৯. বিদ্রধিনিদানম্

Meaning of the śloka

Now we shall explain the diagnosis of vidradhi. Thus spoke the revered Dhanvantari.

Key terms

vidradhi

A classical category of deep, painful swelling or suppurative lesion discussed in this chapter.

nidAna (nidāna)

The account of causation, development, and diagnostic features.

dhanvantari (Dhanvantari)

The revered teacher to whom the teaching is attributed.

Meaning of the śloka

The illustrious teacher of all the immortal gods, who became a king among human beings through another circumstance, taught his student this complete account of the signs of vidradhi.

Key terms

sarvAmaraguru (sarvāmaraguru)

Teacher of all the immortal gods, an epithet of Dhanvantari here.

nimittAntara (nimittāntara)

Another circumstance or cause, interpreted in more than one way by the commentary.

bhaiShajyAmRuta (bhaiṣajyāmṛta)

The nectar of medicine or healing in the commentator's figurative explanation.

vidradhilakShaNa (vidradhi-lakṣaṇa)

The characteristic features of vidradhi.

Meaning of the śloka

The aggravated doṣas are said to vitiate skin, blood, muscle, and fat, become established around bone, and gradually produce a severe, prominently raised swelling. Learned authorities call a lesion vidradhi when it has a broad or deep root, is painful, and is round or elongated. It should be understood as sixfold: caused separately by each doṣa, by all the doṣas together, by injury, or by blood. The signs of all six will now be stated.

Key terms

tvagraktamAMsamedAMsi (tvag-rakta-māṃsa-medāṃsi)

Skin, blood, muscle, and fat, the tissues said here to be vitiated.

asthisamAshrita (asthi-samāśrita)

Situated in relation to or taking support near bone in the classical account.

mahAmUla (mahāmūla)

Having a broad or deep-seated base or root.

vidradhi

A severe, painful, raised swelling described by this classical category.

samastadoShaja (samasta-doṣaja)

Attributed to the combined action of all the doṣas.

kShataja (kṣataja)

Arising from injury.

Meaning of the śloka

A vidradhi attributed to vāta is described as black or reddish, rough, and extremely painful, with irregular patterns in its onset, elevation, and suppuration.

Key terms

vAtasambhava vidradhi (vāta-sambhava vidradhi)

Vidradhi attributed to vāta in the classical classification.

kRuShNa (kṛṣṇa)

Black or very dark in colour.

aruNa (aruṇa)

Reddish in colour.

paruSha (paruṣa)

Rough in texture or character.

citrotthAnaprapAka (citrotthāna-prapāka)

Varied or irregular in arising and suppuration.

Meaning of the śloka

A vidradhi attributed to pitta is described as resembling a ripe udumbara fruit or as dark bluish-brown, accompanied by fever and burning, and arising and suppurating quickly.

Key terms

pittasambhava vidradhi (pitta-sambhava vidradhi)

Vidradhi attributed to pitta in the classical classification.

pakvodumbarasa~gkAsha (pakvodumbara-saṅkāśa)

Resembling the colour or appearance of a ripe udumbara fruit.

shyAva (śyāva)

A dark, dusky, or bluish-brown coloration.

jvara

Fever.

kShiprotthAnaprapAka (kṣiprotthāna-prapāka)

Rapid in arising and reaching suppuration.

Meaning of the śloka

A vidradhi arising from kapha is described as shaped like a shallow earthen dish, pale, cold, firm or rigid, mildly painful, slow to arise and suppurate, and accompanied by itching.

Key terms

kaphotthita vidradhi

Vidradhi attributed to kapha in the classical classification.

sharAvasadRusha (śarāva-sadṛśa)

Resembling a broad shallow earthen dish, explained as indicating large size.

pANDu (pāṇḍu)

Pale or whitish in appearance here.

stabdha

Firm, fixed, or rigid.

cirotthAnaprapAka (cirotthāna-prapāka)

Slow to arise and slow to reach suppuration.

kaNDU (kaṇḍū)

Itching.

Meaning of the śloka

The discharges from these three types are traditionally described, in the same order, as thin, yellow, and white.

Key terms

AsrAva (āsrāva)

Discharge or fluid issuing from the lesion.

tanu

Thin or watery, assigned to the vāta type.

pIta (pīta)

Yellow, assigned to the pitta type.

sita

White, assigned to the kapha type.

kramashaH (kramaśaḥ)

Respectively, following the previously stated order.

Meaning of the śloka

A sannipatika vidradhi is described as having varied colors, kinds of pain, and discharges; a large raised top, irregular character, and great size; and an uneven course of suppuration.

Key terms

sAnnipAtika vidradhi (sannipatika vidradhi)

The classical abscess type attributed to the combined doshas.

nAnAvarNa (nanavarna)

Having varied colors, glossed as black, yellow, and white.

nAnArujA (nanaruja)

Having varied pains such as pricking, burning, and itching.

ghATAla (ghatala)

Having a large or prominent upper part.

viShamaM pacyate (vishamam pachyate)

Suppurating in an uneven or irregular manner.

Meaning of the śloka

In a person who follows an unsuitable regimen after being struck or wounded by various causes, heat arising from the injury is spread by vayu and sets pitta together with blood in motion. Fever, thirst, and burning then arise. This is called an external or traumatic vidradhi and is said to show the features of a pittaja vidradhi.

Key terms

Agantu vidradhi (agantu vidradhi)

A vidradhi attributed here to an external injury.

kShata (kshata)

A wound, including an open or cut injury in the commentary.

kShatoShmA (kshatoshma)

Heat arising from an injury.

saraktaM pitta (saraktam pitta)

Pitta associated with blood in the classical explanation.

apathyasevin

A person following a regimen considered unsuitable in the source.

Meaning of the śloka

A vidradhi covered with black eruptions or blisters, dark or dusky in color, and accompanied by intense burning, pain, and fever, while also displaying the features of a pittaja vidradhi, is called raktaja vidradhi.

Key terms

raktaja vidradhi

The classical vidradhi type attributed to rakta.

kRuShNasphoTa (krishnasphota)

Black eruptions or blister-like lesions.

shyAva (shyava)

Dark or dusky coloration.

tIvradAha (tivradaha)

Intense burning sensation.

pittavidradhili~gga (pittavidradhilinga)

Features assigned to pittaja vidradhi in the classical classification.

Meaning of the śloka

These varieties of vidradhi have now been described. Among them, the type arising from all the doshas is said to be incurable.

Key terms

vidradhi

A classical category of painful swelling or abscess-like disorder.

sarvaja

Arising from all the doshas.

sAnnipAtika (sannipatika)

Involving the three doshas together in the classical classification.

asAdhya (asadhya)

Regarded as incurable in the historical prognosis.

bAhya (bahya)

External, specifying the scope given by the commentary.

Meaning of the śloka

The text next describes internal vidradhis. Heavy, unsuitable, mutually incompatible, dry, or improperly combined food; excessive sexual activity or exercise; suppression or injury of natural urges; and substances regarded as causing internal burning are said to disturb the doshas, separately or together. Internally they form a hard, gulma-like swelling raised on all sides like an anthill. Such vidradhis are located at the rectum, the mouth of the bladder, the navel, the abdomen, the groins, the kidneys, liver, spleen, heart, or kloman. Their particular signs are to be understood by comparison with those of external vidradhi, and their unripe or ripe condition is to be determined through the examination described for ama and pakva states.

Key terms

Abhyantara vidradhi (abhyantara vidradhi)

An internally situated vidradhi.

gulmarUpin (gulmarupin)

Resembling gulma through hardness.

valmIkavatsamunnaddha (valmikavat samunnaddha)

Raised on all sides like an anthill.

bastimukha

The mouth or outlet region of the bladder in the source.

va~gkShaNa (vankshana)

The groin or region at the root of the thigh.

kloman

A classical anatomical term whose exact modern correlate is uncertain.

Ama/pakva (ama/pakva)

Unripe and ripe stages of the swelling in the classical account.

Meaning of the śloka

The particular signs are then given according to the site. At the rectum there is obstruction of flatus; at the bladder region, difficult and scant urination; at the navel, hiccup and internal rumbling or agitation; and in the abdomen, aggravation of maruta. A groin vidradhi causes severe stiffness or constriction of the waist and back; at the kidneys there is a drawing-in pain of the flanks; and at the spleen, obstruction of breathing. At the heart there is severe rigidity or constriction of the whole body and terrible pain; at the liver, breathlessness and thirst; and in a kloman-born condition, thirst is especially marked.

Key terms

adhiShThAna (adhishthana)

The particular anatomical site assigned to the vidradhi.

vAtanirodha (vatanirodha)

Obstruction of flatus.

kRucchrAlpamUtratA (krichchhralpamutrata)

Difficult passage of a small quantity of urine.

ATopa (atopa)

Internal rumbling, agitation, or disturbance according to the commentary.

pArshvasa~gkoca (parshvasankocha)

Painful drawing or constriction of the flank.

sarvA~ggapragraha (sarvangapragraha)

Severe constriction or rigidity affecting the whole body.

klomaja

Arising in kloman, a classical anatomical site of uncertain modern correspondence.

Meaning of the śloka

Any vidradhi arising at a marma is said to be difficult, whether it is unripe or ripe and whether it is large or small.

Key terms

Ama (ama)

The unripe or pre-suppurative stage in the classical account.

pakva

The ripe or suppurative stage in the classical account.

marma

A vital or vulnerable anatomical site in classical Ayurveda.

vidradhi

A classical abscess-like painful swelling.

kaShTa (kashta)

Difficult or grave in prognosis and management.

Meaning of the śloka

When internal vidradhis arising above the navel mature, their discharge is said to move upward, whereas the others discharge downward. The text gives a favorable prognosis when discharge occurs downward and an unfavorable one when it occurs upward. Except for those situated at the heart, navel, or basti, a person may sometimes survive if an internal vidradhi breaks outward, but is said not to survive if it ruptures inward.

Key terms

antarvidradhi

An internally situated inflammatory swelling or abscess in the classical classification.

pakva

Matured or suppurated in the passage's account.

UrdhvaniHsRuti (urdhvanihsriti)

Discharge or drainage moving upward.

adhoniHsRuti (adhonihsriti)

Discharge or drainage moving downward.

bAhyato bhinna (bahyato bhinna)

Ruptured or opened toward the outside.

abhyantarato bhinna

Ruptured inwardly.

Meaning of the śloka

The passage says that a severe raktavidradhi causing burning and fever may arise in women after pregnancy loss, or after childbirth, through factors regarded by the text as unsuitable.

Key terms

raktavidradhi

A vidradhi attributed to rakta in the classical account.

apaprajAtA (apaprajata)

A woman after pregnancy loss, according to the commentary.

prajAtA (prajata)

A woman who has given birth at the proper time.

ahita

Factors considered unsuitable; glossed here as cold and dry food and activities.

dAha-jvara (daha-jvara)

Burning sensation and fever.

Meaning of the śloka

Even after a birth at the proper time, blood that has not left the body is said to produce a blood-origin vidradhi in the abdomen, designated makkalla. If it does not subside within seven days, the text says that it proceeds to suppuration.

Key terms

asRuk aniHsRuta (asrik anihsrita)

Blood described as not having left the body after childbirth.

raktaja vidradhi

A vidradhi attributed to rakta in the classical explanation.

makkalla

The postpartum abdominal condition named here as the cause of this vidradhi.

samprapacyate

Proceeds to mature or suppurate.

pittoShman (pittoshman)

The heat of pitta, proposed by the commentary as producing internal maturation.

Meaning of the śloka

The text distinguishes vidradhi from gulma. Although both are said to arise from doshas, gulma does not ordinarily suppurate while vidradhi does. Gulma has no fixed material basis: the doshas themselves assume its form. Vidradhi, by contrast, is established in flesh and blood. Gulma is compared to a bubble moving through spaces in water and therefore does not mature. Vidradhi suppurates because flesh and blood are abundant in it, while gulma does not because they are absent or scant. Thus gulma remains in its own dosha, whereas vidradhi is situated in flesh and blood; for this reason vidradhi matures and gulma does not.

Key terms

vidradhi

An inflammatory swelling described here as based in flesh and blood and capable of suppuration.

gulma

A classical mass or swelling described here as formed by the doshas without the same tissue basis.

nibandha

A root, fixed basis, or material support in the commentator's reasoning.

mAMsashoNita (mamsashonita)

Flesh and blood, presented as the tissue basis of vidradhi.

vivarAnucara (vivaranuchara)

Moving through spaces or passages, like a bubble in water.

pAka (paka)

Maturation or suppuration in this discussion.

Meaning of the śloka

A mature vidradhi arising at the heart, navel, or basti, and one caused by all three doshas, should be left aside as unsuitable for curative treatment according to the classical prognosis.

Key terms

hRunnAbhibastija (hrinnabhibastija)

Arising at the heart, navel, or basti.

pakva

Matured or suppurated.

tridoShaja (tridoshaja)

Attributed to all three doshas.

sAnnipAtika (sannipatika)

Involving the combined disturbance of all three doshas.

muShTipramANa (mushtipramana)

Having the measure or approximate size of a fist in the additional transmitted verse.

Meaning of the śloka

The passage describes a grave maturation of marrow within bone. When obstruction by bone and flesh prevents an outlet, the affected person is tormented as if burned by fire. The bone is said to deteriorate under the heat arising from the marrow, and this persistent disorder acts like an embedded foreign body. When an outlet is created by an operation and the bone is opened, pus is discharged that resembles fat: it is unctuous, white, cool, and heavy. Authorities skilled in the texts identify this as a bone-situated vidradhi that brings pain associated with all the doshas.

Key terms

majjaparIpAka (majjaparipaka)

Suppuration or destructive maturation described as occurring in the marrow within bone.

asthimAMsanirodha (asthimamsanirodha)

Obstruction by bone and flesh that prevents an outlet.

shalyabhUta (shalyabhuta)

Acting like a retained foreign body and causing prolonged distress.

shastrakarma

An operative or surgical action, as the commentary explains karma here.

medaHprabha pUya (medahprabha puya)

Pus described as resembling fat in appearance and qualities.

asthigata vidradhi

A vidradhi situated in bone in the classical classification.

Meaning of the śloka

Thus ends the ninth chapter of the Nidanasthana in the Sushruta Samhita, entitled Vidradhinidana, the diagnostic account of vidradhi.

Key terms

vidradhinidAna (Vidradhinidana)

The chapter's title, concerning the causes and diagnostic description of vidradhi.

nidAnasthAna (Nidanasthana)

The division concerned with causes and diagnostic descriptions.

navama adhyAya (navama adhyaya)

The ninth chapter.

nibandhasa~ggraha (Nibandhasangraha)

The title of Dalhana's commentary.