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Chapter 54 – Masurika Nidanam

The 54th chapter of Madhava Nidana is Masurika Nidanam which deals with Diagnosis of the different types of Pox.

Etiopathogenesis —

कत्वम्ल – लवण – क्षार – विरुद्धाध्यशनशनैः |
दुष्ट – निष्पाव – शाकाध्यैः प्रदुष्टपवनोदकैः || १ ||
क्रूरग्रहेक्षणाच्चापि देशे दोषाः समुद्धताः |
जनयन्ति शरीरे अस्मिन् दुष्टरक्तेन सङ्गताः || २ ||
मसूराकृतिसंस्थानाः पिडकाः स्युर्मसूरिकाः |

katvamla – lavaṇa – kṣāra – viruddhādhyaśanaśanaiḥ |
duṣṭa – niṣpāva – śākādhyaiḥ praduṣṭapavanōdakaiḥ || 1 ||
krūragrahēkṣaṇāccāpi dēśē dōṣāḥ samuddhatāḥ |
janayanti śarīrē asmin duṣṭaraktēna saṅgatāḥ || 2 ||
masūrākr̥tisansthānāḥ piḍakāḥ syurmasūrikāḥ |

The Masurika is a disease that is marked as appearance of eruptions resembling masura (lentils) in shape and size. This disease is generated because of over – indulgence in eatables that are pungent, sour, salty, alkaline, as well as incompatible in nature. Other pathogenic factors of this morbidity include the following:

  • Taking food in excess quantity
  • Maintaining an irregular eating habit and fasting,
  • Intake of contaminated beans, leafy vegetables, air and water as well as bad planetary influences on certain areas of the country and on the community of people and the like.

Such factors generate an increase in the doshas in the body that subsequently in association with polluted blood generate the above eruptions. 1-2

Prodromata —

तासां पूर्वं ज्वरः कण्डूर्गात्रभङ्गो अरतिर्भ्रमः || ३ || 
त्वचि शोथः सवैवर्ण्यो नेत्ररागश्च जायते |

tāsāṁ pūrvaṁ jvaraḥ kaṇḍūrgātrabhaṅgō aratirbhramaḥ || 3 ||
tvaci śōthaḥ savaivarṇyō nētrarāgaśca jāyatē |

In its premonitory features, the disease identified as Masurika will have —

  • Fever,
  •  Itching,
  • Pain all over the body,
  • Restlessness,
  • Giddiness,
  • Swelling, and
  • Discoloration of the skin and
  • Redness of the eyes. 3
 Vataja Masurikaa —

स्फोटः श्यावारुणा रूक्षास्तीव्रवेदनया अन्विताः || ४ ||
कठिनाश्चिरपाकाश्च भवन्त्यनिलसम्भवाः |
सन्ध्यस्थिपर्वणां भेदः कासः कम्पो अरतिः क्लमः || ५ ||
शोषस्ताल्वोष्ट – जिह्वानां तृष्णा चारुचिसंयुता |

sphōṭaḥ śyāvāruṇā rūkṣāstīvravēdanayā anvitāḥ || 4 ||
kaṭhināścirapākāśca bhavantyanilasambhavāḥ |
sandhyasthiparvaṇāṁ bhēdaḥ kāsaḥ kampō aratiḥ klamaḥ || 5 ||
śōṣastālvōṣṭa – jihvānāṁ tr̥ṣṇā cārucisanyutā |

The features of Masurikaa generated by vata include such symptoms —

  • Eruptions that are black or crimson in colour,
  • Rough,
  • Very painful, and
  • Hard.

They form pus but very slowly. Moreover, there appears —

  • Pain in the joints,
  • Cough,
  • Shivering,
  • Restlessness,
  • Exhaustion,
  • Dryness of the palate, lips and tongue,
  • Thirst and
  • Loss of appetite. 4-5
Pittaja Masurikaa —

रक्ताः पीत – सीताः स्फोटः सदाहास्तीव्रवेदनाः || ६ ||
भवन्त्यचिरपाकाश्च पित्तकोपसमुद्भवाः |
विड्भेदश्चाङ्गमर्दश्च दाहस्तृष्णा अरुचिस्तथा || ७ ||
मुखपाको अक्षिरागश्च ज्वरस्तीव्रः सुदारुणः |

raktāḥ pīta – sītāḥ sphōṭaḥ sadāhāstīvravēdanāḥ || 6 ||
bhavantyacirapākāśca pittakōpasamudbhavāḥ |
viḍbhēdaścāṅgamardaśca dāhastr̥ṣṇā arucistathā || 7 ||
mukhapākō akṣirāgaśca jvarastīvraḥ sudāruṇaḥ |

The features of Masurika generated by pitta include —

  • Red, yellowish white eruptions,
  • With severe burning sensation and
  • Pain.
  • It is also marked by a fast pus formation,
  • Diarrhoea,
  • Pain all over the body,
  • Burning sensation,
  • Thirst ,
  • Loss of appetite,
  • Ulceration of the mouth,
  • Redness of eyes,
  • Very high fever, and a
  • Great distress. 6-7
 Raktaja Masurikaa —

रक्तजायां भवन्त्येते विकाराः पित्तलक्षणाः || ८ ||

raktajāyāṁ bhavantyētē vikārāḥ pittalakṣaṇāḥ || 8 |

The raktaja masurikaaa (the one generated by bad blood) manifest the features that are identical to those of pittaja type of masurika. 8

 Kaphaja Masurika —

कफप्रसेकः स्तैमित्यं शिरोरुग्गात्रगौरवम् |
हृल्लासः सारुचिर्निद्रा तन्द्रालस्यसमन्विताः || ९ ||
श्वेताः स्निग्धा भृशं स्थूलाः कण्डूरा मन्दवेदनाः |
मसूरिकाः कफोत्थाश्च चिरपाकाः प्रकीर्तिताः || १० ||

kaphaprasēkaḥ staimityaṁ śirōruggātragauravam |
hr̥llāsaḥ sārucirnidrā tandrālasyasamanvitāḥ || 9 ||
śvētāḥ snigdhā bhr̥śaṁ sthūlāḥ kaṇḍūrā mandavēdanāḥ |

masūrikāḥ kaphōtthāśca cirapākāḥ prakīrtitāḥ || 10 ||

The features of the disease kaphaja masurikaa are —

  •  The watery discharge from the mouth, nose and eyes,
  • Inactivity,
  • Headache,
  • Feeling of heaviness of the body,
  • Nausea,
  • Loss of appetite,
  • Sleep,
  • Stupor, and
  • Lassitude.

In this case, the eruptions remain white in colour, big in size, soft, itching, slightly painful, and there is a slow formation of pus. 9-10

Sannipataja Masurika –

नीलाश्चिपिट – विस्तीर्णां मध्ये निम्ना महारुजः |
चिरपाकाः पूतिस्रावाः प्रभूताः सर्वदोषजाः || ११ ||
कण्ठरोधारुचि – स्तम्भ – प्रलापारतिसंयुताः |
दुश्चिकित्स्याः समुद्दिष्टाः पिडकाश्चर्मसंज्ञिताः || १२ ||

nīlāścipiṭa – vistīrṇāṁ madhyē nimnā mahārujaḥ |
cirapākāḥ pūtisrāvāḥ prabhūtāḥ sarvadōṣajāḥ || 11 ||
kaṇṭharōdhāruci – stambha – pralāpāratisanyutāḥ |
duścikitsyāḥ samuddiṣṭāḥ piḍakāścarmasañjñitāḥ || 12 ||

The features of Masurika generated by the vitiation of all the three doshas in combination include —

  • Eruptions that are blue in color, flat and broad in shape,
  •  Depressed in their centre  and elevated at their edges.
  • They are severely painful.
  • They form pus slowly.
  • They also exude pus of a disagreeable smell and in large quantity.
  • They generate blockage in the throat.

Moreover, there is

  • Loss of appetite,
  • Stiffness of the body,
  • Delirium, and
  • Restlessness.

This condition known as Carmapidaka, is generated by all the three doshas together and is difficult to manage. 11-12

 Romantika (?Measles) —

रोमकूपोन्नतिसमा रागिण्यः कफपित्तजाः |
कासारोचकसंयुक्ता रोमान्त्यो ज्वरपूर्विकाः || १३ ||  

rōmakūpōnnatisamā rāgiṇyaḥ kaphapittajāḥ |
kāsārōcakasanyuktā rōmāntyō jvarapūrvikāḥ || 13 ||

The morbidity marked by small, red eruptions at the roots of hairs making slight elevations, associated with cough, loss of appetite and the disease preceded by fever is known as Romantika (measles). It is generated by morbid increase in kapha and pitta. 13

Involvement of the seven dhatus
Masurikaa located in tvak (The rasa dhatu) —

तोयबुद्बुदसङ्काशास्त्वग्गतास्तु मसूरिकाः |
स्वल्पदोषाः प्रजायन्ते भिन्नास्तोयं स्रवन्ति च || १४ ||
रक्तस्था लोहिताकाराः शीघ्रपाकास्तनुत्वचः |
साध्या नात्यर्थदुष्टाश्च भिन्ना रक्तं स्रवन्ति च ||१५ ||
मांसस्था कठिनाः स्निग्धाश्चिरपाका घनत्वचः |
गात्रशूल – तृषा – कण्डू – ज्वरारतिसमन्विताः || १६ ||

tōyabudbudasaṅkāśāstvaggatāstu masūrikāḥ |
svalpadōṣāḥ prajāyantē bhinnāstōyaṁ sravanti ca || 14 ||
raktasthā lōhitākārāḥ śīghrapākāstanutvacaḥ |
sādhyā nātyarthaduṣṭāśca bhinnā raktaṁ sravanti ca ||15 ||
mānsasthā kaṭhināḥ snigdhāścirapākā ghanatvacaḥ |
gātraśūla – tr̥ṣā – kaṇḍū – jvarāratisamanvitāḥ || 16 ||

The eruptions could be like bubbles of water; they would exude thin watery fluid on pricking and will have features of mild increase in doshas if masurika is localized in the skin (affecting the rasa dhatu).

If the masurika were lodged in the blood, the eruptions that would appear would be red in complexion. It would form pus quickly, turn the skin thin and the abnormality of doshas is more and eruptions bleed heavily on pricking. Thus, it is difficult to cure.

The masurikaa lodged in the muscles could be marked through the eruptions that appear hard, and greasy. It would form pus quickly while the skin would remain thick in shape. Usually they would be associated with pain all over the body, thirst, itching, fever, and restlessness.  14 – 16

Masurikaa located in the Meda dhatu —

मेदोजा मण्डलाकारा मृदवः किञ्चिदुन्नताः |
घोरज्वरपरीताश्च स्थूलाः स्निग्धाः सवेदनाः || १७ ||
सम्मोहारतिसन्तापाः कश्चिदाभ्यो विनिस्तरेत् |

mēdōjā maṇḍalākārā mr̥davaḥ kiñcidunnatāḥ |
ghōrajvaraparītāśca sthūlāḥ snigdhāḥ savēdanāḥ || 17 ||
sammōhāratisantāpāḥ kaścidābhyō vinistarēt |

If the masurikaa is lodged in the fat, the eruptions that appear are in round patches. These would remain soft, slightly elevated, large, greasy, painful, and they are usually accompanied with very high fever, delusion, restlessness, and distress: few persons would recover from these conditions.  17

Masurikaa located in the asthi and majja dhatus —

क्षुद्रा गात्रसमा रूक्षाश्चिपिटाः किञ्चिदुन्नताः || १८ ||
मज्जोत्था भृशसम्मोह – वेदनारतिसंयुताः |
च्छिन्दन्ति मर्मधामानि प्राणानाशु हरन्ति हि || १९ ||
भ्रमरेणेव विद्धानि कुर्वन्त्यस्थीनि सर्वतः |

kṣudrā gātrasamā rūkṣāścipiṭāḥ kiñcidunnatāḥ || 18 ||
majjōtthā bhr̥śasammōha – vēdanāratisanyutāḥ |
cchindanti marmadhāmāni prāṇānāśu haranti hi || 19 ||
bhramarēṇēva viddhāni kurvantyasthīni sarvataḥ |

If it is  lodged in the majja (marrow) the eruptions that appear are small, of the same level as that of the skin. It would remain rough, flat, or slightly elevated. These eruptions would usually be associated with severe delusion, pain and restlessness.

If it is lodged in the bone there would be a cutting pain in vital organs endangering life and pain in the bones as though one has been stung by the bees. 18-19

Masurikaa located in the shukra dhatu — 

पक्वाभाः पिडकाः स्निग्धाः सूक्ष्माश्चात्यर्थवेदनाः || २० ||
स्तैमित्यारति – सम्मोह – दाहोन्मादसमन्विताः |
शुक्रजायां मसूर्यां तु लक्षणानि भवन्ति हि || २१ ||
निर्दिष्टं केवलं चिन्हं दृश्यते न तु जीवितम् |

pakvābhāḥ piḍakāḥ snigdhāḥ sūkṣmāścātyarthavēdanāḥ || 20 ||
staimityārati – sammōha – dāhōnmādasamanvitāḥ |
śukrajāyāṁ masūryāṁ tu lakṣaṇāni bhavanti hi || 21 ||
nirdiṣṭaṁ kēvalaṁ cinhaṁ dr̥śyatē na tu jīvitam |

If the masurikaa is lodged in the shukra (semen) the eruptions that appear would be ripe, waxy, small in size, very painful. They are associated with stiffness of body, restlessness, delusion, burning sensation and toxicity and the patient may soon expire.

 Association of doshas in masurika located in the dhatus —

 दोषमिश्रास्तु सप्तैता द्रष्टव्या दोषलक्षणैः || २२ || 

dōṣamiśrāstu saptaitā draṣṭavyā dōṣalakṣaṇaiḥ || 22 ||

The above seven types might also be having the features of one or more of the provoked doshas that are to be recognised. 22

Prognosis —
The easily curable Masurikas —

त्वग्गता रक्तजाः इव पित्तजाः श्लेष्मजास्तथा |
श्लेष्मपित्तकृताः इव सुखसाध्या मसूरिकाः || २३ ||

tvaggatā raktajāḥ iva pittajāḥ ślēṣmajāstathā |
ślēṣmapittakr̥tāḥ iva sukhasādhyā masūrikāḥ || 23 ||

Masurika that resides in the skin and those generated by rakta, pitta and kapha separately and kapha and pitta in combination are easy to cure. 23

Masurikaa curable with difficulty —

वातजा वात – पित्तोत्थाः श्लेष्म – वातकृताश्च याः |
कृच्छ्रसाध्यतमास्तस्माध्यत्नादेता उपचारेत् || २४ ||

vātajā vāta – pittōtthāḥ ślēṣma – vātakr̥tāśca yāḥ |
kr̥cchrasādhyatamāstasmādhyatnādētā upacārēt || 24 ||

The cases of Masurika that has been produced by Vata, Vatapitta, Kaphavata are very difficult to cure and so they are to be managed with great effort and care. 24

The Incurable varieties of Masurika —

असाध्याः सन्निपातोत्थास्तासां वक्ष्यामि लक्षणम् |
प्रवालसदृशाः काश्चित् काश्चिज्जम्बूफलोपमाः || २५ ||
लोहजालसमाः काश्चिदतसीफलसन्निभाः |
आसां बहुविधा वर्णा जायन्ते दोषभेदतः || २६ ||

asādhyāḥ sannipātōtthāstāsāṁ vakṣyāmi lakṣaṇam |
pravālasadr̥śāḥ kāścit kāścijjambūphalōpamāḥ || 25 ||
lōhajālasamāḥ kāścidatasīphalasannibhāḥ |
āsāṁ bahuvidhā varṇā jāyantē dōṣabhēdataḥ || 26 ||

The masurikaa generated by morbid increase in all the three doshas together are incurable, their features are the following:

  • Eruptions resembling the coral beads,
  • Appearing like fruits of jambu or like an iron sieve,
  • Some appear in shape like fruits of atasi (linseed and
  • Several other in various colours due to admixture of doshas involved in the ailment. 25-26
Masurika with a grave prognosis —

कासो हिक्का प्रमेहश्च ज्वरस्तीव्रः सुदारुणः |
प्रलापश्चारतिर्मूर्च्छा तृष्णा दाहो अतिघूर्णता || २७ ||
मुखेन प्रस्रवेद्रक्तं तथा घ्राणेन चक्षुषा |
कण्ठे घुर्घुरकं कृत्वा श्वसित्यत्यर्थवेदनम् || २८ ||
मसूरिकाभिभूतस्य यस्यैतानि भिषग्ज्वरैः |
लक्षणानि च दृश्यन्ते न दध्यादत्र भेषजम् || २९ ||

kāsō hikkā pramēhaśca jvarastīvraḥ sudāruṇaḥ |
pralāpaścāratirmūrcchā tr̥ṣṇā dāhō atighūrṇatā || 27 ||
mukhēna prasravēdraktaṁ tathā ghrāṇēna cakṣuṣā |
kaṇṭhē ghurghurakaṁ kr̥tvā śvasityatyarthavēdanam || 28 ||
masūrikābhibhūtasya yasyaitāni bhiṣagjvaraiḥ |
lakṣaṇāni ca dr̥śyantē na dadhyādatra bhēṣajam || 29 ||

An experienced physician should not take up the case if a patient suffering from masurika manifests the following complications:

  • Cough,
  • Hiccough,
  • Urinary disorders,
  • Acute hyper pyrexia,
  • Delirium,
  • Restlessness,
  • Fainting,
  • Thirst,
  • Burning sensation,
  • Excessive yawning,
  • Blood discharge from the mouth, the nose and the eyes,
  • And a difficult and painful breathing with rumbling noise in the throat. 27-29
Fatal Masurika —

मसूरिकाभिभूतो यो भृशं घ्राणेन निःश्वसेत् |
स भृशं त्यजति प्राणान् तृषार्तो वायुदूषितः || ३० ||

masūrikābhibhūtō yō bhr̥śaṁ ghrāṇēna niḥśvasēt |
sa bhr̥śaṁ tyajati prāṇān tr̥ṣārtō vāyudūṣitaḥ || 30 ||

The patient of masurika who have very shallow breathing and who is feeling severe thirst and who is having profound features of vitiated vata are likely to pass away. 30

Complications —

मसूरिकान्ते शोथः स्यात् कूर्परे मणिबन्धके |
तथां असफलके चापि दुश्चिकित्स्यः सुदारुणः || ३१ ||

masūrikāntē śōthaḥ syāt kūrparē maṇibandhakē |
tathāṁ asaphalakē cāpi duścikitsyaḥ sudāruṇaḥ || 31 ||

In the last stages of Masurikaa there is a profound swelling in the elbow, wrist and in shoulder joints. Moreover, this is an incurable condition. 31

इति श्री माधवकरविरचिते माधवनिदाने मसूरिकानिदानं समाप्तम् || ५४ ||

iti śrī mādhavakaraviracitē mādhavanidānē masūrikānidānaṁ samāptam || 54 ||

Thus concludes the chapter of Masurika.