseases –

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

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

प्राणमांसक्षयः  शोषस्तृ ष्णा च्छर्दिर्ज्वरस्तथा॥५॥
अतीसारश्च मुर्च्छा 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 –

–   diminution of  strength and musculature,
–   consumption,
–   thirst,
–   vomiting,
–   fever,
–   diarrhoea,
–   fainting,
–   hiccup and
–   dyspnoea

Life taking complications of Vata Vyadhi

शूनं सुप्तत्वचं भग्रं कम्पाध्माननिपीडितम् ।
नरं रुजार्तमन्तश्च वातव्याधिर्विनाशयेत्॥७॥

VataVyadhi (diseases caused by predominance of aggravated vata) would kill the patient when associated with the below mentioned complications –

–   oedema
–   loss of touch / tactile sensation – numbness
–   fractures,
–   tremors,
–   flatulence and
–   pain

Fatal complications of Prameha

यथोक्तोपद्रवाविष्टमतिप्रस्रुतमेव वा।
पिडकापिडितं गाढं प्रमेहो हन्ति मानवम् ॥८॥

Prameha (diabetes) would kill the person when it is associated with the below mentioned complications –

–   complications mentioned in Nidana Sthana (chapter 13),
–   too much urination,
–   many troublesome eruptions

Fatal complications of Kustha: Leprosy / Skin disorders

प्रभिन्नप्रस्रुताड्गं च रक्तनेत्रं हतस्वरम् ।
पञ्चकर्मगुणातीतं किष्ठं हन्तीह किष्ठीनम्॥९॥

Presence of the below mentioned complications associated with Kustha (leprosy) would kill the patient –

–   tearing or splitting of the body parts,
–   decaying and falling off of the body parts,
–   reddish discolouration of the eyes,
–   loss of voice,
–   the condition (kushta) which cannot be treated by Panchakarma therapies

Life threatening complications of Arshas: Haemorrhoids

तृष्णारोचकशूलार्तमतिप्रस्रुतशोणितम् ।
शोफातीरसंतुक्तमर्शोव्याधिर्विनायेत् ॥१०॥

Arsas (haemorrhoids) would definitely kill the patient when associated with the below mentioned complications –

–   thirst,
–   loss of taste,
–   colic / abdominal pain,
–   copious bleeding,
–   oedema and
–   diarrhoea

Life threatening complications of Bhagandara: Fistula-in-ano

वारमुत्रपुरीषाणि क्रिमयः शुक्रमेव च।
भगन्दरात् प्रस्रवन्ति यस्य तं परिवर्जयेत् ॥११॥

The physician should refuse treating Bhagandara (fistula- in-ano) when the below mentioned are seen coming out of the fistula –

–   air / gas
–   flatus,
–   urine,
–   faeces,
–   worms and
–   semen

Fatal complications of Ashmari: Urinary calculus

प्रशूननाभिवृषणं रुद्धमूत्रं रुगन्वितम्।
अश्मरी क्षपयत्याशु सिकताशर्करान्विता ॥१२॥

Asmari (urinary calculus) would kill the patient when associated with the below mentioned complications –

–   severe swelling of the umbilicus
–   severe swelling of scrotum,
–   obstruction of urination,
–   severe pain and
–   elimination of urinary gravel

Life taking complications of Mudha Garbha: Obstructed foetus

गर्भकोषपरासङ्गो मक्कल्लो योनिसंवृतिः।
हन्यात् स्रियं मूढगर्भ यथोक्ताश्चाप्युपद्रवाः॥१३॥

Mudha Garbha (obstructed foetus) is going to kill the woman when associated with below mentioned complications –

–   obstruction of uterus,
–   post-partum pain
–   constriction of vagina
–   other complications mentioned in Nidana Sthana (chapter 8)

Lethal complications of Udara: Abdominal enlargement

पार्श्वभग्ङ्गान्नविद्वेषशोफातीसारपीडितम् ।
विरिक्तं पूर्यमाणं च वर्जrÉåदुदरार्दितम् ॥१४॥

A patient of Udara (abdominal enlargement) is going to die when the below mentioned complications are present –

–   splitting pain in the flanks,
–   aversion of food
–   oedema
–   diarrhoea
–   abdomen gets filled up once again even after administering virechana – therapeutic purgation

Fatal complications of Jwara: Fever

यस्ताम्यति विसंज्ञश्च शेते निपातितोऽपि वा ।
शीतार्दितोऽन्तरुष्ण श्च ज्वरेण  म्रियते नरः ॥१५॥
यि हृष्टरोमा  रक्ताक्शो हृदि संघातशुलवान् ।
नित्यं वक्रेण चोच्छवस्यात्तं ज्वरो हन्ति मानवम् ॥१६॥।
हिक्काश्वासपिपासर्तं मूढं विभ्रान्तलोचनम् ।
संततोच्छवासिनं क्षीणं नरं क्षपयति वरः ॥१७॥
आविलाक्षं प्रताम्यन्तं निद्रायुक्तामतीव च ।
क्षीणशोणितमांसं च नरं नाशयति ज्वरः ॥१८॥

Jvara (fever) kills the patient in the presence of the below mentioned complications –

–   frequent fainting,
–   falling unconscious on the ground,
–   coldness on the surface of the body and increased heat inside the body,
–   frequent horripilations,
–   redness of the eyes,
–   pain in the heart as if hit by stone,
–   always breathing through the mouth,
–   hiccups,
–   dyspnoea,
–   severe thirst,
–   unconsciousness,
–   unsteady look,
–   constant expirations,
–   debility,
–   dirtiness / turbidity of the eyes,
–   frequent fainting,
–   deep sleep and
–   diminution of blood and muscles

Fatal complications of Atisara: Diarrhoea

श्वासशूलपिपासर्तं क्षीणं ज्वरनिपीडितम् ।
विशेषेण नरं व्रुद्धमतीसारो विनाशयेत् ॥१९॥

Atisara (diarrhoea), when associated with below mentioned complications would definitely kill the patient, especially in older persons –

–   dyspnoea
–   colic / pain in abdomen
–   severe thirst
–   emaciation of the body,
–   fever

Life threatening complications in Rajayakshma: Pulmonary tuberculosis

शुक्लाक्षमन्नद्वेष्टारमूर्ध्वश्वासनिपीडितम् ॥
कृच्छेषेण   बहु मेहन्तं  यक्ष्मा  हन्तीह मानवम् ॥२०॥

Rajayaksma (pulmonary tuberculosis) when accompanied with the below mentioned complications would kill the patient –

–   eyes looking bright / white coloured eyes
–   aversion to food,
–   exaggerated / prominent expiration
–   frequent urination

Fatal complications in Gulma: Abdominal tumour

श्वासशूलपिपासान्नविद्वेषग्रन्थिमूढताः ।
भवति दुर्बलत्वं च  गुल्मिनो मृत्युमेष्यतः ॥२१॥

Gulma (abdominal tumour) when accompanied with the below mentioned complications would kill the patient –

–   dyspnoea,
–   colic – pain in the abdomen,
–   severe thirst,
–   aversion to food,
–   immobility of tumour and
–   debility

Life threatening complications of Vidradhi: Abscess

आध्मातं बद्धनिष्यन्दं छर्दिहिक्कातृडन्वितम् ।
रुजाश्वाससमाविष्टं  विद्रधिर्नाशयेन्नरम् ॥२२॥

Vidradhi (abscess) when associated with the below mentioned symptoms would kill the patient –

–   distention or enlargement of abscess,
–   obstruction to the flow of discharges / exudations (blood, pus etc),
–   vomiting
–   hiccup,
–   thirst,
–   pain and
–   dyspnoea

Lethal complications of Pandu Roga: Anaemia

पाण्डुदन्तनखो यश्च पाण्डुनेत्रश्च मानवः ।
पाण्डुसंघातदर्शी च पाण्डुरोगी विनश्यति॥।२३॥

In the presence of the below mentioned symptoms / complications, the patient suffering from Pandu Roga – anaemia will surely die –

–   pallor (whitish yellow coloration) of teeth, nails and eyes
–   sees everything around him as yellowish white in colour

Lethal Symptoms of Raktapitta: Bleeding disorders

लोहितं छर्दयेद्यस्तु बहुशो लोहितेक्षणः।
रक्तानां चदिशां द्रष्टा रक्तपित्ती विनश्यति॥२४॥

The patient of Raktapitta (bleeding disease) would definitely die if he

–   vomits blood frequently,
–   has red coloured eyes and
–   sees everything around him as red in colour (in spite of they not being red in colour)

Life threatening complications of Unmada: Insanity

अवाङ्मुखस्तून्मुखो वा  क्षीणमांसबलो नरः ।
जागरिष्णुरसंदेहमुन्मादेन विनश्यति ॥२५॥

Unmada (insanity) kills the patient who

–   always keeps his head bent with his face looking down towards the ground or
–   always keeps his head raised up with his face looing up towards the roof,
–   has lost his muscles,
–   has lost his strength and
–   keeps awake always and does not sleep at all

Fatal complications of Apasmara: Epilepsy

बहुशोऽपस्मरन्तं तु प्रक्षीणं चलितभ्रुवम्
नेत्राभ्यां च विकुर्वाणमपस्मारो विनाशयेत्॥२६॥

Patient of Apasmara (epilepsy) would die in the presence of the below mentioned symptoms –

–   frequent fainting
–   severe emaciation
–   eyebrows are unsteady
–   abnormal movements of the eyeballs

इति  श्रीसुश्रुतसंहितायां सूत्रस्थानेऽवारणीयो नाम त्रयस्त्रिंशत्तमोऽध्यायः ॥३३॥

Thus ends the Thirty third chapters by name Avaraniya in Sutra Sthana of Susruta samhita.