अथातो विद्रधिवृद्धिगुल्मनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter Vidradhi, vriddhi, gulma nidanam-diagnosis of abscess, hernia and abdominal tumors; thus said Atreya and other great sages.
Vidradhi nidana and samprapti – causes and pathogenesis of abscess
पर्युषितात्युष्णरूक्षशुष्कविदाहिभिः ।
जिह्मशय्याविचेष्टाभिस्ततस्तैश्चासृक्प्रदूषणैः दुष्टत्वङ्मांसमेदोस्थिस्नाय्वसृक्कण्डराश्रयः यः शोफो बहिरन्तर्वा महामूलो महारुजः ॥२॥
वृत्तः स्यादायतो यो वा स्मृतः षोढा स विद्रधिः ।भुक्तैः॥१॥
दोषैः पृथक्समुदितैः शोणितेन क्षतेन च ॥३॥
Indulgence in foods which are stale (kept overnight), very hot, dry (without moisture and fat), dried up, those causing burning sensation during digestion; lying on uneven bed, improper movement of the body parts and those (foods and activities) which cause vitiation of blood; the dosas getting aggravated cause vitiation of the skin, muscle, fat, bone, ligaments, blood and tendons and produce a swelling arising from them (any one or more), either outside or inside (the body) situated deep inside accompanied with severe pain; being either round or wide, this is known as Vidradhi (abscess); it is of six kinds; from each dosa seperately, from the combination of all, from blood and from trauma. 1-3.
Rupa – clinical features of abscess
बाह्योऽत्र तत्रतत्राङ्के दारुणो ग्रथितोन्नतः । आन्तरो दारुणतरो गम्भीरो गुल्मवद्धनः॥४॥
वल्मीकवत्समुच्छ्रायी शीघ्रघात्यग्निशस्त्रवत् । नाभिबस्तियकृत्प्लीहक्लोमहृत्कुक्षिवड्ङ्क्षणे स्यावृक्कयोरपाने च ॥ ५ ॥
The external one, occurs here and there (anywhere on the body) difficult to bear, hard and elevated; the internal one is more difficult to bear, deep seated, hard like a tumor, growing upwards like an anthill, causes quick death like the fire or weapon, manifests on (near) the umbilicus, urinary bladder, liver, spleen, kloma (pancreas?) heart, abdomen (epigastrium), groins, kidneys, and rectum. 4-6a.
वातात्तत्रातितीव्ररुक् । श्यावारुणश्चिरोत्थानपाको विषमसंस्थितिः ॥ ६ ॥
व्यधच्छेदभ्रमानाहस्पन्दसर्पणशब्दवान् । रक्तताम्रासितः पित्तात्तृण्मोहज्वरदाहवान् ॥ ७ ॥ ॥८॥
क्षिप्रोत्थानप्रपाकश्च पाण्डुः कण्डूयुतः कफात् । सोत्क्लेशशीतकस्तम्भजृम्भारोचकगौरवः चिरोत्थानविपाकश्च सङ्कीर्णः सन्निपाततः ।
सामर्थ्याच्यात्र विभजेद्वाह्याभ्यन्तरलक्षणम् ॥ ९ ॥
That arising from vata has very severe pain, blackish-red in colour takes long time to grow and suppurate; of irregular placement (uneven shape), has pains such as puncturing, excising, rotating, flatulent and throbbings; of the nature of spreading to other parts and of producing sound.
That caused by pitta, is red, coppery or black in colour; produces thirst, delusion, fever and burning sensation, quick to grow and suppurate.
That caused by kapha is white, itshing (irritating), accompanied with nausea, cold, stiffness of the body, (more of) yawnings, loss of taste and feeling of heaviness of the body; slow in growth and suppuration.
All the symptoms are present together, in that caused by all the dosas.
Determination whether it is external or internal should made on ability (severity) and relation with organs etc. (of the symptoms). 6b-9.
कृष्णस्पोटावृतः श्यावस्तीव्रदाहरुजाज्वरः । पित्तलिङ्गोऽसृजा बाह्यः स्त्रीणामेव तथाऽऽन्तरः ॥ १० ॥
That caused by blood is surrounded by black eruptions, blue in colour, accompanied with severe burning sensation, pain and fever and other symptoms of pitta (aggravation) and is external; it is internal only in women (implying that it arises in the uterus). 10.
शस्त्राद्यैरभिघातेन क्षते वाऽपथ्यकारिणः । क्षतोष्मा वायुविक्षिप्तः सरक्तं पित्तमीरयन् ॥ ११ ॥ पित्तासृग्लक्षणं कुर्याद्विद्रधिं भूर्युपद्रवम् ।
Vayu (vata) getting aggravated by assault by weapons, etc. or by unsuitable foods etc. and by displacing the heat at the site of trauma, leads to the aggravation of pitta and rakta (blood) and gives rise to an abscess, presenting symptoms of pitta and rakta and producing severe complications, secondary diseases. 11-12a.
तेषूपद्रवभेदश्च स्मृतोऽधिष्ठानभेदतः ॥ १२॥
नाभ्यां हिध्मा, भवेद्वस्तौ मूत्रं कृच्छ्रेण पूति च । श्वासो यकृति, रोधस्तु प्लीयुच्छ्वासस्य, तृट् पुनः ॥ १३ ॥
गलग्रहश्च क्लोम्नि, स्यात्सर्वाङ्गप्रग्रहो हृदि । प्रमोहस्तमकः कासो हृदये घट्टनं व्यथा ॥ १४ ॥
कुक्षिपार्श्वान्तरांसार्तिः कुक्षावाटोपजन्म च । सक्नोर्ग्रहो वड्क्षणयोर्वृक्कयोः कटिपृष्ठयोः ॥ १५ ॥
पार्श्वयोश्च व्यथा पायौ पवनस्य निरोधनम् ।
These complications depend upon the site (of the abscess etc.) such as; hiccup if the abscess is near the umbilicus; difficult and foul-smelling urine if the abscess is in the bladder; dyspnoea, if in the liver; obstruction to expiration, if in the spleen; thirst and obstruction of the throat if in the kloma (pancreas?); catching pain (or rigidity) all over the body, profound delusion, darkness (unconsciousness), cough, friction and pain in the heart manifest if the abscess is in the heart; pain in the abdomen (upper region), flanks and shoulders, gurgling noise in the epigastrium appear if it is in the epigastium; stiffness of the thighs, if it is in the groins; catching pain in the waist and back, pain in the flanks if it is in the kidneys; obstruction of flatus if it is in the rectum. 12b-16a.
आमपक्वविदग्धत्वं तेषां शोफवदादिशेत् ॥ १६ ॥
नाभेरूर्ध्वं मुखात्पक्वाः प्रस्त्रवन्त्यधरे गुदात् । गुदास्यान्नाभिजो विद्याद्दोषं क्लेदाच्च विद्रधौ ॥ १७ ॥ यथास्वं व्रणवत्
The unripe, ripening and ripened stages are similar to those of sopha (infammatory oedema).
Those (abscesses) localised above the umbilicus expel their contents (pus, blood etc.) through the mouth, after ripening and those localised below the umbilicus, through the rectum.
The features of the dosas and of the exudate in abscesses, should be understood as similar to those of an ulcer (organic ulcer and not traumatic wound). Sadhyasadhyata ( prognosis ) – 16b-18a.
तत्र विवर्ज्य: सन्निपातजः । पक्को हन्नाभिबस्तिस्थो भिन्नोऽन्तर्बहिरेव वा ॥ १८ ॥ पक्वाश्चान्तः स्त्रवन् वक्त्रात् क्षीणस्योपद्रवान्त्रितः ।
Those produced by all the dosas together; those located in the heart, umbilicus and urinary bladder, which have burst after ripening either inside or outside; those which have burst inside and have expelled their contents inside through their opening; those arising in debilitated persons, those having complications/secondary diseases should be rejected.
18a-19a.
Stana vriddhi – breast abscess
एवमेव स्तनसिरा विवृताः प्राप्य योषिताम् ॥ १९ ॥
सूतानां गर्भिणीनां वा सम्भवेच्छ्रयथुर्घनः । स्तने सदुग्धेऽदुग्धे वा बाह्यविधिलक्षणः ॥ २० ॥
नाडीनां सूक्ष्मवकत्वात्कन्यानां न स जायते । इति विद्रधिनिदानम् ।
In the same way (the dosas) invading the open channels of the breasts in women, who have either delevered (the baby) or pregnant produce a hard swelling in the breasts, having the features of an external abscess; when the breasts are either having milk or not, this is Stana vidradhi (breast abscess), It does not happen in virgins (girls who have not menstruated) because the mouths of the channels (in their breasts) are small. 19b-21a.
Thus ends the diagnosis of vidradhi ( abscess).
Vriddhi nidana – diagnosis of enlargement of the scrotum
अथ वृद्धिनिदानम् । क्रुद्धो रुद्धगतिर्वायुः शोफशूलकरश्चरन् ॥ २१ ॥
मुष्कौ वड्ङ्क्षणतः प्राप्य फलकोशाभिवाहिनीः । प्रपीड्य धमनीर्वृद्धि करोति फलकोशयोः ॥ २२ ॥
दोषास्त्रमेदोमूत्रान्त्रैः स वृद्धिः सप्तधा गदः । मूत्रान्त्रजावप्यनिलाद्धेतुभेदस्तु केवलम् ॥ २३ ॥
Vayu (vata) getting aggravated from obstruction of its movements, begins to move from the groins to the scrotum, producing swelling and pain, followed by pulling down of the dhamani (blood vessels) going into the scrotum and gives rise to enlargement of dhamani (blood vessels) inside the scrotum. This is known vriddhi roga-enlargement of the scrotum.)
It is of seven kinds-viz each of the dosa seperately, by blood, by fat, by urine and by the intestines; those by urine and intestines are (actually) caused by vata itself but are designated differently (to denote the organs involved). 21b-23.
Rupa – clinical features of scrotal enlargement
वातपूर्णदृतिस्पर्शो रूक्षो वातादहेतुरुक् । पक्वोदुम्बरसङ्काशः पित्ताद्दाहोष्मपाकवान्॥ २४ ॥
कफाच्छीतो गुरुः स्निग्धः कण्डूमान् कठिनोऽल्परुक् । कृष्णस्फोटावृतः पित्तवृद्धिलिङ्गश्च कफवन्मेदसा रक्ततः ॥ २५ ॥ वृद्धिर्मृदुस्तालफलोपमः ।
In that (swelling of the scrotum) caused by vata, the ( scrotum) resembles a leather bag filled with air for touch, is dry and painful without any other reason; in that caused by pitta (the scrotum) resembles a ripe fruit of udumbara (brownish red in colour and small) and has burning sansation, heat and suppuration; in that caused by kapha (the scrotum) is cold, heavy, unctuous, itching, hard and with slight pain; in that caused by blood it ( scrotum) is studded with black eruptions (boils) and has the symptoms of increase of pitta; in that caused by fat the swelling of the scrotum is soft and resembles a ( ripe ) fruit of tala (blackish-blue) in colour and big in size ).
Mutraja vriddhi – hydrocele
मूत्रधारणशीलस्य मूत्रजः स तु गच्छतः ॥ २६ ॥
अम्भोभिः पूर्णदृतिवत्क्षोभं याति सरुड्मृदुः । मूत्रकृच्छ्रमधस्ताच्च वलयं फलकोशयोः ॥ २७ ॥
vriddhi (scrotal enlargement) caused by urine happens in persons who suppress the urge of urine habitually, the scrotum resembles a leather bag filled with water, producing movements; is painful and soft, accompanied with difficult micturition and creating round rings underneath the scrotum.
Antraja vriddhi – hernia
वातकोपिभिराहारैः शीततोयावगाहनैः ।
धारणैरणभाराध्वविष्माङ्गप्रवर्तनैः ॥ २८ ॥
क्षोभणैः क्षुभितोऽन्यैश्च क्षुद्रान्त्रावयवं यदा | पवनो विगुणीकृत्य स्वनिवेशादधो नयेत् ॥ २९ ॥
कुर्याद्वड्ङ्क्षणसन्धिस्थो ग्रन्थ्याभं श्वयथुं तदा । उपेक्ष्यमाणस्य च मुष्कवृद्धि
माध्मानरुकुस्तम्भवतीं स वायुः । प्रपीडितोऽन्तः स्वनवान् प्रयाति
प्रध्मापयन्नेति पुनश्च मुक्तः ॥ ३० ॥ अन्त्रवृद्धिरसाध्योऽथं वातवृद्धिसमाकृतिः ॥ ३१ ॥
रूक्षकृष्णारुणसिरातन्तुजालगवाक्षितः
इति वृद्धिनिदानम् ।
By indulgence in foods which cause increase of vata, immersing the body in cold water, suppression or premature initiation of the urges of the body, carrying heavy loads, walking long distance, improper movements of the body and such other acts, vata getting increased pulls down the debilitated small intestine from its place and produces a tumor like swelling in the groin (inguinal hernia). By neglecting it, vata produces enlargement of the scrotum accompanied with flatulence, pain and rigidity of the abdomen; when the swelling (of the groin and of the scrotum) is pressed (by the hand) it (intestine) goes inside (the abdomen) accompanied with a sound and comes down again (into the scrotum) when released. This Antravriddhi (scrotal hernia) is incurable and possesses symptoms similar to vriddhi (scrotal enlargement) caused by vata, along with network of blackish-red threads of veins spread all over. 28-31.
Notes The term ‘vriddhi’ in its common use means-an increase more than the usual. It may refer to number, qualities etc. of substances.
Increase in the size of the scrotum is named as ‘vriddhi’ based on this meaning only, but the term has somehow gained a technical sense, to stand for scrotal enlargement. vriddhi is also called as Bradhna. In mutraja vriddhi it is not the urine that collects in the scrotum but it is a fluid secreted by the layers of the scrotum itself (hydrocele). Antraja vriddhi includes both inguinal and scrotol hernia. Hernia occurs at the umbilicus also especially in weak children (hiatus hernia).
Thus ends the diagnosis of vriddhi (scrotal enlargement).
Gulma nidana – diagnosis of abdomen tumors
अथ गुल्मनिदानम् ।
गुल्मोऽष्टधा पृथग्दोषैः संसृष्टैर्निचयं गतैः ॥ ३२ ॥ आर्तवस्य च दोषेण नारीणां जायतेऽष्टमः ।
Gulma (tumours inside the abdomen) is of eight kinds viz, from each dosa seperately, by the combination if any two of them, by the combination of all of them, the eighth in women only, due to disorders of artava (menstrual blood/ avum). 32-33a.
Gulma nidana – causes of abdomibal tumors
कर्मभिः ॥ ३३ ॥ ज्वरच्छर्द्यतिसाराद्यैर्वमनाद्यैश्च कर्शितो वातलान्यत्ति शीतं वाऽम्बु बुभुक्षितः ।
यः पिबत्यनु चान्नानि लड्ङ्घनप्लवनादिकम् ॥ ३४ ॥
सेवते देहसङ्क्षोभि छर्दि वा अनुदीर्णामुदीर्णान्वा वातादीन्न स्नेहस्वेदावनभ्यस्य शोधनं वा निषेवते ।
शुद्धो वाऽऽशु विदाहीनि भजते स्यन्दनानि वा ॥ ३६ ॥
वातोल्बणास्तस्य मलाः पृथक्कुद्धा द्विशोऽथवा । सर्वे वा रक्तयुक्ता वा महास्त्रोतोनुशायिनः ॥ ३७॥
ऊर्ध्वाधोमार्गमावृत्य कुर्वते शूलपूर्वकम् । स्पर्शोपलभ्यं गुल्माख्यमुत्प्लुतं ग्रन्थिरूपिणम् ॥ ३८ ॥
Person who has become weak by fever, vomitting, diarrhoea etc. (other such debilitating diseases) or by therapies like emesis etc., begins to eat foods which cause increase of vata, or drinks cold water when hungry or indulge in jumping, swimming and such other streneous activities immediately after food; or initiates the urge of vomitting which has not started or suppresses the urges of flatus etc. Which are patent; who resorts to purifactory therapies (emesis, purgation etc.) without oleation and sudation therapies; who beings to consume foods which cause burning sensation during digestion or which produce more secretions (moisture) inside the tissue immediately after purifactory therapies (without following the diet schedule prescribed); by these causes, the malas (dosas) with the predominance of vata, undergo increase either seperately, in combination of any two or all the three or even with blood, invade the alimentary tract, spread to both the upward and downward paths, and gives rise to a palpable, elevated hard mass, preceded by pain in the abdomen; this is known as Gulma. 33b-38.
Rupa – clinical features of abdominal tumors
Vataja Gulma
कर्शनात्कफविट्पित्तैर्मार्गस्यावरणेन वा । वायुः कृताश्रयः कोष्ठे रौक्ष्यात्काठिन्यमागतः ॥ ३९ ॥
स्वतन्त्रः स्वाश्रये दुष्टः परतन्त्रः पराश्रये । पिण्डितत्वादमूर्तोऽपि मूर्तत्वमिव संश्रितः ॥ ४० ॥
गुल्म इत्युच्यते बस्तिनाभिहृत्पार्श्वसंश्रयः । वातान्मन्याशिरः शूलं ज्वरप्लीहान्त्रकूजनम् ॥ ४१ ॥
व्यधः सूच्येव विट्सङ्गः कृच्छ्रादुच्छ्रसनं मुहुः । स्तम्भो गात्रे मुखे शोषः कार्यं विषमवह्निता ॥ ४२ ॥
रूक्षकृष्णत्वगादित्वं चलत्वादनिलस्य च । अनिरूपितसंस्थानस्थानवृद्धिक्षयव्यथः पिपीलिकाव्याप्त इव गुल्मः स्फुरति तुह्यते ।
Either by weakness (due to loss or dep ion of tissues) or by obstruction of its passage by kapha, vit (faeces) or pitta, vata gets aggravated, localised in the alimentary tract, becomes hard (forms a mass) by (causing) dryness. If it (mass) develops in its own (of vata) seat (the seat of vata is pakvasaya-large intestine) then the disease is primary and if it develops in the seat of the others (pitta and kapha) then the disease is secondary; though the mass is not having any shape, still it is considered as having a shape because of (aggregated at any one place) forming an elevation, and so called as a gulma (tumour); it (usually) occupies the region of the urinary bladder, umbilicus, heart and the flanks.
Pain in the sides of the neck, headache, fever, enlargement of the spleen, gurgling sound in the intestines, pain as though being pricked by needles, constipation, difficulty in breathing often, rigidity of the body, dryness of the mouth, emaciation, irregular digestion, dryness and black colour of the skin etc. (nails, eyes, urine, faeces); because of unsteadyness of anila (vata) the tumor mass is indefinite in shape, place, increase or decrease (in size) and nature of pain, there is feeling as though (the tumor) is being swarmed by ants; throbbing and cutting pain. 39-44a.
Pittaja Gulma
पित्ताद्दाहोऽम्लको मूर्च्छाविड्भेदस्वेदतृड्ज्वराः ॥ ४४॥
हारिद्रत्वं त्वगद्येषु गुल्मश्च स्पर्शनासहः । दूयते दीप्यते सोष्मा स्वस्थानं दहतीव च ॥ ४५ ॥
In gulma of pitta origin, there is (increased) sourness (acidity), fainting, diarrhoea, sweating, thirst, fever, deep yellow colour of the skin etc.; the tumour does not tolerate touching (tenderness), has burning sensation, great heat as though burning its own site. 44b-45.
Kaphaja Gulma
कफात्स्तैमित्यमरुचि: सदनं शिशिरज्वरः । पीनसालस्यहृल्लासकासशुक्लत्वगादिताः ॥ ४६ ॥
गुल्मोऽवगाढः कठिनो गुरुः सुप्तः स्थिरोऽल्परूक् ।
In gulma of kapha origin, there is inactivity, loss of taste/appetite, weakness, cold, fever, nasal catarrh, lassitude, nausea, cough, white colour of the skin etc.; the tumor is deep seated, hard, heavy, painless, static and slightly painful.
46-47a.
स्वदोषस्थानधामानः स्वे स्वे काले च रुक्कराः ॥ ४७ ॥
Tumors arising from each dosa are found to develop generally in their own seats and produce pain at their own specific times. 47b.
त्रयस्तु द्वन्द्वोत्था गुल्माः संसृष्टलक्षणः । सर्वजस्तीव्ररुग्दाहः शीघ्रपाकी घनोन्नतः ॥ ४८ ॥ सोऽसाध्यो
The three kinds arising from the combination of two dosas, have mixed symptoms; that arising from the combination of all the dosas has severe pain, burning sensation suppurates soon, hard and greatly elevated, this is incurable. 48a.
Rakta gulma
रक्तगुल्मस्तु स्त्रिया एव प्रजायते । ऋतौ वा नवसूता वा यदि वा योनिरोगिणी ॥ ४९ ॥
सेवते वातलानि स्त्री क्रुद्धस्यस्याः समीरणः । निरूणद्धयार्तवं योन्यां प्रतिमासमवस्थितम् ॥ ५० ॥
कुक्षिं करोति तद्गर्भलिङ्गमाविष्करोति च। हल्लासदौहृदस्तन्यदर्शनक्षामतादिकम् ॥५१॥
क्रमेण वायुसंसर्गात्पित्तयोनितया च तत् । शोणितं कुरुते तस्या वातपित्तोत्थगुल्मजान् ॥५२॥
रुक्स्तम्भदाहातीसारतृड्ज्वरादीनुपद्रवान् गर्भाशये च सुतरां शूलं दुष्टासृगाश्रये ॥ ५३॥
योन्याश्च स्त्रावदौर्गन्ध्यतोदस्पन्दनबेदना: । । न चाङ्गैर्गर्भवद्गुल्मः स्फुरत्यपि तु शूलवान् ॥ ५४॥
पिण्डीभूतः स एवास्याः कदाचित्स्यन्दते चिरात् ।
न चास्था वर्द्धते कुक्षिर्गुल्म एव तु वर्द्धते ।। ५५ ।।
Rakta gulma (tumor arising from blood) occur in women only. Women who during their menstrual period, or period soon after delevery or who are having diseases of the yoni (uterus and vagina) indulge in foods and activities which aggravate vata, in them samirana (vata) getting increased obstructs the artava (menstrual blood) coming out every month, within the yoni (utreus) and produces signs and symptoms of pregnancy inside the abdomen, such as nausia, longings (desires of pregnancy), appearance of breast milk, emaciation etc; gradually the rakta (blood) with the association of vayu (vata) and pitta, such as pain, stiffness, burning sensation, diarrhoea, thirst, fever and such other secondary diseases; severe pain in the uterus by accumilation of vitiated blood, exudation, foul smell, tearing and pulsating pain in the vagina. The tumor, though moves inside the uterus is like a foetus without its part (head, arms and legs), such movements being painful, and also rare, because it is a gathered mass; there is no growth of the abdomen (steadily as in pregnancy) but there is growth only of the tumour. 48b-55.
Notes Rakta gulma is the different kinds of tumours and cysts developing in the uterus, ovaries or ovarian tubes.
स्वदोषसंश्रयो गुल्मः सर्वो भवति तेन सः । पाकं चिरेण भजते नैव वा, विद्रधिः पुनः ॥ ५६ ॥ पच्यते शीघ्रमत्यर्थं दुष्टरक्ताश्रयत्वतः। अतः शीघ्रविदाहित्वाद्विद्रधिः सोऽभिधीयते ॥ ५७ ॥
Gulma (tumors) have only the (causative) dosa as their base (supporting material) and so they undergo suppuration after a long time, or not at all; whereas Vidhradhi (abscesses) undergoes suppuration quickly because their base (suppoting material) is the vitiated blood. Because of their quick suppuration they are called as vidradhi. 56-57.
गुल्मेऽन्तराश्रये बस्तिकुक्षिहृत्प्लीहवेदनाः । अग्निवर्णबलभ्रंशो वेगानां चाप्रवर्तनम् ॥ ५८ ॥
अतो विपर्ययो बाह्ये कोष्ठाङ्गेषु तु नातिरुक् । वैवर्ण्यमवकाशस्य बहिरुन्नतताऽधिकम् ॥ ५९ ॥
इति गुल्मनिदानम् ।
Gulma (tumours ) situated inside (the alimentary tract ) produce pain in the regions of the urinary bladder, upper abdomen (epigastric region), heart and or spleen; weakness of digestive activity, loss of colour/complexion and of strenghth, non-appearance of the urges (non-elimination of urine, faeces, flatus etc.) ; those situated outside ( the alimentary tract) and in the abdominal organs produce opposite symptoms such as mild pain, discolouration at the site (of the tumor) and greater outward growth. 58-59.
Anaha
साटोपमत्युग्ररुजमाध्मानमुदरे
ऊर्ध्वाधोवातरोधेन तमानाहं
भृशम् । प्रचक्षते ॥ ६० ॥
Severe pain in the abdomen accompanied with gurgling noise, and profound enlargement of the abdomen, due to obstruction of the upward and downward movement of vata is spoken of as anaha (flatulence). 60.
Asthila and pratyasthila
घनोऽष्ठीलोपमो ग्रन्थिरष्ठीलोर्ध्वं समुन्नतः ।
आनाहलिङ्गस्तिर्यक्तु प्रत्यष्ठीला तदाकृतिः ॥ ६१॥
A hard tumor resembling a cobblers stone, elevated upwards, presenting symptoms of anaha is known as Asthila; if elevated sidewards in same shape it is pratyasthila. 61.
Tuni and pratituni
पक्वाशयाद्गदोपस्थं वायुस्तीव्ररुजः प्रयान् ।
तूनी, प्रतूनी तु भवेत्स एवातो विपर्यये ॥ ६२ ॥
Vayu (vata) produces severe pain travelling from pakvasaya (large intestine) to the guda (rectum) and upastha (penis) is known as Tuni and pain travelling in the reverse direction (from rectum and penis to the large intestine) is known as pratituni. 62.
Gulma purvarupa – premonitory symptoms of tumors
उद्गारबाहुल्यपुरीषबन्धतृप्त्यक्षमत्वान्त्रविकूजनानि आटोपमाध्मानमपक्तिशक्तिमासन्नगुल्मस्य वदन्ति चिह्नम् ॥ ६३ ॥
More of belchings, obstructions to elimination of faeces, (morbid) feeling of contentment, intolerance, intestinal gurglings, movement of air ( as ) inside the intestines, flatulence, and poor digestive capacity are the premonitory symptoms of gulma ( abdominal tumors).
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने विद्रधिवृद्धिगुल्मनिदानं नामैकादशोऽध्यायः ॥ ११ ॥
Thus ends the chapter Vidradhi-vriddhi-gulma nidana the eleventh in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
