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Chapter 40 – Vidradhi Nidanam

The 40th chapter of Madhava Nidana is Vidradhi Nidana which deals with Abscesses.

Pathogenesis and Classification of Vidradhi —

त्वग्रक्तः – मांस – मेदांसि संदूष्यास्थिसमाश्रिताः |
दोषाः शोथं शनैर्घोरं जनयन्त्युच्छ्रिता भृशम् || १ ||
महामूलं रुजावन्तं वृत्तं वा अप्यथवा आयतम् |
स विद्रधिरिति ख्यातो विज्ञेयः षड्विधश्च सः || २ ||
पृथग्दोषैः समस्तैश्च क्षतेनाप्यसृजा तथा |
षण्णामपि हि तेषां तु लक्षणं सम्प्रवक्ष्यते || ३ ||

tvagraktaḥ – mānsa – mēdānsi sandūṣyāsthisamāśritāḥ |
dōṣāḥ śōthaṁ śanairghōraṁ janayantyucchritā bhr̥śam || 1 ||
mahāmūlaṁ rujāvantaṁ vr̥ttaṁ vā apyathavā āyatam |
sa vidradhiriti khyātō vijñēyaḥ ṣaḍvidhaśca saḥ || 2 ||
pr̥thagdōṣaiḥ samastaiśca kṣatēnāpyasr̥jā tathā |
ṣaṇṇāmapi hi tēṣāṁ tu lakṣaṇaṁ sampravakṣyatē || 3 ||

The doshas when vitiated bring about abnormal changes in the skin, blood muscle, fat, and bones, and generate a localized swelling. The swelling increases slowly in size; it remains deep – seated, painful, round or elongated in shape. This swelling has been identified as Vidradhi. There are six types of Vidradhi, three of them are produced by each of the three doshas, and the fourth is due to combination of all the three doshas, the fifth is caused by external injuries while the sixth is caused by the vitiated blood (rakta). Their specific features have been described below. 1-3

Vataja Abscess —

 कृष्णो अरुणो वा विषमो भृशमत्यर्थवेदनः |
चिन्नोत्थानप्रपाकश्च विद्रधिर्वातसम्भवः || ४ ||

kr̥ṣṇō aruṇō vā viṣamō bhr̥śamatyarthavēdanaḥ |
chinnōtthānaprapākaśca vidradhirvātasambhavaḥ || 4 || 

Features of vidradhi generated due to morbid increase on Vata include the following:

  • Swelling black or brown in colour ,
  • The lump increasing or decreasing in size, and
  • Associated with severe pain.

It has varied types of onset, and suppuration.  4

Pittaja Abscess —

पक्वोदुम्बरसङ्काशः श्यावो वा ज्वरदाहवान् |
क्षिप्रोत्थान – प्रपाकश्च विद्रधिः पित्तसम्भवः || ५ || 

pakvōdumbarasaṅkāśaḥ śyāvō vā jvaradāhavān |
kṣiprōtthāna – prapākaśca vidradhiḥ pittasambhavaḥ || 5 ||

Features of vidradhi due to morbid increase on Pitta include the following:

  •  Swelling resembling a ripened wild fig (udumbara) fruit or blue in colour associated with fever, and burning sensation. The swelling is quick in manifesting, and suppurating. 5

 Kaphaja Abscess —

 शरावसदृशः पाण्डुः शीतः स्निग्धो अल्पवेदनः |
चिरोत्थानप्रपाकश्च विद्रधिः कफसम्भवः || ६ || 

śarāvasadr̥śaḥ pāṇḍuḥ śītaḥ snigdhō alpavēdanaḥ |
cirōtthānaprapākaśca vidradhiḥ kaphasambhavaḥ || 6 ||

Features of vidradhi due to morbid increase on Kapha include the following:

  • Appearance of a swelling that resembles a saucer,
  • Yellowish white, cold, smooth, with mild pain
  • Slow in manifesting, and
  • Suppurating. 6

Characteristics of Discharges —

तनु – पीत – सिताः चैषामास्रावाः क्रमशः स्मृताः |

 tanu – pīta – sitāḥ caiṣāmāsrāvāḥ kramaśaḥ smr̥tāḥ |

The discharges of the above three could be thin, yellow, and white respectively.

Sannipataja Abscess —

नानावर्ण – रुजा – स्रावो घाटालो विषमो महान् || ७ ||
विषमं पच्यते चापि विद्रधिः सान्निपातिकः |

nānāvarṇa – rujā – srāvō ghāṭālō viṣamō mahān || 7 ||
viṣamaṁ pacyatē cāpi vidradhiḥ sānnipātikaḥ |

Due to increase in all the three doshas, there could be several kinds of colours, pain, and exudation on cases of the Sannipataja Vidradhi. This type of vidradhi produces an elevated sprout that is unsteady in nature, and is quite troublesome. 7

Traumatic Abscess —

तस्तैर्भावैरभिहते क्षते वा अपथ्यकारिणः |
क्षतोष्मा वायुविसृतः सरक्तं पित्तमीरयेत् || ८ ||
ज्वरस्तृष्णा च दाहश्च जायते तस्य देहिनः |
आगन्तुर्विद्रधिर्ह्योष पित्तविद्रधिलक्षणः || ९ ||

tastairbhāvairabhihatē kṣatē vā apathyakāriṇaḥ |
kṣatōṣmā vāyuvisr̥taḥ saraktaṁ pittamīrayēt || 8 ||
jvarastr̥ṣṇā ca dāhaśca jāyatē tasya dēhinaḥ |
āganturvidradhirhyōṣa pittavidradhilakṣaṇaḥ || 9 ||

Through injury by some weapons, stone, chips, or piece of wood one is wounded. Through such wounds as well as by taking incompatible food stuff or by indulging in inappropriate activities the heat of wounded limbs of patient vitiates the pitta, and rakta, and thus generates vidradhi. In traumatic abscess (Aagantuja vidradhi) fever, thirst, burning sensation and other features of pitta vrddhi could be noticed. 8-9

Raktaja Abscess —

कृष्णस्फोटावृतः श्यावस्तीव्रदाह – रुजाकरः || १० ||
पित्तविद्रधिलिङ्गस्तु रक्तविद्रधिरुच्यते |

kr̥ṣṇasphōṭāvr̥taḥ śyāvastīvradāha – rujākaraḥ || 10 ||
pittavidradhiliṅgastu raktavidradhirucyatē |

Features of Raktaja vidradhi include the following:

  • Appearing of sprouts that are black or blue in colour,
  • Being more than one in number.
  • Moreover, there is a severe burning sensation, pain, and other features of pittaja vidradhi as well. 10
Internal Abscesses —

Pathogenesis —

पृथक् सम्भूय वा दोषाः कुपिता गुल्मरूपिणम् ||११ ||
वल्मीकवत् समुन्नद्धमन्तः कुर्वन्ति विद्रधिम् | 

pr̥thak sambhūya vā dōṣāḥ kupitā gulmarūpiṇam ||11 ||
valmīkavat samunnaddhamantaḥ kurvanti vidradhim |

Sites —

गुदे बस्तिमुखे नाभ्यां कुक्षौ वङ्क्षणयोस्तथा || १२ ||
वृक्कयोः प्लीह्नि यकृति हृदि वा क्लोम्नि वा अप्यथ |
तेषामुक्तानि लिङ्गानि बाह्यविद्रधिलक्षणैः || १३ ||

gudē bastimukhē nābhyāṁ kukṣau vaṅkṣaṇayōstathā || 12 ||
vr̥kkayōḥ plīhni yakr̥ti hr̥di vā klōmni vā apyatha |
tēṣāmuktāni liṅgāni bāhyavidradhilakṣaṇaiḥ || 13 ||

Clinical features —

 अधिष्ठानविशेषेण लिङ्गं शृणु विशेषतः | 

adhiṣṭhānaviśēṣēṇa liṅgaṁ śr̥ṇu viśēṣataḥ |

Vidradhis are produced due to the doshas vitiated either singly or in combination internally. The places that may be the site of the abscess resembling an anthill or a bush in shape include the following:

  • The rectum,
  • the orifice of the urinary bladder,
  • umbilicus,
  • Stomach,
  • Groins,
  • Kidneys,
  • Spleen,
  • Liver,
  • Heart, and
  • Pancreas.

They have all the features of external abscesses, and in addition, it has some special features as well which have been described below. 11 – 13

गुदे वातनिरोधश्च ,बस्तौ कृच्छ्राल्पमूत्रता || १४ ||
नाभ्यां हिक्का तथा आटोपः , कुक्षौ मारुतकोपनम् |
कटि – पृष्ठग्रहस्तीव्रो वङ्क्षणोत्थे तु विद्रधौ || १५ ||
वृक्कयोः पार्श्वसङ्कोचः प्लिह्नयुच्छवासावरोधनम् |
सर्वाङ्गप्रग्रहस्तीव्रो हृदि कासश्च जायते |
श्वासो यकृति हिक्का च क्लोम्नि पेपीयते पयः || १६ ||

gudē vātanirōdhaśca ,bastau kr̥cchrālpamūtratā || 14 ||
nābhyāṁ hikkā tathā āṭōpaḥ , kukṣau mārutakōpanam |
kaṭi – pr̥ṣṭhagrahastīvrō vaṅkṣaṇōtthē tu vidradhau || 15 ||
vr̥kkayōḥ pārśvasaṅkōcaḥ plihnayucchavāsāvarōdhanam |
sarvāṅgapragrahastīvrō hr̥di kāsaśca jāyatē |
śvāsō yakr̥ti hikkā ca klōmni pēpīyatē payaḥ || 16 ||

If the internal abscess is situated in the

  • Region of the rectum, obstruction of flatus occurs.
  • Urinary bladder, there is difficult and scanty urination.
  • Umbilicus, Hiccough, and gurgling noise in the stomach.
  • Stomach, there could be features of Vata Vrddhi (pain, distension, and the like).
  • Groins, there could be severe catching pain in the waist, and back.
  •  Kidney, constriction of the flanks appears.
  • Pliha, there would be blockage to expiration.
  • Region of the heart, there could be severe catching pain in all parts of the body and excessive cough would be produced.
  • Liver, breathlessness and hiccough occur;
  • Kloma, the patient would develop a morbid thirst, and would like to drink water repeatedly. 14-16

नाभेरूपरिजाः पक्वा यान्त्यूर्ध्वमितरे त्वधः |
nābhērūparijāḥ pakvā yāntyūrdhvamitarē tvadhaḥ |

Those internal abscesses situated above the level of umbilicus (i.e., in the spleen, kidney, stomach, heart ,and the like) on suppuration spread or burst upwards and drain through the mouth and nose; While other abscesses discharge through the downward routes like the anus and ureter.

Prognosis —

अधःस्रुतेषु जीवेत्तु स्रुतेषूर्ध्वं न जीवति || १७ ||
हृन्नाभि – बस्तिवर्ज्या ये तेषु भिन्नेषु बाह्यतः |
जीवेत् कदाचित् पुरुषो नेतरेषु कदाचन || १८ ||

 adhaḥsrutēṣu jīvēttu srutēṣūrdhvaṁ na jīvati || 17 ||
hr̥nnābhi – bastivarjyā yē tēṣu bhinnēṣu bāhyataḥ |
jīvēt kadācit puruṣō nētarēṣu kadācana || 18 ||

It has been stressed that if the discharge comes out in the downward route the patient might survive but if it takes the upward route the patient might expire. This assumption is true except in cases of the abscesses in heart, umbilicus, and bladder. The patient of these abscesses may survive if the abscesses burst outwards, but never otherwise. 17-18

Prognosis of Abscess in General —

 साध्या विद्रधयः पञ्च विवर्ज्यः सान्निपातिकः |
आम – पक्व – विदग्धत्वं तेषां शोथवदादिशेत् || १९ || 

sādhyā vidradhayaḥ pañca vivarjyaḥ sānnipātikaḥ |
āma – pakva – vidagdhatvaṁ tēṣāṁ śōthavadādiśēt || 19 ||

Fatal Complications of Abscess —

आध्मातं बद्धनिष्यन्दं छर्दि – हिक्का – तृषान्वितम् |
रुजा – श्वाससमायुक्तं विद्रधिर्नाशयेन्नरम् || २० || 

ādhmātaṁ baddhaniṣyandaṁ chardi – hikkā – tr̥ṣānvitam |
rujā – śvāsasamāyuktaṁ vidradhirnāśayēnnaram || 2 ||

Those vidradhis caused by a combination of all the three doshas vitiated cannot be cured while the first five kinds of vidradhis are curable. The unripe, ripening, and ripened stages of vidradhis are the same as described in cases of Shotha, and inflammatory oedema ahead in the next chapter. If the symptoms like distension of the stomach, blockage of urine,vomiting, hiccough, thirst, severe pain, and difficulty in breathing is found in a patient of vidradhi, he might not survive.

इति श्री माधवकरविरचिते माधवनिदाने विद्रधिनिदानं समाप्तम् || ४० ||

iti śrī mādhavakaraviracitē mādhavanidānē vidradhinidānaṁ samāptam || 40 ||

Thus concludes the chapter on Vidradhi.