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AYANAACADEMYby Dr Vijaya Dwarampudi
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੪. ਭਗਨ੍ਦਰਨਿਦਾਨਮ੍

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Adhikarana ੧ (੧-੨) · Śloka ੨

ਅਥਾਤੋ ਭਗਨ੍ਦਰਾਣਾਂ ਨਿਦਾਨਂ ਵ੍ਯਾਖ੍ਯਾਸ੍ਯਾਮਃ ||੧|| ਯਥੋਵਾਚ ਭਗਵਾਨ੍ ਧਨ੍ਵਨ੍ਤਰਿਃ ||੨||

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अथातो भगन्दराणां निदानं व्याख्यास्यामः ||१|| यथोवाच भगवान् धन्वन्तरिः ||२||

Meaning of the śloka

Now the diagnosis of bhagandara will be explained, as taught by the revered Dhanvantari.

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ਅਥੇਤ੍ਯਾਦਿ||੧-੨||

Meaning of the commentary

The commentary repeats the conventional opening and provides no further explanation for these verses.

Key terms

bhagandara
A classical anorectal fistula-like disease category.
nidAna (nidāna)
An account of causes and diagnostic features.

Adhikarana ੨ (੩) · Śloka ੩

ਵਾਤਪਿਤ੍ਤਸ਼੍ਲੇਸ੍ਮਸਨ੍ਨਿਪਾਤਾਗਨ੍ਤੁਨਿਮਿਤ੍ਤਾਃ ਸ਼ਤਪੋਨਕੋਸ੍ਟ੍ਰਗ੍ਰੀਵਪਰਿਸ੍ਰਾਵਿਸ਼ਮ੍ਬੂਕਾਵਰ੍ਤੋਨ੍ਮਾਰ੍ਗਿਣੋ ਯਥਾਸਙ੍ਖ੍ਯਂ ਪਞ੍ਚ ਭਗਨ੍ਦਰਾ ਭਵਨ੍ਤਿ | ਤੇ ਤੁ ਭਗਗੁਦਬਸ੍ਤਿਪ੍ਰਦੇਸ਼ਦਾਰਣਾਚ੍ਚ ‘ਭਗਨ੍ਦਰਾ’ ਇਤ੍ਯੁਚ੍ਯਨ੍ਤੇ | ਅਭਿਨ੍ਨਾਃ ਪਿਡਕਾਃ, ਭਿਨ੍ਨਾਸ੍ਤੁ ਭਗਨ੍ਦਰਾਃ ||੩||

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वातपित्तश्लेष्मसन्निपातागन्तुनिमित्ताः शतपोनकोष्ट्रग्रीवपरिस्राविशम्बूकावर्तोन्मार्गिणो यथासङ्ख्यं पञ्च भगन्दरा भवन्ति | ते तु भगगुदबस्तिप्रदेशदारणाच्च ‘भगन्दरा’ इत्युच्यन्ते | अभिन्नाः पिडकाः, भिन्नास्तु भगन्दराः ||३||

Meaning of the śloka

Five kinds of bhagandara are enumerated according to causes involving vāta, pitta, kapha, combined doṣas, and an external factor: śataponaka, uṣṭragrīva, parisrāvin, śambūkāvarta, and unmārgin respectively. They are called bhagandara because they tear or disrupt the region of the perineum, anus, and bladder. Before rupture they are termed swellings or boils; after rupture they are called bhagandara.

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ਵਾਤਪਿਤ੍ਤੇਤ੍ਯਾਦਿ| ਸਙ੍ਖ੍ਯੇਯਨਿਰ੍ਦੇਸ਼ਾਦੇਵ ਸਙ੍ਖ੍ਯਾਸਿਦ੍ਧੌ ਪਞ੍ਚੇਤਿਵਚਨਂ ਸ਼ੋਣਿਤਜਾਦਿਨਿਸੇਧਾਰ੍ਥਮ੍| ਭਗਨ੍ਦਰਨਿਰੁਕ੍ਤਿਮਾਹ- ਤੇ ਤ੍ਵਿਤ੍ਯਾਦਿ||੩||

Meaning of the commentary

The commentary notes that the five names and five causes already imply the number. The explicit word 'five' excludes additional categories such as a blood-origin type. It then points to the verse's own derivation of the name bhagandara from disruption of the involved anatomical region.

Key terms

shataponaka (śataponaka)
The vāta-associated type, named for having many small openings.
uShTragrIva (uṣṭragrīva)
The pitta-associated type, whose name means camel-neck shaped.
parisrAvin (parisrāvin)
The kapha-associated, continuously discharging type.
shambUkAvarta (śambūkāvarta)
The combined-doṣa type, named for a spiral resembling a snail shell.
unmArgin (unmārgin)
The externally caused type characterized by an abnormal tract.

Adhikarana ੩ (੪) · Śloka ੪

ਤੇਸਾਂ ਤੁ ਪੂਰ੍ਵਰੂਪਾਣਿ- ਕਟੀਕਪਾਲਵੇਦਨਾ ਕਣ੍ਡੂਰ੍ਦਾਹਃ ਸ਼ੋਫਸ਼੍ਚ ਗੁਦਸ੍ਯ ਭਵਤਿ ||੪||

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तेषां तु पूर्वरूपाणि- कटीकपालवेदना कण्डूर्दाहः शोफश्च गुदस्य भवति ||४||

Meaning of the śloka

Prodromal features of bhagandara are pain in the pelvic or sacral plate, together with itching, burning, and swelling of the anal region.

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ਪੂਰ੍ਵਰੂਪਮਾਹ- ਤੇਸਾਂ ਤ੍ਵਿਤ੍ਯਾਦਿ| ਤੇਸਾਂ ਤੁ ਪੂਰ੍ਵਰੂਪਾਣਿ ‘ਭਵਨ੍ਤਿ’ ਇਤ੍ਯਰ੍ਥਃ| ਕਟੀਕਪਾਲਃ ਕਟੀਫਲਕਃ||੪||

Meaning of the commentary

The commentary identifies these as signs arising before bhagandara becomes manifest and glosses kaṭīkapāla as the bony plate or broad region of the waist and pelvis.

Key terms

pUrvarUpa (pūrvarūpa)
A prodromal feature appearing before full manifestation.
kaTIkapAla (kaṭīkapāla)
The pelvic, sacral, or broad waist region described as a bony plate.
gudashopha (guda-śopha)
Swelling in the anal or perianal region.

Adhikarana ੪ (੫) · Śloka ੫

ਤਤ੍ਰਾਪਥ੍ਯਸੇਵਿਨਾਂ ਵਾਯੁਃ ਪ੍ਰਕੁਪਿਤਃ ਸਨ੍ਨਿਵਤ੍ਤਃ ਸ੍ਥਿਰੀਭੂਤੋ ਗੁਦਮਭਿਤੋਙ੍ਗੁਲੇ ਦ੍ਵ੍ਯਙ੍ਗੁਲੇ ਵਾ ਮਾਂਸਸ਼ੋਣਿਤੇ ਪ੍ਰਦੂਸ੍ਯਾਰੁਣਵਰ੍ਣਾਂ ਪਿਡਕਾਂ ਜਨਯਤਿ, ਸਾਸ੍ਯ ਤੋਦਾਦੀਨ੍ ਵੇਦਨਾਵਿਸ਼ੇਸਾਞ੍ਜਨਯਤਿ, ਅਪ੍ਰਤਿਕ੍ਰਿਯਮਾਣਾ ਚ ਪਾਕਮੁਪੈਤਿ, ਮੂਤ੍ਰਾਸ਼ਯਾਭ੍ਯਾਸਗਤਤ੍ਵਾਚ੍ਚ ਵ੍ਰਣਃ ਪ੍ਰਕ੍ਲਿਨ੍ਨਃ ਸ਼ਤਪੋਨਕਵਦਣੁਮੁਖੈਸ਼੍ਛਿਦ੍ਰੈਰਾਪੂਰ੍ਯਤੇ, ਤਾਨਿ ਚ ਛਿਦ੍ਰਾਣ੍ਯਜਸ੍ਰਮਚ੍ਛਂ ਫੇਨਾਨੁਵਿਦ੍ਧਮਧਿਕਮਾਸ੍ਰਾਵਂ ਸ੍ਰਵਨ੍ਤਿ , ਵ੍ਰਣਸ਼੍ਚ ਤਾਡ੍ਯਤੇ ਭਿਦ੍ਯਤੇ ਛਿਦ੍ਯਤੇ ਸੂਚੀਭਿਰਿਵ ਨਿਸ੍ਤੁਦ੍ਯਤੇ, ਗੁਦਂ ਚਾਵਦੀਰ੍ਯਤੇ, ਉਪੇਕ੍ਸਿਤੇ ਚ ਵਾਤਮੂਤ੍ਰਪੁਰੀਸਰੇਤਸਾਮਪ੍ਯਾਗਮਸ਼੍ਚ ਤੈਰੇਵ ਛਿਦ੍ਰੈਰ੍ਭਵਤਿ; ਤਂ ਭਗਨ੍ਦਰਂ ਸ਼ਤਪੋਨਕਮਿਤ੍ਯਾਵਕ੍ਸਤੇ ||੫||

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तत्रापथ्यसेविनां वायुः प्रकुपितः सन्निवृत्तः स्थिरीभूतो गुदमभितोऽङ्गुले द्व्यङ्गुले वा मांसशोणिते प्रदूष्यारुणवर्णां पिडकां जनयति, साऽस्य तोदादीन् वेदनाविशेषाञ्जनयति, अप्रतिक्रियमाणा च पाकमुपैति, मूत्राशयाभ्यासगतत्वाच्च व्रणः प्रक्लिन्नः शतपोनकवदणुमुखैश्छिद्रैरापूर्यते, तानि च छिद्राण्यजस्रमच्छं फेनानुविद्धमधिकमास्रावं स्रवन्ति , व्रणश्च ताड्यते भिद्यते छिद्यते सूचीभिरिव निस्तुद्यते, गुदं चावदीर्यते, उपेक्षिते च वातमूत्रपुरीषरेतसामप्यागमश्च तैरेव छिद्रैर्भवति; तं भगन्दरं शतपोनकमित्यावक्षते ||५||

Meaning of the śloka

In a person following an unsuitable regimen, aggravated vāyu is said to become confined and fixed around the anus, at a distance of one or two aṅgulas, disturb flesh and blood, and produce a reddish swelling. It causes pricking and other distinctive pains. If not treated, it suppurates. Because the wound lies near the urinary bladder, it becomes moist and develops numerous minute openings like a śataponaka. These continually discharge a large quantity of clear, frothy fluid. The wound feels beaten, split, cut, and pierced with needles, and the anus feels torn. If neglected, flatus, urine, feces, and semen are said eventually to pass through those openings. This form is called śataponaka bhagandara.

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ਪੂਰ੍ਵਰੂਪਾਨਨ੍ਤਰਂ ਪਿਡਿਕੋਤ੍ਪਤ੍ਤਿਪਾਕੋਪਦ੍ਰਵਨਿਰੁਕ੍ਤੀਦਰ੍ਸ਼ਯਨ੍ਨਾਹ- ਤਤ੍ਰਾਪਥ੍ਯੇਤ੍ਯਾਦਿ| ਸਨ੍ਨਿਵਤ੍ਤੌ ਵ੍ਯਾਘੁਟਿਤਃ| ਗੁਦਮਭਿਤੋ ਗੁਦਸ੍ਯ ਸਰ੍ਵਤਃ; ਅਨ੍ਯੇ ‘ਗੁਦਸਨ੍ਨਿਧੌ’ ਇਤ੍ਯਾਹੁਃ| ਅਭ੍ਯਾਸਃ ਸਮੀਪਮ੍| ਸ਼ਤਪੋਨਕਃ ਸ਼ੂਕਦੋਸਪਰਿਪਠਿਤੋ ਵ੍ਯਾਧਿਃ; ‘ਚਾਲਨਿਕਾ’ ਇਤਿ ਜੇਜ੍ਝਟਃ; ਤਨ੍ਨੇਚ੍ਛਤਿ ਗਯੀ, ਲੋਕਸ਼ਾਸ੍ਤ੍ਰਯੋਸ਼੍ਚਾਲਨਿਕਾਯਾਂ ਸ਼ਤਪੋਨਕਸ਼ਬ੍ਦਸ੍ਯਾਪ੍ਰਸਿਦ੍ਧਤ੍ਵਾਤ੍; ‘ਅਸ਼੍ਵਪੁਚ੍ਛਬਾਲਰਚਿਤਂ ਸ਼ਤਾਕ੍ਸਕਂ’ ਇਤ੍ਯਨ੍ਯੇ| ਤੁਦ੍ਯਤੇ ਵ੍ਯਥ੍ਯਤੇ| ਤਾਡ੍ਯਤੇ ਦਣ੍ਡੇਨੇਵਾਭਿਹਨ੍ਯਤ ਇਤ੍ਯਰ੍ਥਃ| ਭਿਦ੍ਯਤੇ ਤ੍ਵਗ੍ਵਿਦਾਰ੍ਯਤ ਇਵ| ਛਿਦ੍ਯਤੇ ਦ੍ਵਿਧਾ ਕ੍ਰਿਯਤ ਇਵ||੫||

Meaning of the commentary

The commentary traces the sequence from swelling through suppuration, complications, and naming. Sannivṛtta means turned back or confined. 'Around the anus' is taken literally as on all sides, though others interpret it simply as near the anus. Abhyāsa means proximity. Śataponaka is also the name of a disorder listed among śūka-related conditions. Jejjhaṭa identifies it with cālanikā, but Gayī rejects this because that usage is not established in common or technical language. Others compare it with a many-eyed object woven from horse-tail hairs. The pain terms describe sensations as if struck by a stick, as if the skin were being torn, as if cut in two, and as if pierced.

Key terms

piDakA (piḍakā)
A swelling, boil, or inflammatory lump before it ruptures.
pAka (pāka)
Suppuration or maturation of the swelling.
shataponaka (śataponaka)
The many-opening vāta-associated form of bhagandara.
aNumukha chidra (aṇu-mukha chidra)
An opening with a minute mouth.
ajasra AsrAva (ajasra āsrāva)
Continuous discharge.

Adhikarana ੫ (੬) · Śloka ੬

ਪਿਤ੍ਤਂ ਤੁ ਪ੍ਰਕੁਪਿਤਮਨਿਲੇਨਾਧਃ ਪ੍ਰੇਰਿਤਂ ਪੂਰ੍ਵਵਦਵਸ੍ਥਿਤਂ ਰਕ੍ਤਾਂ ਤਨ੍ਵੀਮੁਚ੍ਛ੍ਰਿਤਾਮੁਸ੍ਟ੍ਰਗ੍ਰੀਵਾਕਾਰਾਂ ਪਿਡਕਾਂ ਜਨਯਤਿ; ਸਾਸ੍ਯ ਚੋਸਾਦੀਨ੍ ਵੇਦਨਾਵਿਸ਼ੇਸਾਞ੍ਜਨਯਤਿ; ਅਪ੍ਰਤਿਕ੍ਰਿਯਮਾਣਾ ਚ ਪਾਕਮੁਪੈਤਿ; ਵ੍ਰਣਸ਼੍ਚਾਗ੍ਨਿਕ੍ਸਾਰਾਭ੍ਯਾਮਿਵ ਦਹ੍ਯਤੇ, ਦੁਰ੍ਗਨ੍ਧਮੁਸ੍ਣਮਾਸ੍ਰਾਵਂ ਸ੍ਰਵਤਿ, ਉਪੇਕ੍ਸਿਤਸ਼੍ਚ ਵਾਤਮੂਤ੍ਰਪੁਰੀਸਰੇਤਾਂਸਿ ਵਿਸਜਤਿ; ਤਂ ਭਗਨ੍ਦਰਮੁਸ੍ਟ੍ਰਗ੍ਰੀਵਮਿਤ੍ਯਾਚਕ੍ਸਤੇ ||੬||

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पित्तं तु प्रकुपितमनिलेनाधः प्रेरितं पूर्ववदवस्थितं रक्तां तन्वीमुच्छ्रितामुष्ट्रग्रीवाकारां पिडकां जनयति; साऽस्य चोषादीन् वेदनाविशेषाञ्जनयति; अप्रतिक्रियमाणा च पाकमुपैति; व्रणश्चाग्निक्षाराभ्यामिव दह्यते, दुर्गन्धमुष्णमास्रावं स्रवति, उपेक्षितश्च वातमूत्रपुरीषरेतांसि विसृजति; तं भगन्दरमुष्ट्रग्रीवमित्याचक्षते ||६||

Meaning of the śloka

Aggravated pitta, driven downward by anila and situated near the anus as described earlier, produces a thin, raised, reddish swelling shaped like a camel’s neck. It causes burning and related distinctive pains and, if untreated, suppurates. The resulting wound feels as though burned by fire or alkali and releases a hot, foul-smelling discharge. If neglected, it may discharge flatus, urine, stool, and reproductive fluid. This bhagandara is called uṣṭragrīva.

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ਪਿਤ੍ਤਂ ਤ੍ਵਿਤ੍ਯਾਦਿ| ਪੂਰ੍ਵਵਦਵਸ੍ਥਿਤਮਿਤਿ ਗੁਦਮਭਿਤੋਙ੍ਗੁਲੇ ਦ੍ਵ੍ਯਙ੍ਗੁਲੇ ਵੇਤ੍ਯਰ੍ਥਃ| ਵਿਸਜਤਿ ਸ੍ਰਵਤਿ ਵ੍ਰਣ ਇਤਿ ਸਮ੍ਬਨ੍ਧਃ||੬||

Meaning of the commentary

The commentary explains ‘situated as before’ as located about one or two fingerbreadths around the anus. In the final sentence, it is the wound that discharges the listed substances.

Key terms

uShTragrIva (uṣṭragrīva)
The pitta-predominant bhagandara subtype named for a camel-neck-shaped swelling.
piDakA (piḍakā)
A localized swelling or inflammatory lesion.
pAka (pāka)
Suppuration or maturation of the swelling into a wound.
AsrAva (āsrāva)
Discharge from the lesion.

Adhikarana ੬ (੭) · Śloka ੭

ਸ਼੍ਲੇਸ੍ਮਾ ਤੁ ਪ੍ਰਕੁਪਿਤਃ ਸਮੀਰਣੇਨਾਧਃ ਪ੍ਰੇਰਿਤਃ ਪੂਰ੍ਵਵਦਵਸ੍ਥਿਤਃ ਸ਼ੁਕ੍ਲਾਵਭਾਸਾਂ ਸ੍ਥਿਰਾਂ ਕਣ੍ਡੂਮਤੀਂ ਪਿਡਕਾਂ ਜਨਯਤਿ, ਸਾਸ੍ਯ ਕਣ੍ਡ੍ਵਾਦੀਨ੍ ਵੇਦਨਾਵਿਸ਼ੇਸਾਞ੍ਜਨਯਤਿ, ਅਪ੍ਰਤਿਕ੍ਰਿਯਮਾਣਾਂ ਚ ਪਾਕਮੁਪੈਤਿ, ਵ੍ਰਣਸ਼੍ਚ ਕਠਿਨਃ ਸਂਰਮ੍ਭੀ ਕਣ੍ਡੂਪ੍ਰਾਯਃ ਪਿਚ੍ਛਿਲਮਜਸ੍ਰਮਾਸ੍ਰਾਵਂ ਸ੍ਰਵਤਿ, ਉਪੇਕ੍ਸਿਤਸ਼੍ਚ ਵਾਤਮੂਤ੍ਰਪੁਰੀਸਰੇਤਾਂਸਿ ਵਿਸਜਤਿ; ਤਂ ਭਗਨ੍ਦਰਂ ਪਰਿਸ੍ਰਾਵਿਣਮਿਤ੍ਯਾਚਕ੍ਸਤੇ ||੭||

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श्लेष्मा तु प्रकुपितः समीरणेनाधः प्रेरितः पूर्ववदवस्थितः शुक्लावभासां स्थिरां कण्डूमतीं पिडकां जनयति, साऽस्य कण्ड्वादीन् वेदनाविशेषाञ्जनयति, अप्रतिक्रियमाणां च पाकमुपैति, व्रणश्च कठिनः संरम्भी कण्डूप्रायः पिच्छिलमजस्रमास्रावं स्रवति, उपेक्षितश्च वातमूत्रपुरीषरेतांसि विसृजति; तं भगन्दरं परिस्राविणमित्याचक्षते ||७||

Meaning of the śloka

Aggravated śleṣman, driven downward by samīra and situated near the anus as previously described, produces a pale or white, firm, itchy swelling. It causes itching and related discomfort and, if untreated, suppurates. The resulting wound is hard, swollen, predominantly itchy, and continuously discharges sticky material. If neglected, it may discharge flatus, urine, stool, and reproductive fluid. This bhagandara is called parisrāvin.

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ਸ਼੍ਲੇਸ੍ਮੇਤ੍ਯਾਦਿ| ਸਂਰਮ੍ਭੀ ਸ਼ੋਫਵਾਨ੍| ਕਣ੍ਡੂਪ੍ਰਾਯਃ ਖਰ੍ਜੂਬਹੁਲਃ| ਪਰਿਸ੍ਰਾਵੀਤ੍ਯੇਵਂਸ਼ੀਲਃ ਪਰਿਸ੍ਰਾਵੀ||੭||

Meaning of the commentary

The commentary glosses saṃrambhin as swollen and kaṇḍū-prāya as having abundant itching. Parisrāvin means a lesion characterized by continuous discharge.

Key terms

parisrAvin (parisrāvin)
The kapha-predominant bhagandara subtype characterized by persistent discharge.
shleShma (śleṣman)
Kapha, the predominant doṣa in this subtype.
saMrambhin (saṃrambhin)
Swollen or inflamed according to the commentary.
picchila AsrAva (picchila āsrāva)
Sticky or mucilaginous discharge.

Adhikarana ੭ (੮) · Śloka ੮

ਵਾਯੁਃ ਪ੍ਰਕੁਪਿਤਃ ਪ੍ਰਕੁਪਿਤੌ ਪਿਤ੍ਤਸ਼੍ਲੇਸ੍ਮਾਣੌ ਪਰਿਗਹ੍ਯਾਧੋ ਗਤ੍ਵਾ ਪੂਰ੍ਵਵਦਵਸ੍ਥਿਤਃ ਪਾਦਾਙ੍ਗੁਸ੍ਠਾਗ੍ਰਪ੍ਰਮਾਣਾਂ ਸਰ੍ਵਲਿਙ੍ਗਾਂ ਪਿਡਕਾਂ ਜਨਯਤਿ, ਸਾਸ੍ਯ ਤੋਦਦਾਹਕਣ੍ਡ੍ਵਾਦੀਨ੍ ਵੇਦਨਾਵਿਸ਼ੇਸਾਞ੍ਜਨਯਤਿ, ਅਪ੍ਰਤਿਕ੍ਰਿਯਮਾਣਾ ਚ ਪਾਕਮੁਪੈਤਿ, ਵ੍ਰਣਸ਼੍ਚ ਨਾਨਾਵਿਧਵਰ੍ਣਮਾਸ੍ਰਾਵਂ ਸ੍ਰਵਤਿ, ਪੂਰ੍ਣਨਦੀਸ਼ਮ੍ਬੂਕਾਵਰ੍ਤਵਚ੍ਚਾਤ੍ਰ ਸਮੁਤ੍ਤਿਸ੍ਠਨ੍ਤਿ ਵੇਦਨਾਵਿਸ਼ੇਸਾਃ; ਤਂ ਭਗਨ੍ਦਰਂ ਸ਼ਮ੍ਬੂਕਾਵਰ੍ਤਮਿਤ੍ਯਾਚਕ੍ਸਤੇ ||੮||

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वायुः प्रकुपितः प्रकुपितौ पित्तश्लेष्माणौ परिगृह्याधो गत्वा पूर्ववदवस्थितः पादाङ्गुष्ठाग्रप्रमाणां सर्वलिङ्गां पिडकां जनयति, साऽस्य तोददाहकण्ड्वादीन् वेदनाविशेषाञ्जनयति, अप्रतिक्रियमाणा च पाकमुपैति, व्रणश्च नानाविधवर्णमास्रावं स्रवति, पूर्णनदीशम्बूकावर्तवच्चात्र समुत्तिष्ठन्ति वेदनाविशेषाः; तं भगन्दरं शम्बूकावर्तमित्याचक्षते ||८||

Meaning of the śloka

Aggravated vāyu takes hold of aggravated pitta and śleṣman, moves downward, and settles near the anus as previously described. It produces a swelling about the size of the tip of the great toe and bearing signs of all the doṣas. The lesion causes pricking pain, burning, itching, and related discomfort and, if untreated, suppurates. Its wound releases discharge of various colours, and distinctive severe pains arise like the eddies of a full river and the spiral of a conch. This bhagandara is called śambūkāvarta.

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‘ਪੂਰ੍ਣਨਦੀਸ਼ਮ੍ਬੂਕਾਵਰ੍ਤਵਨ੍ਨੈਰਨ੍ਤਰ੍ਯੇਣ ਵੇਦਨਾ ਉਤ੍ਤਿਸ੍ਠਨ੍ਤਿ’ ਇਤ੍ਯੇਕੇ; ਅਨ੍ਯੇ ਤੁ ‘ਤਥਾਵਿਧਗਤ੍ਯਾਰਮ੍ਭਕਸ੍ਯ ਸ਼ੋਫਸ੍ਯ ਪੂਰ੍ਣਨਦ੍ਯਾਵਰ੍ਤਸ਼ਮ੍ਬੂਕਾਵਰ੍ਤਾਕਾਰੇਣੇਵਾਵਗਤ੍ਵਾਦਵਗਾਢਵੇਦਨਾ ਭਵਨ੍ਤੀਤ੍ਯਰ੍ਥਃ’| ਸ਼ਮ੍ਬੂਕਾਃ ਸ਼ਙ੍ਖਾਃ||੮||

Meaning of the commentary

One interpretation says that pain arises continuously, like the uninterrupted eddies of a full river and the spiral of a conch. Another says that the swelling’s course or form resembles river eddies and a conch spiral, causing deep-seated pain. Śambūka means a conch.

Key terms

shambUkAvarta (śambūkāvarta)
A combined-doṣa bhagandara subtype named for a conch-like spiral or eddy pattern.
sarvali~gga (sarva-liṅga)
Displaying signs attributed to all the doṣas.
pUrNanadIAvarta (pūrṇa-nadī-āvarta)
The eddy of a full river, used to characterize continuity or form of pain.
avagADhavedanA (avagāḍha-vedanā)
Deep-seated or severe pain in the second interpretation.

Adhikarana ੮ (੯) · Śloka ੯

ਮੂਢੇਨ ਮਾਂਸਲੁਬ੍ਧੇਨ ਯਦਸ੍ਥਿਸ਼ਲ੍ਯਮਨ੍ਨੇਨ ਸਹਾਭ੍ਯਵਹਤਂ ਯਦਾਵਗਾਢਪੁਰੀਸੋਨ੍ਮਿਸ਼੍ਰਮਪਾਨੇਨਾਧਃਪ੍ਰੇਰਿਤਮਸਮ੍ਯਗਾਗਤਂ ਗੁਦਮਪਕ੍ਸਿਣੋਤਿ ਤਦਾ ਕ੍ਸਤਨਿਮਿਤ੍ਤਃ ਕੋਥ ਉਪਜਾਯਤੇ, ਤਸ੍ਮਿਂਸ਼੍ਚ ਕ੍ਸਤੇ ਪੂਯਰੁਧਿਰਾਵਕੀਰ੍ਣਮਾਂਸਕੋਥੇ ਭੂਮਾਵਿਵ ਜਲਪ੍ਰਕ੍ਲਿਨ੍ਨਾਯਾਂ ਕ੍ਰਿਮਯਃ ਸਞ੍ਜਾਯਨ੍ਤੇ, ਤੇ ਭਕ੍ਸਯਨ੍ਤੋ ਗੁਦਮਨੇਕਧਾ ਪਾਰ੍ਸ਼੍ਵਤੋ ਦਾਰਯਨ੍ਤਿ, ਤਸ੍ਯ ਤੈਰ੍ਮਾਰ੍ਗੈਃ ਕਮਿਕਤੈਰ੍ਵਾਤਮੂਤ੍ਰਪੁਰੀਸਰੇਤਾਂਸ੍ਯਭਿਨਿਃਸਰਨ੍ਤਿ; ਤਂ ਭਗਨ੍ਦਰਮੁਨ੍ਮਾਰ੍ਗਿਣਮਿਤ੍ਯਾਚਕ੍ਸਤੇ ||੯||

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मूढेन मांसलुब्धेन यदस्थिशल्यमन्नेन सहाभ्यवहृतं यदाऽवगाढपुरीषोन्मिश्रमपानेनाधःप्रेरितमसम्यगागतं गुदमपक्षिणोति तदा क्षतनिमित्तः कोथ उपजायते, तस्मिंश्च क्षते पूयरुधिरावकीर्णमांसकोथे भूमाविव जलप्रक्लिन्नायां क्रिमयः सञ्जायन्ते, ते भक्षयन्तो गुदमनेकधा पार्श्वतो दारयन्ति, तस्य तैर्मार्गैः कृमिकृतैर्वातमूत्रपुरीषरेतांस्यभिनिःसरन्ति; तं भगन्दरमुन्मार्गिणमित्याचक्षते ||९||

Meaning of the śloka

The text says that when a person unknowingly swallows a bone fragment with food, it may mix with hard stool, be driven downward by apāna, travel improperly, and injure the anus. Putrefaction then develops from the wound. In the injured, pus- and blood-covered flesh, worms are said to arise as they do in waterlogged soil. By consuming the tissue, they tear passages along the sides of the anus; through these worm-made tracts, flatus, urine, stool, and reproductive fluid may emerge. This bhagandara is called unmārgin.

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ਉਨ੍ਮਾਰ੍ਗਿਣਃ ਸਮ੍ਪ੍ਰਾਪ੍ਤਿ ਦਰ੍ਸ਼ਯਨ੍ਨਾਹ- ਮੂਢੇਨੇਤ੍ਯਾਦਿ| ਮੂਢੇਨ ਅਜ੍ਞਾਤੇਨ| ਅਪਕ੍ਸਿਣੋਤਿ ਸਕ੍ਸਤਂ ਕਰੋਤਿ| ਕੋਥਃ ਪੂਤਿਭਾਵਃ| ਪਾਰ੍ਸ਼੍ਵਤੋ ਦਾਰਯਨ੍ਤਿ ਪਕ੍ਸਤੋ ਦਾਰਯਨ੍ਤਿ| ਅਸ੍ਯਾਗ੍ਰੇ ਅਰ੍ਸ਼ੋਭਗਨ੍ਦਰਂ ਕੇਚਿਤ੍ ਪਠਨ੍ਤਿ; ਤਨ੍ਨ, ਸਰ੍ਵੈਰ੍ਨਿਬਨ੍ਧਕਾਰੈਰ੍ਨਿਰਾਕਤਤ੍ਵਾਤ੍||੯||

Meaning of the commentary

The commentary presents the pathogenesis of unmārgin. Mūḍha means unaware or unknowing; apakṣiṇoti means causes injury, and kotha means putrefaction. The tearing is lateral. Some sources add the phrase arśo-bhagandara after this passage, but the commentator rejects it because all compilers exclude it.

Key terms

unmArgin (unmārgin)
A traumatic bhagandara subtype characterized by abnormal tracts.
asthishalya (asthi-śalya)
A sharp or foreign bone fragment swallowed with food.
kotha
Putrefaction or tissue decay arising in the wound.
kRumikRuta mArga (kṛmi-kṛta mārga)
Abnormal passages attributed by the text to worms in damaged tissue.

Adhikarana ੯ (੧੦-੧੧) · Śloka ੧੧

ਭਵਨ੍ਤਿ ਚਾਤ੍ਰ- ਉਤ੍ਪਦ੍ਯਤੇਲ੍ਪਰੁਕ੍ ਸ਼ੋਫਾਤ੍ ਕ੍ਸਿਪ੍ਰਂ ਚਾਪ੍ਯੁਪਸ਼ਾਮ੍ਯਤਿ | ਪਾਯ੍ਵਨ੍ਤਦੇਸ਼ੇ ਪਿਡਕਾ ਸਾ ਜ੍ਞੇਯਾਨ੍ਯਾ ਭਗਨ੍ਦਰਾਤ੍ ||੧੦|| ਪਾਯੋਃ ਸ੍ਯਾਦ੍ ਦ੍ਵ੍ਯਙ੍ਗੁਲੇ ਦੇਸ਼ੇ ਗੂਢਮੂਲਾ ਸਰੁਗ੍ਜ੍ਵਰਾ | ਭਾਗਨ੍ਦਰੀਤਿ ਵਿਜ੍ਞੇਯਾ ਪਿਡਕਾਤੋ ਵਿਪਰ੍ਯਯਾਤ੍ ||੧੧||

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भवन्ति चात्र- उत्पद्यतेऽल्परुक् शोफात् क्षिप्रं चाप्युपशाम्यति | पाय्वन्तदेशे पिडका सा ज्ञेयाऽन्या भगन्दरात् ||१०|| पायोः स्याद् द्व्यङ्गुले देशे गूढमूला सरुग्ज्वरा | भागन्दरीति विज्ञेया पिडकाऽतो विपर्ययात् ||११||

Meaning of the śloka

A mildly painful swelling or pustule arising at the anal margin and subsiding quickly is to be distinguished from bhagandara. By contrast, a deeply rooted, painful lesion with fever arising within a region of two angulas around the anus is called bhagandari because it may lead to bhagandara.

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ਅਭਾਗਨ੍ਦਰੀਂ ਭਾਗਨ੍ਦਰੀਂ ਚ ਪਿਡਕਾਮਾਹ- ਭਵਨ੍ਤਿ ਚਾਤ੍ਰੇਤ੍ਯਾਦਿ| ਪਾਯ੍ਵਨ੍ਤਦੇਸ਼ੇ ਪਿਡਕਾ ਸ਼ੋਫਾਦੁਤ੍ਪਦ੍ਯਤ ਇਤਿ ਸਮ੍ਬਨ੍ਧਃ| ਅਲ੍ਪਰੁਕ੍ ਅਲ੍ਪਵੇਦਨਾ, ਪਾਯ੍ਵਨ੍ਤਦੇਸ਼ੇ ਗੁਦਸ੍ਯਾਨ੍ਤੇ, ਅਨ੍ਯਾ ਭਗਨ੍ਦਰਾਤ੍ ਅਪਰਾ ਭਗਨ੍ਦਰੇਭ੍ਯ ਇਤ੍ਯਰ੍ਥਃ| ਏਤੇਨਾਭਾਗਨ੍ਦਰੀ ਪਿਡਕੋਕ੍ਤਾ, ਯਤੋਸ੍ਯਾ ਭਗਨ੍ਦਰੋ ਨੋਤ੍ਪਦ੍ਯਤੇ| ਅਤੋਭਾਗਨ੍ਦਰ੍ਯਾਃ ਪਿਡਕਾਯਾਃ, ਵਿਪਰ੍ਯਯਾਤ੍ ਵਿਪਰੀਤਤ੍ਵਾਤ੍, ਭਾਗਨ੍ਦਰੀਤਿ ਭਗਨ੍ਦਰਕਰੀ ਭਵਤੀਤ੍ਯਰ੍ਥਃ||੧੦-੧੧||

Meaning of the commentary

The commentary contrasts an abhagandari pidaka with a bhagandari pidaka. The first arises from swelling at the end or margin of the anus, has little pain, resolves quickly, and does not produce bhagandara. Bhagandari has the opposite features and is so named because it produces bhagandara. Alparuk means slight pain, and payvantadesha means the terminal anal region.

Key terms

abhAgandarI piDakA (abhagandari pidaka)
A mildly painful, quickly resolving perianal lesion said not to lead to bhagandara.
bhAgandarI piDakA (bhagandari pidaka)
A deeply rooted, painful, fever-associated lesion considered capable of leading to bhagandara.
gUDhamUlA (gudhamula)
Deeply rooted.
pAyvantadesha (payvantadesha)
The end or margin of the anal region.
dvya~ggula (dvyangula)
A distance of two finger-breadths in the source's measurement system.

Adhikarana ੧੦ (੧੨) · Śloka ੧੨

ਯਾਨਯਾਨਾਨ੍ਮਲੋਤ੍ਸਰ੍ਗਾਤ੍ ਕਣ੍ਡੂਰੁਗ੍ਦਾਹਸ਼ੋਫਵਾਨ੍ | ਪਾਯੁਰ੍ਭਵੇਦ੍ਰੁਜਃ ਕਟ੍ਯਾਂ ਪੂਰ੍ਵਰੂਪਂ ਭਗਨ੍ਦਰੇ ||੧੨||

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यानयानान्मलोत्सर्गात् कण्डूरुग्दाहशोफवान् | पायुर्भवेद्रुजः कट्यां पूर्वरूपं भगन्दरे ||१२||

Meaning of the śloka

Itching, pain, burning, and swelling at the anus associated with riding or travel and with passing stool, together with pain in the waist or pelvic region, are described as prodromal signs of bhagandara.

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ਯੋਨੇਤ੍ਯਾਦਿ| ਯਾਨਯਾਨਾਤ੍ ਰਥਾਦਿਗਮਨਾਤ੍| ਮਲੋਤ੍ਸਰ੍ਗਾਤ੍ ਪੁਰੀਸਤ੍ਯਾਗਾਤ੍| ਕਣ੍ਡੂਰੁਗ੍ਦਾਹਸ਼ੋਫਵਾਨ੍ ਪਾਯੁਰ੍ਭਵੇਤ੍, ਤਤੋਨਨ੍ਤਰਂ ਕਟ੍ਯਾਂ ਕਣ੍ਡੂਰੁਗ੍ਦਾਹਸ਼ੋਫਾਦਿਕਂ ਪੂਰ੍ਵਰੂਪਂ ਭਵੇਤ੍| ਅਯਂ ਵਾ ਪਠਨੀਯਃ ਪੂਰ੍ਵੋ ਵਾ; ਪੂਰ੍ਵਰੂਪਗ੍ਰਨ੍ਥਦ੍ਵਯਂ ਵਾ ਪਠਨੀਯਂ, ਪੂਰ੍ਵਸ਼੍ਚਾਪ੍ਰਸਿਦ੍ਧਃ, ਅਯਂ ਤੁ ਪ੍ਰਸਿਦ੍ਧਃ||੧੨||

Meaning of the commentary

The commentary explains yanayana as travel by chariot or a similar conveyance and malotsarga as passing feces. It first locates itching, pain, burning, and swelling at the anus, followed by similar features or pain in the waist region. Regarding textual placement, this passage may be read instead of an earlier prodromal passage, or both passages may be read. The earlier one is said to be less established, while this one is well known.

Key terms

pUrvarUpa (purvarupa)
A prodromal or early warning feature.
yAnayAna (yanayana)
Travel by a vehicle such as a chariot.
malotsarga
Evacuation or passage of feces.
kaNDU (kandu)
Itching.
pAyu (payu)
The anus or anal region.

Adhikarana ੧੧ (੧੩) · Śloka ੧੩

ਘੋਰਾਃ ਸਾਧਯਿਤੁਂ ਦੁਃਖਾਃ ਸਰ੍ਵ ਏਵ ਭਗਨ੍ਦਰਾਃ | ਤੇਸ੍ਵਸਾਧ੍ਯਸ੍ਤ੍ਰਿਦੋਸੋਤ੍ਥਃ ਕ੍ਸਤਜਸ਼੍ਚ ਭਗਨ੍ਦਰਃ ||੧੩||

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घोराः साधयितुं दुःखाः सर्व एव भगन्दराः | तेष्वसाध्यस्त्रिदोषोत्थः क्षतजश्च भगन्दरः ||१३||

Meaning of the śloka

All forms of bhagandara are described as grave, distressing, and difficult to treat. Among them, the form arising from all three doshas and the form arising from injury are declared incurable in this classical prognosis.

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ਤਤ੍ਰ ਕੇਸਾਞ੍ਚਿਦਸਾਧ੍ਯਤ੍ਵਂ ਦਰ੍ਸ਼ਯਨ੍ਨਾਹ- ਘੋਰਾ ਇਤ੍ਯਾਦਿ| ਘੋਰਾ ਦੁਃਖਪ੍ਰਦਾਃ| ਸਾਧਯਿਤੁਂ ਦੁਃਖਾਃ ਕਸ੍ਟਸਾਧ੍ਯਾਃ, ‘ਭਵਨ੍ਤਿ’ ਇਤ੍ਯਧ੍ਯਾਹਾਰਃ||੧੩||

Meaning of the commentary

The commentary says that this passage identifies forms considered incurable. Ghora means causing suffering, and 'difficult to accomplish' means difficult to cure. The verb 'are' is understood though not expressed in the verse.

Key terms

bhagandara
The classical anorectal tract or fistula-like disease category discussed in the chapter.
kaShTasAdhya (kashtasadhya)
Difficult to cure or manage.
tridoShottha (tridoshottha)
Arising from combined involvement of all three doshas.
kShataja (kshataja)
Arising from injury or trauma.
asAdhya (asadhya)
Considered incurable in the historical prognosis.

Adhikarana ਪੁਸ੍ਪਿਕਾ · Śloka ੪

ਇਤਿ ਸੁਸ਼੍ਰੁਤਸਂਹਿਤਾਯਾਂ ਨਿਦਾਨਸ੍ਥਾਨੇ ਭਗਨ੍ਦਰਨਿਦਾਨਂ ਨਾਮ ਚਤੁਰ੍ਥੋਧ੍ਯਾਯਃ ||੪||

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इति सुश्रुतसंहितायां निदानस्थाने भगन्दरनिदानं नाम चतुर्थोऽध्यायः ||४||

Meaning of the śloka

Thus ends the fourth chapter of the Nidanasthana in the Sushruta Samhita, entitled Bhagandaranidana, the diagnosis of bhagandara.

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ਇਤਿ ਸ਼੍ਰੀਡਹ੍ਲਣਵਿਰਚਿਤਾਯਾਂ ਨਿਬਨ੍ਧਸਙ੍ਗ੍ਰਹਾਖ੍ਯਾਯਾਂ ਸੁਸ਼੍ਰੁਤਵ੍ਯਾਖ੍ਯਾਯਾਂ ਨਿਦਾਨਸ੍ਥਾਨੇ ਚਤੁਰ੍ਥੋਧ੍ਯਾਯਃ||੪||

Meaning of the commentary

The commentary colophon states that the fourth chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.

Key terms

bhagandaranidAna (Bhagandaranidana)
The chapter on causes and diagnostic description of bhagandara.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.
caturtha adhyAya (caturtha adhyaya)
The fourth chapter.
nibandhasa~ggraha (Nibandhasangraha)
The title of Dalhana's commentary.
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