अथातो विद्रधिवृद्धिगुल्मनिदानं व्याख्यास्यामः । इति ह स्माद्दुरात्रेयादयोः महर्षयः ॥ १ ॥
We will now expound the diagnosis of Vidradhi (abscess), Vruddhi (enlargement of the scrotum) and Gulma (tumors of the abdomen); thus said Atreya and other great sages. (1)
Vidradhi nidanam – diagnosis of abscess
भुक्तैः पर्युषितात्युष्णरूक्षशुष्कविदाहिभिः । जिह्मशय्याविचेष्टाभिस्तैस्तैश्चासृक्प्रदूषणैः ॥२॥
दुष्टत्वङ्मांसमेदोस्थिस्त्रावासृक्कण्डराश्रयः । यः शोफो बहिरन्तर्वा महामूलो महारुजः ॥३॥
वृत्तः स्यादायतो यो वा स्मृतः षोढा स विद्रधिः ।
By indulgence in foods which are stale, very hot (heat producing dry, dehydrated and those causing heart-burn during digestion, uneven bed, improper activities and factors which bring about vitiation of blood, produce a swelling, localised in the skin, muscle fat, bone, tendons, blood and big tendons, either outside or inside, the body that which is deepseated, having severe pain, round and broad is known as Vidradhi (abscess); it is of six kinds. (2-3)
Lakshana-clinical features
दोषैः पृथक्ः समुदितैः शोणितेन तेन न ॥४॥
बाह्योऽत्र तत्र तत्राङ्गे दारुणो ग्रथितोन्नतः । आन्तरो दारुणतरो गम्भीरो गुल्मवद्धनः ॥५॥
वल्मीकवत् समुच्छ्रायी शीघ्रघात्यग्निशस्त्रवत् । नाभिबस्तियकृत्प्लीहक्लोमहृत्कुङ्क्षिवणे ॥६॥ स्यावृक्कयोरपाने वा
One from each dosha seperately, one from all of them combined one from the blood and one from injury. The Bahya ( external one) develops in many parts of the body, is dreadful, hard and bulged up. The Antara (internal) is more dreadful, deep rooted, hard like a tumor growing upwards like an anthill, quickly killing (the person) like fire or a sharp weapon, developing in the (area of) umbilicus, urinary bladder, liver, spleen, kloma (pancreas), heart, stomach, groins, kidneys or apana (rectum). (4-6)
वातात्तत्रातितीव्ररुक् । श्यावारुणश्चिरोत्थानपाको विषमसंस्थितिः ॥ ७ ॥
व्यधच्छेदभ्रमानाहस्पन्दसर्पणशब्दवान् । रक्तताम्रासितः पित्तात्तृण्मोहज्वरदाहवान् ॥ ८ ॥
क्षिप्रोत्थानप्रपाकश्चपाण्डुः कण्डूयुतः कफात् । सोत्क्लेशशीतकस्तम्भजृम्भारोचकगौरवः ॥९॥
चिरोत्थानविदाहश्च सङ्कीर्णः सन्निपातः । सामर्थ्याच्चात्र विभजेद्बाह्याभ्यन्तरलक्षणम् ॥१०॥
कृष्णस्फोटावृतःश्यावस्तीव्रदाहरुजाज्वरः । पित्तलिङ्गोऽसृजा बाह्यः स्त्रीणामेवतथान्तरः ॥११॥
That caused by vata has very severe pain, bluish-red colour, is slow in developing and maturing (forming pus), with irregular stages and having pains such as cutting, tearing, circulating, distending, throbbing, spreading and noisy.
That caused by pitta has red, coppery, or black in colour, causing thirst, delusion, fever and burning sensation quick in developing and maturing (forming pus).
That caused by kaphahas yello wish-white colour,itching, causingexcess salivation, cold (rigors), inactivity, yawning, loss of appetite (or taste ) and feeling of heaviness of the body, slow in developing and maturing (forming pus).
That produced by sannipata has the symptoms of all the doshas; their distinction to be done based on the location and the symptoms. That caused by rakta (blood) is surrounded by blakish vesicles, blue in colour, with severe burning sensation, pain and fever and other symptoms of pitta and occuring externally, the internal one occurs only in women. (7-11a)
शस्त्राद्यैरभिघातेन क्षते वापथ्यकारिणः । क्षतोष्मा वायुविक्षिप्तः सरक्तं पित्तमीरयन् ॥१२॥
पित्तासृग्लक्षणं कुर्याद्विरधिं भूर्युपद्रवम् । तेषूपद्रवभेदश्च स्मृतोऽधिष्ठानभेदतः ॥ १३॥
That caused by injury from sharp instruments etc or in those who indulge in unhealthy foods and activities, the heat of the wound, transported by vayu (vata) and associating with pitta, vitiates the blood and produces the ksata vidradhi, having the symptoms of increase of pitta and rakta and accompanied with many complications (secondary diseases). (11-13a)
Upadrava-secondary diseases
नाभ्यां हिध्मा भवेद्वस्तौ मूत्रं कृच्छ्रेण पूति च । श्वासो यकृति रोधस्तु प्लीह्न्युच्छवासस्यतृट्पुनः ॥१४॥ गलग्रहश्च क्लोम्नि स्यात् सर्वाङ्गप्रग्रहो हृदि । प्रमोहस्तमकः कासो हृदयोद्धटनं व्यथा ॥१५॥ कुक्षिपार्श्वान्तरांसार्तिः कुक्षावाटोपजन्मच | सक्थोर्ग्रहो वक्षणयोवृक्कयोः कटिपृष्ठयोः ॥१६॥ पार्श्वयोश्च व्यथा पायौ पवनस्य निरोधनम् । आमपक्वविदग्धत्वं तेषां शोफवदादिशेत् ॥१७॥
The complications (secondary diseases) arising in them (different kinds of vidradhi) are also different depending upon the site (of vidradhi), such as
That located in the umbilicus produces hiccup; in that of the bladder, there is difficulty of micturation and the urine is foul smelling; in that of the liver, there is difficult respiration; in that of the spleen there will be obstruction to expiration; in that of the kloma (pancreas), there will be thirst and obstruction in the throat; in that of the heart, there will be catching pain in all the parts of the body, delusion, darkness (unconsciousness), cough, hitting pain in the heart, discomfort in the epigastium, flanks and shoulders; in that of the epigastrium, there develops gurgling noise in the groins, and catching pain in the thighs; in that of the kidney, there is pain in the waist, back and flanks; in that of the rectum there is obstruction to expulsion of flatus.
Determination of unripe, ripe and ripening stages of these (vidradhis) is like those of sopha (inflamatory swelling). (13b-17)
नाभेरूर्ध्वंमुखात्पक्वाः प्रस्त्रवन्त्यधरेगुदात् । गुदास्यान्नाभिजो विद्याद्दोषं क्लेदाच्चविद्रधौ ॥१८॥
Those (vidradhi) which arise in areas above the umbilicus, after maturing,cause the elimination of the exudate (pus) through the mouth; those which arise in areas below (the umbilcus), through the rectum; those arising in (or around) the umbilicus from either the mouth or the rectum (or from both). In vidradhi, the symptoms of the doshas are to be recognised in the exudates, similar to their recognition in vrana (organic ulcers). (18)
यथास्वं व्रणवत्तत्र विवर्ज्य: सन्निपातजः । पक्को हृन्नाभिबस्तिस्थो भिन्नोऽन्तर्बहिरेव च ॥१९॥
पक्वश्चान्तःस्रवन् वक्त्रात् क्षीणस्योपद्रवान्वितः ॥ २०॥
Those (vidradhi) caused by sannipata (combination of all the doshas), those which are on the heart, umbulicus and urinary bladder and have burst after maturing, either internally or externally, those which have burst internally and the exudate (pus etc) coming out through the mouth; those occuring in emaciated persons and those associated with complication (secondary diseases) should be rejected. (19-20)
Stana vidradhi – abscess of the breast
एवमेव स्तनसिरा विवृताः प्राप्य योषिताम् । सूतानां गर्भिणीनां वा सम्भवेच्छ्वयथुर्घनः ॥ २१ ॥
स्तने सदुग्धेऽदुग्धे वा बाह्यविद्रधिलक्षणः। नाडीनां सूक्ष्मवक्त्रत्वात् कन्यानां तु न जायते ॥ २२॥
In the same manner (as the vidradhi) the doshas invading the dilated siras (veins, vessels, ducts) of the breasts of women, who have delivered or those who are pregnant, produce a swelling in the breasts, which are with or without milk, presenting all the symptoms of an external vidradhi (abscess). Such breast abscess does not occur in virgins, because in them, the ducts have small openings. (21-22)
Vruddhi nidanam-diagnosis of scrotal enlargement
क्रुद्धो रुद्धगतिर्वायुः शोफशूलकरश्चरन् । मुष्कौ वड्ङ्क्षणतः प्राप्य फलकोशाभिवाहिनीः ॥२३॥
प्रपीड्य धमनीर्वृद्धिं करोति फलकोशयोः । दोषास्त्रमेदोमूत्रान्त्रैः स वृद्धिः सप्तधा गदः ॥२४॥
मूत्रान्त्रजावप्यनिलाद्धेतुभेदस्तु केवलम् । वातपूर्णदृतिस्पर्शो रूक्षो वातादहेतुरुक् ॥२५॥
Vayu (vata) getting aggravated (increased) by obstruction (in its passages) reaches the scrotum and the groins, invades the channel of the phalakosa (scrotum) and vrsana (testicles), produce abnormalities of the dhamanis (arteries and other vessels) and cause enlargement of the phalakosa ( scrotum); this ( disease) known as Vruddhi is of seven kinds-one from the doshas (seperately), asra (blood) medas (fat), mutra (urine) and antra (intestine); even those caused by urine and intestine are due to anila (vata) itself, they are mentioned seperately inview of the specific (apparant) cause. (23-25a)
पक्कोदुम्बरसङ्काशः पित्ताद्दाहोष्मपाकवान् । कफाच्छीतो गुरुः स्निग्धः कण्डूमान्कठिनोल्परुक् ॥२६॥
कृष्णस्फोटावृतः पित्तवृद्धिलिङ्गश्च रक्ततः । कफवन्मेदसा वृद्धिर्मृदुस्तालफलोपमः ॥२७॥
In that (kind) caused by vata, the scrotum resembles a bag filled with air for touch, is rough and develops pain without any apparent (expernal reason); that caused by pitta resembling a ripe fruit of udumbara, is accompanied with burning sensation, heat and formation of pus; that caused by kapha, is cold, heavy, smooth, itching, hard with mild pain; that caused by rakta (blood) has papules of black colour spread all over alongwith the symptoms of increase of pitta, that caused bymedas (fat) has all the symptoms of increase of kapha, is soft and resembles the fruit of tala. (25b-27)
Mutraja vruddhi – hydrocele
मूत्रधारणशीलस्य मूत्रजः स तु गच्छतः । अम्भोभिः पूर्णदृतिवत्क्षोभं याति सरुड्मृदुः ॥ २८ ॥
मूत्रकृच्छ्रमध: स्याच्च वलयः फलकोशयोः ।
Mutraja vruddhi, occurs in those who are in the habit of suppressing urination; it (scrotum) has movements like a bag filled with water, is painful, soft, there is difficulty of micturition and wrinkles appear below the scrotum. (29a)
Antraja vruddhi – scrotal hernia
वातकोपिभिराहारैः शीततोयावगाहनैः ॥२९॥
धारणेरणभाराध्वंविषमाङ्गप्रवर्तनैः । क्षोभणैः क्षुभितोऽन्यैश्च क्षुद्रान्त्रावयवं यदा ॥३०॥
पवनो विगुणीकृत्य स्वनिवेशादधो नयेत् । कुर्यात्वङ्क्षणसन्धिस्थो ग्रन्थ्याभं श्वयथुं तदा ॥३१॥
उपेक्षमाणस्य च मुष्कवृद्धिमाध्मानरुक्स्तम्भवतीं स वायुः । ॥३३॥
प्रपीडितोऽन्तः स्वनवान् प्रयाति प्रमापयन्नैति पुनश्च मुक्तः ॥३२॥
आन्त्रवृद्धिरसाध्योऽयं वातवृद्धिसमाकृतिः । रुक्षकृष्णरुणसिरातन्तुजालगवाक्षितः
By indulgence in foods which aggravate vata, sitting in cold water (for long hours), suppressing or premature initiation of the urges of the body,carrying heavy weights, walking long distance, improper movements of the parts of the body and such other strenous activities, vata getting aggravated (increased), displaces the small intestines downward and produces enlargement resembling a tumor, in the groin. In those who neglect this, vata, produces enlargement of the scrotum, distention, pain and loss of movement. When pressed by the hands it (intestines) goes inside with a sound and returns back again causing enlargement. This (diseases) known as Antravruddhi is incurable, has all the symptoms of increase of vata such as roughness, blackish-red colour, and network of veins. (29b-33)
Gulma nidanam – diagnosis of tumors of the abdomen
गुल्मोऽष्टधा पृथग्दौषैः संसृष्टैर्निचयं गतैः । आर्तवस्य च दोषेण नारीणां जायतेऽष्टमः ॥३४॥
Gulma (tumors of the abdomen) is of eight kinds-one from each of the doshas, from their combination in two’s; from combination of all three and the eighth from artava (menstrual blood) only in women. (34)
अथ यो ज्वरातिसारादिभिर्वमनादिभिर्वा कर्मभिः कर्शितो वातलान्याहारयत्याहाराभिलाषी वा शीतमुदकं पिबत्यन्नपानानन्तरंवा लङ्घनप्लवनव्यवाययानयानादीन्देहविक्षोभिणः सेवतेऽनुदीर्णां वा छर्दिमुदीरयत्युदीर्णान् वा वातादीन् निश्वासोच्छ्वासौ वा निगृह्णात्यस्नेहपूर्वं वा वमनविरेचने करोति तथा शोधित एव वाऽतिविदाहिनोऽभिष्यन्दिनो वा निषेवते तस्य यथास्वं वातप्रधानाः कुपिता दोषाः पृथक् संसृष्टाः समस्ताः सरक्ता वा महात्रोतोऽनुप्रविश्यावृत्योर्ध्वमधश्च मार्गमवश्यं शूलमुपजनयन्तो गुल्ममभिनिर्वर्तयन्ति । यतश्च तस्मिन् शूलविद्ध इव व्यथते तीव्रवेदनार्दितः कृच्छ्रोच्छ्वासस्तस्माच्छूलमित्युच्यते ॥ ३५ ॥
In those who are debilitated from fever, diarrhoea and other diseases, or emaciated by therapies such as emesis etc; who indulge in foods which increase vata, who take large quantities of foods, who drink very cold water, who indulge in jumping, swimming, sexual intercourse, physical exercises and such other activities which cause fatigue to the body, who forecibly initiate vomiting when its urge has not commenced or who suppress the urge, who resort to therapies, like emesis and purgation without oleation and sudation therapies earlier, who, after purifactory therapies indulge in foods which are vidahi (cause heart-burn) and abhisyandi (causing more secretion which obstruct the tissue pores) the doshas with the predominance of vata, undergo aggravation, either individually, in combination of two’s or all the three, or in association with rakta (blood) enter the mahasrotas (alimentary tract), block the upward and downward routes (pasages) and produce Gulma (tumor), because it causes pain as though pierced by a sharp and pointed lance, the patient suffers greatly from pain, and severe difficulty for respiration it (gulma ) is also called sula (colic ). ( 35 )
Gulma Samprapti – pathogenesis
तत्रातिकर्शनात् कफपित्ताभ्यां वा मार्गनिरोधाल्लब्धाश्रयो वायुरुत्प्लुतो रौक्ष्यात् कठिनीभूतः स्वाश्रये स्वतन्त्रः परतन्त्रो वा पित्तश्लेष्माश्रये स्पर्शोपलभ्यः पिण्डितत्वादमूर्तोऽपि मूर्ततामिवोपगतो ग्रन्थिरूपेणावतिष्ठमानो गुल्मसंज्ञां लभते । तस्य पञ्च स्थानानि बस्तिर्नाभिः पार्श्वे हृदयं च । अथास्य पूर्वरूपाणि सदनमग्निशरीरयोररुचिः सौहित्यासहिष्णुता कुक्षिशूलमाध्मानमुगिरणं बहुशो विदग्धेऽन्ने छर्दिराटोपो मलस्य प्रादुर्भावोऽप्रवृत्तिश्च ॥३६॥
Vayu (vata) aggravated by profound emaciation or by obstruction of its channels from kapha and pitta, gets localised, becomes hard (rough) by increase of dryness, gives rise to a palpable mass, independently in its own place or in association with pitta and slesma (kapha) in their places. Though formless (shapeless) by itself, it (vata) attains a solid form and remaining inside (the abdomen) like a round mass, gets the name gulma (bush). Its five places (of manifestation) are ( areas near) the urinary bladder, umbilicus, the two flanks and (the region of) the heart.
Purva rupa (prodromal symptoms) are weakness of digestion and of the body, loss of appetite, intolerance of satiation (lack of contentment of food), pain in the abdomen, distention (flatulence) more of belchings, vomiting of partly digested food, gurglings, production of faeces but its non-elimination. ( 36 )
Vataja gulma
तत्र वातात् सूच्येव च शङ्कनेव च व्यधो मन्याशिरःशङ्खशूलज्वराङ्गमर्दप्लीहाटोपान्त्रकूजोदावर्तोच्छ्वासोपरोधमुखशोषस्तब्धगात्रताः वायुकालेषूपद्रववृद्धिर्विषमाग्निता कृष्णारुणपरुषत्वङ्नखादित्वं गुल्मश्चास्य चलत्वाद्वायोरनियतस्थानसंस्थानोदयप्रलयाल्पमहारुजः पिपीलिकापरिगत इव तोदस्फुरणबहुलो विस्तारयतीव स्वदेशे चर्म कदाचित् कदाचित्सङ्कोचयतीव हर्षयति रोमाणि वेदनातिप्रवृत्तौ तु सर्वस्मिन्नपि देहे प्रायो बस्त्याश्रयश्च भवति ॥३७॥
In the gulma produced by vata the symptoms are; the pain is like as though pricked by needles, or as peirced by sharp hooks, pain in the neck, head and temples, fever, bodyaches, enlargement (or pain) of the spleen, noise (in the abdomen), intestinal gurglings, upward movement (of materials), obstruction to expiration, dryness of the mouth, stiffness of the body, increase of distress during vayukala (periods of predominance of vata viz, last part of the day, night and digestion of food). erratic type of digestion, blackish-red colour and roughness of the skin, nails etc, in view of unsteadyness of vata, there is unspefic in the tumors regarding its site, symptoms, growth and mitigation, mild or severe pain, feeling as though surrounded by ants, with predominance of pricking or pulsating type of pain, feeling as though the skin over its site is sometimes expanding and sometimes constricting, horripilations during the time of increase of pain and the tumor commonly located in the (area of the) bladder (hypogastrium). (37)
Pittaja gulma
पित्ताद्दाहो धूमकोऽम्लकस्तृष्णा ज्वरः स्वेदो विभेदो मूर्च्छा शीतोपशयता हरितहारिद्रत्वगादित्वं गुल्माश्चास्य तप्तायः पिण्ड इव तमवकाशं दहति दूयते धूमायते ऊष्मायते शिथिल इव व्रण इवास्पर्शसहो निर्लोमा प्रायो नाभ्याश्रयश्च ॥३८॥
In that caused by pitta the symptoms are – burning sensation, feeling of hot fumes coming out, sourness (acidity), thirst, fever, perspiration, looseness of bowels, fainting, comfort by cold things. greenoor deep yellow discolouration in the skin etc, the tumor causes burning sensation in the mouth, palate and lips, cause burning sensation in the head, neck, throat and palate, increase of local temperature, looseness or flaccidity (of the tumor), not tolerating touch like an ulcer, having no hairs (over the place of the tumor) and commonly localised near the umbilicus. (38)
Kaphaja gulma
कफात् स्तैमित्यमरोचकाविपाकौ हृदयोपलेपः शीतज्वरस्तृप्तिः सदनं कासो हल्लास: पीनसोनिद्राऽलस्यं नखादिशुक्लता गुल्मश्च सुप्तस्थिरगुरुकठिनोऽवगाढोऽल्परुक् प्रायो हृत्पार्श्वाश्रयश्च । संसृष्टलिङ्गः संसर्गात् स त्रिविधः । सर्वलिङ्गनिचये निचयगुल्मः
In that caused by kapha the symptoms are – inactivity, loss of appetite, indigestion, heaviness of the heart, fever with cold (chills) contentment (abnormal), weakness, cough, nausea, nasal catarrah, sleepiness, lassitude, whiteness of the nails etc, the tumor appears as sleeping (without movement, sensation and growth), immovable, heavy, hard, broad with mild pain and commonly occupying the region of the heart (chest) and the flanks.
That caused by the combination of two doshas are three, that caused by the combination of all the three doshas will have the features of all the doshas and is incurable. (39)
Rakta gulma – uterine tumor
रक्तगुल्मस्तु गर्भकोष्ठार्तवागमनवैशेष्यात् पारतन्त्र्यादवैशारद्यादुपचारानुरोधाच्च स्त्रिया एव भवति ॥४०॥
तत्र यदासावृतुमती नवप्रसूता योनिरोगिणी वा वातलान्यासेवेत तदास्या वायुः प्रकुपितो योन्या मुखमनुप्रविश्यार्तवमुपरुणद्धि ।
तदुपरुध्यमानं मासे मासे कुक्षिमभिनिर्वर्तयति गर्भलिङ्गानि च हल्लसतन्द्राङ्गसाददौहृदस्तन्यदर्शनादीनि ।
वायुसंसर्गात् पुनः पित्तैकप्रकोपतया च वातपित्तगुल्मरूपाणि क्रमाच्छूलस्तम्भदाहाती सारादीनि गर्भाशये च सुतरां शूलं तया योन्या दौर्गन्ध्यमास्त्रावं च करोति । गुल्मश्च न गर्भ इवाङ्गैः पिण्डित एव तु चिरेण सशूलं स्पन्दते गुल्म एव वर्द्धते न कुक्षिः ॥४१॥
Rakta gulma occurs only in woman because of the peculiarity of discharge of menstrual flow (blood) from the uterine cavity, as a secondary disease (complication) due to lack of good knowledge (of management of menstruation, pregnancy, delivery ) and improper therapies. (41)
When a woman who during the period of menstruation one who has recently delivered or one who is suffering from diseases of the uterus indulges in foods and activities which increase vata, then the vayu (vata) getting aggravated entering into the mouth of the vagina, blocks the flow of menstrual blood. Thus obstructed, month after month, it produces an enlargement of the abdomen, and signs of pregnancy also, such as nausea, stupor, debility, longings (cravings) and appearance of breast milk. With the increase of pitta and its association with vata, the tumor exhibits the symptoms of both vata and pitta, such as pain, loss of movement, burning sensation, diarrhoea etc, severe pain in the uterus and foul smelling discharge from the vagina; the tumor is felt as having no foetal parts but like a round mass, makes movements after long time, is accompanied with pain, the tumor only grows in size but not the abdomen. (41)
स्वदोषाधिष्ठानश्च सर्वो भवति गुल्मः | तस्माच्चिरेण नैव वा पाकमेति ।
भृशदुष्टरक्ताश्रयत्त्वात्तु विद्रधिः शीघ्रपाको भवतीति । भवति चात्र ॥ ४२ ॥
All gulmas ( abdominal tumors) are confined to the natural seats of the (causative) doshas, so they undergo maturity (pus formation or ulceration) after a long time or not at all, Vidradhi (abscess) is quickly maturing because of large amount of vitiated blood residing (accumilated) in it. (42)
गुल्मेऽन्तराश्रये बस्तिकुक्षिहृत्प्लीहवेदनाः । अग्निवर्णबलभ्रंशो वेगानां चाप्रवर्तनम् ॥४३॥
अतो विपर्ययो बाह्ये कोष्ठाङ्गेषु तु नातिरुक् । वैवर्ण्यमवकाशस्य बहिरुन्नतताधिकम् ॥४४॥
साटोपमत्युग्ररुजमाध्मानमुदरे भृशम् । ऊर्ध्वाधोवातरोधेन तमानाहं प्रचक्षते ॥४५॥
Further on –
In internal gulmas, there is pain in the region of the bladder (hypogastrium), pit of a abdomen (epigastrium) region of the heart, and the spleen, loss of strength of agni (digestive activity) colour and physical capacity and non-manifestation of the urges. In the external gulmas the opposite symptoms are found such as no severe pain in the organs of the abdomen, but predominance of discolouration of the affected parts and outward growth.
Great enlargement of the abdomen with gurgling noise, severe pain, caused by obstruction of upper and lower vata (belching and flatus respectively) is known as Anaha. (43-45)
घनोऽष्ठीलोपमो ग्रन्थिरष्ठीलोर्ध्वं समुन्नतः । आनाहलिङ्गस्तिर्यक् तु प्रत्यष्ठीला तदाकृतिः ॥४३॥
A hard rumor resembling a cobblers stone, bulging upwards with symptoms of anaha is known as Asthila, the same facing downwards is Pratyasthila. (46)
पक्वाशयात् गुदोपस्थं वायुस्तीव्ररुजश्चरन् । तूनी प्रतूनी तु भवेत्स एवातो विपर्यये ॥४७॥
Movement for vayu (vata) accompanied with severe pain from the pakvasaya (large intestines) to the guda (rectum) is known as Tuni and Pratuni (pratituni) is that of opposite nature (pain from the rectum to the large intestine).
॥ इति एकादशोऽध्यायः ॥
Thus ends the Eleventh chapter.
