Chapter CLXXIII - The Nidanam of diseases of the female reproductive organs

Hear me, O Sushruta, now discourse the Nidanam of diseases that are peculiar to the opposite sex. Ingestion of incompatible articles of fare, eating before the digestion of a previous meal, indigestion, abortions, sexual excesses, excessive travelling in carriages, or riding on horse-back etc., exhaustion through excessive grief or anguish, lifting or carrying of inordinately heavy weights, local-injuries and day sleep may be described as the exciting factors of Asrigdara (uterine or vaginal catarrh) of which a bruised or aching pain in the limbs forms the specific concomitant. Weakness, vertigo, epileptic fits, mental distraction, somnolence, delirium with a burning sensation in the body and various other nervous distempers manifest themselves on the aggravation of the discharge. There are four different types of Pradara, brought about through the several actions of the deranged Vayu, Pittam, and Kaphah and through their concerted action as well. In the type of Pradara (leucorrhœa) due to the action of the-deranged Kaphah, the discharge becomes greyish and slimy, or resembles the washings of meat in colour. In the Pittaja type of leucorrhœa, the discharge becomes hot and assumes, a yellowish, bluish, blackish or reddish colour, and other specific symptoms of the deranged Pittam are found to supervene. In the Vataja type of leucorrhœa the discharge is frothy and scanty, and resembles the washings of meat. It is ejected in small quantities, attended with the other specific affections of the deranged Vayu. In the Sannipatika type of leucorrhœa the discharge assumes the colour of honey, clarified butter, yellow oxide of arsenic (Haritala) or of marrow, and gets a cadaverous smell. This Sannipatika form of leucorrhœa should be regarded as incurable, and a physician, with any regard to his personal fame, should not prescribe any medicine in cases of this type. A case of leucorrhœa, attended with fever, thirst, weakness, poverty of blood, and a copious and constant discharge with a burning sensation in the body, should be regarded as beyond all cure. Catamenial blood which follows a regular periodicity as regards its out-flow and flows out for five days, each month, unattended with any pain or burning sensation, and which is neither exceedingly thin nor slimy, should be regarded as the indication of sound health in a woman. Catamenial blood, which is coloured either like the washings of shellac, or the blood of a hare, and which leaves no stain on the linen after washing, should be likewise regarded as pure (healthy.)

Twenty different varieties of vaginal diseases are recognised in practice, O Sushruta, of which injudicious and unwholesome food, menstrual disorders, congenital taints, and dynamics of acts done by a woman in her previous births act as the exciting factors.

In the variety known as Udavarta (dysmenorrhœa) frothy catamenial blood is emitted with the greatest pain. In the disease known as Vandhya (sterility) the menstrual flow is either absent or suppressed. In the disease known as Vipluta, an intolerable pain is felt in the reproductive organs. In the variety known as Paripluta (Vaginitis) an excruciating pain is felt in the vagina during an act of sexual congress. In the variety known as Vatala-yoni, the vaginal canal is felt rough and numbed, attended with an aching, piercing pain. In all these four varieties of vaginal complaints the pain experienced is of a nervous (Vataja) character. A female reproductive organ, which loses blood (bleeds, attended with a burning sensation in its inside, is called Lohita-Kshaya. In the disease known as Vamini, a large number of ova is ejected with blood, accompanied by loud reports. In the disease called Prasransini, the vagina is displaced from its natural seat (prolapsus of the Vagina), while the disease known as Kshobhita precludes the possibility of conception on account of the extremely agitated condition of the local nerves. In the disease known as Putraghni, the patient may conceive at close intervals, but the pregnancy is often destroyed though the emission of uterine blood, which is facilitated by a weakened condition of the local nerves which is one of the specific features of this disease. In the disease known as Pittalayoni, fever with a burning sensation and suppuration in the vagina is found to supervene. These four foregoing types of Yoni-roga should, be regarded as marked by a predominance of the deranged Pittam, and of symptoms peculiar to that morbific diathesis. In the disease known as Atyananda the patient knows no satisfaction in respect of sexual pleasures (nymphomania). In the disease known as Karnini, polypi grow in the vaginal canal through the agency of the deranged Kaphah and blood. In the disease known as Acharana, the woman spends herself before her husband during an act of sexual congress, while in that called Atichara the woman is never satisfied, hence in both these diseases the seeds of man and woman never meet. In the disease known as Shleshmala-yoni, the vaginal canal is felt cold and slimy and is marked by an itching sensation. These four forms of Yoni-roga should be regarded as marked by the predominance of the deranged Kaphah. A woman in whom the catamenial flow and the mammae do not appear, and whose vaginal canal is perceived rough during acts of sexual congress is called a Shandi. An immature girl by holding sexual intercourse with a fully developed and exceedingly large-limbed man suffers from evils which are called Andalis. A vagina with an extremely dilated Vulva is called Maha-yoni, while that with an extremely constricted (external) orifice is called Suchi-Vaktra. These four last-named types of Yoni-roga should be regarded as due to the concerted action of the deranged Vayu, Pittam, and Kaphah, and hence incurable.

The deranged Vayu, Pittam and Kaphah of the vaginal region,) aggravated through such exciting factors as day-sleep, excessive irascibility, over-fatiguing physical exercise, sexual excesses, bites, and scratches, give rise to excrescences in that locality which assume a colour, blended of those of pus and blood, and resemble Lakucha fruit in shape. These vaginal growths or excrescences are called Kandas. In the Vataja type of this disease the growths become rough, discoloured and cracked. In the Pittaja type they are marked by redness and a burning sensation. In the Kaphaja type they are coloured blue like Atasi flowers and are marked by an itching sensation. In the Sannipatika type they are marked by all the aforementioned specific symptoms.