Chapter VII - Diagnosis of enlargement of the abdomen

Now we shall discourse on the Nidana of Udara (dropsy with an abnormal condition of the abdomen). I.

Metrical Text:—

The royal sage Dhanvantari, the foremost of all pious men who equalled in splendour and glory the lord of the celestials, thus blissfully discoursed on the Nidana of Udara to Sushruta, the son of the holy Vishvamitra, who devoutly approached him for that purpose. 2.

Classification:—

This disease may be divided into eight different types, of which four are produced by the several actions of the three deranged Doshas of the body and their concerted action as well. Of the remaining types, two being known as Plihodara (including Yakritodara), and Vaddha-Gudodara (tympanites due to the constriction of the anus), the seventh Agantuka (traumatic or of extraneous origin), and the eighth Dakodara (Ascites proper). 3.

Predisposing Causes:—

The deranged Doshas of a person of extremely impaired digestion, addicted to the habit of taking unwholesome food, or of eating dry, putrid food, or of violating the rules of conduct to be observed in connection with oleaginous measures etc.,^[1] are aggravated and find lodgment in the abdomen. Thus appearing in the shape of an abdominal tumour (Gulma), they give rise to this dreadful disease, attended with all its characteristic symptoms. The lymph chyle formed out of the assimilated food gets vitiated, and, impelled by the aggravated Vayu, it percolates through the peritoneum in the same manner as a quantity of oil or clarified butter kept in, a new, earthen pot will transude through the pores of its sides. It thus gradually distends the skin (Tvak) of the abdomen. The process becomes general all through the abdominal region and the disease (Udara) is produced in consequence. 4—5.

Premonitory sypmtoms:—

The precursory symptoms of the disease are loss of strength, complexion and appetite, emaciation of the muscles of the abdomen, appearance of veins on its surface, acid reaction of food closely following upon its digestion (Vidaha), pain in the bladder, and swelling of the lower extremities. The patient cannot ascertain whether his meal has been digested or not. 6.

The Vataja, Pittaja, and Kaphaja Types:—

A case of Udara in which the abdomen enlarges on its sides and posterior part, and is overspread with nets of black veins should be ascribed to the action of the deranged Vayu. A pain (Shula), suppression of the stool and urine (Anaha) and a cutting and piercing pain and flatulent rumbling in the intestines are the symptoms which likewise characterise this Vataja form of Udara. A sucking pain in the abdomen, thirst, fever with a burning sensation, yellow colour of the swollen skin of the abdomen, on the surface of which yellow veins appear, yellow colour of the eyes, nails, face, stool and urine and the rapid increase of the dropsical swelling, are the characteristics of the Pittaja Udara. In a case of Kaphaja type the dropsical swelling is cold to the touch and becomes overspread with white-coloured veins. The abdomen seems heavy, hard, glossy and is extremely distended. The swelling slowly increases, and the fingernails and face of the patient become white, and he complains of a general lassitude. 7—9.

The Tridoshaja Type:—

Evil-natured women (with a view to win the affections of their husbands or lovers sometimes) mix with their food and drink such refuse matters of their bodies as nails, hair, feces, urine, catamenial blood etc. (which are supposed to be possessed of talismanic virtues). The three Doshas of the body, vitiated by such food or drink, or through imbibing any sort of chemical poison (Gara) administered by one’s enemy, or by taking poisonous waters, or Dushi-Visha (slow poison whose active properties have been destroyed by fire or any antipoisonous medicine), will vitiate the blood and give rise to a kind of dreadful dropsical swelling of the abdomen, marked by the specific symptoms of each of them The disease is aggravated in cold and cloudy days and a burning sensation is felt (in the inside of the abdomen). The patient becomes pale, yellow and emaciated, and is afflicted with thirst and dryness in the mouth, and loses consciousness at short intervals. This disease is also known as the dreadful Dushyodara. 10.

Plihodara (Spleen with dropsy of the abdomen):—

Now hear me describe the symptoms of Plihodara. The blood and the Kapha of a person, deranged and aggravated through the ingestion of phlegmagogic food, or of those which is followed by an acid digestionary reaction (Vidaha), often enlarge the spleen, (which gives rise to a swelling of the abdomen). This disease is called Plihodara by the experts. Plihodara protrudes on the left side of the abdomen, its characteristic symptoms being lassitude, low fever, impaired digestion, loss of strength, jaundice, weakness, and other distressing symptoms peculiar to the deranged Pitta and Kapha. A similar enlargement of the liver through similar causes on the right side of the abdomen is called Jakriddalyudara. 11—12.

Vaddha-gudodara^[2]:—

The fecal matter, mixed with the deranged Vayu, Pitta etc. of the body, lies stuffed in the rectum of a person whose intestines have been stuffed with slimy food (as pot herbs) or with stones and hair (enteritis). They give rise to a sort of abdominal dropsy by swelling the part between the heart and the umbilicus which is called Vaddha Gudodara. Scanty stools are evacuated with the greatest pain and difficulty and the patient vomits a peculiar kind of matter with a distinctly fecal smell (scyabalous?). 13.

Parisravi-Udara:—

Now hear me describe the causes and symptoms of the type of Udara which is called Parisravi-udara. Thorny or sharp-pointed substances (such as fish-bones etc.), carried down with the food in a slanting way from the stomach into the abdomen, sometimes scratch or burrow into the intestines. Causes other than the preceding ones, (such as a long yawn or over-eating etc.) may contribute to the perforation of the intestines, giving rise to a copious flow of a watery exudation which constantly oozes out of the anus and to a distension of the lower part of the abdomen situated below the umbilicus. This is called Parisravyudara which is marked by a cutting pain and a burning sensation. 14.

Dakodara:—

Now hear me describe the causes and symptoms of the type known as Dakodara (ascites). The drinking of cold water immediately after the application of an Aunvasana or Asthapana enema, or closely following upon the exhibition of any purgative or emetic medicine, or just after the taking of a medicated oil or clarified butter, etc. tends to derange the water-carrying channels of the body. The same result may be produced by the drinking of oil, etc. in inordinate quantities The water, by percolating or transuding through the walls of these channels, as before described, inordinately enlarges the abdomen, which becomes glossy on the surface and is full of water, being rounded about the umbilicus and raised like a full-bloated water-drum. The simile is complete as it fluctuates under pressure, oscillates, and makes a peculiar sound like a water-drum under percussion. 15.

Distension of the stomach, incapacity of locomotion, weakness, impaired digestion, edematous swelling of the limbs, a general sense of lassitude and looseness in the limbs, suppression of flatus and stool, and a burning sensation and thirst are among the general characteristics of the disease in its various forms. 16.

Prognosis:—

All cases of Udara after the lapse of considerable time develop into those of ascites, and a case arriving at such a stage should be given up as incurable. 16—17.

 

Thus ends the seventh Chapter of the Nidana Sthana in the Sushruta Samhita which treats of the Nidana of Udara.

Footnotes and references:

[1]:

These include purgative, emitic, Asthapana and Anuvasana measures.

[2]:

Dropsical swelling of the abdomen with tympanites due to the constriction of the rectum known as intestinal obstruction.