अथातो उदरनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Udara nidanam – diagnosis of enlargement of the abdomen; thus said Atreya and other great sages.
Udara nidana – causes
रोगाः सर्वेऽपि मन्देऽग्नौ सुतरामुदराणि तु । अजीर्णान्मलिनैश्चान्नैर्जायन्ते मलसञ्चयात् ॥ १ ॥
Generally all diseases are produced by mandagni (weak digestive activity) especially so the udara (enlargement of the abdomen); it also arises from indigestion, contaminated foods and accumulation of malas (dosas and waste products).
Samprapti – pathogenesis of Udara
ऊर्ध्वाधो धातवो रुवा वाहिनीरम्बुवाहिनीः। प्राणाग्न्यपानान् सन्दूष्य कुर्युस्त्वङ्मांससन्धिगाः ॥ २ ॥ आध्माप्य कुक्षिमुदरम्
Dhatus (dosas-vata, pitta and kapha) getting aggravated, obstruct the channels of ambu (body water ) both at the top and bottom, bring about abnormalities in the prana (division of vata), agni ( digestive activity) and apana (division of vata), causes accumulation of water in between the (layers of) skin, muscles and joints and produce Udara, by enlarging the abdomen. 2-3a.
अष्टधा तच्च भिद्यते । पृथग्दोषैः समस्तैश्च प्लीहबद्धक्षतोदकैः ॥ ३ ॥
तेनार्ता: शुष्कताल्वोष्ठाः शूनपादकरोदरा: । नष्टचेष्टाबलाहाराः कृशाः प्रध्मातकुक्षयः ॥ ४ ॥ स्युः प्रेतरूपाः पुरुषाः
It is of eight kinds; from each dosa seperately, by all of them together, by pliha (enlargement of the spleen), baddha (obstruction of the intestines ) , ksata (perforation of the intestines) and udaka ( accumulation of fluid).
Affected by this disease, the persons have dryness of the palate and lips, swelling of the feet, hands and abdomen; loss of activeness, strength and desire for food; emaciation, severe flatulence and appear like a cadaver. 3a-5a.
Purvarupa ( premonitory symptoms )
भाविनस्तस्य लक्षणम् । क्षुन्नाशोऽन्नं चिरात्सर्वं सविदाहं च पच्यते ॥ ५॥
जीर्णाजीर्णं न जानाति सौहित्यं सहते न च । क्षीयते बलतः शश्वच्छ्रसित्यल्पेऽपि चेष्टिते ॥ ६ ॥
वृद्धिर्विशोऽप्रवृत्तिश्च किञ्चच्छोफश्च पादयोः । रुग्बस्तिसन्धौ ततता लघ्वल्पाभोजनैरपि ॥ ७ ॥ राजीजन्म वलीनाशो जठरे
Loss of hunger, digestion of food after a long time and accompanied with burning sensation, the person cannot decide wheather the food is digested or not, does not tolerate intake of food, loses strength steadily, pants for breath even faeces but it is not ( easily ) eliminated, slight swelling of the feet, pain in the joints on either sides of the urinary bladder, and distention even with easily digestable and little quantity of food, appearance of white lines and disappearance of folds over the abdomen. 5a-8a.
Rupa ( clinical features )
सर्वेषु तन्द्रा सदनं दाहः जठरेषु तु । मलसङ्गोऽल्पवह्निता ॥ ८ ॥
सलिलसम्भवः । श्वयथुराध्मानमन्ते त्वतोयमरुणमशोफं नातिभारिकम् ॥ ९ ॥
सर्वं गवाक्षितं सिराजालैः सदा गुडगुडायते । नाभिमन्त्रं च विष्टभ्य वेगं कृत्वा प्रणश्यति ॥ १० ॥
मारुतो । हृत्कटीनाभिपायुवड्ङ्क्षणवेदनाः सशब्दो निश्चरेद्वायुर्विड्बद्धा मूत्रमल्पकम् ॥ ११ ॥
नातिमन्दोऽनलो लौल्यं न च स्याद्विरसं मुखम् ।
In all types of jathara (another synonym of the abdomen and its enlargement ) there is stupor, debility, accumulation of wastes ( especially the faeces), poor digestive activity, burning sensation, swelling, flatulence and collection of fluid ( in the abdomen) at the terminal stages.
In all the types, before the collection of fluid, the abdomen is of slight red colour, without any swelling, not very heavy and covered with the network of venis, maruta (air or gas) moves inside producing constant sound, obstruction of the umbilicus and intestines and then subsides; there is pain in the region of the heart, waist, umbilicus, rectum and groins, the flatus comes out with great sound, faeces is obstructed and urine little in quantity; the digestive capacity is not very dull, there is neither increased desire for food nor bad taste in the mouth. 8-12a.
Vataja Udara
तत्र वातोदरे शोफः पाणिपान्मुष्ककुक्षिषु ॥ १२ ॥ कुक्षिपार्श्वोदरकटीपृष्ठरुक् पर्वभेदनम् ।
शुष्ककासोऽङ्गमर्दोऽधोगुरुता मलसडग्रहः ॥ १३ ॥ श्यावारुणत्वगादित्वमकस्माद्वृद्धिह्रासवत् ।
सतोदभेदमुदरं तनुकृष्णसिराततम् ॥ १४ ॥
आध्मातदृतिवच्छब्दमाहतं प्रकरोति च। वायुश्चात्र सरुक्शब्दो विचरेत्सर्वतोगतिः ॥ १५ ॥
In vatodara (abdominal enlargement due to vata) there is swelling of the hands, feet, scrotum and upper abdomen; pain in the upper abdomen, flanks, central abdomen, waist and back, cutting pain in the joints, dry cough, body ache, heaviness of the lower parts of the body, accumulation of wastes, blackish-red discolouration of the skin etc., the abdomen increases or decreases in size without any reason, occassionaly; pricking and peircing pain, appearance of thin black veins on the abdomen; the abdomen produces sound
when tapped similar to an inflated leather below; vayu (air, gas) moves in all places ( inside the abdomen) accompaneid with pain and noise. 12-15.
Pittodara
पित्तोदरे ज्वरो मूर्च्छा दाहस्तृट् कटुकास्यता । भ्रमोऽतिसारः पीतत्वं त्वगादावुदरं हरित् ॥ १६ ॥
पीतताम्रसिरानद्धं सस्वेदं सोष्म दह्यते । धूमायति मृदुस्पर्शं क्षिप्रपाकं प्रदूयते ॥ १७ ॥
In pittodara, there is fever, fainting, burning sensation, thirst bitter taste in the mouth, dizziness, diarrhoea, yellow colour in the skin etc. the abdomen has green, yellow, or coppery red veins appearing everywhere; it is sweating, warm, feels as though being scroched by fire, as though emiting hot fumes; is soft to touch and undergoes ripening (collection of fluid) quickly. 16-17.
Kaphodara
श्लेष्मोदरेऽङ्गसदनं स्वापः श्वयथुगौरवम् । निद्रोत्क्लेशारुचिश्वासकासशुक्लत्वगादिता ॥ १८ ॥
उदरं स्तिमितं श्लक्ष्णं शुक्लराजीततं महत् । चिराभिवृद्धि कठिनं शीतस्पर्शं गुरु स्थिरम् ॥ १९ ॥
In kaphodara, there is debility of the body, loss of tactile sensation, swelling, feeling of heaviness, more of sleep, nausea, loss of taste and appetite; dyspnoea, cough, white colour of the skin etc., the abdomen is static ( without any movement), smooth, has white lines everywhere, increasing slowly in size, over long period of time; hard, cold to touch, heavy and immovable. 18-19.
Sannipatodara
त्रिदोषकोपनैस्तैस्तैः स्त्रीदत्तैश्च रजोमलैः । गरदषीविषाद्यैश्च सरक्ताः सञ्चिता मलाः ॥ २० ॥
कोष्ठं प्राप्य विकुर्वाणाः शोषमूर्च्छाभ्रमान्वितम् । कुर्युस्त्रिलिङ्गमुदरं शीघ्रपाकं सुदारुणम् ॥ २१ ॥ बाधते तच्च सुतरां शीतवाताभ्रदर्शने ।
By indulgence in things ( food, activities etc.) which cause increase of all the three dosas simultaneously; by ingestion of menstrual blood, excreta etc., administered by women (in order to kill or seduce), ingestion of artificial poison (administered by others to kill) and of dusivisa (poison which are weak to kill but can cause diseases), the malas ( dosas) along with rakta, get aggravated, become localised in the abdomen and gives rise to abnormalities; emaciation, fanting, dizziness and produce enlargement of the abdomen, having the features of all the dosas; it undergoes ripening (collection of fluid) quickly, the condition is severe, gives utmost troubles, when the sky is full of cold wind and clouds. 20-22a.
Plihodara-yakridudara
अत्याशितस्य सडक्षोभाद्यानयानादिचेष्टितैः ॥ २२ ॥
अतिव्यवायकर्माध्ववमनव्याधिकर्शनैः वामपार्श्वाश्रितः प्लीहा च्युतः स्थानाद्विवर्द्धते ॥ २३ ॥
शोणितं वा रसादिभ्यो विवृद्धं तं विवर्द्धयेत् । सोऽष्ठीलेवातिकठिनः प्राक् ततः कूर्मपृष्ठवत् ॥ २४ ॥
क्रमेण वर्द्धमानश्च कुक्षावुदरमावहेत् । ॥२५॥
श्वासकासपिपासास्यवैरस्याध्मानरुग्ज्वरैः पाण्डुत्वमूर्च्छाछर्दीभिर्दाहमोहैश्च संयुतम् । अरुणाभं विवर्णं वा नीलहारिद्रराजिमत् ॥ २६ ॥
उदावर्तरुजाना हैर्मोहतृड्दहनज्वरैः गौरवारुचिकाठिन्यैर्विद्यात्तत्र मलान् क्रमात् ॥ २७ ॥ ।
In persons who consume large quantity of food habitually, by exhaustion, strain of travelling in vehicles, riding on animals and such other activities, over-indulgence in sexual intercourse, physical activities, long distance walk, too much of vomitting and by weakness due to diseases, pliha (the spleen) situated on the left side gets dusplaced from its place and becomes enlarged; the blood, rasa ( plasma) and other tissues which have increased also bring about its enlargement; it (spleen) getting enlarged becomes very hard like the cobblers stone in the beginning, then increasing gradually resembling the shell of the tortoise, occupies the entire abdomen starting from its upper portion and producing abdominal enlargement, accompanied with dyspnoea, cough, severe thirst, bad taste in the mouth, flatulence, pain, fever, yellowish-white colouration of the skin, fainting, vomitting, burning sensation and delusion; the abdomen is either slightly red or of any other discolouration, with blue, or deep yellow lines appearing on it.
Predominance of the mala (dosa) should be determined by the presence of udavarta (upward movement of vata), pain and flatulence (these three are produced by vata); delusion, thirst, burning sensation and fever (these are caused by pitta); feeling of heaviness, loss of taste/appetite and hardness ( of the abdomen caused by kapha) respectively. 22-27.
प्लीहवद्दक्षिणात्पार्श्वात् कुर्याद्यकृदपि च्युतम् ।
Similar to the pliha, the yakrit (liver) situated in the right side might also cause enlargement of the abdomen when it is displaced and elarged. 28a.
Baddhodara
पक्ष्मवालैः सहान्नेन भुक्तैर्बद्धायने गुदे ॥ २८ ॥
दुर्नामभिरुदावर्तैरन्यैर्वाऽन्त्रोपलोपिभिः । वर्चः पित्तकफान् रुद्वा करोति कुपितोऽनिलः ॥ २९ ॥
अपानो जठरं तेन स्युर्दाहज्वरतृद्धवाः । कासश्वासोरुसदनं मलसङ्गोऽरुचिश्चछर्दिरुदरं शिरोहन्नाभिपायुरुक् ॥ ३० ॥
मूढमारुतम् । स्थिरं नीलारुणसिराराजिनद्धमराजि वा ॥ ३१ ॥
नाभेरुपरि च प्रायो गोपुच्छाकृति जायते । By ingestion of eyelashes and hair along with food, by obstruction of the rectum by diseases like durnama (piles) udavarta (upward movement of vata) or by anything forming a coating inside the intestines, apana vata becoming aggravated, obstructs the movement of varca ( faeces), pitta and kapha and produces abdominal enlargement; from that arises, burning sensation, fever, thirst, more of sneezing, cough, dyspnoea, weakness of the thighs, pain in the region of the heart, umbilicus and rectum, constipation, anorexia, vomitting; the abdomen has no movement of vata ( flatus ), is with lines of blue or light red, veins or not static, covered having lines; enlargement resembling the tail of a cow appears (broad at the top small at bottom) above the umbilicus.
Ksatodara
अस्थ्यादिशल्यैः सान्नैश्चेद्भुक्तैरत्यशनेन वा ॥ ३२ ॥
भिद्यते पच्यते वाऽन्त्रं तच्छिद्रैश्च स्त्रवन्बहिः । आम एव गुदादेति ततोऽल्पाल्पं सविड्सः ॥ ३३ ॥
तुल्य: कुणपगन्धेन पिच्छिलः पीतलोहितः । शेषश्चापूर्य जठरं जठरं घोरमावहेत् ॥ ३४ ॥
वर्द्धयेत्तदधो नाभेराशु चैति जलात्मताम् । उद्रिक्तदोषरूपं च व्याप्तं च श्वासतृड्भ्रमैः ॥ ३५ ॥ छिद्रोदरमिदं प्राहुः परित्रावीति चापरे ।
By ingestion of bone and other sharp foreign bodies along with food or consuming large quantity of food, the intestines get perforated or ulcerated; the undigested food material flows out through that hole or ulcer in small quantity and collects in the rectum, getting mixed with the faeces it becomes foul smelling like that of a dead body, slimy, yellowish-red in colour, gradually fills up the abdomen producing its enlargement, which increases in size below the umbilicus; the condition soon changes into collection of fluid in the abdomen; presenting symptoms of the predominant (causative) dosa and associated with dyspnoea, thirst and dizziness; this disease is called as Chidrodara and as parisravi udara by some others (also as ksatodara). 32a-36a.
Jalodara
प्रवृत्तस्नेहपानादेः अत्यम्बुपानान्मन्दाग्नेः क्षीणस्यातिकृशस्य वा । रूद्धवाऽम्बुमार्गाननिलः कफश्च जलमूच्छितः ॥ ३७॥
वर्धयेतां तदेवाम्बु तदेवाम्बु तत्स्थानादुदराश्रितौ । ततः स्यादुदरं तृष्णागुदस्स्रुतिरुजान्वितम् ॥ ३८ ॥
कासश्वासारुचियुतं नानावर्णसिराततम्। सहसाऽऽमाम्बुपायिनः ॥ ३६ ॥
तोयपूर्णदृतिस्पर्शशब्दप्रक्षोभवेपथु दकोदरं महत्स्निग्धं स्थिरमावृत्तनाभि तत् । ॥३९॥
In person who drink unboiled water during the course of therapies such as oleation etc., drinking large quantity of water by those who have poor digestive capacity, who are debilitated (by depletion of tissues) and who are very emaciated (by debilitating diseases), anila (vata) and kapha get aggravated to either, mix with the body-water, make for its great increase, displaces it from its place and cause its accumulation in the abdomen; then there develops thirst, exudation from the rectum, cough, dyspnoea and loss of taste / appetite accompaning; the abdomen has veins of many colours appearing all over, resembles a bag filled with water for touch, sound, movement and tremors, large in size, greasy static ( movementless) and bulging umbilicus. This disease is called Dakodara (udakodara or jalodara). 36b-40a.
उपेक्षया च सर्वेषु दोषाः स्वस्थानतश्चयुताः ॥ ४० ॥
पाकाद्रवा द्रवीकुर्युः सन्धिस्त्रोतोमुखान्यपि । स्वेदश्च बाह्यस्त्रोतःसु विह्तस्तिर्यगास्थितः ॥ ४१ ॥
तदेवोदकमाप्याय्य पिच्छां कुर्यात्तदा भवेत् । गुरूदरं स्थिरं वृत्तमाहतं च न शब्दवत् ॥ ४२ ॥
मृदु व्यपेतराजीकं नाभ्यां स्पृष्टं च सर्पति । तदनूदकजन्मास्मिन्कुक्षिवृद्धिस्ततोऽधिकम् ॥ ४३ ॥
सिरान्तर्धानमुदकजठरोक्तं च लक्षणम् ।
By neglecting (quick and effective treatment) in all kinds of udara, the dosas getting displaced from their own sites (due to increase) make more fluid to accumulate even in the channels of the joints and tissues; the sweat obstructed in its outer openings, beings to move in all directions, gets mixed with the body-water making it slimy, it collects in the abdomen, which becomes heavy, static, round, not producing sound when tapped, soft, and absence of veins; the fluid spreads to other parts when the umbilicus is pressed; gradually accumulation of fluid in the abdomen occurs, leading to great increase in the size of the abdomen, disappearance of veins and other symptoms of udakodara. 40b-44a
Sadhyasadhyata – prognosis of ascites
वातपित्तकफल्पीहसन्निपातोदकोदरम् ॥ ४४ ॥
कृच्छ्रं यथोत्तरम् पक्षात्परं प्रायोऽपरे हतः ।
सर्वं च जातसलिलं रिष्टोक्तोपद्रवान्वितम् ॥ ४५ ॥
जन्मनैवोदरं सर्वं प्रायः कृच्छ्रतमं मतम् । बलिनस्तदजाताम्बु यत्नसाध्यं नवोत्थितम् ॥ ४६ ॥
Udara-(abdominal enlargement) caused by vata, pitta, kapha, pliha ( spleen ) , sannipata ( all the three dosas together) and udaka (water) are difficult to cure in their successive order; other kinds usually kill the patient by a fortnight, so also all types after the formation of fluid and accompanied with complications or secondary diseases enumerated in the chapter on rista ( fatal signs ) ( chapter 5 of sarira sthana).
All kinds of udara are by their very onset are said to be very difficult to cure, those occuring in persons who are strong, which have not reached the stage of fluid formation and those of recent onset may get cured by great effort (effective treatment). 44b-46.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने उदरनिदानं नाम द्वादशोऽध्यायः ॥ १२ ॥
Thus ends the chapter Udara nidana-the twelfth in the Nidana sthana of Astanga hrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
