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AYANAACADEMYby Dr Vijaya Dwarampudi
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12. vr̥ddhyupadaṁśaślīpadanidānam

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Adhikarana 1 (1-2) · Śloka 2

athātō vr̥ddhyupadaṁśaślīpadānāṁ nidānaṁ vyākhyāsyāmaḥ ||1|| yathōvāca bhagavān dhanvantariḥ ||2||

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

Meaning of the śloka

Now we shall explain the diagnosis of vṛddhi, upadaṃśa, and ślīpada. Thus spoke the revered Dhanvantari.

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athāta ityādi||1-2||

Meaning of the commentary

The commentary only marks the conventional opening and its two verses and provides no further explanation.

Key terms

vRuddhi (vṛddhi)
A classical category of enlargement, especially involving the groin or scrotal region in this chapter.
upadaMsha (upadaṃśa)
A classical category of genital lesion discussed later in the chapter.
shlIpada (ślīpada)
A classical category of marked limb swelling discussed later in the chapter.
nidAna (nidāna)
The account of causes, development, and diagnostic features.

Adhikarana 2 (3) · Śloka 3

vātapittaślēṣmaśōṇitamēdōmūtrāntranimittāḥ sapta vr̥ddhayō bhavanti | tāsāṁ mūtrāntranimittē vr̥ddhī vātasamutthē, kēvalamutpattihēturanyatamaḥ ||3||

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वातपित्तश्लेष्मशोणितमेदोमूत्रान्त्रनिमित्ताः सप्त वृद्धयो भवन्ति | तासां मूत्रान्त्रनिमित्ते वृद्धी वातसमुत्थे, केवलमुत्पत्तिहेतुरन्यतमः ||३||

Meaning of the śloka

Seven forms of vṛddhi are described, associated respectively with vāta, pitta, kapha, blood, medas, urine, and intestine. Of these, the urine-origin and intestine-origin enlargements also arise through vāta; urine or intestine is their distinct initiating basis.

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vr̥ddhīnāṁ saṅkhyāmāha- vātētyādi| saṅkhyēyanirdēśādēva saptasaṅkhyāsiddhau saptagrahaṇaṁ dvandvajādivr̥ddhiniṣēdhārthaṁ; tāsāṁ punarasambhavō vyādhisvabhāvāt| dhātumalakr̥tāyāmapi vr̥ddhau dōṣasyaiva cikitsārthaṁ sambhavaṁ darśayannāha- tāsāmityādi| vātasamutthē vātāt samyaguttiṣṭhētē vr̥ddhiṁ gacchata ityarthaḥ| jananahētuḥ punaranyatama iti taṁ pratipādayannāha- kēvalamutpattihēturanyatama iti| kēvalaṁ param, utpattērutpādakasya hētuḥ kāraṇamanyat mūtramantraṁ vā| anyē tu anayōrvr̥ddhyōryaṁ utpattērhēturvāyuḥ sō'nyatamō bhinnō jñēyaḥ; ētēna mūtrasandhāraṇakupitō vāyurmūtravr̥ddhēḥ kāraṇaṁ, bhāraharaṇādibhiḥ kupitastvantravr̥ddhērityarthaḥ||3||

Meaning of the commentary

The commentary says that although the seven items already establish the number, the explicit word ‘seven’ excludes additional mixed-doṣa categories; such mixed forms are considered impossible because of the nature of this disorder. Even where the enlargement is named for a tissue or waste product, a doṣa is still involved for purposes of treatment. The urine-origin and intestine-origin forms are said to arise fully through vāta, while urine or intestine is the separate material cause. Another interpretation says the vāyu initiating each of these two should itself be understood as distinct: vāyu aggravated by retaining urine causes the urine-origin form, whereas vāyu aggravated by carrying loads and similar exertion causes the intestine-origin form.

Key terms

sapta vRuddhayaH (sapta vṛddhayaḥ)
The seven classical forms of enlargement listed here.
mUtranimitta (mūtra-nimitta)
Having urine as the distinct initiating or material basis.
antranimitta (antra-nimitta)
Having intestine as the distinct initiating or material basis.
vAtasamuttha (vāta-samuttha)
Arising through aggravated vāta in the classical explanation.
dhAtumala (dhātu-mala)
Tissue or waste-product categories used to name some forms.
utpattihetu (utpatti-hetu)
The initiating or productive cause.

Adhikarana 3 (4) · Śloka 4

adhaḥ prakupitō'nyatamō hi dōṣaḥ phalakōśavāhinīrabhiprapadya dhamanīḥ phalakōṣayōrvr̥ddhiṁ janayati, tāṁ vr̥ddhimityācakṣatē ||4||

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अधः प्रकुपितोऽन्यतमो हि दोषः फलकोशवाहिनीरभिप्रपद्य धमनीः फलकोषयोर्वृद्धिं जनयति, तां वृद्धिमित्याचक्षते ||४||

Meaning of the śloka

When one of the doṣas becomes aggravated downward, it is said to enter the vessels that carry to the phalakośa and cause enlargement of the scrotal or testicular-sac region. This is called vṛddhi.

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tāsāṁ samprāptimāha- adhaḥ prakupita ityādi| phalakōśayōrityanēna dvivacanēna muṣkadvaya ēva vr̥ddhiriti na jñēyaṁ, kiṁ tarhi ēkasminnapi pakṣē vr̥ddhiriti jñātavyam||4||

Meaning of the commentary

The commentary presents this as the general development of the seven forms. Although the source uses the dual when referring to the two phalakośas, it should not be understood to require enlargement on both sides; the condition may occur on only one side.

Key terms

adhaH prakupita doSha (adhaḥ prakupita doṣa)
A doṣa described as aggravated in a downward direction.
phalakoshavAhinI dhamanI (phalakośa-vāhinī dhamanī)
A vessel said to carry toward the scrotal or testicular-sac region.
phalakosha (phalakośa)
The paired scrotal or testicular-sac region in this context.
vRuddhi (vṛddhi)
Enlargement of this region in the classical category.
ekasmin pakShe (ekasmin pakṣe)
On one side only, which the commentary expressly allows.

Adhikarana 4 (5) · Śloka 5

tāsāṁ bhaviṣyatīnāṁ pūrvarūpāṇi- bastikaṭīmuṣkamēḍhrēṣu vēdanā mārutanigrahaḥ phalakōśaśōphaścēti ||5||

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तासां भविष्यतीनां पूर्वरूपाणि- बस्तिकटीमुष्कमेढ्रेषु वेदना मारुतनिग्रहः फलकोशशोफश्चेति ||५||

Meaning of the śloka

The preliminary signs of an approaching vṛddhi are said to be pain in the bladder region, waist or pelvis, scrotum, and penis; obstruction of flatus; and swelling of the scrotal region.

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tāsāṁ pūrvarūpāṇyāha- tāsāmityādi||5||

Meaning of the commentary

The commentary simply identifies these as the preliminary signs of the forms of vṛddhi and gives no additional interpretation.

Key terms

pUrvarUpa (pūrvarūpa)
A preliminary or prodromal sign.
basti
The bladder or bladder region in this context.
kaTI (kaṭī)
The waist, pelvic, or lower-back region.
muShka (muṣka)
The testicle or scrotal region.
meDhra (meḍhra)
The penis.
mArutanigraha (māruta-nigraha)
Obstruction or retention of flatus.
phalakoshashopha (phalakośa-śopha)
Swelling of the scrotal or testicular-sac region.

Adhikarana 5 (6) · Śloka 6

tatrānilaparipūrṇāṁ bastimivātatāṁ paruṣāmanimittānilarujāṁ vātavr̥ddhimācakṣatē; pakvōdumbarasaṅkāśāṁ jvaradāhōṣmavatīṁ cāśusamutthānapākāṁ pittavr̥ddhiṁ; kaṭhināmalpavēdanāṁ śītāṁ kaṇḍūmatīṁ ślēṣmavr̥ddhiṁ; kr̥ṣṇasphōṭāvr̥tāṁ pittavr̥ddhiliṅgāṁ raktavr̥ddhiṁ, mr̥dusnigdhāṁ kaṇḍūmatīmalpavēdanāṁ tālaphalaprakāśāṁ mēdōvr̥ddhiṁ; mūtrasandhāraṇaśīlasya mūtravr̥ddhirbhavati, sā gacchatō'mbupūrṇā dr̥tiriva kṣubhyati mūtrakr̥cchravēdanāṁ vr̥ṣaṇayōḥ śvayathuṁ kōśayōścāpādayati, tāṁ mūtravr̥ddhiṁ vidyāt; bhāraharaṇabalavadvigrahavr̥kṣaprapatanādibhirāyāsaviśēṣairvāyurabhipravr̥ddhaḥ prakupitaśca sthūlāntrasyētarasya caikadēśaṁ viguṇamādāyādhō gatvā vaṅkṣaṇasandhimupētya granthirūpēṇa sthitvā'pratikriyamāṇē ca kālāntarēṇa phalakōśaṁ praviśya muṣkaśōphamāpādayati, ādhmātō bastirivātataḥ pradīrghaḥ sa śōphō bhavati, saśabdamavapīḍitaścōrdhvamupaiti, vimuktaśca punarādhmāyatē , tāmantravr̥ddhimasādhyāmityācakṣatē ||6||

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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||

Meaning of the śloka

The vāta form is described as distended like a bladder filled with air, rough, and affected by unpredictable vāta-type pain. The pitta form resembles a ripe udumbara fruit, has fever, burning, and heat, and arises and suppurates rapidly. The kapha form is hard, cold, mildly painful, and itchy. The blood form is covered with dark blisters and otherwise displays the signs of the pitta form. The medas form is soft, unctuous, itchy, mildly painful, and resembles a tāla fruit. The urine-origin form is said to occur in a person habitually retaining urine; while walking, it moves like a leather bag filled with water and produces painful difficulty passing urine and swelling of the scrotal region. For the intestine-origin form, the text says that exertions such as carrying loads, wrestling with a stronger person, or falling from a tree aggravate vāyu, which takes hold of part of the large or small intestine, descends to the groin, remains there as a lump, and, if not addressed, later enters the scrotal region and causes swelling. That swelling is distended, extended, and elongated like an inflated bladder; when pressed, it moves upward with a sound, and after release it fills again. This intestine-origin form is historically described as unsuitable for curative treatment.

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tāsāṁ vātādijānāṁ lakṣaṇamāha- tatrānilētyādi| ātatām ādhmātām| mēdōvr̥ddhimiti kaphēna saha| mūtrētyādi śīlaṁ svabhāvaḥ| kṣubhyati sañcalati| ādhmātō bastiriva paripūrṇō mūtrāśaya iva| ātatō vistīrṇaḥ| upaiti udgacchati, vimuktaśca saśabdamēvādhmāyatē||6||

Meaning of the commentary

The commentary glosses ātata in the vāta form as distended or inflated. It states that the medas form involves kapha as well. Habitual urine retention is explained as a person's regular practice, and kṣubhyati means that the urine-origin swelling moves. The intestine-origin swelling is compared with a full urinary bladder: ādhmāta means filled or inflated, ātata means expanded, and upaiti means it rises upward when pressed; after pressure is released, it fills again with an audible sound.

Key terms

vAtavRuddhi (vāta-vṛddhi)
The enlargement attributed to vāta, described as air-filled and variably painful.
pittavRuddhi (pitta-vṛddhi)
The enlargement attributed to pitta, described with heat, fever, and rapid suppuration.
shleShmavRuddhi (śleṣma-vṛddhi)
The enlargement attributed to kapha, described as hard, cold, itchy, and mildly painful.
raktavRuddhi (rakta-vṛddhi)
The blood-associated enlargement, described with dark blisters and pitta-like signs.
medovRuddhi (medo-vṛddhi)
The enlargement associated with medas and, according to the commentary, kapha.
mUtravRuddhi (mūtra-vṛddhi)
An enlargement attributed to urine in the classical classification.
antravRuddhi (antra-vṛddhi)
An enlargement attributed to descent of a portion of intestine into the groin or scrotal region.
va~gkShaNasandhi (vaṅkṣaṇa-sandhi)
The groin region or junction.

Adhikarana 6 (7) · Śloka 7

tatrātimaithunādatibrahmacaryādvā tathā'tibrahmacāriṇīṁ cirōtsr̥ṣṭāṁ rajasvalāṁ dīrgharōmāṁ karkaśarōmāṁ saṅkīrṇarōmāṁ nigūḍharōmāmalpadvārāṁ mahādvārāmapriyāmakāmāmacaukṣasalilaprakṣālitayōnimaprakṣālitayōniṁ yōnirōgōpasr̥ṣṭāṁ svabhāvatō vā duṣṭayōniṁ viyōniṁ vā nārīmatyarthamupasēvamānasya tathā karajadaśanaviṣaśūkanipātanādbandhanāddhastābhighātāccatuṣpadīgamanādacaukṣasalilaprakṣālanādavapīḍanācchrukravēgavidhāraṇānmaithunāntē vā'prakṣālanādibhirmēḍhramāgamya prakupitā dōṣāḥ kṣatē'kṣatē vā śvayathumupajanayanti, tamupadaṁśamityācakṣatē ||7||

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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||

Meaning of the śloka

The text attributes upadamsha, a swelling of the penis whether or not a wound is visible, to aggravated doshas reaching the organ after various forms of friction, trauma, contamination, or obstruction. Its historical list includes excessive intercourse or intercourse after prolonged abstinence; intercourse during menstruation, without mutual willingness, with genital disease, or involving features thought to increase friction; non-vaginal or animal contact; injury from nails, teeth, a poisonous aquatic creature, constriction, manual impact, or pressure; washing with unclean water or not washing after intercourse; and holding back ejaculation.

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vr̥ddhērantaramupadaṁśānāṁ hētvadyabhidhānamāha- tatrātimaithunētyādi| atibrahmacāriṇyā maithunātinivr̥ttyā saṅkucitakarkaśayōnimukhatvāt| cirōtsr̥ṣṭāṁ prabhūtakālatyaktāṁ, atrāpi sa ēva hētuḥ| brahmacāriṇyā janmanaḥ prabhr̥tyēva maithunābhāvaḥ, cirōtsr̥ṣṭāyāstu kadācidēvētyanayōrbhēdaḥ| rajasvalāyā duṣṭārtavaprasaṅgāt| dīrghakarkaśādirōmābhigamanē pīḍanābhighātaprasaṅgāt| saṅkīrṇarōmā ghanarōmā| nigūḍharōmā abhyantararōmā| alpadvārāyāmapi sa ēva hētuḥ| mahādvārāyāṁ śōphahētuścinttya ēva, tasmāt kēcinna paṭhanti| apriyāyāṁ liṅgānutthānēnētaścētābhighātaprasaṅgāt| akāmāyāḥ sakthisaṅkōcēna dvārālpatvāt| acōkṣasalilaprakṣālitayōnēḥ saliladōṣāt, acōkṣamapavitram| aprakṣālitayōnēḥ svēdamaladōṣāt| yōnirōgōpasr̥ṣṭāyā rōgadōṣānusārēṇa dōṣōdayāt| svabhāvatō vā duṣṭayōnērvātādaya ēva kāraṇam| viyōniṁ hastajaṅghāntaraṁ, tasya karkaśatvāt| karajā nakhāḥ, daśanā dantāḥ, śūkasya saviṣajalajakīṭasya, nipātanālliṅgādiśarīrē pātanādathavā tēṣāṁ mardanāt pīḍanāt| catuṣpadyō'jādayō rāsabhyādayō vā, tāsāmapyalpāramyayōnitvāt| acōkṣasalilaprakṣālanādibhiriti acōkṣasalilaprakṣālanamatra liṅgasya na tu yōnēḥ||7||

Meaning of the commentary

The commentary explains the list through its historical ideas about constriction, roughness, friction, injury, menstrual discharge, sweat, dirt, diseased tissue, and disturbed doshas. It distinguishes lifelong abstinence from a long interval since intercourse. It interprets samkirnaroma as dense hair, nigudharoma as inward hair, and viyoni as contact with the hand or between the thighs. Some omit the reference to a large genital opening because they find its proposed connection with swelling doubtful. The comments concerning an unwanted partner explain injury through lack of arousal or bodily contraction; these statements describe the commentator's reasoning and do not assign fault to that person. Karaja and dashana mean nails and teeth. The mention of shuka is explained as contact with or crushing of a venomous aquatic creature. The final reference to unclean-water washing concerns the penis rather than the vagina.

Key terms

upadaMsha (upadamsha)
A classical category of genital swelling or ulcerative disease affecting the penis.
meDhra (medhra)
The penis in this passage.
kShata/akShata (kshata/akshata)
With or without a visible wound.
viyoni
Non-vaginal sexual contact, glossed here as the hand or space between the thighs.
shUka (shuka)
A venomous aquatic creature in the commentary's explanation; the precise referent is uncertain.
shukravegavidhAraNa (shukravegavidhArana)
Holding back the urge to ejaculate.

Adhikarana 7 (8) · Śloka 8

sa pañcavidhastribhirdōṣaiḥ pr̥thak samastairasr̥jā cēti ||8||

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स पञ्चविधस्त्रिभिर्दोषैः पृथक् समस्तैरसृजा चेति ||८||

Meaning of the śloka

Upadamsha is classified into five types: one arising separately from each of the three doshas, one from all of them together, and one from blood.

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tēṣāṁ saṅkhyāmāha- sa pañcavidha ityādi| tribhirdōṣaiḥ pr̥thagiti trayaḥ, samastairēkaḥ, asr̥jā caikaḥ, ēvaṁ pañca||8||

Meaning of the commentary

The commentary counts three single-dosha forms, one combined-dosha form, and one blood-born form, making five in total.

Key terms

upadaMsha (upadamsha)
The genital disorder being classified.
vAtaja (vataja)
Attributed to vata.
pittaja
Attributed to pitta.
shlaiShmika (shlaishmika)
Attributed to kapha.
sarvaja
Attributed to all three doshas together.
raktaja
Attributed to blood.

Adhikarana 8 (9) · Śloka 9

tatra vātikē pāruṣyaṁ tvakparipuṭanaṁ stabdhamēḍhratā paruṣaśōphatā vividhāśca vātavēdanāḥ; paittikē jvaraḥ śvayathuḥ pakvōḍumbarasaṅkāśastīvradāhaḥ kṣiprapākaḥ pittavēdanāśca; ślaiṣmikē śvayathuḥ kaṇḍūmān kaṭhinaḥ snigdhaḥ ślēṣmavēdanāśca; raktajē kr̥ṣṇasphōṭaprādurbhāvō'tyarthamasr̥kpravr̥ttiḥ pittaliṅgānyatyarthaṁ jvaradāhau śōṣaśca, yāpyaścaiva kadācit; sarvajē sarvaliṅgadarśanamavadaraṇaṁ ca śēphasaḥ kr̥miprādurbhāvō maraṇaṁ cēti ||9||

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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||

Meaning of the śloka

In vatika upadamsha there is roughness, cracking of the skin, stiffness of the penis, coarse swelling, and varied pains attributed to vata. The paittika form has fever and swelling resembling a ripe udumbara fruit, intense burning, rapid suppuration, and pitta-type pains. The shlaishmika form is swollen, itchy, hard, smooth, and accompanied by kapha-type discomfort. The raktaja form develops black eruptions, profuse bleeding, marked pitta signs, fever, burning, and wasting; it is sometimes described as manageable but persistent. The sarvaja form displays all these signs, fissuring of the penis, appearance of worms, and a fatal prognosis.

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tēṣāṁ vātādijānāṁ pratyēkaṁ lakṣaṇamāha- tatra vātikē ityādi| “mēḍhrasandhau vraṇāḥ kēcit kēcit sarvāśrayāḥ smr̥tāḥ| kulatthākr̥tayaḥ kēcit kēcinmudgadalōpamāḥ|| rujādāhaparītāśca tr̥ṣṇāmōhasamanvitāḥ| śīghraṁ kēcidvisarpanti śanaiḥ kēcittathā'parē|| strīṇāṁ puṁsāṁ ca jāyantē upadaṁśāḥ sudāruṇāḥ”- iti tantrāntarē||9||

Meaning of the commentary

The commentary introduces the individual signs and then quotes another treatise. That source says some upadamsha ulcers occur at the junction of the penis and others occupy broader sites; some resemble kulattha seeds and others split mudga pulses. They may involve pain, burning, thirst, and altered consciousness, and may spread quickly or slowly. It explicitly says that severe upadamsha can occur in women as well as men.

Key terms

tvakparipuTana (tvakpariputana)
Cracking or splitting of the skin.
stabdhameDhratA (stabdhamedhrata)
Stiffness of the penis.
pakvoDumbarasa~gkAsha (pakvodumbarasankasha)
Resembling a ripe udumbara fruit in appearance.
kRuShNasphoTa (krishnasphota)
Black eruption or blister-like lesion.
yApya (yapya)
Manageable but persistent in classical prognosis.
avadaraNa (avadarana)
Fissuring or splitting.

Adhikarana 9 (10) · Śloka 10

kupitāstu dōṣā vātapittaślēṣmāṇō'dhaḥprapannā vaṅkṣaṇōrujānujaṅghāsvavatiṣṭhamānāḥ kālāntarēṇa pādamāśritya śanaiḥ śōphaṁ janayanti, taṁ ślīpadamityācakṣatē | tattrividhaṁ- vātapittakaphanimittamiti ||10||

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कुपितास्तु दोषा वातपित्तश्लेष्माणोऽधःप्रपन्ना वङ्क्षणोरुजानुजङ्घास्ववतिष्ठमानाः कालान्तरेण पादमाश्रित्य शनैः शोफं जनयन्ति, तं श्लीपदमित्याचक्षते | तत्त्रिविधं- वातपित्तकफनिमित्तमिति ||१०||

Meaning of the śloka

Aggravated vata, pitta, and kapha are described as moving downward and settling over time in the groins, thighs, knees, and lower legs. On reaching the foot, they gradually produce swelling called shlipada. Three types are recognized, caused respectively by vata, pitta, and kapha.

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ataḥ paraṁ ślīpadārambhaḥ, upadaṁśasthānē'pi ślīpadasambhavāt; ‘śiśnauṣṭhanāsāsvapi ca kēcidicchanti tadvidaḥ’ iti vacanāt| tēṣāṁ samprāptiṁ nirdiśannāha- prakupitāstvityādi| prakupitā ityanēna sāmarthyādēva hētavō nirdiṣṭāḥ, ahatōrdōṣasyāduṣṭatvāt| sthānasaṁśrayalakṣaṇā samprāptirapi lakṣaṇamēva| tatra pūrvō lakṣaṇōdayō dōṣadūṣyarāśērēva; dūṣyān dūṣayantō dōṣāḥ śōphaṁ janayanti| taṁ ślīpadamityācakṣatē iti pāribhāṣikī nirupādhirēva ślīpadasañjñētītiśabdēna prakāśayati||10||

Meaning of the commentary

The commentary begins the section on shlipada and notes a cited view that it may also occur at the penis, lips, or nose. It says the word 'aggravated' implicitly supplies the causes, because doshas are not disturbed without a cause. Their localization and the resulting swelling constitute both pathogenesis and signs. The expression 'they call it shlipada' establishes the term as a technical name without an additional qualifier.

Key terms

shlIpada (shlipada)
A classical disorder of gradually developing swelling, especially of the foot or lower limb.
va~gkShaNa (vankshana)
The groin region.
Uru (uru)
The thigh.
ja~gghA (jangha)
The lower leg.
sthAnasaMshraya (sthanasamshraya)
Localization of disturbed doshas in a bodily site.
shopha
Swelling.

Adhikarana 10 (11) · Śloka 11

tatra, vātajaṁ kharaṁ kr̥ṣṇaṁ paruṣamanimittānilarujaṁ parisphuṭati ca bahuśaḥ; pittajaṁ tu pītāvabhāsamīṣanmr̥du jvaradāhaprāyaṁ ca; ślēṣmajaṁ tu śvētaṁ snigdhāvabhāsaṁ mandavēdanaṁ bhārikaṁ mahāgranthikaṁ kaṇṭakairupacitaṁ ca ||11||

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तत्र, वातजं खरं कृष्णं परुषमनिमित्तानिलरुजं परिस्फुटति च बहुशः; पित्तजं तु पीतावभासमीषन्मृदु ज्वरदाहप्रायं च; श्लेष्मजं तु श्वेतं स्निग्धावभासं मन्दवेदनं भारिकं महाग्रन्थिकं कण्टकैरुपचितं च ||११||

Meaning of the śloka

Vatika shlipada is rough, dark, coarse, repeatedly cracked, and affected by apparently unprovoked vata-type pains. The pittaja form appears yellowish, is slightly soft, and is characterized mainly by fever and burning. The shlaishmika form is white with a smooth or oily appearance, mildly painful, heavy, marked by large nodules, and covered with thorn-like projections.

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kaphajē bhārikaṁ gurvityarthaḥ||11||

Meaning of the commentary

The commentary provides only one gloss: in the kapha-born form, bharika means heavy.

Key terms

vAtaja shlIpada (vataja shlipada)
The rough, dark, painful type attributed to vata.
parisphuTati (parisphutati)
Cracks or fissures repeatedly.
pittaja shlIpada (pittaja shlipada)
The yellowish, softer type associated here with fever and burning.
shleShmaja shlIpada (shleshmaja shlipada)
The pale, smooth, heavy, nodular type attributed to kapha.
mahAgranthika (mahagranthika)
Having large nodular swellings.
kaNTaka (kantaka)
Thorn-like projections on the swollen surface.

Adhikarana 11 (12) · Śloka 12

tatra saṁvatsarātītamatimahadvalmīkajātaṁ prasr̥tamiti varjanīyāni ||12||

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तत्र संवत्सरातीतमतिमहद्वल्मीकजातं प्रसृतमिति वर्जनीयानि ||१२||

Meaning of the śloka

In this context, cases lasting beyond one year, those that are extremely large, those that have developed an anthill-like form, and those that have spread extensively are to be left aside as unsuitable for curative treatment according to the classical prognosis.

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valmīkajātaṁ valmīkavajjātam, atibahutaraśikharairgranthibhirupacitatvāt; parapadārthēṣu hi pravr̥ttā śabdā vatimantarēṇāpi vatyarthaṁ janayanti||12||

Meaning of the commentary

The commentary explains valmikajata as having become like an anthill because the swelling is built up from very many projecting, knot-like elevations. It adds a grammatical observation: a word used with reference to another object may convey the sense of likeness even without the explicit suffix -vat.

Key terms

saMvatsarAtIta (samvatsaratita)
Persisting for longer than one year.
atimahat
Extremely large.
valmIkajAta (valmikajata)
Anthill-like, explained as having numerous projecting nodular elevations.
prasRuta (prasrita)
Spread or extended widely.
varjanIya (varjaniya)
To be left aside, expressing an unfavorable historical prognosis.

Adhikarana 12 (13) · Śloka 13

bhavanti cātra- trīṇyapyētāni jānīyācchlīpadāni kaphōcchrayāt | gurutvaṁ ca mahattvaṁ ca yasmānnāsti vinā kaphāt ||13||

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भवन्ति चात्र- त्रीण्यप्येतानि जानीयाच्छ्लीपदानि कफोच्छ्रयात् | गुरुत्वं च महत्त्वं च यस्मान्नास्ति विना कफात् ||१३||

Meaning of the śloka

All three forms of shlipada should be understood as having a predominance of kapha, because heaviness and great enlargement do not occur, in this classical account, without kapha.

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vātapittaślīpadānyapi kaphādhikānyēvēti darśayannāha- trīṇītyādi||13||

Meaning of the commentary

The commentary emphasizes that even the vata- and pitta-classified forms of shlipada remain predominantly associated with kapha.

Key terms

shlIpada (shlipada)
A classical disorder category characterized in this context by marked enlargement and heaviness.
kaphocchraya
Predominance or marked increase of kapha.
gurutva
Heaviness.
mahattva
Great size or enlargement.
vAtapittashlIpada (vatapittashlipada)
The vata- and pitta-classified forms, also said here to contain abundant kapha.

Adhikarana 13 (14) · Śloka 14

purāṇōdakabhūyiṣṭhāḥ sarvartuṣu ca śītalāḥ | yē dēśāstēṣu jāyantē ślīpadāni viśēṣataḥ ||14||

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पुराणोदकभूयिष्ठाः सर्वर्तुषु च शीतलाः | ये देशास्तेषु जायन्ते श्लीपदानि विशेषतः ||१४||

Meaning of the śloka

Shlipada is said to arise especially in regions where old or standing water is abundant and where the climate remains cool in every season.

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dēśaviśēṣa ēvāsyōtpattiṁ darśayannāha- purāṇōdakabhūyiṣṭhā ityādi| anūpadēśasya purāṇōdakabhūyiṣṭhatā| jāṅgalasyōnnatasamabhūtalatvāt salilaṁ patitaṁ na tiṣṭhati, sthitamapi rūkṣōṣṇaśuṣkatvāddēśasya śōṣamupaiti; tēna jāṅgaladēśasya śītē'pyaśītatā||14||

Meaning of the commentary

The commentary explains this as a regional association. Anupa country is characterized by abundant retained water. In contrast, the elevated and even terrain of jangala country does not retain fallen water; any water that remains dries because the region is rough, hot, and arid. For that reason, jangala is said not to be truly cold even during the cold season.

Key terms

purANodaka (puranodaka)
Old, standing, or retained water.
anUpadesha (anupadesha)
A wet or marshy ecological region characterized here by retained water.
jA~ggaladesha (jangaladesha)
A dry ecological region described as elevated, hot, rough, and water-shedding.
shItala (shitala)
Cool or cold.
shlIpada (shlipada)
The classical swelling disorder associated here with a particular environment.

Adhikarana 14 (15) · Śloka 15

pādavaddhastayōścāpi ślīpadaṁ jāyatē nr̥ṇām | karṇākṣināsikauṣṭhēṣu kēcidicchanti tadvidaḥ ||15||

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पादवद्धस्तयोश्चापि श्लीपदं जायते नृणाम् | कर्णाक्षिनासिकौष्ठेषु केचिदिच्छन्ति तद्विदः ||१५||

Meaning of the śloka

A shlipada-like condition may arise in the hands just as it does in the feet. Some authorities knowledgeable about the disorder also recognize it at the ears, eyes, nose, and lips.

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ślīpadasya pādābhyāmanyasminnapyaṅgē utpattiṁ darśayannāha- pādavaddhastayōścāpītyādi||15||

Meaning of the commentary

The commentary states that this verse extends the possible location of shlipada beyond the feet to other parts of the body.

Key terms

shlIpada (shlipada)
A classical enlargement or swelling disorder, named from its typical association with the feet.
hasta
The hand, identified as another possible site.
karNa (karna)
The ear.
akShi (akshi)
The eye or eye region.
nAsikA (nasika)
The nose.
oShTha (oshtha)
The lip.

Adhikarana puṣpikā · Śloka 12

iti suśrutasaṁhitāyāṁ nidānasthānē vr̥ddhyupadaṁśaślīpadanidānaṁ nāma dvādaśō'dhyāyaḥ ||12||

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इति सुश्रुतसंहितायां निदानस्थाने वृद्ध्युपदंशश्लीपदनिदानं नाम द्वादशोऽध्यायः ||१२||

Meaning of the śloka

Thus ends the twelfth chapter of the Nidanasthana in the Sushruta Samhita, entitled Vriddhi-Upadamsha-Shlipada-Nidana, the diagnostic account of vriddhi, upadamsha, and shlipada.

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iti śrīḍalha(hla)ṇaviracitāyāṁ nibandhasaṅgrahākhyāyāṁ suśrutavyākhyāyāṁ nidānasthānē dvādaśō'dhyāyaḥ||12||

Meaning of the commentary

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

Key terms

vRuddhi (vriddhi)
A classical enlargement or swelling category named in the chapter title.
upadaMsha (upadamsha)
A classical genital-lesion category named in the chapter title.
shlIpada (shlipada)
A classical disorder involving marked swelling or enlargement.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.
dvAdasha adhyAya (dvadasha adhyaya)
The twelfth chapter.
nibandhasa~ggraha (Nibandhasangraha)
The title of Dalhana's commentary.
← 11. granthyapacyarbudagalagaṇḍanidānam13. kṣudrarōganidānam →