The Nidanam of abscesses, etc. ||160||

1Dhanvantati said: -Hear me, O Susruta, now disclose on the aetiology and sympto-mology etc., of abscesses, (Vidradhi) and Gulmas (internal glands). Ingestion of stale, dry, parchifying, or extremely hot food may be set down as the primary cause of Vidradhis and Galmas.
2-3The blood vitiated through such factors as gratification of carnal propensities by unnatural means, use of hard and uneven beds etc., vitiates, in its, turn, the skin, flesh, fat, and bones of the body, and takes refuge in the abdominal cavity, causing a round or extended swelling to appear either in the inside or on the surface of the body, attended with an excruciating, aching pain, which is called a Vidracthi.
4The morbific principles of the body, such as the deranged Vayu, Pittam and Kapham, either severally or combinedly, may give rise to an abscess, which may likewise occur is any part of the body, which has been profusely bled. An external abscess appearing at any part of the body as an outcome of profuse bloodletting is found to have a knotty formation.
5An internal tumour, on the other hand, is always found to be deep-swatted, compact as an internal gland (Gulma) and chequered with orifices, like an anthill, through which secretions are exuded. The patient complains of impaired digestion in this internal type of Vidradhi, which proves fatal in many instances.
6The spleen, liver, lungs, heart, urinary bladder, intercostal, and inguinal regions; principally form the seats of these internal abscesses. A heavy palpitation of the heart, enhancing the pain, is experienced when an abscess occurs in that locality.
7The abscess assumes either a blackish or bluish red colour, is slow in its growth and suppuration, and regular in its, formation.
8Loss of consciousness, vertigo, tympanites with suppression of the stool and urine, and bleeding, attended with a kind of. indistinct report, are the distressing symptoms which are found to supervene:
9-10An abscess originated through the action of the action of the deranged Pittam assumes either a red, copper, or black colour, and is attended with fainting, fever and a burning sensation. The abscess is rapid in its growth, and suppuration sets in early in the Pittaja type. An abscess of the Kaphaja type is tinged grey, and is attended with an itching sensation, and shivering. Numbness of the affected part, yawning, and heaviness of the limbs, with a non-relish for food are the symptoms which further characterize this Kaphaja type. An internal abscess of the Sannipata type, like an external one of the same kind, is slow in growth and suppuration. It assumes a black colour, becomes studded over with blebs, and is attended with an intolerable burning pain, with fever and loose motions of the bowels.
11The external abscesses have all their origin in the deranged condition of the Pittam. There is another kind of external abscess which is peculiar to women. The blood, enrage~ by a blow or hurt, may give rise to another kind of Vidradhi.
12The blood in any part of the body, that has been wounded, becomes agitated through the action of the local Vayu (nerve force). The enraged blood, failing to find out an outlet, mixes with the deranged Pittarn, and produces a kind of abscess, which is attended with all the symptoms peculiar to the deranged Pittam and vitiated blood.
13Different symptoms are exhibited according to the variation in the seat of an abscess in the body, as for example, an internal abscess, occurring about the region of the umbilicus, brings on an obstinate tympanites, while the one, which appears in the urinary bladder, produces painful micturition.
14An abscess of the spleen brings on dyspnea, and an unquenchable thirst. An abscess in the lungs produces constriction of the larynx, while the one in the heart produces a pain all over the body.
15An abscess, occurring inside the I inter-coastal region, produces vertigo, fainting, a digging pain in the heart, and the peculiar form of dyspnea known as Svasa (described before).
16And abscess, occurring inside the inguinal regions, about joint of the thighs, or about the union of the back and waist (sacrum), produces the incarceration of the wind and kind of intolerable pain.
17The non-suppurated, suppurating, and suppurated stages of an abscess should be ascertained in the manner of any other swelling. An internal abscess, occurring in the region above the umbilicus, with its head pointing upward, bursts out in the Epitomic, and evacuates its contents through the passage of the anus.
18-19An internal abscess, occurring in the rectum, or the umbilicus, and exuding its (peculiar) secretion, should be regarded as indicating a painful prognosis. An internal abscess of the Sannipata type appearing in any of the aforesaid localities in the body produces an alteration in the composition of the local tissues, while an external one, occurring about the umbilicus, or in or above the urinary bladder, runs to suppuration and bursts. an internal abscess, fully developed, is always found to suppurate, while the one, that is not well developed, gives rise to may a supervening, distressing symptom in its immature stage.
20A peculiar kind of abscess in found to occur in the uterus of wicked women, who are addicted to the sinfu practice of effecting miscarriage of their pregnancy. The swellings in the uterus, caused by frequent abortions, become compact and condensed, and are thus transformed into abscesses. A mammary abscess should be regarded as an external one to all intents and purposes.
21An internal abscess can never occur in any of the reproductive organs of a girl, owing to the comparatively greater thinness of blood that courses in the female economy, during childhood.
22It is the aggravated and obstructed Vayu (nerve force) that should be regarded as the primary cause of all swellings.
23The local Vayu, any wise aggravated, courses down from the region of union between the penis and the scrotum, finds lodgment in the spermatic chord of the testes, presses upon the local vessels, and produces a swelling of the scrotum by vitiating the fat of the locality. The disease is called Vrddhi Roga, which admits of being divided into seven different types.
24A preponderance of the deranged Vayu in a Vidradhi Roga of this type, whether external or internal, is followed by copious micturitions. In the Vataja type of this Vrddhi Roga, the swelling (scrotal tumour) becomes inflated, parched and rough to the touch, marked by a burning sensation in its inside.
25In the Pittaja type, the swelling assumes a vermilion tint like that of a ripe Audumabara fruit (Ficus Indica), and is attended with heat, burning, and suppuration. In the Kaphaja type, the swelling becomes, cold, heavy, glossy, and slightly painful, attended with an itching sensation.
26In the Raktaja type (Hematocele) (due to the action of the contaminated blood), the swelling becomes compact, and is covered with a crop of bulbous eruptions on its surface, its other features being one with those described under the head of Pittaja type of Vrddhi. The swelling in the type originated through the action of the deranged fat and Kapham becomes soft and rounded like a palm fruit.
27-28The type known as Mutraja Vrddhi (Hydrocele), usually appears in those who are in the habit of voluntarily suppressing their urine. The patient leads a sort of quiescent life, and does not evince any desire for anything in special. The swelling becomes distended with serious accumulations, and suffers a perceptible diminution in size, if its fluid contents are in any way evacuated.
29Cold ablutions and use of articles of fare, that tend to aggravate the bodily Vayu, are the factors which produce a kind of ring-like swelling at the bottom of the scrotum, producing painful micturition.
30The Vayu aggravated by voluntary repression of natural urgings of the body to urination or defecation, or by violent physical exercise or straining of the lower limbs in any unnatural posture, or suck like aggravating factors, tends to produce a determination of blood to the lower limbs and inguinal regions, instantaneously causing the appearance of a ring like glandular swelling (hernea) in the groin.
31Neglected at the outset, a case of this type of Vrddhi Roga may run into one of Guhna, attended with tympanites, pain, and hosts of other distempers. Firmaly pressed, the ring-like, protuberant, swelling rises upward, making a distinctly audible report.
32The type (Rakta Vrddhi) is incurable, while the swelling a case of Vataja Vriddhi continues in the same size, traversed by a network of dry, bluish red veins. The aforesaid diseases may be divided into eight different type according as the morbific principles of the deranged Vayu, Pittam, and Kapha severally or combinedly act as their exciting and underlying factors.
33The eighth kind of abscess (Vidradhi) is that, which occurs in any of the generative organs (ovary or uterus, etc.,) of women of impaired menstrual functions:
34-36Even a strong patient (during an attack) is afflicted with fever, dysentery, vomiting, rigor, and hunger, and gets emaciated. A Vidradhi-patient, who partakes of boiled rice, or drinks copiously, or bathes, or fasts, during an attack, is soon overwhelmed with fits of fainting. Diaphoretic or emollient measures should not be resorted to in a case of Vidradhi, and expedients calculated to promote a free and healthy circulation of blood should be at once tried, no matter whether the morbific principles have been eliminated from the body of the patient with the help of suitable purgatives, or not.
37In a case of Vataja Vidradhi, the wind and the filthy matter are either combinedly emitted from the abscess, or they may be separately emitted at different times. The aggravated Vayu, coursing through the· capillaries, sometimes gives rise to bloody discharge from a Vataja abscess, while obstructing the upward and downward passages of the body it brings on a violent aching pain.
38A Guhna (internal gland) is tangible (can be caught hold of with the hand) like a stone, hot, and glandular in shape. The Vayu, aggravated through fasting, suppression of stool or urine, or obstruction of the channels of the body, finds lodgment in the abdominal cavity, and dries up, in virtue of its own parchifying property, the feces and mucous accumulated therein in the shape of a hard lump, which is called Gulma.
39-40The deranged Vayu continuing in its own locations acts independently, while located in the seat of any other morbific pinciple of the body (such as the Pittam and Kapha) it acts subservient to that principle. The consolidated lump of Kapham, solidified in combination with mucous, and which is found to occupy the region either about the umbilicus, sides, or thoracic or abdominal cavity, is called a Gulma.
41-44In the Vataja type of Gulma, fever with an excruciating headache, enlarged spleen, a rumbling or croaking sound in the intestines, loose motions of the bowels, a pricking pain in the limbs, and difficult or painful urination are the symptoms, which are invariably exhibited. The patient suffers from an oedematous swelling of the face of extremities, or from a general anasarca. The ball-like tumour rolls about, or shifts from one place to another, in the region of its location, the skin of the patient becomes parched and dark, the pupils of the eyes are dilated, and the sight is perceptibly impaired. The patient complains of a, creeping sensation in the Gulma, as if hosts of ants are traversing its inside, and the ball-like tumour is perceived to be shifting from place to place.
45In the Pittaja type, symptoms such as Epilepsy, acid eructation’s with loose motions of the bowels and a burning sensation in the body, perspiration, thirst, chlorosis, and anasarca are found to be manifest.
46-47In the Kaphaja-type, the Gulma becomes hard, heavy, and fixed attended with insomnia, or fretful sleep at irregular hours, obesity, nausea, white or dark colour of the skin, heaviness of the head, and a sensation, as if the body has been packed with a wet compress, with a non-relish for food are also present.
48The deranged Kaphaha in the system is aggravated or suffers a diminution at times without any apparent reason, scorching its specific seats in the organism. The distressful concomitants in this disease such as, hemorrhage etc., soon manifest themselves through the deranged condition of the specific organs they are found to attack, thus bringing on a complication which invariably proves fatal.
49The type known as Rakta-gulma (ovarian tumour) which occurs in women are found to be hard, raised and compact. The type should be attributed to the concerted action of the deranged Vayu, Pittam and Kapha, etc., and is marked by an excruciating pain and rapid suppuration.
50A long exposure to the wind by a woman, during her menses, or by one suffering from any kind of uterine or vaginal disease, tends to augment and aggravate the Vayu in her system. The Kikuyu, thus aggravated, obstructs the orifice of the menstrual duct, and the blood accumulated, each month, in her abdominal cavity, produces all the symptoms of pregnancy.
51Nausea, appearance of milk in the mamme, and a fretful mood are the symptoms, which characterize this disease in which the patient becomes fastidious in her taste, and evinces her desires for various kinds of food, as in true pregnancy.
52The deranged Pittam, in contact with the aggravated Vayu, leads to the accumulation of blood in the uterus, and the Gulma, generated in consequence thereof, manifests symptoms which are peculiar to both of them (Vayu and Pittam).
53The accumulated blood in the uterus produces an intolerable aching pain in that viscus, attended with pain in the vagina, and a fetid, water like, vaginal discharge, or leucorrhoea.
54The Gulma in this type sometimes develops all other symptoms of pregnancy. All these types of Gulma should be regarded as having their origin in excessive or unnatural gratification of sexual propensities.
55The food long remains undigested in the stomach of a Gulma-patient, and the growth and progress of an abscess are arrested as soon as a Gulma makes its appearance in the body of the patient. A Vradhi (abscess) is so called from the fact of its soon running to suppuration.
56A Gulma, occurring in the abdominal cavity, is marked by a burning sensation in the pelvic cavity, and a pain in the inside of the Gulma like that, which is experienced in an enlarged spleen. The complexion of the patient becomes pale and sallow, the strength of the body is diminished, the digestion is impaired, and the stool and urine are suppressed.
57External symptoms develop themselves, and the patient complains of a pain in his limbs and abdomen, or about the umbilicus, while the reverse is the case (i.e., in cases where the preceding symptoms are not exhibited). Cough, palour, bulging out of the abdomen, rumbling sound in the intestine, tympanites, and an excruciating pain in the abdomen are the symptoms, which are found to supervene.
58When in combination with the preceding symptoms, emission of flatus or rising of eructation’s are stopped the diseases is called Anaha.
59A thick, raised, knotty, and stone-like gland, appearing in a case of Gulma, is called Ashthla. When the Vayu incarcerated in the stomach gives is to an excruciating pain, accompanied by all the foregoing symptoms, the disease is called Pmteyasthild.
60Bulging out of the abdomen, suppression of stool, dullness of the senses with a rumbling sound in the intestines, tympanites.
61And distension of the abdomen are the symptoms, which mark all types of Gulma.