The seventh chapter of Nidanasthana of Sushruta Samhita is known as as Udara Nidanam Adhyaya. This chapter offers with Enlargement of the Stomach.
अथात उदराणां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Udara Nidana – prognosis of enlargement of the stomach; as revealed by the venerable Dhanvantari.
Order to Sushruta by Dhanvantari
धन्वन्तरिर्धर्मभृतां वरिष्ठो राजर्षिरिन्द्रप्रतिमोऽभवद्यः |
ब्रह्मर्षिपुत्रं विनयोपपन्नं शिष्यं शुभं सुश्रुतमन्वशात् सः ||३||
Lord Dhanvantari, who was credited to be the chief and finest among the many upholders of Dharma – righteousness, the Rajarshi – king of sages and Indrapratima – just like Lord Indra in abundance of information, thus ordained his obedient scholar Sushruta, son of the divine sage (Vishwamitra).
Udara Bheda: Sorts of Udara Roga
पृथक् समस्तैरपि चेह दोषैः प्लीहोदरं बद्धगुदं तथैव |
आगन्तुकं सप्तममष्टमं च दकोदरं चेति वदन्ति तानि ||४||
Udara is of eight varieties. They’re –
– One from every dosha individually – Vataja, Pittaja and Kaphaja Udara
– One sort from mixed aggravation of all of the three doshas – Tridoshaja Udara
– The fifth sort from enlargement of spleen – Plihodara / Pliha Udara
– The sixth sort from enlargement of the stomach because of obstruction of rectum / intestinal obstruction – Baddhaguda Udara
– The seventh sort which is precipitated from extraneous causes – Agantuka Udara
– The eighth variety precipitated because of accumulation of fluids within the stomach – Dakodara / Udakodara / Jalodara
Nidana – Samprapti: Trigger and Pathogenesis
सुदुर्बलाग्नेरहिताशनस्य संशुष्कपूत्यन्ननिषेवणाद्वा |
स्नेहादिमिथ्याचरणाच्च जन्तोर्वृद्धिं गताः कोष्ठमभिप्रपन्नाः ||५||
गुल्माकृतिव्यञ्जितलक्षणानि कुर्वन्ति घोराण्युदराणि दोषाः |६|
Causative Components –
The doshas get aggravated within the under talked about folks –
– In those that have very poor digestive fireplace (digestive capability) and indulging in unsuitable meals and actions
– In those that eat dry meals
– In those that eat meals having unhealthy scent
– To those that have been administered with oleation and different therapies in an improper manner
Pathogenesis –
The aggravated doshas get localized within the kostha – intestine / alimentary tract and provides rise to udara vriddhi i.e. enlargement of stomach. The stomach which is enlarged resembles and has options of a bush i.e. spherical formed and bulging upwards. This situation is dreadful.
कोष्ठादुपस्नेहवदन्नसारो निःसृत्य दुष्टोऽनिलवेगनुन्नः ||६||
त्वचः समुन्नम्य शनैः समन्ताद्विवर्धमानो जठरं करोति |७|
The anna rasa – i.e. essence of meals will get vitiated. It comes out of the kostha i.e. intestine, in small portions by way of the small pores, by way of the method of upasneha – osmosis, being pushed by the motion of vata. This annarasa regularly accumulates beneath the pores and skin of the stomach and regularly causes enlargement of stomach. This situation known as as Udara.
Purvarupa: Premonitory Signs
तत्पूर्वरूपं बलवर्णकाङ्क्षावलीविनाशो जठरे हि राज्यः ||७||
जीर्णापरिज्ञानविदाहवत्यो बस्तौ रुजः पादगतश्च शोफः |८|
The premonitory signs of Udara Roga are –
- need for power, complexion, and meals,
- disappearance of pure strains / muscular folds of the stomach,
- strains / striae seem on the stomach
- improper or unsure understanding of 1’s digestion
- burning sensation within the stomach whereas the meals is being digested
- ache within the urinary bladder and the area round it
- edema within the ft
Rupa: Indicators and Signs
Vataja Udara
सङ्गृह्य पार्श्वोदरपृष्ठनाभीर्यद्वर्धते कृष्णसिरावनद्धम् ||८||
सशूलमानाहवदुग्रशब्दं सतोदभेदं पवनात्मकं तत् |९|
Under talked about are the signs of Vataja Udara i.e. stomach enlargement attributable to Vata –
– catching / gripping ache within the flanks, stomach, again and navel area
– stomach slowly grows in dimension|
– blackish veins seem on the stomach
– ache
– flatulence
– loud sounds within the stomach
– pricking and splitting ache within the stomach
Pittaja Udara
यच्चोषतृष्णाज्वरदाहयुक्तं पीतं सिरा भान्ति च यत्र पीताः ||९||
पीताक्षिविण्मूत्रनखाननस्य पित्तोदरं तत्त्वचिराभिवृद्धि |१०|
Under talked about are the signs of Pittaja Udara – stomach enlargement attributable to Pitta –
– gentle warmth or heat everywhere in the physique
– thirst
– fever
– burning sensation
– look of yellow-colored veins over the abdome
– yellowness of eyes, feces, urine, nails and face
– fast enlargement of stomach
Kaphaja Udara
यच्छीतलं शुक्लसिरावनद्धं गुरु स्थिरं शुक्लनखाननस्य ||१०||
स्निग्धं महच्छोफयुतं ससादं कफोदरं तत्तु चिराभिवृद्धि |११|
Under talked about are the signs of Kaphaja Udara – stomach enlargement attributable to Kapha –
– stomach feels chilly on contact
– look of whitish veins overlaying the stomach,
– stomach turns into heavy and immovable
– nails, face and so on change into white and unctuous
– stomach turns into huge in dimension
– large swelling of stomach
– debility
– gradual enlargement of the stomach
Sannipatodara / Dushyodara
स्त्रियोऽन्नपानं नखरोममूत्रविडार्तवैर्युक्तमसाधुवृत्ताः ||११||
यस्मै प्रयच्छन्त्यरयो गरांश्च दुष्टाम्बुदूषीविषसेवनाद्वा |
तेनाशु रक्तं कुपिताश्च दोषाः कुर्वन्ति घोरं जठरं त्रिलिङ्गम् ||१२||
तच्छीतवाताभ्रसमुद्भवेषु विशेषतः कुप्यति दह्यते च स चातुरो मूर्च्छति सम्प्रसक्तं पाण्डुः कृशः शुष्यति तृष्णया च ||१३||
प्रकीर्तितं दूष्युदरं तु घोरं … |१४|
Causes –
Extreme consumption of –
– meals or drinks blended with nails, hairs, urine, feces and menstrual blood administered by girls who wouldn’t have good conduct or good intentions or
– garavisa (synthetic or gradual poisons) administered by enemies or consumes contaminated water or
– dusivisa (cumulative toxin, latent poison)
Pathogenesis –
As a result of above mentioned causes, the blood and vata and so on. (pitta and kapha) doshas will shortly bear aggravation. These collectively will produce dreadful stomach dysfunction having signs of aggravation of all of the three doshas. This udara roga i.e. stomach dysfunction would particularly get aggravated and change into extreme by publicity to chilly and breeze and likewise on cloudy days after which produce burning sensation.
Signs –
The affected person stricken by Sannipatodara will
– incessantly (repeatedly) faint,
– will change into pale (anemic) and
– weak and
– will get emaciated because of extreme thirst
On this manner the dreadful dusyudara i.e. sannipatodara has been defined.
Plihodara: Yakridodara
… प्लीहोदरं कीर्तयतो निबोध |
विदाह्यभिष्यन्दिरतस्य जन्तोः प्रदुष्टमत्यर्थमसृक् कफश्च ||१४||
प्लीहाभिवृद्धिं सततं करोति प्लीहोदरं तत् प्रवदन्ति तज्ज्ञाः |
वामे च पार्श्वे परिवृद्धिमेति विशेषतः सीदति चातुरोऽत्र ||१५||
मन्दज्वराग्निः कफपित्तलिङ्गैरुपद्रुतः क्षीणबलोऽतिपाण्डुः |१६|
सव्येतरस्मिन् यकृति प्रदुष्टे ज्ञेयं यकृद्दाल्युदरं तदेव ||१६||
Now pay attention about Plihodara – enlargement of stomach attributable to enlarged spleen: –
Causes –
– recurring consumption of meals which trigger burning sensation throughout digestion of meals
– recurring consumption of meals which produce extreme moisture within the tissues
Pathogenesis –
As a result of above mentioned causes, the Asrk – blood and Kapha change into enormously vitiated. These trigger gradual enlargement of Pliha – spleen within the left aspect of the stomach and therefore trigger Plihodara – enlargement of stomach because of enlargement of spleen.
Signs –
– weak point
– gentle fever
– weak digestion
– signs of elevated kapha and pitta
– lower of power
– anemia
The identical sort of enlargement happens because of affliction of Yakrit (liver), on the suitable aspect of the stomach it will likely be known as as Yakrtodara or Yakrtddalyudara.
Baddhagudodara
यस्यान्त्रमन्नैरुपलेपिभिर्वा बालाश्मभिर्वा सहितैः [१] पृथग्वा |
सञ्चीयते तत्र मलः सदोषः क्रमेण नाड्यामिव सङ्करो हि ||१७||
निरुध्यते चास्य गुदे पुरीषं निरेति कृच्छ्रादपि चाल्पमल्पम् |
हृन्नाभिमध्ये परिवृद्धिमेति त(य)च्चोदरं विट्समगन्धिकं च ||१८||
प्रच्छर्दयन् बद्धगुदी विभाव्यः, … |१९|
Causes – the inside of intestines being coated inside both with meals or some other sticky supplies or stones, hairs and so on.
Pathogenesis – As a result of above mentioned causes, the waste a part of the meals and aggravated doshas regularly accumulate within the intestinal lumen, similar to the filth accumulates within the pipes and clogs them.
Signs –
– The feces will get obstructed within the rectum and is expelled in small portions with issue.
– The stomach enormously enlarges between the guts and navel areas.
– Vomiting of supplies smelling like feces.
The illness produced by the above mentioned causes and presenting with the above mentioned signs needs to be understood and recognized as Baddha Gudodara.
Parisravyudara
…ततः परिस्राव्युदरं निबोध |
शल्यं यदन्नोपहितं तदन्त्रं भिनत्ति यस्यागतमन्यथा वा ||१९||
तस्मात् स्रुतोऽन्त्रात् सलिलप्रकाशः स्रावः स्रवेद्वै गुदतस्तु भूयः |
नाभेरधश्चोदरमेति वृद्धिं निस्तुद्यतेऽतीव विदह्यते च ||२०||
एतत् परिस्राव्युदरं प्रदिष्टं… |२१|
Causes – Consumption of meals blended with overseas our bodies or overseas our bodies which have individually entered into the intestines.
Pathogenesis – The above mentioned overseas supplies puncture the internal partitions of the intestines and perforate them.
Signs –
– Exudation of fluids resembling water from these holes attributable to the overseas our bodies
– These fluids stream down and accumulate excessively within the rectum
– The stomach will get enlarged extra under the extent of umbilicus giving rise to
– Extreme pricking ache and burning sensation
This illness known as Parisravi Udara.
Dakodara
… दकोदरं कीर्तयतो निबोध |
यः स्नेहपीतोऽप्यनुवासितो वा वान्तो विरिक्तोऽप्यथवा निरूढः ||२१||
पिबेज्जलं शीतलमाशु तस्य स्रोतांसि दुष्यन्ति हि तद्वहानि |
स्नेहोपलिप्तेष्वथवाऽपि तेषु दकोदरं पूर्ववदभ्युपैति ||२२||
स्निग्धं महत् सम्परिवृत्तनाभि भृशोन्नतं पूर्णमिवाम्बुना च |
यथा दृतिः क्षुभ्यति कम्पते च शब्दायते चापि दकोदरं तत् ||२३||
Causes – Extreme consumption of water instantly after ingesting medicated fat (oleation remedy), taking oil enema, emesis, purgation and decoction enema by the one that is present process these therapies.
Pathogenesis – As a result of above mentioned causes, the channels meant for transportation of water within the physique change into contaminated, because the fatty supplies get smeared inside these channels. These occasions give rise to Dakodara in the identical method described earlier.
Indicators and signs –
– The stomach seems unctuous
– Stomach is huge and the umbilicus is bulged out
– Stomach resembles a bag stuffed with water
– The stomach will get excited i.e. shakes, fluctuates and makes sounds similar to the water stuffed bag.
This illness Is named Dakodara (Udakodara, Jalodara).
Samanya Laksana: Frequent signs
आध्मानं गमनेऽशक्तिर्दौर्बल्यं दुर्बलाग्निता |
शोफः सदनमङ्गानां सङ्गो वातपुरीषयोः |
दाहस्तृष्णा च सर्वेषु जठरेषु भवन्ति हि ||२४||
The signs which seem generally in every kind of stomach enlargements (udara) are –
- flatulence,
- lack of ability to stroll,
- debility,
- weak digestive energy,
- swelling and
- weak point of the physique elements,
- obstruction (non-elimination) of flatus and feces,
- burning sensation and
- thirst
Accumulation of fluid in every kind of udara
अन्ते सलिलभावं हि भजन्ते जठराणि तु |
सर्वाण्येव परीपाकात्तदा तानि विवर्जयेत् ||२५||
Because of ripening, on the finish levels, every kind of udara i.e. stomach enlargement would attain the stage of accumulation of water. In these situations, the udara needs to be rejected i.e. shouldn’t be handled.
इति सुश्रुतसंहितायां निदानस्थाने उदरनिदानं नाम सप्तमोऽध्यायः ||७||
Thus ends the seventh chapter by title Udara Nidanam- in Nidana sthana of Susruta Samhita.
