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Chapter 45 – Nadi (li) Vrana Nidanam

The 45th chapter of Madhava Nidanam is Nadi (li) vrana Nidanam which deals with Sinus ulcers.

Etiopathogenesis —

यः शोथमाममतिपक्वमुपेक्षते अज्ञो यो वा व्रणं प्रचुरपूयमसाधुवृत्तः |
अभ्यन्तरं प्रविशति प्रविदार्यतस्य स्थानानि पूर्वविहितानि ततः स पूयः || १ ||

yaḥ śōthamāmamatipakvamupēkṣatē ajñō yō vā vraṇaṁ pracurapūyamasādhuvr̥ttaḥ |
abhyantaraṁ praviśati pravidāryatasya sthānāni pūrvavihitāni tataḥ sa pūyaḥ || 1 ||

The physician who cuts open an unripe swelling or delays the opening of a fully ripened one is considered as ignorant; the physician who does not drain out the pus from an ulcer completely, allows the pus a chance to make a sinus deep inside the structures mentioned earlier is considered as an unscrupulous one. 1

 Etymology —

तस्यातिमात्रगमनाद् गतिरिष्यते तु नालीव यद्वहति तेन मता तु नाली |

 tasyātimātragamanād gatiriṣyatē tu nālīva yadvahati tēna matā tu nālī |

The pus flows continuously inside the body as through the dried stem of a plant (that becomes like a pipe).

Types —

 दोषैस्त्रिभिर्भवति सा प्रुथगेकशश्च संमुर्च्छितैरपि च शल्यनिमित्ततो अन्या || २ ||

dōṣaistribhirbhavati sā pruthagēkaśaśca sammurcchitairapi ca śalyanimittatō anyā || 2 || 

Because of the formation of a hollow passage, inside, it is named as Nadi vrana and there are five kinds of sinus, one from each of the three doshas, one from the combination of all the three together and from the presence of a foreign body. 2

 Vataja Sinus–

 तत्रानिलात् परुष सूक्ष्ममुखी सशूला फेनानुविद्धमधिकं स्रवति क्षपासु | 

tatrānilāt paruṣa sūkṣmamukhī saśūlā phēnānuviddhamadhikaṁ sravati kṣapāsu |

The vataja type of sinus is

  • hard,
  • painful,
  • having a small orifice, and
  • exuding frothy material especially during the cold hours of the night.
Pittaja Sinus —

पित्तात्तृषा – ज्वरकरी परिदाहयुक्ता पीतं स्रवत्यधिकमुष्णमहःसु चापि || ३ ||

pittāttr̥ṣā – jvarakarī paridāhayuktā pītaṁ sravatyadhikamuṣṇamahaḥsu cāpi || 3 ||

The pittaja type of Sinus produces —

  • Thirst,
  • Fever, and
  • Burning sensation.
  • It discharges yellowish material especially during warm hours (midday).
Kaphaja Sinus —

ज्ञेया कफाद्बहु – घनार्जुन – पिच्छिलास्रा स्तब्धा सकण्डुररुजा रजनीप्रवृद्धा |

jñēyā kaphādbahu – ghanārjuna – picchilāsrā stabdhā sakaṇḍurarujā rajanīpravr̥ddhā |

In Kaphaja type of sinus the discharge is

  • Copious
  • thick,
  • white, and
  • Unctuous.
  • The ulcer remains hard producing more itching and pain at nights.
 Tridoshaja Sinus —

 दाह – ज्वर – श्वसन – मूर्च्छन – वक्त्रशोषा यस्यां भवन्त्यभिहितानि च लक्षणानि || ४ ||
तामादिशेत् पवनपित्तकफप्रकोपाद् – घोरामसुक्षयकरीमिव काल रात्रिम् |

dāha – jvara – śvasana – mūrcchana – vaktraśōṣā yasyāṁ bhavantyabhihitāni ca lakṣaṇāni || 4 ||
tāmādiśēt pavanapittakaphaprakōpād – ghōrāmasukṣayakarīmiva kāla rātrim |

Features of Tridoshaja type of sinus that is going to take away the life like the sister of god of death (Kalaratri) include the following:

  •  Burning sensation,
  • Fever,
  • Difficulty in breathing,
  • Fainting, and
  • Dryness of the mouth. 4
Sinus due to a foreign body —

नष्टं कथचिन्दनुमार्गमुदीरितेषु स्थानेषु शल्यमचिरेण गतिं करोति || ५ ||
सा फेनिलं मथितमुष्णमसृग्विमिश्रं स्रावं करोति सहसा सरुजा च नित्यम् |

naṣṭaṁ kathacindanumārgamudīritēṣu sthānēṣu śalyamacirēṇa gatiṁ karōti || 5 ||
sā phēnilaṁ mathitamuṣṇamasr̥gvimiśraṁ srāvaṁ karōti sahasā sarujā ca nityam |

Due to physical activity or pressure by a foreign body (shalya) hidden inside, there will, in course of time, occur a different type of sinus. In this case of sinus, the patient exudes a frothy, warm material mixed with blood spontaneously, accompanied with pain, and on regular basis so. 5

Prognosis of Sinuses —

 नाली त्रिदोषप्रभवा न सिध्येर्च्छेषाश्चतस्रः खलु यत्नसाध्याः || ६ || 

nālī tridōṣaprabhavā na sidhyērcchēṣāścatasraḥ khalu yatnasādhyāḥ || 6 ||

Sinus ulcer (Nadi vrana) of the kind involving the three doshas does not respond to treatment while the other four kinds of sinus ulcers could be cured, albeit with difficulty. 6

 इति श्रीमाधवकरविरचिते माधवनिदाने नाडीव्रणनिदानं समाप्तम् || ४५ || 

iti śrīmādhavakaraviracitē mādhavanidānē nāḍīvraṇanidānaṁ samāptam || 45 ||

Thus concludes the chapter on Nadi Vrana.