Hydrocele: Ayurveda Concept, Disease Review, Symptoms, Types

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Hydrocele is compared to Mutra Vriddhi, one of the types of Vruddhi (scrotal swellings as explained in Ayurvedic texts).
Vriddhi means ‘to increase’. The term necessarily doesn’t denote scrotal swelling. It has to be understood according to the context and situation.

Examples:
– Vata Vriddhi indicates pathological increase in Vata, leading to paralysis, hemiplegia, arthritis etc.
– Medo vriddhi indicates pathological increase of fat tissue. This may lead to many diseases like obesity, diabetes etc.

But when the term ‘Vriddhi’ is not used with any suffix or prefix, it indicates – ‘Vrushana Vruddhi or Mushka Vruddhi or Andakosha Vriddhi’ i.e. swelling in the scrotum (small bag like structure which holds the testes in men).
(Vrushana = testes, Mushka = scrotum, Andakosha = Scrotum)

Causes (Nidana) of Vriddhi
The causes of Vriddhi have not been explained in the treatises.
Vriddhi has been included by Acharya Charaka in the context of ‘Shotha’, the chapter which deals with ‘Swelling’ and its types.
Thus Vriddhi is a type of Shotha, therefore all the causes (etiological factors) of Shotha shall be considered as the causative factors causing Vruddhi also.

The causative factors of Shotha and Vriddhi are as enlisted below –
Kshara amla teekshna ushna guru bhojana – Excessive intake of foods which are alkaline (kshara), sour in taste (amla), intense, sharp and corrosive (teekshna), very hot in nature (ushna) and heavy for digestion (guru) by those people who have been already debilitated due to excessive administration of shuddhi (cleansing treatment procedures in the form of Panchakarma treatments), due to long standing (chronic) diseases) and or due to lack of proper food and nutrition.

Excessive consumption of –

  • Dadhi – curds
  • Ama – unprocessed foods
  • Mrut – mud
  • Shaka – green vegetables
  • Virodhi – mutually incompatible foods
  • Dushta – contaminated foods
  • Garaopasrushta – food contaminated or poisoned by artificial poisoning, food poisoning

Arsha – as an effect of piles or hemorrhoids
Acheshta – lack of physical activities and exercises, sedentary life
Na cha deha-shuddhihi – Not administering shodhana or body cleansing treatments in spite of their requirements

Marma upaghata – injury to the marmas (vital points in the body which on injury cause damage, disorders, deformity and or death)
Vishama prasuta – miscarriage or abortion (artificial or untimely or induced)
Mithya upachara – Improper administration of Vamana etc panchakarma procedures

Pathogenesis (Samprapti) of Vriddhi
The Vayu on getting vitiated moves upwards (natural course of vayu is to move downwards).
Vayu reaches the mushka (scrotum, testes) and vankshana (groin) while causing swelling (shotha) and pain (shula).

On getting localized in these places, the vitiated vayu contaminates the dhamanees (blood vessels) therein and causes vruddhi (engorgement, enlargement, and swelling) of the phalakosha (scrotum).
This condition wherein the scrotum and groin get engorged and swollen up due to vitiated Vayu is called Vruddhi.

Purvarupa of Vruddhi (premonitory symptoms)

  • Basti vedana – pain in the urinary bladder
  • Kati vedana – pain in the pelvis
  • Mushka vedana – pain in scrotum, testes
  • Medhra vedana – pain in the penis
  • Maruta nigrahaha – obstruction of vayu
  • Phalakosha shopha – swelling of the scrotum

Types of Vruddhi
Vriddhi is of 7 types. They are:

  • Vata Vriddhi – caused due to vitiation of Vata
  • Pittaja Vriddhi – caused due to vitiation of Pitta
  • Kaphaja Vriddhi – caused due to vitiation of Kapha
  • Shonita Vriddhi – caused due to vitiation of rakta or blood
  • Medo vriddhi – caused due to excessive deposition or vitiation of fat tissue
  • Mutra Vriddhi – caused by vitiation of Vayu and by accumulation of excessive mutra (urine, water, fluids)
  • Aantra Vriddhi – caused by vitiation of Vata and by displacement of intestine from its place and heading into the groin and scrotum hence causing a bulge (vriddhi) in those places (hernia)

Note: Mutraja and Antraja Vruddhi are mainly caused by vitiated Vayu. Therefore they basically are Vataja Vruddhis with specific causes i.e. Mutraja Vruddhi caused by excessive accumulation of mutra and Aantra Vruddhi caused by displacement of aantra.

Therefore Mutra Vruddhi and Aantra Vriddhi are variants of Vataja vriddhi.
In this context we shall only discuss about Mutra Vriddhi since it correlates with the topic of discussion i.e. Hydrocele.
Read related: Hydrocele Testis: Modern aspect, Causes, Symptoms, Treatment

Mutra Vriddhi vis-à-vis Hydrocele
Mutra Vruddhi or Mutra Vriddhi is a condition which is compared to Hydrocele.
Mutra = Urine, Vruddhi = engorgement or enlargement of Scrotum due to accumulation of mutra or urine

In Hydrocele, we have already seen that there is accumulation of serous fluid in the layers of scrotum and thus causing its swelling. But in Ayurvedic concept the term Mutra is misleading because urine doesn’t collect around the scrotum to cause hydrocele. In fact Hydrocele has nothing to do with urine accumulation or in no way connected to the urine apparatus.

The term Mutra Vriddhi is probably given because the part of the body in which the swelling occurs (scrotum and testes) is seen close to the part of the body which voids urine (penis, urethra?).
Read related: Hydrocele: Prevention, Home Remedies, Useful Yogasanas

Causes for Vruddhi –
The causes mentioned for Vriddhi in general are also the causative factors for Mutra Vriddhi.

Specific causes:
– Mutra Vega Dharana – forcibly withholding the urge to urination
– Vata Prakopa – vitiation of Vata (Mutra vriddhi is a variant of Vata Vriddhi, Vata prakopa or vitiation of vata is a general cause and accumulation of mutra is a specific cause for mutra vriddhi). All causes of Vata vitiation like excessive consumption of dry, cold, light, stale foods rich in pungent, bitter and astringent tastes, excessive exercise and sex, chronic debilitating diseases, exposure to wind, lack of sleep and rest, awakening at nights, forcibly stopping the natural body reflexes, excess grief and anxiety, etc are also indirectly the causes of Mutra Vriddhi.
– Mutra sangraha – accumulation of mutra (serous fluid) in the muskha (scrotum)

Vriddhi Samprapti (pathogenesis) –
The Vayu gets vitiated and moves upwards. It reaches the mushka (scrotum, testes) and vankshana (groin) and causes shotha and shula. The vayu further contaminates the dhamanees in these places, cause accumulation of mutra (fluid) in the vrushana and mushka and cause Mutraja Vruddhi.

Symptoms (lakshanas) of Mutraja Vruddhi –
Mutraja vruddhi occurs in people who are habituated to hold on to their urge (reflex) for urination (mutra vega dharana). The symptoms of Mutraja Vruddhi are as below mentioned –

  • Ambu poorna dhrutivat kshobha – the scrotum feels like a bag filled with fluid
  • Kshobha – fluctuates
  • Mrudu – Soft in touch
  • Sa ruk – associated with pain
  • Mutra kruchchra – dysuria, difficulty in passing urine or painful urination
  • Chalayana phala kosha – oscillating scrotum

Since Mutraja Vriddhi is also a variant of Vataja Vruddhi, the symptoms of Vataja Vruddhi are also evident in Mutraja Vruddhi.

Vataja Vruddhi Symptoms:
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– Vata purna dhruti sparsha – the scrotum looks like an air filled sac or bag (or balloon)
– Ruksha – scrotum looks dry
– Ahetu ruk – pain without any reason

Read related: Treatment strategies for Vruddhi – Hydrocele


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