Chapter IX - Diagnosis of abscess

Now we shall discourse on the Nidana of Vidradhi (abscess etc.). 1.

The blessed Dhanvantari, the honoured of the gods, who for the promulgation of the knowledge of the Ayurveda and for administering proper medicines (to the sick), took his birth at Kasi, (Benares) as a king, thus fully discoursed on the symptoms of Vidradhi (abscess etc.) to his disciple, Sushruta. 2.

Definition and classification:—

The extremely deranged and aggravated Vayu, Pitta and Kapha, resorting to the bone and vitiating the Tvaka (skin), blood, flesh, and fat of a person (with their own specific properties), gradually give rise to a deep-seated, painful, round or extended swelling which is called Vidradhi by the wise. The disease admits of being divided into six types such as the Vataja type, the Pittaja type, the Kaphaja type, the Sannipatika type, the Kshataja type (traumatic), and the Asrija (which has its seat in the vitiated blood). Now we shall describe their specific symptoms. 3-4.

The Vataja Type:—

This abscess assumes a black or vermilion colour, is felt rough to the touch and is characterised by a sort of excruciating pain. The growth and suppuration of the abscess are brought about in a variety of forms (owing to the variable and irregular action of the deranged Vayu involved in these cases). 5.

The Pittaja Type:—

This abscess assumes a blackish yellow colour or one like that of a ripe Audumvara fruit. It is attended with fever and a burning sensation, and is of rapid growth and suppuration. 6.

The Kaphaja Type:—

his abscess is shaped like an Indian saucer (sharava) and seems cold to the touch. It assumes a light yellow colour and is characterised by numbness, itching and little pain. The growth and suppuration of this abscess is very slow. The secretions from a Vataja abscess are thin, those from a Pittaja type are yellow, while the exudations from a Kaphaja abscess are white. 7.

The Sannipatika Type:—

An abscess of the Sannipatika type is of varied colour, and is attended with a varied sort of pain (sucking, drawing, turning etc.) and exudes secretions of various colours (white, yellow, etc.). It is little raised or elevated at its top, large and irregular in its shape and does not uniformly suppurate in all its parts. 8.

Agantuja or Kshataja Type:—

The local or inherent heat of an ulcer, (caused by a blow or a dirt) in a person, addicted to unwholesome regimen, is augmented and conducted by the deranged Vayu and vitiates the blood and Pitta, thus giving rise to a kind of abscess which is known as the Agantuja Vidradhi (traumatic abscess). Symptoms of the Pittaja type likewise mark this type of abscess and fever, thirst and a burning sensation attend it from the very beginning. 9.

The Raktaja Type:—

This abscess assumes a black or tawny colour, covered with a large number of black vesicles, and fever and an intolerable burning and pain attended with all the symptoms peculiar to the Pittaja type, mark the present form of the disease. It is called Raktaja Vidradhi. Of external Vidradhis or abscesses, those of the Sannipatika type should be regarded as incurable. 10—11.

Antara-Vidradhi:—

Now we shall describe the characteristic features of internal abscesses (Antara-Vidradhi). The Vayu, Pitta and Kaphah of the body, deranged through eating heavy, incompatible and in- congenial (to the physical temperament of the eater) articles of food or of dry, putrid and decomposed substances, or by excessive coition and fatiguing physical exercise, or by voluntary repression of any natural urging of the body or through the eating of food which is followed by an acid reaction, either severally or collectively give rise to a tumour-like (Gulma), raised, or elevated abscess in the interior of the organism, which is often felt to be shaped like an ant-hill. 12-13.

Localities:—

They are generally found to be seated at the mouth (neck) of the bladder, or about the umbilicus, or in the sides, or in the Kukshi (inguinal regions), or on the Vrikkas, or on the liver, or in the heart, or on the Kloma, or on the spleen, or in the rectum. Their general characteristics are identical with those of the several types of external abscess. The symptoms of their suppurated or unsuppurated stages should be determined in the light of the chapter on Amapakvaishanyiam (Ch. XVII Sutra.). 14-15.

Their specific symptoms:—

Now hear me describe the symptoms which specifically mark these internal abscesses according to their seats in the different regions of the organism. An abscess appearing in the rectum (Guda) is marked by the suppression of the flatus (Vata). Seated in the bladder, it gives rise . to difficulty of urination and scantiness of urine. Appearing about the umbilicus it produces a distressing hic-cough and a rumbling sound (Atopa) in the intestines. Seated in either of the sides (Kukshi) it tends to aggravate inordinately the vayu of the body. Appearing in the inguinal region it gives rise to an extreme catching pain at the back and waist. Seated in either of the Vrikkas it brings about a contraction of the sides. Appearing on the spleen, it produces symptoms of difficult and obstructed respiration. Seated on the heart it gives rise to an excruciating and piercing pain within its cavity and a drawing pain (Graha) extending all over the body (D. R.—cough). Seated in the Liver its

characteristic indications are thirst and difficult breathing (D. R.—hic-cough) whereas a sort of unquenchable thirst is the symptom which marks its seat on the Kloma. 16-17.

Prognosis:—

An abscess appearing on any vital part (Marma) of the organism, whether large or small in size, suppurated or unsuppurated, should be deemed as extremely hard to cure. Discharge from an abscess formed in the region of the organism above the umbilicus and (spontaneously bursting), will flow out through the mouth whereas similar secretions from down the umbilical region of (the abdomen), naturally find an outlet through the fissure of the anus. The case in which the secretions (pus etc.) find a downward channel and outlet may end in recovery of the patient, whereas the one in which the secretions take an upward course invariably proves fatal. An incision made by surgeon from the outside into an internal abscess, other than the one situated on the heart, or on the bladder or on the umbilicus may occasionally, prove successful, but the one, seated on any of the preceding vulnerable visceras (heart, bladder etc.) of the body and surgically opened invariably ends in death. 18-19.

A woman, who has miscarried or has been even safely delivered of a child at term, may be afflicted with a dreadful abscess in the event of her taking injudicious and unhwholesome food after parturition. The abscess in such a case, which is attended with extreme hyper-pyrexia (Dahajvara) should be considered as having had its origin to the vitiated blood (Raktaja Vidradhi) accumulated in. the organism. The abscess,, which appears in the Kukshi (in the iliac region) of a safely delivered woman owing to the presence of the unexpelled blood-clots in those regions after childbirth, should be also diagnosed as a case of Raktaja-abscess. The unexpelled blood is called Makkalla, Such an abscess, if not absorbed in the course of a week, is sure to suppurate. 20 —21.

Differentiating diagnosis of Gulma and Vidradhi^[1]:—

Now I shall discuss the features which distinguish a Gulma (internal tumour) from a Vidradhi (internal abscess). It may be asked, how is it that Gulma, (internal tumour) though caused by, and involving the co-operation of the same deranged Doshas as an internal abscess, does nut suppurate, while the latter (Vidradhi) does run to suppuration? 22—23..

The answer is that a Gulma (internal tumour), though caused by the same deranged Doshas as a Vidradhi (internal abscess), does not resort to any deranged organic matter, such as flesh, blood, etc., while, on the contrary, in a case of Vidradhi, the diseased flesh and blood of a locality are in themselves transformed into an abscess. An internal tumour (Gulma) is like a water bubble floating and moving about within a cavity of the body etc. without any fixed root of its own. Hence, it is that a Gulma (internal tumour) does not suppurate at all. Suppuration sets in in an abscess only because it largely contains flesh and blood unlike a Gulma (internal tumour) which is not formed of any such organic matter, and depends only on the aggravated Doshas giving birth to it. Hence, a Gulma does not suppurate at all. 24.

Incurable Types:—

A case of an internal abscess suppurating about the heart, bladder or umbilicus as well as one of the Tridosha type (appearing in any part of the organism) should be given up as incurable. The abscess in which the marrow suppurates (generally) becomes fatal. The suppurating process in an internal abscess, which generally affects the underlying bone, is sometimes found to affect the marrow. The suppurated marrow, failing to find an outlet on account of the compactness of the local flesh and bone, produces a sort of burning sensation in the locality which consumes the body like a blazing fire. The disease confined to the bone, like a piercing dirt, torments the patient for a considerable length of time. An incision (made into the affected bone) is followed by the secretion of a fat-like, glossy, white, cold and thick pus. Men, learned in the knowledge of the Medicinal Shastras, designate such an abscess as an Asthighata-Vidradhi (abscess of the bone) which involves all the three kinds of deranged Doshas, and is attended with various kinds of pain which mark them respectively. 25-26.

 

Thus ends the ninth Chapter of the Nidanasthana in the Sushruta Spinbita which treats of the etiology of abscess.

Footnotes and references:

[1]:

A Gulma according to Sushruta does not suppurate, but the sanskrit term “Api” (also) contemplates instances in which a Gulma may suppurate as in the case where it has got its basis in the deranged flesh ?te? of the locality. Charaka asserts that retarded digestion of the ingested food followed by digestionary acid reaction, colic pain, insomnia with fever and a non-relish for food and a sense of oppression, etc. are the symptoms which indicate that suppuration has set in a Gulma, and he advises that it (Gulma) should be treated with poultices, etc.