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AIAPGET Points

 –    There are 20 types of Krimi.

–    Krimis are born from three sources – Purisha, Kapha and Rakta.

–    Pandu, Hrdroga and Vidbheda are caused by Purishaja Krimi.

–    Raktaja Krimi are red or black in colour, unctuous (slimy) and thick in size and produce diseases affecting the organs of blood.

–    Consumption of Masha, Pishtanna, Vidala and Parna Shakha leads to production of Purishaja Krimi.

–    Among 20 Krimis – 7 purishaja and 6 kaphaja Krimis are DRSHYA KRIMI (Visible). The 7 raktaja krimis are ADRSHYA KRIMIS (invisible).

–    Amashaya is the seat of Kaphaja Krimis. Pakvashaya is the seat of Purishaja Krimis. Dhamanis are the seats of Raktaja Krimis.

–    Surasadi Gana Siddha Ghrta should be administered for VAMANA in the treatment of Krimis. (Su.Ut.54/21)

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The 54th chapter of Uttaratantra of Sushruta Samhita is named as Krimiroga Pratiședha. This chapter deals with Treatment of Helmenthiasis.

अथातः कृमिरोगप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Krimiroga pratisedha – treatment of disease produced by worms (helmenthiasis); as revealed by the venerable Dhanvantari.

Nidāna samprāpti – causes and pathogenesis

अजीर्णाध्यशनासात्म्यविरुद्धमलिनाशनैः |
अव्यायामदिवास्वप्नगुर्वतिस्निग्धशीतलैः ||३||
माषपिष्टान्नविदलबिसशालूकसेरुकैः |
पर्णशाकसुराशुक्तदधिक्षीरगुडेक्षुभिः ||४||
पललानूपपिशितपिण्याकपृथुकादिभिः |
स्वाद्वम्लद्रवपानैश्च श्लेष्मा पित्तं च कुप्यति ||५||
कृमीन् बहुविधाकारान् करोति विविधाश्रयान् |
आमपक्वाशये तेषां कफविड्जन्मनां पुनः |
धमन्यां रक्तजानां च प्रसवः प्रायशः स्मृतः ||६||

Below mentioned are the etiological factors of krimiroga –

–       eating foods which are uncooked,

–       eating food more in quantity,

–       eating unaccustomed,incompatible and dirty (contaminated) foods

–       sedentary life – not doing any physical activity,

–       habitually sleeping during daytime,

–       consuming foods which are difficult to digest, very unctuous (fatty) and cold,

–       eating in excess, the foods prepared from māsa, corn flour, pulses, bisa, loka and kaseruka and leafy vegetables,

–       excessive drinking of surā, Sukta, dadhi and ksira,

–       eating snacks prepared from jaggery and sugarcane juice,

–       excessive consumption of paste of tila, meat of animals of marshy lands, pinyāka (paste of sesame added with jaggery), prthuka (paddy fried and flattened),

–       drinking beverages which are sweet and sour

Pathogenesis – By the above said causes, kapha and pitta become aggravated. These aggravated doshas produce worms of different shapes by getting localized in different seats of the body.

Amasaya – stomach is the seat of krimis – worms produced by kapha and Pakvashaya – colon is the seat of krimis produced by Purisha / vit (faeces). Similarly, dhamanis – blood vessels are the seats of the krimis produced by rakta – blood.

Categories and sources of krimi

विंशतेः कृमिजातीनां त्रिविधः सम्भवः स्मृतः |
पुरीषकफरक्तानि, तासां वक्ष्यामि विस्तरम् ||७||

There are twenty categories of krimi – worms. They are born from three sources i.e.

–        purisa – faeces,

–        kapha and

–        rakta – blood

The details of the same will be given by me now.

Purişaja krimi – worms born from faeces

अजवा विजवाः किप्याश्चिप्या गण्डूपदास्तथा |
चूरवो द्विमुखाश्चैव ज्ञेयाः सप्त पुरीषजाः ||८||
श्वेताः सूक्ष्मास्तुदन्त्येते गुदं प्रतिसरन्ति च |
तेषामेवापरे पुच्छैः पृथवश्च भवन्ति हि ||९||
शूलाग्निमान्द्यपाण्डुत्वविष्टम्भबलसङ्क्षयाः |
प्रसेकारुचिहृद्रोगविड्भेदास्तु पुरीषजैः ||१०||
रक्ता गण्डूपदा दीर्घा गुदकण्डूनिपातिनः |
शूलाटोपशकृद्भेदपक्तिनाशकराश्च ते ||११||

The below mentioned seven kinds of krimi are born from faeces –

–        Ajava,

–        Vijava,

–        Kipya,

–        Cipya,

–        Gandupada,

–        Curava and

–        Dvimukha

Features –

–        they are white in colour and small in size,

–        they prick (irritate) the anus and comes out of the anus,

Some of them are big in their tail portion. These krimis give rise to the below mentioned symptoms –

–        pain in the abdomen,

–        dyspepsia,

–        anaemia,

–        constipation,

–        loss of strength,

–        nausea,

–        loss of taste,

–        heart disease and

–        diarrhoea

Gandupada Krimi are –

–        red in colour,

–        long

–        cause itching of the anus, abdominal pain, gurgling sounds in the intestine, diarrhoea and loss of digestive fire

Kaphaja krimi – worms born from kapha

दर्भपुष्पा महापुष्पाः प्रलूनाश्चिपिटास्तथा |
पिपीलिका दारुणाश्च कफकोपसमुद्भवाः ||१२||
रोमशा रोममूर्धानः सपुच्छाः श्यावमण्डलाः |
रूढधान्याङ्कुराकाराः शुक्लास्ते तनवस्तथा ||१३||
मज्जादा नेत्रलेढारस्तालुश्रोत्रभुजस्तथा |
शिरोहृद्रोगवमथुप्रतिश्यायकराश्च ते ||१४||

Below mentioned are the six kinds of krimi born from kapha –

–        Darbhapuspa,

–        Mahapuspa,

–        Praluna,

–        Cipita,

–        Pipilika and

–        Daruna

Features –

–        These krimis have hairs on their body and head.

–        They also have blue patches on their body.

–        They have tails.

–        They resemble sprouted grain in shape, are white in colour and thin (flat).

–        They consume bone marrow.

–        They lick the eyes, palate, ears and shoulders.

–        They give rise to headaches, heart disease, vomiting and nasal catarrh.

Raktaja krimi – worms born from blood 

केशरोमनखादाश्च दन्तादाः किक्किशास्तथा |
कुष्ठजाः सपरीसर्पा ज्ञेयाः शोणितसम्भवाः ||१५||
ते सरक्ताश्च कृष्णाश्च स्निग्धाश्च पृथवस्तथा |
रक्ताधिष्ठानजान् प्रायो विकारान् जनयन्ति ते ||१६||

Below mentioned are the seven kinds of krimi produced by sonita (rakta) –

–        Kesada,

–        Romada,

–        Nakhada,

–        Dantada,

–        Kikkisa,

–        Kusthaja and

–        Parisarpa

Features – These krimi are –

–        red or black in colour,

–        unctuous (slimy) and

–        thick in size and

–        produce diseases affecting the organs / seats of blood

माषपिष्टान्नविदलपर्णशाकैः पुरीषजाः |
मांसमाषगुडक्षीरदधितैलैः कफोद्भवाः ||१७||
विरुद्धाजीर्णशाकाद्यैः शोणितोत्था भवन्ति हि |

Krimiroga Laksana

ज्वरो विवर्णता शूलं हृद्रोगः सदनं भ्रमः ||१८||
भक्तद्वेषोऽतिसारश्च सञ्जातकृमिलक्षणम् |१९|

Below mentioned are the symptoms indicating the presence of worms in the body –

–        fever,

–        discolouration of the body,

–        pain in the abdomen,

–        heart diseases,

–        debility,

–        giddiness,

–        aversion to food and

–        diarrhoea

दृश्यास्त्रयोदशाद्यास्तु कृमीणां परिकीर्तिताः ||१९||
केशादाद्यास्त्वदृश्यास्ते द्वावाद्यौ परिवर्जयेत् |२०|

Among these thirteen kinds of visible worms i.e. seven purisaja and six kaphaja krimis, the krimis commencing from kesada are invisible.

The first two kinds among these i.e. kesada and romada should be rejected i.e. they should not be treated.

 Krimiroga cikitsā – treatment of worm infection

एषामन्यतमं ज्ञात्वा जिघांसुः स्निग्धमातुरम् ||२०||
सुरसादिविपक्वेन सर्पिषा वान्तमादितः |
विरेचयेत्तीक्ष्णतरैर्योगैरास्थापयेच्च तम् ||२१||
यवकोलकुलत्थानां सुरसादेर्गणस्य च |
विडङ्गस्नेहयुक्तेन क्वाथेन लवणेन च ||२२||

At the beginning, the physician should determine which worms should be treated. After doing so, the physician should firstly administer oleation therapy. Next, ghee prepared with herbs belonging to the Surasadi Gana group should be administered for the purpose of producing vomiting. Following this, the patient should be given strong purgative recipes or should be administered decoction enema with decoction of yava, kola, kulattha, herbs belonging to surasadi gana group and vidanga added with oil and saindhava lavana.

प्रत्यागते निरूहे तु नरं स्नातं सुखाम्बुना |
युञ्ज्यात् कृमिघ्नैरशनैस्ततः शीघ्रं भिषग्वरः ||२३||
स्नेहेनोक्तेन चैनं तु योजयेत् स्नेहबस्तिना |२४|

The patient should be asked to take a bath in comfortable warm water after the effects of decoction enema are noted. Following this, foods which have been prepared with herbs which destroy the krimis should be served. The patient should then be administered oil enema with the oil mentioned earlier, in the previous verse.

ततः शिरीषकिणिहीरसं क्षौद्रयुतं पिबेत् ||२४||
केवूकस्वरसं वाऽपि पूर्ववत्तीक्ष्णभोजनः |
पलाशबीजस्वरसं कल्कं वा तण्डुलाम्बुना ||२५||

Next, the patient should be given juice (decoction) of sirisa and kinihi, added with honey, for drinking.

Fresh juice of kebuka should be given mixed with honey, as said previously. Later, foods processed with herbs having penetrating properties should be given for eating.

Juice or paste of seeds of Palasa should be consumed with rice-wash.

पारिभद्रकपत्राणां क्षौद्रेण स्वरसं पिबेत् |
पत्तूरस्वरसं वाऽपि पिबेद्वा सुरसादिजम् ||२६||

Below mentioned may also be consumed –

–        juice of leaves of paribhadraka should be added with honey and consumed,

–        juice of leaves of pattura or of

–        herbs of surasadi gana group

लिह्यादश्वशकृच्चूर्णं वैडङ्गं वा समाक्षिकम् |
पत्रैर्मूषिकपर्ण्या वा सुपिष्टैः पिष्टमिश्रितैः ||२७||
खादेत् पूपलिकाः पक्वा धान्याम्लं च पिबेदनु |२८|

Powder of horse dung or vidanga added with honey should be consumed. Pupalika (puri) should be prepared with leaves of musakaparni added with corn flour. This should be consumed by the patient. After this, he should drink dhanyamla (fermented gruel).

सुरसादिगणे पक्वं तैलं वा पानमिष्यते ||२८||
विडङ्गचूर्णयुक्तैर्वा पिष्टैर्भक्ष्यांस्तु कारयेत् |
तत्कषायप्रपीतानां तिलानां स्नेहमेव वा ||२९||

Taila – oil is cooked with herbs belonging to Surasadi Gana. It is used for drinking. Eatables should be prepared from corn flour and used, added with vidanga powder.

Oil prepared from tila soaked in the decoction of vidanga used for drinking is also useful.

श्वाविधः शकृतश्चूर्णं सप्तकृत्वः सुभावितम् |
विडङ्गानां कषायेण त्रैफलेन तथैव च ||३०||
क्षौद्रेण लीढ्वाऽनुपिबेद्रसमामलकोद्भवम् |
अक्षाभयारसं वाऽपि विधिरेषोऽयसामपि ||३१||

Porcupine excreta is powdered. This powder is soaked in decoction of vidanga or triphala for seven times and is later consumed.

Alternatively, it may be licked with honey. After this, one should drink amalaka or aksa or abhaya juice.

Ayas – iron may also be used in the same procedure.

पूतीकस्वरसं वाऽपि पिबेद्वा मधुना सह |
पिबेद्वा पिप्पलीमूलमजामूत्रेण संयुतम् ||३२||
सप्तरात्रं पिबेद्धृष्टं त्रपु वा दधिमस्तुना |३३|

The below mentioned recipes are also useful when consumed –

–        fresh juice of putika taken with honey or

–        powder of pippalimula taken with goat’s urine or

–        trapu – tin macerated with whey of curds for seven times

पुरीषजान् कफोत्थांश्च हन्यादेवं कृमीन् भिषक् ||३३||

The worms born from faeces and kapha can be destroyed by the physician in this manner.

शिरोहृद्घ्राणकर्णाक्षिसंश्रितांश्च पृथग्विधान् |
विशेषेणाञ्जनैर्नस्यैरवपीडैश्च साधयेत् ||३४||

Collyriums, nasal (oil) drops and nasal drops done using fresh juices of herbs (avapida) may be used to destroy the worms residing especially in the head, heart, nose, ears and eyes.

शकृद्रसं तुरङ्गस्य सुशुष्कं भावयेदति |
निष्क्वाथेन विडङ्गानां चूर्णं प्रधमनं तु तत् ||३५||
अयश्चूर्णान्यनेनैव विधिना योजयेद्भिषक् |
सकांस्यनीलं तैलं च नस्यं स्यात्सुरसादिके ||३६||

Horse dung powder should be soaked in decoction of vidanga. Later it is dried well and may be blown into the nose.

Similarly, the below mentioned may also be used as nasal drops –

–        powder of ayas (iron) or

–        oil prepared with kamsya (bronze) and

–        decoction of herbs belonging to surasadi gana group

इन्द्रलुप्तविधिश्चापि विधेयो रोमभोजिषु |
दन्तादानां समुद्दिष्टं विधानं मुखरोगिकम् ||३७||

The same treatments indicated for indralupta should also be administered to destroy the worms which eat away the body hairs.

The same treatments prescribed for diseases of the mouth should also be administered to destroy the worms which eat away the teeth.

रक्तजानां प्रतीकारं कुर्यात् कुष्ठचिकित्सिते |
सुरसादिं तु सर्वेषु सर्वथैवोपयोजयेत् ||३८||
प्रव्यक्ततिक्तकटुकं भोजनं च हितं भवेत् |
कुलत्थक्षारसंसृष्टं क्षारपानं च पूजितम् ||३९||

The treatment of Kustha should be prescribed to treat the worms born in Rakta – blood.

Herbs belonging to the Surasadi Gana group of herbs should be used in all kinds of worms. They should be used in all modes like decoctions, mixed with food, processing drinking water and for boiling water used for bathing.

Also will be beneficial are the foods which are predominantly bitter and astringent tastes.

Yavakshara should be consumed with the ash of kulattha. This recipe is highly praised.

क्षीराणि मांसानि घृतानि चैव दधीनि शाकानि च पर्णवन्ति |
समासतोऽम्लान्मधुरान् हिमांश्च कृमीन् जिघांसुः परिवर्जयेत्तु ||४०||

Generally, persons desirous of getting rid of worms should avoid the below mentioned –

–        milk,

–        meats,

–        ghee,

–        curds,

–        leafy vegetables,

–        foods which are sour, sweet and cold

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे कृमिप्रतिषेधो नाम (षोडशोऽध्यायः, आदितः) चतुःपञ्चाशत्तमोऽध्यायः ||५४||

Thus ends the fifty-fourth chapter by name Krimiroga pratişedha in Uttara sthana of Suśruta Samhita.