Chapter 39 – Shlipada Nidanam

The 39th chapter of Madhava Nidana is Shlipada Nidanam which deals with Filariasis. Filariasis is an infectious tropical disease caused by any one of several thread-like parasitic round worms. The two species of worms most often associated with this disease are Wuchereria bancrofti and Brugia malayi. The larval form of the parasite transmits the disease to humans by the bite of a mosquito.

 

General Clinical Features —

यः सज्वरो वङ्क्षणजो भृशार्तिः शोथो नृणां पादगतः क्रमेण |
तच्छलीपदं स्यात् कर – कर्ण – नेत्र – शिश्नौष्टनासास्वपि केचिदाहुः || १ ||

yaḥ sajvarō vaṅkṣaṇajō bhr̥śārtiḥ śōthō nr̥ṇāṁ pādagataḥ kramēṇa |
tacchalīpadaṁ syāt kara – karṇa – nētra – śiśnauṣṭanāsāsvapi kēcidāhuḥ || 1 ||

Shlipada means a swelling that slowly spreads to the leg, along with fever and severe pain starting from the groins. However, some others are of the opinion that it can occur even in the hands, ears, eyes, penis, lips, and nose. 1

Specific Types/ Stages and their clinical features — 

वातजं कृष्णरूक्षं च स्फुटितं तीव्रवेदनम् |
अनिमित्तरुजं तस्य बहुशो ज्वर एव च || २ ||
पित्तजं पीतसङ्काशं दाह – ज्वरयुतं मृदु |
श्लेष्मिकं स्निग्धवर्णं च श्वेतं पाण्डु गुरु स्थिरम् || ३ || 

vātajaṁ kr̥ṣṇarūkṣaṁ ca sphuṭitaṁ tīvravēdanam |
animittarujaṁ tasya bahuśō jvara ēva ca || 2 ||
pittajaṁ pītasaṅkāśaṁ dāha – jvarayutaṁ mr̥du |
ślēṣmikaṁ snigdhavarṇaṁ ca śvētaṁ pāṇḍu guru sthiram || 3 ||

In the Vataja variety of the disease, the swelling is black, rough, fissured, severe pain appearing without an apparent reason, along with fever.

In Pittaja variety of the disease, the swelling has a yellow colour, burning sensation, fever, and is soft to touch.

In Kaphaja variety of the disease, the swelling is smooth, white, heavy and hard. 2-3

Signs of Incurability —

वल्मीकमिव सञ्जातं कण्टकैरूपचीयते |
अब्दात्मकं महत्तच्च वर्जनीयं विशेषतः || ४ ||

valmīkamiva sañjātaṁ kaṇṭakairūpacīyatē |
abdātmakaṁ mahattacca varjanīyaṁ viśēṣataḥ || 4 ||

A physician should avoid the type of swelling which has grown like an anthill, is studded with thorny projections, is one year old, and is particularly large. 4

Predominance of Kapha in Elephantiasis —

 त्रीणयप्येतानि जानीयात् श्लिपदानि कफोच्छ्रयात् |
गुरुत्वं च महत्त्वं च यस्मान्नास्ति कफं विना || ५ || 

trīṇayapyētāni jānīyāt ślipadāni kaphōcchrayāt |
gurutvaṁ ca mahattvaṁ ca yasmānnāsti kaphaṁ vinā || 5 ||

Kapha is the main dosha in all the three varieties of Shlipada, because in the absence of kapha, heaviness and increase in size are not possible. 5

Endemicity or Filariasis —

 पुराणोदकभूयिष्टाः सर्वर्तुषु च शीतलाः |
ये देशास्तेषु जायन्ते श्लीपदानि विशेषतः || ६ || 

purāṇōdakabhūyiṣṭāḥ sarvartuṣu ca śītalāḥ |
yē dēśāstēṣu jāyantē ślīpadāni viśēṣataḥ || 6 ||

Elephantiasis occurs specially in those places where there is always a collection of stagnating water, and dampness round the year. 6

Bad Prognostic Features —

 यच्छ्लेष्मलाहारविहारजातं पुंसः प्रकृत्या अपि कफात्मकस्य |
सास्रावमत्युन्नतसर्वलिङ्गं सकण्डुरं श्लेष्मयुतं विवर्ज्यम् || ७ || 

yacchlēṣmalāhāravihārajātaṁ punsaḥ prakr̥tyā api kaphātmakasya |
sāsrāvamatyunnatasarvaliṅgaṁ sakaṇḍuraṁ ślēṣmayutaṁ vivarjyam || 7 ||

The patients of elephantiasis who are not curable, and are thus to be rejected by wise physicians include the following:

• the one who has acquired the shlipada due to intake of eatables, and
• Indulgence in the activities that promote kapha.

A physician should also avoid the cases of elephantiasis involving persons who by birth belong to kapha dominated constitution, and also that case of elephantiasis, which has large exudation, and severe itching. 7 

इति श्रीमाधवकरविरचिते माधवनिदाने श्लीपदनिदानं समाप्तम् || ३९ ||

iti śrīmādhavakaraviracitē mādhavanidānē ślīpadanidānaṁ samāptam || 39 ||

Thus concludes the Chapter on Shlipada.

Source — 

1. Filariasis