नवमोऽध्यायः ।अथातो विद्रधीनां निदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।। ः।।१।।
Now we shall discourse on the Nidana of Vidradhi (abscess etc.). 1
सर्वामरगुरुः श्रीमान् निमित्तान्तरभूमिपः । शिष्यायोवाच निखिलमिदं विद्रधिलक्षणम् ॥ २॥
The blessed Dhanvantari, the honoured of the gods, who for the promulgation of the knowledge of the Ayurveda and for administering proper medicines (to the sick), took his birth at Kasi, (Benares) as a king, thus fully discoursed on the symptoms of Vidradhi (abscess etc.) to his disciple, Susruta. 2
त्वग्रक्तमांसमेदांसि प्रदूष्यास्थिसमाश्रिताः । दोषा: शोफं शनैर्धोरं जनयन्त्युच्छ्रिता भृशम ॥ ३ ॥
महामूलं रुजावन्तं वृत्तञ्चाप्यथवाऽऽयतम् । तमाहुर्विद्रधिं धीरा, विज्ञेयः स च षड्विधः ।। ४ ।।
पृथग्दोषैः समस्तैश्च क्षतेनाप्यसृजा तथा । षण्णामपि हि तेषान्तु लक्षणं संप्रवक्ष्यते ॥ ५ ॥
Definition and Classification: The extremely deranged and aggravated Vayu, Pitta and Kapha resorting to the bone and vitiating the Tvaka (skin), blood, flesh, and fat of a person ( with their own specific properties), gradually give rise to a deep-seated, painful, round or extended swelling which is called Vidradhi by the wise. The disease admits of being divided into six types such as the Vataja type, the Pittaja type, the Kaphaja type, the Sannipatika type, the Ksataja type (traumatic), and the Asrija ( which has it’s seat in the vitiated blood). Now we shall describe their specific symptoms. 3-5
कृष्णोऽरुणो वा परुषो चित्रोत्थानप्रपाकश्च भृशमत्यर्थवेदनः । विद्रधिर्वातसम्भवः ॥ ६ ॥
The Vataja Type : This abscess assumes a black or vermilion eolour, is felt rough to the touch and is characterised by a sort of excruciating pain. The growth and suppuration of the abscess are brought about in a variety of forms (owing to the variable and irregular action of the deranged Vayu inolved in these cases). 6
पक्वोदुम्बरसङ्काशः श्यावो वा ज्वरदाहवान् । क्षिप्रोत्थानप्रपाकश्च विद्रधिः पित्तसम्भवः ।। ७ ।।
The Pittaja Type : This abscess assumes a blackish yellow colour or one like that of a ripe udumbara fruit. It is attended with fever and a burning sensation, and is of a rapid growth and suppuration. 7
शरावसदृशः पाण्डु: शीत: स्तब्धोऽल्पवेदनः । चिरोत्थानप्रपाकश्च सकण्डुश्च कफोत्थितः ।
तनुपीतसिताश्चैषामास्रावाः क्रमशः स्मृताः ।। ८ ।।
The Kaphaja Type: This abscess is shaped like an Indian saucer (sarava) and felt cold to the touch. It assumes a light yellow colour and is characterised by numbness, itching and little pain. The growth and suppuration of this abscess is very slow. The secretions from a Vataja abscess are thin, those from a Pittaja type are yellow, while the exudations from a Kaphaja abscess are white. 8
नानारूपरुजास्रावो घाटालो विषमो महान् । विषमं पच्यते चापि विद्रधिः सान्निपातिकः ।। ९ ।।
The Sannipatika Type : An abscess of the Sannipatika type is of varied colour, and is attended with a varied sort of pain (sucking, drawing, burning etc.) and exudes secretions of various colours (white, yellow, etc.) It is little raised or elevated at its top, large and irregular in its shape and does not uniformly suppurate in all its parts.
तैस्तैर्भावैरभिहते क्षते वाऽपथ्यसेविनः । क्षतोष्मा वायुविसृतः सरक्तं पित्तमीरयेत् ।। १० ।।
ज्वरस्तृष्णा च दाहश्च जायते तस्य देहिनः । एष विद्रधिरागन्तुः पित्तविद्रधिलक्षणः ।। ११ ।।
Agantuja or Kshataja Type : The local or inherent heat of an ulcer, (caused by a blow or a dirt in a person, addicted to unwholesome diet and regimen, is augmented and conducted by the deranged Vayu and vitiates the blood and Pitta, thus giving rise to a kind of abscess which is known as the Agantuja Vidradhi (traumatic abscess). Symptoms of the Pittaja type likewise mark this type of abscess, fever, thirst and a burning sensation attend it from the very beginning. 10-11
कृष्णस्फोटावृतः श्यावस्तीव्रदाहरुजाज्व(क) रः । पित्तविद्रधिलिङ्गस्तु रक्तविद्रधिरुच्यते ।। १२ ।।
उक्ता विद्रधयो ह्येते तेष्वसाध्यस्तु सर्वजः ।। १३ ।।
The Raktaja Type: This abscess assumes a black or tawny colour, covered with a large number of black vesicles, fever and an intolerable burning pain attended with all the symptoms similar to the Pittaja type, mark the present form of the disease. It is called Raktaja Vidradhi. Among external Vidradhis or abscesses, those of the Sannipatika type should be regarded as incurable. 12-13
आभ्यन्तरानतस्तूर्ध्वं विद्रधीन् परिचक्षते ।। १४ ।।
गुर्वसात्म्यविरुद्धान्नशुष्कसंसृष्ट (क्लिन्न) भोजनात् । अतिव्यवायव्यायामवेगाघात विदाहिभिः ।। १५ ।।
पृथक् संभूय वा दोषाः कुपिता गुल्मरूपिणम् । वल्मीकवत् समुन्नद्धमन्तः कुर्वन्ति विद्रधिम् ।।१६।।
Antara-Vidradhi: Now we shall describe the characteristic features of internal abscesses (Antara-Vidradhi). The Vayu, Pitta and Kapha of the body, deranged through eating heavy, incompatible and incongenial (to the physical temperament of the eater) articles of food or of dry, putrid and decomposed substances, excessive coition and fatiguing physical exercise, or by voluntary repression of any natural urging of the body or through the eating of food which is followed by an acid reaction, either separately or collectively give rise to a tumourlike (Gulma), raised, or elevated abscess in the interior of the organism, which is often felt to be shaped like an ant-hill. 14-16
गुदे बस्तिमुखे नाभ्यां कुक्षौ वङ्क्षणयोस्तथा । वृक्कयोर्यकृति प्लीहि हृदये क्लोम्नि वा तथा । तेषां लिङ्गानि जानीयाद् बाह्यविद्रधिलक्षणैः ।। १७ ।। आमपक्वैषणीयेन पक्वापक्वं विनिर्दिशेत् ।। १८ ।।
Localities: They are generally found to be seated at the mouth (neck) of the bladder, or about the umblicus, or in the sides, or in the Kuksi ( inguinal regions), or on the Vrkkas, or on the liver, or in the heart, or in the Kloma, or in the spleen, or in the rectum. Their general characteristics are identical with those of the several types of external abscess. The symptoms of their suppurated or unsuppurated stages should be determined in the light of the chapter on Amapakvaisaniya (Ch XVII Sutra ). 17-18
अधिष्ठानविशेषेण लिङ्गं श्रृणु विशेषतः ।। १९ ।।
गुदे वातनिरोधस्तु बस्तौ कृच्छ्राल्पमूत्रता । नाभ्यां हिक्का तथाऽऽटोपः कुक्षौ मारुतकोपनम् ॥ २० ॥
कटीपृष्ठग्रहस्तीव्रो वङ्क्षणोत्थे तु विद्रधौ । वृक्कयोः पार्श्वसङ्कोचः प्लीह्न्युछ्वासावरोधनम् ।। २१ ।।
सर्वाङ्गप्रग्रहस्तीव्रो हृदि शूलश्च दारुणः। श्वासो यकृति तृष्णा च पिपासा क्लोमजेऽधिका ।। २२ । ।
Their specific symptoms: Now hear me describing the symptoms which specifically mark these internal abscesses according to their seats in the different regions of the organsim. An abscess appearing in the rectum (Guda ) is marked by the suppression of the flatus (Vata). Seated in the bladder, it gives rise to difficulty of urination and scantiness of urine. Appearing about the umblicus it produces a distressing hic-cough and rumbling sound (atopa) in the intestines. Seated in either of the sides (Kuksi) it tends to aggravate inordinately the vayu of the body. Appearing in the inguinal region it gives rise to an extreme catching pain at the back and waist. Seated in either of the Vrkkas it brings about a contraction of the sides. Appearing on the spleen, it produces symptoms of difficult and obstructed respiration. Seated in the heart it gives rise to an excruciating and piercing pain within its cavity and a drawing pain (Graha) extending all over the body (D. R. cough). Seated in the Liver its characteristic indications are thirst and difficult breathing (D. R.–hic-cough) whereas a sort of unquenchable thirst is the symptom which marks its seat in the Kloma. 19-22
आमो वा यदि वा पक्वो महान् वा यदि वेतरः । सर्वो मर्मोत्थितश्चापि विद्रधिः कष्ट उच्यते ॥ २३ ॥
नाभेरुपरिजाः पक्वा यान्त्यूर्ध्वमितरे त्वधः । जीवत्यधो निःसृतेषु सुतेषूर्ध्वं न जीवति ॥ २४ ॥
हृन्नाभिबस्तिवर्ज्या ये तेषु भिन्नेषु बाह्यतः । जीवेत् कदाचित् पुरुषो नेतरेषु कदाचन ।। २५ ।।
Prognosis : An abscess appearing on any vital part (Marma) of the organism, whether large or small in size suppurated orunsuppurated, should be deemed as extremely hard to cure. Discharge from an abscess formed in the region of the organism above the umblicus and (spontaneously bursting), will flow out through the mouth whereas similar secretions from down the umblical region of (the abdomen), naturally find an outlet through the fissure of the anus. The case in which the secretions (pus etc.) find a downward channel and outlet may end in recovery of the patient whereas the one in which the secretions take an upward course invariably proves fatal. An incision made by surgeon from the outside into an internal abscess, other than the one situated on the heart, or o the bladder or on the umbilicus may occasionally, prove successful, but the one, seated on any of the preceding vulnerable visceras (heart, bladder etc.) of the body and surgically opened invariably ends in death. 23-25
स्त्रीणामपप्रजातानां प्रजातानां तथाऽहितैः । दाहज्वरकरो घोरो जायते रक्तविद्रधिः ॥ २६ ॥
अपि सम्यक्प्रजातानामसृक् कायादनिः सृतम् । रक्तजं विद्रधिं विद्यात् कुक्षौ मक्कल्लसंज्ञितम् ।
सप्ताहान्नोपशान्तश्चेत् ततोऽसौ संप्रपच्यते ।। २७ ।।
A woman, who has miscarried or has been even safely delivered a child at term, may be afflicted with a dreadful abscess in the event of her taking injudicious and unwholesome food after parturition. The abscess in such a case, which is attended with extreme hyper-pyrexia (Dahajvara) should be considered as having had its origin to the vitiated blood (Raktaja Vidradhi) accumulated in the organism. The abscess, which appears in the Kuksi (in the iliac region) of a sefely delivered woman owing to the presence of the unexpelled blood-clots in those regions after child-birth, should be also diagnosed as a case of Raktaja abscess. The unexpelled blood is called Makkalla. Such an abscess, if not absorbed in the course of a week. is sure to suppurate. 26-27
विशेषमध वक्ष्यामि स्पष्टं विद्रधिगुल्मयोः । गुल्मदोषसमुत्थानाद् विधेर्गुल्मकस्य च ।। २८ ।।
कस्मान्न पच्यते गुल्मो विद्रधिः पाकमेति च ।। २९ ।।
Differentiating diagnosis of Gulma and Vidradhi¹ : Now I shall discuss the features which distinguish a Gulma (internal tumour) from a Vidradhi ( internal abscess ). It may be asked, how is it that Gulma, (internal tumour) though caused by and involving the cooperation of the same deranged Dosas as an internal abscess, doest not suppurate, while the latter (Vidradhi) does run to suppuration. 28-29
न निबन्धोऽस्ति गुल्मानां विदधिः सनिबन्धनः । गुल्माकाराः स्वयं दोषा विद्रधिर्मांसशोणिते ।। ३० ।।
विवरानुचरो ग्रन्थिरप्सु बुद्बुदको यथा । एवं प्रकारो गुल्मस्तु तस्मात् पाकं न गच्छति ।। ३१ ।।
मांसशोणितबाहुल्यात् पाकं गच्छति विद्रधिः । मांसशोणितहीनत्वाद् गुल्मः पाकं न गच्छति ।। ३२ ।।
1. A Gulma according to Susruta does not suppurate, but the term “Api” (also) contemplates instances in which a Gulma may suppurate as in the case where it has got its basis in the deranged flesh etc. of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestionary acid reaction, colic pain, insomnia with fever and a non-relish for food and a sense of oppression, etc. are the symptoms which indicate that suppuration has set in a Gulma and he advises that it (Gulma) should be treated with poultices, etc.
गुल्मस्तिष्ठति दोषे स्वे विद्रधिर्मांसशोणिते । विद्रधिः पच्यते तस्माद् गुल्मश्चापि न पच्यते ।। ३३ ।।
The answer is that a Gulma (internal tumour), though caused by the same deranged Dosas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity of the body etc. without any fixed root of its own. Hence, it is that a Gulma (internal tumour) does not suppurate at all. Suppuration sets in an abscess only because it largely contains flesh and blood unlike a Gulma (internal tumour) which is not formed of any such organic matter, and depends only on the aggravated Dosas giving birth to it. Hence, a Gulma does not suppurate at all. 30-33
हन्नाभिबस्तिजः पक्वो वर्थ्यो यश्च त्रिदोषजः । अथ मज्जपरीपाको घोरः समुपजायते ॥ ३४ ॥
सोऽस्थिमांसनिरोधेन द्वारं न लभते यदा । ततः स व्याधिना तेन ज्वलनेनेव दह्यते ।। ३५ ।।
अस्थिमज्जोष्मणा तेन शीर्यते दह्यमानवत् । विकार: शल्यभूतोऽयं क्लेशयेदातुरं चिरम् ।। ३६ ||
अथास्य कर्मणा व्याधिद्वरन्तु लभते यदा । ततो मेदः प्रभं स्निग्धं शुक्लं शीतमथो गुरु ।। ३७ ।।
भिन्नेऽस्थिन निःस्रवेत् पूयमेतदस्थिगतं विदुः । विद्रधिं शास्त्रकुशलाः सर्वदोषरुजावहम् ।। ३८ ।।
Incurable Types: A case of an internal abscess suppurating about the heart, bladder or umbilicus as well as one of the Tridosa type (appearing in any part of the organism) should be given up as incurable. The abscess in which the marrow suppurates (generally) becomes fatal. The suppurating process in an internal abscess, which generally affects the underlying bone, is sometimes found to affect the marrow. The suppurated marrow, failing to find an outlet on account of the compactness of the local flesh and bone, produces a sort of burning sensation in the locality which consumes the body like a blazing fire. The disease confined to the bone, like a piercing dirt, torments the patient for a considerable length of time. An incision (made into the affected bone) is followed by the secretion of a fat-like, glossy, white, cold and thick pus. Men, learned in the knowledge of the Medicinal Sastras, designate such an abscess as an Asthigata-Vidradhi (abscess of the bone) which involves all the three kinds of deranged Dosas, and is attended with various kinds of pain which mark them respectively.
इति सुश्रुतसंहितायां निदानस्थाने विद्रधिनिदानं नाम नवमोऽध्यायः ।। ९ ।।
