Sushruta Samhita, volume 2: Nidanasthana

by Kaviraj Kunja Lal Bhishagratna | 1911 | 37,609 words

This current book, the Nidana-sthana (english translation), is the second part of this voluminous medical work. It deals with diseases: their prognosis, their cause, their symptoms and their pathogenesis (development of the disease). The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can poss...

Chapter X - Diagnosis of erysipelas, sinus and mammae

Now we shall discourse on the Nidana of Visarpa (erysipelas), Nadi (sinus) and Stana-roga (diseases affecting the mammae of a woman). 1.

Definition of Visarpa:—

The deranged and aggravated Doshas, (Vayu, Pitta and Kapha) 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 (Shotha) 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 Vatika 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 Pitta) should be given up as incurable. 3.

The Pittaja and Kaphaja Types:—

The 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 Pitta) and a collyrium-like 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 should be looked upon as incurable. 6.

The Kshataja Type:—

(Erysipelas due to a wound or an ulcer):—The Pitta 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[1] in his body and immediately gives rise to Erysipelas (Shopha—lit rash) which assumes a reddish- brown colour, with high fever with a burning sensatioil, and suppuration in its train, and it is found to be covered with black vesicles to the size of Kulattha pulse. 7.


The Vataja, Pittaja and Kaphaja Visarpas are curable; the Sannipatika and Khataja ones being incurable. The symptoms, which indicate an unfavourable prognosis in a case of Vataja 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.[2] 8.

The Nadi-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 Nadi-vrana owing to the presence of a large number of recesses or cavities in its inside. There are five different types of Nadi-vrana (sinuses) such as the Vataja, Pittaja, Kaphaja, Tridoshaja and Shalyaja. 9—10.

The Vataja, Kaphaja and Pittaja Types:—

The Vataja Sinus is rough and shortmouthed, characterised by an aching pain (in its inside). It exudes a sort of frothy secretion which becomes greater at night and is attended with an aching pain. Thirst, lassitude, heat and a piercing pain (in the affected locality) are the usual accompaniments of the Pittaja types. Fever is present from the beginning and the Sinus exudes a large quantity of hot and yellow coloured secretion which is more by day than by night. The Kaphaja Sinus becomes hard and is characterised by 'itching and a slight pain (numbed?). It is found to secrete a copious quantity of thick, shiny, white-coloured pus which becomes greater at night. 11-13.

Dvandaja and Tridoshaja Types:—

A case of Nadi-Vrana involving the concerted action of any two of the deranged Doshas (Vayu, Pitta and Kapha) and exhibiting symptoms peculiar to both, is called a Dvandaja[3] one. There are three types of this class of disease, (such as the Vata-pittaja, Vata-kaphaja and Pitta-kaphaja) A case of Nadi- vrana, exhibiting symptoms of the three aforesaid types, and attended with fever and a burning sensation, difficult breathing, dryness of the mouth and syncope, is called Tridoshaja. An attack of this type should be regarded as dreadful and fatal, casting around the gloom of death. 14-15.

The Shalyaja Nadi-Vrana:—

A foreign matter (such as dirt, bone, splinter etc.), lodged within the body and invisible to the eye, tends to burst open the skin, etc. of the locality along its channel of insertion and gives rise to a type of Sinus. It is characterised by a constant pain, and suddenly and rapidly exudes a sort of hot, blood-tinged, agitated, frothy secretion. This type is called Shalyaja. 16.

The Stana-Roga:—

These may be divided into as many types as the aforesaid Nadi-Vrana and are caused by the same exciting factors as the last named malady. The milk-carrying ducts remain closed in the breast of a nullipera thus barring the possibility of the descent of the Doshas through them and of an attack of any disease at that part of the body. On the contrary, such ducts in the breast of a primipara open and expand of their own accord, thus making the advent of diseases possible that are peculiar to the mamma. 17-19.

The breast-milk:—

The sweet essence of the Rasa (lymph chyle) drawn from the digested food courses through the whole body and is ultimately concentrated in the breast of a mother or a woman (big with child) which is called milk. 20.

Its character:—

The breast-milk, like semen, lies hidden and invisible in the organism, though permeating it in a subtle or essential form. The characteristic features of the breast-milk bear analogy to those of semen The breast milk is secreted, and flows out at the touch, sight or thought of the child in the same manner as the semen is dislodged and emitted at the sight, touch or recollection etc. of a beloved woman. As the strong and unclouded affections of a man are the cause of the emission of semen, so the fondest love of a mother for her children brings about the secretion of her breast-milk Both semen and breast-milk are the product of the essence of digested food, this essence being converted into milk in women. 21—22.

Its abnormal and normal Traits:—

The milk of a mother vitiated by the deranged Vayu of her system has an astringent taste and floats on water The milk of a mother vitiated by the deranged Pitta has an acid and pungent taste and becomes marked with a yellow hue,[4] if left to float on water. The milk of a mother vitiated by the deranged Kapha is thick and slimy and sinks in water. The milk of a mother vitiated by the concerted and simultaneous derangement of the three Doshas of the body is marked by the combination of all the preceding symptoms. An external blow or hurt too (Abhighata) sometimes produces vitiation of the mother’s milk. 23.

The milk (of a mother), which instantly mixes with water, tastes sweet and retains its natural greyish tint, should be regarded as pure. 24.

The bodily Doshas having recourse to the breasts of a woman whether filled with milk or not and vitiating the local flesh and blood give rise to mammary diseases, (Stana-roga). All the types of abscess (Vidradhi) excepting the one called the Raktaja out of the six types described before are found to attack the mammae, and their symptoms should be understood as identical with those of external abscesses. 25.


Thus ends the tenth Chapter of the Nidana Sthana in the Sushruta Samhita which treats of the etiology and symptoms of Erysipelas, Sinus and mammary abscesses.

Footnotes and references:


Or through the extreme augmentation of all the three doshas in the ulcer (Sadyah-kshata-Vrana) according to others.


Golden coloured (yellow) Erysipelas due to the action of the (deranged) Pitta is incurable (Pittatma Kancana-vapustha tatha na sydhyet.).—D. R.


Gayadasa does not read the symptoms of Dvi-doshaja (i.e., due to two morbific principles) types of sinus a given in the text which he has rejected as spurious


The particle “Ca” in the text indicates that the colour may turn blue or pink in some cases.

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