43. hr̥drōgapratiṣēdhādhyāyaḥ

Meaning of the commentary

The commentary says that after the chapter on gulma, beginning hṛdroga is fitting because of nearness of site, or because of its mention by name in the list.

Meaning of the commentary

The commentary says that after the announcement, the cause and pathogenesis of hṛdroga are stated as before. The doṣas, made abnormal by these causes, go to the heart, spoil rasa and cause distress. 'Āghāta' is to be repeated in 'vegāghāta': it means both the holding back of urges (vegāvarodha) and blows such as from a stick. Viruddha (incompatible) is as taught in the 'hitāhitīya' chapter; adhyaśana is eating on top of undigested food; ajīrṇa is of types such as āma and vidagdha. The word 'distress' signals variety of distress. The cause runs from suppression to unsuitable foods; the pathogenesis begins from 'having spoiled'. Premonitory signs of hṛdroga are not stated, because indistinct signs are themselves regarded as premonitory; others say premonitory signs are understood merely from the category.

Meaning of the commentary

The commentary states the number. 'From the doṣas' means from each single doṣa and from the three combined; 'from worms' means with worms. An objection: another tantra teaches five kinds of hṛdroga, so why four here? Answer: the worm-hṛdroga is only the later stage of the tridoṣaja hṛdroga, so there are not five. 'Then' means after the signs.

Meaning of the commentary

The commentary gives the signs of vātika hṛdroga. Āyamyate means it feels lengthened; tudyate means pained as if by a goad; nirmathyate means churned as if stirred; dīryate means as if torn or split; pāṭyate means as if cut in two.

Meaning of the commentary

The commentary gives the signs of paittika hṛdroga. Ūṣā is localised heat; coṣa is a special pain as if being sucked. Dhūmāyana is as if smoke is being emitted.

Meaning of the commentary

The commentary gives the signs of śleṣmika hṛdroga. Stambha means numbness or stiffness. 'Covered by kapha' means the heart is enveloped by kapha.

Meaning of the commentary

The commentary says this gives the signs of tridoṣaja hṛdroga. Ṣṭhīvana is spitting; hṛllāsa is drooling of saliva; tama is seeing darkness or breathlessness. 'In the combined type' is supplied. Pricking and piercing pain are of vāta, nausea, retching and spitting of kapha, and darkness of pitta. Some regard the whole passage up to 'in the worm type' as the signs of sannipātika hṛdroga. From the tridoṣaja type the worm type arises through wrong conduct; quoting another tantra: 'the wicked man who, in tridoṣaja hṛdroga, takes sesame, milk, jaggery and the like gets a knot, and rasa also goes to one part of the vital point (marma) and becomes moist; from that moisture worms arise in the afflicted one'. So the count is not exceeded. Some say the sannipātika hṛdroga does not occur by the nature of the disease; the commentary rejects this, since it is seen in a similar tantra.

Meaning of the commentary

The commentary gives the complications of the hṛdrogas of vāta and the others, apart from the worm type. Bhrama is spinning as if on a wheel; klama is fatigue without exertion; sāda is limb-sinking; śoṣa is dryness of the mouth and of the dhātus. Though giddiness and the rest are of vāta and pitta, they occur in the kapha type too by the nature of the disease.

Meaning of the commentary

The commentary says 'of the kapha types' qualifies 'of the worm-types'; so whatever complications are stated for kapha-related worm types are the ones taken to apply in worm hṛdroga.

Meaning of the commentary

The commentary gives the treatment of vātika hṛdroga. Although emesis is not praised in vāta, here it is beneficial because vāta belongs to the kapha-site group; the same applies in the pitta type. After emesis, the powders from pippalī onward are given. Yavabhasma is yavakṣāra. Fruits means the juice of fruits such as mātuluṅga. Madya and āsava are those of the alcohol group. 'One of the snehas' means one of the four snehas.

Meaning of the commentary

The commentary gives the suitable food in vātika hṛdroga, and asks whether this alone is done or other things too, replying with the basti. Vāta-relieving means cooked with bhadradāru and the like; 'in proper measure' means according to measure.

Meaning of the commentary

The commentary gives emesis in pittaja hṛdroga. Śrīparṇī is kāśmarī; madhuka is yaṣṭīmadhu; sitā is sugar; utpala is kuṣṭha. The word 'water' here does not mean decoction throughout, since honey and the like are not used in decoction. Ghṛta cooked with sweet drugs such as kākolī is used; the pitta-fever-destroying decoctions are those beginning 'sandal, uśīra, śrīparṇī' and the like.

Meaning of the commentary

The commentary gives sneha-basti in pittaja hṛdroga. 'Excellent juices' means juices of eṇa and similar meats; 'sweet' means prepared with sour and other additions. 'Cooked with madhuka' means cooked with yaṣṭīmadhu alone, though others say cooked with jīvanīya drugs.

Meaning of the commentary

The commentary gives the treatment of śleṣmika hṛdroga. After emesis with vacā and nimba decoctions, the powder beginning 'pippalī, elā' described for vātaja hṛdroga is given, and eaten with food. Phalādi is madanaphalādi from the samśodhana-saṃśamanīya chapter; mustādi is from the dravya-saṅgrahaṇīya chapter. Śyāmā is vṛddhadāraka; 'drink' attaches here too. In the tridoṣaja type, the treatment of vāta and others, though not stated, is to be done.

Meaning of the commentary

The commentary gives treatment of kṛmihṛdroga. Meat with rice, with curd and palala (roasted sesame paste), is given for three days to stir up the worms. Afterwards purgation is done with fragrant yogas from the purgation section, or with salted yogas, together with ajājī and sugar; some read 'sapalalaiḥ' in place of 'salavaṇaiḥ' and explain purging with fragrant yogas with fried sesame paste. Dhānyāmla is kāñjika, rich in viḍaṅga. Emesis is not used in worm-type hṛdroga because the heart is worn out by worms, so purgation with fragrant yogas is stated for fear of emesis. After the dhānyāmla, barley food with viḍaṅga is given.

Meaning of the commentary

Thus ends the forty-third chapter, named Hṛdrogapratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.