62 NIDANA STHANAM. Chap. IX. ]
The Kaphaja Type:— This abscess is shaped
like an Indian saucer (s'arava) and seems cold to the
touch. It assumes a light yellow colour and is character-
ised by numbness, itching and little pain. The growth
and suppuration of this abscess is very slow. The
secretions from a Vataja abscess are thin, those from
a Pittaja type are yellow, while the exudations from a
Kaphaja abscess are white. J.
The Sannipatika Type:— An abscess of
the Sannipatika type is of varied colour, and is attended with a varied sort of pain (sucking, drawing, turning etc.) and exudes secretions of various colours (white, yellow, etc.). It is little raised or elevated at its top, large and irregular in its shape and does not uniformly suppurate in all its parts. 8.
Agantuja or Kshataja Type :-~The local
or inherent heat of an ulcer, (caused by a blow or a
dirt) in a person, addicted to unwholesome regimen, is
augmented and conducted by the deranged V^yu and
vitiates the blood and Pittam, thus giving rise to a kind
of abscess which is known as the Agantuja Vidradhi
(traumatic abscess). Symptoms of the Pittaja type like-
wise mark this type of abscess and fever, thirst and a
burning sensation attend it from the very beginning. 9.
The Raktaja Type:— This abscess assumes
a black or tawny colour, covered with a large number
of black vesicles, and fever and an intolerable burning
and pain attended with all the symptoms peculiar tOj
the Pittaja type, mark the present form of the disease.
It is called Raktaja Vidradhi. Of external Vidradhis
or abscesses, those of the Sannipatika type should be
regarded as incurable. 10 — 11.
Antara-Vidradhi :— Now we shall describe the characteristic features of internal abscesses (Antara-
[Chap. IX. THE SUSHRUTA SAMHITA . 6$
VidradhI). The Vdyu, Pittam and Kaphah of the body,
deranged through eating heavy, incompatible and in-
congenial (to the physical temperament of the eater)
articles of food or of dry, putrid and decomposed sub-
stances, or by excessive coition and fatiguing physical
exercise, or by voluntary repression of any natural
urging of the body or through the eating of food which
is followed by an acid reaction, either severally or
collectively give rise to a tumour-like (Gulma), raised,
or elevated abscess in the interior of the organism, which
is often felt to be shaped like an ant-hill. 12-13.
Localities : — They are generally found to be
seated at the mouth (neck) of the bladder, or about the
umbilicus, or in the sides, or in the Kukshi (inguinal
regions), or on the Vrikkas, or on the liver, or in the
heart, or on the Kloma, or on the spleen, or in the
rectum. Their general characteristics are identical with
those of the several types of external abscess. The
symptoms of their suppurated or unsuppurated stages
should be determined in the light of the chapter on
Amapakvaishanyiam (Ch XVII Sutra.). 14-15.
Their specific symptoms : -Now hear
me describe the symptoms which specifically mark these internal abscesses according to their seats in the differ- j ent regions of the organism. An abscess appearing in the rectum (Guda) is marked by the suppression of the flatus ( Vata). Seated in the bladder, it gives rise to difficulty of urination and scantiness of urine. Appearing about the umbilicus it produces a distressing hic-cough and a rumbling sound (Atopa) in the intes- tines. Seated in either of the sides (Kukshi) it tends to aggravate inordinately the vayu of the body. Appear- ing in the inguinal region it gives rise to an extreme catching pain at the back and waiyt. Sea^ted in either
64 NIDANA STHANAM [Chap. IX.
of the Vrikkas it brings about a contraction of the sides. Appearing on the spleen, it produces symptoms of difficult and obstructed respiration. Seated on the heart it gives rise to an excruciating and piercing pain within its cavity and a drawing pain (Graha) extending all over the body (D. R. — cough). Seated in the Liver its characteristic indications are thirst and difficult breathing (D. R. — hic-cough) whereas a sort of unquen- chable thirst is the symptom which marks its seat on the Kloma. 16-17.
Prognosis : — An abscess appearing on any
vital part (Marma) of the organism, whether large
or small in size, suppurated or unsuppurated, should be
deemed as extremely hard to cure. Discharge from an
abscess formed in the region of the organism above the
umbilicus and (spontaneously bursting), will flow out
through the mouth whereas similar secretions from down
the umbilical region of (the abdomen), naturally find
an outlet through the fissure of the anus. The case
in which the secretions (pus etc.) find a down-
ward channel and outlet may end in recovery of the
patient; whereas the one in which the secretions take an
upward course invariably proves fatal. An incision
made by surgeon from the outside into an internal
abscess, other than the one situated on the heart, or on
the bladder or on the umbilicus may occasionally, prove
successful, but the one, seated on any of the preceding
vulnerable visceras (heart, bladder etc.) of the body and
surgically opened invariably ends in death. 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 injudi-
cious 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 child-
birth, 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 symp- toms which indicate that suppuration Has set in a Gulma, and be ' adVises that it (Gulma) should be treated^wixlrpouUices, etc.
66 THE SUSHRUTA SAMHITA. [Chap. IX.
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 in-
curable. The abscess in which the marrow suppurates
(generally) becomes fatal. The suppurating process in
an internal abscess, which generally affects the under-
lying 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.
Now we shall discourse on the Nidanam of Visar- pa (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 as-
sume 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 a
68 THE SUSHRUTA SAMHITA. [Chap. X.
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.
The Kshataja Type (Erysipelas due to a
wound or an ulcer):— The Pittam of a person with a
temperament marked by the extreme aggravation of all
the three Doshas, in conjunction with the blood, resorts
to a wound* in his body and immediately gives rise to
Eiysipelas (Sopha— lit rash) which assumes a reddi.sh-
brown colour, with high fever with a burning sensation,
and suppuration in its train, and it is found to be
covered with black vesicles to the size of Kulattha
pulse. 7.
Prognosis : — The Vataja, Pittaja and Kaphaja
Visarpas are curable ; the Sannipdtika and Khataja
ones being incurable. The symptoms, which indicate
an unfavourable prognosis in a case of Vdtaja or
Pittaja Erysipelas, have been described before. Those,
which attack the vital parts (Marmas) of the body, can
be cured only with the greatest difficulty.i* 8.
* Or through the extreme augmentafion of all the three doshas in the ulcer (Sadyah-kshata-Vj ana) according to others.
t Golden coloured (yellow) Erysipelas due to the action of the (deranged) Pittam is incurable (AV/a/wa /^h-tichana-vapuicha ta^hi na sydhyet.).''V>. R.
Chap. X.] , NIDANA STHANAM. 69
The N^ldi-Vrana :~The pus of an abscess or swelling burrows into the affected part if a person neglects it in its fully suppurated stage, dubious of its being so conditioned, or not, or even neglects to open a fully suppurated abscess. An abscess or swelling is called a Gati Vrana owing to an excessive infiltration of pus, and it is also called a N^di-vrana owing to the presence of a large number of recesses or cavil ies in its inside. There are five different types of Nddi-vrana (sinuses) such as the Vdtaja, Fittaja, Kaphaja, Tridoshaja and Salyaja. 9— 10.
