अथात उदरनिदानं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥ १ ॥
We will now expound the chapter named Udara Nidanam – diagnosis of enlargement of the abdomen; thus said Atreya and other great sages. (1)
Udara Samprapti – pathogenesis
रोगा: सर्वेऽपि मन्देऽग्नौ सुतरामुदराणि तु । अजीर्णान्मलिनैश्चान्नैर्जायन्ते मलसञ्चयात् ॥ २ ॥
ऊर्ध्वाधो धातवो रुध्वा वाहिनीरम्बुवाहिनीः । प्राणाग्न्यपानान् सन्दूष्य कुर्युस्त्वङ्भांससन्धिगाः ॥३॥
आध्माप्य कुक्षिमुदरम् – अष्टधा तच्च भिद्यते ॥४॥
All diseases are produced by mandagni (poor digestive function); especially so, Udara (enlargement of the abdomen).
Indulgence in foods which are not cooked and which are dirty leads to accumilation of the doshas, they in turn get aggravated, block the channels of ambu (water) in the upper and lower parts of the body, bring about abnormalities in the prana (vata), agni (digestive activity vis a vis pitta in the alimentary tract) and apana (vata), getting localised in between the skin and the muscles (of the abdomen) produce Udara by making the abdomen big in size. (2-4a)
पृथग्दोषैः समस्तैश्च प्लीहबद्धक्षतोदकैः । तेनार्ताः शुष्कताल्वोष्ठाः शूनपादकरोदराः ॥५॥
नष्टचेष्टाबलाहाराः कृशाः प्रध्मातकुक्षयः । स्युः प्रेतरूपाः पुरुषा भाविनस्तस्य लक्षणम् ॥६॥
It is of eight kinds – (one) from each dosha seperately, (one) for the combination of all the three, one each from Pliha ( splenic enlargement ), Baddha (obstruction of the intestine), ksata (injury to the intestines ) and Udaka (accumilation of water ). Persons suffering from it have dryness of the palate and lips, swelling of the feet, hands and abdomen diminition of activities, strength and (in take of ) food, emaciation, severe distention of the abdomen, and appear like corpses. (4b-6)
Udara Roga Purva rupa – premonitory symptoms
क्षुन्नाशोऽन्नं चिरात्सर्वं सविदाहं च पच्येत । जीर्णाजीर्णं न जानाति सौहित्यं सहते न च ॥७॥
क्षीयते बलतः शश्वच्छ्वसित्यल्पेऽपि चेष्टिते । वृद्धिर्विशोऽप्रवृत्तिश्च किञ्चिच्छोफश्च पादयोः ॥८॥
रुग्बस्तिसन्धौ ततता लघ्वल्पाभोजनैरपि । राजीजन्म वलीनाशो जठरे – जठरेषु तु ॥९॥
Its premonitory symptoms are – loss of hunger, the entire food gets digested after unduly long time accompanied with burning sensation inside, the person is unable to recognise digestion or indigestion, does not tolerate (like) contentment of good meal (cannot eat to his satisfaction) and there is gradual diminition of strength, breathes with difficulty even after little work, there is increase in the quantity of faeces but it is not eliminated out, slight oedema of the feet, pain in the joints of the urinary bladder (groins), discomfort even with light and little amount of food, appearance of straiae and disappearance of wrinkles (folds) on the abdomen. (7-9)
Udararoga Lakshana – clinical features
सर्वेषु तन्द्रा सदनं मलसङ्गोऽल्पवह्निता ।
दाहः श्वयथुराध्मानमन्ते सलिलसम्भवः ॥१०॥
In all kinds (of udara ), there is stupor, debility, accumilation of faeces, poor digestive activity, burning sensation, oedema, distention of the abdomen and collection of fluid at the terminal stage. (10)
सर्वं त्वतोयमरुणमशोफं नातिभारिकम् । गवाक्षितं सिराजालैः सदा गुडुगुडायते ॥११॥
नाभिमन्त्रं च विष्टभ्य वेगं कृत्वा प्रणश्यति । मारुतो हृत्कटीनाभिपायुवङ्क्षणवेदनः ॥ १२ ॥
सशब्दो निश्चरेद्वायुर्विड् बद्धा मूत्रमल्पकम् । नातिमन्दोऽनलो लौल्यं न च स्याद्विरसं मुखम् ॥१३॥
In all the kinds, before the production of fluid, (the abdomen) is slightly red, without swelling (non-oedematous) not very heavy, with visible network of veins, always making gurgling sound, vata siezing the umbilicus and the intestines creates bouts (sound) and vanishes, there is pain in the (region of the ) heart, waist, umbilicus urinary bladder, rectum and groins, vayu (gas or flatus) moves inside making sound, faeces is obstructed, urine little in quantity, digestive function not very weak, no great desire for food and presence of bad taste in the mouth. (11-13)
Vataja Udara
तत्र वातोदरे शोफः पाणिपान्मुष्कसन्धिषु । कुक्षिपार्श्वोदरकटीपृष्ठरुक् पर्वभेदनम् ॥१४॥
शुष्ककासोऽङ्गमर्दोऽधोगुरुता मलसंग्रहः । श्यावारुणत्वगादित्वमकस्माद्धासवृद्धिमत् ॥१५॥
सतोदभेदमुदरं तनुकृष्णसिराततम् । आध्मातदृतिवच्छब्दमाहतं प्रकरोति च ॥ १६ ॥
In vatodara (caused by increase of vata) there is oedema of the hands, feet, scrotum and joints, pain in the pit of the abdomen, flanks, centre of the abdomen, waist and back, cutting pain in the joints, dry cough, body-ache, feeling of heaviness of the lower body accumilation of wastes, bluish-red colouration of the skin etc, abdomen increasing and decreasing in size without any apparant reason, pricking and cutting pain, appearance of thin, black veins all over it, produces sound like an inflated bag, when percussed vayu ( gas) moving inside in all directions associated with pain and sound. (14-16)
Pittaja Udara
वायुश्चात्र सरुक्शब्दो विचरेत्सर्वतोगतिः । पित्तोदरे ज्वरो मूर्च्छा दाहस्तृट् कटुकास्यता ॥१७॥
भ्रमोऽतिसारः पीतत्वं त्वगादावुदरं हरित् । पीतताम्रसिरानद्धं सस्त्रेदं सोष्म दह्यते ॥ १८ ॥ धूमायति मृदुस्पर्शं क्षिप्रपाकं प्रदूयते ।
In pittodara (caused by increase of pitta) there is fever, fainting, burning sensation, thirst, bitter taste in the mcuth, giddiness diarrhoea, yellow discolouration of the skin etc, the abdomen has green, yellow, or coppery coloured veins, sweating, warmth, feeling of burning sensation of hot fumes coming out, of soft touch, undergoes maturation (formation of fluid inside) quickly and with burning sensation in the mouth, palate and lips. (17-18)
Kaphaja Udara
लेष्मोदरेऽङ्गसदनं स्वापः श्वयथुगौरवम् ॥१९॥
निद्रोत्क्लेशारुचिश्वासकासशुक्लत्वगादिता । उदरं स्तिमितं स्निग्धं शुक्लराजीततं महत् ॥ २०॥
चिराभिवृद्धि कठिनं शीतस्पर्शं गुरु स्थिरम् ।
In slesmodara (caused by increase of kapha) there is weakness of the body, loss (or diminisnes) of tactile sensation, swelling, heaviness, sleep, nausea, loss of appetite, dyspnoea, cough, white colour of the skin etc, the abdomen is static ( without any movement), oily ( smooth, greasy ) full of white straie, large in size, enlarging very slowly, hated, cold to tough, heavy and stable. (19-20)
Sannipataja Udara
त्रिदोषकोपनैस्तैस्तैः स्त्रीदत्तैश्च रजोमलैः ॥२१॥
गरदूषीविषाद्यैश्च सरक्ताः सञ्चिता मलाः । कोष्ठं प्राप्य विकुर्वाणाः शोफमूर्च्छाभ्रमान्वितम् ॥ २२ ॥
कुर्युस्त्रिलिङ्गमुदरं शीघ्रपाकं सुदारुणम् । बाधते तच्च सुतरां शीतवाता भ्रदर्शने ॥२३॥
By indulgence in foods and activities which cause the increase of the three kinds of doshas, partaking of menstrual fluid and other waste products administered by women, artificial and weak poisonous materials the three doshas associated with rakta (blood) undergo increase (accumilation ) reach the alimentary tract, cause swelling, fainting, giddiness and produce Tridoshaja udara (enlargement of abdomen) which is quick in maturing (formation of fluid) and very dreadful, causing great distress especially on dys of cold breeze and cloudy sky. (21-23)
Plihodara – yakurtodara
अत्याशितस्य सङ्क्षोभाद्यानयानादिचेष्टितैः । अतिव्यवायभाराध्वगमनव्याधिकशनैः ॥२४॥
वामपार्श्वाश्रितः प्लीहा च्युतः स्थानाद्विवर्द्धते । शोणितं वा रसादिभ्यो विवृद्धं तं विवर्द्धयेत् ॥ २५ ॥
सोऽष्ठीलेवातिकठिनः प्रोन्नतः कूर्मपृष्ठवत् । क्रमेण वर्धमानश्च कुशावुदरमावहेत् ॥ २६ ॥
श्वासकासपिपासास्यवैरस्याध्मानरुग्ज्वरैः । पाण्डुत्वमूर्च्छाच्छर्दीभिर्दाहमोहैश्च संयुतम् ॥२७॥
अरुणाभं विवर्णं वा नीलहारिद्रराजितम् । उदावर्तरुजानाहैर्मोहतृड्दहनज्वरैः ॥२८॥
गौरवारुचिकाठिन्यैर्विद्यात्तत्र मलान् क्रमात् । प्लीहवद्दक्षिणात् पार्श्वात् कुर्याद्यकृदपिच्युतम् ॥२९॥
By jerks caused by travelling, riding on vehicles and such other acts soon after meals, weakness caused by indulgence in excess of sexual intercourse, carrying heavy loads, walking long distances and diseases, the spleen situated on the left side gets displaced and becomes enlarged, or the blood undergoing increase along with rasa and others (dhatus) might cause its (spleen) and enlargement, the spleen thus enlarged is very hard occupies the entire abdominal cavity, enlarging gradually, produces the disease Plihodara; it is associated with dyspnoea, cough, severe thirst, discolouration, fainting, vomiting, burning sensation and delusion, the abdomen is slightly red or of any other colour, as blue or deep yellow straies upward movement, pain, distention of the abdomen, delusion, thirst, fever with great heat, feeling of heaviness, loss of appetite, and hardners are the symptoms, from which the malas (doshas) are to be inferred in their succeeding order. The yakurt (liver) situated on the right side, displaced (and enlarged) like the spleen, also causes udara (known as Yakurtodara ) . ( 24-29)
Baddhagudodara
पक्ष्मवालैः सहान्नेन भुक्तैर्बद्धायने गुदे । दुर्नामभिरुदावर्तैरन्नैर्वान्त्रोपलेपिभिः ॥३०॥
वर्च: पित्तकफान् रुध्वा करोति कुपितोऽनिलः । अपानो जठरं तेन स्युर्दाहज्वरतृक्षवाः ॥३१॥
कासश्वासोरुसदनं शिरोहन्नाभिपायुरुक् । मलसङ्गोऽरुचिच्छर्दिरुदरं मूढमारुतम् ॥३२॥
स्थिरं नीलारुणसिराराजीनद्धमराजि वा । नाभेरुपरि च प्रायो गोपुच्छाकृति जायते ॥३३॥
Eyelashes and hairs consumed along with food causing obstruction of the rectum, piles, upward movement of vata, foods which adhere to the interior of the intestines and such other causes, produce aggravation of apanavata which in turn associates with pitta and kapha makes for increase of the faeces and obstruction (of the passage), then develop fever with burning sensation, thirst, excess of sneezing, cough, dyspnoea, weakness of the thighs, pain in the head, heart, umbilicus, and rectum, constipation, loss of appetite, vomiting, abscence of movement of maruta (air, gas) inside the abdomen, the abdomen is static (without movement), covered with bluish-red veins, with or without straiae, enlargement is generally above the umbilicus and resembles the tail of a cow. This disease is Baddha-gudodara. (30-33)
Chidrodara
अस्थ्यादिशल्यैः सान्त्रैश्च भुक्तैरत्यशनेन वा । भिद्यते पच्यते चान्त्रं तच्छिद्रैश्च स्रवन् बहिः ॥३४॥
आम एव गुदादेति ततोल्पाल्पं सविड्सः । तुल्यः कुणपगन्धेन पिच्छिलः पीतलोहितः ॥३५॥
शेषश्चापूर्य जठरं जठरं घोरमावहेत् । वर्धते तदधोनाभेराशु चैति जलात्मताम् ॥३६॥
उद्रिक्तदोषरूपं च व्याप्तं च श्वासतृद्भ्रमैः । छिद्रोदरमिदं प्राहुः परिस्रावीति चापरे ॥३७॥
By consuming bones and other foreign bodies along with the food and by eating large quantities of foods, the intestines get punctured and wounded, from those holes, ama (undigested food materials) exudes out, flowsdownwards and collects in the rectum, this fluid getting mixed with faeces assumes the smell of the corpse, is slimy yellowishred in colour fills the remaining portion of the abdomen and produces udara which is dreadful. The abdomen enlargement below the umbilicus, becomes filled with fluid quickly and exhibit all the sugns of increased doshas along with dyspnoea, thirst and giddiness. This is called as Chidrodara and as Parisraviodara by some others. (34-37)
Jalodara – Ascitis – Udakodara
प्रवृत्तस्त्रेहपानादेः सहसामाम्बुपायिनः । अत्यम्बुपानान्मन्दाग्नेः क्षीणस्यातिकृशस्य वा ॥३८॥
रुध्वाम्बुमार्गाननिलः कफश्च जलमूर्च्छितः । वर्द्धयेतां तदेवाम्बु तत्स्थानादुदराश्रितौ ॥३९॥
ततः स्यादुदरं तृष्णागुदस्स्रुतिरुजान्वितम् । कासश्वासारुचियुतं नानावर्णासिराततम् ॥४०॥
तोयपूर्णदृतिस्पर्शशब्दप्रक्षोभवेपथु । दकोदरं महत् स्निग्धं स्थिरमावृत्तनाभि तत् ॥४१॥
By drinking unboiled water during the course of oleation and other therapies, or of large quantites of water by persons who have poor digestive capacity, in persons who are wasted and emaciated too much, anila (vata) and kapha getting aggravated, block the channels of water, getting mixed with that fluid they cause its increase in its own place, move on to the abdomen and accumilates there, producing udara (abdominal enlargement), thirst, exudation from the rectum, pain cough, dyspnoea, anorexia, network of veins of different colours, the abdomen resembles a bag filled with water for touch, sound, movement and vibration, very big in size, greasy, static (without movement) and surrounding the umbilicus. This is Udakodara (udakodara-jalodara). (38-41)
उपेक्षया च सर्वेषु दोषाः स्वस्थानतश्च्युताः । पाकाद्रवा द्रवीकुर्युः सन्धिस्त्रोतोमुखान्यपि ॥ ४२ ॥
स्वेदश्च बाह्यस्त्रोतस्सु विहतस्तिर्यगास्थितः । तदेवोदकमाप्याय्य पिच्छां कुर्यात्तदा भवेत् ॥४३॥
गुरूदरं स्थिरं वृत्तमाहतं च न शब्दवत् । मृदु व्यपेतराजीकं नाभ्यां स्पृष्टं च सर्पति ॥४४॥
तदनूदकजन्मास्मिन् कुक्षिवृद्धिस्ततोऽधिकम् । सिरान्तर्द्धानमुदकजठरोक्तं च लक्षणम् ॥४५॥
All kinds of udara, if neglected, the doshas undergoing increase and getting displaced from their natural seats by maturing (processed by heat) cause liquification of the channels of the joints and of the sweat, thus obstructed in the exterior, these spread in all direction in the dhatus, increase the fluids therein and makes them slimy; the abdomen becomes heavy, static round, not producing sound when purcussed, soft, without straiae, spreads outwards when touched at the umbilicus – these are the features of the stage when there is no fluid production (and collection), this is followed by the next stage with features such as greater enlargement, disappearance of veins and presence of other symptoms of udakodara described earlier. (42-45)
Sadhyasadhyata – prognosis
वातपित्तकफप्लीहसन्निपातदकोदरम् । कृच्छ्रं सर्वं च जातसलिलं रिष्टोक्तोपद्रवान्वितम् ।
यथोत्तरं पक्षात् परं प्रायोऽपरे हतः ॥४६॥
Udaras caused by vata, pitta, kapha, pliha, sannipata, and dakodara are difficult to cure, more in their successive order; others say, that baddhagudodara and chidrodara generally kill the person after a fortnight, so also all the kinds which have developed fluid (inside) and have the complications (secondary diseases) enumerated as fatal signs. (46)
जन्मनैवोदरं सर्वं प्राय: कृच्छ्रतमं मतम् ॥
बलिनस्तदजाताम्बु यत्नसाध्यं नवोत्थितम् ॥४७॥
Generally all udara, by their very onset are difficult to cure; those affecting strong persons, those which have not developed fluid and which are of recent onset, might get cured if great efforts are made. (47)
॥ इति द्वादशोऽध्यायः ॥
Thus ends the Twelvth chapter.
