दशमोऽध्यायः । अथातो विसर्पनाडीस्तनरोगनिदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।
Now we shall discourse on the Nidana of Visarpa (erysipelas), Nadi (sinus) and Stana-roga ( diseases affecting the mamma of a woman ). 1
त्वङ्मांसशोणितगताः कुपितास्तुदोषाः सर्वाङ्गसारिणमिहास्थितमात्मलिगम ।
कुर्वन्ति विस्तृतमनुन्नतमाशु शोकं तं सर्वतो विसरणाच्च विसर्पमाहुः || २ ||
Definition of Visarpa : The deranged and aggravated Dosas, (Vayu, Pitta and Kapha) having recourse to, and affecting the Tvak (Skin), flesh and blood, speedily give rise to a sort of shifting, elevated swelling (Sotha) marked by the characteristic symptoms of any of them involved in the case. This swelling tends to extend all over the body. The disease is called Visarpa from the fact of its extending or swiftly shifting character (Skr. srip–to go, to extend). 2
वातात्मकोऽसितमृदुः परुषोऽङ्गमर्द- सम्भेदतोदपवनज्वरलिङ्गयुक्तः । गण्डैर्यदा तु विषमैरतिदूषितत्वाद्युक्तः
स एव कथितः खलु वर्जनीयः ।। ३।।
The Vataja Type : The swelling (Sotha) is soft and rough and assumes a black colour attended with an aching pain in the limbs and a cutting or piercing pain (in the affected locality). It is further marked by (all the usual) symptoms of the Vatika fever. A case of this type in which uneven flame coloured vesicles or bulbs appear on the affected part through the extreme vitiation (of the blood, lymph and flesh etc.) should be given up as incurable. 3
पित्तात्मको द्रुतगतिर्ज्वरदाहपाक-स्फोटप्रभेदबहुलः क्षतजप्रकाशः ।
दोषप्रवृद्धिहतमांससिरो यदा स्यात् स्रोतोजकर्दमनिभो न तदा ससिध्येत् ।। ४ ।।
शेलेष्मात्मकः सरति मन्दमशीघ्रपाकः स्निग्धः सितश्वयथुरल्परुगुग्रकण्डूः ।। ५ ।।
The Pittaja and Kaphaja Types : The Pittaja Visarpa (erysipelas) rapidly extends (over the body), attended with severe fever, a burning sensation, suppuration and cracking (of the skin). A large number of vesicles appear on the spot which assume a blood-red colour. A case of this type, characterised by the destruction of the local flesh and veins owing to the excessively aggravated condition of the deranged Dosas (Kapha and Pitta) and a collyrium-like black colour (of the swelling), should be regarded as incurable. The Kaphaja Visarpa extends slowly and the process of suppuration is tardy. The affected part becomes white, glossy and swollen, and is marked by a slight pain and excessive itching. 4-5
सर्वात्मकस्त्रिविधवर्णरुजोऽवगाढः पक्वो न सिध्यति च मांससिराप्रणाशात् ।। ६ ।।
The Sannipatika Type: The Visarpa of the Tridosaja type is deep-seated and the affected part assumes all colours and is attended with all sorts of pain which are similar to the three aforesaid types. The local flesh and veins are destroyed in the suppurating stage of this disease and hence, it should be looked upon as incurable. 6
सद्यः क्षतव्रणमुपेत्य नरस्य पित्तं रक्तञ्च दोषबहुलस्य करोति शोफम् ।
श्यावं सलोहितमतिज्वरदाहपाकं स्फोटैः कुलत्थसदृशैरसितैश्च कीर्णम् ॥ ७ ॥
The Ksataja Type: (Erysipelas due to a wound or an ulcer): The Pitta of a person with a temperament marked by the extreme aggravation of all the three Dosas, in conjunction with the blood, resorts to a wound¹ in his body and immediately gives rise to Erysipelas (Sopha-lit. rash) which assumes a reddish-brown colour, with high fever with a burning sensation, and suppuration in its train, and it is found to be covered with black vesicles to the size of Kulattha pulse. 7
1. Or through the extreme augmentation of all the three dosas in the ulcer (Sadyaksata-Vrana) according to others.
सिध्यन्ति वातकफपित्तकृता विसर्पाः सर्वात्मकः क्षतकृतश्च न सिद्धमेति ।
पैत्तानिलावपि च दर्शितपूर्वलिङ्गौ सर्वे च मर्मसु भवन्ति हि कृच्छ्रसाध्या: ।। ८ ।।
Prognosis The Vataja, Pittaja and Kaphaja Visarpas are curable; the Sannipatika and Ksataja ones being incurable. The symptoms, which indicate an unfavourable prognosis in a case of Vataja or Pittaja Erysipelas which have been described before. Those, which attack the viatal parts (Marmas) of the body, can be cured only with the great difficulty.’ 8
शोफं न पक्वमिति पक्वमुपेक्षते यो यो वा व्रणं प्रचुरपूयमसाधुवृत्तः ।
अभ्यन्तरं प्रविशति प्रविदार्य तस्य स्थानानि पूर्वविहितानि ततः स पूयः ।
तस्यातिमात्रगमनाद् गतिरित्यतश्च नाडीव यद् वहति तेन मता तु नाडी ।। ९ ।।
दोषैस्त्रिभिर्भवति सा पृथगेकशश्च समूर्च्छितैरपि च शल्यनिमित्ततोऽन्या ।। १० ।।
The Nadi-Vrana: The pus of an abscess or swelling burrows into the affected part if a person neglects it in its fully suppurated stage, dubious of its being so conditioned, or not, or even neglects to open a fully suppurated abscess. An abscess or swelling is called a Gati Vrana owing to an excessive infiltration of pus, and it is also called Nadi-vrana owing to the presence of a large number of recesses or cavities in its inside. There are five different types of Nadi-vrana ( sinuses ) such as the Vataja, Pittaja Kaphaja, Tridosaja and Salyaja. 9-10
तत्रानिलात् परुषमूक्ष्ममुखी सशूला फेनानुविद्धमधिकं स्रवति तृत्तापतोदसदनज्वरभेदहेतुः स्रवत्यधिकमुष्णमहःसु क्षपायाम् ।। ११ ।। पित्तात् ।। १२ ।। पीतं ज्ञेया कफाद बहुघनार्जुनपिच्छिलास्रा रात्रिस्नुतिः स्तिमितरुक्कठिना सकण्डूः || १३ ।।
The Vataja, Kaphaja and Pittaja Types: The Vataja sinus is rough and short-mouthed, characterised by an aching pain (in its inside). It exudes a sort of frothy secretion which becomes greater at night and is attended with an aching pain. Thirst, lassitude, heat and a piercing pain (in the affected locality) are the usual accompaniments of the Pittaja types Fever is present from the beginning and the Sinus exudes a large quantity of hot and yellow coloured secretion which is more by day than by night. The Kaphaja Sinus becomes hard and is deranged) Pitta
1. Golden coloured (yellow) Erysipelas due to the action of the (is incurable (Pittama Kancana-vapusca tatha na sydhyet.). characterised by itching and a slight pain (numbed). It is found to secrete a copiou quantity of thick, slimy, white-coloured pus which becomes greater at night and associated with itching. 11-13
दोषद्वयाभिहितलक्षणदर्शनेन दाहरज्वरश्वसनमूर्च्छनवकाशोषा तिम्रो गतीर्व्यतिकरप्रभवास्तु विद्यात् ।। १४ ।।
यस्यां भवन्त्यभिहितानि च लक्षणानि । तामादिशेत् पवनपित्तकफप्रकोपाद् घोरामसुक्षयकरीमिव कालरात्रिम् ।। १५ ।।
Dvandaja and Tridosaja Types: A case of Nadi-Vrana involving the concerted action of any two of the deranged Dosas (Vayu, Pitta and Kapha) and exhibiting symptoms similar to both, is called a Dvandaja¹ one. There are three types of this class of disease, (such as the Vatapittaja, Vata-kaphaja and Pitta kaphaja). A case of Nadi-vrama, exhibiting symptoms of the three aforesaid types, and attended with fever and a burning sensation, difficult breathing, dryness of the mouth and syncope, is called Tridosaja. An attack of this type should be regarded as dreadful and fatal, casting around the gloom of death. 14-15
नष्टं कथञ्चिदनुमार्गमुदीरितेषु स्थानेषु शल्यमचिरेण गतिं करोति ।
सा फेनिलं मथितमच्छमसग्विमिश्रमुष्णं स्रवेत सहसा सरुजा च नित्यम् ।। १६ ।।
The Salyaja Nadi- Vrana: A foreign matter ( such as dirt, bone, splinter etc.), lodged within the body and invisible to the eye, tends to burst open the skin, etc, of the locality along its channel of insertion and gives rise to a type of Sinus. It is characterised by a constant pain. and suddenly and rapidly exudes a sort of hot, blood-tinged, frothy secretion like clear churned curd. This type is called Salyaja. 16
यावत्यो गतयो यैश्च कारणैः सम्भवन्ति हि । तावन्तः स्तनरोगाः स्युः स्त्रीणां तैरेव हेतुभिः ॥ १७ ॥
धमन्यः संकृतद्वाराः कन्यानां स्तनसंश्रिताः । दोषाविस(त) रणात् तासां न भवन्ति स्तनामयाः ।। १८ ।।
तासामेव प्रजातानां गर्भिणीनान्तु ताः पुनः । स्वभावादेव विवृता जायन्ते सम्भवन्त्यतः ।। १९ । ।
The Stana-Roga: These may be divided into as many types as
1. Gayudasda does not read the symptoms of Dvi-dosaja (i.e., due to two morbific principles) types of sinus as given in the text which he has rejected as spurious.
therefore said Nadi-Vrana and are caused by the same exciting factors as the last named malady. The milk-carrying ducts remain closed in the breast of a nullipera thus barring the possibility of the descent of the Dosas through them and of an attack of any disease at that part of the body. On the contrary, such ducts in the breast of a primipara open and expand of their own accord, thus making the advent of diseases possible that are similar to the mamma. 17-19
रसप्रसादो मधुरः पक्वाहारनिमित्तजः । कृत्स्नदेहात् स्तनौ प्राप्तः स्तन्यमित्यभिधीयते ।। २० ।।
The breast-milk : The sweet essence of the Rasa (lymph chyle ) drawn from the digested food courses through the whole body and is ultimately concentreated in the breast of a mother or a woman (big with child) which is called milk. 20
विशस्तेष्वपि देहेषु यथा शुक्रं न दृश्यते । सर्वदेहाश्रितत्वाच्च शुक्रलक्षणमुच्यते ।। २१ ।।
स्मरणादपि । तदेव चेष्टयुवतेर्दर्शनात्श ब्दसंश्रवणात् स्पर्शात् संहर्षाच्च प्रवर्त्तते ।। २२ ।।
सुप्रसन्नं मनस्तत्र हर्षणे हेतुरुच्यते । आहाररसयोनित्वादेवं स्तन्यमपि स्त्रियाः ॥ २३ ॥
तदेवापत्यसंस्पर्शादर्शनात् स्मरणादपि । सम्प्रवर्त्तते ॥ २४ ॥ हेतुरुच्यते ।। २५ ।। ग्रहणाच्च शरीरस्य शुक्रवत् स्नेहो निरन्तरस्तत्र प्रस्त्रवे
Its character : The breast-milk, like semen, lies hidden and invisible in the organism, though permeating it in a subtle or essential form. The characteristic features of the breast-milk bear analogy to those of semen. The breast milk is secreted, and flows out at the touch, sight or thought of the child in the same manner as the semen is dislodged and emitted at the sight, touch or recollection etc. of a beloved woman. As the strong and unclouded affections of a man are the cause of the emission of semen, so the fondest love of a mother for her children brings about the secretion of her breast-milk. Both semen and breast-milk are the product of the essence of digested food, this essence being converted into milk in women. Constant love is the cause of secretion of milk from the breast. 21-25
तत् कषायं भवेद् वातात् क्षिप्तञ्च प्लवतेऽम्भसि । पित्तादम्लं सकटुकं राज्योऽम्भसि च पीतिकाः ।। २६ ।।
कफाद् घनं पिच्छिलञ्च जले चाप्यवसीदति । सर्वैर्दुष्टैः सर्वलिङ्गमभिघाताच्च दुष्यति ।। २७ ।।
Its abnormal and normal Traits: The milk of a mother vitiated by the deranged Vayu of her system has an astringent taste and floats on water. the milk of a mother vitiated by the deranged Pitta has an acid and pungent taste and becomes marked with a yellow hue,¹ if let to float on water. The milk of a mother vitiated by the deranged Kapha is thick and slimy and sinks in water. The milk of a mother vitiated by the concerted and simultaneous derangement of the three Dosas of the body is marked by the combination of all the preceding symptoms. An external blow or hurt too (Abhighata) sometimes produces vitiation of the mother’s milk. 26-27
यत् क्षीरमुदके क्षिप्तमेकीभवति पाण्डुरम् । मधुरञ्चाविवर्णञ्च प्रसन्नं तद् विनिर्दिशेत् ।। २८ ।।
The milk (of a mother), which instantly mixes with water, tastes sweet and retains its natural greyish tint, should be regarded as pure. 24
सक्षीरौ वाप्यदुग्धौ वा प्राप्य दोषः स्तनौ स्त्रियाः । रक्तं मांसञ्च सन्दूष्य स्तनरोगाय कल्पते ।। २९ ।।
पञ्चानामपि तेषान्तु हित्वा शोणितविद्रधिम् । लक्षणानि समानानि बाह्यविद्रधिलक्षणैः ।। ३० ।।
The bodily Dosas having recourse to the breasts of a woman whether filled with milk or not and vitiating the local flesh and blood give rise to mammary diseases, (Stana-roga). All the types of abscess (Vidradhi) excepting the one called the Raktaja out of the six types described before are found to attack the mammae, and their symptoms should be understood as identical with those of external abscesses. 29-30
इति सुश्रुतसंहितायां निदानस्थाने विसर्पनाडीस्तनरोगनिदानं नाम दशमोऽध्यायः ।। १० ।।
Thus ends the tenth Chapter of the Nidana Sthana in the Susruta Samhita which treats of the oetiology and symptoms of Erysipelas, Sinus and mammary abscesses.
