Chapter XII - Diagnosis of hernia, tumours, elephantiasis, etc.

Now we shall discourse on the Nidana of Vriddhi (hydrocele, hernia, scrotal tumours etc.), Upadansha (disease of the genital organ), and Shlipada (elephantiasis). 1.

Classes:—

There are seven different types of Vriddhi such as the

1. Vataja-vriddhi,
2. Pittaja-vriddhi,
3. Kaphaja-vriddhi,
4. Raktaja-vriddhi,
5. Medaja-vriddhi,
6. Mutraja-vriddhi
7. and the Antra-vriddhi.

Of these both the Mutraja-vriddhi (hydrocele or extravagation of the urine), and Antra-vriddhi types, though owing their origin to the deranged condition of the bodily Vayu, have been so named after the organic matters or anatomical parts (urine, iliac colon etc.) involved in them. 2.

Definition and Premonitory symptoms:—

Any of the deranged Doshas (Vayu, Pitta, etc.) lying in the nether regions of the body may resort to the spermatic cords (Dhamani) and give rise to a swelling and inflammation of Phalacosha (scrotal sac) which is called Vriddhi (scrotal tumour etc.). A pain in the bladder, scrotum, penis and the waist (Kati) incarceration of the Vayu and the swelling of the scrotum, are the premonitory symptoms of the disease. 3—4.

The Dosha-origined Types:—

The type in which the scrotum becomes distended with Vayu like an inflated air-drum, marked by roughness of (its surface) and the presence of a varied sort of Vataja pain (in its interior) without any apparent cause is called Vataja Vriddhi. The swollen scrotum, of the Pittaja Vriddhi, assumes the colour of a ripe Audumvara fruit and is attended with fever, a burning sensation and heat in the affected part. It is of a marked rapid growth and speedy suppuration (of the scrotum). The swollen organ in the Kaphaja Vriddhi becomes hard and cold to the touch accompanied by little pain, and itching in the affected part. In the Raktaja type the swollen scrotum is covered over with black vesicles, all other symptoms of the type being identical with those of the Pittaja one. In the Medaja type the swollen scrotum looks like a ripe Tala fruit and becomes soft, glossy and slightly painful. The patient feels a constant inclination to scratch the part. The Mutraja-vriddhi (hydrocele) owes its origin to a habit of voluntary retention of urine, its characteristic symptoms being softness and fluctuation on the surface of the swollen scrotum like a skin-bladder filled with water, painful urination, pain in the testes and swelling of the scrotum. 5.

Antra-vriddhi (Inguinal hernia):—

The local Vayu enraged and unusually aggravated by lifting a great load, wrestling with a stronger person, violent physical strain or a fall from a tree and such like physical labour doubles up a part of the small intestine and presses it down into the inguinal regions lying there strangulated in the form of a knot (Granthi) which is known as Antra-vriddhi (inguinal hernia). The part not properly attended to at the outset descends into the scrotum which becomes ultimately elongated and intensely swollen and looks like an inflated air-bladder. It (hernia) ascends upwards under pressure, making a peculiar sound, (gurgling); while let free it comes down and again gives rise to the swelling of the scrotum. This disease is called Antra-vriddhi and is incurable. 6.

The Upadansha:—

An inflammatory swelling of the genital, whether ulcerated or not is called Upadansha^[1]. The disease owes its origin to the action of the local Doshas, aggravated by promiscuous and excessive sexual intercourse, or by entire abstinence in sexual matter; or by visiting a woman, who had observed a vow of lifelong continence or one who has not long known a man, or one in her menses or one with an extremely narrow or spacious vulva, or with rough or harsh or large pubic hairs; or by going unto a woman whose parturient canal is studded with hairs along its entire length; or by visiting a woman not amorously disposed towards the visitor and vice versa; or by knowing a woman who washes her private parts with foul water or neglects the cleanliness of those parts, or suffers from any of the vaginal diseases, or one whose vagina is naturally foul; or by going unto a woman in any of the natural fissures of her body other than the organ of copulation (Vi-yoni); or by pricking the genital with finger nails, or biting it with the teeth, or through poisonous contact, or through practice of getting the (penis abnormally elongated by pricking the) bristles of a water parasite (Shuka) into its body; or by practising masturbation, or any unnatural offence with female quadrupeds; or by washing the genitals with filthy or poisonous water; or through neglect to wash the parts after coition, or voluntary suppression of a natural flow of semen or urine or through any hurt or pressure on the organ etc. The inflammation of the genital thus engendered is called Upadansha. The disease admits of being divided into five distinct types, such as, the Vataja, Pittaja, Kaphaja, Tridoshaja and the Raktaja. 7–8.

The symptoms of different Types:—

The roughness of the genitals, the bursting or cracking of the integuments of the penis and prepuce etc., numbness and swelling of the affected part which is perceived rough to the touch and the presence of a varied sort of pain peculiar to the deranged Vayu are the characteristic indications of the Vataja type. In the Pittaja type fever sets in (from the very beginning), the penis becomes swollen and assumes the colour of a ripe Indian fig (reddish-yellow), attended with a sort of intolerable burning sensation The process of suppuration is rapid and a variety of pain peculiar to the deranged Pitta, (distinguishes it from the other forms of the disease). The penis becomes swollen, hard and glossy in the Kaphaja type marked by itching and a variety of pain characteristic of the deranged Kapha. In the blood-origined type (Raktaja) the organ bleeds heavily and is covered with the eruptions of large black vesicles. Fever, thirst, (Sosha), burning sensations and other characteristic symptoms of the deranged Pitta are also present. Palliation is all that can be occasionally effected in these cases. Symptoms specifically betraying to each of the Vataja, Pittaja and Kaphaja types concurrently manifest themselves in the Sannipatika type of Upadansha. The organ cracks, the ulcers or cancers become infested with parasites and death comes in to put a stop to the suffering of its wretched victim. 9—13.

Shlipadam (Elephantiasis):—

The disease in which the deranged Vayu, Pitta and Kapha, taking a downward course, are lodged in the thighs, knee-joints, legs and the inguinal regions and spread to the feet in course of time and gradually give rise to a swelling therein, is called Shlipadam. There are three types of Shlipada severally due to the actions of the deranged Vayu, Pitta and Kapha. 14—15.

The symptoms of the different Types:—

The swollen parts assume a black colour in the Vataja type and are felt rough and uneven to the touch. A sort of spasmodic pain without any apparent reason is felt (at intervals in the seat of the disease), which largely begins to crack or burst. The Pittaja type is characterised by a little softness and yellowish hue (of the diseased localities) and often attended with fever, and a burning sensation. In the Kaphaja type the affected localities become white, glossy, slightly painful, heavy, contain large nodules (Granthis) and are studded over with crops of papille. 16.

Prognosis:—

A case of elephantiasis of a year’s growth as well as the one which is characterised by excessive swelling (of the affected parts), exudation and vegetation of knotty excrescences resembling the summits of an ant-hill should be given up as incurable. 17.

Memorable Verses:—

A preponderance of the deranged Kapha marks the three types of the disease, in as much as, the heaviness and largeness (of the swelling) can not be brought about by any other factor than Kapha. The disease is peculiar to countries in which large quantities of old rain-water remain stagnant during the greater part (lit.—all seasons) of the year making them damp and humid in all seasons. 18-91

The disease is usually found to be confined to the legs and hands of men but cases are on record in which it has extended to the ear, nose, lips and the regions of the eyes. (Penis—Madhaba-Nidana). 20.

 

Thus ends the twelfth Chapter of the Nidanastbana in the Sushruta Samhita which treats of the Nidana of scrotal tumours, hernia, Upa- dansha and elephantiasis.

Footnotes and references:

[1]:

Upadansha is not syphilis whole to whole. Certain types of Upadansha such as the Raktaja and Sannipatika types which entail the destruction of the organs concerned exhibit certain symptoms which are common to syphilis as well. The secondary eruptions and tertiary symptoms of syphilis are not mentioned by the Ayurvedic Rishis who used to treat it only with vegetable medicines and this fact intimates the probability that the secondary and tertiary symptoms of syphilis might not arise by their efficient and able treatment from the very beginning, preventing the absorption of the poison into the system. The practice of ablution, so common among the Hindus, might be taken into consideration as one of the important preventive factors. Maharshi Charaka has comprised it within the chapter on ‘Senile Impotency’.—Ed.