द्वादशोऽध्यायः । अथातो वृद्धयपदंशश्लीपदानां निदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ।। १ ।।
Now we shall discourse on the Nidana of Vruddhi (hydrocele, hernia, scrotal tumours etc.), Upadansa (disease of the genital organ, and Slipada (elephantiasis). 1
वातपित्तश्लेष्मशोणितमेदोमूत्रान्त्रनिमित्ताः सप्त वृद्धयो भवन्ति । मूत्रान्त्रनिमित्ते वृद्धी वातसमुत्थे केवलमुत्पत्तिहेतुरन्यतमः ।। २ ।।
Classes There are seven different types of Vruddhi such as the Vataja, Pittaja, Kaphaja, Raktaja, Medaja, Mutraja and the AntraVruddhi. Of these both the Mutraja-Vruddhi (hydrocele or extravagation of the urine, and Antra-Vruddhi types, though owing their origin to the deranged condition of the bodily Vayu, have been so named after the organic matters or anatomical parts (urine, iliac colon etc.) involved in them. 2
अधःप्रकुपितोऽन्यतमो हि दोषः फलकोशवाहिनीरभिप्रपद्य धमनीः फल-कोषयोवृद्धि जनयति, तां वृद्धिमित्याचक्षते ।। ३ ।।
तासां भविष्यतीनां पूर्वरूपाणि बस्तिकटीमुष्कमेद्वेषु वेदना मारुतनिग्रहः फलकोषशोफश्चेति ।। ४ ।।
Definition and Premonitory Symptoms : Any of the deranged Dosa (Vayu, Pitta, etc.) lying in the lower regions of the body may resort to the spermatic cords (Dhamani) and give rise to a swelling and inflammation of Phalacosha (scrotal sac) which is called Vruddhi (scrotal enlargement etc.). A pain in the bladder, scrotum, penis and the waist (Kati) incarceration of the Vayu and the swelling of the scrotum, are the premonitory symptoms of the disease. 3-4
तत्रानिलपरिपूर्णां बस्तिमिवाततां परुषामनिमित्तानिलरुजां वातवृद्धिमाचक्षते, पक्वोदुम्बरसङ्काशां ज्वरदाहोष्मवतीञ्चाशुसमुत्थानपाकां पित्तवृद्धिम्, कठिनामल्पवेदनां शीतां कण्डूमतीं श्लेष्मवृद्धिम्, कृष्णस्फोटावृतां पित्तवृद्धिलिङ्गां रक्तवृद्धिम्, मृदुस्निग्धां कण्डूमतीमल्पवेदनां तालफलप्रकाशां मेदोवृद्धिम्, मूत्रसन्धारणशीलस्य मूत्रवृद्धिर्भवति, सा गच्छतोऽम्बुपूर्णा दॄतिरिव क्षुभ्यति मूत्रकृच्छ्रवेदनां वृषणयोः श्वयथुं कोशयोश्चापादयति, तां मूत्रवृद्धिं विद्यात् ॥ ५ ॥
The Dosa-origined Types: The type in which the scrotum becomes distended with Vayu like an inflated air-drum, marked by roughness of (its surface) and the presence of a varied sort of Vataja pain (in its interior) without any apparent cause is called Vataja Vyddhi. The swollen scrotum. of the Pittaja Vruddhi. assumes the colour of a ripe Audumbara fruit and is attended with fever, a burning sensation and heat in the affected part. It is of a marked rapid growth and speedy suppuration (of the scrotum). The swollen organ in the Kaphaja Vruddhi becomes hard and cold to the touch accompanied by little pain, and itching (in the affected part). In the Raktaja type the swollen scrotum is covered over with black vesicles, all other symptoms of the type being identical with those of the Pittaja one. In the Medaja type the swollen scrotum looks like a ripe Tala fruit and becomes soft. glossy, slightly painful and associated with itching. The Mutrajavriddhi (hydrocele) owes its orgin to a habit of voluntary retention of urine, its characteristic symptoms being softness and fluctuation on the surface of the swollen scrotum like a skin-bladder filled with water. painful urination, pain in the testes and swelling of the scrotum. 5
भारहरणबलवद्विग्रह-वृक्षप्रपतनादिभिरायासविशेषैर्वायुरभिप्रवृद्धः प्रकुपितश्च स्थूलान्त्रस्येतरस्य चैकदेशं द्विगुणमादायाधो गत्वा वङ्मणसन्धिमुपेत्य ग्रन्थिरूपेण स्थित्वाऽप्रतिक्रियमाणे च कालान्तरेण फलकोशं प्रविश्य मुष्कशोफमापादयति, आध्मातो बस्तिरिवाततः प्रदीर्घः स शोफो भवति, सशब्दमवपीडितश्चोर्ध्वमुपैति, विमुक्तश्च पुनराध्मायते, तामन्त्रवृद्धिमसाध्यामित्याचक्षते ।। ६ ।।
Antra-Vruddhi (Inguinal hernia) : The local Vayu enraged and unusually aggravated by lifting a great load, wrestling with a stronger person, violent physical strain or a fall from a tree and such like physical labour doubles up a part of the small intestine and presses it down into the inguinal regions lying there strangulated in the form of a knot (Granthi) which is known as Antra-Vruddhi (inguinal hernia). The part not properly attended to at the outset descends into the scrotum which becomes ultimately elongated and intensely swollen and looks like an inflated air-bladder. It (hernia) ascends upwards under pressure, making a peculiar sound, (gurgling); while let free it comes down and again gives rise to the swelling of the scrotum. This disease is called Antra-Vruddhi and is incurable. 6
तत्रातिमैथुनादतिब्रह्मचर्याद् वा तथाऽतिब्रह्मचारिणीं चिरोत्सृष्टां रजस्वलां दीर्घरोमां कर्कशरोमां सङ्कीर्णरोमां निगूढरोमामल्पद्वारां महाद्वारामप्रियामकामामचौक्षसलिलप्रक्षालितयोनिमप्रक्षालितयोनिं योनिरोगोपसृष्टां स्वभावतो वा दुष्टयोनिं वियोनिं वा नारीमत्यर्थमुपसेवमानस्य तथा करजदशनविषशूकनिपातनाद्वन्धयाद् हस्ताभिघाताच्चतुष्पदीगमनादचौक्षसलिलप्रक्षालनादवपीडनाच्छुक्रमवेग विधारणान्मैथुनान्ते वाऽप्रक्षालनादिभिर्मेद्रमागम्य प्रकुपिता दोषाः क्षतेऽक्षते वा श्वयथुमुपजनयन्ति, तमुपदंशमित्याचक्षते ।। ७ ।।
स पञ्चविधस्त्रिभिर्दोषैः पृथक् समस्तैरसृजा चैकः ॥ ८ ॥
The Upadansa: An inflammatory swelling of the genital. whether ulcerated or not is called Upadansa¹. The disease owes its origin to the action of the local Dosas, aggravated by promiscuous and excessive sexual intercourse or by entire abstinence in sexual matter;
1. Upadansa is not syphilis whole to whole. Certain types of Upadansa such as the Raktaja and Sannipatika types which entail the destruction of the organs concerned exhibit certain symptoms which are common to syphilis as well. The secondary eruptions and tertiary symptoms of syphilis are not mentioned by the Ayurvedic Rsis who used to treat it only with vegetable medicines and this fact intimates the probability that the secondary and tertiary symptoms of syphilis might not arise by their efficient and able treatment from the very beginning, preventing the absorption of the poison into the system. The practice of ablution, so common among the Hindus, might be taken into consideration as one of the important preventive factors. Maharsi Charaka has comprised it within the chapter on Senile Impotency’ or by visiting a woman, who had observed a vow of lifelong continence or one who has not long known a man, or one in her menses or one with an extremely narrow or spacious vulva, or with rough or harsh or large pubic hairs; or by going unto a woman whose parturient canal is studded with hairs along its entire length; or by visiting a woman not amorously disposed towards the visitor and vice versa; or by knowing a woman who washes her private parts with foul water or neglects the cleanliness of those parts, or suffers from any of the vaginal diseases, or one whose vagina is naturally foul; or by going unto a woman in any of the natural fissures of her body other than the organ of copulation (Vi-yoni); or by pricking the genital with finger nails, or biting it with the teeth, or through poisonous contact, or through practice of getting the (penis abnormally elongated by pricking the) bristles of a water parasite (Suka) into its body; or by practising masturbation, or any unnatural offence with female quadrupeds; or by washing the genitals with filthy or poisonous water; orthrough neglect to wash the parts after coition, or voluntary suppression of a natural flow of semen or urine or through any hurt or pressure on the organ etc. The inflammation of the genital thus engendered is called Upadansa. The disease admits of being divided into five distinct types, such as, the Vataja, Pittaja, Kaphaja, Tridosaja and the Raktaja. 7-8
तत्र वातिके पारुष्यं त्वक्परिपुटनं स्तब्धमेढ्रता परुषशोफता विविधाश्च वातवेदना:; पैत्तिके ज्वरः श्वयथुः पक्वोदुम्बरसङ्कशस्तीव्रदाहः क्षिप्रणाक: पित्तवेदनाश्च; श्लैष्मिके श्वयथुः कण्डूमान् कठिनः स्निग्धः श्लेष्मवेदनाश्चः रक्तजे कृष्णस्फोटप्रादुर्भावोऽत्यर्थमसृकप्रवृत्तिः पित्तलिङ्गान्यत्यर्थं ज्वरदाहौ शोषश्च; याप्यश्चैव कदाचित् ; सर्वजे सर्वलिङ्गदर्शनमवदरणं च शेफसः क्रिमिप्रादुर्भावो मरणञ्चेति ।। ९ ।।
The Symptoms of different Types: The roughness of the genitals, the bursting or cracking of the integuments of the penis and prepuce etc., numbness and swelling of the affected part which is perceived rough to the touch and the presence of a varied sort of pain similar to the deranged Vayu are the characteristic indications of the Vataja type. In the Pittaja type fever sets in (from the very beginning), the penis becomes swollen and assumes the colour of a ripe Indian fig (reddish-yellow), attended with a sort of intolerable burning sensation. The process of suppuration is rapid and a variety of pain similar to the deranged Pitta, (distinguishes it from the other forms of the disease). The penis becomes swollen, hard and glossy in the Kaphaja type marked by itching and a variety of pain characteristic of the deranged Kapha. In the blood-origined type (Raktaja) the organ bleeds heavily and is covered with the eruptions of large black vesicles. Fever, thirst, (Sosa), burning sensations and other characteristic symptoms of the deranged Pitta are also present. Palliation is all that can be occasionally effected in these cases. Symptoms specifically relating to each of the Vataja, Pittaja and Kaphaja types concurrently manifest themselves in the Sannipatika type of Upadansa. The organ cracks, the ulcers or chancers become infested with parasites and death comes in to put a stop to the suffering of its wretched victim. 9
कुपितास्तु दोषा वातपितश्लेष्माणोऽधः प्रपन्ना वङ्गणोरुजानुजङ्घास्ववतिष्ठमानाः कालान्तरेण पादमाश्रित्य शनैः शोफं जनयन्ति, तं श्लीपदमित्याचक्षते । तत् त्रिविधं वातपित्तकफनिमित्तमिति ।। १० ।।
Slipada (Elephantiasis): The disease in which the deranged Vayu, Pitta and Kapha, taking a downward course, are lodged in the thighs, knee-joints, legs and the inguinal regions and spread to the feet in course of time and gradually give rise to a swelling therein, is called Stipada. There are three types of Slipada due to the actions of the deranged Vayu, Pitta and Kapha. 10
तत्र वातजं खरं कृष्णं परुषमनिमित्तानिलरुजं परिस्फुटति च बहुशः, पित्तजन्तु पीतावभासमीषन्मृदुज्वरदाहप्रायञ्च । श्लेष्मजन्तु श्वेतं स्निग्धावभासं मन्दवेदनं भारिकं महाग्रन्थिकं कण्टकैरुपचितञ्च ।। ११ ।।
The Symptoms of the different Types: The swollen parts assume a black colour in the Vataja type and are felt rough and uneven to the touch. A sort of spasmodic pain without any apparent reason is felt (at intervals in the seat of the disease), which largely begins to crack or burst. The Pittaja type is characterised by a little softness and yellowish hue (of the diseased localities) and often attended with fever, and burning sensation. In the Kaphaja type the affected localities become white, glossy, slightly painful, heavy, contain large nodules (Granthis) and are studded over with crops of papillae.
तत्र संवत्सरातीतमतिमहद् वल्मीकजातं प्रस्तुतमिति वर्जनीयानि ।। १२ ।।
Prognosis: A case of elephantiasis of a year’s growth as well as the one which is characterised by excessive swelling (of the affected parts), exudation and vegetation of knotty excrescences resembling the summits of an ant-hill should be given up as incurable. 12
भवति चात्र त्रीण्यप्येतानि जानीयात् श्लीपदानि कफोच्छ्रयात् । गुरुत्वञ्च महत्त्वञ्च यस्मान्नास्ति विना कफात् ।। १३ ।।
पुराणोदकभूयिष्ठाः सर्वर्तुषु च शीतलाः । ये देशास्तेषु जायन्ते श्लीपदानि विशेषतः ॥ १४ ॥
Memorable Verses: A preponderance of the deranged Kapha marks the three tyes of the disease, in as much as, the heaviness and largeness (of the swelling) can not be brought about by any other factor than Kapha. The disease is similar to countries in which large quantities of old rain-water remain stagnant during the greater part (lit. all seasons) of the year making them damp and humid in all seasons. 13-14
पादयोर्हस्तयोश्चापि श्लीपदं जायते नृणाम् । कर्णाक्षिनासिकौष्ठेषु केचिदिच्छन्ति तद्विदः ।। १५ ।।
The disease is usually found to be confined to the legs and hands of men but cases are on record in which it has extended to the ear, nose, lips and the regions of the eyes. (Penis–Madhava-Nidana). 15
इति सुश्रुतसंहितायां निदानस्थाने वृद्धयुपदंशश्लीपदनिदानं नाम द्वादशोऽध्यायः ।। १२ ।।
Thus ends the twelfth Chapter of the Nidanasthana in the Susruta Samhita which treats of the Nidana of scrotal tumours, hernia, Upadansa and elephantiasis.
