Chapter CLXXVII - The Nidanam of Syphilis

Now hear me, O Sushruta, discourse on the Nidanam of Upadansa. Sexual congress with women who have observed a long vow of perfect continence, or with those, the external orifices of whose reproductive organs are extremely narrow or constricted, or the canals of whose reproductive organs are studded with patches of hairy growths, promiscuous intercourse, neglect in cleansing the parts after coitus, vaginal diseases in women, visited, bites or pinches at the genitals, washing of the parts with hot or alkaline water, carnal acts with beasts, and masturbation etc., are the factors which tend to produce the five forms of Upadansa in the genitals. In the type of Upadansa due to the action of the deranged Vayu, the (primary) pustule assumes a black hue and is produces an aching, piercing pain about the frenum. In the Pittaja type of Upadansa the (primary) pustules assume a yellowish colour and are attended with discharge and a burning sensation. In the type of Upadansa due to contamination of blood the pustules assume a black or fleshlike colour, and readily bleed. Symptoms peculiar to the Pittaja type of Upadansa also manifest themselves in this one. In the Kaphaja type of Upadansa, the swelling becomes extremely great and the pustules (incidental sores) are found to secrete a! thick copious discharge. Cases of Sannipatika, type of Upadansa of which a varied colour and character of the discharge form the chief specific features, should be regarded as incurable. A physician should renounce the medical treatment of a patient whose genitals have been entirely eaten away by parasites, leaving only the balls to dangle. The foolish one, who does not resort to proper medical treatment at the outset, ultimately dies of this disease, with his genitals extremely emaciated, or attended with swelling and suppuration, or eaten away by parasites. Condy-lomatous growths, resembling crests of cocks in shape and occurring upon or about the glanpenis, or between the integuments of the scrotum, or about any other joints of the body, are called Lingarsas. They are painless and slimy in character, and are of a Sannipatika origin, whence their incurablity.

Foolish persons, who get their reproductive organs swollen and elongated by means other than those described in the works of the holy Vatsayana, etc., or by pricking bristles of shuka insects into the cavernous tissues of their reproductive organs, suffer from any of the eighteen forms of the malady designated as Shukadosha. These eighteen forms of malady are respectively known as Sarshapika, Ashthilika, Kumbhika, Alaji, etc. Pustules to the size of white mustard seeds, and occurring over the penis through the aggravation of the local Vayu and Kaphah, in consequence of the bristles of shuka insects lying pricked into its body, are called Sarshapikas. Hard pustules, resembling pea-seeds and occurring over the penis, through the aggravation of the enraged local Vayu, are called Ashthilas. Patches of thready pustules occurring over the penis, through the action of the deranged Kaphah, are called Grathitas. Hard black pustules over the penis, resembling seeds of black berries and having their origin in the aggravation of the deranged Pittam and blood, are called Kumbhikas. Alajis, which are found to crop up on the penis in this disease, are quite identical in character with those described under Prameha. Pustules attended with swelling of the part, which are found to appear on the penis in consequence of rubbing it, in this disease, through the aggravation of the local Vayu, are called Mriditas. Pustules, which appear on the penis in consequence of pressing it with the hands for the purpose of introducing the bristles of shuka, in this disease, are called Sanmuda Pidakas, which are due to the aggravated condition of the local Vayu. Long pappilous pustules, which crop up on the penis, owing to the introduction of shuka-bristles into its body and which burst at their centre and give rise to pain and horripilation, are called Adhimanthas. These pustules should be attributed to the action of the aggravated Kaphah and blood in the locality. In the form of shukadosha known as Pushkarika, round roseolar patches, resembling petals of red lutus in shape, appear upon the penis, surrounded by small pustular eruptions. The local blood, vitiated by the virus of shuka-bristles, produces a kind of anaesthesia in the body of the penis, which is called Sparsha-hani.

Repeated introduction of the bristles of shuka insects into the cavernosa of the penis for the purpose of getting it abnormally swollen and elongated gives rise to a kind of red pustules on its body, which are called Uttamas, which resemble Masha or Mudga pulse and owe their origin to the vitiated condition of blood and the Pittam. Nets of sieve-like sinuses, which are found to invade the male organ of reproduction owing to the injudicious insertion of Suka-bristles into its body, ar e called shataponakas. These sores result from the deranged condition of blood and of the bodily Vayu. An inflammatory suppuration is established inside the skin and prepuce of the penis owing to the injudicious use of Suka, which is called Tvakapaka. A disease of the male organ of generation, resulting from the same cause as above, in which it becomes studded with black pustules and belbous eruptions, attended with an extreme pain, is called Shonitarvuda. Fleshy tumours, which crop up on the body of the penis owing to its being roughly handled after the insertion of Suka-bristles into its body, are called Mansar-vudas. The disease in which the flesh of the penis is found to slough off through the agency of the above-said exciting factor (shuka dosha) is called Mansapaka, which should be attributed to the concerted action of the three Doshas. Abscesses appearing on the male organ of reproduction exhibit the same symptoms as are manifested in connection with the Sannipatika ones. An inflammatory suppuration of the same organ owing to the introduction of the bristles of poisonous, black, or multicoloured Suka insects, and in which the organ becomes, shrivelled, or emaciated, or is entirely destroyed, is called Tilakalaka, which is of a Sannipatika origin. Of these diseases of the male organ of generation, Mansarvuda, Mansapaka, Vidradhi and Tilakalaka should be regarded as incurable.

Impotency and loss of virile power often mark the sequel to Upadansha. A person incapable of discharging his conjugal duties is called a Kliva (impotent), and impotency may arise from a variety of causes, mental, physical, traumatic, etc. Non-erection of one’s virile organ owing to one’s holding sexual congress with a woman whom one detests, or the incapacity of that organ to respond to the call of desire on account of grief or fright are cases which illustrate the mental cause of impotency. Excessive loss of semen through ingestion of extremely saline, pungent, or acid articles of fare, or through such like factors which are calculated to aggravate the deranged Pittam may bring on impotency which may be called Pittaja impotency. Similarly, sexual excesses without using any kind of aphrodisiac medicines may be followed by the same result. Voluntary suppression or erotic propulsions, severance of the spermatic chords, not to speak of congenital deformities, such as absence of the testes, etc., may give rise to impotency. Congenital impotency, as well as that due to the severance of the spermatic chords, sbopld be regarded as incurable.