The Sushruta Samhita — trans. Bhishagratna

18-19.

A woman, who has miscarried or has been even safely delivered of a child at term, may be afflicted with a dreadful abscess in the event of her taking injudicious and unhwholesome food after parturition. The" ?ibscess in such a case, which is attended with extreme

Chap. IX.] NIDANA STHANAM. 65

hyper-pyrexia (Ddhajvara) should be considered as; having had its origin to the vitiated blood (Raktaja Vidradhi) accumuVated in , the organism. The abscess,, which appears in the Kukshi (in the iliac region) of a safely delivered woman owing to the presence of the unexpelled blood-clots in those regions after childbirth, should be also diagnosed as a case of Raktaja abscess. The unexpelled blood is called Makkalla* Such an abscess, if not absorbed in the course of a week, is sure to suppurate. 20 — 21.

Differentiating diagnosis of Gulma and Vidradhi* :— Now I shall discuss the featuresi which distinguish a Gulma (internal tumour) from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration ? 22—23.. The answer is that a Gulma (internal tumour), though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased" flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity

* A Gulma according to Sus'ruta does not suppurate, but the term

*'Api" (also) contemplates instances in which a Giil ma rinay suppurate as in the case where it has got its basis in the- deranged flesK eVcr' of the locality. Charaka asserts that retarded digestion" of the inges.ted -food followed by digestionary acid reaction, colic pain, insomnia with fever and a non- relish for food and a sense of oppcessiohi etc. ar« thei symptoms which indicate that suppuration Has set in a Gulma, and be ' adVises that it (Gulma) should be treated^wixlrpouUices, etc.

p. 66

ar« thei symptoms which indicate that suppuration Has set in a Gulma, and be ' adVises that it (Gulma) should be treated^wixlrpouUices, etc.

p. 66

of the body etc. without any fixed root of its own. Hence, it is that a Gulma (internal tumour) does not suppurate at all. Suppuration sets in in an abscess only because it largely contains flesh and blood unlike a Gulma (internal tumour) which is not formed of any such organic matter, and depends only on the aggravated Doshas giving birth to it. Hence, a Gulma does not suppurate at all. 24.

Incurable Types :— A case of an internal abscess suppurating about the heart, bladder or umbilicus as well as one of the Tridosha type (appearing in any part of the organism) should be given up as incurable. The abscess in which the marrow suppurates (generally) becomes fatal. The suppurating process in an internal abscess, which generally affects the underlying bone, is sometimes found to affect the marrow. The suppurated marrow, failing to find an outlet on account of the compactness of the local flesh and bone, produces a sort of burning sensation in the localit}^ which consumes the body like a blazing fire. The disease confined to the bone, like a piercing dirt, torments the patient for a considerable length of time. An incision (made into the affected bone) is followed by the secretion of a fat-like, glossy, white, cold and thick pus. Men, learned in the knowledge of the Medicinal Sastras, designate such an abscess as an Asthighata-Vidradhi (abscess of the bone) which involves all the three kinds of deranged Doshas, and is attended with various kinds of pain which mark them respectively. 25-26.

Thus ends the ninth Chapter of the Nidanasthanam in the Sui'rut^
3f^nbitd which treats of the setiology of abscess.

CHAPTER X.

Now we shall discourse on the Nidanam of Visarpa (erysipelas), Nad! (sinus) and Stana-roga

(diseases affecting the mammae of a woman), i.

CHAPTER X.

Now we shall discourse on the Nidanam of Visarpa (erysipelas), Nad! (sinus) and Stana-roga

(diseases affecting the mammae of a woman), i.

Definition of Visarpa :~The deranged and aggravated Doshas, (Vayu, Pittam and Kapham) having recourse to, and affecting the Tvaka (Skin), flesh and blood, speedily give rise to a sort of shifting, elevated swelling (Sotha) marked by the characteristic symptoms of any of them involved in the case. This swelling tends to extend all over the body. The disease is called Visarpa from the fact of its extending or swiftly shifting character (Skr. srip -to go, to extend). 2.

The Vataja Type :— The swelling (Sotha) is soft and rough and assumes a black colour attended with an aching pain in the limbs and a cutting or piercing pain (in the affected locality). It is further marked by (all the usual) symptoms of the Vdtika fever. A case of this type in which uneven flame coloured vesicles or bulbs appear on the affected part through the extreme vitiation (of the Vayu and Pittam) should be given up as incurable. 3.

The Pittaja and Kaphaja Types :-Thc

Pittaja Visarpa (erysipelas) rapidly extends (over the body), attended with severe fever, a burning sensation, suppuration and cracking (of the skin;. A large number of vesicles appears on the spot which assume a blood-red colour. A case of this type, characterised by the destruction of the local flesh and veins owing to the excessively aggravated condition of the deranged Doshas (Kaphha and Pittam) and ap. 68 collyrium-Iike black colour (of the swelling), should be regarded as incurable. The Kaphaja Visarpa extends slowly and the process of suppuration is tardy. The affected part becomes white, glossy and swollen, and is marked by a slight pain and excessive itching. 4-5.

The Sannipatika Type : -The Visarpa of the Tridoshaja type is deep-seated and the affected part assumes all colours and is attended with all sorts of pain which are peculiar to the three aforesaid types. The local flesh and veins are destroyed in the suppurating stage of this disease and hence, it shouldbe looked upon as incurable. 6.