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AYANAACADEMYby Dr Vijaya Dwarampudi
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೪. ಭಗನ್ದರನಿದಾನಮ್

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Adhikarana ೧ (೧-೨) · Śloka ೨

ಅಥಾತೋ ಭಗನ್ದರಾಣಾಂ ನಿದಾನಂ ವ್ಯಾಖ್ಯಾಸ್ಯಾಮಃ ||೧|| ಯಥೋವಾಚ ಭಗವಾನ್ ಧನ್ವನ್ತರಿಃ ||೨||

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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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ಅಥೇತ್ಯಾದಿ||೧-೨||

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 ೨ (೩) · Śloka ೩

ವಾತಪಿತ್ತಶ್ಲೇಷ್ಮಸನ್ನಿಪಾತಾಗನ್ತುನಿಮಿತ್ತಾಃ ಶತಪೋನಕೋಷ್ಟ್ರಗ್ರೀವಪರಿಸ್ರಾವಿಶಮ್ಬೂಕಾವರ್ತೋನ್ಮಾರ್ಗಿಣೋ ಯಥಾಸಙ್ಖ್ಯಂ ಪಞ್ಚ ಭಗನ್ದರಾ ಭವನ್ತಿ | ತೇ ತು ಭಗಗುದಬಸ್ತಿಪ್ರದೇಶದಾರಣಾಚ್ಚ ‘ಭಗನ್ದರಾ’ ಇತ್ಯುಚ್ಯನ್ತೇ | ಅಭಿನ್ನಾಃ ಪಿಡಕಾಃ, ಭಿನ್ನಾಸ್ತು ಭಗನ್ದರಾಃ ||೩||

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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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ವಾತಪಿತ್ತೇತ್ಯಾದಿ| ಸಙ್ಖ್ಯೇಯನಿರ್ದೇಶಾದೇವ ಸಙ್ಖ್ಯಾಸಿದ್ಧೌ ಪಞ್ಚೇತಿವಚನಂ ಶೋಣಿತಜಾದಿನಿಷೇಧಾರ್ಥಮ್| ಭಗನ್ದರನಿರುಕ್ತಿಮಾಹ- ತೇ ತ್ವಿತ್ಯಾದಿ||೩||

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 ೩ (೪) · Śloka ೪

ತೇಷಾಂ ತು ಪೂರ್ವರೂಪಾಣಿ- ಕಟೀಕಪಾಲವೇದನಾ ಕಣ್ಡೂರ್ದಾಹಃ ಶೋಫಶ್ಚ ಗುದಸ್ಯ ಭವತಿ ||೪||

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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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ಪೂರ್ವರೂಪಮಾಹ- ತೇಷಾಂ ತ್ವಿತ್ಯಾದಿ| ತೇಷಾಂ ತು ಪೂರ್ವರೂಪಾಣಿ ‘ಭವನ್ತಿ’ ಇತ್ಯರ್ಥಃ| ಕಟೀಕಪಾಲಃ ಕಟೀಫಲಕಃ||೪||

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 ೪ (೫) · Śloka ೫

ತತ್ರಾಪಥ್ಯಸೇವಿನಾಂ ವಾಯುಃ ಪ್ರಕುಪಿತಃ ಸನ್ನಿವೃತ್ತಃ ಸ್ಥಿರೀಭೂತೋ ಗುದಮಭಿತೋಽಙ್ಗುಲೇ ದ್ವ್ಯಙ್ಗುಲೇ ವಾ ಮಾಂಸಶೋಣಿತೇ ಪ್ರದೂಷ್ಯಾರುಣವರ್ಣಾಂ ಪಿಡಕಾಂ ಜನಯತಿ, ಸಾಽಸ್ಯ ತೋದಾದೀನ್ ವೇದನಾವಿಶೇಷಾಞ್ಜನಯತಿ, ಅಪ್ರತಿಕ್ರಿಯಮಾಣಾ ಚ ಪಾಕಮುಪೈತಿ, ಮೂತ್ರಾಶಯಾಭ್ಯಾಸಗತತ್ವಾಚ್ಚ ವ್ರಣಃ ಪ್ರಕ್ಲಿನ್ನಃ ಶತಪೋನಕವದಣುಮುಖೈಶ್ಛಿದ್ರೈರಾಪೂರ್ಯತೇ, ತಾನಿ ಚ ಛಿದ್ರಾಣ್ಯಜಸ್ರಮಚ್ಛಂ ಫೇನಾನುವಿದ್ಧಮಧಿಕಮಾಸ್ರಾವಂ ಸ್ರವನ್ತಿ , ವ್ರಣಶ್ಚ ತಾಡ್ಯತೇ ಭಿದ್ಯತೇ ಛಿದ್ಯತೇ ಸೂಚೀಭಿರಿವ ನಿಸ್ತುದ್ಯತೇ, ಗುದಂ ಚಾವದೀರ್ಯತೇ, ಉಪೇಕ್ಷಿತೇ ಚ ವಾತಮೂತ್ರಪುರೀಷರೇತಸಾಮಪ್ಯಾಗಮಶ್ಚ ತೈರೇವ ಛಿದ್ರೈರ್ಭವತಿ; ತಂ ಭಗನ್ದರಂ ಶತಪೋನಕಮಿತ್ಯಾವಕ್ಷತೇ ||೫||

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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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ಪೂರ್ವರೂಪಾನನ್ತರಂ ಪಿಡಿಕೋತ್ಪತ್ತಿಪಾಕೋಪದ್ರವನಿರುಕ್ತೀದರ್ಶಯನ್ನಾಹ- ತತ್ರಾಪಥ್ಯೇತ್ಯಾದಿ| ಸನ್ನಿವೃತ್ತೌ ವ್ಯಾಘುಟಿತಃ| ಗುದಮಭಿತೋ ಗುದಸ್ಯ ಸರ್ವತಃ; ಅನ್ಯೇ ‘ಗುದಸನ್ನಿಧೌ’ ಇತ್ಯಾಹುಃ| ಅಭ್ಯಾಸಃ ಸಮೀಪಮ್| ಶತಪೋನಕಃ ಶೂಕದೋಷಪರಿಪಠಿತೋ ವ್ಯಾಧಿಃ; ‘ಚಾಲನಿಕಾ’ ಇತಿ ಜೇಜ್ಝಟಃ; ತನ್ನೇಚ್ಛತಿ ಗಯೀ, ಲೋಕಶಾಸ್ತ್ರಯೋಶ್ಚಾಲನಿಕಾಯಾಂ ಶತಪೋನಕಶಬ್ದಸ್ಯಾಪ್ರಸಿದ್ಧತ್ವಾತ್; ‘ಅಶ್ವಪುಚ್ಛಬಾಲರಚಿತಂ ಶತಾಕ್ಷಕಂ’ ಇತ್ಯನ್ಯೇ| ತುದ್ಯತೇ ವ್ಯಥ್ಯತೇ| ತಾಡ್ಯತೇ ದಣ್ಡೇನೇವಾಭಿಹನ್ಯತ ಇತ್ಯರ್ಥಃ| ಭಿದ್ಯತೇ ತ್ವಗ್ವಿದಾರ್ಯತ ಇವ| ಛಿದ್ಯತೇ ದ್ವಿಧಾ ಕ್ರಿಯತ ಇವ||೫||

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 ೫ (೬) · Śloka ೬

ಪಿತ್ತಂ ತು ಪ್ರಕುಪಿತಮನಿಲೇನಾಧಃ ಪ್ರೇರಿತಂ ಪೂರ್ವವದವಸ್ಥಿತಂ ರಕ್ತಾಂ ತನ್ವೀಮುಚ್ಛ್ರಿತಾಮುಷ್ಟ್ರಗ್ರೀವಾಕಾರಾಂ ಪಿಡಕಾಂ ಜನಯತಿ; ಸಾಽಸ್ಯ ಚೋಷಾದೀನ್ ವೇದನಾವಿಶೇಷಾಞ್ಜನಯತಿ; ಅಪ್ರತಿಕ್ರಿಯಮಾಣಾ ಚ ಪಾಕಮುಪೈತಿ; ವ್ರಣಶ್ಚಾಗ್ನಿಕ್ಷಾರಾಭ್ಯಾಮಿವ ದಹ್ಯತೇ, ದುರ್ಗನ್ಧಮುಷ್ಣಮಾಸ್ರಾವಂ ಸ್ರವತಿ, ಉಪೇಕ್ಷಿತಶ್ಚ ವಾತಮೂತ್ರಪುರೀಷರೇತಾಂಸಿ ವಿಸೃಜತಿ; ತಂ ಭಗನ್ದರಮುಷ್ಟ್ರಗ್ರೀವಮಿತ್ಯಾಚಕ್ಷತೇ ||೬||

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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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ಪಿತ್ತಂ ತ್ವಿತ್ಯಾದಿ| ಪೂರ್ವವದವಸ್ಥಿತಮಿತಿ ಗುದಮಭಿತೋಽಙ್ಗುಲೇ ದ್ವ್ಯಙ್ಗುಲೇ ವೇತ್ಯರ್ಥಃ| ವಿಸೃಜತಿ ಸ್ರವತಿ ವ್ರಣ ಇತಿ ಸಮ್ಬನ್ಧಃ||೬||

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 ೬ (೭) · Śloka ೭

ಶ್ಲೇಷ್ಮಾ ತು ಪ್ರಕುಪಿತಃ ಸಮೀರಣೇನಾಧಃ ಪ್ರೇರಿತಃ ಪೂರ್ವವದವಸ್ಥಿತಃ ಶುಕ್ಲಾವಭಾಸಾಂ ಸ್ಥಿರಾಂ ಕಣ್ಡೂಮತೀಂ ಪಿಡಕಾಂ ಜನಯತಿ, ಸಾಽಸ್ಯ ಕಣ್ಡ್ವಾದೀನ್ ವೇದನಾವಿಶೇಷಾಞ್ಜನಯತಿ, ಅಪ್ರತಿಕ್ರಿಯಮಾಣಾಂ ಚ ಪಾಕಮುಪೈತಿ, ವ್ರಣಶ್ಚ ಕಠಿನಃ ಸಂರಮ್ಭೀ ಕಣ್ಡೂಪ್ರಾಯಃ ಪಿಚ್ಛಿಲಮಜಸ್ರಮಾಸ್ರಾವಂ ಸ್ರವತಿ, ಉಪೇಕ್ಷಿತಶ್ಚ ವಾತಮೂತ್ರಪುರೀಷರೇತಾಂಸಿ ವಿಸೃಜತಿ; ತಂ ಭಗನ್ದರಂ ಪರಿಸ್ರಾವಿಣಮಿತ್ಯಾಚಕ್ಷತೇ ||೭||

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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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ಶ್ಲೇಷ್ಮೇತ್ಯಾದಿ| ಸಂರಮ್ಭೀ ಶೋಫವಾನ್| ಕಣ್ಡೂಪ್ರಾಯಃ ಖರ್ಜೂಬಹುಲಃ| ಪರಿಸ್ರಾವೀತ್ಯೇವಂಶೀಲಃ ಪರಿಸ್ರಾವೀ||೭||

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 ೭ (೮) · Śloka ೮

ವಾಯುಃ ಪ್ರಕುಪಿತಃ ಪ್ರಕುಪಿತೌ ಪಿತ್ತಶ್ಲೇಷ್ಮಾಣೌ ಪರಿಗೃಹ್ಯಾಧೋ ಗತ್ವಾ ಪೂರ್ವವದವಸ್ಥಿತಃ ಪಾದಾಙ್ಗುಷ್ಠಾಗ್ರಪ್ರಮಾಣಾಂ ಸರ್ವಲಿಙ್ಗಾಂ ಪಿಡಕಾಂ ಜನಯತಿ, ಸಾಽಸ್ಯ ತೋದದಾಹಕಣ್ಡ್ವಾದೀನ್ ವೇದನಾವಿಶೇಷಾಞ್ಜನಯತಿ, ಅಪ್ರತಿಕ್ರಿಯಮಾಣಾ ಚ ಪಾಕಮುಪೈತಿ, ವ್ರಣಶ್ಚ ನಾನಾವಿಧವರ್ಣಮಾಸ್ರಾವಂ ಸ್ರವತಿ, ಪೂರ್ಣನದೀಶಮ್ಬೂಕಾವರ್ತವಚ್ಚಾತ್ರ ಸಮುತ್ತಿಷ್ಠನ್ತಿ ವೇದನಾವಿಶೇಷಾಃ; ತಂ ಭಗನ್ದರಂ ಶಮ್ಬೂಕಾವರ್ತಮಿತ್ಯಾಚಕ್ಷತೇ ||೮||

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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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‘ಪೂರ್ಣನದೀಶಮ್ಬೂಕಾವರ್ತವನ್ನೈರನ್ತರ್ಯೇಣ ವೇದನಾ ಉತ್ತಿಷ್ಠನ್ತಿ’ ಇತ್ಯೇಕೇ; ಅನ್ಯೇ ತು ‘ತಥಾವಿಧಗತ್ಯಾರಮ್ಭಕಸ್ಯ ಶೋಫಸ್ಯ ಪೂರ್ಣನದ್ಯಾವರ್ತಶಮ್ಬೂಕಾವರ್ತಾಕಾರೇಣೇವಾವಗತ್ವಾದವಗಾಢವೇದನಾ ಭವನ್ತೀತ್ಯರ್ಥಃ’| ಶಮ್ಬೂಕಾಃ ಶಙ್ಖಾಃ||೮||

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 ೮ (೯) · Śloka ೯

ಮೂಢೇನ ಮಾಂಸಲುಬ್ಧೇನ ಯದಸ್ಥಿಶಲ್ಯಮನ್ನೇನ ಸಹಾಭ್ಯವಹೃತಂ ಯದಾಽವಗಾಢಪುರೀಷೋನ್ಮಿಶ್ರಮಪಾನೇನಾಧಃಪ್ರೇರಿತಮಸಮ್ಯಗಾಗತಂ ಗುದಮಪಕ್ಷಿಣೋತಿ ತದಾ ಕ್ಷತನಿಮಿತ್ತಃ ಕೋಥ ಉಪಜಾಯತೇ, ತಸ್ಮಿಂಶ್ಚ ಕ್ಷತೇ ಪೂಯರುಧಿರಾವಕೀರ್ಣಮಾಂಸಕೋಥೇ ಭೂಮಾವಿವ ಜಲಪ್ರಕ್ಲಿನ್ನಾಯಾಂ ಕ್ರಿಮಯಃ ಸಞ್ಜಾಯನ್ತೇ, ತೇ ಭಕ್ಷಯನ್ತೋ ಗುದಮನೇಕಧಾ ಪಾರ್ಶ್ವತೋ ದಾರಯನ್ತಿ, ತಸ್ಯ ತೈರ್ಮಾರ್ಗೈಃ ಕೃಮಿಕೃತೈರ್ವಾತಮೂತ್ರಪುರೀಷರೇತಾಂಸ್ಯಭಿನಿಃಸರನ್ತಿ; ತಂ ಭಗನ್ದರಮುನ್ಮಾರ್ಗಿಣಮಿತ್ಯಾಚಕ್ಷತೇ ||೯||

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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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ಉನ್ಮಾರ್ಗಿಣಃ ಸಮ್ಪ್ರಾಪ್ತಿ ದರ್ಶಯನ್ನಾಹ- ಮೂಢೇನೇತ್ಯಾದಿ| ಮೂಢೇನ ಅಜ್ಞಾತೇನ| ಅಪಕ್ಷಿಣೋತಿ ಸಕ್ಷತಂ ಕರೋತಿ| ಕೋಥಃ ಪೂತಿಭಾವಃ| ಪಾರ್ಶ್ವತೋ ದಾರಯನ್ತಿ ಪಕ್ಷತೋ ದಾರಯನ್ತಿ| ಅಸ್ಯಾಗ್ರೇ ಅರ್ಶೋಭಗನ್ದರಂ ಕೇಚಿತ್ ಪಠನ್ತಿ; ತನ್ನ, ಸರ್ವೈರ್ನಿಬನ್ಧಕಾರೈರ್ನಿರಾಕೃತತ್ವಾತ್||೯||

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 ೯ (೧೦-೧೧) · Śloka ೧೧

ಭವನ್ತಿ ಚಾತ್ರ- ಉತ್ಪದ್ಯತೇಽಲ್ಪರುಕ್ ಶೋಫಾತ್ ಕ್ಷಿಪ್ರಂ ಚಾಪ್ಯುಪಶಾಮ್ಯತಿ | ಪಾಯ್ವನ್ತದೇಶೇ ಪಿಡಕಾ ಸಾ ಜ್ಞೇಯಾಽನ್ಯಾ ಭಗನ್ದರಾತ್ ||೧೦|| ಪಾಯೋಃ ಸ್ಯಾದ್ ದ್ವ್ಯಙ್ಗುಲೇ ದೇಶೇ ಗೂಢಮೂಲಾ ಸರುಗ್ಜ್ವರಾ | ಭಾಗನ್ದರೀತಿ ವಿಜ್ಞೇಯಾ ಪಿಡಕಾಽತೋ ವಿಪರ್ಯಯಾತ್ ||೧೧||

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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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ಅಭಾಗನ್ದರೀಂ ಭಾಗನ್ದರೀಂ ಚ ಪಿಡಕಾಮಾಹ- ಭವನ್ತಿ ಚಾತ್ರೇತ್ಯಾದಿ| ಪಾಯ್ವನ್ತದೇಶೇ ಪಿಡಕಾ ಶೋಫಾದುತ್ಪದ್ಯತ ಇತಿ ಸಮ್ಬನ್ಧಃ| ಅಲ್ಪರುಕ್ ಅಲ್ಪವೇದನಾ, ಪಾಯ್ವನ್ತದೇಶೇ ಗುದಸ್ಯಾನ್ತೇ, ಅನ್ಯಾ ಭಗನ್ದರಾತ್ ಅಪರಾ ಭಗನ್ದರೇಭ್ಯ ಇತ್ಯರ್ಥಃ| ಏತೇನಾಭಾಗನ್ದರೀ ಪಿಡಕೋಕ್ತಾ, ಯತೋಽಸ್ಯಾ ಭಗನ್ದರೋ ನೋತ್ಪದ್ಯತೇ| ಅತೋಽಭಾಗನ್ದರ್ಯಾಃ ಪಿಡಕಾಯಾಃ, ವಿಪರ್ಯಯಾತ್ ವಿಪರೀತತ್ವಾತ್, ಭಾಗನ್ದರೀತಿ ಭಗನ್ದರಕರೀ ಭವತೀತ್ಯರ್ಥಃ||೧೦-೧೧||

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 ೧೦ (೧೨) · Śloka ೧೨

ಯಾನಯಾನಾನ್ಮಲೋತ್ಸರ್ಗಾತ್ ಕಣ್ಡೂರುಗ್ದಾಹಶೋಫವಾನ್ | ಪಾಯುರ್ಭವೇದ್ರುಜಃ ಕಟ್ಯಾಂ ಪೂರ್ವರೂಪಂ ಭಗನ್ದರೇ ||೧೨||

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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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ಯೋನೇತ್ಯಾದಿ| ಯಾನಯಾನಾತ್ ರಥಾದಿಗಮನಾತ್| ಮಲೋತ್ಸರ್ಗಾತ್ ಪುರೀಷತ್ಯಾಗಾತ್| ಕಣ್ಡೂರುಗ್ದಾಹಶೋಫವಾನ್ ಪಾಯುರ್ಭವೇತ್, ತತೋಽನನ್ತರಂ ಕಟ್ಯಾಂ ಕಣ್ಡೂರುಗ್ದಾಹಶೋಫಾದಿಕಂ ಪೂರ್ವರೂಪಂ ಭವೇತ್| ಅಯಂ ವಾ ಪಠನೀಯಃ ಪೂರ್ವೋ ವಾ; ಪೂರ್ವರೂಪಗ್ರನ್ಥದ್ವಯಂ ವಾ ಪಠನೀಯಂ, ಪೂರ್ವಶ್ಚಾಪ್ರಸಿದ್ಧಃ, ಅಯಂ ತು ಪ್ರಸಿದ್ಧಃ||೧೨||

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 ೧೧ (೧೩) · Śloka ೧೩

ಘೋರಾಃ ಸಾಧಯಿತುಂ ದುಃಖಾಃ ಸರ್ವ ಏವ ಭಗನ್ದರಾಃ | ತೇಷ್ವಸಾಧ್ಯಸ್ತ್ರಿದೋಷೋತ್ಥಃ ಕ್ಷತಜಶ್ಚ ಭಗನ್ದರಃ ||೧೩||

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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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ತತ್ರ ಕೇಷಾಞ್ಚಿದಸಾಧ್ಯತ್ವಂ ದರ್ಶಯನ್ನಾಹ- ಘೋರಾ ಇತ್ಯಾದಿ| ಘೋರಾ ದುಃಖಪ್ರದಾಃ| ಸಾಧಯಿತುಂ ದುಃಖಾಃ ಕಷ್ಟಸಾಧ್ಯಾಃ, ‘ಭವನ್ತಿ’ ಇತ್ಯಧ್ಯಾಹಾರಃ||೧೩||

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 ಪುಷ್ಪಿಕಾ · Śloka ೪

ಇತಿ ಸುಶ್ರುತಸಂಹಿತಾಯಾಂ ನಿದಾನಸ್ಥಾನೇ ಭಗನ್ದರನಿದಾನಂ ನಾಮ ಚತುರ್ಥೋಽಧ್ಯಾಯಃ ||೪||

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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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ಇತಿ ಶ್ರೀಡಹ್ಲಣವಿರಚಿತಾಯಾಂ ನಿಬನ್ಧಸಙ್ಗ್ರಹಾಖ್ಯಾಯಾಂ ಸುಶ್ರುತವ್ಯಾಖ್ಯಾಯಾಂ ನಿದಾನಸ್ಥಾನೇ ಚತುರ್ಥೋಽಧ್ಯಾಯಃ||೪||

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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