Sushruta Samhita Nidanasthana Chapter 12 Vrddhi-Upasamsa- Slipasa Nidanam (Enlargement of Scrotum

The twelfth chapter of Nidanasthana of Sushruta Samhita is known as as Vrddhi-Upadamsa- Slipada Nidanam Adhyaya. This chapter offers with Enlargement of Scrotum – Venereal illnesses and Filariasis.

अथातो वृद्ध्युपदंशश्लीपदानां निदानं व्याख्यास्यामः ||१||

यथोवाच भगवान् धन्वन्तरिः ||२||

We are going to now expound Vrddhi – upadamsa – slipada Nidana – prognosis of enlargement of the scrotum, venereal illnesses and filariasis; as revealed by the venerable Dhanvantari.

Vidha – varieties

वातपित्तश्लेष्मशोणितमेदोमूत्रान्त्रनिमित्ताः सप्त वृद्धयो भवन्ति |

तासां मूत्रान्त्रनिमित्ते वृद्धी वातसमुत्थे, केवलमुत्पत्तिहेतुरन्यतमः ||३||

Kinds of Vrddhi –

There are eight sorts of Vrddhi. They’re

1.   Vataja – attributable to vata aggravation
2.   Pittaja – attributable to pitta aggravation
3.   Kaphaja – attributable to kapha aggravation
4.   Raktaja / Sonitaja – attributable to aggravation of blood
5.   Medoja – attributable to vitiated fats tissue
6.   Mutraja – attributable to urine
7.   Antraja – attributable to protrusion of gut

Amongst these Vrddhis, these attributable to mutra and antra are produced by vata itself. Solely their causative and thrilling components are totally different.

Samprapti – pathogenesis (which means) of Vrddhi

अधः प्रकुपितोऽन्यतमो हि दोषः फलकोशवाहिनीरभिप्रपद्य धमनीः फलकोषयोर्वृद्धिं जनयति, तां वृद्धिमित्याचक्षते ||४||

Any one of many above talked about aggravated doshas which get aggravated as a consequence of their etiological components journey downwards and get localized within the blood vessels / arteries of the phalakosa – scrotum. By doing so, the doshas trigger enlargement of scrotum. Due to this fact, this situation is known as as vrddhi, which suggests enlargement.

Purvarupa – Premonitory signs

तासां भविष्यतीनां पूर्वरूपाणि- बस्तिकटीमुष्कमेढ्रेषु वेदना मारुतनिग्रहः फलकोशशोफश्चेति ||५||

The premonitory signs of Vrddhi embody –

–        ache within the bladder

–        ache within the scrotum

–        ache within the penis

–        retention of flatus

–        swelling of scrotum  

Rupa – indicators and signs

तत्रानिलपरिपूर्णां बस्तिमिवाततां परुषामनिमित्तानिलरुजां वातवृद्धिमाचक्षते; पक्वोदुम्बरसङ्काशां ज्वरदाहोष्मवतीं चाशुसमुत्थानपाकां पित्तवृद्धिं; कठिनामल्पवेदनां शीतां कण्डूमतीं श्लेष्मवृद्धिं; कृष्णस्फोटावृतां पित्तवृद्धिलिङ्गां रक्तवृद्धिं, मृदुस्निग्धां कण्डूमतीमल्पवेदनां तालफलप्रकाशां मेदोवृद्धिं; मूत्रसन्धारणशीलस्य मूत्रवृद्धिर्भवति, सा गच्छतोऽम्बुपूर्णा दृतिरिव क्षुभ्यति मूत्रकृच्छ्रवेदनां वृषणयोः श्वयथुं कोशयोश्चापादयति, तां मूत्रवृद्धिं विद्यात्; भारहरणबलवद्विग्रहवृक्षप्रपतनादिभिरायासविशेषैर्वायुरभिप्रवृद्धः प्रकुपितश्च स्थूलान्त्रस्येतरस्य चैकदेशं विगुणमादायाधो गत्वा वङ्क्षणसन्धिमुपेत्य ग्रन्थिरूपेण स्थित्वाऽप्रतिक्रियमाणे च कालान्तरेण फलकोशं प्रविश्य मुष्कशोफमापादयति, आध्मातो बस्तिरिवाततः प्रदीर्घः स शोफो भवति, सशब्दमवपीडितश्चोर्ध्वमुपैति, विमुक्तश्च पुनराध्मायते , तामन्त्रवृद्धिमसाध्यामित्याचक्षते ||६||

Signs of Vataja Vrddhi –

–        look of the scrotum – resembles air crammed bag

–        is tough on contact

–        ache happens with none particular trigger

Signs of Pittaja Vrddhi –  

–        look of the scrotum – resembles a ripe Udumbara fruit in coloration – reddish brown in coloration

–        presence of fever, burning sensation and raised warmth

–        fast in onset

–        fast in ripening / suppuration (pus is fashioned within the swelling rapidly)

Signs of Kaphaja Vrddhi –

–        scrotum is tough to really feel

–        has gentle ache

–        chilly on contact

–        has itching

Signs of Raktaja Vrddhi –

–        black eruptions are current throughout over the scrotum

–        signs of pittaja vrddhi are additionally seen

Signs of Medoja Vrddhi –

–        look of the scrotum – resembles Tala fruit in look – darkish blue in coloration and large in measurement

–        scrotum is tender on contact

–        unctuous

–        has itching

–        has slight ache

Signs of Mutraja Vrddhi –

–        causes – suppression of urge for urination habitually

–        look of scrotum – scrotum resembles a water crammed with bag and likewise develops actions much like that

–        dysuria

–        ache in testicles

–        swelling / oedema of the scrotum

Signs of Antra Vrddhi – vrddhi

Causes –

–        carrying heavy masses habitually

–        combating with sturdy individuals or animals habitually

–        falling from the tree

–        some other strenuous actions

Pathogenesis –

As a result of above stated causative components, vata would get aggravated. This aggravated vata would trigger abnormalities within the colon and small gut, at specific place. Later, the vata would push that a part of the gut down into the groins and keep therein like a tumor for a while.

Sooner or later of time, if left untreated, the coils of the intestines descend into the scrotum and produce swelling of the scrotum.

Signs and indicators

–        look – the scrotum seems like a bag of air, elongated and swollen

–        the intestines transfer up accompanied with sound when the doctor presses it together with his fingers and

–        it swells up as soon as once more when the doctor releases the stress on it

This situation wherein the antra i.e. gut seems to enlarge because it descends into the scrotum, is known as as antra vrddhi. It’s thought of as incurable.