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Ashtanga Hridayam Nidanasthanam Chapter 12:  Udara Nidanam Adhyaya (Analysis of enlargement of the stomach)


The twelfth chapter of Nidanasthanam of Ashtanga Hridayam is known as as Udara Nidanam Adhyayah. This chapter offers with the reason of ‘analysis of enlargement of the stomach’.

The matters coated on this chapter embody –

–       Udara Nidana – causes of enlargement of stomach
–       Samprapti (pathogenesis)
–       Sorts and basic signs of udara
–       Purvarupa – premonitory signs
–       Rupa – Scientific options
–       Vatodara, Pittodara, Kaphodara, Sannipatodara
–       Plihodara – Yakrutodara (enlargement of spleen and liver)
–       Baddhodara – obstruction of stomach (stomach viscera)
–       Kshatodara – stomach enlargement precipitated because of trauma
–       Jalodara – ascites
–       Sadhyasadhyata (prognosis)

Pledge by the creator(s)

अथात उदरनिदानं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having supplied prayers to the God, henceforth we’re going to clarify the chapter pertaining to the reason of ‘analysis of enlargement of the stomach’. Thus say (pledge) atreya and different sages.

Udara Nidana: Causes of enlargement of stomach

रोगाः सर्वेऽपि मन्देऽग्नौ सुतरामुदराणि तु ।
अजीर्णान् मलिनैश्चान्नैर्जायन्ते मलसञ्चयात् ॥ १ ॥
Usually all illnesses are produced by mandagni (weak digestion energy) particularly so the udara – enlargement of the stomach;Udara illness may also be precipitated because of indigestion, because of contaminated meals, or because of accumulation of malas – aggravated doshas and waste merchandise.

Samprapti (Pathogenesis)

ऊर्ध्वाधो धातवो रुद्ध्वा वाहिनीरम्बुवाहिनीः ।
प्राणाग्न्यपानान् सन्दूष्य कुर्युस्त्वङ्मांससन्धिगाः ॥ २ ॥
आध्माप्य कुक्षिमुदरम्
Dhatus – doshas-vata, pitta and kapha getting aggravated, hinder the channel of ambu (water associated physique channels) each on the high and backside,result in abnormalities within the prana (division of vata), agni (digestive exercise) and apana (division of vata),causes accumulation of water in between the layers of pores and skin, and musclesand produce udara, by enlarging the stomach.

Sorts and basic signs of udara

अष्टधा तच्च भिद्यते ।
पृथग्दोषैः समस्तैश्च प्लीहबद्धक्षतोदकैः ॥ ३ ॥
तेनार्ताः शुष्कताल्वोष्ठाः शूनपादकरोदराः ।
नष्टचेष्टाबलाहाराः कृशाः प्रध्मातकुक्षयः ॥ ४ ॥
स्युः प्रेतरूपाः पुरुषा
It’s of eight varieties;from every dosha individually, by all of them collectively,by pliha (enlargement of the spleen), baddha (obstruction of the gut), ksata- perforation of the intestines and udaka accumulation of fluid.Affected by this illness, the individuals have dryness of the palate and lips,swelling of the ft, palms and stomach;lack of activeness, energy and need for meals;emaciation, extreme flatulenceand seem like a cadaver.

Purvarupa: Premonitory signs

भाविनस्तस्य लक्षणम् ।
क्षुन्नाशोऽन्नं चिरात्सर्वं सविदाहं च पच्यते ॥ ५ ॥
जीर्णाजीर्णं न जानाति सौहित्यं सहते न च ।
क्षीयते बलतः शश्वच्छ्वसित्यल्पेऽपि चेष्टिते ॥ ६ ॥
वृद्धिर्विषोऽप्रवृत्तिश्च किञ्चिच्छोफश्च पादयोः ।
रुग्वस्तिसन्धौ ततता लघ्वल्पाभोजनैरपि ॥ ७ ॥
राजीजन्म वलीनाशो जठरे
The premonitory signs (of enlargement of stomach are) lack of starvation, meals takes a really very long time endure digestion, digestion is accompanied with burning sensation, the individual can not resolve whether or not the meals is digested or not, and likewise can’t tolerate satiety, has lack of energy, doesn’t breath (has shortness of breath) even after delicate exercise, there’s enhance within the amount of feces however there’s constipation, slight swelling of the ft, ache within the joints on both sides of the urinary bladder, and distention even with simply digestible and little amount of meals and by not consuming meals additionally, look of white traces and disappearance of folds over the stomach (due to stretching of stomach pores and skin because of distention).

Rupa: Scientific options

जठरेषु तु ।
सर्वेषु तन्द्रा सदनं मलसङ्गोऽल्पवह्निता ॥ ८ ॥
दाहः श्वयथुराध्मानमन्ते सलिलसम्भवः ।
सर्वं त्वतोयमरुणमशोफं नातिभारिकम् ॥ ९ ॥
गवाक्षितं सिराजालैः सदा गुडगुडायते ।
नाभिमन्त्रं च विष्टभ्य वेगं कृत्वा प्रणश्यति ॥ १० ॥
मारुतो हृत्कटीनाभिपायुवङ्क्षणवेदनाः ।
सशब्दो निश्चरेद्वायुर्विड्बद्धा मूत्रमल्पकम् ॥ ११ ॥ नातिमन्दोऽनलो लौल्यं न च स्याद्विरसं मुखम् ।
In all forms of jathara (Udara) there’s stupor, debility, accumulation of wastes-especially the feces, poor digestion energy, burning sensation, swelling, on the terminal phases, flatulence and assortment of fluid – within the stomach. In all of the forms of Udara, earlier than the gathering of fluid, the stomach is of slight pink coloration there won’t be swelling and heaviness of stomach. Stomach coated with the community of veins, air or fuel strikes inside producing fixed sound, vata causes obstruction of the umbilicus and intestines, the signs come up after which subside; there’s ache within the area of the center, waist, umbilicus, rectum and groins, the flatus comes out with nice sound, faeces is obstructed and the urine is expelled little in amount; the digestive capability will not be very boring, there’s neither elevated need for meals nor dangerous style within the mouth.

Vataja Udara

तत्र वातोदरे शोफः पाणिपान्मुष्ककुक्षिषु ॥ १२ ॥
कुक्षिपार्श्वोदरकटीपृष्ठरुक् पर्वभेदनम् ।
शुष्ककासोऽङ्गमर्दोऽधोगुरुता मलसङ्ग्रहः ॥ १३ ॥
श्यावारुणत्वगादित्वमकस्माद्वृद्धिह्रासवत् ।
सतोदभेदमुदरं तनुकृष्णसिराततम् ॥ १४ ॥
आध्मातदृतिवच्छब्दमाहतं प्रकरोति च ।
वायुश्चात्र सरुक्शब्दो विचरेत्सर्वतोगतिः ॥ १५ ॥
In vatodrara –stomach enlargement because of vata there’s, swelling of the palms, ft, scrotum and higher stomach; ache within the higher stomach, flanks, central stomach, waist and again, reducing ache within the inter-phalangeal joints (small joints of the fingers), dry cough, physique ache, heaviness of the decrease components of the physique, accumulation of wastes, darkish brown and reddish brown discoloration of pores and skin and so forth. sudden enhance and sudden lower within the dimension of stomach, pricking and piercing ache within the stomach, look of skinny black veins on the stomach; the stomach produces sound when tapped just like an inflated lather bellow vayu – air / fuel strikes all over the place – contained in the stomach accompanied with ache and noise.

Pittaja Udara

पित्तोदरे ज्वरो मूर्छा दाहस्तृट् कटुकास्यता ।
भ्रमोऽतीसारः पीतत्वं त्वगादावुदरं हरित् ॥ १६ ॥
पीतताम्रसिरानद्धं सस्वेदं सोष्म दह्यते ।
धूमायति मृदुस्पर्शं क्षिप्रपाकं प्रदूयते ॥ १७ ॥
In pittodara, there’s fever, fainting, burning sensation, thirst, pungent feeling within the mouth, dizziness, diarrhea, yellow coloration within the pores and skin and so forth. the stomach has inexperienced, yellow, or coppery pink veins showing in every single place; extra sweating, feeling of heat as if being scorched by fireplace, feeling as if emitting scorching fumes; is mushy to the touch undergoes fast ripening with fast assortment of fluid.

Kaphodara (Shleshmodara)

श्लेष्मोदरेऽङ्गसदनं स्वापः श्वयथुगौरवम् ।
निद्रोत्क्लेशारुचिश्वासकासशुक्लत्वगादिता ॥ १८ ॥
उदरं स्तिमितं श्लक्ष्णं शुक्लराजीततं महत् ।
चिराभिवृद्धि कठिनं शीतस्पर्शं गुरु स्थिरम् ॥ १९ ॥
In kaphodara, there’s debility of the physique, lack of tactile sensation, swelling, feeling of heaviness, extra sleep, nausea, lack of style and urge for food; dyspnea, cough, white discoloration of the pores and skin and so forth (and different organs comparable to nails, tongue and so forth), the stomach is static –with none motion / really feel as if stomach is roofed with moist fabric, is clean, has white traces in every single place, rising slowly in dimension, over lengthy time period;  exhausting chilly to the touch, heavy and secure.

Sannipatodara

त्रिदोषकोपनैस्तैस्तैः स्त्रीदत्तैश्च रजोमलैः ।
गरदूषीविषाद्यैश्च सरक्ताः सञ्चिता मलाः ॥ २० ॥
कोष्ठं प्राप्य विकुर्वाणाः शोषमूर्छाभ्रमान्वितम् ।
कुर्युस्त्रिलिङ्गमुदरं शीघ्रपाकं सुदारुणम् ॥ २१ ॥
बाधते तच्च सुतरां शीतवाताभ्रदर्शने ।
By indulgence in meals and actions that trigger enhance of all of the three doshas concurrently; due to contamination of menstrual blood, excreta and so forth. administered by girls – with the intention to kill or seduce, because of ingestion of synthetic poison –administered by others to kill and of dusivia – poison that are weak to kill however may cause illnesses, the amassed malas dosha together with rakta, get aggravated, turn out to be localized within the stomach and offers rise to abnormalities; emaciation, fainting, dizziness and produce enlargement of the stomach, having the options of all of the doshas; it undergoes ripening – assortment of fluid rapidly and the situation is extreme, provides utmost hassle and discomfort, when expsosed to chilly wind and clouds.

Plihodara: Yakrutodara (Enlargement of spleen and liver)

अत्याशितस्य सङ्क्षोभाद्यानयानादिचेष्टितैः ॥ २२ ॥
अतिव्यवायकर्माध्ववमनव्याधिकर्शनैः ।
वामपार्श्वाश्रितः प्लीहा च्युतः स्थानाद्विवर्धते ॥ २३ ॥
शोणितं वा रसादिभ्यो विवृद्धं तं विवर्धयेत् ।
सोऽष्ठीलेवातिकठिनः प्राक् ततः कूर्मपृष्ठवत् ॥ २४ ॥
क्रमेण वर्धमानश्च कुक्षावुदरमावहेत् ।
श्वासकासपिपासास्यवैरस्याध्मानरुग्ज्वरैः ॥ २५ ॥
पाण्डुत्वमूर्छाछर्दीभिर्दाहमोहैश्च संयुतम् ।
अरुणाभं विवर्णं वा नीलहारिद्रराजिमत् ॥ २६ ॥
उदावर्तरुजानाहैर्मोहतृड्दहनज्वरैः ।
गौरवारुचिकाठिन्यैर्विद्यात्तत्र मलान् क्रमात् ॥ २७ ॥
In individuals who devour massive amount of meals habitually, by exhaustion, extra travelling in automobiles, driving on animals and such different prompts, over-indulgence in sexual activity, bodily actions, lengthy distance stroll, extra vomiting, and by weak point because of illnesses, pliha – the spleen located on the left aspect of stomach will get displaced from its place and turns into enlarged; elevated, vitiated the blood, rasa-plasma and different tissues additionally result in its enlargement of spleen; spleen, getting enlarged turns into very exhausting just like the cobbler’s stone at first, later resembles the tortoise shell, steadily the stomach will increase in dimension and occupies your complete stomach ranging from its higher portion and producing stomach enlargement, accompanied with dyspnoea, cough, extreme thirst, dangerous style within the mouth, flatulence, ache, fever, and related to pale look, fainting episodes, vomiting, burning sensation, and delusion (lack of consciousness) the stomach is both barely pink or discolored, with blue, or deep yellow traces showing on it. Predominance of the mala (dosha) must be decided by the presence of udavarta – upward motion of vata, ache and flatulence, these three are produced by vata; delusion, thirst, burning sensation and fever – these are brought on by pitta, feeling of heaviness, lack of style/urge for food and hardness- of the stomach brought on by kapha respectively.

Plihodara: Yakrutodara (enlargement of spleen and liver)

प्लीहवद्दक्षिणात्पार्श्वात् कुर्याद्यकृदपि च्युतम् ।
Just like the plihodara, the yakritodara (with liver enlargement) will get changed from the suitable aspect, inflicting enlargement of the stomach.

Baddhodara: Obstruction of stomach (stomach viscera)

पक्ष्मवालैः सहान्नेन भुक्तैर्बद्धायने गुदे ॥ २८ ॥
दुर्नामभिरुदावर्तैरन्यैर्वान्त्रोपलेपिभिः ।
वर्चःपित्तकफान् रुद्ध्वा करोति कुपितोऽनिलः ॥ २९ ॥
अपानो जठरं तेन स्युर्दाहज्वरतृट्क्षवाः ।
कासश्वासोरुसदनं शिरोहृन्नाभिपायुरुक् ॥ ३० ॥
मलसङ्गोऽरुचिश्छर्दिरुदरं मूढमारुतम् ।
स्थिरं नीलारुणसिराराजीनद्धमराजि वा ॥ ३१ ॥
नाभेरुपरि च प्रायो गोपुच्छाकृति जायते ।
By ingestion of eyelashes, hair together with meals, by extreme obstruction of the rectum bloating of stomach – upward motion of vata or by different causes which kind a coating contained in the intestines, aggravated apana vata, by obstructing feces, pitta and kapha, produces Udara – stomach enlargement; from that arises, burning sensation, fever ,thirst, extreme sneezing, cough, dyspnea, weak point of the thighs, headache, ache within the area of the center, umbilicus and rectum, constipation, anorexia, vomiting; stomach enlargement, with no motion of vata – flatus within the stomach, stomach is static, coated with traces of blue or gentle pink, veins or not having traces; most likely enlargement resembling the tail of cow (broad on the high and small at backside) seems above the umbilicus.

Kshatodara: Stomach enlargement precipitated because of trauma

अस्थ्यादिशल्यैः सान्नैश्चेद्भुक्तैरत्यशनेन वा ॥ ३२ ॥
भिद्यते पच्यते वान्त्रं तच्छिद्रैश्च स्रवन् बहिः ।
आम एव गुदादेति ततोऽल्पाल्पं सविड्रसः ॥ ३३ ॥
तुल्यः कुणपगन्धेन पिच्छिलः पीतलोहितः ।
शेषश्चापूर्य जठरं जठरं घोरमावहेत् ॥ ३४ ॥
वर्धयेत्तदधो नाभेराशु चैति जलात्मताम् ।
उद्रिक्तदोषरूपं च व्याप्तं च श्वासतृड्भ्रमैः ॥ ३५ ॥
छिद्रोदरमिदं प्राहुः परिस्रावीति चापरे ।
By ingestion of bone and different sharp overseas our bodies together with meals or consuming massive amount of meals, the intestines get perforated or ulcerated; the undigested meals materials flows out (by the opening / ulcer). Rasa – fluids, in small portions, is expelled out of rectum, blended with feces feces turns into foul smelling like that of a lifeless physique, slimy, yellowish-red in coloration. Steadily fills up the stomach, inflicting its enlargement, which will increase in dimension, under the umbilicus; it quickly adjustments into assortment of fluid within the stomach; presenting signs of the predominant—causative dosha and related to dyspnoea, thirst and dizziness; this illness is known as as Chidodara and as parisravi udara by some others (also called Kshatodara).

Jalodara: Ascites

प्रवृत्तस्नेहपानादेः सहसामाम्बुपायिनः ॥ ३६ ॥
अत्यम्बुपानान्मन्दाग्नेः क्षीणस्यातिकृशस्य वा ।
रुद्ध्वाम्बुमार्गाननिलः कफश्च जलमूर्छितः ॥ ३७ ॥
वर्धयेतां तदेवाम्बु तत्स्थानादुदराश्रितौ ।
ततः स्यादुदरं तृष्णागुदस्रुतिरुजान्वितम् ॥ ३८ ॥
कासश्वासारुचियुतं नानावर्णसिराततम् ।
तोयपूर्णदृतिस्पर्शशब्दप्रक्षोभवेपथु ॥ ३९ ॥
दकोदरं महत्स्निग्धं स्थिरमावृत्तनाभि तत् ।
In an individual who at all times drinks water with out boiling, through the course of therapies comparable to oleation and so forth, consuming massive amount of water by those that have poor digestive capability, who’re debilitated – by depletion of tissues and who’re very emaciated – by persistent illnesses, vata and kapha get aggravated collectively and block the water channels of the physique, blended with the body-water, causes enhance of water / fluids, displaces it from its place and trigger water accumulation within the stomach; it’s known as Udara illness related to thirst, exudation from the rectum, and ache, cough, dysponea and lack of style/ urge for food the stomach has veins of many colours showing throughout, resembles a bag crammed with water for contact, sound, motion and tremors, massive in dimension, unctuous, static, much less motion, with bulged umbilicus. This illness is known as Daakodara – Udakodara or Jalodara.

Jalodara: Ascites

उपेक्षया च सर्वेषु दोषाः स्वस्थानतश्च्युताः ॥ ४० ॥
पाकाद्द्रवा द्रवीकुर्युः सन्धिस्रोतोमुखान्यपि ।
स्वेदश्च बाह्यस्रोतःसु विहतस्तिर्यगास्थितः ॥ ४१ ॥
तदेवोदकमाप्याय्य पिच्छां कुर्यात्तदा भवेत् ।
गुरूदरं स्थिरं वृत्तमाहतं च न शब्दवत् ॥ ४२ ॥
मृदु व्यपेतराजीकं नाभ्यां स्पृष्टं च सर्पति ।
तदनूदकजन्मास्मिन्कुक्षिवृद्धिस्ततोऽधिकम् ॥ ४३ ॥
सिरान्तर्धानमुदकजठरोक्तं च लक्षणम् ।
By neglecting fast and efficient remedy in all types of udara, the doshas getting displaced from their very own websites because of digestion the doshas get liquefied and make extra fluid to build up within the channels of the joints and tissues; the sweat obstructed in its outer opening, begins to maneuver in all instructions (indirect, sideward route), will get blended with the body-water causes stickiness, sliminess, it collects within the stomach, which turns into heavy, static, spherical, not producing sound when tapped, mushy, and absence of veins; the fluid spreads to different components when the umbilicus is pressed; steadily accumulation of fluid within the stomach happens, resulting in nice enhance within the dimension of the stomach, causes disappearance of veins and different signs of udakodara.

Sadhya asadhyata (Prognosis)

वातपित्तकफप्लीहसन्निपातोदकोदरम् ॥ ४४ ॥
कृच्छ्रं यथोत्तरं पक्षात्परं प्रायोऽपरे हतः ।
सर्वं च जातसलिलं रिष्टोक्तोपद्रवान्वितम् ॥ ४५ ॥
जन्मनैवोदरं सर्वं प्रायः कृच्छ्रतमं मतम् ।
बलिनस्तदजाताम्बु यत्नसाध्यं नवोत्थितम् ॥ ४६ ॥
Udara- stomach enlargement brought on by vata, pitta, kapha, plihahodara –splenomegaly, sannipata – all of the three doshas collectively and udakodara – ascites are tough to remedy of their successive order; other forms often kill the affected person by a fortnight, udara all sorts after the formation of fluid and accompanied with problems or secondary illnesses dangerous omens and deadly indicators enumerated within the chapter on arista – chapter 5 of sharira sthana. All types of udara are by their very onset, are most likely stated to be very tough to remedy, these occurring in individuals who’re robust, which haven’t reached the stage of fluid formation and people of current onset could get cured by nice effort.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने उदरनिदानं नाम द्वादशोऽध्याय: ॥१२॥
Thus ends the chapter Udara – Nidana- the twelfth within the Nidana sthana of Astangahrudaya samhita composed by Srimad Vagbhata, son of sri Vaidyapathi Simhagupta.



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