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Chapter 41 – Vrana Shotha Nidanam

 

The 41st chapter of Madhava Nidana is Vrana Shotha Nidana which deals with Inflammatory swelling.

Types —

एकदेशोत्थितः शोथो व्रणानां पूर्वलक्षणम् |
षड्विधः स्यात् पृथक् – सर्व – रक्तागन्तुनिमित्तजः || १ ||
शोथाः षडेते विज्ञेयाः प्रागुक्तैः शोथलक्षणैः |
विशेषः कथ्यते चैषां पक्वापक्वादिनिश्चये || २ ||

ēkadēśōtthitaḥ śōthō vraṇānāṁ pūrvalakṣaṇam |
ṣaḍvidhaḥ syāt pr̥thak – sarva – raktāgantunimittajaḥ || 1 ||
śōthāḥ ṣaḍētē vijñēyāḥ prāguktaiḥ śōthalakṣaṇaiḥ |
viśēṣaḥ kathyatē caiṣāṁ pakvāpakvādiniścayē || 2 ||

Inflammatory oedema has been defined as a localized swelling that appear prior to the formation of an ulcer. It is of six kinds, one from each dosha, one from the combination of all the three, one from blood (rakta), and one from external organs (aagantu) causes. Similar features have been already described for all types of swelling, and now only its special feature will be described. 1-2

The Clinical Course —

विषमं पच्यते वातात्, पित्तोत्थश्चाचिराच्चिरम् |
कफजः, पित्तवच्छोथो रक्तागन्तु समुद्भवः || ३ ||

viṣamaṁ pacyatē vātāt, pittōtthaścācirācciram |
kaphajaḥ, pittavacchōthō raktāgantu samudbhavaḥ || 3 ||

 In case of Vataja type of vrana shotha, ripening occurs inconsistently; In case of Pittaja type of the disease, ripening occurs very quickly; in Kaphaja type, the ripening is very slow. In terms of ripening, the raktaja type and aagantuja type of the disease are similar to pittaja sotha. 3

Early Inflammation (Unripe Abscess) —

मन्दोष्मता अल्पशोथत्वं काठिन्यं त्वक्सवर्णता |
मन्दवेदनता चैतच्छोथानामामलक्षणम् || ४ ||  

mandōṣmatā alpaśōthatvaṁ kāṭhinyaṁ tvaksavarṇatā |
mandavēdanatā caitacchōthānāmāmalakṣaṇam || 4 ||

Severe Inflammation undergoing suppuration (Ripening Abscess) —

दह्यते दहनेनेव क्षारेणेव च पच्यते |
पिपीलिकागणेनेव दश्यते च्छिध्यते तथा || ५ ||
भिध्यते चैव शस्त्रेण दण्डेनेव च ताड्यते |
पीड्यते पाणिनेवान्तः सूचिभिरिव तुध्यते || ६ ||
सोषाचोषो विवर्णः स्यादङ्गुल्येवावघट्यते |
आसने शयने स्थाने शान्तिं वृश्चिकविद्धवत् || ७ ||
न गच्छेदाततः शोथो भवेदाध्मातबस्तिवत् |
ज्वरस्तृष्णा अरुचिः चैव पच्यमानस्य लक्षणम् || ८ || 

dahyatē dahanēnēva kṣārēṇēva ca pacyatē |
pipīlikāgaṇēnēva daśyatē cchidhyatē tathā || 5 ||
bhidhyatē caiva śastrēṇa daṇḍēnēva ca tāḍyatē |
pīḍyatē pāṇinēvāntaḥ sūcibhiriva tudhyatē || 6 ||
sōṣācōṣō vivarṇaḥ syādaṅgulyēvāvaghaṭyatē |
āsanē śayanē sthānē śāntiṁ vr̥ścikaviddhavat || 7 ||
na gacchēdātataḥ śōthō bhavēdādhmātabastivat |
jvarastr̥ṣṇā aruciḥ caiva pacyamānasya lakṣaṇam || 8 ||

 Features of the unripe Vrana shotha include the following —

  • Appearance of swelling that is slightly warm,
  • slightly elevated, and hard,
  • and of the colour of a normal skin.
  • It appears with a mild pain.

The inflammation undergoing suppuration generates a feeling as if (the swollen part is) being burnt with fire, being treated with a caustic, being bitten by swarms of ants, being cut by a stick, pressed in by the hands or as if it is being pricked with needles, sucked or pressed by fingers, and the like. Moreover, there appear symptoms like discoloration, patient not finding comfort either on sitting up, lying down or in elevating the affected part. The pain in this pathological is continuous, and identical to that of a scorpion sting. The subsequent swelling that appears there resembles an inflated bag while it remains without wrinkles. Fever, thirst and anorexia are also present. These are the features of Vrana shotha during the stage of its ripening. 4-8

Ripe Abscess —

वेदनोपशमः शोथो अलोहितो अल्पो न चोन्नतः |
प्रादुर्भावो वलीनां च तोदः कण्डूर्मुहुर्मुहुः || ९ ||
उपद्रवाणा प्रशमो निम्नता स्फुटनं त्वचाम् |
बस्ताविवाम्बुसञ्चारः स्याच्छोथे अङ्गुलिपीडिते || १० ||
पूयस्य पीडयत्येकमन्तमन्ते च पीडिते |
भक्ताकाङ्क्षा भवेच्चैतच्छोथानां पक्वलक्षणम् || ११ ||

vēdanōpaśamaḥ śōthō alōhitō alpō na cōnnataḥ |
prādurbhāvō valīnāṁ ca tōdaḥ kaṇḍūrmuhurmuhuḥ || 9 ||
upadravāṇā praśamō nimnatā sphuṭanaṁ tvacām |
bastāvivāmbusañcāraḥ syācchōthē aṅgulipīḍitē || 10 ||
pūyasya pīḍayatyēkamantamantē ca pīḍitē |
bhaktākāṅkṣā bhavēccaitacchōthānāṁ pakvalakṣaṇam || 11 ||

The features of a ripened Vrana Shotha include the following —

  • Reduction in the severity of Pain, redness and swelling;
  • Appearance of wrinkles,
  • A mild pricking or frequent itching.

Moreover,

  • there is relief from various complications,
  • A Slight depression at the top of the shotha
  • An opening on the concerned skin;
  • Feeling of movement of fluid similar to that of a water bag.

In this condition, the pus inside can be collected to any one place by pressing the shotha from any side. The patient of this stage develops a desire for eatables. 9 – 11

Role of the doshas in suppuration —

नर्ते अनिलाद्रुङ्गन विना च पित्तं पाकः , कफं, चापि विना न पूयः |
तस्माद्धि सर्वान् परिपाककाले पचन्ति शोथांस्त्रय एव दोषाः || १२ ||

nartē anilādruṅgana vinā ca pittaṁ pākaḥ , kaphaṁ, cāpi vinā na pūyaḥ |
tasmāddhi sarvān paripākakālē pacanti śōthānstraya ēva dōṣāḥ || 12 ||

There can be no pain without the morbid increase in vata; without pitta, there could be no ripening, and no pus formation without vitiation of the kapha. Hence, at the time of suppuration all the three doshas participate in ripening of the inflammation. 12

Necessity of draining the pus —

कक्षं समासाध्य यथैव वह्निर्वाय्वीरितः सन्दहति प्रसह्य |
तथैव पूयो ह्यविनिःसृतो हि मांसं सिराः स्नायु च खादतीह || १३ ||

kakṣaṁ samāsādhya yathaiva vahnirvāyvīritaḥ sandahati prasahya |
tathaiva pūyō hyaviniḥsr̥tō hi mānsaṁ sirāḥ snāyu ca khādatīha || 13 ||

The pus that has not drained out destroys the muscles, veins, tendons and the like just as a small fire hidden inside a hearth or hay stack when activated by the wind burns up the whole mass of hay. 13

 Importance of Diagnosing the correct stage of an Abscess —

आमं विदह्यमानं च सम्यक् पक्वं च यो भिषक् |
जानीयात् स भवेद् वैद्यः शेषास्तस्करवृत्तयः || १४ ||

āmaṁ vidahyamānaṁ ca samyak pakvaṁ ca yō bhiṣak |
jānīyāt sa bhavēd vaidyaḥ śēṣāstaskaravr̥ttayaḥ || 14 ||

The one who can recognize the stages of unripe, ripening, or a fully ripe abscess, is the real surgeon; others only earn their livelihood by fraudulent means. 14

यश्चिनत्त्याममज्ञानाद्यो वा पक्वमुपेक्षते |
श्वपचाविव मन्तव्यौ तावनिश्चितकारिणौ || १५ ||

yaścinattyāmamajñānādyō vā pakvamupēkṣatē |
śvapacāviva mantavyau tāvaniścitakāriṇau || 15 ||

He who opens an ‘unripe’ swelling due to ignorance, as also one who neglects to open a ‘ripe’ abscess are both considered as out castes on account of their indecisiveness. 15 

 श्री माधवकरविरचिते माधवनिदाने व्रणशोथनिदानं समाप्तम् || ४१ || 

śrī mādhavakaraviracitē mādhavanidānē vraṇaśōthanidānaṁ samāptam || 41 ||

Thus concludes the chapter on Vrana Shotha.