The 9th chapter of Nidanasthana of Sushruta Samhita is named as Vidradhi Nidanam Adhyaya. This chapter deals with Abscesses.

अथातो विद्रधीनां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Vidradhi Nidana –Diagnosis of Abscess; as Venerable Dhanvantari.

सर्वामरगुरुः श्रीमान्निमित्तान्तरभूमिपः |
शिष्यायोवाच निखिलमिदं विद्रधिलक्षणम् ||३||

Lord Divodasa Dhanvantari, who is the preceptor of all the immortals, who in spite of being an eminent king is born on earth with the purpose of propagating the science of surgery, thus explained the features of vidradhi i.e. abscesses to these disciples.

Samprapti: Pathogenesis

त्वग्रक्तमांसमेदांसि प्रदूष्यास्थिसमाश्रिताः |
दोषाः शोफं शनैर्घोरं जनयन्त्युच्छ्रिता भृशम् ||४||
महामूलं रुजावन्तं वृत्तं चा(वाऽ)प्यथवाऽऽयतम् |
तमाहुर्विद्रधिं धीरा, विज्ञेयः स च षड्विधः ||५||
पृथग्दोषैः समस्तैश्च क्षतेनाप्यसृजा तथा |
षण्णामपि हि तेषां तु लक्षणं सम्प्रवक्ष्यते ||६||

The aggravated doshas vitiate the skin, blood, muscle and fat tissues.

Following this, the doshas get localized in the bone tissue and produce troublesome swelling. This swelling slowly bulges up, gets deep rooted, is round or wide in shape and is painful. This swelling is called Vidradhi.

This Vidradhi is of six types. They are –

• Vataja Vidradhi
• Pittaja Vidradhi
• Kaphaja Vidradhi
• Sannipataja Vidradhi / Tridoshaja Vidradhi
• Ksataja Vidradhi – caused by injury
• Raktaja Vidradhi – caused by vitiated blood

Now, the symptoms of all the six kinds of vidradhi will be described.

1. Bahya Vidradhi Lakshanas: Signs and symptoms of external abscess

Vataja Vidradhi

कृष्णोऽरुणो वा परुषो भृशमत्यर्थवेदनः |
चित्रोत्थानप्रपाकश्च विद्रधिर्वातसम्भवः ||७||

Below mentioned are the features of abscess produced by vata –

–        Color – either black or light red
–        Hard on touch
–        Has severe pain
–        Is different in the nature of onset and ripening

Pittaja Vidradhi

पक्वोदुम्बरसङ्काशः श्यावो वा ज्वरदाहवान् |
क्षिप्रोत्थानप्रपाकश्च विद्रधिः पित्तसम्भवः ||८|| 

Below mentioned are the features of abscess produced by pitta –

–        Color and appearance – resembles ripe Udumbara fruit – dark brown in color,
–        Presents with fever and burning sensation
–        Quick in onset
–        Quick in ripening

Kaphaja Vidradhi

शरावसदृशः पाण्डुः शीतः स्तब्धोऽल्पवेदनः |
चिरोत्थानप्रपाकश्च सकण्डुश्च कफोत्थितः ||९||

Below mentioned are the features of abscess produced by kapha –

–        Color and appearance – white in color and resembles a saucer in shape
–        Is cold
–        Is stable / fixed
–        Has mild pain
–        Slow in onset
–        Slow in ripening
–        Accompanied with itching

Color of exudates (discharges) in abscess caused by different doshas

तनुपीतसिताश्चैषामास्रावाः क्रमशः स्मृताः |१०|

The exudates in these three types of abscesses is as below mentioned –

–        In vataja vidradhi – thin and watery liquid

–        In pittaja vidradhi – yellow liquid

–        In kaphaja vidradhi – white liquid

Sannipataja Vidradhi

नानावर्णरुजास्रावो घाटालो विषमो महान् ||१०||
विषमं पच्यते चापि विद्रधिः सान्निपातिकः |११|

Below mentioned are the features of abscess caused by all the three doshas together –

–        Has many kinds of color

–        Has many kinds of pain

–        Has many kinds of exudates

–        The abscess is greatly bulged up, uneven and big in size

–        It is irregular in ripening

Agantuja Vidradhi

तैस्तैर्भावैरभिहते क्षते वाऽपथ्यसेविनः ||११||
क्षतोष्मा वायुविसृतः सरक्तं पित्तमीरयेत् |
ज्वरस्तृष्णा च दाहश्च जायते तस्य देहिनः ||१२||
एष विद्रधिरागन्तुः पित्तविद्रधिलक्षणः |१३|

Causes –

–        Body gets wounded by relevant causes in the persons who are always indulged in unsuitable foods and activities

Pathogenesis – The heat of the wound dispersed by vata would cause aggravation of blood and pitta and cause Agantuja Vidradhi i.e. absbcess of exogenous or traumatic origin.

Symptoms –

–        Fever

–        Thirst

–        Burning sensation

–        Other symptoms of abscess of pitta origin

Rakta Vidradhi

कृष्णस्फोटावृतः श्यावस्तीव्रदाहरुजाज्वरः ||१३||
पित्तविद्रधिलिङ्गस्तु रक्तविद्रधिरुच्यते |१४|

Below mentioned are the symptoms of Raktaja Vidradhi – abscess produced by blood –

–        Color – black

–        Surrounded by – black colored eruptions

–        Presents with severe burning sensation, pain, fever

–        Other symptoms – are the same as the symptoms of pittaja vidradhi

उक्ता विद्रधयो ह्येते तेष्वसाध्यस्तु सर्वजः ||१४||

The vidradhi caused by all the doshas together is incurable among all the vidradhis – abscesses described above.

2. Abhyantara Vidradhi: Internal abscess

आभ्यन्तरानतस्तूर्ध्वं विद्रधीन् परिचक्षते |
गुर्वसात्म्यविरुद्धान्नशुष्कसंसृष्टभोजनात् [१] ||१५||
अतिव्यवायव्यायामवेगाघातविदाहिभिः |
पृथक् सम्भूय वा दोषाः कुपिता गुल्मरूपिणम् ||१६||
वल्मीकवत्समुन्नद्धमन्तः कुर्वन्ति विद्रधिम् |
गुदे बस्तिमुखे नाभ्यां कुक्षौ वङ्क्षणयोस्तथा ||१७||
वृक्कयोर्यकृति प्लीह्नि हृदये क्लोम्नि वा तथा |
तेषां लिङ्गानि जानीयाद्बाह्यविद्रधिलक्षणैः ||१८||
आमपक्वैषणीयाच्च [२] पक्वापक्वं विनिर्दिशेत् |१९|

After this, the abscesses developing inside the body will be described.

Causative factors –

• Excessive indulgence in heavy to digest foods
• Excessive consumption of foods which are unaccustomed, incompatible, dry and unhealthy
• Indulgence in too much of sexual intercourse
• Too much indulgence in physical exercises
• Habitual suppression of natural urges of the body
• Consumption of foods which cause heart-burn etc.

Pathogenesis –

Due to the above said factors, the doshas get aggravated – either singly or in combination.

These doshas would give rise to abscesses inside the abdomen.

These abscesses resemble the shape of an anthill. They grow in one or more of the below mentioned regions of the body –

• Anus
• Orifice of the urinary bladder
• Navel region / umbilicus
• Pit of the abdomen,
• Groins
• Kidneys
• Liver
• Spleen
• Heart
• Kloma – pancreas?

Their symptoms are similar to those of bahya vidradhi i.e. external abscess. Their unripe and ripe stages should be understood to be similar to those explained in the context of Amapakvaisaniya Adhyaya i.e. chapter 17 of Sutra Sthana section of Sushruta Samhita.

Sthana Vishesha Lakshana: Special symptoms

अधिष्ठानविशेषेण लिङ्गं शृणु विशेषतः ||१९||
गुदे वातनिरोधस्तु बस्तौ कृच्छ्राल्पमूत्रता |
नाभ्यां हिक्का तथाऽऽटोपः कुक्षौ मारुतकोपनम् ||२०||
कटीपृष्ठग्रहस्तीव्रो वङ्क्षणोत्थे तु विद्रधौ |
वृक्कयोः पार्श्वसङ्कोचः प्लीह्न्युच्छ्वासावरोधनम् ||२१||
सर्वाङ्गप्रग्रहस्तीव्रो हृदि शूलश्च दारुणः |
श्वासो यकृति तृष्णा च पिपासाक्लोमजेऽधिका ||२२||

Listen now, to the special symptoms concerned to the different sites of the abscess.

• Abscess situated in the anus, produces obstruction of flatus;
• Abscess situated in the urinary bladder produces difficulty in micturition and less quantity of urine,
• Abscess on the umbilicus gives rise to hiccup and gurgling noise;
• Abscess in the pit of the abdomen (epigastrium) aggravates Vata;
• Abscess developing in the groins produce severe catching pain in the waist and back;
• Abscess in the kidney produces constriction of flanks
• Abscess in the spleen causes obstruction to exhalation;
• Abscess developing in the (area of) heart produces severe catching pain all over the body and dreadful pain in the heart;
• Abscess in the liver produces dyspnoea and thirst
• Abscess in the Kloma (pancreas) produces profound thirst

Prognosis of Vidradhi

आमो वा यदि वा पक्वो महान् वा यदि वेतरः |
सर्वो मर्मोत्थितश्चापि [१] विद्रधिः कष्ट उच्यते ||२३||

Irrespective of the vidradhi i.e. abscess being ripe or unripe, big or small in size, it is difficult to treat when it is located on the vital spots.

नाभेरुपरिजाः पक्वा यान्त्यूर्ध्वमितरे त्वधः |
जीवत्यधो निःस्रुतेषु स्रुतेषूर्ध्वं न जीवति ||२४||
हृन्नाभिबस्तिवर्ज्या ये तेषु भिन्नेषु बाह्यतः |
जीवेत् कदाचित् पुरुषो नेतरेषु कदाचन ||२५||

Features of abscesses situated in the organs above the navel region –

• When these abscesses get ripened and burst open, they expel the discharges like pus etc. in the upward route i.e. through the mouth.
• Prognosis of this condition is very bad and the patient will not survive.
  Features of the abscesses situated in the organs below the navel region –
• When these abscesses get ripened and burst open, they expel the exudates in the downward route i.e. through the rectum.
• Prognosis of this condition is good and the patient would survive.
  Features of the abscesses developing in the organs other than the heart, umbilicus and urinary bladder –
• When these abscesses get ripened and burst open, they expel their discharges like pus etc. to the exterior,
• Prognosis of this condition is debatable – the patient sometimes survives and sometimes does not survive

Rakta Vidradhi

स्त्रीणामपप्रजातानां प्रजातानां तथाऽहितैः |
दाहज्वरकरो घोरो जायते रक्तविद्रधिः ||२६||

Rakta Vidradhi i.e. abscesses caused by vitiated blood is occurs in –

–        Women who have had abnormal deliveries (abortion, miscarriage) and
–        Women who indulge in unsuitable foods and activities

Symptoms –

–        Burning sensation
–        Fever

This condition is dreadful.

Makkalla 

अपि सम्यक्प्रजातानामसृक् कायादनिःसृतम् |
रक्तजं विद्रधिं कुर्यात् कुक्षौ मक्कल्लसञ्ज्ञितम् ||२७||
सप्ताहान्नोपशान्तश्चेत्ततोऽसौ सम्प्रपच्यते |२८|

Rakta Vidradhi is also caused even in the abdomen of a woman who had delivered the child properly and when the blood does not flow out of her body. This is known as Makkalla. If Makkalla does not subside within a span of seven days, it is going to ripen and burst open, expelling the discharges (pus etc. exudates).

Vidradhi-Gulma-Vishesha: Difference between abscess and tumor

विशेषमथ वक्ष्यामि स्पष्टं विद्रधिगुल्मयोः ||२८||
गुल्मदोषसमुत्थानाद्विद्रधेर्गुल्मकस्य च |
कस्मान्न पच्यते गुल्मो विद्रधिः पाकमेति च ||२९||
न निबन्धोऽस्ति गुल्मानां विद्रधिः सनिबन्धनः |
गुल्माकाराः स्वयं दोषा विद्रधिर्मांसशोणिते ||३०||
विवरानुचरो ग्रन्थिरप्सु बुद्बुदको यथा |
एवम्प्रकारो गुल्मस्तु तस्मात् पाकं न गच्छति ||३१||
मांसशोणितबाहुल्यात् पाकं गच्छति विद्रधिः |
मांसशोणितहीनत्वाद्गुल्मः पाकं न गच्छति ||३२||
गुल्मस्तिष्ठति दोषे स्वे विद्रधिर्मांसशोणिते |
विद्रधिः पच्यते तस्माद्गुल्मश्चापि न पच्यते ||३३||

After this, the peculiarities between abscess which occurs inside the abdomen and gulma i.e. tumors which occur inside the abdomen will be clearly explained.

The doshas and the causative / exciting causes for both internal abscess and abdominal tumor are the same. In such a case, why is that a tumor does not ripen i.e. pus is not formed inside while the abscess ripens i.e. pus is formed inside?

The reason is that the tumor does not have a root and hence is not attached to any site. On the other hand, the abscess does have an attachment.

In gulma, the doshas themselves attain the shape of a bush. On the other hand, in the vidradhi, the muscle and blood would make up the shape.

Granthi (to mean gulma here) spreads/ moves with a cavity inside just like a bubble on water; because of these features gulma (tumor of the abdomen) does not undergo ripening, whereas vidradhi (abscess) having excess of muscles and blood will undergo suppuration. Since gulma (tumor) has inadequate / less quantity or absence of muscles and blood, it does not undergo ripening. Tumor (gulma) resides in the Doshas only whereas abscess (vidradhi) resides in muscles and blood.

Hence the abscess ripens (suppurates) and tumor does not (suppurate).

 Asadhya vidradhi: Incurable abscesses

हृन्नाभिबस्तिजः पक्वो वर्ज्यो यश्च त्रिदोषजः |३४|
अथ मज्जपरीपाको घोरः समुपजायते ||३४||
सोऽस्थिमांसनिरोधेन द्वारं न लभते यदा |
ततः स व्याधिना तेन ज्वलनेनेव दह्यते ||३५||
अस्थि(थ) मज्जोष्मणा तेन शीर्यते दह्यमानवत् |
विकारः शल्यभूतोऽयं क्लेशयेदातुरं चिरम् ||३६||
अथास्य कर्मणा व्याधिर्द्वारं तु लभते यदा |
ततो मेदःप्रभं स्निग्धं शुक्लं शीतमथो गुरु ||३७||
भिन्नेऽस्थ्नि निःस्रवेत् [१] पूयमेतदस्थिगतं विदुः |
विद्रधिं शास्त्रकुशलाः सर्वदोषरुजावहम् ||३८||

Below mentioned kinds of abscesses should be rejected and not treated –

–        Those located in the region of the heart, umbilicus and bladder which have ripened (i.e. pus is formed in them) and
–        Those produced by all the three doshas together

Asthigata Vidradhi – The abscesses of the bones would become dreadful due to ripening of the bone marrow. The pus would not find an outlet to get expelled due to the obstruction by the bone and muscles. As a result, the pus would remain inside the bone only.

The pus which has remained would cause severe burning sensation as if burnt by the fire itself, aided by the combined heat of bone and bone marrow.

This condition resembles impaction of a foreign body and would give rise to serious troubles. Now the abscess gets an outlet. Through this outlet, it exudes liquids resembling fat, which is white, unctuous, cold and heavy / thick.

There will be exudation of pus, pain and other symptoms of all the doshas when the bone gets punctured exuding pus. This condition should be understood as asthigata vidradhi i.e. abscess of the bone as known to the experts of the science.

इति सुश्रुतसंहितायां निदानस्थाने विद्रधिनिदानं नाम नवमोऽध्यायः ||९||
Thus ends the Ninth chapter by name Vidradhi Nidana- in Nidana Sthana of Susrutha Samhita.