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Chapter 37 – Vrddhi Nidanam

The 37th Chapter of Madhava Nidana is Vrddhi Nidanam which deals with Swellings of the Scrotum.

Pathogenesis —

क्रुद्धो अनूर्ध्वगतिर्वायुः शोथ – शूलकरश्चरन् |
मुष्कौ वङ्क्षणतः प्राप्य फल – कोषाभिवाहिनीः || १ ||
प्रपीड्य धमनिर्वृद्धिं करोति फल – कोषयोः |

kruddhō anūrdhvagatirvāyuḥ śōtha – śūlakaraścaran |
muṣkau vaṅkṣaṇataḥ prāpya phala – kōṣābhivāhinīḥ || 1 ||
prapīḍya dhamanirvr̥ddhiṁ karōti phala – kōṣayōḥ |

Types —

दोषास्र – मेदो – मूत्रान्त्रैः स वृद्धिः सप्तधा गदः || २ ||
मूत्रान्त्रजावप्यनिलाद्धेतुभेदस्तु केवलम् |

dōṣāsra – mēdō – mūtrāntraiḥ sa vr̥ddhiḥ saptadhā gadaḥ || 2 ||
mūtrāntrajāvapyanilāddhētubhēdastu kēvalam |

When morbidly promoted Vata makes a downward movement to reach the groins and scrotum; this condition deranges the vessels there and generates enlargement of the scrotum associated with oedema and pain. This disease is known as Vrddhi roga is of seven kinds, one factored by vitiation of the each of the tridoshas, one factored by vitiation of blood (rakta), one factored by the vitiation of fat (medas), one by vitiation of urine (mutra), and the seventh factored through the vitiation of intestines (Aantras). Though named separately after their causes even mutraja and aantraja oedemas are mainly due to vata. 1-2

Clinical features of each variety
Vataja (Non inflammatory/ neo plastic testicular swelling) —

 वातपूर्णदृतिस्पर्शो रूक्षो वातादहेतुरुक् || ३ ||
vātapūrṇadr̥tisparśō rūkṣō vātādahēturuk || 3 ||

The case of Vataja Vrddhi in the scrotum makes it resemble a bag filled with air as noticed in terms of sound and touch; it appears without any apparent reason and is rough and painful. 3

Pittaja (Swelling in the cellulitis scrotum and pyocele) —

पक्वोदुम्बरसङ्काशः पित्ताद्याहोष्म – पाकवान् |
pakvōdumbarasaṅkāśaḥ pittādyāhōṣma – pākavān |

The case of Pittaja vrddhi in the scrotum resembles a ripe fruit of wild fig/ Ficus glomerata (udumbara). It is accompanied with burning sensation, and heat. Moreover, it progresses very fast.

Kaphaja (? Chronic swelling in the filarial scrotum) —

कफाच्छीतो गुरुः स्निग्धः कण्डूमान् कठिनो अल्परुक् || ४ ||
kaphācchītō guruḥ snigdhaḥ kaṇḍūmān kaṭhinō alparuk || 4 ||

The case of Kaphaja type vrddhi in scrotum, the affected part turns to be cold in touch, heavy, smooth, itching, hard and there is very little pain. 4

Raktaja (Haematocele) —

कृष्णस्फोटावृतः पित्तवृद्धिलिङ्गश्च रक्तजः |
kr̥ṣṇasphōṭāvr̥taḥ pittavr̥ddhiliṅgaśca raktajaḥ |

The case of Raktaja type in the scrotum could have all the features of pitta studded with reddish – black petichiae.

Medaja (Swelling in the filarial scrotum with chylocele) —

कफवन्मेदसा व्रुद्धिर्मृदुस्तालफलोपमः || ५ ||
kaphavanmēdasā vruddhirmr̥dustālaphalōpamaḥ || 5 ||

In case of medaja vrddhi in the scrotum could have all the features of kapha, it is soft and like a wild palm (taala) fruit in appearance. 5

Mutravrddhi (Hydrocele) —

मूत्रधारणशीलस्य मूत्रजः स तु गच्छतः |
अम्भोभिः पूर्णदृतिवत् क्षोभं याति सरुङ्ग्मृदुः || ६ ||
मूत्रकृच्छ्रमधः स्याच्च चालयन् फल – कोषयोः |

mūtradhāraṇaśīlasya mūtrajaḥ sa tu gacchataḥ |
ambhōbhiḥ pūrṇadr̥tivat kṣōbhaṁ yāti saruṅgmr̥duḥ || 6 ||
mūtrakr̥cchramadhaḥ syācca cālayan phala – kōṣayōḥ |

In persons who are in habit of suppressing the urge of urination, the mutraja vrddhi occurs. The diseases scrotum which resembles a water bag filled with fluid and producing sounds, is painful and soft. The micturition also turns difficult.  6

Antravrddhi (Inguina/ Inguino – scrotal hernia) —

वातकोपिभिराहारैः शीततोयावगाहनैः || ७ ||
धारणेरण – भाराध्व – विषमाङ्गप्रवर्तनैः |
क्षोभणैः क्षोभितो अन्यैश्च क्षुद्रान्त्रावयवं यदा || ८ ||
पवनो विगुणीकृत्य स्वनिवेशादधो नयेत् |
कुर्याद्वङ्क्षणसन्धिस्थो ग्रन्थ्याभं श्वयथुं तदा || ९ ||
उपेक्षमाणस्य च मुष्कवृद्धिमाध्मान – रुक् – स्तम्भवतीं स वायुः |
प्रपिडितो अन्तःस्वनवान् प्रयाति प्रध्मापयन्नेति पुनश्च मुक्तः || १० ||
अन्त्रवृद्धिरसाध्यो अयं वातवृद्धिसमाकृतिः ||

vātakōpibhirāhāraiḥ śītatōyāvagāhanaiḥ || 7 ||
dhāraṇēraṇa – bhārādhva – viṣamāṅgapravartanaiḥ |
kṣōbhaṇaiḥ kṣōbhitō anyaiśca kṣudrāntrāvayavaṁ yadā || 8 ||
pavanō viguṇīkr̥tya svanivēśādadhō nayēt |
kuryādvaṅkṣaṇasandhisthō granthyābhaṁ śvayathuṁ tadā || 9 ||
upēkṣamāṇasya ca muṣkavr̥ddhimādhmāna – ruk – stambhavatīṁ sa vāyuḥ |
prapiḍitō antaḥsvanavān prayāti pradhmāpayannēti punaśca muktaḥ || 10 ||
antravr̥ddhirasādhyō ayaṁ vātavr̥ddhisamākr̥tiḥ |

On occasions, the vayu gets vitiated due to such factors as frequent ingestion of vitiating food, immersion of cold water, suppression of the natural urges, straining even when no urge is present, lifting of heavy weights, walking for long distances, moving the limbs in unusual positions and other irritating circumstances. This condition, inturn, dislocated the small intestines and viscera, pushes them downward from their original place, and produces a gland like swelling in the inguinal region. If not treated soon, it descends further down into the scrotum, causing enlargement. The scrotum is painful, has no movement, on pressure it produces sound, recedes, but comes back again on release of pressure. This incurable condition is called Aantravrddhi and it is similar to the condition of Vata Vrddhi. 7-10

इति श्री माधवकरविरचिते माधवनिदाने वृद्धिनिदानं समाप्तम् || ३७ ||

iti śrī mādhavakaraviracitē mādhavanidānē vr̥ddhinidānaṁ samāptam || 37 ||

Thus concludes the chapter on Vrddhi Roga.