Chapter 7 – Krimi Nidana

The 7th chapter of Madhava Nidana deals with Krimi Nidana, i.e., parasitic diseases. A parasite is an organism that lives by necessary means such as on or in a host organism and survives by feeding from or at the expense of that host.2 The term Krimi has adapted a wide interpretation in ancient literature and includes all pathogenic and non-pathogenic organisms covering a vast range of infestation and infection caused by a host of agents from worms to viruses.

क्रिमयश्च द्विधा प्रोक्ता बाह्याभ्यन्तरभेदतः |
बहिर्मल – कफासृग्विड जन्मभेदाच्चतुर्विधाः || १ ||
नामतो विंशतिविधा –

krimayaśca dvidhā proktā bāhyābhyantarabhedataḥ |
bahirmala – kaphāsrgviḍa janmabhedāccaturvidhāḥ || 1 ||
nāmato viṃśatividhā –

Krimis or worms are of two varieties, namely,

• The bahya (the external)
• The abhyantara (the internal)

They are further classified into four types as per their respective origin:

1. Born out of external impurities
2. Generated by kapha
3. Generated by rakta
4. Generated by faecal matter

These worms are 20 in number. The external ones are born out of impurities. 1

The external Worms –

— बाह्यास्तत्र मलोद्भवाः |
तिलप्रमाण – संस्थान – वर्णाः केशाम्बराश्रयाः ||२ ||
बहुपादाश्च सूक्ष्माश्च यूका लिक्षाश्च नामतः |
द्विधा ते कोठ – पिडका – कण्डु – गण्डान प्रकुर्वते || ३ ||

— bāhyāstatra malodbhavāḥ |
tilapramāṇa – saṃsthāna – varṇāḥ keśāmbarāśrayāḥ ||2 ||
bahupādāśca sūkṣmāśca yūkā likṣāśca nāmataḥ |
dvidhā te koṭha – piḍakā – kaṇḍu – gaṇḍāna prakurvate || 3||

External parasites are of two varieties:

• Yuka
• Liksha

They resemble tila (sesame seeds) in shape, features and colour. And dwell on hair and garments. They have many legs and are very small. They cause urticarial patches; pustules, itching sensation and vesicles on the skin. 2-3

Etiology of worm infestation –

अजीर्णभोजी मधुराम्लनित्यो द्रवप्रियः पिष्ट गुडोपभोक्ता |
व्यव्यामवर्जी च दिवाशयानो विरुद्धभुक् संलभते क्रिमिंस्तु || ४ ||

ajīrṇabhojī madhurāmlanityo dravapriyaḥ piṣṭa guḍopabhoktā |
vyavyāmavarjī ca divāśayāno viruddhabhuk saṃlabhate krimiṃstu || 4 ||

Those persons fall victims of krimi roga who involved in regularly taking such food items that are raw, sweet and sour, who take large amount of water and watery beverages and the persons who take incompatible eatables, who frequently consume the jaggery; those who avoid physical exercise and those who sleep during the day hours.

Etiology of worm infestation basing on the origin –

माष – पिष्टाम्ल – लवण – गुड – शोकैः पुरिषजाः |
मांस – मत्स्य – गुड – क्षीर – दधि – शुक्तैः कफोद्भवाः ||५ ||
विरुद्धाजिर्ण – शाकाध्यैः शोणितोत्था भवन्ति हि |

māṣa – piṣṭāmla – lavaṇa – guḍa – śokaiḥ puriṣajāḥ |
māṃsa – matsya – guḍa – kṣīra – dadhi – śuktaiḥ kaphodbhavāḥ ||5 ||
viruddhājirṇa – śākādhyaiḥ śoṇitotthā bhavanti hi |

Use of black gram, eatables that are dry, sour, and salty, jaggery, and leafy vegetables produce growth of parasites in the faeces.

Use of mutton, fish, jaggery, milk, curd, fermented sugarcane juice, etc, could generate parasites in Kapha.

Indulgence in incompatible eatables, uncooked leafy vegetables produces parasites in the blood. 5

Symptomatology of worm infestation —

ज्वरो विवर्णता शूलं ह्रुद्रोगः सदनं भ्रमः ||६ ||
भक्तद्वेषो अतिसारश्च सञ्जातक्रिमिलक्षणम् |

jvaro vivarṇatā śūlaṃ hrudrogaḥ sadanaṃ bhramaḥ ||6 ||
bhaktadveṣo atisāraśca sañjātakrimilakṣaṇam |

The signs and symptoms of the onset of worm infestation –

• Fever
• Discolouration of the body
• Pain
• Ailment in the heart
• Depression
• Vertigo
• Disliking of food
• Diarrhoea

The features of worms of kapha origin –

कफादामाशये जाता वृद्धाः सर्पन्ति सर्वतः || ७ ||
पृथुब्रध्ननिभाः केचित् केचिद् गण्डूपदोपमाः |
रूढधान्याङ्कुराकारास्तनुदीर्घास्तथा अणवः || ८ ||
श्वेतास्ताम्रावभासाश्च नामतः सप्तधा तु ते |
अन्त्रादा उदरावेष्टा ह्रुदयादा महागुदाः || ९ ||
चुरवो दर्भ कुसुमाः सुगन्धास्ते च कुर्वते |
ह्रुल्लासमास्यस्रवणमविपाकमरोचकम् || १० ||
मूर्च्छा – च्छर्दि – ज्वरानाह – कार्श्य – क्षवथु – पीनासान |

kaphādāmāśaye jātā vrddhāḥ sarpanti sarvataḥ || 7 ||
prthubradhnanibhāḥ kecit kecid gaṇḍūpadopamāḥ |
rūḍhadhānyāṅkurākārāstanudīrghāstathā aṇavaḥ || 8 ||
śvetāstāmrāvabhāsāśca nāmataḥ saptadhā tu te |
antrādā udarāveṣṭā hrudayādā mahāgudāḥ || 9 ||
curavo darbha kusumāḥ sugandhāste ca kurvate |
hrullāsamāsyasravaṇamavipākamarocakam || 10 ||
mūrcchā – cchardi – jvarānāha – kārśya – kṣavathu – pīnāsān|

The worms originating from kapha are promoted in the stomach. And having grown up in the stomach, they move about all over. Some of them resemble an intertwined rope, others are like an earth worm and some are shaped like a mature grain sprout; and they may be small, big or very minute in size; They are white or copper coloured and seven in varieties:

• Aantrada
• Udaraveshta
• Hrdayada
• Mahaguda
• Churu
• Darbha Kusuma
• Sugandha

They cause these symptoms –

• Nausea
• Excessive salivation
• Indigestion
• Anorexia
• Fainting
• Vomiting
• Fever
• Enlargement of abdomen
• Emaciation
• Frequent sneezing
• Running of nose. 7- 10

The features of worms of rakta (blood) origin –

रक्तवाहिसिरास्थानरक्तजा जन्तवो अण्वः || ११ ||
अपादा वृत्त – ताम्राश्च सौक्ष्म्यात् केचिददर्शनाः |
केशादा रोम विध्वंसा रोमद्वीपा उदुम्बराः |
षट् ते कुष्तैककर्माणः सहसौरसमातरः || १२ ||

raktavāhisirāsthānaraktajā jantavo aṇvaḥ || 11 ||
apādā vrtta – tāmrāśca saukṣmyāt kecidadarśanāḥ |
keśādā roma vidhvaṃsā romadvīpā udumbarāḥ |
ṣaṭ te kuṣtaikakarmāṇaḥ sahasaurasamātaraḥ || 12 ||

Parasites arising from rakta (blood) are found in all the organs of raktavahasrotas (liver, spleen, arteries, veins and blood itself). They are minute in size, are without legs, round, coppery in colour and some of them are not perceivable to the naked eye. They are named as –

• Keshada
• Romavidhvamsa
• Romadvipa
• Udumbara
• Saurasa
• Matr

They generate kushta (leprosy) or such symptoms which are otherwise seen in leprosy. 11 -12

Worms of Purisha (faeces) origin –

पक्वाशये पुरिषोत्था जायन्ते अधोविसर्पिणः |
प्रवृद्धाः स्युर्भवेयुश्च ते यदा आमशयोन्मुखाः || १३ ||
तदा आस्योद्गार – निःश्वासा विड्गन्धानुविधायिनः |
पृथुवृत्त – तनु – स्थूलाः श्याव – पीत – सितासिताः || १४ ||
ते पञ्च नाम्ना क्रिमयः ककेरुक – मकेरुकाः |
सौसुरादाः सशूलाख्या लेलिहा जनयन्ति हि || १५ ||
विड्भेद – शूल – विष्टम्भ – कार्श्य – पारुष्य – पाण्डुताः |
रोमहर्षाग्निसदनं गुद कण्डूः विमार्गगाः || १६ ||

pakvāśaye puriṣotthā jāyante adhovisarpiṇaḥ |
pravrddhāḥ syurbhaveyuśca te yadā āmaśayonmukhāḥ || 13 ||
tadā āsyodgāra – niḥśvāsā viḍgandhānuvidhāyinaḥ |
prthuvrtta – tanu – sthūlāḥ śyāva – pīta – sitāsitāḥ ||14||
te pañca nāmnā krimayaḥ kakeruka – makerukāḥ |
sausurādāḥ saśūlākhyā lelihā janayanti hi || 15 ||
viḍbheda – śūla – viṣṭambha – kārśya – pāruṣya – pāṇḍutāḥ |
romaharṣāgnisadanaṃ guda kaṇḍūḥ vimārgagāḥ ||16 ||

इति माधवकरविरचिते माधवनिदाने क्रिमि निदानं समाप्तं ||7||

iti mādhavakaraviracite mādhavanidāne krimi nidānaṃ samāptaṃ ||7||

The faecal worms originate in the intestines and when mature they have a tendency to travel downwards. However, when they increase, they instead move towards amashaya (stomach) and produce the odour of faeces in the belch and in the respiration of the patient. They are big, round, thin or thick; blue, yellow, white or black. They are of 5 varieties, namely:

• Kakeruka
• Makeruka
• Sausarada
• Sashula
• Leliha

They generate —

• Diarrhoea
• Pain in the abdomen
• Constipation
• Emaciation
• Dryness
• Pallor
• Horripilation
• Poor digestion
• Itching in anus.

They even move into organs nearby and create problems. 13 – 16

Thus concludes the Chapter of Krimiroga.