The 12th chapter of Nidanasthana of Sushruta Samhita is named as Vrddhi-Upadamsa- Slipada Nidanam Adhyaya. This chapter deals with Enlargement of Scrotum – Venereal diseases and Filariasis.

अथातो वृद्ध्युपदंशश्लीपदानां निदानं व्याख्यास्यामः ||१||

यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Vrddhi – upadamsa – slipada Nidana – diagnosis of enlargement of the scrotum, venereal diseases and filariasis; as revealed by the venerable Dhanvantari.

Vidha – kinds

वातपित्तश्लेष्मशोणितमेदोमूत्रान्त्रनिमित्ताः सप्त वृद्धयो भवन्ति |

तासां मूत्रान्त्रनिमित्ते वृद्धी वातसमुत्थे, केवलमुत्पत्तिहेतुरन्यतमः ||३||

Types of Vrddhi –

There are eight types of Vrddhi. They are

1.   Vataja – caused by vata aggravation
2.   Pittaja – caused by pitta aggravation
3.   Kaphaja – caused by kapha aggravation
4.   Raktaja / Sonitaja – caused by aggravation of blood
5.   Medoja – caused by vitiated fat tissue
6.   Mutraja – caused by urine
7.   Antraja – caused by protrusion of intestine

Among these Vrddhis, those caused by mutra and antra are produced by vata itself. Only their causative and exciting factors are different.

Samprapti – pathogenesis (meaning) of Vrddhi

अधः प्रकुपितोऽन्यतमो हि दोषः फलकोशवाहिनीरभिप्रपद्य धमनीः फलकोषयोर्वृद्धिं जनयति, तां वृद्धिमित्याचक्षते ||४||

Any one of the above mentioned aggravated doshas which get aggravated due to their etiological factors travel downwards and get localized in the blood vessels / arteries of the phalakosa – scrotum. By doing so, the doshas cause enlargement of scrotum. Therefore, this condition is called as vrddhi, which means enlargement.

Purvarupa – Premonitory symptoms

तासां भविष्यतीनां पूर्वरूपाणि- बस्तिकटीमुष्कमेढ्रेषु वेदना मारुतनिग्रहः फलकोशशोफश्चेति ||५||

The premonitory symptoms of Vrddhi include –

–        pain in the bladder

–        pain in the scrotum

–        pain in the penis

–        retention of flatus

–        swelling of scrotum  

Rupa – signs and symptoms

तत्रानिलपरिपूर्णां बस्तिमिवाततां परुषामनिमित्तानिलरुजां वातवृद्धिमाचक्षते; पक्वोदुम्बरसङ्काशां ज्वरदाहोष्मवतीं चाशुसमुत्थानपाकां पित्तवृद्धिं; कठिनामल्पवेदनां शीतां कण्डूमतीं श्लेष्मवृद्धिं; कृष्णस्फोटावृतां पित्तवृद्धिलिङ्गां रक्तवृद्धिं, मृदुस्निग्धां कण्डूमतीमल्पवेदनां तालफलप्रकाशां मेदोवृद्धिं; मूत्रसन्धारणशीलस्य मूत्रवृद्धिर्भवति, सा गच्छतोऽम्बुपूर्णा दृतिरिव क्षुभ्यति मूत्रकृच्छ्रवेदनां वृषणयोः श्वयथुं कोशयोश्चापादयति, तां मूत्रवृद्धिं विद्यात्; भारहरणबलवद्विग्रहवृक्षप्रपतनादिभिरायासविशेषैर्वायुरभिप्रवृद्धः प्रकुपितश्च स्थूलान्त्रस्येतरस्य चैकदेशं विगुणमादायाधो गत्वा वङ्क्षणसन्धिमुपेत्य ग्रन्थिरूपेण स्थित्वाऽप्रतिक्रियमाणे च कालान्तरेण फलकोशं प्रविश्य मुष्कशोफमापादयति, आध्मातो बस्तिरिवाततः प्रदीर्घः स शोफो भवति, सशब्दमवपीडितश्चोर्ध्वमुपैति, विमुक्तश्च पुनराध्मायते , तामन्त्रवृद्धिमसाध्यामित्याचक्षते ||६||

Symptoms of Vataja Vrddhi –

–        appearance of the scrotum – resembles air filled bag

–        is rough on touch

–        pain occurs without any specific cause

 

Symptoms of Pittaja Vrddhi –  

–        appearance of the scrotum – resembles a ripe Udumbara fruit in color – reddish brown in color

–        presence of fever, burning sensation and raised heat

–        quick in onset

–        quick in ripening / suppuration (pus is formed in the swelling quickly)

 

Symptoms of Kaphaja Vrddhi –

–        scrotum is hard to feel

–        has mild pain

–        cold on touch

–        has itching

 

Symptoms of Raktaja Vrddhi –

–        black eruptions are present all around over the scrotum

–        symptoms of pittaja vrddhi are also seen

 

Symptoms of Medoja Vrddhi –

–        appearance of the scrotum – resembles Tala fruit in appearance – dark blue in color and big in size

–        scrotum is soft on touch

–        unctuous

–        has itching

–        has slight pain

 

Symptoms of Mutraja Vrddhi –

–        causes – suppression of urge for urination habitually

–        appearance of scrotum – scrotum resembles a water filled with bag and also develops movements similar to that

–        dysuria

–        pain in testicles

–        swelling / oedema of the scrotum

 

Symptoms of Antra Vrddhi – vrddhi

Causes –

–        carrying heavy loads habitually

–        fighting with strong persons or animals habitually

–        falling from the tree

–        any other strenuous activities

Pathogenesis –

Due to the above said causative factors, vata would get aggravated. This aggravated vata would cause abnormalities in the colon and small intestine, at particular place. Later, the vata would push that part of the intestine down into the groins and stay therein like a tumor for some time.

In due course of time, if left untreated, the coils of the intestines descend into the scrotum and produce swelling of the scrotum.

Symptoms and signs

–        appearance – the scrotum appears like a bag of air, elongated and swollen

–        the intestines move up accompanied with sound when the physician presses it with his hands and

–        it swells up once again when the physician releases the pressure on it

This condition in which the antra i.e. intestine appears to enlarge as it descends into the scrotum, is called as antra vrddhi. It is considered as incurable.

 

 

तत्रातिमैथुनादतिब्रह्मचर्याद्वा तथाऽतिब्रह्मचारिणीं चिरोत्सृष्टां रजस्वलां दीर्घरोमां कर्कशरोमां सङ्कीर्णरोमां निगूढरोमामल्पद्वारां महाद्वारामप्रियामकामामचौक्षसलिलप्रक्षालितयोनिमप्रक्षालितयोनिं योनिरोगोपसृष्टां स्वभावतो वा दुष्टयोनिं वियोनिं वा नारीमत्यर्थमुपसेवमानस्य तथा करजदशनविषशूकनिपातनाद्बन्धनाद्धस्ताभिघाताच्चतुष्पदीगमनादचौक्षसलिलप्रक्षालनादवपीडनाच्छ्रुक्रवेगविधारणान्मैथुनान्ते वाऽप्रक्षालनादिभिर्मेढ्रमागम्य  प्रकुपिता दोषाः क्षतेऽक्षते वा श्वयथुमुपजनयन्ति, तमुपदंशमित्याचक्षते ||७||

Nidana – causes

Indulgence in too much sex / copulation

Indulgence in too much celibacy

Copulating with below mentioned kinds of women

–        the most celibate

–        who has not indulged in copulation for a long time

–        who is in her menstrual periods

–        who has long, rough, matted or hidden pubic hairs

–        who has very small or very big vagina

–        who is not liked

–        who is not interested in sex

–        who has washed her vagina with dirty water

–        who has not at all washed her vagina

–        who is suffering from vaginal diseases

–        who has a bad vagina by nature

Person using places other than vagina – like mouth, rectum, armpits for sex – his penis gets hurt by nails, teeth etc.

Application of paste of poisonous insects and by wrapping it

Squeezing the penis by hands – masturbation

Copulating with quadrupeds like cow, goat, sheep, donkey, horse, dog etc.

Washing the penis with dirty water or water unsuitable for washing

Vigorous kneading

Forcibly controlling the ejaculation

Not washing the penis soon after the copulation

 

Due to the above said and many other such untoward activities, the doshas get aggravated and get localized in the penis. They produce swelling therein, with or without a wound. This disease is called as Upadamsa – venereal disease.

 

Bheda and Laksanas – kinds and symptoms

स पञ्चविधस्त्रिभिर्दोषैः पृथक् समस्तैरसृजा चेति ||८||

तत्र वातिके पारुष्यं त्वक्परिपुटनं स्तब्धमेढ्रता परुषशोफता विविधाश्च वातवेदनाः; पैत्तिके ज्वरः श्वयथुः पक्वोडुम्बरसङ्काशस्तीव्रदाहः क्षिप्रपाकः पित्तवेदनाश्च; श्लैष्मिके श्वयथुः कण्डूमान् कठिनः स्निग्धः श्लेष्मवेदनाश्च; रक्तजे कृष्णस्फोटप्रादुर्भावोऽत्यर्थमसृक्प्रवृत्तिः पित्तलिङ्गान्यत्यर्थं ज्वरदाहौ शोषश्च, याप्यश्चैव कदाचित्; सर्वजे सर्वलिङ्गदर्शनमवदरणं च शेफसः कृमिप्रादुर्भावो मरणं चेति ||९||

Upadamsa is of five types. They are –

–        Vataja Upadamsa

–        Pittaja Upadamsa

–        Kaphaja Upadamsa

–        Sannipataja / Tridoshaja Upadamsa and

–        Raktaja Upadamsa

 

Type of Upadamsa	Symptoms
Vataja Upadamsa	Penis is rough on touch The skin of the penis is cracked Penis is stiff and does not move Swelling – coarse to touch Presents with different kinds of pains of vata origin
Pittaja Upadamsa	Fever Swelling – resembles Udumbara fruit Severe burning sensation Suppurates quickly Presence of other symptoms and pains of pitta aggravation
Kaphaja Upadamsa	Swelling has itching, is hard on touch and is unctuous Presents with other symptoms of kapha origin
Raktaja Upadamsa	Black colored vesicles with severe bleeding Symptoms of pitta aggravation are present, like – fever, burning sensation and dryness This is yapya – manageable, persists for long time and is not totally curable
Tridoshaja Upadamsa	Presence of symptoms of all the three doshas together Penis is cracked and ulcerated Development of worms in the ulcers Death

 

 

 

Samprapti- Pathogenesis

कुपितास्तु दोषा वातपित्तश्लेष्माणोऽधःप्रपन्ना वङ्क्षणोरुजानुजङ्घास्ववतिष्ठमानाः कालान्तरेण पादमाश्रित्य शनैः शोफं जनयन्ति, तं श्लीपदमित्याचक्षते |

तत्त्रिविधं- वातपित्तकफनिमित्तमिति ||१०||

Vata, Pitta and Kapha aggravated by their own etiological factors, move downwards, reach the groins, thighs, foreleg, and calves. Gradually these doshas reach the feet in due course of time and give rise to swelling. This disease is called as Slipada.

There are three kinds of Slipada i.e.

–        Vataja Slipada

–        Pittaja Slipada and

–        Kaphaja Slipada

 

Laksanas- signs and symptoms

तत्र, वातजं खरं कृष्णं परुषमनिमित्तानिलरुजं परिस्फुटति च बहुशः; पित्तजं तु पीतावभासमीषन्मृदु ज्वरदाहप्रायं च; श्लेष्मजं तु श्वेतं स्निग्धावभासं मन्दवेदनं भारिकं महाग्रन्थिकं कण्टकैरुपचितं च ||११||

 

Type of Slipada	Symptoms
Vataja Slipada	Feet are rough, black in color and coarse Presents with vata type of pains Appears without any obvious cause Skin is greatly cracked
Pittaja Slipada	Feet are yellow in color and little smooth Presence of fever
Kaphaja Slipada	Feet are white in color, is unctuous Has mild pain Heaviness Greatly nodular Studded with thorny projections

 

 

Prognosis

तत्र संवत्सरातीतमतिमहद्वल्मीकजातं प्रसृतमिति वर्जनीयानि ||१२||

Slipada with below mentioned features should be rejected and not treated –

–        Existing for one year

–        Grown massively and is very big in size

–        Resembles anthill in appearance

–        That which discharges (exudes) fluids

 

 

भवन्ति चात्र-

Some verses here:-

त्रीण्यप्येतानि जानीयाच्छ्लीपदानि कफोच्छ्रयात् |

गुरुत्वं च महत्त्वं च यस्मान्नास्ति विना कफात् ||१३||

Heaviness and big size of the leg cannot happen without the involvement of kapha and these are the features of all kinds of Slipada. Therefore, all the three kinds of Slipada described above should be considered as produced by increase of kapha.

 पुराणोदकभूयिष्ठाः सर्वर्तुषु च शीतलाः |

ये देशास्तेषु जायन्ते श्लीपदानि विशेषतः ||१४||

Slipada especially occurs in the below mentioned conditions –

–        In places where there is more of old and stagnated water

–        In places which are cold in all the seasons of the year

 

पादवद्धस्तयोश्चापि श्लीपदं जायते नृणाम् |

कर्णाक्षिनासिकौष्ठेषु केचिदिच्छन्ति तद्विदः ||१५||

Just like the feet, Slipada also affects the hands. According to the opinion of other experts, it also develops in the ear, eyes, nose and lips.

 

इति सुश्रुतसंहितायां निदानस्थाने वृद्ध्युपदंशश्लीपदनिदानं

नाम द्वादशोऽध्यायः ||१२||

 Thus ends the Twelvth chapter by name Vrddhi- Upadamsa slipada Nidanam in Nidana sthana of Susrutha Samhita.