The Nidanam of Ascited, etc. ||161||

1Dhanvantari said: -Hear me, O Stigma, now discourse on the Nidanam of Udaram (Ascites), All diseases are but the offspring of impaired digestion, and it is but superfluous to add that Udaram has its origin in the deranged condition of the digestive function.
2An accumulation of feces in the intestines may give rise to indigestion or to any other form of dyspepsia or disease, and the deranged-up coursing and down-coursing Vayus of the system, being obstructed in their course, make the intestines (Pravahini) inoperative.
3-5The Prana Vayu (nerve-force of the respiratory centre) brings about the derangement of the Apana Vayu (pneumogastric nerve force), and keeps them incarcerated in the union of the skin and flesh (faces), thus giving rise to a distended condition of the abdomen, which is called Udara Roga (Ascites). The disease admits of being divided into eight types according as it is engendered through the several, or concerted action of the morbific principles of the deranged Vayu, Pittam, and Kapham, or through the enlargement of the spleen, or abdominal glands, etc., or is produced as the outcome of a wound in the abdomen, or is ushered in through an accumulation of serous fluid in the abdominal cavity. Dryness of the lips and palate, distension of the abdomen, diminution of strength and appetite, incapacity for all kinds of work, bulging out of the abdomen, and a cadaverous look are the premonitory symptoms of Ascites.
6Loss of appetite with a non-relish for food, which if retained in the stomach, gives rise to an acid reaction are the further characteristics of ascites during its period of incubation. He, who does not experience a proper digestion of his ingested food, should do well to live on a wholesome diet.
7The strength of the patient is diminished, every day, and he feels tired after the least exertion. He becomes incapable of fixing his attention to any definite subject, and the least thinking distresses his mind.
8The limbs becomes emaciated, and the patient feels despondent and complains of a breaking pain in the pelvis, even after the scantiest meal.
9Somnolence, lassitude, loose motions of the bowels, fondness for seclusion, impaired digestion with a burning sensation in the body, anasarca, and tympanites are the symptoms, which indicate the accumulation of water (serous fluid) in the abdomen.
10-11A case of Ascites invariably ends in death, and it is futile on the part of the patient’s relations to mourn his death under the circum-stance. A rumbling sound is heard in the intestines, and the surface of the abdomen chequered with a network of veins.
12The intestines and the region of the umbilicus becomes stuffed (with wind) in this disease, and an urging towards defecation vanishes as soon as it is experienced.
13-14In this Vataja-type, the patient experiences a pain in the groins, heart, and other parts of the body, as well as about the waist, anus, and umbilicus. Flatus is often emitted with a loud report, and urine becomes scanty. All desire for food vanishes in this type of the disease, and the patient complains of a bad taste in his mouth.
15-16Oedematous swelling of the face, abdomen, and extremities, a breaking pain in the abdomen, or about the waist, sides, back, or other parts of the body, dry cough, pain in the limbs, heaviness of the nether regions of the body, suppression of stool, varied taste in the mouth, and a reddish or blackish colour of the skin are the further a breaking, piercing, pain is likewise experienced in the abdomen in this type, and the surface of the abdomen becomes covered over with a fret-work of blue or black veins. The· abdomen gets distended, and a variety of sound is heard within its cavity. The deranged bodily Vayu, which courses all through the organism, gives rise to various sounds and diverse kinds of pain in the different parts of the body.
17Fever, epileptic fits, a bitter taste in the mouth, and a burning sensation in the body, vertigo, dysenteric stools, yellowness of the skin, and greenness of the skin of the distended abdomen are the symptoms, which mark the Pittaja type of Ascites.
18Yellow or copper-coloured veins appear on the skin of the patient, who imagines as if fumes are escaping out of his body and complains of constant vanishings of sight. Perspiration becomes copious which does not relieve the intolerable burning sensation in the body. The abdomen is felt soft to the touch and speedily supperates in this (Pittaja) type of Ascites.
19Lassitude of the body, perspiration, edematous swelling of the limbs, heaviness of the body, somnolence with a non-relish for food, dyspnea, cough and whiteness of the skin and conjunctivae are the features, which mark the Kaphaja type of Ascites. The skin of the protruded abdomen becomes glossy and fretted with messes of black· or white veins. characteristics of the Vataja type of Ascites.
20On the excessive accumulation of water (serous fluid) in the abdominal cavity, the abdomen becomes hard, heavy, immoveable, and cold to the touch. In the Tridosha type the symptoms peculiar to each of_ the three aforesaid types manifest-themselves in unison.
21-23All the morbific principles of the body, in combination with the vitiated blood and accumulated fecal matter, find lodgment in the cavity of the abdomen giving rise to vertigo, Epilepsy, and emaciation in a form of Ascites in which symptoms peculiar to the three morbific diatheses of Vayu, Pittam, and Kapham are combinedly developed; and suppuration sets in early in the distended abdomen. The disease shows signs of aggravation in cold and windy day and is extremely hard to cure.
24The spleen, which is situated in the left side of the abdominal cavity, is dislodged (hangs down) from its seat through the ingestion of inordinate quantities of food, mental anxiety, or excessive riding or drinking, or through the abuse of emetics (excessive emesis).
25-26In the alternative, the spleen may increase in bulk through the accumulation of fat or engorgement of blood in its body. It becomes hard and raised like the back of a tortoise, and gradually fills a greater part of the abdominal cavity, bringing on dyspnea, cough, thirst, fever with a bad taste in the mouth, distension of the abdomen, yellowness of the skin, epileptic fits, vomiting, fainting, and a burning sensation in the body in its train.
27In abdominal dropsy due to enlargement of the spleens, nets of red, blue, or yellow veins are found to appear on the skin of the abdomen, and tympanites with suppression of stool and flatus, vertigo, and fever with a burning. sensation in the region of the heart are found to supervene.
28-29Similarly, the liver, which is situated in the upper part of the right side of the abdominal cavity, is pressed down from its natural position either through a voluntary and constant repression of any natural urging of the body, or through the heaviness of any of the surrounding appendages, or through eating without any relish for food, or in reason of its own indurated condition, gives rise, like the spleen, to a peculiar form of abdominal dropsy, which is called Yakritodaram (lit. Dropsy of the enlarged liver). The feces remain obstructed in the rectum of the patients as soon as the process of suppuration is established in the liver, producing dyspnea, tympanites, ·etc.
30-31The enraged and aggravated Vayu, in this disease, arrests the secretion of bile, and those of the glands, of the intestines, thus obstructing the expulsion of the feces. The Apana Vayu, thus incarcerated in the abdominal cavity, brings on fever attended with cough, dyspnea, a gone feeling in the thighs, headache, an aching pain at the sides, in the limbs, or about the umbilicus, constipation of the bowels, vomiting and a non-relish for food. The enraged bodily Vayu should be regarded as the principle agent in engendering this, as well as every other, form of abdominal dropsy.
32-33Blue or red veins are found to appear permanently on the skin of the dropsical abdomen, and the dropsy extends in the form of a cow’s tail transversely above the umbilicus, marked by crow-feet marks.
34-35The visceras of the abdominal cavity separate in the event of any bone or foreign matter being pricked into the cavity of the abdomen.
36The abdominal dropsy engendered in consequence thereof is called Chidrodara or Parisravyodara (Peritonites) according to others.
37The Vayu and Kapham in the system of an emaciated person, or of one of impaired digestive function or addicted to the habit of drinking large quantities of water, become enraged through such injudicious conduct, and arrest the discharged of the add secretions of the stomach, giving rise to an accumulation of water in the abdomen.
38-40Thirst, prolapsusani, pain, cough, and dyspnea with a non-relish for food, are the symptoms which are exhibited during the covered over with a network of veins. The abdomen is found to fluctuate under pressure and is felt soft to the touch. In some cases the abdomen is felt to be firm and glossy like the abdomen of a heron, and the disease is found to invade the intestines. The patient suffers from alternate fits of heat and rigor. In all types of Dropsy, neglect at the outset leads of the further liquefication of the serous accumulations of the abdomen, which are diffused all through the organism, causing edematous swelling of the face, joints etc., and facilitating the accumulation of serous fluid in the vessels of the body.
41-43An obstruction of the ducts-of the body that carry perspiration may help the accumulation of water in the abdomen. Purging or loose motions of the bowels precede an attack of this type of Ascites. The dropsy becomes firm, heavy, and spherical, and does not give the characteristic sound under percussion. the patient gets weaker, every day, and the disease becomes incurable as soon as it invades the internal vessels of the abdomen. A case of Ascites, in which the appearance of veins on the surface of the bulged out abdomen is oblite-rated, should be regarded as of a Sannipatika origin.
44On the different types of dropsy such as, the Vataja, Pittaja, Kaphaja, Plihaja (Dropsy of the enlarged spleen) and Sannipatika (due to the concerted action of the deranged Vayu Pittam, and Kapham), and Dakodara (Ascited), each preceding one should be regarded as more difficult to cure than the one immediately following it in the order of enumeration.
45All types of Dropsy, attended with the symptoms of obstructed (flow), become incurable after a fortnight from the date of their attack. A case of congenital Ascitcs invariably proves fatal.