The 9th chapter of Nidanasthana of Sushruta Samhita is named as Visarpa Nadi Stanaroga Nidanam Adhyaya. This chapter deals with Erysipelas, Sinus Ulcer and Diseases of the Breast.
अथातो विसर्पनाडीस्तनरोगनिदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Visarpa – nadi – sthana roga Nidanam – diagnosis of erysipelas, sinus ulcer and diseases of the breasts; as revealed by the venerable Dhanvantari.
1. Visarpa: Erysipelas
Samprarti: Pathogenesis
त्वङ्मांसशोणितगताः कुपितास्तु दोषाः सर्वाङ्गसारिणमिहास्थितमात्मलिङ्गम् |
कुर्वन्ति विस्तृतमनुन्नतमाशु शोफं तं सर्वतो विसरणाच्च विसर्पमाहुः ||३||
The doshas get aggravated and invade the skin, muscles and blood and produce swelling which manifests in quick time.
The swelling would spread to all the parts of the body and would have their own special features. The lesions are wide and cover large areas of the body but will not bulge up.
Since it spreads to all the parts of the body, this disease is called Visarpa.
Lakshana: Signs and symptoms
Vataja Visarpa
वातात्मकोऽसितमृदुः परुषोऽङ्गमर्दसम्भेदतोदपवनज्वरलिङ्गयुक्तः |
गण्डैर्यदा तु विषमैरतिदूषितत्वाद्युक्तः स एव कथितः खलु वर्जनीयः ||४||
Below mentioned are the symptoms of Visarpa produced by Vata –
– Color – black
– It is soft and rough
– Accompanied by body ache
– Cutting and pricking types of pain
– Symptoms of fever of vata origin
Prognosis – The vata type of visarpa shall be rejected when due to great vitiation of the tissues, uneven nodules / small tumors develop in the disease.
Pittaja Visarpa
पित्तात्मको द्रुतगतिर्ज्वरदाहपाकस्फोटप्रभेदबहुलः क्षतजप्रकाशः |
दोषप्रवृद्धिहतमांससिरो यदा स्यात् स्रोतोजकर्दमनिभो न तदा स सिध्येत् ||५||
Below mentioned are the features of Visarpa caused by pitta –
– Color – resembles the color of blood
– Lesions spread quickly from one place of the body to the other
– Accompanied by – fever, burning sensation
– Ripens – there is formation of pus
– Vesicles of different kinds appear
Prognosis – Pitta type of visarpa cannot be cured when the greatly increased dosha i.e. pitta causes destruction of the muscles and blood vessels making them gangrenous / sloughy.
Kaphaja and Sarvatmaka (Tridoshaja) Visarpa
श्लेष्मात्मकः सरति मन्दमशीघ्रपाकः स्निग्धः सितश्वयथुरल्परुगुग्रकण्डुः |६|
सर्वात्मकस्त्रिविधवर्णरुजोऽवगाढः पक्वो न सिध्यति च मांससिराप्रशातात् ||६||
Below mentioned are the features of Visarpa caused by kapha –
– Color – white
– Swelling – which spreads slowly
– Ripens – after a long time
– Is unctuous
– Presents with slight pain and severe itching
Below mentioned are the features of Visarpa caused by all the three doshas together –
– The swelling presents with color and pain of all the three doshas in mixed proportions
– It is deep rooted
Prognosis – This condition becomes incurable when it ripens because of the falling off of the muscles and blood vessels.
Kshataja Visarpa
सद्यःक्षतव्रणमुपेत्य नरस्य पित्तं रक्तं च दोषबहुलस्य करोति शोफम् |
श्यावं सलोहितमतिज्वरदाहपाकं स्फोटैः कुलत्थसदृशैरसितैश्च कीर्णम् ||७||
In a person who already has severely aggravated doshas in his body, the aggravated pitta and rakta invade a recently caused accidental wound. By doing so, the doshas give rise to swelling. This is Kshataja Visarpa which will present with the below mentioned features.
Features of Kshataja Visarpa –
– Color – blue and slightly red
– Has bleeding
– Presents with severe fever and burning sensation
– There is formation of pus
– It is surrounded by black eruptions which resemble horse gram in shape and color
Sadhyasadhyata: Prognosis
सिध्यन्ति वातकफपित्तकृता विसर्पाः सर्वात्मकः क्षतकृतश्च न सिद्धिमेति |
पैत्तानिलावपि च दर्शितपूर्वलिङ्गौ सर्वे च मर्मसु भवन्ति हि कृच्छ्रसाध्याः ||८||
Curable types of Visarpa – Visarpa caused by individual doshas i.e.
– Vataja visarpa
– Pittaja visarpa and
– Kaphaja visarpa
Incurable type of Visarpa
– Tridoshaja Visarpa – caused by all three doshas together
– Ksataja Visarpa – that caused by wound
– Vata-pittaja Visarpa – that caused by combined vitiation of vata and pitta
Below mentioned type of visarpa is also difficult to cure –
– When the symptoms mentioned earlier i.e. formation of slough and small tumors develop
– All kinds of visarpa occurring on the marmas i.e. vital spots or organs
2. Nadi vrana: Sinus ulcer
शोफं न पक्वमिति पक्वमुपेक्षते यो यो वा व्रणं प्रचुरपूयमसाधुवृत्तः |
अभ्यन्तरं प्रविशति प्रविदार्य तस्य स्थानानि पूर्वविहितानि ततः स पूयः ||९||
तस्यातिमात्रगमनाद्गतिरित्यतश्च नाडीव यद्वहति तेन मता तु नाडी |१०|
He (the physician) who neglects a ripe swelling thinking it as unripe or he who neglects a wound full of pus, then the pus goes deep inside, destroying the tissues mentioned earlier (skin and muscles); because of its moving inside greatly it is known as Gati and since the spread is through a tube it is called as Nadi (sinus) also.
Bheda-Lakshana: Kinds of sinus ulcers and their symptoms
दोषैस्त्रिभिर्भवति सा पृथगेकशश्च सम्मूर्च्छितैरपि च शल्यनिमित्ततोऽन्या ||१०||
Nadis are produced by each individual dosha separately and also by all the three doshas together. The other variety is caused by foreign bodies.
तत्रानिलात् परुषसूक्ष्ममुखी सशूला फेनानुविद्धमधिकं स्रवति क्षपायाम् |११|
तृट्तापतोदसदनज्वरभेदहेतुः पीतं स्रवत्यधिकमुष्णमहःसु पित्तात् ||११||
ज्ञेया कफाद्बहुघनार्जुनपिच्छिलास्रा रात्रिस्रुतिः स्तिमितरुक्कठिना सकण्डूः |१२|
दोषद्वयाभिहितलक्षणदर्शनेन तिस्रो गतीर्व्यतिकरप्रभवास्तु विद्यात् ||१२||
दाहज्वरश्वसनमूर्च्छनवक्त्रशोषा यस्यां भवन्त्यभिहितानि च लक्षणानि |
तामादिशेत् पवनपित्तकफप्रकोपाद्धोरामसुक्षयकरीमिव कालरात्रिम् ||१३||
नष्टं कथञ्चिदनुमार्गमुदीरितेषु [१] स्थानेषु शल्यमचिरेण गतिं करोति |
सा फेनिलं मथितमच्छमसृग्विमिश्रमुष्णं स्रवेत सहसा सरुजा च नित्यम् ||१४||
| Type of Nadi | Features / Symptoms |
| Vataja | CoarseHas small opening / orificeIs painfulDischarges very frothy fluidSymptoms / discharges predominant at night time |
| Pittaja | Discharge of yellow, copious and warm fluidsDischarges mainly happen during the day timeAssociated with thirst, increased warmth, pricking pain, debility, fever |
| Kaphaja | Sinus is hardExudates are large in quantity, thick, white and slimyDischarges / exudates occur mainly at nights,Associated with constant and mild pain, itching |
| Samsarga | They are of three types, caused by combined aggravation of two doshasSymptoms of combination of two doshas are present |
| Sannipata | This is caused by all the three doshas aggravated togetherSymptoms include burning sensation, fever, dyspnea, fainting and dryness of mouthIt is a dreadful condition. It leads to death, just like Kalaratri – sister of Yama, the lord of death. |
| Shalya janya | Any salya – foreign body entering into the tissue and getting lost (hidden) therein – within the tissues mentioned earlier i.e. skin, muscle etc. would produce a sinus quickly. From the sinus there occurs exudes of warm liquid, frothy, churned up, clear or blood mixed. These occur suddenly and always and are accompanied with pain. |
3. Stana rogas: Diseases of the breasts
यावत्यो गतयो यैश्च कारणैः सम्भवन्ति हि |
तावन्तः स्तनरोगाः स्युः स्त्रीणां तैरेव हेतुभिः ||१५||
Stana rogas are the diseases of the breast. The number of stana rogas and their causes are the same as those of gati – i.e. nadi – sinus ulcer.
Reasons why breast diseases occur in those who have delivered children and not in virgins
धमन्यः संवृतद्वाराः कन्यानां स्तनसंश्रिताः |
दोषाविसरणात्तासां [१] न भवन्ति स्तनामयाः ||१६||
तासामेव प्रजातानां गर्भिणीनां च ताः पुनः |
स्वभावादेव विवृता जायन्ते सम्भवन्त्यतः ||१७||
In the virgins, the orifices of the breast are closed. As a result, the doshas do not spread inside the breasts. Hence, the breast diseases do not occur in the virgins. These orifices are naturally open in women who have delivered children and also in those who are pregnant. Therefore, these women suffer from breast diseases.
Stanya lakshana: Breast milk and its features
रसप्रसादो मधुरः पक्वाहारनिमित्तजः |
कृत्स्नदेहात् स्तनौ प्राप्तः स्तन्यमित्यभिधीयते ||१८||
विशस्तेष्वपि गात्रेषु यथा शुक्रं न दृश्यते |
सर्वदेहाश्रितत्वाच्च शुक्रलक्षणमुच्यते ||१९||
तदेव चेष्टयुवतेर्दर्शनात् स्मरणादपि |
शब्दसंश्रवणात् स्पर्शात् संहर्षाच्च प्रवर्तते ||२०||
सुप्रसन्नं मनस्तत्र हर्षणे हेतुरुच्यते |
आहाररसयोनित्वादेवं स्तन्यमपि स्त्रियाः ||२१||
तदेवापत्यसंस्पर्शाद्दर्शनात् स्मरणादपि |
ग्रहणाच्च शरीरस्य शुक्रवत् सम्प्रवर्तते ||२२||
स्नेहो निरन्तरस्तत्र प्रस्रवे हेतुरुच्यते |२३|
Stanya means breastmilk. It is the essence of rasa dhatu. When the food gets properly digested, the essence is formed in the form of rasa dhatu. This essence is sweet and comes into the breast from the entire body to form stanya. Being present in the entire body is said to be the characteristic feature of sukra (semen). This sukra (semen) will not be seen when the body parts are cut (in spite of being present all through the body). Stanya (breast milk) too is described as similar to semen.
The semen flows out (ejaculates) due to the below mentioned causes –
– Sight of the beloved woman
– Remembrance of desired woman
– Hearing the voice of desired woman
– Touch of the desired woman and
– Love of the desired woman
For the excitement in sex to be caused and for the flow of semen (ejaculation), a calm and pleasant mind is desired.
The breastmilk is also similar in properties because of being produced by the essence of food. The breast milk flows out of the woman’s breasts just like the semen, due to the below mentioned reasons –
– By the touch of the child,
– By the sight of the child,
– By remembrance of the child
– By holding the child
The main cause of the flow of breastmilk is the uninterrupted love of the mother towards the child.
Dusta and Suddha Stanya: Vitiated and pure breast milk
तत् कषायं भवेद्वातात् क्षिप्तं च प्लवतेऽम्भसि ||२३||
पित्तादम्लं सकटुकं राज्योऽम्भसि च पीतिकाः |
कफाद्घनं पिच्छिलं च जले चाप्यवसीदति |
सर्वैर्दुष्टैः सर्वलिङ्गमभिघाताच्च दुष्यति ||२४||
यत् क्षीरमुदके क्षिप्तमेकीभवति पाण्डुरम् |
मधुरं चाविवर्णं च प्रसन्नं तद्विनिर्दिशेत् ||२५||
| Type of breast milk contamination | Features |
| Vata Dushta Stanya – breast milk contaminated by vata | Astringent in tasteFloats on water |
| Pitta Dushta Stanya – breast milk contaminated by pitta | Sour and slightly pungent in tasteProduces yellowish lines when put on water |
| Kapha Dushta Stanya – breast milk contaminated by kapha | ThickSlimySinks in water |
| Tridosha Dushta Stanya – breastmilk contaminated by all the three doshas orAbhighataja Stanya – breast milk contaminated by injury | Will have symptoms of all the three doshas together |
Features of normal breast milk –
– That which mixes well with the water when put into it
– White in color
– Sweet in taste
– Not discolored
– Clear in appearance
Stana Roga Karana: Causes for diseases of breasts
सक्षीरौ वाऽप्यदुग्धौ वा प्राप्य दोषः स्तनौ स्त्रियाः |
रक्तं मांसं च सन्दूष्य स्तनरोगाय कल्पते ||२६||
पञ्चानामपि तेषां तु हित्वा शोणितविद्रधिम् |
लक्षणानि समानानि बाह्यविद्रधिलक्षणैः ||२७||
Diseases of the breasts are caused due to the localization of aggravated doshas in the breasts. These doshas get lodged in the breasts, immaterial of them having milk or not, vitiate the blood and muscle tissues and give rise to the diseases of the breasts.
The symptoms of all the five kinds of breast diseases are similar to the symptoms of the bahya vidradhi – external abscesses of the same names, with the exception of that produced by vitiated blood.
इति सुश्रुतसंहितायां निदानस्थाने विसर्पनाडीस्तनरोगनिदानं नाम दशमोऽध्यायः ||१०||
Thus ends the Tenth chapter by name Visarpa-Nadi- sthanaroga Nidanam in Nidana sthana of Susruta Samhita.
