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Sushruta SamhitaNidana SthanaUdara Nidana - Ascitis and abnormal condition of the abdomen - Sushrutasamhita...

Udara Nidana – Ascitis and abnormal condition of the abdomen – Sushrutasamhita Nidanasthana Chapter 7

सप्तमोऽध्यायः । अथात उदराणां निदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।

Now we shall discourse on the Nidana of Udara (dropsy with an abnormal condition of the abdomen). 1

धन्वन्तरिर्धर्मभृतां वरिष्ठो राजर्षिरिन्द्रप्रतिमोऽभवद्यः । ब्रह्मर्षिपुत्रं विनयोपपन्नं शिष्यं शुभं सुश्रुतमन्वशात् सः ।। २ ।।

Metrical Text: The royal sage Dhanvantari, the foremost of all pious men who equalled in splendour and glory and lord of the celestials, thus blissfully discoursed on the Nidana of Udara to Susruta, the son of the holy Visvamitra, who devoutly approached him for that purpose. 2

पृथक् समस्तैरपि चेह दोषैः प्लीहोदरं बद्धगुदं तथैव । आगन्तुकं सप्तममष्टमञ्च दकोदरञ्चेति वदन्ति तानि ।। ३ ।।

Classification: This disease may be divided into eight different types, of which four are produced by the several actions of the three deranged Dosas of the body and their concerted action as well. Of the remaining types, two being known as Plihodara (including Yakrtodara) and Baddha-Gudodara (tymanitis due to the constriction of the anus), the seventh Agantuka (traumatic or of extraneous origin), and the eighth Dakodara (Ascites proper). 3

सुदुर्बलाग्नेरहिताशनस्य संशुष्कपूत्यन्ननिषेवणाद् वा । स्नेहादिमिथ्याचरणाच्च जन्तोर्वृद्धिं गताः कोष्ठमभिप्रपन्नाः ।

गुल्माकृतिव्यञ्जितलक्षणानि कुर्वन्ति घोराण्युदराणि दोषाः ॥ ४ ॥

कोष्ठादुपस्नेहवदन्नसारो निःसृत्य दुष्टोऽनिलवेगनुन्नः। त्वचः समुन्नम्य शनैः समन्ताद् विवर्धमानों जठरं करोति ।।५॥

Predisposing Causes: The deranged dosas of a person of extremely impaired digestion, addicted to the habit of taking unwholesome food, or of eating dry, putrid food, or of violating the rules of conduct to the observed in connection with oleaginous measures etc,¹ are aggravated and find lodgment in the abdomen. Thus appearing in the shape of an abdominal tumour (Gulma), they give rise to this dreadful disease, attended with all its characteristic symptoms. The lymph chyle formed out of the assimilated food gets vitiated, and impelled by the aggravated Vayu, it percolates through the peritoneum in the same manner as a quantity of oil or clarified butter kept in a new earthen pot will transude through the pores of its sides. It thus gradually distends the skin (Tvak) of the abdomen. The process becomes general all through the abdominal region and the disease (Udara ) is produced in consequence. 4-5

तत्पूर्वरूपं बलवर्णकाङ्क्षा वलीविनाशो जठरे हि राज्यः । जीर्णापरिज्ञानविदाहवत्यो बस्तौ रुजः पादगतश्च शोफः || ६॥

Premonitory symptoms: The precursory symptoms of the disease are loss of strength, complexion and appetite, obliteration of abdominal folds, emaciation of the muscles of the abdomen, appearance of veins on its surface, acid reaction of food closely following upon its digestion (Vidaha), pain in the bladder and swelling of the lower extremities. The patient cannot ascertain whether his meal has been digested or not. 6

संगृह्य पार्श्वोदरपृष्ठनाभीर्यद् वर्धते कृष्णसिरावनद्धम् । सशूलमानाहवदुग्रशब्दं सतोदभेदं पवनात्मकं तत् ॥ ७॥ ।।

यच्चोषतृष्णाज्वरदाहयुक्तं पीतं सिरा यत्र भवन्ति पीताः । पीताक्षिविण्मूत्रनखाननस्य पित्तोदरं तत् त्वचिराभिवृद्धि ॥ ८ ॥

यच्छीतलं शुक्लसिरावनद्धं गुरु स्थिरं शुक्लनखाननस्य । स्निग्धं महच्छोफयुतं ससादं कफोदरं तच्च चिराभिवृद्धि ।।९।।

1. These include purgative, emetic, Asthaparna and Anuvasana measures.

The Vataja, Pittaja, and Kaphaja Types: A case Udara in which the abdomen enlarges on its sides and posterior part, and is overspread with nets of black veins should be ascribed to the action of the deranged Vayu. A pain (Sula), suppression of the stool and urine (Anaha) and a cutting and piercing pain and flatulent rumbling in the intestines are the symptoms which likewise characterise this Vataja form of Udara. A sucking pain in the abdomen, thirst, fever with a burning sensaion, yellow colour of the swollen skin of the abdomen, on the surface of which yellow veins appear, yellow colour of the eys. nails, face, stool and urine and the rapid increase of the dropsical swelling, are the characteristics of the Pittaja Udara. In a case of Kaphaja type the dropsical swelling is cold to the touch and becomes overspread with white-coloured veins. The abdomen seems heavy, hard, glossy and is extremely distended. The swelling slowly increases. and the fingernails and face of the patient become white, and he complains of a general lassitude. 7-9

स्त्रियोऽन्नपानं नखरोममूत्र – विडार्त्तवैर्युक्तमसाधुवृत्ताः । यस्मै प्रयच्छन्त्यरयो गरांश्च दुष्टाम्बुदूषीविषसेवनाद् वा ।। १० ।।

तेनाशु रक्तं कुपिताश्च दोषाः कुर्वन्ति घोरं जठरं त्रिलिङ्गम् । तच्छीतवाताभ्रसमुद्भवेषु विशेषतः कुप्यति दह्यते च ।। ११ ।।

च स चातुरो मूर्च्छति सम्प्रसक्तं पाण्डुः कृशः शुष्यति तृष्णया | च प्रकीर्त्तितं दूष्युदरन्तु घोरं….. ।। १२ ।।

The Tridosaja Type: Evil-natured women (with a view to win the affection of their husbands or lovers sometimes) mix with their food and drink such refuse matter of their bodies as nails, hair, faeces, urine, catamenial blood etc. (which are supposed to be possessed of talismanic virtues). The three Dosas of the body, vitiated by such food or drink, or through imbibing any sort of chemical poison (Gara) administered by one’s enemy, or by taking poisonous waters, or DusiVisa (slow poison whose active properties have been destroyed by fire or any antipoisonous medicine), will vitiate the blood and give rise to a kind of dreadful dropsical swelling of the abdomen, marked by the specific symptoms of each of them. The disease is aggravated in cold and cloudy days and a burning sensation is felt (in the inside of the abdomen). The patient becomes pale, yellow and emaciated, and is afflicted with thirst and dryness in the mouth, and loses consciousness at short intervals. This disease is also known as the dreadful Dusyodara. 10-12

.प्लीहोदरं कीर्त्तयतो निबोध | विदाह्यभिष्यन्दिरतस्य जन्तोः प्रदुष्टमत्यर्थमसूक् कफश्च । प्लीहाभिवृद्धिं सततं करोति प्लीहोदरं तत् प्रवदन्ति तज्ज्ञाः ।। १३ ।।

वामे च पार्श्वे परिवृद्धिमेति विशेषतः सीदति चातुरोऽत्र । मन्दज्वराग्निः कफपित्तलिङ्गैरुपद्रुतः क्षीणबलोऽतिपाण्डुः ।।१४।।

सव्येतरस्मिन् यकृति प्रदुष्टे ज्ञेयं यकृद्दाल्युदरं तदेव || १५ ||

Plihodara: (Spleen with dropsy of the abdomen) : Now hear me to be describing the symptoms of Plihodra. The blood and the Kapha of a person, deranged and aggravated through the ingestion of phlegmagogic food, or of those which is followed by an acid digestionary reaction (Vidaha), often enlarge the spleen, (which gives rise to a swelling of the abdomen). This disease is called Plihodara by the experts. Plihodara protrudes on the left side of the abdomen, its characteristic symptoms being lassitude, low fever, impaired digestion. loss of strength, jaundice, weakness, and other distressing symptoms similar to the deranged Pitta and Kapha. A similar enlargement of the liver through similar causes on the right side of the abdomen is called Yakrddalyudara. 13-15

यस्यान्त्रमन्नैरुपलेपिभिर्वा बालाश्मभिर्वा सहितैः पृथग्वा । संचीयते तत्र मलः सदोषः क्रमेण नाड्यामिव संकरो हि ॥ १६ ॥

निरुध्यते चास्य गुदे पुरीषं निरेति कृच्छ्रादपि चाल्पमल्पम् |

हृन्नाभिमध्ये परिवृद्धिमेति यच्चोदरं विट्समगन्धिकञ्च। प्रच्छर्दयन् बद्धगुदी विभाव्यः… ..।।१७।।

Baddha-gudodara : The fecal matter, mixed with the deranged Vayu, Pitta etc. of the body, lies stuffed in the rectum of a person whose intestines have been stuffed with slimy food (as pot herbs) or with stones and hair (enteritis). They give rise to a sort of abdominal dropsy by swelling the part between the heart and the umbilicus which

1. Dropsical swelling of the abdomen with tympanites due to the constriction of the rectum known as intestinal obstruction is called Baddha Gudodara. Scanty stools are evacuated with the greatest pain and difficulty and the patient vomits a peculiar kind of matter with a distinctly fecal smell (scyabalous ). 16-17

..ततः परिस्राव्युदरं निबोध । शल्यं यदन्नोपहितं तदन्त्रं भिनत्ति यस्यागतमन्यथा वा ।। १८ ।।

तस्मात् स्रुतोऽन्त्रात् सलिलप्रकाशः स्राव स्रवेद्वै गुदतस्तु भूयः ।

नाभेरधश्चोदरमेति वृद्धिं निस्तुद्यतेऽतीव विदह्यते च । एतत् परिस्राव्युदरं प्रदिष्टम्.. ।। १९ ।।

Parisravi-Udara: Now hear me to be describing the causes and symptoms of the type of Udara which is called Parisravi-udara. Thorny or sharp-pointed substances (such as fish-bones etc.), carried down with the food in a slanting way from the stomach into the abdomen, sometimes scratch or burrow into the intestines. Causes other than the preceding ones. (such as a long yawn or over-eating etc.) may contribute to the perforation of the intestines, giving rise to a copious flow of a watery exudation which constantly oozes out of the anus and to a distension of the lower part of the abdomen situated below the umbilicus. This is called Parisravyudara which is marked by a cutting pain and a burning sensation. 18-19

..दकोदरं कीर्त्तयतो निबोध | यः स्नेहपीतोऽप्यनुवासितो वा वान्तो विरिक्तोऽप्यथवा निरूढः । पिबेज्जलं शीतलमाशु तस्य स्रोतांसि दुष्यन्ति हि तद्बहानि ।। २० ।। स्नेहोपलिप्तेष्वथवाऽपि तेषु दकोदरं पूर्ववदभ्युपैति । स्निग्धं महत् सम्परिवृत्तनाभि भृशोन्नतं पूर्णमिवाम्बुना च । यथा दूतिः क्षुभ्यति कम्पते च शब्दायते चापि दकोदरं तत् ।। २१ । ।

Dakodara Now hear me to be describing the causes and symptoms of the type known as Dakodara (ascites). The drinking of cold water immediately after the application of an Anuvasana or Asthapana enema, or closely following upon the exhibition of any purgative or emetic medicine, or just after the taking of a medicated oil or clarified butter, etc. tends to derange the water-carrying channels of the body. The same result may be produced by the drinking of oil, etc. in inordinate quantities. The water, by percolating or transudi

through the walls of these channels, as before described, inordinately enlarges the abdomen, which becomes glossy on the surface and is full of water, being rounded about the umbilicus and raised like a fullbloated water-drum. The simile is complete as it fluctuates under pressure. oscillates, and makes a peculiar sound like a water-drum under percussion. 20-21

आध्मानं गमनेऽशक्ति दौर्बल्यं दुर्बलाग्निता । शोफः सदनमङ्गानां सङ्गो वातपुरीषयोः ।

दाहस्तृष्णा च सर्वेषु जठरेषु भवन्ति हि ॥ २२ ॥

Distension of the stomach, incapacity of locomotion, weakness, impaired digestion, oedematous swelling of the limbs, a general sense of lassitude and looseness in the limbs, suppression of flatus and stool, and a burning sensation and thirst are among the general characteristics of the disease in its various forms. 22

अन्ते सलिलभावन्तु भजन्ते जठराणि तु । सर्वाण्येव परीपाकात् तदा तानि विवर्जयेत् ॥ २३ ॥

Prognosis: All cases of Udara after the lapse of considerable time develop into those of ascites, and a case arriving at such a stage should be given up as incurable. 23

इति सुश्रुतसंहितायां निदानस्थाने उदरनिदानं नाम सप्तमोऽध्यायः ।। ७ ।।

Thus ends the seventh Chapter of the Nidana Sthana in the Susruta Samhita which treats of the Nidana of Udara. 62


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