Sushruta Samhita Nidanasthana Chapter 13 Ksudra Roga Nidanam (Minor diseases)

The 13th chapter of Nidanasthana of Sushruta Samhita is named as Ksudra Roga Nidanam Adhyaya. This chapter deals with Minor diseases.

अथातः क्षुद्ररोगाणां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Ksudra roga- nidana-diagnosis of Minor diseases, as revealed by the venerable Dhanvantari.

Sankhya and Laksana-number and features

समासेन चतुश्चत्वारिंशत् क्षुद्ररोगा भवन्ति |
तद्यथा,- अजगल्लिका, यवप्रख्या, अन्धालजी, विवृता, कच्छपिका, वल्मीकं, इन्द्रवृद्धा, पनसिका, पाषाणगर्दभः, जालगर्दभः, कक्षा, विस्फोटकः, अग्निरोहिणी, चिप्पं, कुनखः, अनुशयी, विदारिका शर्करार्बुदं, पामा, विचर्चिका, रकसा, पाददारिका, कदरं, अलसेन्द्रलुप्तौ, दारुणकः, अरुंषिका, पलितं, मसूरिका, यौवनपिडका, पद्मिनीकण्टकः, जतुमणिः, मशकः, चर्मकीलः, तिलकालकः, न्यच्छं, व्यङ्गः, परिवर्तिका, अवपाटिका, निरुद्धप्रकशः सन्निरुद्धगुदः, अहिपूतनं, वृषणकच्छ्रः, गुदभ्रंशश्चेति ||३||

In brief, there are forty-four types of Ksudra Rogas. The names of these 44 Ksudra rogas are – Ajagallika, Yavaprakhya, Andhalaji, Vivruta, Kachchapika, Valmika, Indraviddha, Panasika, Pasanagardabha, Jalagardabha, Kaksa, Visphotaka, Agnirohini, Cippa, Kunakha, Anusayi, Vidarika, Sarkararbuda, Pama, Vicarcika, Rakasa, Padadarika, Kadara, Alasa, Indralupta, Darunaka, Arumsika, Palita, Masurika, Yauvanapidaka, Padminikantaka, Jatumani, Masaka, Carmakila, Tilakalaka, Nyaccha, Vyanga, Parivartika, Avapatika, Niruddhaprakasa, sanniruddhaguda, Ahiputana, Vrsanakacchu and Gudabhramsa.

1. Ajagalika

स्निग्धा सवर्णा ग्रथिता नीरुजा मुद्गसन्निभा |
कफवातोत्थिता ज्ञेया बालानामजगल्लिका ||४||

Ajagallika is a condition caused by aggravated kapha and vata. It mainly manifests in children. It presents in the form of a granthi – small tumor or cystic swelling which has the below mentioned features –

• It is unctuous
• Has same color as that of the skin
• Is hard
• Painless and
• Of the size of mudga – green gram

2. Yavaprakhya

यवाकारा सुकठिना ग्रथिता मांससंश्रिता |
पिडका श्लेष्मवाताभ्यां यवप्रख्येति सोच्यते ||५||

Yavaprakhya is a condition caused by aggravated kapha and vata. It manifests in the form of a pidaka – eruption which has the below mentioned features –

• It is of the size of yava – barley
• Very hard
• Is cystic – appears like a small sized tumor
• Resides in the muscles

3. Andhalaji

घनामवक्त्रां पिडकामुन्नतां परिमण्डलाम् |
अन्धालजीमल्पपूयां तां विद्यात् कफवातजाम् ||६||

Andhalaji is a condition caused by aggravated kapha and vata.

It is a pidaka – eruption which has the below mentioned features –

• Thick
• Does not have any opening, and hence andha – blind
• Bulged up
• Round in shape
• Has little quantity of pus in it

4. Vivrta

विवृतास्यां महादाहां पक्वोदुम्बरसन्निभाम् |
विवृतामिति तां विद्यात् पित्तोत्थां परिमण्डलाम् ||७||
Vivrta is a condition caused by increased pitta. It is a pidaka – eruption presenting with the below mentioned features –

• The eruption has a wide mouth (opening)
• Has severe burning sensation
• It resembles ripe Udumbara fruit (Ficus racemosa) – bluish red in color
• Round in shape
• Arising from the surface

5. Kacchapika

ग्रथिताः पञ्च वा षड्वा दारुणाः कच्छपोन्नताः |
कफानिलाभ्यां पिडका ज्ञेया कच्छपिका बुधैः ||८||

Kachchapika is produced by aggravated kapha and vata.

It is

• a very troublesome condition,
• raised like a tortoise shell and
• is made up of five to six granthis i.e. small sized tumor like growths or cystic growths

6. Valmika

पाणिपादतले सन्धौ ग्रीवायामूर्ध्वजत्रुणि |
ग्रन्थिर्वल्मीकवद्यस्तु शनैः समुपचीयते ||९||
तोदक्लेदपरीदाहकण्डूमद्भिर्मुखैर्वृतः |
व्याधिर्वल्मीक इत्येष कफपित्तानिलोद्भवः ||१०||

Valmika is a condition produced by aggravated kapha, pitta and vata. It is a granthi – small tumor / cystic swelling. It develops in the palms, soles, bony joints, neck and parts above the shoulders. It presents with the below mentioned features.

• Grows in size slowly like an anthill and will have many openings
• Pricking sensation
• Exudation of fluids
• Burning sensation all around
• Itching

7. Indravrddha

पद्मपुष्करवन्मध्ये पिडकाभिः समाचिताम् |
इन्द्रवृद्धां तु तां विद्याद्वातपित्तोत्थितां भिषक् ||११||

Indravrddha is a condition caused by vitiated vata and pitta.

It presents as –

• A pidaka – eruption in the centre
• Surrounded by small eruptions and
• Resembling the base of petals of lotus

8. Gardabhika

मण्डलं वृत्तमुत्सन्नं सरक्तं पिडकाचितम् |
रुजाकरीं गदर्भिकां तां विद्याद्वातपित्तजाम् |

Gardabhika is a condition caused by Vata and Pitta. It will be

round, elevated, red in colour, embedded with eruptions, and it will be associated with pain.

9. Panasika

कर्णौ परि समन्ताद्वा पृष्ठे वा पिडकोग्ररुक् |
शालूकवत्पनसिकां तां विद्याच्छ्लेष्मवातजाम् ||१२||

Panasika is a condition caused by vitiated kapha and vata. It is a pidaka – eruption presenting with the below mentioned features –

• They develop on the ear or its surroundings or back
• Has severe pain
• Resembles a Saluka – tuber of lotus plant in appearance

10. Pasanagardabha

हनुसन्धौ समुद्भूतं शोफमल्परुजं स्थिरम् |
पाषाणगर्दभं विद्याद्बलासपवनात्मकम् ||१३||

Pasanagardabha is a condition caused by aggravated kapha and vata. It is a sopha – swelling presenting with the below mentioned features –

• It develops at the root of the lower jaw
• Is slightly painful
• Is fixed / immovable

11. Jala gardabha

विसर्पवत् सर्पति यो दाहज्वरकरस्तनुः |
अपाकः श्वयथुः पित्तात् स ज्ञेयो जालगर्दभः ||१४||

Jalagardabha is a condition caused by aggravated pitta. It is a sopha – swelling which presents with the below mentioned features –

• It spreads like visarpa – erysipelas
• Has burning sensation
• Associated with fever
• Thin and
• Does not suppurate i.e. pus is not formed in it

12. Irivellika

पिडिकामुत्तमाङ्गस्थां वृत्तामुग्ररुजाज्वराम् |
सर्वात्मकां सर्वलिङ्गां जानीयादिरिवेल्लिकाम् ||१५||

Irivellika is a condition where Pidika or eruptions manifest on the scalp, which are round, cause severe pain and fever; it manifests due to all the three doshas and exhibit symptoms of all the three doshas.

13. Kaksa

बाहुपार्श्वांसकक्षासु कृष्णस्फोटां सवेदनाम् |
पित्तप्रकोपसम्भूतां कक्षामिति विनिर्दिशेत् ||१६||

Kaksa is a condition caused by aggravated pitta. It is a sphota – vesicle which presents with below mentioned features –

• Black in color
• Arises in the sides of the arm, shoulder or axilla
• Has pain

14. Gandhanama

एकामेवंविधां दृष्ट्वा पिटिकां स्फोटसन्निभाम् |

त्वग्गतां पित्तकोपेन गन्धनामां प्रचक्षते ||१७||

Gandhanama is a condition caused by the aggravation of pitta dosha. There will be a single Pitika (eruption) resembling a sphota (vesicle) situated on the skin.

15. Visphotaka

अग्निदग्धनिभाः स्फोटाः सज्वराः पित्तरक्ततः |
क्वचित् सर्वत्र वा देहे स्मृता विस्फोटका इति ||१८||

Visphotaka is a condition caused by aggravation of pitta and rakta – blood. It is a sphota – vesicle / blister which presents with below mentioned features –

• It appears like burns caused by fire,
• Associated with fever
• Occurs in a region of the body or in the entire body

16. Agnirohini

कक्षाभागेषु ये स्फोटा जायन्ते मांसदारु(र)णाः |
अन्तर्दाहज्वरकरा दीप्तपावकसन्निभाः ||१९||
सप्ताहाद्वा दशाहाद्वा पक्षाद्वा न्घन्ति मानवम् |
तामग्निरोहिणीं विद्यादसाध्यां सन्निपाततः ||२०||

Agnirohini is a condition produced by all the three doshas aggravated together. It is a sphota – vesicle which presents with below mentioned features –

• Occurs in the region of axilla
• It tears / splits the muscles
• Causes burning sensation inside the body
• Has fever
• It appears as if produced by flame,
• Killing the person in seven, ten or fifteen days
• It is incurable

17, 18 Cippa-Kunakha

नखमांसमधिष्ठाय पित्तं वातश्च वेदनाम् |
करोति दाहपाकौ च तं व्याधिं चिप्पमादिशेत् ||२१||
तदेवाक्षतरोगाख्यं तथोपनखमित्यपि |
अभिघातात् प्रदुष्टो यो नखो रूक्षोऽसितः खरः ||२२||
भवेत्तं कुनखं विद्यात् कुलीनमिति सञ्ज्ञितम् |

Cippa –

Cippa is a condition caused by aggravated pitta and vata. It gets localized in the muscle of the nail and produces the below mentioned symptoms –

• Pain
• Burning sensation
• Formation of pus

Synonyms of Cippa – Aksta roga, Upanakha

Kunakha –

It is a condition wherein the nail is damaged due to injury / hit.

The nail in this condition becomes –

• Dry
• Black
• Rough

Kunakha is also called Kulina.

19. Anusayi

गम्भीरामल्पसंरम्भां सवर्णामुपरिस्थिताम् ||२३||

कफादन्तःप्रपाकां तां विद्यादनुशयीं भिषक् |

Anusayi is a condition caused by vitiated kapha. It is a deep seated, mild swelling which presents with the below mentioned features –

• It is of the same color as that of the surrounding skin
• It is situated on the scalp
• Pus is formed inside it

20. Vidarika

विदारीकन्दवद्वृत्तां कक्षावङ्क्षणसन्धिषु ||२४||
रक्तां विदारिकां विद्यात् सर्वजां सर्वलक्षणाम् |

Vidarika is a condition which is produced by all the doshas. It is a pidaka – eruption, which presents with the below mentioned features –

• It is round in shape resembling Vidarikanda – tuber of Pueraria tuberosa
• Develops in axilla or groin
• Is red in color
• Exhibits the symptoms of all the three doshas

21. Sarkarabuda

प्राप्य मांससिरास्नायु श्लेष्मा मेदस्तथाऽनिलः ||२५||
ग्रन्थिं कुर्वन्ति भिन्नोऽसौ मधुसर्पिर्वसानिभम् |
स्रवत्यास्रावमत्यर्थं तत्र वृद्धिं गतोऽनिलः ||२६||
मांसं विशोष्य ग्रथितां शर्करां जनयेत् पुनः |
दुर्गन्धं क्लिन्नमत्यर्थं नानावर्णं ततः सिराः ||२७||
स्रवन्ति सहसा रक्तं तद्विद्याच्छर्करार्बुदम् |

Sarkararbuda is a condition caused by aggravated kapha, medas – fat and vata.

Kapha, medas and vata gets localized in the muscles, veins and ligaments and

↓

Gives rise to granthi – small sized tumor / cystic swelling which

↓

Bursts open and

↓

Exudes large quantities of fluids resembling honey, ghee or muscle fat

↓

Now, Vata getting increased would dry up the muscles and

↓

Produces hard crystals

↓

Suddenly there is discharge of blood which smells bad and is very moist from the veins

↓

This condition is called Sarkararbuda

22, 23, 24 – Pama, Vicarcika, Rakasa

पामाविचर्च्यौ कुष्ठेषु रकसा च प्रकीर्तिता ||२८||

Three conditions i.e. pama, vicarcika and rakasa have been described in Kustha Nidana chapter (chapter 5) earlier.

25. Padadari

परिक्रमणशीलस्य वायुरत्यर्थरूक्षयोः |
पादयोः कुरुते दारीं सरुजां तलसंश्रितः ||२९||

Causes – walking too much

Vata becomes very dry and produces painful cracks / fissures in the soles in persons who walk too much. This condition is called as Padadari.

26. Kadara

शर्करोन्मथिते पादे क्षते वा कण्टकादिभिः |
मेदोरक्तानुगैश्चैव दोषैर्वा जायते नृणाम् ||३०||
सकीलकठिनो ग्रन्थिर्निम्नमध्योन्नतोऽपि वा |
कोलमात्रः सरुक् स्रावी जायते कदरस्तु सः ||३१||

Causes –

• Placing the feet on hard or rough surfaces like stone or gravel
• Wounds caused by thorns etc.
• Doshas getting aggravated along with fat and blood

Pathogenesis –

Due to the above said causes, a tumor is formed which presents with the below mentioned features –

• Hard like a bolt
• Flat at the edges
• Elevated at the center
• Is of the size of Kola – jujube fruit
• Has pain
• Has exudation of fluids

The condition caused by the above said causes and presenting with the symptoms mentioned above is called as Kadara.

27. Alasa

क्लिन्नाङ्गुल्यन्तरौ पादौ कण्डूदाहरुगन्वितौ |
दुष्टकर्दमसंस्पर्शादलसं तं विनिर्दिशेत् ||३२||

Causes of Alasa – excessive contact of the foot with bad slush

Symptoms –

• Moistness in between the toes
• Itching
• Burning sensation
• Pain

28. Indralupta

रोमकूपानुगं पित्तं वातेन सह मूर्च्छितम् |
प्रच्यावयति रोमाणि ततः श्लेष्मा सशोणितः ||३३||
रुणद्धि रोमकूपांस्तु ततोऽन्येषामसम्भवः |
तदिन्द्रलुप्तं खालित्यं रुज्येति च विभाव्यते ||३४||

Aggravated pitta located in the hair follicles

↓

Gets associated with aggravated vata and

↓

Causes the hairs of the head to fall off following which

↓

Kapha and rakta – blood together blocks the hair follicles

↓

Making the growth of new hairs impossible and

↓

The disease thus caused is called by names Indralupta or Khalitya or Rujya

29. Darunaka

दारुणा कण्डुरा रूक्षा केशभूमिः प्रपाट्यते |
कफवातप्रकोपेण विद्याद्दारुणकं तु तम् ||३५||

Darunaka is a condition caused by aggravated kapha and vata.

This occurs in scalp and makes the skin of the scalp –

• Cracked
• Dreadful
• Itchy
• Dry

30. Arumsika

अरूंषि बहुवक्त्राणि बहुक्लेदीनि मूर्धनि |
कफासृक्कृमिकोपेन नृणां विद्यादरुंषिकाम् ||३६||

Arumsika is a condition produced by increase of kapha, rakta and krimi – worms.

They manifest with eruptions developing on the skin with the below mentioned features –

• Each eruption has many openings
• Copious exudation occurs from these multiple openings

31. Palita

क्रोधशोकश्रमकृतः शरीरोष्मा शिरोगतः |
पित्तं च केशान् पचति पलितं तेन जायते ||३७||

Excessive anger, grief or exertion

↓

Causes excessive increase of heat in the body which

↓

Gets mixed with increased pitta and

↓

Gets localized in the head and

↓

Cause ripening of hairs and makes them grey and

↓

This condition is called as Palita

32. Masurika

दाहज्वररुजावन्तस्ताम्राः स्फोटाः सपीतकाः |
गात्रेषु वदने चान्तर्विज्ञेयास्ता मसूरिकाः ||३८||

Masurika presents in the form of Sphota – vesicles which present with the below mentioned features –

• Coppery or slightly yellow in color
• Has burning sensation and pain
• Associated with fever
• Appears on the body, face and inside the mouth

33. Mukhadusika

शाल्मलीकण्टकप्रख्याः कफमारुतशोणितैः |
जायन्ते पिडका यूनां वक्त्रे या मुखदूषिकाः ||३९||

Mukhadushika, which is also known as Yuvana Pidaka are pidakas – eruptions caused by aggravated kapha, vata and rakta. They appear on the face of young persons and resemble thorns of Salmali tree (Salmalia malabarica, Bombax ceiba) in appearance.

34. Padmini Kantaka

कण्टकैराचितं वृत्तं कण्डूमत् पाण्डुमण्डलम् |
पद्मिनीकण्टकप्रख्यैस्तदाख्यं कफवातजम् ||४०||

Padmini Kantaka is a condition caused by aggravated kapha and vata.

It is a mandala i.e. patch which appears on the skin and manifests with the below mentioned features –

• Round in shape
• Is itching
• Yellowish-white in color
• Studded with thorn like projections
• Resembles those of lotus flowers

35. Jatumani

नीरुजं सममुत्सन्नं मण्डलं कफरक्तजम् |
सहजं रक्तमीषच्च श्लक्ष्णं जतुमणिं विदुः ||४१||

A mandala (patch of skin) produced by the aggravation of kapha and rakta (blood), painless and evenly elevated on all sides, present right from the birth, slightly red and soft is called as Jatumani.

36. Masaka

अवेदनं स्थिरं चैव यस्य गात्रेषु दृश्यते |
माषवत्कृष्णमुत्सन्नमनिलान्मषकं वदेत् ||४२||

Masaka is a condition caused by aggravated vata. It presents in the form of raised lesions on the body which are painless, static (immovable) and black in color like Masa – black gram in appearance.

37. Carmakila

समुत्थाननिदानाभ्यां चर्मकीलं प्रकीर्तितम ।

The pathogenesis and causative factors of Carmakila have been described earlier (in chapter 2).

38. Tila Kalaka

कृष्णानि तिलमात्राणि नीरुजानि समानि च |
वातपित्तकफोच्छोषात्तान् विद्यात्तिलकालकान् ||४३||

Tilakalaka is a condition produced when kapha is dried up by vata and pitta.

They are black spots which appear on the body and presents with below mentioned features –

• They are of the size of tila – seeds of sesame in appearance
• They are painless
• They are even i.e. at the level of the skin

39. Nyaccha

मण्डलं महदल्पं वा श्यामं वा यदि वा सितम् |
सहजं नीरुजं गात्रे न्यच्छमित्यभिधीयते ||४४||

Nyachcha is a condition present right from the birth and presents in the form of

• big or small patches of skin which are
• blue or white in color and
• are painless

40. Charmakeela

समुत्थाननिदानाभ्यां चर्मकीलं प्रकीर्तितम् |

It is already described about Charmakeela in previously enumerated chapter.

41. Vyanga

क्रोधायासप्रकुपितो वायुः पित्तेन संयुतः ||४५||
सहसा मुखमागत्य मण्डलं विसृजत्यतः |
नीरुजं तनुकं श्यावं मुखे व्यङ्गं तमादिशेत् ||४६||
कृष्णमेवङ्गुणं गात्रे मुखे वा नीलिकां विदुः |

Vyanga is a condition caused by aggravated vata and pitta.

Causes – anger and exertion

Vata gets aggravated due to the above said etiological factors. This aggravated vata combines with pitta quickly reaches the face. Therein these doshas would give rise to patches on the skin. These patches are called as vyanga which are blue in color, thin and painless.

The patch with similar features but black in color, when develops on the face or body, is known by the name Nilika.

42. Parivartika

मर्दनात् पीडनाच्चाति तथैवाप्यभिघाततः |
मेढ्रचर्म यदा वायुर्भजते सर्वतश्चरः ||४७||
तदा वातोपसृष्टं तु चर्म प्रतिनिवर्तते |
मणेरधस्तात् कोशश्च ग्रन्थिरूपेण लम्बते ||४८||
सवेदनः सदाहश्च पाकं च व्रजति क्वचित् |
मारुतागन्तुसम्भूतां विद्यात्तां परिवर्तिकाम् ||४९||
सकण्डूः कठिना चापि सैव श्लेष्मसमुत्थिता |५०|

Parivartika is a condition produced by Vata or external agents.

Causes – too much kneading squeezing or injury to the skin of the penis.

Pathogenesis – due to the above said causes, vata gets aggravated. This aggravated vata becomes localized in the skin of the penis and causes Parivartika.

Symptoms – It roles over the skin of the penis. With this, the glans penis gets exposed and assumes the shapes of a sac and hangs beneath the glans penis. There is pain and burning sensation. In some persons there is also formation of pus.

When the same condition is produced by Kapha, there will be itching and hardness.

43. Avapatika

अल्पीयःखां यदा हर्षाद्बालां गच्छेत् स्त्रियं नरः ||५०||
हस्ताभिघातादथवा चर्मण्युद्वर्तिते बलात् |
मर्दनात्पीडनाद्वाऽपि शुक्रवेगविघाततः ||५१||
यस्यावपाट्यते चर्म तां विद्यादवपाटिकाम् |५२|Causes –

• man copulating with a woman having narrow vaginal orifice or
• copulating with a very young girl or
• assaulting one’s penis by hands – like kneading or squeezing it – masturbating or
• by forcibly obstructing ejaculation of semen

Due to the above said causes, the skin of the penis becomes averted i.e. rolled up and cracked.

This disease is known as Avapatika.

44. Niruddha Prakasa

वातोपसृष्टमेवं तु चर्म संश्रयते मणिम् ||५२|||
मणिश्चर्मोपनद्धस्तु  मूत्रस्रोतो रुणद्धि च |
निरुद्धप्रकशे तस्मिन्मन्दधारमवेदनम् ||५३||
मूत्रं प्रवर्तते जन्तोर्मणिर्न च विदीर्यते |
निरुद्धप्रकशं विद्याद्दुरूढां चावपाटिकाम् ||५४||

Niruddha Prakasa is a condition caused by aggravated vata. When Avapatika becomes improperly healed, it will also be known as Niruddha Prakasa.

Vata gets aggravated due to its own causes and

↓

Gets localized in the skin over the glans penis and

↓

Makes the skin thick and swollen and blocks the urethra

↓

The glans penis becomes concealed and

↓

Stream of urine gets slow and is voided with or without pain but

↓

The glans is not cracked or ulcerated and

↓

This disease is known as Niruddha Prakasa

45. Sanniruddha
    

    guda

वेगसन्धारणाद्वायुर्विहतो गुदमाश्रितः |
निरुणद्धि महत्स्रोतः सूक्ष्मद्वारं करोति च ||५५||
मार्गस्य सौक्ष्म्यात् कृच्छ्रेण पुरीषं तस्य गच्छति |
सन्निरुद्धगुदं व्याधिमेनं विद्यात् सुदुस्तरम् ||५६||

Sanniruddha Guda is a ‘difficult to cure’ condition caused by aggravated vata.

Suppression of the urges of feces / defecation leads to

↓

Aggravation of vata which

↓

Produces blocking of the alimentary tract and

↓

Narrows the anal orifice and due to this narrowing

↓

The feces get eliminated with difficulty and

↓

This condition is known as Sanniruddha Guda

46. Ahiputana

शकृन्मूत्रसमायुक्तेऽधौतेऽपाने शिशोर्भवेत् |
स्विन्नस्यास्नाप्यमानस्य कण्डू रक्तकफोद्भवा ||५७||
कण्डूयनात्ततः क्षिप्रं स्फोटाः स्रावश्च जायते |
एकीभूतं व्रणैर्घोरं तं विद्यादहिपूतनम् ||५८||

Ahiputana is a condition caused by aggravated rakta and kapha in children.

Causes –

• contact of rectum / anus for prolonged time with feces and urine (in children)
• not properly washing the anus after defecation / remaining unclean for many days
• not bathing the child in spite of the child sweating a lot

Pathogenesis – Rakta and Kapha getting aggravated by the above said causative factors would produce itching in the anus of the child.

Symptoms –

• severe itching in the anus
• quick development of sphota – vesicles due to scratching
• exudation of fluids from these vesicles
• formation of ulcers
• formation of big ulcer due to coalescing together of small ulcers

47. Vrsana kacchu

स्नानोत्सादनहीनस्य मलो वृषणसंश्रितः |
यदा प्रक्लिद्यते स्वेदात् कण्डूं सञ्जनयेत्तदा ||५९||
तत्र कण्डूयनात् क्षिप्रं स्फोटाः स्रावश्च जायते |
प्राहुर्वृषणकच्छूं तां श्लेष्मरक्तप्रकोपजाम् ||६०||

Vrushana Kacchu is a condition produced by aggravated kapha and rakta in the scrotal skin.

Causes – not taking regular bath or massage

Symptoms – Due to the above said causes the dirt on the scrotum becomes soaked in sweat and produces severe itching. When the person scratches the scrotum when it itches, sphota – vesicles are formed quickly. These sphotas exude fluids.

48. Guda bhramsa

प्रवाहणातिसाराभ्यां निर्गच्छति गुदं बहिः |
रूक्षदुर्बलदेहस्य तं गुदभ्रंशमादिशेत् ||६१||

Guda Bhramsa is a condition wherein the rectum comes out in persons who have dryness and weakness in the body. Severe straining while in the act of defecation or severe diarrhea are the main causes of guda bhramsa.

इति सुश्रुतसंहितायां निदानस्थाने क्षुद्ररोगनिदानं नाम त्रयोदशोऽध्यायः ||१३||

Thus ends the Thirteenth chapter by name Ksudraroga  Nidana  in Nidana sthana of Susruta Samhita.