160 - Diseases

Dhanvantari said: 

1-3. I shall now describe the pathology of Vidradhi (Erysipelas) and Gulma (Intumescence), please listen O Sushruta. If stale or very hot, dry, coarse and parchifying food-stuffs are taken, or if abnormal activities are indulged in, if hard and uneven beds are used the blood becomes vitiated. Then it vitiates the skin, flesh, fat and bones and takes refuge in the abdominal cavity and produces intumescence inside and outside the body. It gives excruciating pain. It may be elongated or circular in shape. This is called Vidradhi. 

4. The doshas either severally or in combination produce on the surface of the body on different limbs knotty intumescences due to exuding contaminated blood. 

5. Inside, they are in the form of inflammations very terrible, deep seated and exuding. They grow like anthills. They impair digestion. 

6. They usually occur in the umbilical region, urinary bladder, liver, spleen lungs, heart, abdomen and the thigh joints. When there is palpitation of the heart they give excruciating pain. 

7. At the time of incubation it is black in colour and at the time of ripening or suppurating it becomes red. It is irregular information: It brings in loss of consciousness, vertigo, constipation, suppression of urine and noisiness in movement. 

8. In the pittaja type it is red, copper coloured or black producing thirst, fainting, fever and burning sensation. In the kaphaja type it quickly incubates and suppurates. A little greyish in colour it gives an itching sensation. 

9. Shivering, chillness to touch, numbness of the affected part, yawning, nonrelish for food and heaviness are the symptoms. The Sannipataja type is slow in growth and does not suppurate. It is irregular in formation. 

10 Looseness of the bowels is the common characteristic of both the external and the internal vidradhi. It assumes a black colour, surrounded by blisters and is attended with an intolerable burning pain and fever. 

11. The external abscess due to contaminated blood is a sign of Pitta. Such abscess in the internal regions is peculiar to women. There is another Vidradhi due to wounds with a weapon, or hitting with something. 

12. The blood originating from the wound is tossed by the Vayu and it aggravates pitta and produces a vidradhi of grave disorders exhibiting the symptoms of both Pitta and contaminated blood. 

13. Difference in the disorder is due to the difference in the seat of the abscess. If puffing up is the disorder in an abscess in the umbilical region that in the bladder is strangury. 

14. An abscess in the spleen will cause difficulty in inhaling and exhaling and excessive thirst. An abscess in the lungs produces constriction in the throat. An abscess in the heart produces pain all over the body. 

15. An abscess in the abdomen or its side produces loss of sense, Tamaka Shvasa (a peculiar dyspnea) and digging pain in the heart. 

16. If there is an abscess in the thigh joints internally or externally or in the hips or on the back the pain will be in the sides and the wind will be obstructed at the rectum. 

17. The state of incubation, that of ripening and that of fully ripened tumour in the inside are to be known as very like those of any swelling. An internal abscess occurring above the umbilical region sends out the exudation after suppuration through the mouth and the others through the anus. 

18. In a vidradhi formation in rectum mouth or umbilical region the dosha can be known from its suppuration. A sannipataja vidradhi shows alteration from its seat. 

19. The Vidradhi in the umbilical region or in the urinary bladder, externally or internally when ripe, bursts. That which is fully grown suppurates but under-developed is infested with disorders. 

20. Sinful wicked women suffer from internal abscesses when the child in the womb dies; an inflammation occurs there very thick.

21. An abscess on the breasts of women has all the characteristics of an external abscess. The blood in women is very subtle. Hence small girls do not suffer from internal abscess. 

22-23. An aggravated but obstructed Vayu in its path generally causes swellings. From the region between scrotum and the thigh joints it reaches the nerve vessel passing beyond the testicles and oppresses it. Thus, it causes its swelling and a vitiation of the fat in the locality. It is called Vruddhi (Hydrocela). It is of seven types.

24. Due to the affliction of Vayu, in the case of Vruddhi whether external or internal there is excessive micturition. The swelling becomes inflated, parched and rough to the touch accompanied by a burning sensation. 

25. Due to the affliction of Pitta the swelling resembles a ripe Udumbara fruit (Ficus Indica) attended with heat, burning sensation and suppuration. Due to the affliction of Kapha the swelling is heavy, glossy and slightly painful. It produces an itching sensation. 

26. Due to the affliction of contaminated blood, the swelling becomes compact, dark in colour and covered with bulbous eruptions on its surface. All the symptoms of Pittaja Vruddhi are present. Due to the action of fat defiled by Kapha the Vruddhi is soft and rounded like a palm fruit. 

27. This ailment is called Mutraja Vruddhi as the patient habitually suppresses the passage of urine. There are no hair on the swelling. It is soft and quiet but is disturbed on movement. 

28. Plunging into chill water, and taking in food-stuffs aggravating the Vayu produces strangury and ringlike markings beneath the scrotum. 

29-30. Suppression of faeces and passage of urine and abnormal activities of the limbs causes the aggravation of the Vayu that affects the virility of the patient and takes the blood downwards. This causes knotty swelling in the thigh joints. 

31. Neglected at the outset this Vruddhi turns into Gulma (enlarged spleen, etc.) and produces in its wake many disorders like distension, etc. Firmly pressed it goes in with a sound but comes out swelling again. 

32. The Rakta Vruddhi is incurable. Vata Vruddhi continues in the same size with a network of coarse blue and red veins like a window covered with a woollen net. 

33. There are seven types of Vruddhi due to the doshas severally and combined in diverse ways and the eighth one happens in women due to the contamination of menstrual blood. 

34. Fever, dysentery, fainting, vomiting, chillness and hunger make even a strong man emaciated. 

35. The patient who takes boiled rice and drinks too much or fasts or takes bath is soon overwhelmed with fits of fainting 

36. Without resorting to emollient or diaphoretic measures, drying up measures shall be used or those measures provoking free flow of blood shall be used whether the patient is free from defiled doshas or not. 

37-38. In the case of the Vataja Vidradhi the wind and the defiled matter can be eliminated separately or collectively. The Vayu mixed with blood passing through the ducts obstructs their upward or downward passage and produces pain. The swelling Gulma can be felt by the hand in a knotty globular shape. It feels a little hot. 

39. The Vayu lodged in the abdomen becomes hard and coarse due to fasting of obstruction to the passage by Kapha and waste matter. 

40. The aggravated Vayu continuing in its own locatiousacts independently, while located in the seat of any other dosha it is dependent on that dosha. The consolidated lump of kapha in combination with dirt occupying the bladder, umbilical region, thoracic cavity and sides is called Gulma. 

41. In the Vataja type of gulma, headache, fever, inflammation of the spleen, rumbling sound in the entrails, a pricking pain in the limbs, loose motions, and difficult painful urination are the symptoms. 

42. There is swelling (Shotha or Anasarcha) in the limbs, mouth or in the feet, impaired gastric function, parchedness and black colour of the skin etc. due to the fickleness of Vayu. 

43. Like a blind man groping about rolling his eye-balls without realising the place where he is, the gulma rolls about as if a number of ants have covered it. It throbs. 

44. Due to Pitta, burning sensation is felt. There are acid eructations, epileptic fits, loose motions, sweating thirst, chlorosis (Haridrya) and swellings all over the body. 

45. The deranged kapha is aggravated or diminishes and scorches its seat. There is rigidity due to kapha, non relish for food, a feeling of exhaustion, heaviness of head and fever. 

46. Obesity, lassitude, disquietude whiteness or blackness of skin etc. are observed. The swelling becomes hard and fixed and the patient has steady sleep for a short while. 

47. Inflammations caused by two doshas in combination affecting their own respective seats and exhibiting their own symptoms prove fatal. 

48-49. Rakta gulma (ovarian tumour) found only in women is caused by all doshas and exhibits severe pain and burning sensation. It suppurates quickly. It is hard and raised and is incurable. If a woman suffering from uterine trouble exposes herself to gusts of wind during her menstrual period the Vayu principle gets aggravated. 

50. It obstructs the passage of menstrual flow of blood which collecting in the abdominal cavity produces symptoms of pregnancy. 

51. Disquietude, milk in the breasts, craving desire for various foodstuffs etc. as in pregnancy and waywardness are also seen. In combination with Vayu, Pitta accumulates in the vaginal passage. 

52. The blood is too collected there. All the symptoms of Vataja and Pittaja gulmas are observed. In the womb the seat of blood there is acute pain. 

53. There is vaginal discharge with fetid smell and lencorrhoea with pain. Enlarged spleen also appears like pregnancy sometimes. All these are due to unnatural desire for sexual intercourse. 

54. It suppurates slowly and the vidradhi does not grow again. If that is contaminated with impure blood it suppurates quickly. 

55-56. Since it gives a burning sensation quickly it is called Vidradhi. If a gulma occurs on another gulma there is burning sensation and pain in the spleen. Digestion is impaired, colour of complexion is faded and strength diminishes. The natural urges are suppressed. If the previous symptoms are not present the symptoms of an external abscess are present. There is not much pain in the viscera or the limbs. 

57. Pallour, cough, bulging out of the abdomen, rumbling sound in the abdomen with excruciating pain and distension are also present.

58. The wind is obstructed above and below. It is called Anaha. If there is the outcome of thick seed-like thing with knotty grips it is called Ashthila. 

59. When the Vayu originating from the stomach gives rise to an excruciating pain and all other symptoms too are present it is called Pratyashthila. 

60-61. Profuse eructation, suppression of faeces, insatiation, rumbling sound in the entrails, severe distension, inability to digest, etc. are the symptoms of an imminent Gulma.