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Chapter 47 – Upadamsha Nidanam

 The 47th chapter of Madhava Nidana is Upadamsha Nidana which deals with Venereal Diseases.

Etiological Factors —

हस्ताभिघातान्नखदन्तपातादधावनाद्रत्यतिसेवनाद् वा |
योनिप्रदोषाच्च भवन्ति शिश्ने पञ्चोपदंशा विविधापचारैः || १ ||

hastābhighātānnakhadantapātādadhāvanādratyatisēvanād vā |
yōnipradōṣācca bhavanti śiśnē pañcōpadamśā vividhāpacāraiḥ || 1 ||

Factors that lead to veneral diseases (Upadamsha) include the following:

  • Injury to the penis by hand, nails and teeth;
  • Keeping the penis dirty without washing,
  • Indulging in excessive sexual intercourse,
  • Contact with contaminated or diseased vagina, and such other activities.

It is of five varieties. 1

 Doshika Upadamshas —

 सतोद – भेद – स्फुरणैः सकृष्णैः स्फोटैर्व्यवस्येत् पवनोपदंशम् |
पीतैर्बहुक्लेदयुतैः सदाहैः पित्तेन — 

 satōda – bhēda – sphuraṇaiḥ sakr̥ṣṇaiḥ sphōtairvyavasyēt pavanōpadanśam |
pītairbahuklēdayutaiḥ sadāhaiḥ pittēna –

There appear small papules having pricking, cutting, or pulsating type of pain. They would be black in colour in case the upadamsha involves a vataja type of penis.

If the disease upadamsha has occurred due to pitta, the blisters would be yellow with an excessive pain along with a burning sensation.

 — रक्तात् पिशितावभासैः || २ ||
स्फोटैः सकृष्णो रुधिरं रक्तात्मकं पित्तसमानलिङ्गम् |
सकण्डुरैः शोथयुतैर्महद्धिः शुक्लैर्घनैः स्रावयुतैः कफेन || ३ ||

— raktāt piśitāvabhāsaiḥ || 2 ||
sphōṭaiḥ sakr̥ṣṇō rudhiraṁ raktātmakaṁ pittasamānaliṅgam |
sakaṇḍuraiḥ śōthayutairmahaddhiḥ śuklairghanaiḥ srāvayutaiḥ kaphēna || 3 ||

 In case of Raktaja Type upadamsha, the papules are flesh red in colour or black. They discharge blood while all other features of pitta could be present; there is a big swelling, the papules are itching and they exude thick white fluid in case of kaphaja type of penis. 2-3

नानाविधस्राव – रुजोपपन्नमसाध्यमाहुस्त्रिमलोपदंशम् |

nānāvidhasrāva – rujōpapannamasādhyamāhustrimalōpadanśam |

The Upadamsha that has been caused by the vitiation of all the three doshas is manifest by different types of discharges and severe pain. This is an incurable disease indeed.

 विशीर्णमांसं क्रिमिभिः प्रजग्धं मुष्कावशेषं परिवर्जयेच्च ||४|| 

viśīrṇamānsaṁ krimibhiḥ prajagdhaṁ muṣkāvaśēṣaṁ parivarjayēcca ||4||

The case of morbid condition in that the entire fleshy part has been eroded or eaten away by germs leaving only the scrotum must not be taken up by the wise physician. 4

Sequelae in absence of treatment —

 सञ्जातमात्रे न करोति मूढः क्रियां नरो यो विषये प्रसक्तः |
कालेन शोथ – क्रिमि – दाह – पाकैर्विशीर्णशिश्नो म्रियते स तेन || ५ || 

sañjātamātrē na karōti mūḍhaḥ kriyāṁ narō yō viṣayē prasaktaḥ |
kālēna śōtha – krimi – dāha – pākairviśīrṇaśiśnō mriyatē sa tēna || 5 ||

Those persons who do not seek treatment soon after the onset of (such a dreadful) disease and neglect it, become victims of a complicated situation with increased swelling, further infection by bacteria. He develops burning sensation and there is pus formation; finally, destruction of the penis takes place. Thus, the foolish individuals who remain engrossed in sexual activities expire soon. 5

Penile warts or granulomas —

 अङ्कुरैरिव सङ्घातैरूपर्युपरिसंस्थितैः |
क्रमेण जायते वर्तिस्ताम्रचूडशिखोपमा || ६ ||
कोषस्याभ्यन्तरे सन्धौ सर्वसन्धिगता अपि वा |
सवेदना पिच्छिला च दुःचिकित्स्या त्रिदोषजा |
लिङ्गवर्तिरभिख्याता लिङ्गार्श इति चापरे || ७ ||

aṅkurairiva saṅghātairūparyuparisansthitaiḥ |
kramēṇa jāyatē vartistāmracūḍaśikhōpamā || 6 ||
kōṣasyābhyantarē sandhau sarvasandhigatā api vā |
savēdanā picchilā ca duḥcikitsyā tridōṣajā |
liṅgavartirabhikhyātā liṅgārśa iti cāparē || 7 ||

The sprouts of muscular tissue with a shape of crown of the cock have been identified by some linga varti. These sprouts develop inside the prepuce. They produce pain and exudation. The condition is reportedly caused by the combination of all the three doshas. Some other scholars name this condition as the disease lingarsha. Nonetheless, it is commonly accepted that the condition is difficult to cure. 6-7

 इति श्रीमाधवकरविरचिते माधवनिदाने उपदंशनिदानं समाप्तम् || ४७ || 

iti śrīmādhavakaraviracitē mādhavanidānē upadamśanidānaṁ samāptam || 47 ||

Thus concludes the Chapter on Upadamsha.