Sushruta Samhita Nidanasthana Chapter 7 Udara Nidanam (Enlargement of the Abdomen)

The 7th chapter of Nidanasthana of Sushruta Samhita is named as Udara Nidanam Adhyaya. This chapter deals with Enlargement of the Abdomen.

अथात उदराणां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Udara Nidana – diagnosis of enlargement of the abdomen; 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 best among the upholders of Dharma – righteousness, the Rajarshi – king of sages and Indrapratima – similar to Lord Indra in abundance of knowledge, thus ordained his obedient student Sushruta, son of the divine sage (Vishwamitra).

Udara Bheda: Kinds of Udara Roga

पृथक् समस्तैरपि चेह दोषैः प्लीहोदरं बद्धगुदं तथैव |
आगन्तुकं सप्तममष्टमं च दकोदरं चेति वदन्ति तानि ||४||

Udara is of eight kinds. They are –

–        One from each dosha separately – Vataja, Pittaja and Kaphaja Udara
–        One type from combined aggravation of all the three doshas – Tridoshaja Udara
–        The fifth type from enlargement of spleen – Plihodara / Pliha Udara
–        The sixth type from enlargement of the abdomen due to obstruction of rectum / intestinal obstruction – Baddhaguda Udara
–        The seventh type which is caused from extraneous causes – Agantuka Udara
–        The eighth kind caused due to accumulation of fluids in the abdomen – Dakodara / Udakodara / Jalodara

Nidana – Samprapti: Cause and Pathogenesis

सुदुर्बलाग्नेरहिताशनस्य संशुष्कपूत्यन्ननिषेवणाद्वा |
स्नेहादिमिथ्याचरणाच्च जन्तोर्वृद्धिं गताः कोष्ठमभिप्रपन्नाः ||५||
गुल्माकृतिव्यञ्जितलक्षणानि कुर्वन्ति घोराण्युदराणि दोषाः |६|

Causative Factors –

The doshas get aggravated in the below mentioned people –

–        In those who have very poor digestive fire (digestive capacity) and indulging in unsuitable foods and activities
–        In those who consume dry foods
–        In those who consume foods having bad smell
–        To those who have been administered with oleation and other therapies in an improper way

Pathogenesis –

The aggravated doshas get localized in the kostha – gut / alimentary tract and give rise to udara vriddhi i.e. enlargement of abdomen. The abdomen which is enlarged resembles and has features of a bush i.e. round shaped and bulging upwards. This condition is dreadful.

कोष्ठादुपस्नेहवदन्नसारो निःसृत्य दुष्टोऽनिलवेगनुन्नः ||६||
त्वचः समुन्नम्य शनैः समन्ताद्विवर्धमानो जठरं करोति |७|

The anna rasa – i.e. essence of food gets vitiated. It comes out of the kostha i.e. gut, in small quantities through the small pores, through the process of upasneha – osmosis, being pushed by the action of vata. This annarasa gradually accumulates beneath the skin of the abdomen and gradually causes enlargement of abdomen. This condition is called as Udara.

Purvarupa: Premonitory Symptoms

तत्पूर्वरूपं बलवर्णकाङ्क्षावलीविनाशो जठरे हि राज्यः ||७||
जीर्णापरिज्ञानविदाहवत्यो बस्तौ रुजः पादगतश्च शोफः |८|

The premonitory symptoms of Udara Roga are –

• desire for strength, complexion, and food,
• disappearance of natural lines / muscular folds of the abdomen,
• lines / striae appear on the abdomen
• improper or uncertain understanding of one’s digestion
• burning sensation in the abdomen while the food is being digested
• pain in the urinary bladder and the region around it
• edema in the feet

Rupa: Signs and Symptoms

Vataja Udara

सङ्गृह्य पार्श्वोदरपृष्ठनाभीर्यद्वर्धते कृष्णसिरावनद्धम् ||८||
सशूलमानाहवदुग्रशब्दं सतोदभेदं पवनात्मकं तत् |९|

Below mentioned are the symptoms of Vataja Udara i.e. abdominal enlargement caused by Vata –

–        catching / gripping pain in the flanks, abdomen, back and navel region
–        abdomen slowly grows in size|
–        blackish veins appear on the abdomen
–        pain
–        flatulence
–        loud sounds in the abdomen
–        pricking and splitting pain in the abdomen

Pittaja Udara

यच्चोषतृष्णाज्वरदाहयुक्तं पीतं सिरा भान्ति च यत्र पीताः ||९||
पीताक्षिविण्मूत्रनखाननस्य पित्तोदरं तत्त्वचिराभिवृद्धि |१०|

Below mentioned are the symptoms of Pittaja Udara – abdominal enlargement caused by Pitta –

–        mild heat or warmth all over the body
–        thirst
–        fever
–        burning sensation
–        appearance of yellow-colored veins over the abdome
–        yellowness of eyes, feces, urine, nails and face
–        quick enlargement of abdomen

Kaphaja Udara

यच्छीतलं शुक्लसिरावनद्धं गुरु स्थिरं शुक्लनखाननस्य ||१०||
स्निग्धं महच्छोफयुतं ससादं कफोदरं तत्तु चिराभिवृद्धि |११|

Below mentioned are the symptoms of Kaphaja Udara – abdominal enlargement caused by Kapha –

–        abdomen feels cold on touch
–        appearance of whitish veins covering the abdomen,
–        abdomen becomes heavy and immovable
–        nails, face etc become white and unctuous
–        abdomen becomes big in size
–        massive swelling of abdomen
–        debility
–        slow enlargement of the abdomen

 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 –

Excessive consumption of –

–        food or drinks mixed with nails, hairs, urine, feces and menstrual blood administered by women who do not have good conduct or good intentions or
–        garavisa (artificial or slow poisons) administered by enemies or consumes contaminated water or
–        dusivisa (cumulative toxin, latent poison)

Pathogenesis –

Due to the above said causes, the blood and vata etc. (pitta and kapha) doshas will quickly undergo aggravation. These collectively will produce dreadful abdominal disorder having symptoms of aggravation of all the three doshas. This udara roga i.e. abdominal disorder would specifically get aggravated and become severe by exposure to cold and breeze and also on cloudy days and then produce burning sensation.

Symptoms –

The patient afflicted by Sannipatodara will

–        frequently (repeatedly) faint,
–        will become pale (anemic) and
–        weak and
–        gets emaciated due to severe thirst

In this way the dreadful dusyudara i.e. sannipatodara has been explained.

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 listen about Plihodara – enlargement of abdomen caused by enlarged spleen: –

Causes –

–        habitual consumption of foods which cause burning sensation during digestion of food
–        habitual consumption of foods which produce excessive moisture in the tissues

Pathogenesis –

Due to the above said causes, the Asrk – blood and Kapha become greatly vitiated. These cause gradual enlargement of Pliha – spleen in the left side of the abdomen and hence cause Plihodara – enlargement of abdomen due to enlargement of spleen.

Symptoms –

–        weakness
–        mild fever
–        weak digestion
–        symptoms of increased kapha and pitta
–        decrease of strength
–        anemia

The same type of enlargement occurs due to affliction of Yakrit (liver), on the right side of the abdomen it will be called 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 interior of intestines being coated inside either with food or any other sticky materials or stones, hairs etc.

Pathogenesis – Due to the above said causes, the waste part of the food and aggravated doshas gradually accumulate in the intestinal lumen, just like the dirt accumulates in the pipes and clogs them.

Symptoms –

–        The feces gets obstructed in the rectum and is expelled in small quantities with difficulty.
–        The abdomen greatly enlarges between the heart and navel regions.
–        Vomiting of materials smelling like feces.

The disease produced by the above said causes and presenting with the above said symptoms should be understood and diagnosed 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 food mixed with foreign bodies or foreign bodies which have separately entered into the intestines.

Pathogenesis – The above said foreign materials puncture the inner walls of the intestines and perforate them.

Symptoms –

–        Exudation of fluids resembling water from these holes caused by the foreign bodies
–        These fluids flow down and accumulate excessively in the rectum
–        The abdomen gets enlarged more below the level of umbilicus giving rise to
–        Severe pricking pain and burning sensation

This disease is called 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 – Excessive consumption of water immediately after drinking medicated fats (oleation therapy), taking oil enema, emesis, purgation and decoction enema by the person who is undergoing these therapies.

Pathogenesis – Due to the above said causes, the channels meant for transportation of water in the body become contaminated, since the fatty materials get smeared inside these channels. These events give rise to Dakodara in the same manner described earlier.

Signs and symptoms –

–        The abdomen appears unctuous
–        Abdomen is big and the umbilicus is bulged out
–        Abdomen resembles a bag filled with water
–        The abdomen gets excited i.e. shakes, fluctuates and makes sounds just like the water filled bag.

This disease Is known as Dakodara (Udakodara, Jalodara).

 Samanya Laksana: Common symptoms

आध्मानं गमनेऽशक्तिर्दौर्बल्यं दुर्बलाग्निता |
शोफः सदनमङ्गानां सङ्गो वातपुरीषयोः |
दाहस्तृष्णा च सर्वेषु जठरेषु भवन्ति हि ||२४||

The symptoms which appear commonly in all kinds of abdominal enlargements (udara) are –

• flatulence,
• inability to walk,
• debility,
• weak digestive power,
• swelling and
• weakness of the body parts,
• obstruction (non-elimination) of flatus and feces,
• burning sensation and
• thirst

Accumulation of fluid in all kinds of udara

अन्ते सलिलभावं हि भजन्ते जठराणि तु |
सर्वाण्येव परीपाकात्तदा तानि विवर्जयेत् ||२५||

Due to ripening, at the end stages, all kinds of udara i.e. abdominal enlargement would attain the stage of accumulation of water. In these conditions, the udara should be rejected i.e. should not be treated.

इति सुश्रुतसंहितायां निदानस्थाने उदरनिदानं नाम सप्तमोऽध्यायः ||७||
Thus ends the seventh chapter by name Udara Nidanam- in Nidana sthana of Susruta Samhita.