Wounds Abscesses Lymphadenopathies and Superficial Neoplasms

The descriptions of wounds and abscesses in the texts are detailed and quite complete. The term brana, which is often used in the literature and is generally taken to mean an ulcer, has to be interpreted more liberally as a surgical or traumatic wound or even an abscess. A swelling that (1) is localized to one part of the body, (2) is hard, and (3) affects the skin and soft tissues in a particular manner is an inflammatory swelling or shofa. These swellings were thought to arise from various causes and were associated with manifestations of imbalance of the particular humors producing the disease.

Such inflammatory swellings were described as red, yellow, or black in color and increased in size at different rates. They produced local heat, burning, and other abnormal sensations and were said to pass through the phases of Ama (cellulitis), Pacchyamana (localization), and Pakka (localized abscess).

The clinical features specifically diagnostic of an abscess or a wound are also discussed in detail in various chapters; for example, an abscess in connection with a broken bone discharges a mixture of marrow, blood, and often small spicules of bone in a fluid resembling clarified butter. Similar diagnostic features of abscesses at various sites are also given as prognostic signs of danger and curability. The exact timing for the incision of an abscess was thought to be critical, and dependent upon the clinical findings.

Deep-seated spherical or irregular swellings were called Vidradhi. Four types were thought to arise from the three disturbed dosas individually or in combination. Two other types mentioned are Agan-tuka (due to external trauma) and Raktaja (Rakta means "blood"). The descriptions of the various Vidradhis are often similar. They could develop anywhere in the body, and the overlying skin would have shallow ulcers of varying colors with discharges of differing natures - characteristics that identified the dosa responsible.

None of the Vidradhi involving the three dosas were attended with fever, which makes it difficult to accept them as being abscesses (the usual belief). The Sannipataja type — the most serious - resembles the description of a squamous carcinoma more than anything else, and other dosaja Vidradhis could quite well have been the same.

Vidradhi arising in the marrow of a bone was termed Asthividradhi. This seems clearly to have been acute osteomyelitis, as the bone was swollen with acute pain, and the patient had high fever. Finally the abscess discharged outside through the skin and muscles.

The two types of Vidradhi where high fever and thirst were prominent, suggesting an infectious origin, are the Agantuka type (caused by a deep wound due to an external agent) and the Rakta Vidradhi, arising in the pelvis of pregnant women following parturition, doubtless in many cases puerperal fever.

A variant is the Antarvidradhi or internal Vidradhi, a situation in which one developed on an internal organ such as the bladder, spleen, liver, or heart. Rectal examination and the passage of sounds into the bladder were common diagnostic techniques in these cases. A Vidradhi in the rectum caused symptoms suggestive of large intestinal obstructions, and one on the bladder neck probably indicated obstruction of the passage of urine. However, these symptoms also suggest neoplastic obstruction rather than abscess.

Disturbed dosas were also thought to produce slowly growing, cold, round swellings in the tissues, termed Arbuda, which never suppurated and were probably neoplasms. A variant called the Raktar-buda reportedly grew rapidly and produced both a discharge and heaped flesh. Because patients suffering from Raktarbuda quickly become emaciated and the disease was viewed as incurable, the strong suspicion is that they were suffering from a malignant neoplasm.

Cancer, however, as a specific type of illness was not recognized in the Ayurveda, and the process of metastasis seems not to have been appreciated. Nonetheless some Arbudas were known to produce satellite Arbudas close by.

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