The ninth chapter of Nidanasthana of Sushruta Samhita is called as Vidradhi Nidanam Adhyaya. This chapter offers with Abscesses.
अथातो विद्रधीनां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Vidradhi Nidana –Prognosis of Abscess; as Venerable Dhanvantari.
सर्वामरगुरुः श्रीमान्निमित्तान्तरभूमिपः |
शिष्यायोवाच निखिलमिदं विद्रधिलक्षणम् ||३||
Lord Divodasa Dhanvantari, who’s the preceptor of all of the immortals, who regardless of being an eminent king is born on earth with the aim of propagating the science of surgical procedure, thus defined the options of vidradhi i.e. abscesses to those disciples.
Samprapti: Pathogenesis
त्वग्रक्तमांसमेदांसि प्रदूष्यास्थिसमाश्रिताः |
दोषाः शोफं शनैर्घोरं जनयन्त्युच्छ्रिता भृशम् ||४||
महामूलं रुजावन्तं वृत्तं चा(वाऽ)प्यथवाऽऽयतम् |
तमाहुर्विद्रधिं धीरा, विज्ञेयः स च षड्विधः ||५||
पृथग्दोषैः समस्तैश्च क्षतेनाप्यसृजा तथा |
षण्णामपि हि तेषां तु लक्षणं सम्प्रवक्ष्यते ||६||
The aggravated doshas vitiate the pores and skin, blood, muscle and fats tissues.
Following this, the doshas get localized within the bone tissue and produce troublesome swelling. This swelling slowly bulges up, will get deep rooted, is spherical or large in form and is painful. This swelling is named Vidradhi.
This Vidradhi is of six sorts. They’re –
- Vataja Vidradhi
- Pittaja Vidradhi
- Kaphaja Vidradhi
- Sannipataja Vidradhi / Tridoshaja Vidradhi
- Ksataja Vidradhi – attributable to harm
- Raktaja Vidradhi – attributable to vitiated blood
Now, the signs of all of the six sorts of vidradhi will likely be described.
1. Bahya Vidradhi Lakshanas: Indicators and signs of exterior abscess
Vataja Vidradhi
कृष्णोऽरुणो वा परुषो भृशमत्यर्थवेदनः |
चित्रोत्थानप्रपाकश्च विद्रधिर्वातसम्भवः ||७||
Under talked about are the options of abscess produced by vata –
– Colour – both black or mild crimson
– Arduous on contact
– Has extreme ache
– Is completely different within the nature of onset and ripening
Pittaja Vidradhi
पक्वोदुम्बरसङ्काशः श्यावो वा ज्वरदाहवान् |
क्षिप्रोत्थानप्रपाकश्च विद्रधिः पित्तसम्भवः ||८||
Under talked about are the options of abscess produced by pitta –
– Colour and look – resembles ripe Udumbara fruit – darkish brown in shade,
– Presents with fever and burning sensation
– Fast in onset
– Fast in ripening
Kaphaja Vidradhi
शरावसदृशः पाण्डुः शीतः स्तब्धोऽल्पवेदनः |
चिरोत्थानप्रपाकश्च सकण्डुश्च कफोत्थितः ||९||
Under talked about are the options of abscess produced by kapha –
– Colour and look – white in shade and resembles a saucer in form
– Is chilly
– Is secure / mounted
– Has gentle ache
– Sluggish in onset
– Sluggish in ripening
– Accompanied with itching
Colour of exudates (discharges) in abscess attributable to completely different doshas
तनुपीतसिताश्चैषामास्रावाः क्रमशः स्मृताः |१०|
The exudates in these three kinds of abscesses is as beneath talked about –
– In vataja vidradhi – skinny and watery liquid
– In pittaja vidradhi – yellow liquid
– In kaphaja vidradhi – white liquid
Sannipataja Vidradhi
नानावर्णरुजास्रावो घाटालो विषमो महान् ||१०||
विषमं पच्यते चापि विद्रधिः सान्निपातिकः |११|
Under talked about are the options of abscess attributable to all of the three doshas collectively –
– Has many sorts of shade
– Has many sorts of ache
– Has many sorts of exudates
– The abscess is vastly bulged up, uneven and massive in measurement
– It’s irregular in ripening
Agantuja Vidradhi
तैस्तैर्भावैरभिहते क्षते वाऽपथ्यसेविनः ||११||
क्षतोष्मा वायुविसृतः सरक्तं पित्तमीरयेत् |
ज्वरस्तृष्णा च दाहश्च जायते तस्य देहिनः ||१२||
एष विद्रधिरागन्तुः पित्तविद्रधिलक्षणः |१३|
Causes –
– Physique will get wounded by related causes within the individuals who’re all the time indulged in unsuitable meals and actions
Pathogenesis – The warmth of the wound dispersed by vata would trigger aggravation of blood and pitta and trigger Agantuja Vidradhi i.e. absbcess of exogenous or traumatic origin.
Signs –
– Fever
– Thirst
– Burning sensation
– Different signs of abscess of pitta origin
Rakta Vidradhi
कृष्णस्फोटावृतः श्यावस्तीव्रदाहरुजाज्वरः ||१३||
पित्तविद्रधिलिङ्गस्तु रक्तविद्रधिरुच्यते |१४|
Under talked about are the signs of Raktaja Vidradhi – abscess produced by blood –
– Colour – black
– Surrounded by – black coloured eruptions
– Presents with extreme burning sensation, ache, fever
– Different signs – are the identical because the signs of pittaja vidradhi
उक्ता विद्रधयो ह्येते तेष्वसाध्यस्तु सर्वजः ||१४||
The vidradhi attributable to all of the doshas collectively is incurable amongst all of the vidradhis – abscesses described above.
2. Abhyantara Vidradhi: Inner abscess
आभ्यन्तरानतस्तूर्ध्वं विद्रधीन् परिचक्षते |
गुर्वसात्म्यविरुद्धान्नशुष्कसंसृष्टभोजनात् [१] ||१५||
अतिव्यवायव्यायामवेगाघातविदाहिभिः |
पृथक् सम्भूय वा दोषाः कुपिता गुल्मरूपिणम् ||१६||
वल्मीकवत्समुन्नद्धमन्तः कुर्वन्ति विद्रधिम् |
गुदे बस्तिमुखे नाभ्यां कुक्षौ वङ्क्षणयोस्तथा ||१७||
वृक्कयोर्यकृति प्लीह्नि हृदये क्लोम्नि वा तथा |
तेषां लिङ्गानि जानीयाद्बाह्यविद्रधिलक्षणैः ||१८||
आमपक्वैषणीयाच्च [२] पक्वापक्वं विनिर्दिशेत् |१९|
After this, the abscesses growing contained in the physique will likely be described.
Causative elements –
- Extreme indulgence in heavy to digest meals
- Extreme consumption of meals that are unaccustomed, incompatible, dry and unhealthy
- Indulgence in an excessive amount of of sexual activity
- An excessive amount of indulgence in bodily workouts
- Ordinary suppression of pure urges of the physique
- Consumption of meals which trigger heart-burn and so on.
Pathogenesis –
As a result of above mentioned elements, the doshas get aggravated – both singly or together.
These doshas would give rise to abscesses contained in the stomach.
These abscesses resemble the form of an anthill. They develop in a number of of the beneath talked about areas of the physique –
- Anus
- Orifice of the urinary bladder
- Navel area / umbilicus
- Pit of the stomach,
- Groins
- Kidneys
- Liver
- Spleen
- Coronary heart
- Kloma – pancreas?
Their signs are much like these of bahya vidradhi i.e. exterior abscess. Their unripe and ripe phases ought to be understood to be much like these defined within the context of Amapakvaisaniya Adhyaya i.e. chapter 17 of Sutra Sthana part of Sushruta Samhita.
Sthana Vishesha Lakshana: Particular signs
अधिष्ठानविशेषेण लिङ्गं शृणु विशेषतः ||१९||
गुदे वातनिरोधस्तु बस्तौ कृच्छ्राल्पमूत्रता |
नाभ्यां हिक्का तथाऽऽटोपः कुक्षौ मारुतकोपनम् ||२०||
कटीपृष्ठग्रहस्तीव्रो वङ्क्षणोत्थे तु विद्रधौ |
वृक्कयोः पार्श्वसङ्कोचः प्लीह्न्युच्छ्वासावरोधनम् ||२१||
सर्वाङ्गप्रग्रहस्तीव्रो हृदि शूलश्च दारुणः |
श्वासो यकृति तृष्णा च पिपासाक्लोमजेऽधिका ||२२||
Hear now, to the particular signs involved to the completely different websites of the abscess.
- Abscess located within the anus, produces obstruction of flatus;
- Abscess located within the urinary bladder produces problem in micturition and fewer amount of urine,
- Abscess on the umbilicus offers rise to hiccup and gurgling noise;
- Abscess within the pit of the stomach (epigastrium) aggravates Vata;
- Abscess growing within the groins produce extreme catching ache within the waist and again;
- Abscess within the kidney produces constriction of flanks
- Abscess within the spleen causes obstruction to exhalation;
- Abscess growing within the (space of) coronary heart produces extreme catching ache all around the physique and dreadful ache within the coronary heart;
- Abscess within the liver produces dyspnoea and thirst
- Abscess within the Kloma (pancreas) produces profound thirst
Prognosis of Vidradhi
आमो वा यदि वा पक्वो महान् वा यदि वेतरः |
सर्वो मर्मोत्थितश्चापि [१] विद्रधिः कष्ट उच्यते ||२३||
No matter the vidradhi i.e. abscess being ripe or unripe, huge or small in measurement, it’s tough to deal with when it’s positioned on the important spots.
नाभेरुपरिजाः पक्वा यान्त्यूर्ध्वमितरे त्वधः |
जीवत्यधो निःस्रुतेषु स्रुतेषूर्ध्वं न जीवति ||२४||
हृन्नाभिबस्तिवर्ज्या ये तेषु भिन्नेषु बाह्यतः |
जीवेत् कदाचित् पुरुषो नेतरेषु कदाचन ||२५||
Options of abscesses located within the organs above the navel area –
- When these abscesses get ripened and burst open, they expel the discharges like pus and so on. within the upward route i.e. by way of the mouth.
- Prognosis of this situation could be very unhealthy and the affected person is not going to survive.
Options of the abscesses located within the organs beneath the navel area – - When these abscesses get ripened and burst open, they expel the exudates within the downward route i.e. by way of the rectum.
- Prognosis of this situation is nice and the affected person would survive.
Options of the abscesses growing within the organs apart from the guts, umbilicus and urinary bladder – - When these abscesses get ripened and burst open, they expel their discharges like pus and so on. to the outside,
- Prognosis of this situation is debatable – the affected person typically survives and typically doesn’t survive
Rakta Vidradhi
स्त्रीणामपप्रजातानां प्रजातानां तथाऽहितैः |
दाहज्वरकरो घोरो जायते रक्तविद्रधिः ||२६||
Rakta Vidradhi i.e. abscesses attributable to vitiated blood is happens in –
– Ladies who’ve had irregular deliveries (abortion, miscarriage) and
– Ladies who take pleasure in unsuitable meals and actions
Signs –
– Burning sensation
– Fever
This situation is dreadful.
Makkalla
अपि सम्यक्प्रजातानामसृक् कायादनिःसृतम् |
रक्तजं विद्रधिं कुर्यात् कुक्षौ मक्कल्लसञ्ज्ञितम् ||२७||
सप्ताहान्नोपशान्तश्चेत्ततोऽसौ सम्प्रपच्यते |२८|
Rakta Vidradhi can also be induced even within the stomach of a girl who had delivered the kid correctly and when the blood doesn’t stream out of her physique. This is called Makkalla. If Makkalla doesn’t subside inside a span of seven days, it will ripen and burst open, expelling the discharges (pus and so on. exudates).
Vidradhi-Gulma-Vishesha: Distinction between abscess and tumor
विशेषमथ वक्ष्यामि स्पष्टं विद्रधिगुल्मयोः ||२८||
गुल्मदोषसमुत्थानाद्विद्रधेर्गुल्मकस्य च |
कस्मान्न पच्यते गुल्मो विद्रधिः पाकमेति च ||२९||
न निबन्धोऽस्ति गुल्मानां विद्रधिः सनिबन्धनः |
गुल्माकाराः स्वयं दोषा विद्रधिर्मांसशोणिते ||३०||
विवरानुचरो ग्रन्थिरप्सु बुद्बुदको यथा |
एवम्प्रकारो गुल्मस्तु तस्मात् पाकं न गच्छति ||३१||
मांसशोणितबाहुल्यात् पाकं गच्छति विद्रधिः |
मांसशोणितहीनत्वाद्गुल्मः पाकं न गच्छति ||३२||
गुल्मस्तिष्ठति दोषे स्वे विद्रधिर्मांसशोणिते |
विद्रधिः पच्यते तस्माद्गुल्मश्चापि न पच्यते ||३३||
After this, the peculiarities between abscess which happens contained in the stomach and gulma i.e. tumors which happen contained in the stomach will likely be clearly defined.
The doshas and the causative / thrilling causes for each inner abscess and stomach tumor are the identical. In such a case, why is {that a} tumor doesn’t ripen i.e. pus isn’t shaped inside whereas the abscess ripens i.e. pus is shaped inside?
The reason being that the tumor doesn’t have a root and therefore isn’t hooked up to any web site. Alternatively, the abscess does have an attachment.
In gulma, the doshas themselves attain the form of a bush. Alternatively, within the vidradhi, the muscle and blood would make up the form.
Granthi (to imply gulma right here) spreads/ strikes with a cavity inside similar to a bubble on water; due to these options gulma (tumor of the stomach) doesn’t bear ripening, whereas vidradhi (abscess) having extra of muscle tissue and blood will bear suppuration. Since gulma (tumor) has insufficient / much less amount or absence of muscle tissue and blood, it doesn’t bear ripening. Tumor (gulma) resides within the Doshas solely whereas abscess (vidradhi) resides in muscle tissue and blood.
Therefore the abscess ripens (suppurates) and tumor doesn’t (suppurate).
Asadhya vidradhi: Incurable abscesses
हृन्नाभिबस्तिजः पक्वो वर्ज्यो यश्च त्रिदोषजः |३४|
अथ मज्जपरीपाको घोरः समुपजायते ||३४||
सोऽस्थिमांसनिरोधेन द्वारं न लभते यदा |
ततः स व्याधिना तेन ज्वलनेनेव दह्यते ||३५||
अस्थि(थ) मज्जोष्मणा तेन शीर्यते दह्यमानवत् |
विकारः शल्यभूतोऽयं क्लेशयेदातुरं चिरम् ||३६||
अथास्य कर्मणा व्याधिर्द्वारं तु लभते यदा |
ततो मेदःप्रभं स्निग्धं शुक्लं शीतमथो गुरु ||३७||
भिन्नेऽस्थ्नि निःस्रवेत् [१] पूयमेतदस्थिगतं विदुः |
विद्रधिं शास्त्रकुशलाः सर्वदोषरुजावहम् ||३८||
Under talked about sorts of abscesses ought to be rejected and never handled –
– These positioned within the area of the guts, umbilicus and bladder which have ripened (i.e. pus is shaped in them) and
– These produced by all of the three doshas collectively
Asthigata Vidradhi – The abscesses of the bones would turn into dreadful because of ripening of the bone marrow. The pus wouldn’t discover an outlet to get expelled because of the obstruction by the bone and muscle tissue. Because of this, the pus would stay contained in the bone solely.
The pus which has remained would trigger extreme burning sensation as if burnt by the hearth itself, aided by the mixed warmth of bone and bone marrow.
This situation resembles impaction of a overseas physique and would give rise to critical troubles. Now the abscess will get an outlet. By means of this outlet, it exudes liquids resembling fats, which is white, unctuous, chilly and heavy / thick.
There will likely be exudation of pus, ache and different signs of all of the doshas when the bone will get punctured exuding pus. This situation ought to be understood as asthigata vidradhi i.e. abscess of the bone as recognized to the specialists of the science.
इति सुश्रुतसंहितायां निदानस्थाने विद्रधिनिदानं नाम नवमोऽध्यायः ||९||
Thus ends the Ninth chapter by title Vidradhi Nidana- in Nidana Sthana of Susrutha Samhita.
