The twelfth chapter of Nidanasthana of Sushruta Samhita is called as Vrddhi-Upadamsa- Slipada Nidanam Adhyaya. This chapter offers with Enlargement of Scrotum – Venereal ailments and Filariasis.
अथातो वृद्ध्युपदंशश्लीपदानां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Vrddhi – upadamsa – slipada Nidana – prognosis of enlargement of the scrotum, venereal ailments and filariasis; as revealed by the venerable Dhanvantari.
Vidha – sorts
वातपित्तश्लेष्मशोणितमेदोमूत्रान्त्रनिमित्ताः सप्त वृद्धयो भवन्ति |
तासां मूत्रान्त्रनिमित्ते वृद्धी वातसमुत्थे, केवलमुत्पत्तिहेतुरन्यतमः ||३||
Varieties of Vrddhi –
There are eight forms of Vrddhi. They’re
- Vataja – brought on by vata aggravation
- Pittaja – brought on by pitta aggravation
- Kaphaja – brought on by kapha aggravation
- Raktaja / Sonitaja – brought on by aggravation of blood
- Medoja – brought on by vitiated fats tissue
- Mutraja – brought on by urine
- Antraja – brought on by protrusion of gut
Amongst these Vrddhis, these brought on by mutra and antra are produced by vata itself. Solely their causative and thrilling elements are completely different.
Samprapti – pathogenesis (which means) of Vrddhi
अधः प्रकुपितोऽन्यतमो हि दोषः फलकोशवाहिनीरभिप्रपद्य धमनीः फलकोषयोर्वृद्धिं जनयति, तां वृद्धिमित्याचक्षते ||४||
Any one of many above talked about aggravated doshas which get aggravated on account of their etiological elements journey downwards and get localized within the blood vessels / arteries of the phalakosa – scrotum. By doing so, the doshas trigger enlargement of scrotum. Due to this fact, this situation is named as vrddhi, which implies enlargement.
Purvarupa – Premonitory signs
तासां भविष्यतीनां पूर्वरूपाणि- बस्तिकटीमुष्कमेढ्रेषु वेदना मारुतनिग्रहः फलकोशशोफश्चेति ||५||
The premonitory signs of Vrddhi embrace –
– ache within the bladder
– ache within the scrotum
– ache within the penis
– retention of flatus
– swelling of scrotum
Rupa – indicators and signs
तत्रानिलपरिपूर्णां बस्तिमिवाततां परुषामनिमित्तानिलरुजां वातवृद्धिमाचक्षते; पक्वोदुम्बरसङ्काशां ज्वरदाहोष्मवतीं चाशुसमुत्थानपाकां पित्तवृद्धिं; कठिनामल्पवेदनां शीतां कण्डूमतीं श्लेष्मवृद्धिं; कृष्णस्फोटावृतां पित्तवृद्धिलिङ्गां रक्तवृद्धिं, मृदुस्निग्धां कण्डूमतीमल्पवेदनां तालफलप्रकाशां मेदोवृद्धिं; मूत्रसन्धारणशीलस्य मूत्रवृद्धिर्भवति, सा गच्छतोऽम्बुपूर्णा दृतिरिव क्षुभ्यति मूत्रकृच्छ्रवेदनां वृषणयोः श्वयथुं कोशयोश्चापादयति, तां मूत्रवृद्धिं विद्यात्; भारहरणबलवद्विग्रहवृक्षप्रपतनादिभिरायासविशेषैर्वायुरभिप्रवृद्धः प्रकुपितश्च स्थूलान्त्रस्येतरस्य चैकदेशं विगुणमादायाधो गत्वा वङ्क्षणसन्धिमुपेत्य ग्रन्थिरूपेण स्थित्वाऽप्रतिक्रियमाणे च कालान्तरेण फलकोशं प्रविश्य मुष्कशोफमापादयति, आध्मातो बस्तिरिवाततः प्रदीर्घः स शोफो भवति, सशब्दमवपीडितश्चोर्ध्वमुपैति, विमुक्तश्च पुनराध्मायते , तामन्त्रवृद्धिमसाध्यामित्याचक्षते ||६||
Signs of Vataja Vrddhi –
– look of the scrotum – resembles air crammed bag
– is tough on contact
– ache happens with none particular trigger
Signs of Pittaja Vrddhi –
– look of the scrotum – resembles a ripe Udumbara fruit in colour – reddish brown in colour
– presence of fever, burning sensation and raised warmth
– fast in onset
– fast in ripening / suppuration (pus is shaped within the swelling shortly)
Signs of Kaphaja Vrddhi –
– scrotum is tough to really feel
– has delicate ache
– chilly on contact
– has itching
Signs of Raktaja Vrddhi –
– black eruptions are current throughout over the scrotum
– signs of pittaja vrddhi are additionally seen
Signs of Medoja Vrddhi –
– look of the scrotum – resembles Tala fruit in look – darkish blue in colour and large in measurement
– scrotum is comfortable on contact
– unctuous
– has itching
– has slight ache
Signs of Mutraja Vrddhi –
– causes – suppression of urge for urination habitually
– look of scrotum – scrotum resembles a water full of bag and in addition develops actions much like that
– dysuria
– ache in testicles
– swelling / oedema of the scrotum
Signs of Antra Vrddhi – vrddhi
Causes –
– carrying heavy masses habitually
– combating with robust individuals or animals habitually
– falling from the tree
– another strenuous actions
Pathogenesis –
As a result of above mentioned causative elements, vata would get aggravated. This aggravated vata would trigger abnormalities within the colon and small gut, at explicit place. Later, the vata would push that a part of the gut down into the groins and keep therein like a tumor for a while.
Sooner or later of time, if left untreated, the coils of the intestines descend into the scrotum and produce swelling of the scrotum.
Signs and indicators
– look – the scrotum seems like a bag of air, elongated and swollen
– the intestines transfer up accompanied with sound when the doctor presses it along with his palms and
– it swells up as soon as once more when the doctor releases the stress on it
This situation by which the antra i.e. gut seems to enlarge because it descends into the scrotum, is named as antra vrddhi. It’s thought of as incurable.
तत्रातिमैथुनादतिब्रह्मचर्याद्वा तथाऽतिब्रह्मचारिणीं चिरोत्सृष्टां रजस्वलां दीर्घरोमां कर्कशरोमां सङ्कीर्णरोमां निगूढरोमामल्पद्वारां महाद्वारामप्रियामकामामचौक्षसलिलप्रक्षालितयोनिमप्रक्षालितयोनिं योनिरोगोपसृष्टां स्वभावतो वा दुष्टयोनिं वियोनिं वा नारीमत्यर्थमुपसेवमानस्य तथा करजदशनविषशूकनिपातनाद्बन्धनाद्धस्ताभिघाताच्चतुष्पदीगमनादचौक्षसलिलप्रक्षालनादवपीडनाच्छ्रुक्रवेगविधारणान्मैथुनान्ते वाऽप्रक्षालनादिभिर्मेढ्रमागम्य प्रकुपिता दोषाः क्षतेऽक्षते वा श्वयथुमुपजनयन्ति, तमुपदंशमित्याचक्षते ||७||
Nidana – causes
Indulgence in an excessive amount of intercourse / copulation
Indulgence in an excessive amount of celibacy
Copulating with beneath talked about sorts of ladies
– essentially the most celibate
– who has not indulged in copulation for a very long time
– who’s in her menstrual durations
– who has lengthy, tough, matted or hidden pubic hairs
– who has very small or very huge vagina
– who just isn’t appreciated
– who just isn’t excited about intercourse
– who has washed her vagina with soiled water
– who has in no way washed her vagina
– who’s affected by vaginal ailments
– who has a nasty vagina by nature
Individual utilizing locations aside from vagina – like mouth, rectum, armpits for intercourse – his penis will get damage by nails, tooth and so on.
Utility of paste of toxic bugs and by wrapping it
Squeezing the penis by palms – masturbation
Copulating with quadrupeds like cow, goat, sheep, donkey, horse, canine and so on.
Washing the penis with soiled water or water unsuitable for laundry
Vigorous kneading
Forcibly controlling the ejaculation
Not washing the penis quickly after the copulation
As a result of above mentioned and lots of different such untoward actions, the doshas get aggravated and get localized within the penis. They produce swelling therein, with or and not using a wound. This illness is named as Upadamsa – venereal illness.
Bheda and Laksanas – sorts and signs
स पञ्चविधस्त्रिभिर्दोषैः पृथक् समस्तैरसृजा चेति ||८||
तत्र वातिके पारुष्यं त्वक्परिपुटनं स्तब्धमेढ्रता परुषशोफता विविधाश्च वातवेदनाः; पैत्तिके ज्वरः श्वयथुः पक्वोडुम्बरसङ्काशस्तीव्रदाहः क्षिप्रपाकः पित्तवेदनाश्च; श्लैष्मिके श्वयथुः कण्डूमान् कठिनः स्निग्धः श्लेष्मवेदनाश्च; रक्तजे कृष्णस्फोटप्रादुर्भावोऽत्यर्थमसृक्प्रवृत्तिः पित्तलिङ्गान्यत्यर्थं ज्वरदाहौ शोषश्च, याप्यश्चैव कदाचित्; सर्वजे सर्वलिङ्गदर्शनमवदरणं च शेफसः कृमिप्रादुर्भावो मरणं चेति ||९||
Upadamsa is of 5 sorts. They’re –
– Vataja Upadamsa
– Pittaja Upadamsa
– Kaphaja Upadamsa
– Sannipataja / Tridoshaja Upadamsa and
– Raktaja Upadamsa
| Sort of Upadamsa | Signs |
| Vataja Upadamsa | Penis is tough on contact
The pores and skin of the penis is cracked Penis is stiff and doesn’t transfer Swelling – coarse to the touch Presents with completely different sorts of pains of vata origin |
| Pittaja Upadamsa | Fever
Swelling – resembles Udumbara fruit Extreme burning sensation Suppurates shortly Presence of different signs and pains of pitta aggravation |
| Kaphaja Upadamsa | Swelling has itching, is tough on contact and is unctuous
Presents with different signs of kapha origin |
| Raktaja Upadamsa | Black coloured vesicles with extreme bleeding
Signs of pitta aggravation are current, like – fever, burning sensation and dryness That is yapya – manageable, persists for very long time and isn’t completely curable |
| Tridoshaja Upadamsa | Presence of signs of all of the three doshas collectively
Penis is cracked and ulcerated Growth of worms within the ulcers Demise |
Samprapti- Pathogenesis
कुपितास्तु दोषा वातपित्तश्लेष्माणोऽधःप्रपन्ना वङ्क्षणोरुजानुजङ्घास्ववतिष्ठमानाः कालान्तरेण पादमाश्रित्य शनैः शोफं जनयन्ति, तं श्लीपदमित्याचक्षते |
तत्त्रिविधं- वातपित्तकफनिमित्तमिति ||१०||
Vata, Pitta and Kapha aggravated by their very own etiological elements, transfer downwards, attain the groins, thighs, foreleg, and calves. Progressively these doshas attain the toes in the end of time and provides rise to swelling. This illness is named as Slipada.
There are three sorts of Slipada i.e.
– Vataja Slipada
– Pittaja Slipada and
– Kaphaja Slipada
Laksanas- indicators and signs
तत्र, वातजं खरं कृष्णं परुषमनिमित्तानिलरुजं परिस्फुटति च बहुशः; पित्तजं तु पीतावभासमीषन्मृदु ज्वरदाहप्रायं च; श्लेष्मजं तु श्वेतं स्निग्धावभासं मन्दवेदनं भारिकं महाग्रन्थिकं कण्टकैरुपचितं च ||११||
| Sort of Slipada | Signs |
| Vataja Slipada | Toes are tough, black in colour and coarse
Presents with vata sort of pains Seems with none apparent trigger Pores and skin is enormously cracked |
| Pittaja Slipada | Toes are yellow in colour and little easy
Presence of fever |
| Kaphaja Slipada | Toes are white in colour, is unctuous
Has delicate ache Heaviness Tremendously nodular Studded with thorny projections |
Prognosis
तत्र संवत्सरातीतमतिमहद्वल्मीकजातं प्रसृतमिति वर्जनीयानि ||१२||
Slipada with beneath talked about options ought to be rejected and never handled –
– Current for one 12 months
– Grown massively and could be very huge in measurement
– Resembles anthill in look
– That which discharges (exudes) fluids
भवन्ति चात्र-
Some verses right here:-
त्रीण्यप्येतानि जानीयाच्छ्लीपदानि कफोच्छ्रयात् |
गुरुत्वं च महत्त्वं च यस्मान्नास्ति विना कफात् ||१३||
Heaviness and large measurement of the leg can not occur with out the involvement of kapha and these are the options of all types of Slipada. Due to this fact, all of the three sorts of Slipada described above ought to be thought of as produced by improve of kapha.
पुराणोदकभूयिष्ठाः सर्वर्तुषु च शीतलाः |
ये देशास्तेषु जायन्ते श्लीपदानि विशेषतः ||१४||
Slipada particularly happens within the beneath talked about situations –
– In locations the place there’s extra of previous and stagnated water
– In locations that are chilly in all of the seasons of the 12 months
पादवद्धस्तयोश्चापि श्लीपदं जायते नृणाम् |
कर्णाक्षिनासिकौष्ठेषु केचिदिच्छन्ति तद्विदः ||१५||
Identical to the toes, Slipada additionally impacts the palms. Based on the opinion of different consultants, it additionally develops within the ear, eyes, nostril and lips.
इति सुश्रुतसंहितायां निदानस्थाने वृद्ध्युपदंशश्लीपदनिदानं
नाम द्वादशोऽध्यायः ||१२||
Thus ends the Twelvth chapter by title Vrddhi- Upadamsa slipada Nidanam in Nidana sthana of Susrutha Samhita.