Aggravated doṣas situated in the skin, muscle, and blood are said to produce a rapidly spreading, extensive, low-raised swelling that moves throughout the body, is not fixed in one place, and displays the characteristic signs of its causative doṣa. Because it spreads in every direction, it is called visarpa.
The commentary identifies four parts of the account: involvement of skin, muscle, and blood describes development; aggravated doṣas are the cause; spreading through the body, being extensive and low-raised, and related features describe its form; and spreading everywhere explains the name visarpa. It primarily reads asthita as ‘not stationary,’ because the lesion moves from one place to another. Others read āsthita, ‘having acquired,’ so that it has acquired its own characteristic sign, meaning the sign of vāta or another doṣa. Still others join the phrase differently and explain it as being situated in one particular body part. The swelling is called anunnata because it is thin or only slightly elevated. The word ‘and’ also includes spreading in varied ways.
Key terms
visarpa
A disorder named here for spreading in every direction.
tva~gmAMsashoNitagata (tvag-māṃsa-śoṇita-gata)
Situated in or involving skin, muscle, and blood in the classical account.
asthita/ Asthita (asthita/āsthita)
A variant interpreted as either not stationary or having acquired characteristic signs.
Atmali~gga (ātma-liṅga)
Its own characteristic sign, explained as the sign of the causative doṣa.
anunnata
Not prominently raised; explained as thin or only slightly elevated.
sarvato visaraNa (sarvato visaraṇa)
Spreading in all directions, used to derive the name visarpa.
Vāta-type visarpa is described as dark, soft, and rough, with body ache, splitting or piercing pain, and signs associated with vāta and fever. When it is accompanied by irregular swellings or blisters and is severely vitiated, it is said to be unsuitable for curative treatment.
The commentary glosses asita as black or dark and aṅgamarda as a particular kind of bodily pain. It first treats these as signs of pure vāta-type visarpa. It then explains the gaṇḍas as blisters resembling burns from fire and attributes the severe vitiation to vāta and pitta together, making the latter description vāta-type visarpa accompanied by pitta. Other interpreters take the entire verse as describing pure vāta-type visarpa; on their reading, the severe vitiation is due to vāta alone.
Key terms
vAtAtmaka visarpa (vātātmaka visarpa)
Visarpa attributed to vāta in the classical classification.
a~ggamarda (aṅgamarda)
A distinctive aching or painful sensation throughout the body.
sambheda
A splitting type of pain.
toda
Piercing or pricking pain.
gaNDa (gaṇḍa)
A swelling or blister, compared here with a burn blister.
varjanIya (varjanīya)
To be left aside as unsuitable for curative treatment in the historical prognosis.
पित्तात्मको द्रुतगतिर्ज्वरदाहपाकस्फोटप्रभेदबहुलः क्षतजप्रकाशः |
दोषप्रवृद्धिहतमांससिरो यदा स्यात् स्रोतोजकर्दमनिभो न तदा स सिध्येत् ||५||
Meaning of the śloka
Pitta-type visarpa is described as moving rapidly and as having marked fever, burning, suppuration, blistering, and rupture, with an appearance resembling blood. When increased doṣas have damaged muscle and vessels and the lesion resembles dark collyrium-like mud, it is said not to respond to curative treatment.
The commentary says ‘abundant’ applies separately to fever, burning, suppuration, blisters, and rupture. Kṣatajaprakāśa means appearing like blood. The first half describes visarpa arising from pitta alone. In the second half, muscle and vessels are damaged through the increase of pitta and kapha, so this is interpreted as a kapha-pitta form. Its appearance is compared with a muddy substance like dark collyrium.
Key terms
pittAtmaka visarpa (pittātmaka visarpa)
Visarpa attributed primarily to pitta.
drutagati (druta-gati)
Rapidly moving or spreading.
sphoTaprabheda (sphoṭa-prabheda)
Blister formation and rupture.
kShatajaprakAsha (kṣataja-prakāśa)
Having an appearance like blood.
mAMsasirAhata (māṃsa-sirā-hata)
With muscle and vessels described as damaged.
srotojakardamanibha (srotoja-kardama-nibha)
Resembling a dark, collyrium-like muddy substance; the exact compound warrants review.
Kapha-type visarpa is described as spreading slowly, suppurating slowly, being unctuous or smooth, and producing a pale swelling with little pain but intense itching.
The commentary glosses sarati as ‘spreads.’ It then discusses granthi-visarpa, attributed to kapha and vāta and regarded as incurable in the historical prognosis. One explanation says it is not separately listed here because the nodular form was already mentioned earlier, although the source marks uncertainty at this point. Other interpreters say it is included through the stated signs of vāta-kapha visarpa.
Key terms
shleShmAtmaka visarpa (śleṣmātmaka visarpa)
Visarpa attributed to kapha in the classical classification.
mandam sarati (mandaṃ sarati)
Spreads slowly.
ashIghrapAka (aśīghra-pāka)
Slow to suppurate or mature.
sitashvayathu (sita-śvayathu)
A pale or whitish swelling.
ugrakaNDU (ugra-kaṇḍū)
Intense itching.
granthivisarpa (granthi-visarpa)
A nodular form discussed as involving kapha and vāta.
सर्वात्मकस्त्रिविधवर्णरुजोऽवगाढः पक्वो न सिध्यति च मांससिराप्रशातात् ||६||
Meaning of the śloka
Visarpa involving all the doṣas is described as having the colours and pains of all three, being deep-rooted, and, once suppurated, not responding to curative treatment because of destruction of muscle and vessels.
The commentary identifies this as the sannipātika form. ‘Threefold colours and pains’ means the black, yellow, white, and related colours assigned to vāta, pitta, and kapha, together with their respective piercing pain, burning, itching, and other sensations. Avagāḍha means having a root deep within. Praśāta means destruction. The commentator makes the prognosis conditional: after destruction of muscle and vessels it is not curable, whereas before such destruction it may be treated only with difficulty.
Key terms
sarvAtmaka (sarvātmaka)
Involving all three doṣas; sannipātika.
trividhavarNaruja (trividha-varṇa-rujā)
The three groups of colours and painful sensations associated with the doṣas.
avagADha (avagāḍha)
Deep-rooted or extending inward.
pakva
Matured or suppurated in this lesion context.
mAMsasirAprashAta (māṃsa-sirā-praśāta)
Destruction of muscle and vessels according to the commentary.
kRucchrasAdhya (kṛcchra-sādhya)
Treatable only with difficulty in the historical prognosis.
In a person described as having a strong doṣic burden, pitta and blood are said to enter a newly inflicted wound and produce a dusky-red swelling with intense fever, burning, suppuration, and dark blisters resembling kulattha seeds scattered across it.
The commentary connects pitta and blood as producing the swelling after reaching a fresh wound. It explains ‘one with abundant doṣas’ as someone whose tissues were already affected by antecedent signs of conditions such as kuṣṭha or vātarakta, citing ‘spreading from a wound’ among their earlier signs. Other interpreters instead understand it simply as a person with an abundance of all three doṣas. Kīrṇa means covered or pervaded by the dark, kulattha-like blisters.
Key terms
sadyaHkShatavraNa (sadyaḥ-kṣata-vraṇa)
A newly inflicted wound.
doShabahula (doṣa-bahula)
Having a strong doṣic burden, interpreted in two ways by the commentary.
shyAva salohita (śyāva salohita)
Dusky and reddish in appearance.
kulatthasadRusha sphoTa (kulattha-sadṛśa sphoṭa)
Blisters compared in size or form with kulattha seeds.
सिध्यन्ति वातकफपित्तकृता विसर्पाः सर्वात्मकः क्षतकृतश्च न सिद्धिमेति |
पैत्तानिलावपि च दर्शितपूर्वलिङ्गौ सर्वे च मर्मसु भवन्ति हि कृच्छ्रसाध्याः ||८||
Meaning of the śloka
Visarpa produced by vāta, kapha, or pitta alone is said to respond to treatment, while the form involving all doṣas and the form arising from a wound are said not to do so. The previously described severe variants involving pitta and vāta are also included among those with an unfavorable prognosis. Any form situated in a marma, a vital anatomical site, is considered difficult to treat.
The commentary explains ‘does not attain success’ as ‘does not become curable.’ The previously shown signs refer to vāta-type visarpa with burn-like swellings and pitta-type visarpa resembling dark collyrium-like mud. It records another reading: ‘the pitta-type and the one having the appearance of collyrium likewise do not respond.’ On that reading, the word ‘and’ also includes the specially described vāta form with irregular severe swellings. The commentator notes that the unfavorable prognoses of these vāta and pitta forms were already stated; repeating them here while discussing the wound-origin form is contextual rather than needless repetition.
Key terms
sAdhya (sādhya)
Regarded as responsive to curative treatment in the historical prognosis.
शोफं न पक्वमिति पक्वमुपेक्षते यो यो वा व्रणं प्रचुरपूयमसाधुवृत्तः |
अभ्यन्तरं प्रविशति प्रविदार्य तस्य स्थानानि पूर्वविहितानि ततः स पूयः ||९||
तस्यातिमात्रगमनाद्गतिरित्यतश्च नाडीव यद्वहति तेन मता तु नाडी |१०|
Meaning of the śloka
If a person mistakes a mature swelling for an immature one and neglects it, or neglects a wound containing abundant pus while following harmful habits, the pus is said to tear into and enter the previously described tissue sites. Because it travels excessively it is called a gati, a tract; and because it carries fluid like a tube or channel, it is called nāḍī.
The commentary supplies ‘neglects’ with both the swelling and the wound. Asādhuvṛtta means a person following harmful diet and conduct. The sites entered by pus are skin and the other tissues previously described as the basis of a wound. The word ‘and’ in the derivation introduces another explanation of the name nāḍī: it carries or moves material like a tubular channel. The account is organized as follows: neglecting a mature swelling or pus-filled wound is the cause; inward penetration through the tissues is its development; and resemblance to a channel explains the name.
Key terms
pakva shopha (pakva śopha)
A swelling considered mature or suppurated.
pracurapUya vraNa (pracura-pūya vraṇa)
A wound containing abundant pus.
gati
A path or tract, named here from extensive inward travel.
nADI (nāḍī)
A draining tract compared with a tube or channel that carries fluid.
vraNavAstu (vraṇa-vāstu)
The tissue sites forming the basis of a wound, beginning with skin.
asAdhuvRutta (asādhu-vṛtta)
Following conduct or diet regarded by the text as harmful.
दोषैस्त्रिभिर्भवति सा पृथगेकशश्च सम्मूर्च्छितैरपि च शल्यनिमित्ततोऽन्या ||१०||
Meaning of the śloka
A nadi lesion is said to arise separately from each of the three doshas, from their combined involvement, and in another form because of a foreign body or injury.
The commentary reads the verse as allowing three single-dosha types, three types produced by pairs of doshas, one sannipatika type involving all three, and another caused by shalya or trauma. It argues that the words api and ca support inclusion of the paired types. Gayi instead counts only five: three single-dosha types, one sannipatika type, and one caused by shalya.
Key terms
nADI (nadi)
A sinus-like tract or discharging channel in this chapter's classification.
sammUrcchita (sammurchhita)
Mixed or combined, interpreted here as doshas acting together.
Introducing the particular signs of each dosha type, the commentary explains phenanuviddha as discharge mixed with foam. The supplied commentary ends with an incomplete marker.
The nadi attributed to pitta causes thirst, heat, pricking pain, weakness, fever, and splitting pain. It discharges a larger amount of yellow, warm material during the daytime.
The commentary expands the discharge description as copious, dense, white, and slimy. It notes uncertainty over asra being used to mean discharge; others read picchilasrut, in which srut clearly means discharge. Stimitarka is explained as mild or dull pain. The supplied commentary ends with an incomplete marker.
The commentary identifies these three paired types as vata-pitta, pitta-kapha, and vata-kapha. It also records that Gayi does not include this passage describing the signs of the paired-dosha types.
दाहज्वरश्वसनमूर्च्छनवक्त्रशोषा यस्यां भवन्त्यभिहितानि च लक्षणानि |
तामादिशेत् पवनपित्तकफप्रकोपाद्धोरामसुक्षयकरीमिव कालरात्रिम् ||१३||
Meaning of the śloka
A nadi accompanied by burning, fever, difficult breathing, fainting, dryness of the mouth, and the signs previously described is assigned to the aggravation of vata, pitta, and kapha together. It is portrayed as dreadful and destructive of life, like Kalaratri.
The commentary identifies this as the sannipatika type. It glosses asukshayakari as taking away life and explains the comparison as Kalaratri, described here as Yama's sister.
Key terms
sAnnipAtikI nADI (sannipatiki nadi)
A nadi attributed to all three doshas together.
shvasana
Difficult or labored breathing.
mUrcchanA (murchhana)
Fainting or loss of consciousness.
vaktrashoSha (vaktrashosha)
Dryness of the mouth.
asukShayakarI (asukshayakari)
Life-destroying in the verse's grave prognosis.
kAlarAtri (Kalaratri)
A deadly mythic comparison, glossed as Yama's sister.
नष्टं कथञ्चिदनुमार्गमुदीरितेषु स्थानेषु शल्यमचिरेण गतिं करोति |
सा फेनिलं मथितमच्छमसृग्विमिश्रमुष्णं स्रवेत सहसा सरुजा च नित्यम् ||१४||
Meaning of the śloka
A foreign body that has become hidden and follows a path through the previously described tissues soon creates a nadi tract. That painful tract continually and suddenly discharges material that is foamy, churned-looking, clear, mixed with blood, and warm.
The commentary presents the shalya-caused type. The stated sites are tissues beginning with tvak. Mathita means appearing as though churned. The warmth refers to warm touch, and the noun 'discharge' is understood in the sentence.
The commentary introduces the number and causes of breast disorders. It says their number corresponds to the nadi types and names vata, pitta, kapha, sannipata, and trauma as their causes.
Key terms
stanaroga
A disorder of the breast in this classical section.
gati
The nadi types whose number provides the comparison.
धमन्यः संवृतद्वाराः कन्यानां स्तनसंश्रिताः |
दोषाविसरणात्तासां न भवन्ति स्तनामयाः ||१६||
Meaning of the śloka
The text states that in girls or women who have not been pregnant, the openings of the dhamanis associated with the breasts are closed; because the doshas do not spread through them, breast disorders of the type under discussion do not arise.
The commentary explains kanya here as a woman in whom pregnancy has not occurred, rather than merely a member of a different sex or bodily kind. Avisarana means non-spreading or failure to extend through the channels.
Key terms
dhamanI (dhamani)
A classical channel associated here with the breast.
saMvRutadvAra (samvritadvara)
Having a closed opening.
kanyA (kanya)
Interpreted by the commentary as a woman who has not been pregnant.
doShAvisaraNa (doshavisarana)
Non-spreading of the doshas through the described channels.
stanAmaya (stanamaya)
A breast disorder in the category being discussed.
तासामेव प्रजातानां गर्भिणीनां च ताः पुनः |
स्वभावादेव विवृता जायन्ते सम्भवन्त्यतः ||१७||
Meaning of the śloka
In pregnant women and in those who have given birth, those same channels are said to become naturally open; from this, disorders of the breast may arise.
The commentary clarifies that the same dhamanis in pregnant women and those who have delivered acquire open or expanded outlets. Prajata means women who have given birth, ta refers to the dhamanis, and vivrita means having outlets that are open or extended. The words 'breast disorders' are understood as completing the final statement: they may arise from this condition.
Key terms
dhamanI (dhamani)
A channel in the classical anatomical account.
prajAtA (prajata)
A woman who has given birth.
vivRuta (vivrita)
Open, here explained as having extended or opened outlets.
stanaroga
A disorder of the breast; supplied by the commentary to complete the sentence.
Because milk had already been mentioned as a factor in breast disorders, the commentary explains its origin. Rasaprasada means the clearest or finest essence, strength, or radiance of rasa. In the expression 'produced from digested food,' digested food primarily denotes rasa, so the intended meaning is that stanya arises from rasa. It is called stanya when it reaches the breasts from the whole body, since rasa-dhatu, dispersed by vyana, is understood to pervade the body.
Key terms
stanya
Human milk in this passage.
rasaprasAda (rasaprasada)
The refined or finest essence of rasa.
pakvAhAra (pakvahara)
Digested food, used here to indicate rasa as its principal product.
rasadhAtu (rasadhatu)
The classical bodily constituent from which stanya is said to arise.
vyAna (vyana)
The factor said by the commentary to disperse rasa throughout the body.
Just as shukra is not visibly found even when body parts are cut, it is said to reside throughout the body; stanya is described by the same analogy. Shukra is said to flow through arousal produced by seeing, remembering, hearing, or touching a desired young woman, with a clear and pleased mind serving as a cause of that arousal. Similarly, because a woman's stanya is said to arise from the nutritive essence of food, it begins to flow through contact with, sight or remembrance of, and holding her child. Continuous affection is identified as the underlying cause of this milk flow.
The commentary uses the familiar example of shukra to explain how stanya, though not seen inside the body, can become externally manifest. The phrase 'the characteristics of shukra' is completed as 'stanya is said to have them,' because both are understood to reside throughout the body. Shukra is said to emerge when arousal arises through four factors involving a desired young woman: seeing, remembering, hearing, and touch. Samharsha is explained as a particular intention or experience of touch, and a mind unobstructed by jealousy and similar states is treated as a contributing cause. Stanya is likewise said to originate in ahararasa and to flow through four corresponding relations with the child: touch, sight, remembrance, and taking the child into one's arms. In this comparison, the child replaces the desired partner and continuing affection, sneha, replaces arousal as the fundamental cause. The supplied commentary closes incompletely after verses 19-22, while the source includes the line numbered 23.
Key terms
shukra
A reproductive substance used as the passage's analogy for an unseen, body-wide substance that becomes manifest.
stanya
Human milk, compared here with shukra in origin and flow.
saMharSha (samharsha)
Arousal, explained as involving a particular intention or experience of touch.
suprasanna manas
A clear and pleased mind, unobstructed by jealousy and similar states.
apatya
One's child in the explanation of milk flow.
sneha
Continuous affection, identified as the underlying cause of milk flow.
तत् कषायं भवेद्वातात् क्षिप्तं च प्लवतेऽम्भसि ||२३||
पित्तादम्लं सकटुकं राज्योऽम्भसि च पीतिकाः |
कफाद्घनं पिच्छिलं च जले चाप्यवसीदति |
सर्वैर्दुष्टैः सर्वलिङ्गमभिघाताच्च दुष्यति ||२४||
Meaning of the śloka
Milk affected by vata is described as astringent and as floating when placed in water. When affected by pitta, it is sour with a slightly pungent or bitter quality and forms yellow streaks in water. When affected by kapha, it is thick and slimy and sinks in water. When all the doshas are disturbed, it shows all these features; it may also become altered through injury.
Before stating the normal qualities of stanya, the commentary first describes altered milk that should be rejected in the classical account. The conjunction in the vata description is said to include unstated qualities such as thinness. Sakatuka is explained as slightly bitter, since katu may also be used for a bitter taste. Alongside the stated yellow streaks in water, the commentary says blue and red streaks should also be understood. The conjunction after sliminess suggests admixture of doshas. Avasidati means that the sample sinks, and injury is exemplified by a fall, compression, or similar trauma.
Key terms
vAtaduShTa stanya (vatadushta stanya)
Milk classified as altered by vata, described as astringent and floating in water.
pittaduShTa stanya (pittadushta stanya)
Milk classified as altered by pitta, described as sour and producing colored streaks.
kaphaduShTa stanya (kaphadushta stanya)
Milk classified as altered by kapha, described as thick, slimy, and sinking.
rAjI (raji)
A streak or line appearing in water in the classical test.
avasIdati (avasidati)
Sinks or settles downward in water.
abhighAta (abhighata)
Physical injury, exemplified by falling or compression.
Milk that becomes uniformly mixed when placed in water, and that is pale, sweet, without abnormal discoloration, and clear or settled in its natural state, is identified by the text as normal.
The commentary presents these as the signs of stanya without doshic disturbance. Ekibhavati means that it becomes one with or mixes into the water. Avivarna is explained as having a slight natural tint such as pale yellow rather than an abnormal color, and prasanna means remaining in its natural, clear state.
Key terms
nirdoSha stanya (nirdosha stanya)
Milk regarded as free from doshic disturbance in the classical account.
ekIbhavati (ekibhavati)
Becomes one with or mixes uniformly into water.
pANDura (pandura)
Pale or whitish in appearance.
avivarNa (avivarna)
Without abnormal discoloration; explained as allowing a slight natural tint.
सक्षीरौ वाऽप्यदुग्धौ वा प्राप्य दोषः स्तनौ स्त्रियाः |
रक्तं मांसं च सन्दूष्य स्तनरोगाय कल्पते ||२६||
Meaning of the śloka
When a dosha reaches a woman's breasts, whether they contain milk or have not been emptied, it disturbs rakta and mamsa and thereby becomes capable of producing a breast disorder.
After describing normal and altered stanya, the commentary explains the classical pathogenesis of breast disorders. 'Containing milk' refers to the breasts of a pregnant woman, for whom milking or emptying is said not to be possible. 'Not milked' refers to a woman who has given birth, for whom emptying is possible. When breasts that could be emptied are not emptied, the doshas are said to become aggravated under the pressure of the milk load and give rise to breast disease. The final phrase means that they become capable of producing such a disorder.
Key terms
sakShIra stana (sakshira stana)
Breasts containing milk; applied by the commentary to pregnancy.
adugdha stana
Breasts described as not milked or not emptied after childbirth.
doSha (dosha)
A classical regulatory factor said here to disturb breast tissues.
rakta
The classical blood-related tissue affected in the proposed pathogenesis.
mAMsa (mamsa)
Flesh or muscle tissue affected in the proposed pathogenesis.
For concision, the commentary defines the signs of these breast disorders by reference to an earlier category. Tesham refers to the breast disorders, and samana means that their signs are similar to those of external vidradhi; the verb 'are' is understood rather than explicitly stated.
Key terms
stanaroga
A breast disorder in the fivefold classical classification.
shoNitavidradhi (shonitavidradhi)
The blood-origin vidradhi excluded from the comparison.
bAhyavidradhi (bahyavidradhi)
An external inflammatory swelling whose signs supply the comparison.
atidesha
Explanation by extending or referring to features already stated elsewhere.
इति सुश्रुतसंहितायां निदानस्थाने विसर्पनाडीस्तनरोगनिदानं नाम दशमोऽध्यायः ||१०||
Meaning of the śloka
Thus ends the tenth chapter of the Nidanasthana in the Sushruta Samhita, entitled Visarpa-Nadi-Stanaroga-Nidana, the diagnostic account of visarpa, nadi, and breast disorders.
The commentary colophon states that the tenth chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
visarpa
One of the classical disorder categories named in the chapter title.
nADI (nadi)
A tract or channel disorder category named in the chapter title.
stanaroga
Disorders of the breast.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.