The Diagnosis of Abdominal Diseases (Udara Roga)

Verse 1 (garuda.1.161.1)

धन्वन्तरिरुवाच । उदराणां निदानञ्च वक्ष्ये सुश्रुत तच्छृणु । रोगाः सर्वेऽपि मन्दाग्नौ सुतरामुदराणि तु

dhanvantariruvāca udarāṇāṁ nidānañca vakṣye suśruta tacchṛṇu rogāḥ sarve'pi mandāgnau sutarāmudarāṇi tu

Dhanvantari said: O Sushruta, I shall now describe the causes of the abdominal diseases (udara roga); listen to this. All diseases generally arise from a weakened digestive fire, but abdominal diseases arise from it above all.

Verse 2 (garuda.1.161.2)

अनीर्णामयाश्चाप्यन्ये जायन्ते मलसंचयात् । ऊर्ध्वाधो वायवो रुद्ध्वा व्याकुलाविप्रवाहिणी

anīrṇāmayāścāpyanye jāyante malasaṁcayāt ūrdhvādho vāyavo ruddhvā vyākulāvipravāhiṇī

Other, hard-to-cure ailments also arise from the accumulation of waste matter. The upward- and downward-moving winds, being obstructed, become agitated and cease to flow properly.

Verse 3 (garuda.1.161.3)

प्राणानपानान्संदूष्य कुर्युस्तान्मांससन्धिगान् । आध्माप्य कुक्षिमुदरमष्टधा ते च भेदतः

prāṇānapānānsaṁdūṣya kuryustānmāṁsasandhigān ādhmāpya kukṣimudaramaṣṭadhā te ca bhedataḥ

Corrupting the prana and apana airs, they lodge in the flesh and joints; distending the flanks and belly, they give rise to udara roga, which is of eight kinds.

Verse 4 (garuda.1.161.4)

पृथग्दोषैः समस्तौश्च प्लीहवङ्क्षक्षतोदकैः । तेनार्ताः शुष्कताल्वोष्ठाः सर्वपादकरोदराः

pṛthagdoṣaiḥ samastauśca plīhavaṅkṣakṣatodakaiḥ tenārtāḥ śuṣkatālvoṣṭhāḥ sarvapādakarodarāḥ

These eight kinds arise separately from the individual doshas, from all three together, from the spleen, from the groin, from a wound, and from water. Afflicted by them, the patient's palate and lips grow dry, and swelling appears in the hands, feet, and belly.

Verse 5 (garuda.1.161.5)

नष्टचेष्टबलाहाराः कृतप्रध्मात्कुक्षयः । पुरुषाः स्युः प्रेतरूपा भाविनस्तस्य लक्षणम्

naṣṭaceṣṭabalāhārāḥ kṛtapradhmātkukṣayaḥ puruṣāḥ syuḥ pretarūpā bhāvinastasya lakṣaṇam

Men who have lost their movement, strength, and appetite, and whose bellies have grown hard and distended, take on a ghost-like appearance — this is the sign that the disease is soon to come.

Verse 6 (garuda.1.161.6)

क्षुन्नाशोऽरुचिवत्सर्वं सविदाहञ्च पच्यते । जीर्णान्नं यो न जानाति सोऽपथ्यं सेवतेनरः

kṣunnāśo'rucivatsarvaṁ savidāhañca pacyate jīrṇānnaṁ yo na jānāti so'pathyaṁ sevatenaraḥ

Loss of hunger, distaste for everything, and food digesting with a burning sensation — these are the signs. The man who cannot tell that his food is already digested keeps eating unwholesome fare.

Verse 7 (garuda.1.161.7)

क्षीयते बलमङ्गस्य श्वसित्यल्पोऽविचेष्टितः । विषयावृत्तिबुद्धिश्च शोकशोषादयोऽपिच

kṣīyate balamaṅgasya śvasityalpo'viceṣṭitaḥ viṣayāvṛttibuddhiśca śokaśoṣādayo'pica

The body's strength wastes away; he grows breathless with the least exertion and becomes listless; his mind turns from worldly things, and grief and wasting also set in.

Verse 8 (garuda.1.161.8)

रुग्बस्तिसन्धौ सततं लघ्वल्पभोजनैरपि । जराजीर्णो बलभ्रंशो भवेज्जठररोगिणः

rugbastisandhau satataṁ laghvalpabhojanairapi jarājīrṇo balabhraṁśo bhavejjaṭhararogiṇaḥ

Even with light, scanty food, there is constant pain in the bladder-region and the joints; the patient with this belly-disease grows prematurely aged and loses his strength.

Verse 9 (garuda.1.161.9)

स्वतन्त्रतन्द्रालसता मलसर्गोऽल्पवह्निता । दाहः श्वयथुराध्मानमन्त्रे सलिलसम्भवे

svatantratandrālasatā malasargo'lpavahnitā dāhaḥ śvayathurādhmānamantre salilasambhave

Persistent drowsiness and lethargy set in without cause, the bowels move poorly, the digestive fire weakens, and there is burning, swelling and distension of the belly, together with an accumulation of water within.

Verse 10 (garuda.1.161.10)

सर्वत्र तोये मरणं शोचनं तत्र निष्फलम् । गवाक्षवच्छिराजालैरुदरं गुड्गुडायते

sarvatra toye maraṇaṁ śocanaṁ tatra niṣphalam gavākṣavacchirājālairudaraṁ guḍguḍāyate

At this stage, death from the pervading accumulation of water becomes certain, and grieving over it is then useless; the network of veins on the belly shows like a lattice-window, and the abdomen makes a gurgling sound.

Verse 11 (garuda.1.161.11)

नाभिमन्त्रश्च विष्टभ्य वेगं कृत्वा प्रणश्यति । मारुते हृत्कटीनाभिपायुवङ्क्षणवेदनाः

nābhimantraśca viṣṭabhya vegaṁ kṛtvā praṇaśyati mārute hṛtkaṭīnābhipāyuvaṅkṣaṇavedanāḥ

By suppressing the urges around the navel, the wind builds up pressure and becomes provoked; when vata is thus disturbed, there is pain in the heart, waist, navel, anus, and groin.

Verse 12 (garuda.1.161.12)

सशब्दो निः सरेद्वायुर्वहते मूत्रमल्पकम् । नातिमात्रं भवेल्लौल्यं नरस्य विरसं मुखम्

saśabdo niḥ saredvāyurvahate mūtramalpakam nātimātraṁ bhavellaulyaṁ narasya virasaṁ mukham

Wind passes out with a sound, and urine flows only scantily; the man's craving for food is not excessive, and his mouth tastes flavourless.

Verse 13 (garuda.1.161.13)

तत्रवातोदरे शोथः पाणिपान्मुखकुक्षिषु । कुर्क्षिपार्श्वोदरकटीपृष्ठरुक्पर्वभदनम्

tatravātodare śothaḥ pāṇipānmukhakukṣiṣu kurkṣipārśvodarakaṭīpṛṣṭharukparvabhadanam

In vata-udara (wind-caused abdominal disease), swelling appears in the hands, feet, face, and flanks, and there is pain in the flanks, sides, belly, waist, back, and joints.

Verse 14 (garuda.1.161.14)

शुष्ककासाङ्गमर्दाधोगुरुतामलसंग्रहः । श्यामारुणत्वगादित्वं मुखे च रसवद्धिता

śuṣkakāsāṅgamardādhogurutāmalasaṁgrahaḥ śyāmāruṇatvagāditvaṁ mukhe ca rasavaddhitā

There is a dry cough, aching of the limbs, heaviness in the lower body, and retention of stool; the skin takes on a dark-reddish hue, and the mouth carries a strange, persistent taste.

Verse 15 (garuda.1.161.15)

सतोदभेदमुदरं नीलकृष्णशिराततम् । आध्मातमुदरे शब्दमद्भुतं वा करोति सः

satodabhedamudaraṁ nīlakṛṣṇaśirātatam ādhmātamudare śabdamadbhutaṁ vā karoti saḥ

The belly feels as if pierced and torn, and it is covered over with a network of dark-blue and black veins; when distended it produces a strange sound.

Verse 16 (garuda.1.161.16)

वायुश्चात्र सरुक्च्छब्दं विधत्ते सर्वथा गतिम् । पित्तोदरे ज्वरो मूर्छा दाहित्वं कटुकास्यता

vāyuścātra sarukcchabdaṁ vidhatte sarvathā gatim pittodare jvaro mūrchā dāhitvaṁ kaṭukāsyatā

Here the provoked wind produces pain and sound with every movement. In pitta-udara (bile-caused abdominal disease), there is fever, fainting, a burning sensation, and a bitter, pungent taste in the mouth.

Verse 17 (garuda.1.161.17)

भ्रमोतिसारः पीतत्वं त्वगादावुदरं हरित् । पीतताम्रशिरादित्वं सस्वेदं सोष्म दह्यते

bhramotisāraḥ pītatvaṁ tvagādāvudaraṁ harit pītatāmraśirāditvaṁ sasvedaṁ soṣma dahyate

There is giddiness, diarrhoea, and yellowness; the skin and belly turn a greenish hue, and the veins appear yellow-copper coloured; there is sweating, and the body feels hot and burns.

Verse 18 (garuda.1.161.18)

धूमायते मृदुस्पर्शं क्षैप्रपाकं प्रदूयते । श्लेष्मोदरेषु सदनं स्वेदश्वयथुगौरवम्

dhūmāyate mṛdusparśaṁ kṣaiprapākaṁ pradūyate śleṣmodareṣu sadanaṁ svedaśvayathugauravam

It seems as though steaming, is soft to the touch, ripens quickly, and grows inflamed. In kapha-udara (phlegm-caused abdominal disease), there is lassitude, sweating, swelling, and heaviness.

Verse 19 (garuda.1.161.19)

निद्रा क्लेशोऽरुचिः श्वासः काशः शुक्लत्वगादिता । उदरं तिमिरं स्निग्धं शुक्लकृष्णशिरावृतम्

nidrā kleśo'ruciḥ śvāsaḥ kāśaḥ śuklatvagāditā udaraṁ timiraṁ snigdhaṁ śuklakṛṣṇaśirāvṛtam

There is excessive sleep, distress, loss of appetite, breathlessness, and cough; the skin turns pale; the belly appears dark and oily, covered with pale and black veins.

Verse 20 (garuda.1.161.20)

नीरातिवृद्धौ कठिनं शीतस्पर्शं गुरु स्थिरम् । त्रिदोषकोपने तैस्तैस्त्रिदोषजीनैतर्मलैः

nīrātivṛddhau kaṭhinaṁ śītasparśaṁ guru sthiram tridoṣakopane taistaistridoṣajīnaitarmalaiḥ

When the fluid greatly increases, it becomes hard, cold to the touch, heavy, and fixed. When all three doshas are provoked together, then by those very impurities born of the three doshas —

Verse 21 (garuda.1.161.21)

सर्वदूषणदुष्टाश्च सरक्ताः सञ्चिता मलाः । कोष्ठं प्राप्य विकुर्वाणाः शोषमूर्छाभ्रमान्वितम्

sarvadūṣaṇaduṣṭāśca saraktāḥ sañcitā malāḥ koṣṭhaṁ prāpya vikurvāṇāḥ śoṣamūrchābhramānvitam

— the wastes, corrupted by every vitiating factor and mixed with blood, gather together and, reaching the abdominal cavity, cause disorder, bringing on wasting, fainting, and giddiness.

Verse 22 (garuda.1.161.22)

कुर्युस्त्रिलिङ्गमुदरं शीघ्रपाकं सुदारुणम् । वर्धते तच्च सुतरां शीतवातप्रदर्शने

kuryustriliṅgamudaraṁ śīghrapākaṁ sudāruṇam vardhate tacca sutarāṁ śītavātapradarśane

They produce the sannipataja abdominal disease, marked by the signs of all three doshas, swift to ripen and exceedingly dreadful; and it increases still further on exposure to cold wind.

Verse 23 (garuda.1.161.23)

अत्यशनाच्च संक्षोभाद्यानपानादिचेष्ठितैः । अविहितैश्च पानाद्यैर्वमनव्याधिकर्षणैः

atyaśanācca saṁkṣobhādyānapānādiceṣṭhitaiḥ avihitaiśca pānādyairvamanavyādhikarṣaṇaiḥ

From overeating, from the agitation caused by travel and the like, from improper drinking, and from being weakened by vomiting and disease —

Verse 24 (garuda.1.161.24)

वामपार्श्वास्थितः प्लीहा त्युतस्थानो विवर्धते । शोणिताद्वा रसादिभ्यो विवृद्धो जनयेद्व्यथाम्

vāmapārśvāsthitaḥ plīhā tyutasthāno vivardhate śoṇitādvā rasādibhyo vivṛddho janayedvyathām

— the spleen, situated on the left side, is dislodged from its place and enlarges; enlarged by blood or by the bodily fluids, it causes pain.

Verse 25 (garuda.1.161.25)

सोऽष्ठीला चातिकठिनः प्रोन्नतः कूर्मपृष्ठवत् । क्रमेण वर्धमानश्च कुक्षौ व्याततिमाहरेत्

so'ṣṭhīlā cātikaṭhinaḥ pronnataḥ kūrmapṛṣṭhavat krameṇa vardhamānaśca kukṣau vyātatimāharet

That lump becomes exceedingly hard, raised like a tortoise's back; growing by degrees, it comes to occupy the whole flank.

Verse 26 (garuda.1.161.26)

श्वासकासपिपासास्यवैरस्याध्मानकज्वरैः । पाण्डुत्वमूर्छाछर्दित्वग्दाहमोहैश्च संयुतः

śvāsakāsapipāsāsyavairasyādhmānakajvaraiḥ pāṇḍutvamūrchācharditvagdāhamohaiśca saṁyutaḥ

The patient is afflicted with breathlessness, cough, thirst, a bad taste in the mouth, distension, and fever, together with pallor, fainting, vomiting, burning of the skin, and confusion of mind.

Verse 27 (garuda.1.161.27)

अरुणाभं विचित्राभं नीलहारिद्रराजितम् । उदावर्तेन चानाहमोहतृड्द्गहनज्वरैः

aruṇābhaṁ vicitrābhaṁ nīlahāridrarājitam udāvartena cānāhamohatṛḍdgahanajvaraiḥ

It appears reddish, of varied hue, streaked with blue and yellow; the patient also suffers from udavarta (upward-moving wind disorder), constipation, confusion, thirst, and a severe, unrelenting fever.

Verse 28 (garuda.1.161.28)

गौरवारुचिकाठिन्यैर्विघातभ्रमसंक्रमात् । प्लीहवद्दक्षिणात्पार्श्वात्कुर्याद्यकृदपि च्युतम्

gauravārucikāṭhinyairvighātabhramasaṁkramāt plīhavaddakṣiṇātpārśvātkuryādyakṛdapi cyutam

There is also heaviness, distaste, and hardness, together with obstruction and shifting giddiness. In the same way, when dislodged from the right side, the liver too may produce a similar disorder.

Verse 29 (garuda.1.161.29)

पक्वे भूते यकृति च सदा बद्धमलो गुदे । दुर्नामभिरुदावर्तैरन्यैर्वा पीडितो भवेत्

pakve bhūte yakṛti ca sadā baddhamalo gude durnāmabhirudāvartairanyairvā pīḍito bhavet

When the liver is thus affected, the stool remains ever bound up in the rectum; the patient becomes afflicted with piles, udavarta, or other such disorders.

Verse 30 (garuda.1.161.30)

वर्चः पित्तकफान्बद्धान्करोति कुपितोऽनिलः । अपानो जठरे तेन संरुद्धो ज्वररुक्करः

varcaḥ pittakaphānbaddhānkaroti kupito'nilaḥ apāno jaṭhare tena saṁruddho jvararukkaraḥ

The provoked wind binds the stool together with bile and phlegm; the downward-moving apana wind, thus obstructed in the belly, gives rise to fever and pain.

Verse 31 (garuda.1.161.31)

काशश्वासोरुसद्गनं शिरोरुङ्नाभिपार्श्वरुक् । मलासंगोऽरुचिश्छर्दिरुदरे मलमारुतः

kāśaśvāsorusadganaṁ śiroruṅnābhipārśvaruk malāsaṁgo'ruciśchardirudare malamārutaḥ

Cough, breathlessness, heaviness in the thighs, headache, and pain around the navel and flanks follow; there is retention of stool, loss of appetite, and vomiting — this is baddhodara, caused by wind bound up with waste matter.

Verse 32 (garuda.1.161.32)

स्थिरनीलारुणशिराजालैरुदरमावृतम् । नाभेरुपरि च प्रायो गोपुच्छाकृति जायते

sthiranīlāruṇaśirājālairudaramāvṛtam nābherupari ca prāyo gopucchākṛti jāyate

The belly becomes covered by a fixed network of dark-blue and reddish veins; and above the navel it generally takes the shape of a cow's tail.

Verse 33 (garuda.1.161.33)

अस्थ्यादिशल्यै रन्यैश्च विद्धे चैवोदरे तथा । पच्यते यकृतादिश्च तच्छिद्रैश्च सरन्बहिः

asthyādiśalyai ranyaiśca viddhe caivodare tathā pacyate yakṛtādiśca tacchidraiśca saranbahiḥ

When the belly is pierced by a splinter of bone or some other sharp object, the liver and the like become inflamed and suppurate, and matter oozes out through those perforations.

Verse 34 (garuda.1.161.34)

आम एव गुदाहेति ततोऽल्पाल्पः शकृद्रसः । स स्याद्विकृतगन्धोऽपि पिच्छिलः पीतलोहितः

āma eva gudāheti tato'lpālpaḥ śakṛdrasaḥ sa syādvikṛtagandho'pi picchilaḥ pītalohitaḥ

This is called 'ama', since it remains undigested at the anus; then a scant, watery discharge of stool trickles out, which is foul-smelling, slimy, and yellowish-red in colour.

Verse 35 (garuda.1.161.35)

शेषश्चापूर्य जठरं घोरमारभते ततः । वर्धते तदधो नाभेराशु चैति जलात्मताम्

śeṣaścāpūrya jaṭharaṁ ghoramārabhate tataḥ vardhate tadadho nābherāśu caiti jalātmatām

The remainder, filling the belly, then begins to take a dreadful course; it grows below the navel and quickly turns watery in nature.

Verse 36 (garuda.1.161.36)

उद्रिक्ते दोषरूपे च व्याप्ते च श्वासतृट्भ्रमैः । छिद्रोदरमिदं प्राहुः परिस्त्रावीति चापरे

udrikte doṣarūpe ca vyāpte ca śvāsatṛṭbhramaiḥ chidrodaramidaṁ prāhuḥ paristrāvīti cāpare

When the doshas are thus greatly increased and the body is pervaded by breathlessness, thirst, and giddiness, this condition is called chidrodara (perforated abdomen); some also call it parisravin (the oozing one).

Verse 37 (garuda.1.161.37)

प्रवृत्तस्नेहपानादेः सहसापथ्यसेविनः । अत्यम्बुपानान्मन्दाग्नेः क्षीणस्यातिकृशस्य च

pravṛttasnehapānādeḥ sahasāpathyasevinaḥ atyambupānānmandāgneḥ kṣīṇasyātikṛśasya ca

From suddenly taking unwholesome food after beginning a course of oleation, from drinking too much water, and in a man of weak digestive fire who is depleted and greatly emaciated —

Verse 38 (garuda.1.161.38)

रुद्धः स्वमार्गादनिलः कफश्च जलमूर्छितः । वर्धते तु तदेवाम्बु तन्मात्राद्विन्दुराशितः

ruddhaḥ svamārgādanilaḥ kaphaśca jalamūrchitaḥ vardhate tu tadevāmbu tanmātrādvindurāśitaḥ

— the wind, obstructed from its own path, combines with the phlegm which becomes saturated with water; that same water then increases, gathering drop by drop.

Verse 39 (garuda.1.161.39)

तत्कोपादुदरं तृष्णागुदस्नुतिरुजान्वितम् । काशश्वासारुचियुतं नानावर्णाशिराततम्

tatkopādudaraṁ tṛṣṇāgudasnutirujānvitam kāśaśvāsāruciyutaṁ nānāvarṇāśirātatam

From this provocation, the belly becomes afflicted with thirst, oozing and pain at the anus, together with cough, breathlessness, and loss of appetite, its veins appearing in many colours.

Verse 40 (garuda.1.161.40)

तोयपूर्णान्मृदुस्पर्शात्सदृशक्षोभवेपथु । बकोदरं स्थिरंस्निग्धं नाडीमावृत्य जायते

toyapūrṇānmṛdusparśātsadṛśakṣobhavepathu bakodaraṁ sthiraṁsnigdhaṁ nāḍīmāvṛtya jāyate

Full of water, soft to the touch, and quivering wave-like when disturbed, this is called bakodara (heron-belly, i.e. ascites); it is fixed and unctuous, and forms enveloping the urinary channel.

Verse 41 (garuda.1.161.41)

उपेक्षायाञ्च सर्वेषां स्वस्थानां परिचालिताः । पाका द्रवा द्रवीकुर्युः सन्धिस्रोतोमुखान्यपि

upekṣāyāñca sarveṣāṁ svasthānāṁ paricālitāḥ pākā dravā dravīkuryuḥ sandhisrotomukhānyapi

If all these are neglected, the doshas, driven from their proper places, become liquefied and dissolve even the openings of the joints and channels.

Verse 42 (garuda.1.161.42)

स्वेदे चैव तु संरुद्धे मूर्छिताश्चान्तरस्थिताः । तदेवोदरमापूर्य कुर्यादुदरामयम्

svede caiva tu saṁruddhe mūrchitāścāntarasthitāḥ tadevodaramāpūrya kuryādudarāmayam

When sweating is suppressed, the doshas, confounded and lodged within, fill up that very belly and give rise to udara roga.

Verse 43 (garuda.1.161.43)

गुरूदरं स्थितं वृत्तमाहतञ्च न शब्दकृत् । हीनबलं तथा घोरं नाड्यां स्पृष्टञ्च सपति

gurūdaraṁ sthitaṁ vṛttamāhatañca na śabdakṛt hīnabalaṁ tathā ghoraṁ nāḍyāṁ spṛṣṭañca sapati

The belly grows heavy, fixed, and rounded; when struck it makes no sound; the patient's strength is diminished — this is a most dreadful condition, and the disease can be felt even through the pulse.

Verse 44 (garuda.1.161.44)

शिरान्तर्धानमुदरे सर्वलक्षणमुच्यते । वातपित्तकफप्लीहसन्निपातोदकोदरम्

śirāntardhānamudare sarvalakṣaṇamucyate vātapittakaphaplīhasannipātodakodaram

The disappearance of the veins in the abdomen is said to be the common sign of all these — the vataja, pittaja, kaphaja, plihaja, sannipataja, and udaka (dropsical) forms of udara.

Verse 45 (garuda.1.161.45)

पक्षाच्च जातसलिलं विष्टम्भोपद्रवान्वितम् । जन्मनैवोदरं सर्वं प्रायः कृच्छ्रतमं मतम्

pakṣācca jātasalilaṁ viṣṭambhopadravānvitam janmanaivodaraṁ sarvaṁ prāyaḥ kṛcchratamaṁ matam

That form in which fluid arises within a single fortnight, accompanied by constipation and other complications — such an udara roga is held, from its very origin, to be for the most part exceedingly difficult to cure.