Abhinav Vikruti Vigyan

Author(s): Raghuveerprasad Trivedi
Publisher: Chaukhamba Vidyabhavan
Catalog link: https://jainqq.org/explore/020004/1

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sacitra abhinava vikRtivijJAna Wwwwwwww zrI raghuvIraprasAda trivedI For Private and Personal Use Only

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Acharya Sh ||shriiH|| vidyAbhavana Ayurveda granthamAlA 10 abhinava vikRtivijJAna / [pAzcAttya tathA AyurvedIya vaikArikI kA pAThyagrantha] lekhakaAyurvedAcArya paM0 raghuvIraprasAda trivedI e. ema. esa. AyurvedAnusandhAna-saciva tathA prAdhyApaka Ayurveda kAleja, kAzI hindU vizvavidyAlaya prAkathanalekhakaDaoN. prANajIvana mANekalAla mehatA ema. DI., ema. esa., epha. sI. pI. esa., epha. AI. sI. esa., DAirekTara seNTrala insTIcyUTa Apha risarca ina iNDAijInasa sisTamsa Apha maiDIsina, jAmanagara bhUmikAlekhakaAyurvedAcArya DA0 bhAskaragovinda ghANekara bI. esa-sI. ema. bI. bI. esa., prophesara Ayurveda kAleja, kAzI hindU vizvavidyAlaya prastAvanAlekhaka AyurvedatattvamarmajJa DA0 zivanAtha khannA ema. bI. bI. esa., DI. pI. eca. rIDara ina paithAlojI Ayurveda kAleja, kAzI hindU vizvavidyAlaya For Private and Personal Use Only

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prakAzaka- - caukhambA vidyAbhavana cauka, vArANasI-1 I0 1957 ( punarmudraNAdikAH sarvai'dhikArAH prakAzakAdhInAH ) mUlya mudraka - vidyAvilAsa presa, vArANasI - 1 saM0 2013

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THE VIDYA BHAWAN AYURVEDA SERIES 10 THE ABHINAVA VIKRITI VIJNANA [ A Text Book of Pathology-Ancient & Modern ] Tyurvedacharya Dr. Raghuvir Prasad Trivedi A. M. S. ( B. H. U. ) RECISTRAR, AYURVEDIC RESEARCH SECTION AND LECTURER, AYURVEDIC COLLECE, BANARAS HINDU UNIVERSITY. With a Foreword hy Dr. P.M. Mehta M. D., M. S., F. C. P. S., F. I. C. S. DIRECTOR, CENTRAL INSTITUTE OF RESEARCH IN JDIGENOUS SYSTEMS OF MEDICINE, JAMNACAR. An Introduction from Tyurvedacharya Dr. Bhaskar Govind Ghanekar B. SC., M. Bi, B. S. PROFESSOR AYURVEDIC COLLEGE, BANARAS HINDU UNIVERSITY A Preface by Dr. S. N. Khanna M. B. B. S., D. P. H. READER IN PATHOLOGY. AYURVEDIC COLLEGE, BANARAS HINDU UNIVERSITY For Private and Personal Use Only

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The Chowkhamba Vidya Bhawan Chowk, Varanasi. ( INDIA ) 1957 For Private and Personal Use Only

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FOREWORD Dr. P. M. Mehta M. D., M. S., F. C. P. S., F. I. C. S. Director Central Institute of Research in Indigenous Systems of Medicine-Jam Nagar. Independence of India has given very favourable atmosphere for full development of Ayurvedic Educational Institutions. This opportunity has created urgent need of solving two problems to fulfil this cherished goal. These two problems are to have good teachers and good text-books. The problems of Text-books is to be solved from two aspects. The first is to have standard authoritative text-books on Ayurvedic subjects. The ancient classics were encyclopedic and the modern trend is to teach subject-wise; hence new all-comprehensive compilation shall have to be done. The second is to translate all existing modern medical literature to make it available for comparative study and references to the Ayurvedic scholars. The difficulty in this task is great as there is no standard dictionary availble that gives exact meaning and full accurate information about the things that words symbolize. Confusion already exists in the meaning and hectic efforts done at random have confounded it still more. Overenthusiasm spirit in some to prove that every modern concept and subject existed in ancient period has so distorted translation and misconstrued interpretations that it will need additional time to undo them. These are the present circumstances. But we cannot wait for an undated future to: prepare the text-books as the need is so urgent. For Private and Personal Use Only

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[ 21 So it is a sacred call to all Ayurvedic scholars to come together in a team work with all devotion and dedication and take up the task and responsibility with all seriousness and spirit of sacrifice. Let there be no loss of time and all be ready to work with all heart till the object is rightly achieved. A good number of scholars have already taken up the self-accepted responsibility and they are to be congratulated for doing this spade work. The present author Vaidyaraj Shri Raghuvir Prasad Trivedi is a teacher in one of the pioneer institutions of Ayurvedic education. He has wide experience of teaching. He knows the present need of the students. Taking initiative from this, and combining it with appreciable diligence admirable perseverance and wide scholarship he has succeeded to place before the medical world a huge volume on 'Prakriti Vikriti Vignana'. He has thus contributed his share creditably to the cause of medical education. The book will be useful not only to Ayurvedic students but also to the students of the modern science; as in a few years all medical colleges of the modern science shall have to give instruction in Hindi Language. This is the first work of its type. It is prepared under the difficult circumstances mentioned above. Meanings and interpretations may have to be modified or even changed in future editions which is usual in all such publications. It is a great credit, compliment and gratification to the author that his first endeavour will definitely serve as all important and useful basis for the further progressive publications on the subject. For Private and Personal Use Only

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prAkathana prastotA - DaoN0 prANajIvana mANekalAla mehatA ema. DI., ema. esa., epha. sI. pI. es., epha. AI. sI. es. DAirekTara saiNTrala insTIcyUTa Apha risarca ina iNDAijInasa sisTamsa Apha maiDIsina - jAmanagara / AyurvedIya zikSA saMsthAoM ke pUrNa vikAsa ke lie bhAratIya svAtantrya ne atIva anukUla vAtAvaraNa pradAna kiyA hai / isa avasara ne abhIpsita lakSyapUrti ke nimitta do samasyAe~ utpanna kara dI haiM / ina do -samasyAoM meM se eka uccakoTi ke adhyApakoM kI prApti tathA dUsarI utkRSTa pAThyagranthoM kI racanA hai / pAThyagranthoM kI samasyA ke samAdhAna ke do dRSTikoNa ho sakate haiM / unameM prathama dRSTikoNa AyurvedIya viSayoM para uccakoTi ke sAdhikArika pAThyagrantha kA nirmANa karanA hai| prAcIna AyurvedIya granthoM kI racanA vizvakoza jaisI hai jaba ki Adhunika pravRtti viSayAnusAra adhyApana ko mahattva detI hai / ataH eka abhinava aura vyApaka aisA saGkalana apekSita hai jo usa viSaya para jisake lie vaha likhA gayA hai pUrNa prakAza DAlatA ho / dvitIya dRSTikoNa vidyamAna Adhunika cikitsA vAGmaya kA anuvAda karanA hai tAki vaha [ tulanAtmaka adhyayana nimitta nirdezanArtha AyurvedIya vicArakoM ko upalabdha ho sake / isa kArya meM bahuta bar3I kaThinAI upasthita ho jAtI hai kyoMki eka uccakoTi ke aise zabdakoza kA isa samaya nitAnta abhAva hai jo pAzcAtya zabdoM ke dvArA vyakta hone vAle bhAvoM kA pUrA-pUrA jJAna de sake tathA artha batalA ske| unake vAstavika arthoM meM bahuta sambhrama pahale se hI upasthita hai| aura jo Akasmika yatna isa sambandha meM kie jAte haiM ve aura bhI sandeha bar3hA dete haiM / pratyeka Adhunika vicAra aura viSaya prAcInakAla meM yathAvat the yaha pramANita karane kI kucha vyaktiyoM kI tIvra lAlasA bharI umaMga ne anuvAda ko itanA beDhaMgA banA diyA hai tathA artha kA itanA anarthaM kiyA hai ki unake dvArA phailAe gae bhrAmaka arthoM kA prabhAva haTAne ke lie atirikta samaya apekSita hai| yaha vastusthiti hai / pAThyagranthoM kI itanI zIghra mAMga hai ki hama anizcita bhaviSya taka pratIkSA karate hue nahIM raha sakate / isa kAraNa samaya kI yaha eka pukAra hai ki Ayurveda ke vidvAn milakara pUrNa zraddhA aura bhakti ke sAtha samUhyakarma ke rUpa meM isa kArya ko uThAveM aura usakA uttaradAyitva pUrNagambhIratA tathA tyAga kI bhAvanA se ota prota hokara grahaNa kreN| isameM For Private and Personal Use Only

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[ 2 ] adhika vilamba anapekSita hai| saba kArya karane ke lie hRdaya se taiyAra hokara taba taka juTe raheM jaba taka ki lakSya kI ThIka ThIka prApti na ho jAve / ___ kucha vidvAnoM ne svapreraNA se isa uttaradAyittva kA anubhava karake svayaM vahana kiyA hai| isa kaThina parizrama ke lie ve badhAI ke pAtra haiN| isa grantha ke lekhaka vaidyarAja zrI raghuvIraprasAda trivedI AyurvedIya zikSA kI pramukha saMsthAoM meM se eka meM adhyApaka haiN| unheM prAdhyApana kA paryApta anubhava hai| ve vidyArthiyoM kI vartamAna AvazyakatA ko samajhate haiN| isI se preraNA lekara tathA sAtha hI upAgaNya karmiSThatA, prazaMsanIya dhairya tathA vistRta pANDitya kA paricaya dete hue cikitsaka saMsAra ke samakSa 'prakRti vikRtivijJAna' para eka vizAla grantha upasthita karane meM ve saphala hue haiN| isa prakAra unhoMne cikitsAtmaka zikSA ke nimitta apanA bhAga gaurava ke sAtha cukAyA hai| yaha pustaka na kevala Ayurvedika chAtroM ke lie hI lAbhaprada hogI api tu Adhunika vijJAna ke lie bhI upAdeya hogI; kyoMki Adhunika vijJAna ke sampUrNa maiDIkala kAlejoM ko kucha varSoM meM hI hindI bhASA ke mAdhyama dvArA zikSA pradAna karanI pdd'egii| yaha apane Adarza kI pahalI racanA hai| yaha una kaThina paristhitiyoM meM prastuta kI gaI hai jinakA ullekha Upara kiyA jA cukA hai / artha aura vyAkhyAe~ Age calakara sudhAranI yA pUrNatayA badalanI par3a sakatI haiM jo isa prakAra ke sabhI prakAzanoM meM sAmAnyatayA karanA par3atA hai / ___ lekhaka ke lie isase bar3ha kara gaurava, abhinandana tathA santoSa kI kyA bAta ho sakatI hai ki usakA yaha prathama prayatna isa viSaya para kie jAne vAle bhaviSyatkAlIna pragatizIla prakAzanoM kA nizcita rUpa se mahattvapUrNa evaM upAdeya AdhAra bana kara rhegaa| For Private and Personal Use Only

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bhUmikA AyurvedAcArya DA0 bhAskara govinda ghANekara bI0 esa0 sI0 ; em0 bI0 ; bI0 esa0 ; vikRtivijJAna kA mahattva - zAstra kI dRSTi se vaidya kA vaidyatva rogoM kA acUka nidAna karane kI usakI yogyatA para jitanA nirbhara hotA hai utanA cikitsA meM saphalatA prApta karane kI usakI yogyatA para nahIM hotaa| isakA kAraNa yaha hai ki nidAna kI yogyatA vaiyaktika guNasaMpadA hai aura cikitsA kI saphalatA sAmUhika guNasaMpadA hai jisameM vaidya ke atirikta auSadha, rogI, paricAraka inakI guNasaMpadA kI bhI AvazyakatA hotI hai bhiSag dravyANyupasthAtA rogI pAdacatuSTayam / cikitsitasya nirdiSTaM pratyekaM taccaturguNam // ( vAgbhaTa ) aura sabake Upara jaisA ki gItA meM likhA hai- 'devaM caivAtra paMcamam -' bhI rahatA hai / isalie vyavahArapada subhASitakAroM ne kahA hai vyAdhestatvaparijJAnaM vedanAyAzca nigrahaH / etadvaidyasya vaidyatvaM na vaidyaH prabhurAyuSaH // ina bAtoM kA vicAra karane para yaha kahanA par3atA hai ki yadi vaidya ko vaiyaktikahRSTyA apanI yogyatA bar3hAnI ho to usako rogoM ke nidAna meM aura saba viSayoM kI apekSA adhika prAvINya prApta karane kA parama prayatna karanA caahie| yaha prayatna tabhI saphala ho sakatA hai jaba vaidya vividha rogoM meM hone vAlI vividha vikRtiyoM kA tathA unake vikAsakrama kA gADhA adhyayana karake unake kAryakAraNabhAva ko bhalIbhA~ti samajha leM saMcayaM ca prakopaM ca prasaraM sthAnasaMzrayam / vyakti bhedaM ca yo vetti doSANAM sa bhavedbhiSak // ( suzruta ) vikRti vijJAna kI paribhASA - jina kAraNoM se zarIra ke dhAtvAzayAdi aMgoM kI sAmyAvasthA yA svasthAvasthA naSTa hokara unameM vividha vikRtiyA~ utpanna hotI haiM unako rogakAraka hetu (Etiological factors) aura unake zAstra ko haitukI (Etiolgy) kahate haiN| ye kAraNa asaMkhya hote hue nimna vibhAgoM meM vibhakta kiye gaye haiM For Private and Personal Use Only

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[ 2 ] ( 1 ) kulaja, sahaja yA prakRtija (Hereditary, congenital or constitutional) ( 2 ) hInayoga yA Avazyaka dravyoM kI kamI ( 3 ) tRNANuja, kITANuja yA kRmija upasarga ( Infections) ( 4 ) abhighAta ( Trauma ) ( 5 ) bhautika ( Physical ) ( 6 ) rAsAyanika ( Chemical ) / Ayurveda meM bhI rogakAraka hetuoM kA vargIkaraNa zabdabheda se isI prakAra kA haiAdibalapravRttAH, janmabalapravRttAH, saMghAtabalapravRttAH, daivabalapravRttAH, svabhAvabalapravRttAH / suzruta sUtra 24 // (tulanAtmakavivaraNa ke lie lekhaka kI ukta sUtra kI TIkA dekhiye) / ye rogakAraka hetu jisa prakAra se vikRtiyoM ko utpanna karate haiM usako vikRtijanana yA saMprApti (Pathogenesis ) kahate haiM - yathAduSTena doSeNa yathA cAnuvisarpatA / nivRttirAmayasyAsau samprAptirjAtirAgatiH // ( mAdhavanidAna ) rogakAraka hetuoM se zarIra ke dhAtvAzayAdi aMgoM meM jo asvastha avasthAe~ yA sthityantara utpanna hote haiM unako vikRtiyA~ ( Morbidity ), ina vikRtiyoM se yukta dhAtu, aMga yA Azaya ke vivaraNa ko vikRtazArIra ( Morbid anatomy ) aura ina vikRtiyoM ke zAstra ko vikRtivijJAna ( Pathology ) kahate haiM / zarIra ke dhAtvAzayAdi aMgoM meM honevAlI vikRtiyA~ anaMta hote hue bhI pratikriyA ( Reaction ), zotha ( Inflammation ), jIrNodvAra ( Repair ), vRddhi meM bAdhA ( Disturbance in growth ), apajanana ( Degeneration ), arbuda ( Tumour ) ityAdi kucha ine gine sAmAnya prakAra kI hotI haiM / jaba zarIragata saMpUrNa vikRtiyoM kA tathA unake hetuoM kA vivaraNa uparyukta sarvasAdhAraNa prakAroM ke anusAra kiyA jAtA hai taba usako sAmAnya vikRtivijJAna ( General Pathology ) aura jaba zarIra ke pratyeka aMga, Azaya yA saMsthAna kA vivaraNa usameM honevAlI uparyukta prakAra kI vikRtiyoM ke sAtha svatantratayA kiyA jAtA hai taba usako vizeSa vikRtivijJAna ( Special Pathology ) kahate haiN| jaba zarIra ke bhItarI ina vikRtiyoM kA svarUpa AsAnI se indriyagrAhya hotA hai taba usako sthUla ( Gross ) aura jaba asaMlacya svarUpa kA hone se dekhane ke lie sUkSmadarzaka kI AvazyakatA hotI hai taba usako sUkSma ( Microscopic ) kahate haiM / vikRtivijJAna kA vikAsa - vividha rogakAraka hetuoM se zarIra ke dhAtvAzayAdi aMgoM meM jo vividha vikRtiyA~ utpanna hotI haiM unakA kAryakAraNabhAva pradarzita karanA, For Private and Personal Use Only

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[ 3 1 una vikRtiyoM ke sthUla aura sUkSma svarUpoM kA vivaraNa karanA aura unake AdhAra para vividha vyAdhiyoM meM utpanna hone vAle lakSaNoM kA yAvacchakya spaSTIkaraNa denA yaha vikRtivijJAna kA mukhya uddezya hotA hai / yaha uddezya vividha vyAdhiyoM se mRta vyaktiyoM ke saMpUrNa itihAsa ke sAtha maraNottara parIkSaNa se unake zarIra ke dhAtvAzayAdi aMgoM ke bhItara pAye jAne vAlI vikRtiyoM kA mela kiye binA siddha nahIM ho sakatA / prAcIna kAla meM isa uddezya se zavaparIkSaNa na hone ke kAraNa vikRtivijJAna jIvitAvasthA meM vividha rogiyoM ke bAhya parIkSaNa ke samaya prApta vikRtiyoM taka hI maryAdita rahA / arthAt vaha bahuta hI choTA rahA aura usake lie svatantra astitva prApta na ho sakA / solahaveM satrahaveM zatAbdi meM pAzcAtya dezoM meM vikRti vijJAna ke lie zava parIkSaNa kA prArambha kiyA gayA / mArganI ( Morgagni) ne sana 1761 meM usake pUrva kiye ye saikar3oM zavaparIkSaNoM kI chAnabIna karake unameM se sAta sau zavaparIkSaNoM ke vRttAMta tIna bhAgoM ke eka bRhat saMgraha grantha meM prakAzita kiye aura inameM rogiyoM ke dhAtvAzayAdi aMgoM meM pAye gaye cinhoM aura lakSaNoM kA saMbaMdha unake zavoM ke bhItara pAyI gayI racanAtmaka vikRtiyoM ke sAtha kahA~ taka baiThatA hai isakI carcA kii| isake pazcAt vikRtivijJAna ke lie svatantra astitva prApta huA / Age unnIsavIM zatAbdi meM vIracau ( Rudolf Virchow ) ne zarIragata vikRtiyoM ke parIkSaNa meM sUkSmadarzaka kA upayoga Arambha kiyA aura kozikIya vikRtivijJAna ( Cellular Pathology ) para apanA grantha 1846 meM prakAzita kiyA / isase rogoM ke svarUpa kI tathA unake abhyAsa ke lie kauna se sAdhana prayukta hone cAhie~ tathA prayukta ho sakate haiM usake sambandha kI kalpanA meM krAnti paidA kI aura vikRtivijJAna jo pahale roganidAnAntargata eka choTA sA viSaya thA usako roganidAna kA adhiSThAna banA diyA / roga nidAna aura vikRti vijJAna - vaidyaka meM vikRti (vikAra) aura roga ( vyAdhi ) ye do zabda barAbara prayukta hote haiM / donoM kA artha vastutaH eka hI hairogastu doSavaiSamyaM doSasAmyamarogatA / vikArodhAtuvaiSamyaM sAmyaM prakRtirucyate // parantu vyavahAra meM yA laukika artha meM donoM meM antara kiyA jA sakatA hai / vikRtiyoM meM zarIra ke dhAtvAzayAdi aMgoM kI vaiSamyAvasthA para tathA unake racanAtmaka aura svarUpAtmaka ( Morphological and structural ) parivartanoM para jora diyA jAtA hai, rogoM meM unake kAryAtmaka ( Functional ) parivartanoM para dhyAna diyA jAtA hai / vikRtiyoM kA ullekha sadaiva dhAtvAzayAdi aMgoM se sambandhita hotA aura rogoM kA adhikatara lakSaNoM se hotA hai / vikRtiyoM meM prakaTa lakSaNa ho sakate haiM aura nahIM bhI ho sakate haiM, rogoM meM prakaTa lakSaNa jarUra hote haiM aura una lakSaNoM ke AdhAra para unako hama laukika nAma dete haiM / vAstava meM dekhA jAya to jinako hama laukikadRSTyA amukaamuka roga kahate haiM ve vikRtiyoM ke uttarakAlIna pariNAma ( Disease result ) For Private and Personal Use Only

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[ 4 ] hote haiN| isalie zarIra meM vikRtiyoM ke svarUpa meM roga bahuta pahale se rahatA hai, kevala vaha bahuta sUkSma hone se indriyagrAhya kama hokara buddhigrAhya adhika hotA hai aura sAmAnya janatA samajha sake usa prakAra kA usake lie koI nAma nahIM hotA yA diyA jA sakatA / roga nidAna meM rogoM ke nAmakaraNa ko vizeSa mahatva diyA jAne ke kAraNa hI carakAcArya jI ne vaidya ko nimna prakAra kI cetAvanI dI hai vikAranAmAkuzalo na jihIyAt kadAcana / / na hi sarvavikArANAM nAmato'sti dhruvA sthitiH|| isalie jisako roga nidAna meM prAvINya prApta karanA hai usako vikRtivijJAna eka zuddha zAstra ( Pure science ) samajha karake nahIM, balki rogakAraka hetu, rogoM kI samprApti aura rogoM ke lakSaNa inake pArasparika sambandha kA eka vyAvahArika (Applied ) zAstra samajha karake usakA khAsA gADhA adhyayana karanA cAhie / nidAna kAla-jaba zarIra gata vikRtiyA~ kAphI bar3ha jAtI haiM taba unake nidAna meM AsAnI rahatI hai parantu roga nirmUlana aura roganivAraNa meM bahuta kaThinAI hotI hai| isake viparIta jaba vikRtiyA~ bahuta sUcama aura asaMlakSya rahatI haiM taba unake nidAna meM kaThinAI hotI hai, parantu nidAna hone para roganivAraNa aura roganirmUlana meM bahuta saralatA hotI hai| isalie vaidya ko nidAna meM prAvINya prApta karane kA jo prayatna karanA hai vaha uttarottarakAlIna vikRtiyoM ke lie nahIM balki pUrva-pUrvakAlIna vikRtiyoM ke lie-caya eva jayeddoSam / aSTAMgasaMgraha // saMcaye'pahRtA doSA labhante nottarAgatIH / te tUttarAsu gatiSu bhavanti balavattarAH // (suzruta) nidAna ke sAdhana-Aptopadeza pratyakSaparIkSaNa aura anumAna ye nidAna ke tIna sAdhana batalAye gaye haiM / ye Adhunika kAla meM bhI upayukta haiM Aptatazcopadezena pratyakSakaraNena ca / anumAnena ca vyAdhIn samyaga vidyAdvicakSaNaH / (1) Aptopadeza-prAcIna kAla meM jJAna bhaNDAra guru janoM ke pAsa rahatA thA, grantha bahuta kama the aura ve bhI atyanta saMkSipta the| isalie Aptopadeza prathama sAdhana batAyA hai| Adhunika kAla meM mudraNa kalA ke kAraNa guru janoM kA bahuta kucha kArya uttamottama granthoM ke paThana se ho jAtA hai| isalie vaidya ko vikRtivijJAna ke aneka granthoM kA acchA adhyayana karanA caahie| (2) pratyakSa-isameM sarvaprathama jJAnendriyoM dvArA rogI kA parIkSaNa kiyA jAtA hai| Aja kala jJAnendriyoM kI sahAyatA karane ke lie aneka upakaraNa aura yantra upalabdha hue haiM / inake atirikta zarIra ke avakAzoM ko dekhane ke lie aneka vIkSaNa yantra ( Scopes ) hote haiM ina saboM kA upayoga pratyakSakaraNa meM karanA caahie| For Private and Personal Use Only

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[5] aura zarIra ke bhItarI aMgoM aura AzayoM kA sUkSmAMza nikAla karake usakA bhI parIkSaNa sUkSma darzaka se kiyA jAtA hai jisako jIvadvIkSaNa ( Biopsy ) kahate haiM / isase yakRta, plIhA, vRkka, lasagranthiyA~ inake bhItarI vikRtiyoM kA patA rogI kI jIvitAvasthA meM laga jAtA hai / (3) anumAna - vijJAna kI unnati se roga nidAna ke lie aneka yantrazastropakaraNa upalabdha hue haiM jinake kAraNa rogiyoM ke zarIroM ke bhItara kI vikRtiyoM ko pratyakSa karane kA kSetra prAcIna kAla kI apekSA arvAcIna kAla meM kaI sau gunA bar3ha gayA hai isameM tanika bhI sandeha nahIM hai / isakA artha aba saba pratyakSa ho sakatA hai yaha nahIM hotA yaha dhyAna meM rakhanA caahie| bAiDa ne apane vikRtivijJAna ke prArambha meM isa viSaya meM cetAvanI dI hai-- It is true that in actual practice these alterations may be of so fine a character as to escape detection, but this is merely because the methods at our disposal are still compartively crude. This is even more true of the so called functional disorders which form so large a part of the physician's practice. Ayurveda RSiyoM kA to kahanA hai ki doSadhAtuvaiSamya kI prArambhika avasthAe~ kadApi pratyakSa nahIM hotIM, ve sadaiva anumAnagamya hI rahatI haiM aura unakA anumAna vaiSamyatA ke kAraNa rogI ke AtmendriyoM ke Upara jo pratikUla saMvedanAe~ prakaTa hotI haiM unake avalokana para adhiSThita hotA hai- doSAdInAM tvasamatAmanumAnena lakSayet / aprasannendriyaM vIkSya puruSaM kuzalo bhiSak // suzruta // isalie carakAcArya kahate haiM ki jaba taka vaidya vikRtivijJAna saMpanna hokara aura buddhi tathA buddhIndriyoM kA dIpaka lekara rogI ke antarAtmA meM praveza nahIM kara sakatA taba taka na vaha acUka nidAna kara sakatA hai, na cikitsA meM yazasvI ho sakatA hai-- jJAnabuddhipradIpena yo nAvizati tatvavit / AturasyAntarAtmAnaM na sa rogAMzcikitsati // abhinava vikRti vijJAna - vividha rogoM meM zarIra ke bhItara jo vikRtiyA~ sakatA, parantu ve kyoMkara hotI haiM unameM prAcya aura pratIcya karake koI antara nahIM ho aura kaise hotI haiM tathA kisa prakAra ThIka kI jA sakatI hai isake sambandha meM prAcyapratIcya kA antara ho sakatA hai / isa antara ke sambandha meM merA prArambha se yaha vicAra rahA ki isameM virodha kA koI prazna bhinna pahaluoM se dekhane kA yaha phala hai / isa kahAvata ke anusAra eka hI vastu kA nahIM hai, eka hI vastu kI ora bhinnaisake sAtha-sAtha 'adhikasyAdhikaM phalam' abhyAsa jitane adhika pahaluoM se kiyA jAya usa vastu ke sambandha meM utanA hI adhika jJAna prApta hotA hai isa prakAra kA For Private and Personal Use Only

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[ 6 ] bhI merA mata rahA / isalie maiMne apane saba granthoM aura lekhoM meM Ayurveda ke sAmane elopAthI aura elopAthI ke sAmane Ayurveda kA mata diyA hai aura jahA~ para donoM meM antara dikhAI diyA vahA~ para usakA spaSTIkaraNa karane kA prayAsa kiyA hai / Acharya Shri Kailassagarsuri Gyanmandir abhinava vikRti-vijJAna mere ziSya AyurvedAcArya zrIyuta raghuvIra prasAda trivedI kI nayI dena hai / Apa hindI ke siddhahasta lekhaka haiM / Apane Aja taka aneka grantha likhe haiM / Apake isa grantha kI mujhe nimna vizeSatAe~ mAlUma par3atI haiM | hindI Aja taka vikRti vijJAna para koI prAmANika grantha nahIM thA / jahA~ taka merA khyAla hai hindI meM isa viSaya kA yaha prathama grantha hai / prathama hone para bhI yaha choTA nahIM hai balki bahuta bar3A kahA jA sakatA hai / isameM pAzcAtya vikRti vijJAna ke sAtha AyurvedIya vikRti-vijJAna bhI vistRta aura vizada rUpa se varNana kiyA gayA hai / prabodhinI ekAdazI saMvat 2013 kAzI hindU vizvavidyAlaya kaI varSa pUrva meraTha ke hindI - sAhitya sammelana ke vijJAna pariSad ke adhyakSIya bhASaNa meM maiMne bhaviSyavANI kahI thI, 'yadi Aja vaidyaka mahAvidyAlayoM meM hindI dvArA vaidyaka zikSA prArambha kI jAya to usake pA~ca varSoM ke abhyAsakrama ke sAtha-sAtha lagabhaga saba pAThya pustakeM banAyI jA sakatI haiM, isa kAma meM kAzI vizvavidyAlaya ke Ayurveda mahAvidyAlaya se prAvINya ke sAtha uttIrNa hue vaidya bahuta kucha sahAyatA kara sakate haiM / ' Aja isa grantha kI prastAvanA likhane ke samaya apanI bhaviSyavANI kI dRSTi se jaba maiM apane chAtroM dvArA prakAzita aura likhita granthoM kI ora dRSTipAta karane lagA taba mujhe prasannatA avazya huii| apanI icchAnusAra chAtroM dvArA kAma sampanna hote hue dekhakara kisako Antarika prasannatA nahIM hogI / parantu maiM isase adhika prasannatA cAhatA hU~ / ataH anta meM maiM sevAnivRtti ke samaya, Apako hRdaya se premapUrvaka AzIrvAda detA hU~ ki bhagavAn vizvanAtha Apako zakti, buddhi aura utsAha de tAki Apake dvArA uttarottara acche-acche granthoM kA nirmANa hotA rahe / bhAskara govinda ghANekara For Private and Personal Use Only

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prastAvanA AyurvedatattvamarmajJa zrI DA0 zivanAtha khannA ema. bI. bI. esa., DI. pI. eca. rIDara ina paithAlojI, kAzI hindU vizvavidyAlaya, vArANasI Acharya Shri Kailassagarsuri Gyanmandir AyurvedIya patrakAritA meM navayuga ke nirmANakarttA, AyurvedIya sAhitya ke suprasiddha lekhaka, kAzI hindUvizvavidyAlaya meM AyurvedAnusaMdhAna ke saciva, vyAkhyAtA aura sahayogI tathA mere katipaya una ziSyoM meM eka jinake nAma se maiM gaurava kA anubhava karatA hU~ zrI paM0 raghuvIraprasAda trivedI AyurvedAcArya dvArA likhita isa sundara aura upAdeya grantha kI prastAvanA likhane meM mujhe bahuta prasannatA ho rahI hai / zrI trivedI samanvayavAda ke samarthaka haiM / ve eka AyurvedIya mahAvidyAlaya ke snAtaka ko arvAcIna aura prAcIna donoM hI vicArakoM ke dvArA pradatta jJAna se pUrNa paricita dekhanA cAhate haiM / unake prAyaH sabhI grantha mere kathana kI satyatA pramANita karate haiN| abhinava vikRti vijJAna usI zRGkhalA kI eka sudRr3ha kar3I banakara TikegA isakA mujhe vizvAsa hai / isa grantha meM Adhunika paitholojI sAmAnya aura viziSTa ko isa yogyatA ke sAtha suyogya lekhaka ne prastuta kiyA hai ki sampUrNa viSaya mAno isa pramukha bheda ko bhUlakara eka rasa ho gayA hai / sthAna-sthAna para AyurvedIya vaikArikI ke sAtha tulanA aura usakA yathAvat spaSTIkaraNa isa saralatA aura bhAvabodhaka vyaJjanA se kiyA gayA hai ki viSaya kI durUhatA khaTakanA banda hI nahIM kara detI apitu vaijJAnikatA ne kisI sAhityakAra kA AdhAra pA liyA ho aisA pratIta hone lagatA hai jisake kAraNa sabhI viSaya rocaka aura khojapUrNa tathA adyayAvat ( apaTUDeTa ) jJAna se otaprota prakaTa hote haiM / ww prAcIna maharSiyoM ne mAnava ko duHkha se mukta karane ke lie jitane AdhyAtmika kSetra meM prayatna kie usase kama bhautika kSetra meM nahIM kie| yaha mAnava zarIra yugAnuyuga kI tapazcaryA se prApta hotA hai / isakA sadupayoga karake sadaiva ke lie kaSTa se paritrANa kA mArga jahA~ eka bhAratIya dArzanika khojatA hai vahIM isa zarIra ko bhautika kaSToM se, bImAriyoM se, Apatti se bacAkara nirAmaya aura nIroga banAkara itanA lambA kara dene kA sujhAva eka bhAratIya cikitsaka detA hai jisa kAlAvadhi meM mAnava apanI sAdhanA samApta kara nazvara mAyA ke AvaraNa ko bheda kara jIva aura parabrahma ke abheda kA sAkSAtkAra kara janma-maraNa ke saMkaTa se sadaiva ke lie trANa pA ske| isa saduddezya kI pUrti ke lie AyurvedIya zAstra kI racanA purAkAla se Aja taka hotI AI hai| Ayurveda zabda svayaM isakA pramANa hai ki isake dvArA mAnava kI Ayu kA saMvardhana paripoSaNa aura saMrakSaNa karanA hI abhilakSita hai / bhagavAn punarvasu Atreya kA yaha vAkya kisa manISI ko vibhora nahIM kara detA prayojanaM cAsya svasthasya svAsthya rakSaNamAturasya vikAraprazamanazca / For Private and Personal Use Only

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[ 2 ] ki isa zAstra ke dvArA svastha vyakti ke svAsthya kA saMrakSaNa aura rogI ke vikAra kA zamana karanA hI abhISTa hai / isI kAraNa A da svAsthyavarddhaka bhI hai tathA rogasaMhAraka bhii| kitane khule antaHkaraNa se, kitane pakSAbhiniveza se mukta vAtAvaraNa meM, isa AyurvidyA kA praNayana kiyA gayA thA isakI jaba gAthA par3hane ko milatI hai to hRdaya ullAsa se paripUrNa ho jAtA hai aura Ananda kI paramocca anubhUti anAyAsa hI prApta ho jAtI hai| atyanta prAcInakAla meM bhagavAn dhanvantari ke zrImukha se prakaTa hue ye vAkya kisa mahAnubhAva ko na hilA deMge ahaM hi dhanvantarirAdidevo jarArujAmRtyuharo'marANAm / zalyAGgamaGgairaparairupetaM prApto'smi gAM bhUya ihopadeSTum // 'maiM Adideva dhanvantari hU~ jo devatAoM kI vRddhAvasthA, roga aura mRtyu kA haraNa karane vAlA huuN| maiM anya sAtoM aMgoM ke sAtha vizeSarUpa se 'zalyAGga ( Surgery ) kA upadeza karane ke lie isa pRthvI para prApta huA huuN|' ___ Adi sarjana kI yaha vANI hai| yaha pRthvI mara ke devatAoM kI jarA, rujA aura mRtyu ke nAza ke lie tatvavettA kI pukAra hai| isameM bhUmi, deza, rAjya, prAnta, bhASA, veza, varNa kisI ke lie roka thAma nahIM hai| sabhI ko adhikAra hai ki bhagavAn dhanvantari pradatta jJAna se lAbhanvita ho kara isa kolDa aura hauTa vAra se trasta eTama aura hAiDrojana bama se grasita pRthvI mAtA ke satputra bana kara yauvana kA, nIroga kAyA kA tathA amaratva kA sukhopabhoga kara dIrgha jIvana ke carama lakSya kaivalya kI prApti kreN| yaha Ayurveda zAzvata hai-so'yamAdurvedaH zAzvato nirdizyate yaha svayaM Ayurveda ke parama tattva ke prakAzaka maharSiyoM ne svIkAra kiyA hai| yaha yuga-yuga meM yugAnurUpa phalatA phUlatA hai / isakI zAkhA prazAkhAe~ phailatI haiN| aneka prayoga calate rahate haiN| prabhu dvArA pradatta vividha jar3I bUTiyoM kA adhyayana kara ekase eka naye camatkAra kA jJAna vaijJAnika yA vaidya karatA hai tathA usa anubhava se samAja ko lAbhAnvita karatA hai| jIvita aura mRta prANiyoM ke zArIrika avayavoM kA, unakI kriyAoM kA, unakI vikRtiyoM kA jJAna pratyeka yuga meM prANI ne kiyA hai aura usa jJAna ko grantha ratnoM meM saMjokara rakkhA hai tAki Age kA yuga vigata yuga ke anubhavoM ke AdhAra para navIna yuga ke udaya hone para uThane vAlI samasyAoM kA vicAra karake naye zAstra kI racanA kara sake / kisI eka grantha ko Ayurveda zabda kI sImA meM nahIM bA~dhA jA sktaa| koI eka vargavizeSa isa zabda ke dvArA saMkucita vAtAvaraNa utpanna nahIM kara sktaa| saMsAra bhara meM jarA aura mRtyu tathA rogoM ke vinAza ke lie cala rahe sAre prayatna tathA mAnavIya svAsthya ke saMrakSaNa evaM saMvardhana ke lie upasthita kie gaye sAre upAya Ayurveda kI amUlya nivi haiN| brahmavaivarta purANa meM kitane cittAkarSaka zabdoM meM maharSi dvaipAyana vyAsa ne aneka prAcIna AyurvedIya vaijJAnikoM aura unake dvArA praNIta granthoM evaM zAstroM kI carcA kI hai vande taM sarvatattvajJaM sarvakAraNakAraNam / vedavedAGgabIjasya bIjaM zrIkRSNamIzvaram // sa Izazcaturo vedAn sasRje maGgalAlayAn / sarvamaGgalamaGgalyavIjarUpaH sanAtanaH // RgyajursAmAthAkhyAn dRSTvA vedAn prjaaptiH| vicintyateSAmarthaJcaivAyurvedaM cakAra sH|| kRtvA tu paJcamaM vedaM bhAskarAya dado vibhuH / svatantrasaMhitAM tasmAdbhAskarazca cakAra sH|| bhAskarazca svaziSyebhya AyurvedaM svasaMhitAm / pradadau pAThayAmAsa te cakruH sNhitaasttH|| teSAM nAmAni viduSAMtantrANi taskRtAni c| vyAdhi praNAzavIjAnisAdhvimatto nishaamy|| dhanvantaridivodAsaH kAzIrAjo'zvinIsutau / nakulaH sahadevo'zcyivano janako budhaH / / For Private and Personal Use Only

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jAvAlo jAjaliH pailaH karatho'gastya eva ca / ete vedAGgavedajJAH SoDaza vyaadhinaashkaaH|| cikitsAtatvavijJAnaM nAma tantraM manoharam / dhanvantarizca bhagavAn cakAra prathame sati // cikitsAdarpaNaM nAma divodAsazcakArasaH / cikitsAkaumudI divyAM kAzIrAjazvakAra sH|| cikitsAsAratantraJca bhramanaM caashviniisutau| tantraM vaidyakasarvasvaM nakulazca cakAra saH / / cakAra sahadevazca vyAdhisindhuvimardanam / jJAnArNavaM mahAtantraM yamarAjazvakAra h|| cyavano jIvadAnaM ca cakAra bhgvaanRssiH| cakAra janako yogI vaidyasandehabhaJjanam // sarvasAraM candrasuto jAvAlastantrasArakam / vedAGgasAraM tantraJca cakAra jaajlimuniH|| pailo nidAnaM karathastantraM sarvadharaM param / dvaidhanirNayatantraJca cakAra kumbhsmbhvH|| cikitsAzAstravIjAnitantrANyetAni ssoddshH| vyAdhipraNAzavIjAni balAdhAnakarANi ca // mathitvA jJAnamantreNairvAyurveda payonidhim / tatastasmAdudAja navanItAni kovidAH / / kitanA hRdayAvarjaka hai yaha kathAnaka ! ye bhAskarapaMthI vedAGgavedaza solahoM kathAkAra Ayurveda ke vividha granthoM kA praNayana kara kAla ke karAla gAla meM samAjAne para bhI amara ho gye| bhAskarasaMhitA, cikitsAtatvavijJAna, cikitsAdarpaNa, cikitsAkaumudI, cikitsAsAratantra, vaidyakasarvasva, vyAdhisindhuvimardana saba lupta ho gye| yamarAja dvArA likhita jJAnArNava lupta ho gyaa| cyavana kA jIvadAna, yogirAja janaka kA vaidyasandehabhAna nAmaka grantha, jAbAlikA sarvasAra, jAjali kA vedAGgasAra sabhI kho gye| paila RSi gaye unakA nidAna bhI calA gyaa| karatha kA sarvadhara kisa dharA para dharA hai kauna kahegA ! ghar3e se utpanna hokara Adhunika jagat ke vaijJAnikoM ko mahAn Azcarya meM DAlane vAle agastya maharSi kA dvaidhanirNayatantra samApta ho gyaa| ye cikitsA zAstra ke bIja, roga nAza ke mUla tatva, balAdhAna kAraka divyasandezavAhaka grantha ratna jJAna vijJAna ke mantroM ke dvArA Ayurveda sAgara ko mathakara jo navanIta ke samAna zAstra kovidoM ne nikAle saba Aja adRzya hone para bhI zAzvato'yamAyurvedaH kA rava gUMja rahA hai jo yaha batalAtA hai ki Ayurveda na grantha paraka hai na vyakti paraka / granthoM kA nirmANa eka ke bAda dUsarA hotA jaavegaa| vaijJAnika eka ke bAda dUsarA AtA jaavegaa| vaha apane yuga kI pukAra sunegA apane atIta se zakti aura sAdhana prApta kara naye bhavana kA nirmANa karegA aura avazya kregaa| abhinava vikRti vijJAna usI vicAra dhArA se puSTa yugAnurUpa kRti hai| __ Ayurveda yaha mAnatA hai ki zarIra vyAdhi kA mandira hai| isako vividha hetu zArIrika mAnasika, daivika, bhautika kaSTa dete haiM / kaSTa se mAnava duHkhAnubhava karatA hai| isa duHkhAnubhUti kA kAraNa hai adharma prAgapi cAdharmAdRte nAzubhotpattiranyato'bhUt / prAcInakAla meM bhI adharma ke binA roga nahIM utpanna hue / rogotpatti ke sambandha meM eka bar3I manohAriNI kathA carakasaMhitA meM isa prakAra prakaTa huI hai AdikAle hyaditisutamaujaso'tibalavipulaprabhAvAH pratyakSadevadevarSidharmayajJavidhividhAnAH zailasArasaMhatasthirazarIrAH prasannavarNendriyAH pavanasamabalajavaparAkramAH cArusphico'bhirUpapramANAkRtiprasAdopacayavantaH satyArjavAnRzaMsyadAnayamaniyamatapaupavAsabrahma caryavrataparA vyapagatabhayarAgadveSamohalobhazokakrodhamAnaroganidrAtandrAzramalamAlasyaparigrahAzca puruSAH babhUvuH amitAyuSaH teSAmudArasatvaguNakarmaNAM dharmANAmacintyAvAt rasavIryavipAkaprabhAvaguNasamuditAni prAdurbabhUvuH zasyAni sarvaguNasamuditatvAt pRthivyAdInAM kRtaM yugsyaadau| isa parama ramaNIya Adarza jIvana kI kalpanA kA camatkAra prakaTa karake phira unhoMne vikAroM kI utpatti ke sambandha meM isa prakAra likhA hai For Private and Personal Use Only

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[ 4 ] bhrazyati tu kRtayuge keSAzcidatyAdAnAt sAmpatrikAnAM zarIragauravamAsIt / satvAnAM gauravAt zramaH zramAdAlasyama, AlasyAt saJcayaH, saJcayAtparigrahaH, parigrahAllobhaH, prAdurAsIt kRte / tatastretAyAntu lobhAdapidroho'bhidrohAdanRtavacanam, anRtavacanAt kAmakrodhamAnadveSapAruSyAbhighAtabhayatApazokacintodvegAdayaH prvRttaaH|| tatastretAyAM dhrmpaadontrdhaanmgmt| tasyAntardhAnAt yugavarSapramANasya pAdahAsaH pRthivyAderguNapAdapraNAzo'bhUt / tatpraNAzakRtazca zasyAnAM snehvaimlyrsviiryvipaakprbhaavgunnpaadbhrNshH| tatastAni prajAzarIrANi hInaguNapAdehIyamAnaguNezvAhAravikArarayatha. pUrvamupaSTabhyamAnAnimArutaparItAni / prAga vyAdhivarAdibhiH AkrAntAnyataHprANino hAsamavApurAyuSaH kramaza iti / (ca. vi. sthA. a.3) kRtayuga ke bIta jAne para kinhIM sampanna vyaktiyoM ke dvArA atyadhika AdAna se zarIra meM gaurava utpanna ho gyaa| zarIra bhArI hone se thakAvaTa Ane lagI, thakAvaTa se Alasya paidA huA, Alasya se saJcaya kI pravRtti huI, saJcaya ne parigraha bar3hAyA, parigraha ne lobha utpanna kara diyaa| Age calakara tretAyuga meM hI lobha se abhidroha utpanna huA, abhidroha se jhUTha bolanA banA, jhUTha bolane (anRtavacana) se kAma-krodha-mAna-dveSa, pAruSya-abhighAta, bhaya, tApa, zoka, cintA aura udvegoM kI pravRttiyAM pnpiiN| ina saba kupravRttiyoM ke kAraNa dharma kA eka caraNa TUTa gayA usake antardhAna ho jAne ke kAraNa yuga tathA varSa ke pramANoM meM bhI eka caturthAMza kA hAsa ho gayA arthAt 4800 divya varSoM kA jo satayuga rahA usameM se 1200 divyavarSe ghaTakara tretA 3600 divyavarSoM kA raha gayA / pRthvI Adi mahAbhUtoM ke guNoM meM bhI caturthAza kA hAsa ho gyaa| isa kamI se padArthoM kA sneha vimalatA rasa-vIrya-vipAka-prabhAva tathA guNoM meM bhI usI anupAta meM kamI AgaI / unakA upayoga prANiyoM ko karanA par3A isalie prajAvarga ke zarIra meM bhI caturthAMza guNa kama ho gye| agnimArutAdika kI hInaguNatA ke kAraNa jvarAdi rogoM se ve pIDita hone lage aura kramazaH Ayu ghaTa gii| vikAra yA duHkha kA hetu dhIbhraMza, dhRtibhraMza, smRtibhraMza, kAla tathA karma kI samprApti, asAtmya indriyArthoM kA saMyoga Ayurveda mAnatA hai dhIratismRtivibhraMzaH samprAptiH kAlakarmaNAm / asAlyArthagamazceti jJAtavyA duHkhhetvH|| (ca. zA. a 1) uparokta tInoM prakAra ke bhraMza kA hI sAmUhika nAma yadyapi prazAparAdha diyA gayA hai aura usakA vivecana bhI spaSTa kiyA gayA hai ki vaha doSoM kA prakopa karane meM kAraNabhUta hotA hai dhIdhatismRtivibhraSTaH karma yatkurute'zubham / _prajJAparAdhaM taM vidyAtsarvadoSaprakopaNam // nityAnitya aura hitAhita meM viSama jJAna-buddhibhraMza, ahitakara viSayoM kI ora citta kI pravRtti ko rokane kI pravRtti kA abhAva-dhRtibhraMza tathA tatvajJAna kA smaraNa rajomohAvaraNa se naSTa ho jAnA smRtibhraMza ke antargata AtA hai| yaha manaHsthiti jisa bhayaMkara patana kA nirdeza karatI hai usakA zabda-citra svayaM bhagavAn caraka ne adholikhita zabdoM meM prakaTa kiyA hai udIraNaM gatimatAmudIrNAnAM ca nigrahaH / sevanaM sAhasAnAzca nArINAM cAti sevanam // kamekAlAtipAtazca mithyArambhazca karmaNAm / vinayAcAralopazca pUjyAnAM cAbhidharSaNam // jJAtAnAM svayamarthAnAmahitAnAM niSevaNam / paramonmAdikAnAM ca pratyayAnAM niSevaNam // akAlAdezasaJcArau maitrI saMkliSTakarmabhiH / indriyopakramoktasya savRttasya ca varjanam // For Private and Personal Use Only

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[ 5 1 IrSyAmAnabhayakrodha lobhamohamadubhramAH / tajjaM vA karma yatkliSTaM yadvA taddeha karma ca // yaccAnyadIdRzaM karma rajomohasamutthitam / prajJAparAdhaM taM ziSTA bruvate vyAdhikAraNam // AcAryoM ne vikAroM kA vargIkaraNa vividha prakAra se kiyA hai / sAdhyaroga asAdhyaroga, mRdurogadAruNaroga, mano'dhiSThAnabhUta roga zarIrAdhiSThAnabhUtaroga, svadhAtuvaiSamya nimitta roga-Agantu nimittaroga, AmAzaya samuttharoga - pakkAzaya samuttharoga isI prakAra vividha anya bhI vargIkaraNa kie gaye haiN| mAnavIya roga aneka hote haiM tathA unake karttA doSa nizcita haiM isIlie Ayurveda meM vyAdhi ko utanA mahattva nahIM diyA gayA jitanA ki usake utpAdaka doSoM kA vivecana kiyA gayA hai / doSa bhI AcAryoM ne do prakAra ke mAne haiM / 1. mAnasadoSa satva, raja tathA tama aura 2. zarIradoSa vAta, pitta tathA kapha / mAnasadoSoM ke kAma-krodha-lobha-moha - IrSyA-mAna-mada-zoka- cittodvega-bhaya-harSa Adi vikAroM kI utpatti mAnI jAtI hai| zArIra doSoM se jvara - atIsAra kuSTha-zvAsa- zoSaprameha - udararogAdi vividha vikAra hote haiM / ina donoM prakAra ke doSoM kA tIna prakAra se prakopaNa hotA hai 1 - asAtmyendriyArtha saMyogajanya, 2 -- prajJAparAdhajanya, tathA 3 - pariNAmajanya / ina sabake sambandha meM AyurvedIya upalabdha saMhitAoM meM bar3A tarka sammata varNana milatA hai / prakRti aura vikRti ye do zabda AyurvedIya haiM / nidAnAtmaka vicAraNA ke lie unakI AvazyakatA par3atI hai| zAstrakAroM ne 1 - jAtiprasaktA, 2 - kulaprasaktA, 3-dezAnupAtinI, 4- kAlAnupAtinI, 5 - vayo'nupAtinI tathA 6 - pratyAtmaniyatA 6 prakAra kI prakRti mAnI hai / unhoMne kisI jAtivizeSa meM janma hone ke kAraNa svAbhAvika rUpa se jo guNa vyakti meM prApta hote haiM unheM jAtiprasaktA ke antargata samajhAyA hai / jaise kSatriya svabhAva se hI vIra, lar3AkU aura zAsanakarttA hotA hai / jAti kA bodha hone se kSAtra prakRti kA turata bodha ho jAtA hai / kulaprasaktA prakRti dvArA kula kA bodha hotA hai / jaise raghuvaMziyoM kI Ana ki prANa jAne kI cintA nahIM vacana kI rakSA honI cAhie / dezAnupAtinI prakRti vyakti kI janmabhUmi ke guNoM kI prakAzikA hotI hai / baMgadezIya vyakti adhika buddhimAn, magadhadezIya yuddhapriya, mahArASTriya kaTTara, paJjAbI phaizana pasanda, madarAsI sarala jIvana priya Adi / kAlAnupAtinI prakRti vividha kAlakhaNDoM kA bodha karAtI hai| tretAyugIna vyakti, kaliyugIna vyakti / isI prakAra vasantAdi Rtu prabhAva kA bhI bodha isase hotA hai / vayo'nupAtinI prakRti vyakti kI Ayu kA vicAra prakaTa karatI hai / bAlaka, sukumAra aura navayuvaka kA uddaNDatApriya honA eka svabhAva hai / pratyAtmaniyatA prakRti vyakti vizeSa kI apanI pravRttiyoM ke anukUla bane svabhAva kI ora iGgita karatI hai / vikRti tIna prakAra kI kahI gaI hai - 1 -lakSaNanimittA, 2- lakSyanimittA tathA 3- nimittAnurUpA / lakSaganimittA vikRti deva ke kAraNa vyakti meM utpanna lakSaNa - sAmudrika lakSaNa athavA anya vikRtiyA~ jo janma ke sAtha usameM AtI haiN| lakSyanimittA vikRti kA lakSaNa svayaM caraka meM isa prakAra AyA hai cayanimittA tu sA yasyA upalabhyate nimittaM yathoktanidAneSu / jisakA kAraNa nidAnAdika se jJAta ho jAtA hai / vikAra jinakA varNana AyurvedIya yA maiDIsina ke granthoM meM huA hai jinakA nimitta bhUtAdika yA doSAdika kisI na kisI prakAra jJAta kiyA jA sakatA hai isa vikRti ke antargata lie jAte haiM isI kA varNana isa grantha meM huA hai / nimittAnurUpA vikRti vaha vikRti hai jo binA kisI nimitta ke hI lakSaNanimittA tathA lakSyanimittA vikRti ko upasthita kara de jaisA ki gatAyuSa mumarSuoM meM dekhane meM AtA hai| jaba For Private and Personal Use Only

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[6] vyakti ke zarIra meM vividha sAmudrika zAstra sambandhI yA zarIra roga vikRti janaka cinha bana jAte haiM yA doSAdi ke dvArA vikRti se hone vAlI hI vikRti akasmAt A jAtI hai ise mumUrSu vijJAna kahA jA sakatA hai / kavirAja gaGgAdhara ne isI ko nimna zabdoM meM vyakta kara diyA hai - nimittArthaM kAriNo nimittAnAM lakSaNAnAM lakSyANAJca ye'rthA vikRtayastAn arthAn kartuM zIlaM yasyAH sA nimittArthakAriNI | udAharaNena tAM darzayati yAmityAdi / yA vikRtim animittAM nimittaM vinA rekhAdi cihnaM vyAdhyAdikaM kAraNaM vinA prAktana karmato yadRcchayA vA jAtAmAyuSaH pramANa jJAnasya nimittamicchanti bhiSajaH sA nimittArthakAriNI nimittAnurUpocyate / lakSaNanimittA vikRti para apanA koI adhikAra nahIM / lakSyanimittA vikRti hI vAstava meM paithAlojI zabda kA paryAya mAnA jAnA cAhie / nimittAnurUpA prakRti meM prAcIna tatvajJoM ne rogiyoM kI maraNAsannAvasthA ke spaSTa citra aGkita kara diye haiM / inakA vizada varNana caraka saMhitA ke indriyasthAna meM hai / ye varNana kitane gambhIra adhyayana aura anekAneka prayogoM ke uparAnta nizcita kie gaye hoMge isakA vicAramAtra sampUrNa zarIra ko romAJcita kara detA hai / isameM cikitsA zAstra kA mAno vaha nicor3a de diyA gayA hai jisako hRdayaGgama karake vaidya apakIrti se apanI rakSA kara sakatA hai| gatAyu rogI ke parivAra vAle akAraNa hone vAlI arthahAni se baca sakate haiM tathA Adhunika zodhakoM ke lie eka celaia hai ki ina-ina lakSaNoM ke hone para vyakti ko gatAyuSa mAnanA cAhie aisA jo AyurvedajJa kahatA hai usameM apane Adhunika camatkAroM ne itanoM ko jIta liyA tathA nimittAnurUpA prakRti kA itanA kSetra sImita kara diyA gayA / yaha celaia caraka ke kAla se Aja taka yathAvat anusandhAnakarttAoM ke sAmane hai / maiM isa viSaya ko aura adhika spaSTa karane ke abhiprAya se nimittAnurUpA vikRti ke Avazyaka udAharaNa vividha AyurvedIya granthoM se avikala uddhRta karatA hU~ / pratyeka nizcita rUpa se vikAra kI usa caramAvasthA kI ora lakSya karatA hai jise Ayurveda asAdhya mAnatA hai aura spaSTa zabdoM meM ghoSaNA karatA hai ki na svariSTasya jAtasya nAzo'sti maraNAdyate / maraNaJcApi tannAsti yannAriSTa puraHsaram // eka bAra ariSTa utpanna ho jAne para usakA nAza vinA maraNa ke nahIM hotA / tathA usakA bhI maraNa sambhava nahIM hai arthAt use bacAyA jA sakatA hai jise ariSTa lakSaNa pahale utpanna nahIM ho gayA hai / aba hama nimittAnurUpA vikRti ke kucha udAharaNa vA ariSTa lakSaNoM kA ullekha karate haiM ( carakokta ) 1 - hikkA gambhIrajA yasya zoNitaM cAtisAryate / na tasmai bheSajaM dadyAtsmarannAtreyazAsanam // gambhIra hicakiyoM ke sAtha atyadhika raktAtIsAra mAraka hotA hai / 2 - jvaro yasyAparAddhe tu zleSmakAsazca dAruNaH / balamAMsavihInasya yathA pretastathaiva saH // sAyaGkAla meM jvara ke sAtha dAruNa zlaiSmika kAsa se pIDita bala-mAMsa rahita prANI preta jaisA mAnanA cAhie / 3 - zvayathuryasya pAdasthastathA sraste ca piNDike / sIdatazcApyubhe jaGke taM bhiSakparivarjayet // pairoM para sUjana, piNDaliyAM zithila donoM jaGghAeM avasAdita hone para use bhiSak chor3a deM / 4 - zUnahastaM zUnapAdaM zUnaguhyodaraM naram / hInavarNabalAhAramauSadhairnopapAdayet // hAtha, paira, guhyAMga aura udara jisakA sUjA huA ho; varNa, bala aura bhojana kI mAtrA jisakA bahuta ghaTa gaI ho use oSadhi na de / For Private and Personal Use Only

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[ 7 ] 5 - uroyuktI bahuzleSmA nIlaH pItaH salohitaH / satataM vyavate yasya dUrAttaM parivarjayet // chAtI se nIle pIle varNa kA bahuta sA kapha rakta ke sAtha nirantara nikAlane vAle ko dUra se chor3a deN| 6 - jvarAtisArI zophtante zvayathurvAtayoH kSaye / durbalasya vizeSeNa narazcAntAya jAyate // - vizeSa rUpa se durbala hue ko zotha ke bAda jvarAtisAra ho jAya yA jvara aura atIsAra ke bAda zodha ho jAya to usakA anta jAnanA cAhie / Acharya Shri Kailassagarsuri Gyanmandir 7 - hanumanyAgrahastRSNA balahAso'timAtrayA / prANAzcorasi vartante yasya taM parivarjayet // jisakA jabar3A jakar3a gayA ho aura manyA kA bhI graha ho gayA ho pyAsa ho, bala kA atyadhika hrAsa ho gayA ho aura jisake prANa kevala chAtI meM hI raha gaye hoM use chor3a de / 8 - kAmalA'caNormukhaM pUrNa zaGkhayormuktamAMsatA / saMnyAsazvoSNagAtraM ca yasya taM parivarjayet // AMkha aura mukha pIle par3a gaye hoM, mukha bharA huA ho, donoM zaMkha pradezoM se mAMsa naSTa ho gayA ho, trAsa bar3ha rahA ho aura zarIra garama rahatA ho to use chor3a de / 9 - uparuddhasya rogeNa karSitasyAlpamakSataH / bahumUtrapurISaM syAdyasya taM parivarjayet // roga ne jise kRza kara diyA ho thor3A bhojana karatA ho tathA adhika mUtra aura mala kA tyAga karatA ho use chor3a de / 10 - durbalo bahubhuGkte yaH prAgbhuktAdannamAturaH / alpamUtrapurISazca yathA pretastathaiva saH // jo rogI apanI svasthAvasthA se kahIM adhika khAkara thor3A mala-mUtra tyAga karatA hai to use preta jaisA mAnanA cAhie / 11 - vardhiSNuguNasampannamannamaznAti yo naraH / zazvacca balavarNAbhyAM hIyate na sa jIvati // jo nirantara balavarddhaka padArtha khAtA hai phira bhI usakA bala aura varNa barAbara ghaTatA jAtA hai vaha rogI jindA nahIM rahatA / 12- prakUjati pazvasiti zithilaM cAtisAryate / balahInaH pipAsArtaH zuSkAsyo na sa jIvati // gale se kUjatA hai, zvAsa tejI se calatI hai, zithila hai, TaTTI bAra-bAra karatA hai, balarahita, pyAsA aura mukha jisakA bAra-bAra sUkhatA hai vaha jIvita nahIM rahatA hai / 13 - hrasvaM cayaHprazvasiti vyAviddhaM spandate ca yaH - / jisakA prazvAsa choTA ho gayA hai mAno kisI ne mRtameva tamAtreyo vyAcacakSe punarvasuH // kATa liyA ho aise spandana karatA hai use mRta hI mAnanA cAhie / 14 - UrdhvaM ca yaH prazvasiti zleSmaNA cAbhibhUyate / hInavarNabalAhAro yo narona sa jIvati // kapha se jisakA kaNTha ghira gayA ho Urdhva zvAsa letA ho aura varNa tathA bala jisakA naSTa ho gayA ho vaha nahIM jItA / 15 - na bibharti ziro grIvA na pRSTha bhAramAtmanaH / na hanU piNDamAsyasthamAturasya mumUrSataH // mumUrSu kI grIvA sira kA bojha nahIM samhAlatI, pITha apane bhAra ko nahIM samhAlatI, mukha meM to gaye padArtha ko vaha nigalane meM asamartha rahatA hai / 16- saphenaM rudhiraM yasya muhurAsyAtpramucyate / zUlaizva tudyate kukSiH pratyAkhyeyaH sa tAdRzaH // mukha se jo bAra-bAra phenayukta rudhira nikAlatA hai, kukSi meM zUla utpanna ho jAtA hai use pratyAkhyeya samajhanA cAhie / 17 - hRdayaM ca gudaM cobhe gRhItvA mAruto balI / durbalasya vizeSeNa sadyo muSNAti jIvitam // hRdaya aura guda yA donoM ko grahaNa karake balavAn vAyu vizeSakarake durbala ko zIghra mAra DAlatA hai / For Private and Personal Use Only

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[ ] (suzrutokta) 18-zyAvA jihvA bhavedyasya savyaM cAti nimjti|mukhN ca jAyate pUti yasya taM privrjyet|| jisakI jIbha kAlI ho jAtI hai, vAma netra gar3ha jAtA hai, mukha se badabU AtI hai use chor3a de| 19-cikitsyamAnaH samyak ca vikAro yo'bhivrdhte| prakSINabalamAMsasya lakSaNaM tadtAyuSaH / / - lagAtAra cikitsA karane se bhI jisakA vikAra bar3hatA hai aura bala-mAMsakSINa hotA calA jAtA hai usake ye lakSaNa gatAyu ke dyotaka haiN| 20-zUnaMsuptatvacaM bhagnaM kmpaadhmaannipiidditm| naraM rujArtimantaM ca vaatvyaadhivinaashyet|| zotha, sparzajJAnahInatA, asthibhaMga, kampa aura AdhmAna se pIDita atyadhika zulayukta vyakti ko vAtaroga naSTa kara detA hai| 21-yathoktopadravAviSTamatipracutameva ca / piDakApIDitaM gADhaM prameho hanti mAnavam // zAstrokta upadravoM se yukta, adhika mAtrA meM bAra-bAra mUtratyAgI tathA piDakAoM se pIDita prameha mAnava ko naSTa kara detA hai| 22-garbhakoSaparAsaGgo makalo yonisNvRtiH| hanyAt striyaM mUDhagarbhe ythoktaashcaapyupdrvaaH| mUDhagarbha hone para garbhAzaya kriyAhIna ho jAve, makkalazUla ho, yoni meM saMvaraNa ho jAya tathA anya zAstrokta upadrava hoM to strI kA prANanAza ho jAtA hai / 23-pArzvabhaGgAnavidveSazophAtIsArapIDitaH / viriktaM pUryamANaM ca varjayedudarAditam // pArzva meM bhedanavat zUla, anna se dveSa, zopha, atIsAra hoM tathA virecana karane para bhI jisake jala kI mAtrA udara meM barAbara bhara jAtI hai aise udara rogI ko tyAga de| 24-yastAmyati visaMjJazca zete nipatito'pi vA / zItAdito'ntaruSNazca jvareNa mriyate nrH|| sone para bhI jo mUcchita aura visaMjJa ho jAtA hai tathA gira jAtA hai athavA bAhara se ThaNDA aura Temparecara lene para jise adhika garmI mile aisA jvara se mara jAtA hai / (vAgbhaTokta) 25-AnanaM hastapAdaM ca vizeSAdyasya zuSyataH / zUyete vA vinA dehAt sa mAsAdyAti paJcatAm // ___ mukha aura hAtha paira jisake vizeSarUpa se sUkhane lageM yA sUja jAveM parantu zarIra yathAvat rahe to vaha vyakti eka mahIne meM mara jAtA hai| 26-candanozIramadirAkuNapadhvAGkSagandhayaH / zaivAlakukkuTazikhAkuGkumAlamaSIprabhAH / antardAhA nirUSmANaH prANanAzakarA vraNAH / / jina vraNoM se candana, khasa, zarAba, murdA aura dhvakSi ( kAka yA sArasa ) jaisI gandha AtI ho yA jo zaivAla, murge kI kalagI, kuGkuma, chAla athavA syAhI ke raMga ke ho gaye hoM jinameM antardAha to ho para USmA rahita hoM ve prANanAza karate haiN| (mAdhavanidAna) 27-hetubhirbahubhirjAto blibhirbhulkssnnH|jvrH prANAntakRyazca zIghramindriyanAzanaH ||(c) ___ bahuta kAraNoM se utpanna, balavAn , aneka lakSaNayukta jvara aura indriyajJAnazakti naSTa karake prANanAzakAraka hotA hai| 24-pakajAmbavasaMkAzaM yakRtkhaNDanibhaM tanu / ghRtatailavasAmajAvezavArapayodadhi mAMsadhAvanatoyAbhaM kRSNaM nIlAruNaprabham / mecakaM snigdhaka--raM candrakopagataM dhanam // kuNapaM mastuluGgAbhaM sugandhi kuthitaM bahu / tRSNAdAhatamAzvAsahikApAvAsthizUlinam // saMmUrchAratisaMmohayukta pakkabalI gudam / pralApayuktaM ca bhiSagvarjayedatisAriNam // (su.) For Private and Personal Use Only

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pakI jAmuna ke raMga kA, yakRt ke Tukar3e ke samAna, ghI, tela, cIM, majjA, vezavAra, dUdha, dahI, mAMsa dhoye jala ke samAna, kAlA, nIlA, aruNa, aJjanapiNDa ke samAna, cikanAIyukta, nAnA varNa kA, mayUrapiccha ke samAna candrikAyukta, saghana, murde kI gandhavAlA, mastiSka ke padArtha jaisA, sugandhita, sar3A huA, bahuta sA mala jo tyAgatA hai-tRSNAdi lakSaNa haiM, jisakI gudA kI valiyAM paka gaI haiM, pralApa karatA hai aise atisAra rogI kI cikitsA varNya hai| 29-pANDudantanakho yastu pANDunetrazca yo bhavet / pANDusaMghAtadarzI ca pANDurogI vinazyati // (su.) jisake nakha, danta, netra pANDuvarNa ke hoM tathA jo sampUrNa vastuoM ko pANDuvarNa kA hI dekhatA hai vaha pANDurogI mara jAtA hai| 30-hnustmbhaarditaaksseppkssaaghaataaptaankaaH|kaalen mahatAvAtA yatnAsidhyanti vA na vaa|| hanustambha, ardita, AkSepa, pakSAghAta, apatAnaka dIrghakAlIna cikitsA se kabhI ThIka ho jAte haiM kabhI nahIM bhI hote| 31-tRSNAditaM parikliSTaM kSINaM zUlairabhidatam / zakRdvamantaM matimAnudAvartinamutsRjet // bhayaMkara pyAsa, becainI, tIvrazUla, bahuta kSINa vyakti mukha se mala kA vamana karane lage aise udAvartI ko chor3a de| 32-zUnAkSaM kuTilopasthamupaklinatanutvacam / balazoNitamAMsAgniparikSINaMcavarjayet ||(c) jisakI A~khe sUja gaI haiM, mUtrendriya zotha se Ter3hI par3a gaI ho tvacA gIlI aura patalI ho, jisakA bala-rakta-mAMsa aura agni kSINa ho cuke hoM use chor3a de|| 33-asaMzliSTakapAlaM ca lalATe cUrNitaM ca yt| bhagnaM stanAntare pRSThe zaMkhe mUrdhni ca varjayet // kapAla kI sandhiyA~ jisakI khula gaI ho, lalATa cUrNita ho, stanoM ke bIca kA kSetra bhagna ho, pITha, zaMkha yA sira kI haDDI TUTI ho inameM se pratyeka bhAga kA rogI varjanIya hai| 34-zazvarasravantImAsrAvaM tRSNAdAhajvarAnvitAm / kSINaraktAM durbalAM ca tAmasAdhyAM vinirdizet // jisa strI ko nirantara raktasrAva ho rahA hai jo tRSNA, dAha aura jvara se pIDita, kSINa rakta aura durbala hai use asAdhya samajhanA caahie| jisa prakAra zArIrika doSa rogoM ke utpAdaka hai usI prakAra mAnasika doSa bhI vikAroM ke kAraka haiM / yadyapi isa viSaya para Ayurveda ne paryApta prakAza DAlA hai phira bhI pAzcAtya manovijJAna ne isa kSetra meM ekadama nayI krAnti upasthita kara dI hai| isakA pariNAma yaha huA hai ki unmAda kI cikitsA meM Aja AkAza-pAtAla kA antara prakaTa hotA hai| Adhunika vidvAnoM meM san 1300 meM mauNDavile ne mAnasika zAnti ke sambandha meM apane vicAra vyakta kiye the| pairAsailsasa ne sabase prathama yaha mata vyakta kiyA ki eka mastiSka dUsare mastiSka ko prabhAvita karatA hai aura yaha prabhAva eka prakAra ke cumbakIya tarala ke kAraNa hotA hai| maiksavaila aura usake ziSya karzara ne isa kathana ko puSTa karane kA yatna kiyA aura kahA ki mAnasika roga kA kAraNa iso tarala kA abhAva hotA hai tathA isa tarala ko cumbakatva se punaH pUrA kiyA jA sakatA hai| hailamoNTa ne apanA mata prakaTa karate hue batalAyA ki yaha cumbakIya tarala eka manuSya se nikalakara dUsare manuSya kI icchA-zakti ko prabhAvita kara sakatA hai| isI cumbakatva kI mAnavetara prANiyoM meM siddhi maismara (1770) ne kI tathA manuSya ke hAtha kI cumbakIya For Private and Personal Use Only

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[10] zakti ke prabhAva ko vyakta kiyA jisake nAma para maismairijma kA janma huaa| Age bhautika unnati ke yuga kA zrIgaNeza hone se ye vicAra pIche raha gaye / breDa evaM bIDa ( 1830-40) ne inako spaSTa sujhAva dvArA utpanna kiyA jA sakatA hai yaha batalAyA aura usane hipnATijma nAmaka nayA zabda upasthita kiyaa| cArkaTa ne isakA upayoga karake batalAyA ki kaise kisI ko hisTIriyA utpanna kiyA jA sakatA hai yA kaise utpanna hisTIriyA ko ThIka kiyA jA sakatA hai| usane yaha bhI kahA ki mastiSka dhAtuoM meM ina lakSaNoM kI utpatti se vihrAsa bhI ho jAtA hai| ricara ne isa para aura prayoga kie / hIDanahIna ne hipnosisa ( mUrchA ) kI utpatti mastiSka kriyA ke naSTa ho jAne se btlaaii| ___ isI sujhAva ko bebinskI aura phromeNTa ne aura bhI spaSTa kiyA ki sujhAva kA prabhAva kisI vicAra ko utpanna karane meM hotA hai yaha vicAra (AiDiyA ) eka aisI gamanazIla zakti bana jAtA hai jo mUrchA ke lakSaNa utpanna kara detA hai| kue aura baDuina ne ina viSama sujhAvoM ko AtmasujhAva kA rUpa de diyA jisake anusAra eka vicAra jo kisI dUsare vyakti meM pahu~cAyA jAtA hai vaha eka vicAra pratyAvartana zakti se yukta hotA hai| yahI zakti use svIkRti ke lie bAdhA karatI hai| DUbauisa aura DejarAina ne sujhAva ke sthAna protsAhana ( Persuation ) kI mahattA mAnasa-cikitsA kI dRSTi se adhika upayogI ThaharAI hai| jisake anusAra rogI ko kucha vicAra diye jAte the jinakA prabhAva upayukta ho para isake lie rogI kA sahayoga bhI apekSita mAnA jAtA thaa| ve usakI vyavasAyAtmikA buddhi ke anukUla vicAra upasthita karate the| ina vicAroM ke prati rogI kA utsAha kitanA bar3hA hai ise DejarAina ne adhika mahattva diyA jisake pariNAmasvarUpa eDalara kA mAnasa-zAstra prakaTa huaa| rojAnopha ne bhI eDalara ke anusAra mAnasa roga meM zArIrika daurbalya, caritra meM vikAra tathA uttejanAtmaka vAtAvaraNa ko svIkAra karake durbalavAda (Invalidism) ko lakSyaprApti kA eka sAdhana mAnA / jaineTa ne bebinskIya vicAradhArA meM thor3A pRthaktva prakaTa kiyaa| usake anusAra hisTIriyA kI visaMjJatA vAstavika visaMzatA nahIM hotii| usane eka mAnasika tanAva kI sthiti svIkAra kI hai jisake Upara vyaktitva (Personality) ko vyavasthita rakhane kI jimmedArI hai| usake anusAra mastiSka kI kriyA kA avasAda, mAnasika zakti kA pRthaktva aura vahana isa pRthaktva kA usa kArya para AdhArita honA jo nirantara durbala rahA hai aura jo kArya ki rogI ke lie bahuta kaSTadAyaka hai tathA jo uttejanA kI caramAvasthA meM sabase adhika anubhava meM A rahA thA ko hisTIriyA kA kAraNa mAnA hai| ina matoM ne Age cala kara mAnasa-vikRti-vijJAna kI tIna dhArAe~ grahaNa kI haiM-eka boiraka tathA vAlagesI kI jisameM hipnATisma kA punaH ubhAr3a hai, dUsarI vuNTa, pAvalova, baikTU, Danalapa Adi dvArA kaNDIzaNDa riphlekseja se sambandhita hokara tIsarI svabhAvavAda meM pariNata ho gii| isakA manovaijJAnika bhAga bramara aura phrAyaDa ke dvArA paripuSTa huA hai| phrAyaDa ke vicAroM kA mArTanaprinsa, maikaDUgala tathA rivarsa nAmaka vidvAnoM para bhI prabhAva par3A hai / jaMga ne bhI apane prayoga kie haiN| mAnasa-zAstra kA rogoM kI vikRti se sambandha baiThAne ke lie vidvajjana kRtasaMkalpa haiM / mAnasa vizleSaNa ( Psycho-analysis) yA anya paddhatiyoM kA upayoga kiyA jAtA hai| svatantra nADImaNDala, granthi-vihIna praNAliyA~ tathA mAnasika vyaktitva kA ApasI kyA sambandha hai isa para bahuta adhika vicAra kiyA jAne lagA hai| vizvAsa to yaha hai ki Age calakara zArIrika vikRtiyoM ke adhyayana meM manovaijJAnika mahattva bhI sammilita kara liyA jAvegA jo isa yuga kI yugAnurUpa dena hogii| For Private and Personal Use Only

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[ 11 ] hindI bhASA meM vaijJAnika granthoM ke praNayana meM sarvAdhika bAdhA pAribhASika zabdoM ke prayoga kI prAyaH par3A karatI hai| isa viSaya meM do mukhya mata haiM eka jo laiTina vA pAzcAtya zabdoM ke. prayoga ko jyoM kA tyoM svIkAra karanA mano vijJAna ko pragati patha para barAbara bar3hane denA mAnate haiN| ve una zabdoM kA anuvAda karanA samaya aura zakti kA apavyaya samajhate haiN| dUsarA mata anuvAda ke pakSa meM hai| isa mata ke samarthakoM meM bhI matabheda hai| kucha prAcya samarthaka haiM jo kisI bhI naye zabda kA grahaNa taba karane ko taiyAra haiM jaba vaha prAcIna granthoM meM upalabdha hotA ho / kucha navona zabda-racanA ke samarthaka haiM / unake mata se prAcIna zabda ko usake sthAna para hI rahane diyA jAnA cAhie tathA ve navIna zabda jo bhAva kA yathAvat bodha karane meM samartha ho usI ko lenA ucita mAnate haiM / udAharaNa ke lie AksIjana ke lie prAcya samarthaka prANavAyu yA viSNupadAmRta yA anya kisI vedokta vA purANokta athavA zAstrokta zabda ko lAnA caaheNge| navazabdaracanAsamarthaka usake sthAna para AksIjana zabda kI sArthakatA kisa naye zabda meM adhikatama mila sakatI hai ise dekhakara eka aisA zabda upasthita kareMge jisakA prayoga nayA hogA zabda kadAcit koza meM mila jaavegaa| AksIjana ke lie aise loga 'jAraka' kA vyavahAra kara sakate haiM / kyoMki AksIjana kA mukhya guNa jAraNa karanevAlA spaSTa aura prasiddha hai| nayI zabda-racanA meM isa videzI zabda ke vividha rUpoM ko prayoga karane kI sulabhatA kA bhI dhyAna rakha liyA jAtA hai jaise auksAiDa ke lie 'prANavAyu' se zabda nikAlanA hAsyAspada hai| para jAraka se jAreya bana sakatA hai| kucha tulyazabdaracanA ke samarthaka bhI hote haiN| ve auksIjana ko oSajana kahanA pasanda karate haiN| oSajana kahane se to AksIjana kahanA adhika tarka sammata hai kyoMki yaha zabda kA andhAnukaraNa hai jo koI bhI rASTra kadApi svIkAra nahIM kara sakatA vizeSakara bhArata jisake. pAsa saMskRta kA bahuta pavitra aura vizAla aisA zabda bhaNDAra hai ki jisakI tulanA anyatra kI hI nahIM jA sakatI / eka dhAtu meM upasargoM aura pratyaya kA prayoga karake asaMkhya zabdoM kA nirmANa kiyA jA sakatA hai / vyAvahArika zabda-nirmANa kI ora hindI ke rAjyabhASA ke pada para adhiSThita hone ke sAtha hI naye prayatna kie gaye haiN| deza kI aMgarejoM kI dAsatA kI mukti ne aMgarejI se dAsatva mukti ke lie eka navIna mArga khola diyA hai| isa dizA meM sarvAdhika prayatnazIla rahI hai nAgapurastha dI iNTaranezanala ekeDemI Apha iNDiyana kalcara / isa saMsthA ne deza kI atulanIya sevA kI hai| isakA sarvAdhika zreya hai vidvajjagat ke mUrdhanya zrI DA. raghuvIra ema. e., pI. eca. DI. DI. liTa eTa phila ko jinhoMne deza-dezAntara meM jJAnArjana karake svayaM saMskRta ke. prakANDa vidvAn hone ke kAraNa aisI vilakSaNa zabda-racanA deza ko pradAna kI hai ki jisase na kevala hindI api tu, baMgalA, AsAmI, brAhmI, paJjAbI, marAThI, gujarAtI, tAmila, tilagU, kannaDa, malayAlaya, uDiyA Adi sabhI bhAratIya tathA siMhalIya, iNDoneziyAI, hindacInI, malayI, syAmI Adi anya bhAratetara dezoM kI bhASAe~ bhI paryApta lAbha prApta kara sakatI haiN| unake dvArA nirmita kucha zabdoM ke udAharaNa denA maiM Avazyaka samajhatA hU~ Phosphorus ( phAsphorasa ) ke lie unhoMne bhAsvara zabda kA prayoga kiyA hai| isI se eka vizeSaNa banatA hai Phosphorous usake lie mAsvya zabda prayoga kiyA hai / isI se nikale anya zabda isa prakAra haiM phospho phosphate phosphated phosphatic 2 vi0 bhU0 bhAsva bhAsvIya bhAsvIyita bhAsvIyika phosphite phosphonate phosphorate phosphoreal bhAsvita bhAsvAyIya bhAsvaraNa bhAsvariya For Private and Personal Use Only

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[ 12 ] phosphatide bhAsvIyeya phosphorescence bhAsvA phosphatization bhAsvIyana phosphorescence bhAsamAna phosphate bhAsvIya phosphoreted bhAsvarita phosphide bhAsveya phosphoric mAsvika phosphin bhAsvi phosphorite bhAsvIyija phosphine bhAsvI phosphoryl bhAsvarala phosphinic bhAsviyika phosphorylation bhAsvaralatA ___ Adi Adi, jo yaha vyakta karane ke lie paryApta hai ki zabda-nirmANa svayaM eka vijJAna hai aura isakA upayoga bhI samhAlakara karanA paramAvazyaka hotA hai| prAcIna zAstroM meM jo zabda jisa sandarbha meM AyA hai usakA eka spaSTa Azaya hai| yadi hama usI zabda ko Adhunika vaijJAnika zabdoM ke lie le lete haiM to usase bahuta bhrama kI sambhAvanA bar3ha sakatI hai Age cala kara zabda kA mUla rUpa meM jo upayoga huA hai vahA~ isI zabda ke naye artha ke prakAza meM artha kA anartha bhI sambhava hai| astu merI apanI dhAraNA hai ki zabdoM kI nayI racanA jo naye sandarbha meM saMskRta ke vyAkaraNa ke anurUpa DhAlI jA rahI hai jisameM vaijJAnika zabdoM ke sabhI bhAva aura upabhAvoM ke prakaTa karane kA sAmarthya hai unhIM kA upayoga vaijJAnika sAhityakAroM ko nizzaGka karanA caahie| aminava-vikRti-vijJAna meM bhI aisA hI dekhakara mujhe vizeSa prasannatA huI hai| Ayurveda ke vibhinna zabdoM ko unhoMne jyoM kA tyoM rakhA hai aura vaijJAnika zabdoM ko pRthak diyA hai| donoM kI pRthaktA se vidyArthI ko svayaM Avazyaka vicAra ke lie svatantra chor3a diyA hai / yaha koI Avazyaka nahIM ki jo Adhunika vijJAna kI vicArapraNAlI hai vaha AyurvedIya AkaragranthoM meM kahIM na kahIM mile hI / ataH donoM ke svatantra adhyayana ke lie svatantra zabdopayoga samocIna hai| kucha loga hara pAzcAtya viSaya ke lie apanA AyurvedIya mata vyakta kiyA karate haiN| kucha sthAnoM para yaha sambhava hai para uddezya donoM zAstroM kA prANImAtra kI sevA hone para bhI sandarbha meM paryApta bhinnatA hai| udAharaNa ke lie eka zAstra pacanakriyA ko prANavaha srotas, annavaha srotas, samAna vAyu aura jATharAgni ke sandarbha meM samajhAtA hai| dUsarA pacanasaMsthAna kI ileSmalakalA kA zArIra, vividha rasoM kA nirmANa Adi batalA kara apanI bAta kahatA hai| Age eka ne rasa se rakta mAMsa Adi kI kalpanA kI hai tridhAtu kI utpatti batalAI hai aura dUsare ne apanI hI dRSTi se zarIra vyApAra zAstra tathA zarIra racanA zAstra kA digdarzana kiyA hai donoM kI isa bhinnatAoM kI abhivyakti vibhinna prakAra kI zabdAvali se hI sambhava hai| astu TizU ke lie zrItrivedIjI ne dhAtu kA vyavahAra na kara 'Uti' kA vyavahAra kiyA hai jo raghuvIrIya praNAlI ke AdhAra para hone ke sAtha hI yathArtha sthiti kA dyotaka bhI hai| vikRti vijJAna meM lekhaka ne Adhunikatama jJAna kA samAveza karane kA yatna kiyA hai| mujhe vizvAsa hai ki jyoM jyoM samaya vyatIta hotA jAvegA isa grantha ke uttamottama saMskaraNa prakAzita hote raheMge jinameM vijJAna kI navInatama dhArA avicchinna rUpa se pravAhita hotI rahegI / Adhunika vicArakoM ke samakSa prazasta prayogazAlAoM ke sAtha prabuddha vijJAnavettA nizcita samasyAoM ke nirUpaNa meM rata rahate haiM jisake kAraNa eka eka viSaya ke vividha aGgoM meM uttarottara vRddhi dRSTigocara hotI hai / aise sAdhana bhAratIya lekhakoM ko adhika upalabdha nahIM ho pAte / udAharaNa ke lie kSatigrasta UtiyoM meM parama raktatA (hAiparIbhiyA) ke jJAna ko kucha vidvAnoM ne apanA viSaya cunaa| thor3A bhI AghAta lagane para usa sthAna para rakta kA saMcaya hone lagatA hai| isa rakta saMcaya meM kauna hetu mukhya haiM ise samasyA mAna liyA gyaa| jahA~ AghAta For Private and Personal Use Only

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[ 13 ] lagA hai vahA~ rakta kyoM pahu~catA hai ? usa rakta meM AghAta ke samaya prApta jIvANuoM aura unake viSoM ko naSTa karane kI kauna kauna sI vastue~ pahu~catI haiM jo zarIra ke usa bhAga kA saMrakSaNa karane maiM samartha hotI haiM ? isa vAhinI visphAra ( vAsoDAileTezana) meM dhamanikAoM kA visphAra yadi mukhya hai to usakA karttA kauna hai ? yadi usa kSetra meM rakta kA pravAha roka diyA jAya to kSatikartA jIvANu ke dvArA kyA kyA bhayaGkara upadrava ho sakate haiM ? yadi kSatigrasta sthAna para kucha jIvANuoM kA praveza karake thor3e samaya bAda usakA saikzana liyA jAya to bhakSikAyANu kitane milate haiM aura yadi jIvANu praveza ke pazcAt vAhinI visphAra rokane vAlI oSadhi kA sUcI vedha karane ke uparAnta saikzana liyA jAya to kitane jIvANu virodhI kozA milate haiM ? kyA vAhinI visphAra meM mukhya kAraNa hisTaimIna hai ? kyA eDInosIna hAiphospheTa yA anya eDInAina kampAuNDasa isameM sahAyatA karate haiM ? lyUkoTa kjIna kezAloM kI ativedhyatA ( kaipIlarI paramiebiliTI) kitanA bar3hAtI hai ? kyA isa ativedhyatA ke kAraka anya bhI kAraNa haiM ? Uti taraloM ke nipIr3a (prezara) kA vraNazotha para kyA prabhAva par3atA hai ? Adi Adi aneka prazna kevala sthAnIya adhiraktatA kA vraNazotha ke sAtha kyA sambandha hai ise hala karane ke lie lagate haiN| ina sabhI praznoM ke hala karane meM rigDana, ivAnsa, mAilsa, nivena, kUpara, lyUisa, Dela, rojenthala, minArDa, phAkko, rAmsaDela, rocAI silvA, DraigsTaiDa, mainkina, rAiDauna, spekTara, bAyara, mUra, Taubina Adi Adi anekoM vidvAnoM ne samaya samaya para sahayoga karake eka rUpa apane sAmane prastuta kiyA hai| vijJAna kI unnati meM dhIre dhIre pragati hotI calI jA rahI hai| varSoM ke prayogoM aura anusandhAna ke pazcAt kisI eka bAta para pahu~cA jAtA hai aura usa para Age kArya hotA hai / vividha dezoM meM basane vAle vaijJAnika apane apane kArya ko svatantra prajJA se karate haiM aura vahI tathya aura Age bar3hatA jAtA hai| nayI nayI dizAe~ nikalatI AtI haiM una dizAoM para prakAza par3atA calA jAtA hai aura eka naye zAstra kA nirmANa hotA calA jAtA hai / vijJAna ke yuga meM aneka viSaya vizada ho jAte haiM aneka ke sambandha kI kalpanAe~ badala jAtI haiN| udAharaNa ke lie yaha tathya paryApta kAla se jJAta thA ki kucha loga kisI oSadhi vizeSa, bhojana vizeSa yA ilaikzana vizeSa se burI taraha prabhAvita hote haiM / dane ke rogI meM kisI phUla ke sU~ghane se hI daurA prArambha hotA huA dekhA jAtA hai| hephIvara kA nAma aura iDiyosinkresI kA sambandha bahuta dina se jJAta hai| aba isa vijJAna ne kitanI unnati kI hai ? yaha Aja rogApaharaNa sAmarthya vijJAna (Immunology ) kA mukhya viSaya hI bana gayA hai / ise hama paramahaSatA ( hAipara sainjITiviTI ) kahate haiN| laiNDasTInara, gaila hairiMgaTana, rivarsa ne isa para kArya kiyA hai / paramahRSatA utpanna karane vAle dravyoM meM se kucha to vyakti vizeSa ke lie pUrNataH videzI probhUjina hI hote haiM athavA ve usa vyakti kI probhUjinoM ke sAtha haiMpTIna yA proeNTIjana ke rUpa meM mila jAte haiM unake saMyoga meM videzIpana hone se eka aprAkRtika probhUjina zarIra meM praviSTa ho jAtI hai jisake kAraNa usa vyakti vizeSa meM eka pratidravya ( eNTI bauDI ) kA nirmANa hotA hai jisake pariNAmasvarUpa paramahRSatAjanya vividha lakSaNa utpanna hote haiM / sIrama kA prayoga karane ke pUrva vyakti kI paramahaSatA kA dhyAna rakhanA pratyeka cikitsaka kA mAnavIya karttavya hai / isa dizA meM kArya karane vAle vidvAnoM ne ghor3oM meM utpanna hone vAlI rogA-paharaNa sAmarthya para parIkSaNa kie haiN| unhoMne dekhA ki unase prApta Arambhika sIrama Tokjina yA viSa ke sAtha utanI dRDhatA tathA vega se milane meM samartha nahIM hotA jitanA ki bAda meM prApta kiyA gayA sIrama hotA hai| isase spaisIphika eNTI bauDI (viziSTa pratidravya ) kA maulIkyulara svarUpa sadaiva eka sA hI rahatA haiM yaha siddha nahIM hotA usameM barAbara parivartana bhI dekhA jA sakatA For Private and Personal Use Only

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[ 14 ] hai| viziSTa pratidravyoM kA yaha vyavahAra-vaiSamya kaI naI dizAe~ khola detA hai| jinameM eka yaha ki ve rakta meM tathA Uti taraloM meM unmuktAvasthA meM prApta hotI haiN| tathA dUsarI yaha ki zarIra ke khAsa kozAoM ke sAtha ve sambaddha ho jAte haiN| inameM prathama unmukta pratidravya aura dvitIya baddha pratidravya kahe jA sakate haiN| enAphAilaiksisa sambandhI kie gaye vividha prayogoM se pratidravya kI ye donoM avasthAe~ paramhRSatA kI vaikArikI para acchA prakAza DAlatI haiM / unmukta pratidravya tathA pratijana ( antigen) meM yadi sammilana usa avasthA meM hotA jaba ve rakta yA Uti tarala meM svatantra hoM to koI bhI pratIkAra upasthita nahIM hotA, para jaba baddha pratidravya ke sAtha pratijana milatA hai to una sthAnoM meM, jinameM pratidravya baddha hotA hai, viziSTa kriyA dvArA bhayaMkara parama hRSatAjanaka lakSaNa utpanna ho jAte haiN| yadi vyakti ke rakta meM pratidravya paryApta mAtrA meM upasthita hai to praviSTa kiyA gayA pratijana, jo usase kama hai, saralatayA mila jAtA hai aura rogI sakSama ( immune ) prakaTa hotA hai| yadi yaha pratidravya kama hai to pratijana ko dUrastha kSetroM meM pratibaddha pratidravya se milane jAnA par3egA jisa kozA se baddha vaha pratidravya hai usako aisI kriyA se kSati hotI hai| yahI kSati paramahaSatAkAraka hotI hai| isa prakAra sakSamatA yA pratIkAritA vA rogApaharaNa sAmarthya jise immyUniTI kahA jAtA hai, kahA~ paramahRSatA meM pariNata ho jAtI hai ise bhI vaijJAnika Aja dekhane lage haiN| TyUbarakyulina TaisTa meM kyA hotA hai ? yakSmA meM jIvANuoM ke pratijana ke kAraNa zarIra meM unmukta pratidravyoM kI upasthiti kama rahatI hai| jaba vyakti jisake zarIra meM yakSmA kA upasarga hai use jaba viziSTa probhUjina pratijana kA TIkA lagAyA jAtA hai to isa pratijana ko naSTa karane lAyaka usake rakta yA ati tarala meM unmukta pratidravya rahatA nahIM hai jisake pariNAmasvarUpa vaha pAsa ke kozAoM meM upasthita pratibaddha pratidravya se milatA hai| ye kozA kSatigrasta hokara Tayubarakyulina TesTa kA astyAtmaka lAla cihna (erythema) upasthita kara dete haiN| yadi yaha viziSTa pratijana dhIre dhIre Akara prativaddha pratidravya ke sAtha sammilita ho to itanA upadrava upasthita na ho| sAtha hI UtiyA~ bhI vihRSa ( desensitised ) ho jaaveNgiiN| eka bAra vihRSatA paidA kara dene para phira pratijana ko kitanI hI zIghratA se praviSTa kiyA jAve paramahRSatA ke bhISaNa lakSaNa upasthita nahIM hote yaha sthiti tabhI taka rahatI hai jaba taka ati vihRSa hai / kucha saptAhoM meM yaha sthiti samApta ho jAtI hai aura Age punaH viziSTa pratijana paramahRSatA upasthita kara sakatA hai| rAiTa ne paramahRSatA kalpanA spaSTa karate hue likhA hai ki prAthamika hRSatA kisI viprakRta videzI probhUjina yA kisI pratikriyAtmaka rAsAyanika dravya ke UtiyoM meM praveza para nirbhara karatI hai| kisa prakAra vyaktivizeSa ke zarIra meM sthita probhUjina ke sAtha praviSTa dravya saMyukta hotA hai aura saMyukta hokara kitanA videzIpana vaha upasthita karatA hai isa para bhI bahuta kucha nirbhara hai| eka bAra yA kaI bAra dravya vizeSa ke praveza ke kAraNa viziSTa pratidravya kA nirmANa vyakti ke jAlakAntazchadIya saMsthAna meM hone lagatA hai| raktapravAha ke dvArA nirmita pratidravya zarIra bhara meM vitarita kara diyA jAtA hai| jaba ati taraloM taka vaha pahu~catA hai to kucha to anaicchika peziyoM meM aura kucha adhicarma ke kozAoM meM aneka varSoM taka pratibaddha pratidravya ke rUpa meM par3A rahatA hai| unmukta pratidravya kucha kAla taka to rakta meM pravAhita rahatA hai para Age cala kara vaha kama hotA calA jAtA hai aura jaba kabhI koI pratijana zarIra meM acAnaka praveza karatA hai to usase rakSA karane vAle unmukta pratidravya kA pUrNataH abhAva ho jAtA hai jo usake sAtha milakara use prabhAva zUnya kara sake aura isakA pratibaddha pratidravya se saMyoga For Private and Personal Use Only

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[ 15. ] roka sake / isake kAraNa eka to una kozAoM ke AghAta ke kAraNa dUsare kozAoM kI kSati ke kAraNa utpanna hisTaimIna, eDInosIna tathA esITilakolIna ke kAraNa bhISaNa paramahRSatA kI upalabdhi ho jAtI hai / jina prAyogika pazuoM kA sAmAnya hRSIkaraNa kara diyA jAtA hai unameM pratijana kA pratibaddha pratidravya se saMyoga vividha zArIrika UtiyoM meM hotA hai jo mAraka svarUpa ke paramahRSatA ke lakSaNoM ko utpanna karane meM samartha hotA hai / para jahA~ pratibaddha pratidravya tvacA yA zvasanikIya peziyoM meM hI sthAnika rUpa meM nibaddha haiM to tvacA yA zvasanasaMsthAna ke upadrava dRSTigocara hoNge| vividha lakSaNoM kI bhISaNatA pratijana kI prakRti para utanI nirbhara nahIM rahA karatI jitanI ki vaha kisa mArga se usakA gamana ho rahA hai-mukha se, pezIvedha se, sirAvedha se ityAdi tathA pratibaddha pratidravya kina kozAoM meM vitarita haiM ina do bAtoM para nirbhara karatI hai| Adhunika yuga meM sUcIvedha dvArA oSadhiyoM kA bahuta adhika pracAra bar3ha gayA hai jisake kAraNa mAnavajAti meM paramahRSatA bahuta adhika pAI jAne lagI hai| phenAima ke saMyoga, painIsilIna, sthAnika visaMjJaka padArtha, madhvazi ( insulIna ), yakRt sattva, eNTITokjika sIrA Adi isake kAraNa haiN| paramahRSatA ko Ajakala kucha rogoM kA hetu taka svIkAra kiyA jAne lagA hai| yadi Age anusandhAna ne sahAyatA dI to riumeTika phIvara, polauArTarAiTisa noDosA tathA ekyUTa nephrAiTisa ko anutIvra hRSa vraNazotha (subacute allergic inflammation) nAma diyA jAne lgegaa| kyoMki tInoM meM hI vikSatoM kA svarUpa eka dUsare se milatA julatA hotA hai aura tInoM hI mAnava yA mAnavetara prANiyoM meM paramahaSatA ke vikSatoM ke sAtha bhI samAnatA rakhate haiN| ina tInoM kA kAraka kauna pratijana hai isakI kabhI pUrI pUrI khoja nahIM ho sakI hai / AmavAtajvara kA kartA mAlAgolANu svayaM kisI bhI AmavAtIya vikSata meM pratyakSa nahIM prApta huA hai isake kAraNa yaha vizvAsa dRr3ha hotA jArahA hai ki usa jIvANu ke kAraNa eka viziSTa viSahRSajana (specific toxallegen ) taiyAra hokara vividha pratikriyAeM upasthita karatA hai| para yaha mAlAgolANu svayaM jisa prakAra kA AmavAtajvara utpanna karatA hai ThIka vaise hI lakSaNoM se yukta jvara grahaNI, viSamajvara kevala AghAta tathA saiNDaphlAI phIvara kara sakatA hai aisA kopamaina, glejabaka, laumasana Adi kA vicAra hai| isakA abhiprAya yahI huA ki mAlAgolANu ina lakSaNoM ke utpanna karane meM viziSTa kAraNa na hokara gauNa kAraNa hai| tathA paramahRSatA hI mukhya kAraNa hai| eka aura vicAra vaijJAnikoM ke sAmane hai ki manuSya kI probhUjina kinhI ajJAta kAraNoM se videzI probhUjina yA pratijana kA rUpadhAraNa karake bhI paramahRSatA kA kAraNa hotI hai| kucha bhI ho AmavAtajajvara ke sambandha meM paramahRSatA ke dvArA kitane lakSaNoM kA samAdhAna ho jAne para bhI yaha viSaya abhI vivAdAspada hI hai| paulI ArTarAiTisa noDosA kI upasthiti salphAvarga kI oSadhiyoM ke prayoga ke pazcAt adhika dekhane meM AI hai aisA rica kA kathana hai / isa roga meM madhyama aura laghukAya dhamaniyoM meM vikSata banate haiM upasipriyakozAoM kI vRddhi hotI hai| ye vikSata vRkkoM tathA hRdaya meM adhika milate haiM anyatra inakI laghutA bAdhaka banatI hai| una mAnavetara prANiyoM kI kSudra dhamaniyoM meM Thoka isI prakAra ke vikSata banate hue bAuTana ne dekhe haiM jina para bhayAnaka paramahRSatA kI pratikriyAe~ hone para bhI jo baca gaye the / manuSya meM ye vikSata paramahRSatA ke pariNAmasvarUpa hI hote haiM ise siddha karanA zeSa hai / itanA to milatA hai ki jo vyakti vividha videzIya sIrA yA oSadhiyoM ke prati paramahRSa the unhIM meM ye vikSata mile haiN| For Private and Personal Use Only

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[ 16 ] kucha lagabhaga 40 varSa pUrva zika ne eka mata pracalita kiyA thA ki lohita jvara ke upasarga ke hI dina pazcAt utpanna hone vAle tIvra gucchikIya vRkkapAka kA sambhAvita hetu viziSTa pratidravyoM kI rakta meM unmuktatA ho / yadyapi pratyakSatayA isakA koI pramANa abhI upalabdha nahIM ho sakA hai| para kisI mUSaka yA zazaka ke vRkka ko sUkSma bhAgoM meM vibhakta kara use kisI dUsare varga ke usI prANI meM sUcIvedha dvArA praviSTa karane se prApta lasI kA mUla jAti meM TIkA lagA dene se vRkka Uti meM bahuta kSati utpanna ho jAtI hai / yaha kSati gucchikIya bhAga meM pahale Arambha hotI hai / ye vikSata jo mUSaka yA zazaka meM banate haiM ve mAnavIya vRkkapAka ke lakSaNoM se paryApta milate haiM jo zika ke mata kA eka aMza meM pratipAdana kara dete haiM para jaba taka spaSTa pramANa nahIM milate taba taka isa zrRMkhalA ko jor3A nahIM jA sakatA / kainAve tathA usake sahayogiyoM ne svasthavRtta, udyama aura sAmAjika stara kA sambandha karkaTa kI utpatti se jor3ane kA yatna kiyA hai| iMgaleNDa aura velsa meM phuphphusa karkaTa 1921 kI apekSA 1945 meM solahagunA bar3hA hai| yaha na sar3akoM para tArakola mizrita vAyu ke zvasana se hai aura na atra se utpanna dhUmra ke zvasana ke kAraNa hai isakA pratyakSa kAraNa kucha aura hI pratIta hotA hai / ina kAraNoM meM tambAkU, paiTrola aura DIjela gAr3iyoM se utpanna gandha tathA anya aneka ho sakate haiM / garbhAzaya karkaTa ke sambandha meM isI vidvAn kI gaveSaNA yaha rahI hai ki yahUdI striyoM kI apekSA gaira yahUdI striyoM meM yaha adhika pAyA jAtA hai kyoMki mAsikadharma ke Arambha hone ke uparAnta bAraha dina yahUdI strI kA apane pati ke sAtha saMsarga nahIM hotaa| -stara ke kula meM strI kA janma huA hai usakA bhI prabhAva isa karkaTa kI ucca vaMza ke puruSoM meM vRSaNakarkaTa kA abhAva tathA nimna Arthikastara ke vyaktiyoM meM usakI upasthiti spaSTataH karkeTa aura Arthika stara kA sambandha sthApita karane kA mArga khola detI hai / yakRt prAthamika karkaToM para likhate hue barmana ne bhI aphrIkA ke baNTU logoM kA udAharaNa dete hue svIkAra kiyA hai ki vAtAvaraNa isa karkaTa kI utpatti meM jitanA kAraNa hai utanA vaMza nhiiN| phiNDale ne pazcimI aphrIkA nivAsiyoM para kArya karake yakRddAlyutkarSa kA kAraNa apUrNa AhAra ThaharAyA haiM / - yaddA lyutkarSa ke Age kI avasthA yakRt karkaTa hI hotI hai / isake atirikta kisa Arthika utpatti meM kArya karatA hai / jise hama hRdbheda yA hArTaphelyora kahate haiM usake sambandha meM zApazephara ne tathA phrI Dilavardha ne paryApta kArya kiyA hai| isa roga kI tIvrAvasthA ke tIna rUpa hamAre sAmane Ate haiM / eka jisameM rakta saMvahana kA sahasA avapAta hotA hai / yaha raktasrAva yA kriyAvarodha ( zauka ) ke kAraNa hotA hai / isameM sirAjanya rakta lauTa kara hRdaya taka nahIM pahu~cane pAtA / jisake kAraNa hRdaya ke koSThakoM kA rakta se bharanA tathA usakA Age bar3hanA ruka jAtA hai / mRtyUttara parIkSA meM mahAsirAe~ khAlI milatI haiM aura hRdaya saMkucita huA dekhA jAtA hai| dUsarA tIvra hRdbheda kahA jAtA hai / isakI utpatti hRtpezI kA sahasA kArya karanA banda karanA hotA hai / hRtpezIya RNAstra ke kAraNa athavA hRdaya ke phuphphusIya antaHzalyatA ke kAraNa hRdaya kA khAlI honA ruka jAtA hai / ina avasthAoM meM hRdaya meM rakta kI mAtrA bar3hatI jAtI hai jo use visphArita kara detI hai jisake kAraNa mahAsirAoM meM nipIr3a bahuta adhika bar3ha jAtA hai jisake kAraNa unameM atizaya tanAva ho jAtA hai / mRtyuttara parIkSaNa meM hRdaya meM sirAja adhiraktatA khUba dekhane meM AtI hai| tIvra hRdbheda kA tIsarA kAraNa hotA hai jise parihRt bhAra kahA jAtA hai| jaba parihRt yA hRdayAvaraNa meM druta gati - se tarala kA saMcaya hone lagatA hai vizeSa kara jaba usameM raktasrAva hone lagatA hai taba bhI hRdbhedotpatti ho jA sakatI hai| tarala kA saMcaya hRdaya ke bAhara nipIr3a bar3hA detA hai / jaba yaha nipIr3a - itanA adhika hotA hai ki sirAjanipIr3a se adhika ho jAtA hai to isake kAraNa hRdaya bisphArA For Private and Personal Use Only

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[ 17 ] vasthA meM pUrI taraha rakta se bhara nahIM paataa| isake kAraNa rakta kI bAhara jAne vAlI mAtrA bhI ghaTa jAtI hai jisake kAraNa sirAoM meM nipIr3Adhikya ho jAtA hai aura hRdaya kA bharAva kucha kAla ke lie bar3ha jAtA hai para Age jAkara hRdaya kA bharanA samApta hone ke kAraNa hRdaya kI gati ruka hI jAtI hai| ___ jIrNa hRdbheda aneka kAraNoM se hone ke kAraNa usakA varNana kaI vicAra upasthita karatA hai| jina rogoM se raktapravAha meM bAdhA par3atI hai yA hRtpezI kI kArya zakti ghaTatI hai ve sabhI isase sambaddha hote haiM / asvAbhAvika rUpa se pravRddha rakta pravAha ( abnormally increased blood flow ) bhI jIrNa hRdbheda ( chronic heart failure ) kA kAraNa ho sakatA hai| raktapravAha kI pravRddhi rakta kI hRdaya se jAne vAlI mAtrA ( output) ko bar3hA detI hai| vividha roga isa vikRti meM sahAyaka banate haiN| rakta kA adhika mAtrA meM pravAha bar3hane se hRdaya ko adhika kArya karanA par3atA hai kAryabhArAdhikya hI hRdaya ke phelyora ke lakSaNa upasthita karatA hai| AmavAta aura nipIDAdhikya ke dvArA bhI jIrNa hRbheda hotA hai| kisI bhI kAraNa se yaha hRdbheda utpanna ho parivartana eka se hI rahate haiN| sabase pahale prabhAvita huA hRtprakoSTha ThIka se khAlI nahIM ho paataa| para yaha dera taka nahIM calatA aura usakA zIghra santulana ho jAtA hai thor3I mAtrA meM jo rakta baca jAtA hai vaha sirAjanya pravAha ke sAtha mila jAtA hai jisase hRdaya kucha tana jAtA hai jisake kAraNa hRdaya aura zakti ke sAtha saMkoca karatA hai isakA pariNAma yaha hotA hai ki hRdaya punaH apanI pUrva sthiti ko prApta kara letA hai| isa avasthA meM rakta pravAha prakRta to ho jAyagA aura hRdbheda ke koI viziSTa lakSaNa prakaTa nahIM hoMge para hRdvisphAra ( dilatation of the heart) to milegA hii| sAtha hI hRdaya kI saMcita zakti ghaTa jAne se thor3e hI parizrama para zvAsa phUlane lgegii| hRdvisphAra ke kAraNa hRtpezI kI paramapuSTi ( hypertrophy ) ho jaavegii| paramapuSTi ke kAraNa hRdaya kA bala phira bar3ha jAtA hai aura vaha lakSaNadRSTathA svatantra ho jAtA hai| jisa kAraNa hRdvisphAra huA vaha yadi Age na bar3hA to hRdaya kI paramapuSTi varSoM banI raha sakatI hai para yadi hRdaya ke tanAva kA kAraNa banA rahA to eka prakAra kI tIvratA (strain) nirantara banI rahatI hai jaisA ki rakta nipIr3Adhikya meM dekhA jAtA hai| jo loga yaha samajhate haiM ki adhikapuSTa yA pravRddha hRdaya meM rakta kI mAtrA usakA poSaNa karane ke lie kama pahu~catI hai unake isa bhrama ko biMga aura unake sahayogiyoM ke prayogoM ne naSTa kara diyA hai| hRdaya jitanA hI bar3A hotA hai rakta kI usakI pUrti bhI usI anupAta meM huA karatI hai / para paramapuSTa hue hRtpezI ke tantu itane moTe ho jAte haiM ki unake kendriya bhAga taka rakta kI paryApta mAtrA nahIM pahu~cane se unameM jArakAbhAva (anoxia) mila sakatA hai / paramapuSTa hRdaya adhika kAla taka santulana (compensation) kAyama nahIM rakha pAtA hai jisake kAraNa nilaya rakta ko pUrI mAtrA meM Age calakara nikAlane meM asamartha ho jAte haiN| jaba vAma nilaya meM yaha sthiti hotI hai to phuphphusa sirAoM meM nipIr3a bar3ha jAtA hai / isake kAraNa dakSiNa nilaya para bhI usakA prabhAva par3atA hai aura palmonarI kSetra meM nipIr3a sarvatra bar3ha jAtA hai / isake bar3hane se vAma bhAga meM rakta bharane kI zakti bar3ha jAtI hai aura vAmanilaya aura zakti se saMkoca karatA hai para yaha saMkoca asthAyI hI hotA hai| isa nipIr3a vRddhi ke kAraNa phuphphusa meM nizceSTa adhiraktatA ( passive congestion of the Ings) aura zvasana kriyA meM alpazrama para hI vRddhi pragaTa ho jAtI hai| yaha bhI asthAyI svarUpa kI hotI hai| thor3e samaya bAda dakSiNa nilaya kI kriyA zakti samApta hone se adhiraktIya hRdbheda ke lakSaNa upasthita ho jAte haiM jisameM sirArakta kA avarodha aura zophotpatti dekhI jAtI hai| For Private and Personal Use Only

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[18] aba taka yahI samajhA jAtA thA ki hRdaya ke kAraNa utpanna sarvAMga zopha kA mukhya hetu kezAloM meM rakta ke nipIr3a kI vRddhi hotI hai isa vRddhi meM sahAyaka hotI hai kezAla prAcIroM kI ajArakamaya sthiti (anoxia ) parantu Aja kala mairila kI gaveSaNA ne yaha siddha kara diyA hai zopha kI utpatti meM soDiyama Ayana kI rukAvaTa bhI mahattva kA bhAga letI hai / hRdbheda meM vRkkoM meM hokara rakta kA pravAha bahuta kama ho jAtA hai / mairila kA kathana hai ki yadi hRdaya meM rakta kA pravAha AdhA raha jAya to vRkka meM vaha pe bhAga raha jAtA hai| jisake kAraNa gucchikAoM meM nipAvana kArya bhI ghaTa jAtA hai isake kAraNa breDale, bleka, homarasmitha ke eka dUsare se vibhinna mata hone para bhI yaha spaSTa ho jAtA hai ki soDiyama Ayana kA pracUSaNa nAlikAoM dvArA prakRta kriyA se kahIM adhika ho jAtA hai / isa prakAra zarIra meM soDiyama Ayana bar3hane lagatA hai / jisake kAraNa UtiyoM meM jalIyAMza kI vRddhi hone lagatI hai jo ki sarvAMga zopha kA kAraNa hai / isa mAnavIya vaikArikIpara Upara jo vihaMgama dRSTi DAlI gaI hai vaha isa kSetra meM anusandhAna viSaya liyA gayA hai usa para kI mahattA ko spaSTa karane ke lie hai / isa grantha meM jitanA hI vyApaka rUpa se vicAra kiyA gayA hai| kucha prakaraNa raha bhI gaye haiM jinheM agale saMskaraNa meM pUrA kara liyA jAvegA aisI mujhe pUrNa AzA hai / grantha kI vizAlatA aura upAdeyatA pratyakSa siddha hai / maiM AzA karatA hU~ ki isa grantha kA Ayurveda kAlejoM meM hI nahIM maiDIkala kAlejoM meM bhI acchA svAgata hogA / For Private and Personal Use Only -- zivanAtha khannA

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hRdgata naivAtivAkpaTutayA na ca kAvyadarpAnnaivAnyazAstramadabhaanahetunA vA / kintu svakIyatapa ityavadhArthaM varyamAcAryamArgamadhigamya vidhAsyate tat // svAdhyAyamAhurapare tapasAM hi mUlaM manye ca vaidyavaravatsalatApradhAnam / tasmAttapazcaraNameva mayA prayatnAdArabhyate svaparasaukhyavidhAyi samyak // ( u0 ) bahuta-bahuta vilamba ke pazcAt, pratIkSA karate-karate nairAzya kI avasthA ko pahu~ce hue bhaktajanoM ke samIpa jaba yaha grantha pahu~cegA to isakI prApti ko ve svapnaloka ke kisI bhrama kA upAdAna hI samajheMge, maiM kisa mu~ha se isa grantha ko upasthita karU~ / Aja se dasa varSa pUrva abhinava vikRti vijJAna kI kalpanA mere mastiSka meM usa samaya AI jaba Ayurveda kAleja ke eka zAstrI vidyArthI ne grIna kI paithAlojI uThA kara pheMka dI thii| bhASA kI durUhatA hI usakA kAraNa thA / isa ghaTanA ne mere mAnasa meM bhISaNa jvArabhATe utpanna kie the aura maiMne dRr3hatA ke sAtha kahA thA, zAstrIjI, bhaviSya meM bhASA kI durUhatA yaha nATakIya dRzya upasthita na kara sakegI / hindI mAdhyama dvArA bhI uccatama jJAna kI upalabdhi saralatayA kI jA skegii| maiMne dRr3hatA ke sAtha kArya Arambha kiyaa| par3ha kara samajhane meM viSaya sarala hone para bhI usakA hindIkaraNa karanA eka aisI vikaTa samasyA thI ki usase pAra jAnA nitAnta kaThina lagA / Ayurveda kAleja ke tatkAlIna prinsipala svargIya zrI DA. bAlakRSNa amarajI pAThaka ko jaba zAstrI vAlI ghaTanA sunAI gaI aura merA nizcaya unako prakaTa huA to unhoMne kahA, 'barobara, barobara, trivedIjI ise avazya kara DAleMge maiM vinaMtI karatA hU~ ki ve ise cAlU kareM / ' dhIre dhIre eka pustaka kI rUparekhA banI / usako DAkTara sAhaba ne dekhA / prasanna bhI hue para unheM usase santoSa nahIM huA / unhoMne do tIna ghaNTe barAbara isakA spaSTIkaraNa kiyA ki isa viSaya meM unakI kyA dhAraNA thI / ve paithAlojI kA anuvAda nahIM cAhate the api tu eka Ayurveda ke vidyArthI ke lie vikRti vijJAna kI aisI pAThyapustaka cAhate the jo samaya ke anurUpa ho aura AyurvedIya paramparAoM ke bhI anurUpa ho| maiM ghabarA gyaa| Ayurveda ke vividha tathyoM para jitanI vyAkhyAe~ milatI thIM unheM AdhAra mAna kara 'vikRta zArIra' para grantha kA nirmANa asambhava pratIta huA / koI hRdaya ko mastiSka meM mAnatA hai koI chAtI meM / koI dhamanI ko sirA samajhatA hai to koI sirA ko narva / kaise isakA sAmaJjasya baiThAyA jAyagA, maiM nizcaya nahIM kara sakA / isI samaya guruvara zrImAn DA0 ghANekarajI ke dvArA likhita sUtrasthAna tathA zArIrasthAna kI vyAkhyA ko punaH eka bAra dekhane lagA / yadyapi vidyArthI jIvana meM use parIkSA kI dRSTi se par3ha cukA thA kintu isa bAra use pustaka likhane kI bhUmikA meM par3hanA thA / unhoMne apanI vyAkhyA kI yathArthatA ke pIche itane vipula pramANa upasthita kara diye the ki unheM samajha kara Age bar3hane kA paryApta sAhasa mujhe sulabhatayA upalabdha ho gayA / maiMne dhIre-dhIre punaH eka pustaka likha DAlI / usakI kApI 200-250 pRSTha kI hI thii| maiMne pUjya DA0 ghANekarajI se Darate-Darate prArthanA kI ki maiM unake dvArA isa para bhUmikA likhAnA cAhatA hU~ / DaratA isalie thA ki unake vyaktitva ke samakSa For Private and Personal Use Only

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[ 20 ] DA0 pAThakajI taka cakadhinnI kATate the phira hama jaisoM kI to bisAta hI kyA thii| para nAriyala kI UparI kaThoratA ke nIce susvAdu namakIna jala tathA snigdha madhura girI prApta ho gii| unhoMne apanI svIkRti de do| vaha pANDulipi unake pAsa kucha dinoM ke lie chor3a dI gii| thor3e dina bAda vaha unhoMne lauTA dii| maiMne use punaH par3hA aura dekhA ki yaha pUjya pAThakajI ko bhAvanA ke anukUla aba bhI nahIM ho skii| pAThakajI isa asAra saMsAra ko sarvadA ke lie chor3a cuke the aura karAla kAla ke grAsa bana cuke the| merI pustaka na pAThakajI kA AzIrvAda pA sakI na unase prAkathana hI juTA skii| boca meM kaI pustakoM kA lekhana aura vizeSAGkoM kA sampAdana bhI ho cukA thaa| samaya badala gayA thA aura isa naye vAtAvaraNa ke anukUla purAnI pANDulipi mujhe a~ca nahIM rahI thii| ataH naye sire se tIsarI bAra ise likhaa| 8-8 ghaNTe ghora parizrama karanA pdd'aa| eka-eka zabda kA hindI paryAya juTAne ke lie saptAhoM khoja karanI pdd'ii| kAma meM parizrama bahuta thA aura likhA kama jAtA thaa| kaI bAra to eka-eka adhyAya cAra-cAra bAra badalanA par3A / likhane kA jaba kabhI utsAha kama ho jAtA thA to caukhambA saMskRta pustakAlaya ke adhyakSa zrImAn jayakRSNadAsajI gupta ke anujazrIkRSNadAsajI gupta kI patravarSA hone lagatI thI-kApI abhI taka nahIM bhejI hai| kAma kaba taka hogA, vijJApana kara diyA gayA hai| mA~ga A rahI hai| hameM mu~ha chipAnA par3a rahA hai, kApI jaldI bhejie AdiAdi / bar3I kaThinAI se kApI pUrI huii| ise zrIkRSNadAsajI kAzI hindU vizvavidyAlaya Ayurveda kAleja ke suprasiddha prAdhyApaka zrI paM0 gaGgAsahAya pANDeyajI ke pAsa le gye| unhoMne kahA-yaha eka nahIM, do pustakeM haiM / eka doSadhAtumalavijJAna para hai jise svatantra chapAiye aura dUsarI abhinavavikRti vijJAna / isakA mudraNa avilamba Arambha kara dIjie / ataH grantha kA mudraNa cAlU ho gayA, jo mahInoM calatA rahA / idhara maiM apanA nivAsa sthAna puradilanagara (alIgar3ha ) chor3a kara punaH kAzI vApasa A gayA ataH mudraNa kArya bhI drutagati se pUrNa hone lgaa| jaba pustaka chapa gaI aura punaH pANDeyajI ko dikhAI gaI to unhoMne isameM citroM kA abhAva batalAyA aura prakAzana roka diyaa| citroM kI khoja kI gii| bhAratIya lekhaka jo vaijJAnika viSayoM para likhate haiM, citroM kI bar3I kaThinAI unake sAmane AtI hai| citra kaise taiyAra kiye jAyeM yaha samasyA thI / na citrakAra milate, na usakA bhAva hI koI samajha kara citra banA paataa| rAdhArAnI kA citra banAkara kalA ko cirasthAyI karanA jahA~ rucatA hai vahA~ vikRta UtiyoM ke citra banAnA kaise ruce ? astu, jo DijAineM banavAI bhI gaI ve bar3I bhaddI thI ataH vikRtivijJAna kI prasiddha pustakoM se hI citroM kI pratilipi vivaza hokara lenI pdd'ii| viSaya ke nirvAcana meM aura use kramAnusAra sajAne meM bhI vizeSa kaSTa kA anubhava huaa| eka paramparA Adhunika vikRti vizeSajJoM ne apanA rakhI hai jisake anusAra ve pahale sAmAnya vaikArikI kA vicAra upasthita karate haiM phira usI ke AdhAra para viziSTa vaikArikI kA pratipAdana karate haiN| yaha paramparA mujhe kabhI rucI nahIM hai| isIlie maiMne vaikArikI ke ina do bhedoM ko apane isa grantha se haTA kara viSayAnusAra pratipAdana kiyA hai / vraNazotha kA sAmAnya vivecana pahale karake usI zRGkhalA meM zarIrAvayavoM meM usakA prabhAva citrita kara diyA hai| isake kAraNa sAmAnya aura vizeSa donoM prakAra kA jJAna vidyArthI ko eka hI sthala para mila jaavegaa| ___ Adhunika vikRtizAstra se sambaddha prAyaH sabhI viSayoM kA samAveza maiMne isa graMtha meM kiyA hai| kucha viSaya jinakA sambandha jIvANuvijJAna yA kITANuvijJAna se hai isa grantha meM jAnabUjha kara sammilita nahIM kie gye| unheM pAThaka tatsambandhI graMthoM meM dekha sakate haiN| kucha anya bhI aise For Private and Personal Use Only

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[ 21 ] viSaya chUTa gaye haiM jinakA sambandha sAmAnya vaikArikI ke viSayoM ke sAtha pUrA-pUrA nahIM judd'taa| itanA saba hone para bhI grantha meM vaha saba hai jise jAna lene para koI bhI deza-videza meM saralatayA vaikArikI zAstra kA paramaniSNAta mAnA jA sakatA hai| merI icchA yaha bhI thI ki grantha ko bodhagamya karane ke lie eka Arambhika adhyAya aura jor3a kara autikI (hisTolojI) kA varNana kara dU~ para vaha isa grantha ke lie eka prakAra se aprAsaGgika hI thaa| use tatsambandhI granthoM meM hI pAThaka ko par3hanA abhISTa hai| isI prakAra doSadhAtumalAdi vijJAna ke bhale prakAra samajhe vinA AyurvedIya vaikArikI meM praveza nahIM ho sakatA jisake lie pRthak grantha kI yojanA kI jA rahI hai / vaikArikI se sambaddha pramukha-pramukha viSayoM kA isameM samAveza kiyA gayA hai| mujha para mere guruoM kI sadA kRpA rahI hai| unhIM ke AzIrvAda se hI maiM AyurvedIya vAGmaya kI sevAkarane ke satprayatna meM laga sakA huuN| isa grantha ke lie apanA amUlya samaya nikAla kara parama AdaraNIya vidvajjana-ziromaNi zrI DA0 prANajIvana mANekalAla mehatA ema. DI. ema. esa, epha. sI. pI. esa, epha. AI. sI. esa. DAirekTara saiNTrala insTIcyUTa Apha risarca ina iNDAijInasa sisTamsa Apha maiDIsina jAmanagara ne jo prAkkathana likhane ko kRpA dikhalAI hai usake lie maiM unakA bahuta kRtajJa huuN| DA0 mehatA kI Ayurveda bhakti aura vidvattA kA mUrtarUpa hameM unake dvArA sampAdita caraka saMhitA ke 6 vizAla grantha khaNDoM meM upalabdha hotA hai| Aja bhI ve sabala hRdaya aura supuSTa buddhi ke sAtha thor3I sI haDDiyoM kA halakA zarIra lekara AyurvedAnusandhAna ke puNyatama kArya kA saJcAlana kara rahe haiN| unakI tapazcaryA ne bar3e-bar3e Ayurveda virodhiyoM ko isakA saccA bhakta banA diyA hai| ve isa samaya eka sphUrti ke rUpa meM vidyamAna haiN| unake caraNoM meM baiThakara jinheM bhI AyurvedoddhAra kA avasara milA hai ve kRtArtha ho gaye haiN| Aja jAmanagara jo Ayurveda jagat meM eka gauravAspada sthAna grahaNa karatA jA rahA hai vaha isI tapasvI kA prabhAva aura prasAda hai| pUjya DA0 ghANekarajI ke prati apanA AbhAra pradarzita karane ke lie merA zabdakoza bahuta hI choTA par3a gayA hai| unakI kRpA paga-paga para prakaTa hotI rahI hai| unakA AzIrvAda merA sabase bar3A sambala hai| AdaraNIya DA0 zivanAtha khannA ema. bI. bI. esa., DI. pI. eca. Ayurveda kAleja meM paithAlojI ke rIDara haiN| ApakI vidvattA apratima hai / Apane kRpA karake apane vyasta jIvana meM se samaya nikAla kara jo prastAvanA likhakara dI hai usake lie maiM ApakA hRdaya se dhanyavAda karatA huuN| prastAvanA Apake AyurvedIya pANDitya kI pratyakSa prakAzikA hai| Adhunika jJAna ke bhaNDAra gurudeva ne 17 pRSThIya prastAvanA dekara mujhe AbhAra se nata kara diyA hai| isa grantha ke lekhana meM citroM kA saMgraha karane meM tathA anya nirdeza grahaNa karane meM mujhe anekoM dezI tathA videzI granthoM kI pratyakSa sahAyatA lenI par3I hai| inake khyAtanAmA lekhakoM aura suyogya vaijJAnikoM kI sUcI grantha ke anta meM prakAzita kI jA rahI hai| ina sabake prati maiM pUrNatayA kRtajJa huuN| jina granthoM kA upayoga mujhe karanA par3A hai unake saujanyamUrti prakAzakoM ke prati bhI meM apanA AbhAra sAdara prakaTa karatA huuN| kAzI ke suprasiddha cikitsaka AdaraNIya bandhu AyurvedAcArya paM0 zrI gaGgAsahAya e. ema. esa. prAdhyApaka, Ayurveda kAleja kAzI hindUvizvavidyAlaya, jinake maulika sujhAvoM ne isa grantha kI kAyApalaTa kara dI hai, ke prati bhI maiM sAdara AbhAra prakaTa karatA huuN| For Private and Personal Use Only

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[ 22 ] isa grantha ke prakAzaka caukhambA saMskRta pustakAlaya evaM caukhambA vidyAbhavana, vArANasI ke adhyakSa zrI jayakRSNadAsajI gupta ke prati dhanyavAda prakaTa karatA hU~, jinhoMne samaya-samaya para utsAha varddhana kara isa itane bar3e grantha ko sahasroM rupaye vyaya karake prakAzita kiyA hai| vyAkaraNAcArya zrI paM0 rAmacandrajI jhA, jinhoMne anavarata mAnasika evaM zArIrika zramapUrvaka bahuta kaSTa uThAkara isa grantha ke prakAzana meM sahAyatA kI hai, bhI dhanyavAda ke pAtra haiN| itane bar3e grantha ke nirmANa meM aneka prakAra kI truTiyA~ rahanA svAbhAvika haiN| merA vizvAsa hai ki sahRdaya pAThaka unheM sudhAra leMge tathA jahA~ jaise sudhAra kI AvazyakatA hogI, mujhe sUcita kara anugRhIta kareMge tAki Age ke saMskaraNoM meM maiM unakA upayoga sAbhAra kara skuuN| jo tila meM tAr3a dekhane ke abhyAsI haiM unase mujhe kucha kahanA nahIM hai / ityalam // vasantapaJcamI saM0 2013 5-2-1957 -raghuvIraprasAda trivedI For Private and Personal Use Only

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samarpaNa S kAzI hindU vizvavidyAlaya ke Ayurveda kAleja ko vaibhava ke uccazikhara para AsIna karane meM jina mahAn vibhUtiyoM ne apanA jIvana lagA diyA aura Asetu himAcala Adhunika Ayurveda se otaprota AyurvedajJoM kI eka aisI zRGkhalA khar3I kara dI jo unake AzIrvAda kA sambala pAkara timirAcchanna jagat meM pUrNa AyurvedIya dIpa kA prakAza phailAne meM sarvathA samartha siddha ho rahI hai| una parama zraddhaya gurudeva zrI DA0 mukundasvarUpa varmA prinsipala Ayurveda kAleja tathA supariNTeNDeNTa sara sundaralAla cikitsAlaya kAzI hindU vizvavidyAlaya ko jinhoMne hindI mAdhyama dvArA Adhunika cikitsA zAstra sambandhI anya racanA evaM vyAkhyAna paramparA dvArA hI mArga darzana nahIM kiyA api tu eka snigdha mRdula antastala kI aisI divya jhoMkI bhI karAI hai jo yugAnuyuga taka prema vikala sevakoM aura ziSyoM ko tar3apAtI rahegI tathA ___ una parama zraddhaya gurudeva zrI DA0 bhAskaragovinda ghANekara prophesara Ayurveda kAleja kAzI hindU vizvavidyAlaya ko jinakA sArA jIvana hI mAnoM eka pAvyagrantha bana gayA hai jise par3ha kara Adarza hindU jIvana kI kalpanA mUrtimatI ho uThatI hai tathA jinhoMne suprasiddha suzruta saMhitA kI AyurvedIya rahasya dIpikA nAmaka aisI TIkA bhI pradAna kI hai jo kAla kI chAtI para paira rakha kara apanI chApa se vidvajanoM kI bhrAnti kA ananta kAla taka nivAraNa karatI rhegii| unhIM ke hI dvArA pradatta jJAna rAzi ke kucha kaNoM ko abhinava vikRti vijJAna nAmaka unhIM ke isa grantha meM sazcita kara pAyA hU~ jise unhIM ke caraNoM meM vidAI kI smRti ke rUpa meM sAdara samarpita karatA huuN| raghuvIra prasAda trivedI 3 vi0 bha0 For Private and Personal Use Only

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viSayAnukramaNI prathama adhyAya vraNazotha yA zopha [ Inflammation] 1-32 - paribhASA-1, hetu-3, sAmAnyaliGga-5, vizeSalakSaNa-6, vraNazotha meM kyA hotA hai-8, vraNazothotpatti meM rakta kA kArya-8, boNazothAtmaka jalasaMcaya kyoM hotA hai-10, vraNazothotpatti aura zArIrika kozAe~ 12, vraNazotha kI prAcIna kalpanA- 16, . vraNazotha-doSa tathA dUSya 19, vraNazotha ke kAraNa kSetrIya parivartana-21, vraNazotha kA prasAra-22, bhautikIya vibheda-23, vraNazotha ke naidAnikIya prakAra-26, zleSmala kalA ke vraNazotha-27, lasyakalAoM ke vraNazotha -29, jIrNa vraNazotha-31 / dvitIya adhyAya vividha zarIrAGgoM para vraNazotha kA prabhAva 33-226 [Effect of inflammation on various systems & organs of the body 1 asthidhAtu para vraNazotha kA pariNAma-35, asthisandhiyoM para vraNazotha kA pariNAma-42, mAMsadhAtu para vraNazotha kA pariNAma-54, hRdaya para vraNazotha kA pariNAma-57, rakta tathA lasavAhiniyoM para vraNazotha kA pariNAma-68, jAlikAantazchadIya saMsthAna para vraNazotha kA pariNAma-75, zvasanasaMsthAna para vraNazotha kA pariNAma-77, mahAsrota para vraNazotha kA pariNAma-98, yakRt para vraNazotha kA prabhAva-110, pittAzaya para vraNazotha kA prabhAva-133, sarvakiNvI para vraNazotha kA pariNAma-135, vRkoM para vraNazotha kA pariNAma-137, adhomUtramArga para vraNazotha kA pariNAma-157, puruSaprajananAMgoM para vraNazotha kA pariNAma-161, strIprajananAMgoM para vraNazotha kA pariNAma-163, vAtanADIsaMsthAna para vraNazotha kA pariNAma-176 / tRtIya adhyAya atimRtyu yA utinAza [ Tissue necrosis ] 230-236 atinAza ke tIna pramukha kAraNa-230, UtimRtyu ke prakAra-234 / For Private and Personal Use Only

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[ 2 ] caturtha adhyAya vihAsa [ Degeneration ] 236-257 meghAbha yA meghasama zotha-236, snaihika vihrAsa -238, hRdaya kA snaihika vihrAsa-243, yakRt kA snaihika vihrAsa-243, mAMsapezI kA snaihika vihrAsa-244, vRkkoM kA snaihika vihrAsa-245, anya snaihika parivartana-245, madhujanIya antarAbharaNa-246, phAnagIrka roga-246, zleSAbha vihrAsa-247, kAcara vihrAsa-247, maNDAbha vihrAsa-249, plIhA kA maNDAbha vihrAsa-251, vRkkoM kA maNDAbha vihrAsa-252, yakRt kA maNDAbha vihrAsa-253, mahAsrotas kA maNDAbha vihrAsa-254, maNDAbha vihrAsa ke pariNAma-254, dhamanIvihrAsa-255, cUrNIyana-255, azmariyA~-257 / paJcama adhyAya raktaparivahana kI vikRtiyA~ 258-285 [ Pathological disorders of blood circulation ] vizoNatA-258, kotha-259, ghanAsratA yA ghanAsrotkarSa-263, antaHzalyatA-268, RNAsrapradeza-274, atiraktatA yA paramaraktatA-278 / SaSTha adhyAya punarnirmANa [ Repair ] 285-301 prathama ropaNa-287, kaNana dvArA ropaNa-289, punarjanana dvArA ropaNa-293, asthiropaNa-295, ropaNa meM pratiropaNa kA mahattva-298, atighttn-300| saptama adhyAya jvara [ Fever ] 302-462 jvarasamprApti-303, jvara kA pUrvarUpa-308, jvara kI saMkhyAsamprApti-315, ekarUpa jvara-315, dvividha jvara-316, paJcavidha jvara-323, pralepaka jvara-333, saptavidha jvara-343, aSTavidha jvara-354, vAtajvara-355, pittajvara-371, kaphajvara-386, vAtapittajvara-407, vAtakaphajra-411, zleSmapittajvara-413, sannipAtajvara-416, Agantu jvara-452, aSTavidha jvarasamprApti-454, jvara ke sambandha meM Adhunika vicAra-454, avirAmajvara-460, daNDakajvara-467, marumakSikAjvara-468, For Private and Personal Use Only

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[ 3 ] pItajvara-468, tantrikajvara - 469, mUSikadaMzajajvara - 470, plega yA vAtAlikA - 471, taraMgajvara - 473, kAlajvara - 474, riyA- 477, kAlamehajvara - 485, yAntrikajvara - 487 / zrAvartakajvara - 471, viSamajvara yA male aSTama adhyAya yakSmA [ Tuberculosis ] 463-574 yadimakA- 494, yakSmakavakavetrANu - 496, yakSmA ke prabhavasthala - 497, yakSmA ke pravezamArga - 499, upasarga kA prasAra - 505, zrautikIya pratikriyA - 506, yakSmikAoM ke parivartana - 510, kilATIyana - 511, tantUtkarSa - 512, cUrNiyana - 514, vAhinyaparivartana - 514, yakSmAnuSatA tathA pratIkAritA - 515, tIvra sarvAGgINa yakSmA - 517, yakSmA ke sahAyaka kAraNa - 518, asthiyoM para yakSmadaNDANu kA prabhAva ( asthi yakSmA ) - 520, sandhiyoM para yamadaNDANu kA prabhAva ( sandhiyakSmA ) - 524, yakSmaparihRtpAka - 529, yakSmadhamanyantazchadapAka - 529, yakSmalasagranthipAka - 530, yakSmasvarayantrapAka-531, phuphphusa para yakSmadaNDANu kA prabhAva ( phauphphusika yA phuphphusa yakSmA ) - 532, yakSmA kA zreNIvibhAjana - 548, Antra para yakSmA kA prabhAva ( Antrika yA yakSmA ) - 556, upavRkka pranthiyoM para yakSmA kA prabhAva ( eDIsanAmaya ) - 563, mUtraprajananasaMsthAna para yakSmA kA prabhAva - 567, vAtanADIsaMsthAna para yakSmA kA prabhAva - 572 / For Private and Personal Use Only navama adhyAya phiraGgaprakaraNa [ Syphilis ] 575-638 phiraMga zabda kI vyutpatti - 575, sahajaphiraGga - 579, avAptaphiraGga-585, bAhya phiraGga-585, AbhyantaraphiraGga - 590, bahirantarbhava phiraGga - 593, phiraGgArbuda kyA hai - 595, phiraGga kI caturyAvasthA - 599, asthiphiraGga - 600, sandhiphiraGga -603, raktavAhiniyoM para phiraGga kA prabhAva - 605, lasagranthiyoM para phiraGga kA prabhAva - 611, plIhA para phiraGga kA prabhAva - 612, svarayantra para phiraGga kA prabhAva - 612, phuphphusa para phiraGga kA prabhAva - 612, zroSTha para phiraGga kA prabhAva - 614, mukha meM phiraGga kA prabhAva - 614, jihvA para phiraGga kA prabhAva - 614, mahAsrota aura phiraGga - 615, yakRt para phiraGga kA prabhAva - 616, nAsA para phiraGga kA prabhAva - 617, phiraGga - 618, avaTukA pranthi para phiraGga kA prabhAva - 618, phiraGgika vRkkapAka - 619, vRSaNoM para phiraGga kA prabhAva - 620, prabhAva- 621, vAtanADI saMsthAna para phiraGga kA prabhAva - 621, zrAmAzaya aura hRdaya aura phiraGga - 618, garbhAzaya para phiraGga kA paJcakArzya yA pracalanA

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saGgati-625, unmattasya sarvAGgavAta - pratyAvartIjvara - 636, galazopha - 637, padika sukuntalANvika kAmalA - 638 / Acharya Shri Kailassagarsuri Gyanmandir [ 4 ] yA sarvAGgaghAta - 632, nyupadaMza yA paraGga - 638, kuntalA tkarSa - 636, vIlaroga yA jAna dazama adhyAya anya viziSTa kaNArbudika vyAdhiyA~ 636 - 656 [ Other specific granulomatous diseases ] aratrbuda - 639, mahAkuSTha - 639, kavaka roga - 646, azvagranthi - 654, nAsAvRddhi - 655, lasakaNArbuda - 656, bAhyadravyakaNArbuda - 657, kAlasphoTa - 658 / nAsAbIjAtkarSa - 658, For Private and Personal Use Only ekAdaza adhyAya arbuda prakaraNa [ Tumours ] 660-862 adhicchadIya arbuda kI paribhASA - 660, vi - vibhinnana - 663, arbudIya racanA - 664, pratIpagAmI parivartana - 666, arbudIya vistAra - 667, arbuda ke naidAnika prakAra - 671, duSTa tathA sAdhAraNa arbudoM meM andara - 673, arbuda - dauSTaya kI aMzAMza kalpanA - 676, arbuda prabhAva - 677, karkaTotpatti - 679, prAyogika karkaTagaveSaNA - 682, kulajapravRtti - 691, anuSatA tathA pratIkAritA - 692, arbudoM kA pravikiraNa - 698, arbudahaSatA - 701, upasarga - - 703, arbuda kA vargIkaraNa - 704, Ayurveda meM arbuda - 705, Uti ke arbuda - 706, karkaTa yA karkaTArbuda - 7 da- 707, karkaTa ke prakAra - 709, karkaTa kA vistAra - 713, kozIya dRSTi se karkaTa vicAra - 714, stabdhakozIya karkaTa - 718, golAbhakozIya karkaTa - 719, zleSAbha karkaTa - 720, zvasanasaMsthAna ke karkaTa - 721, mahAsrotIya karkaTa - 729, yAkRta karkaTa - 741, avaTukApranthIya karkaTa - 745, poSaNikA pranthikarkaTa - 747, adhivRkka granthikarkaTa - 748, mUtrasaMsthAna ke karkaTa - 751, puruSa prajananAGgIya karkaTa - 754, strIprajananAGgIya karkaTa - 759, stana karkaTa - 764, adhicchadIya Uti ke sAdhAraNa arbuda - 774, carmakIla yA aGkurArbuda - 774, granthyarbuda - 783, adhicchadIya Uti ke anya arbuda - 797, ativRkkArbuda - 797, jarAyvadhicchadArbuda - 7 dantAkAcArbuda6-800, saMyojI Uti ke arbuda - -801, saGkaTArbuda - 801, asthi kA saMkaTArbuda - 808, phuphphusasaGkaTa - 813, lasAbha Uti yA jAlakAntazchadIya saMsthAna saGkaTa-814, mahAsrotIya saGkaTArbuda - 818, anya audarika saGkaTArbuda - 819, prajananasaMsthAnIya saGkaTArbuda - 819, pRSThamervarbuda - 824, tantvarbuda - 825, bArbuda - 834, zleSmArbuda - 836, kAsthyarbuda - 838, asthyarbuda - 841, pezI Uti ke - 798, mUtravime

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Shri Mahavir Jain Aradhana Kendra arbuda - 843, arbuda - 851, zrauNArbuda - 860 / www.kobatirth.org [ 5 ] vAhanIya arbuda - 845, antazchadArbuda - 6-850, zoNotpAdaka UtiyoM ke raGgita arbuda - 856, vAtaUtIya arbuda - 851, saMyuktArbuda yA bhaGguratA - 874, parivartana - 875, rAgu rasaparibhASA aura usake kArya - 863, -866, rudhirANuoM kI vikRtiyA~- 869, raMgadezanA-870, saMkhyAsambandhI parivartana - 871, sambandhI parivartana - 872, prAisajonsa vakratA - 8712, bharaJjanasambandhI parivartana - 873, dvAdaza adhyAya vaikArika [ Blood Pathology ] 863-646 AtaJcanajanya zoNaprasamUhijanya Acharya Shri Kailassagarsuri Gyanmandir rasarakta vyApattija roga-865, rudhizoNavartulisambandhI parivartana - 860, bahukozAraktatA - 871, AkArasvarUpasambandhI parivartana - 873, nyaSTivAn rudhirANu - 874, rudhirANu aura parivartana - 875, raktAvasAdana gatijanya parivartana - 876, rudhira ruhotkarSazrauNIya - 878, sitakozotkarSa - 882, sitakozA sitakozA- 881, raktabimbANu - 880, pakarSa - 884, akaNakAyANutkarSa - 8 - 884, araktatA, alparaktatA yA raktakSaya - 887, raktakSayaka zreNIvibhAjana - 889, ghAtaka raktakSaya-891, anya paramakAyANvika raktakSaya - 901, amajjakIya raktakSaya - 901, grahaNIjanya raktakSaya - 901, ve raktakSaya jinameM lohAdi kA prabhAva rahatA hai - 905, prAthamika upavarNika raktakSaya - 907, haridutkarSa - 909, asthimajjakIya kriyA kA avasAda - 910, bahukozArakatA - 937, parama bala bahukozArakatA - 938, sitaraktatA - 938, majjAjanya sitaraktatA - 939, tIvra sitarakatA - 945, ekakozIya sitaraktatA - 947, asitarakkIya sitaraktatA - 979 / trayodaza adhyAya agnivaikArikI 650-1020 zrAhAravidhi - 951, bhojyasAdguNya - 951, AhAra aura mAtrA - 952 zrAmadoSa aura unake guNa - 953, caturvidha jATharAmi - 954, pAcakAbhi kI mahattA - 957, prakRtidRSTathA agnivicAra - 958, agnimAndya aura zramadoSa - 959, ajIrNa lakSaNa - 959, ajIrNa ke kAraNa - 961, ajIrNa aura usake prakAra - 962, visUcikA, saka tathA vilambikA - 965, atIsAra - 968, vAtaja zratIsAra- 972, pittaja atIsAra - 973, kaphaja atIsAra - 974, sAnnipAtika pratIsAra - 975 zrAmAtisAra tathA pakkAtIsAra- 976, zokAtIsAra- 978, raktAtIsAra - 978, vibhinna pratIsAroM kI samprAptiyoM para saMkSipta vicAra - 979, pravAhikA - 980, grahaNI - 981, grahaNI roga For Private and Personal Use Only

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[6] kI utpatti meM agni kA mahattva - 985, vAtika grahaNI - 987, paittika grahaNI - 989, zlaiSmika prahaNI - 990, sAnnipAtika grahaNI - 991, saMgrahagrahaNI, ghaTIyantra grahaNI yA zramavAta grahaNI - 991, grahaNI - Adhunika vicArakoM kI dRSTi meM - 992, AmagrahaNI - 993, jIvANujanya aura zramIbAjanya grahaNiyoM meM antara - 997, daNDANvika grahaNI - 998, kITANugrahaNI - 1000, TrApIkalastra - 1001, arza prakaraNa - 1003, zanirukti - 1005, jAtasyottarakAlaja arza-1008, vAtArza - 1009, pittArza - 1010, zleSmA - 1 -1011, dvandvaja arza - 1012, tridoSajArza - 1013, sahajArza - 1014, arza kA sthAna - 1017, arza samprApti - 1019, arzo kA vargIkaraNa - 1010, arzAdi meM agnibala kA mahattva - 1020 / Acharya Shri Kailassagarsuri Gyanmandir caturdaza adhyAya rogApaharaNasAmarthya [ Immunity ] 1021-1036 aprApa rasAyana tantra aura rogapratIkAritA - 1021, kSamatA ke do prakAra - 1022, zravAptakSamatA - 1023, bahirviSa - 1026, antarviSa - 1026, kAri - 1027, rogANavika zrAkramaNa aura zArIrika ke viziSTa upAya - 1029, sthAnika pratIkAritA - 1031, siddhAnta - 1032, aharlikIya pArzvazRMkhalAvAda - 1032, vyaMziyA~ - 1027, pratirakSA - 1028, zarIrapratirakSA rogApaharaNasAmarthya ke vividha arhIniyasa aura madasena - vAda - 1034, borDevAda - 1034, sAMparIkSa avalokana - 1034, zrAdhunikavAda - 1036, janapadoddhvaMsa - 1737 / pazcadaza adhyAya samprApti vimarza 1040-1076 samprAptiparyAya- 1041, samprApti para gaMgAdhara kavirAja kA mata - 1041, cakrapANidatta - 1042, indu - 1042, vijaya rakSita - 1044, aruNadatta - 1044, hemAdri - 1044, samprApti ke bheda - 1050, saMkhyA samprApti - 1053, vikalpa - 1054, saMkhyA aura vidhi - 1055, vividha vikAra aura unakI samprApti - 1057 / -ope For Private and Personal Use Only

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vidvajjana nAmAvalI akUkairo kaisila kona ( yahA~ prAyaH una sabhI vidvAnoM ke nAma sadhanyavAda aGkita kie jAte haiM jinakI kRtiyoM se isa grantha kI racanA meM sahAyatA milI hai ) jaunsTana ayyara kaiNTI jaubaliMga aruNadatta jyorjI azkopha jejara azvinIkalpakAra konahIma Tarka aSTAMgasaMgrahakAra kauka TIla aSTAGgahRdayakAra vAgbhaTa kyUziMga TribauNDo ahalarica klotsa Dapha AtaGkadarpaNakAra klauraja AyurvedakAra khannA DArliga AlIvara kharanAda DIDe gaMgAdhara kavirAja Denisa iGgilTana gaNanAthasena DailIpAina IviMga gAI DeviDasana ugrAditya guDapAzvara Doara upAdhyAya guDaula toDara eDeyara golDa blaiTa trimallabhaTTa eNDarasana govindadAsa gauDa thIza aijanau dvivedI dRDhavaladhara aimbilTana grAhama dhIrendranAtha) banarjI opAI nAgabhartR opI grIna phIlDa nigelI auro grUTara nityanAtha kajAla ghANekara kaTalara cakrapANidatta nyUbarSa kazyapa caraka paramezvara kArtikakuNDa cintAmaNi paraDro kAmeTa cauphArDa parAzara kuNDreTa jAnskI kuziMga jainasana pAThaka gaula grIna nIDhama For Private and Personal Use Only

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pAvalova pAsamora pITarasana peTanarUsa vRddhavAgbhaTa vRndamAdhava vaiDiGgaTana paigaTa vaidyavinodakAra vailsa painaphIlDa porTara prAisa philDe phiza phebara phrauyana phlaiksanara bakulakara baroja baunI barDaka bArakrophaTa [ 2 ] maikakArTanI maiksvInI maiDalara mausa yaMga yAdavajI yAveTa yUnzolma yogAnandanAtha rasavAgbhaTa rasaila rasailabrena rAmaje haNTa rica ribarTa raikliga Aujana lAlacandra lIbaramena lUgola laikAsegne laiNDasTInara laiviDiTI laiviza laizameTa biTanara bujharDa bulaka belI vaisTaragrIna vomaka zarmA snaam zIlara zukla zailDana zauDina sasAno siddhavidyAbhUH silvaravarga sulemAna suzruta savila sTrAsa sTrajaveja sTona sTrosa . smitha haginsa haraviyara haricandra harAza harbarTaphreJca hArIta higginsa hilekara hemAdri haimilTanabelI berI borDe bauyaDa bloca bvAyaDa bhagavAn punarvasu Atreya bhAluki bhAvamizra bheDa bhela mI varmA vATasana vasavarAjIyakAra bAgbhaTa vAcaspati vaidya vArena vAlDeyara vIjanara vijayarakSita viNTroba viliyama bvAyaDa vilisa vilkI vilphreDazA vilsana vIDa malorI mAilsa mAdhavakara mArTalaNDa mInsa haiDo haiNDale hainsana haujakina mekina haujamaina mevArAma mehatA maikaIkarna hauphamana hoTeMgA DailarAyo For Private and Personal Use Only

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// zrIH // abhinava vikRtivijJAna O prathama adhyAya vraNazotha yA zopha | INFLAMMATION ] zopha kI paribhASA karate hue AcArya suzruta ne likhA hai| --- zophasamutthAnA granthividradhyalajIprabhRtayaH prAyeNa vyAdhayo'bhihitA anekAkRtayaH, tairvilakSaNaH, pRthurgrathitaH sama viSamo vA tvaGmAMsasthAyI doSasaMghAtaH zarIraikadezotthitaH zopha ityucyate / ( su. sU. a. 17-2 ) granthi, vidradhi, alajI Adi aneka prakAra kI utsedhayukta choTI moTI vyAdhiyoM se bhinna, vistRta, gAMThadAra, sama yA viSama AkAra vAlA, tvacA aura mAMsa meM sthita, vAtAdi doSoM kA saMghAta, zarIra ke eka deza meM uThA huA jo eka vizeSa roga hotA hai, vaha zopha kahalAtA hai / kahIM koI gAMTha uTha Ave yA alajI ho jisake kAraNa sthAna kucha uThA sA dikhAI de, to vaha zopha nahIM hai, vaha to phailI sI, ga~ThIlI sI, U~cI nIcI, doSoM kA jhuNDa lekara calane vAlI, eka sthAna para sthita sUjana yA pAka vizeSatAyukta hotI hai / vahI zopha nAma se pukArI jAtI hai / mAdhavakara ne isI ko vraNazotha nAma se pukArA hai / sAdhAraNa zotha se isakA are karane ke lie batalAyA hai ki pakkApaka kA jahA~ sambandha hotA hai vahA~ zotha vraNazotha kahalAtA hai / ekadezotthitaH zotho vraNAnAM pUrvalakSaNam / SaDvidhaH syAt pRthaksarvaraktAgantu nimittajaH // zothAH SaDete vijJeyAH prAguktaiH zothalakSaNaiH / vizeSaH kathyate caiSAM pakkApakkAdinizcaye // ( mA. ni. 41 ) 6 prakAra kA ( vAtika, hotA hai ( jisakA varNana pacyamAna aura paka ina arthAt eka bhAga meM sthita, vraNoM ke pUrvalakSaNoM se yukta, paittika, zlaiSmika, sAnnipAtika, raktaja, Agantuja ) jo zotha zothaprakaraNa meM mAdhava ne kiyA hai ) usI kA yahA~ para apaka, tIna avasthAoM kI dRSTi se vicAra kiyA jAtA hai / For Private and Personal Use Only

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vikRtivijJAna vraNazotha yA zopha kI sUjana sAdhAraNa sUjana se pRthak hotI hai / isakA pramukha kAraNa vraNa kA bananA hai / vraNa kI Ama, pacyamAna aura pakvAvasthAoM kA pUrvasvarUpa vraNazotha se hI hotA hai / isakI dUsarI vizeSatA yaha hai ki yaha ekadezastha hotA hai / eka deza kA abhiprAya kisI eka Uti se bhI ho sakatA hai aura kisI aMgavizeSa se bhI / sampUrNa zarIra vraNamaya kadApi nahIM ho pAtA usakA ekAdhika aMga vraNamaya ho sakatA hai | ataH ekadezastha honA vraNazotha kA mahattva kA lakSaNa hai / zodha sarvAGga prAyazaH huA karatA hai ataH usase pRthak pragaTa karane kI dRSTi se isa eka dezotthatva para vizeSa jora DAlA gayA hai / tIsarI dhyAna dene yogya bAta isa sambandha meM yaha hai ki yaha doSoM ke saMghAta se utpanna hotA hai / isameM prakupita hue doSa vibhinna lakSaNotpatti karate haiM / isI kAraNa tInoM doSoM ke anusAra vraNazotha ke vAtika, paittika, zlaiSmika aura sAnnipAtika vibhAga kara diye gaye haiM / raktaja aura Agantuja meM bhI doSabAhulya -rahatA hI hai / paripakvAvasthA, jo pratyeka prakAra ke vraNazotha meM sambhava hai, kA varNana karate hue ina tInoM doSoM ke vibhinna kAryoM kA sundara citraNa nIce ke zloka meM suzruta ne kiyA hai: -- vAtAdRte nAstirujA, na pAkaH pittAvRte, nAsti kaphAcca pUyaH / tasmAt samastAH paripAkakAle pacanti zophAMstraya eva doSAH // ( su. sU. a. 17-11 ) pAka nahIM ho sakatI, ataH Marate meM binA vAta ke zUla nahIM ho sakatA, binA pitta ke sakatA tathA binA kapha ke usameM pUya ( pus) kI utpatti nahIM ho pAkakAla meM tInoM hI doSa milakara usako pakAte haiN| cauthI dhyAna yaha hai ki yaha vraNazotha tvaGmAMsasthAyI hotA hai | tvacA aura mAMsa ke atirikta jina anya bhAgoM meM vraNa ho sakate haiM unakA varNana karate hue likhA gayA hai ki: dene yogya bAta tvaGmAMsasirAsnAyvasthisandhikoSThamarmANItyaSTau vraNavastUni / atra sarvatraNasannivezaH // (su. sU. a. 22-2 ) ( walls of the white & grey tvacA jisameM bAhya (skin ) aura Abhyantara ( mucous membrane ) donoM sammilita haiM, mAMsa ( muscular tissue ), sirA veins, arteries & capillaries ), snAyu ( nerves, matters of the brain and the tendons of the muscles), arfer (bones & cartilages), sandhi ( joints ) koSTha, ( viscera ), marma ( vital parts ) kA samAveza kiyA gayA hai| ina sabhI sthaloM meM vraNa dekhA jA sakatA hai / jahA~ vraNa hogA vahA~ vraNazotha sarvaprathama huA karatA hai / Adhunika vidvAn pratyeka aMga aura Uti meM vraNazotha kI kalpanA karate haiM / aba hama vraNazotha kA Avazyaka vicAra prArambha karate haiM / For Private and Personal Use Only paribhASA - Adhunika vicAraka yaha mAnate haiM ki vraNazotha sajIva zarIrastha kozAoM ke dvArA kisI bhI prakSobha ke virodha meM kI gaI pratikriyA mAtra hai / isakA tAtparya yaha hai, ki kisI bhI kAraNa se hamAre zarIra ko kSati pahu~cAne kA jo

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vraNazotha yA zopha 3 bhI prayatna hogA usakA uttara hamArA jIvamAna zarIra avazya dekara pratirodha karegA / isa pratirodha ke do svarUpa haiM, eka rAsAyanika jisake dvArA pratidravya utpanna hote haiM aura jinakA varNana pratIkAritA ke pATha meM kiyA jAyagA / usakA dUsarA rUpa deha paramANuoM (kozAoM) dvArA sakriya virodha karanA hai / ye deha paramANu ( cells) svayaM tathA rakta dvArA zakti prApta karake kSatikAraka abhikartAoM se lar3ate haiM / isa lar3AI kA Arambha, madhya aura anta vraNazotha kI Ama, pacyamAna aura pakvAvasthAe~ hotI haiN| jina jina prANiyoM kA nirmANa kozAoM dvArA hotA hai phira cAhe unameM rakta ho yA na ho sabhI AghAta ko pAkara prakSubdha ho uThate haiM aura unameM pratikriyA utpanna ho jAtI hai / pratikriyA zopha yA vraNazotha kahalAtI hai / ~ hetu - deha paramANuoM kA prakSobha kina kAraNoM se ho sakatA hai usakA vicAra karane se Adhunika vidvAn nimna 4 hetu upasthita kara dete haiM: --- 2. rAsAyanika dravya 4. mRtaUtiyA~ 1. AghAta 3. jIvANu tathA AghAta ke dvArA vraNazotha kI utpatti Akasmika hotI hai / eka bAra kisI ko coTa AI, IMTa kA Tukar3A girA, cAkU lagA, lAThI lagI, garma vastu chU gaI, bijalI kA tAra chU gayA yA aura koI usI prakAra kA upadrava huA ki zarIra ke kisI eka bhAga meM kSati ho gaI / kSati karane vAlA kAraNa eka bAra karake haTa gayA aba Age zarIra kozAoM meM pratikriyA utpanna hogI jisake dvArA kSatigrasta kozA haTAye jAyeMge aura naye kozA ( cells ) unakA sthAna leMge | rAsAyanika dravyoM ke dvArA vraNazotha kI utpatti hone kA kAraNa yaha hai ki tejAba ( amla) aura dAhakatAra Adi kucha tIkSNa rAsAyanika padArtha zarIra kozAoM ko hAni pahu~cAte haiM unake prarasa ( cytoplasm ) ke sAtha mila kara use nissAdita kara dete haiM yA usakI kriyA ko naSTa karake ghAva banA dete haiM / isake bAda zarIra kI pratikriyA zopha yA vraNazotha ke rUpa meM hotI hai / jIvANu yA rogANu - vraNazotha ko utpanna karane meM jitanA bhAga lete haiM vaha sarvavidita hai / koI bhI jIvANu jo zarIra ke lie ahitakArI hai, kisI na kisI mArga se jaba zarIra meM praveza pA jAtA hai to vaha vahA~ para kisI na kisI Uti (tissue) kI kSati prArambha karatA hai / usa kSati ko rokane ke lie zarIrastha kozAoM kI jo pratikriyA hotI hai vaha bhI vraNazotha ko janma detI hai / jIvANuoM ke dvArA utpanna vraNazothoM kA varNana vividha rogoM kA varNana karate samaya yathAsthAna kiyA jAvegA / mRta UtiyA~ bhI vraNazothotpatti meM sahAyaka hotI haiN| kisI bhI kAraNa se jaba sajIva Uti kA koI bhAga naSTa hokara zarIra se pRthak hokara bhI andara par3A rahatA hai to vaha samIpastha kozAoM ko prakSubdha kara detA hai jisake kAraNa vahA~ vraNazodha dekhA jAtA hai / For Private and Personal Use Only

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vikRtivijJAna vraNazotha ke kAraNoM para AyurvedIya zAstroM ne jo mata diyA hai vaha bhI paryApta mahatvapUrNa hai / unhoMne zotha ko Agantuka aura nija ina do kAraNoM se hone vAlA mAnA hai / bAhya kAraNoM se jo zotha hotA hai use Agantuzotha kahA hai aura jo Abhyantarika kAraNoM se zodha hotA hai use nijazotha mAnA hai / ina donoM ke pRthaka pRthaka hetu diye gaye haiM / ( 1 ) tatrAgantavazchedana bhedanakSaNanabhaana picchanotpeSaNaprahAravadhabandhana veSTanavyadhana pIDanAdibhi va bhallAtakapuSpaphalarasAtmaguptA zUkakrimizUkAhitapatralatAgulma saMsparzanairvA svedanaparisarpaNAvamUtraNairvA viSiNAM saviSAviSaprANidaMSTrAdantaviSANanakhanipAtairvA sAgaraviSavAtahi madahanasaMsparzanairvA zodhA: samupajAyante / ( 2 ) nijAH punaH snehasvedanavamana virecanAsthApanAnuvAsana zirovirecanAnAmayathAvatprayogAnmithyAsaMsarjanAdvA chardyalasakavimUcikAzvAsakAsAtIsAra zoSapANDurogodara jvarapradara bhagandarAzavikArAtikaNairvA kuSThakaNDUpiDakAdibhirvA chardikSavathUdgArazukravAtamUtrapurISavegavidhAraNairvA karma rogopavAsAtikarzitasya vA sahasA'tigurvamlalavaNapiSTAnnaphalazAkarAga dadhiharitaka madyamandakavirUDhanavazUkazamIdhAnyAnUpaudakapizitopayogAnmRtpaGkaloSTrabhakSaNAlavaNAtibhakSa gAdgarbhasampIDanAdAmagarbhaprapatanAtprajAtAnAM ca mithyopacArAdudIrNadoSatvAcca zophAH prAdurbhavantIti / ( ca. sU. a. 18-4,5 ) isakA artha yaha hai ki nimna kAraNoM se zotha vA vraNazotha kI utpatti prAcIna mAnate haiM / 1. kisI bhI vastu yA padArtha dvArA chedana ( excision ), bhedana ( incision ), kSaNana ( comminution ), bhaJjana ( fracture ), picchana ( laceration ), utpeSaNa ( pounding ), prahAra ( blow ), vadha ( concussion ), bandhana ( binding ), veSTana ( ligaturing ), vyadhana ( piercing ), pIDana ( compression ) ye sabhI sAdhAraNataH AghAta meM Ate haiM / 2. prakSobhaka padArthoM kA saMsparza jaise bhallAtaka ke phala yA puSparasa kA saMsparza, koMca ke yA kisI viSaile kRmi ke zUka kA saMsparza, yA kisI viSAkta latA ke patra, gulma Adi kA saMsparza | 3. viSadhara jantuoM ke sveda se yA zarIra para unake reMga jAne se, viSayukta vA virahita prANiyoM ke dvArA kATa lie jAne se yA sIMga laga jAne se yA nakha laga jAne se bhI vraNazotha ho sakatA hai / 4. samudra ke kinAre kI dUSita vAyu kA saMsparza bhI vraNazothakAraka ho sakatA hai / 5. himasaMsparza vA agnisaMsparza vraNazotha karatA hai / vidyuttArasaMsparza bhI isI meM le sakate haiN| 6. snehana, svedana, paMcakarmAdi ke ayathAvat prayoga se zotha hotA hai / ina karmoM meM jo pathya batAyA jAtA hai ( saMsarjana ) usake viparIta AhAra-vihArAdi bhI zora hotA hai| 7. vamana, alasaka, visUcikA, zvAsa, kAsa, atIsAra, zoSa, pANDuroga, jvara, For Private and Personal Use Only

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vraNazotha yA zopha udararoga, pradara, bhagandara, arza, atikarSaNa, kuSTha, kaNDU, piDakAdi rogoM ke ho jAne para zotha bhI pratyeka avasthA meM mila sakatA hai| 8. vamana, chIMka, DakAra, zukrotsarga, vAtotsarga, malotsarga, mUtrotsarga ke vegoM ke rokane se bhI zotha hotA hai| 9. paJcakarma kie hue vyakti ko yA roga se uThe hue vyakti ko yA atIva kRza vyakti ko atyadhika guru, amla, lavaNa, piSTamaya, anna, phala, zAka, acAra, caTanI, dahI, adarakha, madya, adhajamI dahI (mandaka), binA aMkura nikale dhAnya, navIna zUkadhAnya (prAGgodIya ), zamIdhAnya (probhUjina ), AnUpa, audaka mAMsa prayoga Adi se bhI zotha ho sakatA hai| 10. miTTI, kIcar3a yA lavaNa kA atyadhika bhakSaNa karanA / 11. garbha kA saMpIDana ( pressure of gravid uterus ) / 12. Amagarbha kA prapatana ( abortion ) / 13. prasUtA striyoM ke pathyAdi sevana na karane se zotha ho sakatA hai| uparokta 13 kAraNa ko dekhane se yaha jJAta hotA hai ki prathama 5 kAraNa vraNa-zotha ke hetu haiM, 6 se 10 taka zotha ke hetu haiM aura zeSa 3 donoM ke hetu haiN| zotha kA varNana jaba hama yathAsthAna kareMge taba unake sambandha meM vizada vivecana upasthita kiyA jaayegaa| isa samaya to hama vraNazotha kA vicAra kara rahe haiM / Agantuja zotha kA jitanA varNana caraka ne kiyA hai yA zotha nAmaka varNana suzruta aura vAgbhaTa ne upasthita kiyA hai vaha saba vraNazotha yA inphlemezana ( inflammation ) ke hI sambandha meM kahA gayA hai / zotha aura vraNazotha donoM ko prAcIna eka hI mAnate haiM parantu vicArapUrvaka dekhane se donoM kA pArthakya ve jAnate the| ise samajhane meM koI vizeSa ar3acana na hogii| vraNazotha ke hetu likhate hue kazyapa ne nimna sUtra upasthita kiyA haiAgantuH kSataniSpiSTacyutabhannAdisaMbhavaH / daSTAvamUtritAghrAtasaMsparzagarayogajaH // (ka. saM. khi. a. 17-8) yaha smaraNa rakhane yogya hai ki prAcInoM ne zotha vA vraNazotha ke hetu varNana meM bhautika aura rAsAyanika padArthoM kA samAveza to bar3hA car3hAkara kiyA hai para navInoM dvArA upasthita jIvANuoM aura mRta UtiyoM kI zarIra meM upasthiti ke kAraNa bhI vraNazotha ho sakatA hai ise spaSTa nahIM kiyaa| sAmAnya liGga-mahAzaya grIna ne vraNazotha ke sAmAnya liGga batalAte hue likhA hai: "The cardinal signs of inflammation are heat, redness, swelling, and pain; associated with these is impairment of function due partly to tissue damage and partly to pain. A Manual of Pathology arthAt vraNazotha ke pramukha cihna tApa, lAlimA, zotha aura zUla hote haiM inake For Private and Personal Use Only

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vikRtivijJAna sAtha hI sAtha utiyoM meM kucha AghAta hone se aura kucha zUla ke kAraNa aMga kI kriyAzakti kA hrAsa bhI rahatA hai| isI ko caraka ne nimna zabdoM meM abhivyakta kiyA hai : sagauravaM syAdanavasthitatvaM sotsedhamUSmAtha sirAtatatvam / salomaharSAGgavivarNatA ca sAmAnyaliGgaM zvayathoH pradiSTam // (ca.ci. a. 12-10) arthAt jisa sthAna para zotha hotA hai vahA~ 1. gurutA ( heaviness ), 2. zotha kI anavasthitatA (variability of oedema), 3. utsedha (swelling), 4. USmA ( heat ), 5. sirAvyApti (jisake kAraNa aMga kA adhika lAla ho jAnA redness ), 6. aGga meM romaharSa, 7. aGga kA vivarNa honA (prakRtavarNa kA abhAva) ye 7 lakSaNa dikhane para use zotha ke tathA vraNazotha ke bhI lakSaNa mAna lenA caahie| caraka ne Agantu aura nija donoM zothoM ke ye lakSaNa diye haiN| navInoM ke 5 lakSaNa aura prAcInoM ke 7 lakSaNa donoM hI eka dUsare ke pUrakAnupUraka haiM aura donoM ke jJAna se vijJAna kA vikAsa hI hotA hai| isake viparIta vicAra rakhane vAlA vyakti nissandeha donoM hI zAstroM kA zatru aura saMkIrNatAvAdI hai| vizeSa lakSaNa-yadyapi navIna vicAraka uparokta 5 lakSaNa dekara Age bar3ha jAte haiM aura phira vividha UtiyoM meM hone vAle zotha ke vividha lakSaNa batalAne lagate haiM / prAcIna vicArakoM ne apane ko tridoSa se sambaddha kara liyA hai ataH unhoMne vraNazotha ke nimna bheda kie haiM : 1. vAtika zopha-vAtazopho'ruNaH kRSNo vA paruSo mRduranavasthitAstodAdayazvAna vedanA vizeSA bhavanti-isameM aruNatA (redness), kRSNatA (darkness) hotI hai tathA yaha paruSa ( rough ), mRdu ( tender ), anavasthita, todAdi vizeSa vedanA ( pain ) se yukta hotA hai| ____2. paittika zopha-pittazophaH pIto mRduH sarakto vA zIghrAnusAyauMSAdayazcAtra vedanAvizeSA bhavanti-isa zopha meM zothasthala kA varNa pIta ( yellow ) hotA hai tathA yaha mRdu ( tender ), sarakta ( hyperaemic ) / zIghra bar3hane vAlA, oSa coSadAha Adi vedanA ( burning pain) se yukta hotA hai| _____3. zlaiSmika zopha-kaphazophaH pANDuH zuklo vA kaThinaH zItaH snigdho mandAnusArI kaNDavAdayazcAtra vedanA vizeSA bhavanti-isa zopha kA varNa pANDu ( pale ) yA zukla ( white ) hotA hai yaha kaThina ( hard ) zItala ( cold ) snigdha ( unctuous ), zanaiH zanaiH bar3hane vAlA ( slowly progressing ) hotA hai tathA isameM kaNDU Adi vedanAe~ vizeSa milatI haiN| 4. sAnnipAtika zopha-sarvavarNavedanaH sannipAtajaH-isameM sabhI prakAra ke varNa aura vedanAe~ hotI haiM / isake lie kazyapa ne likhA hai: nIlapItAruNAbhAsaH siraajaalopsnttH|| . anekopadravasrAvaH sarvarUpasamanvitaH / sutIvravedano'mAdhyaH zvayathuH sAnnipAtikaH / / For Private and Personal Use Only

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vraNazotha yA zopha 5. raktaja zopha - pittavacchoNitajo'tikRSNazca - yaha pittajazotha ke samAna parantu varNa meM atyadhika kRSNatA lie hotA hai / 6. Agantuzopha - pittaraktalakSaNa AgantulohitAvabhAsazva - isameM paittika aura raktajazopha ke lakSaNa hote haiM aura yaha dekhane meM lohita (lAla ) varNa kA hotA hai. / rakta, zyAva, aruNavarNa vAle atyuSNa, todabhedAdi pIr3AoM se yukta zopha ko kazyapa Agantuzopha mAnatA hai / 8. dvandvaja zopha-do do dvandvaja zopha banate haiM / ye 3 3. pittakaphaja / 1 Acharya Shri Kailassagarsuri Gyanmandir 7. viSaja zopha "saviSastAmraH kRSNo vA''zu visarpitaH / hRllAsArucitRNmUcrchAjvarA rucikaro bhRzam // ( kA. saM. khi. a. 17 ) viSaja zopha tA~be ke samAna lAla yA kAle varNa kA zIghra visarpaNazIla hotA hai sAtha meM hRllAsa ( nausea ), aruci, tRSNA, mUrcchA, jvara aura aruci rahatI hai / isI ko vAgbhaTa ne 'mRduzcalo'valambI ca zIghro dAharujAkaraH' bhI likhA hai / doSoM ke lakSaNa jaba eka zopha meM mila jAte haiM to prakAra ke hote haiM / 1. vAtapittaja 2. vAtakaphaja vraNazotha yA zophoM kA vargIkaraNa vibhinna granthakAroM ne bhinna-bhinna rUpa se kiyA hai / caraka ne zotha ko vAtika, paittika, aura laiSmika ina 3 bhedoM meM mAnakara phira unake nija aura Agantu do vibhAga kiye haiM / nija kAraNoM se utpanna ko zotha aura Agantu kAraNoM se utpanna ko vraNazotha karake hamane liyA hai| suzruta ne 6 prakAra zodha mAne haiM- 'sa pavidho vAtapittakaphazoNitasannipAtAgantunimittaH' Agantu zopha unakA aura caraka kA donoM kA vibhinna AdhAroM para sthira hone se eka nahIM samajhA jA sakatA / caraka doSaja zophoM meM bhI Agantuja aura nija dekhatA hai para suzruta doSazopha pA~ca dekara Agantujazopha pRthak darzAyA hai / vAgbhaTa ne 9 prakAra ke zopha mAne haiM - 3 eka eka doSaja, 3 dvidoSaja, eka sannipAtaja, AThavA~ abhighAtaja aura navA~ viSaja | usane nija aura Agantu dRSTi se 2 zreNiyoM meM punaH bA~TA hai / sarvAGga aura ekAGgazopha isa dRSTi se bhI 2 bheda usane kara diye haiN| usane AkAra dRSTi se zopha ke 3 aura bhI bheda kie haiM, jinameM prathama pRthutA kI dRSTi se hai, dvitIya unnatatA kI hai aura tRtIya grathitatA kI dRSTi se hai / pRthutA vistIrNatA bodhaka hai, unnatatA U~cAI kA jJAna karAtI hai aura grathitatA usakI gaThana ( texture ) ko batalAtI hai / kazyapa ne bhI zotha ke 6 bheda vAtika, paittika, laiSmika, sAnnipAtika, Agantu aura viSaja mAne haiM / mAdhavakara vAtika, paittika, laiSmika, sAnnipAtika, abhighAtaja aura viSaja ye 6 zopha mAne haiM / vraNazotha ke varNana meM vAtika, paittika, zlaiSmika, sAnnipAtika, raktaja aura Agantuja 6 nAma diye haiM- SaDvidhaH syAt pRthak sarvaraktAgantu nimittajaH / I For Private and Personal Use Only hai

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www.kobatirth.org vikRtivijJAna zodha aura vraNazotha ke ina prakAroM ko dekhakara kaI eka ulajhaneM pAThakoM ke hRdaya meM AveMgI para unake Ane kA koI kAraNa nhiiN| kyoMki vraNazotha kI pahacAna usakI AmAvasthA, usake bAda pacyamAnAvasthA aura anta kI pakvAvasthA se hotI hai| jaba ki sAdhAraNazotha meM ye tInoM avasthAe~ nahIM hI hotI haiM / sampUrNa Agantuja, raktaja, abhighAtaja aura viSaja zopha vraNazothAtmaka pratikriyA ( inflammatory reaction ) ko hI pragaTa karate haiM / zotha meM kyA hotA hai ? aba hama Adhunika vaijJAnika jaisA mAnate haiM usa vicAra ko upasthita karate haiM ki Akhira vraNazotha kyA balA hai aura zarIra meM isake kAraNa kyA bAta hotI hai / mAna liyA ki kisI ke paira meM kisI ne lAThI mArI aura vaha sthAna sUja gayA phira paka gayA aura eka phor3e kA rUpa dhAraNa kara liyaa| isameM hameM yaha dekhanA hai ki lAThI mArane ke bAda zarIra ke paira meM sthita kozAoM meM kyA kyA pratikriyAe~ huIM / vraNazothAtmaka pratikriyA jo zarIra meM vibhinna kAraNoM se hotI huI dekhI jAtI hai usameM 2 pradhAnataH bhAga lete haiM- eka rakta aura dUsare kozA / hama inhIM donoM ke kriyAkalApa ko Age prakaTa kareMge / vraNazothotpatti meM rakta kA kArya jisa sthAna para AghAta ho jAtA hai vahA~ sarvaprathama kArya hotA hai-tejI se rakta kA pahu~canA / raktapravAha kI yaha tejI bahuta thor3I dera rahatI hai aura phira pravAha manda par3a jAtA hai / isa tejI kA kAraNa pratikSepa kriyA ( reflex action ) dvArA dhamanikAoM ( arteriole ) kA abhistaraNa dilatation ) hai / dhamanikAoM kA yaha abhistaraNa unake kezAloM ( capillaries ) ke abhistaraNa se pahale hotA hai aura jaisA ki abhI abhI kahA hai bahuta thor3I dera rahatA hai / raktapravAha kI mandatA - yaha dUsarA kArya hai jo usa sthAna para hotA hai / isa mandatA kA pradhAna kAraNa hai kezAloM kA ghAta ( paralysis of the capillaries ) / dUsarA kAraNa hai kezAloM ke antazchadIya kozAoM kA gaNDa yA utsedha ( swelling of the endothelial living cells of the capillaries ) / tIsarA kAraNa hai kezAloM meM sthita rakta ke jalIyAMza meM cale jAne ke kAraNa rakta ke Atmagatva ( viscosisy ) kI vRddhi tathA caturtha aura antima kAraNa hai cAroM ora kI UtiyoM bhare hue tarala ke prapIDana se kezAloM kA samavasAda (collapse of capillries ) / aba hama raktapravAha ko manda karane vAle ina cAroM kAraNoM para vistAra se prakAza DAlate haiM / kezAloM kA ghAta kisa prakAra ho sakatA hai usake lie do vidvAnoM kI 2 rAyeM haiM / eka kA nAma laiviza hai / vaha kahatA hai ki jisa prakAra UtitiktI ( histamine ) nAmaka padArtha zAloM kA ghAta karake unakI saMkocanazIlatA ko naSTa kara detA hai usI For Private and Personal Use Only

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vraNazotha yA zopha prakAra coTa yA AghAta yA jIvANuoM ke kAraNa vinaSTa hue kozAoM se UtitiktIsadRza eka padArtha nikalatA hai aura kSatigrasta sthala ke kezAloM kA ghAta kara detA hai / dUsare kA nAma meni hai / isane vraNazothApana UtiyoM se eka sphATa padArtha ( crystalline substance ) taiyAra kiyA hai jise vaha lyUkoTaiksIna ( leucotaxine ) nAma detA hai | yaha padArtha eka prakAra kA purupAceya ( polypeptide ) hai aura usakA UtitiktI se koI sambandha nahIM hai / vaha isa lyUkoTaiksIna ko hI harathara kA kAraNa mAnatA hai / 6 UtitiktI-sadRza padArtha ( H. substance ) ke kAraNa yA lyUkoTaiksIna ke kAraNa kezAloM kA ghAta hokara kezAloM kA kSetra atyadhika vistIrNa ho jAtA hai / parantu dhamanikAoM se usI anupAta meM rakta kI adhika mAtrA jA nahIM pAtI / jisake kAraNa thor3A rakta bahuta bar3e kSetra meM jAne se usake pravAha kI gati manda par3a jAtI hai / kSatigrasta kozAoM aura UtiyoM se nikale hue padArtha ke hI kAraNa yaha kezAlaghAta hotA hai / isakA pramANa yaha hai ki yadi usa aMga ke saba nAr3I sambandha vicchinna kara deM tathA usa kSetra kI sampUrNa vAhaniyoM ko bA~dha bhI deM to bhI yaha ghAta avazya hotA hai / jo spaSTataH yaha pragaTa karatA hai ki yaha padArtha kSatigrasta UtiyoM dvArA utpanna kiyA gayA hai aura sthAnika hai / kezAloM ke antazchaddIya kozAoM ke sUja jAne se kezAloM meM hokara rakta ke pravAha meM rukAvaTa aura asuvidhA utpanna ho jAtI hai / jisake kAraNa bhI rakta kA pravAha manda hone meM sahAyatA milatI hai / harat kI prAcIroM ke atyadhika abhistIrNa ho jAne ke kAraNa rakta kA jalIyAMza UtiyoM meM calA jAtA hai / rakta ke jalIyAMza ke nikala jAne ke kAraNa vaha gAr3hA ho jAtA hai | yaha gAr3hApana usake prahAra ko aura bhI manda kara detA hai / kezAloM ke cAroM ora atiyoM meM jaba jala kA adhika saMcaya ho jAtA hai to jala kA dabAva zAla prAcIroM kA avapAta yA samavasAda kara detA hai| jisake kAraNa rakta ko pravAhita hone kA avasara bhI nahIM rahatA aura isI kAraNa raktapravAha na kevala manda hI apitu banda sA hI ho jAtA hai / For Private and Personal Use Only zAla prAcIroM ke abhistaraNa ke kAraNa bahuta sA rakta eka hI sthAna para ekatra ho jAtA hai / jisake kAraNa vaha sthAna aruNa, tAmra, kRSNa yA anya varNa kA ho jAtA hai aura vahA~ kucha USmA bhI bar3hI sI mAlUma par3atI hai| tApamAna se nApane para usa sthala kA tApAMza sampUrNa zarIra ke tApAMza ke samAna hI rahatA hai| rakta vA jalIyAMza kI eka sthAna vA aMga meM adhikatA hone ke kAraNa utsedha ( swelling ) ho jAtA hai| thor3e sthAna meM adhika tarala Ane se UtiyoM para tanAva hotA hai tathA saMjJAvahA nAr3iyoM ke agra bhAgapara pIDana adhika ho jAne ke kAraNa usa sthAna para zUla bhI vizeSa ho jAtA hai aura gaurava ( heaviness ) bhI bar3ha jAtA hai / aisA hone

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vikRtivijJAna se vaha sthAna kAryakSama bhI nahIM rhtaa| vraNazotha ke sAmAnya liGga jo pahale batA cuke haiM ve kyoM hote haiM ? ve yahA~ bhale prakAra samajhe jA sakate haiN| vraNazothAtmaka jalasacaya kyoM hotA hai ? jisa prakAra kSatigrasta sthAna meM pahale pahala raktapravAha bar3ha jAtA hai usI prakAra usa rakta ko lauTA kara sirAoM meM rakta le jAne vAlI lasavahAoM kI gati bhI prArambha meM bar3ha jAtI hai tathA anya kaI naI lasavahAoM ke mukha bhI khula jAte haiM, jisake kAraNa paryApta mAtrA meM rakta lauTane lagatA hai / parantu jisa prakAra kezAloM kI prAcIroM kA ghAta hotA hai usI prakAra lasavahAoM kI prAcIreM bhI vistRta ho jAtI haiM aura unakI ativedhyatA ( permeability ) bhI bar3ha jAtI hai / jisake kAraNa kucha samaya pazcAt lasapravAha bhI kama ho jAtA hai / kucha samaya pazcAt lasa meM probhUjina kI mAtrA adhika ho jAtI hai ataH tantvijana kI upasthiti lasavahA meM ghanAsratA ( thrombosis ) utpanna kara detI hai| unameM rakta ke zvetakaNa tathA lAlakaNa bhI dekhe jAte haiN| inhIM saba kAraNoM se UtiyoM meM sthita jalasaMcaya ko ghaTAne meM lasavAhiniyA~ asamartha ho jAtI haiM aura unake dvArA bahuta kama jala bAhara jA pAtA hai| ___ lasavahAoM dvArA saMcita jala kI rAzi ko bahA le jAne meM rukAvaTa hone ke kAraNa ke atirikta UtiyoM meM jalasaMcaya ke nimna mahattvapUrNa kAraNa haiM 1. kSatigrasta kozAoM kA troTana ( break-down of the damaged cells)-kSatigrasta kozA jaba TUTane phUTane lagate haiM to usa kSetra ke atitarala meM vyUhANuoM kA saMkendraNa hone lagatA hai jisake kAraNa Utitarala kA AsRtIya nipIDa ( osmotic pressure ) bar3hane lagatA hai| isake bar3hane se raktavAhiniyoM se jalIyAMza bhAga nikala nikala kara UtiyoM ko bharane lagatA hai| 2. kezAla antazchada meM parivartana ( change in the endothelium of the capillaries)-jaba rakta kA pravAha kezAloM meM ruka jAtA hai to vahA~ auksIjana (jAraka) kI kamI hone lagatI hai isa kAraNa kezAla prAcIra meM bhI ajArakaraktatA (anoxemia) ho jAtI hai| zarIrastha kisI bhI ati ko jaba jAraka kI pUrti nahIM hotI to vaha bigar3ane lagatA hai| kezAla kA antazchada jAraka ke abhAva meM kSatigrasta hojAtA hai| jAraka kI kamI kA dUsarA pariNAma amlolkarSa (acidosis) meM hotA hai| amlotkarSa kA pariNAma kezAloM kI pravezyatA vA ativedhyatA (permeability ) bar3hAne meM hotA hai / 3. prarasa probhUjinoM kI hAni ( loss of plasma proteins) kezAla prAcIroM meM hokara jaba rakta kA tarala aura usake sAtha usakI probhUjine bhI Utijala meM mila jAtI haiM to rakta ke prarasa kI probhUjineM kama ho jAtI haiN| jinake kAraNa raktarasa kA zleSAbha AsRtIya nipIDa ghaTa jAtA hai aura Utirasa meM vahI bar3ha jAtA hai| jitanA adhika kezAla prAcIra vinaSTa hojAtA hai usI anupAta se aura vaisA hI ucca For Private and Personal Use Only

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vraNazotha yA zopha yA hIna prakAra kA probhUjina naSTa hogA / sarvaprathama lasazukli (serum albumen ) naSTa hotI hai / vaha prarasa se nikala kara UtiyoM meM calI jAtI hai| isa probhUjina kA sabase choTA vyUhANu hotA hai| usake bAda bar3e vyUhANu (molecule ) vAlI probhUjineM calatI haiM / jinameM tantvijana ( fibrogen) mukhya hai| zukli kI upasthiti ke kAraNa atiyoM meM vaha vartuli (globulin) se cAragunA adhika AsRtIya nipIr3a DAlane meM samartha hotI hai| para usake nikala jAne se prarasa kA nipIr3a ghaTatA hai aura utiyoM kA bar3hatA hai / isase jalasaMcaya khUba hotA hai / vraNazothAtmaka jalasaMciti ke 2 spaSTa kAraNa hameM Upara ke varNana se prApta hote haiN| eka kAraNa vaha jisameM raktavAhiniyoM se raktarasa kA gamana UtiyoM kI ora hotA hai| jisameM kezAloM kI kSati, AsRtIya nipIr3a ke sthAnika parivartana aura UtiyoM kA pratirodha AtA hai| dUsarA kAraNa vaha jisameM lasavahAoM ko saMcita jala ko sameTane kI zakti naSTa ho jAtI hai sAtha hI sirA dvArA punaH pracUSaNa kI svAbhAvika vidhi bho samAptaprAya ho jAtI hai| jatiyoM meM jalasaMcaya kA kAraNa vibhinna bhautika-rAsAyanika kAraka haiM / para sAtha hI isakA eka mahattva bhI hai ki jo jIvANu zarIra ke isa bhAga meM apanA viSailA prabhAva karake zarIra ko viSamaya kara rahe the unakA vaha viSa atyadhika jalarAzi meM ghula kara alpaprabhAvI raha jAtA hai| jisake kAraNa bhakSakAyANu (phagocytes) una para apanA kArya saralatA se karane meM samartha hote haiN| eka aura bhI bAta yaha hai ki yaha sampUrNa jalarAzi rakta se AtI hai / ataH usake sAtha jIvANunAzakatatva bhI pracura parimANa meM mile cale Ate haiM / UtiyoM meM saMcita jala kA ApekSika ghanatva 1015 se Upara hotA hai / usameM 3 pratizata taka probhUjina hotI hai| probhUjinoM meM zukli, kUTavartuli ( pseudo globulin ), suvartuli ( euglobulin ) aura tantvijana UtiyoM kI kSati ke anupAta meM eka ke bAda dUsarI milatI haiM / jahA~ vraNazotha alpa rahatA hai vahA~ prathama do dekhI jAtI haiN| jahA~ vraNazotha adhika hotA hai anya bhI mila jAtI haiN| eka bAta aura hai ki vibhinna aMgoM meM saMcita jala meM vibhinna mAtrA meM hI probhUjina milatI hai / phuphphusacchadIya srAvoM (pleural exudates) meM ve adhika mAtrA meM hotI haiN| udaracchadIya srAvoM meM kama tathA mastiSkacchadIya nAvoM meM to bahuta kama mAtrA meM milatI haiN| upatvaka UtiyoM ( subcutaneous tissues ) meM to ye sabase kama milatI haiN| vraNazothIya jala kozAoM aura rakta ke kaNoM kI kamIbezI ke anusAra upalabhAsI (opalescent) yA meghasama hotA hai| kahIM vaha kevala lasasama (serous), kahIM lasapUyIya ( sero-purulent ) aura kahIM pUrNataH pUyIya milatA hai| yadi yaha jala thor3I dera kisI parakhanalI meM bhara kara rakha diyA jAya to usakA AtaMca (clot) bana jAtA hai / yaha AtaMca jala meM vyApta tantvijana kI mAtrA para nirbhara hotA hai| isa jala meM For Private and Personal Use Only

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12 vikRtivijJAna aratekArI jIvANuoM ko bhI dekhA jA sakatA hai aura unakA saMvardhana ( culture ) bhI kiyA jA sakatA hai / Acharya Shri Kailassagarsuri Gyanmandir tatvijana kA mahattva - tantvijana eka probhUjina hai| vaha bhI anya probhUjinoM kI taraha adhika kSati hone para vraNazothIya jala meM dekhI jAtI hai / UtiyoM meM kaI AtaMci dravya ( coagulins ) hote haiM jinake samparka se vaha AtaMcita ho jAtI hai| aura aba vaha tantvi ( fibrin) kahalAtI hai / tanvi UtiyoM meM jAlikA ( reticulum ) ke rUpa meM nissAdita hokara saMcita ho jAtI hai / udaracchadAdi meM jahA~ jalasaMcaya hotA hai vahA~ to isakA kucha mahattva dekhA nahIM jAtA / parantu vidhiyoM kI sImAoM para jo eka pUyajanika kalA ( pyogenic membrane ) dekhI jAtI hai jo upasarga ko sImita karane meM bahuta kArya karatI hai vaha isI tanvi se banatI hai / yahIM para jIvANuoM para zarIra kI ora se tagar3A prahAra karane ke lie bhakSakAyANu taiyArI karate haiM / meGkina svayaM isameM vizvAsa karate haiM ki yaha tatvijAlikA kA stara upasarga ke pratirodha meM avazya kArya karatA hai| yahI nahIM, vaha yaha bhI batalAte haiM ki jIvANuoM kI AkramaNa karane vAlI zakti nirbhara hI isa para rahatI hai ki ve isa tatva ke nirmANa meM kahA~ taka sahAyatA karate haiN| udAharaNa ke liye puMjagolANu ( staphylococci ) tantvinirmANa meM sahAyaka siddha hote dekhe gaye haiM tathA mAlAgolANu ( streptococci ) tanvinirmANa kArya rokate haiM / rica nAmaka vidvAn tatva ke isa mahatva ko svIkAra nahIM karate vaha upasarga ko rokane meM sahAyaka prasamUhiyoM ( agglutinins ) ko mAnate haiM / rakta ke sAtha kaNa bhI saMcita jala meM pragaTa hote dekhe gaye haiM para unakA koI vizeSa mahattva nahIM hai / kezAloM meM rakta kI sthiratA hone ke kAraNa vahA~ ghanAstratA ho sakatI hai aura vinAza vA zotha mila sakatA hai I vraNazothotpatti aura zArIra - kozAe~ vraNazotha kI utpatti meM rakta kyA bhAga letA hai use vistAra se samajhA diyA gayA hai aba yaha samajhanA Avazyaka hai ki zArIrika kozAoM dvArA vraNazothAtmaka pratikriyA meM kahA~ taka sahayoga milatA hai / purukhaNDanyaSTi kozAoM kA pArzvagamana ( margination of polymorphonuclear cells ) - jyoM hI raktapravAhagati manda par3atI hai tyoM hI rakta ke sitakozA yA purukhaNDanyaSTikozA raktadhArA ko chor3a kara vAhinIprAcIra ke pArzvoM kI ora gamana karane lagate haiM / isI ko unakA pArzvagamana ( margination ) kahA jAtA hai / yaha kArya ve bahuta dhIre-dhIre karate haiM / purukhaNDanyaSTi kozAoM kA bahirgamana - vAhinIprAcIra ke samIpa Ane ke uparAnta sitakozAprAcIra kI TUTI-phUTI dazA se lAbha uThAte haiM / jaha para TUTa-phUTa adhika hotI hai aura bAhara kI ora jAne ke lie tanika bhI sthAna dekhate haiM ve apane For Private and Personal Use Only

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vraNazotha yA zopha kUTapAda ( pseudopodia ) bar3hA dete haiN| antazchada ke sUje hue do kozAoM ke bIca ke mArga se kUTapAda bar3hAte hue ve prAyazaH dekhe jAte haiN| kUTapAda bar3hAte hue aura apanI nyaSThIlAoM ko bhI ghasITate hue kezAlaprAcIra ko pAra karake vahA~ pahu~cate haiM jahA~ Uti meM jala bharA hai yA upasargakArI jIvANuoM kA aDDA jamA hai| isa prakAra ye sitakozA lagAtAra rakta kI dhArA se unmukta ho hokara upasarga se yuddha karane ke lie bar3I se bar3I saMkhyA meM ekatra hote cale jAte haiN| unakA janmasthala asthimajjA hone ke kAraNa vahA~ para inakI utpatti kA kArya joroM se calane lagatA hai aura rakta meM inakI saMkhyA paryApta bar3ha jAtI hai| isI ko sitakozotkarSa (leucocytosis ) kahate haiN| sitakozAoM ke AkarSaNa kA kAraNa-ye sitakozA kSatigrasta sthAna ke pAsa kyoM daur3akara pahu~cate haiM isake do kAraNa upalabdha hue haiM-eka to yaha ki kSati prApta UtikozAoM se yA upasargakArI jIvANuoM se kucha aise padArtha utpanna hote haiM jinako prApta karane kI lAlasA sitakozAoM meM bar3ha jAtI hai aura ve bar3I se bar3I saMkhyA meM vahA~ pahu~cane lagate haiM ise hama rAsAyakrama ( chemio-taxis ) kahate haiN| dUsarA yaha ki kSatigrasta sthAna meM tApa paryApta ho jAtA hai aura tApayukta sthAna kI ora bhI inakA AkarSaNa paryApta hotA hai ise tApakrama ( thermo-taxis) kahate haiN| prAcInakAla meM kSatigrasta sthAna ke svedana aura upanAhana ke jo tarIke apanAe jAte the usakA artha usa sthAna ke tApAMza kI vRddhi karake adhika se adhika sitakozAoM ko vahA~ ekatra karanA thaa| kaccA vraNa zIghra paka sake isake lie uSNopacAra kA kAraNa bhI yahI tApakrama hai| kSatiprApta kozAoM meM utpanna atitiktosama padArtha yA menakina kI lyUkoTaikjIna bhI sitakozAoM ko apanI ora AkRSTa karatI haiN| __kauna kauna sitakozA vraNazotha sthAna meM pahu~catA hai ?-yaha jAnanA bhI lAbhaprada hai ki kauna sitakozA isa kArya meM adhika bhAga letA hai| purukhaNDanyaSTikozAtItopasargajanya vraNazothoM meM yaha sitakozA pramukhatayA bhAga letA hai| sAdhAraNatayA rakta ke eka ghana sahastrimAna sthAna meM 8000 sitakozA svastha vyakti meM dekhe jAte haiN| inameM se 65 pratizata purunyaSTikozA hote haiN| para jaba sitakozotkarSa ( leucocytosis) hotI hai taba pratighana sahasrimAna rakta meM 20000 taka sitakozA bar3ha jAte haiM aura unameM purunyaSTiyoM kI saMkhyA 90 pratizata taka milatI hai aisA tIvra vraNazothoM meM prAyazaH dekhA jAtA hai| purunyaSTikozAoM kA kArya jIvANuoM kA bhakSaNa ( phagocytosis ) hai bhakSaNa karane ke bAda unakA vinAza karanA bhI unhIM kA kAma hai / para kabhI kabhI ve apane udara meM sajIva rogANu rakha to lete haiM para unheM naSTa nahIM kara paate| aise purunyaSTikozA jaba eka sthAna se dUsare sthAna para gamana karate haiM to vahA~ eka naye sthAna para eka navIna upasarga kendra sthApita kara dete haiN| inakA prabhavasthala asthi kI majA hai| menakina kA kathana hai ki asthimajA meM purunyaSTiyoM kI utpatti meM sAdhAraNa vRddhi to lyUkoTaikjIna ke kAraNa ho sakatI hai 2 vi0 For Private and Personal Use Only

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14 vikRtivijJAna parantu tIvra pUyAtmaka vraNazothoM meM koI anya bhI padArtha banatA hai jo rakta meM pravAhita hotA huA asthimajjA ko adhikAdhika purunyaSTikozAoM ke nirmANa ke lie bAdhya karatA hai| manuSyoM meM bhakSakakozAoM kI utpatti jAlakAntazchadIyasaMhati ( reticulo endothelial system ) ke dvArA hotI hai / isa saMhati kA janma garbha ke madhyastara ( mesoblast ) se huA hai / isa saMhati ke kozAoM meM aneka paitRka guNa vidyamAna rahate haiM jinameM bhakSakAyANUtkarSa (phogocytosis ), kozAoM kI sImAoM kA abhAva jisake kAraNa do tIna kozA kabhI bhI milakara eka ho sakate haiM, ati zIghra eka se do, do se cAra hone kI mahatI zakti, tathA vividha prakAra se kozAoM ko nirmANa karane kI yogyatA mahatva ke guNa haiN| ___ jIvANubhakSaNa kArya ko sitakozA karate haiM / jIvANuoM ko susvAdu banAne ke lie atikozAoM se susvAdi ( opsonin ) nAmaka padArtha nikalatA hai jo jIvANuoM ko svAdiSTa kara detA hai jinheM purunyaSTikozA bar3e prema se udarastha kara jAte haiN| ____ekanyaSTIya sitakozA ( mononuclear leucocytes)-inako ekanyaSTibhakSikozA ( mononuclear phagocytes ) yA protikozA ( histiocytes) bhI kahate haiM / ye jAlakAntazchadIya saMhati ke koTarAbha (sinusoidal ) yA velA ( littoral ) kozAoM se utpanna hote haiN| inakA nirmANa garbha kI yojyUtikara ( mesenchyme ) ke abhinnaka stAra (undifferentiated sheet ) se bhI hotA hai jinase ki lasIkAgranthiyoM kI AdhAroti (ground substance ) kA vikAsa hotA hai| vraNazotha kSetroM kA apavahana karane vAlI granthiyoM ke andara koTarAbhoM ( sinusoids ) ke Astaraka kozA ( lining cells) atyadhika upacita hone ke kAraNa kitane hI stara moTe ho jAte haiN| yahI svatantratayA calane phirane vAle kozA bar3e aura aNDAkRtika hote haiM inameM paryApta prarasa hotA hai eka nyaSTIlA hotI hai jo AkRti meM viSama evaM kucha kaTI sI hotI hai| ina ekanyaSTikozAoM kA kArya bhI bhakSaNa kA hai parantu ye mRtakozAoM aura mRtaUti ko hI khAte haiN| prAyazaH jIvANuoM ko ve nahIM khAte yA kevala una jIvANu yA parajIviyoM ( parasites ) ko ThikAne lagAte haiM jinheM purunyaSTikozA sevana karane meM asamartha hote haiN| ye vicaraNazIlakozA haiM aura kAmarUpyAbha gati (amoeboid movement) karate haiM / UtiyoM meM ye svacchakoM ( scavengers ) ke samAna kArya karate haiM / vahA~ ke mRtakozAoM ko haTAte haiM, idhara udhara ghUmate hue jIvANuoM ko pakar3a lete haiM, koI raMga dravya ho to use nigala lete haiM / videzI padArthoM ko tathA anya apadravyoM ko ( ve cAhe sthUlarUpa meM ho yA vileya meM ) hajama kara jAte haiM / jaba inakI vicaraNazIlatA samApta ho jAtI hai to inameM tAntuka pravardha ( fibrillar process ) nikala Ate haiM aura ye tAntava Uti ke kozAoM meM pariNata hone meM samartha ho jAte haiM / jaba vraNazotha kI tIvratA samApta ho jAtI hai to ye apanI svacchatA kA kArya prArambha karate haiN| ye tantu-ruho ( fibro For Private and Personal Use Only

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vraNazotha yA zopha 15 blasts ) ke sAtha milakara tanvi kA aMzana ( fibrinolysis ) bhI kara DAlate haiM / jaba purunyaSTikozAoM ke dvArA jIvANunAza kArya nahIM ho pAtA taba ye bahuta bar3I saMkhyA meM utpanna hote hue dekhe jAte haiM / yahI kAraNa hai ki mantharajvara ( typhoid fever ) meM rakta meM inakI saMkhyA bar3ha jAtI hai| isI prakAra jIrNa vyAdhiyoM meM jaba atyadhika UtinAza hotA rahatA hai jaisA ki yakSmA yA phiraMga meM dekhA jAtA hai to rakta meM inakI saMkhyA vRddhi spaSTataH prakaTa ho jAtI hai / isa prakAra hama dekhate haiM ki vraNazotha kI tIvrAvasthA meM sUkSmabhakSa purunyaSTikozAoM tathA mahAbhakSa ekanyaSTikozAoM ke dvArA jIvANu saMhAra kA atIva mahattvapUrNa kArya sampanna hotA hai / jyoM jyoM roga kI tIvrAvasthA samApta hokara jIrNAvasthA AtI jAtI hai tyoM-tyoM anya prakAra ke kozA bhI rakta meM dRSTigocara hone lagate haiM aba hama unhIM kA varNana Age kareMge / laghulasIkozA --- yaha eka gola kozA hai jisakI nyaSTIlA bar3I saralatA se dekhI jAtI hai jo sampUrNa kozA meM vyApta hotI hai usa nyaSTIlA ke cAroM ora prasa kI eka patalI paTTI hotI hai / ye kozA upasarga kI tIvrAvasthA samApta hote samaya utpanna hote haiM aura roga kI jIrNAvasthA ke prakaTAyaka hote haiM vizeSakara yakSmA tathA phiraGga ke / viSANuoM ke upasagoM meM ye kozA aura ekanyaSTikozA roga kI tIvrAvasthA meM hI dekhe jAte haiM, purunyaSTikozA bahuta kama dRSTigocara hote haiM / yaha kozA kyA kAma karate haiM ? isakA to abhI taka vizeSa jJAna nahIM ho pAyA para itanA jJAta avazya huA hai ki ye kozA ekanyaSTiprotikozAoM ( monocytic histiocytes ) meM badala jAte haiM / aharica aura harIza isa pariNAma para pahu~ce haiM ki lasIkozA aura pratidravya nirmANa ( anti-body formation ) meM paraspara bahuta bar3A sambandha hai tathA pratidravyoM ko yathArthataH ye kozA banAte hI haiM / uSasirajyakozA ( eosinophil leucocytes ) - yaha bhI kAmarUpyAbhagatiyukta aisA kozA hai jisake kAryoM ke sambandha meM abhI paryApta sandeha hai / ye jIrNa rogoM meM sthAnika UtiyoM se utpanna hone vAlA kozA hai / yaha kabhI kabhI to bahuta bar3I mAtrA meM utpanna ho jAte haiN| isakA eka udAharaNa paryApta samaya se vraNazothayukta antrapuccha meM naye sire se punaH roga bhar3aka uThe aise rogI kA hai / carma meM vraNazothagrasta kSetroM ke kAraNa sthAnika upasipriyatA ( eosinophilia ) mila sakatI hai / prajIvA ( protozoa ) yA antraparAzrayI jIvANujanya roga meM bhI upasipriyatA milatI hai / jaba kRmi kA upasarga kisI ko ho jAtA hai to antra kI zleSmalakalA meM tathA rakta meM upasipriyatA bar3ha jAtI hai| zvAsa ( ashtma ) roga meM ye kozA thUka aura kapha ke andara taka dekhe jAte haiM / prarasa kozA ( plasma cells ) --- ye lasIkozAoM se paryApta bar3e hote haiM / isake kozA kI nyaSTIlA gAr3I ke pahiye ke samAna banI hotI hai / yaha anutIvra yA For Private and Personal Use Only

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16 vikRtivijJAna jIrNa rogoM meM bahuta milate haiM jaise phiraMga meM / inakI utpatti lasIkozAoM se hotI hai / kucha loga aisA mAnate haiM ki inakA nirmANa sIdhA lasAbhaUtiyoM ke sthira jAlikA kozAoM se hotA hai| ye UtiyoM meM hI dekhe jAte haiM aura rakta meM ye svabhAvataH nahIM pAye jAte haiM / isa prakAra vraNazothAvasthA meM (1) rakta ke pravAha kI prArambhika tIvratA phira ( 2 ) mandatA aura phira (3) vAhiniyoM meM nizcalatA jisake kAraNa jAraka kI kamI jisake dvArA (4) kezAloM ke antazchada ke kozAoM kA AghAtita honA / (5) kSatiyukta bhAga meM hokara rakta ke jala kA UtioM meM cale jAnA (6) lasikA vahAoM dvArA apavahana kArya meM mandagati aura (7) zotha kA bar3hanA (8) vibhinna kozAoM kA AnA aura jIvANuoM evaM kSatiprApta kozAoM kA bhakSaNa karate hue upasarga ko naSTa karanA taka batalAyA gayA hai / vraNazotha kI prAcIna kalpanA uparokta varNana vraNazotha sambandhI Adhunika khojoM para AdhArita hai / isakI prAcIna kalpanA yaha hai ki pratyeka prakAra kA zotha AmAvasthA, pacyamAnAvasthA aura paripakvAvasthA meM AtA hai / hama nIce inhIM kA varNana karate haiM vraNazotha kI AmAvasthA tatra mandoSmatA tvaksavarNatA zItazophatA sthairya mandavedanatA'lpazoSatA cAmalakSaNamuddiSTam / ( su. sU. a. 17-6 ) vraNazotha apanI prArambhika avasthA meM 'mandoSmatA ( very little production of heat at the site of inflammation) tvaksavarNatA (no change in the colour of the skin of the inflammed part ) 'zItazophatA ( beginning of the inflammation | part swollen_and_cold )' sthairya ( very hard ), mandavedanatA ( very little pain ), alpazophatA ( little swelling ) nAmaka 6 lakSaNa dekhe jAte haiM / hama isa avasthA ko vraNazotha kI usa prArambhika avasthA se milA sakate haiN| jisameM navInoM ne rakta kA adhika vega se lAnA likhA hai| jisameM kezAloM ke antazchada adhika vikAra nahIM ho pAyA, kevala kSatigrasta UtiyoM meM sthAnika pratikriyA utpanna hone lagI hotI hai / jisake kAraNa thor3I garmI thor3A darda aura thor3I sUjana aura kar3Apana prakaTa ho jAtA hai / yadi prayatna kiyA gayA to isa avasthA ko yahIM roka kara vraNazotha ko bilkula baiThAyA jA sakatA hai / zotha kI pacyamAnAvasthA -- sUcIbhiriva nistudyate dazyata iva pipIlikAbhistAbhizca saMsarpyata iva dvidyata iva zastreNa bhidyata iva zaktibhistADyata iva daNDena pIDayata iva pANinA ghaTyata iva caGgulyA, dahyate pacyata iva cAgnikSArAbhyAm, oSacoSaparIdAhAzca bhavanti, vRzcikaviddha iva ca sthAnAsanazayaneSu na zAntimupaiti, AdhmAtabastirivAtatazca zopho bhavati, tvagvaivarNya zophAbhivRddhirjvaradAha pipAsAbhaktArucizca pacyamAnaliGgam / ( su. sU. a. 17-7 ) For Private and Personal Use Only

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vraNazotha yA zopha pacyamAno vivarNastu rAgI bastirivAtataH / sphuTatIva sanistodaH sAGgamardavijRmbhikaH // saMrambhArucidAddoSAtR jvarAnidratAnvitaH / styAnaM viSyandayatyAjyaM vraNavatsparzanAsahaH // (a. hR. sU. a. 29-3,4 ) vraNazotha kI dvitIyAvasthA pacyamAnAvasthA yA vidagdhAvasthA kahalAtI hai isameM - vividha vedanAe~ ( all sorts of pains ) - jaise suI cubhanA, cIMTI dvArA kATanA, cIMTiyoM kA sA calanA, zastra dvArA kATanA, DaNDe se pITanA, bhAle se bhedanA, hAtha se dabAnA, aGguliyoM se maror3anA Adi itanI dekhI jAtI haiM ki rogI becaina hai / 17 vividha dAha ( burning sensation ) - aisA lagatA hai ki mAno koI cAra yA Aga rakhakara sthAna ko jalA rahA ho, pArzva meM yA eka sthAna para yA sampUrNa meM jalana macatI hai, vicchU ke kATane sarIkhI dAha ke kAraNa baiThane khar3e hone yA leTane meM caina nahIM milatA, sphuTana aura toda paryApta hotA hai / zopha ( swelling ) - jaise pAnI se bharakara basti phUla jAtI hai yA havA se peTa phUla jAtA hai / usa prakAra kA khUba zotha ho jAtA hai / tvagvaivarNya ( decoloration of the skin ) - tvacA kA varNa badala jAtA hai tathA lAla ho jAtA hai / 1 vividha zArIrika lakSaNa ( & number of physical symptoms ) - bhI prakaTa hote haiM jinameM aruci, dAha, tRSNA, jvara, anidratA (insomnia) mukhya haiM / uparokta varNana rogI ke vraNazotha kI pacyamAnAvasthA kA eka naidAnika citraNa ( clinical picture ) mAtra hai / isa samaya kSatigrasta UtiyoM taka paryApta jala pahuMca jAtA hai / kezAloM ke antazchada vidIrNa hokara raktarasa aura raktastha kozAoM ke bahirgamana kI vyavasthA kara dete haiM / purunyaSTikozA sImA banda karake jIvANuoM se saMgrAma prArambha kara dete haiM / paryApta raktAgama se sthAna lAla aura garma ho jAtA hai jalA - dhikya ke kAraNa UtiyoM meM tanAva par3atA hai aura saMjJAvaha nADiyoM ke agra bhAga para bhAra par3atA hai jisake kAraNa aneka prakAra kI dussaha vedanAe~ rogI ko vyathita karatI huI usakI nIMda ko tAka meM rakha detI haiN| usakI ghabarAhaTa bar3ha jAtI hai, jvara utpanna ho jAtA hai, pyAsa lagatI hai / For Private and Personal Use Only zotha kI pakvAvasthA ( Suppuration ) - ise pUyIbhavana kI avasthA kaha sakate haiM / pUyIbhavana eka aisA kArya hai jisameM Uti-mRtyu, sitakozAoM kI saJciti tathA probhUjAMzika udAsargoM dvArA AtmapAcana ( autolysis by proteolysic ferments ) ye tIna kriyAe~ sammilita hotI haiM / pUya ( pus ) kA mukhya kAraNa puSTikozA hai / pUya usI kA nAma hai jisameM yaha kozA bahuta bar3e parimANa meM milatA hai / grIna ne pUya kI paribhASA karate hue likhA hai-pus is therefore a collection of dead polymorphonuclear leucocytes in the fluid of an inflammatory exudate -- pUya mRta purukhaNDanyaSTi

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18 vikRtivijJAna sitakozAoM kI vraNazothAtmaka tarala meM saMcitimAtra hai / yaha pUya pragADha ( thick ) aura tanu ( thin ) donoM prakAra kA ( upasarga ke anusAra ) ho sakatA hai / tanupUya kA kAraNa hotA hai jIvANuoM dvArA nAstyAtmaka rAsAyakrama ( negative chemiotaxis ) kA pracalana jisake kAraNa sitakozA udhara ko bahuta kama AkRSTa hote haiM / isI kAraNa pUya tanu raha jAtA hai / tanupUya nirmANa meM ghAtaka mAlA golANu (virulent streptococci ) pramukha bhAga lete haiN| tanupUya meM prAyaH rakta bhI milA huA dekhA jAtA hai / yaha koI Avazyaka nahIM ki pakvAvasthA sadaiva Ave hI / eka sthAna para bahuta se purunyaSTikozA hone para bhI pUyIbhavana binA hue hI vraNazotha naSTa ho hai / kabhI kabhI pUrA banane se pUrva viSa kI tIvra mAtrA zarIra ko hI zava banA detI hai / zaizava yA vRddhAvasthA meM aisA prAyaH hotA hai yA jaba upasarga atyanta ghAtaka hotA hai taba bhI pUyIbhavana se pUrva mRtyu dekhI jAtI hai / puJjagolANu, phuphphusagolANu aura mastiSkagolANuoM dvArA pragADha pUya banatA hai / itanA Adhunika jJAna lene ke uparAnta hama prAcInoM ke dvArA pradatta varNana kA upayoga karate haiM sakatA Acharya Shri Kailassagarsuri Gyanmandir vedanopazAntiH pANDutA'lpazophatA valIprAdurbhAvastvakparipuTanaM nimnadarzana maGgulyA'vapIDite pratyunnamanaM bastAvivodakasaMcaraNaM pUyasya prapIDayatyekamantamante vA'vapIDite, muhurmuhustodaH kaNDUrannatatA vyAdherupadravazAntirbhatAbhikAMkSA ca pakkaliGgam / ( su. sU. a. 17-- 3, 4 ) pakke'lpavegatA glAniH pANDutA valisambhavaH / nAmo'nteSUnnatirmadhye kaNDUzophAdimArdavam // spaSTe pUyasya saMcArI bhavedabastAvivAmbhasaH / ( a.hR.sU. a. 29-5 ) pressure ) / ke zotha ke paripakka hone para usakI saMrambhAvasthA ( vedanA, pIDana, dAhAdi kI tIvratA ) kA vega ghaTa jAtA hai, vedanA zAnta ho jAtI hai, tvacA kA varNa pANDura ho jAtA hai, sUjana bhI kama ho jAtI hai, usa aMga para jhurriyA~ par3a jAtI haiM, khAla phaTa jAtI hai, aMguli se dabAne para gaDhDhA par3a jAtA hai ( pitting on phira aMguli haTA lene se jagaha bhara jAtI hai jaise muzaka meM pAnI hotA hai vaise hI eka ora dabAne se dUsarI ora pUya kA pIDana ( fluctuation ), raha raha kara toda hotA hai, khujalI uThatI hai, sUjana kA ubhAra ghaTa jAtA hai, pacyamAnAvasthA ke saba upadrava haTa jAte haiM, aruci dUra hokara bhojana para icchA A jAtI hai, vraNazotha kA jo sthAna patthara sA kar3A thA vaha mRdu ho jAtA hai / ina lakSaNoM se paripakva vraNazotha kA jJAna pUrNataH ho jAtA hai / saMcaraNa kA jJAna mAlUma par3atA hai yadi hama dhyAnapUrvaka dekheM to jJAta hogA ki navInoM ne jisa vikRti kA jJAna zarIra ke kozA kozA meM paiTha kara pratyeka Uti aura dhAtu se samparka sthApita karake kiyA prAcInoM ne vahI bAhya lakSaNoM ko dekhakara aura Abhyantara kaSTa kA anubhava karate donoM kI AvazyakatA hai / para prAcInoM / hue kiyA, donoM kA jJAna pUrakAnupUraka hai, kA sampUrNa dRSTikoNa abhI samakSa nahIM huA usakA bhI vicAra karane ke bAda hama donoM prayAsa kreNge| doSoM kI dRSTi se unakI jo kalpanA hai zAstroM meM sAmaJjasya sthApita karane kA For Private and Personal Use Only

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praNazotha yA zopha vraNazotha-doSa tathA dRSya vAtAdRte nAsti rujA na pAkaH, pittAdRte nAsti kaphAcca pUyaH / tasmAt samastAH paripAkakAle pacanti zophAMstraya eva dossaaH|| kAlAntareNAbhyuditaM tu pittaM kRtvA vaze vAtakaphau prasahya / pacatyataH zoNitameva pAko mato'pareSAM viduSAM dvitIyaH // (su. sU. a. 17-11-12) zUlaM narte'nilAhAhaH pittAcchophaH kaphodayAt / rAgo raktAca pAkaH syAdato doSaiH sazoNitaiH / / (a. hR. sU. 29-6) mArutaH sarvazophAnAM muulheturudaahRtH| yathA ca pittaM dAhasya, zaityasya ca yathA kphH|| tvagraktamAMsamedAMsi zotho'dhiSThAya vardhate / (kA. saM. khi. a. 17-26) narte'nilAdragna vinA ca pittaM pAkaH karpha cApi vinA na puuyH| tasmAddhi sarvAn paripAkakAle pacanti zooNstraya eva doSAH / / (mA. ni. 41-12) vraNazotha kI AmAvasthA se pakkAvasthA taka pahu~cane meM doSa kisa prakAra bhAga lete haiM ise jAnane ke lie Upara ke uddharaNa paryApta sahAyatA kreNge| ina uddharaNoM meM prathama suzruta kA hai / usakA kathana hai ki isa sambandha meM do mata vidyamAna haiN| eka zAstrIya ( official) mata yaha hai ki vraNazotha kAla meM jo zUla hotA hai usakA kAraNa hai vAta, usameM jo pAka aura dAha calatA rahatA hai usakA hetu hai pitta tathA jo usameM pUya banatA hai vaha kapha ke kAraNa banatA hai| zUla, dAha aura pUya kamazaH vAta, pitta aura kapha nAmaka doSoM ke prasAda haiM ataH paripAka kAla ko lAne meM tInoM doSa hI sahAyaka hote haiN| vAtanADiyA~ vizeSakara saMjJAvaha nADiyoM (sensory nerves) ke anoM para tanAva honA hI zUla kA mukhya hetu hama pahale hI likha cuke haiN| Ayurveda kI vAta-kalpanA yahA~ . yathArtha baiThatI hai / nADiyoM ke dvArA gamanazIla zaktivizeSa hI vAta hai aura usakA prakSobha hI zUla kA kAraNa hai| dAha yA pAka ke samaya jo agni sI jalatI hai usakA artha hai rakta nAmaka dRSya meM upasthita pitta tathA AtmapAcI udAsarga ( autolytic ferments ) ye jIvANuoM ke zarIra ko utiyoM ke kozAoM tathA anya padArthoM kA pAcana karate haiM jisase USmA bar3hatI hai aura usakA bodha hotA hai yaha pitta ke kAraNa hai / kapha ke kAraNa pUya hotA hai / pUya meM pramukha padArtha purunyaSTi tathA anya sitakozA haiN| isakA artha to yaha hai ki ye sitakozA zveta aura snigdha aura jalamaya hone ke kAraNa AyurvedIya kapha ke sAdhAraNa svarUpa ko pUrNataH spaSTa kara dete haiM / ataH kapha ko jalIyAMza sahita sitakozAoM ke rUpa meM yadi hama mAna lete haiM to hamArA kAma jyoM kA tyoM cala jAtA hai tathA Adhunika aura prAcIna varNanoM meM bahuta kama antara raha jAtA hai| tInoM doSoM ke kAraNa hI vraNazotha kA paripAka hotA hai| cAhe vraNazotha kA prArambha kisI eka doSa se hI ho parantu usakI paripakvAvasthA taka pahu~cane ke lie tInoM doSoM kA hI uttaradAyittva hotA hai| eka dUsare azAstrIya ( unofficial ) mata kA bhI ullekha suzruta ne kiyA hai| vaha yaha ki kAlAntara meM pitta pravRddha ho kara vAta aura kapha ko apane vaza meM karake For Private and Personal Use Only

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vikRtivijJAna rakta ko pakA detA hai| pitta dhIre dhIre abhivRddha hotA hai / isakA pramANa dhIre dhIre vraNa zotha meM USmAbhivRddhi honA hai jo pratyakSa hai| vAta usake vaza meM rahatI hI hai isI se zUla rahatA hai, kapha bhI vaza meM rahatA hai tabhI to jalIyAMza pracura mAtrA meM kSatigrasta sthAna para saMcita hojAtA hai aura sitakozAoM kA bhI jamAva jamane lagatA hai tathA rakta kA hI paripAka hotA hai yaha bhI dhruva satya hai kyoMki rakta kA hI jalIyAMza usIke sitakozA aura lAla kaNa Uti kSetra meM phaila kara pUya kA rUpa dhAraNa kara lete haiN| doSa vAta, pitta aura kapha tathA dUNya rakta isa prakAra cAra hI vraNazotha ke kAraNa haiM / aSTAGgahRdayakAra ne suzrutIya zAstrIya mata kA samarthana usake azAstriya mata ke sAtha sAmaJjasya baiThAte hue kiyA hai| isane vAta ko zUla kA kAraNa, dAha pitta ke kAraNa tathA zotha kapha ke kAraNa kahA hai tathA rakta ke kAraNa lAlI aura pAka batalAyA hai| isane pUya kA nAma nahIM liyaa| kapha ko zopha kA kAraNa kaha diyA hai| sampUrNa kledAMza kapha kahalAtA hai jalAdhikya ke vinA sUjana ho nahIM sakatI ataH zopha kA kAraNa kapha kahanA ayathArtha nahIM hai / raktAdhikya se lAlI aura pAka donoM batalAnA bhI asaGgata nahIM hai| kazyapa ne zopha kA mUla kAraNa vAta ko batalAyA hai| zopha kA prArambha zUla hotA hai tathA Agantu zotha jise zopha kahate haiM jaisA ki pahale kaha cuke haiM usameM bhI vAta dharma kA prAbalya hotA hai tatpazcAt anya doSoM kA sambandha AtA hai ataH zopha kA mUla kAraNa vAta doSa ko batalAnA pUrNataH nyAyya hai / phira antima kAraNa meM tInoM doSoM ko samAviSTa karane kA koI virodha AyA hI nahIM hai| kazyapa ne zotha kA adhiSThAna tvacA, rakta, mAMsa aura medas ko ginAyA hai jo Adhunika dRSTivindu se bhI saGgata hai| mAdhavakara ne jo vAkya saMgraha kiyA hai vaha uparokta dRSTikoNoM kA samarthana hI karatA hai| ___ sArAMza yaha nikalA ki vraNazotha kA prArambha vAta doSa ke sakAraNa prakupita hone se hotA hai / kahIM bhI kSata yA prahAra huA nahIM ki vahAM vAta prakopa hogayA jisakA pramANa vahAM para tIvra zUla hotA hai| isI kAla meM dhIre dhIre pitta bar3hane lagatA hai jo kezAloM kI antazchada kA bhakSaNa karatA huA vAta ko apane Azrita karake kapha ko prAcIroM meM se UtiyoM meM bhejatA rahatA hai adhika kapha ke saMcaya se zopha ho jAtA hai idhara pitta kA abhivarddhana vizeSa hone se oSa coSa dAha pAka kA kArya bar3ha jAtA hai| kaphAdhikya ke kAraNa sitakozAoM aura Utistha jIvANuoM meM paraspara saMgharSa cala par3atA hai jisase pUya kI utpatti hone lagatI hai / jaba paryApta pUya bana jAtA hai to vAta kA prakopa ghaTa jAtA hai jisase zUla kama ho jAtA hai kapha kA prakopa zAnta ho jAtA hai to zopha aura adhika bar3hatA nahIM balki ghaTane lagatA hai jisase tvacA para jhurriyAM par3a jAtI haiN| pitta ke prakopa kI kamI se vahAM dAha nahIM rhtaa| yaha hI vraNa kI For Private and Personal Use Only

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vraNazotha yA zopha 21 pakkAvasthA hai| isI kAla meM pUyaniharaNa ke lie zastrakarma ( operation ) kA vidhAna zAstra karatA hai| vraNazotha ke pakkApakka ke jJAna ke viSaya meM vaidya ko pUrNataH sajaga rahanA cAhie jo inako nahIM samajhatA use taskara tathA jo vinA samajhe hI cIra detA hai use cANDAla kI padavI se zAstra ne vibhUSita kiyA hai:____ AmaM vipacyamAnaM ca samyaka pakkaM ca yo bhiSaka / jAnIyAt sa bhavet vaidyaH shessaastskrvRttyH|| tathA-yazchinattyAmamazAnAyazca pakkamupekSate / zvapacAviva mantavyau tAvanizcitakAriNau // atipAka aSTAGgahRdayakAra ne atipakka zopha kA varNana karate hue likhA hai:pAke'tivRtte suSirastanutvagdoSabhakSitaH / valIbhirAcitaH zyAvaH zIryamANatanUruhaH / jaba pAka atikrAnta kara jAtA hai to tvacA patalI par3a jAtI hai tvacA se vraNa zothAdhiSThAna taka saba bhAga suSira (polA ) ho jAtA hai aura pUya dvArA bhakSita ho jAtA hai, tvacA para jhurriyAM par3a jAtI haiM, vaha sthAna kAlA ho jAtA hai aura vahAM ke roma gira jAte haiN| raktapAka rakta pAka ke nAma se jisa pAka kA usI granthakAra ne varNana kiyA hai vaha isa prakAra hai: kaphajeSu tu zopheSu gambhIraM pAkamatyasak / pakkaliGgaM tato'spaSTaM yatra syAtchItazophatA // tvaksAvaye rujo'lpatvaM dhanasparzatvamazmavat / raktapAkamiti brUyAttaM prAjJo muktsNshyH|| (a. hR. sU. 29-8, 9) arthAt kaphaja zothoM meM gambhIra sthAnoM meM yadyapi rakta kA pAka ho jAtA hai para pakkAvasthA ke lakSaNa aspaSTa hote haiN| zItazophatA tvagsavarNatA alpazUla patthara ke samAna kaThina sparza Adi AmAvasthA ke lakSaNa milane para bhI yaha pAka ho jAtA hai aura ise raktapAka kahate haiN| vraNazotha ke kAraNa kSetrIya parivartana ___ vraNazotha ke kendravindu para viSa kA sarvAdhika prabhAva dekhA jAtA hai / isa kAraNa Uti ke isa kendrastha bhAga kI mRtyu sabase adhika hotI hai| uti kA yaha kSatigrasta bhAga mRtaprAya hokara samIpastha svastha bhAga se pRthaka ho jAtA hai tathA usakA kucha aMza svapAcita ho jAtA hai| jaba vidhi ( abscess ) phUTatI hai to yaha Uti kA naSTa aMza jise nirmoka ( slough ) kahate haiM bAhara nikala jAtA hai| isa kendriya vinaSTa bhAga ke cAroM ora Uti ke ve kozA hote haiM jo naSTaprAya hone kI taiyArI kara rahe hote haiN| yahAM para meghAbha zopha (cloudy swelling) tathA snaihika vihAsa (fatty degeneration) prAyazaH dekhA jAtA hai| isa kSetra meM kucha kozA mara jAte haiM tathA kucha punaH sajIva ho uThate haiN| isa kSetra ke bAhara kA jo bhAga hotA hai usameM vraNazotha For Private and Personal Use Only

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22 vikRtivijJAna kartA viSa kI mAtrA mAraka na ho kara uttejaka hotI hai| yahAM kozAoM kA praguNana (proliferation ) hotA hai| vizeSa karake saMyojaka Uti ke kozA khUba banate haiM sAtha hI raktavAhiniyoM ke naye antazchadoM kA bhI nirmANa hotA hai jo Age calakara rakta kI navIna vAhiniyoM kA rUpa dhAraNa karate jAte haiN| ucca bhinna kie adhicchadIya kozAoM ( highly differentiated epithelial cells ) para viSa kA atyadhika prabhAva yahAM para bhI par3atA hai isI kAraNa yahAM saMyojaka Uti ke kozA unakA sthAna lete haiM parantu isa bhAga ke Age ke kSetra meM ye kozA bhI khUba praguNita hote haiM jisake kAraNa unakI udAsarga kriyA kI paryApta abhivRddhi dekhI jAtI hai| yadi kendrastha viSa kI mAtrA jIvANuoM kI ugratA se bar3hatI calI jAtI hai to ye vividha kSetra bhI vistRta hote jAte haiM anyathA ye eka sthAna vizeSa para hI raha jAte haiN| vraNazotha kA prasAra prAyazaH vraNazotha eka sthAna yA eka ativizeSa meM hI dekhA jAtA hai| para jaba vaha parajIviyoM ( parasites) ke kAraNa utpanna hotA hai to usake kSetra ke vistRta hone kI paryApta sambhAvanA rahatI hai| naidAnikadRSTi se vraNazotha ke prasAra meM UtisAtatya ( continuity of tissue ) lasIkAvAhiniyAM (lymphatics ), athavA raktavAhiniyA~ vizeSa uttaradAyI hote haiN| __sUkSma jIva pahale eka sthAna para avasthita hote haiM phira ve usa ora zIghra bar3hate haiM jahAM unheM kisI bAdhA kA sAmanA nahIM karanA par3atA, kabhI kabhI unheM vAhiniyoM ke udAsarga kucha dUra taka ghasITa le jAte haiM, kabhI kabhI lasa-dhArA (lymph-stream) ke pravAha se bhI ve dUra taka phaila jAte haiM, kabhI kabhI sitakozA unheM udarastha karake anya anya sthAnoM meM pahuMcA dete haiN| ina saba kAraNoM meM UtisAtatya kI hI pradhAnatA dekhI jAtI hai| . Uti-sAtatya ke atirikta vraNazotha ke prasAra kA eka aura sAdhana hai-lsvhaaeN| prArambhika sthala se lasavahA dvArA vraNazotha kA kAraka calatA hai aura jisa lasIkAgranthi meM vaha vAhinI samApta hotI hai usameM praveza kara jAtA hai aura usa granthi meM vraNazotha utpanna ho jAtA hai jise lasIkAgranthizotha (lymphangitis) kahate haiN| raktavAhiniyA~ vraNazotha ke prasAra karane ke lie tRtIya sAdhana kA kAma karatI haiM / jIvANuoM ko raktavAhiniyA~ lekara cala detI haiM jaba ye jIva kezAloM ke samIpa pahu~cate haiM to vahAM ruka jAte haiM tathA vahA~ vraNazotha utpanna kara dete haiN| sudUrastha bhAgoM taka vraNazotha ke prasAra kA mukhya kAraNa yahI vAhiniyA~ haiN| isa prakAra prApta vraNazotha ko hama dvitAyaka yA uttarajAta vraNazotha ( secondary inflammation) kahate haiN| aisA prAyazaH pUyaraktatA (pyaemia) nAmaka vyAdhi meM vividha sthAnoM para dekhA jAtA hai tathA kanapheDa ( mumps ) meM taba dekhA jAtA hai jaba aNDakoza yA bIjakoza zothagrasta ho jAte haiN| For Private and Personal Use Only

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vraNazotha yA zopha 23 vraNazotha ke prasAra ko rokane ke lie zarIra meM eka tanvibandha ( fibrin barrier ) banatA hai tathA viziSTa prasamUhi (specific agglutinins ) banatI haiN| ina surakSAtmaka kavacoM ko bhI bheda kara kucha jIvANuprasAra kArya karate haiM / udAharaNa ke lie zoNAMzI mAlAgolANu ( streptococcus haemolyticus ) isa tantvibandha ko jalAne vAlI eka tantra-aMzI ( fibrinolysin ) kA udAsarjana karatA hai / kucha jIvANu eka prasAra - kAraka ( spreading - factor ) kA nirmANa karate haiM / ina kArakoM meM eka aisA vikara ( enzyme ) hotA hai jo UtiyoM aura UtitaraloM meM prApya eka atyanta Alaga ( viscid ) padArtha kA carikAmla ( hyaluronic acid ) ko vilIna kara detA hai / isa vikara ko kAcarIeda ( hyaluronidase ) kahate haiM / zotha kA grahaNa arrate kA grahaNa ( arrest ) do prakAra se hotA hai a-nAzana ( destruction ) - vraNazothakara kAraNa ke naSTa hote hI UtiyoM ke naSTaprAya evaM kSatigrasta bhAga punaH svasthAvasthA ke svarUpa ko prApta karane ke svabhAva ke anurUpa AcaraNa karate haiN| naSTa hue kozAoM ko bhakSakozA uThA le jAte haiM aura unake sthAna para nava kaNa Uti ( granulation tissue ) ke dvArA nirmANa kArya cala par3atA hai / A- ATopana ( encapsulation ) - jaba prakSobhaka kAraNa ko naSTa karanA sambhava nahIM hotA jaise bAhya dravyoM yA sajIva kITANuoM meM dekhA jAtA hai to unheM eka tAntava Uti ke ATopa meM cAroM ora se ghera kara eka dRr3ha AvaraNa banA diyA jAtA hai jisameM usakI sajIva samAdhi ho jAtI hai / autikIya vibheda yadyapi vraNazotha kI prakriyA eka hI prakAra kI hotI hai tathApi jaba hama vibhinna UtiyoM meM vraNazotha kA autikIya nidarzana ( histological observation ) karate haiM to unameM bahuta vibheda dekhane ko milatA hai / isa vibheda ke nimna kAraNa haiM:--- prakSobhaka kI prakRti - prakSobhaka kI prakRti meM kucha vaibhinya hotA hai / koI to sitakozotkarSa ( leucocytosis ) karatA hai jaise puMjagolANu, phuphphusagolANu tathA mAlAgolANu inake kAraNa pUyana hotA hai aura vraNazotha ke saba lakSaNa prakaTa hote haiM tathA koI sitakozApakarSa karatA hai jaise yakSmA kA jIvANu yaha sitakozAoM kA nAza karatA tathA unakI kriyA ko manda kara detA hai isa kAraNa isa roga meM vraNazotha ke lakSaNa pUre pUre prakaTa nahIM hote / isameM vraNazotha kI AmAvasthA to dikhatI hai para pacyamAnAvasthA tathA paripakvAvasthA apUrNa rahatI haiM / yadyapi bArDe ne yaha spaSTa kara diyA hai ki prArambha meM sitakozAoM dvArA yacmA jIvANu kA bhakSaNa hotA huA dekhA jAtA hai jo vraNazotha pratikriyA kI astyAtmakatA ko isa roga meM siddha karatA hai / For Private and Personal Use Only

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24 vikRtivijJAna parantu sitakozAoM kA nirodhana karane kA guNa hone se isa roga kA autakIya citra badalA huA dekhA jAtA hai / yahI bAta Antrika jvara tathA ( sambhavataH ) phiraGga ke lie bhI ThIka utaratI hai| viSANu (virus) janya rogoM meM pUyana kA pUrNataH abhAva rahatA hai kyoMki viSANuoM para purunyaSTi kozAoM kA kucha bhI prabhAva nahIM par3atA hai| isI kAraNa viSANujanya tIvratama vraNazothAvasthA meM bhI prayotpatti dekhI nahIM jAtI hai / ina avasthAoM meM lasIkozA tathA ekanyaSTikozAoM kI vRddhi hotI hai jo autikIya citroM dvArA spaSTa dekhI jA sakatI hai / pratizyAya, kanapher3a, masUrikA aura tIvra mastiSkazotha ( encephalitis ) nAmaka viSANujanya vyAdhiyoM meM autikIya citra ke vibheda kA yahI kAraNa hai / prakSobhaka kI caNDatA - vibhinna rugNoM meM prakSobhaka abhikartA ne kisa mAtrA meM AkramaNa kiyA hai isa para bhI autikIya citra meM vibheda ho jAtA hai| isI kAraNa kisI vraNazotha ko 'mRdu' ( mild ) aura kisI ko 'tIvra' ( acute ) zabdoM se prakaTa kiyA jAtA hai / prakSobha kI mAtrA ke sAtha vyakti kI pratikriyA bhI vizeSa kArya karatI hai / tIvra svarUpa kI mAtrA vyakti kI vijayavAhinI zakti ke kAraNa 'mRdu' AkramaNakAriNI hotI hai isI prakAra isakA viloma bhI samajhanA cAhie / bAlakoM meM thor3A saMsarga bhI tIvra vraNazothakAraka ho sakatA hai jaba ki praur3ha bar3e saMsarga para bhI vijaya prApta kara lete haiM / isa prakAra prakSobha kI caNDatA prakSobhaka kI mAtrA, rugNa kI pratIkAra zakti tathA vyakti kI vaya ke anusAra badalA karatI hai / prakSobhaka kA kriyAkAla - kitane samaya taka kauna prakSobhakartA ne vyakti para AkramaNa kiyA hai isake anusAra vraNazotha kI tIvra, anutIvra athavA jIrNa avasthAoM kA jJAna prApta hotA hai / pratyeka prakAra ke vraNazotha meM ye tInoM avasthAeM kama yA adhika pAI jA sakatI haiM / prakriyA vahI hotI hai para kisa aMza meM kauna prakriyA calI hai yahI vibheda kara detA hai / kisI meM vAhinya parivartana ( vascular changes ), pramukha - tayA dekhe jAte haiM; kisI meM tanturUhoM ( fibroblasts ) kA praguNana hotA huA dekhA jAtA hai; kisI meM raktarasa kA niHsrAva hotA hai; kahIM purunyaSTikozA kA saMcaya hotA hai | vividha avasthAoM ke ye pratIka vizeSa prakAra ke vraNazotha ke viziSTa lakSaNa na hokara sabhI meM avasthAnurUpa mila sakate haiM / eka se dUsarI prAvasthA ( phase ) meM vibhedaka rekhA khIMcanA sambhava nahIM hai / phira bhI pratyeka prAvasthA meM kyA kyA hotA hai isakI sthUla bAteM smaraNa rakhanA sadaiva lAbhaprada dekhA jAtA hai jinheM hama nIce dete haiM vraNazotha kI tIvrAvasthA- isameM nimna vizeSatAe~ milatI haiM: ( 1 ) adhiraktatA ( hyperaemia ) (2) meghAbhazotha ( cloudy swelling ) For Private and Personal Use Only

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- vraNazotha yA zopha (3) snaihika vihAsa ( fatty degeneration ) (4) jIvitakakozAmRtyu ( necrosis of parenchymatous cell ) (5) zothatarala dvArA utiyoM ke avakAzoM meM tanAva ( distension of tissue-spaces by oedema fluids ) (6) tantvimaya jAlikA kI upasthiti ( presence of a fibrinous __reticulum) (7) sitakozAoM kA antarAbharaNa (infiltration of the part by ___leucocytes ) tathA (8) pUyana evaM pUyakozAoM kI upasthiti / vraNazotha kI anutIbAvasthA-isameM nimna vizeSatAe~ milatI haiM:(1)tIvAvasthA ke saba lakSaNa para mRdurUpa meN|| (2) tansuruha praguNana ( fibroblastic proliferation) (3) upasirajya sitakozAoM, antacchadIya ekanyaSTikozAoM, laghulasIkozAoM tathA prarasa kozAoM kI paryApta mAtrA meM upasthiti / (4) pUyana tathA pUyakozAoM kI upasthiti / vraNazotha ko jIrNAvasthA-isameM nimna vizeSatAe~ milatI haiM:(1) tantUtkarSa ( fibrosis) (2) lasIkozIya tathA prarasakozIya antarAbharaNa ( infiltration of lym. phocytes & plasma. cells) (3) abhilopI antardhamanIpAka ( obliterative endarteritis ) (4) pU~yana tathA pUyakozAoM kI upasthiti / pUyana aura pUyakozAoM kI upasthiti kA lakSaNa sabhI avasthAoM meM mila sakatA hai ataH ise dekha kara avasthA vizeSa kA pUrNa bodha nahIM kiyA jAsakatA / prabhAvita Uti kA prakAra-kisa prakAra kI Uti meM vraNazotha huA hai isa para autikIya citra nirbhara rahatA hai| udAharaNa ke lie asthi eka aisI ati hai jo atikaThora hotI hai isa kAraNa tIvra vraNazothAvasthA kI sUjana asthi meM AsAnI se nahIM dekhI jA sakatI aura jaba sUjana bar3hatI hai to kezAla daba jAte haiM usake kAraNa rakta kI pUrti na hone se asthi kI mRtyu (necrosis of the bone ) hojAtI hai aura tIvAvasthA meM asthimRtyu dekhI jAtI hai| taruNAsthi prAyaH raktarahita Uti hone se vraNazotha kA isa para bahuta kama prabhAva par3atA hai| sarvakiNvI (peMkriyAja ) granthi meM vraNazotha hone se usameM sthita kiNvoM ( ferments) kI vRddhi hone lagatI hai aura ye kiNva usa granthi kA hI pAcana kara DAlate haiM jisase usake bahuta se bhAga kI mRtyu ho jAtI hai aura snaihika vihAsa ke lakSaNa milane lagate haiN| lasyakozAoM (sero. us cells ) meM vraNazotha hone se lasthAvakAza meM srAva bhara jAtA hai aura sampUrNa 3,4 vi0 For Private and Personal Use Only

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26 vikRtivijJAna lasyAvakAza meM saMsarga pahu~ca jAtA hai / talIya apicchada meM vraNazotha hone se sthAnika UtinAza hokara vraNana ( ulceration ) hojAtA hai para UtiyoM meM bhItara vraNazotha vidhi ( abscess ) banatI hai / isa prakAra hamane vraNazothoM meM autikIya citra ke vibhedakAraka kAraNoM para thor3A sA prakAza DAlA hai tAki pAThaka Age jahA~ kahIM vraNazothoM kA Uti vizeSa kI dRSTi se varNana kiyA jAvegA usameM pratyakSa hone vAle vibhedoM ko dekhakara cauMke nahIM / zotha ke naidAnikIya prakAra yadyapi yaha satya hai ki vraNazothAtmaka prakriyA sadaiva eka hI rahatI hai para prakriyA kI ugratA tathA prabhAvita sthAna ke AdhAra para usake sambandha meM vibhinna zabdAvalI prayukta hotI hai ataH viziSTa vraNazotha pravicAra ko prakaTa karane ke pUrva hama vraNazotha ke vividha naidAnikIya prakAroM kA varNana kreNge| inameM zleSmalakalA evaM lasyakalA ke vraNazotha pramukha haiM / zleSmakalA ke vraNazotha -- zleSmalakalA ( mucous membrane ) ke vraNazotha do prakAra ke hote haiM :( 1 ) parisrAvI ( catarrhal ) ( 2 ) tanvimaya ( fibrinous ) parisrAvI vraNazotha - isameM niHsrAva ( exudation ) sadaiva taralAvasthA meM rahatA hai tathA vaha zleSmala, zleSma- pUya ( muco-purulent ) yA sapUya ( purulent ) ina tInoM meM se kisI bhI prakAra kA ho sakatA hai / zleSmala praseka meM zlezmala granthiyoM ke dvArA pracura mAtrA meM zleSmA kA nirmANa hotA rahatA hai / yaha zlaiSmika strAva yA to granthi ke Upara cipaTA rahatA hai, jaisA ki grasanIpAka ( pharyngitis ) meM prakaTa hotA hai, yA lasyaniHsrAva ke sAtha milakara bAhara nikala AtA hai / lasya - zleSma srAva kabhI kabhI pUrNataH svaccha hotA hai para jaba isameM thor3e yA bahuta kozA bhI A jAte haiM to yaha kama yA adhika pArAndha ( opaque ) ho jAtA hai / kozAoM meM mukta ( escaped ) sitakozA tathA vizalkita adhicchadakozA ( desquamated epithelial cells) hote haiM / nAsA ke pratizyAya yA pInasa nAmaka vikAroM meM kabhI svaccha srAva dekhA jAtA hai kabhI pragADha yA ghana yA paripakva srAva dekhA jAtA hai yaha isI zleSmala praseka yA parisrAva kA sthUlatama udAharaNa hai / yadi prakSobha kA kAraNa ugra huA to sitakozA srAva meM adhika mAtrA meM nikalane lagate haiM isa kAraNa srAvita tarala zlegmapUya yA sapUya ho jAtA hai / ina avasthAoM maiM adhicchada ( epithelium) paryApta mAtrA meM vizalkita ( desquamated ) ho jAtI hai usake nIce kI UtiyoM meM sitakozAoM kI bharamAra ho jAtI hai / adhaH For Private and Personal Use Only

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vraNazotha yA zopha stRtakalA ( basement membrane ) phUla jAtI hai tathA sampUrNa zleSmalakalA sUja jAtI hai| isameM sampUrNa lasAbha racanAe~ prabhAvita hotI haiN| lasasyUnikAe~ (lymph-follicles ) sUja jAtI haiM, unake Adheya ( contents ) mRdu ho jAte tathA unameM sUkSma vidradhiyA~ bana jAtI haiM, ve jaba phUTatI haiM to pUya zleSmA ke sAtha mila jAtA hai aura una sthAnoM para vraNa bana jAte haiN| Antra, antrapuccha tathA grasanI ke vraNazothoM meM aisI dazA paryApta milatI hai| ____jaba vraNazotha kI tIvrAvasthA samApta ho jAtI hai aura jIrNAvasthA A jAtI hai to sthAnika adhiraktatA ghaTa jAtI hai parantu sitakozAoM kA bahirgamana jArI rahatA hai, adhicchadIya kozAoM kA vizalkIkaraNa tathA guNana (desquamation & multiplication) calatA rahatA hai tathA adhaH adhicchadIya Uti ( subepithelial tissue ) meM sitakozAoM kI pUrNataH bharamAra rahatI hai| Age calakara adhicchada aura usakI granthiyoM meM apoSakSaya ( atrophy ) hone lagatA hai jaba ki adhaH adhicchadIya saMyojaka Uti meM lasIkozA, prarasakozA aura tanturuhoM kI bharamAra prArambha ho jAtI hai jo antatogatvA tantUtkarSa ( ( fibrosis ) meM jAkara samApta hotI hai| adhaH adhicchadIya saMyojaka Uti meM jo-jo parivartana hote haiM unhIM ke sAtha-sAtha lasAbhasyUnikAoM meM vraNazothAtmaka vardhana ( enlargement ) hone ke kAraNa zleSmalakalA kA rUpa granthikAtmaka (nodular ) yA kaNAtmaka (granular ) hojAtA hai| tantvimaya vraNazotha-zleSmala kalA ke zotha kA yaha eka dUsarA prakAra hai| isakI vizeSatA kA kAraNa eka kUTakalA ( false membrane ) kA nirmANa ho jAnA hai| isa kUTakalA ko prAcInoM ne aGkura yA mAMsAMkura nAma se kahA hai| rohiNI nAmaka roga meM yaha kalA vizeSa karake utpanna hotI hai ataH tantvimaya ke sthAna para rohiNika nAma se bhI isa vraNazotha kA varNana kiyA gayA hai| tantvimaya vraNazotha nimna avasthAoM meM milatA hai: 1. rohiNI gadANu ( clostridium diphtheri ), mAlAgolANu yA phuphphusa daNDANu ( pneumo bacilli) dvArA uttuNDikA ( tonsils) svarayantra (larynx) ke vraNoM ( wounds ) yA anya bhAgoM meM / __2. snigdha dagdha ( scalds ) dvArA bhI jaise garma dugdha yA vAyu se jala jAne para mukha meM tantvimaya vraNazotha dekhA jA sakatA hai| 3. dAhaka rAsAyanika padArthoM ke kAraNa tejAba yA dAhaka soDA pIne se yaha milatA hai| 4. basti meM tIvra bastipAka (oystitis) kI kucha avasthAoM meM athavA prasava ke uparAnta bhI yaha mila sakatA hai| * mAMsAkurAH kaNThaniropinAH syuH| For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 28 www.kobatirth.org vikRtivijJAna 5. antrapuccha meM kisI kaThora padArtha ke kAraNa jaba upasarga bhI ho to yaha milatA hai / 6. pravAhikA meM Antra meM yaha zotha dekhA jA sakatA hai| 7. abhi milatA hai / Acharya Shri Kailassagarsuri Gyanmandir zvasanikApAka ( plastic bronchitis ) meM bhI yaha dekhane ko yaha vraNazotha vibhinna sidhmoM (patches ) ke rUpa meM dekhA jAtA hai / kUTakalA kA sima choTA yA bahuta bar3A ho sakatA hai / kUTakalA kA raMga ApIta yA AdhUsara zveta hotA hai / yaha sudRr3ha yA mRdu kaisI bhI dekhI jAtI hai / yaha atyadhika raktaraMjita bhI mila sakatI hai / kUTakalAe~ bhI prabhAvita Uti kI gaharAI ke anupAta meM vibhinna prakAra kI hotI haiM / yadi adhicchada kA kevala dharAtala hI naSTa ho rahA ho to jo kalA banegI vaha patalI hogI tathA saralatA se chur3AI jA sakegI / isameM tantvi ke kaI stara hoMge ina staroM ke bhItara sitakozA, vizalkita adhicchadIya kozA tathA anya padArtha hoMge / yaha kalA raktapUrNa zleSmala kalA ke Upara adhiSThita hogI jisake andara bhI bahuta se sitakozA bhare mileNge| yadi sampUrNa zleSmalakalA prabhAvita hogI, jaisA ki rohiNI meM dekhA jAtA "hai to jo kUTakalA banegI use kaThinatA se hI pRthak kiyA jA sakatA hai / isa kUTakalA ke gambhIra bhAga mRta Uti ( necrosed tissue ) dvArA banate haiM / aisI kalA jaba haTA lI jAtI hai to jo sthAna raha jAtA hai usameM khUba rakta bahane lagatA hai / adhika dina hone ke bAda mRta vA sajIva Uti-aMzoM meM bheda karanA bhI kaThina hai| prabhAva - zleSmala kalAoM para vraNazotha prakriyA kA jo prabhAva par3atA hai vaha una nAla ( tubes ) vA guhAoM ( cavities ) ke AkAra tathA kriyA para nirbhara karatA hai| jinameM vraNazotha cala rahA ho / parisrAva ke kAraNa vedanA tathA anaicchika pezIgraha ( spasm of the involuntary muscular tissue ) prAyaza: huA karatA hai / isI kAraNa bAlAtIsAra meM zUla evaM pezIgraha ke kAraNa bAlaka tilamilA jAtA hai / jaba prabhAvita nAla choTe hote haiM aura unake dvArA nikalA huA srAva jaba ruka jAtA hai to bhayaGkara pariNAma taka dekhe jA sakate haiM / yahI kAraNa hai ki jaba rohiNI meM vraNazotha ke kAraNa svarayantra tathA kaNTha nAr3I kA mArga avaruddha hone se zvAsa * prazvAsa meM bAdhA Akara jIvanalIlA hI samApta ho jAtI hai / kabhI-kabhI choTe-choTe nAloM meM vraNazotha ke kAraNa itanA tantUtkarSa ho jAtA hai ki prabhAvita nAla kA mukha ( lumen ) vikRta yA saGkucita ( stricture ) hojAtA hai| isakA pramukha pramANa pUyamehagolANu ke prabhAva se utpanna huA mUtramArga kA saMkoca hai| anya sAdhAraNa aGgoM meM isa prakAra kI mArgagata saMkIrNatA ( stricture ) ke kAraNa saMkIrNa bhAga ke pichale bhAga meM saMcita taralayukta gA~TheM ( retention cysts ) bana jAyA karatI haiN| For Private and Personal Use Only

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tanttrimaya tarala pRSTha 29 Acharya Shri Kailassagarsuri Gyanmandir yaha phuphphusacchadapAka meM phuphphusacchada ( plUrA ) kA citra hai jo eka lasyakalA hai / citra meM tantvimaya tarala yA utsyanda nikalatA huA dekhA jA rahA hai| For Private and Personal Use Only

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vraNazotha yA zopha yadi yaha avarodha sthAyI svarUpa kA huA to pezI prAcIroM kI atipuSTi ( hyper trophy ) saMkIrNa bhAga ke Upara milA karatI hai| lasya kalAoM kA vraNazotha naidAnikIya dRSTi se tIna prakAra ke milate haiM1-vizuSka yA abhighaTya vraNazotha (dry or plastic inflammation) / 2-lasya-utsyanda yA lasyatantvimaya utsyandakara vraNazotha ( serous or sero-fibrinous effusion ) / 3-sapUya ( purulent) vraNazotha / 1. vizuSka yA abhighaTaya vraNazotha-lasI kalA para vraNazotha kA pahalA prakAra prAyazaH zuSka hotA hai| sabase pahale kisI prakSobhaka abhikartA ke kAraNa lasI kalA para kisI eka sthAna para aDDA jamatA hai jisake kAraNa vahA~ adhiraktatA ho jAtI hai usake pazcAt antazchadIya dharAtala para jo svAbhAvika camaka hotI hai vaha naSTa ho jAtI hai / antazchada ke kozA sUja jAte tathA kaNAtmaka ho jAte haiM unakA jaldI-jaldI guNana hone lagatA hai kucha kozA jo prakSobhaka padArtha ke kAraNa coTa khA jAte haiM ve vizalkita ho jAte haiN| adhaH antazchada ke bhAga meM raktavAhiniyoM se nikala-nikala kara bahuta se sitakozA pahu~ca jAte haiM jo usakA antarAbharaNa kara lete haiN| kucha sitakozA to dharAtala taka pahu~ca jAte haiM jinake sAtha-sAtha tansvi kA srAva bhI ho jAtA hai ina donoM ke kAraNa zveta yA ApItazveta varNa kA eka stara lasIkalA ve dharAtala para bana jAtA hai| yaha stara cuTaila antazchada ke sAtha abhilagna (adherent ) hotA hai| tansvi kA yaha ropa unhIM sthAnoM para hotA hai jahA~ pIDana atyalpa hotA hai| ___ lasIkalA ke jo tala camakarahita aura khuradare ho jAte haiM vahIM para tantvimaya abhilAga ( fibrinous adhesion ) huA karatA hai / jaba vraNazotha zAnta ho jAtA hai to bahuta sI tantvi ko probhUjAMzana kriyA tathA bhakSakriyA dvArA caTa kara diyA jAtA hai para kucha raha kara tAntava Uti kA nirmANa karatI hai| tAntava Uti ke kAraNa abhilagna tala sadaiva ke lie saMyukta ho jAte haiN| jina sthAnoM para do lasI kalAoM ke madhya gati hotI rahatI hai vahAM para navanirmita tAntava sambandha khiMca- khiMca kara dhAgoM ke AkAra ke ho jAte haiM jinakI moTAI kahIM adhika aura kahIM kama dekhI jAtI hai| udara meM inhIM tAntava abhilagnatA ke kAraNa Antra kA yantravat avarodha ( mechanical obstruction ) hotA huA dekhA jAtA hai| 2. lasya vraNazotha-antazchada kI adhiraktatA tathA dharAtala kI rUkSatA to utanI hI hotI hai jitanI vizuSka vraNazotha meM para isameM tarala kA utsyandana ( effusion ) bahuta adhika hotA hai| isI se adhikAMza meM antazchada para zAyada lasIkA (lymph) Akara AtaMcita hotA ho isI kAraNa utsyanda tarala bahuta svaccha For Private and Personal Use Only

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30 vikRvivijJAna dikha par3atA hai| kahIM-kahIM guhA kI prAcIroM ke Upara lasIkA kA eka stara jama jAtA hai tathA tarala ke andara AtaMcita tanvi ke kucha zalkala ( flakes ) pAye jAte haiM / isI kAraNa yaha lasya tantvimaya ( sero - fibrinous ) tarala kahalAtA hai / isa tarala ko jaba zarIra se nikAlA jAtA hai to vaha zlepyaka ( jelly ) ke rUpa meM jama jAtA hai / kabhI kabhI isI tarala meM rakta ke lAla kaNa itanI adhikatA se A jAte haiM ki isakA varNa lAla ho jAtA hai ise raktasrAvI utsyanda ( haemorrhagic effusion ) kahA jAtA hai / jaba yaha vraNazotha zAnta honA cAhatA hai to sampUrNa tarala ko sirAe~ tathA lasIkAvAhiniyAM Dho Dhokara pheMka detI haiN| jaba tarala kI mAtrA atyadhika hojAtI hai jisake kAraNa ina vAhiniyoM para itanA bhAra par3A hotA hai ki ve apanA kArya karane meM akSama ho jAya~ taba kRtrima rIti se tarala niSkAsana kA prayatna kiyA jAtA hai / lasya vraNazotha sadaiva sAdhya hotA hai tathA mRdusvarUpa kA yA anugra hotA hai| isI kAraNa do taloM kI abhilagnatA nahIM dekhI jAtI / yadi kahIM abhilAga ( adhesion ) banate bhI haiM to bahuta thor3e / kI jA sakI to 3. sapUya vraNazotha - - jaba uparokta utsyandita tarala meM sitakozAoM kI bharamAra ho jAtI hai to tarala lasyapUya ( seropurulent ) athavA pUrNataH pUyayukta ho jAtA hai / yaha pUya svayameva zarIra dvArA pracUSita nahIM hotA balki rukA rahatA hai / use zastrakarma dvArA yadi zarIra ke bAhara nikAlane kI vyavasthA na vaha lasIkA ko moTA kara detA hai antazchadIya kozA vilupta hojAte haiM unakA sthAna kaNAtmaka Uti le letI hai / pUya kA eka banda kuNDa sA bharA rahatA hai jo kAlAntara meM sUkha jAtA hai aura sampUrNa Adheya padArtha cUrNIbhUta ( calcified ) ho haiM tathA sampUrNa guhA kA abhilopana ( obliteration ) ho jAtA hai / lasI kalA meM vraNazotha kA pradhAna kAraNa upasarga hai / yaha upasarga AghAtaja ( traumatic ) bhI ho sakatA hai jaise kisI aMga kA vidAra yA bhAle Adi dvArA vraNa honA aura raktadhArA yA lasIkAvahA dvArA bhI lAyA jA sakatA hai / kisI aMga meM upasarga ho aura usake cAroM ora lasyakalA kA AvaraNa ho to bhI lasyakalA meM vraNazotha ho sakatA hai / phuphphusa pAkakAla meM hI upasarga jA sakatA hai| usake paryAvaraNa ( pleura ) meM eka vraNazothAbhikartA ke kAraNa, vibhinna avasthAoM meM, vibhinna prakAra kA vraNazothAtmaka pratikriyAe~ kI jAnI sambhava haiN| udAharaNa ke lie yakSmA meM eka sthAna para udaracchada guhA meM tarala bharane se jalodara dekhA jA sakatA hai aura dUsare meM adhaH udaracchadoya Uti meM zyAmAkasama piNDa (miliary tubercles) bhI dekhe jA sakate haiM / prabhAva - lasyakalA ke vraNazothoM meM zuSka vA abhighaTya meM sUje hue dharAtaloM ke anavarata gharSaNa ke kAraNa paryApta zUla rahatA hai / lasya - utsyanda kI avasthA meM tarala For Private and Personal Use Only

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vraNazotha yA zopha kI atyadhika mAtrA ke kAraNa vibhinna AvRtta aGgoM para vizeSa prabhAva par3a sakatA hai| parihRdayAvaraNa meM taralAdhikya hRdgati para pariNAma karatA hai| phuphphusacchada meM tarala saMcaya se phuphphusoM para jo prabhAva par3atA hai vaha sarvavidita hai| atyadhika jIrNa avasthAoM meM tAntavaUti ke sikur3ane para vikRti bahuta ho jAtI hai| yaha smaraNa rakhanA cAhie ki lasIkalA kI do satahoM meM vraNazotha ke kAraNa jo abhilagnatA A jAtI hai vaha prAyazaH surakSAtmaka hI hotI hai / phuphphusa meM yakSmAjanya sthAna ke Upara phuphphusacchada ke abhilagna ho jAne (cipaka jAne) se phuphphusacchadIya guhA ( pleural cavity ) taka yakSmA kA vraNIbhavana nahIM pahu~ca paataa| isI prakAra AmAzaya yA Antra para unakI lasIkalA kI abhilagnatA unake chidraNa (perforation ) ko rokane meM paryApta sahAyatA karatI hai| aura yadi chidraNa huA bhI to upasarga maryAdita ( localised ) rahatA hai| jIrNa vraNazotha jaba koI mRdu yA sAdhAraNa prakSobhaka dIrghakAlaparyanta apanI kriyA zarIra ke kisI aGga vizeSa para karatA rahatA hai to vraNazotha kI jIrNAvasthA prakaTa hotI hai isameM vighaTanAtmaka evaM racanAtmaka donoM kriyAe~ sAtha sAtha calatI rahatI haiN| prArambha meM prakSobhaka ke kAraNa tIvra vraNazotha utpanna huA karatA hai para kahIM kahIM kaba vraNazotha ne paira jamAye isakA jJAna hI nahIM ho pAtA / jIrNa vRkapAka (chronic nephritis) ke kucha rugNoM meM prArambha meM koI kaThinatA yA roga lakSaNa nahIM prakaTa hotA para dhIre dhIre vRkka kA vinAza calatA rahatA hai aura jaba pahalI bAra vRkkoM kI kriyA banda hotI hai usa samaya taka do tihAI vRkka naSTaprAya ho cuke hote haiN| jaise tIvra vraNazotha eka niHsrAvakAriNI ( exudative ) avasthA hai vaise hI jIrNa vraNazotha praguNanAvasthA ( proliferative ) hotI hai| tAntava Uti kA praguNana isakI vizeSatA hai / tAntava dhAtu kI vRddhi ke do kAraNa haiM eka to barAbara aMga meM adhiraktatA honA jisake kAraNa poSaka tatva nirantara milate rahate haiM isase Uti kA nirmANa lagAtAra calatA rahatA hai| dUsare, aMga ke jo viziSTa atikozA ( specialised tisue cells ) marate haiM to ve isa tAntava uti ke nirmANa ke lie uttejanA pradAna karate haiN| ____tAntava Uti ke nirmANa yA utpatti ke sambandha meM prAcIna AMgla kalpanA yaha hai ki pratyeka uti meM sthAnIya kucha tAntava Uti kozA hote haiM / jIrNa vraNazotha kAla meM inhIM se tanturuho ( fibroblasts ) kI utpatti hone lagatI hai| ve jaba prauda ( mature ) ho jAte haiM to apanA zleSajana ( collagen ) chor3akara tantukozA ( fibrocyte ) meM pariNata hojAte haiN| parantu, navIna kalpanA eka dama navIna hai| isake anusAra vraNazotha sthala para zarIrastha mahAbhakSI protikozA ( macrophage For Private and Personal Use Only

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vikRtivijJAna histiocytes ) bar3I se bar3I saMkhyA meM ekatra hote haiM aura unhIM kI AkRti meM parivartana hokara ve tAntava kozAoM meM pariNata ho jAte haiN| ___ tantUtkarSa ( fibrosis) ke atirikta jIrNa vraNazotha meM nimna avasthAe~ aura bhI dekhI jAtI haiM: 1. aMga kI rakta pUrti meM bAdhA-prabhAvita aMga meM adhiraktatA (hyperaemia) thor3I bahuta milatI hai parantu eka mahattva kA parivartana jo tIvra vraNazothAvasthA meM dRggocara nahIM hotA thA vaha yahA~ vizeSa karake hotA huA dekhA jAtA hai| ise abhilopI antardhamanI pAka ( obliterative endarteritis) kahate haiN| isameM vraNazotha kSetra meM par3I dhamanI kA antazchada jo bahuta samaya se prakSubdha huA rahatA hai usameM akasmAt ativRddhi ( hyperplasia ) prArambha hokara tantUtkarSa hone lagatA hai jisake kAraNa dhamanI supiraka ( lumen of the artery ) yA dhamanImukha taMga hotA calA jAtA hai aura kucha samaya bAda ghanAsrotkarSa ke kAraNa pUrNataH banda ho jAtA hai| isa prakAra usa aMga kI raktapUrti kama hotI calI jAtI hai| AsapAsa ke kezAloM para vraNavastu ( scar tissue ) ke saMkoca kA bhAra par3ane se aura bhI kama rakta kI mAtrA aMga taka pahu~catI hai / isake kAraNa vikSata ke ThIka hone meM aura vilamba ho jAtA hai| 2. prabhAvita aMga meM, tantUtkarSa kI kriyA hone se, tarala saMcaya se tathA kozAoM ke antarAbharaNa se paryApta sUjana (pragaNDatA) hotI hai| 3. prabhAvita aMga meM zUla barAbara rahatA hai| 4. prabhAvita aMga na zItala hI lagatA hai na uSNa / 5. jIrNa vraNazothagrasta kSetroM meM ekanyaSTikozA, lasIkozA tathA prarasakrozA prAyazaH milate haiM, bahunyaSTi sitakozA bhI rahate haiN| yadi vraNazotha kA kAraNa pUryajanaka jIvANu hue to cirakAlIna pUyana bhI milatA hai| yadi vraNazotha kA kAraNa koI avileya bAhyapadArtha ho athavA bahuta adhika UtinAza ho cukA ho to vahA~ assI assI nyaSThIlAyukta atikAyakozA (giant cells) bhI prakaTa hone lagate haiN| jo vidradhiyA~ sUkha jAtI haiM unake pAsa jo paittavasphaTa ( cholesterol crystals) bana jAte haiM unake samIpa bahuta bar3I saMkhyA meM ye mahAkAya kozA dekhe jAte haiN| ye yacamA, phiraMga ke goMdAdhuMda, kiraNakavakotkarSa ( actinomycosis), kuSTha tathA kabhI-kabhI cirakAlIna pUyajanaka upasargoM meM mila jAte haiN| ina rogoM meM bahuta adhika UtinAza hotA hai| For Private and Personal Use Only

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dvitIya adhyAya vividha zarIrAGgoM para vraNazotha kA prabhAva aba hama zarIra ke aMga-pratyaGgoM para vraNazotha kA kyA kyA prabhAva par3atA hai, unakI svAbhAvika racanA meM kauna-kauna parivartana ho jAte haiM tathA unake kAraNa kauna-kauna rogalakSaNa prakaTa hote haiM ina sabakA sUkSmadRSTi se vicAra kareMge / yadyapi yaha varNana viziSTa vikRtivijJAna ke antargata AtA hai parantu hamane apanA dRSTikoNa upasthita karane ke lie aisI kAlpanika vibhedaka rekhA ko mAnanA Avazyaka nahIM samajhA / eka sAtha hI sampUrNa viSaya ko par3hane se na kevala viSaya kA jJAna hI pUrNa ho jAtA hai api tu bhaviSyakAla meM kisa mArga kA avalambana karane se isa dizA meM gaveSaNAtmaka kitanA kArya ho sakatA hai isakI bhI sUjha A sakatI hai / mahAdhamanIpAka ( aortitis ) AntrapucchapAka ( appendicitis ) dhamanIpAka ( arteritis ) maNipAka (balanitis ) AyurvedIya vidvAnoM ke lie yaha viSaya navIna na hote hue bhI jitane vistRta rUpa meM idhara dekhane ko milegA utanA anyatra abhI taka prApta nahIM huA hogA / isameM jo navIna dRSTikoNa diyA gayA hai usakA samAveza AyurvedIya saMhitAoM ke nUtana saMskaraNoM meM jJAna-vijJAnavRddhi ke lie paramAvazyaka hai / isa adhyAya meM varNita sampUrNa jJAna pratyakSa digdarzana para tathA samIcIna avalokana ke AdhAra para hI saJcita hone se grAhya hai / 'navIna zabdoM kA prayoga viSaya ko spaSTa karane ke lie hai tAki samajhane meM kaThinatA na pdd'e| udAharaNa ke lie asthi ke vraNazotha ko asthizotha yA asthizopha na kahakara asthipAka se prakaTa kiyA gayA hai / vraNazotha meM rakta kI adhikatA, uSNatA, zUla, sUjana Adi sabhI prakopa ke lakSaNa haiM ataH vibhinna aGgoM ke vraNazotha 'pAka' athavA 'kopa' ke dvArA prakaTa kie gaye haiN| inakI nAmAvali nIce prakaTa kI jAtI hai :: zvAsanAlapAka ( bronchitis ) hRtpAka ( oarditis ) kozoti pAka (cellulitis ) kezAlapAka ( capillaritis ) garbhagraivapAka ( cervicitis ) pittapraNAlapAka ( cholangitis ) pittAzayapAka (cholecystitis ) malAzayapAka (colitis ) Acharya Shri Kailassagarsuri Gyanmandir bastipAka (cystitis ) aMgulipAka ( dactilitis ) carmapAka ( dermatitis ) carmapezIpAka ( dermatomyositis ) aMdhasyUnapAka ( divertioulitis ) mastiSkapaka ( encephalitis ) mandakamastiSka pAka ( encephalitis lethar gica ) antardhamanIpAka (endarteritis ) hRdantaHpAka (endocarditis ) garbhAzayAntaHpAka ( endometritis ) AntrapAka (enteritis ) For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 34 vezmakalApAka (ependymitis ) asthi zirapAka (epiphysitis ) tAntavapAka (fibrositis ) jaTharapAka (gastritis ) jihvApAka ( glossitis ) yakRtpAka ( hepatitis ) www.kobatirth.org bIjapare (cophoritis ) muSkapAka ( orchitis ) asthipAka ( osteitis ) vikRtivijJAna zeSAntrakapAka (ileitis ) AmAzayikakozIya UtipAka (linitis ) lasI kinIpAka (lymphangitis ) stanapAka ( mastitis ) mastiSkacchadapAka (meningitis ) garbhAzayapAka (metritis ) suSumnApAka (myelitis ) hRtpezIpAka ( myocarditis ) vRkkapAka (nephritis ) vAta nADIpAka (neuritis ) abhilopAntardhamanI pAka endarteritis) obliterative asthisandhipAka (osteo-arthritis ) asthikAsthipAka (osteochondritis ) asthimajjApAka (osteomyelitis ) sarvavipAka (pancreatitis ) parAgarbhAzayapAka ( parametritis ) upakarNagranthipAka (parotitis ) Acharya Shri Kailassagarsuri Gyanmandir parihRtpAka (pericarditis ) parikAsthipAka ( perichondritis ) pariyakRpAka (perihepatitis ) paryasthapAka (periosteitis ) udaracchadapAka (peritonitis ) grasanIpAka (pharyngitis ) sirApAka (phlebitis ) phuphphulapAka ( pneumonitis ) bahudhamIpaka (polyarteritis ) bahusandhirpAka (polyarthritis ) bahuta nADIpAka (polyneuritis ) aSThIlAnthipAka (prostatitis ) dantagordapAka (pulpitis ) vRkkanivApapAka (pyelitis ) vRkkanivApa - vRkkapAka ( pyelonephritis ) kezikA bhAjisirApAka ( pylephlebitis ) nAsAkopa ( rhinitis ) garbhAzayapraNAlIpAka ( salpingitis ) koTarapAka (sinusitis ) kIkasapAka ( spondylitis ) mukhapAka ( stomatitis ) sandhikalApAka ( synovitis ) kaNDarApAka (tenosynovitis ) galagranthipAka (thyroiditis ) tuNDikApAka ( tonsillitis ) mUtramArgapAka ( urethritis ) yonipAka ( vaginitis ) isa prakaraNa kA varNana hama nimna 13 zIrSakoM meM kareMge: 1. asthi dhAtu para vraNazotha kA pariNAma 2. sandhi para vraNazotha kA pariNAma 3. mAMsadhAtu para vraNazotha kA pariNAma 4. hRdaya para vraNazotha kA pariNAma 5. rakta tathA lasavAhiniyoM para vraNazotha kA pariNAma 6. jAlikA antazchadIya saMsthAna para vraNazotha kA pariNAma 7. zvasanasaMsthAna para vraNazotha kA pariNAma For Private and Personal Use Only -- 8. mahAsrota para vraNazotha kA pariNAma 9. yakRt tathA pittAzaya para vraNazotha kA pariNAma 10. sarvakiNvI para vraNazotha kA pariNAma

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vividha zarIrAGgoM para vraNazotha kA prabhAva 11. apraNAla granthiyoM para vraNazotha kA pariNAma 12. mUtra prajanana saMsthAna para vraNazotha kA pariNAma 13. vAtanADIsaMsthAna para vraNazotha kA pariNAma (1) asthi dhAtu para vraNazotha kA pariNAma isa prakaraNa meM hama asthiyoM, asthimajjA tathA kAsthiyoM para vraNazotha ke pariNAma kA varNana kreNge| sAdhAraNataH eka asthi kI racanA meM 3 bhAga milate haiM 1. eka bAhyatAntava AvaraNa ( an outer fibrous sheath ) jise paryastha kahate haiM / yaha eka vAhinIyuta ( vascular ) kalA hai jisake dvArA asthi ke bAhya bhAgoM kA poSaNa hotA hai| pahale aisA vicAra thA ki isa paryastha bhAga ke dvArA hI asthi kA nirmANa hotA hai para vaha aba mAnya nahIM haiM kyoMki yadi kevala paryastha ko khuraca kara kisI zarIra meM pratiropaNa kara deM to asthi nahIM bntii| para yadi paryastha ke sAtha cAhe bahuta thor3A sA asthi kA bhAga bhI Ane diyA jAya aura taba use ropita kareM to naI asthi banane lagatI hai| isase jJAta huA ki asthijanaka kozA paryastha ke nIce tathA mukhya asthi ke bAhya staroM meM nivAsa karate haiN| pratiropita asthi kA sambandha yadi sajIva bhAga se thor3A bahuta banA rahe to nava asthi nirmANa saralatA se ho jAtA hai| paryastha asthidaNDa ( shaft of the bone) para halakI halakI cipakI hotI hai para asthizira ( epiphysis) para dRDhatA se ba~dhI rahatI hai| yadi paryastha ko ucela diyA jAve to asthi ke bAhya bhAgoM kI rakta pUrti na hone se asthi kA nAza hone lagatA hai| 2. dUsarA mukhya asthi kA bhAga jise nibiDAsthi ( compact bone ) kaha sakate haiM / yaha pahale aura tIsare bhAgoM ke bIca meM par3atA hai aura vAstavika asthi kA bodhaka yahI bhAga hai| isakA punarjanana karane ke lie rakta kA yatheccha A sakanA, nibiDAsthi ke bAhyastaroM meM asthijanaka asthirahoM ( osteoblasts ) kI upasthiti tathA Avazyaka khanija lavaNoM kI pracuratA ye 3 bAteM avazya pUrNa honI caahie| nibiDAsthi ke hI sAtha nikulyA saMsthAna (Haversian system ) AtA hai jisake antargata asthipoSaNI vAhiniyA~ AtI haiM jo isa bhAga ko puSTa karatI haiN| 3. tIsarA majjaka ( medulla.) jisake sAtha chidriSTha asthi ( cancellous bone ) kA bhAga bhI rahatA hai jisake andara atyanta raktapUrNa majA ( marrow) nivAsa karatI hai| isakA poSaNa asthipoSaNI vAhiniyA~ tathA majjAsthavAhinI pratAna (plexus ) ke dvArA hotA hai| ___ uparokta tInoM bhAgoM meM vraNazotha ho sakatA hai aura inake paryasthapAka ( periostitis ). asthipAka (osteitis) tathA asthimajjApAka (osteomyelitis) ye 3 nAma haiM jinakA vivaraNa Age diyA jA rahA hai / asthi ke vraNazotha ke prabhavasthala For Private and Personal Use Only

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36 vikRtivijJAna usake raktapUrNa sthAna paryastha athavA majjaka hote haiN| jaba hama paryastha pAka kahate haiM to usakA artha kevala paryastha mAtra meM hI pAka nahIM hai balki asthidaNDa ke bAhyastaroM meM bhI pAka jAnanA cAhie / isI prakAra asthipAka yA asthimajjApAka meM paryastha kA bhI kucha na kucha pAka avazya milatA hai / paryasthapAka ( Periostitis ) yaha tIna prakAra kA hotA hai - lasyaparyasthapAka ( serous ), praguNana paryasthapAka ( proliferative ) tathA sapUya paryasthapAka ( suppurative ) / inameM lasya paryastha pAka bahuta kama dekhA jAtA hai tathA yaha atIva saumya svarUpa kA hotA hai / praguNana paryasthapAka nimna kAraNoM se milatA hai: 1. AghAta 2. paryastha ke nIce raktasrAva 3. anutIvra upasarga 4. phiraMga kI dvitIya evaM tRtIyAvasthA sapUya paryasthapAka kA kAraNa tIvra pUyajanaka upasarga hotA hai / asthipAka (Osteitis ) yaha bhI 3 prakAra kA hotA hai -- viralaka asthipAka ( rarefying osteitis ) yA asthyazanApAka ( caries of bone ), jAraThaka yA saMghanana asthipAka (scle - rosing or condensing osteitis ), tathA sapUya asthipAka / viralaka asthipAka yA asthyazanApAka aise samajhanA cAhie jaise mRdu UtiyoM kA vraNIbhavana | asthi ke aNuoM kA vighaTana ( disintegration of molecules ) hone lagatA hai jisake kAraNa asthi ke kozAoM kI dhIre dhIre mRtyu hotI jAtI hai| mRtakozAoM ko asthidalaka ( osteoclasts) bhakSaNa karate cale jAte haiM jisake kAraNa asthipadArtha virala hotA jAtA hai / jahA~ jahA~ se asthi kA bhakSaNa hotA jAtA hai vahA~ gaDDhe banate jAte haiM jisake kAraNa pratyakSa darzana se aisA mAlUma par3atA hai ki asthi ko kIr3oM ne khA liyA ho / yaha pAka saMpUya athavA pUyavirahita donoM prakAra kA dekhA jAtA hai / pUyavirahita asthipAka ko keyarIjasikkA ( caries sicca ) nAma se pukArate haiN| jAThaka yA saMghanana asthipAka meM viralana kA kArya nahIM hotA api tu vahA~ navIna asthi aura banane lagatI hai jo asthi ko Thosa karatI calI jAtI hai| jisake kAraNa asthi nikulyA aura chidriSTa bhAga ghaTate cale jAte haiM aura haDDI hAthI dA~ta kI taraha Thosa ho jAtI hai / asthi meM vraNazotha ke kAraNa vahI saba kriyAe~ dekhI jAtI haiM jo anyatra milatI haiM / asthi kA raktapUrNa ho jAnA, upasargAbhikartA ke dvArA Uti vinAza honA tathA svastha Uti dvArA asvastha bhAga kA punarnirmANa karanA yaha saba yahA~ bhI calatA hai / asthiyoM meM UtinAza kA artha asthi kA zoSaNa ( absorption ), viralana For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 37 ( rarefaction ) tathA nAza ( necrosis ) kiyA jAtA hai / punarnirmANa kA kArya kaNIyana Uti (granulation tissue) ke dvArA bhI hotA hai tathA navIna, ghana (dense) athavA jAraThaka ( sclerotic ) asthi ke nirmANa dvArA bhI hotA hai / yaha nirmANa vaisA hI samajhanA cAhie jaisA anya UtiyoM meM tantUtkarSa ( fibrosis ) / sarvaprathama jyoM hI paryastha bhAga meM raktAdhikya hotA hai usake nIce ke bhAga meM upasthita asthikAraka kozA ( osteoblasts ) utsAhita ho jAte haiM / isa kAraNa navAsthinirmANa cala par3atA hai usa sthAna para asthinAzaka kozA ( osteoclasts ) kI saMkhyA bahuta kama hotI hai jisake kAraNa unakI kriyA zAnta rahatI hai / parantu chidriSTa ( cancellous ) asthi meM ina donoM kI saMkhyA samAna hotI hai isa kAraNa asthibhavana evaM asthinAza donoM sAtha-sAtha calate haiM yadyapi asthinAza hI adhika hotA hai / hI adhiraktatA ghaTatI hai jahA~ asthikara tatva adhika hotA hai, asthi kA jaraThana ho jAtA hai tathA jahA~ asthihara tatva adhika hote haiM vahA~ usakA chidraNa aura pracUSaNa adhika ho jAtA hai / asthidalaka kaI-kaI chidroM ke bIca ke asthibhAga ko khAkara bahuta bar3A avakAza bhI banA dete haiM isa kriyA ko asthidalakIya gartikIya punarcUSaNa ( osteoclastio lacunar resorption ) kahate haiM / isI prakriyA dvArA asthi kA viralana bhI hotA hai / mA meM asthi kA nAza aura pracUSaNa punarnirmANa se kahIM adhika hone ke kAraNa asthi ke bar3e-bar3e bhAga yA kabhI-kabhI sampUrNa asthi ( kIkasa vertebra ) pUrNataH vilupta hotI huI dekhI jAtI hai| phiraGga meM asthinirmANa nAza se adhika hotA hai isa kAraNa asthikozAoM ke praguNana ke kAraNa asthi Thosa ho jAtI hai / sapUyAvasthA meM asthivairalya aura asthisaMghanana donoM dekhe jAte haiM / asthipAka ke tInoM prakAra asthimajjApAka meM prAyazaH milate haiM / ataH hama aba Age usI kA varNana kareMge / sapUya asthimajjA pAka tIvra (Acute Suppurative Osteomyelitis) isa roga kA paricaya dete hue suzruta likhatA hai: -- atha majjaparIpAko ghoraH samupajAyate / so'sthimAMsanirodhena dvAraM na labhate yadA / tataH sa vyAdhinA tena jvalaneneva dahyate // asthimajjoSmaNA tena zIryate dahyamAnavat / vikAraH zalyabhUto'yaM klezayedAturaM ciram // athAsya karmaNA vyAdhidvArantu labhate yadA / tato bhedaH prabhaM snigdhaM zukuM zItamatho guru || bhinne'sthi niHsravet pUyametadasthigataM viduH / vidradhiM zAstrakuzalAH sarvadoSarujAvaham // ( su. ni. sthA. a. 9 ) isakA tAtparya yaha hai ki kabhI-kabhI asthi ke bhItara majjA meM ghorapAka ( acute inflammation in the marrow of the bone ) utpanna ho jAtA hai / For Private and Personal Use Only

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38 vikRtivijJAna isa pAka ko asthi tathA mAMsa ke avarodha ke kAraNa jaba koI dvAra yA mArga nahIM milatA to rogI isa vyAdhi se agni kI taraha jalatA hai asthimajA kI vaha USmA atyanta utinAza ( tissue necrosis ) karatI huI vyakti ko kaSTa detI hai| yaha zalyabhUta ( surgical ) vyAdhi hai jo cirakAlIna ( chronic) hone ke kAraNa bahuta samaya taka rogI ko kleza detI hai| yadi zastrakarma ( operation ) dvArA use mArga mila gayA to usameM se medaprabha snigdha zukla aura zItala tathA guru srAva nikalane lagatA hai| ise eka prakAra kI sarvadoSayukta tathA saba prakAra ke zUloM vAlI vidhi zAstrakuzala batalAte haiN| caraka ne asthimajjApAka kA varNana vAtavyAdhi prakaraNa meM asthimajjA meM prakupita vAta ke nAma se dete hue nimna lakSaNa likhe haiM:medo'sthiparvaNAM sandhizUlaM mAMsabalakSayaH / asvapnaH saMtatA ruk ca majjAsthikupite'nile / / uparokta varNana se prakaTa hai ki isa viSaya kA jJAna hameM bahuta pahale se hai| para cUMki itane se hI matalaba hala ho jAtA thA isa kAraNa usakA autikIya UhApoha prAcIna kAla meM hotA nahIM thA para aba usake lie sampUrNa sAdhana upalabdha haiM ataH usakA varNana hama nIce kie dete haiM: ghora asthimajjApAka nimna kAraNoM se utpanna ho sakatA hai 1. pratyakSa upasarga se-jaba AghAtavaza haDDI bhanna hokara bAhara nikala AtI hai aura usameM upasarga laga jAtA hai| 2. samIpastha pUyika kendra se-jaise dantavidradhi se hanvasthi meM athavA madhyakarNa vidradhi se zaMkhakAsthi meM majApAka hotA huA dekhA jAtA hai| 3. zoNitajanita upasarga dvArA yaha prakAra bAlakoM yA kizoroM taka sImita hai| praur3ha yA lar3akiyA~ isase kama prabhAvita hotI huI dekhI jAtI haiN| upasarga kA kAraNa svarNapuMjagolANu ( staphylococcus aureus ) nAmaka rogANu hai| camar3e meM kahIM koI vraNa yA vidradhi huI vahA~ se upasarga rakta meM pahu~cA rakta dvArA asthipoSaNI vAhinI meM gayA aura asthi ke bhItara usake pratAnoM meM asthizira rekhA (epiphyseal line ) ke pIche kahIM antaHzalya bana kara ruka gayA aura majA kA paripAka Arambha ho gayA / yahI isakI kathA hai| yaha Urdhvasthi ( femur ) aura jaMghAsthi ( tibia) meM adhika hotA hai anyatra kama / bAhu kI asthiyoM meM bhI milatA hai| ____ asthizira rekhA ke pIche chidriSTha uti meM eka vidradhi bana jAtI hai| prArambha meM tIvra adhiraktatA dekhI jAtI hai jisake sAtha-sAtha asthi kA viralana aura asthinikulyA (Haversian canal) kA vistIrNa honA calatA hai jo pravRddha asthidalana kriyA ( osteoclasis ) kA dyotaka hai| asthi ke bhItara jitanI bhI mRdu utiyA~ nivAsa karatI haiM una saba para vraNazothAtmakazopha ( inflammatory oedema) kA itanA pIDana hotA hai ki unakI raktapUrti meM bAdhA pahu~ca kara unakI mRtyu hone For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 36 lagatI hai / paryastha bhI sazopha aura sarakta ho jAtI hai| dhIre dhIre upasarga andara se bAhara kI ora AtA hai / asthi aura paryastha ke bIca meM itanA pUya ekatra ho jAtA hai ki paryastha asthidaNDa se kAphI U~cI uTha jAtI hai| kucha samaya pazcAt paryastha ko bhedakara pUya Upara kI mRdu UtiyoM meM praveza karatA hai, paryastha ke nIce ke asthidaNDa para lAla tathA dhUsara ( grey ) varNa ke dhabbe par3e hue dekhe jAte haiM tathA vaha karburita ( mottled ) ho jAtA hai / asthi ke bhItara pUyanakriyA bar3hakara nIce asthi ke madhyabhAga taka pahu~catI hai para asthizira ko bheda kara Upara kI ora isalie nahIM jA pAtI ki asthizirIyakAsthi (epiphysial cartilage) prAyazaH raktavirahita hotI hai / pAka ke prArambha se hI yadyapi asthi kA viralana ( rarefaction ) aura vicUrNiyana ( decalcification ) hotA rahatA hai jo lagAtAra calatA rahatA hai parantu pAka-kSetra ke cAroM ora jahA~ pAka kA prabhAva atyalpa hotA hai navIna asthi kA nirmANa usI prakAra prArambha ho jAtA hai jisa prakAra kisI vidradhi ke cAroM ora tAntava Uti kA nirmANa hone lagatA hai / isake kAraNa upasarga kA prasAra rokane meM sahAyatA milatI hai / asthimajjApAka meM asthinAza kaI kAraNoM se hotA hai / unameM nimna mukhya haiM: : 1. paryastha bhAga aura asthidaNDa ke bIca meM pUrA bhara jAne se asthi ke bAhyastaroM meM rakta pahu~cane meM bAdhA honA / 2. asthikulyA ke svataH kaThora hone ke kAraNa tathA bhItara pAka prakriyA ke kAraNa tarala bhAga bar3ha jAne se itanA adhika pIDana bar3ha jAtA hai ki raktasaMvahana kArya meM avarodha AjAtA hai / 3. dera taka raktavAhiniyoM meM rakta kA pracalana na hone se vahA~ jAraka kI kamI hotI hai sAtha hI saba ora pUya hI pUya vyApta rahatA hai isa kAraNa vAhiniyoM kA antazchada TUTa phUTa jAtA hai isake kAraNa antarvAhinI AtaMcana (intravascular clotting ) hokara ghanAstrotkarSa ( thrombosis ). dekhA jAtA hai| ina tIna kAraNoM se asthi ke prabhAvita bhAga kI raktapUrti ruka jAtI hai aura asthi kA vaha bhAga mRtaka ho jAtA hai / ise mRtAsthilava ( sequestrum ) kahate haiM / isa mRtAsthilava ke cAroM ora eka gulAbI rekhA bana jAtI hai jo sajIva aura mRtaka asthi meM vibheda karatI hai / asthi kA yaha mRta Tukar3A aba zarIra kA eka bhAgarUpa na hokara bhArarUpa videzI padArthavat ho jAtA hai jisake cAroM ora pUyotpatti calatI rahatI hai jo mahInoM taka dekhI jAtI hai / mRtAsthilava ko zastrakarma dvArA yadi na nikAla diyA jAve to isakA pracUSaNa bahuta dhIre dhIre hotA hai aura anta meM kisI nAr3Iar (sinus ) dvArA isakA niSkAsana ho pAtA hai / ghora asthimajjA pAka ke kAraNa kaI prakAra ke upadrava bhI dekhe jAte haiM vizeSakara puMjagolANujanya upasarga dvArA rogotpatti hone para / ye upadrava do prakAra ke ho sakate haiM eka sthAnika aura dUsare sArvadehika | sthAnika dRSTi se yaha eka jIrNapUyika For Private and Personal Use Only

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40 vikRtivijJAna avasthA (chronic suppurative condition) meM pariNata ho jAtA hai jo anta meM upacAra na karane para maNDAbha vihAsa meM pariNata ho jAtA hai / rogANu saghana jaraTha asthi ( dense sclerotic bone) ke navanirmita bhAga ke bhItara ke avakAza meM ghira jAte haiM / isI se phira Age calakara jo vidradhi banatI hai use bauDIya vidhi ( brodie's abscess ) kahA jAtA hai / ye vidradhiyA~ saghana asthi ke madhya ke avakAza meM kucha kAla taka zAnta tathA kucha kAla taka savega sazUla dekhI jAtI haiM / kabhI-kabhI asthi meM ekatra pUya asthisandhi ( joints ) taka pahu~ca jAtA hai vahA~ kucha kAla taka rahakara yA to pracUSita ho jAtA hai athavA jIrNa asthisandhipAka ( chronic osteoarthritis ) meM pariNata ho jAtA hai / ghora sapUya sandhipAka acute suppurative arthritis ) ke rUpa meM puMjagolANujanya asthimajjApAka prAyaH dekhane meM nahIM AtA hai / sArvadehika upadrava dRSTi se upasarga pIDitA asthimajjA meM sthita kezAloM meM jo ghanAtra hote haiM jaba unameM se kucha zarIragata raktasaMvahana cakra meM cale jAte haiM to pUyaraktatA ( pyemia ) athavA rogANuraktatA ( septicaemia ) nAmaka bhISaNa vyAdhiyoM ke kAraNa banate haiM / atyadhika upasarga hone para mRtyUparAnta parIkSA meM zarIra ke vibhinna aMgoM meM vidradhiyA~ banI huI dekhI gaI haiN| ye visthAnAntarita vidhiyA~ ( metastatic abscesses) parihRt meM pAI jAtI huI bahudhA dekhI gaI haiN| ghora asthimajjApAka sapUyaparihRtpAka ( suppurative pericarditis ) kA bhI kAraNa hotA hai / asthimajjApAka puMjagolANuoM ke atirikta nimna anya rogANuoM se bhI honA sambhava hai: : 1. mAlAgolANu - inake dvArA utpanna majjApAka meM mRtAsthilava nirmANa kama hotA hai para ye asthizirIyakAsthi ko naSTa kara sandhiyoM meM pAka karane meM bahuta nipuNa hote haiM ye ghAtaka svarUpa ke upadrava karane vAle hote haiM / 2. phuphphusagolANu - ye zizuoM meM phuphphusapAka ke pazcAt madhyakarNapAka hone ke kAraNa zaMkhAsthi meM asthimajjApAka karane meM nipuNa hote haiM / mRtAsthilava nirmANa meM bhI kama karate haiM / sandhiyoM taka inakI pahu~ca to hotI hai para ye unheM zIghra chor3a dete haiM / 3. AntradaNDANu - Antrikajvara ( motIjharA ) se pIr3ita rogI ko mahInoM yA varSoM pazcAt yaha roga hotA huA dekhA jAtA hai / paryastha ke nIce vidvadhiyoM kA bananA mukhyataH milatA hai / upasarga asthi ke bAhya bhAga para hI rahane se mRtAsthilava nahIM banatA / / 4. kiraNakavaka ( actinomycosis ) - isake kAraNa hanvasthi meM asthimajjApAka hotA hai / yaha vyAdhi kRmidanta dvArA vahA~ taka pahu~catI hai| kapola para kaI nADIvraNa isI ke kAraNa khulate haiM jinameM patalA pUya hotA hai aura pUya meM gandhaka ke kaNa (sulphur granules ) jo isa upasarga kI vizeSatA hai avazya pAye jAte haiN| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 41 asthimajjApAka meM nimna zArIrika lakSaNa ( symptoms ) mila sakate haiM :1. viSaraktatA ke sAtha tIvra upasarga meM pAye jAne vAle saba lakSaNa jaise uccasantApa, jvara ke sAtha kampana ( rigors ) tathA kabhI-kabhI pralApa ( delirium ) / 2. sitakozotkarSa ( leucocytosis ) / 3. pAka ke sthAna para ghora zUla milatA hai aura vaha sthAna uSNa, lAla aura phUlA huA rahatA hai / asthi, paryastha tathA asthimajjA para vraNazotha kA jo pariNAma hotA hai use hamane bahuta pRthaka karane kA yatna pIche kiyA hai parantu saba kA saba itanA milA julA hai. ki use ina tIna bhAgoM meM bA~TA nahIM jA sakatA / paryastha se lekara majjA taka asthi kA itanA eka dUsare bhAga se ghaniSTha sambandha hai ki eka meM pAka dUsare aura tIsare bhAga ko bahuta adhika prabhAvita karatA hai / ataH yadi saba pArkoM ko asthipAka (osteitis) nAma diyA jAya to vaha pUrNataH yuktiyukta hai hama isake pramANa svarUpa nimna uddharaNa pAThakoM ke lAbhArtha uddhRta karate haiM: . "That the various parts of the bone are one, the perios teum, osteum, and medula being intimately connected and continuous with one another; wherefore it follows that an inflammatory process in a bone will affect all these structures in a greater or lesser degree, and it is thus absured to discus the diseases of the three constituent parts separately. Hence the older terms, periostitis, osteitis, and osteomyelitis, as denoting separate diseases, will be abandoned and the inflammations of bone tissue alluded to as osteitis a term which can be regarded as covering all the essential structures of a bone'. For Private and Personal Use Only The Science and Practice of Surgery. asthizirapAka ( Epiphysitis ) asthidaNDa meM pAka hone para kabhI-kabhI asthizira para usakI kAsthi meM bhI zotha dekhA jAtA hai| use asthizirapAka kahate haiM / yaha tIvra, anutIvra tathA cirakAlIna yA jIrNa tInoM prakAra kA ho sakatA hai / tIvra yA ghora asthizirapAka ( acute epiphysitis ) bAlakoM kI mAraka svarUpa kI vyAdhi hotI hai / yaha mAlAgolANuoM se utpanna huA karatI hai| isakI tathA asthipAka kI vikRti meM koI antara vizeSa nahIM hotA / asthikArI nyaSTIlA ( ossific nucleus ) meM pahale upasarga pahu~catA hai aura vahI isa upasarga kA kendra rahatI hai / vahA~ taka upasarga rakta ke usa cakra dvArA pahu~cAyA jAtA hai jo sandhi kI zleSmalakalA, paryastha bhAga Adi

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vikRtitijJAna kI raktapUrti karatA hai / isakA pariNAma yaha hotA hai ki bahuta hI thor3e samaya bAda pUya asthizira se samIpa kI sandhi taka pahu~ca kara sandhi ko sujA detA hai aura sandhipAka ( arthritis) kA kAraNa banatA hai| isa avasthA meM bAlaka kaSTa se bahuta cillAtA hai usakI asthisandhi sUja jAtI hai tathA bAlaka arddhamUchitAvasthA meM par3A hotA hai| anutIvra asthizirapAka ( subacute epiphysitis) yaha avasthA pUyajanaka jIvANuoM tathA phiraMga donoM ke dvArA mila sakatI hai| yaha ghorAvasthA se milatI julatI hotI hai| yaha bhI zizu roga hai| isameM krandana adhika evaM mUrchA kama rahatI hai| isameM asthizira asthidaNDa se pRthak hotA huA prAyaH milatA hai / ___ jIrNa asthizirapAka (chronic epiphysitis) bhI asthikArI nyaSThIlA meM pUyajanaka jIvANuoM kA upasarga hone se hI roga hotA hai isake kAraNa asthiyoM kI vRddhi viSama ho jAtI hai| lambI asthiyoM meM yaha roga hone se zarIra ko vikRta (deformed ) kara detA hai| (2) asthisandhiyoM para vraNazotha kA pariNAma (Inflammation of the Joints ) Ayurveda asthi, pezI, snAyu, sirA ina saba kI sandhiyoM ke sambandha meM prakAza DAlatA hai, parantu mukhyatayA usane asthisandhi kA varNana kiyA hai| sandhi zabda jahA~ kahIM hamane vyavahAra kiyA hai vahA~ asthisandhi hI samajhanA caahie| asthisandhi eka gupta avakAza ( potential cavity ) hotA hai jo asthiyoM ke do siroM ke saMgama sthala para banatA hai / yaha avakAza gaharAI meM hotA hai isake cAroM ora snAyu ( ligaments ) lage hote haiM jinake Upara pezI tathA kaNDarAe~ dekhI jAtI haiN| snAyuoM, peziyoM aura kaNDarAoM kA pratAna sandhi ke Upara isa prakAra kiyA gayA hotA hai ki sandhisthala para eka prakAra kI niyantrita gati sambhava hotI hai| kisI bhI sandhi para koI gati karanI ho vahA~ lagI kucha peziyA~ usakA virodha karatI haiM tathA kucha usakI sahAyatA karatI haiM isa kAraNa eka nizcita maryAdA taka vaha gati ho sakatI hai| ___ asthi ke sire sandhi ke lie nizcita gati meM bhAga le sakeM isake lie unakA masUNa (cikanA) honA Avazyaka hai usake lie jitanA hissA gatiyoM kI dRSTi se dUsare hisse ke samparka meM AtA hai utane hisse para donoM asthizIrSoM para eka taruNAsthi (kAsthi) kI TopI car3hI hotI hai| yaha masRNa rakta-virahita kAcarakAsthi ( smooth avascular hyaline cartilage ) state foarte raratante ( articular cartilage ) kahate haiN| isa sandhAyIkAsthi ke bhAga ko chor3akara asthisandhi ke avakAza kA sampUrNa antastala sandhizleSmakalA ( synovial membrane ) dvArA Astarita ( lined ) hotI hai| yaha eka prakAra kI lasyakalA ( serum membrane ) hai| isa kalA meM se asaMkhya sUkSma aMkura (villi) For Private and Personal Use Only

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43 vividha zarIrAGgoM para vraNazotha kA prabhAva nikale rahate haiM jo ise makhamalI banA dete haiM / ina aMkuroM ke kozAoM se eka svaccha aura picchila tarala nikalatA hai jise sandhizleSmA' yA zleSakara kahate haiM nikala kara sandhi bhAga kA abhyaMjana yA upasnehana (lubrication ) karatA rahatA hai| yaha sandhizleSmakalA sampUrNa asthi ke Upara lagI snAyu ATopikA ( capsule ) ke bhItara Astara lagA detI hai tathA yadi sandhi ke bhItara koI pezI kaNDarA bhI A jAtI hai to usa para bhI bAhupa ( sleeve ) banakara chA jAtI hai| isa prakAra isa kalA dvArA sandhAyI bhAgoM ko chor3a zeSa sampUrNa bhAga sandhi ke avakAza sthala meM bhI pRthaka rakhe jAte haiN| yaha kalA sandhAyIkAsthi ke kinAroM para Akara samApta ho jAtI hai| yaha pahale hI kahA jA cukA hai ki sandhAyIkAsthi para isa kalA kA AvaraNa bilkula nahIM hotaa| sandhizleSmadharAkalAguhA ( synovial cavity ) ke bhItara ye bhAga par3e hue sandhi kI svAbhAvika kriyAoM ko sampanna karate rahate haiN| ___kahIM kahIM sandhizleSmadharAkalA sandhi ke Age hI nikala kara samIpavartI kaNDarAoM ko bhI AcchAdita kara letI hai jinakI peziyA~ sandhi-kriyA meM pratyakSa bhAga letI haiN| aisI avasthA meM sandhi ke sAtha jo inakA sambandha hotA hai vaha bahuta choTe chidra jaisA hotA hai / jaba sandhi meM pAka ho jAtA hai to vaha bhI phUla jAtA hai aura zotha ho jAtA hai / yadi sandhi meM adhika tarala ekatra ho jAtA hai to vaha ina sthAnoM meM bhI bhara jAtA hai / chidra se sambaddha ye sthAna zleSmadharakalApuTaka ( bursae ) kahalAte haiN| jaba ina kalApuTakoM meM tarala bhara jAtA hai aura ve phUla jAte haiM aura yadi unako koI kaNDarA do bhAgoM meM vibhakta kara detI hai to do phUle hue bhAga dekhe jAte haiM jinheM idhara udhara haTAyA jA sakatA hai ye moreMTa bekara kI granthiyA~ (morant baker's cysts ) kahalAtI haiN| __zleSmadharAkalA ko rakta paryApta mAtrA meM mila jAtA hai phira bhI yaha upasarga se jitanI pIDita hotI huI dekhI jA sakatI hai vaha sarvavidita hai| isa kalA ke aMkura kabhI kabhI aticayita hokara bar3e ho jAte haiM aura lAipomA Arboresensa ( lipoma arborescence ) kahalAte haiN| unameM vihAsa, cUrNIyana athavA pRthakkaraNa kucha bhI mila sakatA hai / sandhAyIkAsthi ko bahuta kama rakta milatA hai ise usase lagna asthi se lasIkA (lymph) tathA lasa ( serum ) prApta hote haiM jinake dvArA usakA poSaNa hotA hai / zleSmadharAkalA ke zleSmA se bhI usakA poSaNa hotA hai| jaba taka sandhAyIkAsthi pUrNatayA saMlagna rahatI hai upasarga kA pratirodha karatI hai para jaba sandhipAka kI avasthA meM pIDana ke sthAnoM para yaha viyojita ( disintegrated ) ho jAtI hai taba kAsthi tathA usase lagI asthi meM bhI upasarga laga jAtA hai| kAsthi choTe choTe sidhmoM meM naSTa hokara ukhar3a jAtI hai aura zveta zalkala (flakes) banAtI hai jo tIvra vraNazotha meM vizeSa karake dikhalAI dete haiN| 1 sandhisthastu zleSmA sarvasandhisaMzleSAt sarvasandhyanugrahaM karoti-suzruta 2 parvastho'sthi sandhizleSaNAt zleSaka iti-vRddhavAgbhaTa For Private and Personal Use Only

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vikRtivijJAna ___asthizira kAsthi kI sthiti kA jJAna paramAvazyaka hotA hai ki usakA ATopikIya snAyu ke bandhanoM se kaisA sambandha hai kyoMki kahIM kahIM yaha asthizirarekhA (epi. physeal line ) sandhi kI ATopikA ke bhItara par3atI hai| prAyazaH asthi kA upasarga poSaNI dhamanI meM hokara jaba jAtA hai to vaha asthizira ke samIpa se hI gujaratA hai| yadi asthizira kA bhAga sandhiguhA meM hI par3egA to upasarga sandhi meM atizIghra praveza kara sakatA hai isIlie asthizira kI sthiti kA jJAna paramAvazyaka hai| sandhiyoM ko vAtanADiyoM kI prApti samIpastha peziyoM aura unakI kaNDarAoM se hotI hai| ye vAtanADIsUtra zleSmadharakalA tathA sandhikAsthi donoM ko inhIM se pahu~cate haiM / ina nADIsUtroM meM se kucha vedanA ke lie, kucha sandhi kI kriyAoM ke lie tathA kucha sthitibodhaka hote haiN| prAyaH eka hI nADIskandha ( nerve trunk ) se kaI kaI sandhiyoM ko vAtanADI sUtra jAte haiM ataH eka meM hue kaSTa ko dUsarI sandhi meM bhI pAyA jA sakatA hai| isalie isakA dhyAna rakhanA cAhie nahIM to roga kisI sandhi meM hogA aura ilAja kisI dUsare kA hI calatA rhegaa| sandhiyoM meM jo gatiyA~ hotI haiM unakA kAraNa vibhinna pezIsamUhoM kI samanvayatA (co-ordination ) hai / ye peziyA~ eka hI suSumnA kI vAtanADI dvArA puSTa hotI haiN| eka gati ke viruddha dUsarI gati karane ke lie dUsarA pezIsamUha rahatA hai usakI vAtanADiyA~ bhI usI suSumnA khaNDa se nikalatI hai jisameM se pahale pezIsamUha ke lie suSumnA kI vAtanADI AI thI, isake dvArA yathAmAtrA pratyeka gati aura usake niyantraNa kA prabandha ho jAtA hai| yaha niyantraNa suSumnA ke hI kendra kara lete haiM aura inakA patA taka nahIM lagane paataa| ina tathyoM kA jJAna kaNDarAoM ke pratiropaNa ke samaya Avazyaka hai jo aMgaghAta ke samaya zalyavid kiyA karatA hai| ___ yaha bhI smaraNa rahanA cAhie ki zleSmadharakalA kI raktapUrti tathA sandhiguhA meM zleSmA kA saMvahana samIpastha peziyoM kI kriyAzIlatA para adhikAMzataH nirbhara karatA hai ataH jahA~ sandhi ke taralAdhikya ko pracUSita karanA ho yA vahA~ ke raktasaMvahana ko tIvra karanA ho to pezIbala aura pezIgatiyoM kA saMdhAraNa paramAvazyaka hai| yahI kAraNa hai ki peziyoM kI gatiyoM, abhyaMga, uSNasekAdi kA prayoga cikitsArtha vizeSa calatA hai| __ kyoMki peziyoM se vAtanADIsUtra, sandhiyoM meM jAte haiM ataH jaba koI vraNazotha sandhi meM hotA hai to nADIpezIya vighna (neuromuscular disturbances ) sAtha sAtha milA karate hai| isake kAraNa sarvaprathama pezIbala ( tone ) kI kamI pahale hI prakaTa ho jAtI hai tathA usa kSetra kI sArI peziyA~ zlatha ( flabby ) ho jAtI haiN| unameM aMgagraha (spasm) bhI pAyA jAtA hai| Age calakara sandhi kI kucha peziyoM meM kSaya hone se sandhi patalI par3a jAtI hai ( wasting of the For Private and Personal Use Only

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www.kobau Acharya Shri Kailassagarsuri Gyanmandir vividha zarIrAGgoM para vraNazotha kA prabhAva 45 muscle ) / isI kAraNa sandhi ke rogoM meM bala kA hrAsa, peziyoM kI zlathatA, unakA aMgagraha aura kSaya nAmaka lakSaNa dekhe jAte haiN| ___ sandhiyoM ke sambandha meM thor3A sA paricaya dene ke pazcAt aba hama apane mukhya viSaya (vraNazotha kA asthiyoM para pariNAma) para Ate haiN| jisa prakAra anya UtiyoM para vraNazotha kA pariNAma hotA hai ThIka usI prakAra sandhiyoM arthAt unakI ATopikA, zleSmadharakalA, sandhAyIkAsthi tathA asthi ke ziroM para bhI vaisA hI prabhAva par3atA aura pariNAma hotA hai| para kyoMki sandhAyIkAsthi ( articular cartilage ) azoNitIya ( avas. cular ) hotI hai isa kAraNa vraNazothAtmaka pratikriyA koI vizeSa yahA~ para nahIM dekhI jaatii| sAtha hI jaba taka asthi ke sAtha isakA sambandha pUrvavat aura svAbhAvika rUpa meM rahatA hai taba taka isameM upasarga kA bhI praveza nahIM ho pAtA / parantu jyoM hI isakA sambandha asthi ke dvArA hone vAle isake poSaNa se samApta ho jAtA hai kyoM hI yaha naSTa prAyaH ho jAtA hai tathA chilake kI taraha chUTa par3atI hai| kaNAtmaka Uti bhI ise phira zIghra vinaSTa kara detI hai| chUTI huI kAsthi ke zveta khaNDa sandhiguhA meM itastataH mila sakate haiN| masRNa sthAna para kaNamaya aura azita (granulating and carious ) usakA dharAtala dekhA jAtA hai| kinAroM para jahA~ sandhAyIkAsthi kA sambandha zleSmadharakalA ke sAtha AtA hai vahA~ yA to isa kalA se kaNana kriyA hone lagatI hai (jaise yacamA meM ) athavA yaha kAsthi hI kalA taka phaila jAtI hai| (jaise Asthika sandhipAka meN)| ___ sandhiyoM ke pAka meM sandhiguhA meM jisa zIghratA se tarala ekatra hotA hai usI gati se usakA pracUSaNa nahIM ho pAtA isa kAraNa sandhipAka hote hI sandhi kA bharA aura sUjA honA prakaTa hone lagatA hai / yaha usakA utsyandana ( effusion ) kahalAtA hai| yaha utsyandana jaba sarakta ( blood stained ) hotA hai to use zoNasandhitA ( hamearthrus ) kahate haiM / yaha AghAta athavA adhiraktasrAva ( hemophilia) se prAyazaH dekhI jAtI hai| jaba utsyanda sapUya hotA hai to use sandhi kI antaH pUyatA ( empyema of the joint) kahate haiM / jaba utsyanda lasya ( serous) hotA hai jaisA ki jIrNa upasargoM, vAtanAr3Ijanya rogoM ( neuropathic diseases), sandhigata abaddhapiNDoM ( loose bodies ) tathA ghora vaiSika upasargoM meM dekhA jAtA hai taba una avasthAoM ko jalasandhi (hydrops articuli yA hydrarthrosis) athavA jIrNa lasya sandhikalApAka ( chronic serous synovitis ) kahate haiM / ghora sandhipAka ( Acute Arthritis ) sandhi meM sUjana, lAlI, uSNatA tathA zUla ye vraNazotha ke cAroM cihna spaSTa ho jAte haiM, tarala kA utsyanda bhI prArambha ho jAtA hai jo yadi lasya huA to jalasandhi aura yadi sapUya huA to pUyasandhi (pyarthrosis ) nAma kA kAraNa hotA hai| For Private and Personal Use Only

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46 vikRtivijJAna jalasandhi AMtrika jvarajanya upasarga ke kAraNa vaMkSaNasandhi ( hip joint ) meM dekhI jAtI hai / pUyasandhi pUyajanaka golANuoM ke upasargoM ke kAraNa milatI hai| upasarga kA kAraNa sandhi ke Upara kI tvacA yA sandhi ke samIpa kI asthi meM vraNa kA honA bhI ho sakatA hai tathA anya kisI pUtikendra ( septic focus ) se rakta ke dvArA bhI ho sakatA hai| upasarga ke kAraNa sandhi kI zleSmadharakalA meM tIvra pAka prArambha ho jAtA hai tathA sandhAthI kAsthi kA vraNIbhavana evaM kaNAtmaka Uti dvArA aparadana ( erosion) prArambha ho jAtA hai / sandhi pUya se pUrNa ho jAtI hai, usake andara kI snAyue~ mRdula ho jAtI evaM mRtaprAya ho jAtI haiN| sandhi ke UparI bhAga kI racanAe~ bhI sapAka ( inflammed ) evaM mRdu ( softened ) ho jAtI haiN| uparokta sampUrNa kriyA yaha pragaTa karatI hai ki sandhi meM vidradhi bana gaI / vidradhi phUTane ke lie sthAna DhU~DhA karatI hai aura kAla pAkara tvacA ko vidIrNa karake phUTa sakatI hai| para kaI sandhipAkoM meM utsyanda bhItara hI bhItara pracUSita ho jAtA hai aura vidradhi rUpa nahIM banatA tathA sandhi pUrvavat pUrNataH svastha ho jAtI hai|| Ayurveda meM ghora sandhipAka kA spaSTa varNana hameM AmavAta prakaraNa meM milatA hai:sa kaSTaH sarva rogANAM yadA prakupito bhavet / hastapAdazirogulphatrikajAnUrusandhiSu // karoti sarujaM zothaM yatra doSaH prapadyate / sa dezo rujyate'tyarthaM vyAviddha zva vRshcikaiH|| (mA. ni. A. ni. 25) sandhipAka kA dUsarA varNana hameM sandhigata vAta ke prakaraNa meM milatA hai: ___ hanti sandhigataH sandhIn zUlATopau karoti ca / (mA.ni. vA. ni. 22). vAtapUrNadRtisparzaH zothaH sandhigate'nile / prasAraNAkuJcanayoH sandhivRttizca vedanA // (ca.ci. a. 28) sandhipAka kA tIsarA varNana hameM vAtarakta ke prakaraNa meM milatA haijAnujaGghorukaTayaMsahastapAdAGgasandhiSu / nistodaH sphuraNaM bhedo gurutvaM suptireva ca / / arvAcIna vaidyakazAstra kI dRSTi se nimna prakAra ke sandhipAka milate haiM1. AghAtajanya saMdhipAka 2. rogANujanya sandhipAka isake bhI do bheda hote haiM-eka pUyajanaka jIvANuoM dvArA jisameM mAlAgolANu, puMjagolANu, pramehANu (gonococci ), phuphphusa golANu ( pneumococci ), AntravetrANu ( B. coli ), Antrika jIvANu, atIsArajanaka jIvANu pAka ke kAraNa hote haiM, aura dUsarA viziSTa kaNArbudoM ( specific granulomata ) dvArA jinameM yamA aura phiraMga Ate haiN| 3. vaiSika sandhipAka isameM AmavAta, vAtarakta aura lasI antaHnikSepajanya pAka ( serum arthritis) Ate haiN| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 4. vAtanAr3I vikSata ( neuropathic lesion ) janya sandhipAka | sandhiyoM meM utsyandana ( effusion ) ke do mukhya kAraNa haiM ( 1 ) kucha rakta ke roga - sahaja raktaroga ( adhirakta roga ) avApta raktaroga ( zItAda, araktatA, raktasrAvI jvara ) ( 2 ) samIpastha aMgoM ke roga - asthi ( asthipAka tathA ghAtaka arbuda ) tathA pezI evaM stara - fascia ( sapUyapezI, pramehANujanita starapAka - fasciitis ) aba Age hama inakA paricayAtmaka saMkSipta varNana karane ke pUrva sandhipAka evaM sandhizleSmadharAkalApAka kA vibheda batalAaiMge sandhizleSmadharAkalApAka ( synovitis ) kevala sandhizleSmadharAkalA meM hI hotA hai / sandhipAka ( arthritis ) jaba pAka kAsthi, asthi, ATopikA Adi sabhI meM hotA hai / vividha sandhi tathA sandhizleSmadharAkalApAka 47 pUyajanaka rogANuoM se hone vAle mAlA tathA puMjagolANuoM se hone vAle sandhipAka meM sandhi utsyandana ke kAraNa sUja jAtI hai, tanika bhI hilAne para vicchU ke kATane sarIkhA tIvra zUla hotA hai yahI kAraNa hai ki bAlaka zalyavid dvArA aMga ke sparza mAtra se cIkhane lagate haiN| peziyA~ anAmya ( rigid ) hojAtI haiM tathA vaha bhAga bhI zothayukta hojAtA hai / vaha aMga arddhAkuMcita ( semiflexed ) rahatA hai Age calakara jaba ATopikA tathA sandhAyIkAsthi naSTa ho jAtI hai to pUya peziyoM taka meM pahuMca jAtA hai | yadi sandhi taloparika ( superficial ) huI to usake Upara kI tvacA lAla, camakadAra tathA uSNa milatI hai / vaikArikIya sandhicyuti ( pathological dislocation ) upasthita rahatI hai jo bahudhA milatI hai| rogI bahuta bImAra dikhAI detA hai arddhamUcchita, saMnyAsAvasthA meM yA pralApAvasthA meM milatA hai use sakampa jvara AtA hai jIbha romAnvita ( furred ), mUtrarAzi kI alpatA, svacA kA rUkSa evaM zuSka honA Adi viSaraktatA ke sampUrNa lakSaNa mila jAte haiM / golANujanya ina sandhipAkoM meM zleSmadharAkalA atizIghra naSTa hone lagatI hai, usake sthAna para pUyanissAriNI kaNAtmaka Uti banane lagatI hai jo zIghra hI sandhAyIkAsthi para apanA niyantraNa jamAtI calI jAtI hai / kAsthi kA vinAza kinAroM se andara kI ora calatA hai / kAsthi kA mRdubhavana ( softening ), aparadana ( erosion ) aura pIDana sthaloM (pressure points ) para kaNoM dvArA sthAna grahaNana hone lagatA hai / isake kAraNa vraNasthaloM ke kinAroM para kAsthi zalkaloM meM chilane lagatI | kAsthi se upasarga samIpastha asthi meM calA jAtA hai / asthinikulyAoM (Haversian canals ) meM roga ke jIvANu tathA kaNAtmaka Uti donoM khUba bhara jAte haiM / asthi kA sampUrNa dharAtala kIr3oM kA sA khAyA huA ho jAtA hai / For Private and Personal Use Only sandhiguhA meM pahale lasyapUya tarala rahatA hai jo bAda meM zuddha pUya bana jAtA hai tatpazcAt sandhi ke antaHpura meM sthita snAyu tathA sandhi kI ATopikA meM upasarga pahuMca jAtA

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vikRtivijJAna . hai kaNAtmaka dhAtu bhI ugane lagatA hai aura vaha viyojita ho jAtA hai pUya jisake kAraNa staroM ( fasciae), kaNDarAoM ( tendons ) tathA peziyoM taka pahu~ca jAtA hai vahAM se Age tvacA taka nADIvraNa ( sinus ) bana jAte haiN| isake pazcAt sandhiyoM kA visaMghaTana ( disorganisation) pUrNa ho jAtA hai aura vikRtika sandhimukti ho jAtI hai| yadi upazama (resolution ) ho gayA to sandhi sthairya (ankylosis) ho jAtA hai| isake kAraNa aMgavikRta, anupayukta tathA Ter3hA-mer3hA (crippled ) ho jAtA hai| __yugmagolANuoM se utpanna hone vAlA phuphphusagolANujanita sandhipAka (Pnue. mococcal arthritis) eka zizu roga hai jo phuphphusapAka ke pazcAt yA phuphphusagolANujanita madhyakarNapAka ke pazcAt hotA hai| isameM zUlarahita sandhipAka rahatA hai| bar3I eka sandhi hI isase prabhAvita hotI hai jisake kAraNa visaMghaTana tathA vikRtika sandhimukti prAyazaH milatI hai| utsyandana bahuta bar3A hotA hai| pUya patalA, krIma jaisA, harA harA sA hotA hai / isameM phuphphusagolANu bahuta se dekhe jAtehaiM / inhIM phuphphusagolANuoM kI upasthiti se isa sandhipAka meM anya pUyajanaka jIvANuja sandhipAka se vibheda karate haiM / AmavAtaja sandhipAka meM aura isameM, yahI antara hai ki yaha pAkakAla meM zUlarahita aura kevala eka hI sandhi meM milatA hai| yugmagolANuoM se dUsarA sandhipAka pramehANujanita sandhipAka (Gonococcal arthritis ) kahalAtA hai / mUtraprajanana patha meM kahIM bhI uSNavAta yA sujAka hone ke kAraNa dvitIyaka roga ke rUpa meM isakA udaya hotA hai| sujAka (pUyameha) kA prArambha ati saumya rUpa kA bhI ho phira bhI yaha ho sakatA hai aura prAyazaH upasarga ke tIsare saptAha meM yaha milane lagatA hai / bahuta kama sujAka pIDitoM meM yaha sandhipAka dekhane meM AtA hai| maNibandha yA jAnu kI sandhiyA~ isase pahale prabhAvita hotI haiM / yaha pAka eka sandhi se dUsarI meM jAtA hai / roga ke prArambha kI tIvrAvasthA meM sandhi meM bahuta zUla dekhA jAtA hai| vikRtivijJAna kI dRSTi se sujAkajanita sandhipAka meM kaI bAteM mahatva kI haiN| eka to usakI ugratA kabhI atyalpa aura kabhI atyadhika dekhI jAtI hai| kabhI kabhI to vinA kisI utsyanda kA sandhizleSmadharAkalA pAka mAtra hI dekhA jAtA hai, kabhI kevala utsyanda hokara hI raha jAtA hai tathA kabhI pUya saMcaya ho jAtA hai| lasya utsyanda se pramehANuoM kI prApti kaThinatA se hotI hai jaba ki pUya meM khUba milate haiM / isa pAka meM zleSmadharAkalA chidriSTha ( spongy ), lAla tathA kaNAtmaka (graunlating ) ho jAtI hai jisase prArambha meM lasa aura bahuta bAda meM pUya niHsRta hotA hai jo sandhAyIkAsthi taka bar3hatA calA jAtA hai isake kAraNa sandhAyIkAsthi kA aparadana aura nAza hone lagatA hai jisase paryApta tAntava sandhisthairya (fibrous ankylosis) mila sakatA hai parantu sampUrNa sandhi kA visaMghaTana isa roga meM milatA nahIM hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 46 adhikAMzataH yaha upasarga parisandhAyI staratAntava pAka ( periarticular fasciofibrositis ) ke rUpa meM pahale sandhi ke bAhara prArambha hotA hai jisameM vistRta pAkaH pAyA jAtA hai aura vahAM para isako lasya yA pUya srAva meM pramehANu pracura mAtrA meM milate haiM / usake bAda zleSmagharakalA meM pAka jAtA hai / isake kAraNa tIvra parisandhAyI tantUskarSa ( periarticular fibrosis ) hojAtA hai jo eka kUTa sandhisthairya ( false ankylosis ) kA kAraNa banatA hai jisake kAraNa eka ceSTAvantasandhi alpaceSTasandhi meM badala jAtI hai / naidAnika dRSTi se sujAka yA pramehajanya sandhipAka ke do bheda milate haiM 1. ekasandhija (monarticular ) --jo prAyaH bar3I sandhi meM hotA hai jo sujAka ( pUyameha ) kI tIvrAvasthA meM prAyaH milatA hai aura sapUya hotA hai / 2. bahusandhija (polyarticular ) --- jo prAyaH choTI choTI sandhi jaise maNibandha, vizeSa karake uraH phalaka aura akSakAsthi ke bIca kI sandhi, kIkasa sandhiyA~, pAdazalAkA sandhiyoM meM jIrNa saumya upasarga ke pariNAmasvarUpa hotA hai / isameM sandhiguhA meM pUya nahIM pAyA jAtA / yadi pUya milatA bhI hai to parisandhi pradeza meM hotA hai / upasarga lagane ke 20-20 varSa bAda taka yaha dekhA jAsakatA hai 1 pramehajanya sandhipAka meM ghora vedanA hotI hai| isakI lAlI sandhi se dUra taka dekhI jAtI hai| eka sImA taka isameM sudhAra hokara phira roga banA rahatA hai aura aMga vikRta ho jAtA hai / Adhunika AviSkAroM ne una vikRtiyoM ko dUra karane meM bahuta kucha bhAga liyA hai / Antrikajvarajanya sandhipAka ( Typhoid arthritis ) - motIjharA yA Antrikajvara ke samApti kAla se kucha pUrva prArambha hotA hai isameM eka yA do sandhiyA~ prabhAvita hotI haiM / pUya banatA hai aura usameM Antrika daNDANu milate haiM / 1 grahaNIjanya sandhipAka ( Dysenteric arthritis ) - sajvara grahaNI yA austral grahaNI ( bacillary dysentery ) ke upadravasvarUpa bar3I bar3I kaI sandhiyoM meM eka sAtha hone vAlA roga hai / sandhiyA~ khUba sUjatI haiM aura unameM pracaNDa vedanA hotI hai aura rogI hila bhI nahIM sakatA / mA aura phiraMga kA sandhiyoM para jo prabhAva par3atA hai use unhIM ke prakaraNoM meM batalAyA jAvegA | AmavAtajanya sandhipAka ( Rheumatic arthritis ) tIvra aura anutItra do prakAra kA vizeSa hotA hai, tIvra kA prArambha sahasA hotA hai aura vaha bar3I sandhiyoM ko adhika prabhAvita karatA hai / pahale roga eka sandhi meM uThatA hai phira vahA~ se kisI bhI niyama ko na mAnatA huA kisI bhI sandhi meM calA jAtA hai isa prakAra eka sandhi se dUsare sandhi meM pAka cala par3atA hai / isameM utsyanda ke sAtha tIvra zUla hotA hai Upara kI tvacA lAla aura sUjI hotI hai / sandhi kI gati karanA kaThina hotA hai parantu 5 vi0 For Private and Personal Use Only

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50 vikRtivijJAna peziyoM meM koI parivartana yA vikRti nahIM milatI / anutIvra prAyazaH eka bAlaroga hai jo roga ke tIvra AkramaNa ke kAraNa bahudhA milatA hai para kabhI-kabhI vinA AkramaNa ke bhI dekhA jAtA hai| isameM AmavAta kA pramukha prabhAva hRdaya para hotA hai| bAlaka asthi ke siroM para athavA sandhiyoM meM zUla kA anubhava karatA hai vaha vikRta caraNa (pes planus ) ho jAtA hai / AmavAtaja sandhipAka meM sandhiyoM meM zUla kI tIvratA hotI hai unameM lasya-utsyandana hotA hai jo kAlAntara meM pracUSita ho jAtA hai para usameM pUya kabhI nahIM bntaa| AmavAtajvara prAyaH milatA hai / isa viSaya para adhika vicAra AmavAta prakaraNa meM hogaa| vAtaraktajanya sandhipAka(Gouty arthritis)-vAtarakta nAmaka roga (gaThiyA) meM sandhAyIkAsthiyoM meM mehIya lavaNa ( urates ) saMcita hone lagate haiM jisake kAraNa unakA tAntukavihAsa ( fibrillar degeneration ) hojAtA hai aura unakI AkRti makhamalI ( velvety ) hojAtI hai| mehIya saMcaya bAhya do tihAI bhAga meM hotA hai vaha asthi taka nahIM jA paataa| isa roga meM choTI sandhiyA~ prArambha meM prabhAvita hotI haiM aura bar3I bAda meM / sampUrNa sandhiguhA meM mehIya lavaNoM ke bhara jAne se sandhi kI ceSTAe~ samApta hokara kUTa gatisthairya ( false alikylosis ) A jAtA hai| bar3I sandhiyoM meM kAsthi kA aparadana aura vraNana una sthAnoM para vizeSa milatA hai jahA~ sandhAyI dharAtala Apasa meM milate haiM unhIM kAsthiyoM ke parisarIya bhAga meM kAsthikIya praguNana (cartilaginous proliferation ) hotA rahatA hai| ___ yaha praur3hAvasthA kA roga hai| isameM pAdAGguSTha aura aMguliyoM para sarvAdhika pariNAma hotA hai / isa roga kA prArambha sahasA hotA hai| sandhi ke samIpastha bhAga kA varNa baiMganI hojAtA hai sUja aura phUla jAtA hai| lasI antaHnikSepajanya sandhipAka (Serum arthritis) kA prArambha lasI ke antaHnikSepa ke dasaveM dina hotA hai vaha hasta-pAda kI choTI sandhiyoM ko prAyazaH prabhAvita karatA hai para kabhI-kabhI bar3I sandhiyoM meM vedanAyukta utsyandana dekhA jA sakatA hai / skArleTa jvara, inphlueMjA yA anya kiNvika jvaroM (zymotic fevers ) meM bhI dasaveM dina yaha sandhipAka yA sandhikalApAka dekhA jAtA hai| sazUla utsyandana vahA~ para milatA hai| sandhiyA~ gativihIna aura AkuMcita hojAtI haiM / samIpastha aMga cikane aura phUle (puffy ) se pratIta hote haiN| zarIra para utkoTha ( rash ) hojAte haiN| isa roga meM uraHakSakAsthi sandhi (sternoclavicular joint ) tathA zaMkha-hanvasthisandhi ( temporo-mandibular joint ) kadAcit hI prabhAvita hote hoM ye donoM sandhiyA~ pramehajanya sandhipAka meM vizeSa prabhAvita hotI hai| * jAnujaMghorukaTacaMsahastapAdAGgasandhiSu / nirastodaH sphuraNaM bhedo gurutvaM suptireva ca // (caraka) + aMgulasandhInAM saMkoco'Ggagraho'tiruk / (caraka) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 51 vAtanADI vikSatajanya sandhipAka ( Neuropathic arthritis ) - yaha vihAsAtmaka prakRti ke vAtika vikSatoM ( nervous lesions of degenerative nature ) meM vizeSa karake pracalAGga vaiSamya ( locomotor ataxia ) nAmaka roga meM phiraMga ke kAraNa ho sakate haiM / dUsarA roga jisameM ye dekhe jAte haiM suSumnA kulyAvisphAra ( syringomyelia ) kahalAtA hai / isa meM apuSTi ( atrophy ) adhika hotI hai / isa prakAra ke sandhipAka ko cArkaTa sandhi ( charcot's joint ) kahate haiM / ina avasthAoM kA mukhya lakSaNa vedanA kA na honA yA kama honA hai / cAsandhi atipuSTa (hypertrophic ) tathA apuSTa ( atrophic ) do prakAra kI hotI haiM / atipuSTa meM sandhi kA atyadhika visaMghaTana aura viralana ho jAtA hai tathA asthiyoM ke sandhAyI siroM para asthi kI vRddhi dekhI jAtI hai / apuSTa meM asthi kA viralana evaM pracUSaNa drutagati se hotA huA zleSmadharakalA utsyanda se bhara jAtI hai / sandhAyIkA sthiyoM ke vinAza aura vicUrNana ( decalcification ) ke kAraNa asthi ke viralana ke atirikta aura adhika vaikArikI kA jJAna nahIM ho sakA hai / zleSmadharakalA meM kaNAtmaka Uti kI bharamAra ho jAtI hai, prAvara tathA antarbAhya bhAgoM para bhI kaNAtmaka Uti pahu~ca jAtI hai jisake kAraNa sandhi pUrNataH vighaTita ho jAtI hai aura vaikArika vicyuti ( pathological dislocation ) dekhane meM AtI hai / ina sandhiyoM kI gatiyA~ bar3I-bar3I vicitra dekhane meM AtI haiM / sAdhAraNataH jo gati eka svastha sandhi nahIM kara sakatI ve saba bhI ina sandhiyoM meM milatI haiM eka vicitra asthira cAla isa roga meM milatI hai / atipuSTa prakAra bahuta milatA hai sandhi ke bhItara pravRddha asthi usakI kisI gati ko roka bhI sakatI hai| yA asthi ke lava TUTa kara idhara udhara ghUmate hue bhI dekhe jA sakate haiM / apuSTa prakAra sakthni (upper extremities) kI sandhiyoM meM dekhA jAtA hai aura sahasA milatA hai / zUla hokara aMga phUla jAtA hai saMdhi bekAra ho jAtI hai thor3e dina bAda jaba sUjana ghaTatI hai to saMdhi visaMghaTita huI dekhI jAtI hai / jIrNa sandhipAka- jIrNa sandhipAka ke nAma se do sandhipAka lie jAte haiM inameM eka aupasargika (infective ) hai aura jo AmavAtAbha sandhipAka (Rheuamtoid arthritis) ke nAma se prasiddha hai aura dUsarA vihAsAtmaka ( degenerative ) hai jo asthisandhipAka ( osteoarthritis ) yA virUpakara sandhipAka ( arthritis deformans ) kahalAtA hai / hama inhIM donoM kA nIce varNana karate haiM : -- AmavAtAbha sandhipAka ( Rheumatoid arthritis ) -- isakA dUsarA nAma aupasargika bahusandhipAka ( infective polyarthritis ) bhI hai / yaha roga jitanA prArambhika Ayu ke vyaktiyoM meM hotA hai utanA praur3hoM meM nahIM dekhA jAtA / bAlakoM meM isakA prArambha tIvratApUrvaka hone ke kAraNa yaha AmavAtaja sandhipAka se For Private and Personal Use Only

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52 vikRtivijJAna milatA julatA hotA hai isI kAraNa ise AmavAtAbha saMjJA dI gaI hai / sAdhAraNataH isakA prArambha zanaiH zanaiH hotA hai / yaha roga puruSoM kI apekSA striyoM meM adhikatara dekhA gayA hai / isa roga meM sarvaprathama choTI choTI asthiyoM kI sandhiyoM meM pAka dekhA jAtA hai jaise hAtha yA zaMkhAsthi kI sandhiyoM meM tatpazcAt bar3I bar3I asthiyA~ isase prabhAvita hotI haiM para vaMkSaNa sandhi ( hip joint ) para isakA koI prabhAva nahIM hotA hai| jina sandhiyoM meM yaha roga rahatA hai unameM cirakAla taka dekhA jAtA hai tathA usake kAraNa unameM sthAyI svarUpa kI kSati bhI pahu~cAtA hai / jisa prakAra anya jIrNa rogoM meM vividha lakSaNa dekhe jAte haiM usI prakAra isa roga meM bhI daurbalya, ke avasara, prasvedAsrAva, lasagranthiyoM kI vRddhi Adi lakSaNa dekhe jAte haiM / bAlakoM meM isa roga meM jaba plIhAbhivRddhi bhI ho jAtI hai to ise sTila kI vyAdhi ( still's disease ) kahakara pukArate haiN| cauthAI rogiyoM meM unakI upacarma UtiyoM meM vraNa zodhAtmaka tAntava granthiyA~ bhI pAI jAtI haiM / inameM vedanA bilkula nahIM hotI aura ye agrabAhu ke pRSTha para prAyaH dekhI jAtI haiM / sajvarAvasthA -- isa roga meM sandhiyoM meM nimna parivartana dekhe jAte haiM :1. ve pravRddha ('enlarged ) ho jAtI haiM / 2. unakI AkRti tarka ke samAna ( spindle-shaped ) ho jAtI hai ina donoM lakSaNoM kA kAraNa parisandhAyI UtiyoM (periarticular tissue ) kA paramacaya ( hyperplasia ) tathA sandhiguhA meM tarala kA utsyandana hai / 3. prArambhika avasthA meM yaha roga eka sandhizleSmagharakalApAka mAtra hotA hai| jisameM sandhizleSmadharakalA sUja jAtI hai usameM raktAdhikya ho jAtA hai tathA kozAoM kA praguNana hone ke kAraNa vaha moTI par3a jAtI hai / 4. kaNAtmaka Uti zleSmadharakalA se prArambha hokara viSamatayA sandhAyI dharAtaloM taka pahu~catI hai jisake kAraNa sandhAyIkAsthi kA aparadana ( erosion ) hojAtA hai tathA usake nIce kI asthi kA viralana ( rarefaction ) hojAtA hai / 5. isakA pariNAma tAntava sandhisthairya ( fibrous ankylosis ) meM ho jAvegA jaba ki sandhiguhA meM tAntava abhilAga ( fibrous adhesions ) bana jAveMge / 6. parisandhAyI vraNazotha ke kAraNa sandhi kA prAvara ( capsule ), usake snAyu, atyanta durbala hojAte haiM jisake kAraNa bar3I bar3I virUpatAe~ dekhane ko milatI haiM / yaha kisa jIvANu ke kAraNa hotA hai isakA patA nahIM cala pAtA / isameM sitakozA gaNanA meM atyadhika, para raktAlpatA adhika dekhI jAtI hai| avasAdana gati ( rate of sedimentation ) bar3ha jAtI hai / upanIrodIyatA ( hypochlorhydria ) meM bhI bahuta parivartana ho jAtA hai / adhika khoja karane para kama ugratAyukta - zoNAMzika mAlAgolANu sandhiyoM se prApta kie gaye haiN| aisA pratIta hotA hai ki zarIra ke kisI bhAga meM koI pUtikendra ( septic focus ) hone ke kAraNa hI yaha roga utpanna hotA hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva virUpakara sandhipAka ( Arthritis Deformans ) -- yaha praur3ha vyaktiyoM meM dhIre se prArambha hotA hai / puruSa, striyoM kI apekSA adhika grasita hote haiM / yaha sarva prathama bar3I bar3I sandhiyoM para AkramaNa karatA hai vaMkSaNa sandhi para isakA prabhAva prAyaH dekhA jAtA hai / tatpazcAt hAtha kI choTI sandhiyAM isake prabhAva meM AtI haiM / isameM anya sAdhAraNa sandhipAka ke lakSaNoM kA abhAva rahatA hai kyoMki yaha aupasargika na hokara vihAsAtmaka roga hai / sandhi kI gati kucha maryAdita hone para bhI gatisthairya nahIM hotaa| isa roga kA prArambha sandhAyIkAsthi ( articular cartilage ) se hotA hai na ki sandhizleSmagharakalA se / 53. sandhAyIkAsthi kA vihAsa hone lagatA hai jisake kAraNa yaha tantuloM (fibrils ) meM vibhakta hojAtI hai aura makhamala jaisA isakA dharAtala hojAtA hai / jaba sandhi meM gati prArambha hotI hai to gharSaNa ke kAraNa ye tantula bhAga ghisa jAte haiM aura kAsthi samApta hokara asthi anAvRta ho jAtI hai / yaha asthi paryApta cikanI hojAtI hai aura hastidanta ke samAna lagatI hai / sandhAyI dharAtala para prasItAeM ( grooves ) bana jAtI haiM / ye prasItAeM dUsare dharAtala para bane ubhAroM ( ridges ) ke kAraNa banatI haiN| prasItAeM vA ubhAra ina dharAtaloM para eka dUsare ke samAnAntara bane hue dekhe jAte haiM / sandhi ke kinAroM meM asthi dhAtu kI bahirvRddhi ( outgrowth ) dekhI jAtI hai / sandhAyI dharAtaloM ke cAroM ora mAno asthi kI aMgUThI banA dI gaI ho yA oSThana (lipping ) ho gayA ho aisA pratyakSa dekhA jAtA hai / sandhAyI dharAtala ke nIce kI asthi kA viralana aura pracUSaNa barAbara calatA rahatA hai jisake kAraNa vaMkSaNa sandhi meM Urvasthi kI grIvA nirantara ghaTatI calI jAtI hai / sandhiguhA meM zleSmadharakalA kI jhallaroM ( fringes ) meM choTI choTI tAntava yA kAsthiyoM kI granthikAeM ( nodules ) bana jAtI haiM jo Age cala kara unase pRthakkRta ( detached ) ho jAtI haiM usa samaya inheM abaddha padArtha ( loose body ) kahA jAtA hai / sandhi ke bandhaka yA rajju ( ligaments ) meM bhI vihAsAtmaka parivartana hone lagate haiM / jisase ve prAyaH vinaSTa ho jAte haiM aura Age calakara sandhi ke visaMghaTana kA kAraNa banate haiM / For Private and Personal Use Only pRSThavaMza meM yaha roga antarAkIkasa bimboM ( intervertebral discs ) meM prArambha hotA hai thor3e samaya bAda sandhiguhAoM kA gatisthairya ho jAtA hai aura samIpastha kIkasa eka dUsare se tAlakita ( locked ) ho jAte haiN| kIkasoM ke cAroM ora kI bahirvRddha asthi aura bhI jakar3a letI hai jisase unameM koI gati bhI nahIM ho jAtI / yaha roga madhyavaya ke pazcAt hotA huA dekhA jAtA hai / ise virUpakara kI sapAka ( Spondylitis deformans ) kahate haiM / yaha roga uttarottara bar3hatA

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54 vikRtivijJAna calA jAtA hai jisase pRSThavaMza Age kI ora jhuka jAtA hai rogI kI Thor3I Age kI ora nikala jAtI hai aura sira jhukatA calA jAtA hai aura vaha use sIdhA karane meM asamartha ho jAtA hai / kIkasoM meM se nikala kara jAne vAlI vAtanAr3iyoM para bhAra par3ane se kucha vedanA bhI ho sakatI hai / 1 avayaskoM meM bhI eka prakAra kA kIkasapAka dekhA jA sakatA hai jise sTrampaila merI siMDroma (Strumpel Marie syndrome ) kahate haiM isakA prArambha sahasA hotA hai bhI AtA hai tathA yaha bhI jJAta hotA hai ki yaha koI aupasargika roga hai parantu upasarga kA jJAna nahIM ho pAtA hai / isameM asthi kI bahirvRddhi nahIM hotI / bar3I bar3I sandhiyAM juTakara sampUrNa pRSThavaMza meM gatisthairya kara sakatI haiM / asthi kA viralana aura mRddana khUba hotA hai / puTapAka (Bursitis ) -- jisa prakAra sandhiyoM meM pAka hotA hai usI prakAra sandhizleSmadharakalA puTakoM ( bursae ) meM bhI pAka hotA hai / AghAtajanya sAdhAraNa puTapAka meM vraNazotha aura utsyanda donoM hote haiN| para jIrNa puTapAkoM meM tAntava sthaulya ( fibrotic thickening ) tathA sandhizleSmagharakalA kI bahirvRddhi vizeSa karake dekhI jAtI hai / pUyajanaka upasarga ke kAraNa ye puTaka vidhi kA rUpa dhAraNa kara lete haiM / (3) mAMsa dhAtu para vraNazotha kA pariNAma yahAM mAMsadhAtu, mAMsadharAkalA tathA kaNDarAoM para vraNazotha ke pariNAma kA saMkSipta varNana kiyA jAyegA / / mAMsadhAtu ko pezI nAma se bhI pukArA jAtA hai / yaha sAdhAraNatayA do prakAra kI hotI hai| eka aicchika yA rAjIvapezI ( striped muscle ) tathA dUsarI anaicchika yA rAjIrahita (unstriated muscle) pezI kahalAtI hai / aicchika peziyoM meM pezI kozA lambe aura ekanyaSTrIya hote haiM ve samUhoM meM kramita hote haiM / ina samUhoM ke Upara tAntava Uti kI cAdara car3hI hotI hai jisameM hokara pezIpoSaka raktavAhiniyAM tathA vAtanAr3iyAM gamana karatI haiM / ye samUha zArIra zAstra kI dRSTi se pezI kI paribhASA ko pUrNa karate haiM / sampUrNa pezI ke Upara eka bar3I tAntava cAdara car3hI rahatI hai jo dUsarI peziyoM kI cAdara se tathA paryastha ( periosteum ) se santata rahatI hai / yahI cAdara mAMsadharAkalA kahalAtI hai / samUhoM para car3hI cAdara bhI mAMsadharAkalA hI hai / rAjIrahita pezI meM kozAoM kA prarasa eka samAna aura milA julA hotA hai usameM bIca bIca meM cAdara jaisA kucha nahIM hotA / kaNDarA ( tendons ) eka ora pezI kI mAMsadharAkalA se sambaddha hotI hai aura dUsarI ora paryastha se saMlagna hotI hai| kaNDarA kI kriyA samyaktayA sampanna ho sake 1. tAsAM prathamA mAMsadharA nAma, yasyAM mAMse sirAsnAyudhamanIsrotasAM pratAnA bhavanti / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva isake lie usake cAroM ora eka zleSmadharakalA kA kancuka car3hA hotA hai / jahAM kaNDarA kA pratyakSa gharSaNa asthi ke sAtha hotA hai vahAM kaNDarA kA eka bhAga ghanIbhUta gAMTha kA rUpa dhAraNa kara letA hai jo kAlAntara meM asthi bana jAtA hai| mAMsadharAkalA kI tAntava Uti lambe lambe ekanyaSTi tanturUhoM ( fibroblasts ) ke dvArA banatI hai| ina tanturuhoM ke bIca bIca meM unakI AvazyakatAnusAra raktavAhiniyAM, vAtanAr3iyAM, lasavahA, vasA Adi rahate haiN| tAntava Uti kI saghanatA bhI kahIM kama aura kahIM adhika dekhI jAtI hai| vraNavastu ( scar tissue ) meM saba ke saba tanturuha hote haiN| mAMsadharAkalA meM tanturuha aura anya saba vAhiniyAM hotI haiM tathA antarAlita Uti ( areolar tissue ) meM sneha tathA vAhiniyoM kI bahulatA hotI hai| pezIpAka ( Myositis)-pezI meM do prakAra kA pAka prAyaH dekhA jAtA haieka tIvra aura dUsarA jIrNa / tIvra pezIpAka kA kAraNa samIpastha UtiyoM meM vraNazotha jaise paryasthapAka yA kozotipAka kA honA mAnA jAtA hai| yadi kisI tIkSNa zastra se bhedana karake vraNa kara diyA jAya to pratyakSa rUpa se bhI tIvra pezIpAka ho sakatA hai| sarvaprathama vraNazotha kA prabhAva mAMsadharAkalA para hotA hai usase pezI ke tantu prabhAvita hote haiN| pezI ke kozA kaNAtmaka ho jAte haiM phUla jAte haiM aura khAlI ho jAte haiM unakI anuprastha rekhAeM miTa jAtI haiM aura anta meM ve vighaTita ho jAte haiN| yadi upasarga tIvra huA to vahAM sapUya vidradhi bana jAtI hai yA pUyAntarAbharaNa prasAra ( diffuse purulent infiltration ) ho jAtA hai| mAMsagata kupita vAta kA lakSaNa likhate hue caraka spaSTa karatA haigurvaGgaM tudyate stabdhaM daNDamuSTihataM yathA / saruk stimitamatyarthaM mAMsamedogate'nile // suzruta kahatA hai ............ "granthIn sarlAn mAMsasaMzritAn / vAgbhaTa batalAtA haimAMsamedogato granthIMstodADhyAn karkazAn zramam / gurvaSaM cAtirukstabdhaM muSTidaNDaitopamam // aGga kA bhArIpana, toda, kAryazakti kA hrAsa hokara stabdhatA AnA, zUla honA, bhIgA bhIgA sA laganA, gAMTha par3a jAnA, zrama karane meM kaSTa honA tathA aisA pratIta honA mAno DaNDe se pITA gayA ho yA muSTika prahAra huA ho| yaha vivaraNa pezIpAka ke naidAnika svarUpa ( clinical aspect ) ko pragaTa karatA hai| pezIpAka eka aura prakAra kA hI tIvra svarUpa kA dekhA jAtA hai| yaha sajvara evaM sahasA hotA hai| peziyoM meM zUla paryApta hotA hai ve sUja aura phUla jAtI haiM sAtha hI tvacA para bhI utkoTha yA nIlohika sidhma (purpuric patches ) dekhe jAte For Private and Personal Use Only

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56 vikRtivijJAna haiN| pezI aura tvacA donoM kA sambandha hone ke hI kAraNa ise tvacA pezIpAka ( Dermatomyositis ) kahate haiM / isa roga kA ThIka kAraNa jJAta nahIM ho sakA / kadAcit yaha kapha - raktajanya ( allergic ) vyAdhi ho / jaba yaha zvasanapeziyoM meM ho jAtA hai to phira asAdhya hI ho jAtA hai / jIrNa pezIpAka upasarga ke kAraNa bhI ho sakatA hai aura vinA upasarga ke bhI / isameM pezI ke sUtra tAntava Uti meM pariNata ho jAte haiN| jisake kAraNa pezI kI kriyA zakti naSTa ho jAtI hai / mAMsadharAkalApAka ( Fibrositis ) - ise pezIya AmavAta ( muscular rheumatism ) bhI kaha sakate haiM / yaha atyadhika rujAkara avasthA hai / isameM zarIra kI saMyojaka UtiyAM aura peziyAM donoM meM vraNazotha hotA hai / isakA prArambha pahale eka kSetra meM hokara phira dUsare meM hotA hai / sarva prathama jahAM pAka prArambha hotA hai vahAM pahale raktAdhikya hojAtA hai aura vaha sthAna sUja jAtA hai jisake kAraNa zUla hone lagatA hai usa sthAna para lasIkozA ekatra hone lagate haiM tathA kendra bhAga naSTa hone lagatA hai dhIre-dhIre roga kI tIvrAvasthA samApta hojAtI hai tathA jIrNAvasthA prArambha hone lagatI hai jisameM tantUskarSa ( fibrosis ) kA prAdhAnya hotA hai / yaha roga antarparzakIya tathA sakthi kI peziyoM meM prAyazaH dekhA jAtA hai mAMsadharakalA ke atirikta anya kalAoM ko bhI yaha roga AkrAnta karatA hai jaise vAtanADI AvaraNa ( nerve sheath ), raktavAhiniyoM kI prAcIreM, sandhiyoM ke samIpa yA tvacA ke niice| isa roga kA kAraNa ThIka se jJAta nahIM ho skaa| kucha aisA samajhate haiM ki kalA ke bhItara medas ke choTe choTe lava ghusakara ise karate haiM / pUtikendra zarIra meM kahIM hone se isake hone meM sahAyatA milatI hai aisA bhI kucha kA vicAra hai / asthikara pezIpAka ( Myositis Ossificans ) -- jaba pezI para nirantara AghAta hotA hai aura pezI ke bhItara barAbara raktasrAva hotA rahatA hai to pezI kA pAka hote hote vraNavastu banane lagatI hai jo dhIre dhIre asthi kA rUpa dhAraNa kara letI haiM / asthikara pezIpAka 1-sthAnika, 2 -sArvadehika (generalised ) evaM 3 - pragAmI (progressive) tIna prakAra kA hotA hai| sthAnika kA udAharaNa ghur3asavAra kI Uru saMvyUhanI gariSThA ( adductor magnus ) pezI meM asthi bana jAne kA hai / pragAmI asthikara pezIpAka meM zarIra kI kaI peziyoM meM asthi kI paTTiyAM (plates ) bana jAtI haiM yaha avasthA bahuta kama dekhI jAtI hai / ye paTTiyAM pezI kI gati kama karate karate use pUrNataH gatihIna (stabdha ) kara detI haiM / pRSThavaMza kI peziyoM meM yaha roga hotA hai / isI se milatA julatA eka aura pezIpAka hotA hai isameM pezI meM tantUtkarSa to hotA hai para asthi nirmANa kArya nahIM hotA / yaha vraNazothAtmaka na hokara vihAsAtmaka avasthA mAlUma par3atI hai ise pragAmI tantukara pezIpAka ( Progressive Fibrosing Myositis ) kahate haiN| I For Private and Personal Use Only

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parihatpAka pRSTa 57 kI kAni yaha parihRtpAka kI tIvra avasthA ko prakaTa karatA hai / romAnvita parihRt ( Pericardium ) usake srAva ke kAraNa isa avasthA ko prApta haI hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva (4) hRdaya para vraNazotha kA pariNAma parihRcchadapAka ( Pericarditis) hRdaya kI lasIkalA parihRcchada kahalAtI hai| ise parihRt bhI kahate haiN| isake bhI do parta hote haiM eka jo hRdaya se cipakA rahatA hai aura dUsarA jo usake Upara rakhA rahatA hai| donoM partoM ke bIca meM rikta sthAna hotA hai| isa sthAna meM zleSmA kA svAbhAvika srAva utanA hotA hai ki eka dUsare para gati karatA rhe| jisa prakAra anya lasIkalAoM meM pAka hotA hai usI prakAra yahA~ bhI dekhA jAtA hai| parihRcchada meM do prakAra ke pAka hote haiM inameM eka sAdhAraNa aura dUsarA sapUya kahalAtA hai| sAdhAraNa parihRcchadapAka meM antazchada ke adhikAMza kA vistRta vinAza hotA hai jisameM lasyatantvi ( sero-fibrinous) srAva hotA hai tantvi kA eka stara parihRt ke donoM pardo ko AcchAdita kara letA hai jisake kAraNa donoM padaM eka dUsare se cipaka jAte haiN| donoM patoM ke bIca ke avakAza meM eka zuklAbha tarala bhara jAtA hai / yaha tarala kabhI kabhI bahuta adhika parimANa meM ho jAtA hai jisake kAraNa parihRtsyUna ( pericardial sac ) khUba phUla jAtA hai| tantvi kA jo stara donoM padoM para car3hatA hai vaha eka atyanta tanu ropaNa (jo kevala parihRt kI. camaka ko dhuMdhalI kara detA hai) se lekara / iJca moTe AvaraNa taka ho jAtA hai| jaba vraNazotha kA zamana hotA hai taba tarala pracUSita ho jAtA hai tathA tantvi kA samaGgIkaraNa ( organisation ) ho jAtA hai / jahA~ taralAdhikya aura tantvi-alpatA rahatI hai vahA~ parihRt ke donoM paryoM meM abhilAga ( adhesions ) nahIM banate tathA tarala kA punazcUSaNa pUrNataH ho jAtA hai| adhika gambhIra avasthAoM meM jahA~ tantvi kA samaGgIkaraNa hotA hai vahA~ patale paTToM ( bands ) ke rUpa meM bhI abhilAga milate haiM tathA donoM parde pUrNataH cipake hue bhI dekhe jAte haiN| kabhI kabhI tantvi pUrNataH cUrNiyita (calcified) ho jAtI hai aura aisA lagatA hai mAno ki hRdaya eka ghoMghe (shell) meM banda ho gayA ho / ___ parihRcchadapAka ke kAraNa zarIra tathA hRdaya para kyA prabhAva par3atA hai vaha bhI atyanta mahattva kA hone ke kAraNa hama nimna zabdoM meM use ginAte haiM 1. sarvaprathama donoM staroM kI ragar3a se zUla utpanna hotA hai| 2. gharSaNa kA zabda sunAI par3atA hai jo tantvi ke dRDha hone ke sAtha sAtha teja hone lagatA hai| 3. prAyazaH parihRtpAka gauNarUpa se hotA hai isa kAraNa pramukhaupasarga dvArA zarIra meM sajvarAvasthA bahudhA mila jAtI hai ataH binA jvara yaha roga dekhA nahIM jAtA; para kabhI * kabhI jaba dhAtukSaya adhika hone ke sAtha yaha roga hotA hai to zarIra kI UtiyoM kI pratikriyA zakti itanI alpa rahatI hai ki binA jvara vA zUla ke bhI yaha roga dekhA jAtA hai| 4. prArambha meM jaba gharSaNa hotA hai yA jaba taralAdhikya kA dabAva par3atA hai donoM avasthAoM meM hRdaya kI kAryazakti kama ho jAtI hai vizeSa karake alindoM tathA dakSiNa nilayoM kI kriyAzakti meM kamI A jAtI hai| For Private and Personal Use Only

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vikRtivijJAna ____5. vraNazotha parihRt se hRtpezI ke bAhyabhAga meM bhI calA jAtA hai jisake kAraNa hRdaya kI kriyAzakti kama ho jAtI hai Age jaba tansvi kA samaGgIkaraNa hotA hai aura abhilAga utpanna hote haiM to kArya manda ho jAtA hai| 6. jaba sampUrNa parihRt ke donoM parde hRdaya para cipaka jAte haiM to hRdaya kI kAryazakti atyanta ghaTa jAne se usake saba prakoSThoM kA paramacaya (hypertrophy) hone lagatA hai| hRdaya ekarUpatayA ( uniformly ) saba ora paramapuSTa hokara bRhadAkRtika bana jAtA hai jo anta meM visphArita hotA phela hotA aura mRtyu kA kAraNa banatA hai / ina avasaroM para phuphphusAntarAlapAka ( mediastinitis) bhI ho jAtA hai jisake kAraNa hRdaya parihat tathA phuphphusAntarAlIya UtiyA~ jama kara tantUtkarSa ke kAraNa eka Thosa puJja ( solid mass ) meM pariNata ho jAtI haiN| 7. parihRt ke bAhyadharAtala para prAyaH bahuta se dUdhiyA dhabbe (milk patches) pAye jAte haiN| dhabboM ke sthAnoM para parihat moTI, zvetatara evaM pArAndha ho jAtI hai / ina dhabboM kA kAraNa parihRt kA bAhara se pIDita honA hai jisake kAraNa usake donoM pardo meM gharSaNa ke kAraNa ve utpanna hote haiN|| abhI Upara hamane sAdhAraNa parihRtpAka kA varNana kiyA hai| sapUya parihRtpAka (Suppurative Pericarditis) phuphphusapAka, sapUya asthimajjApAka tathA pUyaraktatA meM se kisI ke bhI kAraNa ho sakatA hai / isameM parihRt ke donoM pardo ke bIca meM tantvi tathA pUya bhara jAtA hai / yaha avasthA atyanta zocanIya hotI hai| ___ AmavAtajahRcchotha (Rheumatic Carditis ) nirdhana apuSTa bAlakoM tathA taruNoM ko jo AI jalavAyu meM rahate haiM AmavAta kA upasarga laga jAtA hai| isa roga ke prArambha hone se pUrva uttuNDikA pAka (tonsillitis) kA itihAsa zata-pratizata milatA hai| AmavAta ke mukhya lakSaNa-jvara, AmavAtaja hRcchotha, sandhipAka, upacarma kSetra meM dRDha granthikAoM kI upasthiti tathA tANDava jvara ( chorea) pAye jAte haiN| Ajakala AmavAta kI tIvrAvasthA ghaTatI jArahI para hai anutIvAvasthA jyoM kI tyoM hai tathA isameM hRdaya kI hone vAlI kSati kisI bhI dazA meM kama nahIM hotii| yaha jJAna ki yaha rogI AmavAta se vyathita hai jAnane kA sAdhana askAphagranthi hotI hai| yaha eka kaNikAbha granthikA (granulomatous nodule ) hotI hai jo kapATa tathA prAcIra donoM kI hRdantazchada (endocardium) hRtpezI kI saMyojaka UtiyoM, phaphphasacchada tathA parihRcchada kI lasIkalAoM, sandhiyoM kI parisandhAyI Uti tathA zleSmadharakalA kaNDarAoM, upacarma Adi sthAnoM meM dekhI jAtI hai| mahAdhamanI ke kapAToM tathA anya dhamaniyoM kI UtiyoM aura AvaraNoM meM ye mila sakatI haiN| isase yaha jJAna aura puSTa ho jAtA hai ki AmavAta nAmaka vyAdhi eka sArvadaihika For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 56 upasarga hai jisakA vistAra sampUrNa deha kI saMyojaka UtiyoM meM hotA hai para cUMki isakA atyadhika prabhAva hRdaya para hotA hai isalie yahA~ para hI isakA vizeSa dhyAna diyA gayA hai / aNvIkSa meM dekhane para askApha granthi meM eka yA do antazchadIya prakAra ke vizAla kozA hote haiM jinake cAroM ora choTe gola kozA tathA kucha eka kozIya protikozA (monocyte histiocytes) ghire rahate haiM / pariNAha para navatantukozA banane lagate haiN| isa granthikA ke kendra meM mRta padArtha kA eka choTA sA puMja rahatA hai / spezI tathA anya gambhIra sthaloM para ye granthikAe~ kSudra dhamaniyoM ke sAtha sambaddha hotI haiM aura ye pAradhamanika ( pararterial ) kahalAtI haiN| dhamaniyoM kI saMyojaka Uti meM ve protikozAoM ke rUpa meM milatI haiM / hRdrohiNI ( coronary vessels ) meM jo antarpezI paTa ( intermuscular septa ) meM milatI haiM vahAM se ve pezI meM calI jAtI haiM pezIdhAtu ko bhakSaNa karake vahA~ tantumaya vraNavastu kA nirmANa karatI haiM / hRtkapAToM meM ye askApha granthiyA~ kapATa pallavoM ( valve flaps ) ke hRdantazchada meM milatI haiM / dvipatraka kapATa isake lie bahuta prasiddha hai mahAdhamanika kapATa daloM { cusps of the aortic valves ) meM bhI ye milatI haiM hRdaya ke dakSiNa bhAgastha kapAToM meM bhI inakI upasthiti milatI to hai parantu bahuta kama / vAmAlinda ke hRdantazchada ke nIce, pacapArzva prAcIra meM trikoNAkAra kSetra meM, jisakA AdhAra bhAga dvipatraka sure ke pazcadala se banatA hai, ye granthiyA~ bahuta bar3I saMkhyA meM milatI haiM / kapAToM ke AdhAroM para, kapATavalayoM (valve rings), hRdajjuoM (chordae tendineae ) hRtpezI ke antarpezIya paTa ( intramuscular septum of myocardium ) tathA upaparihRtsaMyojaka Uti meM ye granthikAe~ bikharI par3I hotI haiN| hRdaya kA koI bhI aisA bhAga bacA huA nahIM dikhAI detA jahA~ ye na hoM isI kAraNa zAstrakAroM ne AmavAta janita hRdantazchadIya pAka kI apekSA sampUrNa hatpAka kA varNana karanA adhika yuktiyukta ThaharAyA hai| pArTI kA kArya khulanA aura banda honA hai tAki raktasaMvahana kA kArya yathAvat calatA rhe| jaba kapAoM kI antazchada ke nIce askApha granthiyAM utpanna ho jAtI haiM to vahA~ kI antazchada meM sUjana A jAtI hai vaha U~cI nIcI ho jAtI hai / usako jaba lagAtAra khulanA aura banda honA par3atA hai to vaha vahA~ se haTa jAtI tathA naSTa ho jAtI hai / raktavahasaMsthAna meM yadi kahIM para antazchada vidIrNa ho jAtI hai to vahAM tatkAla rakta bimbANu ( blood platelets ) cipakane lagate haiM aura svalpa mAtrA meM bhI utpanna ho jAtI hai isa prakAra askApha granthi ke Upara bimbANu ghanAstra kI eka rekhA bana jAtI hai / ina bimbANuoM para Age calakara aura bimbANu cipaka cipaka kara isakA eka bar3A rUpa kara dete haiM / ina ghanAtroM ke AdhAra bhAga meM samaGgIkaraNa kriyA calatI rahatI tathA tantUtkarSa bar3hatA rahatA hai, aneka rakta kezAla unakI jar3oM ko raktapradAna karatI haiM jisase ApadmavarNa ke ( pink ) kSudra carmakIlavardhanoM ( warty For Private and Personal Use Only

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60 vikRtivijJAna vegetations ) kI eka rekhA bana jAtI hai jo hRtkapAToM se itanI dRr3hatA se cipakI rahatI hai ki usake TUTa kara antaHzalya banane kA bahuta hI kama avasara AtA hai| eka bAra AmavAta ke kAraNa hRtpradeza meM koI vikSata bana jAne ke bAda cAhe phira roga kA AkramaNa dhImA par3a jAya yA punaH punaH bar3he vaha vikSata bar3hatA calA jAtA hai| yadi roga ke lakSaNa kucha samaya ke lie cale bhI jAya taba bhI punaH upasarga se AkrAnta hone kI pUrI pUrI saMbhAvanA rahatI hai| ___ jaba kapATa ke Upara AmavAtaja granthiyA~ bana gaI aura unameM tantUtkarSa hone lagA to usakA pahalA pariNAma kapATa ke sikur3ane meM hotA hai jisake kAraNa usakA mukha vivara Ter3hA-mer3hA ho jAtA hai| sikur3ane para mahAdhamanI ke kapAToM ke dala (cusps ) mahAdhamanI prAcIra kI ora khIMcate haiM jisase kapATa svakArya karane ke ayogya ho jAte haiM aura mahAdhAmanika pratipravAhaNa ( aortic regurgitation ) hone lagatA hai| kabhI kabhI parantu bahuta hI kama aisA dekhA jAtA hai ki ye dala eka dUsare se mila jAte (fused ) haiM, usa dazA meM mahAdhAmanika sannirodhotkarSa (aortic stenosis) ho jAtA hai / dvipatraka kapAToM ke donoM ora ke pallava ( flaps ) eka dUsare se dvipatrakIya vivara para cipaka jAte haiM jisase dvipatrakIya sannirodhotkarSa (mitral stenosis) ho jAtA hai / bAlakoM meM isa sannirodhotkarSa kA svarUpa eka nivApa ( funnel ) jaisA hotA hai parantu vayaskoM meM vaha darI sadRza (slit like ) hone se usakA nAma kuDmachidra sannirodhotkarSa ( button hole stenosis ) par3a jAtA hai / yaha Age calakara cUrNAyita ho jAtI hai| dvipatrakIya kapATa meM lagI hRdrajaoM meM tantUskarSa hone se ve moTI tathA choTI ho jAne se isa kapATa meM eka jIrNa svarUpa kI vyAdhi bana jAtI hai| dvipatrakIya sannirodhotkarSa ho jAne ke kAraNa vAmAlinda ke rakta ko vAmanilaya meM jAne ke lie chidra atyadhika saMkucita ho jAne se bar3I kaThinAI par3atI hai use dUra karane ke lie vAmAlinda balapUrvaka rakta ko dhakelatA hai jisake pariNAmasvarUpa vAmAlinda kI prAcIra paramapuSTa ( hypertrophic ) ho jAtI hai| jaba isase bhI kArya nahIM calatA to paramapuSTi kA sthAna prakoSTha visphAra ( dilatation of the chambers) le letA hai| isa visphAra ke kAraNa rakta kA dvipatrakadvAra se jAnA asambhava ho jAtA hai aura rakta vAmAlinda se phuphphusoM kI ora ulaTA jAne lagatA hai jisake kAraNa zanaiH zanaiH jIrNa nizceSTa adhiraktatA (chronic passive congestion) utpanna ho jAtI hai| vAmanilaya meM rakta kI kamI hone se isakI prAcIra apuSTa ho jAtI hai| zeSa tInoM prakoSThoM kI prAcIreM atipuSTa ho jAtI haiM / vAmAlinda meM rakta ke Thaharane se kandukaghanAstra ( ball-thrombi ) banate haiM aura jaba ve phUTate haiM to aneka aMgoM meM RNAsrotpAdana karate haiN| ina ghanAsroM ke nirmANa meM alindIya pezItantukampa (auricular fibrillation ) vizeSa bhAga letA hai jo jIrNa dvipatrakIya sannirodhoskarSa meM eka sarva sAmAnya upadrava dekhA jAtA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva - hRtpezI meM askApha granthiyAM bhItara taka praveza kara jAtI haiN| AmavAtopasarga kI tIvrAvasthA meM hRtpezI meM paryApta sUjana aura vedanA rahatI hai jisake kAraNa pezIsUtroM ke AkuJcana-prasAra meM bAdhA par3atI aura hRdgraha kI AzaMkA bar3ha jAtI hai, Age calakara ina granthiyoM se AveSTita pezI bhAga meM tantUtkarSa hone lagatA hai| jisake kAraNa pezI paryApta durbala hojAtI hai aura usakI kAryakara zakti kama hojAtI hai| yaha tantUtkarSa atyadhika prabala nahIM hotA isa kAraNa zaktahRtpezI bhAga ke bAhara kI ora yaha agratovRddha ( bulged) ho jAtA hai| yaha tantUtkarSa hI jIrNa antarAlIya hRtpezIpAka (chronicinterstitial Myocarditis) yA prasara hRtpezIya tantUtkarSa (diffuse myocardial fibrosis) kA kAraNa hotA hai| jaba hija ke pUla ( bundle of His ) meM vikSata ho jAtA hai to hRttaraGga ke AvAgamana meM bAdhA par3ane kI tathA hRdgraha ( heart block ) hone kI sambhAvanA ho jAtI hai| parihRt meM askApha granthi upAntazchadIya saMyojaka Uti meM banatI hai isake kAraNa parihRtpAka hotA hai| isa roga kI pravRtti utsyandanazIla hone ke kAraNa parihat meM utsyanda bhI ekatra ho jAtA hai| AmavAtajanya utsyanda mAtrA meM alpa tathA lasya hotA hai jo sapUya kadApi nahIM ho paataa| tantvi ke saMcaya ke kAraNa satantvi parihRtpAka prAyazaH dekhA jAtA hai jisameM zUnya aura gharSaNa zabda donoM milate haiN| . AmavAtaja hRtpAka ke kAraNa hone vAlI vikRtiyoM kA varNana karate samaya yaha batAnA bhI Avazyaka hai ki Adhunika dRSTi se isa roga kA kartA kauna hai ? pahale se zoNaharita mAlAgolANu (streptococcus viridans) ko isakA janaka mAnA gayA hai parantu jaba tuNDikApAka hotA hai to usake bAda AmavAtajvara ke lakSaNa bar3hate hue dekhe gaye haiM / tuNDikApAka kA kAraNa pUyajanamAlAgolANu (streptococcus pyogen) hotA hai| isa dRSTi se AmavAta kA kartA jIva kucha pUyajana mAlAgolANu ko mAnate haiN| para yataH ye donoM hI jIva askApha kI granthiyoM meM milate nahIM ataH tIsarA mata yaha ho gayA hai ki yaha viSANujanita roga hai para usakA bhI koI pratyakSa pramANa milA nhiiN| eka anya mata jo isa samaya cala rahA hai vaha yaha hai ki pUyajanamAlAgolANu kI upasthiti se eka kapharatIya pratikriyA ( allergic reaction ) ke rUpa meM yaha vikAra hotA hai| yaha pratikriyA isa roga ke kAraka viziSTa viSANu kI kriyA ko uttejanA dekara roga kA daurA utpanna karane meM samartha hotI hai| kucha bhI ho AmavAtaja hRtpAka ke nimna pariNAma dekhe jAte haiM: 1. dvipatrakIya sannirodhotkarSa jisake sAtha puras-hRtkuMcana marmaradhvani ( presystolio murmur ) milatI hai, ____2. mahAdhamanI kapAToM kI akAryakaratA jisake kAraNa mahAdhAmanika pratipravAhaNa tathA sAtha hI hRtsphArajanita marmaradhvani ( diastolic murmur ) milatI hai, ___3. dvipakSakIya akAryakaratA ( mitral incompetence ) tathA mahAdhAmanika sannirodhotkarSa ye donoM bahuta kama dekhe jAte haiM, 6 vi0 For Private and Personal Use Only

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62 vikRtivijJAna 4. isa roga meM yadi eka bAra kapAToM para AkramaNa ho gayA ho to phira kisI bhI samaya roga kA punarAkramaNa yA punaH upasarga ho sakatA hai, 5. yadi kisI kAraNa se parihRtpAka hojAtA hai to usameM utsyanda bhI dekhA jAtA hai jisakA pracUSaNa yadi na huA to tAntava samaGgIkaraNa hotA hai jo parihRt ke donoM staroM ko pezI ke Upara cipakA detA hai jisase hRdaya meM paramapuSTi hotI hai / vAmAlinda kI paramapuSTi kA varNana pahale kiyA jA cukA hai, 6. AmavAtaja upasarga ke hI kAraNa Age calakara aicchika peziyoM meM AkSepa Ane kA roga jise tANDavajvara ( chorea ) kahate haiM hojAtA hai, 7. isa roga meM mRtyu kA kAraNa hRtpezI ke tantuoM meM tantUskarSa honA yA parihRt ke donoM staroM ke cipaka jAne se hRdgraha yA hRdbheda (heart failure ) kA honA hai / kapAToM kI vikRti se hRtpezIkampa hokara bhI hRdbheda ho sakatA hai / hRdantazchadapAka ( Endocarditis ) kAraNa kI dRSTi se hRdantazchada kA vraNazotha do prakAra kA hotA hai jisameM eka AmavAtajanya hai jisakA varNana hama pIche kara cuke haiM dUsarA jIvANujanya hotA hai jise hama Age leMge, sAtha hI, vijJata ke sthAna kI dRSTi se bhI yaha do prakAra kA hI hotA hai jisameM eka kapATIya hRdantazchadapAka ( Valvular endocarditis ) yA hRtkapATapAka ( Valvulitis ) kahalAtA hai jisameM vikSata kevala hRtkapArTI para hI hote haiM tathA dUsarA prakoSThIyahRdantazchadapAka (Mural endocarditis ) kahalAtA hai usameM hRdaya ke prakoSThoM ( chambers ) kI antazchada meM vraNazotha ho jAtA hai / dUsarI bAta jo isa sambandha meM smaraNIya hai vaha yaha ki garbhottara kAla meM hRdantazchadapAka hRdaya ke dakSiNa bhAga meM prAyazaH dekhA jAtA hai parantu prasavoparAnta vAmabhAga meM roga kA AkramaNa DaTa kara hotA hai usameM bhI dvipatraka tathA mahAdhAmanika kapAToM para hI usakA atyadhika prabhAva par3atA hai / tIsarI bAta udbhedoM (vegetations ) ke sambandha meM jAna lenI cAhie ki AmavAtaja udbheda rakta ke bimbANuoM ke kAraNa banate haiM isalie choTe choTe aura dRr3hamUla vAle hote haiM tathA ve carmakIla sadRza dekhe jAte haiM / jIvANuoM ke kAraNa hone vAle hRdantazchadapAka meM udbhedoM kA kAraNa tanvi hotI hai / ye udbheda paryApta bar3e hote haiM aura AsAnI se TUTakara antaHzalyatA karane meM dakSa hote haiM / avasthA ke anusAra bhI hRdantazchada pAka ke do bheda hote haiM, eka tIvrAvasthA ( acute stage) tathA dUsarI jIrNAvasthA ( chronic stage ) / jIrNa hRdantazchadapAka kA kAraNa AmavAta, phiraGga yA kapAToM meM utpanna hone vAlA vihAsAtmaka parivartana hotA hai / jIrNAvasthA ke udbheda cUrNIya piNDa ( calcareous masses) hote haiN| aba hama zeSa rahe vividha hRdantazchadapAkoM para saMkSipta prakAza DAleMge | For Private and Personal Use Only

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anutIvrajIvANvIya hRdantazchadapAka pRSTha 63 Acharya Shri Kailassagarsuri Gyanmandir / www.kobatirth.org H-Meerenceceive-EPUmarnatSHTIONNOINTIMALAI- For Private and Personal Use Only SHE CHERE MIRPAN Friend Shri Mahavir Jain Aradhana Kendra isa citra meM dvipatraka kapATa se vAmAlinda taka hRdantazchadapAka dikhalAI de rahA hai| isa citra meM udbheda saralatA se dekhe jA sakate haiN| ye udbheda mRdu bar3e aura AsAnI se TUTa kara aneka antaHzalya utpanna karane kI sAmarthya rakhate ha /

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vividha zarIrAGgoM para vraNazotha kA prabhAva anutIvra jIvANvIyahRdantazchadapAka (Subacute Bacterial Endocarditis) AmavAtajanya hRtkapAToM para zIghra hI yA varSoM pazcAt lagabhaga 80 pratizata rugNoM meM zoNaharita mAlAgolANuoM kA upasarga lagane se yaha vikAra hotA hai| yaha mAlAgolANu rakta kI dhArA meM upasthita rahatA hai aura vahAM se askApha granthiyoM meM yA unake dvArA naSTa pradeza meM praveza kara jAtA hai| AmavAta ke atirikta yadi dUsarA koI kAraNa isa roga kA utpAdaka ho sakatA hai to vaha hRdaya kI sahaja vikRti (congenital deformity of the heart ) hI ho sakatI hai| AmavAtottha upasarga kA prabhAva dvipatrakIya kapATa para sarvAdhika phira vAmAlinda kA pazcapArzva kSetra, tatpazcAt mahAdhamanI ke kapAToM para par3atA hai| tathA anya prakAra se hone para mahAdhamanI kA dvipatrakIya kapATa vizeSa prabhAvita hotA hai / ___zoNaharita mAlAgolANu rakta meM kisa prakAra pahuMcate haiM isake sambandha meM batAyA jAtA hai ki pahale unakA koI pUtikendra ( septic focus ) dAMtoM, tuNDikA-graMthiyoM yA galatoraNikAoM meM bana jAtA hai aura vahIM se ve rakta ko dUSita karane meM samartha hote haiN| sAdhAraNa jvara ke rakta kI parIkSA karane para bhI kabhI kabhI grAhama aura DairavIlara nAmaka vidvAnoM ne isa mAlAgolANu ko binA kisI anya pUtikendra ke bhI pAyA hai| ___ isa mAlAgolANu dvArA jaba hRdaya upasraSTa ho jAtA hai to yadi isake vinAzaka navIna dravyoM kA yathocita upayoga na kiyA gayA to rogI // 2 sAla taka hI jI sakatA hai| ___jIvANvIya hRdantazchada pAka meM jo vraNazothAtmaka pratikriyA dekhI jAtI hai vaha AmavAtaja hRdantazchadapAka se paryApta bhinna hotI hai| isake ubheda prAyaH bar3e tathA tamvi tathA bimbANu donoM ke dvArA nirmita hote haiM, ve sugamatayA TUTa jAte haiM, unake TUTe hue bhAga vibhinna aGgoM meM jAkara RNAsra ( infarcts) banAne meM samartha hote haiM tathA ina bhAgoM meM bahuta se mAlAgolANu bhare hote haiN| yadi rogI 6 mAsa yA usase adhika kAla taka jIvita rahA to udbheda ke AdhAra tantUtkarSa ke kAraNa samaGgIkRta (organised) ho jAte haiN| ____ yadi ubheda kI Antarika racanA kI ora dhyAna deM to hameM usakI TopI ke rUpa meM tantvimaya ( fibrinous ) padArtha milegaa| TopI ke nIce kaNAtmaka Uti milegI jisakA AdhAra tAntava Uti kA banA hogaa| isa ubheda ke dharAtala para tantvi raktadhArA meM se nikala nikala kara barAbara car3hatI rahatI hai| udbheda ke samIpa hI bahuta se ekanyaSTikozA tathA lasIkozA tathA kucha bahunyaSTisitakozA pAye jAte haiN| .. ina udbhedoM ke dvArA na kevala vAmahRdaya ke kapATa tathA hRdajju hI AvRta rahate haiM api tu vAmAlinda kI sampUrNa hRdantazchada para jyoM jyoM roga meM vRddhi hotI jAtI hai - syoM tyoM ye ubheda bar3hate hue cale jAte haiN| hRtkapAToM meM roga kA sabase adhika For Private and Personal Use Only

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64 vikRtivijJAma prabhAva hone para bhI hRtpezI bhI isase achUtI nahIM rahatI hai| jahAM jahAM hRtpezI meM pahale rate granthiyAM ho jAtI haiM vahAM vahAM yaha vikAra bhI dekhA jAtA hai / unake Asa pAsa bahunyaSTikozA gherA DAle hue dekhe jAte haiM / ina aneka vidradhiyoM ko brAkTa - vAkTara piNDa ( bracht - wachter bodies) kahate haiN| ye piNDa hRdrohiNI yA valayadhamanI ( coronary artery ) kI zAkhA prazAkhAoM dvArA jIvANvIya antaHzalyoM ke pariNAma mAlUma par3ate haiM / yadi zIghra hI mRtyu na ho jAve to isa roga ke kAraNa hRdaya ke vibhinna bhAgoM meM apAra kSati dekhI jAtI hai / yadi hama pahale kapAToM ko leM to unameM vidradhibhavana ( ulceration ) hone lagatA hai jisake kAraNa unakI dhAtu durbala par3a jAtI hai jisake kAraNa kapAToM kA visphAraNa ( aneurysmal dilatation ) athavA chidraNa ( perforation ) ho jAtA hai / hRdvajju bhI aparadita hokara phaTa jAte haiN| mahAdhAmanika kapAToM meM jaba vikSata unake daloM ( cusps ) meM ho jAtA hai to vAlasalvA koTara ( sinus of Valsalva ) meM visphAraNa ( aneurysm ) ho jAtA hai / kabhI kabhI valayavAhinI meM antaHzalya turata mRtyu kA bhI kAraNa hotA hai / dhvani sunane meM usa pArTI para ina vividha pariNAmoM ke kAraNa kaI prakAra kI marmara samaya vizeSa AtI hai jaba ki AmavAtaja vikRti ke pazcAt yaha saba ke kAraNa rakta ke jAraNa meM kamI Ane lagatI hai jo aMgulyamoM meM bbing of the fingers ) kA kAraNa banatI hai / " isa roga ke kAraNa plIhA meM RNAtroM ke bana jAne se plIhazUla aura vRkkoM meM RNAtra bana jAne se raktameha ( haematuria ) dekhA jAtA hai / jaba ye RNAstra mastiSka meM banate haiM to vahAM ve mRdUna ( softening ) evaM raktasrAva ke kAraNa ho jAte haiM / bAhu-pAdoM kI dhamaniyoM meM RNAtroM ke kAraNa kotha hotA hai tathA Antrapradeza meM RNa hone se atIsAra kA lakSaNa dekhA jAtA hai| ina aneka RRNAtroM ke kAraNa rogI kA citra bar3A vicitra ho jAtA hai aura vAstavika roga kA jJAna karanA kaThina hotA hai| For Private and Personal Use Only roga huA ho / ina sthaulya (clu - anutIvra jIvANvIya hRdantazchadapAka ke kAraNa jo antaHzalya vibhinna sthAnoM meM RNAtra banAte haiM unakA Upara varNana ho gayA hai / unake atirikta vRkkoM, svacA ke nIce aura hRtpezI meM bhI antaHzalya vibhinna vicitratAe~ kara dete haiM unase bhI paricita honA Avazyaka hai / hRtpezI meM valayadhamanI kI prazAkhAoM dvArA antaHzalyoM ke lAne se brAkTa - vAkTara piNDoM ke nirmANa kI kahAnI hama sunA cuke haiN| ina piNDoM ke hI kAraNa hRtpezI meM bhayaGkara vedanA hotI hai / yadi vRkka ke prAvara ( capsule ) ke nIce hama dekheM to vahA~ asaMkhya lAla chIMTe par3e hue dekhe jAte haiM mAno ki anekoM pissuoM ne vRkka ko khA liyA ho| ina chIMToM kA kAraNa aneka kezikA jUToM ( glomeruli ) meM upasthita antaHzalya haiM / sampUrNa kezikAjUTa para prabhAva prAyaH nahIM dekhA jAtA usake kisI bhAga meM vikRti pAI jAtI hai vikRta bhAga meM kAcara

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vividha zarIrAGgoM para vraNazotha kA prabhAva padArtha bhara jAtA hai tathA Adi prAvara ( bowman's capsule ) meM kucha lAla kaNa dekhe bhara jAte haiM jinake kAraNa ve chIMTe dRggocara hote haiN| yadi sampUrNa kezikAjUTa vikRta hotA hai to vahA~ vraNazothAtmaka pratikriyA ke lakSaNoM ke sAtha sAtha vRkANu kI mRtyu hokara vahA~ para tantUtkarSa ho jAtA hai| aise vikSata viSamatayA phaile hote haiM tathA unake sidhma ( patches ) pAye jAte haiN| nita naye naye kezikAjUTa RNAnita ( infarcted ) hote rahate haiM / isa kriyA ko tIvra nAbhya vRkapAka (acute focal nephritis ) yA antaHzAlyika vRkkapAka ( embolic nephritis) kahate haiN| isake kAraNa zuklimeha (albuminuria) tathA raktameha pAyA jAtA hai| tvacA ke nIce kI kezikAoM meM antaHzalya ke kAraNa camar3I para aneka nIlohAGka (petechiae ) bana jAte haiM / nakhoM ke nIce ye aGka prAyazaH milate haiN| gauNa alparaktatA ( secondary anaemia) bhI isa roga meM milatI hai para usakA kAraNa ajJAta hai| kahIM kahIM sitakozotkarSa milatA hai para adhikatara sitakozApakarSa ( leucopenia)-jisake sAtha lasIkozotkarSa tathA ekanyaSTikozotkarSa sammilita rahatA hai-milatA hai| ___ Adhunika vaijJAnikoM kI dRSTi meM isa roga meM jvara ke lakSaNa ke atirikta anya koI bhI lakSaNa spaSTa nahIM miltaa| yaha roga Aja bhI asAdhya hai| 6 mAsa se lekara 2 varSa taka rogI jIvita rahatA hai anyathA mara jAtA hai| binA kisI cikitsA ke bhI yaha zIghra mAraka svarUpa kA roga hai / - Ayurveda kI dRSTi se yaha aneka antarvidradhi yukta roga hai aura asAdhya hai "tatra vivaryaH sannipAtajaH / pakko hRnnAbhibastistho bhinno'ntarbahireva vA / / pakkazcAntaH sravan vaktrAt kssiinnsyopdrvaanvitH| tIvrajIvANvIya hRdantazchadapAka (Acute Bacterial Endocarditis) yaha roga atyanta bhayAnaka hai aura mRtyu 1 mAsa ke bhItara hI ho jAtI hai / isa roga ke kAraNabhUta nimna jIvANu haiM zoNAMzana mAlAgolANu phuphphusa golANu tathA svarNapuMja golANu ( staphylococcus aureus) guhyagolANu (gonococci) inake atirikta anya jIvANuoM ke dvArA bhI yaha roga ho sakatA hai jinameM yakSmA daNDANu bhI eka hai| ina jIvANuoM ke dvArA sarvaprathama sArvadehika rogANuraktatA ( septicaemia) yA pUyaraktatA ( pyaemia) hotA hai| usI se raktadhArA dvArA upasarga hRskapAToM ko lagatA hai| rakta kA saMvardha ( culture) karane para ye jIvANu nissandeha pragaTa ho jAte haiM yadyapi vaisA anutIvra hRdantazchada pAka meM nahIM hotA For Private and Personal Use Only

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vikRtivijJAna kyoMki vahAM rakta meM jIvANu virodhI zakti vizeSa rUpa se utpanna ho jAtI hai| yahA~ para roga kI bhayAnakatA ke kAraNa vaha zakti utpanna hone ke pUrva mRtyu ho jAtI hai| isa roga meM anutIvra roga ke samAna hI lakSaNa dekhe jAte haiM / para yahA~ udbheda bar3e tathA bhaMgura hote haiM tathA kapAToM meM Uti kA nAza atyadhika dekhA jAtA hai vizeSa karake guhya golANu (pramehANu)to isa UtinAza ke lie bahuta prasiddha hai| mRtyUttara parIkSA meM kapAToM kA adhikAMza pUrNataH vilupta pAyA jAtA hai / hRdajju ukhar3e hue tathA vidIrNa ( ruptured ) milate haiN| antaHzalya evaM RNAsra khUba milate haiM isake kAraNa visthAnAntarita vidradhiyA~ ( metastatic abscesses ) aneka sthAnoM para milatI haiN| roga kI mArakatA kA ullekha hama kaI bAra kara cuke haiN| phuphphusa golANuja vyAdhi adhika mAraka hotI hai| jIrNa hRdantazchadapAka ( Chronic Endocarditis ) hRdantazchada ke cirakAlIna vraNazotha ke 3 pramukha kAraNa hote haiM: 1-AmavAta 2-phiraGga 3-jAraThika vihAsa AmavAtaja tIvra hRdantazchada pAka ke uparAnta jIrNa pAka hotA hai| kapAToM meM tantUtkarSa hone se kapATIya daloM meM vikarSaNa (distortion) ho jAtA hai jisake kAraNa sannirodhotkarSa yA kapAToM kI akAryakaratA (incompetence ) dekhI jAtI hai| cUrNiyana ke kSetra bhI dekhe jAte haiM jisake kapATa pUrNataH kaThora ho jAte haiN| phiraGgajanya pAka kA varNana phiraGga ke prakaraNa meM dekhanA Avazyaka hai| jAraThika vihAsa (senile degeneration) meM hRtkapATIya daloM para cUrNiyita padArtha camakIlavat jama jAtA hai| usI para rakta ke AtaMca banate rahate haiN| yaha mahAdhAmanika kapAToM para adhika hotA hai / ye kapATa eka dUsare ke sAtha mila jAte haiM aura cUrNiyita ho jAte haiM jisake pariNAmasvarUpa mahAdhAmanika sannirodhotkarSa (aortic stenosis ) ho jAtA hai jisake kAraNa vAmanilaya prAcIra atipuSTa ho jAtI hai / yadi atipuSTi ke bAda samatolana ( compensation ) meM gar3abar3I dikhAI detI hai to nilaya visphAritaho jAtA hai jisake kAraNa dvipatrakakapATa kI akAryakaratA ho jAtI hai| hRtpezI pAka ( Myocarditis) yaha tIvra aura jIrNa donoM prakAra kA hotA hai| hama pahale kaha cuke haiM ki hRtpezI para AmavAta aura daNDANu donoM kA hI prabhAva par3atA hai| isIlie ina donoM ke dvArA hone vAle pAkoM ke varNana meM hRtpezI para jo prabhAva hotA hai use hamane vizeSa karake aGkita kiyA hai| tIna hRspezIpAka bhI do prakAra kA hotA hai eka tIvra vaiSika For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 67 hRtpezIpAka ( acute toxic myocarditis) tathA dUsarA tIvra jIvANvIya hRtpezI pAka (acute bacterial myocarditis) / tIvra vaiSika hRtpezIpAka kA dUsarA nAma jIvitaka hRtpezIpAka (parenchymatous myocarditis) hai| isameM hRdaya moTA tathA bhaMgura hotA hai| hRtpezI tantu sUje, kaNAtmaka hote haiN| ina tantuoM meM pahale meghasama zotha hotA hai phira ve kaNAtmaka ho jAte haiM unakI nyaSTiyA~ viSama evaM vikarSita ho jAtI haiN| hRtpezI kI anuvyasta rekhAeM miTa jAtI haiM aura sidhmoM ke rUpa meM kAcarIkaraNa pAyA jAtA hai| aisA rohiNI tathA Antrika jvara ke kAraNa huI vyAdhiyoM meM prAyaH dekhA jAtA hai| Age bhakSakAyANu praveza karate haiM una para tanturuha pragaNana hotA hai jisake Upara tantUtkarSa ho jAtA hai| tIvra jIvANvIya hRtpezIpAka to eka prakAra kA usI rUpa meM antarAlita saMyojaka Uti kA kozotipAka ( cellulitis ) hai jisa rUpa meM ki tIvra sapUya aicchika pezIpAka hotA hai / isa pAka ke nimna kAraNa hote haiM 1. sArvadaihika pUyakara upasarga ___2. sapUya parihRtpAka kA vistAra 3. jIvANvIya hRdantazchada pAka jisameM jIvANu valayadhamaniyoM dvArA pezI taka pahaMcate haiM, kisI bhI kAraNa se yaha hRtpezIpAka ho, vraNazotha kI sampUrNa pratikriyA yahA~ pragaTa hotI hai / sarvaprathama upasRSTa sthAna kI raktavAhiniyA~ visphArita ho jAtI haiM phira vahA~ bahunyaSTi sitakozAoM kI bharamAra ho jAtI hai phira vahA~ uti-vihAsa hokara pezI-tantuoM kI mRtyu ho jAtI hai| arthAt tIvra sapUya vraNazotha meM jo jo ho sakatA hai vahI yahA~ bhI milatA hai| ___ jIrNahRtpezIpAka ko tantvAbhahRtpezIpAka ( Fibroid myocarditis ) bhI kahate haiN| isa roga meM tIvra pAka kA pramANa prAyazaH nahIM mila paataa| sthAna sthAna para hRtpezI meM tAntavika vraNavastu ke sidhma bana jAte haiM zeSa tantuoM meM thor3e kama yA adhika vihAsa ke lakSaNa milate haiN| uttarottara pezInAza hokara tantUtkarSa meM pariNati kA citra isa vyAdhi meM vizeSa karake dekhA jAtA hai| hRtprAcIra sthUla evaM kaThora ho jAtI hai| kyoMki isa roga meM tIvrAvasthA ke lakSaNa nahIM milate isa kAraNa yaha avasthA kisI pUrva meM huI vyAdhi kA antima utpAda mAnI jA sakatI hai jisake nimna kAraNa diye jAte haiM 1. hRtpezIya phiraMga (vArthina isa para vizeSa jora detA hai) 2. ajJAtakAraNajanya prabala jAraThya ( tonic sclerosis) 3. hRvalaya-vAhiniyoM meM vizoNika apuSTijanya jAraThya 4. hRdvalaya-vAhiniyoM kA phiraMga dvArA mukha sAMkocya 5. AmavAta, Antrikajvara yA anya jIvANuoM yA viSaraktatAoM ke dvArA ThIka hue vikSatoM se bhI yaha dekhA jA sakatA hai For Private and Personal Use Only

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68 vikRtivijJAna yadi hija ke tantu pUla (bundle of His) meM pezI bhAga kI sthAnapUrti tAntava Uti se huI to eka prakAra kA roga hotA hai jise sToka Adama roga (stoke-adam's syndrome ) kahate haiM kyoMki yahAM hRttaraGga meM avarodha utpanna ho jAtA hai / isakA prabhAva yaha hotA hai ki hattaraMga nilayoM ko nahIM pahuMcatI jisase ve hRdgati se mandagati para svecchA se gati karatI hai jaba ki alindoM meM gati svAbhAvika rahatI hai| jisake kAraNa nADI mAndya hotA hai tathA mastiSka meM rakta kI kamI se behozI ke daure par3ate haiM / Acharya Shri Kailassagarsuri Gyanmandir (5) rakta tathA lasavAhiniyoM para vraNazotha kA pariNAma raktavAhiniyAM 3 prakAra kI hotI haiM jo dhamanI, kezAla tathA sirA kahalAtI haiM / ina tInoM kI racanA meM paryApta antara hotA hai / dhamanI meM 3 paTala hote haiM jinameM eka AbhyantarI prAcIrikA ( tunica intima ) kahalAtA hai isakA dUsarA nAma Antara cola bhI hai| isameM cipiTita antazchadIya kozAoM ke eka hI stara dvArA sampUrNa dhamanI kA bhItarI bhAga Astarita ( lined ) rahatA hai / isa Astara ke bAhara eka tanu saMyojI Uti tathA anvAyAma vinyasta ( longitudinally arranged ) pratyAstha tantu ( elastic fibres ) lage rahate haiM / yaha cola atyanta tanu hotA hai tathA saralatA se vidIrNa ho jAtA hai / madhyama prAcIrikA ko madhya cola ( tunica media ) kahate haiM / isa bhAga meM anaicchika arekha pezI ( unstriped muscle ) ke tantu milate haiM jo vAhinI ke cAroM ora vRttAkAra vinyasta ( circularly arranged ) hote haiM / isa bhAga meM bhI anvAyAma vinyasta kucha pezIsUtra tathA pratyAstha tantu milate haiM / yaha madhya cola saba se adhika sthAna gheratA hai tathA paryApta moTA evaM AkuMcana-prasAraNa kA guNa rakhatA hai / tIsarI prAcIrikA bAhyacola ( tunica externa yA tunica adventitia ) kahalAtA hai / yaha tAntava Uti dvArA banatA hai tathA kucha pIta pratyAstha tantu bhI sammilita hote haiM / isI bAhyaMcola meM hokara rakta kI bahuta sUkSma vAhiniyAM bahatI haiM jo vAhinI prAcIra ko poSaka dravya pahuMcAtI haiM / isI meM svatantra nAr3iyoM ( sympathetic nerves ) kA pratAna hotA hai evaM lasavahAyeM dekhI jAtI haiM / dhamanI ke bAhara yojI Uti kI eka kaMcukI car3hI hotI hai jisake andara dhamanI idhara-udhara pratyAkarSaNa ( retraction ) kara sakatI hai / yaha kaMcukI dhamanI para DhIlI-DhIlI car3hI hotI hai / jitanI hI bar3I dhamanI hogI usa para utanI hI bar3I kaMcukI car3hI hotI hai aura vaha kaMcukI usI anupAta meM dRr3ha bhI hotI hai / jitanI hI dhamanI choTI hotI hai usameM unake anupAta se utanI hI adhika pezI evaM pratyAstha tantu kA bhAga pAyA jAtA hai / kezAloM kI racanA bahuta sAdhAraNa hotI hai unameM pezI aura pratyAstha tantu nahIM hotA unakI prAcIreM cipiTita antazchadIya kozAoM ke eka stara dvArA nirmita hotI haiM / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 66 sirAoM kI prAcIreM donoM se vibhinna prakAra kI hotI hai / ve dhamanI prAcIroM se kAphI patalI hotI haiM tathA unameM pezI tantu bhI bahuta alpa mAtrA meM hote haiM / sirAoM ke bAhya aura madhya cola milakara eka hote haiM jo tAntava Uti evaM pratyAstha tantuoM ke saMmizraNa se banatA hai / Antara cola dhamanI ke Antara cola se adhika dRr3ha hotA hai| adhikAMza sirAoM meM kapATa hote haiM jo rakta ko viruddha gati karane nahIM dete| ye arddhacandrAkAra hote haiM aura ve tAntava Uti ke banate haiM jina para sAdhAraNa antazchada car3hA hotA hai / ina kapAoM meM kahIM eka aura kahIM do pallava ( flaps ) hote haiN| dekhane meM ye hRdaya ke mahAdhAmanika yA phuphphusa kapAoM ke sadRza hote haiM / aneka mahatvapUrNa sirAe~ binA kapAToM ke bhI hotI haiM ina sirAoM meM kezikA bhAjisirA, uttara mahAnIlA, adharA mahAnIlA, yAkRtasirA, vRkkasirA, muSkasirA ( spermatic vein ), gudasirA, pRSThanitambasirA, aurvI, manyA Adi sirAe~ vinA kapATa ke hotI hai| jaba kabhI koI sirA praphullita ( distended ) ho jAtI hai to usake kapAToM kA kArya banda ho jAtA hai / banda hone se rakta kA Upara car3hanA aura bhI adhika ruka jAne se vaha aura bhI adhika praphullita ho jAtI hai / isa prakAra eka duzcakra cala par3atA hai / 1 lasIkA saMsthAna meM do pramukha racanAe~ hotI haiM lasIkAvAhiniyAM jinheM lasIkinI yA lasavahA bhI kahate haiM tathA lasIkAgranthiyAM / kezAloM kI prAcIroM se nikala kara lasa Asa-pAsa kI UtiyoM kA poSaNa karatA hai phira antarkozIya sthAnoM meM saMcita hotA hai bahuta se avakAzoM aura syUnoM meM bhI vaha ekatra ho jAtA hai vahAM se lasIkiniyoM dvArA vaha mukhyA rasakulyA ( thoracic duct ) tathA dakSiNA rasakulyA dvArA raktadhArA meM pahuMca jAtA hai / lasavahAoM kI racanA sirA kI racanA se milatI-julatI hotI hai yadyapi usakI prAcIreM sirAprAcIroM se kahIM adhika tanu hotI haiM aura unameM adhika kapATa hote haiM / ye savahAe~ rasakulyAoM kI ora gamana karate samaya bIca-bIca meM aneka lasagranthiyoM meM calI jAtI haiM aura vahAM se punaH apanA mArga banA letI haiM / lasagranthiyAM mAnava zarIra kA eka viziSTa cihna hai anya prANiyoM meM ye itanI adhika nahIM milatIM / manuSya meM inake vizeSa samUha evaM zRGkhalAe~ hotI haiN| ye granthiyAM pariprAvarIya racanAe~ ( encapsulated structures ) haiM / inakA eka vRnta yA dvAra (hilum ) hotA hai jisameM hokara raktavahA evaM lasavahA praveza karatI haiM tathA nikalatI bhI haiM / ina granthiyoM kA saMdhAra ( stroma ) tanu saMyojI Uti dvArA nirmita hotA hai, isa saMdhAra ke avakAzoM meM sitakozA bhare par3e hote haiM / ina granthiyAM se jaba lasa pAra hotA hai to usakA niHsyandana yA pAvana ( filtration ) hotA hai usameM baha kara Ae hue jIvANu, kSepya utpAda ( waste products ) bAhya dravya ( foreign matter ), anya kosA Adi yahIM chAMTa kara pRthak kara diye jAte haiM aura isa kArya ko karane vAle hote haiM-- sitakozA / lasIkAgranthiyAM isa For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 70 www.kobatirth.org vikRtivijJAna dRSTi se zarIra kI surakSA ke lie prathama paMkti banA kara rogoM se vyakti kI rakSA karatI haiM / lasagranthiyoM ke samUhoM evaM zrRMkhalAoM kA jJAna karane ke lie zArIrazAstra ke granthoM kA adhyayana Avazyaka hai aba hama Age vraNazothoM ke dvArA ina vividha cAhiniyoM aura lasa granthiyoM para kyA prabhAva par3atA hai use pragaTa kareMge / I Acharya Shri Kailassagarsuri Gyanmandir dhamaniyoM para vraNazotha kA pariNAma hama yahAM para tIvra aupasargika dhamanIpAka (Acute infective Arteritis), burgara vyAdhi - ( buerger's disease ), sagaNDa bahudhamanIpAka ( polyarteritis nodosa ), abhilopI antaHdhamanIpAka ( obliterative endarteritis ) kA varNana kara rahe haiM : P tIvra aupasargika dhamanIpAka kA kAraNa pUyajanaka jIvANuoM dvArA dhamanI prAcIra kA upasarga hai| yaha upasarga nimna mArgoM se hotA hai 1. dhamanI prAcIra ko raktapradAna karane vAlI vAhiniyoM dvArA 2. dhamanI meM pravAhita rakta ke dvArA 3. kisI sapUya antaHzalya ke dvArA 4. dhamanI ke bAhara kI UtiyoM meM upasarga rahane para upasarga ke do pariNAma hote haiM-- eka ghanAstrotkarSa yadi dhamanI kA antazchada vidIrNa ho jAve, tathA dUsarA vAhinI - visphAra ( aneurysm ) yadi dhamanI ke madhyacola meM vidhi yA vimAza ho jAve to usake pariNAmasvarUpa yaha dekhA sakatA hai| mahAdhamanI tathA anya bar3I dhamaniyoM meM tIvra yA jIrNa vraNazothAtmaka vikSata AmavAtaja upasarga ke kAraNa ho jAyA karate haiM / mahAdhamanI ke bAhyacola meM askApha granthiyA~ dekhI jAtI haiM parantu adhikatara dhamanIya vAhinI ( vasavasorum ) ke dvArA lasIkozAoM kI bharamAra hotI huI dekhI jAtI hai jo madhyacola taka pahu~catI hai / inake kAraNa vAhinI - visphAra nahIM ho paataa| eka bAra AmavAtaja upasarga ho jAne para gauNa upasarga ke rUpa meM mAlAgolANu bhI eka tIvra mahAdhAmanika zodha ke kAraNa banate haiM / hotA hai jisameM sampUrNa dhamanI - prAcIra meM sthAna sthAna para phaTa jAtA hai tathA usameM se eka AzcaryakAraka ghaTanA hai / isameM ghanAstrotkarSa nahIM hotA / anya dhamaniyoM meM aupasargika dhamanIpAka tIvra na hokara anutIvra ( subacute ) vraNazotha ho jAtA hai aura Antara cola naI naI vAhiniyA~ nikalane lagatI haiM yaha eksare yA reDiyama ( tejAtu ) kA jaba kisI sthAna para prayoga kiyA jAtA hai to usakI kiraNeM Antara cola ke antazchada ko vidIrNa kara detI haiM jisake kAraNa eka apUya vraNazotha dhamanI meM utpanna ho jAtA hai aura ghanAtrotkarSa bhI ho jAtA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para praNazotha kA prabhAva burgara vyAdhi ko saghanAna abhilopI vAhinIpAka ( thrombo angiitis obliterance ) kahate haiM / yaha taruNa aura prauDha puruSoM kI vyAdhi hai jo sakthi (inferior extremitiss ) pradeza kI dhamaniyoM meM dekhI jAtI hai| isakA nAma vAhinIpAka isalie diyA gayA hai ki isameM dhamanI evaM sirA donoM meM hI pAka hotA hai aura yaha pAka choTI-choTI dhamaniyoM tathA sirAoM meM adhikatara dekhA jAtA hai| isameM sampUrNa vAhinI meM ekasA ghanAsrotkarSa nahIM hotA api tu kahIM kahIM milatA hai| isameM antazchada vidIrNa ho jAne se ghanAsrotkarSa hotA hai| bIca-bIca meM jahAM vraNazotha nahIM hotA svastha antazchada ke sidhma bane rahate haiN| isa vyAdhi meM sitakozAoM ke atirikta antazchadIya mahAkozA (giant endothelial cells) bhI dekhe jAte haiN| jahAM jahAM ghanAsra bana jAte haiM unakA samaMgIkaraNa hone lagatA hai jo kaNAtmaka Uti ke dvArA hotA hai aura jisake kAraNa usameM se nayI nayI vAhiniyAM banane lagatI haiM jinameM hokara rakta ko AvAgamana punaH prArambha ho jAtA hai| dhamanI ke cAroM ora paridhamanIpAka (periarteritis ) dekhA jAtA hai jisake kAraNa Age cala kara samIpastha dhAtuoM ke sAtha dhamanI ke tAntava abhilAga ( fiborus adhesions) ho jAte haiN| isa vyAdhi kA kAraNa jJAta nahIM hai mukhya lakSaNa pezIgata AkSepa ( muscular cramps ) tathA zUla hotA hai / AkSepoM kA kAraNa pratikSepa prathama svAyatta uddIpana ( reflex sympathetic stimulation ) hai jo vAhinI-saMkoca karake AkSepa utpanna karatA hai, ye AkSepa kotha taka utpanna kara sakate haiN| aisA vicAra hai ki yaha roga aupasargika hai| zUla ke zamana karane ke lie tathA kotha kA parihAra karane ke lie Ajakala prathama svAyattoccheda ( sympathectomy ) jisase svAyattoddIpana zAnta ho jAtA hai tathA vAhinI visphAra adhika se adhika ho jAtA hai| sagaNDa bahadhamanIpAka meM sampUrNa yA kinhIM dhamaniyoM kI prAcIra ke sAtha sAtha aneka choTe choTe gaNDa ( nodules ) dekhe jAte haiN| ye gaNDa vAstava meM choTe choTe vAhinI-visphAra ( aneurysm ) hI hote haiM jo tanika bhI vidIrNa hone para. bahuta adhika raktasrAva ke kAraNa banate haiN| aise raktasrAva kabhI kabhI to mRtyu taka ke kAraNa bana jAte haiN| sagaNDa bahudhamanI pAka 40 se nIcI Ayu ke vyaktiyoM kI eka virala vyAdhi hai jo eka se tIna mAsa taka rahatI hai| jisake lakSaNoM meM bhayaGkara pezIzUla evaM udarazUla ke sAtha sAtha jvara, prasvedAdhikya tathA zarIra bhAra meM hAsa vizeSa karake milate haiN| ' aNvIkSa se dekhane para dhamanI-prAcIra kA vinAza ( necrosis) milatA hai| manI-prAcIra sampUrNatayA yA AMzika rUpa meM viyojita hokara racanAvihIna padArtha ke rUpa meM badala jAtI hai jo isake mukha ko bhara detA hai| prArambhika vikSatoM meM antazchadIya bhazakozAoM kI saMciti milatI hai jinakA sthAna Age calakara bahunyaSTi For Private and Personal Use Only

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72 vikRtivijJAna sitakozA le lete haiN| vijJatoM se kucha haTakara antazchada meM prakSobha ke kAraNa paramacaya (hyperplasia ) hone lagatA hai / isa vinAzakAriNI pravRtti ke kAraNa vAhinI kA vidAra yA visphAra hone lagatA hai / jisake kAraNa raktaSThIvana, raktavamana yA raktameha ke lakSaNa dekhe jAte haiM / ye lakSaNa isa vidAra kI sthiti ke anusAra hote haiM / yadi yahAM hama suzrutokta raktapitta kI samprApti kA smaraNa kareM to bahuta kucha mila jAtA hai :---- 1 pittaM vidagdhaM svaguNairvidahatyAzu zoNitam / tataH pravartate raktamUrdhva cAdho dvidhA'pi vA // para lagaNDa bahudhamanIpAka hI raktapitta ho aisA nahIM api tu isa roga meM raktapitta kA lakSaNa milatA hai, vaha kyoM ? use samajhAne ke liye uparokta uddharaNa rakhA gayA hai / . abhilopI antaHdhamanIpAka eka prakAra kI jIrNa vyAdhi hai jisameM dhamanI ke Antaracola meM kozAoM kA praguNana ( proliferation ) hone lagatA hai jisake Age unameM tantUtkarSa ho jAtA hai / Antaracola meM kozAoM ke bar3hane se dhamanI kA mukha dhIre dhIre choTA hone lagatA hai, jaba bahuta choTA ho jAtA hai to phira eka ghanAtra bana kara usakA mukha pUrI taraha se banda kara detA hai / yaha roga svAbhAvika rUpa se bhI hotA hai tathA vikArajanita bhI hai| prasava ke uparAnta zizu kI kaI una dhamaniyoM meM yaha dekhA jAtA hai jo mAtA se garbha ke lie rakta lAyA karatI thiiN| prasava ke uparAnta garbhAzaya kA saMkoca ( inovution ) prArambha ho jAtA hai usa avasthA meM kaI dhamaniyoM meM svAbhAvika rUpa se yaha dekhA jAtA hai| vRddhAvasthA meM striyoM ke prajananAGgoM ko raktaprApti kama karane meM yahI vidhi siddha hotI hai / vraNa kI ropaNAvasthA jaba pUrNa ho jAtI hai to kaNAtmaka Uti kI dhamaniyoM meM yahI kriyA hotI hai / vikArajanita avasthA meM kucha aise vraNoM meM bhI yaha hotI hai jo kabhI bharate nahIM jaise kauTilya sirA ( varicose ulcers ), AmAzayikavaNa | arbudoM kI dhamaniyoM meM bhI yaha milatA hai / yakSmA aura phiraGga ke vikSatoM meM bhI yaha dekhA jAtA hai / prAyaH yaha choTI dhamaniyoM kA roga hai / vRkka, mastiSka tathA hasta pAda pariNAha kI vAhiniyoM evaM unakI zAkhAoM tathA bar3I dhamanI - prAcIroM ko rakta pradAna karane vAlI dhamaniyoM meM yaha milatA hai / yaha eka prakriyA hai jo pUrNataH vraNazothAtmaka nahIM hotI / For Private and Personal Use Only yaha koI Avazyaka nahIM ki dhamanImukha pUrNataH banda ho jAve / dhamanI ke Antara pradeza meM kozAoM kA praguNana hote rahane se dhamanImukha choTA par3a jAtA hai / prasavoparAnta jaba garbhAzaya ko adhika rakta kI AvazyakatA nahIM rahatI taba isa prakriyA se dhamanImukha bahuta choTe ho jAte haiM jisake kAraNa bahuta kama rakta hI unameM hokara bahatA hai aura garbhAzaya sikur3atA calA jAtA hai /

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vividha zarIrAGgoM para vraNazotha kA prabhAva guDaula kA kathana hai ki isa prakriyA meM Antaracola kI pratyastha zalkikA ( elastic lamina) meM kAcara vihAsa (hyaline degeneration) hone lagatA hai jaba ki vahAM ke kozAoM meM praguNana cala par3atA hai| isa kAcara padArtha ke mAntara pradeza meM antazchada kA eka nUtana stara car3ha jAtA hai isI meM pezI ke tantu bhI praviSTa ho jAte haiN| isa saba kA pariNAma yaha hotA hai ki eka bar3e mukha kI dhamanI ke bhItara eka choTe mukha vAlI dhamanI kA nirmANa hone lagatA hai| phuphphusAbhigA dhamanI kI choTI zAkhAoM meM yahI vyAdhi lagane se sampUrNa phuphphusa meM tantUtkarSa ho jAtA hai| hRdaya kA dakSiNa bhAga atyadhika puSTa ho jAtA hai / isa saba ke kAraNa atyadhika zvAsAvarodha evaM zyAvatA ( cyanosis ) hone lagatI hai aura pUraNa nimitta rakta meM atiraktakozatA (polycythaemia) ho jAtI hai / isa roga ko ayeI kA roga (Ayerza's disease) kahate haiM tathA yaha kyoM hotA hai ise batAnA abhItaka pUrNataH kaThina hai| sirApAka ( Phlebitis) sirAoM meM pAka hone se sabase bar3I AzaMkA unake andara ghanAsrotkarSa ( thrombosis) hone kI rahatI hai jisake kAraNa phauphphusa yA yAkRt antaHzalya bana sakate haiN| yadi jisa kSetra meM pUyana ho rahA ho aura vahIM kI sirA meM ghanAsrotkarSa huA ho to vaha ghanAstra dUSita hokara TUTa phUTa jAtA hai aura usake Tukar3e jahAM jahAM antaHzalya banakara pahuMcate haiM vahIM vahIM vidradhiyAM utpanna kara dete haiN| sapUya annapuccha pAka meM jaba kezikAbhAjisirAjanya pUyaraktatA (portal pyaemia) ho jAtI hai to yakRt meM aneka vidradhiyoM kA kAraNa ghanAsra kA dUSita ho kara TUka TUka ho yakRt meM antaHzalya (emboli) bananA hai| bAlakoM ke tIvra madhyakarNapAka meM pArzvikAkhyA sirA parikhA (lateral sinus) meM dUSita dhanAsrotkarSa hone ke kAraNa dUSita phauphphusa RNAsra banate haiN| Antrika jvara meM sirAoM meM vAhiniyoM ke bhItara rakta kA AtaJcana bahudhA ho jAtA hai / vAtarakta meM dIrghottAnA sirA meM pAka milatA hai| eka sirApAka calAyamAna sirApAka (phlebitis migrans ) kahalAtA hai isameM bAhyA sirAoM ( superficial veins) meM pAka hone lagatA hai unameM sUjana evaM zUla eka ke pazcAt dUsare sthAna para raha raha kara uThatA rahatA hai / isake kaI kAraNa dekhane meM Aye haiM jinameM upasarga, vAtarakta, kapharakta tathA karkaTArbuda (phuphphusa, AmAzaya yA garbhAzaya ke karkaTArbuda) mukhya haiN| sirApAka sAdhAraNa aura aupasargika do prakAra kA hotA hai| sAdhAraNa sirApAka kA kAraNa koI sA AghAta ho sakatA hai| prasavakAla kI mUDhagAbhika kaThinAiyoM se zizu kI asthiyoM meM bhagna hone ke sAtha sAtha yaha prAyaH milatA hai| isa pAka meM sirA sparza se rajju ke samAna prakaTa hotI hai, usameM zUla hotA hai| aupasargika sirA pAka gambhIra vyAdhi hai isI ke kAraNa bhaneka vidradhiyAM itastataH dekhI jAtI haiN| yaha 7, vi0 For Private and Personal Use Only

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. vikRtivijJAna... tabhI sambhava hai jaba kisI Uti meM upasarga kA adhika bala ho kabhI kabhI sirA ke cAroM ora zotha hone para bhI yaha hotI hai usa avasthA ko parisirApAka ( periphlebitis ) kahate haiN| sirApAka meM sirAprAcIra adhiraktita aura sthUla hojAtI hai usakI antazchada lAla aura rUkSa bana jAtI hai| usameM lAla ghanAstra mila sakatA hai| yadi upasarga huA to yaha ghanAsra TUTa kara sthAnika vidradhi kA rUpa dhAraNa kara letA hai| sAdhAraNa sirApAka meM antaHzalya adhika dekhe jAte haiN| ____ vyAdhi kA nidAna karane kI dRSTi se sAdhAraNa sirApAka vistRta pAdasirAoM ( varicose veins ) meM dekhA jAtA hai tathA antaHdIrghottAnA sirA ( internal saphenous vein) meM dekhA jAtA hai| isakA prArambha sahasA hotA hai| pahale sthAnika tIvra zUla rahatA hai tathA kucha jvara ho jAtA hai jisake sAtha thor3A kampa tathA becainI ( malaise ) rahatI hai| yadi sirA bAhyA huI to usameM dabAne para zUla milegA aura sirA kA sampUrNa mArga sUja aavegaa| dabAkara dekhane se sampUrNa sirA rassI sI kar3I dikhegI aura jahAM jahAM sirA meM kapATa hote haiM vahAM vahAM adhika phUlI huI milegii| thor3e samaya pazcAt sampUrNa tvacA jo sirA ke Upara hotI hai lAla aura sUjI sI ho jAtI hai| aMga vizeSa kI kriyA zakti manda par3a jAtI hai tathA sirA dvArA siMcita pradeza meM bhI sUjana milatI hai / jvara aura zUla thor3e dina bAda kama ho jAte haiM para zotha, raktavarNatA, sparzAkSamatA aura utphullatA barAbara banI rahatI hai / yadi pUyotpatti hogaI to eka sthAnasImita anutIvra vidradhi bana jAtI hai| yadi sirA gambhIrA huI to sirApAka ke lakSaNa gaharAI ke kAraNa adhika na pAye jAkara sampUrNa aGga meM bahuta adhika sphAya yA zopha (oedema) ho jAtA hai| sampUrNa aMga dRr3ha aura phUlA huA evaM zvetAbha ho jAtA hai jise dabAne se gaDDhA par3a jAtA hai (pitting on pressure ) / yahAM bhI zUla thor3e samaya raha kara zAnta ho jAtA hai para sphAya saptAhoM calatA hai| prasavoparAnta aurvI sirA meM pAka hone ke kAraNa striyoM ko prAyaH zvetapAda ( white leg ) yA phlegmeziyA elbA Dolensa nAmaka roga ho jAtA hai| aupasargika sirApAka sahasA prArambha hotA hai jvara tathA kampana ( rigors) pAyA jAtA hai| yadi sirA bAhyA huI to vraNazotha ke vibhinna lakSaNa milate haiM para gambhIrA sirAoM meM ve lakSaNa pratyakSa nahIM hote vahA~ to prakampapUrvaka kaI bAra jvara car3hanA tathA pUyaraktatA ke lakSaNa milate haiN| prAyaH gambhIrA sirAe~ hI isa pAka se prabhAvita hotI haiN| ___ lasIkApAka ( Lymphangitis) yaha tIvra aura jIrNa do prakAra kA hotA hai| tIvralasavahApAka pariNAha kI lasavahAoM meM tIvra vraNazotha hone ke kAraNa hotA hai jo upasarga ke kAraNa (vizeSa karake pUyajanaka mAlAgolANu dvArA) dekhA jAtA hai| kabhI kabhI thor3I khursaTa ( scratch) tvacA para laga jAne se yA koI dUSita phusI uTha Ane se bhI isakA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva prArambha ho jAtA hai| isake kAraNa lasavahAoM kI prAcIra lAla aura sthUla ( thickened ) ho jAtI hai usake AsapAsa kI UtiyoM meM pAka prArambha ho jAtA hai| yaha pAka prakriyA lasavahA ke sampUrNa mArga se lekara pAsa kI lasagranthiyoM taka pahu~ca jAtI hai jo use Age bar3hane se roka detI haiM para kabhI kabhI to sArvadaihika rogANuraktatA ( septicaemia) bhI hotI huI dekhI jAtI hai| vAhiniyoM meM lasa AtaMcita ho jAtA hai| samIpastha UtiyoM meM hue vraNazotha ko parilasIkApAka (perilymphangitis) kahate haiN| ina pAkoM meM pUyana prAyaH prArambha ho jAtA hai jisake kAraNa eka prasI kozotipAka (spreading cellulitis) ho sakatA hai yA lasIkA pranthiyoM meM bahuta bar3I vidradhi bana sakatI hai| - isa roga kA prArambha sahasA hotA hai aura 102-103 taka jvara ho jAtA hai jo kampa ke sAtha car3hatA hai, nAr3I druta ho jAtI hai tathA rogI kI becainI bar3ha jAtI hai use vamana aura ziraHzUla bhI hotA hai| jisa sthAna se pAka hotA hai vahA~ se lasagranthiyoM taka lAla rekhAe~ bana jAtI haiM jo sUjI huI tathA sparzAkSama hotI haiN| inameM atyanta dAha hotA hai / kabhI kabhI kaI lasavahAoM meM eka sAtha pAka hone se eka lAla paTTI sI bana jAtI hai jise chUnA bicchU ke DaMka ke samAna lagatA hai Age calakara rogANuraktatA ke lakSaNa prakaTa hone lagate haiN| yadi rogAkramaNa nirantara huA to tAntava vraNavastu bana jAne ke kAraNa lasavahAe~ abhilupta (obliterated ) ho jAtI haiM jisase lasIkAjanya sphAya yA zlIpada, ( elephantiasis ) bana jAtI hai| lasavahAoM meM vraNazotha kA pariNAma prAyaH pUyotpatti yA pUyana meM huA karatA hai| jisake kAraNa dhUmila mAMsavargIya gaNDa ( dusky brawny swelling ) prakaTa ho jAtA hai jo zIghra hI mRdu hokara uccAvacana ( fluctuation) karane lagatA hai| kabhI kabhI vidradhiyoM kI eka zrRMkhalA bana jAtI hai jo sadaiva lasa ke pravAha kI dizA meM hotI hai / samIpastha eka do lasapranthiyA~ bhI phUTa kara vidradhi kA rUpa dhAraNa kara letI haiN| ____jIrNa lasavahApAka phiraGga athavA yakSmA ke kAraNa hotA hai jise phiraGga aura yakSmA ke adhyAyoM meM dekha sakate haiN| (6) jAlikA-antazchadIya saMsthAna para vraNazotha kA pariNAma _____jAlikA-antazchadIya saMsthAna ( reticulo-endothelial system) eka aMga meM sImita nahIM hai, vaha plIhA, asthimajA, yakRt , lasIkAgranthiyA~ tathA una sabhI sthAnoM meM jahA~ lasAbha ati hai milatA hai| hama yahA~ para kevala lasIkAgranthipAka (lymphadenitis) kA varNana kreNge| ___ lasIkAgranthipAka kA pradhAna kAraNa upasarga hai| yaha tIvra aura jIrNa do prakAra kA hotA hai| tIvra lasIkAgranthipAka uttarajAta roga hai| lasIkAgranthi ke dvArA apavahita kSetra meM upasarga hone para vahA~ se vaha granthi taka jAkara tIvra pAka kiyA karatA hai| tvacA yA zleSmala kalA meM coTa lagane tathA upasarga ho jAne se bhI prAyaH For Private and Personal Use Only

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76 vikRtivijJAna samIpastha lasagranthiyoM meM pAka pAyA jAtA hai / prAthamika upasarga aura lasIkAgranthipAka ke madhya kI lasavahAoM meM bhI pAka ho yaha Avazyaka nahIM para jaba hotA hai to ve lAla rekhA sadRza sparzAkSama hotI haiN| tIvra lasIkAgranthipAka sAdhAraNa (simple ) evaM sapUya ( suppurative ) do prakAra kA ho sakatA hai| yadi upasarga halakA hai to sAdhAraNa anyathA sapUya hotA hai| sAdhAraNa tIvra lasIkAgranthipAka meM sarvaprathama lasagranthi sUja tathA phUla jAtI hai, usameM raktAdhikya ho jAtA hai jisake kAraNa usakA varNa lAla ho jAtA hai| yadi kaI granthiyoM meM pAka ho to ve pRthaka pRthaka ginI jA sakatI haiN| granthi ke bhItara kA padArtha mRdu evaM gordamaya (pulpy ) hotA hai jo sthAna sthAna para thor3A thor3A raktasrAvAGkita hotA hai| aNvIkSa dvArA dekhane para zoNAvakAza (sinusoids ) rakta se paripUrNa milate haiM tathA kozotpAdaka kendroM (germinal centres ) meM praguNana tejI se hotA huA milatA hai usakA pramANa bar3e bar3e jAlikIya kozAoM meM sUtribhAjikIya aMkoM ( mitotic figures) kA milanA hai / antazchadIya kozA bhI sUje hue hote haiM tathA bar3e ho jAte haiM jo praguNana ko pramANita karate haiN| __ Antrika jvara meM lasagranthiyoM ke zoNAvakAzoM ke kozAoM kA paramacaya bahuta adhika milatA hai bIca bIca meM nAbhyamRtyu (focal necrosis) ke kSetra bhI dekhe jAte haiN| sAdhAraNa lasIkA granthipAka kI prakriyA thor3A ugra hone para sapUyalasIkA granthipAka kA kAraNa bana jAtI hai / yaha prAyaH bAhyA yA taloparika ( superfeial) granthiyoM meM jitanA adhika milatA hai utanA gaMbhIra (deep) granthiyoM meM nhiiN| pUya na hone para eka tantvimaya niHsrAva granthi ko bhara detA hai jisameM sitakozIya pAragamana (leucocytic diapedesis) hotA rahatA hai jisake kAraNa granthi ke gahvaroM ( loculi ) meM pUya bhara jAtA hai aura vidradhi kI utpatti pramANita ho jAtI hai / pUyana ke sAtha sAtha parilasagranthipAka (periadenitis) granthi ke prAvara tathA samIpastha UtiyoM meM pAka hone se ho jAtA hai| mahAsrota meM upazleSmakalA ( submucosa ) meM upasthita lasAbhasimma (lymphoid patches ) kA upasarga hokara pUyana hone se syUnikIya vidhi ( follicular abscess ) bana jAtA hai jisake vidIrNa ho jAne para vahA~ syUnikIya vraNa raha jAte haiM jinake mukha A~toM meM khulate haiN| lasAbha utiyoM ke pUyana kA sudhAra tantUtkarSa dvArA hotA hai| jIrNa lasIkAgranthipAka yA apacI meM nimna lakSaNa sAdhAraNatayA dekhe jAte haiM:1. lasagranthi kI vRddhi / 2. jAlikAntazchadIya kozAoM kA prgunnn|| 3. thor3A yA bahuta tantUtkarSa / inhIM tIna lakSaNoM para anya vizeSa lakSaNa avalambita hote haiN| jIrNa lasIkAgranthipAka bhI sAdhAraNa tathA vizeSa karake do prakAroM meM kahA jA sakatA hai| sAdhAraNa jIrNa lasIkAgranthipAka gale kI pranthiyoM meM usa samaya For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva milatA hai jaba mukha, dAMta, tuNDikA granthiyA~, vAyu koTarAdi meM upasarga ho; AmAzaya vraNa yA vistIrNa sirA vraNa kA apavahana karane vAlI granthiyoM meM bhI yaha dekhA jA sakatA hai, karkaTArbuda ke kSetroM kA apavahana karane vAlI granthiyoM meM visthAnAntara ( metastasis) ke pUrva dekhA jAtA hai; tathA tIvra lasagranthipAka ke pariNAmasvarUpa bhI granthiyoM meM milatA hai / sAdhAraNa jIrNa lasIkAgranthipAka meM granthiyAM moTI hone ke sAtha hI sAtha kaThina aura eka dUsare se saTI huI ho jAtI haiM / saTane kA kAraNa parilasagranthipAka hotA hai / aNvIkSa se dekhane para tAntava saMdhAra (fibrous stroma) phUla jAtA hai tathA prAvara vraNazothAtmaka tantUtkarSa ke kAraNa sthUla ho jAtA hai / utpAdaka syUnikAoM kI saMkhyA meM bhI paryApta vRddhi milatI hai / jAlikIya kozAoM ke kendrIya kSetra bhI phUla jAte haiM. unameM praguNana tIvra ho jAtA hai / zoNAvakAzoM ke antazchadIya kozAoM meM paramacaya hone se kitane hI protikozA ( histiocytes ) svatantra ho jAte haiM / yadyapi ina granthiyoM meM paramacaya (hyperplasia ) itanA hotA hai phira bhI unakA AkAra svAbhAvika hI rahatA hai Age calakara tantUskarSa ke kAraNa AkAra meM kucha viSamatA dekhI jAtI hai / 77 jIrNa sagranthipAka kA eka udAharaNa apacI hai / isakA varNana jo zAstrakAroM ne diyA hai use par3hakara sandeha ke lie sthAna nahIM rhtaa| yahI nahIM jIrNa lasagranthipAka ko apacI nAma se bhI kahA jA sakatA hai / vAstava meM apacI sAdhAraNa evaM viziSTa: donoM prakAra ke jIrNa sagranthipAka ke lie vyavahRta hone vAlA zabda hai / hama apacI kA suzrutokta uddharaNa nIce de rahe haiM: - hunvasthikakSAkSakabAhusandhimanyAgaleSUpacitaM tu medaH / granthi sthiraM vRttamathAyataM vA snigdhaM kaphazcAlparujaM karoti // taM granthibhistvAmalakAsthimAtrairmatsyANDajAlapratimaistathA'nyaiH / ananyavarNairupacIyamAnaM cayaprakarSAdapacIM vadanti // kaNDUyutAste'lparujaH prabhinnAH sravanti nazyanti bhavanti cAnye / maidaHkaphAbhyAM khalu roga eSa sudustarI varSagaNAnubandhI || (su. saM. ni. sthA. 11 ) viziSTa jIrNa sagranthipAka yakSmA tathA phiraMga ke kAraNa hote haiM / apacI sAdhAraNa kI apekSA viziSTa meM adhika AtI hai ataH isakA vistRta vicAra hama yakSmAjanya jIrNa sagranthipAka ke varNana ke sAtha yathAsthAna kareMge / For Private and Personal Use Only (7) zvasanasaMsthAna para vraNazotha kA pariNAma isa prasaGga meM hama nAsA, galA yA grasanI ( pharynx ), svarayantra, kaNThanAlI, zvAsanalikA, phuphphusa evaM phuphphusacchada ke pArkoM kA varNana upasthita kareMge / vikRta zArIra ke jJAna ke pUrva yadi thor3A prakRta zArIra kA manana kara liyA jAve to viSaya ko samajhane meM bahuta sI kaThinAiyA~ tirohita ho jAveMgI /

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78 vikRtivijJAna nAsAguhA nAsAjavanikA ke dvArA 2 bhAgoM meM vibhakta ho jAtI hai| pratyeka bhAga kA prArambha eka bAhya nAsAchidra se hotA hai usake pazcAt guhA ke Upara kI chata, bAhara kI ora kI prAcIra, pharza bhUmi ( floor ), tathA pazca nAsAchidra hotA hai| varNana kI suvidhA ke lie pratyeka bhAga ko 3 kSetroM meM bA~TA jA sakatA hai jisameM eka nAsAlinda ( nasal vestibule ) kahalAtA hai yaha bAyanAsAchidra ekadama saTA huA hotA hai isameM tvacA bichI rahatI hai jisa para bAla ugate haiN| dUsarA kSetra nAsAsuraGgAtoraNa ( nasal atriun ) kahalAtA hai| yaha nAsAlinda se madhyasuraMgA ( middle meatus ) taka rahatA hai| isameM nAsA zleSmalakalA bichI rahatI hai| yahA~ nAsAguhA paryApta caur3I hotI hai tIsarA nAsAsuraMgAoM kA kSetra hotA hai| nAsA meM 4 suraMgAe~ haiM pahalI nAsA adhosuraMgA nAsA bhUmi evaM adhaHzuktikA ( inferior conche) ke bIca meM hotI hai isa suraMgA meM nAsApraNAlI ( nasal duct ) khulatI hai| dUsarI nAsAmadhyasuraMgA ( middle nasal meatus ) hai jo adhaH aura madhya zuktikA ke bIca meM rahatI hai| isameM kaI mahattvapUrNa racanAeM pAI jAtI haiM jinameM eka jharjharIyasphoTa ( bulla ethmoidalis ) hai jo madhya zuktikA ke ThIka nIce phUlA huA bhAga hai jo jhajharAsthi ke madhyabhAga meM sthita vAyukozAoM ke kAraNa banatA hai isa sphoTa ke sAmane mur3A huA jharAsthi pravarddhana (uncinate process of the ethmoid bone ) hotA hai| sphoTa aura pravarddhana ke madhya meM eka arddhacandrAparikhA ( hiatus semilunaris ) hotI hai| yaha parikhA Upara aura Age kI ora bar3hakara eka kUpikA ( infundibulum ) taka jAtI hai jahA~ yA usake samIpa puraznAsAsrota (fronto nasal sinus) khulatA hai| isa parikhA ke pichale bhAga meM hanugarbhakoTara ( maxillary antrun ) khulatA hai| isI parikhA meM jhajharAsthi ke agra aura madhya vAyu kozA bhI khulate haiN| tIsarI nAsA UrdhvasuraMgA yaha madhya aura Urdhva zuktikAoM ke madhya meM hotI hai isameM jharjharAsthi ke pazca vAyukozA khulate haiM / cauthI jAtUka jhajharikakhAta ( sphenoethmoidal recess ) kahalAtI hai isameM jatukAsthi ke koTara khulate haiN| jharjhara paTala (cribriform plate ) ke bhAga ko chor3akara jahA~ ghrANendriya kA adhicchada hai tathA nAsAlinda ke bhAga ko chor3akara jahA~ tvacA hai zeSa sampUrNa parikhAoM yA anya sthAnoM meM nAsA kI zleSmalakalA hI bichI huI hai / yaha kalA romAvRta ( ciliated ) hai aura usakA nIce kI paryastha se sIdhA sambandha rahatA hai / yaha una saba praNAliyoM ke sAtha bhI saMtata rahatI hai jo nAsAguhA se sambaddha rahatI haiN| vAyu ke kozAoM aura koTaroM meM kalA yadyapi mRdu adhika hotI hai evaM romAvRta hotI hai para usakA sambandha isase avazya rahatA hai / adhaHzuktikA tathA nAsAjavanikA ke nicale bhAga meM yaha kalA kucha moTI ho jAtI hai usameM sirAjAla kI bhI adhikatA hotI hai usake kAraNa vaha ucchIrSaka Uti ( erectile tissue ) sadRza lagatI hai| nAsApraNAlI ke kAraNa nAsAguhA kA sambandha azruyantra se sadaiva banA rahatA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva nAsA ke pazvabhAga ke pIche galA hai| yadi hama mukha ko khUba caur3Akara khola leM tathA jIbha ko dabAkara AdhA zabda kareM to galA yA grasanikA kA sampUrNa kSetra bhale prakAra dekhA jA sakatA hai| vahA~ hameM komala tAlu aura kAkalaka (uvula) dekhane ko milate haiM / komala tAlu ke sAmane se tathA pIche se do galatoraNikAe~ ( fauces ) eka purastambhikA (anterior pillar of the fauces ) dUsarI pazcima stambhikA ( posterior pillar of the fauces ) nikalI huI dekhI jA sakatI haiN| ye toraNikAe~ zleSmalakalA ke bhaMjana ( folds ) se banatI haiM jinake garbha meM pezI rahatI haiN| ye peziyA~ kaNThasaMkocinI ( constrictor of the pharyux) hotI haiN| donoM toraNikAoM ke bIca meM donoM ora eka eka tuNDikAgranthi (tonsil ) rakhI rahatI hai| jahA~ toraNikAe~ milatI haiM vahA~ tuNDikAoM ke Upara eka khAta (recess) chUTA rahatA hai ise tuNDikorddhakhAta ( supratonsillar fossa ) kahate haiN| tuNDikAgranthi ke svatantra dharAtala para zleSmalakalA bichI rahatI hai jisameM tuNDikIya gau ( crypts ) ke mukha Akara khulate haiM / ina goM meM bhI isI zleSmalakalA kA adhicchada rahatA hai aura donoM saMtata rahatI haiN| bAharI yA gaMbhIra tala para tuNDikA granthi Uti se AcchAdita rahatI hai jo eka prakAra kA apUrNa prAvara ( incomplete capsule ) sA mAlUma detA hai / isI prAvara ke kAraNa binA kisI kaThinAI ke grasanI ko hAni binA pahuMcAe hue tuNDikoccheda kiyA jA sakatA hai / zeSa sampUrNa grasanI kI zleSmalakalA zalkAdhicchadIya kozAoM ( squamous cells) dvArA nirmita tathA annanalikA kI zleSmalakalA se saMtata hotI hai| _ grasanI ke nicale bhAga se svarayantra (larynx)prArambha hotA hai| svarayantra eka prakAra kA baksa hai jo kRkATaka (cricoid ) evaM avaTuka ( thyroid ) taruNAsthiyoM dvArA banatA hai parantu jisameM adhijibikA ( epiglottis) tathA ghATikA ( arytenoid) kAsthiyA~ bhI bhAga letI haiN| svaratantriyA~ caturtha graivika kazerukA kI sIdha meM hotI haiN| sAmane avaTukA taruNAsthi ke koNa ( notch ) meM kucha nIce usake patrakoM ( alae ) se jur3I rahatI haiM tathA pIche kI ora ghATikAoM ke svaravardhanakoM ( vocal processes ) se jur3I hotI haiN| unake Upara kUTa svaratantriyA~ ( false vocal cords ) hotI haiM jo snAyavIya tathA mAMsa tantuoM se yukta guhApaTTiyA~ ( ventri. cular bands ) haiM jinake Upara zleSmalakalA kA eka bhaMja ( fold ) car3hA hotA hai| kUTa svaratantriyA~ Age svaratantriyoM ke Upara cipakI rahatI haiM aura pIche kI ora svarayantra ke pAzrthoM meM koNikA ( cuneiform) kAsthiyoM meM vilIna ho jAtI haiN| svaratantriyoM ke bIca ke vidara ( fissure ) ko tantrI dvAra ( rima of the glottis) kahate haiM / isake bhI 2 bhAga hote haiM jinameM agrabhAga svarakArI hotA hai aura lambA hotA hai tathA pazcabhAga choTA evaM zvasanakArI hotA hai| svarayantra sarvatra zleSmalakalA romAvRta yA pakSmala ( ciliated ) hotI hai, parantu svaratantriyoM para yaha bahuta patalI evaM tanI huI hotI hai aura vahA~ roma nahIM hote tathA adhijihvA ke pazca bhAga For Private and Personal Use Only

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Go vikRtivijJAna para yaha zalkAdhicchadIya hotI hai / kUTa svaratantrI aura svaratantrI donoM ke bIca meM eka eka koTara ( sinus ) hotA hai / svarayantra kI zleSmalakalA bar3I hRSa ( sensitive ) hotI hai / yaha hRSatA kaNThanADI taka meM milatI haiM para jaba vaha dvivibhakta ho jAtI hai to pUrNataH samApta ho jAtI hai / Acharya Shri Kailassagarsuri Gyanmandir svarayantra ke nIce kRkATikA kAsthi se nIce kaNThanADI (trachea ) prArambha hotI hai yaha 4 - 43" lambI kAsthi ke bane challoM ke milane se banatI hai / ye challe 15 se 20 taka hote haiM pIche kI ora ye ghor3e kI nAla kI taraha khAlI hote haiM jise tantu pratyastha Uti se pUrA kiyA jAtA hai / pIche kI ora anaicchika pezI tantu cipake hue rahate haiM ve kaNThanADI ke mukha ko choTA kie rahate haiM / kaNThanADI meM lAbha zleSmakalA bichI rahatI hai jisameM adhicchadIya kozA pakSmala evaM stambhAkAra ( columnar ) hote haiM / pacmoM kI dizA UrdhvagAmI hotI hai / kaNThanADI ke samAna hI zvAsanAleM ( bronchi ) hotI haiM / aba hama Age zvasanasaMsthAna para vraNazotha kA jo pariNAma hotA hai use prakaTa kareMge / pratizyAya athavA nAsA ke vraNazotha ( Rhinitis ) tIvra ( acute ), sapUya ( purulent ), jIrNa paramacayika ( chronic hypertrophic ) tathA jIrNa acayika ( chronic atrophic ) isa prakAra nAsA ke vraNazotha ke 4 prakAra zalyajJoM ne yathAsthAna likhe haiM / AyurvedIya zAlAkyajJoM ne nAsA ke kaI vraNazothoM kA varNana kiyA hai / sarvaprathama unhoMne nAsA ke nAsAlinda kSetra ke pAka kA varNana kiyA hai / yahA~ para unhoMne batalAyA hai : ghrANAzritaM pittamarUMSi kuryAt yasminvikAre balavAMzca pAkaH / taM nAsikApAkamiti vyavasyed vikledakothAvapi yatra dRSTau // (su. u. ta. a. 22 ) nAsikAstha pitta nAsAlinda pradeza meM sarvaprathama aruMSikAe~ ( nasal furunculosis ) utpanna kara detA hai jisake pariNAmasvarUpa pAka balavAna ho jAtA hai arthAt vahAM atyadhika vedanA hotI hai sitakozAoM kA ekatraNa bar3ha jAtA hai adhiraktatA ho jAtI hai jisase ArdratA tathA pUtibhAva bhI bar3hane lagatA hai / isa avasthA ko nAsApAka kahA jAtA hai / nAsikA ke vividha pAkoM ke lie Ayurveda ne vividha nAmoM kA prayoga kiyA hai | nAsApAka yA nAsikApAka kA spaSTa artha nAsAlinda yA bahirnAsikA pAka ( inflammation of the vestibule of the nose ) hai| jise hama sardI jukAma ( common cold ) nAma dete haiM usakA AyurvedIya nAma pratizyAya yA tIvra nAsAkalApAka ( acute rhinitis ) hai | tIvra nAsAkalApAka nAsAkalA meM rakta kI adhikatA ho jAtI hai jisake kAraNa zleSmala kalA kI granthiyoM kI kriyA bar3ha jAtI hai aura bahuta tarala srAva nAsA se hone lagatA hai| nAsA - For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 81 kalA ke pakSmoM ( cilia) kI bhI kriyA vRddhi ho jAtI hai jisake kAraNa nAsA kA srAva zIghra zIghra bAhara nikAla diyA jAtA hai| jyoM jyoM dina adhika bItate haiM nAsAkalA kA bahuta aMza TUTa phUTa jAtA hai pacamoM kI kriyA kama ho jAtI hai aura srAva itanA gAr3hA hone lagatA hai ki vaha bAhara nahIM pheMkA jA pAtA aura nAsAchidroM kA avarodha ho jAtA hai| isI srAva meM jaba sthAnika kozAoM ke nirmoka bhI mila jAte haiM to usakA varNa pIlA ho jAtA hai| vraNazotha kI pakkAvasthA pUyotpattikAraka hotI hai isI se pakka pratizyAya ke srAva meM pUya kI upasthiti anahonI ghaTanA nahIM hai| isa roga meM jvara honA Avazyaka nahIM hai| thor3e samaya bAda sthiti sAdhAraNa ho jAtI hai| isake hetuoM ke sambandha meM suzruta likhatA hai nArIprasaGgaH ziraso'bhitApo dhUmo rajaH zItamatipratApaH / sandhAraNaM mUtrapurISayozca sadyaH pratizyAyanidAnamuktam // cayaM gatA mUrddhani mArutAdayaH pRthak samastAzca tathaiva zoNitam / prakopyamANA vividhaiH prakopaNairnRNAM pratizyAyakarA bhavanti hi // (su. u. ta. a. 24) strIsahavAsa, ziraHzUla, dhUma, raja, zItAdhikya, vegavidhAraNa, pratizyAyakAraka sadyojanaka hetu haiM yathA doSoM kA sira meM saMcita honA aura rakta kA bhI saMcita honA tathA krodhAdi aneka prakopaka kAraNoM se unakA prakupita honA ye pratizyAya ke kAlAntara janaka kAraNa haiM donoM prakAra ke kAraNoM se upasarga tathA Rtugata prabhAva donoM kA bhAva pUrNataH AtA hai jinheM navInajana mAnate haiN| ve mAnate haiM ki yaha dazA aupasargika bhI haiM tathA sAMsparzika ( contagious ) bhii| ___ nAsAkalA pAka yA pratizyAya ko AyurvedajJoM ne vAtika, paittika, zlaiSmika sAnnipAtika tathA raktaja karake mAnA hai| vAtika meM tanu srAvAdhika, paittika meM uSNapIta srAvAdhikya, zlaiSmika meM guru zIta zukla srAvAdhikya, dvandvaja yA tridoSaja meM inhIM lakSaNoM kA sammelana tathA raktaja meM sarakta srAvAdhikya milatA hai| raktaja meM kRmi taka milane kA itihAsa hai| ___ sapUya nAsAkalApAka ( Purulent rhinitis) se navIna use lete haiM jisameM zuddha pUya hI nissarita hotA hai| yaha eka zizu yA bAla roga hai| zleSmA aura pUya kA mizra to zlaiSmika pratizyAya meM A jAtA hai / zuddha pUya ke nAsArandhroM se nikalane ke kaI kAraNa haiM unameM sahajaphiraMga, bAhya dravya kI upasthiti yA kaMThazAlUkoM (adenoids ) kA honA mukhya haiN| ___ jIrNa paramacayika nAsAkalApAka pratizyAya kI uttarakAlIna avasthAmAtra hai| bahuta samaya taka pratizyAya rahane ke kAraNa na kevala mRdu api tu asthi Adi kaThina UtiyoM meM bhI paramacaya hone lagatA hai tathA vahAM jIrNa adhiraktatA bhI pAI jAtI haiisa roga meM nAsA ke sabhI bhAgoM kA praguNana hone lagatA hai zleSmala kalA, zleSAbha bhAga, lasAbha bhAga, granthikIya (glandular) bhAga aura raktavAhinya ( vascular ) bhAga sabhI meM praguNana dikhAI par3atA hai| adhozuktikA para isa praguNana kA vizeSa For Private and Personal Use Only

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82 vikRtivijJAna prabhAva par3atA hai| vizeSa karake usakA pazca bhAga to bar3ha kara choTe bera ( mulberry ) sA phUla jAtA hai / isa roga meM nAsAvarodha, tanu tathA zleSmapUyIya nAsAkhAvAdhikya tathA chIMkoM kA AnA Adi lakSaNa milate haiM / acayika nAsAkalApAka ( Atrophic rhinitis ) ko pInasa yA apInasa kahA jAtA hai / isI kA eka nAma pUtinasya ( ozaena ) bhI hai / yaha eka jIrNa kAlika avasthA hai / isameM nAsakalA kI apuSTi yA zoSa ( artophy ) hone lagatA hai jahAM pacamala zleSmalakalA rahatI hai vaha badala kara Ayataja ( cuboid ) yA stRta ( stratified ) ho jAtI hai / tAntava Uti meM vRddhi ho jAtI hai / usameM gola aura prarasa kozoM kI bharamAra ho jAtI hai / zleSmalakalAstha granthiyAM sUkSma ho jAtI haiM tathA raktavAhiniyAM saMkIrNa yA pUrNataH chidra vihIna ho jAtI haiM nAsA kA srAva ina saba kAraNoM se ruka jAne ke kAraNa khuraMTa bahuta nikalate haiM aura durgandha bhI bahuta AtI hai / yahI parivartana zuktikA tathA anya asthiyoM meM bhI dekhA jA sakatA hai / nAsA koTaroM ke mArgoM kA avarodha hone se unake rUddha srAvoM meM aneka pUyakArI yA vikArI jIva Akara bar3hane lagate haiM / isake kAraNa nAsAzoSa aura pUtinasya ye do lakSaNa vizeSa milate haiM / nAsAzoSa ko rAinAiTisa sikkA ( rhinitis sicca ) bhI kahate haiM isameM nAsAguhA ke sUkha jAne se zvAsa lene meM avarodha ho jAtA hai / zoSa kA kAraNa vRddhiMgata vAyu kI rUkSatA aura pitta kI uSNatA hotI hai jo zleSmA kA zoSaNa karatI hai isI ko bhAvamizra ne nimna zabdoM meM prakaTa kiyA hai : - ghrANAzrite zleSmaNi mArutena pittena gADhaM parizoSite ca / samucchvasatyUrdhvamadhazca kRcchrAdyastasya nAsAparizoSa uktaH // ise videha ne bhI puSTa karate hue likhA hai vizeSa kapha ke sAtha rakta kA zoSaNa bhI batalAyA hai : : vAtapittau yadA prANaM kaphara ktaM vizoSayet / tadAsyAduchvasennAsAttasya zuSkaM vidhIyate // bhRzaM zuSkAvacUrNena nAsAzoSaM tu taM viduH / - pUtinAsA (ozena ) meM durgandha kA kAraNa batalAte hue videha likhate haiM: kaphapittamasRmizraM saMcitaM mUrdhni dehinAm / vidagdhamUSmaNA gADhaM rujAM kRtvAkSizaMkhajAm // tena prasyandate prANAtsaraktaM pUtipItakam / pUtinasyaM tu taM vidyAtprANakaNDujvarapradam // mUrdhA ( sira yA puraHkapAlAsthi tathA jharjharAsthi ke nAsA koTaroM ) meM kaphapitta aura rakta saMcita ho jAte haiM jo USmA ke dvArA vidagdha ho jAte haiM aura nAsAsrAva ko gAr3hA kara dete haiM jisake kAraNa nAsA tathA zaMkhapradeza meM zUla ( pain in the eyes and temples ) kara dete haiM tathA nAsA se raktayukta pIlA badabUdAra srAva nikAlate haiM jisake kAraNa rogI ko durgandha kA spaSTa jJAna hotA hai thor3I khujalI tathA jvara bhI jJAta hotA hai / AyurvedIya paddhati se vikRti nidarzinI isa zailI ke jAna lene para phira kauna navIna zailI kI AvazyakatA rahatI hai| vAyu koTaroM meM pAka hone For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva se bhI yaha dazA banatI hai use sapUya vAyukoTarapAka ( suppurative sinusitis) kahate haiM / 83 rohiNI daNDANu ke kAraNa nAsA se lagAtAra cirakAla taka praseka hotA rahatA hai use rohiNIya nAsAkalApAka ( diphtheritic rhinitis ) kahate haiM / tuNDikerI yA tuNDikApAka ( Tonsillitis ) aSTAGgasaMgrahakAra ne mukharogavijJAna kA vicAra karate hue tuNDikerI ( tonsillitis ) kI nimna byAkhyA kI hai jo isa prakAra hai: hanusandhyAzritaH kaNThe kArpAsIphalasannibhaH / picchilo mandaruk zophaH kaThinastuNDikerikA // yaha eka prakAra kA zopha ( inflammation ) hai jo kaMTha meM hanusandhi meM sthita hai, jo kapAsa ke phala ke sadRza ( gola bAdAma jaisA ) hotA hai isake Upara cipakanA srAva rahatA hai, manda manda zUla hotA hai aura isameM paryApta kAThinya bhI hotA hai / yaha saba varNana tuNDikerI ko TAnsilAiTisa batAne ke lie paryApta hai / Adhunika bhASA meM tuNDikerI yA tuNDikApAka tIvra aura jIrNa do prakAra kA hotA hai / tIvra tuNDikerI ko syUnikIya tuNDikApAka ( follicular tonsillitis ) bhI kahate haiM / yaha tuNDikA granthi ke gata ( crypts ) aura unake samIpa kI lasAbha Uta kA zopha hai / isameM tuNDikAgranthiyA~ lAla varNa kI tathA sUja jAtI haiM / gata ke mukha se pU nikalatA rahatA hai / isake kAraNa kaNTha meM zUla kA honA tathA kucha jvara ho jAnA prAyaH milatA hai / yadi kucha avasthA meM aura girAvaTa AI to samIpastha kozAoM meM prazotha hokara parituNDikIya vidradhi ( peritonsillar abscess ) kA rUpa bana sakatA hai| jIrNa tuNDikerI hI vAstava meM uparokta zAstrokta tuNDikerI hai yaha bahudhA hotI hai isakA hetu tIvra tuNDikerI ke AkramaNa kA bAra bAra honA prAyaH huA karatA hai; para kabhI kabhI yaha svayaM bhI binA tIvra AkramaNa ke dhIre se hotI huI dekhI jAtI hai / isameM tuNDikA granthiyAM phUla kara bar3I 'kArpAsI phalasannibha' ho jAtI haiM ve dUSita ( septic ) ho jAtI haiM kATane para lasAbha Uti kI pravRddhi milatI hai tantUtkarSa aura jIrNa pUyana ke pramANa bhI milate haiN| yaha roga una baccoM meM adhika pramANa meM milatA hai jinheM kaNThazAlUka ( adenoids ) bhI hote haiM / For Private and Personal Use Only svarayantrapAka ( Laryngitis ) tIvra aura jIrNa do prakAra kA svarayantra pAka hotA hai / tIvra svarayantrapAka tIvra sekI vraNazotha ke kAraNa hotA hai jisameM jIvANujanya upasarga - phuphphusa golANu tathA prasekI gucchagolANu (micrococcus catarrhalis ) -- pramukha hetu hotA hai / pratizyAya yA pInasa yA sardI ke kAraNa bahutoM kA svarabhaMga ho jAtA hai / yaha romAntikA, lohita jvara, inphlueMjA ina saba ke kAraNa ho sakatA hai| tIvra svarayantrapAka

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vikRtivijJAna meM sarvaprathama svarayantra meM adhiraktatA bar3hatI hai tathA svarayantra ke nirmANa meM bhAga lene vAlI zleSmala kalA sUja jAtI hai tathA usameM se svaccha zleSmA kA srAva bhI hotA rahatA hai| ___jaba bAra bAra tIvra svarayantrapAka hotA rahatA hai to phira usI se jIrNa svarayantrapAka bhI ho jAtA hai| isameM zleSmalakalA sthUla ho jAtI hai jise sthala carmatA ( pachydermia) kahate haiN| usa paramacarmita kalA para kaNayukta granthikAeM (granular nodules ) bana jAte haiM ghATikA-adhijibikIya bhaMjoM ( ary tenoepiglottidean folds ) para choTI choTI vidhiyAM bana jAtI haiN| yojanikA ( commissure ) para bhI ve banatI haiN| zvAsanAla pAka yA zvasanIpAka ( Bronchitis) yaha bhI tIvra aura jIrNa do prakAra kA kahA gayA hai| tIvra zvasanIpAka kA kAraNa zvAsanAla meM prakSobhaka vAtiyoM kA praveza hokara kSobhotpatti karanA yA upasarga (mAlAgolANu, prasekI gucchagolANu tathA phuphphusagolANu) hotA hai| inphlueMjA evaM zvagraha ( whooping cough) ke kAraNa bhI yaha vyAdhi lagatI hai| upasarga ke kAraNa hone vAle zvasanIpAka ke zikAra prAyaH bAlaka yA vRddha hote haiM jina para isakA bahuta ghAtaka pariNAma bhI dekhA jAtA hai| prArambha meM zleSmala kalA lAla aura sUjI huI hotI hai usake Upara kucha picchila srAva milatA hai Age cala kara srAva bar3ha jAtA hai jisameM kabhI kama kabhI adhika sitakozA milate haiN| isake kAraNa srAva zleSmapUyika ( mucopurulent ) ho jAtA hai| zlaiSmika kalA meM kitane hI vraNazothakAraka kozA pAye jAte haiM jinake kAraNa zvasanI kA pacamala apistara vizalkita (desquamated ) ho jAtA hai| sUje hue kozA srAva meM milane kI taiyArI se DhIle DhIle par3e rahate haiN| jaba tIvra zvasanIpAka kA bAra bAra AkramaNa hotA hai tathA usakA yogya upacAra apUrNa raha jAtA hai taba jIrNa zvasanIpAka ke lakSaNa prakaTa hone lagate haiN| jIrNa zvasanIpAka adhiratIya hRdubheda (congestive heart failure ) ke kAraNa athavA Urdhva zvasanamArga meM upasthita kisI upasarga ke kAraNa bhI ho sakatA hai| isakA prArambha bahuta dhIre dhIre hotA hai| eka bAta jo dhyAna dene yogya hai vaha yaha ki yaha bAlakoM yA kizoroM meM itanA adhika nahIM hotA jitanA vayaskoM aura bar3oM meM milatA hai / zvasanI kA pacamala adhicchada (ciliated epithelium ) adhikatara naSTa ho jAtA hai zeSa zleSmalakalA apuSTa ho jAtI hai aura usameM zalkAtighaTana (squamous metaplasia) hone lagatA hai| kahIM kahIM zleSmalakalA kA dharAtala kaNAtmaka uti se paripUrNa ho jAtA hai jisameM se zleSmapUyIya sAva kA atyadhika udAsarjana hotA hai| itastataH sUkSma vidhiyA~ bana jAtI haiN| vraNazothAtmaka prakriyA sampUrNa zvasanI prAcIra ( bronchial wall ) ko grasita kara letI hai| prAcIra For Private and Personal Use Only

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55 vividha zarIrAGgoM para vraNazotha kA prabhAva atyadhika mRdu ho jAtI hai usakI taruNAsthi aura mAMsapezI vilupta ho jAtI hai usake sthAna para tAntava Uti kA nirmANa hone lagatA hai| yadi yaha tAntava UtinirmANa kArya phuphphusa taka meM vyApta ho gayA to usake kAraNa uraHkSata ( bronchiec. tasis ) taka bana jAtA hai| grIna kA kahanA hai ki jIrNa zvasanIpAka vAstava meM saumya uraHkSata hI mAnA jAnA caahie| jisa prakAra jIrNa zvasanIpAka se uraHkSata hotA hai usI prakAra uraHkSata se bhI jIrNa zvasanIpAka (chronic bronchitis ) ho sakatA hai| ___ vAyu kozAbhistaraNa ( emphysema ) ke sAtha bhI jIrNa zvasanIpAka dekhA jA sakatA hai ina donoM rogalakSaNoM ke kAraNa hRskriyA para ghAtaka prabhAva par3a kara hRdbheda taka sambhava ho sakatA hai| yadi hRdaya durbala hai to phuphphusoM meM pazcanipIDa ( back pressure ) hone se UtiyoM kA poSaNa ThIka ThIka na hone ke kAraNa unameM upasarga kI pravRtti hokara jIrNa zvasanIpAka dekhA jA sakatA hai| vAstava meM vAyukozAbhistaraNa, hRdbheda tathA jIrNa zvasanIpAka kI eka vizeSatrayI ( triad ) hai| kisa kAraNa yaha avasthA banatI hai yaha kahanA sambhava nahIM hai kucha ise kapharakta yA anUrjAjanya mAnate haiM jisameM phuphphusagolANu yA mAlAgolANu zoNaharita anUjana (allergen ) vat kArya karate haiN| zvasanIpAka ke do prakAra aura dekhe jAte haiM jinameM eka ko kezAla zvasanIpAka ( capillary bronchitis ) kahate haiM yaha vAstava meM zvasanikAoM ( bronchioles ) kA pAka ( bronchiolitis) kahate haiM isameM zvasanikAoM tathA phuphphusa ke vAyukozoM ( alveoli ) meM vraNazothotpatti ho jAtI hai| usI se phira zvasanIphuphphusapAka ( broncho-pneumonia) bana jAtA hai| ___ dUsarA tantvimat zvasanIpAka ( fibrinous bronchitis ) yA abhighaTana zvasanIpAka ( plastic bronchitis) kahalAtA hai| isameM zvAsAvarodha ke aneka AkSepayukta AkramaNa hote haiM zvasaniyoM ke viziSTa nirmoka nikalate haiM isakA kAraNa bhI abhI jJAta nahIM hai| phuphphusapAka (Pneumonia) yaha eka tIvra svarUpa kA tathA aupasargika roga hai| isameM phuphphusoM meM vraNazotha ke kAraNa eka srAva nikalatA hai jo jama kara phuphphusa ko ghanIbhUta kara detA hai| yaha saMghaTana yA to eka phuphphusa ke kisI eka yA do pUre khaNDoM meM hotA hai (khaNDIya phuphphusapAka-lobar pneumonia) yA ye donoM phuphphusoM ke khaNDoM meM thor3A idhara thor3A udhara karake kaI sthAna para hotA hai (khaNDakhaNDIya phuphphusapAkabroncho pneumonia) / aba hama ina donoM prakAroM kA pRthak pRthak varNana karate haiM: For Private and Personal Use Only

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vikRtivijJAna khaNDIya phuphphusapAka zvasanaka jvara yA karkaTaka sannipAta saivila khaNDIya phuphphusapAka kA paricaya dete hue likhatA hai: Acute lobar pneumonia commences suddenly with well marked constitutional symptoms, such as, headache, backache, rigor, and in children, vomiting or convulsions. The temperature during the rigor rises to 103deg or 104deg F. and it remains at this point for about a week. The aspect of a pneumoina patient is very characteristic the face is flushed and cyanosed and herpes often appears near the mouth. There is pain in the affected side, due to involvement of the pleura, short cough, shallow rapid breathing, and on the third or fourth day tenacious rusty coloured sputum. The pulse respiration rate is 3 to 1 or 21 to 1 instead of the normal 4 to I. The urine is scanty and high coloured. The patient shows more and more distress, and in a short time there may be delirium, with signs pointing to failure of the cardio vascular system about the seventh or eighth day the fever as also the pulse and reshiration rate, in favourable cases terminates by crisis, falling to normal in the course of a faw hours. This is accompanied by marked general improvement the pulse respiration ratio returnes to normal and a critical sweating or diarrhoea may occur, Pseudo crises occasionally occur, but these are distinguished from true crises by the fact that the pulse and respiration do not retun to normal, Upara jina lakSaNoM kI ora aMgulinirdeza kiyA gayA hai unheM bhAvamizra dvArA kathita nimna sUtroM meM bhI dekhA jA sakatA hai: madhyahInapravRddhastu vAtapittakaphaizca yaH / tena rogAsta evoktA yathAdoSabalAzrayAH // antardAho vizeSo'tra na ca vaktuM sa zakyate / raktamAlaktakenaiva lasyate mukhamaNDalam // pittenAkarSitaH zleSmA hRdayAnnAprasicyate / iSuNevAhataM pAzrva tudyate khanyate hRdi / / pramIlakazvAsahikkA varddhante tu dine dine / jihvA dagdhA kharasparzA galaizUkairivAvRtaH // visarga nAbhijAnAti kUjeccApi kapotavat / atIva zleSmaNA pUrNaH shusskvktrausstthtaalukH|| tndraanidraatiyogaato htvaanihtdyutiH| na ratiM labhate nityaM viparItAni cecchti|| Ayamyate ca bahuzo raktaM SThIvati cAlpazaH / eSa karkaTako nAmnA sannipAtaH sudAruNaH // For Private and Personal Use Only

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khaNDIya phuphphusa pAka 14 86 Acharya Shri Kailassagarsuri Gyanmandir isa citra meM phuphphusa kA UparI khaNDa dhUsara savanAvasthA meM pahu~cA huA hai| usake nIce kA khaNDa jisakA thor3A bhAga dikhalAI de rahA hai svastha hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva khaNDIya phuphphusapAka yA karkaTaka sannipAta phuphphusa golANu (pneumococcus) nAmaka jIvANu dvArA utpanna vyAdhi hai| upasargakArI jIvANu vAyumArga dvArA phuphphusoM meM pahuMcatA hai aura phuphphusa ke pariNAha para pazcapArzva ( dorso lateral ) bhAga meM eka sidhma ( spot ) banAkara vahAM se eka vAyukoza se dUsare meM upasarga karatA calatA hai| vikRti zArIra kI dRSTi se karkaTaka sannipAta kI nimna cAra avasthAeM hotI haiN| 1. adhiraktAvasthA ( stage of congestion ) 2. lAlasaghanAvasthA ( stage of red hepatisation) 3. dhUsarasaghanAvasthA ( stage of grey hepatisation ) 4. upazamAvasthA ( stage of resolution ) adhiraktAvasthA-yaha karkaTaka sannipAta kI sarvaprathama avasthA hai jisakA prArambha zItAnubhUti ( rigor ) se hotA hai| isa avasthA meM phuphphusIya vAyu kozAoM kI prAcIroM meM sthita kezAla visphArita ho jAte haiM aura unase chana chana kara zukliyukta ( albuminous ) tarala vAyukozA meM bhara jAtA hai| vAyukozA meM aneka sitakozA bhI pahuMca jAte haiM vahIM para bahuta bar3I saMkhyA meM phuphphusa golANu bhI rahate haiN| ye golANu kozAbAhya ( extracellular ) hote haiM / isa saba ke kAraNa adhiraktatAyukta bhAga kA bhAra bar3ha jAtA hai usakI pratyasthatA (elasticity ) naSTa ho jAtI hai, usake padArtha meM bubuda dhvani ( Grepitation) kI kamI tathA vaha apekSAkRta bhidura (friable ) ho jAtA hai| usake dharAtala ko dabAne se garta par3a jAtA hai| kATane para usameM se jhAgadAra Arakta (reddish) picchila (tenacious) tarala nikalatA hai| isa tarala meM tantvijana, lAlakaNa aura jIvANu hote haiN| yaha avasthA lagabhaga 1 dina taka banI rahatI hai| lAla saghanAvasthA yA lAla yakRtIbhavana kI avasthA-yaha dvitIyAvasthA hai jo dUsare yA tIsare dina se prArambha ho jAtI hai| isa avasthA meM prathamAvasthA se Age kA kArya hotA hai| visphArita kezAloM kI prAcIroM se chana chana kara rakta ke lAla kaNa aura tantvimat tarala vAyukozA meM ekatra hone lagate haiN| kucha kezAla vidIrNa ho jAte haiM jinase rakta bhI Akara bhara jAtA hai| vAyukozAoM meM tantvi ekatra hokara jAlikA ( reticulum ) banA letI hai, yaha jAlikA vAyukoSa ke pariNAha para bahuta saghana hotI hai jisake jAloM meM lAla kaga, sitakozA tathA vizalkita adhicchadIya kozA ulajhe rahate haiN| sitakozAoM meM bahunyaSTiyoM kI adhikatA rahatI hai| yaha sitakozAoM kI pahalI lahara hotI hai| phuphphusa golANu kI upasthiti bhI bahutoM meM milatI hai para vaha hotA kozAbAhya ( extracellular ) hI hai| isa avasthA meM phuphphusa kA bhAra apane svAbhAvika bhAra ( 250 mASA) se bar3ha kara cAragunA (1000 grAma) ho jAtA hai usakA AkAra bhI bahuta bar3ha jAtA haiM jisake kAraNa For Private and Personal Use Only

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vikRtivijJAna usa para pahuMkAoM kA cihna aGkita ho jAtA hai| phuphphusa pUrNataH sAndra ( solid ) ho jAtA hai usake eka Tukar3e ko kATa kara jala meM DAlane se DUba jAtA hai (svAbhAvika phuphphusa jala meM tairatA rahatA hai) use kisI bhI prakAra se phulAyA nahIM jA sakatA hai| na usase koI dhvani (crepitation ) hI nikalatI hai| use thor3A dabAne se TUTane yA phaTane lagatA hai vaha vAyurahita hotA hai use nicor3ane se bahuta kama tarala nikalatA hai| kATane para kATA huA dharAtala dAnedAra dikhAtA hai usakA kAraNa tantvi ke choTe choTe niga ( plugs ) vAyukoSoM se Age kI ora nikale rahate haiM jinheM ve bhare rahate haiN| vraNazothayukta kSetra ke kinAroM kA khaNDakaraNa ( lobulation ) nahIM hotA na bAhya ekavardhyakSa granthikAoM ( racemose nodules ) kA hI kucha cihna milatA hai jo yaha prakaTa kare ki upasarga zvasanI se phaila rahA hai| phuphphusa kA varNa asita Arakta babhru (dark reddish brown) hotA hai| kahIM kahIM bIca meM zveta yA dhUsara varNa ke sidhma bhI mila jAte haiN| phuphphusa kA itanA Thosapana dekhakara aisA lagatA hai ki mAno yaha lAla raMga kA yakRt hI ho / isa lAlI ke kAraNa kezAla prAcIroM ke phaTane se gaye rudhira kI upasthiti ho sakatI hai| ___ phuphphusa ke Upara kA phuphphusacchada (pleura) adhika raktamaya, manda tathA tantvimat srAva se AcchAdita rahatA hai| phuphphusacchada pAka (pleurisy ) ke kAraNa pAvazUla kI upasthiti itanI sAmAnya vastu ho gaI hai ki use phuphphusapAka kA eka upadrava na mAnakara usakA hI eka Avazyaka bhAga mAna lenA par3atA hai| rogI sAMsa lene meM DaratA hai kyoMki sAMsa ke sAtha hI atyadhika zUla hotA hai khA~sane meM to yaha zUla atyadhika kaSTa detA hai isI ko bhAvamizra ne tIra se Ahata ke samAna todayukta zUla kahA hai| isa zUla ke kAraNa rogI atyadhika nisteja ho jAtA hai tathA usakI nidrA vidA ho jAtI hai| __thUka kA raMga morcA lage lohe jaisA (rusty) kahA hai 'raktaM SThIvati cAlpazaH' nAma se jo varNana hai usakA artha lAlavarNa ke thUka se hI abhiprAya hai yadyapi lAlI kA kAraNa svayaM rakta ke lAlakaNa hI haiM: The sputum in this stage is rusty'owing to the presence in it of blood cells from the pulmonary exudate. -A Manual of Pathology. isa thUka meM asaMkhya kozAbAhya phuphphusagolANu pAye jAte haiM / thUka kI mAtrA bahuta thor3I hotI hai, vaha itanA zuSka aura picchila hotA hai ki use nikAlane ke lie bar3I dera taka kaSTadAyaka kAsa uThatI rahatI hai| phuphphusapAka kI dvitIyAvasthA meM mRtyu prAyaH nahIM huA krtii| - dhUsara saghanAvasthA yA dhUsara yakRtIbhavana kI avasthA-karkaTaka sannipAta kI yaha tRtIyAvasthA hai yaha pAMcaveM se AThaveM dina taka dekhI jAtI hai isa avasthA meM For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva te kuphphusa ke vAyu kozAoM meM rakta ke sitakozAoM kI bharamAra hone lagatI hai jisake kAraNa vAyukozA pUrNataH bhara jAte haiM / sitakozAoM kI yaha dUsarI lahara ( second wave ) hai / vAyukozAoM meM tantvi kA prasAra pahale hI se rahatA hai jisakI jAlikAoM kA varNana dvitIyAvasthA meM kiyA jA cukA hai / isa tanvi jAlikAoM ke pariNAha meM pahale sitakozAoM kA jamaghaTa hotA hai jahAM se phira ve aura andara kI ora gamana karate haiM / yadi isa avasthA meM yakRt ko kATA jAya to vaha kaNAtmaka tala jo dvitIyAvasthA meM dRggocara hotA thA nahIM milatA api tu dharAtala kA varNa ApIta ho jAtA hai / sitakozAoM ke cAroM ora eka tarala valaya kA nirmANa dhIre dhIre hone lagatA hai jisakA tAtparya yahI hai ki tantvi jAlikAoM ko tarala karane ke lie abhipAcika kiNva ( tryptic ferments ) ne apanA kArya prArambha kara diyA hai| dhIre dhIre jAlikAoM kA pUrNataH viyojana ho jAtA hai aura eka ghulanazIla padArtha bana jAtA hai / yaha padArtha kAsa ke sAtha bAhara bahuta kama AtA hai yA bilkula nahIM AtA / isa samaya yadi hama phuphphusa golANuoM kA vicAra kareM to ve sitakozAoM ke udara meM samAye hue milate haiN| aba inakA kozAbAhya svarUpa na mila kara Antara - kozIya ( intracellular ) svarUpa hI prakaTa hotA hai / bahuta thor3e kozA bAhya bhI mila sakate haiN| pahalI aura dUsarI laharoM meM bahunyaSTisita kozAoM kA hI bAhulya rahatA hai / para jaba sitakozAoM kI tIsarI lahara AtI hai to usameM bahunyaSTi ke sthAna para ekanyaSTi sitakozA yA jAlikAntazchadIya saMsthAna ke mahAbhakSa ( macrophages of reticulo-endothelial system ) vAyukozAoM meM utara Ate haiM / yaha tIsarI lahara jvara ke dAruNya ( crisis ) ke samaya prAyazaH dekhI jAtI hai / ye mahAbhakSa jitane cAva se phuphphusagolANuoM kA saphAyA karate haiM utane bahunyaSTi kozA nahIM karate / yadi tRtIyAvasthA adhika kAla taka rahatI hai to vAyukozAoM kI prAcIreM prAyazaH naSTa bhraSTa ho jAtI haiM / dvitIyAvasthA kI apekSA isa avasthA meM phuphphusa kA bhAra, usakA ghanatva tathA usakI bhiduratA ( friability ) adhika bar3ha jAtI hai / Uti atyanta mRdu aura godamaya (pulpy ) ho jAtI hai / sabase bar3A parivartana phuphphusa ke varNa meM ho jAtA hai pahale jo asita Arakta babhru ( dark reddish brown ) varNa kA phuphphusa batalAyA gayA thA vaha isa avasthA meM dhUsara ( grey ) varNa kA yA ApItazveta varNa kA ho jAtA hai jisake bIca bIca meM raMgayukta yojaka ati khacita rahatI hai / varNa parivartana ke nimna 3 kAraNa haiM jo AMzikarUpa meM isake lie uttaradAyI haiM : 1. dvitIyAvasthA meM Aye hue rakta ke lAla karNo kA zoNAMzana ( haemolysis) 2. sitakozAoM kA atyadhika saMkhyA meM Agamana 3. vraNazothAtmaka srAva ( inflammatory exudate ) ke dvArA raktavAhiniyoM para itanA pIr3ana DAlanA ki unakI adhiraktatA samApta ho jAya / phuphphusa ke isa varNa parivartana ke AdhAra para hI isa avasthA ko dhUsarAvasthA yA For Private and Personal Use Only

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vikRtivijJAna dhUsara yakRtIbhavanAvasthA (grey hepatisation) kahA jAtA hai| yakRt ke samAna Thosa aura dhUsara varNa kA phuphphusa honA tRtIyAvasthA kA mahattva kA lakSaNa hai| isase Age phuphphusa kI jo dazA hotI hai vaha phuphphusa kA pUyana yA pUyIya antarAbharaNa ( purulent infiltration ) kahalAtA hai| isa avasthA meM thUka pIlA tathA pUyayukta hotA hai| isakI mAtrA paryApta bar3ha jAtI hai aura yaha bahuta abaddha ( loose ) hotA hai / isa samaya sabhI phuphphusagolANu AntarakozIya (intracellular ) hote haiN| ina sabhI avasthAoM meM rogI kA tApAMza paryApta ucca rahatA hai aura sthira hotA hai| jaba tRtIyAvasthA kI samApti hotI hai usa samaya bhakSakozAoM dvArA phuphphusagolANuoM kA bhakSaNa kara liyA jAtA hai isI samaya vyaMziyAM bhI utpanna ho jAtI haiM jisake kAraNa sahasA bahuta bar3I saMkhyA meM unakA aMzana hone lagatA hai jisake kAraNa bahuta adhika mAtrA meM antarviSi (endotoxin ) svatantra hokara rakta meM mila jAtI haiM isI kAraNa isa avasthA meM rogI kI mRtyu dekhI jAtI hai| mRtyu kA kAraNa yaha hotA hai ki isa roga meM hRdaya bahuta bhrAnta aura viSAkta pahale se hI hotA hai jisa samaya ina antarviSiyoM kA bojha usa para par3atA hai to vaha sahana nahIM kara sakatA aura apanA kArya banda karake mRtyu kA kAraNa banatA hai| phuphphusapAka kI caturthAvasthA ko upazamAvasthA ( stage of resolution ) kahate haiM / upazama kA vizeSa vicAra isa adhyAya ke antima caraNa meM kiyA jAvegA parantu prasaGgavaza phuphphusapAka meM upazama kisa prakAra hotA hai ise hama pAThakoM ke sammukha upasthita kara rahe haiM tAki adhika asuvidhA na rhe| upazamAvasthA kA artha hai phuphphusa kA apane svAbhAvika rUpa meM A jAnA tathA upasargakArI jIvANuoM kA pUrNataH vinAza / naidAnika dRSTi se upazama kA prArambha dAruNya ( crisis ) se hotA hai jisameM rogI kA tApAMza ekadama girakara svAbhAvika para AtA hai jisake sAtha sAtha sitakozAoM kI saMkhyA meM bhI hAsa hotA hai| para yaha hAsa tabhI sambhava hai jaba anya koI upadrava sAtha meM na ho| upazama aura samaGgIkaraNa ( organisation ) meM antara hai| samaGgIkaraNa meM phuphphusa eka tAntava Uti kA nikammA Dhera mAtra bana jAtA hai para upazama eka viziSTa prakriyA hai jisakA prArambha atitIvAvasthAoM ke turata bAda hotA hai para jisameM aMga apane svAbhAvika kArya karane kI avasthA meM AjAtA hai| para yaha bhI Avazyaka nahIM ki sampUrNa aMga kA upazama ho jAya, kucha bhAgoM meM samaMgIkaraNa bhI dekhA jA sakatA hai jisakA pramANa tantUtkarSa kA milanA hai| upazama vahIM sambhava hai jahAM viSa kA prabhAva kitanA hI ho parantu phuphphusa ati kA vinAza tathA phuphphusa kI raktavAhiniyoM ko kama se kama kSatigrasta honA pdd'e| khaNDIya phuphphusapAka meM phuphphusa kA cAhe adhika kSetra prabhAvita ho jAve aura cAhe kitanA hI srAva nikala nikala kara phuphphasa ke vAyukozAoM ko Thosa banA de parantu For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva vAstavika phuphphusa Uti kI kSati bahuta alpa hotI hai| isI kAraNa isa niHsrAvika (utsyandI) praticAra (exudative response ) ko kapharaktaja (allergic) ghaTanA samajhA jAtA hai| karkaTaka sannipAtI ke rakta meM sitakozAoM kI gaNanA 50000 taka pAI jA sakatI hai jisameM 90 pratizata bahunyaSTi sitakozA hote haiN| dAruNyakAla meM yaha saMkhyA ekadama giratI hai para koI anya upadrava jaise antaHpUyatA ( empyema) ho to yaha saMkhyA giratI nahIM balki sthira rahatI hai| kabhI kabhI thor3e samaya girakara phira bar3ha jAtI hai| yadi sitakozA saMkhyA kama hokara akasmAt phira bar3ha jAve to sadaiva yaha samajhanA cAhie ki zarIra meM kahIM na kahIM pUya kA saMcaya ho gayA hai| isa roga meM rakta kA Alagatva ( viscosity ) bar3ha jAtA hai| jisake kAraNa antarvAhinI AtaMcana ( intravascular clotting ) kI bahuta sambhAvanA dekhI jAtI hai| isa roga meM UtiyoM meM nIreyoM ( chlorides) kA saMcaya hone lagatA hai jisakA pramANa yaha hai ki rogI ke mUtra tathA rakta kI nIreya-mAtrA ghaTa jAtI hai| phuphphusapAka meM bhaya kA kAraNa zvasanakriyA meM gar3abar3I honA utanA nahIM hai jitanA ki roga ke kAraNa utpanna huI viSamayatA kA hRdaya para prabhAva honA hai| isa viSa ke kAraNa hRtpezI meM meghAbhazotha tathA snaihika vihAsa hone lagatA hai| caMki rakta isa roga meM kucha adhika gAr3hA ho jAtA hai ataH rakta ke saMvahana ke lie hRdaya se adhika parizrama apekSita rahatA hai tAki thor3e se svastha phuphphusa kSetra dvArA sampUrNa raka ko prANavAyu yukta kiyA jA sake / rogI para zyAvatA ( cyanosis) kA lakSaNa rakta meM vAyu kI kamI kA pramANa hotA hai aura ajAraka-raktatA (anoxaemia) isa roga meM avazya milatI hai| isake kAraNa hRtpezI aura adhika durbala ho jAtI hai| isa prakAra eka duzcakra cala par3atA hai jisameM viSAkta hRdaya kama kArya karatA hai rakta kI ThIka zuddhi nahIM hotii| kama zuddhi ke kAraNa rakta meM prANavAyu kI kamI hotI hai isa prANavAyu virahita rakta se jaba hRtpezI kA poSaNa hotA hai to vaha aura adhika durbala ho jAtI hai aura usakI durbalatA ajArakaraktatA bar3hAtI hai ityAdi / nyUbardha, mInsa tathA porTara nAmaka vaijJAnikoM kA kathana hai ki ajArakaraktatA kA pradhAna kAraNa prANadA nAr3I kI kriyA kA nirodha (vagal inhibition) hai| jisake kAraNa prANagranthi ( medulla) kI prAMgAra-dvijAreya vAti Atati (tension CO.) kI vRddhi ke prati bar3hatI huI usakI svAbhAvika asahanazIlatA ko kama kara detA hai / isI kAla meM zvasanakriyA ati duta aura gAdha ( shallow ) hotI hai vAyukozoM kA adhikAMza sthAna zotha tarala se bharA hotA hai| phuphphusa ke Thosa bhAgoM meM vAyu kA praveza hotA nahIM tathA unake samIpa kI phuphphusa Uti kA samavasAda (collapse) huA rahane se vaha bhI bekAra hotI hai| yaha saba mAnava jIvana ko saMkaTa kI ghora sthiti meM le Ate haiN| prANadA nAr3I kI kriyA ke nirodha kA pariNAma prANadA nADI dvArA anuprANita auda For Private and Personal Use Only

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62 vikRtivijJAna rika kSetroM para bhI hotA hai baccoM meM phuphphusapAka ke prArambha meM prANadA nADI ke nirodha kI pratyAvartana kriyA (reflex action ) ke kAraNa vaidya ko paryApta bhrama ho jAtA hai aura phuphphusapAka ke sthAna para vaha use antrapucchapAka ( appendicitis ) yA udaracchadapAka ( peritonitis ) yA tIvra sarvakiNvIpAka ( acute pancreatitis) samajhane lagatA hai / aise samaya zIghratA karane kI AvazyakatA nahIM hai api tu dhIrajapUrvaka phuphphusoM kI parIkSA karake phira udara kI ora dhyAna denA cAhie yadi binA isakA dhyAna diye udaraccheda ( laparotomy ) zastrakarma kara diyA gayA to bAlaka kI mRtyu meM kucha bhI sandeha nahIM raha jaataa| isa dizA meM vicAra karane ke lie utsAhita karane kA kArya bvAiDa ne kiyA hai / khaDakI phuphphusa pAka (Broncho-Pneumonia or Lobular Pneumonia) khaNDIya aura khaNDikIya phuphphusapAkoM meM mahattva kA antara yaha mAnA jAtA hai ki eka meM phuphphusa kA eka pUrA khaNDa vikRta ho jAtA hai parantu dUsare meM phuphphusa meM itastataH thor3A thor3A kSetra vikRta hotA hai tathA bIca kA kSetra pUrNataH svAbhAvika rahatA hai / eka meM vyAdhi eka hI phuphphusa khaNDa meM dekhI jAtI hai para dUsare meM do yA adhika phuphphusa khaNDoM meM roga milatA hai / eka meM eka phuphphusa pIDita milatA hai| parantu dUsare meM donoM phuphphusoM meM bhI eka sAtha roga pAyA jAtA hai| eka meM vraNazotha eka dama AtA hai para dUsare meM vaha zanaiH zanaiH evaM uttarottara vRddhiMgata hotA jAtA hai / eka meM tApAMza eka dama car3hakara ekadama dAruNya ke sAtha giratA hai para dUsare ( khaNDikIya) maiM dhIre dhIre tApAMza bar3hatA aura dhIre dhIre hI asta hotA hai| eka (khaNDIya) meM phuphphusa meM upasarga kA kAla alpa samaya taka rahatA hai aura dUsare meM dekhA jA sakatA hai / khaNDikIya zvasanaka meM phuphphusacchadapAka halkI sI zvAsakRcchratA pAI jAtI hai para jaba roga kA svarUpa zyAvatA aura viSaraktatA ke lakSaNa bhI rogiyoM, bAlakoM tathA vRddhoM meM prAyaH dekhI jAtI hai / vaha kaI saptAha taka ( plUrisI ) tathA ugra hotA hai to dekhe jAte haiM / isa roga kA AkramaNa durbala hotA hai isa kAraNa mRtyu bahudhA hotI huI I yaha roga zizuoM meM dUsare varSa ke Arambha meM Adya yA dvitIyaka ( uttarajAta) svarUpa meM dekhA jAtA hai / zizu pUrNataH svastha hote hue akasmAt zvasanaka se jaba pIDita hotA hai to vaha Adya ( primary ) khaNDikIya phuphphusapAka se vyathita mAnA jAtA hai para jaba pahale use romAntikA ( measles ) zvagraha ( whooping cough ), rohiNI, inphlueMjA Adi ho cuke hoM to unake kAraNa hone vAlA phuphphusapAka dvitIyaka ( secondary ) phuphphusapAka mAnA jAtA hai / phakkaroga ( rickets ), sahaja phiraGga, kSINatA ( marasmus ) ke kAraNa bhI dvitIyaka phuphphusapAka dekhA jA sakatA hai / yaha to huA navajAta zizuoM meM isa roga ke kAraNoM para prakAza | parantu vRddhoM For Private and Personal Use Only

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63 vividha zarIrAGgoM para vraNazotha kA prabhAva meM isa roga kA kAraNa sarvathA bhinna hotA hai zastrakarma hone para yA AghAta lagane para, asthibhagna ke kAraNa jaba unako bahuta samaya taka zaiyA para rahanA par3atA hai yA vRkkapAkAdi vraNazotha zarIra ke kisI bhAga meM rahatA hai to unako yaha roga laga jAtA hai| isa roga kA kAraNa phuphphusa golANu ( pneumococcus ) hai tathA mAlAgolANu, puMja golANu, pratizyAya zoNapriyANu ( H. influenzae) bhI isake kAraNa hote haiN| prAyazaH isa roga meM upasarga kA kAraNa eka jIvANu na hokara kaI eka jIvANu kA mizraNa hotA hai| - phuphphusa meM zvAsanalikAeM do prakAra kI hotI haiN| eka ve jinameM kAsthi yA taruNAsthi hotI hai aura jinakA vyAsa 1 milImITara se adhika hotA hai inheM zvAsanAla ( bronchi) yA zvAsa praNAlI kahate haiM dUsarI ve hotI haiM jo pUrNataH mAMsapeziyoM ke dvArA hI nirmita hotI haiM aura jinakA vyAsa 1 milImITara se kama hotA hai inheM zvasanikA ( bronchiole ) kahate haiN| khaNDikIya phuphphusapAka ina zvasanikAoM kA hI pAka hotA hai| eka zvasanikA ke sAtha jitanA bhI phuphphusa kA aMza lagA hotA hai usameM bhI pAka ho jAtA hai| zvasanikA ke sAtha saMlagna phuphphusa ati prAyaH apasaraNa ( divergence ) karatI huI hotI hai ataH pAka kA kSetra trikoNAkAra hotA hai| kabhI kabhI isa roga ke sAtha sAtha zvAsa nAla meM bhI pAka dekhA jAtA hai para vaha pAka isa roga ke sAtha sadaiva honA Avazyaka nahIM hai| vaha to khaNDikIya phaphphasapAka ke uparAnta hone vAlA upadrava hai| isa roga meM upasarga pradhAnatayA Urdhvazvasana mArga dvArA hI lagatA hai aura caMki zvasana kI naliyAM eka dUsare se sambaddha haiM ataH upasarga lagate dera nahIM lgtii| ___ yadi kisI khaNDikIya phuphphusapAka se pIDita vyakti ke vyAdhigrasta sidhma ( patch) kA sUcama nirIkSaNa kiyA jAve to usameM nimna tIna vikSata dekhane ko milate haiM: 1. anukendrapAkI zvasanikA ( centrally inflammed bronchiole ), jisake cAroM ora ghanIbhUta phuphphusa Uti hotI hai| 2. madhyavartI kSetra jahAM ke vAyukozA samavasAdita (collapsed ) hote haiM / 3. bAhyakSetra jahAM vAyukozA visphArita hote haiN| mRtyUttara parIkSA karane ke lie jaba khaNDikIya zvasanaka se mRta zava ke phuphphusa nikAla kara dekhe jAte haiM to ve svAbhAvika se adhika bhare hue prakaTa hote haiN| unakA bAhya dharAtala viSama hotA hai usameM itastataH vivarNa sidhma pAye jAte haiN| bIca bIca ke sthAna camakadAra, nIlAbha, kucha dabe se tathA cikane hote haiM ye samavasAdita vAyukozAoM ke kSetra haiN| unake samavasAdana kA kAraNa srAva dvArA zvasanikAoM kA bhara jAnA mAnA jAtA hai| kucha bhAgoM kA raMga lAla hotA hai ve dharAtala se uThe hue hote For Private and Personal Use Only

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64 vikRtivijJAna haiM unake Upara tanvi kA kucha Astara car3hA hotA hai jisake kAraNa unakI AkRti kucha manda ( dull ) ho jAtI hai / ye saMghanana ( consolidation ) ke kSetra bole jAte haiM yahAM para phuphphusacchadapAka bhI rahatA hai / yadi phuphphula kA sparza kiyA jAve to svAbhAvika bhAga mRdu aura karkara dhvani karate haiM ( soft and crepitant ) para pAka se pIDita bhAga kar3e hote haiM tathA dabAne se dabate nahIM ( resistant to pressure ) / samavasAdita kSetra chUne se iNDiyA rabara ke samAna lacalacA lagatA hai / yadi khaNDikIya phuphphusapAka ke kAraNa mRta phuphphusa ko kATA jAve to vaha rakta se paripUrNa milatA hai aura bUMda bUMda karake rakta usameM se girane lagatA hai / kaTe hue dharAtala se nikale hue vraNazotha grasta kSetra hote haiM unakA varNa lAla yA dhUsara hotA hai dekhane meM kaNAtmaka unakI AkRti hotI hai aura ve chUne se TUTane lagate haiM / prArambha meM ina kSetroM kA varNa lAla hotA hai para jyoM jyoM bahunyaSTi sitakozAoM kA antarAbharaNa hotA jAtA hai tathA saMghanita kSetra ke kozIya padArtha kA pacana hotA calatA hai unakA varNa dhUsarA pIta hotA jAtA hai sAtha hI unake andara kA srAva adhika tarala aura pUya hotA jAtA hai / aNvIkSa parIkSA karane para citra khaNDIya phuphphusapAkavat AbhAsita hotA hai parantu thor3A sA antara yaha hotA hai ki vraNazotha kSetra eka zvasanikA ke cAroM ora pAyA jAtA hai / kabhI kabhI yaha antara bhI tirohita ho jAtA hai yadi ye kSetra bahuta pAsa pAsa hokara mila jAveM / yadi ina kSetroM kI pRthak pRthak parIkSA kI jAve to ve saba eka hI Ayu ke hoM yaha Avazyaka nahIM, kisI ke nirmANa kI koI avasthA dekhI jAtI hai aura kisI kI koI / koI adhiraktAvasthA meM hotA hai, kisI meM tantvi evaM lAlakaNa bhare rahate haiM kisI meM sitakozAoM kI bharamAra huI rahatI hai to kisI meM upazamAvasthA milatI hai / jisa prakAra phuphphusa ke vAyukozAoM meM khaNDIya phuphphusapAka meM lAlakarNIoM tathA tantvi kI bahulatA milatI hai vaisI khaNDikIya meM nahIM hotI para yahAM sitakozA aura ekanyaSTi kozAoM kI bahulatA apekSAkRta adhika hotI hai / ausata zvasanaka ke sidhmoM kI saMkhyA bhI nizcita nahIM hai kisI kisI meM eka yA do granthikA spaSTa dikhatI hai jinakA vyAsa cauthAI se pauna ica taka kA hotA hai para kahIM kahIM sampUrNa khaNDa meM itanI granthikAeM hotI haiM ki unameM se kucha eka dUsare se mila jAtI haiM aura aisA lagatA hai ki mAno khaNDIya saMghanana ho gayA ho / abhI hamane batalAyA thA ki isa roga ke kAraNabhUta jIvANu kaI prakAra ke hote haiM aura jisa jIvANu ke dvArA yaha roga hotA hai usameM kucha na kucha vizeSatA pAI jAtI haiM jise hama Age pragaTa kareMge / udAharaNa ke liye mAlAgolANujanya zvasanaka jo Adya bahuta kama para gauNa (uttarajAta) prAyazaH dekhA jAtA hai aura jo pratizyAya zoNapriyANu ke upasarga ke sAtha bahudhA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva milatA hai yahAM raktasrAvI zopha ( haemorrhagic oedema ) ho jAtA hai / yahAM upasarga kA kAraNa zoNAMzika mAlAgolANu hotA hai| raktayukta utsyanda antima avasthA taka sapUya nahIM hotA huA dekhA jaataa| isalie jaba aise phuphphusa ko kATA jAtA hai to usameM se bahuta sA rakta Tapaka par3atA hai aura saMghanana bahuta dUra dUra para milatA hai| choTI choTI zvAsanAloM kI prAcIroM meM vidradhi bana jAtI haiM aura unakI racanA naSTa ho jAtI hai| yadi rogI jIvita rahA to vahAM tantUtkarSa ho jAtA hai| prAyazaH rogI prArambhika avasthA meM hI isa roga se kAlakavalita ho jAtA hai| yadi vaha jIvita rahA to Age cala kara khaNDikIya phuphphusapAka kA yugapaccalita rUpa ( confluent form of broncho-pneumonia) prakaTa hotA hai jisameM saba sidhma eka dUsare meM mila kara phuphphusa saMghanana kA AbhAsa kara dete haiM tathA jo phuphphusa vidradhi yA pUyoras ko janma detA hai yaha to huA zoNAMzana mAlAgolANujanya zvasanaka kA vrnnn| parantu zoNaharitaka mAlAgolANuoM (streptococcus viridans ) dvArA hone vAle zvasanaka meM vikRti phuphphusa golANuja zvasanaka ke samAna rahatI hai aura roga kA svarUpa kama gambhIra rahatA hai| pratizyAya zoNapriyANujanya zvasanaka zuddha svarUpa kA prAyaH nahIM milatA yaha sadaiva phuphphusagolANuoM yA mAlAgolANuoM ke sAtha milatA hai| jaba inphlueMjA yA pratizyAya ke lakSaNoM ke sAtha zvasanaka hotA hai to usakA prArambha kaNThanAr3IpAka se hotA hai jahAM se pAka zvAsanAla aura zvasanikAoM taka jAtA hai zuSka prakSobhakAraka kAsa ke sAtha sandhiyoM aura peziyoM meM zUla ke sAtha isakA prArambha hotA hai| vAyumArgoM ke pacamala adhicchada kA nAza hone lagatA hai zvasanikAoM kI prAcIreM TUTa jAtI haiM jinakI pUrti tantUtkarSa se hotI hai ye tantatkarSa ke sthAna hI phira Age cala kara uraHkSata vA yakSmA ke utpanna karane ke kendra bana jAte haiN| grIna ke zabdoM kI ora dhyAna dIjie A dry irritating cough is usual with fever and generalised pains in the joints, and muscles. In larger air passages there is destruction of the wall, this is later repaired by fibrosis and may form a starting point of bronchiectasis. aba tanika caraka ke nimna sUtroM kI ora dRSTipAta kIjie: pratizyAyAdatho kAsaH kAsAt saMjAyate kSayaH / kSayo rogasya hetutve zoSasyApyupajAyate // pratizyAya se kAsa kAsa se kSaya aura kSaya se zoSa utpanna hotA hai yaha kyoM sampanna hotA hai ise jAnane ke lie vidvAnoM ke caraNoM meM baiThanA pdd'egaa| pratizyAyAtmaka zvasanaka ( Influenzal Pneumonia) meM vraNazothAtmaka pratikriyA vAyukozAoM kI apekSA parizvAsanAlIya antarAlita Uti (peribronchial interstitial tissue ) meM adhika sthAnIbhUta rahatI hai| vAyukozoM meM For Private and Personal Use Only

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6 vikRtivijJAna raktasrAvI zophajanya tarala tathA tanvimat utsyanda ( fibrinous exudate ) rahatA hai / lasIkozAoM kI aura Age calakara prarasakozAoM ( plasma cells ) kI paryApta saMkhyA meM phuphphusa kI Uti evaM utsyanda yA niHsrAva meM upasthiti dekhI jAtI hai| sitakozIyagaNana isa vyAdhi meM yA to aparivartita dekhA jAtA hai yA bahunyaSTi sitakozAoM kA apakarSa pAyA jAtA hai| isa roga meM vikSatoM kA upazama na hokara tantUtkarSa hone kA pramukha kAraNa yaha bahunyaSTi sitakozApakarSa ( leucopenia ) hI pratIta hotA hai / isa roga meM jo parizvAsanAlIya saMghanana hotA hai aura vAyukozA lAlakaNoM se bhare hote haiM yaha sampUrNa kSetra phuphphusIya RNAstra ( infarct ) se sAdRzya rakhatA hai / isa roga meM kaNThanADI tathA zvAsanAla ke adhicchada kI paryApta mRtyu ho jAtI hai / jIvANu vAyukozIya prAcIroM kA vinAza karate haiM lasavahAoM aura antarAlita Uti ko bhI kSatigrasta karate haiM / yaha saba pratizyAya viSANu ( virus) dvArA na hokara anya sAthI pUyajanaka jIvANuoM kI kRpA se sambhava hai ataH kisI roga ko sAdhAraNa na samajha baiThanA hI buddhimAnI hai / pratizyAyAtmaka evaM mAlAgolANuja phuphphusapAka ke atirikta dvitIyaka phuphphusapAka ke 2-3 prakAra aura bhI dekhe jAte haiN| inameM niHzvAsajanya phuphphusapAka (Inha lation Pneumonia ) eka hai / jaba svarayantra aura usakA bhAga saMjJAzUnya ho jAtA hai yA annavaha srotas meM karkaTa utpanna ho jAtA hai to vividha srAva yA bhojana ke kama niHzvasita hokara phuphphusoM meM pahuMca jAte haiM / isake kAraNa eka rogANvika kuphphusapAka ( septic broncho pneumoina ) utpanna ho jAtA hai jo prAyaH mAraka hI hotA hai / rogo durbala hotA jAtA hai vraNazothAtmaka prakriyA ke kAraNa pUya kI phuphphuloM meM utpatti ho jAtI hai jisake kAraNa vidradhi bana jAtI hai aura kabhI kabhI to ate as ana jAtA hai| aisA hone ke kAraNa phuphphusa Uti kA bahuta vinAza hotA hai aura ThIvana (sputum ) atyanta durgandhapUrNa ho jAtA hai usameM pratyastha Uti (elatic tissue ) bhI milatI hai / tuNDikA granthipAka yA tuNDikoparibhAga meM vidradhi hone se yA prasanikA, svarayantra yA mukha meM savraNa karkaTa bana jAne se bhI yaha phuphphusapAka ho sakatA hai / jaba yuddhakAla meM viSAkta prakSobhaka vAtiyA~ niHzvasita ho jAtI haiM taba bhI isI prakAra ke phuphphusapAka ke lakSaNa pragaTa hote haiM / vAtiyoM (gases) ke kAraNa zvAsamArgoM kA adhicchada naSTa hojAtA hai aura tIvra zUla utpanna hotA hai vAyukozoM meM raktayukta srAva ekatra ho jAtA hai aura sUjana A jAtI hai / jisake kAraNa vahA~ para upasthita rogANuoM ko apanA kArya karane kA paryApta avasara mila jAtA hai / yadi rogI baca gayA to kSatigrasta sthAna meM tantUtkarSa aura samaGgIkaraNa hotA hai / zastrakarmottarakAlIna phuphphusapAka ( Post-operative Pneumonia ) ke sambandha meM yaha kahanA ki vaha niHzvAsajanya phuphphusapAka hai kaThina hai kyoMki vahA~ to For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva zvasanikAoM meM zleSmA bhara jAne ke kAraNa zvasanakarma meM avarodha vizeSa hokara phuphphusapAka hotA hai / niHzvAsajanya kAraNa kevala mukha nAsA aura svarayantra ke zastrakarmoM ke kAraNa dekhe jA sakate haiM / kabhI kabhI jaba nizcetanAvasthA ( anaesthetic state ) 1 kAsa pratyAvartana kA abhAva pAyA jAtA hai to zvAsakarma bahuta zithila hotA hai aura zvasanikAeM zleSmala srAva se bhara jAtI haiM jisake kAraNa phuphphusa meM samavasAdita sidhma bana jAte haiM jinameM dhIre dhIre rogANu bar3hate rahate haiM jinakA bAlakoM aura vRddhoM para bar3A ghAtaka prabhAva par3atA hai / zastrakarmottara kAla meM gAdhazvasana ( shallow breathing ) ke kAraNa Ane vAlI isa vipatti se bacane ke lie haiMDarasana aura habbarDa ne yaha batalAyA hai ki prAMgAra dvijAreya kI adhika mAtrA se yukta vAyu kA zvasana karAnA cAhie tAki zvasana gambhIra ho tathA zvAsanAla zleSmA se avaruddha na ho jAve / 67 tailIya phuphphusapAka (Lipoidal pneumonia) bhI eka prakAra kA niHzvAsa phuphphusapAka hai / likviDa pairAphIna kA jaba nAsA meM upayoga hotA hai to vahAM se vaha phuphphusa meM calA jA sakatA hai| kabhI kabhI baccoM ko kADalivara Aila dete samaya vaha niHzvasita hokara phuphphusa meM pahu~ca jAtA hai vahA~ usakA jalAMzana (hydrolysis) hotA hai aura taila sAbuna meM badala kara phuphphusa meM prakSobha karake vraNazotha kara detA hai / kSa-citra meM taila kI chAyA A sakatI hai aura rogI jIrNakAsa se pIDita dekhA jAtA hai / upasthAyIya phuphphusapAka ( Hypostatic pneumonia ) bhI eka prakAra kA khaNDikI phuphphusapAka hotA hai / vRddhAvasthA meM rogI ko asthibhagna yA anya kisI kAraNa se adhika kAla taka par3A rahanA par3atA hai tathA usake durbala hRdaya ke dvArA raktasaMvahana kI kriyA pUrI taura para na ho sakane se usake phephar3e adhiraktamaya aura sUje hue ho jAte haiM jisake kAraNa unameM alpaghAtakArI rogANuoM kA upasarga ho jAtA hai aura khaDaka phuphphusapAka bhI utpanna ho jAtA hai| isase rogI kI mRtyu atizIghra ho jAtI hai isa prakAra ke phuphphusapAka ke saba naidAnika lakSaNa jIvita rogI meM nahIM mila pAte / mRtyUttara parIkSA meM samavasAdi phuphphusaUti, adhiraktatA tathA phuphphusAdhAroM para khaNDikIya phuphphusapAka Adi saba milate haiM / / visthAyI phuphphusapAka ( Metastatic pneumonia ) jaba zarIra meM kisI anya sthAna meM koI upasarga ho jAtA hai aura vaha phira rakta ke dvArA phuphphusa meM visthAnAntaraNa ( metstasis ) karatA hai to phuphphusoM meM sthAna sthAna para pUti kSetra bana jAte haiM aura upasargakArI antaHzalya ( emboli ) phuphphusapAka ke kAraNa banate haiM jagaha jagaha vidradhiyA~ bana jAtI haiM aura rogI kI zIghra mRtyu ho jAtI hai I For Private and Personal Use Only Adya avizeSa phuphphusapAka ( Primary Atypical pneumonia ) ise nyUmonAiTisa ( Pneumonitis ) bhI kahate haiN| yaha Adhunika kAla meM hI prakAza meM AyA huA viSANujanya roga hai / isameM anya kisI jIvANu kI upasthiti na milane ke kAraNa hI ise viSANujanya mAnA jAtA hai isameM kozAoM kI pratikriyA bhI anya 6. 10 vi0

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18 vikRtivijJAna viSANujanya rogoM ke samAna hI hotI hai| yaha saumya svarUpa kA roga hai para kucha rugNa kAlakavalita bhI hote dekhe gaye haiM isa roga kI mahAmArI sI calatI hai isakA prArambha ziraHzUla, nAsApraseka aura gale kI kharAbI se hotA hai phira kucha kAloparAnta jvara, kAsa, daurbalya aura phauphphusIka lakSaNa prakaTa hote haiM kabhI kabhI to kevala zvAsanAlapAka ( bronchitis) yA zvasanikApAka ( bonchiolitis ) se Age yaha roga nahIM bddh'taa| kAsa meM zleSmapUyIya ( muco-purulent ) padArtha nikalatA hai| vAyukozoM meM srAva kama milatA hai| parizvAsanAliya antarAlita kSetroM meM ekanyaSTikozAoM kI bharamAra dekhI jAtI hai / tIvrAvasthAoM tIvrazotha ( acute oedema) mila sakatA hai| isa roga meM sTona aura pAsamora ne rakta rasa meM 'zIta' zoNaprasamUhiyoM ( cold haemoglutinins ) kI upasthiti batalAI hai jo 0-25deg zatAMza para lAla kaNoM ke prasamUhana kI zakti rakhatI haiN| ye prathama saptAha ke antima caraNa meM prArambha hokara 10 se 14 dina meM adhikatama hokara phira ghaTa jAtI haiN| (8) mahAsrota para vraNazotha kA pariNAma mukha se lekara guda taka kA sampUrNa bhAga mahAsrota kahalAtA hai| vraNazotha kA mahAsrota para kyA pariNAma hotA hai use aba hama vyakta karate haiN| sarvasara yA mukhapAka ( Stomatitis ) yaha eka prakAra kA zizu yA bAla roga hai| isameM mukha kI zleSmalakalA kA pAka ho jAtA hai / suzruta ne sarvasara nAma se mukhapAka kA varNana kiyA hai| usane vAtaja sarvasara, pittaja sarvasara, kaphaja sarvasara tathA raktaja sarvasara usake 4 bheda kie haiN| unake lakSaNa nimna prakAra diye gaye haiM sphoTaH satodairvadanaM samantAd yasyAcitaM sarvasaraH sa vAtAt / raktaiH sadAbastanubhiH sapItairyasyAcitaM cApi sa pittakopAt / / kaNDUyutairalparujaiH savarNairyasyAcitaM cApi sa vai kaphena / / raktena pittodita eka eva kaizcit pradiSTo mukhpaaksNshH|| (su. ni. sthA. a. 16) zArGgadhara ne mukhapAka ke 5 bheda kie haiM:1. vAtika mukhapAka 4. raktaja mukhapAka 2. paittika mukhapAka 5. sannipAtaja mukhapAka 3. zlaiSmika mukhapAka vAtaja sarvasara meM satodasphoTa hote haiM, pittaja meM lAlavarNa sadAha patale pIle sphoTa hote haiM, kaphaja meM savarNa sphoTa kaNDUyukta dekhe jAte haiM, raktaja meM paittika sarvasara ke samAna lakSaNa hote haiM aura sAnnipAtika meM tInoM doSoM ke lakSaNa pAye jAte haiN| For Private and Personal Use Only

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sako mukhapAka pRSTha 99 Acharya Shri Kailassagarsuri Gyanmandir citra meM nicalA oSTa naSTa ho gayA hai tathA roga adhohanu taka pahu~ca rahA hai For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva pazcimI vidvAnoM ne mukhapAka ke nimnabheda svIkAra kie haiM:1-parisrAvI sarvasara ( catarrhal stomatitis ) 2-zlaiSmika sarvasara ( aphthous stomatitis) 3-zvetamukhapAka ( thrush) 4-sakotha mukhapAka yA mahAzauSira (gangrenous stomatitis or cancrum oris ) 5-savraNa sarvasara yA pAradIya sarvasara (ulcerative stomatitis or mercurial stomatitis ) :: 3-sazopha sarvasara ( Vincent's angina) parisrAvI sarvasara meM mukha ke adhicchada meM pUyika vraNazotha ho jAtA hai isakA kAraNa mukha meM vraNa yA dantavidhi kA honA, atizaya dhUmrapAna athavA vibandha aura ajIrNa huA karatA hai| yaha sarvasara sarvaprathama hotA hai / isameM mukha kI zleSmalakalA meM raktAdhikya ho jAtA hai aura aneka phUle hue sidhma dekhe jAte haiM mukha se gAr3he aura picchila lAlArasa kA srAva hotA hai thor3e samaya pazcAt sidhmoM para kA adhicchada ukhar3a jAtA hai tathA vahA~ vraNa tathA ghAva ho jAte haiN| zlaiSmika sarvasara meM mukha meM zveta varNa ke sidhma bana jAte haiM unameM se zvetarasa kA srAva hotA hai zleSmalakalA lAla ho jAtI tathA sUjI rahatI hai| thor3e samaya bAda zvetavarNa ke vraNa yahA~ para bana jAte haiN| - zvetamukhapAka zlaiSmika sarvasara ke Age kI avasthA hai isameM zveta sidhma mila kara bar3e bar3e sidhma jihvA oSThoM yA gale meM dekhe jAte haiN| zizuoM meM danto bhedakAla meM yaha prAyaH ho jAtA hai aisA lagatA hai mAno dahI jama gayA ho| isakA kAraNa oIDiyama elbIkensa (oidium albicans ) nAmaka parAzrayI jIvANu batalAyA jAtA hai jo khaTTe dugdha meM rahatA hai| isa roga ke kAraNa lasIgranthiyA~ bar3ha jAtI haiM para ve kabhI sapUya nahIM hotii| durbala vayaskoM meM bhI yaha roga mila sakatA hai| sakotha mukhapAka oSTha aura kapoloM kI mRdu UtiyoM kA vinAzaka yaha roga Ajakala bahuta kama dekhA jAtA hai| yaha dIna bAlakoM meM jo nagaroM ke durgandhapUrNa sthaloM meM nivAsa karate haiM usameM upasarga dvArA hotA huA dekhA jAtA rahA hai pahale kapola ke bhItarI bhAga meM chila jAne se eka dhUsara varNa kA nirmoka ( slough ) bana jAtA hai usameM se durgandhayukta srAva nikalatA hai kotha Age phailatA jAtA hai kapola phUla jAtA hai tana jAtA hai aura camakane lagatA hai, Upara kI tvacA kAlI par3a jAtI hai dhIre dhIre nirmoka bana banakara mRdu UtiyA~ naSTa hotI jAtI haiM aura roga oSThA, jihvA, tAlu aura hanu kI asthiyoM taka pahuMca jAtA hai| isa roga meM viSaraktatA ke lakSaNa prAyaH milate haiM / roga kA kAraNa pUyajanaka mAlAgolANu (streptococcus pyogenes), viMseMTa kA adhikuntalANu ( Vincent's spirillum ) tathA kuntalANu (spirochaetes) ho sakate haiN| For Private and Personal Use Only

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100 vikRtivijJAna saNa sarvasara anya mukhapAkoM kI apekSA adhika ugra vyAdhi hai / isakA udbhava durbala vyaktiyoM ko tIvra jvaroM meM yA pUyika dantarogoM meM ho jAtA hai| jo loga azuddha pArada kA upayoga karate haiM yA usase bane lavaNa lete rahate haiM unheM bhI yaha sarvasara ho sakatA hai isIlie isakA eka nAma rasajanya sarvasara ( mercurial stomatitis ) bhI hai / dhUmapAna atyadhika karane vAle vyaktiyoM ko pAradayukta padArtha sevana ke pazcAt yaha roga lagate hue pratyakSa dekhA jAtA hai / pahale lAlAsrAvAdhikya hotA hai phira dantamAMsa ( masUr3oM) meM zUla hotA hai ve baiMganI raMga kI rekhA se yukta ho jAte haiM unase rakta nikalatA hai dAMta bhI DhIle hokara gira jA sakate haiN| hanu kA nAza ho sakatA hai aura jihvA meM bhI rasajanya jihvApAka utpanna ho sakatA hai| kapoloM aura oSThoM kI zleSmalakalA para choTe pIle pUyika vraNa utpanna ho jAte haiM mukha se durgandha AtI hai| Acharya Shri Kailassagarsuri Gyanmandir sazopha sarvasa bhI eka ugra vyAdhi hai isake kAraNabhUta viMseMTa kA adhikuntalANu( Vincent's spirillum ) tathA tarkurUpa daNDANu (bacillus fusiformis) do jIvANu hote haiM / isameM mukha kI zleSmalakalA bahuta sUkha jAtI hai mukha zuSka aura bAlU bharA sA ho jAtA hai yadi cikitsA na huI to dantamAMsa aura mukha ke tala para vraNa bana jAte haiM / dantamUlapAka yA dantamAMsapAka ( Gingivitis ) masUr3oM ( gums ) meM vraNazotha hone para ve phUla aura sUja jAte haiM unase rakta bahane lagatA hai zUla hotA hai aura pAka hokara pUya kA srAva bhI dekhA jAtA hai | dAMtoM meM gandagI, sitakozotkarSa, skarvI, pAradaM viSa Adi kAraNoM se dantamUla yA dantamAMsa meM pAka ho jAtA hai / adhika ugra avasthA meM dA~ta hila jAte haiM aura gira par3ate haiM / suzruta ne dantamUlagata 15 vyAdhiyoM kA varNana kiyA hai inameM prathama 8 dantamUla pAka kI vibhinna avasthAoM ko hI prakaTa karatI haiN| inakA varNana nimna hai : --- 1. zItAda - zoNitaM dantaveSTebhyo yasyAkasmAt pravartate / durgandhIni sakRSNAni prakledIni mRdUni ca // dantamAMsAni zIryante pacanti ca parasparam / zItAdo nAma sa vyAdhiH kaphazoNitasambhavam // yaha pArada viSajanya yA skarvI ( jIvati ga hInatA ) janya mukhapAka hai / 2. danta puppuTaka dantayostriSu vA yasya zvayathuH sa rujo mahAn / dantapuppuTako jJeyaH kapharaktanimittajaH // ( gum boil ) hai / mAMsa 3. dantaveSTa-- sravanti pUyarudhiraM calA dantA bhavanti ca / dantaveSTaH sa vijJeyo duSTazoNitasaMbhavaH // ise pUyAtmaka dantamUlapAka ( suppurative gingivitis ) yA pAyoriyA ailviyolairisa ( Pyorrhoea alveolaris ) kahate haiM / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 101 4. zauSirazvayathurdantamUleSu rujAvAn kapharaktajaH / lAlAsrAvI sa vijJeyaH kaNDUmAn zaupiro gadaH // yaha dantamUla zotha hai| 5. mahAzauSira--- dantAzcalanti veSTebhyastAlu cApyavadIryate / dantamAMsAni pacyante mukhaM ca paripIDyate / yasmin sa sarvajo vyaadhirmhaashaussirsNjnykH|| yaha kaikrama orisa ( canerum oris ) sakothamukhapAka hai / 6. paridaradantamAMsAni zIryante yasmin SThIvati cApyasak / pittAmukkaphajo vyAdhizeyaH paridaro hi sH|| yaha dantamUlagata UtiyoM ke naSTa hone kA dRzya hai| 7. upakuzaveSTeSu dAhaH pAkazca tebhyo dantAzcalanti ca / AghaTTitAH prasravanti zoNitaM mndvednaaH|| AdhmAyante sute rakte mukhaM pUti ca jAyate / yasminnupakuzaH sa syAt pittaraktakRto gadaH // isI kA yathAvat varNana eka aMgreja ne nimna zabdoM meM kiyA hai: Gingivitis or inflammation of the gums is a subacute or chronic condition......... the breath is foul, while the gums become swollen, shaggy or congested; they bleed easily and may have shallow ulcers upon them, while the teeth become loose and may fall out. spaMjI gamsa ( spongy gums ) ke lie AdhmAyanta zabda kA prayoga vizeSa dhyAna dene yogya hai| zuddha dantamUlapAka ko upakuza zabda dvArA abhivyakta karanA pUrNataH upayukta hai| 8. vaidarbhaghRSTeSu dantamUleSu saMrambho jAyate mahAn / bhavanti ca calA dantAH sa vaidarbho'bhighAtajaH // yaha abhighAtaja dantamAMsapAka (traumatic gingivitis ) kA varNana hai| dantaveSTa yA pAyoriyA elviolairisa kA jo varNana Upara diyA hai vaha bahuta sUkSma hai| yaha roga vayaska yA prauDhoM ko hotA hai| 30 varSa ke pazcAt isa roga se pIDita aneka strI puruSa dekhe jAte haiN| isa roga ke kAraNa kA abhI taka kucha patA nahIM calatA kyoMki isake pUya meM anekoM jovANu (mAlAgolANu, adhikuntalANu, dantamAMsa antaHkAmarUpI-endamoeba. gingivitis ) milate haiN| kucha kA aisA mata hai ki vRddhAvasthA ke kAraNa dantamAMsa dantamUla ko chor3akara sikur3atA hai usI ke kAraNa usameM dvitIyaka upasarga ke rUpa meM ye jIvANu saba yA kucha dantaveSTotpatti kara dete haiN| For Private and Personal Use Only

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vikRtivijJAna jihvApAka (Glossitis) Ayurveda ne 3 prakAra ke jihvApAkoM kA varNana trividha jihvAkaNTaka nAma se kiyA hai: jihvA'nilena sphuTitA prasuptA bhavecca zAkacchadanaprakAzA / pittena pItA paridahyate ca citA saraktairapi kaNTakaizca / kaphena gurvI bahulA citA ca mAMsodgamaiH shaalmliknnttkaabhaiH|| navIna zAstrakAroM ne isake cAra bheda svIkAra kiye haiM: 1. tIvra bAhya jihvApAka ( acute superficial glossitis) isameM choTe choTe vraNa bana jAte haiN| yaha parisrAvI prakAra kA vraNazotha hai yaha mukhapAka ke sAtha sAtha hotA hai| Ayurvedokta tInoM jihvAkaNTaka roga isI ke antargata samAviSTa hote haiN| 2. tIvra jIvitaka jihvApAka ( acute parenchymatous glossitis) yaha pUyika vraNazotha hai jo jihvA kI saMyojI tathA pezI UtiyoM meM hotA hai| samIpastha vraNa ke mAlAgolANu isa roga ko utpanna karate haiN| kisI ke kATane yA DaMka mArane se bhI yaha prArambha ho sakatA hai| kabhI kabhI tIvra jvaroM meM bhI yaha dekhA jAtA hai| azuddha pArada ke kupariNAma se hone vAle mukhapAka ke sAtha hI pAradajanya jihvApAka ( mercurial glossitis ) dekhA jA sakatA hai| ..... pAradajanya jihvApAka meM eka vistRta kSetra meM sUjana tathA zUla dekhA jAtA hai sampUrNa jIbha phUla jAtI hai usakA prabhAva kaNTha taka par3atA hai nigalanA aura zvAsa lenA kaThina ho jAtA hai| durbala aura madyapAyI vyaktiyoM meM aura bhISaNa rUpa dhAraNa kara letA hai| isameM pUyana prAyaH nahIM hotA yadi hotA bhI hai to alAsa ( sublingual abscess ) ke rUpa meM / sAtha meM tIvra santApa, glAni aura graivika lasIgranthiyoM meM pAka evaM zotha hotA hai jo bar3ha kara grIvA meM kozotikopa ( cellulitis) tathA madhyorasapAka ( mediastinitis) kA kAraNa banatA hai| pazuoM ke pAda tathA mukha roga ( foot & mouth disease ) ke upasarga dvArA isa jihvApAka kA aura ugra rUpa dekhane ko mila sakatA hai| jihvA atyadhika phUla aura sUja jAtI hai usa para choTe choTe Azayaka ( vesicles ) bana kara paka jAte tathA phUTa kara vraNa kA rUpa dhAraNa kara lete haiN| kabhI kabhI AdhI jihvA meM pAka dekhA jAtA hai aura zeSa ThIka rahatI hai| tIvra jIvitaka jihvApAka ke pariNAmasvarUpa jihvA vidradhi yA alAsa hotA hai| yaha jihvA ke bhItara dekhA jAtA hai isake kAraNa jihvA kI gatizIlatA jAtI rahatI hai jihvAtale yaH zvayathuH pragADhaH so'lAsasaMjJaH kphrktmuurtiH| . jihvAM sa tu stambhayati pravRddho mUle tu jihvA bhRzameti pAkam // For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 103 3. jIrNabAhya jihvApAka (chronic superficial glossitis) __ yaha jihvA kI zlaiSmikakalA kA jIrNa vraNazotha hai yaha jaba hotA hai tabhI kapoloM aura oSThoM kI zlaiSmikakalA meM bhI pAka hotA hai| isakA kAraNa tRtIyaka phiraMga, pUyikadanta, atyadhika tambAkU sevana, masAledAra padArthoM kA atizaya prayoga, AsavoM yA surA kA sevana sAtha meM ajINaM yA vAtarakta kI upasthiti isa roga ko utpanna karatI hai| isa roga kI vibhinna avasthAeM jihvA para eka hI kAla meM dekhI jAtI haiM yaha roga 40 se 60 varSa kI avasthA meM puruSoM meM hotA hai aura karkaTArbuda (kaiMsara) kA kAraNa bana sakatA hai| isa roga kI nimna avasthAeM dekhI jA sakatI haiM prathamAvasthA-isameM adhicchada ke bhItarI bhAgoM meM pAka ho jAtA hai, usameM gola kozAoM kI bharamAra ho jAtI hai, thor3A tantUtkarSa bhI milatA hai| isakA pariNAma yaha hotA hai ki jihvAMkura sUja jAte haiM jihvAtala lAla ho jAtA hai aura usameM adhiraktayukta sidhma bana jAte haiN| ye sidhma dhIre dhIre milakara eka ho jAte haiN| dvitIyAvasthA-kucha kAloparAnta jihvAtala kI abhivRddhi ( overgrowth) tathA kadarIkaraNa ( cornification ) hone lagatA hai jisake kAraNa jihvAtala moTA, pArAndha, kaThina, , uThA huA, zveta tathA kaThina paTTa ( hard plaques) yukta ho jAtA hai aura lAla sidhma miTa jAte haiN| naye sidhma zveta tathA caukona yA dIrghavRttAkAra ( oblong-shaped ) ho jAte haiM / isa avasthA ko sitapaTTatA (leucoplakia), yA sitazRGgotkarSa ( leucokeratosis) kahate haiN| isake kAraNa jihvAtala zveta, moTA aura kaThina ho jAtA hai| ___ tRtIyAvasthA-dvitIyAvasthA ke utsedhayukta adhicchada ko puSTa karane ke lie jitane rakta kI AvazyakatA hotI hai vaha use nahIM mila pAtA isa kAraNa kucha kAloparAnta yaha utsedha kahIM kahIM se girane lagatA hai aura usake nIce cikanI, lAla, aMkurarahita, kaccI camakavAlI ( raw-glazed ) sataha raha jAtI hai| zeSa bhAga meM dvitIyAvasthA rahatI haiN| caturthAvasthA-tRtIyAvasthA ke pazcAt jihvA para vraNa, pATa ( cracks ), vidara (fissures) banane lagate haiN| jihvA ke madhya bhAga meM eka vidara hotA hai usakI zAkhA se anya pATa banate haiM jo paryApta gahare hote haiN| gaharAI kA kAraNa navIna tAntava jati jo gahare staroM meM banatI hai usakA saMkoca hai| paMcamavasthA-isa avasthA meM pAToM aura vidaroM meM karkaTArbuda kA janma hotA hai / uparokta pAMcI avasthAeM jihvA ke vibhinna bhAgoM meM eka sAtha bhI dekhI jA sakatI haiN| ____4. jIrNa jIvitaka jihvApAka ( chronic parenchymatous glossitis ) yaha phiraMga kI tRtIyAvasthA ke kAraNa utpanna goMdAdhuMda ke kAraNa hone vAlA prakAra hai jisakA varNana Age yathAsthAna hogaa| For Private and Personal Use Only

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104 vikRtivijJAna karNamUlanthipAka ( Parotitis ) kanapheDa ( mumps ) nAmaka roga meM karNamUla granthipAka huA karatA hai isameM lasIkozAoM kI bharamAra tathA sitakozApakarSa ( leucopenia ) vizeSa rUpa se dekhA jAtA hai| ise aupasargika karNamUlagranthipAka ( infective parotitis ) bhI kahate haiM / isameM eka ora yA donoM ora kI karNamUla granthiyAM paka jAtI haiM / kabhI kabhI tInoM lAlAgranthiyoM ( salivary glands ) meM bhI zotha dekhA jAtA hai / upasargakAla meM prajanana granthiyAM ( genital glands ) bhI sUjI huI dekhI jA sakatI haiN| kabhI kabhI prajanana granthiyoM kI apuSTi vandhyatA ( sterility ) bhI kara sakatI hai / upasarga ke kAraNa karNamUlagranthiyoM meM vraNazothAtmaka zopha ( oedema ) utpanna ho jAtA hai jisase ve sUja jAtI haiM tathA unase prabhAvita kSetra meM zUla hone lagatA hai / upasarga kA kAraNa eka prakAra kA viSANu ( virus ) hotA hai jisake dvArA vAnaroM meM vaijJAnika kRtrimarUpa se isa roga ko utpanna karane meM samartha ho sake haiN| ardita roga meM upadrava ke rUpa meM tathA anya viziSTa sajvara upasargoM meM kama yA adhika yaha zotha dekhA jA sakatA hai / azuddha mukha se granthipraNAlI vivaroM meM hokara upasarga kA ArohaNa granthi taka hotA hai / karNamUlazotha ko caraka ne sannipAtaja jvara ke anta kA eka upadrava karake varNana kiyA hai| *-* sannipAtajvarasyAnte karNamUle sudAruNaH / zodhaH saMjAyate tena kazcideva pramucyate // Acharya Shri Kailassagarsuri Gyanmandir isa para TIkA karate hue zrIvAcaspati vaidya likhate haiM: sannipAtajvarasya ante avasAne sannipAtakSapitazarIrasya puMsaH karNamUle karNaparyante sudAruNaH kaSTatamo rAgarujAdiyuktaH zophaH samprAptivizeSAt karmavaicitryAt saMjAyate, tena zophena kazvidevAturo vimucyate, prAyo mArayatItyarthaH / parantu karNamUlazotha sabhI mAraka hoM aisA nahIM mAnanA cAhie / svayaM AyurvedazAstrajJa isa sambandha meM nimna niyama mAnate haiM jvarasya pUrvaM jvaramadhyato vA jvarAntato vA zrutimUlazodha: / kramAdasAdhyaH khalu kaSTasAdhyaH sukhena sAdhyaH munibhiH pradiSTAH // jvara se pUrva yA jvararahita zrutimUlapAka asAdhya, sajvara kaSTasAdhya tathA jvara ke anta meM utpanna sukhasAdhya hotA hai / sannipAta jvara ke anta kA zrutimUlazotha carakamana mAraka hotA hai / eka jIrNakarNikIya karNamUlazotha mikUlikja lakSaNa ( mickulicz syndrome) kahalAtA hai jo kaI mAsa yA varSa taka raha sakatA hai| isameM alparujA hotI hai / ise hama pASANagardabha kaha sakate haiM: hanusandhau samudbhUtaM zophamalparujaM sthiram / pASANagaIMbhaM vidyAt balAsa pavanAtmakam // ( su. ni. sthA. a. 13 ) isa roga meM anya lAlAgranthiyAM tathA azrugranthiyAM ( lachrymal glands ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva bhI prabhAvita hotI huI dekhI jA sakatI haiN|suucm racanA jAlikotkarSa (reticulosis) sadRza hotI hai| sapUyazrutimUlazotha ( suppurative parotitis) azuddha mukha se zruti. mUlagranthi praNAlI ( parotid duct ) ke vivara dvArA upasarga pahu~cane para athavA isa praNAlI meM avarodha ho jAne para yaha hotA huA dekhA jAtA hai| dAruNa sannipAtAvasthA meM yaha upadrava svarUpa ho sakatA hai yaha grIna mAnatA hai-...... it may complicate severe febrile illnesses in which the normal salivary secretion is inhibited...........' usakA kathana hai ki 70 pratizata sapUya zrutimUlazotha kA kAraNa puMja yA gucchagolANu hai jo granthi ke bhItara aneka vidradhiyAM utpanna karatA tathA usake Upara kI tvacA galA detA hai| ___ grasanIpAka ( Pharyngitis) nAsAguhA kI zleSmalakalA yA galatoraNikAoM ( fauces ) meM upasarga ho jAne para unake dvArA grasanI meM bhI upasargakArI jIvANuoM kA praveza ho jAyA karatA hai| sahasA zIta laga jAne se yA dUSita vAti kA saMsarga Ane se yA romAntikA, lohita jvara vA rohiNI ke kAraNa bhI grasanI para prabhAva par3atA hai| tIvragrasanIpAka (acute pharyngitis ) meM sarvaprathama grasanI kI zleSmalakalA lAla par3a jAtI hai, tathA sUja jAtI hai, usake Upara atyadhika cipakanA zleSmA yA zleSmapUya ( muco-pus) jama jAtA hai / isake kAraNa nigalane kI kriyA karate samaya rogI ko apAra kaSTa hotA hai tathA use zuSka prakSobhaka kAsa utpanna ho jAtA hai| mukha ke anya bhAgoM kI bhA~ti yahA~ para bhI vaNana ho sakatA hai / zizuoM meM tIvra grasanIpAka ke pazcAt romAntikAdi vikAra dekhe jAte haiM jinakA dhyAna rakhanA caahie| jIrNagrasanIpAka meM gale kI zleSmalakalA meM bahuta kAla se zotha ho jAtA hai aura vaha moTI (hyperplastic ) ho jAtI hai| kaI bAra tIvra grasanIpAka ke AkramaNa ke pariNAmasvarUpa yA azuddha vAtAvaraNa meM zvAsa-prazvAsa lene para kucha kAloparAnta yaha roga laga jAtA hai| yaha zizuoM kI apekSA vayaskoM meM tathA strI kI apekSA puruSoM meM adhika hotA hai / tambAkU, adhyazana, madirApAna isa roga ke pravardhaka hetu haiN| dUSita danta, upasargagrasta tuNDikA granthiyA~, nAsAvarodha jo mukhena zvAsa kA kAraNa ho, nAsAkoTaroM ke upasarga, vAtarakta (gout), AmavAta, sandhivAta aura phiraGga isake sahAyaka kAraNa haiN| atyadhika khAMsane ke pazcAt kapha kA nikalanA tathA svarasAda ye 2 lakSaNa pramukhatayA hote haiN| _ yadi A~kha se grasanI ko dekhA jAve to usameM koI vizeSa antara nahIM dikhAI detA para kabhI kabhI vahA~ raktAdhikya dekhA jAtA hai| rogI ko galaparIkSA karAne meM kaSTa hotA hai| sampUrNa zleSmalakalA para choTe choTe dAne uThe rahate haiN| jinake kAraNa For Private and Personal Use Only

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106 vikRtivijJAna vaha kaNadAra ho jAtI hai / usakA tala prAyaH bhIgA aura thUka se DhakA hotA hai| kabhI kabhI vaha sUkhA bhI mila jAtA hai| vAstava meM isa roga meM upazleSmalakalA ( submucosa) kI raktavAhiniyA~, tAntava Uti aura lasAbha Uti sabakI parama puSTi prArambha hotI hai isa kAraNa isa bhAga meM bahuta se parama puSTabhAga dekhe jAte haiN| inhIM meM mile hue kucha apuSTa kSetra bhI dekhe jAte haiN| AmAzayapAka ( Gastritis ) __ AmAzaya meM tIvra aura jIrNa donoM prakAra kA vraNa zotha mila sakatA hai| AmAzayika vraNazotha kA pradhAna kAraNa prakSobha huA karatA hai| AhAra ke dvArA jIvANvika viSiyAM ( bacterial toxins ) pahuMca jAne se yA prakSobhakAraka padArtha jaise rAsAyanika viSoM ( poisons ) ke khAne se yA anya usI prakAra ke kisI kAraNa se AmAzaya meM pAka ( inflammation ) dekhA jAtA hai / saumya vyAdhi meM adhiraktatA tathA ugra vyAdhi meM UtimRtyu dekhI jAtI hai| mAlAgolANuoM ( streptococci ) ke dvArA kabhI kabhI samagra AmAzaya kopa (acute phlegmonous gastritis) nAmaka vyAdhi dekhI jAtI hai| isameM AmAzaya kI sampUrNa prAcIra zothapUrNa evaM moTI ho jAtI hai| usameM pUyana kA prArambha hone ke kAraNa anekoM vidhiyA~ AmAzaya kI zleSmalakalA para prakaTa ho jAtI hai| unake kAraNa udaracchadapAka (peritonitis) taka hotA huA dekhA jAtA hai| ajIrNa, madyapAna, prasUti jvara (puerperal fever) AmAzayika vraNa (gastric ulcer ) tathA AmAzaya para kiyA gayA zastrakarma ( operation ) AmAzayapAka ke kucha anya mahatvapUrNa kAraNa haiN| samagra AmAzaya kopa meM sarvaprathama AmAzaya kI upazlezmalakalA para prabhAva par3atA hai jisake pazcAt sampUrNa prAcIra roga grasta ho jAtI hai| tIvra AmAzayapAka (acute gastritis) ko AmAzayika pInasa (gastric influenza ) yA tIvra prasekI AmAzayapAka ( acute catarrhal gastritis ) bhI kahate haiN| duSpAcya padArthoM kA adhika mAtrA meM sevana karane se yA atyadhika madyapAna ke kAraNa yaha roga ho sakatA hai| lohita jvara (scarlet fever) rogANuraktatA (septicaemia ) tathA anya upasargakArI jIvANu bhI isake kAraka haiN| mUtraraktatA (uraemia) ke viSi AmAzaya meM utsRSTa hokara bhI ise utpanna karate haiN| yuddha kAla meM kSobhakArI vAtiyoM ( irritant gases) se mizrita lAlA rasa ke dvArA bhI AmAzaya pAka sambhava hai| AmAzaya kI zleSmala aura upazleSmalakalA meM vraNazotha ke saba lakSaNa prakaTa ho jAte haiN| jinake kAraNa hRllAsa ( nausea.) evaM vamI ( vomiting ), AdhmAna, aruci, agnimAndya, udgArabAhulya tathA AmAzayazUla pradhAnatayA dekhe jAte haiN| roga kI saumyatA lakSaNoM kI bhI saumyatA kara detI hai| jaba zleSmalakalA meM atyadhika vikSata ho jAte haiM taba vamana ke sAtha rakta bhI jAne lagatA hai| sAdhAraNatayA isa roga meM vibandha (consti For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 107 pation ) rahatA hai parantu jaba prakSobhaka AMtoM para bhI prakSobha karane meM samartha hotA hai to atIsAra dekhA jAtA hai| AmAzaya meM itane vikAroM kA pariNAma ziraHzUla meM ho jAtA hai| mUtra kI pratikriyA Amlika hotI hai usameM zukli kI jhalaka dekhI jAtI hai / jvara prAyaH nahIM rahatA para baccoM meM nAr3I drautya ke sAtha jvara bhI mila sakatA hai oSThoM kA pAka ( herpes labialis ) bhI kabhI kabhI milatA hai| rakta ke zveta kaNa bar3ha jAte haiM / AmAzayika amla zanaiH zanaiH kama (hypochlorhydria) hokara pUrNataH samApta (achlorhydria) hotA huA bhI milatA hai| tIvra sapUya AmAzaya pAka (acute suppurative gastritis) nAmaka vyAdhi meM tIvra udara zUla ke sAtha vamana milatI hai jisameM pUya kI upasthiti dekhI jAtI hai| mAlAgolANu ke atirikta AntradaNDANu ( B. coli ) athavA phuphphusagolANuM ( pneumococci ) bhI pUyotpatti ke kAraka ho sakate haiN| pUyaraktatA (pyaemia), kAlasphoTa ( anthrax ), yA masUrikA ( small pox ) ke dvArA bhI yaha roga banatA hai| isameM upazleSmalakalA meM vidradhiyAM banatI haiM jo phaTatI haiM aura pUyotsarga kA kAraNa hotI haiM yaha udaracchadakalApAka kA bhI kAraNa ho sakatA hai| jIrNa AmAzayapAka (chronic gastratis) do prakAra kA dekhA jAtA hai| eka vaha jisameM AmAzaya se atyadhika amlasrAva hotA hai (acid gastritis) / isake koI vizeSa lakSaNa prakaTa nahIM hote jaba taka ki usake sAtha AmAzayika vraNa kA upadrava na ho| kevala AmAzaya bhAga meM sakhtI tathA sparzAkSamatA ke sAtha mala meM raktAMza kI upasthiti milatI hai| kSa-citra meM bhI koI virUpAkRti nahIM dekhI jaatii| para yadi vraNa huA to kSa-citra meM usakI chAyA pAI jA sakatI hai| vraNa kI upasthiti meM yA kSata ho jAne para raktavamana kA honA jIrNa AmAzaya pAka meM sambhava hai| AmAzaya ke pratyakSa darzana (gastroscopy) dvArA isa roga kA jJAna ThIka se milatA hai| dUsarA vaha hai jisameM amla kI kamI dekhI jAtI hai (achlorhydric gastritis ) isakA mukhya lakSaNa hRllAsa yA macalI AnA hai jo sadaiva dekhA jAtA ho aisA bhI koI niyama nhiiN| hallAsa ke pazcAt tudhAnAza (anorexia) dekhA jAtA hai| tudhAnAza svatantratayA bhI ho sakatA hai| peTa meM bhArIpana kA anubhava hotA hai agnimAndya hone para bhI kabhI kabhI khaTTI DakAreM dekhI jAtI haiN| vamana kabhI kabhI AtI hai aura rogI ko usase zAnti kA anubhava hotA hai / isa roga kA kAraNa madyapAna prAyazaH hotA hai| ___ atipuSTa yA apuSTa ye do prakAra ke jIrNa AmAzaya pAka ke prakAroM meM pahale kA pariNAma hI dUsarA hotA hai| atipuSTa AmAzayapAka jisameM amla kA atisrAva hotA hai, isake ho jAne para AmAzaya kI zleSmala kalA moTI par3a jAtI hai usameM aneka moTI valiyAM ( heavy folds ) par3a jAtI haiM aura ve bahuzAkha ( polypoid ) bhI ho For Private and Personal Use Only

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108 vikRtivijJAna jAtI haiN| yaha parivartana mudrikAdvAra yA nijaTharadvAra ( pyloric end ) para pAyA jAtA hai| AmAzaya kA cheda ( section ) lene para zleSmAstrAvI kozAoM kI saMkhyA atyadhika bar3hI huI dekhI jAtI hai unameM se bahuta mAtrA meM zleSmalasrAva hotA huA pAyA jAtA hai / yadyapi zleSmalakalA svayaM atipuSTa nahIM hotI parantu (1) zotha (2) vraNazothakAraka kozAoM kI bharamAra tathA (3) upazleSmalakalA ke tantUtkarSa ke kAraNa vaha atipuSTa dikhalAI detI hai| zanaiH zanaiH pranthiyAM apuSTa honA prArambha karatI haiM jisake kAraNa paramanIroda ( hyperchlorhydria) upanIroda ( hypo. chlorhydria) meM pariNata ho jAtA hai| upanIrodAvasthA meM zleSmalakalA kI granthiyAM vilupta ho jAtI haiM aura usake saba AvaraNa ( coats ) kSINakAya ho jAte haiN| isake kAraNa zleSmalakalA cikanI aura tanI huI lagatI hai| ___jIrNa yA cirakAlIna AmAzayapAka eka aisI avasthA hai jo varSoM calatI hai| isa roga ke 2 cakra calate hai eka cakra meM zleSmalakalA kI granthiyoM kA luptIkaraNa prArambha hotA hai dUsare cakra meM jo AghAta granthiyoM meM ho jAtA hai use sudhArA jAtA hai| jaba sudhAra kriyA calatI hai taba zleSmalakalA vraNazothAtmaka kozAoM, bahunyaSTi, prarasakozA, lasIkozAdi se bhara jAtI hai aura usameM raktAdhikya ho jAtA hai| jisake kAraNa viziSTa prakAra kI granthiyAM racanAoM vAlI kaNAtmaka Uti kA sRjana hotA hai| vayaskoM meM jo isa roga se pIDita hote haiM yadi aNvIkSa se unake AmAzaya ke antara bhAga ko dekhA jAve to kahIM kahIM dvIpa sarIkhe zleSmAsrAvI kozAoM ke samUha mileMge aura zeSa bhAga granthi virahita apuSTa dikhAI degaa| ye kSetra bRhadantra kI zleSmalakalA se itane milate haiM ki antara karanA kaThina ho jAtA hai / zizuoM ke AmAzaya meM yaha dRzya dekhane ko nahIM miltaa| ' yaha Avazyaka nahIM ki jIrNAmAzayapAka AmAzaya kI sampUrNa zleSmalakalA ko hI grase usa dRSTi se sthAnika ( localised ) tathA sArvatrika (diffuse ) do rUpa isake dekhe jAte haiN| sthAnika jIrNAmAzayapAka prAyaH nijaThara yA mudrikA dvAra ke pAsa dekhA jAtA hai aura isakA sambandha prAyaH jIrNa AmAzayika vraNa ke sAtha hotA hai athavA isameM vraNa sarIkhe lakSaNa dekhe jAte haiM cAhe vraNa ho yA na ho| autikIya dRSTi se ( histologicaly ) sampUrNa AmAzaya prAcIra meM vraNazothAtmaka sUjana tathA vraNazothakArI bahunyaSTiyoM kI kama yA adhika bharamAra ho jAtI hai| zleSmalakalA para gahare yA uthale aneka aparadana ( erosions ) dekhe jAte haiN| ye aparadana bahudhA ThIka ho jAte haiM para kabhI kabhI ve jIrNa vraNa kA rUpa bhI dhAraNa kara lete haiN| AmAzayika vraNa nirmANa ke kAraNoM ke jJAna meM isa tathya kA bhI vicAra kara lenA caahie| sArvatrika prakAra meM vraNazothAtmaka parivartana adhika nahIM dekhe jAte balki zleSmalakalA kI apuSTi hI sarvatra dekhI jAtI hai jisase aisA jJAta hotA hai ki mAno isa vikSata kA prArambha kAla vraNazothAtmaka rahA ho| isa prakAra ke AmAzayapAka kA sambandha karkaTArbuda ( carcinoma ) se hotA hai / zleSmalakalA kI apuSTi hI anIroda (achlorhy. For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 106 dria ) kA kAraNa hai aura anIrodatA AmAzaya ke karkaTArbuda meM vizeSatayA dekhI jAtI hai| mArAtmaka araktatA ( pernicious anaemia ) AmAzayapAka dekhA jAtA hai usameM aura isa AmAzayapAka meM hotA hai kyoMki usameM jahAM vraNazotha kA nAma nizAna bhI vraNazotha yA zopha honA Avazyaka ho vahAM to AhAra ke hI apuSTijanaka hotA hai / meM eka jo apuSTika bahuta adhika antara nahIM hotA jaba ki isameM kisI ghaTaka kA abhAva AntrapAka ( Enteritis ) AntrapAka meM Antra ke saba bhAga A sakate haiM grahaNI ( duodenum ) se lekara bRhada taka | parantu yaha zabda laghu antra taka hI prAyazaH sImita rahatA hai / antra kI ve saba gar3abar3e jinameM udarazUla, atIsAra tathA kabhI kabhI vamana bhI sammilita ho Antra pAka ke antargata mAnI jAtI haiM / vamana hone para use AmAzayAntrapAka (gastro-enteritis ) bhI kahA jAtA hai / AntrapAka ke kaI mahatvapUrNa kAraNa haiM jinameM AhAraviSatA (food poisoning ), Antrika jvara, grahaNI, Antrika kSaya mukhya haiN| bahuta aise bhI kAraNa hote haiM jo pUrNataH ajJAta haiM para jinake kAraNa svalpakAlIna AntrapAka dekhA jAtA hai / Antra meM vraNazotha tIvra aura jIrNa donoM prakAra kA mila sakatA hai| kSudrAntra para prabhAva DAlane meM pramukha bhAga Antrika jvara ke jIvANu lete haiN| kSudra aura bRhat donoM AMtoM para prabhAvakAraka upAntrika jvara ke jIvANu tathA yakSmA ke jIvANu hote haiM tathA jo kevala bRhadAntra ko hI vraNazotha se grasate haiM ve grahaNI ( dysenteries ) jIvANu, kavaka (actinomycosis) savraNa malAzayapAka ( ulcerative colitis ) tathA phiraGga ke cakrANu hote haiM / AntrapucchapAka kA kAraNa inameM se bhI koI yA anya bhI ho sakatA hai / tIvra AntrapAka ( acute enteritis ) yA AmAzayAntrapAka atIsAra ( diarrhoea ) ke sAtha hotA hai jisake sAtha meM vamana ho bhI sakatA hai aura nahIM bhI ho sakatA AhArajanya viSatA ke kAraNa yaha prAyaH hotA hai / sthUlAntra meM mala kI gati itanI druta ho jAtI hai ki vahAM para koI vikRti nahIM milatI, tIvraAnpAka ke sAtha tIvra AmAzayapAka mila sakatA hai / AmAzayika pratizyAya ke kAraNa tIvra AntrapAka dekhA jA sakatA hai isa dazA meM atIsAra evaM vamana donoM lakSaNa pAye jAte haiM / jIrNa AntrapAka, tIvra Antra kA hI pariNAma hotA hai / kRmiyoM ( worms ) vizeSa kara sphIta kRmi ( tape worm ) dvArA bhI jIrNa AntrapAka bana sakatA hai / jo prAkRtika cikitsA vizvAsI sajjana atyadhika apacya yA duSpacya vAnaspatika padArthoM kA sevana karate rahate haiM unakI A~toM meM ina padArthoM kI ragar3a se bhI jIrNa AntrapAka bana sakatA hai / jaba AmAzaya meM amla kI kamI hotI hai to amla kI kriyA dvArA binA pace hI gayA huA AhAra bhI AMtoM ko prakSubdha kara detA hai jisake pariNAmasvarUpa yaha roga mila sakatA hai / jo vyakti prAyazaH virecana dravya 1 For Private and Personal Use Only

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110 vikRtivijJAna salohayoga athavA mallayukta padArthoM kA sevana karate haiM unheM bhI jIrNAntrapAka se vyathita dekhA gayA hai| AmAzayika anamlatA tudAntra meM aise aneka rogANuoM ko bhejane meM samartha ho jAtI hai jo amla meM naSTa ho sakate the aise rogANu grasanI, nAsA yA mukha meM rahate haiN| ve kSudrAntra meM pahu~ca kara vahAM prakSobhakAraka siddha ho sakate haiN| jaba kisI kAraNa se cudrAntrIya gatisthairya ( intestinal obstruction ) ho jAtA hai to zudrAntra meM rogakAraka jIvANuoM kI kriyAzakti bahuta bar3ha jAtI hai jisase vahAM prakSobhakAraka rAsAyanika padArtha utpanna hone lagate haiM jinake kAraNa atyanta kaSTa dAyaka AntrapAka dekhA jAtA hai / vaha tathya yaha spaSTa kara sakatA hai ki kyoM kSudrAntrIya gatisthairya meM vibandhana hokara atIsAra pAyA jAtA hai| samagra AmAzayapAka kI bhAMti samagra sthAnika AntrapAka ( localised phlegmonous enteritis) bhI dekhA jAtA hai aura usakA kartA bhI mAlAgolANu hI hotA hai jo udaracchadakalApAka taka kara sakatA hai| vikRtivijJoM ne AntrapAka ko do rUpoM meM aura spaSTa kiyA hai, eka rUpa painasa yA prasekI AntrapAka ( catarrhal enteritis ) hai jisakA kAraNa AhArajanya viSatA hai aura jisake janaka AntrakopI annaviSANu (Salmonella enteritidis yA Bacillus enteritidis yA Gartener's bacillus ), apyAntra jvaradaNDANu (B. paratyphosus B ) haiM jo tudAntra meM upasarga le jAte haiN| zizuoM aura bAlakoM ko hone vAle vyApaka atIsAra (epidemic diarrhoea of the chil. dren ) roga ke kAraNa bhI yaha hotA hai| mUtraraktatA ( uraemia ) athavA saumya rAsAyanika viSoM athavA anya kendroM se visthAnAntarita upasargoM ke kAraNa bhI yaha hotA hai| isameM zleSmalakalA tathA usake nIce kI lasAbha syUnikAe~ (lymphoid follicles ) sUja jAtI haiM aura unameM raktAdhikya ho jotA hai tathA vahA~ se atimAtra zleSmasrAva hotA hai / dharAtala para aneka choTe choTe vraNa bane hue dekhe jAte haiM / aNvIkSa dvArA dekhane se vraNazotha meM jo prAyaH citra prakaTa hotA hai vaisA hI yahAM bhI milatA hai / kezIya bharamAra ( jinameM lasIkozA adhika tathA bahunyaSTi kama) bhI khUba milatI hai| dUsarA rUpa kalAvat AntrapAka ( membranous enteritis) hai jo painala AntrapAka ke kAraNa vinaSTa huI zleSmalakalA ke dharAtalIya vinAza para jamI tantvimat kUTakalA ( fibrinous false membrane ) ke nAma para calatA hai| jaba yaha kalA chUTa jAtI hai to usake nIce gahare vraNa milate haiN| AntraprAcIra moTI par3a jAtI hai, usase adhiraktatA bar3ha jAtI hai tathA naidAnikIya dRSTi se raktAtIsAra, zleSmA tathA nirmoka (slough) mala meM milate haiM / isa kalAvat AntrapAka kA prabhAva sthUlAntra evaM malAzaya para atyadhika hotA hai| jaba yaha pAka samApta hotA hai to ina sthAnoM meM tantUtkarSa hone se vahA~ kI prAcIra itastataH saMkIrNa ho jAtI hai tathA usameM avarodhAtmaka upasaMkoca ( obstructive constrictions) bana jAte haiN| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 111 zeSAntrakapAka ( Regional Ileitis) zeSAntraka ( ileum ) kA antima bhAga sarvaprathama vraNazothagrasta hotA hai| vahA~ se uNDuka ( caecum ) taka vraNazotha phailatA hai| kSudrAntra aura sthUlAntra kA bhAga bhI prabhAvita ho sakatA hai jisake bIca-bIca meM svastha A~ta ke khaNDa ( segment ) rahate haiN| asvastha khaNDoM kI zleSmalakalA sUja jAtI hai aura Age calakara usameM vraNana ( ulceration ) ho jAtA hai| AntrakhaNDa ke saba stara ( coats ) isa roga meM prabhAvita hote haiM sUja jAte haiM aura moTe par3a jAte haiN| vraNazotha kI isa tIvrAvasthA ke pazcAt tantUtkarSa ho jAtA hai jisake kAraNa Antra khaNDa kA suSiraka ( lumen) saMkIrNa ho jAtA hai| antrabandhanI ( mesentery ) sthUlita ho jAtI hai, tathA lasagranthiyAM pravRddha ho jAtI haiN| AntrakhaNDoM ke nikaTavartI bhAga abhilagna ho jAte haiM aura unameM nAla ( fistulae ) bana jAte haiN| aNvIkSa parIkSaNa para tIvra, anutIvra yA jIrNa vraNazothoM meM mahAkozAoM (giant cells) kI upasthiti milatI hai| isake kAraNa yaha vraNazotha AntrayakSmA ke se lakSaNa upasthita kara detA hai| pUrvakAla meM isa roga kA aura yakSmA kA antara karanA prAyaH kaThina hotA thaa| parantu kyoMki yakSmAdaNDANu kI upasthiti isa roga meM kahIM pAI nahIM jAtI na isake dvArA masUrIkRta ( inoculated ) prANiyoM meM hI yakSmA utpanna hotA hai ataH yaha svatantra vraNazothAtmaka vyAdhi karake mAnI jAtI hai| nissandeha yaha eka aupasargika roga hai| isa roga meM chadrAntra kA uttarottara avarodha ho jAtA hai nAbhi ke samIpa tIvra, tIvratara aura tIvratama udarazUla anubhava kiyA jAtA hai jisake sAtha sajala virecana aura vamana ke lakSaNa milate haiN| udara kA adhara dakSiNa bhAga bharA huA dIkhatA hai use TaTolane para arbudAkAra vRddhi kA jJAna hotA hai jo zeSAntraka ke simaTane se banatI hai| sthUlAntrapAka (Colitis) __ sthUlAntra meM vraNazothAtmaka parivartana sampUrNa sthUlAntra meM tathA usake eka bhAga meM sthAnika donoM prakAra kA ho sakatA hai| sthAnika ke sthAna bheda se aneka nAma haiM jaise uNDakapAka (typhlitis), uNDuka-ArohI bRhadantra zroNiguhIya bRhadantra-malAzaya pAka (proctitis ), zroNiguhIya malAzayapAka ( pelvi-rectal colitis ) / __ vraNazothAtmaka prakriyA zeSAntra se uNDuka evaM sthUlAntra kI ora to bar3hatI hai para uNDuka se zeSAntraka kI ora nahIM bar3ha pAtI kyoMki sandaMza kapATIya dvAra ( ileocaecal sphincter ) usa dizA meM upasarga kI pragati kA damana karatA rahatA hai| isa kAraNa AntrapAka ( enteritis ) to sthUlAntrapAka kA hetu banA rahatA hai usakA viloma nhiiN| . ____sAmAnyatayA vraNazotha kA prabhAva zleSmalakalA taka sImita rahatA hai parantu upazleSmalakalA bhI prabhAva meM A sakatI hai| kabhI kabhI to antra ke saba stara tathA udaracchada bhI prabhAvagrasta ho jAtI hai jise udaracchada sthUlAntrapAka ( pericolitis) kahA jAtA hai| For Private and Personal Use Only

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112 vikRtivijJAna naidAnika dRSTi se sthUlAntrapAka ke kaI bheda kie jA sakate haiM jinameM pramukha nimna haiM : tIvraprasekI sthUlAntrapAka ( acute catarrhal colitis)-yaha AmAzaya pAka yA AntrapAka kA pariNAma hai| udara meM kabhI kabhI tIvrazUla ke sAtha atIsAra jisameM tarala durgandhayukta mala aura sarakta Ama nikalatI huI dekhI jAtI hai| kabhI kabhI drutanADI ke sAtha tApAMzAdhikya bhI milatA hai| jIrNaprasekIsthUlAntraprAka (chronic catarrhal colitis)- samaya samaya para virecana dravyoM kA prayoga isa roga kA kAraNa banatA hai| AdhmAnayukta bhArI Antrapradeza meM kabhI kabhI zUla kA honA jo bhojanoparAnta bar3ha jAve vizeSa karake dekhA jAtA hai| tIvra prasekI sthUlAntrapAka ke pariNAmasvarUpa hone vAle roga meM atIsAra milatA hai sarakta AmAtIsAra tarala mala jisameM annAMza bahuta kama rahatA hai milatA hai pUyajanaka jIvANuoM ke dvArA upasraSTa sthUlAntra bhI isa roga kA kAraNa hotI hai| satraNa sthUlAntrapAka ( ulcerative colitis)-yaha eka tIvra svarUpa kA vraNazotha hai jisameM gudabhAga se sarakta, sAma, sapUya mala nikalatA hai| mala kA atisaraNa anekoM bAra (20-30 bAra ) hotA hai, sAtha meM jvara rahatA hai| roga anutIvra ( subacute ) rUpa meM utpanna hotA hai| isameM peTa andara ko dhaMsatA hai para jaba sAtha meM AdhmAna ho to gambhIratA adhika ho jAtI hai| sparza karane meM prAyaH zUla nahIM milatA para jaba udaracchada taka vraNazotha pahu~ca jAtA hai to udara ke vAma evaM adhovAma bhAga meM kAThinya evaM zUla kA anubhava ho jAtA hai| kisI bhI sthUlAntrapAka meM jaba Antra meM vraNa ( ulcers ) utpanna ho jAte haiM to vaha savraNasthUlAntrapAka ke nAma se sambodhita kiyA jAtA hai| vikRtivettA isake nidAna ke sambandha meM kisI eka mata para abhI taka nahIM pahu~ca sake haiN| isakA prArambha kabhI. tIvra jvara ke sAtha grahaNI ke samAna hotA hai aura kabhI bahuta dhIre dhIre / isa roga meM vikSata ( lesions ) daNDANvIya grahaNI yA sajvara grahaNI ( bacillary dysentery ) ke sadRza hote haiN| vraNa prAyaH tathA adhikAMza meM upariSTha superficial ) bhAga meM hI hote haiM / mala ke sAtha nirantara rakta ke jAne ke kAraNa isa roga kA eka pariNAma araktatA ( anaemia) meM hotA hai jo dvitIyaka prakAra kA ( secondary type ) hotA hai| grahaNI ke samaya hI isa roga meM bhI kucha vraNa pezIstara tathA udaracchadIya stara meM bhI cale jAte haiM jisake kAraNa sthUlAntra kA chidraNa (perforation ) taka ho jAtA hai| parantu grahaNI se viparIta vraNoM kA upazama hote samaya tAntava uti bahuta kama banatI hai jisake kAraNa sthUlAntra kI svAbhAvika kriyA meM koI avarodha nahIM ho pAtA / yaha roga jIrNasvarUpa kA yA anutIvra hone se varSoM calatA huA dekhA jAtA hai jo uNDuka se calakara gudabhAga taka apanA prabhAva jamAtA aura vikSata utpanna karatA jAtA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 113 vraNoM ke madhya kI zleSmalakalA kA aticaya ( hyperplasia ) hotA rahatA hai / aticayita bhAga zleSmalakalA ko ghere hue dekhe jAte haiM aura aMkuroM yA apUpoM ke sadRza dekhane meM Ate haiN| gudabhAga meM aise aneka aMkura dekhe jAte haiM jinake kAraNa sAGkuragudapAka ( proctitis polyposa ) usakA nAma hI par3a gayA hai / inhIM aGkuroM se Age calakara ghAtaka karkaTArbuda kI utpatti hotI huI dekhI gaI hai| ina aticayita bhAgoM meM kabhI kabhI kAlababhruraGgaka ( deep brown pigment) bhI milatA hai jise sthUlAntrika kUTa kAlyutkarSa ( pseudomelonosis coli) kahate haiM / isa raGga kI utpatti kA kAraNa bhI abhI taka ajJAta hai / uNDukapucchapAka ( Appendicitis ) uNDukapuccha jise Antrapuccha bhI kahA jAtA hai, una sampUrNa vraNazothAtmaka prakriyAoM dvArA prabhAvita ho sakatI hai jinase uNDuka svayaM prabhAvita hotA hai jinameM Antrika jvara yA manthara, kavaka evaM yakSmA pramukha hai / parantu usameM sthAnika pAka bhI ho sakatA hai jo tIvra anutIvra aura jIrNa kisI bhI svarUpa kA ho sakatA hai / tIvra pAka ke kAraNabhUta do jIvANu vizeSa haiM eka mAlAgolANu aura dUsarA AntradaNDANu (B.coli) / ye donoM eka sAtha yA pRthak pRthak tIvra pAka utpanna karane kI sAmarthya rakhate haiM / manthara jvara kA daNDANu upazlaiSmika lasAbha Uti para AkramaNa karatA hai jo uNDuka puccha meM pracura mAtrA meM pAI jAtI hai isa kAraNa vaha bhI aneka vraNotpatti karake tIvrAvasthA kA kAraNa bana jA sakatA hai / vikRtivettAoM kA anumAna yaha hai ki uNDukapucchapAka hamArI Adhunika sabhyatA kI pramukha "dena hai / jitanA hama AhArya padArthoM ko chIla chAnakara lete haiM utanA hI yaha hameM adhika satAtA hai isI kAraNa asabhya kahAne vAlI jAtiyoM meM tathA vAnaroM aura vanamAnuSoM meM yaha dekhA taka nahIM jAtA / vigata 50 varSoM meM yaha jitanA bhISaNa huA hai utanA pahale kabhI nahIM thA / yaha tathya bhI isakA aura Adhunika sabhyatA kA sambandha sthApita karane meM vizeSa bhAga letA hai / uNDukapucchapAka zizuoM, bAlakoM tathA vRddhoM ko nahIM satAtA hai / usakA pramukha lakSya navayuvaka, navayuvatI, taruNa aura adher3a vyakti rahate haiM / jyoM hI uNDukapuccha kA mukha banda ho jAvegA aura usake andara ke padArthoM kA sambandha tathA AvAgamana uDuka se banda ho jAvegA yA jyoM hI uNDukapuccha kI raktapUrti meM bAdhA par3egI tyoM hI usameM vraNazotha hone lagatA hai / vivarAvarodha ke malAzma ( faecolith) use banda kara sakatA hai yA vivara ke cAroM ora ke pezItantuoM meM AkSepa ( spasm ) hokara bhI avarodha ho sakatA hai / kabhI kabhI mukha para anutIvra pAka hone se tAntava Uti kA nirmANa hone se vivara atyadhika saMkucita hotA huA dekhA jA sakatA hai / raktapUrti meM bAdhA par3ane ke bhI kaI kAraNa ho sakate haiM jinameM usakA aiMThA khAjAnA ( kinking ) eka hai, raktavAhiniyoM kI aneka kAraNa ho sakate haiM / koI 1 For Private and Personal Use Only

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- vikRtivijJAna prAcIroM meM pAka hokara tantUtkarSa hone se rakta-saMvahana meM bAdhA par3anA dUsarA hai, isa prakAra uNDukapucchapAka ke utpAdaka aneka kAraNa ho sakate haiN| jo loga amarUda ke bIja yA anya guThaliyoM ke nigalane ko isakA kAraNa mAnate haiM ve adhika mahattva nahIM rkhte| - aba hama uNDukapucchapAka ke vividha naidAnika bhedoM kA varNana karate haiM tIvra uNDukapucchapAka-jaba yaha vraNazotha saumya ( mild ) avasthA meM rahatA hai taba vaha zleSmalakalA aura usake upazleSmala bhAga taka hI jAtA hai tathA udaracchada para prabhAva nahIM pdd'taa| zleSmalakalA sUja jAtI hai, phUla jAtI hai aura raktamayI ho jAtI hai tathA usase bahuta sA zleSmA TapakanA prArambha ho jAtA hai| upazleSmala stara meM prarasa kozAoM kI bharamAra ho jAtI hai, lasIkozA tathA bahunyaSTikozA bhI bhara jAte haiN| jaba tIvrAvasthA zAnta ho jAtI hai to phira upasipriyakozA ina kozAoM kA sthAna bhara lete haiN| sAdhAraNataH yaha avasthA samApta hokara usakI anutIvAvasthA Arambha ho jAtI hai| udara ke dakSiNa adho bhAga meM jo tIvrazUla ugrAvasthA meM utpanna ho jAtA hai vaha ghaTa kara halakA halakA darda bana jAtA hai jo thor3e thor3e kAla pazcAt daure kA rUpa dhAraNa kara sakatA hai| isa avasthA meM zanaiH zanaiH uNDukapuccha meM tantUtkarSa hone lagatA hai tathA vaha moTI par3atI jAtI hai / isake kAraNa usakA vivara avaruddha ho jAtA hai aura bahuta sA srAva bhI ruka kara use aura phulA detA hai ( mucocele ) / jisake kAraNa aura gambhIra svarUpa kA prabhAva uNDakapuccha ke saba staroM tathA usake Upara ke udaracchada ke bhAga para bhI par3atA hai una saba meM pUyotpatti ho jAtI hai / zleSmalakalA vraNoM se bhara jAtI hai| UtiyoM kA vinAza udaracchadakalA taka jA pahuMcatA hai raktasrAva aura atyadhika raktAbharaNa milatA hai| prAcIroM meM bahunyaSTiyoM kI bezumAra bharamAra ho jAtI hai| udaracchadIya stara bhI avaruddha ho jAtA hai usameM santivamat yA tanvipUyIya (fibrino purulent ) niHsrAva chA jAtA hai| rakta kA parIkSaNa karane para usameM 95% taka bahunyaSTikozA dekhe jAte haiN| vraNazotha aura sapUyatA ke pariNAmasvarUpa uNDukapucchIya vidradhi ( appendicular abscess ) bana jA sakatA hai jo pahale to apane udaracchadIya bandhanoM taka sImita rahatA hai phira unheM bhI tor3a sakatA hai| isake kAraNa udara kA dakSiNa adhobhAga bhara jAtA hai nADI kI gati bar3ha jAtI hai para tApAMza kA bar3hanA Avazyaka nahIM hai| sakotha uNDukapucchapAka (Gangrenous appendicitis ) .. sakotha uNDukapucchapAka kA pradhAna kAraNa uNDukapuccha kI raktapUrti meM bAdhA kA honA hai jo nimna kAraNoM se hotI hai : 1. uNDukapuccha kA apanI dhurI para aiMTha jAnA ( torsion ) 2. tAntava abhilAgoM ( fibrous adhesions ) ke kAraNa uNDukapuccha kA - simaTa jaanaa| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 113 3. uNDukapucchrIya vAhiniyoM meM dUSita ghanAtrotkarSa ( septic thrombosis ' kA ho jAnA jisakA mUla kAraNa koI upasarga ho sakatA hai / vilkI mahodaya kA kathana hai ki binA uNDukapuccha ke rakta saMvahana meM bAdhA par3e hue kisI upasarga ke kAraNa kisI eka vAhinI kA mukha banda hone ke kAraNa bhI jIvANvika kotha ( bacterial gangrene ) ho sakatI hai / yadi uNDukapuccha ke andara yA bAhara koI azma ( concretion ) kisI sthAna para pIr3ana karatA hai to sthAnika ko ho sakatA hai / yaha niyama hai ki jaba uNDukapuccha meM koI kotha ho jAtA hai to usameM chidraNa ( perforation ) bhI avazya hotA hai jo udaracchadakalApAka (peritonitis ) | kara sakatA hai yadi usase pUrva hI uNDukapucchoccheda na kara diyA jaave| isa roga meM mukhya upadrava udaracchadakalApAka hai| dUsarA upadrava jo dekhane ko fear hai vaha hai dhabhavana (formation of abscesses) vidradhiyAM uNDukapuccha htombaI ke anusAra vibhinna sthAnoM para ho sakatI haiM vidradhiyAM uNDukapuccha ke pezI bhAga ko phAr3a kara udaracchadakalA taka pahuMca kara udaracchadakalApAka kA kAraNa banatI haiN| kabhI kabhI ye vidradhiyAM udaracchadakalAntargata ( intraperitoneal ) hotI haiN| yadi inakA pracUSaNa na kara liyA jAve to vidIrNa ho jAtI haiM / vidIrNa hokara ve yA to udaracchadakalA guhA meM yA kisI Antra kI kuNDalI ( coil ) ke pAsa khulatI haiM yA udara prAcIra meM khula kara Antra bhagandara ( faecal fistula ) banAtI haiN| kabhI kabhI ye pIche kI ora bhI khula sakatI haiM aura vRkkoM taka pahu~ca sakatI haiM aura vahAM parivRkkavidradhi ( prinephric abscess ) banA detI haiM yadi aura Upara pUya pahu~ca gayA to upamahAprAcIrika vidradhi ( subdiaphragmatic abscess ) kA kAraNa banatI haiN| lambI uNDukapuccha zroNicakrIya udaracchadakalApAka ( pelvic peritonitis ) kara sakatI haiN| ina saba ke kAraNa kezikA bhAji pUyaraktatA (portal pyaemia), sapUya kezikA bhAjisirApAka (suppurative pylephlebitis), pUyaraktatA tathA rogANuraktatA ( septicaemia ) nAmaka roga ho sakate haiM / kezikA bhAji pUyaraktatA kA kAraNa uNDukapucchIya sirA kA ghanAstrotkarSa hotA hai / ghanAtra se antaHzalya nikala kara yakRt taka cale jAte haiM usameM aneka RNa bana jAte haiM jinake kendroM para pUyana hotA rahatA hai jisake kAraNa asaMkhya vidradhiyAM yakRt meM bana jAtI haiM jinase sampUrNa rakta meM pUyaraktatA A sakatI haiN| jIrNa uNDukapucchapAka - yaha tIna prakAra kA hotA hai jinameM eka vraNazothAtmaka dUsarA apoSajanita ( atrophic ) tathA tIsarA avazeSakIya ( vestigial ) / inameM tIsare meM na to vraNavastu milatI hai aura na koI vikRti pAI jAtI hai jaisA ki anya jIrNa pArkoM meM dekhA jAtA hai api tu isameM uNDukapuccha tanu tathA apuSTa milatA hai aura usakA mukha bahuta saMkucita sA dekhA jAtA hai| isameM koI kozIya bharamAra bhI For Private and Personal Use Only

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116 vikRtivijJAna nahIM milatI / zeSa donoM meM uNDukapucchapAka ke kAraNa udara meM dakSiNa adhobhAga meM kucha vedanA kI pratIti hotI hai / thor3e thor3e samaya ke pazcAt hone vAlI vraNazothAtmaka prakriyA ke kAraNa uNDukapuccha kI AkRti vikRta ho jAtI hai usameM sthAna sthAna para tantUtkarSa ho jAtA hai / usakI zleSmalakalA apuSTa ho jAtI hai tathA usake aGkura ( villi ) naSTaprAyaH ho jAte haiM / usakI lasAbha Uti yA to atipuSTa ho jAtI hai vA usakI mAtrA ghaTa jAtI hai / usake upazleSmala bhAga meM tantUtkarSa tathA lasIkozAoM kI bharamAra khUba milatI hai / usake supiraka ( lumen ) meM tAntava avarodha ( fibrous stricture ) milate haiM jo upazamita vraNoM ke pariNAmasvarUpa utpanna hote haiM / ina avarodhoM ke pIche zleSmA kA saMgraha hotA rahatA hai jo zleSmAvRddhi (mucocele) kA kAraNa hotA hai / uNDukapuccha ke Upara kI udaracchadakalA meM sthUlana ( thickening ) hone lagatA hai aura vaha samIpastha aMgoM se yA pazcodara prAcIra se cipakA detI hai / kabhI kabhI uNDukapucchapAka meM zleSmalakalA kAlababhru ( deep brown ) varNa kI bhI mila jAtI hai jise kUTa kAlyutkarSa ( pseudomelanosis) kahA jAtA hai / sthUlAntra ke jIrNavraNazotha meM bhI kUTa kAlayutkarSa pAyA jAtA hai / kahIM kahIM sampUrNa uNDukapuccha meM vikRtijanya vikSata lambAI aura moTAI meM sarvatra eka saharA dekhe jAte haiM / supiraka khulA huA milatA hai aura uNDukapuccha lambI milatI hai usakI prAcIra atyadhika sthUlita hotI haiM kyoMki usake upazleSmalabhAga meM tantUtkarSa milatA hai aura pezI meM atipuSTi parantu yahAM choTe golakozAoM kI bharamAra kama milatI hai / udaracchada pAka (Peritonitis ) udaracchada ke dvArA jitanI satarkatA se upasarga kA damana zarIra meM hotA hai vaisA anyatra nahIM dekhA jAtA hai / yaha kArya vaha tIna prakAra se karatA hai / prathama vapAjAla ( omentum ) ke dvArA / vapAjAla atyadhika caliSNu hone ke kAraNa jahAM kahIM udaracchada meM vraNazotha hotA hai yaha vahAM jAkara cipaka jAtA hai| jahAM kahIM chidra hone kI sambhAvanA huI ki yaha vahAM niga ( plug ) kA kAma kara detA hai / yadi mUSakIya udaracchada meM kucha roga jIvANu praviSTa kara diye jAyeM to thor3e samaya pazcAt ve vahAM na mila kara vapAjAla meM ba~dhe hue pAye jAyeMge / dvitIya udaracchadIya taloM ke abhilAga se / yadi udaracchada kA koI bhAga sUja jAya yA AghAtayukta ho jAya to vahAM udaracchada ke donoM tala ghaMTe do ghaNTe meM tantvi ke kAraNa abhilagna ho jAte haiM jisake kAraNa udaracchada meM kiyA gayA chidra zIghra banda ho jAtA hai, koI bhI pUyakendra sImita ho jAtA hai aura sArvatrika udaracchadakalApAka nahIM ho pAtA / tRtIya utsyanda ke dvArA ( by exudation ) hotA hai / jaba kabhI udaracchada meM koI upasarga AyA ki udaracchadakalA se eka aisA srAva hone lagatA hai jo upasargakArI jIvANuoM ke lie kAlasvarUpa tatvayukta hotA hai| sAtha hI yadi rogI ne kinhIM rogANuoM ke viruddha kucha pratIkArakara tatva banA liye hoM to ve bhI isa srAva meM pragaTa ho jAte haiM / isa kAraNa For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 117 zastrakarma karate samaya jaba taka chidraNa ke kAraNa Antra ke padArtha na A gaye hoM isa srAva ko poMchane kI koI AvazyakatA nahIM hai / aba hama udaracchadakalApAka ke vibhinna pahaluoM kA varNana yathA vidhAna kareMge tIvra udaracchakalApAka-yaha sthAnika tathA sampUrNAGgika donoM prakAra kA dekhA jAtA hai / isake hone meM 5 mukhya kAraNa grIna mahodaya ne prakaTa kie haiM: 1. udara prAcIra ke nicchidraNakArI ( perforating ) vraNoM ke dvArA, 2. AghAta yA vraNana ke kAraNa Antrastha padArthoM ke cyAva (leakage) ke dvaaraa| 3. Antra ke upasarga ke dvArA, kyoMki upasarga grasta Antra meM hokara jitanI saralatA se rogakArI jIvANu udaracchadakalA kI ora gamana karane meM samartha hote haiM vaisI saralatA svastha Antra meM pAnA asambhava hai / 4. raktadhArA ke dvaaraa| 5. mahilAoM meM prasavakAlIna rogANutA ( puerperal sepsis), garbhAzaya kA vidaraNa, garbhAzayanAla kA uSNavAtika golANuoM (gonococci ) dvArA upasraSTa honA, tathA sAhasika garbhapAta (criminal abortion ) ke kAraNa bhI tIvrodaracchadakalApAka dekhA jAtA hai jo rogANu tIvra udaracchadakalApAka karane meM samartha hote haiM unameM AntradaNDANu (jisakA pUya malagandhI hotA hai ) tathA zoNAMzika mAlAgolANu mukhya haiN| Antra rogANuoM meM puMjagolANu, zvasana golANu, golANu, vAtijanaprAvara gadANu (clostridium welchii) bhI u. ka. pA. kara sakate haiN| udaracchadakalA meM upasarga ke prasAra kA eka mArga usakA tala hai| upasargakArI jIvANu tala para pahu~ca jAtA hai tathA Antra kI gatiyoM ke sAtha eka sthAna se dUsare sthAna taka bar3ha jAtA hai / dUsarA mArga lasIkA vAhiniyoM kA hai tathA tIsarA mArga upodaracchadakalIya saMyojI UtyavakAzoM ( subperitoneal connective tissue spaces ) kA hai| mAlAgolANu sadaiva lasIkA vAhiniyoM dvArA upasarga kA prasAra karate haiM yahI mArga unake drutavega se upasarga prasAra kA pradhAna sAdhana hai| ve sarvaprathama udaracchadIya protikozApAka ( peritoneal cellulitis) karate haiM isI kAraNa ina upasargoM meM mRtyu adhika saMkhyaka dekhI jAtI haiN| AntrarogANu udaracchada tala para ArohaNa karate hue upasarga kA prasAra karate haiM jise vapAjAla bhI sImita kara detA hai aura Antra ke pAza eka dUsare se abhilagna hokara bhI sImita kara dete haiM isa prakriyA se sampUrNa udaracchada guhA se sazotha upasraSTa bhAga pRthak kara diyA jAtA hai| kevala manthara jvara meM hone vAle AzukArI chidraNa ko chor3a kara anya vidhi se Antra meM zotha yA pAka hone para usake cAroM ora udaracchada kI aisI surakSAtmaka saMsakti bana jAtI hai ki Antra meM bar3A chidra hokara bahuta sA padArtha udaracchada guhA ko bharane kI apekSA eka For Private and Personal Use Only

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118 vikRtivijJAna sUkSma chidra ho jAtA hai jisase atyalpa mAtrA meM Antrastha padArtha cyavana karatA hai| mantharajvarIya chidraNa sampUrNa udaracchadakalApAkakArI hotI hai udaracchadakalA meM vraNazotha kA vahI pariNAma hotA hai jo anya kisI bhI lasikAkalA ke pAka meM dekhA jAtA hai aura jisakA varNana pahale kara diyA gayA hai| vaikArika parivartana bhI koI vizeSa prakAra ke nahIM hote para unakI gambhIratA rogakArI jIvANu kI ugratA yA anugratA para nissandeha nirbhara rahatI hai| upasarga kA prArambha eka sthAna vizeSa se bhI ho sakatA hai / jisa sthAna para upasarga lagatA hai vahA~ raktAdhikya ho jAtA hai| udaracchadakalA kI camaka ghaTatI jAtI hai aura vahA~ tantvi (fibrin) ekatra hone lagatI hai jo use manda aura rUkSa banA detI hai choTe pIle raMga ke tamtvi ke phUla ( flakes ) AntrakuNDaliyoM ke bIca bIca meM milate haiM jo una kuNDaliyoM ko eka dUsare se saMsakta kara dete haiN| prArambha meM vahA~ para tarala utsyanda bhI ekatra ho jAtA hai jo saumya upasargoM meM tarala hI rahatA hai parantu gambhIra upasargoM meM sapUya ho jAtA hai bahudhA udaracchadIya upasarga saphalatApUrvaka sImita kie jAte haiN| jaisA ki udara ke dakSiNa adhobhAga meM sthita uNDukapucchIya vidradhi ke nirmANa se dekhA jA sakatA hai| mahAprAcIrA pezI ke nIce, yakRt ke Upara dakSiNI bhAga meM tathA AmAzaya, plIhA ke Upara vAmabhAga meM ye upamahAprAcIrika vidhiyA~ usI ke udAharaNa haiM jinakA eka kAraNa AmAzaya yA grahaNI kA chidraNa hai aura dUsarA uNDukapuccha vRkka yA anya nicale bhAga se Upara kI ora pUya kA gamana hai| yaha bhI smaraNIya hai ki phuphphusacchada guhA meM siMcitapUya ( empyema) ke dvArA upamahAprAcIrika vidhi (subdiaphragmatic abscess ) kI utpatti isalie asambhava hai kyoMki lasavahAe~ sadaiva nIce se Upara kI ora gamana karatI haiN| upamahAprAcIrika vidhi vidIrNa hokara phuphphusacchada kalA meM praveza kara sakatI hai| sampUrNAGgika (generalised ) tIvra udaracchadapAka atyadhika mRtyu kA kAraNa hotA hai| sImita yA sampUrNAGgika donoM prakAra ke pAkoM ke kAraNa atyadhika bhayakArI roga saMstambha Antra ( paralytic ileus) utpanna ho jAtA hai| bhayaGkara mAlAgolANuoM ke kAraNa rogANuraktatA ( septicaemia) hone kA bhaya rahatA hai| Antra ke saMstambhana se upasarga ko sImita karane meM vapAjAla tathA udaracchada donoM ko hI kucha lAbha ho jAtA hai parantu adhika kAla kA saMstambhana antatogatvA adhika vinAzaka siddha hotA hai| yadi sImita udaracchadapAka se sambaddha AntrapAza meM punaH halacala prArambha na ho sakI to prANanAza meM kucha bhI sandeha nahIM rhtaa| vAstava meM tIvra sampUrNAGgika udaracchadakalApAka kA pariNAma prAyazaH mRtyu hI hotA hai yadi saumyarUpa rahA to rakSA ho jAtI hai srAva zoSita hokara tantvi bhI haTa jAtI hai tathA saMsaktiyAM bhI adhika nahIM banatIM para kahIM kahIM saMsaktiyAM itanI adhika bana jAtI haiM ki Antra kA bahuta bhAga vikRtarUpa ho jAtA hai aura usake avarodha ( obstruction ) yA pAzana ( strangulation ) kA sadaiva bhaya banA rahatA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 114 jIrNa udaracchadapAka-tIvra yA anutIvra udaracchadapAka kA pariNAma jIrNapAka meM huA karatA hai jaba ki tantvimat abhilAga yA saMsaktiyoM kA upazama (resolution ) nahIM hotA hai aura ve tAntavapaTTiyoM meM samaMgIkRta ( organised) ho jAtI haiM yadyapi paryApta samaya ke pazcAt ve bhI lupta ho jA sakatI haiN| AmAzaya yA AMtoM ke jIrNa vraNAtmaka vikSatoM ke kAraNa sambaddha udaracchada meM jIrNa pAka ke lakSaNa dekhe jA sakate haiN| yakRddAlyutkarSa (cirrhosis of the liver) yA jIrNa vRkkapAka ke sAtha bhI jIrNa udaracchadapAka dekhA gayA hai para vaisA kyoM hai yaha kahanA abhI taka kaThina hai| bahulasIkalApAka ( Polyserositis) ___ ise pikaroga (pick's disease) bhI kahate haiM / isameM parihRcchada, phuphphusacchada tathA Uodaracchada kA sthUlana (thickening) ho jAtA hai / Urbodara meM plIhA aura yakRt ko AcchAdana karane vAlI udaracchada AtI hai| sarva prathama tantUkarSa hotA hai phira tAntava uti kA kAcarIkaraNa (hyalinisation ) ho jAtA hai jisake kAraNa ina taloM para eka zveta, dRr3ha, 3 iMca moTI zarkarA jaisI vastu jama jAtI hai| parihRcchada kA thailA ulaTa jAtA hai jisameM hRdaya banda ho jAtA hai aura usakI atipuSTi ruka jAtI hai kabhI kabhI vapAjAla bhI prabhAva meM Akara usakA golana ( rolled up) ho jAtA hai / phuphphusacchada nicale bhAga meM sthUlita hotA hai| yaha roga jalodara ke sAtha sAtha dekhA jAtA hai jaba ki vibhinna abhilAgoM meM jala bhara jAtA hai| jIrNa vRkkapAka yA yakRddAlyutkarSa tathA jIrNa madAtyaya ke sAtha yaha roga milatA hai| AyurvedIya dRSTikoNa AmAzaya se lekara malAzaya taka jitane prakAra ke vraNazotha Upara varNana kie gaye haiM unake vividha lakSaNoM kA vicAra karate hue hama yaha pAte haiM ki eka dUsare dRSTikoNa ko lekara prAcIna AcAryoM ne bhI bahuta kucha pradAna kiyA hai itanA hI kahanA ucita samajhate haiM ki aruci, ajIrNa, atIsAra aura grahaNI tathA jalodara ke prakaraNoM meM AyurvedajJoM ke dvArA mahAsrota aura udaracchadake vraNazotha kA paryApta vikAsa kiyA gayA hai| (9) yakRt para vraNazotha kA prabhAva yakRcchotha ( Hepatitis) sAdhAraNatayA yakRt para do prakAra se vraNazotha kA prabhAva par3atA hai / eka ke kAraNa vaiSika yakRcchotha yA vaiSika yakRtpAka (toxic hepatitis) hotA hai aura dUsare ke kAraNa aupasargika yakRcchotha yA aupasagika yakRtpAka ( infective hepatitis) hotA hai| vaiSika aura aupasargika donoM yakRt pAkoM ke tIvra aura For Private and Personal Use Only

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120 vikRtivijJAna jIrNa donoM prakAra ke svarUpa mila sakate haiM / vaiSika yakRtpAka kA kAraNa rakta meM hokara kisI viSa vizeSa kA yakRt para pariNAma karanA hai tathA aupasargika yakRtpAka kA kAraNa kisI upasarga kA yakRta taka pahuMcanA hai| aba hama isa viSaya kA vivecana inhIM donoM prakAroM ke anusAra karate haiM / tIvra vaiSika yakRtpAka ( acute infective hepatitis ) - yaha atyadhika ghAtaka svarUpa kI yakRdvikRti hai / isameM yakRtkozAoM meM mRtyu ( necrosis ) ho jAtI hai / yakRt ke kSetra vizeSa ke anusAra isa prakAra kI kozAmRtyu ke vividha nAma diye gaye haiM / isa roga meM kAmalA ( jaundice ) prAyaH avazya ho milatA hai / kAmalA ke do kAraNa vizeSataH ullekhya haiM / pahalA to pittapraNAliyoM kA kozAmRtyu kSetra meM vinAza hai dUsarA ina praNAlikAoM meM pitta kA saMghanana hai jo unake mukha ko avaruddha karake pittapravAhana roka detA hai / aNvIkSaNa karane para yakRt meM spaSTataH kozAmRtyukSetra ( necrotic area ) dikhalAyI detA hai tathA usake cAroM ora pariNAha ( periphery ) para snaihika vihAsa ( fatty degeneration ) kA eka pradeza ( zone ) milatA hai / isa roga meM jvara kA paryApta vega pAyA jAtA hai / yadi isa roga meM kucha lAbha huA to upazama kaNana Uti ke dvArA hotA hai aura yakRt kozAoM kA sthAna tAntava Uti le letI hai / yakRt tathA mUtra meM isa roga meM vizvitI (leucine) tathA dadhikI ( tyrosine ) ke sphaTa dekhane ko milate haiM / aba hama vividha kSetroM meM hone vAlI kozAmRtyu ke AdhAra para isa roga kA varNana prastuta karate haiM-- saMvahita viSatA zArIrika racanA nAbhya kSetrIya kozAmRtyu ( focal necrosis ) - jaba rakta meM paryApta ugra hotI hai to yakRt meM sthAna sthAna para binA kisI vizeSa krama kA dhyAna rakhate hue kozAmRtyu ko prApta ho jAte haiM / isa prakAra ke vijJata mantharajvara, rohiNI tathA tatsama vyAdhiyoM ke rugNoM meM prAyaH pAye jAte haiM / mRtakozAoM ko bhakSikozA itastataH le jAte haiM aura unakA sthAna yA to tAntava Uti letI hai yA yadi kSetra bahuta choTA huA to yakRt ke svAbhAvika kozAoM kA hI punarjanma ho jAtA hai jisa avasthA meM nAbhya mRtyu ko prApta kSetroM kA hI patA lagAnA bhI kaThina par3a jAtA hai / khaDakI yA prAdezika kozAmRtyu ( lobular or zonal necrosis )yakRta kI khaNDikAeM 3 pradezoM meM vibhakta kI jA sakatI haiM jinameM eka kendriya pradeza kI jo antarkhaNDikIya yA yakRt sirA ke cAroM ora hotI haiM, dUsarI jise yAkRt dhamanI rakta pahu~cAtI hai tathA tIsarI pariNAha pradeza kI jo kezikAbhAji avakAza ( portal spaces ) kA parisImana karatI hai / isa prakAra 3 pradezoM meM 3 prakAra kI khaNDakAeM hotI haiM; kendriya khaNDikA madhyapradezIya khaNDikA tathA pariNAha pradezIya khaNDikA / ina tInoM khaNDikAoM meM se kisI eka ke yakRt kozAoM kI mRtyu hotI hai isa kAraNa tIna prakAra kI prAdezika kozAmRtyu dekhI jAtI hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 121 kendriya kozAmRtyu ( central necrosis ) - yaha gambhIrasvarUpa ke mAlAgolANuja upasarga ke kAraNa yA nIravamralaviSatA ( klorophArma poijaniMga ) ke kAraNa hotI hai| isameM una kozAoM kI sarvaprathama mRtyu hotI hai jo kendriya sirA ( central vein ) ke adhika samIpa hote haiM / upazama yadi huA to ina mRtyu prApta kSetroM meM sitakozAoM kI bharamAra ho jAtI hai jo mRtakozAoM ko haTAkara svalpa tUrakarSa kara dete haiM / kabhI kabhI yakRt ke prakRta kozAoM kA bhI punarjanma ho jAtA hai / kendriya kozAmRtyu- pradeza ke pariNAha para snaihika vihAsa kA bhI eka pradeza prakaTa ho jAtA hai / kRt kI jIrNa nizceSTa adhiraktatA ( chronic passive congestion of the liver ) ke kAraNa bhI kendriya yakRtkozAmRtyu dekhI jA sakatI hai / usakA aMzataH kAraNa sirArakta kI sthiratA ke kAraNa utpanna ajArakaraktatA (anoxaemia ) hai tathA aMzataH cayApacayitoM (metabolites ) ke dvArA utpanna viSatA hai kyoMki ye cayApacayita rakta ke pravAha kI kamI yA sthiratA ke kAraNa yakRtkozAoM se zIghra hI nahIM haTa paate| isa avasthA meM bhI pariNAha para snaihika vihAsa milatA hai / kyoMki raktapravAha kI kamI ke kAraNa duSpoSaNa malnutrition ) calatA rahatA hai isa kAraNa yakRt ke navIna kozAoM kA acchI mAtrA meM punarjanma honA sambhava nahIM ho pAtA usake sthAna para kucha tantUtkarSa hotA hai / isa avasthA ko hRjjanya yAlyutkarSa ( cardiac cirrhosis ) kahate haiM / 1. madhyapradezIya kozAmRtyu ( mid-zonal necrosis ) - yaha bahudhA bahuta kama dekhI jAtI hai / udaracchada kalApAka yA anya aupasargika vyAdhiyoM ke kAraNa yaha ho sakatI hai| pariNAhapradezIya kozAmRtyu ( peripheral necrosis ) - isa kozAmRyu kA eka spaSTa kAraNa bhAsvaraviSatA ( phAsphorasa viSatA ) meM dekhA jAtA hai jahA~ sAtha meM snaihikavihAsa milatA hai / Uti kA vyApaka vinAza hone ke kAraNa isa roga meM yakRt kI AkRti choTI par3a jAtI hai usakA prAvara ( capsule ) DhIlA par3a jAtA hai aura usa para jhurriyA~ par3a jAtI haiM / gADhatA ( consistency ) kI dRSTi se vaha atyadhika mRdu evaM bhaGgura ( friable ) hotA hai / isI prakAra kI yakRt kozAmRtyu yoSA kSepaka ( eclampsia ) meM milatI hai / parantu usameM kozAmRtyu kSetra kevala pariNAha taka hI sImita na rahakara anya khaNDikAoM taka phaila jAte haiN| I prasarakozAmRtyu ( diffuse necrosis ) - ise tIvra pIta apoSakSaya yA tIvrapItApuSTi ( acute yellow atrophy ) bhI kahate haiM / jaisA ki isakA nAma hai isake vikSata kisI eka khaNDikA taka sImita nahIM rahate haiM yahI nahIM ve yakRt meM bhI sImita nahIM rahate / jaba yaha vyAdhi atyugra svarUpa kI ho jAtI hai| taba to yakRt dravya ke bahuta bar3e bhAgoM kI mRtyu ho jAtI hai jisake sAtha meM kAmalA rahatA hai jo uttarottara vRddhiMgata hotA calA jAtA hai / rakta evaM mUtra kI miharAzi 11, 12 vi0 For Private and Personal Use Only

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122 vikRtivijJAna ghaTatI jAtI hai, rakta meM tiktI-amloM kI vRddhi hotI jAtI hai, raktastha zarkarA kI rAzi ghaTa jAtI hai jisake kAraNa upamadhuraktatAjanya AkSepa ( hypoglycaemic convulsions ) hone lagate haiM / jvara, vamana tathA pralApa roga ke prArambha se hI milate haiM ina saba ke kAraNa sAdhyAsAdhyatA kI dRSTi se roga ghAtakasvarUpa kA hotA hai parantu bahuta se rogI bacate hue bhI dekhe gaye haiM / yaha roga kisI bhI avasthA aura liMga ke prANI meM ho sakatA hai parantu antarvatniyoM meM yaha adhikatara dekhA gayA hai / isa roga ke aneka kAraNa haiM / striyoM meM sagarbhAvasthA meM viSAkta rakta honA jinameM eka hai / phiraMga ke rogI ko kendriya somala ke prayoga se bhI yaha ho sakatA hai | dugdhasthala adhika vyApaka hone para vahA~ zalkika amla ( dainika esiDa ) kA adhika lepa kara dene ke pariNAma svarUpa bhI yaha roga ho sakatA hai / isI kAraNa dugdha ke rugNoM meM aba Tainika esiDa jailI ke lepa kA pracAra kama ho rahA hai, jo loga havAI jahAjoM ke lie kapar3e ke sUta ko tribhUya virAlenya ( trinitro toluene ), kaTvikAmla ( picric acid) caturnIradakSINya ( tetrachlorethane ) Adi viSa meM raMgate haiM unheM bhI isa roga kA zikAra hotA huA dekhA gayA hai| pItajvara (yellow fever ) meM upasargajanya kAraNoM se bhI yaha apoSakSaya milatA hai / yadyapi isa roga kA tIvra aura sphUrta ( fulminant ) prakAra utanA nahIM dekhane ko milatA jitanA ki anutIghra prakAra, phira bhI jaba vaha prakaTa hotA hai to yakRt choTA par3a jAtA hai aura sikur3a jAtA hai usakA prAvara valiyukta ( wrinkled ) ho jAtA hai / jahA~ para Uti kI mRtyu ho jAtI hai ve kSetra ApIta sidhma ( yellowish patches ) se yukta ho jAte haiM / yakRt ke donoM khaNDoM meM aise kSetra pAye jAte haiM ina prabhAvita kSetroM ke bIca-bIca meM kozAoM para AghAta bahuta kama huA milatA hai parantu vahA~ kI Uti adhiraktatA ke kAraNa lAla ho jAtI hai / eka saptAha ke bhItara hI mRta Uti sakaNa mala ( granular debris ) kA rUpa dhAraNa kara letI hai| aura pUrNataH viyojita ho jAtI hai aura kucha samaya meM haTA dI jAtI hai / Uti ke isa prakAra haTa jAne ke hI kAraNa yakRt kA AkAra choTA par3a jAtA hai isI kAraNa yakRt ke prakRta bhAra 1500 mASe se vaha 800 mASe kA hI raha jAtA hai / isa avasthA meM yakRt kA pIlA raMga ur3a jAtA hai aura vaha gADha lAla ( deep red ) ho jAtA hai kyoMki usake kezAla adhika visphArita ho jAte haiM / isa avasthA meM mUtra meM vizvitI tathA dadhikI milane lagatI haiM / jo kadAcit svapAcita yakRt Uti ke dvArA banatI haiM para kucha unakI upasthiti ko yakRt dvArA tiktI-amloM ke nistikkIyana ( deami - (nation) karane kI kriyA kI asaphalatA batalAte haiM / kucha bhI ho sAdhyAsAdhyatA kI dRSTi se yaha roga asAdhya evaM mAraka mAnA jAtA hai / jaba rogotpAdaka viSa kI zIghramAraka mAtrA rakta meM upasthita nahIM rahatI taba anutIvra prakAra kI prasarakozAmRtyu ( subacute necrosis ) hotI hai / prArambha meM isakA svarUpa prasekI kAmalA ( catarrhal jaundice ) ke AkramaNoM se milatA For Private and Personal Use Only

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Page #177
kezikAbhAji yakRddAlyutkape praSTa 123 isa citra meM yakRt ke svastha kozAoM ko tAntabaUti ne badala DAlA hai tathA kaI naI pittapraNAliyoM kA nirmANa bhI prakaTa ho rahA hai| For Private and Personal Use Only

Page #178
vividha zarIrAGgoM para vraNazotha kA prabhAva 123 julatA hotA hai| isa prakAra yakRt meM pItavarNa kI aneka granthikAeM (nodules) milatI haiM jinake bIca kA bhAga visphArita kezAloM ke kAraNa lAla kaNana Utimaya paTTiyoM se bharA rahatA hai jinameM naI asaMkhya pitta praNAlikAe~ spaSTataH dekhI jAtI hai| rugNa yakRt kSetroM ke samIpa hI svastha kSetra milate haiN| yaha vikAra naSTa kiyA jA sakatA hai yadi UtimAraka hetu adhika kAla taka calatA nahIM rhtaa| yaha vyAdhi mahInoM aura varSoM cala sakatI hai kabhI rogI ThIka ho jAtA hai aura kabhI adhika bImAra / roga dUra hone para jo yakRtkozA svasthAvasthA meM avaziSTa raha jAte haiM unameM atyadhika punarjanaka paramacaya ( regenerative hyperplasia ) dekhA jAtA hai| isa ropaNa kriyA ( healing process ) se yakRt khuradarA aura gA~Thaga~ThIlA ( nodular ) ho jAtA hai, jisameM tAntava uti kI bar3I-bar3I-paTTiyoM ke madhya yakRt-Uti ke dvIpa base hue milate haiM / ise dekhane se aisA mAlUma par3atA hai ki bahukhaNDIya yakRddAlyutkarSa (multilobular cirrhosis ) kI hI rUkSAkRti ( coarse form ) yaha ho| ise vaiSika yakRdAlyutkarSa ( toxic cirrhosis ) kahA jAtA hai (mailaurii)| isakA dUsarA nAma bagranthika paramacaya ( multiple nodular hyperplasia) diyA gayA hai (maaddcnd)| ina paramacayita granthikoM meM se kucha jo upariSTha dharAtala para hote haiM yakRt ke mukhyapiNDa se pRthaka se lagate haiM aura una para alaga prAvara ( capsule ) car3hA hotA hai / inako yAkRt granthyarbuda ( hepatic adenoma) bhI kahA jAtA hai parantu vAstava meM ve arbuda nahIM hote, unheM hama punarjananamUlaka nAbhya paramacaya kSetra ( areas of focal hyperplasia of regenerative origin) kaha sakate haiN| yaha bhI sandehAspada hai ki yakRt ke andara vAstavika pranthi-arbuda kabhI milatA ho / jIrNa vaiSika yakRtpAka ( chronic toxic hepatitis)-vaiSika yakRddAlyuskarSa ke sAtha sAtha hI kucha anya aisI avasthAoM kA bhI samUha hai jinheM hama yakRddAlyutkarSoM (cirrhoses) ke nAma se pukArate haiM jinameM ahaituka jIrNatantUtkarSa tathA yakRtkozAoM kI manthara gati se mRtyu yA apuSTi (apoSakSaya) nirantara calatI rahatI hai / a~garejI meM sirahosisa kA artha yakRt varNAntara mAtra thA parantu Ajakala isakA artha prasara tantUtkarSa ( diffuse fibrosis) liyA jAtA hai usI bhAva meM yakRddAlyutkarSa cala par3A hai| ye saMracanA kI dRSTi se do prakAra ke hote haiM eka ko kezikAbhAji yakRddAlyutkarSa ( portal cirrhosis) aura dUsarA paittika yakRddAlyutkarSa ( biliary cirrhosis ) / aba hama ina donoM kA varNana yahA~ para vistArazaH kreNge| kezikAbhAji yakRddAlyutkarSa ( Portal Cirrhosis) isake aneka nAma prasiddha haiM jinameM kucha nimnAGkita haiM :1. bahukhaNDIya yakRhAlyutkarSa ( multilobular sirrhosis) 2. apoSakSayajanya yakRddAlyutkarSa ( atrophic cirrhosis) For Private and Personal Use Only

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124 vikRtivijJAna 3. madAtyayika yakRddAlyutkarSa ( alcoholic cirrhosis) 4. lInvaikIya yakRhAlyutkarSa ( Laenuec's cirrhosis) 5. sakIla yakRt ( hobnail liver ) 6. hapuSirApAyIya yakRt (gin-drinker's liver ) isa roga kA kAraNa eka vizeSa viSi kA prabhAva hai yaha viSi (toxin ) zAntatA se kArya karatI hai aura yakRtkozAoM kI uttarottara nAza karatI jAtI hai jinakA sthAna tantUtkarSa letA calatA hai| yaha tantUtkarSa aMzataH punaHsthApana aura aMzataH vraNazothAtmaka hotA hai| yaha kAlpanika viSi paryApta kAla taka tathA ruka ruka kara kriyA karatI hai / isa viSi kA udbhavasthala kauna-sA hai yaha nizcayAtmaka rUpa se nahIM kahA jA sakatA hai yataH isa vikAra meM kezikAbhAjipradezIya yA pariNAha kI khaNDikAoM meM prabhAva par3atA hai ataH yaha yA to mahAsrota se yA plIhA se AtA hai| kucha kAla pahale isa roga kA madya se bahudhA sambandha jor3A jAtA thaa| yA to madya svayaM, yA madya meM rahane vAlI azuddhiyAM, yA madha ke kAraNa utpanna AmAzayapAka (gastritis ), yA AmAzayapAka ke kAraNa utpanna jIvANuoM ke viSa athavA madya ke pacane se utpanna utpAda isa roga ke kAraNa mAne jAte the parantu aba jahAM madyapAyI isa roga ke zikAra dekhe jAte haiM vahIM para ve bhI pAye jAte haiM jinhoMne janmabhara koI nazA nahIM kiyA isa kAraNa madya ke atirikta koI anya kAraNa isa roga kA utpAdana karatA hai aisA lagatA hai| isakA eka pramANa yaha bhI hai ki sAMparIkSa jIvoM ( expe. rimental animals ) para madya kA ekamAtra prayoga karate rahane para bhI isa roga ko unameM utpanna nahIM kiyA jA sakA / para yadi madya ke sAtha jIvANuoM ko bhI praviSTa kiyA jAve to kucha vaise vikSata mila sakate haiM aisA pAyA gayA hai| jyaurjI evaM golDablaiTa ne mUSakoM ko jIvatikti bI virahita AhAra para rakha kara aura probhUjina kI mAtrA ghaTAkara yakRddAlyutkarSIya vikSatoM ko utpanna karane meM siddhatA prApta kI hai| isI prakAra yadi sAMparIkSa jIvoM ke AhAra se pittI ( choline ) nikAla dI jAve to bhI unheM yaha roga ho sakatA hai| lohaka ( manganese ) tathA jambazilA ( shale ) taila ke vyavahAra se bhI yaha ho sakatA hai| gAI aura parDI ne zazakoM ( rabbits ) ko zleSAbha saikata ( colloidal silica) se bharapUra AhAra kA sevana karAkara bhI bahukhaNDIya yakRddAlyutkarSa utpanna karake dikhA diyA hai| yahI hama phauphphusika saikatotkarSa (pulmonary silicosis ) meM bhI dekhate haiN| saikata utiyoM dvArA ghulakara yakRt meM pahu~ca jAtA hai aura vahA~ bahukhaNDIya yakRddAlyutkarSa ko utpanna karane meM samartha ho jAtA hai| para isa prakAra usakA eka saumya rUpa hI pratyakSa hotA hai| isa sAMparIkSa saikata yakRddAlyutkarSa meM prathamata: koI viSa na raha kara kezAloM ke antazchada meM viSAkta prabhAva hokara yakRt ke kozAoM ko raktapUrti yathAvazyaka nahIM ho pAtI hai aura vizoNatA ho jAtI hai| cauphArDa kA vizvAsa hai ki plIhastha padArthoM ke dvArA bhI kezikAbhAjiyakRddAlyu For Private and Personal Use Only

Page #180
vividha zarIrAGgoM para vraNazotha kA prabhAva 125 skarSa ho sakatA hai| bahuta se rogoM meM, jisameM viSamajvara aura manthara bhI udAharaNasvarUpa lie jA sakate haiM, plIhA kITANuoM ke saMgrahAlaya kA kArya karatI hai, aura aise rogoM meM plaihika sirA kA uttarajAtapAka (secondary phlebitis of the splenic vein) hokara yakRtpAka ho sakatA hai| viSamajvara ke kAraNa yakRdAlyutkarSa dekhA jAtA hai / plaihika araktatA meM pahale plIhotkarSa ( cirrhosis of spleen ) hotA hai phira yakRddAlyutkarSa dekhA jAtA hai| plaihika aura kezikAbhAji sirAoM meM eka sAtha pAka hotA huA bahudhA dekhA jAtA hai jisake kAraNa donoM meM ghanAsrotkarSa ho sakatA hai| yadi isa roga meM plIhA kA uccheda kara diyA jAya to yakRddAlyutkarSa hone meM bahuta vilamba hotA huA dekhA jAtA hai / isase yaha prakaTa hotA hai ki eka prakAra kI viSi upasthita rahatI hai jo pahale plIhA ko aura phira yakRt ko prabhAvita karatI hai| jaba ki kezikAbhAji yakRddAlyutkarSa meM yakRt aura plIhA donoM hI prabhAvita hote haiM parantu pahale yakRt tatpazcAt plIhA rogagrasta hotI huI dekhI jAtI hai| yaha viSi kisa prakAra hai yaha donoM dazAoM meM kahanA sambhava nahIM dekhA jaataa| plIhA aura yakRt. donoM ko Ayurveda ne eka hI sAtha rakhA hai donoM ke rogoM kI cikitsA bhI eka sI. hI hai vaha ina donoM ke paraspara sambandha meM paryApta vizvAsa karatA hai jisakI ora Adhunika jagata bar3hatA-sA pratIta hotA hai| vAtika vyAdhiyoM ( nervous diseases) meM bhI yakRddAlyutkarSa pAyA jAtA hai| vilasana ne zuktikanda ke uttarottara vihAsa ( progressive degeneration of the lenticular nucleus ) nAmaka roga meM, jise vilasana kA roga bhI kahate haiM, yakRddAlyutkarSa kI upasthiti svIkAra kI hai| usa roga meM plIhodara tathA plIhA kA tantUtkarSa hokara phira bAda meM jalodara ho jAtA hai| mastiSkapAka ( encephalitis ) ke bAda yakRddAlyutkarSa hone ke udAharaNa bhI milate haiM / aupasargika yakRtpAka ke vikSatoM kA ropaNa hote hote bhI yakRddAlyutkarSa dekhA jA sakatA hai| ___ ina sampUrNa uparokta tathyoM ko dhyAna meM rakhane se hama isa pariNAma para pahu~cate haiM ki kezikAbhAji yakRddAlyutkarSa koI viziSTa vyAdhi na hokara yakRt para aneka hetuoM ke kAraNa hone vAle AghAtoM kA pariNAma mAtra hai| bahukhaNDIya yakRddAlyutkarSa meM kyA vikRti hotI hai ? isa prazna kA uttara vikRtivijJAna kI dRSTi se bahuta mahatvapUrNa hai| ise hama pratyakSa aura aNvIkSa donoM prakAra se samajha sakate haiN| pratyakSa yakRt ko dekhane se roga ke prArambha meM hameM vaha uttarottara bar3hatA huA milatA hai jisake kAraNa usake kinAre tIkSNa na rahakara gola aura DhAlU ho jAte haiM kabhI kabhI yakRt nirantara bar3hatA jAtA hai aura mRtyu ho jAtI hai para kabhI kabhI roga aura Age bar3hatA hai jaba ki yakRt ke kozAoM meM apoSakSaya hotA hai aura jo tantUtkarSa huA rahatA hai vaha saMkucita hotA hai. For Private and Personal Use Only

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126 vikRtivijJAna jisake kAraNa yakRt kA AkAra choTA ho jAtA hai kabhI kabhI yaha ladhvIkaraNa, jo vAmayakRt khaNDa meM adhikatara hotA hai, itanA bar3ha jAtA hai ki yakRt prakRta AkAra kA AdhA raha jAtA hai| (apoSakSayajanya yakRddAlyutkarSa) para Adhe ke lagabhaga rogiyoM meM mRtyu ke samaya yakRt prakRtAvasthA se adhika bhArI dekhA jAtA hai usa bhAra vRddhi kA mukhya kAraNa yakRtkozAoM meM snaihika bharamAra kA honA mAnA jAtA hai jo jIrNa madAtyayioM meM bahudhA dekhA jAtA hai (snaihika ykRddaalyutkrss)| usameM yakRt kA prAvara sthUlita ho jAtA hai tathA usakA bAhya dharAtala gA~Tha-ga~ThIlA ho jAtA hai| usameM granthikAe~ par3a jAtI haiN| jaba ve granthikAe~ sthUla ( coarse ) hotI haiM to yakRt ko sakIla yakRt (hobnailed liver) kahalAtA hai| sthUlatA tathA rUkSatA kA kAraNa kucha to tAntava Uti kA saMkocana hai aura kucha jIvita yakRt kozAoM kA paramacaya hai jo granthikAoM meM pariNata ho jAtA hai| kabhI kabhI dekhane para yA hAtha phirAne para yakRt meM granthikAe~ na milakara sUkSmakaNa milate haiN| yakRt bar3A dRr3ha hotA hai usakA cAkU se kATanA bhI sarala kAma nahIM hotaa| kATane para tAntava Uti kA pratyakSa darzana ho jAtA hai kaTA huA tala karburita aura kaNayukta hotA hai| gulAbI yA dhUsara varNa kI tAntava Uti meM pIle yA nAraGgI raMga kI khaNDikAoM kI dvIpeM itastataH dRggocara hotI haiM adhika jIrNa rugNoM meM tAntava Uti saghana aura zvetavarNa kI bhI milatI hai| yakRt ke sAtha hI plIhodara bhI dekhA jAtA hai jahA~ saMdhAra (stroma) meM tAntava Uti kI vRddhi hotI hai| aNvIkSaNa karane se tAntava Uti kA vistAra pUrNataH viSama hotA hai jisakA saMracanAtmaka AdhAra koI bhI prakaTa nahIM hotaa| kabhI kabhI to eka khaNDikA meM vaha hotI hai aura dUsarI meM usakA nitAnta abhAva hotA hai aura kabhI kabhI khaNDikA ke bhItara vaha milatI hai na ki usake cAroM ora pariNAha para / prArambha meM tAntava uti naI aura tanturuhayukta ( fibroblastic) hotI hai usameM raktAdhikya hotA hai tathA choTe gola kozAoM kI bharamAra hotI hai| pittapraNAlikAoM kA dviguNana ho jAtA hai isa kAraNa tAntava paTTikAoM ( fibrous strands ) meM paittika adhicchadIya kozAoM ke asaMkhya samUha dekhane ko milate haiM / yakRt kI khaNDikAoM ke svarUpa aura AkAra alaga alaga prakAra ke dekhe jAte haiM kucha sthaloM para kozA meM do gADharaMgita nyaSTiyAM ( deeply staining nuclei ) dekhI jAtI haiM jo usakI vRddhi aura punarjanana kI sAkSiNI svarUpA hotI haiN| kucha kozAoM meM nyaSTiyA~ maratI aura vinaSTa hotI huI bhI dekhI jAtI haiN| yakRt khaNDikA kI svAbhAvika AkRti naSTa ho jAtI hai tathA Ter3hI-mer3hI ho jAtI hai| yadi vAhiniyoM meM raMga kA antaHkSepa kiyA jAye to kezikAbhAji sirA kI zAkhAoM meM hI vikRti adhika AtI hai kyoMki unhIM ke cAroM ora tantUtkarSa kA saMkocana ( contraction ) hotA hai| jitanA hI tantUtkarSa adhika hogA utanI hI yakRt ke jIvita kozAoM kI punarjanana zakti kSINa ho jaavegii| snaihika vihrAsa itanA isa roga meM nahIM dekhA jAtA jitanI ki snaihika For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 127 bharamAra / kAmalA isa roga meM antima avasthAoM meM hI dRggocara hotA hai usakA taba jo kAraNa hotA hai vaha yakRt kI kriyAzakti kA hrAsa adhika hotA hai na ki pittapraNAliyoM kA avarodhAtmaka saMpIDana ( compression) / bahukhaNDIya yakRddAlyutkarSa kA prabhAva ___ jaba taka roga antima avasthA ko prApta nahIM hotA taba taka, yakRt kozAoM kA cAhe kitanA hI vyApaka vinAza ho cukA ho, yakRt kriyA yathAvat calatI rahatI hai| yakRddAlyutkarSa kA sIdhA vaikArikIya prabhAva kezikAbhAjIya avarodha ( portal obstruction) hotA hai jisakA mukhya kAraNa kezikAbhAjisirA kI zAkhAoM ke upara tAntava Uti kA saMpIDana huA karatA hai / isa saMpIDana ke kAraNa pittapraNAlikAoM ke bhItara nipIDana ( pressure ) kI vRddhi ho jAtI hai jise kama karane meM jAlakaraNa vAhiniyAM ( anastomosing channels ) bhAga letI haiN| kezikAbhAjIya saMsthAna aura sAmAnya sirA saMsthAna kI jAlakriyA nimnaprakAra se banatI hai: 1. guda ke samIpa-adharAntrikI sirA (inferior mesenteric vein) tathA gudikA sirA ( hemorrhoidal vein ) ke madhya / 2. nAbhi ke cAroM ora-udara prAcIra kI sirAoM tathA yakRt kI rajjubandhanikA ( round ligament ) kI sirA ke madhya / 3. adharAntrikI sirA ( mesenteric vein) tathA udaracchadapRSThIya (retroperitoneal ) sirAoM ke madhya / 4. AmAzaya kroDikA sirA ( coronary veins of stomach) tathA adhara annapraNAlikA sirAoM ( lower oesophageal veins ) ke madhya / 5. yakRt ke dantazikhirikA snAyu (suspensary ligament of the liver ) kI sirAoM tathA mahAprAcIrApezikIya sirAoM ke madhya jo purovaMzikA ( azygos ) sirA meM rakta bhejatI haiN| ina sirAjAloM kI vRddhi ke 1-arza ( hemorrhoids), 2-nAbhikIya sirAvisphAra ( caput medusae ), 3-udaracchada ke nIce sirAoM kA atyadhika vardhana jo vRkkoM ke cAroM ora vizeSataH dekhA jAtA hai, 4-annapraNAlI ke adhobhAga kI sirAoM ke visphAra ke kAraNa annapraNAlI sirA visphAra (oesophageal varix ) nAmaka vikAra ho jAtA hai yadi isa visphAra meM kisI kAraNa vidAra ho jAve to rakta AmAzaya meM bhara jAtA hai jahA~ se raktavamana ( hematemesis ) hone lagatA hai| kezikAbhAjikIya avarodha ke kAraNa sampUrNa mahAsrotIya sirAsaMsthAna AmAzaya se gudaparyanta nizceSTa raktAnvita (passively congested ) ho jAtA hai| isake kAraNa mahAsrota kI upazleSmala kalA meM sthita vAhiniyA~ rakta se phUla jAtI haiM aura For Private and Personal Use Only

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128 vikRtivijJAna unase rakta cUne yA Tapakane lagatA hai / isake pariNAma svarUpa AmAzaya meM rakta bharane se raktavamana tathA Antra se rakta jAne para raktAtIsAra tathA mala ke sAtha jIvarakta AtA huA dekhA jAtA hai / yaha Urdhvaga yA adhoga raktapitta bahukhaNDIya yakRddAlskarSa kA eka mahattva kA lakSaNa hai / yadi raktapitta kI samprApti batAne ke lie jo AyurvedIya zloka Aye haiM una para thor3A yahIM dRSTipAta kara leM to hameM unake yathArtha bhAva jAnane meM suvidhA milegI pittaM vidagdhaM svaguNaiviMdahatyAzu zoNitam / tataH pravartate raktamUrdhvaM cAdho dvidhA'pi vA // ( suzruta uttaratantra ) kupitaM pittalaiH pittaM dravaM raktaM ca mUcchite / te mithastulyarUpatvamAgamya vyApnutastanum // pittaM raktasya vikRteH saMsargAdUdUSaNAdapi / gandhavarNAnuvRttezca raktena vyapadizyate // prabhavatyasRjaH sthAnAtplIhato yakRtazca tat / ( aSTAGgahRdaya ni0 sthA0 ) isa mahAsrotaka nizreSTa raktAdhikya kA dUsarA mahattva kA pariNAma hotA hai jalodara ( ascites ) / isameM udaracchada kalA meM bahuta bar3I mAtrA meM jala bhara jAtA hai jisake sAtha sAtha kabhI kabhI jIrNasvarUpa kA udaracchadakalA pAka bhI mila sakatA hai / jalodara samprApti ke nimna sUtroM kA pArAyaNa kucha lAbhadAyaka ho sakegA - yaH snehapIto'pyanuvAsito vA vAnto virikto'pyathavA nirUDhaH / pibejjalaM zItalamAzu tasya srotAMsi dUSyanti hi tadvahAni // snehopalipteSvathavA'pi teSu dakodaraM pUrvavadabhyupaiti / snigdhaM mahattatparivRttanAbhi samAtataM pUrNamivAmbunA ca / yathA dRtiH kSubhyati kampate ca zabdAyate cApi dakodaraM tat // ( suzruta ni0 sthA0 ) pravRttasnehapAnAdeH sahasAmA''mbupAyinaH / atyambu pAnAnmandAgneH kSINasyAtikRzasya vA // ruddhvA'mbumArgAnanilaH kaphazca jalamUcchitaH / vardhayetAM tadevAmbu tatsthAnAdudarAzritau // tataH syAdudaraM tRSNAgudasrutirujAnvitam / kAsazvAsAruciyutaM nAnAvarNasirAtatam // toyapUrNa dRti sparzazabdaprakSobhavepathu / dakodaraM mahatsnigdhaM sthiramAvRttanAbhi tat // ( aSTAMgahRdaya ) yakRdAtyudara, plIhodarAdi aneka udara roga Age cala kara jalodara meM pariNata hote haiM yaha hama kaI sthAnoM para pIche tathA Age pAzcAtya dRSTikoNa prakaTa karate hue likheMge / usI ke sambandha meM vAgbhaTa kA nimna vaktavya kitanA upayogI hogA yaha samajha lenA Avazyaka hai: : upekSayA ca sarveSu doSAH svasthAnataracyutAH / pAkAdravA dravIkuryuH sandhisrotomukhAnyapi // svedazca bAhyasrotaHsu vihatastiryagAsthitaH / tadevodakamApyAyya picchAM kuryAttadA bhavet // gurUdaraM sthiraM vRttamAhRtaM ca na zabdavat / mRdu vyapetarAjIkaM nAbhyAM spRSTaM ca sarpati // tadanUdakajanmAsminkukSivRddhistato'dhikam / sirAntardhAnamudakajaTharoktaM ca lakSaNam // ( aSTAMgahRdaya nidAnasthAna ) For Private and Personal Use Only jalodara ke sAtha sAtha prAyaH saumyarUpa sirApAka bhI kezikA bhAjisirA meM rahatA hai jisake kAraNa kezikAbhAji, plaihika yA adharAntrikI sirAoM meM se kisI meM bhI ghanostrotkarSa mila sakatA hai /

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vividha zarIrAGgoM para vraNazotha kA prabhAva 126 raktapitta ke hone se isa roga meM araktatA bahudhA mila sakatI hai tathA yakRt ke pratyaraktatatva (anti-anaemic principle ) ke ThIka prakAra se saMcita karane aura mukta karane kI kriyA meM bAdhA par3ane se kabhI kabhI mahAkozIya araktatA ( macrooytic anaemia ) ho jA sakatI hai| jaba yaha vyAdhi apanI caramAvasthA ko pahu~ca jAtI hai to isameM jvara, kAmalA, raktasrAvI pravRtti, pralApa, saMnyAsAdi lakSaNa dekhane ko milate haiM jaise ki yakRt ke tIvra pIta apoSakSaya meM mile the| yakRtkriyA kA sthagana, hRdbheda, raktasaMvahana kriyA meM avarodha, raktasrAva, zvasanaka yA yakSmA kA upasarga inameM se koI bhI yakRddAlyutkarSa ke rogI kI mRtyu kA kAraNa ho sakatA hai| isa roga se saMtrasta vyakti ko phauphphusika rAjayakSmA hotI huI bahudhA dekhI jAtI hai| __paramacayika paittika yakRdAlyutkarSa (Hypertrophic Biliary Cirrhosis)-yaha do prakAra kA hotA hai| eka kA kAraNa pittapraNAliyoM kA cirakAla taka avarodha hai ise avarodhAtmaka paittika yakRhAlyutkarSa (obstructive biliary cirrhosis) kahate haiM aura dUsare kA kAraNa anutIvra yA jIrNa pittapraNAlIpAka ( cholangitis) hotA hai jise upasargAtmaka paittika yakRddAlyutkarSa (infective biliary cirrhosis ) kahate haiN| donoM hI prakAra sahaja athavA avApta (acquired ) ho sakate haiM aura donoM meM yakRt kA pUrNa vardhana hotA hai jisake sAtha kAmalA rahatA hai| aba hama donoM kA Avazyaka vivaraNa prastuta karate haiN| . avarodhAtmaka paittika yakRddAlyutkarSa-yaha nimna kAraNoM meM se kisI se ho sakatA hai:... a-pittapraNAlI (bile duct) ke sahaja sthairya (congenital stenosis) dvArA / A-sAmAnya pittapraNAlI meM kisI azma (stone ) ke abhighaTTana ( impaction ) dvaaraa| i-kalasikA ( ampulla ) meM sthita kisI navavRddhi ke avarodha dvArA / I-yAkRtpraNAlI yA sAmAnyapraNAlI para bAhya nipIr3a dvaaraa| u-vraNazothAtmaka kriyAoM se prApta tantUtkarSoM yA nava vRddhiyoM ke dvaaraa| isa roga meM navIna tAntava uti kezikAbhAjIya pradezoM meM pratyeka khaNDikA meM usake cAroM ora eka barAbara rahatI hai vaha bar3I bar3I pittavAhiniyoM ke phailAva ke anusAra calatI hai isa kAraNa eka khaNDIya yakRdAlyutkarSa (unilobular cirrhosis ) bhI prAyaH mila sakatI hai| khaNDikAoM ke bAhara kI pittapraNAlI bar3I-bar3I aura vakra hotI haiM unakA bAhya stara moTA hotA hai jisakI moTAI kA kAraNa jIrNa vraNazothAtmaka tantUtkarSa kA honA hai sAtha hI paittika kezAla pittAdhikya ke kAraNa phUla jAte haiN| unakI tAntava paTTikAoM meM cudavRttAkArI kozAoM ( small round *cells) kI bharamAra dekhI jAtI hai| yaha Avazyaka nahIM ki isa roga meM yakRt ke For Private and Personal Use Only

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vikRtivijJAna kozAoM meM vihrAsa ho hI sAtha hI snaihika parivartana bhI unameM nahIM milte| kama se kama Arambha meM to yakRt ati kA bahuta hI kama vinAza hotA hai| yaha roga varSoM cala sakatA hai / isameM jalodara nahIM hotA parantu ISat plIhodara dekhA jA sakatA hai| isa roga meM yakRt kI samAMgIya vRddhi hotI hai, usakA dharAtala cikanA rahatA hai| usakI gADhatA kaThina hotI hai tathA rogI ko pIliyA bharapUra hotA hai| kATane para navIna tAntava Uti kA sUkSma jAla dikhAI detA hai| rogI ke jIvana kAla meM tAntava Uti kA bahuta adhika saMkoca nahIM dekhA jAtA jisake kAraNa kezikAbhAji yakRddAlyutkarSa meM prApta pranthikIya AkRti yahA~ nahIM miltii| kabhI kabhI sarvakiNvI ke karkaTa ke kAraNa pittapraNAlIya avarodha adhika hone ke pUrva karkaTa ke kAraNa mRtyu ho jAtI hai taba taka yakRddAlyutkarSa nahIM bhI prakaTa ho paataa| para usa samaya paittika vAhiniyoM kA sarvasAmAnya visphAra ho cukA hotA hai jise udayakRdutkarSa ( hydrohepatosis ) ke nAma se pukArA jAtA hai isameM yakRt bar3ha jAtA hai aura kAmalAnvita ho jAtA hai| upasargAtmaka paittika yakRddAlyutkarSa ise hainaTa kA paramacayika yakRddAlyuskarSa (Hanot's HypertrophicCirrhosis) bhI kahate haiM / yaha tAruNyakAlIna vyAdhi hai| isameM jvara ke viSama vega, gADha kAmalA, yakRvRddhi tathA plIhodara ye lakSaNa dekhe jAte haiM / yakRt kI AkRti avarodhAtmaka paittika yakRddAlyutkarSa ke samAna hotI hai| tAntava Uti kA vistAra bhI eka khaNDikIya hotA hai jisameM kSudvRttAkArI kozAoM kI bharamAra rahatI hai| isa aura usa roga meM mahattva kA antara yahI hai ki isameM pittapraNAlIya avarodha kA koI bhI kAraNa aura pramANa nahIM miltaa| isa kAraNa ise upasargAtmaka mAnate haiN| upasarga paripittapraNAlIpAka (pericholangitis) dvArA ArohaNa kara ke pahuMcatA hai| Age calakara bar3I pittapraNAliyoM ke cAroM ora kI vraNazothAtmaka Uti kA saMkoca ho jAtA hai jisake kAraNa avarodhAtmaka paittika yakRAlyutkarSa bhI ho jAtA hai / upasarga pahu~cane ke tIna sAdhana haiM___-rakta dvArA, 2-yA lasIkAvahAoM dvArA, 3-athavA grahaNI se sIdhe pittapraNAlI dvaaraa| raGgAyakRddAlyutkarSa (Pigment Cirrhosis)-yadi yakRtkozAoM meM cirakAla taka raGgAkaNoM kA bAhulya rahe to ve apuSTa ho jAte haiM aura unakA sthAna tAntava Uti le letI hai / raGgAyakRddAlyutkarSa zoNavarNotkarSa (haemochromatosis) nAmaka roga meM adhikatara dekhA jAtA hai jisameM yaha zanaiH zanaiH kezikAbhAjikIya sthaloM para prArambha hotA huA milatA hai| jo yakRtkozA naSTa ho jAte haiM unase raMgA nikala kara navIna tAntava paTTikAoM meM upasthita rahatA hai jahA~ usakI upasthiti mAtra prakSobhaka kA kArya karatI huI aura adhika raMgA kI vRddhi kara detI hai| prArambhika avasthA meM yakRt meM vRddhi ho jAtI hai tathA vaha cikanA rahatA hai para Age calakara For Private and Personal Use Only

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131 vividha zarIrAGgoM para vraNazotha kA prabhAva jaba tAntava Uti meM saMkocana hotA hai taba usakA dharAtala khuradarA ho jAtA hai| aisA hI yakRddAlyutkarSa plIhA aura sarvakiNvI meM bhI ho jAtA hai| sarvakiNvI meM hone ke pazcAt madhumeha ho jAtA hai| ghAtaka araktatA (pernicious anaemia ) meM bhI aisA hI yakRddAlyutkarSa dekhA jAtA hai| jisakA kAraNa yakRt ke kozAoM kA zoNAyasi ( haemosiderin ) dvArA atibhArAnvita ho jAnA hotA hai| viSamajvara (maleriyA) meM jo yakRddAlyutkarSa dekhA jAtA hai usakA pradhAna kAraNa kucha loga raMgA ko mAnate haiM parantu kyoMki vaha plIhodara ke uparAnta hotA hai ataH aisA lagatA hai ki plIhA ke jAlakAntazchadIya kozAoM kI vikRti ke pazcAt yakRta meM vahI vikRti hotI hai| yakRt ke jAlakAntazchadIya kozA tAntavakozAoM meM pariNata ho jAte haiM aura yakRddAlyutkarSa ho jAtA hai| aba hama yAkRt-pAka ke upasargAtmaka prakAroM kA varNana karate haiM: upasargAtmaka yAkRtpAka ( Infective Hepatitis) Aja kala isa nAma kA prayoga usa roga ke lie hotA hai jisameM kisI eka yA anya prakAra ke viSANu dvArA yakRt Uti kA vinAza huA rahatA hai aura jisake sAtha jvara tathA kAmalA sahakArI rUpa meM upasthita rahate haiN| ise prasekI kAmalA (Catarrhal Jaundice) yA yakRdabhizIta ( a chill on the liver ) kahate haiN| yaha roga sthAnika yA mahAmArI ke rUpa meM prakaTa hotA hai usake dvArA upasarga kI do rItiyA~ haiM tathA isake kAraka 2 prakAra ke viSANu hote haiN| eka rIti rogopasarga kI hai jaba eka vyakti se dUsare vyakti ko upasarga nAsAgrasanIya bindutkSepa dvArA pahu~catA hai yadyapi yaha rIti adhika nizcayAtmaka nahIM / dUsarI rIti hai jaba ki azuddha udgArikA (contaminated syringe ) dvArA yA saMkrAmaNa (transfusion ) dvArA, lasI yA masUrI ke dvArA jinameM mAnavI lasI milAI gaI ho kA prayoga mAnava zarIra para kiyA jaave| aisA jJAta hotA hai ki viSANu zarIra meM pahuMcane para vinA kisI prakAra kA roga lakSaNa kie cupake se apanA kArya karane lagatA hai| gupta rogoM se pIDita rogiyoM ke cikitsAlaya meM jahA~ rogiyoM ko bahuta suiyA~ lagatI haiM yA rakta nikAlA jAtA hai isa roga kI bahutAyata dekhI jAtI hai| yadi pratyeka rogI ke lie pRthak udgArikA kA prayoga kiyA jAve to roga kama logoM meM dekhA jAtA hai jo sUcIvedha pAtroM ke azuddhi kI ora spaSTa iGgita karatA hai| eka bAra amerikA meM jaba eka senA kI Tukar3I ko mAnavalasImizrita pItajvara kI masUrI kI suiyA~ lagAI gaI to vahA~ upasargAtmaka yAkRtpAka kI mahAmArI phaila gii| romAntikA aura kanapheDa ke pratiSedha ke lie prayukta masUriyoM meM jinameM mAnavI lasI kA prayoga huA vahA~ bhI yaha roga paryApta mila cukA hai| ina saba ko dekhane se yaha jJAta hotA hai ki isa roga ke phailAne meM mAnavI lasI ( human serum ) kA pramukha hAtha rahatA hai| isa roga kA saMcaya kAla bahuta lambA hotA hai jo 3 saptAha se lekara 6 mAsa taka jA sakatA hai isa roga kI ugratA meM bhI vyakti vyakti meM antara dekha par3atA hai For Private and Personal Use Only

Page #187
132 vikRtivijJAna saumya rogiyoM meM kamalAnvita honA anAvazyaka hai / yaha roga bahudhA 3 saptAha taka cala kara rogI ThIka ho jAtA hai parantu kabhI-kabhI vaha mahInoM par3A rahatA hai aura bAda meM tIvra pIta apoSakSaya hokara vaha mara jAtA hai / kAmalA se pUrva kI avasthA meM jvara, akSudhA, hRllAsa aura vamI ke lakSaNa mila sakate haiM / phira kAmalA utpanna ho jAtA hai mala kA varNa miTTI jaisA hotA hai aura viSTambha bhI rahatA hai / isa roga meM sitakozApakarSa 2000 zveta kaNoM kA vizeSa karake milatA hai / yakRt pahale bar3hatA hai, dabAne se usameM darda hotA hai kabhI-kabhI roga kA punarAkramaNa bhI ho sakatA hai / Acharya Shri Kailassagarsuri Gyanmandir isa roga meM kAmalA ke 2 kAraNa haiM / eka to mRtyu ko prApta yakRt kSetroM meM pitta praNAlikAoM ( bile canaliculi ) kA nAza hai aura dUsarA mRta Uti jinake cAroM ora hai aisI choTI praNAlikAoM meM paittika ghanAtra kI upasthiti hai| pitta kI bar3I-bar3I vAhiniyoM ke prasekAtmaka avarodha ( catarrhal blockage ) kA koI pramANa nahIM milatA hai / yakRt meM isa roga meM vikSatoM kA sthAna hotA hai kendriya pradezIya bhAga tathA kezikAbhAjIya sthAnoM meM tIvra vega se vraNazothAtmaka kozAoM kI bharamAra ho jAtI hai / UtimRtyu utane hI bhAga meM hotI hai jitanI bhISaNatA ke sAtha roga kA AkramaNa hotA hai / jitanA adhika AghAta hotA hai utane hI kAla ke anupAta se roga kA upazama hotA hai / yadi roga saumya huA to yakRt ti punarjanana hotA hai anyathA tantUtkarSa / Age cala kara kucha vraNavastu kA punarcUSaNa ho jAtA hai / autikIya citra dekhane se aisA lagatA hai ki mAno vaha bahukhaNDIya yakRddAlyutkarSa kA prArambhika rUpa ho aura isase yaha bhI dhyAna jAtA hai ki kadAcit usa bhayaMkara vyAdhi ke kArakoM meM se upasargAtmaka yAkRtpAka bhI eka ho / pariyakRtpAka ( Perihepatitis ) - bahudhA aura aneka avasaroM para hameM yakRta ke prAvara (kaipasUla ) meM pAka milatA hai / pAka ke kAraNa usakA sthUlana ho jAtA hai tathA vaha AsapAsa ke anya aMgoM ke sAtha abhilagna bhI ho jAtA hai / isake nimna hetu vyAdhivettAoM ne diye haiM : - 1. vRkkapAka ke sAtha jIrNa udaracchadapAka / 2. jIrNa madAtyaya | 3. taruNoM meM jIrNa bahulasIkalApAka ( chronic polyserositis ) / 4. phiraGga / 5. bAhya nipIDa dvArA ( prAvara meM sthAna-sthAna para sthAnika sidhma ho jAte haiM ) / yadyapi isa roga kA vyAdhi kI dRSTi se adhika mahattva nahIM hai phira bhI bahulasIkalApAka ke kAraNa utpanna hone para yaha vyAdhi bahuta vyApaka svarUpa kI hotI hai tathA yakRt meM raktasaMvahana kI kriyA meM bhI bAdhaka ho sakatI hai tathA yakRt kI kriyAzakti ko bhI kama kara sakate hai / sampUrNa prAvara ke Upara tAntava Uti kA eka zveta stara aise car3ha jAtA hai mAno ki cAzanI jamA dI ho ise 'jhakaragUsalbara' ke For Private and Personal Use Only

Page #188
vividha zarIrAGgoM para vraNazotha kA prabhAva 133 nAma se jarmana bolate haiN| jaba yaha sthUla tAntava cAdara saMkoca karatI hai to kezikAbhAjIya raktasaMvahana kA avarodha ho jAtA hai jisase jalodara utpanna ho jAtA hai| sAtha hI yakRt jUte kI AkRta kA na raha kara gola globAkAra ho jAtA hai| isa rogako kUTayakRddAlyutkarSa (Pseudo Cirrhosis) yA kendrAbhigayakRddAlyutkarSa (Centripetal cirrhosis) kahate haiN| (10) pittAzaya para vraNazotha kA prabhAva pittAzaya yAkRtpraNAlI kA andhasyUna ( diverticulum ) hai| isameM stambhAkAra adhicchadIya stara rahatA hai jo sUkSma aMkuroM dvArA vinyasta rahatA hai| isakI prAcIra pUrNa pragalbha arekha pezI kI banI hotI hai| isakA mukhya kArya pitta kA saMkendraNa hai jo yaha pitta meM jala kA pracUSaNa karake karatA hai| sAtha hI yaha pitta kA Alagatva ( viscosity ) usameM eka prakAra kA zleSmA milAkara bar3hA detA hai| pittAzayapAka (Cholecystitis ) anya bhAgoM kI bhAMti pittAzaya kA pAka tIvra aura jIrNa tathA sapUya aura apUya kisI bhI prakAra kA ho sakatA hai / isa roga ke kArakoM meM AntradaNDANu, mAlAgolANu mantharajvaradaNDANu, mukhya haiM jinameM zoNaharita mAlAgolANu adhika mahattvapUrNa hai| ye kAraka nimna mArgoM se pittAzaya taka pahu~cate haiM 1. raktadhArA dvaaraa| 2. yakRt se--a-lasIkAvahAoM dvArA yA A-pitta meM hokara / 3. grahaNI (duodenum) dvArA-a-kisI ArohI upasarga se yA A-lasIkAvahAoM dvaaraa| raktadhArA dvArA jIvANuoM kA praveza sarala sugama aura adhika sambhava hai kyoMki pitta to jIvANuoM para (vizeSa kara mAlAgolANuoM para) prAyaH mAraka prabhAva rakhatA hai / Antrika yA mantharajvara meM daNDANu prathamAvasthA meM hI pittAzaya meM pahu~ca jAtA hai jaba ki jIvANu rakta meM hI hotA hai| grahaNI ke dvArA pittAzaya taka usakA pahu~canA Avazyaka nahIM / aba hama pittAzaya pAka kI tIvra aura jIrNa avasthAoM para thor3A prakAza DAlate haiM: tIvrapittAzayapAka ( Acute Cholecystitis)-jaisA ki vraNazotha kA parisekI, pUyIya yA sphUrta ( fulminant ) prakAra hama anyatra zlaiSmika kalAoM ke pAkoM meM dekha cuke haiM vaisA hI yahA~ pittAzaya meM bhI dekhane ko milatA hai| sphUrta prakAra meM zlaiSmika tathA anuzlaiSmika staroM se raktasrAva hotA hai| isa roga meM pittAzaya praphullita (distended ) aura Atata ( tense ) ho jAtA hai| adhika gambhIra hone para sampUrNa pittAzaya meM kozotipAka (cellulitis) ho jAtA hai, sampUrNa prAcIra sthUlita ho jAtI hai aura usake Upara ke udaracchada meM tanvimat For Private and Personal Use Only

Page #189
134 vikRtivijJAna udAsarga ekatra ho jAtA hai / isa kSetra kI lasIka granthiyA~ phUla jAtI haiM pravRddha ho jAtI hai tathA unameM raktAdhikya ho jAtA hai| manthara ke rugNoM ko chor3akara jahA~ yaha roga prAthamika hotA hai anyatra yaha uttarajAta hotA hai jaba kahIM anya aMga meM jIrNa vraNazotha pahale se upasthita rahe / jaba tIvra pAka hotA hai taba Urdhva udara meM pUyA, zUla, kaThinatA aura sitakozotkarSa ke lakSaNa milate haiN| jIrNapittAzayapAka (Chronic Cholecystitis)-yaha pAka kabhI kabhI to tIvrapAka ke pazcAt hotA hai para adhikAMza meM to yaha cupacApa hotA hai aura yaha jJAta karanA kaThina ho jAtA hai ki roga kaise prArambha huaa| jaise jIrNa uNDukapucchapAka meM dekhA jAtA hai jIrNapittAzaya pAka meM bhI samaya samaya para tIvratA ke daure A sakate haiM jaba zUla evaM kucha jvara sAtha meM rahatA hai| __prArambha meM yA anutIvAvasthA meM pittAzaya prAcIra moTI par3a jAtI hai aura phUla jAtI hai usakI zleSmalakalA ke adhikAMza aMkura naSTa ho jAte haiM aura vaha bhI moTI evaM nikalI sI ( pouting ) ho jAtI hai aNvIkSadRSTayA ( microscopically ) pittAzayaprAcIra meM asaMkhya akhaNDa nyaSTi ( monocyte ) bhakSikozAoM kI bharamAra hotI hai| yadi sAtha meM bahunyaSTi sitakozA bhI hoM to anutIvra sapUyAvasthA kA bhI AbhAsa milatA hai| vAhiniyoM ke atiraktAnvita hone se tathA visphArita hone se zleSmalakalA kA raMga lAla par3a jAtA hai| tanturuha kaNana Uti ( fibroblastic granulation tissue ) anutIvra stara kA sthAna le letI hai aura vahA~ se vaha pezIstara taka pahu~ca sakatI hai| kahIM kahIM zleSmalakalA meM vraNana bhI ho jAtA hai jaba ki una sthAnoM se mAlAgolANu prApta kiye gaye haiN| para vahA~ para upasthita pitta unase sarvathAmukta evaM zuddha pAyA gayA hai jo yaha siddha karatA hai ki unakA upasarga pitta dvArA na hokara anyamArga se hI hotA hai aura pitta unake lie ucita saMrakSaNa pradAna nahIM krtaa| jyoM jyoM roga aura jIrNa hotA jAtA hai tAntava Uti meM saMkoca hone lagatA hai jisake kAraNa pittAzaya adhika saMkIrNa aura apuSTa hotA jAtA hai| zleSmalakalA meM apuSTi hone se aMkura samApta ho jAte haiM aura vaha cikanI tathA tata ( stretched ) ho jAtI hai vaha bahuta tanu (patalI) bhI ho jAtI hai jisameM hokara prAcIrastha tAntava paTTikAe~ dekhI jA sakatI haiN| tantUtkarSa jaba pezI meM pahu~ca jAtA hai to prAcIra bahuta moTI ho jAtI hai jisake kAraNa pittAzaya kA Ayatana ghaTa jAtA hai kahIM kahIM upazleSmalakalA yA pezI ke nIce choTe choTe koSTha ( cysts ) banate hue bhI dekhe jAte haiN| ye koSTha eka se hote haiM aura ve zlezmalakalA ke dvArA banate haiM jaba ki tAntava Uti ke saMkoca unheM idhara udhara khIMca dete haiN| saumya svarUpa ke roga meM zleSmalakalA kA paramacaya bhI milatA hai jaba ki aMkura vizeSatayA bar3e ho jAte haiN| ugra avasthA meM kabhI kabhI rUkSa prasara aMkurotkarSa ( shaggy diffuse papillomatosis) bhI dekhA jAtA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 135 kabhI kabhI pittAzayapraNAlI ( cystic duct ) kI tAntava saMkIrNatA ke kAraNa pittAzaya grIvA para saMkoca hokara usaMcaya (hydrops ) nAmaka vikAra ho jAtA hai jisakA kAraNa jIrNa pittAzayapAka bhI hotA hai aura pittAzmarI bhI ho sakatI hai / isameM pittAzayaprAcIra patalI aura tata ho jAtI hai / pittAzaya meM svaccha, varNahIna, zlaiSmika drava bhara jAtA hai jo pittAzaya ke adhicchada se nikalatA hai / isa roga meM na to zleSmA pittAzaya se bAhara jA pAtA hai aura na pitta andara A sakatA hai / visphArita pittAzaya meM kabhI kabhI isI avasthA meM aura upasarga lagakara pUya bhI bhara sakatA hai jise pittAzaya kI antaH pUyatA ( Empyema of the gall bladder) kahate haiM / (11) sarva kiNvI para vraNazotha kA pariNAma Ayurveda meM ise kyA kahate haiM ise zArIravettAoM kA vicArya viSaya samajha hama pekriyAja ( pancreas) ko sarvakiNvI mAne lete haiM kyoMki isameM AhAra ko pacAne vAle sarva prakAra ke kiNva pAye jAte haiM jinameM abhipAcijana (trypsinogen), vatsAtaJci ( rennin ), vimededa ( lipase ), vibheda ( diastase ) pramukha haiM / ye sabhI sarvakiNvI ke gartANu kozAoM ( acinar eells ) meM utpanna hote haiM / inake atirikta isake andara sthita madhuvazigranthiyoM ( islets of langerhans ) ke dvArA madhuvazi ( insulin ) kA nirmANa hotA hai / isa grantha para vraNazotha kA prabhAva hone se tIvra aura jIrNa donoM prakAra kA pAka hotA hai jisakA varNana nIce kiyA jAtA hai: - tI sarva kavI pAka (Acute Pancreatitis ) - sarvakiNvI para vraNazothAtmaka prakriyA kA jo prabhAva par3atA hai usase adhika vega se uttarajAta lakSaNa prabhAva DAlate haiM isa kAraNa isa roga ko tIvra sarvakiNvIpAka na kaha kara tIvra sarvafeat nAza ( acute pancreatic necrosis ) nAma se bhI ise pukArate haiM / tIvra raktasrAvI sarvakiravI pAka ( acute haemorrhagic pancreatitis ) bhI isakA eka nAma hai, ise sarvakiNvIya saMnyAsa ( pancreatic apoplexy ) athavA sakotha sarvakiNvIpAka ( gangrenous pancreatitis ) bhI kahate haiM / isa roga kA pramukha lakSaNa hai sarvakiNvIya jIvitaka (parenchyma ) kI mahAkAya mRtyu ( massive necrosis ) jisake sAtha raktasrAva ho yA na ho| isa mRtyu kA prabhAva sampUrNa aMga para par3atA hai; kabhI kabhI vaha eka bhAga meM hI sImita rahatA hai, yA yaha prasarasidhmoM ke rUpa meM sampUrNa granthibhara meM dekhI jAtI hai / yadi prasarasidhmoM ke rUpa meM nAza yA mRtyu huI to Age calakara mRtakSetra gala kara dravIbhUta ho jAte haiM aura sthAna sthAna para koSTha bana jAte haiN| yadi ina koSThoM taka upasarga kA praveza ho gayA to phira vahA~ vidradhiyA~ bana jAtI haiM / isalie vikSatoM ke vistAra For Private and Personal Use Only

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136 vikRtivijJAna para roga kI AkRti kA isa aMga meM bodha hotA hai / jaba sampUrNa sarvakiNvI prabhAvita hotI hai to sampUrNa aMga sUja jAtA hai, usake AkAra kI vRddhi ho jAtI hai aura rakta srAva ke kAraNa yA to vaha gAr3ha lAla ho jAtA hai athavA kAlA par3a jAtA hai / isakI gADhatA mRdu aura bhaMgura ( friable ) hotI hai / udaracchada ke choTe syUna meM lAlI lie drava saMcita ho jAtA hai / yaha drava ajIvANu ( sterile ) hotA hai parantu usameM pAcaka guNa vizeSa rUpa se milate haiM / sarvakiNvI ke andara aura bAhara ke sneha meM tathA vapAjAla aura AntranibandhanI ke sneha meM zveta sidhma ( white patches ) pAye jAte haiM jinake AkAra meM paryApta vaibhinya milatA hai / ye sidhma snaihika mRtyu ( fat necrosis ) ko prakaTa karate haiN| inake banane kA kAraNa sarvakiNvI ke vimededa kA usase nikala kara itastataH sakriya rUpa meM giratA hai / vimededa sneha ko madhurI (glinIna ) tathA tiktIamloM meM bA~Ta detA hai / tiktI amla zArIrika srAvoM ke cUrNAtu se mila kara aghulya sAbuna banA detA hai jo zveta sidhma ke rUpa meM itastataH prakaTa hotA hai / yaha eka adher3AvasthA kA roga hai / isakA AkramaNa sahasA hotA hai / yaha bhojana ke uparAnta prArambha hotA hai / usameM udara ke Urdhva bhAga meM ghora vedanA hotI hai, rogI stabdha ho jAtA hai aura avapAtita ( collapsed ) bhI / usake mukha para eka vizeSa prakAra kI zyAvatA ( cyanosis ) prakaTa hone lagatI hai / bhojana ke pazcAt ina vyathAoM kA uThanA adhika mahattva kA hai jaba sarvakiNvI ke srAva sakriyAvasthA meM usa aMga meM vikSata banAnA prArambha karate haiM aura sarvakiNvI kA AtmapAcana (autodigestion ) hone lagatA hai / sarva kiNvI kI Uti ke AtmapAcana ke kaI kAraNa kaI vidvAnoM ne diye haiM inameM rica aura Dapha kA mata yaha hai ki sarvakiNvI ke kisI adhika visphArita gartANu ( acinus ) ke vidAra ( rupture ) ke kAraNa usameM ekatra pAcaka rasa itastataH vikhara kara vividha vikSata banA detA hai / eka aura bhI praur3ha mata yaha hai ki sarvakiNvI praNAlI meM kisI bhI kAraNa yA prakriyA se pAcaka pitta praveza kara jAtA hai aura cU~ki pAcaka pitta aura sarvakiNvIya pAcaka tatva mila kara sakriya ho jAte haiM isalie ve isa aMga ko hI vibhinna sthaloM para AghAtapUrNa kara dete haiM / jIrNa sarvakavI pAka ( Chronic Pancreatitis ) -- mRtyUttara parIkSA karane para kitane hI rogiyoM kI sarvakiNvI granthi meM tantUtkarSa pAyA gayA hai yadyapi jIvana kAla meM una vyaktiyoM meM usake hone kA koI prabhAva bhI prakaTa nahIM huA rahatA / opI ne tantUtkarSa do prakAra ke batalAye haiM- (1) antarkhaNDikIya -jaba ki tAntava Uti praNAlikAoM ke cAroM ora granthikI khaNDikAoM ke bIca bIca meM phailI rahatI hai / (2) antargataNvIya ( intra acinar ) - jaba ki tAntava Uti pratyeka do gartAoM ke bIca meM prakaTa hotI hai / isa avasthA meM madhuvazigranthiyoM para saMkocana kA prabhAva par3ane se unakI puSTi ho sakatI hai jisase intumeha ( glycosuria ) athavA madhumeha (diabetes ) ho jAtA hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 137 donoM avasthAoM meM sarvakiNvI sikur3a jAtI hai aura usake kozA apuSTa ho jAte haiN| kabhI kabhI tantUtkarSa ke sAtha granthi kI AkAravRddhi bhI dekhI jA sakatI hai| ye saba tAntavIya avasthAe~ yakRddAlyutkarSa se milatI julatI hI hotI haiN| kevala zoNavarNotkarSa ko chor3akara jahAM tantatkarSa kA kAraNa zoNAyasi kaNoM kA honA hai / anyatra jIrNa sarvakiNvIpAka kA kAraNa kyA hai yaha jJAta nahIM ho skaa| jIrNa sarvakiNvIpAka ke uparAnta sarvakiNvIya karkaTArbuda hotA huA prAyaH dekhA jAtA hai| Ayurveda kI dRSTi se vicAra karane para hama dekhate haiM ki jaba pitta (bile ) kapha (sarvakiNvI yUSa ) meM milatA hai aura jo bhojana karane ke tatkAla bAda thA jaba vaha jIrNa honA prArambha karatA hai vaha kAla hotA hai tathA atyadhika zUla utpanna hotA hai / yaha atyadhika bhayAnaka vyAdhi hai / yadi hama pariNAmazUla nAmaka prakaraNa ke ina zabdoM para vicAra kareM to hameM bahuta kucha prApta ho jAvegA svainiMdAnaiH prakupito vAyuH saMnihitastadA / kaphapitte samAvRtya zulakArI bhavedbalI // bhukte jIryati tacchUlaM tadeva pariNAmajam / tasya lakSaNamapyetatsamAsenAbhidhIyate / / yaha roga navInoM meM atyadhika bhayAnaka mAnA hai aura prAcInoM ne bhI ise mahAgada aura durvijJeya kahA haibalAsaH pracyutaH sthAnAtpittena saha mUcchitaH / vAyumAdAya kurute zUlaM jIryati bhojane // kukSau jaTharapArtheSu nAbhau bastau stanAntare / pRSThamUlapradezeSu sarvezveteSu vA punaH / / bhuktamAtre'thavA vAnte jIrNe'nne ca prazAmyati / SaSTikavrIhizAlInAmodanena vivardhate // tatpariNAmajaM zUlaM durvijJeyaM mahAgadam / tamAhU rasavAhAnAM srotasAM duSTihetukam // kecidannadravaM prAhuranye tatpaktidoSataH / paktizUlaM vadantyeke kecidannavidAhajam // (12) vRkkoM para vraNazotha kA pariNAma vRkkoM para vraNazotha kA kyA pariNAma hotA hai ise samajhane ke pUrva sarvaprathama hameM vRkkaracanA aura unake vyApAra kA kucha dhyAna kara lenA pdd'egaa| kyoMki Age jo kucha likhA jAvegA vaha saba itanA jaTila hai ki vinA isa sambandha ke samajhe usakA sarala honA aura samajha meM AnA paryApta kaThina ho jaavegaa| vRkkoM kI zArIraracanA kI ikAI ko vRkkANu ( nephron ) kahate haiN| eka vRkkANu meM nimna bhAga hote haiM 1. jUTa (glumerulus ) 2. Adi prAvara ( Bowman's capsule ) 3. nAlikA ( tubule ) jUTa ke Upara Adi prAvara car3hA hotA hai jo eka prakAra kA vAhinIguccha (vascular tuft ) bana jAtA hai jisake sAtha nAlikA lagI hotI hai| nAlikA ke bhI 3 bhAga hote haiM eka kuntala ( spiral ), dUsarA avarohI ( descending ) aura tIsarA For Private and Personal Use Only

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138 vikRtivijJAna ArohI ( ascending ) / usake pazcAt yaha belinI kI praNAlI ( duct of bellini ) meM khulatI hai| sarvaprathama antarkhaNDikIya dhamanI ( interlobular artery ) se abhivAhI dhamanI ( afferent artery ) dvArA rakta jUTa guccha meM praviSTa hotA hai phira jUTa kI vividha kezikAoM meM hotA huA jUTa kI apavAhI dhamanI (efferent artery ) dvArA bAhara calA jAtA hai| yaha smaraNIya hai ki rakta jUTa meM praviSTa hote samaya bhI dhAmanika rahatA hai aura nikalate samaya bhii| usake pazcAt yaha nAlikIya bhAga meM pahu~catA hai yahA~ yaha usakI dhamanI-sirA-kezAla zaiyA para vicchinna ho jAtA hai| isa kAraNa yadi kisI kAraNa se vRkkANu jUTa meM rakta na pahu~ce to nAlikIya bhAga meM vizoNatA hokara usa nAlikA kI mRtyu ho jA sakatI hai| vRkvANu jUTa meM nipAvana ( filtration )ke dvArA tanumUtra (dilute urine ) bana jAtA hai| isake nirmANa meM koI vizeSa kozIya kriyA dekhane meM nahIM AtI isI kAraNa rakta sirAjanya rakta nahIM bana pAtA kyoMki jArakavAti kA koI upayoga nahIM ho paataa| kuznI ke mata se jUTastha mUtra raktarasa kA probhUjina virahita pAvita (protein-free filterate of plasma ) hai jisameM zarkarA, miha tathA vividha lavaNoM ke sphaTAbha (crystalloids ) upasthita rahate haiN| pAvananipIDa dhamanI kezAlanipIr3a ke barAbara hotA hai jo usa vAhiguccha meM upasthita rahatA hai| jyoM jyoM rakta vRkkANu jUTa meM hokara bahatA rahegA tyoM tyoM raktarasa chana chana kara mUtra rUpa dhAraNa karatA rahegA jisameM kaI sphaTAbha bhI sammilita hote rheNge| nAlikAoM meM 2 prakAra ke kArya calate rahate haiM jinameM eka udAsarjaka (secretory) aura dUsarA pracUSaNAtmaka (absorptive) / yaha kArya kozAoM ke dvArA hone se rakta kI jArakavAti kA ve prayoga karate haiM aura dhamanIrakta ko sirArudhira meM parivartita kara dete haiN| jUTIya mUtra meM se zarkarA ( sugar ) kSArAtu nIreya ( sodium chloride ) aura bahuta sA jala pracUSita ho jAtA hai / ina donoM padArthoM ko dvArastha padArtha (threshold substances) kahate haiN| kyoMki jo mUtra bAhara nikala jAtA hai usameM unakI rAzi kA saMkendraNa rakta meM unakI rAzi ke saMkendraNa ke saMtala ( level ) para nirbhara karatA hai| jaisA ki anya kezAla zaiyAoM ke sambandha meM yaha satya hai ki una saba meM se hokara eka sAtha rakta nahIM bahA karatA, balki kucha banda rahatI haiM aura kucha cAlU rahatI haiM, usI ke anusAra vRkkANujUToM ke vAhiguccha sabhI eka sAtha na khulakara bArI bArI se khulA karate haiM, kisI meM hokara rakta pravAhita hotA hai to kucha banda par3e rahate haiM isI kAraNa jaba vRkkANuoM meM hokara koI viSAkta padArtha bahatA hai to jo khule rahate haiM una kezAloM ko to vaha ahita kara detA hai para jo banda rahate haiM ve usake prabhAva se pUrNataH bAhara rahate haiN| - jaba koI viSAkta padArtha rakta se chana kara kezAlajUToM meM AtA hai usa samaya usameM jalAdhikya hone se vaha una jUToM kI prAcIroM para koI prabhAva nahIM DAla pAtA para jaba vaha nAlikAoM meM pahu~catA hai jahA~ jalIyAMza ke pracUSaNa ke kAraNa usakA For Private and Personal Use Only

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136 vividha zarIrAGgoM para vraNazotha kA prabhAva saMkendraNa ho jAtA hai taba vaha nAlikIya adhicchada ko Ahata kara detA hai| AdiprAvara eka adhicchadIya racanA rakhatA hai yadyapi vayaskoM meM usake kozA kucha cipaTe hokara antazchadIya AkRti banA dete haiN| garbha meM vAhinyaguccha para eka Ayataja adhicchada ( cuboidal epithelium ) chAyA rahatA hai| kyoMki ina kozAoM kI kezAloM ke antazchadIya kozAoM se akhaNDatA ( integrity ) rahatI hai isI kAraNa mUtra meM svabhAvataH zviti ( albumen ) prakaTa nahIM hotaa| jaba vraNazothAtmaka athavA anya prakriyA ke dvArA ina kalAoM kA AghAta ho jAtA hai taba probhUjinoM ke prati unakI ativedhyatA ( permeability ) bar3ha jAtI hai jisake kAraNa vitimeha ( albuminuria ) ho jAtA hai| vRkka, tiktAti, miha ( yUriyA) Adi kSepya utpAdoM (waste-products) ke utsarjana ( exeretion ) ke atirikta raktarasa kI lavaNamAtrA ke niyamana ( regulation of salt content of the plasma ) tathA usake udajanAyana saMkendraNa ( hydrogen-ion concentration ) ke niyamana para bhI prabhAvakArI kArya karate haiN| svasthavRkka tiktAti (amoniyA~) kA svayaM nirmANa karake cAhe jaba mUtra ko tiktAti se adhika aura cAhe jaba kama yukta kara sakate haiN| zArIrika dhAtuoM meM cayApacaya kriyA ke anusAra mUtra kI pratikriyA cAhe jaba kSArIya aura cAhe jaba amla ho jAyA karatI hai| svabhAvataH amlacayApacayitoM ke utpAdana ke kAraNa mUtra kI pratikriyA Amlika hotI hai| amlatA kA pramukha kAraNa mUtra meM amla kSArAtu bhAsvIya (acid sodium phosphate) kI upasthiti hai| isI rUpa meM mUtra kA 90 pratizata bhAsvara upasthita rahatA hai| phuphphusoM tathA tvacA ke dvArA adhikAMza jala kA utsarga hote rahane ke kAraNa hI mUtra meM jala kI aparimita rAzi nahIM rahatI tathA saba lavaNa saMkendrita rUpa meM hI utsRSTa hote haiM tathA nAlikAe~ adhikAMza jala kA punacUrSaNa kara letI haiM jo ki zarIra ke lie paryApta hitAvaha hai| lavaNoM ke saMkendraNa kI koI eka rUpatA nahIM hotI vaha to vRkta kI kriyA para hI nirbhara hotA hai / miha rakta kI apekSA mUtra meM 60 gunA adhika saMkendrita hotA hai| nIreya rakta se 2 gune adhika saMkendrita hote haiN| yaha pravRtya saMkendraNa ( selective concentration) vRkka Uti kI eka vizeSatA hai| jaba vRkka rogAkrAnta ho jAte haiM to pravRtya saMkendraNa kI kriyA zithila par3a jAtI hai aura vRkka adhika jala ke pracUSaNa meM asamartha hokara adhika jalarAzi mUtramArga se utsRSTa karate rahate haiM tathA sphaTAbhoM kI bhI adhika mAtrA mUtra meM hokara jAne lagatI hai| yahI kAraNa hai ki svasthAvasthA meM jo vRkka kevala 50 sIsI jala kI sahAyatA se apane saba kSepya utpAdoM ko nikAla pheMkate the ve hI rugNa hone para 1500 sIsI jala kI AvazyakatA anubhava karane lagate haiM tAki ve utane hI kSepya padArthoM ko bAhara nikAla sakeM ( laizameTa tathA nyuubrg)| isI kAraNa bahumUtratA (polyuria ) kA roga ho jAtA hai parantu yaha pUraka bahumUtratA ( compensatory polyurea) kahalAtI hai kyoMki isa avasthA meM rakta kI rasAyana ( blood For Private and Personal Use Only

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140 vikRtivijJAna chemistry ) meM koI parivartana nahIM hokara vaha svAbhAvika avasthA meM hI rahatI hai / Age calakara isa pUraka bahumUtra meM sampUrNa kSepyotpAdoM ko nikAla bAhara karane kI zakti rahatI nahIM tathA aura adhika bahumUtratA bar3hAI nahIM jA sakatI isa kAraNa miha raktatA ( azotemia ) ho jAtI hai jisake kAraNa miha tathA anya padArtha rakta meM saMcita hone lagate haiN| nIreyoM kI mAtrA rakta meM vizeSa nahIM bddh'tii| sAtha hI sphaTAbhoM kA saMkendraNa, udajanAyana kA saMkendraNa mUtra meM sthira anupAta kA hone lagatA hai| idhara mUtra aura adhika tanu hote hote rakta ke rasa ke samabala taka ho jAtA hai| mUtrIya ghaTakoM ke pravRtya saMkendraNa kI zakti kA niyamana kauna kauna kAraka (factors) karate haiM yaha kahanA kaThina hai parantu unameM se eka upavRkkya granthi kA bAhyaka nyAsarga ( cortical hormone of the adrenal ) jisake abhAva meM mUtra dvArA jala aura nIreyoM kI vipula mAtrA zarIra ke bAhara calI jAtI hai / dUsarA poSaNikA granthikA pratimUtrala nyAsarga ( anti diuretic hormone of the pituitary body ) hai jisakI kamI se bhI bahumUtratA ho sakatI hai| tIsarA kAraNa upagalagranthi nyAsarga ( parathormone ) ho sakatA hai jo bhAsvIyoM ke utsarjana kA niyantraNa karatA hai| ina saba kA vRkkapAka se kahA~ taka sambandha ho sakatA hai use dekhanA hai| vRkkya vraNazotha (Renal Inflammation)-vRkkoM para vraNazotha kA pariNAma tIvra aura jIrNa sapUya aura apUya kisI bhI prakAra kA ho sakatA hai| apUyAtmaka vikSatoM ke varga ko vRkkapAka ( nephritis ) kahA jAtA hai| jisakA vistRta varNana hama Age kreNge| vRkkapAka ( Nephritis) vRkkapAkoM tathA vRkkya dhamanIdADharya ko sammilita rUpa se brAiTAmaya ( Brights disease) bhI kahA jAtA rahA hai| para Aja hama vRkkapAka nAma se hI sampUrNa varNana upasthita kara rahe haiM / vRkkapAka 2 prakAra ke hote haiM-1. jUTIyavRkkapAka (glomerulo-nephritis) tathA 2-nAlikIya vRkkapAka (tubular-nephritis) / nAlikIya vRkkapAka meM nAlikIya adhicchada kA itanA vinAza ho jAtA hai ki use tIvra vaiSika vRkkotkarSa ( acute toxic nephrosis) kahA jAtA hai| nIce hama ina donoM vRkkapArko kA varNana kara rahe haiM: jUTIya vRkkapAka (glomerulo-nephritis)-naidAnika dRSTi se (clinically ) isa vRkkapAka ko tIvra, anutIvra aura jIrNa ina tIna bhedoM meM vibhakta kara sakate haiM, parantu autikIya dRSTi se ( histologically ) vikSata prasarita yA nAbhya rUpa meM vitarita hue milate haiM / jahA~ para vikSata prasarita ( diffused ) hote haiM vahA~ adhikAMza vRkkANu Ahata hue dekhe jAte haiM aura unameM AghAta kI mAtrA bhI eka samAna pAI jAtI hai / nAbhyavikSatoM ( focal lesions ) meM vRkkANuoM meM vraNazotha For Private and Personal Use Only

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, she mahorat dan kesehan jUTIya vRkkapAka pacha 150 ki isa citra meM antazchada kA praguNana tathA vRkkajUTa ( Tuft ) kI __ avAhinIyatA prakaTa ho rahI hai| For Private and Personal Use Only

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141 vividha zarIrAGgoM para vraNazotha kA prabhAva 1 kI vibhinna avasthAe~ milatI haiM jisake kAraNa kisI meM AghAta kI mAtrA svalpa aura kisI meM atyadhika dekhI jAtI hai / kucha pUrNataH svastha milate haiM, kucha meM vraNazotha kA prArambha hotA huA dekhA jAtA hai tathA kucha meM tantUkarSa pUrA pUrA huA dekhA jAtA hai ina saba kA tAtparya yaha nikalatA hai ki vibhinna vRkkANuoM para vibhinna kAla meM AghAta hotA hai / prasarita aura nAbhya ina do prakAra ke vRkkapAkoM ke citroM kA dekhane vAlA vyakti yaha bhale prakAra samajha sakatA hai ki prasara vRkkapAka ( diffuse nephritis) kA prArambha sahasA hotA hai vRkkANuoM meM eka sAtha vraNazotha kA prabhAva hotA hai jisake kAraNa pahale tIvrAvasthA phira anutIghrAvasthA aura tatpazcAt jIrNAvasthA AtI hai / nAbhyavRkkapAka meM vraNazotha kA prabhAva vRkkANuoM para eka sAtha aura eka sA na par3ane se tIvrAvasthA anutIvrAvasthA tathA jIrNAvasthA spaSTa prakaTa nahIM hotI / nAbhyavRkkapAka yA to tIvrAvasthA meM milatA hai jo zIghra sudhara jAtA hai aura kaI choTe choTe tIvra AkramaNa milakara eka jIrNAvasthA kA nirmANa karate haiM / isakA donoM avasthAoM meM gAmbhIrya nahIM milatA / prasara vRkkapAka eka gambhIra svarUpa kA roga hai jisameM kisI bhI avasthA meM mRtyu dekhI jA sakatI hai / cAhe prasara ho yA nAbhya jUTikIya vRkkapAka kI ikAI vRkkANu kA vijJata hai / eka vRkkANu meM jo hotA hai use jAna lene para hama vRkkapAka dvArA hone vAlI vikRti kA jJAna kara sakate haiM / kAraNa koI bhI ho jUTikIya vRkkapAka kA pariNAma prabhAvita vRkkANu para eka sAtha hI par3atA hai / jisa vRkkANu meM roga lagatA hai usameM eka uttarottara pragatizIla apUya vraNazotha kI bhinna bhinna avasthAe~ dekhI jAtI haiM / pahale eka totra vraNazothAtmaka avasthA AtI hai usake pazcAt vihAsAtmaka avasthA dekhI jAtI hai jisameM snaihika parivartana milate haiM tathA adhicchadIya mRtyu ( epithelial necrosis ) dekhI jAtI hai taduparAnta tantUtkarSa dvArA upazama hotA hai jisake kAraNa prAyaH Ahata vRkkANu kA abhilopana ( obliteration ) ho jAtA hai / prathamotpanna tAvasthA meM jaba ki mRtyu eka yA do dina meM hI A sakatI hai jUTikIya kezAloM meM vAhinyastambha ( vasoparalysis ) ho jAtI hai / isa vAhinI visphAraNa ke hI kAraNa jUTa paryApta phUla jAtI hai aura sampUrNa prAvarika antarAla ( .capsular space ) ko ghera letI hai | jaba kaI vAhiguccha isa prakAra prabhAvita ho jAte haiM to isa vAhinyasthairya ke kAraNa vRkkoM meM hokara rakta kama mAtrA meM pravAhita hone lagatA hai jisake kAraNa jUTikIya pAvita mUtra kI rAzi bhI kama ho jAtI hai jisakA pariNAma alpamUtratA ( oliguria ) aura miharaktatA ( azotaemia ) meM ho jAtA hai / alpamUtratA ko aura adhika alpa karane kA kAma nAlikAoM dvArA hotA hai ki jo bhI thor3A bahuta mUtra rakta ke pAvana se jUTa bhejate haiM unameM se bahuta kucha ve punaH cUSita kara letI haiM ! isa vAhinyastambha ke sAtha sAtha hI kezAloM kI prAcIroM meM hokara rakta rasa aura sitakozAoM kA cyAva ho jAtA hai jisake kAraNa prAvarika antarAla meM tantvimat jAlaka ( fibrinous reticulum ) bana jAtA hai / vAhiniyoM se kucha lAlakaNa For Private and Personal Use Only

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142 vikRtivijJAna bhI idhara A jAte haiN| Age calakara gucchakezAloM ke antazchada meM praguNana ( proli feration) hone lagatA hai| yaha praguNana jitanA ina kezAloM meM dekhA jAtA hai utanA anyatra nahIM yadyapi yaha hotA saba vraNazothAkrAnta kezAloM meM hai| usake bAda kezAla prAcIra se antazchadIya stara meM hokara suSiraka ( lumen )kI ora bar3hane vAle tantuoM (fibrils) meM bhI praguNana hone lagatA hai jisake kAraNa pahale se saMkucita suSiraka aura adhika hone lagate haiN| isake kAraNa dhIre dhIre ina jUTakezAloM meM hokara rakta kA AvAgamana banda ho jAtA hai aura raktAdhikya kI avasthA se ye guccha lagabhaga raktavirahita avasthA taka pahuMca jAte haiM / yadi rakta kA yaha avarodha jUToM meM bahuta adhika huA to nAlikAoM ko rakta kA pahu~canA kaThina ho jAtA hai jisake kAraNa sampUrNa vRkkANu vizoNatA ( ischaemia) se pIDita ho jAtA hai| jUToM kI apekSA nAlikAoM meM tIvrAvasthA ke lakSaNa kucha bhinna hote haiN| unameM meghasama zotha prAyaH milatA hai yA Age calakara inakA vinAza ho jAtA hai unameM se lAla raktakaNoM kA cyAva bhI ho jAtA hai jo unake suSirakoM meM prAyaH dekhe jA sakate haiN| tIvAvasthA ke pazcAt dhIre dhIre anutIvAvasthA AtI hai jise vihrAsAvasthA ( degenerative stage ) bhI kahA jAtA hai| isameM jUToM meM utanA adhika parivartana prArambha meM nahIM milatA jitanA ki nAlikAoM meM dekhA jAtA hai| usake 2 kAraNa hai-eka vizoNatA aura dUsarA viSAktatA ( toxic poisoning ) / AdiprAvara ke Upara adhicchada phUla jAtA hai aura jUTa ke Upara eka koSa ( sheath) chA jAtA hai jise adhicchadIya arddhacandra (epithelial crescent ) kahate haiN| jUTa AdipAvara kI prAcIra se cipaka jAtA hai jisakA kAraNa usake Upara ke adhicchadIya kozAoM kI mRtyu mAnA jAtA hai / nAlikIya adhicchada meM snaihika aura vimedAbha koSAoM kI bharamAra, sidhmika mRtyu (patchy necrosis) tathA vizalkana ( desquamation ) milate haiM adhika gambhIra avasthA meM kozAoM kA kozArasa (cytoplasm) khAlI ho jAtA hai jise kAcaravindu vihAsa ( hyalime droplet degeneration ) kahate haiM para jahA~ taka avasthA saumya rahatI hai vimedAbha bharamAra hI dekhI jAtI hai / rakta ke lAlakaNa, sitakozA aura tanvimat jAlaka ye sabhI nAlikA suSiraka meM milakara kaNAtmaka nirmoka (granular casts ) banAte haiN| anutIvrAvasthA kI antima avasthA meM jUTikIya kezAlapAzoM ke paramacayika adhicchadIya kozAoM meM kAcaravihrAsa hone lagatA hai tathA AdiprAvara kI adhistRta kalA ( basement membrane of the Bowman's capsule ) meM bhI kAcaravihAsa prArambha ho jAtA hai| usake pazcAt roga kI jIrNAvasthA prArambha ho jAtI hai / isa jIrNAvasthA meM Ahata vRkkANu jUToM kA kAcarIkaraNa itanA ho jAtA hai ki ve pUrNataH abhilupta ho jAte haiM unakI racanA pUrNataH naSTa ho jAtI hai aura unase abhilagna nAlikAoM meM vizoNika mRtyu ke pariNAmasvarUpa tAntava Uti bana jAtI hai| isa prakAra usa roga meM sampUrNa vRkkANu vinaSTa ho jAtA hai| jo vRkkANu baca For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 143 jAte haiM una para itanA kArya kA bhAra par3a jAtA hai ki ve kAryajanya parama puSTi ( work ( hypertrophy ) ke kAraNa paryApta bar3e dikhAI dete haiM / __ itanA saba varNana karane ke uparAnta aba hama prasara aura nAbhya donoM prakAra ke jUTa vRkkapAkoM kA vistArazaH varNana karate haiM jaisA ki pAzcAtya granthakAroM ne prakaTa kiyA hai| prasarajUTikIya vRkkapAka ( Diffuse glomerulo nephritis) ___ kAraNa-prasara jUTikIya vRkkapAka kA mukhya kAraNa mAlAgolANvika upasarga hai| yaha upasarga sardI se yA havA lagane se gale meM lagatA hai jisake kAraNa jvara AtA hai| lohita jvara, visarpa. zvasanaka yA prasUti jvara meM bhI yaha upasarga hotA hai| jaba pahalI tIvrAvasthA bIta jAtI hai aura mAlAgolANuoM ke lie zarIra meM eka pratikAritA taiyAra ho jAtI hai usI ke sAtha jaba eka kapharaktIya hRSakaraNa (allergic sensitisation) bhI zarIra meM sthita ho jAtA hai taba vRkkoM para prabhAva par3a kara unameM vRkkapAka hone lagatA hai| yadi kisI prANI ko mAlAgolANuoM se upasRSTa kara deM to bhI usake vRkkoM para koI prabhAva nahIM pdd'taa| para yadi vaha prANI pahale se pratIkArajanita (immunized ) kara diyA jAve aura phira isa golANu kA praveza kiyA jAve to jaisA ki manuSyoM meM dekhA jAtA hai usa prANI ke vRkkoM meM prasarita vikSata dekhe jA sakate haiN| aba hama isa roga kI tIvra anutIvra aura jIrNa avasthAoM para prakAza DAlate haiM : tIvra avasthA-isa avasthA meM pratyakSadarzIya parivartana bahuta kama hote haiN| yadi vRkka ko kATa kara dekhA jAya to usakA bAhyaka sUja kara moTA ho jAtA hai jisake kAraNa vRkka bhI kucha phUlA huA dikhAI detA hai isa sUjana ke kAraNa prAvara saralatA se chIlA jA sakatA hai| prAvara ke nIce choTe choTe nIlohAGkIya raktasrAva ( petechial haemorrhages ) prAyaH dekhe jAte haiN| vRkka kA dharAtala cikanA rahatA hai aura usake varNa meM koI vizeSa antara nahIM dikhAI detA vRkka kA bAhyaka ( cortex) usake majjaka ( medulla) kI apekSA kucha pANDura ( pale ) dekhA jAtA hai / majjaka meM raktAdhikya hone ke kAraNa bAhyaka aura majjaka kA vibheda spaSTa dikhAI par3atA hai Age calakara jaba jUToM meM raktAbhAva ho jAtA hai to ve AdhUsara vindu ke rUpa meM prakaTa hue dekhe jAte haiN| aNvIkSaNa para nimna sthiti milatI hai: 1. jUToM meM zotha ho jAtA hai jisake kAraNa unakI nyaSTiyoM kI saMkhyA meM vRddhi ho jAtI hai| 2. nAlikAoM meM meghasamazotha ( cloudy swelling ) ho jAtI hai unake bhItara rakta ke lAla kaNa pAye jAte haiM, bahanyaSTi sitakozA dekhe jAte haiM aura adhi For Private and Personal Use Only

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144 vikRtivijJAna cchada kA malavA bhI milatA hai ye tInoM milakara kaNAtmaka nirmoka ( granular casts ) banAte haiN| 3. antarAlita Uti meM thor3A zotha hone ke atirikta koI vizeSa parivartana nahIM dekhA jAtA / vraNazothakArI kozA isa bhAga meM itastataH choTe choTe samUha banA kara par3e hue milate haiM / bar3I vAhiniyoM para unakA koI prabhAva nahIM dekhA jaataa| 4. vraNazothakArI kozA jinameM adhikAMza bahunyaSTi sitakozA aura thor3e lasIkozA sammilita hote haiM AdinAvara meM Ahata vRkajUToM ke cAroM ora saMcita ho jAte haiN| AdiprAvara ke adhicchada meM bahuta kAla taka kozAoM kA praguNana hotA huA nahIM dekhA jaataa| prasara jUTikIya vRkapAkI ke mana meM nimna vizeSatAeM dekhI jAtI haiM :1. mUtra kI mAtrA bahuta kama hotI hai tathA kabhI kabhI to bilkula nahIM hotii| 2. usakA ApekSika bhAra svAbhAvika se adhika hotA hai| 3. dekhane meM mUtra kA varNa dhUmila ( smoky ) hotA hai jisakA kAraNa usameM rakta kI upasthiti hai| 4. mUtra meM zivati yA zukli (albumin ) pAyA jAtA hai jisakI mAtrA bahuta adhika rahatI hai| 5. mathitrita padArtha (centrifuged deposit) meM rakta ke lAla kaNa, bahunyaSTi sitakozA aura aneka kaNAtmaka tathA kAcara nirmoka milate haiN| tIvra vRkapAkI koI hI kAlakavalita hotA hai arthAt prAyaH sabhI baca jAte haiN| jaba roga gambhIrasvarUpa lekara AtA hai to usakA AkramaNa sahasA hotA hai sAtha meM jvara, raktameha aura vRkka kAryAbhAva ( renal failure ) hone se mUtraraktatA (uraemia) kI sthiti bana jAtI hai| jaba roga adhika gambhIrasvarUpa lekara nahIM AtA taba usakA prArambha dhIre dhIre hotA hai, sAtha meM ziraHzUla, vamI tathA kucha zopha (oedema) dekhA jAtA hai| yaha zopha bahuta alpa hotA hai| isakA kAraNa yaha hai ki kapharatIya hRSakaraNa ke kAraNa sampUrNa zarIra kI kezikAe~ usI prakAra sUja jAtI haiM yA prabhAvita hotI haiM jaise ki vRkka kii| jisake kAraNa unakI prAcIroM meM se probhUjinoM ke lie pravezyatA ho jAtI hai| isake kAraNa kucha zotha dekhA jAtA hai| tIvra prasara jUTikIya vRkkapAka meM nimna lakSaNa vizeSa karake dekhe jAte haiM:1. kaTizUla tathA pRsstthshuul| 2. raktameha / 3. zopha / 4. jvara / 5. raktanipIDAdhikya / anutIvra avasthA-isa avasthA ke 2 prakAra hote haiM1. kezAla bAhya prakAra ( extra capillary type ) 2. kezAlAntara prakAra ( intra capillary type ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 145 kezAlabAhya prakAra--yaha dUsare prakAra se adhika gambhIra roga hai isakA prArambha roga ke sahasA AkramaNa hone ke sAtha hotA hai / yaha 13-2 mAsa rahatA hai aura mRtyukAraka hotA hai mRtyu kA kAraNa vRkkakAryAbhAva hotA hai / isameM vRkka sUja jAtA hai usakA dharAtala dhUsara varNa kA ho jAtA hai jisa para upaprAvarika nIlohAGkIya raktasrAvoM ke dhabbe bane hote haiM / raktahIna vRkkaTikAoM ke dhUsara varNa ke vindu sthAna sthAna para usameM camakate haiM / kaTe hue dharAtala para bAhyaka kI paTTI ( band ) pravRddha ho jAtI hai / usameM ( bAhyaka meM ) jo atyadhika zopha aura meghasama zotha ho jAtA hai usake kAraNa bAhyaka aura majjaka kA patA lagAnA kaThina ho jAtA hai aura sabhI kucha usameM aspaSTa ho jAtA hai / autikayA ( histologically ) isa samaya gambhIra svarUpa kA nAlikIya vihAsa hotA hai tathA AdiprAvara ke adhicchada kA paryApta paramacaya dekhA jAtA hai / antarAlita Uti bhI sazopha ( oedematous } ho jAtI hai / usameM sthAna sthAna para vraNazothakArI bahunyaSTi, lasI tathA prarasa kozAoM kI bharamAra ho jAtI hai aneka tanturuha ( fibroblasts ) bhI dekhe jA sakate haiM jo tantUskarSa ke prArambha kI sUcanA dete haiM / isa roga ke mUtra meM rakta khUba milatA hai, saba prakAra ke nirmoka dekhe jAte haiM aura viti bhI paryApta milatI hai / kezAlAntara prakAra -- anutIghra vRkapAka ke isa prakAra kA Arambha apekSAkRta saumya hotA hai / yaha utanA gambhIra bhI nahIM hai / eka varSa taka dekhA jA sakatA hai| yaha prakAra prathama prakAra se adhika rogiyoM meM milatA hai / isa roga meM vRkka pravRddha ho jAtA hai aura usakA raMga zveta ( pANDura ) ho jAtA hai isI kAraNa isa roga ko bRhat zveta vRkka ( large white kidney ) bhI kahA jAtA rahA hai / isameM sneha ke kAraNa ApIta ( yellowish ) rekhAe~ bhI khiMcI huI dikhAI detI haiN| vRkka kI pramukha vizeSatA hai nAlikIya adhicchada meM paittava suoyuda (cholesterol esters) tathA vimedAbha snehoM (lipoid fats) kA saMcita honA yaha vihAsa nahIM balki ina dravyoM kA antarAbharaNa ( bharamAra ) hai / kyoMki vRkkajUToM meM rakta se itanI adhika zviti nikala jAtI hai ki jaba taka rakta nAlikAoM taka pahu~catA hai paittava suvyudoM kI vileyatA rakta rasa meM bahuta ghaTa jAtI hai, isake kAraNa ye paiva suvyu nAlikIya adhicchada meM avasAdita ( deposited ) ho jAte haiM / snaihika avasAdana ke kAraNa isa vRkka ko vimajji vRkka ( myelin kidney ) bhI kahA jAtA hai / inhIM avasAdanoM ke kAraNa vRkka kA varNa zveta pANDura ho jAtA hai / usakI zvetatA meM vRddhi karane meM dUsarA kAraNa vRkka meM sUjana kA honA hai jo raktapUrti karane vAlI vAhiniyoM para dabAva DAlatI hai aura tIsarA parantu sAdhAraNa hetu uttarajAta araktatA hai jo isa avasthA meM sadaiva dekhI jAtI hai / vRkkoM ke kaTe hue dharAtala ko dekhakara majjaka aura bAhyaka meM pharka karanA bahuta kaThina par3atA hai / nIlohAGkIya raktasrAva prAyaH isameM nahIM dekhe jAte / 93.99 fro For Private and Personal Use Only

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146 vikRtivijJAna aNvIkSaNa karane para isa roga meM kezAlabAhya prakAra ke barAbara tIna parivartana prAyazaH anupasthita rahate haiM / yadyapi isameM adhikAMza jUTikAe~ prabhAvita hotI haiM parantu unameM itanI vikRti nahIM AtI ki unakI racanA kA vyaMgIkaraNa yA vighaTana (disorganisation ) ho jAve / vRkkajUTikIya kezAloM ke antazchadIya kozAoM kA praguNana bar3hA huA milatA hai parantu prAvara ke bhItara adhicchadIya arddhacandra kA nirmANa bahuta kama hotA hai| isameM antarAlita Uti meM vraNazothakArI kozAoM kI bharamAra bhI koI adhika nahIM miltii| isa roga meM vimedAbha vihAsa aura usakI nAlikIya adhicchada meM bharamAra saba se adhika dekhI jAtI hai sAtha meM kAcaravindu vihrAsa bhI thor3A sA milatA hai jo adhika gambhIra vRkkapAkoM meM dekhA jAtA hai| Age kI avasthAoM meM tanturahoM ke itastataH praguNana kA bhI pramANa mila jAtA hai aura antarAlita Uti meM tantUtkarSa bhI pAyA jA sakatA hai| bar3I raktavAhiniyoM meM bhI thor3A praguNAtmaka parivartana kA AbhAsa milatA hai jo ki Age prakaTa hone vAle dhamanI jArakhya ( arterio-sclerosis ) kI pUrva bhUmikA jAna par3atI hai| ___isa roga meM mUtra kI mAtrA alpa rahatI hai usakA ApekSika dhanatva bhI adhika rahatA hai usameM zviti kI bahuta bar3I mAtrA upasthita rahatI hai jinake kAraNa mUtra ko thor3A Amlika banA kara ubAlA jAya to vaha prAyaH jama kara Thosa ho jAtA hai| isa avasthA meM vRkka apanA kArya karate rahate haiM jisake kAraNa raktamiha apanI svAbhAvika maryAdA meM rahatA hai| mUtra meM lAla kaNa (rudhirANu) pAye jAte haiM jinake sAtha nirmoka aura bahunyaSTi kozA bhI milate haiN| mUtra meM vimedAbha ke vinduka bhI mila sakate haiN| Age jaba tantUtkarSa hone lagatA hai mUtra kucha adhika patalA par3atA jAtA hai usakI rAzi bar3hatI jAtI hai tathA vitimUtratA kama hotI jAtI hai / naidAnika dRSTi se isa roga meM sthUla zopha (gross oedema ) hotA hai| hama pIche tIvrAvasthA ke varNana meM bhI kucha zopha kA honA likha cuke haiN| grIna ne ina donoM zophoM kA bheda batalAte hue likhA hai 'The oedema of acute nephritis must he distinguished from the massive oedema of the subacute stage. In the former the oedema fluid has characters which are more suggestive of the obstructive or inflammatory oedemas than of true nephritic oedema. The protein content of the fluid is relatively high, being over 1 per cent in contrast to the very low content ( 0.1 per cent ) in true nephritic oedema, while the oedema is itself neither so massive nor so widely distributed. arthAt tIvra vRkkapAka ke zotha meM tathA anutIvra vRkkapAka ke zotha meM paryApta antara hotA hai| pahale meM zotha-drava ke jo lakSaNa milate haiM ve avarodhAtmaka athavA vraNa For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 147 zothAtmaka zothoM kI ora le jAte haiM na ki sacce vRkkapAkajanya zotha kI ora / zotha drava meM probhUjina kI mAtrA 1 pratizata taka hotI hai jaba ki vRkkapAkajanya zotha-drava meM vaha 0.1 pratizata hI milatI hai yadyapi zopha bahuta kama hotA hai| to anutIvra vRkkapAka meM (1) ghanIbhUta zopha milatA hai, (2) raktarasa kI probhUjinoM kI mAtrA meM kamI milatI hai jisakA kAraNa vitimUtratA hotI hai, (3) UtiyoM meM kSArAtu pratidhAraNa (sodium retention) huA rahatA hai tathA (4) raktIya paittava ucca ( raised ) milatA hai| ye cAra pramukha lakSaNa milate haiN| kisa prakAra kezAla prAcIroM kI durbalatA aura vizoNatA se rakta kI probhUjineM nikala kara mUtra meM mila jAtI hai ise hama pahale kaha cuke haiN| parantu usake kAraNa anutIvra vRkapAkIya sarvAMga zotha kaise hotA hai use hama aba saMkSepa meM kahanA cAhate haiM / jo zviti (elbUmina) mUtra dvArA nirgata hotA hai vaha raktarasa (Plasma ) se AtA hai| raktarasa meM se itanI viti bAhara jAtI hai ki usakI mAtrA kevala 50 pratizata raha jAtI hai| 24 ghaNTe meM lagabhaga 20 mASA ( 20 grams) viti zarIra se bAhara calI jAtI hai| rakta meM sAdhAraNataH do probhUjine prAyazaH milatI haiM eka viti aura dUsarI vartuli (globulin) / zviti kA vyUhANubhAra vartali se kama hotA hai jisake kAraNa zviti vartuli kI apekSA adhika zleSAbha AsRtIya nipIDa ( colloid osmotic pressure ) utpanna karatI hai| zciti aura vartuli kA anupAta rakta meM 3: 1 kA rahatA hai| parantu yataH mUtra dvArA zviti kA adhika nikAsa hotA hai isa kAraNa AsRtIya nipIr3a bhI kama ho jAtA hai| isa roga meM donoM kA anupAta 1:3 (bilkula ulaTA) ho jAtA hai| AsRtIya nipIDa kI kamI kA artha hotA hai jala kA zarIra meM saMcaya / isa jala meM zviti yA vartuli kA abhAva rahatA hai kevala 0.03 se 0.05 pratizata probhUjine isa zotha-drava meM milatI haiN| jyoM-jyoM zviti zarIra se adhika nikalatI hai tyoM-tyoM zotha bar3hatA aura jala kA saMcaya hotA calatA hai / yadyapi rogI dekhane meM phUlA huA milatA hai parantu sviti kI kamI usake bala kI kamI karake use durbala kara detI hai| zarIra kI UtiyoM meM jala bhara jAne se, mahAsrotIya bhAga meM vizeSa karake jala kA bhAra par3ane se tathA vRkka meM isa jala ko nikAlane kA sAmarthya na rahane se vamana aura atIsAra bhI prArambha ho jAte haiN| kSArAtu(soDiyama) kA pratidhAraNa bhI mahattvapUrNa hai jisake sambandha meM kucha adhika jAnakArI sadaiva lAbhadAyaka raha sakatI hai| mUtra meM lavaNa yA kSArAtunIreya (sodiumchloride) kI kamI isa roga meM dekhI jAtI hai| yadi adhika jalasaMcaya zarIra meM hogA to lavaNa bhI kama nikalegA aura kama hogA to vaha adhika nikalegA aisA prAyaH dekhA jAtA hai| kucha loga aisA samajha sakate haiM ki lavaNa pratidhAraNa hI zotha yA jala saMcaya kA hetu hai jo sarvathA galata hai| unheM yaha samajhanA cAhie ki jalasaMcaya ke . pariNAmasvarUpa lavaNa yA tArAtu pratidhAraNa hotA hai| kyoMki lavaNa kA pratidhAraNa For Private and Personal Use Only

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148 vikRtivijJAna rakta meM na hokara utiyoM yA dhAtuoM meM hotA hai| jala meM ghulakara lavaNa vRkkoM taka jAne se pUrva hI UtiyoM meM pahu~ca jAtA hai isa kAraNa vRkka dvArA usake bAhara jAne kA prazna hI nahIM uThatA / lavaNa tabhI taka rukatA hai jaba taka jala rukA rahatA hai / yadi hama bhojana se lavaNa nikAla deM to jala adhika kAla taka utiyoM meM rukA nahIM raha sktaa| isI AdhAra para prAcInoM ne zothahara upacAroM meM lavaNa ko varjita batalAyA hai| kyoMki probhUjinoM kA bhI bahuta aMza zarIra se bAhara jAtA rahatA hai ataH isa roga kI cikitsA meM lavaNa-virahita probhUjina-bahula cikitsA adhika upakAriNI siddha huA karatI hai / ___ zarIra meM raktarasa meM sAdhAraNataH 250 milIgrAma pratizata paittava rahatA hai parantu isa roga meM vaha bar3ha kara 500 se lekara 1000 milIgrAma pratizata taka pAyA jAtA hai isa avasthA ko paramapaittavaraktatA ( hypercholesterinaemia) kahate haiN| garbhiNI strI meM svAbhAvikatayA paramapaittavaraktatA dekhI jA sakatI hai| kezAlAntara prakAra nAmaka anutIvra vRkkapAka ke atirikta yaha madhumeha, vRkkotkarSa (nephrosis) jIrNavRkkapAka jisake sAtha meM dhamanI jAraThya yA raktapIDanAdhikya ho, jIrNa avarodhAtmaka kAmalA jo pittAzmarIjanya avarodha se na huA ho tathA kucha plIhodaroM meM vikRti ke rUpa meM dekhI jAtI hai| paittavAdhikya kA mukhya hetu raktarasa kI probhUjinoM kA lagAtAra kama hote cale jAnA hai| yaha bhUlanA nahIM hai ki vRkkajanya sthUla sarvAMga zotha ke atirikta anya prakAra ke zothoM meM yaha paittavAdhikya nahIM dekhA jAtA tathA yaha svayaM vRkkajanyazotha kAraka ho so bhI nahIM hai balki vaha to isa zotha kA pariNAma mAtra hai jisakA mUla kAraNa vitimUvratA hai| isake kAraNa rakta meM vimediraktatA ( lipaemia) bhI dekhI jAtI hai| ___ isa roga meM rakta meM mahattva kA anya parivartana jIrNa aNukozAtmaka araktatA ( chronic microcytic anaemia) aura dekhA jAtA hai jo kAphI gambhIra hotA hai / isakA ThIka kAraNa patA nahIM cltaa| aisA lagatA hai ki zoNavatuli ke nirmANa ke lie Avazyaka vartuli kA abhAva yA usake donoM ghaTakoM ke saMyukta hone ke lie Avazyaka vAtAvaraNa kA abhAva bhI ho sakatA hai yA probhUjinoM kI kamI ke kAraNa avaTukAgranthi kI kriyAzIlatA kI mandatA isakA kAraNa hai| raktastha miha kI mAtrA meM vRddhi anutIvrAvasthA meM vizeSa nahIM ho paatii| raktanipIDa meM uttarottara vRddhi hone lagatI hai jisake kAraNa hRdaya meM paramapuSTi ( hypertrophy ) ke kucha lakSaNa milane lagate haiN| isa roga meM mRtyu kucha mahInoM bAda hotI hai| mRtyu kA kAraNa vRkka kriyA kA abhAva na hokara sarvAMgazotha tathA zArIrika daurbalya ke kAraNa lage upasargoM kA prabhAva vizeSa hotA hai jinameM zvasanaka, zvasanakajanya udaracchadapAka ho sakatA hai / kucha rogiyoM ke vRkkoM meM maNDAbha vihAsa (amyloid degeneration) bhI prakaTa hotA huA dekhA jAtA hai / yaha avasthA yuvaka-yuvatiyoM meM prAyaH dekhI jAtI hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 141 jIrNa avasthA-kisI kisI rogI meM pahale tIvrAvasthA phira anutIvrAvasthA hokara taba jIrNAvasthA AtI hai parantu kucha meM roga kA patA kevala tabhI lagatA hai jaba vRkka apanA kArya banda karanA prArambha karate haiN| aise rogI itanA to kahate haiM ki kabhI unheM thor3A zotha huA thA yA raktamUtratA huI thI yA kutizUla huA thA para usakI koI vizeSa cintA unhoMne kI ho aisA nahIM btlaate| yahA~ taka ki dhIre-dhIre roga jIrNAvasthA ko pahu~ca jAtA hai| ye sabhI rogI prAyaH navayuvaka, navayuvatI yA adher3a hote haiM aura roga kA kAraNa gale kI kharAbI, lohitajvara ( scarlatina ) yA zvasanaka hotA hai| vikRtidRSTayA jIrNa avasthA, tIvra aura anutIvra avasthAoM meM hue ghAvoM ke bharane kI avasthA hai jisameM vizeSa ullekhanIya tantUtkarSa kA honA hai| isa avasthA meM vRkka jati kA sakriya vinAza kama hone lagatA hai, malavA haTAyA jAtA hai / Ahata vRkkANuoM kA sthAna tAntava Uti le letI hai tathA jo vRkkANu jIvita rahate haiM unheM adhika kArya karanA par3atA hai isa kAraNa ve paramapuSTa ho jAte haiN| jitane vRkkANu sajIvAvasthA meM raha jAte haiM usI ke anupAta meM rogI kI Ayu bhI calatI hai| adhikatara rogI isa avasthA meM 2 varSa taka jIte haiM aura unakI mRtyu kA kAraNa miharaktatA (uraemia) hotA hai kabhI kabhI anya upasargoM ke kAraNa hRdbheda hokara bhI mRtyu hotI huI dekhI gaI hai| kabhI kabhI mRtyu kA kAraNa parihRcchadapAka yA udaracchadapAka bhI hotA hai| isa roga meM vRkka kA AkAra ghaTe yaha Avazyaka nahIM hai vaha apanI svAbhAvika AkRti bhI banAe rakha sakatA hai| isake bAhyaka kI caur3AI kucha kama ho jAtI hai tathA usake cihnana ( markings ) kucha aspaSTa ho jA sakate haiM usakA prAvara kucha cipaka jAtA hai aura yadi tantUkarSa kA kSetra bAhyaka meM huA to usakA dharAtala sUkSma kaNoM se yukta bhI dekhA jA sakatA hai| vRkka dekhane meM pANDara hotA hai jisa para vimedAbhIya rekhAe~ aGkita ho jAtI haiM / dhamanI jAraThika parivartanoM ke kAraNa kucha dhamaniyA~ ubharI huI bhI dekhI jA sakatI haiN| aNvIkSaNa se vRkka jUToM meM kAcarIkaraNa ( hyalinisation) tathA tantUtkarSa milate haiM / dhamanikAoM kA kAcarIkaraNa aura AdiprAvara se abhilagnatA vizeSa dekhI jA sakatI hai| yadyapi vRkkANuoM kA pUrNataH nAza nahIM dekhane meM AtA parantu adhikAMza meM kama yA adhika AghAta tathA tantUtkarSa dekhA jA sakatA hai| uttarajAta dhAmanika jAravya ke kAraNa vizoNika UtimRtyu mila sakatI hai| sajIva vRkkANuoM kI parama puSTi mahattvapUrNa hai / isake lie sarvaprathama nAlikAe~ visphArita ho jAtI haiM tathA unakA adhicchada cipaTA ho jAtA hai jo Age calakara zAyada punarjanana ke kAraNa Ayataja yA stambhAkAra ho jAtA hai / vRkkajUTa bhI pravRddha ho jAtA hai isa sabake kAraNa vRkkANu meM adhika kArya karane kI sAmarthya utpanna ho jAtI hai| kabhI kabhI nAlikAoM ke Uti visphAra ke kAraNa usakI prAcIra phaTa jAtI hai aura ve dUsarI nAlikA kI phaTI huI prAcIra se For Private and Personal Use Only

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vikRtivijJAna mila kara sadbhavagranthi yA koSTha ( cyst ) kA nirmANa karatI haiN| aise koSTa jIrNanAbhya vRkkapAka meM jitane adhika milate haiM utane idhara nahIM dekhe jaate| bahuta sI nAlikAoM meM jUToM se hokara rakta na A sakane ke kAraNa unakI apuSTi ho jAtI hai aura phira unakA sthAna tAntavaUti le letI hai| antarAlitaUti meM bhI kAphI tantUtkarSa hotA hai| para vaha kAphI isalie kahA jAtA hai kyoMki aneka nAlikAeM tAntava banakara antarAlitaUti meM samA jAtI haiM / isa kSetra meM lasIkozAoM aura prarasakozAoM kI bharamAra bhI dekhI jAtI hai| __ Ahata vRkkANuoM ke abhilopana ke kAraNa tantatkarSa ho jAne se mUtra meM usake dvArA zviti kA nirgamana nahIM ho pAtA jisake kAraNa raktarasa meM probhUjine bar3hane lamatI haiM jisake pariNAma svarUpa zotha ghaTa jAtA hai| mUtra meM viti kA to AbhAsa mAtra hI milatA hai parantu rakta kA AnA banda nahIM hotA / jyoM jyoM tantRtkarSa bar3hatA hai miha kA mUtra dvArA vinirgamana kama hone lagatA hai jisake kAraNa rakta meM miha ( urea ) kI mAtrA bar3hane lagatI hai| jyoM jyoM vRkka kA kArya rukatA hai zarIra meM bhAsvara kA pratidhAraNa ho jAtA hai jisake kAraNa bhAsvIyika amlotkarSa prArambha hone lagatA hai / rogI kA mUtra sthira svarUpa kA ( fixed ) dekhane meM AtA hai kyoMki vRkta meM use adhika saMkendrita karane kI zakti jAtI rahatI hai / aglotkarSa ke kAraNa asthiyoM kA vicUrNiyana ( decalcification ) hone lagatA hai| baccoM meM to yaha vRkkajanya phakka ( renal rickets ) kA rUpa dhAraNa kara letA hai jisake sAtha sAtha parAvaTukA granthi kI paramapuSTi bhI milatI hai| phuphphusoM, upatvaka UtiyoM aura dhamaniyoM kI prAcIroM meM cUrNiyana milane lagatA hai / vRkkajanya vizoNatA ke kAraNa raktanipIDa ( blood-pressure ) uttarottara vardhamAna hone lagatA hai| vRktadhamanioM meM dhamanI jArakhya (arterio sclerosis ) ke lakSaNa prakaTa hone lagate haiM jisake kAraNa hRdaya meM bhI paramapuSTi hone lagatI hai| rogI ke isa citra ko dekhane se koI bhI yaha kaha sakatA hai ki usakA jIvana adhika dina nahIM cala sktaa| use miharaktatA ( uraemia) mAra sakatA hai, hRdbheda usakI jAna le sakatA hai athavA mastiSkagata raktasrAva use isa asAra saMsAra se bidA kara sakatA hai| nAbhyajUTikIya vRkkapAka ( Focal glomerulo-nephritis) prasara jUTikIya vRkkapAka kA varNana samApta karake aba hama nAbhya ( focal ) vRkkapAka kA varNana prArambha kara rahe haiN| isake 2 prakAra prasiddha haiN| eka tIvra prakAra ( acute type ) aura dUsarA jIrNa prakAra ( chronic type ) / tIna prakAra yaha prAyaH bAlakoM meM vizeSa hotA hai| isakA kAraNa mAlAgolANvika tuNDikAgranthipAka yA visarpa huA karatA hai| isa roga se pIDita vyakti kA mUtra rakta, nirmoka tathA viti se yukta hotA hai parantu na mUtra kI mAtrA kama hotI hai aura na zarIra para kahIM zotha hI hotA hai| mUtra meM jitane parivartana dekhe jAte haiM ve jvara kI tIvratA meM hI prArambha hote haiM bAda meM nahIM jaisA ki prasara vRkkapAka meM dekhA jAtA hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 151 rogotpAdaka jIvANu mUtra meM yA vRkka meM dekhA jA sakatA hai| isameM bahuta thor3e vRkka jUToM meM vikSata dekhe jAte haiM / jUToM ke choTe choTe samUhoM meM prAvarika sthAna meM raktasrAva hotA huA milatA hai| prAvaroM meM bahunyaSTi kozAoM kI bharamAra bhI milatI hai| sAtha hI gucchakezAloM ke antazchada meM praguNana bhI milatA hai yaha praguNana sampUrNa guccha meM bhI ho sakatA hai aura usake eka bhAga meM bhii| kyoMki isa roga meM bahuta thor3e vRkkajUTa Ahata hote haiM isa kAraNa vRkkoM kI svAbhAvika kriyA meM koI bAdhA nahIM phuNctii| isI kAraNa isa roga se rogI maratA nahIM balki kucha dina pazcAt ThIka ho jAyA karatA hai / tIvra prakAra jIrNa prakAra meM prAyaH bahuta kama pariNata hotA hai| tIna prakAra meM antaHzAlyika vRkkapAka ( embolic nephritis) AtA hai| anutIvra daNDANvika hRdantaHpAka hone para vahA~ se koI antaHzalya vRkka meM vRkkajUTa kI kisI kezAla ko avaruddha kara detA hai jisake kAraNa yaha vRkkapAka hotA hai isake kAraNa mUtra meM sviti tathA rakta milate haiM para caMki hRdroga hI kAphI bhayaMkara hotA hai isa kAraNa isakI ora tanika bhI dhyAna nahIM jA paataa| jUTaguccha kA sampUrNa bhAga prabhAvita nahIM hotA jo bhAga prabhAva meM AtA hai vaha prAvara se cipaka jAtA hai tathA yadi rogI kI mRtyu na huI to vahA~ tantUtkarSa bhI ho jAtA hai| prAvarika bhAga meM raktasrAva hone ke kAraNa vRkka ke dharAtala para sUcamalAla vinduka dekhe jA sakate haiN| rogANuraktatA ( septicaemia) nAmaka roga meM raktamUtratA ke kAraNa vRkka ke kezAloM kA viSAkta hokara unakI prAcIroM meM vidaraNa ho jAtA hai jo ThIka usI prakAra hai jaise tvacA kI kezAloM ke phaTane se nIlohAGkana utkoTha ( purpuric rashes ) svacA para ho jAte haiN| ___ jIrNa prakAra eka prakAra kA na hokara kaI prakAra kA hotA hai| isa roga ke kaI nAma pracalita rahe haiM jinameM kucha kaNAtmaka vRkka (granular kidney ), uttarajAta saMkucita vRkka (secondary contracted kidney ), judra lAla yA zveta vRkka ( small red or white kidney ), jIrNa antarAlika vRkkapAka (chronic interstitial nephritis ) haiN| rasaila nAmaka vidvAn ne nimna 4 prakAra isa roga ke kie haiM: prathama prakAra-yaha bahuta gambhIra hotA hai parantu varSoM cala sakatA hai| isameM mukha ke zopha aura raktameha kA itihAsa mila sakatA hai| vRkka kA AkAra bahuta kama ho ho jAtA hai| prAvara usa para halakA halakA cipakA rahatA hai tathA vRkka dharAtala kaNAtmaka hotA hai kATane para bAhyaka paTTI kI caur3AI bhI kama milatI hai tathA usameM vimedAbhIya rekhAe~ bhI milatI haiM / vAhiniyoM meM sthaulya prakaTa hone lagatA hai| aNvIkSaNatayA vibhinna vRkka jUToM meM vikSata bhI vibhinna avasthAoM ko prApta hote hue dekhe jAte haiM kucha svAbhAvika avasthA meM hote haiM, kucha meM antazchadIya praguNana milatA hai, kucha meM tantUtkarSa milatA hai| vibhinna samaya meM jUTikAoM para AghAta hone ke kAraNa eka hI prakAra ke vikSata jinakI kevala avasthAe~ hI bhinna hoM pAye jAte haiN| nAlikAoM meM For Private and Personal Use Only

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152 vikRtivijJAna lAla kaNa aura nirmoka milate haiM parantu inameM vimedAbha yA kAcaravinduka vihAsa adhika nahIM milatA / antarAlita tantUtkarSa tathA lasIkozAoM evaM prarasakozAoM kI yahA~ para bharamAra khUba milatI hai / tAntava Uti kA vibhAjana sidhmoM meM hotA hai / jinake bIca bIca meM sajIva paramapuSTa visphArita nAlikAe~ pAI jAtI haiM / tAntava Uti kA eka jAla sA bicha jAtA hai jo kahIM saghana aura kahIM virala hotA hai / sAtha kI vRkkaTikAe~ pravRddha tathA svastha milatI haiM / jaba kabhI nAlikAe~ bahuta adhika visphAra kara jAtI haiM to ve phaTa jAtI haiN| kaI kaI phaTI huI nAlikAe~ milakara koSTa (cysts ) banA letI haiN| jyoM jyoM vRkkoM kI kriyAzakti kama hotI jAtI hai jIrNa miharaktatA hone lagatI hai jo 1 varSa taka rahatI hai mRtyu kA kAraNa miharaktatA ( ureamia ), hRdbheda ( cardiac failure ) athavA koI upasarga huA karatA hai / dvitIya prakAra - yaha ati cirakArI hai jo 2 se 10 varSa taka rahatA hai aura isakA anta jIrNa miharaktatA ( chronic uraemia ) meM hotA hai | adhika jIrNa hone ke kAraNa pratyakSa vikRti prathama prakAra jaisI hI hotI hai para usase kucha adhika pravRddha dazA meM hI hotI hai / aNvIkSaNatayA aneka vRkka jUTikAoM meM pUrNataH tantUtkarSa ho jAne se ve naSTa ho jAtI haiM aura adhikAMza meM kucha adhika yA kama AghAta kA lakSaNa milatA hai / yaha yuvAvasthA kA roga hai aura isake lakSaNa miharaktatA prArambha hone ke pUrva pratyakSa nahIM ho pAte / tRtIya prakAra - isa prakAra meM vRkkoM kA AkAra jitanA ghaTa jAtA hai utanA anya prakAroM meM nahIM jahA~ svAbhAvika vRkka kA bhAra 150 mASA hotA hai isa roga meM yaha 30 bhASA taka kI dekhA gayA hai / isakA dharAtala rUkSa aura kaNAtmaka ho jAtA hai usa para vraNavastu ( scarring ) khUba ho jAtI hai parantu prAvara cipakA huA nahIM milatA / aNvIkSaNa tathA vRkka Uti kA nAza bahuta adhika huA karatA hai tathA tantUtkarSa pradhAnatayA milatA hai paramapuSTa vRkkANuoM ke dvIpa itastataH bahuta kama saMkhyA meM phaile rahate haiM unameM bhI vraNazothAtmaka parivartana dekhane ko milate haiM / dhamanI - jAraThya adhika bhI mila sakatA hai aura kama bhI / adhika hone para vizoNika apuSTi (ischaemic atrophy ) bhI sAtha meM rahatI hai / grIna isa roga ko eka prakAra kA rahasya ( mystery ) mAnatA hai / kyoMki isase Ahata rogI ko koI vizeSa zArIrika kaSTa yA lakSaNa nahIM hotA aura usakA vRkka itanA choTA ho jAtA hai / jaba taka miharaktatA nahIM ho jAtI isakA jJAna bhI nahIM hotA / yaha bAlakoM meM bhI hotA hai tathA 25 varSa ke taruNa-taruNiyoM meM bhI pAyA jAtA hai / phiraMga isa roga kA kartA hogA aisA mAnanA pUrNataH satya nahIM hai / caturtha prakAra - - nAbhyavRkkapAkoM meM yaha sabase kama gambhIra roga hai / anya prakAroM ke viparIta yaha 40 varSa se Upara ke vyaktiyoM kA roga hai isameM vRkka kI vahI dazA hotI hai jaisI raktanipIDAdhikya se pIDita vyakti ke vRkka kI hotI hai / isameM vRkkajanya lakSaNoM kI apekSA hRd-vAhinIya lakSaNa adhika milate haiM / raktapIDanAdhikya, For Private and Personal Use Only

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153 vividha zarIrAGgoM para vraNazotha kA prabhAva dhAmanika-jAravya tathA hRdaya kI atipuSTi isa roga ke pradhAna lakSaNa haiN| antarAlita Uti meM tantUtkarSa paryApta milatA hai| abhivAhI (afferent) jUTIya dhamaniyoM meM sneha-kAcarIya ( of fatty hyaline type ) dhAmanika-jAraThya pUrNa pragalbha svarUpa kA milatA hai / nAlikAoM meM vizoNika vihAsa milatA hai mRtyu kA kAraNa miharaktatA tathA hRdbheda hotA hai| nAbhyavRkkapAka ke sampUrNa prakAroM meM nimna lakSaNa sarvasAmAnyarUpa se pAye jAte haiM : pratyakSatayA1. vRkka ke AkAra kA atyadhika prahAsana ( reduction in size ) 2. pratidhAraNa koSThoM kI upasthiti ( retention cysts ) 3. sidhmika evaM jAlakIya tantUtkarSa (patchy and reticular fibrosis) 4. kama yA adhika aMza meM dhAmanika jAraThya ( arterio sclerosis) aNvIkSatayA1. vRkkANujUTa sabhI Ahata nahIM hote jo bace rahate haiM ve parama puSTa ho jAte haiM ( healthy hypertrophied glomeruli ) / 2. asvastha vRkkANujUToM meM vikSata nirmANa kI vibhinna avasthAe~ dekhI jAtI haiM (different stages of development of the lesions ), 3. jUTikIya kezAloM meM antazchadIya praguNana vizeSa hotA hai (endothelial proliferation of glomerular capillaries ) i naidAnikatayA1. roga kA prArambha zanaiH zanaiH hotA hai ( onset insidious) / 2. koI vigata itihAsa nahIM milatA (without any previous history) 3. raktameha ( haematuria) / 4. raktanipIDAdhikya ( raised blood pressure ) yA rakta ke nipIDana kI vRddhi kA saMketa jisake kAraNa hRdaya kI parama puSTi ( hypertrophy of cardiac muscle ) , 5. svalpa vitimeha ( slight albuminurea) / 6. mRtyu kA kAraNa miharaktatA yA hRdbheda / 7. roga varSoM calatA hai| . yadyapi Upara hamane nAlikIya vRkapAka yA tIvra vaiSika vRkkotkarSa kA ullekha kiyA hai parantu vaha vraNazothAtmaka (inflammatory ) na hokara vihAsAtmaka ( degenerative ) roga hone se usakA varNana vihAsoM ke sAtha kiyA gayA hai| ataH aba hama sapUya vRkkapAka ( suppurative nephritis ) kA varNana karate haiN| sapUyavRkkapAka sapUya vRkkapAka bhI 2 rUpoM meM batalAyA jAtA hai eka ko pUyaraktIya vRkka (pyaemic kidney ) yA prasara sapUya vRkkapAka (diffuse suppurative For Private and Personal Use Only

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154 vikRtivijJAna nephritis) kahate haiM aura dUsare ko zalyavRkka ( surgical kiney ) yA nAbhya sapUya vRkkapAka ( focal suppurative nephritis ) kahate haiM / -- sapUya vRkkapAkakArI jIvANuoM kA vRkka taka praveza 3 mArgoM dvArA sambhava hai| 1. raktadhArA dvArA jaba ki zarIra meM kahIM bhI pUyika kendra bana gayA ho / 2. adhomUtramArga ke upasraSTa ho jAne se koI ArohI upasarga ho jo vRkka taka pahuMca jAve / 3. gavIniyoM ( ureters ) meM kharAbI A jAne se / yaha tabhI sambhava hai jaba ki basti meM mUtra ruka jAve gavInImukha dUSita ho jAveM aura mUtra unameM hokara Upara kI ora car3he / kisI bhI kAraNa se sahI upasargakArI jIvANu vRkkoM taka pahu~cate haiM aura sapUyavRkka athavA vRkkapAka utpanna karate haiM / aba nIce hama donoM prakAra ke sapUya vRkkapAkoM kA Avazyaka vivaraNa prakAzita karate haiM:: Acharya Shri Kailassagarsuri Gyanmandir prasara sapUya vRkkapAka yA pUyaraktIyavRkka 1. isa roga ke utpAdaka jIvANu 3 haiM--a-puMjagolANu, A-mAlAgolANu tathA i - phuphphusagolANu | ina tInoM meM se koI bhI raktadhArA meM pravAhita hotA rahatA hai aura jaba vaha vRkkakezAloM meM pahu~catA hai to vahA~ use pakar3a liyA jAtA hai / puMjagolANu asthimajjA pAka, vidhi, kArabaMkila yA tIvra daNDANvIya hRdantaHpAka dvArA rakta meM pravAhita hote haiM / 2. donoM vRkkoM meM upasarga eka sAtha jAtA hai aura donoM meM hI asaMkhya choTI choTI zyAmAkasama ( miliary ) vidradhiyA~ bana jAtI haiM / ina vidradhiyoM ke kendra ApIta evaM sapUya hote haiM jinake cAroM ora adhiraktatA ke kAraNa lAlI chAI rahatI hai / ye vidhiyA~ bAhyaka meM prAyaH milatI haiM itanI majjaka meM nahIM para jaba majjaka meM milatI haiM to unakI saMkhyA kama nahIM hotI / 3. mUtra meM pUya nahIM pAyA jaataa| jaba taka vidhiyA~ bar3I hokara vRkkamukha meM khulane yogya hotI haiM usase pUrva hI pUyaraktatA ( pyaemia ) ke kAraNa rogI ihaloka se paraloka kI ora gamana kara jAtA hai / 4. uparokta jIvANu antaHzalya ( emboli ) ke rUpa meM kArya karate haiM unake cAroM ora mRta Uti kA kaTibandha rahatA hai jisake cAroM ora atyadhika vraNazothAtmaka pratikriyA dekhI jAtI hai / nAbhya sapUyavRkkapAka yA zalyavRkka isake 3 vibhAga banAye gaye haiM : -- 1. vRkkamukhavRkkapAka ( pyelonephritis ) 2. vRkkamukhapAka ( pyelitis ) 3. sapUyavRkkotkarSa ( pyonephrosis ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 155 (1) vRkkamukhavRkkapAka 1. isameM vRkka-jIvitaka ( renal parenchyma ) tathA vRkkamukha ( pelvis of the kidney ) donoM kA eka sAtha pUyana hotA hai| isa roga meM upasarga rakta kI dhArA se pravAhita hokara hI pahu~catA hai aura usakA mukhya kAraNa AntradaNDANu ( bacterium coli) mAlUma par3atA hai AntrapUyakArI jIvANu isameM bahuta kama bhAga lete hue dekhe jAte haiN| 2. isa roga ke vikSata sarvaprathama vRkkamajjaka meM banate haiM jaba ki pUyakArI jIvANuoM ke vikSata pahale bAhyaka meM banate haiN| 3. isa roga ke AkramaNa ke pUrva sadaiva AntrapAka ( enteritis) kA itihAsa milatA hai jahA~ se ki AntradaNDANu isa mArga meM pahu~cate haiN| 4. mUtrotsarga meM bAdhA pahu~cAnA, yaha vRkka ke upasraSTa hone kA sarvaprathama pramANa hotA hai| yaha bAdhA kisI vRkkAzmarI dvArA bhI par3a sakatI hai parantu azmariyoM ke sAtha sadaiva hI sapUya upadrava honA Avazyaka nahIM hai| 5. upasarga kA prArambha majjaka kI saMcAyI nAlikAoM (collecting tubules) meM hotA hai (na ki bAhyaka meM jaisA ki pUyaraktatA meM dekhA jAtA hai ) jahA~ se Upara bAhyaka kI ora tathA nIce vRkkadvAra kI ora upasarga jAtA hai| bAhyaka meM choTe choTe uThe hue ApIta phoDe dekhe jAte haiM yA lAla raMga ke sidhma milate haiM jinameM pItavarNa kA pUya bharA huA spaSTa dikhatA hai jise dekhakara RNAsra (infarct) kA AbhAsa hotA hai| 6. vRkka kA kaTA huA dharAtala dekhane se yaha lagatA hai ki majjaka meM jahA~ upasarga kI nAbhi hai vahA~ se bAhyaka kI ora pItavarNa kI rekhAe~ calatI haiM jinake bIca bIca meM lAla vAhiniyA~ dekhI jAtI haiN| ___7. yadi bAhyakIya vidradhiyA~ vidIrNa ho jAtI haiM to upasarga parivRkka ( perirenal ) bhAga meM bhI pahu~ca jAtA hai aura parivRkka vidradhi (perirenal abscess) bana sakatA hai| isakA prArambha sahasA hotA hai, jisake sAtha tIvra pRSThazUla hotA hai aura mUtra meM thor3A pUya milatA hai| saMvardha ke dvArA upasargakArI jIvANu kA patA lagAyA jA sakatA hai| 8. vRka se pUya nikala kara vRkkamukha meM AtA hai jo svayaM upasraSTa hokara pUyotpatti kara sakatA hai yahA~ se vaha nIce ke mUtramArgoM ko jAtA hai jo ki usake prabhAva meM A sakate haiN| isa prakAra yaha eka mUtramArga kA avarohI upasarga ( descending infection of the urinary tract ) ho jAtA hai| isa kAraNa gavInIpAka ( ureteritis ) bhI dekhA jA sakatA hai tathA usase bhI adhika sapUya bastipAka ( suppurative cystitis ) milatA hai| 9. AntradaNDANujanya isa pAka meM mUtra kI pratikriyA Amlika hotI hai, pUyaupasthiti se vaha gaMdalA yA meghAbha ho jAtA hai, usameM kucha viti mila sakatI hai For Private and Personal Use Only

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vikRtivijJAna aura saMvardha dvArA isa daNDANu kA bhI patA lagAyA jA sakatA hai / adhika gambhIra hone para mUtra ke sAtha rakta bhI dekhA jAtA hai / 10. bastidarzana se prArambha meM eka gavInI se aura jIrNa hone para donoM gavIniyoM se pUya nikalatA huA dekhA jA sakatA hai| yaha prakaTa karatA hai ki pahale upasarga eka vRkka meM hotA hai phira donoM vRkkoM meM ho jAtA hai / (2) vRkkamukhapAka-- 1. yaha roga puruSoM kI apekSA striyoM ko hotA hai| sagarbhAvasthA meM prathama prasavAoM meM 5-6 veM mahIne meM yaha prAyazaH dekhane ko milatA hai| bAlA, taruNI, praur3hA koI bhI isase prabhAvita ho sakatI hai / 2. yaha roga kevala vRkkamukha (pelvis of the kidney ) taka hI sImita ho yaha pUrNataH satya nahIM hai kyoMki vRkkamukha kA kisI bhI kAraNa se zotha hone para usakA prabhAva vRkka para par3akara hI rahatA hai| 3. isa roga kA pramukha hetu bhI Antra daNDANu hai| yaha upasarga use rakta dvArA prApta hotA hai / rakta meM bahunyaSTisitakozotkarSa dekhane ko milatA hai| 4. isa roga kA prabhAva sarvaprathama dAhinI ora hotA hai kyoMki dAhinI ora kI gavInI zroNicakra ke mukha para se gaI hai aura usa para garbha kA bhAra bhI par3atA hai jisakA pratyakSa pariNAma usake visphAraNa meM hotA hai| 5. roga prArambha hone para vRtamukha atyadhika raktAnvita ho jAtA hai aura usameM pUya bhara jAtA hai| vRkka bhI mRdu aura pravRddha ho jAtA hai| roga sukhasAdhya rahA to thor3e samaya pazcAt vaha zAnta ho jAtA hai aura koI upadrava nahIM uThate para yadi vaha kaSTasAdhya huA to pUyavRkkotkarSa yA vRktamukhavRkkapAka meM se koI bhI upadrava uTha sakatA hai / antima ke kAraNa parivRkkavidradhi bhI utpanna ho sakatI hai| 6. kabhI-kabhI prasavoparAnta bhI yaha roga mila sakatA hai aura jAr3A car3ha kara uccatApAMzayukta jvara dekha kara prasUtijvara (puerperal fever ) kA bhrama ho sakatA hai| zizuvRkkamukhapAka ( Infantile pyelitis)-yaha bAlakoM kI apekSA bAlikAoM kA roga hai, isakA kAraka AntradaNDANu hI hai| yaha upasarga bhI raktajanita hotA hai / yaha kabhI-kabhI bahuta gambhIrasvarUpa bhI dhAraNa kara letA hai aura ise dekha kara jUTikIya vRkkapAka kA sandeha utpanna ho jAtA hai| donoM ora kA vRkkamukhavRkkapAka zizuoM meM bahuta gambhIra bana jAtA hai| zanaiH-zanaiH vRkka Uti naSTa hone lagatI hai jisase rakta meM miha bar3hane lagatA hai mUtra patalA hone lagatA hai aura usameM viti prApta hone lagatI hai| mUtra meM pUya kabhI AtA hai aura kabhI banda ho jAtA hai / vRkkoM kA AkAra choTA par3a jAtA hai unameM vraNavastu aura tantUtkarSa bahuta hotA hai tathA vRkkakriyA ruka jAne se mRtyu taka ho sakatI hai| For Private and Personal Use Only

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157 vividha zarIrAGgoM para vraNazotha kA prabhAva (3) sapUyavRkkotkarSa 1. isa roga kA kAraka adho mUtramArga se Upara kI ora jAtA hai| yaha vRkkamukhavRkkapAka ke kAraNa bhI hotA hai tathA udavRkkotkarSIya ( hydronephrotic) vRkka ke dvArA bhI ho sakatA hai| 2. kisI bhI kAraNa se ho isa roga meM vRkkapUya se labAlaba bharA huA eka thailA bana jAtA hai jisakI prAcIreM paryApta moTI hotI hai| bhItarI vRkka uti kA bahuta adhika nAza ho jAtA hai aura sampUrNa vRkka kA sthAna eka sthUla prAcIra vAlI sagahvara ( loculated ) vidradhi le letI hai| prAcIroM kI sthUlatA kA kAraNa hotA hai parivRkkakozIya saMyojI Uti kA vrnnshoth| isake kAraNa parivRtavidhi bhI banane kI AzaMkA ho uThatI hai| 3. upasarga kA kAraNa raktajanita hotA hai| mUtraprasekIya nirodha ( urethral stricture ) athavA puraHstha granthi vRddhi ( enlargement of the prostate) ke kAraNa basti meM mUtra ruka jAne se bastipAka ho jAtA hai vahA~ se upasarga Upara ko cala detA hai aura donoM ora kI gavIniyoM meM hokara vRkka se basti taka mUtra bhara jAtA hai isa kAraNa sapUyavRkkotkarSa (pyonephrosis) bhI sAtha hI sAtha mila sakatA hai| mUtra bahuta bharA rahane ke kAraNa vRtamukha para itanA pIDana par3atA hai ki vahA~ raktapUrti meM bAdhA par3ane lagatI hai jisake kAraNa upasarga ko aura bhI adhika avasara milatA hai| 4. uparokta varNana ke kAraNa 2 ghaTanAe~ ghaTatI haiM-eka to zarIra meM viSamayatA (toxaemia) kI vRddhi hotI hai tathA dUsare vRkka Uti kA vinAza hotA hai| isa kAraNa yA to pahale kAraNa se zIghra mRtyu ho jAtI hai anyathA dUsare kAraNa se roga jIrNa hokara dera meM mRtyu hotI hai| roga saumya hone para rakSA bhI sambhava hai jisameM zastrakarma aura navAviSkRta dravyoM kA prayoga anivAryataH karanA par3atA hai| (13) adhomUtramArga para vraNazotha kA pariNAma isameM bastipAka ( cystitis ) tathA mUtranAlapAka ( urethritis) kA varNana kiyA jaavegaa| afeagra ( Cystitis ) basti meM cAhe kitane hI jIvANuoM se yukta yA kaisA hI mUtra bahe koI bhI vikAra taba taka nahIM AtA jaba taka ki basti ko koI AghAta ( trauma ) na lage yA mUtrapravAha banda na ho jAya / ina donoM meM se kisI ke bhI kAraNa basti meM vraNazothAtmaka pratikriyA utpanna ho jA sakatI hai / bastipAkakAraka sarvapramukha AntradaNDANu mAnA jAtA hai usake atirikta nimna anya bhI bastipAka kara sakate haiM : For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 158 www.kobatirth.org vikRtivijJAna Acharya Shri Kailassagarsuri Gyanmandir 1. pUyakAraka mAlA golANu / 2. adhyAntrajvaradaNDANu ( paratyphoid bacillus ) / 3. sAmAnya nAnArUpa ( B. proteus ) / 4. nIlapUyakazAMgANu ( psendsmonas aertginosa ) / 5. uSNavAtagolANu ( gonococci ) / 6. yacamAdaNDANu (B. Tuberculosis ) / bastipAkakArI jIvANuoM ke bastipraveza ke nimna mArga ho sakate haiM - 1. vRkkoM se gavInI dvArA 2. mUtramArga se Upara ko / 3. basti meM bAra-bAra upakaraNa ( instruments ) DAlane se / 4. athavA zroNiguhA meM vraNazotha jaise uNDukapucchapAka dvArA yA striyoM meM garbhAzayanAlapAka (salpingitis ) ke kAraNa / aMgaghAta ke kAraNa jaba basti se mUtra ke visarjana kI kriyA samApta ho jAtI hai| to bhI bastipAka hotA hai tathA use nikAlane ke lie prayukta bastiyantra ke dvArA AghAta hone se bhI yaha roga ho sakatA hai| aba Age hama isa roga ke tIvra aura jIrNa donoM prakAroM kA varNana kareMge / tIvrabastipAka -mUtra ke meghAbha hone ke sAtha-sAtha sazUla muhurmuhu mUtratyAgecchA isa roga meM vizeSa dekhI jAtI hai / zUla kA kAraNa basti ke trikoNa ( trigone ) meM adhiraktatA aura vraNazotha hotA hai / kabhI-kabhI basti ke AdhAra para sparzAsahiSNutA tathA bAra-bAra mUtratyAga dekhA jAtA hai use prakSubdhabasti ( irritable bladder ) kahate haiM parantu vaha tIvra bastipAka nahIM hotA kyoMki vahA~ mUtra meM pUya upasthita nahIM rahatA / isameM trikoNa para kucha adhiraktatA mAtra milatI hai / yaha roga striyoM meM prAyaH dekhA jAtA hai / tIvra bastipAka meM jo adhika gambhIra rogI hote haiM unameM basti kI zleSmalakalA asitanIlAruNa ( dark purplish ) yA lagabhaga kothamaya ( gangrenous ) ho jAtI hai / aisI avasthA meM basti meM atyadhika prayotpatti hone ke pUrva hI mRtyu ho jAtI hai / : para yadi avasthA kucha kama gambhIra dikha par3I to nimna lakSaNa dekhe jAte haiM : 1. basti kI zleSmalakalA kI camaka manda par3a jAtI hai, vaha lAla ho jAtI hai, vaha zotha ke kAraNa phUla jAtI hai, usameM sthAna-sthAna para vraNa bana jAte haiM jinameM se tantvit-pUyIya strAva ( fibrino purulent exudate ) ke Tukar3e ( shreds) basti prAcIra se laTakate rahate haiM / 2. upazleSmalakalA se kaI sthAnoM para raktasrAva hone lagatA hai / 3. mUtra meM pUya, tanvi tathA rakta milatA hai / mUtra kI pratikriyA AntradaNDANu, For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 156 Antrika jvaradaNDANu tathA aNyAntrika jvaradaNDANu ke dvArA roga hone para Amlika hotI hai para yadi mAlAgolANu yA gucchagolANu roga ke kAraNa hue to kSArIya hotI hai; kabhI-kabhI eka hI roga meM rogakArI jIvANu tathA pratikriyA donoM badala jAte haiM / 4. yaha roga zleSmalakalA aura upazleSmalakalA taka hI sImita rahatA hai; jahA~ vraNa bana jAtA hai vaha pezI taka roga pahu~ca sakatA hai parantu bastipezI isa roga meM koI bhAga letI huI nahIM dekhI jAtI hai / 5. mizra deza meM bilhArjiyAsisa nAmaka roga meM basti prAcIra meM jaba strIpuMsa ( schistosoma ) ke aNDe ( ovoid ) apanA mArga banAte haiM usa samaya ve aNDe jinameM zUka ( spike ) hote haiM basti kI zleSmalakalA meM vraNazothAtmaka purvaMgaka ( inflammatory polyps ) utpanna kara dete haiM jisake kAraNa eka prakAra kA anutItra bastipAka utpanna ho jAtA hai / isameM raktameha, zUla, bAra-bAra mUtratyAga Adi hote haiM parantu pUya bahuta kama yA bilkula nahIM milatA / mUtra ke mathitra meM aNDe dekhe jA sakate haiM / I I jIrNa bastipAka -- isameM basti ke prasaratantUtkarSa ke sabhI cihna milate haiM / isa roga meM sabhI stara antarbhUta ho jAte haiM / zleSmalakalA pezIstara se ba~dha jAtI hai aura bahuta phailI huI ( tata ) dikhAI detI hai, vaha cikanI aura apuSTa bhI ho jAtI hai anyathA adhicchada ke nIce kI kaNana Uti isameM aneka paramapuSTa kUTa ( ridges ) aura valiyA~ ( rugose ) utpanna kara detI hai jo saba isa roga meM eka hokara kalA ko cikanA banA detI hai / zleSmalakalA meM aneka purvaMgaka ( polyps ) utpanna ho jAte haiM / zleSmakalA kA raMga ur3a jAtA hai vaha gulAbI na hokara ApIta ho jAtA hai / usameM kahIM-kahIM para babhru varNa kI zoNAyasi saMcita ho jAtI hai usake saMcaya kA kAraNa upazleSmalakalA meM raktasrAva kA honA hai / yadi mUtra ke srAva meM bAdhA rahe to pezItantupuMja ( muscle fasciculi ) meM aneka sthaloM para varmana ( herniation ) ho jAtA hai / I yadi bahuta samaya taka basti zleSmalakalA para prakSobha hotA hai to antarvartI kozAoM vAle adhicchada ( transitional cell epithelium ) meM samapuSTi ( metaplasia ) hone lagatI hai jisake kAraNa eka viziSTa staritazalkAdhicchada ( typical stratified squamous epethelium ) bana jAtA hai / vaha bhI Age cala kara paramapuSTa ho jAtA hai jisake kAraNa zleSmalakalA meM itastataH zveta sidhma (white patches) utpanna kara detA hai jise bastIka sitacaya ( vesical leucoplakia ) kahate haiM / mUtranAlapAka ( Urethritis ) mUtramArga, mUtranAla yA mUtrapraseka yUrethA ke vibhinna nAma haiM / mUtranAla meM prameha yA uSNavAtagolANu (gonococci ) ke dvArA jo vraNazotha hotA hai vaha bahuta mahattvapUrNa hone For Private and Personal Use Only

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160 . vikRtivijJAna se hama usI kA varNana idhara de rahe haiN| yaha strIsaMsarga se prApta roga hai| isakA prabhAva puruSamUtramArga para jitanA adhika par3atA hai utanA strImUtramArga para nahIM pdd'taa|| puruSa meM mer3hIya mUtranAla ( penile urethra) ke agra bhAga kI zleSmalakalA para sapUya vraNazotha kA pariNAma 2-3 dina pazcAt prakaTa hotA hai| usakI zleSmalapranthiyoM meM sarvaprathama upasarga pahu~catA hai vahA~ se phira dhIre dhIre upasarga pazcamUtranAla ( posterior urethra ) ko jAtA hai| zleSmalakalA meM vizalkana ( desquamation ) aura vraNana (ulceration) ke kAraNa pUyIya srAva hotA hai| prAyaH roga zleSmala aura upazleSmala stara taka hI rahatA hai para gambhIra avasthAoM meM yaha mer3hakAya ( corpora cavernosa) taka pahu~ca jAtA hai / jaba upasarga pazcamUtranAla taka calA jAtA hai to phira vahA~ para khulane vAlI granthiyoM (jaise ziznamUla pArzvikagranthiyA~ Cowper's gland tathA puraHstha granthi meM bhI pahu~ca jAtA hai| vahA~ se zukraprapikA ( seminal vesicles ) tathA adhivRSaNikA ( epididymis) ko bhI pahuMca sakatA hai| yadi usakA sambandha raktadhArA se sthApita ho gayA to vaha rakta meM pahu~ca kara rogANuraktatA, uSNavAtika hRdantaHpAka, uSNavAtika mastiSkacchadapAka (gonococcal meningitis), uSNavAtika sandhipAka (gonococcal arthritis ) Adi ho sakate haiM para ve saba mUtramArgapAka kI tIvrAvasthA zAnta hone ke uparAnta hI prakaTa hote haiN| uSNavAta kI tIvrAvasthA jIrNAvasthA ko atizIghra jAne kI pravRtti rakhatI hai| kabhI kabhI to sujAka 2-3 saptAha meM samApta ho jAtI hai| parantu usake pazcAt pazcamUtranAlapAka yA puraHsthagranthipAka yA adhivRSaNikApAka kA prArambha ho jAtA hai / jIrNamUtranAlapAka meM mUtranAlaprAcIra kA zanaiH zanaiH vinAza hotA calatA hai aura usakA sthAna kaNana Uti tathA vraNazothakArI tantUtkarSa lene lagatA hai| Age calakara jaba tAntava Uti saMkucita ho jAtI hai to mUtranAla saMkoca (urethral stricture) ho jAtA hai / yaha mUtranAla ke kalAmaya bhAga ( membranous part ) meM hotA hai jahA~ agra aura pazca mUtranAla milate haiN| isake kAraNa mUtranAla kA supiraka bahuta sikur3a jAtA hai agara aise sthAna para koI upakaraNa DAlA gayA to vaha bajAya isa suSiraka meM hokara jAne ke eka anya hI chidra banA DAlatA hai| mUtranAla saMkoca ke kAraNa basti meM se mUtra kA pravAha adhika druta nahIM ho paataa| basti ko adhika balapUrvaka mUtra ko nIce DhakelanA par3atA hai jisake kAraNa usakI prAcIreM paramapuSTa ho jAtI haiM aura usameM itastataH gartikAe~ ( sacculi ) bana jAtI haiM / yadyapi bastidvArA mUtra bAhara nikAla diyA jAtA hai isa kAraNa basti meM upasargakArI jIvANuoM kA adhikAra vaisA nahIM jama pAtA jaisA ki puraHsthagranthi (prostate) kI vRddhi ke kAraNa saMkucita mUtranAla ke kaarnn| Age calakara Urdhva mUtramArga meM bhI visphAraNa hotA hai jisake kAraNa udavRkkotkarSa ( hydronephrosis), vRkkakriyA meM avarodha tathA miharaktatA bhI ho sakatI hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 161 mUtramArgapAka yA mUtranAlasaMkoca kA kAraNa uSNavAta to hai hI para usake atirikta mUtramArga meM upakaraNa praveza ( instrumentation ) uttarabastiprayoga ( cathe - terisation ), isa prakAra giranA ki mUtramArga meM coTa lage, mUtrAzmarI Adi bhI ho sakate haiM / prasaMgAt hama yahA~ para hI puraHstha granthipAka kA varNana bhI kie dete haiM / puraHsthapranthipAka (Prostitis ) puraHsthagranthi ko aSThIlA granthi bhI kahate haiM / puraHsthagranthi ke pAka ke tIvra aura jIrNa donoM prakAra milate haiM / isa pAka kA pradhAna kAraNa uSNavAta golANu hotA hai para jIrNa prakAra meM uSNavAta golANu mara jAtA hai aura usakA sthAna pUyajanaka daNDANu jinameM AntradaNDANu pramukha hai le lete haiM / tIvra puraHsthagranthipAka meM vraNazothaprasekI yA sapUya kisI bhI prakAra kA ho sakatA hai / yadi sara pUyana ( diffuse suppuration ) huA to granthi meM vidradhibhavana hotA hai jisake kAraNa granthi kA bahuta sA aMza naSTa ho jAtA hai aura basti, mUtramArga, malAzaya yA mUlapITha ( perineum ) meM chidraNa hokara pUya baha nikalatA hai / yadi mUlapITha yA pAyUpasthayorantarAla meM chidraNa huA to gudakaukundarakhAta ( ischio-rectal_fossa ) meM kozotipAka ( cellulitis ) hotA huA bhI dekhA jAtA hai / jIrNapuraH sthagranthipAka meM jaba ki usakA bhI kAraNa uSNavAtika golANu hotA hai to granthi meM prasara tantUtkarSa tathA lasIkozA bharamAra bahutAyata se dekhe jAte haiM / granthi kaThina dvaMhaNa tathA sikur3I huI athavA pravRddha dekhI jAtI hai / puraHsthagranthi kI sAdhAraNa vRddhi meM jIrNopasarga ke lakSaNa dekhe jA sakate haiM sthAna sthAna para lasIkozAoM kI bharamAra mila sakatI hai, kahIM kahIM bahunyaSTirakozA bhI pAye jA sakate haiM / yahA~ uSNavAtagolANu kA koI bhI bhAga roga kAraNa meM na hokara antradaNDANu yA anyapUyajanaka rogANuoM kA hI bhAga dekhA jAtA hai / puruSaprajananAMgoM para vraNazotha kA pariNAma vRSaNapAka ( Orchitis ) karNamUlagranthipAka ke vinA vRSaNapAka bahuta kama dekhA jAtA hai kyoMki adhivRSaNikA ( epididymis ) meM jo tIvra pAka ho jAtA hai vaha prAyaH vRSaNagranthi taka nahIM pahu~catA / vRSaNoM kI sUjana AghAta ( trauma ) ke kAraNa jaise khelane meM pAdAghAta ( kick ) hone para hotI huI bahudhA dekhI jAtI hai / isake kAraNa vRSaNagraMthi zUla hotA hai tathA usakA AkAra bar3ha jAtA hai / AghAtajanya vraNazotha upazama bahuta zIghra hone lagatA hai, kabhI kabhI upazama na hokara apoSakSaya ( atrophy ) bhI hotA huA dekhA jAtA hai / For Private and Personal Use Only

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162 vikRtivijJAna karNamUlagranthipAka ( mumps ) ke sAtha jaba vRSaNapAka hotA hai usa samaya vRSaNagranthi meM zUla hotA hai vaha phUla jAtI hai parantu usameM pUyotpatti nahIM hotii| usameM lasIkozAoM kI bharamAra ho jAtI hai jisake uparAnta tantUtkarSa hokara apoSataya ho jAtA hai jo vandhyAtva vA klaibya ( sterility ) kA kAraNa banatA hai| yaha roga prAyaH eka granthi meM hotA hai na ki donoM vRSaNagranthiyoM meM isa kAraNa pUrNataH klaibya nahIM miltaa| taruNoM meM karNamUlagranthipAka ke sAtha vRSaNapAka milatA hai parantu zizuoM yA bAloM meM vaha utanA nahIM miltaa| vRSaNapAka bhUmadhyasAgarIya jvara ( undulant fever ) athavA Antrika jvara (typhoid fever ) ke sAtha sAtha bhI upadravasvarUpa dekhA jA sakatA hai| phiraMga ke kAraNa hone vAle vRSaNapAka kA varNana phiraMga prakaraNa meM hogaa| adhivRSaNikApAka ( Epdidymitis) adhivRSaNikA meM, uSNavAtIya golANu (gonococci ), pUyajanaka golANu (pyogenic cocci ) athavA AntradaNDANu (B. coli ) ke dvArA vraNazotha ho sakatA hai| ye tInoM yA to pazcamUtramArga dvArA yahA~ taka pahu~cate haiM yA raktadhArA unheM yahA~ lA paTakatI hai| ina tInoM meM uSNavAtIya golANuoM dvArA utpanna adhivRSaNikA pAka bahuta adhika dekhA jAtA hai| isI kA varNana hama Age karate haiN| kisI vyakti ko jaba uSNavAtIya upasarga laga jAtA hai taba usake 2-2 // mAsa pazcAt adhivRSaNikAoM meM pAka prArambha hotA hai yaha pAka sadaiva pUyAramaka hotA hai| uSNavAtIya adhivRSaNikA pAka kI tIvrAvasthA eka yA do saptAha taka rahatI hai| sarvaprathama usakI puccha (globus minor ) prabhAvita hotI hai| vRSaNa sUja jAte haiM unameM zUla hone lagatA hai parantu jaisA ki Upara likhA jA cukA hai vRSaNagranthiyA~ usase aprabhAvita rahatI haiN| zukravAhiniyoM ( vasa deferens ) ke adhicchada ko bahuta hAni pahu~catI hai isake kAraNa rogazamana vraNavastUtpatti ke sAtha hotA hai, vraNavastu ke saMkoca karane para unake suSiraka mur3a jAte haiM jisake kAraNa retovahana meM gar3abar3a ho jAtI hai aura pariNAmasvarUpa klaibya ho sakatA hai| parantu yaha upasarga bhI ekapArzvika (unilateral ) hotA hai jisake kAraNa pUrNa klaibya nahIM ho paataa| pUyotpatti zukravAhiniyoM taka hI sImita rahatI hai aura samIpastha UtiyoM meM nahIM phailatI jisake kAraNa itastataH bahunyaSTikozAoM kA samUhana ho jAtA hai para koI nizcita vidhi nahIM bntii| tIvrAvasthA vyatIta hone para jIrNAvasthA prArambha hotI hai jo varSoM rahatI hai| tantUtkarSa isa avasthA kA pradhAna lakSaNa hai jisake kAraNa uti kA zanaiH zanaiH kramika vihAsa hotA rahatA hai| yadi sAtha meM aNDadharapuTaka ( tunica vaginalis ) kA prakSobha hotA rahatA hai to vraNazothAtmaka mUtrajavRddhi yA muSkavRddhi ( hydrocele ) ho sakatI hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 163 uSNavAtIya adhivRSaNikApAka ke atirikta anyajIvANuoM se hone vAle pAka meM samIpastha UtiyoM taka upasarga pahu~ca kara vidradhi utpanna kara sakatA hai| usameM se tIna vraNa pAka ke lakSaNa yadA kadA uTha par3ate haiN| yahA~ tIvrAvasthA bahuta kAla taka rahatI hai na ki uSNavAtopasarga kI bhA~ti zIghra samApta hotI ho yahA~ bhI puccha se hI rogotpatti hotI hai tathA upazama tantUtkarSa pradhAna hotA hai / strIprajananAGgoM para vraNazotha kA pariNAma bIjakoSapAka ( Oophoritis) bIjakoSoM ( ovaries ) meM upasarga 2 mArgoM se pahu~catA hai eka to raktadhArA dvArA jo karNamUlika jvara, pUyaraktatA tathA manthara jvara meM dekhA jAtA hai aura dUsarA bIjavAhinI ( uterine or fallopian tube) dvArA jo prasUtijvarakArI tathA uSNavAtIya upasargoM meM dekhA jAtA hai / tIvra bIjakoSapAka meM bIjakoSapravRddha raktavarNIya aura zothayukta ho jAtA hai unake bhItara nIlohAMkita raktasrAva hote hue dekhe jAte haiN| yadi unameM pUyana hotA hai to pUya ke pIta vindu yA pIta rekhAe~ itastataH bikharI huI dekhI jA sakatI haiN| kabhI kabhI kisI AdhmAta syUnikA ( distended follicle ), pItapiNDa ( corpus luteum ) yA pIta koSTha ( latein cyst ) upasraSTa ho jAtA hai jisake kAraNa bIjakoSa meM vidradhibhavana ho jAtA hai parantu aisI vidradhi sadaiva sImita hotI hai| para jaba bIjavAhinI dvArA upasarga jAtA hai to kabhI kabhI itanI adhika vIjavAhinI meM pUyotpatti hotI hai ki vaha pUyakoSa (pyovarium) hI bana jAtA hai| bIjakoSa aura vAhinI donoM eka dUsare se itane saTa jAte haiM ki bIjakoSavAhinyavidhi ( tubo-ovarian abscess ) hI usa vidradhi kA nAma ho jAtA hai| aisI vidradhiyA~ udaracchadaguhA (peritoneal cavity )meM Akara phaTatI haiM aura sAmAnya udaracchada kalApAka kA kAraNa banatI haiN| ve kabhI kabhI basti meM yA guda meM yA udara kI agra prAcIra meM bhI phaTa sakatI haiN| jIrNa bIjakoSapAka tIvra yA anutIvra vraNazotha ke pariNAmasvarUpa huA karatA hai aura usameM bIjakoSa meM tAntava vraNavastu kA nirmANa hone lagatA hai| bIjakoSoM kA kucha AkAra bar3ha jAtA hai aura usakA dharAtala gA~Tha-gaThIlA ho jAyA karatA hai| yaha avasthA utanI nahIM AtI jitanI ki jIrNa paribIjakoSapAka (perioophoritis) kI dekhI jAtI hai| usameM vraNazothAtmaka pratikriyA upariSTha hotI hai tathA bIjakoSa bIjavAhinI, zroNiprAcIra yA pakSabandhanI snAyu ( broad ligament ) se tAntava abhilagnoM ke dvArA ba~dha jAtA hai| bahudhA vraNazothAtmaka parivartana isa roga meM bahuta kama milate haiM aura isI kAraNa yaha bhI vicAra uThatA hai ki jo tantUtkarSa yahA~ hotA hai vaha vraNazothAtmaka hai yA vihAsAtmaka ( due to involution ) jaisA ki jIrNa antaH garbhAzayapAka yA jIrNa stanapAka meM dekhA jAtA hai| bIjakoSoM meM kitane hI For Private and Personal Use Only

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164 vikRtivijJAna kSudra koSThaka milate haiM jaise ki stanapAka ke sAtha dekhe jAte haiN| ye koSThaka ( cysts). bIjagranthi yA bIjakoSa ke dharAtala se uThate hue se dikhAI par3ate haiM aura unakA AkAra makoya ke phala se adhika bar3A nahIM hotaa| ye koSTaka bIjasyUnikAoM (gra. ffian follicles ) ke avidArita rahane ke kAraNa utpanna hote haiM, unameM eka prakAra kA svaccha tarala bharA rahatA hai aura tarala para paryApta Atati ( tension ) rahatI hai| bIjavAhinIpAka (Salpingitis ) bIjavAhiniyoM meM tIvra evaM jIrNa do prakAra ke pAka ho sakate haiM / mukhya pAkakArI jIvANu uSNavAtIya golANu hotA hai| usake kAraNa kama se kama 50 pratizata bIjavAhinIpAka hotA hai| anya kArakoM meM yakSmA daNDANu, pUyajanaka golANu, Antra daNDANu Adi Ate haiN| kucha pAka prArambha meM uSNavAtIya golANujanya hote haiM tathA bAda meM yaha golANu mara jAtA hai aura phira pUyajanaka yA AntradaNDANu unake sthAna para pAka ke kAraNa bana jAte haiN| kabhI kabhI bAlAoM kI yoni meM hokara phuphphusa golANu praveza karake bIjavAhinI pAka karatA huA phuphphusagolANvika udaracchadapAka kara detA hai yaha bhI smaraNa rahanA Avazyaka hai| uSNavAtIya golANu (pramehANu) kA upasarga garbhAzayapiNDa kI zleSmalakalA se sIdhA lagatA hai| mAlAgolANu yA to prasUti kAlIna dUSakatA ke kAraNa sIdhe athavA lasIkAvahAoM dvArA yahA~ pahu~cate haiN| kabhI kabhI khAsa kara yakSmA tathA pUyajanaka jIvANuoM ke upasarga kA mArga udaracchadaguhA (peritoneal cavity ) se bIjavAhinI ke puSpita prAnta ( osteum of the tube ) dvArA hotA hai yaha upasargakArI avarohI mArga hai jaba ki pahale ArohI ( ascending ) mArga rahe / yakSmA ke prasAra kA eka mArga rakta dvArA bhI hai| uSNavAtaja upasarga aura strIprajananAGga isase pUrva ki uSNavAtIya bIjavAhinI pAka kA varNana kiyA jAya yaha asthAnIya nahIM hai ki hama uSNavAtIya upasarga (sujAka ) ke prasAra kA thor3A jJAna prApta kara leN| puruSoM kI bhAMti striyoM meM uSNavAta kA upasarga maithuna ke kAraNa AtA hai| jaba koI strI kisI sujAka se pIDita puruSa ke sAtha sambhoga karatI hai to use yaha upasarga prApta hotA hai / choTI choTI bAlikAoM meM yaha upasarga dUSita upakaraNoM ke yonimArga meM praviSTa karane se yA sujAkagrasta puruSoM ke dvArA balAtkAra karane para laga sakatA hai| bAlikAoM ke bAhya prajananAGga sUja jAte tathA paka jAte haiM tathA tIvrAvasthA meM zleSma pUyIya srAva nikalane lagatA hai| yonipAka (vaginitis) unako ho jAtA hai parantu yonidvAraka granthiyA~ ( bartholin's glands ) upasarga se baca jAtI haiM / yuvatiyoM meM bAhya prajananAGgoM kA zalkIya adhicchada bAlikAoM kI apekSA upasarga kA adhika pratirodha karatA hai isa kAraNa prArambha meM upasarga ke kAraNa tIna mUtranAlapAka (acute urethritis) ho jAtA hai tathA kabhI kabhI parimUtranAlIya vidradhi ( peri urethral abscess ) bhI bana sakatI hai| yonidvAraka granthiyoM meM bhI upasarga zIghra hI For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 165 pahu~ca jAtA hai vahA~ para bhI vidradhi bana jAtI hai / kabhI kabhI upasarga garbhAzayagrIvA ( cervix ) taka pahu~ca jAtA hai / bAlikAe~ hoM yA yuvatiyA~ donoM meM tIvrAvasthA taba taka alpakAlIna hotI hai jaba taka koI aura upasarga na vahA~ pahu~cAyA jaave| aisA hone para upasarga jIrNAvasthA ko prApta ho jAtA hai / isa avasthA meM upasarga kA kSetra garbhAzayagrIvA ke samIpa pahu~ca jAtA hai tathA bAhya prajananAGgoM ke samIpa se haTa jAtA hai sAtha meM jIrNa mUtranAlapAka calatA raha sakatA hai parantu vaha puruSoM kI taraha striyoM meM mUtranAla saMkoca nahIM karatA / bAlikAoM tathA yuvatiyoM meM uSNavAtIya garbhAzaya grIvApAka (cervicitis) kI tIvrAvasthA alpakAla taka rahatI hai aura phira vaha jIrNAvasthA meM pariNata ho jAtI hai / garbhAzayagrIvA kAnAla meM sthita granthiyoM meM upasarga sthita ho jAtA hai jisake kAraNa antaH yaivapAka ( endocervicitis ) hotA hai, garbhAzayagrIvA sthUlita ho jAtI hai jisakA hetu vraNazothAtmaka zotha hotA hai tathA usase pUyIya strAva nikalane lagatA hai / grIvAmukha para zalkIya adhicchada kA vizalkana hone upariSTha vidradhibhavana yA graiva aparadana ( cervical erosion ) isa aparadana ke kAraNa vahA~ para stambhakAra adhicchada bana jAtA hai jo granthiyoM kI praNAliyoM ke dvArA banAyA jAtA hai aura vahIM se phailatA hai / Age jIrNAvasthA prArambha hone para granthiyoM kA paramacaya (hyperplasia ) hone lagatA hai aura nimna 4 parivartana dekhane ko milate haiM :: lagatA hai jo vahA~ utpanna kara detA hai / 1. pratyArakSaNakoSTikAoM kI nirmiti (formation of retention cysts) 2. garbhAzayagrIvA kA tAntavikasthUlana ( fibrotic thickening of the cervix) 3. hrasvagolakozIya bharamAra ( small round cell infiltration ) 4. zleSma pUyIya srAva ( muco-purulent discharge ) garbhAzayagrIvApAka kucha kAla taka rahane ke uparAnta yA to maithuna kriyA se athavA mAsika dharma kI pravRtti se jaba yaivakAnAla kA mukha khula jAtA hai to upasarga ArohaNa karake garbhAzaya meM praveza karatA hai / uSNavAtIya garbhAzayAntaH pAka (gonorrhoeal endometritis) garbhAzaya ke anta meM bahuta bar3e parivartanoM kA janaka nahIM hotA / upasarga vahA~ sthita granthiyoM meM samA jAtA hai aura vahA~ se anya gambhIra bhAga meM sthita granthiyoM taka calA jAtA hai jisake kAraNa una granthiyoM se pUyAtmaka srAva hone lagatA hai / gambhIra garbhAzayIya granthiyoM meM upasthita upasarga ke kAraNa garbhAzayapAka (metritis ) ho sakatA hai| jisake kAraNa upasarga garbhAzaya kI prAcIroM meM vraNazotha utpanna karane meM samartha ho jAtA hai / usakI tIvrAvasthA alpakAlika hotI hai phira vaha jIrNAvasthA meM pariNata ho jAtI hai / yaha smaraNIya hai ki bAlikAoM meM mAsikadharmacakra ke pravartita For Private and Personal Use Only

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166 vikRtivijJAna na hone ke kAraNa garbhAzayapAka nahIM hotA aura na unakI bIjavAhiniyA~ hI vraNazotha se vyathita ho pAtI haiM / bIjavAhiniyoM para uSNavAta kA prabhAva ( yuvatiyoM meM ) vizeSataH dekhA jAtA hai / tIvra uSNavAtIya bIjavAhinIpAka ( acute gonorrhoeal salpingitis ) kA prArambha sahasA hotA hai tathA pracaNDagati se hotA hai sAtha meM jvara, kampa ( rigor ), audarika kAThinya ( abdominal rigidity ) tathA zUla nAmaka lakSaNa calate haiM / upasarga ke prArambha hone ke kaI saptAha pazcAt yaha vikAra utpanna hone ke kAraNa cikitsaka ko bhrama ho sakatA hai ki ye lakSaNa kisI anya udara roga ke utpanna hone ke pUrvasUcaka haiN| donoM bIjavAhiniyA~ eka sAtha prabhAvita hotI haiM, donoM meM upasarga pahu~cane kA mArga sIdhA hotA hai jo garbhAzaya se calatA hai aura upasarga kA kAraNa mAsikadharmacakra yA maithunakriyA ina donoM meM se koI hotA hai kyoMki ina donoM kAraNoM se bIjavAhinI kA garbhAzayIya mukha khulatA hai / autika dRSTi se eka tIvra pUyika vraNazotha kA spaSTa citra prakaTa ho jAtA hai| jisake kAraNa bIjavAhinI kA suSiraka eka prakAra ke pUyIya srAva ke kAraNa bhara jAtA hai / bIjavAhinI kI zleSmalakalA para usI prakAra sarvAdhika prabhAva par3atA hai jisa prakAra puruSamUtranAla para par3atA hai / arthAt eka hI AkramaNa se zlepmalakalA meM vidradhibhavana ( ulceration ) ho jAtA hai aura jaba vidradhi kA upazama hotA hai to puruSamUtranAla ke * samAna bIjavAhinI meM bhI saMkoca ( stricture ) ho jAtA hai / bIjavAhiniyoM ke Upara jo udaracchadakalA kA bhAga rahatA hai usameM tanmit udaracchadapAka ho jAtA hai tathA usakI prAcIroM meM vidradhiyA~ utpanna ho jAtI haiM / vasthA kA sthAna jIrNAvasthA le letI hai jisameM kabhI kabhI tIvrAvasthA ke pravega ( exacerbations ) Ate rahate haiM jisake kAraNa raha-raha kara zUla tathA saumyarUpa meM anya lakSaNa dekhe jAyA karate haiM / bIjavAhiniyoM ke puSpitaprAnta ( osteum ) kA dvAra banda ho jAtA hai kyoMki usakI bIjakulyA (fimbria ) saMkucita hokara abhilagna (saMsakta) ho jAtI hai jisake kAraNa bIja yA Dimba bIjavAhinI meM praviSTa nahIM ho pAtA aura strI vandhyA ho jAtI hai| bahudhA sujAka grasta striyoM ko eka bAlaka hone ke pazcAt phira koI bAlaka utpanna na hone kA pradhAna kAraNa unakI bIjavAhiniyoM ke dvAroM kA banda ho jAnA hI hai / bIjavAhiniyoM meM saMkoca ho jAne se vraNazothAtmaka jo pUya vahA~ banatA aura bar3hatA rahatA hai usake nikalane ko koI mArga nahIM milatA jisake kAraNa bIjavAhinI pUya se - ThasAThasa bhara jAtI hai aura usakA dUrastha bhAga caur3A hojAtA hai taba use sapUya bIjavAhinI (Pyosalpinx) kahate haiN| uSNavAtIya golANu kucha samaya pazcAt mara jAtA hai aura usameM ajIvANupUya ( sterile pus ) bharA rahatA hai | usakA punarupasarga AntradaNDANu aura svarNa puMjagolANu ( staphylococcus aureus ) ina donoM meM se kisI se bhI ho sakatA hai| tIvrAvasthA meM hI kabhI kabhI bIjavAhinI meM se pUya For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva kA cyAvana hokara udaracchadaguhA meM pUya pahu~ca kara uSNavAtIya udaracchadapAka (gonococcal peritonitis) hotA huA dekhA jA sakatA hai / yadi upasarga thor3A huA to udaracchadapAka sthAnika hotA hai anyathA usI se sarvasAmAnya udaracchadapAka ho sakatA hai vaise vaha zroNistha udaracchada taka hI sImita rahatA hai| yaha udaracchadapAka tantvimat ( fibrinous ) prakAra kA hotA hai jisameM pUyana bahuta kama hotA hai parantu usakA tAntavIbhavana ho jAtA hai jisake kAraNa zroNistha sampUrNa aMga eka dUsare se abhilagna ho jAte haiN| tantvimata puMja ke bhItara kabhI kabhI vidradhiyA~ bhI bana jAtI haiN| ___ kabhI kabhI puSpitaprAnta kI bIjakulyA bIjakoSa se hI abhilagna ho jAtI hai aura isa kAraNa usakA mArga banda ho jAtA hai| yadi yaha abhilAga kisI pItapiNDa ( corpus luteum) yA syUnikA (follicle ) ke sAtha huA to upasarga bIjakoSa ke antarAla taka praviSTa ho jA sakatA hai jisake kAraNa kulyAkoSIya vidradhi ( tubo ovarian absecess ) bana sakatI hai| isa vidhi ke kAraNa bIjakoSa sampUrNatayA vinaSTa ho sakatA hai athavA vahA~ tantUtkarSa hokara usakI kriyAzakti pUrNataH samApta ho jAtI hai| ____ kabhI-kabhI jaba upasarga kI gati adhika pracaNDa na hokara saumya hotI hai taba pUya dhIre-dhIre punaSita ho jAtA hai aura eka jIrNa prasekI vraNazotha (chronic catarrhal inflammation ) raha jAtA hai jisake kAraNa bIjavAhinI ke suSiraka meM svaccha tarala saMcita hotA rahatA hai| vAhinI ke mArga banda hote haiM isa kAraNa isa tarala ke bar3hane se sodaka bIjavAhinI (Hydrosalpinx ) bana jAtI hai| vAhinI (yA kulyA) ke samIpAnta ( distal end ) kI apekSA dUrasthabhAga ( proximal end ) meM usakA visphAra adhika hotA hai| vAhinI vraNazothAtmaka abhilAgoM ke kAraNa iMTha jAtI hai aura thor3hI mur3a bhI jAtI hai jisake kAraNa vaha vakabhANDAkAra ( retort-shaped ) ho jAtI hai| usakI zleSmalakalA cipiTita aura apuSTa ho jAtI hai usake aMkurita agra baiTha jAte haiM, usakI prAcIreM bahuta patalI ho jAtI haiM aura isa avasthA ko sodaka bIjavAhinI asaMyukta ( Hydro Salpinx simplex ) kahate haiM / eka dUsarA prakAra sodaka bIjavAhinI syUnikIya ( Hydro Salpinx follicularis) kahalAtA hai usameM vAhinI meM aneka khaNDikAe~ dekhI jAtI hai isameM zleSmalakalA kI valiyA~ ( rugae ) phaila kara aura tanakara eka dUsare se milakara aneka vibhAga banA detI haiM jinameM tarala bharA rahatA hai| tarala svaccha hotA hai para usameM kucha sitakozA bhI mila sakate haiM usakA ApekSika ghanatva kama hotA hai usameM thor3I zukli bhI mila sakatI hai| sodakabIjavAhinI kA Adheya ( contents ) ajIvANuka hotA hai para kabhI-kabhI AntradaNDANu yA anya rogANuoM ke dvArA dUSita bhI ho sakatA hai| isa cirakAla se vraNazothamaya vAhiniyoM kI visphArita prAcIroM se kabhI-kabhI For Private and Personal Use Only

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168 vikRtivijJAna raktasrAva ho jAtA hai aura taba ve sazoNa bIjavAhinI (Haemato Salpinx ) kahalAtI hai| usa samaya rogI kI dazA atyanta zocanIya ho jAtI hai aura zastrakarma paramAvazyaka ho jAtA hai| jIrNa bIjavAhinIpAka kA upazama tantUtkarSa ke dvArA hotA hai jisake kAraNa vAhinI prAcIravyAkRSTa (distorted ) aura sthUlita ho jAtI hai| zleSmalakalA ke kucha bhAga tAntavaprAcIra meM khiMca jAte haiM jisake kAraNa gA~Tha gaMThIlA sthaulyarUpa (nodular thickening of adenomatous appearance) dekhA jA sakatA hai jaisA ki jIrNa pittAzayapAka meM pittAzaya kI prAcIra meM milatA hai| yaha bIjavAhinI ke usa bhAga meM hotA hai jahA~ vaha sarvAdhika saMkucita hotI hai ( isthmic part ) usake pezIya bhAga kA bhI sthUlana ho jAtA hai jisake kAraNa isameM aneka adhicchadIya kAnAle (epithelial canals ) banane lagatI haiM isakA mukhya vAhinI kAnAla se koI sambandha nahIM rahatA aura aisA lagatA hai ki mAno yaha eka navavRddhi ( neoplasm) ho| isa avasthA ko saMyogasthalIya gaNDa bIjavAhinIpAka (Salpingitis isthumica nodosa) kahate haiM / yaha prAyazaH uSNavAtika hotA hai parantu yakSmAjanya yA anuSNavAtIya bhI mila sakatA hai| pUyajanaka bIjavAhinIpAka (Pyogenic Salpingitis) jo anuSNavAtIya hotA hai usameM zleSmalakalA ko utanI hAni nahIM pahu~catI balki vaha vAhinI prAcIra meM kozotipAka ( cellulitis ) kara detA hai| aNvIkSaNa para vraNazothAtmaka parivartana pezIya bhAga meM adhika milate haiM na ki zleSmalakalA meM isalie isake kAraNa adhika AghAta nahIM hotA aura na adhika tantUtkarSa hI hotA hai / garbhAzaya ke pAka bAlikAoM kI apekSA taruNiyoM meM, garbhAzaya para vraNazotha kA prabhAva honA eka sarvasAmAnya ghaTanA hai / vraNazotha ke sthAna vizeSa para prabhAva DAlane se usake bhinna-bhinna nAma ho jAte haiN| jaba pAka garbhAzaya grIvA meM hotA hai to use praivapAka (Cervicitis) kahate haiM, jaba garbhAzaya ke antacchada meM hotA hai to use garbhAzayAntaHpAka yA antaHgarbhAzayapAka (Endometritis) kahate haiM; jaba pAkasya sthAna garbhAzaya pezI hotI hai to use garbhAzaya pezIyapAka ( Metritis) kahate haiM; jaba garbhAzaya prAcIra ke bAharasthita abaddha yojI Uti ( loose connective tissue ) meM pAka hotA hai to use parAgarbhAzayapAka ( Parametritis) kahate haiM; tathA jaba pAka garbhAzaya ko DhaMkane vAlI udaracchadakalA meM hotA hai to use parigarbhAzayapAka ( Perimetritis ) khte| garbhAzaya ke jina vibhinna pAkoM kA nAmollekha kiyA gayA hai ve tIvra aura jIrNa donoM prakAra ke huA karate haiN| tIvra upasargoM kA kAraNa prasavakAlIna dUSakatA yA garbhasrAvoparAnta hone vAlI dUSakatA hotI hai| jIrNa upasargoM kA pramukha hetu uSNavAtIya golANu hotA hai tathA jise jIrNa garbhAzayAntaH pAka kahA jAtA hai vaha kaI vidvAnoM kI dRSTi meM upasargajanita nahIM hotaa| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 'aba hama Age garbhAzayAntaHpAka kA varNana kareMge / prasUtika garbhAzayAnta. pAka -- agarbha garbhAzaya (Non pregnant uterus) uSNavAta garbhAzayAntaH pAka ke atirikta anya kisI prakAra kA pAka prAyaH nahIM dekhA jAtA vaha bhI dUSita upakaraNa praveza ke kAraNa hI sambhava hotA hai / parantu prasavoparAnta dUSakatA lagane ke kAraNa garbhAzayAntaHpAka bahuta adhika dekhe jAte haiM / unameM bhI jo pAka zoNAMzimAlAgolANuoM dvArA hotA hai vaha sarvAdhika ghAtaka hotA hai / nimna anya rogANu bhI garbhAzayAntaHpAka meM bhAga le sakate haiN| : 166 zoNaharitamAlAgolANu, avAtajIvIyamAlAgolANu (anaerobe streptococci) puMjagolANu, uSNavAtagolANu AntradaNDANu, vAtajanaprAvara gadANu ( clostridium perfringens ) For Private and Personal Use Only ina rogANuoM kA pravezamArga yoni dvArA upakaraNa praveza yA aMguli praveza dvArA hotA hai jaba ki praviSTita vastuoM kA ThIka prakAra ajIvANukaraNa nahIM kiyA jAtA / eka dUsarA mArga aparA kA Atmajanita ( antogenous ) bhI ho sakatA hai jabaki strI ke zarIra meM kahIM koI dUSIkendra hone para vahAM se rakta ke dvArA upasargakArI jIvANu aparA taka pahu~ca kara nija dUSaNa kA prabhAva DAlate hue pAka kara dete haiM / usa samaya aparA meM upasarga sthAnasImita ( localised ) rahatA hai / para aparA prasavoparAnta eka rakta se paripUrNa aisA kSetra bana jAtA hai jisakI vAhiniyAM to arratarSa ke kAraNa banda ho jAtI haiM parantu jahAM sar3ana prArambha hone lagatI hai / yaha avasthA rogANuoM ke lie sarvottama hone ke kAraNa ve vahAM pahu~cakara prAsUtika upasarga kara dete haiM / yaha upasarga bhI 2 prakAra kA hotA hai eka sImita aura dUsarA prasara / sthAnasImitaprakAra meM upasargakArI jIvANu saumyasvarUpa ke hote haiM aura upasarga bhI aparA ( placental site ) ke eka bhAga meM rahatA hai parantu yahA~ jo viSiyA~ banatI haiM ve rogI ke rakta dvArA zarIra meM pahu~catI haiM jisake kAraNa pUtiraktatA ( sapraemia yA toxaemia ) utpanna ho jAtI hai / aparA aura garbhadharAkalA (decidua) ke avaziSTa bhAgoM ke sar3ane se eka durgandhita srAva ( fetid discharge ) nikalane lagatA hai / prabhAvita kSetra Aharita aura mRta ho jAtA hai / isa kSetra ke pIche sitakozAoM aura tantvi kA eka AvaraNa upasarga ko gaharA jAne se roke rahatA hai phira bhI garbhAzaya phUla jAtA hai tathA usakI pezI meM zotha A jAtA hai / vaha zlatha (flabby) ho jAtA hai aura usakA AkAra bar3ha jAtA hai / isake kAraNa prasavoparAnta svAbhAvikarItyA jo saMkocana aura antarvalayana ( involution ) honA cAhie vaha nahIM ho paataa| isI kAraNa jaba mRtaUti anta meM garbhAzayAt pRthak hotI hai to bhI garbhAzaya kA vraNana calatA rahatA hai / kucha bhI ho isa prakAra se piNDa chur3Akara rogI svastha ho jA sakatA hai| prasaraprakAra meM jahA~ ki atIva ghAtaka mAlAgolANuja upasarga upasthita rahatA hai aparA kSetra meM vraNazodhakArI vikSata bahuta kama dekhe jAte haiM / yahA~ to rogANu sIdhe 15. 16 vi0 .

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170 vikRtivijJAna raktavahAoM meM praviSTa hokara raktadhArA dvArA aneka dizAoM meM phailA diye jAte haiM jisake kAraNa eka sAmAnyita rogANuraktatA (generalized septicaemia ) utpanna ho jAtI hai jo rogI ko zIghra mAra letI hai| jaba roga kama ghAtaka hotA hai to eka patalA pUyIya raktaraMjita srAva bhI pragaTa hotA hai jisameM asaMkhya mAlAgolANu bhare hote haiN| unake kAraNa pUyaraktatA yA tIvra rogANvikahRdantaHpAka ho jAtA hai jisake kAraNa mRtyu avazyambhAvI ho jAtI hai / isa roga kA eka dUsarA pariNAma taba hotA hai jaba yA to garbhAzayaprAcIra ko bhedakara yA bIjavAhinI meM hokara athavA lasavahAoM ke dvArA upasarga udaracchadakalA taka pahu~ca kara usameM pAka prArambha karake mRtyu kA kAraNa banatA hai / isI roga meM yadi garbhAzaya kI sirAoM kA avalokana kiyA jAve to unameM rakta ke AtaMca milate haiM jinheM bar3I saralatA se tor3A jA sakatA hai ve jaba raktadhArA dvArA jAte haiM to phuphphusa meM RNAsraNa (infarction) kara dete haiN| duSTiyukta (septic) aneka RNAtra zarIra ke vibhinna aMgoM meM milate hue dekhe jAte haiM yahA~ taka ki adhivRkkoM ( adrenals ) tathA poSaNikAgranthi ( pituitary gland ) meM bhI ve dekhe gaye haiN| Age cala kara yadi rogI baca gayA to avaziSTa ( residual ) jIrNa garbhAzayAntaHpAka yA jIrNa garbhAzayapezIpAka athavA donoM hI usameM tIvrAvasthA ke uparAnta hote hue dekhe jAte haiN| ___ isa roga meM ghanAsrasirApAka ( thrombo phlebitis) nAmaka upadrava prAyazaH milatA hai : isameM sirAoM meM ghanAsrotkarSa ho jAtA hai| striyoM meM prasavoparAnta aurvI sirA taka jaba yaha ghanAsrotkarSa ho jAtA hai to use zvetapAda ( white leg or phlegmasia alba dolens ) nAmaka roga ho jAtA hai| sirA meM ghanAsra hone se paira kA rakta Age bar3hatA nahIM jisake kAraNa paira meM bahuta sUjana AjAtI hai| isa roga ke kAraNa bahuta hI kama paira kA kotha dekhA jAtA hai| ina ghanAsroM se antaHzalya banakara phuphphusa meM antaHzalyatA ( embolism ) kara de sakate haiM jo tatkAla prANa hara letI hai| yaha phauphphusika antaHzalyatA prAyaH prasava ke dazama divasa para yA usake pazcAt dekhI jAtI hai / prasava ke pazcAt thor3A halakA jvara AtA hai aura rugNA kAlakavalita ho jAtI hai| jaba aise rogiyoM kI mRtyUttara parIkSA kI gaI hai to usakI garbhAzayika sirAoM meM dRr3ha AtaMca mile haiN| zroNi kI UtiyoM meM prasavakAlIna dUSakatA ke kAraNa sthAna-sthAna para vidradhiyA~ banatI huI dekhI jAyA karatI haiN| ye vidradhiyA~ garbhAzaya prAcIra, parAgarbhAzayaUti, yonigudAntarIya sthAlIpuTa (pouch of Douglas) tathA bIjavAhiniyoM meM banatI haiN| kabhI kabhI garbhapAta karAne vAle striyoM kI yoni meM zastrAdi upakaraNoM kA prayoga kara garbha girA dete haiM tathA strI ke komala aMgoM meM zastrAdi ke kAraNa upasarga kA praveza ho jAtA hai| kabhI kabhI to komala garbhAzaya ko cIra kara koI zastra udaracchada kalApAka kara mRtyu kara detA hai / kevala mAtra upasarga kA yathocita upacAra na kiyA gayA to 50 pratizata striyA~ kAlakavalita ho jAtI haiN| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 171 jIrNagarbhAzayAntaHpAka-hama pahale batalA cuke haiM ki jIrNa pAka ke lie upasarga kA honA koI bahuta Avazyaka nahIM / jo yaha jAnate haiM ki garbhAzaya ke antazchada para do nyAsoM ( hormones ) kA prabhAva par3atA hai jinakA nirmANa bIjakoSa meM bIja ke nirmANa ke samaya aura usake paripakva ho jAne ke pazcAt nikala jAne ke bAda syUnikA meM hotA hai tathA ina donoM ke nirmANa kA niyantraNa ziraHstha popaNikA granthi karatI hai; ve ise samajha sakate haiM ki yadi kisI kAraNa prathama strI nyAsarga( oestrin) kI kriyA meM antara AgayA to antazchada kA sthUlana prArambha ho jAtA hai jaisA ki hama svAbhAvikarItyA rajonivRttikAla ( menopause ) meM dekhate haiN| isI nyAsarga meM kharAbI Ane se rajonivRttikAla se pUrva bhI antazchada kA sthUlana ho sakatA hai usakA paramacaya (hyperplasia) dekhA jA sakatA hai / yaha paramacaya jIrNagarbhAzayAntaHpAka hI hai yadyapi isameM garbhAzaya meM DhUMDhane se bhI koI rogANu nahIM milegaa| isake sAtha-sAtha syUnikAoM meM koSThIya parivartana ( cystic changes ) dekhe jA sakate haiM / kevala vahI jIrNa garbhAzayAntaHpAka vaikArikIya ( pathological ) mAnA jAnA cAhie jisameM jIrNa vraNazotha ke spaSTa pramANa upasthita hoN| arthAt 1-antazchada ke saMdhAra ( stroma ) meM lasIkozAoM ke sAtha-sAtha prarasakozA ( plasma. cells) upasthita hoM, 2-tanturuha ( fibroblasts ) yA tAntava Uti kozA pAye jAveM; 3-vAhiniyoM meM sthUlana ho aura abhilopI antardhamanIpAka ( obliterative endarteritis ) bhI ho ( yaha lakSaNa anyatra bhI dekhA jAsakatA hai)| striyoM kA garbhAzaya samaya-samaya para mAsika dharma ke rakta se dhulatA rahatA hai / aura usakA antazchada pratimAsa navIna banatA rahatA hai isa kAraNa usameM bahuta adhika kAla taka upasargakArI prANI nahIM raha sakate isI kAraNa usake antazchada meM jIrNapAka kI kalpanA bhI nahIM kI jA sakatI / parantu yadi garbhAzaya pezI kA jIrNapAka cala rahA ho to isameM jIrNapAka mila sakatA hai| upazlaiSmika arbudoM ke sAtha yaha bhI milatA hai kyoMki unakI zleSmalakalA patalI aura alpapuSTa hotI hai| kabhI-kabhI jaba prasavoparAnta aparA kA pAtana pUrA-pUrA na hokara usake kucha Tukar3e garbhAzaya meM itastataH cipake raha jAte haiM to ve bhI garbhAzayAntaHpAka ke sahAyaka kAraNa bana jAte haiM / rajonivRttikAla meM garbhAzaya kA mAsika saMzodhana banda ho jAne ke kAraNa upasargakArI jIvoM ko vahA~ apanA kArya karane meM bar3I suvidhA aura zAnti milane se bhI yaha roga hotA huA dekhA jAtA hai| jIrNa sapUyagarbhAzayAntaHpAka (pyometra or chronic suppurative endometritis) bhI eka vizeSa roga hai| isameM garbhAzaya kA nicalA mukha kisI arbuda ke kAraNa ruka jAne se usakI guhA meM pUya evaM srAvAdi tarala ekatra hotA rahatA hai use bAhara nikalane kA mArga milatA nahIM hai| isake kAraNa garbhAzaya pUyAzaya ( pyometra ) bana jAtA hai| pUya ke kAraNa garbhAzaya kA antazchada aura usakI For Private and Personal Use Only

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172 vikRtivijJAna pezI ke upariSTa kucha stara vraNita ho jAte tathA naSTa bhraSTa ho jAte haiM / garbhAzaya grIvA ke karkaTa meM yaha prAyaH dekhA jAtA hai / jIrNa garbhAzaya pezIpAka -- yaha vikAra uSNavAta golANujanya hotA hai tathA prasUti dUSakatAkara rogANuoM ke dvArA bhI milatA hai / jaba garbhAzaya prayAzaya meM pariNata ho jAtA hai usa samaya bhI yaha ho sakatA hai| ina saba hetuoM meM garbhAzayAntaHpAka usake sAtha rahatA hai / kabhI kabhI vaha vinA vraNazothakArI jIvANuoM ke bhI ho sakatA hai jaba ki bIjakoSa ke nyAsargoM kI kriyAzIlatA meM bAdhA par3atI hai / isa vyAdhi meM garbhAzaya kI prAcIra tantUtkarSa ke kAraNa sthUlita ho jAtI hai usakI antarAlita Uti meM prarasakozA aura lasIkozA khUba milate haiN| sAtha hI mAsikadharma meM bhI kucha gar3abar3a ho jAtI hai jisake kAraNa atyadhika raktasrAva yA asRgdara bhI milatA hai / I jIrNa graivapAka ( chronic cervicitis ) -- yaha satya hai ki mAsikadharma kI kriyA meM kevala garbhAzayapiNDa kI zleSmalakalA hI bhAga letI hai, garbhAzayagrIvA kI zleSmakalA usameM bhAga nahIM letI isa kAraNa vaha nita navIna bhI nahIM ho pAtI aura sUkSma rogakArI jIvANu saralatA se tathA surakSA ke sAtha usameM nivAsa karate hue dekhe jAte haiN| grIvA meM sthita bar3I bar3I zleSmA granthiyA~ bhI unheM pUrNa saMrakSaNa pradAna karatI haiM / garbhAzayagrIvA meM upasarga 2 prakAra se praveza pAtA hai / eka prakAra hai prasavakAlIna graivika AghAta arthAt jaba garbhAzaya chor3a kara zizu janma letA hai to usake nikalate samaya graivika zleSmalakalA vidIrNa ho jAtI hai jisa para upasargakArI jIvANu saralatayA apanA Asana jamA lete haiM dUsarA prakAra hai uSNavAtaja golANu kI upasthiti / prasavakAla meM garbhAzayagrIvA ke donoM oSTha vivRta ( everted ) ho jAte haiM aura graivAntarIyakAnAla ( endocervical canal ) kA vigopana ( exposure ) ho jAtA hai / praivika zleSmagranthiyoM meM pahale upasarga pahu~catA hai aura vahA~ se zveta zleSmapUyIya srAva nikalane lagatA hai jise hama pradara ( leucorrhoea ) kahate haiM / una granthiyoM ke cAroM ora kI yojI Uti sUja aura phUla jAtI hai (becomes swollen and oedematous ) aura usameM vraNazothakArI kozAoM ( vizeSa karake prarasa kozAoM) kI bharamAra ho jAtI hai / antataH, sampUrNa garbhAzayagrIvA kaThina aura tantvika ( fibrotic ) ho jAtI hai cirakAlIna prakSobha tathA granthiyoM se atyadhika strAva ke kAraNa jaivika aparadana (cervical erosion) ho jAtA hai / graivika aparadana meM garbhAzayagrIvA ke bAhya mukha ke cAroM ora eka lAlakSetra bana jAtA hai jisameM se rakta cUtA rahatA hai tathA use dekha kara maivika karkaTa kA sandeha hone lagatA hai parantu isakA varNa makhamalI ( velvety ) hotA hai tathA chUne para yaha kAphI dRDha ( tough) hotA hai tathA kSodya (friable ) nahIM hotA jaisA ki karkaTa hotA hai / prArambhika avasthAoM meM zalkIya adhicchaMda naSTa ho jAtA hai usameM hasva golakozAoM kI bharamAra ho jAtI hai / usake upariSTa bhAga meM vraNana ( ulceration ) hone lagatA hai 1 For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva jisake sAtha sAtha raktapUrNa kaNana Uti kA nirmANa bhI hotA calatA hai| usa kaNana Uti ke kAraNa dratagati se usake Upara zalkIya adhicchada ke sthAna para eka ucca stambhAkArI adhicchada banane lagatA hai| usakA kevala eka hI stara bhI ho sakatA hai athavA usameM aMkura ( papillary projections ) bhI dekhe jA sakate haiM jinake nIce Age cala kara naI granthiyA~ bhI bana jAtI haiN| anta meM pArthoM se zalkIya adhicchada stambhAkArI adhicchada ke nIce panapane lagatA hai aura ise ukhAr3a pheMkatA hai| jyoM jyoM roga kA upazama hotA jAtA hai granthiyoM taka zalkIya adhicchada calA jAtA hai aura unake mukhoM ko banda kara detA hai yA unheM pUrA pUrA bhara detA hai jisa sabakA pariNAma yaha hotA hai ki jo lAvAdhikya nirantara calatA thA vaha ruka jAtA hai| mukha ke banda ho jAne ke kAraNa kabhI kabhI granthiyA~ apane srAva ke kAraNa bahuta adhika visphArita ho jAtI haiM aura choTe choTe AnIla koSThikIya arbuda banA detI haiM jinheM bAhyagraivakoSThikAe~ ( Nabothian cysts or ovula Nabothi) kahate haiN| ___ jIrNa avapAka kA graiva karkaTa ke sAtha kyA sambandha hai yaha kahanA nitAnta kaThina hai yadyapi isa avasthA ko dekha kara usakA smaraNa ho uThatA hai| ____ strIprajananAGgoM para vraNazotha kA kyA pariNAma hotA hai isakA saMkSiptataH vicAra kara lene ke pazcAt yadi stanoM para vraNazotha ke pariNAmoM kA bhI bodha kara liyA jAve to vaha aprAsaMgika nahIM mAnA jAnA cAhie isI lie hama aba stanapAka kA varNana kahate haiN| FAAT9175 ( Mastitis) tIvrastanapAka-yuvatiyoM meM prasavoparAnta jaba stanoM se dugdha kA srAva hone ko hotA hai usa samaya prArambhika dinoM meM tIvra stanapAka detA jAtA hai usake sAtha pUyana ( suppuration ) bhI ho sakatA hai| parantu yadi sAvadhAnatA se cikitsA kI gaI to pUyotpatti se pUrva hI vraNazotha dUra ho jA sakatA hai| janma ke turanta pazcAt navajAta zizu meM tathA vayaska bAlAoM meM bhI tIna stanapAka dekhA jA sakatA hai| tIvra stanapAkakArI 2 jIvANu mukhyataH hote haiM inameM pradhAna svarNapuMja golANu hai aura gauNa mAlAgolANu / ye jIvANu cUcukapAToM ( nipple cracks ) dvArA, zizu ko dUdha pilAte samaya, stanoM ke samIpa sthita lasIkAvahAoM dvArA stanoM taka pahu~ca kara upasarga kA kAraNa banate haiN| stanoM para vraNazotha ke kAraNa USmAdhikya, zUla, pragaNDatA aura adhiraktatA ke cAroM lakSaNa spaSTataH pragaTa hote haiM / Age calakara jaba isameM pUyotpatti ho jAtI hai jo vidhi bhI bana jAtI hai / samIpastha lasagranthiyA~ sazUla ho kara sUja jAtI haiN| pAzcAtyoM ne stanoM ko bhI prajanana kA hI eka aMga mAnA he :The female breast should be properly regarded as part of the ganerative system, since it is under the same hormonal control as the uterus and goes through similar cycles of hyperplasia and involution, -Green For Private and Personal Use Only

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174 vikRtivijJAna upasarga sadaiva stanoM kI yojI Uti meM apanA prabhAva karatA hai aura usakI nAbhi ( focus ) nimna 3 sthaloM meM se kahIM bhI ho sakatI hai: 1-carmAdhaH ( subcutaneous) 2-antaHstanIya ( intramammary) 3-pazcastanIya ( retromammary ) carmAdhaH upasarga tvacA ke nIce se prArambha hotA hai, antaHstanIya stana Uti kI moTAI meM milatA hai; tathA pazcastanIya stana aura usake nIce sthita mAMsapezI ke bIca ke avakAza meM dekhA jAtA hai| isa tIsarI nAbhi kA kAraNa dUsarI nAbhi ke dvArA hI prasAra se banA karatA hai / arthAt stana ke bhItara upasarga rahate hue usake pIche yA nIce dUSaNa kA kendra sthApita kara detA hai| yadi vidradhiyA~ utpanna huIM to ve inhIM tIna nAbhi-sthaloM meM hI prakaTa hotI haiN| kabhI kabhI tInoM nAbhiyoM para eka sAtha hI vidhiyA~ utpanna ho jAtI haiM aura ve vidradhi pRthak pRthak bhI raha sakatI haiM athavA eka dUsare se saMlagna hokara stanoM kA bahuta adhika vinAza bhI kara sakatI haiN| yadi vidradhiyoM kA pATana na kiyA gayA to ve carma taka pahu~ca kara svataH phaTa jAtI haiN| kabhI kabhI ve vakSaguhA meM yA phuphphusacchadaguhA meM bhI phaTatI haiM para vaisA bahuta kama dekhA gayA hai| jIrNastanapAka-isake 2 prakAra prasiddha haiM: 1. jIrNa upasargAtmaka stanapAka-isakA kAraNa pUyajanaka jIvANu bhI ho sakate haiM aura kavaka ( actinomycosis ) tathA yakSmA daNDANu bhii| kavaka aura yakSmA janya jIrNa stanapAka kA AbhAsa hama unake viziSTa adhyAyoM meM batalAne vAle haiN| pUyajanaka jIvANuoM ke dvArA jaba tIvra stanapAka eka bAra ho jAtA hai aura vaha gaharAI meM rahatA hai to usI se jIrNa upasargAtmaka stanapAka ( chronic infective mastitis) kA udaya hotA hai| tIvAvasthA meM banI vidhi se pUya nikalatA rahatA hai usa vidradhi meM paryApta tantUtkarSa tathA golakozAoM kI khUba bharamAra huI rahatI hai aura usa kSetra kI stanaUti pUrNataH naSTa bhraSTa ho jAtI hai| dhIre dhIre vahAM tAntava uti aura vraNavastu kA nirmANa ho jAtA hai aura sthAna bahuta kaThina ho jAtA hai jise dekha kara stanakarkaTa kA sandeha ho sakatA hai vaha sandeha isalie aura dRr3ha ho jAtA hai ki kakSAstha lasagranthiyoM ( axillary glands ) meM pAka hone ke kAraNa ve pravRddha ho jAtI haiN| 2. jIrNa tanvIya stanapAka ( chronic involutionary mastitis ) isake adholikhita kucha aura bhI nAma haiM a-zimailkhuzAmaya ( schimmelbusch's disease ) A-stanasya tantukoSThIya roga ( fibrocytic disease of the breast) i-jIrNa stanapAka ( chronic mastitis) I-raiklasa vyAdhi ( maladie de R'eclus ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 175 u-jIrNa praguNanAtmaka stanapAka ( chronic proliferative mastitis ) U-jIrNa koSThIya stanapAka (chronic cystic mastitis) e-jIrNa antarAlita UtIya stanapAka (chronic interstitial mastitis) ai-utpAdI stanapAka ( productive mastitis) kitane hI isa vyAdhi ke nAma ho isakA vraNazotha ke sAtha koI sambandha nahIM hai na yaha koI pAka hI hai / isakA sambandha bIjakopIya nyAsoM kI gar3abar3I se hotA hai aura bIji (IsTrIna) ke cayApacaya ( oestrin metabolism ) ke sAtha sambandha hai| kucha isakA sambandha poSaNikA ke stanyapoSi (prolactin) nyAsarga ke sAtha bhI lagAte haiN| ise 'stanapAka' nAma se sambodhita karanA kisI prakAra bhI nyAyya na hone para bhI vaisA cala rahA hai aura hama bhI usI dhArA meM pravAhita hote hue isakA varNana kara rahe haiN| isa roga kI pramukha ghaTanA kA nAma hai praguNana (proliferation ) / jo adhicchada tathA tAntava saMdhAra donoM para prabhAva DAla kara stana kI AkAravRddhi kara detA hai, yaha vRddhi ekIya, nAbhya, bahvIya (bahuvidha ) tathA prasara kisI bhI prakAra kI ho sakatI hai| sparza karane para eka viSamataTIya ( ill-defined ) kaThina loSTa ( hard lump ) ke samAna athavA sampUrNa stana kA golikIya sthaulya ( shotty thickening ) jaisA pragaTa hotA hai| yaha loSTa yA sthUlatA prArambhika avasthA meM bar3I sparzAkSama hotI hai aura yaha sparzAkSamatA kabhI kabhI vizeSa kara RtukAla meM bar3ha jAtI hai| prArambha meM kevala eka hI stana para bAda meM donoM stanoM meM yaha vyAdhi dekhI jAtI hai / loSTa tvacA ke sAtha sambandha nahIM hote tathA nIce kI gambhIra UtiyoM ke Upara ve calanazIla hote haiN| ve utane kaThina bhI nahIM hote jitanA ki stana karkaTa hotA hai| unakA uccheda karate samaya unake vividha svarUpa dekhane ko milate haiM unameM koSTa hote haiM jo prAyaH bahuzAkhIya hote haiM unakA AkAra maTara ke eka dAne se lekara bar3I golikAoM taka kA hotA hai| bAhara se ve nIle lagate haiM unameM paryApta tatiyukta tarala bharA rahane se dabAnA bhI kaThina par3atA hai| yaha tarala svaccha aura ApIta hotA hai nIlA nahIM hotaa| stanapAka kA kSetra prasara hotA hai isI kAraNa usakA prAvarIkaraNa ( encapsulation ) nahIM hotaa| ina koSThoM ke cAroM ora tAntava Uti ke paTTa hote haiM jo sneha Uti meM hokara pratyeka dizA meM jAte haiN| sneha ati bhI bar3ha jAtI hai| ina tAntavIya kSetroM meM paramacayika gANvika ati ( hyperplastic acinar tinssue ) tathA praNAlikIya UtiyoM ke dvIpa pAye jAte haiM jo dhUsaravarNIya sidhmoM ke rUpa meM dekhe jAte haiM kabhI kabhI bahuta se hrasva tantu-granthyarbuda (firbro-adenoma) bhI mila jAte haiN| aNvIkSaNa para, adhicchadIya racanAoM kA paramacaya tathA apoSakSaya donoM ko usI prakAra dekhA jA sakatA hai jaisA ki galagaNDayukta avaTukA meN| kucha kSetroM meM bahuta se gartANu (acini ) bar3ha jAte haiN| kucha anya kSetroM meM garvANuoM kA apoSakSaya For Private and Personal Use Only

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176 vikRtivijJAna (atrophy ) ho jAtI hai tathA unakI praNAlikAeM (ducts ) mAtra hI avaziSTa raha jAtI haiM tanvIyita stanoM kA yaha svAbhAvika parivartana hotA hai| ina praNAlikAoM meM duhare adhicchadIya kozAoM kA stara car3hA hotA hai| sabhI AkAroM ke koSTha bhI dekhane ko milate haiM bar3oM meM adhicchadIya paramacaya ( hyperplasia ) hotA hai aura adhicchada stambhakArI dekhA jAtA hai jisake aMkura andara kI ora jAte hue dekhe jAte haiM / kucha koSThAvakAza aMkurita padArtha dvArA pUrNataH bhare hue bhI milate haiM jaise ki nAbhya paramacaya meM avaTukA ke Azayaka ( vesicles ) bhare hue dekhe jAte haiN| kucha aisA mAnate haiM ki isa adhicchadIya padArtha se mArAtmaka arbuda kA udaya hotA hai| kucha koSThoM ke AstaraNa bar3e, pANDura, amlapriya kAyArasayukta kozA banAte haiM jo vizalkita ho jAte haiM aura unameM snaihika parivartana bhI A jAte haiM / lasIkozAoM kI bharamAra kinhIM sthAnoM meM kama aura kinhIM meM adhika dekhI jAtI haiN| isa bharamAra kA kucha kAraNa to hotA hai paramacayika kSetroM kA antarvalayana yA tanvIyana (involution) aura vaha stanoM ke svAbhAvika antarvalayana ke samaya dekhA bhI jAtA hai / zeSa hetu kenIja ke kathanAnusAra praNAlikAoM meM saMgrahIta srAva ke kAraNa utpanna prakSobha mAnA jAtA hai| isa srAva meM pUyasama, arddhatarala snaihika padArtha rahatA hai jo niHsrAva ke snaihika utpAdoM aura vizalkita kozAoM ke kAraNa taiyAra hotA hai jo ki praNAlikIya adhicchada ke nirantara praguNana ke pariNAmasvarUpa banatA hai| isa roga meM koI bhI viziSTa rogANu stana se bhI abhI taka prApta nahIM kiyA jA skaa| isI kAraNa vraNazotha kA isameM koI mahattvapUrNa hAtha nahIM rahatA aisA mAnA jAtA hai| isameM tAntava Uti kI vRddhi ke kAraNa parikAnAlIya ( pericanalicular ) tantu-granthyarbuda ke samAna AkRtiyA~ prAyazaH dekhI jAtI haiN| yaha praur3hAoM kA roga hai aura jaba unameM hotA hai to yaha prasara tathA ubhayastanIya hotA hai| kinhIM kinhIM navayuvatiyoM meM bhI yaha milatA hai vahA~ yaha sthAnika sidhma kA rUpa letA hai| puruSoM ke stanoM meM jaba yaha hotA hai to unake saMdhAra meM prasara paramacaya milatA hai koSThoM kA nirmANa adhika nahIM dekhA jaataa| yaha kahanA ki yaha stanakarkaTotpatti kI pUrva bhUmikA hai isa samaya kaThina hai kucha vidvAn vaisA mAnate haiM aura bahuta usakA virodha karate haiM / vAtanADIsaMsthAna para vraNazotha kA pariNAma / isase pUrva ki hama vAtanADIsaMsthAna ( nervous system ) para vraNazotha ke pariNAmoM kI carcA kareM hama vAtanADIsaMsthAna kI sAmAnya vaikArikI kA varNana prastuta karate haiM kyoMki binA usakA jJAna kie isa viSaya kA samajhanA kucha durUha ho sakatA hai| ___zarIra kI anya UtiyoM se tulanA karane para hameM vAtanADIsaMsthAna meM kaI dRSTiyoM se kaI vibhinnatAeM dRSTigocara hotI haiM isakI racanA kitanI jaTila hai isakA jJAna taba hotA hai jaba hama usakI yakRt se samAnatA kreN| jina ghaTakoM se yaha saMsthAna For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva banatA hai ve anya zarIrastha ghaTakoM se bahuta bhinna hote haiM tathA ina ghaTakoM kA Apasa meM jaisA sambandha hai vaisA anya kisI saMsthAna ke ghaTakoM meM nahIM dekhA jAtA hai| yadi mastiSka ke kisI bhAga ke abhiraJjita cheda ( stained section ) kA adhyayana kiyA jAve to usameM hameM vividha kozA aura tantusamUha prApta hoNge| ye do bhAgoM meM vibhakta kie jA sakate haiM eka ve jinameM cetaika yA nADIkandANu (neurons) rahate haiM aura dUsare ve jinameM antarAlita Uti (interstitial tissue) milatI hai| cetaka-eka cetaika meM eka cetAkozA (nerve cell) aura usase utpanna kaI pravardha (processes) hote haiN| ina pravarSoM meM se eka akSatantu yA cetAlAMgUla (nerve axon) hotA hai jise vAtanADI tantu kA akSa-rambha (axis cylinder) bhI kahate haiM tathA zeSa pravardha Utantu yA cetAloma (dendrites) kahalAte haiM ina pravarSoM meM se pratyeka vAtanADI (cetA) kozA ke eka koNa meM se nikalatI hai kyoMki aneka pravardha hote haiM ataH cetA kozA meM bhI anekoM koNa dekhe jAte haiM yadyapi abhiraJjita cheda meM 2 yA 3 koNa hI milate haiM usakA kAraNa kozA ke eka hI pRSTha ( plane ) kA vahA~ para dikhAI denA hai yadi dUsare pRSTha se cheda liyA jAtA to anya koNa pragaTa hote / akSa-rambha apane mArga meM kendriya vAtanADIsaMsthAna ( central nervous system ) ke andara vimajikaMcuka ( medullary sheath or myelin sheath) se DhaMkA rahatA hai tathA mastiSka ( brain ) aura suSumnA ( spinal cord ) ke bAhara isa para cetAvaraNa ( neuri. lemma or nucleated sheath of Schwaan) car3hA hotA hai| eka vAtanADI (yA cetA) kozA kI racanA atyadhika jaTila hotI hai / usake kozArasa (cytoplasm) meM eka vizeSa prakAra kI kaNikAe~ (granules ) hotI haiM jinheM prodalenyanIla ( methylene blue ) dvArA abhiraJjita kiyA jA sakatA hai aura unheM prodakaNikA (Nissl granules) kahate haiN| prodakaNikAe~ cetAlomoM taka jAtI haiM parantu akSa-rambha meM nahIM dekhI jAtI haiN| cetaika ke vibhinna bhAgoM para vihAsAtmaka parivartanoM kA jo prabhAva par3atA hai vaha atyanta mahattvapUrNa hai| jaba cetaika ke kisI bhAga para AghAta hotA hai to usake zeSa bhAga para nirantara aura nizcita parivartana dekhe jAte haiN| isa vidhi ke dvArA prANiyoM meM tathA manuSyoM meM bhI AghAtaprApta cetAkozA se nikale kisI cetAtantu ( nerve fibre ) kA mArga DhUMDhA jA sakatA hai aura yaha bhI jJAta ho sakatA hai ki AghAtaprApta cetAtantu kisa cetAkozA se utpanna hotA hai| jaba koI cetAtantu apane utpAdaka cetAkozA se pRthaka kara diyA jAtA hai yA cetAkozA ko hI naSTa kara diyA jAtA hai to usa cetAtantu meM eka viziSTa prakAra kA vihAsa ho jAtA hai jise san 1850 I0 meM vAlara ne batalAyA thA aura jo vAlarIya vihrAsa (Wallerian degeneration) ke nAma se prasiddha hai| isa vihAsa meM tantu ke dUrasthabhAga ke tInoM avayavoM (akSa-rambha, vimajicaJcuka tathA kaJcakanyaSTiyoM) para prabhAva par3atA hai arthAt akSarambha jo ki saMvAhi sAdhitra ( conductiong apparatus) kA Avazyaka aMga hai For Private and Personal Use Only

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178 vikRtivijJAna vaha tAntuka ( fiibrillated ) hokara praphullita ( varicose ) ho jAtA hai tathA anta meM vighaTita ho jAtA hai usake khaNDoM (fragments ) ko bhakSikozA dUra le jAte haiN| vimajikaJcuka vimajji ke vinduko ( droplets of myelin ) meM pariNata ho jAtA hai jo gurvika amla ( osmic acid ) ke dvArA kRSNavarNa ke abhiraJjana se dikhAI dete haiM aura vAtanADIsaMsthAna meM jahA~ taka cetAtantu ko AghAta pahuMcA hai vahA~ taka paha~cAne jA sakate haiN| vimajjikaJcuka kI nyaSTiyoM meM praguNana prArambha ho jAtA hai ve kozA do kArya karate haiM : 1-svacchakIya ( scavenger's work ) jisake dvArA vimajikaJcuka tathA akSa-rambha ke avayavoM ke avazeSoM ko dUra kiyA jAtA hai tathA 2-punarnirmANa ( reconstruction ) jisake dvArA ve eka prakAra kI praNAlI ( tube ) banA lete haiM jisameM hokara akSa-rambha ke samIpAnta se nikale hue cetAtantu punaH Age bar3hate haiN| bajhjhADa aura grInaphIlDa ke kathanAnusAra vihAsa kI prakriyA cupake se punarjananakArIkriyA kI taiyArI karane laga jAtI hai jisake kAraNa cetAkozA yA cetAtantu ke punarjanana kA mArga niSkaNTaka ho jAtA hai / yaha bhI smaraNa rakhanA Avazyaka hai ki vAlarIyavihAsa kA pramukha kAraNa jIvati kha ( vitamin B.) kA zarIra meM abhAva honA mAnA jAtA hai / yaha to hamane kaTe hue cetAtantu ke dUrastha bhAga ( distal end ) kA varNana kiyA aba samIpastha bhAga ( provmal end ) meM jo parivartana hote haiM unheM bhI samajhanA hogaa| yahAM vimajikaJcuka kA vihAsa prathama tanukI ( first node of Ranvier ) taka ho jAtA hai tathA isa prathama khaNDa ( segment ) meM vimajikaJcaka kI nyaSTiyA~ bar3hatI rahatI haiM / kaJcuka ke kozA dUrastha bhAga ke kaTe hue sire kI ora bar3hakara usase milane kA prayAsa karate haiN| parantu akSa-rambha meM sarvAdhika kriyA dekhI jAtI hai usake tantuka ( fibrils ) turata ugane lagate haiM ve bahuta adhika saMkhyA meM utpanna ho jAte haiM aura dUrastha bhAga kI ora bar3hane lagate haiM yadi naSTaprAya bhAga meM atyadhika vraNavastu nahIM bana pAI aura kSetra komala rahA to ve purAne mArga ko phira banA lete haiM aura una para vimajikaJcuka punaH car3ha jAtA hai jitanA mahattva uparokta parivartanoM kA hai utanA hI mahattva una parivartanoM kA bhI hai jo eka cetA-tantu meM usake akSa-rambha ke vihrAsa ke kAraNa utpanna hote haiM / jaba akSarambhIya vihAsa (axonal degeneration) ho jAtA hai to kozA sUja jAtA hai usakI bahubhuja bahIrekhA (polygonal outline ) miTa jAtI hai aura vaha gola ho jAtA hai| kozArasa kI grodakaNikAe~ TUTa-TUTa kara vilupta ho jAtI haiM isa viluptIkaraNa ko varNahAsa (chromatolysis ) kahate haiM / nyaSTi eka pArzva ko saraka jAtI hai jisake kAraNa kozA kI AkRti utkendrita ( eccentric ) ho jAtI hai| cetAtantu ke kaTane ke 3 saptAha pazcAt marammata kA kArya prArambha ho jAtA hai| abhivarNakaNikA ( chrtom. atin granules ) dhIre-dhIre punaH banane lagate haiM nyaSTi kozA ke kendra meM A jAtI hai tathA kozA punaH apanI pUrvAkRti aura bahIrekhA ( outline ) ko prApta kara letA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 176 parivartana AghAta ke anupAta meM hI dekhe jAte haiM yadi vAtanADI (cetAtantu) pUrNataH kATa DAlI gayI hai to koI parivartana nahIM milate para yadi AghAta saumyasvarUpa kA huA to varNahAsAdi parivartana halake aura thor3I dera rahane vAle hI dekhe jAte haiN| ___ upara jisa vihAsa kA varNana kiyA gayA hai usase vibhinna do prakAra ke aura parivartana milate haiM / pahale prakAra kA parivartana saMvedi vAtanADiyoM ke pazcamUla pragaNDoM ( posterior root ganglia of the sensory nerves ) ke kendriya tantuoM ke kATane se yaha milatA hai usake akSa-rambha meM koI vihAsa dRSTigocara nahIM hotaa|yh smaraNa rakhanA cAhie ki yadi unhIM nADiyoM ke pazcamUla pragaNDoM ke pariNAhI tantuoM ( peripheral fibres ) ko kATA jAtA hai to akSa-rambha meM vihrAsa avazya milatA hai / dUsare prakAra kA parivartana una cetaikoM meM hotA hai jo kendriya vAtanADI saMsthAna ke bAhara nahIM Ate ina kozAoM meM vihAsa hone para ve pUrNataH naSTa hokara vilupta ho jAte haiM tathA vahA~ punarjanana kI koI kriyA nahIM dekhI jAtI hai| Upara jitane prakAra ke bhI kozIya parivartana hamane batalAye haiM ve kevala kisI vAtanADI ke AghAta ke kAraNa hI nahIM utpanna hote api tu unakI utpatti meM madya Adi anya kAraka bhI kAraNabhUta ho sakate haiN| sendriya yA nirindriya viSoM ke dvArA cAhe ve bahirbhUta hoM yA antarbhUta varNahAsa, kozA kI kAyA meM rasadhAnI nirmANa ( vacuolation ) tathA kozAnyaSTi kA utkendraNa Adi nAzaka kriyAe~ utpanna ho sakatI haiM / isa prakAra ke vihAsa kA pratyakSa darzana hameM suSumnAdhUsaradravyapAka ( poliomyelitis), sarvAGgaghAta (general paralysis ) tathA anya vraNazothAtmaka avasthAoM meM dekhane ko milatA hai / jahAM vAtanADiyoM kA pratyakSa AghAta na hokara apratyakSatayA vividha abhikartAoM (agent) ke dvArA yaha saMkaTa A upasthita hotA hai| yahI nahIM atyadhika parizrama karane se yA anya prakAra se utpanna thakAna (exhaustion ) ke kAraNa bhI vAtanADiyoM meM vihAsa aura vihAsAtmaka parivartana dekhe jA sakate haiM / jaba yaha vihrAsa atyanta bhISaNa rUpa dhAraNa kara letA hai to phira jo ghaTanA ( phenomenon ) ghaTatI hai use cetaikabhakSaNa ( neuronophagia) kahate haiM isameM kozA ke cAroM ora bhakSikozA (phagocytes ) ekatra ho jAte haiM jo yahA~ upagraha ( satellites ) kaha kara pukAre jAte haiN| ye upagraha cetaikoM ( nADIkandoM) ke vighaTana meM sahAyatA karate haiN| ye kozA antarAlita utiyoM ke 2 ghaTakoM aNuzleSa ( microglia. ) aura alpacetAlomazleSa (oligodendroglia) ke dvArA banate haiN| raMgAyikaparivartana (pigmentary changes )-nADIkozAoM meM raMgAyika parivartana prAyaH dekhe jAte haiM mastiSkakANDa ( brain stem ) tathA mastiSka mUlapiNDadvaya ( basal ganglia ) meM kucha kozAsamUhoM meM kAli ( melanin ) nAmaka raMgA bahuta mAtrA meM ekatra milatA hai zyAmapatrikA ( substantia nigra) meM yaha kAlA raMgA bahulatA se pAyA jAtA hai / vRddhoM aura prauDhoM kI vAtanADiyoM meM For Private and Personal Use Only

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180 vikRtivijJAna eka vimedavarNa ( lipochrome ) pItavarNa kA pAyA jAtA hai, yaha pIta raMgA vividha vihAsAtmaka avasthAoM meM bahuta bar3hatA huA dekhA jAtA hai / kendriya vAtanADI saMsthAna kI antarAlita Uti - mastiSka aura suSumnA kI racanA meM prayukta dravya, cetaikoM tathA antarAlita UtiyoM ina 2 vargoM meM vibhakta kie jA sakate haiM / pahale vidvAn vAtanADiyoM aura unake pravardho ke jJAna kI khoja para adhika dhyAna dete rahe haiM parantu spenadeza ke vidvAnoM ne antarAlita Uti sambandhI pracura anusandhAna karake yaha prasiddha kara diyA hai ki yaha Uti mastiSka kI AdhAraka yA sthAna pUraka UtimAtra nahIM hai api tu vAtanADIsaMsthAna kI arthavyavasthA ( economy ) kI dRSTi se atIva mahattva kA padArtha hai / abhI taka hama yahI samajhate the ki mastiSka meM cetaikoM ( nADIkandANuoM ) tathA cetAdhArI ( neuroglia ) ke atirikta kucha hotA hI nahIM kyoMki mastiSka ke chedoM kA abhiraMjana adhikatara zoNitajArali ( hematoxylin ) uthA uSasi ( eosin ) ke dvArA hotA AyA hai / ina abhiraMjita chedoM meM antarAlita UtikozAoM tathA choTe choTe cetAkozAoM kA antara karanA bahuta kaThina par3atA hai| adhika dhyAna se dekhane para yaha spaSTa avazya ho jAtA hai ki vAtanADI yA cetA ke kozAoM meM jahA~ ninyaSTi ( nucleolus) pAI jAtI hai vahA~ cetAdhArI yA antarAlita Uti kozAoM meM ninyaSTi nahIM hotI / parantu aneka atyanta mahattvapUrNa pravardha araMjita raha jAte haiM / malorI ke bhAsvacaNDika amla zoNitajArali ( phosphotungstic acid hematoxylin ) abhiraMjana se ve pravardha jo tArAkozAoM ( astrocytes ) ke hote haiM ve bhI abhiraMjita ho jAte haiM phira bhI aise aneka kozA aura dIkhate haiM jinameM koI pravardha nahIM hotA aura jo eka nagna nyaSTi ke rUpa meM hI pragaTa hote haiM inheM kajAla ne 'tRtIya dravya' nAma diyA hai / usane prathama dravya ko cetaika yA nADIkandANu aura dvitIyadravya ko cetAdhArI yA lUtANuka (neuroglia ) nAma diyA hai / spainiza kajAla ke suyogya ziSya DailarAyo horTegA ne yaha siddha kiyA hai ki nagnanyaSTi kozAoM meM bhI pravardha hote haiM aura ye kozA do pUrNataH bhinna vargoM meM vibhakta hote haiM / inameM eka varga ke kozAoM ko usane alpacetAlomazleSa ( oligodendroglia ) nAma diyA hai kyoMki ina kozAoM ke cetAloma ( dendrites ) bahuta thor3I saMkhyA meM hote haiM / dUsare varga kA nAma usane aNuzleSa ( microglia ) rakhA hai kyoMki ve bahuta sUkSmakAya hote haiM / ina sabake kAraNa Aja vyavahAra meM mastiSka kI antarAlita Uti meM 3 prakAra ke kozA batalAye jAte haiM : 1 - cetAdhArI yA tArAzleSa ( neuroglia or astroglia ) - 2--- alpacetAlomazleSa ( oligodendroglia ) tathA 3 - aNuzleSa ( microglia ) aisA jJAta hotA hai ki tArAzleSa aura alpacetAlomazleSa donoM kI utpatti bahiHstara ( ectoderm ) se aura aNuzleSma kI madhyastara ( mesoderm ) se hone For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 181 ke kAraNa donoM pUrNataH pRthak prakRti rakhate haiM / itanA samajha lene para hama kaha sakate haiN| ki kendriya vAtanAr3I saMsthAna cetaka, cetAzleSa ( tArAzleSa tathA alpacetAlomazleSa ) tathA aNuzleSa nAmaka 3 dravyoM se mila kara banA hai / 'zleSa' zabda 'glU' ke lie hindI meM prayukta hotA hai jisase gliyA ( glia ) banA hai / aba hama tArAzleSa, alpacetAlomazlepa aura aNuzleSa kA varNana karate haiM / tArAzleSa- isI ko cetAdhArI yA cetAzleSa yA vAtanAr3I zleSa yA lUtANuka (neuroglia ) kahate haiM / tArAzleSa kA nirmANa tArAkAra kozAoM (astrocytes) se hone ke kAraNa yaha nAma diyA gayA hai / isake kozA do prakAra ke hote haiM jinameM eka prarasIya ( plasmatic ) aura dUsare tAntava (fibrous ) / donoM hI prakAroM meM bahuta bar3e kozA hote haiM jinameM anekoM pravardha hote haiN| ina pravardho meM se kama se kama eka pravardha kA sambandha eka stUpAkArI vistAra dvArA jise vAhinIya pAdapa ( vascular foot plate ) kahate haiM eka kezAla yA raktavAhinI se hotA hai| kajAla ke eka dUsare yogya ziSya akrUkairo ne ise cUSaNa sAdhitra ( suction apparatus ) nAma diyA hai ise cUSakapAda ( sucker foot ) bhI kahA jA sakatA hai / yaha batalAtA hai ki tArAkozA kA kyA kArya ho sakatA hai / pratyeka tArAkozA ke pAsa kama se kama eka tathA kaI-kaI aise cUSakapAda hote haiM / tAntava tArAkozAoM para jaba kajAla dvArA prayukta svarNa utsAda (gold sublimate) abhiraMjana kiyA jAtA hai to tantukozA se nikalate hI kozArasa kI mRdula jhillI (film) se AvRta ho jAtA huA dekhA jAtA hai kozAkAya se svatantra tantu koI nahIM nikalatA pratyeka tantu eka pravardha se dUsare meM calA jAtA hai aura kozA meM hokara apanA mArga banA letA hai / eka tantu eka parivAhinIya AsaMjana (perivascular attachment ) se dUsare meM pAra ho jAtA hai aura isa prakAra donoM vAhiniyoM ko bA~dhe rahatA hai / tAntava tArAkozA zveta padArtha meM milate haiM tathA ve mRdutAnikA ( piamater ) ke nIce mastiSka bAhya ke upariSTa ghanastara meM upariSTa sImA kalA (superficial limiting membrane) banAte haiM / ina tArAkozAoM ke cUSakapAda mRdutAnikA se Asakta rahate haiM / jo raktavAhinI mRdutAnikA ko chor3akara mastiSka meM praveza karatI haiM unake Upara isa upariSTa sImA kalA kA eka kaMcuka car3ha jAtA hai jise parivAhinIya sImAkalA (perivascular limiting membrane ) kahate haiM / isa prakAra cetaikoM se vAhiniyA~ tArAkozAoM ke eka stara ke dvArA pRthak kara dI jAtI haiN| ho sakatA hai ki ve eka madhyastha kA kAma karate haiM / jaisA ki cUSaNa sAdhitra nAma se pragaTa hotA hai / 1 prarasIya tArAkozA saba ke saba dhUsara padArtha meM hI prAyazaH pAye jAte haiM, vizeSa karake pramastiSka bAhyaka ( cerebral cortex ) ke madhya aura gambhIra staroM meM tathA nimastiSka ke jAlikAstara ( molecular layer of the cerebellum ) meM For Private and Personal Use Only

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182 vikRtivijJAna ve bahuta hote haiM / jaba prarasIya tArA kozAoM meM vikRti AtI hai to unase tantuka ( fibrils ) utpanna hone lagate haiM / painaphIlDa nAmaka vidvAn ne tArAzleSa kA varNana bahuta thor3e zabdoM meM karate hue batalAyA hai ki aSTabAhu sama tArAkozA vAtanADIsaMsthAna kI anekoM racanAoM ko apane pAza meM Abaddha karake Upara mRdutAnikA se aura nIce zoNavRkSa ( vascular tree ) kI vipula zAkhA prazAkhAoM se viziSTa vistAroM dvArA Asakta ( attached ) rahatA hai| / isake kyA kArya haiM una para jaba hama vicAra karate haiM to hama nizciti se kaha sakate haiM ki kevala yojI Uti kA sAdhAraNa kArya hI tArAzleSa sampanna nahIM karatA kyoMki yadi aisA hotA to usake sAtha cUSaNa sAdhitra ( suction apparatus ) jaisA viziSTa aMga na rhtaa| aisA jJAta hotA hai ki tArAkozAoM kA nADIkandANuoM ( cetaikoM ) kI jIvanakriyA ke sAtha avazya hI koI sIdhA sambandha rahatA hai vyAdhi hone para tArAkozA kriyAzIla hokara bahuta kArya karate haiM yadi mastiSka meM koI vraNa kara diyA jAve to tArAkozA pravRddha ho jAte haiM eka se aneka vana jAte haiM, tAntava ho jAte haiM aura vraNa ke cAroM ora eka prAcIra kA nirmANa kara dete haiM / yaha kArya kevalamAtra tArAkozAoM dvArA hI sampAdita hotA hai alpacetAlomazleSa vA aNuzleSa isa kArya meM tanika bhI bhAga lete hue nahIM dikhate / sarvAMgaghAta tathA anya vAtanADIsaMsthAna ke jIrNa vraNazothoM tathA vihAsoM meM tArAkozAoM kA pramukhabhAga rahatA hai tathA khUba zleSotkarSa ( gliosis ) hotA hai / / alpacetAlomazleSa--inameM na to vAhinIpAda hotA hai aura na tantuka isa kAraNa ye tArAkozAoM se pUrNataH bhinna hote haiM inameM eka nagna nyaSTi dekhI jAtI hai aura yadi horTegA ke rajataprAMgArIyavidhi ( silver carbonate method ) ke dvArA abhiraMjana kiyA to inameM alpasaMkhyaka sUkSma pravardha milate haiM jinake kAraNa usakA nAmakaraNa kiyA gayA hai / alpacetAlomazleSa kozA 2 sthAnoM meM milate haiM1- zveta padArtha meM vAtanAr3I tantuoM ke bIca meM antarApUla kozA (interfascicular cells ) rUpa meM paMktiyoM meM vinyasta tathA 2 - dhUsara padArtha meM paricetaikIya upagrahoM ( perineuronal satellites ) ke rUpa meM, adhikAMza paricetaikIya upagraha inhIM kozAoM ke banate haiM parantu kucha aNuzleSa se bhI nirmita hote haiM / alpacetAzleSa kA kArya kyA hai yaha kahanA abhI kaThina hai parantu kadAcit vaha kendriya vAtanAr3I saMsthAna ke bhItara vimajjikaMcuka ( myelin sheath ) kA nirmANa tathA usakI rakSA kA kArya karatA hogA / isakA pramANa yaha hai ki jaba vimajIkaraNa (myelination ) prArambha hotA hai to usa samaya tantumArgoM meM alpacetAzleSa kozA bahusaMkhyA meM dekhA jAtA hai / arzothAtmaka aura vihAsAtmaka vyavasthAoM meM jahAM tArAzleSakozA atyanta kriyAzIla ho jAte haiM alpacetAlomazleSa kozA sAzcarya zAnta dekhe jAte haiM / mRtyu ke For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 183 pazcAt inakA AtmapAcana itanI drutagati se hotA hai ki mAnava mastiSka chedoM meM ve kadAcit hI dekhe jA sakate haiN| tIvra pratikriyAoM meM alpacetAlomazleSa aura aNu zleSa kozAoM meM kona aura painaphIlDa ko bahuta bhArI antare milA hai| aNuzleSa se jahA~ bhakSikozAoM kI utpatti hotI hai vahA~ ye kozA usI prakAra vihrAsa ko prApta ho jAte haiM jisa prakAra ki vAtanAr3I koshaa| jo vyakti tIvra saMnyAsa ( acute coma ) se maratA hai usake alpacetAlomazlepa meM prAyaH tIvra sUjana ( actue swelling ) pAI gaI hai| kozA kI kAyA sUja jAtI hai, pANDara ho jAtI hai, rasadhAnIyukta( vacuolated ) ho jAtI hai| usake pravardha TUTa-TUTa kara kaNikA bana jAte haiM jaba ki nADIzleSa aura aNuzlepa para koI prabhAva nahIM hotA jo isa bAta kA pramANa hai ki alpacetAlomazleSa tInoM meM saba se adhika hRSa ( sensitive) hotA hai| aNuzleSa--yaha kajAla kA tRtIya dravya' ( third element ) hai| isakI utpatti madhyastara se hotI hai| isake kozA choTe choTe hote haiM / pratyeka meM se kaI kaI pravardha nikalate haiM ina pravoM para samakoNa para cipake sUkSma zalya (spines ) hote haiN| kozA kI kAyA aura pravoM ko rajataprAGgArIya vidhi se abhiraMjita kiyA jA sakatA hai| isameM na to tantu hote haiM aura na vAhinIya pAdapaTTa hI / ye kozA dhUsara padArtha meM zveta padArtha kI apekSA adhika pAye jAte haiM inameM se kucha to nADIkandANuoM yA cetaikoM ke upagraha ( satellites ) bana jAte haiM para ye upagraha adhikatara alpacetAlomazleSakozAoM ke hote haiN| donoM zleSoM kI apekSA pIDA yA mRtyu kA aNuzleSakozAoM para koI prabhAva nahIM pdd'taa| janma ke samaya anya do zleSoM kI apekSA ye bahuta kama saMkhyA meM hote haiM parantu kucha saptAha bItate bItate inakI saMkhyA paryApta ho jAtI hai jisakA kAraNa eka vicitra pravrajana ( migration ) hai| yaha pravrajana 2 srotoM se hotA hai| inameM pahalA srota to vaha Uti hai jo mastiSka nilayoM kA AstaraNa karane vAlI kalA ( ependyma ) ke nIce rahatI hai usa sthAna para jahAM mRdutAnikA antarvalita ( invaginated ) hokara jhallarI pratAna ( choroid plexus) banatI hai / aura dUsarA srota pramastiSka vRntoM (cerebral peduncles) ke nIce ke dharAtala para sthita mRdutAnikA kA bhAga hai| aisA lagatA hai ki ye kozA mRdutAnikA se utpanna hote haiN| sarvaprathama ve zveta padArtha meM pAye jAte haiM aura bAda meM dhUsara padArtha meM bhI cale jAte haiM / ina kozAoM kA kArya bhakSikozIya (phagocytic ) mAlUma par3atA hai| yaha kozA bhakSikozIya tathA kAmarUpIya ( amoeboid ) hotA hai| jaba kabhI mastiSka meM vidradhi ho jAtI hai to ye kozA sUja jAte haiM aura ve gola ho jAte haiM unake pravardha moTe par3a jAte haiM tathA ve andara kI ora khiMca jAte haiM aura kozA kAyA meM meda bhara jAtA hai / 24 se 48 ghaNTe ke bhItara hI yaha aNuzleSakozA eka pUrA aura vAstavika saMyuta sakaNa kozA ( compound granular corpuscle ) yA svacchaka kozA For Private and Personal Use Only

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184 vikRtivijJAna bana jAtA hai / kintu isa rUpa ko lene ke pUrva yaha kozA-daNDa ( rod cell ) kA rUpa dhAraNa kara letA hai jaisA ki sarvAMgaghAta meM prAyazaH milatA hai / saMyuta sakaNa kozA aura daNDa kozA ke rUpa meM hamAre vikRtivettA ise varSoM se jAnate Aye haiM parantu unako isakA patA nahIM thA ki inakA janaka aNuzleSa kozA hai jise hogA ne varSoM bAda apanI rajata prAMgArIya abhiraMjanA paddhati dvArA pragaTa kiyA hai| isa prakAra daNDa kozA jhaura medakaNa kozA kA janaka aNuzleSa kozA hameM mAna lenA caahie| sAtha hI sAtha ye kozA jahAM AghAta hai udhara barAbara bar3hate calate haiM / pUyana sakaNa kozAoM kA nirmANakartA nahIM hotA parantu jahAM mastiSkamArdava yA usakA vinAza hotA hai una vikSatoM meM ye bahuta bar3I saMkhyA meM dekhe jAte haiM / vimukta huI vimajji kA bhakSaNa karake ye kAmarUpAbha bhakSikozA apane Adheya ( contents ) ko samIpastha una vAhiniyoM meM le jAte hue mAlUma par3ate haiM jinake sAtha ve saMlagna hote haiM / yaha ho sakatA hai ki vahA~ ve apane ko khAlI kara dete hoM / aNuzleSa kozAoM kA vihAsI tAntava tArA kozAoM para eka viziSTa prabhAva yaha dekhA jAtA hai ki ve unake TUTe hue vistAroM ke cAroM ora lipaTa jAte haiM aura unako dUra kara dete haiM tathA tArAkozAoM se bilakula bhI nahIM bolte| isa prakriyA ko cetAlomabhakSikozotkarSa ( dendrophagocytosis) kahate haiM aura isakA pratyakSa darzana vihAsI zleSArbuda ( disintegrating glioma ) meM kiyA jA sakatA hai / yaha bhI kahA gayA hai ki aNuzleSa jAlakAntazchadIya saMsthAna ke andara hI samA viSTa kiyA jA sakatA hai kyoMki donoM kA mukhya kArya bhakSikozIya ( phagocytic ) hI hai / sarvAGgaghAta meM aNuzleSa kozAoM meM lohA lada jAtA hai / jAlakAntazchadIya saMsthAna ke kozA bhI lohe ke prati paryApta prIti rakhate haiM / lohA nADI zleSa aura usake donoM prakAroM para koI vizeSa prabhAva nahIM rakhatA aura na unameM pAyA jAtA hai / aNuzleSa svastha mastiSka meM kyA kArya karatA hai yaha abhI taka patA nahIM calA / vikAsa - kendriya vAtanADIsaMsthAna ke vividha dravyoM kA vikAsa ( development ) kisa prakAra se aura kahA~ se hotA hai isakA varNana karanA eka jaTila samasyA hai kyoMki isa dRSTi se usa grantha kA lekhanakArya kiyA bhI nahIM jA rahA hai / parantu jina kozAoM kA abhI hama varNana karate A rahe haiM unhIM ke sambandha meM do zabda likha denA paryApta hogA / majjaka paTTa ( medullary plate ) ke adhicchada se do prakAra ke kozA ugate haiM, eka rohikozA ( germinal cells) aura dUsare chidri - ruha spongioblasts ) / rohikozA vAtanADI rUha yA cetAruha ( neuroblasts ' banAte haiM jo Age cala kara vAtanAr3iyoM meM pariNata ho jAte haiM / chidriruhoM se nissandeha tArAkozA tathA alpacetAlomazleSa banate haiM / aNuzleSa kA nirmANa madhyastarIya Uti dvArA hotA hai / mRdutAnikA ke nIce madhyastarIya uti se hI isaka utpatti hotI hai| jahAM se yaha janma ke pazcAt mastiSka meM pravrajana ( migration ' karake A jAtA hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 185 upasarga ke mArga kendriya vAtanAr3I saMsthAna meM upasarga pahu~cane ke 3 pradhAna mArga ho sakate haiM : : 1 - raktadhArA ke dvArA, 2 - lasadhArA ke dvArA, tathA 3 - akSarambhoM ke dvArA, uraHkSata ( bronchiectasis ), hRdantaHpAka ( endocarditis ) ke kAraNa utpanna mastiSka kI sakala vidradhi ( solitary abscess ) kA kAraNa rogakAraka padArthoM kA rakta dhamaniyoM dvArA mastiSka meM pahu~ca jAnA hai / sUkSmazyAmAkasama vidradhiyoM ( miliary abscesses ) kA pradhAna kAraNa rogANuraktatA ( septicaemia ) kA honA hai jo rakta ke dvArA mastiSka meM ina vidradhiyoM ko kara detA hai / yaha bhI siddha hotA hai ki jIvANu aura inake viSa mastiSka tathA suSumnA meM parivAtanADIya lasavahAoM ( perineural lymphatics ) dvArA pahu~cate haiM jinake pradhAna udAharaNa dhanurvAta aura rohiNI haiN| TIla aura aimbilTana kA yaha dRr3ha mata hai| ki yadi saba nahIM to thor3A to avazya hI dhanurvAta kA viSa karmavAhinI vAtanADiyoM ( motor nerves ) ke sAtha anugAminI lasavahAoM dvArA jAtA hai / jaba upasarga rakta dvArA gamana karatA hai to suSumnA para usakA prabhAva yaha hotA hai ki usameM vihAsa hone lagatA hai aura vaha phUla jAtI hai aura usameM kAcara ghanAkhotkarSa ho jAtA hai / yadyapi sthira UtiyoM meM zotha nahIM AtA / para yadi upasarga kA gamana lasavahAoM dvArA hotA hai to sthira UtiyoM meM zotha prArambha se hI rahatA hai / isase yaha spaSTa ho jAtA hai ki kadAcit anutIva saMyukta suSumnA vihAsa ( subacute combined degeneration of the cord ) nAmaka roga meM upasargakArI viSa (toxin ) kA gamana rakta ke dvArA hI hotA hai tathA suSumnAdhUsaradravyapAka ( poliomyelitis ) nAma vraNazothAtmaka vyAdhikArI upasarga kA gamana vAtanADiyoM kI rekhA ke sAtha sAtha hotA hai / yaha bhI sambhava hai ki yaha gamana parivAtanADIya lasavahAoM meM hokara na ho aura akSarambhoM meM hokara ho / sarpIzuddha ( herpes simplex ) nAmaka roga ke viSANu para guDapAzcara ne jo gaveSaNA kI hai vaha bhI yaha pragaTa karatI hai ki akSarambhoM dvArA hI upasarga kA praveza ho sakatA hai / dhanurvAta kA viSa isa mArga se jAtA hai isameM bahuta kama sandeha hai / vAtanADiyoM dvArA roga kA saMcAra viSANujanya rogoM meM prAyazaH dekhA jAtA hai / kendriya vAtanADIsaMsthAna ke bhItara upasarga kisa prakAra prasarita hotA hai isake lie abhI prayogoM aura khoja kI paryApta AvazyakatA hai / suSumnA dhUsaradravyapAkakArI yA zuddha ke viSa ko jaba mastiSka meM praviSTa kara dete haiM to vaha sampUrNa mastiSka tathA suSumnA meM sarvatra prasara kara jAtA hai / aba yaha dekhanA ki isa prasaraNa ke kArya meM mastiSkasuSumnAjala kA pramukha hAtha hai yA vAtanADIya akSarambhoM kA abhI zeSa raha gayA hai / For Private and Personal Use Only

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186 vikRtivijJAna mastiSkasuSumnAjala-ise mastiSkoda yA mastiSkamerutarala ( cerebrospinal fluid ) bhI kahate haiM / yaha eka hRSadarpaNa hai jisameM vAta vyAdhiyoM ke asaMkhyacitra pratibimbita hote haiN| ye citra pUrNataH spaSTa bhI ho sakate haiM aura aspaSTa bhii| ataH svastha mastiSkoda kA varNana pahale Avazyaka hai| mastiSkoda kA udAsarja jhallarIpratAna ( choroid plexus) dvArA hotA hai| vizeSa karake pArzvanilayoM ( lateral ventricles ) meM / vahA~ se yaha tRtIya nilaya, madhyamastiSkamArga ( aqueduct of midbrain), caturtha nilaya ko pAra karatA huA caturtha nilaya kI chata meM sthita chidroM dvArA upajAlatAnikIya avakAza brahmoda. kulyA ( subarachnoid space ) meM pahu~ca jAtA hai| yaha mastiSka ke AdhAra para sthita bar3e bar3e jalAzayoM meM bahatA huA javanikAkhya mastiSkAvaraNI kalAkhAta ( incisura in the tentorium ) aura madhyamastiSka ke taMga mArga se hokara Upara kI ora upajAlatAnikIya jhIla meM phaila jAtA hai yahA~ jAlatAnikA ke aMkuro ( arachnoid villi ) dvArA jo choTe choTe andhakUpoM kA kArya karate haiM aura jinakA sambandha bar3I bar3I sirAoM se khAsa karake upari anudIrghasirA ( superior longitudinal sinus ) se hotA hai yaha jala rakta meM milA diyA jAtA hai| yaha jala nIce suSumnA meM antimakaTikazerukA ke nicale sire taka jAtA hai| mastiSkadhamaniyoM ko upajAlatAnikIya avakAza (brahmodakulyA) meM hokara jAnA par3atA hai aura unake sAtha mRdu-jAlatAnikA kA eka kaMcuka ( a sheath of pia-arachnoid ) rahatA hai jo upajAlatAnikIya avakAza kA hI eka vistAra mAtra hotA hai| yaha kaMcuka ina vAhiniyoM ke sAtha unakI sUkSma se sUkSma zAkhA ke ke sAtha bhI lagA rahatA hai aura yaha mastiSkavAhiniyoM ke bAhya aura madhya coloM ke bIca ke antarAla ke sAtha saMtata ho jAtA hai ina antarAloM ko varakAu-robina avakAza ( Virchow-Robin spaces ) kahate haiN| isa prakAra vraNazothakArI kozA saralatApUrvaka brahmodakulyA meM pahu~ca jAte haiN| yaha bhI smaraNa rakhanA Avazyaka hai ki mastiSka mastiSkoda dvArA ativedhita (permeated ) aura anuviddha ( saturated ) rahatA hai| isI kAraNa jaba isakI kamI ho jAtI hai to tRSAtura mastiSka rakta ke kama ho jAne ke kAraNa sikur3a jAtA hai tathA bahuta bar3I mAtrA meM eka spakSa kI bhAMti tarala ko sokha liyA karatA hai| isa sampUrNa kriyA meM jAlatAnikA (nIzArikA ) ke aMkuroM kA bahuta adhika mahattva hai| kuziMga ke vicAra se udazIrSa ( hydrocephalous) nAmaka roga meM mastiSka meM atyadhika jala vRddhi kA kAraNa ina aMkuroM ke tarala pracUSaNa kArya meM vikAra kA honA adhika hai na ki tarala ke nirgamana mArga meM bAdhA kA honaa| yadi ina aMkuroM ke pAvana ( filter ) ko ( mastiSkAdhArI jalAzayoM meM kAjala praviSTa karake) niga (plug ) kara diyA jAve to eka cirakAlIna udazIrSa utpanna kiyA jA sakatA hai ( viidd)| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 187 isa tarala ko parIkSaNArtha saMcita karane ke lie pA~coM sthAnoM meM se kisI para bhI kaTivedha karanA Avazyaka hai| adhomastiSka jalAzayavedha dvArA ayyara ne 1920 meM tarala niSkAsana ko eka sugama vidhi pradAna kI hai ise taba prayukta karanA cAhie jaba kaTivedha sambhava na ho ske| donoM sthAnoM ke taraloM kI tulanA karane se bhI kaI mahattva kI vastue~ hAtha laga sakatI haiN| __mastiSkoda svasthAvasthA meM raMgahIna aura svaccha hotA hai usameM vedha ke kAraNa athavA pUrva kAraNoM se rakta bhI mila sakatA hai yadi vedha ke kAraNa rakta alpa hogA to thor3I dera rakhane para mastiSkoda punaH varNahIna ho jAvegA para yadi rakta usameM pahale se hI upasthita hogA to zoNAMzana ke kAraNa usakA raMga pItAbha ho jAtA hai| dUsarI isakI pahacAna yaha hai ki yadi tarala do naliyoM meM ekatra kareM to yadi vedha ke kAraNa rakta nikalatA hai to pahalI nalI meM rakta kI mAtrA adhika aura dUsarI meM kama hogI parantu yadi mastiSka se hI rakta calA hai to donoM meM usakI mAtrA samAna hogii| adhika rakta na hone para tarala ke varNa kA pIlA honA isa bAta kA pramANa hai ki suSumnA meM koI arbuda bana rahA hai| kabhI kabhI pramastiSkIya arbudoM aura dhamanIjAraThya meM bhI pIlApana dekhA jA sakatA hai| jAlatAnikIya raktasrAva hone para pItavarNIya tarala avazya dekhA jA sakatA hai| mastiSkoda para 110 se 130 milImITara jala kA yA 7-9 mi0 mI0 pArada kA nipIDa milatA hai| yaha pIr3ana mastiSkIya sirAoM ke pIDana se sadaiva adhika rahatA hai| yahA~ yaha batalA denA bhI jJAnaprada hai ki vaigaphortha nAmaka vidvAn ne mastiSka kI dIrghikA sirA ( longitudinal sinus ) aura brahmodakulyA meM sambandha sthApita kara diyA jo 4 dina taka lagAtAra rahA parantu sirA meM se eka bUMda rakta bhI mastikoda meM isalie nahIM gayA ki mastiSkoda kA pIr3ana sirA ke rakta ke pIr3ana se adhika thA para jaba agale dina kaTivedha karake usakA pIr3ana ghaTa gayA to turata rakta tarala meM mila gyaa| jaba atibala lavaNodaka kA sirAntaHkSepa kiyA jAtA hai to AsRti ( osmosis ) ke kAraNa mastiSkoda mastiSka se khiMca jAtA hai aura usakA pIDana kama ho jAtA hai| yadi donoM manyAoM para pIDana DAlA jAya to antaHmastikIya pIDana bar3ha jAtA hai| ise kaikensTeTa cihna (Queekenstedt sign) kahate haiM para yadi suSumnA aura jAlatAnikA ke madhya meM koI avarodha hotA hai to yaha nipIDa nahIM bar3hatA pazcamastiSkakhAtastha arbudoM meM bhI yaha nahIM miltaa| ___ svastha mastiSkoda ke prati ghanamilImITara sthAna meM 5 se kabhI adhika kozA nahIM milA krte| zizuoM meM kucha gaNana adhika ho sakatA hai tathA 10 varSa kI Ayu hone para hI svAbhAvika ho jAtA hai aisA bhI mata hai para bauyaDa isako nahIM anubhava krtaa| ye sampUrNa kozA lasIkozA hote haiM parantu rugNAvasthA meM bahunyaSTisitakozA, bRhajjAlatAnikIya ekanyaSTikozA, prarasakozA, saMyukta sakaNakozA Adi sabhI dekhe jA sakate haiM para inakI citrapaTTI ( film ) taiyAra karane ke lie For Private and Personal Use Only

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185 vikRtivijJAna viziSTa paddhati apanAnI par3atI hai jaise jambukI bASpa dvArA sthira karake phira abhi raJjana karanA / jyoM hI mastiSkoda nikAlA jAve turata usake kozAoM ko gina liyA jAnA cAhie kyoMki unameM vighaTana kI pravRtti hotI hai / bahunyaSTikozA to bahuta zIghra adRzya ho jAte haiM yadi unheM gaNanA ke lie bAhara bhejanA par3e to turata 10 pratizata vasva ( formalin ) kA 1 sIsI itane hI mastiSkoda meM milAkara bhejanA cAhie tAki kozA surakSita rakhe jA sakeM / mastiSka ke aneka rogoM meM ( phiraMga ), yakSmAjanya mastiSkacchadapAka, suSumnA dhUsaradravyapAka, janapadoMsaka mastiSka pAka, sarpa josTara, viprathita dA, Adi meM lasIkozotkarSa ( lymphocytosis ) bahuta hotI hai / svasthatarala ( mastiSkoda ) meM probhUjina kI mAtrA 0.02 se 0.04 pratizata ( prAyaH 0.025 ) taka rahatI hai / probhUjina kevala vartuli ( globulin ) hI ho yaha samajhanA bhUla hai / aneka avasthAoM meM vaha zukli ( albumin ) bhI ho sakatI hai / jaba kabhI rogoM ke kAraNa probhUjina kI mAtrA bar3hatI hai kozA bhI bar3hate haiM para kahIM kahIM akele kozA bar3hate haiM probhUjina nahIM ( jaise ki suSumnA dhUsaradravyapAka meM ) aura kahIM probhUjina bar3hatI hai kozA nahIM ( jaise ki suSumnA ke arbudoM meM ) / mastiSkoda meM zarkarA kI mAtrA rakta kI mAtrA se AdhI (0.05 pratizata ) rahatI hai / tIvra mastiSkacchadapAka meM aura yakSmAjanya mastiSkacchadapAka meM yaha mAtrA ghaTa jAtI hai parantu janapadodhvaMsakArI mastiSkapAka ( epidemic encephalitis ) meM vaha bar3ha jAtI hai isa kAraNa tarala meM zarkarA kI mAtrA kitanI hai yaha jJAna prApta kara lene se nidAna meM paryApta sahAyatA milatI hai / nIreya ( chlorides ) kI mAtrA mastiSkoda meM 0.72 se 0.75 taka rahatI hai jo mastiSkacchadapAka meM kama ho jAtI hai / yacmAjanya mastiSkacchadapAka meM to yaha atyanta alpa ho jAtI hai / yadi vaha 0.75 se adhika bar3ha jAtI hai to usakA artha vRkkoM kI kriyA-zakti kA abhAva mAna lenA cAhie tathA 0.72 se nIce mastiSkacchadapAka jAna lenA cAhie / tantvijAla ( fibrin web ) yadi tarala meM tanvijana ( fibrinogen ) upasthita ho to use thor3I dera prakoSThIya tApamAna para hI sthira rakhane se eka tantvijAla bana jAtA hai / yaha jAla pUyIya taraloM ko chor3a kara yacamAjanya mastiSkacchada pAka, suSumnA dhUsaradravyapAka, phiraGgaja mastiSkacchadapAka, arogANvika lasIkozIya mastiSkacchadapAka Adi meM bhI dekhA jAtA hai / yadi yaha jAla bane to pUrvokta 3 rogoM kI ora pahale dhyAna jAnA cAhie aura zeSa kI ora bAda meM / vividha vikAroM meM mastiSkoda meM kucha na kucha parivartana dekhane ko milate haiM / hama yahA~ saMkSepa meM unhIM kA eka bAra smaraNa kie lete haiM tAki usakA mahattva samajha meM A sake For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 186 1. tIvra mastiSkacchadapAka meM tarala pUyIya hotA hai usameM sahasroM kozA rahate haiM jo adhikAMzataH bahunyaSTi hI hote haiM, probhUjina bahuta adhika bar3ha jAtI hai aura zarkarA kI mAtrA yA to bilkula ghaTa jAtI hai yA anupasthita rahatI hai / nIreya prakRtAvasthA se kama milate haiM tathA jisa rogANu ke kAraNa mastiSkacchadapAka huA hai vaha tarala meM mila jAtA hai parantu mastiSkagolANu ( meningococcus ) ke lie saMvardha ( culture ) atyanta Avazyaka hai / karNamUlazotha ( mumps ) ke sAtha hone vAle mastiSkacchadapAka meM lasIkozotkarSa itanA adhika hotA hai ki pratighana milImITara tarala meM 1000 lasIkozA taka dekha par3ate haiN| vahAM zarkarA kI prakRta mAtrA mila jAtI hai / karNamUlazotha akelA hone para bhI lasIkozoM kI saMkhyA mastiSkoda meM bar3ha jAtI hai / I lasya maskiSkacchadapAka ( serous meningitis ) meM rogANu nahIM milate aura zarkarA bhI apanI prakRta mAtrA meM pAyI jAtI hai kozAoM kI saMkhyA kucha bar3ha jAtI hai yA jyoM kI tyoM bhI raha sakatI hai / lasyamastiSkacchadapAka kA pramukha kAraNa karoTi vAyukoTaroM ( cranial air sinuses ) kA vraNazotha hotA hai vizeSa kara gostanakakoTarapAka ( inflammations of the mastoid air sinuses ) meM yaha dekhA jAtA hai| isake sAtha mastiSkavidradhi bhI ho sakatI hai / zizuoM meM tIvra mastiSkacchadapAka ke sampUrNa lakSaNa mila sakate haiM parantu tarala meM kevala parivartana usakA mAtrAdhikya hotA hai jo kaTivedha dvArA turata kama kiyA jA sakatA hai| 2. yakSmAjanya mastiSkacchadapAka meM tarala svaccha yA dUdhiyA varNa kA dekhA jAtA hai; sthira karane para usameM tantvijAla bana jAtA hai; usameM lasIkozotkarSa paryApta hotA hai para sAtha sAtha bahunyaSTikozA bhI milate haiM; probhUjina kI mAtrA khUba bar3hatI hai; zarkarA kA pUrNataH abhAva nahIM hotA para usakI mAtrA avazya kama ho jAtI hai; nIreya isa roga meM nyUnatama pAye jAte haiM, yadi paryApta parizrama kiyA jAye to yacamAdaNDANu bhI mila sakatA hai / 3. tIvra suSumnAdhUsaradravyapAka tathA janapadoddhvaMsaka mastiSkapAka donoM meM mastiSkada prAyaH eka sA hI rahatA hai aura bahuta karake yakSmAjanya mastiSkacchadapAka se milatA julatA hotA hai / tarala prAyaH svaccha hotA hai yA usameM svalpa pArAndhatA dekhI jA sakatI hai; kozA bar3ha jAte haiM, probhUjina unase kama bar3hatI hai, zarkarA aura nIreya apanI prakRtAvasthA meM hI rahate haiM / suSumnAdhUsaradravyapAka meM tarala ko rakha dene se svalpa tanvijAla banatA hai / mastiSkapAka meM zarkarA prakRta mAtrA se Upara rahatI hai tathA zleSAbha svarNa vakra ( colloidal gold curve ) ghAtika svarUpa ( paretic type ) kI hotI hai / mastiSkapAka meM nauna lakSaNa ke viparIta kozAdhikya aura prakRta probhUjina dekhI jAtI hai / 4. sarpI josTara ( herpes zoster ) meM jaisA citra abhI batAyA hai vaisA hI For Private and Personal Use Only

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160 vikRtivijJAna pAyA jAtA hai usameM kama yA adhika darje kA lasIkozotkarSa dekhA jAtA hai / probhUjina prakRta yA svalpa pravRddha dekhI jAtI hai / 5. vAtanADIsaMsthAna ke phiraMga meM lasIkozotkarSa, probhUjinAdhikya tathA phiraMga ke vividha parIkSaNa astyAtmaka ( positive ) milate haiM / 6. pramastiSkIya raktastrAva meM jaba vaha nilayoM yA jAlatAnikIya avakAzoM meM hotA hai to suSumnAstha tarala meM rakta dekhA jAtA hai| yadi kisI kAraNa se raktasrAva gaharAI meM ho to bhI tarala kA varNa 2-3 dina pazcAt pIlA par3a jAtA hai dRDhatAnikAdhaH ( subdural) raktasrAva hone para mastiSkoda taba taka svaccha rahatA hai jaba taka jAlatAnikA bhI vidIrNa na ho jAve / 7. mastiSka vidradhi meM vidradhi gaharI hone para tarala prakRta rahatA hai / kozA ( 5 se 30 ) aura probhUjina ( 30 se 60 migrAma ) thor3e bar3ha jAte haiM para jaba vaha Upara A jAtI hai to zarkarA tathA nIreya donoM ko upajAlatAnikIya antarAla meM sthita jIvANu samApta kara dete haiM / 8. mastikArbuda meM zleSArbuda ke sAtha kozA prakRta saMkhyaka bhI raha sakate haiM tathA 10 se 80 taka bar3ha bhI sakate haiM, probhUjina paryApta bar3hatI hai yadi arbuda nilayoM taka ho to tarala pItavarNIya ho jAtA hai / tAnikArbudoM meM ye lakSaNa nahIM milate | arbudoM ke kAraNa tarala para ucca nipIr3a milatA hai / kaTivedha karanA usa avasthA meM bhaya se rikta nahIM / 9. sauSunika arbudoM meM yA yakSmA meM yA apiDhatAnikIya vidradhi hone se suSumnAkulyA ( spinal canal ) kA mArga avaruddha ho jAtA hai jisake kAraNa avarodha ke nIce eka banda guhA bana jAtI hai| isa guhA ke tarala meM phrAyana lakSaNa ( froin syndrome ) milatA hai arthAt tarala pIta varNa kA hotA hai aura turata Atazcita ho jAtA hai / yA dUsarA nauna lakSaNa mila sakatA hai jisameM raMgahIna tarala atyadhika probhUjina aura prakRta kozA hote haiM / sarvasAmAnya citra hotA hai-- pItavarNatA (xanthochromia ) tathA zukti kI upasthiti / probhUjina 05 pratizata taka bar3ha jAtI hai / avarodha ke kAraNa kvekenasTeTa cinha nAstyAtmaka hotA hai / aba hama vraNa zodhAtmaka pramukha vAtavyAdhiyoM kA varNana upasthita karate haiM / mastiSkavidradhi (Abscess of the Brain ) aeros kI vidhi prAthamika na hokara sadaiva uttarajAta hotI hai, usake upasarga kI nAbhi ( focus ) kahIM na kahIM avazya pAI jAtI hai / prAthamika upasarga nimna sthaloM meM usakI vAramvAratA ke krama ke anusAra diye jAte haiM : 1 - madhyakarNa meM pUyana 2 - lalATya koTara ( frontal sinus ) meM pUyana 3 - nAsyakoTara ( nasal sinus ) meM pUyana 4 - ziro'bhighAta ( trauma of the head ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 161 5- pUyaraktatA - vizeSa kara jaba phuphphusa meM kahIM pUya ekatra ho jAtA hai jaise uraHkSata ( bronchiectasis ) meM athavA pUyoras ( empyema ) meM / kyoMki phuphphusa meM udbhUta antaHzalya ke lie mastiSka eka pAvana ( filter) kA kArya karatA hai / 6 karoTi kI asthiyoM ke roga jaise asthimajjApAka yA phiraMgajanya asthinAza ( syphilitic necrosis ) ina sabhI hetuoM meM madhyakarNapAka pradhAnatama hotA hai / yahA~ upasarga antaH karNamArga dvArA gamana na karake yA to Upara kI ora karNapaTaha Acchada ( tegmen tym pani ) meM hokara yA mastiSka ke padArtha meM hokara bahane vAlI sirAoM ke sahAre sahAre calatA hai / karNapaTahAcchada meM hokara jAne vAle upasarga kA anumArgaNa saralatA se kiyA jA sakatA hai kyoMki isameM asthi kA aparadana hotA hai tathA asthi aura dRr3hatAnikA ke madhya meM kaNanaUti kA puJja hotA hai athavA yaha nizciti se eka upatAnikI vidradhi bana jAtI hai / yaha vizeSa ullekhanIya hai ki yahA~ upasarga jAlatAnikA taka pahu~ca jAne para bhI sAmAnya mastiSkacchadapAka nahIM dekhA jAtA / jo abhilagna ( adhesions ) banate haiM ve sAmAnya roga vistRti ko roke rahate haiM / jaba sirAoM yA lasavahAoM (lymphatics) ke sahAre sahAre roga bar3hatA hai to asthi tathA mastiSka kA bhAga pUrNataH svastha milatA hai / madhyakarNa roga hone para mastiSka ke zaMkhajatukAsthIya khaNDa ke adhobhAga meM vidhi vanatI hai kabhI kabhI nimastiSka ( dhamillaka) meM bhI vaha bana sakatI hai / prathama sthAna vidhi zAntatayA banatI hai aura koI vizeSa lakSaNa nahIM milate yadi huA to aMgaghAta ho sakatA hai para yadi vidvadhi Upara kI ora bar3hI to pahale mukhamaNDala phira bAhu aura anta meM TA~goM para prabhAva par3a sakatA hai kyoMki bAhyaka kendra eka eka karake prabhAvita hote jAte haiN| yadi vaha vidradhi bhItara kI ora bar3hatI hai to pahale TA~ga, phira bAhu aura anta meM cehare para prabhAva par3atA hai kyoMki visAri kiraNamaNDala ( internal capsule ) meM pIche se Age kI ora sUtra isI krama se vinyasta rahate haiM / afrate for prAyazaH akelI hI rahatI hai para pUyaraktatA ke kAraNa vaha bahusaMkhyaka bhI ho sakatI hai / tIvrAvasthA meM samIpastha mastiSka Uti meM bhI vraNazotha ho sakatA hai aura vaha pUya se yukta aura mRdu bana sakatI hai / yadi Age cala kara rogI kI mRtyu na huI to usake cAroM ora eka saMghanita Uti kA prAvara bana jAtA hai jo usa sthAna para utpanna vaipika utpAdoM kA vistAra aura pracUSaNa roka detA hai / eka prAvara ke nirmANa meM 1 // mAsa taka kA samaya laga jAtA hai / vidhi ke Adheya ( contents) kA varNa Aharita (greenish) hotA hai, rakta ke kAraNa usameM halakI babhrutA bhI A sakatI hai tathA usameM atyanta durgandha Ane lagatI hai| vidhi meM puJjagolANu, mAlAgolANu aura phuphphusagolANu vizeSa karake pAye jAte haiM tathA anya jIvANu bhI mila sakate haiM jinameM nIlapUya kazAMgANu (B. pyocyaneus) bhI eka hai jo bahuta adhika dekhA jAtA hai / For Private and Personal Use Only

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162 vikRtivijJAna mastiSkoda sAdhAraNatayA prakRta rahatA hai| para yadi vidradhi dharAtala para hI huI to vaiSika pracUSaNa se saumya mastiSkachadapAka dekhA jAtA hai tathA mastiSkoda meM kozAoM aura probhUjina donoM kI mAtrA kucha bar3hI huI mila sakatI hai| yaha smaraNa rakhanA hogA ki yahAM para rogANupracUSaNa ke sAdhAraNa rUpa se prApta mastiSkachadapAka ke lakSaNa nahIM milate tathA tApAMza prakRta yA adhaHsAmAnya ( subnormal ) rahatA hai| nAr3I kI gati atyanta manda milatI hai tathA rakta meM sitakozotkarSa bahuta kama hotA hai jaba ki mastiSkachadapAka meM vaha bahuta adhika dekhA jAtA hai| jIrNatA ke lie mastiSka vidradhiyA~ bahuta prasiddha haiN| kaI kaI mAsa taka mastiSka meM vidradhiyA~ banI raha sakatI haiM tathA unake dvArA kisI bhI prakAra kI gar3abar3I hotI huI nahIM dekhI jAtI jo atyanta Azcaryajanaka hai Age calakara aisI vidradhiyA~ yA to kisI mastika nilaya meM yA Upara kI ora mastiSkachada meM vidIrNa ho jAtI haiN| mastiSkachada meM vidIrNa hone para unase tIvra aura mAraka mastiSkachadapAka ho jAtA hai / prathama mahAyuddha meM aise aneka rogI dekhe gaye jinake mastiSka meM bAhya vastu ke praveza karane ke bahuta kAla pazcAt mastiSkavidradhi banI ho| mastiSkachadapAka ( Meningitis) mastiSkachada ( meninges ) meM upasarga raktadhArA tathA samIpastha nAbhi kahIM se bhI pahu~ca sakatA hai| yaha nAbhi mastiSka meM bhI ho sakatI hai tathA nAsAgrasanI, nAsAkoTara, karoTikoTara tathA madhyakarNa meM kahIM bhI ho sakatI hai| mastiSkachadapAka meM jitane rogakArI jIvANu jJAta haiM unameM se koI bhI pAyA jA sakatA hai para cAra bahuta karake milate haiM jo mastiSkagolANu ( meningococcus ), phuphphusagolANu ( pneumococcus ), mAlAgolANu (streptococcus) tathA yakSmAdaNDANu ( tuberole bacillus) kahalAte haiN| inameM se prathama tIna pUyajanaka hone ke kAraNa pUyIya vraNazotha utpanna karate haiN| yaha bhI smaraNa rakhanA cAhie ki kabhI kabhI pUyajanaka rogANuoM kI anupasthiti meM bhI eka tIvra aura pUyIya vraNazotha utpanna hotA huA dekhA jA sakatA hai aura usakA kAraNa jIvANu-itara koI prakSobhaka ( nonbacterial irritant ) ho sakatA hai| isakA eka udAharaNa jIvANurahita lavaNavilayana (sterile salt solution ) kA upajAlatAnikIya avakAza (brahmodakulyA) meM antaHkSepa hai jo komala mastiSkachada meM vraNazotha utpanna kara sakatA hai| kaTivedha se pratidhanustambha lasikA antaHkSepa kara dene se bhI iGgilTana usI pariNAma para pahuMca cukA hai| dhanustambha meM jo vyakti isa bhrama meM rahatA hai ki yadi vaha pratidhanustambha lasIkA mastiSkoda meM pahu~cAtA rahegA to yaha roga naSTa ho jAyagA to vaha apane rogI ko mArane kA hI upAya karatA hai| kyoMki vaisA karane se tIva ajIvANuka mastiSkachadapAka ( acute aseptic meningitis ) utpanna ho jAtA hai| jo loga jambeyita taila For Private and Personal Use Only

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tIvramastiSkachadapAka pRSTha 192 slerinarainia 14 yaha mastiSka tAnikAoM meM vraNazotha kA prabhAva pradarzita karatA hai| brahmodakulyA vraNazothakArI kozAoM se paripUrNa dikhalAI de rahI hai| For Private and Personal Use Only

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163 vividha zarIrAGgoM para vraNazotha kA prabhAva ( iodized oil ) ko brahmodakulyA meM pahu~cAkara kSakiraNa citra lene kA upakrama karate haiM ve bhI ajIvANuka mastiSkachadapAka utpanna kara dete haiN| usa taila ke kAraNa dhUsara dravya meM vihrAsa aura agrazRGgoM kI vAhiniyoM meM ghanAsrotkarSa hotA huA dekhA jAtA hai| aba hama yahAM se Age mastiSkagolANuoM dvArA utpanna hone vAle mastiSkachadapAka kA varNana yathAruci karate haiM: mastiSkagolANvika mastiSkachadapAka mastiSkachadapAka utpanna karane meM sarvapradhAna hetu hotA hai mastiSkagolANu / roga prAyazaH kAcitka (sporadic) svarUpa kA prArambha hotA hai aura Age calakara kabhI kabhI vyApaka ( epidemic ) rUpa bhI dhAraNa kara letA hai| isakI vyApakatA romAntikA, lohitajvara tathA zItalA se bhinna hotI hai| isakI vyApakatA meM eka eka kuTumba meM eka se adhikarogI kadAcit hI hotA hai jaba ki uparokta tInoM rogoM meM eka kuTumba meM aneka eka sAtha vyAdhita hote hue dekhe jA sakate haiN| sAtha hI, isa roga meM eka dUsare ko roga jAne ke lie saMsparza ( contagion ) kA koI sambandha ba~dhatA sA prakaTa nahIM hotaa| arthAt eka gA~va se dUsare gA~va yA eka muhalle se dUsare muhalle meM roga kisa prakAra gayA yA sambaddha huA isakA koI spaSTa AdhAra dekhA nahIM jaataa| dasa sahasra vyaktiyoM meM 1-2 kI mRtyu hotI huI dekhI jAtI hai| ina sabake lie bvAyaDa kA nimna vAkya sadaiva lAbhaprada rahatA hai-The explanation lies in the fact that the receptivity of the throat is high, while the susceptibility of the meninges is low.' ki upasarga prApti meM grasanI agraNI hai aura upasarga grahaNa karane meM mastiSkachada pIche rahatI hai| isI kAraNa gale meM upasargakArI jIvANuoM ko lekara calane vAle asaMkhyavAhaka rahate haiM ve svayaM roga se prapIDita nahIM hote para unake dvArA anekoM meM upasarga pahu~catA hai aura jahA~ kI mastiSkachada upasarga grahaNa kara letI hai vahIM roga utpanna ho jAtA hai aura vaisA sahasroM meM eka do ko hotA hai| isI kAraNa eka muhalle meM isa vyAdhi se pIDita milane para bIca meM dUra taka koI pIDita nahIM milatA aura bahuta dUra ke muhalle meM vyAdhita rugNa mila jAtA hai| mArga ke aneka prANiyoM kI grasanI meM jIvANu rahate haiM jo cupake se dUsare sire ke muhalle taka roga pahu~cAne meM samartha ho jAte haiN| mastiSkagolANu kA pUrA nAma hai-yugmagolANu kozAntaHstha vizAla baumIya mastiSka golANu ( diplococcus intracellularis meningitidis ofweichalbaum ) / yaha eka suSava-dhAvya (gram -negative ) yugma golANu hai / yaha uSNavAtIya golANu (gonococcus ) se AkArikIyadRSTayA ( morphologically ) itanA sAmya rakhatA hai ki donoM ko pRthaka kiyA hI nahIM jA sktaa| parantu uSNavAtIya golANu kI apekSA isakA saMvardha zIghra ho jAtA hai| anya suSavadhAvya yugmagolANuoM meM jinase ise pRthak kiyA jAnA cAhie eka hai painasaguccha 17, 18 vi0 For Private and Personal Use Only

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164 vikRtivijJAna golANu ( micrococcus catarrhalis ) jo grasanI meM upasthita rahatA i painasaguccha golANu to prakoSThIya tApAMza para hI saMvardhita ho jAtA hai parantu mastiSka golANu kA saMvarddha karane ke lie rakta ke tApAMza ke barAbara USmA sthira rakhanI par3ata hai / mastiSka golANu svayaM bhI 4 prakAra ke hote haiM aura unameM se eka prakAra ka pratilasI dUsare ke lie upayoga karane meM koI lAbha nahIM karatI huI dekhI jAtI / mastiSkada ke upasRSTa hone kI rIti ( mode ) kyA hai isakA abhI taka samAdhAnakAraka uttara hastagata nahIM ho sakA hai / yaha to ThIka hI hai ki jaba janapadoddhvaMsa ( epidemic ) hotA hai taba grasanIya upasarga ke dvArA eka se dUsare vyakti taka upasarga jAtA hai / svastha aura asvastha donoM vyaktiyoM ke galoM meM mastiSka golANu bahuta bar3I saMkhyA meM dekhe jA sakate haiM / atha ca vraNazothAtmaka srAva mastiSka ke AdhAra para yA mRNAlAntarAla ( interpeduncular space ) meM sarvAdhika mAtrA meM saJcita dekhA jAtA hai / zizuoM kI zarjharAsthi ( ethmoid bone ) ke cAlanIpaTala meM se hokara kucha lasavahAe~ jAtI haiM jo nAsAgrasanI tathA brahmodakulyA donoM ko eka dUsare se jor3atI haiN| ho sakatA hai ki yadi manuSyoM meM nahIM bhI ho to bhI zizuoM meM upasarga pahu~cane kA sIdhA mArga inhIM savahAoM dvArA ho sakatA hai aisI dhAraNA banAlI jA sakatI hai / yaha dhAraNA hI dhAraNA hai kyoMki isako puSTa karane vAle koI pramANa abhItaka upalabdha nahIM ho sake haiM / mastiSkachadapAka se pIDita rugNoM kI jharjharAsthi ke cAlanIpaTaloM meM khojane ke jo bhI prayatna hue haiM ve na to inameM ina na vraNazotha hI dekha sake haiM / mastiSkagolANu athavA vraNazotha jIvANuoM ko hI pA sake haiM aura Ajakala jo sarvAdhika mAnya mata hai vaha yaha hai ki mastiSkachada pratyakSataH raktadhArA dvArA upasRSTa hotI hai / usa dRSTi se isa roga kI 3 avasthAe~ svIkAra kI jAtI haiM-- (1) jaba ki UrdhvazvasanamArga vizeSa karake nAsAgrasanI ke Urdhva bhAga meM upasarga pahu~catA hai / (2) jaba ki raktadhArA upasRSTa hotI hai tathA (3) jaba ki mastiSkachada meM upasarga sthita ho jAtA hai / prathamAvasthA meM jaba ki roga UrdhvazvasanamArga meM hI sImita rahatA hai yadi vahA~ se Age upasarga na bar3hA jo prAyaH dekhA jAtA hai to rugNa kevala vAhaka ( carrier ) mAtra raha jAtA hai / kabhI kabhI kevala dvitIyAvasthA taka hI raha kara roga ruka jAtA hai aura usa samaya mastiSkachadapAka virahita mastiSkagoNvika rogANuraktatA hI dekhI jAtI hai / tRtIyAvasthA kA artha tIvra mastiSkachadapAka hotA hai / katipaya lekhaka uparokta pradarzita mata ke svIkAra karane meM kaI kAraNoM se asamartha haiM / udAharaNArtha, 24 se 48 ghaMTe meM mRta hone vAle ghAtaka rugNoM meM jIvitAvasthA ke raktasaMvardha tathA mRtAvasthA ke hRdvakta ke saMvardhau se mastiSkagolANuoM kI prApti hotI hai, nilayIya taraloM kA saMvardha bhI astyAtmaka hotA hai parantu mastiSkacchada prakRtAvasthA meM hI dekhI jAtI hai / yadi sauSumnika prAvaraka ( spinal theca ) For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 165 ko nilayoM se pRthak banda kara diyA jAve to usake golANu mara jAte haiM, para nilayoM meM ve sajIvAvasthA meM milate haiM isakA spaSTa artha to yaha hai ki nilayoM se golANu barAbara milate rahane cAhie isI AdhAra ko lekara lyUkovikja kahatA hai ki tAnikAoM ( meninges ) ke dvArA roga kA prasAra nahIM hotA aura na rogANu tAnikAoM ko AdhAra mAna kara calate haiM, api tu nilaya brahmodakulyIya saMsthAna taka rogANu jhallarIpratAna ( choroid plexus ) dvArA pahu~cate haiM / rogANuraktatA ( septicaemia ) ke pariNAmasvarUpa eka visthAyika nAbhi ( metastatic focus ) jhallarI pratAna meM utpanna ho jAtI hai jaisA ki mAlAgolANu yA puMjagolANujanita rogANuraktatA meM vRkkakezikAjUToM meM visthAyika nAbhiyAM bana jAtI haiM / isakA pariNAma yaha hotA hai ki pahale eka jhallarIpratAnapAka ( choroiditis ) ho jAtA hai phira adhyasta ra pAka ( ependymitis ) hotA hai / adhyastara ( ependyma ) para usI prakAra rogANu basa jAte haiM jisa prakAra zvasanamArga ke dharAtala para prArambha meM basate haiM / eka vraNazothAtmaka srAva vahAM utpanna ho jAtA hai aura golANu tathA pUya donoM mastiSkoda ke pravAha se pahale mastiSkAdhArastha jalAzayoM ( basal cisterns ) ko pahu~cate haiM usake pazcAt kucha to pramastiSkIya brahmodakulyA meM aura kucha sauSumnika prAvara meM pahu~ca jAte haiN| zizuoM meM vizeSa kara botalapAyI zizuoM meM mastiSka bahuta mRdula hotA hai jisake kAraNa mastiSka sItAoM kI udubjatA (Convexity of the sulci ) cipiTita saMvellanoM ( flattened convolutions ) dvArA banda kara dI jAtI hai isa kAraNa srAva saba mastiSkAdhAra ke jalAzayoM meM ekatrita ho jAtA hai isa kAraNa mastiSkachadapAka pazcAdhArIya ( posterio basic type ) hotA hai / zizuoM meM mastiSkachadapAka kA yahI svarUpa prAyaH dekhane ko milatA hai / unake mastiSka meM jaba antaH nipIr3a atyadhika bar3ha jAtA hai to unakI grIvA pratyAkRSTa ( retracted ) ho jAtI hai kabhI kabhI pazcatAna ( opisthotonus ) dekhA jAtA hai jaba ki zizu sira aura pairoM para Thahara jAtA hai tathA bIca kA bhAga akar3a jAtA hai / mastiSka aura suSumnA kI AkRti isa roga meM roga ke kAla kA anusaraNa karatI hai / sphUrta roga ( fulminant case ) meM jahAM rugNa 24 se 48 ghaNTe ke bhItara maratA hai srAva kI mAtrA svalpa hotI hai tathA jahA~ kucha saptAhoM taka roga rahatA hai vahA~ srAva bahulatA se milatA hai / karoTi-TopI ko utAra dene para dRr3hatAnikA aa aura utphulla ( bulging ) milatI hai mastiSkachadIya vAhiniyoM meM bahuta adhika adhiraktatA pAI jAtI hai / dRr3hatAnikA ko kATa dene para brahmodakulyA ( subarachnoid space ) meM Aharita pIta varNa kA cala mAtrA meM (in varying amount ) srAva nikalatA hai / isakA mArga vAhiniyoM kI dizA meM hotA hai vaha pArzvika piNDa ( parietal lobe ) ke lalATya aura agrabhAgoM meM adhika dekhA jAtA hai jaba mastiSka ko kATa kara alaga kara diyA jAtA hai to mastiSkAdhAra para For Private and Personal Use Only

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166 vikRtivijJAna aura bhI adhika srAva yA utsyanda (exudate ) dekhA jAtA hai jo mRNAlAntarAla ko bhara detA hai aura Age dRSTinADI ke sAtha sAtha jAtA hai, pIche bar3e jalAzayoM (cisterns) taka jAtA hai aura Upara madhya aura agra pramastiSkIya dhamaniyoM ke sAtha sAtha mastiSka ke UparI bhAga ( vertex) taka jAtA hai| isI srAva yA utsyanda dvArA sauSumnika jAlatAnikIya avakAza (arachnoidal space) bhI bhara jAtA hai para yaha bharane kA kArya sAzcarya suSumnA ke pazvabhAga kI ora hI dekhA jAtA hai| suSumnA ke agrabhAga kI tAnikAoM kI prathA naSTa ho jAtI hai srAvAdhikya nahIM dekha pdd'taa| jaba mastiSka ko kholA jAtA hai to, niyamataH nilaya visphArita ( dilated ) milate haiM unameM Avila ( turbid ) tarala bharA rahatA hai| jhallarIpratAna adhiratIya ho jAtA hai yA usakA varNa manda dhUsara ho jAtA hai| nilayoM kA dharAtala jise hamane adhyastara (ependy. ma) kahanA prArambha kara diyA hai rUkSIbhUta (roughened ) ho jAtA hai / vayaskoM kI apekSA bAlakoM meM eka tIvrasvarUpa kA ghAtaka udamastiSka ( hydroce. phalous) bhI dekhA jAtA hai| usakA hetu mastiSka kI mRdulatA (softness of the brain) mAnI jAtI hai| mRdulatA ke kAraNa tarala ke pravAhana meM tathA pracUSaNa meM bAdhA par3atI hai aura mastiSkoda bAhulya ho jAtA hai| Upara hamane pratyakSa kyA dekhA jA sakatA hai usI ko batalAyA hai aba hama aNvIkSatayA ( microscopically ) kyA prakaTa hotA hai use likhate haiM / isa dRSTi se hama brahmodakulyA ko vraNazothAtmaka utsyanda se paripUrNa pAte haiN| usa meM pradhAnatayA bahanyaSTi sitakozA pAye jAte haiM sAtha meM kucha lasIkozA tathA kucha bar3e ekanyaSTi bhakSikozA bhI milate haiN| ina bhakSikozAoM meM se kucha ke udara meM khAye hue kozA dekhe jAte haiM parantu adhikAMza ke udara meM to eka rasadhAnI ( vacu. ole) hI dekhane meM AtI hai| Age cala kara ye kozA aura bhI adhika saMkhyA meM milate haiN| utsyanda meM tantvi bahuta kama aura kabhI kabhI hI pAI jAtI hai| srAva (utsyanda) meM rudhirANu paryApta hote haiN| sitakozAoM ke bAhara aura bhItara donoM avasthAoM meM mastiSkagolANu pAye jAte haiN| parantu ye golANu to mastiSkoda se lipta paTToM ( smears made from the cerebrospinal fluid) ke dvArA adhika spaSTa dekhe jAte haiN| mastiSka jAne kaise subaddha ( intact ) rahatA hai / sItAoM meM srAva bahuta adhika rahatA hai aura vahA~ se vaha brahmodakulyA ke parivAhinIya pralambanoM (perivascular prolongations of subarachnoid space ) meM kucha dUra taka bharA rahatA hai parantu mastiSkaUti kA yA rakta kI tAnikAoM dvArA upasRSTa hone kA koI pramANa nahIM milatA jo mastiSka ke lie satya hai vahI suSumnA ke lie bhI ThIka utaratA hai / yadi kahIM vraNazotha milatA hai to vaha kevala adhyastara meN| ina tathyoM ko dekhane se yaha siddha ho jAtA hai ki upasarga prathamataH jhajharIpratAna se hI prArambha hotA hai| sapUyika For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 167 nAbhiyoM ke dvArA jo kabhI kabhI sampUrNa pramastiSka meM vikIrNa rahatI haiM mastiSkapAka kA pramANa mila jAtA hai| zeSa mRtyUttaraparIkSA rogANuraktatA kA pramANa upasthita karatI hai jisake kAraNa jIvitaka aMgoM (parenchymatous organs ) meM meghasamazotha ke pramANAdi milate haiM / nAsAgrasanI ( nasopharynx ) meM adhiraktatA dikhalAI detI hai usameM zopha ( oedema ) tathA prarasakozAoM tathA lasIkozAoM kA antarAbharaNa (bharamAra ) khUba dekhA jAtA hai| virale hI rogiyoM meM mastiSkagolANujanya hRdantaHpAka dekhA jA sakatA hai| kucha aise bhI rogI dekhe gaye haiM parantu sahasroM meM eka do jahA~ mastiSkachadapAka na hote hue bhI mastiSkagolANvika hRdantaHpAka ( meningococcal endocarditis ) dekhA jAtA hai| sandhipAka, parihRtpAka, pUyorasa , nAsAkoTarapAka, adhivRkkIya raktasrAva ( adrenal haemorrhage ) Adi meM se koI bhI upadrava sAtha meM dekhe jA sakate haiN| parantu ve hote bahuta hI virale rogiyoM meM haiN| aisA kahA jA sakatA hai aura mAnA bhI jA sakatA hai ki mastiSkagolANu eka aisA rogANu hai jo UrdhvazvasanamArgIya dharAtala tathA mastiSkanilayIya adhyastara ke atirikta anya UtiyoM meM bahuta kaThinAI se hI jama pAtA hai / ___ mastiSkachadapAka meM kaTivedha karake mastiSkoda kI prApti avazya karanI caahie| kyoMki usakI parIkSA nirNAyaka hotI hai / mastiSkasuSumnAtarala (mastiSkoda) kA pIDana bar3hA huA milatA hai| vaha svayaM Avila (gaeNdalA) hotA hai, AvilatA kA pradhAna kAraNa tarala meM kozAoM kI vRddhi kA honA hai jo 300 se 400 taka pratighana mi. mITara sthAna meM hotI huI dekhI jA sakatI hai| kabhI kabhI prArambhika mastiSkachadapAka meM kaTivedha dvArA prApta mastiSkoda pUrNataH svaccha milatA hai aura usameM kozAoM kI vRddhi nahIM hotI huI dekhI jAtI para yadi thor3e samaya bAda punaH use nikAlA jAya to itane samaya meM hI vaha Avila mila sakatA hai| tarala meM probhUjina kI mAtrA adhika ho jAtI hai vartuli kA pramANa atyadhika bar3ha jAtA hai tathA viti bhI paryApta bar3hatI hai| probhUjina 0.3 pratizata se bar3ha kara 0.8 pratizata taka ho jA sakatI hai| tarala kI zarkarA sadaiva ghaTa jAtI hai aura prAyaH nahIM bhI miltii| zarkarA ke abhAva kA pramukha kAraNa mastiSkagolANu dvArA madhuma kA kiNvIkaraNa ( fermentation ) karanA hI hai / isa samaya taka kozAoM kI saMkhyA eka ghanamilImITara sthAna meM sahasroM kI ho sakatI hai| sabase adhika jJAna kI prApti kA sAdhana hotI hai citrapaTTI ( film ) / use aNvIkSa ( microscope ) ke nIce rakhane para bahunyaSTikozA dikhalAI par3ate haiN| yadi pratidina kaTivedha kiyA jAve tathA yogya cikitsA calatI ho to citrapaTTI meM pratidina bahunyaSTikozAoM kI saMkhyA ghaTatI huI dekhI jA sakatI hai| unakA sthAna bRhat ekanyaSTibhakSakozA ( large mononuclear phagocytic cells) le lete haiN| ve to For Private and Personal Use Only

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168 vikRtivijJAna ! apanI abhiraMjanAzakti ( staining power ) bhI kho baiThate haiM aura viyojita ( disintegrated ) ho jAte haiM / rogottara kAla meM bRhat ekanyaSTibhattikozAoM kA abhiraMjana bhI halakA hone lagatA hai aura unakA sthAna laghulasIkozA ( small lymphocytes ) le lete haiM / citrapaTTiyoM meM mastiSkagolANu dekhane para kaI vividhatAe~ milA karatI haiN| kabhI to unakI saMkhyA bahuta kama hotI hai, kabhI bilkula nahIM milatI aura kabhI bahuta bar3I saMkhyA meM ve pAye jAte haiM / niyamataH inakI saMkhyA bahuta adhika nahIM rahA karatI / adhikAMza unameM se kozAntaHstha dekhe jAte haiM para kucha kozAoM ke bAhara yugmoM meM svatantra bhI mila jAte haiM / yadi inako dekhanA abhISTa hai to grAma se abhiraMjana na karake prodalenya nIla ( mithAilIna blU ) se abhiraMjita karanA caahie| yadi kisI tIvra mastiSkachadapAka ke rogI ke mastiSkoda meM eka bhI mastiSka golANu dekhane ko na mile to isakA artha yahI lagAnA cAhie ki yaha pAka mastiSka golANvika hI hai aura usI dRSTi se upacAra kI apekSA rakhatA hai / kyoMki phuphphusagolANvika yA mAlAgolANvika mastiSkachadapAka ke mastiSkoda meM phuphphusagolANu athavA mAlAgolANu avazya karake milate haiM / mastiSkoda ke Avarti parIkSaNoM ( periodic examinations ) meM mastiSka - golANu dhIre dhIre samApta hote hue dekhe jAne para bhI usakI AvilatA meM kamI nahIM AtI usakA kAraNa yaha rahatA hai ki mastiSkagolANu ke nAza ke lie jo lasI hamakaTivedha dvArA samaya samaya para prayukta karate rahate haiM usase prakSobha utpanna hokara arogANu mastiSkachadapAka ( aseptic meningitis ) bana jAtA hai / ataH saMvardha, citrapaTTI parIkSaNa se adhika uttama mArga hai / eka parIkSA zarkarA kA punarAgamana hai / jaba mastiSkoda meM zarkarA punaH Ane lage to isakA spaSTa artha yahI hai ki usase mastiSkagolANu samApta ho gaye / isake dvArA bhI hama vAstavika mastiSkachadapAka aura pratilasI dvArA utpanna pratikriyA meM antara kara sakate haiM / bahistAnikIya mastiSkagolAvika upasarga mastiSkagolANvika upasarga rogANuraktatA ( septicaemia ) ke rUpa meM prArambha hokara eka mastiSkachadapAka meM samApta ho jAtA hai / kabhI kabhI antima avasthA bilakula nahIM pahu~catI aura rogANuraktatA hI dekhI jAtI hai / yaha rogANuraktatA kucheka ghaNToM se lekara kaI saptAha paryanta dekhI jA sakatI hai / isakA adhikAMza jJAna hameM hairika ke anusandhAnoM se prApta huA hai / usakA kathana hai ki hameM jo sAdhAraNataH rogaMcitra dekhane ko milatA hai usake sAtha sAtha cAra aura sambhAvanAe~ ho sakatI haiM : - 1 - mastiSka golANvika rogANutA ( meningococcal sepsis ) jisake sAtha mastiSkachadapAka na ho / rakta kA saMvardha karane para mastiSka golANu prApta hoM tathA Adhunika rAsAyacikitsA ( chemotherapy ) dvArA rogI svastha ho jAtA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 166 hai| isa prakAra se mastiSkachadapAka na to nidAna se prakaTa hotA hai aura na mRtyUttara parIkSA karane pr| 2-mastiSkagolANvika rogANatA jisake sAtha nidAna karane para mastiSkachada pAka nahIM milatA para mRtyUttara parIkSA karane para tAnikAoM meM adhiraktatA tathA upasarga dekhA jAtA hai| ___3-mastiSkagolANvika rogANutA jisake sAtha mastiSkachadapAka na hokara pUyika bahusandhipAka ( septic polyarthritis) ho / tathA ___4-mastiSkachadapAka manthara ( meningitis tarda ) jaba ki rakta meM mastiSkagolANu dvArA rogANuraktatA utpanna hone ke kaI saptAha pazcAt mastiSkachada pAka hotA hai| hairika ne mastiSkagolANvika rogANuraktatA kA nimna zabda citra prastuta kiyA hai : "The patient is dull, apathetic, indifferent; he plaintively resents disturbance, responds in monosyllables with the expen. diture of & minimum amount of energy and prefers to lie on the side with knees drawn up and head bent forward. arthAt rogI manda, nirutsAhita, udAsIna hotA hai; vaha azAnti se ghabarA jAtA hai, atyanta alpa zakti vyaya karate hue alpa zabdoM meM uttara detA hai vaha sira Age jhukA kara aura ghuTane moDa kara eka karavaTa se sonA acchA samajhatA hai|' mastiSkachadapAka hone ke pUrva adhikAMza rogiyoM ke rakta kA saMvardha mastiSkagolANa kI upasthiti prakaTa kie binA nahIM rhtaa| mastiSkagolANujanya rogANuraktatA mahInoM rahane ke uparAnta mastiSkachadapAka manthara hote hue dekhA gayA hai| eka rogI ko yaha rogANuraktatA 5 mAsa rahI aura isa bIca ise do bAra mastiSkachadapAka huA jisase vaha donoM bAra baca gyaa| mastiSkachadapAka ke 33 pratizata rogiyoM meM prArambha meM raktasaMvardha astyAtmaka avazya hI milatA hai| rogANuraktatA ke kAraNa raktastrAvI vikSata ( haemorrhagic lesions ) hI kevala mila sake haiM / arthAt tvacA yA zlaiSmikakalA para nIlohIya utkauTha ( purpuric rash ) tathA lasAbha dharAtaloM para nIlohAGkIya raktasrAva (petechial haemorrhages ) pAye jAte haiN| __ mastiSkachadIyAvasthA meM sAmAnya lakSaNoM ke sAtha sAtha pramastiSkIya lakSaNa bhI mila jAte haiN| inameM zIrSazUla aura vamana kA pradhAna kAraNa antaHkaroTIya nipIDAdhikya hai / grIvA kI stabdhatA ( stiffiness ) aura pratyAkarSaNa ( retraction ) kA kAraNa mastiSkAdhAra ke pazvabhAga kA prakSubdha honA hai| grIvA ke ye donoM lakSaNa zizuoM ke pazca AdhArIya mastiSkachadapAka meM ugrarUpa dhAraNa kie hue dekhe jAte haiN| vahA~ sira eDI taka ko chUne lagatA hai / TeratA (strabismus yA squint ) tathA For Private and Personal Use Only

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200 vikRtivijJAna dviguNAkSitA ( diplopia ) kA kAraNa mastiSkAghAra ( base of the brain ) para tRtIya caturtha aura SaSTha nADiyoM kA prabhAvita honA hai / antaHkaroTIyanipIDAdhikya kA kAraNa mastiSkoda ke svAbhAvika pracUSaNa ke kArya meM zIrSa bhAga ( vertex ) meM bAdhA A jAnA hai / mastiSkAghAra para sthita jalAzayoM meM jyoM jyoM taralAdhikya hotA jAtA hai tyoM tyoM hI mastiSka Upara kI ora Adhakita hotA hai aura utanI hI bAdhA bar3hatI jAtI hai / isake kAraNa mastiSkanilaya visphArita hone lagate haiM | isa bAdhA ke kAraNa eka vAstavika antarnihita udamastiSka (a true internal hydrocephalous ) prAyaH nahIM milatA parantu zizuoM meM yaha bahudhA dekhA jAtA hai aura vahAM yaha eka mAraka upadrava ke svarUpa kA hotA hai / kucha meM caturthanilaya ke chidra meM eka tantvimat bAdhA ( fibrinous obstruction ) ke rUpa meM yaha dekhA jAtA hai parantu zaizava meM isa bAdhA se bhI bar3hakara mRdula mastiSka kA saMpIDita honA hai / Acharya Shri Kailassagarsuri Gyanmandir aba hama anya sapUya mastiSkachadapAkoM meM 2 pUyajanaka jIvANuoM se utpanna pArkoM kA varNana karate haiM phuphphusagolAvika mastiSkachadapAka AtA, akasmAt prArambha phuphphusagolANvika mastiSkachadapAka ( Pneumocccal meningitis ) pradhAna ( primary ) aura uttarajAta ( secondary ) donoM prakAra kA dekhA jA sakatA hai / pradhAna yA prAthamika upasarga hone para upasarga kA kendra anyatra kahIM nahIM dekhane meM kevala mastiSka zikhara ( vertex ) kI mastiSkachada meM vistRta ApIta haritavarNa kA pUyIya srAva sthita huA dekhA jAtA hai / yaha roga phuphphusa golANvika udaracchadapAka ( pneumococcal peritonitis ) ke samAna hotA hai tathA utanA hI adhika ghAtaka aura bhayaGkara bhI hotA hai / gauNa yA uttarajAta upasarga kA prAthamika kendra pUyIya madhyakarNapAka meM yA nAsA ke kisI atirikta koTara meM athavA phuphphusa meM ho sakatA hai / yahA~ roga kA prArambha utanA tIvra aura Akasmika nahIM hotA parantu avasAna utanA hI ghAtaka hotA hai jitanA ki mukhya prakAra meM / parantu Ajakala rAsAyacikitsA kI abhyunnati tathA Azcarya oSadhiyoM ke AviSkAra ke kAraNa yaha utanA mAraka raha hI nahIM gayA / isa roga meM mastiSka suSumnAjala ( mastiSkoda ) prAyaH atyanta pUyIya dekhA jAtA hai / para kabhI kabhI vaha itanA svaccha bhI ho sakatA hai ki mastiSkachadapAka kI sambhAvanA bhI atyadhika sandehAspada ho jAtI hai / para svaccha tarala kA yaha abhiprAya nahIM ki rogANu hai hI nahIM / yadi tarala amathitrita ( uncentrifuged fluid) se eka citrapaTTI taiyAra kI jAve to usameM asaMkhya phuphphusagolANu dikhalAI par3a sakate haiM / kabhI kabhI mastiSkoda meM tantujana kI mAtrA kucha bar3hI huI bhI dekhI jAsakatI hai| kabhI kabhI tarala ko parakhanalI meM 10 minaTa taka rakhane para vaha jama kara zleSyaka ( jelly ) ke samAna bana jA sakatA hai / For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 201 mAlAgolANvikamastiSkachadapAka mAlAgolANuoM dvArA utpanna mastiSkachadapAka bhI mukhya yA gauNa donoM prakAra kA ho sakatA hai para prathama bahuta kama aura dvitIya prAyazaH dekhA jAtA hai| gauNakAraNajanya mastiSkachadapAka madhyakarNa vA koTarastha upasarga ke kAraNa huA karatA hai| mAlAgolANuoM ke kaI prakAra isameM bhAga le sakate haiM jinameM zoNAMzIya mAlAgolANu, zoNaharita mAlAgolANu tathA zleSmala mAlAgolANu mukhya haiN| antima mAlAgolANu to madhyakarNa se jAtA hai / jo srAva nikalatA hai vaha atyadhika cipacipA aura sapheda hotA hai| sAdhyAsAdhyatA kI dRSTi se Adhunika rAsAyacikitsA ne isake mArakasvarUpa ko bhI paryApta saumyatA pradAna kara dI hai| isakA srAva mastiSka zikhara para mastiSkAdhAra kI apekSA adhika dekhA jAtA hai| kabhI kabhI koTaroM dvArA upasarga pahuMcane para bhI srAvasthAna mastiSka zikhara milatA hai jaba ki milanA cAhie mastiSkAdhAra meN| ___ anya pUyajanaka jIvANu jinake dvArA mastiSkachadapAka ho sakatA hai unake nAma hama nIce de rahe haiM para yaha kabhI nahIM bhUlanA cAhie ki unake dvArA isa roga kI utpatti bahuta hI kama dekhI jAtI hai kabhI lAkhoM meM eka do| ina jIvANuoM ke nAma nimnalikhita haiM: 1. puMjagolANu-inheM mastiSkoda kI citrapaTTiyoM meM bhI kaThinatA se hI dekhA ___ jA sakatA hai| 2. AMtrajvara daNDANu ( Bacillus Typhi ) 3. apyAntrajvara daNDANu ( Bacillus paratyphoid) 4. AntradaNDANu ( Bacillus coli ) 5. pratizyAya daNDANu ( Bacillus influenza ) 6. nIlapUyakazAMgANu ( Bacillus pyocyaneus ) 7. kAlasphoTadaNDANu ( Bacillus anthracis ) 8. phuphphusapAkaprAvaravetrANu ( Klebsiella pneumonae ) 9. sAmAnya azvagranthi kavaka ( Mallcomyces mallei ) 10. painasagucchagolANu ( Micrococcus catarrhalis ) 51. kiraNakavaka ( Actinomyces ) 12. mAlAvetrANu ( Strpetothrix ) vyApakamastiSkapAka (Epidemic Encephalitis ar Encephalitis Lethargica ) yaha roga san 1917 se lekara 1924 taka sabhya kahe jAne vAle dezoM meM pragaTa huA thA / usake pazcAt yaha pUrNataH vilupta ho gayA para kahIM kahIM ikkA-dukkA rogI isase pIDita mila jAte haiM / AsTriyA aura phrAMsa meM yaha roga 1916-17 ke zItakAla meM tathA iGgaleMDa meM 1918 meM tathA saMyuktadeza tathA kanADA meM 1919 meM For Private and Personal Use Only

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202 vikRtivijJAna pahu~cA thA / saMyuktadeza amerikA ke vinIpega nagara meM isake do vyApaka AkramaNa kramazaH 1919-20 tathA 1923 ke prArambha meM hue the| 1924 ke pazcAt isa roga kA mahAmArI ke rUpa meM phailanA banda ho gayA hai aura itastataH kabhI kabhI eka do rogI dekhe jAte haiN| eka amerikana DAkTara bvAyaDa ne svayaM isa roga ke rogiyoM kI cikitsA aura mRtyUttara parIkSA kI thI ataH hama yahA~ usI ke anusAra sampUrNa vivaraNa prastuta karate haiM jo paryApta jJAnaprada sAmagrI upasthita karane meM samartha huA hai| usane vinIpega kI pahalI mahAmArI meM 75 rugNoM kI cikitsA kI thI jinameM 16 kI mRtyUttara parIkSA (autopsy ) bhI sammilita hai| dUsarI mahAmArI meM usane 63 rugNoM kI cikitsA kI thI aura 9 mRtyUttara parIkSAe~ bhI kI thiiN| usake kathanAnusAra donoM mahAmAriyoM meM roga kA naidAnika citra eka dUsare se itanA vibhinna thA ki donoM eka hI roga ke pRthaka svarUpa haiM aisA vicAra bhI nahIM uThatA thaa| 1920 kA rogI, zayyA para lakar3I ke Tukar3e kI taraha par3A rahatA thA usake palaka jhape aura AMkheM banda rahatI thIM cehare para koI bhAva prakaTa nahIM hotA thA, vaha pragADha tandrA meM par3A rahatA thA jisase caitanyAvasthA lAnA kadApi sambhava nahIM dikhalAI par3atA thA / mana pUrNataH udAsa aura sphUrti naSTa ho jAtI thI usakI samajha meM kucha bhI nahIM AtA thaa| parantu 1923 kA rogI usase bhinna prakAra kA thaa| zarIra aura mana donoM sakriya the| peziyA~ nirantara aura satata kAryarata thIM isakI tulanA aunmAdika prakAra se kI jAsakatI thii| rogI zabdoM kI bauchAra karatA thA jinakA prArambha meM kucha artha hotA thA para bAda meM ve kevala pralApa ko hI puSTa karate the| vArtAlApa kA mukhya viSaya udyama ( occupation) rahatA thA : arthAt rugNa zikSaka nirantara par3hAtA rahatA thA, vyApArI hisAba kitAba karatA huA rahatA thA, bhavananirmANakartA bhavanoM kI paimAiza karatA huA dekhA jAtA thaa| yadi pahale prakAra ko hama mandaka mastiSkapAka (Encephalitis Lethargica ) nAma de deM to dUsare prakAra ke lie vaha nAma pUrNataH ayuktiyukta dekha par3egA kyoMki eka citra kriyAnAza kA dyotaka hai to dUsarA kriyodvega kA prakaTAyaka hai| isI lie kriyAmAnya yA kriyAaugraya se dUra vyApakamastiSkapAka yA janapadodhvaMsaka mastiSkapAka isakA nAma de diyA gayA hai| yaha nahIM bhUlanA cAhie ki dUsare prakAra ke rogI jo prArambha meM atyadhika bakajhaka karate aura kriyAzIla the unameM bhI Age cala kara 56 pratizata rogiyoM meM vilamba se yA zIghra kriyAmAnya ( lethargy ) ke lakSaNa prakaTa hone lage the tathA jinako AturAlaya se svastha ghoSita karake unmukta kara diyA gayA thA ve bhI spaSTatayA tandrAlu ( drowsy ) dikhalAI par3ate the| vikRtazArIra kI dRSTi se donoM prakAroM meM koI vizeSa antara na hone ke kAraNa donoM kA sarvasAdhAraNa varNana kiyA jA rahA hai| vikRtazArIra kI dRSTi se pratyakSa yA aNvIkSIya jo ghaTanA ( feature ) pradhAnataH prakaTa hotI hai vaha hai adhiraktatA ( congestion ) / mastiSkachadIya vAhiniyA~ vizeSa kara ve jo For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 203 mastiSkakANDa ke Upara hotI haiM rakta se atipUrNa ( engorged ) ho jAtI haiN| mastiSka ke kaTe hue dharAtala para asaMkhya choTI choTI vAhiniyAM dhUsara aura zveta donoM bhAgoM meM spaSTataH dIkha par3atI haiN| niyamataH ( as a rule ) yaha adhiraktatA mastiSkakANDa ( brain stem ) meM jitanI adhika hotI hai utanI mastiSka golArdo ( cerebral hemispheres ) meM nahIM hotii| yadyapi vyApaka mastiSkapAka kA nidAna kevala dekhane mAtra se nahIM huA karatA para caturthanilaya kI bhUmi meM choTe choTe raktasrAva dekha kara bvAyaDa ne kaI bAra isa roga kA nidAna kara diyA thA jo Age ThIka niklaa| aNvIkSaNa karane para jo vikSata dIkha par3ate haiM unheM antarAlita aura jIvitaka do prakAroM meM le sakate haiM / antarAlita vikSata kI mUlavikRti kA nAma hai pracaNDa vAhinya visphAraNa ( intense vascular dilatation) jo bvAyaDa ko apanI sampUrNa mRtyUttara parIkSAoM meM dekhane ko milA thA tathA kucha zIghra mAraka prakAroM meM to kevala yahI lakSaNa dikhAI diyA thA / raktasrAva jo bahuta sUkSma hotA hai aura jo kevala 10 rugNoM meM hI use milA thA vaha choTI vAhiniyoM ke cAroM ora ke ( parivAhinIya) thor3e kSetra taka hI sImita rahatA hai| atyanta paricita vikSata hotA hai kozAoM kA parivAhinya maNibandha ( perivascular cuff of cells ) vraNazothakArI kozA usa lasI avakAza taka sImita rahate haiM jo mastiSka kI vAhiniyoM ke bAhya aura madhyacola ke bIca meM sthita rahatA hai aura jisakA sambandha brahmodakulyA ke sAtha hotA hai| isa avakAza ko varcIraubina avakAza ( Virchow-Robin space ) kahate haiM / kabhI kabhI ye kozA itane bar3ha jAte haiM ki parivAhinya avakAza jise hija kA avakAza yA hijAvakAza ( space of His ) kahate haiM ko bhI AplAvita kara lete haiN| vaise to hijAvakAza pUrA hI rikta rahA karatA hai| kozAoM ke isa parivAhinya maNibandha ko dekha kara yaha vicAra uTha sakatA hai ki vaha kadAcit vyApaka mastiSkapAka meM hI vizeSa karake dekhA jAtA ho so bAta yathArtha nahIM hai| yaha to eka prakAra kI aviziSTa pratikriyA ( nonspecific reaction ) hai jo mastiSka kI kaI vikRtiyoM meM dekhI jAtI hai jaise dhUsara dravyapAka, sarvAMgaghAta, pramastiSkIya phiraGga, jala saMtrAsa (Alarka), suSuptiroga ( sleeping sickness ), yakSmika mastiSkachadapAka, tANDavajvara ( chorea) tathA mastiSkavidradhi ke samIpa / athavA isakA mastiSka pAka meM upasthita rahanA bhI nitAnta Avazyaka nahIM hai| ina kozAoM meM mukhyataH laghu lasIkozA hote haiM para kucha prarasa kozA tathA ekanyaSTikozA bhI milate haiN| kevala eka hI rugNa meM bahunyaSTikozA bAyaDa ko dekhane ko mile the| isI AdhAra para yaha kahA jAtA hai ki yaha roga nissandeha apUya vraNazotha kA hI eka rUpa hai| ye kozA raktadhArA se hI prApta hote haiM / For Private and Personal Use Only

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204 vikRtivijJAna parivAhinya kozIya saMciti ke atirikta kozA vAhinya-vikSatoM ke samIpa yA anyatra kahIM bhI mastiSka meM dekhe jA sakate haiN| kucha rugNoM meM maNDAbhapiNDoM ( amyloid bodies ) kI upasthiti dekhI jAtI hai jo dekhane meM kAcara, bahIrekhA se gola aura saMkendraNa rekhAoM ( concentric markings) se yukta pAye jAte haiN| jaise piNDa vRddhajanoM meM brahmadvAra suraMgA (aqueduct of Sylvius) tathA caturthanilaya kI bhUmi meM dekhe jAte haiM vaise hI ye hote haiM para unakA avasthA se koI sambandha yahA~ nahIM hone se yuvaka aura vRddha donoM meM ve milate haiN| sAtha hI inake sthAna bhI nizcita nahIM hote ve mastiSka meM kahIM bhI dekhe jA sakate haiN| isa roga meM zuktigarbha (globus pallidus ) kI vAhiniyoM kA tIvra cUrNiyana ( acute calcification ) dekhA jAtA hai para haiDaphIlDa kI khojoM se jJAta huA hai ki yaha cUrNAtu na hokara ayas kI saMciti hotI hai aura yaha zuktigarbha meM svabhAvataH dekhI jAtI hai tathA mastiSkapAka se isakA koI sambandha bhI nahIM hai| ___ mastiSkachada meM vraNazotha ke ve hI parivartana dekhe jAte haiM jo mastiSka meM hote haiN| para bvAyaDa ko adhiraktatA se bar3ha kara kucha nahIM milA aura isI kAraNa mastiSkoda pUrNataH svastha dekhA gyaa| para kahIM kahIM vizeSa karake mastiSkakANDa para halakA sA lasI kozAoM kA antarAbharaNa bhI dekhA jAtA hai| upajAlatAnikIya zotha vizeSa rUpa se dekhA jAtA hai| yaha to huA antarAlita vikSatoM kA varNana / aba hama jIvitaka ( parenohymatous ) vikSatoM kA vicAra karate haiN| jIvitaka vikSatoM meM nimna mahatvapUrNa haiM:1. nADI kandANuoM (cetaikoM) kA vihAsa (degeneration of neurons) jisakA pramANa hai-varNahAsa ( chromatolysis ) / 2. nyaSTi kI utkendratA ( eccentricity of the nucleus ) / 3. kozA kAyA kA vilopa ( disappearance of cell body ) / inake atirikta kucha vidvAn nADIkandANubhakSaNa ( neuronophagia) ko bhI mAnate haiN| para bvAyaDa use dhUsaradravyapAka (poliomyelitis ) meM adhika dekhatA hai| ___ uparokta parivartana prAyaH mastiSka bAhyaka meM upasthita rahate haiM parantu zIrSaNyA nAr3iyoM ( cranial nerves ) meM bhI ve adhikatara dekhe jAte haiM vizeSa karake tRtIyA, SaSThI, saptamI aura dvAdazI nADiyoM meN| prathama mahAmArI meM 75 pratizata rogiyoM kI tRtIyA nADI nyaSTi meM vihAsa dekhA gayA thaa| vaise hI parivartana dhamillaka ( cerebellum ) ke kalasikAkhyakandANuko ( Purkinje cells ) meM bhI milate haiN| parantu ve atyadhika vistRta rUpa meM nahIM milate jaise ki dhUsaradravyapAka For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 205 meN| vAhinya aura vihAsAtmaka vikSatoM kA Apasa meM koI bhI sambandha bvAyaDa nahIM baiThA sakA hai| usakI dRSTi meM ve vibhinna tathyoM para avalambita jAna par3ate haiM / suSumnA meM jo parivartana hote haiM ve mastiSka ke samAna hI hote haiM aura ve kucha rogiyoM meM dekhe bhI jAte haiN| saba meM hoM aisA anivArya nhiiN| baroja kI dRSTi meM zIrSaNyA nAr3iyoM meM bhI vraNazotha dekhA jA sakatA hai para anyoM ne idhara koI vizeSa dhyAna diyA nahIM aisA pratIta hotA hai / vraNazothAtmaka vikSatoM kA prasAra na to bAhyaka meM hotA hai aura na dhamillaka meN| api tu vaha sarvaprathama madhya mastiSka meM hotA hai usameM bhI brahmadvAra suraGgA ke cAroM ora ke kSetra meM vizeSa prabhAva par3atA hai| dUsarA sthAna AtA hai mastiSka mUla piNDadvaya ( basal ganglia) kA / tRtIya sthAna hai uSNISaka ( pons varolii ) kaa| tatpazcAt suSumnA kA sthAna hai| isa prakAra yaha roga vizeSataH mastiSka kANDa kA roga hai| suSumnA meM vikSata bahuta hI kama aura kabhI kabhI pAye jAte haiN| kucha vikSata vAtanADIsaMsthAna ke bAhara bhI dekhe gaye haiN| inake kAraNa hameM roga ke sambandha meM kucha na kucha adhika jJAna hI hotA hai| bvAyaDa ke sampUrNa rugNoM meM se 3 ke apihRt ( epicardium ) udaracchada, mahAprAcIrA pezI ke dharAtala tathA phuphphusAvaraNa meM aneka nIlohAGkIya raktasrAva dekhe gaye the| vRkkoM meM bhI prAyazaH parivartana mile the| vRkka ke majjaka meM atyadhika adhiraktatA kA milanA atyanta mahattva kA cinha hai| vRkka kI parivalita nAlikAoM ( convoluted tubules ) meM asAdhAraNa mAtrA meM vihAsa milatA hai| nIce hama mastiSkapAka tathA suSumnAdhUsaradravyapAka ke vikSatoM kI tulanAtmaka tAlikA prastuta karate haiM / yadyapi ye donoM roga spaSTa haiM para inameM vikRti kA citra eka sA hI hai isI kAraNa isakI AvazyakatA par3I hai:mastiSkapAka suSumnAdhUsaradravyapAka 1. yaha mukhyataH madhyamastiSka kA roga hai| 1. yaha mukhyataH suSumnA kA roga hai 2. isake vikSatoM kI tIvratA ArohI hai| 2. isake vikSatoM kI tIvratA avarohI hai (Upara adhika nIce kama) / (Upara kama nIce adhika) 3. suSumnA para AghAta halakA hotA hai ! 3. suSumnA para pracaNDa AkramaNa hotA hai 4. nADIkandANubhakSaNa yA pragaNDakozA | 4. nADIkandANubhakSaNa (neurono (ganglion cells ) nAza kama | phagia ) tathA pragaNDakozA nAza hotA hai atyadhika hotA hai 5. kozIya parivAhinyabharamAra dekhI 5. kozIya parivAhinyabharamAra ke sAtha jAtI hai tIvranAbhyabharamAra aura UtimRtyu ( necrosis ) khUba hotI hai 6. bahunyaSTikozA bahuta kama milate haiM / 6. bahanyaSTikozA khUba pAye jAte haiM For Private and Personal Use Only

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206 vikRtivijJAna 7. suSumnA ke agra aura pazcazRMga donoM / 7. agrazrRMgoM ( anterior horns ) para prabhAvita hote haiM / atyadhika AghAta dekhA jAtA hai 8. zleSakozAoM kI vRddhi koI mahattva- 8. zleSa kozAoM (glia cells ) kA pUrNa nahIM hotI mastiSkachada prati- praguNana khUba hotA hai tathA mastiSkakriyA nahIM hotI chada kI pratikriyA pracaNDa hotI hai 9. mastiSkoda meM kozAdhikya nahIM hotA 9. mastiSkoda meM kozAdhikya hotA hai __ mastiSkoda-mastiSkoda kA adhyayana mastiSkapAka kI dRSTi se kara lenA Avazyaka hai / yadyapi mastiSkoda meM koI vizeSa parivartana dRggocara nahIM hote kyoMki yahA~ mastiSkachada kI pratikriyA dekhI nahIM jaatii| phira bhI kaI mahattva ke nidAna ke AdhAra haiM jinheM hama isase pAte haiM aura jo nimna haiM: 1. mastiSkoda kA nipIDa bar3ha jAtA hai| 2. mastiSkoda kI mAtrA bar3ha jAtI hai| 3. vartuli (globulin ) kI vRddhi nahIM hotii| 4. kozAgaNana prAyaH prakRta rahatA hai para kucha meM thor3A bar3ha kara 50 taka ho jAtA hai 100 taka kadAcit hI kabhI jAtA ho / 5. kozA sabhI lasI kozA ( lymphocytes ) hote haiM / 6. suSumnA dhUsaradravyapAka aura yadimaka mastiSkachadapAka meM upasthita tasvi___ jAla ( web of fibrin ) yahA~ anupasthita rahatA hai| 7. zarkarA prakRtamAtrA se sadaiva alpa rahatI hai| roga kA kAraNa ( aetiology ) kyA hai isake sambandha meM aneka mata haiM para nizcayAtmaka koI bhI nahIM hai| hama inake matoM ko vaijJAnikoM ke nAmoM ke sAtha smaraNa kie lete haiM parantu satya kA anveSaNa abhI calatA hI rahegA vIjanara-suSavadhAvya (gram-positive) golANu ko roga kA kAraNa mAnatA hai| aijanau-vIjanara ke mata ko puSTa karate hue suSavadhAvya mAlAgolANu ko kAraNa mAnatA hai| (parantu golANu gauNa AkrAmaka ho sakatA hai mukhya kAraNa nahIM) grUTara-sI sAmAnya ( herpes simplex ) ke viSANu ke dvArA yaha roga phailatA hai| phlaiksanara-aura usake sAthI isa roga ko viSANujanita mAnate haiM para viSANu kA patA nahIM lagA sake / lo tathA sTrausa-isake viSANu kA patA lagAte rahe / levaiDiTI tathA haraviyara-viSANu kI khoja meM tallIna haiN| Doara-viSANu kI khoja meM haiN| maikakArTanI-ne zazakoM ke mastiSkapAka kA kAraNa eka laghu bIjANu ( microsporidium ) mAnA hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 207 aulIvara-ne zazakoM aura manuSyoM ke mastiSkapAka kI tulanA karake yaha batAyA ki donoM kI vikRti prArambha meM eka sI rahane para bhI Age cala kara badala jAtI hai| guDapAzcara ne kahA hai ki jo viSANu isa roga ko phailAtA hai vaha vAtanADiyoM ke akSarambhoM meM se mArga banAtA hai| vimajikaJcuka ise apane sthala meM rakhatI hai para jaba yaha kendra para pahu~catA hai to phira itastataH phaila jAtA hai| levaiDiTI-sIsAmAnya ke viSANu ko hI isakA kAraNa mAnatA hai| paradrau-sIsAmAnya ke viSANu ke kisI ugra prakAra ko isakA kAraNa mAnanA cAhatA hai| parantu sIsAmAnya bar3I saralatA ke sAtha kisI anya meM pahu~cAyA jA sakatA hai aura isakA viSANu bar3I kaThinAI se upasarga karatA hai| isa kaThinAI ko usane samajhAte hue kahA hai ki manuSya ke mastiSka meM AkrAmaka ( aggressin ) aura pratidvandvI (antibody ) do kAraka hote haiM jinameM prathama viSANu kI vRddhi karatA hai aura dvitIya usakI vRddhi ko rokatA hai isI kAraNa sIsAmAnya kA viSANu mastiSkapAka karane meM dera lagAtA hai| usane isa pratidvandvI kAraka ko naSTa karane ke lie mastiSka ko madhurI aura barpha meM rkhaa| pratidvandvI kAraka ke samApta hone para phira isa mastiSka meM sthita viSANu dvArA zazakoM meM saralatA se rogotpatti kI jA sakatI hai aisA usane batAyA hai| ___ sIsAmAnya ke dvArA isa roga kI utpatti ko siddha karane ke mArga meM aneka bAdhAe~ haiM jinheM pahale dUra kara lenA hogA tabhI isa mata kA saMsAra svAgata kregaa| sabase pahale to hama dekhate haiM ki sIsAmAnya kA jitanA prasAra adhika hai vyApaka mastiSkapAka kA utanA hI kama hai| dUsare mastiSkapAka jina jinako huA hai unameM oSTha yA akSagata sI kA koI udAharaNa nahIM dekhA gyaa| lakSaNoM kA vikSatoM se sambandha-vyApaka mastiSkapAka meM jo lakSaNa dekhe jAte haiM unakA vikSatoM se kyA sambandha hai ise kahanA atyanta kaThina hai| pahalI bAta to yaha hai ki koI rogI isa roga meM sotA hai aura koI bakatA hai parantu donoM dazAoM meM vikSata eka se hI dekhe jAte haiN| aisA lagatA hai ki eka deza meM roga kisI eka rUpa meM prArambha hotA hai aura dhIre dhIre apanA rUpa badalatA jAtA hai tathA anta meM pUrNataH vilupta ho jAtA hai| vinIpega kI do mahAmAriyoM ke madhya meM 3 varSa kA antara hai / eka meM suSupti aura niSkriyatA kA bolabAlA rahA aura mRtyu saMkhyA 39 pratizata rhii| dUsarI meM atikriyatA aura pralApa ke sAtha mRtyu saMkhyA 25 pratizata milii| aba hama roga ke pramukha lakSaNoM ko lete hue unakA sambandha vikSatoM se sthApita karate haiN| suSupti-rogI kI suSuptAvasthA, jisase ki use jagAyA jA sakatA hai parantu jagate hI phira vaha usI avasthA ko pahu~ca jAtA hai, isakA kAraNa ajJAta hai| isa ajJAna kA kAraNa hamArA nidrA ke kAraNa kA jJAna na honA bhI hai| itanA hama kaha sakate haiM ki netra ceSTanI nADI ( oculomotor ) kI kriyAoM kI gar3abar3I isakA pradhAna hetu hai jinakA kAraNa madhyamastiSka meM vikSatoM kI upasthiti hai| For Private and Personal Use Only

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208 vikRtivijJAna netraceSTanI nADI kI kriyAoM kA vikAra-prArambha meM rogI kI dvidhA dRSTi ( di. plopia) ho jAtI hai| vartmapAta (ptosis ) TeratA (strabismus) anya adhika hone vAle lakSaNa haiN| dekhane kI gar3abar3I kA mukhya kAraNa calAkSa bhujAyana ( accomo. dation ) kA ghAta hai| yahA~ ArjilarAbarTasana tArA kA viloma milatA hai arthAt prakAza meM tArA ( pupil ) saMkoca karatA hai para calAkSa bhujAyana ke lie saMkoca nahIM karatA / roga ke haTa jAne ke pazcAt bhI bahuta kAla taka calAkSa bhujAyana kI durbalatA rogiyoM meM dekhI gaI hai jinameM eka rogI ko to 5 mAsa taka dvidhA dRSTi rahatI hai| tArA kI utkendratA kA kAraNa madhyamastiSka meM vikSata honA hai| bvAyaDa ke 1920 ke rugNoM meM 16 meM 12 kI tRtIyA nADI kI nyaSTi ke samIpa vikSata dekhe gaye the| zIrSaNyA nADIya ghAta-isa roga kA eka sAmAnyalakSaNa zIrSaNyA nADiyoM ( cranial nerves ) kA daurbalya hotA hai inameM netra ceSTanI ( tRtIyA, caturthI aura SaSThI) nADiyA~ tathA saptamI nADI atyadhika prabhAvita hotI haiN| aneka rogiyoM kI ina nADiyoM kI nyaSTiyoM meM vraNazotha tathA vihAsa donoM hote hue dekhe gaye haiN| kucha vAtanADiyoM ke Upara mastiSka ke andara visphArita raktavAhiniyoM ke dvArA bahuta pIDana hotA rahatA hai| zIrSaNyA nADiyoM kA jo ghAta hama isa roga meM pAte haiM vaha sthAyIsvarUpa kA nahIM hotaa| jaise eka lakSaNa TeratA Aja rogI meM milegA aura kala patA nahIM kahA~ calA jaavegaa| isI prakAra adita Aja hai kala nhiiN| isa ghaTanA se aisA lagatA hai ki yadi nADiyoM kI nyaSTiyoM meM vihrAsa huA hotA to yaha asthAyitva (fleeting character of symptoms ) kadApi na hotaa| isase yaha mata puSTa hotA hai ki jaba nADiyoM para yA unakI nyaSTiyoM para raktavAhiniyoM kA nipIDa adhika hotA hai to ye lakSaNa dekhe jAte haiM aura jaba vaha kama ho jAtA hai to nahIM dekhe jaate| ceSTA vikSobha ( motor disturbances ) zArIrika ceSTAoM kI kaI prakAra kI gar3abar3I isa roga meM dekhI jA sakatI hai / prArambha meM pezIya kAThinya ( muscular rigidity ) milatI hai| rogI pezI kI marjI ke mutAbika nAcatA hai| pahale to koI kriyA prArambha honA hI kaThina hotA hai| para yadi kriyA calapar3I to phira usakA rokanA rogI ke niyantraNa ke bAhara kI bAta hai| yadi rogI thor3A muskarA diyA to phira muskarAhaTa kA bhAva bahuta dera taka cehare para banA rahatA hai| __ isa roga meM Urdhva kriyA ceteka prakAra kA vAstavika aMgaghAta ( true paralysis of the upper motor neuron type ) isa kAraNa nahIM hotA ki mukulatantrikA ( pyramidal tract) para isa roga kA koI prabhAva nahIM dekhA jaataa| tIvra aura jIrNa donoM prakAra ke mastiSkapAkoM meM vikRta pezIya gatiyA~ (ab. normal muscular movements ) dekhI jAtI haiM ye gatiyA~ jhaTake ke sAtha hone vAlI hotI haiM jaisI kI tANDavajvara ( chorea ) meM dekhI jAtI haiN| ThIka inase For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 206 viparIta savirAma AkSepa ( olonic spasms ) hote haiN| inhIM AkSepoM ke kAraNa vinIpega meM vyApaka mastiSkapAka ke sAtha sAtha hikkA kA bhI vyApa dekhA gayA thA jisakA kAraNa udaradaNDikA meM pracaNDa saMkocanoM kI upasthiti thii| yaha hikkA rogiyoM tathA cikitsakoM donoM meM hI dekhI gayI thI aura vaha eka se pA~ca dina lagAtAra isa jora se rahI ki sonA taka dUbhara ho gayA thaa| ikonomo ke eka rogI ko to yaha hikkA eka mAsa taka rahI thii| hikkA kA yaha vyApa dUsarI mahAmArI meM pragaTa nahIM huaa| ina AkSepoM kA samAdhAnakAraka kAraNa abhI taka nahIM milaa| para aisA lagatA hai ki unakA hetu sauSumnika nADI mUloM (spinal roots) kA prakSobha rahA hogA kyoMki sAtha sAtha vAtanADI. kI pariNAhI athavA mUlIya vedanA bhI dekhI jAtI thii| kriyAoM ke jo itane vikSobha dekhane meM Ate haiM unakA kAraNa mukulatantriketara saMsthAna ( extrapyramidal system ) kA vikSobha ho sakatA hai| rAmajehaNTa kA kathana hai ki mastiSkapAka meM jo ceSTAvikSobha hotA hai usakA kAraNa rAjilapiNDa ( corpus striatum) meM vikSatoM kA honA hai| rAjilapiNDa ke 2 bhAga racanAtmaka dRSTi se hote haiM eka prAcIna jise zuktigarbha (globus pallidus ) kahate haiM isameM vikSata hone se pezIkAThinya aura kampa ( tremors ) hote haiM tathA dUsarA nayA jisameM zuktipITha (putamen) aura zapharIkanda (caudate nucleus) sammilita haiM inameM vikSata hone se aneka AkSepa Ate rahate haiM aura gatiyoM kA niyantraNa samApta ho jAtA hai / parantu haNTa ke ukta vicAra kI puSTi isa roga meM kahIM se bhI nahIM hotii| jo mata isa samaya cala rahA hai usake anusAra mastiSkapAkottarIya kampavAta ( post encephalitic Parkinsonism ) kA kAraNa zyAmapatrikA (substantia nigra.) meM pradhAna vikSata kA honA hai| hohamaina ke parIkSaNoM se yaha siddha huA hai ki isa roga meM zyAmapatrikA kI zyAmatA kaI sthaloM para ur3a jAtI hai aura nADIsUtra naSTa ho jAte haiM, zyAmapatrikA meM jitanA AghAta hotA hai utanA anyatra nahIM dekhA jAtA hai| zyAmapatrikA ke pazcAt jina aMgoM para prabhAva par3atA hai vaha AghAta kI ugratA kI dRSTi se kramazaH rAjilapiNDa kA nava bhAga phira prAcInabhAga phira pramastiSkIya bAhyaka ( cerebral cortex) tathA madhyamastiSka kA kuthavitAna ( tegmentum) hai| ina kSetroM meM kozAvihAsa ke cihna kozAoM kA AsaMkocana ( shrinkage ), pravilayana ( dissolutions ) tathA nADI kandANubhakSatA ( neuronophagia) hai| nAr3I tantuoM meM sUjana se lekara zvetadravyakSetroM kA pUrNa vilopana taka dekhA jAtA hai| yaha saba jIrNAvasthA meM milatA hai tathA roga kI tIvrAvasthA meM kevala parivAhinya vikSata milate haiN| saMkSepa meM hama itanA kaha sakate haiM ki mastiSkottara kampavAta yA pArkinsonIyatA meM zyAmapatrikA ke vinAza ke kAraNa pezI kAThinya aura kampa ( tremors) utpanna For Private and Personal Use Only

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210 vikRtivijJAna ho jAte haiM kyoMki zyAmapatrikA mukulatantriketaranADImArga kA eka sTezana hai / parantu ghAtakampa ( paralysis agitans ) nAmaka roga meM vikSata rAjilapiNDa meM hote haiM / saMjJAvikSobha ( sensory disturbances ) - vAtikazUla ( neuralgia ) vyApaka mastiSka pAka ke sAtha itanA hotA hai ki kucha lekhakoM ne to ise vAtika prakAra kA hI mAna liyA hai| eka rogI ke hAthoM aura pairoM meM ghora zUla dekha kara use pariNAhI vAtanADIpAka ( peripheral neuritis ) samajha liyA gayA thA para jaba use suSupti Adi lakSaNa 3 saptAhoparAnta mile to mastiSkapAka kA sandeha huaa| kabhI kabhI isa roga meM udarazUla ho jAtA hai jisake kAraNa vaidya uNDakapucchapAka kA sandeha kara sakate haiM / vinIpega kI dUsarI mahAmArI meM sira aura cehare para zUla anekoM ne batalAyA thA / ina gar3abar3oM ke vikSata kahA~ ho sakate haiM yaha nahIM kahA jA sakatA / ve vAtanAr3iyoM kI pazcamUloM se lekara AjJAkanda ( thalamus ) taka kahIM bhI dekhe jA sakate haiM / mastiSka pAka kha (Encephalitis B ) 1933 I0 meM seNTaluI aura usake Asa pAsa mastiSkapAka kI eka aura mahAmArI phailI thI jise mastiSkapAka kha kahA gayA hai / isa roga kA prArambha Akasmika hotA hai, jisake sAtha mAthe meM aura zikhara para ghora vedanA hotI hai / 24 ghaNTe ziraHzUla ke pazcAt rogI tandrA ( stupor ) meM calA jAtA hai, jvara aura grIvAkAThinya barAbara cane rahate haiM / lagabhaga paJcamAMza rogiyoM meM vamI, udarazUla aura hallAsa kiMsaillA aura brAuna ne batAyA hai / mRtyUttara parIkSA karane para grahaNIpAka ( duodenitis ) bhI kahIM kahIM dekhA gayA hai / ghAtaka rogiyoM meM pratizyAyasama zvasanaka bhI pAyA gayA hai mastiSkoda meM kozAgaNana 50 se 100 taka tathA zarkarA 60 se 100 milI grAma taka pAI gaI hai / isa roga meM aura vyApaka mastiSkapAka meM antara itanA hI rahatA hai ki isameM suSupti ( somnolence ) nahIM milatI, AkSepa prAyaH dekhe jAte haiM, netraceSTanI nADI kA ghAta nahIM milatA, anya upadrava koI nahIM dekhA jAtA / isake vikSata mastiSka meM milate haiM madhyamastiSka meM nahIM milate | isa roga kA kartA eka nizcita prakAra kA viSANu hotA hai jisakA jJAna prApta kara liyA gayA hai / tIvraupasargika mastiSkasuSumnApAka (Acute infective Encephalomyelitis) Adhunika kAla meM bahudhA aisA dekhA gayA hai ki yadi kisI ko kisI rakSANu lasI (prophylactic vaccine) kA antaHkSepaNa kiyA jAve to kucha rogiyoM meM mastiSkapAka ho jAtA hai / romAntikA, zItalA aura kSudramasUrikA se grasta rogiyoM meM bhI yaha mastiSkapAka dekhA jAtA hai / zItalA yA Alarka rakSArtha prayukta lasa dvArA bhI yaha hotA hai / isI se ise lasottarIya mastiSkapAka ( post-vaccinal For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 211 encephalitis ) bhI kahate haiM / iGgaleMDa meM jahA~ yaha roga 50000 meM 1 ko hotA hai hAleMDa meM 50000 meM 10 ko dekhA jAtA hai jisakA kAraNa yaha hai ki prathama deza meM jahA~ 1 varSa se nIce hI masUrIkaraNa hotA hai dUsare deza meM usake bAda hotA hai| yaha roga masUrIkaraNa ke gyArahaveM dina prakaTa hotA hai| roga kA AkramaNa sahasA hotA hai sAtha meM jvara, vamI, TeratA, ziraHzUla tathA aMgaghAta Adi lakSaNa hote haiN| isa roga ke vikSata na vyApaka mastiSkapAka se milate haiM aura na suSumnAdhUsara dravyapAka se hI milate haiN| isameM mastiSkachadapAka vibhinna aMzoM meM dekhA jAtA hai tathA lasIkozIya bharamAra milatI hai| sampUrNa kendriya vAtanADI saMsthAna meM parivAhinyavraNazothIya maNibandha ( jaise ki vyApaka mastiSkapAka meM dekhe gaye the) milate haiM ve zvetapadArtha meM dhUsaradravya kI apekSA bahuta adhika hote haiN| ve kozA kevala parivAhinya ( perivascular ) hI nahIM hote api tu zvetadravya meM pUrNataH prasarita hote haiM, ye uSNIka meM khUba hote haiM tathA suSumnA ke kaTipradeza ( lumbar region ) meM itane adhika hote haiM ki vahA~ para tIvra suSumnApAka ( myelitis ) ho jAtA hai / isa roga kA pramukha vikSata hotA hai vAhiniyoM ke samIpastha zvetadravya kA vimajjIyana (demyelination ) jisake kAraNa ayas zoNitajArali tathA vIgArTapAla citraNa se kAlI sataha para pANDura varNa ke kSetra dikhAI dete haiM / paraDrau kI dRSTi meM pANDura kSetroM meM aNuzleSakozA rahate haiM jo saMyukta kaNAtmaka kozAoM ( compound granular corpuscles ) meM badalate haiM jo kendriya vAtanADIsaMsthAna ke pramukha svacchakakozA ( scavanger cells) kahalAte haiN| isa roga meM vimaji kA apaharaNa bahuta zIghra hotA hai| jahA~ AghAtajanya suSumnApAka meM vimaji kaI saptAhoM meM haTa pAtI hai yahA~ ina svacchaka kozAoM dvArA vaha 3-4 dina meM hI haTA dI jAtI hai / yaha vimajjIyana zItalA, romAntikA tathA prati Alarka masUrIkaraNa (antirabies inocculation ) meM bhI isI drutagati se dekhA jAtA hai| yaha anya do mastiSka rogoM viprathita jAravya ( disseminated sclerosis ) tathA zilDara kA pariakSIya prasara mastiSkapAka (Schilder's encephalitis periaxialis diffusa ) meM aura bhI dekhA jAtA hai| masUrikottarIya mastiSkapAka kA kAraNa Tarnabula tathA maikiMToza masUrI yA rakSANulasIstha viSANu ko mAnate haiM para anyoM kA yaha kathana hai ki yaha viSANu mastiSka meM zAnta par3A rahatA hai aura rakSANulasa ( vaccine ) ke dvArA kriyAzIla kara diyA jAtA hai| romAntikottarIya mastiSkapAka ke pramANa bhI mile haiM inake mukhya vikSata aneka parivAhinya raktastrAvoM ke rUpa meM mastiSka meM milate haiM tathA vraNazothAtmaka kozIya maNibandha pAye jAte haiM / mastiSkoda meM kozAgaNana bar3ha jAtA hai tathA vartuli pratikriyA bhI bar3ha jAtI hai| For Private and Personal Use Only

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212 vikRtivijJAna aba hama tIvra bhagra dhUsarasuSumnApAka yA tIvra agra suSumnA dhUsaradravyapAka kA varNana karate haiM / . tIvra agra suSumnA dhUsaradravyapAka yA zaizavIyAGgaghAta (Acute anterior Poliomyelitis or Infantile Paralysis) 1 suSumnA dhUsaradravyapAka una vAta rogoM meM se eka hai jo sthAnika yA jAnapadika kisI bhI rUpa meM utpanna ho sakatA hai / isa zatAbdI ke Arambhika caturthAMza kAla meM isakA jagadvyApI prabhAva dekhA jA cukA hai / yaha zizu roga na ho kara bAlaroga hai aura 15 varSa yA unase bhI bar3e bAlakoM meM dekhA jAtA hai / yaha roga grISmakAla ke prArambha meM hara varSa AtA aura zIta se pUrva calA jAtA hai / grISma Rtu meM Ane ke kAraNa kucha loga aisA samajhate haiM ki kadAcit isakA saMkrAmaNa ( transmission ) kisI kI prasAraka ( insect vector ) dvArA hotA hogA aura makkhI ko isakA kartA mAnate the jo Aja eka bhramamAtra raha gayA hai / isa roga kA prasArakartA na koI kITa hai aura na isa roga se pIDita eka dukhI prANI api tu eka svastha vayaska vAhaka hotA hai jisakI nAsAgrasanI meM isa roga kA karane vAlA eka viSANu rahatA hai / yadi usa vyakti ko yaha roga ho gayA to usa viSANu kI rogasaMvAhana kI zakti naSTa ho jAtI hai para yadi vyakti roga se pIr3ita na ho sakA to usakI nAsAgrasanI meM yaha viSANu 2-3 saptAha jIvita rahatA tathA roga kA prasAra karatA rahatA hai / cU~ki rogI isa roga kA prasAra karane meM asamartha rahatA hai isI kAraNa AturAlayoM meM sAmAnya Atura koSThoM ( wards ) meM bhI isa roga se pIDitoM ko praviSTa kara liyA jAtA hai / suSumnA dhUsaradravyapAka eka pAvyaviSANu ( filtrable virus ) dvArA hone vAlA roga hai / yaha eka vizuddha cetAkarSI yA vAtotyAkarSI ( neurotropic ) roga hai / yaha roga kRntakoM ( rodents ) dvArA phailAyA jA sakatA hai jisakA pramANa ha hai ki yadi kisI ghara meM isa roga se pIDita koI prANI ho aura usake yahA~ ke kisI cUhe ko pakar3a kara parIkSA kI jAve to usameM yaha roga milatA hai / yaha roga nAsAmArga para viSANu kA lepana karake bandaroM meM bhI utpanna kiyA jA sakatA hai parantu manuSyoM meM isa paddhati se rogotpatti nahIM kI jA sakatI / rogakAla meM tathA rogottarakAla meM isa roga ke viSANu ko rogI ke mala meM bhI dekhA gayA hai aura use vahA~ se pRthak kiyA jA sakatA hai / yaha cudrAntra, bRhadantra tathA AntranibandhanI ke lasagaNDoM (lymph nodes of mesentery ) meM bhI pAyA gayA hai / viSANu kI mala meM prApti jitanI sarala hai utanI siMghANaka ( nasal washings ) meM sarala nahIM hai / mala kaI saptAha taka upasRSTa dekhA jAtA hai pariNAmoM se aisA pratIta hotA hai ki zaizavIyAGgaghAta prathamataH Antrika roga hai na ki zvasanamArgIya / isase yaha bhI lagatA hai ki jaise Antrika jvarAdi ke upasarga azuddha For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 213 anna-jala ke sevana se ho sakate haiM usI prakAra yaha bhI hotA hai / parantu phebara aura silvarabarga ne 8 maraNAsanna rogiyoM kI parIkSA karake yaha batalAyA hai ki zvasanamArga tathA UrdhvamahAsrotIya mArga dvArA isakA praveza jitanA hotA hai utanA AMtoM dvArA nahIM / grasanI isa dRSTi se roga praveza kA mukhya sthala hai / parantu yaha kahanA ki saba - rogiyoM meM yaha viSANu isI eka mArga se jAtA hai sarala nahIM hai / para yaha nirvivAda satya hai ki nAsAmArga dvArA isa roga kA praveza nahIM hotA hai jaisA ki bandaroM meM dekhA gayA hai / viSANu svatantra nADImaNDala ( prathama svAyatta cetAmaNDala - sympa thetic nervous system ) kI nADiyoM dvArA suSumnA taka le jAyA jAtA hai| tathA paMcamI navamI aura dazamI zIrSaNyA nADiyoM dvArA yaha madhya mastiSka USNISaka evaM suSumnAzIrSaka (medulla oblongata ) taka jAtA hai / grIna kI dRSTi meM roga mahAsrota ( alimentary tract ) dvArA vAtanADIsaMsthAna taka pahu~catA hai / mahAsrota kI svatantra nADiyA~ bhI use suSumnA taka le jA sakatI haiM / viSANujanya roga jIvanabhara ke lie pratIkAritA ( immunity ) utpanna karane meM jaise anyatra samartha hote haiM usI prakAra isa prakAra ke kAraNa bhI prANI meM jIvanabhara ke lie pratIkAritA utpanna ho jAtI hai aura pratIkArapiNDa ( immune bodies ) roga se mukta prANI ke rakta meM pAI jAtI haiM / yaha pratIkAritAzakti upasarga ke chaThe dina bhI mila sakatI haiN| eka bAra isa roga se pIDita hone para vyakti ko dUsarA AkramaNa prAyaH nahIM dekhA jAtA / aba hama zaizavIyAGgaghAta yA suSumnA dhUsaradravyapAka ke vikRta zArIra ( morbid anatomy ) kA vicAra prastuta karate haiM / jaba tAnikAoM ( meninges ) ko kholA jAtA hai to suSumnAkANDa udubjata ( bulged ) ho jAtA hai yaha prakRtAvasthA se kahIM adhika dRDha dekhA jAtA hai isakA kAraNa isakA zopha ( oedema ) hotA hai / suSumnA tathA mastiSka donoM meM sthita dhUsara padArtha meM adhiraktatA dekhI jAtI hai tathA tAnikAoM meM bhI raktAdhikya hotA hai / kyA tAnikAoM dvArA roga suSumnA ko pahu~catA hai ? isa prazna kA uttara bvAyaDa nakArAtmaka detA hai para prArambha meM tAnikAoM meM vikSata hote haiM ise vaha mAnatA hai / 1 aNvIkSaNa para jo parivartana dRSTigocara hote haiM ve gahana aura vistRta hote haiM / ye parivartana suSumnA ke trika bhAga ( sacral region ) se lekara mastiSkamUla piNDoM taka dekhe jAte haiM / suSumnA ke kaTIya pravRddha bhAga meM vikSata sarvAdhika hote haiM usake pazcAt graivika pravRddha bhAga meM pAye jAte haiM / isa roga ke pramastikIya suSumnA zIrSIya tathA sauSunika kaI prakAra milate haiM / inakA abhiprAya yaha na samajha lenA cAhie ki unhIM sthAnoM para roga hotA hai api tu usase yahI lenA cAhie ki vahA~ vahA~ roga apanI tIvratA ke sAtha upasthita hai tathA anyatra bhI hai| kA roga dekhA jAtA hai jisakA pramANa vinIpega ke 1924 kI kSudramahAmArI se kabhI kabhI eka hI prakAra For Private and Personal Use Only

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214 vikRtivijJAna rugNoM kA adhyayana kiyA / yaha nahIM bhUlanA cAhie maikaIkarna ne diyA hai | usane batalAyA hai ki usane jitane ve sabhI suSumnAzIrSIya prakAra ( bulbar type ) ke the ki mRtyUnmukha rogiyoM meM suSumnAzIrSaka meM vikSata avazya dekhe jAte haiM kyoMki mRtyu kA kA kAraNa suSumnAzIrSastha zvasanakendra kA ghAta hI isa roga meM hotA hai / tAnikAoM meM raktAdhikya aura prArambhika vikSata hone ke kAraNa roga ke prArambha meM jo do lakSaNa zUla aura grIvAstambha tathA anAmya pRSTha ( rigid back ) dekhe jAte haiM unheM tAnikI vikSatajanya kucha loga kahate haiM parantu harsTa ne bandara meM yaha roga utpanna karake turata mArakara usakI suSumnA kA avalokana karake jJAna yaha prApta kiyA ki usakI tAnikAe~ svastha thIM aura unameM koI vraNazotha ke lakSaNa bhI nahIM the parantu suSumnA ke agrazRMgastha ceSTAvahakozAoM meM vihAsa kA Arambha ho gayA thA / tAnikIya adhiraktatA ke sAtha sAtha unase kucha vraNazothAtmaka srAva bhI atyadhika mAtrA meM hotA huA dekhA jAtA hai / I mastiSka tathA suSumnA meM isa roga meM jo vijJata dekhe jAte haiM ve zveta aura dhUsara donoM padArthoM meM hote haiM parantu dhUsaradravya meM ve jitane ugra hote haiM utane zvetadravya meM nahIM hote / svayaM suSumnA meM gambhIra vikSata na kevala agrazRMgoM (anterior horns) meM hI hote haiM api tu pazcazRGgoM tathA klArka nADItantrikA ( Clark 's column ) meM bhI milate haiM / 've suSumnAzIrSaka, uSNISaka, madhyamastiSka, dhamillaka kI danturakandikA ( dentate nucleus ) tathA mastiSkamUla piNDoM meM bhI dekhe jAte haiM / unake atirikta pazcamUla pragaNDoM ( posterior root ganglia ), tridhAragraMthi ( Gasserian ganglion ), agranADImUla tathA pazcanADImUloM meM bhI pAye jAte haiM / raktavAhiniyoM, antarAlita UtiyoM tathA pragaNDa kozAoM meM bhI vizeSa vizeSa parivartana dekhe jAte haiM / raktavAhiniyoM meM atyanta raktAdhikya ho jAtA hai tathA raktastrAva prAyazaH pAye jAte haiN| choTI aura bar3I donoM prakAra kI raktavAhiniyoM meM kendriya vAtanADI saMsthAna ke vraNazotha ke pramANarUpa parivAhinyakozIya maNibandha pAye jAte haiM ye kozA mukhyataH lasIkozA hote haiM jinake sAtha meM kucha prarasa kozA bhI dekhe jAte haiM ye bahuta karake to bAhya cola ke varco - raubina avakAzoM taka hI sImita rahate haiM para kabhI AlAi hokara hijAvakAza (perivascular space of His ) meM bhI cale Ate haiN| aisA lagatA hai ki ye sabhI kozA adhikAMzatayA rakta se prApta hote haiN| parivAhinya vikSata vyApaka mastiSka pAka ke vikSatoM ke samAna hI hote haiM / parivAhinya vikSata mukhyataH madhyamastiSka yA mastiSkakANDa meM hote haiM tathA vAtanADI vihAsa vahA~ kama hotA hai ataH vikSata aura vihAsa kA eka dUsare se koI sambandha nahIM jor3A jA sakatA / jo loga yaha samajhate haiM ki vAtanADI vihAsa gauNa kriyA hai jo parivAhinya vikSatoM ke uparAnta hotI hai tathA ina vikSatoM ke kAraNa jo srAva nikalatA hai vaha vAhiniyoM ko saMkucita karake vAtanADiyoM taka rakta kA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 215 jAnA roka detA hai aura isa kAraNa unameM vihAsa dekhA jAtA hai asaMgata aura pramANazUnya hai| ___ antarAlita UtIya vikSata ( interstitial lesions ) yadyapi aNvIkSa ke manda vizAlana ( low magnification ) meM suspaSTa nahIM hote parantu ve isa roga ke vAstavika Avazyaka lakSaNa mAne jAne caahie| antarAlita Uti meM vraNazothakArI kozAoM kI prasara bharamAra hotI hai tathA kahIM kahIM unakI saMciti kI nAbhiyA~ bhI bana jAtI haiN| ye nAbhiyA~ bahuta mahattvapUrNa haiM kyoMki ve vyApaka mastiSkapAka (epidemic encephalitis) meM bilkula bhI nahIM dekhI jAtI haiN| bahuta se bahunyaSTikozA bhI dekhe jA sakate haiN| kucha nAbhiyA~ UtimRtyu ke pramANasvarUpa bhI hotI haiN| inameM se koI bhI ghaTanA vyApaka mastiSkapAka meM nahIM dekhI jaatii| yadi sAdhAraNa abhiraMjana kiyA gayA to hameM lasAbha prakAra ke kozA hI dekhane ko milate haiM jinake sAtha sAtha kucha bahunyaSTikozA rahate haiN| para yadi viziSTa rajata abhiraMjana kiyA gayA to pUrNataH vicitra svarUpa dikhalAI detA hai| prasara aura nAbhya srAva meM aba hameM aNuzleSa ( microglia ) milatA hai inheM hogA ke kozA bhI kahate haiM aura ye vAtanADI saMsthAna ke svacchatA kArya meM vizeSataH bhAga lete haiM tathA ve saMyukta kaNAtmaka kozAoM ( compound granular corpuscles ) yA snehakaNakozAoM (fat granule cells) ke agresara ( precursor ) hote haiN| ina aNuzleSa kozAoM kA paryApta pariguNana roga kI prArambhAvasthA se hI cala par3atA hai| sAdhAraNa citrapaTTiyoM meM ina kozAoM kI nyaSTiyA~ hI abhiraMjita hotI haiM unake pravarNoM ko pragaTa karane ke lie hogA kI rajata prAMgArIya abhiraMjanA vidhi kA prayoga atyAvazyaka hotA hai| ye pravardha pahale sUja jAte haiM aura phira vilupta ho jAte haiM unakA kozArasa rasadhAnIyukta (vacuolated ) ho jAtA hai| aneka jo vAtanADI bhakSikozA dekhe jAte haiM ve aNuzleSa kozA hI hote haiN| roga kI tIvrAvasthA meM tArAzleSa kozA (astroglia cells ) praguNita nahIM hote yadyapi Age jaba vraNavastu ( scar ) banatI hai taba usake banAne vAle yahI hote haiN| koNa nAmaka vidvAn ne abhiraMjanA kI spainiza vidhiyoM kA prayoga karake yaha siddha kiyA hai ki isa roga ke kAraNa una bhAgoM meM bhI, jahA~ sAdhAraNatayA vikSata hone kI koI sambhAvanA nahIM thI, tArAzleSa, alpacetAlomazleSa tathA aNuzleSa meM vihAsAtmaka parivartana pAye jAte haiN| suSumnAkANDa ke vAtanADI kozAoM meM sthAyIrUpa meM vihAsAtmaka lakSaNa dekhe jAte haiM cAhe rogI ko sauSumnika ghAta (spinal paralysis) ke koI lakSaNa na pragaTa hue hoN| parivartanoM kI ugratA agrabhaMgoM meM vizeSa hotI hai parantu pazcazRMga tathA klArka nADI tantrikA ke kozAoM ko bhI thor3A prasAda avazya hI milatA hai| agrazRMgoM ke pragaNDa kozAoM (ganglion cells ) meM sabhI prakAra ke vihAsIya lakSaNaprodakaNikA ( Nissl granules ) ke abhAva se lekara nyaSTi kI utkendratA tathA kozA kI pUrNa vilupti taka milate haiN| ye pragaNDa kozA jaba bhara jAte haiM to inake cAroM For Private and Personal Use Only

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216 vikRtivijJAna ora bhatikozA ekatra ho jAte haiM aura unakA carvaNa kara jAte haiN| isa carvaNa kriyA ko vAtanADIbhakSatA ( neuronophagia ) kahA jAtA hai| isa carvaNa kriyA meM aNuzleSakozA to pramukhatayA bhAga lete hI haiM parantu bahunyaSTikozA bhI pIche nahIM rhte| harTa ne kRpApUrvaka yaha batalAyA hai ki jaba ina kozAoM kA nAza atizIghra hotA hai taba to bahunyaSTikozA hI kAma tamAma kara DAlate haiM para jaba zanaiH zanaiH kriyA calatI hai to aNuzleSakozA unakI itizrI karate haiN| kabhI kabhI nADI kozAoM kA nAza atigata vega se bhI hotA hai| hasTa ne eka kapirAja ko isa roga se pIDita pAyA aura dekhA ki usa samaya usake nADI kozAoM meM kucha vikSata haiN| phira 24 ghaNTe pazcAt jaba unakA punaravalokana kiyA to dekhA agrabhaMga kozA kevala zava ke Dhera mAtra raha gaye the| yaha pragaTa karatA hai ki yaha roga kitanA ghAtaka hai tathA kitane zIghra aura pUrNa aMgaghAta ( paralysis ) isake dvArA ho sakatI hai| yaha pahale hI spaSTa kiyA jA cukA hai ki vAtanADiyoM ke vihAsa aura vAhinyavikSatoM kI tIvratA ( intensity ) meM koI bhI nikaTa kA sambandha nahIM dIkha pdd'taa| phira vAtanADiyoM kA vihrAsa kauna karatA hai ? isa prazna kA uttara yahI hai ki yaha kriyA rogakAraka viSANu ke dvArA nADI kozAoM para DAyarekTa ekzana (sIdhA AkramaNa ) hai| mastiSkakANDa meM vraNazothAtmaka vikSata kitane hI gambhIra kyoM na hoM vAtanADI kozAoM meM vihAsAtmaka parivartana ( degenerative changes ) itane adhika kadApi nahIM dekhe jAte / cAhe ardita ( facial paralysis ) ho jAve yA zvasanakendra ke ghAta se mRtyu hI ho jAve parantu isa kSetra ke bahuta hI thor3e nADI kandANuoM (cetaikoM) kA pUrNa nAza dekhane ko milatA hai| anya kozAoM meM kevala varNavAsa (chromatolysis ) tathA nyaSTi kA visthAnAntaraNa mAtra dekhA jAtA hai| pazcamUla pragaNDoM ( posterior root ganglia ) meM jo vikSata dekhe jAte haiM ve bahuta sthAyI hote haiM ve jaise ki pahale batAyA hai vaise hI hote haiM arthAt pragaNDa kozAoM meM vihrAsa hotA hai phira ve apuSTa ho jAte haiM tatpazcAt una para vAtanADI bhakSa TUTa par3ate haiM aura vahAM vraNazothakArI kozAoM kA jamaghaTa ho jAtA hai| pazcamUloM meM bhI vraNazothAtmaka vikSata dekhe jAte haiN| roga kI jIrNAvasthA meM jaba mahInoM yA varSoM pazcAt suSumnA kA avalokana karane para apoSakSaya ( atrophy) kA eka citra mAtra raha jAtA hai| prAyaH eka ora kA agrazRGga sikur3a jAtA hai aura pragaNDa kozAoM kA sthAna tArAzleSakozA le lete haiN| suSumnA kI mRdulatA ke kAraNa usameM kaI sthAnoM para guhAe~ ( cavities ) bana jAtI haiN| vIgArTapAla vidhi se abhiraMjana karane para zvetadravya kA prasara vihAsa spaSTataH prakaTa ho jAtA hai| jo peziyA~ ghAtita ho jAtI haiM unameM bhI apoSakSaya milatA hai snaihika bharamAra tathA tAntava ati kA utkarSa dekhA jAtA hai| yadyapi vyApaka mastiSkapAka ke prakaraNa meM hamane isa roga kI usa roga se tulanA kara dI hai para viliyama bvAyaDa ke zabdoM meM donoM ke sambandha meM nimna vAkya kA ullekha binA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 217 kie hama raha nahIM sakate: The lesions of poliomyelitis are more severe, more_destructive, and more focal in type and that, though the brain is constantly involved, the cord is the chief sufferer. ki vyApaka mastiSkapAka kI apekSA suSumnAdhUsara dravyapAka meM vikSata gambhIratara, adhika vinAzaka, adhika nAbhya prakAra ke hote haiM aura yadyapi mastiSka sthAyIrUpa se prabhAvita hotA hai parantu suSumnA pramukha kaSTabhoktA hotI hai / anya aMgoM meM bhI kucha vikSata isa roga ke sAtha sAtha dekhe jA sakate haiM parantu isa roga ke kartA viSANu ke kAraNa hote haiM inheM koI siddha nahIM kara sakA hai / vidvAnoM kA mata yaha hai ki yakRt kI Uti kI nAbhya mRtyu tathA meghasama zotha, zarIrastha lAbha Uti kI sUjana ( vizeSataH plIhA ke lasakUpoM tathA AMtoM kI lasadaracanAoM kI ) tathA hRtpezIpAka ( myocarditis ) Adi lakSaNa roga ke sAtha sAtha dekhe jA sakate haiM inakA viSANu vizeSa se koI sambandha nahIM / hRtpezIpAka anya viSANurogoM meM bhI dekhane ko milA hai / aba hama vijJatoM se roga ke lakSaNoM kA kyA sambandha hai use bhI saMkSepa meM prastuta kareMge / yaha sadaiva smaraNIya hai ki suSumnA dhUsaradravyapAka eka aupasargika roga hai jisameM aMgaghAta ( paralysis ) ho bhI sakatA hai aura nahIM bhI / jahA~ vaha nahIM hotA yA jaba taka vaha nahIM hotA taba taka pUrvaghAtAvasthA (preparalytic stage) mAnI jAtI hai / isa avasthA meM bAlaka sajvara, prakSubdha, cir3acir3A ( bAta bAta para krodha karane vAlA ) ho jAtA hai aura grIvA tathA pRSThavaMza meM stabdhatA ( stiffness ) dekhI jAtI hai / dUsare yA tIsare dina aMgaghAta prAyaH utpanna hotA hai / utpanna hone ke sAtha hI sAtha yaha adhika se adhika aMgoM kA vadha eka dama kara DAlatA hai yaha nahIM ki dhIre dhIre aMgavadha karatA ho usakA kAraNa yaha pratIta hotA hai ki isa vyAdhi kI pratIkAritA zakti turata hI zarIra meM prakaTa ho jAtI hai jisake hI kAraNa Age aMgavadha yA aMgaghAta yA ghAta sambhava nahIM ho paataa| isa pratIkAritA kI sAkSI roga ke chaThe dina hI rakta se lI jA sakatI hai / yaha sambhava hai ki pUrvaghAtAvasthA meM hI yaha pratIkAritA (immunity ) isalie utpanna ho gaI ho ki usake dvArA ghAta pUrNataH roka diyA jA sake / yaha kahanA nitAnta asambhava hai ki manuSya meM pUrvaghAtAvasthA ke andara suSumnAars ke bhItara kyA kyA vikSata ho jAte haiM kyoMki jIvita manuSya kI suSumnA kA darzana kiyA hI nahIM jA sakatA / para jitanA bhI jJAna prApta kiyA jA sakatA hai vaha yaha hai ki suSanAtha mastiSkoda meM kozAgaNanasaMkhyA bar3ha jAtI hai aura ve kozA bahunyaSTirakozA hI hote haiM jo yaha svaSTataH batalAtA hai ki suSumnA meM vraNazothAtmaka vikSata banate haiM aura vraNazothAtmaka parivartana hote haiM yadyapi sAzcarya ( curiously ) mastiSkachadapAka anupasthita rahatA hai / 16, 20 vi0 For Private and Personal Use Only

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218 vikRtivijJAna aMgaghAtAvasthA ( paralytic stage ) 3 prakAra kI dekhI jA sakatI hai - 1-sauSunika 2-suSumnAzIrSakIya. 3-pramastikIya sauSunika aMgaghAtAvasthA tInoM meM sabase adhika dekhI jAtI hai| yahA~ para jitane vikSata kaTipravRddha bhAga ( lumbar enlargement ) meM dekhe jAte haiM utane graivika pravRddha bhAga ( cervical enlargement of the spinal cord ) meM nahIM dekhe jaate| isI kAraNa isa roga meM sakthiyoM ( TA~goM lower extremities ) meM jitanA prabhAva dekhA jAtA hai utanA sakniyoM (bAhuoM upper extremities ) meM nahIM dekhA jAtA / parantu kabhI kabhI eka TAMga aura eka bAhu bhI prabhAvita milatI hai isakA kAraNa yaha hai ki eka hI agra zRMga adhika prabhAvita hotA hai dUsarA bahuta kama yA bilkula baca jAtA hai| isase yaha bhI jJAta hotA hai ki isa roga kA viSANu nIce Upara yA Upara nIce calatA hai dA~ye bA~ye nhiiN| kabhI kabhI isa roga ke prabhAva se eka dezI yA eka varga kI peziyA~ prabhAvita hotI haiM aura bahuta sI samIpastha chUTa jAtI haiN| isakA kAraNa yaha hai ki suSumnAsthaceSTAvaha kozAoM meM se kucha para bhinna bhinna sthAnoM para viSANu AkramaNa karatA hai saba para yA lagAtAra nahIM yaha avalokana se bhI puSTa huA hai| viSANu yA to lasavahAoM dvArA phailatA hai yA vAtanADiyoM ke akSarambhoM (axis cylinders) se| jo bhI aMgaghAta isa roga meM dekhA jAtA hai vaha zlathaghAta ( flaccid type of paralysis ) hotA hai jise adhoceSTa cetaikaghAta ( lower motor neurone type of paralysis ) kahate haiM / yaha bhI nahIM bhUlanA hai ki suSumnA meM jitane vistRta vikSata dekhe jAte haiM unake anupAta meM aMgaghAta nahIM hotaa| yaha aMgaghAta zIghra pUrA ho jAtA hai, para kucha aise bhI rogI pAye gaye haiM jinameM aMgaghAta uttarottara bar3hatA gayA ho aura jisane sampUrNa suSumnAkAMDa ko hI grasita kara liyA ho use laiNDrIya ArohI aMgaghAta ( landry's ascending paralysis ) kahate haiM / isa roga meM sarvaprathama TA~geM yA eka TAMga eka bAhu meM ghAta hotA hai phira vaha pazukAntarikAoM ( intercostals ) kA ghAta karatA hai aura anta meM mahAprAcIrA pezI kA vadha karake zvasana kriyA ghAta kara mRtyu kara detA hai| rogottara prabhAva yaha hotA hai ki eka aMga meM zlathadhAta ho jAtA hai aura dUsarI ora ke aMga kI apekSA yaha aMga dubalA hotA hai usakI vRddhi bilkula hotI nahIM hai tathA eka varga kI peziyoM kA ghAta hone se unake viruddha kArya karanevAlI peziyoM kI aviruddha utikriyA (unopposed overaction ) ke kAraNa sAMkoca ( contractures ) dikhalAI dete haiN| ___ isa roga meM prabhAvita aMga yA aMgoM meM zUla (pain) hotA hai jo roga kI tIvrAvasthA kI pramukha ghaTanA hai| kabhI manda manda zUla hotA hai jo akasmAt tIvra ho jA sakatA hai| isa zUla kA kAraNa pazcamUlapragaNDoM yA pazcamUloM meM vikSatoM kI upasthiti hai| para yaha smaraNIya hai ki ina aMgoM meM vAstavika saMjJAnAza ( objective sensory loss ) nahIM hotaa| For Private and Personal Use Only

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218 vividha zarIrAGgoM para vraNazotha kA prabhAva grIvA yA pRSTha kI stabdhatA ( rigidity ) ke vahI kAraNa ho sakate haiM jo mastiSkachadapAkastha stabdhatA ke kahe gaye haiN| isa mata ko kaI nahIM bhI maante| . suSumnAzIrSakIya prakAra meM jo vikSata hote haiM ve suSumnA meM bhI prAyazaH milate haiM parantu vinIpega kI eka mahAmArI meM suSumnAstha eka bhI vikSata dekhane ko nahIM milA thaa| anya vikSata mastiSkakANDa tathA USNISaka meM dekhe jAte haiN| kabhI kabhI suSumnAzIrSa ke sAtha suSumnA ke UrdhvabhAga meM spaSTa vikSata dekhe jAte haiM parantu sauSunika ghAta bilakula bhI nahIM pAyA jaataa| kabhI kabhI suSumnAzIrSaka meM koI vikSata na milane para bhI suSumnAzIrSaghAta dekhe jAte haiN| yaha saba prakRti kI nirUr3ha racanAoM ke pramANa haiM parantu zanaiH zanaiH vaijJAnika eka eka pRSTha karake prakRti kI pustaka ko kholakara par3ha rahA hai yaha koI nahIM kaha sakatA ki kitane kAla meM vaha ise bA~ca legA yA usase pUrva hI eTama bama kI dhvaMsakAriNI zakti ke prabhAva se rasAtala ko calA jaaygaa| kucha bhI ho, suSumnAzIrSaka ke kAraNa jo ghAta dikhAI dete haiM unameM ardita ( facial palsy ) TeratA ( strabismus) aura zvasanakArya kA ghAta mukhya haiN| zvasanakArya ke ghAta kA kAraNa paryukAntarikAoM tathA mahAprAcIrA pezI kA ghAta bhI hotA hai jo sadaiva milatA hai| suSumnAzIrSakastha vikSatoM ke kAraNa tIvra vAyukSudhA ( intense air hunger ), nAsA dvArA tarala sUMghane kI azakti tathA grasanI (galA) meM jhAgadAra padArtha kA bhara jAnA ye tIna lakSaNa vizeSataH dikhAI par3ate haiN| yaha bhI vismaraNIya nahIM hai ki isa roga meM lakSaNa aura vikSatoM meM gUDha sambandha sadaiva nahIM miltaa| pramastiSkIya prakAra ke suSumnAdhUsaradravyapAka kI kalpanA karanA hI azuddha hai| yadi kisI bandara ke pramastiSka meM isa roga ke viSANuoM kA praveza bhI kiyA jAya to vikSata pramastiSka meM na banakara mastiSkakANDa aura suSumnA meM hI banate haiN| isa prakAra kA varNana 1855 IsavI meM sTUmpaila ne kiyA thA para taba se aba taka gaMgA jI kA bahuta sA pAnI banArasa ke pula ko pAra kara cukA hai aura usa prakAra kA varNana Aja kucha anupayukta yA ayuktiyukta lagatA hai| ___ yadi isa roga meM mastiSka suSumnAjala ( mastiSkoda) kA vicAra kiyA jAve to hama dekhate haiM ki usameM jo parivartana hote haiM ve vikArapradarzaka na hote hue bhI nidAna ke lie bahuta lAbhadAyaka hote haiM / mastiSkoda meM nimna parivartana dekhane ko milate haiM 1. usakA nipIDa ( Pressure ) bar3ha jAtA hai| 2. mastiSkoda svaccha hotA hai yA ghise kA~ca kI AkRti kA hotA hai / 3. kucha rugNoM meM (saba meM nahIM) yadimaka mastiSkachadapAka ke samAna tantvi kA jAlA (web) bana jAtA hai / yaha lakSaNa mastiSkapAka meM kadApi nahIM miltaa| 4. roga kI pUrvaghAtAvasthA meM kozA adhika ho jAte haiM tathA kozAdhikya ke sAtha vartuli kI kamI bhI ho jAtI hai| For Private and Personal Use Only

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220. vikRtivijJAna 5. roga jaba ghAtAvasthA meM AtA hai to kozA kama hone lagate haiM aura vartuli __ bar3hane lagatI hai| 6. kozA lasIkozA hI hote haiM parantu prArambhika avasthA meM 50 pratizata taka bahunyaSTisitakozA bhI mila sakate haiN| 7. zarkarA aura nIreya aprabhAvita rahate haiN| suSumnApAka ( Myelitis) tIvra suSumnApAka yA suSumnAkANDa kA vraNazotha eka virala roga hai| yaha AghAtajanya yA aupasargika donoM prakAra kA ho sakatA hai| AghAtajanya prakAra usI samaya hotA hai jaba suSumnA meM koI AghAta ho aupasargika prakAra taba hotA hai jaba kahIM anya sthAna meM upasarga upasthita ho aura vahA~ se antaHzalya calakara suSumnA meM basa jAve / hRdantaHpAka (endocarditis) se pUyika antaHzalya ( septic emboli ) calakara agrasauSunika dhamanI dvArA suSumnAkANDa meM pahu~catI hai| anya aupasargika rogoM ke dvArA bhI suSumnApAka ho jA sakatA hai jinameM vyApaka mastiSkachadapAka, uSNavAta, romAntikA, rohiNI, pratizyAya ( influenza), zoNatvagjvara (lohita jvara scarlet fever ), zItalA ( smallpox ), Antrikajvara Adi ullekhya haiN| phiraMga ( syphilis ) ke kAraNa bhI yaha roga ho sakatA hai| eka tIsarA prakAra vaiSika (toxic ) bhI dekhA jAtA hai arthAt vAnaspatika viSa jinameM dhAnyarug ( ergot ) tathA tripuTa ( lathyrus ) dvArA utpanna viSatA mukhya hai tathA khanija viSa sIsa tathA malla ( arsenic ) inake dvArA bhI yaha roga bana sakatA hai| upasarga mahAsrotastha lasavahAoM dvArA le jAyA jAtA hai| kabhI kabhI upasarga kI prAthamika nAbhi kA koI patA nahIM cala paataa| aisI dazA meM kauna rogANu roga kA kartA hai vaha jJAta nahIM ho sakatA kyoMki suSumnA meM jIvANu sajIvAvasthA meM nahIM mila paate| kabhI kabhI mAlA aura puMjagolANu vahA~ pAye jAte haiM para ve mUla rogANu na hokara gauNa pratIta hote haiN| suSumnApAka ko do prakAroM meM vibhakta karane kI prathA hai / eka prasara suSumnApAka ( diffuse myelitis yA disseminated myelitis) tathA dUsarA anuprastha suSumnApAka ( transverse myelitis) / anuprastha suSumnApAka bahudhA dekhane meM AtA hai aura isameM suSumnA ke tIna yA cAra khaNDa prabhAvita ho jAte haiN| vraNazotha isameM suSumnAkANDa ke ArapAra ( across ) hotA hai| prasarasuSumnApAka sampUrNa suSumnAkANDa meM itastataH phailA huA milatA hai| yadi isa roga se pIDita prANI kI suSumnA ko meja para rakhakara hAtha pherA jAya to prabhAvita bhAga mRdu lagate haiM aura ve cipiTita ( flattened ) ho jAte haiM / use kATane para zveta aura dhUsara padArthoM meM antara pUrNataH lupta ho jAtA hai| vahA~ bhI mRdula kSetra ( areas of softening) mila sakate haiM tathA itastataH raktasrAva bhI dekhe jAte haiN| jIrNa rugNoM kI suSumnA For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 221 meM asaMkucita bhAga (shrunken parts) tathA koSThikAe~ (cysts) bhI dekhI jAtI haiN| aNvIkSa citra vraNazotha aura vinAza kA mizraNa hotA hai| vAhiniyA~ visphArita ho jAtI haiM jinake cAroM ora lasIkozA aura bahunyaSTisitakozA vibhinna anupAtoM meM ghire rahate haiM vAtanADIkozA aura vAtanADI tantuoM kA bahuta vinAza milatA hai| bahuta sA apadravya ekatra ho jAtA hai jisameM vAtanADItantuoM ke vimajikaMcuka ke dhvaMsAvazeSa meda se bhare aneka svacchaka kozA dikhalAI dete haiN| ye aNuzleSakozA hI badale hue rUpa meM prAyaH hote haiN| bahuta samaya pazcAt vahA~ nADIzleSakozA Akara vaNavastu kA nirmANa karate haiN| __isa roga ke jo lakSaNa dIkha par3ate haiM ve vikSata ke prakAra para utane nirbhara nahIM rahate jitane ki vikSati kI suSumnA meM sthiti para nirbhara rahate haiN| isa roga kA AkramaNa sahasA hotA hai aura bahuta tIvra svarUpa kA bhI hotA hai rogI saMnyAsa kI taraha nirbala hokara bhUmi para gira par3atA hai| isakA kAraNa kisI bar3I bAhinI meM antaHzalya yA ghanAsrotkarSa kA honA ho sakatA hai| isa roga meM kaTibhAga vizeSa karake prabhAvita hotA hai| isameM adhoceSTa cetaika prakAra kI sakthiyoM kA zlathadhAta hotA hai sAtha meM peziyoM kA apoSakSaya aura gambhIra pratikSepoM ( deep reflexes ) kA lopa ho jAtA hai / pAdatalIya pratikSepa (planter reflex ) bhI lupta ho jAtI hai tathA basti tathA gudapradezastha saMkocakoM ( sphincters) kA bhI ghAta ho jAtA hai| saMjJA vikSobha ( sensory disturbances ) bhI mila sakatA hai jinameM vikSatasthaloM para saMjJAtIvratA (hyperaesthesia) zUla tathA vikSata se nIce saMjJAhInatA (anaesthesia) ho jAtI hai| graivika pradeza meM vikSata hone se cAroM avayavoM ( limbs ) kA ghAta ho sakatA hai / bAhuoM meM jo ghAta hotA hai vaha zlatha ( flaccid) hotA hai kyoMki praivika bhAgastha ceSTAvahakozA naSTa ho jAte haiM / pAdoM meM pahale zlathaghAta hotA hai jo bAda meM sAkSepa ( spastic) ho jAtA hai| jisake kAraNa gambhIra pratikSepoM kA atibhAva ( exaggeration ) ho jAtA hai| isakA kAraNa yaha hai ki yahA~ hama Urdhva ceSTa cetaka prakAra ke vikSata kI ora bar3ha rahe haiM kyoMki mukulatantrikA (direct pyramidal tract) ke tantuoM ke kArya meM isa graivika bhAga meM bAdhA par3atI hai / graivika bhAga ke svatantranADImaNDala meM bhI ghAta hone para tArAlAghava ( miosis ) tathA akSigola kA antarAkarSaNa (enophthalmia) ye do lakSaNa dekhe jA sakate haiN| 31 Tetek ( Rabies ) aba hama Alarka yA jalasaMtrAsa ( hydrophobia) nAmaka roga kA isalie varNana karate haiM kyoMki vaha bhI eka vraNazothAtmaka vyAdhi hai| __ Alarka yA jalasaMtrAsa mAMsabhuja catuSpadoM kI vyAdhi hai jo inake daMzana se manuSya ko prApta hotI hai| kauna kauna jIva pAgala hokara kisa prakAra kA ho jAtA hai usakA varNana karate hue suzruta likhatA hai For Private and Personal Use Only

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222 vikRtivijJAna zvazRgAlataravRkSavyAghrAdInAM yadAnilaH / zleSmapraduSTo muSNAti saMjJAM saMzAvahAzritaH // tadAprasastalAzUlahanuskandho'tilAlavAn / avyaktabadhirAndhazca so'nyo'nyabhidhAvati / / jaba kuttA, gIdar3a, bher3iyA, bhAlU, siMhAdi kI vAyuzleSmA se praduSTa hokara saMjJAvahasrotoM ( sensory nerve paths ) meM jAkara saMjJA kA nAza kara detI hai jisase pU~cha, ThoDI aura kandhe apane sthAna se cyuta ho jAte haiM aura vaha bahuta adhika lAlA kA srAva karatA hai aura vaha badhira vA andhavat eka dUsare kutte gIdar3a manuSyAdi para dhAvA kara detA hai| jalasaMtrAsa isa vyAdhi kA eka asAdhya lakSaNa karake AcAryoM ne mAnA haitrasyatyakasmAdyo'bhIkSNaM dRSTvA spRSTvA'pi vA jalam / jalatrAsaM tu taM vidyAdriSTaM tadapi kIrtitam // koI Avazyaka nahIM ki jalasaMtrAsa vA jalatrAsa nAmaka lakSaNa pAgala prANI ke kATane se hI mile vaha to binA usake bhI mila sakatA hai| usakI vikRti kA varNana AcAryoM ne nimna zabdoM meM kiyA hai: buddhisthAnaM yadA zleSmA kevalaH pratipadyate / tadA buddhau niruddhAyAM zleSmaNA'dhiSThito naraH / / jAgratsupto'thavA''tmAnaM majantamiva manyate / salilAvyasyati tadA jalatrAsaM tu taM viduH // arthAt jaba buddhisthAna meM zleSmA hI kevala saMcita ho jAtA hai to vahA~ mArga roka detA hai jisase jAgatA ho yA sotA ho, rugNa apane ko jala meM DUbA huA anubhava karatA hai isI kAraNa vaha jala ko dekhakara DaratA hai aura yaha roga jalatrAsa (hydrophobia) kahalAtA hai| yataH yaha jalatrAsa kupita kapha dvArA hotA hai isa kAraNa riSTa (asAdhya) nahIM mAnA jAtA: ayaM jalatrAsaH kupitakaphasya bhavatIti riSTaM na bhavati / para suzruta ise bhI asAdhya kahatA hai ___ adaSTo vA jalavAsI na kathaMcana siddhayati / ___ jalanAsa yA Alarka roga kA saMcayakAla sAdhAraNatayA 30-40 dina kA hotA hai para yaha daSTasthAna para nirbhara karatA hai| jahA~ para praduSTa zleSmA par3atA hai vahA~ sthita vAtanADiyA~ usakA grahaNa kara letI haiM aura isakA viSANu vAtanADiyoM dvArA saMjJAvaha nADiyoM dvArA cala par3atA hai| yadi hama suzrutokta sUtroM ko 'yadAnilaH zleSmapraduSTo muSNAti saMjJA saMjJAvahAzritaH' dhyAna se dekheM to jo Adhunika vivaraNa hama de rahe haiM usase vaha yathAvat milatA hai| yadi yaha saMjJAvaha mArga lambA huA jaisA ki hAtha yA paira meM kATane para hotA hai to roga kA saMcayakAla bhI bar3ha jAtA hai para yadi yaha mArga choTA huA jaisA ki gardana yA mukha para kATane ke uparAnta hotA hai to saMcayakAla bhI choTA hotA hai| saMcayakAla kitanA hai isakA dhyAna cikitsA ke samaya isa roga meM karanA paramAvazyaka ho jAtA hai / isa roga meM atyanta mahattva ke do lakSaNa hote haiM eka to nigalane kI peziyoM kA AkSepa (spasm of the muscles of deglutition) aura dUsarA sarvAGgINa prakampana (generalised convulsions ) pahale ke For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 223 kAraNa rogI pAnI taka nigalane meM asamartha ho jAtA hai tathA dUsare ke kAraNa hara samaya kA~patA rahatA hai anta meM zrAnti ( exhaustion ) aura zvAsakRcchratA (asphyxia) ke kAraNa rogI mara jAtA hai| __ Alarka eka pAvya viSANujanya roga hai| yadi eka pAgala prANI ke mastiSka kA pAyasa yA pranilamba (ermulsion) banA liyA jAve aura use phira barkaphIlDapAvana dvArA chAna diyA jAve aura phira chane hue pranilamba ko kisI anya prANI kI dRDhatAnikA meM yA tvagadhaH antaHkSipta kara diyA jAve to vaha prANI bhI Alarka roga se pIDita ho jaavegaa| ___ yaha viSANu kSatasthAna se vAtanADiyoM ke akSarambhoM dvArA yA unake upara lagI lasavahAoM (perineural lymphatics-paricetIya lasavahAoM) dvArA kendriya vAta nADIsaMsthAna ko jAtA hai akSarambha meM hokara sI kA viSANu bhI jAtA hai (guDapAzcara) isase isakA bhI vahI mArga hogA aisA mAnA jA sakatA hai para puSTi abhI taka nahIM ho sakI / jaba viSANu kendriya vAtanADIsaMsthAna taka pahu~ca jAtA hai to phira mastiSka aura suSumnA sabhI sthAnoM para zIghra hI prasarita ho jAtA hai| vaha mastiSkoda meM bhI milatA hai| yaha viSANu sadaiva karNamUlagranthi (parotid gland ) dvArA utsRSTa hotA hai| isI kAraNa prANI ke lAlArasa meM yaha viSANu upasthita rahatA hai jisase jaba kisI ko kATatA hai to praduSTa lAlArasa (praduSTa zleSmA) dvArA vaha anya prANI taka pahu~ca jAtA hai| lAlArasa ke atirikta azru, dugdha tathA sarvakiNvI rasa meM bhI vaha pAyA jAtA hai| yadyapi pAzcara ko isa viSANu kI prakRti kA koI jJAna nahIM thA phira bhI usane isa sambandha meM bahuta adhika khojeM kI thii| usane isa viSANu ko zazaka meM praviSTa kara diyA aura dekhA ki usakI ugratA atyadhika bar3ha gaI aura aba viSANu kevala eka saptAha meM hI roga prakaTa karane lgaa| yaha adhikatama viSatA kA pramANa thaa| ise usane 'vAirasaphikse' (virus fixe) kahakara pukArA thaa| usane isa vAirasaphikse (sunizcita viSANu) ke dvArA zazakoM ke suSumnAkANDoM ko upasRSTa karake sukhAne rakha diyA / kucha samaya bAda usane dekhA ki sUkhe suSumnAkANDa meM se viSANu kI rogakAraka zakti naSTa ho gaI hai aura 14 dina sUkhane para to unake dvArA roga utpanna kiyA hI nahIM jA sktaa| aba usane ina kANDoM kA pranilamba ( emulsion) banAkara pratiSedhAtmaka cikitsA ke rUpa meM prayukta kiyaa| usane vibhinna kAla taka sukhAI huI suSumnAoM ke pranilamboM kA samaya-samaya para prayoga kiyaa| usane yaha batalAyA ki pAgala prANI ke kATane ke 5 dina ke andara yadi isa pranilamba kA tvagadhaH antaHkSepa kiyA jAtA rahe to zatapratizata roga se mukti mila sakatI hai aura rogI svastha ho sakatA hai anyathA mRtyu anivArya hai jalatrAsaM tu taM vidyAdriSTaM tadapi kIrtitam vikRta zArIra kA vicAra karane aura pratyakSa dekhane para suSumnA aura suSumnAzIrSaka meM raktAdhikya hI prakaTa hotAhai tathA caturtha nilaya kI bhUmi meM choTe-choTe kucha raktasrAva milate For Private and Personal Use Only

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224 vikRtivijJAna haiN| para aNvIkSatayA dekhane para jo citra dikhalAI detA hai vaha suSumnAdhUsaradravyapAka ke samAna hI hotA hai| vraNazothAtmaka tathA vihAsAtmaka sampUrNa parivartana adhikatara suSumnAzIrSaka meM milate haiM thor3e se suSumnAkANDa meM hote haiM tathA mastiSka bAhyaka meM sabase kama dekhe jAte haiM / lasIkozAoM ke parivAhinya maNibandha bhI yathAvat milate haiM / vAtanADIkozAoM meM varNahAsa se lekara pUrNanAza taka vinAza ke saba lakSaNa milate haiN| miTate hue kozAoM ko nADIbhakSaka kozA ghere rahate haiN| jina nADiyoM dvArA viSANu kendriya vAtanADIsaMsthAna taka jAtA hai unameM bhI vihrAsAtmaka lakSaNa dekhane ko milate haiN| sabase adhika spaSTa aura eka mAtra ghaTanA jo isa roga meM dekhI jAtI hai vaha hai Alarka piNDoM ( Negri bodies) kI upasthiti / ye vicitra prakAra kI racanAe~ haiM jo upadhAnikA ( hippocampus major ), dhamillaka ke kalasikA kandoM ke pragaNDoM (ganglion ) ke kozAprarasa ( cytoplasm ) meM mukhyataH tathA suSumnAzIrSaka tathA anyatra gauNataH milate haiN| ina piNDoM meM eka prakAra kA amlaraJjya (acidophilic ) padArtha rahatA hai jisake madhya meM nyaSTi kI taraha eka pITharaMjya (basophil) dravya bharA rahatA hai / jaba ucita abhiraMjana kiyA jAtA hai to eka lAla raMga ke piNDa ke nIle varNa kA kendra aisA citra upasthita hotA hai| ye Alarka piNDa vihAsAtmaka utpAda (degenerative products ) mAtra haiN| amlaraMjya padArtha cetAtantukoM (neurofibrillae) ke vidvAsa se banatA hai tathA pITharaMjya dravya kaNAbhasUtroM (mito. chondria ) ke vihrAsa se prApta hotA hai| jaba yaha jJAta ho jAya ki eka pAgala kutte ne kisI vyakti ko kATa liyA hai to usa kutte ke mastiSka meM Alarka piNDoM (naigarI bauDIz2a ) DhUMDhane kA yatna karanA cAhie usake lie citrapaTTI ( film of smear ) taiyAra karanA caahie| usake lie upadhA nikA ke eka Tukar3e ko kATa kara usake dhUsara bhAga para kAcapaTTa rakha kara dabAte haiM isa prakAra kozAoM kA bhAvacitra (impression) A jAtA hai ise jImsA kI abhiraMjanA paddhati se raMga lete haiM / chedoM ( sections ) ke dvArA adhika vizvasta jJAna milatA hai| usake lie uti ko lekara tarala (Zenker's fluid ) meM dRDha kara lete haiM phira use prodalenya nIla (mithAilInablyU) tathA uSasi dvArA raMgate haiM yA use pahale prAMgava dhUmali ( carbolaniline fuschin ) dvArA raMga kara punaH prodalenya nIla meM ra~ga dete haiM aura phira aNvIkSaNa karate haiN| __sI viziSTa ( Herpes Zoster ) yaha vAtanADIsaMsthAna kI eka vraNazothAtmaka avasthA hai| isameM viSANu pazcamUloM ( posterior roots ) meM phailatA hai| yaha suSumnApAka kA hI eka saMjJAsadRkSa ( sensory analogue ) hai kyoMki isakI vikRti aura mastiSkoda kI dazA usake samAna hI rahate haiM yadyapihote haiM ve paryApta siimit| donoM hI roga vAcika (sporadic) rUpa meM prakaTa hokara phira vyApaka (epidemic ) rUpa dhAraNa kara lete haiN| donoM se For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 225 pIDita rogiyoM meM eka prakAra kI pratIkAritA zakti utpanna ho jAtI hai jisake kAraNa roga kA dUsarA AkramaNa sambhava nahIM hotA parantu sIviziSTa meM yaha zakti utanI pUrNa nahIM hotI jitanI ki suSumnApAka meN| jisa prakAra suSumnApAka eka pAvya viSANujanya vyAdhi hai usI prakAra sIviziSTa bhI hai| ____ dAnoM ke udbhedana ( eruption ) ke pUrva vAtazUla ( neuralgia ) eka pUrva rUpa ke taura para dekhA jAtA hai| yaha udbhedana sadaiva Adhe zarIra taka hotA hai aura dUsarI ora nahIM jaataa| dvitIya pRSTha aura dvitIya kaTipradezIya vAtanADiyoM ke bIca kA prAyaH koI eka pragaNDa isa roga ke cakkara meM AtA hai| sakthi-saniyoM meM jaba yaha roga hotA hai to peTI ( zoster ) ke samAna usa aMga kA grahaNa kara letA hai| zira meM udbhedana hone kA artha tridhAragranthi meM vikSata bana jAnA hai / jo udbhedana isa roga meM hotA hai usakA svarUpa sarvaprathama atiraktimA ( erythema) kA hotA hai| usase eka aMkura ( papule ) uThatA hai tatpazcAt eka Azayaka ( vesicle ) kA nirmANa hotA hai jisameM svaccha tarala bharA hotA hai| jaba yaha phUTa jAtA hai to eka parpaTI ( crust ) jama jAtI hai jo Age cala kara vizAlkata ho jAtI hai aura eka vraNa raha jAtA hai jisameM phira vraNavastu banatI hai| yaha roga 20 varSa kI Ayu se pUrva jitanA adhika milatA hai bAda meM utanA nahIM parantu jinako yaha vRddhAvasthA meM satAtA hai unheM atyanta kaSTa aura vedanA pradAna karatA hai tathA bahuta kAlataka rahatA hai| isa roga kA prAthamika vikSata to pUrNataH pazcamUla pragaNDa taka hI sImita rahatA hai parantu dvitIyaka vikSata vAtanADItantuoM taka meM dekhe jA sakate haiN| tridhAragranthi (gasserian ganglion ) para bahudhA prabhAva hotA huA dekhA jAtA hai granthi sUja jAtI hai tathA usameM raktAdhikya ho jAtA hai| aNvIkSaNa para koI viziSTa parivartana to milate nahIM haiM parantu aviziSTa ( nonspecisfic ) parivartana raktAdhikya, raktasrAva, lasIkozAoM kA parivAhinya ekatraNa tathA pragaNDIya kozAoM kA vihAsa Adi lakSaNa jaise ki Alarka suSumnApAka, mastiSkapAka Adi meM dekhe jAte haiM milate haiN| kucha kozAoM kA vihrAsa ho jAtA hai kucha ke cAroM ora vAtanADIbhakSikozA cipaTa jAte haiM, kucha naSTa ho jAte haiM aura kucha ina saba kaThinAiyoM ko jhela kara svastha bane rahate haiN| pragaNDoM ke samIpa kI vAtanADiyoM taka vraNazotha bar3ha jAtA hai| dasa dina pazcAt mArcI kI adhiraMjanA vidhi se dekhane para saMjJAvahatantuoM meM pRSThavAtamUloM ( dorsal nerve roots ) meM tathA pariNAhI vAtanADiyoM ke antima sire taka tathA pazcastambhoM (posterior columns ) taka meM vAlarIya vihAsa dekhA jA sakatA hai| ___ gauNa lAkSaNika sI ( secondary symptomatic herpes ) nAmaka roga una aneka rogAvasthAoM meM dekhA jAtA hai jahA~ pazcamUloM yA pazcamUla pragaNDoM meM AghAta ho jAtA hai TebIz2a (tabes) meM jahA~ pazcanADImUloM meM vikSata sarvaprathama banatA hai yaha roga sAtha sAtha dekhA jAtA hai yaha sarvAMgaghAta (general paresis), For Private and Personal Use Only

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226 vikRtivijJAna suSumnA kA AghAta tathA usake arbudoM meM bhI milatA hai tathA kaTivedha ke kAraNa bha kabhI kabhI ho sakatA hai| sI sAmAnya (Herpes Simplex ) sI sAmAnya tIvra sajvarAvasthAoM meM (jaise mastiSkasuSumnAjvara, Antrika jvara, zvasanaka jvara, viSama jvara, vAtazlaiSmika jvara Adi meM ) malla viSatA meM tathA pRSThIya TebIja ( tabes dorsalis) ke vedanAtmaka dAruNyoM ( painful crises ) meM prAyaH milatA hai| isa roga ke udbheda oSTha, kanInikA tathA prajananAMgoM meM se kahIM bhI dekhe jA sakate haiM jinake kAraNa isake oSThIya sI ( herpes labialis), kanInikIya sI ( herpes cornealis ) tathA prajananAGgIya sI ( herpes genitalis ) Adi nAma par3a gaye haiN| sajvarasI ( herpes febrilis ) bhI eka nAma hai| aisA jJAta hotA hai ki isa roga kA viSANu chipA huA zarIra meM par3A rahatA hai aura jaba kisI tIvra rogANu kA AkramaNa hotA hai aura zarIra kI zakti kama ho jAtI hai to yaha bhI apanA rUpa prakaTa kara detA hai| viziSTa sI se sI sAmAnya meM bahuta antara hai| kyoMki yaha punaH punaH ho sakatA hai| isakA vistAra nADIkhaNDoM ke anusAra nahIM calatA tathA yaha ubhaya pArzvika ( bilateral ) roga hai| isakA viSANu eka prANI se dUsare prANI ko saralatA se pahu~cAyA jA sakatA hai| yaha pAvya hotA hai aura yadi eka zazaka kI kanInikA meM antaHkSipta ( inoculated ) kara diyA jAve to yaha usameM ghAtaka mastiSkapAka utpanna kara detA hai| guDapAzcara ne isa viSANu kA mArga antaHkSepa sthala se saMjJAvaha nADiyoM taka tathA vahA~ se saMjJAvaha nADIkozAoM taka (pazcamUla pragaNDoM tathA mastiSka meM ) khoja nikAlA hai| kucha loga aisA mAnate haiM ki vyApaka mastiSka pAka kA viSANu isI viSANu kI atyugra pratimA hai para isakI puSTi abhI taka nahIM ho sakI hai| aba hama vAtanADIpAka ( neuritis) jise cetApAka bhI kahate haiM kA varNana kara isa prakaraNa ko samApta kreNge| vAtanADI yA cetApAka ( Neuritis ) vAtanADIpAka do prakAra kA ho sakatA hai| eka vaha jo vizuddha vAta uti meM ho jise vAtanADI jIvitakapAka ( parenchymtous neuritis) kahate haiM tathA dUsarA vAtanADItantuoM ko bA~dhane vAlI saMyojI Uti yA antarAlita Uti kA pAka / ise antarAlita pAka ( interstitial neuritis) kahate haiN| yadi pAka eka nADI meM huA to use eka nADIpAka ( mononeuritis ) kahate haiM para jaba vaha kaI nADiyoM meM eka sAtha hotA hai to vaha bahunADIpAka (polyneuritis ) kahate haiN| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 227 jIvitaka vAtanADIpAka kA dUsarA nAma vaiSika vAtanADIpAka ( toxic neuritis ) bhI hai / yadyapi hamane vAtanADiyoM kA pAka aisA kahA hai para jaba hama isakI vikRti kA adhyayana karate haiM to vraNazotha ke sthAna para vihrAsa adhika milatA hai aura vihAsa tathA vraNazotha kA eka mizrita citra sanmukha AtA hai / antarAlita vAtanADIpAka prAyaH vraNazothAtmaka aura jIvitaka vAtanADIpAka prAyaH vihAsAtmaka hotA hai / aba hama inakA thor3A varNana karate haiM / antarAlita vAtanADIpAka - vibhinna prakSobhaka milakara vAtanADI ( cetA ) meM vraNazotha utpanna kara sakate haiN| inameM sarvAdhika mahatvapUrNa hai sardI kA laga jAnA, nipIDa jaise baisAkhI ( crutch ) dvArA kisI aMga kA daba jAnA tathA upasarga / upasarga samIpastha kisI vraNazothayukta nAbhi (phokasa) se AtA hai / sandhipAka ke kAraNa yaha dekhA jA sakatA hai / upasarga ke kAraNa sthAnika vAtanADI meM pAka prArambha ho jA sakatA hai| / jaba koI vAtanADI vigopita ( exposed ) ho jAtI hai to vaha sUja jAtI hai lAla ho jAtI hai aura usakI gADhatA ( consistency ) mRdula ho jAtI hai aNvIkSaNa karane para vAtanADItantu se usakI saMyojI Uti pRthak ho jAtI hai usameM vraNazotha ke sAmAnya cihna udita ho jAte haiM arthAt vAhiniyoM kA visphAraNa, sphAya ( oedema ), golakozAoM kI bharamAra hone lagatI hai aura Age calakara navIna tAntava Uti banane lagatI hai / jo srAva vahA~ nikalatA hai usake pIDana ke kAraNa tathA prakSobha se vAtanADItantuoM meM vihrAsa hone lagatA hai parantu akSarambha jyoM ke tyoM rahate haiM isa kAraNa unakI kriyA ke sAtha prAyaH kisI prakAra kI gar3abar3I dekhane ko nahIM milatI / sAtha hI cetAvaraNa (neurilemma ) meM kozAoM kA praguNana prArambha ho jAtA hai jo kadAcit bhakSaNakArya ( phagocytic action ) karatA hai / jIvitaka vAtanADIpAka -- jaisA pUrva hI spaSTa kara diyA gayA hai yaha vihAsAtmaka vyAdhi jitanI hai utanI vraNazothAtmaka nahIM hai ise vaizlara bahunADIpAka na kahakara bahuvAta nADI roga ( multiple neuropathy ) kahanA adhika yukta ThaharAtA hai / usI prakAra madya tathA sIsa viSa dvArA utpanna pramastiSkIya vikSatoM ko bhI vaha mastiSka pAka na kahakara mastiSkaroga ( encephalopathy ) mAtra kahanA cAhatA hai / jIvitakIya vAtanADIpAka ke vihAsAtmaka vikSatoM ko 1 - viSa ( rohiNIviSa ), 2- vAhyaviSa ( sosa, malla, madya ), tathA 3 - jIvati kha ( Vitamin B. ) utpanna kiyA karate haiM / Adhunika khojoM ne yaha bhI prakaTa kiyA hai ki madya, malla yA prameha meM jo nADIpAka dekhe jAte haiM unakA bhI kAraNa ajIvatiktitA ( avitaminosis ) hI hai / aMgle kA kathana hai ki bahunADIpAka ( polyneuritis ) jaba poSaNajanya hotA hai taba mastiSkoda meM jIvatikti kha kI mAtrA kama tathA mUtra meM sabase kama dekhI jAtI hai jaisA ki vAtabalAsakajvara ( Beri - Beri ) meM dekhA jAtA hai / I For Private and Personal Use Only

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228 vikRtivijJAna vizoNatA ( ischaemia ) bhI isa roga kA eka kAraNa hai| pIDana ke kAraNa poSaNikA vAhinI dvArA vAtanADI kA yathAvat poSaNa nahIM ho paataa| sagranthi paridhamanIpAka (peri-arteritis nodosa ) nAmaka roga meM poSaNikA vAhiniyoM kA mukha saMkucita ho jAne se unake dvArA jo vAtanADiyoM kA poSaNa hotA hai usameM bhI kamI ho jAtI hai jisake kAraNa una vAtanADiyoM meM bhI vihAsAtmaka parivartana hone lagate haiM aura jinake kAraNa usa roga meM vAtikazUla (neuritic pains) vizeSataH dekhe jAte haiN| Ajakala jo vAtikazUloM meM jIvita kha kA prayoga cala rahA hai usakA AdhAra bhI yahI hai ki poSaNikA vAhiniyoM dvArA isa dravya kA adhika pramANa vAtanADiyoM taka pahu~cAyA jAve tAki usakI kamI dUra hokara unakA vihAsa ruka jaave| ___ parivartana sarvAdhika mAtrA meM eka nADI ke pariNAha bhAga (peripheral part) meM dekhA jAtA hai isI kAraNa roga ko pariNAhI vAtanADIpAka ( peripheral neuritis ) kahA jAtA hai / yadyapi isa pAka meM vAtanADI ke sabhI tatvoM para prabhAva par3atA hai parantu vimajikaMcuka para sabase adhika AghAta dekhA jAtA hai| parivartana lagabhaga vaise hI hote haiM jo eka vAtanADI ko kATa dene ke uparAnta dekhe jAte haiM aura jinheM vAlarIya vihrAsa kahakara pukArA jAtA hai| isameM pahale vimajikaMcuka chinna bhinna ho jAtA hai aura usake snehavinduka ( droplets of fat ) bana jAte haiM jinheM mArcI kI abhiraMjanA paddhati se raMgane para kAlA raMga AtA hai / para jaba akSarambhoM ko hama bIlazAvaskI abhiraMjanA vidhi se raMgate haiM to unameM utane adhika parivartana nahIM dekhe jAte jo vAlarIya vihAsa meM milate haiN| para jaba roga gambhIrasvarUpa kA hotA hai to ve tantukita ( fibrillated ) ho jAte haiM aura unake mArga meM praphullita sUjana ( varicose swelling ) A jAtI hai / saumya roga hone para ve aprabhAvita rahate haiM / vAtanADI ke AvaraNa jise sUkSmatarakalAkaMcukA ( sheaths of Schwann ) kahakara gaNanAthasena ne likhA hai atyadhika sakriyatA dekhI jAtI hai / usake kozA praguNita ho jAte haiM aura bhatikozA bana jAte haiM isa kAraNa unake andara medAbha ( lipoid ) padArtha bharA huA dekhA jAtA hai| tIvra aupasargika nADIkandANupAka (Acute Infective Neuronitis) ___ isa roga kA jJAna prathama vizvayuddha meM huA thaa| ise iMglaiNDa meM tIvra aupasargika bahunADIpAka tathA amerikA meM tIvra aupasargika nADIkandANu yA cetaikapAka kahate haiN| isa roga meM mukhamaNDala aura grasanI kI peziyoM kA ghAta ho jAtA hai jisake kAraNa nigalanA atyanta kaThina ho jAtA hai usI ke sAtha sAtha sakthisaliyoM meM daurbalya yA ghAta bhI dekhA jAtA hai / kucha rugNoM meM pazvastambha kA bhI prabhAvita honA pAyA gayA thA jisake kAraNa pezI, sandhi tathA Avepa ( vibration) kI gatiyoM kA bodha ( sense ) naSTa ho jAtA hai / adhotrika khaNDoM meM isa bodha kI kamI hotI hai tathA sAtha meM dvAra saMkocakoM (sphincters) ke niyantraNa meM bhI kamI ho jAtI hai| For Private and Personal Use Only

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vividha zarIrAGgoM para vraNazotha kA prabhAva 226 vikRtazArIra kI dRSTi se isa roga meM sampUrNa kendriya vAtanADIsaMsthAna ke dhUsara dravya para prabhAva par3atA hai / suSumnA ke agra aura pazca donoM zRGgane meM vihAsa milatA hai pazcamUla pragaNDa meM bhI spaSTa parivartana milate haiN| mastiSka bAhyaka ke bRhat pragaNDIya kozAoM (baija kozAoM Betz cells ) meM saumya parivartana milate haiM usI prakAra ke parivartana USNIpaka kI nyaSTiyoM meM bhI pAye jAte haiN| suSumnA ke zvetadravya meM vAlarIya vihrAsa dekhA jAtA hai tathA tantuoM kA vikhaNDana (fragmentation) ho jAtA hai| suSumnA tathA pariNAhI vAtanADiyoM meM raktasrAva pAye jAte haiN| mastiSkasuSumnAchada isa roga meM nirvikAra rahatI hai| bandaroM para isa roga ke sauSumnika pranilamba ke antaHkSepaNa dvArA eka se dUsare meM yaha roga utpanna kiyA jA sakatA hai / nAgUcIya mAdhyama para saMvardhana karake vilsana ne golAbhapiNDoM (globoid bodies ) kA patA lagAyA hai| ye golAbhapiNDa ThIka usI prakAra ke hote haiM jaise phlaikzanara aura nAgUcI ne tIvra suSumnAdhUsaradravyapAka meM prApta kiye the| _isa prakAra hamane vraNazotha ke vividha zArIrika aMgoM ke prabhAva ke sambandha meM nAtivistRta jo vivecanA kI hai usase pAThaka yaha bhale prakAra samajha leMge ki vraNazotha ko sAdhAraNa samajha upekSA karanA atyanta hAniprada ho sakatA hai ataH isake sambandha meM pUrNataH satarka hone kI AvazyakatA hai| hamane isa prakaraNa meM praNAlI vihIna granthiyoM ( ductless gland ) para vraNazotha ke prabhAva kA koI ullekha nahIM kiyA hai kyoMki usake sambandha meM abhI Avazyaka sAmagrI kA abhAva hI dRSTigocara hotA hai| kevala avaTukApAka ( thyroiditis) kA thor3A varNana milatA hai| Age jaba isa sambandha meM vizeSa jJAna prApta hotA jAvegA prakaraNa ke kalevara kI vRddhi kara dI jaavegii| netra aura karNa sambandhI pAkoM kA vivaraNa viziSTa viSaya samajha chor3a diyA gayA hai kyoMki unakA samAveza grantha ko maryAdA se adhika vistRta banA dene vAlA hai| For Private and Personal Use Only

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tRtIya adhyAya UtimRtyu yA UtinAza ( Tissue Necrosis ) hamArA zarIra asaMkhya vA aparisaMkhyeya kozAoM ( cells ) 'jinheM Ayurveda dehaparamANu kahatA hai' dvArA nirmita hotA hai / ye kozA bhI aneka prakAra ke hote haiM / inake eka prakAra ke samUha se eka prakAra kI aura dUsare prakAra ke samUha se dUsare prakAra kI utioM kA nirmANa hotA hai / UtiyoM (tissues ) ke aneka prakAra mAnavazarIra meM pAye jAte haiM unameM kucha ke nAma nimnAMkita hai| : Acharya Shri Kailassagarsuri Gyanmandir yojIUti ( connective tissue ), granthyAbha Uti ( adenoid tissue ), vapA Uti ( adepose tissue ), antarAlita Uti ( areolar tissue ), fafag afa (cancellous tissue), after fa (cartilagenous tissue), pratyAstha Uti ( elastic tissue ), antazchadIya Uti (endothelial tissue), adhichadIya Uti ( epithelial tissue ), tAntava Uti ( fibrous tissue ), zliSIya Uti ( gelatinous tissue ), granthika Uti ( glandular tissue ), kana Uti ( granular tissue ), antarAlIya Uti ( interstitial tissue ), antaranAla Uti ( intertubular tissue ), lasIka Uti ( lymphoid tissue ), zleSmAbha Uti (mucoid tissue ), pezI Uti ( muscular tissue), caita Uti ( nervous tissue ), Adi Adi / ina dhAtuoM kA AdyopAnta prAkRtika varNana zarIravyApAra zAstrAntargata autikI ( Histology ) ke adhyayana ke samaya samajhA jA cukA hai / hama isa adhyAya meM zarIranirmAtrI vibhinna UtiyoM ke hrAsa, vinAza vA kSarti kA sarvasAmAnya Adhunika varNana kareMge / isakA sUkSma sA AbhAsa hamane bhUmikA meM kara diyA hai jisase lAbha uThAyA jA sakatA hai I UtinAza ke 3 pramukha kAraNa nimnAGkita 3 kAraNoM meM se kisI ke athavA sabhI ke upasthita hone se sarvasAmAnya UtimRtyu tattat Uti vizeSa meM dekhI jAtI hai : 1. poSaNa meM bAdhA 2. rAsAyanika viSoM evaM bhautika kartAoM kI kriyA 3. rogANvika viSayA~ ( bacterial toxins ) poSaNa meM bAdhA jaba Uti ko puSTa karane ke lie Avazya sAmagrI vahA~ taka nahIM pahu~ca pAtI taba bhI Uti kA nAza ho sakatA hai / For Private and Personal Use Only

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UtimRtyu yA UtinAza 231 adharacAlakacetaika prakArIya aGgaghAta (lower motor neurone type of paralysis ) ke kAraNa parizuSka aGga poSaNa meM prApta bAdhA kA hI dyotaka hai| poSaNa kI bAdhA hone ke lie 3 hI kAraNa ho sakate haiN| eka to usa Uti ko pahu~cane vAlI dhamanI kA sambandha viccheda ho jAve / dUsare usa Uti kA tarpaNa karane vAle kezAla ( capillaries ) avaruddha hokara rakta kA AvAgamana roka deM athavA tIsare bahuta bar3A sirAvarodha ho jAve aura rakta paribhramaNa meM bAdhA hokara poSaNa kA abhAva ho jaave| isa prakAra dekhane se jJAta huA ki kisI bhI Uti kI mRtyu karane meM nimna kAraNa pradhAna raha sakate haiM: a-prabhAvita Uti ko rakta pahu~canA banda ho jAnA--yaha nimna kAraNoM se ho sakatA hai: 1. vahA~ taka Ane vAlI dhamanI kA kaTanA yA TUTanA, 2. rakta kA antaHskandana ( yA AtaJcana ), 3. kisI roga vA AghAta ke cirakAlIna pariNAmasvarUpa dhamanI ke mukha ke pariNAha kA saGkIrNa ho jAnA, 4. dhamanI kA bA~dhanA ( ligature ), 5. dhamanI kA saMpIDana ( compression ), tathA 6. dhamanI meM nirantara sAGkocika AkSepa ( spasm ) AnA-jaisA ki reno ke roga ( Raynaud's disease ) meM dekhA jAtA hai| A-prabhAvita uti ke kezAloM kA avaruddha ho jAnA--yaha nimna kAraNoM se ho sakatA hai: 1. jaba kezAloM kI prAcIra se chana chana kara raktarasa prabhAvita Uti ke cAroM ora bhara kara kezAloM ko dabAkara unakI kriyA ko avaruddha kara de| 2. jaba prabhAvita Uti meM yA usake samIpa kI uti meM utpanna hone vAle yA hue arbuda ( tumour) kA pIr3ana usa sthAna ke kezAloM para par3a kara unakI kriyA roka de| 3. athavA jaba eka hI Asana para adhika dera . sthira raha jAve to zarIrabhAra ke kAraNa daba kara kisI aMga yA Uti vizeSa ke kezAloM kI kriyA ruka jaave| ___. kabhI kabhI eka aMga meM atighaTana yA aticaya ( hyperplasia ) hokara bhI kriyA ruka jAtI hai / vRkkoM meM upasarga ke kAraNa jaba unake vRkkANuoM ke antazchada meM aticaya hotA hai to rakta kA svayaM avarodha hokara raktaskandana (AtaJcana)ho jAtA hai jisake kAraNa kezAloM kI kriyA ruka jAtI hai| i-zarIragata sirAvarodha-sAdhAraNa sirAvarodhoM ke kAraNa dhAtunAza nahIM huA karatA kyoMki yadi kisI aMga meM eka ora sirAe~ avaruddha bhI ho gaI to For Private and Personal Use Only

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232 vikRtivijJAna dUsarI ora koI na koI mArga raktasaMvahana ko mila jAtA hai| parantu jaba kabhI bar3I bar3I sirAoM meM avarodha ( venous engorgement ) hotA hai tathA usake kAraNa phuphphusoM vA hRdaya meM raktasaMvahana kriyA meM kaThinatA utpanna hotI hai taba yakRt ke madhyakhaNDa kI khaNDikAoM ( lobules ) meM UtimRtyu dekhI jAtI hai| ___ rAsAyanika viSa aura bhautika abhi kartA ( Chemical poisons & Physical agents ) nimnAGkita bhautika aura rAsAyanika (physical & chemical ) kAraNoM se bhI UtimRtyu ho sakatI hai :-- 1. bAhya AghAta ( external violence ) 2. atyadhika santApa vA zIta (extreme variance in temperature) dhrava pradeza kI yAtrA karane vAle yAtriyoM kI atizIta ke kAraNa paira kI aMguliyA~ Adi galakara kaTa jAtI haiM vaha isI kAraNa hai| ___3. dAhaka viSa ( caustic poisons )-isameM koI tIkSNa kSAra yA tIkSNa amla liyA jA sakatA hai| 4. bhAsvara viSatA ( phosphorus poisoning ), 5. somala viSatA (arsenic poisoning ), 6. sIsa viSatA ( lead poisoning ), 7. nIravamrala (klorophArma) viSatA, 8. tejAtu ( radium ) athavA kSa-kiraNoM se aMga vA Uti vizeSa kA naSTa ho jaanaa| __rogANvika viSiyA~ rohiNI ( Diphtheria ), prameha piDikAe~ ( carbuncles ), savraNa mukha91( ulcerative stomatitis ), #1191# ( ulceration of vulva ), meM vibhinna UtiyoM kA nAza hotA hai| inameM vibhinna golANuoM ke kAraNa UtimRtyu hotI huI dekhI jAtI hai| phuphphusapAka ( pneumonia) meM jo phauphphusika Uti kA nAza itastataH milatA hai vaha phuphphusa golANuoM ( pneumococci ) dvArA kiye gaye vinAza kA pariNAma hotA hai| isI prakAra Antrika jvara meM A~toM kI zleSmalakalA meM avasthita jo peyara sidhma (Peyer's patches ) dekhe jAte haiM vaha tadrogakartA jIvANu ke kAraNa dekhe jAte haiN| phuphphusapAka aura Antrika jvara meM yakRtplIhAdi aGgoM meM vikRti kA bhI pariNAma usI nimitta se hai| vAtijana prAvara gadANu klosTrIDiyama vailcAI (Cl. welchii ) nAmaka jIvANu ke kAraNa savAtakotha (gas gangrene ) jaisI vyAdhi hotI hai jo kisI bhI Uti kA sarvanAza kara detI hai| For Private and Personal Use Only

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UtimRtyu yA UtinAza mRtyu meM kyA hotA hai ? Upara jo 3 Uti nAzaka kAraNa diye haiM unameM se kisI vA sabhI ke kAraNa jaba Uti kA nAza hone lagatA hai to usameM aneka parivartana dekhane ko milate haiM / ye parivartana isa krama meM dekhe jAte haiM : - 233 1. sarvaprathama usa Uti ke kozA phUla jAte haiN| isa avasthA ko meghAbha-zothAvasthA ( the stage of cloudy swelling ) kahate haiM / isa avasthA kI mukhya bAta yaha hai ki Uti kI svAbhAvika kSArIya pratikriyA ( alkaline reaction ), usakI mRtyu ke kAraNa sadyaH utpanna dadhika amla, zuktika amla tathA ghRtika amloM ( lactic acid, acetic acid, butyric acids) ke kAraNa Amlika (acidic ) ho jAtI hai / 2. tatpazcAt UtikozAoM meM upasthita sneha kA vighaTana hotA hai / ise sneha vihnAsAvasthA ( the stage of the degeneration of fat ) kahate haiM / isa avasthA meM snehabhAga atisUkSma bU~doM ke rUpa meM Akara zveta sAbuna ke varNa kA svaphenita ( saponified ) ho jAtA hai aura phira usakA pracUSaNa kara liyA jAtA hai / 3. taduparAnta Utistha probhUjinoM kA pAcana hotA hai / jisa prakAra mahAsrota meM AhArya probhUjina kA pAcana agnyAzaya rasa ke dvArA hotA hai ThIka vaise hI kozAnirmAtrI probhUjina tiktAti ( amoniyA ), tittayamla ( amIno esiDsa ), dvitittayamla ( diamino acids ) banane lagate haiM / ise probhUjAMzikAvasthA ( proteolytic stage) kahate haiM / Upara jo tIna avasthAe~ batalAI gaI haiM ve nirmApaka ghaTakoM kI dRSTi se kahI gaI haiM / UtisaMracanAdRSTyA ( histologically ) nimna parivartana bhI dekhe jAte haiM : -- nyaSThIlAnAza 1. nyaSTi- abhiraJjana kI hAni ( loss of nuclea-staining ) hotI hai| 2. kozAstha nyaSThIlA ( nucleus of the cell ) viSamAkRtika ho jAtI hai para usakA abhiraMjana gaharA hotA hai / yaha sAndrAtitA ( pyknosis ) kahalAtI hai / 3. kozAstha nyaSThIlA ke kaNa vighaTita ho jAte haiM jinakA abhiraMjana khUba ho sakatA hai / jise nyaSTibhoTana ( karyorrhexis ) kahate haiM / 4. nyaSThIlA kI abhiraJjana zakti kA hrAsa ho jAtA hai / ise nyaSTayazana (karyolysis) kahate haiM / For Private and Personal Use Only kozAnAza 4. kozAzarIra choTe choTe aNuoM meM vibhakta ho jAtA hai jisake kAraNa usakA AsRtIyanipIDa ( osmotic pressure ) bar3hatA hai jo use phulA detA hai /

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234 vikRtivijJAna 5. kozAzarIra meM sneha-vindu prakaTa hote haiN| 6. anta meM kozAprAcIra naSTa ho jAtI hai aura eka sama, uSasiraMjya (eosinophilic ) kaNayukta padArtha mAtra bacA rahatA hai jo svayaM ke vikara ( enzyme ). dvArA khA liyA jAtA hai| uparokta parivartana antarAlita yojI Uti ( interstitial connective ) kI apekSA adhichadIya uti ( epithelial tissue ) meM adhika druta vega se hotA hai| ___utimRtyu ke prakAra vibhinna Adhunika granthoM kA avalokana karane se jJAta hotA hai ki kula 6 prakAra kI UtimRtyu kA varNana kiyA gayA hai jo isa prakAra hai: (1) nAbhyanAza ( Focal Nercosis ) isa prakAra kI UtimRtyu meM kisI Uti ke eka sthAna ke eka kozAsamUha kA pUrNa saMhAra ho jAtA hai| usI Uti meM sthita vikara usa mRta kozAsamUha ko pacA DAlate haiM tathA zeSa jo avaziSTAMza rahatA hai use bhakSikozA ( phagocytes ) vahA~ se haTAkara le jAte haiM tathA usake sthAna para yA to tAntava Uti kA yA usI viziSTa dhAtu ke kozAsamUha kA punarnirmANa ho jAtA hai| nAbhyamRtyu Antrika jvara, pRSajjvara (TAyaphasa jvara ), kaNTharohiNI, phuphphusapAka tathA garbhAGga viSamayatA ( eclampsia ) meM dekhA jAtA hai| isakA vizeSa prabhAva zarIra kI granthiyoM athavA hRdaya para par3atA huA bhI dekhA jAtA hai| (2) AtaMcin nAza ( Coagulative Necrosis ) isakA pramukha udAharaNa RNAsra ( infarct ) hai| jaba kisI bhI kAraNa se dhAtugAmI kezAla kI antazchada ko kSati pahu~catI hai taba prAcIra durbala hokara raktarasa ko kezAloM ke bAhara pheMka detI hai vahA~ para kozAoM kI mRtyu hone lagatI hai| mRtyuke kAraNa dhAtu se AtaJci ( coagulin ) nAmaka padArtha nikala kara tantvijana ( fibrinogen) nAmaka padArtha se mila kara AtaJcana kara detA hai| isI se prArambha meM RNAsra kA raGga lAla rahatA hai| dhIre dhIre usake pracUSita ho jAne para raGga zveta ho jAtA hai| lAla vA zveta RNAsra bahuta prasiddha haiN| (3) drAvaNanAza ( Colliquative Necrosis) ____ yaha Atazcin mRtyu se Age kI avasthA hai| jisameM zveta vA lAla raMga ke RNAstra ke banane taka ke varNana ke Age kA varNana kiyA gayA hai| isameM lAla vA zveta RNAsra mRdu yA dravIbhUta ho jAtA hai| isakA prAthamika svarUpa mastiSka kI caita (yA vAtika) For Private and Personal Use Only

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UtimRtyu yA atinAza ati ( nervous tissue ) meM milatA hai jahA~ AtaJcana na hokara sIdhA drAvaNa hotA hai| isakA dvitIyaka svarUpa kisI vidhi meM pUyotpatti ke rUpa meM athavA yakSmA meM kilATIyana ( caseation ) ke rUpa meM dRggocara hotA hai| ( 4 ) kilATIyanAza (Caseous Necrosis ) yaha rAjayakSmA tathA phiraGga ( T. B. & syphilis) nAmaka do rogoM meM mukhyataH dekhA jAtA hai| isa UtimRtyu meM dhAtu pUrNataH naSTa hokara zveta kilATa (panIravat mRdu padArtha) meM pariNata ho jAtI hai / isa kilATa meM probhUjina tathA sneha kA bAhulya rahatA hai| ___phiraGga roga meM taralana ( liquefaction ) na hokara vahA~ dhIre se tAntava Uti kA nirmANa ho jAtA hai parantu yakSmA meM taralana hokara tarala bAhara kI ora nikala jAne kA prayatna karatA hai| yadi kisI kAraNa vaisA na hosakA to usake bhI cAroM ora tAntava Uti ( fibrous tissue) kA gherA bana jAtA hai| dhIre dhIre taralAMza sUkhatA calA jAtA hai tathA vahA~ cUnA bharatA jAtA hai| isako hama cUrNiyana ( calcification ) kahate haiN| kilATIya mRtyu 3 kAraNoM se huA karatI:: 1. yakSmA vA phiraGga ke jIvANuoM se nikalA huA viSa Utistha AtmapacanIyakiNvoM (autolytic ferments) ke kArya ko roka detA hai isake kAraNa dhAtu vilupta na hokara kilATa ke rUpa meM raha jAtI hai| ___2. kAraNabhUta jIvANuoM ke dvArA Uti meM aisA viSa bhI bhejA jAtA hai jisakI upasthiti meM sitakozA una rogANuoM para AkramaNa nahIM karate tathA vahA~ para sthita kilATa ko uThAnA pasanda nahIM krte| 3. usa dhAtu ko rakta kI yathAvazyaka mAtrA pahu~canA banda ho jAtA hai kyoMki usake cAroM ora tAntava uti kA eka gherA khiMca jAtA hai tathA raktavAhinI dhamanI kA mukha choTA aura Ter3hA ho jAtA hai| (5) snaihikanAza (Fat Necrosis) __udara meM snaihika mRtyu kA pramukha kAraNa sarvakiNvI ( pancreas ) meM sthita vimededa ( lipase ) kA sneha vA snigdha Uti ke samIpa pahu~canA hai| snaihika mRtyu urasa para abhighAta lagane se kaThina, gola, koSThIya (cystic) rUpa meM dekhI jAtI hai| ise abhighAtaja snaihika mRtyu kahate haiM / ___ jahA~ snaihika mRtyu huI rahatI hai vahA~ 3 se 2 iJca vyAsa ke zveta, dRr3ha kSetra hote haiN| inheM gurvika amla ( osmic acid ) ke dvArA abhirakSita kiyA jA sakatA hai| kabhI kabhI ina kSetroM meM snaihikAmloM ke sphaTa (crystals of fatty acids ) bhI milate haiM jinako aNuvIkSaNayantra kI sahAyatA se dekhA jA sakatA hai| For Private and Personal Use Only

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236 vikRtivijJAna ( 6 ) vyUhANvIya nAza yA vraNana (Molecular Necrosis or Ulceration ) zarIra dharAtala ke nirmANa meM bhAga lene vAlI UtiyoM-tvacA aura kalA meM hone vAlI yaha UtimRtyu hai / isakA pradhAna hetu bAhya upasarga hotA hai / upasarga ke pazcAt kisI aMga para satata pIr3ana honA bhI vraNakAraka huA karatA hai / nirantara zaiyyA para leTe rahane se zarIra ke bhAra kA jaba pIDana durbala rogI ke nikale hue bhAgoM para par3atA hai to zaiyyAtraNa ( bed - sores ) kA honA usakA eka udAharaNa hai / vAhinI visphAra ( aneurysm ) vA arbuda ( tumour ) ke kAraNa bhI eka hI sthAna para pIr3ana hone se vraNa ho sakatA hai / netra meM bAhya vastu ke pahu~cane se svacchaka vraNa ( corneal ulcer ) bana jAtA hai / kabhI kabhI nizcetanakriyA ( anaesthesia ) dvArA saMvedi cetA ( sensory nerve ) para AghAta hone se bhI vraNana hotA hai / jaba yaha kahIM ho jAtA hai to vahA~ prAyaH poSaNatraNa ( trophic ulcer ) bana jAyA karate haiM / mArAtmaka vA duSTa arbudoM ( malignant tumours ) ke kAraNa duSTa vraNa utpanna huA karate haiM / ye sabhI vyUhANvIya UtimRtyu ke sUcaka haiM / I 49ers Acharya Shri Kailassagarsuri Gyanmandir 8 caturtha adhyAya vihAsa ( Degeneration ) yaha bhI Uti vizeSa para hone vAlI kriyA hai / jaba kisI Uti kA vihAsa kahA hai to usakA abhiprAya UtiyoM kA usa Uti meM parivartana samajhanA cAhie / udAharaNArtha snaihika vihAsa kahane se kisI Uti vizeSa meM sneha kI upasthiti hai aisA bodha hotA hai sneha ke abhAva kA nhiiN| Age isa viSaya kA nAtisaMkSepa vistAra pUrvakavarNana kiyA jAtA hai / For Private and Personal Use Only meghAbha yA meghasama zotha ( Cloudy swelling ) ise kaNadAra, zuklAbha yA jIvitaka ( parenchymatous ) vihAsa kahate haiM / jvara vA viSamayatA ( toxaemia ) jina rogoM ke kAraNa mAnavazarIra meM phailatI hai unhIM se yaha vihAsa bhI hotA hai / zlaiSmikakalA meM jo painasa vraNazotha ( catarrhal_inflammation) hotA hai vaha isakA sthAnika udAharaNa hai / rakta meM viSaile padArtha kI upasthiti bhI isakI mUlaka ho sakatI hai tabhI saMkhiyA bhAsvara ( phAsphorasa ) yA khanija amloM kI upasthiti meM meghAbhagaNDa prAyaH milatA

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vihAsa 237 I hai / meghAbhagaNDa snaihika vihAsa ( fatty degeneration ) kI pUrvAvasthA batalAI jAtI hai| meghAbhagaNDa kozA ke kAyANurasa ke una parivartanoM meM se eka hai jinake kAraNa kozA kI mRtyu taka ho sakatI hai / mRta Uti ke AtmAMzana (autolysis ) kA prathama lakSaNa bhI yahI hai / koSAoM ke sAdhAraNa vraNazotha ( inflammation ) meM bhI yaha pAyA jAtA hai / vraNazotha kA pradhAna kAraNa koI prakSobhaka hetu huA karatA hai / yadi vahI hetu aura adhika ugra huA to dhAtunAza vA apajanana ho sakatA hai / meghasamazotha svayaM kAyANurasa ( cytoplasm ) ke una parivartanoM meM se eka hai jinake kAraNa kozA kI mRtyu taka ho sakatI hai / meghAbhagaNDa mRta Uti ke AtmAMzana ( autolysis ) kA bhI prathama lakSaNa hai / jaba kisI viSa se kisI sajIva kozA ko AghAta pahu~catA hai to usake cidrasa ke aNu aura choTe choTe bhAgoM meM vibhakta ho jAte haiM jisake kAraNa kozA ke andara kA AsRtIya pIDana ( osmotic pressure ) bar3ha jAtA hai jisake pariNAmasvarUpa kozA meM jala khiMcane lagatA hai aura vaha phUla jAtA hai / yaha meghAbhagaNDa dUra hokara kozA svastha ho sakatA hai bazarte ki viSa kI kriyA niSkriya vA banda kara dI jAve / svarUpa - meghAbhagaNDayukta Uti ke kozA phUla jAte haiM, zveta aura mRdu ho jAte haiM tathA apAradarzaka ho jAte haiM / aNuvIkSaNa se dekhane para araJjita kozAe~ phUlI huI dikhatI haiM unakA cidrasa kaNamaya ho jAtA hai / nyaSThIlA ( nuclaus ) evaM kozA kI AkRti vicitra huI dIkhatI hai / kaNoM se prakAza kA parAvartana ( reflection ) manda hotA hai, una para gurvika amla kA bhI koI prabhAva nahIM hotA / ve tanu zuktika amla ( dilute acetic acid ) meM ghula jAte haiM / isake kAraNa yaha patA calatA hai ki ye zvitiya ( albuminous ) hote haiN| Age calakara unameM sneha vindu utpanna hone lagate haiM / sthAna - meghAbhagaNDa yA meghasamazotha jaisA parivartana yakRt, vRkka, hRdaya aura aicchika peziyoM meM prAyazaH milA karatA hai / jaba rogANuraktatA ( septicaemia ), phuphphusapAka ( pneumonia ), yA udaracchadapAka ( peritonitis ) Adi meM rogI kI mRtyu ho jAtI hai to usakI mRtyUttara parIkSA meM bhI yaha parivartana prAyaH dekhane ko milatA hai| isakA vRkkoM meM pramukha prabhAva bAhyaka ( cortex ) para par3atA hai vaha zveta par3a jAtI hai tathA vRkka ke stUpoM ( pyramids) evaM vRkkANuoM ( malpighian bodies ) meM rakta adhika bhara jAtA hai / hRdaya kI prAcIroM meM jaba yaha zotha dekhA jAtA hai to ve zveta ho jAtI haiM tathA mRdu bhI / hRtpezI tantuoM kI rekhAe~ ( striation ) samApta ho jAtI haiM / balki ve kaNamaya ho jAtI haiM / racanA meM kamI Ane kA pariNAma kriyA kI kamI meM bhI hotA hai / For Private and Personal Use Only

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238 vikRtivijJAna meghAbhagaeDa kI atyantAvasthA vA jalamaya vihAsa (hydropic degeneration ) isa avasthA meM koSAe~ itanI adhika phUla jAtI haiM ki unake kAyANurasa meM rasadhAnI ( vacuoles) bana jAtI haiM jo Age calakara dravasaJcayasthalikAe~ ( blebs ) kahalAtI haiN| kabhI kabhI tvacA meM phapholoM kI zakla meM tathA nalikAoM ke stara meM bhI yahI parivartana pAye jAte haiN| isa saba kA kAraNa utiyoM kA zotha hai| madhumeha ( diabetes ) meM madhuvazI granthiyoM ( islets of Langerhans ) meM bhI yaha parivartana milatA hai| snaihika vihrAsa ( Fatty Degeneration ) saMyojI UtiyoM ko chor3akara jinakA eka kArya sneha-saJcaya bhI hai anya kisI bhI kozA meM sneha kI prakaTa rUpa meM upasthiti vikRti kI nirdezikA hai| jaba kisI uti ke kisI kozA meM sneha kI upasthiti prakaTa ho jAtI hai to usake do hI artha nikAle jA sakate haiN| eka to yaha ki kozA sneha kA upayoga karane meM asamartha hai yA dUsarA yaha ki kozA svayaM viSAkta ho gayA hai jisase usake prarasa kA abhedya aGgarUpa sneha svatantra hokara prakaTa ho gayA hai / __ sneha zarIra meM UtiyoM ke pratyeka kozA kA eka nizcita saMghaTaka hai tathA yaha zakti ke saJcaya kI utkRSTatama vidhi hai| ina donoM bAtoM kI dRSTi se zarIra meM 2 prakAra ke sneha pAye jAte haiN| jinameM eka rAsAyanika dRSTi se kriyAzIla hotA hai ise vimedAbha ( lipoid ) kahate haiN| yaha pratyeka dhAtu-koSA meM rahatA hai| dUsarA klIbasneha ( neutral fat ) kahalAtA hai jo vibhinna UtiyoM meM saJcita rahatA hai| vimedAbhasneha ( Lipoids )-isameM paittava (cholesterol ), pralavaNa ( cholesterol esters ), soegifat ( lecithin ), Hrasta (cerebrosides ) evaM mizramastadhveya ( compound cerebrosides ) Ate haiN| ina vimedAbhoM ( lipoids ) ke kAraNa hI kozA ke prarasa (protoplasm ) meM sneha kI itanI mAtrA milatI hai| yakRt , hRdaya aura sarvakiNvI granthi meM vimedAbhoM kA kramazaH pratizata pramANa 20, 15 tathA 16 milatA hai / rakta meM paittava 0.1 se 0.2 grAma prati 100 gha. zi. mA. ( sI. sI.) ke hisAba se milatA hai| rakta ke paittava kA pramANa nimna dazA meM bar3ha jAtA hai : 1. sagarbhAvasthA ( pregnancy ) 2. jIrNa avarodhaka kAmalA (chronic obstructive jaundice ) 3. anutIvra vRktakoSa ( subacute nephritis) 4. madhumeha (diabetes mellitus) 5. vRkkANUtkarSa ( nephrosis) 6. dhamanI jAravya (arterio-sclerosis ) evaM ucca rakta nipIDa (high blood pressure ) yukta vRkkaroga ( kidney disease ) / For Private and Personal Use Only

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234 vihAsa 7. tIvrajvaryAvasthAoM meM ( in acute febrile conditions ) 8. rogoM kI cirakAlInatA ( chronicity of the diseases) rakta ke paittava kA pramANa prAthamika (primary ) evaM dvitIyaka (secondary) araktatA ( anaemias ) meM ghaTa jAtA hai| __ yahA~ uparAMkita vimedAbhoM kA kucha paricaya denA Avazyaka pratIta hotA hai / sarvaprathama hama paittava yA kolesTarola ko lete haiN| yaha na to eka sneha hI hai aura na eka vimedAbha hI api tu yaha eka suSava (alkohala ) hai jisakA sambandha vikSAmeNyoM ( anthracenes ) se hai jisameM eka pratisthApya udajArala varga (a replaceable hydroxyl group ) rahatA hai| isI varga kI kRpA se yaha snaihika amloM ke eka vyUhANu se milakara paittava pralavaNa banAtA hai aura isI pralavaNa ke rUpa meM yaha utiyoM ke andara kriyAvAn rahatA hai| ye pralavaNa kahIM bhI zIghratayA naSTa hokara paittava ke sphaToM ko janma dete haiN| ye sphaTa purAne zotha sthAnoM para, koSThoM ( cysts ) meM, muSka vRddhi ( hydrocele ) meM tathA dhamanI jAraThya ke sidhmoM ( patches of arterial atherosclerosis ) meM prAyazaH pAye jAte haiN| ye paittava abhispandita prakAza meM dviguNita bhujAila ( doubly refractile in polarised light ) hote haiN| tathA snaihika abhiraMjakoM se bahuta dhuMdhale abhiraMjita hote haiN| zarIra meM paittavoM ke mahattva para Adhunika khojoM ne bahuta prakAza DAlA hai| udAharaNa ke lie zarIrastha dhAnyaruka-sAndrava ( ergosterol) jIvati dha kA mahattvapUrNa saMghaTaka hai jisameM hokara gayA huA pArajambu prakAza (ultra-violet light ) cUrNAtu cayApacaya ( calcium metabolism ) ko prabhAvita karatA hai / strI aura puruSoM ke laiMgika nyAsarga ( sex-hormones ) paittava se bahuta adhika milate haiN| tathA virAla tailoM ( tar oils) kA karkaTajanakakAraka ( carcinogenic factor ) kA rAsAyanika svarUpa bhI isI ke sadRza hotA hai| aNDapIti tathA mastadhveya donoM jaTila svarUpa ke sneha haiN| inameM prathama bahuta mahattva kI hai| yaha (aNDapIti) kozA-cayApacaya meM mahattvapUrNa bhAga letI hai / yaha sabhI kozAoM meM pAyI jAtI hai, yaha snehoM tathA jalIya ghola ke bIca meM rAsAyanika madhyastha kA kArya karatI hai| yaha jala aura jala meM ghule padArthoM ko zIghra pracUSita kara letI hai tathA svayaM snehoM tathA tailoM meM ghula jAtI hai| aNDapIti madhurava (glycerol ) se banatI hai jisake do prApya udajAralavarga snaihika amloM se milate haiM tRtIya udajAralavarga klIba snehoM kI taraha snaihikAmla vyUhANuoM se na milakara bhAvika amla se mila jAtA hai aura isake sAtha bhUyAtyapITha ( nitrogenous base ) kI pittI ( choline ) milI rahatI hai / aNDapIti aura mastiSka ( cep. halin ) donoM meM madhurava, snaihika amla, bhAsvika amla aura bhUyAtyapITha pAI jAtI haiN| mastadhveyoM kI racanA bhI isI prakAra kI hotI hai para unameM zarkarA kA eka vyUhANu vizeSa kara (kSIradhu kA) aura milA rahatA hai| do mastadhveyoM ke milane For Private and Personal Use Only

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240 vikRtivijJAna se eka mizramastadhveya banatA hai| bhAsvarayukta snehoM kA yaha varga gurvika amla se acchA abhiraMjita hotA hai itanA sUDAna tRtIya (niSecananAraMga) se nhiiN| abhispandita prakAza meM isake sphaTa dvibhujAila tarala bhare hue kaNoM ke samAna prakaTa hote haiN| ye vimedAbha eka ora to klIba snehoM se milate haiM aura dUsarI ora probhUjinoM se aura ye aNDapIti-zvitiyA~ ( lecithin-albumens ) banAte haiM aura isa prakAra snehoM aura probhUjinoM kA eka zleSAbhIya vilayana ( colloidal solution ) banAte haiM jo kozA ke prarasa kA mahattvapUrNa bhAga hotA hai| __klIba sneha ( neutral fats) tvacA ke nIce, udaracchada ke nIce, athavA anya kozIya saMyojI UtiyoM ( cellular connective tissues ) meM, samasta zarIra meM klIva sneha ke pIta piNDa hote haiN| rAsAyanika bhASA meM ye madhurala pralavaNa (glyceryl esters ) haiM tathA ve rAsAyanika dRSTi se pUrNataH klIba bhI haiN| klIba sneha jala meM ghulatA nahIM hai parantu dattu (Ithara) nIravamrala (klorophArma), zauktA (esITona) athavA kASThava (jAyalola) meM vaha pUrNataH ghula jAtA hai| gurvikAmla (AsmikAmla) dvArA isakA abhiraJjana bhI ho jAtA hai| isa para vimededa (lAipeja) kI kriyA hokara yaha madhurI (glisrIna) tathA snaihikAmloM (phaiTI esiDsa) meM vibhakta ho jAtA hai| yakRt meM snaihikAmla ananuviddha ( desaturated ) hote haiM jisake kAraNa unase kriyAkSama vimedAbhoM (active lipoids) kI utpatti hotI hai| snaihika parivartanoM kI samprApti kisI bhI dhAtu ke kozAoM meM snehasambandhI 2 prakAra kI gar3abar3I yA vikRti dekhI jA sakatI hai : 1. snaihika nipAvana ( fatty infiltration ) tathA 2. snaihika vihAsa ( fatty degeneration ) hama ina donoM kA saMkSipta paricaya nIce dete haiM : 1. snaihika nipAvana (fatty infiltration) isa zabda kA abhiprAya hai-kozA meM snehAMza kI atyadhika saJciti / jaba rakta snaihika dravyoM ko bahuta adhika parimANa meM lekara calatA hai to yaha vikRti huA karatI hai| kabhI kabhI yakRt meM snaihika nipAvana vizeSa rUpa se dekhA jAtA hai| arthAt yakRt ke kozA sneha kI bar3I bar3I bUMdoM se bhara jAte haiN| unakA kozA-rasa chipa jAtA hai tathA unakI nyaSTIlA ( nucleus ) eka ora saraka jAtI hai| 2. snaihika vihAsa ( fatty degeneration )-jaba zarIrastha dhAtu kI kozAoM ko koI jIvANuviSa ( bacterial poison ) viSAkta kara detA hai to unakI jAraNa kI zakti (power of oxidation ) kA hAsa ho jAtA For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra vihAsa 241 hai / sAtha hI unake kozA-rasa meM jo eka sneha probhUjinIya zleSAbha padArtha ( colloidal fatty protein ) adRzya rUpa meM rahatA hai vaha eka dama prakaTa ho jAtA hai / yaha prakaTIbhUta sneha aura kucha na hokara svayaM klIba sneha mAtra hotA hai / sneha ke isa prakaTIkaraNa ko sneha-darzana (fat phanerosis) kahate haiN| isa prakAra dekhane se jJAta huA hai ki snaihika vihAsa eka viSagrasta kozA ke snaihika nipAvana ke kAraNa lAye sneha tathA svataH kozA ke kozA-rasa se prApta snaihika vihAsakA yoga mAtra hai| snaihika vihAsa prAyaH meghAbhazotha ke bAda kI avasthA hai / isake ho jAne para kozA ke svastha hone ke avasara bahuta sandehaprada dekhe aura pAye jAte haiM / prAyaH snaihika vihAsa evaM snaihika bharamAra ye donoM vikRtiyA~ eka sAtha hotI haiM isa kAraNa sneha kI adhikatA kozAoM meM prakRtAvasthA se bahuta adhika pAI jAtI hai| zarIra ke vibhinna aGga-pratyaGgoM ke kozAoM meM se pratyeka meM sneha kI mAtrA samAna nahIM hotI / yakRt, hRdaya evaM sarvakiNvI meM jahA~ vAstava meM snehAdhikya hotA hai vahA~ plIhA, vRkkoM vA anya aGgoM meM vaisI snehAdhikatA nahIM milatI / snaihika nipAvana - sneha kA atiyoga ( atisneha sevana ) AhAra meM sneha sAdhAraNa, adhika parantu vyAyAmA - sneha bhAva 1 rAsAyanika T raktahInatA viSa mahAsrotIya vikAra aJjana klorophArma phAsphorasa www.kobatirth.org I jaivika bharamAra aura apajanana meM hetu snaihika vihrAsa hetu nidarzanI tAlikA Antrikajvara rohiNI masUrikA doSamayatA 21, 22 vi0 Acharya Shri Kailassagarsuri Gyanmandir snaihika vihAsa - sneha kA mithyAyoga madya Adi kA sevana jo adhika sneha kA pAcana karake usakI mAtrA zarIra meM bar3hA dete haiM / sneha kA snehazarIra meM saJciti atyadhika vighaTana For Private and Personal Use Only 1 kulaja pravRtti ( duHsneha sevana ) T jAraNa kI kamI | bhakSakAyA NuoM dvArA sneha kA sevana raktasaMva- jAraNa kA hana saM sthAna se sneha kI apUrNa cyuti hAsa sirAjanya adhirakta tA RNAsa

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242 vikRtivijJAna jAraNa (oxidation) kI aparyApti hI donoM vikRtiyoM kA mUla evaM pradhAna hetu hai| snaihika bharamAra meM medodhikyatA kA kAraNa adhika sneha sevana karake kama vyAyAma karanA hai jisake kAraNa jitanA AhAra liyA jAtA hai usake anurUpa usakA bhasmIkaraNa nahIM ho paataa| bharamAra paitRka ( hereditory ) bhI pAI jA sakatI hai| vRddhAvasthA meM bhI yaha dRSTigocara hotI hai| antaHsrAvI granthiyoM (endocrine glands ) meM vikAra hone se bhI medasvitA bar3hatI huI dekhI jAtI hai| isa prakAra dekhane se jJAta hotA hai ki sAdhAraNatayA kozAoM meM sneha kI bharamAra bahuta kucha bhautika kAraNoM se huA karatI hai| viSa kA pariNAma utanA mahattvapUrNa nahIM hai| parantu snaihika vihAsa meM jahA~ jAraNa kI kamI eka kAraNa hai vahA~ usake mUla meM kozA kI kisI jaivika vA rAsAyanika viSa ke kAraNa hone vAlI viSagrastatA mahattvapUrNa kAraNa hotA hai| eka dUsarA kAraNa sakoza apacayaka ( cellular cata. bolite ) bhI batalAyA jAtA hai| kyoMki jAraNa prakriyA meM jaise jaise jAraka vAta ( AksIjana ) kI kamI kozAoM meM hotI jAtI hai tyoM tyoM hI yaha adhika viSayukta dekhA gayA hai| cirakAlIna nizceSTa adhiraktatA (chronic passive congestion ) evaM gambhIra raktahInatA ( serious anaemic conditions ) meM bhI apacayaka ( catabolites ) pramukha bhAga lete haiN| snaihika vihAsa karane vAle rAsAyanika viSoM meM nimna mukhya haiM:sendriya viSa-1. mdy| 2. nIravamrala (klorophArma) nirIndriya viSa-1. bhAsvara (phAsphorasa) 2. sakhiyA ke yoga / snaihika vihAsa karane vAle jaivika virSoM kA vicAra karane para jJAta hotA hai ki vihAsa kI kriyA saba prakAra ke upasarga kI avasthAoM meM ( in all types of infectious conditions ) dekhI jAtI hai mukhyataH phuphphusapAka aura rohiNI (diphtheria ) ke upasargoM meN| cayApacaya ke viSaile padArthoM kA saJcaya bhI snaihika vihAsa kA kAraNa huA karatA hai| yakRt kI nizceSTa adhiraktatA kI dazA meM aisA hI hotA hai| striyoM kI gArmika vA sAdhAraNa viSamayatAoM (eclampsia) meM bhI snaihika vihAsa milatA hai| snaihika vihrAsa aura autikI UtisaMracanA kI dRSTi se dekhane se patA calatA hai ki jisa aGga meM snaihika vihAsa hotA hai vaha sUja jAtA hai, usameM meghAbhagaNDa upasthita hai| usakA raGga zveta yA zvetapItAbha dekhA jAtA hai jisake bIca meM pIle dhabbe athavA pIta rekhAe~ dekhI jAtI haiN| jisa aGga meM snaihika vihrAsa milatA hai usakI pratyAsthatA bhI naSTa ho jAtI hai| vaha aGga mRdu evaM bhidura yA kSodya ( friable ) ho jAtA hai| cAkU se kATane para usake phalaka para snehavindu laga jAte haiN| For Private and Personal Use Only

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(1) hRdaya kA snahika nipAvana pRSTha 243 ( 2 ) hRdaya kA snaihika vihAsa hRtpezI meM sneha kI atyadhika bharamAra spaSTa dikha rahI hai / yaha citra hRdaya ke snehika vihAsa ko prakaTa karatA hai / hRtpezI apAradarzaka aura pANDura ho gaI hai usameM itastataH pIle dhabbe milate haiN|

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vihAsa 243 aNvIkSa dvArA dekhane para jJAta hotA hai ki prabhAvita kozA meM sneha yA to eka bar3I bUMda ke rUpa meM milatA hai yA asaMkhya choTI choTI bUMdoM ke rUpa meM dekhA jAtA hai| ina donoM meM se pahalA svarUpa snaihika bharamAra kA pramukha lakSaNa hai tathA dUsarA svarUpa snaihika vihAsa meM pAyA jAtA hai| sneha kI ye bUMdeM snehavilAyakoM ( fat-solvents) jaise dakSu (Ithara), kASThava (jAyalola) Adi meM ghula jAtI haiM para zuktikAmla (acetic acid ) meM nahIM ghulatI / gurvikAmla inheM kAlA kara detI hai / ___ aba nIce vibhinna aGgoM meM pAye jAne vAle snaihika parivartanoM kA yathAkrama varNana karate haiM: hRdaya kA snaihika vihrAsa ( Fatty Degeneration of the Heart ) nimna kAraNoM se hRdaya kA snaihika apajanana hotA hai :1. gambhIra svarUpa kI raktahInatA ( severe anaemia) 2. anutIvra viSaraktatAe~ ( subacute toxaemias) 3. abhilAgI parihRdcchadapAka ( adhesive pericarditis ) 4. hRtpezIpAka ( Myocarditis) 5. dhamanIpAka ( atheroma) hRtpezI ke snaihika vihrAsa grasta hone para hRtkArya manda par3a jAtA hai| hRdaya zlatha (flabby) bhidura yA kSodya (friable) ho jAtA hai| aNvIkSa se dekhane para hRtpezI ke rekhAGkana (striation) lupta ho jAte haiN| cirakAlIna rugNoM ke hRdaya kA raMga kaburita ( mottled ) ho jAtA hai / hRtpezI apAradarzaka ( opaque ) aura pANDura (pale) ho jAtI hai| usameM itastataH pIle dhabbe milate haiN| tulanA meM vaha cIte kI khAla jaisI hotI hai| __hRdaya meM snaihika vihAsa kA vistAra pahale mAMsastambhI (columnae carnae). se hotA hai / vahA~ se vAmanilaya meM jAtA hai phira dakSiNanilaya meM pahu~catA hai| ____yakRt kA snaihika vihrAsa ( Fatty Degeneration of the Liver ) snaihika vihAsajanita yakRt dekhane meM zveta-ApIta ho jAtA hai| prAkRtika yakRt se dugunA usakA AkAra ho jAtA hai| dharAtala cikanA, kinAre moTe evaM gola ho jAte haiN| usakA ApekSika ghanatva kama ho jAne se usake Tukar3e jala para tairate haiN|' kATane para usakA dharAtala karburita ( mottled ) ho jAtA hai| jahA~ sneha hotA hai vaha pradeza zveta-ApIta evaM apAradarza ho jAtA hai| yadi sneha kA adhika saJcaya rahA to kATane para kevala ApIta kSetra hI dikhAI dete haiN| svastha yakRt raktapUrNa aura lAla dikhAI detA hai| saMracanAdRSTayA vaha piSTIya ( doughy ) aura sagarta rahatA hai| kATane para cAkU ko cikanA kara detA hai| For Private and Personal Use Only

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244 vikRtivijJAna sAdhAraNa yakRt ke khaNDa ( lobes ) 3 bhAgoM meM vibhakta rahate haiN| inameM prathama ko parisarIya bhAga kahate haiN| isakA abhisiJcana kezikAbhAji yA pratihAriNIsirA ( portal vein) ke dvArA hotA hai| madya yA atiyoga meM snehoM kA sevana karane se jo vihrAsa hotA hai vaha kezikAbhAji sirA dvArA prArambha hotA hai isI se vaha parisara se kendra kI ora dekhA jAtA hai / bhAsvarI viSayukta AhAra lene para bhI vikRti parisara se hI prArambha hotI hai| dvitIya ko kendriya pradeza kahate haiN| jahA~ yAkRtsirA abhisiJcana karatI hai| yakRt kI nizceSTa adhiraktatA kI avasthA kAlika hRdbheda ( chronic heart failure ) ke kAraNa huA karatI hai| usameM bhI vinAza vA vihrAsa ke cihna pahale yAkRtisarA meM avarodha hone se kendra meM hI prakaTa hote haiN| vahA~ se ve parisara kI ora jAte haiN| kendriya sirA ke viSAkta hone ke do kAraNa haiN| prathama jAraka (oxygen) kA abhAva aura dUsare sirA ke rakta meM sthita viSAkta cayApacayika utpAda (toxic metabolic products ) kA saJcaya honA hai| klorophArma ke vipa meM bhI vikSata kendra se hI prArambha hote haiN| __ tRtIya ko madhyavartI pradeza kahate haiN| ise yAkRt dhamanI sIMcA karatI hai| isameM eka nAbhya vA sthAnika vihAsa milA karatA hai| isake vikSata kisI pradeza vizeSa meM na hokara itastataH chitare rahate haiN| pahAsa mAMsapezI kA snaihika vihrAsa ( Fatty Degeneration of the Muscles) pezI cAhe rekhAGkita (striated) ho yA arekhAGkita, snaihika vihAsa donoM meM mila sakatA hai| pezI ke kozAoM meM pezItantu ke sthAna para snehavindu ekatra hokara use naSTa kara dete haiM / dhamaniyoM kI anaicchika peziyoM meM bhI vihrAsa milA karatA hai prasUtyuttara kAlIna garbhAzaya meM bhI usake svarUpahAsa (involution ) ke sAtha sAtha snaihika vihAsa mila sakatA hai| rekhAGkita pezI kI rekhAe~ naSTa ho jAtI haiM / kozArasa meM snehavindu milate haiM jo pahale sUkSma rahate haiM aura bAda meM milakara bar3e ho jAte haiN| kabhI pezItantu ke kinAre kinAre kaNoM kI eka paMkti bana jAtI hai / tantu Age calakara atyanta bhidura hone se naSTa ho jAte haiN| jina peziyoM meM aMgaghAta ( paralysis ) ho jAtA hai unameM bhI snaihika vihrAsa mila sakatA hai| pezI ke uttarottara hone vAle apoSakSaya ( progressive muscular atrophy ) meM bhI yaha vihrAsa dekhA jAtA hai / kUTa paramacayika pezIya apoSakSaya (pseudo hypertrophic muscular atrophy ) meM bhI yaha dekhA jAtA hai| rohiNI, puMjagolANvika roga ( staphylococcal diseases ), rakta ke gambhIra roga evaM bhAsvara viSa se pIDita vyaktiyoM kI peziyoM meM snaihika vihAsa mila sakatA hai| For Private and Personal Use Only

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vihAsa vRkkoM kA snaihika vihrAsa (Fatty Degeneration of the Acharya Shri Kailassagarsuri Gyanmandir Kidneys) jina kAraNoM ko lekara zarIra ke anya kisI bhI aGga meM snaihika vihAsa huA huA karatA hai unhIM se vRkkoM meM bhI mila sakatA hai| vRkapAka ( nephritis ) evaM vRkkotkarSa ( nephrosis ) meM bhI yaha pAyA jAtA hai / jaba vRkka meM snaihika vihAsa ho jAtA hai to usakA bAhyaka bhAga ( cortex ) tathA nAlikAoM ( tubules ) ke antazchadIya kozAoM meM meghAbhagaNDa milatA hai / unake kozArasa meM snehavindu bhI milate haiM / isa vihAsa meM parivalita nAlikAoM (convoluted tubules ) kI kozAe~ sabase adhika prabhAvita hotI haiM / anutIkSNa jIvitaka vRkkapAka ( subacute parenchymatous nephritis) meM athavA vRkkotkarSa ( nephrosis ) meM nAlikIya adhicchada kA vihAsa ho jAtA hai| snaihika vihrAsajanita vRkka ko kATane para dharAtala para pIta rekhAe~ milatI haiM ye paittava pralavarNo ( cholesterine esters ) ke kAraNa hotI haiM / yahI snehavindu mUtra meM bhI dekhe jA sakate haiM / yaha bhI kahanA kaThina hai ki yaha snaihika vihrAsa hotA hai yA vRkka meM vimedAbha dravoM kA nipAvana ( bharamAra ) ho rahA hai 1 245 anya snaihikaparivartana aba nIce snaihika vihAsa ke atirikta anya una parivartanoM kA varNana kiyA jAvegA jinameM sneha kI mAtrA unake saMghaTTa Adi meM parivartana hokara vibhinna svarUpa ho jAte haiM / ve isa prakAra haiM: -- a - vimedarakkatA ( Lipaemia ) rakta meM svAbhAvikatayA 0.6 se 0.7 pratizata taka sneha kI mAtrA pAI jAtI hai / jaba vaha bar3ha kara 26 pratizata taka pahu~ca jAtI hai to usa avasthA ko vimedaraktatA kahA jAtA hai / isa avasthA meM sneha kI mAtrA rakta meM itanI adhika ho jAtI hai ki rakta ke Upara eka navanIta - stara ( cream layer ) sA bana jAtA hai / isameM sabhI prakAra ke snehoM kI vRddhi dekhI jAtI hai / yaha nimna rogoM meM ho sakatI hai 1. anutIghra vRkkapAka ( snbacute nephritis ) 2. vRkotkarSa ( nephrosis ) 3. madhumeha (diabetes mellitus ) 4. kAlika madAtyaya ( chronic alcoholism ) kabhI kabhI / A - vimedAbha protikozIyatA (Lipoid Histiocytosis ) For Private and Personal Use Only plIhA, yakRt, lasagranthiyA~ tathA asthi-majjA ke jAlikAntazchadIya saMhati ke kozA ( the cells of reticulo-endothelial system ) svAbhAvika: kriyAzIlatA ke kAraNa prAyaH sneha kI bar3hI huI sAntrA kA svayaM bhakSaNa kara lete haiM jo

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246 vikRtivijJAna unakA svAbhAvika vyApAra hai roga nahIM hai / madhumeha meM isa kriyA ke samApta ho jAne se hI snehacayApacaya (fat metabolism) gar3abar3A jAtA hai aura rakta meM sneha kI mAtrA bahuta adhika ho jAtI hai| use kama karane kI dRSTi se plIhAbhivRddhi hotI hai| jise gaucara (Gaucher ) yA nImainapika (Nieman Pick) kI plIhAbhivRddhi kahA jAtA hai| ___ i-vimedAbhIya vihrAsa (Lipoidal Degeneration) snaihika vihAsa se pIDita rogiyoM ke sneha meM jaba paittava usake lavaNa, vimedAbha, medasAmla, svaphena ( soaps ) Adi bahuta adhika mAtrA meM mile rahate haiM to vaha vimedAbhIya vihAsa ke sUcaka hote haiN| anutIvra vRkkapAka meM yaha apajanana vimedAbha vRkkotkarSa ( lipoid nephrosis ) ke nAma se milatA hai| atyadhika zotha aura atyanta vitimeha ( albuminuria) isa roga meM pAye jAte haiN| vRkka kA varNa pUrNataH zveta ho jAtA hai ise vimajivRkka ( myelin kidney ) ke nAma se pukArA jAtA hai| yaha vAstava meM vihAsa nahIM hai balki snaihika bharamAra kA dyotaka hai| isameM paramapaittavaraktatA ( hyper-cholesteraemia) hotI hai| madhujanIya antarAbharaNa (Glycogen Infiltration) svabhAvataH madhujana kA saJcaya yakRt yA peziyoM meM milatA hai| parantu jaba vikRti kI dRSTi meM vicAra karate haiM to nava vRddhiyoM yA arbudoM ke kozAoM meM, sazotha UtiyoM ( inflammed tissues ) meM, sapUyazotha ( suppurativei nflamma. tion ) meM, sitakozAoM ke bhItara (ise jambukI dvArA abhirakSita karane se hI dekhA jAtA hai) evaM madhumeha meM madhuvazi kI kamI se isakI mAtrA bar3hI huI pAI jAtI hai| kisI bhI sthAna ke kozAoM meM madhujana kI upasthiti isa bAta kI nidarzikA hai ki vahA~ kA prAGgodeyika cayApacaya ( carbohydrate metabolism) adhika bar3hA huA hai yadyapi kozAoM meM zarkarA kA parimANa svAbhAvika se adhika hai| ___phAnagIrka roga ( Van Gierke disease)-san 1929 I0 meM phAnagIrka nAmaka vidvAn ne eka zizuroga kA varNana kiyA jisameM zizu-yakRt kaThina evaM atyadhika pravRddha ho gayA thA kyoMki usake kozAoM meM madhujana kI bharamAra thii| vRkkoM meM bhI vaisA hI milA / kisI kisI rugNa meM to hRtpezI kI vRddhi kA bhI yahI kAraNa hotA hai| yaha roga uttarottara vRddhi karatA hai / rakta kI zarkarA kI mAtrA ghaTa jAtI hai mUtra meM zauktA (esITona) to milatA hai para zarkarA nahIM miltii| yaha zizuroga sahaja (conge. nital) mAlUma par3atA hai| isakA mUla kAraNa madhujana ko madhuma meM parivartana karane kI azakyatA jJAta hotI hai| isa parivartana ko kara sakane kI kSamatA upavRkkI (adrenaline ) meM hotI hai| upavRkkI kA utpAdana kArya poSapranthi ke upavRkkyAvartika nyAsarga ( adrenotropic hormone of the pituitary ) For Private and Personal Use Only

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vihAsa 247 dvArA niyantrita hotA hai / poSagranthijanya vAmanatA ( pituitary dwarfism ) meM bhI yaha roga dekhA jAtA hai / zleSAbha vihAsa (Mucoid Degeneration ) isa vihrAsa kI prApti saMyojI UtioM aura adhicchadIya Uti ( epithelial tissue ) meM hotI hai / jo Uti isa vihAsa se prabhAvita hotI hai usase pahale racanAvihIna structureless ) padArtha banatA hai vaha phira Ardra hokara zleSmisadRza padArtha meM badala jAtA hai ise 'kUTa zleSmi' ( pseudo mucin ) kahate haiM / isa nAma kA kAraNa yaha hai ki yaha tarala zleSmi ( muoin ) kI bhA~ti zuktikAmla dvArA nissAdita nahIM hotA . yaha vihAsa jina kozAoM meM hotA hai. unakI pUrNataH mRtyu kara detA hai / kozA ke andara sarvaprathama usakA kozArasa bar3ha jAtA hai / jo zanaiH zanaiH samasta kozA ko parivyApta kara letA hai / koSTha (siTa) kA nirmANa isI vihAsa ke kAraNa dekhA jAtA hai / saMyojI UtiyoM meM kAsthi meM yaha dekhA jAtA hai / jAnusandhi kI arddhacandrAkAra kAsthiyoM meM coTa lagane se koSTha banatA huA dekhA jAtA hai / saMyojI UtiyoM meM hone vAle arbudoM meM bhI yaha vihAsa sAmAnyatayA dekhA jAtA hai / isI kAraNa tantu-arbuda ( fibroma ) tantu-granthyArbuda ( fibroadenoma ) kA bhI kAraNa yahI hai / jinameM koSTha prakaTa hote haiM / adhicchadIya UtiyoM meM vizeSa karake AmAzaya, Antra, yA vakSa ke karkaTArbudoM ( cancers ) meM yA lAlA granthiyoM ke kucha arbudoM meM bhI yaha vihAsa pAyA jAtA hai | arbuda kA kozIya bhAga ( cellular part of the tumour ) zleSmA meM badala jAtA hai inheM 'zleSAbha adhyarbuda' ( colloid carcinomata ) kahate haiM / yadi isa vihAsa ko aNvIkSa dvArA prArambha se hI dekhA jAve to jJAta hogA ki sarvaprathama kozA-rasa meM zleSmAbhavindukAoM ( mucoid globules ) kI upasthiti gocara hotI hai / ve vinduka bar3hate aura eka dUsare milate hue cale jAte haiM / kozA kI nyaSThIlAe~ eka ora sarakatI jAtI haiM aura kozA eka aMgUThI ( signet ring ) kI AkRti vAlI bana jAtI hai / anta meM kozA bhara jAtI hai tathA kUTa zleSmi svatantra ho jAtI hai / yaha vihAsa saMyojI UtiyoM meM bahuta hotA hai / bahuta kAla taka zothagrasta rahe hue yojI UtiyoM vAle aMgoM meM isa vihAsa ke kAraNa aGga kA eka bhAga uTha AtA hai / isakA eka udAharaNa nAsApUrvaMgaka ( nasal polypus ) hai / kAcaravihAsa (Hyaline Degeneration ) yaha vihrAsa vizeSatayA saMyojI UtiyoM meM pAyA jAtA hai| jaba kisI Uti kI mRtyu ho jAtI hai to phira usameM jo eka bhautika parivartana ( physical For Private and Personal Use Only

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248 vikRtivijJAna change ) pAyA jAtA hai vaha yaha vihAsa hai / isake kAraNa kA abhI taka ThIka ThIka koI jJAna nahIM ho sakA hai| ___ kAcaravihAsa meM sarvaprathama Uti ke tantu (fibres ) sUja jAte haiN| nyaSThIlAe~ lupta ho jAtI haiM tathA sambhavataH upasipriyakoM (eosinophils ) ke sadRza racanAvihIna ( structureless ) padArtha baca rahatA hai| yaha vihAsa nimna sthAnoM para milatA hai:1. tantvarbuda ( fibroma) 2. garbhAzaya ke tantu-pezyarbuda (fibro-myomata of uterus ) 3. cirakAlIna vraNavastu ( old scars) 4. sazotha phuphphusacchada ke sthUla hue bhAga meM ( in the thickened part of the inflammed pleura ) 5. sazotha parihRcchada ke sthUla hue bhAga meM / 6. kRntaka vraNa ke tantu saMdhAra meM (in the fibro stroma of the ____rodent ulcer ) yahA~ ise rambhArbuda ( cylindroma ) kahate haiN| 7. dhamanIjAraThya ( arterio-sclerosis) 8. prAcIna dhanAni kI tantvi ke vihRSTa bhAga para / kabhI kabhI bar3e bar3e tantu-arbudoM meM prathama kAcaravihAsa hotA hai phira vaha bhI taralita ho jAtA hai aura vahA~ eka koSTha ( cyst) utpanna ho jAtA hai / anta meM jahA~ bahuta adhika kAcarIyana ( hyalinisation ) hotA hai vahA~ cUrNIyana ( calcification) bhI dekhA jA sakatA hai| dhamanIjArakhya meM vRkka, plIhA aura yakRt kI choTI choTI dhamaniyoM meM vizeSa parivartana dekhe jAte haiN| unakI prAcIra ke upAntarbhAga ( subintima ) meM kAcaradravya ekatra ho jAtA hai aura unake mukha ko saGkIrNa kara detA hai sAtha hI dhamanI-prAcIra meM upasthita pratyAstha ( elastic ) tantuoM para bhI prabhAva DAlatA hai isake kAraNa rakta ke AvAgamana meM hI kaThinAI nahIM par3atI balki usa aMga ko Ane vAlI raktarAzi bhI nyUna ho jAtI hai| vRkkoM meM kezikAjUToM (glomeruli ) meM hokara rakta kA jAnA kama ho jAtA hai ataH vRktanAlikAoM meM bhI vizoNika apoSakSaya ( ischaemic atrophy ) ho jAtI hai aura vahA~ tAntava Uti utpanna ho jAtI hai| prAcIna ghanAstri ( thrombi ) ke vighaTita hone para usakI tantvi ( fibrin) para kAcaravihAsa Arambha ho jAtA hai| DiphthIriyA meM vRktakezikAoM meM kAcara ghanAstri pAI jAtI haiM / bhAntrika jvara hone para rogI kI hRtpezI tathA rekhAGkita aicchika peziyoM meM yaha vihAsa milatA hai / udaradaNDikA (rectus abdominis), Uru kI peziyA~, mahAprAcIrApezI evaM jihvA kI peziyoM meM bhI yaha vihAsa prAyaH milatA hai| usa dazA meM pezI ke sUtra bahuta phUla jAte haiM unakA anurekhAGkana ( trans-striation ) naSTa For Private and Personal Use Only

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vihAsa 246 ho jAtA hai / pezI - cola ( sarcolemma ) meM racanAvihIna padArtha bhara jAtA hai jo sUkSma dRSTi se dekhane para kAphI bhidura aura sikur3A huA dikhatA hai / sthUla dRSTi se dekhane para tantu arddhapArAdarza ( semi opaque ) zveta, svalpa camakadAra, Arakta- dhUsara yA Aba-pIta varNa ke dikhAI dete haiM / ye bahuta bhidura ( friable ) hote haiM / kintu eka pezI ke sabhI tantu yA pezI ke eka sthAna ke bhI sAre tantu kabhI prabhAvita nahIM hote / jaba kabhI pezItantu phaTa jAte ( ruptured ) haiM to vahA~ eka zoNitArbuda ( haematoma ) kA nirmANa ho jAtA hai jo Age calakara saMsRSTa ( infected ) hokara vidradhi kA rUpa dhAraNa kara letA hai / para yadi upasarga na pahu~cA to pezI dhIre dhIre ThIka ho jAtI hai / maNDAbha kAryo ( amyloid bodies) ko pahale vikRtivettA maNDAbha dravya se pUrNa mAnA karate the / para Aja unheM kAcara tathA sneha mRtakozAsamUhayukta mAnA jAtA hai| ve gola vA aNDAkAra hotI haiM / ve kaI staroM se mila kara banatI haiM / inheM Ayosir (jambukI ) se nIlA raMgA jA sakatA hai / vRddhoM meM vAtanADIsaMsthAna ( nervous system ) meM inake choTe choTe piNDa dekhe jAte haiM / tIvra upasarga ke kAraNa navayuvakoM meM bar3e piNDa bhI milate haiM / dRSTinAr3I ( optic nerve ), dRSTipaTala (retina) tathA jhallarIpratAna (choroid plexus ) tathA suSumnA ( spinal cord ) meM bhI ye dekhe jAte haiM / mastiSka ke zveta bhAga meM mastiSka guhAoM meM bhI milatI haiN| Age cala kara ye piNDa cUrNIbhUta ( calcified ) hokara 'mastiSka - sikatA' ( brainsand ) bana jAte haiM / ina piNDoM ke bar3e svarUpa hameM puraHstha ( prostate ) granthi meM dekhane ko milate haiM / ye zleSmala yA lasya ( serus ) kalAoM evaM phuphphusoM meM bhI pAye jAte haiM / maNDAbhava hAsa (Amyloid, waxy, albuminoid or lardaceous Degeneration ) raft isakA nAma vihAsa hai para vAstava meM yaha eka bharamAra ( infiltration ) kAhI prakAra hai / isakA kAraNa yaha hai ki jina UtiyoM meM yaha hotA hai unake kozA maNDAbha meM parivartita nahIM hote api tu rakta ke dvArA una kozAoM meM isa padArtha kI bahuta bar3I mAtrA pahu~cA dI jAtI hai / yaha maNDAbha padArtha sarvaprathama choTI dhamanikAoM ke antacchada ke nIce sthita kozAoM meM saJcita hotA hai vahA~ se yaha dhamanI ke madhyastara ko bharatA hai / pariNAmasvarUpa madhyastara ke koSAoM para pIr3ana par3atA hai aura unameM se aneka naSTa ho jAte haiN| vahA~ se mArga pAkara vaha padArtha samIpastha kozAoM meM sacita ho kara yojI Uta tathA jIvitaka Uti kozAoM ko naSTa karane lagatA hai / yadyapi yaha dekhA jAtA hai ki maNDa padArtha ke pIDana se kozA svayaM vinaSTa ho jAte haiM para aisA eka bhI pramANa nahIM milatA ki ye maNDAbha padArtha meM kabhI bhI pariNata hue haiN| For Private and Personal Use Only

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250 vikRtivijJAna prayogoM se jJAta hotA hai ki yaha vihAsa plIhoccheda ( spleneotomy ) ke pazcAt dekhane ko nahIM miltaa| jo isakA pramANa hai ki isa padArtha kI jananI svayaM plIhA hI hai| isa vihAsa meM eka dRr3ha, varNahIna, pAradarza padArtha jise vapAbha ( lardacein) yA maNDAbha padArtha ( amyloid substance ) kahate haiM pragaTa hotA hai| yadi isa padArtha ko mukha dvArA sevana karAyA jAve to isakA pAcana karane meM AmAzaya sarvathA asamartha rahatA hai, yadyapi Antra ise pacA DAlatI haiM tathA vaise yaha kaI abhiraJjana pratikriyAe~ ( staining reaction ) detA hai| isakA sUtra probhUjinoM ke hI sadRza hotA hai aura isakA nirmANa probhUjina-medAbha cayApacaya meM gar3abar3a hone se hI hotA hai / isakI utpatti ke nimna kAraNa batalAye jAte haiM:(1) dIrghita pUyana ( prolonged suppuration ), (2) yakSmA-yaha phauphphusika ( pulmonary ), asthi ( bone ), sandhi (joint ) yA vRkka (kidney ) kI yakSmA meM prAyaH dekhA jAtA hai| (3) pUyoras ( empyema ), (4) dUSita saMyukta asthibhagna ( septic: compound fracture ) jinameM satatapUyIbhavana rahA karatA hai| (5) grahaNI (amoebic dysentery), (6) kiraNakavakatA (actinomycosis), (7) anutIvra vRkkapAka ( subacute nephritis), (8) phiraMga kI tRtIyAvasthA ( tertiary syphilis ) jo bhI AMzika pUyIbhavana ke udAharaNa haiN| (9) saralenya (tArapIna ) ( terpentine ), vRkti (renin ), athavA viSi (toxins ) ke sUcyAniHkSepa ke kAraNa hone vAle pUyana meM bhI yaha dekhA jAtA hai| (10) eka kharagoza ko hArAtukilATIya (soDiyama kaisIneTa) ke sUcyAniHkSepa dene para jJAta huA ki isakI plIhA maNDAbha vihAsa se pIr3ita ho gaI tathA vahA~se yaha vihrAsa anya aGgane meM bhI phailA / ___yadi dIrghita pUyana se paripIr3ita rugNoM ko paittava tathA vimedAbhayukta AhAra sevana karAyA jAve to phira isa vihAsa ke hone kI koI sambhAvanA nahIM dekhI jaatii| yaha isa bAta kA dyotaka hai ki vAstava meM ina dravyoM ke pUyadvArA satata nirgamana ke pariNAmasvarUpa tathA AhAra dvArA unakI yatheSTa pUrti na kI jAne ke kAraNa yaha prArambha hotA hai| __maNDAbha padArtha ke isa utkarSa kA nirIkSaNa karane se jJAta hotA hai ki yaha eka. sArvadehika avasthA (generalised condition ) hai jo hamAre zarIra ke kisI bhI aGga vA pratyaGga kI saMyojI Uti meM pAI jA sakatI hai| yaha avasthA vizeSatayA plIhA, yakRt , vRkka, Antra aura lasagranthiyoM meM tathA sAdhAraNatayA AmAzaya, sarva kiNvI, adhivRkkapAka, kaNTha, annapraNAlI, basti, puraHstha, prajananAGga, mastiSka kI kalAe~, suSumnAkANDa kI kalAe~ tathA peziyoM meM pAI jA sakatI hai| For Private and Personal Use Only

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251 vihrAsa cirakAla se zothagrasta lasagranthiyoM, jihvA tathA kabhI kabhI hRdaya meM bhI yaha sthAnika ( local ) parivartana karatI huI dekhI jAtI hai| aNvIkSa se dekhane para maNDAbha padArtha mukhyataH yojI UtiyoM ko prabhAvita karatA hai tathA gauNarUpeNa adhicchada ko| yaha sarvaprathama upAntazchadIya saMyojI UtiyoM ( subendothelial connective tissues ) yA dhamanikAoM ke madhyastaroM yA kezAloM kI prAcIroM meM pAyA jAtA hai| antazchada ko yaha padArtha chor3a detA hai| pariNAma yaha hotA hai ki vAhinImukha atyadhika saGkIrNa ho jAtA hai parantu usakI prAcIra para eka sA prabhAva nahIM par3atA balki kahIM kahIM tAkAra vardhana ho jAte haiM jisase raktapravAha kama ho jAtA hai parantu eka hI aGga kI bahuta sI vAhiniyA~ isa vyAdhi se pUrNataH baca bhI jAtI haiM tathA isa parivartana kA vaMTana ( distribution) prAyaH asama hotA hai| ___sthUladRSTayA, isa vihrAsa se prabhAvita hone vAle saba aMga apane andara eka barAbara bar3hate haiN| unameM se pratyeka ke kinAre gola, bhAra bar3hA huA tathA ApekSika ghanatva bhI bar3hA huA dekhA jAtA hai / unakA bAhya tala mRdu, prAvara ( capsule ) Atata ( tense ) tathA tata ( stretched) pAyA jAtA hai| kATa kara dekhane se unakA rUpa samAGga, camakadAra, pArabhAsI tathA siktharopita dikhAI detA hai| isa vihAsa ke kAraNa vAhiniyoM kA mukha saGkIrNa ho jAne se rakta kA pravAha kama hotA hai ataH ve raktAbhAva ke kAraNa raGga meM pANDura dekhI jAtI haiN| prabhAvita aMga meM maNDAbha padArtha ke kaNa sthAna sthAna para ubale hue sAbUdAne ke svarUpa ke lAMchana yA sidhma (spots or patches) pAye jAte haiN| ____ AyoDIna (jambukI ) ke sAtha abhiraJjana karane se prabhAvita dhAtu ke maNDAbha padArtha kA asita mahArgha babhru ( dark mahogany-brown ) varNa AtA hai tathA zeSa ati pIta varNa kI ho jAtI hai| aNvIkSa kA prayoga karane ke pUrva abhiraMjana ke lie sarvazreSTha sAdhana prodalanIlalohita ( methyl violet ) ke 1 pratizata jalIya vilayana kA prayoga karanA hai / 20 minaTa raMjana karake 1 pratizata zuktika amla car3hAne se bhaNDAbha bhAga dIpta dhUmralI ( bright magenta) aura svastha UtiyoM kA nIlA ho jAtA hai / aba nIce aGgoM para isa apajanana ke kyA kyA pariNAma hote haiM unakA vivaraNa kiyA jAvegAH plIhA kA maNDAbha vihrAsa plIhA meM maNDAbha vihAsa 2 prakAra kA pAyA jAtA hai| eka ko nAbhya prakAra kahate haiN| isameM plIhA ubale hue sAbUdAne ke samAna ho jAtI hai / yahA~ roga plIhANuoM (mAlapISiyana piNDoM) meM pahale prArambha hotA hai| dUsare ko prasRta prakAra (diffuse form) kahate haiM / isameM plIhANuoM ke atirikta samasta plaihika goda ( splenic pulp as a whole ) kA vihrAsa dekhA jAtA hai| pahalA prakAra adhika milatA hai| vaise donoM sAtha sAtha bhI raha sakate haiN| For Private and Personal Use Only

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252 vikRtivijJAna aNvIkSa se prathama prakAra dekhane se jJAta hotA hai ki isa vihAsa kA plIhA prAvara (capsule ) ke Upara koI prabhAva nahIM pdd'taa| andara pahale kezAla evaM dhamanikAe~, phira jAlaka ( reticulum ) aura phira gorda prabhAvita hotA hai| prArambhika avasthA meM plIhANuoM kI kendriya dhamanikA rogayukta rahatI hai para Age calakara usake bhI madhyastara meM roga prArambha ho jAtA hai| __ sthUladRSTayA, plIhA bhArI ho jAtI hai| jisase usakA AkAra bar3ha jAtA hai tathA ApekSika ghanatva bhii| use kATane para usakA dharAtala sUkhA tathA cikanA ho jAtA hai jisameM sAbUdAne ke samAna choTe camakIle piNDa saTe rahate haiN| una piNDoM kA AkAra pina kI noka se lekara ur3ada ke dAne ke barAbara taka hotA hai| AyoDIna dvArA abhiraJjita karane para raMga Arakta babhru ( reddish brown ) ho jAtA hai| para kendriya dhamanI ke aprabhAvita rahane ke kAraNa kendra zveta rahatA hai| prasRta prakAra ke vihAsa meM kArya gorda kI sUkSma sirAoM meM hotA hai| vahA~ se vaha saMdhAra (stroma ) meM jAkara phira daNDikAoM ( trabeculae ) aura tadanantara kezAloM ko jAtA hai| isameM plIhA nAbhya prakAra kI apekSA AkAra meM bahuta adhika bar3ha jAtI hai| sAtha hI usameM paryApta kaThinatA aura dRr3hatA A jAtI hai| usake prAvara (kaipasUla) meM Atati evaM pAradarzatA A jAtI hai| kATane para plIhA zuSka, samAja, pArabhAsI aura raktahIna tala vAlI prakaTa hotI hai| kabhI kabhI vaha pANDura aura kabhI karburita aura kabhI kabhI Arakta babhru varNa kI hotI hai ise cAkU se moma kI taraha kATa sakate haiN| samApastha gorda (gUde ) se ghira jAne se kahIM kahIM plIhANu prabhAvita ho jAne para dikhalAI nahIM dete| vRkkoM kA maNDAbha vihAsa aNvIkSa se dekhane para sarvaprathama mAlapiSiyana piNDoM meM parivartana milatA hai| kucha vRkkANuoM phira kucha kezAla prabhAvita hote haiM tatpazcAt dhIre dhIre sabhI kezAla isa vihAsa ke zikAra bana jAte haiM jisase sampUrNa kuNDala ( coil ) aspaSTa sImAyukta prabhAsI AkRti dhAraNa kara letA hai / yaha parivartana nAlikAoM ke adhicchada para vihAsa kA koI prabhAva prAyaH nahIM miltaa| sAtha hI yaha vihAsa samasta vRkka meM asama hotA hai| nimna meM milatA hai:1. abhivAhI dhamaniyA~ (afferent arteries ) 2. nAlikAoM ke cAroM ora kA kezAla jAla / 3. majjaka kI dhamanikAe~ ( arteriolae rectae of the medulla) 4. ( vihAsa ke bar3ha jAne para) antarnAlikIya Uti ( inter tubular tissue ) 5. nAlikAoM kA mukhya cola ( tunica propria of the tubules) sAdhAraNatayA prArambha meM adhicchada tathA nAlikA donoM para koI parivartana dRggocara For Private and Personal Use Only

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vihAsa 253 nahIM hotA para Age cala kara jaba kezikAoM kA mukha saGkucita ho jAtA hai to rakta kI kamI ho jAne se tathA maNDAbha padArtha ke svayaM bhAra DAlane se nAlikIya adhicchada apoSita evaM snaihika vihAsa se paripUrNa ho jAtA hai / isa dazA meM nAlikAe~ meghAbha evaM snaihika kozAoM se tana jAtI haiM tathA antarnAlikIya Uti meM bahuta se gola kozAoM ( round cells ) kI bharamAra ho jAtI hai / ise maNDAbha vRkkotkarSa ( amyloid nephrosis ) kahate hai / Age cala kara vahA~ tantUtkarSa ( fibrosis ) hotA hai| Age cala kara jaba nAlikAe~ tirohita ho jAtI haiM taba vaha bhAga kar3A hokara sikur3a jAtA hai / sthUladRSTyA, vihAsa ke sAtha sAtha vRkka kA svarUpa bhI badala jAtA hai| jyoM jyoM vihAsa bar3hatA hai tyoM tyoM vRkka bAhyaka ( renal cortex ) bhI pravRddha hotA calA jAtA hai / usakA dharAtala masRNa aura prAvara saralatA se pRthaka kiyA jA sakatA hai / pravRddha bAhya zveta, raktahIna, pArabhAsI aura siktha jaisA ho jAtA hai / vaha kar3A tathA dRr3ha bhI ho jAtA hai| jaba usa para jambukI ( AyoDIna ) kA prayoga karate haiM to vRkkANu babhrubindukoM ( brown dots ) yA babhrurekhAoM ( brown streaks ) sadRza dikhate haiN| nAlikAoM ke adhicchada meM snaihika parivartana hone ke kAraNa bAhyaka meM sUkSma pIta - zveta- pArAdarza rekhAe~ bhI milatI haiN| Age cala kara rakta ke kama pahu~cane se nAlikAoM kA sthAna tAntava Uti le letI hai jisake kAraNa prAvara zeSa vRkka ke sAtha abhilagna ho jAtA hai aura vRkkatala sikur3a jAtA hai / kabhI kabhI vRkkazotha ke kAraNa khUba phUla bhI jAtA hai / yakRt kA maNDAbha vihAsa (Amyloid Degeneration of the Liver) rudraSTA yakRt ke madhyama bhAga meM sarvaprathama yAkRt dhamanI kI kezAloM aura dhamanikAoM kI prAcIroM meM vikRti honA prArambha hotI hai| kaMzikA bhAjisirAkezAloM meM yaha vikRti bahuta kama milatI hai / vahA~ se samApastha antarkhaNDikIya ( interlobular ) saMyojI Uti meM maNDAbha padArtha kA samaya hone lagatA hai aura vaha Uti samAMga stambhoM ( homogeneous columns) meM phUlane lagatI hai jo zalkala ( flakes) meM vibhakta ho jAte haiM / dhyAnapUrvaka dekhane se maNDAbha padArtha itastataH apoSita savarNa yakRt kozAe~ bhI dikhAI par3atI haiM / parisarIya yAkRt kozAoM meM sneha bhara jAtA hai / aura adhika roga bar3hane para Uti samAMga ho jAtI hai khaNDikAoM kA vibhajana miTa jAtA hai / para kahIM kahIM unakI saMkhyA adhika ho jAtI hai ve pRthak pRthaka milate haiM tathA varNa meM sneha ke kAraNa ve pArAdarza ApItazveta varNa ke hote haiM / phiraGgArbuda ( gumma ) ke samIpa eka sthAnIya parivartana ke rUpa meM bhI yakRt meM maNDAbha vihAsa dekhA jA sakatA hai / For Private and Personal Use Only

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254 vikRtivijJAna mahAsrotas kA maeDAbha vihrAsa .. (Amyloid Degeneration of the Alimentary Canal) mukha se lekara gudaparyanta kahIM bhI yaha vihAsa dekhA jAtA hai| annapraNAlI (oesophagus ), AmAzaya aura Antradvaya ke zleSmAbha, upazleSmAbha tathA paizika tInoM hI AvaraNa isake dvArA prabhAvita hote haiN| parantu ye aMga akele kabhI prabhAvita hote nhiiN| jihvAtala ke kezAla prabhAvita hone se zleSmalakalA ko rakta kama pahu~catA hai isase usakA poSaNa nahIM ho pAtA aura isake kAraNa mukha meM aura jihvA para vraNa dekhe jAte haiN| kSudrAntra meM jo prAyazaH isa vihAsa se prabhAvita hotA hai dekhane yaha jJAta nahIM hotA ki isa para koI prabhAva par3A hai kyoMki isakI AkRti meM koI khAsa parivartana dikhAI nahIM detaa| zleSmalakalA, pANDura, pArabhAsI, cikanI aura zophayukta ( oedamatous ) ho jAtI hai| adhika pravRddha rugNoM meM A~ta moTI par3a sakatI hai aura usameM vraNa dekhe jA sakate haiN| yadi zleSmalakalA ko dhokara usa para jambukI vilayana se abhiraMjana kareM to Arakta babhra varNa ke asaMkhya bindu pAsa pAsa saTe hue dekhe jA sakate haiN| ye una rasAMkuroM ( villi ) meM milate haiM jinake kezAloM aura dhamaniyoM meM maNDAma parivartana ho cuke hote haiN| prodalanIlalohita ( methyl violet ) dvArA abhiraJjana karane para kezikAjAla kitanI burI taraha prabhAvita huA hai ise dekhA jA sakatA hai| ___ maNDAbha vihrAsa ke pariNAma ( The effects of amyloid degeneration ) jaba taka vRkka, yakRt evaM Antra meM se koI yA sabhI vikRta aura naSTa nahIM ho jAte taba taka ye pariNAma pragaTa nahIM hote| yakRt kA maNDAbha vihAsa hone para bhI usakA prabhAva kezikAmAjisirA ke avarodha dvArA jalodara utpanna karane kA nahIM hotaa| para jaba kabhI vaha avarodha ho jAtA hai taba jalodara kI yatheSTa sambhAvanA rahatI hai yakRt meM sAtha hI snaihika vihAsa aura apoSakSaya bhI rahate haiM jo usakI kriyAzakti ko manda banA dete haiN| Antra meM maMDAbha vihAsa ke kAraNa usako ApUrita karane vAlI vAhiniyoM kI prAcIra meM vizeSa AghAta ho jAtA hai jisake kAraNa na to Antra meM jalIyAMza kA zoSaNa hotA hai na srAva / ataH jalIya atisAra ho jAtA hai| jo eka gambhIra avasthA hai| vRkkoM meM bhI isake kAraNa vAhinI-prAcIra AghAtapUrNa ho jAtI hai jisase mUtra kI rAzi bar3hatI hai tathA usameM zviti ( albumen ) paryApta milane lagatI hai| isa kAraNa vitimeha evaM bahumUtra donoM hI ho jAte haiM / para jaba vRkkANuoM ( nephrones ) ko rakta kI mAtrA pUrNataH nahIM milatI to phira ve sidhmIya tantUtkarSa (patchy fibrosis) tathA mUtrAlpatA ke kAraNa bana jAte haiM / miha ke For Private and Personal Use Only

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vihrAsa visarjana meM bhI gar3abar3I milane se mUtra viSamayatA yA miharaktatA (uraemia) bhI mila sakatI hai| mUtra meM kaNadAra nirmoka (granular casts ) yA kAcara nirmoka milate haiN| pUrNa pragalbha avasthAoM meM zopha (dropsy ) milatA hai| parantu raktapIDana bar3hA huA nahIM miltaa| grIna kA kathana hai ki uparokta lakSaNoM ke dekhane se vRkka kA maNDAbhotkarSa ( renal amyloidosis ) anutIvra vRkkapAka se pUrNa sAdRzya rakhatA hai| dhamanI vihvAsa (Arterial Degeneration) dhamaniyoM meM 3 prakAra ke apajanana pAye jA sakate haiM: 1. dhamanIjAraThya (athero-sclerosis)-isameM antastara ( intima ) ke andara snaihika bharamAra tathA snaihika vihAsa Arambha ho jAtA hai jisake pariNAmasvarUpa dhamanI prAcIra kahIM sthUla ho jAtI hai tathA choTI vAhiniyA~ bhI avaruddha ho jAtI haiN| yaha parivartana dhamanikAoM ke pUrva kI dhamaniyoM meM dekhA jAtA hai| 2. abhimadhya cUrNIyana ( medial calcification)-isameM dhamanI ke madhyastara meM pahale kAcara vihAsa hokara phira vahA~ cUrNiyana hotA hai| jisake pariNAmasvarUpa sArI vAhinI cUrNiya nAlI ( calcerous tube ) bana jAtI hai| 3. dhamanikIya jAraThaya ( arteriolar sclerosis)--yaha dhamanikAjanya vihAsa hai| isake antaHstara meM sthAna sthAna para kAcara vihAsa hotA hai jinake kAraNa granthikAe~ bana jAtI haiN| ina granthikAoM kA bhAga andara kI ora kucha nikala kara mukhAvarodha kara letA hai| yaha avasthA saMtata rudhira nipIDAdhikya ( continuous high blood pressure ) ke pariNAmasvarUpa hotI hai| cUrNIyana (Calcification) ___ yaha eka nizceSTa ( passive ) prakriyA hai jo mRta vA mRtaprAya kozAoM meM rAsAyanika parivartanoM ke kAraNa milatI hai isake andara UtiyoM meM cUne ke lavaNoM kA nipAvana (antarAbharaNa) hone lagatA hai| asthIyana (ossification ) aura cUrNiyana meM antara yaha hai ki eka meM asthikRta kaNa ( osteoblasts ) sajIva Uti meM cUne kA antarAbharaNa karate haiM tathA dUsare meM mRtaprAya acoSya (unabsorbable) uti meM cUnA bharA jAtA hai| isa prakAra rAsAyanika-bhautika avasthA ucita hone para yaha kisI mRta dhAtu meM ho sakatA hai / cUrNIyana ke kAraNa antataH uti asthi meM badala jAtI hai| cUrNIyana prakriyA ko vyakta karane ke lie Ajakala do mata pracalita haiM: 1. klotsa kA mata-isake anusAra sarvaprathama UtiyoM ke andara snaihika vihAsa hotA hai phira snehoM se kSArIya svaphena (alkaline soaps ) kA nirmANa hotA hai| adhika vileya kSAroM ko cUne ke lavaNa sthAnacyuta karake svayaM unakA sthAna le lete haiM tathA prAMgArika amla (kArbonika esiDa), bhAsvika amla (phorasphorika esiDa)tathA snaihika amloM ko nikAla kara cUrNAtuprAMgArIya (kailziyama kArboneTa) For Private and Personal Use Only

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256 . vikRtivijJAna vahA~ bichA detA hai / isa mata se snaihika uti ( fatty tissue ) ke andara cUrNIyana kI kriyA kI puSTi hotI hai| 2. vailsa kA mata-isa mata ke dvArA kAcara vihrAsa ko prApta kozAoM ke cUrNIyana kI puSTi kI jAtI hai| kahA jAtA hai ki kAcarIkRta kozA cUrNAtu (kailziyama) ko bahuta pasanda karate haiM / rakta meM cUrNAtu dvilavaNoM ( Dabala sAlToM) ke rUpa meM upasthita rahatA hai aura vahA~ use prAMgArika amla ghole rahatI hai| para mRta Uti meM prAMgArika amla bahuta kama rahane se cUne ke lavaNa nissAdita (precipitated ) ho jAte haiN| sAtha hI rakta se aura adhika mAtrA meM vileya cUrNAtu vahA~ pahu~catA rahatA hai jo una kozAoM meM barAbara saJcita hotA rahatA hai| cUrNIyana ke sthAna cUrNIyana nimna sthAna meM hotA hai: 1. kAsthiyA~-kaNTha tathA upaparzakAoM kI kAsthiyA~ vRddhAvasthA meM cUrNIbhUta ho jAtI haiN| 2. pezyarbuda-strI ke rajonivRttikAlIna pezyarbuda ( myoma ) meM / 3. kAcaravihAsa yukta UtiyoM meM jaisA pahale batAyA jA cukA hai| 4. purAnI vraNavastu ( old scar ) meN| purAnI mRta UtiyA~ jo zarIra meM sthAna sthAna para ghirI raha jAtI haiM jaise 5. dhanAstriM ( thrombi ), AtaJca ( clot) prAcIna raktasrAva, vidradhiyA~ Adi sabhI cUrNIbhUta ho jAtI haiN| unase sirA-upala ( phleboliths ) banate haiN| 6. parajIvI jaise maNDala UtikAmI ( trichinella. spiralis) / 7. dhamaniyoM ke vihAsajanita sidhmoM ( atheromatous patches ) meN| 8. yakSmA ke kilATIya padArtha ( caseous mass ) meN| 9. mastiSka ke eka arbuda kA saikatArbuda (psamoma ) nAma isalie par3a gayA hai ki cUne ke kaNa bahuta bar3I mAtrA meM usa para cipake rahate haiN| mastiSka meM jaba pragaNDoM ( ganglion ) meM vihAsa hotA hai to vahA~ cUrNIyana dekhA jAtA hai| 10. kAsthyarbuda ( chondroma ) tathA tantupezyarbuda ( fibromyomata) meM bhI vistRta cUrNIyana dekhA jA sakatA hai| cUrNIyana kA jJAna aNvIkSa se dekhane para sarvaprathama Uti ke kozIya padArtha ( cellular mess ) meM cUne kA bhAga dhUla ke sUkSma kaNoM ke rUpa meM prakaTa hotA hai| unakI pArAdarzatA, kRSNavarNatA, viSamatA evaM sAdhAraNa khanija amloM meM prAMgArika amloM ke bulabuloM ke sAtha ghulanazIlatA se cUrNiyana kA jJAna ho sakatA hai| yadi sthUla dRSTi se dekheM to usase adhika isakA jJAna sparza se hotA hai kyoMki prArambha meM aMgulI se yaha khuradarA (gritty feel ) hotA hai| jo aura kucha samaya bAda kaThina ( hard ) tathA pRthak granthikAoM meM mAlUma hotA hai| ye granthikAe~ Age For Private and Personal Use Only

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vihrAsa 257 cala kara patthara sI kaThina ho kara phira TUTa jAtI haiM aura tala ko viSama banA detI haiM aura varNa meM ApIta yA AdhUsara varNa kI ho jAtI haiM / cUIyita bhAga mRta evaM nizceSTa hotA hai kabhI kabhI to vaha asthIyita ( ossi fied ) ho jAtA hai aura kahIM kahIM usameM asthi kI bhAMti eka majjA kUpa bhI bana jAtA hai| visthAyika cUrNIyana ( Metastatic calcification) kabhI kabhI svastha UtiyoM meM bhI cUrNAtu lavaNa saMcita ho jAte haiN| adhazcarma ( subcutaneous) UtiyA~, vRka, dhamanIprAcIra tathA phuphphusa isase adhika prabhAvita dekhe jAte haiM / isa prakAra lavaNoM ke saMcita hone kA pradhAna kAraNa cUrNAtu bhAsvIya dvArA rakta rasa kA atyanuvedhana (oversaturation) huA karatA hai tathA yaha cUnA unhIM unhIM UtiyoM meM punaH sthApita hotA hai jahA~ kI prAMgAradvijAreya vAta kI Atati ( tension ) adhika hone se udajana-ayana-saMkendraNa ( hydrogen-ion concentration ) meM antara A gayA hai| yaha kriyA bahuta kama dekhI jAtI hai aura kAlika vRkkapAka meM bhAsvika amlotkarSa ( phosphatic acidosis) ke sAtha prAyazaH sambaddha rahatA hai yadi adhika mAtrA meM jIvati gha ( vitamin D ) dI jAve yA jIvoM ko pracura parimANa meM amla bhAsveyoM ko khilAyA jaave| vicUrNIkAraka aneka rogoM meM jaise sAmAnyita tantumaya asthipAka (generalised osteitis fibrosa) yA kaMkAla ke nAzakAraka bahu-arbudoM ( destructive multiple new growths of the skeleton ) meM bhI yaha pAyA jAtA hai| vRkapAkajanita rogiyoM meM upagalagraMthi kA aticaya hone se raktarasa kA cUnA bar3ha jAtA hai kyoMki isa avasthA meM bhAsvika ayana bar3ha jAte haiM isIlie raktarasa kA cUrNAtu bhAsvIya se atyadhika anuvedhana ho jAtA hai| ___eka avasthA jise cUrNotkarSa (calcinosis) kahate haiN| isa dazA se pUrNataH bhinna hotI hai| vaha to zizuoM kA eka cayApacapika roga hai yadyapi usameM bhI adhazcarma UtiyoM aura peziyoM meM bhI cUrNa kSepaNa hotA hai| azmariyA~ ( Concretions) pittAzaya, pittapraNAlI, vRkamukha, gavInI, basti tathA anya bhAgoM meM vibhinna prakAra kI azmariyA~ milatI haiM ve cayApacayika parivartanoM ke kAraNa yA upasargajanita hotI haiN| bhAsvIya, tigmIya yA prAMgArIya lavaNoM ke rUpa meM cUrNAtu inameM milatA hai| ina ke atirikta inameM prAMgArika padArtha jaise mihika amla, mihIya (vRkkAzmariyoM meM ) pittalavaNa, raMjaka, paittava (pittAzmariyoM meM) pAye jAte haiM / kSa-kiraNa parIkSAmeM cUrNAtu ke lavaNa pArAdarza hote haiM / isI se unake citra lie jA sakate haiN| unakA varNana yathAsthAna punaH hogaa| For Private and Personal Use Only

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paJcama adhyAya raktaparivahana kI vikRtiyA~ (Pathological Disorders of Blood Circulation ) vizoNatA (Ischaemia) zarIra ke kisI aMga ke kisI bhAga meM rakta kI sthAnika kamI ko vizoNatA ( ischaemia) kahA jAtA hai| yaha pUrNataH, apUrNa ( incomplete ), zIghra ( quick ) yA zanaiH zanaiH (gradually ) hotI huI dekhI jAtI hai| pUrNa vizoNatA nimna kAraNoM se hotI hai a-dhamanI ko bA~dha dene ( ligature of the artery of the part supplying ) se yA galatI se zastrakarma karate samaya dhamanI ke baMdha jAne se| ____ A-dhamanI-vivara kA Ataci ( clot ) dvArA avarodha ho jAnA jisake kAraNa yadi aura kahIM se rakta kI prApti na hone pAve to dhamanI se abhisiJcita pradeza raktahIna ho jAtA hai| apUrNa vizoNatA nimna kAraNa se hotI hai :__ a-tattat aMga ko raktAbhisiJcana karane vAlI dhamanI vA dhamanikA ke mukha kA saGkucita ho jAnA vA banda hote cale jaanaa| zanaiH zanaiH vizoNatA nimna kAraNoM se dekhI jAtI hai :1. dhamanI prAcIra ke roga jaise dhamanIjAravya ( athero-sclerosis) / 2. dhamanI para bAhara se kisI arbuda yA saJcita jala vA drava kA pIDana / 3. dhamanI ke samIpa kI dhAtu meM utpanna vraNa kI vraNavastu kA saMkoca honA / zIghra vizoNatA nimna kAraNoM se dekhI jAtI hai: 1. reno ke roga ( Raynaud's disease ) meM lagAtAra bahuta samaya se AkSepa ( spasm ) hone se vAhinI preraka vikSobha (vasomotor irritability ) se / 2. zIta ke prabhAva se dhamanI prAcIra kA akasmAt ThiThura jaanaa| 3. argaTa-viSatA (ergot-poisoning) vAstava meM dekhA jAve to kisI aMga vA sthAna meM vizoNatA kA pariNAma vahA~ kI jAlakriyA (anastomosis) para nirbhara karatA hai| yadi vaha paryApta hai to koI hAni nahIM hotI parantu anya avasthAoM meM vizoNatA vahA~ kI ati vizeSa kI viziSTa kozAoM ko naSTa kara detI hai| dhamanI kA turata avarodha hone se kozAoM kI turata mRtyu ho jaavegii| para yadi zanaiH zanaiH rakta kI alpatA hotI gaI to koSAoM kI mRtyu bhI dhIre dhIre hI hogii| jitane anupAta meM usa aGga meM rakta jAtA hai usI anupAta For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 256 kI kozAsaMkhyA bhI jIvita rhegii| jo kozAe~ isa prakAra raktAlpatA ke kAraNa mara jAtI haiM unakA sthAna tAntava ati dvArA grahaNa kiyA jAtA hai| ataH cirakAlIna vizoNatA ( chronic ischaemia) kA artha usa aMga vizeSa kI kriyAzIlatA kA nAza hai| mastiSka meM tantUtkarSa ( fibrosis ) nahIM hotA api tu vahA~ para dhAtumArdava hokara drAvaNamRtyu ( colliquative necrosis ) ho jAtI hai para mastiSka kA kArya anya dhAtuoM kI bhA~ti hI naSTa ho jAtA hai| kotha (Gangrene ) __rakta ke abhAva se hI kotha bhI sambaddha hone se usakA varNana UtimRtyu nAmaka sthAna meM na karake hama yahA~ karate haiN| kotha vikRtivijJAna kI dRSTi se 2 prakAra kA hotA hai| kotha kI sAdhAraNa saMjJA gaiMgrIna dI jAtI hai| isake eka prakAra ko zuSka kotha ( dry gangrene ) tathA dUsare ko AI kotha ( moist gangrene ) kahA karate haiN| zuSkakotha jaba kisI eka bhAga kI dhamaniyoM dvArA kisI aGga ko rakta pahu~cAnA banda kara diyA jAtA hai to vahA~ zuSka kotha hotA hai| yaha smaraNa rakhanA cAhie ki usa sthAna kI sirAe~ aura lasavahAe~ ( lymphatics ) satata kArya rata rahatI haiN| zuSka kotha ke nimna kAraNa haiM :a-antaHzalyatA ( embolism) A-mantharagatyA vardhamAna dhAmanika ghanAstratA (slowly progressing arterial thrombosis ) i-dhAmanika aMgagraha ( arterial spasm ) jo argaTa viSatA yA reno ke roga meM dekhA jAtA hai| ___dhamanI ke avaruddha ho jAne se usake dvArA siMcita pradeza meM rakta kA jAnA banda ho jAtA hai| usa kSetra se rakta yA tarala kA rahA sahA aMza lasavahAoM ( lymphatics ) tathA sirAe~ bahA detI haiN| prasUti ( diffusion) tathA udvASpana (evaporation ) bhI dravAMza kA zoSaNa karate haiN| zeSa rakta vahA~ para zoNAMzita ( haemolysed ) ho jAtA hai| usakI zoNavartuli ( haemoglobin ) samIpastha UtiyoM meM prasaraNa kara jAtI hai aura vahA~ vaha babhru yA kAla raMgA ( brown black pig. ments ) meM pariNata ho jAtI hai jisake kAraNa kotha-grasta aGga jo pahale pANDura aura zItala thA sUkhatA calA jAtA hai tathA kaThina, kAle yA babhru raMga kA ho jAtA hai| sAtha hI vaha bhAga saGkucita bhI ho jAtA hai| zuSkakotha meM jIvANuoM ko bar3hane kA bahuta kama avasara milatA hai| pUyakArI For Private and Personal Use Only

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260 vikRtivijJAna parivartana ( putrefactive changes ) zanaiH zanaiH hote haiM / isake kAraNa viSaraktatA ( toxaemia ) kI vRddhi bhI zanaiH zanaiH hI huA karatA hai / uparyukta tathyoM ke AdhAra para yaha kahA jA sakatA hai ki- 1. zuSka kotha sthAnika hotA hai, 2. usake cAroM ora svastha Uti kA valaya banA hotA hai tathA 3. zastrakarma ke dvArA yA svataH kothagrasta bhAga pRthak kiyA jAtA hai yA ho jAtA hai / Ardrakotha isameM sirAoM dvArA aMga vizeSa se rakta kA hRdaya kI ora DhoyA jAnA pUrNataH ruka jAtA hai| rakta kI usa sthAna meM Amada to hotI hai para nikAsa nahIM hotA / jaba AnnravRddhi ( hernia ) kA kaNThapAzana ( strangulation ) ho jAtA hai yA jaba AntrAntrapraveza ( intussusception ) meM tanuprAcIrI ( thin-walled ) sirAe~ sikur3a jAtI haiM to dhamanI dvArA Agata rakta kisI bhI prakAra nirgata na ho sakane se gambhIra avasthA utpanna ho jAtI hai / dhamanI prArambha meM nija kArya karatI rahatI hai parantu Age calakara avaruddha ho jAtI hai / kezikAoM ( capillaries ) meM lagAtAra rakta Ate rahane se pIDana bar3ha jAtA hai / sar ause raktasthairya hone se zukkiyukta tarala kezikAprAcIroM se chana chana kara dhAtuoM meM bharatA calatA hai / sAtha hI raktasthairya ke kAraNa ajArakatA (anoxaemia) kI sthiti utpanna ho jAtI hai ataH kezikIya antazchada aura adhika durbala evaM naSTa ho jAtA hai aura Uti AzUna ( turgid ) ho jAtI hai / kabhI kabhI AghAta ke kAraNa dhamanI aura sirA donoM ke daba jAne se bhI kotha hotA hai / isa kotha meM sirA aura dhamanI donoM ke hI kSetroM para prabhAva par3atA hai| rakta ke sirA dvArA bAhara nirgata na hone se vahA~ para zotha ho jAtA hai aura lAlakaNa antazchada ko bhedakara dhAtuoM meM pahu~ca jAte haiM vahA~ unakA rudhirAzana ( haemolysis ) hokara eka lAla ghola bana jAtA hai jo dhAtu ke kaNa kaNa meM rama kara use lAla kara detA hai vahI Age calakara loha zulbeya ( sulphide of iron ) kA svarUpa le letA hai / vaha aMga jahA~ kotha hotA hai zothayukta nIlA sA ho jAtA hai aura usake Upara lAla raMga ke phaphole par3a jAte haiM I isa prakAra tarala se bharI huI UtiyoM meM upasargakArI jIvANu dina dUnI aura rAta caugunI vRddhi karate haiM / usa tarala se poSaNa pAkara ve bahuta panapate haiM / ina jINANuoM meM kothotpAdaka jIvANu bahuta mahatvapUrNa hote haiN| ve udajana zulbeya, (H2S) tiktAti, bhUyAti, prAMgAra dvijAreya nAmaka tiktAti vAtiyoM (gaisoM) kA nirmANa karate haiM jisake kAraNa dabAne se karakarAhaTa ( emphysematous crackling ) hotI hai / vahA~ kA raMga lAla se babhru ( sleTI ) aura phira kAlA ho jAtA hai / UtiyA~ mRdu hokara dravIbhUta ho jAtI haiM tathA atyanta tIkSNa durgandha usa aMga se prakaTa hone lagatI hai / durgandha binA upasargakArI jIvANuoM ke praveza ke kabhI utpanna nahIM hotI yaha tathya bhI sadaiva smaraNIya rakhanA cAhie / For Private and Personal Use Only

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zuSkakotha (1, pRSTha 260 REAK ANARVIN zuSkakotha kA yaha citra hai isake cAroM ora svasthaUti kA eka valaya banA huA hai| Ardrakotha (2) Aawal S apana yaha citra AIkotha kI Arambhika avasthA pragaTa karatA hai For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 261 Ardrakotha ke 2 prakAra dekhe jAte haiM eka parilikhita (circumscribed ) aura dUsarA prasI : spreading) / prathama kisI hiMsA ( mechanical violence) yA paridagdhatA ( cauterisation ) ke kAraNa yA kisI sthAna vizeSa ke raktAvarodha kA pariNAma hai tathA dvitIya meM kotha eka sthAna se dUsare sthAna taka dhIre dhIre car3hanA prArambha karatA hai / isa kriyA meM jIvANu bahuta sahAyaka siddha hote haiM jo eka ke bAda dUsarI naI UtiyoM para AkramaNa karake use kupita kara dete haiM tathA kotha bhI vahA~ taka barAbara car3hatA jAtA hai jahA~ taka ki rakta kI pahu~ca nahIM ho paatii| para jahA~ aMga ko rakta kI aparimita rAzi mila sakatI hai vahA~ jAkara yaha sImAbaddha hotA aura ruka jAtA hai| mRta aura sajIva UtiyoM kI yaha eka sImA khiMca jAtI hai| mRta ati nirmoka ( slough ) rUpa meM par3I rahatI hai tathA svastha Uti se svasthakaNamaya Uti (granulation tissue ) apanI kriyA prArambha karatI hai tathA donoM ke saMgama sthala para vraNazotha hone lagatA hai| jaba koI Uti mRta ho jAtI hai to use sajIva Uti se sambaddha karane vAle tantu mRdu ho jAte haiM tathA sitakozAoM ke probhUjanAMzika vikara ( proteolytic enzymes ) tathA AtmapAcaka kiNva (autolytic ferments) unheM khAkara zoSita kara lete haiN| idhara sajIva Uti meM atiraktatA khUba rahatI hai| yahI nahIM sajIva Uti jitanI hI kama rakta vAlI hogI utanI hI dera meM usako mRta dhAtu se pRthak kiyA jA skegaa| kalAoM yA staroM ( fascia) kaNDarAoM (tendons) aura asthiyoM ( bones ) kI gaNanA inhIM meM hotI hai| __ adhika bhItarI bhAga meM kotha vA pUyIbhavana hone se nAloM ke mRta ( fistulae ) kA nirmANa hotA hai| adhika bhItarI bhAgoM ke mRta hone para aura vikArI jIvANuoM ke vahA~ taka na pahu~cane para unakA AtmapAcana ho jAtA hai| yadi vikArI jIvANu pahu~cate bhI haiM to ve pUyotpatti karate haiM kothotpatti nahIM / pUya ke lie nAla eka mArga mAtra hai| naidAnikIya dRSTi se kotha ke bheda ( Clinical varieties of gangrenes ) : 1. antaHzAlyika kotha ( Embolic gangrene )-jaba eka AtaMci (a piece of blood clot ) jo hRdaya ke vAma bhAga se, yA mahAdhamanI prAcIra se yA anya kisI aMga ko dhamanI se calakara rakta ke sAtha saMvahana karatA hai to antaHzalyatA ke dvArA vAhinI ko avaruddha kara le sakatA hai| isake kAraNa zuSkakotha milatA hai| kisI rugNa ko abhighAta hone para yadi ghanAsrotkarSa ho jAve to bhI yaha kotha dekhA jA sakatA hai| 2. upasargajanya kotha ( Gangrene due to infection )-yaha prAyaH mahAsrota meM dekhA jAtA hai jahA~ kaNThapAzayukta AntravRddhi (strangulated hernia ), 3177FAIT ( intussusception ) a merania ( volvulus ) For Private and Personal Use Only

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262 vikRtivijJAna hone para raka kA parivahana ruka jAtA hai aura vahA~ para upasargI jIvANu apanA AkramaNa evaM vRddhi karane lagate haiN| isa kAraNa vahA~ upasargajanya prasapI kotha ho jAtA hai| antrapucchIyA sirA meM raktAvarodha hone se antrapuccha ( appendix vermiformis) meM kotha ho sakatA hai| ____3. vAtikotha (Gas gangrene )-yaha vAtijana prAvaragadANu (cl. welchii ), zophagadANu (ol. oedemantous ), evaM viSUcI AkuntalANu (v. Septique ) nAmaka jIvANuoM meM kisI yA sabhI ke dUSita vraNa meM pahu~ca jAne se vizeSa hotA hai / peziyoM meM vaha kotha bahuta dekhA jAtA hai / gaisa kI utpatti Uti kI vaiSika mRtyu (toxic necrosis of the tissue ) ke kAraNa hotI hai| ye tInoM jIvANu vAtamI (anaerobe ) hone se zarIra ke bhItarI aGgoM meM hI yaha kotha adhika milA karatA hai| 4. madhumehajanita (Diabetic gangrene )- yaha cirakAlIna madhumeha pIr3ita rugNoM meM pAyA jAtA hai| yaha paira ke aGguSTha se prArambha hotA hai| isameM zarIra kI prAyaH sabhI UtiyoM meM zarkarA kI bahulatA hone se upasarga kI sambhAvanA adhika rahatI hai / isakI dhamaniyoM meM vArdhakya kotha jaisI vikRti dekhI jAtI hai| 5. vArdhakyakotha (Senile gangrene )-yaha vRddhAvasthA meM pAyA jAne vAlA zuSkakotha hai / svalpa bhI AghAta hone se, zIta yA santApa kA adhika samparka Ane se, yA aise hI anya kAraNoM se yaha kotha utpanna hotA hai| kAraNa yaha hai ki jahA~ AghAta hotA hai vahA~ rakta kI Amada ruka jAtI hai para vikAsa jArI rahatA hai| dUsare vRddhAvasthA ke kAraNa dhamaniyA~ kar3I par3a jAtI haiM unakI pratyAsthatA ghaTa jAtI hai aura unakA gyAsa (calibre ) kama ho jAtA hai ataH unake dvArA AghAtaprApta raktavihIna mAtra ko rakta kA pahu~canA bahuta hI kama ho jAtA hai| idhara vRddha hRdaya kI gati bhI bahuta manda hone se raktasaMvahana kI gati bhI manda ho jAtI hai| aisA. rakta yadi svalpa kAla ke lie bhI kahIM ruka gayA to vahIM raktasAndra hokara kotha kA kAraNa bana sakatA hai| yaha kotha paira ke aGguSTa se prArambha hokara dhIre dhIre kaTi taka A sakatA hai| 6. reno kA roga ( Renaud's discase)-yaha prAyaH navayuvatiyoM meM hone vAlA roga hai| kisI aMga meM dhamaniyoM meM zIta ke kAraNa aMgagraha (spasm) hokara rakta kA saMvahana svayaM ruka jAtA hai aura vahA~ zuSka kotha prArambha ho jAtA hai| yadi vahA~ uSNatA pahu~cAI jAve yA prathama svatantravAtanADI saMsthAna yA svAyattacetAsaMhati ( sympathetic ) ke sUtra kATa deM to yaha kotha rokA jA sakatA hai| dhAnyarUdoSa (argaTa-viSatA) meM bhI aisI hI paristhiti utpanna hotI huI dekhI jAtI hai| usameM dhAmanika saGkoca ( arterial spasm) bahuta adhika bar3ha jAtA hai| vAhinyika zotha ( thrombo angiitis obliterans) meM bhI rakta kA avarodha kothotpAdaka dekhA jAtA hai| For Private and Personal Use Only

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vAtikotha pRSTha 262 Acharya Shri Kailassagarsuri Gyanmandir vAtikotha kA yaha citra hai isa citra meM pezItantu apane ka se alaga ho gayA hai usake cAroM ora vAti (gaisa) aura drava bhara gayA hai / For Private and Personal Use Only

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rakta parivahana kI vikRtiyA~ zaiyyA - vraNa ( Bed Sores ) durbala jIvanIya zakti se rahita cirakAla se zaiyyAgrasta rogiyoM meM asthi ke nIce ke dharAtalIya UtiyoM ke pIDita hone se sthAnika kotha kI utpatti hotI hai / vahI zaiyyAtraNa kahalAte haiM / yadi ina vraNoM meM upasargI jIvANuoM kA praveza ho sakA hat phira prapako bhI ho sakatA hai / ghanAsratA yA ghanAsrotkarSa ( Thrombosis ) sacetana - sajIva prANI kI sirA, kezikA, dhamanikA yA dhamanI ke bhItara jaba raktabimbANu ( blood platelets) ke kAraNa AtaMcana ( raktaskandana yA raktasaMhati ) ho jAtA hai to usa avasthA ko ghanAstrotkarSa yA ghanAstratA kahA jAtA hai / isa kriyA ke pariNAmasvarUpa rakta jama kara eka ghanAstra ( thrombus ) kA nirmANa karatA hai | 263 ghanAsra ( thrombus ) aura AtaMca ( blood clot ) donoM jame hue rakta ke 2 rUpa haiM / antara yahI hai ki ghanAtra zarIra ke bhItara vAhinI prAcIra ke abhedya rahate hue rakta ke jamane kI eka kriyA hai jise rakta bimbANu pUrA karate haiM / AtaMca vAhinI - prAcIra ke phaTane para bahe hue rakta kI tantvi ( fibrin ) ke dvArA jamA huA rakta hai jo zarIra ke bAhya yA Abhyantarika dharAtala para prakaTa hotA hai / ghanAstratA kyoM hotI hai ? attarai kA sarvaprathama aura sarvopari kAraNa hai rakta kI vAhinI - prAcIra ke antazchada kA rugNa yA AghAtapUrNa hone se TUTa phUTa kara khuradarA ho jAnA / jaba taka raktavAhinI kA antazchada pUrNa aura sucikkaNa tathA zlakSNa hogA rakta kA pravAha avirala gati se hotA rahegA parantu jyoM hI kisI bhI kAraNa se antazchada meM khuradarApana AyA tyoM hI vahA~ para rakta ke bimbANu apanA Asana jamA lete haiM / ve usa sthAna para cipaka jAte haiM aura vahA~ AtaMcana ( raktasaMghAta ) hokara ghanAsrotkarSa ho jAtA hai / saMkSepa meM nimna kAraNa ghanAstrotkarSa ke lie mahattvapUrNa haiM: : 1. abhighAta ( trauma ) - isake kAraNa vAhinI vidIrNa ho sakatI hai ( rupture ), ba~dha sakatI hai ( ligature ), athavA akSa para ghUma sakatI hai ( vimoTana - torsion ) / inake kAraNa dhamanI ke AbhyantarIya evaM madhya ke stara chinna bhinna ho jAte haiM / For Private and Personal Use Only 2. vAhinI - prAcIra kA vraNazotha ( inflammation of the vesselwalls ) - tIvra yA anutIvra jIvANujanya upasarga ghanAsra ( internal clotting or thrombosis ) kA mahattvapUrNa kAraNa hai / yaha dhamaniyoM kI apekSA sirAoM para adhika prabhAva DAlatA hai / tIvra upasargAvasthA meM jIvANuoM ke viSa bAhara se andara sirA meM praveza karate haiM isake kAraNa pahale parisirAzotha ( periphlebitis ) hokara phira samagra sirAzotha ( panphlebitis ) hotA hai / parantu jaba upasarga

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264 vikRtivijJAna raktadhArA dvArA andara hI andara pahu~catA hai to sIdhA antaH sirApAka (endophlebitis ) hI dekhI jAtI hai| ina saba meM kisI na kisI prakAra antazchada kA vinAza hokara ghanAsrotpatti hotI hai / Acharya Shri Kailassagarsuri Gyanmandir Antrikajvara ( typhoid fever ) kA daNDANu ghanAsrana meM bahuta paTu hai / usake kAraNa aurvI ( femoral ) evaM uttAnA ( saphenous ) sirAoM meM eka roga ho jAtA hai jise sirAvarodhI sakthizUla ( phlegmeziyA elbA Dolensa - phleg - masia alba dolens ) yA zveta sakthi ( white leg ) kahate haiM / garbhavatI striyoM ke prasUta hone ke pazcAt sUtikAvasthA meM garbhAzaya ke antazchada ke ghanAtroM dvArA vaisI hI avasthA prAyaH dekhI jAtI hai / jaba kabhI madhyakarNa yA gostanakoTaroM ( mastoid air cells ) meM vraNazotha hotA hai to usase mastiSka kI pArzvikAkhyA sirAparikhA ( lateral sinus ) meM rakta kA AtaMcana hokara gambhIra sthiti utpanna kara detA hai / pragaNDita sirAoM (varicose veins ) meM bAhara se upasarga pahu~ca kara halakA zotha utpanna karake ghanAtra banA sakatA hai / phiraGga (siphilisa) aura yakSmA ( TI. bI. ) meM cirakAlIna vraNazothoM ke upasthita rahane ke kAraNa choTI choTI vAhiniyoM meM abhilopI antaHdhamanIpAka ( obliterative endarteritis ) hone se bhI ghanAstra kI utpatti ho sakatI hai / isI prakAra hRdaya ke antazchada meM tIvra yA cirakAlIna hRdantazchadapAka ( endocarditis ) hone para bhI ghanAtra banatA hai / 3. vAhinIprAcIra ke roga-vAhinI kI prAcIra meM jaba koI roga ho jAtA hai to usakA antazchada khuradarA hokara ghanAsa kA kAraNa bana sakatA hai / vAhinyavihAsI varNo ( atheromatous ulcers ) nagna cUrNIya paTTa ( bare calcareous plates ), phiraGgI dhamanIpAka ( syphilitic arteritis ), vAhinIvistRtijanya ( aneurysmal ) syUna ( SSC ) kI grIvA ke antarAlIya stara ke naSTa ho jAne se vahA~ para bhI ghanAtra utpanna ho jAtA hai / vaha dhIre dhIre bar3A hokara usakI grIvA taka sthAna bhara letA hai / uttAnasirAoM ke pragaNDita ho jAne para yA guda-sirA ( hemorrhoidal vein ) ke pragaNDita hone para ghanAstrayukta arza ho jAtA hai / 4. bAhya vastu ( foreign body in the vessel ) - jaba vAhinI ke bhItara sUcI, ghor3e kA bAla yA tAra jo zastrakarma karate samaya kabhI andara calA jAve yA koI prAcIna AtaMca andara ho athavA koI arbuda yA kITANu ( parasite ) bhItara ho to ina sabhI kA dharAtala rUkSa hone ke kAraNa vahA~ una para rakta jama kara ghanAstrotpatti karane lagatA hai / 5. ajArakatA ( anozaemia ) - ghanAstrotpatti meM eka kAraNa rakta meM jAraka kI kamI tathA rakta kA apacayAtmaka utpAdoM ( catabolites ) dvArA dUSita ho For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 265 jAnA bhI hai| jaba jArakavihIna rakta dhIre dhIre sirAoM meM bahatA hai taba ye utpAda antazchada ko vidIrNa kara dete haiM aura AtaMcana ke kAraNa banate haiN| hRdaya ke dvidala kapATa ke roga meM jo dvidalIya nirodha (mitral stenosis) hotA hai sirA saMvahana avaruddha hokara phuphphusAbhigA dhamaniyoM se hRdaya ke dakSiNa bhAga taka nizceSTa raktAdhikya ( passive congestion ) ho jAtA hai| yahA~ AtaMcana kA kAraNa jAraka kI kamI aura ina utpAdoM kI atizaya upasthiti hai| isI kAraNa dakSiNa Antrika puccha meM bhI raktAtaMcana prAyazaH milatA hai| yahI kAraNa pragaMDita sirAoM meM AtaMcana ke lie diyA jA sakatA hai| ___ yadi dhamanI kA antazchada svastha ho to phira rakta kitanI hI mantharagati se usameM bahatA rahe ghanAsrotkarSa meM vaha gati prAthamika kAraNa kadApi nahIM bana sktii| para jaba eka bAra rakta dhArA meM ghanAsra utpanna ho gayA to phira jyoM jyoM rakta kI saMvahana gati manda hotI jAvegI tyoM tyoM ghanAstra para tantvi jamatI calI jAvegI aura vaha moTA par3atA calA jaavegaa| aisA ghanAstra vAhinI ke antaHstara meM eka sthala para saMzliSTa nahIM hotA api tu raktadhArA meM bahatA hai aura vaha kisI bhI anya aGga meM avasthAna kara sakatA hai| udAharaNa svarUpa strI kI zroNiguhA (pelvis) meM yadi koI zastrakarma kiyA gayA ho to vahA~ kI sirAe~ ghanAsroM se bhara jAtI haiN| jaba taka rugNA sthira aura zAnta rahatI hai koI hAni nahIM hotI para jyoM hI vaha hilI DulI ki ghanAstra nikala kara phuphphusAbhigA dhamanI meM pahu~ca kara tatkAla mAraka siddha ho jAtA hai| gambhIra raktasrAva ke pazcAt rakta meM AtaMcana ( clotting ) bar3hatA jAtA hai| tIvra AmavAta, visarpa, phuphphusapAka tathA urastoya meM bhI yaha pravRtti dekhI jAtI hai / sArAMza yaha hai ki ghanAsrotkarSa meM 3 pradhAna hetu haiM:1. rakta meM sUkSma rogANuoM aura unake utpAda ( products ) kI upasthiti / 2. rakta-bimbANuoM kI vRddhi / yaha tIvrasantApa, raktakSaya, zvetakaNamayatA (leucocythaemia) meM dekhI jAtI hai| 3. tantvi kI mAtrA meM vRddhi / yaha phuphphusapAka meM dekhI jAtI hai / tathA tantvi nirmAtA yakRt meM kama ho jAtI hai| kailziyama ke lavaNoM kI upasthiti jahA~ rakta kI sAndratA ko bar3hAtI hai vahA~ tigmIya (AgjaleTsa) usako kama karate haiN| isI prakAra kozA kI kriyA se prApta nyaSTIlI ( nuclein) bhI usI prakAra sAndratA ko bar3hAtI hai evaM usake zvitadhu ( albumoses ) kI upasthiti sAndratA ko rokatI hai| tIvra rogANuraktatA ( septicaemia ) meM rakta bahuta tarala rahatA hai aura jaldI jamatA nhiiN| yakRt tathA plIhA para gambhIra kSa-kiraNa DAlane ke bAda AtaMcana kAla kama ho jAtA hai| ghanAstra ke lakSaNa aura prakAra mRtyUttarakAlIna ghanAstra kA varNana nyAya vaidyaka meM milatA hai| jIvanakAlIna dhanAstra kA varNana yahA~ diyA gayA hai: 23, 24 vi0 For Private and Personal Use Only

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"266 vikRtivijJAna sthira yA pravAhita kisI bhI prakAra ke rakta meM usI dRSTi se zveta yA lAla raGga ke ghanAsra banate haiN| rogANutA ( sepsis ) kI dRSTi se rogANvika ( septic ) tathA rogANu virahita ( aseptic ) donoM prakAra ke ghanAsra dekhe jAte haiN| jaba pravAhita rakta meM AtaMcana hotA hai to zveta yA mizrita ghanAstra kA udaya hotA hai| dhamanI-visphAra ke syUna ( sac of the aneurysm ) meM yA AghAtaprApta hRtkapAToM meM bhI zveta yA mizrita prakAra kA ghanAsra milatA hai| ____ lAla ghanAstra sthira rakta meM milatA hai| jaba kisI vAhinI kA bandha (ligature) kiyA jAtA hai to usake donoM ora vAhinI-prAcIra se cipakA huA lAla, mRdu, dhanAtra banatA hai| AtaMcana (coagulation of blood ), kI kriyA bahuta mandagati se hotI hai| vAhinI-prAcIroM ke sAtha saMsakta ghanAstra sUkha kara kama lacIlA ho jAtA hai| yadi yahI raktadhArA meM kisI prakAra calA Ave to isake Upara tantvi ke car3ha jAne se yaha bhI zveta ghanAstra meM pariNata ho sakatA hai| pravAhita raktadhArA meM yadi kahIM usake antazchada ko AghAta pahu~catA hai to rakta bimbANu AghAta-prApta sthAna meM abhilagna ho jAte haiN| yadi AghAtasthAna adhika gambhIra huA to aura adhika bimbANu vahA~ adhika se adhika saMkhyA meM jamate haiM / una bimbANuoM meM se ghanAstreda (thrombokIneja) svatantra hotA hai tathA tanvi ( fibrin ) kA nirmANa atyalpa mAtrA meM hotA hai jisameM zveta aura lAla donoM prakAra ke kaNa phaMsa jAte haiM / phira isI meM aura bimbANu pha~sate rahate haiM aura isa prakAra eka ghanAsra kA nirmANa hotA hai| jise kATane meM aneka stara milate haiN| ghanAstra meM dhIre dhIre tantvi saGkucita hone lagatI hai aura vaha kAcarIkRta (hyalinised ) hokara zveta ghanAstra bana jAtI hai| isakA raMga Arakta yA dhUsara hotA hai| vAhinI ko alpAMza yA pUrNAza meM avaruddha karane ke kAraNa ghanAstra ko kramazaH prAcIrIya ( parietal ) yA avarodhaka ( obstructive ) ina do prakAroM meM bhI vibhakta kiyA jAtA hai| prAcIrI ghanAstra zveta varNa kA hotA hai| isake dvArA vAhinI ke mukha kA atyalpa bhAga avaruddha rahatA hai tathA rakta kA AvAgamana jArI rahatA hai| avarodhaka ghanAstra pUrNataH mukha ko avaruddha kara detA hai / yaha zveta aura lAla donoM ke mizrita varNa kA hotA hai / AtaMca bhI isI prakAra kA dekhA jAtA hai / yadyapi dhanAtroM kA janma pravAhita rakta meM hotA hai para vAhinI kA AMzika avarodha rakta kI mandatA ke kAraNa ho jAtA hai / prAyaH ghanAsra kI vistRti raktagati ke ati druta hone se ruka jAtI hai| aura yaha rokane kI kriyA eka vAhinI aura usakI sahAyaka vAhinI ke saGgamasthala para vizeSa dekhI jAtI hai| para kabhI kabhI to pAda se lekara adharAmahAsirA taka sirA kA rakta raktaparibhramaNa kI dizA meM yA viruddha pUrNataH jama jAtA hai / jo avarodhaka ghanAsra hote haiM ve prAyaH vAhinI kI pUrI lambAI meM rakta ko jamA dete haiN| uparyukta prakAroM ke atirikta nimna prakAra aura pAye jAte haiM: For Private and Personal Use Only

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rakta parivahana kI vikRtiyA~ 267 1. kandukIya ghanAtra- yaha aneka starayukta gola ghanAtra hotA hai jo hRdayAlindoM meM ( vizeSakara alindapuccha meM ) pAyA jAtA hai / isakA pradhAna kAraNa dvipatraka dvAra kI sannirodhotkarSatA ( stenosis of the mitral valve ) hai / yaha stara yukta ( laminated ) hotA hai / ye stara tantvi ( fibrin ) ke hote haiM / kabhI kabhI kisI kA kendra bhAga mRdu hone se ve arddhatarala dekhe jAte haiM / 2. kAcara ghanAtra--ye sUkSmAtisUkSma kezikAoM meM rakta kA AtaMcana karake unheM avaruddha kara dete haiM / inheM vigArTa ke taMtvi-raMjaka se gaharA nIlA raMga sakate haiM / 3. tantvighanAsra --- yaha phuphphusapAka ke pazcAt tudra vAhiniyoM meM dekhA jAtA hai / jaba atizvetaraktatA ( ( leukaemia ) meM vAhiniyA~ zvetakaNoM se pUrNataH bhara dI jAtI haiM to use kucha zvetakaNIya ghanAtra ke nAma se pukArate haiM para ve ghanA nahIM haiM / ghanA kA antima parivartana Age cala kara ghanAtra raGgahIna ho jAte haiM aura ve yA to mRdu yA samaMgIkRta ( organised ) ho jAte haiM yA upasRSTa hokara pUyotpatti karane lagate haiM / sarva prathama ghanA banatA hai phira vaha saGkoca karatA hai tadanantara vaha vAhinIprAcIra se chUTakara pRthaka ho jAtA hai / tatpazcAt usake lAla kaNoM kA aMzana hone lagatA hai / usakI zoNavartuli svatantra hokara ghanAstra ke bAhara vyApta hone lagatI hai| yadyapi usakA kucha bhAga kaNadAra ( granular ) zoNiteyI ( haematoidin ) bhI bana jAtA hai / pariNAmasvarUpa ghanAsa kA raMga gaharA surkha nahIM rahatA api tu karburita (mottled ) AraktadhUsara ho jAtA hai| yaha kriyA ghanAstra ke kendra se prArambha hokara saptAhoM meM yA mahInoM meM pUrNa hotI hai / kabhI kabhI ghanA pUrNataH yA aMzataH naSTa bhI ho jAtA hai jisameM do kAraNa hote haiM / eka to AtmazoSaNa (autolysis ) kI pravRtti se usakA mRdu ho jAnA, tathA dUsare bhakSakAyANuoM kI kriyA se / kabhI kabhI AtmazoSaNa na hokara upasarga ke kAraNa bhI mRdutA yA mArdava hotA hai para taba rogI ke zarIra meM pUyaraktatA (pyemia) hokara mRtyu ho sakatI hai / aria kI paJcatva-prApti ( organisation of thrombus ) - yaha kriyA AghAtaprApta antazchada yA jahA~ ghanAtra vAhinIprAcIra se cipakA huA hai vahA~ prArambha hotI hai / sarva prathama vahA~ para zveta kaNoM kA Agamana hotA hai jo ghanAvastha tatva ko le jAte haiM / isI samaya upAntazchadIya ( subendothelial ) dhAtu se navIna kezikIya raktavAhiniyA~ tathA tanturuha ( fibro blasts ) banane lagate haiM / yadi isa samaya taka ghanAsra sikur3a cukA to usake Upara antazchada bana jAtA hai para yadi vAhinI ko vaha avaruddha kiye hue rahA to vahA~ tantUtkarSa ( fibrosis ) hone lagatA hai aura sArI vAhinI eka tAntava sUtra ( fibrous band ) kA rUpa dhAraNa kara letI hai / para jahA~ sirAjanya ghanAsra hotA hai jaise zvetapAda ( Phlegmasia For Private and Personal Use Only

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268 vikRtivijJAna alba dolens ) nAmaka roga to vahA~ para andara ghanAstra meM hokara eka navIna kAnAla ( canal ) taiyAra ho jAtI hai jo punaH rakta ke AvAgamana kA prArambhana karA detI hai| yadi ghanAsra se pIr3ita aura avaruddha vAhinI ke dvArA abhisiJcita pradeza ko koI dUsarI vAhinI nahIM pahu~catI to vaha aGga prAyazaH mara jAtA hai| jaba mastiSka meM isa dhAtu kI mRtyu calane lagatI hai to vahA~ aGga mArdava evaM dravIbhavana hone lagatA hai| choTe aGgoM kI sirAoM ke ghanAsroM ke dvArA koI mahatvapUrNa prabhAva nahIM pdd'taa| kabhI kabhI vahA~ kucha raktAdhikya ( congestion ) dIkha sakatA hai| para yadi bar3I bar3I sirAoM para prabhAva par3A to vahA~ sthAnIya raktAdhikya hokara UtiyoM meM raktasrAva hokara UtimRtyu ho sakatI hai| yadi ghanAstra jIvANuoM se upasRSTa ho gayA to pUyIya padArtha nikala kara phuphphusa yakRtAdi se jAkara visthAnAntaraNa ( metastatic ) vidradhiyA~ banatI haiN| anta meM cAhe ghanAstra jIvANuvirahita hI kyoM na ho vaha sthAnacyuta hokara Tukar3e Tukar3e hokara antaHzalya kA nirmANa kara detA hai| antaHzalyatA ( Embolism ) raktadhArA meM upasthita koI bhI videzI padArtha antaHzalya (embolus) kahalAtA hai| usakA apane AkAra se choTe mukha vAlI vAhinI meM jAkara mukha ko banda kara denA atyanta hAniprada dekhA jAtA hai| udgama-antaHzalyoM kA pramukha udgamasthala sirAjanya ghanAmotkarSa hai jahA~ se ghanAstra ke khaNDa khaNDa hokara itastataH raktadhArA meM phailate hue anya sthAnoM meM antaHzalyatA utpanna kara dete haiN| antaHzalyoM kA udgama nimna sthAnoM se bhI hotA huA dekhA jAtA hai : (a) dhamaniyoM kA antardharAtala / (A) sazotha hRtkapAToM meM abhilagna ghanAsra ke khaNDa / (i) raktadhArA meM sthita koI kITANu vA jIvANu / (I) raktadhArA meM sthita vAyu ke budbuda / eka ghanAsra kaI prakAra se antaHzalyatA kara sakatA hai| unameM kucha nIce likhe jAte haiM: 1. ghanAstra mRdu hokara TUTa jAve aura usake khaNDa raktadhArA meM bikhara jaaveN| 2. kisI prAcIrI ghanAstra ( parietal thrombus) ko rakta kI dhArA bahA kara le jaave| 3. aisA dekhA jAtA hai ki jaba kisI vAhinI meM ghanAsra banatA hai to vaha usa vAhinI kI sahAyaka vAhinI ke saGgamasthala para hotA hai| ataH nirmita ghanAstra kA eka bhAga sahAyaka vAhinI meM praveza pA jAtA hai tathA rakta kI mukhya vAhinI se For Private and Personal Use Only

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266 raktaparivahana kI vikRtiyA~ pravAhita dhArA ise jhaTa se kATa detI hai aura vaha kaTA huA antaHzalya sarva sAmAnyA raktadhArA meM mila jAtA hai| uparyukta avasthAoM meM thor3I sI bhI azAnti yA halacala athavA zrama ke kAraNa kisI bhI ghanAsra kA choTA yA bar3A khaNDa TUTa kara alaga ho jAtA hai| paira kI sirAoM, garbhAzayika evaM zroNipradeza kI sirAoM ke ghanAsra isa prakAra kI AkasmikatAoM ( accidents) ke utpanna karane vAle pradhAna kAraNa haiM udara pradeza meM zastrakarmoparAnta bhI yaha hAni pradAyaka pravRtti banI rahatI hai| Aparezana ke dasaveM dina jaba rogI kucha hilanA-dulanA prArambha kara detA hai taba yaha pravRtti bahuta adhika dekhI jAtI hai| antaHzalyoM kI sabase prathama giraphtArI una prathama vAhiniyoM meM dekhI jAtI hai jo itanI choTI hotI haiM ki unameM se antaHzalya aura Age bar3hane meM asamartha ho jAte haiM / yaha pakar3a yA to kisI vAhinI ke dvizAkhana ( bifurcation ) ke sthAna para hotI hai yA jaba vAhinI kA vyAsa eka dama choTA ho jAtA hai| vaise antaHzalya itane bhI sUkSma ho sakate haiM jo sUkSmAtisUkSma kezikAoM se bhI hokara jA sake aura koI bhI lakSaNa pragaTa na hove athavA nAr3I vAhiniyoM se to saralatA se cale jAveM para choTI vAhiniyoM meM pakar3a lie jaaveN| niyamataH yA to ve dhamaniyoM ke prathama kulaka (set ) meM giraphtAra ho jAte haiM yA ve apane udgamasthala tathA anya vAhiniyoM ke madhya ke mArga meM pakar3e jA sakate haiM jo antaHzalya dakSiNa hRdaya, sAMsthAnika sirAe~, yA phuphphusAbhigA dhamaniyoM dvArA jAte haiM ve phuphphusa kI kezikAoM dvArA pakar3a lie jAte haiN| tathA jo phuphphusottha sirA (pulmonary veins), vAmAlinda, vAma nilaya yA dhamaniyoM se nikalate haiM ve sAMsthAnika dhamaniyoM aura unakI kezikAoM meM khAsa karake plIhA, mastiSka yA vRkkoM meM pakar3a lie jAte haiN| kezikAbhAji (pratihAriNI) sirA ( portal vein) ke antaHzalya yakRt meM yA phuphphusotthA sirA meM pakar3e jAte haiN| ___ antaHzalya ke AkAra, vistAra aura usakI prakRti para avarodha nirbhara karatA hai| yadi vaha mRdu hogA to apanA svarUpa lambotarA karake vAhinI meM ghusa jAvegA tathA sArI dhamanI ko hI avaruddha kara degaa| para yadi AkAra viSama aura racanA sudRr3ha hai to vaha vAhinI ko pUrNataH nahIM bhara pAvegA aura thor3A thor3A rakta kA pravAha jArI rhegaa| antaHzalya ke eka sthAna para pakar3a jAne se usake Age aura pIche rakta meM sAndratA hokara dvitIyaka ghanAsra kI utpatti ho jAtI hai| virodhAbhAsika anyaHzalyatA ( Paradoxical Embolism) jaba koI ghanAsra sirA meM utpanna hokara apanA avasthAna vRkkoM yA mastiSka meM kara jAve tathA usakA phuphphusa para koI bhI prabhAva na par3e to vaha vaimatyika antaHzalyatA kahalAtI hai / sAdhAraNataH sirA dvArA jAne vAle antaHzalya pahale phuphphusoM meM vikAra karate haiM para yahA~ vaisA nahIM hotaa| isake sambandha meM 2 kAraNa diye jA sakate haiM: For Private and Personal Use Only

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270 vikRtivijJAna 1. prathama yaha ki hRdaya ke donoM alindoM ko vibhakta karane vAlI prAcIra meM garbha kAlIna jAmbava vivara ( foramen ovale ) khulA huA raha gayA ho| jisake kAraNa sirottha antaHzalya phuphphusoM meM na jAkara sIdhe isa vivara dvArA mukhya parivAha (greater circulation ) meM jAkara mastiSka vA vRkkoM meM antaHzalyatA utpanna kara de / Acharya Shri Kailassagarsuri Gyanmandir 2. dUsarA yaha ki AtaMca vA jIvANu ( clot or bacteria ) ke lie phuphphusa kI vAhiniyA~ vRkka vA mastiSka kI vAhiniyoM kI apekSA adhika caur3I hone se ve unameM hokara pAra cale jAveM aura kisI prakAra kI kharAbI unameM na kareM / athavA jaba ve phuphphusa kI vAhiniyoM meM rahate haiM to iMtane sUkSma hote haiM ki unako vahA~ se jAnA sugama hotA hai / para Age cala kara una antaHzalyoM ke Upara tantvi ( fibrin ) kA AvaraNa car3hatA rahatA hai aura unheM sthUla karake pariNAma karatA hai / sUtikAjvara sirAoM meM antaHzalya bana kara mastiSka meM pakSAghAta (hemiplegia ) karatA huA dekhA jAtA hai / yahA~ ghanAstra dUSita vA aupasargika hotA hai / isa jIvANuja antaHzalya ke kAraNa hI mastiSka meM vikSati hotI hai / eka aupasargika atra mastiSka kI eka vAhinI meM raktasaMvahana kA avarodha karake usa sthAna kI kArya saMcAlana zakti ko naSTa kara detA hai / pratigAmI antaHzalyatA ( Retrograde Embolism ) jaba koI sirAjanya ghanAtra yA koI arbuda yA navotpatti ( newgrowth ) kisI sirA meM bar3hate lagatI hai athavA jaba vaha kezikAoM meM dhArA ke viruddha bar3hane lagatA hai to usa antaHzalya ko pratigAmI antaHzalya kahate haiM / ghanAtra se banane vAle saba antaHzalyoM meM vaise hI dvitIyaka parivartana dekhe jAte haiM jaise ki ghanAtra meM pahale varNana kie jA cuke haiM / antaHzalyoM ke pariNAma ( The effects & consequences of Embolism ) antaHzalyoM ke kAraNa 2 prakAra ke pariNAma mukhyataH dekhe jAte haiM jinameM eka rakta saMvahana ke avarodha se tathA dUsarA antaHzalya kI racanA se sambandha rakhatA hai / rakta saMvahana ke avarodha kA pariNAma - jaba koI dhamanI akasmAt avaruddha ho jAtI hai to nimna pariNAma dRSTigocara hone lagate haiN| : 1. yA to kevala sthAnika avarodha dekhA jAtA hai aura koI navIna parivartana nahIM milatA / yaha tabhI sambhava hai jaba vAhinI meM se aneka zAkhA prazAkhAe~ avarodha ke sthala se pUrva hI nikalI huI haiM / 2. yA dhamanI dvArA siMcita pradeza kI dhAtuoM meM svalpakAlIna gar3abar3I ho kara kArya pUrvavat calane lagatA hai / 3. yA avaruddha vAhinI dvArA siMcita samasta kSetra kA vinAza ho jAtA hai / yaha For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ tabhI hotA hai jaba vAhinI se alpa zAkhA prazAkhAoM vA alpa vAhiniyoM kA usa kSetra meM pUrNataH abhAva ho| 4. athavA Akasmika sahasA gatisthairya (sudden shook) hokara mRtyu ho jaave| uparyukta samasta pariNAma nimna tathyoM para nirbhara karate haiM:(a) dhAmanika jAlakriyA ( arterial anastomosis ) kI vistIrNatA / (A) dhAmanika jAlakriyA kitane zIghra ho sakatI hai ? (i) dhAmanika jAlakriyA prArambha hone aura dhamanI avarodha ke bIca ke samaya meM jo dhAtuoM meM rakta kI kamI dekhI jAtI hai usake prati kisa dhAtu kI kaisI anuhRSatA ( susceptibility ) hai| jaba kisI dhamanI kA akasmAt avarodha ho jAtA hai to vaha usa sthAna se agalI zAkhA taka saGkoca kara jAtI hai aura usakI jAlakRta (anastomotic) zAkhAe~ visphArita ( dilated ) hone lagatI haiN| hAtha-pairoM meM dhamanI jAlakriyA pUrNa svatantratA se hotI huI dekhI jAtI hai| tathA jaba taka ki koI bahuta bar3I dhamanI avaruddha nahIM hotI jAlakaraNa ho jAtA hai| parantu yadi dhamanI meM vihrAsa ho rahA ho aura vaha kaThina par3a gaI ho to usakA visphAra honA asambhava ho jAtA hai| aisA vRddhAvasthA yA jaraThatA meM dekhA jAtA hai| sAtha hI jAraThika hRdaya bhI durbala hone se rakta bhI dhamanI meM hokara dhIre dhIre bahatA ho to vahA~ kotha (gangrene ) kI utpatti ho sakatI hai| ___ isI prakAra Antra meM jaba koI sazAkha dhamanikA ( branch artery ) jo vahA~ 2 iJca kSetra ko sIMcatI hai avaruddha ho jAtI hai to jhaTa se vahA~ aMgagraha (spasm) ho jAtA hai jisakA pariNAma yaha hotA hai ki vahA~ dhamanI jAlakaraNa kArya ruka jAtA hai aura rakta kA pUrNataH abhAva isa kSetra meM ho jAtA hai aura zIghra kotha hone lagatA hai| pAzita AntravRddhi ( strangulated hernia) meM zIghra kotha hone aura sthiti gambhIra ho jAne kA yahI pramukha kAraNa hai| ___ yahI hRdaya meM bhI dekhA jAtA hai jahA~ dhamanI-jAlakriyA kI kamI aura AkSepAdhikya se atighora hRcchUla ( angina pectores ) hotA aura utanI hRtpezI naSTa ho jAtI hai| __ zarIra ke vibhinna aGgoM kI kozAoM para raktahInatA kA prabhAva alaga alaga par3atA hai| niyama yaha hai ki jo kozA jitanA hI viziSTa ( specialised ) hogA utanA hI adhika usa para raktAbhAva vA raktAlpatA kA pariNAma hogaa| isa dRSTi se sabase adhika anuhRSa ( susceptible ) kozAe~ vAtasaMsthAna, Antra aura vRkkoM kI haiM / kevala eka ora kI mahAmAtRkA dhamanI ( carotid artery ) meM kucha avarodha kara dene para mastiSka cakra ( circle of willis ) meM rakta saMvahana meM koI gar3abar3I nahIM dekhI jAtI phira bhI ardhAGgavAta hone kI pUrI pUrI sambhAvanA rahatI hai| yahI nahIM yadi 30 minaTa ke lie bhI raktasaMvahana na ho sake to mastiSka evaM suSumnA ke pragaNDa For Private and Personal Use Only

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vikRtivijJAna kozA (ganglion cells ) mRta ho jaayeNge| yadi kucha samaya ke lie kisI vRkka kI dhamanI ko banda kara diyA jAve to vRkka ke kitane hI adhicchadIya kozA (epithelial cells ) naSTa ho jaaveNge| para yadi tvacA vA saMyojI Uti ke kozAoM meM raktasaMvahana kama kara diyA yA roka diyA jAya to bahuta kama prabhAva pdd'egaa| antaHzalya kI racanA ke pariNAma-koI bhI sAdhAraNa sA antaHzalya zarIra ke andara yA to pracUSita ho jAtA hai athavA praguNita dhamanIpAka (proliferativearteritis ) tathA samaMgIkaraNa ( organisation ) kara letA hai| aupasargika antaHzalya tIvra dhamanIpAka kA kAraNa dekhA jAtA hai| kabhI kabhI to usake kAraNa dhamanIvisphAra (aneurysm ) ho jAtA hai jise aupasargika dhamanIvisphAra ( mycotic or infective aneurysm ) kahate haiN| Age cala kara yaha phUTa jAtA hai aura usameM se bahuta adhika raktasrAva dekhA jAtA hai| antaHzalyoM ke sAtha yadi ugratama svarUpa ke jIvANu bhare hue haiM to anya pariNAmoM ke sAtha sAtha sthAnika yA sArvadaihika ( local or general ) pUryAbhavana ( suppuration ) hone lagatA hai / aba nIce 3 prakAra ke antaHzalyoM kA varNana aura karake isa prakaraNa ko samApta kiyA jAtA hai| 1. vAtAntaHzalyatA ( Air Embolism) jaba kabhI adhika mAtrA meM sirAoM meM vAta (havA) kA praveza hone lage to vaha bhI antaHzalyatA utpanna kara sakatI hai| aisA 4 sthAnoM meM sambhava hai1. jaba iMjaikzana ( injection ) karate samaya DAkTara apanI udgArikA (sirija) meM havA ko sirA dvArA andara bheja de|| 2. grIvA ke zastrakarma (Aparezana) ke samaya akasmAt koI bar3I sirA khola dI jAve / athavA3. yakSmA ke upacAra meM kRtrima vAtorasa ( artificial pneumothorax ) ke lie diye jAne vAle vAta ke antaHkSepaNa meM asAvadhAnI ho jAve / 4. vAti budbuda roga (kAyasana kA roga) meM adhika vAtapIDana para rakhA huA rogI jyoM hI bAhara AtA hai vAta kA pIDana ghaTane se nAiTrojana eka dama usake zarIra se phUTane lagatI hai jo mArga meM sirAoM meM pahu~ca kara antaHzalyatA kara sakatI hai| vAtAntaHzalyatA kA pariNAma nimna cAra zabdoM meM vyakta kiyA jA sakatA hai1. zyAvatA (cyanosis) 3. saMnyAsa ( coma ) tathA 2. zvAsakRcchratA ( dyspnoea) 4. mRtyu ( death) . / parantu alpamAtrA meM sirA meM praviSTa vAta meM 21% jAraka ( AksIjana) vAta hone se vaha dhAtuoM se zoSita karalI jAtI hai| . For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 273 mRtyu kA eka ati sambhAvya kAraNa to yaha ho sakatA hai ki jaba vAta dakSiNa hRdaya meM AjAtI hai to vahA~ manthana kriyA se jhAgayukta rakta ho jAtA hai| jhAgoM ke kAraNa hRcchidroM meM hokara nikalane meM yA Age phuphphusa kI sUkSma vAhiniyoM meM hokara jAne meM vaha pUrNataH asamartha ho jAtA hai / isase dakSiNa hRdayAvapAta ( right-sided failure of the heart ) dekhA jAtA hai| 2. snehAntaHzalyatA ( Fat Embolism ) nimna kAraNoM se sneha-vindu zarIra kI kSatigrasta vAhiniyoM meM praveza kara sakate haiM(a) asthibhagna ( fractures of bones ) (A) upatvak dhAtu ke kSata ( contusions of subcutaneous tissue) (i) snaihika yakRt kA sphuTana ( rupture of fatty liver ) (I) tIvra asthimajjApAka ( acute osteomyelitis) (u) atyadhika snaihika vihAsa ke kAraNa vyApta viSatA ( poisoning due to excessive fatty degeneration ) (U) raktasrAva yA zothIya utsyandana ( effusion ) ke kAraNa pIDana bar3hane se sirAoM meM bhI snehavindu dekhe jA sakate haiN| isa prakAra rakta ke andara snehavindu Ane para ve dakSiNa hRdaya taka pahu~cate haiM aura vahA~ se phauphphusika dhamanikAoM evaM kezikAoM meM jAte haiM tathA vahA~ se thUka ke andara bhI dekhe jAte haiN| yahI nahIM atisUkSma svarUpa ke ye snehavindu phuphphusa kI kezikAoM meM hokara vAmahRdaya meM pahu~ca kara sAMsthAnika paribhramaNa karane cala dete haiN| aura vahA~ se mastiSka kI sUkSmAtisUkSma vAhiniyoM meM jAkara bahusaMkhyaka raktasrAva utpanna kara dete haiN| jisake kAraNa aGgaghAta aura saMnyAsa hokara mRtyu taka ho jAtI hai| aise hI snehavindu mUtra meM, tathA kezikAjUToM (gucchikAoM) ko kATane para vRkkoM meM milate haiN| phuphphusoM meM inakI upasthiti se mRtyu honA kahA~ taka sambhava hai yaha nahIM kahA jA sktaa| 3. jIvANujanya antaHzalyatA jIvANuoM ke jhuNDa yA saMghoM ke kAraNa bhI antaHzalyatA dekhI jAtI hai jinameM nimna mukhya haiM : 1. pUyika jvaroM meM nIlAruNasidhma ( petechae) kA nirmANa / 2. viSamajvara ke kITANuoM ( malarial parasites ) dvArA mastiSka vAhi niyoM kA avarodha karake mastiSkajanya viSamajvara kI utpatti / 3. zlIpadIya kRmiyoM ( filarae bancrofti ) dvArA lasavahAoM kA avarodha / 4. arbudakozAoM ( tumour cells) dvArA antaHzalyatA hokara visthAnAntarita vRddhi ( metastatic growth) kA sRjana / yahA~ rakta kA avarodha na hone se inake antaHzAlyika pariNAmoM para adhika dhyAna nahIM diyA jaataa| For Private and Personal Use Only

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274 vikRtivijJAna RNAstra - pradeza ( Infarction ) kisI dhamanI ke avarodha se jo dRSTa pariNAma usase siJcita dhAtu ke jisa bhAga para dekhe jAte haiM vaha bhAga RSNAsrapradeza kahalAtA hai / AghAta - prApta usa aGga ko RNAtra bhI kaha sakate haiN| kalpanA meM to RRRNAtra pUre aGga meM bhI dekhe jA sakate haiM parantu vyavahAra meM utane bar3e RNAtra nahIM milate aura jaba taka ki aisI sthiti utpanna ho vyakti vizeSa kI gatisthairya ( shock ) ke kAraNa mRtyu ho jAtI hai / Acharya Shri Kailassagarsuri Gyanmandir kisI kezikA ke andara antaHzalya ke praveza kara jAne se usameM raktasaMvahana nahIM ho sakatA aura usake dvArA abhisiJcita pradeza raktarahita ( RNa-rahita asra - rakta ) ho jAtA hai aura vaha RNAstra kahalAtA hai / kevala vRkkoM ko chor3a kara jahA~ unake pravaroM ( capsules ) meM bhinna raktavAhinI abhisiJcana karatI hai / zeSa saba sthAnoM para RNAstra kA jJAna usa aGga ke UparI dharAtala se ho jAtA hai / pratyeka RNAstra- pradeza kA AkAra zaGka ( cone ) ke samAna hotA hai / usakA AdhAra bhAga aGga vizeSa kA bAhya dharAtala hotA hai aura zIrSa bhAga dhamanI kA avarodha - sthala | isa prakAra ke zaGkAkArI pradeza plIhA meM vizeSa milate haiM / AkAra isa bAta para aura nirbhara karatA hai ki avarodhasthala se jAne vAlI vAhiniyA~ kisa dizA meM jAtI haiM / vRkkoM meM ve mUladhamanI ke samakoNa para nikalatI haiM ataH RNAtra pradeza catuSkoNAkAra hotA hai / jaise hI kisI dhamanI ke raktasaMvahana meM akasmAt avarodha hotA hai vaise hI usa sthAna se Age rakta kA jAnA banda ho jAtA hai aura rakta kA pIr3ana ghaTa jAtA hai / ataH usa pradeza meM raktapIDanajanya zUla taka nahIM mila sakatA / pariNAma yaha hotA hai ki raktapIDana ghaTa jAvegA aura dhamanI se sirA kI ora rakta jAne kI apekSA ulaTA sirA se dhamanI kI ora rakta lauTane lagegA / isI samaya usa pradeza meM jAlakAriNI vAhiniyoM ( anastomotic arteries ) se bhI rakta A jAtA hai / ina saba kAraNoM se vahA~ para raktAdhikya ( congestion ) ho jAtA hai / aura rakta sthira ho jAtA hai / rakta kI isa sthiratA tathA kezikIya raktapIr3ana ke kama ho jAne se rakta rasa dhAtuoM kI ora bar3hane lagatA hai / Age cala kara ajArakatA ( anoxaemia ) ke kAraNa jaba kezikIya antazchada ( capillary endothelium) naSTa ho jAtI hai tathA ve svayaM phaTa jAtI haiM to rakta ke lAlakaNa tathA raktarasa kA pravAha vAhinI - prAcIroM ke bAhara hone lagatA hai ataH prArambhikatama avasthAoM meM sabhI RNAtra gahare lAla baiMganI raGga ke tathA zothayukta hote haiM / RNAstrapradeza anya kSetra se kucha U~cA uTha jAtA hai / isake kAraNa aGga ke Upara kA prAvara kucha tana jAtA hai aura isake kAraNa usameM atyadhika pIDA hotI hai / phuphphusa aura plIhA jaise gatimAn aGgoM meM RNAsra - kSetroM ke zotha se gharSaNa zabda ( friction sound ) utpanna hotA hai / For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 275 RNAstra-pradeza yukta aGga kA yadi kucha bhAga zarIra ke bAhya dharAtala para pragaTa hotA ho to tvacA meM raktAdhikya hokara kucha bhAga vivarNa ho jaavegaa| yaha eka mahattvapUrNa naidAnika cihna hai| phuphphusa ke RNAsroM meM, thUka meM tathA vRkkoM ke RNAsroM meM, mUtra meM rakta kI upasthiti dekhI jAtI hai| Upara jo varNana diyA gayA hai vaha RNAsroM kI prArambhika avasthA kA hai| isa avasthA ke bItane para varNa ke anusAra do prakAra ke RNAtra dekhe jAte haiM-eka lAla aura dUsarA zveta / lAla RNAstra ( Red Infarcts ) jisa aGga meM dhamanI dvArA rakta kA abhisiJcana dhamanI jAlakriyAdi ke kAraNa svatantratApUrvaka ho sakatA hai vahA~ prAyaH lAla RNAsra dekhA jAtA hai| yakRt , phuphphusa tathA Antra aise hI aGga haiM / yaha RNAsra kI prArambhika avasthA ke sAtha hI jur3e rahate haiN| kyoMki RNAstra-pradeza meM pIr3ana kI kamI rahatI hai ataH vahA~ cAroM ora se rakta Ane kA prayatna karatA hai| choTe choTe lAla RNAsra-pradezoM meM rakta itanA adhika nahIM AtA ki vaha bhAga pUrNataH bhara jAve balki vahA~ to thor3e samaya ke bhItara sAmapArzvika saMvahana ( collateral circulation ) prArambha hokara upazama ( resolution ) kA kArya prArambha ho jAtA hai aura AghAtaprApta dhAtu pUrvavat apanA kArya jyoM kA tyoM karane lagatI hai| isI se jahA~ svatantrarUpa se dhamanI jAlakaraNa ( arterial anastomosis ) hotA hai vahA~ kevala dhamanI ke avarodha ke tAtkAlika lakSaNoM ke atirikta koI vizeSa lakSaNa nahIM dekhe jAte / lAla RNAstra-pradeza meM lAlI kA kAraNa rakta ke lAlakaNoM kA Uti meM bhAga kara pahu~canA hotA hai| rakta ke avarodha se jAraka kI kamI ho jAne se kezikAoM kI antazchada durbala hokara naSTa ho jAtI hai jisake kAraNa unameM bharA huA rakta utiyoM meM jAkara unheM lAla raMga detA hai| yaha dhamanI kA hI rakta hotA hai| ____ yadi AghAtaprApta kSetra vistRta ho to sAmapArzvika dhamanI saMvahana se dUratama sthita sthAna meM raktarasa ke srAva se rakta kI jAlakriyA ho jAtI hai| ataH lAla RNAsra kA kendriya bhAga gaharA kAlA tathA lAla aura kaThina hotA hai| jaba AtaMcana ho jAtA hai to phira vahA~ se jalIyAMza kA itane drutavega se nAza hotA hai ki vahA~ zoNAMzana ( haemolysis) nahIM ho paataa| ina paristhitiyoM meM bhItarI atiyA~ mara jAtI haiM aura una para eka lAla valaya kA nirmANa ho jAtA hai| yadi rogI jIvita rahA to inake andara bhI zveta RNAsroM kI taraha parivartana hote haiN| jinakA varNana nIce kiyA gayA hai| zveta RNAstra ( White Infarcts ) / jo aMga ekamAtra dhamanI ( end artery ) se abhisiJcita hote haiM aura jahA~ anya kisI dhamanI yA usakI zAkhA se rakta nahIM pahuMca sakatA vahA~ zveta RNAstra dekhA jAtA hai| mastiSka, plIhA, vRkka aura kucha kucha hRdaya meM bhI ye dekhe jAte haiM / For Private and Personal Use Only

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276 vikRtivijJAna jaba isa prakAra kI zAkha rahita dhamanI ko koI antaHzalya avaruddha kara detA hai taba usase siJcita pradeza meM rakta jAnA banda ho jAtA hai aura vahAM zveta RNAsra banatA hai| prArambha meM thor3I raktAdhikya kI avasthA AtI hai taduparAnta raktarasa UtiyoM meM parivedha ( permeate ) karane lagatA hai tathA vahA~ vaha jamane lagatA hai| isake kAraNa UtiyoM kI mRtyu hone lagatI hai aura bahirgata lAlakoM kA aMzana hone lagatA hai jisase bahuta sI zoNavartuli usa kSetra ke bAhara calI jAtI hai aura zeSa kaNamaya zoNAyasi (hImosAiDrIna-haemosyderin ) rUpa meM baca jAtI hai| isa kAraNa se tathA Age isa bhAga meM rakta A nahIM sakatA ataH vaha kSetra prathama gulAbI aura phira zveta ho jAtA hai, UtikozAoM meM AtaMcanajanya vizoNika mRtyu ( coagulative ischaemic necrosis ) ho jAtI hai| unakI nyaSThIlA lupta ho jAtI hai| kozArasa kaNadAra evaM uSasipriya (eosinophil ) ho jAtA hai granthi yukta (glandular) aMgoM meM adhicchadIya kozAoM kA nAza hone para bhI saMdhAra ( stroma.) kAphI samaya taka banA rahane se unake svarUpa meM antara nahIM aataa| jaba kahIM bhI mRta Uti zarIra meM ho jAtI hai to vaha samIpastha sajIva Uti ko prakSubdha kara detI hai| isake kAraNa RNAsra ke cAroM ora eka sArambhika yA prapAkI ( inflammatory reaction) prakriyA dekhI jAtI hai usakI kezikAe~ caur3a jAtI haiM aura mRta Uti ke cAroM ora eka adhiraktika ( hyperaemic ) kaTibandha banA letI haiM aura unase bhakSaka zvetakaNa nikala kara mRta Uti para AkramaNa karate haiM jo eka prakAra ke probhUjanAMzI kiNva (proteolytic ferment ) kA udAsarjana karate haiM, tathA svataH mRta utiyoM meM AtmapAcana ( autolysis) hote rahane se samasta vinaSTa padArtha Tukar3e Tukar3e hotA rahatA hai| idhara svastha UtiyoM se naI raktavAhiniyA~ tathA tanturuh ( fibro blast ) utpanna hote haiN| jo dhIre dhIre Arakta kaNamaya Uti dvArA sthAnacyuta kara diye jAte haiN| isa prakAra jIvita UtiyoM ke vinAza kI marammata kI jAtI hai| tanturuhoM ke pravRddha hone para ve tAntaba Uti meM pariNata hokara Age cala kara saGkucita ho jAte haiN| yaha saGkoca vAhiniyoM ke mukha ko bhI banda karake zveta tAntavIya vraNavastu kA nirmANa karatA hai| yaha tantUtkarSa kI kriyA pariNAha se kendra kI ora jAtI hai / yadi RNAsra adhika bar3A huA ho to vahA~ kaNamaya Uti ke banane ke pUrva hI AtmAMzana hokara dravaNa ( liquefaction) ho jAne se eka koSTha (sisTa-cyst) kA nirmANa bhI ho sakatA hai| aba nIce vibhinna aMgoM meM pAye jAne vAle RNAsroM kA varNana kiyA jAtA hai| phuphphusa ke RNAstra jaba kabhI vakSapradeza meM akasmAt tIvrazUla ho sAtha meM svalpa raktaSThIvana bhI ho evaM phuphphusacchada meM gharSaNa dhvani mile to samajha lenA cAhie ki anya aneka For Private and Personal Use Only

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ACT raktaparivahana kI vikRtiyA~ 277 rogoM meM eka phuphphusIya RNAsra bhI yaha ho sakatA hai| jaba hRdaya meM dvidala dvArIya sannirodha ( mitral stenosis ) hotA hai taba yaha roga dekhA jA sakatA hai| dvidalIyapratipravAhana ( mitral regurgitation ) meM bhI yaha mila sakatA hai| ina donoM dvipatrakIya rogoM meM alinda ke andara AtaMcana (raktaskandana) hotA hai jisake kAraNa antaHzalyoM kA nirmANa hotA hai phuphphusAbhigA dhamanI ( pulmonary artery ) kA dADhyaM ( atheroma) bhI isa pravRtti ko bar3hAtA hai| kabhI kabhI dIrghottAnA sirA ( saphenous vein ) ke ghanAsra ke khaNDa khaNDa hokara baha Ane se bhI yaha dekhA jA sakatA hai| ye RNAstra phuphphusoM ke bAhya evaM adhaHkhaNDoM meM milate haiN| inakA vyAsa 3" se lekara pUre phuphphusa-khaNDa taka ho sakatA hai| ye raGga meM akAla rakta hote haiM, zuSka dRDha aura kinArIdAra hote haiM tathA aneka aura yugapaccalita ( confluent ) hote haiN| ___ inako dekha kara kabhI kabhI arbudoM kA bhAna hotA hai| parantu arbuda kA raGga, AkAra, sthiti aura utpanna hone kI dazA ko dekha kara donoM ko alaga alaga kiyA jA sakatA hai| ___ kabhI kabhI yakRt ke RNAsra ko dekha kara phuphphusapAka meM utpanna hone vAle saMpIDana ( consolidation in pneumonia ) kA bhI anumAna ho sakatA hai / kintu donoM kA bheda saralatA se A~kA jA sakatA hai| Age cala kara isake kAraNa adhaHsthita phuphphusapAka ( hypostatic pneumonia ) utpanna ho jAtA hai ataH phira bheda nahIM kiyA jA sktaa| aNvIkSa dvArA dekhane se prabhAvita bhAga atyadhika lAla aura raktapUrNa (congested ) dRSTigocara hotA hai| kezikAoM ke atirikta phuphphusa ke vAyukozAoM (alveoli ) ke andara bhI rakta ke lAlakaNa pahu~ca jAte haiN| phuphphusa kI antarAlIya uti ( interstitial tissue ) meM bhI ve dekhe jAte haiN| phuphphusoM meM RNAsra kA kAraNa phuphphusAbhigA dhamanI meM hokara sUkSma antaHzayoM kA praveza hai| yadi bar3e bar3e antaHzalya hone se phuphphusa ke mukha para hI avarodha utpanna ho jAve to prAyaH RNAtra banane se pahale hI mRtyu ho jAtI hai| usa samaya mRtyUttara parIkSA karane para phuphphusa meM koI parivartana nahIM mila sktaa| isa dazA ko RNAstrahIna phauphphusika antaHzalyatA (infarctless pulmonary embolism) kahA jAtA hai| udara para zastrakarma hone ke uparAnta isakI AzaGkA prAyaH bar3ha jAyA karatI hai| yakRt ke RNAstra ye RNAstra lAla raGga ke choTe tathA catuSkoNIya hote haiN| inakA mUlakAraNa zarIrastha koI bhI pUyA ( sepsis) ho sakatI hai| AntrapucchapAka inakA mukhya hetu dekhA jAtA hai| isI ke kAraNa ina RNAtroM ke sAtha pratihAriNI pUyaraktatA ( portal pyemia) dekhI jAtI hai jisake kAraNa kaI vidhiyA~ bana jAtI haiN| For Private and Personal Use Only

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278 vikRtivijJAna hRdaya ke RNAstra kirITikA dhamanI yA hRdrohiNI ( coronary artery ) ke ghanAsrotkarSa ( thrombosis ) ke kAraNa prAyaH karake tathA usakI antaHzalyatA se thor3e se hRdaya ke ghanAstra banate haiN| isakA vikSata ( lesion ) vAmanilaya ke zikhara ( apex ) para prAyaH milatA hai| hRdaya ke RNAsra kA pariNAma adhikatara mRtyu meM hotA hai jIvita rahane para pezI kA utanA bhAga tAntavaUti ( fibrous tissue ) meM pariNata hokara hArdika visphAra ( cardiac aneurysm ) kA rUpa rakha letA hai jo Age cala kara sphuTita ( rupture ) hokara mRtyu kA kAraNa banatA hai| mastiSka ke RNAsra yaha mRdutA evaM dravaNIya parivartana ( collequative change ) ke phalasvarUpa dekhe jAte haiN| yadi RNAstra bar3A huA to vaha koSTa ( cyst) kA nirmANa karatA hai| yadi usameM pUyA A gaI to aneka mastiSkIya vidradhiyA~ bana jAtI haiN| atiraktatA yA paramaraktatA ( Hyperaemia ) saceSTa aura nizceSTa ( active & passive ) do prakAra kI atiraktatA yA paramaraktatA dekhI jAtI hai| saceSTAtiraktatA-yaha vaha avasthA hai jaba kisI aGga vizeSa meM dhamanI rakta kI adhikatA ho jAtI hai| isakA pramukha kAraNa hai dhamanikAoM se udbhUta kezAloM kI rodhaka zakti ( power of resistence ) kA hAsa kisI bhI aGga meM aneka kezAleM hotI haiN| ve sabhI eka sAtha nahIM khulatI kyoMki inakA khulanA aura banda honA kaI bAtoM para nirbhara karatA hai| kisI aGga kI kezAleM khulI rahatI huI bhI usako pahu~cane vAlI dhamanikA saGkucita raha sakatI hai| kezAloM ke dvArA kisI bhAga kI lAlI kA tathA dhamanikAoM dvArA usa bhAga ke tApakrama kA niyantraNa hotA hai| atiraktatA kA abhiprAya aGgavizeSa kI kezAloM kA svAbhAvika se kahIM adhika saMkhyA meM khula jAnA hai jisake kAraNa usakA raGga lAla aura tApakrama adhika ho jAtA hai| zarIravyApArazAstra kI dRSTi se saceSTAtiraktatA vyAyAma, pAcana aura srAvAdhikya ke samaya svabhAvataH dekhI jAtI hai| usa samaya aGga kI kriyAtmaka zakti (functional activity ) sadaiva bar3hI huI milatI hai| zarIra-vikAra-zAstra kI dRSTi se jaba kisI Uti vizeSa para AghAta (trauma) ho jAtA hai to usase eka atitiktI ( hisTemIna) sadRza padArtha nikalatA hai jo samIpastha samasta kezAloM kA ghAta kara detA hai| jisase ve saba abhistIrNa ( dilated ) ho jAtI haiN| kezAloM kA abhistaraNa karane meM koI vAtika kAraka (nervous factor) bhI sahAyaka hotA hai para usakA pUrNa jJAna abhI nahIM ho skaa| paridhAmanika svAyattacetA (svatantranADI) tantuoM (periarterial sympathetic For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 276 fibres ) yA suSumnA ke dhUsaravarNika zRGgoM ( grey rami ) ko kATa dene se bhI atiraktatA utpanna kI jA sakatI hai| pariNAma-atiraktatA ke ve sabhI pariNAma hote haiM jo kisI aGga vizeSa meM dhAmanikarakta kI adhikatA aura usakI gati ke bar3hane se ho sakate haiN| arthAt vahA~ lAlimA aura spandana ( pulsation ) bar3ha jAtA hai, AkAra-vRddhi ho jAtI hai, praspandana ( throbbing ) hotA hai| vahA~ kI kAryazakti bhI bar3ha jAtI hai aura yadi yaha kArya-paratA kucha dina sthira rahI to usa aGga kI atipuSTi ( hypertrophy ) bhI ho jAtI hai| ____ atiraktatA ke kAraNa vAtikakendroM (nerve centres) meM uttejanA pragaTa hotI hai| dRSTi evaM zravaNa kI parahRSatA (parasthesia ) tathA AkSepa ( convulsions) bhI bar3hate haiN| pranthiyoM meM atiraktatA ke kAraNa srAvAdhikya hotA hai|| nizceSTAtiraktatA-ise niSkriya adhiraktatA (passive congestion) bhI kahate haiN| isameM atiraktatA sirAoM aura kezikAoM meM vizeSa hotI hai| kyoMki bhaGga ke usa bhAga se sirAgatarakta ke bAhara jAne meM bAdhA par3atI hai| yaha avasthA tIvra evaM asthAyI ( acute & temporary) yA kAlika evaM sthAyI ( chronic & permanent ) dekhI jAtI hai| yaha sArvadehika yA sthAnika donoM prakAra kI mila sakatI hai| sirAgata rakta ke bAhara jAne meM bAdhA par3ane ke do pramukha hetu dekhe jAte haiM :1. sirAe~ abhistAra kI sImA kA atikramaNa kara deM aura unakI antazchada viSa yukta sirAgatarakta ke kAraNa viSAkta hokara use pUrNa pravezya banA de| 2. aGga vizeSa ke kozA apane hI cayApacaya (metabolism) se utpanna viSaile bhAga kA parityAga karane meM asamartha ho jAveM / sAmAnya nizceSTa adhiraktatA (General Passive Congestion ) isakA jitanA avarodha hRdaya meM hotA hai utanA phuphphusoM meM nahIM dekhA jaataa| vArdhakya ( old age ) athavA Antrikajvarajanya viSa ke kAraNa utpanna durbalatA ina do kAraNoM se hRtpezI meM paryApta sImA taka saGkoca karane kI azakyatA ho jAtI hai| isake kAraNa vAmanilaya se rakta pUrNataH bAhara nahIM jA pAtA isase hRtpezI meM adhika rakta bhara jAtA hai aura vaha Uti pUrNa ( over-filled ) abhistIrNa ( dilated ) ho jAtI hai| isake kAraNa rakta bhI apanI svAbhAvika gati ke anusAra phuphphusa aura mahAsirAoM meM se hokara nahIM jAtA / pariNAma yaha hotA hai ki dhAtuoM kA jAraNa kama hotA hai| jo hRtpezI ko aura bhI nirbala kara detA hai| yaha duScakra ( viscious circle ) barAbara calatA rahatA hai| kabhI kabhI dvipatraka yA mahAdhamanI ke kapAToM meM sannirodhotkarSa ( stenosis) hone se jaisA ki AmavAta meM dekhA jAtA hai dvAra-kapATikAe~ ( valve-cusps ) eka dUsare se saTa jAtI haiM jisase rakta ke jAne meM asuvidhA hone se usake pIche kA For Private and Personal Use Only

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280 vikRtivijJAna prakoSTha rakta se Thasa jAtA hai| kucha samaya tanAtanI calatI hai aura phira vaha koSThaka phaila jAtA hai| kapAToM ke sikur3a jAne se yA kAryakSama na hone se kabhI kabhI rakta kA pratipravAhana ( regurgitation ) bhI ho jAtA hai jisake kAraNa bhI pIche kA prakoSTha atyadhika rakta se bhara kara phaila jAtA hai| anugAbhika jIvana ( post natal life ) meM hRtkapATIya vikSata ke dvArA prAyaH kAlika sirAjanya adhiraktatA (chronic venous congestion ) hotA hai| jaba phuphphusoM meM hokara rakta ke pravAhita hone meM bAdhA par3atI hai to usake kAraNa sAmAnya nizceSTa adhiraktatA ke lakSaNa dikhalAI par3ate haiM aura usase hRdaya kA dakSiNa bhAga adhika zakti se use dUra karane ke prayatna karane meM svayaM pAtita ho jAtA hai / yaha usake koSThakoM ke atibhAra ( over loading ) kA pariNAma hI hai| nizceSTAtiraktatA phuphphusa uti ke tantUtkarSa ( fibrosis of the lung tissue ), cirakAlIna yakSmA athavA saikatotkarSa (silikosisa) nAmaka vyAdhiyoM meM phuphphusa kI kezikAoM aura dhamanikAoM meM kezAla tathA dhamanikIya vraNazothAtmaka abhilopana ( inflammatory obliteration of the capillaries and the arterioles) ho jAne se kezAlIya raktazaiyA ghaTa jAtI hai ataH rakta kA svatantra saMvahana ruka jAtA hai| phuphphusa vAtikozA vistRti ( emphysema) nAmaka roga meM bhI raktazaiyA choTI par3a jAtI hai| jaba bahuta kAla taka rakta kA pIDana bar3hA huA rahatA hai to bhI vahI hotA hai| prArambha meM hRrapezI meM atipuSTi (hypertrophy ) hotI hai parantu jaba rakta kI mAtrA koSThakoM meM barAbara bar3hatI hI jAtI hai aura khapata tadanusAra nahIM hotI to phira raktapUrNa koSThaka phailane lagatA hai aura kAlAntara meM pUrNatayA phailakara usake saGkoca aura vikAsa ke kramika kArya ko zithila kara detA hai| yahI hRbheda ( heart failure ) kahalAtA hai| kArya meM kamI Ane se nizceSTa atiraktatA phuphphusAdika meM aura adhika hone lagatI hai / isa prakAra hama dekhate haiM ki kAraNa kucha bhI ho pariNAma eka hI rahatA hai tathA sAmAnya. nizceSTa adhiraktatA ke sAtha sAtha hRdaya ke visphAra aura pAta kA bhI sahayoga rahatA hai| sirAgata raktasaMvahana do uddezyoM ko sAmane rakha kara hotA hai-eka to yaha ki azuddha rakta ko phuphphusoM meM le jAkara use jArakajanita ( oxygenated ) kara diyA jAve, dUsare yaha ki apacaya ( ketabolic metabolism ) dvArA utpanna viSaile padArthoM ko dUra kara diyA jaave| parantu sAmAnya nizceSTa adhiraktatA (general passive congestion ) ina donoM kAryoM meM bAdhA upasthita karake kozAoM meM ajArakatA (anoxaemia) tathA unake apacayajanya utpAdoM ( catabolites) kA saMgraha kara detA hai| sirAgata rakta ke saMvahana meM cAhe pratyakSa rukAvaTa par3e yA hRdbheda yA hRtpAta ho parantu jo mukhyataH dekhA jAtA hai vaha hai zarIrastha sirAoM aura kezAloM meM rakta kA ekatrita aura sthirIbhUta (stagnatad ) honaa| isa prakaraNa meM Age ke parivartanoM kA mUla kAraNa vAhinIprAcIroM meM jArakAdi poSaNakoM kA For Private and Personal Use Only

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raktaparivahana kI vikRtiyA~ 281 abhAva aura viSaile padArthoM kI vRddhi hai / rakta kA pIDana bhI rAzi kI adhikatA evaM asamarthatA ke kAraNa barAbara bar3hatA jAtA hai| ina sabakA pariNAma mUtravisarjana meM kamI tathA aura bhI uttarottara hone vAle pariNAma jaise tarala kA UtiyoM meM pArayAtana ( transudation of fluid ) lAlakaNoM kA bahirgamana, raktasrAva, apoSaNa, ghanAsrotkarSa tathA mRtyu meM hotA hai| drava ke pArayAtana kA pramukha hetu antaHkezAlIya pIDanotkarSa hotA hai| isakA pariNAma UtiyoM ke zopha ( oedema of the tissues ) meM hotA hai jisase Uti-sthala drava se bhara kara tana jAte haiM / aura zarIra ke lasasyUna (serous sacs) jaise phuphphusacchada ( pleura), parihRcchada ( pericardium ) athavA udaracchada ( peritonium ) meM drava saJcaya hone lagatA hai| rakta ke lAlakaNoM kA bahirgamana (diapedesis of the red blood corpuscles ) mirAgata rakta ke lauTane meM adhika bAdhA par3ane para hotA hai| svayaM lAlakaNa yadyapi amIvA sadRza gati karane meM samartha nahIM hote ataH kezAla prAcIroM kI jAraka kI kamI ke kAraNa jyoM jyoM pravezyatA bar3hatI jAtI hai tyo tyoM ve UtiyoM meM praveza karane meM samartha hote cale jAte haiN| tathA inhIM donoM kAraNoM se vAhiniyA~ atyadhika abhistIrNa ho jAtI haiN| unakI pravezyatA bar3ha jAtI hai| AghAtaprApta antazchadIya kozAoM ke bIca bIca meM vAstavika sthAna chUTA huA dikhane lagatA hai| vahIM se lAlakaNa apanA mArga banAte haiN| nizceSTAtiraktatA meM vAhiniyoM ke phUTa jAne se raktasrAva hotA hai| yaha atyadhika adhiraktatA hone yA sAtha meM upasarga ke kAraNa dekhA jAtA hai| jo vAhiniyA~ nirAdhAra yA alpAdhAra hotI haiM unameM raktasrAva adhika dekhA jAtA hai| yakRddAlyuskarSa ( cirrhosis of the liver ) meM annavahasrotas tathA AmAzaya kI sirAoM meM raktasrAva honA yA dvipatrakIya sannirodhotkarSa (mitral stenosis ) meM phuphphusa se rakta nikalanA isI ke udAharaNa haiM / vAhiniyoM ke cAroM ora yojI Uti meM uttarottara vRddhi hone se honevAlA tantUtkarSa jo niSkriyAtiraktatA kA pariNAma hai aGgavizeSa meM sthita viziSTa ati ( specialised tissue ) ke mandagati se vinaSTa hone kA sUcaka hai| ajArakatA ke kAraNa yaha tantUtkarSa hotA hai| __ ghanAsrotkarSa kA kAraNa kozAoM meM ajArakatA ke kAraNa antazchada kA khuradarApana hai jisameM raktabimbANu Akara cipaka jAte haiN| yaha ghanAsrotkarSa sirAoM yA hRdaya ke alinda pucchoM (vizeSakara dakSiNa bhAga) meM hotA hai| thor3e zabdoM meM hama kaha sakate haiM ki nizceSTAtiraktatA aGga kI jIvanI evaM kAryakara zakti ko naSTa kara detI hai dhAtue~ dhIre dhIre apuSTa hone lagatI haiM yadyapi dekhane meM drava ke pArayAtana tathA raktAdhikya se unakA AkAra pravRddha jAna par3atA hai tathA bhAra meM bhI vRddhi milatI hai| For Private and Personal Use Only

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282 vikRtivijJAna mRtyUttara parIkSA karane para yakRta, plIhA aura phuphphusoM meM sAmAnya adhiraktatA spaSTa dekhI jAtI hai / vRkkoM meM kucha gaharA lAla raMga ho jAtA hai tathA nAlikAoM meM meghasama zotha,alpa snaihika parivartana tathA jIvita rogI ke mUtra meM kucha zvitimUtratA (albuminuria ) evaM rakta ke lAla karNo kI upasthiti evaM nirmokopasthiti ( presence of casts) dekhI jAtI hai / aba hama nIce yakRta, plIhA aura phuphphusa kI nizceSTAtiraktatA kA vicAra karate hai : -- Acharya Shri Kailassagarsuri Gyanmandir 1 yakRt kI nizceSTAtiraktatA -- isakA pramukha kAraNa adharAmahAsirA (inferior vena cava ) kA pazcapIr3ana ( back pressure ) hai jisameM yAkRta sirA apanA rakta pradAna karatI hai / ataH yakRt kI nizceSTAtiraktatA kA prathama pariNAma usakI kendriya ( central ) evaM antarkhaNDIya ( interlobular ) sirAoM meM raktAdhikya tathA unake prAcIroM ke abhistAra meM dekhA jAtA hai / isake kAraNa kezAloM tathA srotasAbhoM meM tanAva ( distension ) hone lagatA hai / pazcapIr3ana ke kAraNa kendriya sirAoM ke cAroM ora kI kozAe~ viSAkta ho jAtI haiM jisake pariNAmasvarUpa unameM pahale snaihika vihAsa ( fatty degeneration ) hotA hai aura phira apuSTi (atrophy ) ho jAtI hai / yaha kriyA kendra se pariNAha ( from centre to peri phery ) calatI hai | ataH eka pravRddha vikSata ko dekhane se jJAta hotA hai ki pahale yakRtkozAoM kA eka naSTa huA kendriya-kaTibandha hai jo upakhaNDoM ( lobules ) ke pariNAha taka pahu~cA rahatA hai pratihAriNI avakAza ( portal spaces ) kA Astara ( lining ) karane vAle kozA prAyaH svastha rahate haiM / yakRt dhAtu meM rakta ke lAlakaNa itastataH bikhare hue milate haiM / madhyabhAga meM bahuta se raGga dravya bhI bana jAte haiM inameM lAlakaNoM se nirmita zoNAyasi ( haemosiderin) mukhya hotI hai / ina saba kAraNoM se upakhaNDoM ke kendriya bhAgoM meM tantUtkarSa kI sambhAvanA adhika pragaTa hotI hai / prArambha meM yakRt cikanA aura bahuta parimANa meM drava evaM rakta ke kAraNa kAphI phUlA huA dikhAI detA hai / use Upara se sparza kiyA jA sakatA hai / kATane se usakI AkRti kati milatI hai / usakA kendra raktasrAva evaM raktAbharaNa ke kAraNa gahare lAlaraMga kA tathA pariNAha snaihika vihAsa ke kAraNa ApIta zveta raMga kA dikhalAI detA hai / kendriya kozA apuSTa ho jAte haiM aura isalie yakRt kI AkRti jAyaphala ( nutmeg ) ke sadRza dekhI jAtI hai / isI ke kAraNa use jAtIphala yakRt ( nutmeg liver ) ke nAma se bolA jAtA hai / Age cala kara yakRt kA AkAra ghaTa jAtA hai usake kozAoM tatkarSa ho jAtA hai jo sikur3a kara dharAtala ko viSama kara detA hai / isI ko. hRdyakRddAlyudara yA zyAva kAThinya ( cardiac cirrhosis or cyanotic induration ) kahate haiM / plIhA kI nizceSTAtiraktatA - plIhA kI AkRti carmakanduka ( krikeTa kI geMda ) For Private and Personal Use Only

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rakta parivahana kI vikRtiyA~ 283 ke samAna ho jAtI hai / yaha gola, phUlI huI, kaThina aura raMga meM gaharI lAla dekhI jAtI hai / aNvIkSa meM dekhane se isameM lAlakarNI kI bahuta adhika bharamAra milatI hai / isakA tantumaya sandhAra ( fibrous stroma ) bar3ha jAtA hai| sAtha hI lasikAbha dhAtu (lymphoid tissue ) kI apuSTi ho jAtI hai / phuphphusoM kI atiraktatA -- isakA dUsarA nAma babhru kAThinya ( brown induration ) bhI hai / yaha bahuta kAla se pracalita raktAbharaNa ke kAraNa hue vizeSa tanAva aura raJjana ke kAraNa utpanna hotA hai / dvidalIya sannirodha kA yaha pramukha pariNAma hai / sabase pahale phauphphusika dhamaniyoM meM atyadhika rakta Ane se ve moTI aura vakra ( tortuous ) ho jAtI haiN| unase Age vAyu koza ( alveoli ) meM rakta bhara jAtA hai jisase vahA~ bRhat kanyaSTisitakozA ( large mononuclear ) tathA babhru varNa kI upasthiti bar3ha jAtI hai / ina kozAoM ko hRdbhedakara kozA ( heart failure cells ) bhI kahate haiM / unakA raMgadravya zoNAyasi ( haemosiderin ) hotA hai / ye kozA raMgadravya ko zvasanikAoM se nikAla kara antarAvakAzika dhAtu ( interstitial tissue ) ke lAbha sidhmoM ( lymphoid patches ) meM ekatra kara dete haiM / isI raMgadravya ke kAraNa sArA yakRt kapiza dikhAI detA hai / ina parivartanoM ke kAraNa antaropakhaNDIya ( inter lobular ) saMyojI Uti kI vRddhi hotI hai tathA vAyu kozAoM kI prAcIra moTI par3a jAtI hai, zvAsanalikAoM kI zlaiSmika kalA gaharI ho jAtI hai aura usakI vAhiniyA~ bhI visphArita ho jAtI haiM / kabhI kabhI ve phaTa bhI jAtI haiM aura raktaSThIvana ( haemoptysis ) kA kAraNa banatI haiN| kabhI kabhI ye parivartana phuphphusa meM RNAstra bana jAne ke pazcAt bhI dekhe jAte haiM / jina sthaloM para phuphphusoM kA varNa babhru ( kapiza ) hotA hai vahA~ ve adhika bhArI, adhika saghana, adhika kaThina ( tough ) aura alpasvanI ( less crepitent ) milate haiM / unake AdhAroM meM adhaHsthAnIya raktAbharaNa ( hypostatic congestion ) milatA hai jo hRdaya kI durbalatA aura pITha ke bala barAbara leTe rahane ke kAraNa hotA hai / AdhAra bhAgoM meM rakta ke ruke rahane se vahA~ ke vAyukoSAoM meM niryAtita tarala bhara jAtA hai aura Uti meM upasarga - zIlatA utpanna ho jAtI hai / isake pariNAma svarUpa adhaH sthita phuphphusapAka (hypostatic pneumonia ) bhI milatA hai / vaha eka halakA prazothIya saghanIbhavana hai jo hRdayAtipAta ke sAtha rogiyoM kI mRtyu kA eka pradhAna kAraNa hai / sthAnika nizceSTa raktAbharaNa ( Local passive congestion ) jaba kisI sthAna se sirAgata rakta kA pravAha avaruddha ho jAtA hai to vahA~ sthAnika raktAbharaNa dekhA jAtA hai / isakA pramukha udAharaNa Antra hai / For Private and Personal Use Only

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284 vikRtivijJAna ___ Antra meM nimna kAraNoM se sirA daba kara sthAnika nizceSTa raktAbharaNa kA kAraNa bana sakatI hai: 1. harniyA ke syUna ( sac ) meM tAntava Uti dvArA sirA kA pIr3ana / 2. koSThAvartana ( volvulous) ke kAraNa Antra meM aiMThana ( twist ) par3a jaanaa| 3. antrAntra praveza (intussusception) meM pIr3anAdhikya (compression) hone se / 4. kisI arbuda yA koSTha (cyst) ke apane akSa para ghUma jAne (twisting of a tumour or cyst) se athavA kisI ghanAstra dvArA sirAmukha banda ho jAne se bhI nizceSTa raktAbharaNa ho sakatA hai| sirA ke avaruddha ho jAne para bhI jaba dhamanI usa aMga ko yathApUrva rakta pradAna karatI rahatI hai to vahA~ kI kezikAoM meM rakta kA pIDana bar3ha jAtA hai para cUMki sthira rakta ne unheM durbala banA diyA rahatA hai, ye kucha cUne lagatI haiM aura phira phaTa jAtI haiN| usa aGga kA raGga gaharA baiMganI lAla (deep purplish red ) ho jAtA hai jo dhAtuoM ke mRta ho jAne para kAlA par3a jAtA hai| kyoMki itane thor3e kAla meM saha pArzvika saMvahana ( collateral circulation ) nahIM ho pAtA / / ___yadi sthAnika raktAbharaNa dhIre dhIre hotA hai to sthAnika zotha, vizeSa kozAoM kA duSpoSaNa tathA viSatA (poisoning ) jArI rahane se aGgakA upasarga ke prati rodha ( resistence ) ghaTa jAtA hai jisase dharAtalIya pradeza meM vidradhi bhI ho jAtI hai| ye avasthAyeM 'TA~goM meM vizeSa kara uttAnA ( saphenous ) sirA meM milatI haiN| isake pariNAmasvarUpa vahA~ utphaulya yA pragaNDatA (varicosity ) dekhI jAtI hai| jo bahuta dera khar3e rahate haiM yA calane kA kArya karate haiM unameM yaha bahuta milatI hai| sabhAra garbhAzaya (gravid uterus ) kA bhAra par3ane se bhI yaha ho jAtI hai| yakR. dAlyutkarSa yA yAkRta tantUtkarSa ke kAraNa antaryAkRta pratihAriNI sirA kI zAkhAoM meM roka hone se plIhA tathA mahAsrota meM bhI raktAbharaNa ho jAtA hai| yaha roka dhIre dhIre hone se pratihAriNI evaM sAMsthAnika sAMghAtika jAlAkRta (portal& systemic anastomotic) sirA mArgoM kA visphAra prArambha ho jAtA hai| yaha visphAra adharAntrikI ( inferior mesentric) evaM guda ( haemorrhoidal ) sirAoM meM vizeSa milatA hai jisase arza vikAra hone kI sambhAvanA rahatI hai| jaba abhistAra ( dilatation) AmAzayika sirAoM meM hote haiM to annapraNAlIya utphulla (oesopbageal varices ) milate haiN| nAbhi ke cAroM ora bhI vakrasUtra ( tortuous bands ) milate haiM / mahAsrota kI sirAoM meM nizceSTa raktAbharaNa hone se AmAzaya kI upazlaiSmika zAkhAe~ phaTa jAtI haiM aura raktavamana ( haemetemesis ) yA Antra meM raktAtIsAra ( melaena ) kara sakatI haiN| udaracchada meM jala bharane se prAyaH jalodara ho jAtA hai ataH sthAnika nizceSTa For Private and Personal Use Only

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punanirmANa 285 raktAbharaNa tathA sAmAnya dazA meM (generalised condition ) kA pariNAma eka sA hotA hai| ___yadi kisI sthAna kA pIr3ana sahasA dUra kara diyA jAve to vahA~ raktAbharaNa hone lagatA hai| kyoMki pIr3ana ke hAsa se vAhiniyoM ke andara ke pIr3ana kA santolaka bAhya pIDana samApta ho jAtA hai ataH unakI prAcIreM phaTa jAtI haiN| jalodarI yA urastoyI kA drava sahasA nikAla dene se jala ke pIr3ana se dabI huI sirAe~ eka dama phUlane ke prayatna meM ati vistIrNa (over distended) ho kara visphoTa (burst) kara jAtI haiN| isI prakAra kucha dera se bhare hue mUtrAzaya ( bladder ) kA sahasA basti praveza (catheterisation ) karane se mUtra meM vizuddha rakta bhI AtA huA dekhA jAtA hai aura mRtyu taka ho jAtI hai| mastiSka ke visaMpIr3ana ( cerebral decompression ) meM bhI yaha bhaya rahatA hai / comso SaSTha adhyAya punarnirmANa ( Repair ) vraNazotha ke varNana meM yathAsthAna hamane vividha utiyoM kA kisa prakAra punarnirmANa hotA hai use spaSTa kara diyA hai parantu yahA~ hama isa viSaya ko vizeSa rUpa se le rahe haiM tAki isakA Avazyaka jJAna eka hI sthAna para mila ske| jIrNa yA vinaSTa huI UtiyoM yA dhAtuoM kI kriyA yathAsambhava punaH prApta kI jAve isa abhiprAya se unakA jo punarjanana hotA hai vaha punarnirmANa yA jIrNoddhAra kahakara pukArA jAtA hai| yaha jIrNoddhAra racanA-sApekSa hotA hai| arthAt yadi prANI ke nirmANa meM paramezvara ne adhika zakti vyaya nahIM kI aura usakI racanA sAdhAraNa rahI to usake aMga-pratyaMga kA jIrNoddhAra ( punarnirmANa) bhI zIghra hI tathA jyoM kA tyoM ho sakatA hai| eka sphIta kRmi ( tape worm ) ke mukha ko choDa kara yadi kATa diyA jAya to punaH 20 phITa lambA sphIta kRmi mukha se taiyAra ho jAtA hai| parantu yadi kisI vyakti kI aMgulI kATa dI jAve to vaha punaH nahIM bntii| aMgulI kI racanA jaTila hai tathA viziSTa hai isa kAraNa isakA jIrNoddhAra usa prakAra kA nahIM hotA jaisA hama cAhate haiM aura aba usa kaTI huI aMgulI ke dvArA hone vAlA kArya bhI pUrNa nahIM ho sktaa| hA~ aMgulI ke kaTe hue dharAtala kA punarnirmANa avazya ho jAtA hai jisase kaTe hue sthala para vraNavastu (scar tissue ) bana jAtI hai| hamAre zarIra meM For Private and Personal Use Only

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286 vikRtivijJAna bhI kucha UtiyoM kI racanA jaTila hai evaM kucha kI sAdhAraNa / jaTila racanA vAlI UtiyoM kA yadi eka bAra nAza ho jAya to phira vaha jyoM kI tyoM punarnirmita nahIM hotIM / sAdhAraNa racanA vAlI UtiyoM meM vikAra hone ke pazcAt unakI punaH racanA dekhI jA sakatI hai / punaH racanA yA jIrNodvAra kA pramukha abhiprAya jo yaha rahatA hai ki jisa Uti ke dvArA jo kArya hotA thA vahIM punaH jArI ho jAya aisA jaTila racanAoM meM apUrNa raha jAtA hai / pUrvasthita Uti jyoM kI tyoM banatI huI isI kAraNa vibhinna avasthAoM meM vibhinna mAtrAoM meM dekhI jAtI hai / jaba kisI Uti meM AghAta pahu~ca jAtA hai to turata hI punarnirmANa kA kArya prArambha hotA huA nahIM dekhA jAtA api tu kucha kAla taka vahA~ koI kriyA nahIM hotI huI dikhAI detI hai / aisA pratIta hotA hai ki yaha samaya punaH racanA kI Avazyaka taiyArI meM vyatIta hotA hai phira tantvi-AtaMca kA vilInIkaraNa, raktAgama aura kozAbhakSaNa kI kriyA sarakta UtiyoM ( vascularised tissues ) meM prArambha hotI hai / kozAoM meM AghAta hone para unake vinaSTa hone ke kAraNa eka prakAra kA padArtha utpanna hotA hai vaisA hI padArtha sitakozAoM se bhI banatA hai / isa padArtha kA guNa vRddhi vardhana (growth stimulation ) hotA hai inheM kairala ke poSaka ( Carrel's trephones ) kahate haiM / inakA kArya sthAnIya kozAoM ko uttejita karake unakA praguNana (proliferation) karanA hotA hai / jaba yaha guptakAla (latent period ) samApta ho jAtA hai to phira punarnirmANa kA kArya paryApta vega ke sAtha cala detA hai yaha vega taba taka calatA rahatA hai jaba taka ki punarnirmANa kA kArya samApta nahIM ho jAtA / isa samAptikAla meM isakI gati phira manda ho jAtI hai| 1 kisI Uti ke punarnirmANa meM kozAoM ke do kArya dekhe jA sakate haiM / eka to yaha ki unakA praguNana ho aura dUsarA yaha ki ve eka sthAna se calakara AghAta sthala taka pahu~ca kara sakriya sahAyatA kareM / kozA praguNana nirmANa meM utanA adhika kArya nahIM karatA jitanA ki kozAgamana karatA hai / hama eka asthibhagna ke rogI ke TUTe hue haDDI ke kinAroM para Aye hue asthiruhoM (osteoblasts ) ko dekha sakate haiM / AghAtagrasta sthaloM meM sitakozAoM kA Agamana aura unake bAda phira protikozAoM ( histiooytes ) kA pahu~canA hameM kozApracalana ( cell migration ) ke mahatva ko siddha kara detA hai / vAtanADiyoM ke punarnirmANa meM akSarambha kA praguNana nahIM ho sakatA kyoMki vaha svayaM eka kozA kA pravardha mAtra hai jo svayaM khaNDita hokara navakozA nirmANa nahIM kara sakatA / jaba ye akSarambha TUTa jAte haiM to phira inakA sammelana karane ke lie unase prarasa ( protoplasm ) nikalatA hai aura prarasa bhI eka gati karatA hai, pracalana karatA hai aura akSarambha ko jor3a detA hai / ataH kozAoM kI gati yA pracalana kA punarnirmANa meM kozApraguNana se bar3hakara mahattva hai rahanA hogA / ise samajhate kozApracalana kA pratyakSa jJAna hama kisI zazaka kI kanInikA ko kisI prakAra For Private and Personal Use Only

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punarnirmANa 287 prakSubdha karake phira dhyAnapUrvaka dekhane se kara sakate haiN| kanInikA eka raktavirahita aMga hai| prakSobha ke kAraNa vahA~ para dhIre dhIre 24 ghaNToM meM samIpastha vAhiniyoM se bahunyaSTi sitakozA AnA prArambha kara dete haiM ve vahA~ eka saptAha taka nivAsa karate haiM vahA~ para sphAya ( oedema) ho jAtA hai jo dhIre dhIre samApta hotA hai| sAtaveM dina samIpastha vAhiniyoM se hI protikozA nikala kara kanInikA kI mUla Uti kA punarnirmANa karane lagate haiN| inake do kArya hote haiM eka to ye kozA ke apadravya (cell debris) ko haTAte haiM dUsare ye svayaM kanInika ruhoM (fibroblasts) meM yA kanInika kozAoM (corneal corpuscles) meM hI pariNata ho jAte haiN| yaha saba kArya kozAoM ke pracalana se huA aisA spaSTa hai| jina prANiyoM meM kanInika zuklIya saMyoja sthala ( corneoscleral junction ) savarNa ( pigmented ) hotA hai vahA~ savarNa kozA gati karate hue dekhe jAte haiN| ye sampUrNa udAharaNa avAhinIya ropaNa ( avas cular healing ) ke diye gaye haiN| avAhinIya ropaNa ke lie kozA pracalana paramAvazyaka hotA hai yaha isase jAna lenA caahie| kisI bhI vraNa ke ropaNa ke lie jahA~ kozApracalana eka pramukha ghaTanA hai vahA~ punarnirmANa meM vaha koI pravizeSa (peculiar ) kriyA ho aisA kadApi na mAnanA cAhie / vaha to bhrUNa vikAsa ( embryonic development ) kA mukhya lakSaNa hai| udAharaNa ke lie jaba adhivRkka granthi kI majaka kA nirmANa hotA hai usa samaya pragaNDa zikhara (ganglionic crest ) se kozAoM kA pracalana hotA huA dekhA jAtA hai| isI prakAra prajanana granthi (gonad ) ke nirmANa meM AdyarohikozAoM (primordial germ cells) kA pracalana hotA hai| isa sabase yaha patA lagatA hai ki pracalana ko yaha zakti una abhinava utiyoM meM pAI jAtI hai jo pUrNataH bhinnita ( differentiated ) nahIM ho skii| yahI lakSaNa una kozAoM ke bhI hote haiM jo punarnirmANa meM bhAga lete haiN| kozAoM kI pracalanAvasthA samApta hone ke pazcAt kozAoM ke bhinnana (differentiation of cell type ) kA kArya pUrNa honA prArambha hotA hai| kisa sthAna para kauna kozA cipakA hai aura aba use kyA karanA hai usake anusAra usakA bhinnana hotA hai / aba usakA pracalana samApta ho jAtA hai| aba hama punarnirmANa ke sambandha meM kucha vizeSa zabdoM ke antargata varNana kreNge| prathama ropaNa ( healing by first intention ) tvacA yA upatvacA kI UtiyoM ke sAmAnya apUyika pATana (incision) kA ropaNa prathama ropaNa kahalAtA hai| jaise kisI vyakti ko akasmAt nayA bleDa laga jAve to usake kAraNa jo vraNa utpanna hogA vaha apUyika hogA aura usake ropaNa kA prakAra prathama ropaNa mAnA jAtA hai| jyoM hI kisI sthAna para kucha lagA ki turata vahAM kI vAhiniyA~ saMkucita ho jAtI haiM usake pazcAt ve visphArita hotI haiM aura vahA~ se rakta strAva hone lagatA hai| vraNa meM rakta jAkara AtaMca ( clot) nirmANa kara detA hai| yaha AtaMca vraNa ke andara kI UtiyoM For Private and Personal Use Only

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288. vikRtivijJAna kI bAhya vAtAvaraNa se rakSA karatA hai tathA vraNa ke donoM oSThoM ko jor3e rahatA hai| pATana ke kAraNa tvacA ke bahuta se kozA kaTa jAte haiM aura bhItara ke bahuta se anya UtiyoM ke kozA kSatigrasta ho jAte haiM aura ve naSTa ho jAte haiN| kozAoM kI mRtyu ke kAraNa usa sthAna para halakI sI vraNazothAtmaka pratikriyA cala par3atI hai tathA AghAtaprApta Uti meM bhakSakAyANUtkarSa (phagocytosis) hone lagatA hai jo vahA~ sthita tantvi aura apadravya ko khatama kara detA hai| yaha kriyA pATana ke pazcAt gupta kAla meM Agata sitakozAoM ke dvArA sampanna hotI hai| jaba unakI sacala ( motile ) bhakSa kAyANukIya avasthA samApta ho jAtI hai taba kucha protikozA unameM se bhinnita hokara tanturahoM ( fibroblasts ) meM pariNata ho jAte haiN| ye tanturuha aNDAkAra nyaSTiyoM se yukta sigAra ke AkAra ke hote haiN| raMge jAne para unakI nyaSTiyoM para khUba raMga car3hatA hai| ina tanturUhoM kA prarasa apUrNa bhinita hokara vayaska tantukozA ke tantuka pravardha (fibrillar process of an adult fibrocyte ) kA rUpa dhAraNa kara letA hai| vraNoM ke oSThoM para sthita saMyojI Uti ke kucha kozAoM meM praguNana bhI hotA hai para vaha bahuta km| samIpastha raktavAhiniyoM se vraNa ke cAroM ora se navIna kezikAe~ (kezAla)nikala par3atI haiN| ve antazchadIya kozAoM ke vibhajana se banatI haiM aura carma ke samAnAntara daNDasama ( rod-like ) rahatI haiN| ye kezAla vraNa ko bhara lete haiM aura eka vAhinIya jAla kI racanA karate haiM jo tanturuhika UtiyoM kA poSaNa karatA hai| dhIre dhIre vraNa ke donoM oSTha isa navIna vAhinImat tAntava Uti ke dvArA eka dUsare se bA~dha diye jAte haiM tathA vraNa kA dharAtala tvacA ke adhicchada se bhara jAtA hai jo kinAroM se pracalana karake jAtA hai| naidAnika dRSTi se itanA hone kA artha vraNa kA ropaNa hai| isa samaya vraNa lAla varNa kA tvacA se thor3A uThA huA hotA hai| ise suzrutokta rohata vraNa samajhanA cAhiekapotavarNapratimA yasyAntAH kledavarjitAH / sthirAzcipiTikAvanto rohatIti tamAdizet / / Age calakara tanturuha tantukozAoM meM pariNata ho jAte haiM unakA prarasa bhinnita hokara aneka tantuka banA detA hai aura zleSajana ( collagen) vahA~ utpanna ho jAtI hai unakI nyaSTiyA~ lambI tathA patalI ho jAtI haiM unake tantuka dUsare tantukoM meM antarvayana (interlace ) karate haiM jisake kAraNa eka namata jAla ( felted net work ) bana jAtA hai| phira ve tantuka dhIre dhIre kaI saptAhoM meM saMkucita honA prArambha karate haiN| saMkoca ke kAraNa samIpastha vAhiniyA~ bhI daba jAtI haiM jisase unakI raktapUrti bhI kama ho jAtI hai aura unameM utanI lAlI nahIM rahatI balki unakA varNa pANDura zveta ho jAtA hai aura anta meM tvacA se kucha nIcI sataha vAlI vraNavastu vahA~ bana jAtI hai / ise hama samyagUDhAvasthA kahate haiM rUDhavAnamagranthimazUnamarujaM vraNam / tvaksavarNa samatalaM samyagUDhaM vinirdizet // yahA~ sUjana rahita, zUlarahita, tvacA ke varNa vAle samatala vAle bhare hue vraNa ko For Private and Personal Use Only

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naU pRSTha 289 Acharya Shri Kailassagarsuri Gyanmandir isa citra meM navIna vAhinya kuDmala tathA tanturUhoM se nirmita kaNana Uti dikhalAI de rahI hai| sAtha hI sAtha aneka vraNazothakArI kozA bhI prakaTa ho rahe haiM / For Private and Personal Use Only

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punarnirmANa 286 samyagUDha kahA | prathama ropaNa se yahI avasthA AnI cAhie aisA AyurvedajJoM kA mata hai usameM vaksavarNa na kahakara pANDura zvetavarNa kaha denA samatala na batalAkara tvacA tala se kucha nIce le jAnA jo antara diyA hai use bhI dhyAna meM rakhanA Avazyaka hai / prathama ropaNa ke lie vraNa kA jIvANu virahita rahanA aura vraNoSThoM kA samIpastha honA Avazyaka hai | kaNana dvArA ropaNa ( Healing by granulation ) - jaba atyadhika Uti kA nAza ho jAtA hai aura vraNoSThoM kA samIpa honA kaThina ho jAtA hai taba vraNa ke tala se ropaNa kA kArya prArambha hotA hai / ropaNa kI isa paddhati kA nAma kaNana dvArA ropaNa yA rohaNa Uti ( granulation tissue ) dvArA ropaNa hai / jina vraNoM kA kaNana Uti yA rohaNa Uti dvArA ropaNa hotA hai unameM AghAta ke kaI kAraNa dekhe jAte haiM unameM AghAta, dagdha, aupasargika vraNana tathA upasarga jinakA anya kAraNoM se sambandha hote haiM mukhya haiM / yaha smaraNa rakhanA atyanta Avazyaka hai ki jisa vraNa meM upasarga kI pahu~ca ho gaI ho vaha kadApi prathama ropaNa dvArA siddha nahIM hotA, apitu, vahA~ kaNana Uti ke nirmANa dvArA hI ropaNa hotA hai / jo vraNa dharAtalIya hote haiM unameM kaNana Uti ke dvArA hone vAle ropaNa kA darzana kiyA jA sakatA hai / parantu gahare vraNoM meM isa kriyA kA avalokana nahIM kiyA. jA sakatA / 'kaNana' isa nAma kA kAraNa yaha hai ki dharAtalIya vraNoM meM jo nava Uti nirmita hotI hai vaha kucha khuradarI hotI hai aura usameM choTe choTe aMkura utpanna ho jAte haiM jinheM kaNa ( granule ) kahA jA sakatA hai / rohaNa Uti yaha AyurvedIya dRSTi se nAmakaraNa hai / jina vraNoM meM atyadhika UtinAza ho jAtA hai vahA~ bahuta adhika apadravya ekatra ho jAtA hai, rakta ke AtaMca, mRta UtiyA~ tathA upasarga evaM aupasargika srAva milate haiM / sarva prathama vraNa meM vraNazothAtmaka pratikriyA prArambha hotI hai jisake sAtha meM sitako zAoM tathA protikozAoM kA pracalana ( migration ) prArambha ho jAtA hai / ropaNI kriyA sampUrNa vraNa ke dharAtala para eka sAtha cala par3atI hai jisakA pramANa tanturUhoM kI utpatti ( ye tanturuha protikozAoM - histiocytes se utpanna hote haiM ) tathA kezAla antazchada kI pravRddhi hai jisake dvArA vAhinyakuDmala ( vascular bud ) kA nirmANa hotA hai / ye navIna kezAla prathama ropaNa kI taraha dUsarI ora ke kezAloM se milane nahIM pAte kyoMki vraNa ke bIca kA avakAza adhika hotA hai isa kAraNa ve eka dUsare se antarmela yA jAlakriyA ( anastomosis ) ke pAza ( loops ) utpanna karate haiM / ina pAzoM ke kAraNa aneka vAhinya toraNa ( vascular arches ) bana jAte haiM jinake Upara tanturUhoM kA kaJcuka car3ha jAtA hai / ina pAzoM ke Age nikale hue bhAgoM ko dekhakara aisA lagatA hai ki mAno ropita tala para kaNa bikhare hue hoM / yadi ina kaNoM ko thor3A sA bhI AghAta laga jAya to atyadhika raktasrAva hone lagatA hai / isI kAraNa jaba kisI aise vraNa meM DAlI gaI paTTI cipaka 25, 26 vi0 For Private and Personal Use Only

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260 vikRtivijJAna jAtI hai aura use binA sAvadhAnI pUrvaka bhigoye jaldI meM chur3A diyA jAtA hai to aisA raktasrAva hotA huA dekhA jAtA hai / kaNana yA rohaNa Uti kA varNa sadaiva gaharA lAla hotA hai aura usameM raktAsrAvI pravRtti dekhI jAtI hai / pAtA cAhe tvacA tanturUhoM aura raktavAhiniyoM ke bIca meM vraNazodhakArI kozA bhare rahate haiM jinameM bahunyaSTi, ekanyaSTi, lasIkozA aura prarasakozA sabhI milate haiM / ina vraNazothAtmaka kozAoM kA mukhya kArya vraNa se upasarga ko dUra karanA hai / dUsarA inakA kArya apadravya ko harAnA hai / kaNana Uti upasarga ke pratirodha karane meM bahuta bhAga letI hai isI kAraNa isake nIce kI UtiyA~ usake Upara ke bhAga meM sthita upasarga se bacI rahatI haiN| yaha eka prakAra se rakSaka rodha ( protective barrier ) kA kArya karatI hai / yahI kAraNa hai ki yadi eka vraNa kaNana Uti se bhara jAve to phira rogI rogANuoM se bhI baca jAtA hai aura rogANuoM ke viSoM kA pracUSaNa bhI nahIM ho meM vraNa ropita na ho pAyA ho / isake aneka pramANa haiM / yadi kisI ghAva meM jaba taka ki kaNana Uti na bana pAI ho dhanustambhakArI viSa kA praveza kiyA jAve to prANI zIghra hI dhanustambha ke cakkara meM A jAtA hai para yadi vahA~ kaNana Uti kA nirmANa ho gayA hai aura taba dhanustambhakArI viSa kA lepa kiyA gayA hai to phira dhanustambha honA paryApta kaThina ho jAtA hai| dUsarA udAharaNa grIna ne paTa lepa kA diyA hai / kisI vraNa para jaba paTa lepa ( plaster ) lagA diyA jAve to sampUrNa durgandhapUrNa pUyAdi ko vaha sokhakara apane meM le letA hai| aba dhIre dhIre kaNana Uti bananI prArambha hotI hai aura paTa lepa kitanA hI durgandhita kyoM na ho usakA vraNa para koI prabhAva nahIM par3atA tathA dhIre dhIre vaha pUrNataH ropita ho jAtA hai / ki vahA~ nitya prati aneka Adhunika yuddha ne hameM eka aspatAloM kI prAcIna I hama prAyaH sAdhAraNa koTi ke aspatAloM meM dekhate haiM kaSTa dekara rogiyoM ke vraNoM kA svacchana kiyA jAtA hai / zikSA yaha dI hai ki vraNa ko ThIka karane kA sarvottama upAya paddhati nahIM hai | balki yadi vraNayukta aMga ko pUrNa vizrAma diyA jAya aura eka bAra vraNa ko svaccha karake chor3a diyA jAve to vaha atizIghra ThIka ho jAtA hai / mAilsa Adi vidvAnoM kA bhI yaha mata hai ki punaH punaH vraNa svacchana yadi pUrNa zuddhatApUrvaka na kiyA gayA to punaH punaH vraNa ko upasargAnvita kara detA hai / para hama isa mata ko amAnya karate haiN| kyoMki yadi vraNa meM svastha kaNana Uti utpanna ho cukI hai to koI kAraNa nahIM ki usake svacchana se punaH vraNa meM upasarga praveza kara jAve / yadi svacchana kArya karate samaya isa kaNana Uti para AghAta ho gayA to yaha nitAnta sambhava hai ki punarupasarga ho jAya anyathA yaha nahIM ho sakatA / para eka bAta mahattva kI yaha hai ki vraNazodhana ke lie jo rAsAnika dravya prayukta hote haiM unameM prAMgavikAmla ( carbolic acid ), pAradika nIreya ( perchloride of mercury ) Adi bahuta prakSobhaka hote haiM aura inakA vraNa dvArA pracUSaNa bahuta sambhava hai / jisake kAraNa navIna kozA For Private and Personal Use Only

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punarnirmANa 261 kSatigrasta ho sakate haiM ataH jaba vraNa meM kaNana uti kA nirmANa ho jAve to phira ina prakSobhaka padArthoM ke prayoga kI koI AvazyakatA pratIta nahIM hotii| ___ sampUrNa vraNa meM kaNana Uti bhara jAne ke uparAnta jo kArya Age hotA hai vaha hai tanturahoM kI tantu kozAoM ( fibrocytes ) meM pariNati / sabase pahale jo stara banatA hai usake tanturUhoM kA tantukozA meM pariNamana hotA hai| usake pazcAt dUsare, tIsare, cauthe staroM meM vahI kriyA hotI hai / tathA dUsarA kArya zleSajana (collagen ) tantukoM kI sthApanA kA honA hai| yaha zleSajana kyA hai ? yaha tAntava Uti kozAoM se nikalA huA eka probhUjinIya padArtha hai jo rUkSa kAcara tantukoM ( coarse hyaline fibrils ) ke sadRza dekha par3atA hai| jAlakAntazchadIya saMsthAna ke kucha kozAoM se niHsRta hone vAlI jAlakI ( reticulin ) ke saMghanana aura jaraThatA ke kAraNa bhI zleSajana bana jAyA karatA hai| zleSajana eka antaHkozIya padArtha hotA hai jisake nirmANa ke lie jIvati gakA nirantara pahu~canA atyAvazyaka hai / yadi kisI prANI kA ghAva nahIM bharatA hai to sambhava hai ki use paryApta mAtrA meM jIvati ga na dI gaI ho yA usake zarIra meM vaha upasthita na ho / jIvati ga (vitamin C) virahita vraNa meM zleSajana ke na banane kA pramANa yaha hai ki vraNa meM tantUtkarSa apUrNa raha jAtA hai vraNavastu ( scar tissue ) mRdula aura kozIya rahatI hai jisake kAraNa usakI dRDhatA meM kamI A jAtI hai| jaba tanturuha kA tantukozAoM meM pariNamana. hotA rahatA hai aura zleSajana kA nirmANa nirantara jArI rahatA hai tabhI adhicchada (epithelium ) bhI andara kI ora bar3hatA rahatA hai| isake kAraNa vraNa kI cauDAI ghaTa jAtI hai aura gaharAI bhI kama hone lagatI hai| isa prakAra, kaNanaUti tAntavaUti meM dhIre dhIre badalane lagatI hai / jaba tAntava Uti meM saMkocana ( contraction ) prArambha hotA hai to sampUrNa vAhiniyA~ daba jAtI haiM aura rakta kI usasthAna kI pUrti meM kamI A jAtI hai| bar3I bar3I dhamaniyoM meM abhilopI antardhamanIpAka (obliterative endarteritis) ho jAne se vAhinI mukha zanaiH zanaiH banda ho jAte haiN| yaha antardhamanIpAka vaikArika kriyA na hokara prAkRtika aisI kriyA hai jisake dvArA kisI eka sthAna kI rakta pUrti ko zarIra kama karatA hai| isa kriyA kA pariNAma hotA hai tAntavaUti kA avAhinya hokara pANDura varNa kA ho jAnA aura tvacA se kucha nIcI vraNavastu kA bnnaa| jo adhicchada usa vraNa vastu ( scar ) ko AvRta karatA hai vaha bhI pUrNa ho jAtA hai parantu yaha svAbhAvika svacA ke varNa se kucha bhinna hotA hai| yaha kucha patalA bhI hotA hai aura nyadhicarma ( malpighian layer ) bhI alpanirmita hotA hai| nicarma ( dermis ) meM sveda granthiyA~ aura keza kUpikAoM ( hair follicles) kA punarjanana na hone se na to vahA~ se sveda srAva hI hotA hai aura na bAla hI ugate haiN| isI kAraNa Ayurveda meM romotpAdana aura savarNIkaraNa karane kI kucha viziSTa paddhatiyA~ kahI gaI haiN| samaGgIkaraNa dvArA ropaNa-gaharI UtiyoM meM sthita vikSatoM ke ropaNa meM samaGgI For Private and Personal Use Only

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262 vakRtivijJAna karaNa ( organisation ) kI kriyA calatI hai| lasAbhasyUnoM meM jahA~ tantvimatsrAva hote haiM, kisI aMga meM sthita RNAstra, evaM kisI vAhinI meM sthita ghanAsra ina saba meM bhI ropaNa kA prakAra samaGgIkaraNa dvArA hI sampanna hotA hai / samagIkaraNa kI kriyA meM Uti kozAoM kA praguNana tathA apadravya kA apaharaNa ye do kriyAe~-jo ropaNa meM sarvatra prayukta hotI haiM-hI dekhI jAtI haiM / sarva prathama kozAoM kI mRtyu ke kAraNa vikSata Uti meM prakSobha hone lagatA hai prakSobha vraNazotha ko Amantrita karatA hai| malabA (apadravya) ke haraNArtha vahA~ para AtmapAcana aura bhakSikozotkarSa nAmaka kriyAe~ cala par3atI haiN| jisa prakAra anyatra vraNazothAtmaka pratikriyAe~ hotI haiM ThIka vaisI hI yahA~ bhI dekhI jAtI haiN| bhatikozA bhI usI prakAra ke hote haiN| jisa prakAra anyatra nava vAhinya kuDamala dRSTigocara hote haiM yahA~ bhI dekhe jAte haiN| yahA~ bhI tanturuha bana kara zleSajanIya tAntava Uti meM pariNata hote aura vraNavastu banatI hai| ___ tantvimat srAva jina lasAbha utiyoM meM hotA hai vahA~ antazchada se hI kaNana yA rohaNa Uti bananA prArambha kara detI hai tathA bhakSikozA tantvi ko uThA kara le jAte haiN| usake pazcAt usa sampUrNa kSetra meM antazchada ( endothelium ) utpanna ho jAtA hai jaise ki tvacA kisI dharAtalIya vraNa ke Upara uga AtI hai / parantu adhikatara to syUna ( sac ) ke prAcIrastara aura antasthastara ( parietal & visceral layer ) kSatigrasta ho jAte haiM jisake kAraNa donoM staroM para kaNana ati bananA prArambha kara detI hai jo Age calakara eka jagaha mila jAtI hai aura abhilAga ( adhesion ) utpanna kara detI hai| ye abhilAga zanaiH zanaiH tAntava bana jAte haiM jisase sthAyI ho jAte haiN| sandhiyoM meM hama bahudhA dekhate haiM ki aise hI sthAyI abhilAgoM ke kAraNa unakI gatiyA~ ruka jAtI haiM aura ve tAntava gatisthairya (fibrous ankylosis ) ke kAraNa apane svAbhAvika kArya karane meM asamartha ho jAte haiN| jaba yahI parihRt (pericardium) meM hotA hai to vahA~ saMsakta parihRtpAka ( adherent pericarditis ) dekhane ko milatI hai| phuphphusacchada (pleura) ke donoM staroM meM tAntava paTTa ( fibrous bands ) mRtyUttara parIkSAoM meM isI kAraNa pragaTa hote haiM / udaracchada meM jaba ye abhilAga bana jAte haiM to Antra ke aneka pAza ( loops ) saMkucita ho jAte haiM yA unakA kaNTha pAzana ( strangulation ) ho jAtA hai| __ vAhiniyoM meM jahA~ dhanAsa bana jAte haiM samaGgIkaraNa kI kriyA viziSTa prakAra se sampanna hotI hai| yadi ghanAstra ne vAhinI kA sampUrNa mukha AvRta kara liyA ho aura rakta ke AvAgamana meM bAdhA par3a rahI ho to isa kriyA dvArA ghanAsra ( thrombus ) ke bIca se eka navIna suraGga kA nirmANa hone lagatA hai ise punaHsuraMgIkaraNa (recanalisation ) kahate haiN| isa vidhi se vAhinI kA mukha avazya saMkucita ho jAtA hai parantu rakta ke AvAgamana meM bAdhA koI nahIM par3a paatii| jaba vAhinI meM yA hRdaya ke alindAdi meM yaha ghanAsra bana jAtA hai aura aisA banatA hai ki rakta saMvahana kriyA yathApUrva calatI rahe to usake Upara antazchada AvRta ho jAtA hai| kahIM kahIM For Private and Personal Use Only

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punarnirmANa 263 eka hI ghanAsra meM se kaI kaI suraMgeM banatI huI dekhI jAtI haiN| kahIM kahIM jahA~ yaha suraMgIkaraNa kI kriyA nahIM dekhI jAtI hai vahA~ para vAhinI kA mukha pUrNataH banda ho jAtA hai aura vaha vAhinI eka tAntava raju bana jAtI hai| ati praphullita sirAoM ( varicose veins ) meM antaHkSepaNa ( injection ) ke dvArA prakSobhaka padArtha pahu~cAyA jAtA hai tAki vahA~ eka ghanAstra bana jAve aura sirA ko tAntavaraju meM pariNata kara de| hRtkRpAToM ( valves of the heart)meM vraNazotha hone para unameM bhI samaGgIkaraNa kI kriyA hotI hai aura vahA~ tAntava Uti banatI hai jisake saMkoca karane se usakA svarUpa vikRta ho jAtA hai aura kapATa pallava ( valve flaps ) saMyukta ho jAne se yA to dvAra atyadhika saMkucita ho jAtA hai jise saMnirodhotkarSa ( stenosis ) kahate haiM yA vaha cauDa jAtA hai jise akAryakaratA (incompetense ) kahA jAtA hai| punarjanana dvArA ropaNa-punarjanana kA artha hai punarutpatti / jo uti eka bAra kSatigrasta ho cukI hai usakI punarutpatti ko punarjanana ( regeneration ) kahA jAtA hai| para kyA saba zArIrika Uti aura dhAtue~ punarutpanna kI jA sakatI haiM ? isa prazna kA uttara yaha hai ki nahIM / kevala ve UtiyA~ jo vardhana (growth ) meM lagI rahatI haiM unakI punarutpatti ho sakatI hai para jo kArya meM lagI rahatI haiM ve bahuta kama punarutpanna hotI haiN| manuSya aura striyoM meM rakta ke kozAoM kI punarutpatti dekhI jAtI hai tathA striyoM ke garbhAzayAntazchada (endometrium ) kA pratimAsa punarjanana hotA hai| rakta aura garbhAzaya kI antazchada vRddhi meM mahattvapUrNa bhAga lete haiM ataH prakRti ne inakA punarjanana samaya samaya para karanA Avazyaka samajhA hai| racanA kI dRSTi se kSudra prANiyoM meM punarjanana kI DaTa kara kriyA hotI hai| sphIta kRmi ke muNDa se 20 phITa lambA kRmi taiyAra honA isakA udAharaNa hai| uccavargIya prANiyoM meM punarjanana bahuta kama hotA hai / kucha aMgoM meM jahA~ punarjanana nahIM hotA tAntava Uti kA nirmANa hotA hai| yaha ati usa aMga kI kriyA ko sampanna karane meM asamartha hotI hai kyoMki yaha to eka sthAnapUrikA Uti hai| isakA pariNAma yaha hotA hai ki aMga kI kAryakara zakti kama ho jAtI hai| ___ atyanta viziSTa ( highly specialised ) UtiyoM meM punarjanana na hokara tantUskarSa hI hotA hai| jo uti atyanta bhinnita (differentiated ) ho jAtI haiM unameM tantUtkarSa hI dekhA jAtA hai| para jo uti bhrauNa ( embryonic ) hotI haiM aura jinakA bhinnana alpa hotA hai unameM punarjanana ho jAtA hai| rakta aura garbhAzayAntazchada ko chor3a jina UtiyoM meM punarjanana milatA hai unameM pUrNataH pUrva kriyAzakti lauTa AtI ho yaha sambhava nahIM hai| punarjanana arthAt rassI meM gAMTha / rassI meM gAMTha lagane para usase kArya to ho sakatA hai para ekasUtratA nahIM raha paatii| kriyA zakti kucha na kucha ghaTa jAtI For Private and Personal Use Only

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264 vikRtivijJAna hai| kahIM kahIM punarjanana ke samaya UtivizeSa thor3I sI aura thor3I tAntava Uti ye donoM banane lagatI haiM vaha bhI pUrva kriyAzakti ko kama karatI haiN| ___ zarIra kI vibhinna UtiyoM kA vicAra karane para hama yakRt kI ora dhyAna deM to jJAta hogA ki isakA viziSTa kArya hone para bhI isameM punarjanana kI adbhuta zakti vyApta hai| higginsa aura eNDarasana ne kucha mUSakoM ke yakRt kA 70 pratizata bhAga kATa kara pheMka diyA para pandraha dina ke bAda unhoMne dekhA ki yakRt kA punarjanana ho gayA hai aura usane apanI pUrvAkRti prApta kara lI hai| manuSya meM bhI yakRt ke viziSTa kozAoM meM punarjanana dekhA jAtA hai| yadi kSati yA AghAta thor3A huA taba to yakRt ke viziSTa kozA jyoM ke tyoM punarutpanna ho jAte haiM jaisA ki yakRt kI Uti ke nAbhya nAza ( focal necrosis) meM dekhA jAtA hai| para yadi adhika bhAga kSatigrasta huA jaisA ki tIvra vaiSika yakRtpAka ( acute toxic hepatitis) meM dekhane ko milatA hai to vahA~ tantUtkarSa dekhA jAtA hai yadyapi bIca-bIca meM svastha yakRtakozApuMjoM ke dvIpa itastataH mila jAte haiM / vAtanAr3iyA~ parama viziSTa prakAra ke kozAoM se banI hone ke kAraNa unameM punarjanana hotA nahIM parantu yadi vAtakozA kA akSarambha bhagna ho jAve aura zeSa bhAga jyoM kA tyoM rahe to usakA punarjanana ho jAtA hai| adhicchadIya racanAoM meM tvacA meM punarjanana kI aparimita zakti hai utanI zleSmalakalAoM meM nahIM hai| saMyojI UtiyoM meM tAntavasaMyojI Uti, asthi, taruNAsthi (kAsthi ), raktavAhiniyA~ tathA kendriya vAtanADI saMsthAna kI vAtazleSa nAmaka Uti meM punarjanana kI paryApta zakti pAI jAtI hai| peziyA~ anaicchika hoM yA aicchika kaThinatApUrvaka punarutpanna hotI haiN| praNAlIvihIna granthiyoM meM kevala avaTukAgranthi ko chor3akara jisameM paryApta paramacaya dekhA jAtA hai anyoM meM punarjanana nahIM dekhA jAtA / antarvartI ( transitional ) tathA zalkIya (squamous) adhicchadoM kI punarutpatti saralatApUrvaka ho jAtI hai isI kAraNa vRkkoM ke nAlikIya adhicchada kA punarjanana sukhapUrvaka hotA huA dekhane ko milatA hai| yaha sadaiva smaraNa rakhanA hogA ki punarjanana ke lie atyanta Avazyaka padArtha rakta hai| yadi kSatigrasta aGga kI raktapUrti ThIka ThIka hotI rahegI to usa Uti kA svAbhAvika svarUpa bana sakegA para yadi rakta kI kamI hogI to kheta meM gehUM na uga kara ghAsa ugegI arthAt tAntava Uti bnegii| yahI kAraNa hai ki choTI choTI kSatiyoM meM Uti kA punarjanana ThIka ThIka hotA hai para bar3e AghAtoM meM rakta kI ThIka ThIka pUrti na hone se tantUtkarSa dekhA jAtA hai| upazamana dvArA ropaNa-yaha ropaNa kA vaha prakAra hai jisameM kSatigrasta aGga kI svAbhAvika kriyAzakti yathApUrva banI rahatI hai| yaha tabhI hotA hai jaba Uti meM atyalpa kSati ho / upazamana ( resolution ) kA sarvottama udAharaNa phuphphusa golANvika zvasanaka ( pneumococcal pneumonia) hai| isa roga meM phuphphusa kA eka yA ekAdhika khaNDa vAyukoSoM meM srAvoM ke AtaJcana se jama kara eka saghana piNDa For Private and Personal Use Only

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punarnirmANa 265 bana jAtA hai| vraNazotha khUba dekhA jAtA hai aura vikSata bahuta bar3A dikhAI detA hai para jaba vaha sitakozA ekanyaSTikozA aura probhUjinAMzIya kiNva apanA kArya karake sampUrNa AtaJcita padArtha kA AtmapAcana aura bhakSaNa kara lete haiM to phuphphusa ke sabhI vAyukoSa khula jAte haiM aura phuphphusa kI svAbhAvika kriyA punaH cala par3atI hai| upazama kA eka udAharaNa gaGgA kI bAr3ha ke samaya ghAToM kI sthiti se de sakate haiN| jaba bAr3ha AtI hai to ghAToM ke kinAre ke saba koThe koThariyA~ pAnI aura bAlU se bhara jAte haiN| para jaba bAr3ha utara jAtI hai to jyoM ke tyoM bane hue dekhe jAte haiN| phuphphusoM meM zvasanaka hone ke kAraNa roga ke lakSaNa kitane hI ugra dikhalAI deM parantu phuphphusa kI ati meM vikSata banate nahIM yA bahuta kama banate haiN| isa kAraNa yahA~ upazama ke dvArA ropaNa kriyA sampanna hotI hai| yadi kisI kAraNa se AtaJcapAcana kA kArya karane vAle kozA aura kiNva apanA kArya na kareM to vahA~ yaha sambhava nahIM ki ropaNa upazamana dvArA ho| usa avasthA meM vahA~ tantulkarSa ho sakatA hai vraNavastu bana sakatI hai aura phuphphusa kI svAbhAvika kriyAzakti meM kamI A sakatI hai| anya atyuma jIvANuoM dvArA utpanna zvasanaka meM upazama kriyA na hokara tantUtkarSa dekhA jAtA hai| phuphphusa golANvika zvasanaka meM bhI jaba sitakozIya bharamAra nahIM ho pAtI aura srAva Adi ko vahA~ se haTAyA nahIM jAtA to vahA~ upazamAsiddhi ( failure of resolution ) ho jAtI hai| jisake kAraNa tantvimat srAva kA samaGgIkaraNa ho jAtA hai jisake pazcAt tantUtkarSa evaM vraNavastu nirmANa kArya calatA hai| ropaNaM kI kriyA ke sambandha meM kaI zabdoM kA vyavahAra huA hai| para ina saba ke vyavahRta hone para bhI ropaNa kI mukhya kriyA do hI prakAra se sampanna hotI huI dikhAI detI hai| eka prakAra to yaha hai ki kSatigrasta Uti apane svAbhAvika rUpa meM utpanna ho jAya ise viziSTa kozAoM kA praguNita punarjanana kaha sakate haiN| tathA dUsarA prakAra yaha hai ki kSatigrasta Uti kA sthAna tAntava ati le le| ise tantUtkarSa kahA jAtA hai| asthiropaNa ___ yadyapi hamane Upara kaI prakAra se ropaNa kA varNana kiyA hai parantu ropaNa jo mRdula utiyoM meM hotA hai tathA jo kaThina utiyoM meM dekhA jAtA hai ina donoM meM bahuta bar3A antara hai| yadyapi kriyA donoM meM eka hI siddhAnta kA anusaraNa karatI hai parantu yahA~ cUrNIyana ( calcification ) kI eka viziSTa kriyA hotI hai jise spaSTa karanA paramAvazyaka hai| ___ jaba koI asthibhagna ho jAtA hai to hama vahA~ yaha dekhate haiM ki haDDI ke hI Upara car3hI paryastha (periosteum ) kSata-vikSata ho jAtI hai / kahIM to vaha haDDI se bilkula ukhar3a jAtI hai, kahIM TUTe bhAga ke Age bhI usakA kucha bhAga lagA rahatA hai, kahIM vaha kaTa jAtI hai aura kahIM vaha TUTa jAtI hai| TUTe hue bhAga ke bIca kI raktavAhiniyA~ TUTa-phUTa jAtI haiN| donoM ke bIca meM rakta ke AtaJca bana jAte haiN| yadi For Private and Personal Use Only

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266 vikRtivijJAna asthibhagna pUrNa ( complete ) huA hai to asthiyoM para saMlagna peziyA~ unake Tukar3oM ko Ter3hA sIdhA kara detI haiM jisake kAraNa ve kabhI tvacA ke bAhara dikhate haiM aura kabhI bhItara hI viSama sthitiyoM meM sthita ho jAte haiN| yadi samIpa meM koI marmasthala ( vital part ) huA to use bhI kSatigrasta karake kaI prakAra kI hAniyA~ kara dete haiN| asthibhagna hone ke pazcAt sarvaprathama ropaNa kA kArya vizeSa prakAra kI kaNana yA rohaNa ati ke dvArA prArambha hotA hai jisameM vAhinya evaM tanturuhIya praguNana to jaisA anyatra hotA hai vaisA hI calatA rahatA hai parantu asthi antarastha ( endosteum ) bhAga se tathA paryastha (periosteum ) ke andara se asthiruh ( osteoblasts ) kA pracalana hone lagatA hai| ye sabhI atyadhika praguNana (pro. liferation ) karate haiM aura eka arbudAkArI mRdu acUrNIyita asthyAbha Uti kA eka puMja bana jAtA hai isameM sthAna sthAna para daNDikAe~ ( trabecube ) vinyasta rahatI haiN| isa puJja meM antavya ( matrix ) saghana ( dense ) tathA kAcara (hyaline ) hotA hai| isI antavya meM vAhiniyoM ke cAroM ora asthiruhoM kA aDDA jamatA hai aura ve prArambhika nikulyA ( Haversian canal ) kA nirmANa karate haiN| yaha antardravya eka kozAntarIya padArtha hai jo asthirahoM ke dvArA utpanna hotA hai isake nirmANa ke lie bhI jIvati ga kA honA atyAvazyaka hai| isI puJja ( mass ) meM haDDiyoM ke TUTe hue sire nyAviSTa (embedded ) ho jAte haiN| yaha puJja na kevala asthiyoM ke TUTe hue bhAgoM ke siroM para hI banatA hai api tu donoM ke madhyavartI bhAga meM bhI rahatA hai tAki ropaNa ko antima rUpa diyA jA ske| isI prakAra kI Uti kA puMja asthiyoM ke majjaka ( medulla ) meM bhI banatA hai| isa nava dhAtu ko prArambhika yA mRdu kiNaka ( provisional or soft callus) kahate haiN| ____ asthyAbha Uti ke nirmANa aura kozAoM ke praguNana kA kArya AghAta ke dUsaretIsare dina prArambha hotA huA dekhA jAtA hai jaba taka saptAha pUrA hotA hai taba taka asthiruhIya bahuta sI Uti bana kara taiyAra ho jAtI hai| jaba taka dUsarA saptAha samApta hotA hai taba taka jitanA bhI rakta utsyandana ( effusion ) dvArA bAhara A gayA hotA hai use sitakozA samApta karake svayaM bhI usa sthala meM bidA ho jAte haiM / bhagna ke bIca vAlA bhAga asthyAbha daNDikAoM ( osteoid trabeculae) dvArA jinake andara asthiruha bhI rahate haiM, kAsthiyoM ke Tukar3oM tathA saMyojI Uti kI paTTiyoM ( strands) dvArA bharA jAtA hai| zanaiH zanaiH cUrNAtu ke lavaNa isa asthyAma Uti meM ropita ( deposited ) ho jAte haiN| jisake kAraNa vaha uti dhIre dhIre asthi meM pariNata ho jAtI hai| kucha prANiyoM meM mRdu kiNaka ( callus ) kA cUrNiyana tathA nava asthyAma Uti nirmANa ye donoM kArya eka sAtha hI hote hue dekhe jAte haiM parantu manuSya meM asthyAma For Private and Personal Use Only

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punanirmANa 267 ati ati zIghra bana jAtI hai aura utanI jaldI usameM cUrNAtu ke lavaNa Aropita nahIM ho paate| cUrNiyana hone ke lie zarIra meM eka vizeSa prakAra ke vikara ( enzyme ) kI upasthiti anivArya hai| isa vikara ko bhAsvIyeda ( phosphatase ) kahA jAtA hai| manuSyetara prANiyoM meM jahA~ prayogArtha asthibhagna kie jAte haiM vahA~ vidvAnoM ne isa vikara ko paryApta mAtrA meM pAyA hai| isI kAraNa unameM sAtha sAtha asthyAbha Uti kA nirmANa hotA hai aura sAtha hI sAtha bhAsvIyeda nAmaka vikara usameM cUrNAtu lavaNoM ko bichAkara asthi kA nirmANa karatA calatA hai| manuSya meM isa vikara kI utanI mAtrA upasthita nahIM rahatI tathA upasarga ke kAraNa bhI yaha vikara apanI kriyA sAnanda nahIM kara pAtA isa kAraNa asthiyoM ke bhagna bhAgoM ke saMyukta hone meM vilamba laga jAtA hai / ___ asthi aura paryasthi ke madhya meM daNDikAoM ( trabecule ) kA nirmANa jitanA hotA hai utanA asthi aura usakI majjaka ke madhya nahIM hotaa| jaba idhara asthi kA punarnirmANa kA kArya tathA asthizIrSoM ke saMyoga kA tamAzA calatA rahatA hai usI samaya mRta Uti tathA asthiyoM ke tIkSNa aura nukIle bhAga kA pracUSaNa (absorption ) bhI calatA rahatA hai| isa prakAra cUrNAtu lavaNoM ke bhAsvIyeda kI kRpA se asthyAbha Uti meM Aropita hone tathA anAvazyaka bhAga ke vilopana dvArA dvitIya sthAyI kiNaka kA nirmANa hotA rahatA hai| usake pazcAt usako aisA kara diyA jAtA hai ki vaha asthi jaisA ho jAve / jaise valaya ( lamellae) asthi meM dekhe jAte haiM vaise isameM bhI mileN| sthAyI kiNaka ko grIna 3 bhAgoM meM bA~TatA hai| vaha jo asthi ke cAroM ora banatA hai use vaha bAhya kiNaka (external callus) mAnatA hai| jo TUTe hue asthi siroM ke madhyavartI bhAga meM par3atA hai vaha madhyavartI kiNaka (intermediate callus ) tathA jo majakIya suraGga ko milAtA hai use antarvartI kiNaka ( internal callus ) karake vaha pahacAnanA cAhatA hai| yadi asthi ke TUTe hue Tukar3oM kA ekarekhaNa vA samAsama baiThAnA ( alignment) ThIka prakAra se kara diyA jAtA hai to bAhya evaM antarvartI donoM kiNaka samApta ho jAte haiM kevala antarvartI kiNaka raha jAtA hai kyoMki ve donoM kiNaka nirarthaka ho jAte haiM aura unakA koI upayoga bhI nahIM rhtaa| kiNaka naSTa karane ke kArya karane vAle kozAoM ke dala ko asthidalaka ( osteoclasts ) kahA jAtA hai| yadi TUTe bhAga samAsama na baiTha sake to bAhya kiNaka ko asthidalaka samApta nahIM karate balki vaha barAbara isalie banA rahatA hai ki zarIra bhAra par3ane para asthi use saha sake aura manuSya apane prAkRtika svarUpa meM raha ske| tanvIyana ( involution ) kI sarvaprathama kriyA ke dvArA asthi siroM ke nukIle bhAgoM ko dUra kiyA jAtA hai tathA pRthaka hue asthilavoM ( detached fragments of bone ) kA pracUSaNa kiyA jAtA hai| jaba asthi ke TUTe hue sire eka dUsare se For Private and Personal Use Only

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268 vikRtivijJAna dRDhatApUrvaka tathA nibiDa uti (compact tissue ) dvArA pUrNataH juTa jAte (sandhAnita ho jAte) haiM taba kiNaka kA punarjUSaNa prArambha hotA hai / yaha kArya prAyazaH asthi bhagna hone ke samaya se tIsare mahIne meM cAlU hotA hai aura isake karane vAle hote haiM asthidlk| isa kriyA kA nAma hai asthidalakIya gartikIya pracUSaNa ( osteoclastic lacunar absorption) / yaha sadaiva smaraNIya rahanA cAhie ki asthibhagna meM asthi ke sire jitane ThIka aura samAsama baiThA diye jAveMge tathA unakI jitanI hI adhika zArIrika sthiti lAI jAvegI utanI hI pUrNatA se kiNakIya vilopa ho sakegA / isI lie zalyazAstravettAoM ko asthibhagnoM ko baiThAne kI kriyA meM parama dakSa honA caahie| AhAra meM khanija tatvoM kI kamI honA tathA jIvatiktiyoM kA abhAva honA asthibhagna ke ThIka karane meM vilamba kA kAraNa sadaiva banA karatA hai| jIvatikti ga vA gha kI kamI se to asthiyoM ke bhagna kA ThIka honA ruka jAtA hai| nimnAGkita anya kAraNoM se bhI kiNaka nirmANa yA asthisandhAna kriyA meM bAdhA A upasthita hotI hai : 1. vaha kAraNa jo asthikhaNDoM ko atyadhika gatimAn banAtA hai| 2. asthikhaNDoM ke madhya meM pezI yA anya bAhya apadravya kA upasthita rhnaa| 3. koI zArIrika roga jo UtiyoM kI punarjananazakti ko kSINa karatA ho 4. vRddhAvasthA ' 5. upasarga kI upasthiti jisake kAraNa bhAsvIyeda ( phosphatase ) nAmaka vikara apanA kArya ThIka prakAra se nahIM kara sakatA tathA dUsarI hAni isake kAraNa yaha hotI hai ki bhagnasthala para satata evaM anAvazyaka adhiraktatA A upasthita hotI hai jo asthiruhoM kI kriyA ko bar3hAvA na dekara asthidalakoM kI sahAyatA karatI hai jisake kAraNa jaisA anyatra hotA hai yahA~ bhI tanturuhIya kaNanaUti kA nirmANa hone lagatA hai jo asthi kA pracUSaNa karane lagatI hai| yadi asthikhaNDoM meM se kisI ko jAne vAlI asthipopaNI vAhinI kA sambandha viccheda ho gayA yA asthipoSaNI vAhinI ( nutrient artery ) ko hI AghAta laga gayA to asthi ko yA usake eka khaNDa ko rakta kA pahu~canA dUbhara ho jAtA hai jisake kAraNa usameM ropaNa ke koI lakSaNa dikhAI nahIM dete aura usakI apuSTi ho jAtI hai| ropaNa meM pratiropaNa kA mahattva ___ yadi kisI aMga meM ati vistRta UtinAza huA ho to yaha bahuta kaThina hotA hai ki usa aMga kA ropaNa ho sake yadi kisI kAraNa se usa aMga kA jIrNoddhAra honA Arambha bhI ho to vahA~ atyadhika vraNavastu bana jAvegI aura aMga kArya kI dRSTi se pUrNataH bekAra ho jaavegaa| aisI dazA meM yaha Avazyaka hai ki usa vinaSTa Uti ke sthAna para sajIva evaM svastha Uti kA pratiropaNa ( transplantation) kara diyA jaave| For Private and Personal Use Only

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'punarnirmANa 266 yadi dazA meM koI parivartana na ho to eka hI jIva ke eka bhAga meM sthita ati ko nikAla kara dUsare bhAga meM pratiropita kiyA jA sakatA hai yA eka jIva kI usa svastha Uti ko kisI dUsare jIva meM bhI pratiropita kiyA jA sakatA hai aura ropaNa kA pratiropaNa bhI eka sugama sAdhana bana sakatA hai| ve kauna zarte haiM jinakA pAlana karanA nitAnta Avazyaka hai ki pratiropaNa ho sake ? isakA samAdhAna yaha hai ki jaba eka Uti dUsare sthAna para le jAI jAve to sarvaprathama usa Uti ko atIva komalatA ke sAtha tathA ati zIghratA se uThAyA jAve tAki usakI sajIvatA sthira rahe dUsare jahA~ use le jAnA hai vahA~ use pUrNa sambaddha kara diyA jAve, usakA tApAMza barAbara ThIka rahe tathA isa sampUrNa kriyA kAla meM pahale yA pIche kisI prakAra kI azuddhi na hone pAve jisase vahA~ upasarga utpanna ho jaave| ina zartoM kA pAlana karane se prathama ropaNa dvArA hI vaha Uti pratiropita ho jaavegii| usakA poSaNa lasa ke dvArA hogA jo usake tala se nikalegA aura yaha taba taka hogA jaba taka raktavAhiniyA~ isakA sambandha anya bhAgoM se nahIM kara detiiN| ___ jo UtiyA~ sabase kama samaMgIkRta hotI haiM tathA jo bahuta kama poSaNa cAhatI haiM sarvAdhika saralatA se pratiropita ho jAtI haiN| pratyeka pratiropa (graft) kI saphalatA utanI hI zIghratApUrvaka hotI hai jitanI zIghratApUrvaka vaha apanA raktasaMvahana cAlU karane meM samartha hotI hai| itanA saba hone para bhI yaha kadApi nahIM bhUlanA hogA ki atyadhika viziSTa granthiyoM ke pratiropa kucha kAla taka sajIva rahate haiM aura apanA prabhAva dikhAte haiM para kucha kAla pazcAt dhIre dhIre mRtyu unheM apane pAza meM jakar3a letI hai aura ve punarcupita ho jAte haiN|| ___ kauna Uti kitane samaya meM pratiropita ho jAtI hai isakA vicAra karane se jJAta hogA ki adhicchada ( epithelium ) eka aisI Uti hai jo sabase jaldI pratiropita ho jAtI hai| isI AdhAra para tvacA kA prati ropaNa kiyA jAtA hai jisameM eka svastha kaNana Uti yukta dharAtala para tvacA kA upariSTha bhAga ( superficial part of the rete ) choTe choTe bhAgoM meM karake pratiropita kara diye jAte haiN| nIce se jo srAva nikalatA hai pahale to usake dvArA ye tvacA khaNDa paripoSita hote haiM ye bar3hate tathA usa dharAtala se abhilagna ho jAte haiM aura phira ve kucha kendra banA lete haiM jahA~ se adhicchada kA bar3hanA aura phailanA prArambha ho jAtA hai isa prakAra kaNana Uti ke Upara navIna tvacA utpanna kara dI jAtI hai| para yaha carma-ropaNa-kArya vraNavastu ke saMkocana ke samaya hI kiyA jAyagA taba to ThIka hai anyathA vraNavastu meM TUTa jAne kI pravRtti ho sakatI hai| kAsthi aura paryasthi jaba ve naI naI hI ho arthAt zaizava vA tAruNyakAlIna ho taba unakA bhI pratiropaNa saralatayA ho jAtA hai| asthiyoM ke choTe choTe Tukar3oM kA pratiropaNa bhI usI prakAra sarala hotA hai| asthi pratiropaNa kI kriyA Adhunika abhighaTana zalya vijJAna ( plastic surgery ) kI eka sAdhAraNa ghaTanA bana gaI hai| For Private and Personal Use Only

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300 vakRtivijJAna Adhunika kAla meM netra ke svacchA ( cornea.) kA pratiropaNa bhI hone lagA hai aura usake lie netrAdhikoSa ( Eye Bank ) kA nirmANa bhI ho calA hai| prAcIna kAla meM pratiropaNa kI kriyA meM hamAre zalyavettA paryApta agraNI the| unakI nAsA sandhAna ( rhinoplasty ) kI prakriyA Aja bhI jyoM kI tyoM pratIcIna vijJAnavidoM ne apanA lI hai| peziyoM kA pratiropaNa bhI kiyA jA sakatA hai| eka pakSI kI gRdhrasI nADI kA pratiropa dUsare pakSI meM prAyogika rUpa meM saphalatA ke sAtha kiyA jA cukA hai| isI prakAra anya prANiyoM kI vAta nADiyoM kA pratiropaNa manuSya meM bhI karake dekhA gayA hai aura usameM usa samaya bhI saphalatA milI hai jaba ki kSatigrasta vAtanADI ko haTA kara mahInoM bAda isa nADI ko lagAyA gyaa| yahI nahIM aisA karane para pUrva vAta nADI kI sampUrNa kriyAe~ nava prati ropita nADI dvArA sampanna hotI huI dekhI gaI haiN| praNAlI vihIna granthiyoM kA pratiropaNa karane meM vidvAn lage hue haiM / aNDakozoM kA pratiropaNa saphalatApUrvaka kiyA jA cukA hai| parAvaTukAgranthiyoM para bhI prayoga saphala ho rahA hai para anyoM ke sambandha meM sthAyI taura para kucha bhI likhA nahIM jA sktaa| kabhI kabhI pratiropaNa hone ke kucha samaya pazcAt pratiropa mara jAte haiM athavA unakI apuSTi bhI ho jAtI hai / yaha vidyA abhI adhika parizrama kI apekSA rakhatI hai aura vizvAsa hai ki IsA kI bIsavIM zatI samApta hone se pUrva hI isakA paryApta vikAsa ho jaavegaa| atighaTana ati ke lie AGgala zabda hai 'maiTA' aura ghaTana ke lie 'plAsiyA' diyA gayA hai| isa prakAra atighaTana maiTAplAsiyA huaa| ghaTana ke sthAna para hamane isa pustaka meM kahIM 'caya' kA prayoga kiyA hai isase ise 'aticaya' bhI kaha sakate haiM / atighaTana vaha kriyA hai jisake dvArA eka prakAra ke kozA apanA itanA parivartana karate haiM ki unakA dUsarA hI prakAra bana jAtA hai| eka prakAra kA adhicchada jaba dUsare prakAra meM pariNata ho jAtA hai taba vaha pahale prakAra ke adhicchada kA 'atighaTana' yA aticaya aisA mAnanA cAhie / paramacaya ( hyperplasia ) yA parama ghaTana aura atighaTana meM paryApta bheda hai| paramaghaTana yA paramacaya meM kozA kI vRddhi DaTakara hotI hai usakA prakAra nahIM badalatA tathA atighaTana meM vaha apanI sImA ko pAra karatA huA atighaTita ho jAtA hai jisase usakA prakAra hI badala jAtA hai| donoM kA prayoga isa grantha meM khulakara huA hai isa kAraNa inakA bheda jAna lenA paramAvazyaka hai| jIrNa vraNazothAtmaka avasthAoM meM hama dekhate haiM ki eka aMga vizeSa ko roga ne aisA jakar3a liyA hai ki usake kArya karane kA svAbhAvika vAtAvaraNa bilkula hI samApta ho jAtA hai / isa naye vAtAvaraNa meM jaba kisI Uti vizeSa ko kArya karanA par3atA hai to avazya hI usake ghaTaka kozAoM meM parivartana hone lagate haiM aura eka Uti dUsare prakAra meM badala jAtI hai / isakA eka udAharaNa hama basti ke adhicchada kA dete haiN| basti kA prakRta adhicchada antarvartIya kozAoM ( transitional cells) ke dvArA For Private and Personal Use Only

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punarnirmANa 301 banA hotA hai aura use hama antarvartI adhicchada kahate haiN| yadi basti meM jIrNa bastipAka (chronic cystitis ) ho jAve aura vaha paryApta kAla taka rahe to ina kozAoM meM parivartana hone lagatA hai aura zanaiH-zanaiH vaha mRdu racanA guruzAhnita zalkIya adhicchada (heavily keratinised squamous epithelium ) meM pariNata ho jAtI hai jaisI kI mukha meM hotI hai| kisI bhI prakAra kA adhicchada ho jIrNa vraNazotha ke kAraNa yA parivartita vAtAvaraNa meM vaha zArjita zalkIya adhicchada meM hI badala jAtA hai| garbhAzaya kI cyuti ( prolapse ) yA prativartana ( eversion) meM; uraHkSata yA jIrNa zvasanikApAka hone para phuphphusa meM pittAzmariyoM kI upasthiti hone ke kAraNa pittAzaya meM; vRkkAzmariyoM ke kAraNa mUtramArga meM adhicchada badala kara zalkIya aura zAhnita ( keratinised ) ho jAtA hai| eka se dUsare prakAra meM parivartana sadaiva surakSAtmaka hotA hai| pahale prakAra ke kozA parivartita vAtAvaraNa ( environment ) ko saha nahIM pAte ataH eka adhika kaThora aura sahanazIla prakAra kA kozA usakA sthAna lekara usa kaSTa ko jhelatA hai| kabhI-kabhI prayogazAlA ke sabhI jIvoM ko atyadhika mAtrA meM strImadi ( oestrin ) kA prayoga karAke unake prajanana saMsthAna ke adhicchada ko bhI parivartita karake dekhA jAtA hai jo ise batalAte haiM ki na kevala vAtAvaraNa hI api tu nyAsargika prabhAva ( hormonal influence ) bhI atighaTana kA kAraNa bana sakatA hai| saMyojI UtiyoM ke atighaTana tathA unake kAcarIya vihAsa meM itanA kama antara hotA hai ki unameM atighaTana kA honA hI abhI vivAdagrasta viSaya banA huA hai| __ sandhikalAoM meM jIrNa upasarga hone ke kAraNa kabhI-kabhI vahA~ kAsthi yA asthi kA nirmANa ho jAtA hai / ise atighaTana kahA jAve yA kAcarIya vihAsa yaha abhI samasyA hI hai| stanoM ke praNAlIya adhicchada meM kabhI-kabhI kAsthi-sama racanA bana jAtI hai jisake kAsthi hone meM sandeha hai vaha zleSAbha vihAsa ( mucoid degeneration)mAlUma par3atA hai| lAlAsrAvI granthiyoM meM bhI isI prakAra kAsthi-sama racanA ko zleSAbha vihAsa meM liyA jAtA hai| anaghaTana ( anaplasia ) meM kozAoM kA bhinnana samApta ho jAtA hai aura ve zrauNa prakAra ko prApta hone lagate haiN| jidhara se Aye udhara hI jAne kI isa pratIpagamanIya kriyA ( retrograde process ) kA hI dUsarA nAma anaghaTana hai jo aghaTana yA acaya ( aplasia ) aura atighaTana se pUrNataH bhinna hotI hai| For Private and Personal Use Only

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saptama adhyAya jvara jvara prANImAtra kA eka sarvasAmAnya roga hai / isake vinAzaka pariNAmoM se Aja sArA saMsAra trasta hai / isake Aja anekoM rUpa pragaTa ho rahe haiM aura Aja yaha saMsAra meM manuSya kI mRtyu kA sabase bar3A kAraNa bana gayA hai / uvara nAmaka vikAra meM svedAvarodha, santApa ( rise of temperature ) aura sarvAGgagraha ye tInoM rogalakSaNa eka sAtha dekhe jAte haiM svedAvarodhaH santApaH sarvAGgagrahaNaM tathA / yugapadyatra roge ca sa jvaro vyapadizyate // kisI bhI roga meM santApa kA honA eka sarvasAdhAraNa lakSaNa hai use jvara nAma se pukArane kI apekSA santApa nAma se pukAranA adhika zAstrIya hai| jvara meM svedanAza, tApAdhikya aura zarIragata vedanA ye tIna sAmAnyatayA pAye jAte haiM viziSTatayA inakA Adhikya yA abhAva bhI liyA jA sakatA hai / jvarotpatti ke sambandha meM eka prAcIna anuzruti calI AtI hai ki jaba dakSa prajA - *vaktavya -- jvarotpatti ke sambandha meM yaha eka purAnI kathA hai| purANoM ke tAle banda haiM unake bhItara kyA hai jAnane ke pahale tAlI cAhie jise gulAmI aura paraspara dvandva ke hajAroM varSoM meM hama ajJAna ke sAgara meM pheMka cuke haiM ataH paurANika gAthAoM kA jo rahasya hai vaha samajhanA kaThina hai / dakSaprajApati kA asuroM ko na mAranA azAnti uThatI rahane denA, bhagavAn zaGkara kA zAntivrata meM AsIna honA, zAGkara bhAga ko yajJa meM prajApati dvArA na diyA jAnA, vratapUrNa hone para zaGkara kA tIsarA netra khola krodha se vIrabhadra kA janma jisake dvArA asuroM kA saMhAra kiyA jAnA tathA yajJa kA vidhvaMsa honA phira devatAoM dvArA prArthanA karanepara ziva kA santuSTa hokara vIrabhadra ko jvara rUpa meM rahane kA Adeza denA / janma mRtyu ke samaya tathA anya apacAra karane vAloM meM isakA prAdurbhAva honA yaha saba kapola kalpita maurya isaliena hIM hai ki inakA varNana cikitsA ke sarvazreSTha grantha meM huA hai jisakA upadeza vizva ke mAne hue vidvAn bhagavAn punarvasu Atreya ne apane zrImukha se kiyA hai / itane ucca grantha kA nirmANa isa galpa meM vizvAsa karatA thA yaha nahIM kahA jA sktaa| isake pIche avazya koI sAragarbhita tattva chipA huA hai / prazAnta mahAsAgara ke bIkinI TApuoM ke bIca meM yunAiTeDa sTeTsa Apha amerikA ke vaijJAnikoM ne jo eTama yA hAiDrojana bamoM ke parIkSaNa kiye usakA pariNAma hajAroM mIla dUra jApAna taka phuNcaa| vahAM raiDiyoaikTiva kaNoM se yukta varSA huI aura lAkhoM rupaye kI bahumUlya machaliyAM mara gaI / jaba eka bama kA itanA ghAtaka pariNAma ho sakatA hai to sambhava hai rudra nAmaka ghora azAnti ke prakaTAyaka zaGkara ne kruddha hokara kisI vizeSa zakti ko prakaTa kiyA ho jisane asuroM kA vinAza aura dakSa yajJa kA vidhvaMsa kiyA para jaba ziva nAmaka parama zAnti ke nidhAna zaGkara ne lokopakAraka rUpa samhAlA to usane vaha mAyA sameTa lI / para usakA pariNAma prANiyoM para huA aura vaha nirantara hotA calA AtA hai / prANI jaba paidA hotA hai yA maratA hai athavA kupathya sevana karatA hai to usako jvara avazya hotA hai / varabhadra nAmaka kisI bhayaGkara eTaumika yA usI prakAra kI kisI zakti kI utpatti ke uparAnta vizva meM jvara ko sRSTi huI ho yaha asambhava kalpanA nahIM hai / - ( lekhaka kRta carakavimarza se ) For Private and Personal Use Only

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jvara 303 pati ne apane yahA~ yajJa racA thA aura zaGkara bhagavAn ko Amantrita nahIM kiyA thA to bhI satI jI vahA~ pahu~cI thIM aura vahA~ pati ko Amantrita na karane ke apamAna se duHkhI hokara jaba svAgni se hI apane zarIra ko paridagdha kara rahI thIM taba hI bhagavAn zaGkara ke gaNoM ne dakSa ke yajJa ko vidhvasta kara diyA thA / zaGkara ke krodha karane se unakI zvAsa se vIrabhadra jvara utpanna huaa| isa kathAnaka kA kyA abhiprAya rahA ise kAla ke ananta pravAha ne AtmasAt kara liyA hai aura jaise tAle lage ghara kI varSoM se tAlI kho jAtI hai usI prakAra purANa rUpI tAloM kI khoI huI tAlikA ke kAraNa hama jJAna bhaNDAra kA ThIka ThIka upayoga karane meM pUrNataH asamartha ho gaye haiM / yadi kisI prakAra koI tAlI mila sakI to ye tAle khuleMge aura unake prakoSThoM meM sacita dravyarAzi se jagat kA atyadhika kalyANa ho sakegA / isa samaya to usakI koI AzA isalie nahIM dikhatI ki adhikatara vyakti una tattvadarziyoM ke dvArA upasthita rUpakoM ko makhaula mAna kara calatA hai aura unameM ghusane kI apekSA unase bacakara mArga nikAla letA hai / jvara kI samprApti ke sambandha meM mAdhavanidAnokta nimna sUtra bahuta prasiddha hai / mithyAhAravihArAbhyAM doSA hyAmAzayAzrayAH / bahirnirasya koSThAgniM jvaradAH syU rasAnugAH // isakA abhiprAya yaha hai ki mithyAhAra aura mithyAvihAra ke dvArA AmAzayAzrita vAtapittAdi doSa AmAzaya meM utpanna rasa kA anugamana karake koSThAgni ko bAhara pheMka dete haiM aura jvara ho jAtA hai / jvarotpatti meM isa prakAra mithyA AhAra aura mithyA vihAra mukhya jar3a haiM yadi mithyA AhAra na kiyA jAve athavA mithyA vihAra na baratA jAve to jvarotpatti nahIM ho sakatI / mithyAhAra kI kalpanA ke lie nimna sUtra prasiddha hai-- akAle cAtimAtraM ca sAtmyaM yacca bhojanam / vipamaM cApi yadbhuktaM mithyAhAraH sa ucyate // akAla meM, atyadhika mAtrA meM, asAtmya yA viSama bhojana karanA mithyAhAra kaha lAtA hai / caraka vimAna sthAna meM jo AhAra vidhi vizeSAyatana kahe gaye haiM unake viruddha upayoga mithyAhAra kahalAtA hai / dravyoM ke gurutva laghutvAdi guNa prakRti ke antargata Ate haiM ur3ada kI prakRti guru aura mudra kI prakRti laghu hai | guru ur3ada kA prayoga mithyAhArakAraka hai / karaNa saMskAraparaka hai saMskAra se dhAna guru aura lAjA laghu hotI hai / dUdha aura machalI kA eka sAtha pakAnA mithyAhAratva janaka hai| rAzi dravya ke avayava yA samudAya ke parimANa ko kahate haiM / yaha parimANa adhika prayukta honA yA atyalpa prayoga karanA mithyAhArajanaka hotA hai / deza, dravya kI utpatti aura pracAra kA vicAra prastuta karatA hai / kisa bhUmi meM kauna dravyotpatti huI hai usakA bhI sambandha AtA hai | himAcalotpanna oSadhiyoM kI apekSA vindhyapradezAdi kI vanaspatiyA~ hIna vIrya hotI haiM / aprazasta bhUmyutpanna dravya mithyAhAratva kAraka hotA hai yaha kisI at avidita nahIM hai / kAla kA bhI pariNAma hotA hai / nityaga yA Avasthika kAla at vinA vicAra kie prayukta dravya mithyAhAra kA kAraNa banatA hai| kaba kisa doSa kA rAjya hai kauna guNabhUyiSTha padArtha kisa Rtu yA kAla meM prayukta honA cAhie isakA For Private and Personal Use Only

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304 vikRtivijJAna kuvicAra mithyAhArajanaka mAnAgayA hai| upayoga saMsthA AhAravidhi vizeSAyatana ke antargata AtI hai| isakA abhiprAya hai AhAra dravya ke upayoga kA niyamana / jIrNa hone ke pUrva AhAra kA prayoga rasodvega kAraka arthAt rogotpAdaka hotA hai| upabhoktA kA bhI isa dRSTi se utanA hI mahattva hai jitanA ki upayoga saMsthA kA / upabhoktA kI prakRti ke anukUla padArtha na milane se yA apanI prakRti ke viruddha AhAra karane kA artha hI mithyAhAra meM AtA hai| hamAre mitra zrI sundaralAla trivedI rAtri meM takrapAna nahIM kara sakate kyoMki yaha unakI prakRti ke viruddha hai| ataH upabhoktA para bhI AhAra ke mithyAtva kA vicAra AtA hai| jisa prakAra mithyAhAra usI prakAra mithyAvihAra bhI jvarotpatti meM pUrNataH sahAyaka hai| mithyAvihAra kI paribhASA batalAte hue likhA gayA hai azaktaH kurute karma zaktimAnna karoti yH| mithyAvihAra ityuktaH sadA taM parivarjayet // jisameM kArya karane kI sAmarthya nahIM hai vaha jaba apanI sAmarthya se adhika kArya karatA hai athavA jo sAmarthyavAn hai vaha tadanukUla kArya se jI curAtA hai to ye donoM mithyAvihAra karate haiM aura use rokanA cAhie / mithyAvihAra ke kAraNa utpanna hone vAlA Azvina kArtika kAlIna zItapUrvaka jvara hai| rabI kI phasala ke lie eka eka kisAna jaba rAtri bhara apane bailoM ko lie kheta jotatA rahatA hai to vaha nissandeha apanI zakti bahuta adhika vyaya karane lagatA hai| isa mithyAvihAra ke pariNAmasvarUpa use jvara AtA hai| koI hI vyakti isa jvara se baca pAtA hai| isI mithyAvihAra meM Rtuparivartana bhI AtA hai| grISma se zaratkAla yaha jo parivartana hai yaha bhI svayaM mithyAvihArotpAdaka hai isake kAraNa bhI bahudhA roga dekhA jAtA hai| mithyAhAra aura mithyAvihAra ina donoM ke kAraNa doSoM kA prakopa hotA hai| isa doSa-prakopa ke sambandha meM vividha kAraNoM se jo varNana tIsaTAcArya ne kiyA hai vaha parama rocaka hai aura paryApta hone se usako yahA~ uddhRta karate haiM:vyAyAmAdapatarpaNAda prapatanAdbhaGgAt kSayAjjAgarAt , vegAnAM ca vidhAraNAdatizucaH zaityAdatitrAsataH / rUkSakSobhakaSAyatiktakaTukairebhiH prakopaM vrajet , vAyuridharAgame pariNate cAnne'parAhne'pi ca // kaTavamloSNavidAhitIkSNalavaNakrodhopavAsAtapastrIsamparkatilAtasIdadhisurAzuktAranAlAdibhiH / mukte jIryati bhojane ca zaradi grISme sati prANinAM madhyAhne ca tathA'rdharAtrisamaye pittaM prakopaM vrjet|| gurumadhurarasAtisnigdhadugdhezubhakSyaMdravadadhidinanidrApUpasarpiSprapUraiH tuhinapatanakAle zleSmaNaH saprakopaH prabhavati divasAdau bhuktamAtre vsnte| doSoM se tAtparya vAta, pitta aura zleSmA se hI hai| ina tInoM kI spaSTa kalpanA aura tatsambandhI matoM para paryApta UhApoha vividha AyurvedIya granthoM meM hai| ye tInoM doSa mAnava zarIra kI eka eka ikAI-zarIrakozA-meM upasthita rahate haiN| kisa mAtrA meM rahate haiM yaha usa aGga vizeSa kI viziSTatA se sambaddha viSaya hai / For Private and Personal Use Only

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jvara 305 AmAzaya nAbhi aura stanoM ke bIca ke bhAga meM rahane vAlA aMga vizeSa hai / kaccA (Ama) anna rasa jahA~ saJcita rahatA hai aura banatA hai vaha sthAna AmAzaya kahalAtA hai| isameM sTamaka grahaNI cudAntra aura sthUlAntra kA UparI bhAga taka A jAtA hai| eka zabda meM hama sampUrNa mahAsrota ko isameM lA sakate haiN| sTamaka ke anuvAda ko AmAzaya kahA jA sakatA hai para yahA~ AmAzaya utane saMkucita bhAva meM prayukta nahIM kiyA gayA / nAbhistanAntaraM jantorAmAzaya iti smRtaH ke anusAra hI ise isa sthala para grahaNa karane yogya hai| kucha loga eka mAtra sTamaka ko hI jvarotpatti meM kAraNa mAnakara calate haiN| hindI meM 'peTa' zabda jisa artha meM AtA hai usI meM AmAzaya lene se spaSTArtha pragaTa ho jAtA hai| jvara jisa samaya hotA hai usa samaya bhUkha nahIM lagatI khAnA nahIM pacatA TaTTI nahIM utrtii| ye tInoM kriyAe~ peTa kI kharAbI kI dyotaka haiM inameM kucha jvara ke kAraNa svarUpa haiM aura kucha usake pariNAmarUpa AmamannarasaM kecitkecittu malasaJcayam / kahane vAle jahA~ bhI mala kA arthAt doSa kA saMcaya ho usI sthAna ko AmAzaya mAna lete haiM tathA isa prakAra jvara kI utpatti zarIra ke pratyeka mArga meM siddha karate haiN| koSThAgni se jATharAgni abhipreta hai| AmAzaya ko peTa mAnane vAloM ke lie jATharAgni tathA kisI bhI mala saMcaya sthala ko AmAzaya mAnane vAloM ke lie use dhAtvagni liyA jA sakatA hai / jvara kI samprApti ke vicAra karate samaya kevala jATharAgni se bhI kArya cala jAtA hai kyoMki vaha saba dhAtvagniyoM kA adhipa hai aura usI ke dvArA unameM garmI pahu~catI hai usI kI vRddhi se ve bar3hatI haiM aura usI kI kamI se ve kSaya ko prApta hotI haiM:annasya paktA sarveSAM paktRNAmadhipo mataH / tanmUlAste hi tvRddhikssyvRddhikssyaatmikaaH|| ataH jATharAgni kI mahattA kama nahIM kI jA sktii| jATharAgni anna ko pakAne vAlI hai aura Ama annarasa ko bhI pakAkara laghu rasa dhAtu kA nirmANa karane vAlI hai| ataH AmAzaya aura jATharAgni kA jvarotpatti meM Ayurveda parama mahattva kA hAtha mAnakara calatA hai| aba yadi hama mithyAhAravihArAbhyAM vAle sUtra ko samajhane kA yatna kareM to jJAta hogA ki AmAzayAzrita tInoM doSoM meM se koI eka yA do yA saba mithyA AhAra vihAra ke vazIbhUta hokara vahA~ kI annapAcinI agni ko bAhara nikAla kara aura rasAnugAmI hokara jvarapradAna kara dete haiN| doSoM kA rasAnugamana aura agni kA bAhyAgamana ye do kriyAe~ parasparAzrita haiN| rasa kA paripAka aura usa para agni kA kArya hone se zArIrika svAsthya ThIka rahatA hai usI rasadhAtu ke sAtha jaba mithyAhAra-vihAra ke pariNAmoM se kSubdha AmAzaya meM sthita doSa milakara calane lagate haiM to rasastha agni svatantra ho jAtI hai aura vaha phira bAhara nikala kara zarIra ko uttapta kara detI hai| AmAzayAgni kI kriyA santApotpatti meM pramukha bhAga letI hai ise Ayurveda apanA For Private and Personal Use Only

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306 vikRtivijJAna AdhAra mAnatA hai| isI lie jvara kI cikitsA meM vaha laMghana ko pramukhatA detA hai tAki akAraNa jATharAgni kI prabalatA ko tathA usake pariNAmasvarUpa bar3hane vAle uttApa ko rokA jAve / jvara meM laMghana karane vAlA yadi bIca meM AhAra kara letA hai to usake bhISaNa pariNAmoM se koI bhI vaidya aparicita nahIM dikhtaa| turata uttApa vRddhi usakA pariNAma hai| uttApa vRddhi ke sAtha sAtha pralApAdi gambhIra kAraNa usI ke kAraNa dekhe jAte haiM use kauna nahIM jaantaa| jATharAgni kI bAhara nikalane vAlI pravRtti ko rokanA hI AyurvedIya cikitsA kA mUlAdhAra banatA hai jisakA prauDhatama pramANa laMghana hai| laMghana ke dvArA zAnta hone meM jvara ko jitanA alpakAla lagatA hai utanA anya prakAra se nhiiN| ataH jATharAgni aura AmAzaya peTa meM sthita agni aura peTa ke hI kramazaH paryAya mAnane meM hameM koI Apatti nahIM dikhtii| kisI bhI koSTha yA aMga meM doSa saMcaya ko AmAzaya mAnakara calane vAle vahA~ kI dhAtvagni yA koSThAgni ke bAhara nikalane kA nAma jvara de sakate haiM para Age jo zloka diye haiM unase ThIka ThIka tAratamya nahIM baiTha pAtA / koSTAgni vA jATharAgni ke bAhara kI ora nikalane se hI uttApa yA santApa yA uSNatA kI vRddhi hotI hai| suzruta ne jahA~ svedAvarodha, santApa aura sarvAGgagrahaNa ina tIna lakSaNoM ke eka sAtha upasthita hone ko jvara saMjJA dI hai vahA~ aSTAGgahRdayakAra ne atyuSNagAtratA ko hI jvara mAnA hai aura isa jvara kI samprApti ke lie jo zloka diye haiM ve nimna haiM: ........ malAstatra svaiH svairduSTAH pradUSaNaiH / AmAzayaM pravizyAmamanugamya vidhAya ca / srotAMsi paktisthAnAcca nirasya jvalanaM bhiH| saha tenAbhisarpantastapantaH sakalaM vpuH|| kurvanto gAtramatyuSNaM jvaraM nirvartayanti te // aruNadatta ne isa samprApti ko nija jvaroM kI utpatti mAnA hai| malAH arthAt vAtAdidoSa svaiH svaiH ( apane apane ) pradUSaNaiH (kopa ke dvArA) duSTAH (kupita hokara) jvaraM nirvatayanti (jvarotpatti karate haiN)| vAta tiktAdi dravyoM se pitta kaTukAdi auSadhiyoM se aura kapha madhurAdi padArthoM se prakupita ho sakate haiN| Agantu hetu ke kAraNa bhI jvarotpatti hotI hai para na hi vAtAdIn vimucya vyAdheH samudbhavaH kathamapi sambhAvyate / ___ ataH Agantu kAraNa bhI doSoM ko hI uttejita karate haiN| doSaja yA nija vyAdhi pahale vAtAdi kupita karatI hai phira bAda meM zarIra meM pIr3A hotI hai| Agantuka meM sarvaprathama zarIra meM vedanA hotI hai tatpazcAt vAtAdikopana hotA hai| ye doSa jo pahale yA bAda meM prakopa karate haiM nAbhistanAntara meM sthita AmAzaya meM praveza karake Ama kA anugamana kara rasavahasrotasoM meM baiTha kara paktisthAna se jATharAgni ko zarIra ke bAhara nikAla dete haiM / yaha agni (rasAgni rUpa se) sampUrNa zarIra meM prasaraNa karatI hai aura gAtra ko atyuSNa kara detI hai| 1. AmAzayastho hatvAgniM sAmo mArgAn pidhAya yat / vidadhAti jvaraM doSastasmAllaMghanamAcaret // For Private and Personal Use Only

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jvara 307 vAyukRta jvara meM vAyu ke yogavAhI hone ke kAraNa tathA pittakRta jvara meM pitta ke agnisadRza guNa hone se santApopalabdhi mAnalI jA sakatI hai para agni kA pratipakSI hone se zleSmajvara meM santApa vRddhi kA kyA kAraNa hai ( kathamiva santApakatvaM yuktam ? ) aisI eka zaMkA aruNadatta ne svayaM uThA kara svayaM hI usakA nirmUlana bhI kiyA hai ki svabhAvAdupapannametat svabhAva se hI yaha utpanna hotA hai kyoMki jvara kA svabhAva acintya hai isake dvArA avazya hI santApotpatti hotI hai arUpa hone para bhI gulmAdi meM zyAvatA yA aruNatA kI upalabdhi hotI hai usI prakAra ise bhI samajhanA hogA / / jaise ki vAta amUrta aura hemAdri paktisthAna se grahaNI ko grahaNa karatA hai / hamane svayaM mahAsrota ke usa bhAga ko jisameM pratyakSa anna kA paripAka hotA hai aura agni kI upasthiti rahatI hai paktisthAna ke rUpa meM liyA hai / grahaNI pAcaka pitta yA pAcakAni kA pramukha sthala hai ataH usI se doSa sambaddha hokara jvarotpAdaka vAtAvaraNa karate hoM to koI Azcarya nahIM hai / vAgbhaTa ne jvara kI samprApti ko aura bhI spaSTa karate hue likhA hai tatra yathoktaiH prakopanavizeSaiH prakupitA doSAH pravizyAmAzayamUSmaNA mizrIbhUyA''mamanugamya rasasvedavAhIni srotAMsi pidhAya pittaM tu dravatvAttaptamiva jalamanalamupahatya sarve'pi ca doSAH paktAraM svasthAnAdbahirnirasya saha tena sakalamapi zarIramabhisarpantastatsaMparkAllabdhabalena svenoSmaNA nitarAM dehoSmANamevayanto'ntastrotomukhapidhAnAt stambhamAdadhAnA bahirapi svedamapaharantaH sarvendriyANi copatApayanto jvaramabhinirvartayanti / / doSa prakopaka vizeSa padArthoM vA kAraNoM se prakupita doSa AmAzaya meM praviSTa hokara USmA se mizrita hokara Ama kA anugamana karake rasavAhI aura svedavAhI srotoM meM baiTha jAte haiM / pitta drava hai aura uSNa hai jaise uSNodaka agni para DAla dene se ani apane sthAna para to ThaNDI ho jAtI hai para usakI USmA didigantara meM vyApta ho jAtI hai ThIka isI prakAra sabhI prakupita doSa agni ko apane sthAna para zAnta kara sampUrNa zarIra ke bAharI bhAga meM abhisarpita kara dete haiM / isa USmA ke samparka se bala prApta kara dehoSmA antaHsrotomukhoM ke banda hone se sveda kA bAhara kI ora gamana banda ho jAtA hai jisake kAraNa sarva indriyA~ aura adhika uttapta ho jAtI haiM aura jvara utpanna ho jAtA hai / yahA~ svedanirgamana kA banda honA aura doSaprakopa se jATharAgni kI pracalanadizA kA bAhyamukha honA ye do kAraNa jvarotpatti ke lie diye gaye haiM / vAstava meM doSaprakopa eka mukhya ghaTanA hai svedAvarodha yA santApavRddhi usake pariNAmarUpa hai / jahA~ doSaprakopa pramukha ghaTanA nahIM hai vahA~ bhI jvarotpatti ke hone meM paryApta kAla lagatA hai / jise hama Agantu vyAdhiyoM kA saMcayakAla kahate haiM yaha vaha avasthA hai jaba upasarga zarIra meM doSaprakopa kA vAtAvaraNa taiyAra karatA hai jaise hI vAtAvaraNa taiyAra ho jAtA hai| saMcayakAla samApta hokara jvarotpatti Arambha ho jAtI hai / For Private and Personal Use Only

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vikRtivijJAna prakupita doSa sarvaprathama zarIra ke pAcakAGgoM kI kriyA ko avaruddha kara dete haiN| bhUkha na laganA ( aruci) jvara kA sarvaprathama lakSaNa mAnA jA sakatA hai| pAcanakriyA kI kamI ke kAraNa pavitra anna rasa kA nirmANa kArya banda ho jAtA hai jisake kAraNa zarIra meM Alasya gaurava aura daurbalya bar3ha jAtA hai| jahA~-jahA~ hokara rasa bahatA hai una srotasoM para dUSita doSoM kA adhikAra ho jAtA hai| rasavahAoM dvArA yaha dUSita rasa sampUrNa zarIra meM pahu~cAyA jAtA hai jisake kAraNa zarIra bhara meM aMgagraha (jakar3atA) ho jAtA hai| saMkSita viparItagAminI jATharAgni zarIra ke kozA-kozA meM sthita dhAsvagni ko aura bhI tIvra karake sampUrNa zarIra ko garma kara detI hai| zarIra kI ye garmI sveda pravAhI mazIna ko Thappa kara detI hai / jaba zarIrastha USmA prasvedapatha se bAhara hone ke lie mArga nahIM pAtI to usake kAraNa zarIrottApa aura bhI bar3ha jAtA hai aura rogI eka prakAra kI becainI yA ghabarAhaTa kA anubhava karane lagatA hai| yaha ghabarAhaTa bar3e se bar3e zUravIra meM pAI jAtI hai| jvara kA pUrvarUpa zramo'ra tirvivarNatvaM vairasyaM nayanaplavaH / icchAdveSau muhuzcApi zItavAtAtapAdipu / / jambhAGgamardo gurutA romhrsso'rucistmH| apraharSazca zItaM ca bhavatyutpatsyati jvare // sAmAnyato vizeSAttu jambhAtyarthaM samIraNAt / pittAnnayanayordAhaH kaphAdannArucirbhavet / / (suzruta tasya prAgrUpamAlasyamaratirmAtragauravam / AsyavairasyamarucijammA sAmrAkulAkSitA / / aGgamardo'vipAko'lpaprANatA bhunidrtaa| romaharSo vinamanaM piNDikodveSTanaM klamaH // hitopadezeSvakSAntiH prItiramlapaTUpaNe / dveSaH svAdupu bhakSyeSu tathA bAleSu tRDbhRzam // shbdaagnishiitvaataambucchaayossnnessvnimitttH| icchAdveSazca............ // ( aSTAGgahRdaya ) uparokta do uddharaNoM meM jvaroM meM pAye jAne vAle lagabhaga sabhI mahattva ke pUrvarUpIya lakSaNoM kA samAveza ho gayA hai| hama eka-eka karake unheM punaH pAThaka ke dvArA AlocanAtmaka dRSTipUrvaka vicAra karane ke lie prastuta karate haiM-- zrama-yA parizrama jise thakAvaTa ( fatigue ) kahate haiM jvara meM sarvaprathama dekhA jAtA hai / sAdhAraNataH jaba adhika parizrama peziyoM se liyA jAtA hai to vaha garama ho jAtI hai aura unameM durbalatA A jAtI hai / jvara meM zarIra ke tApAMza meM vRddhi hotI hai ataH peziyoM meM eka prakAra kI svAbhAvika thakAna ho hI jAtI hai| ataH jvara ke bAda meM yA jvara hote samaya to zrama ko koI bhI samaya legA para jvara ke pUrvarUpa kA sarvaprathama lakSaNa zrama hI hogA yaha samajhanA pdd'egaa| mithyA AhAra vihAra ke kAraNa mahAsrota se prANapradAna karane vAlI rasa dhAtu kI nirmiti ThIka se nahIM hotI aura isa kAraNa doSoM kA vyatikrama bhI calatA rahatA hai| para zarIra kA jIvana vyApAra isa viSama paristhiti ke hone para bhI calanA Avazyaka hotA hai| isa kAraNa asvAbhAvika aura parivartita vAtAvaraNa ke kAraNa jisakA pariNAma Age cala kara jvara huA karatA hai / pahalI sthiti yadi zArIrika aMgoM meM thakAvaTa kI ho to koI Azcarya kI bAta nahIM hai / jvara Adhunika dRSTi se bAhya rogAtmaka kAraNoM kA pariNAma hotA hai| arthAta For Private and Personal Use Only

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jvara 306 jvarotpatti ke samaya eka prakAra kA viSa. zarIra ke aMga pratyaMga meM halakA-halakA daur3ane lagatA hai jo zarIra meM zrama kI sthiti utpanna kara de sakatA hai| Alasya-Alasya bhI jvara kA hI pUrvarUpa batalAyA gayA hai suzruta ne usakA ullekha jvarapUrvarUpa meM nahIM kiyA vAgbhaTa ne use likhA hai| para suzruta ne Alasya kI nimna vyAkhyA avazya dI hai sukhasparza prasaGgitvaM duHkhadveSaNalolatA / zaktasya cApyanutsAhaH karmaNyAlasyamucyate // sukhasparza hone para duHkha se dveSa aura zakti rahate hue bhI anutsAha kA honA karma meM Alasya kI paribhASA hone para bhI yahA~ vAGmanaHkAyakarmasvanudyamaH Alasyam / kI paribhASA ThIka baiThegI bolane kI icchA nahIM, socane kI tabiyata nahIM, kArya karanA to dUra yaha avasthA jvara ke pUrvarUpa Alasya meM huA karatI hai| usakA kAraNa hai zarIrAGgoM meM zrama kI abhivyApti / zrama kahane se Alasya kI aura Alasya kaha dene se zrama kI prApti mAnane meM kisI ko Apatti nahIM ho sktii| Alasya ke sAtha-sAtha caraka ne dIrghasUtratA ko bhI jvara ke pUrva meM hone vAlA eka lakSaNa svIkAra kiyA hai| __ arati-jvara ke pUrvarUpoM meM eka arati hai| aratiranavasthitacittatvam athavA ekatrAnavasthitizcetas ke dvArA samajhI jA sakatI hai| citta kA calAyamAna rahanA eka sthalI para mana kA sthita na rahanA arati hai| arati eka mana kI avasthA vizeSa hai| mandagati se jvara vyakta hone se pUrva bahane vAle zarIra meM saJcita virSoM kI mastiSka para huI vikRta kriyA kA mUrtarUpa hI arati ho sakatI hai| vivarNatA- ise mlAnagAtratA bhI kahate haiM / arthAt zarIra kI kAnti yA varNa kA phIkA yA manda par3a jAnA jvara ke pUrva kA eka mahattvapUrNa lakSaNa hai| doSa vividha kAraNoM se dUSita aura prakupita hone lagate haiM jisake kAraNa unake pariNAmasvarUpa viziSTa varNa kA rogI kI tvacA para prAdurbhAva ho jAyA karatA hai| caraka bhI hAnizca balavarNayoH ke dvArA varNahAni ko svIkAra karatA hai| virasatA yA Asyavarasya-vairasyamiti mukhasya viruddhrstaa| arthAt mukha ke svAda kA vikRta ho jAnA virasatA kahalAtA hai / jihvA meM sthita AsvAdana saMjJAvaha nADiyoM ke agroM meM koI vikAra ho jAtA hai yA AsvAdana kendra meM hI vikRti hotI hai isakA nirNaya karanA hai| vAstavikatA to yaha hai ki jvara kA pUrvarUpa jo zrama vA Alasya ke sAtha Arambha hotA hai usI kA spaSTa vivecana yaha lakSaNa hai| AsvAdana kendra, AsvAdana vAtanADiyA~ tathA unake agrabhAga sabhI thakita aura alasita ho jAne ke kAraNa unake lie nizcita jo kArya hai usakI pUrti yathAvat nahIM kara pAte aura Asyavairasya ko janma dete haiN| sAsrAkulAkSitA yA nayanaplava-yaha lakSaNa jvara hone se kucha hI pUrva utpanna hotA hai / isake upasthita hone para 30 minaTa se lekara 4 ghaNTe taka jvara avazyameva utpanna ho jAtA hai / sAsrAkulAkSitA kA artha sahAreNa varteta iti sAne Akule akSiNI For Private and Personal Use Only

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310 vikRtivijJAna yasya sa evam tasya bhAvaH sAmrAkulAkSitA arthAt azrupUritanetratA isI ko nayanaplavaH yAnI azrupUrNanetratvam kahate haiN| zrama aura Alasya jo sarvagAtra meM chAyA rahatA hai usake kAraNa netra kA azru utpAdaka vyApAra Thappa na hokara bar3ha jAtA hai aura netroM meM azruoM kA udaya hotA hai / azrunirmANa kArya sadaiva mastiSka kI avasAdita avasthA kA pariNAma huA karatA hai| idhara jvarI ko sarvaprathama sampUrNa zarIrAlasya aura avasAda se bheMTa karanI par3a rahI hai| isa kAraNa yaha vAtAvaraNa nayanaplavatA ke atIva yogya hotA hai| gAtragaurava yA gurutA-aMga kA bhArIpana yaha pUrvarUpa pratyeka jvara meM dekhA jA sakatA hai para kapha prakopajanitajvara meM isakI abhivyApti vizeSa karake pAI jAtI hai| zarIra ke srotasoM, sirAoM aura dhamaniyoM meM bahane vAlA jvarakArI viSa yA prakupita doSasamUha zarIra meM gurutA utpanna karane meM samartha hotA hai / zarIrastha IMdhana ko jalAkara bala vA zakti pradAna karane vAlI mazIna ke pAsa IMdhana kA Dhera lagA huA hai aura vaha antarmukhI na banakara bahirmukhI banane jArahI hai aisI sthiti meM gurugAtratA kA honA pUrNataH svAbhAvika hai| __aruci-ise vRddha vAgbhaTa ne anannAbhilASA kahA hai| jvara Ane ke pUrva bhUkha kI icchA calI jAtI hai| pazupakSiyoM meM yaha lakSaNa bahuta adhika dekhane meM AtA hai| jvarotpatti ke pUrva hI ve cArA khAnA banda kara dete haiM / manuSyoM meM aruci kA honA eka spaSTa lakSaNa hai| AsvAdanakriyA vikRta hone se aura jATharAgni dvArA AmAzayastha khAdyapadArthoM ke ayathAvat pacAne se anna kI icchA honA kadApi sambhava nahIM hotaa| jvarakArI tatvoM kA sarvAGgAvasAdaka prabhAva hotA hai / isI avasAda kA pariNAma aruci bhI huA karatA hai / yaha bhI kaphaja lakSaNa hai| jambhA-arthAt jamhAI kA AnA / yaha Alasya kA prakaTa cihna hai| aGgamarda-jvara ke pUrva rogI kA sampUrNa gAtra aisA ho jAtA hai mAno use kUTA gayA hai| sampUrNa zarIra meM eka prakAra kI aisI becainI hotI hai jo gurugAtratA aura sarvAGgazUlatA ke bIca meM par3atI hai / aMga-aMga meM mardana ise har3aphUTana yA pezIphUTana bhI kahate haiN| mAMsapeziyoM meM thakAvaTa kAraka amla padArthoM ke saJcaya ke pariNAmasvarUpa yaha lakSaNa utpanna hotA hai| avipAka-anna kI avipakti yA na pacanA avipAka kahalAtA hai| AmAzaya yA mahAsrota meM sthita anna kA paripAka nahIM huA hai yaha koI lakSaNa nahIM hai, pariNAma hai / aruci yA Asyavarasya ke kAraNa annAvipAka kA anumAna kiyA jA sakatA hai| isa dRSTi se hI suzruta ne avipAka ke jvara ke pUrvarUpoM meM sthAna nahIM diyA hai| parantu bAda ke saMhitAkAroM ne ise grahaNa kiyA hai| caraka ne bhI avipAka ko mAnA hai / AmAzaya meM bhojana rakhA huA hai aura usakA bhArIpana rogI anubhava karatA hai| isa AdhAra para avipAka ko eka pUrva lakSaNa mAna liyA gayA hai| yathArthatA bhI yahI hai ki anna kA paripAka ThIka se nahIM ho pAtA / For Private and Personal Use Only

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- jvara 311 - zItavAtAtapAdi meM icchA dveSa-jvarAkrAnta hone vAle rogI ke zarIra meM zarIra vyApAraniyamana hone ke kAraNa kabhI ThaNDaka acchI lagatI hai kabhI garmI kabhI vaha havA cAhatA hai kabhI havA se dveSa karatA hai| jise loka bhASA meM 'tatAsIrI' kahate haiM vaha use hone lagatI hai / aruNadatta ne ise yuktarItyA spaSTa kiyA hai- kAraNaM vinA sajvarasya prItyaprItI jAyete / kadAcidapriyamapi zabdaM na veSTi kadAcit priyamapi vegavINAdi janitaM vesstti| evaM zItArto'pi kadAcidagni dveSTi, kadAcidazItA?'pyagnimabhilaSati / evaM zItAdiSvapi yojyam / . ... yahA~ usane sajvara prANI meM prIti aprIti kA vicAra kiyA hai| para yaha lakSaNa jvarapUrvAvasthA kA hai jo sajvaratA meM bhI barAbara raha sakatA hai / jvarotpatti meM jaba pitta kI pradhAnatA hotI hai taba zItala upacAra aura havA kI rogI icchA karatA hai jaba zleSmA ke kAraNa jvara banane vAlA hotA hai taba dhUpa yA agni sevana vA uSNopacAra para mana jAtA hai aura jaba vAta janita vikAra hotA hai to snigdha uSNa upacAra priya lagatA hai / parantu yaha to vyakta jvaratA para hI sambhava hai / jvara kA spaSTa pUrvarUpa to zIta se turata dveSa aura turata prIti, uSNatA se turata dveSa aura turata prIti tathA havA se turata dveSa aura turata prIti / rogI kabhI kahatA hai paMkhA karo / kabhI kahatA hai uThA do aura kabhI saba kapar3e utAra kara pheMka detA hai| ise anavasthita cittatA kahA jA sakatA hai jisakA dUsarA abhivyaktIkaraNa sahiSNutvAbhAva nAmaka zabda meM nihita hai| jvara pUrvIrogI alpaprANa hotA hai| usakA jI andara se ghuTatA hai eka prakAra kI becainI use vyathita kie hotI hai isa kAraNa vividha prakAra kI icchAe~ aura dveSa jAgRta ho jAte haiN| ___ yaha icchA dveSa suzruta ne zItavAtAtapAdiSu batalAyA hai| caraka ne use jvalanAtapavAyavambubhaktidveSAvanizcitI ke dvArA agni, dhUpa, vAyu aura jala ina cAra meM anizcita icchA aura dveSa ko kahA hai| vAgbhaTa ne zabda, agni, zIta, vAta, ambu, chAyA aura uSNatA meM Akasmika icchA vA dveSa kA honA svIkAra kiyA hai| kahane kA tAtparya yaha hai ki bArambAra kisI padArtha aura vyavahAra kI icchA karanA phira usI se dveSa karanA anyamanaskatA yA asthira cittatA ke dyotaka vyakta lakSaNa jvarAnupUrvI rugNazarIriyoM meM dekhe jAte haiN| - alpaprANatA-jvara eka aisI vyAdhi hai jisakI utpatti meM sampUrNa zarIra ko bhAga lenA par3atA hai aura jisakA avasAdaka prabhAva jitanA mastiSka para par3atA hai utanA hI hRdaya para bhii| prANoM kA Azraya hRdaya hI hai| sampUrNa cetanA tatva yahIM nivAsa karatA hai| isa kAraNa jvara ke pUrva hRdayAvasAda yA alpaprANatA kA honA asvAbhAvika nahIM hai| caraka kI hAnizca balavarNayoH meM bala kI hAni kA aura aruNadatta ke dvArA vyakta stoka balatvam alpaprANatA kA eka hI artha hai| pratyakSa vicAra meM bhI kitanA hI zUravIra prANI kyoM na ho jvara usako bhIru banA detA hai| caraka ne sadana yA avasannatA yA avasAdakatA ko pRthaka se eka pUrvarUpa mAnA hai| For Private and Personal Use Only

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312 vikRtivijJAna bahunidratA - yaha lakSaNa aSTAMgahRdayakAra vAgbhaTa ke atirikta kisI ne bhI nahIM likhA hai / jvara ke pUrva zrama Alasya aura alpaprANatA kI vyApti kA pariNAma atizaya zayana karanA yA leTe rahane meM honA sambhava hai / atizleSmAjanita jvara meM nidratA kI adhikatA svayaM siddha hai tathA vAtapradhAna jvaroM meM anidratA mukhyatayA pAI jAtI hai| para leTe rahane kI sthiti donoM meM pAI jAtI hai / bahunidratA ke dvArA yahI bhAva yahA~ vyakta hotA hai / Acharya Shri Kailassagarsuri Gyanmandir romaharSa - roMgaTe khar3e honaa| zarIra meM zIta ke kAraNa prakampa hokara tvacA ke rogoM ko pahu~cane vAle tvacA meM sthita pezI sUtroM ke saMkocana se romaharSa hotA hai / kisI bhI trAsakArI vicAra ke kAraNa bhI romaharSa ho sakatA hai / jvara jo prAyaH zItapUrvaka hote haiM unameM romaharSa sadaiva milatA hai / para jo dAhapUrvaka hote haiM unameM bhI jvara AvegA aisA vicAra hI romaharSa kara diyA karatA hai / suzruta to jvara kA eka anivArya pUrvarUpa zIta mAnatA hai ataH romaharSa ko anivAryatayA batalAne kA usakA bhAva ucita hI kahA jA sakatA hai / vaise bhI zalyasambandhI pratyeka jvara zIta ke sAtha ( with a rigor ) hote hue pAye jAte haiM / usase pUrva ke lekhaka zIta aura romaharSa ina donoM ko hI jvara ke pUrvarUpa meM grahaNa nahIM karate / bAda ke lekhaka romaharSa taka jAte haiM zIta taka nahIM / hArIta ne bhI jvara ke vyakta lakSaNoM kA varNana karate hue rogokA dhyAna rakhA hai / vinamana - zarIrAMgoM kA vinAma yA adhika komala ho jAnA bhI jvara kA eka pUrvarUpa hai / gAtra kA jhukanA yA peziyoM kA jhukanA yA unake bala kI kamI honA vinamana kahalAtA hai / isakA mukhya bhAva zarIrastha aMgoM ke bala ( tone ) meM kamI AjAnA hai / peziyoM meM jo loca hotA hai usakA abhAva vinAma kahalAtA hai / hamAre zarIra meM jvarakArI viSoM ke nirantara pravAhita rahane se aMgoM kI nirbalatA mukhyatayA dekhI jAtI hai jisake kAraNa vAstavika rUpa meM antara A jAtA hai / vinAma ko hemAdri ne gAtrazaithilya ( loss of muscular tone ) spaSTataH svIkAra kiyA hai| piNDiko dveSTana - piNDikAoM meM aiMThana honA yaha lakSaNa jvarottarakAlIna jitanA hotA hai utanA jvara kI pUrvAvasthA meM nahIM, jaba taka ki rogI atyadhika durbala na ho yA roga kA AkramaNa itanA bar3A na ho / sAdhAraNa jvaroM meM aGgamarda taka dekhA jAtA hai | hArIta kA jatva phira aMgamarda aura phira piNDikodveSTana eka ke pazcAt eka uttarottara bar3hI huI avasthAoM ko prakaTa karane vAle vividha zabda haiM / piNDaliyoM meM loca kI kamI yA vinamana hone se aura eka vizeSa prakAra kI thakAna hone se saMjJAvaha vAtanADiyoM ke agrabhAgoM meM khiMcAva adhika hone lagatA hai jisase bhedana karane kA sA darda Arambha ho jAtA hai jise hama haDaphUTana aMgamarda yA piNDikodveSTana taka kaha dete haiM / 1. zramo jaDatvaM nayanaplavaH syAdromodgamo ghurdhurakaca jRmbhA / vaivarNatA dveSasazoSatAsye jvarasya ca vyaktakalakSaNAni // For Private and Personal Use Only

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jvara 313 tama-netroM ke Age andhakAra honA yA netra khule hone para bhI a~dhere hI a~dhere kA anubhava honA eka aisA lakSaNa hai jise suzruta ne mAnA hai| zalyarogIya jvaroM meM tama kA honA asvAbhAvika nahIM hai| sarvAGgazaithilya ke kAraNa jahA~ jihvA apanI rasagrAhakatA ko bhUla sakatI hai vahA~ netra apanI pUrI zakti se kArya kara sakeM aisA bhI sambhava nahIM hai| agraharSa--isakA artha hai AnandAbhAva / Ananda kA abhAva cehare para prasannatA ke sthAna para audAsInya A jAnA hai| duHkhapUrNa jIvana hone para kAtaratA se yukta Anana dikhalAI detA hai| yaha sArvadaihika avasAda kA pratyakSa pariNAma hotA hai| koI bhI jvarI prasannamudrA meM taba taka dekhA nahIM jA sakatA jaba taka vaha yogI yA pAgala na ho| zIta-ThaNDa laganA yaha lakSaNa zalyajanita jvaroM kA, vAtapradhAna jvaroM kA aura viSamajvara kA pradhAna lakSaNa hai| jvara ke pUrva zIta kI prApti inhIM meM prAyaH milA karatI hai| sarvasAmAnya jvara meM sadaiva zIta lage yaha Avazyaka nahIM hai| bala kI kamI citta kI anavasthitatA aura alpaprANatA ke kAraNa thor3I sI sardI bahuta adhika zIta meM badala jAne kI sambhAvanA to rahatI hI hai| klama --- yaha glAni ke artha meM AtA hai| sAtha hI isakI zAstrIya paribhASA nimna haiyo'nAyAsaH zramo dehe pravRddhazvAsavivarjitaH / kumaH sa iti vijJeya indriyArthaprabAdhakaH // zarIra meM acAnaka utpanna huI vaha thakAvaTa jisameM vyakti kI zvAsa nahIM phUlatI klama kahalAtA hai jo ki indriyArthagrahaNa meM bAdhaka siddha hotI hai / glAni hone para khAnA, sunanA, sUMghanA, cakhanA, sparza karanA Adi kucha nahIM suhAyA karatA / jvara kI pUrvAvasthA meM anAyAsa zrama kA honA svAbhAvika hai| suzruta ne zrama kA varNana kara diyA hai ataH klama ko pRthaka dikhAne kI AvazyakatA nahIM huii| vAgbhaTa ne Alasya kA varNana to kiyA hai, jo klama ke pUrNa bhAva kA bodha karA nahIM sakatA ataH klama kA use spaSTa ullekha karanA par3A hai| asUyA-isakA artha mahAmahopAdhyAya indu ne 'parasya doSAviSkaraNam' kiyA hai jisakA artha hai dUsare ke doSa ko prakAzita karanA parantu yahA~ jvara ke dvArA grAsA jAne vAlA rogI kisI ke doSa kI ora utanA dhyAna nahIM de pAtA jitanA ki apanI becainI kI ora detA hai / yahA~ hama asUyA se asahiSNutA leNge| jvara kI pUrvAvasthA meM rogI meM tunukamijAjI bar3ha jAtI hai / jisake pariNAmasvarUpa hitopadezeSvakSAnti - guru, pitA Adi ke dvArA diye gaye hitakara upadeza kI asahanatA / isI ko aSTAMgasaMgrahakAra ne 'hitopadezeSu pradveSaH' likhA hai / yaha bhI asUyA kA hI eka vyaktarUpa hai| , prItiramlapaTUSaNe-jvara ke pUrva rogI meM 'dveSaH svALuSu bhakSyeSu' ho jAtA hai / vaha madhura bhakSya padArthoM ke nAma se hI cir3hane lagatA hai| use khaTTe, namakIna, carapare cATa par3Ake Adi pasanda Ane lagate haiM / yaha Asyavairasya kA mUrta pariNAma hai / mukha 27, 28 vi0 For Private and Personal Use Only

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-314 vikRtivijJAna meM virasatA hone ke kAraNa aura asthira cittatA kI sahavyApti ke hone se khAdya dravyoM meM ati aura kupathyakara padArthoM meM prIti milatI hai / para yaha prIti bhI cirasthAyI nahIM hotI / apathya ko rokane ke lie jo hitecchu kucha kahatA hai to usase rogI bahuta abhadra vyavahAra karane lagatA hai / bAlaka yA zizu jinheM madhura dravya atyanta priya hote haiM jvara Ane se pahale unase dveSa karane lagate haiM / isa prakAra asUyA se ye do lakSaNa milate haiM / gatiskhalana - kriyAzakti meM kamI yA gati karane para gira par3anA, lar3akhar3A jAnA yaha bhI eka lakSaNa hai jo jvara ke pUrva mila sakatA hai| rogI ko lAThI kI yA kisI ke sahAre kI AvazyakatA par3atI hai / yaha lakSaNa jvarottarakAlIna yA sajvarAvasthA maiM adhika milatA hai para jaba saMkrAmaka vyAdhijanita gambhIrajvara kA viSa zarIra meM pravAhita ho rahA ho to gatiniyAmaka kendra meM vibhramotpatti ho sakatI hai jo gatiskhalana karA diyA karatI hai / yaha lakSaNa vRddha vAgbhaTa ne pradarzita kiyA hai / vRSA - bAleSu tRbhRzam kA artha bAlakoM meM pyAsa kI adhikatA honA kiyA jAtA hai | adhika pyAsa kA honA yaha jvarAnupUrvI rogiyoM meM Arambha se bhI mila sakatA hai / jitanA hI jvarakArI hetu adhika viSAkta hogA pyAsa utanI hI adhika lagegI / jvara bAlakoM meM sadaiva adhika tRSNA kI utpatti karatA hai / zIlavikRti - caraka ne zIla kI vikRti ko bhI jjara ke pUrvarUpoM meM rakha diyA hai / yahA~ zIla se svabhAva abhipreta hai| rogI kA jo svabhAva sAdhAraNa loka meM dekhA jAtA hai usameM thor3A bahuta parivartana ho jAtA hai / jo dAnI dAna karatA rahatA thA vaha thor3e se padArtha kA bhI apane lie saMcaya karane lagatA hai / nissvArthabuddhi svArthaparAyaNa bana jAtA hai| miSTabhASI kaTubhASI ho jAtA hai / nirlajjatA, lobha, bhIrutA, svArthAdi durguNoM kA pratyeka prANI meM kitanA saMgraha hai / ise usake jvarAkrAnta hone ke pUrva yA jvarakAla meM bhale prakAra dekhA jA sakatA hai| isI ko caraka ne svakAryeSu pratIpatA kaha kara bhI pukArA hai / saMkSepa meM, jvarapUrvAvasthA pratyeka prANI meM eka atyanta mahattva kA sthAna rakhatI hai / vyakti kA apanA svabhAva badala detI hai usakA sAhasa kama kara detI hai / use thakA detI hai aura use khATa para leTe rahane ko vAdhya kara detI hai / usakA aMga pratyaMga dukhane lagatA hai aura vaha tunukamijAja ( anavasthita citta ) ho jAtA hai / yataH ye sabhI vikRtiyA~ haiM jo eka prakRtaM prANI meM dekhane meM AtI haiM ataH hamane abhinavavikRtivijJAna nAmaka isa pustaka meM inakA samAveza kiyA hai| jvara ke pUrvarUpoM kA saMkSipta para sampUrNatvena varNana kI dRSTi se carakasaMhitA ke nidAnasthAna meM varNita vivaraNa hama yahA~ avikula uddhRta kiye dete haiM / inameM kucha lakSaNa aise bhI haiM jinheM hamane pIche nahIM diyA / bahuta se lakSaNa uvara ke samaya adhika spaSTa hone se Age kahe jAveMge tasyemAni pUrvarUpANi bhavanti - tadyathA - mukhavairasyaM gurugAtratvamanannAbhilASazcakSuSorAkulatvamazvAanaM nidrAdhikyaM aratiH jRmbhA vinAmo vepathuH zramabhramapralApajAgaraNaromaharSadantaharSAH zabdazItavA For Private and Personal Use Only

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jvara tAtapasahatvAsahatvamarocakAvipAko daurbalyamaGgamardaH sadanamalpaprANatA dIrghasUtratAlasyamucitasya karmaNa hAniH pratIpatA svakAryeSu gurUNAM vAkyeSvabhyasUyA bAlebhyaH pradveSaH svadharmesvacintA mAlyAnulepanabhojanaklezanamadhurebhyazca bhakSyebhyaH pradveSaH uSNAmlalavaNakaTupriyatA ceti jvarasya pUrvarUpANi bhavanti prAkasantApAt , api cainaM santApAtamanubadhnanti / / jvara kI saMkhyA samprApti . jvara ke kitane prakAra hote haiM isake sambandha meM vibhinna cikitsA paddhatiyoM meM vibhinna mata pAye jAte haiN| Ayurveda meM bhI sabhI AcArya eka mata nahIM hai| unhoMne jvaroM ke kitane hI dRSTikoNoM se vibheda kiye haiN| hama pahale caraka saMhitA meM vyaktajvara ke bhedoM kA ullekha karanA yahA~ saGgata mAnate hue calate haiN| caraka ne santApalakSaNa ke AdhAra para jvara ko eka prakAra kA sarvaprathama mAnA hai| ekarUpajvara santApa-yaha lakSaNa sivA jvara ke anyatra kahIM nahIM milA krtaa| yaha zarIrottApa kA mApaka cihna hai| ise Adhunika kAla meM tharmAmITara dvArA nApA jAtA hai| kisI anya roga meM santApa nAmaka cihna nahIM prApta hotaa| dAha nAmaka roga meM santaptatA kA anubhavamAtra hotA hai| tharmAmITara ke dvArA vaha vyakta nahIM hotaa| para jvara meM svabhAvoSmA ke atirikta dehoSmA bhI milatI hai| santApo dehendriyamanastApaH / isa lakSaNa ke anusAra deha meM tApa, indriyoM meM vaikalya aura mana meM vaicitya, arati aura glAni kA milanA Avazyaka hai| jvara meM jo santApa hotA hai vaha nizcaya hI dehendriya manastApa huA karatA hai| dAha meM vaha tApa dUsarI zreNI kI vastu hai| pahale hamane suzruta kA jo sveTAvarodhaH santApaH sarvAGgagrahaNaM tathA / yugapadyatra roge ca sa jvaro vyapadizyate // nAmaka paribhASA dvArA jvara ko vyakta kiyA hai vaha bhI caraka ke eka eveti jvarasyaikameva svarUpaM santApalakSaNatvam ke Age phIkA par3a jAtA hai| parantu svedAvarodha kuSTha kA pUrva rUpa hai aura sarvAGgagrahaNa vAta rogoM ke pahale pAyA jAtA hai ataH kevala santApa (rise of temperature ) tApAMza kA bar3hanA mAtra hI jvara ko vyakta karane kA ekameva sAdhana hai / ataH jvara ko eka hI prakAra meM rakhane ke lie use 'santApa' nAmaka saMjJA se abhivyakta kara sakate haiM / ataH ko'yaM vyAdhiriti ? ke prazna kA uttara__ ayaM vyAdhivaraH dehendriyamanastApitvAt yathA dAho dehatApI yathA ca dAho dehaM tApayati tathAyaM dehendriyamanAMsi tApayati tasmAdayaM jvara iti / jvara hai aisA kaha dene para jaba prazna ho ki kauna jvara hai ? taba-- jvaro'yaM vAtajo viSamArambhavisargAdilakSaNatvAt , yathA pittajaH yathA ca pittajvaraH kaTukAsya - - 1. jvarastveka eva santApalakSaNaH / For Private and Personal Use Only

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316 vikRtivijJAna tvAdilakSaNastathA cAyaM viSamArambhavisargitvAdi lakSaNastasmAjjvaro'yaM vAtaja ityevamasAdhAraNalakSaNa sahacaritasavyabhicAri lakSaNenApi sAmAnyato vizeSatazcAnumIyate / arthAt yaha vAtajajvara hai yA paittika hai yA zlaiSmika hai aisA kahanA hotA hai| dvividha jvara (1) abhiprAyavizeSa se jvara ke do prakAra batalAye gaye haiMa-zItAbhiprAyajvara-pittAtmaka A-uSNAbhiprAyajvara-vAtAtmaka tathA kaphAtmaka zItAbhiprAya kA artha jisameM rogI zItala padArtha khAne kI icchA rakhatA hai yaha uSNasamuttha arthAt paittika hotA hai| uSNAbhiprAya jisameM rogI upNapadArtha sevana karane kI icchA rakhatA hai| ye vAtika aura zlaiSmika donoM prakAra ke jvaroM meM dekhe jAte haiM kyoMki ve donoM zItasamuttha hote haiN| vAyu svayaM yogavAhI hone ke kAraNa pitta ke sAtha milakara zItAbhiprAya aura kapha ke sAtha milakara upNAbhiprAya jvara utpanna kara sakatI haivAtapittAtmakaH zItamuSNaM vAtakaphAtmakaH / icchatyubhayametat tu jvaro vyAbhizralakSaNaH / / yogavAhaH paraM vAyuH saMyogAdubhayArthakRt / dAhakRt tejasA yuktaH zItakRt somasaMzrayAt / / vAyu kI yogavAhI zakti ko yadi pAThaka yahIM pahacAna leMge to ve Age dvandvaja vikAroM meM vividha roga lakSaNoM ko jAna pAyeMge aura AyurvedajJoM ne dvandvaja vikAroM kI jo cikitsA dI hai usake mUla taka pahu~cane kI sAmarthya bhI prApta kara skeNge| (2) nijAgantu bheda se bhI jvara ke 2 prakAra kahe gaye haiMa-nija jvara A-Agantu jvara nijajvara zArIra doSoM meM mithyAhAra vihArAdi ke kAraNa utpanna vikRti ke kAraNa utpanna hotA hai| isakA hetu saba zarIra ke antarbhAga meM hI nihita hotA hai / Agantu jvara sadaiva bAhmakAraNoM se utpanna hotA hai| Adhunika vicArakoM ne jitane rogANu yA jIvANu jvarakArI ginAe haiM unake dvArA utpanna hone vAlA jvara isI zreNI meM AtA hai| nija aura Agantu ina do bhedoM ke andara manuSya ko hone vAle sabhI prakAra ke jvaroM kA samAveza ho jAtA hai| (3) prakAra bheda se bhI jvara ke 2 bheda kie gaye haiMa-zArIrajvara A-mAnasajvara zArIrajvara zarIra meM hotA hai aura mAnasajvara bhI zarIra meM hI adhiSThita dekhA jAtA hai| parantu ye do prakAra isa vibheda ko vyakta karane ke lie haiM ki jvara ne pahale zarIra ko grasA yA mana ko udAharaNa ke lie zoka ke kAraNa mana vyathita huA aura phira jvara A gayA yaha zokajajvara mAnasajvara kahA jaavegaa| dUsarA udAhaNa daNDAbhighAtajanita jvara kA hai| daNDa kA abhighAta zarIra para huA aura vAta kA prakopa hokara abhighAtaja vAtika jvara banA yahA~ mana ko kaSTa bAda meM huA yaha zArIra jvara hai| ise svayaM bhagavAn Atreya ne spaSTa kara diyA hai For Private and Personal Use Only

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jvara zArIro jAyate pUrvaM dehe manasi mAnasaH / vaicityamaratiglAnirmanasastApalakSaNam / / indriyANAM ca vaikRtyaM dehe santApalakSaNam / / mAnasajvara meM vicittatA, arati aura glAni ye 3 lakSaNa mukhya rUpa meM pragaTa hote haiM aura zArIrajvara meM indriyoM kI vikRti pradhAna rUpa se pAI jAtI hai| yahA~ yaha smaraNa rakhanA cAhie ki Ayurveda ne samanaska zarIra ko hI jvara kA adhiSThAna mAnA hai| jvara mana aura zarIra donoM ko hI vyathita karatA hai| para mana pahale vyathita huA to mAnasa aura zarIra pahale vyathita huA to zArIrajvara kahA jaavegaa| (4) saumya aura Agneya bheda se bhI jvara 2 prakAra kA kahA jAtA hai| a-saumyajvara A-Agneyajvara vAtika aura zlaiSmika jvara saumya haiM / vAtazlaiSmika jvara bhI saumya hai| paittika jvara aura vAtapaittikajvara Ameya haiN| sAnnipAtika jvara tathA pittakaphAtmaka jvara ye donoM zItoSNa yA saumyAgneyaguNabhUyiSTha mAne jAte haiN| yathArtha meM to saumyajvara, Agneyajvara aura saumyAgneyajvara karake tIna prakAra banate haiM parantu cUMki saumyAgneya rUpa meM bhI soma yA agnitatva kI thor3I bahuta kamI bezI hone ke kAraNa use uparokta do meM se hI kisI eka meM liyA jA sakatA hai tathA saumya aura Agneya vyatirikta anya koI bhAva bhI udita nahIM hone se ye do prakAra hI mAnya haiN| cikitsA aura dravyaguNa kI dRSTi se inakA bahuta mahattva hai| inake sAtha hI pAThaka ko abhiprAyAtmaka bheda ko bhI punaH smaraNa kara donoM kA sAmya mAlUma karake viSaya kA ThIka ThIka pratipAdana kara lenA caahie| (5) vegoM kI dRSTi se bhI jvaroM ke do bheda haiM:1. antarvegajvara 2. bahirvegajvara antardAho'dhikastRSNA pralApaH zvasanaM bhramaH / sandhyasthizalamasvedo doSavarcI vinigrahaH / / ___antarvegasya liGgAni jvarasyaitAni lakSayet / / / antarvegajvara meM antardAha aura pyAsa kI adhikatA hotI hai rogI pralApa karatA hai zvAsa kI gati bar3ha jAtI hai use bhrama ho jAtA hai asthi sandhiyoM meM zUla, prasveda kA na nikalanA aura vAtapitta zleSmA ye doSa tathA mala kA ruka jAnA nAmaka lakSaNa pAye jAte haiM / ye lakSaNa spaSTataH pragaTa karate haiM ki jvara kA vega zarIra ke andara adhika hai| yahI nahIM rogI ke hAtha paira ThaNDe mAlUma par3ate haiM yaha lagatA hai ki rogI ko adhika jvara nahIM hai para jaba tharmAmITara lagA kara dekhate haiM to use 104 aura 105 taka jvara milatA hai| zarIra meM bhayAnaka dAha ke sAtha pralApa aura zvAsa kI gati kA bar3hanA ye sadaiva gambhIra lakSaNa mAne jAte haiN| santApo'bhyadhiko bAhyastRSNAdInAM ca mArdavam / bahirvegasya liGgAni sukhasAdhyatvameva ca // 1. kevalaM samanaskaM ca jvarAdhiSThAnamucyate zarIram / 2. cakravaddhamato gAtraM bhUmau patati sarvadA / bhramaroga iti zeyo rajaH pittAnilAtmakaH // For Private and Personal Use Only

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318 vikRtivijJAna bahirvega jvara meM bAhya santApa atyadhika hotA haiM / pyAsa, bhrama, zvAsavega, pralApa, sandhizUla Adi lakSaNa jo pahale antarvega meM batalAye haiM ve yahA~ saumya vA mRdu rUpa meM hote haiN| dekhane meM jvara kI tIvratA hone ke kAraNa roga gambhIra jAna par3atA hai para yathArthataH yaha sukhapUrvaka siddha hone vAlA roga hai / Acharya Shri Kailassagarsuri Gyanmandir bahirvaiga meM bAhya bhAga adhika uSNa aura antarvega meM zarIra kA antara bhAga adhika uSNa hotA hai / bAhya bhAga yA pariNAha ( peripheral part ) meM tApAdhikya kucha kAla raha kara dhIre dhIre vilIna ho jAtA hai / yahA~ pralApAdi gambhIra yA mAraka lakSaNa nahIM pAye jAte / antarvega meM zarIra ke andara sthita aMga (visceral parts ) adhika tapta ho jAtA hai / mArgoM ke avarodha aura sveda ke na nikalane se prANI andara hI andara ghuTatA hai jisase use bhayAnaka dAha aura bhISaNa pyAsa ke sAtha sAtha zvAsa vega kI vRddhi aura bakavAsa sUjhatA hai / aisA rogI bahuta kama bacatA huA Aja kala dekhA gayA hai / zarIra kA bhItarI bhAga jIvana ke lie paramAvazyaka aMgopAGgoM se yukta hai usa para jvara kA viziSTa prahAra sadaiva gambhIra pariNAmakArI ho sakatA hai / bAhya bhAga to Antara zarIra kI rakSA ke hI nimitta hone se jvara ke jhaTake ko jhela letA hai aura rogI baca jAtA hai / Adhunika ina bhedoM ko nahIM mAnate aura unakA zarIra vyApAra vikRti darzaka zAstra isake lie koI upayukta kAraNa bhI nahIM de pAtA para yathArthatA yaha hai ki aise rogI jinheM antarvega jvara ho yA bahirvega bahudhA pAye jAte haiM inakI kamI nahIM hai| ( 6 ) prakRti vikRti bheda se bhI jvara 2 prakAra kA kahA jAtA hai: A- - vaikRtajvara cakrapANidatta ne prAkRta jvara kI vyAkhyA karate hue likhA hai: aprAkRta jvara - tatra kAlasvabhAvaprakupitadoSaH prakRtirucyate, tajjAtIyAcca dopAdbhUto jvaraH prAkRta ucyate / kAla ke svabhAva ke anusAra doSoM kA jo prakopa hai use yahA~ prakRti mAnA jAnA cAhie isa prakRti ke kAraNa kupita doSaja jvara jitane bhI hoMge ve sabhI prAkRta jvara kI koTi meM AveMge prAkRtaH sukhasAdhyastu vasantazaradudbhavaH / kAlaprakRtimuddizya procyate prAkRto jvaraH // vasanta Rtu meM kapha ke prakopa kA prAkRtika samaya hone se vasanta meM utpanna kapha jvara prAkRta jvara hai / varSA Rtu meM utpanna vAta jvara bhI vAta ke prAkRtika prakopaka kAla utpanna hone se prAkRta jvara hotA hai / isI prakAra prakRti ke niyama ke anusAra zarada Rtu meM pitta kA prakopa hotA hai aura usake kAraNa utpanna pittajvara bhI prAkRta jvara kahA jAtA hai / ina prAkRta jvaroM meM vasanta kA kapha jvara aura zarad kA pitta jvara sukha sAdhya hotA hai / aura varSA kAlIna vAta jvara kaSTa sAdhya hotA hai / / kaise hotA hai ? isakI bhI eka jisakA vistRta varNana suzruta prAkRta jvara kaise utpanna hote haiM aura doSoM kA saMcaya, prasara aura prakopa kyA aura nitAnta lAbhaprada zatapratizata vaijJAnika eka kathA hai sUtrasthAna ke 21 veM adhyAya meM tathA aSTAMgahRdaya sUtra For Private and Personal Use Only

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... jvara 316 sthAna ke 12 veM adhyAya meM diyA huA hai| yahA~ saMkSepa meM caraka ne jo likhA hai vaha isa prakAra hai uSNamuSNena saMvRddhaM pittaM zaradi kupyati / citaH zIte kaphazcaivaM vasante samudIryate // varSAsvamlavipAkAbhiradbhiropavibhistathA / saJcitaM pittamudriktaM zaradyAdityatejasA / / jvaraM saJjanayatyAzu tasya cAndra balaH kaphaH / prakRtyaiva visargAcca tatra nAnazanAda bhayam / / adbhiroSadhibhizcaiva madhurAbhizcitaH kaphaH / hemante sUryasantaptaH sa vasante prakupyati // tasmAd vasante kaphajo jvaraH samupajAyate / AdAnamadhye tasyApi vAtapittaM bhavedanu / AdAvante ca madhye ca jJAtvA doSabalAbalam / zaradvasantayovidvAn jvarasya pratikArayet // uSNa pitta uSNa grISma Rtu meM bar3ha kara zarada Rtu meM prakupita hotA hai| zItala kapha zIta Rtu meM bar3ha kara vasanta meM prakupita ho jAtA hai| varSA Rtu meM oSadhiyA~ tathA jala amlanipAkI hokara sUrya ke teja se saJcita huA prANiyoM ke zarIra kA pitta zarad Rtu meM udIrNa hokara zIghra jvara ko utpanna karatA hai| kAla ke svabhAva ke kAraNa aura visarga kAla hone se usa jvara meM kapha kA bhI thor3A anubandha hotA hai| ataH pitta aura zleSmA donoM ko ThIka sthiti meM lAne ke lie anazana yA laMghana karAne se koI hAni nahIM hotii| kahane kA tAtparya yaha ki zaratkAlIna jvaroM ke AmadoSa ko pacAne kA paramottama upAya laMghanakarma hai| madhura rasa yukta jala aura oSadhiyoM ke kAraNa hemanta Rtu meM prANiyoM ke zarIra meM saMcita huA kapha vasanta Rtu meM sUrya ke kucha tapta hone ke sAtha hI prakupita ho jAtA hai| aura isI ke kAraNa jvarotpatti bhI hotI hai| yaha AdAna kAla hone se pitta kA bhI anubandha rahatA hai aura sUrya kiraNoM ke dvArA snehabhAva kI kamI hone se rUkSatA mI hone lagatI hai ataH vAta kA bhI anubandha hotA hai| arthAt vasantakAlIna kaphajvara ke sAtha-sAtha vAta aura pitta ke donoM doSa anubandha rUpa meM milate haiN| kahA bhI hai vasantohyAdAnamadhyama RtuH sUryakarasahasreNa prANinAM svehAdAnato madhyamatvena madhyabalatvAt rokSyoSNAbhyAM tasyApi jvarasyAnu anubandharUpaM vAtapittaM bhavet / yahA~ bhI kapha ko dUra karane ke lie laMdhanoM kA Azraya liyA jA sakatA hai kyoMki prANI madhyama balayukta hotA hai| ataH vidvAn vaidya ko zarad yA vasanta Rtu ke Adi madhya yA anta meM doSa ke balAbala kA vicAra kara ucita pratIkAra karanA caahie| kyoMki ye prAkRta jvara sukha sAdhya hote haiN| varSA kAlIna vAtika jvara jisameM thor3A pitta kA bhI anubandha rahatA hai kaSTasAdhya mAnA gayA hai kyoMki vahA~ saMcita aura prakupita doSa vAta ko laMghana dvArA nikAlA nahIM jA sakatA aura varSA kA kAla svayaM duHkhadAyI hone se AmadoSa kA atyadhika saMcaya ho jAtA hai| - uparokta tInoM kAloM meM jisa krama se jvara batalAyA gayA hai usake viruddha jo jvara kA anya krama banegA vaha sabhI vaikRta jvara kI kuJjI meM AtA hai| jaise zarad Rtu meM For Private and Personal Use Only

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320 vikRtivijJAna vAta jvara, vasanta Rtu meM pitta jvara aura varSA Rtu meM zleSmajvara Adi / nidAna meM jo jvarakArI vividha hetu diye gaye haiM jinake kAraNa cAhe jisa Rtu meM kisI bhI niyama kA vinA pAlana kie hue jo jvara ho jAtA hai vaha sabhI vaikRta uvara kI sImA meM jAtA hai| aba gaMgAdhara ne prAkRta aura vaikRta jvaroM ke sambandha meM svayaM zaGkA uThA kara usakA acchA samAdhAna kara diyA hai / kAlaprakRtimuddizya nirdiSTaH prAkRto jvaraH / yaha sampUrNa samAdhAnoM kI kuJjI hai / kAla ke svabhAva se sambandhita doSoM kI hetukatA kA lakSya karake hI prAkRtajvara batalAyA gayA hai / prAkRta jvara ke sambandha meM atra tu kAlaprakRtyA cayapUrvakA doSaprakopa jAtA rogAH prAkRtA na tu doSa kopAjjAtA iti / kAla prakRti ke anusAra cayapUrvaka doSoM ke prakopa ke kAraNa utpanna roga prAkRta kahalAte haiM / kevala madya doSa ke kopa se utpanna jvara prAkRta nahIM / pahale hama pitta ko lete haiM / isakA caya varSA Rtu meM hotA hai zaratkAla meM prakopa hotA hai aura zItakAla meM prazamana ho jAtA hai / ataH pitta jvara kA prAkRtika kAla zaratkAla huA / kapha kA zItakAla meM saMcaya hotA hai, vasanta meM prakopa hotA hai aura grISma kAla meM prazamana ho jAtA hai ataH kapha jvara kA prAkRtika kAla vasanta Rtu hai / isI prakAra vAyu kA grISma meM sacaya hotA hai, phira usakA prAvRT meM prakopa ho jAtA hai tathA varSA meM prazamana ho jAtA hai | ataH vAtaja jvara kA prAkRtika kAla prAvRT yA pAvasa Rtu hotA hai / phira dUsarA eka cakra aura calatA hai jisameM pitta kA saMcaya kAla vasanta Rtu ho kara grISma meM prakopa aura prAvRT meM prazamana hotA hai / isa avasthA meM grISma pittaja jvara kA prAkRtika kAla bana jAtI hai / kapha kA saMcaya prAvRT meM aura prakopa varSA meM tathA zamana zarad meM hotA hai yahA~ varSA kAla jvara ke lie prAkRtika hotI hai / isI prakAra vAyu kA zarada meM saMcaya aura zIta meM prakopa aura vasanta meM prazamana ho jAtA hai isa dRSTi se vAtaja jvara ke lie zItakAla prAkRtika kAla bana jAtA hai / ataH kisI bhI doSa kA jaba vidhivat saMcaya hokara phira ThIka kAla para prakopaka kAraNoM kI upasthiti meM prakopa hotA hai to yaha avasthA eka vizeSa niyama ke anusAra huI yahI prAkRta jvara hai / jaba niyamoM kI koI bhI zrRMkhalA bekAra ho jAtI hai taba jo jvara hotA hai vaha vaikRtajvara kahalAtA hai / anya kAloM ko pradarzita karate hue jalpakalpataru TIkAkAra likhate haiM te hyanyeSu zaravasantaprAvRT bhinneSu paJcasvRtusu hemantavasantagrISmaprAvRvarSAsu svakAraNakupitAt pittAjjAtAH, grISmaprAvRTvarSAzaraddhemanteSu tu svahetukopAt kaphAjjAtAH, varSAzaraddhemantavasantagrISmeSu svanidAnakupitAd vAtAjjAtAzca rogA vaikRtAH te ca duHkhAH prAyeNa bhavanti / hetava ityAdi / yahA~ mUla prAkRta jvara tIna hI mAna kara cale haiM arthAt zarad Rtu meM pittajvara, vasanta Rtu meM kapha jvara tathA prAvRT Rtu meM vAta jvara / pittajvara zarad Rtu ke atirikta anya pA~coM RtuoM meM jaba bhI hogA vaha vaikRta jvara kahalAvegA / ataH hemanta, vasanta, For Private and Personal Use Only

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jvara 321 grISma aura prAvRT aura varSA meM pittajvara apane viziSTa kAraNoM meM kupita hotA hai aura vaikRta pittajvara banatA hai| kaphajvara vasanta Rtu meM prAkRta para jaba vaha anya pA~coM RtuoM grISma prAvRT varSA zarad aura hemanta Rtu meM vizeSa kaphakAraka AhAra vihArAdi ke kAraNa utpanna hotA hai to vaikRta / eyarakaMDIzaNDa relave ke Dabbe meM madarAsa se dillI taka 3 dina yAtrA karane vAlA prANI jaba dillI meM garmI ke mausama meM utare aura use kaphajvara ho jAve yaha jvara Rtu viparIta yA prAkRtika niyamoM ke viparIta kAla meM utpanna hone se vaikRta jvara hI khlaavegaa| prAvRTa meM vAtajvara prAkRta jvara hai para varSA, zarada, hemanta, vasanta aura grISma meM vividha kAraNoM se utpanna hone ke kAraNa vaikRta vAta jvara bnegaa| ____ 'prAkRtaH sukha sAdhyastu' ke kAraNa prAkRta aura vaikRta ke vicAra meM bahuta bar3I bAdhA par3I huI hai| prAkRta sukhasAdhya hotA hai ataH zaratkAlIna pittajvara aura vasanta kAlIna kaphajvara sukha sAdhya hone se prAkRta haiM aura varSA yA prAvRT kAlIna vAtajvara kaSTasAdhya hone se vaikRta jvara hai aisA eka bhrama cala par3A hai| parantu vaisA bhrama rahanA nahIM cAhie / vAtajvara to prAvRT kAlIna vAta ke prakopa ke kAraNa hotA hai vAstava meM adhika kaSTapUrvaka siddha hone vAlA yA asAdhya na hokara siddha ho hI jAtA hai aura prAkRta vaikRta jvara kA jJAna roga kI sAdhyatA aura kaSTasAdhyatA para nirbhara nahIM hai / vaha to kAlaprakRtimuddizya nirdiSTaHprAkRto jvaraH vAlI paribhASA para nirbhara karatA hai| prAyeNAnilajo duHkhaH ki anilaja (vAtaja) vyAdhi prAyaH karake kaSTasAdhya hotI hai itanA iGgita kara dene ke hI kAraNa pahale prAkRtaH sukhasAdhyastu kA vyavahAra kiyA gayA hai| kahane kA tAtparya yaha hai ki prAvRT kAlIna vAtaja jvara kaSTasAdhya hone para bhI prAkRta jvarAntargata hI caraka mAnatA hai| (7) sAdhyAsAdhyatA kI dRSTi se bhI jvara ke 2 bheda kiye jAte haiM :a-sAdhya jvr| __ A-asAdhya jvara / / sAdhyAsAdhyatA ( Prognosis ) jvarAkrAnta ke jIvana kI dRSTi se atyanta mahattva pUrNa hai| eka atyanta haTTA kaTTA vyakti jisakI avasthA 34 varSa kI thI kevala 24 ghaNTe ke jvara meM isa asAra saMsAra ko apanI strI aura baccoM ko sadA ke lie vilakhatA chor3a kara calA gayA / jvara sAdhya hai yA asAdhya isakA pUrNa vicAra karanA paramAvazyaka hai / yaha zarIra meM huI vikRti kI mApa kA eka sthUla anumAna hotA hai| sAdhya jvara ke sambandha meM likhA hai balavatsvalpadoSeSu jvaraH sAdhyo'nupadravaH / balavAn tathA alpa doSa vAle prANiyoM meM upadrava rahita jvara sAdhya hotA hai| rogI meM balaparyApta ho jvara ke kAraNabhUta doSoM kI azAMza kalpanA karane para ve thor3e hoM aura upadrava' koI na ho to aisA jvara sukhasAdhya mAna lenA caahie| agara zarad 1. zvAsomU rucicchrditRssnnaatiisaarviddgrhaaH| hikkAkAsAGgabhedAzca jvarasyopadravA daza / / For Private and Personal Use Only

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322 vikRtivijJAna Rtu meM pitta kA prakopa bahuta se kAraNoM se ho, vasanta Rtu meM usI prakAra kapha kA prakopa kaI bar3e bar3e kAraNoM se ho aura prAvRTa meM vAta kA prakopa bahuta se kAraNoM se ho to prAkRtaH sukhasAdhyastu vasantazaradudbhavaH meM antarnihita bhAva naSTa hogA ki nahIM ? para nahIM vahA~ to kAlaprakRtijAta varSAsvamlavipAki jalAdi kAraNoM se saJcita huA pitta zaratkAla meM sUrya ke teja se abhivyakta hokara jo pittajvara kA rUpa grahaNa karatA hai vaha sukhasAdhya hai na ki pittakAraka kAraNoM se utpanna huA ( usI kAla kA hI cAhe sahI) pittajvara / idhara zaratkAla kA pittajvara aura vasantakAlIna kaphajvara kevala sUrya kI kiraNoM ke dvArA hI uttejita hote haiM ataH sukhasAdhya haiM para varSAkAlIna vAtajvara ke preraka kAraNa aneka hote haiM ataH vaha kaSTasAdhya hotA hai| vaikRta jvara sabhI kaSTasAdhya mAne gaye haiN| sukha sAdhya roga meM upadrava koI nahIM honA caahiye| pIche hama pAdaTippaNI meM upadravoM kI tAlikA de cuke haiM para usakI vAstavika paribhASA haiupadravastu khalu rogo rogAntarakAlajo rogAzrayo roga eva sthUlo'NurvA rogAt pazcAjjAyata iti / aba asAdhya jvara ke lakSaNa jo carakasaMhitA meM varNita haiM upasthita kie jAte haiM:hetubhirbahubhirjAto blibhirbhulkssnnH| jAraH prANAntakRd yazca zIghramindriyanAzanaH / / saptAhAdvA dazAhAdA dvAdazAhAttathaiva ca / sapralApabhramazvAsastIkSNo hanyAjjvaro naram / / jvaraH kSINasya zUnasya gambhIro dairdhraatrikH| asAdhyo balavAn yazca kezasImantakRjjvaraH / / bahuta se hetuoM ke kAraNa utpanna huA jvara jisameM bahuta se balavAn lakSaNa bhI ho zIghra prANAnta kara detA hai| jvara kI bahuliGgatA (adhikalakSaNatA) bahuta kharAba mAnI jAtI hai / parantu bahuta se balavAn hetuoM ke kAraNa vyAdhi bhI bahuta se lakSaNoM vAlI banegI yaha Avazyaka nahIM hai| athavA eka yA do hetuoM ke kAraNa utpanna jvara sadaiva eka yA do roga lakSaNoM se yukta hogA yaha bhI nahIM kahA jA sktaa| balavAn bahuta se hetuoM se yukta adRSTa prAktanakarmAdi kAraNoM se jvara meM alpalakSaNa yA bahulakSaNa dekhe jA sakate haiN| zarIra ke kitane dUSyoM ke sAtha doSoM kA samparka hai jitane adhika dUSyoM ke sAtha samparka hotA hai utane hI adhika roga ke lakSaNa bhI jvara ke sAtha dekhe jA sakate haiN| isI prakAra vikRti viSama samavAya ke kAraNa alpa hetu hone para bahulakSaNatA aura bahuta hetu hone para alpalakSaNatA pAI jA sakatI hai| __thor3e hetuoM ke kAraNa bahulakSaNa janaka doSa duSTi ke dvArA bahulakSaNatA utpanna ho jAne para bhI prANAntakArI asAdhyatA nahIM aatii| isI prakAra abalasampanna yA alpabala yukta bahuta se yA thor3e hetuoM se bahuta se lakSaNoM se yukta hue jvara meM bhI prANAnta kA koI kAraNa dikhAI nahIM par3A krtaa| jisa jvara ke kAraNa zArIrika jJAnendriyoM yA kamandriyoM meM se kisI eka yA kaI kI kriyAzakti naSTa hotI calI jAve aura yaha indriya nAza bahuta drutagati se ho to samajha lenA cAhie jvara yA roga asAdhya hai| For Private and Personal Use Only

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jvara 323 tIkSNa atyugra vega vAle jvarI meM pralApa, bhrama aura zvAsa, prazvAsa, gati, tIcA hotI calI jAve to vaha manuSya avazya hI mara jAtA hai / marane ke dina bhI batalAye gaye haiM ki vAtika eka saptAha meM, paittika daza dinoM meM tathA zlaiSmika kAraNa bAraha dinoM meM mAra detA hai| vAyu zIghrakArI hone se jaldI pitta para zIghrakArI hone se kucha vilamba se tathA kapha cirakArI hone se sabase adhika samaya lekara nAratA hai|' rogI kA bala tINa ho gayA ho aura vaha sUja gayA ho, ghara dIrghakAlIna aura gambhIra ho to vaha asAdhya hotA hai| isI prakAra jisa ghara meM svataH hI bAloM kI mA~ga bana jAtI hai vaha bhI asAdhya hotA hai / suzruta ne isa sambandha meM likhA hai hataprabhendriyaM kSAmaM durAtmAnamupadrutam / gambhIratIkSNavegAta jvaritaM parivajayet // sthA--kezAHsImantino yasya saMkSipte vinate dhruvau / lunanti cAkSi pakSmANi so'cirAt yAti mRtyve|| Upara jvara kI saMkhyA samprApti kI dRSTi se 2-2 karake jitane bhI jvara ke carakokta bheda kaha diye haiM unheM hama upasthita kiyA hai aba Age aura bhI jo bheda haiM unheM pragaTa kiyA jAtA hai| paJcavidha jvara punaH paJcavidho dRSTo doSakAlabalAbalAt / santataH satato nyedyustRtIyakacaturthako / dvividha jvaroM ke pazcAt punaH pAMca prakAra ke jvara dekhe jAte haiM jo doSa ke bala aura kAla ke bala se athavA doSAvala aura kAlAbala se utpanna hote haiN| ve 1. santata 2. satata 3. anyezuSka 4. tRtIyaka aura caturthaka kahe jAte haiM / ye pA~coM jvara tridoSAtmaka kahe gaye haiMjvaraH paJcavidho prokto malakAlabalAvalAt / prAyaH sa sannipAtena bhUyasA tvapadizyate // santataH satato'nyedyastatIyakacaturthako / / eka hI jvara maloM kI dRSTi se arthAt vAtapittakapha ke balavAn yA balarahita hone se pA~ca prakAra kA kahA jAtA hai| yahA~ mala zabda doSabAcI hai| tathA jvara kA kAraNa doSakopa ke sAtha-sAtha kAla kA bhI sambandha jur3e vahA~ pA~ca prakAra kA batalAyA jAtA hai| ye pA~coM prAyaH sannipAta dvArA arthAt tridoSa dvArA hI hote haiN| inake nAma santata satata anyezuSka tRtIyaka aura cAturthaka haiN| ye pA~coM suzruta ne viSamajvara ke nAma se pukAre haiMdoSo'lpo'hitasambhUto jvaro sRSTasya vA punaH / dhAtumanyatamaM prApya karoti viSamajvaram // ahitakArI padArthoM ke sevana se ubaramukta vyakti ko rasaraktAdi dhAtuoM meM se kisI eka ko doSa prApta karake viSama jvarotpatti karate haiN| viSamajvara kI nirukti bhAluki nimna zabdoM meM karatA hai 5. isI viSaya para cakrapANidatta ne 2 zloka aura diye haiMpittakaphAnilavRddhathA dazadivasadvAdazAhasaptAhAt / hanti vimuJcati vAzu jvaroSmAdhAtumalapAkAt // tathA-dazadvAdazasaptAhaiH pittazleSmAnilAdhikaH / dagdhoSmaNA dhAtumalAn hanti muJcati vA jvrH|| For Private and Personal Use Only

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324 vikRtivijJAna yaH syAdaniyatAtkAlAcchItoSNAbhyAM tathaiva ca / vegatazcApi viSamo jvaraH sa viSamaH smRtH|| jo jvara aniyatakAlika hai aura zIta vA uSNa vega ke sAtha utpanna hotA hai vaha viSama jvara kahalAtA hai| isI viSamajvara ke santata, satata, anyezuSka, tRtIyaka aura cAturthaka 5 bheda hote haiM / suzruta ne dhAtuoM kI dRSTi se bhI inakA vicAra kiyA haisantataH rasaraktasthaH so'neyuH pizitAzritaH / medogatastRtIyehni tvasthimajjagataH punaH / / kuryAccaturthakaM ghoramantakaM rogasaMkaram / / santata rasadhAtu meM satata raktadhAtu meM, anyecuSka mAMsadhAtu meM, tRtIyaka medo dhAtu meM aura cAturthaka asthi aura majA dhAtu meM sthita rahatA hai / viSamajvara ko prAcInoM ne ghora arthAt kaSTakAraka, antaka arthAt yama ke samAna mAraka tathA gambhIrasthAna meM hone se, ciraklezadAyaka rahane se anya anekoM rogoM ko utpanna karane meM samartha hotA hai| acikitsita viSamajvara vAstava meM ghora aura antakArI hI hotA hai| saMsAra ko mRtyu saMkhyA kA Aja bhI eka tihAI isI kI bheMTa ho jAtA hai| isako rokane kA upAya sahaja hote hue bhI kAlAntara se yaha bahuta bhayAnaka aura kaSTadAyaka mAnA jAtA rahA hai| aba hama viSamajvara ke pA~coM bhedoM kA yathArthavarNana upasthita kahate haiM santatajvara srotobhirvisRtA doSA guravo rsvaahibhiH| sarvadehAnugAH stabdhAH kurcate santatajvaram / / dazAhaM dvAdazAhaM vA saptAhaM vA suduHsahaH / sa zIghraM zIghrakAritvAt prazamaM yAti hanti vA / / kAladUSyaprakRtibhirdoSastulyo hi santatam / niSpratyanIkaM kurute tasmAjzeyaH suduHsahaH / / yathA dhAtUMstathA mUtraM purISaJcAnilAdayaH / yugapaJcAnupadyante niyamAt santate jvare / / sazuddhathA vApyazuddhayA vA rasAdInAmazeSataH / saptAhAdiSu kAleSu prazamaM yAti hanti vA / / yadA tu nAtizudhyanti na vA zudhyanti srvshH| dvAdazaite samuddiSTAH santatasyAzrayAstadA / / visarga dvAdaze kRtvA divase'vyaktalakSaNaH / durlabhopazamaH kAlaM dIrghamapyanuvartate / / iti buddhvA jvaraM vaidyaH santataM samupAcaret / kriyAkramavidhau yuktaH prAyaH prAgapatarpaNaiH / / uparokta 8 zlokoM meM bhagavAn Atreya ne nimna viSaya samajhAne kA yatna kiyA hai1. santata jvara kaise utpanna hotA hai ? 2. santata jvara ke prazamana yA hanana kI maryAdA kyA hai ? 3. santata jvara itanA dussaha kyoM hai ? 4. santata jvara meM doSa kahA~ kahA~ prApta hote haiM ? 5. sAta, daza yA bAraha dina meM santatajvarI ThIka hotA hai yA maratA hai isakA rahasya kyA hai ? 6. santata jvara dIrghakAlAnubandhi jvara meM kaise badala jAtA hai ? 7. santata jvara meM apatarpaNa karane kI AvazyakatA kyA hai ? For Private and Personal Use Only

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jvara 325 santatajvara kI utpatti santata eka nirantara rahane vAlA viSama jvara hai| yaha 7 dina, 10 dina yA 12 dina lagAtAra rahatA hai| isake avisargI svabhAva ko dekha kara bahuta se vaidya ise Antrika jvara yA doSI jvara mAna kara cikitsA karane lagate haiM / ataH isake avisargI svabhAva kI ora sadaiva dhyAna rakhane kI AvazyakatA paga paga para par3atI hai| yaha jaba car3hatA hai to lagAtAra 7, 10 yA 12 dina paryanta AtA hI rahatA hai utaratA nahIM hai| isakI utpatti ko caraka meM bahuta saMkSepa meM aura yogyatApUrvaka pratipAdita kiyA gayA hai srotobhirvisRtA doSA guravo rasavAhimiH / sarvatrAnugAstabdhA jvaraM kurvanti santatam / / guru yAnI sAma vAta, pitta aura kapha doSa rasavAhaka srotoM meM phaila kara sampUrNa zarIra meM anugamana karate hue sampUrNa zarIra meM hI ruka jAte haiM yA stabdha ho jAte haiM aura santata jvara ko utpanna kara dete haiN| pahale AmAzaya meM sthita hue doSa jo paryApta mithyAhAra vihAra ke dvArA guru yA sAma bana gaye haiM rasavAhI nAliyoM meM jAte haiM / ye nAliyA~ unheM samasta zarIra meM pahuMcA detI haiM arthAt sampUrNa zarIra ina rakta aura dUSita doSoM ke kAraNa santRpta ho jAtA hai / yaha santRptAvasthA turata samApta nahIM hotI api tu vaha eka saptAha taka yadi vAta doSa hI mukhyatayA sAma hokara pravAhita ho rahA ho, athavA dasa dina taka jaba pitta kA prAbalya ho athavA bAraha dina taka jaba ki kaphadharma kA adhikAra vizeSa rUpa se ho zarIra pUrNataH doSapUrNa aura sAma doSoM se santRpta banA rahatA hai aura yaha jo avisargI svarUpa kA caubIsoM ghaNTe eka sA banA rahane vAlA jvara ho jAtA hai yahI santata jvara kahalAtA hai| isake bAre meM jJAtavya yaha hai ki a-yaha avisargI hai| A-isake lie kAraNa bhUta dravya svayaM vAtAdi tIna doSa haiN| i-yaha rasavaha srotoM dvArA gamana karatA hai| I-yaha sampUrNa zarIra meM pahu~catA hai aura u-jvarakArI tatva sampUrNa zarIra meM phailA rahatA hai| santatajvara kI maryAdA santatajvara vyakti ko 7 dina, 10 dina yA 12 dina meM yA to mAra detA hai yA chor3a hI detA hai / isakI vyAkhyA karate hue gaMgAdhara kavirAja likhatA hai sa kAladhyaprakRtitulyadoSajaH santato jvaraH doSaduSyANAM niHzeSeNa saMzodhanAbhAvAta saMzodhanAcca dazAhaM, sarvazaH saMzodhanAt tathA saMzodhanAbhAvAd dvAdazAhaM, sarvazaH saMzodhanAt saMzodhanAbhAvAcca saptAhaM vApya suduHsahaH zIghrakAritvAt zIghraM prazamaM yAti hanti vaa| vA dvayavyavasthayA pittAdhiko yo bhavati sa dazAhaM vyApya zleSmAdhiko yo bhavati sa dvAdazAhaM vyApya vAtAdhiko yo bhavati sa saptAha vyApya suduHsahaH zIghrakAritvAt zIghra prazamaM yAti zIghraM hanti veti / / santata jvara kA kAla, dRSya aura prakRti tulya doSaja hone se doSa dUSyoM ke sampUrNatayA saMzodhana se yA asaMzodhana se paittikAvasthAdhikya 10 dina meM, zlaiSmikAdhikya For Private and Personal Use Only

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326 vikRtivijJAna 12 dina meM aura vAtAdhikya 7 dina meM vaha zAnta hotA yA mAra detA hai / zAnta hone ke lie malapAka hotA hai aura mArane ke lie dhAtupAka hotA hai| ina pAkoM ke lie pralApabhramazvAsaiH santatajvare dhAtupAko zeyo'nyathA tu malapAka iti // se samajha lenA caahie| santatajvara kI suduHsahatA jisa prakAra balavAn rAjA ke sAmane hRdaya meM pratipakSIbhAva lenevAlA dUsarA rAjA bhI ThIka prakAra kA AcaraNa karatA hai usI prakAra kAla kI vibhinnatA, dRzyoM kI vividhatA, prakRti kI pRthakatA Adi sabhI santatajvarakArI doSoM ke samAna AcaraNa karane lagate haiM aura sampUrNa zArIrika vAtAvaraNa santatajvara ke pUrNatayA anukUla vana jAtA hai isI kAraNa ise suduHsaha kahA jAtA hai| doSoM kA gamana santatajvara meM vAtAdidoSa traya rasavaha srotoM dvArA sarvaprathama rasadhAtu ko anugamana karate haiM aura Age itane zIghra anya dhAtuoM meM pahu~cate haiM ki zAstrakAroM ne sapta dhAtuoM meM unakA yugapat ( aikakAlika ) gamana svIkAra kara liyA hai / sAta dhAtu hI nahIM ve mala aura mUtra meM bhI prApta ho jAte haiN| yaha saba niyamAt (niyamapUrvaka ) hotA hai| kahane kA tAtparya yaha hai ki vAta, pitta, aura kapha jo santatajvarotpatti ke mukhya ghaTaka haiM rasa, rakta, mAMsa, medas , asthi, majA aura zukra nAmaka sAto dRpyoM meM eka sAtha hI pahu~cate haiM aura mala tathA mUtra meM bhI usI samaya pahu~cate haiM / isa prakAra mala, mUtra, sAta dhAtu aura tIna doSa kula bAraha ghaTakoM ke dvArA santata jvara kI racanA hotI hai| yahI dvAdaza usake Azraya kahalAte haiM phira bhalA usako duHsaha na kahA jAve to kise kahA jA sakatA hai / prazamana yA hanana kA rahasya santata jvara 7, 10 yA 12 dina meM yoM to zAnta hotA hai yA yoM mAra detA hai? yaha eka aisA prazna hai jisakA thor3A hala yahA~ nikAlA jA cukA hai ki jaba doSa mala pAkI hoMge to roga dUra ho jAvegA athavA jaba dhAtupAkI hoMge to rogI saMsAra se dUra ho jAvegA / isI ko adhika spaSTa karane ke lie likhA hai-- sa zuddhayA vApyazuddhayA vA rasAdInAmazeSataH / saptAhAdipu kAleSu prazamaM yAti hanti baa| kAladUSya prakRtitulya santatajvara doSa dUSyoM ke niHzeSeNa saMzodhana se paittika DropAdhikya ho to 10 dina meM zAnta ho jAtA hai aura niHzeSa zodhanAbhAva ho to 5. hI dina meM mAra detA hai| vahI doSa dRSyoM ke pUrNataH zuddha hone para kaphAnubandha yukta 12 dina meM zAnta ho jAtA hai yA pUrNa zodhanAbhAva hone se 12 dina meM mAra detA hai athavA vAtika bhAva kI pradhAnatA hone para vahI santata doSa dUSyoM ke saMzodhana hone se 7 dina meM ThIka ho jAtA hai aura niHzeSeNa saMzodhanAbhAva hone para 7 dina meM mAra DAlatA hai| rasAdi sapta dRSyoM ko saMzuddha karane ke lie yogya upacAra na ho sakA For Private and Personal Use Only

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jvara to vyakti ko santatajvara samApta kara degA aura yadi unakA zodhana yathAvat aura pUrNataH ho gayA to santajvara svayaM samApta ho jaavegaa| athavA daivavazAt svataH malapAka ho gayA to santatajvara svayaM samApta ho jAvegA aura durdaivavazAt dhAtupAka ho gayA to rogI svayaM samApta ho jaavegaa| cakrapANidatta ne isI ko aura bhI spaSTa kiyA hai-- __santataH yadA sarva rasAdayaH sarvathA vizuddhA bhavanti tadA prazAmyati saptAhAdiSu, yadA rasAdayaH sarve sarvathA vA avizuddhA bhavanti tadA ghnantItyarthaH / yaha nahIM bhUlanA hai ki yaha zuddhikArya santatajvara meM bArahoM AzrayoM meM Avazyaka hai| __santatajvara kI USmA sadaiva maloM athavA dhAtuoM ko kSINa kiyA karatI hai| jaba usake dvArA mala kSINa hote haiM to rogI jI par3atA hai aura jaba dhAtukSINa hote haiM to rogI mara jAtA hai / isI ko vRddha vAgbhaTa ne bar3e sundara zabdoM meM vyakta kiyA hai-- malAvaroSmA dhAtUn vA zIghra kSapayaMstataH / sarvAkAraM rasAdInAM zudhyA'zudhyA'pi vA kramAt / / vAtapittakaH sapta dazadvAdazavAsarAn / prAyo'nuyAti maryAdAM mokSAya ca vadhAya ca / / santatajvara kI dIrghakAlAnubandhitA niHzeSeNa dvAdazAzrayoM kI zuddhi kA pariNAma vijaya aura niHzeSeNa hI dvAdazAzrayoM kI azuddhi kA pariNAma parAjaya itanA jAna lene para aba yaha jAnanA zeSa rahA ki niHzeSeNa zuddhi na hokara stoka zuddhi hI ho to kyA hogaa| indra ne hArIta ke vAkya zudhyazuddhau jvaraH kAlaM dIrghamapyanuvartate kI TIkA meM likhA hai ki-- ___yadA tu rasAdInAM madhye keSAJcicchuddhizuddhirazca keSAzcittadA santato jvaro na muJcati, nApi mArayati kevalaM dIrghakAlamanuvartate / jaba rasAdi dhAtuoM kI pUrNa zuddhi nahIM ho pAtI athavA dvAdazAzraya sabhI zuddha nahIM ho pAte to santatajvara bArahaveM dina visarga yA vizrAma lekara avyakta lakSaNa aura durlabhopazama bana kara dIrghakAla taka calatA rahatA hai / santatajvara ke dIrghakAlAnubandhI hone kA mukhya kAraNa dvAdazAzraya kA pUrNataH zuddha na honA yA unameM se kucha kI zuddhi ho jAnA aura kucha kA jyoM kA tyoM azuddha par3A rahanA hai| aisI avasthA meM bArahaveM dina yaha jvara thor3A utara jAtA hai aura usake pazcAt halakA halakA barAbara banA rahatA hai aura aise jvara kA nikalanA bahuta kaThina ho jAtA hai usakA upazama honA atyanta kaSTakAraka ho jAtA hai isa rUpa ko dIrghakAlAnubandhirUpa kahA jAtA hai / eka brAhmaNapatnI ko santatajvara kA prathama AkramaNa huA aura usakI jo vidhivat cikitsA honI cAhie thI vaha na kI jA sakI pariNAmataH rogiNI ke jvara ke dvAdazAzrayoM kA pUrNa zodhana sambhava na ho sakA isakA pariNAma yaha huA ki paNDita jI ko 2 varSa nirantara cikitsA karAnI par3I phira bhI jvara 99deg se nIce nahIM jA sakA bAda meM dhIrajapUrvaka ukta doSa dUSyAdi kI pUrNa zuddhi kI vyavasthA kI gaI taba jAkara usakI jIvanarakSA huii| ataH santata kI dIrghakAlAnubandhitA kI ora, kabhI durlakSya For Private and Personal Use Only

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328 vikRtivijJAna karanA nitAnta hAniprada hotA hai| jvara kA punarAvartana ( relapse of fever ) kA kAraNa Adhunika loga roga ke jIvANuoM kA pUrNataH nAza na honA mAnate haiM / yadi ve hamAre Upara ke kathana kI ora dhyAna deM to usameM aura unakI bAta meM koI bhI antara nahIM milegA / hama kahate haiM ki jabataka pUrNatayA vAta, pitta, kapha, rasa, rakta, mAMsa, medas, asthi, majjA, zukra aura mala tathA mUtra kI zuddhi nahIM hogI santatajvara na jAvegA alpazuddhi yA apUrNa zuddhi roga ke punarAkramaNa ke lie nimantraNa hai / isase afas a far kahate haiM / hamane santatajvarakArI kisI jIvANu kA nAmakaraNamAtra nahIM kiyA / ke jo zuddhi karake zarIra ko jIvANu - virahita karanA cAhate haiM vaha to hama bhI cAhate kyA karate hI haiM / dvAdazAzrayoM kI zuddhi / kisase ? saMtatajvara se / jvaroSmA se / yaha USmA kina kAraNoM se banatI hai ? mithyAhAra vihAra ke kAraka koI nija hI kAraNa haiM yA Agantu bhI Agantu sadaiva nirjIva padArtha hI hote haiM yA jIvadhArI bhI / adhika gaharAI meM jAne para donoM pUrva ke cikitsaka aura pazcima ke vikRtivettA eka hI sthala para pahu~cate haiM / Upara jo bArahaveM dina jvara kA visarga batalAyA hai vaha vAtAnubandhi meM sAtaveM aura pittAnubandhi meM dasaveM dina bhI ho sakatA hai tathA inake dUne dina bhI laga sakate haiN| tathA apUrNa zuddhi ke kAraNa santata 7, 10 yA 12 veM dina ke uparAnta dIrghakAlAnuaf hI kahA jAtA hai / santatajvara aura apatarpaNa Upara kahI huI dvAdazAzraya kI zuddhi aura azuddhi kA ThIka ThIka vicAra karake hI vaidya ko yogya upacAra meM pravRtta honA cAhie / Arambha meM apatarpaNa arthAt laMghana kA Azraya karake calane ke lie caraka kA Adeza hai / yaha viSaya apane viSaya se itara hone se aura prakaraNa bhinnatA ke kAraNa hama kevala iGgitamAtra karake chor3e dete haiM / satatajvara raktadhAtvAzrayaH prAyoH doSaH satatakaM jvaram / sapratyanIkaM kurute kAlavRddhikSayAtmakaH // ahorAtre satatako dvau kAlAvanuvarttate / kAlaprakRtidUSyANAM prApyaivAnyatamAd balam // kharanAda ne santata ko chor3a zeSa cAroM ko viSamajvara' mAnA hai / ataH caraka aura suzruta kyA kharanAda ke mata meM bhI satatajvara viSamasaMjJaka jvara hai / prAyaH karake vAta, pitta aura kapha nAmaka tInoM doSa satatajvara meM raktadhAtu kA Azraya karake rahate haiM / aura kAla ke anusAra vRddhi athavA kSaya ko prApta hote haiM / avirodhI kAla hone para jvara kA vega hotA hai aura virodhI kAla pAkara vaha vega zAnta ho jAtA hai| dina aura rAtri meM satatajvara do bAra car3hatA hai / kAla, prakRti athavA dUSya kisI eka se yA donoM yA tInoM se bala pAkara usakA vega hotA hai jaba usa bala kA virodhI kAla, prakRti yA dUvya A jAtA hai to vaha zAnta ho jAtA hai / 1. jvarAH paJca mayo kA ye pUrva santatakAdayaH / catvAraH santataM hitvA jJeyAste viSamajvarAH // For Private and Personal Use Only

Page #390
jvara 326 cakrapANidatta kA kathana hai ki prAyaH zabda AcArya ne isalie likhA hai ki yaha jvara raktAzrita to hotA hI hai aMsAzrita bhI ho sakatA hai| athavA anya dhAtuoM meM bhI Azrita raha sakatA hai| jaba doSAnuguNa kAla hotA hai taba jvarotpatti yA jvara kA vega ho jAtA hai aura doSAnuguNavyatirikta kAla hotA hai to jvara kA kSaya ho jAtA hai| vaha likhatA hai ki jvarasya (jvara ke) kAlaprakRtidUSyANAM (kAlaprakRtidUSyoM ke) madhye ( bIca meM) anyatamAd balaprAptau (anyatama bala kI prApti se ) satyamapi ( satya bhI) doSasamprAptimahinA ( doSasamprApti kI mahattA hone para bhI) hi (nizcaya pUrvaka) kAlaH pradhAna iti niyamo jJeyaH (kAla kI pradhAnatA hotI hai yaha niyama jAna lenA caahie|) arthAt doSa jvara ko utpanna karane meM kAla ke anusAra hI calate haiM usake pratikUla nhiiN|| __ raktAzritavAtolbaNa satatajvara, pittolbaNa satatajvara yA kapholbaNa satatajvara apane-apane prakopa kAla meM vRddhi ko prApta hote haiM tathA anya kAla meM kSaya ko prApta hote haiM / pitta madhyAhna yA madhyarAtri meM, vAta sandhyA yA rAtri ke antima prahara meM aura kapha prabhAta meM yA pUrva rAtri meM adhika balavAna hote haiN| isa prakAra dina rAtri meM do bAra isakA vega bar3ha kara satatajvara car3ha sakatA hai| kabhI-kabhI jaba rAtri meM do bAra yA dina meM do bAra jvara car3hatA hai taba eka ke sthAna para do doSoM kI adhikatA mAnI jA sakatI hai| ___ satatajvara visargI ( intermittent ) hai / yaha caubIsa ghaNToM meM kevala do bAra car3hatA utaratA hai| anyezuSkajvara anyezuSkaM jvaraM kuryyAdapi saMzritya zoNitam / anyezuSkaM jvaraM doSo ruddhA maidovahA siraaH|| sapratyanIkaM janayatyekakAlamaharnizam / anyezuSkastvahorAtra ekakAlaM pravartate // kAla prakRti aura dUSyoM se anyatama bala prApta karake satata jvara jahA~ do bAra car3hatA hai vahA~ isa anyatama bala kI upalabdhi na hone ke kAraNa raktAzrayI hone para bhI anyedhuSkajvara dina rAta meM kevala eka bAra hI car3hA karatA hai| anyezuSka-jvarakArI vAtAdi doSa medovaha srotasoM meM gamana karate hue raktAzrayI athavA mAMsAzrayI hokara alpabala ko prApta karane ke kAraNa tathA saMtata jvara kI apekSA nirbala hone se 24 ghaNToM meM kevala eka hI bAra jvarotpatti karate haiM / medovaha srotoM se mAMsavaha srotoM meM bala kI alpatA ke kAraNa vaha dina meM eka bAra yA rAtri meM eka bAra hI AtA hai| ____ anyeyaSka jvara meM medovaha nADiyoM kA vAtAdi dorSoM dvArA rodha hone ke kAraNa medoduSTi ho jAtI hai| kyoMki--teSAM srotasAM rodhAt sthAnasthAzcaivaM mArgagAzca doSAH prakopamApadyante / arthAt jaba kisI srotasa kA avarodha ho jAtA hai to usa sthAna para sthita aura mArga meM gamana karane vAle sabhI doSoM kA prakopa hone lagatA hai tathA-sroto. duSTayA dhAtuduSTiravagantavyA ke anusAra jaba medavAhI srotasoM kI duSTi huI to medodhAtu bhI duSTa ho jAtA hai aura jvaroSmA meda kA nAza karane lagatI hai yadi malapAka na For Private and Personal Use Only

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vikRtivijJAna huA aura dhAtupAka kI sthiti banI to medo dhAtu ke vinaSTa hone se rogI kA muTApA ghaTa kara vaha sUkha jAtA hai| atyadhika medasvitA ko ghaTAne kA acchA sAdhana anyedhuSkajvara bana to sakatA hai para dhAtupAka ke kAraNa hone vAle ariSTa lakSaNoM ke lie zamanopAya kahA~ milegA ? atyadhika mAtrA meM malla prayoga se kuSTha kA nAza to ho sakatA hai para kuSThI kA jIvana bhI sAtha hI sAtha iha loka se jAne ke lobha kA saMvaraNa kara nahIM skegaa| tRtIyakajvara anyezuSkaH pratidinaM dinaM kSiptvA tRtIyakaH / nAti prakupito doSa ekakAlamaharnizam / ___ mAMsasrotasyanugato janayet tu tRtIyakam / / tthaa--tRtiiykstRtiiye'hni| anyedhuSka jahA~ pratidina hotA hai tRtIyaka jvara eka eka dina chor3a kara AtA hai| anyedhuskArambhaka doSa jo adhika prakupita na hone ke kAraNa aharniza meM kevala eka bAra hI jvarotpatti karate haiM ve hI doSa mAMsavAhI srotoM kA anugamana karate hue aura nAti prakupita hone ke kAraNa eka dina chor3a kara hara tIsare dina tRtIyaka nAmaka jvara ko utpanna karane meM samartha hote haiM / anyedyaSka 24 ghaNTe meM eka bAra sarakArI hotA hai tathA tRtIyaka 48 ghaNTe meM eka bAra Ane vAlA hotA hai| itavAra ko sabere 8 baje jo jvara car3hA hai vahI maMgalavAra ko 8 baje ThIka 48 ghaNTe bAda Ane para tRtIyaka kahA jAtA hai| suzruta ne anyezuSka ko pizitAzrita yA mAMsa meM sthita mAnA hai jaba ki caraka tRtIyaka ko mAMsAzrita mAnatA hai / kAraNa usakA hai anyedhuSka ke pazcAt tatIyaka kA honA / yaha prAyazaH dekhA jAtA hai ki pahale dina meM eka bAra jvara Akara phira vahI tRtIyaka meM badala jAtA hai| suzruta tRyIyaka jvara ko medogata mAnatA hai usake lie mAMsa dhAtu se hI doSa jIrNa hokara medodhAtu ko prApta huA karatA hai ataH 'medogatastRtIye'hni' pUrNataH ucita hai virodha nahIM hai| . cAturthakajvara saMzrito medaso mArga doSazcApi caturthakam / dinadvayaM yo vizrAmya pratyeti sa caturthakam / / adhizete yathA bhUmi bIjaM kAle'varohati / adhizete tathA dhAtUn doSaH kAle'vakupyati / / sa vRddhiM balakAlaJca prApya doSastRtIyakam / caturthakaM ca kurute pratyanIkaM balakSayAt / / kRtvA vegaM gatabalAHsve sve sthAne vyvsthitaaH| punarvivRddhAHsve kAle jvarayanti naraM mlaaH|| kaphapittAttrikagrAhI pRSThAdvAtakaphAtmakaH / vAtapittAcchirogrAhI vividhaH syAttRtIyakaH / / caturthako darzayati prabhAvaM dvividhaM jvrH| jaGghAbhyAM zlaiSmikaH pUrva ziraso'nilasambhavaH / / viSamajvara evaanyshcturthkvipryyH| trividho dhAturekaiko dvidhAtusthaH karocayam / / prAyazaH sannipAtena dRSTaH paJcavidho jvrH| sannipAte tu yo bhUyAn sa doSaH parikIrtitaH / / RtvahorAtra-doSANAM manasazca balAbalAt / kAlamarthavazAccaiva jvarastaM taM prapadyate / / isa cAturthaka jvara ke vivaraNa ke sAtha-sAtha kaI mahattva kI bAtoM kA aura bhI samAveza uparokta sUtroM meM ho jAne ke kAraNa aura prasaMgavaza hama yahA~ nimna viSaya upasthita kareMge For Private and Personal Use Only

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jvara 1. cAturthaka jvara kyA hai? 2. jvara kucha kAla zAnta hokara punaH car3hatA hai aisA kyoM hai ? / 3. doSoM ke vicAra se tRtIyaka-caturthaka ke vibheda kyA haiM ? 4. caturthaka-viparyaya jvara kauna sA hai ? 5. paMcavidha viSamajvara tridoSAtmaka haiM kyA ? 6. vividha kAloM meM jvara prApta hone ke lie kauna paristhitiyA~ prabhAvaka haiM ? cAturthaka jvara kA vicAra cAturthaka jvara kI utpatti tabhI hotI hai jaba doSa medovaha srotasoM ko prApta ho jAte haiN| medovaha srotoM kA avarodha anyezuSka jvara ke prakaraNa meM bhI A cukA hai para vahA~ jitane adhika bala ke sAtha doSoM kA prakopa hai vaha yahA~ atyanta ghaTa jAne se vahI doSa yahA~ kevala cAturthaka jvara kI hI utpatti karane meM samartha hote haiN| cAturthaka jvara meM eka bAra jvara bar3hatA hai phira doSa do dina vizrAma lekara punaH tIsare dina jvarotpanna karate haiM / savere 8 baje itavAra ko ghara Age ke pazcAt budhavAra ko savere 8 baje ThIka 72 ghaNTe pazcAt cAturthaka jvaropalabdhi huA karatI hai| zruta - dogatastutIye'hni vasthimajjagataH punH| kuryAccAturthakaM ghoramantakaM rogasaGkaram // kaha kara asthi aura majjAgata jvara ko cAturthaka mAnA hai aura ise yama sadRza ghora athavA mAraka kara kahA hai| gaMgAdhara ne isakI ghoratA para Apatti prakaTa karate hue likhA hai-- uktaM hi muzrutena 'asthimajjagataH punH| kuryAcAturthaka ghoramantakaM rogasaGkaram' iti / medaHsrotogatastu na cAntaka rogasaGkaraM caturthakaM janayedityato medogato nAtiprakupitadoSastu yaM caturthakaM janayati sa nAtikaSTa prati bodhyam / aura usane jo cAturthaka kI paribhASA dI hai vaha sarala aura sundara haiyo jvaro dina yaM vizramya na bhUtvA pratyeti punarAgacchati sa caturthakaH / ____ jvara ke punarAvartana kA AdhAra jvara kabhI car3hatA hai aura kabhI utara jAtA hai isakA kyA abhiprAya hai ? ise samajhAne ke lie AcArya ne eka udAharaNa bahuta sundara diyA hai| ve kahate haiM ki jaise pRthvI meM bIja bone para vaha turata hI nahIM ugatA balki kAla pAkara jaba usake ugane kA samaya hotA hai tabhI ugatA hai| usI prakAra doSa bhI dhAtuoM meM jAkara so jAte haiM aura kAla pAkara hI prakupita hote arthAt jvarotpatti karate haiN| makkA aura bAjarA jina dinoM utpanna hotA hai unhIM ke sAtha sAtha seMdhA nAmaka phala apane Apa uga AtA hai| kucha seMdhe sar3a jAte haiM aura unake bIja usI bhUmi meM soye yA par3e raha jAte haiN| una para havA kA koI prabhAva nahIM par3atA varSA ho jAne para bhI unakA kucha nahIM bigar3atA aura garmI aura ThaNDaka ke saba kAla ko pAra karake agale varSa ThIka samaya para ve bIja seMdhe kI beloM meM parivartita ho jAte haiM aura samaya para unheM vinA boye hI hama punaH For Private and Personal Use Only

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332 vikRtivijJAna seMdhoM kA rasAsvAdana karate hue prakRti dvArA saMrakSita isa vidhi ko dekhakara paramAtmA ke prati apanI zraddhAJjali samarpita karate hue thakate nhiiN| ThIka seMdhA kI taraha hI zarIra meM vAta, pitta kaphAdi ke pradUSaka bhAva zarIra dUSya rUpI bhUmi meM bIjavat par3e rahate haiM aura zarad meM pitta, vasanta meM kapha aura prAvRT meM vAta ke upadravoM ke rUpa meM phUTa par3ate haiN| tRtIyaka yA caturthaka jvara jo eka yA do dina taka vizrAma lekara dhAtuoM se puSTa hokara tathA bala pAkara punaH kupita ho jAte haiM aura jvara kA ThIka samaya para vega ho jAtA hai| satatakAdikAraka doSa vega karake gatabala ho jAte haiN| gatabala hone ke kAraNa ve apaneapane raktAdi sthAnoM meM Thahara jAte haiM phira kAla pAkara punaH balavAna banane aura jvarospatti kara dete haiM / 'sve sve' ke sthAna para 'zleSmasthAne' aisA pATha hai| usakA tAtparya dete hue gaMgAdhara likhate haiM__ sva-sva-nidAnavizeSairjanitakopavizeSeNa jAtasvabhAvavizeSA malA doSAH zleSmasthAne AmAzaye hRdaye kaNThe zirasi ca vyavasthitAH santo yathAkramaM dvikAlamekakAlaM dinaikaM kSiptvA ekakAlaM dinadvayaM kSiptvA ekakAlaM vegaM kRtvA krameNAmAzayaM prApya jvaraM kRtvA kRtavegatvAt taddinameva punaH svasthAnaM gatvA ca gatabalA hInabalAH santo vai tatra vartante, punazca svabhAvAt saMvRddhAH santaH sve kAle pratidina-dvikAlaikakAladinaikakSiptaikakAladinadvayakSiptakakAle naraM jvarayantiki apane-apane hetuvizeSa se utpanna vizeSa svabhAvoM se yukta paristhiti-vizeSa ke kAraNa prApta guNoM se yukta vAtAdidoSa zleSmasthAna 1. AmAzaya, 2. hRdaya, 3. kaNTha athavA 4. zira meM vyavasthita ho jAte haiM aura yathAkrama do bAra, eka bAra, eka dina chor3akara eka bAra athavA do dina chor3akara eka bAra vegotpanna karake usI krama se AmAzaya meM pahu~ca jvara utpanna kara dete haiN| jvara kA vega samApta ho jAne para usI dina punaH apane sthAna meM jAkara gatabala yA hInabala hokara rahate haiM phira svabhAvAt punaH vivRddha ho jAte haiM aura phira apane apane kAla arthAt do bAra, eka bAra, eka dina chor3akara eka bAra athavA do dina chor3akara eka bAra vegotpanna karake jvara utpanna karate haiN| isI ko suzruta ne apane zabdoM meM yoM vyakta kiyA hai kSAmANAM jvaramuktAnAM mithyAhAravihAriNAm |dossH svalpo'pi saMvRddho dehinaamnileritH|| satatAnyezuSkatryAkhyacAturthAn sapralepakAn / kaphasthAna-vimAgena yathAsaMkhyaM karoti hi // ahorAtrAdahorAtrAt sthAnAt sthAnaM prapadyate / tatazcAmAzayaM prApya dhoraM kuryAjjvaraM nRNAm / / jaba doSa AmAzaya meM sthita hotA hai to vaha svakAla pAkara kAlasvabhAvAnusAra vRddhi ko pAtA hai / aura dina meM eka bAra jvara ho jAtA hai| jvara kA vega doSa ke gata bala hote hI ghaTa jAtA hai aura doSa punaH AmAzaya meM hI rukA rahatA hai aura punaH svakAla pAkara aura kAlasvabhAvAt eka bAra rAtri meM phira car3ha jAtA hai| yaha varNana huA satatajvara kA jo rasa vA raktAzrita hokara rahatA hai| ___ anyezuSka jvara meM doSa mAMsAzrita hotA hai aura vaha medovahAsirAoM ko avaruddha kara detA hai ataH Ayurveda kI kalpanAnusAra yaha hRdayastha zleSmasthAna se sambaddha mAnA jAtA hai| yaha doSa hRdaya se AmAzaya taka Ane meM eka kAla kA samaya khA jAtA hai For Private and Personal Use Only

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jvara 333 aura jaba vaha AmAzaya meM pahu~catA hai to jATharAgni ko kupita kara jvara ke vega ko 24 ghaNToM meM kevala eka bAra hI kara pAtA hai| usake pazcAt hInabala hokara punaH hRdayagata zleSmasthAna meM calA jAtA hai / yaha anyedyaSkajvara yA ekAhnikajvara kA kAraNa spaSTa karatA hai / isa prakAra dina yA rAtri meM yahA~ eka hI prakopa karaNa bana pAtA hai| Age mAMsagata doSa medovahAsirAoM kA avarodha karake medo mArga kA saMzraya karate hue kaNTha meM avasthita ho jAte haiN| kaNThastha doSa eka dina rAtri meM hRdaya taka Akara usa dina jvara karane meM samartha nahIM ho pAte aura ve dUsare dina hRdaya se AmAzaya meM Akara jATharAgni ko bahirmukha karake jvarotpanna karate haiN| isa prakAra jvara ke vega ke eka bAra car3hane ke 48 ghaNTe bAda dUsarI bAra jvara car3hatA hai jise hama tRtIyakajvara kaha kara pukArate haiN| isI prakAra medomArga kA saMzraya karake asthi aura majAgata doSa zira meM baiTha jAte haiM / ye mUrddhastha doSa eka ahorAtra meM zirase kaNTha meM A pAte haiM aura usa dina jvarotpatti nahIM karate / kaNTha se dUsare dina hRdaya taka Ate haiM aura usa dina bhI jvarotpatti nahIM karate tathA tIsare dina ThIka 72 ghaNTe bAda ve doSa AmAzaya meM Akara koSTAgni ko bahirmukha karake jvara kA vega utpanna kara dete haiM aura punaH hIna bala hokara zira ko lauTa jAte haiM / yaha cAturthaka jvarotpatti kA itihAsa hai| pralepakajvara suzruta ne satata, anyezuSka, tRtIyaka aura cAturthaka jvaroM kI samprApti batalAte hue eka pralepaka jvara kI samprApti aura dI haitathA pralepako jJeyaH zoSiNAM praannnaashnH| duzcikitsyatamo mandaH sukaSTo dhAtuzoSakRt // yaha pralepaka jvara nirantara rahatA hai| yaha eka prakAra kA manda jvara hai jo dhAtuoM kA zoSaNa karatA hai tathA zoSiyoM ke prANa kA nAzaka hotA hai| isa jvara ke karanevAle doSa sarva sandhiyoM meM jo kapha sthAna hai vahA~ nivAsa karatA hai aura sandhiyoM meM se kisI na kisI se doSa dina-pratidina kyA pratyeka samaya AmAzaya meM Ate rahate haiM jisake kAraNa pratyeka samaya jvara banA rahatA hai| ____ Adhunika kAla meM viSamajvarakArI cakroM (sAikiloM) kA bahuta varNana hotA hai| satatajvarakArI jIvANuoM kI sAikila dina meM do bAra pUrNa hotI hai isa kAraNa jvara do bAra AtA hai| anyezuSka kI eka bAra pUrNa hone se 24 ghaNTe meM eka bAra jvara hotA hai tRtIyaka jvara kI sAikila 48 ghaNTe meM eka bAra pUrNa hotI hai aura cAturthaka kI 72 ghaNTe meM eka bAra isalie jvara kramazaH eka dina chor3akara athavA do dina chor3a kara AtA hai| Ayurveda ne isa viSaya meM sahasroM varSoM pUrva se apanI eka nizcita kalpanA banA rakhI hai| vaha jvarotpatti zleSmasthAna vizeSakara AmAzaya se mAnatA hai / AmAzaya meM doSoM ke prakopa dvArA jATharAgni kA bahirmukha honA usane sarva prathama svIkAra kiyA hai ataH vaha jaba taka doSa AmAzayastha nahIM ho jAte taba taka jvarotpati kA honA vaha sambhava nahIM smjhtaa| isIlie hRdaya, kaNTha, zira aura sandhisthaloM meM vyApta doSoM For Private and Personal Use Only

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334 vikRtivijJAna ko prakupita hokara AmAzayastha bananA par3atA hai tabhI ve jvarotpatti meM samartha ho pAte haiM / AmAzaya taka Ane ke lie kucha kAla lagatA hai| kAla svabhAva unake prakupitaH hone meM bhI kucha dera karatA hai isI kAraNa ve nizcita samaya nizcita sAIkileM pUrI karate hue jvarotpatti kara pAte haiN| santata, satata, anyezuSka, tRtIyaka aura cAturthaka ye pAMcoM jvara viSama jvara kahalAte haiM-'viSamatvaM viSamakAlatvena bhavati'viSama isalie ki ve viSamakAlotpanna hote haiN| kucha loga jaise kharanAda santata ko viSama-saMjJaka nahIM mAna kara zeSa cAroM ko viSamajvara nAma se mAnane ko kahatA hai jvarAH paJcamayoktA ye pUrva santatakAdayaH / catvAraH santataM hitvA neyAste viSamajvarAH / / para cakrapANidatta santata ko viSamajvara hI mAnate haiM-santate tu dvAdazAhavisargeNa ayodazAhe punaranubandhAt kAlavaiSamyamasti tena so'pi viSama iti / vicchinna-santApatva bhI viSamajvara kA kAraNa mAnA gayA haisUkSmasUkSmatarAsyeSu dUradUratareSu c| doSo raktAdimArgepu zanairalpazcireNa yat / / yAti dehaM ca nAzeSaM bhUyiSThaM bheSaje'pi ca / kramo'yaM tena vicchinnasantApo lakSyate jvaraH / / viSamo viSamArambhakriyAkAlo'nuSaGgavAn / / isa viSaya para mahAmahopAdhyAya paNDitapravara indu ne jo vyAkhyA dI hai vaha prasaGgAnukUla aura atisarala hone se avikala yahA~ uddhRta kI jA rahI hai-- sUkSmasUkSmatarAsyetyAdinA satatAdInAM caturNA viSamajvarANAM vicchinnasantApatve kAraNamucyate iha hi dhAtuvAhini srotAMsyuktAni tAni ca pratAnasadRzAni / krameNa mUle mUle sthUlA'nyagre'gre sUkSmANi / tatra sUkSmAsyeSu sUkSmatarAsyeSu ca tathA dUreSu dUratareSu ca raktAdisrotassu yadyasmAdalpo doSaH zanairyAti cireNa ca sthAnaM prApnoti nizzeSaM ca dehaM na vyApnoti tena kAraNena viSamo vicchinnasantApo lkssyte| anenaitaduktam-prabhUto doSo'ti sthUlamukheSu srotaHsu yadyatmAcchIghraM mahAnimnanikaTadezeSu ca gacchan santatajvaramabhinivartayati / alpastu doSaH sUkSmamukheSu mahAnimnAda dUreSu ca raktAdimArgeSu ca gacchan zanaizca gacchan satataM kurute / tato'pyalpaH sUkSmatamAsyeSu dRratareSu ca gacchan amyedhumbhinivrtyti| tato'pyalpasUkSmatabhAsyeSu dRratameSu ca gacchannatimandagatiratiM cireNa gacchaMstRtIyakamaminirvatayati / tato'pyatizayena caturthako vAcyaH / ataeva ca vyAptezcireNa doSasya vegAt santApasya vicchedH| santatAdau ca prayujyamAne bheSaje bhUyiSThamayameva krmH| tena santate zIghra bheSajena doSasya prApteH zIghraM jvara upazAmyati / satatAdau tu krameNa doSasya dUradUratarasroto'nugatatvAt tathaiva bheSajena cireNa ciratareNa copazamaH bhUyiSThagrahaNaM bAhulyopalakSaNA. rtham / tena kiJcidbheSajaM prathamameva rasasrotAMsi prApya sakalaM zarIraM prApnoti / kiJcittu dhAtukrameNa dUratarANi srotAMsi gatveti / tena yato hetorvicchinnasantApastata eva viSamo naikruupH| yatazca viSamo yato viSamArambhakriyAkAlo'nuSagavAn / anenaitaddarzayati yathA-santataH svenarUpeNa rAtarUpo'pi viSamo'nena rUpeNa duHsAdhya eva / tena viSama ityasyAH saMjJAyAH pravRttinimittamanakarUpatA kRcchrasAdhyatA vA / viSamaH asamaH ArambhaH prathamA pravRttiryasya sa viSamArambhaH / yathA caturthake kaphena hetunA pUrva jaMghAbhyAM prabhAvaM darzayecchirasazcAnilAtpUrva prabhAvaM darzayediti vissmaarmbhH| viSamA kriyA yatra doSasyauSadhasya vaa| doSasya yathA grAhI pittAnilAnmUrdhna ityAdi / auSadhasya yathA-cikitsita uktaM mAMsaM medhyamannena saha sevitvollikhedityatra For Private and Personal Use Only

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335 viSamatvaM santarpaNamapataga viSamakAlo'niyatapUrvAhlAdyAgamakAlaH / tathA ca yaH satatAdirekasminnahani pUrvAle bhUtaH so'nyasminaparAle pi bhavan dRSTa ityetattrayaM viSasaMjJAyA hetuH anuSaGgavAnyaH spe naiva hetunA nivRttaH punaranuSajyate etadapi saMjJAhetuH // indu ne jo kucha kahA hai usakA sArAMza nimna zabdoM meM vyakta kiyA jA sakatA hai 1. dhAtumAhI sotana ke mUla sthUla aura pratAna sUkSma hote haiN| jaise jaise ve sthUla se sUkSma aura sUkSmatara hote jAte haiM usI prakAra ve dUra se dUratara aura dUratama bhI hote jAte haiN| 2. yadi alpamAtrA meM doSa ina srotasoM meM hokara gamana kareM to ve zanaiH zanaiH tathA bahuta dera meM apane gantavya sthAna ko pahu~ca pAte haiM ve nizzeSa sampUrNa zarIra meM prApta nahIM ho pAte isI kAraNa unake dvArA utpanna viSamajvara ko vicchinna santApa nAmaka saMjJA dI jAtI hai / 3. jaba prabhUta ( bahuta se ) doSa atisthUla mukhavAle srotasoM meM hokara zIghra hI mahAnimnanikaTa bhAgoM meM cale jAte haiM taba santatajvarotpatti hotI hai| 4. anya doSa bhUkamasukhasrotasoM meM hokara jaba mahAnimnabhAga se dUra pariNAhAdi yA antarvartI bhAgoM ora raktAdi bhAgoM se dhIre-dhIre jAte haiM to satatajvarotpatti hotI hai| __5. usase bhI sadoSa jaba sUkSmatara lotasa mukhoM ke dvArA dUratara bhAgoM meM jAte haiM to aura bhI dhIre-dhIre pahu~cane se anyedyaSka jvarotpatti hotI hai| 6. jaba atyalpa doSa sUcamatama srotasoM meM hokara dUratama deza meM praviSTa hote haiM to unakI gati aura manda ho jAtI hai aura isake kAraNa tRtIyaka tathA aura bhI sUkSmAtisUkSma mArgoM se dUrAtidUravartI bhAgoM meM doSoM kI atyalpa madhya ke jAne se cAturthaka jvarotpatti hotI hai / 7. santatajvara mAsoM se jAtA hai ataH use auSadha saralatA se vaza meM kara lato hai ataH santarAjyakAla rogI jaldI ThIka ho jAyA karatA hai| satatAdi jvarAkrAnta rogI kramAnukrama se dera meM ThIka ho pAte haiN| oSadhi ko dUrastha bhAgoM meM jAne ke lie rasavAhI raktavAhI Adi srotoM dvArA karanA par3atA hai| kahIM kahIM dhAtukrama se oSadhi ko jAne se dera lagatI hai isI kAraNa santata ke Age satatAdi kI cikitsA meM barAbara dera hotI calI jAtI hai| aura viSama kA viSama hI prArambha hotA hai aura usakI cikitsA kI vyApti bhI viSamatayA hI huA karatI hai| doSadRSTayA vibheda doSAnusAra tRtIyaka ke nimna 3 bheda hote haiM: 1. kaphapittolbaNa tridoSa yukta tRtIyaka-isameM kapha aura pitta ye donoM doSa adhika balI hote haiN| yaha viSayasaMjJaka jvara trika sthAna se Arambha hotA hai| trika sthAna meM pahale vedanA hotI hai jo sarvazarIra meM pahu~catI hai| trika vAtasthAna hai| For Private and Personal Use Only

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336 vikRtivijJAna yahA~ jaba kaphapittolbaNa doSa pahu~cate haiM to bahuta adhika prakupita nahIM ho pAte aura eka dina chor3a kara hone vAlA tRtIyaka saMjJaka jvara utpanna ho jAtA hai| ___2. vAta kapholbaNa tridoSa yukta tRtIyaka-isameM vAta aura kapha ye donoM doSa adhika balI hote haiN| yaha viSamasaMjJaka jvara pRSTha sthAna se Arambha hotA hai| vedanA pRSTha se Arambha hokara sampUrNa zarIra meM pahu~ca jAtI hai tathA vAtapitta donoM pRSThabhAga meM jo pittasthAna mAnA jAtA hai adhika jora nahIM kara pAte aura eka dina chor3akara hone vAlA tRtIyaka saMjJaka jvara utpanna ho jAtA hai| 3. vAtapittolbaNa tridoSayukta tRtIyaka-isameM vAta aura pitta ye donoM doSa adhika balI hote haiN| yaha viSamasaMjJaka jvara zira se prArambha hotA hai / zira meM pahale vedanA hotI hai jo sampUrNa zarIra meM jAtI hai| zira zleSmA kA sthAna hone se yahA~ vAta aura pitta kA kopa bahuta adhika balavAn na ho sakane ke kAraNa eka dina chor3a kara hone vAlA viSamasaMjJaka tRtIyaka jvara utpanna ho jAtA hai| jejjaTa ne trikasthAna meM Arambha hone vAle kaphapittolbaNatA yukta tRtIyaka jvara ke sambandha meM jo apanI vyAkhyA dI hai usakA eka aMza hama isalie pradarzita karate haiM tAki Upara jo hamane artha kiyA hai usakA AdhAra bhI pAThaka jAna leN| vaha kahatA hai ki trikagrAhI vedanayA trikavyApI, trikasya vAtasthAnatvena tadgatau pittakaphAvanyasthAnagatatvena durbalau tRtIye dine vegaM kurutaH, yadi tu svasthAnasthitau syAtAM tadA santatajvarameva kuryAtAmiti jejjttH| Upara jo tRtIyaka jvara kA varNana hai usI prakAra cAturthaka jvara ke usake prabhAva kA bhI vicAra rakhate hue nimna bheda mAne jAte haiM: 1. zlaiSmika cAturthaka-isameM tridoSAtmaka svarUpa hone para bhI zleSmolbaNatA vizeSatayA pAI jAtI hai| isakA prAdurbhAva jaMghAoM meM pIr3A ke sAtha hotA hai / jaMghA vAtasthAna hai aura isalie kapholbaNa doSa utane balapUrvaka prakopa na karane se do dina bIca meM chor3a kara hone vAlA cAturthaka bana jAtA hai| 2. vAtika cAturthaka-isameM cAturthaka tridopAtmaka rUpa hone para bhI vAtolbaNatA vizeSa karake pAI jAtI hai| isakA Arambha ziraHzUla ke sAtha huA karatA hai| zira zleSmasthAna hai ataH vAtadoSa utanA prakopa yahA~ nahIM kara sakatA jitanA svasthala meM usase sambhava thaa| ataH doSa zanaiH zanaiH prakopa karatA hai aura ziraHzUla ke sAtha do dina chor3a kara Ane vAlA cAturthaka rUpa dhAraNa kara letA hai| cAturthaka jvara ke andara zlaiSmika aura vAtika rUpa Ane se do prakAra kI zaMkAeM vikRtivettAoM ko ho sakatI haiM eka to yaha ki cAturthaka tridoSAtmaka hai yA vahIM aura dUsarI yaha ki pittaja cAturthaka hotA hai yA nhiiN| cAturthaka jvara tridoSaja hai isake lie dUra jAkara pramANa DhUMDhane kI koI avazyakatA nahIM hai svayaM caraka kA nimna vacana hI paryApta hai For Private and Personal Use Only

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jvara 337 prAyazaH sannipAtena dRSTaH paJcavidho jvaraH / sannipAte tu yo bhUyAt sa doSaH parikIrtitaH // ataH pA~coM viSamajvara ke bheda prAyazaH tridoSAtmaka yA sannivAtaja hote haiM yaha mAna kara calanA cAhie para prAyaH kahane se eka doSaja aura dvidoSaja bhI ho sakate haiM / tathA jejjaTa ke hI zabdoM meM vikRti viSamasamavAyarabyAH santatAdayaH sannipAtajAH, teSAmevodbhUtadoSeNa vyapadezaH; prakRtisamasamavAyArabdhasta ekadoSaja dvidoSajA api bhavantIti jejjaTaH / Age hArItAcArya kA jo mata diyA hai vaha bhI cAturthaka ko sAnnipAtika svIkAra karatA hai / pittaja cAturthaka hotA hai yA nahIM a - prakRti samasamavAyArabdha caturthaka pitta ke dvArA nahIM huA karatA aisA vyAdhi svabhAva hai / jaise ki pittaja galagaNDa nahIM hotI usI prakAra pittaja cAturthaka bhI nahIM hotA yaha eka mata hai / A-- hArItAcArya kA nimna mata hai : caturthako nAma gado dAruNo viSamajvaraH / zoSaNaH sarvadhAtUnAM balavarNAgninAzanaH // tridoSajo vikAraH syAdasthimajjagato'nilaH / kupitaM pittamevaM tu kaphazcaivaM svabhAvataH // zItadrAhakarastIvrastrikAlaM cAnuvartate / sannipAtasamudbhUto viSamo viSamajvara : UrdhvaM kAyasya gRhNAti yaH pUrvaM so'nilAtmakaH / pUrvaM gRhNAtyadhaH kAryaM zleSmavRddhacaturthakaH // 11 ki cAturthaka nAmaka roga dAruNa viSama jvara hai jo sarva dhAtuoM kA zoSaNa karatA hai tathA zarIra ke bala aura varNa tathA agni kA nAzaka hai / yaha tridoSaja vikAra hai isameM vAta asthi aura majjAgata ho jAtI hai pitta bhI kupita hotA hai aura kapha bhI svabhAvataH prakopa karatA hai / yaha zIta aura dAhakArI tIvra aura tInoM kAloM meM hotA hai yaha sannipAtottha viSamajvara hai / jo Urdhva zarIra meM vedanotpatti karatA hai vaha kaphAtmaka cAturthaka hai tathA jo adhaH kAyA meM pahale Arambha hotA hai yA vahA~ zUlotpatti karatA hai vaha zleSmAtmaka cAturthaka jvara mAnA jAtA hai / yahA~ hArIta ne UrdhvakAyA aura adhaHkAyA kA vicAra lekara do hI prakAra ke cAturthaka mAne haiN| pittAtmaka doSa ko inhIM donoM ke sAtha anubandha rUpa meM hI mAnA hai / vaha yaha to kahatA hai ki vAta pitta aura kapha tInoM kA kopa cAturthaka jvarakArI hai aura pitta cAturthaka jvarotpatti meM pratyakSa kAma letA hai itanA kahane para bhI spaSTataH paittika cAturthaka vaha bhI nahIM likha sakA / i-bheDa ne paittika cAturthaka par3hA hai AmAzayasthaH pavano hyasthimajjagato'pi vA / kupitaH kopayatyAzu zleSmANaM pittameva ca // I - nAgabhartR tantra meM paitika cAturthaka kA spaSTa nirdeza hai : UrdhvakAryaM tu yaH pUrva gRhNAti so'nilAtmakaH / madhyakAyaM tu gRhNAti pUrvaM yastu sa pittajaH // pUrva gRhNAtyadhaH kAryaM zleSmavRddhazcaturthakaH / isa prakAra madhyakAyA meM paittika cAturthaka kA vicAra koI asambhava bAta nahIM hai / ataH caraka aura suzruta to isa mata ke haiM ki do hI prakAra kA cAturthaka hotA hai 26, 30 vi0 For Private and Personal Use Only

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338 vikRtivijJAna hArIta aura malapitta kI mahattA aMgIkAra karate haiM tathA nAgabhattatantra spaSTatayA paittika cAturthaka kA udghoSa karatA hai| viparyaya vicAra cAturthaka jvara kA hI eka viparyaya bheda cAturthaka viparyaya ke nAma se prasiddha hai| yaha bhI eka prakAra kA viSamajvara hai isameM eka dina rogI ko ArAma milatA hai dUsare aura tIsare dina jvara ho jAtA hai aura cauthe dina punaH ArAma milatA hai / sa madhye jvarayati ahni AdAvante ca muJcati / isake sambandha meM vAgbhaTa likhatA hai asthimajjobhayagate caturthakaviparyayaH / tridhA, dvathahaM jvarayati dinamekaM tu muJcati // . aba hama yadi madhukoza TIkAkAra kI dRSTi se caleM to hameM isa cAturthaka viparyaya kI saba gutthiyoM kA hala mila jAvegA / isake anusAra sarvaprathama jejaTa kA mata yaha milatA hai ki yaha jvara asthi aura majA donoM meM jAkara rahane vAlA hai| Adi ke pahale dina jvara nahIM AtA para bIca ke do dina jvara lagAtAra banA rahatA hai| parAzara kA bhI yahI mata hai asthimajjobhayagate caturthaka viparyayaH / tryahAd dvayaha jvarayati AdAvante ca muJcati // yahA~ tIna dina meM eka dina zAnti aura do dina jvara rahatA hai / aura tIna dina bItane para cauthe dina zAnti rahatI hai| haricandra kA mata nimna haidve ahanI nirantaraM jvarayitvA uparabhyaikamahaH / punarbara yatItvevaM caturthaka viparyaya iti / / isake anusAra do dina nirantara jvara calatA rahakara tIsare dina utara jAtA hai aura phira do dina ke lie car3ha baiThatA hai| jisa prakAra cAturthaka viparyaya ho sakatA hai usI prakAra tRtIyaka viparyaya anyedyaSka viparyaya Adi bhI dekhA jA sakatA hai / isake lie madhukoza kI bhASA hI samajhie madhye eka dinaM jvarayati AdyantayormuJcatIti tRtIyaka vipryyH| eka kAlaM vimucya sarvamahorAtraM vyApnotItyanyeduSkaviparyayaH, ( kAladvaye muJcati sarvamahorAtraM jvarayatIti satataka vipryyH|) yahA~ ina viparyayoM meM dopavikRti nAnA prakAra ke hetuoM meM badala jAtI hai| arthAtkaphasthAneSu vA tiSThan doSo dvitri caturyu ca / viparyayAkhyAna kurute vidhamAn kRcchrasAdhanAn / doSa jaba do tIna yA cAroM kaphasthAnoM meM vyApta ho jAte haiM to eka sthAna se calakara doSa jaba AmAzaya meM AtA hai tabataka tIsare sthAna kA doSa hRdaya meM pahu~ca jAtA hai aura cauthe sthAna kA kaNTha meM calA AtA hai isa prakAra eka krama bana jAtA hai aura viparyayAkhya viSamajvaroM kA tAMtA laga jAtA hai ise mUlabhASA meM samajhie AmAzaya hRdayasthadoSo yathodAhRta evAnyezuSkaviparyayaH, AmAzayahRdayakaNThasthitena tRtIyaka viparyayaH;, tatraikasmin dine hRdayastho doSa AmAzayamAgatya jvarayati, evaM dinadvayaM bhUtvA pazcAdekadinaM na bhavatIti tRtIyakaviparyayaH; AmAzaya hRdayakaNThaziraHsthena doSeNa caturthaka viparyaya For Private and Personal Use Only

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jvara 336 iti tatra yasmin dine hRdayastho doSa AmAzayamAgatya jvarayati tasmin dine kaNThastho hRdayaM zirasthaJca kaNThamAyAti, aparadine hRdayastha AmAzayamAgatya jvarayati kaNThasthitazca hRdayamAyAti, aparadine hRdistha evAmAzayamAgatya jvarayati, evaM dinatraye bhUtvA pazcAdekadinaM na bhavatIti caturthakaviparyaya iti / ye sabhI viparyayajvara munipraNItatvAt zAstraviruddha nahIM mAne jAte / tathA inakI cikitsA mUlatRtIyaka kA cAturthaka roga ke samAna hI kI jAtI hai| viSamajvaroM kI tridoSAtmakatA . ' isa sambandha meM paryApta vicAra kiyA jA cukA hai| yaha paJcavidha viSamajvara prAyaH sanipAtAtmaka hI hotA hai aura sannipAta meM bhI jo doSa adhika prabala hotA hai usI doSa ke nAma para usakA nAmakaraNa ho jAtA hai| parivartanIya paristhitiyA~ eka prakAra kA viSamajvara dUsare prakAra ke viSamajvara meM badala jAtA hai isake lie nimna paristhitiyA~ uttaradAyI hotI haiM : 1. Rtu 2. ahorAtra 3. doSa 4. mana 5. kAla 6. prAktanakarma / .. santatAdi jvara uttarottara durbala hote haiM / arthAt santata se satata, satata se anyedyaka, anyedyapka se tRtIyaka aura tRtIyaka se cAturthaka jvara alpadoSa bhUyiSTha huA karatA hai| ye durbala jvara Rtu, ahorAtra, doSa, manas ke bala se prabala hokara pUrva pUrva prabala jvarakAla ko prApta ho jAte haiM / usa kAla ke kAraNa use vaisA vaisA jvara kaha kara pukArA jAtA hai| RtvAdi ke abala hone se prabala jvara kA hrAsa hone lagatA hai aura uttarottara durbala jvaropalabdhi ho jAtI hai| usa kAla ke anusAra vaha vaha durbala jvara kahA jAtA hai| santata jvara RtvAdi bala aura saba meM pahalA hone se ati balavAn hotA hai caturthaka jvara sabase bAda meM Ane ke kAraNa RtvAdibala se atyanta durbala yA naSTa kahA jAtA hai| . aise hI vAta pradhAna cAturthaka, tRtIyaka, anyezuSka yA satatajvara prAvRTa Rtu Ane para balopalabdhi karake apane pUrva pUrva ke jvaroM ko prApta ho jAte haiN| satata santata meM badala jAtA hai anyedyaSka satata ho jAtA hai, tRtIyaka anyedhuSka aura cAturthaka tRtIyaka ho jAtA hai| yadi jvara pitta pradhAna hue to zaratkAla meM labdhabala hokara pUrva pUrva meM pariNata ho jAte haiN| kapha pradhAna jvara vasanta Rtu meM isI prakAra apane rUpa ko chor3a kara apane se balavAna svarUpa kA dhAraNa kara lete haiN| ... vAta pradhAna santata satatakAdi jvara zarada yA vasanta kAla meM alpabala ho jAte haiM jisake kAraNa santata satata meM satata anyezuSka meM, anyeduSka tRtIyaka meM tRtIyaka cAturthaka meM aura cAturthaka do ke sthAna para 3 yA 4 dina chor3a kara AnevAle jvara meM badala jAtA hai yA pUrNataH naSTa ho jAtA hai| isI prakAra pitta pradhAna viSama jvara hemanta 1. caturthazcedavam atikSINo vA naSTo vA syAditi / For Private and Personal Use Only

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340 vikRtivijJAna yA vasanta meM alpabala hokara prabala se durbalatA ko pUrva se anu ko prApta hone lagate haiN| isI prakAra kapha pradhAna grISma yA zaratkAla meM alpabala hokara santata se satatakAdi meM badala jAte haiM / ahorAtra bala se bhI cAturthaka tRtIyakAdi meM badala jAte haiM aura ahorAtrabalAt tRtIyaka cAturthaka meM badala jAtA hai / vaha isa prakAra hotA hai ki mAna lo ki rUkSoSNa guNa meM kupita vAta pradhAna cAturthaka ho to vaha grISma Rtu meM dina meM balavAn hokara tRtIyaka rUpa ko prApta ho jA sakatA hai| zIta guNa kupita vAta grISma meM balahIna hokara caturthaka ko pacamaka yA SaSThaka banA degI yA use naSTa hI kara degI / pitta pradhAna doSa zaradaRtu meM labdhabala dina meM hone se caturthaka ko tRtIyakAdi meM badala degA / kapha pradhAna doSa hemanta vasanta RtuoM meM ahorAtra kA bala lekara santatAdi atibala jvaroM meM pariNata kara degA | aura santatAdi vAta pradhAna hone para zaradvasantAdi meM ahorAtra bala khokara satatAdi bhAva ko prApta kareMge / pitta pradhAna dopa zIta Rtu meM ahorAtra bala khokara usI prakAra nIce utara AyeMge / kapha pradhAna dopa grISma ke ahorAtra bala se hIna hokara nIce utara AyeMge / ahorAtra kA jvaroM para prabhAva katipaya vidvAn hI mAnate haiM kyoMki eka eka ahorAtra ke balAbala se vaha vaha jvara balI yA durbala hotA hai yaha mAnanA RtvAdi anya bhAvoM ke bhI prabhAva ko chor3a ekAntena prAyaH nahIM liyA jA sakatA / parantu ahorAtra kA prabhAva hotA hai tathA ho sakatA hai ise bhUlanA nahIM hai / vAta pradhAna cAturthaka yadi ho to vaha vyAyAma, apatarpaNa, rUkSaNa, laghu Adi hetuoM ko prApta karake aura adhika vAta doSa yukta ho jAtA hai aura tRtIyaka rUpa ko dhAraNa kara letA hai / pitta pradhAna cAturthaka kaTvamlAdi sevana se pittAdhikya prApta karake tRtIyaka rUpa dhAraNa kara letA hai / isI prakAra kapha pradhAna guru madhurAdi ke atyadhika sevana se kapha bala ko prApta kara cAturthaka se tRtIyakAdi rUpa grahaNa kara letA hai / isI kA viloma yadi vAta pradhAna santatAdi ko madhurAmla guru padArtha sevana karAye jAveM to usakI vAta kA svarUpa ghaTa jAvegA aura santata satatAdi meM badala jAvegA / tathA pitta pradhAna santatAdi ko tikta madhura kaSAyAdi padArtha dene se usakA bala kama ho jAvegA aura vaha satatakAdika meM pariNata ho jAvegA / evaM kapha pradhAna santatAdi pIDitoM ko kaTutiktakaSAyAdi kaphaghna padArthoM yA vihArAdika kA upayoga karAyA jAvegA to kapha kA doSa kSINa hokara santata satata meM satata anyedyuSkAdi meM badala jAyeMge / mana ke kAraNa bhI vyAdhi ke calate hue krama meM antara par3a jAtA hai / yaha prakaraNa Adhunika manovijJAna vettAoM ke lie kautUhala kAraka hogA para prAcInoM ne mAnasika kAraNoM ko sadaiva apane sthAna para zraddhA pUrvaka dekhA hai aura mana ke dvArA hone vAle prabhAvoM kA mUlyAMkana yathocita kiyA hai / gaMgAdhara likhatA hai na tu RtvAdibalAdvadyAvibalam abalAdvayAdherabalamiva manaso balAdvayAdhibalamabalAdvayAdherabalamiti khyApitam / tathA ca santatAdijjarI yadi dhanabandhuputrapautrAdinAnAharSakara bhAvegAtipramodita cittaH syAt tadA manasaH prabalatvAt satatAdijvarI syAt yadi dhanavAndhavaputrapautrAdivinAzAdi For Private and Personal Use Only

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jvara 341 vividhaduHkhakarabhAvega viSaNNavittaH syAt tadA cAturthakAdijvarI tRtItakAdijvarI syAnmanaso durbalatvAt / jaise Rtu Adi ke bala se vyAdhi balavAn aura abala se durbala hotI hai vaisA mana se bhI sambhava hai para vaha dUsare DhaMga kA hai usa prakAra kA nhiiN| RtvAdi kAla se to zanaiH zanaiH rUpaka baMdhatA hai para yahA~ to sahasA bijalI kI taraha kArya hotA hai / putra yA pautra janma kA harSa sunakara tRtIyaka eka dina Age calA jAtA hai usa dina nahIM hotA aura vaha phira cAturthaka saMjJaka bana jAtA hai| isI prakAra jo jvara kala Ane vAlA hai vaha kisI kI mRtyu kA samAcAra suna kara turata A jAtA hai / mana kA zarIra para kitanA prabhAva hai isake lie eka udAharaNa anupayukta na hogaa| puradilanagara ke samIpa eka grAma barIkAnagalA hai vahA~ eka vRddha ThAkurasAhaba tridoSaja santata jvara meM par3e hue antima zvAseM gina rahe the| dekhane kI zakti jA cukI thI zravaNa zakti javAba de rahI thI hamAre agraja eka kuzala cikitsaka haiN| ve vahA~ upasthita the koI aisA upAya nahIM dikhAI detA thA jisase ThAkura sAhaba kI rakSA kI jA ske| bhAI sAhaba ne vahA~ pUchA ki kisI ko rogI kA rupayA to nahIM denaa| isa para unhIM ke eka bhAI ne kahA ki mujhe inake tIna sau rupaye dene haiN| vaidya jI ne unase rupaye ma~gavAye aura rogI ke kAna para bahuta jora se pukArA ki amuka sAhaba Apa ke rupaye de rahe haiM lelo / jyoM hI usane sunA usameM cetanA zakti daur3a gaI netroM meM jyoti A gaI aura rogI rupayA samhAlane ke lie uTha baitthaa| usakA roga jAtA rahA dUsare dina use pathya denA par3A aura vaha ThAkura bholUsiMha abhItaka jIvita haiM jaba ki isa ghaTanA ko ghaTe bAraha varSa bIta cuke| ___ mana kI taraha buddhi bala bhI roga ke bar3hAne yA ghaTAne meM apanA kArya karatA hai / buddhi bala se santata satatakAdi meM badala jAtA hai| buddhivala se hI prajJAparAdha kI rokathAma kI jAyA karatI hai| usake lie balimaGgaladrAnasvastyayanapUjopahAradevaguruvRddhasiddhaRSi Adi kI tathA oSadhiyoM kI sevA AtI hai| bacapana meM maiM svayaM eka bAra ekatarA jvara (anyevUSka) se pIDita huaa| mahIne bhara taka jvara AtA rahA auSadhopacAra vyartha siddha thaa| merI mA~ jise maiM bIbI kahatA thA bahuta cintita thii| eka dina bIbI mujhe nagara ke bAhara eka tAlAba para le gii| usane mere pAdAMguSTha se sira taka sAta bAra kaccA sUta nApA aura samIpa ke eka choTe babUla ke per3a para lapeTa diyA aura mere hAtha jur3avA kara kahalavAyA ki he devatA merA jvara lelo / usake bAda tAlAba ke pAnI meM mukha dhulavAyA aura mujhe batA diyA ki aba jvara yahIM raha gyaa| ghara Ane para mujhe pUrNa vizvAsa thA hI ki jvara nahIM AvegA aura huA bhI ThIka vaisA hI / Aja isa ghaTanA ko lagabhaga paccIsa varSe ho gaye mujhe viSama yA koI bhI jvara nahIM aayaa| __ arthavazAt yA pUrva karmoM ke kAraNa bhI santata satata meM badala jAtA hai| cAturthaka tRtIyaka bana jAtA hai| yaha prAktana karma vAda kA pracalana vaha Age kI sIr3hI hai jahA~ Adhunika manovaijJAnikoM ko pahu~canA abhI zeSa hai sambhavataH unheM yahA~ taka pahu~cane meM For Private and Personal Use Only

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342 vikRtivijJAna do sau varSa laga jAveM / prAktanakarma ke kAraNa santata satata meM aura cAturthaka tRtIyaka meM badala jAtA hai| isako samajhane kI anya bhI vidhiyA~ haiM jaise mAnalo ki Apake grAma meM sarvatra santata jvara cala rahA hai| para vahA~ eka vyakti usI ghara kA usI khAna pAna kA AdI eka hI prakRti vAlA santata ke sthAna para satata jvara se pIDita ho jAtA hai| jaba anya sabhI bAteM samAna haiM to use bhI santatajvarApanna honA cAhie thaa| yaha jo dUsarI bAta huI isa para prAktana karma kA adhikAra hai| ise isa prakAra bhI samajhA jA sakatA hai ki ati durbala komala zleSma prakRti bhUyiSTha bAlaka ke kapha pradhAna tRtIyaka hotA hai jaba atibaliSTha pittaguNa bhUyiSTha usI ke pitA ko santata jvara hotA hai aura bhI Azcarya yaha ki pitA usako na saha kara mara jAtA hai aura komala bAlaka baca jAtA hai / yaha saba prAktana karma kI kriyA meM socane ke lie bAdhya karanevAlI ghaTanAe~ haiN| do bAlakoM ko eka hI mA~ dugdha pilAtI hai doSadRSTi se donoM eka samAna jur3avA~ haiM para eka prAktana karma vaza eka prakAra ke jvara se pIDita hotA hai aura dUsarA usase gambhIra jvara meM mara jAtA hai yA adhika kaSTa bhogatA hai| yadyapi sarvatra hetu ke anukUla hI karma hotA hai para jahA~ kAraNAntarAbhAva ho taba bhI kArya ho to vahA~ prAktanakarma hI lenA par3atA hai| viSamajvaroM ke sambandha meM jalpakalpatarukAra ne kucha sUtra saMgraha karake likhe haiM unheM hI yahA~ avikala de rahe haiM :(1) paro hetuH svabhAvo vA viSaye kaishcidiiritH| AgantuzcAnubandho hi prAyazo viSamajvare / / (2) vAtAcikatvAt pravadanti tajjJAstRtIyakaJcApi caturthakaJca / aupatyake madyasamutthite ca hetuM jvare pittakRtaM vadanti / / pralepakaM vAtabalAsakaJca kaphAdhikatvena vadanti tajjJAH / mUcrchAnubandhA viSamajvarA ye prAyeNa te dvandvasamutthitAstu / (3) tvaksthau zleSmAnilau zItamAdI janayato jvre| tayoHprazAntayoHpittamante dAhaM karoti ca // karotyAdau tathA pittaM tvaksthaM dAhamatIva ca / tasmin prazAntetvitarau kurutaH zItamantataH / / dvAvetau dAhazItAdi jvarau saMsargajau smRtau / dAhapUrvastayoH kaSTaH kRcchrasAdhyatamazca sH|| pralipannivagAtrANi dharmeNa gauraveNa vaa| mandajvaravilepI ca sazItaH syaatprlepkH|| nityaM mandajvaro rUkSaH zUnakaratena sIdati / stabdhAGgazleSmabhUyiSTho na te vAtabalAsakI // samau vAtakaphau yasya hInapittasya dehinaH / prAyo rAtrau jvarastasya divAhInakaphasya ca / / vidagdhe'nnarase dehe zleSmapitte vyavasthite / tenArddhazItalaM dehe cArddhacoSNaM prajAyate / / kAye duSTaM yadA pittaM zleSmA cAnte vyvsthitH| uSNatvaM tena gAtrasya zItatvaM hstpaadyoH|| kAye zleSmA yadA duSTaH pittamante vyavasthitam / zItatvaM tena gAtrANAmuSNatvaM hstpaadyoH|| (4) vAtenoddhUyamAnastu yathA pUryeta saagrH| vAtenodAritAstadvadoSA kurvanti vai jvarAn / yathA vegAgame velAM chAdayitvA mhoddheH| vegahAnau tadevAmbhastatraivAntarNidhIyate / / doSavegodaye taddudIryeta jvarasya vaa| vegahAnau prazAmyeta yathAmbhaH sAgare tathA / uparokta zlokoM meM kaI kAma kI bAteM A gaI haiM jo isa prakAra haiM: viSamajvara parahetuvAlA aura svabhAvAt viSamatva rakhanevAlA jvara hai yaha prAyaH karake Agantu aura anubandhI hotI hai| For Private and Personal Use Only

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-- jvara 343 tRtIyaka aura cAturthaka meM vAtAdhikya pittakRta aupatyika vA adyasamuttha hotA hai| vAtabalAsaka aura pralepaka meM kaphAdhikatva rahatA hai jina viSamajvaroM meM mUrchA kA anubandha hotA hai ve prAyaH dvandvasamuttha hote haiM aisA kisI-kisI kA mata hai| ___ jaba zleSmA aura vAta ye donoM rogI ke pariNAhI bhAga meM rahate haiM to viSamajvara ke Arambha meM zIta AtA hai inakI prazAnti pitta ke dvArA hone ke lie zarIra ke andaradAha hotA hai| jaba tvacAdya pariNAhI bhAga meM pitta sthita hotA hai to jvara ke Adi meM dAha hotA hai usakI zAnti andara zaitya hone se hotI hai| ye donoM dAha aura zItapUrvaka jvara saMsargaja hote haiN| upasarga doSa ke binA ye nahIM ho paate| jisa jvara ke pUrva meM dAha ho vaha kaSTadAyaka aura kRcchrasAdhya huA karatA hai / sampUrNa zarIra ko jo jvara garmI aura gurutA se pralipta kara detA hai jisameM jvara manda-manda aura zItapUrvaka hotA hai vaha pralepaka kahA jAtA hai| vAta balAsakajvara kA varNana Age hama punaH kareMge yaha bhI eka prakAra kA mandajvara hai isameM rUkSatA, zotha aura avasAda khUba pAyA jAtA hai isake kAraNa aMga stabdha ho jAte haiM aura yaha kaphAdhikya se utpanna hone vAlA roga hai| jisa jvara meM vAta aura kapha donoM samAna hote haiM aura pittahIna hotA hai use jvara prAyaH rAtri meM AtA hai aura jisameM pitta aura vAta sama hoM tathA kapha kama ho vaha dina meM AtA hai| jaba zarIra meM annarasa vidagdha ho jAtA hai para zleSmA aura pitta vyavasthita rahate haiM taba AdhI deha zItala aura AdhI uSNa rahA karatI hai| zarIra meM jaba pitta duSTa ho jAtA hai tathA bAhyabhAga meM zleSmA vyavasthita ho jAtA hai to sampUrNa zarIra uSNa aura hAtha paira ThaNDe ho jAte haiN| zarIra meM jaba zarIrastha zleSmA duSTa yA pitta andara vyavasthita ho to zarIra meM zItalatA para hAtha paira garma milate haiN| bahudhA hama dekhate haiM ki viSamAdijvaroM meM kabhI hAtha paira ThaNDe rahate haiM kabhI garma rahate haiM kabhI AdhA zarIra garma milatA hai to AdhA zarIra tthnnddaa| ina sabake lie Ayurveda ne jo hetu diye haiM ve hI Upara spaSTa kiye gaye haiM inake sambandha meM aura bhI jo milegA use hama pAThakoM ke samakSa yathAsthAna prakAzita kareMge / caturtha bhAga meM jvara ke begodaya aura vega zAnti kA sAhityika rUpaka bA~dhA gayA hai| saptavidhajvara saptadhAtuoM meM se pratyeka meM jaba kisI roga kI vyApti hotI hai to roga uso dhAtu ke nAma se pukArA jAtA hai / isI ke samarthana meM bhela kA 'yasminvyApadyate dhAtau tasmin vyAdhIn karotyatha / ' vAkya hai| jvara bhI eka atyanta kaSTakara vyAdhi hai aura jaba vaha jorNa ho jAtA hai to vaha eka ke pazcAta dUsarI dhAtu meM vyApta ho jAtA hai| vividha dhAtuoM meM hone ke For Private and Personal Use Only

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644 vikRtivijJAna kAraNa usake vibhinna aura spaSTa lakSaNa pragaTa hote haiM unhIM ke AdhAra para AcAryoM ne jvara ko dhAtuoM kI dRSTi se sAta prakAroM meM vibhakta kara diyA hai|| cikitsA kA sarvasAmAnya vidyArthI bhI itanA to jAnatA hI hai ki jaba jvara AtA hai to vaha zarIra ke tApAMza ko bar3hA detA hai isake kAraNa rasa, rakta, mAMsa, medas , asthi, majA tathA zukra sabhI kA tApAMza bar3ha jAtA hai| jvara meM maithuna karane vAloM ke bAhara Aye vIrya kA tApAMza liyA jAve to vaha zarIra ke UrdhvaMgata tApAMza se thor3A bahuta adhika hI milatA kama nhiiN| ataH jvara cAhe kisI dhAtuvizeSa kA ho athavA anya kisI aupasargika kAraNa se AyA ho usake kAraNa sampUrNa zarIra vyathita hotA hai aura sampUrNa zarIra ke pratyeka avayava meM hI jvara kA prabhAva dekhA jAtA hai| taba phira AyurvedajJoM kI yaha kauna kalpanA hai jisake phalasvarUpa dhAtugata jvaroM kA vicAra kiyA gayA ? pIche hamane vraNazotha prakaraNa meM spaSTataH aGkita kara diyA hai ki vividha UtiyoM meM vraNazotha huA karatA hai| kahIM bhI vraNazotha bana sakatA hai / jahA~ vaha banegA vahA~ usa aMga ke viziSTa lakSaNoM ke atirikta sarvasAdhAraNa saMrambha (zUla, uSNatA, lAlimA aura sUjana) avazya milegaa| jisa prakAra vragazotha pratyeka Uti meM milatA hai aura usake kAraNa utpanna jvara sampUrNa zarIra meM vyApta hotA hai usI prakAra viziSTa dhAtu ko lakSya karake jvarotpatti ho sakatI hai aura usa viziSTa dhAtu ko pIDita karate hue viziSTa lakSaNa bhI mila sakate haiN| AdhunikoM dvArA mAnyajvaroM kA bhI vicAra kareM to viSamajvara rasa aura rakta ke prabhavasthala yakRt plIhA yA jAlakAntazchadIyasaMsthAna ke antargata apane utpAdaka jIvANuoM ko prazraya detA hai| bhela ne rasavyApattija rogoM kA ullekha karate hue inheM bhI ginAyA hai anyedyuSkaM satatakaM tRtIyakacaturthakam / pittaM lohitapittaM ca raktAzIsi praleyakam / / vipATikAMzca tAn vyAdhIna rasajyApattijAnviduH / kAlAjAra nAmaka jvara kA jIvANu plIhA ke andara tathA jAlakAntazchadIyasaMsthAna ke antargata pAye gaye aMgoM meM nivAsa kara jvarotpatti karatA hai| Age jo yakSmA kA varNana hone vAlA hai vaha apanA spaSTa nirdeza karatA hai ki mAnava zarIra ke kisI bhI aMga yA Uti meM yakSmA jIvANu ke kAraNa jvarotpatti tathA anya kSaya darzaka lakSaNa pAye jA sakate haiN| yakSmA meM jvara nirantara banA rahatA hai| vividha aMga usake kAraNabhUta jIvANu ko apanI zaraNa meM lekara mAnavazarIra para vipatti bulAte rahate haiN| Ayurveda zArIrika doSa dhAtu aura mala ko zarIra kA mUla mAnakara calatA hai| isa kAraNa kAraNabhUta jIvANuoM kA koI vizeSa vicAra na karate hue yadi usane dhAtustha jvaroM kI kalpanA svIkAra kara lI ho to koI Apatti kA vizeSa viSaya nahIM hai| aisI kalpanA kI jA sakatI hai aura usake lie jina lakSaNoM kI abhivyakti usane kI hai vaha yathArtha tathA mUrta tathyoM para avalambita haiM aisA mAnakara For Private and Personal Use Only

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jvara 345 calA jA sakatA hai| isI dRSTi se aba hama saptavidha dhAtugatajvaroM ko spaSTa karane kA yA karate haiN| rasagatajvara (1) gurutvaM zItamudvegaH sadanaM chargharocakau / rasasthite bahistApaH sAGgamardo viz2ambhaNam / / (caraka) (2) gurutA hRdayotklezaH sadanaM chargharocakau / rasasthe tu jvare liGga dainyaM cAsyopajAyate // (suzruta) (3) rasasthe tu jvare vatsa lakSaNAni nibodha me| gurutvaM dainyamutklezaH sadanaM charca rocakau (DalhaNaTIkA) (4) utklezo gauravaM dainyaM bhaGgoGgAnAM vijambhaNam / arocako vabhiH sAdaH sarvasmin rasage jvare // ( vRddha vAgbhaTa) rasasthaH santatam isa dRSTi se Upara jo lakSaNa diye haiM ve santata jvara ke haiM / para santata vyatirikta kisI bhI hetu vizeSa ke kAraNa jaba ye lakSaNa pragaTa hoMge to nissandeha use rasagata jvara kI saMjJA dI jA sakatI hai| ___ avikRta rasa dhAtu kA zreSTha karma prINana yA tRpti mAnA gayA hai| jaba isakI vRddhi hotI hai to zarIra meM zleSmA kA dharma bar3ha jAtA hai jisase agnisAda ho sakatA hai| rasa dhAtu kI kSINatA hone para rUkSatA, zrama, zoSa, glAni aura zabda ke sunane mAtra meM asahiSNutA pAI jAtI hai| rasa dhAtu ke prakRta aura vikRta svarUpoM ko hRdayastha karake bhaba yadi hama rasagata jvara kA adhyayana kareM to paryApta gaharAI taka hama pahu~ca sakate haiN| rasadhAtu meM jvara ke pahuMcane se zarIra meM gaurava yA gurutA kI avilamba vRddhi hotI hai| gaurava kI vRddhi zleSma jvara kA bhI eka lakSaNa hai| zleSmA ke nirduSTa lakSaNoM meM sthiratA, snigdhatA sandhibandhana dArya pramukha haiN| jvara jaba rasadhAtu meM praviSTa ho jAtA hai to zarIrastha zleSmasrAvI aura zleSma vAhaka aMgoM para vizeSa prabhAva DAlatA hai| isakA prabhAva sarvAMgINa avasAda meM hotA hai jise caraka aura suzruta donoM ne sadana zabda se vyakta kiyA hai| sarvAMgINa avasAda sadaiva hRdaya para hue avasAda kA hI pratyakSa pariNAma mAnA jAtA hai ataH usake pUrva hRdayokleza yA udvega nAmaka lakSaNa kA ullekha kiyA jAve to vaha bhI saGgata mAnA jAnA caahie| zlaiSmika rasadhAtu kI vRddhi ke kAraNa aruci kA honA eka svAbhAvika paramparA hai| Ayurveda meM jahA~ kahIM aruci nAmaka lakSaNa mile vidyArthI kA dharma hai ki vaha samajha le ki rogI kI rasadhAtu dUpita hai aura zleSmA kA jora hai| aruci ke sAtha jvara kA anubandha hone para vamana kA honA svAbhAvika hai| isI kAraNa rasagatajvara ke Arambha meM jahA~ sampUrNa zarIra bhArI ho jAtA hai aura halakI halakI macalI Ane lagatI hai Age calakara do eka dina meM hI vamana bhI pAI jA sakatI hai| 3 dina pUrva eka rogI (jo eka rAjakIya auSadhAlaya meM vaidya hI haiM) ko dekhane kA avasara milA unakA sira bhArI thA aura unheM utkleza tathA vamana cala rahA thaa| jvara santata rahA / mahattva kI bAta yaha rahI ki unake hRdaya para bhI thor3A zUla thA jise unhoMne zvasanaka yA nyUmoniyA~ kA Adi kAraNa smjhaa| zvasanakIya cikitsA se unheM koI bhI lAbha huA nahIM aura roga viSamajvara ke zamanopAyoM dvArA ThIka kiyA jA skaa| For Private and Personal Use Only

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346 vikRtivijJAna aba yadi isa citra ko hama apane sAmane rakheM to jJAta hogA ki vaidyajI kI rasadhAtu meM jvara ke vyApta hone ke kAraNa hI vamana, ziraHzUla aura nirantara jvara thaa| unheM avasAda bahuta adhika thaa| zleSmAdhikya bahudhA zItapUrvI jvarakArI huA karatA hai| para sadaiva zIta lage yaha paramAvazyaka nhiiN| isI kAraNa eka AcArya ne zIta kA ullekha kiyA hai para dUsare ne usa ora koI dhyAna nahIM diyA / zItapUrvaka jvara sadaiva svastha hotA hai / rasa dhAtu meM lIna jvarakArI padArtha meM bahistApa caraka ne mahatvapUrNa mAnA hai isIlie zItapUrvakatA ko bhI pragaTa kiyA hai| ___ aMgamarda yA jamhAiyoM kA adhika AnA athavA mukha para atyadhika dInatA kA pragaTa honA ve sarvasAdhAraNa lakSaNa hai jo jvaroM meM bahudhA mila jAte haiN| itanA to mAnanA hI cAhie ki rasagata jvara pUrNatayA sAdhya hote hue bhI isakA prArambhika AkramaNa itanA vikaTa hotA hai ki sAdhAraNatayA vaidya ise bahuta gambhIra vyAdhi se nIce nahIM mAna kara calate aura dhokhA khAte haiN| aSTAMgasaMgrahakAra ne rasadhAtugatajvara ke nimna lakSaNa diye haiM:utklezo gauravaM dainyaM bhaGgo'GgAnAM vijRmbhaNam / arocako vamiH sAdaH sarvasmin rasage jvare / yahA~ aMgabhaMga zabda se adhika coMkane kI AvazyakatA nahIM vaha yahA~ aGgamarda kA hI nirdezaka mAnanA caahie| prasaMgAt yaha kaha denA bhI anupayukta nahIM hai ki rasagatajvara kI cikitsA karate samaya AcAryoM ne upavAsa tathA vamana karmoM ko pradhAnatA dI hai ___ jvare rasasthe vamanamupavAsaM ca kArayet / upavAsa zArIrika gaurava ko dUra karane ke lie aura vamana utkleza tathA vamana ke zarIra dvArA kie gaye ucita prayAsa kI hI abhivRddhi karake rogazamanopAya karanA hI hai| raktagatajvara (1) jvaroSNatA vidAhazca mdaalsymtibhrmaaH| ___aGgavaikalyamUrchA ca jvaro raktagataH smRtaH // ( vasavarAjIya ) (2) raktaniSThIvanaM dAho mohazchardanavibhramau / pralApaH piTakA tRSNA raktaprApta jvare nRNAm // (mAdhavanidAna) (3) raktotyAH piDakAstRSNA saraktaM ThIvanaM muhuH / dAharAgabhramamadAH pralApo raktasaMsthite // (caraka) (4) raktaniSThIvanaM tRSNA raktoSNapiTakodgamaH / / dAharAgaNabhramamadapralApA raktasaMzrite // ( aSTAGgasaMgraha ) zAstrakAroM ne raktagatajvara ke jo lakSaNa diye haiM ve yaha spaSTataH pragaTa karate haiM ki yaha jvara sAdhAraNa svarUpa kA na hokara eka gambhIra vyAdhi hI ise mAnanA Avazyaka hai| caraka ne For Private and Personal Use Only

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jvara raktadhAtvAzrayaH prAyo doSaH satatakaM jvaram / dvArA kahA hai ki satatajvara rakta dhAtu ke Azrita yAnI raktagatajvara hI mAnanA cAhie aura ahorAtre satatako dvau kAlAvanuvartate ke anusAra yaha jvara dina rAtri meM do bAra car3hane vAlA hotA hai / para satatajvara ke isa lakSaNa kA varNana ki yaha do bAra car3hatA hai| raktagata jvara ke lakSaNoM ke varNana meM kahIM bhI nahIM diyA gyaa| isakA abhiprAya yahI hai| ki satatajvara raktadhAtu ko Azraya banAkara viSama saMjJaka eka jvara vizeSa kA rUpa ho sakatA hai aura vaha do bAra dina rAtri meM car3hatA hai / parantu raktagata yA raktadhAtugata jo jvara AcAryoM ne saptavidha jvara ke sAtha spaSTatayA upasthita kiyA hai vaha satatajvara na hokara eka gambhIra svarUpa kI pUrNataH pRthak sattAsampanna vyAdhi vizeSa hai / 347 vaRvarAjI meM matAntaroM ke ullekha meM jisa raktagata jvara kA vicAra kiyA gayA hai| usameM jvara, uSNatA aura dAha ye tInoM pRthak-pRthak kahe gaye haiM isase yaha AbhAsa milatA hai ki isa jvara meM paryApta tApAMza ke sAtha khUba antardAha rahA karatA hai / rakta aura pitta athavA ani kA Apasa meM jitanA ghaniSTa sambandha hai use Ayurveda kA pratyeka vidyArthI samajhatA hai / astu, raktagata jvara meM rogI ko garmI kA adhika anubhava karanA koI nitAnta anAvazyaka ghaTanA na hokara sahaja aura svAbhAvika upalakSaNa hai jo tApAMza kI uttarottara vRddhi kI ora bhI dhyAna khIMcatA hai| isake kAraNa matibhrama honA bhI svAbhAvika hai| rogI alamArI meM rakhe kapar3e ke Dhera ko bAlaka samajha sakatA hai / jahA~ Aga na ho vahA~ Aga aura jahA~ jala na ho vahA~ jala vaha batalA sakatA hai | yaha matibhrama ke saralatayA prApta udAharaNoM meM se kucha haiN| rogI ko dekhane se aisA lagatA hai ki mAno usane nazA kara liyA ho / usakI A~kheM car3hI huI rahatI haiN| pUchane para vaha zarIra meM becainI batalAtA hai aura bahudhA mUcchitAvasthA meM par3A rahatA hai / atyadhika jvara mati meM bhrama aura mUrcchA ye lakSaNa sadaiva atyadhika gambhIra avasthA ko pragaTa karane ke upAya haiM / suzruta ne jisakA ullekha mAdhavakara ne kiyA hai raktagata jvara ko aura bhI adhika gambhIra mAnA hai / arthAt usakI kalpanA ke anusAra itanA jvara ki rogI ko pralApa ho jAve, piDakAe~ nikala AyeM, pyAsa bar3ha jAve aura jisameM mUrcchA evaM matibhrama bhI ho / rogI kA khUna thUkanA yA raktaSThIvana ( haemoptysis ) tathA vamI ye do lakSaNa 1 vizeSa diye haiM / For Private and Personal Use Only uparokta lakSaNoM ke sAtha jaba hama carakokta lakSaNoM kA sAmaJjasya baiThA lete haiM to hameM bAra-bAra rakta kA thUkanA, tRSNA kI upasthiti aura pralApa ke gambhIra lakSaNoM ke sAtha hI sAtha dAha, zarIra kA lAla par3a jAnA, matibhrama, mada aura piDakodgama bhI milate haiM | tIvrajvara ke sAtha raktaSThIvana kA milanA aura zarIra para piDakAoM kA bananA nissandeha eka spaSTa raktagata jvara kI ora iGgita karatA hai / vRddha vAgbhaTa ne piTikAoM ke svarUpa kA bhI varNana diyA hai ki raktadhAtugata jvara meM

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348 vikRtivijJAna lAla aura uSNa hotI hai| usane pralApa, dAha, rAga, matibhrama, tRSNA aura raktaSThIvana ko svIkAra kiyA hai / Adhunika TAyaphAiDa se isakI tulanA kiijie| ____ jahA~ rasadhAtu meM jvara ke pahuMcane se zarIra meM gaurava, utkleza aura vamana kI pravRtti bar3hatI hai yAnI zleSmA kA prabhAva bar3hatA hai usI prakAra jaba raktadhAtu meM jvara bar3hatA hai to tApAdhikya, dAha aura uSNatA kI abhivRddhi spaSTataH yaha udghoSita kara detI hai ki aba zarIra meM pittAdhikya ho rahA hai / suzruta ne pitta ko raktadhAtu kA mala mAnA haikaphaH pittaM malaHkheSu svedaH syAnnakharoma ca / neviTa tvakSu ca sneho dhAtUnAM brAmazo malaH // raktadhAtu zarIra meM 3 kArya karatI hai| pahalA varNa kA prasAdana, dUsarA mAMsa kI puSTi tathA tIsarA praanndhaarnn| jaba rakta svayaM jvara ke kopa kA kAraNa banatA hai to rogI ke zarIra kA varNa aura adhika lAla ho jAtA hai| mAMsa kSINa hone lagatA hai athavA zithila ho jAtA hai jisake kAraNa Alasya kI vRddhi hotI hai aura tIsare mAnavIya prANazakti kama ho jAtI hai jisakA pariNAma pralApa, matibhrama athavA mUrchA meM hotA hai| ___ rakta jaba jvara kI utpatti meM pramukha bhAga letA hai to rakta ke svAbhAvika guNoM meM kucha hInatA A jAtI hai| usI ke phalasvarUpa rakta kA skandana kA dharma kama ho jAtA hai aura thUka meM raktAgama ho jAtA hai| raktagata tarala padArtha adhika uttApa ke kAraNa bAhara jAne ke kAraNa tRSNA bar3hatI hai / mastiSka meM sthita medhAkRta sAdhaka pitta raktagata jvara ke kAraNa vikRta hokara matibhrama tathA pralApa utpanna kara detA hai| tvacA meM sthita USmakRt bhrAjaka pitta vikRta hokara adhika USmA hI nahIM piTikAoM ko bhI subhIte se utpanna karane meM sahAyatA karatA hai| mAMsagatajvara (1) piNDikodveSTanaM tRSNA sRssttmuutrpuriisstaa| USmAntardAhavikSepau glAniH syAnmAMsage jvare // (suzruta) (2) antardAho'dhikastRSNA glAniH sNsRssttvittktaa|daurgndhyN gAtravikSepo jvare mAMsasthite bhavet ||(crk) (3) atitIvrajvaraH zvAsaH svedstRssnnaanggkvythaa| tandrAvidAhapulakamUrchA mAMsagatajvare / / (vasavarAjIya) (4) tRDaglAniH sRSTavarcastvamantaho bhrmstmH| daurgandhyaM gAtravikSepo mAMsasthe / / ( aSTAGgasaMgraha ) mAMsagata jvara eka spaSTa lakSaNayukta jvarAvasthA hai| isameM aicchika aura anaicchika donoM hI peziyoM meM vizeSa kaSTa rahatA hai| mAMsagata jvara meM mAMsadhAtu dhIre dhIre kSINa hone lagatI hai / aicchika pezI dvArA nirmita piNDaliyoM meM aiMThana par3atI hai aura anaicchika peziyoM se nirmita A~toM meM kriyA zakti ke alpa ho jAne ke kAraNa dasta Ate rahate haiN| isI prakAra mUtra saMsthAna kI peziyoM ke zaithilya se bAra-bAra mUtratyAga rogI karane lagatA hai| peziyoM dvArA hI zarIra meM USmA bar3hatI hai jise vyAyAma ke samaya dekhA jA sakatA hai| idhara jvarAkrAnta peziyoM meM vikSepa nAmaka kriyA kI adhikatA hone se aura antardAha rahane se USmAdhikya rahA karatA hai| isI ko vasavarAjIyakAra ne ati tIvrajvara kahA hai rogI ko thor3I glAni bhI milatI hai| For Private and Personal Use Only

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jvara 346 isa jvara meM svedotpAdaka granthiyoM meM bhI kucha kriyA bar3ha jAtI hai ataH svedAgama hotA rahatA hai| adhika USmA aura antardAha ke kAraNa tRSNA kA honA asvAbhAvika nahIM hai | zvAsocchvAsakAriNI peziyoM ke prabhAvita hone se zvAsa kA vega bhI bar3ha sakatA hai| rogI kI peziyoM meM thakAna ( fatigue ) paryApta mAtrA meM rahane se tandrA kA AnA yA pulakana honA yA aGgoM meM vyathA kA anubhava honA sAdhAraNa sI ghaTanAe~ haiM / tIvrajvara, zvAsa aura prasvedAdhikya kA pariNAma mUrcchA taka jA sakatA hai / vasavarAjIyakAra ne mAMsagatajvara kA jo rUpa hamAre sAmane rakhA hai vaha bahuta bhayAnaka aura ugrAvasthA kA citraNa karatA hai / isameM sRSTamUtrapurISatA kA lakSaNa usane nahIM likhA / sambhavataH dastAdi hone ke pUrva ugratA kI adhikatA ke kAraNa dekhe gaye mAMsagata jvara kA yaha svarUpa rahatA ho isako pratyakSa dekhakara hI yahA~ pragaTa kiyA gayA hai / caraka aura vRddhavAgbhaTa donoM ne mAMsagata jvara meM gAtra kI durgandhatA para bhI bala diyA hai / svedAdhikya athavA sRSTamUtrapurISatA ke kAraNa rogI se durgandha AnA eka sAdhAraNa bAta hai / para yaha gAtravikSepa ke kAraNa peziyoM meM kucha na kucha kriyA hone ke kAraNa utpanna durgandhatA hama mAnate haiM / jaisA ki adhika vyAyAmazIla pahalavAna ke zarIra se jaba kabhI gAtra daurgandhya dekhA jAtA hai / gAtra kI durgandhatA kA eka kAraNa yaha bhI hai ki mAMsagatajvara se pIDita rogI sadaiva jIrNa yA adhika kAla se bImAra hI huA karatA hai / ataH usameM durgandhatA milanA sadaiva sambhava hai / aSTAMgasaMgrahakAra ne bhrama aura tama ye do lakSaNa aura bhI batalAye haiM / usakA kAraNa yaha hai ki mAMsagata jvara bahudhA raktagata jvara ke Age kI avasthA hai | ataH rakta dhAtu ke hAsa ke sAtha bhrama yA cakkaroM kA AnA aura tama arthAt dRSTi ke samakSa andhakAra ho jAnA yA dRSTimAnya ho jAnA asvAbhAvika nahIM hai / ye donoM bhI lakSaNa anya aneka zArIrika lakSaNoM kI taraha asthAyI haiM aura roganirmUlana ke sAtha-sAtha inakA bhI nirmUlana saralatayA ho jAtA hai / so'nyedyuH pizitAzritaH ke anusAra anyedyuSka jvara nAma kA viSamajvara bhI mAMsa meM Azraya karake rahatA hai / parantu anyedyuSka jvara meM aura mAMsagata jvara meM bahuta antara hai | eka svayaM mAMsa nAmaka dhAtu ko lakSya banAkara calatA hai aura dUsarA kevala usameM AzrayI Azrita ke bhAva se rahatA hai / anyedyuSka ko bhela rasavyApattija mAnakara rasAzrita batalAtA hai | mAMsagata jvara nirantara rahane vAlA eka jIrNa jvara hai tathA anyedyuSka jvara dina rAta meM kevala eka hI bAra AtA hai zeSa samaya rogI pUrNa sukhI rahatA hai / sAdhAraNa anyedyuSka jvara meM USmA, antardAha, mUrcchA, zvAsa, atIsAra bhrama Adi ke ve lakSaNa bhI nahIM milate jinako mAMsagata jvara ke sAtha prAcInoM ne bA~dha diyA hai / ataH ina donoM kI pRthak-pRthak sattA ke sambandha meM saMzaya karane kA koI kAraNa nahIM hai / donoM kI cikitsA meM bhI paryApta bheda rahA karatA hai / For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra . 350 *.. vikRtivijJAna medogatajvara bhRzaM svedastRSA sUrcchA pralApazchardireva ca / daurgandhyArocakau glAnirmedaHsthe cAsahiSNutA || (suzruta) svedastItraH pipAsA ca pralApAratyabhIkSNazaH / sagandhAsyAsahatvaJca bhedaHsthe glAnyarocakau // (caraka) " maidasi sthite / ... svedo'titRSNA vamanaM svagandhasyAsahiSNutA / pralApo glAniraruciH // ( vRddhavAgbhaTa ) www.kobatirth.org { medogatajvara mAMsagatajvara ke Age kI avasthA hai / mAMsagata jvara meM sveda, tRSNA mUrcchA aura gAtra daurgandhya kA jo rAga alApA gayA thA vaha yahA~ vizeSa mahattva ke sAtha prakaTa huA hai| caraka kA svedastItraH zabda aura suzruta kA bhRzaM svedaH adhika prasvedatA ora iti karatA hai / vRddhavAgbhaTa atitRSNA pyAsa kI mahattA ko spaSTa karatA hai / gAtradurgandha itanI adhika ho jAtI hai ki svayaM rogI ko usake prati asahiSNutA pAI jAtI hai / becainI kI mAtrA bhI bar3ha jAtI hai / roga kI ugratA meM vRddhi kA pariNAma vamana, pralApa aura mUrcchA nAmaka lakSaNoM se prakaTa hotA hai / aruci kA artha yahA~ kevala bhojana se glAnimAtra nahIM hai usake lie caraka ne glAni zabda kA pRthaka ullekha kiyA hai / yahA~ aruci eka gambhIra cetAvanI hai jisameM rogI ko jIvana se aruci ho jAtI hai / yaha eka kaSTasAdhya vyAdhi hai / isakA vicAra karate hue hI isakI kalpanA karanI cAhie / Acharya Shri Kailassagarsuri Gyanmandir ... asthigatajvara (1) bhedossthanAM kUjanaM zvAso virekarachardireva ca / vikSepaNaM ca gAtrANAmetadasthigate jvare || ( suzruta ) (2) virekavamane cobhe sAsthibhedaM prakUjanam / vikSepaNam ca gAtrANAM zvAsazcAsthigate jvare // ( caraka ) (3) * asthisthe tvasthibhedanam / doSapravRttirUrdhvAdharazvAsAGgakSepakUjanam // ... ( vRddhavAgbhaTa ) asthibhedana, kUjana, vamana, virecana, zvAsa, aGgavikSepaNa ina 6 lakSaNoM se pIDita rogI ko asthigata jvarAnvita mAnA gayA hai / asthiyoM meM zUla paryasthapAka yA asthi pAkAvasthA meM milA karatA hai| har3aphUTana nAmaka jo aMgamarda hotA hai usase adhika gambhIra sthiti isameM pAI jAtI hai / kyoMki vaha peziyoM kI vyathA hai aura kevala dabAne mAtra se yA sekane se zAnta ho jAtI hai / para asthibhedana aura asthikUjana utanA sAdhAraNa vikAra nahIM hai / yaha dina rAta rahane vAlA lakSaNa hai / rAtri meM jaba rogI cAhatA hai ki vaha sukhapUrvaka so jAve usa samaya haDDiyA~ caTakhatI aura darda karatI haiM / zvAsocchvAsagati isa roga meM bahuta bar3ha jAtI hai / zvAsocchvAsa gati bar3hate hI dUsarA prazna jo eka jIrNajvarI meM kiyA jAnA cAhie vaha asthibheda kA hI vedha karake ucita nidAna kara sakatA hai / vamana aura virecana roga kI ugratA ko sUcita karate haiM / udara meM koI vastu Tikane nahIM pAtI / rogI Urdhva yA adhomArga se use nikAla detA hai / isake kAraNa zarIra meM jahA~ jalAbhAva ho jAtA hai vahA~ atyadhika zithilatA aura daurbalya bhI use dAruNya kI For Private and Personal Use Only

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jvara 351 ora le jAte haiM / zarIrastha jala ke abhAva ke kAraNa hI gAtravikSepaNa huA karatA hai| rogI kI peziyA~ phar3akA karatI haiN| ___ asthigata jvara ke uparokta 6 lakSaNa kaha dene se hI itizrI nahIM ho jaatii| asthigata jvara se pIDita rogI paryApta azakta hotA hai| usakI mAMsadhAtu kramazaH kSINa hone lagatI hai| ise jvara pratyeka kSaNa banA rahatA hai| rasa, rakta, mAMsa aura medagata jvara ke uparAnta isa roga ke lakSaNa zarIra meM pragaTa hote haiN| ataH ina jvaroM meM vyakta lakSaNa isa roga meM sadaiva yA kabhI bhI dekhane meM A sakate haiM / gaurava, utkleza, avasAda, aruci, raktaSThIvana, dAha, moha, bhrama, pralApa, piDikotpatti, tRSNA, antardAha, uttApAdhikya, pezikodveSTana, glAni, svedAdhikya, mUrchA, daurgandhya Adi lakSaNa ukta 6 lakSaNoM ke atirikta mile to koI Azcarya nahIM / majjAgatacara (1) tamaH pravezanaM hikA kAsaH zaityaM vamistathA / antardAho mahAzvAso marmacchedazca majjage // (suzruta) (2) hikA zvAsastathA kAsastamasazcAtidarzanam / marmacchedo bahiH zaityaM dAho'ntazcaiva mjjge||(crk) (3) antardAho bahizzaityaM zvAso hidhmA ca majjage / ( vRddhavAgbhaTa ) isa jvara ke varNana meM yadyapi rogalakSaNa to bahuta kama dikhalAye gaye haiM para ve sabhI bahuta gambhIra svarUpa ke haiN| isase yaha spaSTa hotA hai ki majAgata jvara anya aneka jvaroM kI apekSA bahuta adhika kaSTasAdhya vA asAdhya roga hai| isameM rogI ko aisA jJAta hotA hai mAno ki vaha andhakAra meM praviSTa hotA jA rahA ho aura prakAza usase chInA jA rahA ho / yaha eka manovaijJAnika avasthA hai tathA raktadhAtu kI kamI yA rakta meM se jala ke adhika parimANa meM cale jAne ke pariNAmasvarUpa utpanna huA karatI hai| dUsarI kaThina avasthA hikkA kI hai / jisa rogI ko hicakI kA upadrava Arambha ho jAve tathA sAtha meM aneka gambhIra lakSaNa bhI hoM usakA to phira allA hI belI ( Izvara hI rakSaka) hotA hai| suzrutokta pATha meM 'zaityaM vamistathA' ke sthAna para yadi 'zaityaM bahistathA' par3hA jAve to anya donoM AcAryoM ke sAtha usakI saMgati baiTha jAtI hai, vamana kramAnukrama se raha sakatI hai para yahA~ bahiH zaitya aura antardAha ye do lakSaNa adhika balavAn ho jAte haiN| hamane aneka aise rogI dekhe haiM jo upara se bilkula ThaNDe dikhalAI par3ate haiM para jaba tharmAmITara lagAkara dekhA gayA to unheM tApAMza 104 yA usase bhI Upara niklaa| rogI nirantara cillAtA hai ki vaha dAha se marA jAtA hai use koI garma davA na dI jaave| porA nAmaka grAma kA vAsI khvAjabakhza 25 varSa se bImAra hai| use thor3A bahuta jvara banA rahatA hai / rasagata se raktagata, phira mAMsagata, medogata, asthigata hotA huA aba use majjAgata jvara AtA hai| do dina pUrvataka hamArI cikitsA rahI hai| khvAjabakhza kI avasthA 60 varSa se upara hai| DAkTaroM ne usakA TI. bI. kA sampUrNa ilAja karake chor3a diyA na to vaha marA aura na usakA kaSTa dUra huaa| Ajakala vaha antardAha aura bahiH zIta se parezAna rahatA hai / zvAsa kI gati bar3hI huI hai yahA~ taka ki vaha saza For Private and Personal Use Only

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352 vikRtivijJAna bdazvAsa letA hai aura apane ko dame se pIDita samajhatA hai| khA~sI bahuta adhika hai| Ayurveda ne use asAdhya na mAnakara kRcchrasAdhya mAnA hai| isI AzA para cikitsA hai para usake jarAjIrNa zarIra se bahuta AzA lagAnA pUrNataH vyartha mAlUma hotA hai / mahAzvAsa isa roga kI vizeSatA haiudhUyamAno vAto yaH zabdavad dukhito naraH / uccaiH siti saMghaTTo mattarSabha ivAnizam // prnssttjnyaanvijnyaanstthaavibhraantlocnH| vivRtAkSyAnano baddhamUtravarcA vizIrNavAk // dInaH prazvasitaM cAsya dUrAdvijJAyate bhRzam / mahAzvAsopasRSTastu kSiprameva vipadyate / / yaha nizcita hai ki mahAzvAsAkrAnta rogI thor3I hI dera kA mehamAna huA karatA hai| Upara carakokta mahAzvAsa kA jo svarUpa varNita hai vaha maraNAsannAvasthA kI eka jhalaka hai| parantu majjAgata jvara meM jo mahAzvAsa milatI hai usameM uddhRyamAnavAta kA sazabda nikalanA mAtra abhipreta hai| rogI jora jora se zvAsa letA hai jisakA zabda dUrI para sunA jA sakatA hai| zvAsa kI adhikatA aura antardAha ke kAraNa rogI ulaTA par3A rahatA hai yA baiThanA adhika pasanda karatA hai| marmaccheda majjAgata jvara kA eka mahattva kA lakSaNa hai| asthigata jvara meM asthi yA paryasthazUloparAnta bane majAgata jvara meM kisI marmasthala para chedanavat pIr3A mila sakatI hai / yaha asvAbhAvika nahIM hai / para kArtika ne (nisane dhAtugata jvaroM para paryApta kArya kiyA hai) marma zabda se hRdaya liyA hai aura marmaccheda se hRtpIr3A ko grahaNa kiyA hai| hRtpIDA yA hRtspandana kA banda hokara hArTaphela honA bhI isameM liyA jA sakatA hai| eka anya rogI kakkA kallAsiMha bahuta jIrNa rogI the, zvAsopadrava yukta antardAha se pIDita zarIra meM jinake asthimAtra hI avaziSTa thaa| akasmAt rAtri meM marmaccheda ke Akasmika AkramaNa se cAra dina pUrva kAlakavalita ho cuke haiN| ataH hRdbheda yA hRcchrala yA asthimarmazUla kucha bhI sandarbhAnusAra liyA jA sakatA hai| cAturthaka jvara bhI asthi tathA majjAgata hotA hai| viSamajvara kA vaha eka rUpa hai, usameM antardAha, mahAzvAsa, marmaccheda, hikkAdi lakSaNa nahIM milate aura na majjAgata jvara ke isa varNana meM kahIM yaha AyA hai / isakA jvara hara caturtha dina car3hatA hai / isase yaha spaSTa vidita hotA hai ki cAturthaka jvara tathA majjAgata jvara ye do vibhinna rUpa vAle do pRthak jvara haiM aura donoM kA varNana eka hI lekhaka pRthak-pRthak karatA bhI hai / zukragatajvara (1) maraNaM prApnuyAttatra zukrasthAnagate bare / zephasaH stabdhatA mokSaH zukasya tu vizeSataH / / ( suzruta ) (2) tamasA darzanaM marmacchedanaM stabdhamer3hatA / zukrapravRttirmRtyuzca jAyate zukrasaMzraye // ( vRddhavAgbhaTa) (3) zukrasthAnagate zukramokSaM kRtvA vinAzya ca / prANavAyvagnisomazca sArdhaM gacchatyasau vibhuH // (caraka) zukragata jvara ke sambandha meM Upara jo sUtra diye gaye haiM ve zukragatajvara ke lakSaNa na batalA kara zukradhAtugata jvara ke kAraNa hone vAlI rogI kI mRtyu kA dRzyamAtra upasthita karate haiM ki zukrasthAnagata jvara meM mRtyu milatI hai| mRtyu se pUrva mer3ha kar3A ho jAtA hai aura usase zukra kA kSaraNa ho jAtA hai| vRddhavAgbhaTa ne isa roga ke kucha lakSaNa For Private and Personal Use Only

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353 jvara dene kA yatra bhI kiyA hai ki zukragata jvara meM rogI ko andherA ho andherA dikhalAI detA hai hRdaya meM chedane kI sI pIr3A hotI aura meDhU meM stabdhatA pAI jAtI hai / caraka AtmA ke zarIra tyAga ke samaya prANa vAyu, agni aura soma ke sAtha cale jAne kA . ullekha bhI kiyA hai| / majjAgata jvara meM tamaH praveza aura marmaccheda ke lakSaNoM kA varNana kiyA gayA hai / ve hI lakSaNa vRddhavAgbhaTa ne zukragata jvara ke sAtha diye haiM / isakA artha yaha nikalA ki zukragata jvara majjAgata jvara ke Age kI avasthA hai / majjAgata jvara eka kaSTasAdhya vyAdhi hai usI ke asAdhya svarUpa kA nAma zukragata jvara diyA jA sakatA hai / puradila nagara ke samIpa eka nagariyA nAmaka grAma hai / vahA~ eka rogI paM0 bhUdevaprasAda nAma kA thA / usake zarIra kA mAMsa samApta ho cukA thaa| bhUkha kA nAma taka nahIM thA / udara meM guDaguDa zabda calatA rahatA thA / atisAra kA upadrava yadA kadA ho jAtA thA / usakI mUtra parIkSA karane para sadaiva usameM zukradhAtu pAI jAtI thI / vaha bhI bahudhA kahA karatA thA ki usakI dhAtu kSINa hotI rahatI hai / mere vicAra se yaha jvarI zukradhAtugata jvara se pIDita thaa| DAkTaroM ne use tapaidika karAra de diyA thA / yakSmA nAzaka upacAra usake lie kabhI hitakara par3A nahIM aura zAstrokta zukragata jvara meM varNita mRtyu hI use prApta huI / astu, zukragata jvara kI kalpanA kara lenA kucha kaThina nahIM / jIrNa jvarI jo cirakAla se rogAkrAnta ho jisakI pahalI 6 dhAtue~ kramazaH samApta ho rahI hoM aura zukrasrAva eka nitya ghaTane vAlI ghaTanA ho ise pahacAnane kI saralatama vidhi hai / yataH jvara zukra nAmaka sAtavIM dhAtu meM rahatA hai / isa kAraNa isameM bahuta teja jvara Upara nahIM pAyA jaataa| rogI ko tApamApaka yantra dvArA jvara sadaiva Ave yaha bhI Avazyaka nahIM / kyoMki vaha jvara jo tharmAmITara spaSTa karatA hai rasa, rakta, mAMsa aura medodhAtugata hI hotA hai / asthigata, majAgata aura zukragata jyaroM meM pahale donoM kA AbhAsamAtra milatA hai tathA antima kA AbhAsa 24 ghaNTe meM kucha hI kSaNoM ko ho pAtA hai / usake mUtra kA varNa dekhakara tathA usakI zukradhAtu kA parIkSaNa karake hI usakA patA laga pAtA hai / zukradhAtugata jvara ke sambandha meM vidvAnoM meM paryApta matabheda mila sakate haiM para isakA rogI hRdayagati ke rukane se maratA hai aura marane ke pUrva zukra kA kSaraNa karatA hai ye do lakSaNa aise haiM jinameM matabhinnatA nahIM milegI / zukradhAtugata jvara asAdhya mAnA gayA hai rasaraktAzritaH sAdhyo medomAMsagatazca yaH / asthimajjagataH kRcchraH zukrastho naiva sidhyati // Upara hama dhAtuoM kI dRSTi se saptavidha jvaroM kA varNana upasthita kara cuke haiM / ukta varNana meM eka bAta yaha batAnA raha gayA thA ki bahuta se AcArya dhAtugata jvaroM ko mAnanA pasanda nahIM krte| isI kAraNa cakrapANidatta ke dvArA dI gaI caraka TIkA For Private and Personal Use Only

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354 vikRtivijJAna meM cakrapANidatta ne maunAvalambana kara rakkhA hai| aSTAMgahRdaya meM bhI inakA varNana nahIM milatA tathA kucha vidvAn dhAtugatajvaroM ko anArSa mAnate haiM / jejjaTa ne bhI isa viSaya para kucha nahIM likhaa| suzruta kI DalhaNa dvArA pradatta nibandhasaMgraha nAmaka TIkA meM dhAtugata jvaroM kA varNana Arambha karane ke pUrva acchA varNana isa prakAra kiyA gayA hai| kecidatra rasAdidhAtugatajvarasya lakSaNaM paThanti-- 'rasasthe tu jvare vatsa lakSaNAni nibodha me| gurutvaM dainyamutvalezaH sadanaM dharocakau // rAgoSNapiTikAstRSNA saraktaM SThIvanaM bhramaH / dAho mUrchA'rucizchardiH pralApo raktasaMsthite / / piNDikodveSTanaM tRSNA sRSTamUtrapurISatA / USmAntarmohavikSepau glAniH syAnmAMsaje jvare / vegastIvraH pipAsA ca mUrchA chardiH pralApakaH / gandhasya cAsahatvaJca medaHsthe glAnyarocakau / / virekavamane cobhe tvasthimedaH prakUjanam / vikSepaNaJca gAtrANAM zvAsazcAsthigate jvare / / hikA kAso mahAzvAsastamasazca pravezanam / marmacchedo bahiHzaityaM dAho'ntazcaiva majjage / / tasmAnmaraNamApnoti zukrasyApyupasarpaNe / zephasaH stabdhatA mokSaH zukrasya tu vizeSataH / / ' iti / etacca na paThanIyam / kutaH 1 yataH sarvazarIraM santatena vyAptaM satatAdibhizca rasAdidhAtava iti kuto'paro rasAdi dhAtugatajvarAvakAza iti rasAdisthajvarANAM pATho na paTanIya eveti jejjaTAcAryAbhimatam / zrIgayadAsAcAryeNa cAyaM pATho'nyAdRzaH paThito vyAkhyAtazca, tanmatAnusAribhirasmAbhirapi paThyate vyAkhyAyate ca / / isakA artha yaha hai ki jaba santataM rasaraktasthaH ityAdi vAkyoM ko dekhate hue rasa raktAdi dhAtuoM meM santatAdi jvaroM kA nivAsa pahale hI kaha diyA gayA to phira pRthaka se dhAtugata jvara kahA~ se A gaye / arthAt rasagata jvara santatajvara hogA tathA raktagata jvara satatajvara hogA phira ina jvaroM ke atirikta kauna sthAna meM dhAtuviziSTa jvara hoMge ataH unhoMne dhAtugata jvaroM ko viSama jvara vyatirikta kucha bhI pRthaka se nahIM maanaa| para anya AcAryoM ne yaha spaSTa dekhA ki rasAdi dhAtuoM meM jahA~ santatAdi jvara nivAsa karate haiM vahA~ svayaM rasAdi dhAtuoM ke apane jvara bhI banate haiN| unake apane lakSaNa hote haiM jo eka do dina chor3a kara nahIM Ate jaisA ki viSama jvaroM meM milatA hai api tu nirantara pAye jAte haiM / santatAdi jvaroM meM rasAdi dhAtuoM kA vinAza utanA nahIM hotA jitanA dhAtugata jvaroM meM dekhA jAtA hai| ataH gayadAsAcArya yA bhagavAn punarvasu yA bAda ke vyaktiyoM ne dhAtugata jvaroM kI kalpanA ko ThIka mAnA ho aura usI dRSTi se ve Age bar3he hoM to yaha koI asaMgata vArtA nahIM ho sktii| dRSTikoNoM meM antara ke sAtha pratyakSa antara hone para donoM ke do mata ho sakate haiN| aSTavidhajvara saptavidhadhAtugata jvaroM kA varNana kara dene ke uparAnta ava hama aSTavidha jvaroM kA varNana Arambha karate haiM / ye jvara bahuta mahattvapUrNa mAne gaye haiM / ina jvaroM ko sAdhAraNa bhASA meM doSI jvara ke nAma se pukArate haiN| doSI bukhAra yA doSajanya jvaroM ke caraka ne 8 bheda mAne haiM / doSoM ke anusAra jvara kI kalpanA Ayurveda kI apanI eka viziSTa dena hai| ye jvara samAja meM bahudhA dekhe jAte haiN| isake jo bhI lakSaNa Age batalAye For Private and Personal Use Only

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jvara jAveMge unase yukta ye jvara barAbara pAye jAte haiN| ye kyoM hote haiM isake sambandha meM pAzcAtya vaijJAnika abhI bahuta bar3e saMzaya kalpa se hokara gujara rahe haiN| . bhagavAn punarvasu Atreya ne ATha prakAra ke jvara kA varNana karane ke pUrva jvarotpatti ke ATha kAraNa batalAye haiM / isakA varNana unhoMne nimna zabdoM meM kiyA hai| .. -- iha tu jvara evAdau vikArAgAmupadizyate, tatprathamatvAcchArArANAm / atha khalvaSTabhyaH kAraNebhyo jvaraH sajAyate manuSyANAm / tadyathA-vAtAt , pittAt , kaphAt, vAtapittAbhyAM, vAtakaphAbhyAM, pittazleSmAbhyAM, vAtapittazleSmabhyaH, AgantoraSTamAt kAraNAt / tasya nidaanpuurvruuplinggopshysmpraaptivishessaanupdekssyaamH| aba hama Age ina AThoM prakAra ke jvaroM kA varNana Arambha kreNge| vAtajvara (1) tasyemAni liGgAni bhavanti, tadyathA-viSamArambhivisargitvam , USmaNo vaiSamyaM, tIvratanumbhavAnuvasthAnAni jvarasya, jaraNAnte divasAnte nizAnte dharmAnte vA jvarAbhyAgamanamabhivRddhi jvarasya, vizeSeNa paruSAruNavarNatvaM, nakhanayanavadanamUtrapurISatvacAmatyartha klaptIbhAvazca, anekavidhopamAzcalAcalazca vedanAsteSAM teSAmagAvayavAnAM, tadyathA pAdayoH suptatA, piNDikayorudveSTanaM, jAnunoH kevalAnAM ca sandhInAM vizleSaNam, UoMH vAdaH, kaTIpArzvapRSThaskandhabAhrasorasAM ca bhagnarugNamRditamathitacaTitAvapIDitAvanunnatvamiva, hanvo zvAprasiddhiH, svanazca karNayoH, zaGkhayonistodaH, kaSAyAsya- tA''syavairasyaM vA, mukhatAlukaNThazoSaH, pipAsA, hRdayagrahaH, zuSkachardiH, zuSkakAsaH, kSavathUdgAravinigrahaH, annarasakhedaH, prasekArocakAvipAkAH, viSAdavijRmbhAvinAmavepathuzramabhramapralApajAgaraNaromaharSadantaharSAstathoSNAbhiprAyatA, nidAnoktAnAmanupazayo viparItopazayazceti vAtajvaraliGgAni syuH| (caraka) (2) vepathurviSamo vegaH kaNThoSThaparizoSaNam / nidrAnAzaH kSavastambho gAtrANAM raukSyameva ca // zirohRdgAvarugvaktravairasyaM gADhaviTakatA / zUlAdhmAne jambhaNaM ca bhavantyanilaje jvare / / (suzruta) (3) AgamApagamakSobhamRdutA vedanoSmaNAm / vaiSamyaM tatra tatrAGge tAstAH syurvedanAzcalAH // pAdayoH suptatA stambhaH piNDikodveSTanaM klamaH / vizlepa iva sandhInAM sAda UrboH kaTIgrahaH / / pRSThaM kSodamivApnoti niSpIDyata ivodaram / bhidyanta iva cAsthIni pArzvagAni vizeSataH // hRdayasya grahastodaH prAjaneneva vakSasaH / skandhayormathanaM bAhvorbhedaH pIDanamaMsayoH / / azaktirbhakSaNe hanvojabhaNaM karNayoH svanaH / nistodaH zaGkhayoni vedanA virasAsyatA / kayAyAsyatvamathavA malAnAmapravartanam / rUkSAruNatvagAsyAkSinakhamUtrapurISatA // prsekaarockaashrddhaavipaakaasvedjaagraaH| kaNThoSThazoSastRTazuSkau chardikAsau viSAditA // | romAGgadanteSu vepathuH kssvthorgrhH| bhramaH pralApodharmecchA vinaamshcaaniljvre| (vRddhavAgbhaTa) ( 4 ) vepathurviSamavegazoSaNaM kaNThatAluvadane virasyatA / rUkSatA vapuSi bandhakukSayoz2ambhaNaM zirasi jhagvinidratA // kRSNatA karahAM pralApako gAtrabhaGgabalavAn bibhatsyati / zItavatsvapiti jAgrato naro lakSaNairbhavati vAtakRjjvaraH // ( hArIta ) (5) hRtpRSThagAtrazirasAmativedanAni viSTambharUkSavirasatvavijambhaNAni / AdhmAnazUlamalalocanakRSNatAtizvAsorukAsaviSamoSmakakampanAni / / stabdhAtisuptatanutAtihimApriyatvanidrAkSatizvasanasambhavalakSaNAni / / vAtajvare satatameva bhavanti tAni jJAtvAnilaghnamacirAdvicaredyathoktam // (ugrAdityAcArya) For Private and Personal Use Only

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356 vikRtivijJAna (6) sarvAGgaduHkhaM ziraso'tighAto / mandoSNamatyuSNamiti prabhAvam // kampo vibandhI malamUtrazuSkam / dantoSThabhAge tvaci kRSNavarNam // vijRmbhaNaM zItamarocakaM syAt / viSTambhanaM bandharujA ca pArzve // romAJcakaM vAnti rujAvanAhaM / pralApanaM mUrcchanakaM vidAhaH // atyantazaityaM hyatimUtraghAtaH / padAtizUlaM nakhazoSaNazca // ( vasavarAjIya ) (7) aGgapIDanamalamArgAtirodhanAtipIDanadhAtu mArgavigamanAnilAdanalasthalacalanAdinA'nilajvaraH / ( AyurvedasUtra ) Acharya Shri Kailassagarsuri Gyanmandir Upara jo sAta uddharaNa vividha ArSa granthoM se diye gaye haiM ve vAtadoSa ke prakupita hone ke kAraNa mAnava zarIra meM jo jvara ke sahavartI vividha lakSaNa utpanna hote haiM unakA apanI-apanI bhASA meM dRSTikoNa vizeSa ko lete hue citraNa karane kA prayAsa hI jAnanA cAhie / mAdhavanidAna meM varNita suzrutokta vAtajvaralakSaNa hI bahudhA loka meM prasiddha haiM / jisake anusAra kampa, jvara ke vega kI viSamatA, kaNTha aura oSThoM kA sUkhanA, nidrA kA nAza, chIMka kA rukanA, gAtra kI rUkSatA, ziraHzUla, hRcchUla, sarvAMgazUla, mukha kI virasatA, mala kI gAr3hatA, udarazUla, AdhmAna aura jamhAiyoM kA adhika AnA ye 14 lakSaNa bahudhA hone para vAtajvara kA vicAra karate hue vaidyagaNa cikitsA meM pravRtta hote haiM / caraka ke dvArA vAtajvara ke jo lakSaNa varNita haiM usase pUrva usane jo pRSThabhUmi taiyAra kara rakhI hai use TAlate hue yA usakI upekSA karate hue ukta lakSaNoM ko samajhane kA prayAsa karanA prayAsamAtra hI ho sakatA hai usase kisI Thosa tathya para nahIM pahu~cA sakatA / vaha pRSThabhUmi hai : tadyathA - rUkSa laghuzItavamana virecanAsthApana zirovirecanAtiyogavyAyAma vegasandhAraNAnazanAbhighAtavyavAyogazoka zoNitAbhiSeka jAgaraNa viSamazarIranyAsebhyo'tisevitebhyo dAyuH prakopamApadyate / sa yadA prakupitaH pravizyAmAzayamuSmaNaH sthAnamuSmaNA saha mizrIbhUya AdyamAhArapariNAmadhAtuM rasanAmAnam anvavetya rasasvedavahAni srotAMsi vidhAyAgnimupahatya pattisthAnAt USmANaM bahirnirasya kevalaM zarIramanupadyate tadA jvaramabhinirvarttayati / rUkhA, halakA, ThaNDA, bhojana yA auSadha yA deza yA kAla kA sevana, vamana, virecana, AsthApana, zirovirecana nAmaka zodhana karmoM kA atiyoga ho jAnA / vyAyAma adhika kara baiThanA / vegoM ko roka lenA / anazana karanA / coTa laganA / atimaithuna karanA / udvega yA zokAdhikya rakhanA / raktamokSa kA adhika ho jAnA / rAtri meM adhika jAganA tathA zarIra ko viSamAvasthA meM ulaTA pulaTA kara rakhanA Adi kAraNoM se vAyu kA prakopa hotA hai / jaba vAyu prakupita ho jAtI hai taba vaha nAbhi aura stanoM ke madhya meM bane AmAzaya meM praveza karatI hai / praveza karane ke sAtha hI sAtha vAtajvara ke pUrvarUpa mukhavairasya, guru gAtratA ityAdi banane lagate haiM / AmAzaya meM aura usake bhI Age pacyamAnAzaya meM azna kA jo paripAka hotA rahatA hai aura usake kAraNa jo rasa nAmaka dhAtu banatI hai jo For Private and Personal Use Only

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jvara 357 zeSa 6 dhAtuoM kA poSaNa karatI hai usa rasadhAtu ko prakupita vAyu vikRta kara detI hai tathA rasavAhI aura svedavAhI srotasoM kI ora gamana karatI huI unake mukhoM ko rokakara unake dvArA abhi kA niSkramaNa nahIM hone detI / vaha jo pacanasthAna meM sthita USmA rahI vaha vahA~ kama hone lagatI hai aura sampUrNa zarIra meM tvacA ke nIce bAhara kI ora phailane lagatI hai aura jvarotpatti kara detI hai / jvarotpatti kI ukta kalpanA nirAlI kahI jA sakatI hai AdhunikoM kI nirAlI buddha ke kAraNa anyathA yaha saralatama hote hue sabhI praznoM kA sarvottama aura saMkSiptatama uttara hai| vAtajvara ke vividha lakSaNa jo carakasaMhitA meM varNita haiM unakA vicAra karane para sarvaprathama viSamArambha kA lakSaNa milatA hai / vAtajvara sadA viSama Arambha karatA hai / arthAt kahIM to yaha bahuta tejI se AtA hai aura kahIM dhIre se / isakA AnA kabhI to 103-4-5 taka kA jvara pahale pahala kara detA hai aura kabhI 99-100 se adhika nahIM ho pAtA / eka rogI meM usakA Arambha teja bukhAra se hotA hai to dUsare meM halake jvara ke sAtha bhI vAtajvara utpanna ho jAtA hai / eka hI rogI meM bhI kisI dina yaha tejI ke sAtha AtA hai aura kisI dina halakA car3hatA hai| jvara car3hane meM jo viSamatA hai vahI viSamatA usake visarga kAla meM bhI dekhane meM AtI hai / viSama visargitA isI kA nAma hai / kisI rogI ko jvara ekadama dAruNya ke sAtha utara jAtA hai aura kisI kisI meM dhIre-dhIre utaratA hai / eka hI rogI meM eka dina jvara dhIre se aura dUsare dina tejI yA jhaTake se bhI utara sakatA hai| viSayArambhavisargitvam kA kAraNa dete hue gaMgAdhara ne vAyorasthiratvasvabhAvAt likhA hai / vAyu ke svabhAva kI asthiratA hI vAtajvara ke viSamArambha yA viSama mokSa kI karane vAlI hai / vAyu kI asthiratA ke kAraNa vimArambha kA eka artha yaha bhI kiyA jAtA hai ki kabhI jvara sira se uThe aura kabhI pairoM se / aruNadatta ne AgamApagama kA artha karate hue isI ko kahA bhI hai| -- AgamAdInAM vaiSamyamanilajyare liGgamiti yojyam / jvarasyAgamaH santApArambhaH, tasya vaiSamyaM ziraHprabhRtInAmaGgAnAM na yugapatsantApaH api tu kadAcidasya zirasi pUrvamAgacchati kadAcidaMsayogapAdayorveti / apagamo-jvarasya mokSaH tasya vaiSamyaM kadAcidasya pUrve pAdayoH santApamokSaH kadAcitrike kadAcicchisi santApasya muktiriti / uSmaNo vaiSamyam - jvara ke tApAMza ( temperature ) meM parivartana yA viSamatA pAI jAtI hai / isI ko vAgbhaTa ne kSobha aura mRdutA mAnA hai / kSobha jvarAdhikya aura mRdutA jvalpatA ke dyotaka zabda haiM / jvara ke tIvratanubhAvoM kI viSamatA ke pIche bhI vAyu hai aura vAyu kI asthiratA ko hI ina saba lakSaNoM kA kAraNa mAna kara cakrapANidatta bhI calA hai etat sarvaM vAyoranavasthitatvenopapannam / kSobha aura mRdutA ko caraka ne tIvratanubhAva rUpa meM liyA hai / vedanAvaiSamya - zUla kI viSamatA ko aneka vidhopamAzcalAcalAzca vedanAH caraka For Private and Personal Use Only

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358 vikRtivijJAna ne kahA hai| Ayurveda sUtrakAra ne aGgapIDana mAtra kahakara chor3a diyA hai aura usake TIkAkAra ne sarvAGgAnAmatipIDanaM karoti kaha kara usakI vyAkhyA kara dI hai| atyadhika pIDA honA athavA viSamarUpa se pIDA honA ina donoM meM bheda hai / para kyoMki adhika vedanA kA hI ullekha prAyazaH hotA hai ataH mukhya kaSTakara vyathA kA ullekha Ayurveda sUtrakAra ne kiyA hai / para carakAdi ne vedanA kI viSamatA ko likha kara vedanA kI vAstavika prakRti kI ora iGgita kiyA hai| indu ne apanI zazilekhA TIkA meM vedanAnAmUSmaNAM ca vAtavazAtkadAcidAgamo bhavati kdaacidpgmH|| kaha kara vAstavikatA ko spaSTa kiyA hai| kahane kA sArAMza yaha hai ki vAtajvara meM vedanAoM kI viSamatA rahatI hai| kabhI vaha DaTakara dekhI jAtI hai aura kabhI zAnta ho jAtI hai / vedanA kabhI kisI aMga meM hotI hai aura kabhI kisI aMga meN| jisa aMga meM eka bAra vedanA hotI hai vaha dUsarI bAra nahIM hotI / vahA~ kabhI kama aura kabhI adhika usa rUpa meM uThatI hai| yahI nahIM eka aMga meM Aja vedanA hai to kala usameM bilkula nahIM milatI yaha saba vAyu kI anavasthitatA yA asthiratA kA hI mUrta pramANa kahA jA sakatA hai| vedanAoM ke vibhinna svarUpa haiN| suzruta ne jise gAtraruka kaha kara chor3a diyA hai use caraka aura vAgbhaTa ne pratyeka gAtra meM kisa-kisa prakAra kI vedanA hotI hai isakA vAkcitra upasthita kiyA hai| hArIta ne gAtrabhaGga hI kahA hai| ugrAditya ne gAtravedanA mAtra kahA hai| vasavarAjIyakArane use sarvAGgadukham mAnA hai| ina sabane sampUrNa zarIra meM sAdhAraNatayA tathA viziSTa-viziSTa zarIrAGgAvayavoM meM vizeSatayA zUla kI yA vyathA kI upasthiti svIkAra kI hai| ataH koI Azcarya nahIM ki vAtajvarI ko sampUrNa zarIra meM thor3I yA bahuta pIDA hotI ho| pratyakSa meM bhI rogI yahI kahatA hai ki usake saba aMga phaTe jAte haiM / bhavanti vividhAH vAtavedanAH kaha kara bahuta prakAra kI vedanAoM kI kalpanA bhI zAstrakAroM ne mAnI hai| zazilekhAkAra ne vedanAoM kI pratIti kI ugratA aura mandatA ko dehavizeSa, dezavizeSa aura kAlavizepa ke AdhIna mAnA hai| anekavidha aura aneka upamAoM se yukta cala vA acala vedanAoM kA jo rUpa diyA gayA hai usakI ora dRSTipAta karane se sarvaprathama hameM pAdayoH suptatA kA dhyAna AtA hai jise vasavarAjIyakAra ne padAtizUlama kahA hai| gaMgAdhara ne suptatA kA artha sparzAnabhijJatA kiyA hai jo yathArtha hai| pAdasuptatA ke sthAna para ugrAditya ne stabdhAtisuptatanutA kaha kara sampUrNa zarIra ko hI supta yA sparzabhAva se zUnya mAna liyA hai| aruNadatta ne pAdayoH suptatA kA artha pAdayoH suptiH-nizcetanatvam nakhakSatAdikamapi na cetayetAM tAvityarthaH / pairoM meM nizcetanatA kA honA athavA unakA stabdha yA soyA huA honA vAtajvarI kI eka sAdhAraNa ghaTanA hai| sAdhAraNa hone ke hI kAraNa usakA ullekha sabhI AcAryoM ne bahuta mahattva ke sAtha nahIM diyA hai| phira bhI paira sunna ho sakate haiM stambhana unameM ho For Private and Personal Use Only

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jvara 356 sakatA hai unameM gaurava kA anubhava ho sakatA hai aura kabhI-kabhI unameM itanA zUla bhI ho sakatA hai ki rogI unheM kapar3e se bAMdhe rahatA hai / suptatA yA stabdhatA ke dvArA vAtika lakSaNa kA sukhAvabodha ho jAtA hai / * piNDikodveSTanam yA piNDikayorudveSTanam Acharya Shri Kailassagarsuri Gyanmandir ise jAnvadhomAMsapiNDayorudveSTanam mAnA jAtA hai| pairoM kI piNDaliyoM meM har3akana kI adhikatA bahudhA pAI jAtI hai / rogI isa har3akana se itanA vyathita ho jAtA hai ki vaha kapar3e yA rassI se piNDaliyoM ko jaba taka kasa nahIM letA taba taka use ArAmAnubhava hI nahIM ho pAtA / piNDaliyoM dhar3akana ke sAtha-sAtha zrama ( thakAna ) bhI ho jAtI hai aisA lagatA hai ki rogI ne mAno kitanA kArya nahIM kiyA / piNDikA kI vyAkhyA cakrapANidatta ne jAnvadhojaGghA madhyamAMsapiNDikA ko hI piNDikA kahA hai jise loka mAnatA hai / vizleSa iva sandhInAm - sandhiyoM meM sAdhAraNatayA aura jAnusandhi meM vizeSatayA eka aisI pIr3A hotI hai jisase rogI ko aisA AbhAsa hone lagatA hai ki usakA jor3a khula gayA yA apanI jagaha se Tala gayA yA DhIlA ho gyaa| isI ko vizleSaNa kahA hai| aruNadatta ne ise vicchedana mAnA hai / UrdhvoH sAdaH - UrdhvoH sAdo'vasannatA / UruoM meM sAda yA avasAda ho jAtA hai | aruNadatta ne sAda kA artha svakriyAyAmasamarthatvam arthAt apanI kAryazakti meM * asamarthatA kiyA hai / vAtajvara se pIDita vyakti kI Uru ( jAMgheM ) avasanna ho jAtI haiM / vahA~ sthita bar3I-bar3I mAMsa peziyA~ apanA-apanA kArya karane meM asamartha ho jAtI haiN| jisake kAraNa TAMgeM idhara udhara hilAne meM kaSTa hotA hai aura kabhI kabhI calanA to eka maruka jAtA hai / A kaTIgraha: yA kaTIbhana eka sarvasAdhAraNa ghaTanA hai / vAtajvarI kI kamara meM jakar3ana yA TUTane kA sA darda huA karatA hai / jvarakAla meM bhI vaha dekhA jAtA hai aura jvara ke zAnta hone para bhI vaha hotA hai / pArzvarugNa yA rujA ca pArzve yA chidyanta iva asthIni pArzvagAni vizeSataH ye sabhI zabdasamUha pasaliyoM kI pIr3A kI ora saMketa karate haiM / pasaliyoM meM yA pasaliyoM kI haDDiyoM meM chedane kI sI pIr3A kA honA eka aisI ghaTanA hai jise caraka aura usake anuyAyI vRddhavAgbhaTa ne tathA vasavarAjIyakArane mAnA hai para anya ne usakA adhika mahattva nahIM diyA / 1 pRSTha kSotramivApnoti - pITha meM saMtuSNatA yA mardanavat pIDA hotI hai / ugrAditya ne pRSTha meM atyadhika vedanA ko mAnA hai| 1 skandhayormathanam--skandhoM meM mathane kI sI pIr3A hotI hai / pIDanamaMsayo: - aMsaphalakoM meM aisI pIDA hotI hai jaise ki tailAdi meM lakar3I ko paTakanA / ise caraka ne avapIDana mAnA hai / bAhvorbheda:- bAhuoM meM vidAraNa karane jaise yA utpATanavat pIr3A hotI hai / aisA lagatA hai ki bA~hoM ko koI unake jor3oM meM se ukhAr3atA ho / For Private and Personal Use Only

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360 vikRtivijJAna prAjaneneva vakSasA - vakSa yA uras meM pratodana hotA hai / caraka use anunnatva yA bandhabhUta mAnatA hai / prAjana kA artha pratoda hotA hai / vAtajvara meM chAtI ba~dhI sI kar3I sI yA kaSTa meM pAI jAtI hai / Acharya Shri Kailassagarsuri Gyanmandir niSpIDyata ivodaram - jaisa tila kUTe jAte haiM aise udara meM niSpIDanavat vedanA hotI hai / azaktirbhakSaNe hanvoH - jabar3oM dvArA cabAne meM asAmarthya ho jAtI hai / isI ko hanvozvAprasiddhi caraka ne kahA hai jise hanvo svavyApArAkaraNam cakrapANidatta ne tathA acAlanatvamiva gaMgAdhara ne kahA hai I bandhakukSayoH - kukSiyoM kA ba~dhanA yA unameM jakar3ana utpanna honA yaha hArIta ne eka vizeSa lakSaNa parakhA aura pAyA hai ataH usakA ullekha kiyA hai I gAruk se lekara kukSibandhana taka ye jitane bhI lakSaNa yA vedanAe~ varNita haiM ve yadi hama dhyAnapUrvaka dekheM to sampUrNa zarIra meM sthita mAMsapezI saMsthAna ke hI vikAra pAye jAte haiM / vAtanADiyoM kA mAMsapeziyoM ke sAtha aTUTa sambandha hai / vAta kA prakopa hone kA spaSTa artha zarIrastha mAMsapeziyoM kA unameM pratyakSa aura sakriyabhAga lenA hI ho sakatA hai | zrama zabda kA sthAna-sthAna para ullekha ina peziyoM kI thakAna ko hI prakaTa karatA hai / jaba ye pezI thakatI haiM to kisI meM baMdhanavat pIr3A kA AbhAsa karAtI haiM, kahIM maMthanavat darda karAtI haiM, kahIM cAlana utpATanAvapIDanavat vividha vyathAoM ko pradarzita karatI haiN| mUlasiddhAnta yaha hai ki isa roga meM zarIrastha pezIsaMsthAnAntargata sthita vAta meM prakopa huA hai / zvAsa, hRdayagraha, jRmbhaNa Adi jahA~ anaicchika peziyoM kI vyathAoM kI ora iGgita karatI haiM vahA~ zrama, bAhvorbhedaH, aMsayoH pIDanam Adi aicchika peziyoM kI tabiyata kharAba ho jAne kI bAta pukAra -pukAra kara batalAtI haiM / vepathu yA zarIrakampa pezI kI hI eka vyathA hai jo vAtanADiyoM ke niyantraNa kI kamI se athavA AyurvedIya zabdoM meM vAtaprakopa ke kAraNa utpanna hotI hai / aba hama vAtajvarasambandhI anya mahattvapUrNa lakSaNoM ko lete haiM jinameM jvara ke Agamana aura abhivRddhi ke kAla kI ghoSaNA mukhya hai / jaraNAnta, divasAnta, nizAnta tathA gharmAnta ye cAra kAla vAtajvara ke lie adhika mahattvapUrNa kahe gaye haiM / jaraNAnta yA anna ke jIrNa hone ke samaya 'jIrNe'nne vardhate vAyuH' Adi kI dRSTi se anna ke lene ke turata pazcAt zleSmA, madhyakAla yA anna kI pacyamAnAvasthA pitta aura anna kI jIrNAvasthA meM vAyu kA prakopa hotA hai / ataH vAtajvara se pIDita hone vAlA rogI prAyaH yaha kahatA hai ki bhojana karane ke tIna cAra ghaNTe bAda use jvara AnA Arambha huA / nidAna kI dRSTi se jvarotpatti tathA bhojanagrahaNa karane ke kAla meM kitanA antara hai ise jAna lenA paramAvazyaka hai / kabhI-kabhI rogI ko jvara to banA rahatA hai aura vaha bhojanagrahaNakAla yA pacyamAnAvasthA meM bar3hatA bhI nahIM hai para bhojana kA pAka hone para jaba apAna vAyu zuddha hotI hai tathA punaH bhUkha kI kucha icchA hone lagatI hai usI kAla meM jvara kA punarAgamana yA jvara kI abhivRddhi hone laga jAtI hai / divasAnta arthAt For Private and Personal Use Only

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jvara 361 dina ke bItane ke samaya arthAt aparAhna kAla meM bhI vAtajvarotpatti yA vAtajvarAbhivRddhi pAI jAtI hai| vAgbhaTa ne aSTAGgahRdaya ke Arambha meM jo____ 'vayoahorAtribhuktAnAM te'ntamadhyAdigAH kramAt' ke anusAra doSoM kA kAla batalAyA hai unameM vAyu kA kAla vaya kA anta arthAt bur3hApA, dina kA anta arthAt aparAla, rAtri kA anta arthAt apara rAtri yA rAtri kA tIsarA pahara, bhojanAnta arthAt bhojana kI pakvAvasthA isa prakAra 4 ko ginAyA gayA hai| suzrutasaMhitA meM bhI vAta ke prakopa ke kAla ke sambandha meM nimnalikhita nirdeza kiyA gayA hai: sa zItAbhrapravAteSu dharmAnte ca vishesstH| pratyUSasya parAle tu jIrNe'nne ca prakupyati // .. isake anusAra zItakAla meM, bAdala hone para adhika havA calane para vizeSa karake garmI ke bAda varSA Rtu meM, pratyUSakAla vA aparAhnakAla meM tathA bhojana ke paca jAne ke bAda hI vAta prakupita hotA hai| kahane kA tAtparya yaha hai ki divasAnta meM tIsare pahara para vAtajvara kI vRddhi yA utpatti vAyu ke prakopa ke ThIka kAla meM hI hotI hai| nizAnta ko suzruta ne pratyUSakAla mAna liyA hai| yaha rAtri kI samApti se pUrva kA samaya hai / isa avasara para vAyu kA vega svabhAvataH adhika rahane ke kAraNa vAtajvara kI utpatti yA vRddhi sadaiva sambhava hai| ataH aba yadi yogya vicAra kA Azraya liyA jAve to yaha kahanA kadApi ayuktiyukta na hogA ki vAtajvara dina rAta ke 24 ghaNToM meM yA to dina ke tIsare prahara athavA rAtri ke tIsare prahara meM bar3hatA hai| vaha do samaya bhI bar3ha sakatA hai| bhojana ke jIrNa hone kI dRSTi se koI yaha bhI kaha sakatA hai ki vaha do bAra bhojana jIrNAvasthA meM aura do bAra divasAnta aura nizAnta meM yaha bar3ha sakatA hai adhika bhAra isalie nahIM le jAtA kyoMki prAtaH 10 baje taka kiyA huA bhojana dina ke tIsare prahara meM hI paca pAtA hai tathA sAyaMkAlIna bhojana rAtri ke tIsare prahara taka hI paca pAtA hai ataH divasAnta aura nizAnta ye do avasara hI vAtajvarotpatti yA vAtajvarAbhivRddhi ke ucita kAla huA karate haiN| cakrapANidatta ne - yacca vAyorjaraNAntadivasAntAdipu balavatkAryakartRtvaM proktam , tadapi prAyikatvena jJeyam / kaha kara bar3A upakAra kara diyA hai| nizAnta yA divasAnta ye zabda prAyika haiM / ina samayoM meM vAyuvega kI vRddhi hone ke kAraNa prAyaH isI samaya jvarotpatti hotI hai| prAyaH kaha dene se anya kAloM ko miTAyA nahIM jA sakatA arthAt anyakAloM meM bhI vAtajvara kA Agamana mila sakatA hai tathA kahIM-kahIM aura kabhI-kabhI to nizAnta athavA divasAnta bilkula chUTa jA sakate haiM aura anya kAloM meM vAta ke prakopa ke anya kAraNoM kI adhikatA hone ke kAraNa vAtajvara kI vRddhi yA utpatti dekhI jA sakatI hai / rAtri ko zleSmakAla mAnA gayA hai| zIta kI atizayatA jahA~ rAtri meM zleSmAbhivarddhaka hotI hai vahA~ zIta vAyu kA prakopaka bhI mAnA jAtA hai jisake kAraNa sandhyA ke tIsare pahara aura rAtri ke tIsare prahara meM zaityAnubandhana bhI vAtaprakopa ke lie AhUta kara sakatA hai| 31, 32 vi0 For Private and Personal Use Only

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362 vikRtivijJAna varSa kI dRSTi se vicAra karane para vAtajvara kA pradhAna kAla dharmAnta arthAt varSA mAnA gayA hai| zItakAla yA vaha samaya jaba AkAza meghAcchanna ho athavA vAyu kA vega vipula gati ke sAtha cala rahA ho taba bhI vAtajvara dekhA jA sakatA hai| varSARtu meM vAta ke prakopa ke aneka kAraNa ekatra ho jAte haiN| ataH isa Rtu meM vAtika vikAra vizeSa rUpa se dekhe jAte haiN| ataH koI Azcarya nahIM ki vAtottejaka isa vAtAvaraNa meM varSA kI phuhAroM ke bIca se vAtajvara nikala kara prANiyoM ko kaSTa pradAna kara de| __zavayonistodaH arthAt donoM ora ke zaMkhapradezoM athavA kanapaTiyoM meM tudanavat pIDA.kA honA / yadyapi vAtajanita vedanAoM ke sAtha isakA ullekha kiyA jA sakatA thA phira bhI zirovyathA isa roga kI atyanta mahattva kI ghaTanA hone se ise hamane svayaM pRthak likhA hai tathA kaI AcAryoM ne bhI isakI gaNanA pRthaka se kI hai| sampUrNa vAta. saMsthAna kA pradhAna kendra mastiSka hai / vahA~ se vAtanADiyoM kA udaya hotA hai| vahIM sampUrNa Adeza pradAna kiye jAte haiM tathA vahA~ sampUrNa bAhya jagat kI anubhUtiyA~ bhI prApta hotI haiN| vAyu ke prakopa kA jo itihAsa jAnate haiM ve yaha bhale prakAra jAna sakate haiM ki vAtatatvabhaNDAra mastiSka isa prakopa se kadApi achUtA nahIM raha sktaa| / astu zaMkhapradeza meM toda honA yA ziroruka honA svAbhAvika hai| nistoda kA artha niHzeSato vedanA iti mAnA jAtA hai| vAgbhaTa ne zaDayomUnivedanA ke dvArA zira tathA donoM zaMkhapradezoM meM vedanA kA ullekha kiyA hai| hArIta bhI zirasi ruka ko mAnatA hai / ugrAdityAcArya to zira meM atyadhika vedanA kA anubhava karatA hai| vahI vasavarAjIyakAra kI sthiti hai / vAtika kAraNoM se utpanna yaha zirorujA prAyazaH vAtika hI huA karatI hai| usake lakSaNa suzruta ne nimna likhita batalAye haiM yasyAnimittaM ziraso rujazca bhavanti tIvrA nizi cAtimAtram / bandhopatApaiH prazamazca yatra ziro'bhitApaH sa samIraNena // ki yaha animittika, rAtri meM tIvra rUpa dhAraNa karane vAlI sira ke bA~dhane yA sekane se zAnta hone vAlI aura rAtri meM adhikatA ke sAtha pAI jAnevAlI hotI hai| yadyapi yaha animittika nahIM hai, yahA~ usakI utpatti ke lie prabala kAraNa upasthita haiM jinakA pratyakSa rUpa hama vAtajvara ke mUrtimanta svarUpa meM pAte haiN| nidrAnAzaH nidrA kA sarvathA naSTa ho jAnA ziro'bhitApa ke sAtha sambaddha hI dUsarI mahattvapUrNa ghaTanA hai| rAtabhara sira meM darda jise rahegA vaha so sakegA yaha sambhava nhiiN| suzruta ne vAtavRddhi ke lakSaNa ginAte samaya nidrAnAzo'lpabalatvam Adi kitane hI lakSaNoM kA spaSTa ullekha kiyA hai| vRddha vAgbhaTa ne nidrA kI upapatti meM___ zleSmAvRteSu srotassu zramAduparateSu ca / indriyeSu svakarmebhyo nidrA nizati dehinAm / / jo zleSmAvRta srotoM ke kAraNa nidrA kA AhvAna kiyA hai / nidrA zleSmatamobhavA ke dvArA bhI tamoguNa aura zleSmA kI abhivRddhi nidrAkAriNI hotI hai| para vAtajvara meM zleSmA kahA~ ? tathA tamoguNa ke sthAna para sampUrNa vAtAvaraNa sakriya arthAt rajoguNa For Private and Personal Use Only

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jvara 363 bhUyiSTha rahatA hai ataH nidrA ke lie yogya vAtAvaraNa kA sarvathA abhAva pAyA jAtA hai| isake kAraNa vAtajvara meM nidrAnAza bahudhA rahatA hai| rogI rAta bhara sira darda se parezAna rahatA hai aura sotA nahIM, jAgaraNa karatA hai| isake kAraNa raukSya kI atyadhika vRddhi hotI hai, vAta kA vega aura bar3hatA hai aura jitanA hI vAtasya vega bar3hatA hai utanA hI nidrAnAza evaM zirovyathA kA svarUpa abhivRddha hotA hai| isI ko duzcakra kahate haiM jise tor3anA vaidya kI cikitsA kA mahattvapUrNa lakSya honA caahie| hArIta ne vinidratA, ugrAditya ne nidrAkSati, vRddha vAgbhaTa aura caraka ne jAgaraNa nAma se isa rogalakSaNa kA ullekha kiyA hai| zleSmA meM zaitya ke sAtha snigdhatA hotI hai para vAta meM zaitya ke sAtha rUkSatA rahatI hai| ataH kevala zaitya nidrAkAraka nahIM, snigdhatA tathA vAtAvaraNa meM tamoguNa kA Adhikya honA paramAvazyaka hai| bahudhA yaha zaGkA kI jA sakatI hai ki rogI jaba bahuta adhika harakata karatA hai, kahIM piNDaliyoM meM udveSTana hotA hai to kahIM sandhiyoM meM vizleSaNa hotA hai phira zramAdhikya kA pariNAma nidrA kA abhAva kyoM rahatA hai ? isakA spaSTa uttara yahI hai ki yahA~ mana para zrama kA bhAva AtA nhiiN| rogI durbala thakA sA pA~ca dina se vinA bhojana ke rahate hue bhI vAtadoSa kI satata prakupitatA ke pariNAmasvarUpa rUkSatA se yukta hone ke kAraNa aura aMgapratyaMga meM vedanAoM kI viSama vibhISikA ke pratyakSa nartana karane ke kAraNa use nidrA nAmaka vastu ko pAne ke lie avasara hI nahIM mila pAtA / hArIta ne bhItavatsvapiti jAgrato naro yadyapi / kahA hai para vahA~ sonA upalakSaNa mAtra hai| Dare hue ke samAna jhapakI lagA jAnA eka bAta hai aura sonA dUsarI bAta / ___ gAtrANAM raukSyameva ca likhane vAle suzruta ne zarIra ke saba aMgoM meM rUkSatA kI spaSTa sthiti kA ullekha karake nidrAnAza kI sahaituka sArthakatA kA udghoSa kara bhI diyA hai| caraka ne anekoM lakSaNa dete hue aura paryApta gAthA gAte hue bhI ise spaSTa nahIM kahA / para usake anuyAyI vRddha vAgbhaTa ne use nahIM chor3A ugrAditya jisane AyurvedIya vicAraNA meM eka svatantra nIti apanAI hai ise bhI spaSTa kiyA hai| ___ malAnAmapravartanam , malamArgAtirodha, malamUtrazuSkatA, viSTambhatA yA mUtrapurISasvacAmatyartha klRptIbhAva se eka hI bhAva udita hotA hai ki vAtajvara se pIDita rogI ko TaTTI nahIM AtI, mUtra bhI bahuta kama utaratA hai| hArIta to hyatimUtrAghAtaH kahakara mUtrAghAta kI bhI sthiti ko batalAtA hai| para vaha atyadhika utkaTAvasthA kA citraNa hai / vAtajvara ke kisI-kisI rogI meM mUtrAghAta pAyA jA sakatA hai para bahudhA yaha lakSaNa milatA nahIM mUtrAlpatA to nissandeha pAI jAtI hai| parantu mUtra vega ke nirantara rokane se vAtakuNDalikA, vAtabasti, mUtrAtIta, mUtra jaTharAdi vikAra dekhe jA sakate haiN| kyoMki 'jAyante kupitairdoSairmUtrAghAtAstrayodaza / ' ke anusAra terahoM mUtrAghAtoM kA Adi kAraNa to doSoM kA kopa hI Ayurveda ne mAnA hai| mala kI apravRtti kA artha viSTambha meM hotA hai| yaha apAnavAyu ke prakupita hone For Private and Personal Use Only

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364 vikRtivijJAna kA hetu hai tathA sarvAMgINa zarIra vyApI vyAnavAyu ke kopa kA pariNAma bhI hai| bhAratavAsiyoM ke sampUrNa rogoM meM se adhikAMza kI utpatti meM vegavidhAraNa eka pradhAna kAraNa AyurvedajJoM ne mAna liyA hai| malotsarjana kI kriyA para mAnasika bhAvoM kA vizeSa prabhAva hotA hai| para jaba mana para vAtajvara kA pratyeka kSaNa prabhAva par3atA ho eka ke pazcAt eka gambhIra aura duHkhada ghaTanA utpanna ho rahI ho to malotsarga honA kadApi sambhava nahIM hotaa| zarIrastha rUkSatA bhI viSTambhakAriNI huA karatI hai| rUkSatA kA pariNAma zuSkatA meM hotA hai ataH vasavarAjIyakAra kA malamUtrazuSkaH likhanA saMgata hai| mUtra aura purISa kA klRptIbhAva jo caraka ne likhA hai usakA abhiprAya mUtra aura purISa kI apravRtti yA pracalecchAbhAva karanA cAhie / arthAt basti meM mUtra rahatA hai aura malAzaya meM mala maujUda hai para vAta ke prakupita hone ke kAraNa banI anyamanaskatA ne svAbhAvika sthiti ko bigAr3a diyA hai arthAt yogya rAjA kI kamI ke yA zithilatA ke athavA rugNatA ke kAraNa mehataroM ne har3atAla karake zarIra vAtAvaraNa ko atyadhika dUSita karane meM koI kora kasara uThA nahIM rkhii| isa klRptIbhAva ko haTAnA cikitsA kA parama prathama lakSya honA caahie| isI ko dhyAna meM rakha kara vAtajanita rogoM meM isa klRptIbhAva ko miTAne ke lie virecana basti Adi vividha upAyoM ko pradhAnatA dI gaI hai| mala ke klRptIbhAva ke kAraNa mala meM saDA~gha utpanna hokara vAyu kI vRddhi kA pratyakSa pariNAma AdhmAna meM huA karatA hai| AdhmAna ke sAtha udarazUla pAyA jAtA hai| ataH ina donoM lakSaNoM ko suzruta ne likhA hai| ugrAdityAcArya ne bhI mAnA hai parantu anya AcAryoM ne ise mahattvapUrNa nahIM mAnA ataH ullekha spaSTatayA nahIM kara ske| vegavidhAraNa ke kAraNa athavA malasaMcalana kI apravRtti ke pariNAmasvarUpa kaNThoSThaparizoSaNam yA mukhatAlukaeThazoSaH ho jAtA hai| sarvAGgINa rUkSatA rahane ke kAraNa tathA malamUtra kI apravRtti se utpanna becainI yA viSamayatA ke kAraNa mukha, oSTha aura galA sUkhane lagatA hai arthAt ina sthAnoM para ArdratA vA snigdhatA kI kamI vyakta hone lagatI hai| ___ kaNTha meM zuSkatA hone para pipAsA bar3hatI hai isa kAraNa tathA sarvAGgINa raukSya ke kAraNa bhI tRSNA vAtajvarI kA eka sarvasAdhAraNa lakSaNa bana gayA hai| jAr3e kI rAta meM jaise kabhI kabhI svastha vyaktiyoM ko pyAsa lagatI hai usI prakAra kI pyAsa yahA~ 'pAI jAtI hai| rogI ko jaba pyAsa lagatI hai to paryApta aura jaba nahIM lagatI to bilkula nahIM / isI se jahA~ caraka aura vRddha vAgbhaTa ne ise likhA hai anyoM ne isakA ullekha karanA bhI Avazyaka nahIM maanaa| ____ dantoSThabhAge tvaci kRSNavarNam athavA paruSArUNavarNatvaM nakhanayanavadanamUtrapurISatvacAm vA rUkSAruNtvagAsyAkSinakhamUtrapurISatA yA kRSNakararuhAm kiM vA For Private and Personal Use Only

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jvara 365 malalocanakRSNatAti ko kaI AcAryoM ne pratipAdita kiyA hai| dAMta, oTha aura tvacA kA koI kAlA honA mAnatA hai koI nakha, netra, mukhamaNDala, mUtra, purISa aura tvacA kI paruSatA tathA aruNatA ko svIkAra karatA hai, koI kevala nakhoM kI kRSNatA para jora detA hai tathA koI mala aura netra ina donoM kI atyadhika kRSNatA kA varNana karatA hai / vAtadharma ke zarIra meM atyadhika prakupita hone se utpanna rUkSatA yA paruSatA ke do svarUpa abhivyakta hote haiM eka aruNatA aura dUsarA kRSNatA / navIna vAtajvara meM A~khoM meM lAla DorA nAkhUnoM kA halakA lAla honA, mukha para sukhI, pezAba meM sukhI tathA mala meM bhI sukhI dekhI jA sakatI hai| para jaba vAta kA vega adhika hone lagatA hai aura usake kAraNa rUkSatA bahuta adhika bar3ha jAtI hai arthAt zarIra meM jaba viSaraktatA (toxaemia ) apane pUre vega para AtI hai to dA~ta kAle par3a jAte haiN| oTha kAle par3a jAte haiN| mala aura mUtra kA varNa kAlA ho jAtA hai tathA nAkhUna bhI kAle ho jA sakate haiN| ataH yaha lakSaNa vAtaprakopajanya raukSya aura viSaraktatA kA pramANa hai| aruNatA bahuta jaldI dRSTigocara ho jAtI hai aura kRSNatA bahuta adhika kaSTasAdhya yA asAdhya rogiyoM meM dekhane ko milatI hai| isa kAraNa vasavarAjIyakAra jisane ugravAta jvara kA hI varNana diyA hai aura jahA~ usane pralApa mUtrAghAta aura mUrchA jaise lakSaNoM ko likhA hai vahA~ svabhAvataH dantoSThabhAge tvaci kRSNavarNam kahanA usake lie sulabha ho gayA hai| caraka ne vAtajvarI meM paruSAruNavarNatva ko pradhAnatA dI hai / suzruta ne jisane sarvasAdhAraNatayA loka meM pAye jAne vAle vAtajvara ke moTe moTe mahattvapUrNa lakSaNoM ko likhA hai isa lakSaNa kA koI ullekha nahIM kiyaa| vRddha vAgbhaTa tathA aSTAGgahRdayakAra vAgbhaTa ne aruNatA ko hI mAnA hai| hArIta ne ugravAta jvara kI ora iGgita kiyA to avazya hai para kevala kRSNanakhatA para hI use chor3a diyA hai| ugrAditya ne mala aura locanoM kI kRSNatA ko hI spaSTa kiyA hai| 80 prakAra ke vAtarogoM kA jinhoMne varNana kiyA hai unhoMne zyAvatA ko nahIM chor3A-kampaH kAzyaM zyAvatA ca pralApaH ityAdi ataH kAlApana AnA vAtaprakopa kA svAbhAvika dharma hai| kaSAyAsyatA tathA Asyavarasya ye do lakSaNa mukha ke andara milate haiN| caraka ne ina donoM kA hI ullekha kiyA hai| usane jo anekoM rogI dekhe unameM se kisI ke mukha meM kaSAyatA yA kasailepana kA anubhava pAyA aura kisI meM virasatA kaa| vaktra vairasya ke nAma se suzruta ne bhI ise batalAyA hai| vAta ke 80 roga jinhoMne svIkAra kiye haiM unhoMne ye donoM lakSaNa mAne haiManavasthitacittatvaM kAThinyaM virsaasytaa| kaSAyavaktratA''dhmAnaM pratyAdhmAnaM ca zItatA / / vRddha vAgbhaTa ne kaSAyAsyatA mAnI hai| vasavarAjIyakAra ne inakA ullekha nahIM kiyA / ugravAtajvarI meM inheM samajhane ke lie samaya hI kahA~ milatA hai ? hArIta ne virasatA ko ugrAdityAcArya ke samAna hI svIkAra kiyA hai| Asyavairasya ko cakrapANidatta ne arasajJatA batalAyA hai; parantu gaMgAdhara ne use svabhAvarasAnyathAbhAvaH For Private and Personal Use Only

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366 vikRtivijJAna mAnA hai jo adhika ucita hai para donoM hI avasthAe~ eka hI rogI meM roga kI tIvratara tIvratamAvasthA ko lakSya karake pAI jA sakatI haiM / aruNadatta ne virasAsyatA 'avyaktarasatvaM mukhasya bhavati yena madhurAdyanyatamaM rasaM na nizcinoti athavA kaSAyarasatvaM vaktrasya' likhakara viSaya ko bahuta adhika spaSTa kara diyA hai / indu ne AsyarasatvaM vizeSonAkhyeyaduSTarasatvam mAnA hai / hRdayagraha nAmaka lakSaNa vAtajvara meM bhI pAyA jA sakatA hai / yaha caraka mAnatA hai| suzruta ne isI ko hRdruka kahA hai / vAgbhaTa ne bhI hRdgraha svIkAra kiyA hai / ugrAdityAcArya ke vicAra se hRdaya meM atyadhika vedanA hotI hai / isa prakAra hRdaya aura vAtajvara kA samIpatama sambandha jur3a jAtA hai / gaMgAdhara ke mata meM hRdayagraha ko vakSagraha mAnanA batalAyA hai / parantu vAgbhaTa ne hRdayasya grahastodaH prAjaneneva vakSasaH likhakara hRdgraha aura vakSasaH pratodana ina do lakSaNoM ko likhakara hRdaya aura vakSas ke andara pRthak-pRthak hone vAlI ghaTanAoM kA ullekha kara diyA hai / vAta ke jo 80 roga kahe gaye haiM unameM hRdgraha kA ullekha nahIM / isa lakSaNa se hRdayadeza meM jakar3ana yA pIr3A liyA jA sakatA hai / hRtpradeza meM zUla honA yaha eka sarvasAdhAraNa lakSaNa hai jo vAtajvara meM mila sakatA hai / atyadhika zUla kA honA sAdhAraNatayA nahIM milA karatA para kisI-kisI meM mila bhI sakatA hai / zuSkacchardi yA chardi kA vega mAtra utpanna honA jise sAdhAraNa bhASA meM jI micalAnA yA matalI AnA kahate haiM vAtajvara meM pAyA jAne vAlA lakSaNa hai / isakA kAraNa yaha hai ki mukha kI virasatA athavA kaSAyatA pAI hI jAtI hai / viSTambha aura aruci barAbara banI rahatI hai tathA vAta ke prakopa ke kAraNa utpanna zaitya se zleSmA kI vRddhi ko thor3A protsAhana mila jAtA hai isI protsAhana kA upalakSaNa sUkhI hulakAroM kA AnA mAnA jAtA hai / zaMkhapradeza meM jaba nistoda hotA hai taba vamana yA hallAsa bahudhA pAyA jAtA hai / yaha nistoda vAtajvara meM to avazyameva milatA hai / hemAdri ne Ayurveda rasAyana nAmaka TIkA meM zuSka ke lie zleSmavirahita artha diyA hai / zleSmA ke prakopa meM zleSmarAhitya kA kyA abhiprAya yaha prazna kiyA jA sakatA hai| usakA artha itanA hI hai ki yadi zleSmA ke pUre vega kA pariNAma honA hotA to vamana hI hotI zuSka vamana na hotI ataH vAtika zaitya ke kAraNa zleSmA kA sparzamAtra hI hotA hai jo matalI kA kAraNa hai / zuSkakAsa kA honA bhI vAtikajvara meM caraka, suzruta aura vAgbhaTa tInoM ne svIkAra sA kara liyA hai / vAta ke prakopa ke kAraNa jo khAMsI AtI hai usameM kapha nahIM nikalatA / isakA artha yaha bhI huA ki jina sajvara rogoM meM unameM jvara vAtika hI huA karatA hai / sAdhAraNa broMkAiTisa meM vahA~ jo jvara sAtha meM AtA hai vaha vAtika svarUpa kA hI adhikAMzataH dekhane meM AtA hai| gAranivigraha vAti jvara kA eka mahattva kA lakSaNa mAnA jAtA hai| rogI sUkhI khA~sI AtI hai sUkhI khA~sI AtI hai ko na chIMka AtI hai aura na DakAra / arthAt use pratizyAya se pUrva kI avasthA bana For Private and Personal Use Only

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367 jAtI hai athavA bahuta kabja vAle rogI kA sA svarUpa ho jAtA hai| vAtika jvara ke rogI ko ina do vegoM kI pravRtti hI nahIM hotii| suzruta ne kSavastambha kaha kara isI ko pukArA hai / kSavathu (chIMka) ke vega ko rokane se jo vikAra utpanna hote haiM ve sabhI vAtika haiM manyAstambhaH ziraHzUlamarditArdhAvabhedakau / indriyANAM ca daurbalyaM kSavathoH syAdvidhAraNAt // isI prakAra udgAra ke vega ko rokane para bhI ghora vAtika vikAra hI huA karate haiM: kaNThAsyapUrNatvamatIva todaH kuujshcvaayorthvaa'prvRttiH| udgAravege'bhihate bhavanti ghorA vikArAH pvnprsuutaaH|| jaba ina vegoM ke rokane se pariNAma vAtika vikAroM kI utpatti meM hotA hai to jisa roga meM ye donoM svayameva hI pAye jAte haiM vaha vAtika na hokara aura kyA ho sakatA hai / ataH vAtika jvara meM ina donoM ke vegoM kA rodha pAyA jAnA gaira svAbhAvika nahIM hai| yaha jvara kA Azcarya karane kI koI AvazyakatA nahIM hai ki azItirvAta vikAra meM atyudgAraH zabda kA ullekha huA hai kyoMki udgAra kI kriyA kA niyantA vAyu hai ataH usake kAraNa kabhI udgArabAhulya aura kabhI udgAravegAvarodha donoM meM se koI bhI ho sakatA hai| - jambhAtyartham athavA jamhAiyoM kA bahuta AnA eka mAnI huI ghaTanA hai jo vAtika jvara meM pAI jAtI hai| jvara ke pUrvarUpoM kA jahA~ mAdhavakara ne varNana kiyA hai vahA~ sAdhAraNa aura asAdhAraNa do prakAra ke pUrvarUpa diye haiN| inameM jambhA'Ggamardo gurutA ke dvArA sAdhAraNa pUrvarUpoM meM bhI tathA jambhAtyarthaM samIraNAt dvArA vizeSapUrvarUpoM meM bhI jamhAiyoM kI adhikatA yA bAra bAra jamhAiyoM ke Ane kA varNana kara diyA gayA hai / vAtajanya vikAroM meM vizeSa karake jaba ve sajvara ho jambhA ke adhika Ane kA lakSaNa bAra-bAra dekhA jAtA hai| . ___annarasakheda, praseka, arocaka aura avipAka ye cAra lakSaNa lagabhaga eka saMsthAna kI ora hI iGgita karate haiM jise hama pacanasaMsthAna kahate haiM / anna ke rasa meM koI svAda nahIM AtA, mukha se lAlAsrAva bahuta hotA hai / isa srAva para manovaijJAnika viSAda avasAdAdi kAraNoM kA prabhAva rahatA hai isa kAraNa isameM anna ko pacAne kI zakti kA abhAva rahatA hai| mukha meM virasatA tathA kaSAyatA barAbara banI rahatI hai isa kAraNa anna ke prati sahaja svAbhAvika pAI jAne vAlI ruci samAptaprAya ho jAtI hai ruci ke nAza meM vAta kA kitanA bar3A hAtha rahatA hai use vyakta karate hue caraka likhate haiM: vAtAdibhiH shokbhyaatilobhnodhairmnonaashnruupgndhaiH| tathA kaSAya vaktrazca mato'nilena kaha kara unhoMne kaSAyavaktratA dvArA tathA zokAdi manonna kAraNoM dvArA aruci kI sthApanA kI hai| vAtika jvara meM ye sabhI kAraNa thor3e yA bahuta pAye jAte hI haiM isa kAraNa arocaka kA honA isa jvara meM koI kaThina bAta nahIM hai| yaha bhI smaraNa rakhanA cAhie ki aruci ke kAraNa bhojana kI anicchA rahatI hai tathA na khAnA yA laMghana karanA sadaiva vAtika lakSaNoM ko teja karatA jAtA hai For Private and Personal Use Only

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368 vikRtivijJAna isa kAraNa vAtika jvara kabhI-kabhI duzcakra ke kAraNa eka bhayAnakarUpa bhI dhAraNa kara letA hai jisakA AbhAsa vasavarAjIyakAra ne diyA hai| arocaka kA lakSaNa vAtika jvara ke pUrvarUpa kA lakSaNa hone ke kaI zAstrakAroM ne usakA varNana kiyA bhI nahIM hai para jinhoM ne isa viSaya kA yatheSTa UhApoha kiyA hai unhoM ne ise nahIM bhI chodd'aa| vAgbhaTa ne prasekArocakAzraddhAvipAka ye cAra lakSaNa ginAe haiN| inameM arocaka aura azraddhA ke bheda para aruNadatta ne jo prakAza DAlA hai vaha bahuta spaSTa hai___ arocakAzraddhayoH ko vizeSaH ? brUmaH / arocakena vaktrasthamapi na mujhe| azraddhayA tu kevalaM nAbhilapati mukhasthaM tu bhakSayatyeveti vishessH| arocaka ko hemAdri ne jihvendriyApravRtti tathA zraddhA ko manaHpravRtti mAnA hai / arocaka meM mukha meM rakhA huA anna khAyA nahIM jAtA aura azraddhA meM mukhastha anna kA bhakSaNa kara liyA jA sakatA hai para anna ke mukha meM Ane ke lie koI utsAha nahIM hotaa| caraka kA annarasakheda aura azraddhA eka hI koTi meM A sakatI haiN| anna ke rasa yA AsvAdana mAtra se kheda honA azraddhA kA hI pramANa hai ise anannAbhilASA kaha sakate haiN| manona aneka kAraNoM kI upasthiti na kevala anannAbhilASA hI utpanna karatI hai api tu avipAka kA bhI kAraNa banatI hai| manovicAroM yA manovikAroM kA anna ke pacana para kitanA prabhAva par3atA hai use rUsI vidvAn pAvalova se puuchie| usane yaha siddha kiyA hai ki AmAzaya kA pAcaka rasa manovikAroM kI upasthiti meM bahuta kama yA bilkula hI nahIM banA krtaa| ataH Azcarya nahIM ki anna ke prati azraddhA hone athavA aruci hone ke kAraNa AmAzaya meM pAcaka rasoM kI utpatti kA abhAva ho jAve aura anna kA vipAka na ho sake / viSAditA yA viSaNNatA vAta jvara meM koI anahonI ghaTanA nahIM hai| sampUrNa zarIra ke aMgapratyaMga meM jisa samaya vedanA rahatI ho bhojana meM koI zraddhA na ho jvara kabhI car3hatA aura kabhI utaratA huA rahatA ho to ina manoghnakAraNoM kI upasthiti meM atyadhika viSAdAvasthA ho jAnA asvAbhAvika nahIM ho sktaa| isI kAraNa vAtajvara se pIDita vyakti pralApa kara uThatA hai bakane lagatA hai| maiM jA rahA hU~ maiM nahIM banUMgA, baccoM ko kauna dekhegA pIche kyA hogA Adi nirarthaka bAteM use sUjhA karatI haiM / isa viSAda ko bar3hAne meM do ghaTanAe~ aura bhI bar3A kArya karatI haiM jinameM eka hai hRdayagraha kI jisake kAraNa hRdaya ke kSetra meM jakar3ana yA zUla rahatA hai jo viSAda kI mAtrA ko caramAvasthA taka le jA sakatI hai hRdayAvasAda jisakA ki mUrtarUpa banatA hai aura dUsarI asvedatA jo bahuta adhika ghabarAhaTa utpanna kara detI hai| viSAda ke hI pariNAmasvarUpa vinAma nAmaka lakSaNa pAyA jAtA hai / vinAma ko gaMgAdhara ne natazirastam mAnA hai arthAt isameM rogI kA sira jhuka jAtA hai| yaha eka daurbalya vizeSa kara manodaurbalya kA lakSaNa hai| rogI apanI gardana para sira ko sAdhane meM asamartha sA ho jAtA hai ataH vaha sira ko eka ora lur3hakA letA hai| yaha koI For Private and Personal Use Only

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jvara 366 adhika mahattva kA lakSaNa na hone se caraka aura vAgbhaTa ke atirikta kisI ne isakA varNana nahIM kiyA | vepathu zabda se hI suzruta ne vAtika jvara ke lakSaNoM kA Arambha kiyA hai / vepathuH kA artha DalhaNa nekapaH diyA hai / zrIvAcaspati vaidya ne bhI vahI mAnA hai / jvara ke Adi meM ka~paka~pI ba~dhanA vAtajvara kA pradhAna lakSaNa hai / vepathu yA kampa svayaM eka vAtika lakSaNa hai tathA eka prakAra kA vAta roga bhI hai : sarvAGgakampaH ziraso vAyurvepathusaMjJakaH / sAre zarIra meM kampotpatti honA tathA sira, hAtha, paira Adi aGgAvayavoM meM usakI vizeSa pratIti honA vepathu yA sarvAGga kampa yA kampa isa nAma se kahA jAtA hai / vAtika jvara meM vepathu eka lakSaNa ke rUpa meM pAyI jAne vAlI vastu hai / isakA sAmAnya bhAva ka~paka~pI ke sAtha jvara kA car3hanA hai / I kampa ke pUrva romaharSa kA honA svAbhAvika hai / roMgaTe khar3e honA assI vAtavikAroM meM hI eka vikAra bhI mAnA jAtA hai para yahA~ yaha upalakSaNa ke rUpa meM hI pAyA jAtA hai / romaharSa sAtha sAtha zItam yA zaitya kA bhI eka upalakSaNa dekhA jA sakatA hai / rogI kahatA hai ki use jAr3A lagatA hai / roMgaTA khar3A ho rahA hai tathA aba ka~paka~pI ba~dha rahI hai / ina tInoM kA spaSTa bhAva yaha hai ki zarIra meM vAyu ke prakopaka kAraNoM kI vidyamAnatA aura unako dUra karane vAle prahariyoM kI anavadhAnatA ke kAraNa vAta doSa kA prAbalya Arambha ho gayA hai aura usakA rUkSaH zIto laghuH sUkSmazcalo'tha vizadaH kharaH meM se raukSya aura tatpazcAt zaitya kA prAdurbhAva hone laga gayA hai aura thor3e hI samaya meM santApAdhikya hokara vAtadoSajanya jvara ke sabhI lakSaNa pragaTa hue jAte haiM / vasavarAjayakAra ne zItam, vidAha aura atyanta zaityam ye dekhane meM paraspara virodhI haiM eka hI roga meM ekatra karake rakha diye haiM / yaha hai ki Arambha meM rogI ko ThaNDa lagatI hai / phira jvara ke bar3hane ke sAtha dAha bar3hatA hai aura jvara kI zAnti ke sAtha zarIra atyanta ThaNDA par3a jAtA hai / maleriyA ke rogI kI zIta pratIti ke pazcAt dAhakatA kI pratIti nahIM milatI parantu vAtikajvara meM zaitya aura kampa ke uparAnta dAha mila sakatA hai / tIna lakSaNa jo isakA abhiprAya uAditya ne zvasana kA eka lakSaNa diyA hai / yaha zvasanakarma kI vRddhi kA lakSaNa hai| kisI kisI rogI ko zvAsocchvAsa gati paryApta bar3ha jAtI hai jise zvAsa nAma se bhI pukArA jA sakatA hai / yaha lakSaNa sadaiva na dikhAI dekara kisI kisI meM pAyA jAyA karatA hai / zaitya kI adhikatA tathA vAta kI prabalatA hI isakA mukhya hetu hai / zItapAnAzanasthAnarajodhUmAtapAnilaiH ke dvArA suzruta ne zvAsa ke nidAna ke anya ghaTaka batalAte hue zItala pAna, zItala khAnA aura zItala sthAna kA bhI ullekha kara diyA hai / vAtika rogoM meM nidrAnAza yA jAgaraNa jitanA adhika karanA par3atA hai usakA For Private and Personal Use Only

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370 vikRtivijJAna ullekha kiyA jA cukA hai| parantu bhrama kI ora utanA dhyAna nahIM jA sakA hai| yaha rajodharma, pittadoSa aura vAtadoSa ina tInoM ke mela se banatA hai aura yaha eka prakAra kA mAnasika vikAra hai___ cakravardramato gAtraM bhUmau patati sarvadA / bhramaroga iti jJeyo rjHpittaanilaatmkH|| bhrama kA lakSaNa caraka ne jahA~ mAnA hai vahA~ vRddhavAgbhaTa ne bhI svIkAra kiyA hai para anyoM ne isakI ora koI dhyAna nahIM diyA hai| rogI ko aisA lagatA hai ki mAno cakra kI taraha usakA zarIra ghUma rahA ho isI ko cakkara AnA bhI kahate haiM / yaha vikAra usI dazA meM utpanna hotA hai jaba peTa meM kharAbI yA viSTambha hone se vAta kA kopa huA ho yA sira meM rakta atyadhika car3ha gayA ho yA bahuta hI kama raha gayA ho| pitta vAyu aura rajoguNa bhUyiSTha vAtAvaraNa bhrama ke lie bahuta upayukta hotA hai| yaha eka mAnasika vikAra hai| vAtika jvara meM do aura mAnasika vikAra dekhane A sakate haiM inameM eka pralApa aura dUsarA mUcho hai| vasavarAjIyakAra ne ina donoM lakSaNoM ko vAtika jvara ke sAtha sambaddha batalA kara roga kI ugratA kI ora dRSTi niHkSepa karAne kA pUrA pUrA prayatna kiyA hai| hArIta ne pralApa ko mAnA hai| vRddha vAgbhaTa bhI pralApa ko mAnatA hai kyoMki vaha caraka kA hI to anuyAyI hai| mUrchA to saMjJAvaha nAr3iyoM ke vAtAdi dvArA AvRta hone ke kAraNa tamo bAhulya se utpanna hotI hai aura pralApa zuddha vAtika roga hai| roga kI ugrAvasthA sAdhAraNa rahane para bhrama, kucha adhika hone para pralApa aura atyadhika hone para mUrchA dekhI jA sakatI hai| zrama ke sAtha karNayo svanaH kAnoM meM sanasanAhaTa bhI dekhI jA sakatI hai| AdhmAna yA peTa phUlanA vAtika roga meM eka bahuta kaSTadAyaka aura gambhIra lakSaNa ke rUpa meM upasthita huA karatA hai| AdhmAna kA lakSaNa suzruta ne nimna diyA hai sATopamatyugrarujamAdhmAtamudaraM bhRzam / AdhmAnamiti taM vidyAddhoraM vAtanirodhajam // ugrAditya tathA suzruta donoM ne hI isakI upasthiti ko svIkAra kiyA hai| udara meM atyadhika zUla kA honA bhI AdhmAna ke sAtha yA svatantra rUpa se pAyA jA sakatA hai|. vAta jvara meM dantaharSa kI upasthiti caraka, aSTAGgahRdayakAra aura aSTAGgasaMgrahakAra tInoM mAnate haiM / dantaharSa sarvadA pitta aura vAta ke prakopa se utpanna huA karatA hai zItarUkSa pravAtAmlasparzAnAmasahA dvijAH / pittamArutakopena dantaharSaH sa nAmataH / / ataH yahA~ dantaharSotpAdaka kAraNa bana bhI sakate haiM aura kucha kamI bhI raha sakatI hai| jahA~ bane vahA~ likha diye gaye jahA~ na bana sake unakA ullekha nahIM huaa| vAta jvara ke anya aneka lakSaNoM ke sAtha sAtha uSNAbhiprAyatA (caraka), dharmecchA (vRddha vAgbhaTa ), himApriyatvam ( ugrAdityAcArya) dhUpa yA garma dravyoM kI lAlasA bhI eka mahatva kA guNa hai| isa dRSTi se isa lakSaNa kI sahAyatA se roga For Private and Personal Use Only

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jvara 371 kA nidAna karane meM bar3I saralatA rahatI hai| rogI ko dhUpa yA tApanA acchA lagatA hai jahA~ aisA dekhA nahIM ki vAtajvara kA anumAna huA nhiiN| pittajvara (1) tasyemAni liGgAni bhavanti / tadyathA-yugapadeva kevale zarIre jvarasyAbhyAgamanam , abhivRddhiA, muktasya vidAhakAle madhyandine'rddharAtre zaradi vA vizeSeNa, kaTukAsyatA, ghrANamukhakaNThoSThatAlupAkastRSNA mado bhramo mUrchA pittacchaInam atIsAro'nnadveSaH sadanaM svedaH pralApo raktakoSThAbhinirvRttiH zarIre / haritahAridratvaM nakhanayanavadanamUtrapurISatvacAmatyarthamuSmaNastInabhAvo'timAtraM dAhaH zItAbhiprayatA nidAnoktAnupazayo viparItopazayazceti pittajvara liGgAni bhavanti / (caraka) (2) vegastIkSNo'tisArazca nidrAlpatvaM tathA vamiH / kaNThauSThamukhanAsAnAM pAkaH svedazca jAyate / / pralApo vaktrakaTutA mUrchA dAho mada stRSA / pItaviNmUtranetratvaM paittike bhrama eva ca // (suzruta) (3) yugapad vyAptiraGgAnAM pralApaH kaTuvaktratA / nAsAsya pAkaH zItecchA bhramo mUrchA mado'ratiH viTAMsaH pittavamanaM raktaSThIvanamamlakaH / raktakoThodgamaH pItaharitatvaM tvagAdiSu // svedo niHzvAsa vaigandhyamati tRSNA ca pittaje // ( vRddha vAgbhaTa) (4) mUrchA dAho bhramamadatRSAvegatIkSNo'tisArastandrAlasyaM pralapanavamI pAkatApazca vaktre ! svedaH zvAso bhavati kaTukaM vihvalatvaM sudhA vA etailiGgairbhavati manuje paittiko vai jvarastu // ( hArIta) (5) tRSNApralApamadadAhamahoSmatAti mUbhrimAnanakaTutvavimohanAni / nAsAsyapAkarudhirAnvitapittamizraniSThIvanAti zizirapriyatAti rossH|| vibhedpiitmlmuutrvilocnaatiprsvednprcurrktmhaatisaaraaH|| niHzvAsapUtiritibhASita lakSaNAni pittajvare pratidinaM prabhavanti tAni / / ( ugrAdityAcArya) (6) sarvAGgadAhaH karapAdadAhaH, tRSNAdhikaM vibhramaNaM ziro'ti / dAho vipAko mukha zoSaNaM ca, mUrkhAgnimAndhaM hyaruciH kRzatvam // jaDaM manazcaJcalatAratizca, vizleSitaM syAddhanamarmajAlam / kaNDUtidussvapnavivAditA vA, pittAdhikaM yasya matAni cihnam // ( vasavarAjIya) (7) pItatAdAhatUTasvedo mUrkhAlpasvapnatiktatA vamibhramapralApAzcarekaH ( aJjananidAna) (8) netre vidAho mukhatiktatA tRD bhramaH pralApo bhRzamuSNamaGgam / vego'titIkSNaH saraNaM vamizca pItA ca mA pittabhave jvare syAt / / (vaidyavinoda ) Upara jo ATha vividha ArSagranthoM se uddharaNa diye gaye haiM ve pittajvara ke svarUpa ko spaSTataH pragaTa karane ke lie nissandeha paryApta haiN| jisa AcArya ne jisa koTi ko apanA mApadaNDa sthira kara liyA usI ko usa usa jvara ke nAma se mAnA yA jAnA tathA likhA hai| ataH * pittajvara kI eka paribhASA denA kaThina hai jaise anya kisI jvara kI nahIM dI jA sktii| kucha lakSaNasamUha eka viziSTa roga ke nAma se kahe gaye haiM unameM bhI koI AcArya kucha kama ginAtA hai aura koI kucha adhika / carakasaMhitA meM pittajvara ke 36 lakSaNa ginAe gaye haiN| suzrutasaMhitA meM lagabhaga 20 lakSaNa hI diye haiN| aSTAGgahRdayakAra aura saMgrahakAra donoM ne eka se hI lakSaNa For Private and Personal Use Only

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372 vikRtivijJAna diye haiM aura unakI saMkhyA 20 ke AsapAsa hai| hArIta ne kula 26 lakSaNa mAne haiN| ugrAditya 21 lakSaNa likhe haiN| vasavarAjIya meM 22, aMjana nidAna meM 8 tathA vaidyavinoda meM 10 hI lakSaNoM se pittajvarAbhivyakti mAnI gaI hai| pittajvara ke lakSaNoM ke sambandha meM vizada vicAra prastuta karane ke pUrva yaha aprAsaGgika na hogA ki hama una lakSaNoM kA nAmollekha kara leM jinheM sabhI AcAryoM ne athavA adhikAMza ne muktakaNTha se svIkAra kara liyA hai / ye lakSaNa nIce likhe jAte haiM (1) atyadhika vega ke sAtha sampUrNa zarIra meM jvara kI vyApti / (2) mukha kI kaTutA athavA tikttaa| (3) nAsikA kA pknaa| (4) mukhapAka tathA mukha meM dAha kA honaa| (5) pyAsa kA adhika lgnaa| (6) mada / (7) bhrama / (8) mUrchA / (9) paittikavamana kA honaa| (10) atisAra / (11) adhika mAtrA meM sveda kA aanaa| (12) dAha kI adhikatA vizeSakara hAtha pairoM, mukha aura netroM meM / (13) zItalapadArthoM kI icchaa| aba hama pittajvara se sambaddha vividha lakSaNoM kI ora apane pAThakoM ko le calate haiM tAki ve unakI vyAkhyA ThIka se samajhate hue pittajvara ke sAtha apanA ghaniSTa sambandha jor3a leN| isa sambandha meM sarvaprathama hama 'yugapadeva kevale zarIre jvarAgamanamabhivRddhirvA' isa carakokta vAkya ko lete haiN| parantu isa vAkya kA vicAra karane ke pUrva hameM caraka ne pittajvara ke sambandha meM jo nimnalikhita pRSThabhUmi taiyAra kara dI hai use bhUla nahIM sakate kyoMki usI kI sahAyatA se pittajvara ke vividha kAraNoM ko aura unake dvArA utpanna lakSaNoM ko samajhA jA sakatA hai__uSNAmlalavaNakSArakaTukAjIrNabhojanebhyo'tisevitebhyaH tathA tIkSNAtapAgnisantApazramakrodhaviSamAhArebhyazca pittaM prakopamApadyate / tadyathA prakupitamAmAzayaM pravizat evoSmANamupasRjadAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAya dravatvAdagnimupahRtya paktisthAnAduSmANaM bahirnirasya prapIDayat kevalaM zarIramanuprapadyate, tadA jvaramabhinivarttayati / garama, khaTTe, namakIna, khAre, caTapaTe padArthoM ke atimAtrA meM barAbara prayoga karate cale jAne se, athavA ajIrNa se pIDita hone para inake kupathyakArI dravyoM ke prayoga karate cale jAne se athavA uSNAdi padArthoM ke adhika sevana se athavA ajIrNa para bhI bhojana karate rahane para tathA tIkSNa dhUpa yA agni se lagAtAra santapta hote rahane se, adhika zrama karane se, viSamAzana karane se athavA anya aneka kAraNoM se jinakA ullekha pIche ho cukA hai pitta prakupita ho jAtA hai / vaha kupita pitta AmAzaya meM jAkara jaTharAgni ko upasRSTa karake AhAra se utpanna sarvaprathama dhAtu rasa ke sAtha jAkara rasavahasrotasoM tathA svedavahasrotasoM ko banda karake tathA pitta ke svAbhAvika guNa dravatva ke kAraNa jATharAgni ko naSTa karake paktisthAna se USmA ko bAhara nikAla kara sampUrNa zarIra ko prapIDita karatA huA jvarotpatti kara detA hai| uSNAmlalavaNakSArakaTukAdi padArthoM ke nirantara prayoga karane se pAcaka pitta kA adhika kupita ho jAnA svAbhAvika hai| kupita pitta kA AmAzayastha jaTharAnala ko For Private and Personal Use Only

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jvara apane dravatva ke kAraNa bujhA denA bhI sarala hai| jaba agni AmAzaya se bujha gaI to phira vaha sampUrNa zarIra meM hokara pragaTa hotI hai vaha Ayurveda kI kalpanA hai| tathA pitta zarIra bhara meM saMcAra karane lagatA hai| usakI saMcaraNatA kA mArga rasavahasrotasoM ke dvArA hai tathA vaha svedavAhIsrotasoM ke bhI mArga meM calA jAtA hai| pitta kA Azraya sveda aura rakta mAnA gayA hai pittaM tu svedrktyoH| tathA pitta ke jo guNa kahe gaye haiM unameM snigdhatA, uSNatA, tIkSNatA, dravatva, amlatA, saratva aura kaTutva mukhya haiN| pitta ke jo sAmya lakSaNa ginAe haiM unakA bhI smaraNa kara lenA hAniprada nahIM hai ........"pittaM pktyuussmdrshnaiH| kssuttciprbhaamedhaadhiishaurytnumaardvaiH| ___ jaba isa samatA meM vikAra kA Akara paittika prakopa hotA hai to pItabiNmUtranetratvakSuttRDdAhAlpanidratA / ye pittavRddhi ke sarvasAmAnya lakSaNa pragaTa ho jAte haiM / aba hama 'yugapadeva kevale zarIre jvarAbhyAgamanamabhivRddhi' kI ora apanA dhyAna le jAte haiM / isa para gaMgAdhara ne apanI vyAkhyA dete hue likhA hai yugapadevetyAdinA pittajvaraliGgAni / kevale kRtsne zarIre yugapadeva jvarAbhyAgamanamutpattirabhivRddhiH prakopa iti dvayam / vA zabdenAbhivRddhizca jvarasya / paittikajvara sampUrNa zarIra meM eka sAtha hI utpanna hotA hai tathA jaba use bar3hanA hotA hai to eka sAtha hI bar3hatA hai| kahane kA abhiprAya yaha hai ki anya jvara to dhIre-dhIre bar3hA karate haiM parantu pittajvara ekadama bahuta U~cA jAtA hai| rogI ko ekadama sahasA tIvrajvara kA ho jAnA pittajvara kA mahattvapUrNa lakSaNa hai| yugapat arthAt ekasAtha yaha nahIM ki pahale sira meM phira pairoM meM jaisA ki bAta jvara meM dekhA jAtA hai api tu sampUrNa zarIra meM ekasAtha eka hI joza ke sAtha yaha jvara zarIra bhara meM phailatA hai| isameM hAtha pahale ThaMDe raheM yA paira ThaMDe raheM / aisI sthiti nahIM dekhI jaatii| isameM to sArA zarIra pUrA kA pUrA hI garma hotA hai| ataH jina jvaroM meM pahale hAtha yA paira ThaNDe rahate haiM yA zarIra ke anya bhAgoM meM tApa kucha adhika lage aura kucha meM kama to ve saba yugapadeva kevale zarIre jvarasyAbhyAgamana kI zreNI meM nahIM Ate ataH unameM se kisI ko bhI pittajvara nahIM kahA jA sakatA hai| vAgbhaToM ne yugapadvathAptiraGgAnAm kaha kara isI vicAra ko vyakta kiyA hai isakI sarvAMga sundarI vyAkhyA meM aruNadatta ne___ yugapat-tulyakAlaM, aGgAnAM vyAptiH-ziraHprabhRtInyaGgAni santApenaikakAlaM vyApyante / na tu vAtajvara ivAgamAdInAM vaiSamyamiti vyAptigrahanena dyotayati / vahI vicAra vyakta kiyA hai jo hamane Upara pradarzita kara diyA hai| pitta kA dravatva guNa use garoM ora phailane meM bahuta sahAyatA detA hai| jisa prakAra svatantra nADImaNDala ke dvArA nikalI huI eDrInalIna ekadama sampUrNa zarIra meM vyApta ho jAtI hai yA jaise ilekzana kI suI ke dvArA rakta meM praviSTa oSadhi kA sampUrNa For Private and Personal Use Only

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374 vikRtivijJAna zarIra meM sahasA prabhAva par3atA hai usI prakAra rasaraktagAmI prakupita drava pitta kI vyApti sampUrNa zarIra meM sira se paira taka eka sAtha hotI hai| jaba vaha bar3hatA hai to vaha vRddhi bhI eka sAtha eka hI kAla meM huA karatI hai| uSmaNastIvrabhAvaH USmA se artha bAhya USmA yA santApa se hai jise hama lokabhASA meM jvara se pukArate haiN| isa jvara kA bhAva pittaprakopaka hetu se utpanna hone para bahuta tIvra hotA hai / pittajvara ke vegastIkSNaH kA artha apanI sarvAGgasundarI bhASATIkA meM dete hue lAlacandravaidya ne jvara ke vega ko 504 DigarI pharenahAiTa ke Upara tApAMza mAnA hai / caraka, suzruta, hArIta, ugrAdityAcArya tathA vaidyavinodakAra vega kI tIkSNatA, mahoSmatA, aMgoM kI atyadhika uSNatA ko jahA~ svIkAra karate haiM vahIM vRddhavAgbhaTa yA vAgbhaTa, vasavarAjIyakAra aura aJjananidAnakAra usakA ullekha bhI nahIM krte| vasavarAjIyakAra ne sarvAGgadAhaH karapAdadAhaH ye do likhane ke bAda eka bAra punaH dAhaH zabda kA ullekha kiyA hai| ina tInoM meM eka dAha ko hama jvara kI tIvratA aura USmAbhivRddhi ke lie le sakate haiM / aJjananidAna svayaM eka bahuta laghukAyapustikA hai / ataH anya aneka lakSaNoM ke chUTa jAne ke kAraNa vega kI tIkSNatA kA ullekha raha gayA ho to koI mahattva kI bAta bhI nahIM hai| dAha ke Dallekha ko yahA~ vega kI tIkSNatA ke lie prayukta nahIM kiyA jA sakatA phira bhI dAha se antarvAhya USmAnubhava kI pratIti to svIkAra kI hI gaI hai| yahA~ to hameM bAhaTa ( vAgbhaTa ) kI varNanazailI para atyanta Azcarya yaha hotA hai ki usane paittikajvara meM spaSTataH pragaTa hone vAlI jvara ke vega kI tIvratA kI ora koI bhI saGketa nahIM kiyA hai| yahI nahIM dAha taka kA ullekha nahIM kiyaa| paraMtu sarvAGgasundarI TIkAkAra aruNadatta ne apanI TIkA meM eka uttama prakAra se isa kamI ko pUrA karate hue jo vicAra saraNi prastuta kI hai vaha nissandeha usakI yogyatA kI digdarzikA hai| usI ke zabdoM meM nanu, doSAstrayo'pi jvaraM nivartayantItyuktam / pittajvare ca pittena yuktasya kAyAgnabhUyo vRddhayA bhAvyam , nAgnimAnyena vRddhiH samAnaiH sarveSAm ( aSTAMgahRdaya, sU. a. 1 / 14 ) iti vacanAt / evaM cAgnimAndyAbhAvAt jvarasya sambhave'pyupapattirayuktA / naivam / svsthaanaanycaalnenaagnermaandyaaptteH| sthAnavazAdvA'nyathA tvasyApi kriyAsAmarthya dRSTam / tathA cASTAGgasaMgrahe carake zopanidAne vakSyati (ca. ni. a. 6|5)-'yo'sh ( tasya ) zarIrasandhInAvizati tena ( asya ) jammA jvrsyopjaayte|' ityaadi|tsmaats evAgniH kvacideva deze paktuM zakto bhavati, na sarvatra / uSNaguNena tu pittena yuktaH paktA bhavatyevoSNataraH / ata eva santApArdAnadhikatarAn karotIti naM kiJcidatrAnupapannam / kahane kA abhiprAya yahI hai ki paittika jvara meM jvara kA tApAMza (temperature) sadaiva U~cA rahatA hai| vaha jaba car3hatA hai to tIkSNatA yA tIvratA ke sAtha hI car3hatA hai| caraka ne isa roga meM atimAtradAhaH zabdAvali kA prayoga kiyA hai| suzruta ne bhI dAha ko svIkAra kiyA hai| hArIta, ugrAditya, vasavarAja, agniveza aura vaidya vinodakAra ina pAMcoM ne dAha ko mAnyatA dI hai| vAgbhaToM ne dAha ko isa sthAna para koI mAnyatA denA Avazyaka nahIM mAnA hai| vidAhaH nAma se caraka ne isakA ullekha For Private and Personal Use Only

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jvara 375 40 prakAra ke pittarogoM meM kiyA hai / isa kAraNa isakA ullekha karanA eka prakAra se Avazyaka ho jAtA hai / vinA dAha ke koI paittika jvara ho hI nahIM sktaa| vasavarAja ne to sarvAGgadAha, karapAdadAha tathA dAha ina tIna zabdoM meM jvara ke svarUpa kA varNana kiyA hai| pittajvara kI utpatti ke sambandha meM prAcInoM ne cAra pramukha kAloM kI ghoSaNA kI hai1. bhuktasya vidaahkaale| 2. mdhyndine| 3. arddhraatre| 4. zaradi vA vizeSeNa / isake anusAra bhojana jisa kAla meM AmAzaya yA Antra meM paca rahA ho taba pittajvara Arambha hotA hai / khAnA khA lene ke do ghaNTe se 6 ghaNTe paryanta jo jvara utpanna hotA hai vaha bahudhA pittajvara hI huA karatA hai / anna kI jIryamANAvasthA athavA pacyamAnAvasthA meM utpanna hone vAlA jvara sadaiva pittajvara kaha kara pukArA jAtA hai / dina kA madhyama bhAga bhI pittajvarotpatti ke lie acchA vAtAvaraNa utpanna kara detA hai / dina arthAt sUryodaya se sUryAsta taka ke kAla ko 3 bhAgoM meM bA~Ta kara unameM prathama aura antima kAla ko chor3a deM aura jo madhya kA kAla AtA hai jo dasa baje savere se do baje aparAhna taka yaha kAla par3atA hai| usameM bhI dopahara ke ThIka 12 baje isakI utpatti kA pradhAna samaya mAnA jAtA hai| rAtri kA madhya bhAga jise madhyarAtri kahate haiM isa jvara kI utpatti vA abhivRddhi athavA vegavRddhi kI dRSTi se acchA vAtAvaraNa upasthita kara detA hai| yaha kAla bhI 10 baje rAtri se 2 baje rAtri taka AtA hai rAtri ke bAraha baje isakI utpatti kA mahattva kA kAla huA karatA hai| pitta ke prakopa ke kAla kA vicAra dina aura rAtri kI dRSTi se kara cukane ke pazcAt jaba varSa kI dRSTi se karanA par3atA hai to hama pitta ke saMcaya prakopa aura prazamana kAla kI ora ghUma jAte haiM / pitta kA saMcaya varSAkAla meM hotA hai: tatra varSAsvoSadhayastaruNyo'lpavIryA ApazcAprasannAH kSitimalaprAyAH, tA upayujyamAnA nabhasi meghAvatate jalapraklinnAyAM bhUmau kvinnadehAnAM prANinAM zItavAtaviSTAmbhitAgnInAM vidahyante vidAhAt pittsNcyaapaadynti| vahI saJcita pitta zaratkAla meM prakupita hotA hai:sa saJcayaH zaradi praviralameghe viyatyupazuSyati paGke'rkakiraNapravilApitaH paittikAn vyAdhIn janayati / inhIM paittika vyAdhiyoM ke antargata pittajvara kI bhI samAviSTi ho jAtI hai| pitta ke prakopa ke kAraNa jvarotpatti ke sAtha-sAtha jo atyanta mahattvapUrNa aura nirNAyaka lakSaNa dekhA jAtA hai vaha hai : haritahAridratvaM nakhanayanavadanamUtrapurISatvacAm / 1. taduSNairuSNakAle ca meghAnte ca vishesstH| madhyAhne cAdharAtre ca jIryatyanne ca kupyati ||-sushrutH / For Private and Personal Use Only

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376 vikRtivijJAna haritatvam ko palAzapuSpavarNatvam tathA hAridratvam ko haridrAvarNatvam gaMgAdhara kavirAja ne svIkAra kiyA hai| hArIta ne paittika prakRti kA jo varNana kiyA hai usameM gaurAtipiGga zabda kA prayoga kiyA hai gaurAtipiGgaH sukumAramUrtiH prItaH suzIte mdhupinggnetrH| tIkSNo'pi ko'pi kSaNabhaGgurazca trAsI mRdurgAvamalomakaM syAt // piGga kA artha pIlA hotA hai ataH gaurI jaise pIle varNa kA zarIra hokara aura halake pIle (madhupiGgaH) varNa ke netroM kA pAyA jAnA svAbhAvika mAnA gayA hai| usI dRSTi se paittika jvara meM pitta ke prakopa se asvAbhAvika vAtAvaraNa meM zarIra kA TesU ke phUla ke samAna hariyAlI lie pIlA raMga ho jAnA yA haldI jaisA pIlA varNa ho jAnA sadaiva sambhava hotA hai| zarIra kI kAnti kA pIlA ho jAnA yA zarIra para pIle varNa kI chAyA kA par3a jAnA ugrAdityAcArya bhI svIkAra karatA hai| usane pittarogAdhikAra meM pittaprakopa ke lakSaNoM meM spaSTataH pItAbha ko svIkAra kiyA hai AraktalocanamukhaH kaTuvAkpracaNDaH / zItapriyo madhuramRSTarasAnnasevI / / pItAvabhAsuravapuH purusso'tirossii| pittAdhiko bhavati vittapateH smaanH|| suzrata ne bhI pItaviSamUtranetratvam ko svIkAra kiyA hai| vaha mAnatA hai ki mala, mUtra aura netroM meM pIlApana A jAtA hai| vRddhavAgbhaTa kA bhI pItaharitatvaM tvagAdiSu ko svIkAra karanA spaSTa jhalakatA hai| svagAdiSu meM tvagAsyakSinakhamUtrapurISeSu liyA jAtA hai| ugrAditya kA pItamalamUtravilocanAni, mala, mUtra aura netroM kI pItatA kI ora spaSTataH saGketa kara detA hai| vaidyavinoda kA pItA ca bhI kA svIkAra karanA tathA aJjananidAnakAra kA pItatA ko svIkAra kara lenA hameM batalAtA hai ki pittajvarI kA zarIra pIlA par3a jAtA hai yA usameM hariyAlI (haritatva) A jAtI hai / pAcaka pitta svayaM harA hotA hai tathA usameM pIlApana bhI hotA hai isakA pramANa pittajachardi kA varNana karate hue svayaM suzruta ne hI upasthita kara diyA hai yo'mlaM bhRzoSNaM kaTutiktavaktraH pItaM saraktaM haritaM vabhedA / sadAhacoSajvaravaktrazoSaM sA pittakopaprabhavA hi chardiH / / pItatA vA haritatA pIle aura hare vargoM meM se pahale haritavarNa kA vikAsa hotA hai jo nAkhUnoM, netroM, mukhamaNDala, mUtra, purISa aura tvacA para prakaTa hotA hai| kAlAntara meM roga kI ugratA hone para harI AMkheM pIlI par3a jAtI hai nakha, mala, mUtra aura tvacA tathA ceharA ye sabhI pIle varNa ke ho jAte haiN| kabhI-kabhI jaba Arambha se hI roga ugra ho to pItatA roga ke sAtha-sAtha hI prakaTa ho jAtI hai| pitta ke kAraNa pItatA kI prApti anya bhI kaI rogoM meM dekhI jAtI hai| paittika atisAra meM, "pittAtpItaM nIlamAlohitaM vA paittika grahaNI meM ___ so'jIrNa nIlapItAbhaM pItAbhaM sAryate dravam / pittapANDurogI bhI pItamUtrakRnnetro dAhatRSNAjvarAnvitaH / bhinnaviTako'tipItAbhaH pittapANDvAmayI nrH|| For Private and Personal Use Only

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jvara yahI nahIM paittika svarabheda jaise sarala roga meM bhI Acharya Shri Kailassagarsuri Gyanmandir pittena pItanayanAnanamUtravarcA brUyAdvalena sa ca dAhasamanvitena / pIta ke sAtha haritavarNa kA varNana bhI paittika rogoM meM milA karatA hai jaise pittaja mUrcchA meM raktaM haritavarNa vA viyatpItamathApi vA / pazyaMstamaH pravizati sasvedazca prabudhyate // sapipAsaH sasantApo raktapItAkulekSaNaH / jAtamAtre patati ca zIghraM ca pratibudhyate // saMbhinnavarcAH pItAbho mUrcchAye pittasambhave // carakokta pittajachardi ke udAharaNa meM bhI aisA hI milatA haipItaM bhRzoSNaM haritaM satiktaM dhUmraM ca pittena vametsadAham / pitta ke 40 rogoM meM se kaI roga to zarIrAvayavIya pittaroga pItavarNatA ke kAraNa banate haiM:daurgandhyaM pItamUtratvamaratiH pItavikatA / pItAvalokanaM pItanetratA pItadantatA // zItecchA pItanakhatA tejodveSo'lpanidratA / 377 --- ataH zarIra kI pItimA yA haritAbhA ina donoM meM se kisI eka ko pAnA pitta kI prakupitatA kA spaSTa pramANa mAna lenA caahie| kisI-kisI ko ina do varNoM se pUrva atyadhika raktavarNatA kI vyApti bhI dekhI jAtI hai / vaha bhI pitta ke kAraNa prakupita rudhira kA pramANa hai / tRSNA ke bAda dAha aura usake pazcAt pAka AyA karatA hai / hamane tRSNA ke sambandha meM vicAra kiyA hai ki yaha lakSaNa zarIra meM jaba atyadhika uttApa yA saMtApa bar3hatA hai arthAt tApAdhikya yA uccazArIrika tApa kA sarvaprathama pramANa tRSNA, tRSA, tRT, tRD, atitRSNA vA tRSNAdhikam ke nAma se zAstrakAroM ne kahA hai / tRSNA yAnI pyAsa kA adhika laganA arthAt rogI dvArA pAnI-pAnI cillAnA tathA jitanA hI use pilA diyA jAve utanA hI use pAnI kI cAha kA aura bar3hanA tRSNA kahalAtI hai / tRSNA yA pipAsA kI utpatti ke aneka kAraNa hone para bhI pittavarddhaka vAtAvaraNa yA pittakAraka dravyoM kA prayoga atyadhika mahatva ke kAraNoM meM ginA jAtA hai bhayazramAbhyAM balasaMkSAyAdvA hyUrdhvaM citaM pittavivardhanaizca / pittaM sa vAtaM kupitaM narANAM tAluprapannaM janayet pipAsAm // isa para TIkA karate hue madhukoSakAra likhate haiM pittavivardhanairiti kaTmloSNAdibhiH krodhopavAsAdibhizca svasthAna eva saJcitaM kupitaca pittaM, vAtazca bhayazramabalakSayaiH kupitaH UrdhvaM prasarat pipAsAM janayati / For Private and Personal Use Only jaba kaTvalakSAroSNAdi dravyoM kA sevana pittAbhivRddhi karatA huA pittaja jvarotpatti kara sakatA hai to usake sAtha-sAtha tRSNA kA bhI udaya ho jAve to koI Azcarya nahIM honA cAhie / yaha tRSNA bhI pittajA tRSNA hotI hai jisake suzrutokta lakSaNa nimnalikhita haiMmUrcchAnnividveSavilApadAhA raktekSaNatvaM pratatazca zoSaH / zItAbhinandA mukhatiktatA ca pittAtmikAyAM paridUyanaM ca // pittajvara ke sambandha meM zAstrakAroM ne jo aneka lakSaNa gAye haiM unameM se prAyaH sabhI pittaja tRSNA ke lakSaNoM meM bhI samAviSTa haiM / mUrcchA annadveSa vilApa dAha raktanetratA

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378 vikRtivijJAna atyadhika gale kA sUkhanA zItala padArthoM kI cAha aura mukha kA tikta honA ye sabhI lakSaNa pIche pittajvara ke sambandha meM kaha diye gaye haiM / ghrANamukha kaNThauSThatAlupAkaH kahane se pitta ke uSNa aura tIkSNa svabhAva ke kAraNa hue anartha kI puSTi kI gaI hai / USmA kI adhikatA ke kAraNa nAka paka jAtI hai, mukha meM pAka ho jAtA hai jinheM hama lokabhASA meM muMha meM chAle par3a jAnA kahA karate haiM / gale meM bhI pAka ho jAtA hai jise pheriJjAiTisa yA gale kI kharAzamAtra kaha diyA tA hai / tAlu meM bhI usake nirantara sUkhane aura pyAsa lagane se zotha yA pAka ho jAyA karatA hai / suzruta ne kaThauSThamukhanAsAnAM pAkaH aisA likhA hai / jisameM tAlu pAka ko chor3a kara zeSa carakokta nAsA, mukha, kaNTha aura oSThoM meM pAka ho jAtA hai / vAgbhaTa ne nAsAsyapAkaH hI svIkAra kiyA hai jise nAsAyAmAsye ca pAkaH kahakara aruNadatta ne chor3a diyA hai| hemAdri ne AsyapAka ko mukharogeSu kaha diyA hai / mukhapAka eka prakAra kA mukha roga to hai hI ise kauna asvIkAra kara sakatA hai / mukhapAka nAmaka lakSaNa ko suzruta, caraka, vAgbhaTa ke atirikta hArIta, ugrAditya aura vasavarAjIyakAra ne bhI svIkAra kara liyA hai / pittaja 40 vikAroM meM aGgapAkatA jo lakSaNa AyA hai vaha pitta kI tIkSNatA ke kAraNa hone vAle vividha zarIrAGgapAkoM ke lie hI prayukta huA hai jinameM oSTapAka, mukhapAka, tAlupAka, kaNThapAka tathA nAsApAka bhI A jAte haiM / pakane kA pradhAna kAraNa pitta kI tIcNatA tathA uSNatA ke sAtha ina sthAnoM kI snigdhatA meM kamI AnA aura rUkSatA kA bar3hanA bhI hai / vraNazothajanya pAka ke samAna hI yaha pAka huA karatA hai paraMtu hotA usase kucha saumya hai / jaba vaha tIvra ho jAtA hai to cikitsaka use vraNazothodbhava mAnate hue jvara ko doSaja na mAnakara pAkajanya mAna lete haiM jo yathArtha nahIM / yahA~ doSaprakopa prathama hai tatpazcAt kaNThauSThamukhanAsAtAlvAdi meM pAkotpatti hotI hai / vahA~ prathama pAka banakara taba jvara AtA hai / yahA~ pAkotpAdaka doSa hote haiM para vahA~ pAkotpatti meM rogakAraka aneka kAraNa jinameM jIvasRSTi mahattvapUrNa bhAga letI hai / yaha na bhUlanA cAhie ki vraNazothajanya jitane bhI pArkoM kA pIche varNana kara diyA gayA hai vahA~ jo zUla, USmA, lAlimA aura sUjana ye jo cAra lakSaNa batalAye the unameM USmA aura lAlI pitta ke kAraNa huA karatI hai / ataH jo jvara vraNazothAdi meM prakaTa hotA hai vaha barAbara pittaja jvara yA pittajvara mizrita anya uvara huA karatA hai pittAnubandha vyatirikta vraNazotha vA zarIrAvayavagatapAka honA sambhava nahIM / kaNThauSThamukhanAsa tAlu nAmaka pradezoM meM hI pittajvara janya pArka' ho itanA saGkucita bhAva bhI lekara calane kI AvazyakatA nahIM hai / ye pAka uparokta sthaloM ko chor3a kara yA unheM sAtha lekara zarIra ke kisI bhI aGga meM ho sakate haiM / For Private and Personal Use Only

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jvara 376 pittajavidradhi ke jo lakSaNa ginAye gaye haiM unameM jo jvara saMjJA AI hai vaha pittajvara kI ora hI aMgulinirdeza karatI haipakkodumbarasaMkAzaH zyAvo vA jvaradAhavAn / kSiprotthAnaprapAkazca vidradhiH pittasambhavaH // abhighAtaja vidradhi meM bhI pittapradhAna jvara pAyA jAtA haikSatoSmA vAyuvisRtaH saraktaM pittamIrayet / jvarastRSNA ca dAhazca jAyate tasya dehinaH / Aganturvidradhi Sa pittavidradhilakSaNaH // pAka jahAM bhI hotA hai usakA pradhAna kyA ekamAtra kAraNa AcAryoM ne pitta ko mAnA hai narte'nilAd ruG na vinA ca pittaM pAkaH karpha cApi vinA na puuyH| tasmAddhi sarvAn paripAkakAle pacanti zothAMstraya eva doSAH // (suzruta ) ataH vraNazothAdhyAya meM varNita pAkoM meM pitta kI pradhAnatA arthAt pittajvara ke anubandha ko kadApi vistRta karane kI AvazyakatA nahIM hai| vAta aura kapha kA bhI mahattva hai kyoMki vAta zUlakAriNI aura kapha pUyakAraka hai parantu zUla kA mUla kAraNa sthAna vizeSa meM pitta ke dvArA kie jAte hue pAka kI upasthiti hai tathA pAka kA pariNAma pUyotpatti meM hotA hai ataH vraNazothajanya vikAroM meM pitta kI mahattA ko bhulAyA nahIM jAsakatA aura vahA~ jitane jvara dekhe jAte haiM unameM pitta kA mahattvapUrNa anubandha rahA karatA hai tathA adhikAMza vaha jvara pittajvara svayaM yA usakA choTA yA bar3A bhAI hI huA karatA hai| ___ dAha aura pAka ke kAraNa tathA jvara kI tIvratA ke kAraNa zarIra meM rogI ko itanI USmA bar3ha jAtI hai ki vaha pyAsa se cillAne lagatA hai aura ThaNDA pAnI mA~gatA hai| yaha jo ThaNDe padArtha mA~gane kI pravRtti hai vaha pittajvara kA jJAna prAta karane meM bahuta sahAyatA detA hai / zItAbhiprAyatA se isI lakSaNa ko caraka ne prakaTa kiyA hai| parantu suzruta ne isakI ora dhyAna nahIM diyaa| suzrata bhAvAnugAmI aSTAGgahRdayakAra ne zItecchA svIkAra kI hai| ugrAdityAcArya ne atizizirapriyatA aisA likhA hai| anya logoM ne isa ora vizeSa dhyAna nahIM diyaa| madhukozavyAkhyAkAra mahAmahopAdhyAya zrI vijayarakSita ne paittike bhrama eva ca meM ca zabda kI vyAkhyA karate hue likhA hai ki cakAraH pUrvavadanuktasamuccayArthaH / tadyathA tIvroSNatA raktakoThAH zItecchatA'ruciriti / ataH suzruta zItapadArthoM kI icchA aisA lakSaNa pittajvara kA mAnatA hai| pittajvarI kabhI ThaNDA pAnI mA~gatA hai kabhI barpha kI icchA prakaTa karatA hai aura kabhI malAI kA barpha mA~gatA hai| ThaNDe padArthoM meM usakA laulya bahuta adhika lagA rahatA hai| parantu yaha bhI samajhanA hogA ki kaI logoM ne isake lakSaNa kI ora adhika mahattva pradarzita nahIM kiyaa| isakA kAraNa yaha hai ki pittajvara eka atyugra svarUpa kA jvara hai jisakA vega atyanta tIkSNa hotA hai| rogI ekadama mUJchita yA aceta ho jAtA hai| mUrchA, mada aura bhrama ye sabhI visaMjJatAkAraka lakSaNa sAtha meM rahate For Private and Personal Use Only

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280 vikRtivijJAna haiM / muMha kholakara pAnI DAlane ko to vaha grahaNa kara letA hai para zItAbhiprAyatA yA zItecchA ko sAdhAraNa paricAraka nahIM jAna paataa| vaidya bhI isa lakSaNa kI ora adhika dhyAna na dekara anya gambhIra lakSaNoM kI ora vizeSa dhyAna detA hai| catvArizatpittaroganAmAni ke andara zItecchA ko bhI eka pittaroga mAnA gayA hai| pyAsa ke sAtha sAtha vamana kA honA bhI pittajvara meM mahattvapUrNa sthAna rakhatA hai| caraka ne paittika vamana, pittacchardanama kI upasthiti svIkAra kI hai| vAgbhaTa ne pittavamanam, aJjananidAnakAra ne tiktatA vami tathA anyoM ne vamiH mAtra mAnA hai / ugrAdityAcArya bar3e bar3e gambhIra lakSaNa diye haiM para vaha paittika vamana kAla kSaNa nahIM likha sakA / pittakopaprabhavA chardi kA varNana karate hue suzrata likhatA hai yo'mlaM bhRzoSNaM kaTutiktavaktraH pItaM saraktaM haritaM vamedvA / sadAhacoSajvaravaktrazoSaM sA pittakopaprabhavA hi chardiH // tathA caraka ne mUrchApipAsAmukhazoSamUrdhatAlvakSisantApatamobhramA''taH / pItaM bhRzoSNaM haritaM satiktaM dhUmraM ca pittena vametsadAham / / pittacchardijanya jitane lakSaNa diye gaye haiM ve sabhI pittajvara meM prAyazaH upasthita hone se pittajvara meM pittaja chardi hI hotI hai aisA anumAna aura pramANa se mAna liyA jAnA caahie| gaMgAdhara ne pittacchardanamiti kapha vinA kevala pittavAntiH aisA likhA hai / arthAt pittajvara meM jo vAnti hotI hai usameM zuddha harA pIlA pAcaka pitta hI nikalatA hai anya doSoM kA aMza nahIM aataa|| ___ sadAha jvara meM hare pIle pittoM kA vamI ke rUpa meM nikala jAnA pittajvara kI sadaiva puSTi kiyA karatA hai| yaha vamana yakRt dvArA bane prakupita asvAbhAvika pitta kI adhika mAtrA meM nivRtti ke kAraNa hotI hai| pitta grahaNI se ulaTA calakara AmAzaya meM AtA hai vahA~ paittika ugratAvaza mukha kI ora vAyu dvArA Dhakela diyA jAtA hai aura vamana ho jAtI hai| paittika vamana ke sAtha sAtha raktaSTIvanamamlakaH ko tathA ugrAditya rucirAnvita pittamizraniSThIvana kA bhI ullekha karate haiM / pitta ke prakopa se rakta kA udIrNa honA svAbhAvika hai, ataH kevala pitta vamana hI nahIM rucira vimizrata paittika vamana bhI ho sakatI hai / rudhira kA jAnA sthiti kI AtyayikatA kI ora hI nirdeza karatA hai| yaha lakSaNa pratyeka pittajvarI meM milanA sambhava nhiiN| AcAryoM ne jo kaTukAsyatA, vaktrakaTutA, kaTuvaktratA, AnanakaTutva athavA mukhatiktatA Adi zabdoM kA vyavahAra kiyA hai vaha kyA uparokta pittardi ke kAraNa hai athavA kaTukAsyatAdi ke kAraNa pittacardi utpanna hotI hai ? yaha eka sarala prazna nahIM hai / para isakA uttara paryApta sarala hai / pittaja jvara meM pAcaka pitta kA paryApta mAtrA meM bAhara AnA aura usakA UrdhvAdhaH gamana karanA eka sarvasAdhAraNa kriyA hai| koI Avazyaka nahIM ki yaha pitta bahuta bar3I mAtrA meM vamana kA rUpa lekara Ave / usake For Private and Personal Use Only

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jvara 381 kucheka kaNa gale yA mukha taka A sakate haiM aura mukha meM kaTutA yA tiktatA utpanna kara sakate haiN| jaba eka bAra paittika vamana ho jAtA hai to usakI kaDuvAhaTa paryApta kAla taka mukha meM banI raha sakatI hai| kaTuvaktratA arthAt kaTurasatvamAsye yA mukha meM kaTurasa kI upasthiti itanA liyA jAtA hai kucha loga jo tiktAsyatA svIkAra karate haiM unake mata se mukha meM tiktatA liyA jAsakatA hai| kahane kA tAtparya yaha hai ki pittajvara meM mukha caraparA tIkSNa athavA kaDavA raha sakatA hai| gaMgAdhara ne isa viSaya para kucha prakAza DAlA hai| vizeSeNa kaTukAsyatA tiktAsyatA mahArogAdhyAye hi pittanAnAtmajeSu tiktAsyatvamuktam anye tu kaTuH syAt kaTutiktayoriti smRtyA tathA yo'mlaM bhRzoSNaM kaTutiktavaktraH pItaM saraktaM haritaM vamaidvA / sadAhacoSajvaravakrazoSaM sA pittakopaprabhavA hi chardiH / iti suzrutavacanAcca kaTatiktAnyatarAsyatvamicchanti, dRzyate hi tiktAsyatvameva jvare iti / mukha meM kaTutA ( caraparApana ) rahatI hai yA tiktatA ( kaDavAhaTa) isake sambandha meM caraka, suzruta, vRddhavAgbhaTa, vAgbhaTa, ugrAdityAcArya eka mata haiM para vaidyavinoda mukha meM tiktatA kA hI ullekha karatA hai| paittika vyAdhiyoM meM sadaiva kaTurasa kI hI vRddhi hotI hai / kaTurasa svayaM bhI pitta kA udbodhaka hai isI kAraNa AcAryoM ne kaTuvaktratA ko hI pradhAnatA dI hai| suzruta ne kaTurasa aura pitta ke sambandha kyA hI sundara uddharaNa upasthita kiyA hai auSNyataikSNyaraukSyalAghavavaizadyaguNalakSaNaM pittaM, tasya samAnayoniH kaTuko rasaH so'syauSNyAdauSNyaM vardhayati, taikSNyAttaikSNyaM, raukSyAdraukSya, lAghavAllAghavaM vaizadyAdvaizadyamiti / (su. sU. a. 42) kaSAyatiktamadhurAH pittaM pranti isa paramezvara likhita vAkya se to tiktarasa pittanAzaka rasa hai ataH usakI utpatti pitta ke prakopa kAla meM nahIM ho sakatI ataH tiktamukhatA ke sthAna para kaTuvaktratA hI adhika ucita jJAta hotA hai para mukha kA svAda pitta ke kar3avAhaTa ke kAraNa kaDavA bhI kahA jA sakatA hai para vaha vAstava meM kaTu hI hai| tApazca cakre zabda kA vyavahAra hArIta ne kiyA hai| jaba vyakti kaTu padArtha jaise soMTha mirca yA pIpala khA letA hai aura phira Upara se garma dUdha yA jala pItA hai to thor3I sI garmI se hI mukha adhika tapta ho jAtA hai aura kaTu rasa sameta uSNatA ke kAraNa vaktra meM tApa yA adhika garmI mAlUma par3atI hai| ataH zarIra jvara se dagdha hai aura kaTukAsyatA maujUda hai ataH vaktra meM tApa hai aisA le sakate haiN| hArIta ne pAka tApazcacake zabda vyavahAra kiyA hai jisase yaha siddha hai ki hArIta mukha ke pAka aura mukha ke tApa donoM ko hI mAnatA hai| ___ annadveSaH aisA eka lakSaNa tittajvara kA caraka ne diyA hai| anna meM aruci honA isakA bhAva hai| aruci nAmaka eka lakSaNa vasavarAja ne bhI diyA hai| isakA bhI bhAva anna se dveSa honA kiyA jAnA cAhie / anna se dveSa kA kAraNa mukha kI kaTutA vA tiktatA hai| jo kucha bhI khAyA jAtA hai vaha kaDuA lagatA hai isalie vyakti anna se For Private and Personal Use Only

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382 vikRtivijJAna dveSa karane lagatA hai| hArIta ne kSudhA kA honA batalAyA hai| anna se dveSa honA eka sthiti hai aura bhUkha kA laganA dUsarI sthiti / donoM sAtha-sAtha raha sakatI hai aura nahIM bhii| hArIta kI dRSTi meM bhUkha rahatI hai| para vasavarAja ke mata se agnimAncha pAyA jAtA hai| aruNadatta ne agnimAnya hotA hai yA nahIM isa para bahuta vicArapUrvaka apanI lekhanI sIdhI kI hai, vaha likhatA hai: pittajvare ca pittena yuktasya kAyAgnebhUyo vRddhayAbhAvam nAgnimAnchana, 'vRddhiH samAnaiH sarveSAM (a. hR. sU. a. 1-14) iti vacanAt / evaM cAgnimAndyAbhAvAt jvarasya smbhve'pyuppttiryuktaa| naivam / svsthaanaaccaalnenaagnermaandyaaptteH| sthAnavazAdvA'nyathA tvasyApi kriyAsAmarthya dRSTam / tathA cASTAGgasaMgrahe carake zoSanidAne vakSyati (ca. ni. sthA. 6-5) yo'zaH ( tasya ) zarIrasandhInAvizati tena ( asya ) jammA jvarazcopajAyate' ityAdi / tasmAtsa evAgniH kvacideva deze paktuM zakto bhavati na sarvatra / uSNaguNena tu pittena yuktaH paktA bhavatyevoSNataraH ataeva santApAdInadhikatarAn karotIti na kiJcidatrAnupapannam / hArIta ne jahA~ kSudhA kI upasthiti pittaja jvara meM svIkAra kI hai vahIM vasavarAja ne spaSTa zabdoM meM agnimAndha kA ullekha kara DAlA hai| ataH sa eva agniH kvacideva deze paktuM zakto bhavati na sarvatra nAmaka aruNadattIya vicAra dhArA ko hI svIkAra kara lenA hogaa| __vasavarAja aura aJjananidAnakAra ko chor3a kara sabhI lekhakoM ne pittajvara meM atIsAra kA ullekha spaSTa zabdoM meM kara diyA hai| caraka ne use kaI lakSaNoM ke bAda smaraNa kiyA hai para suzruta ne pittajvara kA dUsarA lakSaNa hI atIsAra diyA hai / vAgbhaTa ne use viTAsaH ke nAma se pukArA hai| hArIta ne atIsAra aura ugrAditya ne use viDabheda kahA hai / vaidya vinoda meM saraNam hI likha kara chor3a diyA hai| ___gaMgAdhara ne likhA hai ki pitta drava hotA hai ataH vaha mala ko bhI tarala kara detA hai isa sadRva vipravRtti ko loga atIsAra mAnate haiM para vAstava meM vaha DhIlA pAkhAnA mAtra hai atIsAra nhiiN| usane isa viSaya ko bahuta samajhadArI ke sAtha Age bar3hAyA hai atIsAra iti pittasya saratvena sa eva viTpravatirna tviisaarrogH| tasya jvropdrvtveniikttvaat| kecit tu yadA sadravapravRttistadA pittajvara eva yadA tUpadravatvenAtisArarogastadA jvarAtIsAra itIcchanti / vastutastu dravapurISatvamiti noktvAtIsAra iti vacanena dravAtisaraNaM vAtAdijvarApekSayA syAt tathA rasadhAtorativRddhattve pittadUSitatve ca yasmin pittajvare pittasyeva vahridUSakatvaM purIpamizratA ca syAt tasmin pittajvare tvatosAro bhavati, atisArajvarayostulyasamprAptikatvAt ityubhayarUpatvaM khyaapitmiti| kecintu asyAmevAvasthAyAM jvaro jvarAtIsAra ityAhustadyathA-pittajvare pittabhavo'tisAraH tathAtisAre yadi vA jvaraH syAt / doSasya dUSasya samAnabhAvAt jvarAtisAraH kathito bhiSadbhiH // iti / atra tathAtisAre pittajAtisAre ityrthH| anye tu vAtAdyatisAre'pi vAtodarAmAzayagamanam abdhAtuvizeSarasadhAtudUSaNaJceti jvarasya doSa dRSyasAmAnyAd yadi vAtAdyatisAre'pi jvaraH syAt tadA so'pi jvarAtisAra ucyate, tena jvarAtisAre bheSajavidhAnaM pRthagiSyate yato jvaraghnaM prAyazo bhedi atisAraghnantu stmbhi| tacca pratyekaM na yujyate ityaahuH| tacca na carakasuzrutAcamimataM yuktathA jvaroktAtisAroktabheSajayormizreNa bheSajakalpanayA siddheH kriyAsAmAnyaJca yuktyAbhisandhAya prayoktumarhati / vahrivarddhanapAcanAdikaM hi labdhanAdikaM jvare cAtisAre ca yuktaM For Private and Personal Use Only

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jvara 383 dRzyate iti varAtisAraH pRthaka nokta iti / upadravANAJca svasvacikitsA vihitA, anyathA tattadupadravavatAM pratyekaM cikitsAvizeSasya vAcyatvApattiH syAt / na cAtisArajvarayoviruddhopakramo'sti tAvAneva ladhanAdisamopakramadarzanAt / svedaH arthAt pasIne kA nikalanA pittajvara kI hI vizeSatA hai kyoMki svedAvarodhaH santApaH sarvAGgagrahaNaM tathA, yugapadyatra roge ca sa jvaro vyapidizyate / kA pATha karane vAle hI kaNThoSTha mukhanAsAnAM pAkaH svedazca jAyate kA aTTahAsa jaba karane lagate haiM to isa virodhAbhAsa se bar3e-bar3e anartha hone kI AzaMkA utpanna ho jAtI hai| suzrutasaMhitA ke andara hI ye donoM viruddha uktiyoM kA pradarzana huA hai / para suzruta ke sarvottama TIkAkAra DalhaNAcArya ne svedAvarodhaH svedAnirgamaH, etacca prAyikaM lakSaNaM paittike svedanirgamAt dvArA spaSTa kara diyA hai ki sveda kA nikalanA jvara meM bahudhA hotA hai anivAryataH nahIM kyoMki pittajvara isakA apavAda maujUda hai| gaGgAdhara ne isI ko kucha aura spaSTa kara diyA hai svedo dharmapravRttiH sarvajvare prAyazo dharmanirodhe'pi paittikAdijvare pittasya tekSNyAt jvaraprabhAvAdvA dharmanirodho na syAt / / pitta kI tIkSNatA athavA jvara ke vizeSa prabhAva ke kAraNa svedAgamana huA karatA hai| ataH pittajvara ke jJApaka lakSaNoM kA bhale prakAra vicAra karane vAle ko svedAgamana bahuta saralatA se usake paittika hone kA pramANa upasthita kara sakatA hai / madhukozavyAkhyAkAra ne bhI gaMgAdhara ke hI mata kA samarthana kiyA hai prAyeNa sAmadoSeNa srotasA nirodhAt sarvajvareSu dharmanirodhaH, atra tu pittasya taikSNyAjjvaraprabhAvAdvA sa na bhavati / vasavarAja aura aMjananidAnakAra ko chor3akara zeSa sabhI vidvAnoM ne svedAgama svIkAra kiyA hai| ugrAdityAcArya ne to pracuratA ke sAtha prasvedana svIkAra kiyA hai| jaba atyadhika garmI par3atI hai taba DaTa kara pasInA AyA karatA hai| isI prakAra jaba yahA~ rogI pitta kI bhayaMkara jvAlA se jala rahA ho aura pitta kI USmA zarIra ke kaNa-kaNa ko pradagdha kara rahI ho to svedotpatti honA asambhava nahIM hai| jvara ke vega kI prabalatA, dAha aura tIkSNatA ke kAraNa ghabarAyA huA rogI bakabaka karane lagatA hai / tApAdhikya jaba bhI 104 se Upara jAne lagatA hai rogI kI jJAnazakti kSINa ho jAtI hai aura mastiSkastha vAkkendra svatantra ho jAtA hai| isI ko pralApa nAma se pukArA gayA hai| pralApa, pralapana aura vivAditA Adi zabdoM dvArA prAcInoM ne isa lakSaNa ko vyakta kiyA hai| pralApa svayaM eka vAtika lakSaNa hai jisakA ullekha assI prakAra ke vAtarogoM meM AcukA hai| para gaMgAdhara ke zabdoM meM 'pralApo'sambandhavacanaM vAtakAryavat pittakAryazca' pralApasambaddha bakabaka hai jo vAtakArya hai aura pittakArya bhI ho sakatA hai| pralApa kA varNana nimna rogoM meM AvegA1. vAtajvara 2. bhayaja jvara 3. pacyamAnajvara 4. pittajvara 5. zokaja jvara 6. raktaja jvara For Private and Personal Use Only

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384 vikRtivijJAna 7. sannipAtaja jvara 8. antarvegajvara 9. medogatajvara inake atirikta chinnazvAsa, yamalAhikA, tRSNA aura madAtyaya meM bhI isakA ullekha AcukA hai| pittajvara meM mada bhI bar3ha sakatA hai| rogI eka naze se meM par3A huA dekhA jA sakatA hai / madhukozakAra zrI vijayarakSita ne supArI, kodo yA dhatUrA khAne se jisa-jisa prakAra kA nazA car3hatA hai vaisA nazA pittajvarI ko ho sakatA hai aisA mada kA artha diyA hai / gaGgAdhara kavirAja ne bhI usI kA pratipAdana kara diyA hai aura mado mattatva. miva yathA pUgakodravadhattUrabhakSaNAdau kaha kara madhukozakAra ne svIkAra kara liyA hai| ___ Ayurveda ne mada kI vyApti pittaja jvara, raktagatajvara, paittika kAsa, paittika yakSmA, atimadyapAna, paittika zotha aura paittika vAtarakta meM svIkAra kI hai| dimAga kI garmI car3ha jAne ke kAraNa jo santApa kI adhikatA ke kAraNa sadaiva sambhava hai yaha avasthA utpanna huA karatI hai| vasavarAjIya, aJjananidAna aura vaidyavinoda ko chor3a anya sabhI ne madopasthiti svIkAra kI hai|| bhrama kA varNana aJjananidAna ko chor3a sarvatra AyA hai| bhrama yA matibhrama sadaiva eka paittika lakSaNa yA roga mAnA gayA hai| bhrama nimna rogoM meM mila sakatA hai(1) vAtajvara (2) pittajvara (3) sannipAtajvara (4) abhicArajvara (5) antarvegajvara (6) pacyamAnajvara (7) vAtapittajvara (8) vAtakaphajvara (9) vAtajamUrchA (10) pittaja. zotha (11) halImaka (12) pANDuroga (13) chidrodara (14) parisrAvyudara (15) sannipAtodara (16) madAtyaya (17) raktagatajvara (18) mAMsagatajvara (19) agnivisarpa (20) granthivisarpa (21) raktagatavAtavyAdhi (22) kRmivikAra (23) vAtikavidradhi (24) tRSNA (25) pittajahRdroga (26) pittAvRtaprANavAyu (27) pittAvRta udAnavAyu (28) bahirvegajvara (29) pittajakAsa tathA vAtajatRSNA aura paittika madAtyaya meM vizeSa krke| bhrama ke sambandha meM bahuta vicArapUrvaka gaGgAdhara kavirAja ne apanA mantavya prakaTa kiyA hai jo pAThakoM ke lie bahuta lAbha kI vastu hai bhramazcakrasthitasyeva, bhramaNazothavastudarzanamiva svadehabhramaNajJAnaJca / yadyapi mahArogAdhyAye vAtajAzItivikAreSu bhramo'bhihitastathApi rajaHpittAnilAd bhramaH iti vacanAt vAtajatvavat pittajatvamapi bhramastha khyApanArthamidaM vacanaM vAtajvare'pi bhramasyoktatvAt / anye tu na rogo'pyekadoSaja iti vacanAt paittike jvare Arambhakatvam , na hi svanidAnakupitastatra vAyuH kintu ekaH prakupito doSaH sarvAneva prakopayediti vacanAt prerakatvazaktimAtreNaiva vAyoH kopo na tu rUkSatvAdidharmeNa / tathAtve hi vAtapittajatvavyapadezApattiranyataralakSaNApattizca / pare tu doSadUSyasaMyogaprabhAvAt kAraNadRSTasyApi kAryyatvena sambhavo yathA haridrAvarNasaMyogAdraktatvamaruNatvaJca nIrUpatve'pi vAtAtisAre purISasya ityAhustadapi na manoramaM tathAvidharUpAntarApatteH / kecittu pittadUSitanetratvena zaGkhaH pota iti jJAnavad bhrmjnyaanmaahuH| AtaGkadarpaNakAra ne bhramahetumAha-raja ityAdi / For Private and Personal Use Only

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jvara 385 rajoguNena pittAnilAbhyAM yuktena bhramo bhavati, tatra bhramaH sthAyI puruSajJAnaM viparItasattvajJAnAdikaM, anye cakrasthitasyeva saMbhramadvastudarzanamiti / / ___ jaba pitta aura vAyu donoM rajoguNa bhUyiSTha ho jAtI haiM to bhrama hotA hai jisameM puruSa ThIka jJAna kI sthiti ko ulaTa detA hai| kucha loga bhrama se cakra meM ghUmate samaya jaise padArtha calate hue dikhAI dete haiM aise use prakaTa hote haiM mAno bhUmi ghUma rahI ho / buddhi meM bhramatA aura sira meM cakkara donoM hI rUpa meM bhrama ho sakatA hai| paittika jvara meM eka lakSaNa mUrchA bhI AtA hai| jaba rogI kI saMjJAvahanADiyA~ vAtAdi doSoM se banda ho jAtI yA bhara jAtI hai athavA unameM saMjJAjJAna ko vahana karane kI zakti jAtI rahatI hai to rogI ke sAmane ekadama a~dherA chA jAtA hai| (mUrchAndhakArapraveza iva jJAnam ) to vyakti mUJchita ho jAtA hai use sukha duHkha kA jJAna nahIM rahatA aura vaha kASThavat gira par3atA hai| pittajvara meM jo mUrchA AtI hai vaha pittaja hI huA karatI hai jisake lakSaNa nimna batalAye gaye haiM raktaM haritavarNa vA viyatpItamathApi vA / pazyaMstamaH pravizati sasvedazca prabudhyate // sa pipAsaH sa santApo raktapItAkulekSaNaH / jAtamAtre patati ca zIghraM ca pratibudhyate / __saMbhinnavarcAH pItAbho mUrchAyai pittasambhave / / mUrchA nimna mAnavI rogoM meM dekhI jAsakatI hai-1. pittajvara, 2. vAtapitta jvara, 2. oSadhi gandhaja jvara, 4. abhiSaGgAkhya jvara, 5. abhicaraja jvara, 6. visarpa (agni, kardama, granthi ), 7. kRmiroga (kaphaja), 8. vAtarakta (pittaja ), 9. apa. tantraka, 10. sAmajvara, 11. apatAnaka, 12. zvAsa (tamaka), 13. chardi (paittika), 14. hRdroga (paittika), 15. tRSNA (paittika), 16. atisAra (paittika), 17. atimadyapAna, 18. grahaNI, 19. mUtrazakarA, 20. gulma (paittika ), 21. udararoga (paittika), 22. samipAtodara, 23. plIhodara, 24. pANDuroga (paittika) Adi / ___mUrchA ke sambandha meM aMjananidAna aura vaidyavinoda ina do granthoM ko chor3a. sabhI ne likhA hai| hArIta ne to pittajvara ke lakSaNoM kA Arambha hI mUrchA se kiyA hai / ugrAdityAcArya ne pittajvara kA eka lakSaNa mUrchA ke atirikta vimohanAni yA moha diyA hai / arthAt vaha isa roga meM moha bhI ho sakatA hai aisA mAnatA hai| moha aura mUrchA samAnArthaka hote hue bhI vAtapittajvara ke prakaraNa meM isakA bheda samajhAyA jaavegaa| __caraka aura vAgbhaToM ne raktakoThAbhinivRttiH athavA raktakoThodgamaH ke dvArA eka lakSaNa lAla cakattoM kI utpatti kA diyA hai| ___ raktakoThAbhinivRttiriti jvarabhramAvAt pittAzayakopAdA raktasya duSTayAraktavarNakoThaH syAt , koThastu varaTIdaSTadehapradeze iva kSaNikotpattivinAzI maNDalAkAraH zophaH / gaMgAdhara ne jvara ke prabhAva se yA pitta ke atizaya kupita hone ke kAraNaH rakta kI usa duSTi ko rakavarNa koTha kahA hai jo bare ke kATane se camar3e meM 33, 34 vi0 For Private and Personal Use Only

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386 . vikRtivijJAna cakatte ke rUpa meM maNDalAkAra zopha kI AkRti bana jAtI hai| koTha kA jo rUpa yahA~ varNana kiyA gayA hai vaisA pittajvara meM nahIM milatA varaTI ke daSTa kA cakattA jitanA bar3A hotA hai vaisA cakattA yahA~ nahIM hotaa| yahA~ to bahuta sUkSma kabhI dikhane vAle kabhI na dikhane vAle jvara kI tIvratA ke kAraNa dAne uThA karate haiN| suzruta, hArIta, ugrAdityAdi aneka AcArya carakokta raktakoThoM kI upasthiti varaTIdaSTavat na pA sakane ke kAraNa apane apane granthoM meM isa lakSaNa kA varNana nahIM kara ske| uttara bhArata meM motIjhalA ke jina dAnoM kA varNana AtA hai jo camakadAra aura aruNavarNa ke hote haiM jinakI utpatti kA kAraNa tIvrajvara yA atizaya pittakopa hai tathA jo kSaNikotpattivinAzI hote haiM raktakoTha ke nAma se le sakate haiN| motIjharA svayaM bhI eka paittika vyAdhi hai aura usake jIvANuoM kI saccI nivAsabhUmi pittAzaya aura pAcaka pitta hI unakA poSaka mAnA jAtA hai / usakI sampUrNa cikitsA svarNamuktA haritAzma bahula pittazAmaka hotI hai ataH raktakoThodgama ko motIjharA ke dAne mAna lene meM koI vizeSa ar3acana hotI nhiiN| nidAnadIpikAkAra dvArA grIvAyAM pari. dRzyante sphoTakAH sarSapopamAH jo likhA hai usa sarSapopama sphoTaka ko raktakoThAbhinivRtti mAna lenA caahie| TAyaphAiDa meM raktavarNAni maNDalAni ko upasthiti Adhunika vidvAnoM ne svIkAra kI hai| inheM ve 'rojaspoTsa' ( rose spots ) kahate haiN| ___ uparokta mukhya mukhya lakSaNa jo pittajvara meM pAye jAte haiM unake atirikta caraka kI dRSTi meM avasAda kA honA; suzruta kI dRSTi meM nidrA kI kamI, vAgbhaTa kI dRSTi meM arati kA honA jisakI puSTi vasavarAja ne arati tathA ziro'rti ke rUpa meM kI hai; hArIta kI dRSTi meM vihvalatA kA honA; ugrAditya kI dRSTi meM atiroSa kA honA; aura vasavarAja kI dRSTi meM mukhazoSaNa, kRzatA, jaDatA, mana kI caJcalatA, marmajAla kA vizleSa yA kaNDU, duHsvapnatA kA honA aura batalAyA gayA hai| pittajvara kA rogI USmA se atyadhika vyathita rahatA hai isa kAraNa use zItecchA, zItAbhiprAyatA yA atizizirapriyatA rahatI hai| vaha kapar3e pheMka detA hai khule badana rahanA cAhatA hai aura ThaNDI barpha kI icchA prakaTa karatA hai| kucha AcAryoM ne pittajvarI ke mukha se yA zvAsa meM eka prakAra kI durgandha bhI AtI huI batAI hai| jise unhoMne niHzvAsa vaigandhyaH, zvAso bhavati kaTukam , yA niHzvAsapUti Adi zabdoM se vyakta kiyA hai / vAgbhaTa, hArIta aura ugrAditya tInoM ne zvAsa kI durgandhatA kI ora iGgita kiyA hai| kaphajvara (1) tasyemAni liGgAni bhavanti-tadyathA yugapadeva kevale zarIre jvarasyAbhyAgamanamabhivRddhirvA / bhuktamAtre pUrvAle pUrvarAtre vasantakAle vA vizeSeNa / gurugAtratvaM anannAbhilASaH zleSmapraseko mukhamAdhuyaM hRllAso hRdayopalepaHstimitatvaM chardimRdvagnitA nidrAdhikyaM stambhastandrA kAsaHzvAsaH pratizyAyaH zaityaM zvaityazca nakhanayanavadanamUtrapurISatvacAmatyarthaJca zItapiDakA bhRzamaGgebhya uttiSThanti, uSNAbhiprAyatA nidAnoktAnupazayo viparItopazayazceti zleSmajvaraliGgAni bhavanti / (caraka ) For Private and Personal Use Only

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jvara 387. (2) gauravaM zItamutklezo romaharSo'tinidratA / sroto rodho rugalpatvaM praseko madhurAsyatA // nAtyuSNa gAtratAcchaddiraGgasAdo'vipAkatA / pratizyAyo'ruciH kAsaH kaphaje'kSNozca zuklatA // ( suzruta ) Acharya Shri Kailassagarsuri Gyanmandir (3) staimityaM stimito vega AlasyaM madhurAsyatA / zuklamUtrapurISatvaM stambhastRptirathApi ca // gauravaM zItamutkledo romaharSo'tinidratA / pratizyAyo'ruciH kAsaH kaphaje'kSNozca zuklatA // ( DalhaNa ) (4) vizeSAdarucirjADyaM sroto rodho'lpavegatA / praseko mukhamAdhurye hallepazvAsapInasAH // hRlAsazchardanaM kAsaH stambhaH caityaM tvagAdiSu / aGgeSu zItapiTikAstandrodardaH kaphodbhave // ( vRddhavAgbhaTa ) (5) staimityaM madhurAsyatA ca jaDatA tandrA bhrazaM syAttathA / gAtrANAM gurutAruciviramatA romodgamaH zItatA // prasvedAH zrutirodhanaM ca bhavate netre ca pANDucchavI / viSTabdhaM malavRttikAsavamanaM zleSmajvare jJAyatAm // ( hArIta ) (6) nidrAlutA ruciratIva zirogurutvaM mandoSmatAtimadhurAnanaromaharSAH / srotAvarodhanamihAlparugakSipAtachardi prasekadhavalAkSimalAnanatvam // atyaGgasAdanavipAkavihInatAtikA sAtipInasakaphodgamakaNThakaNDUH / ileSmajvare prakaTitAni ca lakSaNAni // ( ugrAdityAcArya ) (7) kAsazvAsau pInasaH kaNThazoSo dAho bhrAntiH zvetavarNaM balAsam / tandrAkAraM gauravarNaM ca gAtraM vAGmAdhurye vAripUraM salAlam 11 cintA bhItirviddhitaM mandavahniM tApaH svedaH zophamUtraM ziro'rtiH / snigdhaM gAtraM vardharaM sAraNaM syAt hetuzleSmadyotito'yaM jvaraH syAt // ( vasavarAja ) (8) staimityotkledamAdhurya pratizyAyArucigauravam / kAsAlasye tRptizauklyaM zaityaM zleSmajvarAkRtiH // ( aJjananidAna ) (9) annArucirgauravamaGgasAdo romodgamo mUtranakhAdizauklyam / nidrA'tizaityaM madhuratvamAsye zleSmajvare syAtstimito hi vegaH // ( vaidyavinoda ) caraka kaphajvara kI utpatti meM sahAyakabhUta hetuoM kA saGkalana nimna vAkya meM kara diyA hai : :-- snigdha-guru-madhura-picchila - zItAmla - lavaNa - divAsvapna - harSA vyAyAmebhyo'ti sevitebhyaH zleSmA prakopamApadyate / phira isakI samprApti nimna zabdoM meM spaSTa kI hai :--- sa yadA prakupitaH pravizyAmAzayamuSmaNA saha mizrIbhUya AdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyAgnimupahatya pattisthAnAt uSmANaM bahirnirasya prapIDayan kevalaM zarIramanuprapadyate, tadA jvaramabhinirvartayati / kahane kA tAtparya yaha hai ki cikane, bhArI, cipacipe, ThaNDe, khaTTe, namakIna padArthoM ke atyadhika prayoga se, dina meM sone se, vyAyAma na karane se tathA atyadhika Ananda manAne se kapha prakupita ho jAtA hai / yaha prakupita kapha jaba AmAzaya meM pahu~catA hai to vahA~ jATharAgni ke sAtha mizrita ho jAtA hai aura usake andara taiyAra hone vAlI AhAra kI prathama drava dhAturasa kA anugamana karatA huA rasavaha srotas jo nAbhikada se utpanna hue haiM unameM tathA For Private and Personal Use Only

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388 vikRtivijJAna svedavAhI asaMkhya srotoM meM pahu~ca kara unheM AvRta karake agni ko paktisthAna se haTAkara yA manda karake jATharAgni kI uSNatA ko tvacAgata karake sampUrNa zarIra meM jvararUpa meM vyApta kara detA hai / kaphajvara kI utpatti kI yaha kahAnI hai / doSapUrNa AhAravihArAdi ke kAraNa zarIra kI santulita samadoSAvasthA meM vighaTana ho kara kapha dhAtu kA prakopa ho jAtA hai / vahI prakSubdha kapha AmAzayastha USmA kI svAbhAvika annapAkinI kriyA ko zAnta kara detA hai aura usa agni ke sAtha vaha praveza karatA hai zarIra ke una srotoM meM jo AhArotpanna prathama padArtha annarasa ko zarIra kI AvazyakatA pUrti nimitta Dhote rahate haiM / ani AhArapAcana kA kArya roka detI hai aura prakupita kapha ke dvArA . zarIra ke roma roma meM vyApta hokara prANI meM sajvarAvasthA paidA kara detI hai / Ayurveda ne jvarotpatti kI eka hI kahAnI likhI hai / viSama se viSama paristhitiyA~ vAta, pitta yA zleSmA ko hI prakupita karane meM samartha hotI haiM / ye doSa kAlAntara meM apane-apane saJcaya kAloM ke anusAra AmAzaya meM Ate haiM Akara pAcana kriyA ko zAnta kara agni ko sAtha le yAnI agni se svayaM dagdha hokara zarIra ke rasaparibhramaNa aura sveda paribhramaNakArI mArgoM meM ghusa kara zarIra ke roma-roma ko dagdha karake yA santapta karate hue baiTha jAte haiM / isI ko loka jvara kahatA hai / yaha kArya taba taka nirantara calatA rahatA hai jaba taka doSa apanI samAvasthA ko prApta nahIM ho jAtA / doSI bukhAra yA miyAdI bukhAra meM miyAda se jvara utaratA hai / isakA bhAva yahI hai ki utanI miyAda eka doSa ko zarIrAnukUla paristhiti meM lAne meM samartha hotI hai / kabhIkabhI ugrauSadhiyoM ke prayoga se zarIra kI santaptAvasthA ko ekadama roka diyA jAtA hai| aura rogI kA zarIra ThaNDA par3a jAtA hai para jvara ke AdikAraNa prakupita doSa kI samAvasthA nahIM AI rahatI ataH bar3e-bar3e gambhIra pariNAma bhI dekhe jAte haiM / AmAzayastha USmA ko zAnta karate hI jvara utara jAyagA para yaha USmA aura prakupita doSa ye do pRthak vastu haiM USmA kI zAnti jvara ke kAraNa ko naSTa karane meM samartha nahIM hotI aura jaba zarIra meM eka prakupita doSa banA hI huA hai to rogI ko ArAma kahA~ ! isI kAraNa kabhI-kabhI jo jvara miyAda se pUrva paca jAte haiM unameM zarIra ThaNDA ho jAne para bhI tathA 2-2, 4-4 dina vyatIta ho jAne para bhI rogI ko bhUkha nahIM lagatI, utsAha nahIM AtA, moda prApta nahIM hotA niSprabha sA thakA sA maratA sA vaha par3A rahatA hai / isakA kAraNa yahI hai ki kAraNabhUta doSa apanI samAvasthA ko nahIM pahu~ca ki yaha roga kI jar3a kI sakA / isIlie Ayurveda ko jaba samAja yaha kahatA hai cikitsA karatA aura roga ko jar3a mUla se ukhAr3a pheMkatA hai to usameM nissandeha eka yathArthatA, maulikatA aura dRDhatA chipI huI hai jo Thosa vaijJAnika vicAraNA para ava- lambita hai / lakSaNaparivarjana AyurvedIya buddhi se lakSya nahIM hai nidAnaparivarjana lakSya hai; hetuparivarjana roga kI jar3a para kuThArAghAta karatA hai / lakSaNaparivarjana rogI ko Akasmika zAnti mAtra dene kA upAya hai jisake gambhIra pariNAmoM kI ora AdhunikoM kA bhI dhyAna jA rahA hai / For Private and Personal Use Only

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jvara 386 aba hama kaphajvara ke sambandha kI vividha zArIrika vikRtiyoM kA vicAra zAstradRSTayA eka-eka karake kreNge| yugapadeva kevale zarIre jvarasyAbhyAgamanamabhivRddhirvAyaha lakSaNa hamAre sAmane hai / yaha carakokta hai| isakA artha yaha hai ki kaphajvara sampUrNa zarIra meM yugapat ( eka sAtha) utpanna hotA hai / sira meM jaba kaphajvara kI garmI AtI hai tabhI pairoM meM bhI pahu~catI hai| tathA yadi isakI vRddhi honI hotI hai to vaha bhI yugapat hI hotI hai| sthAnIya paristhiyoM ko chor3a kara zarIra bhara meM yadi tharmAmITara se bukhAra nApA jAve to vaha eka barAbara hI milegaa| kaphajvarotpatti meM kAla kI dRSTi se vicAra karane para1. bhojana ke turata baad| 2. sabere ke smy| 3. rAtri ke prathama prahara meM sandhyA ke turata baad| 4. vasanta Rtu meM / kaphajvara paidA hotA yA bar3hatA hai| jvarI ke upasthAtA ko pUchA jA sakatA hai ki use jvara dinarAtri meM kisa samaya car3hatA yA bar3hatA hai| yadi vaha pUrvAhna yA pUrva rAtri athavA bhojanoparAnta kahe to kaphajvara hai aisA le sakate haiN| suzruta ne sUtrasthAna ke 21 veM adhyAya meM inhIM kAloM ko zlokabaddha karake rakha diyA hai: sa zItaiH zItakAle ca vasante ca vizeSataH / pUrvAle ca pradoSe ca bhuktamAtre prakupyati // kapha zItala padArthoM se zItakAla ( zleSmaNaH zizirAdiSu ) meM tathA vizeSa karake. vasanta Rtu meM, pUrva dina yA pUrva rAtri meM athavA bhojana karate hI kupita hotA hai| kaphajvara ke sambandha meM lagabhaga 40 prakAra ke lakSaNa vibhinna zAstrajJoM ne batalAye haiM / ina lakSaNoM meM se adhikatara eka dUsare se milate julate haiN| do eka lakSaNa paraspara virodhI bhI haiN| ye saba lakSaNa jaba eka sAtha adhyayana ke viSaya banate haiM to spaSTataH isa bAta kA saMketa ho jAtA hai ki prAcInoM ne kaphajvara nAma se eka suspaSTa loka meM bahudhA pAye jAne vAle hI kisI jvara kA varNana kiyA thaa| vaha jvara Aja bhI pAyA jAtA hai aura thor3A vicArapUrvaka dekhane vAlA koI bhI Adhunika ise pahacAna sakatA hai / aba hama vividha lakSaNoM kA vicAra karate haiM jaisA pahale kiyA gayA hai| gurugAtratA vaha sabase pahalA lakSaNa hai jo kisI bhI kaphajvara se pIDita rogI meM saralatayA DhUMDhA jA sakatA hai| gurutA, gAtragarutA yA gaurava ye tInoM paryAyavAcI zabda haiN| inakA prayoga kaphaja vyAdhiyoM meM hI adhika hotA hai| rogI ko apanA zarIra bahuta bhArI mAlUma par3atA hai isake kAraNa vaha karavaTa nahIM le sakatA, koI aGga uThA nahIM sktaa| sira uThAne meM bahuta bhAra kA anubhava hotA hai| isI ko ugrAditya ne atIva zirogurutvam aura vasavarAja ne ziro'tiH kaha kara pukArA hai| zarIra kA sampUrNa rUpa se bhArI honA athavA usake kisI eka aMga kA bhArI honA yaha saba kaphaja lakSaNoM meM hI Ate haiN| sira kA bhArI honA bhI isI kA eka aMga hai / zarIra ke. bhArIpana meM zarIra ke pratyeka bhAga meM halakI-halakI pIr3A kA anubhava hone lagatA hai| For Private and Personal Use Only

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360 vikRtivijJAna isI ke kAsaNa zarIra meM jar3atA athavA jAnya utpanna ho jAtA hai| vAgbhaTa aura hArIta ne gaurava ke sthAna para jADya zabda kA hI prayoga kiyA hai| jar3atA kA artha Alasya huA karatA hai| halake zarIra ko jADya kyoM satAne lgaa| jisake zarIra ke saba srotasa aura dvAra kaphAdhikya se ruMdhe par3e hoM use karane lAyaka koI zArIrika kriyA karanA atyadhika kaThina ho jAtA hai jisake pariNAmasvarUpa jADya yA Alasya yA gaurava athavA gAtragurutva kA rogI ko avazya anubhava hone lagatA hai| bIsa prakAra ke jo zleSma roga ginAe gaye haiM unameM gaurava bhI eka svayaM kaphaja roga yA kaphaja lakSaNa hai| kapha kA jo svarUpa batalAyA jAtA hai usameM gurutA usI ke bAMTa meM AI hai-zleSmA zveto guruH snigdhaH picchilaH zIta eva ca, doSoM ke zarIra meM saJcita hone ke sAtha hI sAtha gaurava aura Alasya mAnava zarIra meM yA usake kisI aMga vizeSa meM bar3hane lagatA hai| ye donoM lakSaNa kapha ke svayaM guru hone ke kAraNa aura bhI bar3ha jAte haiN| zarIra meM pA~ca zleSmasthAna hote haiN| jaba kabhI kapha kA zarIra meM prakopa hotA hai to inhIM pAMcoM sthAna (chAtI, zira, kaNTha, sandhiyA~ tathA AmAzaya) meM bhArIpana kA adhika anubhava hotA hai| chAtI meM bhArIpana, kapha kA bar3hanA, zvAsa ke sAtha gharghara zabda kA honA, zvAsa kI prati minaTa gatiyoM meM vRddhi honA aura chAtI kA bharA sA mAlUma par3anA tathA pAryo meM zUla vA vedanA kA honA koI anahonI bAta nahIM hai| sira meM bojha sA hone para Adhe yA pUre sira meM vedanA yA darda ho sakatA hai kaphaja ziroroga meM gaurava kI mahattA svayaM zAstrajJoM ne svIkAra kI hai: ziro bhavedyasya kaphopadigdhaM guru pratiSTabdhamatho himaM ca / zUnAkSikUTaM vadanaM ca yasya ziro'bhitApaH sa kaphaprakopAt // ataH zira kA bhArI honA aura sira meM pIr3A kA honA kaphaja prakopa kA hI pratyakSa pariNAma hai| kaNTha meM zleSmA ke saMcaya ke kAraNa kaNTha kA bhArI honA bhI eka ghaTanA hai jo kaphajvara ke sAtha pAI jA sakatI hai| gale meM kaphopalepa ho yA svarayantra meM donoM hI ke kAraNa AvAja bhArI ho sakatI hai| brUyAt kaphena satataM kphruddhknntthH| sandhiyoM meM kapha ke saJcita ho jAne se vahA~ bhI kaSTa kA anubhava aura jar3atA pAI jA sakatI hai| kaphajvara meM bhI jo jar3atA yA gurugAtratA dekhI jAtI hai vaha sandhiyoM meM zlaiSmika saJciti ho jAne ke kAraNa unakI kriyAzakti kI kamI bhI mahattva kA kArya karatI hai| ___AmAzaya meM zleSmA kI saJciti pradhAnatayA rahA hI karatI hai, aura gaurava kA jo mukhya svarUpa hamAre sAmane AtA hai vaha peTa kA bhArI honA hI adhika dekhA jAtA hai / yadi kucha khAlI liyA gayA hai to vaha peTa meM bojha banakara par3A rahatA hai aura kabhI peTa meM halakApana prakaTa nahIM ho paataa| For Private and Personal Use Only

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jvara 361 gurugAtratA yA gaurava hameM nimna rogoM meM adhikatara milatA hai 1. kaphajvara, 2. kaphaja plIhodara, 3. kaphaja udararoga, 4. sAmajvara, 5. rasagata jvara, 6. kaphaja yakSmA, 7. kaphaja aNDavRddhi, 8. kaphaja vidradhi, 9. kaphAdhika vAtarakta, 10. kaphArza, 11. sAmavAyuvikAra, 12. kaphAvRta vAta, 13. mAMsagata vAtavyAdhi, 14. medogata vAtavyAdhi, 15. kaphaja mUrchA, 16. kaphaja madAtyaya, 17. sannipAtajvara, 18. kaphaja zvitrakuSTha, 19. kaphAvRta udAna, 20. kaphAvRta vyAna, 21. kaphaja gulma, 22. kaphaja atIsAra, 23. kaphaja kAsa / __ gAtragurutA ke anya rogoM meM bhI paryApta udAharaNa milate haiM ataH jisa kisI aMga meM gAnagaurava dekhA ki usI ko kaphaja jvara mAna liyA so ThIka nahIM hai| kyoMki vAtodara meM zarIra kA adhobhAga gauravAnvita ho jAtA hai| kaphAtisAra, viSamAgnidoSa se, kaphaja grahaNI, athavA kaphodara meM udara meM gaurava milatA hai / urustambha meM Uru meM gaurava milatA hai| kaphajAtIsAra hone para guda gaurava milatA hai| gurutA basti meM kaphAzmarI, kaphAtisAra yA kaphaja mUtrakRcchra ke hone se hI dekhI jAtI hai| sira kA bhArIpana kaphaja yakSmA, kaphArza, grahaNI, viSamajvara tathA kaphaja kAsa ina pA~ca rogoM meM dekhA jAtA hai / mUtrasaMga hone para mer3hagaurava milatA hai| kaphaja kAsa athavA kaphaja hRdroga meM hRdvaurava pAyA jAtA hai| ____ ataH kevala gaurava mAtra se kaphajvara kA bodha nahIM ho sakatA para koI bhI aisI kaphaja vyAdhi nahIM pragaTa huI jisameM lakSaNa yA upalakSaNa ke rUpa meM kapha ke guNa gaurava kA ullekha na kiyA jAsakA ho| ___ jADya yA jar3atA kA zAstrIya ullekha vAtakaphajvara, kaphajvara, viSamajvara ina tIna vyAdhiyoM meM hI ho gayA hai / zirojADya kaphaja tRSNA meM tathA hRjADya sAmajvara meM milatA hai| gaurava ke mahattva ke prati ucita sammAna pradarzita karane ke lie caraka ne use jvara ke uparAnta tathA suzruta ne sarvaprathama usakA smaraNa kara liyA hai| DalhaNAcArya dvArA uddhRta zloka meM gaurava kA ullekha yathAsthAna huA hai| vAgbhaTa ne aruci ke bAda jADya kA hI smaraNa kiyA hai| hArIta ne bhI ise tIsarA sthAna diyA hai| ugrAditya tathA vasavarAja ne zirogurutva athavA ziro'rtiH kA ullekha kiyA hai| aJjananidAnakAra tathA baidyavinodakAra donoM ne hI gaurava ke gaurava ko A~kA hai| jaba yaha gaurava zarIra kI aicchika peziyoM kI kriyAzakti para prabhAva DAlakara unheM durbala banA detI haiM to zarIra zlatha yA zithila ho jAtA hai aura usake kAraNa Alasya kI zarIra meM vRddhi huA karatI hai| ___ kaphajajvara meM zarIra ke santApa kI jo sthiti rahA karatI hai vaha eka spaSTa prakAra kI hI hotI hai| use hama nAtyuSNagAtratA kaha sakate haiM / arthAt isameM jvara rahatA hai, zarIra garama rahatA hai aura tApa bar3hatA hai para vaha atyadhika nahIM hotaa| rogI kI sthiti pittajvarI ke samAna jvara ke tIvra vega se vyApta nahIM milatI / gAtra uSNa rahatA For Private and Personal Use Only

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362 vikRtivijJAna hai para atyuSNa nahIM / use 100 se lekara 102 taka bhI tApAMza mila sakatA hai para usase Upara prAyazaH nahIM jAtA / caraka ne ise mRdvagnitA kaha kara pukArA hai| aura usakI TIkA karate hue jalpakalpatarukAra ne mRdvagnitA vAtAdi jvarApekSayA - dhikamandAgnitA sarvajvare'pi vahnimAnyAt kaha kara jATharAgni kI mandatA kI ora aGguli nirdeza kara kaphajvarI ko agnimAnya kI zikAyata rahatI hai yaha vyakta karane kA yatna kiyA hai / para ugrAditya ne bhI mandoSNatA zabda kA vyavahAra kiyA hai tathA vasavarAja ne mandavahni aisA likhA hai jinase abhiprAya jATharAgni kI mandatA na nikala kara zarIrastha tApa kI mRdutA yA mandatA jise suzruta ke mata se nAtyuSNagAtratA kahA gayA hai hI lenA cAhie / karotyagnistathA mando vikArAn kaphasambhavAn / Acharya Shri Kailassagarsuri Gyanmandir mAdhava ke isa vAkya ko dekha kara mandAgni kA honA siddha to kiyA jAsakatA hai para kaphajvara meM yaha sarvasAdhAraNatayA pAyA jAne vAlA lakSaNa hai / agni jaba taka AmAzaya chor3akara doSoM ke dvArA bAhara kI ora pravRtta nahIM hotI taba taka to koI jvara utpanna hotA hI nahIM hai / ataH agnimAMdya to sabhI jvaroM meM anivAryataH pAyA jAne vAlA lakSaNa hai / svayaM pittajvara bhI isakA apavAda nahIM vahA~ to paittika ugratA ke kAraNa kucha bhI khAyA ki chardi ke dvArA bAhara AyA svayaM tIkSNa pitta bhI use pacAne meM asamartha rahatA hai / ataH mandoSNatA yA mRdvagnitA ko nAtyuSNagAtratA ke paryAya rUpa meM hI lenA cAhie / kapha ke svAbhAvika guNoM meM zItatA bhI isI ke bA~Ta meM par3I hai / jaba vaha kupita hotA hai to zaitya bhI sAtha hI sAtha bar3hatA hai / zaitya ke kAraNa zarIra para jvara kA ugra rUpa se AkramaNa nahIM ho paataa| rogI ko jvara to AtA hai para kapha ke zItala prabhAva se usameM mandoSNatA ke lakSaNa pAye jAte haiM / suzruta ne zlaiSmika hRdroga meM 'agnimArdavam' kA vyavahAra kiyA hai vahA~ bhI agnimAMdya na lekara tApAMzAlpatA hI lenA cAhie / lhaNa ne jvara ke vega ke sambandha meM jo kiyA hai vaha jvara ke manda vega kI ora lakSya hai bar3hatA hai usI prakAra usakA vega bhI adhika nahIM hotA / stimito vegaH zabda kA prayoga kyoMki kaphajvara meM jaise tApAMza kama anannAbhilASA yA aruci kapha roga kI eka mahattvapUrNa vizeSatA mAnI jAtI hai| jvara ke pUrvarUpoM kA varNana karate hue vizeSa lakSaNoM meM kaphAdannArucirbhavet pIche kahA jA cukA hai| rogI ko anna kI abhilASA nahIM hotI / use peTa bharA sA jAna par3atA hai | DalhaNa ne jo kaphajvara ke rUpoM kA varNana kiyA hai jise mAdhavakara svayaM bhI grahaNa kara liyA hai usameM aruci ke atirikta eka lakSaNa tRpti diyA hai | annAbhipakA kAraNa gaurava jo kaphAtireka ke kAraNa huA hai vaha hone ke kAraNa rogI khAne kI ora se tRpta dikhalAI detA hai mAno use bhojana kI icchA kabhI hotI hI nhiiN| bhojana se dveSa use nahIM hotA na bhojana dekhate hI kai AtI hai aura na anna meM koI durguNa use dikhalAI par3atA hai api tu vaha svayaM tRpta rahatA huA For Private and Personal Use Only

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363 hai aura binA khAye calatA rahatA hai| isI anannAbhilASA aura tRpti ke kAraNa kaphajvarI ko bhUkha Ane meM sabase adhika dera lagA karatI hai| yadi vAtajvarI sAta dina meM bhUkha para AtA hai to pittajvarI 9 dina meM tathA kaphajvarI gyAraveM dina tudhAtura hotA hai| zleSmA kA kArya svayaM sandhi se zleSaNa karanA, snehana karanA, ropaNa karanA, pUraNa karanA tathA balavarddhana karanA hai| kapha kI vRddhi hone para zaithilya, zaitya, sthairya, gaurava, avasAda, tandrA aura sandhyasthivizleSa kI jo kathA AcAryoM ne gAI hai usameM tandrA aura nidrA bhUkhe peTa utanI nahIM AtI jitanI bharapeTa bhojana kara tRpta hue vyakti ko AtI hai| ____ zleSmA kI vRddhi svayaM agnisAdajanaka' hotI hai aura prasekakAriNI hotI hai| jvara ke kAraNa bhI agnimAndya banA karatA hai ataH AmAzaya meM agni kI kamI rahatI hai sAtha hI praseka ke kAraNa kledaka kapha AmAzaya meM paryApta mAtrA meM pahu~ca jAtA hai isake kAraNa agnimAndya itanA adhika ho jAtA hai ki AhArapAcanAsAmarthya ho jAtI hai jaba cUlhA car3hAnA hI nahIM hai to phira dAla ATe kI mA~ga karane kI kauna AvazyakatA ? ataH anannAbhilASa kaphaprakopajanya jvara kI prAkRtika pariNati hai| suzruta, DalhaNa, ugrAditya aura aMjananidAnakAra jahA~ ise aruci kaha kara santoSa kara lete haiM vahA~ vAgbhaTa ise vizeSAdaruciH kaha kara vizeSa rUpa se aruci hotI hai isa ora hamArA dhyAnakarSaNa karatA hai / zrImAn aruNadatta ne apanI TIkA meM hamAre vicAra ko spaSTa hI kiyA hai-sarvajvare'rucirbhavatyeva, atizayena tu kaphaje / hemAdri ne vizeSAdaruci ko atyaruciH kaha kara kArya pUrNa kiyA hai| medogata jvara, sAmajvara, kaphajvara, saMgajajvara, Amaja vikAra, yakRt ke vikAra aura grahaNI doSa meM aruci kI prabalatA dekhI jAtI hai| hArIta ne rucirviramatA kaha kara apanA bhAva vyakta kiyA hai| praseka aura mukhamAdhurya donoM kA eka dUsare se cacA bhatIje kA sambandha hai| mukhamAdhurya, madhurAsyatA, madhurAnana, madhuratvamAsye yA vAGamAdhurya ke kAraNa prasekotpatti hotI hai| vasavarAja ne vAripUraM salAlam zabda ke dvArA praseka kI hI abhivyakti kI hai| mukhamAdhurya se praseka bar3hatA hai aura praseka se mukha kI madhuratA kI bar3hotarI hotI hai| praseko lAlasrAvaH yaha hemAdri kahatA hai| mukha meM lAra kA bahuta bananA praseka kahalAtA hai lAra binA mukha kI madhuratA ke banatI nhiiN| yahA~ hameM eka bAta spaSTa ho jAtI hai ki mukha madhurarasa se vyApta aura lAlA kA paryApta udreka hone para bhI kaphajvarI ko atyadhika aruci rahatI hai| jisakA artha yaha huA ki lAlA rasa kledaka aura annapAcaka ho sakatA hai agnisaMdhukSaka nhiiN| isI kAraNa jahA~ jahA~ prasekopasthiti gAI gaI hai vahIM vahIM agnisadana bhI upasthita kiyA gayA hai| udAharaNa ke lie kaphaja rAjayakSmA meM praseka hotA hai aura aruci bhI kaphAdarocakacchardiH kAsomUrdhAGgagauravam / prasekaH pInasaH zvAsaH svarasAdo'lpavahnitA // 1. zleSmA'misadanaprasekAlasya gauravam / zvaitya zaityazlathAGgatvaM zvAsakAsAtinidratA // (vAgbhaTa) For Private and Personal Use Only

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364 vikRtivijJAna zleSmolbaNa arza meM hRllAsaprasekakAsazvAsapInasArucicchardiH / vAtajvara meM prasekArocakAzraddhAvipAkAsvedajAgarAH // hama spaSTatayA apanI vastu kI yathArthatA pAte bhI haiN| mukha kI madhuratA kyoM hotI hai ? isako samajhane se pUrva yadi hama thor3A madhura rasa ke lakSaNoM aura guNoM kI ora dRSTipAta kara leM to bahuta lAbhaprada hogaa| (1) tatra yaH paritoSamutpAdayati prahlAdayati tarpayati jIvayati mukhopalepaM janayati zleSmANaM cAbhivarddhayati sa mdhurH| (2) tatra madhuro raso rasaraktamAMsamedo'sthimajjaujazukrastanyavardhanazcakSuSyaHkezyo vo balakRtsandhAnaH zoNitarasaprasAdano bAlavRddhakSatakSINahitaH..."tRSNAmUrchAdAhaprazamanaH ....'kRmikaphakarazceti / (3) sa evaM guNo'pyeka evAtyarthamAsevyamAnaH kaasshvaasaalskvmthuvdnmaadhurysvropghaatkRmiglgnnddaanaapaadyti| uparokta tInoM uddharaNoM se yaha vidita hotA hai ki, (1) madhura rasa kapha kA abhi varddhana karatA hai ki vaha kaphakAraka hai tathA (2) vaha mukha meM madhuratA utpanna karatA hai / sAtha hI zleSmA ke prakupita hone ke lie snigdha guru-madhurapicchila zItAmla lavaNa padArthoM kA sevana karanA paramAvazyaka hai| madhura padArtha kA sevana kapha kI vRddhi karatA hai to kapha kI vRddhi yA kopa ke kAraNoM kI mUla meM hetuoM kI madhuratA bhI sammilita ho jAtI hai| isa dRSTi se mAdhurya aura zleSmA anyonyAzrita se hI dikha par3ate haiN| ataH kaphavRddhi ke kAraNa mukha meM lAlA srAva kA adhika honA svAbhAvika hai / lAlArasa svayaM madhura guNa bhUyiSTha hotA hai ataH mukhamAdhurya kI upasthiti rahanA koI kaThina nhiiN| ataH jvara car3hA rahatA hai, bhUkha lagatI nahIM ataH yaha mukhamAdhurya kisI utsAha aura ullAsa kA pradAtA na banakara eka prakAra kI glAni kA hI janaka hotA hai aura madhura mukha hote hue bhI rogI ko hRllAsa vA vamana AtA rahatA hai| kaphaja jvara ke atirikta aSTAGgasaMgrahakAra ne viSamajvara, kaphaja chardi tathA kaphaja tRSNA meM bhI mukha kI madhuratA ko svIkAra kiyA hai| AcArya yAdavajI ne mAdhavanidAna meM madhurAsthatA ke sthAna para lavaNAsyatA pATha bhI diyA hai| mukha kA namakIna honA kahA~ taka sambhava hai yaha patA nahIM para ho sakatA hai| usake kAraNa praseka aura adhika ho sakatA hai / isakA vizeSa varNana hRllAsa ke sAtha milegaa| hallAsa tathA chardi ye do lakSaNa zleSmA ke prakopa ke kAraNa utpanna jvara meM dekhe jA sakate haiM / kapha ke rogoM ko dUra karane ke lie AcAryoM ne vamana eka mahatvapUrNa upAya batalAyA hai / aSTAGgahRdayakAra ne likhA hai___zleSmajvarapratizyAyagulmAntarvidradhISu ca / pracchardayedvizeSeNa yAvatpittasya darzanam // kaphajvara, pratizyAya, gulma aura antarvidradhi nAmaka rogoM meM vizeSa rUpa se vamana karAveM aura taba taka vamana karAte raheM jaba taka ki vamana meM pitta ke darzana na hone lgeN| For Private and Personal Use Only

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jvara 365 isa kathana se aura kaphajvara meM chardi kA lakSaNa prakaTa tathA dekhane se hameM AdhunikoM ke isa vicAra ko samajhane kA svayaM protsAhana mila jAtA hai ki zarIra svayaM hI eka bahuta bar3A cikitsaka hai| isase eka dUsarA yaha bhI niSkarSa nikalatA hai ki vikAra vizeSa ke varNana ke sAtha-sAtha jo kucha lakSaNa samUha likhe jAte haiM ve sabhI roga ke dUSaNa ke pariNAmasvarUpa nahIM hote api tu unameM se kucha to nizcita rUpa se vikArakArI dUSaNa kA pratirodha karane ke lie svayaM zarIra cikitsaka ke dvArA upasthita kie pratirodhaka lakSaNa haiN| kaphaja jvara meM jo vamana utpanna hotA hai vaha kapha ke prakopa ke kAraNa se hI hone ke kAraNa kaphaja hI hotA hai| kaphaja chardi ke nimna lakSaNoM ke sAtha yadi hama kaphajvara ke lakSaNoM kI tulanA kareM to kitanA sAmya milatA hai tndraasymaadhurykphprseksntossnidraarucigaurvaartH| snigdhaM ghanaM svAdu kaphAdvizuddhaM saromaharSo'lparujaM vamettu // aisA jJAta hotA hai mAno kaphajvara kI vAnti kA hI mUrtarUpa yaha kaphaja vamana ho / para donoM meM thor3A antara hai isameM jvara kA lakSaNa nahIM diyA gyaa| kaphaja chardi ke lie jvara kA honA anivArya nahIM para kaphajajvara meM jo chardi hogI usameM kaphaja chardi ke saba lakSaNa mila sakate haiN| kaphaja chardi pratyeka kaphajajvara meM rahe yaha koI anivArya nhiiN| parantu vamana yA vamana kI choTI bahina matalI jise hRllAsa yA utkleza athavA utkleda saMjJA dI jAtI hai avazya hI kaphajvara meM pAyA jAne vAlA lakSaNa hai| mukha mIThA hai sira bhArI hai hilane Dolane meM darda hotA hai| tRpti banI huI hai kapha kA prakopa ho rahA hai to jI macalAnA nitAnta svAbhAvika ghaTanA hokara rahatI hai| kapha kA eka sthAna zira bhI hai| zira ke andara jaba kapha kA kopa hotA hai to zira bhArI ho jAtA hai aura kaphAdhikya ke kAraNa zirastha kendroM para kucha pIDana bar3hane lagatA hai jisakA pratyakSa pariNAma Arambhika utkleza meM tathA jaba pIDana atyadhika bar3hatA hai to vamana meM hotA hai| kazyapa ne kapha ke sthAna ginAte hue likhA haimedaH zira urogrIvA sandhirbAhuH kaphAzrayaH / hRdayaM tu vizeSeNa zleSmaNaH sthAnamucyate // usake mata se medo dhAtu, zira, uras , grIvA, sandhiyA~ aura bAhu ye kapha ke Azraya haiM tathA hRdaya vizeSa rUpa se kapha kA sthAna kahA jAtA hai / hRdaya ke bhArI hone para yA avasAdita hone para vamana banatI hai| utkleza bhI hRdaya meM becainI kA pramANa hai| isI ko lakSaNa meM lekara gaMgAdhara ne hRllAsa kI vyAkhyA batalAte hue likhA hai hRllAso hRdayastha kaphasyopasthiti vamanamiva hRllAsa vamana ke samAna hRdaya ke kapha kI upasthiti ko prakaTa karatA hai| utkledaH kaNThopasthitavamanatvamiva aisA varNana madhukoza vyAkhyAkAra ne diyA hai| utkleda meM gale taka vamana A gaI aura aba hulakAra Akara rahegI aisI sthiti ho jAtI hai / utklezaH zleSmaniSThIvanam aisA DalhaNa mAnatA hai praseka ko lAlAsrAva mAnatA hai| For Private and Personal Use Only

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366 vikRtivijJAna utkleza huA yAnI rogI ne kapha kA thUkanA Arambha kara diyaa| hRllAsa kA artha hRdayAtsalakNazleSmanirgamaH aisA hemAdri aura toDara donoM karate haiN| hRdaya pradeza se arthAt hRdayasamIpavartI uropradeza se namaka ke svAda se yukta kapha kA nikalanA bhI hRllAsa kahalAtA hai| mAdhavanidAna meM jo eka sthAna para kaphajvara meM lavaNAsyatA kA varNana AtA hai vaha hRllAsa ke isa artha ko lene se ThIka baiTha jAtA hai| vamana Ane ke pUrva yaha kisI ne bhI anubhava kiyA hogA ki mukha pAnI se bhara jAtA hai aura vaha pAnI namakIna hotA hai| ataH sandeha nahIM ki jaba salavaNa hRdaya se zleSmotsarga hogA to mukha kA svAda bhI namakIna banA rahe / kazyapa ne jo kaphaja 20 roga ginAe haiM unameM hRllAsa kA bhI ullekha kiyA huA hai| para Azcarya to yaha hai ki mAdhavanidAna meM varNita kaphaja 20 rogoM meM hRllAsa yA utkleza kA koI jikra nahIM kiyA gyaa| hRdayopalepaH (caraka) athavA hallepaH (vAgbhaTa ) nAmaka eka lakSaNa kaphajvara ke sambandha meM diyA gayA hai / isakA artha antarvakSaHsthazleSmaNAntarvakSasi upalepaH ( gaGgAdhara ) tathA zleSmaliptahRdayatvam ( hemAdri) ne kiyA hai| jinakA tAtparya yaha hai ki chAtI ke andara hRdaya kA jahAM nivAsa hai usa madhya ke bhAga meM kapha cipaTA rahatA hai jisase aisA mAlUma par3atA hai ki mAno svayaM hRdaya hI kapha dvArA lIpa diyA gayA ho| isake kAraNa yaha sthala bhArI ho jAtA hai| kapha kA bojha sIdhA hRdaya para hI rogI anubhava kiyA karatA hai| ____kapha svayaM zItala hai tathA zItala dravyoM ke sevana se zItala vAtAvaraNa meM hI usakA prakopa hotA hai isake kAraNa zaitya yA zItalatA kA anubhava honA yA jAr3A laganA kaphajvara meM bahuta mahatva kA sthAna rakhatA hai| jaba kabhI koI yaha kahe ki ise sardI laga gaI to usakA spaSTa artha hai zaitya kA prAdurbhAva jo kapha ko prakupita karake kaphajvara kI sthiti utpanna kara sakatA hai| ___ stamityam kaphajvara kA vaha lakSaNa hai jise mAdhavanidAnakAra athavA DalhaNa tathA hArIta aura aJjananidAnakAra ne sarvaprathama likhA hai| isI ko caraka ne stimitatvama batalAyA hai| isa stimitatvam kI vyAkhyA karate hue gaMgAdhara batalAtA hai ki jaba yaha lakSaNa prakaTa hotA hai to rogI ko aisA lagatA hai mAno use kisI ne bhIge kapar3e meM lapeTa diyA ho stimitatvamArdravasanAvaguNThitatvamiva manyate gaatrm| parantu DalhaNa ne stamityaM nizcalatvaM jvaritasya aisA artha likhA hai jisakA bhAva hai jvarita kA zAnta aura gatihIna ho jAnA / stimito vegaH kI bhI aisI hI vyAkhyA dete hue DalhaNa kahatA hai ki vego'pi stimitaH satatasthito nizcalaH kaphajvara meM tApAMza eka barAbara rahatA hai aura vaha ghaTatA bar3hatA nahIM nizcala ho jAtA hai / kucha For Private and Personal Use Only

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jvara 367 loga stimito vegaH ko jvara kA manda udgama mAnate haiM aisA bhI ullekha DalhaNa ke nibandha meM hai| madhukozakAra bhI staimityamaGgAnAmAIpaTAvaguNThitatvam hI mAnate haiN| zarIra meM jalIyAMza kI vRddhi yA tarala bhAga kA bAhara kI ora gati karanA yaha kapha kI kupitatA kA pramANa mAnA jAtA hai / kapha ke kopa meM jahA~ zleSmalakalA meM upasthita pranthiyA~ tathA lAlagranthiyA~ apane apane srAvoM ko pracuratA ke sAtha bAhara nikAla kara prasekotpatti karatI haiM vahA~ svedagranthiyA~ bhI zAnta nahIM baiThatIM unase bhI prasveda nikalatA hai yaha sveda snigdhatA lie hue hotA hai| kapha ke snigdha guNa ke kAraNa isI sveda se snigdhagAtratA A jAtI hai jise hArIta aura vasavarAja donoM ne svIkAra kiyA hai| rogI svayaM yaha anubhava karatA hai ki usakA zarIra svayaM gIle kapar3e se DhaMkA huA hai usameM ArdratA hai to kyA vAstava meM yaha AbhAsamAtra hI hotA hai yA gIlApana milatA bhI hai / inphlueMjA, he phIvara athavA pratizyAya se pIDita vyaktiyoM se pUchane se patA calegA ki gIle kapar3e se DhaMkA sA zarIra ho gayA hai arthAt unheM rUkSatA ke sthAna para zItalatA aura snigdhatA kA anubhava hone lagA hai| vAstava meM gIlApana bahuta kama milatA hai| hA~, jahA~ svedAgama hotA rahatA hai vahA~ yaha gIlApana pAyA jAtA hai| svedAgama bhI paryApta kSetroM meM pAyA jAtA hai| kaphajvarI ko sveda AtA hai aura zarIra ko bhigo detA hai yaha kucha kA kathana hai aura kucha aisA mAnate haiM ki yaha sveda nirantara thor3A thor3A bahatA rahatA hai aura zarIra ko AI rakhatA hai| sveda nikale yA na nikale para itanA avazya satya hai ki camar3e aura zleSmalakalA ke bhItara kapha kA pUrA pUrA kopa hai jisake kAraNa camar3I aura zleSmalakalA meM taralAMza nirantara banatA aura bar3hatA rahatA hai| isI taralAMza kI pracuratA ke kAraNa kaphajvara meM jvara kA vega kama pAyA jAtA hai aura use jora se bukhAra na Akara manda prakAra kA hI jvara banA huA rahA karatA hai| __DAkTara ghANekara mahodaya ne nidrA ke sambandha meM nimna vicAra eka sthala para prakaTa kie haiM:___'vAta aura pitta kI vRddhi meM nidrA kA nAza hotA hai kyoMki vAtAdhikya se manobhramaNa adhika hotA hai aura pittAdhikya se dimAga meM jalana mAlUma hotI hai| nidrA zleSmatamobhavA hai / isalie zleSmA kI vRddhi meM nidrA adhika huA karatI hai| aura zleSmaviruddha pitta aura vAta kI vRddhi meM ghaTa jAtI hai:___ 'tamobhavA shlessmsmudbhvaac| nidrA shlessmtmomvaa| ileSmAvRteSu srotassu zramAduparateSu ca indriyeSu svakarmebhyo nidrA nizati dehinam ( aSTAGgasaMgraha ) / ' nidrA kI utpatti kapha aura tamoguNa se prAyaH hotI hai| kaphajvara meM kapha kI kupitatA sarvaprathama Avazyaka hai, isa kAraNa kaphanvara meM nidrA kA honA pUrNataH svAbhAvika hai / isI kAraNa kaphajvara ke lakSaNoM kA varNana karate hue caraka ne nidrAdhi For Private and Personal Use Only

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368 vikRtivijJAna kyam , suzruta ne atinidratA, DalhaNa dvArA uddhata kaphajvara ke lakSaNoM meM atinidratA ugrAditya ne nidrAlutA aura vaidyavinodakAra ne nidrAti zabdoM kA vyavahAra karake nidrA kI upasthiti ko asandigdha rUpa meM svIkAra kiyA hai|| vAgbhaTa ne yahA~ nidrAdhikya kA koI vivaraNa nahIM diyA para zleSmala vRddhi ke prakaraNa meM kapha ke bar3hane para hone vAle lakSaNasamUha kA nAmollekha karate hue usane atinidratA ko nahIM chor3A_zleSmA'gnisadanaprasekAlasyagauravam / zvaityazaityazlathAGgatvaM shvaaskaasaatinidrtaaH| jaba aGgoM kA zaithilya, gaurava aura Alasya ye tIna lakSaNa use svIkAra haiM to inake kAraNa utpanna huI nidrA ko vaha asvIkAra nahIM kara sktaa| sampUrNa aSTAGgahRdaya ko par3hane para kaphajvarI nidrAlu nahIM hotA aisA bhAva na vAgbhaTa ko hI pratIta hotA hai na pAThaka ko prakaTa hotA hai na vaisA use bhrama hI ho sakatA hai| dUsarI zaMkA yaha hotI hai ki aSTAMgasaMgrahakAra ne nimna sthAnoM para nidrA kA honA mAnA hai 1. kaphaja hRdroga, 2. kaphaja tRSNA, 3. kaphaja madAtyaya, 4. kaphaja gulma, 5. kaphodara, 6. kaphaja atIsAra, 7. kaphaja zopha, 8. agnivisarpa, 9. kardamavisarpa, 10. dhvaMsakamadAtyaya, 11. viSaja mada / jaba vaha ukta gyAraha sthaloM para nidrA kA spaSTa ullekha karane meM pUrNa samartha hai to phira usane kaphajvara meM nidrA kA bakhAna kyoM nahIM kiyA ? isase koI yaha samajhe ki vaha nidrA kA ullekha karanA bhUla gayA yaha nitAnta asambhava hai| . taba phira hameM aGgeSu zItapiTikAstandrodardaH kaphodbhave ko dhyAnapUrvaka dekha kara apanA matalaba nikAlanA hogaa| tandrA yaha lakSaNa vAgbhaToM ko mAnya hai / aruNadatta ne apanI sarvAGgasundarI vyAkhyA meM nidrArtasyeva viSayAgrahaNaM tandrA aisA artha lagAyA hai ki nidrA se pIDita vyakti kA indriyoM ke viSayoM meM asamartha hone kI avasthA tandrA kahalAtI hai| jaba vyakti pUrNataH so jAtA hai taba use indriya viSaya grahaNa karanA asambhava hI hotA hai| para jaba vaha nidrAlu hotA hai taba vaha viSayoM ke grahaNa karane meM thor3A satarka aura thor3A asatarka yA AlasI bana jAtA hai| kahAnI kahate samaya jaba koI hA~ hA~ kahate samaya sone lagatA hai aura bIca-bIca meM kabhIkabhI phira hA~ hA~ kara detA hai to yaha samaya tandrA kA mAnA jAtA hai| astu vAgbhaToM ko nidrA mAnya na hokara tandrA mAnya hai / tandrA kA varNana suzruta ne nimna diyA haiindriyArtheSvasamprAptirgauravaM jambhaNaH klmH| nidrArtasyeva yasyehA tasya tandrAM vinirdizet // DA. ghANekara ne nidrA aura tandrA kA bheda yaha batalAyA hai ki nidrA se prabodhita hone ke pazcAt manuSya utsAhayukta hotA hai aura tandrA se prabodhita hone para vaha utsAharahita hotA hai| yaha avazya yukta hai| nidrAlu vyakti tandrA kI avasthA meM hai| yadi use jagA diyA jAve aura kAma liyA jAve to vaha kArya ko utane utsAha se For Private and Personal Use Only

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jvara nahIM kara paataa| parIkSA kAla meM vidyArthI jaba bahuta sabere nIMda chor3a kara uThate haiM to vaha utsAha nahIM hotA jo prAkRtika nidrA lene ke uparAnta AyA karatA hai| api tu bhayavaza adhyayana nimagna ve ho jAte haiN| isI bhaya ke kAraNa ve rAtribhara svapna dekhA karate haiN| nidrAlutA yA tandrA ke uparAnta nidrA kA sukhapUrvaka upayoga paramAvazyaka hai aura jaba yaha sambhava nahIM to indriyArthoM meM asamprApti rahe vinA mAnegI nhiiN| tandrA meM nidrAtasyeva arthAt nidrA se pIDita ke samAna ceSTAe~ huA karatI haiN| kaphajvara jisameM nidrA aura tandrA donoM kA rAjya ho vahA~ utsAha nAmaka jantu apane darzana dene meM asamartha rahatA hai| vahA~ Alasya nAmaka jIva hI vyApta huA rahatA hai| gAtragurutA ke sAtha sAtha hamane Alasya kA vicAra diyA hai| suzruta zArIra kA samarthasyApyanutsAhaH karmasvAlasyamucyate ko bhI bhUlanA nahIM cAhie ki kArya karane meM samartha hote hue bhI kArya karane meM anutsAha Alasya kahalAtA hai| haTTe kaTTe moTe tAje bhikhamaGge bhArata meM isa Alasya kI yathArtha mUrti haiM jo samartha hote hue bhI karma karake jIvikopArjana se dUra raha kara Alasya meM jIvana vyatIta karate haiN| stambhaH kaphajvara kA eka aisA lakSaNa hai jise caraka, vAgbhaTa aura DalhaNa dvArA vyakta kiyA gayA hai| gaGgAdhara kavirAja ne stambhaH zarIrasya purISasya ca ke dvArA zarIra kA stambhita rahanA tathA mala kA stabdha raha jAnA ye donoM mAne haiN| madhukozakAra ne aGgastabdhatA mAtra ko stambha mAnA hai| kaphajvara ke atirikta vAtakuNDalikA, kaphavidhi, kardamavisarpa, sarvAGgAzraya vAtavyAdhi', vAtAdhika vAtarakta Adi meM bhI stambha kA lakSaNa kahA gayA hai| antarAyAma meM netroM meM stabdhatA ho jAtI hai| urustambha meM UruoM meM stambha pAyA jAtA hai vAtaja gRdhrasI meM sphik-kaTi pRSTha-UrujAnu-jacA aura pairoM taka stambha pAyA jAtA hai / __zleSmA ke sAmya lakSaNoM meM eka hai sthiratva aura dUsarA sandhi bandhana hai / jaba zleSmA kA prakopa hotA hai to yaha sthiratA aura adhika bar3ha jAtI hai aura sandhiyoM taka vyApta ho jAtI hai jisake kAraNa paira kA uThAnA yA hAtha kA calAnA kaThina ho jAtA hai / sthiratA ke kAraNa saba aMga baMdha jAte haiN| eka to rogI jvara se pIDita hai dUsare nidvAlu hai tIsare usameM aGga pratyaMgoM meM sthiratA bar3ha rahI hai| isa kAraNa sampUrNa gAtra zlatha ho jAtA hai usI ko stabdhatA zabda se vyakta kiyA gayA hai| gaMgAdhara ne AGgika stabdhatA ke sAtha mala kI stabdhatA kI ora bhI saGketa kiyA hai| parantu hArIta dvArA likhita viSTabdhaM malavRtti ke atirikta kisI bhI AcArya ne mala ke stambha kI ora koI vizeSa saGketa nahIM kiyA hai| yaha satya hai ki kapha soma kA pratIka aura pitta Adhikya kA pratIka hone ke kAraNa eka zIta aura dUsarA uSNa hai| isake kAraNa donoM parasparavirodhI kriyAe~ sampAdita karate haiN| pitta ko hama pahale likha cuke haiM ki vaha atIsArakAraka hai ataH usakA virodha malastambhakArI hogA isa 1. sarvAGgasaMzrayastodabhedasphuraNa bhaJjanam / stambhanAkSepaNasvApasandhyAkuJcanakampanam // For Private and Personal Use Only

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400 vikRtivijJAna prakAra kI kalpanA kI satyatA para viSTambha yaha guNa kaphajvara meM likha sakate haiM para usameM adhika sAra nahIM hai kyoMki vAyu kA rUkSa guNa nissandeha mala kI zuSkatA aura stambhatA kA kAraNa banatA hai para kapha to snigdhaguNa bhUyiSTha hai isameM mala kA pUrNataH stambhana ho hI nahIM sktaa| mala meM kapha ke dvArA pradatta kledaka aMza yA jalIyAMza hI use saralatApUrvaka niHsRta karane kI kSamatA pradAna karatA hai| anya bhI kisI AcArya yA TIkAkAra ne malastabdhatA ko kaphajvara meM mAnane kA protsAhana nahIM diyaa| gaMgAdhara ne zarIra kI aicchika peziyoM kI zlathatA ko dekhakara hI mala ko khader3ane vAlI peziyoM ke stambha kI kalpanA kara lI hai| zarIra kA sampUrNa bAhya vyApAra kaphajvara meM mamda par3a jAtA hai para Antarika vyApAra calatA hai nirantara calatA hai koI bhI mahAsrotIya granthi aisI nahIM bacatI jo kucha srAva na karatI ho| mahAsrota meM strAvoM kA utkarSa zithila par3I huI A~toM para bhI bala DAlatA hai ki ve mala ko bAhara khader3a deN| yahA~ taka to mAnA jA sakatA hai ki kaphajvara ke Arambhika kucha samaya taka A~toM kI zithilatA malastambhakAriNI ho| yaha sabhI jAnate haiM ki zItala padArthoM ke prayoga se kapha vRddhi hotI hai, yahI zItalatA vAyu ko bhI bar3hAvA diyA karatI hai / ataH kucha vRddhi ke sAtha-sAtha yA vAyu kA bhI anubandha hogA to koI kAraNa nahIM ki mala meM zuSkatA A jaave| malakriyA meM stabdhatA taba bhI nahIM A sakatI kyoMki vAyu svayaM saJcaraNa zIla aura kapha ko bhI gati dene vAlA prasiddha hai| ataH hamAre vicAra se stambha se hameM madhukozakAra dvArA vyakta agastabdhatA ko hI mAnyatA denI cAhie na ki stambhaHpurISasya ko| aba hama kaphajvara ke una tIna pramukha lakSaNoM kA varNana karate haiM jinake dvArA koI sAdhAraNa bhAratIya yaha kaha detA hai ki rogI kaphajvara se pIDita hai| ye tIna lakSaNa haiM kAsa, zvAsa aura pratizyAya | kaphajvara ke Arambha hote hI jukAma banatA hai khA~sI AtI hai aura usake bAda sAMsa phUla jAtI hai| kAsa aura pratizyAya ye donoM eka sAtha Ate haiN| zvAsa kA vega kabhI-kabhI hI AtA hai isI kAraNa zvAsa ke lakSaNa ko suzruta, DalhaNa, hArIta, ugrAditya athavA aJjananidAnakAra ne likhA hI nahIM hai| vAstava meM to yadi kAsa aura pratizyAya se yukta kaphajvara kI yogya cikitsA kI jAve to zvAsa bar3hatI hI nahIM isI kAraNa ina AcAryoM ko vaise rugNa dekhane kA avasara nahIM milA para jina AcAryoM ne sarvAGgINa satya kA darzana kiyA hai unhoMne isa zvAsa ke mahattva ko bhI samajhA hai| Aja ke yuga meM rogI ko jahA~ sardI ( cold ) lagI ki khA~sI ( bronchitis ) banI aura kucha hI kAla meM zvAsa ( Pneumonia) bana gayA yaha pratidina cikitsaka ke sAmane se bItatA hai| yaha saba kaphajvara kA hI vyakta svarUpa hai jise logoM ne bhramavaza samajhane meM bhUla kI hai| __ kAsaH sazleSmA gaMgAdhara kavirAja ne spaSTa kiyA hai ki kAsa kaphajvara meM kapha se yukta pAI jAtI hai khA~sI meM kapha bahuta jhar3atA hai| yaha kapha gAdA (sAndra kapha) hotA hai For Private and Personal Use Only

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401 jvara pralipyamAnena mukhena sIdan zirorujArtaH kaphapUrNa dehaH / abhaktaruggauravakaNDuyuktaH kAsedbhRzaM sAndrakaphaH kaphena // vaidyavinodakAra ko chor3a kara zeSa sabhI AcAryoM ne kAsa kA varNana kiyA hai / isakA kAsa anivAryataH rahane vAlA lakSaNa hai / zItakAla yA garmI AtI hai aise samaya jo bahudhA gAr3he kapha se yukta aura sAtha meM manda manda jvara banA rahatA hai vaha saba artha yaha huA ki kaphajvara meM vasanta Rtu meM yA jaba sardI khA~sI hotI huI dekhI jAtI hai kaphajvara ke hI kAraNa hotA hai / se pratizyAyo nAsAsrAvaH pratizyAya kA artha nAsikA ke dvArA siGghANaka kA adhika mAtrA meM nikalanA hotA hai / suzruta ne pratizyAya kA kAraNa sira meM mArutAdi doSoM ke saJcaya ko batalAyA hai / pratizyAya ke Arambha meM chIMka AnA, sira kA bharA huA yA bhArI honA, stambha, aGgamarda aura romaharSAdi lakSaNa hote haiM / kaphajvara meM kaphaja pratizyAya huA karatA hai aura ghrANAt kaphaH kaphakRte zItaH pANDuH sravedvahuH ke anusAra nAka se ThaNDA, pANDura aura adhika mAtrA meM kapha nikalatA rahatA hai / pratizyAya yA pInasa kaphajvara ke atirikta nimna likhita vyAdhiyoM meM aura bhI dekhA jAtA hai-- 1. vAtazlaiSmika jvara, 2. kaphaja kAsa, 3. kSayajakAsa, 4. tamaka aura pratamaka zvAsa, 5. rAjayakSmA, 6. kaphajayacamA, 7. kaphaja arza, 8. udAvarta, 9. nAsArza, 10. kaphajagrahaNI, 11. kaphajagulma, 12. kaphajakRmiroga, 13. prANavAyukoSa, 14. udAna vAyukopa / pratizyAya aura kAsa ye donoM eka ke bAda dUsarA hotA hai / carakokta nimna vicAra jise hama pahale bhI vyakta kara cuke haiM punaH isalie dete haiM ki ina donoM ke dvArA hone vAle bhayaGkara pariNAmoM kI ora koI bhI vikRtivizArada upekSA kI dRSTi se na dekhe - divAsvApAdidoSaizca pratizyAyazca jAyate / pratizyAyAdatho kAsaH kAsAt saMjAyate kSayaH // kSaya rogasya hetutve zoSasyApyupajAyate / For Private and Personal Use Only divAsvapnAdi kaphakopaka kAraNoM se pahale kaphajvara banatA hai jisake sAtha pratizyAya rahatA hai | yadi yaha jvara aura pInasa kucha kAla taka aura ruka jAve to kAsa bana jAtI hai | kAsa ke sAtha jvara kA anubandha barAbara rahatA hai / yadi sajvara kAsa kI ora. . upekSA baratI gaI to yakSmA yA dhAtukSaya ho jAtA hai usake Age dhAtuzoSa yA zoSa bana jAtA hai / kaphajvara, pratizyAya, kAsa, kSaya, zoSa yaha eka aisI zrRMkhalA hai ki yadi jur3a gaI to prANa lekara hI TUTatI hai / ugrAditya ke mata meM pInasa bahuta adhika kaphajvara meM pAI jAtI hai / zvAsa se zvasanakriyAbhirvRddhiH lenA sarvathA ucita hai | kAsavRddhayA bhavecchavAsaH bhI koparAnta vAsotpatti kI upapatti ko sArthaka karatA hai / hama to zvAsa ke isa lakSaNa ke sAtha ise zvasanaka kI saMjJA dete haiM / zvasanaka arthAt nyUmoniyA~ jitane mAraka hotA hai utane hI mAraka zvAsa aura hikkA roga haiM-

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402 vikRtivijJAna sarve'pi roganAzAya na tvevaM zIghrakAriNaH / himAzvAsau yathA tau hi mRtyukAle kRtAlayau // zIghrakArI hone ke kAraNa zvAsa mRtyu kA kAraNa bana sakatA hai ataH kaphajvarIya zvAsa kI ora atyanta satarkatApUrvaka vicAra karate hue turata ucita pratIkAra kI vyavasthA honI paramAvazyaka hai| zvAsa kA jo upadrava kaphajvara ke sAtha-sAtha dekhA jAtA hai vaha anya upadravoM kI upasthiti meM ThIka vaisA hI milatA hai jaisA sAdhAraNatayA hama rakta meM upasipriya kaNoM kI vRddhi hone ke samaya ( eosinophilia ) dekhate haiN| yaha zvAsa tamaka zvAsa se halkI aura kSudra zvAsa se kucha adhika hotI hai| vaise vAtAdhiko bhavet kSudrastamakastu kaphodbhavaH ke anusAra kaphajajvara meM tamaka zvAsa pAI jA sakatI hai / kapha ke kAraNa hI tamaka zvAsotpatti mAnI gaI hai pratilomaM yadA vAyuH srotAMsi pratipadyate / grIvAM zirazca saMgRhya zleSmANaM samudIrya ca / / karoti pInasaM tena ruddho ghughurakaM tathA / atIva tIvravegaM ca zvAsaM prANaprapIDakam // Adi / zaitya tathA zvaitya ye do lakSaNa kapha ke kAraNa hote haiM aura una sabhI sthaloM para milate haiM jahA~ kapha kI vyApti atyadhika rahatI hai| kapha ke prAkRta lakSaNoM meM zItatva aura zvetatva donoM hI kahe gaye haiM zvetatvazItatvagurutvakaNDU snehopadehastimitatvalepAn / ' utsedhasaMkledacirakriyAJca kaphasya karmANi vadanti tajjJAH / / ( yogaratnAkara ) - jo bIsa zleSmavikAra zAstrakAroM ne ginAe haiM inameM caraka aura kazyapa donoM hI inakI upasthiti svIkAra karate haiM (1) zvetAvabhAsatAGgAnAM tathA mUtrapurISayoH // ( kazyapa) (2) zvetAvalokanaM zvetaviTakatvaM zvetamUtratA / zvetAGgavarNatA shaitym"| (mAdhavanidAna) (3) zItAgnitAzca, udardazca, zvetAvabhAsatA ca, zvetamUtranetravarcatvaJcetiviMzatiH shlessmvikaaraaH| (caraka) ataH yaha siddha ho gayA ki zaitya aura zvaitya ye donoM hI lakSaNa kaphaja haiM aura kaphajajvara meM inakA AcAryoM dvArA ullekha pUrNataH vaijJAnika tathA tathyAvalambita hai| caraka ne nakhazvaitya, nayanazvaitya, vadanazvaitya, mUtrazvaitya, purISazvaitya aura tvacAzcaitya ye cha lakSaNa diye haiN| suzruta ne akSaNozca zuklatA mAtra likhakara chor3a diyA hai| DalhaNokta kaphajvara ke lakSaNoM meM zuklamUtrapurISatvam aura akSaNozca zuklatA Aye haiM / vAgbhaTa ne zvaityaM tvagAdiSu likhakara chor3a diyA hai| svagAdi meM nakhanayanavadanamUtrapurISatvacA sabhI kA samAveza hotA hai| hArIta ne netre ca pANDucchavI ugrAditya ne dhavalAkSimalAnanatvam, vasavarAja ne gauravarNaH aJjananidAna meM zauklyam aura vaidyavinodakAra ne mUtranakhAdizauklyam aisA lakSaNa diyA hai| ___ yaha zuklatA AtI kahA~ se hai| isa prazna ko sarala sAdhAraNarUpa se yoM siddha kiyA jAtA hai ki rakta meM upasipriyakaNa bar3hate haiM, pitta ke svarUpa lAla kaNoM kI kamI hotI hai, yakRt kI kriyAzakti meM uttara AjAne ke kAraNa rogI kI svasthAvasthA kI For Private and Personal Use Only

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jvara sursI gAloM se haTa jAtI hai aura ve zveta ho jAte haiN| A~khoM kI kalA kI sursI haTane se hArIta kA netre ca pADucchavI yAdhavalAkSitvam meM se eka avazya hI ho jAtA hai rakta kI kamI se nAkhUna sapheda par3a jAte haiN| kaphajavikAra meM rakta kI kamI ke kAraNa koI bhI bhAga zleSmala yA carmala kalA meM zveta ho sakatA hai| mala kI zvetatA kA mukhya kAraNa mahAsrota meM pittotsarga kA niyamita ho jAnA hotA hai| isake kAraNa annapAcana meM zleSmAvirodhI pitta kI alpatA ke kAraNa mala kA varNa harA pIlA yA jo svAbhAvika hotA hai vaha na hokara sapheda raMga kA mala Ane lagatA hai| mUtra meM bhI saphedI AtI hai / mUtra meM oja ( elbumIna) nikala sakatA hai yA bhAsvarIya (phAspheTsa) Asakate haiN| oja ke guNoM ko yadi hama zleSmA ke guNoM ke sAtha milAna kareM to dekheMge ki oja zleSmA kA hI eka puSTa yA sAra rUpa haiojaH somAtmakaM snigdhaM zuklaM zItaM sthiraM saram / viviktaM mRdu mRtsnaM ca praannaaytnmuttmm||(sushrut) kazyapa ne isakI vRddhi ke lie unhIM padArthoM ko svIkAra kiyA hai jo zleSmAvardhaka haimadhurasnigdhazItAni laghUni ca hitAni c| ojaso vrdhnaanyaahustsmaadvaalaaNstthaa''shyet|| (kazyapa) ____ ataH ojaH svayaM zleSmA na hote hue eka dUsare se sambaddha avazya hai| donoM somAtmaka, snigdha, zItala, zukla aura sthira svarUpa ke padArtha haiN| oja bhI balavarddhaka hai aura zleSmA bhI bala ko bar3hAtA hai ataH zleSmA kI vRddhi ke sAtha-sAtha yadi oja bhI kupita hokara zarIrapoSaNa kriyA na kara mUtramArga se baha nikale to koI sandeha nahIM honA caahie| ataH kaphajvara meM bAlakoM yA bar3oM meM kabhI-kabhI zuklameha yA zuklamUtratA yA elbuminUriyA mila sakatI hai| ___ kaphajvarI kI A~kheM sapheda ho jAtI haiM, yaha eka aisA tathya hai jise ugrAditya ne dhavalAkSitA, DalhaNa aura suzruta ne akSNozca zuklatA aura caraka ne atyartha nayanazvaityama karake svIkAra kiyA hai| kevala hArIta ne ise na mAna kara netre ca pANDucchavI aisA likhA hai / paittika ugratA pItAkSitA jaba mila sakatI hai to zleSmavikAra meM dhavalAkSitA bhI pAI jAsakatI hai| sAdhAraNatathA kRSNapaTala ko chor3akara netroM kA paTala zukla varNa kA hI hotA hai| para yadi gaura se dekhA jAya to yaha zuklatA kabhI ghaTatI aura kabhI bar3hA karatI hai| kabhI usameM aruNatA aura kabhI pItatA AjAtI hai| kabhI ve harI bhI ho jAtI haiN| jo netravizArada unake varNa ko zuklapaTala meM dhyAna se par3hatA hai vaha zuklatA meM vRddhi yA ghaTotarI ko spaSTataH batalA sakatA hai| kaphajvara ke Arambha hote hI yaha lakSaNa mila sakatA hai aura kAlAntara meM 2-4-5-7 dina vyatIta hone para bhI dekhA jA sakatA hai| vAtaja arza meM netra kA zukla paTala kRSNavarNa kA, pittajamUrchA meM pItavarNa kA, majAgata yA asthigata kuSTha yA pittajamUrchA hI meM tathA sannipAtajvara meM lAlavarNa kA, kRmija hRdroga tathA kRmija chardi meM zyAvatA lie hue kAmalA meM hare varNa kA mila sakatA hai / ina saba pahacAnoM ke lie thor3e anubhava kI AvazyakatA hai / kaphaja pANDu For Private and Personal Use Only

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404 vikRtivijJAna roga meM bhI netroM kA varNa zveta milatA hai-kaphaja pANDu meM kaphAcchuklasirAditA para indu likhatA hai Adi grahaNena nakhaviNmUtranetrANAm / __mukha kI surthI ghaTa jAtI hai aura vaha zveta varNa kA ho jAtA hai| tvacA kI surthI bhI ghaTa jAtI hai aura vaha bhI saphedI lie hue dikhalAI detA hai| isakA kyA kAraNa hai ? kAraNa spaSTa hai ki parisarIya vibhAga meM ( tvacA meM ) rakta kI kezAloM meM se rakta bhItara kI ora calA jAtA hai aura zleSmala kalA kI granthiyoM meM pracuratA ke sAtha nAvotpatti meM laga jAtA hai| rakta kI kezAloM meM rakta kI kamI hone se tvacA para saphedI A jAtI hai tathA bAhya bhAgoM meM rakta kI kamI hone kA pratyakSa pariNAma zaitya meM hotA hai aura zaitya kaphajvara kA eka pradhAna lakSaNa kahA hI jAtA hai| ataH jahA~ tvacA zvaitya vahIM tvacA zaitya bhI isa kAraNa bAhara se kaphajvara bahuta hI manda svarUpa kA prakaTa hotA hai / yahI nahIM tvacA para hAtha rakhane se kabhI to yaha dhokhA bhI ho jAtA hai ki vyakti ko jvara hai bhI yA nhiiN| kaphajvara meM zaitya aura zvaitya kI yaha mahimA hai| mUtra meM zvaitya ke nikalane se bala meM kamI hokara zlathagAtratA bhI usI kA eka pariNAma hai| ___ aba hama aGgeSu zItapiTikAH kI ora dRSTipAta karate haiN| isa para gaGgAdhara kA zItamArutAdi sambhavakoThavacchophA udarda ityAkhyAH bhRzamatyarthamuttiSThantyaGgebhya iti bhASya hai ki zItavAyu dvArA utpanna koTha ke samAna zopha utpanna ho jAte haiM jinako udarda kahA jAtA hai ye anekoM udarda camaDI meM uThate haiM udarda kA lakSaNa dete hue aruNadatta likhate haiM___ zItapAnIyasaMsparzAcchItakAle vizeSataH / zvayathuH zizirArtAnAmudardaH kaphasambhavaH / jAr3oM meM zItala jala ke vizeSa kara sparza karane ke kAraNa zIta se pIDita ko jo kaphajanita zotha utpanna ho jAtA hai vaha udarda kahalAtA hai| mAdhavakara ne udarda kA varNana karate hue likhA hai kisotsajhaizca sarAgaizca kaNDUmadbhizva maNDalaiH / zaiziraH kaphajo vyAvirudarda iti kIrtitaH // uThe hue, lAlavarNa ke, khujalI se yukta jo jAr3e kI Rtu meM cakatte uThate haiM ve udarda kahalAte haiN| vAgbhaTa ne zItapiTikA aura udarda ye do pRthak-pRthak mAne haiN| zIta ke kAraNa utpanna piTikAoM aura udarda meM koI vizeSa antara caraka ne nahIM mAnA hai| hemAdri ne udarda ko 'urobhispandanam' kahA hai / candra aura toDara ne use zItavepathu mAnA hai| ina sabakA artha hai ki udarda eka prakAra kI jAr3e se kA~pane kI avasthA kA nAma hai| ___ kaphajvara ke kAraNa zIta piTikAoM kA udgama honA pUrNataH svAbhAvika ghaTanA hai / para yaha ghaTanA pratyeka rogI meM sarvadA ghaTe yaha Avazyaka nahIM / Adhunika dRSTi se vicAra karane para zarIra ke rakta meM jaba uSasipriya zvetakaNoM kI vRddhi hotI hai taba usake kaI prakAra ke rUpa prakaTa hote haiM kisI meM vaha zvAsa kA rUpa (tropicaleosinophilia) For Private and Personal Use Only

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jvara 405 dhAraNa karatI hai| kisI meM khujalI yukta cakattoM ( urticaria) kA rUpa dhAraNa karatI hai aura kisI meM carmadala ( eczema ) hI bana kara raha jAtI hai / hama AyurvedIya bhASA meM isa sthiti ko kapharaktAvasthA (elargI alergy) arthAt rakta meM kaphAdhikya mAnate haiM / ataH kaNDrayukta cakatte jinake sAtha-sAtha jAr3A yA kampana bhI ho prAyaH dekhe jA sakate haiN| para pratyeka kaphajvara meM ve nahIM milte| Adhunika dRSTi meM kaphajvara eka bahuta vyApaka viSaya hai jisake antargata anekoM lakSaNoM kA samAveza kiyA jA sakatA hai jinameM kucha eka dUsare ke Azrita haiM aura kucha pUrNataH svatantra bhI haiN| zItapiTikA yA udardotpatti zaitya ke Azrita vyAdhi hai| para zaitya eka svatantra roga hai jo kaphajvara meM vibhinna rUpoM meM pragaTa hotA hai| suzruta, DalhaNa, hArIta, ugrAditya AdiyoM ne zIta piTikAoM kA koI varNana kiyA nhiiN| kaphajvara ke sambandha meM kucha lakSaNa aise haiM jinheM eka AcArya svIkAra karate hai para anya usake sambandha meM mauna haiM / isameM eka uSNAbhiprAyatA hai| ise caraka mAnatA hai / para isake sambandha meM svayaM carakamatAnuyAyI aSTAGgasaMgrahakAra mauna hai| usane kaphA vRta vAyu meM__ zaityagauravazUlAni kaTavAyupazayo'dhikam / laGghanAyAsarUkSoSNakAmatA ca kaphAvRte // uSNakAmatA ko mAnA hai para kaphajvara meM use nahIM likhA / para likhe yA nahIM, zaitya se kaSTa pAyA huA vyakti uSNa padArthoM kI sarvadA cAha kiyA hI karatA hai usameM adhika zAstra carcA ko sthAna bhI nahIM ho sktaa| kaphajvara meM romaharSa yA romodgama nAmaka lakSaNa na caraka ne likhA na vAgbhaTa ne para kyA vaha nahIM hotA? kaphajvara ke zIta se vyathita rogI ke roMgaTe avazya khar3e hote haiM isa sarva sAdhAraNa satya ko koI dhokhe se ojhala kare yA na kare para vaha hai avshy| kaphajvara meM vedanA utanI nahIM hotI jitanI ki vAtajvara meM pittajvara se bhI kama vedanA hone ke kAraNa ugrAditya tathA suzruta ne rugalpatvam aisA lakSaNa de diyA hai / para rujA kI alpatA kI ora kisI ne vizeSa dhyAna nahIM diyaa| suzruta aura ugrAditya tathA vaidyavinodakAra ne atyaGgasAdana yA aGgasAda kA ullekha avazya kiyA hai| isakA abhiprAya yaha hai ki kaphajvarI meM sArvadaihika avasAda pAyA jAtA hai| ise jAnate hue bhI kaI AcAryoM ne vyakta karanA Avazyaka nahIM maanaa| suzruta aura ugrAditya donoM ne avipAka kI ora bhI dRSTikSepa kiyA hai ki zleSmajvara meM jATharAgni ke bahuta naSTa ho jAne ke kAraNa AhAra kA vipAka ThIka-ThIka nahIM ho paataa| ___ vAgbhaTa aura ugrAditya donoM srotorodha yA srotAvarodhana ke prati eka mata ho gaye haiN| kapha kI pracuratA ke kAraNa srotasoM ke mukha banda ho jAte haiM aura unameM rodha ho jAtA hai yaha eka anivArya ghaTanA hai| hArIta ne zrutirodhanam ke dvArA kAnoM ke banda hone yA ruMdha jAne kI ora bhI dRSTipAta kiyA hai| ugrAditya ne akSipAta, vihInatA, kaphodgama tathA kaNThagata karADU kI ora For Private and Personal Use Only

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406 vikRtivijJAna dhyAnAkarSaNa karAyA hai| vasavarAja ne kapha kI zvetavarNatA, kaNThazotha, bhrAnti, cintA, bhIti, sAraNa, ghargharazvAsazabdatA ke atirikta dAha aura tApa kA bhI ullekha kara diyA hai| vividha AcAryoM aura zAstrajJoM ne jahAM taka sambhava huA hai apane se bar3e ke mata se sAmaJjasya milAte hue hI kaphajvara kA varNana kiyA hai para jahA~ svatantra mata vyakta karanA par3A hai yahA~ ve usase pIche bhI nahIM haTe haiN| dvandvajajvara ekadoSaja jvaroM ke vicAra ko samApta kara aba hama dvandvaja jvaroM kI ora agrasara ho rahe haiN| dvandvaja vA sAnnipAtika jvaroM ke sambandha meM caraka bhagavAn kA nimna abhibhASaNa bar3A sArapUrNa hone se hama use nIce avikala uddhRta kie de rahe haiM: viSamAzanAdanazanAdannasyAparibartAdRtuvyApattaH asAtmyagandhopaghrANAt viSopahatya codakasyopayogAd garebhyo girINAJcopazleSAt snehasvedavamanavirecanAsthApanAMnuvAsanazirovirecanAnAm ayathAvat prayogAt mithyAsaMsarjanAdvA strINAJca viSamaprajananAt prajAtAnAJca mithyopayogAt yathoktAnAJca hetUnAM mizrIbhAvAt yathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doSA yugapat prakopamApadyante, te prakupitAstayaivAnupUrvA jvaramabhinivartayanti / tatra yathoktAnAM jvaraliGgAnAM mizrIbhAvavizeSadarzanAt dvAndvikamanyatamaM jvaraM sAnnipAtikaM vA vidyAt / ( carakasaMhitA nidAnasthAna prathama adhyAya ) / arthAt 1. viSamAzana, 2. anazana, 3. AhAraparivartana, 4. kAla kA ayoga, atiyoga, mithyAyoga, 5. asAtmyagandha kA sUMghanA, 6. viSAkta jala, 7. kRtrimaviSa, 8. girike nikaTa vAsa, 9. paJcakarmoM kA anucita prayoga, 10. mithyAsaMsarjana, 11. viSama prajanana, 12. prasUtA kA mithyA upayoga, 13. pUrvokta doSa kopoM ke mizraNa inameM se kisI ke bhI dvArA koI sA eka dvandva yA tInoM hI doSa eka sAtha prakupita ho jAte haiN| prakupita hue doSa usI-usI krama se apane-apane prakAra ke jvara kI utpatti karate haiM / isa jvara meM pUrva vAtika paittika zlaiSmikAdi jina-jina jvaroM ke lakSaNa mileM unhIM ke anusAra usakA nAmakaraNa vAtapaittika, vAtazlaiSmika athavA pittazlaiSmika huA karatA hai| yadi tInoM doSoM ke lakSaNa mile hue rahate haiM to vaha jvara tridoSaja yA sAnnipAtika kahalAtA hai| dvandvaja yA sannipAta jvaroM meM pratyeka doSa ke lie vyakta lakSaNoM kA samAveza pAyA jAtA hai / dvandvaja jvaroM meM pUrvokta doSaja jvaroM ke hI jaba lakSaNoM kA mizrIbhAva hotA hai to usako prakRtisamasamavAyArabdha dvandvajajvara mAnA jAtA hai| para jaba dvidoSaja jvara meM donoM doSoM ke lakSaNoM kA viSamArambha hotA hai to aise jvara meM donoM doSoM ke atirikta bhI kucha lakSaNa dekhane meM Ate haiM isa jvara ko vikRtiviSamasamavAyArabdha dvandvajajvara mAnA jAtA hai| isI prakAra jisa tridoSaja jvara meM eka bhI vizeSa lakSaNa na hokara pratyeka doSaja jvara meM kahe hue liMgoM kA hI samAveza ho to use prakRtisamasamavAyArabdha sannipAtikajvara kahA jAtA hai| para jaba kucha aura vizeSa lakSaNa bhI mileM to use vikRtiviSamasamavAyArabdha sannipAtikajvara kahate haiM / For Private and Personal Use Only

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jvara 407 isI ko bar3e sundara zabdoM meM gaGgAdhara ne nimna vAkyoM meM rakkhA hai etenaitad uktaM bhavati-prakRtisamasamavAyArabdhe dvandvajo sAnnipAtike vA vyAdhau prakRtibhUtayordvayordoSayoH prakRtibhUtAnAM trayANAM vA doSANAM svasvakAryarUpANyeva liGgAni bhavanti na tu atiritAni / vikRtivipamasamavAyArabdhe tu tAni ca tattad dvizasrikasya vA doSasya kAraNavaicitryAt kopavizeSAt vikRtivizeSAt saMyogato doSANAM, svasvakarmANi militvA pariNamyAsamAnajAtIyAni liGgAni bhavantIti / madhukozaTIkAkAra ne isa viSaya ko bahuta hI dhIraja ke sAtha samajhate hue likhA haiprakRtisamasamavAyavikRtiviSamasamavAyayozcAyamarthaH-prakRtyA hetu bhUtayA samaH kAraNAnurUpaH samavAyaH kAryakAraNabhAvasambandhaH prakRtisamasamavAyaH, kAraNAnurUpaM kAryamityarthaH, yathA zuklatantusamavAyArabdhasya parasya zuklatvam / vikRtyA hetubhUtayA viSamaH kAraNAnanurUpaH samavAyo vikRtiviSamasamavAyaH yathA haridrAcUrNasaMyogajaM lauhitymiti|| ... zvetatantu ke kAraNa kapar3e kA raMga zveta ho jAnA prakRti samasamavAya kA aura haldI tathA cUne ke milane se na pIlA na zveta api tu lAla raMga kA ho jAnA yaha vikRti viSama samavAya kA udAharaNa hai| aba hama prathama dvandvaja jvaroM ke saMkSipta varNana ko prakRti samasamavAyArabdhaka tathA vikRtiviSamasamavAyArabdhaka rUpa meM yathAsambhava rakhane kA prayatna kreNge| dvandvaja jvara 3 prakAra ke hote haiM1. vAtapittajvara, 2. vAtazleSmajvara tathA 3. zleSmapittajvara / vAtapittajvara (1) lomaharSazca dAhazca parvabhedaH zirorujA / kaNThAsyazoSo vamathustRSNA mUrchA bhrmo'rtiH|| svapnanAzo'tivAk jammA vaatpittjvraakRtiH| (caraka) (2) tRSNA mUrchA bhramo dAhaH svapnanAzaH zirorujA / kaNThAsyazoSo vamathU romahaSo'rucistamaH / / ___ parvabhedazca jambhA ca vAtapittajvarAkRtiH / ( suzruta 1) (3) jambhAdhmAnamadotkampa-parvabhedaparikSayAH / tRTapralApAbhitApAH syuz2are mArutapaittike // (suzruta 2) (4) shiro'timuuvimidaahmohknntthaasyshossaartiprvbhedaaH| ___ unnidratAtRDbhramaromaharSA jammA'tivAktvaM ca calAt sapittAt / / ( vAgbhaTa ) (5) tRSNA mUrchA vamana kaTutA cAnane rUkSatA syAt antardAhe vapuSi nayane raktatA knntthshossH| nidrAnAzaH zvasanazirasorukprabhedo'GgabhaGgo romoddharSastamakamiti kedvAtapittajvaraH syAt / / (hArIta) (6) kaNThAsyazoSastRNamUrchAdAho'svapno vamirdhamaH / tamaH parvaziroruk ca vAtapittajvarAkRtiH / / ( aJjananidAna) (7) tRSNA bhramo dAhazirorujazca knntthaasyshossaaruciromhrssaaH| ___ mUtimacchadivijambhaNAni nidrAtyayo mArutapittaje syAt // (vaidyavinoda ) (8) pavanapittahetukarasavirasajAtAjIrNajanyAmarasAsRgdhAtucarAdyadoSa ubhayalakSaNayuktarogaH pavanapitta prkopjvrH| vAtapittaja jvara eka dvandvaja vikAra hai| vAyudoSa zItAdika kAraNoM se prakupita hotA hai tathA pitta USmAdika hetuoM se prakopa ko prApta hotA hai donoM ke hetuoM meM jamIna AsamAna kA antara hone ke kAraNa yo kahie ki eka yadi zIta hai to dUsarA uSNa, eka yadi rUkSa hai to dUsarA snigdha aura ina paraspara virodhA kAraNoM se For Private and Personal Use Only

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408 vikRtivijJAna eka se utpanna vikAra dUsare se zAnta honA cAhie para vyavahAra meM vaisA nahIM dikhAI detaa| vAta jina sthAnoM meM dUSita hotA hai una-una sthAnoM meM vikArotpatti karatA huA rakta ko dUSita kara detA hai / vahI pitta karatA hai| jaba zarIra ke do doSa apanI samatA kho baiThate haiM to phira zAnti kaisI ? vikAra eka vicitra prakAra kA rUpa lekara upasthita hotA hai usameM na zItopacAra kiyA jAsakatA hai aura na uSNopacAra / phira bhI prAcIna AcAryoM ne apanI sUjhabUjha ke bala para isa gutthI ko bahuta sAvadhAnI ke sAtha sulajhA liyA hai| Upara jo ATha zAstrIya uddharaNa hamane diye haiM inameM Ayurveda sUtrakAra ne kevala vAtapittajvara kI samprApti mAtra likha dI hai ki vAta aura pittakAraka rasa jaba ajIrNa ke kAraNa virasatA ko prApta ho jAte haiM to ve AmAzaya meM Amarasa kI utpatti karate haiM aura rakta ke dvArA dhAtuoM meM pahu~ca kara ubhaya lakSaNajanya vAtapittajvara banatA hai| zeSa, AcAryoM ne vAtapittajvara meM 25 lakSaNa ginAe haiN| ye lakSaNa vAta paittika dRSTi se bA~Tane para nimna zreNiyoM meM Ate haiM vAtika lakSaNa paittika lakSaNa anya vA mizra . 1 romaharSa X to x x x 4 zirorujA kaNThAsyazoSa ___x XX x vamathu x x tRSNA mUrchA x x arati x nidrAnAza x x x x x ativAka x x aruci x * x x x x x x x x x x x 4QIA x tama hai.x xxx x uskampa x x moha rakanetratA 20 x kaTakAsyatA x rUkSatA 22 23 zvasana aGgabhaGga For Private and Personal Use Only

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jvara 406 uparokta lakSaNoM meM aGgabhaGga ko chor3a zeSa lakSaNa bahuta hI spaSTa hai / aMga ke bhaGgahone para vizeSa kara asthibhagnatA yA pezIsUtroM ke kucala jAne se na kevala vAta- balki pitta bhI kupita ho jAtA hai ataH hArIta ne aGgabhaGga nirdeza lakSaNadRSTyA na kara dRSTyA kara diyA hai / vAtika lakSaNa romaharSa, zirovedanA, kaNThazoSa, mukhazoSa, arati, nidrA kA nAza, bhAI kA adhika AnA, netroM meM surkhI aura rUkSatA ko dekhakara athavA paittika lakSaNa dAha, vamI, tRSNA, mUrcchA, bhrama, mada aura kahue mukha ke hone se kisI eka mata para nahIM pahu~cA jA sakatA yadi hama dvandvaja jvaroM kA vicAra na kreN| ye sabhI lakSaNa prakRti-samasamavAyAtmaka vAtapaittika jvara ke rUpa kA nirdeza karate haiM / parvabheda, pralApa, aruci, tama, kampa, moha aura zvasana kriyA kI vRddhi, jo use vikRtiviSamasamavAya kI zreNI meM pahu~cAte haiM ke dvArA bhI dvandvaja dRSTikoNa ke binA kisI bhI nirdiSTa mArga kI ora lakSya nahIM karateM, ataH ina ulajhanoM ko sulajhAne ke lie hI AcAryoM ne dvandvaja roga ko kalpanA ko pahacAnA | zarIra meM santApa bar3hA huA hai| rogI ko na nidrA ArahI hai na caina par3a rahA hai, sira bhArI hai, AMkheM sukha haiM, pyAsa bar3hI huI hai, dAha use jalA rahI hai, kai bhI hotI hai ora naze se ye rogI par3A huA hai jo khAnA nahIM mAMgatA kevala pAnI cAhatA hai 1 zvAsa kI gati bar3hI huI hai / zarIra kI isa avasthA ko na maleriyA kahA jA sakatA hai na Antrikajvara / isa dazA meM nissandeha use kisI Agantu jIvANu ne nahIM satAyA / ataH ise nijaroga saMjJA ke antargata hI rakhanA par3egA / vAstavikatA to yaha hai ki vAtanAr3IsaMsthAna kA mukhya kendra mastiSka aura pAcaka pitta kA utpAdaka aMga yakRt ina donoM meM eka sAtha hI saGkaTa chAyA huA hai / isake kAraNa yakRt kI kriyA viSama ( irregular ) ho gaI hai aura mastiSka bhI avyavasthitarUpa se uttejita ( disorderly irritated ) ho gayA hai / isI ko hamAre AcAryoM ne vAtapittajvara kA nAma de rakhA hai / ise hama. Adhunika kisI eka roga ke nAma se nahIM jAna sakate / aba hama vividha lakSaNoM kA saMkSepa vicAra upasthita karate haiM romaharSa yA lomaharSa - isa lakSaNa ko caraka, suzruta, vAgbhaTa, hArIta tathA vaidyavinoda prAyaH sabhI ne svIkAra kiyA hai / suzruta pAThAntara meM isake lie utkampaH zabda kA vyavahAra kiyA gayA hai / caraka ne cikitsAsthAna meM likhA hai nidAne trividhA proktA yA pRthagjajvarAkRtiH / saMsargasannipAtAnAM tathA coktaM svalakSaNam // isa zloka se yaha artha nikalatA hai ki nidAnasthAna meM jo vAta, pitta aura kapha jvaroM kA alaga alaga varNana kiyA hai vaha aneka prakRtisamasamavAya lakSaNoM kI dRSTi se hai tathA jo cikitsAsthAna meM lomaharSAdi kA varNana AyA hai vaha vikRti-viSayasamavAyadRSTayA hai / romaharSa ko isa dRSTi se vikRtiviSaya samavAyAkhyaka 35, 36 vi0 For Private and Personal Use Only

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410 vikRtivijJAna lakSaNa mAnA jaavegaa| vijayarakSita ne isa kathana ko puSTa kiyA hai| gaMgAdharane bhI vAtapittayovikRtiviSamasaMyogAllomaharSArdAni liGgAni bhavanti na tvanyasmin vaatpittjvyaayau| dAha yA antardAha-yaha paittika lakSaNa vAtapaittika jvara meM bahuta mahattvapUrNa rahatA hai| vAta kI rUkSatA kozAoM ko sukhAtI hai aura pitta kI uSNatA unheM jalAtI hai jisase rogI ko bahuta adhika USmA prApta hotI hai| parvabheda aura parikSaya-a~guliyoM ke poruoM meM darda kA honA yA unakA kSINa ho jaanaa| yaha lakSaNa vAtodara, kSataja kAsa aura vAtapittajvara ke atirikta anyatra nahIM milA krtaa| bhedanakriyA vAyu ke dvArA hotI hai bar3e jor3oM meM yaha isalie nahIM ho pAtI ki pitta kA sAtha sAtha hone vAlA prakopa use panapane nahIM detA para poSaNa atyadhika dUrastha bhAga meM hone ke kAraNa yahA~ pitta kI apekSA vAta kI zuSkatA aura rUkSatA kA prabhAva vizeSa par3atA hai| ziraHzUla-vAtika lakSaNoM ke antargata hamane use mAnA hai kyoMki zUla arthAt pIr3A kA kAraNa vAtika prakopa huA karatA hai para paittika kAraNa bhI zUlotpatti meM sahAyatA detA hai| jaba vAtapaittika jvara meM vAta ke kAraNa ziraHzUla hotA hai to rAtri meM vaha bar3hatA hai para jaba paittika dharma ke kAraNa hotA hai taba rAtri meM kama ho jAtA hai| nidrAnAza-svayaM eka vAtika lakSaNa hai| vAtika prakopa kI kamI ke kAraNa nidrAlpatA aura adhikatA hone para nidrA kA sarvathA nAza ho jAtA hai| __ raktanetratA ke dvArA saralatayA yaha jAna liyA jAtA hai ki rogI ke mastiSka meM khUna bar3ha rahA hai jisase mastiSka ke vAtanAr3I kendroM para bhAra bahuta par3ane se unameM vAta kA prakopa ho jAtA hai tathA netroM meM aruNatA kI vRddhi tathA ativAcAlatA bar3ha jAtI hai| vamatha-yadyapi vamana vAtika aura paittika donoM prakAra kI hotI hai parantu vAtapaittikajvara meM vaha paittika hI pAI jAtI hai| vAtapaittika vamana jaisI koI vyAdhi pAI nahIM jaatii| tRSNA-pyAsa vamana kA sahavartI lakSaNa hai aura pittadoSa pradhAna hai| mUrchA-vAtapittajvara meM bahuta adhika mahattva nahIM rakhatI phira bhI rogI kI mudrA tandrAyukta hotI hai vaha besudha rahatA hai pitta ke kAraNa utpanna hue tIvra jvara kA vaha pramANa hai| bhrama aura mada-ye donoM paittika haiM bhrama kA kAraNa nidrAnAza tathA mada kA kAraNa mUrchA kI avasthA kA honA hai| jambhA-vAyu kI pradhAnatA ko hI prakaTa karatA hai| ativAk yA pralApa-zuddha vAtavyAdhi meM pralApa jitanA prabala hotA hai vaha rUpa to yahA~ dekhane ko nahIM milatA phira bhI hoza rahate hue adhika bolane kI vRtti isa roga meM bar3ha jAtI hai| For Private and Personal Use Only

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jvara 411 tama-yA A~khoM ke Age a~dherA sA AnA eka lakSaNa hai jisameM pitta doSa ke prakopa kI ora iGgita hotA hai| yaha lakSaNa sarvasAdhAraNa rUpa se mAMsagata jvara meM, pittaja pANDu meM aura pittAvRta vAta meM pAyA jAtA hai / isa lakSaNa ko caraka ne nahIM likhA na vAgbhaTa meM hI isakA ullekha pAyA jAtA hai| aruci-yaha lakSaNa jahA~ jahA~ jvara mAtra hotA hai vahIM vahIM pAyA jAtA hai isI kAraNa ise suzruta aura vaidyavinodakAra ke atirikta anya kisI ne bhI ullekhanIya nahIM smjhaa| vAgbhaTa ke TIkAkAra hemAdri ne parvabheda se sampUrNa zarIra kI sandhiyoM meM bhedanavat pIr3A ko svIkAra kiyA hai| vAtakaphajvara (1) zItako gauravaM tandrA stai mityaM parvaNAJca ruk / zirograhaH pratizyAyaH kAsaH svedApravartanam / santApo madhyavegazca vAtazleSmajvarAkRtiH / / ( caraka ) (2) stamityaM parvaNAM bhedo nidrAgauravameva ca / zirograhaH pratizyAyaH kAsaH svedApravartanam / / santApo madhyavegazca vAtazleSmajvarAkRtiH / ( suzruta ) (3) shuulkaaskphotkleshshiitvepthupiinsaaH| gauravAruciviSTambhavAtazleSmasamRddhaye // ( suzrutapAThAntara ) ( 4 ) tApahAnyaruciparvazirorukapInasazvasanakAsavibandhAH / zItajADyatimirabhramatandrAzleSmavAtajanitajvaraliGgam // ( vAgbhaTa ) ( 5 ) zItaM vepathuparvabhaGgavamathurgAtre jaDatvaM caruGa. mandoSmArucibandhanaM parupatA kAsastamaH zUlavAn / tandrA kUjanatAtmalaulyamathavA stamityaz2ambhAruciH prasvedomalamUtrarodhasahitaH syAcchleSmavAtajvaraH / / ( hArIta) ( 6 ) stamityaM kAsamantApau gauravaM parvamUrdharuk svApo'svedaH pratizyAyo vAtazleSmajvarAkRtiH / ( aJjananidAna ) (7) stmitykaasaaruciprvbhedshirorujHpiinsmdhyvegau| santApakampau gurutA zarIre nidrA vyathA vAtakaphajvare syAt // (vaidyavinoda) ( 8 ) pavanakaphavikArahetukarasavirasayAjAtAjIrNajanyAmayamAMsamedodhAtucara ubhayalakSaNasahitaH pavanakaphavikArajAtajvaraH / ( AyurvedasUtra ) vAtakaphajvara kA jo varNana vibhinna granthoM meM milatA hai usase lagabhaga 26 lakSaNayukta eka vyAdhi kA jJAna hotA hai| ina lakSaNoM meM se kabhI koI kama aura kabhI koI adhika athavA kabhI kisI kA abhAvAdi hone se eka hI yaha vyAdhi kaI rUpoM meM dekhI jA sakatI hai para mUlataH gaurava, nidrA, stamitya, parvabheda, zirograha, pratizyAya, kAsa, atisveda aura madhyama santApa ye lakSaNa avazya hI milate haiN| For Private and Personal Use Only

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412 vikRtivijJAna dhyAnapUrvaka dekhane se yaha roga sira, asthikoTara aura phuphphusa para prabhAva vizeSa karake 'DAlatA hai / vAtasaMsthAna sira meM aura kapha urasa meM vizeSa sthAna pAte haiM ataH inhIM sthaloM meM isakA bAhulya hotA hai| sira kA bhArI honA yA usameM darda honA, jukAma honA aura koTaroM meM pAnI kA bahanA yA najale kA giranA isI roga meM pAyA jAtA hai| caraka ne vAtazleSmajvara ke vikRtiviSamasamaveta rUpa kA varNana yahA~ upasthita kiyA hai prakRtisamasamaveta rUpa ko mUla vAtajvara aura kaphajvara ke lakSaNoM ko milA kara samajhA jA sakatA hai| zItaka arthAt zItapitta (Urticaria) aura pratizyAya ko dekhakara Adhunika vidvAnoM kI dRSTi meM yaha alI ( allergy) janita jvara ThaharAyA jA sakatA hai| vAgbhaTa kA zvasana kA ullekha bhI usI dazA kI ora iGgita karatA hai| doSAnusAra lakSaNoM kA krama nimna rahatA haivAtika lakSaNa zlaiSmika lakSaNa vAtazlaiSmika lakSaNa zItaka ( zaitya) gaurava tandrA stamitya xx xxx xxx parvaraka x x x x x vepathu zvasana bhrama ziraHzUla pratizyAya kAsa prasvedatA kaphokleza 11 jammA jADya mandoSmA viSTambha . isa roga meM vAtika lakSaNa kama aura zlaiSmika adhika hote haiM aisA vicAra karanA mahattvapUrNa nahIM hai eka hI vAtika lakSaNa itanA ugra ho sakatA hai ki aneka zlaiSmika lakSaNoM kA atikramaNa kara de| ataH lakSaNa kI ugratA para dhyAna denA adhika mahattvapUrNa hai| isa roga meM sveda adhika AtA hai yA bilkula nahIM AtA isa viSaya para TIkAkAroM meM matabhinnatA pAI jAtI hai| kavirAja gaGgAdhara ne svedApravartanama kA artha svadesya AsamantAtkAreNa pravarttanamatisveda ityarthaH aisA kiyA hai| ise usane madhukozaTIkAkAra ke dvArA prApta kiyA hai jisane kArtika ke uddharaNa ke rUpa meM ise diyA hai| isakI dRSTi meM vijayarakSita ne hArIta zirograhaH svedabhavo jvarasya kAsazca liMGga kaphavAtajasya kA udAharaNa dete hue svedabhavaH svedotpattiH aisA kiyA For Private and Personal Use Only

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jvara 413 hai / hamAre pAsa jo hArIta saMhitA hai usameM yadyapi yaha vAkya nahIM phira bhI prasvedo mala-mUtrarodhasahitaH meM prasveda dvArA kArttika vijayarakSita athavA gaMgAdhara kA samarthana ho jAtA hai / dUsarI ora suprasiddha carakaTIkAkAra zrI cakrapANidatta Ate haiM jinhoMne svedastambha iti svedApravartanam aisA diyA hai / pratyakSa meM zlaiSmika staimityayukta vyAdhi hone se, isa roga meM pasInA bahuta AtA hai jo jvara ke madhyavega kA kAraNa hotA hai ataH hama bhI vAtazlaiSmika jvara meM kArttika ke hI mata ke pakSapAtI haiM / Acharya Shri Kailassagarsuri Gyanmandir zleSmapittajvara (1) muhurdAho muhuH zItaM svedaH stambho muhurmuhuH / mohaH kAso'rucistRSNA zleSmapittapravartanam // ( caraka ) ( 2 ) liptatiktAsyatA tandrA moha: kAso'rucistRSA / muhurdAho muhaH zItaM ileSmapittajvarAkRtiH // ( suzruta ) ( 3 ) zItadAhArucistambhasvedamohamadabhramAH / kAsAGgasAdahallAsA bhavanti kaphapaittike // ( suzruta pAThAntara ) (4) zItastambha svedadAhAvyavasthA tRSNAkAsaH zleSmapittapravRttiH / mohastandrA liptatiktAsyatA ca jJeyaM rUpaM zleSmapittajvarasya / ( vAgbhaTa ) (5) nidrAgauravakAtsasandhizirarukcArtistathA parvaNAM maido madhyama vegamatra nayane vAtAnvite zleSmaNi / santApaH zvasanaM ruciH zrutipathe kaNThe ca zuSkAvRtistandrA mohamarocakabhramamathazleSmajvare pittale // ( hArIta ) (6) zItaM dAho muhustandrA mohaH kAso'rucizca tRT / liptatiktAsyatA pittabalAsajvaralakSaNam // ( aJjananidAna ) (7) kAso'rucirmohavamiprasekAH saMliptatiktaM vadanaM vigandhi / zItadAhA liMGga jvare tatkaphapittaje syAt // ( vaidyavinoda ) (8) kaphapittavikArahetukarasavira sajAtAjIrNajanyAmayAsthimajjAdhAtucarAdyadoSazcobhayalakSaNayuktoM rogaH kaphapittavikArajAtajvaraH / ( AyurvedasUtra ) Ayurveda sUtra bhASyakAra zrI yogAnandanAtha ne doSatrayotpAditajvarAstrayaH tattaddvandvadoSajAtajvarAstrayaH ke sambandha meM vaktavya dete hue likhA hai ki kevala ajIrNa dvArA bhI jvarotpatti ho sakatI hai tathA sarve'pi jvarA rasavirasajAtAjIrNajanyA eva / arthAt mUla rasa ke virasatA meM pariNata hone para sabhI jvaroM kI utpatti hotI hai / rasa kI virasatA binA ajIrNa ke sambhava nahIM / ataH nAjIrNena vinA jvaraH aisA usane nirazaGka svIkAra kara liyA hai| ataH vAta, pitta, kapha, vAtapitta, vAtakapha athavA pittakapha eka yA do doSa jAkara AmAzaya meM pAcanakriyA kA vighaTana kara dete haiM jisase anna ajIrNavasthA meM par3A rahatA hai aura vividha lakSaNoM se yukta jvarotpatti kA kAraNa banatA hai / vAtapittajvara ajIrNajanita hai aura rasa aura rakta ina do dhAtuoM meM vyApta hotA For Private and Personal Use Only

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414 vikRtivijJAna hai / vAtazlaiSmika jvara bhI ajIrNajanita hai para yaha mAMsa aura medo dhAtuoM meM vyApta hotA hai / tathA pittakaphajvara ajIrNajanita hotA hai aura yaha asthimajjA dhAtuoM para prabhAva DAlatA hai / jina dvandvaja jvaroM meM vAta kA sambandha AtA hai ve gambhIra svarUpa ke hote haiM para unameM vAta ke zIghragAmI hone ke kAraNa ve zIghra svAsthya lAbha kara lete haiM para kapha aura pitta donoM hI bhArI aura mandacArI hone se samAvasthA meM Ane ke lie paryApta vilamba karate haiM / pittakaphajvara meM sabhI AcAryoM ke dvArA vyakta lakSaNoM kI saMkhyA 27 taka pahu~catI hai| inameM caraka, suzruta, vAgbhaTa, aJjananidAnakAra tathA vaidyavinodakAra ne kevala loka meM pracalita sarvasAdhAraNa pittakaphajvara kA varNana karake apane karttavya kI itizrI kara dI hai para suzruta pAThAntara meM tathA hArItasaMhitA meM kaphapittaja jvara ke vividha rogiyoM meM kahA~ taka lakSaNa pAye jA sakate haiM isa dRSTi se vicAra kiyA gayA hai / hArIta isa dizA meM bahuta Age gaye haiM / unhoMne sarvasAmAnya zleSmapitta jvara ke lakSaNoM kI ora utanA dhyAna na dekara anya aise 10 yA 11 lakSaNoM kA samAveza kiyA hai jinheM anya zAstrakAroM ne nahIM likhA / udAharaNa ke lie unhoMne muhurdAhaH muhuH zItam ise huA bhI nahIM jise prAyaH sabhI ne vyakta kiyA hai| unhoMne aruci kA ullekha na karake ruciH zrutipathe kA vivecana kiyA hai| kaNThe ca zuSkAvRti kA ullekha kara yaha dikhalAne kA yatna kiyA hai ki unhoMne apanI khojoM aura sUjha ke bala para hI apanA varNana upasthita kiyA hai / vaidyavinodakAra dvArA upasthita kaphapittajvara kA citra bhI kucha pRthak sA hai / stambhasveda ko na suzruta likhatA hai, na hArIta, na agniveza aura na vaidyavinodakAra / isa sampUrNa prakaraNa meM moha hI eka aisA lakSaNa hai jise saba zAstrakAra pAte haiM / kabhI dAha kA honA aura kabhI zIta kA laganA isa lakSaNa ko hArIta ke atirikta prAyaH sabhI ne svIkAra kiyA hai / kAsa bhI hArIta vyaktirikta sabhI ko mAnya hai / hArIta kAsa na mAnakara zvAsa ko mAnyatA pradAna karatA hai / pyAsa kA laganA suzrutapAThAntara, hArIta saMhitA aura vaidyavinoda ko mAnya nahIM hai / liptatiktAsyatA tathA tandrA ye lakSaNa caraka, suzruta pAThAntarakAra aura hArIta ko svIkAra nahIM / mada aMgasAda tathA hallAsa aise lakSaNa haiM jinheM akele suzruta pAThAntara meM hI isa prakaraNa meM dekhA jA sakatA hai | bhrama kA samarthana bhI hArIta aura suzrutapAThAntarakAra karate haiM / mI vaidyavinodakAra dvArA hI vyakta kI gaI hai / usI ne praseka, mukha kI vigandhi aura muhurSaNa ko mAnA hai / gaurava, sandhizUla, parvabheda, ziraHzUla, netroM meM vAtazlaiSmika srAva, madhyama vegI santApa aura nidrA akele hArIta kI khoja se prApta phala hai / aruci ko vAgbhaTa ke atirikta sabhI ne svIkAra kiyA hai / tandrA suzrutapAThAntara aura vaidyavinoda ko chor3a sarvatra vidyamAna hai / For Private and Personal Use Only

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jvara 415 aba hama doSoM kI dRSTi se ina lakSaNoM ko upasthita karate haiM zlaiSmikalakSaNa paittikalakSaNa pittazlaiSmikalakSaNa mh bh zIta stambha svedostambha xxx s + h m aruci m m tiktAsyatA m m liptAsyatA tandrA x x x x x x x x x x HR x x xx agasAda hRllAsa, vami 14 gaurava sandhiziroruka 15 nidrA, praseka x santApa, arati, parvabheda dvandvaja jvaroM ke sambandha meM aruNadatta ne eka prazna uThAyA hai ki-atha dvidoSajAnAM jvarANAM kimAgamApagamavaiSamyAdInAM krameNotpattiH ? dvidoSaja jvaroM ke Ane yA jAne meM doSa vaiSamyAdi kI utpatti kA krama kyA rahatA hai ? ve doSa sampUrNa zarIra meM eka sAtha vyApta hote haiM yA vibhinna kAloM meM ? uttara dete hue vahI kahatA hai ki dvandvaja jvara saMsargaja hone ke kAraNa donoM hI pakSasambhava haiN| kintu donoM pakSoM ke virodhI hone para yugapat sambhava nahIM ho sakatA aura Age usI ke zabdoM meM 'yadi saMsargaje jvare balavAn vAyuH syAt tadA AgamApagamavaiSamyAdinA krameNa, atha pittasya balIyastvaM tadA yugapatsarvazarIravyAptikrameNa jvaro bhvti| samau yadA dvAvapi bhavataH, tadA'pi yasya dezakAlAdinA balalAbhastadA tasyai votpattikrameNa jvaro bhavati / sannipAte tu yugapadeva shriirvyaaptiH|' arthAt jaba vAyu balI hotA hai to AgamApagama kI viSamatA ke sAtha jvara hotA hai, jaba pitta balavAna hotA hai taba usake kAraNa zarIra meM eka sAtha hI jvarotpatti ho jAtI hai para jaba ve donoM sama hoM to jisa doSa ke anukUla deza vA kAla athavA do| hoM usI ke anusAra jvarotpatti huA karatI hai / sannipAta meM tInoM doSoM ke dvArA eka sAtha jvarotpatti hotI hai / jvara ke Agama aura apagama meM zIta athavA dAha yA anya lakSaNoM kA kyA krama rahatA hai isa para ugrAdityAcArya kA nimna sUtra mahattvapUrNa hai doSadvayeritasulakSaNalakSitaM taddoSadvayodbhavamiti jvaramAhuratra / dopaprakopazamanAdiha zItadAhAvAdyaM tayovinimayena bhaviSyatastau // For Private and Personal Use Only

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vikRtivijJAna ki jisameM do doSoM ke lakSaNa lakSita hote haiM use dvandvaja jvara kahA jAtA hai| dorSoM ke prakopa aura upazamana ke anusAra zIta aura dAha ke parivartana jvara ke Adi aura anta meM hote haiM arthAt yadi jvara ke Adi meM vAta kA kopa ho to zIta lagegA aura pitta kA kopa ho to dAhAdhikya milegA / yahI anta ke lie bhI samajha leN| aba hama Ayurveda meM sarvAdhika mahattva ke prasaGga para apanI lekhanI uThAte haiM-- sannipAtajvara sannipAta jvara ke sambandha meM AcAryoM ne apane apane vicAra bahuta bhinnatA ke sAtha prakaTa kie haiM ataH unakA nirUpaNa pUrvapaddhati ke anusAra nahIM kiyA jA skegaa| isake lie hama pratyeka AcArya ke dvArA vyakta vicAroM ko pahale eka sthAna para rakha kara phira usakA sAmUhika vicAra vyakta kreNge| isase sannipAta nidAna kI duruhatA bahuta kucha sarala kI jA skegii| carakasaMhitA meM sannipAtajajvara ke 12 bhedoM kA varNana kiyA gayA hai tatpazcAt vikRtiviSamasamavAyArabdha sannipAtajvara ke lakSaNoM kA varNana kiyA gayA hai isake bAda sannipAtajvara ke asAdhya lakSaNa ginA diye gaye haiM(1) bhramaH pipAsA dAhazca gauravaM ziraso'tiruk / vAtapittolbaNe vidyAlliGgaM mandakaphe jvare / / (2) zaityaM kAso'rucistandrA pipAsA dAharugvyathA / ___ vAtazleSmolbaNe vyAdhau liGgaM pittAvare viduH|| (3) chardiH zaityaM muhardAhastRSNA moho'sthivednaa| mandavAte vyavasyante liGga pittakapholbaNe / / (4) sandhyasthizirasaH zUlaM pralApo gauravaM bhramaH / vAtolbaNe syAyanuge tRSNA kaNThAsyazoSatA // (5) raktaviNmUtratA dAhaH svedstRddblsNkssyH| mUrchA ceti tridoSe syAlliGga pitte garIyasI / / (6) aalsyaarucihRllaasvmidaahtRssaabhrmaiH| kapholbaNaM sannipAtaM tandrAkAsena cAdizet // (7) pratizyAcchadirAlasyaM tandrArucyagnimArdavam / hInavAte pittamadhye liGgaM zleSmAdhike matam / / (8) hAridramUtranetratvaM daahstRssnnaabhrmo'ruciH| hInavAte madhyakaphe liGgaM pittAdhike matam / / (9) zirorugvepathuH zvAsaH pralApaccharocakau / hInapitte madhyakaphe liGgaM vAtAdhike matam / / (10) zItako gauravaM tandrA pralApo'sthiziro'tiruka hInapitte vAtamadhye liGgaM zleSmAdhike matam // (11) zvAsaH kAsaH pratizyAyo mukhazoSo'tipAvaruk / kaphahIne pittamadhye liGga vAtAdhike matam / / (12) parvabhedo'gnimAndhaM ca tRssnnaadaaho'rucibhrNmH| kaphahIne vAtamadhye liGgaM pittAdhike viduH|| vikRtiviSamasamavAya sannipAtalakSaNakSaNe dAhaH kSaNe zItamasthisandhizirorujA / sAsrAve kaluSe rakte nirbhugne cA'pi locane / sasvanau sarujau kau~ kaNThaHzUkairivAvRtaH / tandrAmohaH pralApazca kAsaH zvAso'rucibhramaH / / paridagdhA kharasparzA jihvA srastAGgatA praa| SThIvanaM raktapittasya kaphenonmizritasya ca // ziraso loThanaM tRSNA nidrAnAzo hRdi vyathA / svedamUtrapurISANAM cirAdarzanamalpazaH / / kRzatvaM nAtigAtrANAM satataM kaNThakUjanam / koThAnAM zyAvaraktAnAM maNDalAnAJca darzanam // mUkatvaM srotasAM pAko gurutvamudarasya ca / cirAtpAkazca doSANAM sannipAtajvarAkRtiH / / sannipAtajvara ke 13 prakAroM ke sambandha meM nimna bhAvaprakAzokta sUtra acchA mArga darzana karatA hai For Private and Personal Use Only

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jvara pravRddhamadhyahInaistu vAtapittakaphaizca SaT / ekolbaNAstrayasteSu dvathulbaNAJca tathepi SaT 1 yulbaNazca bhavedeko vijJeyaH sa tu saptamaH // sannipAtajvarasyaivaM yurvizeSAstrayodaza // arthAt Acharya Shri Kailassagarsuri Gyanmandir vAtolvaNa sannipAta pittolbaNa sannipAta 3 sannipAta kapholbaNa vAtapittalbaNa sannipAta vAtazleSmolbaNa sannipAta 3 pittazleSmolbaNa sannipAta vAtapittazleSmolbaNa sannipAta- vAtapravRddha madhyapitta hAnakapha sannipAta vAtapravRddha madhyakapha hInapitta sannipAta pittapravRddha madhyavAta hInakapha sannipAta zleSmapravRddha madhyavAta hInakapha sannipAta zleSmapravRddha madhyakapha hInavAta sannipAta For Private and Personal Use Only 9 6 417 13 aba hama bhAlu kitantrokta sannipAtoM kA aura varNana karate haiMvAtapittAdhiko yasya sannipAtaH prakupyati / tasya jvaroGgamardastRtA luzoSapramIlakAH // AdhmAnatandrArucayaH zvAsakAsazramazramaH / pittazleSmAdhiko yasya sannipAtaH prakupyati // antardAho bahiHzItaM tasya tandrA ca bAdhate / tudyate dakSiNaM pArzvamuraH zIrSagalagrahAH // niSThIvet kaphapittaM ca tRSNAkaNDUzca jAyate / viDbhedazvAsahikkAzca bAdhante sapramIlakAH // vibhuphalgU ca tau nAmnA sannipAtAvudAhRtau / zleSmAnilAdhiko yasya sannipAtaH prakupyati // tasya zItajvaro nidrA kSuttRSNA pArzvanigrahaH / zirogauravamAlasyamanyAstambhapramIlakAH / / udaraM dahyate cAsya kaTibaMstizca dUyate / sannipAtaH savijJeyo makarIti sudAruNaH // vAtolbaNaH sannipAto yasya jantoH prakupyati / tasya tRSNAjvaraglAnipArzva rugdRSTisaMkSayAH // piNDikodveSTanaM dAha UrusAdo balakSayaH / saraktaM cAsya viNmUtraM zUlaM nidrAviparyayaH // nirbhidyate gudaM cAsya bastizca parikRtyate / Ayabhyate bhidyate ca hikkate vilapatyapi // mUrcchate sphAyate rauti nAmnA visphurakaH smRtaH / pittolvaNaH sannipAto yasya jantoH prakupyati // tasya dAho jvaro dhoro bahirantazca vardhate / zItaM ca sevamAnasya kupyataH kaphamArutau // tatazcainaM pradhAvante hikkAzvAsapramIlakAH / visUcikA parvabhedaH pralApo gauravaM klamaH // nAbhipArzvarujA tasya svinnasyAzu vivardhate / svidyamAnasya raktaM ca srotobhyaH sampravartate // zUlena pIDyamAnasya tRSNAdAhazca vardhate / asAdhyaH sannipAto'yaM zIghrakArIti kathyate // na hi jIvatyahorAtrame tenAviSTavigrahaH / kapholvaNaH sannipAto yasya jantoH prakupyati // tasyazItajvarasvapnagauravAlasyatandrayaH chardimUrcchAtRSAdAhatRptyarocakahRdUgrahAH // ThInaM mukhamAdhurye zrotravAgdRSTinigrahaH / zleSmaNo nigrahaM cAsya yadA prakurute bhiSak // tadA tasya bhRzaM pittaM kuryAt sopadravaM jvaram / nigRhIte tu pitte ca bhRzaM vAyuH prakupyati // nirAhArasya so'tyarthaM medomajjAsthi bAdhate / athAtra snAti bhuGko vA trirAtraM na hi jIvati // maidogataH sannipAtaH kaphphaNaH sa udAhRtaH / kAmAnmohAccalobhAcca bhayAccAyaM prapadyate // madhyahInAdhikairdoSaiH sannipAto yadA bhavet / tasya rogAsta evoktAH prAyo doSabalAzrayAH // I

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sannipAtabhedadarzakatAlikA [1] carakokta lakSaNasamUha bhAluki tantrokta lakSaNa samUha 418 krama doSAnusAra sannipAta nAma 1 vAtapittolbaNamandakapha-bhrama, pipAsA, dAha, gaurava, jvara, aGgamarda, tRSA, tAluzoSa, pramIlaka, AdhmAna, tandrA, aruci, sannipAta-(vibhu yA babhru ziraHzUla / zvAsa, kAsa, bhrama, zrama / sannipAta) vAtazleSmolvaNamandapittaH zaitya,kAsa, aruci, tandrA, zItajvara, nidrA, kSudhA, tRSNA, pArzvanigraha, zirogaurava, Alasya, sannipAta (zIghrakAri pipAsA, dAha, pIr3A athavA manyAstambha, pramIlaka, udaradAha, kaTizUla, bastizUla / sannipAta) hRdvyathA / - 3 pittakapholbaNamandavAta- chardi, zaitya, muhurdAha, tRSNA, antardAha, bahiHzIta, tandrA, dakSiNapArzvazUla, urograha, zirograha, sannipAta (phalgu yA moha, asthishuul| galagraha, kaphapittaniSThIvana, tRSNA, kaNDU, viDbheda, zvAsa, hikkA, prmiilk| bhallusannipAta ) vAtolbaNasannipAta sandhizUla, ziraHzUla, pralApa, tRSNA, jvara, glAni, pArzvazUla, dRSTikSaya, piNDikodveSTana, dAha, (visphAraka sannipAta ) gaurava, bhrama, tRSNA, kaNThAsyazoSa ! urusAda, balakSaya, raktaviTa, raktamUtra, zUla, anidrA, gudazUla, bastizUla, Ayamana, bhedana, hikkA, vilApa, mUrchA, sphAyana, rodana / 5 pittolbaNasannipAta raktavid, raktamUtratA, dAha, sveda, ghora dAha, ghorajvara, bahiHantaHvRddhi-hikkA, zvAsa, pramIlaka, visUcI, (AzukArI sannipAta) tRSNA, balakSaya, muurchaa| parvabheda, pralApa, gaurava, klama, nAbhizUla, pArzvazUla, svidyamAnarasa, tRSNA, daah| kapholbaNasannipAta Alasya, aruci, hRllAsa, dAha, zItajvara, svapna, gaurava, Alasya, tandrA, chardi, mUrchA, tRSA, dAha | (kaphphaNasannipAta) vami, arati, bhrama, tandrA, kaas| tRpti, arocaka, hRdgraha, ThIvana, mukhamAdhurya, zrotravAgdRSTinigraha, shlessmnigrh| vikRtivijJAna

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(bhAvaprakAzokta lakSaNasamUha ) 7 | zleSmolbaNahInavAtamadhya- pratizyAya, chardi, Alasya, alpazUla, kaTitoda, madhyabhAga meM dAha aura zUla, bhrama, atyadhika pitta sannipAta (vaidArika tandrA, aruci, agnimaandh| klama, zirovastimanyAhRdayavANI meM pIDA, pramIlaka, zvAsa, kAsa-hikkA, sannipAta) jADya, visaMjJatA, roga zAnti ke nikaTa karNamUla meM piDikA utpanna hotI hai jo kaSTasAdhya hotI hai| 8 / pittolbaNahInavAtamadhya- hAridramUtra, haridranetratA, dAha. hRddAha, yakRtplIhAntraphuphphusapAka, mukhaguda se pUyaraktanirgamana, kaphasannipAta ( yAmya- tRSNA, bhrama, aruci / / / shiirnndnttaa| sannipAta) 9 vAtolbaNahInapittamadhya- | ziraHzUla, vepathu, zvAsa, pralApa, pralApa, zrama, sammoha, kampa, mUrchA, arati, bhrama, manyAstambha / kaphasannipAta (krakaca- / chardi, aruci / sannipAta) 10 zlepmolbaNahInapittavAta- zaitya, gaurava, tandrA, pralApa, / antardAha, vakta zakti kA abhAva, mukhamaNDalalAla, pArzva meM ghorazUla, madhyasannipAta (karkaTaka asthizUla, atishirHshuul| hRdaya meM zUla, pramIlaka, zvAsa, hikkA, dagdhajihvA kharasparzA, galazUkAvRta, sannipAta) malamUtra tyAga kA jJAna nahIM, kapotavat karAhanA, kaphaghira jAnA, oTha mukhatAluzoSa tandrA, nidrA adhika, ojahIna, raktaSThIvanAdi / 11 | pittolbaNahInakaphamadhya- parvabheda, agnimAnya, tRSNA, ! moha, pralApa, mUrchA, manyAstambha, zirograha, kAsa, zvAsa, bhrama, vAtasannipAta (pAkala dAha, aruci, bhrmH| tandrA, saMjJAnAza, hRdivyathA, chidroM se raktAgama, saraktastabdhanetratA / sannipAta) 12 vAtolbaNakaphahInapittama- zvAsa, kAsa, pratizyAya, mukha- pralApa, zrama, moha, kampa, mUrchA, arati, bhrama, ekapakSavadha / dhyasannipAta (saMmohaka sa0) zoSa, atipaarshvshuul| 13 vAtapittakapholbaNa sanni paramocchvAsa, stabdhAGga, stbdhlocn| / pAta(kUTapAlakasannipAta) jvara 388

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420 vikRtivijJAna sannipAtabhedadarzakatAlikA ko dekhane se hameM yaha patA calatA hai ki bhAluki tantra tathA caraka ke kAzmIra pATha meM sannipAta ke vibhAjana kI samAnatA pAI jAtI hai / para ina donoM ne jina lakSaNoM kA eka hI sannipAta ke antargata jo varNana kiyA hai usameM paryApta bheda hai| yAdavajI dvArA bhAlukitantra kA jitanA aMza uddhRta kiyA gayA hai usake anusAra kevala 6 sannipAtoM kA hI varNana huA hai zeSa hamane zAligrAmavaizyasampAdita bhAvaprakAza se pUre kie haiN| bhAvaprakAza aura bhAlukitantra ina donoM ne bhI jo varNana diye haiM unameM kucha sAmya aura kucha bheda pAyA jAtA hai| - kavirAja gaMgAdhara ne carakokta 12 sannipAta bhedoM ko mAnanA asvIkAra kara diyA hai / usakA kahanA hai ki ina 12 sannipAtoM meM jo lakSaNa ginAe gaye haiM ve prakRtisamasamavAya lakSaNa haiM jinheM granthakAra granthavistArabhaya se kadApi dete nahIM dUsare jo vAkyAvali prayukta kI gaI hai vaha bhI ucita nhiiN| jaise pahale sannipAtajaucyate, kahakara phira Age sannipAtajvarasyUddham likhanA ataH sannipAtajvarosyUdardhva se ato vakSyAmi lakSaNaM taka ke kAzmIrI carakasaMhitA ke pATha ko anArSa mAnA gayA hai / para kyoMki vaha varNana hamAre samakSa hai tathA kAzmIra deza ke carakIya pATha se upalabdha hai anArSa mAnane kA koI kAraNa nahIM mUla Atreya saMhitA jisameM vartamAna caraka saMhitA se kaI gune zloka rahe sambhavataH usI se yaha prApta aMza ho / jo varNana ina sUtroM meM AyA hai vaha yathArtha hai| vAtolbaNa sannipAta bhAlukitantra bhAvaprakAza aura kAzmIrIcarakokta sannipAtoM meM nAma sAmya rahane para bhI bahuta kucha antara pAyA jAtA hai - 1-bAtolbaNa sannipAta ko visphAraka nAma se bhAvaprakAzakAra ne tathA visphuraka. nAma se bhAluki ne likhA hai / bhAvaprakAzakAra likhate haiM zvAsaH kAso bhramo mUrchA pralApo moha vepathuH / pArzvastha vedanA jammA kaSAyatvaM mukhasya ca / / vAtolbaNasya liGgAni sannipAtasya lakSayet / eSa visphArako nAmnA sannipAtaH sudAruNaH / bhAluki ne isake lakSaNa nimna sUtroM meM diye haiM vAtolbaNaH sannipAtoM yasya jantoH prakupyati / tasya tRSNA jvaraglAni prvrugdRssttisNkssyH|| piNDikodveSTanaM dAha arusAdo balakSayaH / saraktaM cAsya viNmUtraM zUlaM nidrAviparyayaH / / nirbhidyate gudaM cAsya bastizca parikRtyate / Ayamyate bhidyate ca hikkate vilapatyapi / / mUrcchate sphAyate rauti nAmnA visphurakaH smRtH| caraka ke kAzmIrIpATha meM isakA varNana nimnalikhita zabdoM meM huA haisandhyasthizirasaH zUlaM pralApo gauravaM bhramaH / vAtolbaNe syAd dvayanuge tRSNAkaNThAsyazoSatA / / For Private and Personal Use Only

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421 xxx . nx xxx xxxx x 2 bhrama x x x x x x x x x x hama tInoM ke vAtolbaNa sannipAta kI tulanAtmaka tAlikA de rahe haiM:caraka bhAluki bhAvaprakAza 1 sandhizUla 2 asthizUla 3 ziraHzUla '4 pralApa 1 pralApa 5 gaurava 6 bhrama 7 tRSNA 1 tRSNA 8 kaNThazoSa 9 mukhazoSa 2 jvara 3 glAni 4 pArzvazUla pArzvazUla 5 dRSTisaMkSaya 6 piNDikodveSTana 7dAha 8UrusAda 9 balakSaya 10 saraktamala 11 saraktamUtra 12 zUla 13 nidrAviparyaya 14 gudazUla 15 bastizula 16 Ayamana 17 bhedana 18 hikana 19 vilayana 20 mUrchA 4 mUrchA 21 sphAyana 22 rodana 5 zvAsa 6kAsa 7 moha 8 vepathu 9 jRmbhA 10 kaSAyAsyatA x x x x x x x x x x x 4. For Private and Personal Use Only

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422 vikRtivijJAna uparokta tAlikA ko dekhakara kyA anumAna kiyA jA sakatA hai ? yahI ki tInoM AcAryoM kI vAtolbaNa sannipAta kI vyAkhyA meM antara hai mahAn antara hai| eka hI nAma hote hue bhI eka bhI aisA lakSaNa nahIM pragaTa hotA jo tInoM meM samAna ho / caraka ne 9 lakSaNa ginAe haiM bhAluki ne 22 tathA bhAvamizra ne 10 / caraka aura bhAluki tRSNA ko svIkAra karate haiM / bhAluki aura bhAvamizra-pArzvazUla aura mUrchA ko mAnate haiM caraka aura bhAvamizra pralApa aura bhrama ko eka sAtha kahate haiN| isa bheda kA kAraNa kyA hai ? jisane Ayurveda kA tanika bhI gambhIratA se adhyayana kiyA hai vaha dekhegA ki kisI bhI roga kA nAmakaraNa karanA pUrNataH Ayurvaidika paddhati nhiiN| doSoM kI aMzAMza kalpanA hI Ayurvedika vicAradhArA kI AdhArazilA hai / vAta kahane se kitane bar3e kSetra kA jJAna hotA hai ise hama pRthvI kahane mAtra se samajha sakate haiN| pRthvI yA pArthivadravya kahanA sarala hai para isameM kitanI vyApakatA hai use sahaja hI nahIM liyA jA sktaa| isI prakAra vAtolbaNa sannipAta nAma denA sarala hai para vAta ke kauna lakSaNa upasthita haiM kauna nahIM isake anusAra hInakapha hInapitta vAtAdhika-sannipAta ke saMsAra meM anekoM rUpa mila sakate haiN| na caraka na bhAluki aura na bhAvamizra galata haiN| tInoM hI vAta ko jAnate haiM tInoM hI mAne hue AcArya haiM para tInoM ne apane jIvana meM jina rUpoM meM vAtolvaNa sannipAta ke darzana kie haiM unheM yathAvat likha diyA hai| kevala sandhi-asthiziraHzUla ke sAtha pralApa milatA huA sannipAtI dekhA jA sakatA hai| kevala udarazUla, bastizUla, gudazUla, mUrchA aura pArzva. zUla se karAhatA huA tridoSapIDita vyakti dekhA jA sakatA hai tathA zvAsakAsapAvazUla se pIDita pralApa karatA huA bhI rogI sannipAta se pIDita pAyA jA sakatA hai| inheM kyA kahA jAvegA ? ina tInoM meM hI vAtolbaNatA pAI jAtI hai pitta aura zleSmA kI vyApti nAmamAtra kI hai ataH ina tInoM ko hI hama vAtolbaNasannipAta kI saMjJA de sakate haiN| pittolbaNasannipAta isI dRSTi se aba hama pittolbaNa sannipAta kI tAlikA prastuta karate haiM :caraka bhAluki bhAvamizra 1 raktaviTa 2 raktamUtratA 3 dAha 1 ghora bahirantardAha 1 atIva dAha 4 sveda 2 sveda 5 tRSNA 3 tRSNA 6 balakSaya 7 mUrchA 1 mUrchA 4 ghora bahirvara X X XX For Private and Personal Use Only

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jvara 5 ghora an 6 hikkA 7 zvAsa 8 pramIlaka 9 visUcikA 10 parvabheda 11 pralApa gaurava caraka 1 Alasya 2 aruci 12 13 kuma 14 nAbhizUla 15 pArzvazUla 16 srotoM se raktAgama 17 zUla Acharya Shri Kailassagarsuri Gyanmandir X X X X X X X X X X X X 4 atisAra 5 ama 6 mukhapAka uparyukta tAlikA se yaha vidita hotA hai ki tInoM ne dAha kI ghoratA ke balapara hI pittalbaNa nAma diyA hai / tInoM ne raktAgama batalAyA hai| eka ne mala aura mUtra meM dUsare ne srotoM se aura tIsare ne tvacA se / do ne tRSNA meM aura do ne mUrcchA meM samAnatA batalAI hai / bhAluki ne jo apane 17 lakSaNa diye haiM usakA kAraNa spaSTataH batalAyA hai 1 Alasya 2 arocaka zItaM ca sevyamAnasya kupyataH kaphamArutau / tatazcainaM pradhAvante hikkAzvAsapramIlakAH // Adi Adi pittalbaNa sannipAta meM ghora jvara aura ghora dAha se jalate hue rogI ko jaba zIto. pacAra kiyA jAtA hai taba use kapha aura vAta kA prakopa hokara hikkA, zvAsa, pramI kAdi roga banate haiM / la kA jina vaidyoM ne vicAra kiyA hai unheM patA hai ki zItopacAra karate karate nyUmoniyA kA AkramaNa ho jAtA hai / isa prakAra hama yahA~ dekhate haiN| ki tInoM kA lakSaNa eka hI rahA hai para tInoM ne tIna rUpoM meM hI pittolbaNasannipAta ko dekhA hai / For Private and Personal Use Only 423 gAtre ca vindavo raktAH kapholbaNasannipAta ise bhAluki ne kaphphaNa batalAyA hai aura bhAvamizra ne kampana | isakA jJAna nimnalikhita tAlikA se sahaja hI ho jAtA hai bhAluki bhAvamizra x X

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424 vikRtivijJAna x 3 hRllAsa 4 dAha 5 vami 6 arati 3 hRdgraha 4 dAha 5 chardi x x xx x x 7 bhrama x x x x x x x x 8 tandrA 6 tandrA 9kAsa 7 zItajvara 8 nidrA 1 rAtrI nidrA 9 gaurava 50 mUrchA 11 tRSNA 12 tRpti 13 STIvana 14 mukhamAdhurya 2 mukhamAdhurya 15 zrotranigraha 16 vAnigraha 3 gadgadavANI 17 dRSTinigraha 4 prastabdhanetratA 5 jADya isa sannipAta meM bhAvamizra ne carakokta eka bhI lakSaNa nahIM par3hA unake par3hane kI AvazyakatA bhI nahIM kyoMki prakRtisamasamavAyarogalakSaNa granthakAra bahudhA ginAte nahIM / para bhAluki ne arati bhrama aura kAsa ko chor3a 6 lakSaNa caraka ke dete hue 11 lakSaNa alaga diye haiN| jinameM 4 lakSaNa bhAvamizra se milate haiN| bhAvamizra ne jADya nAmaka lakSaNa svatantratayA diyA hai / tInoM kA lakSya yahA~ bhI eka hai| vAtapittolbaNa sannipAta ise bhAvaprakAza meM babhru yA babhra kahA jAtA hai| bhAluki ne ise vibhru nAma diyA hai / isake lakSaNoM kI tAlikA nIce dI jAtI hai:caraka bhAluki bhAvamizra 1 bhrama 2 tRSNA 1 tRSNA 3 dAha 4 gaurava 5 ziraHzUla 2 jvara 1 tRSNA xxx 2jvara For Private and Personal Use Only

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jvara 425 3 mukhazoSa 3 aGgamada 4 tAluzoSa 5 pramIlaka 4 pramIlaka 6 AdhmAna 5 AdhmAna 6 tandrA 8 aruci 7 aruci 9 zvAsa 8 zvAsa 10kAsa 9 kAsa 11 bhrama 10 bhrama 12 zrama 11 zrama tInoM ne tRSNA nAmaka lakSaNa ko mAnA hai| zeSa carakokta lakSaNa donoM ko mAnya nhiiN| bhAluki aura bhAvamizra ne aGgamarda aura mada inakI kramazaH bhinnatA rakhate hue zeSa gyAraha-gyAraha lakSaNoM meM samatA rakhI hai| aisA lagatA hai ki bhrama ziraHzUla, dAha aura gaurava ko prakRtisamasamavAyalakSaNa mAna kara nahIM diyA gayA zeSa lakSaNa mahatvapUrNa hone ke kAraNa batalAye gaye haiN| vAtakapholbaNa sannipAta bhAluki ne ise makarI mAnA hai parantu bhAvamizra ne ise zIghrakAri saMjJA se sambodhita kiyA hai / isake sambandha kI tAlikA nimna hai:caraka bhAvamizra 1 zaitya 2 kAsa 3 aruci 4 tandrA 1 tandrA 5 pipAsA 2 pipAsA 6dAha 2 udaradAha 7 rugvyathA x 8 hRvyathA 3 zItajvara 3 zItajvara 4 nidrA 5 kSudhA 4 dudhA 6 pArzvanigraha 5 pArzvanigraha 7 zirogaurava 8 Alasya 9 manyAstambha bhAluki x xxx -X pipAsA xxx xxx For Private and Personal Use Only

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426 vikRtivijJAna xxx 10 pramIlaka 11 kaTizUla 12 bastizUla 6 mUrchA 7 asveda 8 zala 9 zvAsa yaha satya hai ki carakokta lakSoM meM bhAluki pipAsA ke sAtha aura bhAvamizra tandrA ke sAtha mela khAtA hai anyathA usake kisI lakSaNa ke sAtha ina donoM ke lakSaNoM kA mela nahIM baitthtaa| vAtakapholvaNasannipAta meM caraka ne 8, bhAluki ne 12 aura bhAvamizra ne 9 lakSaNoM kA samAveza kiyA hai / jvara, pyAsa, kSudhA, pAvanigraha ina cAra lakSaNoM ke atirikta donoM ne apanA svatantra vaktavya diyA hai / makarI atidAruNa sannipAta hai tathA zIghrakArI asAdhya aisA ina AcAryoM ke mata meM hai| pittakapholbaNa sannipAta ise bhAlukitantrakAra ne phalgu nAma diyA hai jaba ki bhAvaprakAzakAra ise bhallu kahate haiM / isakI tAlikA nIce dI jAtI hai:caraka bhAluki bhAvamizra 1 vamana 2 zaitya 1 bahiHzIta 1 bahiHzIta 3 muhurdAha 2 antardAha 2 antardAha 4 tRSNA 3 tRSNA 3 tRSNA 5 moha 6 asthizUla 4 tandrA 4 dakSiNapArzvatoda 5 dakSiNapArzvatoda 5 urograha 6 urograha 6 zirograha 7 zirograha 7 galagraha 8 galagraha 8 kaphapittaniSThIvana 9 kaphapittaniSThIvana 10 kaNDU 11 viDbheda 9 viDbheda 12 zvAsa 10 zvAsa 13 hikkA 11 hikkA 14 pramIlaka 12 pramIlaka 13 koTha x + x For Private and Personal Use Only

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jvara 427 & caraka phalgu yA bhallu ke varNana meM tInoM hI AcArya ekamata hote hue dekhe jArahe haiN| tInoM ne roga ke mUla lakSaNoM ko svIkAra kiyA hai ki zIta aura dAha ye donoM hI isa roga meM dekhane meM Ate haiN| bAhya aGga meM zItalatA arthAt dekhane se hAtha phirAne se zarIra ThaNDA aura bhItara rogI jalA jAtA ho aisA anubhava karatA hai| tharmAmITara se dekhane para jvara 104 mile aura Upara se dekhane para 99 se adhika na lage tathA ghora jvAlA ke sAtha DaTakara pyAsa ho yaha isa roga kI vizeSatA hai| isameM chAtI aura sira meM jakar3ana, zvAsa kA pratiminaTa vega bar3hA huA tathA hicakI bhI milatI hai| zarIra para khujalI yA cakatte dekhe jAte haiN| isase hama yaha kaha sakate haiM ki isa sannipAta ke sambandha meM adhika matabheda nahIM hai aura isake lakSaNoM meM paryApta sthAyitva pAyA jAtA hai| ___Age bhAluki ne sannipAtoM kA varNana nahIM kiyA ataH hameM kevala caraka aura bhAvamizrokta varNana kA hI Azraya lenA par3atA hai| inako hamane sannipAta bhedadarzakatAlikA ke antargata spaSTa kara diyA hai yahA~ sAmya vaiSamya pradarzanArtha tAlikA prastuta karate haiM:___ saMmohakasannipAta pAkalasannipAta yAmyasannipAta (adhika vAta madhyapitta- (madhyavAta adhikapitta (hInavAta adhikahInakapha) hInakapha) pittamadhyakapha) bhAvamizra bhAvamizra caraka bhAvamizra pralApa 1 moha x 1 hRddAha 2 zrama 2 pralApa x 2 yakRtpAka 3 moha 3 mUrchA x 3 plIhApAka 4 manyAstambha x 4 phuphphulapAka 5 nUrchA 5 zirograha x 5 AntrapAka 6 aruci 6 kAsa x 6 pUyaraktanirgama 7 zvAsa x 7 zIrNadantatA 8. ekapakSavadha 5 bhrama 8 bhrama 1 hAridramUtra 1 zvAsa 9 tandrA 2 hAridranetratA 2 kAsa 10 saMjJAnAza 3 dAha 3 pratizyAya 11 hRdivyathA 4 tRSNA 5 mukhazoSa 12 srotoraktasruti 5 bhrama 4 atipAvazUla 13 saMraktastabdhanetratA 6 aruci 2 parvabheda 3 agnimAnya 4 tRSNA 5 dAha 6 aruci x x x x x x x x For Private and Personal Use Only

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3 moha . x x x x x x x x x x x 428 vikRtivijJAna krakaca sannipAta karkaTaka sannipAta vaidArika sannipAta (adhika vAta hIna pitta (manyavAta hIna pitta (hInavAta madhya pitta madhyakapha) adhika kapha) adhika kapha) caraka bhAvamizra caraka bhAvamizra caraka bhAvamizra 1 pralApa 1 pralApa x 1 antardAha / 1 alpazUla 2 zrama x 2 vAGsAmarthyAbhAva x 2 kaTitoda 4 3 raktavarNamukhamaNDana 3 madhyadAha 4 zleSmAzuSka 4 rujA 5 mUrchA x 5 pArzvazUla 5 bhrama 2 aruci 6 aruci x 6 hRdvyathA 6 klama 7 bhrama ., x 7 pramIlaka 7 ziraHzUla 8 manyAstambha x. 8 zvAsa 8 bastizUla 3 ziraHzUla x 9 kAsa 9 manyAzUla 4 vepathu x 10hikA 10 hRcchUla 5 zvAsa x 11 jihvAdagdhakhara / 11 pramIlaka 6 vamI x 12 galazUkAvRta 12 zvAsa x 13 kUjana 13 kAsa 4 14 zuSkavakrauSThatAlu 14 hikA x 15 tandrA 15 jADya x 16 nidrA 16 visaMjJatA x 17 hatavAka x 17 piDakA x 18 nihatadyuti 1 pratizyAya x 19 viparItecchA 2 vamI x 20 raktaSThIvana 3 Alasya 1 zItaka 4 tandrA 2 gaurava 5 aruci 3 tandrA 6 agnimAMdya 4 pralApa 5 asthizUla 6 zirazUla uparokta 6 sannipAtoM kA tulanAtmaka vivecana karane se jJAta hotA hai ki caraka ke kAzmIra pATha tathA bhAvaprakAzokta lakSaNa varNana meM koI mahattvapUrNa sAmya nahIM hai| inake sAmya baiThAne kI koI AvazyakatA bhI hameM pratIta nahIM hotii| aba hama anya granthoM meM jo 13 prakAra ke sannipAta diye haiM unakA nAmollekha karake eka eka kA varNana Arambha kreNge| ye 13 sannipAta nimna kahe jAte haiM x For Private and Personal Use Only

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jvara 426 1 zItAGga sannipAta 7 jihvakasannipAta 2 tandrika sannipAta 8 sandhigasannipAta 3 pralApakasannipAta 9 antakasannipAta 4 raktaSThIvisannipAta 10 rugdAhasannipAta 5 bhugnanetrasannipAta 11 cittavibhramasannipAta 6 abhinyAsannipAta 12 karNakasannipAta 13 kaNThakubjakasannipAta zItAGga sannipAta ( 1 ) himazizirazarIraH sannipAtajvarI yaH / shvsnksnhikkaamohkmpprlaapaiH|| klamabahukaphavAtAdAhavagyaGgapIDAsvara vikRtibhirAtaH zItagAtraH sa uktaH / / (bhAvaprakAza) (2) himasadRzazarIro vepathuzvAsahikkA / zithilitasakalAGgaH khinnnaadHprlaapH|| klamathudavathukAsaccharyatIsArazokAn / tvaritamaraNahetuH zItagAtraprabhAvAt // (Ayurveda) (3) ugratApaH klamaH zaityaM charvatIsAravegavAn / zokakampabhramazvAsazItagAtrAdyupadravAH // ( mA. ni.) (4) zarIraM himazItaM ca ccharyatIsArakampanam / kSIganADyaGgatApazca hikkaashvaasklmshrmaaH|| sarvAGgazithilo hanti zItAGgasannipAtakaH / (nityanAtha ) (5) sarvAGgaM candravacchItaM kAsaH zvAsazca jaayte| hikkA sarvAGgazaithilyaM vAntisantApamUrcchanam // atisAroGgakampazca zItAne sannipAtike / / (cintAmaNi) (6) tuSArazItaM sakalaM zarIraM prakampahikke zithilAGgatA ca / khinnaH svaraH kAsavamiprasekAH sa zItagAtraH zaraNArthamuktaH // ( vaidyavinoda) zItAGgasannipAta kA jo varNana Upara likhA gayA hai usameM zItagAtratA mukhya lakSaNa hai / isa zItagAtratA kI upamA kisI ne himagAtratA se dI hai kisI ne use candravacchIta ThaharAyA hai aura kisI ne use tuSArazIta kahA hai| rogI kA zarIra aisA ThaNDA ho jAtA hai jaise olaa| usakA tApAMza gire yA na gire para zarIra kA bAhya dharAtala ThaNDA par3atA calA jAtA hai / bhAvaprakAza meM jisa granthAntara kA uddharaNa diyA gayA hai usake anusAra zvAsa, kAsa, hikkA, moha, kampa, pralApa, klama, kapha, vAta aura dAha kI adhikatA, vamI, aMgazUla aura svaravikRti ye lakSaNa aura milate haiN| basavarAjIya se 2, 3, 4 aura 5 anukramAGka ke udAharaNa liye gaye haiN| unameM Ayurveda bhAvaprakAzIya dRSTikoNa ko adhika spaSTa karatA hai usane aGgapIr3A ke sthAna para zithilita sakalAGga kA prayoga kiyA hai, vikRta svara ke sthAna para khinna nAda batalAyA hai, davathu aura atIsAra do usake atirikta lakSaNa diye haiN| bhAvaprakAzIya moha bahukaphavAtAdAha nahIM aaye| mahattva kI bAta yaha hai ki jahA~ bhAvaprakAza meM dAha aura adhika kaphatA athavA moha ko mahattva diyA hai vahA~ isane unakA ullekha bhI nahIM kiyaa| basavarAjIya mAdhavanidAna meM ugratApa, klama, zaitya, vamana, vegavAn atIsAra, zoka kampa, bhrama, zvAsa aura zItagAtratA nAmaka lakSaNa diye gaye haiN| kahanA nahIM hogA For Private and Personal Use Only

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430 vikRtivijJAna ki ye sabhI lakSaNa sarvasAdhAraNatayA zItAGga sannipAta meM pAye jAte haiN| rogI kA zarIra ThaNDA barpha ke mAninda hotA hai para tharmAmITara para pArA 104deg taka bar3ha jAtA hai| rogI kI zvAsa bar3ha jAtI hai use ThaNDa lagatI aura hArthoM meM kaMpakapI AtI hai / bAra bAra dasta jAtA hai| isane pralApa nAmaka lakSaNa nahIM diyA jo zItagAtratA ke bAda dUsarA Avazyaka lakSaNa hai / nityanAtha ne kSINanAjyaGgatApa ye bar3e prasiddha lakSaNa kaha diye haiN| nADI kI gati zItAGgasannipAta meM kSINa hotI calI jAtI hai| pralApa aura moha isane bhI nahIM diye para zvAsa, hikkA, atIsAra, kampa, zithilagAtratA himazItazarIra ke atirikta svIkAra kiye haiN| cintAmaNi ne tathA vaidyavinodakAra ne mukhya lakSaNa zItagAtratA mAnI hai usake atirikta pahale ne kAsa zvAsa, hikkA, aMgazaithilya vamana, atisAra, ugratApa, mUrchA tathA dUsare ne kampa, hikA, zithilAGgatA, khinnanAda, kAsa, vami aura praseka ko svIkAra kiyA hai| ___ AcAryoM ne zItAGgasannipAta kA jo citraNa kiyA hai vaha suspaSTa hai / zItAGgasannipAta kA kAraNa koI bhI ho yaha asAdhya kahA gayA hai| isakI koI cikitsA nahIM aura yaha yadi sarvalakSaNayukta hai to Adhunika, AyurvedIya, homyopaithI, necuropaithI tiba kisI bhI ilAja se bacatA nhiiN| jina vaidyoM ko yA DAkTaroM ko bhrama ho ki ve zItAGgasannipAtagrasta ko bacA lete haiM unhoMne zItAGga kA vAstavika rogI dekhA hI nahIM aisA unheM svIkAra karane meM jhijhakanA nahIM caahie| isameM ugratApa ( high temperature ) atisAra, vamana, hikkA, zvAsa ( asphyxia) aura himAGgatA ke sAtha sAtha aisA klama aura zaithilya calatA hai ki rogI kI jIvanIzakti nirantara kSINa hotI calI jAtI hai| kucha loga isakA nyUmoniyA~ samajha kara ilAja karate haiM karor3oM yUniTa painisilIna, auriyomAisIna, TairAmAisIna, bRhatkastUrI bhairavAdi dene para bhI saba vyartha hotA hai| itanI zItagAtratA kA kAraNa rogI ke zarIra ke aNu aNu meM vAta aura zleSmA kA prakopa honA hai jisakI pratikriyA ke liye ugratApa hotA hai para Antra kriyA atIsAra ke kAraNa aura zvAsa kriyA zvasana kAsa hikkA ke kAraNa tathA mana para aparimita viSAda hone se rogI kI prANarakSA nahIM kI jA sakatI / 2. tandrika sannipAta (1) tandrAtIvatatastRSA'tisaraNaM zvAso'dhikaH kAsaruka / santaptAtitanurgala: zvayathunA sArddhaJca kaNDaH kphH|| suzyAmA rasanA klamaH zravaNayormAndya dAhastathA / yatra syAtsa hi tandriko nigadito doSatrayottho jvaraH // ( bhA. pra.) (2) tandrAzulajvarazleSmatRSNAcacchardikaNTharuk / utkaNThaH syAdanazanaM tAndrike zvAsakaH kaphaH / / ( mA. ni.) For Private and Personal Use Only

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jvara 431 (3) prabhUtAtandrArtijvarakApipAsAkulataro, bhavecchathAmA jihvA pRthula kaThinA knnttkvRtaa| __ atIsAraHzvAsaHklamajayaritApaHzrutirujo, bhRzaM kaNThe jADyaM zamanamanizaM taandrikgde||(aa.) ( 4 ) atitandrA jvaraH zvAsaH zramastApo'tisAratRT / sthUlakaNThayutiH zyAmA jihvaaktthinknnttkaa| zrutiH svalpA kAzceti tAndrike sAnnipAtike / / (ni.) (5) baddhapralApastandrA ca jilhA zyAmA sknnttkaa| kaThinA nidravA zuSkaM sntaapshcaatisaarkH|| zvAsaH kaNDUvivarNazca toyaM sravati locane / jvaramatyutkaTaM caiva tAndrike sAnnipAtike // (ci.) (6) prabhUtatandrAvara vegatRSNAH zyAmA kharasparzavatI ca jihvA / zvAsAtisArau bamathuH pradAhaH karNe rujastandrikasannipAtaH // (vai. vi.) sannipAta meM atizaya tandrA hotI hai / tandrA ke lie paribhASA dete hue likhA haiindriyArtheSvasamprAptirgauravaM jRmbhaNaM klamaH / nidrArtasyeva yasyehA tasya tandrAM vinirdizet / / ataH tandrA kahane se gaurava, jRmbhaNa klama aura nidrA ina sabhI kA AbhAsa ho jAtA hai| ataH jinhoMne ina lakSaNoM kA ullekha kiyA hai vaha vyartha kA piSTapeSaNa hai| tAndrika sannipAta meM tandrA, tRSNA, zvAsa, santApa, jvara ina pA~ca lakSaNoM ke atirikta jihvA, karNa aura kaNTha ke jo lakSaNa milate haiM ve ise pahacAnane meM bahuta sahAyaka hote haiN| jIbha kA raMga zyAma hotA hai sparza meM vaha zUkayukta aura khuradarI ho jAtI hai usa para kAMTe jama jAte haiM / kAnoM se rogI bahuta kama suna pAtA hai kisI-kisI ke mata se kAnoM meM pIr3A yA pradAha bhI hotA hai| galA yA kaNTha sUja jAtA hai| kabhI-kabhI to gale meM itanI sUjana hotI hai ki usake kAraNa usameM sthUlatA A jAtI hai| gale meM kapha kA bar3ha jAnA bhI eka lakSaNa hai jo mila sakatA hai| inake atirikta kAsa, dAha, zUla, soyA sA rahanA, vegapUrvaka jvara kA bar3hanA aura jvara kA nirantara banA rahanA bhI aise lakSaNa haiM jo samaya-samaya para vyakti-vyakti meM Rtu vA dezakAlInabhinnatA ke sAtha bar3hate ghaTate rahate haiN| atIsAra isa roga kA bahuta hI kaSTadAyaka upadrava hai| ___ yaha eka duHsAdhya roga hai para hai yaha sAdhya aura isase pIDita vyakti kI dhyAnapUrvaka cikitsA karane se vaha nissandeha ThIka ho jAtA hai| pralApakasannipAta (1) yatrajvare nikhiladopanitAntaroSa-jAte pralApabahulA sahasotthitAzca / kampavyathApatanadAhavisaMjJatAH syurnAmnA pralApaka iti prathitaH pRthivyAm // (bhA. pra.) 12) prlaapkmpekprjnyaanaashvaiklyvibhrmaaH| pralApaH prANahantA ca vilaapogrjvraadibhiH|| (mA.ni.) (3) kampapralApaparitApanakaNThapIDAzophapravAtapratikaH pvmaancintaa| prajJApraNAzavikalaH pracurapravAdaH kSidraM prayAti pitRpAlipadaM prlaapii|| (A.) (4) pralApakampo bhrAntizca prajJAnAzo'titApavAn / pAdazophAgapIDA ca yatra syAtprativAditA // jJeyaM pralApake cihna sannipAto nikRntakaH / / (ni. nA.) (5) kampapralApasantApA vAtazleSmaprajAyate / hikAtApajvarazcaiva pralApe sAnnipAtike // (ci.) (6) kampaH pralApaH paritaptamaMgaM dAho jvarasyAbhyadhiko hi vegaH / saMjJAvinAzo vikalAGgatA ca pralApako'sAdhyatamo matazca // (vai. ni.) For Private and Personal Use Only

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432 vikRtivijJAna pralApaka sannipAta eka asAdhya roga hai isameM rogI jo mana meM AtA hai vaisA pralApa karatA hai aNTa-saNTa bolane lagatA hai / isakA kAraNa ugratApa atitApa, paritApa yA santApa hotA hai jo vAta aura zleSmA ke prakopa se utpanna hotA hai / pralApa ke sAtha kampa AtA hai| donoM hAtha khar3e khar3e kAMpane lagate haiM / eka vRddha vaidya kA to yahA~ taka anubhava hai ki jisa sannipAta pIDita ko kampa A jAya vaha bacatA nhiiN| tIsare isameM rogI ko hoza nahIM rahatA visaMjJatA, prajJAnAza yA saMjJAnAMza mahattva pUrNa lakSaNa hai / rogI meM vikalatA yA becainI itanI bar3ha jAtI hai ki vaha idhara se udhara hilatA rahatA hai kabhI kapar3e phAr3atA hai kabhI khAMsatA hai kabhI apanI jIbha kATa letA hai aura kabhI vaise hI hAtha idhara se udhara hilAtA rahatA hai / zarIra bahuta garma hotA hai| jvara kA vega bar3hatA ghaTatA bhI pAyA jAtA hai| pairoM para zophAdi lakSaNa bhI pAye jA sakate haiN| . raktaSThIvI sannipAta ( 1 ) niSThIvo rudhirasya raktasadRzaM kRSNaM tanau maNDalam lauhityaM nayane tRSA rucivamizvAsAtisArabhramAH / AdhmAnaM ca visaMjJatA ca patanaM hikkAGgapIDA bhRzaM raktaSThIvini sannipAtajanite liGgaM jvare jAyate // ( bhA. pra. ) (2) raktacchardibhramaravAsA ajJAnAdhmAnahikkikA / AraktamaNDalaM zyAmaM raktaSThIvI yamAlayam // ( mAdhava ) ( 3 ) raktaSThIvIjvaravabhitRSA mohazUlAtisArAH / hikkAdhmAnabhramaNadavathuzvAsasaMjJApraNAzAH // zyAma raktAdhikatarasanA maNDalotthAnarUpA / raktaSThIvI nigadita iha prANahantA prasiddhaH // ( A.) (4) raktaSThIvanasammUrcchAjvaramohatRSNAbhramAH / vAntirhikkAtisArazca saMjJAnAzI vyathA zvasaH // maNDalA zyAmaraktAzca dAhaH syAllakSaNAni vai / jJAtavyaM sannipAto'yaM raktaSThIvI tu ghAtakaH // ( ni. nA. ) ( 5 ) jihvoSThasphoTanAzcaiva raktaM sravati vegataH / jvaratRSNAmohamUrcchAhikkAtIsAravibhramAH || kAsazirobhramaH kampo jihvA zyAmA sakaNTakA / Acharya Shri Kailassagarsuri Gyanmandir raktaSThIvI sannipAto vizeyazcAtibhISaNaH // ( ci. ) (6) raktaSThIvI bhavati manujo yatra tRSNA pramohaH / zvAsaH zUlaM bhramavamimadA''dhmAnasaMjJApraNAzAH // zyAvA raktA tanuratitarAM dAruhikkAtisArA / raktaSThIvI sumunibhiruditaH prANahA sannipAtaH // uparokta uddharaNoM se hama isa niSkarSa para pahu~cate haiM ki yaha sannipAta atyanta bhISaNa aura yamAlaya taka le jAne vAlA hai / isa raktaSThIvI sannipAta kA atyanta spaSTa citra dekhane ko milatA hai / AcAryoM ne jo varNana diyA hai vaha paryApta bhI milatA julatA hai jo spaSTataH yaha pragaTa kara detA hai ki isa roga se For Private and Personal Use Only

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jvara 433 pIDita vyakti ke lakSaNoM ke sambandha meM vibhinna AcAryoM meM mataikya adhikAMza dekhane meM AtA thaa| ___raktaSThIvana ( Haemoptysis) isa roga kA pramukha lakSaNa hai / rakta kA srAva mukha ke dvArA hotA hai mukha meM rakta phuphphusa tathA udara donoM meM se kisI bhI sthala se AsakatA hai para adhika sambhAvanA jaisA ki anya lakSaNoM ke dekhane se pratIta hotI hai vaha hai phuphphusa kii| ___raktaSThIvana ke sAtha hI sAtha lAla gahare yA zyAmatA lie patale maNDaloM kI utpatti tvacA meM honA eka mahattva kA lakSaNa hai| camar3I para itastataH ye pAye jAte haiN| tIsarA lakSaNa jihvA kA phaTI huI honA tathA usase rakta kA cUnA athavA usakA kAlA lAla varNa ho jAnA tathA usa para kaoNToM ke jamane kA hai| hicakI eka aisA lakSaNa hai jise pratyeka nidAnavettA ne isa roga meM batalAnA apanA karttavya mAnA hai| bhrama yA cakkara AnA tathA tRSNA arthAt pyAsa kA laganA ye do aise lakSaNa haiM jo raktasrAva yA raktaSThIvana ke pariNAmasvarUpa dekhe jAte haiN| jyoM jyo. zarIra meM rakta kama hotA calA jAtA hai sira ghUmane lagatA hai aura pyAsa bar3hane laga jAtI hai| visaMjJatA yA saMjJAnAza bhI raktaSThIvana prAcurya ke pariNAma kA mUrtarUpa hotA hai| zvAsa kI kriyA kI vRddhi hokara jaldI jaldI zvAsa kA calanA bhI raktasrAva kA hI eka pariNAma huA karatA hai| sAtha hI udara meM bhI vikAra kA prakopa adhika rahatA hai| isakA pramANa vamana, atisAra, aruci, tathA AdhmAna nAmaka lakSaNoM ke kAraNa mila jAtA hai| zarIra meM zUla rahanA, A~khoM meM jalana par3anA, zarIra kA patita ho jAnA, dAha kA rahanA, mUrchA yA moha kI avasthA kA pAyA jAnA, ye saba lakSaNa bhI isa roga meM kama yA adhika rUpa meM avazya dekhane meM Ate haiN| vaidyavinoda ne mada kA bhI ullekha kiyA hai| __ raktaSThIvana kA nirantara honA aura usake pariNAmasvarUpa vibhinna gambhIra lakSaNoM kA utpanna ho jAnA aura usake kAraNa rogI kI yathAsamaya taka pahu~cane kI sthiti AjAnA asvAbhAvika ghaTanAe~ nahIM haiN| bhugnanetra sannipAta (1) bhRzaM nayanavakratA zvasanakAsatandrA bhRzaM prlaapbhdvepthushrvnnhaanimohaastthaa| puro nikhiladoSaje bhavati yatra liMga jvare purAtanacikitsakaiH sa iha bhugnanetro mataH // ( bhA.) (2) akSibhaGgaH zruterbhaGgaH pralApazvAsavibhramAH / bhugnadRSTiM vijAnIyAdasAdhyaM kaNThazoSavat // (mA.) (3) jvarabalApacayazrutizUnyatA shvsnbhgnvilocnmohitaaH| __ pralapanabhramakampanazokavAn tyajati jIvitamAzu sa bhugnadRk // ( A.) 37, 38 vi0 For Private and Personal Use Only

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434 vikRtivijJAna (4) zvasanaM locane bhugne zrutizUnyaM jvarAdhikam / mohaH pralApanaM kampo bhramo nidrApi lakSaNaiH / jJAtavya bhugnanetro'yaM sannipAtaH sudAruNaH // ( ni. vA. ) Acharya Shri Kailassagarsuri Gyanmandir (5) bhugnaM vilocanadvandvaM bASpaM sravati santatam / nirIkSaNena rahitaM pralApabhramakampanam / jJAtavyo bhugnanetro'yaM sannipAtaH sudAruNaH // ( ci. ) (6) smRtizUnyatA jvaravivRddhiratizvasanaM vibhugnatarale nayane / bhramakampanapralapanAni mRtiH kathito vibhugnanayano munibhiH // ( vai. vi . ) netra sannipAta kA pramukha lakSaNa netroM kI bhugnatA, TeratA ( strabismus ) yA vakratA hai| rogI kI putaliyA~ tirachI car3ha jAtI haiN| jvara bahuta teja ho jAtA hai / usI ke kAraNa madhyamastiSka meM vikRti Ane se yaha lakSaNa banA karatA hai / isake atirikta rogI kI zravaNazakti bhI naSTa ho jAtI hai| zvAsa kI gati bar3ha jAtI hai| rogI pralApa karatA rahatA hai tandrA yA moha use hotA hI hai vaha kisI ko pahacAna bhI nahIM pAtA / hAtha pairoM meM kampa spaSTataH prakaTa hotA hai / bhrama, zoka, bala kI kamI, kAsa, mada, nidrA Adi aise lakSaNa haiM jo kahIM prakaTa hote aura kahIM nahIM bhI milate haiM / abhinyAsa sannipAta (1) doSAstIvratarA bhavanti balinaH sarve'pi yatra jvare, moho'tIva viceSTatA vikalatA zvAso bhRzaM mUkatA / dAhacikkaNamAnaJca dahano mando balasya kSayaH so'bhinyAsa iti prakIrtita iha prAjJairbhiSagbhiH purA // (2) karapAdatale dAhaH prajJAhAnizca jAyate / jAnIyAttamabhinyAsamAyurvedavizAradaH // ( mA. ) (3) doSatrayasnigdhamukhatvanidrAvaikalya nizceSTanakaSTavAcaH / balapraNAzaH zvasanAdinigraho'bhinyAsa ukto nanu mRtyukalpaH // ( A. ) (4) tridoSaM ca mukhaM snigdhaM nidrAvaikalyakampanam / nizceSTanamatizvAsamandAgnibalahAnayaH / mRtyutulyaM hyabhinyAsaM sannipAtaM sulakSayet // ( ni. nA. ) (5) doSatrayaM jvarazvAsasnigdhAsyamatinidratA / aGgavaikalyatApazca balahAnistRSA jaDaH // atyutkaTaH sannipAto hyabhinyAsaH sudAruNaH // ( ci. ) (6) nidrAtyayaH zvAsacalaprakopAnizcetano naSTavapurgatizca / brUte hi kaSTaM vikalatvamaGge'bhinyAsa uktaH sa tu mRtyutulya: (vai. vi . ) mRtyutulya isa sannipAta meM tInoM doSa apanI utkaTAvasthA meM hote haiM jisake kAraNa atyadhika nidrA kI arthAt behozI kI sthiti meM rogI dekhA jAtA hai / vaha naSTa ceSTArahita jaisA par3A rahatA hai, zvAsa kI gati bahuta tIvra hotI hai aisA lagatA hai mAno rogI kA aGga aGga dukha rahA ho aura vaha bahuta bar3I becainI kA anubhava kara 1 rahA ho / bola pAtA nahIM jvara atyadhika umra rUpa meM hotA hai, bala kA itanA adhika kSaya ho jAtA hai ki use bolane kI sAmarthya nahIM raha pAtI / kisI kisI ko kampa, mandAgni, tRSA aura jaDatA bhI mila sakatI hai / jias sannipAta ( 1 ) tridoSajanite jvare bhavati yatra jihvA bhRzaM vRtA kaThinakaNTakestadanu nirbharaM mUkatA / zrutikSatibalakSatizvasanakAsasantaptayaH purAtanabhiSagvarAstamiha jihnakaM cakSate || ( bhA. pra. ) For Private and Personal Use Only

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435. (2) zvAsakAsaparitApavihvalo mIlitAkSi ca kaphAvRtaM mukham / nizvasanbadhiramUkalakSaNazcAntakRdbhavati yaH sa jihvakaH // (mA.) (3) zvasanakAsaparitApavihvalaH kaThinakaNTakavRtA ca jibikaa| badhiramUkabalahAnilakSaNo bhavati kaSTatarasAdhyajihvakaH // (A.) ( 4 ) kaNTakA kaThinA jihvA kAsazvAsAtivihvalaH / mUko badhiratA tApo balahAnirvilakSaNaiH / jihvakaH sannipAto'yaM kaSTasAdhyaM vidurbudhAH // (ni. nA.) (5) nizvAso vegasantApau kAsaH ktthinjihikaa| kaNTakA zyAmavarNA ca mUkatvaM badhiro jddH| jihvakaH sannipAto'yamasAdhyaM ca vinirdizet // (ci.) .. (6) zvAsakAsaparItApavihvalaH knnttkairvivRtknntthjihvkH| mUkatA badhiratA balakSayaH kaSTa eva kila jihvakaH smRtaH // (vai. vi.) jihvaka sannipAta eka tridoSaja, para kaSTasAdhya vyAdhi hai| isameM jvara kA tApa bahuta adhika ho jAtA hai| jIbha kaThina kA~ToM se pUrNa aura zyAmavarNa kI ho jAtI hai| ye kAMTe kaNThataka vyApta hote haiN| jvara ke vega kI tIvratA ke kAraNa rogI kA sunanA tathA jihvA meM svayaM atyadhika kaSTa hone ke kAraNa bolanA banda ho jAtA hai| isake sAtha hI zvAsa kI gati bar3hI huI hotI hai| khA~sI bhI sAtha hI sAtha calatI rahatI hai rogI atyanta vihvala aura durbala ho jAtA hai| sandhiga sannipAta (1) vyathAtizayitA bhavecchavayathusaMyutA sandhiSu prabhUtakaphatA mukhe vigatanidratA kAsaruk / samastamiti kIrtitaM bhavati lakSaNaM yatra jvare tridoSajanite budhaiH sa hi nigadyate sandhigaH // (bhA. pra.) ( 2 ) aGgazopho vAyukaphau tndraashuulprjaagraaH| sandhikAkhye sannipAte balahAnizca jAyate // ( mA. ni.) ( 3 ) pUrvarUpakRtazUlasambhavaM zophavAtabahuvedanAnvitam / zleSmatApabalahAnijAgaraM sannipAtamiti sandhikaM vadet // ( A.) ( 4 ) zarIraM pUrvavacchUlaM zophavAtaM ca vednaa| kaphastandrA matA paJca sandhike sAnnipAtike / / (ni. nA.) (5) sadAsyaM zleSmaNApUrNa shuulnaasaativednaa| zokaH syAllakSaNaM zeyaM sandhike sAnnipAtike // (ci.) (6) zUlaM ca zopho jaThare gurutvaM srastAGgatA sandhiSu vedanA ca / balakSayo vAtakaphaprakopo nidrAtyayaH sandhigasannipAte // (vai. vi.) isa sannipAta kA mukhya lakSaNa sandhiyoM meM zopha aura zUla ke sAtha vAtakapha ina doSoM kI ulbaNatA se utpanna tIvra jvara kA honA hai| rogI kA aMga aMga kasakatA hai| nidrA use bilkula nahIM AtI, darda se DakarAtA rahatA hai / kabhI kabhI mukha meM kapha bhara jAtA hai| rogI kA bala kSINa ho jAtA hai| kabhI kabhI tandrA, kAsa, nAsAzUla, udara meM bhArIpana yA thakAvaTa kA anubhava hotA hai| yaha sAdhya roga hai| For Private and Personal Use Only

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vikRtivijJAna antaka sannipAta (1) yasmillakSaNametadasti sakalairdoSairudIte jvare 'jasraM mUrddhavidhUnanaM sakasanaM sarvAGgapIDAdhikA / hikkAzvAsakadAhamohasahitA dehe'tisantaptA vaikalyaJca vRthA vacAMsi munibhiH saMkIrtitaH so'ntakaH // (bhA.pra.) (2) antrdaahshirHkmphikaarodnvibhrmaaH| tamantakaM vijAnIyAdasAdhyazcApratikriyaH // (mA.) (3) dAhamohaziraHkampahikkAkAsAGgapIDanam / santApazcAtmanozeyazcAntake sAnnipAtake // (A.) (4) dAhaM karoti paritApamAtanoti mohaM dadAti vidadhAti ziraHprakampam / / hikAM karoti kasanaM ca samAtanoti jAnIhi taM vibudhavarjitamantakAkhyam // (ni. vA.) (5) sadAhamohastApazca ziraHkampaH pralApanam / ____ vAntihikkA jvarazcaiva hyantake sannipAtake ||(ci.) (6) dAhaH prakampo bhRzamuSNamaGgaM mUrdhnaH prakampaH kasanaM ca hikkaa| zvAsapramohau satataM ca yasmiMstamantakAkhyaM vibudhairvivaya'm / / (vai. vi.) antaka sannipAta eka asAdhya vyAdhi hai| isakA pramukha lakSaNa jise sabhI zAstrakAroM ne svIkAra kiyA hai vaha hai sira kA dhunnaa| rogI apane sira ko hajAroM bAra idhara se udhara karatA hai| ziraH kampa yA sira kA kA~panA bhI usI ko kahA jAtA hai| rogI ko tInoM doSoM kI ulbaNatA ke kAraNa ati tIvra jvara car3hatA hai / dUsarA mahattva pUrNa lakSaNa hai dAha vA antardAha / rogI dAha se jalatA rahatA hai para isa dAha meM pyAsa mahattvapUrNa nahIM rahatI kyoMki usake bAre meM kisI bhI nidAnakAra ne ullekha nahIM kiyA hai / isakA kAraNa hai moha kI adhikatA; rogI mohita sA par3A rahane se pAnI nahIM mAMga pAtA / tApAMza 104 se nIce nahIM rhtaa| hicakI aura khA~sI isa roga kA bahuta bar3A upadrava hai| hicakI kisI davA se zAnta nahIM hotI aura mRtyukAla taka rahatI haiM / zvAsa, rodana, bhrama, vamana, pralApa, vikalatA aura prakampa ke lakSaNa bhI kisI-kisI meM dekhane meM Ate haiN| rugdAha sannipAta (1) dAho'dhiko bhavati yatra tRSA ca tIvrA zvAsapralApavirucibhramamohapIDAH / manyAhanuvyathanakaNTharujAzramazca rugdAhasaMjJa uditastribhavo jvaro'yam // ( bhA. pra.) (2) zophapralApamohAgnimAndhaM zAntitRSAbhramaH / rugdAhe zvAsazUlau ca kaNThamanyArujA tathA // ( A.) (3) mohastApaHpralApazca vyathA kaNThe bhramaH kumaH / vedanAti tRSA jADyaM zvAsastvetaizca lkssnnaiH| kaSTAtkaSTataraM zeyaM rugdAhasannipAtikaH / / (A.) (4) pralApaparitApanaprabalamohamAndhazramAH paribhramaNavedanAvyathitakaNThamanyAhanuH / nirantaratRSAkaraH zvasanazUlahikkAkulaH sakaSTatarasAdhano bhavati hanti rugdAhakaH // (ni.nA.) (5) pralApatApau mohazca kaNThe vai vedanAbhramaH / vedanAtitRSAkAso jADyakampapralApanam / svedo lalATe kaNThe ca rugdAhe sAnnipAtike // For Private and Personal Use Only

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37. jvara (6) pralapanaparitApabhramAntimohaprakampA bhramaNadahanamAndhaM kaNThamanyAgrahazca / zvasanakasanazalaM vyAkulatvaM tRDatirbhavati mRtirahorugdAhake sannipAte / ( vai. vi.) rugdAha sannipAta kA mukhya lakSaNa kaNTha meM zUla yA kaNThagraha kA honA hai| hanu aura manyA ke pradeza meM zUla kA honA bhI isakA eka mahatva kA lakSaNa hai| rogI ko dAha yA tApa bahuta lagatA hai jisake pariNAmasvarUpa sira cakarAtA rahatA hai tathA pyAsa khUba lagatI hai / zvAsa kI gati bar3hI huI milatI hai aura pralApa ( delirium) use barAbara rahatA hai| rogI arddhamUJchita vA moha se vyApta par3A rahatA hai| usake zarIra meM kasa kara darda hotA rahatA hai| vaha thakA sA, agnimAndya se pIDita sA, jaDatA yukta, bhI dekhA jA sakatA hai| hicakI, khAMsI, kampa, vyAkulatA, mAthe aura kaNTha para svedAgamana, aruci Adi lakSaNa bhI kisI kisI meM dekhe jAte haiN| yaha sannipAta atyanta kaSTasAdhya yA asAdhyasvarUpa kA hotA hai| isameM rogI ko pratyeka kSaNa dAha yA tApa vaha bhI kaNTha yA hanu vA manyApradeza meM bahuta milatA hai| cittabhrama sannipAta (1) gAyati nRtyati hasati pralapati vikRtaM nirIkSate muhyet / ___ dAhavyathAbhayArto narastu cittabhrame jvare bhavati / / ( bhA. pra.) (2) pralApo nartanaM hAsyaM nAsApIDAmadabhramAH / vaikalyaM kopanaM gAnaM dussaadhyshcittvibhrmH|| (mA.) (3) moho mado bhramastApo hAsyagItapralApanam / nRtyaM vikalatA pIDA vikaTAkSo vicakSaNaH / / ___ lakSaNaiH sannipAto'yaM jJAtavyazcittavibhramaH / ( A.) (4) yadi kathamapi puMsAM jAyate kAyapIDA bhramamadaparitApA mohvaiklybhaavau| vikaTanayanahAso nRtyagItapralApo hyabhidazati na sAdhya kehi cittabhramAkhyam // (ni. nA.) (5) sarvAvayavavaikalyaM vAtapittaprakopanam bhramamohau bhrukuTilo gItanRtyapralApanam / ____ mahAghoraH sannipAto jJAtavyazcittavibhramaH // (ci.) (6) bhramamadaparitApA mohavaikalyabhAvA vikalanayanahAsyaM gItanRtyapralApAH / zvasitamadhikametalakSaNaM yatra sarva bhavati ca tamasAdhyaM kepi cittabhramAkhyam // (vai. vi.) cittavibhrama sannipAta kucha ke mata meM sAdhya aura kucha ise asAdhya mAnate haiM / avazya hI yaha kaSTasAdhya vyAdhi hai| yaha unmAda se milatI julatI hone para bhI usase pUrNataH pRthaka aura spaSTa vyAdhi hai| isameM manovegoM kI prabalatA ke kAraNa kabhI rogI gAtA hai, kabhI nAcatA hai, kabhI ha~satA hai tathA kabhI pralApa karane lagatA hai / usake netra kuTila yA vikRta dekhate haiN| yaha eka sAnnipAtika jvara hai jaba ki unmAda eka anya vyAdhiyoM kI bhA~ti vyAdhi hai jisameM jvara kA honA Avazyaka nahIM / moha, mada, bhrama aura vikalatA ye cAra lakSaNa isa rogI ko bahuta kaSTa dete haiN| rogI bhayArta bhI ho sakatA hai / dAha, nAsApIDA, zvAsAdhikya Adi lakSaNa bhI mila sakate haiM / isa sannipAta meM vAta aura pitta ina doSoM kI adhika ulbaNatA dekhI jAtI hai| For Private and Personal Use Only

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438 vikRtivijJAna . karNika sannipAta .. (1) doSatrayeNa janitaH kila karNamUle tIvrA jvare bhavati tu zvayathurvyathA ca / ___ kaNThagraho badhiratA zvasanaM pralApaH prasvedamohadahanAni ca karNikAkhye // (2) jvarogratApakarNAtiMgranthiH krodhaHpralApanam / zvAsakAsaprasekAH syuH karNikaH kRcchrasAdhyakaH // (mA. ni.) (3) pralApazrutihAsakaNThagrahAGgavyathAzvAsakAsaprasekaprabhAvam / jvaraM tApakarNAntayorgallapIDA budhAH karNikaM kaSTasAdhyaM vadanti // (A.) (4) jvaraH karNAntazophazca zvAsakampapralApanam / svedaH kaNThagrahastApo hallAso'GgavyathApi ca // karNike sannipAte ca lakSaNAni ca pnndditaiH| (ni. nA.) (5) pralApajihvAsphuTanahikkAkAsAGgakampanam / karNAntazophastApazca karNike sAnnipAtike // (ci.! (6) kaNThagrahAyAsazarIrapIDA sntaapkaasshvsnprsekaaH| zophazca zUlaM bahukarNamUle sa kaSTasAdhyaH kila karNikAkhyaH // ( vai. vi.) karNika sannipAta meM pramukhatama lakSaNa hai karNa ke mUla meM sthita granthi ( parotid gland ) meM zotha ho jAnA aura zUla honaa| sAtha meM tIvra jvara rahatA hai| isa granthi meM zotha kA pariNAma kaNThagraha yA kaNTha ke avaruddha hone meM bhI par3a jAtA hai jisake pariNAmasvarUpa zvAsa kI prati minaTa gati bar3ha jAtI hai tathA kAna para bhI prabhAva par3ane se rogI kI zravaNazakti meM bhI kamI A jAtI hai| roga kI kaThina avasthA ke kAraNa pralApa (DilIriyama) kA pAyA jAnA asvAbhAvika ghaTanA nahIM hai api tu pratyeka karNikasannipAtagrasta rogI vvara kI tIvratA ke kAraNa pralApa karatA huA pAyA jAtA hai| lAlAgranthi zotha ke kAraNa mukha meM prasekAdhikya bhI dekhA jA sakatA hai| prasveda, moha, dAha, krodha, kAsa, aGgapIDA, hRllAsa, jihvAsphuTana, hikkA, kampa, zrama tathA zotha ke lakSaNa vibhinna rogiyoM meM kamI bezI ke sAtha dekhe jA sakate haiN| kaNThakubja sannipAta ( 1 ) kaNThaH zUkazatAvaruddhavadatizvAsaH pralApo'ruci ho deharujA tRSApi ca hanustambhaH ziro'rtistathA / moho vepathunA saheti sakalaM liGgaM tridoSajvare yatra syAtsahi kaNThakubja uditaH prAcyazcikitsAbudhaiH // ( bhA. pra.) ( 2 ) hanukaNThazirazzUlo mohkmpjvraanilaaH| mUrchAdAhapralApAH syurityAdyA kaNThakubjake // (mA. ni.) . (3) ziro'rtikaNThagrahadAhamohakampajvarAraktasamIraNArtiH / hanugrahastApavilApamUrchAH syAtkaNThakubjaH khalu kssttsaadhyH|| ( A.) For Private and Personal Use Only

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jvara ( 4 ) kaNThagraho jvaro mUrcchA dAhaH kampo vilApanam / mohastApaH ziro'rtizca vAtArtaH * pralapan zvasan // ( ni. nA. ) (5) mohadAhauH ziraHkampaH kaNThakubjazca mUkatA / vilApastapanaM mUrcchA tvaGgazaithilyakaM kaphaH // chardihikkA gumphanaM ca hyuttamAGgavyathA tataH / sa eva sannipAto'yaM jJAtavyaH kaNThakubjakaH // ( ci. ) Acharya Shri Kailassagarsuri Gyanmandir ( 6 ) zirovyathA dAhahanugrahAzca santApamUrcchAgalarodhapAkAH / pravedanAvAtabhavAH pralApAH sa kaSTasAdhyaH kila kaNThakubjaH // ( vai. vi . ) kaNThakubja sannipAta kA mukhya lakSaNa hai tIvra tridoSaja jvara ke sAtha kaNTha kA * ugra pAka honA jisake kAraNa galarodha honA aura aisA laganA mAno saikar3oM zUkoM se kaNTha AvRta ho gayA ho| rogI ko atyanta dAha aura sira meM vedanA hotI hai isake kAraNa rogI vilApa yA pralApa karane lagatA hai / moha aura kampa ye do lakSaNa bhI isa roga meM Arambha se hI sAtha rahA karate haiM / kabhI kabhI rogI mUcchita bhI hotA huA dekhA jAtA hai / gale meM pAka ke sAtha hI sAtha hanugraha bhI ho sakatA hai / vAtikazUla aMga aMga meM mila sakatA hai / zarIra kA tapta yA paritapta honA bhI eka svAbhAvika sI ghaTanA hai / aruci, tRSNA, mUkatA, aGgazaithilya, bamana, gumphana, hikkA aura zvAsa ke lakSaNoM meM se bhI koI dekhane meM A sakatA hai / inake sUtra nIce diye jAte haiM: uparyukta 13 sannipAtoM ke atirikta anya granthoM meM nimnalikhita sannipAtoM kA aura bhI nAma AyA hai :: 1. kumbhIpAka, 2. prorNunAva, 3. pralApI, 4. antardAha, 5. daNDapAta, 6. antaka, 7. eNIdAha, 8. ajaghoSa, 9. bhUtahAsa, 10. yantrApIDa, 11. saMnyAsa, tathA 12. saMzoSI / -- ( 1 ) kumbhIpAka - ghoNAvivarajhara dUbahuzo gAsitalohitaM sAndram | viluNThanmastakamabhitaH kumbhIpAkena pIDitaM vidyAt // 436 nAsA se kAle lAla raMga ke gADhe rudhira kA bahanA tathA mastaka ko idhara udhara luNThita karanA isa sannipAta ke do hI mahattvapUrNa lakSaNa mAne jAte haiM / ( 2 ) prorNanAva --- utkSipya yaH svamRGgaM kSipatyadhastAnnitAntamucchvasiti / taM prorNunAvajuSTaM vicitrakaSTaM vijAnIyAt // uTha uTha kara bhUmi para gira par3anA aGgoM ko paTakanA tathA jora jora se ucchvAsa lenA prorNunAva sannipAta ke mukhya lakSaNa haiM / (3) pralApI - svedabhramAGgabhedAH kampo davathurvabhirvyathA kaNThe / gAtraJca gurvatIva pralApijuSTasya jAyate liGgam // For Private and Personal Use Only

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440 vikRtivijJAna sveda, bhrama, zarIra meM bhedana sadRza zUla, kampa, A~khoM meM jalana, vamana, kaNTha meM vyathA, zarIra kA bhArIpana ye 8 lakSaNa pralApI sannipAta meM pAye jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir ( 4 ) antardAha--antardAhaH zaityaM bahiH zvayathuraratirapi tathA zvAsaH / aGgamapi dagdhakalpaM so'ntardA hArditaH kathitaH // zarIra ke bhItara dAha, bAhara zaitya, zotha, arati, zvAsa, zarIra dAha ke kAraNa jalatA huA sA ina 6 lakSaNoM se antardAha sannipAta pahacAnA jA sakatA hai / (5) daNDapAta - naktandivA na nidrAmupaiti gRhNAti mUDhadhIrnabhasaH / utthAya daNDapAtI bhramAturaH sarvato bhramati // nidrA kA na AnA, mUDhadhI hokara AkAza ko hAtha se pakar3ane kA yatna karanA tathA bhrama se Atura honA ina 3 lakSaNoM dvArA daNDapAta sannipAta kA patA calatA hai / ( 6 ) antaka - sampUryate zarIraM granthibhirabhitastathodaraM marutA / zvAsAturasya satataM vicetanasyAntakArtasya // yaha antaka pichale antaka se bhinna hai / isameM sampUrNa zarIra meM gA~The nikalatI haiM, vAyu kA AdhmAna peTa meM vyApta rahatA hai, rogI kI zvasana kriyA bar3ha jAtI hai tathA vaha visaMjJatA ke kAraNa nizceSTa par3A rahatA hai / granthi, AdhmAna, zvAsAdhikya tathA cetanAhInatA ke cAra lakSaNoM se isakA patA calatA hai / (7) aiNIdAha - paridhAvatIvagAtre rukpAtre bhujaGgapataGgahariNagaNaH / vepathumataH sadAhasyaiNIdAhajvarArtasya // isa sannipAta meM rogI ke zarIra meM hirana, patana, sA~pa daur3a rahe hoM aisA use anubhava hotA hai tathA jvara, dAha aura kampa hotA hai / ( 8 ) hAridraka - yasyA'tipItamaMgaM nayane sutarAM malastato'pyadhikam / dAho'tizItatA bahirasya sa hAridrako jJeyaH // zarIra, A~kheM aura mala jisakA eka se bar3ha kara dUsarA adhika pIlA ho jAve andara dAha aura bAhara zaitya ho vaha hAridraka sannipAta kA rogI jAnanA cAhie / ( 9 ) ajaghoSa - chagalakasamAnagandhaH skandharujAvAnniruddhagalarandhraH / ajaghoSasannipAtAdAtAmrAkSaH pumAn bhavati // ajaghoSa sannipAta meM zarIra se bakare kI gandha AtI hai / kandhoM meM darda hotA hai galA ruMdha jAtA hai aura A~kheM tAmra varNa kI ho jAtI haiM / (10) bhUtahAsa - zabdAdInadhigacchati na svAnviSayAnyadindriyagrAmaiH / hasati pralapati paruSaM sa jJeyo bhUtahAsArtaH // indriyA~ jaba apane viSayoM ko grahaNa karane meM asamartha ho jAveM aura rogI kabhI jora se ha~se vA rove to use bhUtahAsAta sannipAta se pIDita mAna lenA cAhie / For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra vikRtivijJAna - pRSTha 411 ( ka ) tandrika sanipAta sandhika lakSaNa tIvra jvara ke sAtha zarIra kI pramukha lakSaNa sandhiyoM meM zodha tathA atyadhika vedanA doSolvaNatA tRSNA dAha zvAsa kAsa pralApa kampa tandrA nidrA jAgaraNa zrama krama bhrama vamana atIsAra 1 jaDhatA prasveda praseka agnimAndha vAtakapha + ++++ mada moha mUrcchA vikalatA bedanA saMjJAnAza AdhmAna balakSaya +++ tApa + zaitya aGgazaithilya kaNTharuk ra-zyAmA la-zUkAvRta nA-kaThinA karNazUla, vikRta netra + ++++++ ++ +++++ r + tIvra jvara ke sAtha atyadhika tandra vAtakapha +++++ ++ +++++ + ++ ++ +++++ ++ ++++ ++++ ++++ ++++ ++++ ++++ pralApa 3 tIvra jvara ke sAtha pralApa bahulatA vAtakapha + + ++++++ ++ www.kobatirth.org citavanama jihvaka ++++ 4 tIvra jvara ke sakSa nartaka gAyana, zasya aura prA bahulatA ++++++++++++ vAtakapha + + +++++ ++++ +++++ +++ +++++ +++ ++ +++++ 5 +++++ tIvra jvara ke sAtha jilhA kaThina kaNTaka | se AvRta aura usake kAraNa mUkatA vAtakapha +++++ ++ ++++ ++++ ++++++ ++++ ++++++ karNika + tIvra ubara ke sAtha karNamUlagranthi meM zodha aura vedanA bAhulya vAtakapha + ++++++++++++++++ ++++ ++ + + + + +++ + Acharya Shri Kailassagarsuri Gyanmandir ++ rugdAha ++ +++ 19 For Private and Personal Use Only pitta ++++++ tIvra jvara ke sAtha tIvra jvara ke sAtha atyadhika dAha, nirantara ziravidhU hanumanyA aura kaMTha | meM ativyathA nana yA ziraHkampa ++++ + ++++++ +++++++++++ + ++++++ + +++++ + + +++++++++++ ++ antaka ++++++++++ 8 + ++++++ pitta ++ + ++++++ + + +++++++++++ ++ + +++ +++++ +++++ bhunanetra ++ +++++ + + ++ 9 tIvra jvara ke sAtha vakradRSTitA vAtapitta +++++ + +++ +++ ++++ ++++++

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-sannipAtabhedapradarzikAtAlikA___ kaNThakubja | raktaSThIvI zItAGga / abhinyAsa | vibhu phalgu makarI / visphuraka / zIghrakArI / kaphphaNa bhAlukitantriya samipAta vizeSa .. aruci tIvra jvara ke sAtha tIvra jvara ke sAtha zItajvara kSudhA jvara, glAni / varaghora bahijvara tIvra jara ke sAtha jvara antardAha | antaHvara parvabheda | zIta jvara gaura pArzvanigraha ziro- pArzvazUla, dRSTikSaya, ziraHzUla tathA raktaSThIvana aura tIvra jvara ho yA naha atIva moha yA para bahiHzIta dakSiNa gaurava Alasya piNDikoTeSTana bhava gaurava nAbhipArzva | Alasya aroca zUkAvRta kaMTha aura tvacA para lAla nidratA ceSTAnAza tAluzoSa - pArzvatoda urograha manyAstambha kaTi- sAda saraktaviNamUtra zUla svinAzupraH tRpti hRdgrahaSThIvaH galarodha hanustambha zItala zarIra makatA khigdhamuSNataH cakatte / ziraHzUla kaNDU vastizUla | gaTastimAla vRddhi srotoM meM rakta mukhamAdhurya ___ kA pravartana vAtapitta / pittavAta / vAtapitta tridotra vAtapitta / kaphapitta | kaphavAta / vAta pitta kapha + +++++ +++ +++ +++ +++ +++ +++ ++++++ ++ +++ +++ +++ + ++ +++++ +++++ +++++ +++ +++ ++++ +++ 1 +++ + +++++ +++ - - +++ -- - --- +++ - ++++++ +++ +++++ +++ +++++ +++ +7 ++++ ++++++ + ++ + | ++++ ++++++ +++++ ++++ ++ + / +++++ +++++ +++ +++ +++++ + +++ +++++. +++ ++++ +++ ++ | + + ++++ ++ ++++ +++++ +++ +++ + / + ++++ + 11 +++ +++ +++ +++ For Private and Personal Use Only

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/ pAlaka yAmya vaivArika vasavarAjIyakAra ke dvArA kathita sannipAta vizeSa | antardAda vizeSa manyAstambha ziro- hRddAha yakRtplI / raktamukhamaNDala kaTitoda alpazUla graha hRyAthA chidroM hAntraphuphphusapAka pArzvazUla kapotavat zirI vastimanyA seraktasrAva saMrakta manyAstambha pUyaraktanirgama kujana zleSmApUrNa | hRdaya vAjaH stabdhanetratA . zIrNadantatA zuSka raktoSThatAlu karNamUlapiDakA hatvAkaraktaSThIvana pittavAta pittakapha vAtapitta kaphavAta kaphapitta + + + + + + + + + + + + __ + + + + + + __ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + | + + + + + + + + + + + + + + + + + + + + + + ++ _ + + + + + + + + + + + + + + + + + + ++ + + + + For Private and Personal Use Only

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/ kUTapAlaka sammoha / pAlaka / yAmya krakaca / karkaTa / vaivArika. vasavarAjIyakAra ke dvArA kathita sasipAta vizeSa antardAha vizeSa manyAstamma ziro- hRddAha yakRtplI raktamukhamaNDala | kaTitoda alpazUla stabdhAGga ekapakSAmi- yaha | graha havyAthA chidroM hAntraphuphphusapAka pArzvazUla kapotavata ziro bastimanyA stabdhanetratA ghAta / manyAstambha seraktasrAva saMrakta pUyaraktanirgama kUjana ileSmApUrNa hRdaya vAkajaH stabdhanetratA zIrNadantatA zuSka raktoSThatAlu karNamUlapiDakA itavAk raktaSThIvana tridoSa vAtapitta pittavAta pittakapha vAtapitta kaphavAta kaphapitta + + + + + + +++ +++ + + + + + + + ++ + + + + + + + + + ++ + + + + + + + + ++ | +++ + + + + + + + + + + + + +++ +++ + + + + + __ + ++ +++ +++ +++ + ++ +++ ... + ++ ++ + | + + + : | + + + +++ +++ +++ ++ + + ++ ++ + + + + For Private and Personal Use Only

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jvara 441 (11) yantrApIDa-yena muhurcaravegAdyantreNevAvapIDathate gAtram / raktaM pittaJca vamedhantrApIDaH sa vijJeyaH / / jo jvarI kolhU meM pele jAne ke samAna anubhava kare aura raktapitta se pIDita ho vaha manyApIDa sannipAta kA rogI hotA hai| ( 12 ) saMnyAsa-atisarati vamati kUjati gAtrANyabhitazciraM naraH kSipati / saMnyAsasannipAte pralapatyugrAkSimaNDalo bhavati // atIsAra, vamana, kUjana, gAtrakSepaNa, pralApa tathA atyugra netratA ina sAta lakSaNoM se saMnyAsa sannipAta banatA hai| (13) saMzoSi-mecakavapuratimecakalocanayugalo malotsargAt / ___ saMzoSiNI sitapiDikAmaNDalayukto jvare naro.bhavati / malotsarga ke sAtha zarIra aura netra donoM kA kAlA par3a jAnA tathA zarIra meM zveta maNDaloM ke sAtha piDikAoM kA pAyA jAnA saMzoSI sannipAta kA lakSaNa hai| sannipAtabhedapradarzikA tAlikA [tAlikA pR0 441 ( ka ) para dekhie ] sannipAtoM kI sAdhyAsAdhyatA sandhikastandrikazcaiva pralApazcittavibhramaH / jihakaH karNikazcaiva SaT sAdhyAzca prakIrtitAH / / rugdAhamantako bhugnanetraM syAtkaNThakubjakaH / raktaSThIvI zItagAtramabhinyAsazca dAruNAH / / . ___ sannipAta ime saptApyasAdhyAH parikIrtitAH // ( basavarAjIya ) sandhigasteSu sAdhyaH syAttandrikazcittavibhramaH / karNiko jihvakaH kaNThakubjaH paJcApi kaSTakAH / / rugdAhastvatikaSTena saMsAdhyasteSu bhaassitH| raktaSThIvIbhugnanetraH zItagAtraH prlaapkH|| abhinyAso'ntakazcaite paDasAdhyAH prakIrtitAH / / ( bhA. pra.) uparyukta vivaraNa ke anusAra eka zAstrakAra ne saMdhika, tandrika, pralApaka, cittavibhrama, jihvaka aura karNika ina 6 sannipAtoM ko sAdhya mAnA hai jaba ki dUsare ne sandhika ko sukhasAdhya aura tandrika, cittavibhrama, karNika, jihvaka aura kaNThakubja ko kaSTasAdhya mAnA hai tathA rugdAha ko atikaSTasAdhya ginA kara kula 7 sannipAtoM ko sAdhyatA pradAna kii| jahA~ pahale ne 6 ko sAdhya aura 7 ko asAdhya mAnA hai vahIM dUsare ne 7 ko sAdhya aura zeSa 6 (raktaSThIvI, bhunanetra, zItagAtra, pralApaka, abhinyAsa) ko asAdhya mAnA hai| mahattvapUrNa yaha hai ki basavarAja ne jahA~ pralApaka ko sAdhya kahA hai vahA~ bhAvamizra ne use asAdhya mAnA hai| kaNThakubja ko bhAvamizra ne kaSTasAdhya meM ginA hai para basavarAja use asAdhya mAnatA hai| hamane jo sannipAtoM meM prApta lakSaNoM ke AdhAra para tAlikA prastuta kI hai use dekhakara bar3I saralatA se sAdhyAsAdhyatA kI gutthI ko * sulajhAyA jA sakatA hai| For Private and Personal Use Only

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442 vikRtivijJAna sannipAtoM ke 17 mAraka upadravoM ko siddhavidyAbhU ne nimna zabdoM meM ginAyA haijvarastIkSNo'thavA zItamathavAlpajvaro'pi vA / netrAntau raktarahitau pANipAdanakhAstathA / / netre kAntivihIne ca na zrutau sAgaradhvaniH / svedahInajvarazcaiva hyathavA sveda utkaTaH // mukhe kAntistato hInA netre bhugne'thavA kRze / nAbhihRnnAsikApAdapANizaityaM zirovyathA // UrdhvazvAso dhanurvAto hikkAsarvAGga kampanam / zira:kampo'pyapasmAraH kaphaH kaNThe smaagtH|| gandhasvAdu na jAnAti malaM kapilavarNakam / zithilA capalA caiva nADIkuTilasUtrakA / Adau pittagatirnADI tato vAtagatirbhavet / tataH zleSmagatirnADI cakravad bhramate muhuH // mandanADI bhavedyasya svasAdhyaM bhavati dhruvam // sa rogI nidhanaM yAti vizeyaM vaidypaargaiH| sAdhyAsAdhyavidhi jJAtvA cikitsetpaNDitaH svayam / / azvinIkampa meM isake sambandha meM likhA haijvaro nihanti raktAkSamakSAbhaM hRdi zUlinam / sadA zvasantaM svidyantaM zaktihInaM hatAnalam // Ayurveda meMjihvAzyAmA mukhaM pUtikSatamakSi nimajjati / khagAzca mUniriSyanti yasya romAMzca varjayet // nityanAthIya meMsuzItA haritA yasya romakUpAzca saMvRtAH / amlAbhilASaH satataM mRtyumApnoti tattvataH / / 17 sAdhya lakSaNoM kA varNana siddhavidyAbhUH ne nimna zabdoM meM prakaTa kiyA hai:atha sAdhyaguNAnvakSye zrotavyaM bhissjottm| indIvarasamaMnetraM mukhaM tArezasannibham / / samadhAtugatirnADI svaraH kokilasannibhaH / kSutaM kSudhA mUrdhni kaNDUrannavAnchA tanurlaghuH // dantAH kundanibhAbhAsA jihvAsadravamAvA / yavAgUprAzane svedaH karNayoH zravaNaM samam // ghrANe gandhasamajJAne paannipaadtlossnntaa| nakhapakSmAkSirekhAsu raktasampUrNatA yadA / jJAtvA cainaM sukhaM sAdhyaM cikitset paNDito bhiSak / sAmAnya sannipAta lakSaNa sAmAnyataH sannipAta ke nimna lakSaNa zAstroM meM diye gaye haiM:(1) kSaNe dAhaH kSaNe zItamasthisandhizirorujA / sAsrAve kaluSe rakte nirbhugne cApi locane // sasvanau sarujau karNau kaNThaH zukairivAvRtaH / tandrAmohaH pralApazca kAsaH zvAso'rucibhramaH // paridagdhA kharasparzA jihvA saMsrAGgatA param / SThIvanaraktapittasya kaphenonmizritasya ca // ziraso loTana tRSNA nidrAnAzo hRdi vyathA / svedamUtrapurISANAM ciraadrshnmlpshH|| kRzatvaM nAtigAtrANAM pratataM kaNThakUjanam / koThAnAM zyAvaraktAnAM maNDalAnAM ca darzanam // mUkatvaM srotaso pAko gurutvamudarasya c| cirAtpAkazca doSANAM snnipaatjvraakRtiH||(crk) (2) rAtrau jAgaraNaM divA ca kRzatA mUrchA'tidAho marut / zItasvedapralApanaM mRdu tRSA hAsyaM ca hRtpIDanam // kAsazvAsavidAhizaityajvaritA tRSNA zirorodhanam / jihvAdagdhakRzatvamaGgapulakaM syAtsannipAtajvare // (siddhavidyAbhUH) sandhyasthimUni rugdaahshiittndraarucibhrmaaH| kaNThakUjanakarNAtiraktadRgbhunanetratA // raktaniSThIvanaM mUrchA tRSNA nidrAkSayo nizi / jihvAsnigdhajvaratRSNA shyaamaarktaanggrodhitaa|| vipAke mUDhatA ceti sannipAtajvarakRtiH // ( Ayurveda ) For Private and Personal Use Only

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jvara anya(3) aGgavyathA zirorukasyAddAhaH sarvAGganetrayoH / netre zoNitapItAme mUrchAbhrAntipralApakam // hRcchUlaM gumphanaM hikA kAsaH syAdromaharSaNam / sannipAtajvare ghore vaidyo jAnAti nizcayAt // (4) nidrAnAzo bhramaH zvAsastandrA suptAGgatA'ruciH / tRSNA moho madaH stambho dAhaH zItaM hRdi vyathA // paktizcireNa doSANAmunmAdaH zyAvadantatA / rasanA paruSA kRSNA sandhimUrdhAsthijA rujaH / nirbhugne kaluSe netre karNI zabdaruganvitau / pralApaH srotasAM pAkaH kUjanaM cetanAcyutiH // svedamUtrapurISANAmalpazaH sucirAt sra tiH / sarvatra sarvaliGgAni vizeSaJcAtra me zRNu // (suzruta) (5) sarvajolakSaNaiH sarvairdAho'tra ca muhurmuhuH / tadvacchItaM mahAnidrA divA jAgaraNaM nizi / / sadA vA naiva vA nidrA mahAsvedo'ti naiva vaa| gItanartanahAsyAdivikRtehApravartanam // sAzruNI kaluSe rakte bhagne lulitapakSmaNI / akSiNI piNDikA pArzvamUrddhapasthirugbhramaH / / sasvanau saruoM kau~ kaNThaH shuukairivaacitH| . paridagdhA kharA jihvA guruH srastAGgasandhitA // raktapittakaphaSThIvo lAlanaM ziraso'tiruk / koThAnAM zyAvaraktAnAM maNDalAnAM ca darzanam / / hRduvyathA malasaMsaGgaH pravRttirvAlpazo'ti vA / snigdhAsyatA balabhraMzaH svarasAdaH pralApitA / / doSapAkazcirAttandrA pratataM kaNThakUjanam / ( vAgbhaTa ) (6) kharA jihvAkSiNI bhugne srAvi rakte tRDasthiruk / vikRtehAsvedanidrA zItadAhAvyavasthitiH / / tandrA pralApo mohAGgasrastatA (kaNTha zUkatA / raktaSThIvanamityAdiH sannipAtajvarAkRtiH // ( aJjananidAna) (7) kSaNe kSaNe zItamatho vidAhaH zvAsazca sandhyAsthizirassu pIDA sasrAvayukta kalughe vibhugne rakte ca netre bhramamohakAsAH / / tandrA pralApo vamathurvinidrA karNau sazabdau sarujau prakampaH kaNThastu zUkairiva saMvato hi syAtsannipAte kaThinA ca jihvA / / (vaidyavinoda) (8) satRSNAzUlazoSaH zvasanamatha nizA jAgaro vAsarastu tandrA mohazca zoSo bhavati ca vadane ghrANajihvAdharANAm / pAkaM niSThIvate yaH kRzatanuzca bhavenmaNDalAnAJca dehe sambhUtiH zyAvanetrAdharavadanamasveda aadhmaanshossH| kSunnAzo vA bhramAtirbhavati ziraso loThanaM vA ziro'tiH / srotorodho vamirvA galakaghuraghurAzUlakairvA vRtastu / etailiGgairyutAnAM prabhavati ca nRNAM sannipAteti saMjJA - rogANAmAzukArI jvara atiduHkhado vAjinAM vA dvipAnAm // For Private and Personal Use Only

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888 Shri Mahavir Jain Aradhana Kendra sAzru For Private and Personal Use Only sannipAta ke sAmAnya lakSaNoM kI tAlikA krama carakasaMhitA suzrutasaMhitA aSTAGgahRdaya siddhavidyAbhU aJjananidAna vaidyavinoda Ayurveda anya hArItasaMhitA 1 kSaNa meM dAha dAha muhurmuhaH dAha atidAha dAhAvyavasthA kSaNa meM dAha dAha sarvAGga dAha x 2 kSaNa meM zIta zIta muhurmuhuH zIta zIta zItAvyavasthA kSaNa meM zIta zIta x x 3 asthisandhirujA asthisandhikaja asthiparvazUla x asthizUla asthisandhipIr3A asthisandhizUla x x 4 zirorujA mUrdhAruja mUrdAzUla x ziraH pIDA ziraHzUla ziraHzUla ziro'rti 5 netraH netraH netraH netraH netraH netraH netraH netra sAzru sAzru sAzru dAha kaluSa kaluSa kaluSa kaluSa zyAva rakta rakta rakta rakta raktAbhA nirbhugna bhugna bhugna vibhugna bhugna pItAmA lulitapakSya 6 karNaH karNaH sasvana zabdayukta saravana sazabda saruja ruganvita x kRSNaoSTha kRSNavadana 8 zUkAvRtakaNTha x zUkAvRtakaNTha x kaNThazUkatA zUkAvRtakaNTha 4 gale meM ghudhura zabda aura zUla 9 tandrA tandrA tandrA 4 tandrA tandrA tandrA www.kobatirth.org vikRtivijJAna xxx x nirbhugna X kaNaH karNaH saruja saruja Acharya Shri Kailassagarsuri Gyanmandir

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moha x 10 moha 11 pralApa ____x pralApa moha pralApa pralApa pralApakax 12 kAsa X moha pralApa kAsa zvAsa x Shri Mahavir Jain Aradhana Kendra lex xxx x 13 zvAsa zvAsa 14 aruci aruci x x x x x X 15 bhrama bhrama x x x zrA x x zvAsa aruci / bhrama bhrAnti bhrama x mukhazoSa jihvA dagdhA kharasparzA zyAmA rasanA jihvA jihvA X 17 jihvA paridagdhA kharasparzA kRSNA paridagdhA dagdhA x paruSA kharA For Private and Personal Use Only x x x x x xxx kaThinA www.kobatirth.org 18x X AdhmAna x x X gurusrastAGgatA aGgaphalaka srastAGgatA x raktapittakaphaSThIvana + raktaSThIvana x aGgarodhitA raktaSThIvana x niSThIvana 19 srastAGgatA suptAGgatA 20 kaphamizrita x - raktapittaSThIvana 2144 22 ziraloThana 4 23 tRSNA tRSNA 24 nidrAnAza nidrAnAza balabhraza mUrddhaloThana zirorodhana x x x tRSNA tRSNA - divAnidrA rAtrijAgaraNa vikRtanidrA vinidrA nizijAgaraNa divAnidrA xx x x ziraloDana tRSNA nizAjAgaraNa divAtandrA Acharya Shri Kailassagarsuri Gyanmandir tRSNA nizi meM nidrAkSayax

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Shri Mahavir Jain Aradhana Kendra x x x xx x x x x For Private and Personal Use Only krama carakasaMhitA suzrutasaMhitA aSTAGgahRdaya siddhavidyAbhU aJjananidAna vaidyavinoda Ayurveda anya hArItasaMhitA sadA nidrA sadA anidrA 25 hRdivyathA hRdivyathA hRdvyathA hRtpIDanax 26 sveda dera se thor3A sveda alpazaH sveda kI a, alpa sveda vikRta sveda x sveda cirAt sruti ati pravRtti 27 mUtra dera se thor3A mUtra alpazaH mUtra kI a, alpa x x x x x x cirAt khuti ati pravRtti 28 mala dera se thor3A mala alpazaH mala kI a, alpa x cirAt sruti ati pravRtti 29 gAna adhika kRza nahIM x x kRzatA x xx x zUla tathA zotha 31 nirantara kaMTakUjana kUjana nirantara kaMThakUjana x xx kaNThakUjana xx 32 zyAvaraktakoSThadarzana x zyAvaraktakoSThadarzana x 33 zyAvaratamaNDala- x zyAvaraktamaNDala- x x x x x maNDalotpatti darzana darzana 34 mUkatA 35 x dudhAnAza 36 srotasa pAka srotasapAka nAsAjihvA oSThapAka vikRtivijJAna www.kobatirth.org x x kRzatA x x x x x x x x xxxx Acharya Shri Kailassagarsuri Gyanmandir x x xxx x x x x x x x x x

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& & & & x xx x 52 X X X X X X X X X X 51 X X X X x x X 50 X X 447 X X X X X X X X X romaharSa feat aGgavyathA x x X 49 prakampa vamathu X X X X X X X X afa X X X 4 X 48 mUrcchA 47 X X X X X X X For Private and Personal Use Only X X X 46 svarasAda hAsya pArzvazUla nartana faceretar piNDikAzUla gIta vikRtaceSTA X 45 Acharya Shri Kailassagarsuri Gyanmandir X X X X X X X X X X X X X X X X ETFT X X jvara 44 82 42 89 www.kobatirth.org X X X vikRtaceSTA vikRtaceSTA X mUDhatA gumphana X X X X X X X X X 40 39 37 stambha mada X cetanAcyuti SCHIE zyAvadantatA 38 doSoM kA cirapAka doSoM kA cirapAka doSapAkacirAt X X X X X X X X X X X x x X X X X X X X X X Xx X X X X X X x x X X X mada X X X X X X X X X strotorodha Shri Mahavir Jain Aradhana Kendra

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448 vikRtivijJAna sannipAtajvara ke sAmAnya lakSaNoM ko caraka suzruta vAgbhaTa basavarAja Adi sabhI ne likhA hai / inake dvArA likhe lakSaNoM kI jo tAlikA Upara dI hai usase yaha spaSTa ho jAtA hai ki sannipAtajvara ke sambandha meM vibhinna AcAryoM kI jo kalpanA hai usameM paryApta sAmya hai| udAharaNa ke lie jihvA, karNa, aura netra ke lakSaNoM ke dvArA sannipAtajvara kA jJAna bahuta kucha ho jAtA hai| sannipAta se pIDita rogI kI jihvA jalI sI kAle raMga kI hogI aura sparza meM kAThinya yA kharatA spaSTataH jhlkegii| kAnoM meM rogI ko sanasanAhaTa yA bhanabhanAhaTa kA zabda sunAI par3egA tathA zUla yA pIr3A bhI hogii| netroM ke dekhane se tridoSa kI sthiti bahuta kucha spaSTa ho jaavegii| arthAt rogI ke netra phaTe phaTe aura putaliyA~ phailI phailI hoNgii| unameM azru bhI bhare ho sakate haiM tathA ve lAla surkha aura kaluSayukta dekhe jA sakate haiN| A~khoM ke pakSma vAgbhaTa ke mata se bikhare yA phaile hue milate haiN| ___asthisandhiyoM yA jor3oM meM zUla kA honA eka aisA lakSaNa hai, jise siddhavidyAbhU ke atirikta zeSa sabhI ne svIkAra kiyA hai| para sannipAta meM sadaiva jor3oM meM zUla ho yaha Avazyaka nhiiN| bahuta se rogiyoM meM yaha pAyA jAtA hai| kisI kisI ke asthipoM meM hI vaha hotA hai| sira meM vedanA kA honA athavA sira kA idhara udhara luDhakanA ye do mahatva ke lakSaNa haiM / sira meM binA darda kA koI bhI sannipAtI kadApi nahIM dikhalAI detaa| darda kI tejI ke kAraNa aura vAta kI vRddhi se vaha apane sira ko bhI asthira rakhatA hai| sannipAtAvasthA meM jvara sadaiva tIvra rahatA hai| usakI ugratA hI ziraHzUla kA kAraNa hotI hai| rogI ko kSaNa meM hI dAha aura dUsare kSaNa meM zIta kA anubhava hotA hai| kabhI garmI se saba kapar3e pheMka detA hai aura kabhI sardI se cAra cAra or3ha letA hai| rogI kI cetanA zakti rahatI hai suzruta ne cetanAcyuti itanA nirdeza avazya kiyA hai anyathA anya kisI bhI AcArya ne saMjJAnAza vA cetanA nAza kI ora iGgita nahIM kiyA hai| parantu tandrA eka aisA lakSaNa hai jise basavarAja dvArA uddhata tInoM mahAnubhAvoM ke atirikta sabhI ne svIkAra kiyA hai| isI tandrA ke kAraNa rogI ko hoza nahIM rahatA phira bhI yadi vaidya kucha pUchatA hai to vaha usakA uttara de detA hai yahA~ taka ki tharmAmITara mu~ha meM lagAne ke lie kahane para mu~ha khola detA hai| para pralApa, bhrama, mada aura moha ina cAroM meM se kucha yA sabhI ke lagAtAra bane rahane ke kAraNa vaha bahuta spaSTa nahIM ho pAtA aura usake samajhane meM bhI bahuta kamI A sakatI hai| vikRtaceSTA yA ceSTA kI vikRti kA honA bhI mahattvapUrNa hai / vaha kabhI ha~satA, gAtA, rotA, gUthatA yA mUDhavat AcaraNa karatA hai| basavarAja dvArA uddhata 'siddhavidyAbhU' Ayurveda aura anya ina tIna uddharaNoM meM mUrchA kI upasthiti bhI darzAI gaI hai| For Private and Personal Use Only

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jvara 441 zUkAvRtakaNThatA, kaNThakUjana, pArzvazUla, kAsa, zvAsa, hikA ina 6 lakSaNoM meM se kisI na kisI kA varNana kisI na kisI grantha meM A gayA hai| caraka, vAgbhaTa, aMjana nidAna aura vaidyavinoda meM kaNTha meM kA~ToM kA sA uga AnA kahA gayA hai| hArIta ne gale meM ghuraghura zabda aura zUla batalAyA hai / kaNTha sUkha jAne ke kAraNa aura teja bukhAra hone se pyAsa kA laganA eka sarvavidita lakSaNa hai, jise kaI AcAryoM ne mAnA hai| cAra sthaloM para kAsa aura utane hI para zvAsa kA ullekha hai| kaNThasUjana gale meM kapha Ane se bahudhA hotA hai| vAgbhaTa ne svara baiThanA bhI isa roga meM batalAyA hai| pArzvazUla bhI usI kI khoja hai / hikkA ko anya mata ke rUpa meM sthAna kevala eka jagaha milA hai| jo yaha batalAtA hai ki sarvasAmAnya lakSaNoM kI dRSTi se sannipAta roga meM hikkA ko sthAna nhiiN| sannipAta jvara meM rakta yA kaphamizrita rakta kA thUkanA bhI sammilita kiyA gayA hai| ise caraka, vAgbhaTa, aMjananidAna aura Ayurveda ke racayitAoM ne svIkAra kiyA hai para suzruta, siddha vidyAbhU , vaidya vinoda aura anya nAmaka lekhakoM kI dRSTi se yaha anarthakara lakSaNa chipa dayA hai| isakA artha yahI hai ki raktapitta kA yaha lakSaNa sabhI rogiyoM meM sthira nahIM hai| hRvyathA yA hRdaya kA baiThanA yA phela honA yA hRdaya meM zUla kA honA eka atyadhika gambhIra lakSaNa hai jise sabhI mukhya granthakAroM ne svIkAra kiyA hai| zarIra ke maloM ( sveda, mUtra, purISa) kI sannipAta meM sadaiva eka sI gati nahIM rahA krtii| kisI rogI ko adhika sveda AtA hai kisI ko bilkula nhiiN| kisI ko pezAba bilkula nahIM utaratA 2-2 dina bIta jAte haiN| kisI ko thor3A pezAba utaratA hai kisI ko bar3I dera bAda thor3A utaratA hai / mala kI bhI yahI sthiti rahatI hai 2-46 dina taka TaTTI nahIM AtI yA dera se AtI hai| kabhI-kabhI yA kisI-kisI sannipAta meM malotsarga pracuratA ke sAtha hotA hai| malotsarga kriyA eka hI rogI meM kisI dina abhAva se, kisI dina alpa, kisI dina dera se aura kisI dina bArabAra aura adhikatA se dekhI jA sakatI hai| nidrA kI sthiti meM bhI paryApta bheda hotA hai / sAdhAraNatayA rogI dina meM tandrita rahatA aura rAta meM jAgA karatA hai| kabhI vaha varAbara dina rAta jApa aura pralApa karatA par3A rahatA hai| kabhI vaha dina rAta sotA hI dekhA jAtA hai| kabhI vahI vinidrita aura kabhI vikRta nidrita rahatA hai| sAdhAraNatayA nidrA kA krama eka rogI meM Arambha se antataka eka sA calatA hai para kabhI-kabhI vaha badala bhI jAtA hai / roga kA zamana AsAnI aura jaldI se nahIM huA karatA / rogI ke doSa paryApta samaya meM pakate haiN| mukha, nAsA, gudAdi srotoM meM pAka kI sthiti bhI bahudhA dekhane meM AtI hai| rogI ke bala meM kamI A jAtI hai usakA aMga zithila par3a jAtA hai arthAt usameM utsAha kA abhAva ho jAtA hai| para roga itanI zIghratA se banatA hai aura itanA atipAtI hotA hai ki isameM jIrNa rogiyoM kI sI kRzatA nahIM A paatii| For Private and Personal Use Only

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.450 vikRtivijJAna kabhI-kabhI romaharSa, zyAvadantatA, kampa, zoSa, srotorodha, piNDikAoM meM zUla, zarIra meM zUla, unmAda, stabdhatA, AdhmAna, mUkatA, zyAvarakta koThoM yA maNDaloM kI utpatti, aruci Adi lakSaNa bhI pAye jA sakate haiM / inameM se kaI yA kucha yA ekAdha kSaNa bhI mila sakatA hai / para tIvrajvara, dAha, zaitya, nidrA, sveda, mala, mUtra, inakI avyavasthA, netra kI putaliyoM kA phaila jAnA, kAnoM meM sannAhaTa, hRdivyathA, pyAsa pralApa, tandrA, pArzvazUlAdi lakSaNa avazya hI pAye jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir AcAryoM ne sandhika tandrikAdi jina sannipAtoM kA varNana kiyA hai vaha uparokta lakSaNoM meM kisI eka lakSaNavizeSa kI vizeSatA ke kAraNa hI kiyA gayA hai / sandhika meM asthisandhiyoM meM vizeSa zUla milatA hai kAsa, tandrA, vedanA, balakSaya, aMgazaithiyadi lakSaNa vahI haiM jinheM sarvasAmAnya sannipAtIya tAlikA meM hama saralatA se 'dekha sakate haiM / tadrikA meM tandrA vizeSa hotI hai / pralApaka sannipAta meM pralApAdhikya pAyA jAtA hai / kahane kA tAtparya yaha hai ki sarvasAmAnya sannipAta jvarIya lakSaNoM meM jo lakSaNa adhika ugra aura bahuta spaSTa ho to usI ke nAma para usa sannipAta ke nAmakaraNa kI eka prathA ke anusAra hI vividha sannipAtoM kA nAmakaraNa kiyA gayA hai / caraka, suzruta, vAgbhaTAdi dvArA racita saMhitA granthoM ko dekhane se hameM jJAta hotA hai ki unhoMne sandhika tandrikAdi aise bhedoM yA nAmoM ko protsAhana na dekara sannipAta jvara ko eka hI mAnA hai aura usI ekatA kI dRSTi se cikitsA likhI hai / Age TIkAkAroM ke samaya meM yA laghutrayI ke kAla meM ye bAkI ke bheda adhika dekhane meM Aye haiM / hamane ina bhedoM kA varNana pahale isIlie kiyA ki aba sAmAnya vivecana meM usakI mahattvahInatA ko jise bRhatrayI ke racayitAoM ne samajhA thA hamAre pAThaka bhI jAna leM / sAmAnya lakSaNa 47 yA 48 haiM / inameM se jo lakSaNa adhika ugra hogA usI ke anusAra hama 48 alaga alaga nAmoM se sannipAta jvara kA nAmakaraNa kiyA jA sakatA hai / doSoM ke cirapAka ke sambandha meM likhA hai doSe vibaddhe naSTa'gnau sarvasampUrNalakSaNaH / sannipAtajvaro'sAdhyaH kRcchrasAdhyastato'nyathA // saptame divase prApte dazame dvAdaze'pi vA / punarghorataraM bhUtvA zamanaM yAti hanti vA // etaizca dviguNairvApi mokSAya ca vadhAya ca / doSoM ke ba~dha jAne se aura agni ke naSTa ho jAne ke kAraNa asAdhya yA kaSTasAdhya sannipAta banatA hai / yaha 7-10 yA 12 dinoM yA unake dUne tIna gune yA caugune samaya meM zAnta hotA yA mAra DAlatA hai / vAstavikatA hai ki adhika ugra lakSaNa hone para jIvana adhika dina nahIM calatA aura doSoM ke pAka meM jitanA hI adhika samaya bItatA hai rogI utanA hI adhika balakSINa ho jAtA hai / aSTAGgahRdaya aura sannipAtajvara aSTAGgahRdayakAra ne sannipAtajvara kA sAmAnya lakSaNa likha kara phira sannipAta ke do kA aura nAmollekha kiyA hai: :1 For Private and Personal Use Only

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jvara 1. abhinyaassnnipaat| 2. hataujassannipAta / - hemAdri ne sannipAta, abhinyAsa tathA hataujas ke sambandha meM likhA hai ki jisameM vAtapradhAna rahatI hai vaha sannipAta kahalAtA hai aura jisameM kaphapradhAna ho use abhinyAsa kahate haiM tathA jisameM pittapradhAna ho vaha hataujasa kahalAtA hai| usane vaGgasena kA udAharaNa dekara abhinyAsa aura hataujas kA nimna varNana diyA hai:nidropetamabhinyAsaM kSipraM vidyAddhataujasam / AcitAmAzayakaphe sannipAtajvare dRDhe / zAntye'pyavazyaM tasyAzu tandrA smupjaayte| atidravarasakSIradivAsvapnaniSevaNAt // . durbalasyAlpavAtasya jantoH zleSmA prakupyati / vAyumArgasamAvRtya dhamanIranusRtya saH // tandrAM sughorAM janayettasyA vakSyAbhi lakSaNam / unmIlitavinirbhugne parivartitatArake / / bhavatastasya nayane lulite calapakSmaNI / vivRtA nanadantauSThaM muhuruttAnazAyinaH / / picchilocchinnatantuzca kaNThAcchaleSmA'sya gcchti| kaNThamArgoparodhazca vaikRtaM copajAyate // so'rvAka trirAtrAtsAdhyaH syAdasAdhyastu tataH param / trayaH prakupitAdoSA uraHsrotonugA bhRzam // AmAvibaddhA grathitA buddhIndriyamanogatAH / janayanti mahAghoramabhinyAsaM mahAdRDham / / pradhvastagAtraH zvasiti na ceSTAM kAJcidIhate / na ca dRSTirbhavettasya samarthA rUpadarzane // na ca gandharasasparzazabdAMzcApyavabudhyate / ziro lolayate'bhIkSNamAhAraM nAbhinandati / / kUjate tudyate caiva pratipattizca hiiyte| kalaM prabhASate'trApi kiJcitsandigdhavAk cirAt // na vA prabhASate kiJcidabhinyAsaH sa ucyate / pratyAkhyeyaH sa bhUyiSThaM kazcidevAtra sidhyati / / nidrA se yukta abhinyAsa aura usase hataujas sannipAta banatA hai| jaba sannipAta jvara meM AmAzaya se kapha kA saJcaya ho jAtA hai to atizIghra rogI ko tandrA utpanna ho jAtI hai / kapha kI saJciti meM ati patale padArtha ikSurasa, dugdha kA sevana divAsvapna karanA Adi kAraNa hote haiN| ina kAraNoM se alpavAta durbala jIvoM meM kapha kA kopa ho jAtA hai aura vaha kapha vAyumArga ko AvRta karake dhamaniyoM kA anusaraNa karane laga jAtA hai jisase ghora tandrA kI utpatti hotI hai| isameM A~kheM unmIlita, nirbhagna aura parivartita tAre vAlI ho jAtI haiN| netra khule aura pacama calanazIla rahate haiM mukha, dA~ta, oSTha saba vivRta hote haiN| vaha Upara ko muMha karake sotA hai kaNTha se picchila tantu rahita zleSmA jAtA hai vaha kaNThamArga kA rodha karake vahA~ vikRti kara detA hai| idhara tInoM doSa kupita hokara usasrotonugAmI ho jAte haiN| ve Ama, vibaddha aura grathita buddhi, indriya aura mana meM jAkara ghora abhinyAsotpatti karate haiM / isase zarIra stabdha yA dhvasta ho jAtA hai, zvAsa teja calatA hai| vaha koI ceSTA nahIM krtaa| usakI A~kheM rUpadarzana ke lie asamartha hotI haiN| gandha, rasa, sparza zabdAdi kA avabodha ThIka ThIka nahIM ho paataa| vaha sira ko itastataH pheMkatA hai AhAra kI use icchA nahIM hotI / kUjana, toda Adi barAbara milate haiM bolane meM bhI kucha vicAra rahate haiN| yahI abhinyAsa hai| ___ hataujasa jisameM oja kA hrAsa hotA hai ise vAgbhaTa ne sannipAta ke paryAya ke rUpa meM hI likha diyA hai| For Private and Personal Use Only

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452 vikRtivijJAna pitta vAgbhaTa ne anya sannipAtoM kA aura vivaraNa nimna sUtroM meM diyA haianyacca sannipAtottho yatra pittaM pRthak sthitam / tvaci koSThe'thavA dAhaM vidadhAti puro'nu vA // tadvadvAtakaphau zItaM daahaadirdustrstyoH| isake anusAra sannipAta ke nimna 4 rUpa banate haiM krama doSa sthAna pariNAma pitta tvacAgata bahirdAha antaHzaitya koSThagata antardAha bahiHzaitya vAtakapha tvacAgata bahiHzIta antardAha vAtakapha koSThagata antaHzIta bahirdAha . jaba pitta tvacAgata hotA hai to vAtakapha koSThagata aura jaba pitta koSThagata hotA hai taba vAtakapha tvacAgata hote haiN| sannipAtoM kA jo varNana vividha granthoM meM milatA hai usase patA calatA hai ki tridoSa ke dvArA utpanna jvara ke anekoM rUpa haiM aura vividha AcAryoM ne apanI sUjha aura anubhava ke AdhAra para apanI dRSTi se sannipAtoM kI saMkhyA meM kamI yA vRddhi Agantu jvara Agantujvara AThavA~ jvara hai isake nimna cAra bheda zAstrakAroM ne batalAye haiM 1-abhighAtajajvara, 2-abhiSaGgajajvara, 3-abhicArajajvara, 4-abhizApajajvara, inakA varNana caraka ne nimna zabdoM meM kiyA hai:-- AganturaSTamo yastu sa nirdissttshcturvidhH| abhighAtAbhiSaGgAbhyAmabhicArAbhizApataH / / zastraloSTrakazAkASThamuSTayaranitaladvijaiH / tadvidhaizca hate gAtre jvaraH syAdabhighAtajaH / / tatrAbhighAtajo vAyuH prAyo raktaM pradUSayan / savyathAzophavaivaye sarujaM kurute jvaram / / kAmazokabhayanodhairabhiSaktasya yo jvaraH / so'bhiSaGgajvaro jJeyo yazca bhuutaabhissnggjH|| kAmazokabhayAd vAyuH krodhAt pittaM trayo mlaaH| bhUtAbhiSaGgAt kupyanti bhuutsaamaanylkssnnH|| bhUtAdhikAre vyAkhyAtaM tadaSTavidhalakSaNam / viSavRkSAnilasparzAt tathAnyaviSasambhavaiH / / abhiSaktasya cApyAhujvarameke'bhiSaGgAjam / cikitsayA viSaghyaiva sa zamaM labhate jvaraH / / abhicArAbhizApAbhyAM siddhAnAM yaH pravartate / sannipAtajvaro ghoraH sa vijJeyaH suduHsahaH / / sannipAtajvarasyoktaM liGga yat tasya tat smRtam / cittendriyazarIrANAmArttayo'nyAzca naikshH| prayogantvabhicArasya dRSTvA zApasya caiva hi / svayaM zrutvAnumAnena lakSyate prazamanena c| vaividhyAdabhicArasya zApasya ca tdaatmke| yathAkarmaprayogeNa lakSaNaM syAt pRthagvidham / / dhyAnaM vizvAsabahulaM liGgaM kAmajvare smRtam / zokaje bASpabahulaM vAsaprAyaM bhayajvare / / krodhaje bahusaMrambhaM bhUtAveze tvamAnuSam / mUrchAmohamadaglAni bhUyiSThaM viSasambhave / / keSAJcideSAM liGgAnAM santApo jAyate purH| pazcAt tulyantu keSAJcideSu kAmajvarAdiSu / / kAmAdijAnAmuddiSTaM jvarANAM yad vizeSaNam / kAmAdijAnAM rogANAmanyeSAmapi tat smRtam / / manasyabhihute pUrva kAmAdyairna tathA balam / jvaraH prApnoti kAmAdyairmano yAvanna duSyati / / te pUrva kevalAH pshcaannijairvyaamishrlkssnnaaH| hetvauSadhaviziSTAzca bhavantyAgantavo jvraaH|| For Private and Personal Use Only

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jvara 453 zastra, loSTha, cAbuka, lakar3I, arani, hAtha yA paira kI talI, dA~ta yA anya kisI bhI kAraNa se deha para abhidhAta yA coTa lagane se abhighAtajvara ho jAtA hai| abhighAtajajvara meM coTa lagane se pahale vAyu prakupita ho jAtA hai vaha rakta ko dUSita kara detA hai jisake kAraNa coTa ke sthAna para vyathAyukta zotha, viparNatA aura kaphajajvara utpanna kara detA hai| yaha sammApti vraNazothAtmakajvara ( iflammatory fever ) ke lie hI nahIM hai / isameM vAtadoSa aura raktadUSya meM kharAbI AtI hai| abhiSaGgajajvara meM manovikAra, kAmakrodhAdi manovegoM ke kAraNa jvara kI utpatti hotI hai| kAma yA zoka yA bhaya se vAyudoSa, krodha se pitta, bhUtAbhiSaGga se tInoM doSa prakupita hote haiM / vividha bhUtoM se utpanna jvara meM kaI prakAra ke lakSaNa hote haiN| abhiSaGgajajvara meM ve jvara sammilita haiM jo kisI saMga yA sparza ke kAraNa utpanna hote haiN| viSAkta vRkSoM ko chUkara AnevAlI vAyu ke dvArA yA viSAkta yuddhakAlIna gaisoM ke sparza se jo jvara hotA hai vaha bhI abhiSaGgaja hI mAnA jAtA hai| abhicArajajvara aura abhizApajajvara inameM eka abhicAra ke kAraNa aura dUsarA abhizApa ke kAraNa hotA hai| abhicAra meM hiMsArtha homa AtA hai| yaha socakara ki amuka kA aniSTa kiyA jAve jo kucha homa Adi kiyA jAtA hai vaha abhicAra ke antargata AtA hai| abhizApa meM zApa dene ke kAraNa utpanna jvara kA samAveza hotA hai / abhicAra aura abhizApa ye do prAcInakAla meM hote the Ajakala unakA astitva nahIM miltaa| yoga kI ve prakriyA samApta prAyaH haiM jinake karane mAtra se vyaktivizeSa ko roga ho jAtA thaa| Adhunika kAla meM jo roga ke jIvANuoM jarmavArapheyara dvArA yuddha calatA hai vaha eka abhicAraja prakriyA hai isake dvArA eka kSetra meM roga barsAyA jAtA hai rogANuoM se dUSita anAja pheMkA jAtA hai| zApa dene ke lie tapasyA kI AvazyakatA par3atI hai tapasvI jaba kupita aura krodhita ho jAte haiM taba ve zApa de dete haiM / aisA bhI Ajakala nahIM hone paataa| ataH ina do prakAra ke jvaroM kI paramparA naSTaprAya hai| kAmajajvara meM cintA, zvAsa bar3hanA, zokaja meM azrubahulatA, bhayaja meM trAsa, krodhaja meM saMrambhAdhikya, bhUtAviSTa meM amAnuSI kriyAe~, viSaja meM mUrchA, moha, mada glAni Adi bar3hate haiN| ye lakSaNa kabhI jvara ke pUrva aura kabhI jvara ke bAda banate haiN| ___Agantujajvara pahale svatantra hote haiM phira unameM doSoM kA mizraNa ho jAtA hai| jise Adhunika paribhASA meM doSoM kA saJcayakAla kahate haiM usakA vicAra te pUrva kevalA: pazcAnijaiA mizralakSaNAH' meM kiyA gayA hai| Agantujajvara ke vibhinna kAraNoM meM abhighAta, abhiSaGgAdi se pahale svatantratayA svastha zarIra meM upasarga pahu~ca jAtA hai| yaha upasarga dhIre-dhIre zarIra ke dUSya aura doSoM ko dUSita karake eka niyata kAla meM Agantu se nija meM badala jAtA hai taba jora-zora se rogArambha hotA hai| ataH roga kA svarUpa nija honepara bhI bAhya kAraNoM ke dvArA utpanna hone ke kAraNa vaha Agantu For Private and Personal Use Only

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vikRtivijJAna kahalAtA hai| kAmAdi janitajvara Arambha meM utanA balavAn nahIM hotA jitanA ki vAtAdi doSoM ke kupita ho cukane ke bAda dekhA jAtA hai| saMkSepa meM aSTavidhajvaroM kI samprApti . saMsraSTAH sannipatitAH pRthagvA kupitA mlaaH| rasAkhyaM dhAtumanvetya paktiM sthAnAnnirasya ca / / svena te noSmaNA caiva kRtvA dehoSmaNo balam / srotAMsi ruddhA samprAptAH kevalaM dehamulbaNAH // santApamadhikaM dehe janayanti narastadA / bhavatyatyuSNasarvAGgo jvaritastena cocyate / / cAhe dvandva cAhe sannipAta athavA svatantratayA prakupita hue doSa rasadhAtu kA anusaraNa karake jaTharAgni ko apane sthAna se nikAla kara apanI USmA se dehoSmA kI vRddhi karate haiN| isI samaya unake dvArA srotasa aura bhI phaila jAte haiM jisase aura adhika jvara ho jAtA hai| AyurvedajJa uparokta prakAra ke jvaroM ke atirikta Ama pacyamAna aura nirAmajvaroM kI bhI kalpanA kiyA karate haiM :(1) arucizcAvipAkazca gurutvamudarasya ca / hRdayasyAvizuddhizca tandrA cAlasyameva ca / jvaro'visargI balavAn doSANAmapravartanam / lAlApraseko hRllAso kSunnAzo virasaM mukham / / stabdhasuptagurutvaJca gAtrANAM bahumUtratA / na viDjIrNA na ca glAnijvarasyAmasya lakSaNam / (2) jvaravego'dhikastRSNA pralApaH zvasanaM bhramaH / malapravRttiruklezaH pacyamAnasya lakSaNam // (3) kSutkSAmatA laghutvaM ca gAtrANAM jvaramArdavam / dopapravRttiraSTAho nirAnajvaralakSaNam / Ama, pacyamAna aura nirAma ye jvara kI 3 avasthAe~ haiN| Arambha meM jvara ke sAtha aruci, avipAka, gaurava, hRdayadeza kI avizuddhi, tandrA, Alasya, jvara kA nirantara vanA rahanA, doSoM kA bAhara na nikalanA, lAlA giranA, macalI AnA, kSudhAnAza, mukhavirasatA, gAtra kI stabdhatA, suptatA yA gurutA, mUtra kA adhika bAra tyAga aura glAni ye lakSaNa milate haiN| kisI bhI jvara meM Arambha meM yahI lakSaNa milate haiM ye lakSaNa zArIrikavikAra kI ora lakSya karate hue bhI rogagAmbhIrya kI ora dRSTi nahIM le jAte / ___jvara kI dUsarI avasthA jise pacyamAnAvasthA kahate haiM gambhIra hotI hai| isameM jvara kA vega bar3hatA hai, pyAsa bar3hatI hai, pralApa, zvAsa, bhrama, malapravRtti aura utkleza milate haiN| ___ tAsarI avasthA AzAjanaka hotI hai jaba jvara nirAma ho jAtA hai taba rogI ko bhUkha lagatI hai, zarIra halakA ho jAtA hai, jvara mRdu par3a jAtA hai, doSoM kA pracalana hotA hai aura AThavA~ dina A jAtA hai| dina 7,9,12 kA dUnA tInagunA bhI ho jAtA hai AThavA~ to upalakSaNa hai| jvara ke sambandha meM Adhunika vicAra upasarga-jvara ke sambandha meM vicAra karane ke pUrva upasarga ( infection ) ke sambandha meM thor3A spaSTa jJAna ho jAne se sadaiva lAbha rahatA hai / vikArI padArthoM ke dvArA sajIva zarIra para hone vAlA AkramaNa upasarga kahalAtA hai / hamane isa viSaya ko grantha For Private and Personal Use Only

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jvara 455 ke Arambha meM upasthita kara diyA hai| kevala vikArI padArthoM kI upasthiti mAtra hI 1. upasargakAraka nahIM huA karatI usake lie vAstavika AkramaNa kI AvazyakatA hotI hai| isake lie eka svastha tathA rogottarakAlIna svastha kA udAharaNa diyA jA sakatA hai| jaba taka svastha vyakti rahatA hai usake zarIra meM jIvANu rahate hue bhI upasarga se pIDita vaha nahIM tathA roga se tatkAla chUTA huA prANI svAsthyalAbha karatA huA bhI asaMkhya rogakAraka jIvANuoM kA bhaNDAra hotA hai| puradilanagara (alIgar3ha) kSetra meM masUrikA roga se lagabhaga 200 bAlakoM kI jIvanalIlA samApta ho gii| cecaka se bace hue eka . bAlaka ke zarIra para virAjamAna asaMkhya rogakArI tatva usakA kAraNa bne| eka bAlaka se dUsarA, dUsare se tIsarA bImAra par3atA aura maratA gyaa| ataH rogakArI tattva kI upasthiti . mAtra roga nahIM, usa tattva kA saphalatApUrvaka zarIra ko hAni pahu~cAne kI dRSTi se kiyA gayA AkramaNa hI rogotpatti kA pradhAna sAdhana hai| isI eka kalpanA ko AdhAra mAna kara calane vAlA vyakti Ayurveda ke dvArA upasarga ke sthAna para kSetra ke mahatva ko samajha sakatA hai| upasarga taba taka laganA sambhava nahIM jaba taka ki abhikartA vikArI nahIM hai| kucha jIvANu zarIra ke mitra aura kucha zatru ke rUpa meM hote haiN| inameM zatruvat vyavahAra karane vAle jIva hI roga utpanna karate haiN| sAdhAraNatayA 3 mArgoM se upasarga zarIra meM praveza karatA hai| jinameM eka tvacA hai, dUsarA pacanasaMsthAna hai aura tIsarA zvasanasaMsthAna hai| inameM zvasanasaMsthAna mahatvapUrNa mArga hai / rogI vikArIpadArtha ko sA~sa ke sAtha bhItara le jAtA hai vaha eka vinduka ke rUpa meM zvasanasaMsthAna meM praveza karatA hai| yaha vinduka kisI anya rogI vA vAhaka kI nAsA yA gale dvArA khA~sane athavA chIMkane ke sAtha bAhara AtA hai samIpa meM usase vArtAlApa karane pucakArane yA eka ke sUMghe padArtha ko sUMghane se vaha anya meM laga jAyA karatA hai| ina vindukoM ke dvArA utpanna upasarga sadaiva atyadhika saMkrAmaka huA karatA hai| ina vindukoM meM zegakArI jo padArtha meM nihita hotA hai use DAkTara ghANekara kI bhASA meM viSANu (vhAirasa) kahA jAtA hai| viSANuoM dvArA sAdhAraNa zaitya pratizyAya yA inphlueMjA, romAntikA ( mIjhilsa) kanapheDa ( pampsa ), tvaGmasUrikA (cikinapauksa ), masUrikA (smAlapauksa), jarmanatvaGamasUrikA ( rubelA), mastiSkasuSumnAjvara, poliyomAilAiTisa aura mastiSkapAka (ekaiphailAiTisa) Adi roga utpanna hote haiN| jIvANuoM dvArA zvagraha (ipiMgakapha), lohitajvara (skAraleTaphIvara) rohiNI yA DiphthIriyA tathA gucchagolANujanya grasanIpAka ( Streptoco' coal sore throat ) hai| ye sabhI roga apane ArambhikakAla meM bahuta adhika ugra hote haiM kyoMki isa avasthA meM ThIka-ThIka roganirNaya karanA kaThina hotA hai| mere pAsa eka hI ghara ke tIna prANI bImAra hokara Aye tInoM ko 104deg taka jvara thA raha rahakara vamana thI, sira meM paryApta vedanA thI aura khA~sI thor3I-thor3I calatI thii| eka ko unameM se pratizyAya ( inphlueMjA) hokara raha gyaa| dUsare ko romAntikA banI aura tIsare ko masUrikA huii| viSANuoM ke dvArA upasRSTa ina tInoM bAlakoM kA Arambhika nidAna For Private and Personal Use Only

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vikRtivijJAna karanA bahuta hI kaThina thaa| pUrvarUpoM kA itanA sAmya vividha viSANujanita rogoM ko utpanna kara detA hai| ina rogoM kI ugratA kA vicAra karake Adhunika cikitsaka inake pratirodha para jitanA dhyAna dekara TIkA yA masUrIkaraNa kI vyavasthA karate haiM vaha sarvathA upayukta hai| . khAdya athavA peya padArthoM ke dUSita hone para jaba unakA kisI vyakti ke dvArA grahaNa ho jAtA hai to usase pacanasaMsthAna dUSita hokara aneka rogoM kI utpatti karanA sambhava ho jAtA hai| isa prakAra se Antrika jvara, saMgrahaNI, sAlmonA janita roga, AntrikakSaya, kSayaja lasagranthiyA~, asthikSaya, sandhikSaya, visUcikA, bruselosisa Adi utpanna hote haiM / inase bacane ke lie zuddha khAdya peyoM kI ora dhyAna denA paramAvazyaka hai| prAcIna RSi muniyoM dvArA jo khAdyapeyAdi ke sakarAnikharAdi vyavasthAe~ banAI gaI haiM ve ina rogoM se mAnava kI rakSA kI dRSTi se haiM jinheM aneka sAdhAraNa buddhi vAle yA avikasita jJAnavAle DhoMga kaha kara chor3a dete haiN| a~gareja aura amerikana ye svapna dekhane lage haiM ki khAna-pAna kI vastuoM meM pUrNa zuddhi kA pracAra karake bAjAroM meM unakI khapata aura kArakhAnoM meM unakI utpatti kA vicAra aura niyantraNa lagAkara ve niHsandeha pacanasaMsthAnajanya, vyAdhiyoM se mukti pA sakate haiN| para cirakAlIna vAhakoM kI kRpA se bar3e-bar3e sammelanoM aura meloM meM pacanasaMsthAna ke rogoM kI mahA. mAriyA~ hotI rahatI haiM jinake kAraNa sahasroM prANiyoM kA saMhAra Aye varSa ho jAyA karatA hai| pacanasaMsthAna ke upasargoM se pIDita 5 pratizata se adhika rogI cirakAlIna vAhaka ( carriers ) bana jAyA karate haiN| ___sparza dvArA phailane vAle rogoM ke jIvANu mAnavatvacA yA zleSmalakalA ke sAtha apanA riztA jor3a lete haiN| isa taraha se visarpa, vAtAlikA yA plega, laipTospAirosisa, phiraMga, maleriyA, eMthrAksa, TiTenasa (dhanurvAta ) aura TAyaphasa Adi roga banate haiN| mazaka athavA pissuoM ke vinAza se maleriyA tathA plega se pAzcAtya dezoM ko paryApta chuTakArA mila cukA hai para bhAtaravarSa jaise deza meM sampUrNa rASTra kI Aya kA homa kara dene para bhI mazaka saMhArapUrNa nahIM ho sktaa| __ maiksvInI' nAmaka vidvAn kA kathana hai ki kevala zarIra aura rogakArI jIvANu ina donoM ke sammelana kA pariNAma roga nahIM hai api tu rogotpatti ke lie eka tIsarA 1. There is one feature comected with infection which deserves to be emphasized. For many years it has been taught that Infection was the result of bringing together a pathogenic agent ( bacillus, coccus. spirochaete, virus ) with a susceptible victim. It is becoming increasingly clear that a 3rd factor is generally required if a clinical reaction is to be provoked by this meeting of missile with target. This 3rd factor is trauma, often physical (e.g. in meningitis a fall on the head, in poleomyelitis excessive exercise) but sometimes psychological (e. g. worry about domestic, business or financial affairs, our study for examinations etc. ), For Private and Personal Use Only

Page #522
jvara 457 hetu (yogya vAtAvaraNa ) atyanta mahatva rakhatA hai| arthAt yA to coTa laganI cAhie yA koI cintA honI caahie| cintA yA coTa se vyatirikta zarIra aura rogANu kI sannidhi mAtrA rogotpatti karane meM bahudhA asamartha rahatI hai| kevala upasarga vA jIvANu dvArA rogotpatti ke siddhAntavAdiyoM ke kaphana meM maiksvInI ke isa spaSTa vaktavya dvArA eka kIla aura gar3ha gii| isa sAhityika vAkyAvali kA prayoga hameM karanA par3A hai, para videzI vidvAn satya ke khojI aura dveSa se bahuta dUra haiM ataH ve nissandeha unhIM tathyoM taka pahuMca leMge jahA~ sahasroM varSoM kI khoja bIna ke pazcAta prAcIna AyurvedamanISI phuNce| isa tIsare hetu ke kAraNa kaI bAra una logoM meM bhI roga ho jAtA hai jo pUrNataH svastha hote haiN| ye svastha na hokara inheM hama svasthavAhaka nAma de sakate haiM arthAt unameM rogotpAdaka jIvANu rahate haiM para roga utpanna taba hotA hai jaba coTa yA cintA unheM akasmAt satAne lge| . kaNThakRcchratA-cikitsAzAstra eka bahuta hI mahattvapUrNa zAstra hai| kisI roga ke nirNaya para pahu~canA itanA sarala kArya nahIM jitanA ki do aura do milAkara cAra kaha denaa| udAharaNa ke lie yadi kisI kA galA kharAba ho jAve to hamArA yaha kartavya nahIM ki usakA mukha kholavA kara turata dekhA jaave| usake roga kI kathA AdyopAnta sunanA paramAvazyaka hai phira dekhanA hai ki usakI grIvA meM kahIM sUjana to nahIM / sparza karake dekhanA par3egA ki rogI kI grIvA meM sthita gA~The phUlI haiM yA sthAnika zotha ho gayA hai athavA yadi grIvA kI lasagranthiyoM meM zotha hai to phira kyA vaha bAhyatrikoNa meM hai yA pazcatrikoNa meN| isase roga ke sambandha meM paryApta mahattva kA jJAna mila jAtA hai / phira mAlUma karanA cAhie ki____ usakA ceharA phIkA hai yA surkha ? usakA vyavahAra kaisA hai ? usakI nAr3I kI gati kyA hai ? jvara kitanA hai ? ___ yadi usakA ceharA tamatamAyA huA lAla hai nAr3I kI gati druta tathA pUrNa hai nigalane meM darda hai aura bAhya graivika granthiyA~ sUjI huI haiM to yaha mAlAgolANujanya prasanIpAka kA rogI mAnA jaavegaa| para yadi rogI pIlA, muAyA, ojahIna, jvararahita graivika prasRtapAka (diffuse cellulitis of the cervical glands) se grasita hai to vaha galadaNDIya rohiNI ( faucial diphtheria) kA rogI banegA / rohiNI ke rogI ko nigalane meM kaSTa prAyazaH nahIM hotA kevala usake gale meM kaSTa banatA aura bar3hatA calatA hai| rohiNI kI nAr3I manda aura saumya rahatI hai jo Age viSama bana jAtI hai| yadi rogI kI grIvA ke bAhya aura pazca donoM trikoNoM meM gAMThe sUjI hoN| sAtha hI kakSA taka kI gA~ThoM para varama ho| usakI vaMkSaNa granthiyoM para bhI sUjana ho sakatI hai| aisA rogI granthikajvara (glandular fever ) se pIDita mAnA jaavegaa| jaba rogI kA itihAsa jJAta ho jAve taba usake kaNTha kA parIkSaNa kiyA jAtA hai / eka caur3e cammaca kI sahAyatA se tathA Taurca ke prakAza meM gale kA valaya, ipI 36, 40 vi0 For Private and Personal Use Only

Page #523
458 vikRtivijJAna gloTisa kA zikhara aura grasanI kA bahuta sA bhAga dekhA jA sakatA hai| rogI kI galadaNDikAoM para koI srAva yA kalA ho to phira kyA vaha rohiNI hai isakA bhale prakAra vicAra kara lenA caahie| kyoMki rohiNI ke atirikta (1) mAlAgolANujanya galapAka / (2) tuNDikIya vidhi / (3) viMseTa kA galAmaya ( vincent's angina) / (4) utkoThoparAnta lohitajvara ( post ruptive scarlet fever ) / (5) pUyika vaNana ( septic ulceration ) / (6) yakSmika vrnnn| (7) phiraGgika vaNana / (8) akaNakAyotkarSa ( agranulooy. tosis ) aura (9) sitaraktatA ( lukaemia ) Adi bhI hote haiM / rohiNI meM kalA sadaiva tuNDikAgranthiyoM para banatI hai jo camakIle bhUre raMga kI hotI hai aura 36-48 ghaMTe meM mRdutAlu aura kAkalaka (uvula) taka pahu~ca jAtI hai| usake kAraNa yA to zUla nahIM hotA yA yadi hotA hai to bahuta thodd'aa| thor3A sA halakA jvara rahatA hai| sAtha meM praivika kozotipAka ( cervical cellulitis) pAyA jAtA hai| TauMsila para bar3hatI huI isa kalA meM eka prakAra kI saDA~dha AtI rahatI hai| yadi isa kalA ko chur3Ane kA yatna kiyA jAve to rakta ke binduka jhalaka Ate haiN| ye raktabinduka anya kisI bhI roga ke srAva yA utsnAva (exudate) meM nahIM milte| rogI pIlA par3a jAtA hai usakI nAr3I halakI hotI jAtI hai aura vaha kAhila banatA jAtA hai jo rohiNI ke viSa kA pariNAma hai| roga ke Arambhika 4 dinoM meM mUtra ke andara zivati nahIM pAI jaatii| yaha eka zizu roga hai| ___mAlAgolANuja kaNThakRcchatA meM gale meM sabase adhika kaSTa hotA hai| isameM tuNDikA granthiyoM para utsrAva hotA hai zUla bahuta hotA hai| utsrAva bahudhA rekhAoM meM milatA hai para kabhI-kabhI sidhmoM meM bhI milatA hai| yaha bahuta mRdu aura saralatA se haTane yogya hotA hai isako haTAne se rakta binduka nahIM dikhalAI dete isa roga meM gale meM bahuta adhiraktatA pAI jAtI hai| isameM jvara bahuta rahatA hai| agra graivika gA~The sUja jAtI haiM ve kaThina aura sparzAkSama ho jAtI haiN| mUtra meM zivati pAI jAtI hai| kAna meM darda bhI ho jAtA hai| yaha roga tuNDikAoM kI asvasthatA kA pramANa hai aura jaldI jaldI ho jAtA hai yaha taruNa aura vayaskoM kA roga hai| tuNDikIya vidradhi tuNDikA ke cAroM ora yA usake andara kA roga hai| yaha roga jitanA adhika gale meM zUla karatA hai utanA koI galaroga nhiiN| nigalanA bahuta kaThina ho jAtA hai| hanustambha ( trismus ) bhI isameM milatA hai| bAhya galatrikoNa meM rugNatuNDikerI kA bhAga phUlA huA hotA hai aura bahuta sparzAkSama hotA hai| yaha avasthA prAthamika rUpa meM na banakara prAyaH mAlAgolANuja kaNThakRcchratA ke uparAnta banatI huI pAI jAtI hai| viseNTa ke aJjAinA meM tuNDikA ke pAsa yA usI para eka nirmoka vraNa (slo. (ughing ulcer) banatA hai| isa roga meM pUrva ke donoM rogoM ke viparIta Uti kI hAni hotI hai jaba ki una donoM meM Uti kI vRddhi pAI jAtI hai| isI Uti For Private and Personal Use Only

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jvara 456 nAzaka ( necrotic) vraNAtmaka prakriyA ke kAraNa jo nirmoka banatA hai vaha bhaMgura Asita, harita yA pIta varNa kA hotA hai / yaha vraNa ke AdhAra bhAga para par3A rahatA hai aura binA raktasrAva ke hI ukhAr3A jA sakatA hai| isameM tApAMza nahIM bar3hA karatA na zUla hotA hai aura na graivika granthiyA~ hI phUlatI haiN| kabhI-kabhI isI ke sAtha dA~toM kI jar3oM meM choTe-choTe vraNa bane hue dekhe gaye haiN| isa roga kI puSTi ke lie vraNa se thor3A sA padArtha lekara aNvIkSa ke nIce dekhate haiM aura viseMTa ke cakrANuoM kI upasthiti mAlUma karate haiN| lohitajvara kI utkoThottarIya avasthA meM utkoTha samApta ho cukatA hai para tuNDikAoM para utsrAva banA rahatA hai| lohitajvara svayaM raktasrAvI mAlAgolANuvarga ke jIvANu se banatA hai isa kAraNa mAlAgolANujakaNThakRcchratA ke bahuta se lakSaNa isameM pAye jAte haiN| isameM galA lAla ho jAtA hai aura agragraivikalikoNa kI lasagranthiyA~ phUla jAtI haiM / jihvA kA varNa tRNa badarIya ( strawberry ) ho jAtI hai / ___ kaNTha yA gale meM vraNa kaI kAraNoM se banA karate haiM jinameM pUyA ( sepsis ) eka hai| pUyika vraNana sampUrNa mukha meM hotA hai yahA~ taka ki oSTa taka usase nahIM bacate sAtha hI nAsAstrAva aura karNasrAva bhI pAye jA sakate haiN| bAhya graivika lasagranthiyA~ bhI pUyasrAvI ho jAtI haiN| tApAMza bar3ha jAtA hai jvara ke sAtha hI zivatimUtratA bhI pAI jAtI hai| sAtha sAtha carmavikAra jaise pAmA, impaiTIgo Adi bhI rahatA huA dekhA jAtA hai| yakSmA ke jIvANuoM dvArA gale kA vaNana bahuta kama dekhA jAtA hai vaha bhI dvitIyaka upasarga ke rUpa meM svarayantrIya yakSmA ke bAda banatI hai / isameM eka jIrNasvarUpa kA vraNa banatA hai jisameM kSodya ( friable ) nirmoka tuNDikA yA tAlu para pAyA jAtA hai / sAtha meM svara kA baiThajAnA bhI pAyA jAtA hai| jvara nahIM miltaa| rogI patalA dubalA raktakSayajanita milatA hai| kSakiraNIyacitra se yakSmA phupphusoM meM avazya milatI hai| vraNa se alpAMza lekara aNvIkSa se dekhane para yakSmAdaNDANu kI upasthiti se puSTa hogA ki vraNa yadamAjanya hI hai| phiraMga ke dvArA hone vAlA vraNana asama yA viSama hotA hai| aisA lagatA hai jaise ghoMghA kA mArga (snail track ) bana gayA ho| yaha bahudhA kaThinatAlu ko pakar3atA hai jo Age calakara phUTa bhI jAtA hai / phiraMga ke anya lakSaNa bhI sAtha hI sAtha pAye jAte haiN| granthIyajvara meM gale meM utsrAva sAdhAraNatayA paryApta rahatA hai| ise mAlAgolANuja kaNThakRcchratA athavA viMseMTa ke galAmaya se pRthaka karanA kaThina hote hue bhI sampUrNa deha meM lasagranthiyoM kI vRddhi khAsakara pazcagraivika trikoNa kI granthiyA~ bAhyatrikoNa kI granthiyoM kI apekSA adhika bar3hatI haiM / rakta ke citra meM lasakAyANUtkarSa ( lymphocytosis) pAyA jAtA hai| sitaraktatA tathA akaNakAyANUtkarSa ina do raktAvasthAoM meM gale meM kabhI kabhI utstrAva hotA huA dekhA jA sakatA hai / daurbalya, plIhodara (splenomegaly) For Private and Personal Use Only

Page #525
460 vikRtivijJAna tathA zarIra kI pranthiyoM kI sarvasAmAnyavRddhi dvArA roga kA nidAna huA karatA hai| lasakAyANuoM kI vRddhi, kSudra ekakAyANuoM kI adhika saMkhyA meM vRddhi khAsakara apUrNa lasakAyANuoM kI vRddhi dvArA nidAna kI puSTi kI jAtI hai| akaNakAyANUtkarSa meM rasacitra meM bahunyaSTisitakozAoM kI bahuta bar3I kamI aura adhika kAla taka zulbauSadhiyoM ke prayoga kA itihAsa milegaa| rogI pIlA milegaa| avirAmajvara ( Continued fever )-Adhunika vaijJAnikoM kI dRSTi meM aisA jvara jo lagAtAra 1 saptAha taka AtA rahe aura use zamana karane ke samasta sAdhAraNa upacAra vyartha siddha ho avirAmajvara kahalAtA hai| ve avasthAe~ jinameM 1 saptAha taka jvara AnA sambhava hai anekoM haiM / Antrikajvara (enteric fever ) eka avirAmajvara hai| isakA Arambha zirovedanA, glAni aura Antrika kaSTa ke sAtha hotA hai| isameM udara bharA aura phUlA huA milatA hai| plIhA bar3ha jAtI hai, jihvA para eka zveta varNa kA AvaraNa car3ha jAtA hai, netra camakadAra tathA putaliyA~ visphArita ho jAtI haiM, kapoloM para eka prakAra kI lAlI car3hI huI milatI hai 5 se 7 veM dina taka sarSapopama yA rAjikAsama athavA muktAsama choTe choTe dAne nikala Ate haiN| rogI jo hara dRSTi se ThIka hotA hai isa avasthA meM badhira ho jAtA hai / phupphusa sApha hote haiN| tApAMza 100 se 102 taka rahatA hai phira bhI nAr3I kI gati manda (70.80) rahatI hai| maTara kI dAla ke raMga kA atisAra eka saptAha samApta hote hote bana jAtA hai| kinhIM kinhIM meM atisAra ke sthAna para viSTambha pAyA jAtA hai| avirAmajvara kA dUsarA kAraNa tIvra zyAmAkasama yadhamA ( acute miliary tuberculosis ) huA karatI hai| tIvrazyAmAkasama yakSmA Antrika jvara se milatAjulatA roga hotA hai para kucha lakSaNoM aura cihnoM ke balapara isako pahacAnA jA sakatA hai| yahA~ ceharA dhUmila hotA hai na ki Antrikajvara ke samAna lAla / rogI ko koI vizeSa kaSTa nahIM mAlUma par3atA hai para AntrikavarI paryApta becaina pAyA jAtA hai| isa rogI ko itanA pasInA AtA hai ki usake saba vastra tara ho jAte tathA badalane par3ate haiN| tIvra zyAmAkasama yakSmI kA itihAsa dekhane se granthiyoM, asthiyoM, sandhiyoM meM se kahIM na kahIM yakSmA ke upasarga kI sAkSI mila skegii| jvara tIvra zyA. ya. meM eka bAra avazya utara jAtA hai| nAr3I kI ati 120 se nIce nahIM jAtI zvAsa kI gati prati minaTa 30 taka hotI hai| jo AntrikajvaroM meM nahIM dekhI jAtI / plIhA isameM bhI bar3hatI hai| ina donoM rogoM meM se kauna-sA hai isakI parIkSA kA sarvettama upAya dAnoM kI khoja hai / yadi eka bhI gulAbI yA muktAsama dAnA pAliyA gayA to avazya hI jvara kA kAraNa Antrikajvara mAnA jAnA caahie| yadimaka AntrapAka ke kAraNa tI. zyA. ya. se pIDita vyakti ko atIsAra bhI pAyA jA sakatA hai| para yahA~ malakA raMga maTara kI dAla jaisA nahIM hotaa| udara bhI phUlA huA aura sparzAkSama nahIM pAyA jAtA / dUsare harazmi-citraNa lene para phupphusoM meM tuSArajhaljhAbhAsa ( snow storm appearance ) milegii| For Private and Personal Use Only

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jvara. yacimaka udarAvaraNapAka ( Tuberculous peritonitis ) vaha anya avasthA hai jisameM avirAmajvara banA karatA hai| yakSmA se pIDita rogI kI Ayu 18 se 30 varSa kI hotI hai| ye nirdhanavarga ke vyakti hote haiM jinheM paryApta bhojana prApta nahIM ho pAtA hai| ye pIle pANDu yA araktatA se pIDita hote haiM inake peTa nikale hue hote haiN| inheM jvara viSamatayA AtA hai| yaha ubara zulbauSadhiyoM yA kUrcaki (penIsilIna:) Adi se zAnta nahIM hotaa| isase pIDita bahudhA strI hI milA karatI hai| unakA peTa nikalA huA hotA hai vaha paryApta kaThina hotA hai| udara meM sparzasaha lasagranthiyA~ pAI jAtI haiM sAtha-sAtha jalodara bhI hotA hai| yacimaka mastiSkAvaraNa pAka ( Tuberculous Meninigtis ) bhI avirAmajvara karane vAlI vyAdhi hai / yahA~ jvara viSamatayA AtA hai para barAbara banA rahatA hai aura nADI kI gati manda rahatI hai| yahA~ zirovedanA ke sAtha pralApa rahatA hai| Antrika jvara kI zirovedanA jahA~ sAta dina meM tirohita ho jAtI hai aura Antrikrajvara kI dUsarI avasthA meM pralApArambha hotA hai para yahA~ pralApa aura ziraHzUla sAtha sAtha hI calate haiN| yahA~ atIsAra yA AdhmAna kabhI nahIM pAyA jaataa| isa roga meM tandrA Arambha se hI rahatI hai jaba ki Antrika jvara prathama yA dvitIya saptAha ke pazcAt AtI hai / isa roga meM peTa andara kI ora dhaMsa jAtA hai jise naiyAkArAkRti (Sca phoid appearance ) kahA jAtA hai| yahA~ atIsAra yA anya audarika prakSobha nahIM pAyA jaataa| grIvA isa roga meM bahuta jakar3I huI milatI hai| palakoM kA banda rahanA (ptosis), putaliyoM ke AkArameM viSamatA honA, ardita, tathA dvidhAdRSTi ( diplopia) ve vAtanADIsaMsthAna ke lakSaNa haiM jo isa roga meM bahudhA milate haiN| isa roga meM 3 rI aura 7 vIM zIrSaNyA nADiyA~ adhika prabhAvita hotI haiM jinake kAraNa putaliyoM kA ghUma jAnA tathA ardita kA ho jAnA bahudhA milatA hai| ___ yacmA ke prati kSamatA kI utpatti ke samaya bhI avirAmajvara pragaTa hotA hai| usa samaya phupphusa svaccha hote haiM zulbauSadhiyA~ aura kurcaki prabhAvahIna ho jAtI hai nADI kI gati druta hotI hai, prasveda, bhAra meM kamI AtI hai, khA~sI bar3hatI calI jAtI hai| kSarazmicitraNa se roga kA nidAna hone meM sahAyatA milatI hai| zvasanaka ( pneumonias) avirAmajvara ke anya mahattvapUrNa udAharaNa haiM / prArambhika zvasanaka se pIDita rogI kI pahacAna karanA kaThina nahIM hai| usakA tApAMza bar3hatA calA jAtA hai, nADI kI gati bhI teja rahatI hai tathA zvAsa kI gati bhI inhIM ke anupAta se bar3hatI calI jAtI hai| plUrisI ke kAraNa pAzvoM meM zUla kA honA kapha meM lAlI kA AnA milatA hai / vAtanADIsaMsthAna, udara, kaNTha aura asthikoTaroM meM kucha bhI nahIM milatA aura hama saralatA se isa phupphusa khaNDIya zvasanaka ( lobar pneumonia) ko aGguliThepaNa tathA zravaNayantra kI sahAyatA se pahacAna sakate haiM / para yaha zvasanaka kisa jIvANu ke dvArA banA hai use pahacAnane ke lie ThIva parIkSA (thUkaparIkSA) paramAvazyaka hai| kyoMki phuphphusagolANuoM ke atirikta anya jIvA For Private and Personal Use Only

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462 vikRtivijJAna "NuoM dvArA bane zvasanaka kI cikitsA dUsarI vidhi se hotI hai / vahA~ painIsilIna vyartha siddha hotI hai| phrIDalaiNDarsa nyUmoniyA sTraipTomAyasIna dvArA tathA viSANujanya nyUmoniyA kloromAIsiTIna dvArA zAnta hotI hai / brAko nyUmoniyA~ yA phuphphusa khaNDakhaNDIya zvasanaka eka bAlakoM ko hone vAlA vikAra hai / sthAna sthAna para phuphphusa meM mandatA, budbudadhvani ( crepitations ) tathA sadravazabda ( rales ) pAe jAte haiM kabhI kabhI bAlakoM meM zvasanI phuphphusapAka ke sampUrNa lakSaNa mila jAne para bhI vAstava meM avirAma jvara kA mukhya kAraNa Antragata upasarga bhI huA karatA hai / annaviSANu ( salmonella ) dvArA jo bhojana kA dUSaNa ho jAtA hai vaha yUropa meM dvitIya mahAyuddha ke pazcAt adhika dekhane ko milane lagA hai| isakA kAraNa kolAya TAiphAiDa varga ke jIvoM ke dvArA hotA hai / yaha anna ke dvArA utpanna hone vAlA roga hai ise hama annaviSANUtkarSa ( salmonellosis ) kaha sakate haiM / pake hue siddha bhojana para makkhI Adi baiThakara use dUSita karake isa roga kI utpatti karatI haiN| isameM tIvra mahAsrotIya lakSaNa banate haiM jo kabhI kabhI to bahuta gambhIra rUpa dhAraNa kara lete haiM / dUSita bhojana ke lene ke 36 ghaNTe bAda kabhI bhI yaha roga dekhA sakatA hai| peTa meM maror3a ( cramps ) bahuta jora se hotI hai| dasta bar3e jora se hotA hai jisameM Ama aura rakta mile hue rahate haiN| Arambha meM itane bAra aura lagAtAra mana AtI haiM ki isa roga kA pahacAnanA kaThina nahIM hai / eka parivAra ke eka se adhika vyakti eka sAtha isa roga se pIDita ho sakate haiM / yaha roga 1 saptAha meM samApta ho jAtA hai jaba ki Antrikajvara eka saptAha meM to Arambha hI ho pAtA hai | annavidhatA kA pUrA jJAna karane ke lie dUSita khAdya dravya kI prayogazAlA meM jA~ca karavAI jA sakatI hai / ke jIvANujanya grahaNI ( bacillary dysentery ) meM bhI yahI citra upasthita hotA hai para vahA~ dasta meM Ama aura rakta annaviSANUrakarSa kI apekSA adhika pAye jAte haiN| apigolANUkarSa ( brucellosis ) bhI eka roga hai jo avirAma jvara kI utpatti kara sakatA hai / yaha roga apigolANuvargIya jIvoM ke kAraNa hI utpanna hotA hai / iMgalaiNDa meM yaha vinA auTAe hue godugdha ke kAraNa ho jAtA hai / mAlTA meM bakarI dUdha se isakI utpatti hotI hai / isa roga ke saba sAmAnya lakSaNa Antrikajvara se milate-julate hue hote haiN| isameM nahalA dene vAlA pasInA sabase mahattvapUrNa lakSaNa hai jise dekha kara vaidya saralatayA yaha mAna sakatA hai ki apigolANUskarSa roga kauna sA hai| isa roga meM atIsAra, nahIM milatA na udara meM AdhmAna yA bhItara dhaMsa jAnA bhI nahIM dekhane meM AtA / plIhA avazya bar3hI huI mila sakatI hai / kabhI-kabhI bIca meM roga yA jvara pUrNataH zAnta bhI ho jAtA hai / nADIgati anupAta se adhika manda rahatI hai / pralApa isameM hotA hai / isa roga kA prabhAva jitanA cikitsakoM para dekhA jAtA hai utanA anyatra nahIM / For Private and Personal Use Only

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jvara 463 velAmaya ( Weil's disease ) cUhe se phailatA hai| cUhe ke mUtra dvArA isa roga kA jIvANu atikuntalANu ( leptospirillum ) bAhara AtA hai| manuSya kI tvacA se usakA sparza hone para velAmaya ( weil's disease ) kA Arambha eka tIvra roga ke rUpa meM hotA hai jisameM khUba bukhAra car3hatA hai, zirovedanA hotI hai, glAni rahatI hai tathA udara zUla bhI rahatA hai| sAtha meM udvarNika koTha ( erythematous rash) bana sakatA hai| pA~caveM dina kAmalA (jaundice ) utpanna ho jAtA hai jo bar3hatA calatA hai| yakRt bar3ha jAtA hai tathA sparzAsahiSNu ho jAtA hai| plIhA bhI bar3hI huI milatI hai| tvacA meM tathA zleSmalakalA meM raktasrAva milate haiN| yadi rogI baca gayA to use jvara 7 se 10 dina taka rahatA hai| para eka saptAha ke bAda rogI ko jvara kA vizrAma mila kara punaH jvara utpanna ho jAtA hai| isa roga meM 30% taka bImAra mara jAte haiM / ataH cUhoM kA vinAza vA usake mUtra se zarIra kI rakSA karanA sarvaprathama mahatva kA pratiSedhaka upacAra hai jisase samAja kI rakSA kI jA sakatI hai| avirAmajvara kA eka udAharaNa anutIvra jIvANvika hRdantaHpAka ( sub acute bacterial endocarditis) hai| yaha nissandeha eka mAraka vyAdhi hai / AmavAtIya hRtkapATIyA vyAdhi yA hRdaya kI eka sahaja dazA ke kAraNa mAlAgolANuzoNaharita ( streptococoi virdans ) ke dvArA upasRSTa hRdaya ke dvArA yaha roga hotA hai| isameM avirAma jvara cirakAla taka calatA hai sAtha meM jADA AtA hai nADI kI gati drata rahatI hai, plIhA bar3ha jAtI hai, nIlohAGka (petechiae) tathA audarika vA vapAvAhaka dhamaniyoM kI antaHzalyatA ke kAraNa banda ho jAnA bhayAnaka ghaTanAe~ dekhI jA sakatI haiN| a~guliyoM ke gUdoM meM zUlakAraka gA~ThoM kA honA bhI antaHzalyatA kA spaSTa pramANa haiM / Aja yaha roga mAraka nahIM raha gayA / Antrikajvara aura isa jvara meM paryApta antara hai| isase pIDita rogI kA mukha mailA hogA aura nADI bharI huI tathA teja hogii| Antrikajvara ke rogI kA mukha camakatA, sukha aura nADI manda hogI / hRdaya kI marmaradhvaniyoM kI vRddhi hRdmAndyakSetra kI vistRti aura yakRddAlyUtkarSa tathA anya antaHzAlyika pramANa anutIvra jIvANvika hRdantaHpAka ke rUpa ko bhale prakAra pragaTa kara dete haiN| ___ avirAmajvara kA eka kAraNa aupasargika yakRtpAka bhI huA karatA hai| painasakAmalA ( catarrhal jaundice ) eka viSANu dvArA phailane vAlA roga hai| yaha roga zIta yA jAr3A lagakara Arambha hotA hai| sAtha meM hallAsa bhI rahatA hai aura vamana bhI hotI hai| tIsare yA cauthe dina vamana hotI hai| jvara sAdhAraNa milatA hai| rogI bahuta bImAra nahIM mAlUma pdd'taa| yadi kAmalA adhika bar3hane lage to velAmaya kA vicAra karanA nahIM bhUlanA caahie| jaba mAnavIya raktarasa (sIrama) kisI viziSTa viSANu se upasRSTa ho cukA ho aura jaba usakA TIkA manuSya ke zarIra meM lagA diyA jAve to phira usake kAraNa raktarasajanya yakRtpAka ( serum hepatitis ) utpanna ho jAtI hai / ise aupasargika For Private and Personal Use Only

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vikRtivijJAna yakRtpAka bhI kahA jA sakatA hai| isakA saJcayakAla kAphI lambA hotA hai jo ise 3 // mAsa taka le sakatA hai| pItajvara aura romAntikA kI roka ke lie lagAye gaye TIkoM ke kAraNa aupasargika yakRspAka hotA huA dekhA gayA hai| vigata dvitIya mahAyuddha meM amerikana 30000 sipAhiyoM ko pItajvara nirodhaka jo mAnavIya raktarasa kA TIkA lagAyA gayA thA usake 100 dina bAda unameM kAmalA kA udaya ho gyaa| yaha iMjekzana kI sUciyoM kI apavitratA ke kAraNa bhI ho sakatA hai| raktarasIya kAmalA aura aupasargika yakRtpAka donoM lagabhaga eka hI vyAdhi ke do rUpa haiM / kAmalAjanaka tattva raktarasa se alaga karanA bahuta hI kaThina kArya hai| raktarasa kA ekatrIkaNa isI kAraNa hAnidAyaka hai| use rokane ke lie use nIlalohitAtIta kiraNoM meM anAvRta karane kI prathA bhI cala par3I hai| aupasargika ekanyaSTiyakaNotkarSa (mononucleosis) yA granthikajvara (glandular fever ) bhI eka avirAmajvara hai| yaha kaNTha kI eka tIvra avasthA se Arambha hotA hai| jisake sAtha kucha niHsrAva yA utsrAva bhI hotA hai| isa roga meM ucca saMtApa hotA hai| grIvA ke pazcatrikoNa meM sthita granthiyA~ kAphI phUla jAtI haiM tathA jaba zulbauSadhiyA~ aura kUrcaki ke dvArA koI vizeSa lAbha dikhalAI na par3e to granthikajvara kA sahaja hI anumAna lagAyA jA sakatA hai| rakta kA citra lene para usameM lasakAyANuoM kI vRddhi milegii| isa roga meM kloromAisiTIna dvArA paryApta lAbha huA karatA hai| ___ tandrikajvara (TAyaphasa phIvara ) avirAmajvara kA eka aura udAharaNa hai| yaha jU yA cIlara dvArA utpanna honevAlA roga hai| yadi isa jIva se manuSya kI rakSA karane ke lie svacchatA ke AyurvedIya niyamoM kA pAlana kara liyA jAye to yaha roga kadApi utpanna nahIM ho sktaa| isI kAraNa yUropa meM 19 vIM zatAbdI meM roga kA jo rUpa thA vaha Aja nahIM hai| ___. avirAmajvara kA eka kAraNa vRkkamukhapAka (pyelitis) bhI hotA hai| usake lie mUtraparIkSA karane para pUya ke kozA, rakta ke zveta kaNa tathA nirmoka prApta hote haiN| yaha baccoM meM pAyA jAnevAlA roga hai| yaha roga AntradaNDANujanita hI ho yaha Avazyaka na hokara udarAvaraNa meM yakSmA ke vikSatoM ke kAraNa bhI bana sakatI hai| sitaraktatA ( leukaemias ) meM bhI avirAmajvara milatA hai| usake parIkSaNa kA sugama upAya rakta kA citra hotA hai / isameM rogI ke varNa kI niSprabhatA (pallor) bhI nidAnakAriNI hotI hai| __ akaNakozotkarSa ( agranulocytosis ) meM bhI tvacA niSprabha hotI hai para usameM nirantara jvara banA rahatA hai| rakta ke citra dvArA isakA jJAna ThIka-ThIka ho jAtA hai / isa roga kA kAraNa Ajakala zulbauSadhiyoM kA andhAdhundha prayoga hai| asthi koTara pAka ( sinusitis) ke kAraNa bhI avirAma jvarotpatti ho sakatI For Private and Personal Use Only

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jvara 465 hai| isameM sthAnika vedanA jitanI mahattvapUrNa hotI hai utanI jvara kI vRddhi yA anya zArIrika vikRti nahIM huA krtii| avirAma jvara kA eka mahattva kA kAraNa maleriyA bhI ho sakatA hai| hamAre pAsa anekoM rogI avirAma jvara ke Aye jinheM logoM ne TI. bI. kaha kara chor3a rakkhA thA para ve do-do cAra kvinIna kI sUiyoM se ThIka hokara cale gye| ___ Adhunika kAla meM maiksvInI ke mata se jvara kA eka kAraNa ilekzana bhI hai / suI jahA~ lagAI jAtI hai vahA~ yadi eka choTI vidradhi utpanna ho gaI to usake kAraNa lagAtAra jvara pAyA jA sakatA hai / vaha likhatA hai| If you can not find any cause for a swinging temperat. ure associated with sweats without undue toxaemia, dia. rrhoea, heart abnormalities, or tropicel implications, think of this as a possible cause.' yadi bar3hate hue tApAMza jisake sAtha prasveda ho para viSamayatA atIsAra, hRdtavikAra yA uSNakaTibandhIya koI vizeSatA na mile to Apa ko samajha lenA cAhie ki suI bhoMkane ke sthAna para gaharAI meM banatI huI eka vidradhi hai / puradila nagara (alIgar3ha) ke samIpa eka mahilA ko isI prakAra kI vidhi nitamba ( buttock ) pradeza para banI jisameM se lagabhaga 3 sera pUya kA mujhe nirharaNa karanA pdd'aa| atiraktimAyukta utkoTha-atiraktimA ( erythema ) tvacA kI lAlI hai jisake anekoM kAraNa ho sakate haiN| rakta varNa utkoTha ( erythematous rash ) isa nAma se hama ise pukArate haiM / raktavarNa utkoTha lohita jvara, romAntikA Adi rogoM meM dekhA jAtA hai| lohita jvara meM utkoTha sampUrNa zarIra para dUsare dina cehare ko chor3a kara nikalatA hai| jIbha vizalkita ho jAtI hai, gale meM adhiraktatA pAI jAtI hai| romAntikA meM praseka yA pratizyAya mahatvapUrNa hotA hai| isake kAraNa A~khoM se A~sU , nAka se nAva, kAsa, kSavathu aura tIna dina taka jvara ye lakSaNa pAye jAte haiN| cauthe dina jvara 103deg taka pahu~ca jAtA hai| jvara usase Upara bhI jA sakatA hai| utkoTha (raiza) kAnoM ke pIche se Arambha hokara cehare para pahu~ca kara agale 24 ghaNToM meM sampUrNa zarIra para chA jAtA hai| yaha udvarNika ( macular ) hotA hai| udvarNa eka sAtha mila kara bar3e-bar3e sidhma bhI banA dete haiN| jinake bIca meM tvacA ke kSetra hote haiM / sparza meM yaha makhamalI lagatA hai jvara dAne ugane taka bar3hatA hai phira yadi anya upadrava na huA to zAnta ho jAtA hai| jarmana romAntikA ( rubella ) lohita jvara tathA romAntikA donoM se hI milatI hai| yaha roga taruNoM meM adhika pAyA jAtA hai| isameM prasekIya lakSaNa bahuta sAdhAraNa hote haiM A~kheM surkha, thor3I chIMke yA khA~sI rahatI hai mukha pAka kadApi nahIM milatA kaupalikasidhma jo romAntikA meM milate haiM, yahA~ nahIM milate / pazcapraivika, kakSIya aura vaMkSaNapradeza kI lasagranthiyoM meM thor3I vRddhi pAI jA sakatI hai para yaha vRddhi maTara se adhika bar3I nahIM hotii| mukha kI zlaiSmikakalA ThIka dekhane For Private and Personal Use Only

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466 vikRtivijJAna meM AtI hai| raktimAyukta utkoTha kI utpatti raktarasa ke TIke ke kAraNa bhI ho sakatI hai| cecaka kA prArambha bhI raktavarNIya utkoTha ke rUpa meM hI hotA hai| cecaka jisa rogI ko hone vAlI hotI hai usake Arambhika 48 ghaNToM meM pratizyAyAtmaka lakSaNa milate haiM tIvrajvara, jAr3A, kaTizUla, daurbalya ye lakSaNa utpanna ho jAte haiM phira dAne nikalate haiM jo kaTi pradeza yA hAtha pairoM meM dekhe jAte haiN| ise Arambhika utkoTha ( prodromal rash) kahate haiM yaha lAla varNa kA ( scarlatinaform ) hotA hai / sthAnika romAntikIya ( morbilliform ) utkoTha bhI bana sakatA hai| ye donoM prakAra ke utkoTha tIsare dina jaba cecaka kI vAstavika masUriyA~ nikalatI haiM lupta ho jAte haiN| sarvAGgINa romAntikIya utkoTha kA eka rUpa mahAciMgaTIya (lobster form) hotA hai| rogI ko ucca tApa hotA hai aura usake dAnoM kA varNa dubale hue mahAciMgaTo kA sA hotA hai| yaha rUpa prAyazaH asAdhya aura dekhane meM bhayAnaka huA karatA hai| eka dUsare prakAra kA utkoTha jise nIlohAMkIya sphoTa (petechial earuption) kahate haiM vaha kamara ke kSetra meM utpanna hotA hai jise phrAMsIsI bAthiMgaDrAyarsa rAza kahate haiM / isakA AdhAra saMgama (symphysis ) hotA hai vahA~ se yaha bagala taka trikoNa rUpa meM phailatA hai / nIlohAGka zarIra meM bhI itastataH phailate haiN| ___ alargI ke kAraNa jvara virahita utkoThotpatti hotI hai| inake sAtha jarmana romAntikA kI bhA~ti pratizyAya yA prasekI lakSaNa yA lohita jvara ke samAna mukha yA jihvAgata lakSaNa nahIM milA karate / tvaG masUrikA meM bhI prArambhika lohita jvararUpI dAne pAye jAte haiN| katipaya oSadhiyoM ke kAraNa jinameM zulbauSadhiyA~ bhI haiM utkoThotpatti ho sakatI hai| granthika jvara meM bhI utkoTha milate haiM / kI dena tandrikajvara meM bhI kaI prakAra ke utkoTha banate haiM jinameM gulAbI sidhma banate haiM jo bAda meM bhUre ho jAte haiM aura dabAne se lupta nahIM hote / nIlohAGka jaise pissu kATatA hai banate haiM ve baiMganI (nIloha ) raMga ke hote haiN| tvacA ke nIce bahuraMgApana jo bagala aura kamara (groin) kSetroM meM bana jAte haiN| isameM rogI kI jihvA choTI sikur3I tote jaisI hotI hai| netra surkha aura putaliyA~ choTI ho jAtI haiM rogI kI buddhi meM kamI AtI jAtI hai| ati kuntalANUtkarSa meM bhI raktimAyukta utkoTha dekhe jA sakate haiN| anya vibhinna utkoTha-utkoThoM ke anya tIna prakAra aura prasiddha haiM jinameM eka utkaNIya ( papular ), dUsarA uddavika ( vesicular ) tIsarA utpUyika ( pustular ) utkoTha kahalAtA hai| ye tInoM utkoTha pRthaka pRthaka bhI hote haiM aura milAkara bhI jaise utkaNotpUyika ( papulovesicular ) utkoTha Adi / cecaka yA masUrikA meM sadaiva donoM kI eka sI avasthA rahatI hai| pahale saba utkaNIya avasthA meM rahate haiM phira uvika yA utpUyika avasthA AtI hai / Arambha ke do dina zirovedanA, kaTizUla, daurbalya aura jvara ke bAda taba cecaka ke dAne nikalate haiN| For Private and Personal Use Only

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jvara 467 isa samaya 104 taka gayA huA jvara samatala para A jAtA hai| jaba taka utkaNika yA udavika avasthA rahatI hai jvara kI vRddhi nahIM hotI para utpUyikAvasthA meM punaH jvara bar3hane lagatA hai jo rogArambha ke 10 dina bAda par3atI hai| jvara ko dvitIyaka jvara (secondary fever) kahate haiM cecaka ke dAne bhadde lAla utkaNoM ke rUpa meM janma lete haiM jo pahale pahala mAthe para nikalate haiM jahA~ se ve ceharA, kalAiyA~ aura pairoM taka jAte haiN| ye utkaNa camar3e ke Upara camar3e meM hote haiN| ye kAphI kar3e aura dRr3ha hote haiN| asthiyA~ jahA~ nikalatI huI haiM vahA~ jhuNDa banA lete haiN| aise inake jhuNDa kapoloM para, kuhanI ke nIce kalAI para dekhe jAte haiN| cecaka kA utkoTha eka dikhAvaTa pasanda karane vAlA utkoTha hai jo pahAr3a kI coTiyoM para to milatA hai ghATiyoM meM nahIM arthAt zarIra ke gartamaya bhAgoM kI apekSA ughare aura uThe bhAga para adhika dekhI jAtI haiM / cecaka meM mukha para adhika vikSata mileMge para tvaGmasUrikA meM mukha kI apekSA anya bhAgoM para vikSatoM kI adhikatA pAI jaavegii| cecaka ke utkoTha sadaiva kendrApaga ( centrifugal ) hote haiM ve dRr3ha aura svatantra ( unyielding ) hote haiN| udvANutpUyAvasthA meM dabAne se ve phaTA nahIM karate / inakA vikAsa niyamita hotA hai tIsare dina utkaNa bana jAte haiM 5 veM se 9 veM dina taka uddava aura 9 se 12 veM dina taka utpUya yukta utkoTha banA karate haiN| jisa prakAra ki romAntikA ke udvarNa ( macules ) mila jAte haiM isa prakAra cecaka ke utkaNa milate nhiiN| tvaGmasUrikA ke utkoTha kendrAbhiga (centripetel ) hote haiN| phiraMga ke dvArA bhI kaI prakAra ke dAne nikalate haiN| ye dAne kapar3oM ke nIce chipe rahane vAle bhAga meM nikalate haiN| arthAt ve mukhar3A yA kalAiyoM para nahIM nikalate / isake utkaNa cecaka ke utkaNoM se bar3e aura adhika cipaTe hote haiN| unameM kucha vizalkita ho jAte haiM unapara halakA tAmravarNa ( coppery colour) car3hA hotA hai| unameM kucha utpUyika bhI ho jAte hai inameM khujalI nahIM pdd'tii| unameM kucha to ati rUpIya (pleomorphic ) hote haiN| sampUrNa zarIra meM lasagranthipAka pAyA jAtA hai guptAGgoM meM prathama vikSata kA itihAsa milatA hai tathA phiraMga ke anya lakSaNa milate haiN| zItapittAvasthAoM meM utkaNIya utkoThotpatti paryApta bhramotpatti kara detI hai ve kendrApaga nahIM hote| aba hama vividha jvaroM kI vikRti kA saMkSepa meM varNana karate hue Age bddh'eNge| ina jvaroM meM bahutoM kA varNana pustaka meM pIche ho cukA hogA para hama yahA~ eka saMkSepa vivaraNa pratyeka jvara kA hama eka hI sthAna para pragaTa karate haiM: 1-daNDakajvara-( Dengue fever )-yaha eka uSNakaTibandhIya roga hai jo mazakoM dvArA phailatA hai| daNDakajvara se pIDita rogI ke rakta meM tIna dina taka isa roga kA karttA viSANu rahatA hai| jaise hI mazaka yA macchara isa kAla meM use kATatA hai yaha viSANu macchara meM praveza karake 11 dina meM panapatA hai aura taba yadi macchara For Private and Personal Use Only

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468 vikRtivijJAna kisI ko kATatA hai to daNDakajvara dUsare manuSya ko laga sakatA hai| isa roga meM jvara rahatA hai asthiyoM aura sandhiyoM meM itanA darda rahatA hai ki aisA lagatA hai mAno har3iyA~ TUTanevAlI haiM / isI kAraNa ise har3ItoDajvara (bone break fever) bhI kahate haiM / isakA eka utkoTha bhI nikalatA hai| isa jvara kI tIvrAvasthA 10 dina taka rahatI hai usake bAda rogI bahuta durbalatA kA anubhava karatA hai| samprApti aura vikRti kI dRSTi se isa jvara meM kUparottarikalasagranthiyA~ (supra trochlear lymph glands ) phUla jAte haiN| rakta kA citra dekhane se usake zveta kaNa kama hokara 3 se 1 // sahasra taka ho jAte haiM kaNikakAyANuoM kI saMkhyA 40% lasakAyANu 60% yA kucha adhika dekhI jAtI hai| jvara utara jAne ke bAda upasipriya kozA bar3ha jAte haiM / isa roga se maranevAloM kI mRtyUttara parIkSA meM sandhiyoM ke pAsa lasIkA kA utsyandana ( effusion ), hRtpezIzotha ( myocarditis ), vRkkazotha aura mastulaMgapAka ( encephalitis ) pAye jAte haiM phuphphusa meM zotha aura raktAdhikya bhI pAyA jAtA hai / roga kA AkramaNa akasmAt hotA hai| jvara 1-2 aMza bar3hakara thor3e hI kAla meM 104 taka pahu~ca jAtA hai / jvara ke sAtha pUrvakapAla meM zUla, netra, pRSTha, zAkhAoM meM sardI aura phuraphurI hotI hai| __ 2-marumakSikAjvara-( Sand hy fever )-yaha eka viSANujanya roga hai| yaha tIna dina rahanevAlA jvara hai isa kAraNa isakA nAma tridivasIya jvara bhI kahate haiN| phleboTomasa papATasI nAmaka marumakSikAoM ke kAraNa yaha roga hotA hai| isake AkramaNa ke samaya rogI ko zIta, ziraHzUla, zarIra meM aGgamada, mukhamaNDala, netra aura grIvA pradeza meM lAlI tathA 104deg taka jvara kA ho jAnA Adi pAye jAte haiN| 3-pItajvara-(Yellow fever )-yaha bhI eka viSANujanya roga hai| yaha maiksiko, madhya amerikA, dakSiNa amerikA kA pUrvItaTa, aphrIkA kA pazcimI kinArA Adi sthAnoM meM sImita hai| yaha roga IDisa ijipTI nAmaka mazaka ke daMza se utpanna hotA hai| maccharI jaba pItajvara pIDita rogI ko prathama 3 dina meM kabhI kATa letI hai to roga ke viSANu usake zarIra meM praviSTa ho jAte haiM usake bAraha dina bAda maccharI meM vaha zakti A jAtI hai ki vaha AjIvana pItajvara kA upasarga samAja ko pradAna kara sakatI hai| pItajvara ke viSANu ke kAraNa sarvAdhika pariNAma yakRt para huA karatA hai| isake yakRta kI kozAoM kA apajanana hotA hai jisake kAraNa usameM madhujanabhAva ho jAtA hai| rakta ke andara pUrvaghanAsri (prothrombin) kI kamI ho jAtI hai tathA kAmalA utpanna ho jAtA hai| kAmalA itanA ugra hotA hai ki usake kAraNa sampUrNa zarIra aura kAsthiyoM kA varNa pIta ho jAtA hai| pUrvadhanAni kI kamI ke kAraNa rakta kA srAva zarIra ke anya logoM se adhika hone kI pravRtti bar3ha jAtI hai| rakta bhI isake kuprabhAva se For Private and Personal Use Only

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jvara 466 bacate nahIM unakI Arambhika kuNDalikA ke adhicchadIya kozAoM kA apajanana ho jAtA hai vahA~ zotha aura UtinAzAdi ke kAraNa zukkimeha bana jAtA hai raktameha aura mUtraviSamayatA bhI khUba banate haiM / kezikAoM ke antazchada meM apajanana ke kAraNa remara hotA hai / AmAzaya kI zlaiSmika kalA meM raktastrAva ke kAraNa kAlAvamana hotA hai / isakA varNa kahave jaisA hotA hai / hRtpezI meM apajanana ke kAraNa tathA hija hafore meM kharAbI par3ane se rogI kI nADI kI gati manda par3a jA sakatI hai / mastiSka meM bhI kahIM na kahIM raktasrAva dekhA jA sakatA hai| mastiSka - suSumnA jala kI mAtrA bar3ha kara usakA pIDana mastiSka para prabhAva DAla sakatA hai / udara kI lasagranthiyA~ bhI bar3ha jAtI haiM / rakta ke citra ko dekhane se Arambha meM bahvAkAri zvetakaNa kI saMkhyA bar3ha jAtI hai / lasakAyANu kama ho jAte haiM uSasipriya lupta ho jAte haiM bAda meM zvetakAyANuoM kA apakarSa tathA eka nyaSTi zvetakaNotkarSa hotA hai / 3 - tantrikajvara ( Typhus fever ) -- ise bandI gRha jvara, akAma jvara athavA zivirajvara ina nAmoM se bolA karate haiM / tandrikajvara yUkA, pissU, kilanI aura kuTakI ina jIvoM ke dvArA phailatA hai aura cAroM hI prakAra kA hotA hai / tandrika - jvara se pIDita rogI ko yadi koI yUkA yA jU~ kATa letA hai to isa roga ke kAraka rikaiTsiyAvarga ke sUkSma jIvANu usakI madhyAntra meM praveza kara jAte haiM / madhyAntra kI adhicchadIya kozAoM meM punaH praveza kara parivarddhita hone lagate haiM 5-7 dina bAda ve kozA tor3a kara Antra meM AjAte haiM aura vahIM se mala dvArA utsargita huA karate haiM / yaha yUkA kA mala svastha zarIra ke Upara tvacA para giratA hai aura yadi tvacA meM koI kharoMca yA vidAra huA to usake dvArA jIvANu zarIra ke andara praveza pAjAte haiN| Ayurveda fare snAna aura dhauta vastroM ke pahanane para jo itanA jora diyA gayA hai usakA yadi niyamataH pAlana kiyA jAve to tandvikajvara kisI bhI bhAratavAsI ko nahIM ho sakatA / yataH yaha paramparA varSo sthita rahI isI se yaha jvara apane deza meM bahuta hI kama pAyA jAtA hai / pissU ke zarIra meM yUkA ke barAbara isa jIvANu kI vRddhi nahIM huA karatI / kilanI ( tick ) meM tandrikajvarakArI jIvANu kI bahuta adhika vRddhi huA karatI hai koI bhI dhAtu yA Uti aisI nahIM chUTatI jahA~ isakA praveza aura vRddhi na hotI ho / kuTakI (mite ) ko roga ke jIvANu cUhoM se milate haiM jinake Upara vaha nivAsa karatI hai | I yUkA kA mala jaba zarIra para laga jAtA hai aura tvacA ke kisI vidAra ke dvArA jaba vaha zarIra meM praveza kara jAtA hai to phira raktavahAoM aura lasavahAoM dvArA usakA prasAra sampUrNa zarIra meM hotA hai| dhamaniyoM aura kezAloM ke antaHstara meM ve praveza karake antazchadIya kozAoM meM bar3hate aura viSa kA nirmANa karate haiM / inase yukta kozA bhI praguNita ho jAte haiM / isa duharI vRddhi ke kAraNa raktavAhiniyoM meM gAMTheM bana jAtI hai jinheM tandrika granthiyA~ kahA jAtA hai / raktavahAoM ke bAhyAvaraNa meM prarasa kozA tathA lasakozAoM kI bhI bharamAra pAI jAtI hai / jina kozAoM meM yaha vikRti For Private and Personal Use Only

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470 vikRtivijJAna dekhI jAtI hai unameM bhI nAza hotA rahatA hai| tvacA, hRtpezI, mastiSka aura anya aMgoM kI raktavAhiniyoM meM ye vikRti dekhI jAyA karatI haiN| tvacA meM vikRti hone se visphoTa banate haiM jisake kAraNa sthAna-sthAna para vRkkadvaya meM meghasama zotha hotA hai / plIhodara ho jAtA hai para parivRddha plIhA mRdu hotI hai / zvasanasaMsthAna ke vAyumArgoM meM praseka kA honA tathA adhastala raktAdhikya ( hypostatic congestion ) bhI pAyA jA sakatA hai| kuTakI dvArA kATane se prathama eka vraNa banatA hai vraNa ke samIpa kI sagranthiyA~ phUla jAtI haiM aura zarIrabhara kI lasagranthiyoM meM bhI kucha na kucha sUjana pAI jAtI hai / hAbhivRddhi, yakRt hRdaya vRkkadvayAdi aMgoM meM bhI kucha na kucha vikRti pAI jAtI hai| tandrikagranthiyoM meM yUkAjanita graMthiyoM kI taraha raktavahAoM ke antazchada meM vikRti na hokara raktavAhiniyoM ke bAhya cola meM vikRti adhika milatI hai tathA ekanyaSThIya kozAoM kI bharamAra paryApta milatI hai / kilanIjanita tandrika meM tvacA meM bahuta adhika vikRti hone ke kAraNa zarIra adhika karburita ho jAtA hai isI se ise karburita jvara ( spotted fever ) bhI nAma diyA jAtA hai / medU aura vRSaNoM kI tvacA kA nAza tathA kotha pAyA jA sakatA hai / phuphphusoM meM adhastalAdhiraktatA tathA nyumoniyA~ ke samAna saMghanatA ( consolidation ) pAI jAtI hai / isakI tandrika granthiyA~ adhika spaSTa nahIM huA karatI haiM / lasagranthivRddhi, hodara, guhyAMga kI tvacA meM dhamaniyoM aura dhamanikAoM kI kharAbI ke kAraNa raktasrAvI pravRtti pAI jA sakatI hai / tandrika jvarI ke rakta meM nimna parivartana dekhane meM Ate haiM: (1) zveta kAyANvapakarSa / ( 2 ) vIla pheliksa pratikriyA' ( Weil Felix reaction ) / ( 3 ) assyAtmaka vAsaramaina pratikriyA / 4. - mUSikadaMzajajvara ( Rat - Bite fever ) - yaha roga spirillama mAinasa yA spAirokITA maursasa myUrisa nAmaka vakra jIvANu ke kAraNa hotA hai / isa jIvANu se pahale cUhe yA mUSe upasRSTa hote haiM jinake bAda manuSya ko upasarga lagatA hai / mUSe ke kATane ke sthAna para usakI lAra vahA~ gira jAtI hai jisameM isake jIvANu hote haiN| kATane ke sthAna se lasavahA unheM lasagranthiyoM tathA raktavahAoM meM le jAtI haiN| rakta meM unake pahu~cane para hI roga ke lakSaNa pragaTa hote haiM / jIvANu plIhA meM bhI pahu~ca 1. yaha pratikriyA una do vaijJAnikoM ke nAmoM ke AdhAra para hai jinhoMne rogI ke mUtra meM proTiyasa varga ke jIvANuoM ko pAyA jo adhika ghola meM upasRSTa prANiyoM ke sIrama meM abhiSTi ho jAte haiM / sIrama ke 30000 meM 10 itane tanu ghola meM bhI pratikriyA astyAtmaka mila cukI / yaha pratikriyA pA~caveM dina bhI mila jAtI hai / 2. zukreNAtha purISeNa mUtreNApi nakhaistathA / daMSTrAbhirvA kSipantIha mUSikAH paJcadhA viSam // For Private and Personal Use Only

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jvara 471 sakate haiM rakta meM inakI upasthiti kevala rogI meM hI milatI hai aura eka bAra acchI upasthiti mila jAne para phira mahInoM yA varSoM taka ve bane rahate haiM / jvara ke Ave kAla meM rakta ke zveta kaNa 15 se 20 hajAra taka bar3ha jAte haiM / uSasipriya kaNoM kI saMkhyA adhika dekhI jAyA karatI hai / vAsaramaina kI kasauTI yahA~ thor3I sI vyakta hotI hai / jvara ke kAla meM hI rakta meM jIvANu pAye jAte haiM, nirjvarAvasthA meM nahIM / isa roga meM yakRt aura vRkkoM meM adhika apajanana milatA hai yaha roga bahuta kAla taka rahatA hai granthayaH zvayathuH kotho maNDalAni bhramo'ruciH / zItajvaro'tiruksAdo vepathuH parvabhedanam // romaharSaH sra utimUrcchA dIrghakAlAnubandhanam // ( vAgbhaTa ) 5- Avartakajvara - ( Relapsing fever ) - yaha jvara boreliyA yA spAironemA nAmaka jIvANu ke dvArA utpanna hotA aura yUkA athavA kilanI ke dvArA phailatA hai / ina do jIvoM ke AdhAra para yUkAvaha ( louse borne ) tathA kilanIvaha ( Tick borne ) Avartakajvara hote haiM / Avartakajvara se grasta rogI ko jaba yUkA kATatA hai to usake AmAzaya meM jIvANu praviSTa ho jAtA hai vahA~ se 24 ghaMTe bAda zarIra ke andara pahu~catA hai do saptAha taka vizeSa parivartana hotA rahatA hai jisake bAda ve jIvANu punaH rogotpAdana sAmarthya se yukta ho jAte haiM / khujalAte -khujalAte jaba yaha yUkA jisake zarIra meM sahasroM Avartaka jvarakArI jIvANu bhare hue rahate haiM bhara jAtA hai to kharoMca sthAna meM usakA rakta laga jAyA karatA hai aura tvacA upasRSTa ho jAtI hai / ekabAra upasRSTa hone para yUkA AjIvana roga kA prasAra karane meM samartha rahatI hai / kilanI ke dvArA bhI aise hI roga phailatA hai| tvacA se jIvANu rakta meM pahu~ca jAte haiM / jvarakAla meM rogI ke tvacAgata rUpa meM ve pAye jAte haiM tathA nirjvarakAla hone para svacAgata rakta meM ve na milakara AbhyantarIya yakRta, plIhA, mastiSka Adi aMgoM meM pahu~ca jAte haiN| sajvarAvasthA meM ekanyaSTIya zveta raktakaNoM kI vRddhi hotI hai / kabhI-kabhI plIhA bar3ha jAtI aura komala ho jAtI hai usameM kaI RNAtra ( infarcts ) pAye jAte haiM / yakRt meM bhI vRddhi ho jAtI hai / hRdaya aura vRkkoM meM meghasamazotha athavA snehApajanana dekhA jAtA hai / nalakAsthiyoM meM majjA kA varNa rakta ho jAtA hai / 6 - plega yA vAtAlikA - yaha roga baisIlasa pesTisa se honevAlA hai / yaha eka cUhoM kA roga hai| bImAra cUhe kA khUna pInevAlA pissU cUhe ke marane ke bAda dUsare svastha cUhe kA khUna cUsate samaya use plegAkulita kara detA hai / jaba pissU ko cUhoM kA milanA banda ho jAtA hai taba vaha manuSya para AkramaNa karatA hai / pissU ke daMza se manuSyazarIra meM pravezasthAna para eka choTA visphoTa yA phapholA bana jAtA roga kA AkramaNa saumya prakAra hai yaha pratikriyA adhika kSamatAvAle prANI meM yA jaba kA hotA hai tabhI pragaTa hotI hai / phaphole kA tala aura hokara phUla jAtA hai usake nIce kI gambhIra UtiyoM meM usake samIpa kA bhAga lAla kozAoM kI bharamAra hokara For Private and Personal Use Only

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472 vikRtivijJAna kozotpatti ho jAtI hai| aba jo vraNa banatA hai vaha kArabaGkila ke samAna hotA hai| isa vraNa meM plega ke asaMkhya jIvANu bhare hote haiM yaha sthAnika vraNa DA. ghANekara ke anusAra 5-10 pratizata rugNoM meM hI dikhalAI detA hai| para jinameM kSamatAzakti kA prakAra madhyama hotA hai daMzasthAna se sambaddha lasagranthiyA~ phUla jAtI haiN| daMzasthalI se plega ke jIvANu lasavahAoM dvArA ina granthiyoM meM pahuMcate haiN| phUlI huI lasIkAgranthi bada yA bUbo kahalAtI hai| ye gilTiyA~ aksara jA~ghoM meM nikalatI haiN| yadi pissU ne hAtha meM kATA ho to gilTI bagala yA gardana meM nikalatI haiN| pahale-pahala jo granthiyA~ prabhAvita hotI haiM unameM lAlI tathA vikRti bahuta adhika hotI haiM inheM prAthamika bada (primary bubo) kahate haiN| vikRta lasIkAgranthiyoM ke sAtha lasavahAoM dvArA jina lasagranthiyoM kA Age sambandha hotA hai unameM bAda meM jo parivartana aura vikRtiyA~ pAI jAtI haiM ve pahale kI apekSA kama hone ke kAraNa unheM dvitIyaka bada ( secondary bubo ) kahate haiN| jo plega ke jIvANu rakta ke lasIkAgranthiyoM meM praveza karate haiM aura unheM phulA dete haiM ve tRtIyaka bada ( tertiary bubo ) kA nirmANa karate haiM / tRtIyaka bada sampUrNa zarIra meM kahIM bhI mila sakatI hai| prAthamika bada kA nirmANa kaI granthiyoM ke prabhAvita hokara phUla jAne aura Apasa meM mila jAne se hotA hai| isa para zotha cauthe dina taka milatA hai| ani,yoM ke samIpastha atiyoM meM kozAoM kI bharamAra, raktasrAva aura vraNazotha kI utpatti dekhI jAtI hai| yadi isa bada ko utpanna hote hI kATa kara dekhA jAya to usameM se tanu lAlAsrAva nikalatA hai| usameM pUyakozA, rakta ke kaNa aura plega ke asaMkhya jIvANu pAye jAte haiN| kucha kAla bAda jIvANu viSa unameM kozotpatti karake unheM mRdu banA detA hai| aisI avasthA meM bada ko kATane para pUya tathA granthi kA kuthita (sar3A) bhAga AtA hai / isameM plega ke jIvANu apekSAkRta kama saMkhyA meM pAye jAte haiN| dvitIyaka bada meM kozA bharamAra tathA kotha nahIM milA karatA aura samIpastha UtiyoM meM vraNazotha milatA hai| ___tRtIyaka bada jo sampUrNa zarIra ke kisI bhI aMga meM milate haiM sazUla aura kaThina hote haiN| roga kI pratIkAritA para plega kA rUpa bahuta adhika nirbhara rahA karatA hai| yadi rogI kI kSamatA zakti alpa huI to jIvANu sIdhe rakta meM ghusa kara doSamayatA ( septicaemia) utpanna karate haiN| aisI avasthA meM badotpatti prAyazaH nahIM dekhI jAtI / rakta meM gaye jIvANu AmAzaya, tvacA, Antra, yakRt , plIhA, hRdaya, phuphphusa, vRkka aura lasyakalAoM meM praveza karake raktasrAvayukta zotha utpanna karate haiM jisake kAraNa yakRtplIhodara, zvasanI phuphphusa pAka, raktavAhiniyoM kI antaHzalyatA yA ghanAstrotkarSa ityAdi upadrava utpanna ho jAte haiM (ghANekara ) rakta meM jIvANuoM kI saMkhyA bahuta druta vega se bar3hatI hai| yahA~ taka ki 1 ghana sIsI meM 10000 se 1000000 taka jIvANu mila jAte haiN| phuphphusa meM jIvANuoM ke pahuMcane se bane zvasanI phuphphusapAka se pIDita For Private and Personal Use Only

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. . . jvara 473 rogI ke thUka meM bhI plega ke asaMkhya jIvANu dekhe jAte haiN| thUka se havA meM milakara ye jIvANu svastha vyaktiyoM para AkramaNa karate haiN| aisI avasthA meM pissU ko plega phailAne meM kaSTa nahIM karanA pdd'taa| raktagata parivartanoM kA plega meM vicAra karane para nimna vizeSatAe~ mila jAtI haiM 1-lAlakaNoM kI vRddhi 60 lAkha taka / 2-zveta kaNoM kI vRddhi sAdhAraNatayA-20000 taka para plega doSa mayatA hone para-60000 tk| 3--bahvAkArI zvetakaNoM kI vRddhi adhika hotI hai| plega kA jIvANu antarviSotpAdaka hotA hai ataH jitane jIvANuoM kA zarIra meM nAza hotA hai unakA viSa rakta ke dvArA daur3atA hai jo raktavahAoM ke antaHstara ko naSTa karake tvacA, zleSmalakalA, lasyakalA tathA anya aMgoM meM rakta kA srAva kara detA hai| isakA viSailA pariNAma kozAoM para bhI hotA hai| jisase hRdaya, mastiSka, yakRt tathA vRkkAdi aMgoM meM meghasamazotha tathA snaihikavihvAsa hotA hai| hRdaya kA dakSiNa bhAga visphArita ho jAtA hai| plIhA kA AkAra svAbhAvika se do tIna gunA bar3ha jAtA hai vaha adhiraktita tathA raktasrAvI ho jAtI hai| mastiSkatAnikAe~ bhI adhiraktita ho jAtI haiM aura mastiSka meM bhI raktasrAva ho jA sakatA hai / phuphphusa meM Arambha se zvasanI phuphphusapAka hotA hai jo bar3hakara pUre eka khaNDa ko bhI grasa le sakatA hai| phuphphusacchada meM adhiraktatA aura raktimA ( ecchymoses ) mila sakatI hai| ___ 7-taraGgajvara (Vudulant fever) ise DA0 ghANekara ne armimAna jvara mAnA hai| ise bruselosisa ( apigolANUtkarSa), mAlTAjvara, bhUmadhyasAgarIyajvara ( Mediterranean fever) Adi nAmoM se bhI pukArA jAtA hai / yaha roga brasellAgaNa ke mailiTainsisa tathA aborTasa nAmaka do daNDANuoM ke dvArA do rUpoM meM dekhA jAtA hai| ___ 0 mailITainsisa mAlTA TApU kI bher3a bakariyoM meM garbhapAta karAne vAlA roga hai / usa TApU kI 50% bher3a bakariyA~ isase pIr3ita hotI haiM aura unake malamUtra, dugdha se yaha daNDANu sadaiva utsargita hotA rahatA hai brU. aboTasa gAyoM aura zUkarI ke andara pAyA jAtA hai aura unake malamUtra aura dugdha dvArA barAbara utsargita hotA rahatA hai| dRSita dugdhAdi ke sevana karane se Antra meM aura mala, mUtra, mA~sAdi ke samparka se svacA ke vraNoM meM pahuMce hue jIvANu rakta ke dvArA plIhA, lasagranthiyA~, yakRt , majA Adi jAlakAntazchadIya saMsthAna ke aGgoM meM jAkara vRddhi karane lagate haiN| jaba ve paryApta bar3ha jAte haiM to phira ve rakta ke andara jvara kI lahareM yA taraMgeM paidA karate hue Ate haiN| yaha jvarataraMga yA jvaromi kaI dina rahatI hai| aisI jvaromiyA~ kaI bAra AtI haiM / DA. ghANekara ke vicAra se aura jaisA ki prAisa kA bhI mata hai yaha roga eka kAlika tRNANumayatA (chronic bacteraemia) hai| isameM plIhAdi aMgoM meM jIvANuoM ke kendra hote haiM jahA~ bIca bIca meM tRNANumayatA kI UrmiyA~ nika For Private and Personal Use Only

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474 vikRtivijJAna latI rahatI haiM / tRNANumayatA ke sAtha sAtha viSarakatA ( toxaemia) bhI rahatI hai| plIhA, lasagranthiyA~, asthimajA, yakRtAdi aMgoM meM sadaiva jIvANu milA karate haiN| para rakta meM ye jIvANu Arambha meM kucha kAla taka milate haiM para bAda meM jyoM jyoM rakta meM pratiyogI utpanna hote jAte haiM inakI upasthiti kama hotI jAtI hai| ___ plIhA meM isa roga ke kAraNa mAlapISiyana piNDoM meM zotha hojAtA hai aura lasAbha Uti kI vRddhi hotI hai| inake kAraNa plIhA bar3ha jAtI hai| vaha mRdu aura pilapilI bhI hojAtI hai para Age calakara jaba roga bahuta bar3ha jAtA hai taba vaha kaThina bhI ho jAsakatI hai| AntranibandhanI kI lasapranthiyA~ bhI pravRddha ho jAtI haiM AsapAsa raktasrAva bhI ho jAtA hai| budrAntra ke ye parIya sidhmoM meM zotha aura vraNotpatti ho jAtI hai sAtha hI yakRt vRkka, phuphphusa, mastiSka, vRSaNa, stana, asthimajjA, yoni, bIjAdhAra (ovary), bIjavAhinI, Adi aMgoM meM bhI vraNazotha ho jAtA hai / Antra aura vRkka upasRSTa hone ke kAraNa rugNavyakti ke mala aura mUtra meM jIvANuoM kI upasthiti pAI jA sakato hai| yakRta, vRkka aura phuphphusAdhAroM para adhirakatA dekhI jAtI hai| plIhA kA vajana 20 auMsataka ho jAtA hai| 8-kAlajvara-ise kAlAjAra, Dama Dama jvara, vardhamAna jvara, uSNakaTibandhaja plIhAbhivRddhi gambhIra yA Azayika lIzamainIyAsisa (visceral leishmaniasis) Adi nAmoM se pukArA jAtA hai| yaha uSNakaTibandhaja roga hai jo lIzamana DonovanI nAmaka kITANu ke upasarga se utpanna hotA hai| yaha eka jIrNa svarUpa kA roga hai aura isakA pratyakSa prabhAva jAlakAntazchadIya saMsthAna para par3A karatA hai| yaha roga phlaiboTomasa jAti ke eka bhunage ke dvArA utpanna hotA hai| kAlAjAra kA kITANu bhunage ke daMza ke dvArA manuSyazarIra meM praveza karatA hai| daMza sthalI se tvacA meM pahu~ca kara vaha sthAnika kezAloM ke antazchadIya kozAoM ( endothelial cella ) meM praveza kara jAtA hai| yahIM para yaha kITANu apanI saMkhyAbhivRddhi karatA hai jisake kAraNa ve kozA phUlane lagate haiM phUlate-phUlate unameM kucha vidIrNa bhI ho jAte haiM jisake kAraNa kITANu rakta meM svatantra ho jAte haiN| svatantra kITANu punaH naye kozAoM meM ghusa jAte haiN| kucha kozA to apane kITANuoM se lade hue bhI svatantra hokara rakta meM cala par3ate haiM jinheM rakta ke eka kAyANu bhakSita kara lete haiM / ataH kAlAjAra ke kITANuoM kA raktavahAoM ke antazchadIya kozAoM se nikaTa kA sambandha AtA hai| tathA eka kITANuoM se bhI acchA sambandha par3atA hai| antazchada aura ekakAyANu ye donoM hI jAlakAntazchadIya saMsthAna ke antargata Ate haiM jo sampUrNa zarIra meM itastataH bikharA huA hai| eka kAyANu meM praviSTa kAlAjAra ke kITANu unake dvArA bhakSita na hokara panapate haiM isake kAraNa jAlakAntazchadIya saMsthAna ke kozA ina kITANuoM se DaTa kara bhara jAte haiM / ye kozA bhI apanI abhivRddhi karate haiM pariNAma yaha hotA hai ki jAlakAntazchadIya saMsthAna ke antargata Ane vAle aGgoM kI kezAla pUrI yA adhUrI avaruddha ho jAyA karatI haiM jisake kAraNa ve aMga AkAra meM bar3ha jAte haiM For Private and Personal Use Only

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jvara 475 tathA apane kArya yathAvat karane meM asamartha ho jAte haiM / jAlakAntazchadIya saMsthAna kA kArya, lAla kaNoM kA nirmANa, zveta kaNoM kA nirmANa, zarIra kI pratIkAritA zakti kI vRddhi karanA aura vikArI jIvANuoM kI upasthiti hone para pratiyogiyoM kA taiyAra karanA Adi hotA hai / kAlAjAra meM ye sabhI kArya bigar3a jAne se rakta ke lAla kaNa pUre pUre nahIM bana pAte aura rogI ko araktatA bar3ha jAtI hai raktakSaya ke kAraNa zarIra kRza ho jAtA hai / zveta karNoM kI kamI se zveta kaNApakarSa ( leucopenia ) isa roga kA pramukha lakSaNa bana gayA hai| isase zarIra kI pratIkAritA zakti bhI bahuta ghaTa jAtI hai aura rogI ko koI na koI anya upasarga laga sakatA hai| prati donoM dravyoM kI utpatti bhI yathocita na hone se zarIra kA surakSA vibhAga durbala par3a jAtA hai / upacUrNaraktatA tathA kAyANvapakarSa ke kAraNa rakta meM ghanAstra tathA raktastrAvI pravRtti bar3ha jAtI hai / yaha hama abhI kaha cuke haiM ki kAlAjAra meM jAlakAntazchadIyasaMsthAna ke pratyaGgoM kI kozAe~ bar3hatI haiM aura kITANuoM se bharI rahatI haiM isake kAraNa ye pratyaGga pravRddha ho jAyA karate haiN| plIhA jAlakAntazchadIyasaMsthAna meM pramukha sthAna grahaNa karatI hai ataH yaha sarvAdhika pravRddha huA karatI hai / yaha tola meM sAr3he tIna sera taka bar3ha jAtI hai ( sAmAnyatayA plIhA kA bhAra r3hAI chaTA~ka hI huA karatA hai ) Arambha meM vaha mRdu hotI hai para jyoM-jyoM roga kI jIrNAvasthA AtI jAtI hai vaha kaThinatama banatI jAtI hai / usakI ATopikA ( capsule ) meM kaThinatA bar3hA karatI hai vaha sthUla bhI hotI calI jAtI hai| plIhA ke kozAoM meM paramacaya ( hyperplasia ) tathA adhiraktatA donoM dekhe jAyA karate haiN| DA. ghANekara ke anusAra kucha logoM kA aisA bhI anumAna hai ki kAlAjAra ke rogI meM plIhA ke bhAra kA pacamAMza kITANuoM kA hI hotA hai / pariplIhapAka ( perisplenitis ) tathA RNAstra ( infarcts ) kI upasthiti bhI usameM pAI jA sakatI hai| plIhA ke pazcAt dUsarA sthAna yakRt kA hai / yakRt kI bhI vRddhi hone lagatI hai para vaha plIhA ke mukAbale kama hI rahatI hai / yadi roga bahuta kAla taka calA to plIhA aura yakRt donoM eka barAbara pravRddha dekhe jA sakate haiM / yakRt kA varNa jAyaphala ( nutmeg ) ke samAna syAhI lie bhUrA ho jAtA hai / yakRt dRr3ha aura kSodya ( friable ) ho jAtA hai usakI ATopikA bhI sthUlita ho jAtI hai yakRt meM jAlakAntazchadIyasaMsthAna kA bhAga kUphara kI kozAyeM hotI haiM jinakI asaMkhya gunI saMkhyAvRddhi ho jAtI hai tathA ve kAlAjAra ke kITANuoM se ThasAThasa bharI huI hotI hai unake bhAra aura dabAva kA pariNAma yaha hotA hai ki yAkRtkozA apuSTa ho jAte haiM aura Age calakara antarkhaNDIya tantUtkarSa ( intralobular fibrosis ) ho jAtI hai sirosisa jisakA antima rUpa hai / / asthimajjA prAyaH lAla aura mRdu hotI hai usameM meda ( fat ) ko kamI ho jAtI hai| isameM bhI kozAbhivRddhi paryApta hotI hai / usakI raktotpAdaka uti meM kamI For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 476 vikRtivijJAna hone lagatI hai kozAoM ke andara yahA~ bhI kITANu bahuta bar3I saMkhyA meM bhare par3e rahate haiM / yadi roga saumya huA to koI bAta nahIM anyathA lasIkAgranthiyA~ khUba phUlatI hai| vizeSakara AntranibandhanI ( mesentery ) kI lasagranthiyA~ khUba bar3hatI hai| unameM bhI kITANu pAye jAte haiM para unakI saMkhyA kama hotI hai / lasIkAgranthiyoM ke kendrabhAga meM UtinAza ( central necrosis ) pAyA jAtA hai / lasagranthiyoM ke atirikta gale meM, kSudrAntra meM tathA anyatra bhI jo lasAbha Uti hotI hai usakI abhivRddhi hotI hai tathA usameM kITANuoM kI upasthiti bhI dekhI jA sakatI hai / isI kAraNa gale aura nAsA ke srAvoM tathA mala taka meM kAlAjAra ke kITANuoM kI upasthiti kI khoja kI jA sakatI hai / www.kobatirth.org rogI kA hRdaya bhI visphArita ho jAtA hai tathA vaha kucha latha ( flabby ) bhI pAyA jAtA hai | sthUlAntra meM vraNa tathA atIsAra jaise lakSaNa bhI dekhe jA sakate haiM / inake atirikta vRkka, adhivRkka, phuphphusa, agnyAzayAdi aMgoM ke andara bhI vikRti A jAtI hai / mastiSkasaMsthAna isa roga se achUtA rahatA hai / para jIrNa rogI kI tvacA meM rogottara kAla meM kAlajvarottara lIzamanIyatA pAI jA sakatI hai / / kAlAjAra meM raktagata vikRti ke sambandha meM hama DA0 ghANekara kI pustikA aupasargika roga se kucha tathya saMgraha karake nimna paMktiyoM meM rakha dete haiM : --- 1 - roga ke uttara kAla meM rakta ke lAla kaNoM kI kamI 25 lAkha taka ho jAtI hai ! Acharya Shri Kailassagarsuri Gyanmandir ukta kamIkA kAraNa asthimajjAgata rudhirotsphoTaka uti ( erythroblastic tissue ) kA nAza hotA hai / "9 2 -- lAlakaNoM kI kamI ke sAtha zoNavartuli ( haemoglobin ) kI kamI hone se raMgadezanA ( colour index ) ho jAtI hai / 3---- vetakarNo kI saMkhyA kA ghaTanA -- zvetakAyANvapakarSa kA krama nimna calatA hai( a ) 95 pratizata rogiyoM meM - 3000 se kama -2000 "" (A) 03 (i) 42 1000 "" 4 --- svasthAvasthA meM zvetakAyANu eka hone para 750 lAlakaNa pAye jAte haiM / kAlAjAra meM yahI anupAta 1 : 1500-2000 taka calA jAtA hai / 13- kAlAjAra meM bahvAkArI ( polymorph ) ghaTate haiM lasakAyANu tathA eka kAyANu bar3hate haiM tathA upasipriya dikhalAI nahIM dete ! 39 " "" 6--raktacakrikApakarSa ( thrombocytopenia ) bhI hotA hai jise dhanAtraarraorSa kahate haiM / 7-rakta ke rAsAyanika saMghaTana meM bho bar3e parivartana dekhane meM Ate haiM yathA For Private and Personal Use Only

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viSamajvara kITANu kA jIvana citra _pRSTha 477 ameya CHAHI 0000 000 OM Vivinity . maithunIcakra 15 isa rekhAcitra ke dvArA viSamajvara kITANu kA jIvana citrita kiyA gayA hai| mAnava zarIra meM amaithunI cakra banatA hai jisakA varNana nIce diyA jAtA hai:1-rakta ke lAla kaNa meM kSullaketa yA dAtrabIja (sporojvAiTa) praveza kara rahA hai| -lAlakaNa meM aMzuketa (mIrojvAiTa) praveza kara rahA hai| 2, 3, 4-lAlakaNa ke andara vibhaktaka (zAijoNTa) ke vikAsa kI vibhinna avsthaaeN| 5-lAlakaNa meM aMzuketa bhare hue haiN| 6-lAlakaNa phaTa gayA hai aura aMzuketa raktarasa meM svatantra ho cuke haiN| macchara ke zarIra meM maithunIcakra calatA hai jisakA varNana nIce diyA jAtA hai: 3'-aMzuketu / 7-arddhacandrAkAra AkRti meM aMzuketu / 8-puM-arddhacandra / 9-strI0 arddhacandra / 10-puM0 vyavAyakAyANu (mela gaimeTosAiTa) 11-strI0 vyavAyakAyANu / 12-sUkSma puM0 vyavAyaka kI utpatti / 13-sthUla strI0 vyavAyaka kI utpatti / 14-maithunI kriyA (jhAigosisa) se puM0 strI0 vyavAyaka milakara mithuna (jhAigoTa) ___ banAte haiN| 15-calayuktA yA gatikANDa (UkIneTa) 16-aNDakozA (asistt)| 17-tulakozaka yA bIjANukoza (sporosisstt)| 18-sunAketa / For Private and Personal Use Only

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jvara 477 (ka) rakta kI kSArIyatA kA ghaTanA / (kha) rakta meM cUrNAtu ( calcium ) kI mAtrA kA ghaTanA aura usake kAraNa upacUrNaraktatA ( hypooaloaemia ) kA ho jAnA / (ga) zuklavali ke anupAta meM antara honA 4.5% zukti 2% vartuli 2.8% zu0 4% va0 pAI jAtI hai / svastha meM- kAlAjAra meM - 8 - viSamajvara ( Malaria ) - yA jUr3I bukhAra plAjmoDiyama jAti ke kITANu yaha kITANu apane vaMza ko calAne bhItara maithunI tathA amaithunI cakra ke dvArA phailatA hai jisakI kaI jAtiyA~ hotI haiM / ke lie macchara tathA manuSya ina do prANiyoM ke rUpa meM parivartita hokara pUrNa pragalbha ho pAtA hai / kAlAjAra kI bhAMti viSamajvara ke kITANu bhI Uti meM Azrita rahanevAle hote haiM / inakA nivAsasthala rakta kA lAlakaNa hotA hai aura vahA~ zoNavartali nAmaka raMga dravya kA bhakSaNa karate rahate haiM / zoNabhakSaNa karate haiM isa kAraNa inheM zoNakITANu ( haematozoa ) nAma se bhI sambodhita kiyA jAtA hai / macchara ke kATane se macchara kI lAra dvArA kITANuoM kA kSullaketa nAmaka rUpa ( sporozoite ) zIghra hI rakta ke lAlakarNI para AkramaNa karake apanA manuSya zarIrAntargata amaithunI cakra Arambha karate haiM / ve lAlakarNI meM nihita zoNavartulikA I bhakSaNa karate jAte haiM aura / punaH punaH naye lAlakaNa meM praveza pAte rahate haiM / isa taraha lAlakaNoM kA nAza aura kITANuoM kI vRddhi DAkTara ghANekara ke mata se jvArabhATA kI taraha zarIra meM barAbara jArI rahate haiM / eka kITANu lAlakaNa meM praveza karake apanI upajAti ke anusAra 10 se lekara 32 naye kITANuoM kI utpatti kara letA hai anekoM ko plIhA lAlakaNa ke sAtha hI sAtha naSTa kara detI hai cale gaye kITANuoM ke dvArA zarIra ke lAlakaNoM kA bhaNDAra diyA jaave| pratyeka samaya 3 yA 4 lAlakaNa baca pAte haiM panapatA rahakara apane amaithunI cakra ko pUrNa kiyA karatA hai ina kITANuoM meM se anyathA to naye banate kabhI kA naSTa-bhraSTa kara viSamajvarakArI kITANu 1 A sakatA hai jaba prati eka lAkha isa dRSTi se eka praur3ha vyakti meM jisa samaya upasRSTa lAlakaNa phaTate haiM aura unameM nihita kITANu raktarasa meM svatantra hote haiM usa samaya manuSya ko jAr3A dekara bukhAra car3hatA hai / DAkTara ghANekara kA kathana hai ki jAr3A dekara bukhAra usI avasthA meM lAlakaNoM ke pIche eka lAla kaNa kITANUpasRSTa ho / 15 karor3a lAlakaNa kITANUpasRSTa hone Avazyaka haiN| lagatA hai vahI saJcayakAla ( incubation period ) kAla amaithunI cakra kA kAla hai jo aMzuketoM ( merozoite ) kI saMkhyA aura unakI pratIkAritA para nirbhara rahA karatA hai / cAturthaka ke maithunI cakra kA kAla lambA 72 ghaNTe kA hotA hai aMzuketoM kI saMkhyA kI alpatA ke kAraNa tathA kSamatA kI kamI hone se saJcayakAla sabase lambA huA karatA hai| mAraka viSama jvara ( malignant malaria ) meM amaithunI cakra kA kAla sabase choTA hotA hai aMzuketoM kI saMkhyA sabase isake lie jitanA samaya kahalAtA hai / yaha sacaya For Private and Personal Use Only

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478 vikRtivijJAna adhika hotI hai aura kSamatA adhika rahane ke jAne ke kAraNa usakA saMcayakAla sabase madhyama rahane se 48 ghaNTe kA hI saMcaya kAla hotA hai / Acharya Shri Kailassagarsuri Gyanmandir kAraNa adhika saMkhyA meM aMzuketoM ke baca choTA hotA hai| tRtIyaka meM sabhI bAteM yaha satya hai ki kama se kama 15 karor3a lAla kaNoM kA upasRSTa honA jAr3A bukhAra bulAne ke lie paryApta hai para vAstavikatA yaha hai ki isa maryAdA se kaI sau gunA adhika lAlakaNa viSamajvarIya kITANvabhibhUta pAye jAte haiM / sAdhAraNatayA cAturthaka meM 1 lAkha ke pIche 500, tRtIyaka meM 2500 aura mAraka meM 5000 lAlakaNa upasRSTa milate haiM / mAraka meM kabhI-kabhI tihAI se Adhe taka lAlakaNoM kA upasarga ho jAtA hai / kahane kA tAtparya yaha ki jitane hI adhika rakta ke lAlakaNa upasRSTa hoMge mRtyu kI AzaGkA utanI hI adhika bar3hegI / mAraka meM jvara ke vega ke sAtha-sAtha samasta zarIra ke lAlakoM kA dasaveM se lekara pA~caveM bhAga taka kA khAtamA ho sakatA hai / Tags meM yaha hAni sabase kama hotI hai / lAlakaNoM ke nAza kA pariNAma raktakSaya aura zoNavartula kA hrAsa hotA hai jisake kAraNa zarIra ko ucita parimANa meM prANavAyu nahIM pahu~ca pAtI / jisase ajArakamayata / ( anoxaemia ) aura hRdayAdi marmAGgoM meM apajanana yA vidvAsa ho jAtA hai / viSamajvara ke kITANu jaba apane lAlakaNoM kI goda meM vizrAma lete haiM taba ve na kevala jisa thAlI meM khAte haiM usI meM cheda bhI karate haiM balki lAlakarNI ke bhakSaNa se kiTTa ke rUpa meM eka rAgaka taiyAra karate haiM jise hImojhAina ( hemzoin ) kahA jA sakatA hai / yaha rAgaka lAlakarNI ke madhya meM saJcita hotA rahatA hai aura jaba lAlakaNa usakI puSTi meM saMkhyA vRddhi ho ear hai taba kITANuoM ke sAtha yaha bhI bAhara nirgata ho jAtA hai / yaha rAgaka eka prakAra kA viSa hai aura jAr3e se jo bukhAra AtA hai usakA yaha karttA mAnA gayA hai / jisa prakAra vijAtoya probhUjinoM ke dvArA jvara car3hatA hai vaise hI yaha bhI vijAtIya probhUjina ke samAna hI kArya karatA hai zIta laga kara jvara AnA tathA jvarAvega ke samaya zvetakAyANuoM kI jAnA hotA hai / rAgaka kA prabhAva uSNatA niyAmaka kendra para sIdhA prabhAva hokara bhI jvarotpatti ho sakatI hai| vaha rAgaka rakta meM svatantra hone ke uparAnta jaba punaH antazchadIya kozAoM dvArA kezAloM ke antaHstara meM praveza pA jAtA hai taba usake kaNa vahA~ bhI lAlakaNoM kA nAza karate hue ve kezAlIya prAcIra ko vidIrNa karake raktastrAva kiyA karate haiM / rAgaka ke ye kaNa kAle hote haiM jo plIhA meM saJcita hote rahate haiM / hImojhAina ko kaI zAstrajJa zoNita ( hematin ) mAnate haiM plIhAdi aMgoM meM yaha zoNiti pIta babhru zoNAyastri (haemosiderin ) tathA pIta zoNadhUmali ( haemofuscin ) meM badala jAtI hai / ina dravyoM kI saJciti kA pariNAma ina aMgoM ke kAlapIta yA babhrupIta varNa meM hotA hai / isa prakAra 1-jvarotpatti, 2 - zoNAMzana ( haemolysis ) tathA 3 - AbhyantarIya aMgoM kA ra~gA jAnA ye tIna kArya hImojhAina karatA hai / For Private and Personal Use Only

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jvara 47 hamane dekhA ki viSamajvara ke kITANuoM ke kAraNa rakta meM lAlakoM ke Tukar3e, zoNavartuli tathA rAgaka ke kaNa pracura parimANa meM A jAte haiN| ina vijAtIya dravyoM ko naSTa karane yA grahaNa karane kA mukhya kArya jAlakAntazchadIya saMsthAna ko karanA par3atA hai ataH sarvaprathama unake kozAoM kA paramacaya ho jAtA hai| plIhA ina kozAoM kA bhANDAgAra hai tathA vahIM para lAlakoM kA vinAza pUrNataH hotA hai ataH plIhAbhivRddhi viSamajvara kA eka atyanta mahattva kA kArya hai| yadi roga jIrNa yA kAlika ho jAve to yakRt ko bhI isa kArya meM sahAyatA denI par3atI hai ataH yakRdvRddhi bhI prAyazaH milatI hai| majjAgata jAlakAntazchadIya saMsthAna ke kozAoM meM bhI abhivRddhi hotI hai jisake kAraNa rudhirodbhAvana ( erythropoiesis ) kama hotA hai arthAt rakta ke lAlakaNa kama utpanna ho pAte haiM jisake pariNAmasvarUpa raktakSaya (anaemia ) bar3hane lagatA hai| rakta meM ekakAyANukozA jAlakAntazchadIya saMsthAna ke pratinidhi hote haiM ataH unakI abhivRddhi aura saMkhyAvRddhi paryApta hotI hai jisake kAraNa sApekSa gaNana meM ve 2 se 15-20% taka pAye jAte haiN| ataH ye rAgaka ke kaNoM ko khA DAlate haiM ataH unake udara meM rAgaka bhI pAyA jAtA hai| ___ zoNa vartuli ke rakta meM bahuta adhika mAtrA meM svatantra hone ke kAraNa usase pittarakti ( bilirubin ) kI utpatti karane kI dRSTi se bhI jAlakAntazchadIya saMsthAna kI AvazyakatA par3atI hai / ataH zleSAbha pittarakti kA yakRt meM paryApta mAtrA meM saJcaya ho jAtA hai aura usase phira sphaTAbha yA pitta meM upasthita hone vAlI pittarakti banatI hai| isake kAraNa pittAdhikya ho jAtA hai| pittAdhikya kA pariNAma hRllAsa, tikkAsyatA, pittajachardi, paittika pravAhikA tathA netroM aura tvacA meM kAmalA yA pIliyA ke hone meM hotA hai| mAraka viSamajvara ke kITANu jina lAlakaNoM meM ghusa jAte haiM unheM bhidura ( frssgile ) cipaTu ( sticky ) aura anamya ( inflexible ) kara dete haiN| ye parivartana jyoM-jyoM praviSTa hue kITANu kA vikAsa hotA hai tyoM-tyoM bar3hate jAte haiN| kezAloM meM se jAte samaya unake antazchada para ye upasRSTa kaNa cipakate jAte haiM aura jaba ve saMkhyA meM adhika ho jAte haiM to unake mArgoM kA avarodha kara dete haiN| kezAloM ke antazchada kA paramacaya bhI hotA rahatA hai| inake kAraNa kezAloM ko tathA samIpastha Uti ke pAsa rakta kA pahu~canA kama ho jAtA hai jisase vahA~ prANavAyu kI kamI hotI calI jAtI hai aura vahA~ ke kArya kA ucita rUpa se calanA ruka jAtA hai| jaba yaha sthiti mastiSka meM hotI hai to jvara kA tApAMza atyadhika bar3ha jAtA hai pralApa, visaMjJatA tathA apasmAra ke samAna AkSepa Ane lagate haiN| yadi Antra kI kezAloM kA mArgAvarodha hokara prANavAyu kI kamI huI to atIsAra yA visUcikA jaise lakSaNa milane lagate haiM / hRdaya meM aise lakSaNoM ke kAraNa hRdayAtipAta ho sakatA hai| anya bhI kisI aMga meM ye lakSaNa banane se usI-usI prakAra ke bhISaNa lakSaNa paidA hote hue dekhe jA sakate haiN| zarIra meM lAla kaNoM kI kamI, zoNavartali kA vinAza ina do sthitiyoM ke hone For Private and Personal Use Only

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480 vikRtivijJAna se phuphphusa se jAne vAlI prANavAyu ko grahaNa karane kI zakti rakta ke pAsa kama hotI jAtI hai jisake kAraNa ajArakamayatA ( anoxaemia ) jise ajArakaraktatA bhI kaha sakate haiM utpanna ho jAtI hai / raktasaMcAra meM bAdhA par3ane se bhI yaha sthiti bana sakatI hai / viSamajvara yA maleriyA meM hama dekhate haiM ki zoNavatuli kA nAza aura lAla karNo kA satyAnAza jitanA khulakara hotA hai usase kama kezAloM ke antazchada meM pravRddha viSama kITANuoM ke dvArA hue mArgAvarodha ke kAraNa banI raktasaMcAra kI bAdhA nahIM hotI / raktasaMcAragata bAdhA aura lAlakaNoM kI kamI ina donoM kAraNoM ke upasthita hone ke phalasvarUpa zarIra meM ajArakarakatA paryApta pAI jAtI hai| mAraka viSamajvara meM ye donoM kAraNa pracuratA se hone se mastiSka, hRdaya Adi marmAGgoM meM ajArakaraktatA hokara mRtyu kA kAraNa upasthita ho jAtA hai / viSamajvara jIrNasvarUpa kA ho jAne para ajArakaraktatA mandasvarUpa kI ho jAtI hai jisake kAraNa kRzatA, kSINatA vA duHsvAsthya ( cachexia ) kI sthiti banatI hai| DA. ghANekara kA kathana hai ki viSama jvara meM jitanI bhI vikRtiyA~ dekhane meM AtI haiM unakA pradhAna kAraNa ajArakaraktatA yA ekjImiyA hI hai anya kAraNoM kA adhika mahattva nahIM hai / isa prakAra maleriyA kI samprApti kI dRSTi se ajArakaraktatA kezAlAvarodha, bahupittatA ( polycholia ), bhakSakAyAtkarSa, jvarotpatti, viSaile padArthoM kI saJciti tathA kITANu kA dhAtvAzrayI honA ina 6 bAtoM kI ora hI vizeSa lakSaNa kiyA jAtA hai| aba hama aMga pratyaMgoM kI vikRti kI dRSTi se thor3A vicAra aura kie lete haiM / plIhA para viSamajvarIya kITANu kA sarvAdhika prabhAva par3atA hai| mArAtmaka svarUpa ke viSamajvara meM jaba rogI turata mara jAtA hai usa samaya usakI plIhA kI mRtyUttara parIkSA karane para usameM adhiraktatA ( hyperaemia ) ke atirikta anya koI mahatva kI vikRti dekhane ko nahIM milatI hai usakA AkAra koI khAsa nahIM bar3ha pAtA usakA gorda atyanta mRdula raktasrAvI kAlA aura DA. ghANekara ke zabdoM meM vipravAhI ( diffluent ) hotA hai jise pAnI ke sAtha pravAhita kiyA jA sakatA hai plIhA kI ATopikA tanu evaM tanI huI dekhI jAtI hai / 1 jaba viSamajvara kucha kAlataka jArI rahatA hai to plIhA meM rAgaka tathA upasRSTa areer ke adhikAdhika saJcaya ke kAraNa vaha aura bhI kAle varNa kI ho jAtI hai / usakA AkAra bhI paryApta bar3ha jAtA hai | adhika jIrNa viSamajvara hone para sthUlabhakSaka ( macrophages ) kI upasthiti ke kAraNa usakA AkAra aura bhI sthUla ho jAtA hai / jIrNa viSamajvara meM laiha ATopikA moTI aura apAradarzaka ho jAtI hai / kabhI-kabhI vaha samIpastha aGgoM ke sAtha abhizliSTa ho jAtI hai / jvarAvega kAla meM kucha apane AkAra se adhika bar3hI huI pragaTa hotI hai aura jaba jvara utara jAtA hai taba usakA AkAra kucha ghaTa jAtA hai / yaha ghaTa-bar3ha bahuta adhika nahIM hotI / ter kA AkAra adhika jIrNa viSama yA ekabAra viSamajvara ThIka hone para punaH punaH upasarga lagate cale jAne para itanA adhika bar3ha jA sakatA hai ki phira use mohodara For Private and Personal Use Only

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jvara 481 kiyA jA sakatA hai| jisa prakAra kAlAjAra meM phavRddhi hotI hai vaisI hI kaI sera taka kI plIhA bhI dekhI jA sakatI hai| tRtIyaka viSamajvara meM aisI sthiti prAyaH dekhane meM AtI hai| viSamajvara ke kAraNa bane plIhodara meM plIhA bahuta hI komala ho jAtI hai aura thor3e AghAta se bhI vidIrNa hokara mRtyu kA kAraNa bana sakatI hai ataH bhAratavarSa meM jahA~ asaMkhya plIhodarI viSamajvara dvArA hI banate haiM bahuta hI saumya aura mArdava ke sAtha vyavahAra karane kI AvazyakatA hai / sAdhAraNa se ghUse ke dvArA bhI prANanAza kA kAraNa viSamajvarajanya plIhodara ho sakatA hai| ____aNvIkSa se dekhane para tIvrajvarI kI plIhA meM adhiraktatA bhI milatI hai / plaihamajaka meM viSamakITANUpasRSTa lAla kaNoM kI bharamAra dekhI jA sakatI hai yahA~ vibhaktaka ( scizont ) aura vyavAyaka (gamete ) plIhA pradeza meM jitane prApta hote haiM utane anyatra kahIM bhI nahIM milA krte| pUrvokta rAgaka ( hImojhAina) bhI yahA~ pracura parimANa meM dekhA jA sakatA hai| rAgaka ke kaNa sthUlabhakSoM, srotAsAbhoM (sinusoids ) tathA kezAloM ke antaHstaroM meM antarnihita milate haiN| rAgaka ke kaNa rogArambha kAla meM bahuta thor3e hote haiM para jyoM-jyoM roga jIrNa hotA jAtA hai inake puJja yA samUha banate hue dekhe jAne lagate haiN| yakRt vaha dUsarA avayava hai jisameM viSamajvara kITANuoM ke kAraNa abhivRddhi hotI hai / isa abhivRddhi kA mukhya kAraNa to yaha hai ki yakRt svayaM jAlakAntazchadIya saMsthAna kA eka aMga hai aura cUMki viSamajvara kA kITANu jAlakAntazchadIya saMsthAna ke kozAoM meM paramacaya karatA hai ataH yakRt ke jAlakAntazchadIya kozA bhI paramaH cayita ho jAte haiM / dUsare yakRt meM adhiraktatA hotI hai tathA tIsare isameM hImojhAina nAmaka rAgaka ke kaNoM kA bhI saMcaya hotA hai| isa rAgaka ke kAraNa yakRt kA varNa bhI kAlA ho jAyA karatA hai| kITANuoM kA nAza aura rAgaka kI grAhakatA ye donoM kArya prathamataH plIhA ke adhIna haiN| plIhA jaba unheM karane meM asamartha ho jAtI hai tathA paryApta pravRddha ho jAtI hai tathA roga bhI jIrNa khUba ho letA hai tabhI yakRt kI vRddhi dekhane meM AyA karatI hai| sampUrNa yakRt ke andara na rAgaka pAyA jAtA hai aura na kITANu / yakRt meM jAlakAntazchadIya saMsthAna ke kUphara ke kozA hote haiN| rAgaka aura kITANu ye donoM inhIM kozAoM meM pAye jAte haiN| ye kozA hI vAstava meM paramacayita aura pravRddha huA karate haiN| yAkRt kozAoM ( hepatic cells ) meM zoNAyasvi tathA pittarakti pAI jAtI hai| Age calakara ajArakaraktatA ke pariNAma svarUpa yakRt meM snaihika vihrAsa ho jAyA karatA hai / maleriyA ke kAraNa yakRddAlyUtkarSa kA honA grIna svIkAra karatA hai| asthimajjA yaha jAlakAntazchadIya saMsthAna kA hI eka aMga hai yahA~ rAgaka ke kaNa aura kITANu bahuta kama pAye jAte haiN| raktakSaya hone ke kAraNa rudhirodbhAvaka Uti kI vRddhi hokara majjA ke kozAoM kA apacaya ho jAtA hai jisakA pariNAma zvetakAyA.. NvapakarSa meM hotA hai| 41, 42 vi0 For Private and Personal Use Only

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482 vikRtivijJAna kendriya vAtanADIsaMsthAna meM mArAtmakasvarUpa ke viSamajvara meM hI vikRti hone kI sambhAvanA milatI hai / tRtIyaka aura caturthaka jvaroM ke kAraNa nADIsaMsthAna para koI prabhAva par3atA huA nahIM dekhA jAtA hai / jaba viSamajvarIya mArAtmaka kITANuoM se lade lAla karNoM ko lekara rakta mastiSka meM pahu~catA hai to vaha sUkSma care ko avaruddha karatA tathA bar3I dhamanikAoM ko visphArita kara detA hai / rakta ke sAtha-sAtha rAgaka ke kaNa bhI pAye jAte haiM / sakITANu lAla kaNa aura rAgaka ye donoM milakara mastiSka ke svakSIya bhAga ko sIdhAtu ke samAna kAlA banA dete haiM / jahA~ rAgaka ke kaNa saJcita hote haiM vahA~ vindvAkAra ( punctiform ) raktastrAva hotA hai / yaha raktasrAva anutvatIya zveta bhAga meM hone ke kAraNa vaha karturita ho jAtA hai / viSamajvara ke kAraNa jinakI mRtyu hotI hai unakI mRtyUttara parIkSA yaha batalAtI hai ki mRtakoM ke mastiSka kA zveta bhAga asaMkhya choTe-choTe raktasrAvoM se bharA hotA hai / kezalAvarodha tathA raktasrAvoM ke kAraNa atyadhika santApa ( hyperpyrexia ) "visaMjJatA, saMnyAsa, tandrA, AkSepa, mUkatA tathA aMgaghAtAdi lakSaNa pragaTa huA karate haiM / hRdaya meM bhI vikRti kA kAraNa viSamajvara kA mArAtmaka kITANu hI huA karatA hai / hRdaya kI raktavAhiniyoM meM kITANuoM se lade rakta ke lAla kaNa pahu~cate haiM / hRdantazchada ke nIce nIlohAGkita raktasrAva pAye jAte haiN| sUkSma kezAoM ke avarodha se hRtpezI pAka, snaihika bharamAra yA vihAsa athavA hRtpezI tantuoM kA nAza Adi vikRtiyA~ pAI jAtI haiM / mahAsrota meM sArikAoM ( villi ) ke kezAla kITANuoM se lade lAla kaNoM se visphArita tathA avaruddha ho jAyA karate haiM jisake kAraNa zleSmAvaraNa sUja jAtA hai jagaha-jagaha raktasrAva aura vraNa ho jAte haiM ina vraNoM meM Antrastha pUyajanaka jIvANuoM kA dvitIyaka upasarga ho jAtA hai pariNAmasvarUpa atIsAra, visUcI ityAdi ke samAna ukSaNa bhI pAye jA sakate haiN| isako zItAGga viSamajvara ( algid malaria ) kahate haiN| vRkkoM meM mArAtmaka viSamajvara tathA cAturthaka meM bhI vRkapAka kI sambhAvanA huA karatI hai / roga kI tIghrAvasthA meM vRkkoM meM raktAdhikya pAyA jAtA hai aura bomana kI ATopikAoM meM kITANuyukta lAla kaNoM kI bharamAra milatI hai / vRkka kuNDalikAoM ( convoluted tubules ) ke adhacchadIya kozAoM meM vihAsa yA UtinAza pAyA jAtA hai / gambhIrasvarUpa ke viSamajvara ke kAraNa kuNDalikAoM kI nAliyA~ zukkIya nimakoM ( albumin casts ) tathA raktastrAvoM se bharI huI pAI jAtI haiN| vRkkoM meM rAgaka kA mala bahuta hI kama pAyA jAtA hai / ve AkAra meM bar3ha jAte haiM aura unakA pRSThabhAga camakIlA ho jAtA hai / / Acharya Shri Kailassagarsuri Gyanmandir phuphphusoM meM kITANuoM se lade lAla kaNoM kI bharamAra milatI hai / phuphphusoM meM raktAdhikya milatA hai aura sthUlabhakSa antaHstarIya yA antazchadIya kozAoM kI bhI bharamA pAI jAtI hai / rAgaka ke kAraNa unakA varNa kAlA par3a jAtA hai / inake kAraNa rogI kI kSamatA zakti ghaTa jAtI hai aura use zvasanI phuphphusapAkAdi vyAdhiyA~ laga jA sakatI haiM / For Private and Personal Use Only

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jvara 483 aparA para viSamajvara kITANu kA kyA prabhAva par3atA hai ise DA0 ghANekara ne apanI pustikA 'aupasargika roga' meM vyakta kiyA hai| aparA ( placenta ) ke raktasrotasoM meM raktAdhikya tathA rakta saJcAra kI mandagati ke kAraNa kITANuoM se upasRSTa lAlakaNoM kI bahuta bar3I saMkhyA yahA~ upasthita rahatI hai / isake kAraNa eka to raktapravAha meM bAdhA, pahuMcatI hai dUsare isa bAdhA kA pratyakSa pariNAma garbhapAta meM ho jAtA hai / sAdhAraNatayA aparA ke srotasoM kI prAcIra ko lA~gha kara viSamajvara kA kITANu garbha ke rakta meM pratyakSa nahIM A sakatA jaise ki phiraMgANu kara sakatA hai isalie sahaja phiraMga kI bhA~ti sahaja viSamajvara ke rugNa kadApi nahIM milate para yadi aparA meM vidAra ho jAve to viSamajvara ke kITANu garbha para bhI pratyakSa AkramaNa karane meM samartha ho jA sakate haiM aisA vizeSajJoM kA mata kahA jAtA hai / antaHsrAvI granthiyoM meM adhivRkka granthiyoM meM kITANuyukta lAlakaNoM ke kAraNa kezAlAvarodha ho jA sakatA hai / ina granthiyoM meM vikRti ke kAraNa hI kucha tajjJoM ke mata se zItAGgatA ( algidity ) huA karatI hai / Upara jo kucha aMgoM meM hone vAlI vikRti kA varNana kiyA gayA hai vaha ina vikRtiyoM ke do hI pradhAna kAraNoM kI ora hamArA dhyAnAkRSTa karatI hai jinameM eka viSamajvarakArI kITANuoM se lade rakta ke lAla kaNoM kI tathA ina lAla kaNoM kI zoNavartula kA bhakSaNa karake kITANuoM dvArA utpanna rAgaka kI vividha aMgoM meM bharamAra hai aura dUsarA jAlakAntazchadIya kozAoM kI vRddhi tathA bhakSakAyANUskarSa hai / ye donoM kAraNa plIhA meM sarvAdhika yakRt meM madhyama tathA asthi majjA meM sabase kama mAtrA meM pAye jAte haiM anya aMgoM kI vikRtiyoM meM prathama kAraNa hI adhika mahatva rakhatA hai / viSamajvara meM raktagata jo parivartana dekhe jAte haiM unheM hama nIce pragaTa karate haiN| : (1) lAla kaNoM meM parivartana - viSamajvara ke kITANu kI mukhya khurAka rakta kA or a hai | ataH isa roga meM inakA jitanA nAza dekhA jAtA hai utanA anya kisI roga meM nahIM huA karatA / pratighanasahasrimAna mArAtmaka viSamajvara meM ye lAla kaNa 20 lAkha tathA tRtIyaka caturthaka meM 40-30 lAkha inakI saMkhyA rahA karatI hai / lAla kaNoM ke nAza ke kAraNa zarIra meM jo vyAdhi utpanna hotI hai use raktakSaya yA araktatA ( enImiyA ) kahA jAtA hai / viSamajvara kA kITANu do prakAra se isa araktatA ko utpanna karatA hai / eka to vaha pratyakSa lAla kaNa ko naSTa karake use apanA AhAra banA letA hai dUsare usase nirmita rAgaka ke dvArA rudhirodbhAvana ( erythropoiesis ) meM bAdhA utpanna hotI hai / viSamajvara ke kITANuoM ke dvArA lAla kaNoM kA jitanA nAza hotA hai usake kAraNa unake utpAdana kA kArya bhI drutagati se bar3hatA hai para viSamajvarIya upasarga ke kAraNa lAla kaNoM kI zarIrasvAsthya kI dRSTi se Avazyaka mAtrA meM utpatti nahIM ho pAtI / rudhirodbhAvana kriyA bar3hane se lAla kaNoM meM jAlaka kAyANuoM ( reticulocytes ) kI pratizatikatA meM vRddhi ho jAtI hai / jAlaka For Private and Personal Use Only

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484 vikRtivijJAna jAnA- * kAyANu apragalbha hote haiM jinameM viSama jvara kITANu bar3e prema se praveza pA jAtA hai aura saralatA se unakA nAza kara detA hai / isake kAraNa raktahInatA yA raktakSaya lagAtAra calatA aura bar3hatA rahatA hai / lAla karNoM kI isa kamI ko alparudhira kAyAnuraktatA ( oligocythaemia ) kahA jAtA hai| lAla kaNoM kI AkRti parimiti aura raMga grahaNa karane kI zakti ina tInoM meM parivartana hone ke kAraNa lAla karNoM kA Ter3hA ho - pravidhakAyANUtkarSa (poikilocytosis ), karNo kA choTA-moTA ho jAnA( anisocytosis ), bahuvarNapriyatA ( polychromatophilia ) aura kSArapriyakaNikA bhavana (basophilic stippling ) Adi raktataya ke cihna pragaTa ho jAte haiM / kSArapriyakaNikAbhavana ke kAraNa lAlakaNoM ke andara nIle raMga ke choTe-choTe dAne dikhalAI dete haiM jo viSamajvaropasarga samApta hone ke bAda taka milate haiM aura supta upasarga yA bhUta upasarga kI sUcanA dete haiN| lAlakaNoM kI zoNavartuli ke vinAza ke kAraNa unakI raMgadezanA ( colour index ) eka se kama ho jAtI hai / upasRSTa lAlakarNI meM kucha kaNikAe~ bhI pAI jAtI haiM / mArAtmaka viSamajvara meM ve mArarakaNikAe~ ( maurer's ), tRtIyaka meM zUphanara kI aura cAturthaka meM jhImana ( ziemann ) kI kahalAtI haiM / cAturthaka aura mArAtmaka ke lAlakaNa tRtIyaka ke * lAlakaNoM kI apekSA kucha choTe hote haiN| (2) zveta kaNoM meM parivartana - jvarAvegakAla meM zvetakaNoM kI saMkhyA nirjvarAvasthA kI apekSA bar3hI huI dekhI jAtI hai / yadi sAtha meM Antrastha lakSaNa bhI hoM to mArAtmaka upasarga meM inakI saMkhyA aura bhI bar3ha jAtI hai / nirjvarakAla meM yaha saMkhyA DA0 vANekara ke anusAra ise 5 sahasra taka kama ho jAtI hai jisake kAraNa zvetakaNa tathA lAlakarNI kA svasthAvasthA kA 1 : 700 kA anupAta 1 : 900 ho jAtA hai / jIrNa viSamajvara meM zvetakAyANvapakarSa itanA adhika aura itanA sthAyI nahIM pAyA jAtA / jaisA ki kAlAjAra meM hamane dekhA hai viSamajvara meM bhI ekanyaSTi zvetakaNa ( mononuclears) tathA eka kAyANuoM kI saMkhyA meM vRddhi hotI hai / zIta lagate samaya aura jvara ke AraMbha kAla meM inakI saMkhyA ghaTakara nirjvarAvasthA Ane para 15 - 20% taka bar3hakara saptAha taka vaisI hI rahI AtI hai ( ghANekara ) / jaba eka kAyANu -bar3hate haiM to bahnAkArI ( polymorph ) ghaTa jAte haiN| eka kAyANu 40 se 45 pratizata taka bar3ha jAte haiN| eka kAyANu eka bhakSaka kozA hai ataH usake andara * rAgaka ke kaNa pAye jA sakate haiM ina kaNoM ke milane para maleriyA kA nidAna saralatA se ho jAyA karatA hai / jina rogiyoM meM viSamatA adhika hotI hai vahA~ jvarAvegakAla * meM bahvAkArI bhI 75-80% taka sApekSagaNana para mila sakate haiM / (3) rAsAyanika parivartana - rakta ke andara jIvarAsAyanika ( biological ) kaI parivartana dekhane meM Ate haiM / sarvaprathama to kula probhUjinoM kI rAzi kA kama honA hai| zukla kI rAzi kI kamI ke kAraNa yaha ghaTotarI huA karatI hai / vartuli kI vRddhi huA karatI hai jisase zuktiH vartuli anupAta 1 : 1 kA ho jAtA hai / vartula vRddhi ke For Private and Personal Use Only

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jvara 48 kAraNa kAlAjAra jvara kI taraha zliSaka aura aMjana kI kasauTiyA~ ISad vyakta milatI haiN| usI ke kAraNa lAlakaNAvasAdana gati teja ho jAtI hai| lAlakaNoM kA paryApta nAza ho jAtA hai jisase raktarasa meM ayas , dahAtu ( poTAziyama) aura pittarakti ( bilirubin ) kI adhikatA pAI jAtI hai| pittarakti kI adhikatA kI parIkSA phAnaDenavarga kI kasauThI ke apratyakSatayA vyakta hone se kI jAtI hai| kAmalAdezanA ( icterus index ) ke adhika milane se bhI isakI parIkSA kara lI jA sakatI hai| agnyAzaya, adhivRkka aura yakRt meM kharAbI ke pariNAmasvarUpa raktazarkarA kI mAtrA bar3ha jAtI hai| para Age calakara vaha zanaiH zanaiH ghaTane lagatI hai / paittava kI bhI mAtrA ghaTa jAtI hai / DA. ghANekara kA kathana hai ki maleriyA kI tIvrAvasthA meM vAsaramena aura kAhana kI kasauTiyA~ taka vyakta ho jAtI haiN| aisA kyoM hotA hai usakA koI kAraNa abhI taka jJAta nahIM ho sakA hai| ___ 10-kAlamehajvara ( Black Water fever ) ise viSamajvara zoNavartulimeha ( malarial haemoglobinuria) yA mecakamahajvara ( melanurie fever ) bhI kahate haiN| isa roga kA kyA kAraNa hai usake sambandha meM abhI taka zaGkAe~ haiM para yataH isakA viSamajvara se ghaniSTa sambandha hai tathA unhIM vyaktiyoM ko hotA hai jinheM viSamajvara kA AkramaNa ho cukA ho, mArAtmaka viSamajvara ke lakSaNoM ke sAtha isake lakSaNa milate haiM tathA viSamajvara ke hI kAla meM utpanna hotA hai ataH isakA kAraNa bhI viSamajvarakArI kITANu ho sakatA hai| yadi ucita aura yuktiyukta kahane kA mUlya ho to yaha roga kinIna ke atimAtra prayoga kA pariNAma kahA jA sakatA hai| jo vinIna nahIM lete unameM yaha bahuta hI kama pAyA jAtA hai| __ jIvarAsAyanika parIkSAoM ke AdhAra para aisA siddha huA hai ki kAlamehajvara mArAtmakaviSamajvara kA hI eka atyugra aura atizAyI rUpa hai| mArAtmakaviSamajvara kI apekSA jo vizeSatA isameM pAI jAtI hai vaha hai atyadhika zoNAMzana ( haemo lysis) kA honA / zoNAMzana kA kAraNa abhI taka ajJAta hai| logoM kA vicAra hai ki zoNAMzana karane vAle tatva plIhA meM saMcita rahate haiN| plIhA ke saMkoca ke sAtha hI sAtha ve bhI rakta meM bhramaNa ke lie nikala par3ate haiM aura lAlakaNoM kA nAza karane lagate haiN| rakta meM amlotkarSa hone se bhI zoNAMzana ho jAtA hai| atIsAra, pravAhikA, raktakSaya, sardI-garmI, bhIganA, adhika parizrama, madyasevana Adi kAraNa bhI amlotkarSa kArI hote haiN| eka mata yaha bhI hai ki mAnavIya UtiyoM meM zoNAMzanakArI eka tatva sadaiva banA rahatA hai jise vyaMzi (lytic) kahate haiN| ThIka isakA virodhI tatva rakta meM rahatA hai jisakI upasthiti ke kAraNa hI vyaMzi apane kArya ko karane meM samartha nahIM ho paataa| isa roga meM kisI bhI kAraNa se kahIM se rakta vA rakta se vyaMzivirodhI tatva samApta ho jAtA hai isa kAraNa vyaMzi khUba manamAnI gharajAnI karatA hai aura lAla kaNoM ko DaTa kara galAtA hai| kucha kA yaha mata bhI hai ki yakRt meM kharAbI ho jAne ke kAraNa vaha apanA kArya karane meM asamartha ho jAtA hai aura lAlakaNa galane lagate haiM / For Private and Personal Use Only

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456 vikRtivijJAna ___ isa roga meM sarvAdhika vikRti rakta meM pAI jAtI hai| lAlakaNoM ke naSTa hone ke kAraNa unakI saMkhyA sAmAnya roga meM 50 pratizata tathA tIvra meM 80% evaM sphUrjaka meM 90" taka 24 ghaNTe ke andara naSTa ho jAtI hai| raktarasa meM zoNavartuli svatantra rUpa meM milatI hai jisake AdhAra para ise zoNavartuliraktatA ( haemoglobinaemia) kahate haiN| zoNavartuli Arambha meM jAraka (oxygen) para bAda meM sama (meta) tathA samazoNazukli ( methaemalbumin ) meM badala jAtI hai| zoNavartuli mUtra dvArA kadApi bAhara nahIM AtA para jaba isakI rAzi sAtha meM atyadhika ho jAtI hai to phira vRkkoM dvArA ise mUtra meM utsRSTa kiyA jAyA karatA hai| isI ke kAraNa isa roga ko zoNavartulimeha ( haemoglobinuria) kahA jAtA hai / isakA raMga kAlA hone ke kAraNa ise kAlameha kahA jAtA hai| zoNavartuli kI adhikatA ke kAraNa jAlakAntazchadIyasaMsthAna use pittarakti meM pariNata karatA hai yaha pittarakti naM0 1 hotI hai ise yakRt mAtrAdhikya ke kAraNa naM. 2 meM pariNata karane meM asamartha rahatA hai isake kAraNa pittaraktimayatA ( bilirubinaemia) utpanna ho jAtI hai| isake kAraNa pittarAgaka rakta meM upasthita hokara tvacA ko pIlA banAtA huA kAmalA utpanna kara detA hai / yahA~ phAnaDenavarga pratikriyA parokSavyakta hotI hai| rakta meM miha (yUriyA) bhI bar3hane lagatA hai jo mUtrAghAta kA sUcaka lakSaNa hai| ___ isa roga meM rakta meM zoNavartuli. pittarakti, miha, samazoNazukli pAI jAtI haiN| rakta patalA aura usameM kSAra saMciti kama milatI hai kSArIyatA ghaTane lagatI hai| roga ke ThIka hone ke sAtha-sAtha rakta meM nyaSTIlAyukta lAlakaNa (nucleated erythrocytes) milate haiM jAlakakAyANu evaM ekakAyANu ye donoM kramazaH 25% aura 12% taka bar3he hue dikhe jAte haiN| plIhA meM lAlakoM kA vyaMzana aura zoNavartulikA kA viniyoga karane ke lie jAlakAntazchadIyakozAoM kI vRddhi hotI hai| ina kozAoM meM TUTe-phUTe lAlakaNa aura rAgaka bharA rahatA hai| ise zoNabhakSaNa (haematophagy) kahate haiN| isase plIhAbhivRddhi hotI hai| yakRt meM bhI jAlakAntazchadIya saMsthAna ke kozA abhivRddhi karate haiM aura unameM rAgaka bharA rahatA hai| yakRt meM pitta kI utpatti bar3ha jAne se Antra meM, pittAzaya meM tathA yakRt kI pitta kAnAlikAoM meM vaha khUba bharA rahatA hai| kAlamehajvara meM vRkkoM kI khAsa karake vikRti pAI jAtI hai| unakA raMga kAlA, bhUrA, nIlA sA hotA hai| unameM adhiraktatA pAI jAtI hai| vRkka kI gucchikAoM aura prathama kuNDalikAoM meM vikAra nahIM milatA dvitIya kuNDalikAeM aura usake Age kI nAlikAoM meM vikRti sarvAdhika hotI hai| isa vikAra meM nAlikAeM kAcarIya ( hya. line ) tathA kozikIya (cellular) nirmokoM se bhara jAtI haiN| nirmokoM ke kAraNa mUtra nAlikAe~ pUrI yA aMzataH avaruddha ho jAtI haiM jisake kAraNa alpamUtrameha (oliguria) yA amUtrameha ( anuria) kI sthiti utpanna ho jAtI hai isa avarodha ke atirikta vRkkoM meM rakta kI kamI athavA usa kamI ke kAraNa utpanna ajArakatA ( anoxia) For Private and Personal Use Only

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487 * ke kAraNa alpamUtrameha yA amUtrameha utpanna hotA hai aisA kucha tajjJoM kA mata hai| . 11-Antrikajvara ( Typhoid fever )-ise Antrajvara, mantharajvara, mantharaka jvara, madhurakajvara, madhurA, mauktikajvara, motIjharA Adi nAmoM se pukArate haiM / isakA kAraNa eka tandrA bhI daNDANu ( bacterium typhosum ) hotA hai / yaha dUSita khAdyapeya padArthoM ke kAraNa hone vAlA roga hai| motIjharA se upasRSTa rogI ke mala kA samparka jahA~-jahA~ pratyakSa vA apratyakSatayA ho jAtA hai vahIM yaha phailatA hai| rogI aura usase bhI adhika mahattvapUrNa vAhaka isake prasAra meM mukhya kAraNa banate haiN| ___ dUSita khAdyapeyAdi padArthoM ke dvArA Antrajvara daNDANu mukha meM hokara mahAsrota meM pahu~catA hai| yadi peTa khAlI huA tathA AmAzaya meM amla kI kamI huI athavA khAne ke sAtha pracura parimANa meM jala pI liyA gayA jisase amla kI daNDANu saMhAraka zakti kA hrAsa ho jAtA hai to ve daNDANu kSudAntra meM praviSTa ho jAte haiN| tudrAntra inakI vRddhi ke sarva sukha upasthita kara detI hai| isa anukUla vAtAvaraNa ke kAraNa ve yahA~ sukhapUrvaka vaMza vRddhi karate haiN| ye Antra ke suSiraka meM na bar3ha kara Antra kI prAcIra meM pAI jAne vAlI lasAtmaka Uti (lymphatic tissue ) meM upasthita sthUlabhakSoM ( macrophages ) tathA prarasa kozAoM . ( plasma cells) meM bar3hA karate haiN| lasAtmaka Uti taka inake gamana kI kahAnI abhI taka anumAna ke bala para gar3hI gaI hai| upazleSmala lasAya kUpikAoM ( submucous lymphoid follicles ) tathA Antra nibandhinI kI lasIkA granthiyoM meM ye upasthita hokara apane saMcayakAla meM vRddhigata huA karate haiN| vahA~ se ye rakta kI dhArA meM cale jAte haiM aura jIvANuraktatA ( bactraemia ) utpanna kara dete haiN| roga ke prathama saptAha meM isI lie Antrajvara daNDANu ko raktasaMvarddha ke dvArA prApta kiyA jA sakatA hai| parantu dUsare saptAha meM jaba inako naSTa karane kI dRSTi se raktarasa meM pratiyogI dravyoM kA nirmANa Arambha ho jAtA hai to phira dvitIya saptAha meM aura usake Age unakA rakta meM pAyA jAnA kaThina ho jAtA hai| Antrika jvara kI cAra avasthAe~ sAdhAraNatayA svIkAra kI jAtI haiM:1-tRNANumayatA yA daNDANumayatA-jaba jIvANu rakta meM pahu~catA hai| 2-sthAnasaMzrayAvasthA-jaba rakta meM saJcAra karane vAle jIvANu peyarIya tathA ekala lasapiNDoM ( peyer's and solitary lymph follicles ), plIhA, yakRt , asthimajjA aura jahA~-jahA~ lasAbha kozA mila sakate haiM meM avasthAna karate hue bar3hate haiM aura apanA viSailA prabhAva pragaTa karate haiN| 3-pratIkArAvasthA-java AntradaNDANu ke lie zarIra meM pratiyogI dravya bananA Arambha karate haiN| 4-upabhamAvasthA-jaba jvara samApta ho jAtA hai aura Antrastha vraNoM kA upazamana hone lagatA hai| rakta meM isakA daNDANu ho yA na ho yaha vyAdhi eka tIvra viSaraktatA kI avasthA For Private and Personal Use Only

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488 vikRtivijJAna ko sUcita karatI hai| isakA daNDANu zarIrastha lasAbha Uti kI ora vizeSa karake AkRSTa huA karatA hai| isalie zarIra kI lasAbha UtiyoM meM inakA avasthAna hokara vahA~ zothotpatti huA karatI hai| yaha vikRti Antra aura plIhA meM sarvAdhika dekhI jAtI hai / isa vikRti kA nimna svarUpa hotA hai: 1-upasargoparAnta lasAbha Uti kI vRddhi honaa| 2-Antrajvara daNDANuoM kI upasthiti ke kAraNa huI pratikriyA ke pariNAmasvarUpa __sthUlabhakSoM aura prarasa kozAoM kI vRddhi honaa| 3-Uti meM paramaraktatA honA / 4-Uti meM zotha honaa| 5-isa vraNazotha ke pariNAmasvarUpa vahA~ granthikAoM kA nirmANa ho jaanaa| aba hama aMgavizeSa meM hone vAlI Antrajvarajanya vikRti kA varNana karate haiN| Antra-laghu aura bRhat donoM hI A~toM kI zleSmalakalA meM jahA~ lasAbha Uti pAI jAtI hai| vahIM roga kA bhI kendra rahA karatA hai| lasAbha uti ke kucha kSetra sthUla Antra meM bikhare hue tathA laghvantra meM eka sthAna para jhuNDa banAe rahate haiN| pahale ko ekala lasAtmakagranthikA (solitary lymphatic nodules) kahate haiN| dUsare ko peyarIyasidhma yA prazna (peyer's patcles) kahate haiM / Antrikajvara meM inhIM prazna tathA granthikAoM meM rogotpatti tathA vikRti dekhI jAtI hai| vikRti laghu A~ta ke antima bhAga meM tathA sthUla A~ta meM kevala uNDuka meM milatI hai| Antragata vikRti rogAvasthA ke anusAra badalatI rahatI hai| prati saptAha vikRti meM kucha na kucha parivartana ho jAyA karatA hai| yaha parivartana nimna prakAra kA hotA hai 1. vraNazothAvasthA-lasAtmaka grana aura granthikAoM meM kozAoM kA praguNana hotA hai| vAhiniyA~ visphArita ho jAtI haiN| isa visphAra ke kAraNa ve Antra ke suSiraka meM pratyakSa dekhI jA sakatI haiN| _____2. saMkothAvasthA-kozIya praguNana ke bar3hane ke kAraNa usameM raktasaMvahana ThIka se nahIM hone ke kAraNa vahA~ rakta aura prANavAyu donoM kI alpatA hI dekhI jAtI hai| roga ke kIr3oM kA viSa aura bhI kaSTotpAdana kara detA hai isake kAraNa lasAbha Uti meM kothotpatti yA sar3ana paidA ho jAtI hai| ___3. saMtraNAvasthA-lasAbha uti tIsare saptAha meM acche prakAra paka jAtI hai aura vraNazotha apanI uccatama avasthA ko pahu~ca jAtA hai jisake pariNAmasvarUpa usameM vraNa bana jAte haiN| vraNazotha lasAbha Uti ke AsapAsa bhI hotA hai para usameM vraNa nahIM banate vahA~ upazama ho jAtA hai para lasAma uti kA kucha bhAga sar3a yA gala jAtA hai isa sar3e gale bhAga ke nikalane ke kAraNa hI vraNotpatti huA karatI hai| Antrastha peyarIya granthiyoM meM bane vraNa golAkAra hote haiM golA kucha lambotarA hotA hai aura usakI lambAI Antra kI lambAI kI dizA meM rahatI hai| ye AntranibandhinI For Private and Personal Use Only

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jvara 486 ke sammukha pAye jAte haiN| ekala lasapiNDoM se bane vraNa AkAra meM pUrNatayA gola hote haiN| Antrikajvarajanya vraNa kA tala upazleSmala yA Antra kI pezI ke stara se banatA hai| kinAre yA oSTha phUle aura antaHsuSira (under mined ) hote haiN| vraNa jyoM jyoM gahare hote jAte haiM tyoM tyoM unameM upazleSmala ke sthAna para pezIya tarAtala dekhane meM AtA hai| koI koI vraNa adhika gaharA bana jAne se sirA yA dhamanikA taka usameM phUTa AtI hai aura raktasrAva hone lagatA hai| usase Age bar3he hue vraNoM meM Antra kI prAcIra taka phUTa jA sakatI hai| usa dazA ko chidrodara kahA jAtA hai| chidrodara hone ke sAtha hI udaracchada meM bhI pAka ho jA sakatA hai| chidrodara tathA udaracchadapAka ye donoM roga kA atyanya gambhIrAvasthA ke sUcaka mAne jAte haiN| roga kI tIvrAvasthA vraNoM kI saMkhyA para nirbhara na hokara viSamayatA para nirbhara karatI hai / para chidrodara svayaM eka mahAbhayAnaka avasthA hai jisakA yadi turata zalyopacAra na kiyA gayA to rogI ke marane meM koI sandeha nahIM raha jaataa| chidrodarAdi prAyaH tudrAntra ke antima bhAga zeSAntraka ( ileum ) meM 1 phuTa sthala meM jahA~ lasAbha Uti bahuta adhika mAtrA meM hotI hai huA karate haiN| Antrika jvara ke vraNa prAyaH gahare jAte haiN| ve pRSThabhAga ko adhika na ghera kara gaharAI meM adhika jAte haiM jo unakI mahattvapUrNa pravRtti hotI hai| ____4. saMropaNAvasthA-tIsarA saptAha bItate bItate vraNoM kA saba sar3A galA bhAga naSTa hokara jhar3a jAtA hai aura cauthe saptAha meM vraNoM kA upazama Arambha ho jAtA hai| sabase prathama vraNoM kI talI para kaNana ati yA rohaNa dhAtu banane lagatI hai| jaba vaha paryApta bana letI hai taba vraNoSThoM se Antra kI zleSmalakalA phaila kara ropaNakArya pUrA kara detI hai| isa prakAra ropita huA vraNa komala, thor3A nimna aura halakA lAla hotA hai| ye vraNa tAntava Uti se vraNavastu nahIM banAte isa kAraNa Antra meM upasaGkoca nahIM huA karatA hai| hA~ jaba vraNa pezI taka pahu~cA hotA hai taba vaNavastu avazya banatI hai aura upasaMkocana bhI ho sakatA hai| isa prakAra Antrika jvara meM A~toM meM pahale saptAha meM sUjana AtI hai dUsare meM saMkotha yA sar3ana hotI hai tIsare meM vraNa banate haiM tathA cauthe saptAha meM ropaNa ho jAtA hai| ____ AntranibandhinI lasIkA granthiyoM meM lasavahAoM ke dvArA Antrika jvara ke daNDANu pahu~cakara unake AkAra ko kaI gunA bar3A kara dete haiM unake bhItara kA majjaka bhAga ati mRdula ho jAtA hai usakI ATopikA ko kATa kara dekhane se usameM utinAza ke kaI kendra dekhane meM Ate haiM ve hare pIle varNa ke hote haiN| rogopazAnti hone para unameM AtmAMzana dvArA yA snaihika vihAsa ke dvArA unakA sudhAra ho jAtA hai| plIhA-Antrika jvara meM plIhA AkAra aura bhAra donoM meM hI do tIna gunI For Private and Personal Use Only

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460 vikRtivijJAna bar3ha jAtI hai| usameM atyadhika raktAdhikya ( congestion ) ho jAtA hai| yaha raktAdhikya aura vRddhi kabhI kabhI bilkula bhI nahIM pAI jaatii| jIrNa rogiyoM meM bhI vaha nahIM milA krtii| plIhA kI raktavAhiniyA~ rakta se ruMdha jAtI haiM apane prakRta AkAra se vRddha hone ke kAraNa ise Antrika jvarajanya tIvra plaihikArbuda (acute splenic tumour of typhoid ) bhI kahA jAtA hai| roga ke prathama saptAha meM yaha plaihikArbuda kAphI kar3A hotA hai| dUsare saptAha meM mRdu hone lagatA hai jo tIsare saptAha meM paryApta mRdu ho jAtA hai| isakI gADhatA arddhataralIya hotI hai| plIhA kA prAvara ( capsule ) paryApta tanA hone ke kAraNa thor3e pIDana se phaTa taka sakatA hai| Arambha meM hI yadi plIhA ko kATa kara dekhA jAya to vaha asita raktavarNa ( dark red ) kI milegii| saptAhoparAnta mAlapIdhipana piNDa bar3e ho jaaveNge| ina piNDoM kI jAlakIyakozAoM meM parama puSTi hone ke kAraNa ve kucha naSTa bhraSTa bhI ho sakatI haiM plIhA meM sthAna sthAna para Antrikajvara daNDANuoM ke samUha bhI ekatra hue dekhe jAte haiN| plIhA meM sthAna sthAna para nAbhya UtinAza ( focal necrosis ) ke kSetra pAye jAte haiM ina kSetroM kI tulanA grIna ne araktatAjanya RNAsroM (infarcts due to anaemia) se kI hai| snaihikasrotasAbhoM ( sinusoids ) meM sakriya paramapuSTi jAlakAntazchadIya kozAoM kI hotI hai| inhIM vAhiniyoM meM aneka antazchadIya ekanyaSTikozA ikaThe hue pAye jAte haiN| jvara ke samApta ho jAne para raktAdhikya yA adhiraktatA samApta hotI jAtI hai aura kucha tantUtkarSa hotA huA dekhA jAtA hai| yakRta-Antrika jvara meM yakRt kA bhI AkAra bar3ha jAtA hai| yakRt ke srotasAbhoM meM bhI plIhA kI hI bhA~ti aneka ekanyaSTikozA ekatra hote haiM aura vibhajana ( mitosis ) dvArA hI taiyAra hote haiN| ina kozAoM kI bar3hotarI ke kAraNa yakRt kozAe~ cAroM ora se unase ghira jAtI haiN| ina ghirI huI kozAoM kA tIsare saptAha se nAza hone lagatA hai| isa prakAra nAbhya UtinAza ke kaI kSetra yakRt meM pAye jAte haiN| Antrikajvara daNDANu ke anekoM samUha itastataH yakRt meM milate haiN| inakA nAbhya Uti nAza ke kSetroM se pratyakSa koI khAsa sambandha nahIM hotaa| yakRt meM meghasamazotha tathA snaihikavihAsa bhI pAyA jAtA hai jaisA ki kisI tIvra viSaraktatA ke antargata mila sakatA hai / kUphphara ke kozAoM meM bhI parama puSTi pAI jAtI hai| pittAzaya-Antrika jvara meM pittAzaya ko Antrikajvara daNDANu rakta ke dvArA pahu~cA karate haiN| roga ke Arambha se hI pittAzaya meM ye daNDANu upasthita rahate haiM para taba unake koI mahattva ke lakSaNa yahA~ nahIM pAye jAte / kahate haiM ki roga ke zAnta hone ke kucha varSa bAda inake kAraNa pittAzayapAka ( cholecystitis) aura pittAzmarI banatI huI dekhI gayI haiN| kabhI-kabhI pittAzaya meM tIvrapAka Arambha ho jAtA hai| jaba motIjharA kA AkramaNa halakA hotA hai to pittAzaya kucha kAla bAda svastha ho jAtA hai para 5 se 10 pratizata taka rogiyoM meM pittAzaya Antrikajvara daNDANuoM kA For Private and Personal Use Only

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jvara 461 sAtha nikala kara bhaNDAra bana jAtA hai jo varSoM banA raha sakatA hai / isI ke kAraNa pittAzmariyA~ taiyAra hotI haiM / ye daNDANu varSoM sajIvAvasthA meM pittAzaya ke pitta ke mala ke sAtha bAhara jAte rahate haiM tathA jIvana bhara vAtAvaraNa meM phailAne kA kArya karate rahate haiM / isa prakAra rogI eka kara sakatA hai / Antrikajvara ko jIrNavAhaka kA kArya jIvana bhara asthimajjA - jaisA ki anyatra dekhA jAtA hai usI prakAra asthimajjA meM bhI jAlakAntazchadIya paramapuSTi pAI jA sakatI hai| isa kAraNa ekanyaSTikozAoM kI saMkhyA paryApta bar3ha jAtI hai| sAtha hI inakI vRddhi rakta ke lAlakarNI ke adhika nAza kA bhI pramANa upasthita karatI hai / Antrikajvarajanya viSaraktatA ke kAraNa majjAkAyANu kI saMkhyA paryApta ghaTa jAtI hai jisake phalasvarUpa bahunyaSTi kAyANuoM kI bhI kamI ho jAtI hai jinake kAraNa Antrikajvara se pIDita rogI kA raktacitra zvetakaNApakarSa kA milatA hai / sitakaNotkarSa ( leucocytosis ) jahA~ tIvra jvaroM ke sAtha sadaiva milatA hai motIjhare tiNApakarSa hI milatA hai / sakalasitakaNagaNana 2000 pratighana mi0 mI0 se bhI nIce calA jA sakatA hai / grIna kA kathana hai ki yadi mantharajvara ke sAtha-sAtha udarapAkAdi sitakaNotkarSakArI jvara ho taba bhI sitakaNotkarSa jitanI ki AzA hai usase kahIM kama milatA hai / hRdaya tathA anya peziyA~ - hRdaya tathA anya peziyoM meM jheMkarIya (zenker's) kAcaravihAsa ( Hyaline degeneration ) hotA hai isake kAraNa hRdaya mRdu aura durbala hokara visphArita ho jAtA hai / usake tantuoM kI rekhAe~ bhI miTa jAtI haiM / yahI vihAsa hRdaya ke atirikta udaradaNDikA tathA mahAprAcIrA ina peziyoM meM bhI mila sakatA hai / pariNAma yaha hotA hai ki peziyA~ vidIrNa hone lagatI haiM aura unameM raktastrAva bhI ho jAtA hai / raktasrAva ke kAraNa usameM dvitIyaka upasarga ho sakatA hai / svarayantra meM bhI vraNana ho sakatA hai jisase ( odems of the glottis ) ..." ho jA sakatA hai tathA vahA~ kI kAsthiyA~ bhI gala sakatI haiM / zvasanikAoM meM vraNazotha hokara zvasanIphuphphusapAka hotA huA dekhA jAtA hai / mArakasvarUpa kA roga phuphphusa meM zothotpatti ke sAtha bana sakatA hai / phuphphusakhaNDIya - zvasanaka (lobar pneumonia ) Antrikajvara ke sAtha bahudhA dekhA jAtA hai / para ye zvasanakIya vikSata mantharajvara ke daNDANuoM ke kAraNa na hokara phuphphusa golANuoM dvArA huA karate haiM / manthara meM mukha zuSka aura gandA hone ke kAraNa usameM mukhapAka, dantamAMsapAka athavA sapUya karNamUla granthipAka suppurative parotitis ) taka mila sakatA hai / mukha kI ina dUSaka pravRttiyoM ke kAraNa hI zvasanakotpatti batalAI jAtI hai / vRkkoM meM meghasama zotha ke atirikta anya vikRti nahIM dekhI gaI yadyapi sajIva mantharajvara daNDANu mUtra dvArA utsRSTa hote hue milate haiM / asthi--jaMghAsthi ( tibia ) athavA kazerukAoM meM jIrNasvarUpa kA asthimajjApAka ( osteomyelitis ) mila sakatA hai / manthara meM eka do mAsa se lekara For Private and Personal Use Only

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462 vikRtivijJAna varSa do varSa bAda bhI yaha dekhA jA sakatA hai / jIrNaparyastha vidradhi bhI dekhI jA sakatI hai / rakta - Antrikajvara kA viSa raktotpAdaka aGgoM ko atyadhika hAni pahu~cAtA hai lasAbha Uti usakA vizeSatayA zikAra banatI hai / isake pariNAmasvarUpa sitakozAoM kI saMkhyA kama hotI jAtI hai jyoM-jyoM roga kI bhayaGkaratA bar3hatI jAtI hai yaha saMkhyA bhI ghaTatI jAtI hai yahA~ taka ki ati tIvra mantharajvara meM pratighana milImITara 2000 se bhI kama ho jA sakatI hai / unake sApekSa gaNana meM bhI antara A jAtA hai / bahunyaSTi kozA 50 pratizata taka ghaTa jAte haiM lasakozA 50 pratizata taka bar3ha jAte haiM / rogArambha kAla meM to avazya jIvANuraktatA kucha pAI jAtI hai aura prathama saptAha ke rakta meM raktasaMvardha karane para mantharajvara ke jIvANu mila bhI jAte haiM para Age calakara kitanA hI saMvardha kiyA jAve jIvANu nahIM mila pAte / DA0 ghANekara kA kathana hai ki jabataka jvara ArohI svarUpa kA rahatA hai rakta mantharajvara daNDANuoM se yukta hotA hai / dvitIya saptAha Arambha hote hote rakta pratiyogI padArthoM kI utpatti Arambha ho jAtI hai / ina padArthoM meM abhizleSi kA mukhya mahattva hotA hai / isI abhizleSi para viDAla kI abhizleSaNa kasauTI nirbhara karatI hai / rakta meM upasipriya sitakarNI kA sarvathA abhAva ho jAtA hai / meM 12-aparatandrAbhajvara yA pAnIjharA ( Paratyphoid fever ) - isa jvara kA utpAdaka eka prakAra kA jIvANu hai jise baisIlasa pairATAiphosasa yA aparatandrAbha sir kahA jAtA hai / mantharajvara kI bhAMti isameM bhI A~toM kI lasAbha Uti, sagranthiyA~, plIhA, hRdaya Adi aMgoM meM vikRti ho jA sakatI hai / yaha vikRti mantharajvara ke barAbara ugra nahIM huA karatI / yaha gaharA na jAkara Upara adhika phailatA hai / Arambha meM isake lakSaNa manthara yA Antrikajvara kI apekSA adhika tIvra ho sakate haiM vamana aura atIsAra ke sAtha bhI rogArambha ho sakatA hai / manthara kI apekSA isameM sthUlAntra adhika prabhAvita hotI hai / isameM raktasrAva athavA chidrodara kI pravRtti kama milatI hai / isa roga meM sitakaNApakarSa na hokara sitakozotkarSa hotA hai isa kAraNa anya aMgoM meM vidradhiyoM kI utpatti kI AzaMkA rahatI hai / yakRt meM aisI dvitIyaka vidradhiyA~ isa roga meM banatI huI pAI gaI haiM / 1 isa roga kA utpAdaka jIvANu 3 prakAra kA hotA hai use vaijJAnikoM ne e. bI. sI. karake tIna rUpoM meM svIkAra bhI kiyA hai / lAkSaNika dRSTi se isa roga ke tIna rUpa dekhe jAte haiM / eka jisameM atIsArAdhikya pAyA jAtA hai / dUsarA jo pratizyAyAtireka se yukta hotA hai aura tIsarA jo vRkkapAkasameta AtA hai / vRkapAkasameta vikAra meM vRkkapUyatA ( pyelitis ) athavA bastipAka ( cystitis ) pAI jAtI hai / pratizyAyAtmaka roga meM zvasanakIya lakSaNa adhika milate haiM / yaha smaraNIya hai ki isa roga ke vikSatoM ke upazamana meM tantUtkarSa aura vraNavastUtpatti manthara kI apekSA adhika hotI hai / For Private and Personal Use Only

Page #559
aSTama adhyAya yakSmA yaha eka mahAbhayAnaka vyAdhi hai jo prativarSa sampUrNa saMsAra ke marane vAle vyaktiyoM meM se ko apane karAla pAza meM Abaddha kara isa asAra saMsAra se mukta karane ke lie uttaradAyI banatI hai| yaha rAjayakSmA, kSaya, zoSa aura rogarAda Adi nAmoM se pukArI jAtI hai:anekarogAnugato bahurogapurogamaH / rAjayakSmA kSayaH zoSo rogarADiti ca smRtH|| (aSTAMgahRdaya ni. sthA. a. 5) isa roga ke prArambha hone se pUrva kaI roga lagate haiM aura jaba yaha roga pragaTa ho jAtA hai to bhI aneka roga lagate haiM isI se ise rogarAT , rAjayakSmA, kSaya vA zoSa ina nAmoM se pukArA jAtA hai| inhIM zabdoM kI nirukti karate hue likhA gayA hai ki saMzoSaNAdrasAdInAM zopa itybhidhiiyte| kriyAkSayakaratvAcca kSaya ityucyate punaH // rAjJazcandramaso yasmAdabhUdeSA kilaamyH| tasmAttaM rAjayakSmeti kecidAhurmanISiNaH // tathAnakSatrANAM dvijAnAM ca rAjJo'bhUd yadayaM purA / yacca rAjA ca yakSmA ca rAjayakSmA tato mataH / / dehauSadhakSayakRte kSayastatsammavAcca saH / rasAdizoSaNAcchoSo rogarAT teSu rAjanAt / / kahane kA tAtparya yaha ki rasAdi dhAtuoM kA isa roga meM zoSaNa ho jAtA hai isa kAraNa ise zoSa kahate haiN| kriyAzakti kA, deha kA tathA oSadhiyoM kA atyadhika kSaya karanA par3atA hai isalie ise kSaya kahakara pukArate haiM / nakSatreza evaM dvijeza candramA ko zApavazAt yacamA roga huA isa kAraNa se tathA aneka rogoM se parivRta roga yakSmA usakA rAjA isa kAraNa rAjayakSmA yaha nAma bhI isakA prasiddha huA hai| hamane pAribhASika zabdanirmANa meM sahAyatA pAne kI dRSTi se tathA loka meM bhI pracalita hone se rAjayakSmA yA zoSa yA anya nAma na lekara yakSmA ko hI apanAyA hai| kyoMki yaha saba rogoM meM alaga pragaTa hotA hai aura viziSTatA rakhatA hai isa kAraNa ise rogarATa isa upAdhi se bhI vibhUSita kara diyA gayA hai| ___ Adhunika zabdAvalI kA avalokana karane para bhI hamako kaI zabda milate haiM jinameM TyUbarakyulosisa (yamA ), thAyasisa (zoSa), kaJjampazana (kSaya) tathA kaipTena Ava Daitha (rogarATa) mukhya hai| Adhunika kAla meM TyUbarakyulosisa yA baisIlasa kAksa inphekzana ( bacillus koch's infection ) ina nAmoM dvArA isa roga ko pukArA jAtA hai| kucha roga aise haiM jo zarIra ke pratyeka aMga para kucha na kucha prabhAva DAlate haiM aura isake kAraNa zarIra ke tattat aMga meM viziSTa prakAra kI vikRtiyA~ utpanna ho jAtI haiN| For Private and Personal Use Only

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464 vikRtivijJAna ina rogoM meM vraNazotha, yakSmA, phiraMga, arbuda tathA kavaka mukhyataH ullekhya haiM inakA pUrNataH adhyayana ho jAne para Adhunika vikRtivijJAna zAstra kA paryApta evaM Avazyaka jJAna ho jAtA hai / isI dRSTikoNa ko lekara hamane ina viSayoM ko pRthak-pRthak adhyAya meM pragaTa karanA nizcaya kiyA hai| vizvAsa hai ki pAThaka vRnda isa dRSTi ko samajha kara hI isa grantha kA avalokana kareMge / yacmA aura phiraMga aise roga haiM jo vraNazothAtmaka sthitiyA~ utpanna karake kaNana Uti ke nirmANa ko protsAhita karate haiM aura ve viziSTa kArbuda ( specific granuloma ) kahalAte haiM aura kyoMki hama abhI-abhI vraNazotha evaM kaNana Uti kA vicAra kara cuke haiM ataH kaNana Uti dvArA utpanna aura vraNazotha dvArA poSita navavRddhiyoM kA vicAra karanA hI isa samaya yuktiyukta hai ataH hamane yakSmA ke isa prakaraNa ko prArambha kiyA hai / yahA~ hama Adhunika vicAroM kA hI samAveza kara rahe haiM aura AyurvedIya samprApti kA UhApoha yathAsthAna apane avikala rUpa meM diyA jAvegA / itastataH kisI Adhunika vAda kI puSTi ke lie Avazyaka sUtra kA ullekha yathAvat calatA rahegA / yakSmA eka viziSTa tathA aupasargika roga hai isakI utpatti kA pradhAna hetu yakSmA daNDANu ( Bacillus tuberculosis ) hai jise mAikobaikTIriyama TyUbarakyulosisa ( yakSma kavaka vetrANu ) yA kauksabaisilasa ( kauka daNDANu ) kahA jAtA hai / ise kauka ne san 1882 I0 meM khoja nikAlA thaa| Ayurveda isake pradhAna cAra kAraNa mAnatA hai-- sAhasaM vegasaMrodhaH zukraujaH snehasaMkSayaH / annapAnavidhityAgazcatvArastasya hetavaH // ( a. hR. ) yamadaNDANu aura usakA viSa ye donoM milakara prANiyoM ko yakSmAgrasta kara dete haiN| ho sakatA hai ki adhika kAyena vAcA athavA bala prayukta karane se ( sAhasAt ), vAtaviNmUtrAdInAmunmukhIbhUtAnAM vegAnAM dhAraNa karane se ( vegarodhAt ), zukraM ca ojazca snehazca teSAM vinAza karane se ( kSayAt) tathA annapAnayoryathAzAstraM yo vidhiH usakA tyAga karane anyathA sevana karane anyathA avyavahAra karane se ( viSamAzanAt ) zArIrika bala kama ho jAtA hai aura yaha yacamAdaNDANu prANI ke zarIra meM apanA Asana jamA kara baiTha jAtA ho / isa roga kA mukhya lakSaNa yadimakA ( tubercle ) kI utpatti hai | yaha kyA hai isakA varNana karate hue sva0 DaoN0 dhIrendra nAtha banarjI likhate haiM: 'A tubercle is an inflammatory, more or less circumscribed nodule which undergoes degeneration in the form of cas eation, necrosis and ulceration or heals with the formation of fibrous tissue and subsequent calcification' arthAt yacimakA eka traNazothAtmaka alpAdhika parilikhita gA~Tha hotI hai jisakA vihAsa kilATIyana, UtimRtyu tathA vraNana dvArA ho jAtA hai yA vaha tAntava Uti tathA uttaravartI cUrNiyana kA nirmANa karatI huI ropita ho jAtI hai / For Private and Personal Use Only

Page #561
yatmA AcArya usake isa lakSaNa kI ora koI dhyAna na dekara usake prathama 3 lakSaNoM ke dvArA yakSmA ko pahacAnane kA iGgita karate haiMaMsapArdhAbhitApazca santApaH karapAdayoH / jvaraH sarvAGgagazceti lakSaNaM rAjayakSmaNaH // (caraka ci. sthA. a. 8) aMsapArzva meM pIDA (pain or tenderness in the apex of the lung ), hastapAdoM meM jalana ( burning sensation in the extremities ) tathA sarvAGga meM jvara (rise of temperature all over the body surface ) ina tIna lakSaNoM meM yakSmA ke jJAna kI sampUrNa reDiyolaujI bharI huI hai| loga yaha prazna kara sakate haiM ki kyA ina tIna lakSaNoM ke hone kA artha usameM yakSmAdaNDANu ko dekhA jA sakatA hai ? isakA uttara hai nhiiN| jisa samaya hama yacmAdaNDANu ke pratyakSa darzana kara lete haiM aura usake dvArA utpanna vikSatoM tathA yadimakAoM ko pA lete haiM taba to roga itanA dRDha ho gayA rahatA hai ki usakA niSkAsana anekoM 'vaNDaraDragsa' karane meM Aja taka asamartha rahI haiN| ye 3 lakSaNa arthAt yakSmAdaNDANu ke zayana ke lie ArAma kursI bichA denA hai| rogarATa kaba vahA~ padhArate haiM isakA vicAra karane ke pUrva hI usa kursI ko uThA kara pheMka do yA vahA~ svAsthyarATa ko AsanAsIna kara do tabhI inakA saMhAra sambhava hai| yacimakAe~ dekha kara yakSmA pahacAnanA arthAt pakA Ama dekhakara pahacAnanA ki Ama kA phala laganA prArambha ho gyaa| aMgarejI meM Tyubarakyulosisa zabda kA nirmANa isI mUrkhatA kA dyotaka hai| yakSmA meM Tyubarakila kI utpatti to bahuta bAda meM hotI hai ise yadi thAyasisa (kSaya) yA kanjampazana (zoSa) hI kahanA prArambha kiyA jAya to kahIM adhika yuktiyukta hogaa| isI ke sambandha meM azkaupha ke nimna zabda ullekhya haiM: It is about time that we should again employ the name phthisis for this disease entity. Then we shall see that tuberculosis is only a special reaction form in the course of phthisis.' yaha roga tIvra sarvAGgINa rUpa meM bhI phaila sakatA hai aura atIva viSaraktatA bhI utpanna kara sakatA hai / kabhI kabhI yaha jIrNa sthAnika vinAzaka svarUpa meM bhI ho sakatA hai taba yaha viziSTa aMgoM meM hI sImita rahatA hai yA eka ke bAda dUsarA isa prakAra kaI aMgoM ko prabhAvita kie rahatA hai| isa roga ke prArambhika vikSata sadaiva phuphphusoM meM yA lasIka granthiyoM meM banate haiM tathA vRkka, mastiSkachada, lasAbha utiyA~, mahAsrota, vRSaNa granthiyA~, asthiyA~, sandhiyA~ tathA anya utiyA~ isase bAda meM gauNa rUpa meM prabhAvita hote haiN| yadyapi ati prAcInakAla se isa roga kA varNana calA AtA hai parantu pahale yaha rAjAoM ko honevAlA roga thaa| yakSmA meM dhAtukSaya vizeSa karake dekhA jAtA hai yaha saya 2 prakAra se honA sambhava hai eka ko anulomakSaya aura dUsare ko pratilomakSaya For Private and Personal Use Only

Page #562
466 vikRtivijJAna kahakara pukArate haiM / jaba rasa se rakta, rakta se mAMsa aura isI prakAra dhAtunAza hotA hai to ise anulomakSaya kahate haiM tathA jaba vIrya, oja yA sneha kA saMkSaya hotA hai| to zukra se majjA, majjA se asthi, asthi se meda Adi kA kSaya dekhA jAtA hai yaha pratiloma kSaya hai / pahale rAjA loga adhika vyasanI hote the aura unameM zukrakSaya hokara pratilomakSaya adhikatara dekhA jAtA thA / Ajakala isa roga ke phailane ke anya aneka hetuoM meM janasaMkhyA bahulatA vyasanAdhikya tathA bhukhamarI sabhI bar3he hue haiM / isa kAraNa eka hI vyakti ko anuloma aura pratilomakSaya eka sAtha bhI hotI huI dekhI jA sakatI hai | yakSmA sabhya jAtiyoM kA roga Ajakala mAnA jAtA hai aura una nagaroM meM adhika 'dekhA jAtA hai jahA~ kI janasaMkhyA atyadhika hotI hai / uttarapradeza meM kAnapura eka aisA hI nagara hai jo yakSmA ke lie paryApta prasiddha hai / sAMkhyikI ke vidvAnoM kA mata "hai ki pratyeka nagara kI 10 se lekara 20 pratizata janatA isa roga kI pratyakSa vA apratyakSa zikAra banI rahatI hai / bhAratIya nagaroM aura upanagaroM meM yaha roga jisa drutagati se prasArita hotA jA rahA hai vaha atIva bhayAnaka hai / isa roga ke upasarga se kevala jaMgalI jAtiyA~ athavA parvatastha janasamudAya hI bhale bace hoM anyathA to prAyaH sabhI ko isakA sparza ho jAtA hai| jina samudAyoM meM yaha roga chU taka nahIM gayA yadi vahA~ kisI prakAra yaha roga pahu~ca jAve to unameM yaha aise phailatA hai jaise pha~sa meM agni / kyoMki jahA~ yaha roga prAyazaH rahatA hai una sthAnoM ke nivAsiyoM meM isake virodha meM pratIkAritA zakti kA nirmANa ho jAtA hai para yaha pratIkAritAzakti ( immunity ) una samudAyoM meM anupasthita rahatI hai isI kAraNa roga prasAra itane adhika vegapUrvaka dekhA jAtA hai / saba prajAtiyoM para yakSmA kA eka sA prabhAva nahIM hotA / azvetavarNIya prajAtiyoM ( black races ) para yakSmA kA jitanA adhika kopa dekhA jAtA hai utanA zvetaprajAtiyoM para nahIM hotA / jitanI hI koI prajAti isake prati adhika anuha ( susceptible ) hotI hai utanI alpavaya meM usa prajAti meM rogiyoM meM isakA upasarga laga jAvegA aura mRtyu ho jAvegI / yacamakavakavenrANu ( mycobacterium tuberculosis ) kI khoja kauka ne kI thI aura usa sambandha ke prapatra 1884 I0 meM prakAzita kie gaye the / isa daNDANu yA kavakaventrANu ko kaI samajani ( strains ) hote haiM / unameM saMracanAdRSTyA kitanI hI vibhinnatA dekhI jA sakatI hai / unameM kucha hasva, sthUla aura Rju hote haiM tathA anya dIrgha, tanu tathA anju hote haiM / kabhI-kabhI kucha prAdarzoM ( specimens ) kaNayukta piNDa ( granular bodies) milatI hai jisake kAraNa unakI AkRti maNimaya. yA mAlAsama ( beaded ) aimI aNvIkSaNa para milatI hai / yamakavakavetrANu acara ( nonmotile ), abIjANvika ( non sporing ), supavAdhAvya ( gram positive ) aura amlasthira ( acid fast ) hotA hai / use madhurI, raktarasa yA For Private and Personal Use Only

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yakSmA 467 DorsaTIya aNDa saMvardhAza ( dorset egg medium ) para saMvardhita kiyA jA sakatA hai| SThIva ( sputum ) meM yacamAkavakavetrANu kaI saptAha paryanta sajIvAvasthA meM raha sakatA hai| yadi yaha pUrNataH sukhA diyA jAve to 1 ghaNTe taka 10. za. ke tApa ko saha sakatA hai para yadi AI vAtAvaraNa meM tapAyA jAve to yaha 70deg za. para atyalpa kAla taka Thahara kara hI apanI jIvana lIlA samApta kara detA hai| dugdha ke nIrogana (pasteurization ) karane meM isa tathya kA khUba upayoga kiyA jAtA hai| isake lie dugdha ko 70 za. para 20 minaTa taka ubAlanA par3atA hai| sUryaprakAza ( sunlight) isa roga ke lie sarvAdhika nAzakAraka mAnA jAtA hai| yadi pratyakSa sUryarazmiyoM ke kSetra ye sadeha jhA~kI de gaye to yamarAja kA nimantraNa mila gayA yahI inheM mAna lenA caahie| yacamakavakavetrANu kaI prakAra ke hote haiM inameM eka prakAra mAnava ( human mycotacterium ), dUsarA gomaya ( mycobacterium stercoris) jo gAya ke gobara meM milatA hai, tIsarA pati ( mycobacterium avium) jo kabUtara murgI Adi pakSiyoM meM yakSmA utpanna karatA hai tathA gAyoM meM bhI kara sakatA hai para manuSyoM meM yaha prakAra atyanta virala dekhA jAtA hai, cauthA mAtsya ( mycobacterium piscium ) aura pA~cavA~ mANDUka ( mycobacterium ranae ) tathA chaThA sArpa ( mycobacterium tropidonatum ) hotA hai ye apane-apane vargoM meM yacamotpatti karate haiN| manuSya ko isa roga kI prApti prAyaH mAnava aura ganya prakAroM se hI hotI hai| isa prakAra hama dekhate haiM ki yakSmA kA prabhAva thalacara, jalacara, nabhacara sabhI varga ke prANiyoM para par3atA hai isa kAraNa yadi isa roga ko rogarATa kahA jAve yA yadi isake jIvANu ko DaoN. ghANekara ke zabdoM meM rAjarogANu yA rAjajIvANu kahA jAve to vaha sarvathaiva upayukta hai| yakSmA ke prabhavasthala yamA kA upasarga kahA~ se lagatA hai (source of infection ) ise binA jAne Adhunika yuga meM cikitsA kSetra meM Age bar3hA hI nahIM jA sktaa| yamopasarga pratyakSarUpa se yA apratyakSatayA sadaiva kisI rogagrasta prANI (manuSya yA pazu) se hI prApta hotA hai| inameM mAnavaSThIva (sputum of human beings ) tathA godugdha mukhya haiN| apane deza meM godugdha ko ubAlakara pIne kI jo prathA hai usI ke kAraNa yaha deza aba taka jIvita raha sakA hai aura gavya yakSmA jo pazcimI dezoM kA pramukha ziraHzUla hai idhara vyApta nahIM ho skii| Ayurveda kahatA hai ki saMskArato viruddhaM tadyada bhojyaM viSavada brajet-saMskAra se viruddha bhojya padArthako viSa ke samAna parityakta kara denA cAhie kyoMki vaha viSa ke hI samAna hai| ina vAkyoM kA artha eka vaijJAnika jitanA samajha sakatA hai eka chadamacara svayaMbhU artharata cikitsaka nhiiN| dugdha ko uSNa banAnA eka saMskAra hai jise sampUrNa bhAratavarSa kazmIra ke kanyAkumArI taka For Private and Personal Use Only

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438 vikRtivijJAna aura sindhu se brahmadeza paryanta mAnatA aura lAbha uThAtA rahA hai tathA sambhavanti mahA. rogA azuddha kSIra sevanAt kA tatva usane sadaiva samajhA hai| aba hama yakSmA ke vividha prabhavasthaloM kA saMkSipta varNana prastuta karate haiN| TIva-yakSmA se pIDita prANI itastataH DheroM kapha thUkatA hai| usake SThIva yA thUka ( sputum ) meM lakSAvadhi yacamAdaNDANu upasthita rahate haiN| vaha kabhI isakA dhyAna nahIM karatA hai ki jisa miTTI meM vaha thUka rahA hai usI meM bAlaka vRnda loTate haiM aura unake zarIra para vaha dUSaNa laga kara unheM isa roga meM grasta kara detA hai| aura asaMkhyoM vyaktiyoM meM yakSmA ke pahu~cane kA pradhAna kAraNa ThIva milatA hai| apane deza meM rASTradharma kA pAratanvya kAla se kucha lopa sA calA A rahA hai jisake kAraNa itastataH thUkane se rASTra ke svAsthya para kitanA bhayAvaha AkramaNa hotA hai isakI ora dRSTi bhI nahIM jAtI pariNAmasvarUpa eka hI parivAra meM eka ke pazcAt dUsarA prANI kSaya se pIDita hotA huA aura maratA huA calA jAtA hai / grIna kA kathana hai ki yadi kisI citrapaTTI para SThIva meM yacamAdaNDANu kI upasthiti mila jAtI hai to usakA yaha artha lenA cAhie ki eka dhanasaMTImITara SThIva meM paccIsa sahasra yakSmA ke daNDANu upasthita haiM / kSaya pIr3ita prANI apane SThIva ko kabhI dIvAloM para thUkate haiM, kabhI vaha kapar3oM para gira jAtA hai aura kabhI anyatra pahu~ca kara jaba vaha sUkha jAtA hai to usako dhUla ke kaNa grahaNa kara lete haiN| dhUla ke kaNoM se vaha kisI bhI svastha vyakti ke phuphphusoM meM sahaja hI apanA sthAna banA kara use yakSmAnAmaka mahAghAtaka vyAdhi ke lauhapAza meM jakar3a detA hai jisase mukti kA yathArtha mArga Aja taka to prApta huA nhiiN| dugdha-dugdha dvArA yadamA prasAra ke do mArga haiN| eka to vaha jaba gAya svayaM yadamA pIDitA ho aura usake dugdha meM yacamA ke daNDANu upasthita dekhe jaaveN| dUsarA yaha ki jaba gAya pUrNataH svastha ho parantu gAya ko kADhane vAlA gvAlA kSaya se pIDita ho aura usake zvAsa prazvAsAdi se upasarga dugdha meM pahu~ca jaave| kyoMki dugdhapAna pradhAnataH bAlaka adhika karate haiM isa prakAra bAlakoM aura zizuoM meM yakSmA isa DhaMga se bhI phaila sakatI hai| para yadi dugdha 100 za. taka kucha kAla taka ubAla kara piyA jAve to isa mArga se yakSmA kA upasarga laganA kaThina ho sakatA hai| AcArya suzruta ne kacce aura ubAle hue dugdha ke guNa batalAte hue likhA hai : / payo'bhiSyandi gurvAmaM prAyazaH parikortitam / tadevoktaM laghutaramanabhiSyandi vai zRtam / / kaccA dugdha abhiSyandI aura bhArI kahA gayA hai tathA yadi vahI auTAliyA jAve to vaha anabhiSyandI tathA laghu ho jAtA hai| suzruta ne prAbhAtika dugdha se AparAhika dugdha ko adhika zreSTha batalAyA hai| usakA kAraNa dete hue kahA hai ki rAtri meM pazu para rAtri ke somaguNa kA prabhAva par3atA hai| dUsare vaha vyAyAma nahIM karatA isa kAraNa dugdha bhArI, viSTabhI aura zItala ho jAtA hai| dina meM pazu sUrya se paritapta ho jAtA hai aura pracura parizrama karatA aura vAyusevana karatA hai isa kAraNa usakA dugdha zramahara, vAtAnulomaka (carminative) For Private and Personal Use Only

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yakSmA 466 aura netroM ke lie hitAvaha hotA hai : kyoMki sUryarazmiyoM ke kAraNa pazu meM jIvati kagha ( vitamins A & D) paryApta bar3hatI haiM jinameM ka kA netroM para zubha prabhAva dekhA jAtA hai| prAyaH prAbhAtika kSIraM guruviSTambhizItalam / rAtryAH somaguNatvAcca vyAyAmAbhAvatastathA / divAkarAbhitaptAnAM vyAyAmAnilasevanAt / vAtAnulomi zrAntighnaM cakSuSyaM cAparAhnikam // (ca. sU. a. 45) mala-mUtra-mala-mUtra ke dvArA bhI yakSmA kA prasAra ho sakatA hai| AntrakSaya yA bastikSaya hone para mala athavA mUtra aupasargika yakSmA daNDANuoM se yukta ho jAyA karate haiN| nayaja vidradhiyoM ke srAvoM meM bhI yaha daNDANu khUba pAyA jAtA hai| isake phalasvarUpa jo paricArikA yA zalyakarmI isa mala se bhare vraNoM ko dhotA hai yA isa nAva ko le jAtA hai vaha bhI isa roga kA zikAra ho sakatA hai| mAMsa-yakSmA se pIDita pazuoM ke mAMsa dvArA bhI isa roga kA prasAra ho sakatA hai| yahA~ mAMsa svataH to yakSmA se pIDita hotA nahIM para isameM upasthita lasIkA granthiyoM meM isake daNDANu upasthita rahate haiM jo mAMsa ke sAtha sAtha jAkara roga kA kAraNa bana sakate haiN| kabhI kabhI mAMsa ke andara sthita kSayaja vidhi ke srAva se yaha sana jAtA hai aura upasarga kA prasAra karane meM samartha ho jAtA hai| paripakka mAMsa se daNDANu bidA ho jAte haiM para jo kacce mAMsa kA rasa pIte haiM yA use yoM hI khAnA cAhate haiM ve isake dUSita hone se yakSmA ke caMgula meM phaMsa sakate haiN| mAtA-mAtA yadi kSaya se pIDita hai to usake rakta dvArA garbhastha zizu ko bhI yakSmA ho sakatI hai| isI kAraNa manusmRti meM manu ne jina dazakuloM meM vivAha karane kA niSedha kiyA hai unameM yacmA se pIDita kula bhI hai : ........... dazaitAni kulAni parivarjayet / hInakriyaM niSpuruSaM nizchando romazArzasam / kSayyAmayAvyapasmArizvitrikuSThikulAni ca // jaba stana meM yakSmA ho jAtI hai to strI kA dugdha usase dUSita ho jAtA hai usa dUSita dugdha ko jaba baccA cUsatA yA jaba bhayagrasta stana ko mukha meM letA hai to use taba bhI yakSmA kA upasarga laga sakatA hai| yakSmA ke pravezamArga yakSmA ke daNDANuoM kA zarIra meM praveza jina jina mArgoM se ho sakatA hai usakA aba vicAra karanA Avazyaka hai| yakSmA daNDANuoM ke praveza ke 2 prasiddha mArga haiN| eka zvasana (inhalation) aura dUsarA mukhadvArA (by ingestion) / 'yacmA kA mAnavI prakAra (yamakavakavetrANu) prAyaH zvasana dvArA phailatA hai| yakSmA kA sUkhA huA balagama jaba dhUla meM mila jAtA hai aura usa dhUla ko koI svastha puruSa sUMgha jAtA hai to usako yakSmA laga jAtA hai ( kornett)| phluge kA kathana hai ki jaba taka STIva ke kaNa ArdrAvasthA meM rahate haiM tabhI taka yakSmA daNDANuoM kA upasarga ho sakatA hai For Private and Personal Use Only

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500 vikRtivijJAna isa kAraNa vindUtkSepa ( droplet infection ) dvArA yaha roga adhikatara phailatA hai / kucha bhI ho zvasana dvArA yakSmA mukhyataH phailatA hai ise hameM isalie aura mAna lenA cAhie ki isa roga kA mukhya kendra phuphphusa rahate haiM tathA jo vyakti kSayI ke ati samIpa rahatA hai use hI yaha roga sarvaprathama pakar3atA hai| ina donoM kA artha zvasana dvArA upasarga kA phailanA hI mAnA jAnA cAhie / Acharya Shri Kailassagarsuri Gyanmandir Pari kA aisA kathana hai ki zvasana mArga dvArA yaha upasarga phuphphusoM meM nahIM pahu~catA kyoMki use phuphphusa kA pacamala adhicchada ( ciliated epithelium ) andara jAne se rokatA hai / para usI ne yaha bhI siddha kiyA hai ki prAGgArika kaNa (carbon particles ) jinheM AmAzaya meM praviSTa kiyA thA unameM se kucha phuphphusa meM bhI mile| yaha usI ke vAda ko svayaM hI kATa detA hai / jaba prAGgArika kaNoM para pakSmala acchida kI gatividhi kA koI prabhAva nahIM par3atA to koI Azcarya nahIM ki yakSmA daNDANu bhI isa gatividhi se sApha baca jAtA ho / eka bAra jaba aupasargika padArtha vAyu mArga dvArA phuphphusoM meM pahu~ca gayA ki use bhI eka bAhya padArtha (foreign material ) kI bhA~ti hI phuphphusa dvArA vyavahAra kiyA jAtA hai / vaha padArtha antazchadIya bhakSikozAoM ( mahAkozAoM --marcrocytes ) dvArA grahaNa kara liyA jAtA hai jo use samIpatama lasAma Uti ke sUkSma sidhma taka le jAte haiM ye sidhma phuphphusa kI antarAlita Uti meM paryApta mAtrA meM itastataH phaile rahate haiM / isa lasAbha Uti meM hI sarvaprathama aupasargika nAbhi utpanna hotI hai / isa sthAna se lasavahAoM dvArA yaha upasarga vRntayustha ( at hilum ) prAdezika lasagranthiyoM (regional lymph gland ) taka pahu~catA hai | yadi dhUla ke sAtha yA vindUstepa ke dvArA yakSmA daNDANu sU~gha lie jAveM to unakI tIna gatiyA~ hotI haiM- pahalI to yaha ki unameM se kucha mukha meM yA nAsA - grasanI meM cipake raha jAveM / dUsarI yaha ki unameM se kucha nigala lie jAveM aura udarastha kara lie jAveM tathA tIsarI yaha ki unameM se kucha phuphphusa meM praveza kara jAveM / mukha yA nAsA prasanIstha daNDANuoM ko graivika lasagranthiyoM meM tatrastha lasavahAe~ pahu~cA detI haiM jisake kAraNa ve bar3hane lagatI haiM / udarastha yakSmA daNDANu udarastha lasagranthiyoM ko vizeSataH saMdaMza lasapranthiyoM ( ileo caecal glands ) ko pahu~ca jAte haiM tathA phuphphusa meM gaye daNDANu vRntayustha granthiyoM ( glands at the hilum of the lung ) meM cale jAte haiM / hamane dekhA hai ki mAnavIya prakAra ke daNDANu uparokta kinhIM tIna sthAnoM para jA sakatA hai| usake kAraNa grIvA meM kaNThamAlA ho sakatI hai phuphphusa meM phauphphusika yakSmA ho sakatI hai tathA Antra meM AntrakSaya dekhI jA sakatI hai| 1 mukha dvArA praveza mArga kA vicAra karane para hama dekhate haiM ki yacmakavakavetrANu bhI jA sakate haiM / parantu yaha dvAra vizeSataH goyacmakavakavenrANu ( mycobacterium bovine ) ke dvArA prayukta hotA hai / jo dUdha yA dUdha se nikAlA makkhana yA ghI For Private and Personal Use Only

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yakSmA 501 koI prANI sevana karatA hai ki usake mukha dvArA gavya prakAra ke yakSmA daNDANu udara meM pahu~ca jAte haiM / iMgalaiNDa meM DeyarI phArmoM meM 30 pratizata gAyoM ko goyacmA hotA hai isa kAraNa DeyarI kA dugdha sevana karane se yakSmA ke bar3hane kA bhaya rahatA hai| isI kAraNa prativarSa 3000 zizu usa deza meM gavya yakSmA ke kAraNa mara jAte haiM / mukha dvArA praviSTa yacamAdaNDANu mukha yA mahAsrota kI zleSmalakalA dvArA ghusatA hai / yaha Avazyaka nahIM ki jahA~ hokara yaha ghuse vahA~ koI sthAnika vikSata banAve isa kAraNa binA usa prakAra kA vikSata utpanna kiye yaha jIvANu zleSmalakalA meM calA jAtA hai / yadi zleSmalakalA pahale se kucha kaTI huI yA savraNa huI to ise acchA mArga mila jAtA hai| mukha meM praveza kA sugama dvAra tuNDikAgranthi ( tonsil) hotA hai / yadyapi tuNDikAoM ke dvArA yakSmAdaNDANu praveza karatA hai parantu yaha jAna kara Azcarya hogA ki tuNDikI yakSmA nAmaka vyAdhi kadAcit hI kabhI dekhI jAtI ho / tuNDikA yaha daNDANu tuNDikIya tathA graivika lasagranthiyoM meM calA jAtA hai jahA~ yaha yakSma lasagranthipAka ( tuberculous lymphadenitis ) utpanna kara detA hai / griphitha kI dRSTi meM 50 pratizata tathA milara kI dRSTi meM 90 pratizata rugNoM meM jaivika upasarga gavya yacamAdaNDANu dvArA utpanna kiyA jAtA hai / jo yamAdaNDANu tuNDikAoM meM praveza na kara sIdhe udarastha ho jAte haiM ve mahAsrotIya zlemalakalA meM binA koI sthAnika vikSata utpanna kiye hI praviSTa ho jAte haiM / yacamAdaNDANu zleSmalakalA meM hokara donoM avasthAoM meM jA sakate haiM / eka to jaba ki zleSmalakalA kSata-vikSata yA kaTA phaTA ho aura dUsare jaba vaha pUrNa svastha ho / arthAt jyoM hI vaha zleSmalakalA ke sAnnidhya meM AtA hai vaha usameM praveza kara jAtA hai / mahAsrottIya zleSmalakalA dvArA pahu~ce hue yacmAdaNDANu AntranibandhanIka lasagranthiyoM meM apanA aDDA jamAte haiM / unameM bhI jo adhozeSAntraka ( lower ileum ) ko tathA zeSAntraka-uNDukIya koNa ( ileocaecal angle ) kAlasotsAraNa ( drain ) karate haiM vahA~ inakA acchA jamAva ho jAtA hai / ina yakSmAdaNDANuoM ke prakAra nirNaya kA ullekha karate hue griphitha ne batalAyA hai ki 82 pratizata gavya yakSmAdaNDANu vahA~ para milate haiM / AntranibandhanIka ( mesenteric ) lasagranthiyoM meM yakSmAdaNDANu kI upasthiti ke kAraNa AntranibandhanIka kArya ( tabes mesenterica ) tathA usake pazcAt udaracchadapAka hotA huA dekhA jA sakatA hai / isa prakAra sarvaprathama yacama- AntravaNa banatA hai usase yakSma AntranibandhanIka kArzya hotA hai usake dvArA anta yakSma udaracchadapAka dekhA jAtA hai / yaha bhI sambhava hai ki binA prathama yakSma AntravaNa utpanna kie rogANu sIdhe yakSma AntranibandhanIka kA utpanna kara deN| kAmeTa kA Antravitata eka raktajanya upasarga kA pariNAma hotA hai| yama daNDANuoM kI nAbhi ho aura vahA~ se rakta ke dvArA ve vikSata ( primary lesion ) banA deN| vayaskoM ke Antra ke prathama vikSata sadaiva kathana hai ki prArambhika kisI eka sthAna para Akara Antra meM prathama For Private and Personal Use Only

Page #568
502 vikRtivijJAna phuphphusa yakSmA ke pazcAt utpanna hote haiM jaba ki rogI apanA SThIva nirantara nigalakara ina vikSatoM kA kAraNa svayaM banatA hai / udaracchada se Upara kI ora calakara rogANu phuphphusa yA zvasanikIya lasagranthiyoM ko upasRSTa kara sakate haiM phAna behariMga kA kathana hai ki zaizavakAla meM yamadaNDANu AntrazleSmalakalA meM praviSTa hokara Age Atma-upasarga (auto infection ) dvArA phuphphusa - yacamA utpanna kara sakatA hai / pahale hama kaha cuke haiM ki phuphphusa - yacamA prAyaH mAnavIya yacamAdaNDANu ke dvArA utpanna hotA hai| rogI apane SThIva ko nirantara nigalatA raha kara AntrayakSmA jaba utpanna karatA hai taba usameM bhI mAnavIya prakAra adhikAMzataH mila jAtA hai / vahA~ yacamAdaNDANu kA aDDA vizeSa taura para jamatA hai / AmAzaya meM yakSmA kA prasAra bahuta kama hI dekhA jAtA hai yadyapi AmAzayika tIkSNa rasa kA usa para koI prabhAva nahIM par3a pAtA / hRdvAntra meM jahA~ peyarIya sidhma aura ekala lasakRpikAe~ ( solitary follicles ) adhika hote haiM vahA~ arthAt adhobhAga meM inakA jamAva hotA hai / bRhadantra meM bhI yakSmavicata bahuta kama dekhe jAte haiM / mAtA-pitA ke dvArA bhI yakSmA kA praveza garbhAvasthA meM ho sakatA hai / suzruta ne 7 prakAra kI vyAdhiyoM kA varNana karate hue eka prakAra Adi bala pravRttA vyAdhiyoM kA kahA hai| isameM ve vyAdhiyA~ AtI haiM jo mAtA yA pitA ke zukrazoNita doSa se utpanna hotI haiM / ye bhI do zreNiyoM meM kahI haiM eka mAtRjA aura dUsarI pitRjA / ya bhI eka Adi bala pravRtta vyAdhi mAnI gaI hai 1 4:5 'tatrAdi balapravRttA ye zukrazoNitadoSAnvayAH kuSThAzaHprabhRtayaH te'pi dvividhA - mAtRjAH pitRjAzceti / " su. zru. ) uparokta vAkya meM kuSThArza, prabhRtayaH meM prabhRtayaH kI vyAkhyA karate hue DalhaNa ne yacamA yA kSaya kA bhI ullekha kiyA hai : 'ye zukazoNitadoSAnvayAH iti, zukrazoNitasthitavAtAdidoSa anitAH / tAneva nAmato darzayati-- kuSThArza, prabhRtaya iti / prabhRti grahaNAnmehakSayAdayaH / mAtRjA iti mAtuH zoNitajAH, pitRjAzva iti pituH zukrajAH / ' isa prakAra jahA~ Ayurveda mAtA-pitA ke dvArA kSayotpatti ko svIkAra karatA hai vahA~ Adhunika bhI kucha kucha ise mAnate haiM aura vizvAsa yaha hai ki kucha kAla meM ve pUrNataH prAcInoM ke vicAra se sahamati prakaTa karane ke anurUpa apane ko pA sakeMge / ve isa samaya aisA koI pramANa nahIM pA sake jisase zukrANuoM ( spermatozoa ) dvArA kSayopasarga kA pramANa milatA ho / parantu ve strIbIja ( ovum ) ke dvArA isakA praveza sambhavanIya mAnate haiM / aparA ( placenta ) se hokara yakSmA ke jIvANu jAte haiM / isakA pramANa bvAyada yaha upasthita karatA hai ki usane eka dina kI Ayu ke zizu tathA mRtagarbha ( still born ) kI AntranibandhanIka granthiyoM meM yakSmAdaNDAzuoM ko upasthita pAyA hai / varthina tathA kovI ne to yaha bhI iGgita kiyA hai ki For Private and Personal Use Only

Page #569
yamA 503 garbharakta meM adhika saMkhyaka yakSmAdaNDANu dekhe gaye haiM jaba ki garbhaUtiyoM meM inakA koI vikSata nahIM mila skaa| grIna kA kathana hai ki kSayapIDitA strI ke aparA dvArA yakSmA ke jIvANu gamana to kara sakate haiM para vaisA dekhA bahuta kama jAtA hai| jisa prakAra viSANu tathA phiraGgANuoM ke mAtA se garbha meM jAne ke pramANa milate haiM vaise pramANa yakSmAdaNDANuoM ke viSaya meM use mila nahIM sake haiN| __kAmeTa kA dRSTikoNa yaha hai ki aparA pAra kara yacamAdaNDANu jAte to haiM parantu ve jaba pAvyasvarUpa ( filtrable form ) meM hote haiM usI samaya pAra kara pAte haiM anyathA nhiiN| ___ antarropaNa dvArA ( by inoculation ) bhI kabhI kabhI yakSmA kA prasAra ho sakatA hai| isa prakAra kA upasarga vadhAjIviyoM ( butchers) ko usa samaya lagatA hai jaba ve yakSmA se upasRSTa mAMsa ko kATate hoN| DAkTaroM ko taba laga sakatA hai jaba yakSmA ke vikSoM kA zastrakarma karane meM unake zarIra se usakA upasarga laga jAve / nasoM ko taba hotA hai jaba ve kisI kSayI ke SThIvapAtra ko uThA rahI hoM aura bIca hI meM vaha TUTa jaave| TUTane se unake zarIra para AghAta ho jAve aura usameM chIva laga jAve / prayogazAlAoM ke kAryakartAoM ko sparzAdi ke kAraNa isa daNDANu kA antarropaNa ho sakatA hai| mRtyUttara parIkSaNa (posTamArTama) kAla meM jo zavoM para kArya karate haiM unheM bhI yaha laga sakatA hai| ___antarropaNa dvArA jo yakSmA utpanna hotA hai vaha bahudhA sthAnika ( localised) hotA hai| kisI ko yakSmArbuda ( tuberculoma) nikala AtA hai to kisI ko carmakIla ( wart ) bana jAtA hai| vadhAjIviyoM ko eka jIrNa hone kI pravRtti vAlI aisI hI carmakIla nikalatI hai jise 'bUcara kA vArTa' yA verUkA nekrojenikA (verruca necrogenica ) kahate haiM / antarropaNa dvArA bahudhA jo upasarga hotA hai vaha bahuta ghAtaka nahIM hotA usase phuphphusa yA Antra yakSmA jaisI bhayAnaka vyAdhiyAM bahuta hI viralI dekhI jAtI haiN| isakA kAraNa DAkTara dhIrendranAtha banarjI yaha dete haiM ki yataH atyalpa pramANa meM upasarga zarIra meM pahu~catA hai aura vaha kaI bAra pahu~catA hai isa kAraNa yakSmA ke prati pratIkAritA zakti kA nirmANa hone lagatA hai jisase yaha roga adhika ugrarUpa meM AkramaNa nahIM kara paataa| uparokta cAra praveza mArgoM ke atirikta do aura bhI mArga kahe gaye haiN| inameM eka rakta dvArA hai / phuphphusa meM jaba koI zvasanikAlasagranthi yakSmA se prabhAvita ho jAtI hai to vaha samIpastha UtiyoM para bhI prabhAva DAlatI hai jinameM raktavAhiniyA~ bhI sammilita hotI haiN| yadi kisI prakAra kisI raktavAhinI kA aparadana ho jAve to yakSmA kA kilATIya padArtha rakta meM mila jAtA hai aura vaha eka sthAna se dUsare sthAna ko le jAyA jAtA hai| jaba koI zvasanikIya ( bronchial ) dhamanI isa prakAra ke For Private and Personal Use Only

Page #570
504 vikRtivijJAna padArtha ko lekara calatI hai to usake dvArA sampUrNa phuphphusa ko yA usake eka bhAga ko tIna phuphphusa zyAmAkasama yakSmA (acute pulmonary miliary tuberculosis) kA zikAra bananA par3atA hai / jaba kilATIya padArtha (caseous matter) phuphphusIyA sirA ( pulmonary vein) meM calA jAtA hai to usake dvArA yakSmA asthiyoM, sandhiyoM, mUtraprajananasaMsthAna taka calI jAtI hai| usase sarvAGgika zyAmAkasama yakSmA utpanna ho sakatI hai tathA yacama mastiSkachadapAka ( tuberculcus meningitis) bhI ho sakatI hai| ___ yadyapi AntradaNDANu kI taraha yacamakavakavetrANu rakta meM saMvardhita nahIM hotA, parantu rakta kI dhArA use eka sthAna se dUsare sthAna para uThAye phiratI hai jisake kAraNa eka sthAnika yA sarvAGgINa yakSmavikSata dekhane ko milA karate haiN| rakta meM yakSmadaNDANu kisI vikSata dvArA na Akara sIdhe kisI lasavahA dvArA bhI pahu~ca sakate haiN| vaha lasavahA mukhyA lasakulyA ( thoracic duct ) meM khule aura mukhyA lasakulyA rakta meM khulatI hai| kabhI-kabhI mukhyA lasakulyA svayaM bhI yakSmA pIDita dekhI jAtI hai| UtiyoM ke dvArA bhI yacamAdaNDANu kA praveza ho sakatA hai| UtiyoM kI samIpatA ( contiguity ) tathA avicchinnatA ( continuity ) bhI yakSmaprasAra meM sahAyaka hotI haiM / udaracchada aura phuphphusacchada ye donoM kalAe~ kramazaH Antra tathA phuphphusa ke samIpa hotI haiM isa kAraNa jaba Antra yA phuphphusa meM yakSmA kA vikSata hotA hai to usakA prabhAva ina samIpastha kalAoM para par3atA hai aura inameM vraNazotha aura yakSmavikSata bana jAte haiN| yadi eka kloma zAkhA ( bronchus ) meM yakSma vikSata ho to Uti kI avicchinnatA ke kAraNa usakA prabhAva dUsarI klomazAkhA para bhI par3a sakatA hai / khA~sate samaya eka klomazAkhA kA kilATIya padArtha dUsare meM gira kara dUsare svastha phuphphusa ko bhI upasRSTa kara sakatA hai| isa prakAra yacmapraveza ke lie uparokta 6 mArga uttaradAyI hote haiM jinake nAma punaH sukhasmaraNArtha nIce diye jAte haiM 1-zvasanamArga ( by inhalation ) 2-mukhamArga ( by ingestion ) 3-AdibalapravRtti ( by heredititly transmission) 4-antarropaNa ( by inoculalion ) 5-raktadhArA ( through blood stream ) 6-UtiyoM kI samIpatA aura avicchinnatA (through continuity & contiguity of tissues ) uparokta 6 mArgoM meM se zvasanamArga dvArA mAnavIya yamakavakavetrANu aura mukhamArga dvArA gavyakavakavetrANu praveza karate haiM tathA inhIM donoM prakAroM ke antargata sampUrNa hI yakSma prakaraNa A jAtA hai| hamAre deza meM mAnavIyakavakavetrANu hI pramukhatayA For Private and Personal Use Only

Page #571
yadamA yakSmAkAraka hai kyoMki yahA~ pakka dugdha yA zRta dugdha pAna kI prAcIna paripATI yathAvat pracalita hai dUsare yahA~ ke pazuoM meM yakSmA utanI nahIM jitanI anyatra / phuphphusa meM vikSata prasAra 3 prakAra se hotA hai / eka lasavahAoM dvArA, yaha prakAra adhika pracalita hai| dUsarA kloma zAkha janita ( bronchogenic ) jaba ki kilATIya dravya eka klomazAkha se dUsarI meM pahu~ca jAtA hai| tathA tIsarA jaba ki phuphphusIya sirA ( pulmonary vein ) kA suSiraka ( lumen ) bhI yakSmA se prabhAvita ho jAtA hai jisake kAraNa eka bhAga se dUsare bhAga meM yadamA jAtI hai aura jo zyAmAkasama prakAra kI yakSmA ke lie uttaradAyI hai| upasarga kA prasAra yadyapi thor3A sA hama yakSmAdaNDANu ke dvArA hone vAle upasarga ke prasAra kA AbhAsa karA cuke haiM para nIce isI ko hama aura adhika spaSTa kara rahe haiM / yakSma upasarga kA prasAra 4 rItiyoM se hItA hai :1. lasavahAoM dvArA 2. raktavahAoM dvArA 3. prakRtamArgoM dvArA 4. ativedhana dvArA yamopasarga ke prasAra kA sarva sAmAnya mArga lasavahAoM ( lymphatics ) dvArA hai| daNDANu ke bhAra se lade sitakozA tathA svatantra yakSmAdaNDANu lasadhArA ( Jym. ph stream ) meM baha kara samIpastha lasapranthika taka pahu~ca jAte haiN| Antrika yamavraNa se AntranibandhanIka lasagranthi ke upasarga kA mArga lasavahAoM dvArA hotA hai| inhIM lasavahAoM ke dvArA ina daNDANuoM ke gamana kI pravRtti ke kAraNa hI bahudhA na mukha meM koI prAthamika vraNa milatA hai aura bahudhA A~toM meM bhI nahIM milatA parantu graivika lasapranthiyoM ( cervical lymph glands) tathA Antra nibandhanIka lasagranthiyoM meM yamopasarga bahudhA dekhA jAtA hai| ___ yakSmopasarga kA dUsarA sAdhana raktavahAe~ haiN| jahA~ yakSmavikSata ho aura usake samIpa kI raktavAhinI kA suSiraka abhilopI antazchadIya pAka ke kAraNa banda na ho gayA ho to yakSma kaNana ati vAhinIprAcIra kA ativedhana karake usake antazchada meM yadimakA (tubercles) utpanna kara sakatI hai| ye yadimakAeM vAhinI ke suSiraka meM phaTa sakatI haiM aura taba yakSmAdaNDANu nikala kara raktadhArA meM bahate hue zarIra ke dUrastha bhAgoM taka pahu~ca sakate haiN| audarikayacamA meM mukhyAlasakulyA dvArA rakta ko yakSmAdaNDANu bheje jA sakate haiN| rakta meM daNDANu Ana para Age kA prabhAva rogI kI pratirodhakazakti, yamAdaNDANuoM kI saMkhyA tathA unakI ugratA ( virulence ) para nirbhara rahatA hai| yadi jIvANu atyugra haiM aura rogI kI pratirodhakazakti kA hAsa ho cukA hai to eka sarvAGgINa upasarga (generalised infection ) laga sakatA hai| para yadi upasargakArI jIvANuoM kI saMkhyA kama hai aura zarIra meM pratIkAritAzakti paryApta hai to uttarajAta vikSatoM ke utpanna hone kA kAI avasara ho nahIM , A sakatA hai / yadi pratirodhakazakti aura jIvANvika ugratA donoM santulita ( bala 43 vi0 For Private and Personal Use Only

Page #572
506 vikRtivijJAna nced ) haiM to visthApika nAbhya upasarga ( metastatic focal infections) asthiyoM, sandhiyoM, kendriya vAtanADI saMsthAna evaM mUtraprajanana saMsthAnAdi bhAgoM meM ho jAte haiN| prAkRtika mArgoM ke dvArA bhI upasarga kA prasAra hotA huA dekhA jAtA hai| jaba koI kSayI sA~sa andara ko bharatA ho usI samaya koI yakSma nAbhi phaTa jAye to usake andara kA kilATIya dUSita padArtha zvasanikAoM ( bronchi ) meM calA jAtA jisake kAraNa eka sAtha phuphphusa ke aneka bhAgoM meM kilATIya zvasanIphuphphusapAka ( caseous broncho-pneumonia) hotA huA dekhA jAtA hai| isI prakAra nigale hue ThIva se Antra, vRkkoM se adhomUtramArga aura jihvA ke upasarga se tAlu ( palate ) upasRSTa ho sakate haiN| ativedhana dvArA ( by permeation ) yakSmA kA prasAra prAyazaH hotA hai| prArambha meM jo prAthamika nAbhi (primary focus) banatA hai vahA~ se yakSmAdaNDANuoM ko bhakSikozA uThA lete haiN| ve bhakSikozA samIpastha UtiyoM meM praveza kara jAte haiM jahA~ unakA vihAsa hokara mRtyu ho jAtI hai| vahA~ para ve daNDANu bar3hate haiM aura eka yakSmikA utpanna kara dete haiN| yaha yadimakA prAthamika nAbhi ke samIpa hI hotI hai| donoM yacimakAe~ samIpatA ke kAraNa eka dUsare se milakara bar3A rUpa dhAraNa kara letI haiN| isa prakAra vaha dhIre-dhIre bar3hatI rahatI hai aura usakA kilATIyana (caseation) hotA rahatA hai| autikIya pratikriyA yakSmAdaNDANu ke prati utiyoM kI pradhAna pratikriyA ( reaction ) kA nAma jAlakAntazchadIya kozAoM kA atighaTana yA paramacaya ( hyperplasia ) hai / aura kyoMki jAlakAntazchadIya kozA pratyeka Uti meM aura zarIra ke hara aMga meM kucha na kucha milate haiM isa kAraNa pratyeka zarIrAGga meM hone vAle yakSma vikSata sadaiva eka se hI hote haiN| yadi eka bAra yakSmAdaNDANu kisI sthAna para surakSApUrvaka sthita ho jAve to phira vaha apanA praguNana tathA yakSmikA ( tubercle ) kA nirmANa karatA hai| borila ne zazaka parIkSaNoM dvArA yaha pragaTa kiyA hai ki yakSmAdaNDANuoM ke prati jati pratikriyA vaisI hI hotI haiM jaisI ki anya kisI rogANu ke prati / arthAt yakSmA. daNDANuoM ke antaHkSepaNa ke thor3e samaya pazcAt hI unheM bahunyaSTi sitakozA ghera lete aura apane udara meM samA lete haiN| para ina vicAroM kI koI zakti nahIM ki ve inakA vinAza karane meM samartha ho sake isa kAraNa tIsare dina upasRSTa sitakozA mRtyu ko prApta hone lagate haiM aura unakA vighaTana hone lagatA hai| ___ uparokta sitakozIya pratikriyA yacamamastiSkachadapAka meM bahuta spaSTarUpa se dikhatI hai| kyoMki vahA~ utpanna viSa ko atyadhika mAtrA meM upasthita mastiSkoda manda ( dilute ) karatA rahatA hai| vahA~ prArambha meM mastiSkoda meM bahunyaSTikozA For Private and Personal Use Only

Page #573
yakSmikA pRSTha 507 yaha phuphusa ke antargata nirmita eka zyAmAkasama yadimakA kA citra hai / isameM adhicchadAbha kozA, mahAkozA tathA pariNAha para lasIkozA dikhalAI par3a rahe haiN| For Private and Personal Use Only

Page #574
yakSmA gaNana 70-80 pratizata taka dekhA jAtA hai| dUsare dina vahA~ bRhat ekanyaSTi bhramaNazIla kozA jo jAlakAntazchadIya UtiyoM dvArA utpanna hote haiM ina upasRSTa bahunyaSTi kozAoM ke samIpa A jAte haiM tathA tIsare dina ve daNDANu puMjoM ke cAroM ora kaI-kaI jur3akara bar3e-bar3e mahAkozAoM ( special giant cells) kA rUpa dhAraNa kara lete haiN| kyoMki bahunyaSTikozA ekanyaSTikozAoM ke sAtha milakara mahAkozA banate haiM hama yakSmavikSatoM meM usa pUya kA darzana nahIM pAte jo pUyajanaka upasargoM meM bahunyaSTiyoM ke dvArA banatA hai| yahA~ sitakozotkarSa ( leucocytosis ) roka diyA jAtA hai| sArAMza yaha ki sthAnika Uti kI pratikriyA ko hama usake kozAoM ke saJcalana ( mobilisation ) tathA rUpAntaraNa (metamorphosis ) se jAna sakate haiN| kozAoM kA rUpAntaraNa adhicchadAbhakozAoM ( epitheloid cells), mahAkozAoM ( giant cells ) tathA golakozIya bharamAra ( round celled infiltration) meM hotA hai| adhicchadAbha kozA kAphI bar3e AkAra ke hote haiM ve dekhane meM aNDAbha hote haiM unakA prarasa amlapriya (acidophil ) hotA hai tathA unakI nyaSTi kucha lambotarI hotI hai aura usameM abhivarNi ( chromatin ) kI mAtrA kama hotI hai| inakA nAma adhicchadAbha isalie hai ki ve adhicchadIya kozAoM ke tulya hote haiM ve vAyakozIya adhicchada ( alveolar epithelium ) se utpanna nahIM hote haiM api tu ve jAlakAntazchadIyasaMsthAna ke protikozAoM ( histiocytes ) dvArA utpanna kie jAte haiN| ye kozA atyadhika bhakSaNakArya karate haiN| inake aneka vidvAnoM ne vibhinna nAma diye haiN| . jyoM-jyoM samaya bItatA jAtA hai adhicchadAbha kozAoM kA kaTibandha bar3hane lagatA hai aura unake sAtha-sAtha parivAhinIya lasAvakAzoM ( peri vascular lymphatic spaces ) se tathA lasavahAoM se bahuta se lasakozA (lymph corpuscles) vahA~ ekatrita hone lagate haiN| isI ko golakozIya bharamAra ( round-celled infiltration ) kahA jAtA hai| - isa kSetra meM jahA~ adhicchadAbha kozAoM kA jamAva hai aura golakozIya bharamAra ho rahI hai naI raktavAhiniyoM kA nirmANa nahIM hotA isake kAraNa yadimaka avAhinya (avascular ) hI rahatI hai| ataH yakSmAdaNDANu ke utpAda vinAzaka kArya meM rata rahate haiM, vahA~ para rakta kA Agamana nahIM hotA hai tathA samIpastha raktavAhinI meM abhilopI antazchadIyapAka ( obliterative endarteritis) ho jAtA hai isa kAraNa yakSmanAbhi ke kendra bhAga ko koI poSaNa na milane se usameM Atazcita nAza (coagulative necrosis) ho jAtA hai| naSTa padArtha panIra (kilATa ) jaisA hotA hai aura isa prakriyA ko kilATiyana ( caseation ) kahA jAtA hai| isakA vistRta vivaraNa Age diyA jaaygaa| ... eka rekhAcitra ( diagram ) kI dRSTi se yadi vicAra kiyA jAve to eka yamikA meM hameM nimna padArtha mileMge: For Private and Personal Use Only

Page #575
500 vikRtivijJAna 1-kendra meM- (a) eka yA adhika bahunyaSTiyukta mahAkozA (A) mahAkozAoM ke andara yakSmAdaNDANu (i) mahAkozAoM ke cAroM ora kaNIya apadravya 2-bAhara jAlakAntazchadIya yA adhicchadAbhakozA jinameM svaccharasa bharA huA hogA tathA nyaSTi bar3I hogii| 3-2 ke bAhara-(a) lasIkozAoM kA eka kaTibandha / (A) usI kaTibandha meM mile hue tanturuha ( fibroblast ) isa kaTibandha kI bAhya yA Abhyantara koI vizeSa sImA nahIM dekhI jaatii| yadi vikSata kA nirmANa zanaiH zanaiH huA to mahAkozAoM se pravadha nikala kara unake cAroM ora phaile adhicchadAbha kozAoM ke sAtha jAlakriyA ( anastomosis) banAte haiN| uparokta jo racanA batAI gaI hai vaha pUrNataH sthira ho aura brahmA kI lakIra ho aisA nahIM hai aura na mahAkozAoM kI upasthiti kA hI artha yakSmA kA pUrNa nidAna hai| pratyeka yadimakA kA atIta aura bhaviSya donoM hI hote haiN| isakA vikAsa eka vidhi (process ) dvArA hotA hai| ataH jaba vaha vidhi pUrNa ho jAtI hai tabhI yakSmikA ( tubercle ) bana jAtI hai / saba yakSmikAe~ sadaiva sAtha-sAtha banatI ho aura eka barAbara samaya lagatA ho so bhI nahIM hai| isa kAraNa koI yacimakA kabhI aura koI kabhI milatI rahatI haiN| jisa prakAra anya upasargoM meM upasargakArI jIvANu kI ugratA eka mahattva kA bhAga adA karatI hai vahI yakSmA meM bhI hotA hai| jitanA hI ugra yakSmakavakavetrANu hogA utanA hI zIghra yakSmikA bnegii| jaba daNDANu adhika ugra prakAra kA hotA hai to yakSmikA meM mahAkozA nahIM dikhate na yacimakAe~ hI pRthaka-pRthaka dekhI jAtI haiN| vahA~ to kevala eka kilATIya apadravya kA eka puJja jisake pariNAha meM golakozIyabharamAra itanA hI dRggocara ho pAtA hai / isa parivartana kA kAraNa yakSmAdaNDANu dvArA pradatta tIvra viSa hai jo UtiyoM kA vinAza karatA calatA hai aura mahAkozA nirmANa kA koI samaya nahIM detaa| eka acchA autikIya citra jisameM mahAkozAdi sabhI kozA spaSTa dIkha sakeM jIrNa yakSmA pIDitoM meM milA karatA hai jahA~ yakSma prakriyA aura zArIrika pratirodha donoM santulita hokara rahatI haiN| ___yadi yamakavakavetrANu saumya prakAra kA hai yA usakI ugratA adhika nahIM hai to bhI mahAkozAoM kA nirmANa nahIM hotA kyoMki uddIpanazakti ( stimulus ) apUrNa rahatI hai usa samaya tantUtkarSa lasIkozIya bharamAra tathA vikIrNa dIrghabhakSi ( macrophages ) yukta autikIya citra dikhAI detA hai / For Private and Personal Use Only

Page #576
yakSmA sUkSma se sUkSmatama yamikA jise hama dekha pAte haiM tIna yA cAra mahAkozAoM dvArA nirmita hotI hai jisakA svarUpa vaisA hI hotA hai jaisA hama Upara likha cuke haiM / isa prakAra jitanI bhI nAbhiyA~ ( foci ) banatI haiM ve dhUsara yA zyAmAkasama yamikAkoM ke nAma se pukArI jAtI haiN| ve AdhUsara ( greyish ), arddhapAradarza, golIya piNDakAe~ hotI haiM jinakI AkRti eka bindu se lekara eka Alapina ( andhasUcI) zIrSa ke barAbara yA kucha bar3I hotI haiN| ye yadimakAe~ dRDha, golikAsama (shotty) spaSTataH parilikhita ( distinctly circumscribed ) hotI haiM tathA jaba Uti ko kATA jAtA hai to usake dharAtala para kucha uThe hue ( projected - prakSipta ) bhAga dikhAI dete haiM / 506 pItayadimakA - isa nAma se bhI kucha yacimakAe~ pukArI jAtI haiN| Upara varNita yamikAoM se kucha bar3I, kama santata ( less regular ), apragalbha less closely defined ) tathA kucha saumya yadimakAoM ko jinameM kilATIyana prakriyA cala par3I ho pIta yamikAoM ( yellow tubercles ) ke nAma se pukArA jAtA hai / kaI choTI-choTI dhUsara yadimakAe~ mila kara jo pAsa-pAsa banatI haiM aura sAtha-sAtha hI apanA evaM samIpastha Uti kA kilATIyana karake jo eka dIrghapuMja ( large mass ) banatA hai vaha bhI pItayamikA yA saMpiDana yakSmikA ( conglomerate tubercle ) kahA jAtA hai | kilATIyana ke kAraNa inakA varNa pIta ho jAtA hai / para pIta varNa ke cAroM ora eka saMkIrNa zliSIya ( gelatinous ) kaTibandha dhUsara yakSmikAoM kA bhI dekhane ko milatA hai / ye dhUsara yamikA kilATIya nAbhi se samIpastha UtiyoM maiM vikirita ( radiating ) dekhI jAtI haiM / jo isako puSTa karatI haiM ki kendriya puMja se upasarga samIpastha UtiyoM meM jAkara naI yacimakAe~ utpanna kara rahA hai aura jyoM-jyoM yaha puMja bar3hatA jAtA hai ve yacimakAe~ bhI isI kendriya puMja ke bhAga ke rUpa meM pariNata ho jAtI haiM / For Private and Personal Use Only jaisA eka bAra aura kahA jA cukA hai| anya vraNazothAtmaka vitoM aura yakSmavijJatoM (yadimakAoM ) meM eka bar3A antara yaha hotA hai ki jahA~ prathama meM paryApta rakta hotA hai vahA~ dUsaroM meM raktavAhiniyoM kA pUrNataH abhAva hotA hai / yadimakAoM kI ora yadi koI vAhinI jAtI bhI hai to yA to usakA mukha ghanAsrotkarSa ke kAraNa banda ho jAtA hai yA usake antazchada meM prakSobhajanya paramacaya ( atighaTana ) hone se antazchada kA vinAza hokara abhilopI antazchadIyapAka ho jAtA hai / isameM koI raktavAhinI banatI nahIM tathA adhiraktatA nAmaka ghaTanA isake andara kabhI dekhI nahIM jAtI / hA~, yadi rogAkramaNa atitIvra huA to yadimakAoM ke pariNAha (periphery ) para kucha adhiraktatA mila sakatI hai / raktavAhiniyoM kA jaise mukha banda ho jAtA hai ThIka usI prakAra kucha-kucha lasavahAoM kA mukha bhI nicUSita ( occluded ) ho jAtA hai /

Page #577
510 vikRtivijJAna mikAstha kozAoM kA prabhavasthala jAlakAntazchadIya kozAoM ke ekIkaraNa ( fusion ) ke dvArA mahAkozA ( giant cells ) banate haiM / unakI nyaSTiyA~ pariNAha kI ora par3I rahatI haiN| inakA nirmANa usa samaya taka nahIM hotA jaba taka zarIra meM UtimRtyu (tissue necrcsis) na huI ho| ye gati Uti aura yakSmAdaNDANuoM kA bhakSaNa karate calate haiM / eka mahAkozA meM 3 se lekara 60 taka nyaSTiyA~ pAI jAtI haiM / vibhajana kAla ( mitosis ) ke samaya ye yaSTiyA~ upasthita nahIM hotIM tathA prAyazaH ve vivAsita hotI haiM jo yaha batalAtI haiM ki eka hI nyaSTi ke nirantara vibhajana se ve na banakara kaI kozAoM ke ekIkaraNa se banatI haiN| ye nyaSTiyA~ kozA ke pariNAha bhAga meM kyoM avasthita hotI haiM usake do kAraNa sambhavataH ho sakate haiM / eka to yaha ki kozA kA bAhya bhAga adhika poSaNa prApta karatA rahatA hai isalie nyaSTiyA~ pariNAhI bhAga meM rahatI haiM / dUsarA yaha ki jaba eka mahAkozA kisI Uti ke samIpa usakA bhakSaNa karane jAtA hai to usakA prarasa ( cytoplasm ) turata nikala kara Uti ke prarasa se kyoMki prarasa amIbAbha ( amoeboid ) gati karatA hai tathA nyaSTiyA~ gativihIna ( motionless ) hone ke kAraNa prarasa ke eka kinAre para par3I rahatI haiN| donoM matoM dUsarA adhika samajha meM AtA hai I samarasa ho jAtA hai meM Acharya Shri Kailassagarsuri Gyanmandir adhicchadAma yA jAlAkAntazchadIya kozA jo yakSmopasarga kI pramukha ghaTanA hai unakA nirmANa kaI prakAra ke kozAoM se milakara hotA hai / unakA kucha aMza to bhramaNazIla proti kozAoM ( wandering histiocytes ) dvArA banatA hai / kucha lasIkozAoM se taiyAra hotA hai tathA adhikAMza usa aMga ke jAlakAntazchadIya saMsthAna ke paramacaya ( atighana ) se banatA hai aura atighaTana kA kAraNa usa aMga kA prakSubdha ho jAnA hai / sAbina tathA Dona yaha prakaTa kara cuke haiM ki yakSmAdaNDANu ke jo do aMza hote haiN| unameM snaihika ghaTakoM vAlA aMza jAlakAntazchadIya kozAoM kA praguNana drutagati se karatA hai tathA probhUjinAMzika ghaTaka vizuddha viSAkta prabhAva DAlatA hai / yaha smaraNa rakhanA hogA ki yakSmA eka lasIka Uti ( lymphatic tissue ) kA roga hai tathA isase rakSA tathA roga kI prati pratIkAritA zakti unhIM bhakSikozAoM dvArA hotI hai jo lasIkaracanAoM se utpanna hote haiM / mikAoM ke parivartana eka yakSmanAbhi ( tuberculous foci ) yA yadimakA meM Age cala kara nimna viziSTa parivartana dekhane ko milate haiM : -- ( 1 ) kilATIyana ( caseation ) ( 2 ) tantUtkarSa ( fibrosis ) ( 3 ) cUrNiyana ( calcification ) ( 4 ) vAhinya parivartana ( vascular change ) For Private and Personal Use Only

Page #578
yakSmA 511 aba hama inhIM parivartanoM kA Avazyaka varNana upasthita karate haiM jinake bala para yakSmA kI sampUrNa vaikArikI avalambita hai| kilATIyana jisa kisI Uti meM koI yakSmakavakavetrANu ( yakSmAdaNDANu) pahu~ca jAtA hai to jaba taka usameM vAhinyaparivartana hote haiM usase bahuta pahale se hI usa Uti para usakA viSailA prabhAva par3ane lagatA hai| yaha prabhAva yakSmikA ke kendrabhAga meM sarvaprathama par3atA hai aura sarvaprathama kendrastha mahAkozA yakSmaviSa ke kAraNa naSTa hone lagatA hai| kendrabhAga se pariNAha kI ora viSa kA prabhAva hotA calatA hai aura adhikAdhika ati usameM grasita hotI calI jAtI hai tathA kozAoM para prabhAva par3atA jAtA hai| kilATIya kaTibandha ke pariNAha para atikozAoM meM snaihika vihrAsa milatA hai jo vaiSika ati mRtyu se pUrva sadaiva dekhA jAtA hai / kisa prakAra kilATIyana prakriyA sampanna hotI haiM yaha eka samasyA hI hai| isakA prapuSTa pramANa abhI taka pragaTa nahIM ho sakA hai| jaubaliMga aura pITarasana ne apane prAyogika parIkSaNoM se yaha mata pragaTa kiyA hai ki yakSmAdaNDANu kucha aise padArtha utpanna karatA hai jo una probhUjinAMzika aura snehAMzika (lipolytic ) kiNvoM ke kArya meM bAdhA DAla dete haiM jo sAdhAraNatayA mRta UtiyoM kA AtmapAcana ( auto. lysis )karate haiN| isa prakriyA ke kAraNa yadimakA kA kendrabhAga jisameM kilATIyana prArambha ho cukA hai eka prakAra ke ati sUkSma kaNIya asphaTIya apadravya se bhara jAtA hai tathA jisake pariNAha para kozAoM ke bhagnAvazeSa svarUpa AsaMkucita (shrunken ) nyaSTiyA~ dekhI jAtI haiN| kilATIyita kSetra ke bhItara yA usake bilakula samIpa vihAsita mahAkozA dekhe jA sakate haiN| kilATIyana kI prakriyA ati drutagati se hotI hai| isakA drautya jIvANu kI ugratA ke anupAta se bhI adhika dekhA jAtA hai| yaha kriyA vistRta yA prasRta vikSatoM meM bahuta adhika milatI hai| ye vikSata pIle raMga ke racanA vihIna, dadhikasama (cheesy ) tathA mRdula padArtha se bhare rahate haiN| kilATIyana ke pazcAt prAyaH taralana ( liquefaction ) hotA hai| jahA~ phiraMga ke vikSata jyoM ke tyoM tathA kar3e bane rahate haiM vahA~ yamavikSata unake viparIta vighaTita hone kI pravRtti meM pUrNa vizvAsa karate haiM / atiyoM kA taralana kyoM hotA hai isake lie yaha sambhavataH kahA jA sakatA hai ki UtiyoM meM sthita kiNva UtiyoM ke AtmapAcana meM jaba yakSmaviSa dvArA azakta kara diye jAte haiM to kiNvana nahIM ho pAtA tathA tarala rUpa meM Uti pariNata ho jAtI hai| kilATa padArtha meM ananuviddha snehAmloM (unsaturated fatty acids) atyadhika mAtrA meM rahate haiM aura ho sakatA hai ki inhIM ke kAraNa pravRtta kiNva azakta kara diye gaye hoN| taralana kA pariNAma yakSmaja yA kSayaja vidradhi kI utpatti meM hotA hai| kabhI kabhI kilATIya padArtha ko pUyajanaka jIvANu upasRSTa karake vahA~ pUyana kara dete haiN| For Private and Personal Use Only

Page #579
512 vikRtivijJAna yaha pRyana aura taralana donoM pRthak pRthak vastue~ haiM eka meM pUyakozA upasthita rahate haiM jaba ki dUsare meM ve nahIM milte| yahI kAraNa hai ki pUyika vidhiyoM meM vraNazotha ke samasta cihna santApa, lAlimA, zUlAdi lakSaNa milate haiM para taralana dvArA utpanna kSayaja vidradhi ( tuberculous abscess ) meM vraNazotha kA koI lakSaNa nahIM huA karatA / isI lie kSayaja vidradhi ko zItavidradhi ( cold abscess ) bhI kahA jAtA hai / zItavidradhi kA tarala apanA mArga banAkara paryApta dUra calA jAtA hai| kaTilambinIya vidradhi (psoas abscess ) usakA hI udAharaNa hai| yaha vidradhi pRSTakaTIya kazerukAoM meM eka sthAna para upasarga hone se utpanna hotI hai parantu yaha kaTipradeza meM eka vaMkSaNikA snAyu ( inguinal ligament ) ke nIce aura kabhI kabhI to aru ( thigh) ke nIce kaTilambinI pezI ke kaJcaka meM hokara eka sujana ke rUpa dekhI jAtI hai| aisI vidradhiyoM meM yakSmapUya ( tuberculous hus) bharA hotA hai| yaha yamapUya racanAvihIna kaNIya snaihika kozAoM kA apadravya ( structureless granular fatty-cell debris ) mAtra hotA hai jisameM kucha vihAsita lasIkozA pAye jAte haiM / jaba taka pUyajanaka jIvANuoM kA usameM upasarga nahIM hotA yakSmapUya meM bahunyaSTi kozA milate nhiiN| jaba kabhI ye vidradhiyA~ dharAtala para Akara phUTatI hai to eka lambA nADIvraNa (sinus) dekhA jAtA hai jisake prAcIroM para yakSma kaNana Uti kA stara car3hA hotA hai| isa kaNana Uti meM aura sAdhAraNa kaNana Uti meM itanA hI antara hotA hai ki isameM mahAkozA tathA yakSmAdaNDANu aura pAye jAte haiM / prAyaH ye nADIvraNa pUyajanaka jIvANuoM dvArA upasRSTa ho jAyA karate haiN| yadi yaha taralana kriyA kisI phuphphusa meM huI to zIghra yA vilamba se kisI kloma nAlI ( bronchiole) kA aparadana avazya ho jAtA hai aura rogI khA~sI ke sAtha taralita padArtha bAhara uDela detA hai / tarala ke nikala jAne ke bAda jo rikta sthAna bana jAtA hai vaha kUpa yA vivara ( cavity ) kahalAtA hai| isakA nirmANa jitanA samaya letA hai usI ke anusAra use tIna yA jIrNa nAma diyA jAtA hai / tIvra vivara vaha jaba kilATIpana drutagati se hokAra zIghra tarala na ho aura zIghra hI vivara bana jAve jIrNa meM saba kAma vilamba se hotA hai / tIvra vivara bhaddA, rUkhA aura viSamaprAcIra yukta hotA hai jisameM koI nizcita stara nahIM hotA na tAntava sImA (fibrous demarcation ) hI hotA hai| jaba ki jIrNa vivaroM meM sunizcita tAntava prAcIra hotI hai jisameM lAla makhamalI yakSmakaNana ati hai aura jisameM klomanAlI ( bronchiole ) khulatI huI dekhI jAtI hai| tantUtkarSa yamopasarga meM UtiyoM kA vinAza hotA hai tathA raktapUrti ( blood supply) meM bAdhA par3atI hai| isa kAraNa yahA~ vikSatoM kA ropaNa tantUtkarSa dvArA hI sambhava hotA hai| yadi zarIra kI pratirodhaka zakti adhika ho tathA rogakArI jIvANu kI ugratA bhI For Private and Personal Use Only

Page #580
yakSmA kama ho to choTe-choTe vikSatoM kA sampUrNa kilATIya padArtha pracUSita ho jAtA hai tathA usake pariNAha meM sthita saMyojIUti kozA zanaiH-zanaiH eka saghana tathA saMkocana zIla tAntavaprAvara ( fibrous capsule ) kA nirmANa kara dete haiN| yadi vikSata bar3A ho aura usameM taralana ho gayA ho tathA vaha bAhya yA Abhyantara dharAtala para khula gayA ho to vahA~ ropaNa kaNanaUti ke nirmANa tathA tantUtkarSa dvArA hotA hai| anta meM vahA~ eka saghana vraNavastu ( dense sear ) bana jAtI hai| isa vraNavastu yA tAntavaUti ke bhAga meM bhI kilATIya kSetra mila sakate haiM jinameM gADha ( inspissated ) yA cUrNiyita kilATIya padArtha dekhA jA sakatA hai| ____alpa ugra jIvANu dvArA utpanna yakSmA meM pratikriyA kA kilATIya honA Avazyaka nahIM hai| vaha kevala tAntava bhI raha sakatI hai| aise avasaroM para yadimakAoM meM kendriya mahAkozA tanturUhoM dvArA ghire hue rahate haiN| isa prakAra kI pratikriyAoM meM prabhAvita bhAga tAntavika sthaulya dvArA ghanIbhUta kara diyA jAtA hai aura isa yakSmA ko paramapauSTika yakSmA (hypertrophictuberculosis) kahate haiM / paramapauSTika yakSmA phuphphusa ke tantvAbha zoSa ( fibroid phthisis ) meM dekhI jAtI hai jo bahuta kama hone vAlI vyAdhi hai| taruNoM kI uNdukIya-yakSmA nAmaka vyAdhi meM bhI yaha mila jAyA karatI hai| jaba vahA~ yaha milatI hai to vahA~ jaba tAntava Uti kA saMkocana prArambha hotA hai to aisA lagatA hai ki mAno jIrNa baddhodara ( chronic intestinal obstruction ) ho gayA ho / tantUtkarSa tathA yakSmadaNDANvika ugratA ye donoM eka dUsare ke pratIpAnupAtI ( inversely proportional ) hote haiN| arthAt yadi tantUkarSa adhika hotA hai to yakSmA. daNDANukI ugratA kama hogI yadi ugratA adhika hogI to tantUtkarSa kama hogaa| tantUtkarSa meM jahA~ hamane tantuoM kA ullekha kiyA hai vahA~ sAdhAraNa zleSajanIya tantuoM ( collagenous fibres ) ko hI samajhanA caahie| zleSajanIya tantuoM ke atirikta eka sUkSma tantu aura hote haiM jinheM hama jAlikIya tantu (fibres of reticulin ) kahate haiM / jAlikA ( reticulum ) nAmaka eka jAla ( network) atisUkSma tantuoM kA banA huA hotA hai jo phuphphusa tathA yakRt donoM meM pAyA jAtA hai aura jisakA nirmANa jAli ( reticulin ) ke tantuoM se hotA hai| yaha jAli jAlakAntazchadIyasaMsthAna ke kozAoM dvArA taiyAra kI jAtI hai| isakA pradarzana rajata vyApana ( silver imprgnation ) paddhati dvArA kiyA jA sakatA hai / inake dvArA jo jAla banatA hai vaha eka dUsare se milatA huA hotA hai tathA vaha sampUrNa uti kA ativedha kiye hotA hai| milara kA kathana hai ki yama-vikSatoM meM ina jAlikIya tantuoM kA bhI jIvANu ugratA ke sAtha pratIpAnupAta hI hotA hai| yadi roga ugra svarUpa kA hai to vahA~ jAlikIyatantuoM kA abhAva hogA para yadi rogANu meM ugratA kama hai to vahA~ ye tantu khUba dekhe jA sakate haiM, isa dRSTi se jAlikIya tantuoM kI upasthiti tIvropasarga meM na milakara jIrNopasarga meM DaTakara dekhI jAtI hai| For Private and Personal Use Only

Page #581
514 vikRtivijJAna ye tantu Age jaba adhika kAla taka rahate haiM to saghana aura sthUla hokara tAntava Uti kI zleSajana meM pariNata ho jAte haiN| isake atirikta jAlakIya tantuya cimakAoM kA bhI ativedha ( permeation ) kara DAlate haiN| ye mahAkozAoM ke sAtha nikaTa kA sambandha rakhate haiM tathA kilATIya kSetroM meM jahA~ sAdhAraNa abhiraMjanA para kucha bhI nahIM milatA rajata vyApI abhiraMjana karane para ye una vinAza ko prApta UtiyoM meM bhI khUba dekhe jAte haiN| isa prakAra jAlikIya tantuoM kI upasthiti yA abhAva dekha kara vyakti kI pratIkAritA zakti kA patA lagAyA jA sakatA hai| cUrNiyana yaha purAne ( jIrNa) aura sImita yakSmavikSatoM meM hone vAlI prakriyA hai| kilATIyana ke pazcAt cUrNiyana ( calcification ) hotA huA dekhA jAtA hai jaba kilATIya kSetra para prAvara car3ha gayA ho aura usake andara kA kilATIya padArtha pracUSita ho gayA ho usa samaya isa dadhikasama padArtha meM cUne ke lavaNa (cUrNAtulavaNa) nissAdita ho jAte haiM jo use yA to eka viSayAkRtika pASAgavat piNDa (stony body) meM badala dete haiM yA eka ravAdAra (gritty ) puMja meM pariNata kara dete haiN| hama aisA parivartana phuphphusa meM bhI kabhI-kabhI pAte haiM tathA AntranibandhanIka kilATIya lasagranthiyoM meM bhI dekhate haiN| vAhinya parivartana vAhinIyaparivartana jo yakSmA meM dekhA jAtA hai usakA nAma hai abhilopI dhamanyantazchadapAka ( obliterative endarteritis ) yaha pAka surakSAtmaka hai| hotA yaha hai ki jahA~ para yadimakA banatI hai vaha svayaM to vAhiniyoM se virahita hotI hai tathA usake Asa-pAsa kI vAhiniyoM para yakSmaviSa kA prabhAva par3atA hai jisake pariNAmasvarUpa dhamaniyoM ke antazchada ke kozA praguNita hone lagate haiM aura kaI-kaI stara moTe ho jAte haiM / unake bahuta moTe hone ke kAraNa dhamaniyoM ke suSiraka bhI choTe par3ate jAte haiM aura anta meM vahA~ rakta kA eka AtaMca jama jAtA hai jo usake mukha ko pUrNataH nigita (plugged ) kara detA hai| yaha vAhinya parivartana surakSAtmaka (protective) isa dRSTi se hotA hai ki eka to isa prakAra banda huI dhamanI kI prAcIroM ko cAhe yakSmaUti-nAzakriyA kitanI hI hAni pahu~cAve usase raktasrAva nahIM ho sakatA; dUsare isa paddhati dvArA yakSmAdaNDANuoM ko raktadhArA meM pahu~ca kara khurAphAta karane kA avasara nahIM mila pAtA / aisA hI parivartana phiraMga meM bhI dekhA jAtA hai jisakA varNana agale adhyAya meM kiyA gayA hai| yadi koI yaha samajha le ki Upara jo mahAkozA nirmANa, kilATIyana, tantUtkarSa tathA abhilopI dhamanyantazchadapAkAdi vikRtiyA~ batalAI gaI haiM ve kevala yakSmA meM hI hotI haiM tathA anyatra kahIM nahIM dekhI jAtI to yaha usakI bhUla hai evaM ajJAnatA kI ghotaka hai| ye saba parivartana to pratyeka jIrNa vraNazothAtmaka avasthA meM mila For Private and Personal Use Only

Page #582
yakSmA 515 sakate haiN| vizeSa karake ye jIrNa aupasargika kaNArbudoM ( chronic infective granulomata. ) yA jinheM viziSTa kagArbuda ( specific granuloma ) kahate haiM vahA~ prAyazaH milate haiM / yakSmA, phiraMga, kuSTha, kiraNa kavaka evaM azvagranthi (glanders ) aise hI roga haiM jahA~ ye vikRtiyA~ dekhI jA sakatI haiN| yadyapi ina saba meM roga ke kartA vibhinna prakAra ke jIvANu haiM parantu inake vikSatoM meM jo samAna moTI moTI bAteM hotI haiM ve yaha batalAtI haiM ki autikIya praticAra ( response ) ke atirikta bhI koI aisA kAraka hai jo ina saba meM samAna rUpa se ukta samAna parivartanoM ko karane ke lie uttaradAyI hai| ye saba parivartana bahuta dhIre dhIre hote haiM aura prArambha meM mukhyataH adhicchadIya dharAtaloM para dekhe jAte haiN| aisA jJAta hotA hai ki isa samAnatA kA kAraNa jIvANvika anUrjA (( bacterial allergy ) hai / yakSmAnuhRSatA tathA pratIkAritA yaha bhale prakAra batalAyA jA cukA hai ki jAtiyoM aura vyaktiyoM meM upasargoM ke prati kamAdhika anuhRpatA ( susceptibility ) hotI hai| eka hI jAti meM yA vyakti meM vibhinna Ayu para bhI upasarga ke prati anuhRSatA meM antara dekhA jAtA hai yaha antara kitanA aura kaisA hai vaha usa upasarga dvArA utpanna vikSata ko dekhane se jAna liyA jA sakatA hai / isa viSaya kA vizeSAdhyayana ghoNa tathA opAI ne kiyA hai| unhoMne do viziSTa prakAra ke phuphphusavikSatoM ko batalAyA hai| unameM eka ko ghoNa vikSata (ghon lesion) nAma diyA gayA hai aura dUsare ko uttarajAta vikSata kahA jAtA hai| __ ghoNa vikSata kA dUsarA nAma prAthamika jaTilatA ( primary complex ) bhI hai| yaha vikSata bAlakoM meM atyadhika tathA taruNoM evaM vayaskoM meM kama dekhA jAtA hai| prAthamika jaTilatA (ghoNavikSata ) meM eka kilATIya nAbhi hotI hai jisakA vyAsa AdhA yA eka prAGgula (iJca ) hotA hai| yaha phuphphusa ke agra ( apex ) para na hokara usake pariNAha bhAga meM banatA hai aura isakA sambandha phuphphusavRntayu yA phuphphusadvAra ( hilum ) meM sthita lasagranthiyoM ke yamavikSata ke sAtha hotA hai| yaha vikSata bhI unhIM granthiyoM meM banatA hai jo ghoNavikSatIya bhAga kA lasIya utsAraNa karatI haiN| kyoMki ghoNavikSatakAlIna rogI kI avasthA aisI hotI hai jaba usameM pratIkAritA zakti kA abhAva hotA hai yaha vikSata drutagati se phaila sakatA hai aura usa pradeza kI sampUrNa lasagranthiyoM ko upasRSTa kara sakatA hai / yaha vikSata na to phuphphusa meM vivara nirmANa karatA hai aura na isake kAraNa upasarga kA sthAnasImana (localisation) karane vAlA tantUtkarSa hI ho pAtA hai| yadi jIvANu atyugra hai aura paryApta mAtrA meM praviSTa kiyA gayA hai to roga kA sarvAGgINa prasaraNa (generalised dissemination) hokara rogI kI mRtyu ho jAtI hai| parantu, yadi mAtrA alpa huI aura prAkRtika pratIkAritA zakti usakA pratirodha karane ke lie paryApta huI to vikSata kA ropaNa hone lagatA hai For Private and Personal Use Only

Page #583
516 vikRtivijJAna aura zarIra meM yakSmAvirodhI zakti kA nirmANa honA prArambha ho jAtA hai aura bhAgyavazAt aisA hI prAyaH dekhane meM bhI AtA hai| zaizavakAla meM yakSmA kI thor3I-thor3I mAtrAoM kI prApti zizu yA bAlaka meM yakSmA ke prati pratIkAritA tathA anuhRSatA yA anUrjA meM vRddhi kara detI hai| isI pratIkAritA ke kAraNa hI jo bAlyakAla meM prApta ho jAtI hai Age calakara tAruNyakAla meM maraka gati ( mortality rate) meM kamI A jAtI hai| anuvartI yA dvitIya upasargoM ke kAraNa eka anuhRSa ( sensitised ) vyakti ke phuphphusa meM kAka ghaTanA ( koch's phenomenon ) ghaTA karatI hai| isameM vikSata sadaiva kisI eka phuphphusa ke agra para sthita hotA hai para sthAnIya lasagranthiyA~ upasRSTa nahIM hotii| sthAnika atimRtyu tathA vivarIbhavana ( cavitation ) eka sAmAnya vastu hai| para yahA~ bhI tantUtkarSa dvArA drutagati se ropaNa ho sakatA hai| kozIya pratikriyA aura UtimRtyu anUrjA ( allergy ) ke dvArA hotI hai aura yaha surakSAtmaka kadApi nahIM haiN| vikSata kA eka sthAna para sImita rahanA bahuta mahattvapUrNa hotA hai aura usakA kAraNa pahale upasagoM ke kAraNa avApta pratIkAritA (aequired immunity ) kA zarIra ke pAsa saMcita rahanA hI hai| yadi bAlyakAlIna avApta pratIkAritA adhika hai to dvitIya upasarga para vijaya prApta kI jA sakatI hai tathA usa avasthA meM vikSata kA ropaNa tantUtkarSa dvArA ho jAtA hai para yadi avApta pratIkAritA kama hai to upasarga dabakara gupta ( latent ) ho jAvegA tathA kilATIya zoSa ( caseous phthisis ) kA rUpa dhAraNa kara legaa| dvitIya upasarga kI gati sadaiva jIrNa ( chronic ) rahatI hai| para vikSata tIvra yA sakriya (active ) bhI mila sakate haiN| sakriyatA jisa kAraNa se sambhava hai vaha hai zarIra meM pratIkAritA kA abhAva jisakA artha hai vyakti ko prAthamika vikSata nahIM ho sakA yAnI use bAlyakAla meM yakSmopasarga kA AbhAsa nahIM milaa| isakA dUsarA artha yaha bhI hai ki avApta pratIkAritA zarIra meM saMrakSita rahane meM asamarthatA kA anubhava karatI hai| avApta pratIkAritA kI zakti kI ti meM asamarthatA prAyaH pratilomakSaya meM hI sambhava hai jaba vyakti nirantara zukranAza kara zarIra kI isa pracaNDazakti ke sAtha rogoM ke prati pratIkAraka zArIrika zakti kA vinAza kara detA hai| kucha bhI ho yadi ekabAra bhI zarIra meM yakSmA ke prati pratIkAritA kA janma hA gayA to vaha nissandeha ekabAra tIna aura ugrasvarUpI tayAkramaNa kA bhI sAmanA kara legii| avApta pratIkAritA prApta karane kA gupta rahasya hai ki bAlyakAla meM bahuta se, bahata bAra thor3e-thor3e yacmopasarga ke sAtha bAlaka kA samparka sthApita hone diyA jAya / isase na to phuphphusa meM koI vikSata banegA para yakSmArodhaka zakti avazya bana jaaygii| parantu isa zakti ke sAtha eka durguNa bhI utpanna hotA hai jise hama anUjika hRSakaraNa ( allergic sensitisation ) kahate haiM / yakSmA ke kAraNa jo bhI UtiyoM meM vinAza dekhA jAtA hai vaha anUjika pratikriyA ke dvArA hI hotA hai aisA vidvAn For Private and Personal Use Only

Page #584
.., yakSmA mAnane lage haiN| yahI kAraNa hai ki sabhI jIrNa rogoM meM yaha vinAza eka sA hI rahatA hai| bahuta bar3e parimANa meM upasarga kI mAtrA dene kA pariNAma mRtyu to ho sakatA hai (sarvAGgINa yakSmA hone se ) kyoMki usake kAraNa zarIra kI sampUrNa pratIkAritA zakti samApta ho jAtI hai parantu ye vinAzaka UtIya dRzya nahIM dekhane ko milte|| kAmeTa ne cikitsAtmaka dRSTi se ( therapeutically ) isI AdhAra para yakSmarodhaka zakti utpanna karane ke prayoga kiye haiN| usane jIvita yakSmAdaNDANu kI ugratA ko kama karake usase masUrI ( vaccine ) taiyAra kI hai| usane jisa prakAra kA jIvANu liyA hai use bI. sI. jI. prakAra ( B. C G. strain-bacille cal. mette-guerin strain ) yA daM. kA. gve. ( daNDANu kAmeTa gverIna ) kahate haiM / isa daMkAgve kI masUrI se usane govatsoM kI yakSmA ko dUra kiyA hai aura usI AdhAra para Aja vizva ke vibhinna dezoM meM daMkAgve antaHkSepaNa (bI. sI. jI. ilekzana) cala par3A hai| parantu daMkAgve paddhati ko anya vidvAn abhI taka saMzayAtmaka dRSTi se dekha rahe haiN| isakA prayoga karane se paryApta hAni bhI ho sakatI hai kyoMki isa paddhati se zarIra meM jIvita yakSmAdaNDANuoM kA praveza kiyA jAtA hai| ighara bar3e paimAne para bI. sI. jI. TIke lagAye gaye haiM jinake pariNAma apekSita haiN| tIvra sarvAGgINa yakSmA ( Acute Generalised Tuberoulosis ) yaha eka raktadhArA dvArA prasArita hone vAlA roga hai aura usI samaya prasArita hotA hai jaba atyugra prakAra ke yakSmAdaNDANu bahuta bar3I saMkhyA meM raktadhArA meM svatantratayA vicaraNa karane laga jAveM tathA rogI svayaM anuhRSAvasthA ( susceptible condition ) meM ho| jitanI mAtrA meM yakSmAdaNDANuoM kI isa roga ko utpanna karane ke lie AvazyakatA hai utanI mAtrA manuSyoM meM bAhara se kadApi nahIM A pAtI kyoMki unameM to bAhya vAtAvaraNa se eka sImita mAtrA meM hI daNDANu andara pahu~cate haiM / isa kAraNa tIvra sarvAGgINa yakSmA manuSyoM meM sadaiva uttarajAta ( secondary ) ghaTanA hai jisakI prAthamika nAbhi mAnavazarIra meM pahale se hI upasthita rahatI huI prAyazaH milatI hai| yaha nAbhi udara yA vakSaHsthalI kI kisI lasagranthi meM rahA karatI hai| yaha kilATIya hotI hai| jaba vaha kisI samIpastha raktavAhinI kI prAcIra kA aparadana karatI hai ( erodes ) to raktadhArA meM jIvANuoM kA paryApta praveza ho jAtA hai aura isa prakAra ve sampUrNa zarIra meM bikhara jAte haiN| kabhI-kabhI mukhyA lasakulyA ( thor acio duct ) yakSmopasarga se pIDita dekhI jAtI hai jahA~ se asaMkhya yakSmAdaNDANu sirArakta meM gira kara raktadhArA meM pahu~cate rahate haiN| yaha roga bAlakoM tathA taruNoM kA hai jinameM yakSmA ke virodha ke lie yatheSTa pratI kAritA upasthita nahIM miltii| yaha roga isI kAraNa adhika bhAyuvAle manuSyoM meM nahIM dekhA jaataa| yataH yaha eka rogANuraktatA ( septicaemia ) hai ataH ugrasvarUpa ke 44 vi0 For Private and Personal Use Only

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518 vikRtivijJAna adhika saMkhya jIvANuoM kI rakta meM upasthiti tathA pratIkAritAzakti kI kamI ye donoM bAteM jaba taka pUrI pUrI nahIM hoMgI taba taka yaha roga honA sambhava nahIM hai / jahA~ raktadhArA meM thor3I-thor3I mAtrA meM yacmAdaNDANu pahu~cate haiM tathA jahA~ zArIrika pratIkAritA ucca koTi kI hai vahA~ kevala zAkANuraktatA ( bacteraemia ) hI honA sambhava hai tathA aisI avasthA meM uttarajAta vikSatoM kA nirmANa honA bahuta hI kaThina dekhA jAtA hai / yA to daNDANu mRtyu ko prApta ho jAte haiM yA phira dUrastha bhAgoM meM sthAnasImita upasarga dekhA jAtA hai / kahane kA tAtparya yaha hai ki aisI dazA meM sarvAGgINa upasarga nahIM hotA hai / yaha roga lakSaNoM kI dRSTi se Antrika jvara kI viSaraktatA se milatA julatA hotA hai / pahale kucha dina dhIre-dhIre bar3hatA huA jvara AtA hai jo Age calakara arddhavisargI ( remittent ) ho jAtA hai| jvara ke sAtha meM Arambha meM ziraHzUla tathA zItakampa ( shivering ) bhI hotA hai; Age calakara atyadhika kSINatA, pralApa tathA zrAnti ( exhaustion ) pAI jAtI hai / roga kI prArambhika avasthA meM kisI vizeSa aMga ke prabhAvita hone se utpanna viziSTa lakSaNa dekhane meM nahIM Ate para maraNAsanna avasthA meM mastiSkachadopasarga ke lakSaNa milate haiM aura mRtyu saMnyAsAvasthA ( comatose condition ) meM hotI hai / yaha roga 13 se 3 mAsa taka rahatA hai / mRtyUparAnta parIkSaNa karane para zarIra ke lagabhaga sabhI aMgoM meM yacimakAe~ banI huI aura UtiyoM meM jar3I huI dekhane meM AtI haiN| kevala aicchika peziyA~, stanagranthiyA~ aura avaTukAgranthi meM ve nahIM milatIM / phuphphusoM meM ye yadimakAe~ sarvAdhika milatI haiM / ina yamikAoM meM kucha dhUsara aura kucha pIta varNa kI hotI haiM jo prakaTa karatI haiM ki upasarga kI eka ke pazcAt dUsarI lahareM ( waves of infection ) AtI rahI haiM / ye sampUrNa vikSata pRthak-pRthak ( discrete ) hote haiM tathA unake paMDita hone ke lie Avazyaka samaya na milanA hI isakA kAraNa hai / yakSmA ke sahAyaka kAraNa 1 - vaya tathA liMga - jIvana ke prathama pA~ca varSoM meM jaba ki roga pratIkAritA zakti pUrNataH anupasthita rahatI hai upasarga kI prApti tathA mRtyu kI saMkhyA bahudhA ucca rahatI 1 hai / jyoM-jyoM bAlaka yA bAlikA bar3I hotI jAtI hai usake zarIra meM roganAzaka vijayavAhinI zakti kA udaya hone lagatA hai jisake kAraNa tAruNya meM mRtyusaMkhyA kama rahatI hai| usake pazcAt punaH yaha / apekSA kucha pahale yaha bar3hatI hai meM mRtyu saMkhyA adhika hotI hai; hotI hai / saMkhyA bar3hane lagatI hai / yuvatiyoM meM yuvakoM kI isI kAraNa 20 se lekara 30 varSa taka kI yuvatiyoM puruSoM meM bhAratavarSa meM 36 se 45 varSa taka adhika bAlakoM meM aourasvetrANujanya upasargAdhikya rahane se vikSata phuphphusa meM prArambhika hotA hai / vahA~ se lasagranthiyoM meM hotA huA asthi- sandhiyoM meM pahu~ca jAtA hai aura jise hama zastrayakSmA ( surgical tuberculosis ) kahate haiM jisameM For Private and Personal Use Only

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yakSmA 516 zastrakarma Avazyaka hotA hai vaha dekhI jAtI hai| yaha upasarga sthAnasImita rahatA hai tathA usameM mRtyu kama hotI hai / para jyoM jyoM avasthA bar3hatI jAtI hai vikSata tyoM tyoM phuphphusoM meM hI adhika milane lagate haiM isa kAraNa vayaskoM meM phuphphusa yakSmA jitanI adhika milatI hai utanI anyatra nhiiN| sAtha hI aba yamakavakavetrANu kA mAnavI prakAra ( human type ) isakA kartA hotA hai| phuphphusa yakSmA meM banane vAlA apadravya nigalane se Antra yakSmA kA milanA bhI hotA hai jo kucha kAla bAda dekhA jA sakatA hai yA sAtha sAtha hI vaha mila sakatI hai| 2. pitrAgati-yadyapi mAtA ke aparA dvArA yakSmAdaNDANu garbha taka pahu~ca sakate haiM parantu vaisA bahuta kama dekhA gayA hai ataH apavAdoM ko chor3akara anyatra yaha nahIM dekhI jAtI / jo mAtA-pitA yakSmA se pIDita hote haiM unake putra-putriyoM ko pitrAgati ( heredity ) dvArA upasarga na pahu~ca kara anya upAryoM se pahu~catA huA bahuta adhika dekhA jAtA hai| __3. paryAvaraNa-yakSmA meM prasAra kA pramukha kAraNa bAhya vAtAvaraNa yA paryAvaraNa (environment ) hai jisameM vyakti rahane ko majabUra ho jAtA hai| yakSmA se upasRSTa padArtha sevana karatA hai yakSmotpAdaka prakAza vihIna AI sthAnoM meM yakSmopasRSTa rogiyoM se sAtha rahatA hai aura yakSmA kA zikAra bana jAtA hai| yadi rogI meM pratIkAritA zakti paryApta huI to usake andara roga ke vikSata rahane para bhI vaha svastha dikhatA hai para jyoM hI rasakSaya (anulomakSaya) yA zukrakSaya (pratilomakSaya) ke kAraNa usakI vijayavAhinIzakti samApta huI ki vaha yakSmA se pIDita spaSTataH dIkha par3atA hai| kabhI kabhI sakriya yA niSkriya vikSata bane rahate haiM aura rogI pIDita nahIM dikhatA / barkhArTa ne mRtyUttara parIkSaNoM ke bAda batAyA ki usake pAsa jitane zava 5 se 14 varSa kI Ayu ke Aye unameM eka cauthAI meM yakSmA ke gupta vikSata pAye gaye the| ___ yaha Avazyaka nahIM ki yakSmaparyAvaraNa meM pale sabhI vyakti yakSmA ke zikAra ho / yakSmI mAtA-pitAoM ke baccoM meM yakSmAvirodhI pratIkAritA itanI adhika bhI dekhI jA sakatI hai ki Azcarya ho| isakA kAraNa bAra bAra alpamAtrA meM upasarga prApti ke kAraNa zarIra meM atyadhika avApta pratIkAritA kI upasthiti hI mAnA jAnA caahie| ____ yadi kisI ko gavya yakSmA ho jAve to mAnavI prakAra ke yakSmadaNDANu se pIDita nahIM dekhA jAtA yahI bAta isake viloma ke sambandha meM bhI hai / kyA isakA artha yaha nahIM liyA jA sakatA ki eka prakAra kA yakSmAdaNDANu dUsare prakAra ke viruddha kucha saMrakSaNa karatA hai kyoMki donoM prakAra eka sAtha hote hue prAyaH nahIM dekhe jAte / para yaha saMrakSaNa parihAsa mAtra hI mAnanA ucita hai aura jahA~ taka ho yakSma paryAvaraNa aura yakSmopasarga athavA yakSmApIDitA gAya ke dugdha se prANI kI rakSA karanA parama anivArya hai| yakSmA ke sambandha meM sampUrNa Avazyaka sarvasAmAnya tathyoM ko yogya sthaloM se For Private and Personal Use Only

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520 vikRtivijJAna prApta kara aba hama vividha aMgoM meM isa mahAvinAzaka vyAdhi se hone vAle kuprabhAvoM kA varNana usI prakAra Age kareMge jaisA ki vraNazotha ke sambandha meM kara cuke haiN| asthiyoM para yakSmadaNDANu kA prabhAva [ asthiyakSmA] asthikSaye sthizUlaM dantanakhabhaGgo raukSyaM ca / ( suzruta ) asthanya sthitodaH sadanaM dantakezanakhAdipu / ( vAgbhaTa ) asthikSaya meM Ayurveda asthizUla, dA~ta, nakha aura keza kA patana ho jAnA aura rUkSatA mAnatA hai| atigatayakSmA (Bone tuberculosis) raktadhArA ke dvArA hone vAlA eka roga hai jisakA kAraka bAlakoM evaM taruNoM meM prAyaH gavyakavakavetrANu huA karatA hai| pahale to roga kI nAbhi kisI anya sthala para yA kisI asthisandhi meM banatI hai vahA~ se raktadhArA dvArA upasargakArI jIvANu asthi meM Azraya grahaNa karake isa roga ko utpanna karane meM saphalatA prApta karate haiN| yakSmAdaNDANu dvArA jo vikSata asthi meM utpanna kie jAte haiM ve sabhI vinAzaka ( destructive ) hI hote haiN| isake viparIta asthi phiraMgIya sampUrNa vikSata praguNAtmaka (proliferative ) aura utpAdaka ( productive ) dekhe jAte haiN| tIvra sarvAGgINa yakSmA hone para asthiyoM aura sandhiyoM donoM meM hI zyAmAkasama yakSmikAoM ( miliary tubercles ) kI upasthiti pAI gaI hai| asthiyoM ke chidriSTha ( cancellous ) bhAga meM aura sandhiyoM kI zleSmalakalA ( synovia) tathA upazleSmala UtiyoM meM yaha dekhI jAtI hai| yama-asthi-majjApAka chidiSTha asthi kA jIrNa yakSmaja vraNazotha jisase paryasthi bhI zIghra hI yA vilamba se prabhAvita hotI hai yakSmaasthimajjApAka ( tuberculous osteomyelitis) kahalAtI hai| yaha roga asthiyoM meM nimna sthAnoM meM laga sakatA hai 1. lambI asthiyoM ke agoM ( ends ) para / 2. kazerukAoM ( vertebrae ) meN| 3. pAdakUrcAsthiyoM ( tarsal bones ) meM / 4. maNibaMdhIya ( carpus ) asthiyoM meN| 5. aMgulipasthiyoM ( phalangeal bones ) meN| ina sthAnoM ke atirikta hasta-pAda kI zalAkAoM ( metacarpal and metatarsal bones ) meM tathA paryukAsthiyoM ( ribs ) meM yaha roga bahuta kama dekhA jAtA hai tathA lambI asthiyoM ke daNDoM ( shafts ) meM tathA karoTi kI asthiyoM meM yaha roga bilkula nahIM dekhA jAtA hai / yamaasthimajjApAka kA vikSata sarvaprathama asthi meM nirmita hotA hai paryasthi meM nhiiN| isakI utpatti pahale pahala asthizira (epiphysis) yA upAsthizira For Private and Personal Use Only

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yakSmA 521 ( metaphysis ) meM hotI hai| jisa mArga se yakSmAdaNDANu asthi meM praviSTa huA usake anusAra vikSata kA sthAna asthi meM badala sakatA hai| poSaNI dhamanI aura bAhinIcakra ( circulus vasculosus ) ye do mArga haiN| vAhinIcakra sandhi ke Upara rahatA hai yaha prAyaH sandhikalA ke andara rahatA hai aura usakI zAkhAe~ asthizIrSa taka jAtI haiM kabhI kabhI upAsthizira bhI sandhikalA ke andara rahatA hai aura vahA~ bhI zAkhAe~ pahu~catI haiN| ina rakta kI vAhiniyoM ke sAtha lasIkAvAhiniyoM kI zAkhAe~ bhI rahatI haiM / yadi upasarga sandhi dvArA praviSTa hotA hai to vaha inhIM lasIkA vAhiniyoM dvArA asthizira yA upAsthizira ko jAtA hai aura asthi kA yaha chidiSTha bhAga hI usase prabhAvita hotA hai| kabhI kabhI sandhAyIkAsthiyoM meM yakSmopasarga laga jAtA hai jisake kAraNa vahA~ se sIdhe asthi meM bhI roga kA praveza ho sakatA hai| jaba asthi meM yA asthizira yA upAsthizira meM yakSmAdaNDANu praviSTa ho jAtA hai to sarvaprathama zyAmAkasama ( miliary ) yakSmikAeM utpanna hotI haiM usake cAroM ora viziSTa yakSmakaNanaUti ( tuberculous granulation tissue ) parivArita ( surrounded ) ho jAtI hai| yadi daNDANu kI ugratA bahuta adhika na huI to usake bhI cAroM ora saghana tAntava Uti pariveSTita ho jAtI hai| isI bAhyabhAga meM asthIya daNDikAe~ ( bony trabeculae ) saghanIbhUta ho jAtI haiM aura isa prakSobhaka pratikriyA dvArA asthi ke avakAzoM ko usI prakAra bhara detI haiM jisa prakAra ki kisI mRdula Uti meM tAntava uti bhara jAtI ho |jhaaN vikSata ke bAhara kI ora asthi kA sthUlana calatA rahatA hai vahA~ vikSata ke kendriya bhAga meM asthikRntaka apanA kArya karate rahate haiM aura asthi ko virala karate rahate haiN| unake uttejita hone kA mukhya kAraNa hai raktAdhikyayukta yakSmakaNana uti / isa asthiviralana ko yakSma asthya zanA ( tuberculous caries of the bone ) kahate haiM / isa prakAra kI asthyazanA meM kaNanaUti kA nirmANa atyadhika hotA hai tathA kilATIya UtimRtyu yadi huI to bahuta hI kama dekhI jAtI hai| __parantu yadi tantUtkarSa dvArA upasarga kA sthAna sImita na kara diyA gayA to vaha khUba phailane lagatA hai aura uttarottara bar3hatA calA jAtA hai aura pariNAma usakA kilATIyana meM hI hotA hai / yakSmakaNanaUti tAntavaUti ke kSetra meM bhI phaila jAtI hai aura usakA sthAna le letI hai tathA asthijAraThya ( sclerosis ) jo hotA rahatA hai usakA bhI sthAna le letI hai| isake kAraNa yaha jAraThya kendriya bhAga se kucha dUra para (haTakara) hone lagatA hai| dhIre-dhIre yaha prakriyA asthi ke bAhya dharAtala taka A jAtI hai; jaba aisA hotA hai to asthi ke Upara sthita mRdula utiyA~ bhI upasRSTa ho jAtI haiM jisakA pariNAma yaha hotA hai ki nADIvraNa ( sinus ) bana jAtA hai jisakA mukha tvacA para Akara khulatA huA dekhA jAtA hai| kilATIyana ke kAraNa yadi kisI asthi kA koI Tukar3A gala kara alaga ho jAtA For Private and Personal Use Only

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522 vikRtivijJAna hai to vaha mRtAsthilava ( sequestrum ) kahakara pukArA jAtA hai / prAyaH isa prakAra mRtAsthi ke choTe-choTe lava (Tukar3e ) asthi se pRthak hote rahate haiM / jaba taka yaha prakriyA paryApta tIvra nahIM hogI taba taka adhika bar3e Tukar3e galakara pRthaka nahIM ho sakate / kabhI-kabhI to sampUrNa asthizira taka mRtAsthilava ke rUpa meM gala jAtA hai / Urvasthi ( femur ) kA zIrSa isa prakAra vizIrNa hote hue dekhA gayA hai / mRtAsthi aat kI daNDikAe~ sadaiva sthUlita milatI haiM jo yaha prakaTa karatI haiM ki jIrNa vraNazodhAtmaka kriyA unameM calatI rahI hai / usI kriyA ke bAda meM jo parivartana hote haiN| unhIM se asthi kI mRtyu yA nAza ( necrosis ) hotA hai / kabhI-kabhI mRtAsthilava bahuta mRdula evaM bhidura hote haiM aura unameM viralIbhUta ( rarefied) asthi lagI huI milatI hai / kabhI-kabhI isa viralIbhUta asthi meM bar3he hue rikta avakAzoM kI vastuoM kA cUrNIyana ho jAtA hai / ina saba avasthAoM meM eka vidradhi avazya bana jAtI hai / vidradhi UtinAza ke sAtha bhI ho sakatI hai tathA binA usake bhI dekhI jA sakatI hai / gucchagolANujanya asthimajjApAka se rakSA karane meM jitanA asthizira ( epiphysis ) kArya karatA hai utanA yacamaasthimajjApAka meM kArya nahIM karatA / yakSmA ke jIvANu vinA asthizirastha Uti kA lohA mAne saTAsaTa asthi kI ora bar3he cale jAte haiM / yakSmA asthizirIya paTTa (plate ) kA aparadana karate hue sandhAyIkAsthi taka pahu~catA hai jisase sandhi bhI yamAgrasta ho jAtI hai / kabhI-kabhI pahale sandhi se roga lagakara phira asthi taka jAtA hai / asthi meM upasarga do dizAoM meM bar3hatA hai / eka paryasthi kI ora aura dUsarA asthi kI majjakaguhA ( medullary cavity ) kI ora bar3hatA hai / jyoM hI paryasthipaTTa para yakSmopasarga kA prabhAva par3A ki asthi kI vRddhi hone lagatI hai / paryasthi kI vRddhi ke bhI 2 kAraNa haiM aura donoM hI isakI vRddhi meM uttaradAyI haiM / pahalA yaha ki yakSmakaNanaUti kI vRddhi hone lagatI hai jo paryasthi ke gambhIra staroM meM dekhI jAtI hai / usI ke sAtha sAtha nikulyA ( Haversian canal ) kI bhI vRddhi hotI hai / dUsarA yaha ki paryasthi ke andara raktAdhikya ho jAne ke kAraNa naI asthi kA nirmANa bhI hone lagatA hai / yacama paryasthipAka meM navIna nirmita asthi sadaiva chaSTa huA karatI hai, vaha chidriSTha nUtana asthi prAcInaasthi ke sAtha dRDhatA se Abaddha rahatI hai tathA vaha toraNoM ( arches ) ke rUpa meM jamatI hai / toraNoM ke bhItara ke avakAzoM meM yakSmakaNanaUti bharI rahatI hai / Age calakara isa nUtana asthibhAga ko kilATIyana naSTa kara sakatA hai isa kAraNa vijJatoM ke kinAroM para jahA~ austus viSa ghAtaka prabhAva karane meM asamartha rahatA hai aura kevala prakSobhaka prabhAva mAtra dikhAtA hai vahA~ yaha acche prakAra se pragaTa hotI hai / sAdhAraNataH ina sampUrNa avasthAoM meM eka yakSmavidradhi bana jAtI hai jisase eka nADIvraNa cala par3atA hai jisakA eka mukha asthi ke andara rahatA hai aura dUsarA bAhya tvacA para khulatA hai / For Private and Personal Use Only

Page #590
yakSmA yakSmAGguliparvasthipAka (Tubrculous dactylitis ) yaha bhI yaha asthimajjApAka kA prakAra hai / yaha kisI aGguliparva ke asthidaNDa ( shaft ) meM dekhA jAtA hai / isake hone para aGguliparva meM prasarazotha ( diffuse swelling ) ho jAtI hai / parvasthi kA vinAza aura paryasthIya nUtana asthi kA kA vikAsa hotA hai / nUtanAsthinirmANa ke kAraNa hI parva sUja jAtA hai / jo vikRti sUcaka parivartana anyatra isa roga meM dekhe jAte haiM ve hI saba yahA~ bhI hote haiM / kabhI kabhI sahaja phiraMgiyoM ke aGguliparvoM meM jo sUjana hotI hai vahI ise mAna liyA jAtA hai kyoMki donoM ke naidAnika lakSaNa eka sadRza dekhane meM Ate haiM / asthyazanA sAdhAraNI yaha yakSma asthi- paryasthapAka kA eka virala udAharaNa hai / yaha prAyaH aMsasandhi ( shoulder joint ) meM vizeSa karake bAhrasthi zIrSa ( upper end of the humerus ) para dekhI jAtI hai / isameM prAcIna asthi kA viralana aura paryasthi se nUtanAsthi kA nirmANa nAmaka donoM kriyAe~ hotI haiM / isameM kilATIyana aura taralana nAmaka donoM kriyAe~ nahIM hone ke kAraNa hI ise asthyazanA sAdhAraNI ( caries sicca ) nAma diyA gayA hai| isa roga meM kaNana Uti tanvita ( fibrosed ) ho jAtI hai, asthikSaya aura asthipracUSaNa paryApta hotA hai| sAtha meM samIpastha mRdula bhAgoM kA bhI kSaya hotA hai / 523 kazerukIya yakSmA [ pauTAmaya ] yaha eka zaizavakAlIna roga hai jo prAyaH 6 varSa aura usase nIce ke zizuoM meM milatA hai / yakSmavikSata kazerukA ( vertebra ) ke piNDa ( body ) meM yA donoM meM se kisI eka asthizira paTTa ( epiphyseal plate ) meM milatA hai / isameM eka se adhika kazerukA prabhAvita hotI haiM / viralana ( rarefaction ), kilATIyana tathA taralana ye tIna prakriyAe~ hotI haiM / kazerukA ke bAhupravardhanaka ( transeverse processes of the vertebra ) tathA sandhipravardhanaka ( articular processes of the vertebra ) para yakSmA kA prabhAva dekhane meM nahIM AtA hai / antarkazerukIya bimba ( intervertebral discs ) asthi ke samAna hI vinaSTa ho jAtI haiM / For Private and Personal Use Only yataH suSumnAstambha yA pRSThadaMDa ( spinal column ) para hI sampUrNa zarIra kA bhAra sadhA huA hai ataH isake kisI kazerukA ke vinAza kA artha virUpatA ( deformity ) meM hotA hai| yaha virUpatA koNIya vakratA (angular curvature) nAmaka hotI hai tathA koNa kI noka pazcamukhI ( pointing posteriorly ) hotI hai / isa vakratA ke kAraNa suSumnAkANDa saMpIDita ( compressed ) nahIM hotA / parantu kaNana aft kI adhikatA tathA pazcasnAyu meM yakSmapUya kI atyadhika saJciti ke kAraNa suSumnA kA saMpIDana ho sakatA hai / suSumnA ke saMpIDita hone kA pariNAma yaha hotA hai ki vikSata ke nIce ke bhAgoM dvArA pUrta aMgoM kA ghAta ho jAtA hai aura kabhI-kabhI to

Page #591
524 vikRtivijJAna I adharAGgaghAta ( paraplegia ) ho jAtA hai / parantu jyoM hI saMpIDana dUra hotA hai ye sabhI ghAta ThIka ho jAte haiM / vikSata ke sthAna ke anusAra yacmapUya tvacA para vibhinna sthAnoM para prakaTa huA karatA hai / aurasa bhAga meM to yaha phuphphusacchada meM bhI praveza kara sakatA hai yA pazukIya paryasthi ke sahAre - sahAre calakara uras ke agrabhAga meM bhI dekhA jA sakatA hai / kaTipradeza meM yaha pUya kaTilambinIpezIkaMcuka ( sheath of psoas_muscle ) meM hotA huA vaMkSaNapradeza ( groin) meM jA sakatA hai aura bhI nIce jAnupRSTha ( popliteal space ) taka pahu~ca sakatA hai / jaivika bhAga meM eka pazcagrasanI vidradhi ( retropharyngeal abscess ) bana sakatA hai yA grIvA pArzva meM eka nADIvraNa dekhA jA sakatA hai / vidradhi phUTane para nADIvraNa bhale prakAra dekhA jA sakatA hai / yamavidhi kI ropita na hone kI pravRtti hotI hai / dUsare isameM pUyajanaka jIvANuoM kA uttarajAta upasarga bhI ho jAtA hai / jaba kazerukIya vikSata ropita ho jAtA hai to prabhAvita kazeruka svastha bhAgoM se jur3a jAte haiM tathA vahA~ gati sthairya ( ankylosis ) ho jAtI hai / 1 Acharya Shri Kailassagarsuri Gyanmandir aresoN meM bhI yaha roga jaba hotA hai to vaha kazerukAoM ke agrabhAgoM kI ora hotA hai / asthiyoM kA atisvalpa aparadana hone se ve kRmidaSTa (worm eaten ) sI lagatI haiN| isakI virUpatA isa kAraNa koI khAsa nahIM hotI kyoMki vikSata adhika vistRta nahIM dekhA jAtA / asthi meM yakSmA hone para taba taka usakA patA nahIM calatA jaba taka ki paryasthi bhI prabhAvita na ho kyoMki zUla aura zotha ye donoM paryasthi meM adhika hote haiM / gambhIra asthiyoM meM kabhI-kabhI yakSma vidhi bahuta kAla taka banI rahatI hai aura jaba paryastha taka usakA prabhAva pahu~catA hai taba jJAta hotA hai ki koI vikAra asthi meM huA hai / asthi ke vita vaise svayaM ropita hone ko pravRtti rakhate haiM para jaba ve bAra-bAra upasRSTa ho jAte haiM to vahAM vimedAbha roga yA zyAmAkasama yakSmA ke lakSaNa hokara tatkAla mRtyu taka ho jA sakatI hai / vividha asthiyoM meM isa roga meM anya sthAnika vividha lakSaNa bhI dekhe jA sakate haiM / ( 2 ) sandhiyoM para yakSmadaNDANu kA prabhAva [ sandhiyakSmA ] asthisandhiyoM ( bony joints ) para yakSmAdaNDANu kA usI prakAra prabhAva par3atA hai jisa prakAra anya pUyajanaka jIvANuoM kA par3atA hai / bAlakoM aura vayaskoM meM do bhinna rIti se sandhiyakSmA hotA hai / arthAt bAlakoM meM pahale kisI samIpastha asthi meM yakSmA hokara phira vahA~ se sandhi meM pahu~catA hai / vayaskoM meM upasarga jaba rakta dhArA meM hotA hai to vahA~ se sandhi kI zleSmalakalA meM Akara sImita ( localised ) ho jAtA hai / For Private and Personal Use Only

Page #592
yakSmA 525 isa prakAra 2 prakAra ke upasarga hameM, sandhigata yakSmA ke dekhane ko milate haiM eka vaha jisameM samIpastha asthi meM upasthita yakSmAnAbhi se upAsthizira ( metaphysis ) ko phor3a kara upasargakArI daNDANu sandhizleSmalaguhA ( synovial cavity ) meM cale AveM / yaha prakAra bahuta karake dekhA jAtA hai / bAlaka aura yuvaka sabhI isI ke kAraNa prAyaH vyathita hote haiN| inakI vaMkSaNasandhi ( hip joint ) meM pahale pahala yaha roga dekhA jAtA hai usake pazcAt gulpha sandhi ( ankle joint ) kUparasandhi ( elbow joint ) tathA aMsasandhi ( shoulder joint ) meM dekhane meM AtA hai / bAta yaha hai ki bAlakoM meM vaMkSaNasandhistha urvasthi kA asthizira anasthIyita ( unossified ) hotA hai jo yakSmadaNDANuoM kA pratirodha karane meM pUrNataH azakta hone ke kAraNa ve vaMkSaNasandhi meM saralatApUrvaka praviSTa ho jAte haiN| kabhI-kabhI asthigata yakSmavidradhi asthizira meM hokara sandhi meM sahasA phUTa par3atI hai aura yakSma padArtha bahuta bar3I mAtrA meM sandhi meM praveza kara detA hai| isase rogI jvarayukta ho jAtA hai tathA use vedanA hone lagatI hai| aisI sandhi ko 'tIvra yakSmasandhi' (acute tuberculous joint ) kaha kara pukArate haiN| _dUsarA prakAra jisameM upasarga asthi se na Akara sIdhA raktadhArA se AtA hai aura sandhi meM sandhi ke cAroM ora sthita vAhinI valaya ( circulous vasculosus ) ke rakta dvArA sandhizleSmalaguhA meM Thahara jAtA hai| yaha prakAra bahudhA vayaskoM, prauDhoM tathA vRddhoM meM dekhA jAtA hai / yaha prAyaH jAnusandhi ( knee joint ) meM vizeSa karake hotA hai| yaha upasarga pahale kI apekSA saumyasvarUpa kA hotA hai| isameM sandhikalA meM sidhmika sthaulya (patchy thickening ) dekhI jAtI hai isa kAraNa ise 'konigagranthikasandhikalIya yakSmA' ( konig's nodular synovial tuber. culosis) kahA jAtA hai / koI bhI prakAra ho prAyazaH roga kA Arambha zanaiH zanaiH hotA hai jahA~ roga asthi ke pazcAt hotA hai vahA~ yaha aura dhIre dhIre banatA hai kyoMki vahA~ pahale se hI zUla hotA rahatA hai, mAMsakSaya hotA rahatA hai, saumya sandhi lApAka hotA hai tathA thor3A utsyandana ( effusion) pAyA jAtA hai jaba taka ki vAstava meM yakSmasandhipAka hotA hai / upasarga ke sandhi meM pahu~cane para prArambha meM tarkurUpa zotha (fusiform swelling ), sandhi-gati kA parisImana ( limitation ) tathA vedanA ye tIna lakSaNa pramukhatayA dekhe jAte hai sandhigati ke parisImana se prAramma meM kucha sandhi kI surakSA ho jAtI hai| zUla kA pradhAna kAraNa sandhAyIkAsthi kA aparadana hai| yadi gati kama hogI to zUla bhI kama hogA, gati adhika hone para zUlAdhikya hotA hai| Age calakara jaba roga bahuta bar3ha jAtA hai to snAyuoM ( ligaments ) ke TUTa phUTa jAne tathA sandhAyIkAsthiyoM ke vinAza se sandhi vidUSita ho jAtI hai tathA usakI gati meM antara A jAtA hai / sandhi vicyuti (dislocation) prAyaH mila jAtI hai| For Private and Personal Use Only

Page #593
526 vikRtivijJAna sandhikalA meM nimna parivartana sandhigata yakSmA hone para milA karate haiM : 1. zyAmAkasama tIvrayakSmA-jaba asthizira ko phor3a kara drutagati se sandhAyIkAsthiyoM meM hokara upasarga sandhiguhA meM praveza karatA hai| isake kAraNa mahApuMja upasarga ( massive infection ) dekhA jAtA hai| tIvra sarvAGgINa yakSmA ke kAraNa sandhikalA adhiratIya ( hyperaemic ) ho jAtI hai aura usameM aneka tudra zyAmAkasama yacimakAe~ jur3I huI dekhI jAtI haiN| 2. prasarasthaulya yA zvetArbudikA ( tumor albus )-yaha eka prakAra kI zveta varNIya sUjana hai jo prAyaH dekhI jAtI hai isI kA eka prakAra prArbudikA sandhikalApAka ( synovitis tuberosa ) kahalAtA hai| 3. lasya utsyandana ( serous effusion ) ise udasaMcaya ( bydrops ) bhI kahate haiN| prasarasthaulya ( diffuse thickening ) hone kA mukhya kAraNa upasandhikalIya UtiyoM meM yacimakAoM kA utpanna ho jAnA tathA sandhikalA kI jhallaroM ( firinges ) meM bahuta adhika adhiraktatA honA yA mAnanA caahie| Upara se sandhi kholakara dekhane para ye yadimakAe~ dikhalAI nahIM detIM para yadi sandhikalA ko bhI kATa diyA jAve to usake nIce kI UtiyoM meM yacimakAe~ pAI jAtI haiN| sandhikalApuMja ( synovial masses ) mRdula tathA dRr3ha do prakAra kA ho sakatA hai| mRdula taba hogA jaba usameM zliSIya vihAsa ( myxomatous degeneration ) ke lakSaNa pAye jAveMge / dRDhatA usameM taba AvegI jaba usake andara tAntavaUti bar3ha jaavegii| jyoM jyoM upasarga bar3hatA calatA hai ina Uticayita puMjoM meM kilATIyana prAraMbha ho jAtA hai / kilATIyana ke uparAnta taralana hotA hai / yadi kucha adhika dina se sandhi meM yakSmA kA praveza huA taba to usameM yakSmapUya ( tuberculous pus ) mila sakatA hai parantu sAdhAraNataH sandhi meM sandhizleSmA kI bahuta mAtrA dekhI nahIM jAtI para usakI jo zvetavarNIya sUjana dekhane meM AtI hai usakA eka kAraNa sandhikalA kA paramacaya hai aura dUsarA kAraNa parisandhIya mRdula UtiyoM meM upasarga kA pahu~ca jAnA hai jisake kAraNa kabhI kabhI zItavidradhi ( cold abscess ) taka bana jAtA hai| sandhikalA ke Upara kabhI kabhI tansvi jama jAtI hai jo bAda meM TUTa jAtI hai usakI AkRti kharabUje ke bIja jaisI ho jAtI hai aise dazAGgalIya bIjAkArI piNDa ( melon-seed - bodies ) sandhiguhA meM par3e hue bahuta dekhe jAte haiN| ye piNDa yakSma sandhikaNDarApAka ( tenosinovitis ) meM bahudhA milate haiN| Age calakara yamasandhipAka meM roga kA AkramaNa sandhAyIkA sthi (articular cartilage ) para hotA hai| yadi asthizirIya aparadana ke kAraNa sandhi meM yakSmopasarga huA hai to yaha kAsthi donoM ora se upasargAnvita ho jAtI hai| aisI avasthAoM meM sandhAyIkAsthi ke asthIya dharAtala para aparadana ( erosion ) eka For Private and Personal Use Only

Page #594
yakSmA 527 atyadhika raktAnvita kaNana Uti ke dvArA hotA hai / maje kI bAta yaha hai ki yaha kaNana Uti yakSmA kI sAdhAraNataH autikIya racanA ko prakaTa nahIM krtii| isa kaNana Uti kI kRpA se becArI sandhAyIkAsthi apane sthAna se yA to choTe-choTe zalkoM ( flakes ) meM yA eka hI khaNDa ( piece ) meM ukhar3a jAtI hai| kAsthi ke sandhAyI dharAtala kI ora sandhikalA se Akara yahI kaNana ati phaila jAtI hai aura usakA aparadana prArambha kara detI hai jisase usameM sthAna-sthAna para aneka gartikAe~ (pits) bana jAtI haiM / ina sabakA eka hI artha hai aura vaha yaha ki sandhAyIkAsthi cakanAcUra (chinna-vicchinna) ho jAve aura usakA sthAna kaNanaUti le le| vahI hotA hai jisake kAraNa sandhi meM asthi anAvRta (exposed ) ho jAtI hai| yaha vinAzaka kriyA yahIM nahIM rukatI balki yaha khule hue asthibhAga viralita asthipAka ( rarefying, osteitis ) ho jAtA hai aura phira aparadana hokara asthimuNDa kA pUrNataH vinAza ho jAtA hai aura asthimuNDa vilupta ho jAtA hai| isa vinAzakAla kI ghorAvasthA Ane ke pUrva eka bAta yaha ho sakatI hai ki atyadhika kilATIyana ke dvArA yaha kaNana uti naSTa kara dI jaave| usa dazA meM aparadana kA kArya kucha vilamba se hotA hai| isa uparokta vinAzalIlA meM asthirajjuoM yA snAyuoM ( ligaments ) ko bhI apanA abhinaya karanA par3atA hai| unakA mRdubhavana hone lagatA hai jisake kAraNa ve khiMca jAte haiM aura thor3e samaya bAda TUTa jAte haiM jisake kAraNa sandhi vicyuti (displacement) ho jAtI hai| isakA eka udAharaNa jAnusandhi kI vicyutitrayI ( triple displacements of knee joint ) meM dekhA jAtA hai| yaha vicyuti taba hotI hai jaba jAnusvastikA snAyu ( crucial ligaments ) kA vinAza ho jAtA hai| isameM jAnusandhi AsaMkucita ho jAtI hai jaMghAsthi ( tibia) pazcabhAga kI ora vicyuta ho jAtI hai tathA usakI antardhAnti ( internal rotation) ho jAtI hai| ___ grIna kI dRSTi meM utsyandana ke kAraNa sandhi meM udasaMcaya ( hydrops ) bahuta adhika nahIM dekhA jaataa| sandhikalA ke paramacaya ke sAtha vaha utanA nahIM dekhA jAtA jaisA yakSma udaracchadapAka kAla meM jalodara ke rUpa meM dekhA jAtA hai| jo bhI tarala sandhiguhA meM ekatra hotA hai vaha yakSma prakAra kA vraNazothAtmaka srAva ( infla. mmatory exudate of the tuberculous type ) mAtra hai jaisA ki kisI bhI lasyakalA meM yakSmopasarga ke kAraNa anyatra dekhane meM AtI hai| kabhI-kabhI sandhi para eka zItavidradhi utpanna ho jAtI hai| jisameM bahuta adhika yakSmapUya hotA hai jisake kAraNa sandhi khUba tana jAtI hai| anya vidvAnoM kA mata yaha hai ki sandhi-yakSmA kI 3 avasthAe~ hotI haiM1-utsyandanAvasthA ( the stage of effusion) For Private and Personal Use Only

Page #595
528 vikRtivijJAna 2-kAsthinAzAvasthA ( the stage of invasion of cartilage and joint cavity ) 3-sandhivighaTanAvasthA ( the stage of destruction of the liga. ments and capsule with disorganisation of the joint), utsyandanAvasthA meM upasarga kevala sandhikalA taka hI sImita rahatA hai tathA sandhikalA mulAyama tathA kaNanaUtiyukta hotI hai| sandhi meM zUla tathA pezyAkSepa ( muscle spasm ) adhika nahIM rahatA parantu peziyoM kI tAna (tone ) meM kabhI AjAtI hai, ve kucha zlatha (flabby) ho jAtI haiM aura unakA zoSa (wasting) hone lagatA hai| isake kAraNa unakI kriyAzakti sImita ho jAtI hai jisase sandhi kI gati kama ho jAtI hai yadyapi gati karane meM koI zUla nahIM hotA aura ve sabhI dizAoM meM hotI haiM para kamI ke sAtha hotI haiN| yaha avasthA vayaskoM meM dekhI jAtI hai jahA~ upasarga rakta dvArA AtA hai aura bahuta kAla taka rahatI hai / kAsthinAzAvasthA tathA sandhiguhA meM yakSmapraveza kI avasthA vaha hai jaba asthizira tor3akara yacmopasRSTa sAmagrI sandhiguhA meM pha~sa par3atI hai jisameM kAsthi phUTa jAtI hai aura yacamakaNana Uti donoM ora se use naSTa karane kA bIDA uThAkara cala par3atI hai| isa avasthA meM thor3I sI gati karane se hI bhayaMkara zUla hotA hai isake kAraNa atyadhika pezyAkSepoM dvArA sandhi acala ( immobile ) banA dI jAtI hai| thor3I bhI gati ke kAraNa bijalI kI camaka ke samAna zUla prArambha hotA hai| isa zUla ko 'vidyucchUla' vidyut vat zUla ( starting pain ) kaha sakate haiM / isa avasthA meM pezIkSaya khUba hotA hai, sandhi ke cAroM ora lagI peziyoM meM jo pezI samUha adhika balavAn hotA hai usa ora kI sandhi jhuka jAtI hai aura eka virUpa sthiti ( deformed position ) le letI hai| parantu isameM aMga choTA nahIM pdd'taa| sandhiguhA meM kaNana Uti yA kilATIya yakSmapUya bharA huAra hatA hai / sandhivighaTanAvasthA meM sandhi meM lage snAyu aura usakA prAvara ( capsule ) naSTa ho jAtA hai sandhisthala virUpa ho jAtA hai tathA choTA par3a jAtA hai| adhika balazAlI pezI samUha kI aura asthiyA~ vicalita ho jAtI haiN| sandhiguhA abhilupta ho jAtI hai usameM kaNanaUti tathA kilATIya Uti bhara jAtI hai| ___ yakSmasandhipAka kA ropaNa cAhe usakI koI bhI avasthA A gaI ho ho sakatA hai aura yaha ropaNa tAntava Uti ke dvArA hI hotA hai / yadi roga hote hI usakI rokathAma kara lI gaI to sandhi kI gati barAbara jArI raha sakatI hai aura usakA virUpa bhI nahIM hotaa| para yadi paryApta kAla bAda jaba ki saMdhAyIkAsthiyA~ vinaSTa ho cukI ho aura sandhiguhA (abhiluptaprAya ho sandhi ko usake prakRta kArya ke anurUpa banAnA atyadhika kaThina hotA hai| aise avasaroM para sandhisthala para DaTa kara tantUrakarSa hotA hai jo tAntava asthisandhAna ( fibrous ankylosis) kara detA hai jisake kAraNa sandhi kI gatiyA~ ghaTa jAtI haiM yA samApta ho jAtI haiM aura vaha apanI prakRtakriyA sampanna For Private and Personal Use Only

Page #596
yadamA 526 karane meM asamartha ho jAtI hai| yadi sandhiguhA se tvacA taka koI nADIvraNa bana jAve aura usameM hokara pUyajanaka jIvANusandhi meM praveza kara leM to usake kAraNa asthIya sandhAna (bony ankylosis) hokara sandhi pUrNataH sthira ho jAtI hai / vinA vAstavika pUyotpatti ke asthIyasandhAna asambhava hai| yaha kabhI na bhUlanA cAhie ki asthi-sandhIya yakSmA yadi sarvAGgINa zyAmAkasama yamA ke kAraNa huI hai to mRtyu ho jA sakatI hai| sarvasAmAnya vimedAbhIya vihAsa (generalised amyloid degeneration ) hokara bhI mRtyu ho sakatI hai para vaha bahuta kama hotI hai| (3) yakSma parihRtpAka yaha bahuta adhika hone vAlA roga nahIM hai| yakSmazAkANuraktatA ( tuberculous bacteraemia ) ke kAraNa yA phuphphusAntarAlIya lasagranthiyoM se prasAra karake parihRt ( pericardium ) meM pahu~catA hai| anya lasya yakSmopasargoM kI bhA~ti yaha AI ( wet ) yA zuSka ( dry ) koI bhI rUpa le sakatA hai| AI meM yakSma utsyandana milatA hai tathA zyAmAkasama yadimakAe~ dekhI jA sakatI haiM tathA zuSka meM tantvimat abhilAga (fibrinous adhesions ) milate haiM jo Age cala kara pUrNataH tAntava ho sakate haiN| jo utsyanda hotA hai vaha pUrNataH svaccha bhI ho sakatA hai, kabhI-kabhI Avila bhI ho sakatA hai, kabhI usameM thor3A rakta bhI dekhA jA sakatA hai aura kabhI pUrNataH raktamaya bhI ho sakatA hai| yakSma dhamanyantazchadapAka yakSmA meM do prakAra ke vAhinyavikSata (vascular lesions) dekhane ko mila sakate haiM / eka vaha jisameM bAhara se vAhinIprAcIra para kaNanaUti AkramaNa karake vAhinIprAcIra ko vidIrNa karake usake bhItara bar3hatI huI usake upAntazcola ( sub intima ) meM eka yacimakA utpanna kara detI hai jo kAlAntara meM bar3hatI huI eka samaya vAhinI ke bhItarI bhAga meM phaTa jAtI hai jisake kAraNa yakSmopasargasaMsRSTa bahuta sA apadravya raktadhArA meM mila jAtA hai| isa prakriyA ke kAraNa vAhinIprAcIra bahuta durbala ho jAtI hai aura usameM sirAjagranthi (aneurysm) utpanna hotA huA dekhA jA sakatA hai| aisI sirAjagranthi phuphphusastha vAhiniyoM meM utpanna ho sakatI hai jisake vidIrNa hone se gambhIra raktasrAva hotA huA dekhA jA sakatA hai| dUsarA vaha jo kisI yamavikSata ke samIpa vAstavika praguNanAtmaka antazchadapAka ( true proliferative endarteritis ) rUpa meM dekhA jAtA hai aura jise hama abhilopI antazchadapAka (obhterative endarteritis) - 45,46 vi0 For Private and Personal Use Only

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530 vikRtivijJAna ke nAma se jAnate A rahe haiN| isameM dhamanI ke antazchada meM prakSobha ke kAraNa atighaTana (paramacaya-hyperplasia) hone lagatA hai jisake uparAnta tantUtkarSa hotA hai isake kAraNa vAhinI supiraka pUrNataH banda ho jAtA hai yA usameM koI rakta kA AtaMca baiTha jAtA hai aura usake dvArA hone vAlI rakta pUrti roka detA hai| yaha vikAra aneka jIrNa aupasargika rogoM meM dekhA jAtA hai| isa abhilopI antazchadapAka kA yakSmA meM bar3A mahattvapUrNa sthAna hai| bAta yaha hai ki yakSmopasarga aba UtiyA~ ko mRdu kara detA hai| yadi dhamanI kA abhilopI antazchadapAka pahale se nahIM huA to yakSmA usa para bhI apanA prabhAva kara sakatI hai aura pahale prakAra kA antazchadapAka hokara sirAjagraMthi utpanna ho sakatI hai| para yadi abhilopI antazchadapAka yakSmavikSata ke samIpa ho gayA to koI kAraNa nahIM ki vAhinI meM prathama prakAra kA antazchadapAka ho aura yadi huA bhI to vahA~ sirAjagranthi nahIM bana sakatI / isI kAraNa phuphphusagata yA Antragata yakSmA meM atyadhika raktasrAva se saMrakSaNa pAne ke lie antazchadapAka eka varadAnasvarUpa prathA hai jisake kAraNa rogI sirAjagranthi ke vidAraNa se utpanna raktasrAva dvArA zIghra hI hI na mara kara kucha adhika kAla taka jI sakatA hai jisameM yogya cikitsA ko paryApta avasara rahatA hai| (5) yakSma lasagranthipAka yaha lasagranthipAka (lymphadenitis ) sadaiva jIrNa ( chronic ) prakAra kA hotA hai / yakSmopasarga prAyaH lasagranthiyoM ko lasadhArA dvArA prApta hotA hai| isa roga meM lasagranthi ke bAhyaka ( cortex ) meM kSudra, pANDura, dhUsara, yadimakAe~ utpanna ho jAtI hai jo zanaiH zanaiH bar3hatI haiM unameM kilATIyana ho jAtA hai jo upasarga ko granthi ke majjaka ( medulla ) taka le jAtA hai| jaba upasarga bAhyaka aura majjaka donoM bhAgoM meM pahu~catA hai to isake kAraNa granthikA AkAra bar3hane lagatA hai| mahAkozA prakAra kI jo autikIya citra ( histological picture ) anyatra dekhane meM AtA hai vaha yahA~ yakSmA meM pUrNataH milatA hai arthAt jAlakAntazchadIya paramacaya yahA~ DaTa kara hotA hai jisake sAtha parigranthipAka (periadenitis) kilATIyana, cUrNIyana tathA taralana kI kriyAe~ bhI calatI hai| eka dUsarA prakAra bhI yakSmalasagranthipAka kA dekhA jAtA hai jisameM mahAkozAdi kA nirmANa nahIM hone pAtA aura na kilATIyana hI hotA hai| yaha prakAra bahuta kama milatA hai aura ise praguNanAtmaka ( Proliferative ) prakAra kaha sakate haiM kyoMki isameM antazchadIya kozAoM kA paramacaya yA praguNana bahuta hotA hai| paramacayita ina kozAoM ke samUha granthi ke andara aneka dvIpikAe~ ( islets ) banA lete haiN| __yakSmopasarga ke kAraNa praivika ( cervical ), AntranibandhanIka (mesenteric) tathA phuphphusAntarAlIya ( mediastinal ) lasagranthiyA~ atyadhika prabhAvita hotI haiM / graivika granthiyoM meM tuNDikA granthiyA~ ( tonsillar glands )mukhya haiM / Antrani For Private and Personal Use Only

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yakSamA 531 bandhanIka aura graivika granthiyoM meM gavya yakSmakavakavetrANu dvArA prathama upasarganAbhiyA~ banAI jAtI haiM aura isa kAraNa bAlakoM meM yakSmopasarga hone para ve bahudhA phUla jAtI haiN| bhArata meM dugdhapAna kI prathA vibhinna hone se hamAre yahA~ praivika aura Antra nibandhanIka granthiyoM meM bhI upasarga mAnavI prakAra ke yakSmakavakavetrANu dvArA hI hotA huA dekhA jAtA hai isI kAraNa yahA~ ve na kevala bAlakoM meM hI api tu vayaska strIpuruSoM meM bhI prabhAvita prAyaH milatI hai| phuphphusAntarAlIya lasagranthiyoM para mAnavI prakAra dvArA hI vikSata banAe jAte haiN| prArambha meM jaba upasarga lagatA hai to lasagranthiyA~ dRDha aura pRthaka pRthaka rahatI haiM / Age calakara jaba parilasagranthipAka ( periadenitis ) hotA hai to pranthiyoM ke prAvara ( capsules ) phUla phUla kara eka dUsare se mila jAte haiN| Age jaba ina pranthiyoM meM taralana hotA hai to tarala sthAna banAkara tvacA taka A jAtA hai aura eka zItavidradhi utpanna ho jAtI hai| usake phUTane para eka nADIvraNa bana jAtA hai jisakA ropaNa honA atyanta kaThina kArya hotA hai| usa nADIvraNa meM pUyajanaka jIvANuoM dvArA uttarajAta upasarga lagane se vahAM para pUyotpatti bhI ho jAtI hai / ____ audarika yakSmA meM AntranibandhanIka granthiyoM meM upasarga ke kAraNa AntranibandhanIkakArya ( tabes mesenterica ) utpanna hotA hai jisake sAtha eka jIrNa vyAdhi laga jAtI hai jisake kAraNa raha raha kara vamI hotI aura tIvra daure par3ate haiM aura aisA lagatA hai ki mAno pUyajanaka jIvANujanya udaracchada kA tIvropasarga ho gayA ho| ____ yakSma tuNDikApAka bahudhA nahIM dekhA jAtA yadyapi gavyakavakavetrANu kA prAthamika praveza inhIM granthiyoM meM hokara hotA hai| micaila kA kathana hai ki usane graivika lasagranthiyoM ke yakSmopasarga se pIDita 30 pratizata vyaktiyoM meM yadama tuNDikApAka ( tuberculous tonsillitis ) dekhA hai| yakSmasvarayantrapAka ___ yakSmasvarayantrapAka (tuberculous laryngitis yA laryngeal phthisis) phauphphusika yakSmA ke pazcAt hone vAlA uttarajAta roga hai aura usakA kAraNa yasmopasRSTa ThIva hotA hai| yaha roga upaadhicchadIya yadimakAoM ke rUpa meM prArambha hotA hai jo ghATikA adhijibikIya baliyoM ( ary taeno-epiglottic folds ), svaratantrI (vocal cords ) tathA adhijihvA ( epiglottis ) ke adhastala para banatI haiN| inakI saMkhyA alpAdhika kucha bhI ho sakatI hai| inakA yA to vaNana hotA hai yA ye prasara bharamAra karatI haiM jisake kAraNa ghATikA adhijitikIya bali meM eka pArzva para nAzapAtI ke samAna eka bar3I phailI huI sUjana dekhI jAtI hai| jaba ye vikSata kilATIyana karake vraNa meM pariNata ho jAte haiM to svara rUkSa ( husky ) ho jAtA For Private and Personal Use Only

Page #599
532 vikRtivijJAna hai aura bolane meM kaSTa hone lagatA hai| Age calakara vraNoM para pUyajanaka jIvANu apanA adhikAra jamA kara khUba pUyotpatti karate haiM aura vidhi banAte haiM usase kAsthiyoM kI UtimRtyu ho jAtI hai tathA yadi pUya zvasana ke sAtha phuphphusa meM calA gayA to zvasanaka bana jAtA hai aura mAra DAlatA hai| zvAsanalikA yA klomanalikA meM bhI upa adhicchadIya yadimakAe~ bana sakatI haiM jo upariSTa bhAga meM kSudra hotI haiM para gaharAI meM hone para bahuta vistRta ho sakatI haiM unameM bhI vaNana aura pUyajanaka upasarga laga sakatA hai| (7) phuphphusa para yakSmadaNDANu kA prabhAva [phauphphusika yA phuphphusayakSmA ] (Pulmonary Tuberculosis ) yamA ke sambandha meM sAdhAraNatayA jo pahale likhA jA cukA hai ho sakatA hai ki isa prakaraNa meM usakI kucha punarAvRtti ho jAve parantu phuphphusa meM yakSmA kA jo mahatva pUrNa sthAna hai use vyakta karanA hamArA pahalA uddezya hai| upasarga kI rIti-yamAdaNDANu kisa rIti se phuphphusoM meM pahu~catA hai isake sambandha meM aikamatya nahIM hai / eka prANI ko hama prayogAtmaka rUpa se tvacA ke dvArA upasRSTa kara sakate haiM, zvasana ke dvArA bhI vaha yakSmA kA zikAra bana sakatA hai aura mukha dvArA antargrahaNa karake bhI kSaya se pIr3ita kiyA jA sakatA hai| inhIM saba prakAroM se yA vidhiyoM se eka manuSya bhI yakSmA se saMtrasta hotA hai para yaha kahanA ki kauna vidhi adhika mahatva rakhatI hai kaThina hai| ___upasarga sahaja ( congenital ) bhI ho sakatA hai aura bvAyaDa kA vizvAsa hai ki aisA avazya hotA hai para kyA vaha puruSa ke zukradvArA hotA hai isake sambandha meM pazcimI dezoM ke vidvAnoM ke pAsa eka bhI udAharaNa nahIM hai| hA~, mAtA ke aparA dvArA upasarga jAne ke anekoM udAharaNa haiN| sahaja yakSmA kitane pratizata dekhI jAtI hai yaha abhI taka ThIka-ThIka A~kA nahIM jA sakA hai| saMsparza dvArA yakSmA kA prasAra zalya cikitsakoM ( surgeons ) ko laga sakatA hai jo yakSma vikSatoM para kArya karate haiM / vadhAjIviyoM ko laga sakatA hai jo yakSmapIDita pazuoM kA mAMsa kATate haiM tathA vaikArikIvid (vikRtivettAoM) ko laga sakatA hai jo yama daNDANuoM para kArya karate haiM para yaha rIti bhI koI adhika mahattva kI nahIM hai| aba jo do rItiyA~ raha gaIM yA to upasarga mukhamArga se antargrahaNa ( inges. tion ) dvArA ho yA zvasana mArga se ho| ina donoM meM adhika mahattvapUrNa vidhi hai zvasana dvArA upasarga ke phuphphusa meM pahu~cane kii| mukha se sA~sa lene meM daNDANu phuphphusa meM khIMcA jA sakatA hai, yA thUke hue SThIva ke bindUtkSepa dvArA mukha meM praviSTa ho sakatA hai athavA For Private and Personal Use Only

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yakSmA 533 upasRSTa dhUla ke zvasana se ho sakatA hai / ina saba meM mukha dvArA sA~sa lene kA mArga adhika sAmAnya mAlUma par3atA hai I prasAra kI vidhi - sampUrNa zarIra meM yakSmA kA prasAra tathA phuphphusa meM yakSmA kA prasAra ye do mukhya samasyAe~ haiM jina para vicAra karanA hai / yamadaNDANu acala ( immobile ) prANI hai isake kAraNa yaha svayaM gati karane meM asamartha rahatA hai arthAt isako calAnA par3atA hai / ise calAne kA kArya bhakSikozA karate haiM jo ise apane garbha meM rakhakara itastataH calate hue sthAna sthAna para isakA upasarga pahu~cA dete haiN| jyoM hI eka yakSmAdaNDANu phuphphusa yA udara kI zleSmala For para baiThatA hai ki use eka antazchadIya yA bahunyaSTi bhattikozA pakar3a letA hai aura use zleSmala kalA meM hokara lasAvakAza (lymph spaces ) meM le jAtA hai / lasAvakAza se lasadhArA meM hotA huA yaha apane prathama vizrAma sthala meM A jAtA hai / jise hama sagranthi kahate haiM / vAstava meM dekhA jAve to yakSmA lAbha Uti kA eka roga hai aura lAbha Uti vaha Uti hai jo zarIra para AkramaNa karane vAle jIvoM kA saMhAra karane ke lie banAI gaI hai / para yaha ghAtaka jIvANu hamAre zarIra ke rakSakoM se DaTa kara yuddha karatA hai unheM parAsta karatA hai tathA apanA praguNana karatA hai / yadi yakSmAPost apanI prathama vizrAma sthalI meM praguNita ho jAtA hai to phira yaha sarva zarIra para vijaya prApta karane ke lie nikala par3atA hai / isakA mArga kendrAbhimukha hotA hai isa kAraNa yaha mukhyA rasakulyA dvArA sirArakta meM praveza kara jAtA hai / sirArakta se yaha hRdaya ke dakSiNa bhAga meM AtA hai jahA~ se yaha phuphphusa meM praveza karatA hai / abhI taka daNDA ko bhakSikozA lie cala rahA thA aura vaha use phuphphusa taka le AyA / yahA~ Ate Ate vaha khUba phUla jAtA hai aura use phuphphusa ke kezAloM meM hokara jAnA kaThina ho jAtA hai ataH vaha kezAla mukha ke pAsa Thahara jAtA hai aura vAhinI kI prAcIra phor3a kara phuphphusa ke lasAvakAza meM sthita ho jAtA hai yA lasAbha Uti meM vizrAma karane lagatA hai / ho sakatA hai ki yahA~ yaha phira pakar3A jAve aura roga kI eka nAbhi utpanna kara de athavA yaha Age bhI bar3ha sakatA hai aura zvAsaklomanAlIya lasagranthiyA~ ( tracheobronchial lymph nodes ) meM avasthAna kara sakatA hai| isakA to artha yaha huA ki zarIra ke kisI bhI bhAga meM upasarga lage upasargakArI daNDANuoM ko kabhI na kabhI phuphphusa meM AnA par3egA aura phuphphasIya lasagranthiyoM se samparka sthApita karanA par3egA ( sa ) | zvasana dvArA upasarga lagane se anya UtiyoM kI apekSA phuphphusa sabase adhika prabhAvita hote haiM isakA kAraNa aba bhale prakAra samajhA jA sakatA hai / jaba phuphphusarUpI lauhapAza se ye yakSmAdaNDANu baca pAte haiM taba kahIM ve raktadhArA meM hokara anyatra yakSmopasarga zarIra meM karane meM samartha ho pAte haiM / lasa Uti dvArA upasarga ke prasAra kA itanA mahattva hote hue bhI roga pratyakSa prasAra ( direct extension ) dvArA bhI phaila sakatA hai, zarIrastha prakRta mArgoM dvArA bhI bar3ha sakatA hai tathA raktadhArA bhI use phailA sakatI hai / rakta meM daNDANuoM kI For Private and Personal Use Only

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534 vikRtivijJAna upasthiti yakSmAdaNDANuoM ke pratyakSa dhamanIprAcIra para AkramaNa ke kAraNa na hokara phuphphusoM dvArA hotA hai| aura jaba kabhI asthi, sandhi, vAtanADIsaMsthAna, netra yA vRkka meM yakSma vikSata kA kucha bhI patA cale rogI ke phuphphusoM kI avazya parIkSA karanI cAhie / parIkSA karane para nissandeha yakSmA kA koI gupta vikSata vahA~ para milegA hii| isa dRSTi se phuphphusa eka aisA sTezana ( sthAtra ) hai jahA~ yakSmAdaNDANuoM kI gADI AtI bhI hai tathA jAtI bhI hai| ____ jo kucha Upara kahA gayA hai usase yaha spaSTa ho gayA hogA ki sAmAnya zyAmAkasama yakSmA sAmAnya yakSmopasarga kA eka Atyantika naidAnika rUpa ( extreme clinical form ) mAtra hai jo prAyaH hIna hokara niyamataH hotI hai / naidAnika dRSTi se yacamA eka sthAnika upasarga mAtra mAlUma par3atA hai yadyapi yakSmAdaNDANu sampUrNa zarIra meM phaila jAte haiM aura jahA~-jahA~ ve phailate haiM vahA~-vahA~ choTe-choTe vikSata banAte haiM para yataH vyakti meM pratIkAritA ( immunity ) adhika hotI hai ataH ve sUkSma vikSata dRSTipatha meM Ate nhiiN| tvacAgata yakSmA kA udAharaNa yaha siddha karane ke lie paryApta hai ki yakSmopasarga bahuta vistRta hotA hai para yaha hara jagaha para bahuta bar3e roga kA rUpa le yaha Avazyaka nahIM hai / roga kA bananA yA bar3hanA rogANu kI mAtrA nizcita kiyA karatI hai / yadi rogANuoM kI mAtrA adhika hai to bar3I se bar3I pratIkAritA zakti bhI naSTa kI jA sakatI hai| - isakA artha yaha huA ki kisI bhI prakAra kI yakSmA ho jaba kata kisI viziSTa aMga meM usakA vikSata bana kara usakA vizeSa nAma nahIM par3a jAtA taba taka use yakSmAdaNDANu raktatA ( tuberculous bacillaemia )hI mAnanA hogA / usakA pramANa yaha hai ki kisI bhI prakAra kI yakSmA se pIDita vyakti ke rakta meM viziSTa paddhati dvArA zatapratizata yacamAdaNDANuoM kI upasthiti darzAI jA sakatI hai / ___ aba hama eka bAra punaH phuphphusa meM yamadaNDANuoM ke prasAra kA vicAra kara sakate haiN| yaha prasAra 3 vidhi se hotA hai yA ho sakatA hai| eka to lasavahAoM dvArA, dUsare vAyu mArga dvArA tathA tIsare raktadhArA dvaaraa| ina tInoM meM lasavahAoM dvArA prasAra sAmAnyatama hai / lasavahA raktavAhiniyoM aura klomanAla ke sAtha-sAtha calatI haiM isa kAraNa lasavahAoM dvArA prasarita hone vAle yakSmopasarga ke vikSata parivAhinya (perivascular ) tathA pariklomanAlIya ( peribronchial ) hote haiM / ye vikSata bahuta choTI-choTI granthikAoM ke rUpa ke hote haiM jinheM kATane para unameM yadimakAoM ke gucchasamUha (staphyloid groups of tubercles ) milate haiN| pratyeka samUha ke kendra meM eka choTI vAhinI yA klomanAla prAyazaH pAI jAtI hai| ye gucchasamUha eka kilATIya kSetra ke cAroM ora dekhe jAte haiM jo yaha bhI prakaTa karate haiM ki roga abhI phaila rahA hai / aNvIkSa meM dekhane se patA calatA hai ki klomanAla yA vAhinI kI prAcIra meM yacimakA phaTanA cAhatI hai jisake kAraNa kisI bhI samaya roga kinhIM do tIvra rUpoM meM For Private and Personal Use Only

Page #602
yakSmA 535 badala sakatA hai| vAyu mArgoM dvArA roga kA prasAra bahuta prasiddha nahIM hai / raktadhArA dvArA prasAra zyAmAkasama yakSmA meM dekhA jAtA hai jaba ki koI tIvra vikSata kisI vAhinI meM phaTa jAtA hai aura sarvAGgoM meM vyApta ho jAtA hai| yamadaNDANuprakAra-phuphphusoM meM na kevala mAnavI prakAra kA, api tu gavya prakAra kA yamakavakavetrANu (mycobacterium tuberculosus) bhI yakSmopasarga karane meM samartha ho sakatA hai / para gavya prakAra kA yakSmAdaNDANu yadi thor3I-thor3I mAtrA meM barAbara liyA jAve to bhI vaha rogotpatti karatA huA nahIM dekhA jAtA / isakA eka udAharaNa nAyaDa ne yaha diyA hai ki ekavAra eka rajisTarDa gozAlA se kucha dhanika vargoM ko lagAtAra dugdha AtA rahA aura dhanika parivAroM ke bAlaka-strI-puruSa saba DaTakara varSoM dugdhapAna karate rahe / eka bAra saMyuktarAja amerikA kI sarakAra ne gozAlA kI gAyoM kA parIkSaNa karAyA aura yacimaparIkSA ( tuberculin test ) dvArA yaha jJAta huA ki unameM se 45 pratizata gAyeM yakSmA se pIDita ataH vadhArha haiM / AdezAnusAra unako mAra diyA gayA aura zavaparIkSA dvArA yaha siddha ho gayA ki ve yakSmApIDitA hI thiiN| aba jina parivAroM ne dugdhapAna kiyA thA unakI parIkSA prArambha huI aura dekhA gayA ki sahasroM meM kevala eka hI aisA vyakti milA jise yathamopasarga rahA / para vaha gAya dvArA prApta upasarga hai isakI puSTi nahIM kI jA skii| yaha udAharaNa isa kathana ko siddha karane ke lie paryApta hai ki alpa mAtrA meM goyamadaNDANu kA bhakSaNa yamAkAraka nahIM hotaa| usa gozAlA ke anekoM niyuktoM ( employees ) ne bahuta mAtrA meM aura varSoM una gAyoM kA dugdha piyA thA para unheM bhI kucha nahIM huaa| isakA eka artha yaha bhI hai ki eka mAtra yakSmAdaNDANu hI kisI zarIra meM yakSmA utpanna kara nahIM sakatA usake lie anya bhI kAraNa hone cAhie jaba ve kAraNa bharapUra hote haiM tabhI yakSmAdaNDANu bhI apanA cakra calAne meM samartha ho pAtA hai| Ayurveda yakSmA ko tridopostha aura hetu catuSTya ke kAraNa mAnatA hai vegarodhAt kSayAccaiva sAhasAdviSamAzanAt / tridoSo jAyate yakSmA gado hetucatuSTayAt // prAthamika upasarga aura punarupasarga-yadi kisI svastha zUkara meM yakSmAdaNDANuoM kA antaHkSepaNa kara diyA jAve to 10 se 14 dina ke bhItara usa sthAna para eka granthikA ( nodule ) nikalatI hai jisameM usa sthAna ke antazchadIya kozA praguNita hue pAye jAte haiN| thor3e samaya pazcAt vaha pranthikA phUTa jAtI hai aura vahA~ eka vraNa bana jAtA hai jisakA ropaNa kabhI nahIM hotA kyoMki zUkara meM yakSmA ko vinaSTa karane ke lie tanika bhI pratIkAritA nahIM rhtii| thor3e samaya pazcAt usa sthAna ke samIpa kI (prAdezika) lasagranthiyA~ upasRSTa hokara unameM atizIghra kilATIyana hone lagatA hai| yaha ghaTanA isalie adhika mahattvapUrNa hai ki isase prAthamika upasarga ke Asana ( seat ) kA patA laga jAtA hai| praivika granthiyoM ke upasRSTa hone para tuNDikA meM, kaNThazvAsanAlIya For Private and Personal Use Only

Page #603
536 vikRtivijJAna pranthiyoM ke upasarga meM phuphphusa meM tathA AntranibandhanIka granthiyoM ke prabhAvita hone para AMta meM roga kA prAthamika Asana hogA yaha turata dhyAna meM A jAtA hai / ina sthAnoM kI surakSA kA dAyitva mukhyataH vahA~ sthita ati para hI hotA hai isa kAraNa prathama surakSApati ( first line of defense ) kA nirmANa yakSmAdaNDANuoM ke prati lasa uti (lymphoid tissue ) dvArA kiyA jAtA hai| lasAbha Uti kA sambandha lasagranthiyoM se hone ke kAraNa prAdezika lasagranthikAe~ (regional lymph nodes ) surakSA kI dUsarI tathA sudRDhapati kA nirmANa karatI haiN| lasagranthikAoM meM zotha hote hI sampUrNa zarIra meM yakSmopasarga vyApta ho jAtA hai aura 13 se 3 mAsa ke bhItara zUkara kAlakavalita ho jAtA hai| ghaTanAoM kA jo anukrama eka prANI meM yacmopasarga ke kAraNa dekhA jAtA hai vaha manuSyoM kI apekSA bahuta bhinna hotA hai| yadi pahale antaHkSepa ke eka do saptAha pazcAt dUsarA antaHkSepaNa kara diyA jAve to thor3e hI dinoM meM vahA~ para eka jaraTha yA kaThina ( indurated ) kSetra bana jAtA hai jo zIghra hI nirmokayukta ( sloughing) ho jAtA hai aura jo vraNa banatA hai vaha atizIghra aura sthAyIrUpa se ropita ho jAtA hai tathA prAdezika lasagranthikAoM para koI prabhAva nahIM par3atA / isa ghaTanA ko kAkaghaTanA ( koch phenomenon ) kahate haiN| prAthamika upasarga se yaha dvitIyaka yA uttarajAta upasarga do dRSTiyoM se bhinna hotA hai| eka yaha ki isameM UtinAza adhika hotA hai tathA dUsarA yaha ki yahA~ upasarga sthAnasImita hotA hai| ina do dRSTiyoM kI karjI bhI do vibhinna kalAe~ ( mechanism ) haiN| eka kalA kA nAma hai anUrjika (kapharaktIya) vraNazotha (allergic inflammation ) jo atyadhika utinAza kA kAraNa hotI hai| dUsarI kalA kA nAma hai pratIkAraka piNDoM kA nirmANa jinameM prasamUhiyA~ (agglutinins ) tathA AsvAdiyA~ (opsonins) mukhya haiN| ye pratIkAra piNDa (immune bodies) yakSmAdaNDANuoM ko eka sthAna para hI sImita rakhate haiN| yaha sampUrNa jJAna Aja hameM ArnolDa rica dvArA prApta huA hai| uparokta jJAna se hameM mAtrA kI alpAdhika kalpanA ho jAnI caahie| yadi kisI govatsa ( calf ) ko thor3I mAtrA meM ugra yakSmAdaNDANu (gavya prakAra ) antaHkSipta kara diyA jAve to jo vikSata utpanna hote haiM ve eka sthAna para maryAdita rahate haiM, zIghra hI unakA pratIpagamana ( retrogression ) Arambha ho jAtA hai jisake kAraNa ve tanvIyita aura cUrNIyita ( fibrosed & calcified ) ho jAte haiN| yadi daNDANuoM kI madhyama mAtrA kA upayoga kiyA gayA to pariNAma viSama hote haiM aura yadi adhika mAtrA meM yakSmAdaNDANuoM kA antaHkSepa kiyA gayA to sarvAGgINa yakSmA se abhibhUta hotA huA govatsa kucha saptAhoM se lekara kucha mahInoM meM kAlakavalita ho jAtA hai| For Private and Personal Use Only

Page #604
yakSmA 537 yaha zaMkA kiyA jAnA svabhAvika hai ki cAhe thor3I mAtrA meM mAnava zarIra meM yakSmA Curry praveza kareM ve to praguNita hokara cAhe jitane bar3ha sakate haiM ataH mAtrA kI kalpanA karanA vyartha hai / parantu sarvAdhika mahatva kI bAta yaha hai ki jitanI mAtrA meM yakSmAdaNDANu praveza karate haiM unheM usa prItakAritA zakti kA sAmanA karanA par3atA hai joyA kI choTI mAtrA dvArA jIvana ke prArambha kAla meM hI utpanna ho cukI hotI hai / mAtrA adhika hone para pratIkAritAzakti kA bA~dha tor3a kara rogakArI jIvANu manamAnA AghAta karane meM samartha hote haiM / kama mAtrA hone para zarIra kI vijayavAhinI zakti unakA kacUmara nikAla de sakatI hai isIlie mAtrA kI kalpanA kara lene se adhika vizvasanIya pariNAmoM para vaidya pahu~ca sakatA hai / mAna lo ki eka bAlaka kisI gvAle kI gAya kA dUdha pItA hai jo yakSmA se pIDitA hai / eka dUsarA bAlaka eka gozAlA se dugdha pItA hai jahA~ 10-20 pratizata gAyoM meM yakSmopasarga hai / kauna se bAlaka ko yakSmA hone kA adhika bhaya ho sakatA hai ? isa prazna kA uttara sAdhAraNa hai | ekamAtra yakSmA pIDitA gAya ke dugdha meM se eka pAva dugdha lene para jitane yakSmA - daNDANu AveMge utane eka pAva gozAlA ke dugdha se Aye dugdha meM nahIM ho sakate kyoMki gozAlA ke dugdha meM anya svastha gAryo kA dugdha bhI sammilita ho gayA hai| jisane yamAdaNDANuoM kI mAtrA ko bahuta dugdha meM bA~Ta diyA hai / pahale bAlaka ko jahA~ yakSmA honA svAbhAvika hai dUsare bAlaka meM yakSmA ke prati pratIkAritA kA jAgRta honA utanA hI svAbhAvika hai kyoMki adhikamAtra yacamAdaNDANu jahA~ vinAzaka kArya karate haiM vahA~ alpamAtra yakSmAdaNDANu zarIra meM pratIkAritA vA vijayavAhinI zakti ko protsAhana dete haiM / eka kSaya pIDita rogI ke kamare kI vAyu meM jaba ki cAhe jahA~ vaha thUkatA hai jitane parimANa meM yacamAdaNDANu hoMge utane bAjAra kI dhUla meM nahIM hoNge| isI kAraNa jahA~ bAjAra kI dhUla ke andara sthita yacamAdaNDANuoM ke zvasana se pratIkAritA zakti jagegI ( jaisA ki sar3aka jhAr3ane vAle harijana meM bhI dekhA jAtA hai) vahA~ yakSmI ke samIpa rukA huA prANI kSayI kI mauta se pahale hI apane marane kI taiyArI kara legA / bhAratavarSa meM hama yaha prAyaH dekha rahe haiM ki jisa kuTumba meM yakSmA kA eka prANI par3atA hai aura mara jAtA hai vahA~ / eka ke bAda dUsarA yakSmA kA zikAra banatA jAtA hai yahA~ taka ki usa parivAra kA satyAnAza ho jAtA hai / jo zikAra banatA hai use adhikamAtra ugra yakSmAdaNDANu kI atyadhika prApta ho gaI hai aisA mAnakara calanA cAhie tathA jo usa kuTumba meM baca gaye haiM unameM yakSmA ke prati pratIkAritA zakti bar3hI hai aisA mAnanA cAhie, puradilanagara (alIgar3ha) ke samIpa eka grAma ajagarA hai vahA~ eka sampanna yAdavakSatriya kula meM mere dekhate-dekhate cAra mauteM ho cukIM eka strI punaH roga grasita hai aura eka yuvaka para prahAra hone jA rahA hai para eka 60-70 varSa kI vRddhA jo usa gRha meM hai usakA bAla bhI bA~kA nahIM huA Izvara use ciraMjIvinI kare para yaha eka acchA udAharaNa hai / I prAthamika upasarga aura punarupasarga ke sambandha meM isa samaya hama vicAra karate-karate mAtrA kI kalpanA aura usake mahatva ko samajha cuke haiM hamane prANiyoM para hue prayogoM For Private and Personal Use Only

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538 vikRtivijJAna kA bhI jikra kiyA hai / aba hama manuSya meM prAthamika upasarga aura punarupasarga kA eka bAra naye sire se vicAra karate haiM / hamAre isa vicAra karane kA masAlA aiMTana ghoNa nAmaka vidvAn ne apane 184 zavoM kI parIkSA dvArA taiyAra karake rakha diyA hai jise vizva bhara meM sarvatra vicArya viSaya mAna liyA gayA hai| use koNahIma kI yaha bAta yAda thI ki yakSmA ke prAthamika upasarga kI prathama nirdezikA prAdezika lasagranthikAe~ huA karatI haiM / isI ko lakSya banAkara jaba apanI khoja ghoNa ne Arambha kI to use 92 4 pratizata bAlakoM ke phuphphusoM meM prAthamika vikSata kA patA claa| yaha vikSata 2 se 1 seMTImITara kI eka kilATIya nAbhi ( caseous focus ) hotI hai / yaha phuphphusa ke kisI bhI pradeza meM phuphphusacchada ke nIce hotI hai jisake Upara saMyojI Uti kA eka prAvara car3hA hotA hai jo usakI zeSa phuphphusa Uti se pRthakatA darzAtA hai| ise loka ghoNavikSata ke nAma se pukAratA hai / isa vijJata kA sambandha eka bRhattara kilATIya nAbhi se hotA hai jo ki usa vikSata se sambaddha lasagranthika meM banatI hai / apane parIkSaNa kAla meM ghoNa ne yaha bhI dekhA ki ghoNavikSata yA prAthamika vikSata kA ropaNa 8 se lekara 14 varSa kI Ayu meM hotA hai / ropaNa ke kAraNa vahA~ na kevala tAntava Uti hI banatI hai api tu vAstavika asthi kA hI nirmANa ho jAtA hai / jina nAbhiyoM meM phuphphusa meM yA usakI lasagranthikoM meM asthi pAI jAtI hai unheM sadaiva prAthamika vikSata dvArA banI aura yacamopasarga ke prathama prahAra kI nirdezikA karake mAna lenA cAhie aisA usakA Agraha hai / yadi bAlaka meM isa prAthamika vitta kA ropaNa nahIM huA to utsyandana ( exudation ), kilATIyana (caseation ) kI kriyA drutavega se cala par3atI hai lasagranthikAe~ kilATIyita ho jAtI haiM aura phUTakara samIpastha klomanAla ( bronchi) meM cU par3atI haiM jisake kAraNa kilATIya zvasana ( caseous pneumonia ) phuphphusa ke adhokhaNDa meM bana jAtA hai aura mRtyu kA kAraNa banatA hai| 1 prAthamika vikSoM para opAI ne bhI bahuta bar3A evaM gaveSaNAtmaka kArya karake dikhalAyA hai| usane una logoM ke zavoM meM se phuphphusoM ke kSarazmicitra ( roentgen ray photographs ) lie jo yakSmA ke atirikta anya kisI roga se mara cuke the / vaha yaha jAnatA thA ki koI bhI aisA vyakti nahIM jise sabhya saMsAra meM zaizavakAla meM yamopasarga na ho tathA yacamopasarga ke kAraNa prAthamika vikSata na bne| isI kI puSTi ke lie usane yaha khoja prArambha kii| isa kriyA se usane sUkSmatama cUrNIyita granthikAoM kA patA lagAyA jinameM prAthamika vikSata bana cukA thA / usakI khoja ke AdhAra para saMsAra ko 2 prakAra ke vikSatoM kA patA lagA / eka to ve jinheM hama prAthamika vikSata ke nAma se pukArate haiM aura jo phuphphusa ke kisI bhI bhAga meM pragaTa ho sakate haiM tathA jinake sAtha kilATIya yA cUrNIyita lasagranthiyoM ke vikSata milate haiM inheM nAbhIyavikSata ( focal lesion ) kahate haiM / dUsare ve vikSata jinheM hama phuphphusazIrSavikSata ( apical lesions ) kaha sakate haiM jo For Private and Personal Use Only

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yakSmA 536. sadaiva phuphphusazIrSa ( apex of the lung ) meM hote haiM jinakI yaha pravRtti nahIM hotI ki ve prAdezika lasagranthiyoM para prabhAva DAleM / ye vikSata uttarajAtavikSata ( secondary lesions ) hote haiM / nAbhIyavikSata itane sUkSma hote haiM ki sAdhAraNa zavaccheda karane para ve milate nahIM / inhIM nAbhIyavikSatoM kI kRpA se yakSma pratikAraka zakti mAnava zarIra meM prAdurbhUta hotI hai / para yaha zakti sImita hotI hai jise adhikamAtra ugrayamadaNDANu kabhI bhI naSTa bhraSTa kara sakate haiN| usane dekhA ki prathama varSa ke zizuoM ke tarazmi citroM meM nAbhIyavikSata kA koI patA nahIM lagatA ar razmicitra to tabhI AtA hai jaba ve ropita ho jAte haiM / jIvana ke prathama varSa / usakA kAraNa yaha hai ki vijJata ke to prAthamika kSitoM yA ina nAbhIyavikSatoM meM uttarottara kilATIyana calatA rahatA hai / 2 se lekara 5 varSa kI avasthA ke bAlakoM meM se 43 pratizata meM tarazmicitra meM nAbhIya vikSata use mila gaye arthAt itane pratizata zizuoM meM vikSatoM kA ropaNa pAyA gayA / 20 varSa se Upara 80-90 pratizata meM nAbhIyavikSata mile tathA 30 varSa pazcAt to ye vikSata zatapratizata pAye gye| yaha hama pahale kaha cuke haiM ki. opAI dvArA parIkSita phuphphusa una vyakti ke rahe jinheM yakSmA kA prakaTa rUpa meM roga nahIM huA thA / isase spaSTa hotA hai ki prabhu kI kRpA hI hamArI rakSA kA kAraNa hotI hai anyathA jitane ghAtakasvarUpa ke vikSata isa vidvAn ko kabhI kabhI dekhane ko mile haiM ve hI mAraka siddha ho sakate the| kabhI kabhI jo vyaktiyoM ko ahaituka jvara, anudhA, bhArahrAsa aura daurbalyAdi dekhe jAte haiM unakA inase sambandha rahatA ho yaha Azcaryajanaka nahIM hai / nAbhIyavikSata ke sAtha prAdezika lasagranthikAoM kA lipta rahanA prathama yacmopasarga kA pramANa hotA hai / phuphphusazIrSivikSata dvitIyaka yA uttarajAta upasarga kA. pramANa hotA hai / jaba uttarajAta upasarga hotA hai taba taka prathama upasarga ke kAraNa banA vraNa ropita ho jAtA hai| prathama aura dvitIya upasargoM meM pratyakSa koI bhI sambandha nahIM hotA kabhI kabhI to eka vikSata eka phuphphusa meM aura dUsarA dUsare phuphphusa meM dekhA jAtA hai / prAthamika upasarga 10 varSa kI avasthA meM dekhane meM Ate haiM aura jyoM jyoM avasthA bar3hatI jAtI hai unakI saMkhyA bar3hatI jAtI hai / phuphphusazIrSivikSata kA ropaNa bhI ho sakatA hai tathA ve kucha dina prasupta ( latent ) bhI par3e rahakara phira ekadama uttejita ho sakate haiN| yUnzolma ne isa para khoja kI hai aura dekhA hai ki 50 pratizata vikSatoM kI prasuptAvasthA ( period of latency ) 10 varSa se bhI Upara pAI jAtI hai / yakSmA ke sambandha meM kucha kAla pUrva jo vAda pracalita the unameM paryApta antara AtA jA rahA hai / pahale yakSmA 2 prakAra kI kahI jAtI thI eka zaizavakAlIna aura dUsarI yauvanakAlIna / para Aja vaisA bhinna karane kI koI AvazyakatA pratIta nahIM hotI / pahale eka vAda aisA calatA thA ki sampUrNa yakSmA zaizavakAla meM hI laga For Private and Personal Use Only

Page #607
540 vikRtivijJAna jAtI hai tathA vayaskoM ko yakSmA kA upasarga nahIM lagatA tathA yuvAvasthA meM jo yakSmA dekhI jAtI hai usakA kAraNa zaizavakAlIna upasarga hotA hai jo zarIra meM hI fafe rahatA hai bAhara kA upasarga koI prabhAva nahIM rakhatA hai / para Aja jo gaveSaNAe~ isa viSaya para cala rahI haiM unhoMne isa vAda ko bhI vyartha karake rakha diyA hai / yaha to satya hai ki eka bAra yamopasarga hone se zarIra meM pratIkAritA utpanna ho jAtI hai para yaha bhI satya hai ki yaha pratIkAritA zanaiH zanaiH samApta hotI calI jAtI hai yadi bAra bAra thor3A thor3A yacamopasarga na hotA rahe / tathA yaha bhI satya hai ki zarIra meM nirmita pratIkAritA itanI balazAlI vastu nahIM hai ki yakSmA ke pUrNAkramaNa ko jhela sake / pahale aisA anumAna thA ki yacamopasarga ke kAraNa jo prAthamika saMyoga ( primary complex ) banatA thA vaha sabhI bAlakoM meM samAna hotA hogA para Aja yamaparIkSaNa ( tuberculin test ) praNAlI se yaha patA calatA hai ki 10 - 15 pratizata bAlakoM meM upasarga vRddhi karatA hai / prAthamika upasarga bAlakoM meM na hokara yuvAoM aura vayaskoM meM adhika dekhA jAtA hai aura yaha prAthamika upasarga adhikatara hAnirahita hotA hai| prAthamika upasarga kA lakSaNa hotA hai ghoNavikSata jo bAlaka meM sakriyarUpa ( aotive form ) meM rahatA hai tathA vayaska meM ropita rUpa ( healed form ) meM dekhA jAtA hai / uttarajAta vikSatoM kA prakAra eka na hokara aneka hotA hai| unakA prakAra rogANu kI mAtrA tathA vyakti kI usake prati pratikriyA para nirbhara karatA hai / pratikriyA kA jJAna vyakti meM utpanna pratIkAritA tathA anUrjA ( allergy) se hotA hai / Upara jitanA jJAnapuMja diyA gayA hai usakI ora dRSTipAta karate hue yaha kahanA ki eka manuSya meM yakSmA hone para kyA aura kaise hotA hai atyadhika kaThina hai / jo ghaTanAe~ ghaTatI haiM unakA anukrama nimna prakAra kA ho sakatA hai / 1 - koI bhI zizu apane janma ke sAtha yakSmA ke viruddha koI pratIkAritA ( immunity ) lekara nahIM AtA / 2- yadi zizu ko sahasA ugra yacamAdaNDANu kI adhika mAtrA prApta ho gaI to usake zarIra meM yakSmA kA sakriya rUpa prakaTa ho jAvegA phuphphusa meM zvasanakIya lakSaNa hone lageMge aura tantUtkarSa jaisI prakriyA ko koI avasara nahIM mila sakegA / usake phuphphusoM meM jIrNa dRDha prAcIra guhAe~ jaisI ki vayaskoM meM dekhI jAtI haiM nahIM mileMgI / isa avasthA meM usakA zarIrAnta honA pUrNataH sambhava hai / 3 -- yadi zizu ko alpamAtra yacamopasarga prApta huA to ( jo ki gozAlA ke dugdha ke dvArA mila sakatA hai ) choTe-choTe vikSatoM kA vaha nirmANa kara lenA hai jo zanaiH-zanaiH ropita ho jAte haiM / unake ropaNa ke sAtha hI sAtha usake zarIra meM pratIkAritA uttarottara vRddhiMgata hotI jAtI hai / yaha pratIkAritA taba aura bar3hane lagatI hai jaba vaha galiyAroM kI dhUla meM loTatA aura khelatA hai kyoMki aisA karane se usako For Private and Personal Use Only

Page #608
yakSmA 541 alpa pramANa meM yakSmopasarga nirantara milatA jAtA hai jo usakI pratIkAritA ko bar3hAtA calatA hai| 4-jyoM jyoM pratIkAritA zakti bar3hatI jAtI hai tyoM tyoM phuphphusastha vikSatoM ko tAntava Uti kI prAcIroM meM banda karane kI zakti phuphphusoM meM bar3hatI calI jAtI hai / isake kAraNa saba vikSata svastha Uti se pRthaka kara diye jAte haiN| ___5-jyoM jyoM bAlaka bar3A hotA jAtA hai use aise avasara Ate cale jAte haiM jaba ki use adhika pramANa meM yakSmopasarga pahu~ce / isa avasthA meM zarIra meM jo avApta anUrjA rahatI hai vaha kAka ghaTanA ko protsAhita karatI aura vivara nirmANa ( cavity formation ) hone lagatA hai| 6-yadi kisI samaya use bahuta bar3A upasarga laga gayA yA adhika parizrama ke kAraNa (sAhasAt ), anazanAdi (viSamAzanAt ), anya upasargoM ke dvArA (kSayAt ) usakI pratIkAritA zakti TUTa gaI to use tIvasvarUpa kA upasarga laga kara yakSmA kA sakriya rUpa cala par3a sakatA hai| pratIkAritA kA yakSmA ke sAtha kitanA nikaTa kA sambandha hai use prakaTa karane ke lie hama bvAyaDa ke nimna zabda uddhRta karanA apanA karttavya samajhate haiM: Immunity is the master word in tuberculosis. It is more to be desired than freedom from infection, for the better is an unattainable ideal and the rarer the infection the more dangerous does it become. pratIkAritA yakSmA meM eka bahuta bar3A zabda hai| yaha jitanI abhIpsita hai utanI upasarga se mukti nahIM, kyoMki upasarga se mukta huA hI nahIM jA sakatA tathA upasarga jitanA adhika virala hogA utanA hI yaha adhika bhayAvaha bnegaa| bhArata meM bahudhA purAne logoM kA kahanA hotA hai ki kisI roga se ghRNA na karo anyathA vahI ho jaavegaa| yaha bAta kalataka jitanI avaijJAnika aura mUrkhatApUrNa lagatI thI utanI uparokta vAkya ke pazcAt nhiiN| kyoMki aba to hameM roga ke sAtha thor3A samparka rakhakara apane zarIra ko sikhAnA hogA ki vairI kI bhayAnakatA kyA ho sakatI hai| yadi hama vaisA nahIM kareMge to zarIra usa astra ko avApta na kara pAvegA aura usa roga ke prati arakSita raha jaavegaa| dRSTikoNa meM Aja kitanA bar3A antara hai ! antaraM mahadantaram !! pahale zizuyamA atyanta bhayAnaka vyAdhi mAnI jAtI thI para Aja usase bhaya karane kI koI AvazyakatA hI nahIM raha gii| Aja hamArA kArya yaha raha gayA hai ki kSayapIDita zizuko itanA surakSita kara do ki vaha yakSmA se punarupasRSTa na hone paaye| itanI sAvadhAnI rakhI nahIM ki bAlaka yakSmA ke vikSatoM ko apane vaza meM karake itanI pracaNDa pratIkAritA apane meM utpanna karegA ki phira usakA bAla bhI bA~kA honA sambhava nahIM hai yadi AcaraNa zuddha rahA to / phuphphusa yakSmA se pIDita bAlaka khADana evaM meDovI kI dRSTi meM 'paripuSTa, jvararahita, prasannacitta tathA ojasvI For Private and Personal Use Only

Page #609
vikRtivijJAna ( well nourvished, afebrile, happy and vigourous ) hotA hai| usameM yacamA kA nidAna nADI dvArA nahIM hotA api tu yacimaparIkSA aura kSarazmicitra se hI kI jA sakatI hai| prAthamika upasargoM meM daNDANu kI mAtrA kA sabase adhika mahattva hotA hai| mAtrA se abhiprAya balasamprApti se hai| Ayurveda meM vyAdhi kI balasamprApti dI gaI hai jo yaha batAtI hai ki kitane bala se vyAdhi ne zarIra ko jakar3A hai| jaba balasamprApti thor3I hotI hai (jaba alpa mAtra yakSmAdaNDANuoM kA upasarga hotA hai) taba ghoNavikSata banatA hai| yaha vikSata phuphphusazIrSa ko chor3a phuphphusa meM kahIM bhI dekhA jA sakatA hai usake sAtha klomanAlIya lasagranthikAe~ bhI pravRddha hokara kilATIyana karane lagatI haiN| yaha vikSata prAyaH ropita tathA cUrNIthita ( calcified) ho jAtA hai| jaba balasamprApti adhika hotI hai to yaha vikSata mahInoM raha sakatA hai / yadyapi bAlaka ko dekhane se koI naidAnika vikArajanaka lakSaNa prakaTa nahIM hotA para yadi usakA kSarazmicitra liyA jAve to usameM bahuta bar3I chAyA dekha par3atI hai| yaha chAyA sAdhAraNa yakSmavikSatoM se bahuta bar3I hotI hai| itanI vistRta chAyA kA kyA artha hai yaha abhI taka spaSTa nahIM ho skaa| kucha aisA mAnate haiM ki yaha chAyA yakSma ghoNavikSata ke cAroM ora anUrjita pratikriyA hai jise apiyakSmA (epituberculosis) kaha sakate haiN| parantu kyoMki usameM bhI yakSmA. daNDANu paryApta hote haiM ataH vaha bhI yakSma ( tuberoculous) hI mAna lenA caahie| chAyA dikhane kA eka kAraNa klomazAkha kA avarodha hokara vahA~ saMbharaNa (atelectasis) honA bhI ho sakatA hai jo zleSmalakalA ke zotha ke kAraNa sambhava hai| Age calakara chAyA khatama ho jAtI hai aura eka cUrNIyita ghoNavikSata mAtra raha jAtA hai| citra meM vRntayustha granthiyoM kI cUrNAtuchAyAe~ ( hilar shadows ) bhI itastataH, mila sakatI haiN| ___adhika mAtrA meM upasarga pahu~cane para vistRta kSetra meM kilATIyana ho sakatA hai, vivara nirmANa dekhA jA sakatA hai, sampUrNa phuphphusakSetra meM upasarga mila sakatA hai, ghAtaka yama kilATIya zvasanaka ho sakatA hai athavA raktadhArA upasRSTa hokara upasarga ko sarvAGgINa banA sakatI hai| parantu svabhAvataH upasRSTa zizu binA koI bAhyalakSaNa prakaTa kie apane yakSmavikSata ko ropita karane meM samartha ho jAtA hai yadi use adhika mAtra punarupasarga zIghra hI na hove / ___uparokta vicAra ki zaizavakAlIna yakSmA mAraka nahIM hotI kucha vidvAnoM ko amAnya bhI ho sakatA hai| usake lie skATalaiMDa ke blaikalAka kA nAma bvAyaDa ne prastuta kiyA hai jisakA mata yaha hai ki usake pradeza meM bAlaphuphphusa yakSmA sadaiva ghAtaka roga rahatA hai| usake sthAnika kAraNa ho sakate haiN| skAca vyakti yakSmA se jitanA prabhAvita hotA hai utane anya dezIya nahIM / For Private and Personal Use Only

Page #610
yakSmA 543 yadimakA-nirmANa tathA vikAsa kisI bhI mArga se sahI, yakSmAdaNDANu jaba phuphphusa meM pahu~ca jAtA hai taba yahA~ rahakara jo ghaTanAeM ghaTatI haiM ve sadaiva eka sI hotI haiN| arthAt lasadhArA se hokara Ane vAlA daNDANu kucha anya kriyA karatA hogA aura raktadhArA se AnevAlA koI anya aisA nahIM hotaa| yacamAdaNDANu cAhe to kisI kezAla meM ho yA kisI vAyu mArga meM, use bhakSikozA zlaiSmika yA antazchadIya stara meM hokara le jAyA karate haiM aura jhaTa se vaha apanA sambandha lasAvakAzoM se yA lasAbha ati se banA letA hai| yadi yaha yahIM pakar3A gayA to yacamapratikriyA prArambha hone lgegii| yaha pratikriyA prathamopasarga meM vizuddha hogI jisameM zanaiH zanaiH yamadaNDANuoM kA praguNana hogA aura navIna Uti kA nirmANa hogaa| para yadi upasarga uttarajAta hogA to anavadhAnatA ( anaphylaxis ) ke pariNAmasvarUpa vahA~ vraNazothAtmaka utsyanda ( inflammatory exudation ) hone lgegaa| yaha pratikriyA 2 prakAra kI hotI haiM : 1-utpAdI pratikriyA ( productive reaction ) 2-utstandI pratikriyA ( exudative reaction ) utpAdI pratikriyA-isa pratikriyA meM jo pratIkAritA rahita prANiyoM meM utpanna huA karatI hai eka hI prakAra ke kozA kI vRddhi hotI hai jise adhicchadAbhakozA ( epithelioid cell ) kahate haiN| inhIM kozAoM dvArA vikAsonmukhI yacimakAoM * kA prakAya ( bulk ) banatA hai| isake pazcAt mahAkozA jinheM DAkTara ghANekara ne rAkSasakozA (giant cells) kaha kara pukArA hai banane lagate haiN| ye bahuta bar3e hote haiM inameM aneka nyaSTiyA~ pAI jAtI haiM jo kozA meM bAhara kI ora pariNAha meM yA eka dhruva ( pole ) ke pAsa athavA sampUrNa prarasa meM vikIrNa milatI haiN| ye mahAkozA atyadhika bhakSaNa zakti rakhate haiM tathA inake garbha meM yamadaNDANu par3e hue dekhe jA sakate haiN| ___ eka saptAha samApta hote-hote usa kSetra meM eka navIna kozA prakaTa ho jAtA hai jise hama lasIkozA (lymphocyte) kahate haiM / yaha kozA sthAnika lasAma ati dvArA pradAna kiyA jAtA hai na ki rakta dvArA / lasIkozAoM kI vRddhi se yacmA meM kyA kArya sampAdita hotA hai yaha abhItaka nizcita nahIM kiyA jA sakatA parantu yaha avazya anumAna lagAyA jA sakatA hai ki inake dvArA avazya hI koI mahattvapUrNa kArya sampAdita hotA hogaa| praguNita vA navAgata kozAoM se nirmita yaha tudra kozApuJja yakSmikA kahalAtA hai yaha vAhinI rahita hotA hai kyoMki yahA~ koI naI kezAla praveza nahIM krtii| kezAloM vA zirAoM kA abhAva bahuta mahattvapUrNa mAnA jAtA hai| dUsarA saptAha hote-hote ina yamikAoM meM kilATIyana ( caseation) cala par3atA hai| isameM hotA yaha hai ki yacimakA ke kendrabhAga ke kozAoM kI bahIrekhA ( outline ) For Private and Personal Use Only

Page #611
544 vikRtivijJAna miTane lagatI hai abhiraMjana karane para una para prasaratayA ( diffusely ) raMga car3hatA hai tathA unakI nyaSTiyA~ lupta hone lagatI haiN| eka prakAra ke isa AtaMcI nAza ( coagulation necrosis ) ke vahA~ hone ke kAraNa yacimakA kI saba racanA abhilupta ho jAtI hai aura yaghimakA eka zuSkakaNIya dadhika padArtha ( dry granular cheesy material ) meM pariNata ho jAtI hai| upasi ( eosin ) se raMgane para yadimakA meM bAhyabhAga meM asita nIlalasIkozA hote haiM, usake pariNAha meM pANDura adhicchadAbhakozA rahate haiM jinameM mahAkozA upasthita bhI raha sakate haiM aura anupasthita bhI tathA usakA kendra eka samarasa padArtha se bharA rahatA hai jisakA varNa lAla hotA hai| yaha kadApi nahIM samajhanA cAhie ki yakSmA ke sAtha sadaiva kilATIyana huA hI kre| yadi alpa ugra yakSmAdaNDANu alpamAtra hoM yA zArIrika pratirodhaka zakti tIvra ho to jo paramacayika yakSmA hotI hai usameM kilATIyana bilkula bhI nahIM milatA / kilATIyana ke kartA 2 hote haiN| eka yakSmAdaNDANu kA vipa aura dUsarA vikSata kI raktahInatA ( avascularity of the tubercle ) maiDalara ne isa viSaya kA adhyayana karake batalAyA hai ki adhicchadAbhakozAoM kI durgati se prabhAvita hokara parama kAruNika bahunyaSTikozA sarvaprathama usa padArtha meM pahu~cate jisakA kilATIyana honA hai| vahAM ve yaha jAna kara ki unakA korA AzIrvAda unakI rakSA karane meM asamartha hai to ve dabe pAMva lauTa Ate haiM arthAt kilATIyana prArambha hote samaya ve vahAM nizcita rUpa se anupasthita milate haiN| ____ Age kilATIya vikSata kA kyA hotA hai isakA vicAra karanA hai| ho sakatA hai ki vaha vikSata pUrNatayA lupta ho jAya aura apanA cihna taka na chodd'e| aisA hama prAyaH dekhate haiN| jina rogiyoM kI yakSmAnAzaka cikitsA kI jAtI hai unake kSarazmi citra meM pahale vikSata dekhe jAte haiM jo bAda meM bilkula nahIM rhte| kaI rogiyoM ke udaracchada meM ekabAra zastrakarma karane para aneka yadimakAe~ dRSTigocara hotI haiM para ve hI yakSmAhara cikitsoparAnta aura dUsarI bAra zastrakarma karane para pUrNataH vilupta milatI haiM to kilATIya vikSata kA eka gamana usakA mUloccheda bhI ho sakatA hai| kilATIya vikSata kA dUsarA mArga usameM cUne kA bharanA yA cUrNIyana hai| vikSata meM cUnA bhara diyA jAtA hai aura tAntava Uti use cAroM ora se DhaMka letI hai| aisA lagatA hai ki mAno marA huA sA~pa yA rassI kA Tukar3Avat vaha ho gayA ho / parantu sAvadhAna ! isa vikSata ke garbha meM sajIva yakSmAdaNDANu rahate haiM jo kisI bhI samaya phUTa sakate aura rogI ko sA~pa kI taraha Dasa sakate haiM !! bvAyaDa ne isake lie soye hue kutte kA udAharaNa diyA hai| ___eka aura mArga yakSmAdaNDANuoM kA antazchadIya kozAoM dvArA le jAyA jAnA hai aura pAsa hI navIna vikSatoM kA vikasita karanA hai jo bhI bahudhA dekhane meM AtA hai| do prakAra kI yacimakAoM kA jJAna mAnavIya zyAmAkasama yakSmA meM rica tathA For Private and Personal Use Only

Page #612
yadamA maikkauDauMka ne diyA hai / unakA kahanA hai ki alpaupra yacamadaNDANuoM ke kAraNa kaThina yakSmikAe~ ( hard tubardles ) banatI haiM jo pRthak-pRthak hotI haiM jinake bAhya bhAga meM lasIkozA hote haiM bhItara adhicchadAbha kozA bhare hote haiM thor3e se mahAkozA rahate haiM tathA thor3e yakSmAdaNDANu unake andara dekhe jAte haiN| dUsare prakAra kI mRdula yacimakAe~ ( soft tubercles ) hotI haiM jinakA nirmANa ugra yakSmadaNDANuoM dvArA hotA hai ye prasara hotI haiM inameM kozA DhIle DhIle vinyasta rahate haiM unake kinAre anizcita hote haiM, unameM kaI prakAra ke kozA milate haiM atinAza bahuta hotA hai tathA unameM yakSmAdaNDANuoM kA bahuta bar3A bhaNDAra dekhA jAtA hai| kaThina yadimakAoM ko yakSmAdaNDANuoM ke bhAsvavimedi ( phospholipins) banAtI haiM jaba ki mRdula yacimakAe~ yakSmAdaNDANuoM ke sikthoM ( waxes ) ke dvArA banatI haiN| utsyandI pratikriyA-abhI taka hama eka aise prANI kI yacimakA ke vikAsa kA vicAra kara rahe the jo pahalI bAra yakSmA dvArA pIDita huA ho| aisI avasthA meM hama vizuddha utpAdI pratikriyA bhale prakAra dekha sakate haiM yA samajha sakate haiM / aba yadi hama mAnava jIvana para dRSTipAta kareM jahA~ upasarga barAbara mAnava para prahAra karatA rahatA hai aura kabhI-kabhI to Abhyantara meM samAyA upasarga prabhAva karane lagatA hai to hameM usa prANI kI yAda A jAvegI jise phira se dUsarI bAra yakSmA dvArA upasRSTa kara diyA gayA ho| uttarajAta (secondary) upasarga ke lagate hI utpAdI pratikriyA kI vizuddhatA samApta ho jAtI hai| vahA~ to prANI meM pratIkAritA aura anUrjA nAmaka do aura zaktiyoM ko samajha lenA par3atA hai| phAnapirkeTa pratikriyA meM jahA~ pahale antaHkSepa kA prabhAva zAntatApUrvaka hotA hai dUsare antaHkSepa meM kucha hI ghaNToM meM vAhiniyA~ caur3a jAtI haiM lasI bhara jAtI hai aura bahunyaSTi kozA daur3ate cale Ate haiM jisake kAraNa antaHkSipta bhAga lAla par3a jAtA hai aura sUja jAtA hai| thor3e kAla pazcAt yaha vraNazothAtmaka upadrava daba jAte haiM aura praguNanAtmaka parivartana hokara yadimakA kA nirmANa ho jAtA hai| prAthamika upasarga meM jitanI saralatA se aura dhIre-dhIre ye parivartana yadimakA kA nirmANa karate haiM vaisA aba nahIM miltaa| ___yahA~ zIghra yadimakA kA nirmANa hotA hai aura pratikriyA drutagati se hotI hai aura atizIghra zAnta bhI ho jAtI hai jisake kAraNa vikSata zIghra hI lupta bhI ho jAtA hai| ye jitanI tvacAgata pratikriyAe~ dekhI jAtI haiM ve saba anUrjA (allergy ) ke kAraNa dekhI jAtI haiM tathA anUrjA ke sAtha sAtha rakta meM lasIkozotkarSa hotA hai| yakSmA kI antimAvasthA meM yaha anUrjA khatama ho jAtI hai aura usakA sthAna vyUrjA ( anergy ) le letI hai| vyUrjA hone para tvacAgata pratikriyAe~ nAstyAtmaka ho jAtI haiM tathA lasIkozotkarSa samApta ho jAtA hai / ___ ye jo anUrjA ke kAraNa aneka pratikriyAe~ hotI haiM unhIM ko utsyandI pratikriyAe~ kaha kara pukArA jAtA hai ye saba dvitIyaka upasarga ( secondary infection ) ko batalAne vAlI haiN| For Private and Personal Use Only

Page #613
546 vikRtivijJAna hama eka koSThaka dekara yaha prakaTa karanA cAhate haiM ki pratIkAritA, daNDANuoM kI ugratA aura yakSmA ke vikSatoM meM kyA sambandha hai tAki yaha viSaya aura spaSTa ho jAve - - - daNDANukI zArIrika ugratA pratirodha yakSmAdaNDANu kA zarIra para prabhAva 1-sama sama 2-alpa | adhika 3-atyalpa / 4-adhika alpa sAdhAraNa yadimakA banatI hai jisameM UtinAza, mahAkozA, jAlaka nirmANAdi yathAvat pAye jAte haiN| paramacayika yakSmA hotI hai utinAza aura mahAkozA nahIM milate yaha uNDaka aura lasagranthikAoM meM bahudhA dekhane meM AtI hai| halakA tantUtkarSa mAtra milatA hai, UtinAza nahIM hotA, yacimakA nahIM bntii| phuphphusacchada ke zAnta vikSata isI prakAra ke banate haiN| timRtyu adhika, yakSmikAe~ aneka, kabhI-kabhI mahA. kozA milate haiM jAlaka nirmANa kA prayatna calatA hai parantu surakSAtmaka zleSajanatantuoM kA nirmANa nahIM hotaa| yaha tIvra phuphphusa yakSmA meM dekhA jAtA hai| yahA~ saMyojI Uti kI koI pratikriyA nahIM ho paatii| jAlakanirmANa, yakSmikAnirmANa, mahAkozAnirmANa saba banda rahatA hai| yacamAviSa kI tIkSNatA ke kAraNa utiyA~ kevala galanA jAnatI haiN| yaha bhayaGkara zoSa roga meM dekhA jAtA hai| 5-atyadhika atyalpa vikRtazArIra aba hama phuphphusa yacamA ke vikRta zArIra para vicAra karate haiN| isa vicAra meM hama prAthamika aura uttarajAta upasargoM kI vikRtiyoM ko sarvaprathama aura eka bAra punaH pratyakSa kareMge prAthamika upasarga-prAthamika upasarga dvArA nirmita vikSata sadaiva kilATIya rUpa dhAraNa karatA hai, vaha phuphphusa ke kisI bhI kSetra meM bana sakatA hai para prAyaH hotA vaha usake dharAtala para aura phuphphusacchada ke nIce hI hai| yaha vikSata niyamataH akelA hI hotA hai para kabhI kabhI do yA tIna vikSata bhI mila sakate haiN| kilATIya kSetra ke cAroM ora eka zyAmAkasama yA upazyAmAkasama granthikAoM kA samUha pAyA jAtA hai inameM kucha to vAstava meM yadimakAe~ hI hotI haiM jo saMyojI Uti kI paTiyoM (septa) meM pAye jAte haiN| unameM se kucha gANvika vikSata (acinus lesions ) hote haiM usakA kAraNa hotA hai yakSmaprakriyA dvArA zvasanikAoM kA AkrAnta karanA jisake kAraNa kucha strAva ( exudation ) nikalane lagatA hai aura jo zIghra hI kilATIya For Private and Personal Use Only

Page #614
yakSmA rUpa dhAraNa kara letA hai| yadi ina granthikAoM meM se koI kisI raktavAhinI meM phaTa jAve to usake kAraNa sarvAGgINa yA phauphphusika zyAmAkasama ( miliary) yakSmA utpanna ho jaavegii| yadi vahI kisI bar3e klomanAla meM phaTa par3e to usake kAraNa bhI sampUrNa phuphphusa meM gANvika vikSata bana jAte haiN| ye gANvika vikSata prAthamika upasarga ko na prakaTa karake dvitIyaka yA uttarajAta upasarga ke dyotaka hote haiN| prAthamika upasargakAla meM phuphphusa meM vivara nirmANa ( cavity formation ) nahIM hotaa| isameM ropaNa yA to cUrNIyana (calcification ) dvArA hotA hai athavA yahA~ asthIyana (ossification ) hotA hai aura vAstavika asthi nirmita hotI hai| uttarajAta upasaga-kisI bhI mArga se zarIra meM gayA huA yakSmAdaNDANu antatogatvA phuphphusa ke jIvitaka tathA klomanAla prAcIra ( bronchial wall) meM sthita lasAbha Uti dvArA pakar3A jAtA hai| dakSiNa phuphphusa isa roga meM jitanA adhika prabhAvita hotA hai utanA vAma phuphphusa nahIM jisakA kAraNa yaha hai ki kaNThanADI ke sAtha jitanA dakSiNa klomanAla kA sIdhA sambandha hai utanA vAma klomanAla kA nahIM hai| koI bhI kAraNa kyoM na ho| uttarajAta upasarga kA vikSata sadaiva phuphphusa zIrSa meM dekhA jAtA hai| phuphphusa kI noka (agra) se 1-13 iJca nIce Akara yaha vikSata banatA hai| cAhe roga kA prArambha adhokhaNDa meM hI ho parantu vikSata phuphphusAgra se thor3A nIce yaha vikSata avazya banA karatA hai| phuphphumAna meM hI vikSata kyoM banatA hai isake sambandha meM aneka mata haiM para unameM sarvAdhika mahatva kA mata Dauka kA hai| usakA kahanA hai ki eka vyakti ko nirantara kaI ghaMTe taka ucchIrSa avasthA ( erect posture ) meM khar3e rahanA par3atA hai jisake kAraNa phuphphusazIrSoM meM sadaiva dhamanIka nipIDa ( arterial pressure ) kama rahA karatA hai jisake kAraNa jAraka kA tanAva bhI kama rahatA hai| jina sthAnoM para jAraka kA nipIDa kama hotA hai vahA~ yakSmAdaNDANu prAyaH apanI jar3a jamA liyA karate haiM isI kAraNa phuphphusAgra yakSmAdaNDANuoM ke lie sukhAsana kA kArya karate haiM / eka roga kA nAma hai dvipatrakIya saMnirodhotkarSa ( mitral stenosis) isa roga ke kAraNa phuphphusa zIrSoM para bhI dhamanika raktanipIDAdhikya rahatA hai / isa roga se pIDitoM ko yakSmA kA zikAra hote nahIM dekhA jAnA bhI Dauka ke mata kI puSTi karatA hai| hai| hamAre deza meM AcAryoM ne zIrSAsana ko buddhivaddhaka aura Ayuprada batAyA hai| zIrSApana karane se phuphphusazIrSa kA dhAmanika nipIDa avazya bar3hatA hai ho sakatA hai yakSmAdaNDANuoM ke sukhAsana ko naSTa karanA hI sarvAdhika AyupradAtA mAna kara hI aisA batalAyA gayA ho| koI bhI kAraNa ho, phuphphupazIrSa meM hama sadaiva uttarajAtIya yakSma vikSata ko pAte haiN| yaha vikSata kucha kAla taka sakriya rahatA hai phira usameM tantUtkarSa hone lagatA hai aura thor3e dina bAda vaha ropita ho jAtA hai aura usake sthala para eka kSudra, nimnita, raGgita vraNavastu raha jAtI hai| raMga kA kAraNa yaha hai ki dhUla ke kaNoM ko lAde hue For Private and Personal Use Only

Page #615
548 vikRtivijJAna bhakSikozAoM kA jo kAphilA lasavahAoM meM hokara calA ArahA thA aura apane gantavya sthAna kaNThaklomanAlIya lasagranthikAoM ko jAnA cAhatA thA use mArgAvarodha ke kAraNa mArga meM hI vikSata sthala para rukanA par3atA hai jisake kAraNa varNa meM parivartana dekhane meM AtA hai| aNvIkSaNa karane para eka racanAvihIna (structureless ) kendra dikhAI detA hai jisake cAroM ora raMgI tAntava Uti kA eka saghana kaTibandha banA rahatA hai yA sampUrNa vikSata vraNavastu mAtra hI dikhatA hai| kilATIya padArtha meM cUne ke lavaNa bahudhA nissAdita hue dekhe jAte haiN| inhIM cUne ke lavaNoM ke kAraNa kSarazmi citra dvArA hameM yakSmA ke vikSatoM kA jJAna prApta hotA hai| jaba cUrNIyita granthikAe~ bahuta hotI haiM to citra pASANa khani ( stone quarry ) svarUpa kA lagatA hai / yaha tantUtkarSa dvArA ropaNa kA eka prakAra hai / phuphphusa cUrNIyana (pulmonary calcification ) yadyapi ropita yacmA ke kAraNa hotA hai, parantu isakA yaha artha nahIM ki aba kisI prakAra vaha nahIM hotaa| amerikA meM atiprarasotkarSa ( histoplamosis) nAmaka roga ke kAraNa tathA eka prakAra ke prajIvIkavakaroga (coccidiomycosis ) nAmaka rogoM meM bhI phuphphusa cUrNIyana dekhA jAtA hai / phuphphusazIrSa kI tAntava vaNavastue~ unakA vikSAmeNyika varNa ( anthracotic pigmentation ) tathA svalpa vAyukozAbhistaraNa ( emphysena) kA milanA Adi lakSaNa yakSmA ke astyAtmaka mAne jAte haiN| parantu maiDalara ne isa tathya ko na mAnanA hI svIkAra kiyA hai| usake kathanAnusAra phuphphusazIrSoM meM vraNavastu yamo. pasarga se adhika mAtrA meM pAI jAtI haiM / yamavikSata dvArA banane vAle aura sAdhAraNataH phuphphusazIrSa para pAye jAne vAle vraNavastuoM ( scars ) meM bahuta antara vaha batalAtA hai| aisA lagatA hai ki phuphphusazIrSi vraNavastu do prakAra kI hotI hogii| eka yamajanya aura dUsarI saikajA ( silica ) nAmaka rjyukt| saikajA kI upasthiti hone para sarvaprathama upaphuphphusacchadIya lasavahAoM meM saikata rajayuktakozAoM kA nissAda ho jaavegaa| phira pratyakSa Uti kA praguNana hogA tathA vAyukozA prAcIroM meM zleSmajana ekatra ho jAtI hai| phira phuphphusacchada kA zleSmajanayukta sthaulya ho jAtA hai| yakSmA kA zreNIvibhajana ( classification ) karanA bahuta kaThina kArya hai para isa roga meM jo parivartana hote haiM unheM hama 3 samUhoM meM vibhakta kara sakate haiM jo isa prakAra haiM : 1. tantukilATIya yakSmA ( fibrocaseous tuberculosis ) 2. yakSmakilATIya zvasanaka ( tuberculous caseous pneumonia) 3. tIvrazyAmAkasama yakSmA ( acute miliary tuberculosis) aba hama inhIM kA varNana saMkSepa meM kreNge| tantukilATIya yakSmA ise jIrNa satraNa yakSmA ( chronic ulcerative tuberculosis ) bhI kahate haiN| yaha yakSmA kA vaha prakAra hai jisameM yamadaNDANu adhika mAtra hokara For Private and Personal Use Only

Page #616
yadamA 546 AkramaNa karate haiM yA ve atyadhika ugra hote haiN| zArIrika praticAra ( response) bhI unake prati atipracaNDa hotA hai| yahA~ para kAkaghaTanA bahuta spaSTa ho jAtI hai| __ vikSata kI kilATIya Uti TUTa kara klomanAla meM phUTa jAtI hai aura zarIra upasarga ko bAhara pheMka dene kA yatna karatA huA pratIta hotA hai| isake kAraNa klomanAla prAcIra TUTa phUTa kara durbala ho jAtI hai tathA abhistAra karane lagatI hai| yaha kriyA hI phuphphusa meM vivaranirmANa kA zrIgaNeza karatI hai| jyoM jyoM adhikAdhika kilATIya Uti mRdula ho jAtI hai vaha klomanAla meM phUTatI jAtI tathA tyo tyoM hI vivara bar3A hotA jAtA hai| yaha citra zArIrika pratirodha aura jIvANvika ugratA nAmaka do zaktiyoM ke santulana ke anusAra choTA yA bar3A banakara sanmukha AtA hai| zarIra kI pratirodhaka zakti jitanI hI sudRDha hogI utanA hI adhika tantUtkarSa vahA~ para hogA jisake kAraNa vivara kI prAcIroM meM utanI hI adhika tAntavaUti car3hI huI rhegii| ___ phuphphusazIrSa para isa roga meM prAyaH hama eka yA do vibhinna AkAra ke vivara dekhA karate haiM / ina vivaroM kI prAvara masRNa ( smooth ) hotI hai, yaha granthikIya ( noduler ) bhI ho sakatI hai, parantu yaha eka tIvra vivara jaisI cIrayukta ( ragged ) avasthA meM nahIM AtI aura kaTI phaTI sI nahIM dikhatI kyoMki isa para eka nizcita sasIma kalA kA AstaraNa car3hA hotA hai| isa vivara ke bhItara prAyaH zvAsanalikA tathA raktavAhiniyA~ pAragamana ( traverse ) karatI huI dekhane meM AtI haiM / ina vAhiniyoM kA aparadana hone se yA unakI prAcIroM meM choTI choTI sirAja granthiyA~ ( aneurysms ) banane se gambhIrasvarUpa kA Urdhvaga raktapitta (raktasrAva-haemorrhage ) ho sakatA hai| __ ina vivaroM kA ropaNa bhI hotA hai jo yA to vahA~ para vraNavastu ke nirmANa ke kAraNa athavA kilATIya padArtha ke bhara jAne ke kAraNa huA karatA hai / vivara ke samIpa choTe choTe kaI gANvika saghana vikSata pAye jAte haiM ye kaI kaI Apasa meM milakara bar3e bar3e AkRti ke puMjoM meM badala jAte haiN| Upara ye puMja adhika milate haiM tathA nIce kama / jisa prakAra eka garmANu (acinus ) phuphphusa uti kA mUla eka hai usI prakAra gANvika vikSata phuphphusa yakSmA kI vaikArikI ke mUla eka hote haiN| phuphphusIya gartANuoM para yakSmakaNana ati kA AkramaNa hotA hai jisake kAraNa yA to usakA avapAta ho jAtA hai yA phira usameM srAva bhara jAtA hai jo atizIghra kilATIya rUpa dhAraNa kara letA hai| isa prakAra ke vikSatoM ke kendra meM eka sUkSma zvAsanAlI yA klomanAlI hotI hai aura usa nAlI ke cAroM ora candra granthikAoM ke samUha rahate haiM ye prArambha meM pANDura tathA pArabhAsI (translucent) hote haiN| para jaba unameM kilATIyana hotA hai to ve pArAndha ( opaque ) ho jAte haiM aura unakA varNa zveta yA pIta ho jAtA hai| unake kaTe hue tala para aneka tAntava tAra dekhe jA sakate haiM jo tantUrakarSa kA kitanA bhAga unake nirmANa meM rahA hai ise batalAte haiN| tantUtkarSa For Private and Personal Use Only

Page #617
550 vikRtivijJAna kI aura adhika puSTi zvAsa nAlI tathA vAhinya prAcIroM ke sthUlana se ho jAtI hai| isa dharAtala se sambaddha phuphphusacchada bhI sthUlita ho jAtA hai aura usameM navIna kAMsyakroDa (plUrisI-urastoya ) ke lakSaNa dekhane ko milane lagate haiN| phuphphusacchadIya abhilAgoM ( pleural adhesions ) sadaiva ropita vA sakriya yakSmA ke nidarzaka mAne jAte haiN| ye bhI mahattvapUrNa haiM kyoMki ve isa prakAra prabhAvita phuphphusa kSetra ko vizrAnti pradAna karate haiN| isa roga meM prAdezika lasagranthikAe~ prabhAvita nahIM hotI jaisA ki prathamopasarga meM avazyameva dekhA jAtA hai| zAyada hI kisI para koI prabhAva par3atA ho| isakA kAraNa yaha hai ki prathamopasarga ke kAraNa inameM bahuta pratIkAritA utpanna ho jAtI hai jo yakSma daNDANuoM ko apane andara Ane se rokatI hai, para jinameM thor3I usakI kamI ho jAtI hai unameM halakA sA prabhAva bhI dekhA jA sakatA hai| uttarajAta yakSmA ke tantukilATIya prakAra kI tulanA yadi hama prAthamika prakAra ke roga ke sAtha kareM to hameM 3 mahatva ke lakSaNa dikhalAI dete haiM: 1-vivaranirmANa 2-gANvika vikSatoM kA Adhikya, 3-kaNThazvAsanAliya lasagranthikAoM kA yakSmopasarga se aprabhAvita rhnaa| aNvIkSa citra meM bhI paryApta antara rahatA hai| prAthamika vikSata zyAmAkasama ( mi. liary ) banatA hai / yamikA kA mukhya ghaTaka adhicchadAbha kozA rahatA hai / yaha prati. kriyA yacmA kI pramukha dyotikA ( characteristic ) hai| cAhe sAmAnyatayA milane vAle mahAkozA aura kilATIyana na mileM parantu adhicchadAbha kozA bahuta bar3I saMkhyA meM avazya milatA hai| adhicchadAbha kozAoM ke cAroM ora choTe gola kozA yA lasIkozA pAye jAte haiN| eka eka yacimakA anya anya yadimakA ke sAtha milakara bahuta bar3A puMja (mass) banA letI hai| ina puMjoM meM kilATIyana kI upasthiti bahuta spaSTa rUpa se prakaTa hotI hai| kilATIya kendra ke andara kucha pratyAstha (ilAsTika) Uti bhI mila jAtI hai| isI Uti ke kAraNa kilATIya puMja meM itanI kar3AI dekhane meM AtI hai| para jaba kilATIyana ke Upara pUyajanaka jIvANu apanA aDDA jamA lete haiM to ve isa pratyAstha Uti ko bhI galA dete haiM jisake kAraNa kilATIka padArtha DhIlA ho jAtA hai aura SThIva meM pratyAstha Uti ke tantu pAye jAte haiN| jAlaka ( reticulum ) ke abhiraMjana karane vAle abhivarNa se raMgane para pratyAstha Uti kI bahulatA kA jJAna saralatApUrvaka ho jAyA karatA hai| tantukilATIya yakSmA meM uparokta parivartanoM ke sAtha sAtha tanturUhoM (fibroblasts ) kA praguNana bhI mukhya ghaTanA hai jisake kAraNa saMyojIUti kA khUba nirmANa hotA hai| jisake kAraNa antarkhaNDikIya paTiyoM kA sthUlana ho jAtA hai, phuphphusacchada bhI sthUla ho jAtI hai tathA zvAsanalikAoM tathA raktavAhiniyoM kI prAcIreM bhI khUba moTI par3a jAtI haiN| pratyAstha Uti bhI bar3ha jAtI hai / vAhiniyoM kA na kevala bAhya For Private and Personal Use Only

Page #618
551 yakSmA cola hI bar3hatA hai antazcola bhI praguNita hokara abhilopI antazchadapAka ( endarteritis obliterans ) hotA huA dekhA jAtA hai jisake kAraNa vAhinI kA mukha taMga hote-hote pUrNataH lupta taka ho jAtA hai| vAhiniyoM kA yaha parivartana prabhu kI ananta anukampA kA vAstavika paricaya mAnanA cAhie jisake kAraNa raktastrAva kI pravRtti kI paryApta rokathAma ho jAtI hai / isa roga ke sAtha meM thor3A yA bahuta zvAsanalikApAka ( bronchitis) avazya milatA hai| uparokta sampUrNa parivartana yakSmAdaNDANu kI kRpA ke pratyakSa pariNAma mAne jAte haiN| ina parivartanoM ke atirikta, vikSatoM ke samIpa ke vAyukozAoM se kucha to avapatita ho jAte haiM, kucha meM srAvI lasI bhara jAtI hai tathA kucha meM prasekI ( catarrhal) kozA bhare hue dekhe jAte haiN| inakA bhI kAraNa yakSmaviSa kA prasaraNa hI mAnA jAtA hai / srAva ke andara jAlaka tantu ( reticulum fibres ) bhI mila sakate haiN| jaba roga adhika tanvAbharUpa (fibroid form) dhAraNa karane lagatA hai to vAyu kozAoM ke AstaraNa ke kozAoM meM bahuta parivartana dekhane meM AtA hai arthAt ve cipiTitarUpa (flattened form ) tyAga kara ghanAkArarUpa ( cubical form) dhAraNa kara lete haiM / isa parivartana kA pariNAma yaha hotA hai ki vAyukozAoM kI racanA granthIka (glandular ) ho jAtI hai| yakSmakilATIya zvasanaka yadi adhika saMkhya yamadaNDANu alpa pratIkAritAyukta prANI para AkramaNa kareM to usake kAraNa jo vikRta zArIra dekhane meM AtA hai vaha bahuta bhinna hotA hai tathA jo roga banatA hai vaha bahuta tIvrasvarUpa kA hotA hai| yahA~ utpAdI pratikriyA bilkula nahIM milatI usake sthAna para eka prakAra kA utsyandI vikSata (exudative lesion) banatA hai| UtiyoM ke dvArA roga kA koI pratirodha nahIM hotA tathA roga dAvAgni ke samAna phuphphusoM meM phaila jAtA hai| ise hama tIvra zoSa ( acute phthisis ) yA drutagAmI kSaya (galloping consumption ) ke nAma se pukArate haiM / - isa roga kA prasAra do prakAra se hotA hogaa| eka prakAra sampUrNa phuphphusa meM pratyakSa prasAra ( direct extension ) kA ho sakatA hai jisake kAraNa eka dUsare se saTe hue kSetra eka ke uparAnta dUsare prabhAvita hote cale jAte haiN| dUsarA prakAra yaha ho sakatA hai ki yakSmapadArtha ko zvAsa nalikAe~ pracUSita kara leM aura gANvika kilATIya zvasanaka ( acinar caseous pneumonia ) utpanna ho jaave| ye vikSata zIghra hI eka dUsare se milakara yugapaccalita ( confluent ) ho sakate haiN| vikSatIya yugapaccAlana kA pariNAma yaha hotA hai ki jahA~ tantukilATIya yakSmA meM vikSata pRthakpRthak dekhane meM Ate haiM isa roga meM zvasanakIya saMpiNDana ( consolidation ) dekhA jAtA hai / yaha saMpiMDana phuphphupa ke eka khaNDa meM bhI ho sakatA hai, usake eka bhAga meM bhI ho sakatA hai athavA sampUrNa phuphphusa meM bhI mila sakatA hai| isa avasthA meM For Private and Personal Use Only

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552 vikRtivijJAna phuphphusa kI AkRti dhUsara yakRdrUpatA ( gray hepatization ) se milatI huI hotI hai / jahA~ eka ora phuphphusa kA saMpiMDana hotA hai vahA~ dUsarI ora bAhara kI ora ke vikSata roga ko phailAte hue bhI dIkhate haiM / ye yacmazvasanI phuphphusapAka ( tuberculous broncho pneumonia ) ko pradarzita karate haiM / ye vikSata midhmoM ke rUpa maiM itastataH milate haiM / pratyeka sidhma ke kendra meM eka kilATIyita zvAsanAlI hotI hai jisake cAroM ora phuphphusa kA eka saMpiMDita bhAga rahatA hai / ) saMpiDita bhAgoM meM vivara ( cavities ) bhI mila sakatI hai para ye tIvra prakAra ke hote haiM jo tantukilATIya yakSmA ke jIrNa prakAra ke vivaroM se bhinna hote haiM / tIvra prakAra ke vivaroM kA jIrNa prakAra ke vivaroM ke barAbara AkAra nahIM hotA ve choTe hote haiN| isakI prAcIreM masRNa na hokara cIrita ( ragged sImita karane ke lie koI tAntavaUti kA kaTibandha unake hai / phuphphusa yakSmA meM kAMsyakroDa ( urastoya ) tathA zvasanikApAka sadaiva pAye jAte haiN| ye donoM yahA~ bhI avazya hI milate haiM / phuphphusamUlIya lasagranthikAoM meM bhI kilATIyana milatA hai kyoMki phuphphusa meM yamadaNDANuoM ko niyantrita rakhane ke lie Avazyaka pratIkAritA kA bahuta abhAva rahatA hai / hotI haiM tathA unako cAroM ora nahIM rahatA eka vAkya meM yacamakilATIya zvasana kA aNvIkSa citra varNana yaha hai - 'eka vraNazothAtmaka strAva jo zIghra kilATIya ho jAtA hai / ' aNvIkSaNa karane para isa roga karSa nahIM milatA / kozAoM se pUrita phuphphusa ke vAyu kozAoM meM koI jAlaka tantu nahIM milate tathA pratyAstha tantu bhI nahIM milate / mahAkozA yA rAkSasa kozA jo zArIrika pratirodhaka zakti ke nirdezaka mAne jAte haiM bilkula nahIM hote yA bahuta thor3e hote haiM / jhIlanIlasana paddhati se isake srAva kA kAcapaTTa taiyAra karake dekhane para usameM asaMkhya yacamAdaNDANu dekhe jAte haiM / vAyukozAoM ko bharane vAle kozA prasekI ( catarrhal ) hote hai / ye adhicchadIya AstaraNa se nirmita na hokara jAlakAntazchadIya saMsthAna ke protikozAoM ( histiocytes ) kI Uti dvArA utpanna hote haiM / tIvrazyAmAkasama yammA yaha roga tIvra sarvAGgIya yakSmA ( acute generalised tuberculosis ) kA hI eka bhAga hai jisakA varNana hamane pahale kara diyA hai / yaha roga raktadhArA dvArA utpanna hotA hai / Da yamadaNDANuraktatA ( tbbereculous bacillaemia ) tathA sAmAnya zyAmAkasama yakSmA donoM kA bheda samajhane kI sammati dete hue likhatA hai ki yaha sambhava hai ki pratyeka sakriya yakSmarogI meM daNDANu raktadhArA dvArA hI praveza kareM arthAt savahAoM dvArA mahAsirAoM meM pahu~cAye jAveM aura asthiyakSmA, vRkkayacmA, prajananAGgIya yakSmA Adi meM prabhAvagrasta aMga ko yamadaNDANu raktadhArA For Private and Personal Use Only

Page #620
yakSmA 553 ke dvArA hI mileM parantu ina yakSmAoM ke sAtha sAmAnya zyAmAkasama yakSmA bhI vikasita ho aisA nahIM dekhA jAtA / ataH ina donoM ke antara ko jAna lenA bahuta lAbhadAyaka hai yadyapi grIna isa roga ko yamadaNDANuraktatA kA hI eka rUpa mAnatA hai aura donoM maiM koI vizeSa antara karanA Avazyaka nahIM samajhatA / yaha roga daNDANu kI mAtrA ke anusAra calatA hai| yadi kisI prANI ke rakta meM hama adhika saMkhyA meM unheM pahu~cA deM to use turata zyAmAkasama tIvra yakSmA ho jAvegI / yadi koI kilATIya granthi apanA saba padArtha kisI vAhinI meM chor3a de to bhI phuphphusa meM yaha roga ho jAvegA / yadi vaha padArtha nirantara vAhinI meM chUTatA rahe taba to nissandeha yaha roga bana jAvegA / zarIra kI pratirodhaka zakti ko dabAkara sarvatra isa roga ke sakriya vikSata utpanna ho jAte haiM / tIvra zyAmAkasama yakSmA meM phuphphusoM meM atyadhika raktAdhikya ho jAtA hai tathA unameM asaMkhya sUkSma yadimakA jar3a jAtI haiM / ye yacmikA itanI sUkSma hotI haiM jitanA ki savA~ ( zyAmAka ) nAmaka dhAnya hotA hai isI kAraNa inheM zyAmAkasama nAma diyA gayA hai / aMgarejI kA 'miliyarI' zabda bhI usI AdhAra para banA hai / yacimakAe~. hAtha meM vIkSa ( lens ) lekara dekhI jA sakatI haiM / kucha jo 1-2 mi. mI. vyAsa kI hotI haiM phuphphusacchada ke nIce se svayaM camakatI haiM / 1 prArambhika vikSata dhUsara varNa ke tathA pArabhAsI hote haiM jo unameM kilATIyita ho jAte haiM ve pIta aura pArAndha ho jAte haiM / tIvra zyAmAkasama yacamA eka sarvAGgINa roga hai / para jaba koI kilATIya vikSata kisI phuphphusIya dhamanI kI zAkhA meM phUTatI hai taba vaha kevala phuphphusa meM hI milatA hai / aNvIkSa meM dekhane para sampUrNa phuphphusakSetra meM asaMkhya zyAmAkasama yamikAe~ phaila jAtI haiM / ve raktavAhiniyoM tathA zvasanikAoM kI prAcIroM meM, antarkhaNDIya paTiyoM meM tathA vAyukozAoM ke bIca-bIca meM sarvatra pAI jAtI haiM / vAyukozAoM meM prasekI kozA bhara jAte haiM jisake kAraNa saMpiMDana ke choTe-choTe kSetra bana jAte haiM jo kucha kAla pazcAt kilATIya ho jAte haiM / kabhI-kabhI yaha roga jIrNasvarUpa bhI dhAraNa kara letA hai aura isake vikSatoM kA ropaNa tantUrakarSa dvArA ho jAtA hai / ise hama jIrNaprasarita yakSmA (chronic disseminated tuberculosis ) kaha sakate haiN| isameM sampUrNa phuphphusa meM tAntava kSetra phaila jAte haiM ina kSetroM meM se kucha meM upasarga sakriya rUpa meM bhI mila sakatA hai jaba ki antroM meM upasarga bilkula bhI nahIM miltaa| isa roga kA mUla phuphphusabAhya ( extrapulmonary ) hotA hai / jo asthiyoM, lasagranthikoM yA mUtraprajananasaMsthAna meM upasarga hone ke kAraNa vahA~ kahIM se bhI choTI-choTI mAtrA meM AtA hai / ye mUtravikSata varSo gupta rahakara yamadaNDANuraktatA yA visthAyi vijJata utpanna kara sakate haiM / tAntavakSetroM ke cAroM ora vAyukozAbhistaraNa ( emphysema ) 47, 48 vi0 For Private and Personal Use Only

Page #621
554 vikRtivijJAna ho sakatA hai aura usake kAraNa udumbara ( bullae ) bana sakate haiM / yadi ina udumbaroM meM se koI phUTa gayA to vAtoras ( pneumothorax ) hokara prANanAza bhI ho sakatA hai / komanAlIya badamA komavRkSa ( bronchial tree ) meM yakSmA ke bar3e prasiddha vikSata dekhe jAte haiM / vikSata sadaiva klomanAla ke upazleSmalastara meM banA karate haiM aura pArzvoM meM adhicchada ke nIce-nIce phailate rahate haiN| Age calakara unakA eka vraNa ( ulcer ) kA rUpa bana jAtA hai / vahA~ para kaNanaUti kA eka puJja bhI bana jAtA hai / vaha komanAla ke mArga kA avarodha kara detA hai aura isake pariNAmasvarUpa prabhAvita bhAga avapatita ( collapsed ) ho jAtA hai yA vahA~ para prasara jIrNa vraNazotha banakara vahA~ tantUrakarSa kara sakatA hai aura use saMkIrNa banA sakatA hai / ina parivartanoM kA svAbhAvika pariNAma yaha hotA hai ki yakSmAdaNDANuoM kA utsarga ( discharge ) ruka jAtA hai / komanAla se suSiraka ke saMkIrNa hone ke kAraNa uraHkSata ( bronchiectasis ) bhI banatA huA dekhA jA sakatA hai / lakSaNa - vikSatasambandha aba hama phuphphusIya yakSmA se grasita rogI meM sAdhAraNataH pAye jAne vAle lakSaNoM ke kAraNoM kA patA calAte haiM / sAmAnya lakSaNa - yakSmA pIDita vyakti ko jo aneka sAmAnya lakSaNa dekhane meM Ate haiM unameM jvara, kArzya, bhArahAsa, rAtriprasvedAdi kucha haiM / ina lakSaNoM ke hone kA pradhAna kAraNa yakSmA daNDANvika viSa kA zarIra dvArA pracUSaNa kara lenA mAnA jAtA hai 1 jvara - jo 99 se 104 - 5 aMza taka dekhA jAtA hai vaha rogANuoM ke pracUSaNa kA pariNAma hai| zuddha yakSmA ke sAtha sAtha kucha anya upasarga bhI rahakara jvara bulAte haiM bvAyaDa ne isI ko apane vAkya meM likhA hai-- 'The hectic type of fever, in which the temperature fluctuates wildly between subnormal and 104deg or 105deg F isdue to septic absorption, a mixed infection having taken the place of the pure tuberculous one'. yahA~ use yaha dhyAna nahIM rahA ki doSa dUSyoM kI asaMtulitAvasthA ke kAraNa koSThAni ke bAhara Ane se yaha jvara utpanna hotA hai / kAza pazcimI vidvAn prAcIna khojoM kA lAbha uThA pAte ! vaha use yacamajanya nahIM mAnatA aura anya upasargoM ke matthe mar3hatA hai kyoMki use aise aneka bAlakoM kA jJAna hai jinake zarIra meM prAthamika sakriya vikSata hote hue bhI unheM jvara nahIM hotA kyoMki vahAM doSa dUSya santulita rahatA hai aura koSThAni ko adhika prajvalita hone kI AvazyakatA nahIM hotI / bhArahAsa, rAtrimasveda aura araktatA ( anaemia ) Adi ko pratIcIna vijJajana yacamAdaNDANuoM ke viSa ke dvArA utpanna huA mAnate haiM / For Private and Personal Use Only

Page #622
yakSmA kAsa-kAsa kA kAraNa Adhunika vidvAn bar3I zvAsanalikAoM meM vraNazotha ko batalAte haiN| isakA dUsarA kAraNa ve yaha dete haiM ki jaba phuphphusa meM SThIva bhara jAtA hai to usake kAraNa kAsa AtI hai tAki use bAhara pheMka diyA jAve / Ayurveda meM kSayaja kAsa kI samprApti meM hI kSaya ke anya lakSaNa gAtrazUla, jvara, dAha, prakSINa. mAMsatA (asthenia) Adi kA kAraNa samajhA diyA gayA hai viSamAsAtmyabhojyAtivyavAyAdveganigrahAt / ghRNinAM zocatAM nRNAM vyApanne'gnau trayau malAH / / kupitA kSayajaM kAsaM kuryurdehakSayapradam / sagAtrazUlajvaradAhamohAn prANakSayaM copalabhet kaasii| zuSyanviniSThIvati durbalastu prakSINamAMso rudhiraM sapUyam / / taM sarvaliGga bhRza duzcikitsyaM cikitsitajJAH kSayajaM badanti / zUla-gAtrazUla yA phusphusazUla kA kAraNa sAtha meM kAMsyakroDa yA zuSka phuphphusacchadapAka (pleurisy ) kA honA batalAyA jAtA hai| plUrisI meM zUla tanAva ke kAraNa hotA hai gharSaNa (friction ) dvArA nahIM jaisA abhI taka mAnA jAtA rahA hai / _SThIva-phuphphusa meM jo parivartana samaya-samaya para hote rahate haiM unhIM ke anusAra SThIva kA svarUpa badalatA rahatA hai| sarvaprathama dUsarI mAtrA thor3I hotI hai aura yaha sapheda raMga kA hotA hai isameM yakSmAdaNDANu nahIM milte| ve tabhI milate haiM jaba vikSatoM meM kilATIyana hone lagatA hai| yahI kAraNa hai ki zyAmAkasama yacamI ke TIva meM bhI unakA nitAnta abhAva rahatA hai| vivaranirmANa ke sAtha-sAtha SThIva kA parimANa bar3ha jAtA hai aura SThIva ke gaTTe kaTa-kaTa kara Ate hue dekhe jAte haiM jo jala meM DUba jAte haiM aura nimameM yakSmAdaNDANu bharapUra hote haiM / jyoM-jyoM phuphphasIya Uti kA nAza hotA calatA hai SThIva meM pratyAstha (ilAsTika ) ati bhI milane lagatI hai| isa Uti kI pahacAna kA sAdhAraNa DhaMga yaha hai ki ThIva ke eka gaTTe ko kAca kI do paTTiyoM ke bIca dabAkara aNvIkSa dvArA dekha liyA jAve / raktaSThIvana-raktaSThIvana ( haemoptysis ) kaI prakAra se ho sakatI hai| Arambha meM kisI choTI vAhinI ke aparadana ke kAraNa kucha rakta A sakatA hai| Age jaba vivara ko pAra karatI huI kisI dhamanI kA nAza prArambha hotA hai to bahuta adhika yakSmA meM raktasrAva hotA hai| vivara se pAra jAtI huI vAhinI ko AdhAra na milane ke kAraNa usameM eka sUkSma sirAjagranthi bana jAtI hai usake phaTane se bhayAnaka tathA ghAtakasvarUpa kA raktasrAva ho jAtA hai| vAtorasa-kisI vivara ke phaTane se yA kisI upariSTha vikSata ke phUTane se vAtoras ho sakatA hai| ___ anyacihna-ye cihna vaikArika parivartanoM ke anusAra hI hote haiN| inameM saMpiMDana, vivarIbhavana aura phuphphusazchadIya sthaulya Ate haiN| zyAmAkasama yakSmA meM saMpiMDana nahIM milatA / sapiMDana aura vivaroM ke kAraNa vibhinna cihna milate haiM inameM pratisvanatA kA doSapUrNa honA ( defective resonance ), yA usakA atyadhika manda jaaye| For Private and Personal Use Only

Page #623
556 vikRtivijJAna (dall ) honA mukhya hai| sparza karane para vAcika lahariyoM ( vocal fremitus ) kI vRddhi milatI hai| vivara ke Upara nAlikIya zvasana ( tubular breathing ) tathA jora kI zvasanadhvani (amphoric ) bhI milatI hai| ye saba cihna phuphphusacchadIya sthaulya ke kAraNa kama hue mAlUma par3ate haiN| jaba taka tantUtkarSa atyadhika nahIM hogA taba taka zvAsa kI mandatA kASThIya ( wooden) nahIM hogii| jaba kabhI bubud dhvani ( moist rales ) hone lage to kilATIya padArtha kA phUTanA pratilakSita hotA hai| vivaroM ke caur3ane para ye dhvaniyA~ aura adhika gaDagaDAhaTayukta (gurgling ) ho jAtI haiM / kAMsyakroDa (urastoya) ke kAraNa gharSaNadhvani Arambha meM to milatI hai para Age jaba abhilAga bana jAte haiM to nahIM miltii| (8) Antra para yakSmA kA prabhAva [ Antrika yA AntrayakSmA ] phuphphusayamA kA sarvasAdhAraNa eka upadrava Antra kA vraNana hotA hai| hama usI vraNAtmaka yakSmA ( ulcerative tuberculosis) kA varNana nIce de rahe haiN| zaizavakAla meM yakSmopasRSTa dugdhapAna karane se sarvaprathama gavyakavakavetrANujanya yamavikSata Antra meM hI milate haiM / para amerikA meM gavyaprakAra kI yakSmA nahIM milatI aura na bhArata hI usakA zikAra hai / vaha to AMgala bAlakoM meM pAI jAtI hai| ___ kucha vidvAnoM kA yaha vicAra hai jise loka bhI svIkAra kara sakatA hai ki phuphphusa yakSmA se pIDita vyakti jaba apanA SThIva bAhara na thUkakara nigala letA hai to aisA karane se vaha Antra meM yakSmavraNa utpanna karane meM samartha ho jAtA hogaa| parantu yaha bAta bahuta satya yoM nahIM hai ki hamane varSoM SThIva nigalane vAle rogiyoM ko dekhA hai jinako Antra meM eka bhI vikSata yA lakSaNa nahIM mila skaa| isakI vizeSa khoja karane ke lie 72 vaNTamUSoM (guinea pigs ) ko yakSmopasRSTa SThIva khilAyA gayA unameM se 35 ko sAtha meM paryApta mAtrA meM jIvati ga (vitamin C ) diyA gayA tathA 37 ko jIvati ga bahuta kama diyA gyaa| yaha sabhI jAnate haiM ki vaNTamUSoM para yakSmA kA atyadhika prabhAva par3atA hai| parantu isa bhakSaNa prayoga kA pariNAma yaha dekhane meM AyA ki jIvati ga pAnevAle 35 vaNTabhUSoM meM kevala 2 ko Antragata yakSmA huA aura unakI A~toM meM yakSmavaNa bane tathA jina 37 ko alpamAtrA meM jIvati ga diyA gayA thA unameM se 26 ko yaha roga lagA huA pAyA gyaa| ___ uparokta prayoga kA spaSTa artha yaha hai ki yadi jIvanIya dravya hameM bharapUra milate raheMge to cAhe hama phuphphusa vivaroM kA sampUrNa ThIva mahAsrota meM calA jAne deM yakSma vraNa A~toM meM banane vAle nhiiN| jIvati ga ke sAtha jIvati ka aura gha bhI bahuta mahattvapUrNa haiN| For Private and Personal Use Only

Page #624
yakSmA aba aisA mAnA jAtA hai ki Antrika yacmopasarga uttarajAta prakAra kA bahuta adhika dekhA jAtA hai yadyapi pahale itanA hotA hogA yaha mAnA nahIM jAtA thaa| Antra meM yakSmavikRti kisa prakAra hotI hai ise nizcitarUpeNa batalAnA abhItaka isalie kaThina hai ki isa sambandha ke prayoga jina prANiyoM para kie jA sakate haiM unameM yakSmavaNoM kI utpatti karanA svayaM eka bar3I samasyA rahatI hai kAmeTa kA kathana hai ki Antragata vikSata antaHzalyika ( embolic) hote haiM jisake kAraNa Antra prAcIra meM choTe-choTe RNAtra bana jAte haiN| parantu bvAyaDa kI dRSTi meM yaha upasarga jitanA Antrajanita ( enterogenous ) hai utanA raktajanita nhiiN| jaba phuphphusa se atyadhika mAtrA meM yakSmadaNDANu Antra meM jAte haiM to ve vahA~ Antra kI zleSmala kalA ke ghaniSTa samparka meM Akara vraNita ho jAte hoNge| jaba kisI prANI kI upatvacA meM yamadaNDANuoM kA antaHkSepa kara diyA jAve to hama usakI Antra meM yakSmavraNana dekhate haiM use dekhakara upasarga ko raktajanita mAna liyA jA sakatA hai para yaha isalie nahIM mAnA jA sakatA kyoMki usa prANI ke yakRt meM asaMkhya kSudra yamavikSata dekhe jAte haiM jo pittapraNAlI meM phaTate hoMge aura pitta meM hokara Antra meM gamana karate hoNge| maiDalara aura sasAno ne yaha jAnane ke lie 8 vaNTamUSoM kA upayoga kiyA ki unakI A~toM meM upasarga pahu~catA hai ki nhiiN| unhoMne una AThoM prANiyoM meM upatvacA ke nIce yakSmAdaNDANuoM kA antaHkSepa kara diyA aura dekhA ki kevala eka vaNTamUSa meM Antrika vaNana huA hai tathA anyoM meM nahIM huaa| unhoMne zeSa sAtoM vaNTamUSoM kI Antra kI lasAbha Uti kA punarIkSaNa kiyA aura dekhA ki sabhI meM yakSmAvikSata aura yamadaNDANu donoM hI hai| sabase pahale jo vikSata huA vaha eka vraNazothAtmaka strAva thA jo una Antra lasagranthiyoM se hotA thA jo bahuta adhika gaharAI meM lasAbha uti meM paiThI huI thiiN| isI kAraNa unakA lasotsAraNa hotA nahIM thaa| yahA~ se bhakSikozA Akara unheM uThAkara upariSTha dharAtala para le Ate the aura upazleSmalakalA meM unake vikSata bana jAte the| ina vikSatoM ke Upara kI zleSmalakalA kahIM-kahIM mRta hokara apane sthAna se ukhar3a jAtI hai jisake kAraNa eka vraNa prakaTa ho jAtA hai parantu adhikAMza sthAnoM para vaha jyoM kI tyoM rahatI hai isa kAraNa yaha jJAta nahIM ho pAtA ki vahA~ vraNa hai yA nhiiN| ___ Antra kI lasavahAeM kAphI caur3I hotI haiM isa kAraNa bhakSikozA yakSmAdaNDANuoM ko apane garbha meM chipAye hue bar3I saralatA ke sAtha unameM hokara gamana karate haiM aura AntranibandhanIka lasagranthakoM meM pahu~ca jAte haiN| vahA~ pahu~cate hI sabase pahalA unakA yahI kAma hai ki ina granthakoM ( nodes ) ko upasRSTa kara deN| uparoktavarNana se do bAteM spaSTatayA prakaTa ho jAtI haiM : -Antra kA prArambhika yA prAthamika vikSata AntravraNakAraka sadaiva nahIM hotaa| For Private and Personal Use Only

Page #625
vikRtivijJAna 2-lasagranthakoM ke vikSata Antra meM hI hone vAle vikSata hote haiM yadyapi ve pratyakSa tayA nahIM dIkha paate| prAthamika vikSata sarvaprathama saMdaMza ( ileocaecal ) kSetra meM utpanna hotA hai jahA~ se phira vaha Upara yA nIce vikSata utpanna karatA hai / isa kSetra meM lasAbha Uti atyadhika mAtrA meM milatI hai aura usI meM roga kA prArambha sarvaprathama hotA hai isI se yahA~ usakA Arambha honA svAbhAvika sA hai| peyarasidhmoM (peyer's patohes ) tathA ekala lasakUpoM ( solitary lym. phoid follicles ) meM sarvaprathama sUcamagranthakIya dhUsaravarNa ke jo pahale pArabhAsI hote haiM para jo Age calakara kilATIyana se pIta par3a jAte haiM aise vikSata banate haiN| inake Upara kI zleSmalakalA lAla hotI hai| jaba yaha zleSmalakalA chUTa-phUTa jAtI hai to gAdha ( shallow), cIrita, viSamAkRtika tathA dabe hue kinAroM vAle Antra vraNa bana jAte haiN| ina vraNoM kI bhUmi upazleSmalakalA dvArA, AntrapezI dvArA tathA kabhI-kabhI udaracchadakalA dvArA banA karatI hai| kSudrAntra meM vraNa pezI taka jAkara udaracchada taka pahu~ca jAtA hai| parantu bRhadantra meM pezI ke Age vaha bar3ha nahIM pAtA isa kAraNa yahA~ udaracchada para koI vizeSa prabhAva nahIM par3a paataa| kabhI-kabhI to uNDaka se gudaparyanta sampUrNa bRhadantra vraNIbhUta ( ulcerated ) ho jAtI hai| yaha vraNana lasavahAoM ke dvArA hotA hai / lasavahA isa bhAga meM anuprasthatayA ( transversely ) bahA karatI haiN| isake kAraNa sampUrNa Antra meM valayAkAra vaNana hotA hai| mAno ki vraNa kI eka mekhalA bana gaI ho / isI se ise mekhalAkAravraNa (girdle ulcer ) kahA jAtA hai| yaha mekhalAkAravraNa acala nahIM hotA na sthAyI hotA hai vaha Age jAkara Antra ke dIrgha akSa ( long axis ) meM par3a sakatA hai jaba ki vaha kevala eka peyarasidhma meM hI sImita ho jAve / vraNa ke Upara sthita lasyakalA kI lasavahAoM meM choTI-choTI yacimakAe~ milatI haiM jo pramANita karatI rahatI haiM ki yaha yakSmopasarga dvArA banAyA huA vraNa hI hai / ye yadimakAe~ eka tantvirahIya utsyanda (fibroblasticexudate) dvArA AvRta rahatI haiN| AntravaNIya kSetroM meM abhilAga ( adhesions ) prAyazaH dekhane meM Ate haiN| abhilAgoM ke sAtha kabhI-kabhI Antra meM aiMThane (kinks ) bhI dekhane meM AtI haiM jo baddhodara ( obstruction of the bowel ) kara de sakatI haiN| AntrikayacamA kA pramukha upadrava AntrAvarodha hI mAnA jAtA hai / vaNana ke sAtha-sAtha AntranibandhanIka lasagranthaka pravRddha ho jAte haiN| unameM kilATIyana kabhI milatA hai aura kabhI nahIM bhI miltaa| aNvIkSaNa karane para hameM kilATIyana-adhicchadAbha evaM lasIkozAoM kI bharamAra-mahAkozAnirmANAdi yathAvat milate haiN| yahA~ dhamaniyoM meM abhilopI antazchadIya pAka prAyaH hotA hai isI kAraNa yahA~ raktasrAva adhika nahIM pAyA jAtA / mala meM thor3A sA jIvarakta dekhA jAtA hai para usakA artha bahuta bar3e raktasrAva kA honA nahIM hai| For Private and Personal Use Only

Page #626
AntrayakSmA pRSTa 558 yaha citra Antragata yakSmA kA hai isameM vividha kozAoM kI bharamAra Upara spaSTa dRSTigocara hotI hai| nIce kilATIyana dikhalAI derahA hai / For Private and Personal Use Only

Page #627
yadamA 556 yadi AntrayakSmA meM Adhunika yacamopacAra kA Azraya liyA jAve to missandeha ropita ho jAtI hai aisA pratIcIna vidvAnoM kA mata hai| sUrya cikitsA (heliothera. py ) yA nIlalohitAtIta kiraNoM kA prayogAdi karane se AntravraNa avazyameva ropita hone lagate haiN| unake AdhAra bhAga para kaNana Uti banane lagatI hai jisase dhIre-dhIre vraNavastu banatI hai| zleSmala aura upazleSmalakalA ke kozAoM kA to punarjanana taka ho jAtA hai| na kevala nayA adhicchadIya stara hI banatA hai api tu granthiyA~ bhI punaH taiyAra ho jAtI haiN| nayA adhicchada vraNa ke kinAre se banakara usakI bhUmi kI ora jAtA hai| eka aura bhI Azcarya isa bAta se hotA hai ki vaha punarjanana kI kriyA usa samaya hI prArambha ho jAtI hai jaba ki Antra meM vraNazotha apanI pUrNataH sakriyAvasthA meM upasthita rahatA hai| yadi phuphphusa tathA anya donoM sthAnoM para vikSata ho to cAhe phuphphusIya vikSatoM meM roga kI vRddhi dekhI jA rahI ho AntravikSatoM meM ropaNI kriyA cala par3atI hai / ina tathyoM ke kAraNa AntrayamA cikitsA utanI AzArahita nahIM mAnI jAnI cAhie jaisI ki Ajataka mAnI jAtI rahI hai| prasaGgAt Ayurveda isa roga kI cikitsA ke sambandha meM sAdhyAsAdhyatA kA nirdeza do vAkyoM meM isa prakAra karatA hai. (1) vraNitasya ca bhavecchopaH sa cAsAdhyatamo mataH / jisakA artha yaha hai ki yamavraNa ke sAtha zarIra bhI sUkhatA calA jAve yA sUkha jAve to phira vaha rogI asAdhya hI mAna lenA caahie| . (2) mahAzanaM kSIyamANamatIsAranipIDitam / zUnamuSkodaraM caiva yakSmiNaM parivarjayet // : jaba adhika bhojana karate hue bhI rogI kSINa hotA calA jaave| sAtha meM atIsAra se pIDita ho, aNDakoza tathA udara sUja jAveM yA unameM jala bhara jAve to aisA yakSmI chor3a denA caahie| atIsAra yacamA meM honA asAdhyatA kA dyotaka hai isI ko hippokreTIja bhI mAnatA hai-'phthisical persons die if diarrhoca set in' usI kI puSTi sAiDanahaima karatA hai-lastly to close the scene,a loose ness succeeds' ( 3 ) jvarAnubandharahitaM balavantaM kriyAsaham / upakramedAtmavantaM dIptAgnimakRzaM naram // yadi yacamI meM jvara kA anubandha na ho, vaha balavAn aura cikitsA ke kaSTa ko jhela sake, use kArya na ho tathA usakI agnidIpta ho tathA usakA Atmabala ho to aisA nara cikitsA ke yogya mAnA jAtA hai| yahA~ balavanta aura Atmavanta zArIrika aura manovaijJAnika donoM dRSTiyoM ke dyotaka haiN| ___ Antrika yakSmA kA eka upadrava AntrakAryAvarodha hotA hai| jaba Antra kA vinAza bahuta adhika dekhA jAtA hai to itanI adhika vraNa vastu banatI hai aura itane mekhalA vraNa bana jAte haiM ki usake svAbhAvika kArya meM bAdhA utpanna ho jAtI hai| lauDAsana brAuna ne eka rogI ke andara grahaNI se uNDuka taka 20 mekhalA vraNa dekhe the| vAstavika AntrakriyAvarodha kA kAraNa to abhilAgoM ke kAraNa Antra meM par3I aiMThane For Private and Personal Use Only

Page #628
vikRtivijJAna (kinks ) hotI haiN| unhIM ke kAraNa Antrika sannirodhotkarSa ( intestinal stenosis) ho jAtA hai| ____ Antrika yacmA kA dUsarA upadrava chidrodara ( perforation ) kahalAtA hai| yaha upadrava bahuta kama dekhane meM AtA hai kyoMki vraNa kA AdhAra tantUrakarSa dvArA moTA bana jAtA hai tathA usa para udaracchadakalA cipaka jAtI hai| lauDAsana brAuna kI dRSTi meM yaha utanA hI sAmAnya hai jitanA Antrika jvara meN| usane jitane yadhimayoM kI zava parIkSAe~ kI unameM 2.5 pratizata kI A~toM meM pUrNa yA apUrNa chidraNa avazya milA thaa| chidraNa itanI sAmAnya ghaTanA nahIM hai jitanI lauDAsana kahatA hai| pUrNa chidraNa ke sthAna meM apUrNa chidroM kA honA sambhava hai jinake kAraNa malavidradhiyA~ ( faecal abscess ) bana sakatI haiN| kSudrAntra meM pUrNa aura bRhadantra meM apUrNa chidraNa mila sakate haiN| lakSaNa-vikSatasambandha . Antrika yakSmA ke lakSaNa bahuta parivartanazIla dekhe jAte haiN| ve sarvAGgINa aura sthAnika donoM prakAra ke hote haiN| sarvAGgINa lakSaNoM meM balahInatA, bhArahAsa, vAtika prakSobha kI vRddhi Adi adhika hote haiM jo yakSmaviSa ke dyotaka hote haiM / sthAnika lakSaNoM meM udarazUla bahuta mahatvapUrNa hai| yaha zUla vraNoM ke kAraNa nahIM hotA kyoMki ve hRSatA rahita ( insensitive ) hote haiN| usakA pradhAna kAraNa antragata AkSepa ( spasm of the bowels) tathA anya kAraNa udaracchada kA prabhAvI honA aisA mAnA jAtA hai| jaba AntranibandhanIka granthiyoM meM yakSmopasarga laga jAtA hai to dakSiNodarakhAta (right iliac fossa ) meM bahuta zUla huA karatA hai / cUrNIyita pranthiyA~ bhI zUlakAriNI hotI haiN| atIsAra kA upadrava bhI vraNoM se koI khAsa sambandha nahIM rakhatA hai| A~toM kI aticaliSNutA ( hypermotility ) hI atIsArakAriNI hotI hai| aticaliSNutA kA kAraNa Antra prAcIra meM zotha kA honA tathA AntrapezImadhyanADIcakra (myenteric plexus of Auerbach ) kA prabhAvita honA hai / kabhI-kabhI A~toM meM yacimaka vraNana khUba hotA rahatA hai aura atIsAra bilkula nahIM dekhA jAtA aura kabhI kabhI jaba Antrika yacamA ke sAtha atIsAra kA upadrava bhI milatA hai to anya pezImadhyagatanADIcakra meM vikSata pAye jAte haiM jinake kAraNa pragaNDa (ganglian ) kozAoM meM vihrAsa, nADIkaMcukoM meM zopha tathA parinADIya tathA paripragaNDIya kSetroM meM golakozAbharamAra khUba hotI hai| prAyaH kSudrAntra meM yamavikSata hone para malabaddhatA milatI hai, ArohI ( ascending ) bRhadantra ( colon ) meM yakSma vikSata hone para kucha atIsAra ho sakatA hai tathA avarohI (descending)bRhadantra meM vikSata hone para to avazyambhAvI atIsAra prakaTa ho jAtA hai| . . jo vraNoM ke kAraNa pratyakSa lakSaNa dekhe jAte haiM unameM mala ke andara gupta rakta ( occult blood ) tathA pUya kI upasthiti mukhya haiN| For Private and Personal Use Only

Page #629
yakSmA 561 mala meM yakSmAdaNDANuoM kA milanA Antrika yakSmA kI koI khAsa pahacAna nahIM batalAI jAtI kyoMki phuphphusayamApIDita vyakti jaba apanA ThIva nigala letA hai to usake mala meM avazya hI yamadaNDANu mila sakate haiN| yadamamalAzayapAka Antra yacmA ke sAtha-sAtha malAzaya (rectum) meM yakSmopasarga dvArA vraNa banate haiM / vraNa malAzaya ke nicale bhAga meM (guda bhAga meM) adhika banate haiM vraNa ke cAroM ora dhUsara dhabboM ke rUpa meM zyAmAkasama yacimakAe~ bhI banatI huI dekhI jAtI haiM / ye vraNa upariSTha hote haiM inake Upara sUje hue kinAre laTakate rahate haiN| unakI AkRti aNDAkAra hotI hai unakI bhUmi meM paryApta pANDuravarNIya kaNana hotA rahatA hai / gudanalikA ( anal canal ) kA kAThinya ( induration ) tathA granthana ( nodu. lation ) vraNa ke cAroM ora itanA bar3ha jAtA hai ki use dekha kara karkaTa (kainsara)kA AbhAsa hone lagatA hai| gudabhAga meM pAka ho jAtA hai jise yakSmagudapAka ( tuberculous proctitis) kahate haiM / kabhI-kabhI yahA~ nADIvraNa yA bhagandara (fistula) bhI bana jAtA hai| yakSmodaracchadapAka yamodaracchadapAka ( tuberculous peritonitis) yA udaracchadasyUna kA yakSmopasarga tIvra aura jIrNa donoM prakAra kA ho sakatA hai| jIrNapAka sadaiva uttarajAta hotA hai| usakI prAthamika nAbhi zarIra meM kahIM anyatra hotI hai| upasarga kA prabhava ( source ) sadaiva sthAnika hotA hai| upasarga vraNita antra dvArA, upasRSTa AntranibandhanIka granthi dvArA, athavA striyoM meM upasRSTa garbhAzayanAla dvArA phaila sakatA hai| isake atirikta upasarga kA eka sAdhana raktadhArA bhI ho sakatA hai jabaki upasarga kI nAbhi zarIra meM kahIM anya sthAna para ho yaha sthAna bahudhA phuphphusa hotA hai| jaisA ki anya lasya syUnoM ke upasarga meM dekhA jAtA hai udaracchadIya upasarga ke kAraNa utsyandana ( effusion ) utpanna ho kara vaha jalodara ( ascites ) kara sakatA hai| kabhI-kabhI vinA utsyandana ke abhighaTya udaracchadapAka (plastic peritoni. tis ) bhI ho sakatA hai| ina donoM prakAra ke udaracchadapAkoM ko kramazaH AI (wet) tathA zuSka ( dry ) prakAra karake mAnA jAtA hai| Ardra prakAra meM jisameM jalodara sAtha rahatA hai udaracchada meM tudra pIta vA dhUsara varNa kI yakSmikAe~ jar3I hotI haiM tathA udaracchadIya syUna ( sac ) meM paryApta mAtrA meM laghu pIta varNa kA upalabhAsI (opalescent ) tarala bharA rahatA hai jise thor3A sthira kara dene para halakA jAlakIya AtaJca (slender reticulatedclot ) banatA hai| kabhI kabhI tarala raktaraMjita bhI dekhA jAtA hai| isa prakAra meM anya kuNDaliyoM ( coils of intestines ) meM abhilAga nahIM milate aura yadi ve hote bhI haiM to bahuta halake hote haiN| yakSmodaracchadapAka ke zuSka yA abhighaTya rUpa meM utsyandana nahIM hotA para eka For Private and Personal Use Only

Page #630
562. vikRtivijJAna prakAra kA vimatsrAva nikala kara anya kuNDaliyoM ko eka dUsare ke sAtha abhilagna kara detA hai / yaha srAva ( utsyanda) Age tAntava Uti meM pariNata ho jAtA hai / isameM mikAe~ DhUMDhane para bhI bahuta kama milatI haiM kyoMki ve srAva ( exudate ) ke nIce chipI rahatI haiM / vapA yA vapAjAla (omentum) mur3a kara eka lambe arbuda kA AkAra banA letA hai jo udara ke Urdhva bhAga meM par3A rahatA hai / jaba use bAhara se sparza karate haiM to eka puJja ( doughy mass ) sA lagatA hai / anya kuNDaloM meM kilATIyana ke bar3e-bar3e kSetra dekhane meM Ate haiM / ye kuNDala udaraprAcIra ke sAtha abhilagna ho jAte haiM aura unameM chidraNa ho jAtA hai jisake kAraNa mala nADIvraNa ( faecal fistula ) bana jAte haiM / kabhI-kabhI yacamodaracchadapAka ke Ardra aura zuSka donoM rUpa mila jAte haiM jisake kAraNa tarala ke gahvara itastataH milate haiM tathA saghana abhilAga bhI pAye jAte haiM / paramapuSTika yakSmA (uNDukIya yakSmA ) paramapuSTi yakSmA (hypertrophic tuberculosis ) ko bvAyaDa Antrika yakSmA kA hI eka rUpa nahIM maantaa| vaha use kraunaroga (crohn's disease ) se sambaddha kahatA hai tathA pezyutkarSa ( sarcoidosis ) use yakSmA nahIM' mAnatA hai / yaha roga uNDuka (caecum ) yA zeSAntraka ke uNDukIya prAnta meM bAlakoM meM dekhA jAtA hai / isameM na to kilATIyana hotA hai aura na vraNana api tu tantUtkarSa khUba hotA hai jisake kAraNa zleSmakalA kA paramacaya ( hyperplasia ) hotA huA dekhA jAtA hai / zleSmakalA granthika hokara antra ke suSiraka meM uThatI huI sI ( projecting ) prakaTa hotI hai / ina pradhikAoM meM mahAkozA bhale prakAra se bane hue dekhe jAte haiM parantu kilATIyana nahIM milatA Age calakara unakA sthAna tanturuhU ( filbroblastic ) pratikriyA le letI hai / antra prAcIra meM vraNazodhAtmaka tAntava Uti ativedha (permeate) kara jAtI hai isake kAraNa A~teM bahuta adhika sthUlita ho jAtI haiM, kaThina ho jAtI haiM tathA anAmya ( rigid ) ho jAtI haiN| isase A~teM itanI ghira jAtI haiM aura suSiraka itanA saMkucita ho jAtA hai ki usake banda hone kI naubata A jAtI hai / zastrakarma karate samaya aisA lagatA hai ki mAno vaha eka karkaTa ( kaiMsara ) hI ho jisakI puSTi prAdezika lasagranthiyoM kI pravRddhi bhI kara detI hai para vaha karkaTa nahIM hotA yaha bhI satya hai / yaha roga ArohI A~ta kI ora bhI bar3ha sakatA hai tathA pIche zeSAntra meM bhI bar3ha sakatA hai| isa roga ke sAtha koI vizeSa lakSaNa nahIM hote parantu Age cala kara Antrika avarodha ho jA sakatA hai / anya vidvAn bhI isake yadamAjanya hone meM sandeha karane lage haiM / 1. A non caseating so-called hypertrophic form used to be described occurring. in the caecum. These cases are more related to crohn's disease or sarcoidosis Can to tuberculosis. For Private and Personal Use Only

Page #631
yakSmA ( 9 ) upavRkka granthiyoM para yakSmA kA prabhAva ( eDIsanAmaya ) upavRkka granthiyoM ( adrenal glands ) ke bAhyaka ( cortex ) meM hone vAlA eDIsana dvArA ghoSita eka lakSaNa samUha ( syndrome) eDIsanAmaya (Addison's disease) ke nAma se pukArA jAtA hai| isameM uttarottara balahAni ( asthenia ) ho jAtI hai, raktanipIDa kama rahatA hai, tvacA para kAli ( melanin ) nAmaka raMgA car3ha jAtA hai aura vahI raMgA mukha vA yoni kI zleSmalakalA meM bhI milatA hai / vamana aura atIsAra tathA udarazUla vizeSa rUpa se dekhA jAtA hai / roga dhIre-dhIre prArambha hotA hai rogI pahale adhika thakAvaTa anubhava karatA hai aura Age calakara yahI thakAvaTa ( zrAnti ) bhISaNa rUpa dhAraNa kara letI hai / yaha striyoM aura bAlakoM kI apekSA puruSoM meM adhika dekhA jAtA hai kucha bhI ho, yaha roga sadaiva ghAtaka hI hotA hai aisA logoM kA Ajataka kA anubhava hai / mA ke prakaraNa meM hamane isa roga ko isalie liyA hai ki vikRtizAstriyoM kA mata hai ki upavRkkoM ke bAhyaka vinAza kA mukhya kAraNa yakSmAkilATIyana hotA hai / yakSmA 80 pratizata rogiyoM ke roga kA kAraNa banatI huI dekhI gaI hai / yaha roga jIrNasvarUpa kA hotA hai aura mRtyu taba hotI hai jaba viSaraktatA atyadhika bar3ha jAtI hai tathA bAhya kA bahuta adhika nAza ho jAtA hai / isa roga kA kAraNa yacamakilATIyana hotA hai na ki sarvAGgINa zyAmAkasama yakSmA / upavRkka granthiyoM taka roga raktadhArA dvArA pahu~catA hai tathA isakI prAthamika nAbhi anyantra hotI hai / yaha nAbhi kahA~ hotI hai yaha hU~DhanA bahuta kaThina hotA hai / kabhI-kabhI zavaparIkSA karane para upavRkka granthiyoM meM to kilATIyana pAyA gayA para anyatra kahIM bhI yakSmA kA nAma nizAna bhI dekhane ko nahIM milA jo bahuta Azcaryajanaka hote hue bhI isa roga meM vizeSa rUpa se dekhA jAtA hai / aisA mAlUma par3atA hai ki yakSmA kA kAraNa mAnavIya yacamakavakavenrANu hotA hai / gadhya prakAra isameM bhAga nahIM letA nahIM to yaha roga bAlakoM meM adhika milatA jinheM gavya kavakavetrANu kA upasarga adhikatara hotA hai / 563 For Private and Personal Use Only prasaGgAt hama eDIsAnAmaya kAraka anya hetuoM kA bhI ullekha kareMge jo yakSmA se pRthak hote haiM / unameM upavRkka bAlaka kA apoSakSaya yA apuSTi ( atrophy ) eka aura bahuta mahattvapUrNa hai / yaha kahA jAtA hai ki eDIsanAmaya se pIDita 100 rogiyoM meM 80 ko vaha yakSmA ke kAraNa aura 20 ko apuSTi ke kAraNa yaha roga hotA hai / para yaha sAdhAraNa apuSTi hogI isameM sandeha karane kA paryApta avasara hai / kucha kA kathana hai ki jisa prakAra vaiSika yakRtpAka ( toxic hepatitis ) meM Uti mRtyu hotI hai vaisI hI yahA~ hotI hogI aura ve isako tIvra, anutIvra tathA jIrNa viSaraktatA meM vibhakta karate haiM / kucha aisA samajhate haiM ki isa UtinAza kA kAraNa pAzcAtya tIvrauSadha . prayoga hai kucha isakA sambandha phiraMga se jor3anA cAhate haiM / para apuSTi kI vAstavika

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564 vikRtivijJAna prakRti kA koI patA nahIM cltaa| usakA eka kAraNa yaha bhI hai ki upavRkagranthiyoM uttarottara choTe AkAra kI hotI calI jAtI haiN| donoM meM se eka kA hRsvana kucha adhika vega se hotA hai aura dUsare kA kucha dhIre-dhIre / / aba hama isa roga ke kucha lakSaNoM para prakAza DAleMge aura unakA vikSatoM se jo bhI sambandha jur3a sakatA hai jor3a deNge| isa roga meM hameM nimna lakSaNa prAyaH milate haiM 1-daurbalya yA balahAni (asthenia)-nirantara zArIrika bala kA srAsa honA arthAt mAMsakSaya yA mAMsapeziyoM kA uttarottara hAsa honA isa roga kAati mahatva kA lakSaNa hai jisake kAraNa hI rogI uttarottara zrAnta hotA calA jAtA hai| ___2-mahAsrotIyadAruNya (gastro-intestinal crises )-yaha lakSaNa roga ke prArambha kAla se hI rahatA hogA yaha satya nahIM hai| yaha bahuta bAda meM uThatA hai, isameM vamana honA, atIsAra honA tathA udarazUla honA mukhya haiN| kabhI-kabhI to udaraprAcIra itanI kar3I aura anAmya ho jAtI hai jaisI udaracchadapAka meM prAyaH milatI hai| mahAsrotIya dAruNya ke pariNAmasvarUpa bhArahAsa tathA khAdyadravyoM aura oSadhiyoM ke paripAcana meM bAdhA nAmaka do upadrava aura bar3ha jAte haiN| 3-pANDuratA ( pallor ) isa roga kI eka sthAyI ghaTanA hai| 4-aNukozIya araktatA ( microcytic anaemia) bhI mila sakatI hai| 5-SaNDhatA (impotence ) puruSa meM napuMsakatA ke sAtha-sAtha aNDakozoM kI apuSTi tathA strI meM anArtava ( amenorrhoea) tathA napuMsakatA dekhI jAtI hai| 6-hRdaya meM babhru apuSTi hone se vaha choTA hotA calA jAtA hai| 7-zarIra kI lasAbha utiyoM meM sAmAnya paramacaya milatA hai| 8-carma kA raMjana ( pigmentation of the skin ) yA jise kAli carma ( melanoderma) kahate haiM idhara bahuta hotA hai| yaha na kevala carma para hI api tu mukha aura yoni kI zleSmalakalA para bhI prabhAva DAla detA hai| aba hama uparokta lakSaNoM ke hone kA kAraNa kyA hai use spaSTa kreNge| pAThakoM ko yaha smaraNa rakhanA cAhie eDIsanAmaya upavRkka granthiyoM kA roga hai aura vaha bhI bAhyaka (cortex of the adrenal glands) kaa| isa bAhyaka se eka vizeSa bAhyakIya nyAsarga (cortical hormone) utsRSTa hotA rahatA hai| isa nyAsarga kA eka mahatvapUrNa kArya hai| vRkta kI nAlikAoM kI zvasanakriyA ko (jAraka grahaNa karane aura dene kI kriyA ko ) jArI rakhanA tAki punarvRSaNakriyA ( selective reab. sorption of threshold substances) ko barAbara pracalita rakhe / hamAre zarIra meM jo jAraNa kriyAe~ ( oxidative processes ) calA karatI haiM unakA saMyojana jIvati kha2 ( vitamin B 2 ) hotI hai jisakA dUsarA nAma dugdhapiMgI ( riboflavin ) hai / yaha dugdhapiMgI ko bhI apanA kArya karane ke lie isa bAhyaka nyAsarga kI atIva AvazyakatA rahatI hai / isa nyAsarga ke itane tathyoM se paricita karane ke pazcAt For Private and Personal Use Only

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yakSmA aba hama pAThakoM se prArthanA karate haiM ki ve zarIrastha kSArAtu (soDiyama) tathA dahAtu (poTAziyama) kI khoja kreN| ve dekheMge ki hamAre raktarasa meM tathA anya zarIrastha taraloM meM kSArAtu ke lavaNa rahate haiM tathA utikozAoM ke prarasa ( cytoplasm ) meM dahAtu ke lavaNa rahate haiN| hArAtu aura dahAtu svasthAvasthA meM prAyaH apanA sthAna eka dUsare se parivartita nahIM krte| para jaba upavRkka bAhyaka meM roga hone se bAyaka nyAsarga kI utpatti meM kamI AtI hai to vRkka nAlikAoM kI punarpeSaNI kriyA DhIlI par3a jAtI hai jisake kAraNa mUtra meM hokara kSArAtu aura nIreya (klorAiDsa) paryApta mAtrA meM bAhara cale jAte haiN| kSArAtu ke nirantara bAhara jAne ke kAraNa zarIra ke taraloM meM isa tasva kI kamI ho jAtI hai usa kamI ko bharane ke lie kozAprarasa meM sthita dahAtu ke ayana (ions ) taraloM meM Ane lagate haiM tAki AsRtIya nipIDa ( osmotic pressure ) kI gar3abar3I na par3a ske| phira bhI raktarasa kA kSArAtu. dahAtu anupAta gira jAtA hai tathA dahAtu-cUrNAtu anupAta bar3ha jAtA hai| dugdhapigi (rIbophlevIna) yA jIvati kha 2 zarIra kI UtiyoM meM jAraNa kriyAe~ yA samavarta yA cayApacayika kriyAe~ karAtI rahatI hai| vaha bAhyaka nyAsarga ke vinA paMgu hotI hai isa kAraNa vRkkanAlikAoM ke adhicchadIya kozAgucchikAoM dvArA pradatta mUtra meM se dvArIya padArthoM ( threshold substances ) kA punarvRSaNa karane meM asamartha ho jAtI hai aura lavaNa ke donoM ghaTaka kSArAtu aura nIreya zarIra se saralatApUrvaka bAhara cale jAte haiN| zarIra ke taraloM meM isI kAraNa dahAtu bar3hatA calatA hai| dahAtu svayaM eka avasAdaka padArtha hai aura vaha mAMsapeziyoM kA avasAda karake thakAvaTa bar3hA detA hai| yaha jo isa roga meM uttarottara vRddhiMgata zrAnti milatI hai usakA kAraNa isa dahAtu kA Adhikya hai / jaba kabhI bhojana meM dahAtvIya padArtha adhika ho jAte haiM yA zarIra meM lavaNa kI kamI aura bhI kara dI jAtI hai to yaha zrAnti bahuta adhika bar3ha jAtI hai aura roga kA daurA sA ho jA sakatA hai| yadi kisI bhI mArga se zarIra meM lavaNa yA namaka paryApta mAtrA meM pahu~cA diyA gayA to vaha kaSTa kucha kAla ke lie haTa sakatA hai| UtiyoM kI jAraNakriyA meM isa bAyakanyAsarga (cortical hormone) kI kamI ke kAraNa jo bAdhA par3atI hai usakA dUsarA pariNAma yaha hotA hai ki peziyA~ aura yakRt utane vega se aba madhujana kA nirmANa karane meM asamartha ho jAte haiM jisake kAraNa peziyoM dvArA zarkarA kA upayoga ghaTa jAtA hai jisake kAraNa uttarottara mAMsakSaya aura balahAni hotI calI jAtI hai tathA mUlacayApacaya ( basal metabolism) kama ho jAtA hai| ina sabake pariNAmasvarUpa hRdaurbalya khUba ho jAtA hai / dhAtuoM kI jAraNa kriyA ke tIvra karane meM isa nyAsarga kA jitanA mahatva hai use dhyAna meM rakhakara Ajakala kaI cikitsAtmaka camatkAra kie jA rahe haiN| zarIra se nIreya mUlaka ( chloride radical ) kI kamI hone se upanIrodatA (hypochlorhydria ) yA anIrodatA ( achlorhydria) ho jAtI hai jisake kAraNa mandAgni kA honA eka anya mahatva kA lakSaNa hotA hai| For Private and Personal Use Only

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vikRtivijJAna : yadi bAhyakanyAsarga kA yathocita rUpa meM prayoga karAyA jAve to yaha sambhava hai ki uparokta aneka lakSaNa dUra ho jAveMge parantu jo yakSmopasarga ina granthiyoM meM calane lagatA hai usa para koI prabhAva na par3ane ke kAraNa antatogatvA prANanAza ho jAyA karatA hai| yadi nyAsarga kI adhika mAtrA de dI gaI to adhika lavaNa zarIra meM saMcita ho jAne ke kAraNa tathA kezAloM kI ativedhatA ko kama karane kA isa nyAsarga kA guNa hone ke kAraNa zarIra para zopha ( oedema) bar3ha sakatA hai tathA raktanipIDAdhikya bhI ho sakatA hai| / kAlicarma yA tvacA ke raMge jAne ko chor3akara anya jitane bhI lakSaNa isa roga meM dekhe jAte haiM unakA kAraNa kSArAtu kA nAza, jalAbhAva ( dehydration ) tathA nIreyAbhAva hai| jisa prakAra kSArAtu aura nIreya kA punarvRSaNa vRknAlikAe~ nahIM kara pAtIM vaise hI ve jala bhI cUsane meM asamartha rahatI haiM jisake kAraNa zarIra se bahuta bar3I mAtrA meM jalIyAMza bAhara calA jAtA hai jisake kAraNa jalAbhAva ho jAtA hai tathA zoNasaMkendraNa ( haemoconcentration ) bhii| / kAlicarma ( melanoderma ) yA tvacAbhiraMjanA kA kyA kAraNa hai vaha abhI taka ajJAta hai kadAcit bAhyakanyAsarga kA abhAva hone ke kAraNa tvacA apane prakRta varNa ko sthira nahIM rakha pAtI aura kAli ( melanin ) usameM bharane lagatA hai| bloca nAmaka vidvAn ne isa viSaya para bahuta khoja kI hai| usakA kahanA hai ki dvi udajAradarzala AsuvI ( dihydroxyphenylalanine ) yA saMkSepa meM dvijAdA (dopa ) eka vizeSa jAreda ( oxydase ) ke sAtha milakara raMge hue kSetra ke kucha kozAoM ke varNa ko gaharA kAlA banA detA hai| isa pratikriyA ko vaha dvijAdApratikriyA ( dopa reaction ) kahatA hai| tvacA meM kAlA raMga AtA hai kAli ( melanin ) se / isa kAli kA nirmANa hotA hai kAliruha ( melanoblasts ) kozAoM dvArA eka vizeSa kiNva kI upasthiti meM rakta se kAlijana ( melanogen ) 'nAmaka varNahIna padArtha liyA jAtA hai aura vaha kiNva use kAli meM pariNata karake svacA ko raMga detA hai| yaha dvijAdApratikriyA kAliruhoM aura viziSTa kiNva kI kriyA ko batalAtI hai| yaha pratikriyA adhitvacA tathA keza kUpikAoM meM atsyAtmaka hotI hai tathA madhyastarIya kozAoM ke lie nAsyAtmaka hotI hai| yaha dvijAdA kAlijana tathA vRkka (adrenalin ) donoM se nikaTa kA sambandha rakhatA hai / jaba upavRkkoM meM kharAbI AtI hai to dvijAdA vRkti na banakara kAlijana bana jAtA hai aura tvacAoM yA zleSmalakalAoM ke una kozAoM meM jahA~ usakI pratikriyA atsyAtmaka hotI hai kAli utpanna karake varNa de detA hai / hama bloca mahodaya ke dvArA diye gaye mata kA Adara karate haiM parantu vaha Aja grAhya isalie nahIM ho rahA kyoMki vRkti kA nirmANa granthi ke majjaka meM hotA hai aura roga granthi ke bAhyaka meM hai| dUsarA yadi yahI uttara paryApta hotA to jaba pUrNataH upavRkka granthiyoM kA uccheda kara diyA jAtA hai taba to zarIra ko kAlAbhUta-sA bana jAnA cAhie para vaha hotA nhiiN| isase aisA lagatA For Private and Personal Use Only

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yakSmA 1567 hai ki bAhyakIya nyAsarga kI hI eka kriyA svacA ko kAlA hone se rokane kI hai jise vaha karane meM asamartha ho jAne se yaha sthiti AtI hai| hama yahA~ pAThakoM ko thor3A Ayurveda jJAna kI ora le jAte haiM jahA~ suzruta ne 5 prakAra ke pittoM kA varNana kiyA hai ye pitta pAcaka, sAdhaka, bhrAjaka, raMjaka aura Alocaka haiN| pAcakapitta kI kamI se agnimAnya hotA hai| sAdhaka kI kamI se hRdaya durbala hotA hai, bhrAjakapitta kI kamI se zarIra meM garmI kI kamI hotI hai jo mUlacayApacaya kI kamI ko pragaTa karatA hai, raMjakapitta kI kamI se zarIra vivarNa ho jAtA hai aura araktatA bhI ho sakatI hai tathA Alocakapitta kI kamI se dRSTi durbala ho jAtI hai| hama isa roga meM ye sabhI vastue~ dekhate haiM aura saba lakSaNa yahA~ milate haiM isalie isa bAhyakanyAsarga ko zarIravyApI pitta kA hI eka aMza kyoM na mAna leN| aisA karane se hameM blocAdi ko binA kaSTa diye hI apane mata ko samajha lene meM suvidhA hogii| bAhyakanyAsarga atyadhika pittaprabhAvaka tatva hai aisA mAnakara eka AyurvedajJa isakA nizzaMka prayoga karake lAbha uThA sakatA hai| uparokta dRSTikoNa se hama eDIsanAmaya ko ghAtaka paittikakSaya kaha sakate haiN| . (10) mUtra-prajananasaMsthAna para yakSmA kA prabhAva yatmavRkkapAka tIvra aura jIrNa donoM prakAra kI yakSmAoM dvArA acamavRkkapAka utpanna kiyaa| jA sakatA hai| zyAmAkasama yakSmA-prathama prakAra zyAmAkasama yacmA hai| jisa prakAra vaha anyatra phailatI hai aise hI vaha mUtraprajananasaMsthAna meM bhI phaila jAtI hai aura vRkka para bahuta prabhAva DAlatI hai| vRkka meM kSudra dhUsara granthakoM ke rUpa meM yadimakAe~ prakaTa hotI haiM jo vRkka ke bAhyaka meM atyadhika saMkhyA meM phailatI haiM utanI ve vRkkamajaka meM nahIM phailtiiN| yaha donoM vRkkoM meM eka sAtha dekhA jAne vAlA roga hai| pUyika vRkta kI bhAMti yaha adhiraktatA ke eka kaTibandha se ghirA huA nahIM miltaa| vraNAtmaka yakSmA-yaha vayaska hone ke uparAnta hone vAlA eka jIrNa roga hai jisakA prArambha pahale eka vRkka meM hotA hai jo Age calakara donoM vRkkoM meM apane paMje jamA letA hai| yaha roga bahuta zanaiH zanaiH hotA hai jisake kAraNa vRkkAla kA itihAsa koI khAsa nahIM dekhane meM AtA / upasarga raktadhArA dvArA yahA~ taka pahu~catA hai, usakI prathama nAbhi phuphphusa, asthi, sandhi, lasagranthakAdi meM se kahIM bhI ho sakatI hai| mAnavI aura gavya donoM prakAra ke kavakavetrANuoM meM se kisI se bhI roga laga sakatA hai| isa roga ke prArambhika vikSata vRkka ke bAhyaka meM dekhe jAte haiM parantu vikSata ke sAmAnya sthAna bAhyaka majaka saMgamasthala yA majaka ke aGkura huA karate haiN| For Private and Personal Use Only

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565 vikRtivijJAna ___ sarvaprathama isa roga meM kozIya pratikriyA usI prakAra hotI hai jaisA ki anyatra dekhI jAtI hai| usake pazcAt kilATIyana hotA hai tatpazcAt taralana dekhA jAtA hai| taralana ke kAraNa kaI yakSmavidradhi bana jAtI haiM jo vRkkamukha (pelvis of the ki. dney ) meM phUTatI haiM / Age cala kara vRkka kI Uti kA atyadhika bhISaNa vinAza hone lagatA hai jisake kAraNa vRkta kA sthAna saghana tAntava prAcIra vAle gahvarita koSThaka ( loculated cysts with dense fibrous walls ) le lete haiN| ina koSThakoM kA AstaraNa yacamakaNana Uti dvArA nirmita hotA hai| ina koSThakoM meM yamapUya bharA rahatA hai jo vRkkamukha taka phailA rahatA hai| isa avasthA ko yakSmapUya vRkkANUtkarSa ( tuberculous pyonephrosis ) kahate haiN| jaba yahI dazA donoM vRkkoM kI ho jAtI hai to mUtra viSamayatA (mUtraraktatA-uraemia) ke kAraNa rogI kA prANa nikala jAtA hai| kisI-kisI meM mRtyu ke pUrva sarvAGgINa zyAmAkasama yakSmA kA puTa bhI laga jAtA hai| kabhI-kabhI jaba vRkka kA adhika vinAza nahIM huA rahatA taba vRkka stUpoM (py. ramids ) meM yacma vivara bana jAte haiM una stUpoM se hokara upasarga bAhyaka taka phailatA huA bhI dekhA jAtA hai usake kAraNa upaprAvarika vidradhiyA~ ( subcapsular abscess) bana jAte haiN| jisa prakAra upasarga Upara kI ora ArohaNa karatA hai usI prakAra yaha nIce kI ora avarohaNa bhI karatA hai jisase vRkkamukha yA vRkkadvAra sadaiva yakSmA se pIDita huA pAyA jAtA hai| kabhI-kabhI kilATIyana ke sAtha cUrNIyana hokara azmarI nirmANa bhI ho sakatA hai parantu yakSmA vRkkAzmarI kAraka roga nahIM mAnA jAtA tathA azmariyA~ jo bahudhA dekhI jAtI haiM ve yakSma nahIM hotii| yakSmavRkkoM se utpanna mUtraprAyaH amla pratikriyA vAlA hotA hai yadi koI anya pUyajanaka upasarga Upara se na car3ha baitthe| jyoM-jyoM roga bar3hatA jAtA hai yakSma kilATIyana ke kAraNa prApta apadravya usameM bar3hate jAte haiM jo mUtra ko gAr3ha ( thick ) tathA Avila ( turbid ) banA dete haiN| mUtra meM rakta prArambha se hI A sakatA hai usakA kAraNa vRkka vAhiniyoM kA cyavana ( leakage ) yA aparadana ( erosion ) koI bhI ho sakatA hai| mathitrAloDita ( centrifugalised ) mUtra kI pratyakSa parIkSA karane para yakSmAdaNDANu dekha lie jA sakate haiM para ve bahuta kaThinAI se milate haiN| unakI upasthiti nihArane ke lie unakA saMvadha yA mUtra kA vaMTamUSa meM antaHkSepaNa paramAvazyaka ho jAtA hai| mUtra meM zephamalIya jIvANu ( smegma bacillus ) bhI hote haiM ve yakSmAdaNDANu ke sAtha sambhramita ( confused ) kiye jA sakate haiM ataH unakA dhyAna rakhate hue inakA jJAna karanA hogaa| mUtra ke sAtha yakSma apadravya kA gamana bahuta adhika hAnikAraka dekhA jAtA hai| jahA~-jahA~ hokara vaha jAtA hai (gavInI, basti ityAdi ) vahA~-vahA~ vaha yakSmopasarga kara de sakatA hai| isake kAraNa gavIniyA~ (ureters ) moTI par3a jAtI haiM, anAmya For Private and Personal Use Only

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yakSmA 566 ho jAtI haiM tathA unakA suSiraka saMkIrNa hotA calA jAtA hai jisakA kAraNa yaha hai ki usake upazleSmalastara meM yadimakAoM kA nirmANa tathA prAcIra meM tantUrakarSa hone lagatA hai / dhIre dhIre zleSmalakalA vraNIbhUta ho sakatI hai tathA gavInIsaMkoca ( stricture of the ureter ) ho sakatA hai 1 basti (bladder) meM upasarga prAyaH vRkkoM dvArA pahu~catA hai para kabhI-kabhI yaha kahanA kaThina ho jAtA hai ki upasarga kA prAthamika sthAna vRkka hai yA basti / jahA~ rait basti meM khulatI hai usa dvAra para hI sarvaprathama upasarga Arambha ho sakatA hai| jisa vRkka meM yamopasarga hotA hai usI kI gavInI ke dvAra para hI basti meM vikSata dekhA jAtA hai vahA~ se yaha bassyantarIya trikoNa ( trigone ) kI upazleSmalakalA ke nIce phailatA hai jahA~ se phira bastiprAcIra taka pahu~ca jAtA hai / yacamopasarga ke kAraNa upasRSTa basti hone para bAra-bAra mUtra tyAga karane kI icchA kA honA aura mUtrotsarga ke samaya kaSTa kA honA ye do lakSaNa vizeSatayA dekhe jAte haiM ! basti se yopasarga kaI mArgoM ko jAtA huA dekhA jAtA hai / ina mArgoM meM eka mArga parigavInIya lasavAhiniyoM (periureteric lymphatics ) dvArA dUsare vRkka ko jA sakatA hai / pahale roga eka vRkka meM hotA hai aura phira vaha dUsare buka meM kucha kAloparAnta pahu~catA hai yaha hama kaha cuke haiM isakA kAraNa basti kA madhyasta bananA hai / dUsarA 'mArga hai aSTIlA yA puraHstha granthi ( prostate gland) meM yakSmopasarga kA pahu~canA aura vahA~ yacamapuraH sthagranthipAka ( tuberculous prostatitis) honA hai / puraHsthagranthi se zukraprapikA ( seminal vesicles) zukravAhinI (vas deferens) aura anta meM adhivRSaNikA ( epididymis ) taka yakSmA pahu~ca jAtI hai| mUtramArga ( urethra ) meM yakSmopasarga hotA huA dekhA nahIM gayA / upasarga jaba basti meM pahu~catA hai to sarvaprathama gavInIdvAra para adhiraktatA A jAtI hai usake pazcAt kSudra zveta yacimakAe~ vahA~ uga AtI haiM ve Apasa meM eka dUsarI se sAyujyata ( fused) ho jAtI haiM / phira unameM kilATIyana prArambha hotA hai tatpazcAt na hotA hai / ina kriyAoM ke kAraNa bastiprAcIra meM eka jvAlAmukha sadRza ( cra* ter-like ) mukha bana jAtA hai / kabhI-kabhI jaba prajananAMgoM yA puraHsthapranthi se upasarga ArohaNa karatA huA basti kI ora AtA hai to upasarga kA sthAna bastigrIvA rahatA hai| yamopasarga prAyaH basti prAcIra para phailatA hai / usake kAraNa aneka vraNa banate haiN| jinake AdhAra cIrita aura kinAre phUle hue ( oedamatous ) dekhe jAte / kabhI kabhI raktastrAva ho sakatA hai jisakA pramANa mUtra meM rakta kI upasthiti se ho jAtA hai / yadi Upara se koI anya upasarga na ho to yakSma bastipAka ( tuberculous eystitis ) meM mUtra kI pratikriyA Aglika ho jAtI hai / yacmadaNDANu mUtra meM kaThinatA se pradarzita kie jAte haiM / vaMTamUSoM meM antaHkSepaNa paddhati dvArA yakSmA kA saralatApUrvaka patA laga jAtA hai / For Private and Personal Use Only

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vikRtivijJAna yakSmaadhivRSaNikApAka yamaadhivRSaNikApAka ( tuberculous epididymitis) sadaiva eka uttarajAta upasarga ke kAraNa hone vAlA roga hotA hai / adhivRSaNikA (epididymis) meM upasarga raktadhArA dvArA pahu~catA hai| upasarga ke kAraNa yacamavikSata yA to zIrSa (globus major ) meM banatA hai yA vaha adhivRSaNivAhinI ( vas) meM banatA hai| vAhinIstha vikSata lasavahAoM dvArA basti yA mUtramArga se upasarga Ane ke kAraNa banatA hai| .. yakSmopasarga ke kAraNa adhivRSaNikA meM yadimakAe~ bana jAtI haiM jinake kAraNa vaha granthIka ( nodular ) tathA pravRddha (enlarged ) ho jAtI hai| yadi upasarga mUtramArga dvArA AtA hai to vAhinI upasRSTa hokara sthUlita evaM granthika ho jAtI hai / para yadi upasarga kA prAthamika kAraNa raktadhArA hai to vAhinI se Upara kI ora upasarga calakara zukraprapikA, puraHsthagranthi tathA basti taka pahu~ca sakatA hai| isakA artha yaha huA ki adhivRSaNikA meM ArohI upasarga aura avarohI upasarga donoM dekhe jA sakate haiM / avarohI upasarga basti se lasavahA dvArA adhivRSaNikA taka AtA hai| ArohI upasarga adhivRSaNikA taka rakta dvArA AtA hai aura yahAM se basti taka pahu~catA hai| : ___ adhivRSaNikA kI yacimakAe~ kilATIyita hone ke pazcAt cUrNAyita bhI ho sakatI haiN| adhivRSaNikA vRSaNakoSa ( scrotum) kI tvacA se saMsakta ho jA sakatI hai jisake kAraNa usake pazcabhAga para badama nADIvraNa ( fistula. ) bana sakatA hai| yakSmopasarga ke kAraNa aNDadharapuTaka ( tunica vaginalis) meM aneka zyAmAkasama yakSmikAe~ jar3I huI milatI haiN| vahA~ para tarala kA utsyandana hone ke kAraNa yama muSkavRddhi ( tuberculous hydrocele ) ho sakatI hai| ____ yakSmopasRSTa adhivRSaNikA dvArA yadamA vRSaNoM meM bhI pahu~ca sakatI hai| jisake kAraNa usake andara zveta varNa kI dRr3ha yamikAeM bana sakatI haiN| eka vRSaNa kA roga saralatApUrvaka dUsare meM bhI laga sakatA hai / isakA pradhAna kAraNa yaha hai ki donoM vRSaNoM ko eka lasavAhinIcakra se lasa pahu~catA hai| ___strI prajananAMgoM meM, bIjakoSa ( ovary ) meM yakSmA kA upasarga bahuta kama hotA hai| jo bhI hotA hai vaha prAthamika na hokara uttarajAta hotA hai jo yA to bIjavAhinI se yA udaracchada se prApta hotA hai| yakSmabIjavAhinIpAka __yakSmA kA upasarga bIjavAhiniyoM ( fallopian tubes ) ke atirikta strIprajananAMgoM meM anyatra bahuta kama pAyA jAtA hai| saba prakAra ke bIjavAhinIpAkoM meM 8 pratizata yacama huA karate haiN| yahA~ yakSmopasarga uttarajAta (secondary ) hI hotA hai| vaha bhI adhikatara raktadhArA dvArA prApta hotA hai sIdhA udaraguhA dvArA upasarga bahuta kama AtA hai / For Private and Personal Use Only

Page #639
yadamA bIjavAhinIya yakSmA kisI bhI avasthA meM dekhI jA sakatI hai parantu 16 se 25 varSa kI lar3akiyoM meM yaha adhikatara milatI hai| isa roga kA mArga aura pariNAma uSNavAtIya upasarga ke samAna hI hotA hai| jaba bIjavAhinI meM yakSmapUya bhara jAtA hai to sapUya bIjavAhinI ( pyosalpinx ) bana jAtI hai| jaba isake Upara kI udaracchada bhI isase abhilagna ho jAtI hai to usakI AkRti vakabhANDa (retort) ke samAna ho jAtI hai| ___ anyanna yakSmA ke kAraNa no autikIya citra dekhA jAtA hai vahI yahAM bhI hotA hai| bIjavAhinI meM paryApta tantUtkarSa hotA hai, usakA suSiraka saMkucita ho jAtA hai aura kahIM-kahIM to Damarumadhya ( isthmus ) vizeSa karake prabhAvagrasta ho jAtA hai jisake kAraNa bIjavAhinIya prAcIra granthikAkRtika ho jAtI hai ise DamarUmadhyIya pranthikIya bIjavAhinIpAka ( salpingitis isthmica nodosa ) kahate haiN| bIjavAhinIya yakSmA ke sAtha sthAnika yakSma udaracchadapAka dekhA jA sakatA hai jo zyAmAkasama yA abhighaTya yama prakAra kA hotA hai| yakSmaantaHgarbhAzayapAka jaisA ki Upara kaha cuke haiM garbhAzaya meM yacmopasarga kA pradhAna kAraNa bIjavAhinIya yakSmA hI hotA hai / UtiyoM ke sAtatya ke kAraNa bIjavAhinI se yakSmA kA daNDANu sIdhA garbhAzaya taka utara sakatA hai| garbhAzaya meM yakSmopasarga garbhAzaya kAyA meM hI hotA hai / garbhAzaya grIvA (cervix uteri ) bahuta kama prabhAvita hotI hai| . zleSmalakalA meM yadimakAe~ dhUsaravarNIya zyAmAkasama vikSatoM ke rUpa meM dekhane meM AtI haiN| Age calakara ve bar3hatI haiM eka dUsare se sAyujyita hotI haiM phira unameM kilATIyana hotA hai aura phira vaNana hotA hai / isa kriyA ke kAraNa garbhAzaya prAcIra kA aparadana hone lagatA hai aura ApIta cIrita vraNa bana jAte haiN| yadi garbhAzayagrIvA kA mukha bhI sAtha hI banda ho gayA to yakSma sapUya garbhAzaya ( tuberculous pyometra ) bana jAtA hai| roga ke prArambhika kAla meM garbhAzaya pezIstara prabhAvita nahIM hotA para Age cala kara usakA aparadana hotA hai aura kabhI-kabhI to garbhAzaya prAcIra phaTa taka jAtI hai| garbhAzayagrIvA meM akelI yacmA nahIM dekhI jAtI hai| jaba garbhAzaya piNDa prabhAvita hotA hai tabhI vaha bhI prabhAvita ho jAtI hai| vahA~ yakSmA hone para itanA UtinAza calatA hai ki use karkaTa se pRthaka karanA kaThina par3a jAtA hai| __ yakSmastanapAka yacamopasarga stanoM meM prAthamika kabhI nahIM hotaa| yA to vaha raktadhArA dvArA vahA~ pahu~catA hai yA sIdhA kisI nAbhi se pratyakSa sambandha sthApita karake pahuMcatA hai| raktadhArA dvArA jo upasarga AtA hai usake kAraNa stana kI antarAlita ati meM yacimakAe~ banatI haiM ve pahale bar3I hotI haiM phira sAyujyita ho jAtI haiM tatpazcAt unake For Private and Personal Use Only

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572 vikRtivijJAna kilATIya puMja bana jAte haiM jo granthikIya Uti kA sarvanAza karake zIta vidradhi utpanna kara dete haiM jo tvacA para phUTa jAtI hai| isameM tantUtkarSa khUba milatA hai| pratyakSa upasarga stana ke nIce kI kisI parzakA kI paryasthi meM sthita yakSmavikSata dvArA hotA hai| isake kAraNa pazcastanIya vidradhi ( retromammary abscess ) banatI hai jo stana ke nIce se stana meM praveza karatI hai| parzakA meM yakSmavikSata kisI yakSmopasRSTa kazerukA se bahakara Aye hue yamapUya dvArA banA karatA hai| yadi yacmopasRSTa stana ke dugdha kA pAna koI zizu karatA hai to nissandeha use yaha roga laga sakatA hai| __isa roga ke kAraNa kakSAgatalasagranthiyA~ bar3ha jAtI haiM aura unameM kilATIyana hone lagatA hai / stana meM tantUtkarSa adhika hone ke kAraNa stana carma se tathA bhItara kI UtiyoM se saMlagna ho jAtA hai| isa citra ko dekhakara kauna use stanakarkaTa se pRthaka kara sakatA hai ? kabhI-kabhI yakSmA aura karkaTa donoM hI stana meM sAtha-sAtha hote haiN| . (11) vAtanADIsaMsthAna para yakSmA kA prabhAva jaba zarIra meM kisI aMga meM yakSma nAbhi upasthita ho to yaha asAmAnya nahIM hai ki mastiSka meM sthAnasImita yakSmikAe~ yA yakSmArbudikAe~ ( tuberculomata) na mileN| ye arbadikA aneka hotI haiM aura inakA AkAra maTara se lekara eka kukkuTANDa ke barAbara taka dekhA jA sakatA hai| ve gola, tAntava, prAvarita arbudikAe~ hotI haiM jinake bhItara kilATIya yA cUrNiya ( calcareous) padArtha bharA huA rahatA hai / ye arbudikAe~ mastiSkAdhAra ( base of the brain ) para dikhAI diyA karatI haiN| ve bAlakoM meM adhika milatI haiN| unake dhamillaka (nimastiSka) aura uSNISaka bahuta prabhAvita hote haiN| jaba ye mastiSka kI gaharAI meM hote haiM taba to utanI dikkata nahIM hotI para yadi ve upariSTha bhAga meM hI rahe to unake samIpasthita mastiSkachada prabhAvita ho jAtI haiM jisake kAraNa usameM aneka zyAmAkasama yadimakAe~ ho jAtI haiM aura vaha sthUlita ho jAtI hai| ___ yadi mastiSka para zastrakarma karate samaya ye arbudikAe~ dikhAI deM aura unako dUra karane kA yatna kiyA jAve to yacamamastiSkachadapAka ho sakatA hai jo atIva ghAtaka svarUpa kI vipatti hotI hai aura jisakA ki varNana nIce diyA jArahA hai / yakSmamastiSkachadapAka ___ yakSmamastiSkachadapAka ( tuberculous meningitis) eka rakta dhArA se mastiSka taka lAyA gayA upasarga hotA hai| yaha yakSmamadhyakarNapAka ke dvArA bhI ho sakatA hai yA karoTi ke bhItara anya yakSmanAmi ke kAraNa bhI dekhA jA sakatA hai| isa mastiSkachadapAka kA kartA mAnavIya yakSmakavakavetrANu hotA hai jo do tihAI For Private and Personal Use Only

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yakSmA rogiyoM meM kartA hotA hai zeSa eka tihAI rogI gavya yacamAdaNDANu dvArA pIDita hote haiN| yaha roga sarvAGgINa yakSmopasarga kA hI eka bhAgarUpa banakara bhI ho sakatA hai jo zyAmAkasama yacamA kara detA hai athavA asthi, sandhi aura vRkkAdi meM vikSata hone ke kAraNa daNDANuraktatA hotI hai jisase bhI mastiSkachada prabhAvita ho sakatI hai / kabhI-kabhI to uparokta sthAnoM ke vikSatoM kA patA na lagakara sarvaprathama mastiSkachadagata vikSatoM kA hI jJAna hotA hai| mastiSkachada meM sthita yakSmavikSata cupacApa tathA itastataH bikhare par3e rahate haiN| unake dvArA usa samaya mastiSkachadapAka hotA hai| jaba ve brahmodakulyA yA upajAlatA. nikIyaavakAza ( sub arachnoid space ) meM phUTa jAte haiN| ___ yakSmAdaNDANuoM dvArA mastiSka kA upasarga kisa mArga dvArA hotA hai yaha abhI taka anizcita sA hI hai| isa sambandha meM rica kA yaha mata hai ki upasarga jhallarIpratAna ( choroid plexus ) dvArA mastiSkoda ko jAtA hai jahA~ se brahmodakulyA ( subarachnoid space ) meM ho jAtA hai| isI kAraNa mastiSka kA AdhAra bhAga isase prabhAvita hotA hai / yadi upasarga sIdhA tAnikIya vAhiniyoM dvArA AtA to vaha mastiSkAdhAra ko pahale na prabhAvita karake mastiSka zikhara ( vertex) ko pahale prabhAvita karatA hai jo nahIM dekhA jAtA / ____ yakSmamastiSkachadapAka eka zizu yA bAla roga hai jo taruNAvasthA taka hI dekhane meM AtA hai| jo zyAmAkasama yadimakAe~ isa roga meM banatI haiM ve adhikatara mastiSka ke AdhAra para ( base of the brain ) para khUba milatI haiN| kabhI-kabhI srAva ke kAraNa ve DhaMka avazya jAtI haiM / yadi unheM spaSTataH dekhanA ho to madhya mastiSka dhamanI ke kinArekinAre zaMkhapArthAntarA sItA ( lateral cerebral fissure ) meM saralatayA mila jAtI haiM / mastiSka ke saMvelloM ( convolutions ) meM ve gaharAI meM chipI rahatI haiN| kabhI-kabhI kucha dhUsara varNAbha yadimakAe~ mastiSka golArDoM ke UparI dharAtala para dikhAI detI haiM jo dharAtala ke samIpa hI kisI zAnta yadimakA ke phaTa jAne ko prakaTa karatI haiN| mRtyUttara parIkSAkAla meM yadimakAe~ dekhane kI eka vidhi yaha hai ki madhyamastiSka dhamanI aura usakI zAkhAoM ke samIpa se eka Tukar3A tAnikA kA utAra kara use jala meM kisI kAcapaTTa para phailA diyA jAve aura phira pIche kI ora andhakAra karake ( over a dark back ground ) dekhA jAve to ve zveta yA dhUsaravarNa kI granthikA sarIkhI dikhAI detI haiM sAdhAraNa taura para unheM pratyakSa karanA bahuta kaThina hotA hai| kyoMki ve eka andhasUcI (Ala pina) ke sUkSmasira ke barAbara bar3hI hotI haiN| ina yacimakAoM meM vahI adhicchadAbha kozAoM kA samUhana dekhane meM AtA hai| mahAkozAoM kA nirmANa bahuta kama hone se unakA dikhAI denA kaThina hotA hai / For Private and Personal Use Only

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vikRtivijJAma ina yecimakAoM meM kilATIyana hotA hai| inakA AkAra jaba taka bar3hatA hai usase pUrva hI rogI prAyaH mara jAtA hai| isa kAraNa kilATIyana pratyakSa nahIM ho paataa| tAnikA se jahA~ vikSata hotA hai usake ThIka nIce kI mastiSka Uti meM AghAta ho jAtA hai| isa roga meM vAtazleSakozAoM kA paryApta praguNana milatA hai tathA mastiSka kezAloM ke parivAhinIya avakAza meM vraNazothAtmaka kozIya pratikriyA paryApta mAtrA meM dekhane ko milatI hai| mastiSka Uti kA kinArA aNvIkSaNa karane para asama aura dantura hotA hai| ____ yacimakAe~ bahudhA eka gAr3he srAva ke nIce dabI huI rahatI haiM jo hare se raMga kA hotA hai / yaha mastiSkAdhAra para tathA dhamillaka ke upariSTha dharAtala para adhika banatA hai aura mastiSka zikhara para nhiiN| isa srAva ke kAraNa mastiSkoda pravAha meM bAdhA par3a sakatI hai| isa bAdhA ke kAraNa svalpa udazIrSa ( hydrocephalous ) prAyaH mila sakatA hai| mastiSkoda (mastiSkasuSumnAtarala) kI mAtrA bar3ha jAtI hai tathA usapara Atati (tension) bhI bar3ha jAtI hai / roga kI prArambhika tIvAvasthA meM vaha Avila ho jAtA hai jisameM bahunyaSTikozAoM kI bahalatA ho jAtI hai jo Age calakara lasIkozAoM dvArA badala jAtI hai| tarala ko sthira kara dene se sUkSma jAlaka sA bana jAtA hai jise ThIka se abhiraMjita karane se jIvANuoM kA patA cala jAtA hai| roga ke prArambha meM zarkarA tathA nIreya ina donoM kI mAtrA ghaTa jAtI hai donoM meM nIreya bahuta adhika ghaTatI hai| Age cala kara phira ina donoM dravyoM kI vRddhi Arambha hotI hai / nIreyoM kI kamI jo 600 mi. grA. pratizata taka milatI hai roga kI pahacAna karAne meM atyadhika mahattvapUrNa siddha hotI hai| ___ mRdutAnikA (piameter ) meM uparokta jitane parivartana hote haiM unake kAraNa usameM adhiraktatA A jAtI hai, kozIya bharamAra ho jAtI hai tathA vahA~ zopha ho jAtA hai| sAtha hI samIpastha mastiSka bAhyaka meM kucha mRdulatA A jAtI hai| isake kAraNa pralApa kA honA yA jJAnendriyoM kA aticeta ( hyperaesthesia ) ho jAtA hai| nilayastara (ependyma) tathA jhallarIpratAna bhI gADha srAva se DhaMka jAtA hai / para nilaya, madhyasetubhAga ( central commissure ) aura chatrikA (fornix) kI prAcIreM mRdula ho jAtI haiN| rogArambhakAla meM grIvA kA pratyAkarSaNa tathA karniga cihna kI astyAtmakatA milatI hai jo pramastiSkIya prakSobha ke sUcaka haiN| phira AkSepa hone lagate haiM / srAva ke dvArA tRtIyA aura SaSThI vAtanADiyoM ke dabane se TeratA, dvidhA dRSTi aura varmapAta (ptosis) Adi netra cAlinIya ( oculomotor ) cinha milate haiN| ____ antakAla ke samaya mastiSkoda kI Atati se mastiSka Uti daba jAtI hai jisase acaitanya kA nirmANa hotA hai phira saMnyAsAvasthA Akara mRtyu ho jAtI hai| For Private and Personal Use Only

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navama adhyAya phiraGga prakaraNa aba hama isa adhyAya meM phiraGga ( syphilis ) tathA phiraMgasama ( spirochaetal ) upasargoM para eka dRSTi DAleMge tAki zArIrika vikRti ke eka aura paramasahAyaka se pAThakoM kA ThIka-ThIka paricaya ho jaave| ___hamane phiraMga zabda kA upayoga isalie kiyA hai ki Aja se anekoM varSa pUrva isI nAma se bhAvamizra ne sarvaprathama isa roga kA varNana kiyA hai| phiraMga zabda kI vyutpatti karate hue ve likhate haiM: phiraMgasaMjJake deze bAhulyenaiva yadbhavet / tasmAphiraMga ityukto vyaadhirvyaadhivishaardaiH|| ___ arthAt 'phiraMga saMjJaka deza meM jo vizeSarUpa se hotA hai isalie yogya vaidya ise phiraMga isa nAma se pukArate haiN|' isa vAkya kA yaha abhiprAya kadApi nahIM ki isa roga kA nAmakaraNa bhAvamizra ne kiyA hai| isase yahI patA calatA hai ki loka meM yaha 'phiraGga' isa nAma se pracalita rahatA AyA hai usI kA anusaraNa karate hue bhAvamizra ne bhI usakA upayoga kiyA hai| bhAvamizra ne isa roga ke jo lakSaNa diye haiM ve isI roga meM milate haiM, ise usane visphoTakAdhikAra ke uparAnta likhA hai, usane upadaMza nAmaka vyAdhi kA pRthak se varNana kara diyA hai, isakI cikitsA meM pArada ke eka yaugika rasakapUra kA prayoga kiyA hai ina sabako dekhate hue hama isa roga ko jise siphilisa kaha kara pratIcIna pukArate haiM phiraMga nAma dvArA hI prakaTa kreNge| ___ jo loga upadaMza aura phiraMga ko eka mAnate haiM ve donoM ke vikRta zArIra ko jAnane se mukha mor3ate haiN| upadaMza zoNita priya varga ke jIvANu se hone vAlA roga hai jise mRdusaMdaMza bA sAphTa zaikara ( soft chanere ) yA zaikroyaDa ( chanoroid ) kahA jAtA hai / yaha eka sthAnika roga hai jo puruSa kI meDhU aura strI kI yoni taka sImita rahatA hai| phiraMga eka ati vyApaka roga hai jo zarIra ke vividha bhAgoM meM apanA prabhAva jamAtA hai tathA jo kuntalANu ( spirochaeta ) varga ke jIvANuoM dvArA huA karatA hai / upadaMza kI sampUrNa cikitsA sthAnika hai yA vaha pAradamallAdivirahita hotI hai itanA jAna lene para phiraMga aura upadaMza meM bheda na jAnanA atIva bhrAmaka ho jA sakatA hai| phiraMga nAma se jo deza pUrvakAla meM apane deza meM pukArA jAtA thA vaha sambhavataH purtagAla deza rahA hogaa| purtagAliyoM ke dvArA hI yaha roga apane deza meM AyA hai| aisA mAnA jAtA hai ki jaba kolambasa san 1492 I0 meM bhArata kI khoja karane ke For Private and Personal Use Only

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576 vikRtivijJAna uddezya se pazcima kI ora hokara calA aura amerikA kI khoja karane meM saphala huA taba isa nava jagat ke prANiyoM se yaha bheMTa prApta huI jise hama phiraMga kahate haiM / san 1493 I. meM lauTane se pUrva heTI dvIpa kI striyoM ke sAtha kolambasa ke niSAdoM ne sambhoga kiyA to unase yaha roga unheM prApta huaa| heTI meM yaha roga kaise aura kaba AyA ise bhagavAn hI jAne para naye jagat kI khoja ke eka upahAra ke rUpa meM hI sabhya jagat ise mAnatA hai| una niSAdoM ne iTalI kI striyoM ko bhraSTa karake isa roga ko vahA~ phuNcaayaa| vahAM se phrAMsa hotA huA yaha roga sampUrNa jagat meM vyApta ho gyaa| 'mAtRvat paradAreSu' kI saMskRti kA pATha yadi una khojapriya yuvakoM ne par3ha liyA hotA to yaha roga kabhI kA apanI mauta heTI meM hI mara jAtA jaise ki heTI ke Adi. vAsI yUropIya samAja ke "Atmavat sarvabhUteSu' ke pATha ko na jAnane ke kAraNa mara gaye aura apanI sabhyatA taka ko na chor3a gaye aura hameM itane pRSTha likhane ke lie bAdhya na honA pdd'taa| apanI saMskRti kI kamI hone se vezyAgamana kI pravRtti bar3hatI gaI jise hamArI paratantratA ne aura bhI puSTa kiyA aura bhAratIya vyaktitva ne kAmAndha bana apane parama pavitra, ujjvala bhaviSya aura paramocca atIta vAle bhavya deza meM isa pApa vyAdhi ko prasArita kara diyaa| zauDina aura hauphamaina ne san 1905 I. meM isa roga ke kartA jIvANu kA patA lagAyA thA jisa para borDa tathA vAzaramaina ne apanI mahattvapUrNa khojoM ko 1907 meM prakAzita kiyA thaa| __ yaha eka aupasargika roga hai aura prAyaH phiraMga se pIDita strI ke sAtha sambhoga karane se utpanna hotA hai / isI kI puSTi karate hue bhAvamizra likhate haiM gandharogaH phiraMgo'yaM jAyate dehinAM dhruvam / phiraMgiNoGgasaMsargAt phira GgiNyAH prasaMgataH / / vyAdhirAgantujo hyaSa doSANAmatra saMkramaH / bhavet , tallakSayet teSAM lakSaNairmiSajAM vrH|| ki 'phiraMga roga gandharoga hai gandha se phailane vAlA yA ur3akara lagane vAlA roga hai| yaha prANiyoM meM phiraMgI vyakti ke saMsparzana se athavA phiraMgapIDita striyoM ke sambhoga ke kAraNa phailatA hai| yaha eka bhAgantuja vyAdhi hai jisameM doSoM kA anubandha pIche se hotA hai isalie vaidyoM ko doSoM kA vicAra karake lakSaNAnusAra cikitsA karanI caahie|' ___ kahanA nahIM hogA ki ina do tIna vAkyoM meM phiraMga ke sampUrNa Adhunika vicAroM ko bhAvamizra ne rakha diyA hai| phiraMga na kevala maithuna se api tu phiraMgI ke aMgasparza mAtra se bhI ho sakatA hai, jaisA ki zalyacikitsakoM meM dekhA jAsakatA hai| isa roga kA mukhya aura gauNa hetu hai eka jIvANu yA cakrANu jo DATa kholane ke peca kI taraha pecadAra hotA hai| ise spAirokITA pailiDA yA deponImA pailiDA kahate haiM / jIvANu ke pecoM ( spirals) ko kuntala kahA jAtA hai usI AdhAra para isakA nAma phiraMga sukuntalANu hai jise hama samaya-samaya para prayoga kreNge| eka phiraMga sukuntalANu meM 6 se lekara 15 taka tIkSNa kuntala hote haiN| saba prakAra ke For Private and Personal Use Only

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phiraGga 577 phiraMgI vikSatoM meM yaha pAyA jAtA hai para tRtIyAvasthA ke vikSatoM meM yaha bahuta kama rahatA hai / isakI abhiraMjanA kaThinatA se hotI hai para saMvardha saralatApUrvaka kiyA jA sakatA hai / phiraMga kA saMkramaNa 4 prakAra se ho sakatA hai : : (1) prasaMga (2) aMgasaMsparza (3) raktamArga ( 4 ) sahaja ( congenital ) / prasaMga yA maithuna dvArA upasRSTa strI puruSa ko tathA upasRSTa puruSa strI ko yaha roga pahu~cA sakate haiM aura 95 se 97 pratizata phiraMgapIDita vyakti prasaMga yA maithuna ke dvArA hI phiraMga prApta karate haiM / vezyAgamana Adhunika yuga meM isa roga ke prasAra kA sabase bar3A sAdhana hai / rati ( maithuna ) ke kAraNa hone ke kAraNa ise ratijanya vyAdhi ( Venereal Disease ) bhI mAnA jAtA hai / I jaba strIpuruSa meDhU yoni gharSaNa karate haiM to usake kAraNa puruSa kI zizna kI zleSmakalA meM aura strI kI yoni kI zleSmalakalA meM sUkSmakSata bana jAte haiM / phiraMgapIDita vyakti ke kSata meM hokara dUsare vyakti kI kSata vA akSata zleSmalakalA para sukuntalANu Akara par3a jAte haiM aura vahA~ se pracUSita ho jAte haiM aura phiraMga kA kAraNa banate haiM / kabhI-kabhI yaha bhI hotA hai ki manuSya ke zizna para phiraMga kA koI vraNa na ho para vaha strI ko phiraMga se pIDita kara de / isakA kAraNa hai manuSya ke zukra kA phiraMgopasRSTa honA / vIrya ke andara nihita sukuntalANu strI ko phiraMga de sakate haiM / yaha to sambhava hai ki akSata zleSmalakalA kA bhedana karake sukuntalANu svastha strI yA puruSa ko upasRSTa kara deM para yaha kadApi sambhava nahIM ki akSata carma para par3A huA sukuntalANu zarIra ke bhItara praviSTa ho sake / ataH aMgasaMsparza mAtra se abhiprAya kSatigrasta tvacA kA sukuntalANu se sambandha AnA mAnA jAnA cAhie / maithuna ke pazcAt puruSa strI kA cumbana letA hai / cumbana prakriyA hI kadAcit oSTha para phiraMgIya vraNa kI utpatti karatI hogI aisA sahaja hI mAnA jA sakatA hai kyoMki guptAGgoM ke atirikta phiraMga kA vijJata oSTha para hI sabase adhika dekhA jAtA hai / jo zalyacikitsaka yA paricAraka phiraMgopasRSTa vraNoM para kArya karate haiM yadi asAvadhAnatayA unako prayukta zastra dvArA aMgulI meM kSata ho jAve to sukuntalANu aMgulI meM praveza karake vahIM vikSatotpatti kara sakatA hai / guhyAGgoM ke keza kATane ke lie prayukta ustarA kabhI-kabhI phiraMgopasRSTa ho jAtA hai usIko jaba koI svastha puruSa prayoga meM lAtA hai to use phiraMga ho sakatA hai / rakta dvArA phiraMgopasarga kI prApti kA eka mAtra sAdhana svastha vyakti ke zarIra meM phiraMgI vyakti ke rakta kA saMkrAmaNa ( transfusion of blood ) hai / sahaja mArga vaha hai jisake dvArA mAtA apane zizu meM phiraMgopasarga pahu~cAtI hai / phiraMga sukuntalANu hI phiraMgakAraka hai usakA pramANa yaha hai ki phiraMga ke dvArA hone vAle saba vikSatoM meM aura sadaiva hI alpAdhika mAtrA meM yaha pAyA jAtA hai tathA 46, 50 vi0 For Private and Personal Use Only

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578 vikRtivijJAna una vikSatoM ke rasa kA kisI svastha prANI meM antaHkSepa kara deM to usako bhI phiraMga kA upasarga lagatA huA pratyakSa dekhA jAtA hai / ___ praveza ke pazcAt rogotpatti karane meM sukuntalANu 10 se lekara 40 dina taka le sakatA hai| kabhI-kabhI to jaba roga atyugra rUpa meM hotA hai to tIsare cauthe dina hI upasarga kA patA laga jAtA hai / sAdhAraNataH isakA saMcayakAla 3 saptAha kA mAnA jAtA hai| phiraMga nAmaka gandharoga jisa sthAna para lagatA hai vaha isakI prAthamika nAbhi hotI hai| vahA~ se yaha raktadhArA dvArA zarIra kI sampUrNa atiyoM taka jAtA hai| nidAnavizAradoM ne suvidhA ke lie usako nimna cAra avasthAoM meM mAnA hai: 9-94AITEIT ( primary stage ) 2-dvitIyAvasthA ( secondary stage ) 3-tRtIyAvasthA ( tertiary stage) 4-caturthAvasthA ( quaternary stage) ye avasthAe~ vividha UtiyoM meM vibhinna vikSatoM kI utpatti ke anusAra kahI gaI haiN| phiraMga kI prathamAvasthA kA tAtparya hai sukuntalANu ke antaHkSepa ke sthAna para vikSata kA honA / dvitIyAvasthA kA artha hai sarvAGgINa (generalised ) pratikriyA kA sampUrNa zarIra meM honaa| tRtIyAvasthA meM vAhinya vikSata hote haiM tathA phiraMgArbuda (gammata ) utpanna ho jAte haiM tathA caturthAvasthA meM kendriya vAtanADIsaMsthAna ( central nervous system ) kA kramika nAza prArambha ho jAtA hai / isa avasthA ko parAphiraMga ( para syphilis ) bhI kaha sakate haiM / ye avasthAe~ kitane vega se zarIra meM prakaTa hotI haiM yaha sukuntalANu kI ugratA para -nirbhara karatA hai| jitanA hI ugrajIvANu hogA utane hI zIghra ye avasthAe~ prakaTa ,, hoNgii| caturthAvasthA ko kucha vidvAn tRtIyAvasthA ke antargata hI lete haiN| phiraMgI kI pahalI avasthA meM roga prAyaH bAhya bhAga meM sthita hotA hai| dvitIyA. vasthA meM vaha Abhyantara praveza karatA hai tathA tIsarI avasthA meM Abhyantara aura . bAhya donoM tarapha prakaTa ho jAtA hai| jaba hama ina avasthAoM kI vikRti ko spaSTa kareMge taba nissandeha yaha bAta ThIka prakAra se samajha meM A jAvegI para isa samaya hamArA kahane kA tAtparya yaha hai ki AcArya bhAvamizra ne phiraMga kI inhIM tIna avasthAoM kA varNana kiyA hai| ve cauthI avasthA ko nahIM mAnate tathA use tRtIyAvasthA meM hI sannihita samajhate haiN| bhAvaprakAza ke kucha TIkAkAra jinheM Adhunika phiraMga kA jJAna nahIM ho sakA ina tIna avasthAoM ke varNana ko tIna pRthaka roga likhate rahe haiM / ve tIna roga na hokara phiraMga kI tIna pRthak-pRthaka avasthAoM kA varNana hai / bhAvamizra ke anusAra phiraMga kI avasthAe~ nimna prakAra batalAI gaI haiM:phiraMgastrividho jJeyo bAhya AbhyantarastathA / vahirantarbhavazcApi teSAM liGgAni ca bruve / / For Private and Personal Use Only

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phiraGga 576 tatra bAhya phiraMgaH syAdvisphoTasadRzo'lparak / sphuTito vraNavadvedhaH sukhasAdhyo'pi sa smRtaH // sandhiSvAbhyantaraH sa syAdAmavAta iva vyathAm / zothaJca janayedeSa kaSTasAdhyo budhaiH smRtaH / / tathA tRtIya ke sAtha nimna upadrava rahate haiM :kArya balakSayo nAsabhaMgo vahvezca mandatA / asthizoSo'sthi vakratvaM phiraMgopadravA amI / / ina zlokoM kA bhAva yaha hai ki bhAvamizra ke mata se phiraMga kI tIna avasthAe~ hotI haiM:(1) bAhyAvasthA yA bAhya phiraMga ( primary stage of syphilis ) / (2) AbhyantarAvasthA yA Abhyantara phiraMga (second stage of syphilis) / (3) bahirantarbhavAvasthA yA bahirantarbhavaphiraMga (tertiary & quaternary stage of syphilis ), bAhyaphiraMga meM alpavedanAyukta visphoTa hote haiM jo vraNa ke samAna phUTate haiM aura yaha sukhasAdhya hotA hai| AbhyantaraphiraMga meM AmavAta ke samAna sazUla aura sazopha sandhipAka hotA hai aura yaha kaSTasAdhya hotA hai| bahirantarbhavaphiraMga meM kRzatA, balakSaya, nAsAbhaMga, agnimAndya, asthizotha, asthivakratAdi upadrava rahate haiM aura yaha asAdhya hotA hai| hama Age ke apane varNana meM phiraMga kI avasthAoM kI vistRta vivecanA karane ke lie prathama dvitIya tRtIyAdi avasthAoM kA nAmollekha na kara bhAvamizra prokta nAmoM kA hI prayoga kreNge| phiraMga kI pUrvAvasthA ( early stage of syphilis ) tathA phiraMga kI uttarAvasthA ( later stage of syphilis ) karake kucha loga ise kevala do avasthAoM meM bhI vibhakta karate haiN| pahalI avasthA meM bAhyaphiraMga tathA AbhyantaraphiraMga ye do AtI haiM aura dUsarI meM bahirantarbhavaphiraMga kA samAveza kiyA jAtA hai| phiraMga ke do mahattvapUrNa prakAra aura haiM jinameM eka avApta phiraMga ( acquired syphilis ) kahalAtA hai jisakA artha hai vyakti dvArA svakarmoM se phiraMgopasRSTa honA tathA dUsarA sahajaphiraMga kahalAtA hai| isakA artha hai ki zizu dvArA mAtA ke karmoM se phiraMgopasRSTa honA / sahajaphiraMga meM hama Upara varNita prakAroM ko usa prakAra nahIM pAte kyoMki vahAM to zizu ke zarIra kI vividha utiyoM meM phiraMga ke sukuntalANu pahale se hI vyApta hote haiN| isase pUrva ki hama avApta phiraMga kA varNana kareM sarvaprathama sahaja phiraMga kA hI varNana Arambha karate haiM: sahajaphiraMga sahajaphiraMga ( congenital syphilis ) garbhAzaya ke bhItara garbha ke mAtA ke dvArA phiraMgopasRSTa hone kI kriyA hai / mAtA ke aparA meM hokara garbha ke rakta meM sukuntalANu praviSTa ho jAte haiM aura rakta dvArA garbha kI vibhinna UtiyoM meM pahu~ca jAte haiN| pitA ke dvArA bhI garbha ko phiraMgopasarga laga sakatA hai yaha siddhAntataH satya hai kyoMki puruSa ke zukra dvArA upasarga strI ke bIja taka jA sakatA hai| para isake lie For Private and Personal Use Only

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580 vikRtivijJAna mahatvapUNa pramANa isa samaya aprApya sA hai| kucha bhI ho AyurvedajJoM kA nimna vAkya sadaiva phiraMga kI dRSTi se to avazya hI sArthaka hai: zukaM hi duSTaM sApa yaM sadAraM vAdhate naram / arthAt puruSa kA vIrya yadi duSTa hai to vaha usakI strI tathA apatya donoM ko bAdhA pahu~cAtA hai| phiraMgI puruSa kA zukra duSTa huA to pahale strI ko phiraMga se pIDita karatA hai phira mAtA ke aparA dvArA rakta ke sAtha garbha meM pahu~catA hai aura apatya ko vikArayukta vA phiraMgI banA detA hai| phiraMga se pIDitA mAtA kyA pratyeka avasthA meM garbha ko phiraMga se pIDita karane meM samartha hotI hai ? yaha eka mahatva kA prazna hai jisakA samAdhAna karane ke lie sadaiva taiyAra rahanA caahie| isa prazna ko samajhane ke lie hameM mAtA kI phiraMga kI ora garbha kI sthiti ko samajhanA pdd'egaa| ye nimna prakAra kI ho sakatI haiM:(1) jaba mAtA ko phiraMga kA roga lagA huA hai aura usakI prathamAvasthA cAlU hai usa samaya garbhAdhAna huA hai| (2) jaba mAtA ko phiraMga kI dvitIyAvasthA cAlU hai aura taba garbhAdhAna huA hai| (3) jaba mAtA ko phiraMga kI tRtIyAvasthA cAlU hai aura taba garbhAdhAna huA hai| (4) jaba mAtA ko garbhAdhAna hone ke uparAnta phiraMga kA upasarga garbhAdhAna ke turata bAda huA hai| (5) jaba mAtA ko garbhAdhAna hue kaI mAsa vyatIta hone ke uparAnta garbhAdhAna huA hai| (6) jaba mAtA kA garbhakAla pUrNa ho cukA hai tathA prasUti ke kucha pUrva phiraMgopasarga lagA hai| uparokta sthitiyoM meM se prathama tIna sthiti ve haiM jaba garbhAzaya ke pUrva phiraMgopasarga huA hai / ina tInoM sthitiyoM meM garbha nissandeha sahajaphiraMga grahaNa kara sakatA hai / eka bAra eka strI jo 37 varSa pUrva phiraMga se pIDita huI thI sahajaphiraMgI zizu ko janma dene meM samartha dekhI gaI thii| cauthI sthiti meM bhI sahajaphiraMga hone kI bharapUra guJjAyaza rahatI hai| pA~cavIM sthiti meM guMjAyaza kama hotI hai tathA chaThI sthiti meM guMjAyaza bilkula nahIM rahatI hai / hA~ prasava ke samaya zizu ko upasarga laga sakatA hai jo phira avAptaphiraMga kA rUpa dhAraNa karatA hai na ki sahajaphiraMga kaa| eka sAtavIM sthiti yaha bhI ho sakatI hai ki prasavakAla ke pazcAt strI ko phiraMga roga lagA ho| usa sthiti ke kAraNa bhI avApta phiraMga hone kI hI sambhAvanA ho sakatI hai aura vaha bhI bahuta kama / eka aura prazna yaha hai ki phiraMgopasarga ke kitane dina pazcAt taka sahajaphiraMgI bAlaka kA janma karane meM strI samartha rahatI hai| isake lie 37 varSa vAlA udAharaNa diyA jA cukA hai| moTA andAja isa prakAra kA hai ki yadi strI naI-naI hI phiraMga se pIDita huI hai to garbha kA pAta ho jAnA svAbhAvika hai| garbhavicyuti ke sambandha meM suzruta kA eka sUtra bahuta mahattva kA hai: For Private and Personal Use Only

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phirana kRmivAtAbhighAtaistu tadevopadrutaM phalam / patatyakAle'pi yathA tathA syAdgarbhavicyutiH // jaise ki kRmi se kRntita, vAta se tADita yA abhighAta se pIDita phala vRkSa se akAla meM gira jAtA hai vaise hI jIvANuoM ( kRmi ), vAtakAraka bhoSadhiyoM aura mAnasika avasthAoM ( vAta ) athavA coTa AghAta ( abhighAta ) ke kAraNa akAla garbha bhI gira sakatA hai / sukuntalANu eka aisA hI kRmi yA jIvANu hai jo garbharUpa phala ko akAla meM hI patita kara detA hai / 581 parantu phiraMgiNI strI kA garbha sadaiva hI patita ho yaha Avazyaka nahIM, vahA~ eka Ists mahAzaya kA niyama lAgU hotA hai / vaha niyama yaha hai ki aneka bAra garbhadhAraNa hone para uttarottara phiraMga kI garbhanAzaka zakti ghaTatI calI jAtI hai / isakA krama ya rahatA hai (1) sarvaprathama garbhastrAva ' ( abortion ) / ( 2 ) tatpazcAt garbhapAta' ( miscarriage ) / ( 3 ) taduparAnta mRtagarbhajanma ( still birth ) / ( 4 ) tadanantara sajIva phiraMgI zizu kA janma ( syphilitic child's birth) / yaha bhI Avazyaka nahIM ki eka ke pazcAt dUsare garbha meM ye krama upasthita hoM / eka do garbhasrAva hokara 2-3 garbhapAta hote hue 1-2 mRtagarbha janma hokara phira phiraMgI zizu utpanna hotA hai / yaha bhI sambhava hai ki yaha jo phiraMgI jIvANu kI uttarottara garbhanAzakatA kA hAsa hotA jAtA hai usake kAraNa pUrNasvastha phiraMgavihIna bAlaka kA janma ho jAve / garbha kI mRtyu kA kAraNa hotA hai garbha ke yakRt, phuphphusa, sarvakiNvI, upavRkka granthiyA~ tathA anya aMgoM kA asaMkhya sukuntalANuoM dvArA AkrAnta honA / yakRt aura phuphphusa sabase adhika kSatigrasta ho jAte haiN| mRtyUttara parIkSA meM aneka aMgoM meM vikSata pratyakSa dekhe jA sakate haiM / For Private and Personal Use Only I phiraMgI mAtA se jaba sajIva zizu utpanna hotA hai taba kabhI to usako phiraMgopasarga ke kucha pratyakSa dekhane meM Ate haiM aura kabhI nahIM / ve cihna kucha saptAha pazcAt prakaTa ho sakate haiM / bAhya phiraMga kA prathama saMdeza ( primary chancre ) usameM nahIM milatA / parantu Abhyantara phiraMga tathA bahirantarbhavaphiraMga ke aneka vikSata mila sakate haiM / niyamataH zizu ke vikAsa kA pUrNataH mAndya ( retardation ) dekhane meM AtA hai jisake kAraNa vaha patalA dubalA tathA araktika ( anaemic ) dikhAI detA hai usakI camar3I laTakI huI hotI hai jisameM jhurriyA~ par3I hotI haiM / usake pANipAda taloM ke camar3e para visphoTaka ( pemphigus ) utpanna hue Ate haiM yA bAda meM utpanna ho jAte haiM / usake nitamboM ( buttocks ) para utkaNa ( papules ) tathA vraNa utpanna ho jAte haiM tathA mukha koNoM para vicarcikA ( rhagades ) utpanna ho jAtI 1. AcaturthAttato mAsAt prasravedgarbhavicyutiH / tataH sthirazarIrasya pAtaH paJcamaSaSThayoH // ( suzruta )

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582 vikRtivijJAna haiM / isake bAda zleSmalakalA meM zotha hote haiM sAtha meM prasekI nAsApAka ke kAraNa nAsapraseka (snuffles) ho jAtA hai / zleSmalakalAoM meM vraNana hone lagatA hai, lambI asthiyoM meM asthizirIya vijJata dekhe jAte haiM / dantAkAca ( enamel of the teeth ) naSTa ho jAtA hai, netra meM antarAlita svacchApAka (interstitial keratitis ) ho jAtA hai jisake kAraNa svacchA ( cornea ) pArAndha ( opaque ) ho jAtI hai tathA antaHkarNa roga Adi dekhe jAte haiM / asthiyoM meM phiraMgika asthizirapAka ( syphilitic epiphysitis ) yA asthi kAsthIyapAka ( osteochondritis ) ho jAtA hai jisakA kAraNa ina UtiyoM meM phiraGgArbudikIya ( gummatous ) Uti kA vikAsa hai / yaha vikAsa lambI asthiyoM ke asthizirIya bhAga meM vahA~ hotA hai jahA~ asthIyana kI rekhA hotI hai / yahA~ UtimRtyu hone ke kAraNa asthizira asthi ke daNDa ( shaft ) se pRthaka ho jAtA hai / cAhe unameM Age calakara ropaNa ho jAve parantu asthiyA~ choTI par3a jAtI haiM yA raha jAtI haiM / asthigata majjA jisakA kArya raktakaNa nirmANa kA hai usakA bhI paryApta nAza ho jAtA hai jisake kAraNa raktanirmANakArya meM bhI bahuta bAdhA par3a jAtI hai / asthiyoM ke svayaM ke vikAsa meM bAdhA hone ke kAraNa phakka roga sarIkhe vikSata idhara bhI asthiyoM meM dekhane ko milate haiM / ye vikSata phakka rogI kI Ayu se bhI pahale hote haiM / phiraMgika karoTikA ( cranio tabes) ke kSetra bhI dekhe jAte haiM jaba ki karoTi kI asthiyA~ kRza hotI jAtI haiM / kahIM-kahIM jahA~ asthi ke Upara praguNAtmaka paryasthapAka hotA hai karoTi kA utthana ( bossing ) ho sakatA hai zizu kA dantodbhava vilamba se hotA hai aura jaba dA~ta nikalate haiM to ve vikArapUrNa hote haiM aura jaba unakI punarutpatti hotI hai to Urdhva hanu ke madhya ke rAjadantoM meM candrAkAra khAta hotA hai ina dA~toM ko haciMsanIya danta ( Hutchinson's teeth ) nAma diyA jAtA hai / / kRt meM phiraMgArbudikA ( gammata ) anya aMgoM kI bhA~ti bana sakatI haiM parantu mukhyavikSata parikozIya yakRddAlyuskarSa ( pericellular cirrhosis ) kA hotA hai / yakRt meM sukuntalANuoM kI bahuta bar3I saMkhyA rahatI hai jo yakRt Uti kA DaTa kara vinAza karatI rahatI hai jisake kAraNa eka vAstavika ( true ) aupasargika yakRtpAka ho jAyA karatA hai / mRtakozA Atmapacana (autolysis ) dvArA svataH lupta ho jAte haiM aura unakA sthAna sUkSma tAntavaUti le letI hai jisake kAraNa eka aisA jAla sA bana jAtA hai jisameM do yA tIna kozAsamUha pahacAna meM Ate haiM atara aura prare kozAoM kI ausata darje kI bharamAra dekhI jAtI hai tathA itastataH phiraMgArbudIya nAbhiyA~ pAI jAtI haiM jo zyAmAkasama phiraMgArbudikAoM kA nirmANa kara detI haiM / jitane kozAoM kA vinAza ho jAtA hai usI anupAta meM yakRt kI kriyAzakti bhI naSTa ho jAtI hai / pAcaka pitta kA udAsarga bhI ruka jAne se kAmalA utpanna ho jAtA hai / yahI kAraNa hai ki navajAta zizu meM sahaja phiraMga roga meM kAmalA milatA hai / yakRt pravRddha ho jAtA hai aura usakI gADhatA ( consistency ) rabara / lasa For Private and Personal Use Only

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phiraGga 583 jaisI ho jAtI hai / isakA dharAtala mamRNa (smooth) tathA pANDara hotA hai yA kAmalA hone para Aharita bhI ho jAtA hai| navajAta sahajaphiraMgI zizuoM meM 'zveta zvasanaka' ( white pneumonia) nAmaka eka roga hotA hai jo vAstava meM zvasanaka to isalie nahIM hotA kyoMki usameM vraNazothAtmaka saMpiMDana (inflammatory consolidation ) nahIM dekhA jaataa| isase pIDita bAlaka yA to mRta hI janma lete haiM yA thor3e kAla pazcAt mara jAte haiM / isameM phuphphusa vAyuzUnya tathA Azveta dhUsara hotA hai vaha tAntavaUti dvArA banatA hai jisameM itastataH ghana adhicchada ( cubical epithelium ) se Astarita visphArita avakAza bane rahate haiM jinameM ati kRntaka ( histioclytic) kozA rahate haiN| inameM sukuntalANu khUba dekhe jAte haiN| DAkTara ghANekara ne lakSaNoM kA varNana karate hue batalAyA hai ki kAlakramAnusAra sahajaphiraMga ke 3 vibhAga kara sakate haiM: 1-kSIrapAvasthika yA zaizavIya, 2-vardhamAnAvasthika, 3-uttarakAlIna / inameM kSIrapAvasthika yA zaizavIya sahajaphiraMga meM nimna lakSaNa dekhane ko milate haiM: (1) bAlaka dekhane meM choTA, nATA, sUkhA, dubalA, rogI, buDhDhe yA bandara ke samAna dekhA jAtA hai| (2) usakI tvacA kAgajI salavaTadAra, nirjIva aura dhUsara varNa kI hotI hai| usa para kahIM-kahIM nIlimA dekhI jA sakatI hai| (3) mukha para tathA zAkhAoM meM sUjana ho sakatI hai| (4) peTa bar3hA huA aura Age nikalA huA hotA hai| (5) tvacA para AbhyantaraphiraMgAvasthA (dvitIyAvasyA) ke samAna mAMsavarNa sphoTa utpanna ho sakate haiN| unase ArdratA ke kAraNa srAva nikalatA hai, pANipAdatala para bar3e sapUya visphoTa dekhe jA sakate haiN| (6) mukha ke koNoM para vicarcikA ke samAna vidAra yA rekhAe~ mila sakatI haiM, vraNa bhara jAne para bhI unake nizAna bane rahate haiN| (7) mukha yA guda ke samIpa arza ( condylomata ) dekhe jA sakate haiN| (8) sira ke bAla jhar3a jAte haiN| (9) nakhoM ke tala aura cAroM ora zotha hokara phiraMgI cippa ( onychia) ho jAtA hai jisase srAva bhI nikalatA hai| kucha nakha moTe ho jAte haiM aura unakI pAradarzatA samApta ho jAtI hai| kabhI-kabhI nakha saba yA thor3e gira bhI jAte haiN| (10) mukha, grasanI, svarayantra, nAsA Adi kI zleSmakalAoM meM vraNotpatti ho jAtI hai jisake kAraNa svara baiTha jAtA hai zizu ThIka se ro nahIM sakatA, nAsAgata visphoToM se srAva hone lagatA hai, strAva pahale patalA phira gAr3hA hotA hai jisake sUkhane se papaDI jama jAtI hai jisake kAraNa zvAsa-prazvAsa kriyA meM bAdhA par3atI hai isI ko nAsApraseka ( snuffles ) kahate haiN| isase stanapAna karane meM bhI bAdhA par3a jAtI hai| For Private and Personal Use Only

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584 vikRtivijJAna (11) dIrgha asthiyoM meM paryasthi aura asthizirIya bhAga meM zotha hotA hai jisase dabAne se darda aura AmavAta sadRza pIDA ho jAtI hai| asthizira ke madhyabhAga se pRthak hone ke kAraNa kabhI-kabhI zAkhAoM kA kUTaghAta ( pseudo paralysis) ho jA sakatI hai| kapAlAsthiyA~ kahIM moTI aura kahIM patalI ho jAtI haiN| patalA bhAga dabAne para vaha zuSka carmapatra ( parchment ) vat pratIta hotI haiM, moTA bhAga dabAne para gA~Tha sadRza lagatI haiM ina gA~ThoM ko pairaTa granthi ( Parrot's nodes ) kahate haiM kabhI-kabhI aGguliparvapAka ( dactylitis ) hone se ve tAkAra ho jAtI haiN| (12) dantodbhava dera se hotA hai yA kabhI-kabhI janma ke sAtha bhI dA~ta nikala Ate haiN| (13) tArAmaNDalapAka ( iritis ) bhI ho jAtA hai| (14) madhyakarNapAka hone se zizu badhira ho jAtA hai / (15) yakRtplIhodara ho sakatA hai| (16) araktatA ( anaemia ), atisAra ( diarrhoea) Adi lakSaNa bhI mila sakate haiN| vardhamAnAvasthika sahajaphiraMga kI avasthA taba prArambha hotI hai jaba phiraMgapIDita zizu jIvita rahatA hai| kSIrapAvasthika phiraMga ke lakSaNa sAla Der3ha sAla kI avasthA taka bAlaka meM dekhe jAte haiN| usake bAda ve kucha kAla taka tirohita rahate haiM phira 7 aura 14 varSa kI avasthA meM nimna lakSaNa milate haiM: (1) sthAyI rAjadanta danturita ( notched ) hote haiM ye haciMsana ke danta kahalAte haiM tathA prathama carvaNaka ( molar ) gartayukta ( dome shaped ) dekhe jAte haiN| inheM mUna dA~ta ( Moon's teeth ) kahate haiN| hacisana danta saba rogiyoM meM nahIM nikalate tathA bIsa sAla kI avasthA ke pazcAt ThIka ho jAte haiN| mUna ke dA~ta saba rogiyoM meM aura sadA ke lie vikRta rahate haiM yahI donoM meM andara hai| (2) netra ke svacchAmaNDala meM pAka ( keratitis) ho jAtA hai yaha pAka pahale eka netra meM phira dUsare meM hotA hai isameM svacchA ghise hue kAca ke samAna ho jAtI hai| (3) karNakSveDa ho jAtA hai| (4) asthiyoM meM paryasthapAka, naI haDDI kA bananA tathA asthi kA khuradarA aura gA~ThadAra ho jAnA mukhya hai / (5) sandhiyoM meM zUlarahita sandhikalApAka ( synovitis) dekhA jAtA hai / yaha vikRti jAnusandhi meM tathA anya bar3I sandhiyoM meM hotI hai ise klaTana sandhiyA~ ( Clutton's joints ) kahate haiN| ____ uttarakAlIna avasthA meM 15 varSa kI Ayu ke uparAnta hone vAle vikAroM ko liyA gayA hai ye vikAra kSIrapAvasthika vikAroM ke hI pravRddha rUpa hote haiN| koI navIna vikRti yahA~ nahIM milatI / jaise (1) yadi zaizava meM mukhakoNIya vicarcikA (rhagades ) ho cukA ho to For Private and Personal Use Only

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phiraGga 585 isa avasthA meM kevala vahA~ vraNavastu rekhAe~ ( Panot's cicatrices ) mileNgii| ye rekhAe~ mukha, tAlu, grasanI meM bhI mila sakatI haiN| (2) tAlu meM chidra ho sakatA hai| (3) karoTi beDaula ho jAtI hai| (4) nAsA cipaTI ho jAtI hai ( saddle nose ) / (5) antarjaGghAsthiyA~ talavAra ke samAna vakra aura capaTI ( sabre bladed ) ho jAtI haiN| (6) zvetamaNDalapAka kama ho jAtA hai para dhuMdhalApana zeSa rahatA hai tArAmaNDala pAka ke kAraNa dRSTi kama raha jAtI hai| (7) kAna meM bAdhirya ho jAtA hai| (8) dA~ta nokIle choTe aura dantura ho jAte haiN| (9) sahaja phiraMgI kA zarIra durbala, patalA, kamajora hotA hai mAnasikazakti ke vikasita na hone ke kAraNa vaha mandabuddhi, pAgala yA buddhU ho sakatA hai| (10) sahajaphiraMgI strI meM garbhapAtAdi lakSaNa milate haiN| (11) sahajaphiraMgI puruSa vA strI phiraMgapIDita santAnotpatti kara sakate haiM aura yaha roga pIr3hI dara pIr3hI isI prakAra calatA raha sakatA hai| sahajaphiraMga kA kucha citraNa karane ke pazcAt aba hama mukhya roga kA varNana upasthiti karate haiN| ise hama svakRta phiraMga yA avApta phiraMga ( acquired syphilis) kisI eka nAma se pukAra sakate haiN| avApta phiraMga jaisA ki pUrva hI spaSTa kara cuke haiN| avApta phiraMga kI cAra avasthAe~ hotI haiM jinheM hama bAhya phiraMga, Abhyantara phiraMga, bahirantarbhava phiraMga tathA nADIphiraMga kaha sakate haiN| nADIphiraMga kA antarbhAva bahirantarbhava phiraMga meM bhI kiyA jA sakatA hai para suvidhA isI meM hai ki hama isa caturtha prakAra ko pRthak hI se samajhe rheN| bAhyaphiraGga ( Primary syphilis) tatra vAhyaH phiraMgaH syAd visphoTa sadRzo'lparuk / sphuTito vraNavad vaidyaiH sukhasAdhyo'pyasau mtH|| (bhAvaprakAza) vahA~ eka bAhyaphiraMga hotA hai jisameM visphoTa ke samAna gAMThe uThatI haiM jinameM alpavedanA hotI hai unake phUTane para vaNa ke samAna cikitsA karane se lAbha hotA hai| uparokta zloka kA yahI bhAvArtha hai| parantu isase bAhyaphiraMga kI sampUrNa vikRti kA citra apane sAmane upasthita nahIM hotA hai / use samajhane ke lie hameM Adhunika tattvavettAoM kI sevA avazyameva karanI pdd'egii| ____ yaha sadaiva smaraNa rakhanA cAhie ki jahA~ hokara sukuntalANu zarIra kI UtiyoM meM praveza karate haiM vahA~ ve prAthamika vikSata ( primary lesion ) avazya nirmANa For Private and Personal Use Only

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586 vikRtivijJAna kiyA karate haiN| yaha vikSata atyanta sUkSma hone ke kAraNa dikhalAI nahIM detaa| striyoM meM to usakA patA calanA bahuta Ter3hIkhIra hotA hai| sukuntalANu kSatavirahita svastha zleSmalakalA meM hokara yA carma meM vidAra hone para unameM hokara zarIra kI UtiyoM meM praveza karatA hai| upasargasthala para hI yaha sthAnika vikSata bana jAtA hai / yaha vikSata maithuna ke eka mAsa pazcAt banatA hai| kabhI-kabhI Der3ha mAsa paryanta yaha nahIM bntaa| jaba taka vikSata bananA Arambha karatA hai usa samaya taka yaha roga zarIra ke pratyeka aMga meM prasarita ho jAtA hai| upasarga ke sthala para hI sukuntalANuoM kA pragaNana hone lagatA hai aura ve lasavahAoM tathA raktadhArA se kucha ghaMToM meM hI apanA sambandha kara lete haiN| inheM apanA kArya karane meM bahuta dina na lagakara kucha ghaMTe hI lagate haiM ise samajhanA hogA kyoMki maithuna ke pazcAt liMga vA yoni kA prakSAlana vizodhaka dravyoM ke sAtha zIghra ho karavA diyA jAnA caahie| __ prAthamika vikSata ko kaThina saMdaMza yA kaThina upasthavraNa ( hard chancre ) kahate haiN| yaha pahale eka utkaNa ( papule ) ke rUpa meM nikalatA hai aura vinAzUla ke bar3hatA hai (pAThaka Upara ke zlokoM se milAte caleM) aura eka unnata gA~Tha kA rUpa dhAraNa kara letA hai| yaha tvacA yA zleSmalatvacA para banatA hai| isakA AdhAra kaThina hotA hai tathA dharAtala vraNita hotA hai| sAdhAraNataH yaha dharAtala svaccha aura Ama ( raw ) hotA hai| yadi koI dvitIyaka pUyajanaka upasarga laga jAtA hai to yaha eka AdhUsarita mRta apadravya kI jhillI se AvRta ho jAtA hai / yaha duannI ke barAvara bar3A hotA hai aura ise haNTarIya saMdaMza (Hunterian chancre) kahate haiN| aNvIkSatayA kaThina yA haNTarIya saMdaMza meM kaNanaUti kA eka puJja hotA hai tathA sparza meM jo kAThinya milatA hai usakA kAraNa vraNazothAtmaka zotha kA milanA hai| upa adhicchadIya UtiyoM meM sadaiva gola kozAoM ( round cells), asaMkhya prarasa kozAoM ( plasma cells) aura madhyamasaMkhya bRhat adhicchadIya kozAoM kI bharamAra dekhI jAtI hai| pUyakozA tabhI milate haiM jaba pUyajanaka upasarga bhI sAtha-sAtha upasthiti ho anyathA ve nahIM milte| madhyama aMza meM vahA~ tanturuha paramacaya ( fibroblastic hyperplasia ) bhI milatA hai jisake sAtha meM kucha naye kezAloM kI bhI nirmiti hotI hai| mahAkozA kabhI-kabhI hI milate haiM athavA nahIM milate tathA saMdaMza meM Uti mRtyu vaisI nahIM hotI jaisI ki prAthamika yakSmikA meM batalAyA jA cukA hai| ___ yadi saMdaMza ko dabAkara usakA yUSa ( juice ) nikAlA jAve aura usa yUpa meM sukuntalANu dekhe jAveM to ve bahuta bar3I saMkhyA meM usameM milate haiM yahI eka mAtra pramANa hai ki yaha upasarga phiraMgajanita hI hai| isa prArambhika avasthA meM upasRSTa bhAga kI vAhiniyoM meM vraNazothakArI parivartanoM kA zrIgaNeza hotA huA dekhA jA sakatA hai kyoMki vahA~ sUjana A jAtI hai aura unake adhicchadIya kozAoM kA paramacaya hone lagatA hai| jo adhicchada saMdaMza For Private and Personal Use Only

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haeTarIya sandeza pRSTha 586 "- inate lod 44 yaha citra bAhyaphiraMga ke prathama vikSata ke aNvIkSaNa para upalabdha huA hai| isameM dharAtalIya adhicchada dikhalAI detA hai / vAhinyavRddhi, vAhinIya antazchada kA zotha tathA gola kozAoM kI atyadhika bharamAra spaSTataH prakaTa ho rahI hai| For Private and Personal Use Only

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phiraGga 587 ( zaiGkara ) ko DhaMke hue rahatA hai vaha vraNita ho jAtA hai tathA jIvita adhikozAoM kI dvIpikAe~ vraNazothAtmaka granthikA ke upariSTha bhAga meM dekhI jA sakatI haiN| phiraMga kA prAthamika saMdeza yA vraNa upasarga ke pahale haphte se lekara tIsare saptAha paryanta bAhya upastha ( external genitals ) para adhikatara prakaTa ho jAtA hai / 'upastha ke atirikta yaha adharoSTha para dekhA jA sakatA hai, jihvA para mila sakatA hai, galatoraNikAoM para dekhA jA sakatA hai athavA aMguliyoM para bhI prakaTa ho sakatA hai / striyoM meM yaha kabhI-kabhI garbhAzaya ke bAhyadvAra ke samIpa ho sakatA hai jo yoni ke andara dUra para sthita hone ke kAraNa dekhane meM nahIM bhI AtA aura upasRSTa strI anupasRSTa lagatI hai / yaha upasthavraNa prAyazaH ekala ( single ) hotA hai para ekAdhika vraNoM ke udAharaNa bhI na milate hoM aisA nahIM hai / puruSoM meM prAyaH eka upasthavraNa dekhA jAtA hai jaba ki striyoM meM kaI bhI mila sakate haiM / striyoM meM yaha vraNa bhagoSTha, bhagAJjalikA ( fourchette ), bhagaziznikA athavA bhUtradvAra para kahIM bhI mila sakate haiN| cumbana, dhUmrapAnAdi kAraNoM se hI upasthavraNa ( primary chancre ) mukha, oSTha, jihvA, netravarma, stana, aMguliyA~ Adi para hote haiM / ina sthAnoM para upastha kI apekSA vraNa kucha adhika bar3e hote haiM / vraNana kArya oSTha yA jihvA para bahuta zIghra prArambha ho jAtA hai / aMguliyoM ke antima parvo ke vraNa adhika vedanAkAraka dekhe jAte haiM / ziznacchadA zleSmalakalA ke vraNa atyanta kaThina hote haiM / isa kalA ke dvAra para jo vraNa banatA hai vaha dvAra ke cAroM ora valayAkAra hokara phailatA hai / eka jIvANu kA nAma hai zoNapriyANu mRdUpasthatraNa ( Haemophylous of Duorey ) isa jIvANu ke kAraNa jo roga hotA hai use upadaMza kahA jAtA hai jo ki eka ratijanyaroga ( Venereal Disease ) hai / usakA nidAna isa prakAra hai :hastAbhighAtAnnakhadantapAtAdadhAvanAdratyatisevanAdvA / yonipradoSAcca bhavanti zizne patropadaMzA vividhApacAraiH // hastamaithuna ke kAraNa hAtha yA nakha dvArA coTa lagane se, mukhamaithuna karane ke kAraNa dA~ta laga jAne se na dhone se, atyadhika maithuna karane se, yoni ke doSa se yA anya upacAroM (brahmacAriNIgamana, gudamaithuna, catuSpadIgamanAdi ) ke kAraNa 5 prakAra ke upadeza ho jAte haiM / upadaMza ke kAraNa bhI vraNa hote haiM inheM mRdUpasthavraNa ( soft chancre ) kahate haiM mesandhau vragAH kecit kecitsarvAzrayAH smRtAH / kulatthAkRtayaH kecit kecinmudgadalopamAH // rujAdAhaparItAzca tRSNAstodasamanvitAH / zIghraM kecidvisarpanti zanaiH kecittathA'pare / strINAM puMsAM ca jAyante upadaMzAH sudAruNAH // Ayurveda ne upadaMzaja vraNoM kA jo Upara ke sUtroM meM citraNa kiyA hai vaha batalAtA hai ki ve isako bhalI prakAra jAnate the tathA bhAvaprakAzakAra ne sarvaprathama upadaMza ke atirikta phiraMga nAmaka roga kA ullekha kiyA hai / kabhI-kabhI vaidyagaNa siphilisa ko For Private and Personal Use Only

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588 vikRtivijJAna phiraMga na kahakara upadaMza batalA dete haiM jo pUrNataH asaMgata hai| donoM do vibhinna varga ke jIvANuoM se utpanna do pRthak roga haiM / DA0 ghANekara ne upadaMzajavaNa (soft chancre ) tathA phiraMgajatraNa ( hard chancre ) ke vyacchedaka lakSaNoM ko prakaTa karane vAlA eka koSThaka apanI suzruta saMhitA kI TIkA meM diyA hai jo nimna hai :phiraMgaja vraNa :-- upadaMzaja vraNa 1 - maithuna ke pazcAt tIsare yA cauthe dina 1 - maithuna ke pazcAt prAyaH tIsare saptAha meM saMdeza utpanna hotA hai / saMdeza utpanna hotA hai / 2- sAdhAraNatayA aneka saMdeza hote haiM / 3 - TaTolane se saMdeza mRdu hotA hai / 2- sAdhAraNatayA eka hI saMdeza hotA hai / 3- taruNAsthi (kAsthi ) ke samAna kaThina pratIta hotA hai / 4- dAha nahIM hotA tathA usase lasikA ke 4 - usameM dAha hotA hai tathA pracura pUya, raktalasikA ityAdi bahate haiM / 5- vraNa ke kinAre sApha kaTe hue bhItara se kucha pole aura vraNa ke tala se kucha U~ce hote haiM / 6 - atyanta pIDAyukta / 7 - sUkSmadarzaka se parIkSA karane para DyUkre kA daNDANu (bacillus Ducrey ) milatA hai / 8- vraNasrAva anya sthAna para tvacA meM suI se praviSTa karane para samAna vraNa paidA hotA hai / Acharya Shri Kailassagarsuri Gyanmandir atirikta kucha bhI nahIM nikalatA / 5 - kinAre na sApha hote haiM, na pole hote haiM, na tala se U~ce hote haiM / 6- pIDA rahita / 7- TriponemA pailIDama ( sukuntalANu ) nAmaka pecadAra jIvANu milatA hai / 8- srAva praviSTa karane se samAna vraNa prAyaH paidA nahIM hotA hai / 9 - vraNa kI ora kI jaMghAse kI graMthiyA~ phUlatI haiM ve mRdu pakane vAlI aura atyanta vedanAyukta hotI haiM / 9 - donoM ora kI graMthiyA~ phUlatI haiM ve kaThina, na pakane vAlI aura vedanA rahita hotI haiM / 10 - cikitsA na karane se vraNa adhika bar3ha kara sthAnika UtiyoM kA nAza hotA hai parantu sArvadehika lakSaNa prAyaH nahIM utpanna hote / 10 - cikitsA na karane se bhI sthAnika vikRti nahIM bar3hatI, parantu viSa sarvazarIra meM phaila kara sArvadehika lakSaNa utpanna hote haiM / uparokta koSThaka jAnane vAle upadaMza aura phiraMga ko eka samajhane kI bhUla nahIM kareMge aisA apanA vizvAsa hai / kabhI-kabhI upadaMza aura phiraMga donoM kA upasarga sAtha sAtha bhI ho sakatA hai ataH vahAM bahuta sAvadhAnI ke sAtha nidAna karanA par3atA hai / prAthamika upasthavraNa prakaTa hone ke 10 dina pazcAt upasarga prAdezika lasIkAgranthiyoM meM pahu~ca jAtA hai jisake kAraNa ve granthiyA~ sUja jAtI haiM tathA unakA sparza na karane se vaMkSaNa meM kSudra golikAoM jaisI pratIta hotI haiM / ye dhIre-dhIre bar3hatI haiM, For Private and Personal Use Only

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58 phiraGga zUla virahita hotI haiM aura taba taka pUya na hone kA unameM koI prazna nahIM utpanna hotA jaba taka ki prAthamika vikSata para pUyajanaka dvitIyaka upasarga aura na lada jAve / ina granthikAoM kA vedha (puncture ) karane se unase sukuntalANu pRthak kie jA sakate haiN| grIna likhatA hai: "The presence of a painless genital sore, resistent to simple antiseptic treatment and accompanied by painless enlargement of the inguinal lymph glands is strongly suggestive of a primary syphilitic infection and should be regarded as such until it can be proved to be otherwise.' eka vedanAzUnya upasthavraNa kI upasthiti jo sAdhAraNa pratipUyika (antiseptic) upacAra kA rodhaka ho tathA jisake sAtha vedanAzUnya vaMkSaNIya lasagranthikIya pravRddhi ho to yaha nizcitarUpeNa prAthamika phiraMgika upasarga kI dyotikA hai jaba taka ki isake viparIta siddha na ho jAve / ___ zoNAMzana phiraMga parIkSA ( haemolysis test of syphilis ) jise vAzara maina pratikriyA ( Wassermann's reaction ) kahate haiM kaThina saMdaMza ke prakaTa hone ke 3 saptAha uparAnta astyAtmaka (positive ) ho jAyA karatI hai| yaha agale 6 mAsa meM aura bhI tIna ho jAtI hai aura apanA bhUyiSTha ( maximum ) AbhyantaraphiraMga (dvitIyAvasthA) ke madhyakAla meM prApta karatI hai (sToksa / / saMkSepa meM bAhyaphiraMga (prathamAvasthA) ke sambandha meM nimna smaraNIya hai :1-phiraMga ke saMcayakAla kI samApti para eka gA~Tha kA uThanA / 2-dhIre dhIre gA~Tha kA bar3hanA aura duannI ke AkAra kI ho jaanaa| 3-madhya kI tvacA ke nAza ke kAraNa vraNa bana jAnA / 4-vraNa ke cAroM ora 1-3 milImITara kA lAla valaya bana jaanaa| 5-vraNa meM kaThinatA kI uttarottara vRddhi honaa| 6-vraNa kA pIDAzUnya honA / 7-vraNa kA lekhana karane se rakta kA na nikalanA api tu aise lasa kA nikalanA jisameM asaMkhya sukuntalANu hote haiN| 8-prAthamika vraNa banane ke 1-2 saptAhoparAnta bada ( bubo ) kA bananA / bada lasagranthiyoM kI pravRddhi kA hI nAma hai| bar3hI huI lasagranthiyA~ pRthak-pRthaka rahatI haiM kA~ca kI goliyoM jaisI kaThina tathA vedanAzUnya hotI haiM aura kabhI eka dUsare ke sAtha abhilagna nahIM hotii| For Private and Personal Use Only

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vikRtivijJAna AbhyantaraphiraMga ( Secondary syphilis ) sandhiSvAbhyantaraH sa syAdAmavAta iva vyathAm / zopha ca janayedeSa kaSTasAdhyo budhaiH smRtH|| (bhAvaprakAza) AbhyantaraphiraMga vaha hotA hai jisameM sandhiyoM meM AmavAta ke samAna zopha aura zUla ( oedema and pain ) hotA hai| ise buddhimAn kaSTasAdhya mAnate haiN| Upara Abhyantara phiraMga kA sampUrNa svarUpa AcArya ne vyakta nahIM kiyA kevala eka asthisandhiyoM ke AmavAta sadRza vikAra kI ora iGgita kara diyA hai / vAstava meM to prAthamika vikSata hone ke pazcAt prazAntikAla (peroid of quescence) AtA hai| eka aupasargika jvara ke lie jitane lambe saMcayakAla kI AvazyakatA hotI hai utanA hI bar3A yaha prazAntikAla huA karatA hai| yaha 6 se lekara 12 saptAha taka ho sakatA hai| usake pazcAt phiraMgika vikSata sarvAGgINa svarUpa ke ho jAte haiM yadyapi sukuntalANu kI sarvavyApakatA (generalisation) zarIra kI sampUrNa atiyoM meM to usI samaya ho jAtI hai jaba ki vaha prathamataH zarIra meM praviSTa hotA hai| bAhyaphiraMga (prathamAvasthA) ke pazcAt Age kI avasthAoM meM anUrjika anuhRSatA kA dauradaurA prArambha ho jAtA hai jisake kAraNa AbhyantaraphiraMga meM jvara tathA utkoTha ( rashes ) Adi dekhe jAte haiN| bahirantarbhavaphiraMga meM UtimAraka vraNazothAtmaka vikSata banate haiM jinake sAtha sAtha vAhinya vraNazotha bhI rahatA hai tathA phiraMga kI caturthAvasthA meM mastiSka meM vraNazotha ke kAraNa manda-manda UtimRtyu hokara sarvAMga ghAta ho jAyA karatA hai| Abhyantara phiraMga kA zrIgaNeza saumyajvara, vyAkulatA, zirazUla, araktatA tathA lasagranthiyoM kI sArvadaihika vRddhi ke sAtha hotA hai| graivika, karNamUlIya evaM pazcakaroTIya ( occipital ) pradeza kI lasagranthiyoM meM vizeSa karake prabhAva par3atA hai ve choTIchoTI golI ( shots ) ke samAna ho jAtI haiN| ziraHzUla kA pradhAna kAraNa halakA sA mastiSkachadapAka kA ho jAnA hotA hai jisake kAraNa mastiSkoda kA nipIDa bar3ha jAtA hai aura mastiSkoda meM lasIkozAoM kI saMkhyA bhI bar3ha jAtI hai| tvak utkoTha ( skin rashes ) isa roga meM eka sarvasAdhAraNa ghaTanA rahA karatI hai, ve gulAbIraMga ke hote haiM aura unameM sukuntalANu kI upasthiti A~kI jA cukI hai| ina utkoThoM kA kAraNa svacA ke upariSTha (superficial) staroM meM vraNazothAtmaka adhiraktatA ke sAtha-sAtha kSudra kozAoM (small cells) kI bharamAra mAnA jAtA hai| ye uskoTha dvitIyaka tvak phiraMguSThoM ( secondary cutaneous syphilides ) ke nAma se bhI pukAre jAte haiN| kabhI kabhI tvaka rogoM ( papillae ) kI vRddhi hokara adhicchadIya kozAoM kA atyadhika praguNana ho jAtA hai| zleSmalakalAoM para phiraMguSThoM ke kAraNa zveta sidhma ( white patch ) bana jAte haiM ve mukha meM tathA jihvA para prAyaH dekhane ko milate haiN| ye zveta sidhma bahirantarbhavaphiraMga (tRtIyAvasthA) meM utpanna carma ke sitaghaTana (leucoplasia) For Private and Personal Use Only

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phiraGga 561 se bhinna huA karate haiM yaha nahIM bhUlanA cAhie / phiraMgArza (condylomata) unnata, Ardra, tvakzothajanya sidhma hI hote haiM ve sadaiva una sthitiyoM meM utpanna hote haiM jahA~ do tvacAoM ke dharAtala eka dUsare se milate haiN| aise sthAna striyoM ke upastha tathA strI puruSoM ke guda pradeza meM huA karate haiN| inameM sukuntalANu bahuta bar3I saMkhyA meM milate haiM tathA ye atyadhika upasargakAraka hote haiN| inhIM sthaloM para kabhI-kabhI uSNavAtIya carmakIleM ( warts ) banA karatI haiM ataH donoM ke antara ko samajhe rahanA Avazyaka hai| AbhyantaraphiraMga ke anya do vikSatoM meM eka kRSNamaNDalapAka ( iritis ) hotA hai aura dUsarA paryasthapAka (periostitis ) milatA hai| isa paryasthapAka ke kAraNa hI asthiyoM meM vedanA huA karatI hai jo rAtri meM adhika bar3hatI hai| yaha vedanA zira aura TA~goM kI asthiyoM meM bahuta hotI hai| bhAvamizra ne isI ko AmavAta iva zUla likhA hai| aNvIkSatayA dekhane para koI vizeSa lakSaNasampanna vikSata nahIM milte| granthiyoM meM jAlakAntazchadIya paramaghaTana saumyarUpa kA pAyA jAtA hai tathA UtinAza kA koI pramANa milatA nahIM hai| kSudra vAhiniyoM ke bAhya cola (adventitia externa) tathA parivAhinyakaMcukoM (perivascular sheaths) meM vraNazothAtmaka bharamAra dekhI jAtI hai| isa avasthA ke cihna zarIra meM saMmita ( symmetrical ) hote haiM tathA ve anasthAyI ( transient) svarUpa ke hote haiM tathA ve cikitsA karane se cale jAte haiN| AyurvedajJa use sAdhya ( kaSTasAdhya ) mAnate rahe haiM / saMkSepa meM Abhyantara phiraMga (dvitIyAvasthA) meM nimna vizeSatAe~ dekhane meM AtI haiM 1. bAhya phiraMga ke pazcAt kucha samaya taka guptAvasthA rahatI hai jisameM saba kucha sudharA huA dikhalAI detA hai| ise hama Abhyantara phiraMga ke pUrvarUpa dvArA prApta kAla kaha sakate haiN| 2. upasarga ke 2-3 mAsoparAnta bahistarIya UtiyoM (ectodermal tissues) meM UtikriyA utpanna hotI hai jisake phalasvarUpa tvacA, zleSmalakalA aura kendriya vAtanADIsaMsthAna meM vikSata sarvaprathama utpanna hone lagate haiN| ye vikSata kucha mahInoM taka raha kara phira vilupta ho jAte haiN| isa avasthA meM atinAza na hone ke kAraNa vraNavastu nahIM bntii| parantu kahIM kahIM tAmravarNIya raMgA ( coppery pigmentation ) dekhA jA sakatA hai| 3. eka bAra tvacA, zleSmalakalAdi meM bane vikSatoM kA lopa ho jAne ke pazcAt yadi sthAnika pratikAritA zakti ghaTa gaI to mRtaprAya sukuntalANuoM meM se kucha punarjIvita ho jAte haiM aura vahA~ para naye sire se phira vikSata dekhe jA sakate haiN| isa prakAra bAra bAra sthAna punarupasRSTa hotA rahatA hai aura upasarga kabhI bhI samApta nahIM ho paataa| For Private and Personal Use Only

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562 vikRtivijJAna 4. AbhyantaraphiraMga meM lasapranthipAka (lymphadenitis) eka pramukha ghaTanA hai| sampUrNa zarIra kI lasagranthikAe~ bar3I ho jAtI haiN| yaha lasagranthikIya vRddhi bahuta adhika to hotI nahIM para rahatI mahInoM vA varSoM taka hai| antaH kRparIya pranthiyA~ ( epitrochlear glands ) tathA pazcagraivika lasagranthakoM ( posterior cervical nodes) kI vRddhi vizeSakara hotI hai| kaI cikitsaka phiraMga roga kA nidAna karate samaya kAhana yA vAsaramaina kasauTI ke pariNAmoM ke lie pratIkSA na karake antaH kUrpakIya granthiyoM kI vRddhi kA jJAna karake hI phiraMgopacAra prArambha kara dete haiM aura zatapratizata lAbha uThAte haiN| pravRddha lasaka granthiyoM kA aNvIkSaNa karane para unameM yA to prasara paramacaya (atighaTana ) milatA hai yA yadimakA kI taraha adhicchadAbha kozA yA mahAkozA milate haiN| ___5. tvacA meM Abhyantara phiraMga ke jo vikSata banate haiM ve kaI prakAra ke hote haiM para ve saba hote saMmita haiM / ve bahuracanAnvita ( polymorphous ) hote haiM arthAt eka hI samaya ve aneka svarUpa ke ho sakate haiN| ye vikSata tAmravarNa ke hote haiM aura unakI bahI rekhA vRtta ( circle ) ke eka khaNDa ( segment ) jaisI hotI hai / ve UtiyoM kA nAza nahIM karate jaisA ki Abhyantara phiraMga ke anya vikSata karate haiN| yadi kozIyasaMciti kama hotI hai tathA vAhinya visphAra khUba hotA hai to ve romAntikA ke dAnoM kI bhAMti udvarNika ( macular ) hote haiN| yadi kozA adhika ho to ve utkaNika ( papular ) hote haiN| yadi unameM upasarga laga jAve to ve utpUyika ( pustular ) ho jAte haiN| Age calakara jaba aura bhI vikRti bar3hatI hai to nAzakArI sidhma ( necrotic patches ) bana jAte haiM aura eka prakAra kI parpaTI ( crust ) jama jAtI hai jise ucchuktikA ( rupia ) kahate haiM / phiraMgArza ( condylomata) sadaiva AI bhAga ( bhaga, guda) meM hotA hai usameM asaMkhya sukuntalANu bhare rahate haiN| hAtha kI hatheliyoM aura pairoM ke talavoM meM eka zalkIya ( scaly ) avasthA bhI dekhI jAtI hai| nakha bhaMgura aura vidarita ( fissured ) hokara kunakhatA ho sakatI hai| 6. zleSmalakalA para vikSata hone ke kAraNa svarasAda ho sakatA hai| mukha, grasanI, yoni kI zleSmalakalA para sidhma mila sakate haiN| ye sidhma cipiTita upariSTha vikSata mAtrA hote haiM aura inheM dekha kara aisA lagatA hai ki mAno koI zambUka (ghoMghA snail ) vahA~ calatA rahatA ho aura usake dvArA ye banAe gaye hoN| ina sidhmoM meM asaMkhya sukuntalANu hote haiM aura ve ghora upasargakAraka hote haiN| 7. yadyapi kendriya vAtanADIsaMsthAna isa avasthA meM bahuta pahale se hI upasRSTa ho jAtA hai parantu bahirantarbhavaphiraMga (tRtIyAvasthA) ke prArambha hone se pahale koI adhika bhayAnaka lakSaNa dekhane meM AtA nahIM / isa avasthA meM to vAtanADIzUla, akSipeziyoM kA ghAta Adi lakSaNa dekhe jA sakate haiN| mastiSkoda meM lasIkozAoM For Private and Personal Use Only

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phiraGga 563 kI vRddhi tathA vartula kA Adhikya dekhA jAtA hai / isameM sukuntalANu dekhane ke lie tarala kA prANizarIra meM antaHkSepa karanA hotA hai / inakI upasthiti barAbara milatI hai / 8. netra meM kRSNamaNDalapAka ( iritis) dekhA jAtA hai / 9. jaGghAsthi, akSakAsthi, uraH phalaka aura karoTi kI asthiyoM kI paryasthi meM pAka hone se inameM ghora zUla hotA hai / yaha zUla rAtrikAla meM adhika hotA hai kyoMki isa kAla meM zleSmAdhikya hone se adhiraktatA ho jAtI hai / bhAvaprakAza meM isI zUla ko AmavAta iva vyathA kahA hai / ekAdha asthisandhi meM saumyasvarUpa kA pAka bhI pAyA jA sakatA hai / bahirantarbhavaphiraMga ( Tertiary Stage ) kAra balakSayo nAsAbhaGgo vahnezca mandatA / asthizoSo'sthivakratvaM phiraMgopadravA amI // bahirantarbhavazcApi kSINasyopadravairyutaH / vyApto vyAdhirasAdhyo'yamityAhurmunayaH purA // (bhAvaprakAza) kRzatA, balakSINatA, nAsA kA baiTha jAnA, agni kI mandatA, asthizoSa, asthivakratA ye phiraMga ke upadrava haiM / balakSINa bahirantarbhava phiraMga se vyathita vyakti upadravoM se yukta hone ke kAraNa aura vyAdhi kA bahuta adhika vyApa hone kAraNa muniyoM ne ise asAdhya batalAyA hai / yaha phiraMga kI tRtIyAvasthA hai / isameM nAsAbhaMgAdi kA kAraNa kyA hai use jAnane ke lie kevala mAtra uparokta do vAkyoM se hI kAma calanA sambhava nahIM hai / isa viSaya meM bar3e bar3e vidvAnoM ne jo karor3oM rupaye vyaya karake Adhunika kAla meM khojeM kI haiM unakA tiraskAra na kara namaskAra karanA hI adhika lAbhaprada hai / jisa prakAra bAhya phiraMga ke pazcAt Abhyantara phiraMga kA svarUpa banane ke lie kucha kAla Avazyaka hotA hai usI prakAra Abhyantara phiraMgAvasthA se bahirantarbhava phiraMgAvasthA Ane ke lie bhI kucha gupta kAla Avazyaka hotA hai / isa kAla meM rogI punaH yaha samajhane kI bhUla kara baiThatA hai ki vaha rogonmukta ho gayA / yaha gupta - kAla kaI saptAhoM se lekara kitane hI mAsaparyanta taka cala sakatA hai / antatogatvA yaha guptakAla samApta hotA hai aura phiraMga kI tRtIyAvasthA ( bahirantarbhavAvasthA ) ke vikSata upasarga lagane ke dina se pUre do se cAra varSa pazcAt prakaTa ho jAte haiM / kabhI kabhI ve pahale varSa meM hI ho jA sakate haiM yA phira dasa, pandraha yA bIsa varSa pazcAt bhI ho sakate haiM / parantu vaha asAdhAraNa avasthAoM meM hI hotA hai sAdhAraNataH 4 varSa kA kAla inake lie rahatA hai / yaha vikSata upasarga kA prasAra bahuta kama kara pAte haiM kyoMki inameM sukuntalANu bar3I kaThinAI se prApta kiyA jA sakatA hai / isa avasthA kA prAcIna vikSata phiraMgArbuda ( gumma ) kahalAtA hai aura sAmAnyatama vikSata jIrNatantUtkarSa yA sAmAnya tantvAbhaMjAravya ( simple fibroid indurations ) kahA jAtA hai / pradhAna aura sAmAnyatama donoM prakAra ke vikSatoM kA sammelana bahudhA dekhA jA sakatA hai / For Private and Personal Use Only

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564 vikRtivijJAna sampUrNa bahirantarbhavAvasthA ke vikSatoM ke sAtha vAhiniyoM meM parivartana dhamanyantazchadapAka tathA sirApAka avazya dekhA jAtA hai aura yaha parivartana upariSTha yA gambhIra kisI bhI zarIrAvayava meM mila sakatA hai| yaha tantvAbhajAraThya kyA hai ? zarIraracanA kI dRSTi se, zarIrAvayava meM lage hue viziSTa kozAoM kA vinAza hokara unake sthAna para vraNazothAtmaka kaNanaUti kA praguNana ho jAnA jisase tantUskarSa kA honA tathA vraNavastu (scar tissue ) kA bananA yahI tantvAbha jAraThya meM dekhA jAtA hai| kaNanaUti kI bharamAra sampUrNa zarIrAvayava meM eka sI bhI ho sakatI hai aura kahIM kahIM tathA kabhI kabhI zarIrAvayava meM itastataH svastha Uti banI rahatI haiM aura zeSa meM tantUtkarSa ho jAtA hai| yaha jo vikSatoM kA zarIrAvayavoM meM viSama vitaraNa hotA hai yaha phiraMga kA eka viziSTa lakSaNa hai| tantvAbhajAravya ke kAraNa zarIrAMgoM ke prAvara viSamatayA sthulita ho jAte haiM una para yadi koI lasyakalA AcchAdita rahatI hai to vaha bhI prabhAvita ho jAtI hai tathA samIpa ke anya aGga ke sAtha abhilAga bhI bana jAte haiN| vikSatoM ke viSama-vitaraNa ke kAraNa zarIrAMga ke dharAtala para kahIM saMkoca ho jAtA hai, kahIM jhurriyA~ par3a jAtI hai aura kahIM bhAga phUlA rahatA hai isase dharAtala kI samatA naSTa ho jAtI hai aura aMga viSamatalIya ho jAtA hai| kabhI kabhI to aMga ke bIca meM eka aisA vidAra par3a jAtA hai ki usake do khaNDa ( lobes ) taka hote hue dekhe jAte haiN| aisI sthitiyoM meM prasara tantUtkarSa ke sAtha sAtha phiraMgArbuda bhI rahate haiM tathA sthUlita prAvara tAntava sUtroM ke dvArA samIpastha utiyoM se sambaddha ho jAtA hai| ye sUtra ina utiyoM meM bahuta gaharAI taka ghuse rahate haiN| phiraMgika jAraThya mastiSka tAnikAoM meM bahudhA dekhA jAtA hai| tAnikAeM vA mastiSkachada sthAna sthAna para sthUlita ho jAtI haiM jisake kAraNa phiraMgika sthUla mastiSkachadapAka (pachymeningitis) dekhA jAtA hai jisakA varNana yathAsthAna kiyA jaavegaa| isa mastiSkachadapAka ke sAtha sAtha prasara phiraMgArbudikIya bharamAra raha sakatI hai aura nahIM bhii| jaba tAntava Uti saMkucita hotI hai to poSaNikAgranthi (picyUTrI)para pIr3ana hone se bahumUtra (diabetes insipidus ) ho sakatA hai yA yaha pIr3ana jaba bAhara jAne vAlI vAtanAr3iyoM para par3atA hai unase pUrNa bhAgoM kA ghAta ho sakatA hai| netraghAta isI prakAra isa roga meM hotA hai| ___ asthiyoM ke paryAvaraNa meM jIrNapAka hone ke kAraNa naI asthi banane lagatI hai| yaha asthi paryasthi yA paryAvaraNa ke ataHstara se banatI hai jisake kAraNa haDDI sthUla ho jAtI hai tathA sUjI rahatI hai| naI asthi saghana aura guru hotI hai| yaha smaraNa rahanA cAhie ki yakSmA meM jahA~ asthizoSa hotA hai vahA~ phiraMga meM asthisthaulya milatA hai| phira bhI bhAvamizra ko kahIM kahIM asthizoSarUpI upadva milA hai| For Private and Personal Use Only

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phiraGga asthivakratA to ho sakatI hai kyoMki phiraMgika sthaulya kA vitaraNa viSama hotA hai aura asthi ko vakra kara sakatA hai| bar3I bar3I dhamaniyoM meM phiraMga ke kAraNa eka prakAra kI vraNazothAtmaka pratikriyA hone lagatI hai| yaha pratikriyA unameM do sthAnoM para dekhI jAtI hai jinameM eka dhamanIya vAhiniyoM ( vasa vasorum ) kI parivAhinIya lasavahAoM meM aura dUsarI dhamanI ke antaHstara meM milatI hai| parivAhinIya lasavahAoM meM lasIkozAoM aura prarasakozAoM kI bharamara ho jAne se parivAhinIya maNibandha Kperivascular cuffing ) bana jAtA hai tathA antaHstara meM pratikriyA hone ke kAraNa abhilopI dhamanyantazchadapAka hotA rahatA hai yahA~ taka ki dhamanI kA suSiraka pUrNataH banda ho jAtA hai| bar3I dhamanI meM dhamanIya vAhinI jahA~ jahA~ hokara jAtI hai usake anusAra dhamanI ke madhyastara meM eka sidhmika vraNazotha utpanna ho jAtA hai vahA~ eka kSudra phiraMgArbuda bhI bana jA sakatA hai ina saba kA pariNAma yaha hotA hai ki isa stara ke pratyastha aura pezIsUtra badala kara tantUtkarSa ho jAtA hai| isake kAraNa madhyama stara ke vartula pezIsUtra khaNDita ho jAte haiM jisake kAraNa dhamanIprAcIra meM eka daurbalya utpanna ho jAtA hai| usakA kAraNa yaha hai ki jo tantUtkarSa hotA hai usa para jaba rakta ke pIDana kA prabhAva hotA hai to ina sUtroM meM lacakIlepana kA abhAva hone ke kAraNa ve khiMca jAte haiM aura sirAja granthiyoM ( aneurysms ) ko janma dete haiN| mahAdhamanI meM isa parivartana ko phiraMgaroga meM bahudhA dekhA jAtA hai aura yaha kahA jAtA hai ki mahAdhamanIstha sampUrNa sirAja granthiyoM kA hetu phiraMga hI hai / dhamanI ke antazchada meM kozAoM kA prakSobhAtmaka praguNana hone lagatA hai| parantu yataH inake suSiraka bar3e hote haiM isalie ve itane nahIM sikur3a pAte ki koI gambhIra avasthA utpanna hove / cuddha dhamaniyoM meM jinameM dhamanIya vAhiniyA~ hotI nahIM vahA~ vAhiniyoM meM sirAja granthiyA~ nahIM banatIM vahA~ to ghanAsrotkarSa hotA hai kyoMki abhilopI antardhamanIpAka ( obliterative endarteritis) usakA kAraNa hotA hai| isI kAraNa pramastiSkIya ghanosrotkarSa phiraMga meM bahudhA dekhA jAtA hai| ghanAsrotkarSa hone ke uparAnta mastiSka ke usa bhAga kA mRdvana ( softening) tathA taralIya jatinAza ( liquefactive necrosis ) hone lagatA hai| phiraMgArbuda kyA hai ? phiraMgArbuda ko aMgrejI meM gammA yA gammaiTA kahate haiM jisakA artha goMda hone ke kAraNa ise kucha vidvAn goMdAbaMda bhI kaha dete haiN| hamane phiraMga ke kAraNa utpanna isa utsedha vizeSa ko cAhe vaha goMda ke sadRza ho yA na ho phiraMgAbUMda kahanA hI adhika yuktiyukta samajhA hai aura tadanusAra usakA prayoga kiyA hai| For Private and Personal Use Only

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566 vikRtivijJAna phiraMgAbaMda ( syphilomata or gummata) ApIta zveta varNa kI ISaskaThina (moderately firm ) granthikAe~ ( nodules ) hotI haiN| inheM hama phiraMgArbudikA bhI kaha sakate haiN| ye choTI maTara se lekara supArI yA akharoTa taka bar3e AkAra kI huA karatI haiN| phiraMgAbUMdoM ke cAroM ora eka pArabhAsaka tAntava ati kaTibandha hotA hai jo prAvara sarIkhA lagatA hai| yaha kaTibandha samIpastha UtiyoM dvArA itanA kasakara jakar3A rahatA hai ki samUce phiraMgArbada kA nikAlanA (enucleation ) atyanta kaThina ho jAtA hai| phiraMgArbuda kI bahIrekhA viSama hotI hai| usakA kAraNa asaMkhya tAntava sUtroM kA itastataH phailanA hai| sahaja phiraMgiyoM ke yakRt meM phiraMgArbuda bahuta zIghra bana jAte haiM unako dekhane para unakA varNa Arakta zveta (reddish white ) dIkha par3atA hai / isa lAlI kA kAraNa una taka rakta kI adhika pahu~ca honA mAnA jAtA hai| ve bahuta adhika mRdu aura raktAnvita dekhe jAte haiN| para adhika Ayu para tRtIyAvasthA ke kAraNa utpanna phiraMgArbuda ativistRta vihAsAtmaka parivartanoM ke kAraNa ve pArAndha, pIta tathA snehayukta adhika dekhe jAte haiN| bAda meM jo pracUSaNa aura tantUtkarSa hotA hai usake kAraNa aMga meM khUba vraNavastu banatI hai| vAstava meM dekhA jAve to phiraMgArbuda mRta uti ke ve kSetra hote haiM jinake cAroM ora eka vraNazothakriyA calatI rahatI hai| phiraMgAdoM ke nirmANa meM do bAteM vizeSa karake bhAga letI haiN| unameM eka bAta yaha hai ki abhilopI dhamanyantazchadapAka ke kAraNa eka kSetra kA jahA~ phiraMgArbuda banatA hai raktavihIna kara denA hai| dUsarI bAta yaha hai ki sukuntalANuoM kI upasthiti ke kAraNa usa kSetra meM eka anUrjika anuhRSatA ( allergic sensitisation ) utpanna ho jAtI hai jisake kAraNa vahA~ eka utinAzaka vraNazothAtmaka vikSata bana jAtA hai| yadi smaraNa ho to pAThaka yakSmikAoM ke nirmANa ke samaya bhI jIvANuoM ke prati zarIra kI anUrjika anuhapatA ko par3ha cuke hoNge| yaha anuhRSatA hI donoM meM sAmAnya hone ke kAraNa phiraMgArbuda tathA yadimakAoM kI racanA meM samAnatA dekhI jAtI hai| phiraMgArbuda saba prakAra se yadimakAoM ke sadRza hI ho so bAta bhI nahIM hai / jahA~ yakSmikAe~ eka sAtha kaI kaI hotI haiM phiraMgArbuda akelA hI rahatA hai| gambhIra zarIrAvayavoM ke phiraMgArbudoM meM taralana hokara nADIvraNa bana jAyA karate haiM tathA upariSTha avayavoM ke phiraMgArbuda vraNIbhUta ho jAte haiM tathA una para anya pUyajanaka jIvANuoM kA upasarga bhI laga jAtA hai| prArambha meM phiraMgAbaMda aura yakSmikA donoM kA autikIya citra eka sA hI rahane ke kAraNa phiraMgArbuda ko kilATIya yakSmAma phiraMgAbaMda ( caseous tuberculoid gumma ) taka kahA jAtA hai / sukuntalANuoM se saMrakSaNa kA kArya zarIra meM yakSmAdaNDANuoM se saMrakSaNa kI bhA~ti, jAlakAntazchadIya saMsthAna kA hai| isI kAraNa dAnoM sthAnoM para anUjika UtinAza eka sA hI hotA hai| isI kAraNa autikIya citra donoM For Private and Personal Use Only

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phiraGga kA lagabhaga eka sA hI rahatA hai / kendriya mahAkozA jisake cAroM ora antazchadIya kozAoM kA eka kaTibandha rahatA hai, usake bAhara lasIkozAoM kI bharamAra jisake sAtha tanturuha ( fibroblastic ) praguNana hotA hai donoM rogoM meM eka sA dekhA jAtA hai / Age calakara phiraMgArbuda ke kendriya bhAga meM UtimRtyu tathA snaihika vihrAsa hone lagatA hai / isake kAraNa kendriya bhAga kI saba racanAe~ galakara eka upasipriyapuMja ( eosinophile mass bana jAtA hai jo samarasa ( homogeneous ) hotA hai jisameM kozAoM kA saba apadravya, snaihika kaNa, paittava Adi ghule rahate haiM isake bAhara kabhI mahAkozA dikhAI de jAte haiM jinake sAtha antazchada ke kozA tathA lasIkozA bhI milate haiM / yadimakAoM meM jitanI saMkhyA meM mahAkozA milate haiM utanI bar3I saMkhyA meM ve yahA~ nahIM milA karate / prarasa kozA bahuta bar3I saMkhyA meM dekhane meM Ate haiM / yadi phiraMgArbuda kI vRddhi ruka jAve to usake Adheya ( contents ) dhIre-dhIre pracUSita ho jAte haiM tathA bAhya tAntavastara aura adhika sthUla ho jAtA hai yahA~ taka ki sampUrNa puMja eka saghana vraNavastu meM pariNata ho jAtA hai / phiraMgArbudoM meM sukuntalANu bahuta kama hote haiM tathA unheM DhU~DhanA bhI paryApta kaThina hotA hai| jyoM-jyoM phiraMgArbuda purAnA par3atA jAtA hai tyoM-tyoM pariNAha para tantUtkarSa kA kaTibandha adhikAdhika spaSTa hotA calA jAtA hai jisake kAraNa kevala do hI kaTibandha dRSTigocara hote haiM jinameM eka kilATIya aura dUsarA tAntava hotA hai / 1 phiraMgArbuda ke utpanna hote hI yadi yogya cikitsA kI jAve to ve vilupta ho sakate haiM para yadi phiraMgArbuda utpanna hone ke pazcAt paryApta samaya bIta jAve tathA zArIrika Uti kA atyadhika vinAza ho cukA ho to kendriya snaihika bhAga kA pracUSaNa ho jAtA hai para eka jhurrIdAra vraNavastu avaziSTa avazya raha jAtI hai / yahA~ cUrNIyana nahIM dekhA jAtA, phiraMgArbudoM kA taralana sahasA kadApi nahIM hotA para yadi pUyajanaka gANuoM ke dvArA ve 'upasRSTa ho jAte haiM to ve mRdu bana jAte haiM aura unake cAroM ora pUyana ho jAtA hai / Age calakara vidradhi phUTatI hai aura usameM se pIta nirmoka (slough ) nikala jAtA hai | yaha nirmoka prakSAlita hati wash leather bag) camar3e sarIkhA hotA hai / aisA lagatA hai ki mAno bhIgI mazaka kA Tukar3A ho / yaha carmala aura samanugata ( coherent ) hotA hai| isameM aura yadimakAoM kI mRta ti meM bahuta antara hotA hai / jaba yaha pRthak hotA hai to eka gaharA chidrakita ( punched ) vraNa bana jAtA hai jisake kinAre viSama hote haiM / aise vraNa jaMghAsthi ke Upara sAmane kI ora dekhe jA sakate haiM / ye jaba ropita hote haiM to vraNavastu banatI hai aura raMgAyaNa ( pigmentation ) bhI hotA hai / ye punaH punaH hote haiN| isake kAraNa vraNa kaI-kaI dekhane meM Ate haiN| tvacA aura zleSmalakalAoM ke phiraMgArbuda sadaiva isI mArga kA anusaraNa karate haiM arthAt inake dvArA chidrakita vraNana hotA hai / isa vraNana meM aura prArambhika avasthA ke vraNana meM jo antara hotA hai use bhUlanA na cAhie kyoMki yaha zarIra ke gambhIra bhAgoM se hotA hai aura prArambhika vraNana upariSTha bhAgoM meM huA karatA hai / For Private and Personal Use Only 567

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568 vikRtivijJAna phiraMgArbuda sadaiva vedanAvihIna hote haiN| yahI nahIM, jina aGgoM meM atyadhika saMvedanA ( sensation ) ho sakatI hai vahA~ isakI upasthiti hone se vaha aMga vedanAzUnya ho jAtA hai| aisA vRSaNoM meM phiraMgAbuMda hone ke pazcAt dekhA jAtA hai| ye phiraMgArbuda tvacA tathA upatvam UtiyoM meM kaThina vedanAzUnya piNDoM ke rUpa meM dekhe jAte haiN| inameM Age calakara vaNana hotA hai| vaNana ke kAraNa svarayantra meM ve svaratantrI ko naSTa karake svarabhaMga ( hoarseness ) kara sakate haiN| tAlu meM inake kAraNa chidraNa ho sakatA hai| usI ko dekha kara kadAcit bhAvaprakAzakAra ne asthizopa nAmaka upadrava isa roga meM batalAyA hogaa| jihvA para vaNana ho sakatA hai| pahale gambhIra zarIrAvayavoM meM ye jitanI bahalatA ke sAtha milate the utane Aja kala nahIM milte| ye peziyoM, prAvaragiyoM ( fasciae ), asthiyoM, yakRt , mastiSka, mastiSkatAnikAoM, vRSaNa, vRkka tathA kabhI-kabhI hRtprAcIra taka meM dekhe jAte haiN| ye phuphphusa meM bhI dekhe jA sakate haiN| saMkSepa meM bahirantarbhavaphiraMga meM AbhyantaraphiraMga ke uparAnta eka yA aneka varSa ke guptakAla ke pazcAt tRtIyasvarUpa ke vikSata utpanna hote haiM ye saMmita nahIM hote tathA gambhIra aura bAhya donoM prakAra kI racanAoM para prabhAva DAlate haiM-they affect deep as well as superficial structures-isI kAraNa ise bhAvamizra ne bahirantarbhavaphiraMga nAma yathArtha hI diyA hai| ina vikSatoM kI pravRtti UtivinAza vA mRtyu kI rahatI hai inameM bahuta kama sukuntalANu pAye jAne se ve bahuta kama upasargakAraka hote haiM / ye tRtIyaka vikSata do mukhya prakAroM meM bAMTe jA sakate haiM eka prakAra sthUla aura sthAnika (gross & localised ) vikSata kA hai jise phiraMgAbuMda kahate haiM aura dUsarA aNu aura prasara ( microscopic & diffuse ) vikSata kA hai| prathama prakAra kA vikSata yadyapi saralatA se dekha liyA jAtA hai para vaha utanA nahIM hotA jitanA ki dUsare prakAra kA vikSata dekhA jAtA hai| phiraMgAbUMdoM ke sambandha meM nimna bAteM dhyAna meM rakhane yogya haiM: 1. yaha sthAnIya uti ke nAza se utpanna hotA hai, ekanyaSTikozAoM dvArA yaha nirmita hotA hai tathA usake kendra meM atimRtyu aura kilATIyana ke kAraNa eka goMda jaisA padArtha bana jAtA hai jisake kAraNa ise gammA yA goMdAdhuMda kahate haiM / isa kendra ke sire para thor3e se mahAkozA rahate haiM / jaba ki yakSmA meM ye mahAkozA bahuta se hote haiN| 2. gammA ke cAroM ora tanturuha praguNana karate haiM aura eka prAvara kA nirmANa kara dete haiM / jaba ki yakSmA meM eka yacimakA ke samIpa dUsarI kaI yadimakAeM dekhI jAtI haiM phiraMga meM eka phiraMgArbuda ke samIpa dUsarA phiraMgArbuda nahIM hotA api tu yaha ekala hI milatA hai| 3. phiraMgArbuda ke kSetra kI vAhiniyoM meM paridhamanIpAka (periarteritis) tathA dhamanyantazchadapAka ( endarteritis ) milatA hai| For Private and Personal Use Only

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phiraGga 566 4. utinAza kA mukhya kAraNa sukuntalANu kA kArya tathA vAhinIya parivartana mAne jAte haiN| 5. saMkSepataH phiraMgArbuda pIle raMga ke rabara jaise padArtha kA eka aisA puMja hotA hai jo choTI maTara se lekara eka bar3e saMtare ke barAbara taka ho sakatA hai| 6. phiraMgArbuda ke Upara phailI tvacA yA zleSmalakalA meM vraNana bahudhA dekhA jAtA hai| vraNabhUmi meM vedanA nahIM hotI aura vaha chidrakita hotI hai aura prakSAlita carma jaisA usakA AdhAra hotA hai| usakI bahIrekhA sAkRtika (serpiginous) hotI hai| 7. phiraMgavaNa ke bAda jo vraNavastu banatI hai vaha raMgI huI hotI hai| 8. jAnu yA TA~ga ke UparI tihAI bhAga meM vraNavastu mile to use phiraMgajanya samajhA jA sakatA hai| 9. nAsAnati yA nAsAbhaMga nAmaka upadva bhAvamizra ne phiraMga meM batalAyA hai vaha phiraMgArbuda ke dvArA vinaSTa huI nAsA ke picaka jAne se dekhA jA sakatA hai aura bahudhA milatA hai| 10. mukha meM vikSata, grasanI meM vraNa, mRdu tAlu meM chidraNa, svaratantriyoM kA nAza ye sabhI sambhava haiN| 11. vRSaNa meM phiraMgArbuda hone para unheM kitanA hI dabAveM darda nahIM hotaa| prasara phiraMga vikSatoM ke sambandha meM nimna smaraNIya hai: 1. sukuntalANu zarIra meM bahuta bar3e kSetra meM phaila jAte haiM tathA ve parivAhinya lasAvakAzoM meM jIrNasvarUpa kI vraNazothAtmaka pratikriyA utpanna karate haiM / 2. chudra vAhiniyoM ke cAroM ora lasIkozAoM aura prarasakozAoM kI saMciti ( accumulation ) milatI hai| ____3. yahA~ kilATIyana na hokara satata prakSobha ke kAraNa jIvitaka utiyA~ badala jAtI haiM aura unakA sthAna tAntava uti le letI hai| phiraMga kI caturthAvasthA phiraMga kI caturthAvasthA ( Quaternary stage of syphilis ) vaha avasthA hai jaba phiraMga kA mastiSka para vizeSa prabhAva par3ane lagatA hai aura jisake kAraNa 2 pramukha vikAra pRSThIyakAya ( tabes dorsalis ) tathA aunmAdika sarvAGgaghAta ( general paralysis of the insane ) utpanna ho jAte haiN| hama ina donoM kA varNana 'vAtanADIsaMsthAna para phiraMga kA prabhAva' nAmaka sthala para isI adhyAya meM Age kreNge| parantu itanA hama yahA~ kaha sakate haiM ki pUrva meM hamane isa caturthAvasthA ko tRtIya bahirantarbhavAvasthA ke antargata mAna liyA thaa| yadi vAstava meM dekhA jAya to yaha koI pRthak avasthA na hokara phiraMgika prasarajAraThaya ke suSumnA evaM mastiSka para hue prabhAva ko hI prakaTa karatI hai| isa prakAra yaha bahirantarbhavaphiraMga ke prasarIya vikSatoM ke antargata A sakatI hai| For Private and Personal Use Only

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600 vikRtivijJAna zvetajihvatA ( lingual leucoplakia) eka anya upadrava hai| jo phiraMga ke kAraNa hotA hai tathA bahuta bAda meM hotA hai| isameM jihvA kA stRta adhicchada (stratified epithelium ) khUba moTA par3a jAtA hai aura zveta varNa kA ho jAtA hai| ise karkaTapUrvI avasthA (precancerous condition ) bhI kahA jAtA hai / isameM upatvacA ke nIce kSudra golakozAoM kI bharamAra hotI hai / jisa prakAra hamane eka bAra sarvasAdhAraNa varNana upasthita karake vividha aMgoM ke prabhAva kI dRSTi se yakSmA kA varNana kiyA hai ThIka usI prakAra aba hama phiraMga kA vividha zArIrika aMgoM para kyA prabhAva hotA hai use spaSTa kreNge| (1) asthiphiraMga (Syphilis of the Bone ) sahaja aura avApta donoM prakAra kA phiraMga roga asthiyoM meM dekhA jA sakatA hai| asthi kA phiraMgika roga eka prakAra kA vraNazotha ThIka usI prakAra se huA karatA hai jaise ki asthiyakSmA kA vraNazotha / parantu ina donoM prakAra ke vraNazothoM meM nimna bheda hotA hai: 1. yakSmA kA prabhAva asthizira ( epiphysis ) para adhika hotA hai parantu phiraMga kA prabhAva asthidaNDa ( diaphysis ) para adhika hotA hai| _____2. yakSmA meM bahudhA sandhi asthi ke sAtha sAtha hI prabhAvita hotI hai parantu phiraMga meM sandhi para prabhAva bahuta kama hotA hai| 3. yakSmA meM jahAM asthizoSa ( osteoporosis) hotA hai vahAM phiraMga meM navIna asthi ke banate rahane se asthisthaulya yA asthijAraThya (osteosclerosis) adhika hotA hai arthAt yakSmA ke vikSata jahAM vinAzAtmaka hote haiM vahAM phiraMga ke vikSata praguNanAtmaka huA karate haiN| karoTi kI asthiyAM, lambI asthiyA~ (jaGghAsthi, Urdhvasthi), akSakAsthi, mukha kI asthiyAM (tAlvasthi tathA nAsAsthi) vizeSa karake isa roga meM prabhAvita hotI haiM / aba hama pahale sahaja phiraMga kA asthi para kyA prabhAva hotA hai use prakaTa karake phira avApta phiraMga kA vicAra kreNge| asthi kI sahaja phiraMga phakka roga meM jisa prakAra ke lakSaNa dekhane ko milate haiM usI prakAra ke lakSaNa lagabhaga eka sahaja phiraMgI zizu meM bhI dekhane meM Ate haiN| inameM karoTi kI asthiyoM meM kahIM to utthana ( bossing ) ho jAtA hai aura kahIM karoTikAdyaM ( cranio tabes ) dikhalAI par3atA hai| isakA kAraNa yaha hai ki phiraMga ke kAraNa kAsthiyoM meM atyadhika adhiraktatA ho jAtI hai aura bahuta vAhinyana ( vascularisation ) ho jAtA hai| isake kAraNa unameM bahuta vRddhi ho jAtI hai tathA sAtha hI sAtha asthiziroM meM sUjana A jAtI hai| karoTi kI asthiyA~ kalAtmaka asthiyA~ ( membrane For Private and Personal Use Only

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phiraGga bones ) kahalAtI haiM ina kalAtmaka asthiyoM meM jahA~ asthIyana kendra ( centres of ossification ) hote haiM vahA~ kahIM to navIna asthi adhika banatI hai aura eka bhAga kA utthana ( bossing ) kara detI hai tathA kahIM para asthi kA viralana ho jAtA hai jisake kAraNa karoTikArya dekhane ko milatA hai| sahaja phiraMga meM 4 prakAra kI vikRtiyA~ bahuta karake milatI haiM :1. karoTigata parivartana ( changes in the eranium ) 2. phiraMgika asthizirapAka ( syphilitic epiphysitis ) 3. phiraMgika aMguliparvapAka ( syphilitic dactylitis ) 4. nAsAnati aura tAluchidraNa (saddle nose and perforated palate) karoTigata parivartana karoTi kI asthiyoM meM do prakAra ke vikSata dekhe jAte haiM, eka ko paryasthagranthikA (periosteal node ) kahate haiM aura dUsare ko prasara asthipAka (diffuse osteitis ) / paryasthagranthikAe~ sahajaphiraMga meM saMmita tathA aneka milatI haiN| ye sthAnika zotha mAtra hotI haiM jo pUrvakapAlAsthi yA pArzvakapAlAsthiyoM para brahmarandhra ( anterior fontanelle ) ke cAroM ora dekhA jAtA hai aura jise hama 'utthana' kaha cuke haiN| prArambha meM yaha naI banI haDDI chidriSTha ( spongy ) hotI hai jo zanaiH zanaiH jaraTha asthi kA rUpa dhAraNa kara letI hai| avAptaphiraMga kI paryasthagranthikA kabhI. asthi meM pariNata nahIM hotI parantu yahA~ vaha hotI huI avazya hI dekhI jAtI hai| chidriSTha asthi kabhI-kabhI mRdu hI banI rahatI hai aura mukhya asthi kA aparadana kara detI hai jisake kAraNa vaha bhI chidrita ho jA sakatI hai aura karoTi ke andara eka ArapAra cheda ho sakatA hai para prAyaH cheda na hokara vahA~ kI AkRti kRmidaSTa ( worm eaten ) avazya ho jAtI hai| yadi karoTi meM phiraMgArbuda kA nirmANa hone lage to nissandeha usameM cheda ho jA sakatA hai| prasara asthipAka ke kAraNa karoTi kI asthiyA~ moTI yA sthUla tathA kaThina ho jAtI haiM / kahIM kAThinya aura kahIM vairalya ye do lakSaNa sahajaphiraMga pIDita karoTi meM bahudhA dekhane ko milate haiN| kahIM kahIM abhilopI dhamanyantaH pAkAdi ke kAraNa jahA~ ina asthiyoM kI raktapUrti meM bAdhA par3atI hai to kaI AkAra ke mRtAsthilava ( sequestra ) bhI dekhe jA sakate haiN| phiraMgika asthizirapAka sAdhAraNataH javAsthi yA Urvasthi kA asthizira eka camakIle dhUsara varNa kI rekhAmAtrA hotI hai| para jaba phiraMga ke kAraNa usameM pAka hotA hai to vaha cauDI, viSama, dantura ( toothed ), pArAndha, ApIta zveta varNa kI paTTI kA rUpa dhAraNa kara latI hai / yaha dekhane ke lie ki zizu kI mRtyu sahajaphiraMga se huI hai mRtyUttara parIkSA karane para jAnusandhi se kucha Upara yA nIce jaMghAsthi yA Urvasthi ke asthizira ko dekhA jAtA hai yadi vaha sAdhAraNa dhUsara rekhA ho to sandeha galata tathA yadi vaha 51, 52 vi0 For Private and Personal Use Only

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602 vikRtivijJAna ApIta zvetavarNa kI paTTI ho to nizcita mAna liyA jAtA hai| sAtha kA citra urvasthi ke adhobhAga meM phiraMgika asthizirapAka ko prakaTa karatA hai| aNvIkSaNa karane para aisA patA lagatA hai ki yahA~ para asthIyana kI prakriyA atyadhika vicalita ho gaI hai kAsthi kI viSama rekhAe~ asthidaNDa meM ghusa ghusa kara asthizirIya rekhA ko caur3I paTTI meM badala rahI haiN| adhika gambhIra avasthAoM meM asthizirIya kAsthi kA sthAna phiraMgika kaNana ati le letI hai jisameM UtimRtyu tathA kilATIyana hone lagatA hai| ye saba upadrava eka sandeha kI puSTi karate haiN| sAdhAraNataH asthizira kI kAsthi kA asthIyana hokara zira aura daNDa ye donoM asthi ke bhAga saMyukta ho jAte haiM parantu phiraMga roga ke kAraNa ve donoM jur3ate nhiiN| balki yA to sahasA yA koI AghAta pAkara asthizira aura asthidaNDa donoM bilkula pRthaka ho jAte haiM jisake kAraNa kRTa aMgaghAta ( pseudo-paralysis ) ho jAtA hai jise kSa-citra dvArA dekha sakate haiN| phiraMgika aMguliparvapAka phiraMga ke kAraNa eka yA ekAdhika aMguliparva kI majjA majjAguhA ke vistAra aura aparadana hone se bAhara nikala AtI hai aura dharAtala para eka naI paryasthIya asthi banA detI hai| isake kAraNa aMguliparva tAkAra ( spindle-shaped ) ho jAtA hai jaisA ki yakSmaparvapAka meM hotA hai| nAsAnati Adi sahajaphiraMga meM nAsAsthi tathA tAlvasthi meM phiraMgArbuda ho jAte haiM aura jaba unakA vinAza hotA hai to nAka baiTha jAtI hai (nAsAnati) aura tAlu meM chidra ( tAluchidraNa ) ho jAtA hai| tAluchidraNa avApta phiraMga meM bhI milatA hai| asthi kI avApta phiraMga avApta ( acquired ) phiraMga meM asthi ke andara do viziSTa vikSata dekhane meM Ate haiN| inameM eka ko paryastha granthikA aura dUsare ko prasara asthipAka kahate haiN| paryasthagranthikAe~ ( periosteal nodes ) paryasthagranthikA nAmaka vikSata ke dvArA hameM asthigata phiraMga kA nidAna karane meM bahuta saralatA rahatI hai / kyoMki yaha jaMghAsthi para prAyazaH tathA pragaNDAsthi, Urvasthi, tathA antaHprakoSThAsthi para kabhI kabhI dekhI jAtI hai| yaha eka vAkya meM carmAdhaH, sparzazUlI, vedanAmaya, dRDha, sthAnasaMzrita zotha hotA hai| yaha sthAnasaMzrita ( localised ) hote hue bhI isake kinAre spaSTataH pRthaka nahIM kie jA sakate balki yaha samIpa kI asthi meM cAroM ora ghusA huA dikhatA hai| paryasthagranthikAoM ke kAraNa jaMghAsthi kabhI kabhI itanI tIvra aura Age kI ora nikala jAtI hai ki use talavAradhAra jaMghAsthi ( sabre tibia) nAma diyA jAtA hai| paryastha ke bhItarI vAhinyastara meM sukuntalANu sthita rahate haiM tathA vAhiniyoM ke cAroM ora bahuta bar3I mAtrA meM kaNanaUti bana jAtI hai yaha uti na kevala paryastha meM hI banatI For Private and Personal Use Only

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phiraGga 603 hai api tu asthinikulyA ( Haversian canal ) ke mukhoM para bhI paryApta mAtrA meM hotI hai| isa naI Uti ke kAraNa nikulyA meM jo Atati utpanna hotI hai usI ke kAraNa rogI rAtabhara asthi-bhedaka zUla ke kAraNa tar3apatA rahatA hai| prabhAvita paryasthi ke nIce jo asthi rahatI hai usakA kaNanaUti kI upasthiti ke kAraNa sabase pahale viralana hone lagatA hai para kyoMki phiraMga meM viralana ke sthAna para jAraThya kA prAdhAnya rahatA hai isa kAraNa kaNanaUti ke dvArA viralIkaraNa kA kArya thor3I dera hokara ruka jAtA hai aura usake sthAna para asthiruha yA asthikRta Akara naI asthi banAnA Arambha kara dete haiM isa kaNanaUti ko bhI asthi meM badala dete haiN| inake dvArA Thosa aura bhArI asthi banatI hai / __ Age calakara phiraMgAvaMdIya paryasthapAka (gummatous periostitis ) ho jAtA hai / phUle hue bhAga kA kendra vihAsita hone lagatA hai| isa vihAsa kA kAraNa abhilopI dhamanyantazchadapAka ho sakatA hai| phiraMgArbuda tvacA meM hokara vraNa banA sakatA hai / jaba vraNa se carmala pItavarNa kA nirmoka baha jAtA hai to naSTa huI asthi spaSTataH dikhAI dene lagatI hai| prasara asthipAka (diffuse osteitis) ise prasara asthiparyasthapAka (diffuse osteoperiostitis) bhI kahate haiN| prasara asthipAka kA prabhAva sampUrNa asthi para paryasthi se majaka taka tathA eka sandhAyIkAsthi se dUsarI taka dekhA jAtA hai| isameM prakriyA pUrvavat hI rahatI hai arthAt kaNanaUti banatI hai vaha asthi kA viralana karatI hai phira asthiruha milakara asthi meM jAraThya utpanna kara dete haiM / isake kAraNa sampUrNa asthidaNDa sthUla ho jAtA hai asthinikulyA meM asthi kI ghanatA bar3ha jAtI hai tathA majaka guhA abhilupta ho jAtI hai| isake kAraNa sampUrNa asthi bhArI aura ghana ho jAtI hai| ____ asthi meM jo yaha parivartana calate rahate haiM unake kAraNa ghora vedanA hotI rahatI hai jo rAtri meM aura ugrarUpa dhAraNa kara letI hai| isameM phiraMgArbudIya asthipAka hotA hai parantu usakA vraNana dharAtala para nahIM hotaa| pRSThavaza ( spine ) meM phiraMga hone para vaha prasara asthipAka kA hI rUpa dhAraNa karatI hai aura kaI kazerukAe~ sthUla aura kaThina ho jAtI haiM / kahIM kahIM para phiraMgArbuda bhI banatA hai aura vaha phUTa kara yakSmA sadRza svarUpa dhAraNa kara letA hai| (2) ___ sandhiphiraMga ( Syphilis of the joints ) sandhigata yakSmA jitanI mahatvapUrNa hai usakI tulanA meM sandhigata phiraMga nagaNya hai| Abhyantara (dvitIyAvasthA) aura bahirantarbhava (tRtIyAvasthA) donoM meM hI phiraMga kA thor3A yA bahuta sandhiyoM para prabhAva par3atA hai| For Private and Personal Use Only

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604 vikRtivijJAna Abhyantara phiraMga meM udasandhitA ( hydrarthrosis ) vizeSa karake dekhI jAtI hai / yA vedanA zUnya hotI hai tathA isameM vraNazotha kA koI lakSaNa dekhane ko nahIM milatA hai| jaise Abhyantara phiraMga ke lakSaNa asthAyI hote haiM vaise udasandhitA bhI asthAyI hotI hai / udasandhitA hone kA artha sandhi meM bahuta se utsyandana ( effusion ) kA bhara jAnA hai / yaha udasandhitA akSa korasandhi ( sternoclavicular joint ) meM bahuta dekhI jAtI hai| Acharya Shri Kailassagarsuri Gyanmandir bahirantarbhavaphiraMga meM jo parivartana hote haiM ve sandhiyakSmA ke lakSaNoM se milate julate hote haiM / isa avasthA meM asthizira para phiraMgArbudikAe~ nikala nikala kara pahale sandhi kI sandhAya kAsthiyoM ko kSati pahu~cAtI haiM phira zleSmagharakalA ko AghAtita karatI haiM / jAnusandhiyA~ donoM hI samAna rUpa se aura eka sAtha isa roga dvArA prabhAvita hotI huI mila sakatI haiM sandhAyI kAsthiyoM ( articular cartilages) aparadana ke kAraNa tathA zleSmadharakalA ke vinAza se sandhi kI gatiyA~ sImita ho jAtI haiM aura dhIre-dhIre asthi pUrNataH nizcala bhI bana sakatI hai / isI avasthA meM yaha bhI ho sakatA hai ki parisandhAyI UtioM ( sandhi ke Upara ke aMgoM ) meM phiraMgArbudIya parisandhipAka ( gummatous periarthritis ) ho jAve / / ke bahirantarbhavaphiraMgAvasthA meM sandhi meM tIna parivartana dekhane meM A sakate haiM : ---- 1 - zleSmadharakalA meM zotha / 2 - kAsthi kA aparadana / 3 - parisandhAyI UtiyoM meM phiraMgArbudanirmANa | cArakaTa sandhiyA~ ( Charcot's joints ) phiraMga kI caturthAvasthA meM sandhiyoM meM vizeSa parivartana dekhane ko milate haiM / para ve parivartana sukuntalANu ke pratyakSa vighna ke kAraNa na ho kara apratyakSa prabhAva se dekhe jAte haiM / arthAt phiraMga kI caturthAvasthA Ane para phiraMga kA kendriya vAtanADI saMsthAna para prabhAva hotA hai jisake kAraNa saMjJAvahavAtanADiyA~ vinaSTa ho jAtI haiN| saMjJAvaha vAtanADiyoM ( sensory nerves ) ke naSTa ho jAne se eka prakAra kA vihAsAtmaka parivartana vaMkSaNa jAnu tathA gulphasandhiyoM meM hotA hai / sandhi thor3I yA bahuta caur3I hotI jAtI haiM aura unakI gatiyA~ svatantra aura aniyantrita hotI calI jAtI haiM / itanA saba hone para bhI zUla kisI bhI samaya nahIM hotA / sandhi meM eka Avila Ababhru varNa kA tarala bhara jAtA hai / sandhi kI saba racanAe~ naSTa hotI calI jAtI haiN| snAyu bhI lupta ho jAte haiM / asthiyoM ke siroM para sandhi kA koI lakSaNa avaziSTa nahIM raha jAtA / sandhi pUrNataH nirarthaka ho jAtI hai aura na to usake dvArA koI gati hI ho pAtI hai aura na vaha aMga ko sAdha hI sakatI hai| kahIM kahIM jIrNAvasthA hone para zleSmagharakalA kA sthUlana tathA sandhAyI dharAtala para asthi kA bar3hanA dekhA jAtA hai / jahA~ sandhi kI saMjJAzUnyatA ho gaI ki usakI gati aniyantrita ho jAtI hai paira yA For Private and Personal Use Only

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phiraGga hA~tha U~cI nIcI jagaha para par3a jAyA karate haiN| isa viSaya kA kucha varNana hama pahale bhI kara cuke haiN| raktavAhiniyoM para phiraMga kA prabhAva dhamaniyoM ( arteries ) para phiraMga kA bahuta adhika prabhAva dekhA jAtA hai / para jaba hama naidAnika dRSTi se pratyakSa dekhane kA yatna karate haiM to hameM kevala do hI aise sthAna milate haiM jahA~ phiraMga ke ghAtaka pariNAma kA kucha bodha ho pAtA hai inameM eka mahAdhamanI hai aura dUsarA mastiSka hai / vAstava meM to phiraMga kSudra vAhiniyoM kA roga hai / vAhiniyoM meM bhI lasavahAoM kA tathA una lasavahAoM ( lymphatics ) kA jo tudra raktavAhiniyoM ke sAtha-sAtha rahatI haiN| jinameM sukuntalANu Thahare rahate haiN| isa lie mUlavikSata kA svarUpa paridhamanIpAka yA parivAhinIpAka (peri arteritis) kA hotA hai aura usake sAtha-sAtha vAhinI antazchadapAka yA dhamanyantazchada (endarteritis) raha sakatA hai| yataH bAhya aura madhya cola bRhat yA madhyamAkArIya vAhiniyoM ke vAhinyavAhiniyoM dvArA sIMce jAte haiM ataH ina dhamaniyoM ke ina coloM meM adhika AghAta dekhA jAtA hai| varSoM se mahAdhamanI tathA mastiSkastha vAhiniyoM ke Upara phiraMgIya prabhAva kA avalokana kiyA jAtA rahA hai isI kAraNa isake sambandha meM jo bhI sAhitya upalabdha ho sakA hai usako hama yathAmati prakaTa karane vAle haiN| phiraMgika mahAdhamanIpAka phiraMgika vikSatoM meM sAmAnyatama vikSata mahAdhamanIpAka kA mAnA jAtA hai / vArthina kA to yahA~ taka kathana hai ki phiraMga ke pratyeka rugNa meM mahAdhamanI meM avazya hI vikSata milatA hai| yaha praur3hAvasthA meM pAyA jAne vAlA roga hai jo mahilAoM kI apekSA puruSoM meM adhika milatA hai| prArambhika vikSata mahAdhanI kapATa ( valve ) se 1-2 iJca Upara hotA hai jahA~ se yaha nIce Upara donoM ora phailatA hai| audarika mahAdhamanI meM mahAprAcIrA pezI taka to vikSata mila sakate haiM parantu usake nIce nahIM dekhane meM Ate / hA~, nIce bAhya cola meM aNvIkSadRSTa vikSata mila sakate haiN| vAstava meM upasarga sarvaprathama bAhyacola meM hI lagatA hai vahA~ se vaha una lasavahAoM taka phaila jAtA hai jo vAhinya vAhiniyoM ( vasa vasorum ) ke sAtha-sAtha jAtI haiN| isa prakAra vaha madhyacola taka yA usase bhI Age pahu~ca jAtA hai| klautja ke anusAra yataH mahAdhamanIya toraNa ( aortic arch ) tathA ArohI mahAdhamanI ( ascending aorta ) kI lasa pUrti bahuta adhika hotI hai isa kAraNa phiraMga kA mukhya prabhAva kSetra yahIM rahatA hai / arthAt jahA~ taka vAhiniyoM kI prAcIroM meM lasavahAoM kA praveza hotA hai vahIM taka phiraMga kA prabhAva prArambha meM dekhA jAtA hai| isI kAraNa jaba parivAhinIya For Private and Personal Use Only

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606 vikRtivijJAna kSetroM meM lasIkozAoM tathA prarasakozAoM kA jamAva hotA hai usa samaya pratyakSa (gross ) yA aNvIkSa ( microscopic ) kisI bhI prakAra kA vikSata antaHcola para nahIM mila pAtA / isa madhyacolIya mahAdhamanIpAka ( mesaortitis ) ke kAraNa, jise sukuntalANu utpanna karate haiM, madhyacola kI saMyojI evaM pratyAstha donoM prakAra kI UtiyoM kA vinAza ho jAtA hai aura usake kAraNa vinaSTa Uti ke sidhma itastataH bana jAte haiM / ina sidhmoM meM hI phira vraNavastu ( scartissue ) kA udaya hotA hai / com antaH cola meM madhyacolIya sidhmoM ke sthAnoM para saMyojI Uti kI pUraka pensatory ) vRddhi hotI hai / isa vRddhi meM tathA dhamanIprAcIroM ke snaihika vihAsa ( atheroma ) ke kAraNa utpanna sidhmoM meM koI sAmya nahIM huA karatA / mahAdhamanI ke phiraMgopasRSTa ho jAne ke kAraNa varSoM taka upasarga sakriyAvasthA meM rahatA hai isalie tIvra pAka hotA huA sadaiva pahacAnA jA sakatA hai / yaha uttarottara vRddhiMgata vikSata usI avasthA meM zAnta hotA hai jaba usake sukuntalANu samApta ho jAva yA mara jAveM tathA pratyeka vRddhiMgata sirAja granthi ( aneurysm ) sadaiva sukuntalANuoM dvArA upasRSTa hotA rahatA hai| sthUlacitra - yadi dhamanIprAcIra meM snaihikavihAsa na huA ho, jo bahudhA ho jA sakatA hai, to isa roga kA sthUlacitra bahuta spaSTa milatA hai / arthAt mahAdhamanI phuphphusAntarAlIya ( mediastinal ) racanAoM se abhilagna ho jAtI hai tathA usakA kATakara dekhA gayA sirA khUba sthUla ho jAtA hai| prabhAvita kSetra meM antazcola kI sthAnika sthUlatA ke kAraNa kaI unnata sidhma itastataH dikhAI dete haiM, ye sima pahale to pANDura varNa ke aura masRNa muktA jaisI AbhA vAle hote haiM para Age cala kara unakA dharAtala gartita ( pitted ) aura vraNavastuyukta ho jAtA hai / ina sidhmoM ke bIca kI Uti meM itanI jhurriyAM aura baliyA~ par3a jAtI haiM ki vaha per3a kI chAla jaisI dikhane lagatI haiM / yaha per3a kI chAla jaisA citra vAhinya snaihikavihAsa ( atheroma ) meM nahIM dekhane meM AtA / snaihikavihAsa ke snaihika sidhma cUrNIyana tathA vraNana yahA~ pUrNataH anupasthita rahatA hai / antazchada meM itastaH zotha ho jAne ke kAraNa hRdaya kI kirITikA dhamaniyoM ( coronary arteries ) ke mukha itane saMkucita ho jAte haiM ki ve kevala pina ke sira ke barAbara khule rahate haiM jisake kAraNa unameM roga ho jAtA hai para atyAzcarya ke sAtha likhanA par3atA hai ki roga ke sAtha hI sAtha vikSata nahIM clte| mahAdhamanI kapATa pUrNataH svAbhAvika rUpa meM raha sakatA hai yA usameM do vizeSa vikSata bana jAte haiM unameM eka hai ki jahA~ mahAdhamanI ke kapATa dala ( cusps ) eka dUsare se milate haiM vaha mukha ( commissure ) yA samAmila bahuta caur3A ho jAtA hai aura dUsarA hai kapATa daloM ke svatantra kinAre (edges ) rajjusama (cord like ) sthUla ho jAte haiM / mahAdhamanI ke kaTe huye kinaroM se yaha parilakSita hotA hai ki antazchada kA For Private and Personal Use Only

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phiraGga 607 bhAga to sthUla sidhma kA rUpa le rahA hai tathA usI ke Upara madhyacola meM tanutva tathA viralatA ho gaI hai / vikSata kA UparavartI bAhmacola usI prakAra bAhara kI ora sthUla tathA bahuta spaSTa ho jAtA hai jisa prakAra antazchada andara kI or| isa kAraNa binA mahAdhamanI ko cIre hue bAhara se bhI usakI dazA kA avalokana kiyA jA sakatA hai| sUkSmacitra-aNvIkSa dvArA dekhane para jo citra prakaTa hotA hai vaha viziSTa hotA hai| sabase pahale bAhyacola meM vikSata banate haiN| ve bAhinyavAhiniyoM (vasa vasorum) ke cAroM ora kozAoM ke puMjoM yA kozAoM kI rekhAoM ke rUpa meM dekhe jAte haiM / ye kozA lasIkozA tathA prarasakozA hote haiN| ina donoM prakAra ke kozAoM meM kabhI koI adhika ho jAtA hai aura kabhI koI kama ho jAtA hai| bvAyaDa ke eka rogI kI mahAdhamanI ke bAhyacola meM saba kozA lasIkozA mile aura usI ke madhyacola ke saba kozA prarasakozA pAye gaye the| prArambhika avasthAoM meM bAhya cola meM asaMkhya sukuntalANuoM kI upasthiti pAI jAtI hai| para mahattva pUrNa parivartana prAyaH madhyacola meM milA karate haiN| kyoMki yahA~ pezItantu tathA pratyAsthatantu donoM kA paryApta vinAza hotA rahatA hai| pratyAstha ati kA abhirakSana kiyA jAve to vaha vikSata taka pAI jAtI hai para vikSata ke andara pUrNataH vilupta ho jAtI hai usameM usake kucha tantu (shreds ) mAtra zeSa rahate haiN| madhyacola ke ina spaSTa vikSatoM ke kAraNa bar3I saralatA ke sAtha mahAdhamanI kI phiraMga ko madhyacolIyapAka kahA jA sakatA hai| isa pratyAstha Uti ke vinAza ke hI kAraNa Age cala kara mahAdhamanI meM sirAja pranthi (aneurysm ) kA udaya huA karatA hai ise smaraNa rakhanA bahuta Avazyaka hai| kucha navIna vAhiniyA~ bhI vanakara madhyacola taka pahu~catI huI dekhI jAtI haiM jo bahuta vismayakAraka hai| ve antazchada ke sthUlita sidhmoM meM bhI kucha gaharAI taka praveza karatI huI milatI haiN| Age calakara kozIya bharamAra kA sthAna vraNavastu le letI hai parantu vaha pUrNataH vilupta nahIM hotii| eka bAra jahA~ mahAdhamanI meM sukuntalANu ne praveza pAliyA ki phira koI bhI cikitsA unheM vahA~ se cyuta nahIM kara sakatI, antazchada meM jo itastataH tAntaya sthaulya ho jAtA hai usakA hetu sukuntalANu nahIM hotA api tu vaha to eka prakAra kI pUraka kriyA (compensatory action) mAtra hai| kAloparAnta yaha navIna tAntava Uti kAcara ( hyaline ) mayI ho jAtI hai| para na to yaha naSTa hotI hai na isameM koI snaihika vihAsa hI dekhA jAtA hai / jaisA kI vAhinyakoSThoM ( atheroma ) meM hotA hai| isI samaya yadi phiraMgika mahAdhamaniyoM kI eka paMkti kA avalokana kiyA jAve to kisI ko bhI yaha jAnakara bahuta vismaya hogA ki kitanI bahulatA ke sAtha usake antazchada meM vAhinyakoSThIya (atheromatous) vikSata pAye jAte haiN| phiraMga vAhinyakoSTha kA pratyakSa hetu cAhe bhale hI na ho para sahAyaka kAraNa avazyameva huA karatI hai| mahAdhamanI kA prasara visphAra usakI pratyAsthatA ke nAza kA pratIka hai| yadyapi For Private and Personal Use Only

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608 vikRtivijJAna mahAdhamanIka dala ( aortic cusps ) para bahuta kama prabhAva par3atA hai parantu mahAdhamanI balaya thor3A khiMca yA phaila avazya jAtA hai isa kAraNa mahAdhamanIka akAryakaratA ( aortic incompetence ) isa roga meM bahudhA dekhI jAtI hai| mahA. dhamanI kI granthiyA~ yA koSThoM ke nirmANa kA pradhAna hetu usake madhyacola meM sthita pratyAstha Uti ( elastic tissue ) kA nAza huA karatA hai| bahudhA uraHphalaka ke nIce rogI ko zUla huA karatA hai jisakA kAraNa mahAdhamanI ke mUla meM sthita uti kA vraNazotha mAnA jA sakatA hai| isI vraNazotha ke kAraNa hRtpradeza meM saMkoca ( constriction ) yA jakar3ane kA sA anubhava honA thA isa saMkoca kA vAma bAhu kI ora jAte hue pratIta honA Adi dekhA jAtA hai| hRdaya kI kirITikA dhamaniyoM ke antazchada ke sUjana ke kAraNa hRdaya ko raktapUrti sahasA rokI jA sakatI hai aura jo turata mRtyu kA kAraNa bana sakatI hai| phiraMgika dhamanIpAka jaisA ki hama pUrva hI prakaTa kara cuke haiM mahAdhamanI ko chor3akara phiraMga ke dvArA gRhIta dUsarA sthAna mastiSka kI vAhiniyoM meM hotA hai jise sarvaprathama san 1874 I0 meM hubnara ne batalAyA thaa| phiraMga dvArA utpanna vikSata tAnikAoM kI kSudra dhamaniyoM meM bahuta spaSTa dekhane meM Ate haiM / jaba pracalanAsaMgati yA pRSThIyakAya (tabes dorsalis) nAmaka roga ho yA phiraMgajanya sarvAGgaghAta ho yA mastiSkasuSumnA phiraMga ho to ye vikSata avazya milate haiN| yahI nahIM, jaba ina rogoM meM se koI bhI nahIM hotA taba bhI tAnikAoM kI tundra dhamaniyoM meM itastataH dasa pA~ca aise vikSata dekhe jA sakate haiN| ye vikSata mastiSkIya phiraMgArbuda ke samIpa bahuta spaSTatayA dekhane meM Ate haiN| bAhyacola kI lasavAhiniyoM meM sukuntalANuoM kI upasthiti ke kAraNa mukhya vikSata eka prakAra kA paridhamanIpAka ( periarteritis) hotA hai| isake kAraNa dhamanI cAroM ora se lasIkozAoM tathA prarasakozAoM ke kaTibandha se ghirI rahatI hai| vahA~ se Age upasarga madhyacola meM praveza karatA hai jisake kAraNa usakI mAMsapezIya tantuoM meM apopakSaya hone lagatA hai tathA antazchada meM spaSTa aura eka barAbara sthUlana hone lagatA hai jisake kAraNa dhamanI suSiraka saMkucita ho jAtA hai aura isI ko abhilopI dhamanyantazchadapAka (endarteritis obliterans ) saMjJA dI jAtI hai| yaha prathama vikSata ( primary lesion) nahIM hai api tu bAhyacoloM meM hue parivartanoM ke pariNAmasvarUpa dvitIyaka pratikriyA ( secondary reaction) hai| jyoM jyoM antazchadIya sthUlana bar3hatA jAtA hai suSiraka choTA par3atA jAtA hai yahA~ taka ki eka samaya eka ghanAsra usake mukha ko banda kara detA hai| yahA~ mahAdhamanI kI taraha sidhmIya sthUlana nahIM hotA isa kAraNa vAhinya granthiyoM ke banane kA prazna hI nahIM utthtaa| mukha banda ho jAne ke kAraNa dhamanI mastiSka ke jisa bhAga ko rakta pahu~cA rahI thI vahA~ rakta kA pahu~canA ruka jAtA hai aura raktavihIna vaha mastiSkakSetra apuSTa ho jAtA hai aura aneka mastiSka phiraMga meM dekhe jAne vAle lakSaNa dekhane meM Ate haiN| For Private and Personal Use Only

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phiraGga 606 phiraMgika vAhinyagranthiyA~ (Syphilitie aneurysms ) __ abhI abhI hamane yaha batalAyA hai ki mahAdhamanI ke madhya cola kI pratyAstha ati ke naSTa-bhraSTa ho jAne ke kAraNa vAhinyagranthiyA~ mahAdhamanI meM utpanna ho jAtI haiN| prasaMgAnurUpa hone se isI kAraNa aba hama isa viSaya kA Avazyaka vivecana karate haiN| vAhinyagranthi (sirAjagranthi ) eka prakAra kA vAhinI kI prAcIra kA visphAra hai jisakA kAraNa vAhinI ke bhItara ke rakta kA pIDana vAhinIprAcIra kI pIDana sahane kI sAmarthya se adhika honA hai| isa kAraNa se vAhinyagranthi eka prakAra vAhinIvisphAra hai| pIDana sahane kI sAmarthya sadaiva vAhinI ke madhyamacola meM rahatI hai| jaba isa cola meM kisI prakAra kA AghAta hotA hai yA kisI upasarga ke kAraNa vaha durbala ho jAtA hai yA kisI anya sahaja yA uttarajAta kAraNa se vaha kSatavikSata ho jAtA hai to vAhinya granthiyA~ yA bAhinIya visphAra utpanna ho jAtA hai| isa kAraNa yaha mahAdhamanI se lekara mastiSka kI cudratama dhamaniyoM meM bhI dekhA jA sakatA hai| vAhinyagranthiyoM ke lie prAcInoM ne sirAjagranthi nAma bhI diyA hai vyAyAmajAtairabalasya taistairAkSipya vAyustu sirApratAnam / saMkucya saMpIDya vizoSya cApi granthi karotyunnatamAzu vRttam // granthiH sirAjaH sa tu kRcchrasAdhyo bhavedyadi syAtsarujazcalazca / sa cArajazcApyacalo mahAMzca marmotthitazcApi vivarjanIyaH // ( suzruta ) vyAyAma aise jo AghAtakAraka hoM yA upasargAdi kAraNoM se utpanna AghAtoM se sirApratAna sirAjAla yA dhamanI vizeSa nirbala ho gaI hai vahA~ rakta ko saMcArita karane vAlI usI dhamanI yA sirA meM sthita vAyu (nipIDa ) saMkocana, saMpIDana yA vizoSaNa ke dvArA usa dhamanI meM zIghra tathA golAkAra aura U~cI uThI huI eka granthi banA detI hai| yahI sirAjagranthi (aneurysm ) hai yaha sazUla hone para tathA spandanamatI hone para kaSTasAdhya hotI hai para yadi yaha pIDA rahita, acala, bar3I aura marmadeza meM sthita huI to asAdhya hotI hai / uparokta zlokoM kI gUr3hatA jAnanI Avazyaka hai| nUtana jJAna se yukta vyakti usa gUDhatA ko jAna sakatA hai aura pahacAna sakatA hai ki RSiyoM ne abala, vyAyAma, vAyu, sirApratAna, saMkocana, pIDana, vizoSaNa, granthi Adi zabdoM kA prayoga vyartha nahIM kiyA api tu sampUrNa vikRtivijJAna ko kucha hI zabdoM meM rakhane kA saphala yatna kiyA hai| mahAdhamanI kI granthiyA~ mahAdhamanI eka marma deza hai / isameM sthita granthi Ayurveda kI dRSTi se asAdhya hotI hai| isameM granthi kA mukhya kAraNa phiraMga mAnA jAtA hai| kucha vidvAnoM kA to yahA~ taka vizvAsa hai ki mahAdhamanI kI sampUrNa sirAjagrasthiyoM kA eka mAtra kAraNa phiraMga hI hotI hai para aisA kahanA bahuta bar3I bAta hai| For Private and Personal Use Only

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610 vikRtivijJAna / karatA hai svAbhAvika mahAdhamanI kI phiraMgika sirAjagranthiyA~ 2 prakAra kI huA karatI haiM :1--syUnAkAra ( saccular ) 2 - tarkurUpa ( fusiform ) syUnAkAra sirAjagranthiyoM kA nirmANa mahAdhamanIka prAcIroM ke phailane se taba hotA hai jaba usake madhyamacola meM sthita sthAnika koI tAntava yA phiraMgArbudIya vikSata hI svayaM phaila jAve yaha phiraMgika madhyamahAdhamanIpAka ( mesaortitis ) ke pariNAmasvarUpa hotA hai / prAcIroM ke phailate samaya hRcchralAbha vedanA huA karatI hai / madhyamacola kA vaha sthAna jo dhIre-dhIre phailane kA yatna zArIra racanAoM se vaJcita ho jAtA hai arthAt usa sthAna para sAdhAraNataH pAye jAne vAle stara nahIM raha jAte / jo syUna banane lagatA hai usakI grIvA para hI madhyacolIya pratyAstha Uti ke tantu samApta ho jAte haiM vahIM para antazchada bhI khatama ho jAtA hai / isalie sirAja granthi kI prAcIra kA nirmANa eka navIna saMyojI Uti dvArA hotA hai jo bAhyacola ke praguNana se banatI hai / yadi granthi kA nirmANa itane adhika vega se hotA hai ki isa navIna Uti kA utane zIghra bananA saMbhava na ho sake to vaha phaTa jAtI hai / mahAdhamanI prAcIra meM Acharya Shri Kailassagarsuri Gyanmandir yataH isa syUnAkAra sirAjagranthi meM antazchada nahIM hotA aura kevala Ama tAntava Uti hI hotI hai isake andara pahu~cA huA rakta AtaMcita ho jAtA hai / isI kAraNa ina syUnoM ko kholane para unameM starIyita raktAtaMca ( laminated blood clot) prAyazaH dekhane meM AtA hai | raktAtaMca kA eka kAraNa antazchadAbhAva hai tathA dUsarA kAraNa rakta kA vahA~ sthira honA bhI hai / yaha raktAtaMca prAyaH tAntava Uti meM anya antarvAhinIya ghanAtrotkarSa kI taraha badalatA nahIM hai api yaha to eka dRDha, masRNa AtaMcavat banA raha kara thor3A yA bahuta mahAdhamanIprAcIra ke durbala vindu ko dRDha karane kA yata mAtra karatA hai| yaha AtaMca TUTa kara antaHzalyoM ko utpanna nahIM karatA hai / isa prakAra kI sthUnAkAra sirAjagranthiyA~ mahAdhamanI ke toraNa ke anuprastha aura avaroha bhAgoM meM eka nahIM aneka bhI dekhI jA sakatI haiN| citra dekhane se jJAta hogA ki mahAdhamanI toraNa meM sirAjagranthi hone ke kAraNa 3 se 6 pazca kazerukAoM meM asthiyoM meM aparadana ( erosion ) bana gaye haiM parantu vahA~ bhI pratyAsthika antarkazeru * kI bimba ( elastic intervertebral dises ) jyoM kI tyoM hone se kucha Age kI ora nikalI huI dikhalAI detI haiM / anuprastha toraNa kI sirAjagranthiyoM ke kAraNa uraH phalaka kA aparadana isI prakAra dekhA jA sakatA hai / jahA~-jahA~ asthiyoM meM sirAja granthi dvArA aparadana hotA hai vahA~ paryApta vedanA huA karatI hai / nipIDajanya anya prabhAvoM meM kaNThanADI para dabAva par3ane ke kAraNa duzvasana yA zvAsAvarodha ( dyspn - oea ) ho sakatA hai, pratyAvarti svarayantragA nADI ( recurrent laryngeal nerve ) para dabAva par3ane se svarabhaMga ho sakatA hai tathA annapraNAlI para dabAva kA pariNAma durnigalana ( dysphagia ) meM ho jA sakatA hai / audarika mahAdhamanI meM phiraMgika sirAjagranthiyA~ bahudhA nahIM dekhI jAtIM / For Private and Personal Use Only

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phiraka 611 tarkurUpa sirAjagranthiyA~ syUnAkAra graMthiyoM kI apekSA kama huA karatI haiN| inakA mukhya sthAna ArohI toraNa ( ascending arch ) kA prathama bhAga tathA mahAdhamanI valaya ( aortic ring ) huA karatA hai / valaya meM sirAjagraMthi ke kAraNa mahAdhamanIka pratipravAhaNa ( aortic regurgitation ) ho jAtA hai / isakA kAraNa hai mahAdhamanI ke eka bhAga kI sampUrNa lambAI meM prasara Atati ( diffuse distension ) yA phailAva ho jAtA hai jo prasaramahAdhamanI madhyamacola pAka ke kAraNa hotA hai / yaha granthi eka tafkArI sUjana ke rUpa meM dekha par3atI hai aura isameM bhI starIyita AtaMcita rakta mila sakatA hai / aisI granthiyoM kI prAcIreM prAyaH aparadita ho jAyA karatI haiM jisake kAraNa vyAvasirAjagranthi ( leaking aneurysen ) utpanna hote haiM jinase rakta parihRtsyUna ( pericardial sac ) meM cU jAtA hai / toraNa ke anuprastha aura avarohI bhAga meM tarkurUpa granthiyA~ bahuta kama dekhane meM AtI haiM / mahAdhamanIka granthiyoM kA vidAra ( rupture ) zanaiH zanaiH vA drutagati se hotA hai yaha atizIghra mAraka hotA hai / yaha kisI bhI aMga meM ho sakatA hai / yathA jaba yaha annapraNAlI meM hotA hai to raktavamana ( haemetemesis ) aura jaba zvAsapraNAlI meM hotA hai to raktaSThIvana ( haemoptysis ), phuphphusAntarAla meM hone para zoNoras ( haemothorax ) tathA parihRcchada meM hone para zoNaparihRcchada (haemopericardium) kahalAtA hai / ( 4 ) lasagranthiyoM para phiraMga kA prabhAva phiraMga ke dvArA lasagranthiyA~ phUla jAtI haiM tathA vedanArahita rahatI haiM ise hama pahale kaha cuke haiN| ina do lakSaNoM ke dvArA tathA phiraMga ke anya zArIrika cihnoM dvArA bahuta saralatApUrvaka phiraMga kA sApekSanidAna kiyA jAyA karatA hai / bAhyaphiraMga (prathamAvasthA ) meM upasargagrasta kSetra ko sIMcane vAle lasagranthaka kaThina, dRDha tathA zUlarahita milate haiN| vaMkSaNapradezastha lasapranthiyA~ prAyaH karake sUjatI haiM / para bhagacumbanAdi ke kAraNa jaba saMdeza oSTha para banatA hai to adhohanu kI granthiyA~ ( submental glands ) phUla jAtI haiM / dvitIyAvasthA yA Abhyantara phiraMga meM sampUrNa zarIra kI sagranthiyoM meM vRddhi hotI hai para yaha vRddhi bahuta adhika nahIM hotI jisake kAraNa kucha vizeSa prakaTa nahIM hotA / bahirantarbhavaphiraMga (tRtIyAvasthA ) meM lasagranthiyoM meM phiraMgArbuda bana sakate haiM para ve dekhe bahuta hI kama jAte haiM aNvI citra koI khAsa nahIM hotA hai / anya phiraMgika vikSatoM kI taraha yahA~ bhI antazchadIya kozAoM kA praguNana, lasIkozAoM tathA prarasakozAoM kI vRddhi dekhI jAtI hai / bAhya aura Abhyantara phiraMga meM sukuntalANu pracura parimANa meM milate haiM tRtIyAvasthA meM nahIM milate yA bahuta kama milate haiM / / For Private and Personal Use Only

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612 vikRtivijJAna plohA para phiraMga kA prabhAva vayaskoM meM phiraMga roga hone para usakA koI vizeSa prabhAva plIhA para par3atA huA nahIM dekhA jAtA bahirantarbhavaphiraMga meM phiraMgArbuda nirmANa kI apekSA kucha prasara tantUtkarSa hI hotA huA dekhA jAtA hai| bAlakoM meM sahajaphiraMga se pIDita hone para plIhAbhivRddhi dekhI jAtI hai| plIhA meM do hI prakAra ke vikSata bAlakoM meM hote haiM jinameM pradhAna hai pharaka roga aura dUsarA phiraMga hai| (6) svarayantra para phiraMga kA prabhAva AbhyantaraphiraMga meM mukha ke andara jaise zleSmala sidhma bana jAte haiM vaise hI svarayantra kI zleSmala kalA para bhI bana jAte haiM / tRtIya bahirantarbhavAvasthA meM phiraMgA. buMdAbha bharamAra ho jAtI hai jisake kAraNa cIrita yA rUkSa ( ragged ) vraNa bana jAte haiN| jyoM jyoM roga kI vRddhi hotI hai vraNa ke sthAna para vraNavastu banatI jAtI hai| isa vraNa vastu kA jaba saMkoca hotA hai taba svarayantra kA nirodhotkarSa (stenosis of the larynx ) ho jAtA hai aura vahA~ kI zleSmalakalA aMkurIyita ( papillo. matous ) ho jAtI hai| vraNazotha gaharAI taka calA jAtA hai jisake kAraNa svarayantra kI kAsthiyA~ bhI naSTa ho jAtI haiN| isa sthiti ko parikAsthipAka (perichondritis) kahate haiN| yaha parikAsthipAka na kevala phiraMga kI hI ghaTanA hai api tu yakSmA athavA Antrika jvara ke kAraNa hone vAle vraNana meM bhI dekhI jA sakatI hai| (7) phuphphusa para phiraMga kA prabhAva phuphphusa para phiraMga kA prabhAva sahaja aura avApta donoM prakAra kA dekhA jA sakatA hai| sahajaphiraMgI zizuoM ke phuphphusoM meM phiraMga kA upasarga mila sakatA hai| bAlaka yA to marA huA utpanna hotA hai yA utpanna hote hI mara jAtA hai / mRtyUttara parIkSA karane para sthUla rUpa se sampUrNa phuphphusa yA usakA eka bhAga AdhUsara pANDura varNa kA dikhAI detA hai aura vaha pUrNataH saMghaTita hone ke kAraNa jala meM DAlate hI DUba jAtA hai| saMghaTana ke kAraNa ise zveta zvasanaka ( pneumonia alba ) nAma bhI diyA jA sakatA hai| saMghanita bhAga kA kaTA huA dharAtala zuSka tathA masRNa For Private and Personal Use Only

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phiraGga ( smooth ) milatA hai| isa prasara avasthA ke sAtha phiraMgArbudikAe~ bhI mila sakatI haiN| __ aNvIkSIya citra sakriya vraNazotha ko na prakaTa karake vikAsa ke avasAda ( arrest of development ) ko prakaTa karatA hai arthAt phuphphusa ke vAyukozA yA to bilkula hI nahIM bana pAte yA unakA thor3A bhAva banakara raha jAtA hai| jahA~ ve pUrNatayA raha jAte haiM vahA~ bhI unakA AkAra prakRta se choTA dekhA jAtA hai| vAyukozA (alveoli ) meM zleSmalagranthiyoM kA sA ghanAkAra adhicchada bichA hotA hai| vAyu kozAoM ke bIca bIca meM tathA zvAsanalikA tathA raktavAhiniyoM ke cAroM ora kozIya tAntava Uti bahuta bar3e parimANa meM chAI rahatI hai| yaha Uti sIdhI phuphphusa kI madhya starakRta ati ( mesoblastic tissue ) se nikalatI hai| kahIM kahIM vAyukozAoM kA pUrNa vikAsa huA milatA hai aura unameM painasa aura antazchadIyakozA bhI dekhe jAte haiN| avApta phiraMga kA nidAna na to sajIvAvasthA meM hI ThIka prakAra se hotA hai aura na mRtyUttara parIkSA hI usakI puSTi kara pAtI hai isI kAraNa nizcitarUpa se yaha kahanA ki ina lakSaNoM se yukta yaha phuphphusa phiraMga kA citra hai bahuta kaThina hai| kucha loga phuphphusa phiraMga bahuta kama hone vAlA roga hai aisA kahate haiM / phuphphusaphiraMga ke 2 rUpa mila sakate haiM:1. zvAsanAla kA vrANana ( ulceration of a bronchus) 2. phuphphusa kA phiraMgArbuda zvAsanAlIya vaNana tatpazcAt vraNavastunirmANa aura usake anantara nirodhotkarSa honA yaha saba zvasanayantrIya phiraMga ke bahirantarbhava prakAra se bahuta sAdRzya rakhatA hai| jaba phiraMga kI sakriyAvasthA cala rahI ho taba kisI dhamanI kA aparadana hone ke kAraNa atyadhika raktaSThIvana dekhA jA sakatA hai| zleSmalakalA meM vraNavastu banane ke kAraNa usakI AkRti rassI se banI nasenI ( rope ladder ) se milatI julatI ho jAtI hai| zvAsanalikA meM nirodhotkarSa hone ke kAraNa phuphphusa kA ekAdhika yA eka khaNDa avapatita ho jA sakatA hai| phuphphusa ke phiraMgAbuda laghu ApIta dhUsara granthikAoM jaise hote haiM jo sampUrNa phuphphusa meM phaile rahate haiM / inameM kilATIyana ho sakatA hai para guhAnirmANa yA kUpIyana ( cavitation ) jaisA ki yakSmA meM milatA hai kadApi nahIM hotaa| yaha dazA phiraMgika mahAdhamanIpAka ke sAtha sAtha hotI hai yA usake uparAnta dekhI jAtI hai| aNvIkSa citra vaisA hI rahatA hai jaisA sahaja phiraMga meN| raktavAhiniyoM meM dhamanyantazchadapAka dekhA jAtA hai| sukuntalANu bar3I kaThinatA se dikhAI dete haiN| phiraMga ke sukuntalANuoM ke dhokhe meM kabhI kabhI phuphphusa Uti ke vinAza ke kAraNa utpanna galazophakuntalANu (spirochaeta vincenti) pAye jA sakate haiM ataH donoM ko ThIka se dekhanA aura samajhanA caahie| For Private and Personal Use Only

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614 vikRtivijJAna (8) oSTha para phiraMga kA prabhAva bAhyaphiraMga kA prathama saMdaMza ( primary chanere ) oSTha para bana sakatA hai| isake do kAraNa haiM / eka cumbana aura dUsarA phiraMgapIDitA dhAya kA dUdha piinaa| saMdaMza prArambha meM eka kaThina gA~Tha ke rUpa meM banatA hai jo bAda meM praNita ho jAtA hai aura eka saMdaMza kA rUpa le letA hai| isI kAraNa isa kSetra ko sIMcane vAlI granthiyA~ phUla jAtI haiM kar3I ho jAtI haiM tathA unameM vedanA nahIM miltii| vraNa meM sukuntalANuoM kI upasthiti saralatApUrvaka dekhI jA sakatI hai| mukha meM phiraMga kA prabhAva mukha kI zleSmalakalA para phiraMga ke pariNAmasvarUpa AbhyantaraphiraMga (dvitIyA. vasthA) meM donoM ora AdhUsara zveta zleSmala sidhma (grayish white mucous patches ) banate haiN| ye sidhma zambUka dvArA banAye mArga jaise hote haiM yA upariSTha ghraNa sarIkhe hote haiN| ye vikSata na kevala mukha kI zleSmalakalA para hI dekhe jAte haiM api tu tuNDikAgranthiyoM tathA tAlu kI zleSmalakalA meM bhI ho sakate haiN| bahirantarbhavaphiraMga (tRtIyAvasthA ) meM phiraMgArbudikAe~ banatI haiM jo TUTa kara gahare chidrakita ( punched out ) vraNoM kA rUpa chor3a jAtI haiN| yaha vikSata prAyaH kaThina tAlu para banatA hai aura tAlu kA chidraNa (perforation ) kara detA hai| isake kAraNa mukha se khAyA huA padArtha nAsA dvArA nikalatA huA dekhA jA sakatA hai| phiraMgAIdikAe~ komala tAlu tathA galatoraNikAoM para bhI bana sakatI haiM / (10) jihvA aura phiraMga jihvA para bAhya, Abhyantara aura bahirantarbhava tInoM prakAra ke vikSata bana sakate haiM / bAhyaphiraMga kA prathama saMdaMza khUba kar3A hotA hai jaisA anyatra milatA hai| usameM sukuntalANuoM kI upasthiti dekhI jA sakatI hai| jihvA para saMdaMza hone ke kAraNa mukhabhUmi ke lasagranthaka phUlate aura kar3e ho jAte haiM jisake kAraNa karkaTa kA sandeha ho sakatA hai| AbhyantaraphiraMga ke kAraNa zleSmAbhasidhma yA upariSTa vraNa jihvA para bana jAyA karate haiN| bahirantarbhavaphiraMga ke kAraNa yA to jihvAvraNa ( ulcer of the tongue ) banatA hai yA prasara jihvApAka ( diffuse glossitis ) hotI hai| jihvAtraNa jihvA para bane phiraMgArbuda ke TUTa jAne ke kAraNa banatA hai aura vaha prAyazaH pRSThabhAga ( dorsum of the tongue ) para banatA hai ise dekhakara aisA For Private and Personal Use Only

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phiraGga 615 samajhane meM bhUla ho sakatI hai ki vaha jihnA kA karkaTa ho para isake samIpa kI na to lasagranthiyA~ phUlatI haiM aura na isameM itanA kAThinya hotA hai jitanA ki karkaTa meM isa kAraNa ise thor3e hI vicArapUrvaka samajhane se pahacAnA jA sakatA hai / phiraMgika jihvApAka upariSTha aura gambhIra donoM prakAra kA ho sakatA hai upariSTha jihvApAka meM koI sudha dharAtala rahatA hai jaise dhUmapAna yA madirApAna ke kAraNa jihvAla prakSubdha ho sakatA hai aisI avasthA meM jihnApAka upariSTha hotA hai / gambhIra jihvAstara taka jaba vraNazotha pahu~catA hai to jihvA meM vidAra ho jAte haiM aura upariSTha acchida eka jagaha ikaTThA hokara dahI sA jama jAtA hai aura jihvA-pRSTha aisA lagatA hai mAno isa para koI paccIkArI kI gaI ho| ise jihvA kA sitaghaTana ( leuco. plakia of the tongue ) kahate haiM / phiraMgika sitaghaTana karkaTa kA pUrvarUpa prAyaH nA karatA hai aura karkaTa jihvA ke kisI eka vidAra meM banatA hai / adhicchadIya pragutighaTana ke sAtha sadaiva ho aisA bhI nahIM hai tathA jihvAtala masRNa, lAla raMga kA tathA vraNazotha prakriyAoM ke kAraNa jihvAMkuroM ke abhilupta hone ke kAraNa apuSTa bhI ho sakatA hai / gambhIra prakAra kA jihvApAka bhI karkaTa kA pUrvarUpa ho sakatA hai / jihvA ke bhItarI bhAga meM vraNazothAtmaka Uti kA nirmANa hotA hai tathA bAda meM tantUtkarSa hotA hai jisakI vraNavastu banatI hai, vidara ( fissures) banate haiM tathA jihvA ke dharAtala para viSama gA~Tha banatI haiM jo isa roga kI vizeSa paricAyikA hotI haiM / phiraMgika jihvApAka meM sAmAnyatama jo lakSaNa dekhe jAte haiM unameM jihvA kA paramacaya aura AkAra vRddhi mukhya haiM / phiraMgika paramajihvatA ( syphilitic or luetic macroglossia ) kabhI kabhI itanI bar3ha jAtI hai ki vaha sampUrNa mukhavivara ko bhara letI hai / ataH paramajihvatA hone para sarvaprathama phiraMga kA avazya dhyAna rakhanA cAhie / ( 11 ) mahAsrota aura phiraMga mahAsrota para phiraMga kA prabhAva bahuta kama hotA hai aura jo hotA bhI hai vaha malAzaya, guda tathA pAyUpasthAntarAla ( pairIniyama ) para hI kahA jAtA hai| ina sthAnoM para yA to bAhya phiraMga kA prathama saMdeza banatA hai yA Abhyantara phiraMga kA phiraMgAzaM (con. dylomata ) banatA hai bAda ke vitata phiraMgArbudIya hote haiM yA jAraThIya ( sclerosing ) hote haiM / phiraMgArbudIya rUpa hone para malAzaya meM itane gambhIra ga banate haiM jo basti taka ghusane ke kAraNa malAzaya bastIya bhagandara ( recto vesical. fistula ) bana jAtA hai tathA kabhI kabhI vaha gudakakundarakhAta ( ischio rectal fossa ) meM calA jAkara anta meM svacA para phUTatA hai / jAraThIya rUpa hone para malAzaya ke adhobhAga meM adhika vraNana na hokara sIdhA tantUtkarSa hotA hai jo For Private and Personal Use Only

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616 vikRtivijJAna Age cala kara saMkoca ( stricture ) utpanna kara detA hai| yaha striyoM meM adhika hotA hai| prAyaH malAzayAdi sthAnoM meM phiraMga utanA vyApta nahIM jitanA vaMkSaNIya lasakaNAbuMda ( lymphogranuloma inguinale ) isa kAraNa gudasaMkoca kA kAraNa phiraMga na hokara yaha arbuda hI adhikatara striyoM meM huA karatA hai / (12) yakRt para phiraMga kA prabhAva yakRt para sahajaphiraMga kA jitanA adhika prabhAva par3atA hai utanA avApta phiraMga kA nahIM pdd'taa| sahajaphiraMga ke kAraNa yakRt meM parikozIya yakRdAlyUtkarSa (pericellular cirrhosis ) hotA hai| isI ko phiraMgika yakRhAlyUtkarSa ( syphilitic cirrhosis ) bhI kahate haiN| yaha prasara-vikSata kA pramANa hai / avApta phiraMga ke kAraNa jo vikSata banate haiM ve nAbhya hote haiM unake kAraNa phiraMgArbuda banate haiM yA tantUtkarSa ke sthAnika kSetra banate haiM / parikozIya yakRhAlyutkarSa yA phiraMgika yakRddAlyutkarSa yaha una zizuoM meM dekhA jAtA hai jo sahajaphiraMga ke kAraNa mara jAte haiN| jaba unake yakRt ko khola kara dekhate haiM to yakRt ke kozAoM ke bIca bIca meM prasara vraNazothAtmaka tantUtkarSa kI eka sI bharamAra pAI jAtI hai| jo vikSata banate haiM ve sampUrNa yakRt meM bhI mila sakate haiM athavA sthAnika sidhmoM ke rUpa meM bhI raha sakate haiN| yakRt kA AkAra bar3A ho jAtA hai aura usakA varNa pANDara ho jAtA hai kahIM kahIM gambhIra kAmalA bhI mila sakatA hai usakA dharAtala masUNa aura racanA kI gADhatA rabara jaisI hotI hai| plIhA kI bhI eka samAna vRddhi sAtha sAtha dekhI jA sakatI hai kyoMki vahA~ bhI prasara tantU. skarSa hotA hai| yakRt meM atyadhika tantUtkarSa hone ke kAraNa usake andara kA padArtha bahuta dRr3ha tathA pratyAstha ho jAtA hai / ____ aNvIkSaNa se aisA patA calatA hai ki mAno nayI tAntavaUti ne yakRt padArtha ko asaMkhya choTI dvIpikAoM meM vibhakta kara diyA ho / pratyeka dvIpikA meM kucha yakRt kozA milate haiN| kahIM kahIM to do hI yakRt kozAoM ke bIca meM Dhera sI tAntavaUti pAI jAtI hai| yaha tAntavati asaMkhya sukuntalANuoM kI kriyA se yakRt ke svastha kozAoM ke TUTane se banatI hai| ye sukuntalANu yakRt tathA plIhA donoM avayavoM meM ucita rUpa se dekhane meM paryApta milate haiN| kahIM kahIM yakRt ke kozA punarjanma kA yatna karate hue bhI dekhe jAte haiM tAki yakRt apanI svasthAvasthA prApta kara sake / aise kozAoM meM do nyaSTiyA~ hotI haiM aura ve abhiraMjita kiye jAne para gaharA raMga letI haiN| roga ke Arambha kAla meM tAntavaUti kozIya tathA sarakta ( vascular ) hotI hai para bAda meM ye donoM bAteM tirohita ho jAtI haiN| For Private and Personal Use Only

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phiraGga phiraMgika yakRhAlyutkarSa meM tAntavaUti kI vRddhi kA kAraNa svayaM sukuntalANu hote haiM jinakI saMkhyA agaNya hotI hai| yaha prasara tantUtkarSa yakRt ke khaNDa khaNDa aura kozA kozA ko vibhakta kara detA hai| sukuntalANu tanturuhoM ko AghAta pahu~cA dete haiM jisake kAraNa unakA bahuta adhika praguNana hotA hai jisake kAraNa yakRt kozAoM kI uttarajAta apuSTi ( secondary atrophy ) ho jAtI hai| aisA honA anya prakAra ke sAdhAraNa yakRhAlyutkarSa ke viruddha ghaTanA hai| jaba yaha tAntava Uti sikur3atI hai to yakRt bhI apuSTa ho jAtA hai usakA tala avazya masRNa rahatA hai| yakRt meM cudra gola kozIya bharamAra ( small round cell infiltration ) khUba hotI hai jo kisIkisI sthAna para bahuta adhika ho jAtI hai aura zyAmAkasama phiraMgArbuda (miliary gumma. ) kA rUpa le letI hai| aise phiraMgArbuda bhI yakRt meM anekoM sthAnoM para dekhe jAte haiN| kucha sahajaphiraMgI zizu jo jIvita hI janma lete haiM unameM Age cala kara phiraMgika yakRtpAka usI prakAra kA jaisA Upara kahA hai mila sakatA hai| vayaskoM meM vaisA kucha nahIM miltaa| avAptaphiraMga kA mukhya vikSata phiraMgArbuda hotA hai jo phiraMga kI tRtIyAvasthA (bahirantarbhava phiraMgAvasthA) kA dyotaka hotA hai| aise phiraMgArbuda eka yakRt meM anekoM hote haiM unakA AkAra bhI khUba bar3A hotA hai| ye vAmakhaNDa meM dakSiNa khaNDa kI apekSA adhika milate haiN| yakRt ke dharAtala para arbuda ke samAna unnata sthAna mila sakate haiM / jaba yaha phiraMgArbuda ropita hotA hai to bahuta sI vraNavastu banA detA hai| vraNavastu jaba saMkoca karatI hai to asaMkhya vidara dharAtala para dekhe jAte haiN| ina vidaroM ke kAraNa yakRt aneka aprakRta khaNDoM meM ba~Ta jAtA hai aura usakA svAbhAvika rUpa naSTa ho jAtA hai aise yakRt ko khaNDita yakRta (hepar lobatum) kahate haiN| yakRt meM phiraMgAbuMda ke hone ke sAtha sAtha jvara, jalodara aura kabhI kabhI kAmalA bhI raha sakatA hai| yakRt meM maNDAbha vihrAsa bhI mila sakatA hai| yakRt ke Upara phiraMgika pariyakRt pAka (perihepatitis ) bhI milatA hai| anya kuntalANu yakRt para aisA prabhAva nahIM DAlate jaisA ki sukuntalANu DAlatA hai| (13) nAsA para phiraMga kA prabhAva sahaja yA avApta donoM prakAra kI phiraMga nAsA meM mila sakatI hai| sahaja phiraMga ke kAraNa apuSTika nAsApAka (atrophic rhinitis) banatI hai aura nAsA se durgandhapUrNa srAva nikalatA hai| For Private and Personal Use Only

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618 vikRtivijJAna (14) AmAzaya aura phiraMga bahuta samaya taka AmAzaya kI phiraMga bahuta hI kama hone vAlA roga mAnA jAtA rahA hai parantu Adhunika sAhitya meM isa sambandha meM bahuta kucha milane lagA hai| parantu aba bhI AmAzaya kI phiraMga ke bahuta thor3e rogI milate haiN| AmAzaya vraNa phiraMga se pIDita meM ho sakatA hai para vaha vraNa phiraMgika ho yaha Avazyaka nhiiN| sAdhAraNa AmAzayavraNa (peptic ulcer ) aNvIkSaNa para phiraMgika vikSata se milatA julatA ho sakatA hai para vaha phiraMga se sarvathA dUra vastu hai| Tarnabala kA kathana hai ki phiraMga meM jaise prarasakozA lasIkozA aura upasi priyakozAoM kI bharamAra dekhI jAtI hai, jaise dhamanyantazchadapAka hotA hai, athavA mahAkozA banate haiM vaisA hI eka sAdhAraNa AmAzayavraNa meM bhI mila sakatA hai| isakA artha yaha hai ki aNvIkSa citra mAtra hI phiraMga kA puSTa pramANa nahIM hai| puSTa pramANa yadi koI hai to vaha hai sukuntalANuoM kI vraNa meM upasthiti / para mukhastha kuntalANu bhI AmAzaya meM pahu~ca sakate haiM aura vahA~ para utpanna karkaTa meM yA vraNa meM dekhe jA sakate haiM ataH siMgara kI dRSTi meM yaha bhI koI pramANa vizeSa mahattva kA nahIM hai| isa vidvAn ne aneka aise citra prastuta kie haiM jinameM vraNa kuntalANuoM se bhare hue haiM para ve sukuntalANu (spirochaeta pallida) nhiiN| hairisa tathA maurgana ne avazya eka aise rogI kA varNana kiyA hai jisake AmAzaya meM sukuntalANu hI the jo samIpastha lasagranthikAoM meM bhI upasthita the aura unake dvArA upasRSTa zazakoM meM bhI ve phiraMga utpanna karane meM samartha hue aura unake vikSatoM se asaMkhya sukuntalANu prakaTa kara ske| yahI eka udAharaNa nissandeha AmAzayika phiraMga kA puSTi kartA hai| bvAyaDa ne likhA hai ki yaha roga bahuta kama hotA hai| landana AturAlaya meM 13000 zavaparIkSaNoM meM Tarnabula eka bhI AmAzayika phiraMga kA rogI nahIM pA skaa| tathA baileva AtarAlaya ke 4880 zavoM kI parIkSAoM meM 316 phiraMga ke siddha hue unameM bhI kevala eka AmAzayika phiraMga kA rogI mila skaa| (15) avaTukAgranthi para phiraMga kA prabhAva avaTukAgranthi ( thyroid gland ) para AbhyantaraphiraMga kA pariNAma yaha hotA hai ki usakA AkAra bar3ha jAtA hai| bahirantarbhavaphiraMga ke kAraNa phiraMgArbudikA utpanna hotI huI bahuta hI kama dekhI jAtI hai / (16) hRdaya aura phiraMga hArdika phiraMga bahuta kama hone vAlA roga hai| phiraMgika hRtpezIpAka sahasroM For Private and Personal Use Only

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phiraGga 616 phiraMgiyoM meM ekAdha meM milatI hai / kabhI kabhI koI phiraMgArbuda bana jAtA hai jo anta nilayIyapaTI ( interventricular septums ) para banatA hai| yaha hRdaya ke vAmanilaya ke agraprAcIra para bhI bana sakatA hai| paTI para isake sthita hone ke kAraNa hRttaraMga saMcAlana kArya meM bAdhA par3a sakatI hai jisake kAraNa hRddati meM bAdhA ( heart block ) A sakatI hai yA mUrchA ( syncope ) bana sakatI hai yA mRgI ke daure (epileptiform convulsions ) dekhe jA sakate haiM kyoMki mastiSka ko paryApta mAtrA meM rakta kA pahu~canA ruka jAtA hai / ina lakSaNoM ko sToksa Adamsa sahalakSaNa ( stokes-adams syndrome ) kahate haiN| (17) phiraMgika vRkkapAka vRkkapAka bahuta hI kama avasthAoM meM phiraMga ke kAraNa hotA hai / phiraMga kI bAhyAvasthA kA vRkkoM para pariNAma nahIM hotA jo kucha pariNAma hotA hai vaha AbhyAntarAvasthA yA bahirantarbhavAsthA meM dekhA jAtA hai| Abhyantara phiraMgAvasthA ke kAraNa tIvra vRkkapAka banatA hai jo prAyaH dUsare mAsa meM prakaTa hotA hai / yaha visphoTa svarUpa kA hotA hai aura jaba tvacA aura zleSmalakalA meM visphoTa hote haiM usI samaya vRkka meM bhI roga lagatA hai| naidAnika citra vRkkotkarSa yA vRkkarujA ( nephrosis ) jaisA hI hotA hai| isake kAraNa paryApta zopha ho jAtA hai tathA mUtra dvArA zviti kA khUba utsarga hotA hai| dvibhujAyalavimedAbha piNDa ( double refractive lipoid bodies) asaMkhya nirmokoM ke sAtha nikalatI haiM parantu unake kAraNa koI hAni vizeSa nahIM hotii| vRkta kI kriyAzakti meM koI pharka nahIM aataa| parantu phiraMganAzaka upacAra kA prabhAva jAdU sA kArya karatA hai| yahA~ taka ki zopha aura ojaHmeha ( albuminuria ) do dina meM hI raphUcakkara ho jAte haiN| yaha roga mAraka nahIM hotaa| jo bhI rugNa dekhe jA sake haiM unameM vRkkotkarSa yA vRkkarujA kA nAlikIya vihAsa ( tubular degeneration of nephrosis) pAyA gayA hai| sAtha meM vRkkanAlikAoM meM sukuntalANu bhI upasthita dekhe gaye haiN| bahirantarbhavaphiraMgAvasthA kA vRkapAka bahuta hI kama milatA hai jaba vaha milatA hai to usake sAtha vRkka kA maNDAbha roga (amyloid disease of the kidney) bhI rahatA hai| yaha vRkkapAka zuddha gucchakIya vRkkapAka (glomerulo-nephritis) hotA hai jisameM sAdhAraNa prAthamika vikSata gucchikAoM yA jUToM meM milate haiM tathA nAlikAoM meM dvitIyaka parivartana milate haiM vaise hI parivartana vRkta ke antarAlita ati meM bhI hote haiN| ye vikSata phiraMga ke anya vikSatoM se pRthaka hote haiN| For Private and Personal Use Only

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vikRtivijJAna (18) vRSaNoM para phiraMga kA prabhAva vRSaNapiNDa meM bahirantarbhavaphiraMga (tRtIyAvasthA ) ke sarvaprathama lakSaNa prakaTa hote haiM vahA~ se roga adhivRSaNikA (epididymis) ko pahu~catA hai| yakSmA meM pahale adhivRSaNikA meM roga lagatA hai jahA~ se phira mukhya vRSaNa yA vRSaNapiNDa meM jAtA hai| anya UtiyoM kI taraha phiraMgika vRSaNapAka bhI do prakAra ho sakatA hai:-eka phiraMgAbuMdIya aura dUsarA prasaratAntava jaraThotkarSa (diffuse fibrous sclerosis) / jo phiraMgArbuda banatA hai vaha tAntavaUti ke eka saghana stara se AcchAdita vinaSTa Uti kA puMja jaisA dikhatA hai jo vRSaNa ke piNDa meM rahatA hai| sparza karane meM vaha paryApta dRDha hotA hai usakA varNa ApIta zveta hotA hai / anya phiraMgArbudoM kI bhA~ti isakA mRdvana na hokara yaha dhIre dhIre pracUSita ho jAtA hai aura isakA sthAna eka saghana tAntava vaNavastu le letI hai| prAyaH vRSaNa muSkaprAcIra ( scrotal wall ) se abhilagna ho jAte haiM tathA aNDadhara yA vRSaNadhara puTaka ke staroM ke bIca kA antarAla abhilupta ho jAtA hai kabhI kabhI thor3I muSkavRddhi ( hydrocele ) bhI mila jA sakatI hai / vRSaNoM kI abhilagnatA carma taka prakaTa ho jAtI hai aura Age kI ora eka phiraMgAbuMdIya vraNa bhI bana sakatA hai jisake kAraNa vRSaNa bAhara dekhe jA sakate haiN| bAharI tala para vRSaNoM kA dekhA jAnA vRSaNavarma ( hernia testis) kahalAtA hai| isI vraNa meM phira dvitIyaka upasarga laga sakatA hai jisake kAraNa vidradhi bana sakatI hai aura phiraMgArbuda kA vinaSTa prAya ( necrotic ) kendriya bhAga carmadhAvana nirmoka ( wash leather slough ) ke samAna unmukta ho jAtA hai / prabhAvita vRSaNa kucha bar3e AkAra kA ho jAtA hai parantu usameM zUla bilkula nahIM miltaa| prasara phiraMgika jaraThotkarSa jaba hotA hai to vRSaNa ke piNDa meM zUlahIna tAntvika apuSTi ( fibrotic atrophy ) ho jAtI hai| yaha Avazyaka nahIM ki vRSaNa kA AkAra kucha bar3A ho| yaha to kucha choTA ho jAtA hai aura atyadhika kaThina ho jAtA hai isake kAraNa koI vizeSa lakSaNa utpanna nahIM hote| aNvIkSaNa karane para prarasakozAoM aura lasIkozAoM kI prasara bharamAra hotI hai sAtha meM navIna tAntava ati banatI hai tathA zukrika Uti ( spermatic tissue ) kI apuSTi bhI hotI hai| vRSaNa kI kAyA meM tAntavaUti kI paTTiyA~ zveta rekhAoM jaisI dekhI jAtI haiM Age calakara tantUrakarSa adhivRSaNikA taka A jAtA hai jisake kAraNa suSiraka abhilupta ho jAtA hai tathA muSkavRddhi utpanna ho jAtI hai| For Private and Personal Use Only

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phiraGga 621 (19) garbhAzaya para phiraMga kA prabhAva garbhAzayapiNDa kI phiraMga jitanI kama milatI hai utanI hI garbhAzayagrIvA kI phiraMga milatI hai| garbhAzayagrIvA para prathama saMdeza bhI mila sakatA hai| Abhyantara phiraMga ke utkaNa ( papules ), AIsidhma athavA vaNana kucha bhI usake dvAra (os ) para yA usakI suraMga ( canal ) meM mila sakate haiN| bahirantarbhavaphiraMga meM dvAra ke agra yA pazvabhAga meM phiraMgArbudIya vraNa bana sakate haiN| (20) vAtanADIsaMsthAna para phiraMga kA prabhAva phiraMgika upasarga kA sarvAdhika prabhAva do hI saMsthAnoM para vizeSatayA par3atA hai jinameM eka vAhinya saMsthAna ( vascular system ) hai tathA dUsarA jisakA varNana aba hama karane vAle haiM vaha vAtanADIsaMsthAna hai| vAtanADIsaMsthAna para yadyapi Abhyantara phiraMgAvasthA meM hI jaba sampUrNa zarIra meM phiraMga kA viSa vyApta hotA hai tabhI phiraMga kA upasarga laga jAtA hai parantu phiraMga kA vAstavika prabhAva bahirantarbhava phiraMga (phiraMga kI tRtIya aura caturtha donoM avasthAoM) meM hI dekhane meM AtA hai / mastiSkasuSumnAjala ( mastiSkoda) eka darpaNa ( mirror ) ke samAna hai jisameM phiraMga kI chAyA bar3I AsAnI se oNkI jA sakatI hai| mastiSkoda ke parivartana to bAhya phiraMgAvasthA meM bhI milate haiN| vAila aura sToksa ke adhyayana kA varNana karate hue vyAyaDa likhatA hai ki unhoMne bAhyaphiraMga ke 6 rugNa dekhe aura unake mastikoda kI parIkSA kii| parIkSaNa kA pariNAma yaha nikalA ki unameM se 4 kA mastikoda AsvAbhAvika thA yahA~ taka ki eka ke mastiSkoda meM kozA gaNanA 200 milI mastiSkoda meM sukuntalANuoM kI upasthiti Abhyantara phiraMga (dvitIyAvasthA) meM mila jAtI hai| use prANiyoM meM praveza karake yA aNvIkSaNa para svayaM pahacAnA jA sakatA hai| kucha rogiyoM meM kucha vAtaroga ke lakSaNa bhI mila sakate haiM jaba ki anyoM meM ye lakSaNa bilkula nahIM milte| san 1913I0 meM antArASTriya cikitsaka saMgha kI baiThaka meM nIsara ne kahA thA ki kisI ko bhI phiraMga se mukta kaha kara taba taka nahIM chor3a denA cAhie jaba taka ki usake mastiSkasuSumnAjala kA parIkSaNa karake use pUrNatayA svAbhAvika na pA liyA jAve / arthAt mastiSkoda phiraMgopasarga ke kAraNa bahudhA anRju rahatA hai aura vAtanADI saMsthAnajanya phiraMga kA kAraNa banatA hai| _ vAtanADIgata phiraMga ke sambandha meM do bAteM Ajakala vizeSa taura kaho jAtI haiN| eka to yaha ki yaha roga kulacA pravRtti vAlA hai arthAt kucha vizeSa parivAroM ko jitanA For Private and Personal Use Only

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622 vikRtivijJAna rogagrasta karatA hai utanA anya parivAroM ko nahIM krtaa| dUsare vAtanADIsaMsthAna para kArya karane vAlA sukuntalANu eka viziSTa prakAra kA hotA hai kyoMki jisa eka sAdhana dvArA kisI ko vAtanADIsaMsthAnagata phiraMga hotA hai usI sAdhana dvArA upasRSTa kaiyoM ke vAtanADIsaMsthAna meM phiraMga hotA huA dekhA jAtA hai| ye donoM bAteM kahA~ taka yuktiyukta haiM abhI nizcayAtmaka rIti se nahIM kahA jA sakatA kyoMki isa viSaya para adhika gaveSaNA kI AvazyakatA hai| ___vAtanADIsaMsthAna meM phiraMgopasarga yA phiraMga viSa do prakAra kA prabhAva DAlatA hai jinameM prathama prabhAva isa saMsthAna kI saMyojI UtiyoM aura raktavAhiniyoM para par3atA hai| isake kAraNa jo roga utpanna hotA hai use vAtaphiraMga ( neurosyphilis) yA tAnikAvAhinIya phiraMga ( meningovascular syphilis ) kahate haiM tathA dvitIya prabhAva isa saMsthAna kI jIvitaka Uti para par3atA hai jisake kAraNa pazcakAya ( tabes dorsalis) jise pracalanAsaMgati ( locomotor ataxia) bhI kahate haiM tathA unmattasya sarvAGgaghAta (general paralysis of the insane) yA sarvAGga ghAta (general paresis ) hotA huA dekhA jAtA hai| hama inhIM kA varNana nIce yathAkrama de rahe haiN| vAtaphiraMga ___ isa mastiSkasuSumnAphiraMga (cerebro spinal syphilis ) bhI kahate haiM / para cAhe vAtaphiraMga kaheM yA mastiSkasuSumnAphiraMga ye donoM nAma hI vyartha haiM kyoMki ve roga ko pazcakArya tathA sarvAGgaghAta se pRthaka batalAne meM asamartha haiM / mauTa ne jo antarAlita asthiphiraMga tathA jIvitaka UtiyaphiraMga nAma diye haiM ve kucha sArthaka haiM parantu inakA prayoga bahuta hI kama kiyA gayA hai| vAtaphiraMga kA kAraNa hotA hai vAtanADIsaMsthAna kI antarAlita Uti meM phiraMga kA upasarga laga jAnA jisakA bhAva hai tAnikAoM, unake parivAhinya varddhanakoM (perivascular prolongations ) tathA raktavAhiniyoM kI prAcIroM meM phiraMga kA upasarga laga jAnA / yahA~ jo vikRti dekhI jAtI hai vaha usI prakAra kI hotI hai jisase hama paryApta paricita haiN| arthAt kaNana Uti kI utpatti, UtinAza, phiraMgArbudikAnirmANa tathA viziSTa prakAra kA dhamanIpAka hI ve vikRtiyA~ haiM jo vAtaphiraMga meM milatI haiN| ye vikRtiyA~ sthAnika bhI ho sakatI haiM aura prasara bhii| sthAnika hone para phiraMgArbuda banate haiM aura prasara hone para tAnikAmastiSkapAka ( meningo-encephalitis ) athavA tAnikIya suSumnApAka ( meningo myelitis ) hotA hai| inhIM kA varNana aba kiyA jaavegaa| phiraMgArbuda-mastiSka yA suSumnA meM AjakAla phiraMgArbuda hotA ho vaha na to mRtyUttara parIkSaNa gRha se siddha hotA hai na nidAna se / yaha to tAnikAoM para eka prakAra ke prabhAva ke phalasvarUpa hotA hai aura mastiSka yA suSumnA ke bhItara milane kI apekSA dharAtala para hI milatA hai / isakA sthAna bahudhA mastiSka zikhara rahA karatA For Private and Personal Use Only

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623 phiraGga hai| para jaba vaha mastiSka ke bhItara taka dekhA jAtA hai to vaha mRdu-jAlatAnikAoM ke bAhupa ( sleeve of pia-arachnoid ) para jahA~ sAtha sAtha vAhiniyA~ bhI rahatI haiM banatA hai / isakA AkAra maTara se lekara nAraMgI ke barAbara taka ho sakatA hai yaha gADhatA kI dRSTi se dRr3ha tathA varNa meM dhUsara hotA hai / aNvIkSaNa para isameM phiraMgika kaNanaUti bharI hotI hai jo vAhiniyoM se samRddha hotI hai| isameM prarasa kozA, lasIkozA tathA adhicchadAbha kozA pAye jAte haiN| kendra meM atinAza huA rahatA hai tathA kilATIyana bhI ho jAtA hai| phiraMgArbuda ke nIce basI mastiSka Uti apuSTa ho jAtI hai tathA vAtazleSa ( neuroglia) kA praguNana hone lagatA hai| jaba phiraMgArbuda kA AkAra bar3ha jAtA hai taba vaha antaHkaroTIya nipIDa ( intracranial pressure ) ke kucha cihna prakaTa karatA hai| isaliye mastiSkArbudoM kA nidAna karate samaya sabase pahale phiraMgAvuda ko pRthaka kara lenA Avazyaka hotA hai| yahI bAta suSumnAstha arbudoM ke lie bhI jAneM / paridhamanIpAka ke kAraNa mastiSka meM aneka sUkSma phiraMgArbudikAe~ utpanna ho jAtI haiN| bahuta hI kama bar3e phiraMgArbuda banate haiN| mRdu-jAlatAnikIya bAhupoM meM ve kabhI kabhI banate haiM aura dhIre dhIre samIpastha mastiSka ati kA vinAza karate haiM ve anya phiraMgArbudoM kI taraha pahale vAhinImaya, dhUsara tathA pArabhAsaka hote haiM bAda meM unameM kilATIyana hotA hai unakA kendra mRdu bana jAtA hai Upara eka saghana tAntava prAvara car3ha jAtA hai| karoTi meM nipIDa vRddhi ke kAraNa ziraHzUla, vamana, akSinADIpAkAdi ke lakSaNa mila sakate haiN| phiraMgika tAnikIya mastiSka pAka-sulemAna kA kathana hai ki phiraMga kA tAnikIya upasarga bahuta karake milatA hai aura vaha sambhavatayA 20-30 pratizata phiraMga pIDitoM meM mila sakatA hai| parantu zavaparIkSAgRha meM tAnikAphiraMga ke rogI bahuta kama pAye jAte haiN| phiraMga ke kAraNa dRr3hatAnikA, mRdu tAnikA tathA jAlatAnikA tInoM prabhAvita huA karate haiM. para mRdu-jAla tAnikAoM para jo prabhAva par3atA hai vaha dRDhatAnikA para nahIM dekhA jAtA hai| mastiSka ke AdhAra para vizeSa karake antarmastiSkamRNAlakIya avakAza ( inter peduncular space ) tathA dRSTinADIyojanika ( optic chiasma ) ke kSetroM meM vikSata pAye jAte haiM jisake kAraNa tRtIyA nADI para prabhAva par3anA sambhava ho jAtA hai| kucha rugNoM meM tAnikAoM meM phiraMgAvudikIya bharamAra bahuta milatI hai vizeSa karake mastiSka zikhara (vertex) para / isa roga meM jaisA ki nAma se spaSTa hai kama yA adhika aMza meM mastiSka padArtha bhI prabhAvita hotA hai| pratyakSa rUpa meM antarmastiSka mRgAlakIya avakAza meM zliSIya utsyanda (gelati. nous exudate ) sA dekhA jAtA hai yA vahA~ bahuta halakA bemAlUma dUdhiyApana For Private and Personal Use Only

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624 vikRtivijJAna milatA hai athavA sampUrNa mastiSkArddha 1 sUta moTI eka saghana kalA dvArA AvRta ho jAtA hai| mastiSkasuSumnAjala ke pravAha meM bAdhA Ane se phiraMgika udamastiSka hotA huA bhI dekhA jAtA hai| aNvIkSaNa se jaba taka phiraMgArbudIya nirmANa kI puSTi na ho tAnikIya utsyanda (srAva) ko phiraMgika nahIM kahA jA sakatA / jaise ki yacamamastiSkacchadapAka yA yakSmatAnikIya pAka meM kozA hote haiM vaise hI yahA~ bhI milate haiM arthAt prarasakozA tathA lasIkozAoM kI bharamAra vahA~ pAI jAtI hai| kabhI kabhI tAnikAoM ke nIce kI mastiSka uti meM vraNazotha phailatA hai| vAhiniyA~ vraNazothAtmaka kozAoM ke praiveyoM ( collars ) yA maNibandhoM (cuffs) se AcchAdita ho jAtI haiN| adhika adhyayana karane para jJAta hotA hai ki yaha tAnikIya srAva kA prasAra brahmodakulyA ( subarachnoid space ) ke parivAhinIya dIrghaNa ( prolongation ) ke kAraNa hai| yaha mAna lenA par3egA ki isa prasAra meM sukuntalANu kA pUrA pUrA hAtha rahatA hai| kucha bhI ho isa saba kA pariNAma mastiSkapAka meM hotA hai jisake kAraNa nizcita lakSaNa prakaTa hote haiM / suSumnA meM phiraMgika suSumnApAka hotA hai| yaha pAka mastiSkapAka kI apekSA adhika spaSTa hotA hai| bujharDa aura grInaphIlDa kA kathana hai ki suSumnApAka ke 80 pratizata rogo phiraMgopasRSTa huA karate haiN| suSumnApAka anuprastha dizA meM hotA hai aura kucha hI khaNDoM ( segments) taka sImita rahatA hai / isa pAka kA kAraNa rugNa vAhiniyoM meM ghanAsrotkarSa kA honA hai| isake kAraNa suSumnA kA mRdana hone lagatA hai sAtha meM phiraMgArbudikAoM kI bharamAra ho jAtI hai, nADIkozA naSTa ho jAte haiM nADIsUtra bhI khaNDita ho jAte haiM tathA vAhiniyoM meM bhI bahuta parivartana ho jAtA hai / Upara jitane bhI vikSata batalAye gaye haiM saba meM phiraMgika dhamanIpAka avazya rahatA hai| dhamaniyoM kI phiraMga kA varNana pahale kiyA jA cukA hai| isa phiraMga meM dhamaniyoM ke bAhyacola meM sthita lasavahAoM meM sukuntalANuoM kI bharamAra ho jAtI hai aura lasIkozA tathA prarasakozA bhI bhara jAte haiN| ina kSudra vAhiniyoM meM mukhya dvitIyaka parivartana inake antazchada meM yaha hotA hai ki vaha lagAtAra sthUla hotA calA jAtA hai yahA~ taka ki abhilopI dhamanyantazchadapAka ho jAtA hai| mahAdhamanI meM madhyacola kA jaisA sidhmika nAza hone se sirAja granthiyoM jaisI sthiti yahA~ nahIM bntii| yahA~ to ghanAstrotkarSa hokara supiraka pUrNataH banda ho jAtA hai| isa prakAra eka vAhinI ke bhAtara jahA~ antazchada moTA par3atA jAtA hai vahA~ Upara se phiraMgAbuMdIya pravRddhi hotI calatI hai aura dhamanyantazchadapAka tathA paridhamanApAka donoM hI isa roga meM milate haiN| isa roga meM vikSatoM aura rogalakSaNoM kA kyA sambandha hotA hai usakI ora bvAyaDa ne kucha iGgita kiyA hai| yadi kucha AkAra kA phiraMgArbuda banatA hai to antaHkaroTIya abuda ke lakSaNa prakaTa hone lagate haiM / ye lakSaNa vikSata kI mastiSka For Private and Personal Use Only

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phiraGga 625 meM sthiti ke anusAra hote haiM / mastiSkacchadapAka ke kAraNa mastiSkAdhArIya lakSaNa milate haiM / phiraMgArbudIya sthUlatA tRtIya, caturtha aura SaSTha nADiyoM ko, jisa samaya ve mastikA se nikalatI haiM, usI samaya pakar3a letI haiN| isake kAraNa rogI varmapAta ( ptosis ), TeratA (strabisinus ) tathA dvidhA dRSTi ( diplopia ) pIDita ho jAtA hai / ye lakSaNa sthAyI nahIM hote / dvitIyA nADI ke prabhAvita hone se akSinADIpAka ( optic neuritis ) ho sakatA hai dekhane kI kriyA meM vikRti A sakatI hai / anya zIrSaNyA nADiyA~ bhI sakatI haiM para vaisA bahuta hI kama dekhA jAtA hai / I aura netra ke prabhAvita ho kabhI kabhI lakSaNa tIvra aura caMcala ( fulminating ) hote haiM / isakA udAharaNa dete hue vaha likhatA hai ki eka rogiNI sarvAGgINa | AkSepoM se yukta AI aura vaha 48 ghaNTe meM hI mara gaI / parIkSaNa para jJAta huA ki vaha phiraMgapIDitA thI / zavaparIkSA se jJAta yaha huA ki vaha tAnikIya mastiSka pAka se prabhAvita thI aura usake mastiSka bAhyaka meM ghAtaka vikSata pAye gaye / Acharya Shri Kailassagarsuri Gyanmandir vAta phiraMga kI prArambhikAvasthA meM kabhI kabhI ghAtaka mastiSkacchadapAka ke lakSaNa dekhe jAyA karate haiM / madhyamA pramastiSkIya dhamanI kI zAkhAoM meM ghanAstrotkarSa ho jAne se aura raktapUrti meM bAdhA Ane se pakSAghAta (hemiplegia ) bhI ho sakatA hai / kyoMki isase mastiSka kA bhAga mRdula ho jAtA hai| isa prakAra vAtaphiraMga bahujaraThotkarSa se lekara pramastiSkIya raktastrAva taka kisI bhI roga kI kAriNI ho sakatI hai aisA vidvAnoM kA mata hai / 700 mastiSkoda isa roga meM vibhinna prakAra kA dekhA jAtA hai / tIvra phiraMgika mastiSkacchadapAka hone para pratikriyA gambhIra hotI hai jisake kAraNa 400-600taka lasIkozotkarSa dekhA jAtA hai / itanI adhika kozAgaNanA phiraMgika mastiSkacchadapAka meM yA ajIvANuka lasIkozIya mastiSka chudapAka meM hI dekhI jAtI hai / mastiSkoda kI probhUjina kI mAtrA bhI paryApta bar3ha jAtI hai / vAsaramaina pratikriyA pUrNataH astyAtmaka hotI hai / zlepAbha svarNa vakrarekhA ( colloidal gold curve ) aMgaghAtika ( paretic ) prakAra kI hotI hai / yadi vikSata phiraMgArbuda huA to mastiSkoda meM bahuta kama parivartana milate haiM vAsaramaina tathA svarNaparIkSaNa durbala athavA nAtyAtmaka hote haiM / na adhika lasIkozotkarSa hotA hai aura na probhUjina kI mAtrA hI bar3hatI hai / yadi vijJata pUrNataH vAhinIya hue to mastiSkoda pUrNataH apane svAbhAvika svarUpa meM hI dekhA jAtA hai / I pacakA yA pracalanAsaMgati pacakArzya ( tabes dorsalis ) yA pracalanAsaMgati ( locomotor ataxia ) phiraMga kI antima avasthAoM kI pravyaMjanA hai / phiraMga ke upasarga ke 10-15 varSo ke pazcAt yaha roga huA karatA hai| eka bAra phiraMga laga jAne ke kama se kama 2 varSa pazcAt aura adhika se adhika 20 varSa pazcAt taka yaha roga laga sakatA hai / yaha to 53, 54 vi0 For Private and Personal Use Only

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Acharya Shrik 626 vikRtivijJAna nizcita hai ki yaha roga phiraMgajanita hotA hai parantu isameM jo vikSata milate haiM ve phiraMga ke anya vikSatoM se sAdRzya bilkula nahIM rakhate / yadyapi kaI vidvAnoM ne suSumnA se sukuntalANuoM kI upasthiti siddha kara dI hai phira bhI unako isa roga meM pAnA bahuta kaThina aura gurutara kArya hai| yaha roga striyoM kI apekSA puruSoM meM adhika dekhA jAtA hai / yaha prAyaH prauDhAvasthA meM 40 varSa ke pazcAt dekhA jAtA hai / pracalanAsaMgati nAmaka roga ke vikSata do spaSTa prakAra ke hote haiM / sarvaprathama tAnikAoM kA phiraMgika vraNazotha hotA hai| vraNazotha yA pAka yaha Avazyaka nahIM ki bahuta gambhIra svarUpa kA ho / avazya hI vaha saumya prakAra kA bhI ho sakatA hai aura itanA saumya ki usake hone meM bhI sandeha hone lge| isa pAka kI tIvratA ( intensity ) kA Age roga ke dvArA hone vAlI vikRtiyoM se bar3A bhArI sambandha hotA hai| tAnikIya pAka nAmaka prathama vikSata se adhika mahattva kA aura viziSTa (characteristic) lakSaNa hotA hai suSumnA ke pazcastambhoM kA vihAsa aura vilopa (degeneration and disappearance of posterior columns of the spinal cord ) tathA usake sthAna para vraNavastu kA nirmANa / suSumnA ke ye vikSata pratyakSa dekhe jA sakate haiN| prabhAvita stambhoM ke Upara mRdutAnikIya sthUlana ho jAtA hai aura mRdutAnikA suSumnA se abhilagna ho jAtI hai isa prakAra eka pArAndhasama dIkhane vAlI taMga paTTI suSumnA kI sampUrNa lambAI para pazcabhAga meM cipakI huI dikhalAI detI hai| pazcastambhoM kA tala udubja ( convex ) nahIM raha pAtA aura yA to vaha cipiTita ho jAtA hai yA nyubja ( concave ) / jaba use anuprastha dizA meM kATA jAtA hai to zeSa zveta padArtha se nitAnta bhinna pArabhAsaka tathA dhUsara varNIya padArtha dekhane meM AtA hai / pazcastambhoM kI isa apuSTi ke kAraNa hI isa roga kA nAmakaraNa pazcakArya kiyA gayA hai aisA jJAta hotA hai| pazcavAtanADImUloM meM bhI yahI parivartana milate haiM ve choTe ho jAte haiM sikuDa jAte haiM dhUsara hote haiM aura unakI tulanA meM agranADImI khUba moTe hote haiN| aNvIkSaNa para yaha parivartana dekhA jAtA hai ki adho abhivAhI nADIkandANu ( lower afferent neurone ) arthAt jinheM suSumnA ke pazcastambhoM ke bahirjanita tantu kahate haiM vihAsita aura vilupta ho jAte haiN| pazcastambhoM ke sambandha meM kucha zabda kahanA yahA~ Avazyaka hai / pazcastambha antarjanita aura bahirjanita ina do prakAra ke tantuoM ke dvArA nirmita hote haiN| antarjanita tantu suSumnA ke andara ke kozAoM se utpanna hote haiM ve Upara yA nIce 2 yA 3 khaNDoM taka jAte haiM bAda meM anya kozAoM ke cAroM ora samApta ho jAte haiM isa prakAra ve samIpastha khaNDoM (segments) ko sambandhita karate haiN| ye tantuyojanikA ( commissure ) ke pIche agrapArvIya ( antero lateral part) meM ekatra hote haiN| jaba ye tantu naSTa hote haiM to usase pracalanAsaMgati nAmaka roga kI mukhya vikRti kA koI bhI aMza nahIM banatA yaha For Private and Personal Use Only

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pazcakA yA pracalanAsaGgati pRSTa 626 Acharya Shri Kailassagarsuri Gyanmandir yaha citra pazcakArzya (Tabes dorsalis ) se grasita suSumnA hai / isameM suSumnAkANDa ke pazcastambhoM kA I vihAsa saralatayA dekhA jAsakatA hai / ra For Private and Personal Use Only

Page #697
phiraGga 627 samajhane kI bAta hai| bahirjanita tantu pazcamUlapragaNDa ke nADIkozAoM se nikalate haiM / isake kAraNa pratyeka khaNDa para navIna tantu suSumnA meM praviSTa hote jAte haiM / ye tantu 3 samUhoM meM vibhAjita kie jA sakate haiM jo hrasva, madhya tathA dIrgha kahalAte haiN| hasva tantu sIdhe suSumnA ke dhUsara padArtha meM ghusa jAte haiM aura agra tathA pazca zRMgoM ke kozAoM ke cAroM ora samApta ho jAte haiN| ina tantuoM kA sambandha gambhIra pratikSepoM tathA pezItAna ke sAtha hotA hai| isa kAraNa jaba ve tantu naSTa ho jAte haiM to na gambhIra pratikSepoM kA kArya calatA hai aura na pezItAna ( muscle tone ) hI rahatI hai| inhIM hrasva tantuoM dvArA zUla kA bhAva bhI le jAyA jAtA hai| madhyama tantu Upara kI ora jAte haiM aura ve klArkastambha ke kozAoM ke cAroM ora samApta ho jAte haiM / vahA~ se unase Rju nimastiSkIya patha ( direct cerebellar tract ) banate haiM / ina tantuoM meM bAdhA par3ane se nimastiSkIya yA dhammilakIya lakSaNa pragaTa ho jAte haiN| dIrgha tantu suSumnAzIrSastha koNakandikA ( nucleus cuneatus) tathA dazAkandikA (nucleus Gracilis ) meM samApta hote haiM ina kandikAoM se saMvedanAtmaka taraMge AjJAkanda ( thalamus ) tathA dhammilaka ko jAtI haiN| jo bhI pazcastambha meM naye tantu Ate haiM ve bAhara kI ora rahate haiM aura pahale ke tantu jo nIce ke aMgoM se Ate haiM bhItara madhyarekhA kI ora khisaka jAte haiN| isakA artha yaha hai ki gaula kA stambha ( column of Goll ) jo bhItara kI ora rahatA hai usameM kaTi aura trika pradeza ke tantu rahate haiM tathA barDaka ke stambha ( column of Burdach ) meM jo bAhara kI ora hotA hai usameM pRSTha aura grIvA mAtra ke tantu rahate haiN| __ pracalanAsaMgati jo roga hai vaha vAstava meM kaTipradezIya suSumnA kA roga hai| isa sthAna para uccheda karane se sampUrNa bahirjanita tantu pazcastambha ke kaTa jAte haiM yA vihAsita ho jAte / isa vihAsa ke kAraNa sampUrNa abhivAhI tantuoM kA nAza ho jAtA hai / grIvApradeza meM vihAsa ko prApta dIrgha tantu bhItara kI ora vicyuta hokara gaula kA stambha banAte haiM aura yadi pRSTha aura grIvA ke Agata tantu roga grasita nahIM haiM to barDaka stambha prakRtAvasthA meM hI rahatA hai| yadi sampUrNa Agata tantu prabhAvita hue to grIvA kSetra ke donoM stambha jaraThita ( sclerosed ) ho jAte haiN| kabhI kabhI jaba graivika pazcakArya hI hotA hai to gaulastambha prakRtAvasthA meM rahatA hai aura bAhya barDaka stambha vinaSTa ho jAtA hai| isa roga kA eka mukhya vikSata hai nADItantuoM ke akSarambha tathA vimajikaMcuka kA lopa, para lopa ko sAdhAraNa abhiraMjana ke dvArA prakaTa karanA bahuta kaThina hai isake lie vIgarTa vidhi jo vimaji ke lie prayukta hotI hai apanAnI par3atI hai / isa vidhi se prakRta vimajikaMcuka kAlA raMga detI hai aura vinaSTa sUtroM ko jyoM kA tyoM chor3a detI hai| tantuoM ke nAza ke sAtha-sAtha nADIzleSa ( neuroglia ) meM bhI praguNana hotA hai jo eka uttarajAta lakSaNa hai| vAhinI prAcIreM bhI sthUla ho jAtI haiM / saba parivartana For Private and Personal Use Only

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628 vikRtivijJAna sunA taka hI sImita nahIM rahate api tu pazcanADImUloM meM bhI vaise hI vikSata ho jAte haiM / agranADImUloM meM koI parivartana nahIM hotA / pazcamUlapragaNDoM kI avasthA vicitra hotI hai / koI kahatA hai ki unameM vihAsAtmaka parivartana bahuta tIvra hote haiM aura koI unheM gauNa mAnatA hai / akSinADI kA vihAsa prAyaH dekhA jAtA hai / yaha dRSTi paTala meM na hokara nADI hI meM hotA hai / netraceSTanI aura vaktranADiyoM meM bhI yaha vihAsa mila sakatA hai / pazcakA roga ke vikSata suSumnA meM kaise banate haiM isake sambandha meM kitane hI mata rahate hue bhI Adhunika anumAna yaha hai ki phiraMgaviSa abhivAhI nAr3ItantuoM ke sAtha parivAtIya lasavahAoM ( perineural lymphatics ) yA akSarambha meM hokara gamana karatA hai / yaha viSa samIpastha mahAdhamanI ke bAhyacola se yA anya kisI sthala AtA hai | isI ke kAraNa abhivAhI nADItantuoM kA vihrAsa ho jAtA hai / isa roga ke kAraNa jo lakSaNa utpanna hote haiM unake 7 samUha banAe jA sakate haiM:( 1 ) saMvedanAtmaka vikAra, (2) samanvayAtmaka vikAra ( 3 ) pratikSepAtmaka vikAra, ( 4 ) zIrSaNyAnADyAtmaka vikAra, ( 5 ) AGgika dAruNya, ( 6 ) vizUlIya vikAra, (7) mastiSkoda vikAra / saMvedanAtmaka yA saMjJAtmaka vikAra- ye vikAra do prakAra ke ho sakate haiM eka prAtItika ( subjective ) tathA dUsare vaiSayika ( objective ) 1 prAtItika vikAroM meM pahalA lakSaNa yaha hotA hai ki rogI apane pairoM se jisa bhUmi para calatA hai usakI pUrI pratIti karane meM asamartha hone lagatA hai / use aisA lagatA hai ki mAno vaha ruI ke gAloM ke Upara cala rahA ho / kabhI-kabhI sahasA pairoM meM vedanA prArambha hokara calI jAtI hai / kabhI-kabhI zUla itanA tIvra hotA hai ki usakA sahanA kaThina ho jAtA hai| pazcanADImUloM meM sabase pahalA prabhAva zUlasaMvAhaka tantuoM yaha hotA hai ki unameM zUla kI pracaNDa taraMgeM yA preraNAeM ( impulses ) utpanna ho jAtI haiM / yaha zUla adhozarIra ke dharAtala para pratyAgatazUla ( referred pain) ke rUpa meM hotA hai| prArambhika avasthA meM paramazUlatA ( hyperalgesia ) bhI ho sakatI hai para vaha kyoM hotI hai yaha kahanA kaThina hai / vaiSayika saMvedanAtmaka vikAroM meM zUla aura gambhIra saMvedyatA ( deep sensibility ) kA bahuta mahatva hai / zUla TA~goM ( sakthiyoM ) tathA pRSTha para adhika prabhAva DAlatA hai / isakA jJAna kaTivedha karane para cikitsaka ko hotA hai / zUla, tApAMza aura kucha sparzajJAna kA vahana karane vAle tantu dhUsara padArtha ke pazcazcaga ke kozAoM ke cAroM ora samApta ho jAte haiM aura vahA~ se nUtana tantu nikala kara supunnA ke dUsare pArzva meM cale jAte haiM aura vahA~ agrapArzvIya stambha meM AjJAbhigA tantrikA ( spinoth&lamic tract ) banA lete haiM / yaha tathya ki zUla kI saMvedanA ( jo pazcastambha dvArA nahIM lejAI jAtI ) ko isa roga meM bAdhA pahu~catI hai bahuta mahatva rakhatA hai / yaha isa bAta ko siddha karatA hai ki isa roga kA mukhya vikSata pazcanADI mUla ( posterior nerve root ) hI svayaM hotA hai| AjJAbhigA tantrikA meM koI For Private and Personal Use Only

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phiraGga 326 bhI vihRSTa tantu nahIM milatA usakA kAraNa yaha hai ki yaha dvitIya zreNI ( second order ) ke nADIkandANuoM dvArA banatI hai kyoMki isake tantuoM kA janma pazcabhaMga ke kozAoM se hotA hai| pezIgatibodha ( muscle sense ) jisase ki sthiti kA bodha hotA hai pazcastambha ke tantuoM dvArA Upara ko jAtA hai| isI kAraNa pazvastambha meM vikSata hone ke kAraNa sthiti saMvedanA samApta ho jAtI hai / isakA pramANa yaha hai ki jaba rogI ke netra banda kara diye jAte haiM to use yaha patA hI nahIM rahatA ki usake paira kahA~ rakhe haiM yA vaha kisa sthiti meM kiyA jA rahA hai| A~kha banda karake paira cipaTA kara yadi rogI ko khar3A kara diyA jAve to vaha lar3akhar3Ane lagatA hai isa asthiratA ko raumbarjIyatA ( Rombergism ) kahate haiN| isa asthiratA kA eka kAraNa klArkastambha ke kozAoM ko preraNAoM kA na pahu~canA bhI ho sakatA hai jisake kAraNa klArke. stambha se pArzantikA tantrikA ( direct cerebellar tract ) ko bhI koI preraNA ( impulse ) nahIM pahu~ca pAtI / Avepa bodha ( vibration sense ) ke tantu bhI pazvastambha dvArA jAte haiM vaha bhI naSTa ho jAtA hai isake kAraNa rogI eka saMsaraNa dvizAkha ( tuning fork ) ke AvepoM ko jaba vaha kucha hilA kara jaMghAsthi ke Upara rakhI jAtI hai nahIM pahacAna paataa| samanvayAtmaka vakAra-samanvaya ( coordination ) jise sahakAra bhI kahate haiM jaba vikAragrasta hotA hai taba rogI ko pezIgatibodha nahIM hotaa| isake kAraNa rogI kI eka vicitra cAla ( gait ) ho jAtI hai| isI cAla ke kAraNa isa roga ko pracalanAsaMgati nAma diyA gayA hai| jisakA artha hai calane meM asahakAritA yA asaMgati / rogI jaba calatA hai to usake donoM pairoM ke madhya meM adhika sthAna rahatA hai pracalana ke sambandha kI usakI pratyeka kriyA adhika parizramapUrvaka kI huI hotI hai kyoMki kriyAdhikya ko rokane vAlI saMvedanAe~ usakA sAtha nahIM detiiN| vaha apane paira ko bahuta U~cA uThAtA hai aura jhaTake ke sAtha use bhUmi para chor3atA hai mAno ki rabara kI mohara se chapAI paira ke bhUmi para paTakane se kI jA rahI ho ( stamping gait ) / yadi sAtha meM grIvA kA bhAga bhI prabhAvita ho to nAsA-aMguli parIkSA kI jAne para rogI netra banda karake aMguli se nAsA ko chUne meM asamartha rahatA hai| pratikSepAtmaka vikAra-pratikSepAtmaka vikAroM kA kAraNa hai una hasvatantuoM kA prabhAvita honA jo agrazRGga ke kozAoM ke cAroM ora antarmela (anasto. mosis ) karate haiN| ina tantuoM ke vinAza se pratikSepacApa ( reflex-arc ) TUTa jAtA hai aura gambhIra pratikSepa naSTa ho jAte haiN| yadi sarvaprathama suSumnA ke nimnatama tantu prabhAvita hue to pANistha kaNDarAkSepa (achilles jerk ) naSTa ho jAtA hai parantu jAnukSepa ( knee jerk ) banA rahatA hai| jAnukSepa tabhI taka rahatA hai jaba taka ki kaTipradeza ke tRtIya aura caturtha khaNDa ThIka rahate haiN| pANistha kaNDarAkSepa For Private and Personal Use Only

Page #700
630 vikRtivijJAna paJcama kaTikhaNDa aura prathama trikakhaNDa para nirbhara rahatA hai| inakA mahattva nidAna kI dRSTi se bahuta adhika hai| pazcakAya nAmaka roga kA eka pramukha lakSaNa hotA hai netratAraka ke prakAza pratikSepa kA nAza ( loss of the light reflex in the pupil ) parantu calAkSabhujAyana para tAraka saMkoca kA sthita rahanA ( retention of contraction of pupil on accomodation ) / isa lakSaNa ko san 1869 I0 meM eDinabarA ke Arjila rAbarTasana ne sarvaprathama likhA thA aura taba se ise Arjila rAbarTasana tAraka ( Argyll robertson pupil ) kahate haiN| yaha kyoM hotA hai isake sambandha meM Adhunika khojoM se bahuta jJAna milA hai| netratAraka ke pratikSepa kA kendra netraceSTanI nADI ( oculo motor nerve) huA karatA hai parantu isakI nyaSTi yA kandikA ( nucleus ) jo madhyamastiSka meM rahatI hai kA pazcakArya yA pracalanAsaMgati nAmaka roga meM koI prabhAva nahIM pdd'taa| arjila rAbarTasana tAraka kA eka mahattva kA lakSaNa yaha bhI hotA hai ki Rju prathama svAyattika valikAya saupumnika pratikSepa ( normal sympathetic cilio spinal reflex ) samApta ho jAtA hai arthAt tvacA meM kahIM nocane se tAraka visphArita ho jAtA hai| yaha spaSTa hai ki kRSNamaNDala ko do pRthaka mArga jAte haiN| eka to prakAza pratikSepa tantu mUrtipaTa ( retina) se hokara uparikA kAlAyikA (superior quadrigeminal body ) meM hotA huA tRtIyA netraceSTanI nADI kI nyaSTi jo madhyamastiSka meM jAtA hai| yaha mUrtipaTa ke dRSTisUtroM ( visual fibres ) se pRthaka hotA hai| dUsare prathama svAyattika ( sympathetic ) tArakavisphAraka tantukandAdharika bhAga ke pazcabhAga se nikalate (pupillodilator fidres which arise from the posterior part of the hypothalmus ) haiM aura madhyama mastiSka ko jAte haiM jahA~ se ve praivika prathama svAyatta nADI kendra ( cervical sympathetic centre ) ko jAte haiN| ye donoM vAtanADImArga brahmadvAra suraMgA (aqueduct of sylvius ) meM bilkula pAsa pAsa saTe hue rahate haiN| isa kAraNa jaba isa suraMgA meM koI vikSata bana jAtA hai to donoM mArgoM para prabhAva DAla sakatA hai tathA zuddha Arjila robarTasanatAraka utpanna kara sakatA hai| yaha vikSata sadaiva phiraMga janita hI hotA hai| jaba kabhI madhyamastiSka meM koI vAtazlepArbuda (glioma ) utpanna ho jAtA hai to ina donoM vAtanADI mArgoM para prabhAva DAlakara isI roga ko netratAraka meM utpanna kara sakatA hai| anya aneka kAraNoM se bhI netratAraka kA prakAza pratikSepa ( light reflex ) prabhAvita ho sakatA hai parantu vaha vAstavika Arjila robarTasanatAraka nAmaka roga nahIM banA skte| pezItAna kA abhAva ( loss of muscle tone ) una saMvedanAvaha sUtroM kI anupasthiti ke kAraNa huA karatA hai jinakA sambandha agrazRGgoM ke sAtha hotA hai / For Private and Personal Use Only

Page #701
phiraGga tAna kI kamI ke kAraNa sakthi-savinayoM ko kisI bhI asAdhAraNa sthiti meM rakhA jA sakatA hai| zIrSaNyA nADIya vikAra-saMvedanAtmaka yA saMcAlanAtmaka kisI bhI prakAra kA vikAra zIrSaNyA nADiyoM ke vikAra ke kAraNa huA karatA hai| dRSTinADI kI prAthamika apuSTi ke kAraNa rogI andhA ho sakatA hai| yaha dRSTinADI kA vikSata ThIka vaisA hI hotA hai jaisA ki vikSata isa roga meM suSumnA ke pazcanADI mUloM ko prabhAvita karatA hai| anya saMjJAvaha yA saMvedanAvaha ( sensory) vAtanADiyoM meM bhI vikSata ho sakate haiN| jaba paJcamI nADI kI saMjJAtmaka mUla prabhAvita hotI hai to mukhamaNDala para visaMjJatA ( anaesthesia) ho jAtI hai| aSTamI zIrSaNyA nADI ke prabhAvita hone se vyakti vadhira ho jAtA hai| saMcAlanAtmaka vikSobha akSipeziyoM meM hotA hai jisake kAraNa varmapAta, TeratA yA dvidhA dRSTi dekhI jAtI hai para vaha asthAyI svarUpa kA hotA hai| ye lakSaNa pazcakArya ke dvArA hone vAle viziSTa lakSaNa na hokara mastiSkachadapAka (jo vAtaphiraMga ke kAraNa hotA hai|) ke kAraNa hone vAle mAne jAne cAhie aisA vikAravettAoM kA mata hai| AGgika dAruNya ( Visceral crises)-vibhinna zarIrAvayavoM meM kucha vikAra (dAruNya ) milate haiN| jinameM svarayantra tathA AmAzaya meM hone vAlA bhayAnaka zUla ullekhya hai / AmAzayika zUla ke pazcAt vamana ho sakatI hai| vizUlIya vikAra-poSaNavikSobha (trophic disturbances) nAma se kathita vikAroM ko hama vizUlIya vikAra nAma dete haiM ve isa roga meM pahelI haiM jinake kAraNa kA yathArtha bodha abhI taka nahIM ho sakA hai| ina vikAroM meM zUlavihIna cArakATa sandhiyA~, zUlahIna pAdatalIya chidrita vraNa (painless perforating ulcer of the sole of the foot) Ate haiN| vizUlatA (analgesia) hI inakA pradhAna lakSaNa hai jisake kAraNa thor3A sA bhI AghAta kahIM lagane para vahA~ para eka vikSata bana jAtA hai| mastiSkoda vikAra-isa roga meM mastiSkoda meM bahuta bar3e parivartana nahIM hote| lasIkozotkarSa 10 se 50 taka milatA hai para jaba sAtha meM tAnikIya prakopa ( mastikachadapAka) hotA hai jo isa roga kI dAruNyAvasthA meM dekhA jAtA hai to kozIya gaNana saikar3oM meM bhI mila sakatA hai / taba bahunyaSTikozAoM kI upasthiti bhI milatI hai| probhUjina kI bahuta halakI vRddhi hotI hai / zleSAbha svarNa pratikriyA phiraMgika vakra rekhA (luetic curve) prakaTa karatI hai| vAsaramaina pratikriyA 70 pratizata rugNoM meM astyAsmaka ( positive ) hotI hai para sarvAGgINa ghAta kI apekSA kucha alpa tIvra hotI hai| yaha pratikriyA rakta meM nAstyAtmaka hote hue bhI mastiSkoda meM astyAtmaka hotI hai| jitanA hI roga nayA nayA lagatA hai mastiSkoda citra roga kI sthiti batalAne meM utanA hI samartha hogaa| para yadi roga hue varSoM bIta jAve to mastiSkoda pUrNataH prakRta bhI mila sakatA hai| For Private and Personal Use Only

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632 vikRtivijJAna aba hama vAtaphiraMga ke dUsare mahatva ke roga unmattasya sarvAGgaghAta kA varNana karate haiN| unmattasya sarvAGgaghAta yA sarvAGgavAta (General Paralysis of the Insane or General Paresis ) isakA eka nAma ( dementia paralytica ) bhI hai / yaha eka phiraMgajanita vyAdhi hai / isa roga meM mUra tathA naugUcI ne sukuntalANuoM kI upasthiti mastiSkoda tathA pramastiSka meM siddha kI hai / para kevala phiraMgika upasarga mAtra kahane se hI roga kA varNana pUrA nahIM ho jaataa| kyoMki jahA~ phiraMga eka sAmAnya roga hai vahA~ unmattasya sarvAGgaghAta yA sarvAMgavAta eka virala ( rare ) vyAdhi hai| isakA spaSTa artha yaha hai ki isa roga meM phiraMga ke atirikta anya kAraka bhI mahattvapUrNa haiN| para ve kyA haiM unheM kahanA kaThina haiN| aisA kahA jAtA hai ki jo vyakti mAnasika cintAoM se yukta hotA hai azAnta, vyagra, durAcArapUrNa jIvana vyatIta karatA hai vahI sarvAMgavAta se pIDita hotA hai| aphrIkA ke sIdhe sAdhe nIgro logoM meM jahA~ phiraMga paryApta hai parantu vahA~ unmattasya sarvAMgaghAta kA nAma nizAna taka nahIM hai jo yaha prakaTa karatA hai ki Adhunika sabhyatA kA bhI isa roga kI utpatti meM avazya hAtha rahA hogaa| bhAvamizra ke samaya bhArata meM yaha sabhyatA na hone ke kAraNa usane jo phiraMga kA varNana kiyA hai usameM na pazcakArya hI AyA hai aura na yaha phiraMgika sarvAMgaghAta / krAphTa aibita ne sarvAMgaghAta ke nidAna kA sArAMza 'sivilAijezana eNDa siphilAijezana (sabhyatA yatra vartate tatra phiraGgo'pi jAyate) aisA diyA hai| ___ yaha roga prArambhika upasarga ke 10-15 varSa pazcAt hI prakaTa hotA hai| yaha pracalanAsaMgati (pazcakArya ) ke samAna hI hotA hai aura usase kucha kucha milatA julatA hotA hai| sahajaphiraMga se pIDita bAlaka ko daza varSa kI avasthA meM isa roga kA eka bAlarUpa (juvenile form ) bhI dekhane meM AtA hai| pahale yaha roga puruSoM meM striyoM kI apekSA adhika dekhA jAtA thA para aba yaha roga striyoM meM bhI bar3ha rahA hai| pahale jahA~ dasa puruSoM meM yaha roga hotA thA to eka strI bhI isase pIDita mila jAtI thI parantu Aja tIna puruSoM ke pIche eka strI isa roga se pIDitA dekhane ko milatI hai| pracalanAsaMgati kI taraha sarvAMgaghAta ke vikSata bhI sAdhAraNa phiraMgika vikSatoM se bahuta bhinna hote haiM / yadyapi prArambha meM roga ke kAraNa anekoM vyakti 2-3 varSoM meM mara jAte the para Adhunika phiraMganAzaka acUka cikitsA ke kAraNa sAdhyAsAdhyatA meM bahuta antara A gayA hai aura aba yaha roga asAdhya nahIM mAnA jAtA hai| vikRta zArIra kI dRSTi se sarvAMgaghAta meM nimna sthUla vikRtiyA~ dekhI jAtI haiM :1. karoTi TopI ( skull - cap ) sthUlita ho jAtI hai| 2. dRr3hatAnikA (duramater) ke nIce raktasrAva hone ke kAraNa eka kAlI moTI For Private and Personal Use Only

Page #703
phiraGga kalA bana jAtI hai jise antaH raktasrAvI sthUla mastiSkachadapAka (pachymeningitis haemorrhagica interna ) kahate haiM / 3. mastiSka kA bhAra 150 se 200 grAma ( mASA ) taka ghaTa jAtA hai / mastiSka kI yaha apuSTi agrapArzvIya kSetra ( fronto - parietal region ) meM vizeSa hotI hai| 633 4. mastiSka ke saMvella ( convolutions ) kSINa ho jAte haiM jisake kAraNa mastiSka ke vidara (fissures ) caur3e aura gahare bahuta ho jAte haiM / 5. mastiSka Uti kI apuSTi ke kAraNa brahmodakulyA ( subarachnoid space ) tathA nilayoM : ventricles ) meM tarala kI bahulatA ho jAtI hai / 6. mRdutAnikA ( cInAMzuka - piamater ) sthUla tathA pArAndha ho jAtA hai aura mastiska ke agrapiNDa se itanA abhilagna ho jAtA hai ki jaba use ucelane kA yatna kiyA jAtA hai to mastiSka kA bhAga bhI kucha usake sAtha TUTa AtA hai / 7. mastiSka nilayoM meM taralAdhikya ke atirikta usakI bhastarI kalA ( lining membrane ) meM kaNanIyatA ( granularity ) A jAtI hai jo pArzvIya nilayoM meM jitanI dikhatI hai usase kahIM adhika caturtha nilaya kI bhUmi para prakaTa hotI hai| aNvIkSadRSTayA ( microscopically ) sarvAMgaghAta ke vikSatoM kA varNana karanA bahuta kaThina hai kyoMki ve pracalanAsaMgati nAmaka roga kI bhA~ti sarala nahIM hote / aisA jJAta hotA hai ki nADIkandANu ke vinAza kA sarvaprathama vikSata isa roga meM banatA hai tathA usakI unnati meM vAhinyaparivartana sahAyaka banate haiM / vikSata khUba phaile hue milate haiM | atigambhIra vikSata pramastiSka bAhyaka meM tathA caturtha nilaya kI bhUmi meM ( uSNISaka evaM suSumnA zIrSa meM ) milate haiM / suSumnA, dhammillaka tathA mastiSkamUlasthapiNDoM ( besal ganglia ) meM bhI mila sakate haiM / suSumnA ke vikSata uttarAta vihAsa ke kAraNa bane huA karate haiM / For Private and Personal Use Only aNvIkSa se dekhane para nimna sUkSma vikRtiyA~ mila sakatI haiM yadi prayatna kiyA gayA aura navIna khojoM kA yogyatayA prayoga kiyA gayA to : 1. mastiSka tAnikAoM meM jIrNa vraNazodhAtmaka kozAoM kI bharamAra milatI hai / sarvAMgaghAta kA pradhAna aura vAstavika kozA prarasakozA ( plasma cell ) hotA hai jo khUba milatA hai / usake sAtha lasIkozA bhI paryApta rahate haiM / 2. pramastiSka bAhyaka ( cerebral contex ) kI svAbhAvika racanA pUrNataH astavyasta ho jAtI hai aura jo vividha stara sAdhAraNatayA dekhe jAne cAhie ve dikhAI nahIM par3ate / bAhyaka meM vihAsa kI pratyeka avasthA ( varNahAsa, nyaSTi kI utkendratA, nyaSTivilopa, sampUrNa kozA kA vilopa) dekhI jAtI hai / agrima aura pArzvika mastiSka piNDoM meM kozAoM kI bahuta kamI hotI hai / karIrAkRtikandANu ( pyramidal cells ) adhikatA se naSTa hue milate haiM /

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634 vikRtivijJAna uparokta nAza yA vihAsa kyoM hotA hai yaha kahanA kaThina hai kyoMki phiraMgArbudoM kA abhAva rahatA hai| jaise pazcakArya meM sukuntalANuoM ke sadRza pazcanADImUloM kA saphAyA hotA hai vaise hI ina nADIkandANuoM kI tabAhI sukuntalANu hI bulAte hue pratIta hote haiN| 3. vAtanADI sUtroM para bhI bahuta prabhAva par3atA hai| 4. prabhAvita kSetra atyadhika vAhinIya ( vascular ) dekhe jAte haiN| mastiSka kI choTI yA bar3I sabhI vAhiniyoM meM yahI nahIM kezAloM taka meM bhI prarasakozAoM ke ke bAhupa yA maNibandha unake bAhya coloM meM athavA parivAhinya avakAzoM meM DaTakara dekhe jAte haiN| ye vAhinIya vikSata bAhyaka kI sampUrNa gaharAI meM milate haiM jaba ki phiraMgika mastiSkachadapAka meM ve tAnikAoM ke nIce bAhyaka ke upariSTha stara meM hI milate haiN| ____5. kaI daNDAkArI kozAoM ( rod shaped cells ) kI prasara bharamAra dekhI jAtI hai| ye kozA nADIzleSa se utpanna hote haiN| 6. nADIzleSIya praguNana kucha khAsa kSetroM meM (mRdutAnikA ke nIce bAhyaka ke upariSTha stara meM nilaya prAcIroM meM ) khUba dekhA jAtA hai| isI ke kAraNa mRdutAnikA meM bAhyaka se buruza jaise pravardhana cale jAkara use abhilagna kara lete haiM jisase vaha cipaka jAtI hai aura usakA ucelanA kaThina ho jAtA hai ise hama pahale likha cuke haiN| pahale hamane yaha bhI likha diyA hai ki caturtha nilaya tathA anya nilayoM kI bhUmi para kaNanIyatA dekhI jAtI hai| yaha kaNanIyatA isI vAtazleSa ke praguNana kA sthUla darzana hai / kaNoM ke ina ubhAroM meM se kisI kisI para nilaya stara (ependyma ) gAyaba ho jAtA hai / na kevala nADIzleSa kozA hI milate haiM nADIzleSa tantu bhI khUba dekhe jAte haiN| ye kozA tArAkozA ( astrocytes ) hote haiM unameM se eka prarasAtmaka pravardhana nikalatA hai jo eka cUSaNakapAda ke dvArA kisI vAhinI se sambaddha hotA hai| daNDAkArI kozA sUkSma zleSa se nikalate haiN| ye daNDAkArI kozA hogA kozAoM aura saMyukta kaNIyakozA ( compound granular capuscle ) ke madhya kI avasthA hai| hogA kozAoM meM zoNAyasi ( hemosiderin ) kI mAtrA bahuta adhika hotI hai / saba rugNoM meM pramastiSkIya vAhiniyoM ke cAroM ora ayas paryApta mAtrA meM saMcita ho jAtA hai| rAjila piNDa ( corpus striatum) meM vihAsa tathA zleSotkarSa (gliosis ) milatA hai| inhIM ke kAraNa prakampa ( tremors) Ate haiM aura svaravikRti dekhI jAtI hai| zuktipITha (putamen ) isa roga meM sadaiva prabhAvagrasta hotA hai tathA zuktigarbha (globus pallidus ) kabhI kabhI prabhAvita hotA hai| 7. suSumnA ke pArzvastambhoM meM mukulatantrikA (pyramidal tract ) ke For Private and Personal Use Only

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vAhinIya bAhupa yA maNibandha pRSTha 634 image / phiraGgika sarvAGgavAta ke kSetroM meM vAhinIyatA bahuta dekhI jAtI hai| Upara prarasakozAoM ke parivAhinya bAhupa yA maNibandha ( perivascular cuting ) kA citraNa hai| For Private and Personal Use Only

Page #706
phiraGga 635 gi meM kucha vihAsa ho jAtA hai / yaha uttarajAta vihAsa hai jo mastiSka ke saMcAlana bAhyaka ( motor cortex ) ke kozAoM meM AghAta lagane se hotA hai / 8. suSumnA ke pazcastambhoM meM pazcakArya kI bhA~ti hI vihAsa milatA hai jo isa bAta kA pramANa hai ki unmattasya sarvAMgaghAta ke sAtha sAtha pazcakArya bhI raha sakatA hai / para yaha Avazyaka nahIM ki sarvAMgaghAta ke pratyeka rugNa meM pazcakArya pAyA hI jAve | 9. dRSTinADI meM vihrAsa hone ke kAraNa usakI apuSTi dekhI jA sakatI hai / anya zIrSaNyA nADiyoM meM bhI vihAsa ho sakatA hai / : Upara ke vikSatoM ko dekhane se unmattasya sarvAMgaghAta meM nimna vikAra milA karate haiM:(1) mastiSkIya yA mAnasika vikAra, (2) svara vikAra, ( 3 ) prakampa, (4) netratAraka pratikSepa kA abhAva, (5) aMgaghAta, (6) mastiSkoda parivartana | yaha kaha diyA gayA hai ki mastiSka ke agrima piNDa meM vihAsa bahuta adhika hotA hai isa kAraNa nirNaya karanA, tarka-vitarka karanA tathA AtmasaMyama karanA ye tIna jo ucca vicAra kahe jAte haiM una para bahuta adhika prabhAva par3atA hai / rogI aisA vicitra kArya karatA huA dekhA jA sakatA hai jo usake lie pUrNatayA navIna yA vibhinna ho / usakA naitika patana ho jAtA hai / roga kA prabhAva sarvaprathama mana aura AtmA ke ucca bhAvoM para par3hatA hai (opena homa ) | smaraNazakti kA hAsa bahuta pahale se hI hone lagatA hai| jyoM-jyoM unmAda bar3hatA jAtA hai mAnasika sthiti bigar3atI calI jAtI hai| jaba usakA zArIrika aura mAnasika vinAzakArya drutagati se calatA rahatA hai usI samaya bIca-bIca meM kucha svAsthya kI jhA~kI sI bhI dikhAI de jAtI hai jinake kAraNa kabhI-kabhI rogI bahuta U~cI-U~cI bAteM karane lagatA hai / vaha samajhane lagatA hai ki mAno vaha Izvara bana gayA yA karor3apati ho gayA / yaha saba unmAda hai jo Age calakara pUrNa ( dementia ) meM pariNata ho jAtA hai / isa mattatA kA pradhAna kAraNa mastiSka racanAoM kA bihAsa hotA hai jise sukuntalANu anya kArakoM ke sAtha karane meM samartha hotA hai| vANIvikAra isa roga meM eka mahatva kA lakSaNa hai| rogI kI vANI aspaSTa, bhArI aura TUTI phUTI ho jAtI hai| bolane kA jo niyama hai ki pratyeka akSara ke bIca meM thor3A rukanA aura eka akSara ke bAda dUsarA bolanA yaha niyama TUTa jAtA hai| rogI vANI kA saMyama kho baiThatA hai isase binA ruke jaldI-jaldI cAhe jitanA aura vaha sabhI aspaSTa bolatA hai | yaha kyoM hotA hai isakA patA nahIM lagA / prakampa isa roga meM prAyaH dekhe jAte haiM / ye oSThoM aura jIbha meM atyadhika milate haiM / rAjilapiNDa meM vihrAsa hone ke kAraNa bAhupAdoM meM prakampa dekhe jAte haiM / netratAraka meM vikAra isa roga ke sarvaprathama lakSaNoM meM ginA jAtA hai / Arjila raubarTasana tAraka pazcakA ke atirikta isI roga meM milatA hai| isameM prakAza pratikSepa For Private and Personal Use Only

Page #707
636 vikRtivijJAna samApta ho jAtA hai parantu calAkSa bhujAyana kI pratikriyA sthira rahatI hai| donoM tArakoM ke AkAra kI viSamatA aura bahIrekhAoM (outlines) kI viSamatA bhI dekhI jAtI hai| ___ aMgaghAtika pakar3a isa roga kA bahuta mahatva kA vikAra hai| ye pakar3a ( seizu. res ) saMnyAsarUpI ( apoplectiform ) athavA apasmArarUpI (epileptifam) hotI hai| pahale meM rogI mUJchita ho jAtA hai aura jaba hoza meM AtA hai to usake eka aMga meM yA eka pakSa meM ghAta ho jAtA hai| para yaha ghAta sthAyI na hokara asthAyI hotA hai aura kucha kAla hI meM samApta ho jAtA hai| vaha do cAra ghaNToM se lekara do eka dina taka hI rahatA hai / ghAta kA yaha asthAyitva bahuta mahatvapUrNa evaM vicitra hai| yaha kyoM hotA hai aura kyoM calA jAtA hai yaha kahanA bahuta kaThina hai| itanA avazya kahA jA sakatA hai ki jaba yaha pakar3a hotI hai taba mastiSkoda meM kozAgaNana atyadhika bar3ha jAtA hai tathA jaba ghAta haTa jAtA hai to vaha itanA nahIM rhtaa| unmattasya sarvAMga ghAta meM mastiSkodIya parivartana pazcakArya kI apekSA adhika hote haiM aura paryApta sthAyI hote haiN| roga ke prArambha meM ve parivartana vizepa dekhe jAte haiM jaba ki roga kA nidAna karanA kaThina hotA hai, para jyoM-jyoM roga bar3hatA jAtA hai aura jIrNAvasthA ko prApta ho jAtA hai ye parivartana utane adhika nahIM dekhe jAte / kozA 30 se 100 taka prati ghana milImITara ho jAte haiM / mukhya kozA lasIkozA hotA hai parantu bahunyaSTi kozA bhI mila sakate haiN| ghAta pakar3a ke samaya ye atyadhika bar3ha jAte haiN| mastiSkoda meM prarasakozA bhI milate haiN| ye kozA isI roga meM hI milate haiM tathA unheM pahacAnane ke lie aljhImara vidhi ( alzheimer method ) kA prayoga karanA Avazyaka hotA hai| bRhat antazchadIya kozA bhI bahuta bar3I saMkhyA meM mila sakate haiM probhUjinAdhikya to isameM sthAyI ho hotA hai / 96 se 100 pratizata rugNoM meM vAsaramena pratikriyA astyAtmaka milatI hai yadi rogI kI koI cikitsA na kI gaI ho to| zleSmAbha svarNa pratikriyA ghAtika vakra rekhA detI hai| kabhI-kabhI roga kI jIrNAvasthA meM rogI ke rakta kI vAsaramaina pratikriyA nAstyAtmaka hotI hai para mastiSkoda kI astyAtmaka dekhI jAtI hai / kuntalANUtkapa (Spirochaetoses) phiraMga ke varNana ke sAtha-sAtha anya kuntalANujanita vyAdhiyoM kA ullekha kara denA pUrNataH saMgata hai isa kAraNa hama nIce nimna rogoM kA saMkSipta vicAra upasthita karate haiM: 1-pratyAvartI jvara ( relapsing fever ) 2-galazopha ( vincent's angina ) 3-nyupadaMza yA paraMga ( yaws) 4-vIlaroga ( weil's disease) pratyAvartI jvara yaha eka aisA jvara hai jisameM kucha kAla taka jvara aura kucha kAla taka For Private and Personal Use Only

Page #708
phiraGga 637 sAmAnya tApAMza pAyA jAtA hai| yaha uSNa kaTibandha meM hone vAlA eka roga hai / isakA kartA jIvANu zvetadvIpa vikuntalANu ( borrelia recurrentis or spirillum obermeieri ) kahalAtA hai / ise 1873 I. meM obaramiyara ne khojA thaa| roga kA Arambha vamana ke sAtha tIvra jvara ke sAtha hotA hai plIhA kI paryApta vRddhi ho jAtI hai| 4-5 dina jvara Akara akasmAt tApAMza gira jAtA hai / eka saptAha taka tApAMza svAbhAvika raha kara punaH jvara kA AkramaNa hotA hai / AkramaNa ke pUrva vikuntalANu rakta meM dekhe jAte haiN| maicinIkApha kA mata hai ki svAbhAvika tApAMza ke kAla meM vikantalANu plIhA meM rahate haiM jahA~ jAlakAntazchadIya saMsthAna ke kozA unakA bhakSaNa karane kA yatna karate haiN| sauDAkevica ne yaha spaSTa kiyA hai ki yadi plIhA ko pahale nikAla diyA jAve to isa roga ke kAraNa mRtyu honA sarala ho jAtA hai| kucha bhI pratyAvarta jaba taka nahIM hotA taba taka vikuntalANu kahA~ rahate haiM nahIM kahA jA sakatA / na rogI kA rakta hI aupasargika vizrAntikAla meM rahatA hai| AkramaNa ke sAtha vikuntalANu rakta meM Ate haiN| eka bAta yaha Avazyaka hai ki plIhagorda ( splenic pulp ) dvArA vizrAntikAla meM bhI roga kA upasarga kiyA jA sakatA hai| isa roga ke upasarga kA mArga kilanI yUkA yA cIlara ke dvArA hai / ye jahA~ kATate haiM usa daMza kSata meM hokara jIvANu rakta meM cale jAte haiN| ___jvarAvasthA meM ekanyaSTikozAoM kI vRddhi hotI hai| plIhA kI vRddhi ke sAtha sAtha usameM aneka RNAstra bhI pAye jA sakate haiN| yakRvRddhi bhI dekhI jAtI hai| hRdaya aura vRkkoM meM meghasama zotha tathA snaihika vihAsa milatA hai| nalakAsthiyoM meM majA kA varNa lAla ho jAtA hai| galazopha isa roga kA kartA galazotha kuntalANu (spirochaeta Vincenti) kahalAtA hai / isake sAtha sAtha tarkurUpadaNDANu ( bacillu s fusiformis) bhI sadaiva dekhA jAtA hai| yaha nahIM kahA jA sakatA ki ye do jIvANu eka hI jIvANu kI do avasthAvizeSa haiM yA donoM eka sAtha rahane vAle do prANIvizeSa haiN|| ___ galazopha eka vraNAtmaka roga hai jisameM gale meM eka kUTakalA ( false membrane ) banatI hai / upasarga eka dantamAMsapAka ke rUpa meM prArambha karatA hai kyoMki ye jIvANu pUtijIvI ( saprophyte ) ke rUpa meM dAMta ke cAroM ora dekhe jAte haiN| masUr3e sUja jAte haiM unase rakta nikalane lagatA hai| tIvra viSaraktatA, glAni aura ziraHzUla rogI anubhava karatA hai yadyapi use jvara nahIM ho paataa| masUr3oM se zopha gale aura tuNDikA granthiyoM kI ora jAtA hai| kabhI kabhI pahale roga gale meM lagatA hai phira vaha masUr3oM kI ora jAtA hai| donoM dazAoM meM vraNAtmaka vikSata mukha meM banate cale jAte haiN| tuNDikAoM para malina zvetavarNa kI eka kUTakalA chA jAtI hai jise dekhakara rohiNI kI kalA kA sandeha hone lagatA hai / parantu isa kalA kI parIkSA se jJAna prApta kiyA jA sakatA hai| yaha smaraNIya hai ki jina jIvANuoM ke kAraNa For Private and Personal Use Only

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638 vikRtivijJAna galazopha hotA hai unhIM se sakotha mukhapAka ( cancrum oris) hotA hai| tuNDikAoM para vikSata banate haiM jo prArambha meM vinAzaka hote haiM tathA nirmoka haTA dene para tuNDikAoM meM guhA banI huI milatI haiN| nyupadaMza yA paraMga yaha eka uSNa kaTibandha pradezIya roga hai jo kRSNa varNa ke vyaktiyoM meM pAyA jAtA hai / isake kartA jIvANu ko nyupadaMza sukuntalANu (Treponema pertennis ) kahate haiM yaha phiraMga ke sukuntalANu se milatA julatA hotA hai| isake dvArA hone vAle paraMga yA nyupadaMza ke vikSata saba tvacA meM hote haiM / prAthamika vikSata tvacA meM hote haiM phira dvitIyaka lakSaNa jvara tathA sarvatvacA ke udbhedana (generalised cutaneous infection ) ke rUpa meM prakaTa hote haiM / isa roga kI tRtIyAvasthA hotI hai para caturthAvasthA nahIM hotii| paraMga kA upasarga phiraMga ke lie kSamatA pradAna nahIM krtaa| paraMga mAtA-pitA se putra-putrI ko nahIM jaataa| vAsaramaina pratikriyA yahA~ bhI astyAtmaka hotI hai| vIlaroga yA jAnapadika sukuntalANvika kAmalA ( Wcil's disease or epidemic spirochaetal gaundia ) isa roga kA prArambha Akasmika hotA hai| ekadama vamana, ziraHzUla, kaTi aura sakthi-sakthinayoM meM zUla ke sAtha jvara ho jAtA hai sAtha meM kAmalA tathA nIlohAMkIya raktastrAva (petechial haemorrhages ) rahate haiM / zleSmala tvacAoM se itanA raktasrAva hotA hai ki raktavamana, raktameha yA raktAtisAra inameM se kucha bhI dekhA jA sakatA hai| rakta meM bahanyaSTisitakozotkarSa milatA hai tathA yakRt tathA vRkkoM meM vikSata banate haiN| yakRt meM kozAoM kA prasara vinAza milatA hai / isake kAraNa yakRt ke bar3e bar3e kSetroM meM ati mRtyu ho jAtI hai| vRkkoM meM kezajUToM meM raktasrAva milatA hai tathA parivalita nAlikAoM meM bhI atimRtyu pAI jAtI hai| isa roga ke sAtha sAtha oSThasapI ( herpes labialis) bhI sAmAnyatayA milatI hai| isa roga ke jIvANu ko jvarikAmalA atikuntalANu ( leptospira ioterohaemorrhagica) kahate haiM / yaha rogI ke rakta meM, AntraprAcIra meM, adhivRkkagranthiyoM meM, vRkkoM meM tathA mUtra meM pAyA jAtA hai| roga hone ke bAda eka saptAha taka jIvANu rakta meM milatA hai phira bAda meM mUtra meM milatA hai| yadi isa roga ke kAraNa prANI mara jAve to usake zarIra meM ve khUba milate haiN| yaha roga mUSakoM meM khUba pAyA jAtA hai jaba ve garmatara sthAnoM meM rahate haiN| upasRSTa jala dvArA svacA ke vidAroM yA zleSmalakalA dvArA yaha roga manuSya ko lagatA hai| yaha jApAna, amerikA, iMgalaiNDa bhAratavarSa sarvatra pAyA jAtA hai| For Private and Personal Use Only

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nyupadaMza yA paraMga pRSTha 638 kara ANNY ASEAS HTS HAT yaha citra dvitIyaka lakSaNa ke rUpa meM sarvatvacA ke ubhedana vyakta karatA hai| For Private and Personal Use Only

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dazama adhyAya anya viziSTa kaNAvudikIya vyAdhiyA~ ( Other Specific Granulomatous Diseases ) isa adhyAya meM aba hama kuSTha ( leprory ), tathA kavaka roga ( fungus diseases ) kI vaikArikI kA varNana upasthita kreNge| kaNanIyArbuda aupasargika kaNArbuda ( infectious granulomas ) yA viziSTa kaNanIyArbuda ( specific granuloma ) eka viziSTa rogasamUha kA nAma hai| isameM yacmA aura phiraMga donoM sammilita haiM tathA inake atirikta kuSTha aura kavaka roga (myco. ces ) bhI Ate haiN| Arambha meM isa nAmakaraNa kA artha itanA hI thA ki vikSata kaNanIya Uti (granulation tissue) kA eka puMja mAtra hai para Aja ise una aupasargika avasthAoM ke lie bhI pukArA jAtA hai jinameM protikozA ( histioCytes) pramukha kozA hote haiM yadyapi lasIkozA aura prarasakozA bhI mahatvapUrNa bhAga lete haiM / ye protikozA kabhI kabhI phUla jAte haiM aura unameM vimedAbha padArtha bhI pAyA jAtA hai inheM adhicchadAbhakozA kahate haiN| jinheM hamane yakSmA ke prakaraNa meM kucha adhika spaSTatA ke sAtha likhA hai| ye adhicchadAbha kozA kaI kaI eka meM mila jAte haiM aura mahAkozAoM ko janma dete haiM jo na kevala jIrNa kaNanIyArbuda ko hI batalAte haiM api tu bAhyapadArtha ke prati hone vAlI zarIra kI vraNazothAtmaka pratikriyA kI ora bhI iGgita karate haiN| ina kozAoM kI saMciti eka sthAna para itanI ho sakatI hai ki vikSata eka arbuda ke samAna phUlA huA dekhA jAtA hai isI lie ise utpAdI vraNazotha ( productive inflammation ) yA kaNanIyArbuda yA kaNanIyAdhudikA kaha sakate haiN| ina saba kaNanIyArbudoM meM vikSatoM meM anta meM kaNana uti banatI hai aura tantUtkarSa huA karatA hai| aba hama sarvaprathama kuSTha kA varNana karate haiM / mahAkuSTha (Leprosy ) jaisA ki hamane yakSmA ke sambandha meM kiyA hai hama yahA~ kuSTha kA prAcIna AcAryoM dvArA nigadita vicAra adhika prastuta nahIM kareMge kyoMki use hama Age adhyAya meM bahuta adhika vistAra ke sAtha pAThakoM ke samakSa upasthita karane vAle haiN| kuSTha se Aja jo grahaNa kiyA jAtA hai usI ko hI hama yahA~ uddhRta kreNge| For Private and Personal Use Only

Page #712
640 vikRtivijJAna kuSTa yaha nAma kyoM par3A ? kuSTha yaha nAma kyoM par3A isakA uttara dene ke sAtha sAtha vAgbhaTa ne itanI anya bAteM aura kaha DAlI haiM ki unase kuSTha ke Adhunika vicAra ko bhI thor3A prakAza mila jAtA hai / nidAna ke prakaraNa meM vaha likhatA hai Acharya Shri Kailassagarsuri Gyanmandir - kAlenopekSitaM yasmAtsarvaM kuSNAti tadvapuH / prapadya dhAtUnvyApyAntaH sarvAn saMkledya cAvahet // sasvedakledasaMkothAn kRmIn sUkSmAn sudAruNAn / lobha tvaksnAyudhamanI taruNAsthIni yaiH kramAt // bhakSayecchivatramasmAcca kuSThabAhyamudAhRtam // hetu kI apekSA se samaya pAkara vAgbhaTa jisase sampUrNa zarIra khiMca jAtA hai yA phaTa jAtA hai use hI kuSTha kahate haiM / ( yasmAddhetorupekSitaM - anupakrAntaM sat, kAlena sarvaM zarIraM kuSNAti tasmAttat kuSTha ucyate ) / yaha kuSTha sampUrNa dhAtuoM meM pahu~ca kara phira unake andara vyApta hokara sabako kledita karake kRmi sveda, kleda aura kotha se sUkSma dAruNa kRmi utpanna kara detA hai jo loma, svacA, snAyu, dhamanI aura kAsthiyoM kA bhakSaNa karate haiM / zvina ko kuSThabAhya kahA jAtA hai kyoMki usameM vikAra ke bala svacAgata hotA hai / / kuSTha kA artha phAr3anA, galAnA, khIMcanA hai isI kuSTha dhAtu se kuSTha banatA hai jisameM dhAtue~ phaTe, gale yA khIMcI jAveM / isa kuSTha kA kAraNa Ayurveda ne doSoM ko mAnA hai / doSoM kA dUSyoM para aniSTakara prabhAva hone se hI zarIra meM dAruNa kRmi yA jIvANu utpanna hote haiM jo lomAdi kA bhakSaNa karate aura zarIra kI dhAtuoM ko galA dete haiM / parantu Adhunika vidvAn kahate haiM 'Leprosy is a specific infectious disease caused by M. Leprae of Hansen and characterised by the formation of granulomatous lesions of the skin, mucous membranes and nerve sheaths.' - DA. dhIrendranAtha banarjI arthAt kuSTha eka viziSTa aupasargika roga hai jo hainasana dvArA khoje gaye mAiko baikTIriyamalaiprI ( mahAkuSTha kavakavetrANu ) ke dvArA utpanna hone vAlA roga hai jisameM tvacA, zleSmalakalA tathA vAtanADI kaMcukoM meM kaNanIyArbudIya vikSata bana jAte haiM / kahane kA tAtparya yaha hai ki roga kI utpatti Adhunika vidvAn una sUkSmAn sudAruNAn kRmIna ko hI lete haiM aura unheM mAiko baikTIriyama leprI sambodhita karate haiM / isI laimA yA laiprI se hI laiprasI zabda nikAlA hai jisakA artha kuSTha liyA jAtA hai / ca, laiTina aura grIka bhASA meM laiprA yA laiprosa kA artha ( chilakA ) hotA hai vaha roga jisase chilake kI taraha khAla utarane lage vaha laiprosI kahalAtA hai / zalka 'kuSTha' zabda Ayurveda meM lagabhaga sampUrNa tvacAgata rogoM ke lie Aja prayukta hotA hai vaise hI laiprosI bhI prayukta hotA thA / caimbarsa koSa meM laiprosI kA artha eka aisA For Private and Personal Use Only

Page #713
anya viziSTa kaNArbudikIya vyAdhiyA~ nAma jo kitane hI prakAra ke saMsparzajanya tvagrogoM ke lie prayukta hotA hai (a name applied to several different cutaneous diseases of contagious character ) aisA likhA hai| parantu cikitsAzAstra meM laiprosI se laiprAdaNDaNu (jise mAikobaikTIriyama laipI kahate haiM) se hone vAlI viziSTa vyAdhi ko hI nissandigdharUpa se svIkAra kiyA jAtA hai| isIlie jahA~ sAdhAraNa svarogoM ko kSudrakuSTha saMjJA dI gaI hai vahA~ isa viziSTa roga ko AcAryoM ne mahAkuSTha kaha kara pukArA hai| kucha kI aupagikatA suzruta ne aupasargika rogoM kA kAraNa dete hue kucha roga nAma bhI diye haiM jinameM kuSTha bhI eka hai prasaMgAdgAtrasaMsparzAnniHzvAsAt sahabhojanAt / ekazayyAsanAccaiva vastramAlyAnulepanAt // kuSThaM jvarazca zoSa va netrAbhiSyanda eva ca / aupasargika rogAzca saMkrAmanti narAnaram // 'prasaMga se arthAt maithuna se athavA satata sambandhita rahane se, zarIra kA sparza karane se, kisI rugNa kI zvAsa kA punaH zvasana karane se, sAtha bhojana karane se, eka zayyA para leTane se yA eka Asana para baiThane se, rogI ke vastra, mAlA yA anulepana kA prayoga karane se kuSTha, jvara, zoSa aura netrAbhiSyanda ( conjunctivitis ) ye cAra prakAra ke aupasargika roga eka manuSya se dUsare manuSya meM ho jAyA karate haiN| uparokta uddharaNa Adhunika vicAravAdiyoM kI dRSTi se bhI pUrNa yuktiyukta hai / kuSTha eka aupasargika roga hai aura aupasargika roga pAyaroga athavA bhUtopasRSTa roga huA karatA hai-'aupasargikarogAdayo bhuutopmrgjaashcaa|' visUcI ke samAna turata hI kuSTha roga kA upasarga nahIM lagA karatA balki usake lie bahuta kAla taka rogI ke sAtha rahanA, sonA, maithuna karanA, vastra pahananA, mAlAnulepanAdi vyavahAra karanA honA Avazyaka hotA hai| isakA saMcayakAla isIlie bahuta lambA mAnA gayA hai| ____ mahAkuSTha kese phailatA hai ? kuSThiyoM ke sAtha nirantara sambandha hI isake phailane kA mahattvapUrNa pramANa hai| kuSThadaNDANu ke dvArA anya prANiyoM meM kuSTha karane ke saba upAya nirarthaka siddha hue haiN| kevala cimpAMjI para kiye gaye prayoga kucha saphala hue haiN| saiNDavica dvIpa para kuSThAzrama meM nirantara kArya karane vAle pAdarI Demiyana 1873 I0 se vahA~ para the| unheM 9 varSa bAda kuSTha roga huA aura ve 1889 I0 meM paraloka sidhAra gye| usI dvIpa ke eka aparAdhI meM kRtrima rUpa se kuSThopasarga pahuMcAyA gyaa| kuSTha ke jIvANuoM ke 1. suzruta ke hA bhAva ko dUsare zabdoM meM jyoM kA tyoM rakhane vAlA yaha eka Adhunika vijJAnazAstrI kA vaktavya hai--"The mode of spread is unknown, but intimate contact with lepers is essensial, a history of attendance on lepers, of living in the same house, sleeping in the same bed, or sexual connection is frequently obtained" The Practice of Medicine. For Private and Personal Use Only

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642 vikRtivijJAna antaHpraveza ke eka mAsa pazcAt usakI bAhu meM antarbAhukA nADI tathA madhyabAhukA nADI ( ulnar and median nerves ) meM nADI pAka Arambha huA / DhAI varSa pazcAt use kuSTha yA mahAkuSTa ke sampUrNa lakSaNa prakaTa ho gaye tathA jIvANupraveza ke ThIka 6 varSa pazcAt vaha rogI mara gayA / yaha udAharaNa yaha siddha karatA hai| ki mahAkuSTa yA kuSTha eka aupasargika roga hai aura use eka se dUsare vyakti meM utpanna kiyA jA sakatA hai / dyapi kuSTakArI jIvANu azru, lAlArasa, dugdha, thUka Adi kaI zArIra srAvoM meM rahate haiM aura vahA~ se upasarga kA prasAra karate haiM parantu kuSThI ke nAsAsrAva ( nasal secretion ) meM ye bahuta bar3I saMkhyA meM hote haiM aura yahI srAva isa roga ke prasAra kA mukhya sAdhana mAnA jAtA hai / dUsarA sAdhana kuSTa vraNoM ke srAva haiN| yonisrAva, malamUtra Adi se bhI jIvANu prakaTa ho sakate haiM / Adhunika vidvAn isameM sandeha rakhate haiM ki kuSTha maithuna dvArA eka se dUsare vyakti para jA sakatA hai, na unake pAsa aisA koI pramANa hai ki vIrya yA strIbIja dvArA unakA gamana hotA hai / parantu jitane thor3e kAla meM isa vijJAna kI unnati huI hai usameM ye donoM bAteM siddha honA sambhava nahIM / AyurvedajJoM kI isa viSaya kI khojeM sahasroM varSoM kI haiM aura isa dIrghakAlAvadhi meM nissandeha unhoMne aise pramANa svayaM pratyakSa dekhe hoMge jisake bala para ise maithuna dvArA hone vAlI vyAdhi mAnA gayA hai athavA strIbIja vA puMbIja dvArA usakA AvAgamana svIkAra kiyA gayA hai I kupasarga kA mArga kuSTha kA upasarga eka vyakti se jaba dUsare vyakti para pahu~catA hai to vaha yA to usakI tvacA dvArA andara jAtA hai yA nAsA vA zvasanasaMsthAna kI zleSmalakalA dvArA praveza karatA hai / zarIra meM pahu~cate hI vaha lasavahAoM meM praviSTa ho jAtA hai jahA~ usakI vRddhi hotI hai jisase vaha kuSTa kozAoM ( lepra cells ) kA nirmANa kara letA hai / isake uparAnta yA to lasavahAoM dvArA athavA rakta ke mArga se vaha sampUrNa zarIra meM vyApta hotA hai / isa mahAkuSTha roga kA saMcayakAla 10 se 12 aura kabhI kabhI 20 varSa kA bhI ho sakatA hai / yaha prakaTa karatA hai ki kuSTha eka jIrNa vyAdhi hai / sarva prathama kuSTha kA prArambha kaThina gA~ThoM se hotA hai jo mAthe para yA nAsA para utpanna hotI haiM usake pazcAt utkoTha ( rash ) hotA hai / utkoTha ke dAne alasI ke bIja se lekara hathelI ke barAbara taka bar3e ho sakate haiN| unake varNa meM bhI bheda pAyA jA sakatA hai / pahale pahala unakA raMga gaharA lAla hotA hai jo phira zanaiH zanaiH babhru ho jAtA hai / svacA kI sampUrNa prakRtAvasthA naSTa hokara vaha zalkIya ( sealy ) hone lagatI hai / kuSTha kA koI bhI rUpa ho usameM kuSTha ke daure uThate haiM / daure ke samaya jvara AtA hai ThaNDa lagatI hai aura rogI ke rakta meM kuSTha daNDANu dekhe jA sakate haiM / daure ke kAraNa For Private and Personal Use Only

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anya viziSTa kaNArbudikIya vyAdhiyA~ 613 zarIra para naye utkoTha nikalate haiM aura sphoTa ( blisters ) bhI bana jA sakate haiM / daure ke kAraNa zarIra meM pratikAritA zakti jAga par3atI hai jisake kAraNa kuSTha kI gA~TheM naSTa ho jAtI haiM aura aisA lagatA hai ki mAno aba roga pUrNataH calA gayA / para kisI bhI kAraNa se jaba yaha pratikAritAzakti ghaTa jAtI hai taba rogI ko punaH daure hone lagate haiM aura kuSTha apanI pragati karatA calA jAtA hai / mahAkuSTha kA vikRta zArIra mahAkuSTha yA galatkuSTa yA laiprasI ke 2 mukhya rUpa dekhane meM Ate haiM: 1. granthikIya kuSTha ( nodular leprosy ) / 2. nizceta kuSTha ( anaesthetic leprosy ) / ye donoM rUpa bhI bahuta mizrita kuSTa ko svakuSTa aura nizveta kuSTha ko ke ThIka ThIka banane meM pA~ca varSa taka samaya samaya para tvacA meM utkoTha hote hue dikha jAyA karate haiM / yA saMyukta hote hue dekhe jAte haiM / granthikIya nADIkuSTha bhI kahA jAtA hai / kuSTha ke ina rUpoM kA samaya laga jAyA karatA hai / isa kAla meM jIvANu tvacA ke I 1 granthikIya kuSTha - kuSTha kA yaha rUpa taba hotA hai jaba kuSThakArI nIce bharamAra karatA hai aura tvacA meM granthikAe~ yA gA~TheM banA detA hai / ye gA~TheM mukhamaNDala aura bAhupAdoM para bahuta hotI haiM vaise ye sampUrNa zarIra meM nikala sakatI haiM / ye granthikAe~ cipaTI aura choTI hotI haiM / zanaiH zanaiH unakA vikAsa hotA hai tathA kaI kaI eka sthAna para dUsare se mila jAtI haiM taba unakA AkAra kAphI bar3A ho jAtA hai / prabhAvita tvacA prArambha meM paryApta dRr3ha tathA lAla yA babhru varNa kI hotI hai jo Age calakara mRdu tathA pANDura ho jAtI hai / yaha rogagrasta tvacA svataH vraNIbhUta nahIM hotI / isakA vraNana bahuta kAloparAnta yA to ho jAtA hai athavA usa para AghAta par3ane se prArambha ho jAtA hai| jaba vraNa bana jAte haiM to ve aMganAza khUba karate haiM / isa kuSThIya aMganAza ko leprAmyUTIlensa kahA jAtA hai / graMthikAe~ cehare se anya bhAgoM meM bhI jAtI haiM jaise bAhu yA pAdoM ke vikAsI tala ( extensor surfaces of extremities ) tathA netra, nAsA, mukha tathA svarayantra kI zleSmalakalA / isa roga se nAsAkoTaroM kI asthiyA~ prabhAvita nahIM hotIM jaisA ki phiraMga roga meM dekhA jAtA hai / nizceta kuSTha - kuSTa ke isa rUpa meM rambhAkAra yA tarkurUpa sUjana vAtanADiyoM para itastataH dekhI jAtI hai jo madhyabAhukA antarbAhukA tathA pazcima jaGghikA Adi nADiyoM para adhika prabhAva karatI hai / isake kAraNa nADIpAka ho jAtA hai / pariNAhI nADiyoM ke kaMcukoM meM bhI prabhAva hotA hai / nADIkaMcukoM ( nerve sheaths ) ke nIce kuSThakArI jIvANu kI bharamAra ke svarUpa yaha saba hotA hai| isa bharamAra ke kAraNa nADItantu prakSubdha ho jAte haiM aura phira unameM vihrAsa utpanna ho jAtA hai / vAtanADiyoM kA bahuta sA bhAga sUja jAtA hai / vAtanADiyoM meM bhI jo tvacA kI ora For Private and Personal Use Only

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644 vikRtivijJAna AtA hai vaha adhika prabhAvita hotA hai tathA jo peziyoM kI ora jAtA hai vaha utanA prabhAvita nahIM hotA hai| nADIpUloM ( nerve bundles ) ke bIca bIca meM kuSThajIvANu praveza kara jAte haiM usake pazcAt vahA~ kaNana ati banatI hai jo anta meM tAntava Uti meM pariNata ho jAtI hai| vAtanADiyoM meM sarvaprathama prakSobha hotA hai isa kAraNa sabase pahale saMjJAvikRti ke cihna , zUla, sunnatA tathA oSa (dAha) utpanna ho jAte haiN| sAtha meM karmavikRti ke cihna pezIsphuraNa tathA pezyAkSepa una peziyoM meM jinameM ve vAtanADiyA~ AtI haiM dekhe jAte haiN| prabhAvita yA rugNa huI vAtanADI tvacA ke jisa bhAga taka pUrti karatI hai vahA~ ke lomoM yA kezoM kA patana ho jAtA hai tathA vahA~ kezapAta ke pUrva udvarNika ( macu. lar ) udbhedana ( eruption ) ho jAtA hai / kezapAta ke pazcAt tvacA nizceta (anaesthetic ) hone lagatI hai| udvarNika ubheda aura nizcetatA ke kAraNa kuSTha ke isa rUpa ko udvarNa-nizceta rUpa ( maculo anaesthetic form ) bhI kaha kara pukArate haiN| pahale tvacA meM zUla aura atisaMjJatA ( hyperaesthesia ) pAI jAtI hai hai phira tvacA tanu aura visaMjJa ( insensitive ) ho jAtI hai| nADiyoM ke dvArA pUrta peziyAM kRza ho jAtI haiN| prabhAvita nADIkSetra meM sphoTotpatti isa roga kA prathama lakSaNa batalAyA jAtA hai| ina sphoToM ko kuSThasphoTa ( pemphigus leprosus ) kahate haiN| ye sphoTa yA to sUkha jAte haiM aura unake sthAna para pANDura visaMjJa kSetra raha jAte haiM jinake kinAre raMge hue hote haiM yA vahA~ vraNa bana jAte haiN| visaMjJa nADI kSetroM meM vraNoM kA bananA eka avazyambhAvI ghaTanA hai| ye vraNa itane gahare bhI hote haiM ki rogI kI aMguliyA~ gala jAtI haiM aura usake hAtha paira vikRta ho jAte haiM aura aMganAza ( lepra mutilans ) ho jAtA hai| DAkTara dhIrendranAtha banarjI ne eka tIsare kuSTa ke rUpa ko bhI mAnyatA dI hai jise ve mizrita rUpa ( mixed form) kahate haiN| mizrita prakAra ke kuSTha meM nizcetarUpI kuSTha hone ke pazcAt usI meM granthikIya kuSTha kI granthikA bana jAtI haiM jo Age calakara vraNIbhUta ho jAtI haiN| kuSTha ke ina donoM rUpoM meM prabhAvita kSetroM se lasa prApta karane vAlI lasikAgranthiyA~ phUla jAtI haiN| inameM upariSTha lasIkAgranthiyA~ prathama phUlatI haiM phira gambhIra lasIkAgranthiyA~ phUlatI haiN| kuSTha kA prabhAva bhItarI aMgoM para bhI par3atA hai inameM yakRt , plIhA tathA vRSaNa pranthiyA~ mukhya haiM / ye bhI phUla jAtI haiN| nizcetarUpI kuSTha bahudhA uSNa pradezoM meM hotA hai| isase pIDita vyakti jitane dina jItA hai usake Adhe hI kAlaparyanta pranthikIya kuSTha se pIDita rogI jItA hai| For Private and Personal Use Only

Page #717
anya viziSTa kaNArbudikIya vyAdhiyA~ kuSTha kI autikI kuSTha kI vaikArikI kA utanA jJAna abhI taka nahIM kiyA jA sakA hai jitanA ki yakSmA yA phiraMga kA ho cukA hai| aisA jJAta hotA hai ki kuSTha kA jIvANu sarvaprathama mukhamaNDala yA nAsA kI lasavahAoM meM vikasita hotA hai yA vaha tvacA ke dvArA praveza pAtA hai| isa jIvANu kA vitaraNa raktadhArA dvArA hotA hai| yahI kAraNa hai ki isa roga ke vikSata saMmitIya (symmetrical ) hote haiM, ve sampUrNa zarIra meM pAye jAte haiM aura jaba ve utpanna hote haiM yA jaba roga kA daurA hotA hai to sAtha meM tIvra jvara AtA hai| pratyakSa dekhane se jo navIna Uti banatI hai vaha AdhUsara yA ApIta varNa kI aura arddhapAradarza hotI hai| vaha samarasa ( homogeneous) bhI hotI hai| antarAlita Uti para adhika prabhAva par3atA hai tathA lasAbha Uti para usase kama / aNvIkSaNa karane para granthikAoM meM kaganaUti pAI jAtI hai jinameM bahuta se kuSThadaNDANu bhare rahate haiN| navIna ati meM aneka, bRhadAkAra, kaNIya rasadhAnIyukta ( vacuolated ) kozA ke samAna jo puMja ( masses ) hote haiM unheM kuSThakozA ( lepra cells ) kahate haiN| rasadhAniyoM meM asaMkhya kuSThadaNDANu bhare rahate haiN| ye kuSThakozA lasAvakAzoM ( Jymph spaces ) meM khUba pAye jAte haiM ye daNDANu isa prakAra ina kozAoM meM bhare hote haiM jaise Dibbe meM sigareTa bharI rahatI haiN| . ___ kuSTakozA kyA haiM isake sambandha meM navya mata yaha hai ki ve lasya ghanAstra (lymphatic thrombus ) haiN| isako dUsare zabdoM meM yoM bhI kaha sakate haiM ki eka lasavahA kA aisA anuprasthacheda (transverse section ) jisakA nihita lasa ( contained lymph) apane aneka kuSThadaNDANuoM ke sAtha jama gayA ho vahI kAlAntara meM kuSThakozA kahalAtA hai| prAcIna mata yaha hai ki kuSTha kozA antazchadIyakozA haiM jo lasAvakAzoM ke antazchada se nikale haiN| ina kuSThakozAoM meM antarnihita rasadhAniyoM ke sambandha meM yaha mata hai ki kozAoM meM nihita kuSThajIvANuoM ke utpAdasvarUpa unakA janma huA hai| ina lasIya ghanAsroM ke kAraNa prakSobha utpanna hotA hai jo AstarIya antazchada kA praguNana karatA hai jisase ki mahAkozA banate haiN| ye mahAkozA kuSThadaNDANu virahita banate haiN| lasIkAgranthiyoM meM choTe choTe tAntava sidhma banate haiN| yakRt aura plIhA ina donoM meM jIrNa antarAlita UtIya vraNazotha dekhA jAtA hai (ddailiipaain)| aisA kahA jAtA hai ki phuphphusoM meM yacamA rahatA hai / unakI AkRti aisI avazya ho jAtI hai jo yaha prakaTa karatI hai ki kilATIya zvasanakIya zvasana vahA~ ho gayA ho| parantu yaha kahanA ki yaha dazA bhI kuSTha ke jIvANu ke kAraNa huI hai sandehAspada kahA jAtA hai| kyoMki kuSThiyoM meM yakSmA bhI bahudhA dekhI jAtI hai / For Private and Personal Use Only

Page #718
646 vikRtivijJAna jaba kuSTha kI jIrNa vraNazothAtmaka prakriyA cala par3atI hai to udbhedana yA sphoTa nikalane ke pazcAt sarvaprathama sUkSmaraktavahanADiyA~ prabhAvita hotI haiN| kuSTha ke jIvANu vahA~ sthita hokara parivAhinIya bharamAra karane lagate haiN| prArambha meM jaba vraNazotha apanI tIvAvasthA meM rahatA hai taba lasya utsyanda ( serous exudation ) hotA huA dekhA jAtA hai| Age calakara jIrNAvasthA meM vahI kaNIya UtiyoM meM pariNata ho jAtA hai / yaha roga kI pragati pratyeka kuSThI meM bhinna bhinna hotI hai| jitanI jisa roga meM pratikAritA zakti hotI hai usI anupAta meM roga kI gati kama yA adhika usake zarIra meM dekhI jAtI hai| visphoTa, udbheda, granthikAe~, vraNana, nADI ke poSaNika parivartana ye sabhI jIrNa vaiSika prakriyA ( chronic toxic process ) ke kAraNa dekhe jAte haiN| UtiyoM kA mRdvana tathA nAza evaM vaNana yaha saba kuSTha ke daNDANu hI karate haiM para jaba ve yaha saba kara cukate haiM to una vraNoM para anya jIvANu apanA Asana jamA kara roga ko bahuta adhika bar3hA dete haiM aura usako gambhIra kara dete haiN| __ yadi eka kuSTha granthi ko kATA jAve to usake upariSTha kozA yathAvat milate haiM parantu gambhIra kozAoM kA svarUpa eka kaNArbuda ke samAna hotA hai jisameM aneka gola kozA milate haiM, bahuta se prarasa kozA tathA antazchadIya kozA pAye jAte haiM kuSThakozA tanturuha tathA bahuta sI tAntava Uti milatI hai jo raktavAhiniyoM ko sAdhe rahatI hai| ina raktavAhiniyoM ke parivAhinIya kSetra meM kuSThadaNDANuoM kI bharamAra rahatI hai| kuSTha ke kaNArbuda ko hama kuSThArbuda ( leproma. ) nAma bhI de sakate haiN| yaha kuSThAbuMda vAtanADiyoM meM, Abhyantarika aMgoM meM, tathA tvacA meM kahIM bhI ho sakatA hai| isameM sadaiva mahAkozA tathA naSTa huI UtiyA~ milA karatI haiN| ina kuSThArbudoM meM kuSTa ke daNDANu paryApta saMkhyA meM milate haiM ve rakta vAhiniyoM se samRddha hote haiM tathA ye kuSTadaNDANu hI atiyoM kI vRddhi karake unheM itastataH phulA dete haiN| tvacA meM mahAkozAoM kI upasthiti dekha kara phuphphusa kI bhA~ti yakSmA kA sandeha ho jAtA hai| yakRtplIhodara jIrNa kuSThI meM sAdhAraNataH dekhA hI jAtA hai| kATane para unameM aneka Azveta granthikAe~ itastataH vikIrNa dikhalAI detI haiN| ye granthikA aNvIkSaNa para kuSTha kozA siddha hote haiM / vRkkoM para kuSTha kA sadaiva prabhAva par3atA hai jisake kAraNa gambhIrAvasthA meM ve pUrNataH apuSTa dekhe jAte haiM / vRkkoM kI apuSTi kuSTI kI mRtyu kA kAraNa ho sakatI hai| kavakaroga (Mycoses ) zAkANuoM ( bacteria) se U~ce varga meM kiNva, sUkSmakavaka ( moulds ) tathA kavaka ( fungus ) Ate haiN| inake dvArA jo roga utpanna hote haiM ve saba kavaka roga kahalAte haiM / ina kavaka rogoM meM nimna prasiddha haiM: For Private and Personal Use Only

Page #719
(1) kiraNakavaka pRSTha 647 H HES yaha citra pUya meM upasthita mAlAvetrANu sUtroM ( Streptothrix myselium ) kA hai| (2) kiraNakavaka P RAN JHAN VANDAR SEN 91 isa citra meM kiraNakavaka ke cAroM ora pUyana hotA huA prakaTa ho rahA hai, kucha dUrI para kaNanAtmaka Uti tathA tAntava Uti ke kSetra haiN| For Private and Personal Use Only

Page #720
anya viziSTa kaNArbudikIya vyAdhiyA~ ( 1 ) kiraNa kavakaroga ( actinomycosis ) ( 2 ) madurApAda yA kavakArbuda ( madura foot or mycetoma ) ( 3 ) mukhapAka ( thrush ) ( 4 ) yug kavaka roga ( blastomycosis ) ( 5 ) badarANu roga ( coccidiosis ) (6) sUkSma kavakajanya roga ( moulds ) 647 aba hama inameM se pratyeka kA thor3A-thor3A varNana kreNge| ye sabhI kaNanIyArbudIya ( granulomatous ) hone ke kAraNa hI unheM yakSmA, phiraMga tathA kuSTa kI gaNanA meM hI liyA jAtA hai / ye roga bahudhA pazuoM ke dvArA manuSya ke pAsa Ate haiM parantu kaise Ate haiM isake sambandha meM abhI koI nirNaya nahIM ho sakA hai| kiraNakavaka roga yaha roga pazuoM, ghor3oM tathA zUkaroM meM bahudhA hotA hai aura unhIM ke pracura sahavAsa ke pariNAmasvarUpa ise manuSya prApta karatA hogA aisA anumAna hai / yaha gavya kiraNakavaka ( actinomycosis bovis ) dvArA phailatA hai| isakA nAma razmikavaka yA kiraNakavaka isalie par3a gayA hai ki isake maNDala ( colonies ) meM kavakasUtra usI prakAra vinyasta rahate haiM jisa prakAra sUrya kI kiraNeM sUrya ke cAroM ora anukramita rahatI haiM athavA jaise pahiye ke are cAroM ora ko ThIka golAI meM anukramita rahate haiM / yaha kavaka eka prakAra kA mAlAvetrANu ( streptothrix ) hai / yaha zarIra UtiyoM meM eka svalpa pIta puJjaka ( clump ) banA letA hai| ina puMjakoM ko gandhaka (sulphur granules ) kahate haiM / ye puMjaka sUtroM sahita bIjANuoM ke namita puMja tathA mudgarAkRtika kAryoM ke dvArA banate haiM mudgarAkRtika kAyA sadaiva pariNAha para rahatI hai ( these clumps are made of felted mass of filaments with spores and club-shaped bodies at the periphery ) inake sUtra suSavAdhAnya (gram positive ) hote haiM tathA mudgarAkRtikAya suSavadhAvya ( gram negative ) hote haiM / kiraNa kavakoM ke bhI kaI prakAra hote haiM jinameM eka prakAra jAraka jIvoM ( aerobs ) kA hai aura dUsarA ajAraka jIvoM ( anaerobes ) / manuSya vA pazuoM ko jo upasarga karate haiM ve prAyaH ajAraka jIvI huA kA hai karate haiM / For Private and Personal Use Only yaha roga sampUrNa kavaka rogoM meM bhayakArI mAnA jAtA hai| isake kAraNa kaNanIyArbudIya puMja yA vidradhiyA~ banatI haiM jo vikSata banate haiM unameM kavakagandhaka ke kaNoM ke rUpa meM hotA hai / ina kaNoM meM se pratyeka ke kendra bhAga meM sUtroM kI zAkhA - prazAkhAe~ rahatI haiM jinake cAroM ora razmivat vinyasta mudgarAkRtika zotha hotA hai jo sUtroM ke eka kinAre yA pariNAha para rahatA hai /

Page #721
648 vikRtivijJAna yaha roga pazu ke dvArA manuSya para AtA hai / parantu pazu kaise ise karatA hai patA nahIM | aisA samajhA jAtA hai ki anna kI upasRSTa bAla yA dAne ko khAne se yaha roga hotA hai | parantu prakRti meM kavakopasRSTa anna ke dAne nahIM milate / ' manuSyoM meM kiraNakavaka roga zanaiH zanaiH lagatA hai / zanaiH zanaiH hI jIrNa kaNanIyArbudIya puMja upasarga sthalI para banate haiM jo Age calakara pUyana karate haiN| pahale pahala yaha roga tvacA ke nIce yA zleSmalakalA ke nIce prakaTa hotA hai| jisake phalasvarUpa zanaiH zanaiH eka bRhat mAMsavarNIya zotha (a large brawny swelling) utpanna ho jAtA hai / jo adhicchada ise Dha~ke rahatA hai vaha aneka sthAnoM para TUTa hai aura aneka nADIvraNa usameM se bana jAte haiM / unameM hokara patalA pUya nirantara pravAhita hotA rahatA hai / usa pUya meM gandhaka ke kaNa barAbara upasthita rahate haiM / Adhe se adhika rogiyoM meM vikSata sira aura grIvA meM dekhA jAtA hai vizeSa karake adhohanu ( lower jaw ) meN| usake pazcAt zeSAntrakoNDukIya kSetra (ileocaecal area ) meM bhI yaha bahuta milatA hai jisake kAraNa aise lakSaNa utpanna ho jAte haiM jinase jIrNa uNDukapucchapAka kA sandeha hone lagatA hai / kabhI kabhI tathA bahuta hI kama yaha phuphphusa yA vacA meM bhI milatA hai / isa roga meM caMcalatA bilkula nahIM hotI / roga bahuta mantharagati se calatA hai isameM pUyana hotA hai / yaha eka sthAna vizeSa para uttarottara vRddhi karate hue sarvAGgINa pravRtti rakhatA hai / isameM UtiyoM kA sthAnika nAza khUba hotA hai asthi kA bhI nAza hotA hai, mRdu UtiyoM meM tantUtkarSa honA isa roga kA pradhAna lakSaNa mAnA jAtA hai / cheda ( section ) lene para isa roga ke vikSata madhumakkhI ke chatte ( honey comb) ke samAna dikhalAI dete haiN| jinameM se pUyIya srAva nicor3A jA sakatA hai / isa srAva meM pratyakSa pItavarNa ke gandhaka ke kaNa spaSTa dekhe jA sakate haiM / isa roga kI gA~TheM kana Uti dvArA banatI haiM jo bhItara se tAntava Uti ke paTToM se kaI khAnoM meM ba~TI rahatI haiM / aNvIkSaNa karane para kiraNakavaka ke kaNoM ke cAroM ora pUyakArI kozA dekhe jAte haiN| guhAoM kI prAcIroM meM antazchadIya praguNana hotA hai tathA kabhI kabhI mahAkozA bhI milate haiM / aupasargika nAbhi ke cAroM ora saghana tAntava Uti kA praguNana hotA rahatA hai / yaha tAntava Uti vAstavika jIvita Uti kA pAzana ( strangulation ) karake use ghoMTa detI hai / kavaka ke tIna mArga kiraNakavaka nimna 3 mArgoM meM se kisI ke dvArA bhI praveza kara sakatA hai:2. zvasanamArga, 1. mukha, 3. Antra / 1. 'Actinomycoses bovis has never been found in grains or grasses in a state of Nature ( bvAyaDa ) For Private and Personal Use Only

Page #722
anya viziSTa kaNArbudikIya vyAdhiyA~ 646 mukha dvArA kiraNakavaka ke praveza ke 2 mArga haiM eka dA~ta aura dUsarI tuNDikA pranthiyA~ | kRmidanta ( caries of tooth ) hone para yA dA~ta nikalate samaya hue vraNa ke dvArA kiraNakavaka hanvasthi meM praveza kara jA sakatA hai| jisake kAraNa Traft meM kiraNakavaka kA upasarga ho jAtA hai / hanvasthi ke bhItarI sapUya asthimajjApAka ho jAtA hai / usameM dUsare prakAra ke pUyajanaka jIvANuoM kA uttarajAta upasarga ho sakatA hai / pUya kA srAva tathA mRtAsthilava ( sequestra ) dekhe jA sakate haiM / pAka ke sAtha sAtha navIna asthi kA nirmANa bhI calatA rahane se hanvasthi kucha beDaula ho jAtI hai / jaba tuNDikAgranthikUpikAoM ( follicles of the tonsils ) dvArA kiraNakavaka hanvasthi taka praveza karatA hai to pazcagrasanI vidradhi yA parituNDakI vidradhi (peritonsillar abscess ) dekhA jAtA hai / zvAsaprazvAsakriyA karate samaya yaha sambhava hai ki kiraNakavaka kA phuphphusa meM praveza ho jAve / phuphphusa meM pahu~ca kara zvasanikIya praseka ( bronchial catarrh ) utpanna ho jAtA hai aura thUka meM kiraNakatraka kI upasthiti dekhI jA sakatI hai / yadi roga kucha gambhIra huA to gA~ThadAra nAbhiyA~ itastataH dekhane ko milatI haiM jinase guhAe~ ( cavities ) banatI haiN| kaI kaI guhAe~ milakara eka ho jAtI haiM jisake kAraNa uraHkSata ( bronchiectasis ) kI sthiti bana jAtI hai / isa roga ke sAtha sAtha jo atyadhika tAntava vraNavastu banatI hai vaha uraHkSata nirmANa meM aura bhI sahAyatA karatI hai | kiraNakavaka phuphphusa Uti ko nirantara khodatI rahatI hai jisake kAraNa vakSaprAcIra taka phUTa sakatI hai / naidAnika dRSTi se dekhane para rogI kRza hotA jAtA hai use jvara rahatA hai aura vaha khUba kapha thUkatA hai / ye saba lakSaNa yakSmA yA zoSa roga se milate hue hote haiM / yacmA meM jaise raktapitta ke lakSaNa ugrarUpa meM dekhane ko milate haiM vaise idhara nahIM / I antra para kiraNasan kA prabhAva sIdhA bhItara se bhI ho sakatA hai tathA samIpastha aMgoM se yA antaHzalya ke rUpa meM bhI ho sakatA hai| prAthamika upasarga hone para gadara nAbhiyA~ bana jAtI haiM / ye zleSmala aura upazleSmala UtiyoM meM banatI haiN| ina gA~ThoM ke TUTa jAne se vraNa bana jAte haiN| ye vraNa uNDuka pradeza meM hote haiN| unake kAraNa uNDukapucchapAka kA bhrama ho jAtA hai / vraNoM meM pUyana hotA hai aura jo pUya nikalatA hai usameM kiraNakavaka upasthita rahatA hai / kiraNaaas kA dvitIyaka upasarga udaracchada guhA, zroNi, malAzaya, pazca udaracchada UtiyA~ ( retro-peritonal tissues ) Adi sthAnoM meM ho sakatA hai jahA~ se vaha yakRt athavA phuphphusa taka bhI calA jA sakatA hai / audarika prAcIra kI UtiyA~ bhI prabhAvita ho sakatI haiM / cAhe upasarga aneka dizAoM meM phailatA ho, yaha roga jIrNasvarUpa kA hI hotA hai / visthAyi vraNa tathA saghana tantUtkarSa ke kSetra jinase svalpa mAtrA meM pUyotsarga hotA huA varSoM dekhA jAtA hai bahudhA milate haiN| anta meM rogI maNDAbhavihAsa se pIDita ho jAtA hai / 55, 53 vi0 For Private and Personal Use Only

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vikRtivijJAna Upara jo likhA gayA hai usase tathA anya vidvAnoM ke mata se kiraNakavaka ke dvArA 4 pramukhasthaloM para vikSata banate haiN| jinameM eka sthAna sagrIva zira (head & neck) hai| yahA~ 60 pratizata vikSata dekhe jAte haiN| dUsarA sthAna jahA~ 20 pratizata vikSata milate haiM zeSAntraka tathA uNDukapucchakSetra hai| tIsarA sthAna jahA~ 15 pratizata vikSata hote haiM phuphphusa hai aura cauthA kSetra tvacA hai jahA~ 5 pratizata vikSata mila sakate haiM / __ yadi adhohanu meM kiraNakavaka kI kriyA dekheM to patA lagegA ki sarvaprathama eka UtiyoM kA kaThina puMja adhohana para bana jAtA hai isake kAraNa grIvA taka eka mAMsa varNIya kAThinya dekhA jAtA hai / kucha kAla pazcAt yaha puMja chinna bhinna ho jAtA hai aura usameM aneka nADIvraNa aura vidradhiyA~ bana jAtI haiN| nADIvraNa tvacA kA anekoM sthAnoM para bhedana karake calanI ke cheda jaisI AkRti banA dete haiM jo kiraNakavaka kA eka mahatva kA nirdezaka cihna hai / adhohanu para sthita saMyojI Uti, pezI aura asthi sabhI kA uttarottara vinAza hotA calatA hai| pUrva ke andara sUkSma pItavarNIya gandhaka ke kaNa milate haiM jinake dvArA saralatApUrvaka nidAna kiyA jA sakatA hai| ina kaNoM ko dekhanA usa samaya paramAvazyaka hai jaba ki vidradhiyoM ko kholA jA rahA ho kyoMki bAda meM ve dikhAI nahIM diyA krte| aNvIkSaNa karane para kiraNakavaka ke vikSata aise kaNArbuda (granuloma ) se milate haiM jinameM pUyana bhI ho rahA ho| jIrNa vraNazothakArI kozA jaise tanturuha tathA mahAkozA usameM pAye jAte haiN| yadi pUyana adhika huA to sthiti tIvra vraNazotha ke samAna ho jAtI hai / isa roga kA autikIya svarUpa koI adhika mahattva kA nahIM huA karatA / Antragata kiraNakavaka ko aNvIkSaNa karane para khUba tantUtkarSa milatA hai aura tudra golakozAoM kI bharamAra dekhane ko milatI hai| vikSatoM ke pariNAha para kabhI kabhI antazchadIya mahAkozA milate haiN| vikSatoM ke kendroM meM choTI choTI vidradhiyA~ pAI jAtI haiM jinameM bahunyaSTikozA milate haiM tathA gandhaka ke kaNa bhI pAye jAte haiN| yadi kiraNakavaka roga se pIDita uNDukapuccha ko kATa diyA jAve to zastrakarma dvArA banA vraNa thor3e samaya pazcAt vighaTita ho jAtA hai usase patalA pUya nikalane lagatA hai aura vaha sthAna pUyotsargakArI kaNanaUti kA puMjamAtra raha jAtA hai| yahIM se kezikAbhAji (pratihAriNI ) sirA dvArA upasarga yakRt ko pahu~ca sakatA hai jisake kAraNa madhumakkhiyoM ke chatte jaisI aneka choTI choTI vidhiyA~ utpanna ho jAtI haiM kabhI kabhI raktadhArA dvArA phuphphusa bhI upasaSTa ho jAyA karatA hai| uNDaka (caecum) ke upasRSTa hone ke kAraNa audarika prAcIra syUlita ho jAtI hai kyoMki vahA~ zopha tathA tantUtkarSa ho jAtA hai / zleSmalakalA vraNita ho jAtI hai aneka vidradhiyA~ utpanna ho jAtI haiM tathA aneka nADIvraNa ( fistulae ) bhI bana jAte haiM / kiraNakavaka kI vidhiyoM para zastrakarma karane se svacA taka roga A jAtA hai jisase tantUtkarSa aura jIrNa vidradhiyA~ khUba dekhI jAtI haiN| For Private and Personal Use Only

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anya viziSTa kaNArbudikIya vyAdhiyA~ 651 madurApAda yA kavakArbuda isa roga kA kolabuka ne san 1846 I0 meM sarvaprathama avalokana kiyA thA ise madurApAda nAma diyA jAtA hai| yaha roga bhArata, rajatadvIpa (amerikA), kAladvIpa (aphrIkA) tathA zvetadvIpa (yUropa) meM bahudhA milatA hai| . isa roga ke kAlA, zveta tathA rakta tIna mukhya prakAra batalAye jAte haiN| inameM kAlA prakAra bahuta adhika hotA hai aura vaha eka kavakIya roga ( fungus disease ) hai| tathA lAla aura zveta prakAra mAlAvetrANu (streptothrix) nAmaka jIva ke kAraNa mAne jAte haiN| yaha roga prAyaH pAda (foot ) meM prArambha hotA hai| prArambha hone ke pUrva AghAta kA itihAsa bhI milatA hai / pAda ke atirikta TA~ga (leg), hAtha tathA jAnu (knee) meM bhI ho sakatA hai para ye prakAra bahuta kama pAye jAte haiN| isa roga ke sarvaprathama vikSata kA svarUpa eka laghu kaThina sUjana ke rUpa meM hotA hai jisake Upara tvacA meM eka choTA phapholA ho jAtA hai| yaha phapholA kucha kAla pazcAt phUTa jAtA hai aura usameM se thor3A pUyIya padArtha tathA kucha kavakakaNa nikalate haiM / samIpa kI Uti kaThina ho jAtI hai aura vaisI hI aneka pranthikAe~ samIpa ke bhAgoM meM bana jAtI haiM jinameM cheda ho jAte haiM jinakA sambandha Upara tvacA taka ho jAtA hai| dhIre-dhIre sampUrNa pAda meM aneka phaphole aura aneka nADIvraNa ho jAte haiM jo bahuta gaharAI taka cale jAte haiM aura jo pAda ko bahuta phulA dete haiM, jo vikSata banate haiM unakA sambandha pAda kI mRdu UtiyoM se tathA asthiyoM se bhI hotA hai| rogI sthUla pAda se binA adhika ar3acana ke calatA phiratA rahatA hai aura use koI vizeSa zUla bhI nahIM staataa| roga bahuta jIrNa hotA hai tathA isakI pravRtti ropita hone kI bilkula nahIM huA krtii| aNvIkSaNa karane para jo citra AtA hai vaha eka kaNArbuda kA citra hotA hai jisake sAtha-sAtha UtiyoM aura asthiyoM kA vistRta vinAza dekhA jAtA hai| vinaSTa hue kSetra kI prAcIroM meM kavakakaNa hote haiM tathA unake sAtha-sAtha navIna saMyojI Uti ke tantu tathA bahuta bar3I saMkhyA meM golakozA, prarasakozA, antazchadIyakozA tathA kucha mahAkozA dekhane meM Ate haiN| kiNvajamukhapAka yaha eka prakAra ke kiNva ke kAraNa hone vAlA roga hai| isa kiNva ko zveta kiNva ( oidium albicans ) kahate haiM / isa kiNva se tantuoM kI aneka zAkhA-prazAkhAe~ nikalatI haiM jo golIya kozAoM meM samApta ho jAtI haiN| ye kozA eka yA adhika bIjANu (spores) banAte haiN| mukhapAka ( thrush) kA varNana pIche ho cukA hai| yaha sadaiva jihvA se Arambha hotA hai phira isake sidhma mukha kI zleSmala kalA para phailate haiN| sidhmoM kA varNa AdhUsara zveta hotA hai aura ve zleSmalakalA ke For Private and Personal Use Only

Page #725
652 vikRtivijJAna upariSTha dharAtala para hI hote haiN| isa kAraNa unheM adhicchada ko vinA naSTa kie hI haTAyA jA sakatA hai / jaba roga adhika gambhIra hotA hai taba ye kucha gahare bhI ho sakate haiM / yaha eka zizuroga hai jo mukha kI svastha zleSmalakalA para koI prabhAva nahIM rkhtaa| para jo zizu botala dugdhasevI hote haiM jinakA poSaNa ThIka-ThIka nahIM ho pAtA tathA jo durbala hote haiM tathA jinakA mukha yathAvidhi svaccha nahIM rakhA jAtA unhIM ke mukha meM yaha pAka dekhA jAtA hai / aresoN meM bhI yaha roga ho sakatA hai para taba jaba Antrika jjara, zoSa yA koSThabaddhatA yA ajIrNa kA paryApta jora ho / Antrika jvara meM rogI kI jihvA para jo sapheda ru~e se jame hote haiM ve prAyaH kiNvajanita hote haiM / yugakavakaroga ( Blastomycosis ) isa roga ke do rUpa haiM / eka tvagrUpa ( cutaneous form) jo bahuta adhika dekhA jAtA hai aura jo sAdhya hotA hai aura dUsarA phuphphusa rUpa jo prAyaH mAraka hotA hai| tathA bahuta kama dekhane ko milatA hai / yaha dUsarA rUpa phuphphusa taka raktadhArA ke dvArA pahu~catA hai | yugakavaka roga kA tvagrUpa eka prakAra kA svapAka ( dermatitis ) hai / yaha yugakavaka ( blastomyces ) nAmaka kiNvasama jIva ke dvArA utpanna hotA hai / yaha jIvakalikAoM ( budding) dvArA praguNita hotA hai| isake kAraNa sapUya vraNa mukhamaNDala para utpanna ho jAte haiM / ye dekhane meM utkaNa ( papule ) jaise hote haiN| ye mukha maNDala ke atirikta hAthoM aura TAMgoM ( legs ) para bhI hote haiM / ye dhIre-dhIre phailate haiM / aNvIkSaNa para jIrNa kaNArbuda ke samAna inakA rUpa hotA hai / jAlakAntazchadIya paramacaya tathA mahAkozA nirmANa ye do parivartana vizeSa karake dekhane ko milate haiM / phuphphusoM meM upasarga tvacA se rakta ke dvArA pahu~catA hai / vahA~ yaha kaNArbudIya gAMTheM banA detA hai jo phUTa jAtI haiM aura unase pUya nikalatA hai / badarA roga (Coccidioidomycosis ) yaha eka mAraka roga hai jo pazu saMsAra tathA mAnava jagata meM eka sA hI dekhA jAtA hai | zvasanakriyA se vAyu ke sAtha eka prakAra kA kiNva ( yeast ) phuphphusa meM praveza kara jAtA hai / phuphphusoM meM usake dvArA jo vijJata banate haiM ve yakSmA kI yamakA jaise hote haiM / ina vijJatoM meM mahAkozA to hote haiM parantu yacamAdaNDANu na hokara kiNva upasthita milatA hai / yakSmA ke samAna isa roga meM bhI jvara kA anubandha barAbara rahatA hai / For Private and Personal Use Only

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anya viziSTa kaNArbudikIya vyAdhiyA~ sUkSmakavakajanya roga sUkSma kavaka ko molDa ( mould ) kahA jAtA hai / ina molDoM meM se aneka vikArakArI ( pathogenic ) hote haiM / inakI yaha sAmarthya nahIM hotI ki zarIra kI sajIva UtiyoM ko hAni pahu~cAveM / inakA gamana adhicarma ( epidermis ) taka hotA hai aura ve aneka prakAra ke vogoM ko utpanna karane meM samartha ho sakate haiM / 653 ina sUkSma kavakoM meM eka mAnava AdAruNaka ( achorion schoenleinii ) hai | jisake kAraNa AdAruNa ( favus ) nAmaka roga hotA hai / yaha roga kezapUrNa ( hairy ) bhAgoM para hotA hai / mAnava AdAruNaka nAmaka sUcamakavaka halake pItavarNa kA hotA hai / yaha bAloM kI jar3a meM apanA aDDA jamAtA hai / kezakUpikA ( hair follicle ) ke adhicchada para isakA adhikAra rahatA hai / kahIM kahIM yaha adhicchada taka calA jAtA hai tathA aura bhI Age carma ( corium ) taka pahu~ca jAtA hai / carma taka jAne para sthAnika prakSobha aura khujalI bahuta hotI hai / yaha sUkSma kavaka sandhirahita itastataH akrama se phailI zAkhAoM vAlA hotA hai isakI nalikAe~ eka dUsare ko pAra karatI haiN| kisI kisI meM sandhiyoM ke sthAna hote haiM aura vahA~ aNDAkAra bIjANu bana jAte haiM / dUsarA sUkSma kavaka ke kavaka ( trichophyton ) varNa kA hotA hai usakI kaI jAtiyA~ hotI haiM jaise mahAbIjANu kezakavaka ( trichophyton megalo sporon ), antarbahirmahAbIjANu kezakavaka ( T. megalosporon endoectothrix ), zirastvak kezakavaka ( T. tonsurans ) | ye dadru ( ringworm ) utpanna karate haiM / dadu bhI kaI prakAra kA hotA hai / jaba keza para prabhAva par3atA hai to keza kI mUla aura kezadaNDa kA adhobhAga ina kavakoM ke bIjANuoM dvArA khA liyA jAtA hai / ye kavaka vinaSTa hue kezoM kI tantukAoM ke bIca meM paMktibaddha dekhe jAte haiM / keza pArAndha tathA bhidura ho jAte haiM / thor3e samaya pazcAt ke TUTa jAte haiM / jo vikSata banatA hai usakI adhicchada kI papaDI meM aneka sUkSma kavaka bhare rahate haiN| adhika gaharAI meM kezamUla kaMcuka ina jantuoM ke prabhAva se rahita hote haiN| bIjANu khUba milate haiM ve aNDAkAra bhI hote haiM, kavakIya sUtra ( mycelial threads ) bahuta kama hote haiM / ina kavakajanita daduoM ke sambandha meM grIna ne nimna pada ( points ) batalAye haiM : 1. ye prAyaH bAlakoM taka sImita rahate haiM / 2. ye durbaloM para prahAra karane kI pravRtti rakhate haiM / 3. tIvrAvasthA meM saMkramaNazIlatA atyadhika rahatI hai jo jyoM jyoM roga jIrNa hotA jAtA hai kama hotI calI jAtI hai / For Private and Personal Use Only 4. yadi roga kisI pazu dvArA upasRSTa huA ho to vaha adhika umra hotA hai / yaha atyadhika khujalI, prakSobha tathA pUyana bhI kara sakatA hai /

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654 vikRtivijJAna prasaMga vaza aba hama nimna rogoM kA varNana bhI isI adhyAya meM kareMge:1. azvagranthi (Glanders) 2. nAsAvRddhi ( Rhino scleroma) 3. lasakaNArbuda (Lymphogranuloma) 4. bAhyadravya kaNArbuda ( Foreign body granuloma ) 5. nAsAbIjANUtkarSa ( Rhinosporidiosis ) 6. kAlasphoTa ( anthrax ) azvagranthi yaha eka aupasargika kaNArbuda hotA hai| jaba yaha apanI jIrNAvasthA meM hotA hai taba yaha yakSmA, phiraMga yA kavaka roga meM se kisI ke lie bhI bhrama utpanna kara sakatA hai| yaha roga bhI pazuoM se manuSya samAja meM praveza karatA hai| pazuoM meM yaha ghor3oM se prAyaH AtA hai isI kAraNa sAIsoM tathA azvacikitsakoM meM yaha bahudhA milatA hai| yahI kAraNa hai ki ise azvagranthi nAma se sambodhita kiyA jAtA hai| isa roga ke kartA jIvANu ko sAmAnya azvagranthikavaka ( malleomyces 'mallei ) yA azvagranthidaNDANu ( bacillus mallei ) kahate haiN| yaha yakSmAdaNDANu se milatA-julatA patalA suSavadhAvya (gramnegative ) kavaka hai| upasarga upasRSTa azva ke nAsAnAva se huA karatA hai| yaha strAva tvacA ke kisI vidAra meM hokara yA nAsA kI zleSmalakalA dvArA mAnavazarIra meM praveza pAtA hai| do cAra dina se lekara 21 dina taka ke saMcayakAla ke vyatIta hone ke uparAnta isa roga ke prathama vikSata prakaTa hote haiN| sarvaprathama eka utkaNa banatA hai jo kucha kAloparAnta utpUya ( pustule ) bana jAtA hai| isa roga ke vikSata prasI aura vinAzaka hote haiN| inake dvArA bar3e-bar3e viSamAkRtika vraNa banate haiN| upasarga lasavahAoM ke mArga kA anusaraNa karatA hai aura usa mArga meM gA~ThadAra sUjana ( nodular swelling ) utpanna kara detA hai / lasapranthikA sUja jAtI haiM tathA saMyojI Uti aura pezI Uti kA vinAza hone lagatA hai| ___ aNvIkSaNa para aupasargika kaNArbuda jaisA citra milatA hai parantu kilATIyana kA abhAva dekhA jAtA hai| mahAkozA bhI bahuta hI kama aura so bhI kisI-kisI meM dekhe jAte haiM / yaha roga varSoM raha sakatA hai aura anta meM mRtyu kA kAraNa hotA hai| isa roga kI eka tIvrAvasthA azva aura manuSya donoM meM milatI hai jo eka prakAra kI rogANuraktatA kI sthiti hotI hai| isake kAraNa phuphphusoM, yakRt , vRkka ityAdi meM pUyika vidradhiyA~ bana jAtI haiM, yaha avasthA bhI mAraka hotI hai| pazuoM meM isa roga ke do rUpa dekhe jAte haiN| eka rUpa meM unakI nAsA kI For Private and Personal Use Only

Page #728
anya viziSTa kaNArbudikIya vyAdhiyA~ 655 zleSmala kalA meM vikSata banatA hai tathA dUsare meM tvacA, upatvak UtiyoM tathA lasavahAoM meM vikSata banate haiM donoM rUpa tIvra aura jIrNa avasthAoM ko prApta ho sakate haiM / kendrabhAga meM milatA hotA hai| isake bhI manuSyoM meM isa vyAdhi ke ye do rUpa nahIM milte| kisI-kisI meM vikSatoM kI AkRtividhiyoM ke samAna hotI hai aura kisI-kisI meM yadimakAoM ke samAna / eka gola granthi vindu se lekara maTara taka ke AkAra kI uThatI huI dekhI jAtI hai / isa granthi kA cheda karane para usameM sitakozAoM kA eka puJja hai jisake cAroM ora antazchadIya kozAoM kA eka kaTibandha bAhara rakta ke lAla bimboM kA eka kaTibandha aura bhI ho sakatA hai / isa granthi ko kalikA ( fancy bed ) bhI kahate haiM / isameM vAhiniyoM kI upasthiti apUrNa rahatI hai / yaha pahale hI kahA jA cukA hai ki isa roga meM vikSatoM meM mahAkozA nahIM milate tathA kilATIyana bhI nahIM hotA / Age calakara vikSata kendra meM naSTa hote haiM aura pUyana prArambha ho jAtA hai / yadi yaha kalikA dharAtala ke samIpa banI to eka durgandhapUrNa AdhArayukta vraNa banatA hai jisake kinAre tIkSNatA se kaTe hue rahate haiM ye kinAre paryApta kaThina hote haiM / ve vraNa jIrNAvasthA ko prApta huA karate haiM / sAtha meM jvara kA anubandha rahatA hai / roga asAdhya yA kaSTasAdhya mAnA jAtA hai / isa roga kA nidAna karanA kaThina hone se sTrAsa ne eka parIkSA batalAI hai / vaha yaha hai ki vikSata ke padArtha ko lekara eka naravaMTamUSa ( male guinea pig ) kI udaracchada meM antaHkSipta kara deN| isake kAraNa 24 ghaMToM meM vRSaNoM ke aNDadharapuTaka meM ( tunica vaginalis ) meM tIvra vraNazotha utpanna ho jAvegA / aNDadharapuTaka se tarala lekara AlU para jamA dene se pIta madhu ke samAna saMvardha uga AtA hai / yahI isakI parIkSA hai | nAsAvRddhi ( Rhinoscleroma ) yaha bhI eka aupasargika kaNArbuda hai / isa roga meM jAtI hai isI se isakA yaha nAma diyA gayA hai / yaha ke nivAsiyoM meM pAyA jAne vAlA roga hai jo yA to vahIM dvIpa pravAsa karake anyatra kahIM basa jAte haiM to vahA~ bhI dezIya meM yaha nahIM hotA / isa roga kA karttA kavakajAtIya jIva nahIM hotA / usakA nAma nAsAvRddhi prAvara vetrANu (klebsiella rhinoscleromatis ) hai / isakA phiza nAma ka vidvAn ne patA lagAyA thA / For Private and Personal Use Only nAsA meM kaThina sUjana A pUrvIya zvetadvIpa ( yUropa ) hotA hai yA jaba pUrvIya zveta dekhA jA sakatA hai / anya yaha roga azvagranthi se milatA-julatA hotA hai / isake kAraNa kaThina spaSTa prakaTa hone vAle puJja agranAsAraMdhroM ke pAsa kI zleSmalakalA yA nAsAtvacA para dekhe jAte haiM / vahA~ se ve oSThoM, daMtamAMsoM aura nAsAguhA taka cale jAte haiN| yahA~ taka ki unheM tAlu (patate ) taka bhI dekhA jA sakatA hai / Age calakara prasanI aura svara

Page #729
656 vikRtivijJAna yantradvAra ( glottis ) bhI prabhAvita ho jAte haiM jisake kAraNa ve kar3e aura taMga bhI ho jA sakate haiN| aise hI parivartana bAhya karNasuraMgAoM meM bhI mila sakate haiM / yaha roga sarvAGgINa nahIM banatA isa kAraNa sAdhAraNa svAsthya para koI vizeSa prabhAva nahIM dekhA jaataa| yadi roga kA upacAra na kiyA jAve to bhI yaha zIghratApUrvaka prasArita nahIM hotA isakA prasAra zanaiH zanaiH hotA hai tathA hotA lagAtAra hai / nAsAraMdhoM ke pAsa jo puJja dekhe jAte haiM ve paramapuSTa vraNavastu ( hypertrophic Scars ) ke sadRza lagate haiM / ve raMga meM halake yA gahare Ababhru lAla hote haiM / ve kahIM-kahIM vidArapUrNa ( fissured ) aura kahIM-kahIM masRNa hote haiM / unake samIpa kI tvacA pUrNataH svAbhAvika hotI hai / unameM vraNana kI pravRtti atyalpa hotI hai / aNvIkSaNa para tvacA ( corium) meM kSudra golakozAoM kI saghana bharamAra milatI hai ye kozA tanvIya saMghAra ( fibrillated stroma ) meM bhare rahate haiM / aneka kozA aaikArI hote haiM / kucha adhicchadAbha bhI hote haiM / vRddhi ke sAtha vAhinyatA (vascularity ) sAdhAraNa rahatI hai aura snaihika vihAsa kI pravRtti nahIM milatI / UtiyoM meM kAcarapua bhI mila sakate haiM ( kaurnila ) / lasakaNArbuda yA hau kinAmaya hauja kina ne 1832 I0 meM lasagranthiyoM kI vRddhi ke 7 rugNoM kA varNana kiyA thaa| yaha roga nizcita rUpa se mAraka hai / yaha asthimajjA, lasagranthiyoM, plIhA aura yakRt para prabhAva karatA hai / ye sabhI aMga jAlakAntazchadIya saMsthAna ke antargata Ate haiM / isa kAraNa hama isa roga kA varNana vistRta rUpa se usI prakaraNa meM kareMge / isa roga kA kAraNa kyA hai yaha jJAta na hone se 4 mata vizeSa kara Ajakala cala rahe haiM / eka mata ise viziSTa aupasargika kaNArbuda batalAtA hai / viziSTa aupasargika kaNArbuda hone ke lie pahalI bAta to yaha hai ki usakA autikIya citra anya vi0 au0 ka0 se milatA-julatA ho dUsare usameM viziSTa jIvANu pAyA jAve tathA tIsare usa jIvANu ke dvArA roga anya ko pahu~cAyA jA ske| ina tIna parIkSAoM meM kevala autikIya citra to isa roga kA vi0 au0 ka0 sarIkhA hI hai parantu anya parIkSaNa para isakA karttA koI bhI jIvANu nahIM milatA isase isake aupasargika kaNArbuda hone meM sandeha hai / dUsarA mata yaha kahatA hai ki yaha roga yakSmA kA hI eka rUpa hai para yaha nitAnta asatya hai / isa roga ke sAtha-sAtha yakSmA bhI dekhI jA sakatI hai para yaha yakSmAjanya ho aise pramANa anupalabdha haiM / tIsarA mata ise arbuda mAnanA cAhatA hai / tathA cauthA mata ise arbuda yA kaNArbuda ke madhya meM ThaharAtA hai / ye donoM mata bhI vAstavikatA ko vyakta karane meM asamartha haiM / 1 isa roga meM raktotpAdaka saMsthAna ke aMgoM kI jIrNarUpa se vRddhi hone lagatI hai For Private and Personal Use Only

Page #730
anya viziSTa kaNArbudikIya vyAdhiyA~ 657 aura vizeSa kaNana Uti kA nirmANa hone lagatA hai / sarvaprathama vRddhi graivika granthiyoM meM hotI hai / phira pazcagrasanI, AntranibandhanIka aura vaMkSaNagranthiyA~ prabhAvita hotI haiM / prArambha meM prabhAvita granthiyA~ mRdu hotI haiM para ve zanaiH zanaiH bar3hatI aura pragAr3ha evaM kar3I hotI jAtI haiM / ve kitane hI bar3e AkAra kI ho jAveM Apasa meM milatI kadApi nahIM hai / na unameM kilATIyana hotA hai aura na pUyana hI / kabhI-kabhI unameM UtimRtyu ( necrosis ) ho jA sakatI hai / graiva granthiyoM kI vRddhi pahale dekhI jAtI hai isakA artha yaha nahIM ki unhIM kI pahale vRddhi hotI hai / gaharI granthiyA~ pahale pravRddha hotI haiM upariSTa ( superficial ) bAda meM / isI prakAra plIhA meM plIhANu ( malpighian bodies of the spleen ) bhI pravRddha hone lagate haiM / isake kAraNa 75 pratizata rogiyoM meM plIhodara avazya pAyA jAtA hai / usI prakAra asthimajjA meM raktakozAruhIya ( erythroblastic ) tathA sitakozAghaTakIya pratikriyAe~ dekhI jAtI haiM jinameM gA~ThadAra AkRtiyA~ utpanna ho jAtI haiM / rakta meM upasiprikozA bar3ha jAte haiM sitakozAoM meM parivartana lagAtAra aura eka se nahIM milte| raktacakrikAe~ ( raktabimbANu ) bhI bar3hate haiM tathA rakta ke andara (megacaryeytes ) bhI dekhe jAte haiN| rogI ko jvara kA anubandha rahA karatA hai / autakIya dRSTi se isa roga meM laghu aura bRhat donoM prakAra ke golakozA (lasIkozA ) bahuta bar3I saMkhyA meM pAye jAte haiM / adhicchadAbha kozAoM kA praguNana DaTakara hotA hai sAtha meM unameM prarasa ( protoplam ) tathA jAlaka kozAoM kI pracuratA bhI pAI jAtI hai / uSasipriya kozA, tantughaTa yA tanturuha tathA mahAkozA paryApta milate haiM / mahAkozAoM meM eka yA do nyaSTiyA~ milatI haiM adhika nahIM / inheM sTarnabarga mahAkozA ( sternberg giant cells ) kahate haiM / ye kozA bar3e hote haiM tathA paramanyaSTirurho (magaloblasts) jaise lagate haiM / ve samIpa ke kozAoM se prAyaH prarasIya pravardhI dvArA ba~dhe hue se dekhe jAte haiM / prarasakozA bhI khUba milate haiM / taskarSa tathA kAra parivartana bhI prAyaH dekhe jAte haiM / aNvIkSaNika parivartana plIhA tathA anya aMgoM meM vahI hote haiM jo lasagranthiyoM meM hote haiM / bAhya dravya kaNArbuda yadi tvacA meM lAikopoDiyama ke bIjANu antaHkSipta kara diye jAveM to zarIra ke protikozA vahA~ Ate haiM aura ina bIjANuoM ko bAhara nikAlane kA yatna karate haiM / ina protikozAoM meM mahAbhakSi ( macrophage ) ina bIjANuoM ko apane udarastha kara lete haiM aura phira anya mahAbhakSiyoM se milakara mahAkozAoM meM pariNata ho jAte haiN| jitane bIjANu bar3e hoMge utane hI bar3e mahAkozA baneMge / ina mahAkozAoM meM For Private and Personal Use Only

Page #731
658 vikRtivijJAna aneka nyaSTiyA~ hotI haiM aura ve bahuta bar3e bar3e hote haiN| unakA prarasa kaNIya aura amlapriya ( acidophilic ) hotA hai / vahA~ para tanturuha banane lagate haiM jo zIghra praguNita hokara eka tAntava puMja banA dete haiM aura usa kSetra ko jahA~ vraNazothAtmakaprakriyA calatI hai pUrNataH prAvarita ( encapsulated) kara lete haiM / isa prakAra eka kaNArbuda bana jAtA hai| aisA kaNArbuda pairAphIna, vaisalIna, taila, zalya ke padArtha, azmariyA~ Adi meM se kisa se bhI bana sakatA jo zarIra kI UtiyoM ko adhika prakSubdha nahIM karatIM / nAbA ( Rhinosporiodiosis ) yaha bhArata meM bahuta adhika pracalita roga hai / yaha amanAsArandhroM kA eka prakAra kA sthAnika vraNazotha hai / yaha puruSoM meM hotA hai / striyA~ bahuta kama prabhAvita hotI haiN| isa roga kA vijJata eka bahupAdIvRddhi ( polypoid growth ) hotI hai / jo nAsA meM hotI hai / isameM kaNana Uti rahatI hai / isakA aNvIta citra viziSTa hotA hai / vRddhi meM aneka koSThikAe~ ( cysts ) hotI haiM tathA pratyeka koSThI meM eka eka rogakArI jIvANu rahatA hai| isa jIvANu ko sI. bI. DI. kA nAsAbIjANu yA sAmAnya nAsabIjANu ( rhinosporidium seeberi ) kahate haiM yaha eka prakAra kA kavaka hai / yaha jIvANu 8 aNuma ( micron ) kA hotA hai| dhIre dhIre apanI myaSTi kA vibhAjana karake yaha 200-300 aNuma kA ho jAtA hai jisameM 4000 nyaSTiyA~ hotI haiM jo 16000 bIjANu banA detI haiN| pragalbha jIvANu ko dhAna (sporangium ) kahate haiM / yaha duharI bahIrekhA ( out line ) ke liphAphe se Dha~kI rahatI hai| isameM eka randhra hotA hai jisase bIjANu barAbara nikalA karate haiN| isakA upasarga kaise phailatA hai nahIM kahA jA sakatA / kAlasphoTa ( Anthrax ) yaha pazuoM dvArA manuSyoM ko prApta hone vAlA hI eka roga hai / hamane isa prakaraNa meM kitane hI aise rogoM kA varNana kiyA hai jo pazuoM dvArA prApta hote haiM / usI dRSTi se kAlasphoTa yA plIhajvara kA bhI varNana yahA~ diyA jA rahA hai / I kAlasphoTa nAmaka roga zvetadvIpIya pazuoM meM bahudhA pAyA jAtA hai / bher3a usase paryApta prabhAvita rahatI hai / yaha roga manuSyoM ko svacA se lagatA hai / pazuoM ko roga mukha yA zvasana dvArA prApta hotA hai| yahI kAraNa hai ki jaba isa roga kA svarUpa mAnavasamAja meM tvacA meM milatA hai jo pazujagat meM phuphphusa yA AMtra meM dekhA jAtA hai / upasarga rugNa pazuoM kI Una yA khAloM ke chUne se lagatA hai isI kAraNa kasAI, camar3e raMgane vAle camAra, Una ikaTThe karane karane vAle gar3ariye isa roga ke khAsa kara For Private and Personal Use Only

Page #732
anya viziSTa kaNArbudikIya vyAdhiyA~ 656 'zikAra hote haiM / makkhiyoM ke kATane se yaha roga phailatA hai aisA kahA jA sakatA hai para vaha pramANa rahita aura asaMgata batalAyA gayA hai / kAlasphoTadaNDANu suSavAdhAnya daNDANu hai yaha zarIra ke bAhara bar3e pratirodhaka zaktisampanna bIjANu banAne meM nipuNa hai / isI se Una yA khAloM meM tathA bAloM ke brazoM se yaha roga sadaiva ho sakatA hai yadi ve upasRSTa haiM / isa roga kA vikSata eka duSTa utpUya ( malignant pustule ) hotA hai / yaha anAvRta aMgoM ( mukha, hAtha Adi ) meM eka phuMsI ke rUpa meM nikalatA hai| yaha phuMsI zIghra hI eka udbhavikA ( vesicle ) meM pariNata ho jAtI hai| isa udbhavikA meM svaccha tarala bharA hotA hai jo kabhI rakta ke kAraNa lAla bhI ho sakatA hai| isameM asaMkhya kAlasphoTI daNDANu pAye jAte haiN| isI drava se daNDANu kI parIkSA karake roga nidAna kiyA jAtA hai / jaba yaha udbhavikA phUTa jAtI hai to eka kAle varNa kI vraNavastu bana jAtI hai jisake cAroM ora punaH aneka udbhavikA bana jAtI haiM sAtha hI mAMsavarNIya kAThinya utpanna ho jAtA hai / rudra citra tIvra vraNazotha kA hotA hai / kisI bhI samaya daNDANu rakta meM praveza kara jAte haiM aura kAlasphoTadaNDANuraktatA ( anthrax septicaemia ) utpanna kara dete haiM jisakA prabhAva zarIra ke sabhI aMgoM para par3a sakatA hai / yaha jIvANuraktatA aneka anuhRSTa jIvoM ( mUSaka, vaMTamUSaka ) meM dekhI jAtI hai / zvacA ke vikSata mRtyukAraka nahIM hote parantu jIvANuraktatA avazya ghAtaka hotI hai / yaha hamane kahA hai ki jIvoM ke zarIra meM yaha daNDANu bojANu ( spores ) banAne meM asamartha hotA hai | ataH kasAI khAnoM meM jahA~ pazu kaTate haiM vahA~ yadi isa roga se pIDita pazu kA rakta gira gayA to bhUmi para asaMkhya bIjANu bana jAveMge jo nirantara khAloM aura pazuoM ko pIDita karate raheMge / For Private and Personal Use Only

Page #733
ekAdaza adhyAya arbuda prakaraNa arbuda kI paribhASA sazrata apanI saMhitA ke nidAnasthAna ke gyArahaveM adhyAya meM arbuda kA paricaya dete hue likhatA hai: gAtrapradeze kvacideva doSAH saMmUcchitA mAMsamabhipradUSya / vRttaM sthiraM mandarujaM mahAntamanalpamUlaM ciravRddhathapAkam / kurvanti mAMsopacayaM tu zopha tadarbudaM zAstravido vadanti // isakA artha karate hue zrI paM. lAlacandra jI likhate haiM-zarIra ke kisI bhAga meM vAtAdi doSa kupita hokara mAMsa evaM rakta ko dUSita karake gola, sthAyI, thor3I pIDA yukta, bar3A, cauDI mUlavAlA, cira (varSoM meM ) se bar3hane vAlA, kadApi na pakane vAlA evaM atyanta gahare mUla vAlA mAMsocchraya (mAMsapiNDa) kara dete haiM inheM zAstravettA vidvAn 'arbuda' yA rasaulI kahate haiN| uparokta paricaya se hameM nimna vastue~ prApta hotI haiM: 5-arbuda zarIra ke kisI bhI deza meM ho sakatA hai koI bhI sthAna yA Uti aisI nahIM jisameM arbuda na ho sakatA ho / kvacidevAniyatapradeze na punarapacIvat hanvasthyAdisandhiSveva / 2-yaha zArIrika doSoM ke dvArA hI utpanna hone vAlA roga hai isameM jIvANuoM, bhUtoM yA AgantukAraNoM kA koI mahatvapUrNa prabhAva nahIM hai| jaba doSavRddhi ko prApta hote haiM to mAMsAdi dhAtuoM ko dUSita karake arbudotpatti karate haiN| saMmUcchitAH doSAH vRddhiMgatAH doSAH / saMmUJchitA dUSyasaMsRSTA iti kAttikaH / 3-yaha eka prakAra kA vRtta ( circular ), sthira ( steady ), alpazUlayukta, bar3A aura gaharA ( deep seated ) zopha hai| 4-isa zopha kI vRddhi cirakAla meM hotI hai| 5-arbuda kA pAka nahIM hotA / isake lie aSTAMgahRdayakAra bhI likhate haiM prAyo medaH kaphATyatvAtsthiratvAcca na pacyate / ki isameM medodhAtu tathA kaphadoSa kA vizeSa anubandha rahatA hai aura yaha sthira prakRti kA hone ke kAraNa pakatA nahIM hai| pAka sadaiva vraNazothaja vRddhi ( inflammatory newgrowths ) meM hotA hai / ataH usase arbuda kA koI sambandha nahIM hai| 1. kurvanti mAsocchyamatyagAtham -- ( gayadAsaH) For Private and Personal Use Only

Page #734
arbuda prakaraNa 6-yaha dekhane meM mAMsocchya yA mAMsapiNDa jaisA pratIta hotA hai| mAno ki mAMsa kA adhika upacaya hone se bana gayA ho| mAMsopacayaM mAMsasaMghAtam / mAMsocchrayaM mAMsocchrayatayA pratIyamAnam / ... Ayurveda meM arbudoM aura granthiyoM (koSThikAoM) kA varNana eka sAtha hI AtA hai| granthiyoM ko aMgarejI meM sisTa (cysts) kahate haiN| hamane sisTa ke lie isa pustaka meM 'koSTha' zabda kA vyavahAra adhika kiyA hai kyoMki granthizabda se glaiNDa (gland ) le liyA gayA hai / sisToM aura arbudoM meM doSadUSya aura svarUpa samAnatA bahuta karake dekhI jAtI hai| vAgbhaTa ne arbuda kA paricaya mahatta granthito'badam nAmaka do zabdoM meM de diyA hai| arthAt grantheryanmahat tadarbudam / granthi se jo kucha bar3A vaha arbuda hotA hai / yaha bahuta sthUla pahacAna hai| kyoMki koI-koI sisTa (granthi ) to itanI bar3I hotI haiM ki arbuda usake samakSa bahuta choTA pratIta hotA hai jaise bIjakoSa kI granthi ( overiyana sisTa ) Adi / navIna vidvAnoM ne arbuda kI jo paribhASAe~ dI haiM unheM sarvaprathama avikala rUpa meM rakhe dete haiM DA. dhIrendranAtha banarjI A tumour is a newgrowth of tissue which is functionless and often harmful and has a tendency to persist and to increase. It resembles a parasite to its host. It is differentiated from hypertrophy which means uniforms development of the tissue with corresponding increase of the physiological function. It is also differentiated from inflammatory newgrowths which develop under the influence of a definite source of irritation and terminate in a typical process of absorption and formation of fibroconnective tissue: ...There are two chief activities of a cell, one is growth and the other is function. In case of tumour formation there is excessive growth but the function is minimal or more commonly abnormal, particularly in cases of the tumours of the glands of internal secretion. -Text Book of Pathology viliyama bvAyaDa A tumor or nowplasm may be defined as a growth of new cells which proliferate without control and which serve no useful function. Most tumors are easy enough to For Private and Personal Use Only

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662 vikRtivijJAna recognize, but on the outskirts of the group there are tumor like masses regarding which no one can say with certainty whether or not they are true neoplasms. Two common examples are leukaemia and Hodgkin's disease. -- A Text Book of Pathology. grIna A neoplasm or newgrowth, loosely called a tumour is a new formation of tissue which reproduces with greater or less accuracy the structure of the tissue from which it arises, but which serves no useful purpose in the economy of the body. Such a tumour may arise from a single cell or more probably from a group of cells, and these may either be of epithelial or of connective tissue type. The newgrowth differs from a normal tissue and from other new tissue formations such as those seen in inflammatory or in reparative processes, in that its cells are less differentiated, their tendency is towards reproduction rather than usefulness, and their growth is irregular and disorderly. --A Manual of Pathology. ina navIna vicArakoM ne jo kucha kahA hai usakA sArAMza yaha hai ki 1. arbuda zArIrika Uti kI eka prakAra kI navavRddhi hotA hai / 2. Uti kI isa navIna vRddhi kA koI kArya vizeSa nahIM hotA hai| jisakA artha yaha hai ki zarIra meM eka Uti se jisa kArya ke sampAdana kI apekSA kI jAtI hai vaha kArya eka arbudastha vRddhiMgata vahI Uti nahIM karatI / 3. UtIya navavRddhi nirantara banI rahatI hai / 4. UtIya navavRddhi meM uttarottara vRddhi kI pravRtti hotI hai / 5. arbuda jisa Uti meM banatA hai usa Uti ke lie usI prakAra rahatA hai jisa prakAra ki eka parajIvI ( parasite ) apane poSaka ( host ) ke sAtha rahatA huA poSaka kA nAza karatA hai / 6. arbuda aura paramacaya yA paramaghaTana ( hypertrophy ) meM sadaiva yaha antara hotA hai ki paramacaya meM zArIrika Uti kI vRddhi ke sAtha sAtha usa Uti kI svAbhAvika kriyAzakti bhI bar3hatI hai parantu arbuda meM Uti kI vRddhi to hotI hai para svAbhAvika kriyAzakti meM koI vRddhi nahIM hotI / For Private and Personal Use Only

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arbuda prakaraNa 663 7. vraNazothAtmaka UtivRddhi (inflammatory new growth) aura arbuda meM yaha bheda hai ki pahalI kA Adi kAraNa prakSobha hotA hai, vaha kucha kAla taka rahakara svayaM pracUSita ho jAtI hai athavA tAntavaUti yA tantUtkarSa ko janma detI hai| jaba ki arbuda kA prArambha na kisI prakSobha se hotA hai na vaha pracUSita hotA hai aura usakA antima pariNAma tantUtkarSa hI dekhA jAtA hai| 8. kisI ati ke svAbhAvika kozAoM aura usI Uti ke arbudIya kozAoM meM kucha maulika bheda bhI dekhA jAtA hai| jahA~ svAbhAvika kozAoM meM kozA kI vRddhi aura usakI kriyA donoM eka dUsare ke samAnupAta se calatI haiM vahA~ arbuda ke kozAoM kI vRddhi atyadhika aura kriyA yA to bilkula nahIM hotI athavA hotI bhI hai to jaisA ki antaHsrAvI granthiyoM ke arbudoM meM dekhA jAtA hai vaha pUrNataH asvAbhAvika ( abnormal) hotI hai| 9-aisA jJAta hotA hai ki zarIra ke kisI aMga kI vRddhi eka maryAdA taka hokara phira vaha niyantrita ho jAtI hai tathA arbudIya kozAoM kI vRddhi hote samaya vaha niyantraNa samApta ho jAtA hai| 10-arbuda kI utpatti eka kozA se bhI ho sakatI hai aura kaI kozAoM ke samUha dvArA bhI ho sakatI hai| yaha adhicchadIya athavA saMyojI kisI bhI prakAra kI UtiyoM meM dekhA jA sakatA hai| vi-vibhinnana zarIrastha kisI bhI uti ke 3 pahala huA karate haiM jinameM pahalA kozIya, dUsarA racanAtmaka aura tIsarA cyaapcyik| arbuda jisa uti meM banatA hai usa Uti ke ina tInoM pahaluoM meM apacayana dekhA jAtA hai| yaha apacayana ( degradation ) pratyeka arbuda meM pAyA jAtA hai| kisI ke kisI pahalU meM adhika apacayana hotA hai aura anya pahaluoM meM kama / parantu hotA avazya hai| sAtha hI, yaha apacayana jitanA hI adhika hotA hai utanI hI usakI caNDatA yA mArAtmakatA (malignancy)adhika mAnI jAtI hai| isa apacayana ko vi-vibhinnana (de-differentiation) bhI kaha kara pukArA jAtA hai| jina arbudoM meM vi-vibhinmana kama hotA hai jisake kAraNa unake kozIya aura racanAtmaka ( organoid ) pahalU prakRta Uti ke sadRza hI rahate haiM, ve zanaiH zanaiH bar3hate haiM, unameM zIghra phailane kI pravRtti bhI nahIM milatI isa kAraNa ve jisa Uti meM banate haiM usI se pUrNataH samatA rakhate haiM kevala Uti dvArA sampAdita kriyA se apane ko pRthak rakhate haiN| aise arbuda mRdu yA saumya athavA sAdhAraNa ( benign or simple ) arbuda kahe jAte haiN| ye saumya isI lie haiM ki inake dvArA jIvana ko kisI prakAra kI kSati nahIM phuNctii| For Private and Personal Use Only

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664 vikRtivijJAna jina arbudoM meM vi-vibhinnana atyadhika hotA hai unameM Uti kI sI AkRti nahIM banatI unakI racanA usase paryApta bhinna hotI hai| unakI vRddhi bahuta drutavega se hotI hai |ve zarIra meM bahuta zIghratApUrvaka jAte haiM / ye bahuta zIghra mAraka bhI hote haiM isa kAraNa inheM ghAtaka, duSTa yA caNDa ( malignant ) arbuda kahA jAtA hai| inakA vi-vibhinnana jitanA kama hotA hai utane hI ve adhika mAraka mAne jAte haiN| isa dRSTi se vi-vibhinnana eka pratIpagAmI pragati ( retrogressive pro. gress ) hai| yaha ulTA vikAsa hai jo ucca se nIca zreNI kI ora le jAtA hai| isameM Uti kI vaha uccakoTi, vaha viziSTa kriyAzakti samApta prAyaH hotI hai| parantu yaha nahIM kahA jA sakatA hai ki vi-vibhinita uti eka prakAra kI bhrauNa (embryo. nic tissue ) ati hai jaisI ki garbhakAla meM dekhI jAtI hai| kyoMki bhrUNAvasthA meM bhauNa Uti eka kozA se bahukozIya vRddhi karatI huI prakRti ke viziSTa niyantraNa se Abaddha calatI rahatI hai aura usakA lakSya sadaiva U~ce uThanA rahatA hai / arbudika uti kA lakSya sadaiva nIce kI ora ko hotA hai| eka ucca kriyAzakti ke stara se arbudIya kozA eka nimna kriyAzakti ke stara para utara Ate haiN| ve aniyantrita hote haiM aura unase zarIra kA koI upakAra na hokara ve svayaM zarIra para eka bhArasvarUpa dekhe jAte haiN| __ racanAtmaka dRSTi se vicAra karane para vi-vibhinnana meM kozArasIya lakSaNoM (cyto. plasmic characters ) kA abhAva rahatA hai| arthAt kozArasa meM jo tantuka (fibrils) pAye jAte haiM yA kaNikAe~ (granules ) milatI haiM ve yahA~ nahIM hotii| ina lakSaNoM se kozA meM prauDhatA ( adult type ) pradarzita hotI hai| kozArasa isa dRSTi se bahuta sAdhAraNa rahatA hai isase kozAnyaSTi kucha bar3I hotI hai aura usa para gaharA raMga car3hatA hai| arbudoM meM kozA vibhakta hote hue bhI dekhe jAte haiM jo anya UtiyoM meM kadApi nahIM dekhA jAtA hai| kozA vibhajana kA kArya bhI koI bahuta acche DhaMga para na hokara avyavasthita svarUpa kA hotA hai| jisa prakAra arbuda meM kriyA kA sthAna kozA vRddhi le letI hai usI prakAra vAtajIvI madhvaMzana ( aerobic gly. colysis ) jo sAdhAraNatayA prakRta utiyoM meM calatA hai kA sthAna avAtajIvI madhvaMzana ( anaerobic glycolysis) le letA hai| ye jitane bhI parivartana arbudIya kozAoM meM dekhe jAte haiM ve sabhI kozA ke lie naye nahIM haiN| zarIra ke kozA garbhAdhAna se lekara janma taka ina sabhI parivartanoM ko pAra karate hue milate haiM / aisA pratIta hotA hai ki sthiti meM koI aisA AmUlacUla parivartana ho jAtA hai jo uti ke kucha kozAoM meM bhrauNika samavRddhi hone lagatI hai para jo itanI praur3hatA ko prApta nahIM karatI ki usa kriyA ko karane lage jo prakRta praur3ha Uti ke kozAoM dvArA sampAdita hotI hai| - abuMdIya racanA arbuda meM arbudika kozA tathA saMdhAra ( stroma ) ye do racanAe~ milatI haiN| arbudika kozA yA to adhicchadIya hote haiM athavA saMyojI UtiyoM ke kisI bhI prakAra For Private and Personal Use Only

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arbuda prakaraNa kA pratinidhitva karate haiM yA donoM prakAroM kA mizraNa dekhA jAtA hai| ye kozA bahuta bar3I saMkhyA meM isa prakAra bhare hote haiM ki unake dvArA koI mahatva kI kriyA hone vAlI hai yaha socanA nirarthaka hotA hai| saMdhAra raktavAhiniyoM tathA saMyojIUti ke dvArA banatA hai| sAdhAraNa saMyojIUtIya arbudoM meM saMdhAra kA nirmANa arbudikakozA svayaM kara lete haiN| caNDa yA duSTa saMyojIUtIya arbudoM meM jitanI caNDatA ( malig. nancy ) adhika hotI hai saMdhAra usI anupAta meM kama hotA hai| adhicchadIya arburdo meM saMdhAra adhicchada meM sthita saMyojI Uti dvArA hI banatA hai| vahA~ kI saMyojIUti meM praguNana kI kriyA kA vega arbuda nirmANakAla meM kAphI bar3ha jAtA hai| __ saMyojIUti kI mAtrA saMdhAra meM sadaiva eka sI nahIM rahA karatI / kucha duSTAbaMdoM meM tAntavaUti ke saghanapuMja milate haiM tathA arbudika kozA unhIM tAntavaUti ke tantuoM meM itastataH bikhare par3e rahate haiM / aise arbuda bahuta kaThina hote haiM aura unheM azmopama abaMda kahate haiN| kahIM-kahIM jahA~ arbuda kA vikAsa bahuta drutagati se hotA hai saMdhAra kI mAtrA bahuta kama hotI hai aura isa kAraNa aise arbuda bahuta mRdula ( soft ) dekhe jAte haiN| ina abUMdoM ko mastuluGgAbha arbuda (encephaloid tumour ) kahate haiN| mastuluMgAma kA artha mastuluMga jaisA / mastuluMga mastiSka ke mRdula padArtha ko kahate haiN| asthIya arbudoM ko chor3a kara zeSa arbudoM meM kAThinya yA mArdava tAntavasaMdhAra kI mAtrA para nirbhara karatA hai| yadi tAntavasaMdhAra ( fibrous stroma) adhika hogA to arbuda kaThina hogA ; yadi kama hogA to vaha mRdula hogaa| __tAntavasaMdhAra kA, tathA caNDatA (duSTatA) kA koI pratyakSa sambandha nahIM dekhA jaataa| kabhI tAntavasaMdhAra adhika hone para arbuda kI duSTatA adhika milatI hai to kabhI kama milatI hai / jahA~ sAdhAraNa arbuda saMyojIUti ke praguNana kA protsAhana adhika nahIM karate vahA~ caNDArbuda vizeSa karake karkaTArbuda nirantara saMyojIUti ko prakSubdha karatA rahatA hai jisase vahA~ bahuta adhika saMyojIUti banatI huI dekhI jAtI hai| IviMga ke mata se tAntavasaMdhAra kA karkaTArbuda pratyakSa uttejaka huA karatA hai isI kAraNa samIpastha tAntavaUti kA atighaTana jisake sAtha hudagola kozAoM kI bharamAra bhI rahatI hai bahudhA dekhA jAtA hai| arbudoM meM raktavAhiniyA~ aura lasavAhiniyA~ pAI jAtI haiN| vAtanADItantu tathA vAtanADIagra bhI unameM dekhe gaye haiM parantu ina sabakA kyA kArya hai yaha abhI taka ajJAta rahA hai| rakta kI vAhiniyA~ jo una arbudoM meM milatI haiM ve prAyaH pUrvaja (primi. tive ) prakAra kI hotI haiN| ve koTarAbha yA srotasAbha (sinusoids ) se milatIjulatI hotI haiM jinakI prAcIroM ko antazchadIya kozA pUrI taraha Astarita nahIM kie rahate aura kahIM-kahIM to unakA Astara Arbudika kozAoM dvArA banatA hai| ve paryApta pravRddha ho jAtI haiM aura unameM antaH vAhinIya dhanAnotkarSa ho sakatA hai| For Private and Personal Use Only

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666 vikRtivijJAna arbuda kA apane samIpa ke aMgoM ke sAtha sambandha pratyeka avasthA meM badalatA rahatA hai| kahIM vaha parilikhita (circumscribed ) hotA hai aura vaha pAsa ke aMga ko vicyuta karatA tathA dabAtA rahatA hai| isa pIDana ke kAraNa unakI apuSTi ho jAtI hai aura unakA sthAna tAntavati le letI hai| isake kAraNa arbuda ke cAroM ora eka tAntava prAvara bana jAtA hai| isa prakAra sAdhAraNa arbuda kA pariprAvaraNa ( encapsulation) ho jAtA hai| arbuda kisa prakAra kabhI-kabhI apane cAroM ora eka prAvara ( capsule ) banA letA hai use hamane yahA~ batalAyA hai| kucha arbudoM kI vRddhi prasara (diffuse ) hotI hai ve samIpastha UtiyoM meM praviSTa ho jAte haiN| isa avasthA meM arbuda aura usake samIpa ke aMga ina donoM ke madhya meM vibhedaka rekhA nahIM khIMcI jA sakatI hai| A~kha se dekhane para ho sakatA hai ki eka arbuda pRthaka dikhAI de para aNvIkSa ke nIce arbudika padArtha kI bharamAra samIpastha ati meM bhI paryApta milatI hai| inake kAraNa arbuda kI bahIrekhA eka sAra nahIM jAkara Ter3hI-mer3hI ho jAtI hai| aise arbuda prAyaH duSTa yA caNDa hote haiN| unakI AkrAmaka zakti unakI vRddhi ke tIvra vega tathA samIpastha aMgoM ko naSTa karane kI yogyatA para nirbhara karatI hai| eka hI rogI ke zarIra meM eka se adhika prakAra ke arbuda bhI eka sAtha raha sakate haiM tathA yaha Avazyaka nahIM ki do eka se arbuda zarIra meM do sthAnoM para eka hI kAraNa se bane hoN| pratIpagAmI parivartana arbuda svataH kabhI lupta nahIM huA karatA jisa prakAra vraNazothAtmaka ati se banA huA utsedha yA phiraMgArbuda svataH lupta ho jAtA hai / zIghra yA vilamba se arbuda meM atinAza yA vidvAsa hotA huA dekhA jA sakatA hai| arbuda jitane zIghra bar3hatA hai, navaUti utanI hI kama vibhinita hotI hai tathA utanA hI kama usameM sthAyitva hotA hai aura usI anupAta meM hI usameM vihAsAtmaka parivartana adhika dekhe jAte haiN| bAta yaha hai ki jo arbuda zIghra bar3hate haiM ve svatantratayA raktapUrti cAhate haiM parantu raktavAhiniyA~ pUrvaja prakAra kI hotI haiM jisase unameM hokara utanA rakta A nahIM paataa| yadi AtA bhI hai to unakI prAcIra TUTa-phUTa jAtI hai yA unake bhItara ghanAsrotkarSa ho jAtA hai| yahI kAraNa hai ki aneka karkaTArbuda (kaiMsara) evaM saMkaTAbaMda (sArkomA) jitane zIghra bar3hate haiM utanI hI zIghratApUrvaka vihRSTa bhI ho jAte haiN| isake viparIta sAdhAraNa arbuda zanaiH zanaiH utpanna hote haiM jisake kAraNa unakI raktavAhiniyA~ ThIka-ThIka banatI haiM unake andara ucca samaGgita Uti ( highly organised tissue) rahatI hai jisake kAraNa ve cirakAla taka sthira rahate haiN| pratIpagAmI parivartana jaise anya svAbhAvika UtiyoM meM dekhane meM Ate haiM vaise hI hote haiM / arthAt nimna parivartana mila sakate haiM: For Private and Personal Use Only

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667 arbudaprakaraNa snaihika vihAsa varNAtmaka vihAsa cUrNiya vihAsa zleSAma vihAsa kAcara vihAsa zleSmAbha vihAsa UtinAza yA UtimRtyu inake atirikta arbuda vraNazotha, vaNana aura raktasrAva ke bhI adhiSThAna ho sakate haiN| arbuda kI kriyAzUnyatA yadyapi yaha nahIM kahA jA sakatA hai ki arbudika kozAoM dvArA koI bhI kArya sampAdita nahIM hotA parantu yaha pUrNataH satya hai ki ve koI bhI upayogI kriyA karane meM asamartha hote haiN| jitanA hI eka arbuda meM vi-vibhinnana adhika hogA utane hI kama aMzoM meM vaha apanI mAtRUti ke kAryoM ko sampAdita karane meM samartha ho skegaa| jahA~ vi-vibhinnana kama hotA hai vahA~ unake dvArA mAtRUti sarIkhI kriyA bhI hotI hai para isa kriyA para koI niyantraNa nahIM hotA isa kAraNa usakI jitanI AvazyakatA hotI hai usase bahuta adhika dekhI jA sakatI hai| yaha kriyAbAhulya antaHsrAvI anthiyoM ke arbudoM meM adhikatara dekhA jAtA hai| ___ isa dRSTi se arbudIya abhinava vRddhiyoM ko hama kozAoM kI aisI bastiyA~ kaha sakate haiM jo kArya na karake vRddhi hI lakSya banAtI haiM / yadyapi svAbhAvika UtiyoM meM ThIka isakA viloma dekhane meM AtA hai| isa prakAra ye vRddhiyA~ vAstavika parajIvI haiM jo apane lie AhAra to cAhatI haiM para ve kArya kucha nahIM krtii| inheM hama kriyAzUnya bahvAkArI parajIvI hAniprada vRddhiyA~ kaha kara pukAra sakate haiN| arbudIya vistAra sAdhAraNa arbuda apanA vistAra karate samaya kisI vizeSa samasyA ko utpanna nahIM kiyA krte| ve barAbara aura uttarottara phailate jAte haiM unameM jyAM-jyoM bhAra bar3hatA jAtA hai tyoM-tyoM unake cAroM ora kI UtiyA~ dabatI jAtI haiM jo kAlAntara meM sAdhAraNa arbuda ke cAroM ora eka tAntava prAvara kA nirmANa karane meM samartha hotI haiM / arbudIya vistAra kI sabase bar3I samasyA duSTa arbudoM meM dekhI jAtI hai| isakA adhyayana karkaTArbuda meM bhale prakAra ho jAtA hai| arbudIya vistAra kI 3 vidhiyA~ haiM :(a) bharamAra yA antarAbharaNa, (A) antaHzalyatA, tathA (i) punaHropaNa, bharamAra-karkaTArbudika kozA saMyojIUtiyoM ke bhItara ke rikta avakAzoM meM ghusa jAte haiM tathA lasAvahAoM para AkramaNa karate haiN| isakA kAraNa yaha hai ki saMyojIUtiyoM meM itanI pratirodhAtmaka zakti nahIM hotI jitanI ki adhicchadIya utiyoM meM dekhI jAtI hai| arbuda kA jahA~ kinArA hotA hai vahA~ For Private and Personal Use Only

Page #741
665 vikRtivijJAna arbudika kozA samIpastha Uti avakAzoM meM ghusate hue prAyaH dekhe jAte haiM isI kAraNa audiaant prakaTa hone vAlA arbudakSetra pratyakSatayA dekhe gaye arbudakSetra se sadaiva bar3A hotA hai / saimpasana haiMDale ne vakSakarkaTa kA udAharaNa dete hue kahA hai ki arbudika kozA sahAoM kA parivedhana ( permeation of lymphatics ) karate haiM aura isa vidhi se unakA vistAra lasavahAoM ke bhItara ho jAtA hai jahA~ ve unake sAtha-sAtha vRddhi karate haiM / antaH zalyatA -- raktadhArA dvArA yA lasadhArA dvArA arbudika kozA dUrastha zarIrAMgoM taka pahu~cAye jAyA karate haiM / lasIka antaHzalyoM ke dvArA prAdezika sa granthakoM meM uttarajAta vRddhi dekhI jAtI hai, yaha vRddhi prathama arbudika vRddhi ke samIpa to bahudhA hotI hai para vaha dUra bhI ho sakatI hai / AmAzayika karkaTa adhyakSakIya bhAga (supra clavicular part ) kI lasagranthiyoM meM karkaTotpatti kara sakatA hai / yaha smaraNa rakhanA atyAvazyaka hai ki karkaTArbuda lasadhArA dvArA bahuta adhika gamana karatA hai parantu saMkaTArbuda vaisA nahIM kiyA karatA / parantu raktadhArA dvArA gamana kA kArya karkaTa aura saMkaTa donoM prakAra ke duSTa arbudika kozA kiyA karate haiN| adhika vAhinIsampanna arbuda tathA ve arbuda jo raktavAhiniyoM ko karalatA se AkrAnta kara lene meM nipuNa hote haiM ve visthAyotpatti ( metastasis ) zIghra kara lete haiM / isakA pUrNa udAharaNa garbhAzaya kA jarAyvadhicchArbuda ( chorionepithelioma ) hotA hai / 1 phuphphusoM meM upasarga sadaiva daihika raktasaMvahana ke mArga meM sthita arbudoM ke kAraNa pahu~catA hai / jaise yadi asthi yA vRkkoM meM karkaTa yA arbuda banegA to phuphphusoM meM antaHzalya pahu~ca kara vahA~ uttarajAta arbuda banA deNge| yakRt meM uttarajAta navavRddhi ( arbuda) nirmANa kA kAraNa pratihAriNIya raktasaMvahana ke mArga meM arbuda kA upasthita honA hai / AmAzaya yA Antra meM arbuda hone para yakRt meM uttarajAta arbuda yA navavRddhi bana sakatI hai / yadi phuphphusa meM hI sarvaprathama arbuda ho to usase uttarajAta arbuda mastiSka meM athavA anya zarIrAMgoM meM bana sakate haiM / yaha koI Avazyaka nahIM ki eka aMga kA karkaTa kisI nizcita aMga meM hI apane visthAya utpanna karegA / arthAt AmAzaya ke karkaTa ke kAraNa eka rogI meM yakRt meM visthAyapuMja dekhane meM Ate haiM to dUsare rogI ke audarika lasagranthakoM meM visthAya dIkha par3ate haiM tathA tRtIya rugNa meM kahIM bhI visthAya nahIM milte| aisA kyoM hotA hai ? isa prazna kA pUrA uttara abhI taka prApta nahIM ho pAyA hai| 1 hama eka aMga meM karkaTa kI uttarajAta utpatti dekhate haiM parantu dUsare aMga meM nahIM / isakA eka kAraNa paryAvaraNa ( environment ) batalAyA jAtA hai / peziyoM meM karkaTIya antaHzalya bhara diye jAne para bhI peziyoM meM uttarajAta karkaTa kA utpanna honA For Private and Personal Use Only

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arbada prakaraNa 666 asambhava dekhA jAtA hai| phuphphusa meM arbudika antaHzalya prAyaH naSTa ho jAte haiN| kyoMki unake Upara tantvi kA AvaraNa car3ha jAtA hai jisake kAraNa ve phuphphusa Uti meM bhale prakAra ropita nahIM ho pAtI jisake kAraNa unase visthAyika vRddhi nahIM hotii| peziyoM yA phuphphusoM meM uttarajAta arbudoM kA nirmANa na hone kA mukhya kAraNa vahA~ para Avazyaka paryAvaraNa kI kamI mAnI jAtI hai / __ yadi do aise prANI hama pakar3a leM jinake eka se hI arbuda hoN| aura una donoM ke arbudoM ko DaTa kara malA jAve aura malane ke turata bAda eka ko mAra diyA jAve aura phira usakI phuphphusastha kezikAoM kI parIkSA kI jAve to ve arbudika kozAoM se bharI huI mileNgii| phira dUsare prANI ko kucha mahInoM ke uparAnta mAra kara usake phuphphusa dekhe jAveM to vahA~ bahuta kama visthAya milate haiN| usakA kAraNa yaha hai ki jitane antaHzalya phuphphusoM taka pahu~ce the unameM bahuta hI kama ko aisA paryAvaraNa prApta huA ki unase uttarajAta vRddhi ho sakI zeSa asaphala rahe / raktadhArA dvArA arbudika kozAoM kA parivahana ( transportation ) eka bAta hai tathA prAcIroM ko bheda kara arbudika kozAoM dvArA uttarajAta arbudoM kA nirmANa karanA dUsarI bAta hai| kucha arbuda kisI vizeSa aMga ke prati pUrvapakSa rakhate haiN| usakA kAraNa yaha nahIM hai ki ve vahA~ pahu~cAye jAte haiM apitu yaha ki ve vahA~ yogya paryAvaraNa kA anubhava karate haiM / isakA udAharaNa hama asthiyoM ke uttarajAta arbudoM se dete haiN| sarvaprathama vakSa, aSThIlAgranthi, vRkka, phuphphusa athavA avaTukAgranthi meM bane arbudoM ke kAraNa asthi ke uttarajAta ( secondary ) arbuda banate haiN| isI prakAra tvacA ke uttarajAta arbuda kAlyarbuda ( melanoma) se banA karate haiN| zarIraracanA ke hI AdhAra ke anusAra vibhinna aMgoM meM arbudika visthAya nahIM banA krte| aSThIlA yA puraHsthagranthi (prostate gland ) ke karkaTa dvArA bane hue visthAya phuphphusa meM na bana kara graivika kazerukAoM meM athavA lambI asthiyoM meM banA karate haiN| ina asthiyoM ko jAne kA kAraNa baiTasana kazerukIya sirAoM ( vertebral veins ) kI upasthiti dvArA detA hai jo trika, kaTi, udara aura vakSa kI sirAoM ke sAtha jAla banAtI hai| ye Upara sauSumnika suraMgA taka jAtI haiN| anya prANiyoM meM suSumnA ke Ara pAra sirAoM kA eka aisA saMsthAna mAnA gayA hai jisakA sambandha hRdaya yA phuphphusoM se nahIM hotaa| isa prakAra arbuda ke prasAraka cAra sirAsaMsthAna ho sakate haiM jinameM pahalA mahAsirA saMsthAna ( caval system), dUsarA phauphphusika sirAsaMsthAna ( pulmonary system ) tIsarA pratihAriNI yA kezikAbhAji sirAsaMsthAna ( portal system ) tathA cauthA kazerukIya sirAsaMsthAna ( vertebral vein system ) / uttarajAta arbuda prAthamika arbudoM kI jyoM kI tyoM nakala ho sakate haiM tathA unameM vibhinnatA bhI ho sakatI hai| vibhinnatAyukta ve adhikatara milate haiN| For Private and Personal Use Only

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670 vikRtivijJAna baharbudoM ( multiple tumours ) meM yaha pahacAna nahIM kI jA sakatI hai ki prArambha meM eka arbuda se uttarajAta anya arbuda utpanna hue haiM yA bahukendrIya utpattisthala se eka sAtha bahuta se arbuda bane haiN| bahvarbudoM kA eka udAharaNa bahumajjakArbuda (multiple myeloma) kA hai aura dUsarA lasasaMkaTArbuda (lympho sarcoma) kA / tvacA tathA Antra meM prAthamika duSTa bahvarbuda milate haiN| kabhI-kabhI aneka sthAnoM para eka sAtha prAthamika arbuda utpanna hote hue dekhe jAte haiM / kabhI-kabhI zavaparIkSaNa karane para aneka uttarajAta arbuda to milate haiM para prAthamika arbuda kA koI patA nahIM lgtaa| ho sakatA hai ki prAthamika arbuda eka granthikA ke rUpa meM nAsAgrasanI, puruSavakSa, puraHsthagranthi yA zvasanikA meM sthita ho aura jisakI upekSA kara dI gaI ho| punaH ropaNa-bIjagranthi ke karkaTa dvArA udaracchada meM karkaTotpatti punaHropaNa kA eka udAharaNa hai| bIjagranthi se karkaTakozA udaracchada para Aropita ho jAte haiM aura kAlAntara meM uttarajAta arbuda ko janma dete haiN| basti kA aMkurakarkaTArbuda ( papi. llary cancer of the bladder ) eka sthAna para hotA hai| vahA~ se karkaTakozA basti kI zleSmalasvacA para anyatra jama jAte haiM aura basti meM hI anya uttarajAta aGkarakarkaTArbuda ko janma de dete haiN| ___eka arbuda ko dUsare ke zarIra meM punaH ropita karanA eka zaMkAmAtra hai aisA kucha loga mAnate haiM / yaha zaMkA vAstavika hai yA nahIM ise nahIM kahA jA sktaa| arbudoM ke prasAra ke sambandha meM jo kucha hamane kahA hai usase yaha patA lagatA hai ki prAthamika arbuda ke samAna anya arbuda (1) prathama arbuda ke samIpastha praveza meM bana sakate haiM, (2) samIpastha lasIkAgranthi meM bana sakate haiM athavA (3) anya dUrastha aMgoM vA UtiyoM meM bana sakate haiN| __ kabhI-kabhI jaba eka sthAna se arbuda kA uccheda kara diyA jAtA hai to punaH vahA~ para arbuda kI utpatti dekhI jA sakatI hai / arbuda kI punarutpatti arbuda dauSTaya kA lakSaNa nahIM hai yadyapi duSTArbudoM meM yaha lakSaNa bahuta adhika dekhA jAtA hai| __ lasadhArA dvArA sadaiva duSTAbaMdoM kA gamana huA karatA hai| lasIkAgranthiyoM ke andara jo arbuda dvitIyaka yA uttarajAta rUpa banate haiM unake kAraNa lasIkAgranthiyA~ kar3I tathA pravRddha ho jAtI haiM yadi unheM aNvIkSa dvArA dekhA jAye to unameM prAthamika arbudika kozAoM ke sahaza kozA dikhalAI dete haiM jo granthi kI svAbhAvika racanA ko dhvasta kara dete haiN| Arambha meM to kevala aNvIkSa dvArA hI duSTa kozA dekhe jAsakate haiM para bAda meM pranthi kA cheda lene para vRddhi kA zveta saghana puMja saralatApUrvaka dekhA jAsakatA hai / duSTArbudoM ke dvArA vaiSika cayApacayoM (toxic metabolites) jaise banAye jAte haiM isa kAraNa usa pradeza kI lasIkAgranthiyoM meM unake kAraNa jIrNa vraNazothAtmaka parivartana bhI dekhane meM Ate haiM isase pahale ki unameM duSTArbudIya AkramaNa ho / isalie For Private and Personal Use Only

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arbuda prakaraNa 671 granthiyoM kI pravRddhi se yaha samajhanA ki unameM visthApana ho gayA bhUla hai / aisI dazA meM aNvIkSaNa karanA atyAvazyaka hotA hai / lasavahAe~ aura lasakoTara pratyakSa tathA apratyakSa donoM prakAra se arbudika kozAoM dvArA avaruddha kie jA sakate haiM / yadyapi jIrNa vraNazotha ke kAraNa bhI avarodha ho sakatA hai / lasavahAoM meM arbudika ativedhana ke kAraNa lasavahAoM meM lasaparivahana ruka jAtA hai tathA lasa avaruddha bhAga kA cakkara lagAkara jAtA hai / aura isa anya cakkaradAra mArga kAraNa arbudika kozA anya dizAoM meM tathA anya pradezoM meM visthAya utpanna karane meM samartha ho jAte haiM / dUrastha pradezoM meM arbudika visthAyoM ke banane ke lie uttaradAyI raktadhArA hotI hai| saMkaTArbuda kozA sadaiva raktadhArA dvArA hI gamana kiyA karate haiM / isakA kAraNa yA to yaha hai ki arbuda kI vAhiniyA~ koTArAma (sinusoids ) hotI haiM jinakA AstaraNa svayaM arbudika kozAoM kA hotA hai yA arbuda kozA sIdhe raktavAhiniyoM ke suSiroM meM utpanna hote haiM / vahA~ se kucha kozAsamUha TUTa kara dUrastha kezAloM meM duSTa antaHzalyoM ke rUpa meM jama jAte haiM / phira unase abhinava arbuda utpanna ho jAte haiM / adhicchI yAdoM kA prasAra bhinna prakAra se hotA hai jaisA kaha cuke haiM ve lasadhArA dvArA phailate haiM / lasavahAoM kA ativedhana yA antaHzalyatA dvArA unakA prasAra hotA hai / ativedhana ( permeation ) meM vRddhiMgata arbudika kozA prAthamika arbuda se nikala kara lasavahA meM praveza karate haiM aura vahA~ prAcIra meM ugane lagate haiM aura kisI bhI dizA meM bar3hane lagate haiM / isa prakAra eka bhAga se dUsare bhAga taka pahu~ca jAte haiM / vakSakarkaTa ke kozA audarikaguhA meM yA yakRt meM isI prakAra pahu~cate haiM / sAthasAtha saumya prakAra kA vraNazotha calatA rahatA hai tantUtkarSa bhI hotA hai jisase pIDana ke kAraNa arbudika kozAoM kA pUrNataH abhilopana bhI ho sakatA hai phira bhI arbuda prasAra meM koI bAdhA nahIM dekhI jAtI / jaba lasavAhinI kA bahuta bhAga tAntavaUti dvArA lupta ho jAtA hai taba prAthamika aura dvitIyaka arbudoM meM sambandha jor3anA kaThina ho jAtA hai / arbuda ke naidAnika prakAra naidAnikadRSTi se ( Clinically ) arbudoM ko do sthUla prakAroM meM vibhAjita kiyA jAtA hai jinameM eka prakAra sAdhAraNa arbudoM kA mAnA jAtA hai aura dUsarA prakAra duSTa arbudoM kA kahA jAtA hai / sAdhAraNa arbuda ( simple tumours ) ko nirdoSa arbuda ( innocent tumours ) bhI kahate haiM / isakA tIsarA nAma mRdu arbuda ( benign tumour ) bhI hai / yaha eka sthAnika vRddhi hotI hai / vaha zanaiH zanaiH parantu zAnti se bar3hatI jAtI hai| jaba usakA eka nizcita AkAra bana jAtA hai to phira vaha sthira ho jAtI hai| aura usakI vRddhi ruka jAtI hai / sAdhAraNa arbuda kI racanA kisI Rju evaM pragalbha For Private and Personal Use Only

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672 vikRtivijJAna zArIrika Uti ke sAtha pUrNataH samatA rakhatI hai| sAdhAraNa arbuda adhicchadIya aura saMyojI donoM prakAra kI UtiyoM meM se kisI bhI prakAra kA ho jA sakatA hai tathA donoM ke mizraNa se bhI bana sakatA hai| usake cAroM ora tAntavaUti kA eka acchA prAvara car3hA hotA hai isa prAvara (kaipasUla) meM se arbuda ko pUrNatayA nikAlA bhI jA sakatA hai| isakA kAraNa yaha hai ki sAdhAraNa arbuda kI bharamAra samIpastha atiyoM vA aMgoM meM nahIM huA krtii| isI kAraNa eka bAra isakA mUloccheda kara dene para usakI punarutpatti prAyazaH dekhI nahIM jAtI jaba taka ki vaha apUrNa rUpa se na nikAlA jAve yA usake kAraNa pranthiyoM meM uttarajAta vRddhiyA~ na utpanna huI hoN| kahIM-kahIM aisA bhI dekhA gayA hai ki sAdhAraNa arbudoM meM praguNana hokara itastataH uttarajAtavRddhi ke rUpa meM prasAra huA ho| isakA eka udAharaNa basti kA aGkurArbuda hai / prArambha meM yaha jahA~ banatA hai usake kaNa mUtra mArga se utsRSTa hote rahate haiM aura prathama abuMda ke nIce anya kaI vRddhiyA~ bana jAtI haiN| isI prakAra bIjagranthi ke aGkurIya mRdu koSThakIya arbuda ( papillary benign cystic tumour ) jaba udaracchadIya syUna ( peritoneal sac ) meM phUTa jAte haiM to unameM se arbudIya kozA svatantra ho jAte haiM aura ve udaracchadIya guhA meM kahIM bhI uga Ate haiN| ____ nAmataH mRdu hote hue bhI sAdhAraNa arbudoM ke dvArA mRtyu yA gambhIrAvasthA hone kI bhI sambhAvanA rahatI hai| yaha do avasthAoM meM dekhI jAtI hai eka taba jaba unase atyadhika raktasrAva hotA ho aura dUsare taba jaba unake bhAra se koI mahattvapUrNa aMga daba gayA ho aura usakI kriyA meM asAdhAraNa bAdhA utpanna ho gaI ho| jaba A~ta kA avarodha koI arbuda kara de yA mUtrasrAva na hone de to usa avasthA meM gambhIra avasthA utpanna ho jAtI hai / mastiSka meM sthita sAdhAraNa sA arbuda bhI mRtyukAraka ho jAtA hai kyoMki vahA~ antaHkaroTIya tati kI nirantara vRddhi hone lagatI hai| aNvIkSatayA adhyayana karane para eka sAdhAraNa arbuda meM nimna vizeSatAe~ dekhane meM AtI haiM: (1) usake kozAoM kA vinyAsa ( arrangement ) niyamita rahatA hai| (2) granthikIya arbudoM meM kozA adhaHstRta kalA ( basement membrane ) para vinyasta rahate haiM yadi vaha kalA upalabdha ho| (3) kozAoM kI nyaSTiyA~ eka barAbara kI hotI haiM, AkRti meM niyamita hotI haiM tathA unameM sakriya sUtribhAjanA | active mitosis) nahIM pAI jAtI hai| (4) sAdhAraNa adhicchadIya arbudoM meM kozA eka se adhika stara moTe hote haiM unameM kozAoM kI saMkhyA apanI pitR uti se kahIM adhika hotI hai| (5) saMyojI UtiyoM ke sAdhAraNa arbudoM meM bhI kozA pitR ati se adhika saMkhyA meM hote haiN| (6) ina arbudoM ke kozAoM kA praguNana itanA adhika hotA hai ki aMga kI kriyA kI dRSTi se Avazyaka kozApraguNana ko pAra kara jAtA hai| For Private and Personal Use Only

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arbuda prakaraNa 673 duSTa tathA sAdhAraNa arbudoM meM antara duSTa arbuda ( malignant tumours ) kI apano eka viziSTa jAti hotI hai jo sAdhAraNa arbuda jAti se kaI aMzoM meM vibhinnatA rakhatI hai| nIce hama duSTa arbudoM kI ina vibhinnatAoM kI ora aMgulinirdeza karate haiM : (1) duSTa arbuda kA yadi yogyarItyA upacAra na kiyA jAve to vaha rogI kI mRtyu bulA sakatA hai / duSTa arbuda cAhe kitane hI sAdhAraNa aMga meM ho jaise hAtha yA paira meM parantu vaha mRtyukAraka hotA hai| isake viparIta sAdhAraNa arbuda ke dvArA mRtyu taba taka honA sambhava nahIM jaba taka ki vaha kisI viziSTa marmasthala para na ho| (2) duSTa arbuda sadaiva jisa sthAna meM ugatA hai vahA~ ke samIpastha aMgoM meM bhI apane kozA bhejatA hai aura bharamAra ( infiltration ) kara detA hai mAno ki vaha apane paMjoM meM AsapAsa ke sampUrNa kSetra ko jakar3atA jA rahA ho| isake pAsa koI prAvara ( capsule ) nahIM hotA / sAdhAraNa arbuda sadaiva eka prAvara meM vanda hotA hai| isa bharamAra ke 2 kAraNa ho sakate haiM-eka to unakA bhAra aura dUsare unake dvArA utpanna viSAkta cayApacayika utpAda ( toxic metabolites ) jo samIpa ke aMgoM meM viSa kA saMcAra kara dete haiN| (3) uccheda kara dene para bhI duSTa arbuda kI punarutpatti hotI hai / isa punarutpatti ke 2 kAraNa batalAye jAte haiN| eka to yaha ki uccheda karate samaya duSTa arbuda ke kucha kozA apane sthAna para hI chUTa jAte haiM jo do cAra, dasa bIsa varSa meM punaH duSTa arbuda utpanna kara dete haiN| isa prakAra arbuda kI punarutpatti mUlasthAna para bhI dekhI jA sakatI hai tathA thor3A idhara-udhara haTa kara bhii| stanakarkaTa ke uccheda karane para phuphphusoM meM bIsa varSa bAda phira se karkaTotpatti isakA udAharaNa hai| dUsarA yaha ki mUlasthAna ke sarvasAdhAraNa kozA kAlAntara meM duSThaarbudika kozAoM meM pariNata ho jA sakate haiM jisake kAraNa mUlasthAna meM hI punaH eka navIna duSTa arbuda kI utpatti ho sakatI hai| (4) yaha niyama hai ki duSTaarbuda kI vRddhi bahuta zIghratA se ho / vRddhi kA artha hai kozAoM kA vibhajana jaldI-jaldI ho / sAdhAraNa arbudoM meM kozAvibhajana yA sUtribhAjanA hotI huI saralatA se dekhI jAtI hai| eka eka kozA 2,3 tathA 4 bhAgoM taka meM baMTa jAtA hai| nyaSTi ke ye 2,3 yA 4 Tukar3e jo hote haiM ve eka barAbara ke nahIM hote isI kAraNa duSTa arbuda kozAoM kI nyaSTiyA~ bahurUpIya aura bahvAkArI dekhI jAtI haiM jaba ki sAdhAraNa arbuda ke kAzAoM kI nyaSTiyA~ ekarUpIya tathA ekAkArI hotI haiN| ye nyaSTiyA~ abhiraMjana karane para gaharA raMga letI haiM ( hyperchromasia-paramavarNikatA ) / sAdhAraNa autakIya chedoM ( sections ) ko aNvIkSa yantra ke nIce rakhane para jo kozA citra dekhA jAtA hai vaisA duSTa arbuda ke chedoM meM nahIM miltaa| 57, 58 vi0 For Private and Personal Use Only

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674 vikRtivijJAna duSTa abuMdoM meM apane kozAoM ke binA kisI niyama meM ba~dhe hue punarjanana karane kI aparimita zakti hotI hai| yaha punarjanana yA praguNana sUtribhAjanA ( mitosis ) ke dvArA sampanna hotA hai| jaisA ki Upara kahA hai tathA asUtribhAjanA ( amitosis ) dvArA bhI hotA hai| sUtribhAjana rUpa ( mitotic figures ) sadaiva eka se nahIM hote unameM kitanI hI aura kaI prakAra kI viSamatAe~ tathA aniyamatAe~ dekhI jAtI haiN| ve bahuta adhika visthApita (disorientated ) hote haiN| unake pitryasUtra (chromosomes ) saMkhyA aura AkRti donoM kI dRSTi se viSama hote haiN| unakI lambAI kahIM kama kahIM adhika hotI hai, unakI AkRti vicitra hotI hai, kahIM ve aMzataH jur3e hote haiM tathA kahIM aNDAkAra puMja ke rUpa meM dekhe jAte haiN| sAdhAraNa dvilAMgUlIya sUtribhAjanA ( bipolar mitosis) na hokara jisameM do tArAkendra dekhe jAte haiM, sUtribhAjanA bahulAMgUlIya ( multipolar ) hotI hai jisameM tIna yA adhika tArAkendra rahate haiN| ____jo duSTa arbuda bar3e druta vega se bar3hate haiM unameM asUtribhAjanA ( amitosis) hotI huI dekhI jAtI hai| isameM nyaSTi kA vibhajana ho jAtA hai| parantu kozAprarasa ( cytoplasm ) kA vibhajana nahIM hotA jisake kAraNa pRthaka-pRthak aneka kozA na dIkha kara eka hI kozA meM bahuta sI nyaSTiyA~ dekhI jAyA karatI haiN| ghAtaka mAMsArbuda jise hamane saMkaTArbuda ( sarcoma) kaha kara pukArA hai isa asUtribhAjanA kA mahattvapUrNa udAharaNa hai| duSTa arbudoM meM sUtribhAjana-kriyA kA pratyakSa darzana hotA hai| parantu isakA yaha artha nahIM ki jitane hI adhika sUtribhAjita kozA dekhe jAveMge arbuda kI duSTatA bhI utanI hI bar3ha jaavegii| kyoMki druta vibhajana to kaNana uti meM bhI hotA hai, anya punarjanita Uti meM bhI sUtribhAjanA dekhI jA sakatI hai| (5) duSTa arbuda uttarajAta vRddhiyA~ ( secondary growths ) utpanna karate haiM jinheM visthAya ( metastases ) kahate haiN| ye visthAya lasagranthiyoM meM utpanna hote haiM tathA dUrastha aMgoM meM dekhe jAte haiN| koI-koI duSTa arbuda (jaise zleSArbuda) koI bhI visthAya utpanna nahIM krtaa| (6) duSTa arbuda se yaha kadApi sambhava nahIM ki vaha jisa uti meM utpanna hotA usa Uti kI racanA kI punarutpatti kara sake / jitanA hI vaha isameM asamartha rahatA hai utanA hI aghaTita (anaplastic) yA avibhinita (undifferentisted ) arbuda hotA hai aura utanI hI ghAtakatA yA mArAtmakatA ( malignancy ) usameM pAI jAtI hai| ___isake viparIta eka sAdhAraNa yA mRdu arbuda granthIya yA anya racanAoM ko pUrNataH utpanna kara detA hai arthAt yahA~ vibhinnana pUrNa hotA hai| jaba kozA apane samIpa ke aMgoM ke kozAoM ke sAtha svAbhAvika sambandha banAe rakhane meM asamartha ho jAte haiM to isa sthiti ko dhruvitA kA abhAva ( loss of polarity ) kahA jAtA hai| For Private and Personal Use Only

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arbuda prakaraNa 675 . racanA meM vibhinnana kI apUrNatA ke kAraNa duSTa arbudoM meM kozAoM kI kriyA zakti ( functional activity ) kama ho jAtI hai| sAtha hI anRju vRddhi jo unameM nirantara calatI rahatI hai usakA una para Adhipatya ho jAtA hai| yadyapi uti ke kozAoM ke rUpa ke lagabhaga samAna rUpa vAle ye duSTArbudika kozA banate haiM parantu ati kozA ke svAbhAvika svarUpa se ve bahuta nIce hote haiN| duSTa arbudIya kozAoM meM Apasa meM mila jAne kI eka pravRtti bahuta pAI jAtI hai jisake kAraNa ve apanA vyaktitva taka kho baiThate haiN| aisA lagatA hai mAno ki prarasa kI eka saMkozIya cAdara ( syncitial sheet ) bana gaI ho jisameM aneka nyaSTiyA~ chAI huI hoN| isake hI kAraNa unakI kriyAzakti naSTa huI dekhI jAtI hai| kucha duSTa koSThIya abuMdoM meM saMkozIya cAdara se kalikAsama prakSepa ( bud like projections ) nikalate hue dekhe jAte haiM jo iGgita karate haiM ki arbuda kI vRddhi meM kozIya pragugana ke atirikta kozIya pravrajana ( cell migration ) bhI Avazyaka hotA hai / racanA aura vinyAsa kI dRSTi se kozAoM meM jitanA hI svAbhAvika sthiti kI apekSA adhika hAsa dekhA jAvegA utanA hI dauSTaya unameM adhika hogaa| sAdhAraNa aura duSTa ina do rUpoM meM abUMdoM kI gaNanA karanA pUrNataH sveccha (arbitrary ) hai / kyoMki kucha aise bhI arbuda hote haiM jinheM na to hama sAdhAraNa hI kaha sakate haiM aura na duSTa hii| nidAna yA autikIya sahAyatA donoM meM se kisI ke dvArA bhI unheM hama ina do meM se kisI meM rakhane meM asamartha ho jAte haiN| isIlie grIna kA kathana hai ki sAdhAraNa aura duSTa arbudoM ke bIca meM koI eka rekhA nahIM khIMcI jA sktii| zleSArbuda eka sAdhAraNa abuMda hai parantu vaha prAvarayukta nahIM hotaa| kRntakavaNa eka duSTa vRddhi hai parantu vaha granthiyoM meM yA kahIM anya bhAgoM meM uttarajAta vRddhiyA~ utpanna na kara kevala sthAnika bhAga meM antarAbharaNa karatI hai| aGkurArbuda, granthyabuMda, tathA tantupezyarbuda pahale sAdhAraNa arbuda ke rUpa meM utpanna hote haiM parantu kAlAntara meM ve duSTa vRddhiyoM meM pariNata ho jAte haiM / kisI arbuda kI duSTatA nizcita karane ke lie kevala usakI autikI ( histology ) yA kozA-vinyAsa (arrangement of cells) kA vicAra karanA mAtra hI Avazyaka nahIM honA cAhie api tu usakI kauzikI ( cytology ) ko bhI jAnanA Avazyaka hotA hai| isakA artha yaha hai ki kozA kA lakSaNa, usakI nyaSTi tathA ninyaSTi ( nucleolus ) kI prakRti kA paricaya bhI atyAvazyaka hotA hai| kozA kA atyadhika mahatvapUrNa kArya hai apanI probhUjinoM kI punarutpatti karanA / yaha kriyA nyaSTi sampAdita karatI hai / nyaSTi meM bhI jise abhivarNi (chromatin ) kahate haiM usameM nihita nyaSTipobhUjina ( nucleo-protein ) yaha kArya karatI haiN| pArajambu raMgAvalIkSA (ultraviolets pectroscopy ) dvArA dekhA gayA hai ki karkaTa kozAoM meM yaha kriyA bar3I tejI se calatI hai| karkaTa meM kozAvibhajana kriyA kI gati kI vRddhi kA kAraNa sambhavataH nyaSTikAmla cayApacaya For Private and Personal Use Only

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676 vikRtivijJAna ( nucleic acid metabolism ) kA vikSobha hai jisake kAraNa pitryasUtroM kI anRju kriyA prArambha ho jAtI hai| kadAcit reDiyama eksare kI kiraNoM ke prayoga se yaha kriyA banda ho jAtI hai jisake kAraNa karkaTa kozA mara jAte haiN| ___ duSTa nyaSTi sadaiva bar3I hotI hai, paramavarNika (hyperchromic) hotI hai, usakI jAlikA sthUla ( coarse * network ) hotI hai, AkRti meM bahuta bhinnatA hotI hai tathA utkendrita (eccentric) hotI hai / aNubhasmIkaraNa (micro-incineration) kI vidhi se jalA dene para eka duSTa arbudIya kozA kI nyaSTi meM nirIndriya padArthoM kI mAtrA ( inorganic contents ) svAbhAvika nyaSTi kI mAtrA se adhika dekhI gaI haiM / aisA kaithI, skATa tathA hauniMga kA mata hai|| maikkArthI kA kathana hai ki eka duSTa kozA meM sarvAdhika mahatva kI vastu hotI hai ninyaSTi ( nucleolus ), yaha ninyaSTi nyaSTi ke anupAta se bhI bar3e AkAra kI dekhI jAtI hai aura isake cAroM ora eka prabhAmaNDala ( halo ) hotA hai| itanI bar3I ninyaSTi na to svAbhAvika kozA meM hotI hai aura na sAdhAraNa arbudika kozA meM pAI jAtI hai| bvAyaDa kA kathana hai ki ye kauzikIya parivartana jame hue adRDha chedoM ( frozen unfixed sections ) meM pAye jAte haiN| AIpaTTiyoM ( wet films ) meM jinheM turata hI sthira karake abhivarNita kara diyA gayA ho vahA~ dekhe jAte haiN| gIlI paTTiyoM meM bahunyaSTi kozA aura mahAkozA jitanI saralatA se dekhe jAte haiM ve mRdvasA chedoM (parafin sections) meM nahIM pAye jaate| yaha saba karkaTa kozAoM ke liya satya hai kintu saMkaTa kozAoM ke lie nhiiN| arbuda-dauSTaya kI aMzAMza kalpanA eka arbuda meM kitane hI aMza meM dauSTaya dekhA jA sakatA hai| aNvIkSa kI sahAyatA se adhika duSTa arbuda kA jJAna jitanI saralatA se lagAyA jA sakatA hai utanI saralatA se alpa duSTa arbuda ko pahacAnane paryApta kaThinatA dekhI jAtI hai / vaha duSTa hai yA nahIM ise kahanA bhI bar3A kaThina hotA hai| parantu kitane aMza meM kauna abuMda duSTa hai ise jAnanA paramAvazyaka hai kyoMki usI ke AdhAra para cikitsaka arbuda kI sAdhyAsAdhyatA kA nizcaya karatA hai aura cikitsA kI saphalatA vA asaphalatA kI ghoSaNA karatA hai| isalie abuMdoM kI aMzAMza kalpanA (grading of tumours ) kA jJAna bahuta upAdeya vastu hai| bauDarsa ne sAdhyAsAdhyatA tathA pratyakSa dauSTaya ke AdhAra para arbudoM ko cAra vargoM meM vibhAjita kiyA hai| prathama varga ke arbuda alpatama duSTa ( least malignant ) hote haiN| caturtha varga ke arbuda adhikatama duSTa mAne jAte haiN| varga dvitIya aura tRtIya madhyavartI varga haiN| ye varga arbuda kI saMracanA ko dhyAna meM rakhate hue kie gaye haiN| vargIkaraNa (aMzAMza kalpanA) karate samaya 3 bAtoM kA pramukhatayA vicAra kiyA gayA hai 1-vibhinnana kI anupasthiti yA aghaTanatA ( anaplasia ), 2-paramavarNatA ( hyperchromatism ), tathA For Private and Personal Use Only

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arbuda prakaraNa 677 3-sUtribhAjanAMkoM kI saMkhyA ( the number of mitotic figures) ____ hama Age cAroM vargoM ke citra upasthita kara rahe haiN| ye citra spaSTataH pratyeka varga kI viziSTatA ko sthApita karate haiN| citra dekhane se yaha bhI patA cala jAtA hai ki jo arbuda prathama varga meM hai vaha susAdhya hai, dvitIya varga arbuda sAdhya hai, tRtIya varga kA arbuda kaSTa sAdhya hai tathA caturthavargastha pUrNataH asAdhya hai| prathama dvitIya varga vAle arbudoM meM zastrakarmAdi cikitsA se lAbha hone kI AzA hai jaba ki zeSa do vargoM meM nirAzA adhika hai| ye aMzAMza kalpanA cikitsA aura sAdhyAsAdhyatA (2) kI dRSTi se hI mahattva rakhatI haiN| vaikArikIdRSTayA inakA koI mahatva vizeSa nahIM hai| sAtha hI jahA~ yaha vargIkaraNa tvacA aura guda pradeza ke karkaToM meM spaSTataH milatA hai vakSa tathA garbhAzayagrIvA ke karkaToM meM aspaSTa hotA hai| duSTa kAlyarbudoM ( melanomas ) meM bhI isakA koI upayoga nahIM dekhA jaataa| kyoMki hama aNvIkSa ke nIce arbudIya cheda kA adhyayana karake hI varNa vinizcaya karate haiM aura cUMki eka arbuda saba sthAnoM para eka barAbara duSTa nahIM hotA na usakI duSTatA kA vikAsa saba sthAnoM meM eka sAtha hotA hai ataH alpa duSTa sthala kA cheda usa arbuda ko prathama do vargoM meM tathA atiduSTa sthala kA cheda ( sec. tion ) use antima do vargoM meM rakha sakatA hai isa prakAra chedoM se bhrAmakatA kI vRddhi hI hotI hai| isalie aNvIkSa yantra se prApta pariNAma ko pratyakSa naidAnikIya parIkSaNa kI kasauTI para bhale prakAra kasa kara taba Age bar3hanA caahie| isa aMzAMza kalpanA kI mahattA ko kama karate hue bvAyaDa likhatA hai: "The clinician must not take grading too seriously, but must consider the age of the patient, the extent of the disease, its duration, its rate of growth, and most important of all, involvement of lymph nodes.' ___ arthAt cikitsaka ko arbuda dauSTaya kI aMzAMza kalpanA ko hI saba kucha mAna kara nahIM calanA cAhie api tu, rogI kI vaya, roga kA vistAra, roga kA kAla, arbuda vRddhi kI gati kA pUrNataH vicAra karanA cAhie aura sAtha hI sarvAdhika mahatvapUrNa lasa granthiyoM kI prastatA kitanI ho cukI hai ise samajhanA caahie| isa dRSTi se brADarsa dvArA upasthita kiyA huA yaha vargIkaraNa sAdhyAsAdhyatA ke lie koI sahAyatA nahIM detA hai aura na yaha isakI upayogitA bhI hai| isa vargIkaraNa ke dvArA tejAnuhRSatA ( radio--sensitivity ) kA jJAna hotA hai / arthAt arbuda para reDiyo kriyA kitanI kI jA sakatI hai| isa dRSTi se yaha cikitsA kaisI yA kitanI ho isa ora iGgita karatA hai na ki sAdhyAsAdhyatA kI ora / arbuda prabhAva arbuda kA prabhAva sthAnika aura sarvAGgINa donoM prakAra kA par3A karatA hai| arbuda For Private and Personal Use Only

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678 vikRtivijJAna kI vRddhi, usakI sthiti, usakA sAmAnyana (generalisation ) tathA usake uttarajAta parivartana Adi usake dvArA utpanna prabhAvoM ke kAraka hote haiN| sthAnika vRddhi ke kAraNa usa sthAnavizeSa para eka anAvazyaka bojha par3a jAtA hai jo nirantara bar3hatA rahatA hai isa bojha ke kAraNa kaI jIvana ke lie atyadhika Avazyaka bhAga bhI daba jAte haiM aura aparimita hAni ho jAtI hai| mastiSka meM hone vAle sAdhAraNa arbuda bhI isI kAraNa ghAtaka hote hue pAye jAte haiN| uSNISaka (pons) yA prANagranthi yA suSumnAzIrSastha arbuda kitane ghAtaka hote haiM isase cikitsaka samAja aparicita nahIM hai| yaha bojha kabhI-kabhI mahattvapUrNa aMgoM kI kriyA roka detA hai| phuphphusa yA AmAzaya kI kriyA meM vighna honA unake arbudoM ke kAraNa svAbhAvika hai| kabhI-kabhI jaba arbuda suSira ( hollow ) aMgoM meM hote haiM to unheM bhara dete haiN| yadi annavahanalikA ( oesophagus) meM arbuda ho gayA aura usake supiraka ko bhara diyA to phira anna kA AmAzaya meM jAnA asambhava ho jAtA hai aura rogI bhUkha se tar3apa kara mara jAtA hai| duSTa arbudoM kI eka kriyA kA nAma hai UtiyoM kA aparadana ( erosion of the tissues ) yaha aparadana yA vinAza sthAna vizeSa para arbuda kA bojha par3ane se athavA vahA~ rasapUrti banda kara dene se hotA hai yadi kisI kSudravAhinI kA aparadana prArambha ho gayA to vahA~ se rakta cUne lagatA hai| yadi kisI bar3I vAhinI meM vidAra bana gayA to adhika raktasrAva hotA hai| alpa raktacyAva dvArA zarIra durbala ho jAtA hai tathA zarIra meM alparaktatA (anaemia) ho jAtI hai tathA raktasrAva atyadhika durbala kara detA hai tathA zIghra mRtyu kA kAraNa banatA hai / vRkka yA mUtrapiNDastha arbuda ke kAraNa rakkameha ( haematuria) kA honA raktacyAva kA eka udAharaNa hai| garbhAzaya se raktasrAva cAhe jaba hone kA spaSTa artha yahI hai ki vahA~ koI arbuda aparadana kArya kara rahA hai| isI prakAra AmAzaya meM karkaTa hone se raktavamana kA honA tathA Antra meM karkaTopasthiti ke kAraNa jIvarakta kA mala ke sAtha dekhA jAnA milatA hai| jaba koI sudhira aMga arbuda ke kAraNa bhara jAtA hai to usakA prArambhika bhAga visphArita ho jAtA hai / AmAzaya, sAmAnya pitta praNAlI tathA mastiSkIya nilayoM kA atyadhika visphAra isI kAraNa hotA hai| arbudoM meM jahA~ raktasrAva aura vana calatA rahatA hai vahA~ upasarga (infection) kA laganA koI kaThina bAta nahIM hai| jisa prakAra kA upasarga lagatA hai usI prakAra ke lakSaNa zarIra meM dekhe jA sakate haiN| saMtApAdhikya upasarga ke kAraNa hI hotA hai| ___ arbuda ke bhAra ke kAraNa sthAnika zUla kA honA bhI asvAbhAvika nahIM hai sAdhAraNa abudoM meM jahA~ vaha kama hotA hai duSTa arbudoM meM vaha vizeSa dekhA jA sakatA hai| __ abuMda kI upasthiti mana kI sthiti para bahuta kharAba prabhAva DAlatI hai| hara samaya cintA kA honA tathA usake kAraNa bhUkha aura nidrA kI kamI se rogI kA sUkhate cale jAnA nitya dekhane meM AtA hai| For Private and Personal Use Only

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arbuda prakaraNa 66 buMda ke kAraNa mRtyu kaI hetuoM se huA karatI hai| marma pradeza meM arbuda kA honA eka kAraNa hai| arbuda meM pUyA ( sepsis) dUsarA kAraNa hai, raktasrAva tIsarA kAraNa hai, araktatA aura mAnasika kAraNajanya daurbalya ke sAtha upasarga Adi anya kAraNa hai| duSTa arbudoM meM duHsvAsthya ( chachexia) ke mAnasika hetuoM ke atirikta jvara, tathA arbudoM ke dvArA utpanna viSAkta padArthoM kA rakta meM saMbhramaNa bhI mahattva kA hetu hai| karkaTotpatti ( Carcinogenesis) zIrSaka karkaTotpatti hote hue bhI hama yahA~ sampUrNa duSTa arbudoM kI utpatti para saMkSiptataH vicAra kreNge| karkaTa kI utpatti kA mUlabhUta aura mahatvapUrNa hetu kyA hai yaha Aja bhI eka rahasya banA huA hai| jo vyakti isa hetu kA patA lagAvegA use karoDoM rupaye puraskAra svarUpa prApta ho sakeMge tathA vaha mAnavajAti kA aparimita upakAra kara sakegA isameM koI sandeha nahIM hai| abhI taka deza videza meM jo khojeM huI haiM unake AdhAra para jo kucha prApta ho sakA hai use hI hama mukhya sAmagrI mAna kara isa viSaya kA uhApoha kara rahe haiN| hogA koI bhAratIya jo karkaTotpatti kI samasyA ko pUrNataH sulajhAkara bhArata kA bhAla saMsAra ke samakSa U~cA kara sake ? ___ prAthamika karkaTa yadi kisI eka stanI jIva ( mammal ) ko ho jAve aura phira sarjana usakA kucha bhAga kATa kara kisI dUsare jIva meM Aropita (graft ) kara de to yaha dekhA gayA hai ki jisa prANI kA ropaNa hai vaha usI varga ke dUsare prANI meM hI Aropita hotA hai anya dUsare kisI bhI prANI meM nahIM hotA cAhe vaha stanI hI kyoM na ho| ise yoM samajhA jA sakatA hai ki yadi kisI zazaka ko kisI sthAna para karkaTa huA to isa karkaTa kA AropaNa kevala dUsare zazaka meM hI sambhava abhI taka ho sakA hai kisI mUSaka yA anya jIva meM nhiiN| jisa prANI meM karkaTa kA isa prakAra AropaNa huA karatA hai usameM ropaNa ke kAraNa jo karkaTa utpanna hotA hai usako kATa kara tIsare prANI meM ropita kara sakate haiM tIsare se cauthe aura cauthe se pA~caveM meM isa prakAra yaha ropaNI kriyA varSoM cala sakatI hai| mUla karkaTa meM jisa prakAra ke kozA hote haiM pratyeka ropaNa meM usI prakAra ke kozA praguNita hote haiM aura phira cAhe ropaNa pA~caveM prANI meM yA pA~cavIM pIr3hI meM hI kyoM na cala rahA ho kozAoM kI prakRti kadApi nahIM badalA karatI hai / isa prakAra Aropita kisI karkaTa kI Uti ko saralatApUrvaka parakhanalI meM jIvita rakhA jA sakatA hai aura varSoM bAda unheM usI jAti ke prANI meM punaH Aropita kiyA jA sakatA hai| isI kAraNa karkaTa kozAoM ko amara mAnA jAtA hai / parantu prANiyoM ke Upara kie gaye ina ropaNoM ke prayogoM ne isa prazna kA koI samAdhAnakAraka uttara abhI taka prastuta nahIM kiyA ki mAnava zarIra meM eka sAdhAraNa kozA karkaTa kozA yA duSTa kozA meM kyoM kara pariNata ho jAtA hai aura phira vaha sadaiva usI rUpa meM kaise rahA AtA hai ? For Private and Personal Use Only

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650 vikRtivijJAna svAbhAvika zArIrika kozAoM ke duSTa kozAoM meM pariNata hone ke sambandha meM vibhinna samaya para vibhinna vidvAnoM dvArA pRthak pRthak kAraNa diye gaye haiM unakA vicAra karane ke pUrva duSTa kozAoM ke sambandha meM kucha spaSTa spaSTa tathya haiM unheM hama prakAzita karate haiM / Acharya Shri Kailassagarsuri Gyanmandir ( ka ) prakRta kozA rUpI samAja meM duSTa kozA 'vidrohI sadasya' rUpa meM sthita rahate haiM ye prArambha meM anya kozAoM ke sahayoga se bar3hate hue akasmAt virodha Arambha kara dete haiM aura unakI pravRtti racanAtmaka ( constructive ) se vinAzAtmaka (destructive ) ho jAtI hai / (kha) zarIra meM adhicchadIya kozA, antazchadIya kozA, tathA saMyojI UtikozA svabhAva se hI zIghra praguNita hone kI kSamatA rakhate haiM zeSa zArIrika kozA dhIre-dhIre praguNana karake apanI kalevara vRddhi karate haiN| zIghra praguNana kartA tInoM prakAra ke kozAoM meM hI duSTi prAyaH Arambha hotI hai zeSa duSTa nahIM banA karate / ( ga ) duSTatA kA artha zIghrAtizIghra apanI kalevara vRddhi karanA nahIM huA karatA, apitu svAbhAvika vA prakRta kozAoM ke jIvana ke mUlya para apane ko jIvita rakhanA yahI duSTa kozAoM kI pravRtti rahatI hai / (gha) prakRta kozA jitane svAbhAvika rUpa se eka dUsare se saMyojita hokara apanI Uti kA nirmANa karate haiM utane hI asvAbhAvika rUpa meM duSTa kozA apanA abhinaya karate haiM jisake kAraNa ye saralatA se apane sthAna para vRddhi karate haiM aura saralatApUrvaka hI raktavahAoM aura lasavahAoM dvArA zarIra ke anya bhAgoM pahu~ca jAte haiM / (Ga) jina dUsare sthAnoM para duSTa kozA jAte haiM ve vahA~ vaisI hI duSTa vRddhi karate haiM / yaha isa prakAra hotA hai jaise ki kheta meM bIja jaisA DAlA jAyagA vaisA hI phala uga AvegA / (ca) Upara hamane batalAyA hai ki duSTa kozA eka prANI se dUsare meM aura dUsare se tIsare meM saralatA se ropita kie jA sakate haiM / parantu usI Uti ke svAbhAvika kozAoM kA aisA ropaNa kadApi sambhava nahIM huA karatA / (cha) duSTa kozA jisa Uti meM utpanna hote haiM usako apane bhAra se dabA kara naSTa karate haiM tathA pratyakSa UtibhakSaNa bhI dekhA gayA hai jo batalAtA hai ki ve svAbhAvika kozAoM ke vinAza ke lie bhI sajaga tathA sannaddha rahate haiM / aba hama Age karkaTotpatti ke sambandha meM pracalita vAdoM ( theories and hypotheses ) ko likhate haiM usake pazcAt karkaTa para huI khojoM ke AdhAra para prApta tathyoM ko upasthita kareMge vAlDeyara tathA thI-vAlDeyara aura thIrza ne yaha mata vyakta kiyA hai ki zarIra meM adhicchadrIya tathA saMyojI ina do prakAra kI UtiyoM meM eka prakAra kI samatolasthiti ( equilibrium ) rahA karatI hai| isake kAraNa eka bhI Uti yadi adhika praguNita hone kA yatna karatI hai to use dUsarI niyantrita kara detI hai / jyoM For Private and Personal Use Only

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arbuda prakaraNa 681 jyo avasthA bar3hatI jAtI hai yaha niyantraNa DhIlA par3atA jAtA hai aura adhicchadIya uti adhika praguNita hokara karkaTotpatti kara detI hai| isa mata ke mAnane meM kaI ApattiyA~ haiM jo isa prakAra haiM: (1) eka uti para dUsarI Uti kA niyantraNa ho isakA koI pratyakSa pramANa nahIM hai| (2) yadi niyantraNa mAna bhI liyA jAve aura vaha eka ati dvArA kama hotA jAve to dUsarI Uti meM eka dama aneka arbuda eka hI sthAna para utpanna hone cAhie para dekhA yaha gayA hai ki eka sthAna para eka hI arbuda utpanna hotA hai| (3) niyantraNa ghaTane para adhicchadIya Uti meM pratyeka sthAna para eka hI kAla meM karkaTotpatti nahIM dekhI jaatii| (4) eka hI avasthA ke do vyaktiyoM meM karkaTotpatti kA sthAna eka nahIM rhtaa| (5) yaha vAda saMkaTAbaMdotpatti para koI prakAza nahIM ddaaltaa| konahIma-konahIma kA kathana hai ki garbhAvasthA meM bhrUNa ke zarIra meM kucha bhauNakozA ( embryonic cells ) zarIra kI vibhinna kozAoM meM zrauNAvasthA meM ho raha jAte haiM pUrNa paripakka nahIM ho paate| bhrauNa kozAoM kI vRtti sadaiva praguNAtmaka hotI hai| Age bhaviSya meM aise kozA sakriya ho uThate haiM aura jisa prakAra ke ve hote haiM usI prakAra ke arbudoM ko janma dete haiN| isa vAda ke virodha meM sabase bar3A pramANa yaha hai ki bahuta chAnabIna karane para bhI aNvIkSa yantra ina bhrauNakozAoM kA patA lagAne meM asamartha rahA hai| abhI taka kisI bhI autikIvettA ne ina bhrauNakozAoM kA varNana nahIM kiyA / ribbarTa-ribbarTa ne apanA jo mata vyakta kiyA hai vaha vAlDeyara-thIrza tathA konahIma donoM ke matoM kA saMmizraNa mAtra hai| vaha kahatA hai ki UtiyoM meM paraspara samatolasthiti bhI rahatI hai tathA unameM bhrauNakozA bhI pAye jAte haiN| jaba yaha samatolasthiti bigar3atI hai bhrauNakozA uttejita ho jAte haiM aura abuMdotpatti kara dete haiM / phakkaroga ( rickets) dvArA utpanna kAsthIya arbudoM kI utpatti ke hetu ke sambandha meM to kucha sahAyatA milatI hai para anya arbudoM ke lie isa mata kA koI upayoga nahIM hai aisA kahA jAtA hai| antarAveza vAda-eka prakAra kI Uti meM dUsare prakAra kI Uti ke kozAoM kA antarAveza ( inclusicn ) hone se kucha arbuda bana jAte haiN| zrauNArbuda ( teratomas ) isakA udAharaNa hai| yaha satya hai ki bhrauNArbuda ke lie yaha vAda satya ho parantu arbuda kI sarvasAmAnya utpatti kA hetu ise kaise ghoSita kiyA jA sakatA hai ? zrauNArbuda ke sambandha meM bhI navIna khojoM ke anusAra aura bhI adhika dRDha aura santoSajanaka spaSTIkaraNa ho cukA hai jise hama Age prakaTa kreNge| haujamaina haujamaina ke dvArA vyakta mata, arbudotpatti kI vAstavika kalpanA na hokara vividha arbudoM kI kozIya AkRtiyoM kI prakRta racanAoM se pRthakatA prakaTa For Private and Personal Use Only

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682 vikRtivijJAna karane vAlA vaktavya mAtra kahA jA sakatA hai| mata yaha hai ki eka prauDha meM zArIrika kozA kabhI-kabhI apanI bhauNa prakRti (embryonic characteristics ) meM pariNata ho jAte haiM / yaha parivartana unake praguNana ( multiplication ) se adhika sambandhita hotA hai| isake pariNAmasvarUpa kozA-vibhajana ke samaya jo nava kozA banate haiM ve praur3ha na banakara zroNa prakAra ke adhika hote haiN| jaba kozAoM meM thor3I bhrauNatA A jAtI hai to agalI pIDhiyoM meM vaha aura bhI bar3hatI calatI hai isakA pariNAma anaghaTana yA acaya ( anaplasia ) meM hotA hai jisake kAraNa kozA jati ke lie Avazyaka prakAra ke na hokara adhika pUrvajasama ( primitive ) ho jAte haiN| jitanA hI anaghaTana adhika hotA hai arbuda dauSTya utanA hI adhika dekhA jAtA hai| parajIvavAda-aisA kucha logoM kA mata pratyeka kAla meM rahA hai ki arbuda nirmANa kA kartA koI parajIva ( rarasite ) hai| para yaha bhrAnti Aja samUla naSTa ho cukI hai| jinakA yaha vicAra rahA hai ki yaha kisI viSANu ( virus ) dvArA utpanna hotA hai vaha bhI adhika satyatAyukta nahIM pragaTa ho rahA hai| prAyogika karkaTa gavepaNA karkaTa kI gaveSaNA ( research ) ke lie kaI dizAoM meM prayoga ( experiments ) kiye gaye haiM unase koI saMtoSajanaka hala nikalA so bAta nahIM hai phira bhI adhyayana vRddhi ke nimitta hama yahA~ inakA ullekha jaisA jauna pAlIvara ne kiyA hai karate haiM prANiyoM para prayoga-prANiyoM meM duSTa roga ( malignant disease ) bahuta kama hote haiM tathA manuSyoM ke duSTArbudoM ko prANiyoM meM ugAnA atyadhika kaThina yA asambhava vastu hai isa kAraNa prANiyoM para prayoga karate hue karkaTotpatti kA jJAna prApta karanA bahuta kaThina ho gayA hai| tuda prANiyoM meM jo kucha prakAra ke arbuda pAye jAte haiM unhIM ke bala para thor3I bahuta sahAyatA ina prANiyoM se milatI hai phira bhI ina prANiyoM se jo kucha prApta hotA hai vaha kama mahattva kA nahIM hai| jainasana dvArA yaha tathya prakAza meM AyA hai ki eka prANI ke arbuda kozAoM kA ropaNa yadi usI varga ke prANI meM kara diyA jAve to ropita arbudIya kozAoM kA hI isa prANI meM praguNana hotA hai usa prANI kI Uti ke kozA isa praguNana meM koI bhAga nahIM lete haiN| dUsarA tathya jo prakAza meM AyA hai vaha yaha hai ropita prANI kI UtiyA~ isa ropaNa ko eka bAhya vastu (foreign body ) ke samAna samajhatI haiM jisake kAraNa isa ropa( graft ) ko haTAne ke lie bhakSikozA samIpa meM saMcita hote haiM jo kabhI-kabhI use haTAne meM samartha ho jAte haiM / rasela ne jainasana ke kArya ko Age baDhAte hue yaha siddha kiyA hai ki ropita arbu kI rakSA prANI kI utiyA~ karatI haiM aura bhakSakAyANuoM se use bacAtI haiN| ina utiyoM kI saMdhAra pratikriyA ( stroma reaction ) yadi tIba huI to arbuda baca jAtA hai para yadi yaha durvala huI to ropita arbudIya kozA zIghra naSTa ho jAte haiM / For Private and Personal Use Only

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arbuda prakaraNa 683 prakSobhaka tathA karkaTotpatti-kArakhAnoM kI cimanI svaccha karane vAle lar3akoM ko karkaTa se vyathita dekhA jAtA hai ; sUta kAtane vAloM meM bhI karkaTa dekhA jAtA hai tathA eksare kI prakSobhaka kiyA dvArA bhI karkaTa utpanna hotA hai / gaisa tAra (gas tar) yA zela taila ( shale oil ) ke kAryakartAoM meM bhI karkaTa dekhA jAtA hai| anIlIna ke raMgoM ke kAragharoM meM kAma karane vAloM meM bhI duSTa vRddhi dekhI jAtI hai| phIbIgara ne yaha siddha kiyA hai ki yadi tailacora ( cockrcach ) nAmaka jIva ko sUtrakRmiyoM dvArA upasRSTa karake unheM cUhoM ko khilAte rahA jAve to unake AmAzaya meM karkaTa utpanna ho jAyA karatA hai| jApAnI vidvAnoM meM yAmAgIvA, icIkovA tathA sutsuI ne dekhA hai ki yadi zazaka kI vA mUSaka tvacA ko kezarahita karake usa para tArakola barAbara kaI mahIne potA jAya to unakI tvacA meM karkaTotpatti ho jAtI hai| yaha saba batalAte haiM ki aMgoM para prakSobhaka kA satata AghAta hote rahane se bhI karkaTotpatti ho sakatI hai| pratIkAritAjanya prayoga-prANI karkaTa ke prati itanI adhika pratikAritA apane zarIra meM rakhatA hai ki karkaTa kA ropa bahudhA karkaTotpatti meM asamartha rahatA hai| yaha svAbhAvika pratIkAritA hotI hai yA avApta yaha kahanA kaThina hotA hai| parantu yaha rahatI DaTa kara hai| parantu pratIkAritAjanya prayogoM ke dvArA karkaTotpatti ke kAraNoM para koI prakAza nahIM pdd'taa| __ abaMda aura pAvita prayoga-peTana rUsa ne yaha siddha kiyA hai ki kucha viziSTa saMkaTArbuda pakSiyoM meM na kevala ropaNa dvArA hI utpanna kie jA sakate haiM api tu kozA virahita pAvita ( cellfree filtrates ) bhI unheM utpanna kara sakate haiN| jaisI isa prayoga se AzA thI vaisA isake dvArA duSTa arbudotpatti ke sambandha koI vizeSa hetu nahIM prakaTa ho sakA kyoMki kucha khAsa arbuda hI pAvitoM dvArA utpanna ho sakate haiN| viSANu upasarga-gAI aura baranArDa ne 1925 I0 meM apane prayogoM dvArA yaha siddha kiyA ki arbudotpatti meM 2 abhikartA kAraNa bhUta hote haiN| eka abhikartA ( agent ) eka prakAra kA sajIva viSANu hotA hai jo saba prakAra ke arbudoM meM pAyA jAtA hai tathA dUsarA abhikartA eka rAsAyanika padArtha hotA hai jo vibhinna arbudoM meM vibhinna prakAra kA hotA hai| unake ina prayogoM kI abhI taka puSTi ( confirm. ation ) nahIM ho sakA hai| nyAsarga-nyAsoM ( hormores ) ke dvArA duSTa abudoM kI utpatti honA siddha nahIM ho skaa| yaha ho sakatA hai ki ve kisI anya kAraka ko uttejanA dekara yaha kriyA karAte hoN| strImadi ( Oestrin ) ke kAraNa vakSa tathA garbhAzaya donoM meM vRddhi hone lagatI hai isa kAraNa yaha tathA anya nyAsarga arbudakAraka hoMge aisI kalpanA calatI rahI hai| para bahuta adhika mAtrA meM bhI inakA upayoga karane ke pazcAt arbuda utpanna hote hue nahIM pAye gye| For Private and Personal Use Only

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684 vikRtivijJAna sAMparIkSa bhrauNikI-sAMparIkSa bhrauNikI (experimental embryology) ke dvArA bahvabuMdIya sahalakSaNoM ( multiple tumour syndromes ) kA spaSTIkaraNa ho jAtA hai| hainsaspaimaina ne 1919 I0 meM eka saMghaTanakendra (organisation centre ) kI ghoSaNA kI thii| yaha kendra syUtIyabhrUNAvasthA (gastrular stage ) meM Adyantra mukha ke pazcaoSTha para sthita hotA hai| yaha kendra vAtika ( caita ) prasItA ( neural groove ), pRSTa meru ( notochord ) aura tanukhaNDakoM ke nirmANa ke lie uttaradAyI hotA hai jo bhrUNa ke bahiHstara ( ectoderm ) kI uttejanA dvArA banAye jAte haiN| ___ mahattva kI bAta isa prayoga se yaha nikalatI hai ki yadi, isa kendra se kucha bhI sajIva kozA kisI Uti ke dvArA Aropita ho sake to eka atirikta yA parajIvI vAtika akSa utpanna ho sakatA hai| yahI nahIM yadi pahale ina kozAoM ko ubAla kara mAra diyA jAve yA unakA dattu kA nissAra ( Ithariyala eksTrekTa) liyA jAve to vaha bhI vaisA hI nirmANa kreNge| isakA artha yaha hai ki yaha pratikriyA eka rAsAyanika padArtha kI upasthiti para nirbhara karatI hai jo svayaM eka prakAra kA sAndrava (sterol ) mAlUma par3atA hai| yaha eka adbhuta bAta hai ki yaha padArtha strI-puruSa nyAsarga, jIvatiktiyA~ tathA karkaTajanaka strImadi se milatA julatA hotA hai| yaha khoja navInatama ( 1936 I0) hai jise nIDhama, vaiDiMgaTana Adi vidvAnoM ne kiyA hai| cikitsAtmaka prayoga-tejAtu aura kSa-kiraNe duSTa arbuda kozAoM ke vinAza karane meM samartha hone ke kAraNa cikitsA dRSTi se prayukta hotI haiM / kaiMTI tathA DonalDasana ke prayogoM ne yaha siddha kiyA hai ki ye kiraNeM duSTa kozAoM kI vibhajana yA sUtribhAjanA ko manda kara detI haiM jisase unakA praguNana kama ho jAtA hai| adhika vikiraNa (radiation ) se anRju sUtribhAjanA ( abnormal mitosis) hone lagatI hai jo prakRta kozAoM ko bhI naSTa kara detI hai| isase lasIkozAoM kI bharamAra tathA tantUtkarSa ho sakatA hai| __ jarAyujIya Uti kA vinAza kara garbhapAta karane kI pravRtti meM dakSa hone ke kAraNa sIsa ( lead ) kA prayoga kozIya praguNana ko rokane ke lie kiyA gayA hai| akele sIsa prayoga se adhika lAbha na hote hue bhI reDiyama yA eksare ke sAtha sevana ke lie sIsa ke prayoga se paryApta lAbha dekhA gayA hai| sIsa ke dvArA AghAtaprApta kozA reDiyama yA eksare dvArA zIghra aura saralatayA naSTa ho jAte hoMge yahI isakA uttara ho sakatA hai| __ grIna ne apanI pustaka meM karkaTa janaka 4 abhikartA likhe haiM (1) bhautika abhikartA, (2) rAsAyanika abhikartA, (3) nyAsarga abhikartA tathA (4) sajIva abhikrtaa| bhautika abhikartAoM meM nimna lie gaye haiM:atyadhika zIta, atyadhika USmA, vividha vikiraNa ( various radiations ) For Private and Personal Use Only

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arbuda prakaraNa 685 arthAt adhika kAlataka kSa-kiraNoM kA prayoga, adhika kAlataka nIla lohitAtIta kiraNoM kA prayoga, athavA adhika kAla taka tejAtu kA upyog| ___ jo loga tejodgara padArthoM (radio-active) kA prayoga karate haiM jaise lar3akiyoM dvArA tejodgara peNTa kA lepana, ghaDI meM reDiyama DAyala yA anya padArtha unakA tejoddara aMza asthiyoM meM praviSTa ho jAtA hai jo kAlAntara meM asthi ke saMkaTArbuda ke rUpa meM pragaTa hotA hai| dhamaniyoM kA citra lene ke lie thoroTrAsTa ( thorotrast ) kA prayoga hotA hai yaha bhI eka tejodgara padArtha hai aura duSTavRddhi kara sakatA hai| sUrya razmiyoM ke nirantara prayoga kA zarIra para karkaTajanaka koI pariNAma nahIM hotA para prAyogika pAranIlalohita razmiyoM ke prayoga ke kAraNa zarIra meM sAndravoM ko uttejanA mila jAtI hai jo karkaTajanaka udaprAMgAroM se milate julate hote haiM aura karkaTotpatti kara sakate haiN| rAsAyanika abhikartAoM meM udaprAMgAra (hAiDrokArbansa) Ate haiM / kolatAra kA kezavirahita zazaka tvacA para nirantara prayoga tvakarkaTotpAdaka hotA hai| yaha isa tathya ko prakAza meM lAtA hai ki kolatAra meM koI aisA padArtha avazya upasthita hai jo karkaTajanaka hotA hai| Age pairAphIna Aila, zela Aila, khanija taila tathA enIlIna (vinIlI)kA tvacA para prayoga karake sAMparIkSa karkaTa utpanna karake bhI dekha lie gaye haiN| kolatAra kA kezazUnyasthalI para prayoga karate cale jAne se sarvaprathama kezoM kA utpanna honA banda ho jAtA hai| tatpazcAt adhicchadIya kozAoM meM vikSobhajanya atighaTana (aticaya) hone lagatA hai jisake nIce kI atiyoM meM golakozAoM kI bharamAra Arambha ho jAtI hai| ye parivartana pUrvakarkaTAvasthA ke usI prakAra milate haiM jisa prakAra karkaTotpatti ke pUrva mAnavazarIra meM dRSTigocara hote haiM / isake Age yadi cAra mAsa taka nirantara kolatAra kA lepa calatA rahe to adhitvacA meM camakIlavat sthaulya pragaTa hone lagatA hai| yadi lepana isI avasthA meM roka diyA jAve to eka sAdhAraNa carmakIlArbuda yA aMkurAbaMda mAtra banakara raha jaavegaa| parantu yadi aura Age kolatAra kA lepana kiyA jAtA rahA to svakarkaTa (skin cancer ) bane binA nahIM raha sakatA / tArakola ke lepana meM do bAtoM para adhika dhyAna denA hai, eka to yaha ki use kaI mAsa taka nirantara prayoga meM lAnA cAhie tathA dUsare usakA gAr3hA lepa na kara patalA-patalA lagAnA caahie| parIkSA karane para yaha bhI jJAta huA hai ki kevala adhicarma (epidermis) ke hI kozA isa lepa se prabhAvita nahIM hote api tu usake nIce kI utiyA~ bhI prabhAvagrasta ho jAtI haiN| nicarma ( dermis), pratyastha kozA, tAntavaUti kozA Adi bhI kSatigrasta ho jAne se adhicchadIya kozAoM meM vizoNatA utpanna ho jAtI hai jo yaha spaSTa karatI hai ki karkaTotpatti ke lie prabhAvita kozAoM ke Antarika cayApacaya meM eka bar3A parivartana bhI uttaradAyI hotA hai| For Private and Personal Use Only

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686 vikRtivijJAna vidvAnoM ne kolatAra kI Age khoja isalie kI ki ve usake andara nihita karkaTajanaka padArthoM kA patA lagA sakeM / kolatAra kA prabhAgazaH Asavana ( fractional distillation ) karane para unheM eka ucca karkaTajanaka padArtha dhUpAgnenya ( benzpyrene ) kA jJAna huA / Age raMgAvalIkSIya aMzana ( spectroscopic ana lysis ) karane para aneka dhUpavizrAmoM (benzanthracenes ) kA jJAna huA aura usI zrRMkhalA ke aneka aise udaprAMgAroM kA kRtrimatayA nirmANa kiyA gayA jo karkaTajanaka the / ye padArtha 3 vargoM meM vibhakta kie jA sakate haiM Acharya Shri Kailassagarsuri Gyanmandir 1. dhUpavikSAmI vyutpanna ( benzanthracene derivatives ) jinameM 50 pratizata karkaTajanaka hote haiM / 2. darzakSA meNya ( phenanthrene ) jo kucha kama karkaTajanaka hote haiM / tathA uparokta donoM vargoM ke bAhara dhUpavalayika (benozene ring) padArtha jinameM eka yA do karkaTajanaka padArtha rahate haiM / 3. dhUpenya ke 4 valaya jisa padArtha meM hote haiM vaha karkaTajanaka hotA hai yahI uparoka tInoM vargoM ke padArthoM ke parIkSaNa se jJAta huA hai / cAra valaya kA mukhya sambandha unakI karkaTakAraka zakti kI dRSTi se sAmAnya lakSaNa hai anyathA kucha bhI unameM milatA nahIM / para yaha vaktavya bhI pUrNataH satya mAnakara isalie nahIM cala sakate kyoMki vinIlI raMgoM meM kArya karane vAle zramikoM kI basti meM karkaTotpatti dekhI jAtI hai jaba ki vinIlI meM dhUpenya ke 4 valaya nahIM hote / vRjara aura ArmasTroMga ne kuttoM aura mUSakoM meM bastigata karkaTa kI utpatti kramazaH A - uttairalatikti ( Beta-naphthyla. mine ) jisameM do dhUpenya valaya hote haiM, tathA 2 zuktalatikti tarasvinI ( 2-acetylamine fluorine ) khilAkara kara cuke haiM isa dUsare padArtha meM eka bhI dhUpavalaya ( benzene ring ) nahIM hotA / ye sampUrNa karkaTajanaka padArtha jala meM avidrAvya haiM inakA tailIya yA snaihika vilayana taiyAra karanA par3atA hai / kucha dina pUrva eka paryApta karkaTotpAdakazakti sampanna 'jalavidrAvya padArtha kA patA lagA hai jise dvidhUpa vikSAmI tRNIya ( dibenzanthracene succinate ) kahate haiM / jaba ye udaprAMgAra tvacA para pralipta kara diye jAte haiM to ve karkaTa (kainsara ) yA adhicchadArbuda ( irpa thiliyomA ) utpanna karate haiM / para yadi inheM tvacA ke nIce antaHkSipta kara diyA jAve to inake dvArA saMkaTArbuda ( sArkomA ) banatA hai / ye donoM pratikriyAeM adhikAMza karkaTajanaka padArthoM ke lie satya utaratI haiN| adhika sakriya saMyogoM ( compounds ) ke dvArA atyalpa mAtrA meM hI karkaTospAdaka zakti dekhI jAtI hai / dvidhUpavikSAmI tRNIya kI hI saMkaTAkAra dekhI gaI hai| kitane samaya meM kisI yaha usa prANI kI hRpatA ( susceptibility ) tathA prayoga kI paristhitiyoM para nirbhara karatA hai / cUhe para tArakola potate rahane se 4-5 mAsa meM karkaTa bana jAtA hai 00004 mi. grA. kI mAtrA prANI meM karkaTotpatti hogI For Private and Personal Use Only

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arbuda prakaraNa 657 usI dRSTi se manuSya meM karkaTotpatti ke lie tArakola kA prayoga 10 yA 15 varSa taka karanA par3a sakatA hai| vizuddha karkaTotpAdaka padArthoM kA prayoga karane se yaha samaya aura bhI kama ho jAtA hai| 9 : 10-dviprodala-1: 2 vidhAmI kevala 35 dinoM meM cUhoM ( mice ) meM karkaTotpatti kara sakatA hai| yaha padArtha sabase adhika druta karkaTajanaka mAnA jAtA hai / __ yaha smaraNIya hai ki ye rAsAyanika padArtha jahA~ svacA ke nIce antaHkSipta ho jAne ke kAraNa sthAnika saMkaTArbuda kara dete haiM vahA~ ve anyatra karkaTa kI utpatti bhI karate hue dekhe gaye haiM vizeSa karake phuphphusIya karkaTa dekhA jAtA hai / eka vaijJAnika ne eka mUSaka kI svacA ke nIce dvi vikSAmeNya kA antaHkSepa karake mukha dvArA bhI usakA sevana karAyA isa AzA se ki AmAzayika karkaTa isa prakAra utpanna kiyA jA sake parantu vaha isameM saphala na ho sakA api tu usake sthAna para use phuphphusIya karkara prApta ho gyaa| phuphphusa meM karkaTa kA kAraNa upasarga kA ranadhArA dvArA jAnA na siddha hokara sIdhe mukhadvArA gayA huA siddha huaa| mUrSoM meM jaise phuphphusIya karkaTa saralatApUrvaka ho jAtA hai vaise hI zazakoM meM garbhAzayika karkaTa bahulatApUrvaka milatA hai / kaI vidvAnoM ne 1 : 2 : 5 : 6 dvivikSAmeNya ke antaHkSepa (ilekzansa) aneka prANiyoM meM kie aura ve isa pariNAma para pahu~ce ki antaHkSepasthala para kisI prakAra kA bhI arbuda utpanna nahIM huA para garbhAzaya meM 50 pratizata prANiyoM meM karkaTotpatti ho gii| ___ karkaTajanaka padArtha jitanI adhika dera taka svacA yA zlaiSmikakalA ke samparka meM rahatA hai utanI hI zIghratA se karkaTotpatti hotI hai| yadi hama karkaTajanaka udAMgAroM ko kisI aise vilayana meM ghola deM jo turata pracUSita ho jAve to karkaTotpatti asambhava ho jAtI hai| yataH AmAzayaH meM gayA huA karkaTajanakatatva zIghra pracUSita ho jAtA hai athavA vahA~ rAsAyanika dravyoM ke yoga se usakI zakti kSINa ho jAtI hai ataH aneka prayoga karane para bhI vaijJAnika AmAzayika karkaTa kI utpatti prayogazAlA meM karane meM saphala nahIM ho ske| rAsAyanika karkaTajanaka padArthoM ke sAtha yadi bhautika karkaTajanaka padArthoM kI bhI sahAyatA le lI jAve to adhika saMkhyA meM tathA bahuta zIghra karkaTotpatti kI jA sakatI hai| karkaTakArI udAMgAroM ke kAraNa prakRta kozAoM meM kauna-kauna parivartana hote haiM jinake kAraNa karkaTotpatti hotI hai kahanA kaThina hai| aisA lagatA hai ki kozAoM kI cayApacayika kriyA meM madhvaMzanI kriyA (glycolysis ) vAtajIvI se avAtajIvI ( from aerobic to anaerobc ) ho jAtI hai| abAtajIvI madhvaMzana sadaiva vRdvikAraka hotA hai aura vaha bhrauNakozAoM meM dekhA jAtA hai jahA~ vRddhi adhika aura kriyA kama hotI hai| jaba kezA svastha ho jAte haiM to unameM madhvazana vAtajIvI hotA hai jisake kAraNa vRddhi jyoM kI tyoM rahatI hai parantu kriyAzakti bar3ha jAtI hai / vAtajIvI se avAtajIva madhyaMzana ke kAraNa abuMdIya UtiyA~ bar3o saralatA se zarkarA For Private and Personal Use Only

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688 vikRtivijJAna 1 ko upayoga meM lAne ke lie samartha ho jAtI haiM cAhe phira unameM jAraka ( auksIjana ) upasthita ho vA na ho / arbudIyakozA bhrauNakozAoM kI taraha pUrNataH vibhinnita nahIM hote / unameM kriyAzakti kama para varddhana zakti pracura parimANa meM pAI jAtI hai / isase patA lagAyA jA sakatA hai ki jaba kisI pUrNa pragalbha Uti meM jAraka kI pUrti ghaTA dI jAve to vahA~ avAtajIvI madhvaMzana hone laga jAvegA jisake kAraNa yA to Uti hI naSTa ho jAvegI jaisA ki bahudhA hotA hai athavA yaha parivartana Uti ke kozAoM meM praguNana ( proliferation ) kara degA aura jisake pariNAmasvarUpa eka kama lAbha dAyaka para zIghra hI bar3hane vAlA kozAsamUha utpanna hokara arbuda banA degA | naye kozAoM meM vibhinnana ghaTA huA hotA hai para punarutpatti (reproductivity) bar3hI huI hotI hai jisake kAraNa eka arbuda utpanna ho jAtA hai para jisameM ise utpanna karane vAle abhikartA ke prati pratirodha svAbhAvika rUpa meM pAyA jAtA hai / haiDo kA adhyayana yaha hai ki prakRta kI ativRddhi kA pratirodha karkaTajanaka udAMgAra karate haiM tathA yaha abhI nizcitarUpa se nahIM kahA jA sakatA hai ki ye avAtajIvI madhvaMzana ke bhI kAraka hote haiN| usane yaha bhI pradarzita kiyA hai ki ina abhikarttAoM dvArA utpanna arbuda unakI vRddhipratirodhaka kriyA kA pratirodha karate haiM jaisI ki AzA thI kyoMki inake kAraNa naye prakAra ke kozAoM kI utpatti hotI hai / usakA vicAra yaha hai ki udAMgAra kozA vRddhi kA pratirodha bahuta kAla taka karate haiM jaba taka ki duSTa arbuda utpanna nahIM ho jAtA / itanA kAla eka naye prakAra ke kozA ke utpanna hone meM vyatIta hotA hai / karkaTajanakapadArtha mithAila kholenthrIna kI sUkSma mAtrAe~UtisaMvardhI meM tanturuhoM ( fibroblasts ) kI vRddhi ko ghaTA detI haiM / isI prakAra pairADAimithAilaaimInobenajIna jo mUSakoM ke yakRt meM karkaTotpatti karatA hai vaha bhI Arambha meM kozIya vihAsa utpanna karatA hai jisake pazcAt arbudotpatti huA karatI hai | rugNAvasthA meM bhI tantUtkarSa hI raktapUrti ko rokane kA tathA Uti meM jAraka kI kamI kA pradhAna kAraNa hotA hai / jIrNa tatvIya pAka manuSya meM karkaTa ko utpanna karane ke lie prAyaH uttaradAyI dekhA jAtA hai tathA UtiyoM kI mandagati se huI kSati prAyogika karkaTotpattikAraka hotI hai / jo loga udAMgAroM ke kArakhAnoM meM kArya karate haiM unheM chor3akara karkaTotpatti manuSya meM udAMgAroM dvArA hotI huI nahIM siddha hotI / adhika kAla taka hukkA, bIr3I, sigareTa yA tambAkU pIne se phuphphusIyakarkaTa honA avazya sambhava hai / nyAsarga abhikarttAoM ke dvArA bhI karkaTotpatti ho sakatI hai / jaba ki bAhya padArtha karkaTakAraka hote haiM to koI kAraNa nahIM ki zarIra ke bhItarI dravyoM se bhI karkaTotpatti sambhava na hoske| isakA kAraNa yaha hai ki bAhya janata meM prApya karkaTa janaka dravyoM ke sAtha zarIra ke aneka padArtha rAsAyanika dRSTi se milate julate hote haiM / darzavitA meNya ( phenanthrene ) varga ke udAMgAra jo paryApta karkaTajanaka hote haiN| ve racanASTA zarIrastha sAndravoM ( sterols ) se milate julate hote haiM / inhIM sAndravoM meM jIvatikti gha ( viTAmIna DI ), laiMgika nyAsarga ( sex hormones ) For Private and Personal Use Only

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686 arbuda prakaraNa tathA zarIravarddhaka anya tattva Ate haiM / prodalapittIkSAmeNya ( methylcholanth. rene ) jo svayaM eka bahuta bar3A karkaTajanaka padArtha hai usase milate julate paittika amla hote haiM aura vijAra pittika amla ( desoxycholic acid ) dvArA prodalapittIkSAmeNya ko banAyA jA sakatA hai| ye sabhI tathya hameM yaha anumAna karane ko bAdhya karate haiM ki manuSya meM sAndravIya cayApacaya meM vikAra Ane se karkaTotpatti ho sakatI hai parantu abhI taka yaha eka pramANazUnya anumAna mAtra hI hai| laiMgika nyAsargoM meM strImadi ( oestrin ) tathA puMsasAndrava (androsterol ) nAmaka do meM tathA unake vibhinna vyutpAdoM ( derivatives ) meM karkaTajanaka udAMgAroM meM prApya darzakSAmaNya nAmaka nyaSTi vidyamAna hotI hai jo yaha batalAtI hai ki udAMgAroM ke dvArA laiMgika parivartana honA sambhava hai tathA laiMgika nyAsargoM dvArA karkaTotpatti sambhava hai / strImadi (strI nyAsarga-IsTrIna ) kA kArya udAMgAroM dvArA liyA jA rahA hai tathA mUSaka meM stanakarkaTa kI utpatti ke lie IsTrIna kA prayoga paryApta saphalatA de cukA hai| puruSa nyAsarga meM karkaTajanakapravRtti dekhane meM nahIM aatii| isI prakAra puruSa liMga sambandhI uttejanAe~ udAMgAroM dvArA bhI nahIM prApta hotiiN| yadi zIghra karkaTa pAyI mUSaka jAtiyoM ke mUSaka kI bIja granthiyA~ usake 6 mAsa kI Ayu hone ke pUrva hI nikAla dI jAveM to usake stanoM meM karkaTotpatti karanA kaThina dekhA gayA hai jo spaSTa yaha siddha karatA hai ki IsTrIna * karkaTajanana meM sahAyatA avazya karatI hai| jina mUSaka jAtiyoM meM stanakarkaTa AsAnI se utpanna nahIM kiyA jA sakatA yadi unake varga kI kisI cuhiyA ko IsTrInayukta kara diyA jAve to usameM stanakarkaTa saralatApUrvaka aura zIghra bana jAtA hai| yaha dhyAna dene yogya hai ki mUSakoM meM phuphphusIya karkaTotpatti kI svAbhAvika pravRtti hotI hai parantu IsTrIna ke prayoga ke dvArA jo karkaTa dekhA jAtA hai vaha phuphphusa meM na bana kara stana meM hI banatA hai| vArena ke dvArA prakaTIkRta isa tathya ko bhI hameM smaraNa rakhanA hai ki IsTrIna se milate julate karkaTajanaka udAMgAra jIvatikti ga (prAmalaka amla) kI upasthiti meM turata jArita ( oxidised ) ho jAte haiN| yaha tatva adhivRkka granthi ke bAhyaka meM sadA upasthita rahatA hai / isa sabase yaha spaSTa hai ki IsTrIna dvArA udbhUta karkaTa kA sambandha vividha praNAlIhIna granthiyoM ke sAtha rahatA hai aura yaha sAdhAraNa udAMgAroM se utpanna karkaTa se paryApta pRthak hotA hai| sTilabIsTrola nAmaka dravya jisakI kriyA IsTInajanaka hotI hai para jo svayaM sAndrava nahIM hotA dvArA bhI prayogAtmaka stanakarkaTa utpanna kiyA jA sakatA hai / yaha isa tathya kI puSTi karatA hai ki stanakarkaTotpatti kA kAraNa rAsAyanika padArtha nahIM haiM api tu yaha zarIra vyApArika kriyA ( physiological action ) kA pariNAma hotA hai / prakRta vA kRtrima IsTrojanoM ke kucha lakSaNa to karkaTajanaka udAMgAroM se milate haiM jisake kAraNa unase karkaTotpatti hotI hai tathA kucha unameM aise bhI lakSaNa hote haiM jo For Private and Personal Use Only

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660 vikRtivijJAna UtivRddhi ko manda karate haiM / isI antima guNa kI prApti ke lie hI puraHstha granthi ke karkaTa ko dUra karane ke lie sTilabIsTraoNla kA upayoga kiyA jAtA hai / isa kArya ke lie sTilabIsTrola kA prayoga hone se yA to vaha poSagikAgranthi ke dvArA apratyakSarUpa se kriyA karatA hai athavA sIdhe vRSaNoM ke kozAoM meM eNDrojana kA srAva rokatA hai| kucha bhI ho puraHsthIya karkaTa eka antaHsrAvI granthiyoM ke kriyA vaiSamya ( dysendoerinism ) kA eka pariNAma hai jisa para sTilabIsTrola kI kriyA hotI hai aura lAbha bhI hotA hai / anya abhikarttAoM kA bhAga bahuta kama rahatA hai| viTAmIna DI eka sAndrava hai jise nIlalohitAtIta kiraNeM uttejita karake utpanna karatI haiM parantu isake dvArA karkaTa utpanna hotA hai isake sambandha meM koI spaSTa pramANa abhI taka aprApya hai / anya vRddhikartA padArthoM ke bAre meM nizciti se kucha yoM nahIM kahA jAsakatA kyoMki unakI rasAyanika racanA abhI taka pUrNataH jJAta nahIM hai / sajIva abhikartA dvArA karkaTotpatti ho sakatI hai yA nahIM isa prazna ko punaH isa yuga meM uThAyA jArahA hai aura vaijJAnika isa khoja meM lage haiM ki kahIM kisI jIvANu ke dvArA to yaha utpanna nahIM hotA hai / san 1911 meM peTana rUsa ne eka pakSI ke saMkaTArbuda kA kozAvirahita vilayana banAyA aura use jyoMhI dUsare pakSI meM praviSTa kiyA ki use turata saMkaTArbuda utpanna ho gyaa| isa ghaTanA kA sampUrNa karkaTakhojI prayogazAlAoM para prabhAva par3A aura ve kisI aise sajIva tatva kI khoja meM nikala par3e jo manuSyoM ke duSTa arbudoM kA janaka ho / para abhI taka koI saphalatA nahIM milI / pakSiyoM meM 27 prakAra ke arbuda pAye jAte haiM jinameM 11 prakAra ke arbudoM ke kozA virahita pAvita ( cell. free filtrates ) banAe jA sakate haiM / aisA lagatA hai ki ina pAvitoM meM arbuda kAraka tattva koI viSANu (virus ) hogA / ina viSANuoM ke dvArA pakSiyoM meM duSTa arbudoM kI utpatti hotI hai / unameM udAMgAroM ke dvArA bhI arbudotpatti kI jA sakatI hai / stanadhArI prANiyoM ke kaI arbuda pAvitoM dvArA eka se dUsare meM saMkrAmita kie jAsakate haiM / manuSya kA aMkurIya carmakIla ( papillomatous wart aupasargika mAnA jAtA hai / zazakoM ke 3 arbuda aupasargika kahe jAte haiM / ina tInoM ke tIna vibhinna viSANu rahate haiM / inameM aMkurArbuda kA viSANu zazaka meM eka pratirodhaka zakti ko utpanna kara detA hai / isa aMkurArbuda ko zopa aMkurArbuda ( Shope papilloma ) kahate haiM / yaha jaba duSTa ho jAtA hai to phira usakA pAvita dvArA saMkramaNa banda ho jAtA hai 1 sArAMza yaha hai ki jahA~ hamAre pAsa anya prANiyoM para kiye gaye prayogoM ke AdhAra para karkaTajanaka kAraNoM para bahuta kucha prakAza par3atA hai vahA~ hama jahA~ taka manuSya aura karkaTa kA sambandha hai hama abhI taka kucha bhI Age nahIM bar3ha sake haiM / For Private and Personal Use Only

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arbuda prakaraNa 661 mAnava ya karkaTakAraka hetu nimna hetuoM ke kAraNa koI svastha mAnava ati-dauSTaya grahaNa karane meM samartha ho sakatI hai: 1. kula ja pravRtti ( heredity ) 2. Ayu ( age ) 3. anuhRSatA ( susceptibility ) 4. AghAta ( trauma) 5. jIrNa pakSobha ( chronic irritation ) 6. bhrauNikoya avazeSa ( embryonic rests ) 7. tanvIyana yA punarjananIya parivartana ( involutionary or regene rative changes ) kulata pravRtti ( Heredity )-karkaTa svayaM eka paitRka roga nahIM hai parantu kulaja vRtti karkaTotpatti meM prathama sthAna rakhatI hai| mUSakoM meM kulaja pravRtti ke hI bala para karkaTayukta nara-mAdA saMyogoM kI pIr3hiyoM se aise mUSaka utpanna kie jAsakate haiM jinameM turaMta karkaTotpatti kI jA sake / isI prakAra isakA ulaTA bhI kiyA jAsakatA hai aura itane pratirodhaka mUSaka bhI utpanna ho sakate haiM jinameM kaThinatA se hI karkaTotpatti ho ske| __ manuSyoM meM kulaja pravRtti kA vicAra karane ke lie vAlara ne 6000 karkaTarogiyoM ke parivAroM kI, vArasiMka ne 2472 karkaTarogiyoM ke parivAra kI 1931 aura 1935 meM kramazaH parIkSAeM kii| ina parIkSaNoM se unhoMne yaha siddha kara diyA ki karkaTa kI utpatti zIghra yA dera se hone ke lie kulaja pravRtti eka mahatva kA hetu hai| unhoMne nimna anya ariNAma bhI prApta kie : 1. santAna meM karkaTotpatti liMgAnuyAyI hotI hai| arthAt mAtA ko karkaTa hone para beTI meM aura pitA ko karkaTa hone para putra meM karkaTAtpatti hone kI adhika sambhAvanA rahatI hai| 2. karkaTIya kulajapravRtti striyoM meM puruSoM kI apekSA adhika milatI hai| ___3. kulajapravRtti do bhAgoM meM bA~TI jA sakatI hai / eka vaha jo puruSa aura strI donoM se barAbara sambandha rakhatI hai tathA dUsarI vaha jo kevala striyoM se sambaddha rahatI hai| 4. karkaTa aMga vizeSa meM yadi mAtA vA pitA meM pAyA jAve to santAna meM bhI usI aMga meM prAyaH hotA huA dekhA jAtA hai| mUSakoM meM eka vicitra bAta yaha dekhI jAtI hai ki yadi eka ucca karkaTIya pravRtti vAle mUpaka kI santati ko alpakarkaTa pravRtti vAle mUSaka kA dugdha pilAyA jAve to yaha mUpaka bAlaka alpapravRtti vAlA ho jAtA hai tathA alpapravRtti vAle mUSaka ko ucca pravRtti vAle mUpaka kA dugdha diyA jAve to usameM karkaTa kI pravRtti bar3ha jAtI hai| yaha nissandeha siddha karatA hai ki dugdha ke andara karkaTa pravRtti ko kama yA adhika For Private and Personal Use Only

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662 vikRtivijJAna karane vAlA koI tatva avazya rahatA hai| yaha koI kiNva hai, nyAsarga hai vA viSANu yaha nahIM kahA jA sktaa| Ayu-karkaTa kisI bhI Ayu meM ho sakatA hai| parantu vibhinna prakAra ke karkaToM ke lie Ayu kI maryAdA lagabhaga nizcita sI hai| saMkaTArbuda bahudhA bacapana meM hotA hai jaba ki karkaTa prauDhAvasthA meM milatA hai / para isakA artha yaha bhI nahIM ki saMkaTArbuda prauDhAvasthA meM tathA karkaTa zaizava, bAlyakAla vA tAruNya meM nahIM hI milegaa| adhivRkka granthiyoM kA karkaTa zaizavakAlIna hotA hai tathA vRSaNakarkaTa 30 varSa kI Ayu se nIce dekhA jAtA hai| AmAzaya, stana aura Antra ke karkaTa 30 varSa kI Ayu se nIce mila sakate haiN| karkaTa kI utpatti itanI dera meM hone ke 2 kAraNa ho sakate haiM eka to yaha ki karkaTotpAdaka tatva bahuta dera meM jAkara apanA prabhAva jamA pAtA hai aura dUsare yaha ki jaba zarIra UtiyoM meM vizeSa kara striyoM ke prajananAMgoM meM hAsAtmaka parivartana hone lagate haiM taba isakI utpatti sambhava ho pAtI hai| anuhRSatA tathA pratIkAritA-vyavasAya dvArA jina vyaktiyoM ko karkaTotpatti hotI hai unakI saMkhyA usa vyavasAya meM lage hue saba zramikoM kI saMkhyA se bahuta kama hotI hai| karkaTakArI vyavasAya meM saMlagna sabhI vyakti karkaTa se grasita kyoM nahIM hote ? isakA uttara yahI dikhalAI detA hai ki jo grasita ho gaye unameM karkaTa ke prati anuhRSatA adhika hai tathA jo baca gaye unameM karkaTa ke prati eka prakAra kI pratI. kAritA ( immunity ) utpanna ho gaI hogii| - manuSya meM plIhA eka aisA aMga hai jahA~ prAthamika yA uttarajAta arbuda bahuta kama hote haiN| isase yaha anumAna lagAyA jAtA hai ki jAlakAntazchadIya saMsthAna arbuda se zarIra kA saMrakSaNa karane meM avazya pravRtta hotA hogaa| parantu yakRt tathA lasapranthiyoM meM pAye jAne vAle arbudoM ko dekhakara yaha bhrama dUra ho jAnA caahie| to bhI yadi raMgoM kA antaHkSepaNa kisI prANI meM kara diyA jAve to usakA jAlakAntazchadIya saMsthAna raMga se bhara jAtA hai aura koI anya kArya karanA usake lie sambhava nahIM rahatA aise samaya yadi usa prANI ke zarIra meM karkaTa kA pratiropaNa kara diyA jAve to karkaTa bahuta zIghra utpanna hotA hai / yaha tathya spaSTataH batalAtA hai ki karkaTanirodha meM kucha na kucha jAlakAntazchadIya saMsthAna kA avazya hI hAtha rahA karatA hai| jAlakAntazchadIya saMsthAna kA yaha pratirodhAtmaka kArya eka kozIya kriyA hai aisA mAlUma par3atA hai kyoMki jIvANuoM ke prati jaisI pratIkAritA manuSyoM meM pAI jAtI hai vaisI taralIya (humoral) pratIkAritA hogI isakA koI pramANa upasthita nahIM hai|mhaabhtikoshaa arbudakozAoM ko usI prakAra naSTa karate hue dekhe jAte haiM jaise ki ve kisI jIvANu ko apane andara lete haiN| mUSakoM para hue prayogoM se yaha patA lagatA hai ki yadi do mUSakoM meM karkaTa kA pratiropaNa kiyA jAve to jo karkaTa ke prati anuhRSa mUSaka hogA usake saMyojIUti se eka navIna saMdhAra (stroma ) utpanna ho jAvegA jisameM arbuda ko khAdya For Private and Personal Use Only

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63 arbuda prakaraNa sAmagrI dene ke lie raktavAhiniyA~ bana jAveMgI aura mUSaka meM karkaTotpatti ho jaavegii| para karkaTa ke prati jo kisI bhI prakAra anuhRSa nahIM hai aise mUSaka meM karkaTa kA pratiropa karane kA pariNAma yaha hotA hai ki vahA~ kI saMyojIUti koI bhI saMdhAra nahIM banAtI jisake kAraNa pratiropita karkaTa ke kozA khAdya ke abhAva se mara jAte haiN| jisa prakAra jIvANuoM ke prati prANI kI pratIkAritA prAkRtika aura avApta hotI hai vaisI hI arbudoM ke prati bhI hotI hai| eka varga ke mUSakoM meM zIghra karkaTotpatti aura dUsare varga meM bilkula nahIM yaha AnuvaMzika pratIkAritA vA anuhRSatA kA hI pramANa hai / eka hI varga (species)ke sabhI mUSakoM meM bhI karkaTa ke prati anuhRSatA eka barAbara nahIM pAI jAtI hai| mUSakoM meM zizumUSaka jitanA zIghra karkaTa-pratiropoM se prabhAvita hotA hai utanA prauDha mUSaka nahIM jisakA artha hai ki prauDha mUSaka ne pratIkAritA meM vRddhi kI hai tathA eka pIr3hI se dUsarI pIr3hI meM anuhRSatA to AtI hai para pratIkAritA nahIM aisA bhI isase anumAna hotA hai| ___ avApta pratIkAritA kI parIkSA ke lie eka mUSaka meM eka karkaTa pratiropa (transplant) kucha kAla taka ugane diyA gayA aura phira use nikAla diyA gayA aura phira nayA dUsarA pratiropa jamA diyA gayA aura dekhA ki vaha aba ugatA hai yA nhiiN| dekhane se jJAta huA ki vaha kinhIM varga ke mUSakoM meM nahIM ugatA aura kinhIM meM ugatA hai tathA yaha ki kucha prakAra ke pratiropaNazIla arbuda avApta pratIkAritA pradAna karate haiM aura kucha prakAra ke nahIM karate / karkaTa kI pratokAritA ke sambandha meM abhI kucha nizcayAtmaka rUpa se nahIM kahA jA sakatA hai| aisA kahA jA sakatA hai ki yadi koI vyakti karkaTa ke prati anuhRSa hai to usake aMga meM karkaTa utpanna hone para anya aMgoM meM bhI utpanna ho sakatA hai| para yaha asatya hai| tvacA meM kaI duSTa arbuda hoM to usake anya aMgo meM bhI hoMge yaha kama dekhA jAtA hai| striyoM meM AmAzayika karkaTa nahIM milatA para prajananendriya karkaTa bahuta hotA hai manuSyoM meM isakA ulaTA dekhA jAtA hai| holaiNDa meM AmAzayAntrika karkaTa bahuta hotA hai| iMgalaiNDa meM stana aura garbhAzaya ke karkaTa bahuta hote haiM jApAna meM stanakarkaTa na hokara garbhAzaya-karkaTAdhikya hotA hai tInoM dezoM meM tIna prakAra ke karkaToM kI bahutvatA hote hue bhI tInoM kA ToTala eka hI rahatA hai| yadi eka prANI para tArakola potane para eka sthAna meM karkaTa ho jAve to dUsare sthAna para tArakola se karkaTa nahIM hotA yaha avApta pratIkAritA (acquired immunity ) kA acchA udAharaNa hai| jisa prANI meM drata karkaTa (spontaneous cancer ) ho vaha tArakola karkaTa ke lie pratIkArI (immune) hotA hai| parantu pratiropita karkaTa vAle prANI meM tArakola karkaTa ugAyA jA sakatA For Private and Personal Use Only

Page #767
664 vikRtivijJAna hai tathA jisako tArakola karkaTa ho usameM dUsare arbuda kA pratiropaNa saphalatApUrvaka kiyA jA sakatA hai| sArAMza yaha hai ki karkaTajanana meM tIna kAraka vizeSa mAga lete haiM--(1) karkaTajanaka abhikartA (2) anuhRpatA jisakA sambandha kulaja pravRtti ke sAtha rahatA hai tathA (3) samaya / yadi karkaTajanaka uddIpana ( carcinogenic stimulus) paryApta ho tathA prANI meM anuhRSatA ucca ho to turata karkaTa utpanna hogaa| yadi uddIpanA kama ho para anuhRSatA adhika ho to bhI paidA hogA / yadi uddIpanA atyadhika tathA anuhRSatA kama ho taba bhI karkaTotpatti hogI para bAda ke donoM udAharaNoM meM samaya pahale kI apekSA adhika lgegaa| para jahA~ uddIpaka abhikartA aura anuhRSatA donoM hI bahuta kama hoM vahA~ karkaTa bahuta dera meM hogaa| yadi anuhRSatA bilkula na ho para karkaTajanaka uddIpanA pahu~cAI jAve to atidIrghakAla meM karkaTopatti ho bhI sakatI hai aura nahIM bhii| anuhRSatA hone para bhI uddIpanA na mile to yaha Avazyaka nahIM ki karkaTa bana hI jAve / AghAta-AghAta ke kAraNa kucha prakAra ke arbuda bana sakate haiM yaha satya ho sakatA hai para AghAta kA kAraNa sadaiva arbudakAraka ho yA yaha isakA prAyika hetu ho yaha kabhI nahIM mAnA jA sktaa| aisA mAnA jAtA hai ki bAlakoM ke zarIra meM madhyastarakRta ( mesoblastic ) Uti meM punarjanana kI aparimita zakti nihita hotI hai| jaba kisI prakAra bAlakoM meM AghAta laga jAtA hai to yaha zakti aniyantritarUpa meM ubala par3atI hai aura saMkaTArbuda ko janma detI hai| kucha saMkaTArbuda to paramacayika vraNazothAtmaka yA upazama vikSatoM ( reparative lesions ) ke rUpa meM banate haiM aura kucha kaNanIyaUti kI prakriyA (granulomatous process ) se milate. julate haiN| isa bAda ke prakAra meM lasasaMkaTArbuda A sakatA hai| dUsare atyadhika zIghra bar3hane vAlI kaNanIyaUti ko saMkaTArbudIya prakriyA samajhane kI bhUla bhI ho sakatI hai| jo loga duSTAbuMdIya vRddhi ko viSANujanya mAnate haiM unakI bAta AghAta janya karkaTotpatti se samajhanA kucha AsAna bhI hai| kyoMki jaise AghAta lagane se asthi meM vividha jIvANu asthimajApAkotpatti kara dete haiM vaise hI AghAta ke kAraNa kucha viSANu arbudotpatti bhI kara sakate haiM yaha mata yahA~ ThIka-ThIka utaratA pragaTa hotA hai| karkaTa hone ke lie jo prakriyA lAgU hotI hai vaha varSoM calatI hai tathA jisa Uti meM calatI hai usake kozAoM ke cayApacaya meM parivartana ho jAtA hai| isa kAraNa kevala eka bAra ke AghAta kA koI AzcaryakAraka pariNAma na nikale to koI Azcaryajanaka bAta nahIM hai para kabhI-kabhI andara-andara Uti meM duSTArbudIya jar3a jama cukI ho to eka bAra ke AghAta meM bhI pariNAma nikala sakatA hai| kaI bAra AghAta jIrNa prakSobha meM AtA AtA hai jise hama Age likha rahe haiN| jIrNa prakSobha-jIrNa prakSobha kA hetu arbudotpatti meM itanA diyA jAtA hai aura itane samaya se diyA jAtA rahA hai ki ise chor3A nahIM jA sakatA / parantu jIrNa prakSAbha For Private and Personal Use Only

Page #768
arbuda prakaraNa 665 ke kAraNa hone vAle karkaTa ke sthAna bhI nizcita se dekhe jAte haiM aura ye sthAna vahI hote haiM jahA~ AghAta bAra-bAra hotA hai yA dabAva kaI bAra par3atA hai / inameM nimna cAra sthala prasiddha haiM : ( 1 ) amnapraNAlI kA prathama tRtIyAMza jo grasanikA se milatA hai / ( 2 ) annapraNAlI kA madhyama tRtIyAMza jisake Upara vAmaklomanAla ( left bronchus ) kA bhAra par3atA hai / ( 3 ) AmAzaya kA prathama dvAra jo annanalikA se milatA hai / ( 4 ) AmAzaya kA mudrikAdvAra jo grahaNI se sambaddha hotA hai / kSudrAntra meM duSTArbuda na hokara bRhadantra meM dekhane meM Ate haiM jisakA kAraNa ki vahA~ mala ke piNDoM kA AntraprAcIra se sambandha AtA hai aura unakA dabAva bhI par3atA hai / malAzaya aura guda jahA~ yaha dabAva atyadhika dekhA arbudotpatti ke lie prasiddha sthala hai / vraNoM ke kinAre jahA~ prakSobha bahulatA se pAyA jAtA hai prAyaH adhicchadArbuda ko utpanna karane ke mahatva ke sthAna hote haiM / svakpAka ( dermatitis ) ke kAraNa jahA~ nirantara prakSobha hotA hai vahA~ yadi afaNoM dvArA aura prakSobhotpatti kI jAve to karkaTa utpanna ho sakatA hai / tArakola, kAjala, cimanI kI kAloMca, pairAphIna Adi ke sAtha kArya karane vAloM meM ina dvayoM ke kAraNa hone vAle prakSobha ke kAraNa pahale to vraNazothAtmaka pratikriyA hotI hai para vahI karkaTotpatti kA kAraNa bhI banatI hai kyoMki nirantara bahuta kAla taka prakSobha arbudotpAdaka huA karatA hai / yahI hai usa para jAtA hai yakSmAjanya cirakAlIna lasagranthipAka (lymphadenitis ) kA pariNAma lasasaMkaTArbuda (lymphosarcoma) meM ho sakatA hai tathA asthi vA pezI phiraMga jaba bahuta purAnI ho jAtI hai to vaha bhI saMkaTArbuda ke samakakSa rUpa dhAraNa kara letI hai | adhicchadIya racanAoM kA jahA~ taka sambandha hai vahA~ taka phiraMga aura yakSmA pUrvakarkaTakara avasthAe~ mAnI jAtI hai / kuSThiyoM ke vikSatoM meM bhI karkaTa dekhA jAtA hai tathA jihvA para phiraMgajanya pAka ho jAne se athavA sitaghaTana ( leucoplakia ) hone se jihvA meM karkaTa hotA huA pairoM meM hone vAle vraNa jinakA itihAsa varSoM kA milatA hai kadApi karkaTa meM pariNata nahIM hote, AmAzayika vraNa jo varSoM rahatA hai vaha bhI 6 pratizata ko chor3a kara karkaTa meM nahIM badalatA, yakSmA aura phiraMga ke vikSatoM meM se bhI bahuta hI kama karkaTa yA saMkArbuda meM pariNata hote haiM / yaha saba hameM isa ora bhI saMketa karatA hai ki kevala mAtra adhika kAla taka prakSobha hotA rahe aura prakSobhasthalI karkaTIbhUta ho jAve aisA nahIM hai balki kucha aura bhI Avazyaka hai / jIrNa prakSobha ke samAna hI viSoM kA pariNAma bhI karkaTotpAdaka ho sakatA hai / saMkhiyAviSa kA pariNAma jaba use adhika kAla taka sevana kiyA jAve to karkaTotpatti dekhA jAtA hai For Private and Personal Use Only I

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666 vikRtivijJAna yA adhicchadIya vRddhiyoM ke utpAda na meM dekhA jAtA hai| tAmra tathA ketvAtu (cobalt) ke sAtha kArya karane vAle kArIgaroM meM duSTArbuda dekhI jA sakatI hai| tAmra pahale kozAoM ko AghAtagrasta karatA hai phira bAda meM una kozAoM meM pratikriyAtmaka vRddhi ho jAtI hai| jIrNa prakSobha janita paristhitiyoM kA adhyayana karane se yaha vizvAsa dRr3ha ho jAtA hai ki ve karkaTa meM pariNata honI hI cAhie para ve sabhI kyoM nahIM hotIM yaha prakRti kI eka vizeSa kRpA hI kahI jA sakatI hai| kyoMki prakSobha ke nirantara hone se atikozAoM kA vinAza hotA hai usa nAza ke kAraNa vahA~ upazamakArI pratikriyA hotI hai vraNazothakArI abhikartAoM kI upasthiti se jIvita bace kozAoM ke cayApacaya meM parivartana ho jAtA hai sAtha hI vahA~ rakta kI kamI aura tantUtkarSa ho jAtA hai sAtha hI varSoM prakSobha calatA rahatA hai yaha sabhI duSTArbudotpatti ke pradhAna sAdhana haiN| bhrauNikIya avazeSa ( embroyonic rests )-isake paryApta pramANa haiM ki bhrauNikIya avazeSoM ke dvArA bhI arbudotpatti hotI hai arthAt manuSya zarIra meM kucha kozA aise bhI par3e rahate haiM ki jinakA pUrNa vikAza nahIM ho pAtA balki jo apane zrauNikIya rUpa meM hI rahate haiN| aise bhrauNikIya avazeSa hama asthiyoM meM kAsthiyoM kI upasthiti ke rUpa meM dekhate haiN| eka udAharaNa anavatIrNa vRSaNoM ( undescended testis ) kA diyA jA sakatA hai jo duSTArbudotpattikAraka huA karate haiN| jo kozA avazeSoM kA kArya karate haiM ye ve hote haiM jinheM apanI svAbhAvika kriyA karane kA avasara nahIM milA hotA aura jinakI kriyA avaruddha rahA karatI hai| unakI vRddhi bhI ThIka se nahIM hotI, unheM raktapUrti bhI pUrNAMza meM nahIM huA karatI, tathA jo pUrNavayaskatA kI kriyAzIlatA ke guNa se bhI vaJcita rahate haiN| isI se yaha anumAna lagAyA jA sakatA hai ki unameM jaba jIrNa vikSobha yA AghAta kA prabhAva par3atA hai to ve varSoM bAda punaH jagate haiM inake kozikIya cayApacaya meM parivartana hone lagatA hai aura unameM prabala vRddhi hokara arbudotpatti ho jAtI hai| yadi zrauNikIya avazeSoM kI upasthiti ko mahattva diyA jAve to phira duSTAbaMdotpatti ke lie pRthaka se kisI anya viSANu ke khojane kI AvazyakatA bhI nahIM rhtii| tanvIyana ( involutionary changes)-prajananAGgoM ke dvArA jananakriyAoM kI samApti para unameM tanvIyanakArI parivartana dekhe jAte haiN| striyoM meM prajananakAla meM prajananAMgoM meM, stanoM meM tathA kucha antaHsrAvI granthiyoM meM atighaTana aura tanvIyana ke tAlabaddhakAla ( rhythmic periods ) AyA karate haiN| puruSoM meM ye cakra utane spaSTa nahIM huA krte| kucha bhI ho jaba tanvIyana ke kAla Ate haiM usameM striyoM meM IsTrIya kriyA atyadhika rahatI hai aura taba duSTArbudotpattiyA~ prAyaH dekhI jAtI haiN| jaba prajanana kArya pUrNataH stabdha ho jAtA hai taba ina aMgoM meM hue tanvIyana ke bAda karkaTotpatti milA karatI hai| For Private and Personal Use Only

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arbuda prakaraNa 667 duSTAsa ( malignant degeneration ) - duSTavihAsa kA artha hai eka sAdhAraNa arbuda kA duSTa arbuda meM pariNata honA / prayogoM dvArA tvacA para tArakola kA nirantara lepa karane se pahale eka aGkurArbuda utpanna hotA hai / yadi isa aGkurArbuda para bhI tArakola potA jAve to vaha karkaTa meM badala jAtA hai, tArakola se banA aMkurArbuda yadi jala jAve to bhI karkaTa bana jAtA hai / isakA artha yaha hai ki jaba kisI sAdhAraNa arbuda ke kozA ke cayApacaya ( samavarta ) meM parivartana ho jAtA hai: to vRddhi duSTa ho jAtI hai / stana kA tantugranthyarbuda saMkaTArbuda meM pariNata ho jAtA hai. tathA mUtravahasaMsthAna kA aMkurArbuda karkaTa meM badala jAtA hai / bRhadantra kA aMkurArbuda bhI karkaTa meM badalate hue dekhA jAtA hai khAsakara vraNazothAtmaka hetu se utpanna bahuvidha aGkurArbuda ( multiple papillomata ) sAdhAraNa raMgIna tila yA ( naevus ) AghAta ke kAraNa kAlya saMkaTArbuda ( melanotic sarcoma ) meM pariNata ho jAtA hai| kabhI kabhI zarIra meM koI sAdhAraNa arbuda utpanna hokara par3A rahatA hai aura taba taka prakaTa nahIM hotA jaba taka ki vaha pUrNataH duSTa na ho jAve / pUrvakarkaTika vikSata ( precancerous lesions ) - yaha kahane kA rivAja cala par3A hai ki kucha vikSata pUrvakarkaTika hote haiM / yadyapi usake pIche pramANa koI. khAsa nahIM rahA karatA hai / koI bhI jIrNakAlIna vikSata ho yA koI atighaTana jo antaHstrAvI granthiyoM kI vikriyA ( dysfunction ) se sambaddha ho jaise tanvIyita stanapAka yA puraHstha granthi kA jaraThika atighaTana to vaha pUrvakarkaTika avasthA vAlA ghoSita kara diyA jAtA hai / para sabhI jIrNastanapAka karkaTa meM pariNata nahIM hote aura na saba tRtIyAvasthA vAle phiraMgiyoM kI jIbha meM karkaTa ho pAtA hai / ataH 'pUrvakarkaTika vikSata' zabda anAvazyaka pratIta hotA hai / itanA kahA jA sakatA hai ki jina avasthAoM ko pUrvakarkaTika avasthA kahA jAtA hai ve ve avasthAe~ jinakA vidhivat upacAra na kiyA gayA tathA sAvadhAnI na baratI gaI to avazya hI vaha karkaTa meM pariNata ho sakatI haiM / atyadhika adhicchadIya atighaTana ( gross epitpelial hyperplasia ). guru lasIkozIya bharamAra ( heavy lymphocytic infiltration ) tathA tantUtkarSa ye sabhI milAkara usa citra ko upasthita karate haiM jisakI sAvadhAnI na baratI jAne para karkaTotpatti ho sakatI hai / pUrvakarkaTika vikSatoM ke do mahattva ke udAharaNa diye jA sakate haiN| inameM eka to oSTha kA vaha zotha hai jisameM upaadhi tvacA meM oSTha meM khUba golakozAoM kA antarAdhAna hotA hai, tathA jisameM mAlapIdhiyana aMkura bar3ha bar3ha kara lambe hote cale jAte haiN| ve moTe ho jAte haiM aura unameM vibhajanAMka ( mitoses ) bhI dekhane meM Ate haiM / yaha vRddhi duSTa nahIM hotI tathA niyamita hotI hai / yahI Age jAkara duSTa vRddhi meM badala jAtI hai / dUsarA udAharaNa paigaTa carmadala ( Paget's eczema ) kA striyoM stana cUcuka meM dekhane ko milatA hai / ke 56, 60 vi0 For Private and Personal Use Only

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668 vikRtivijJAna ___ itanA saba kahane para bhI yaha kahate hue hameM atyadhika kheda hotA hai ki hama manuSya meM duSTa vRddhiyoM ke hetuoM para koI santoSajanaka prakAza nahIM DAla ske| pratyeka ko koI na koI jIrNa vraNazotha rahatA hai| pratyeka ke prajananAMga vRddhAvasthA meM zithila par3ate haiN| para kyA sabako avazya hI karkaTotpatti hotI hai ? nahIM, phira isa mahAvyAdhi kA mukhya hetu kyA hai vahA~ taka pahu~canA abhI zeSa hai| arbudoM kA pravikiraNa pravikiraNa ( irradiation ) ke lie kSakiraNoM tathA tejAtu kA hI prayoga abhI ho rahA hai| nyUkliyara phijiksa kA jyoM jyoM vistAra hotA jAtA hai tyo tyo sambhava hai ki pravikiraNa ke lie anya prakAra kI kiraNoM kA bhI upayoga hove / yahA~ hama pravikiraNa kA karkaTa kozAoM para prabhAva, pravikiraNa kA atiyoM para prabhAva tathA upazayAtmaka prakriyA ina tIna kA varNana kreNge| pravikiraNa kA karkaTa kozAoM para prabhAva karkaTa kozAoM para pravikiraNa kA prabhAva hama do prakAra se adhyayana kara sakate haiN| eka to hama ati saMvardha ( tissue culture ) para pravikiraNa kareM athavA hama pratyakSa mAnava prANI para usakI kriyA dekheN| kisI bhI prakAra prayoga karane para hama do pariNAmoM para pahu~cate haiM-1. kozAoM kI sakriyatA kA avarodha ( arrest of activity ) tathA 2. kozAoM kA vidvAla tathA vinAza ( degeneration and destruction of cells ). __vargaunI tathA TribauNDau kA eka siddhAnta yaha hai ki kisI bhI Uti kI tejohapatA ( radio-sensitivity ) usakI prajanana kriyA ( reproductive activity ) para nirbhara karatI hai| kozAoM kA vibhajana jitanA hI adhika hogA Uti utanI hI tejohRSa hogii| yahI kAraNa hai ki kaNana Uti, bhrauNikIya Uti, tathA avibhinita druta vibhajanazIla karkaTa adhika tejohaSa hoNge| teja ke prabhAva se kozA kA alpAMza meM yA pUrNAMza meM vihAsa ho jAtA hai| kozA kI nyaSTi TUTa jAtI hai aura usakA varNAzana ( chromatolysis) ho jAtA hai| kozA kA prarasa kaNAtmaka ho jAtA hai aura usameM rasadhAnI ( vacuole ) bana jAtI hai tathA kozA kI mRtyu ho jAtI hai aura vaha lupta ho jAtA hai| yaha pahale kahA jA cukA hai ki teja kA prabhAva nyaSTiprobhUjinoM ke samavarta (cayApacaya) para par3atA hai jo nyaSToya abhivarNi ( nuclear chromatin ) ke andara rahatI hai jisakI ki kriyAzIlatA para kozA kA vibhAjana huA karatA hai| kaimbrija ke eka vidvAn sTejaveja ne tathA kaiNTI ne UtisaMvoM para tejIya pratikriyA ke calacitra taiyAra kie haiM jinako dekhane se tejIya razmiyoM ke dvArA karkaTa kozAoM para kyA bItatA hai use pratyakSa dekhA jA sakatA hai| unheM dekhane se jJAta For Private and Personal Use Only

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arbuda prakaraNa 666 1 hotA hai ki aneka kozA to turaMta mara jAte haiM / citra meM unakA hotA huA visphoTa saralatApUrvaka dekhA jA sakatA hai / kozA vibhajanacakra meM kozA kI sthiti kyA hai usakA aura tejohRSatA kA bahuta sambandha AtA hai / sabase adhika tejohRSa kAla vaha hotA hai jaba kozA vibhajana kA Arambha karane vAlA hotA hai / saMvardha ke sabhI kozA kabhI marate haiM yadyapi mAnava zarIra para jitanI mAtrA meM kiraNoM kA prayoga hotA hai usase kahIM adhika mAtrA meM kiraNoM kA prayoga kiyA. jAtA hai / para kiraNoM kA mAraka prabhAva zarIrastha karkaTa kozAoM kI apekSA bahuta adhika huA karatA hai / kyoMki jaba saMvardha ke padArtha se upasaMvardha taiyAra kie jAte haiM to avaziSTa kozAoM meM punarjanana kI zakti hI nahIM rahatI / parantu isakA artha. yaha nahIM ki unakI punarjanana zakti turata hI gAyaba ho jAtI hai api tu ve eka do nahIM darjanoM pIr3hI utpanna karane ke pazcAt bekAra ho jAte haiM aura dhIre dhIre ke kozA jo unake dvArA vibhajana se bane haiM sabhI naSTa ho jAte haiM / abhI abhI jo UtisaMvargoM para teja kiraNoM ke prabhAva ke sambandha meM prayoga ho rahe haiM ve batalAte haiM ki tejIya pravikiraNa kA prathama prabhAva kozAoM kI zvasanakriyA ke kama hone meM hotA hai / yadyapi unakI madhuaMzanI ( glycolysis ) kriyA sthira rahatI hai / zvasana. kriyA meM bAdhA pahu~canA hI kiraNoM kA mukhya prabhAva pratIta hotA hai / nyaSTi aura kozA kI kalA ( membrane ) para kriyA hone se tathA kaNAbha sUtroM (mito-chondria ) ke vinAza se jo kozIya zvasana se sambandhita hote haiM tathA vAhinIya antararSa ke kAraNa jAraka pUrti ke abhAva ke kAraNa yaha zvasana kArya rukatA hai / isase jJAta hogA ki svAbhAvika athavA Arbudika Uti para pravikaraNa kA prabhAva sAdhAraNa na hokara bahuta jaTila hotA hai / zAvibhajana pUrvI kAla ( premitotic phase ) meM jaba hone hI vAlA hotA hai usa samaya pravikiraNa kA sarvAdhika prabhAva usa samaya kiraNa lagate hI kozA mara jAtA hai / para yadi kozA usa For Private and Personal Use Only nyaSTIya vibhajana dekhA jAtA hai / avasthA ko na pahu~ca pAyA ho to usa samaya kiraNa ke prabhAva se nyaSTIya vibhajana kucha kAla ke lie rukakara phira thor3e samaya bAda ho jAtA hai / para isa samaya kA vibhajana anRju hotA hai aura yA to vibhAjita hote hote hI kozA khatama ho jAtA hai yA vibhajita hue kozA banane ke bAda mara jAte haiM / jaba kozA vizrAma kAla meM ho aura usakA pravikiraNa kara diyA jAve to usa samaya koI parivartana prakaTa nahIM hotA para Age kI pIDhiyoM meM praguNana nahIM hotA aura kozA mara jAtA hai / prAyogika kArya ke dvArA hama isa pariNAma para pahu~cate haiM ki pravikiraNa kA mukhya prabhAva pitrya sUtroM (chromosomes ) para hotA hai / yaha do prakAra kA hotA hai / yadi kozA vibhAjita ho rahA ho to pitryasUtra eka dUsare meM Abaddha ho jAte haiM aura vibhajana ruka jAtA hai aura yadi kozA vizrAmakAla ( resting phase ) meM ho to Age kI kozIya parivartanAvasthA kucha kAla ke lie ruka jAtI hai aura pitryasUtroM meM

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vikRtivijJAna itastataH TUTa phUTa ho jAtI hai jo dhIre dhIre ThIka ho jAtI hai| ThIka hone meM ve anya pitryasUtroM ke Tukar3oM ke sAtha jur3a jAte haiM jisake kAraNa vicitra prakAra ke pitryasUtra bana jAte haiM jisake kAraNa kozA ko usake pitryasUtroM kA abhAva ho jAtA hai aura kozA khatama ho jAtA hai| AtmavihAsa (autolytic degeneration ), mRdvana ( softening ) tathA vRddhi kA avarodha ina tInoM meM se koI bhI avasthA pravikiraNa ke kAraNa arbudoM meM dekhI jA sakatI hai| yaha abhI taka pramANita nahIM huA ki duSTa kozAoM para Rju kozAoM kI apekSA vikiraNa kA adhika prabhAva par3atA hai| aisA kucha bhI nahIM hotA para kauna kozA kitanI jaldI apanA praguNana karatA hai isa tathya kA pravikiraNa se paryApta sambandha hai kyoMki jitanA hI kozA adhika praguNanazIla hogA vaha pravikiraNa ke lie utanA hI adhika anuhRSa hogaa| pravikiraNa kA raktavahAoM para prabhAva jaba kisI arbuda yA Rju Uti para pravikiraNa kiyA jAtA hai to usakA sarva prathama prabhAva kezAloM ke ghAta ( capillary paralysis ) meM hotA hai sAtha hI bahuta tIvra paramaraktatA vahA~ para ho jAtI hai| isake bAda vAhiniyoM ke antazchada meM AghAta hone ke kAraNa unameM ghanAsrotkarSa ho jAtA hai| kabhI vAhiniyA~ phaTa taka jAtI haiN| Age calakara unameM abhilopI antazchadapAka ho jAtA hai| isa sabake kAraNa arbuda ko prApta hone vAlA aparimita raktabhaNDAra banda ho jAtA hai jisake kAraNa usakA tanAva ghaTa jAtA hai aura usake vinAza kA Arambha prakaTa hone lagatA hai| yahA~ hama rausa ke eka rugNa kA varNana karate haiN| jisake zarIra meM eka tejAtu sUcI ( radium needle ) kho gaI aura vaha 3 varSa taka hRtpezI meM par3I rhii| hRtpezI eka Rju Uti thI aura vaha duSTa ati nahIM thii| yahA~ para isa sUcI ke kAraNa 3 prakAra ke vikSata bne| eka jo sUcI ke pUrNataH samIpa banA vaha UtinAzaka ( necrotic ) thaa| dUsarA jo usake cAroM ora banA vahA~ AMzika UtinAza ( partial necrosis ) huI thI vahA~ vAhiniyoM meM kSati hote hue bhI kucha sajIva pezI kozA pAye gaye tathA tIsarA sabase bAhara ke vikSata meM atitIva adhiraktatA tathA raktasrAva pAyA gyaa| upazama kI prakriyA jisa sthAna para vikiraNa ho cukA hai vahA~ vaha eka prakSobhaka kA kArya karatA hai aura vahA~ vraNazothAtmaka pratikriyA utpanna ho jAtI hai / yaha pratikriyA arbuda ke saMdhAra meM hotI hai tathA kozooM meM bhI hotI hai| kozA Arambha meM bahunyaSTi sitakozA hotA hai jo bAda meM lasIkozAoM tathA upasipriya kozAoM dvArA badala diye jAte haiM / ye kozA usa sthAna ke saMrakSaNa kA kArya karane ke lie Ate haiN| Age calakara aura bahuta zIghra tantukRta ( fibroblasts ) vahA~ utpanna ho jAte haiM jo praguNana karane lagate haiM aura eka saghana tantUtkarSa utpanna kara dete haiN| mRta ati ko dUra karane kA kArya mahAmati For Private and Personal Use Only

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arbuda prakaraNa 701 ( macrophages ) karate haiM ye bahuta bar3I saMkhyA meM ekatra hokara una karkaTa kozAoM para AghAta karate haiM jo pravikiraNa dvArA AghAtagrasta hote hue bhI abhI sajIvAvasthA meM hote haiN| dhIre-dhIre sampUrNakSetra meM tantUtkarSa ho jAtA hai| Age jaba yaha saMkucita hotA hai to raktapUrti ko aura bhI kama kara detA hai / tantUtkarSa ke andara kahIM-kahIM arbuda kozAsamUha itastataH par3e hue milate haiM / arbudahRSatA ( sensitivity of tumours ) cikitsA dRSTi se arbuda hRSatA anekoM tathyoM para avalambita hone ke kAraNa usakA samajhanA bahuta kaThina hotA hai use sugama karane ke lie use 4 bhAgoM meM vibhAjita kiyA jAtA hai:: 1 - arbuda vRddhi kI gati / 2-arbuda Uti ke vivibhinnana kI mAtrA | 3- mAtR Uti ke kozA kA prakAra / 4 - razmiyoM aura arbuda kozAoM ke bIca ke padArtha / arbudavRddhi kI gati se una nyaSTiyoM kI saMkhyA ko liyA jAtA hai jo vibhajana ora bar3ha rahI haiM aura jina para razmiyoM kA ghAtaka prabhAva hone vAlA hai / sAdhAraNa tayA hama yoM kaha sakate haiM ki jina arbudoM meM kozA kama aMza meM vibhinnana prakaTa: karate haiM unameM bar3hane kI zakti adhika hotI hai aura unake adhika saMkhya kozA kisI bhI samaya vibhAjita hote haiN| adhika vistAra meM jAne se kisI bhI arbuda kI tejo patA usake vivibhinnana ke aMza ( degree ) ke samAnAntara calatI hai / mAtR Uti kA kozA kauna prakAra kA hai isakA bahuta bar3A mahattva hotA hai / kyoMki tejohRSatA kI dRSTi se Rju UtiyoM meM Apasa meM bahuta antara hotA hai tathA jisa Uti se jo arbuda banatA hai usa arbuda ke dvArA apanI mAtR Uti ke anusAra hI tejohaSatA prApta kI jAtI hai / Rju UtiyoM meM prajananAMgoM ko prajananazIla adhicchada tathA jAlakAnta - dIya saMsthAna ke kozAoM para pravikiraNa kA atyadhika prabhAva par3atA hai arthAt ye donoM sarvAdhika tejohRSa hote haiM / prajananAMgIya arbudoM ke kozIya prakAra jaTila hote haiM khAsa kara NArbuda (teratomatas ) meM / yadyapi vRSaNoM ke zukrArbuda bhI bahuta adhika tejohRSa hote haiM / jAlakIya saMkaTArbuda tathA jAlakotkarSa ( reticuloses ) donoM bhI adhika tejohRSa hote haiN| tvacA meM tejohRSatA madhyama darje kI hotI hai / asthiyoM meM yaha bahuta kama dekhI jAtI hai tathA vAtanADiyoM meM tejohRSatA nAma mAtra ko hI hotI hai| adhicarmAbha karkaTa ( epidermoid cancer) acchA tejohRSa hotA hai vahA~ vi - vibhinnana kA bahuta mahattva hai / asthijanaka saMkaTArbuda kama tejohRSa hotA hai | zleSasaMkaTArbuda (gliosarcoma ) tathA kAlyarbuda ( melanoma ) donoM atyadhika duSTa arbuda hote hue bhI ina para pravikiraNa kA bahuta kama prabhAva hotA hai 1 ve padArtha jo teja kiraNoM ko arbuda kozAoM taka pahu~cane meM kaI prakAra ke hote haiM / yadi arbuda bahuta gaharAI meM hai to Rju bAdhaka ho sakate haiN| UtiyA~ bhI bAdhA For Private and Personal Use Only

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702 vikRtivijJAna pahu~cA sakatI haiN| sAtha hI mRta arbudIya Uti kA AvaraNa car3hA hone para andara sajIva arbuda kozAoM para kiraNoM kA koI prabhAva nahIM dekhA jA sktaa| kucha kyA bahuta se karkaTa jIrNa vraNazotha kara dete haiM jisase unake cAroM ora saghana tAntava AvaraNa car3ha jAtA hai jo unheM kiraNoM ke prabhAva se bacA sakatA hai / stana ke azmopama karkaTArbuda ( scirrhus cancer of tbe breast ) meM yaha vraNavastusama AvaraNa kiraNoM se usakI paryApta rakSA karatA hai| bAra-bAra pravikiraNa ke kAraNa bhI arbuda ke cAroM ora saghana tAntava AvaraNa car3ha jA sakatA hai jo kiraNoM kI mAraka zakti ko ghaTA sakatA hai| arbudoM meM kAcara vihAsa tathA zleSmIya vihrAsa hote haiM jinake kAraNa bhI kiraNoM kA kama prabhAva ho sakatA hai| stana ke karkaTa meM stana ke Upara kA sneha (fat) pravikiraNa kriyA ko pUrI taraha nahIM hone detaa| asthi meM gayA huA karkaTa tejohRSa hotA huA bhI avAhinya saghana asthi ke aMcala meM kiraNoM ke praveza ruka jAne ke kAraNa surakSita raha sakatA hai| ataH pravikiraNa zAstra ke jJAtAoM ko taijasa kiraNoM ke prayoga se pahale bahuta kucha kaThinAiyoM ko pAra karanA par3atA hai taba ve isa cikitsA meM kucha saphalatA prApta kara pAte haiN| isa viSaya ko bvAyaDa ne nimna dRSTi se spaSTa kiyA hai| usakI dRSTi meM arbuda kI hRSatA yA pratirodha nimna para nirbhara karatA hai: vibhinnana ( differentiation ) ati jitanI hI adhika praur3ha prakAra kI hogI tathA jitane hI adhika kozA vibhinnita hoMge arbuda utanA hI adhika pravikiraNa pratirodhI pAyA jaavegaa| prathama varga kA adhicarmAbha karkaTa isakA udAharaNa hai| sAdhAraNa prakAra ke arbuda prAyaH pravikiraNa pratirodhI hote haiM parantu isa zabda kA prayoga sApekSa hI lenA caahie| sAdhAraNa arbuda meM to pravikiraNa se vRddhi kA pratirodha bhI ho jAtA hai| garbhAzaya kA pezyarbuda usakA apavAda hai| pravikiraNa use dravIbhUta kara detA hai| anaghaTita (anaplastic ) tathA atyadhika avibhinnita ( undifferentiated ) arbudoM meM jahA~ sUtra vibhajana paryApta hotA hai ve sarvAdhika tejohRSa huA karate haiM / inameM bhI kaI apavAda mila sakate haiN| zleSaghaTArbuda bahurUpI (glioblastoma multiforme ) kAlyarbuda tathA vAtanADIjanya saMkaTArbuda atyadhika anaghaTita tathA pracaNDa duSTArbuda hone para bhI atyadhika pravikiraNa pratirodhI hote haiN| isake viparIta zanaiH zanaiH bar3hane vAlI kRntaka vidradhi ( rodent-ulcer ) jisameM bhAjanAGka bhI bahuta kama hote haiM pravikiraNa se atizIghra prabhAvita hotA hai| kaithI kA kathana hai duSTa arbuda kI tejohRSatA kI mAtrA usakI nyaSTi meM nihita nirindriya padArthoM kI mAtrA para nirbhara karatI hai| aNudAha ( micro-incineration ) kA eka prakAra hotA hai usake dvArA arbuda ke aNumAtra padArtha ko jalA kara rAkha kara liyA jAtA hai| usa rAkha meM nirindriya ( inorganic ) tatvoM kA patA lagA lete haiN| yadi yaha adhika huA to tejohRSatA bhI adhika hogI para yadi kama huA to kama hogii| For Private and Personal Use Only

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arbuda prakaraNa 703 pravikiraNa ke prati hRSatA eka bAta hai aura sAdhyatA dUsarI bAta hai / atyadhika duSTa arbuda tejohRSa atyadhika hote hue bhI apane sthAna se naSTa kara diye jAte haiM parantu unake dvArA uttarajAta vRddhiyoM kI utpatti jo pahale se hI ho jAtI hai vyakti ko mAra DAlatI hai| isake udAharaNa lasasaMkaTArbuda tathA asthi kA IviMgArbuda (Ewing's tumour of bone ) haiN| vRSaNa ke mizrita arbuda meM jise saMyuktArbuda yA bhrauNArbuda ( teratoma ) kahate haiM jisameM zrauNikIya tathA praur3ha donoM prakAra kI UtiyA~ bhAga letI haiN| pravikiraNa se prathama Uti khatama ho jAtI hai parantu dvitIya jyoM kI tyoM rahatI hai isalie yadyapi prANizAstradRSTayA parivartita hone para bhI arbuda ke AkAra meM koI parivartana nahIM huA krtaa| saMdhAra-yadi saMdhAra saghana ho jaise kAsthi yA asthi kA to pravikiraNa kA kama prabhAva ho pAtA hai| yahI kAraNa hai ki asthi kA asthijanaka saMkaTAbaMda jisameM saMdhAra paryApta hotA hai pravikiraNa pratirodhI hotA hai| para yadi nirantara pravikiraNa kiyA jAve to visthAyI arbudoM kI utpatti kadAcit kama ho jaave| IviMga kA asthyarbuda tathA anya tejohaSa arbudoM meM jo atyadhika tejohRSa hote haiM saMghAra bahuta kama pAyA jAtA hai| arbudazaiyA kI prakRti-yadi karkaTa kozA snaihika ati yA asthi meM cale jAte haiM to pravikiraNa kA koI vizeSa prabhAva nahIM pdd'taa| upasarga-arbuda meM upasarga lagane se vaha adhika pravikiraNa pratirodhI bana jAtA hai| dUsare pravikiraNa upasarga ke prati rahane vAle pratirodha ko bhI samApta kara detA hai| malAzaya ke karkaTa kA adhikAMza bhAga yadi na nikAla kara pravikiraNa kiyA jAve to pravikiraNa ke kAraNa upasarga ke prati audAsInya kI sthiti bhayaMkara pariNAmotpAdikA bana jAtI hai| avApta pratirodha-yadi aparyApta mAtrA meM pravikiraNa kiyA jAve to arbudIya kozA pravikiraNa pratirodhI ho jAyA karate haiN| ataH paryApta mAtrA meM pravikiraNa karanA Avazyaka hotA hai| tejohRSatA kI dRSTi se puSTa arbudoM ko 3 zreNiyoM meM vibhakta kiyA jA sakatA hai:1. atyadhika tejohRSa arbuda-lasasaMkaTAbuda, bahu asthimajakArbuda, lasa adhi cchadArbuda, bhrauNakarkaTa / 2. madhyama tejohaSa arbuda-adhicarmAma karkaTa, sAdhAraNa karkaTa, donoM meM ana ghaTana kI mAtrA kA vicAra Avazyaka hai| 3. atyadhika pravikiraNa pratirodhI-tantusaMkaTArbuda, asthisaMkaTArbuda, vAtasaMkaTArbuda, kAlyarbuda, zleSArbuda, avaTukIya granthikarkaTa ko chor3a zeSa sabhI granthikarkaTa / kevala aNvIkSIya arbuda citra ko dekha kara tejohRSatA kA patA lagAnA lAbhadAyaka nhiiN| isake lie to arbuda ke sthUla citra kA vicAra honA Avazyaka hai zarIra meM For Private and Personal Use Only

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704 vikRtivijJAna kisa sthAna para arbuda hai, roga kA vistAra kitanA ho gayA hai, karkaTIya bharamAra samIpastha UtiyoM meM kahA~ taka gaI hai, abaMda kA sthUla citra kaisA hai tathA rogI kI sthiti kaisI hai ina saba bAtoM kA vicAra karate hue hI pravikiraNa cikitsA kA upayoga karanA caahie| arbudoM kA vargIkaraNa ( Classification of Tumours ) vidvAnoM ne arbudoM ke vividha vargIkaraNa prastuta kie haiM parantu sarvAdhika upAdeya vargIkaraNa vaha mAnA jAtA hai jisake dvArA arbuda kI Uti kA jJAna ho jAve, kozA kA prakAra jJAta ho jAve tathA duSTatA yA sAdhAraNatA kA jJAna ho jAve, para kyoMki bahuta arbudoM meM unake avibhinita yA anaghaTita (anaplastic ) hone ke kAraNa kozA prakAra kA jJAna karanA kaThina ho jAtA hai hama yahA~ pahale eka sarvamAnya vargIkaraNa dete haiM phira eka eka prakAra ke arbuda kA varNana karate haiM tatpazcAt kina kina aMgoM meM vaha arbuda pAyA jAtA hai usakA bhI varNana kie dete haiM tAki sampUrNa viSaya kA pUrNAza meM jJAna pAThakoM ke sAmane A jAve / (1) adhicchadIya Uti ke arbuda (ka) duSTa-karkaTArbuda ( Carcinoma ) / (kha) sAdhAraNa-aGkurArbuda ( Papilloma ) / granthyarbuda ( Adenoma ) / (ga) anya-ativRkkArbuda ( Hypernephroma ) / jarATavadhicchadArbuda ( Chorion epithelioma ) / dantAkAcArbuda ( Adamantinoma ) / (2) saMyojI Uti ke arbuda (ka) duSTa-saGkaTArbuda (Sarcoma) / pRSThamevarbuda (Chordoma ) / (kha) sAdhAraNa-tanvarbuda ( Fibroma ) / zleSmArbuda (Myxoma) / vimedArbuda ( Lipoma) / kAsthyarbuda (Chondroma), asthya rbuda (Osteoma) / (3) pezI Uti ke arbuda arekhita pezyarbuda ( Leomyoma) rekhita pezyarbuda ( Rhabdomyoma ) / (4) vAhinIya arbuda zoNavAhinyarbuda yA sirArbuda (Haemangioma ) lasavAhinyarbuda ( Lymphangioma ) For Private and Personal Use Only

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arbuda prakaraNa (5) antazchadArbuda (Endothelioma ) ( 6 ) zoNotpAdaka UtiyoM ke arbuda duSTa - lasasaGkaTArbuda (lymphosarcoma ) hAja kinAmaya ( Hodgkin's disease ) atizvetaraktatA ( Leukaemia ) bahumajjakArbuda ( multiple myeloma ) sAdhAraNa - lasArbuda (lymphoma ) (7) vAta UtIya arbuda (8) raMgita arbuda carmakIla vA nyaccha ( naevus ) kAlyarbuda ( melanoma ) 1. vAtika arbuda 2. paittika arbuda 3. zlaiSmika arbuda ( 6 ) saMyuktArbuda vA bhrauNArbuda ( Teratoma ) Ayurveda meM jo arbudoM kA vargIkaraNa kiyA gayA hai usake anusAra hameM nimna prakAra ke arbuda milate haiM: - Acharya Shri Kailassagarsuri Gyanmandir raktArbuda ke lakSaNa dete hue likhA hai -- vAtika arbuda - vAtika granthi ke samAna kRSNavarNa, kaThina, basti ke samAna phUlA huA toda zUlAdi yukta honA cAhie / paittika arbuda - paittika granthi ke samAna lAla yA pIle varNa kA dAhayukta uSNa honA cAhie / zlaiSmika arbuda - zlaiSmika granthi ke samAna pASANavat kaThina, dera meM bar3hane cAlA, tvacA ke varNa kA honA cAhie / 4. raktArbuda 5. mAMsArbuda 6. medasArbuda 705 doSaH praduSTo rudhiraM sirAstu sampIDaya saMkocya gatastu pAkam / sAsrAvamunnahyati mAMsapiNDaM mAMsAGkurairAcitamAzuvRddhim // sravatyajatrarudhiraM praduSTamasAdhyametadrudhirAtmakaM syAt / raktakSayopadravapIDitatvAt pANDurbhavedarbudapIDitastu // For Private and Personal Use Only duSTa huA doSa, rakta aura sirAoM ko sampIDita aura saMkucita karake pAka ko prApta huA strAvayukta mAMsAMkuroM se bharA zIghra bar3hane vAle mAMsapiNDa ko uThAtA hai / usase nirantara duSTa rakta nikalatA rahatA hai / yaha raktArbuda asAdhya hotA hai / rakta ke barAbara nikalane se raktakSaya ( anaemia ) ke upadrava se arbuda pIDita rogI pANDu varNa kA ho jAtA hai /

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706 vikRtivijJAna mAMsArbuda - kA varNana karate hue likhA hai / Acharya Shri Kailassagarsuri Gyanmandir muSTiprahArAdibhirardite'Gga mAMsaM praduSTaM prakaroti zopham / avedanaM snigdhamananyavarNamapAka mazmopamamapracAlyam // praduSTamAMsasya narasya bADhametad bhavenmAMsaparAyaNasya / mAMsArbudatvetadasAdhyayuktam ( suzruta ) muSTiprahAra AghAta ( trauma ) Adi se pIDita aMga meM mAMsa praduSTa hokara vedanAzUnya snigdha, ananyavarNa kA, na pakane vAlA, patthara ke samAna kaThina sthira zopha utpanna ho jAtA hai / yaha atyadhika mAMsa khAne vAle meM hotA hai / medasArbuda medogranthi ke samAna zarIra vRddhikSaya ke anusAra bar3hane ghaTane vAlA snigdha, kaSTadAyaka, kaNDUyukta tathA medas yukta hotA hai / inake atirikta eka adhyarbuda batalAyA hai / eka arbuda meM dUsare arbuda kI sthiti ko adhyarbuda kahate haiN| Age hama kaI adhyarbudoM kA varNana kareMge / dvirarbuda nAma se jo varNana hai vaha arbuda kA eka sthAna se dUsare sthAna utpanna hone vAle visthApana ( metastases ) haiM - arbudaM tvarbudaM jAtaM dvandvajaM cAnujaM ca yat / dvirarbudamiti jJeyaM taccasAdhyaM vinirdizet // dvirarbuda asAdhya hotA hai / ( bhoja ) ( 1 ) adhicchadIya Uti ke arbuda saMyojI Uti meM arbudoM kI apekSA adhicchadIya kozAoM se prakaTa hone vAle arbuda adhika spaSTa hote haiM kyoMki inameM 2 ghaTaka hote haiN| eka ghaTaka to svayaM adhicchadIya kozA haiM tathA dUsarA ghaTaka saMyojI Uti kA saMdhAra ( stroma ) hai jo adhicchadIya kozAoM kA AdhAra banatA hai tathA jisake dvArA raktapUrti hotI hai / isI kAraNa adhicchadIya arbudoM meM kozAoM kA vinyAsa ( arrangement ) bahuta spaSTa aura sudRr3ha hotA hai / yaha vinyAsa atyadhika duSTa prakAra ke arbuda meM avazya naSTa hotA huA rahatA hai anyathA barAbara milatA hai| 1 For Private and Personal Use Only adhicchadIya arbudoM ke kozAoM kA vinyAsa vizeSa prakAra kA hotA hai / arthAt adhicchadIya kozA eka dUsare se cipaTa kara samUhoM meM rahate haiM / pratyeka kozA samUha saMyojI Uti ke saMghAra dvArA pRthaka rahatA hai aura eka prakAra kA vinyAsa ( alveolar arrangement ) bana jAtA hai / para pratyeka kUpikA ( alveolus ) ke kozAoM ke bIca meM koI saMyojI UtikozA nahIM rahatA / adhicchadrIya Uti ke 3 arbuda kula milate haiM jinameM karkaTa atyadhika prabhAvI mAraka aura duSTa hotA hai tathA anya do aGkurArbuda tathA grantharbuda sAdhAraNa arbuda hote haiN| aba hama isa viziSTa Uti ke tInoM arbudoM kA Avazyaka varNana upasthita karate haiM:

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707 arbuda prakaraNa karkaTa yA karkaTArbuda ( Caneer or carcinoma.) karkaTa eka prakAra kA duSTa arbada hotA hai jo adhicchadIya racanAoM meM banatA hai, jisake kozA adhicchadIya hote haiM jo saMyojI Uti ke saMdhAra meM nihita rahate haiM / karkaTa prAvara vihIna hotA hai tathA samIpa kI svastha UtiyoM meM yaha isa prakAra ghusA huA rahatA hai ki karkaTa tathA svastha UtiyoM ke bIca meM rekhA nahIM khIMcI jA sktii| karkaTa sadaiva saMyojI UtiyoM ke cAroM ora ke lasAvakAzoM (lymph spaces ) para AkramaNa karatA hai / karkaTa ke kozAoM kA vinyAsa adhicchadIya hotA hai| kozA samUhoM yA avakAzikAoM (alveoli ) meM rahate haiN| pratyeka kozAsamUha yA avakAzikA ke cAroM ora saMyojI Uti rahatI hai| saMdhAra kI mAtrA sadaiva eka barAbara nahIM rahatI tathA usakI mAtrA ke dvArA arbuda kA bhautikIya svarUpa nirdhArita kiyA jAtA hai| prAthamika karkaTa kA cheda dekhane se jJAta hotA hai ki mAnoM vaha aneka pRthak puMjoM ke dvArA banA huA ho| ye puMja kendriya puJja ke bar3he hue bhAga hote haiM jo anekatA kA eka bhrAmaka citra upasthita karate haiN| karkaTa kA saMdhAra Arambha meM usa bhAga meM sthita saMyojI Uti ke dvArA hI banatA hai parantu karkaTa ke kAraNa samIpastha svastha utiyoM meM vraNazotha utpanna ho jAtA hai jisake kAraNa karkaTa ke kinAroM para gola kozAoM kI bharamAra ho jAtI hai aura saMyojI Uti ke prakSobhAtmaka paramaghaTana ke kAraNa tAntava Uti utpanna hone lagatI hai| Arambha meM jaba arbuda bananA Arambha karatA hai taba usameM saMyojI Uti ke sAtha-sAtha anya UtiyoM ke bhAga bhI vRddhi karate haiM jaise vakSa karkaTa meM snehakozAoM kI yA puraHsthakarkaTa meM pezIsUtroM kI vRddhi dekhI jAtI hai parantu Age cala kara jyoM-jyoM arbuda bar3hatA calatA hai ve tirohita hote cale jAte haiN| karkaTa kI racanA karkaTa ke nirmANa meM kozA adhicchadIya hote haiM tathA saMdhAra saMyojIUti kA banA hotA hai itanA hameM pahale se hI jJAta hai| karkaTa ke adhicchadIya kozAoM meM nimna vizeSatAe~ milatI haiM: (1) adhicchadIya kozAoM kA AkAra bar3A hotA hai| (2) mUla adhicchadIya Uti kI tulanA meM ina kozAoM meM vibhinnana kA abhAva pAyA jAtA hai| (3) ye kozA mUla uti ke kozAoM kI apekSA bahuta aniyamita (irregular) hote haiN| (4) ina kozAoM meM nyaSTi adhika bar3I tathA spaSTa (prominent) hotI hai / nyaSTiyA~ gola, aNDAkAra, tarkAkAra, bahubhujIya yA pucchIya ( caudate) hotI haiN| inameM eka yA do ninyaSTiyA~ (nucleoli ) rahatI haiN| eka kozA meM For Private and Personal Use Only

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708 vikRtivijJAna bahudhA eka hI nyaSTi hotI hai tathA vaha paramavarNika ( hyperchromatic ) hotI hai parantu prAyaH do yA adhika nyaSTiyA~ bhI pAI jA sakatI haiM / Acharya Shri Kailassagarsuri Gyanmandir (5) jyoM-jyoM arbuda adhika drutagati se bar3hatA hai tathA aprArUpika ( atypical ) hotA calA jAtA hai usameM sUtribhAjanAGka ( mitotic figures ) adhikAdhika milatI calI jAtI haiN| (6) kozA sadaiva samUhoM yA avakAzikAoM meM rahate haiM / inake bIca meM saMghAra kadApi nahIM hotA yadyapi eka kozAsamUha dUsare kozAsamUha se saMghAra dvArA pRthak kiyA huA rahatA hai | ( 7 ) sAdhAraNa adhicchIya arbuda ke kozAoM ke sAtha karkaTa ke kozAoM kI tulanA karane para yaha jJAta hotA hai ki jahA~ sAdhAraNa adhicchadIyArbuda ke kozA apane sthAna meM hI tathA prAvarita rahate haiM karkaTa ke kozA apanI adhastRta kalA ( basement membrane ) ko nicchidrita ( perforate ) kara dete haiM tathA samIpa kI svastha UtiyoM meM ghusa jAte haiM / (8) jyoM-jyoM kozAoM kA vibhinnana kama hotA jAtA hai tyoM-tyoM unakA vyaktitva kama hotA jAtA hai aura ve eka prarasa ke bhakSaNazIlastAra ( cytoplasmic syncitial sheet ) kA rUpa le lete haiM / karkaTIya saMdhAra kI vizeSatAoM kA hama nimnarUpa samajha sakate haiM: ( 1 ) bhinna-bhinna prakAra ke karkaTa meM saMdhAra kI mAtrA pRthak-pRthak rahatI hai / ( 2 ) jo karkaTa jitanI adhika gati se bar3hate haiM unameM saMdhAra kI mAtrA utanI hI kama pAI jAtI hai / 1 ( 3 ) saMdhAra tAntavaUti se banatA hai / tAntavaUti isa prakAra vinyasta hotI hai ki vaha aneka AkAra kI avakAzikAe~ ( alveoli ) banA detI hai jinake bhItara karkaTIya kozAsamUha rahate haiM / ( 4 ) saMdhAra karkaTa kozAoM ke sAtha na to bahuta adhika saMlagna hotA hai aura na unake bIca meM se pAra jAtA hai / ( 5 ) saMdhAra meM raktavAhiniyA~ rahatI haiM saMkhyA meM ve bahuta adhika hotI haiM aura avakAzikAoM ke cAroM ora eka bahuta ho nikaTa jAla banA letI haiM, ye sadaiva saMdhAra taka hI sImita rahatI haiM tathA kabhI bhI karkaTa kozAoM ke bIca se pAra nahIM hotIM, yaha vAhinIvinyAsa isalie bhI mahattvapUrNa hai ki isI se pArthakya kA patA lagatA hai / karkaTa vA saMkaTArbuda ke ( 6 ) karkaTa jisa bhAga meM sthita hai usa bhAga ko jAne vAlI raktavAhiniyA~ sadaiva AkAra meM bar3hI ho jAtI haiM inakI vRddhi kA spaSTa hetu abhI taka gupta hI hai / (7) saMkaTArbuda kI apekSA karkaTa meM raktavAhiniyA~ adhika acche prakAra banA karatI haiM kyoMki karkaTa utanA koTarAbha ( sinusoidal ) nahIM hotA jitanA kArbuda | For Private and Personal Use Only

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706 arbuda prakaraNa (8) lasavAhiniyA~ bahuta svatantratApUrvaka avakAzikAoM se apanA sambandha rakhatI haiM yahI kAraNa hai jo karkaTa kA lasAbhagranthiyoM se pragADha sambandha rahatA hai| avakAzikAe~ lasAvakAza mAne jA sakate haiM jinake kinAre-kinAre adhicchadIya stambha ugate haiM kyoMki yahIM pratirodha kI rekhA sabase halakI hotI hai / ___ karkaTa ke prakAra karkaTa adhicchada meM utpanna hotA hai| adhicchada ke kaI prakAra hote haiM, ataH karkaTa bhI kaI prakAra kA ho sakatA hai| jisa prakAra ke adhicchada meM usakA janma hotA hai usI prakAra kI vizeSatAoM se yukta karkaTa dekhA jAtA hai| jo karkaTa stRtAdhicchada ( stratified epithelium ) se nikalatA hai usakA vikAsa usI krama se hotA hai aura anta meM usameM kadarIkaraNa ( cornification ) hotA hai tathA adhikAMza meM zitAnakozA ( prickle cells) dekhe jAte haiN| stambhAkAra adhicchada meM utpanna karkaTa apanI racanA ko yathAvat banAe rakhatA hai tathA khule avakAzoM ko ghere rahane kA nirantara yatna karatA hai| kabhI-kabhI kozA praguNita hokara una avakAzoM ko bhara bhI dete haiN| sabase bAharI bhAga ke kozA apanI rambhAkAra AkRti ko sthira rakhate haiN| gANvika granthiyoM ( acinous glands ) ke kozA apane jaise hI kozA taiyAra karate haiM parantu pIDana ke kAraNa unakI AkRti bahuta badalI huI dekhI jAtI hai| isa prakAra apane maulika rUpa ko sthira rakhane ke kAraNa hI zalkIya, stambhAkArI tathA gANvika karkaTa ke nAma se karkaTa pukArA jAtA hai| zalkIya karkaTa ko adhicchadArbuda ( epitheliomata) bhI kahA jAtA hai kyoMki usakI AkRti prakRta adhicchada ke sadRza hI hotI hai| eka prakAra kA karkaTa dUsare prakAra meM badala jAyA karatA hai| stRtAdhicchada se nikalA huA karkaTa kabhIkabhI kadarIbhUta nahIM hotA jaba ki stambhAkArI karkaTa stRtAdhicchadIya karkaTa jaisA dikhAI detA hai| vaha zalkAdhicchadIya karkaTa ke samAna bhI ho jA sakatA hai| aisA parivartana zvasanikA, garbhAzaya tathA pittAzaya meM utpanna karkaToM meM dekhA jAtA hai| kozA prakAra nizcita ho jAne para bhI vaikArikI vizAradoM ne karkaTa ko 2 sthUla prakAroM meM vibhAjita kara diyA hai jinameM eka ko granthikarkaTa (adeno-carcinoma) aura dUsare ko sAdhAraNa karkaTa ( carcinoma simplex ) kahA jAtA hai| yaha vargIkaraNa bhI anyoM kI bhA~ti sveccha hai tathA donoM prakAra ke karkaToM meM koI khAsa vibhAjana rekhA khIMcI bhI nahIM jA sktii| kisI bhI prakAra kA karkaTa ho mUlakarkaTa kI sabhI vizeSatAe~ usake uttarajAta svarUpa meM jyoM kI tyoM utara AtI haiN| karkaTa kI vRddhi kI gati tathA saMdhAra kI upasthiti kA anupAta avazya badala sakatA hai| AbhyantarIya aMgoM kI uttarajAta vRddhiyoM kA vikAsa bahuta tejI se hotA hai ve bahuta adhika raktAnvita tathA mRdu hotI haiN| For Private and Personal Use Only

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vikRtivijJAna karkaTa ke vividha prakAroM kA varNana karane ke pUrva hama usake 2 sthUla rUpoM kA vicAra karanA paramAvazyaka samajhate haiN| inakA nAmollekha pahale ho cukA hai| inameM eka prakAra granthikarkaToM kA hai aura dUsarA prakAra sAdhAraNa karkaToM kA hai| ___ granthikarkaTa-isa varga ke karkaToM meM sAmAnya lakSaNa nimnalikhita dekhane meM Ate haiM-(1) inakI vRddhi guru ( bulky ) tathA mRdu ( soft) hotI hai| (2) racanA aMkurIya ( papillary ) hotI hai| (3) jisa aMga meM ye utpanna hote haiM usameM adhika andara taka praveza na karake usase dUra hI bar3hate haiN| (4) racanA kI dRSTi se ye aGkurAbuMda ke sadRza hote haiM aura ve mUla aMga se paryApta milatI-julatI AkRti kI vRddhi karate haiN| (5) anya karkaToM kI apekSA isa kAraNa unameM dauSTya kucha kama hotA hai unameM bahuta bhayAnaka svarUpa ke bhI karkaTa bana sakate haiM parantu ve prAdezika lasagranthiyoM para prAyaH AkramaNa nahIM karate isa kAraNa se inakA uccheda saralatA se ho sakatA hai / (6) ye karkaTa bahuta adhika kozIya vRddhi karate haiM tathA kisI-kisI meM saMdhAra kI mAtrA bahuta kama hotI hai| (7) inameM vidradhibhavana zIghra hotA hai, UtinAza khUba hotA hai tathA unase raktasrAva saralatA se hotA rahatA hai| (8) isI varga ke jo karkaTa bRhadantra meM banate haiM unameM karkaTakozAoM kA pratikriyAtmaka tAntava saMdhAra utpanna ho jAtA hai| jaba vaha tAntava Uti saMkoca karatI hai to sAtha hI sAtha bRhadantra kA suSiraka bhI choTA par3a jAtA hai| aise tAntava yA upalopama granthikarkaTa kloma (sarva kiNvI ) granthi, sthUlAntra tathA malAzaya meM dekhe jAte haiN| ___granthikarkaTa vaise to kisI bhI adhicchadIya aMga meM banate haiM parantu nimna aGgoM meM vizeSa karake dekhe jAte haiM AmAzaya, uNDuka, malAzaya, vRkka, vakSasthala, bIjakopa / vakSa aura bIja granthi meM ve koSThaka ( cysts) kA nirmANa karate haiN| anya meM inakA sthUla svarUpa antrAvarodha bhI kara sakatA hai tathA antrAntrapraveza ( intussusception ) bhI ho sakatA hai yadi arbuda apane bhAra se nIce kI ora khisaka jAve / . zalkIyAdhicchadoM meM granthikarkaTa kama dekhane meM Ate haiN| gobhI ke phUla ke samAna ye annapraNAlI athavA tvacA para bhI dekhe jA sakate haiN| . sAdhAraNa karkaTa kI apekSA granthikarkaTa meM eka pravRtti zlepAbha vihAsa (apajanana) kI hotI hai| yaha parivartana vihAsa ke kAraNa hotA hai na ki mUla uti meM zlepi ( mucin) banane se ho / duSTa karkaTa kozAoM meM sUkSma zleSAbha bindukoM kI utpatti ke sAtha yaha vihAsa prArambha karatA hai / ye vinduka eka dUsare se mila kara kozA ko phulA dete haiN| kabhI kabhI isa praphullatA meM kozA kI nyaSTi eka kone kI ora jA par3atI hai tathA kozA bhI svayaM bahuta cipaTA ho jAtA hai aura dekhane meM mudrikAvat (signet ring cell ) ho jAtA hai| Age calakara kozA naSTa ho jAtA hai aura usakA sthAna racanAvihIna zleSAbha padArtha le letA hai yaha parivartana purAne bhAgoM meM hI hotA hai isa For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra zva www.kobatirth.org granthi racanA se vividha karkaToM kI utpatti pRSTha 710 cha ka Acharya Shri Kailassagarsuri Gyanmandir ka - yaha sAdhAraNa granthi hai isase vividha karkaTa banate hue pradarzita kie gaye haiMkha - stambhakozIya karkaTa ( granthikarkaTa ) / ga - azmopamakarkaTa ( golAbhakozIya karkaTa ) gha- mastuluMgAbha yA majjakIyakarkaTa ( golAbhakozIya karkaTa ) / ca - mizrakarkaTa / cha - zleSAbhakarkaTa / For Private and Personal Use Only

Page #785
arbuda prakaraNa 711 kAraNa karkaTa kA vistAra lagAtAra hotA rahatA hai aura usameM koI kamI nahIM aatii| ina vRddhiyoM se bane visthAyI karkaToM meM bhI yaha apajanana pAyA jAtA hai| sAdhAraNa karkaTa-isa varga meM adhikAMza karkaTa Ate haiN| sAdhAraNa karkaTa bahadhA unnata, bahiroSThI ( everted edges ) vidhi ke rUpa meM utpanna hotA hai jaba ki vaha kisI tvacA yA anya svatantra tala para prakaTa hotA hai| yadi aisA na dekhA gayA to phira eka nizcita kaThina gADhatA yukta arbuda kA puMja pAyA jAtA hai| racanAzAstra kI dRSTi se isameM kozAsamUha stambhoM meM rahate haiM jinake cAroM ora thor3A yA bahuta saMdhAra rahatA hai / ye arbuda granthikarkaToM kI apekSA adhika duSTa hote haiN| inake dvArA prAdezika lasagranthiyA~ upasRSTa ho jAtI haiM jisake kAraNa karkaTa kA vibhinna aMgoM meM visthApana ho jAtA hai| saMdhAra kI mAtrA bhI ina karkaToM meM bahuta bhinna milA karatI hai| kahIM-kahIM to vaha itanI kama hotI hai ki karkaTa bahuta mRdu aura kozIya hI dikhalAI par3atA hai ise mastuluMgAbha ( encephaloid ) yA majakIya ( medullary) karkaTa nAma de diyA jAtA hai| yahA~ kozA gola hote haiM kyoMki inake AkAra prApti ke mArga meM koI saMdhArIya bAdhA AtI nahIM isa kAraNa unheM golAbhakozIya karkaTa ( spheroidal cell cancer ) bhI kaha dete haiN| ye karkaTa prAyaH bahuta adhika raktamaya hote haiM jisase inameM raktasrAva bhI hotA rahatA hai| UtinAza adhika hone se ve koSThakIya rUpa bhI le liyA karate haiN| pratyakSa dekhane se sajIva bhAga gulAbI, dhUsara yA zveta rahatA hai tathA apajanita bhAga gUdAsadRza (pulpy ) aura raktaraMjita hotA hai / yaha to huA kama saMdhAra vAle karkaToM kA varNana / inake ThIka viparIta adhika saMdhAra vAle karkaTa hote haiM jo choTe-choTe parantu patthara ke samAna kaThina hote haiN| inameM tAntavIya saMdhAra paryApta hotA hai| isameM karkaTa kozAoM ke choTe-choTe samUha tAntavasUtroM ke bIca meM par3e rahate haiM / inhIM vRddhiyoM ko azmopama (scirrhus) karkaTa kahate haiN| aise arbuda vakSasthala meM choTe-choTe maTara ke barAbara taka bhI pAye jA sakate haiM parantu prAdezika lasagranthiyoM ko prabhAvita karane meM samartha hote haiM aura unake dvArA kaI sthAnoM para visthAyita karkaTa pAye jAte haiN| azmopama karkaTa strI-vakSa meM prAyaH milate haiM tathA AmAzaya meM pAye jAte haiN| A~toM meM ve bahuta kama milate haiN| tAntavasaMdhAra kI adhikatA ke kAraNa vakSasthalIya azmopama karkaTa meM cUcuka pratyAkRSTa (retract ) ho jAtA hai tathA stana meM gaDha-gadve se (dimpling) par3a jAte haiN| yahA~ para karkaTa kA itanA adhika sthira hone kA kAraNa tantUkarSa tathA karkaTa kozAoM kI bharamAra kA samIpastha bhAgoM meM adhika honA hai / ___ azmopama karkaTa kA kaTA huA tala nyubja (natodara ) hotA hai isakA kAraNa yaha hai ki cAkU cala jAne ke kAraNa saMdhAra meM upasthita tAntavasUtra pratyAkRSTa ho jAte haiN| tala kA varNa Ababhru zveta hotA hai, vakSasthala meM usa para pArAndha pIta dhAriyA~ par3I rahatI haiM yA dhabbe par3e hote haiM kyoMki avaruddha praNAliyoM meM snehAMza saMcita ho jAtA hai| cAkU se kATane para arbuda kaThina (gritty ) lagatA hai aura kaccI For Private and Personal Use Only

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712 vikRtivijJAna nAzapAtI ke sadRza kaTatA hai tala haTA dene para kozAoM aura kaNoM se yukta karkaTa yUSa milatA hai| azmopama karkaTa ke kendriya bhAga aNvIkSaNa karane para akozIya hote haiM para pariNAha para bahuta kozA milate haiM khAsa kara jahA~ vRddhi snaihika Uti para AkramaNa karatI hai| prAyaH kozAoM kI koI viziSTa AkRti nahIM hotI kyoMki tAntava saMdhAra bahuta adhika saMpIDita ho jAtA hai| adhika Ayu vAle vyaktiyoM meM tantUkarSa ke kAraNa itanI adhika apuSTi ho jAtI hai ki usake kAraNa apuSTa karkaTa ( atrophic cancer ) nAma taka diyA jAtA hai| azmopama karkaTa kI visthAyI vRddhiyoM ke kAraNa saghana tAntava saMdhAra kA nirmANa AkrAnta lasagranthiyoM meM ho jAtA hai| parantu adhikatara uttarajAta arbuda kozIya hote haiM aura unakA mastuluMgAma prakAra hotA hai jinameM golIya kozA hote haiN| ___ tantukarkaTa ( fibro-carcinoma ) nAma se eka atyadhika duSTa prakAra kA karkaTa bhI hotA hai jisameM kozAoM kA vinyAsa koI vizeSa nahIM hotA, na koI arbuda sarIkhA puMja hI dekhA jAtA hai balki kabhI-kabhI to Uti ke andara avizeSa kozAoM kI bharamAra itastataH ho jAtI hai| ye kozA kabhI-kabhI to samUha meM bhI na hokara akele hI idhara udhara phaile hue dekhe jAte haiN| isa karkaTa ke sAtha-sAtha jIrNa vraNazothAtmaka pratikriyA ke lakSaNa bhI milate haiN| tantukarkaTa kA udAharaNa AmAzaya ke prasara sthaulya meM milatA hai jisameM prAcIreM anAmya ( rigid ) ho jAtI haiM aura usakA suSiraka saMkucita ho jAtA hai / isa sthiti ko lAinAiTisa plAsTIkA (linitis plastica ) yA carmakUpI AmAzaya ( leather bottle stomach) kahate haiN| aisA vicitra vikSata AmAzaya ke mudrikAdvAra para banatA hai aura phira vaha yA to vahIM rahatA hai yA phira sampUrNa AmAzaya meM phaila jAtA hai| sthaulya sabase adhika upazleSmalakalA ( sabmucosa ) meM pAyA jAtA hai aura usakA pradhAna kAraNa jIrNa vraNazothAtmaka pratikriyA huA karatA hai isa pratikriyA se golANu yA choTe gola kozA akele yA samUha meM vahA~ para dekhe jAte haiN| __ prasara karkaToM ke anya bhI prakAra hote haiM / inameM eka vakSasthala para hotA hai| yahA~ para eka sphUrta prasara karkaTa strI ko usakI sagarbhatA meM utpanna ho jAtA hai aura kucha saptAhoM meM hI usakI jIvana lIlA samApta kara de sakatA hai| garbha ke kAraNa stanoM kI vRddhi ke sAtha-sAtha raktAdhikya hotA hai aura usI samaya yaha bhI bar3hatA huA dekhA jAtA hai / antaHsrAvI granthiyoM kI kriyA isakA kAraNa ho sakatA hai| uttarajAta parivartana karkaTa meM uttarajAta parivartanoM ( secondary changes ) meM do pramukhatayA dekhe jAte haiM jinameM eka snaihika vihrAsa hotA hai aura dUsarA snaihikanAza (necrosis) / ye donoM parivartana sabhI prakAra ke karkaToM meM hote haiN| isake kAraNa arbuda meM mRdutA A For Private and Personal Use Only

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lasagranthaka pRSTha 713 Acharya Shri Kailassagarsuri Gyanmandir yaha citra eka lasagranthaka (lymph node) kA hai jisameM lasavahAoM meM karkaTotpatti dekhI jA sakatI hai| For Private and Personal Use Only

Page #788
arbuda prakaraNa 713 jAtI hai aura usakI gADhatA krIma ke samAna ho jAtI hai| raktasrAva, raMgAyaNa, zleSmAbha vihAsa, zleSAbha vihAsa Adi parivartanoM ke kAraNa koSThanirmANa (cyst formation ) hone lagatA hai| kabhI-kabhI praNAlikAoM ke mukha banda hone ke kAraNa bhI koSTanirmANa ho jAte haiN| aisA stanoM ke karkaTa meM dekhA jAtA hai| cUrNIyana tathA asthIyana bahuta hI kama dekhe jAte haiN| karkaTa kA vistAra karkaTa kA vistAra yA prasAra 5 prakAra se ho sakatA hai:(1) sthAnIya antarAbharaNa dvaaraa| (2) lasIka antaHzalyatA dvaaraa| (3) lasIka ativedhana dvaaraa| (4) raktapravAha dvaaraa| (5) udaracchada dvaaraa| eka sthAna para karkaTotpatti ho jAne para samIpastha sthAnika UtiyoM meM karkaTa kozA bharamAra karane lagate haiM aura Uti kA vinAza karate cale jAte haiN| karkaTa sthala se kozAsamUha TUTa TUTa kara lasadhArA meM cale jAte haiM aura phira samIgatama lasakagranthi meM pakar3a jAte haiM jahA~ yA to ve vinaSTa kara diye jAte haiM yA phira vahA~ unakI jar3a jama jAtI hai aura vahA~ uttarajAta vRddhi hone lagatI hai| isa rIti ko lasIka anta:zalyatA dvArA karkaTa vistAra kahA jAtA hai| lasIka ativedhana meM yaha hotA hai ki lasIka vAhiniyoM ke sAtha-sAtha duSTa kozAoM ke stambha ugane laga jAte haiN| vRkka, zvasanakanAla aura adhivRkka meM chor3akara sarvatra rakta dvArA arbuda vistAra bahuta vilambita ghaTanA huA karatI hai| AmAzaya yA mahAsrota ke arbuda jo AntraprAcIra se utpanna hote haiM ve udaracchada meM ghusa kara udaracchadaguhA meM apane kozAoM ko mukta kara dete haiN| jisake kAraNa bIjagranthi tathA zroNistha aMgoM meM visthAyI arbuda bana jAyA karate haiN| vistAra ke itane upAryoM meM lasIkIya vistAra sabase adhika mahattvapUrNa hotA hai| lasIkAgranthiyA~ arbudoM ke kAraNa bar3ha jAtI haiN| unakI yaha vRddhi unameM jIrNa vraNazotha kI upasthiti ke kAraNa hotI hai| visthAyI arbudotpatti ke kAraNa phaurana hI granthiyoM meM vRddhi nahIM huA karatI / jaba lasavahAoM kA atyadhika vedhana hotA aura unakA mArga ruka jAtA hai to usa kSetra meM zopha ho jAtA hai| zopha ke bAda tAntava Uti kA paramacaya hone lagatA hai jisase prabhAvita kSetra svAbhAvika se kahIM adhika kar3A ho jAtA hai| nAraMgI para jaisI jhurriyA~ par3a jAtI haiM vaisI hI tvacA ke Upara dikhAI detI hai| adhika vistRta kSetra prabhAvita hone para vahA~ kA bAhya aura gambhIra sabhI bhAgoM kI lasavahAoM kA avarodha duSTa karkaTa kozA kara dete haiN| For Private and Personal Use Only

Page #789
714 vikRtivijJAna karkaTa ke naidAnika lakSaNa paiMtIsa varSa kI Ayu ke pazcAt karkaTArbuda uttarottara bar3hatA huA pAyA jAtA hai / paiMtIsa varSa se nIce ke strI-puruSoM ko yaha vyAdhi bahuta kama lagatI hai / yadyapi zaizava kAla meM bhI yaha mila sakatA hai / kucha zArIrika aMgoM meM yaha roga anya aMgoM kI apekSA zIghra laga sakatA hai / kahane kA tAtparya yaha hai ki stana tathA mahAsrota meM karkaTa paiMtIsa varSa yA usase pUrva bhI pAyA jA sakatA hai jaba ki aSThIlA ( puraHstha ) granthi, oSTa athavA anna praNAlikA meM usake bAda hI lagatA hai / garbhAzaya aura stana karkaTa ke mukhya prabhavasthala hone ke kAraNa striyA~ isa roga se puruSoM kI apekSA adhika maratI haiN| puruSoM meM mahAsrota ( alimentary tract ) kA karkaTa adhikatara milatA hai / grIna kA kathana hai ki strI puruSoM meM isa dRSTi se yaha roga barAbara hI dekhA jAtA hai / bhAratavarSa meM to yaha roga puruSoM kI apekSA striyoM meM adhika milatA hai / prAthamika karkaTa akelA hI utpanna hotA hai / kabhI-kabhI A~toM meM ye kaI-kaI eka sAtha utpanna ho jAte haiM / karkaTa bahuta druta gati se utpanna hokara samIpastha UtiyoM meM phailane lagatA hai sAtha hI sAtha lasIkAgranthiyoM ko upasRSTa karane lagatA hai aura anta meM vividha bhAgoM meM visthAnita ho jAtA hai / yadi ise utpanna hote hI anyathA yaha punaH punaH vividha sthAnoM phAr3a kara dharAtala para A jAtA hai aura Acharya Shri Kailassagarsuri Gyanmandir ucchedita kara diyA jAya to ThIka hotA hai para prakaTa hotA hai / karkaTa prAyaH tvacA ko bahuta durgandhapUrNa vidradhi ko janma detA hai / vividha prakAra ke karkaTa dauSTya ( malignancy ) kI dRSTi se vibhinna svarUpa rakhate haiM arthAt koI adhika duSTa hotA hai to koI kama duSTa hotA hai / jo jitanA hI adhika duSTa karkaTa hotA hai vaha utanI phuratI se visthApana ( metastasis ) karane meM samartha hotA hai aura jo jitanA hI kama duSTa hotA hai vaha bahuta vilamba se 'uttarajAta vRddhiyoM kA janaka bana pAtA hai / kozIya dRSTi se karkaTa vicAra aba hama kozAoM ( cells ) kI dRSTi se karkaTa sambandhI vicAra prastuta kareMge / kozAoM kI dRSTi se karkaToM ko tIna zreNiyoM meM prAyaH vibhAjita kara sakate haiM : (1) zalka - kozIya karkaTa, (2) stambha kozIya karkaTa, tathA (3) golAbha - kozIya karkaTa / zalkakozIya karkaTa ( Squamous-celled Cancer ) ye arbuda tvacA ke dharAtaloM para utpanna huA karate haiN| oSTha, vRSaNa, zizna tathA gudA ye inakI utpatti ke sarvasAdhAraNa sthala rahate haiM / ve zleSmalakalAe~ jo stRtazalkIya adhicchada ( stratified squamous epithelium) dvArA AcchAdita rahatI haiM vahA~ bhI isa prakAra kA karkaTa utpanna ho sakatA hai / mukha, grasanI, svarayantra, For Private and Personal Use Only

Page #790
arbuda prakaraNa 715 anoar aura strI kI yoni aise hI sthAna haiM jahA~ stRtazalkAdhicchada pAyA jAtA hai / isa kAraNa yahA~ zalkakozIya karkaTotpatti huA karatI hai / antarvartI zalkAdhicchada ( transitional squamous epithelium ) jahA~ para hotA hai vahA~ bhI karkaTotpatti dekhI jAtI hai| aise sthAna basti, garbhAzaya tathA vRkkamukha rahate haiM / kabhI-kabhI avazeSa racanAoM ( vestigial structures ) se bhI arbuda nikalA karate haiN| inameM zvAsanAladarI ( bronchial cleft ) avaTu- grasanI praNAlI ( thyroglossal duct ) Adi Ate haiM / zalkAdhicchada kA eka svAbhAvika guNa yaha hai ki vaha bahuta svatantratApUrvaka praguNita hotA hai / yahI isakA guNa isameM karkaTotpatti hone para aura bhI bar3ha jAtA hai / isI kAraNa isa Uti ke arbuda bahuta adhika kozAyukta hote haiM aura unameM saMyojI Uti bahuta kama pAI jAtI hai / isa adhicchada kA eka guNa yaha bhI hai ki Rju tvacA ke vividha stara baneM / arbuda nirantara praguNana ke 'kAraNa bIca ke kozA kucha cipaTe ho jAte haiM jisake kAraNa unameM zArGgi parivartana ( keratinous changes ) A jAte haiM jinheM kozA koTara ( cell nests ) yA adhicchadIya muktA ( epithelial pearls ) kahate haiM / ye bahudhA ina vRddhiyoM meM dekhe jAte haiM / zalkIya kozAoM kI isa nizcita vibhinnatA ke hI kAraNa ina arbudoM meM zreNIvibhAjana saralatA se ho jAtA hai / jaba svAbhAvika se ve adhika milate haiM to unheM alpa duSTa kI zreNI meM rakha diyA jAtA hai para jaba ve svAbhAvika se dUra cale jAte haiM to unheM atiduSTa kI zreNI meM batalAyA jAtA hai / ina arbudoM kA vistAra lasavahAoM dvArA hotA hai tathA bahuta dUra para visthApana inase nahIM huA karatA kyoMki samIpastha sagranthika unheM pakar3e rahate haiM aura unake Age gamana karane ko roka dete haiM / ina arbudoM kI cAra zreNiyA~ prasiddha haiM / prathamazreNI vaha hotI hai jaba zArGgakozA, kozAkoTara, adhicchadIya muktA ye sabhI suspaSTa hote haiM tathA koI vibhajanAGka nahIM hotA / isa zreNI ke karkaTa kA prAgjJAna ( prognosis ) bahuta AzAjanaka hotA hai / yadi karkaTa taka pahu~cA jA sake aura usakA uccheda kiyA jA sake / caturthazreNI meM ve karkaTa Ate haiM jinakI sampUrNa racanA itanI dhvasta ho jAtI hai ki unheM yaha samajhanA ki ve zalkakozIya hI haiM sandehAspada bana jAtA hai / unameM vibhajanAGka asaMkhya hote haiM / prAgjJAna AzA ke bahuta viparIta hotA hai / zalyakarma turata ho gayA to ThIka hai anyathA isake visthApana atizIghra dUra-dUra taka bikhara jAte haiM / vikiraNa cikitsA avazya kucha AzAprada dekhI jAtI hai / zalkakozIya karkaTa kA dUsarA nAma adhicarmAbha karkaTa ( epidermoid carcinoma ) hai tathA tIsarA nAma adhicchadArbuda ( epithelioma ) hai / paiThika kozIya karkaTa yA kRntaka vidradhi ( basal-cell carcinoma or Rodent ulcer ) bhI zalkakozIya adhicchada kA hI eka prakAra hai / parantu yaha For Private and Personal Use Only

Page #791
716 vikRtivijJAna naidAnika tathA vaikArika donoM dRSTiyoM se vizuddha adhicarmAbha karkaTa se vibhinna rahatA hai / usakI apekSA yaha paryApta sAdhAraNa hotA hai, isakI vRddhi bahuta dhIre-dhIre hotI hai| tathA isake kAraNa prAdezika sagranthiyoM ko koI upasarga nahIM hotA / yaha eka aisA arbuda hai jisakA dauSTaya kama hote hue bhI apekSAkRta dUsaroM ke bahuta kama vibhinnata hotA hai / yadi yaha nIce asthi taka na pahu~cA ho to taba yaha tejAtu vikiraNa dvArA kAbU meM A jAtA hai / isakA prasAra bahuta spaSTa aura nizcita hotA hai / kAna kI lora se lekara mukhakoNa taka yadi eka rekhA khIMca dI jAve to usake Upara ceharA, kapola, nAsA, vartma aura kAnoM taka vaha rahatA hai / yaha vidhi kevala yahIM taka sImita nahIM rahatI api tu tvacA ke anya bhAgoM meM bhI dekhI jA sakatI hai / bahudhA kRntakavidradhi eka na hokara aneka bhI hotI haiM / jahA~ yaha hotI hai vahA~ kI tvacA kA vyavahAra aisA ho jAtA hai ki vahA~ anya kaI vidhiyA~ bana jA sakeM / meM yaha bhI hai ki par3atA hai tathA kRtavidradhi una dezoM meM bahuta dekhI jAtI hai jahA~ sUrya kI dhUpa asahya ho uThatI hai / AsTreliyA eka aisA hI deza hai jahA~ vAyu meM bAppa kI kamI aura prakhara dhUpa rahatI hai isI kAraNa yaha roga vahA~ bahuta adhika milatA hai / bvAyaDa kA kathana hai ki siDanI ke cikitsAlaya ke bahiraMga vibhAga pratidina 50 rugNa isI vidradhi se pIDita dekhane meM Ate haiN| AsTreliyA meM isa vyAdhi kA kAraNa vaha eka aisA deza hai jahA~ parizrama kA kArya gorI camar3I ko karanA gorI camar3I sUrya kI dhUpa kI prakharatA ko sahane meM adhika samartha nahIM huA karatI / anya dezoM meM kAlI yA pIlI camar3I vAle isa kArya ko karate haiM / vaha camar3I sUrya se rakSA karane meM samartha hotI hai / iTalInivAsI ke camar3e meM sUrya afare sAmarthya hotI hai isa kAraNa iTalIvAsiyoM ke rakta se nivAsI ko prAyaH yaha roga nahIM dekhA jAtA hai / nyUjIlaiMDa ke adhika hotA hai dakSiNI bhAga meM kama / dhUpa ko sahane kI utpanna AsTreliyAuttarI bhAga meM yaha I yaha vidhi gaharAI meM sthita UtiyoM kA aparadana karatI hai / nAsA ko naSTa karatI hai aura netraguhA ko samApta kara detI hai isI kAraNa ise kRntaka ( rodent ) vidradhi nAma diyA gayA hai jo yathAnAma tathA guNa siddhAnta ke anurUpa hai / avata citra adhicarmAbhakarkaTa se kucha bhinna dekhA jAtA hai / isameM gahare raMge hue kozAoM ke Thosa puMja milate haiM jo adhicarma taka cale jAte haiM yadyapi adhicarma ke sAtha unakA koI sambandha kisI bhI cheda ( section ) meM pAyA nahIM jaataa| isa vidradhi ke vita eka barAbara gaharAI meM phailate haiM unake agra phaile hue tathA mudgarAkRtika ( club-shaped ) hote haiM / adhicarmAbhakarkaTa yA zalkakozIya karkaTa meM jo kozA koTara yA zArGgayatA ( cornification ) dekhane meM AtI hai vaha yahA~ bilkula nahIM hotI / jaise ki adhicarma ( epidermis ) ke paiThika kozA hote haiM ThIka vaise hI isa vidhi ke kozA huA karate haiM isI kAraNa hImaiTojAyalIna se ra~gane para ve / For Private and Personal Use Only

Page #792
arbuda prakaraNa 717 nIle ho jAte haiM / vahA~ vibhajanAGka nahIM milate eka hI vidvadhi meM kabhI-kabhI zalkIya tathA paiThika ( basal ) donoM prakAra kI AkRtiyA~ milI huI dekhI jAtI haiM / arbudotpatti ke sambandha meM kucha mata vaibhinya pAyA jAtA hai isa kAraNa vidradhi ko paiThika kozIya kahane se yahI artha lagAnA cAhie ki vidradhikozA paiThikakozIya ke lakSaNoM ko barAbara banAe rahatA hai / isa vidhi kI utpatti ke 3 sambhAvya sthala ho sakate haiM : adhicarma ke paiThika kozA, kezakUpikA ( hair follicles ) tathA adhicarma se visthAnIbhUta ( misplaced ) kozAsamUha / kisI kRntaka vidradhi kI utpatti kahIM se hotI hai aura kisI kI kahIM se / yaha eka mata hai ki mukha ke khaNa vidAroM ( embryonal fissures ) kI rekhA meM ye utpanna hote haiM yaha visthAnIbhUta kozAsamUha vAlI utpatti kA samarthana hI hai / brukArbuda ( Brook's tumour ) -- zulkakozIya karkaTa kA eka prakAra kArbuda hotA hai | yaha prakAra bahuta kama pAyA jAtA hai isakI mahattA kA kAraNa, dauSTya meM anya arbudoM kI apekSA kamI mAnA jAtA hai / yaha kRntaka vidradhi ke kAla se bahuta pUrva utpanna hotA hai / yaha camar3I para eka Dhera sarIkhA vikSata banA letA hai / isameM adhicchadIya padArtha hotA hai jo kucha granthIka (glandular ) aura kucha koSThIya (cystic ) hotA hai| donoM prakAra kI racanAoM ke kAraNa hI isakA Adhunika nAma grandhyAbha koSThIya adhicchadArbuda ( adenoid cystic epithelioma ) DAlA gayA hai| isameM kozA yA to zalkIya hote haiM yA paiThika / koSThoM ( cysts ) kI upasthiti isa arbuda kI vizeSatA hotI hai / yaha arbuda bahuta hI kama pAyA jAtA hai ise sadaiva dhyAna meM rakhanA cAhie / prasveda granthiyoM ke arbuda - - sAdhAraNa koSThIya adhicchadArbudoM se milate-julate prasveda granthiyoM ke arbuda huA karate haiM / ye arbuda kisI avakAzikA se nikala kara granthyArbuda bhI bana sakate haiM aura inakA yogya nAma kuNDaligranthyArbuda (spiradenoma ) ho sakatA hai aura aNvIkSaNa para isameM catuSkoNAbha kozAoM ke spaSTatayA parilikhita puMja mila sakate haiM / ye arbuda bahudhA sira meM nikalate haiM aura kaI-kaI hote haiM sira meM hone se inheM uSNISakArbuda ( turban tumour ) bhI kaha diyA jAtA hai / prasveda granthiyoM kI praNAlikAe~ phaila kara koSThoM kA nirmANa karatI haiM / ye sabhI sAdhAraNa yA aduSTa arbuda banate haiM para jaba kabhI inameM granthikarkaTa banatA bhI hai to vaha alpaduSTa hotA hai / lasIkAdhicchadArbuda ( Lympho epithelioma ) - yaha eka prakAra kA karkaTa hai jo mukha aura grasanI para chAye hue adhicchada dvArA taiyAra hotA hai isI kAraNa tuNDikAgranthiyA~, grasanIprAcIroM, nAsAmArgoM, nAsAgrasanI - koTaroM meM jahA~ adhicchada sAdhAraNa se antavartI rUpa letA hai vahA~ yaha karkaTa bana sakatA hai / isa karkaTa kI pramukha pahacAna yaha hai ki yaha svayaM to bahuta laghurUpa kA hotA hai yahA~ taka ki isakA patA laganA kaThina ho jAtA hai parantu yaha samIpavartI granthiyoM For Private and Personal Use Only

Page #793
vikRtivijJAna ko upasRSTa kara detA hai jisake kAraNa grIvAstha granthiyA~ phUla jAtI haiN| nAsAgrasanI kSetra meM sthita rahane se isa vyAdhi kA nidAna ThIka-ThIka honA bahuta dinoM taka rukA rahatA hai| Age calakara phuphphusa yakRt Adi aMgoM taka ko yaha upasRSTa karane meM samartha ho jAtA hai| aNvIkSaNa karane para isake kozA bar3e aura pANDura hote haiM unakI vahI sImA aspaSTa aura asImita hotI hai| ve stAroM ( sheets ) meM vinyasta hote haiM / yahA~ para adhicchadIya kozA aura nIce sthita lasAbha Uti se Agata lasIkozA donoM hI paryApta milate haiN| ___ jaba arbuda pUrNataH adhicchadIya hotA hai to use antarvartIkozIya karkaTa ( Transitional-cell carcinoma) kahate haiM sUtribhAjanA yahA~ paryApta hotI hai| isameM kucha pravRtti vibhinnana kI bhI hotI hai jisase zalkakozIya lakSaNoM kA bhI AbhAsa Ane lagatA hai| kabhI-kabhI aghaTana (anaplasia) bhI hotA hai jisake kAraNa sampUrNa citra lasIka saMkaTArbuda se milatA julatA bana jAtA hai / adhicarmAma karkaTa kI apekSA yaha karkaTa vikiraNa dvArA ThIka hone kI paryApta pravRtti rakhatA hai| ise hama sArAMza meM gale kA aghaTita karkaTa (anaplastic tumour of the throat ) kaha sakate haiN| stambhakozIya karkaTa (Columnar-celled Carcinoma ) ye arbuda aneka zarIrastha granthiyoM ke dvArA race jAne ke kAraNa tattat granthi kI racanA ke anurUpa inake vividha svarUpa dekhane meM Ate haiN| stambhakozA stana, zleSmagranthiyoM Adi meM gatoM (acini ) yA praNAliyoM ( tubules ) kA nirmANa karate haiN| avaTukAgranthi meM koSThoM ko banAte haiM tathA vahIM para Thosa kozApuJja kA rUpa dhAraNa karate haiM jaisA ki saMpIDita bAhyakoM meM dekhA jAtA hai| kahIM-kahIM duSTArbudoM meM inakA saMyukta rUpa dekhane meM AtA hai| yakRt meM hama Thosa kozApuMja bhI dekhate haiM aura praNAliyA~ bhii| vRSaNoM aura sarvakiNvI meM karkaTa hone para praNAliyA~, garta tathA Thosa bhAga tInoM dekhe jAte haiN| hama sAtha ke eka citra se yaha batalAte haiM ki eka granthIya racanA se kisa prakAra aneka prakAra ke karkaTa utpanna hote haiN| granthIya prakAra ke karkaTa kA autikIya citra bahudhA aisA huA karatA hai ki jisa Uti se arbuda banatA hai usakI pahacAna bahuta saralatA se kara lI jAtI hai / parantu jaba anaghaTana yA acaya (anaplasia) atyadhika hotA hai taba vibhedaka lakSaNoM kA abhAva ho jAne ke kAraNa uti kA patA lagAnA bahuta kaThina ho jAtA hai| ina pichale prakAra ke arbudoM ko golAbhakozIya karkaTazreNI meM saralatA se lAyA jA sakatA hai| isa dRSTi se stambhakozIya tathA golAbhakozIya vRddhiyoM meM koI vizeSa vibhedaka rekhA khiMcI huI nahIM pAI jaatii| For Private and Personal Use Only

Page #794
(1) stambhakozIyakarkaTa pRSTa 718 / 22- les 1 SAMMELATA NAL HAR FREE OM yaha stana kA praNAlIya (duct ) karkaTa hai / isameM Upara cUcukIya prakRta adhicchada hai| donoM pArthoM meM karkaTIya kSetra hai tathA bIca meM svastha praNAlI hai| (2) stambhakozIyakarkaTa ROMANTAR AKAN RSSC ANSARA CRIBERSewa / THE yaha sthulAntra kA granthi (gland ) karkaTa hai / kucha svasthagranthiyAM haiM tathA kucha karkakIya haiN| For Private and Personal Use Only

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716 arbuda prakaraNa stambhakozIya karkaTa apane granthIya svarUpa ko vyakta karane meM jaba taka samartha rahatA hai taba taka vaha granthikakaTa ( adeno carcinoma ) yA dRSTa granthi abaMda ( malignant adenoma) kahalAtA hai| granthikarkaTotpatti ke sAmAnya sthAna vakSasthala, sarvakiNvI, pittapraNAlikAe~, pittAzaya, bRhadantra, AmAzaya tathA garbhAzaya Adi huA karate haiN| ina karkaToM meM kozAoM kA vinyAsa gartIya yA praNAlIya rahatA hai| ye kozA stambhAkArI hone para bhI unakA rUpa caukora ( cubical ) pAyA jAtA hai| inakI duSTatA kA patA tIna bAtoM se lagA karatA hai: (1) kozAoM aura vizeSa kara unakI nyaSTiyoM kI viSamatA / (2) kozAstaroM kA praguNana, tathA / (3) yakRt racanAoM kI spaSTa bharamAra tathA granthIya bhAga meM prAvara kA abhAva / adhaHstRtakalA sAdhAraNatayA to nahIM hotI yA bahuta apUrNa hotI hai jisake kAraNa sampUrNa citra meM asamatA ( irregularity ) hI prakaTa hotI hai| jaba ki prakRta stambhakozIya racanAoM meM samatA kA honA eka anivArya guNa pAyA jAtA hai / Antra aura AmAzaya meM prakRta kozAoM se duSTa kozAoM meM jo parivartana hotA hai vaha spaSTa aura pUrNa hotA hai isalie ina sthAnoM kI prakRta racanAoM aura duSTa vRddhiyoM meM spaSTataH vibhedaka rekhA khIMcI jA sakatI hai| granthi karkaTa nAma se hama stambhakozIya karkaToM kA paryApta varNana pIche bhI kara cuke haiN| golAbhakozIya karkaTa ye stambhakozIya karkaToM se adhika duSTa hote haiM ye granthIya karkaToM ke hI prakAra haiM jinameM racanAoM kI anaghaTatA ( yA apacaya ) bahuta adhika rahatI hai inake 2 mukhya bheda haiM jinameM azmopama ( scirrhus) karkaTa aura dUsarA majakIya ( medullary ) yA mastulaMgAbha ( encephaloid ) karkaTa kahalAtA hai| inakA varNana karkaTa ke sAtha spaSTataH diyA gayA hai vahA~ pAThakagaNa dekha sakate haiN| saMkSepa meM azmopama karkaTa dhIre-dhIre bar3hatA hai, bahuta kaThina hotA hai| dhIre-dhIre bar3hane ke kAraNa samIpastha UtiyoM ko itanA samaya mila jAtA hai ki ve cAroM aura eka saghana saMyojI Uti kA gherA banA skeN| aNvIkSaNa karane para usameM duSTa kozA saghana piNDoM ke rUpa meM dikhalAI dete haiM tathA garta nirmANa kA koI prayatna huA nahIM dikhtaa| inameM kabhI kabhI kSudra gola kozAoM aura lasIkozAoM kI bharamAra bhI rahatI hai| mastuluGgAbha karkaTa meM kozA adhika tathA saMdhAra bahuta hI kama pAyA jAtA hai| atyadhika duSTa hone para saMdhAra vilupta rahatA hai aura karkaTa eka saMkaTArbuda ke sadRza prakaTa hotA hai| azmopama se lekara mastuluGgAbha karkaToM taka karkaTa ke aneka prakAra ho sakate haiM tathA ina donoM ke madhya meM koI vibhedaka rekhA khIMcI nahIM jA sakatI hai / aNvIkSaNa karane para majakIya arbudoM meM aneka vibhajanAkoM (mitotic figures) kI upasthiti aura bhakSaka pravRtti ( phagocytic tendency ) pAI jAtI hai| For Private and Personal Use Only

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720 vikRtivijJAna vibhajanAGkoM se kozA praguNana kI adhikatA kA jJAna hotA hai tathA bhakSaka pravRtti kA pramANa yaha hai ki karkaTa ke duSTa kozAoM ke garbha meM rakta ke lAla kaNa yA sita kozA pAye jAte haiM jinheM ve ghere rahate haiM / leSAbha karkaTa ( Mucinoid or Colloid Carcinoma ) kucha karkaTa aise bhI hote haiM jinameM zleSAbha vihAsa yA zleSAbha apajanana pAyA jAtA hai| kisI bhI sthAna ke karkaTa ke pUre bhAga meM yA usake eka aMzamAtra meM yaha apajanana ho sakatA hai / kabhI-kabhI to aisA dekhA jAtA hai ki arbuda meM kozIya racanA ke sthAna para kevala zleSyakavat ( jelly like ) padArtha kA puJja hI paryApta mAtrA meM prakaTa hotA hai / yaha padArtha hI usa karkaTa kI duSTa Uti banatA hai / jahA~ taka karkaTa kI duSTatA kA sambandha hai zleSAbha vihAsa kA usa para koI prabhAva nahIM par3A karatA / zleSAbha vihrAsa mukhyarUpa se AmAzaya tathA bRhadantra meM sthita karkaToM meM pAyA jAtA hai aura gauNarUpa se bIjagranthi, vakSasthala tathA pittAzaya ke karkaToM meM milatA hai / jaisA kahA gayA hai kozAoM meM zleSi kI upasthiti koI unakI kriyA ke pariNAma rUpa nahIM hotI api tu vihAsa ke kAraNa huA karatI hai / yaha vidvAsa granthikarkaToM meM jitanA adhika dekhane meM AtA hai utanA sAdhAraNa karkaToM meM nahIM / I karkaTa ke kozAoM meM vihAsa kA zrIgaNeza unake kAyArasa meM zleSAbhavindukoM ke rUpa meM hotA hai / ye binduka eka dUsare se milate cale jAte haiM jisake kAraNa kozA phUla jAtA hai / kabhI-kabhI kozA kI nyaSTi apane sthAna se cyuta ho jAtI hai tathA kozA ke pariNAha taka pahu~ca jAtI hai aura vahA~ vaha cipiTita ho jAtI hai / isase kozA kA citra eka aMgUThI sarIkhA ho jA sakatA hai| isI kAraNa isa kozA ko mudrikIya kozA (signet ring cell ) kahA jAtA hai / Age cala kara kozA kI mRtyu ho jAtI hai aura vaha phaTa jAtA hai / isa prakAra kaI kozAoM ke phaTane se zleSAbha padArtha puMjIbhUta ho jAtA hai / yaha vihAsa karkaTa ke jIrNa bhAgoM meM hone ke hetu karkaTa kA prasAra yA pragati athavA duSTatA meM koI mahatva kA parivartana nahIM hotA / yaha vihAsa uttarajAta vRddhiyoM meM bhI yathApUrva dekhA jAtA hai / vividha aMgoM ke karkaTa Upara karkaTArbuda kA sarvasAmAnya vivecana ho cukA hai aba Age vividha zarIrAvayavoM meM hone vAle karkaToM kA viziSTa varNana upasthita kiyA jAtA hai / hama yahA~ mukhyatayA nimna kA varNana kareMge : 1. zvasanasaMsthAna ke karkaTa ( cancers of respiratory system ) / 2. mahAsrotIya karkaTa ( cancers of alimentary canal ) / 3. yakRt karkaTa ( cancers of the liver ) / For Private and Personal Use Only

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arbuda prakaraNa 4. pittAzaya karkaTa ( cancers of the gall bladder ) / 5. sarva kiNvIya karkaTa ( pancreatic carcinoma ) / 6. avaTukIya karkaTa (thyroid carcinoma ) / 7. poSaNikA granthikarkaTa ( cancers of the pituitary body ) / 8. adhivRkka granthikarkaTa ( cancers of adrenals ) / 9. mUtrasaMsthAna ke karkaTa ( cancers of urinary system) / 10. puruSa prajananAGgIya karkaTa ( cancers of male genitals ) / 11. strIprajananAGgIya karkaTa ( cancers of female genitals ) / 12. stana karkaTa ( cancers of the breast ) 721 ( 1 ) zvasanasaMsthAna ke karkaTa mukha, grasanI, tuNDikA, jihvA Adi aMgoM kI dRSTi se vicAra mahAsrotIya karkaTa. prakaraNa meM Age kiyA gayA hai / zvasanasaMsthAnIya karkaToM meM nimna aMgoM ke karkaToM kA vicAra prastuta kiyA jAvegA : (1) svarayantra, (2) phuphphusa tathA (3) phuphphusacchada / 1 -- svarayantrIya karkaTa ( Cancer of the Laryux ) svarayantra kA karkaTa striyoM kI apekSA puruSoM meM adhika dekhA jAtA hai / isake tIna mukhya hetu haiM-- bolane kA atiyoga, svarabheda kA hetu dete hue zAstra meM likhA hai atyuccabhASaNaviSAdhyayanAbhighAtasaMdUSaNaiH prakupitaH pavanAdayastu / srotaHsu te svaravaheSu gatAH pratiSThAM hanyuH svaraM bhavati cApi hi SaDvidhaH saH // tambAkU pInA tathA madyapAna / yaha karkaTa prAthamika vikSata ( primary lesion ) ke rUpa meM prAyaH hotA hai para kabhI kabhI jaba avaTukA granthi, grasanI kA gambhIra bhAga athavA jihvAmUla meM karkaTa ho to vahA~ se vaha svarayantra taka jA sakatA hai / For Private and Personal Use Only nidAna kI dRSTi se svarayantrIya karkaTa antaH ( extrinsic ) do prakAroM meM bA~TA jA sakatA hai / unake nIce kI svarayantra kI zleSmalakalA meM hotA hai / yaha zalkakozIya ( squamous-celled ) hotA hai ise adhicarmAbha karkaTa bhI kahA jAtA hai / isakA vikAsa bahuta dhIre dhIre hotA hai aura do varSa taka raha sakatA hai / bahiH karkaTa ghATikA adhi jihvIya kSetra ( aryepiglottidean region ), donoM ke khAta yA adhijihvA para bhI ho sakatA hai / yaha stambha kozIya ( columnar-celled ) hotA hai / ise antarvartI karkaTa kI koTi meM rakhA jAtA hai / isakA vikAsa bahuta zIghra hotA hai / isake phala svarUpa svarasAdAdi vikAra bahuta zIghra lagate haiM / isake kAraNa gale kI lasagranthiyA~ phUla jAtI haiM / 61, 62 vi0 ( intrinsic ) tathA bAhya antaH karkaTa svarayantrI aura

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722 vikRtivijJAna I svarayantra meM karkaTa hone kA sarvaprathama lakSaNa svarabhaGga ( impairment of the voice ) huA karatA hai / gale meM zUla honA tathA nigalane meM kaThinAI ( dysphagia ) kA honA ye do lakSaNa roga ke paryApta bar3hane para prakaTa hote haiM / Arambha meM svarayantrIya karkaTa eka kaThina sidhma ke rUpa meM eka ora kI svaratantrI para dikhalAI detA hai / kabhI kabhI isakI AkRti aMkurArbuda sarIkhI bhI hotI hai / Age cala kara arbuda meM vraNana, dUSakatA, UtivinAza Adi milatA hai / svarayantra meM karkaTa hone para aura bhale prakAra jar3a jamA lene para kAna kI jar3a taka jAne vAlA zUla, nigalana kRcchratA, zvAsakRcchratA ( dyspnoea ), durgandha ( foetor ), raktasrAva ( haemorr hage ) Adi paryApta dekhe jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir aNvIkSa se dekhane para svarayantrIya adhicchada kA aprArUpika praguNana ( atypical proliferation ) hotA hai jisase tantriyA~ tathA niga ( plugs ) banate haiM jo lAkSaNika adhicchadIya muktAoM ( characteristic epithelial pearls ) kA rUpa le lete haiM / isa karkaTa ke kAraNa phuphphusa vidradhi athavA nizvAsa zvasanaka ( inhalation pneumonia ) ho sakatA hai / Ayurveda kI dRSTi se yaha kyA ho sakatA hai yaha kahanA kaThina hai vahA~ svarabheda ke prakaraNa meM jo asAdhya svarabheda ke lakSaNa diye haiM ve karkaTajanita svarabheda ke lie bhI yathArtha ho sakate haiN| -- kSoNasya vRddhasya kRzasya vA'pi cirotthito yazca sahopajAtaH / medasvinaH sarvasamudbhavazca svarAmayo yo na sa siddhimeti // ( su. u. a. 53 ) kSINa, vRddha vA durbala vyakti ko paryApta kAla se svarayantra ke sAtha utpanna saba doSoM ke anubandha se yukta aura sAtha hI medasAdhikya hone se jo svarabheda hotA hai vaha siddha nahIM huA karatA / yaha antaHsvarayantra karkaTa kA hI varNana mAlUma par3atA hai| bahiHsvarayantrakarkaTa kA varNana suzruta nidAna sthAna meM mAMsatAna karake AyA haipratAnavAn yaH zvayathuH sukaSTo galoparodhaM kurute krameNa / samAMsatAnaH kathito'valambI prANapraNut sarvakRto vikAraH // ( su. ni. a. 16 ) vistArayukta, duHkhadAyI jo zotha dhIre dhIre gale kA avarodha karake nIce ko laTaka jAtA hai, jo tridoSa se utpanna hotA hai vaha prANanAzaka vikAra hai / 2 - phuphphusa karkaTa ( Cancer of the Lung ) kisa kAraNa se yaha roga hotA hai usake bAre meM vibhinna likhA milatA hai para kyoMki isa roga kA nidAna ThIka ThIka hai isalie kisI para bhI vizvAsa nahIM kiyA jA sakatA / haiM ki tArakola kI sar3akoM ke kAraNa tathA moTara basa Adi ke For Private and Personal Use Only pustakoM meM bahuta kucha abhI taka nahIM ho sakA kucha loga aisA samajhate adhika calane ke kAraNa

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arbuda prakaraNa 723 phuphphusa karkaTa bar3hatA hai parantu yaha isalie mahattvapUrNa nahIM hai ki jahA~ ye nahIM pahu~ca sakI vahA~ bhI yaha roga paryApta pAyA jAtA hai| yaha satya hai ki cUhe yA vaMTamUSa ko kaNThanAr3I dvArA kolatAra phUMka dene para unheM phuphphusa karkaTa ho jAyA karatA hai| marphI tathA sTama ne cUhe kI camar3I para tArakola potakara 60 pratizata eka prakAra ke cUhoM meM aura 78 pratizata dUsare prakAra cUhoM meM phuphphusa karkaTa dekhA hai| yaha roga striyoM kI apekSA puruSoM ko 3: 1 ke anupAta meM hotA hai| kahIM kahIM isakA anupAta 4: 1 bhI ho sakatA hai| __ khAnoM meM kAma karane vAloM ko dhAtu mizrita dhUla ke kaNoM meM zvAsa lenI par3atI hai isa kAraNa unake phuphphusoM meM karkaTotpatti kI bar3I AzaMkA rahatI hai| zlIbarga kI kobAlTa kI khAnoM meM jaba aneka vyakti marane lage taba 1922 meM amerikana sarakAra ne eka Ayoga niyukta kiyA yaha jAnane ke lie ki mRtyu kA kAraNa kyA ho sakatA hai / usa Ayoga ne yaha siddha kiyA ki mRtyu kA mukhya kAraNa phuphphusIya karkaTa thaa| jo loga khAnoM meM kArya nahIM karate the unameM yaha roga nahIM dekhA jAtA thaa| jo dhUla khanika ke sUMghate the usameM saMkhiyA tathA anya prakSobhaka padArthoM ke sAtha sAtha tejosakriya padArtha bhI rahate the jinake kAraNa yaha vyAdhi utpanna hotI thii| Ajakala bhArata meM aura anyatra tambAkU kA bahuta vyavahAra bar3ha gayA hai| bIr3I sigareTa, sigAra, hukkA, cilama anekoM rUpoM meM yaha padArtha sUMghA yA piyA jAtA hai| isakA mala phuphphusa ke andara saMcita hotA rahatA hai isameM prakSobhaka padArtha bhI hote haiM jinake kAraNa yaha vyAdhi Aja pahale se adhika pAI jAne lagI hai| phuphphusa meM aisabesTasAdhikya (asbestosis ) hone se bhI karkaTotpatti ko sahAyatA milatI hai| silikAdhikya (silicosis) se bhI karkaTa bana sakatA hai| phuphphusa meM karkaTa do prakAra kA huA karatA hai, eka prAthamika aura dUsarA uttara jAta hama yahA~ prAthamika karkaTa kA hI vicAra kara rahe haiN| yaha karkaTa sadaiva zvAsanalikA ( bronclus ) meM hotA hai aura AmAzayika, vRkka yA anya karkaTa nAmoM kI bhA~ti zvAsanAlajanita ( bronchogenic ) karkaTa kahalAtA hai| uttarajAta karkaTa anyatra hue karkaToM ke visthAya ke rUpa meM phuphphusa ke vibhinna kSetroM meM prakaTa hotA hai jise hama yathA sthAna likheNge| vikRtazArIra-vikRtazArIra kI dRSTi se kucha loga phuphphusa karkaTa ko usake 3 udbhava sthaloM ke rUpoM meM vibhakta kiyA karate haiN| ye 3 sthala kramazaH zvasanikIya zleSmalakalA, zleSmalagranthiyA~ tathA avakAzikIya adhicchada ( alveolar epithelium ) hai| parantu isa prakAra kA vibhAjana bahuta adhika mahattvapUrNa nahIM hotaa| yadi arbuda meM zleSmA upasthita ho to vaha zleSmala granthi dvArA utpanna huA hogA aisA mAnakara calanA vRthA hai kyoMki zvasanikIya adhicchada dvArA bhI zleSmA kA nirmANa ho sakatA hai| yadi abuMdIya kozA cipaTe hoM to usakA yaha tAtparya kadApi nahIM hai ki vaha phuphphusa kI avakAzikAoM ke cipaTita adhicchada dvArA hI banA hai vAstava meM For Private and Personal Use Only

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724 vikRtivijJAna to phuphphusa kA sampUrNa adhicchada zvasanikIya stara se banatA hai aura aNvIkSatayA garbhaphuphphasIya citra meM pramANita bhI ho jAtA hai| isalie aisA mAnanA pUrNataH ThIka hai ki ki phuphphusa ke sampUrNa karkaTa utpatti se zvasanikAjanita ( bronchogenic ) hI hote haiM / kozAoM ke AkAra meM jo antara hotA hai vaha sthAna vizeSa ke kAraNa na hokara unake vibhinnana ke kAraNa hotA hai| pratyakSa dekhane se phuphphusa karkaTa ko 3 zreNiyoM meM vibhakta kiyA jA sakatA hai:(1) vRntIya ( hilus ), (2) avakAzikIya yA zyAmAkasama ( miliary ) tathA (3) prasara ( diffuse ), vRntIya karkaTa sabase adhika, lagabhaga 90 pratizata taka pAyA jAtA hai yaha zvasanikAjanita hotA hai, yaha kisI zvAsanAla meM Arambha hokara phira zvasanikIya vRha tathA phuphphusa padArtha meM poMr3ha jAtA hai| yaha kevala zvAsanAla meM phuphphusa ke bAhara bhI raha sakatA hai / zvAsanAla meM karkaTa ke kAraNa jo vikSata banatA hai vaha zleSmalakalA kA raukSya mAtra bhI ho sakatA hai tathA usake suSiraka kA pUrNataH avarodhaka bhI ho sakatA hai| yadi pUrNataH zvAsanAlIya suSiraka kA abarodha ( stenosis ) ho gayA to usake dUrastha bhAga meM avapAta, uraHkSata athavA vidradhi bhavana dekhA jA sakatA hai| prAyaH vRntIya arbuda khUba kar3A aura Thosa huA karatA hai para kabhI-kabhI UtimRtyu tathA vivarIbhavana bhI mila sakatA hai| vRntasthala para karkaTIya uti kA bar3A sA puMja hone para bhI dUra-dUra para karkaTIya padArtha ke granthaka ( nodules ) mila sakate haiM / jaba ye karkaTa bar3hate-bar3hate phuphphusacchada taka pahu~ca jAte haiM to vahA~ prakSobha hokara zoNa utsyandana ( haemorrhagic effusion ) hone lagatA hai| avakAzikIya karkaTa bahuta kama pAyA jAtA hai / ye avakAzikAoM meM kaI sthAnoM para hote haiN| kaisilI aura hvAiTa inako bahukendriya avakAzikAjanya karkaTa ( carci. noma alveogenica multicentrica ) ke nAma se pukArate haiM / nyUbarjara inheM avakAzikIya kozArbuda ( alveolar cell tumours ) kahatA hai| inakA eka nAma zyAmAkasama karkaTa ( miliary cancer ) bhI hai / pahale donoM nAmoM se isakI utpatti phuphphusIya avakAzikAoM ke kozAoM se honA nizcita hotA hai jo yathArthataH satya hai| karkaTa kA prasara rUpa phuphphusa khaNDIya zvasanaka ke citra se mRtyUttara parIkSA kAla meM bilkula mila jAtA hai| isa karkaTa meM phuphphusa kA eka khaNDa yA sampUrNa phuphphusa eka Thosa dhUsaravarNIya puMja ke rUpa meM prakaTa hotA hai usa samaya vinA aNvIkSayantra kI sahAyatA ke zvasanaka aura karkaTa meM bheda nahIM kiyA jA sktaa| Upara sthUla rUpa se phuphphusIya karkaToM ke vikRta zArIra para dRSTipAta kiyA gayA hai parantu aNvIkSaNa dvArA vividha kozAoM kI dRSTi se bhI isakA vargIkaraNa calatA hai| kozIyaparivartana jitane phuphphusIya karkaToM meM dekhe jAte haiM vaise anyatra nahIM milte| For Private and Personal Use Only

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arbuda ra 725 yahA~ prasara, majjagataya ( medullary acinar ), granthIya, sAMkura, granthIya (papilliferous adenocarcinoma ) athavA adhicarmAbha ( epidermoid ) kisI bhI rUpa meM karkaTa pAyA jA sakatA hai / phuphphusa karkaToM meM 3 prakAra ke kozA bahudhA milate haiM jinameM rambhAkArI kozA ( cylindrical cells ) zalkIya kozA tathA laghu gola avibhinita yA anaghaTita kozA Ate haiM / ina kozAoM ke kAraNa bane bhinna bhinna karkaToM meM koI mahatva kA antara yoM nahIM ho pAtA kyoMki ye tInoM eka hI phuphphusa meM pAye jA sakate haiM / ina tInoM meM kauna adhika aura kauna kama hotA hai ise bhI sAdhikAra kisI ne kahA nahIM hai / ina tInoM meM koI mahattvapUrNa vibhedaka rekhA bhI nahIM hai / rambhAkArI kozAoM vAlA karkaTa granthIya karkaTa, zalkIya kozAoM vAlA karkaTa: adhicarmA karkaTa tathA kSudrakozA vAlA kSudrakozIya karkaTa nAma se pukArA jAtA hai / rambhAkArI kozAoM se bane arbuda ko granthIya karkaTa kahA jAtA hai para kabhI-kabhI granthi kI utpatti nahIM bhI ho pAtI vahA~ kozA majjakIya puMjoM meM samUhita rahate haiM granthIyakarkaTa ( adenocarcinoma ) meM kozA lambe aura kucha-kucha gola se hote haiM inameM svaccha kAyArasa bharA rahatA hai / ye granthisama avakAzoM ke cAroM ora ghire rahate haiM / ina avakAzoM meM zleSmA ( mucin ) bharA rahatA hai / zleSmA dvArA hI kozA phUla jAte haiM / kozA eka yA aneka stara moTe hote haiN| unase aMkura nikala sakate haiM / vibhajanAGka bahuta milate haiM / kahIM-kahIM karkaTa kozA avakAzikAoM ke. sthAna kI pUrti kara dete haiM para adhika tara to ye kozA avakAzikAoM meM praviSTa ho jAte haiM aura vahA~ eka nayA stara car3hA dete haiM / yaha saba aniyamita rUpa meM hotA hai / ve pUrA-pUrA kisI bhI sthala ko nahIM bhara pAte haiN| eka mahatvapUrNa aura samajhane yogya bAta yaha bhI hai ki kathana meM to granthikarkaTa banatA hai para dekhane meM tathA aNvIkSaNa citra majakIya prakAra ke prasara karkaTa se milatA huA hotA hai jise dekhakara yaha bhrama ho jAtA hai ki kahIM yaha saMkaTArbuda to nahIM hai / isakA koI pramANa nahIM diyA jA sakatA ki ye kozA avakAzikIya adhicchada se utpanna hote haiM / zalkIyakozAoM dvArA nirmita karkaTa kadarayukta ( cornifying ) yA kadara rahita donoM prakAra kA ho sakatA hai / yaha kadAcit phuphphusanAla ( bronchus ) ke adhicchada se Thosa puMja ke rUpa meM nikalatA hai / kucha vidvAn aisA mAnate haiM ki isa prakAra kA arbuda prAyaH yakSmIya vikSatoM ke sAtha-sAtha utpanna hotA hai / yaha bahuta manthara gati se bar3hatA hai aura isake visthAya samIpastha lasagraMthakoM taka hI sImita rahate haiN| isa arbuda meM UtimRtyu, gahvarotpatti tathA upasarga tInoM mila sakate haiM / kSudrakozIya prakAra kA arbuda phuphphusika saMkaTArbuda se bahuta kucha milatA huA hotA hai| isameM anaghaTana athavA avibhinnana hI isakA kAraNa hai / kozA mRdaMgAkRtika ( spindle celled ), aNDAkAra, gola yA naikarUpIya ( pleomorphic ) hote haiM / adhika vicAra karane para isake karkaTa hone kI puSTi ho pAtI hai / iMgalaiMDa meM ise phuphphusAntarAla kA yavakozIya saMkaTArbuda (mediastinal oat-celled sarcoma) For Private and Personal Use Only

Page #802
726 vikRtivijJAna mAnA jAtA rahA hai kyoMki isameM phuphphusAntarAla kI lasagranthiyA~ khUba phUlatI haiN| isake visthAya rambhAkArI kozAoM se yukta milate haiN| phrAMsIsI vidvAn isakI utpatti avakAzikIya adhicchada meM mAnate haiM para vaisA pramANa koI milatA nhiiN| prasAra-phuphphusa kA prAthamika karkaTa sampUrNa phuphphusa meM phailatA hai| yaha prAdezika lasagranthakoM taka phaila jAtA hai tathA apane visthAya dUra-dUra taka pahu~cA detA hai| phuphphusa karkaTa 2 prakAra se phailA karatA hai| eka to jaba karkaTa kozA zvAsa ke sAtha calakara yA reMga kara zvasanikAoM ke choroM para jama jAveM aura avakAzikAoM meM eka naye stara kA nirmANa kara deN| tathA dUsaro vidhi yaha hai ki ve lasavahAoM para AkramaNa kareM aura sampUrNa phuphphusa meM phaila jAveM aura sUkSmAtisUkSma zvasanikAoM ke cAroM ora yakSmA kI bhA~ti kozApuMja banA deN| isase kucha dUra para sthUla lasagranthaka mila sakate haiN| kabhI-kabhI prAdezika vistAra ho jAtA hai jisake kAraNa samIpastha anya aMga bhI prabhAvita ho jAte haiN| udAharaNArtha parihRt athavA hRdaya taka AkramaNa ho sakatA hai| mahAvAhiniyA~ saMpIDita ho sakatI haiM, kabhI-kabhI to kisI mahAsirA para AkramaNa ho jAne se usameM arbudika dhanAsra mila sakatA hai| kabhI-kabhI anna praNAlI, kaNThanAlI athavA svarayantragA parAvartinI vAtanAr3I (recurrent laryngeal nerve) taka saMpIDita ho sakatI hai| prAdezika lasagranthaka prAyaH sadaiva hI prabhAvita ho jAte haiN| phuphphusAntarAla meM isI kAraNa jo padArtha kA paMja banatA hai vaha mUla karkaTa puMja se bahuta bar3A huA karatA hai / akSakAsthi se Upara kI lasagranthiyA~, kakSAstha lasagranthiyA~ tathA graivika lasagranthiyA~ tInoM hI AkrAnta dekhI jA sakatI haiN| ___ phuphphusa karkaTa ke kAraNa dUrastha bhAgoM meM visthAyotpatti bahudhA mila jAyA karatI hai| yakRt usakA eka pramANa hai / phuphphusa meM karkaTa hone para yakRt meM usakA visthAya na bane yaha bahuta hI kama dekhA jAtA hai| dUsarA nambara asthiyoM tathA mastiSka ke visthAyoM kA AtA hai tatpazcAt vRkka evaM adhivRkka Ate haiN| svIra kA kathana hai ki adhivRkka kA donoM hI ora phuphphusa ke adhokhaNDa meM sthita lasagranthiyoM se sIdhA sambandha hone ke kAraNa hI adhivRkka meM bhI visthAya banate haiN| vAstava meM adhivRkka granthiyoM ke visthAyoM ke jo bhI kAraNa hoM phuphphusa meM karkaTotpatti ke kAraNa lagabhaga Adhe visthAya isa granthi meM dekhe jAte haiN| visthAyotpatti ke jo sthala Upara ginAe haiM vahA~ to sarvasAmAnya rUpa meM visthAya milate hI haiN| inake atirikta jahA~ visthAya kabhI-kabhI hI milate haiM unameM sarvakiNvI (pancreas), avaTukAgranthi ( thyroid gland ), hRdaya tathA plIhAdi mukhya haiN| asthiyoM meM vakSasthalIya DhA~ce ke nirmANa karane vAlI asthiyoM meM hI visthAya banA karate haiM jaise pazukAe~, uraHphalaka athavA ksherukaaeN| mastiSka aura adhivRkkoM meM visthAya kA bahudhA kAraNa phuphphusastha karkaTa huA For Private and Personal Use Only

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arbuda prakaraNa 727 karatA hai / isake kAraNa DAsakeTa ke mata se mastiSka meM 31.4 pratizata mastiSkagata arbuda milA karate haiM tathA adhivRkka meM 21.8 pratizata pAye jAte haiM / anya kAraNoM se 0.9 pratizata mastiSka meM tathA 1.9 pratizata adhivRkkoM meM milate haiN| kisI bhI praur3ha puruSa meM jaba drutavega se mastiSkArbuda utpanna ho rahA ho taba use prAthamika vyAdhi na mAna kara uttarajAta mAna lene meM koI hAni nahIM hotI kyoMki bahudhA aisI avasthA meM phuphphusoM meM karkaTopasthiti avazya mila jAyA karatI hai / isakA kAraNa yaha hai ki phuphphusoM aura mastiSka kA rakta ke dvArA sIdhA sambandha jur3A huA hai| phuphphusa karkaTa Adhunika yuga meM jitanA adhika milane lagA hai utanA pahale nahIM milatA thA isakA artha yaha nahIM ki aba yaha adhika hone lagA hai balki isakA artha yaha hai ki isake sambandha meM jo ajJAna thA vaha haTa gayA hai aura aba isakI saMkhyA adhika mAlUma detI hai / isa karkaTa kA jJAna prAcIna kAla meM kSakiraNAdi ke abhAva meM karanA bahuta kaThina par3atA thA / aba bhI isakA nidAna karanA sabhI ke lie sarala nahIM hai / phuphphusa ' meM karkaTa hone ke kAraNa nimnalikhita pramukha lakSaNa dekhane meM Ate haiM : ( 1 ) kAsa, ( 2 ) raktaraJjita SThIva, ( 3 ) zvAsakRcchratA, ( 4 ) uraHzUla / kAsa kA kAraNa zvAsanAla meM karkaTa kI upasthiti ke kAraNa utpanna prakSobha hotA hai isalie vaha prArambha meM zuSka hotI hai parantu nirantara rahatI hai / raktaraJjita TIva kA kAraNa zvasanikIya zleSmalakalA meM raktastrAva kA honA kahA jAtA hai / TI ( thUka ) meM karkaTakozA bahudhA upasthita rahate haiM / inakA parIkSaNa sAdhAraNa vidhiyoM dvArA saralatayA kiyA jA sakatA hai / jaba dhIre-dhIre zvAsanAla kapha se bhara kara avaruddha yA saMkucita hone lagate haiM ( atelectasis ) taba karkaTa kI upasthiti kA AbhAsa ho sakatA hai / zvAsakRcchratA kA dhIre-dhIre bar3hanA karkaTIya upasthiti kA eka mahatvapUrNa lakSaNa hai / zvasanikIya avarodha tIna prakAra kA hotA hai / banda kapATIya avarodha meM vAyu avarodha ko pAra karake phuphphusa ke usa kSetra taka pahu~ca nahIM pAtI / sUkSmamArgayukta kapATa meM se bahuta thor3I mAtrA maiM vAyu AtI jAtI rahatI hai tathA eka ekamArgIya kapATa hotA hai jisameM vAyu eka hI ora ko jAne pAtI hai| jaba vAyu kevala andara kI ora hI jAtI hai taba vanakA vistAra ( emphysema ) tathA jaba vAyu bAhara kI ora nikalatI hai to zvasanikAsaMkoca ( atelectasis ) hone kI sambhAvanA rahatI hai | zvAsanAla meM avarodha kI upasthiti kA honA phuphphusa karkaTa ke pradhAna lakSaNoM meM AtA hai / zvAsakRcchratA Adhe se adhika karkaTaphuphphusiyoM meM milA karatI hai / zvAsakRcchratA zvAsanAlagata avarodha ke hI kAraNa hotI hai yA koI aura bhI kAraNa haiM yaha kahanA For Private and Personal Use Only

Page #804
728 vikRtivijJAna kaThina hai| parantu yaha to nissandeha kahA jA sakatA hai ki kevala avarodha hI usakA kAraNa nahIM hai kyoMki yaha avarodha to bahuta hI dhIre-dhIre huA karatA hai| aisA lagatA hai ki zvAsakRcchUtA ( dyspnea ) kA kAraNa hRdaya hai| hRdaya ke Upara taka phuphphusAntarAla ( mediastinum ) bar3ha jAtA hai aura usakI kriyA meM bAdhA pahu~cAtA hai| * uraHpradeza meM zUla do prakAra kA ho sakatA hai| eka to aisA ki jo phuphphusa meM kahIM bahuta gaharAI meM rahatA hai aura jisakA sthAnanirdhAraNa ( localisation) karanA atikaThina rahatA hai| yaha zUla bahudhA roga ke ArambhakAla meM hotA hai| para jaba prAcIrastha phuphphusacchada ( parietal pleura ) prabhAvagrasta ho jAtA hai taba adhika UparI sataha para dukhadAI phuphphusacchadapAka ( pleurisy ) kA zUla milane lagatA hai| anya avasthAoM meM zUla kA kAraNa vAtanADiyoM para pIDanAdhikya ho sakatA hai yA gale kI asthiyoM meM visthAyana ke kAraNa bhI zUla mila sakatA hai| lagabhaga pacAsa pratizata karkaTaphuphphusiyoM ke pRSTha, uras aura udarapradeza meM zUla huA karatA hai| uparokta lakSaNoM ke atirikta saMtApAdhikya ( fever ) bhI eka lakSaNa hotA hai jisake kAraNa yacmA kA bhrama prAyazaH cikitsakoM ko ho jA sakatA hai| jvara ke kaI kAraNa ho sakate haiM jinameM pUyIya zvAsanAlapAka, uraHkSata yA kisI bar3I zvasanikA kA avarodha honA mukhya hai / jvara ke kAraNa sitakozotkarSa avazya hotA hai| jyoM jyoM roga bar3hatA jAtA hai tyo tyoM vividha aGgoM para pIDana ( pressure ) ke kAraNa bhI kaI lakSaNa utpanna hone lagate haiN| annapraNAlI para pIDana hone se nigalanakRcchratA ( dysphagia) ho jAtI hai| kaNThanAla para pIDana hone se ghurghara. yukta zvasana (stridor ) ho jAtA hai| parAvartinI svarayantraga vAtanADI ke daba jAne se svarasAda yA svarahAsa (aphonia) ho sakatA hai| yadi svatantra nADImaNDala daba gayA to netra tArakoM meM asamatA ( inequality ) A jaaygii| nADI dekhane para donoM hAthoM meM bhinnatA milegii| yadi grIvAstha bRhacchirAoM para pIDana huA to sirArakta kI atipUrNatA (engorgement) se mukhAdi meM zyAmatA A sakatI hai| phuphphusa meM dUSakatA kI upasthiti tathA zarIra ko kama jAraka milane se mudgarAGguliparvatA ( clubbing of the fingers) mila sakatI hai| phuphphusacchada ke prabhAvita hone ke kAraNa urastoya ( wet pleurisy ) Adhe rogiyoM taka dekhI gaI hai| urastoya jo karkaTajanya hai isakI do pramukha vizeSatAe~ hotI haiM eka to yaha ki plUrala tarala meM rakta upasthita hotA hai| dUsare eka bAra isa jala kA nirharaNa kara dene ke bAda bahuta hI zIghra jala phira bhara jAtA hai| isa jala meM karkaTa kozA mila sakate haiM / kabhI kabhI to antazchadIya kozAoM ko bhramavaza karkaTakozA mAna le sakate haiM ataH ina kozAoM kI upasthiti se isa roga kI puSTi For Private and Personal Use Only

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726 arbuda prakaraNa mahattvapUrNa nahIM ho sktii| kozIyagucchoM se kucha tathya kA patA laga sakatA hai yA akSakAsthi ke Upara sthita eka lasagranthaka nikAla aNvIkSa meM parIkSaNa dvArA karkaTopasthiti kI siddhatA ko pramANita kiyA jA sakatA hai| eksare citra se phuphphusIya karkaTa kA patA cala jAtA hai para yadi urastoya sAtha meM huA to karkaTIya chAyA pUrNataH chipa jA sakatI hai| isaliye pahale jala kA nirharaNa karake kucha ghaNToM bAda hI citra lenA caahie| anyathA punaH vahA~ jala bhara jaayegaa| isa citra meM karkaTa hI dikhAI de aisA koI niyama nahIM zvasanakIya saMkoca, hRdaya kI vicyuti, phuphphusAntarAlIya lasagranthiyoM kI vRddhi Adi bhI mila sakatI hai| para jaba phuphphusa meM koI uttarajAta karkaTa hotA hai to vaha phuphphusavRntayu se dUra hone se citra meM spaSTa dikhalAI detA hai / jaba kisI zvAsanAla meM karkaTa ho to zvAsanAladarzaka dvArA use pratyakSa kiyA jA sakatA hai| yaha bhUlanA na cAhie ki isa karkaTa ke visthAyoM ke kAraNa mastiSka, yakRt , asthimajjAdi meM karkaTa bana sakate haiM aura unake lakSaNa mukhya rUpa le sakate haiN| isa kAraNa mUla vyAdhi phuphphusa karkaTa hone para bhI anya sthalIya karkaTa ko mukhya mAnane kA bhrama ho sakatA hai| (2) mahAsrotIya karkaTa 3-oSTha karkaTa ( Epithelioma of the Lip ) oSTha karkaTa bahudhA striyoM kI apekSA puruSoM ko tathA Upara ke oSTha ke sthAna para nicale oSTha meM bahutAyata ke sAtha dekhA jAtA hai| arthAt striyoM ke oSThoM meM karkaTa nahIM dekhA jAtA aura na Upara ke oSTha meM hI yaha milatA hai| nicale oSTha para prakSobha adhika hone kI sambhAvanA rahatI hai isa kAraNa se vahA~ yaha adhika dekhA jA sakatA hai| pahale pahala roga kA Arambha oSTha kAThinya aura oSTha sthaulya (induration and thickening of the lip) ke rUpa meM huA karatA hai| yadi vRddhi UparI tala para huI to eka camakIla sama gA~Tha bana jAtI hai jo nAtivilamba se vraga ke rUpa meM badala jAtI hai| para yadi vRddhi kucha gaharAI meM sthita huI to oSThakAThinya kA hI AbhAsa huA karatA hai aura bahuta kAla taka koI vraNa dekhane meM nahIM AyA krtaa| jaba kabhI vraNa bana jAtA hai to usakI AkRti gobhI ke phUla ke samAna phailatI huI hotI hai jisake kinAre paryApta moTe pAye jAte haiN| aNvIkSaNa karane para oSTha karkaTa adhicarmAbha karkaTa (epidermoid cancer) jJAta hotA hai| oSTha ke gahare bhAgoM meM zalkIyakozA puMja utpanna hone lagate haiM jinake kAraNa kabhI kama aura kabhI adhika kozA koTara ( cell nests) tathA kadara ( corns ) kA nirmANa hotA huA dekhA jAtA hai| karkaTa prathama dvitIya aura For Private and Personal Use Only

Page #806
730 vikRtivijJAna adhika se adhika tRtIya zreNI ( grade ) taka ke hote haiM caturtha zreNI kA karkaTa nahIM milA karatA / oSTa karkaTa kA prasAra prAyaH sthAnika hotA hai / adharoSThIya karkaTa oSTa ko naSTa kara sakatA hai, hanupradeza kI svacA ko vidIrNa kara sakatA hai tathA anta meM hanvasthi taka ko apane prabhAva meM le A sakatA hai / oSTa ke pArzvabhAga se upahanvIya lasagrathaka prabhAvita ho jAte haiM tathA kendra se hanu ke pIche ke ( submental ) lasagranthaka upasRSTa ho jAte haiM parantu lAlAgranthiyoM para koI prabhAva nahIM par3atA / usake Age Urdhvagraivika sampUrNa sapranthaka prabhAva meM A sakate haiM cAhe ve upariSTa hoM yA gaharAI meM hoN| adhograivika ( inferior cervical ) tathA UrdhvaakSakIya ( supra clavicular ) lasagranthakoM kA oSTa se pratyakSa koI samparka nahIM hotA isa kAraNa se ye aprabhAvita rahate haiM tathA yadi prabhAvita hue bhI to taba jaba roga bahuta adhika vistRta aura jIrNa ho jAtA hai / prabhAvita granthakoM meM vraNazothAtmaka sUjana rahatI hai isa kAraNa ve kucha sthUla ho jAte haiM parantu yaha sthUlatA sparza para utanI kaThina nahIM milatI jitanI ki anya karkaToM ke kAraNa lasagranthiyoM meM huA karatI hai / : Ayurveda meM kaI oSTha rogoM kA varNana hai unameM eka isa prakAra hai : kharjUraphalavarNAbhiH piDakAbhiH samAcitau / raktopasRSTau rudhiraM sravataH zoNitaprabhau // mAMsaduSTau gurU sthUlau mAMsapiNDavadudgatau / jantavazcAtra mUrcchanti sRkkasyobhayato mukhAt // (suzruta) isI ko aSTAGgahRdayakAra ne raktopasRSTau rudhiraM sravataH zoNitaprabhau / kharjUrasadRzaM cAtra kSINe rakte'rbude bhavet // mAMsapiNDapamau mAMsAtsyAtAM mUrcchatkRmI kramAt / yaha sampUrNa vivaraNa savraNa oSTha karkaTa ( ulcerating lip cancer ) kA hai / vAgbhaTa ne use raktArbuda nAma bhI de diyA hai / yaha khajUra ke phala ke samAna lAla surkha piNDakAoM se yukta raktasrAvI aura rakta se upasRSTa hote haiM / raktaduSTa arbuda batA kara phira mAMsaduSTa arbuda kA varNana kiyA hai ki vaha oSTha ke mAMsala bhAga ko sthUla guru aura kaThina banA detA hai tathA vahA~ jo vraNa banatA hai usameM rogakArI jIvANu utpanna hote haiM / yaha varNana do vividha karkaToM kA varNana hai yA adhicchadArbuda kI vividha avasthAoM ko vyakta karatA hai yaha nahIM kahA jA sakatA / vyavahAra meM tathA pratyakSa kI dekhane se sampUrNa varNa oSThIya karkaTa kA pratIta hotA hai / raktasrAva honA aura kRmi pUrNatA ye do lakSaNa Adhunika vaikArikI vizArada bhI mAna rahe haiM / 'Ulceration with infection and destruction of the tissues is steadily prosgressive.........Since the ulcerated growth is always infected the glands also become septic and various complications such as abscesses and haemorrhages may ensue. ' For Private and Personal Use Only

Page #807
arbuda prakaraNa 731 arthAt karkaTa meM savraNatA, upasarga aura UtinAza sadaiva milatA hai aura uttarottara bar3hatA jAtA hai kyoMki vraNita vRddhi sadaiva upasarga yukta hotI hai ataH lasagraMthiyA~ bhI dUSita ho jAtI hai jisase raktasrAva aura vidradhi bhavana ke kaI upadrava uTha khar3e hote haiM / grIna kA kathana hai ki yaha roga phiraMgika sitaghaTana ( syphilitic leuco. plakia ) dvArA hotA hai / 4 - rasanA karkaTa ( Cancer of the Tongue ) yaha karkaTa oSTha karkaTa kI taraha striyoM kI apekSA puruSoM meM hI adhika hotA hai / yaha kahA jAtA hai ki jaba taka jIrNa svarUpa kA vraNana yA phiraMgIya jihnApAka nahIM hotA taba taka svastha jihvA karkaTa se prabhAvita nahIM huA karatI hai / yahA~ taka kahA jAtA hai ki yadi kisI kI jIbha para eka arse se vraNa haiM aura raktaparIkSaNa para vAsaramena pratikriyA assyAtmaka nikalatI hai to koI kAraNa nahIM ki una vraNoM ko duSTa yA mArAtmaka na mAna liyA jAve / jihvA ko agra tathA anubhAgoM meM eka V ke AkAra kI aMkurayukta rekhA bA~TatI hai| Age ke do tihAI bhAga meM adhicarmAbha prakAra kA karkaTa hotA hai / jihvA ke kinAre para karkaTotpatti bahudhA huA karatI hai para jaba phiraMgIya vraNa para duSTa vRddhi janma letI hai to vaha jihvA pRSTha ( dorsum of the tongue ) para hI hotI hai / jihvA ke pichale eka tihAI bhAga para karkaTotpatti bahuta kama dekhI jAtI hai / ucca zreNI kI adhicarmAbha vRddhi yA antarvartI kozIya karkaTa ( transitional cell cancer ) hotA hai / rasanAkarkaTa pratyakSa dekhane para Arambha meM eka sthAnika kAThinya ( induration ) se adhika nahIM pratIta hotA / Age calakara isameM vraNana hokara eka carmakIlavat ( warty ) piNDa bana jAtA hai / bahudhA isameM vraNana vilamba se hotA hai tathA vaha pahale gaharAI meM antarbhUta adhika ho jAtA hai / jo vraNa banatA hai vaha paryApta kaThina aura uThA huA hotA hai aura usake kinAre gola hote haiM / Age calakara jaba usameM uttarajAta upasarga laga jAtA hai to UtinAza, nirmocana ( sloughing ) aura vinAza hone se vaha citra samApta ho jAtA hai / aNvIkSaNa para adhicarmAbha ( agra 3 ) yA antarvartI kozIya ( anu 3 ) karkaTa yA zalkIya karkaTa kA citra prakaTa hotA hai / sArka kA prasAra oSThakarkaTa kI apekSA atizIghra hotA hai / jahA~ jihvA para kAThinyayukta sthAna banA nahIM ki kucha hI dinoM meM vahA~ karkaTa dekhA jA sakatA hai| ataH vaisA hote hI aNvIkSIya parIkSaNa ke lie usakA eka lava kATakara bheja denA cAhie | isa tvarA se rasanAkarkaTa ke prasAra ke tIna kAraNa diye gaye haiM / pahalA to yaha ki rasanA meM lasavahAoM kI bahulatA hotI hai / dUsarA yaha ki jihvA meM pratyeka For Private and Personal Use Only

Page #808
732 vikRtivijJAna kSaNa pezIyagati hotI rahatI hai tathA tIsarA yaha ki karkaTa uccazreNI (high grade ) kA hotA hai / lasa ke dvArA vividha samIpastha lasagranthiyoM taka isakA prasAra ho jAtA hai / rakta ke dvArA isakA prasAra bahuta kama dekhA jAtA hai / dUSakatA aura raktasrAva ke kAraNa rasanAkarkaTa se grasta prANI jaldI mara jAtA hai / niHzvAsIya zvasanaka ( inhalation pneumonia ) ke kAraNa yA anujihnikA dhamanI (lingual artry) ke aparadita hone se aura raktastrAva hone se mRtyu hotI hai / 5 - prasanI karkaTa ( Cancer of the Pharynx ) grasanI meM adhicarmAbha karkaTa, anuvartI kozIya karkaTa tathA lasa adhicchadArbuda mila sakate haiM / adhivarmAbha karkaTa kA sthAna grasanIprAcIra, tuNDikApranthiyA~ aura mRdutAlu huA karatA hai / jahA~ yaha banatA hai vahA~ pahale pahale kucha kAThinya hotA hai phira zIghra hI vahA~ vraNa bana jAtA hai jisase gaharAI meM sthita UtiyoM kA vinAza hone lagatA hai aura mukha durgandha se bhara jAtA hai| isa karkaTa ke kAraNa yakRt meM visthAya ho sakate haiN| hanu koNoM meM sthita lasagranthaka prabhAvita ho sakate haiM tathA anumanyAsirA ( jugular vein ) taka AkrAnta ho sakatI hai / ( vilisa ) grasanI ke nicale bhAga (hypopharynx) meM kRkATikA ke pIche (postericoid) kevala striyoM meM karkaTa hotA huA dekhA jAtA hai / jaba yaha hotA hai to nigalana kRcchratA, grasanIya zleSmalakalA kA apoSakSaya tathA upavarNika lohAbhAvI raktakSaya ke lakSaNa dekhe jAte haiM inheM plUmara vinsana sahalakSaNa ( PlummerVinson syndrome ) kahate haiM / lohe kI kamI se zleSmalakalA kI apuSTi pahale hotI haiM vaha pUrvakarkaTAvasthA taiyAra karatI hai yadi isa kAla meM paryApta lohabhasma kA prayoga karAye jAve to sambhava hai isa ghora vyAdhi ke hone kI naubata hI na Ave / anuvartIkozIya karkaTa tathA lasaadhicchadArbuda donoM eka hI vastu ke do svarUpa mAlUma hote haiM / yadi donoM pRthak-pRthak bhI hue to bhI unake sthUla lakSaNa aura visthAya eka se hI hote haiM jinake kAraNa unheM eka sAtha hI likhA jA rahA hai / donoM prakAra kA karkaTa grasanI kI zleSmalakalA ke usa adhicchada se banatA hai lAbha Uti ke Upara hotA hai / nAsAgrasanI, mukhagrasanI aura svaragrasanI isakI utpatti ke mukhya sthAna haiM / isa karkaTa kI mukhyatA yaha hai ki jaba mUla grasanIya karkaTa svayaM bahuta tudra hotA hai taba taka usake visthAya jo donoM ora ke maivika lasagranthakoM meM banate haiM ve bahuta bar3e-bar3e hote haiN| yaha karkaTa kendrAbhiga ( centripetal ) na hokara kendrApaga ( centrifugal ) hotI hai / isa karkaTa ke kAraNa karoTimUla ( base of the skull ) taka prabhAvita hotA hai / pA~cavIM aura chaThI zIrSaNyA nADiyA~ isake For Private and Personal Use Only

Page #809
arbuda prakaraNa 733 kAraNa prabhAvagrasta ho jAtI haiN| zIrSaNya guhA ( cranial cavity ) taka karkaTa pahu~ca sakatA hai / Age cala kara uttarajAta vRddhiyA~ phuphphusa tathA yakRt donoM jagaha dekhI jA sakatI haiM / yaha karkaTa tejahRSa ( radio sesitive ) hotA hai aura eksare ke prayoga se gale kI vRddhi kucha kAla ke lie bilakula gala sakatI hai / aNvIkSadRSTyA anuvartI kozIya karkaTa atyadhika anaghaTita ( anaplastic ) hotA hai usameM pANDuvarNa ke asaMkhya kozAoM kA stAra ( sheet ) dekhA jAtA hai jisameM aneka vibhajanAGka pAye jAte haiM tathA kadarIkaraNa ( cornification ) kA abhAva rahatA hai / lasa adhicchadArbuda bhI lagabhaga aisA hI hotA hai parantu antara itanA hI hai ki adhicchadIya kozAoM ke sAtha-sAtha usameM aneka lasIkozA mile hue hote haiM yA itastataH phaile hote haiM / 6 - annapraNAlIya karkaTa ( Oesophageal Carcinoma ) annapraNAlIya karkaTa striyoM kI apekSA puruSoM meM adhika pAyA jAtA hai para prasanikA ke nicale bhAga meM kabhI-kabhI karkaTa ho jAtA hai use jaba annapraNAlIya karkaTa meM gina lete haiM to striyoM meM vaha adhika pAyA jAtA hai / prAyaH annapraNAlI ke madhyabhAga meM jahA~ vAma zvAsanAla ise pAra karatA hai aura jahA~ vaha kucha saGkucita rahatI hai karkaTa utpanna hotA huA pAyA jAtA hai / madhyama bhAga ke pazcAt adhobhAga meM karkaTa adhika pAyA jAtA hai / annapraNAlI ke UrdhvabhAga meM karkaTa kama hotA hai para prasanikA ke nicale bhAga ke karkaTa ko sammilita kara lene para isa kSetra meM anya donoM kSetroM ke barAbara karkaTa kA anupAta A jAtA hai / madhyama aura agho annapraNAlIya bhAgoM ke prakSobhaka khAdyadravya UrdhvabhAga kI apekSA adhika dera taka rukate haiM isI kAraNa ina sthaloM para prakSobhAdhikya ke kAraNa karkaTotpatti adhika huA karatI hai| annapraNAlI kI zleSmalakalA meM eka choTI gA~Tha ke rUpa meM karkaTa utpanna hotA hai phira vaha samIpastha UtiyoM meM bharamAra karake cAroM ora se annapraNAlI ke eka sthala valayAkAra bhAga meM phailatA hai jisase usakA sudhiraka saMkucita hotA calA jAtA hai / isa saMkucita bhAga se Upara kI annapraNAlI kA bhAga caur3A ho jAtA hai / kucha kAla pazcAt karkaTa ke sthAna para vidradhibhavana hotA hai aura karkaTa kI vRddhi kaNThanADI meM bhI vaNIbhUta ho sakatI hai / vaha vraNa mahAdhamanI ko vidIrNa karake aparimita raktasrAva karatA huA bhI raha sakatA hai athavA phuphphusAntarAla kI UtiyoM meM vraNana hokara sakotha vraNazotha ho sakatA hai| kabhI-kabhI vRddhi samIpastha UtiyoM meM na phaila kara suSiraka ke andara bar3ha kara mArgAvarodha kara detI hai / annapraNAlI ke mArga meM karkaTa ke kAraNa saMkoca ho jAyA karatA hai jisake kAraNa AhAra ke nigalane meM paryApta For Private and Personal Use Only

Page #810
734 vikRtivijJAna bAdhA A jAtI hai| isake kAraNa rogI kA jInA kaThina ho jAtA hai| parantu Ajakala kharAba annapraNAlI ko nikAla kara naI annapraNAlI lagAne kI paddhati jora pakar3a rahI hai| annapraNAlI darzaka yantra (oesophagoseope ) kI sahAyatA se karkaTa ke pratyakSa darzana kie jA sakate haiN| apavIkSaNa para yaha karkaTa adhicarmAma prakAra kA milatA hai, parantu isameM adhicchadIya muktA nahIM hote| kabhI-kabhI yaha granthikarkaTa bhI hotA hai usakI utpatti annapraNAlI kI zleSmalakalA meM sthita grandhiyoM se hotI hai / annapraNAlIya karkaTa kA vistAra yA visthAya samIpastha prAdezika lasagranthiyoM meM huA karatA hai| yadi Upara ke bhAga meM karkaTa ho to graivika evaM phuphphusAntarAlIya lasagranthiyoM meM visthAya baneMge; yadi madhyama bhAga meM ho to phuphphusAntarAlIya bhAga meM hI dekhe jAveMge tathA jaba antima bhAga meM karkaTotpatti hotI hai to mahAprAcIrA pezI ke nIce aura lasagranthi zRMkhalA tathA yakRt meM visthAya banA karate haiN| 7-AmAzayika karkaTa (Cancer of the Stomach ) manuSyoM meM mahAsrota meM sampUrNa zarIra meM utpanna hone vAle karkaToM kA 50 pratizata prApta hotA hai| usameM bhI AmAzaya meM karkaTotpatti jitanI adhika dekhI jAtI hai utanI anyatra nhiiN| bRTena meM jitanA garbhAzaya karkaTa pAyA jAtA hai usase tIna gunA aura jitanA vakSakarkaTa pAyA jAtA hai usase do gunA AmAzayika karkaTa dekhane meM AtA hai| yaha daridroM kA roga hai| dhanika yadi eka isase pIr3ita hotA hai to daridra tIna isase prabhAvita hote haiN| bhaugolika dRSTi se jaikoslovAkiyA meM yaha roga 66 prati sau karkaToM meM milatA hai, hAlaiNDa meM 55, yU0 esa0 e0 meM 42 tathA bRTena meM 22 pratizata pAyA jAtA hai| inakA kAraNa khAna, pAna aura tambAkU sevana kI vidhiyoM meM antara honA kahA jAtA hai| bauna ke kathanAnusAra jAvA aura sumAtrA meM nivAsa karane vAlI malaya jAti meM prAthamika AmAzayika karkaTa prAyaH nahIM hI hotA parantu vahA~ yakRt meM prAthamika karkaTa sabase adhika hotA hai| vahA~ ke hI cIniyoM meM AmAzayika karkaTa paryApta milatA hai aura yakRt karkaTa nahIM miltaa| prAyaH 60 varSa kI Ayu meM yaha roga hotA hai / usase pahale bhI dekhA jA sakatA hai| karkaTa ke pUrva jIrNa AmAzayapAka ( chronic gastritis ) bahudhA dekhA jAtA hai| AmAzayika karkaTa AmAzaya ke mudrika dvAra para lagabhaga 60 pratizata hotA hai| 20 pratizata hArdika dvAra ke pAsa laghuvAkraya ( lesser curvature ) ke samIpa milatA hai| For Private and Personal Use Only

Page #811
arbuda prakaraNa AmAzayika karkaTa se grasta prANI meM nimna lakSaNa dekhe jAte haiM : (1) ajIrNa, (2) tudhAnAza, (3) udarazUla, udara meM udanIrikAmla kA abhAva, dugdhikAmla aura rakta kI upasthiti, (5) araktatA tathA (6) bhaaraalptaa| AmAzayika karkaTa kA pratyakSa darzana karane se usakA nimna svarUpa dekhane meM A sakatA hai a-chatraka ( mushroom) kI taraha eka komala, bar3A aura kavakAnvita ( fungating ) piNDa jo AmAzaya ke suSiraka meM pauMDhatA calatA hai| A--kabhI-kabhI usakA uparyukta rUpa dekhane meM na Akara zleSmalakalA kA kucha sthala uThA huA hotA hai jo bahuta zIghra vraNita ho jAtA hai aura usase raktasrAva hone lagatA hai| isa vraNa ke kinAre uThe hue aura gola hote haiM aura isakA vyAsa 13 iJca taka kA ho sakatA hai| isa prakAra ke karkaTa ko utkhanana ( excavating ) prakAra kaha sakate haiM / sAdhAraNa AmAzayika vidradhi jo mArAtmaka rUpa dhAraNa karatI hai isI meM AtI hai| yadi isake dharAtala ko kATA jAve to prAcIra bahuta moTI ho jAtI hai, usameM pIle UtinAza ke dhabbe milate haiM tathA lasya dharAtala para kabhI-kabhI granthaka bhI dekhane meM Ate haiN| i-tIsare prakAra kA karkaTa aisA hotA hai jisameM AmAzaya prAcIra bahuta sthalita ho jAtI hai| yaha sthUlana sthAnika bhI ho sakatA hai aura prasara bhii| sthAnika sthUlana mudrikAdvAra para huA karatA hai jahA~ para dRr3ha saghana Uti kI eka mudrikA bana jAtI hai jo isa dvAra kA nirodha kara detI hai / isa kAraNa AmAzaya bahuta adhika visphArita ho jAtA hai| kaTA huA dharAtala atyadhika sthUlita ho jAtA hai aura saghana evaM kaThina par3a jAtA hai| prasara sthUlana ko abhighaTita AmAzayapAka ( linitis plastica ) bhI kahA jAtA hai / isake do nAma aura bhI haiM, eka carmakUpIya AmAzaya ( leather bottle stomach ) tathA AmAzayika yakRddAlyUtkarSa ( cirrhosis of the stomach) / isa avasthA meM sampUrNa AmAzaya rogagrasta ho jAtA hai| usakI prAcIreM bahuta sthUla ho jAtI haiM tathA usakA Ayatana bhItara se ghaTa jAtA hai| usakA AkAra bhI choTA ho jAtA hai| svAbhAvika rUpa se jo AmAzaya 1 phuTa lambA hotA hai vahI aba cAra-pA~ca iJca lambA raha jAtA hai aura svasthAvasthA meM jisameM sera savAsera padArtha samA jAyA karatA hai, isa roga meM usameM AdhA pAva sAmAna rakhane ko sthAna nahIM miltaa| usakI prAcIra 1 iJca taka moTI ho jAtI hai| vaha stabdha aura anAmya ( stiff and rigid ) pAI jAtI hai / isa AmAzaya kI zleSmala kalA apane pezIya stara se dRr3hatApUrvaka cipaka jAtI hai yadyapi usameM vaNana nahIM huA karatA / isa roga meM Upara se nIce taka sampUrNa AmAzaya roga se grasita ho jAtA hai / mudrikAdvAra para sthUlana ekadama ruka jAtA hai tathA grahaNI kI ora nahIM bddh'taa| isa roga meM karkaTa kozAoM ko pAnA kaThina ho jAtA hai |ve adhikatara isa sthaulya meM samApta ho jAte haiN| isI kAraNa yaha anya karkaToM ke barAbara duSTa nahIM hotaa| For Private and Personal Use Only

Page #812
736 vikRtivijJAna aNvIkSaNa karane para kaI vibhinnatAe~ dekhane meM AtI haiN| isameM karkaTa kozA yA to puMjoM meM yA rajjuoM (cords ) meM dekhe jAte haiM athavA svatantra rahate haiM / AmAzaya eka granthIya aMga hone para bhI isameM karkaTa ke kAraNa granthiyA~ nahIM banatIM / isakA ulaTA Antrastha karkaToM meM dekhA jAtA hai jahA~ pharkaTa kI granthIya racanA spaSTataH dekhI jA sakatI hai / karkaTa ke kAraNa AmAzaya kI sAdhAraNa zleSmalakalA aprArUpika graMthiya nalikAoM ( atypical glandular tubules ) meM badala kara zleSmalakalAstha pezI tantuoM ( Muscularis mucosae ) meM ghusa jAtI hai aura upazleSmala stara meM praviSTa ho jAtI hai tathA Age cala kara lasya tala ( serous surface ) taka para dekhI jA sakatI hai / granthiyoM para kozAoM ke eka yA aneka stara car3ha jAte haiM / ina kozAoM kI nyaSTiyA~ paramavarNika hotI haiN| inake kAraNa svAbhAvika varNa kI apekSA ve afra kAlI dikhalAI detI haiM / kahIM kahIM karkaTa pUrNataH anaghaTita banatA hai / granthiya gartA yA to bilkula hI nahIM banate yA apUrNa banate haiM / karkaTakozA puMjoM meM ekaeka stambha meM vinyasta dekhe jAte haiM / ina stambhoM ko eka dUsare se eka saghana saMdhAra pRthak karatA hai jaisA ki azmopama karkaTArbuda meM dekhA jAtA hai / yaha citra AmAzayika praNa dvArA utpanna karkaTa meM adhikatara milatA hai| sabase adhika anaghaTana ( anapla - sia ) prasarasthUlIya prakAra meM dekhane meM AtA hai / parantu anaghaTana itanA adhika hone para bhI karkaTa kI duSTatA bahuta kama rahatI hai / prasarasthUlana meM granthiyA~ banane kA koI upakrama na dekhA jAkara karkaTa ke mukta kozA akele yA puMjoM meM vraNavastu ke samAna sudRr3ha saMdhAra meM isa prakAra pha~se rahate haiM mAno ki saMdhAra ne unakA galA hI ghoMTa rakkhA ho / itane saghana tAntava Uti meM pha~se karkaTa kozAoM kI pahacAna baisTa ke kAramAina raMjana dvArA kI jAtI hai jo kozA meM sthita zleSmi ( mucin ) ko lAla raMga detA hai / jaba kozAoM meM zleSi kA nirmANa pracura parimANa meM hone lagatA hai to karkaTa eka kilATIya puMja kA rUpa dhAraNa kara letA hai| isa karkaTa ko zleSmAbha karkaTa ( mucoid cancer ) kahate haiM / isI ko pahale zleSAbha karkaTa ( colloid cancer ) kahA jAtA thA / zleSmAbha karkaTa lagabhaga 5 pratizata pAye jAte haiM / zleSmi jyoM-jyoM bar3hatI jAtI hai karkaTa kozA phUlate jAte haiM / atyadhika bar3ha jAne para ve phaTa jAte haiM / saba karkaTa kozA isa prakAra nahIM phaTate api tu kucha bace rahate haiM aura unhIM ke dvArA karkaTa hai isakI pahacAna ho jAtI hai / yaha saba hone para bhI sAdhyAsAdhyatA ke pariNAma meM koI antara nahIM AtA / 4 AmAzayika karkaTa kA prasAra ( spread ) sthAnika lasa granthakoM taka hotA hai tathA sudUrastha sthAnoM meM bhI pAyA jAtA hai / sthAnika prasAra ke kAraNa samIpastha aMgoM meM tathA AmAzaya prAcIra meM karkaTa kozA pahu~ca jAte haiM / prAcIra meM jo DhIlA-DhAlA upazleSmala stara hotA hai vaha grasita hotA hai / jaba prasara antarAbharaNa ( bharamAra ) hotA hai taba sampUrNa upazlepmala stara pahale ghira jAtA hai phira vaha tanvita (fibrosed ) ho jAtA hai / karkaTa sampUrNa AmAzaya prAcIra kA bhedana karake lasya tala para A

Page #813
arbuda prakaraNa 737 sakatA hai jahA~ se karkaTa kozA udara ke anya aMgoM udaracchada, vapAvAhana, bIjagranthiyoM Adi taka bar3ha jAte haiM / grahaNI para AmAzayika karkaTa kA prabhAva nahIM par3atA / mudrikAdvAra se Age karkaTa bar3hatA hI nahIM hai / yadi AmAzaya kI pazca prAcIra para karkaTa huA to sarvakiNvI meM usakA prasAra ho sakatA hai| yakRt meM bhI karkaTa kA prasAra ho sakatA hai / ye saba sthAnika prasAra ke rUpa haiM / granthakoM meM karkaTa kozAoM kA prasAra prAyaH dekhA jAtA hai| pahale AmAzayastha sagranthaka prabhAvita hote haiM tatpazcAt mukhyA rasakulyA dvArA akSakAsthi ke UparI bhAga kI lasagranthiyoM tathA graivIya lasagranthiyoM meM bhI prabhAva par3atA huA dekhA jAtA hai / raktadhArA ke dvArA dUrastha aMgoM meM karkaTa kA prasAra hotA hai / kezikA bhAjisirA dvArA sabase pahale yakRt para prabhAva par3atA hai / yakRt meM yaha uttarajAta karkaTa AmAzayastha mUla karkaTa se kaI gunA bar3A taka ho sakatA hai / yakRt ke atirikta phuphphusa, vAtanAr3IsaMsthAna, vRkkoM aura asthiyoM taka prasAra ho sakatA hai / AmAzayika karkaTa meM pAye jAne vAle kucha lakSaNoM kA varNana hama pahale kara cuke haiN| unameM eka lakSaNa udarazUla hai / udarazUla sadaiva taba hotA hai jaba AmAzaya meM koI vraNa ho aura pezIyastara para AghAta huA ho| isa roga meM vraNa dvArA jo karkaTa banatA hai use chor3akara zeSa meM pezIyastara ko AghAta nahIM hone se udarazUla bahuta hI kama dekhane meM AtA hai / akSudhA eka dUsarA lakSaNa hai / cudhA taba lagatI hai jaba AmAzaya kA pezIyastara apanI svasthAvasthA meM hotA hai aura zleSmalakalA se pAcaka rasoM kA srAva hotA rahatA hai / AmAzayika karkaTa meM svAbhAvika kozAoM meM karkaTIya kozAoM kI bharamAra ho jAtI hai isase rogI thor3A khAkara bhI tRpta ho jAtA hai tathA binA khAye bhI tRpta rahatA hai / AmAzaya meM udanIrikAmla kA nirmANa jina kozAoM se hotA hai unameM kucha karkaTa dvArA naSTa kara diye jAte haiM aura kucha svayaM apuSTa ho jAte haiM, isa kAraNa yaha amla bahuta kama bana pAtA hai / mudrikAdvArIya avarodha ho jAne para jo Age cala kara dekhA jAtA hai tathA isa avarodha ke pariNAmasvarUpa ruke hue anna kA vidhAna hone se AmAzaya meM dugdhikAmla ( laikTika esiDa ) banane lagatA hai aura usakI upasthiti kI parIkSA kI jA sakatI hai / jo karkaTa vraNa dvArA banatA hai usase raktasrAva paryApta hotA hai jise AmAzaya meM bhI siddha kiyA jA sakatA hai tathA usake kAraNa mala meM bhI rakta mila sakatA hai / AmAzaya pracAlana karma karane para karkaTa ke lava dekhe jA sakate haiN| rakta ke isa prakAra nikalane kA pariNAma raktakSaya meM ho jAtA hai / yaha araktatA yA raktakSaya upavarNika hotI hai / parantu kabhI-kabhI ise paramavarNika araktatA se pRthak karanA bahuta kaThina par3a sakatA hai / aisI avasthA meM kAmalA dezanA (icterus index ) dekhanI caahie| yaha karkaTa hone para kabhI svAbhAvika se Upara nahIM hotii| araktatA kA kAraNa raktasrAva ke atirikta pratyaraktatatva ( antianaemic factor ) kI kamI bhI hotA hai jo paramavarNika prakAra kI arakatA kara detA hai / For Private and Personal Use Only

Page #814
738 vikRtivijJAna eka AmAzayika vraNa kyA sadaiva hI karkaTa kA rUpa le sakatA hai ? isa prazna ko vibhinna vidvAnoM ne vibhinna prakAra se batalAyA hai| kisI ne mukta adhicchadIya kozAoM kI upasthiti vraNa meM dekhakara usake duSTa hone kI ghoSaNA kara dI hai| kisI ne unheM tAntavaUti kI saMkocAvasthA yA punarjanana prakriyA kA citra kaha kara sAdhAraNa hone kA mata vyakta kiyA hai / para satya yaha hai ki na saba vraNa karkaTa banate haiM aura na saba karkaToM kA prArambha vraNoM se hotA hai / kucha vraNa karkaTa meM pariNata ho jAte haiM tathA kucha bilkula nahIM huA karate / duSTatA kI ora agresara vraNa meM nimna bAteM milA karatI haiM: 1. vraNa kA kinArA karkaTAbha huA karatA hai na ki usakA AdhAra / 2. dhamanyantazchada meM vraNazotha / 3. pezIyastara kA pUrNataH vinAza tathA usakI tAntavaUti meM pariNati aura 4. upazama ke kAraNa zleSmalakalAstha pezIsUtroM kI pezIyastara ke sAtha saMlagnatA / Dates kA kathana hai ki karkaTa kA sthAna mudrikAdvAra hotA hai jaba ki vraNa usa dvAra se 2-4 iJca haTa kara banatA hai / ataH vraNa sadaiva karkaTa banegA isameM vaha sandeha vyakta karatA hai / usakI puSTi meM eka pramANa yaha bhI hai ki jahA~ vraNa varSo meM banatA aura varSoM rahatA hai, karkaTa mahInoM meM banatA aura bahuta hI thor3e samaya meM kAma tamAma kara detA hai / tIsare grahaNI meM vraNa jitanA adhika pAyA jAtA hai karkaTa utanA hI kama / sArAMza yaha diyA gayA hai ki jIrNa AmAzayika vraNoM kA kevala 5 pratizata rUpAntara karkaTa meM hotA hai tathA lagabhaga 20 pratizata karkaTa apanA janma vraNoM dvArA kiyA karate haiM / AmAzayika karkaTa kI utpatti ke lie vraNa cAhe utanA Avazyaka na ho para AmAzaya meM vraNazotha kA honA paramAvazyaka hai / vraNazotha ( gastritis ) ke kAraNa zleSmakalA ke kozA amlotpatti meM asamartha ho jAte haiN| ve yA to apuSTa ho jAte haiM yA paramapuSTa aura ve antra kI zleSmalakalA ke kozAoM ke sadRza ho jAte haiM / isa prakAra se jaba zleSmalakalA apanA svAbhAvika rUpa chor3a detI hai tabhI vahA~ karkaTotpatti hotI hai| - grahaNI karkaTa ( Duodenal Cancer ) yaha bahuta kama pAyA jAne vAlA karkaTa hote hue bhI jitanI ki isake hone kI AzA hai usase kahIM adhika hI milatA hai parantu AmAzaya kI apekSA yaha bahuta hI kama dekhane meM AtA hai / kSudrAntra meM karkaTa ke lie yadi koI sthAna hai bhI to vaha grahaNI pradeza ( duodenum ) hI ho sakatA hai / grahaNIvaNa grahaNI ke prathama bhAga meM milatA hai parantu karkaTa dvitIya bhAga meM banatA hai jahA~ sAmAnya pitta praNAlI tathA For Private and Personal Use Only

Page #815
arbuda prakaraNa 736 sarvakiNvi praNAlI ke mukha khulate haiN| isa bhAga ko vATara kI kalasikA ( Vater's ampulla ) kahate haiN| prAyaH stambhAkAra kozIya karkaTa yahA~ banA karatA hai| isa karkaTa ke banane kA viziSTa sthAna hone se grahaNI kA avarodha hone ke sAtha-sAtha pittapraNAlIya tathA sarvakiNvi praNAlIya avarodha bhI ho jA sakatA hai| kabhI-kabhI sarvakiNvIzIrSa ke karkaTa ko dekha kara grahaNI karkaTa kA bhrama ho sakatA hai| -Antra karkaTa ( Carcinoma of the Intestines ) kSudrAnta meM karkaTa bahuta kama hotA hai / sthUlAntra meM malAzaya, uNDuka tathA zroNistha sthUlAntra ( pelvic colon ) meM karkaTa bahudhA huA karatA hai| sthUlAntra meM jitane karkaTa hote haiM usake do-tihAI malAzaya meM pAye jAte haiN| striyoM meM sthUlAntra ke karkaTa aura puruSoM meM malAzaya karkaTa bahuta karake milate haiN| prAyazaH mahAsrota meM pAye jAne vAle karkaTa puruSoM meM striyoM kI apekSA adhika pAye jAte haiN| striyoM meM kabhI-kabhI to AntrakarkaTa tAruNyakAla meM hI dekhe jA sakate haiN| AntrakarkaToM ke lie rogI kI Ayu kA koI khAsa sambandha bahuta kama dikhatA hai isalie ve kabhI bhI utpanna ho jAte haiN| ___ Antra karkaTa do prakAra se utpanna hotA hai| eka to vaha Antra ke suSiraka meM gobhI ke phUla ke AkAra kA bana kara bar3hane lagatA hai aura kucha samaya vAda vraNita ho jAtA hai| dUsare vaha Antra prAcIra meM dhaMsa kara bharamAra kara detA hai aura Antra ke eka khaNDa meM bar3hakara nirodhotkarSa ( stenosis) utpanna kara detA hai| isa nirodha ke UparI bhAga meM Antra meM visphAra ho jAtA hai aura vaha bhAga moTA par3a jAtA hai| nirodha kA nicalA Antra bhAga sikur3a jAtA hai tathA avapatita ( collapsed ) ho jAtA hai| isa nirodha ke samIpatama (proximal ) bhAga meM mala kI gA~The bana jAtI haiM jo apanI kaThinatA ke kAraNa vraNa banA detI haiN| ina vraNoM meM jaba tAntava saMdhAra sikur3atA hai to aisA mAlUma par3ane lagatA hai mAno eka paTTI se Antra kA eka bhAga kasa kara bA~dha diyA gayA ho| gobhI puSpa ke samAna karkaTa meM zleSAbha vihAsa ho jAtA hai jisase bRhadantra zleSAbha karkaTa kA eka mukhya sthala mAnA jAtA hai| aNvIkSaNa para Antra karkaTa granthi karkaTa jaisA lagatA hai / gobhI puSpa rUpI karkaTa antarbharita karkaTa kI apekSA adhika vibhinnita hotA hai aura usameM acchA ghanA saMdhAra banatA hai| ___Antra karkaTa kA vistAra bahuta mandagati se huA karatA hai| malAzaya karkaTa khAsa taura para bahuta dhIre-dhIre phailatA hai| karkaTa kI vRddhi suSiraka kI ora tathA Antra ke For Private and Personal Use Only

Page #816
740 vikRtivijJAna lamba akSa kI ora huA karatI hai| Antra ke pezIyastara meM karkaTa kA antarAbharaNa bahuta kama aura dhIre-dhIre hotA hai| pezIyastara pAra karane para upalasyastara meM karkaTa kozAoM ke pahu~cane para phira lambAta ( long axis ) meM antarAbharaNa ( bharamAra ) hone lagatA hai| karkaTakozA lasavahAoM meM itastataH aise jamA ho jAte haiM ki ve choTe dAnoM kI mAlA se dikhalAI par3ate haiM jinheM dekhakara zalya cikitsaka zastrakarma ke samaya unheM yadimakA samajhane taka kA bhrama kara sakate haiN| dhIre-dhIre AntranibandhinIka tathA pazca udaracchadIya lasagranthakoM taka upasarga pahu~ca jAtA hai aura vahA~ se kezikAmAjisirA dvArA yakRt taka upasarga pahu~ca sakatA hai para vaha bahuta kama dekhA jAtA hai| kabhI-kabhI karkaTa kozA udaracchada yA zroNigata aMgoM para bhI uga Ate haiN| ___ Antra karkaTa hone para Arambha meM koI khAsa lakSaNa dikhalAI nahIM dete haiM / kabhIkabhI thor3A-thor3A vibandha ho jAtA hai aura kabhI-kabhI udrshuul| yahI zUla AntrAvarodha karake sampUrNa jIvanalIlA ko samApta karane meM bhI samartha ho sakatA hai| rogI ko mala phIte ke samAna hotA hai| isakA kAraNa hotA hai vaha nirodhotkarSa jo antara* bharita prakAra ke AntrakarkaTa dvArA utpanna kiyA jAtA hai| gobhIpuSpasama karkaTa meM raktasrAva aura durgandhapUrNa mala kA honA pAyA jAtA hai| isa dazA meM eka bAra malabaddhatA aura dUsarI bAra atIsAra dekhA jAyA karatA hai / malAzaya ke karkaTa meM mala ke sAtha rakta kA AnA prArambhika lakSaNa huA karatA hai para jaba karkaTa kA sthala avagrahAbha antra ( sigmoid colon ) meM hotA hai to raktAtIsAra bahuta bAda kA lakSaNa mAnA jAtA hai| uNDakagata karkaTa ke sAtha araktatA kA honA eka pradhAna lakSaNa hai| yaha araktatA mahAkozIya paramavarNika huA karatI hai| 10-udaracchadIya karkaTa udaracchada taka karkaTa kA prasAra nimna vidhiyoM meM se kisI ke dvArA hotA huA dekhA jAtA hai: 1. raktadhArA dvArA-udaracchada se dUra ke sthAna jaise vakSa meM karkaTa ho to vahA~ se raktadhArA dvArA karkaTa kozA calakara udaracchada taka A sakate haiN| 2. pratyakSa vistAra dvaaraa| 3. udaracchadIya lasavahAoM dvaaraa| 4. viprathana ( dissemination ) dvaaraa| AmAzaya karkaTa uparyukta antima tInoM meM se kisI bhI vidhi se udaracchada meM karkaTa kara sakatA hai| udaracchada meM prAthamika duSTa vRddhiyA~ bahuta hI kama hotI haiN| adhicchadIyArbuda hI kevala dekhane meM A sakatA hai so bhI hajAroM meM ekAdha ko / udaracchada kI uttarajAta vRddhiyA~ niyamataH karkaTArbuda ke rUpa meM hotI haiN| ye For Private and Personal Use Only

Page #817
arbuda prakaraNa 741 bahuta bar3I kabhI nahIM hotii| unake bahuta se choTe-choTe granthaka vapAvahana aura AntranibandhinI meM TApU ke rUpa meM itastataH dekhane meM Ate haiN| ve bhittilagna ( parietal ) udaracchada meM bhI dekhe jA sakate haiN| karkaTa ke kAraNa vapAjAla bahudhA sthUla ho jAtA hai| isa sthUlatA ke kaI kAraNa haiM unameM eka lasavAhanIka zopha hai dUsarA prasaratantUtkarSa hotA hai| udaracchada yA vapAjAla moTI caddara ke rUpa meM Antra para par3A rahatA hai| jaba udaracchada karkaTAnvita ho jAtI hai to vahA~ jalodara avazya hotA hai| jalodara ke jala meM rakta tathA karkaTa kozA donoM pAye jAte haiN| (3) yAkRta karkaTa (Cancer of the liver ) yakRt eka aisA aGga hai jahA~ prAthamika karkaTa bahuta hI kama pAye jAte haiM para uttarajAta karkaTa utane hI adhika dekhane meM Ate haiN| isa kAraNa jaba bhI yakRt meM kabhI koI karkaTa mile use uttarajAta yA dvitIyaka hI mAnanA cAhie jaba taka ki saba sambhava upAyoM se karkaTa kA prAthamika udbhava sthala haTA diyA jaave| ina saba sthaloM meM adhivRkka granthiyA~, vakSa, mahAsrota, phuphphusa, garbhAzaya, canu Adi meM karkaTa ke prArambhika sthala kI khoja bhalI prakAra kara lenI caahie| jaba yahA~ karkaTa na mile taba hI yakRt ke karkaTa ko prAthamika karkaTa mAnA jAnA caahie| kabhI-kabhI anyatra karkaTa bahuta sUkSma hotA hai jisake kAraNa yakRt meM sthita karkaTa uttarajAta hone para bhI prathamajAta jJAta hotA hai / ativRkkArbuda (hyper nephroma) meM vRkka meM karkaTa bahuta sUkSma hotA hai jaba ki usakA uttarajAta svarUpa yakRt meM paryApta vizada hotA hai| aba hama pahale yakRt ke prathamajAta karkaToM kA vicAra karake phira uttarajAta karkaToM kA varNana kreNge| prathamajAta karkaTa-yakRt ke prathamajAta karkaTa ke do rUpa hamAre sammukha AyA karate haiM : (1) yakRdarbuda ( hepatoma ) tathA / (2) pittapraNAlIkArbuda ( bile duct carcinoma) / yakRdarbuda-ise yakRtakozIya karkaTa ( liver cell carcinoma ) kahate haiN| yaha do prakAra kA milatA hai| eka vaha jisameM karkaTa kA eka hI puJja hotA hai jisake cAroM ora thor3e se granthaka par3e hote haiN| dUsare prakAra meM karkaTa ke aneka granthaka yakRt-piNDa meM itastataH phaile rahate haiN| karkaTa ke puJja cAhe aneka hoM yA eka, ve sabhI mRdula aura bhArI hote haiM tathA unameM UtinAza hotA huA tathA raktastrAva hotA huA bahudhA dekhA jAtA hai| donoM hI prakAra ke karkaToM kA sambandha kezikAbhAjIya prakAra ke yakRddAlyudara ke sAtha hotA hai| parantu bahugranthakIya prakAra meM tAntavaUti paryApta saghana hotI hai aura usake kAraNa bahuta For Private and Personal Use Only

Page #818
742 vikRtivijJAna spaSTa citra banatA hai / aisA pratIta hotA hai ki sarvaprathama yakRddAlyudara banatA hai aura yakRddAlyudara ke sAtha jo granthaka paramapuSTa ho jAte haiM unhIM se Age calakara karkaTa taiyAra hotA hai / karkaTakozAoM dvArA yakRt kI sirAyeM prAyaH AkrAnta hotI haiM isa kAraNa jo aneka vRddhiyA~ banatI haiM ve antaHzAlyika hotI haiN| aisA kahA jAtA hai ki ye arbuda bahukendrIya hote haiM aura yakRt ke vibhinna khaNDoM meM svatantratayA utpanna hote haiM / vIkSaNa karane para yakRt kozA bahuta viSama rIti se antarvayita paTTiyA~ ( interlacing strands ) jakar3e prakAroM meM bhI bahuta antara milatA hai / bahunyaSTikozA tathA mahAkozA khUba milate haiN| aura bahuta vibhajanAta dekhane meM Ate haiM / kahIM-kahIM avakAzikIya yA granthIya vinyAsa dekhane meM AtA hai jo pittapraNAlIka karkaTa ke sAtha saMbhrama utpanna karatA hai / vinyasta hote haiM / unako rahatI haiN| kozAoM ke bhaugolika dRSTi se pUrvI dvIpasamUha jAvA, sumAtrA, malayadeza aura cIna meM bahudhA yaha roga milatA hai / amerikA aura yUropa meM yaha roga nahIM hotA phira bhI vainakUvara meM jahA~ cIniyoM kI bahuta bar3I AbAdI hai, kanADA meM sabase adhika yaha roga dekhane meM AtA hai / pUrvI dezoM meM yakRt ke prAthamika karkaTa ke itanI adhikatA se hone ke kaI kAraNa ho sakate haiN| inameM eka parajIvI kITANuoM ( parasites ) kI udara meM adhikatA kA honA ho sakatA hai / jApAna ke sAsAkI aura yozIdA nAmaka vaijJAnikoM ne khoja karake makkhana kI pItimA dvArA mUSakoM meM prAthamika yakRt karkaTa utpanna karane meM saphalatA prApta kI hai| unakA kathana hai ki bhojana meM yadi ajaraMjaka ( Azo dyes ) ko bar3hA diyA jAve to prAthamika yakRt karkaTa bana sakate haiN| isa tathya se yaha spaSTa ho jAtA hai ki yakRt kI prathamajAta karkaTotpatti ke lie bhojana vA khAdyapadArtha bahuta mahattvapUrNa haiM | yakRt ke prathamajAta karkaTa meM jo rogalakSaNa dekhane meM Ate haiM unameM kucha to yaddAlkarSa ke kAraNa hote haiM tathA kucha karkaTa ke kAraNa hote haiM / kAmalA tathA jalodara ye do lakSaNa to sAmAnyataH dekhe hI jAte haiN| dasa pratizata rogiyoM meM jvara rahatA hai| jvara puMjIbhUta yakRdarbuda meM bahudhA milatA ti mRtyu huA karatI hai / kucha meM koI lakSaNa nahIM kAraNa zIghra mara jAtA hai / hai kyoMki usameM bahuta adhika milatA aura rogI raktasrAva ke For Private and Personal Use Only pittapraNAlIka karkaTa - ise pittavAhinyarbuda ( cholangioma ) bhI kahate haiM / yaha bahuta kama hotA hai / jitanA yakRdarbuda hotA hai utanA yaha nahIM hotA / isake sAtha yakRddAlyUtkarSa honA Avazyaka nahIM hai / isameM yakRt kA AkAra bahuta bar3ha jAtA hai / vaha bahuta adhika kAmalAnvita ho jAtA hai aura usameM itastataH asaMkhya arbuda puMja ( tumour masses ) phaile hue pAye jAte haiN| isameM ekapuJjIya prakAra dekhane meM nahIM AtA /

Page #819
arbuda prakaraNa 743 aNvIkSaNa se isakI racanA granthikarkaTa kI hotI hai / Astara ke kozA stambhAkAra yA ghanAkAra hote haiM / ina kozAoM kA prarasa yakRdarbudaka kozAoM ke prarasa kI apekSA adhika svaccha hotA hai / isameM mahAkozA (giant cells) nahIM pAye jAte / jaba yaha karkaTa adhika duSTa ho jAtA hai to vaha yakRdarbuda se milatA-julatA ho jAtA hai / isa karkaTa ke granthakoM ke cAroM ora saghana tAntava Uti chAI rahatI hai jo use samIpa kI yakRt Uti se pRthaka karatI hai / yakRdarbuda meM aisA pArthakya nahIM dekhA jAtA / vahA~ to arbuda yakRt kozAoM ke sAtha mila jAtA hai / isa roga meM lakSaNa yakRdarbuda ke samAna hote haiM parantu kAmalA bahuta adhika hotA hai / uttarajAta karkaTa - yakRt aisA aMga hai jahA~ uttarajAta vRddhiyA~ sarvAdhika pAI jAtI haiM / mahAsrota ke kisI bhI bhAga meM prAthamika karkaTotpatti ho vahA~ se kezikAbhAjisirA dvArA karkaTa kozA yakRt ko avazya aura kabhI bhI pahu~ca sakate haiM / vizeSa kara AmAzaya meM karkaTa hone para yakRt meM usakA uttarajAta svarUpa avazyameva taiyAra hotA hai / usake pazcAt vRkka, garbhAzaya, vakSa aura phuphphusa kI gaNanA kI jA sakatI hai| A~kha meM hone vAle duSTa kAlyarbuda ( melanoma ) kA visthAya yakRt meM banatA hai / uttarajAtIya yakRt ke karkaTa eka na hokara kaI hote haiN| ve kendra meM na jAkara yakRt ke UparI dharAtala ke adhika samIpa hote haiM / ve komala aura UtinAza se yukta hote haiN| unakA raMga UtinAza ke kAraNa pIlA dekhA jAtA hai yA pitta unheM harA raMga detA hai / inakA AkAra kabhI aura kahIM bar3A to kahIM choTA dekhA jAtA hai / UtinAza ke kAraNa dharAtalIya arbuda kendra meM nata ( falling in of the centre ) hote haiM jisake kAraNa Upara se garta se prakaTa hote haiM jise nAbhyana ( umbilication ) kahate haiM / vilisa kA kathana hai ki yadi aise yakRt ko jisameM pittavAhinyarbuda hoM patalepatale chedoM meM kATA jAve to arbuda ke granthaka kezikA bhAjisirA kI bar3I zAkhAoM meM Age kI ora nikale hue dekhe jAte haiM jinheM aNvIkSaNa se dekhane para aisA spaSTa dRSTi gocara ho jAtA hai ki karkaTa kozA vAstava meM raktadhArA meM unmukta kie jA rahe hoM / isa prakAra eka hI karkaTa se aneka vRddhiyA~ yakRt meM bana jAtI haiM / jaba yahI karkaTa kozA bAhara jAne vAlI sirAoM meM unmukta hote haiM to unake kAraNa phuphphusoM meM bhI usI prakAra ke visthAya utpanna ho jAte haiM / 4 - pittAzayika karkaTa ( Cancer of the Gall Bladder ) pittAzaya meM prathamajAta duSTa vyAdhi karkaTa taka sImita rahatI hai / saMkaTArbuda yahA~ utpanna hotA hogA isameM sandeha hai / karkaTa ke kozA stambhAkAra hote haiM para kabhI-kabhI samapuSTi ke kAraNa, jo jIrNa pittAzayapAka tathA azmariyoM ke kAraNa hotI hai, vizalkIya acchidArbuda ho sakatA hai | adhicchadArbuda ke atirikta isa kSetra ke karkaTa ke anya bhI For Private and Personal Use Only

Page #820
744 vikRtivijJAna kaI prakAra hote haiM / inameM granthikarkaTa eka hai / yaha sAGkura ( papillary ) tathA kavakAnvita ( fungating ) hotA hai| isake kAraNa pittAzaya kA suSiraka bhara taka jAtA hai kyoMki yaha vRddhi paryApta Thosa yA prapuJjita (bulky) hotI hai / yaha Age cala kara zleSAbha vihAsayukta ho jAtI hai / sAdhAraNatayA granthikarkaTa eka azmopama vRddhi ke rUpa meM bhI prakaTa hotA hai jisameM eka granthIya racanA saralatApUrvaka sthita rahatI hai| tathA sAtha meM saghana tAntava saMdhAra rahatA hai / jaba vaha saMkucita hotA hai to pittAzaya meM nirodhotkarSa vA avarodha kara detA hai / kabhI-kabhI avakAzikIya rUpa meM sAmAnya karkaTa ( carcinoma simplex ) dikhalAI detA hai / isameM karkaTa ke kozA golAbha ( spheroidal ) ho jAte haiM usameM granthIya racanA koI bhI nahIM hotI / kozA bar3e dvIpoM ke samAna jisameM bahuta thor3A saMdhAra rahatA hai, pAye jAte haiM / yaha saMdhAra kozA puMjoM ke bIca-bIca meM rahatA hai / kabhI-kabhI parantu bahuta hI kama aisA bhI dekhA jAtA hai jaba sAmAnya karkaTa golakozIya karkaTa ( round cell carcinoma ) ke rUpa meM dekhA jAtA hai / yaha prasaratayA antarAbharaNa karatA hai / isake kSudra, gola, adhika raMjanazIla kozA viziSTa prakAra ke huA karate haiM / ise pahale golakozIya saMkaTArbuda kahA jAtA thA / 1 I pittAzayika karkaTa ke sAtha gaharA kAmalA rahA karatA hai / pittAzaya se uttarajAta vRddhi lasavahAoM dvArA yA sIdhe pratyakSa saMbandha hone ke kAraNa yakRt meM ho jAtI hai isake visthAya pittakoSanalikIya ( cystic ) granthi meM tathA mahAdhamanI pUrva kI granthiyoM meM pAye jAte haiM / yaha bhUlanA na cAhie ki 80 pratizata rogiyoM meM karkaTa kI utpatti tabhI hotI hai jaba pittAzmariyoM se pittAzaya saMtrasta ho / para yataH pittAzmarI bahudhA striyoM ko hotI hai ataH pittAzayika karkaTa puruSoM kI apekSA khiyoM meM bahuta hotA hai / 5 - sarva kiNvIya karkaTa ( Cancer of the Pancreas ) / sarva kiNvI athavA kloma granthi ( pancreas ) meM prathamajAta karkaTa bahudhA milA karatA hai / striyoM kI apekSA puruSa isase adhika grasta hote haiM / granthi ke zIrSa bhAga meM prAyaH yaha roga ho jAtA hai tathA isake lakSaNa bahuta aspaSTa hote haiM / isI kAraNa isa roga kA nidAna karanA bahuta kaThina par3atA hai nirantara duHsvAsthya ( cachexia ) tathA udara meM aisA zUla jisakA koI vizeSa sthAna na ho ye donoM lakSaNa bahudhA milA karate haiM / kucha kAla pazcAt jaba grahaNI prAcIra meM vraNana aura raktasrAva hone lagatA hai| to mala meM rakta kA milanA bhI eka sthAyI ghaTanA bana jAtI hai / Age calakara jaba yaha vRddhi pittapraNAlI ko avaruddha kara detI hai to pittapraNAlI ke avarodha se utpanna kAmalA utpanna ho jAtA hai / sarvavI karkaTa ke do rUpa hote haiN| eka vaha jo sarvakiNvI ke adhicchada se utpanna hotA hai aura jo stambhakozIya azmopama granthikarkaTa hI hotA hai / isake sAtha saMdhAra For Private and Personal Use Only

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arbuda prakaraNa paryApta pAyA jAtA hai| dUsarA vaha jo jIvitaka ( parenchyma) meM hotA hai vaha drutagati se vRddhi karatA hai aura prasara hotA hai| ___ azmopama karkaTa sarvakiNvIya praNAlI yA praNAliyoM se nikalatA hai| yaha bahuta karake banatA hai| karkaTa dekhane meM choTA parantu patthara jaisA kaThina hotA hai| yaha sadaiva. sarvakiNvI ke zIrSa meM sthita rahatA hai isa kAraNa yaha pittapraNAlI kA avarodha avazya karatA hai| arbuda saghana saMdhAra ke kAraNa pittapraNAlI saMpIr3ita ho jAtI hai yA karkaTa ke kozA isakA aparadana karake ise naSTa-bhraSTa kara dete haiM / kucha bhI ho gaharA kAmalA aisA jo kisI bhI anya roga meM saMbhava nahIM, yahA~ rogI meM dekhane meM AtA hai| avarodhAtmaka paittika yakRddAlyUtkarSa (obstructive biliary cirrhosis ) kI utpatti se pUrva hI mRtyu ho jAyA karatI hai| isa roga meM pittAzaya bahuta adhika visphArita ho jAtA hai tathA samasta pittavAhiniyoM meM bhI khUba visphAra hotA hai / isa avasthA ko udyakRdutkarSa ( hydrohepatosis) kahate haiN| isa roga kA pariNAma jalodara meM bhI hotA hai| isakA vistAra udaraguhA taka hI sImita rahatA hai| yakRt para prAyazaH prabhAva ho jAtA hai tathA udaracchada meM prasaragranthakIya karkaTotkarSa ( diffuse nodular carcinosis) hokara jalodara banatA hai| ___jIvitakIya karkaTa apane autikIya rUpoM meM bahuta bhinna huA karatA hai| kabhI pranthikarkaTa milatA hai jisameM gartakIya vinyAsa ( acinar arrangement ) hotA hai yA koI bhI vinyAsa nahIM miltaa| azmopama karkaTa kI apekSA yaha arbuda adhika bar3A aura adhika mRdula hotA hai / isameM visthApana khUba tathA svatantratApUrvaka hotA hai| pittapraNAlI sAdhAraNI kA aparadana ho bhI sakatA hai aura nahIM bhii| na hone para kAmalA nahIM miltaa| isa karkaTa ke kAraNa grahaNI prAcIra prabhAvita ho jAtI hai aura vahA~ eka mArAtmaka vraNa bana sakatA hai jisase DaTa kara raktasrAva hotA hai jisake kAraNa raktakSaya aura saraktamalatA vizeSa lakSaNa yahA~ hote haiN| isa kAraNa ise dekha kara AmAzayika karkaTa kA bhI bhrama ho sakatA hai / (6) avaTukAgranthIya karkaTa ( Carcinoma of the Thyroid gland) avaTukA yA galagraMthi meM kalpanA se kahIM adhika karkaTa pAyA jAtA hai| galagaNDa roga hone ke uparAnta isake hone kI sambhAvanA bahuta bar3ha jAtI hai| sAdhAraNa granthyarbuda hone para usameM avaTukaviSatotkarSa ( thyrotoxicosis ) ke lakSaNa milane para bhI karkaTotpatti ho sakatI hai| yaha puruSoM kI apekSA striyoM meM adhika pAyA jAtA hai| jaba mRdula galagaNDa ( goitre ) kI vRddhi adhika drutavega se hone lage tathA sparza se vaha adhika kaThina hone lage to usakA karkaTIkaraNa huA aisA samajhA jA sakatA hai| parantu aisA parivartana eka granthisama koSTa. (adenomatous cyst ) meM raktasrAva hone para bhI dekhA jA sakatA hai| gale meM 63, 64 vi0 For Private and Personal Use Only

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746 vikRtivijJAna zUla aura vRddhi kI sthiratA aura bandhatA ( fixation ) mila sakatI hai| kaNThanAr3I para pIr3ana hone ke kAraNa zvAsakRcchratA mila sakatI hai / jaba karkaTa granthyarbuda meM se utpanna hotA hai taba vaha pariprAvarita hotA hai isa kAraNa vikRtivettA aNvIkSaNa ke nIce jaba taka dekhakara patA nahIM detA taba taka karkaTa hone kA jJAna bhI nahIM ho pAtA / dhIre-dhIre karkaTa kozA prAvara para prabhAva DAlate haiM aura samIpastha aMgoM taka pahu~cate haiM tathA graivika lasagranthiyA~ pravRddha hone lagatI haiN| kahIM-kahIM karkaTa prasara ( diffuse ) hotA hai aura yaha prasaraNa Arambha meM hI pAyA jAtA hai / niyamataH karkaTa bahuta kaThora hotA hai para kendra bhAga meM sakatI hai / kabhI-kabhI aura kahIM-kahIM to yaha mRdulatA itanI zakarmI ko usake saMkaTArbuda hone kA AbhAsa hone lagatA hai / kabhI-kabhI mRdulatA A adhika ho jAtI hai ki 1 aNvIkSaNa karane para avaTukIya karkaTa ke kitane hI rUpa sAmane A jAte haiN| jinameM majakIya, granthikarkaTIya tathA azmopama rUpa mukhya haiM / majjakIya aura granthikarkaTIya ( adenocarcinomatous ) rUpa prAyazaH dekhe jAte haiM para azmopama kama milatA hai / vibhinna karkoM meM to vibhinnatA hotI hI hai parantu avaTukagranthIya eka prakAra ke karkaTa meM bhI usake aneka bhAgoM meM bahuta adhika antara dekhane meM AtA hai / bvAyaDa eka aise hI karkaTa kA varNana karatA huA kahatA hai ki usakA eka bhAga majjakIya karkaTa thA, dUsare meM granthikarkaTa kA citra thA, tIsare meM sAdhAraNa adhicchadIya atipuSTi thI tathA cauthe meM zleSAbha galagaNDa thA / cAroM bhAgoM meM kevala galagaNDa hI mArAtmaka nahIM thA yadyapi yaha aneka visthAyoM ko utpanna kara sakatA thA / For Private and Personal Use Only isa roga kI eka mahattvapUrNa ghaTanA sirAoM ko AkrAnta karanA rahatA hai / isa tathya ko grAhama ne khoja kara nikAlA hai / isa tathya se eka bar3A lAbha yaha hai ki kucha arbuda jo Rju avaTukA Uti jaise hote haiM unameM aura isameM bheda saralatA se kiyA jA sakatA hai / karkaTa kozAoM aura vAhinya antazchada ke madhya meM koI saMyojI Uti kI rukAvaTa nahIM hotI isa kAraNa patalI prAcIroM ko pAra kara karkaTa kozA sirAoM ke bhItara bhI dekhe jA sakate haiN| sirAoM meM ina kozAoM kI isakA vistAra raktadhArA dvArA dUrastha aMgoM meM hotA hai ( innominate vein ), uttarA mahAsirA se lekara dakSiNa isake visthAya banate haiM / visthAyoM ke sambandha meM bhI kucha jAna lenA Avazyaka hai / avaTukAgranthIya karkaTa ke visthAya yA to phuphphusoM meM dekhe jAte haiM yA phira asthiyoM meM banate haiN| kazerukA, karoTi kI asthiyA~ tathA lambI asthiyA~ kahIM bhI uttarajAta vRddhi dekhI jA sakatI hai| kabhI-kabhI aise bhI varNana dekhane meM Ate haiM jahA~ avaTukA pUrNataH Rju ho yA sAdhAraNa galagaNDa vA granthyarbuda se pIr3ita ho para visthAyoM meM avaTukAgranthi ke prakRta svarUpa kA padArtha upalabdha hotA hai / kintu bvAyaDa aise varNanoM ko kapolakalpita mAnatA hai / visthAyakArI galagaNDa upasthiti kA artha hai ki aura galamUlikA sirA alinda taka ke pradeza meM

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arbuda prakaraNa 747. ( metastasizing goitre) nAma kA zabda Aja vyavahRta nahIM hotA / jaba avaTukA meM koI vizeSa parivartana na mile parantu usake visthAya milane lageM to use yaha nAma diyA jAtA hai / para vAstava meM dekhA jAya to jaba galagaNDa aura karkaTa eka sAtha rahate haiM tathA prAvarita hote haiM to karkaTa kA patA nahIM cala pAtA parantu raktadhArA dvArA karkaTa kozA phuphphusa vA asthiyoM meM visthAya banAne ko svatantra ho jAte haiM / prAvara haTane para karkaTa apane asalI rUpa meM A jAtA hai / ataH yaha galagaNDa nahIM jo fararaarta hai balki karkaTa hI visthAya karatA hai / ataH kevala galagaNDa ke lakSaNa pAkara hI samajha lenA ki yahA~ karkaTa nahIM hai, bahuta bar3A dhokhA ho sakatA hai / usakA autikIya parIkSaNa bhI kabhI-kabhI dhokhA de sakatA hai / ataH isa roga kA nidAna karane meM bahuta adhika satarka rahane kI AvazyakatA hai / yahA~ hama suzruta ke galagaNDa ke asAdhya lakSaNoM ke sUtra ko dete haiM / use dekhane se jJAta hogA ki vaha galagaNDa kA varNana na hokara galagaNDayukta karkaTa kA vaha varNana hai jisameM kaNThanAr3I para bahuta pIr3ana hone se zvAsakRcchratA utpanna ho gaI ho tathA svarayantra taka prabhAvita hone se svara baiTha gayA ho / aruci, gAtramArdava, arocaka aura kSINatA karkaTa ke kAraNa haiM jo saMvatsarAtIta hone se aura bhI spaSTa ho gayA hai kRcchrAcchvasantaM mRdusarvagAtraM saMvatsarAtItamarocakArtam | kSINaM ca vaidyo galagaNDayuktaM bhinnasvaraM cApi vivarjayecca // kaSTa se zvAsa lene vAlA, jisakA sampUrNa zarIra mRdu aura kSINa ho gayA ho, jisakA svara baiTha gayA ho, jise eka varSa se adhika roga meM ho gayA ho tathA jise aruci rahatI ho aise galagaNDayukta rogI ko vaidya ko chor3a denA cAhie kyoMki vaha asAdhya hai, usakI cikitsA nahIM ho sakatI / ( 7 ) poSaNikA granthi karkaTa (Cancer of the Pituitary Body) popagranthi, pIyUSagranthi yA poSaNikA granthi meM granthikarkaTa utpanna hotA hai / Arambha meM yaha arbuda dRSTinADIparikhA ( sella turcica ) ke bhItara hI rahatA hai / jyoMjyoM yaha bar3hatA hai, yaha parikhA bhI bar3hatI hai / usakI gulikAe~ (clinoid processes) pracUSita ho jAtI haiM aura parikhA phUTa jAtI hai / tatpazcAt karkaTa tRtIya mastiSka nilaya kI bhUmi ko AkrAnta karatA hai / usake kAraNa samIpastha koI bhI aMga hAni uThA sakatA hai / parikhA ke phUTa jAne se karoTiguhA kA nAsA se sIdhA sambandha jur3a sakatA hai aura mastiSka suSumnA jala nAsA dvArA nikala sakatA hai ( bvAyaDa ) | 1 aNvIkSaNa karane para karkaTa kozAoM ke viSamAkAra samUha athavA saghana rajjue~ asaMkhya raktavAhiniyoM dvArA pRthak hotI huI dekhI jAtI haiM kozAoM kA vinyAsa kucha vicitra aprArUpa (atypical) hotA hai| kabhI-kabhI kozA gartANuoM ke cAroM ora rahate haiM jinameM zleSAbha padArtha bharA rahatA hai / yahA~ koSIya vihrAsa mila sakatA hai / niyamataH For Private and Personal Use Only

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748 vikRtivijJAna poSaNikA granthike raMjanazIla kozA ( chromophobe ) isa vRddhi meM bhAga lete haiN| para kucha kama mArAtmaka prakAroM meM ye kozA bahuta kama saMkhyA meM bhI dekhe gaye haiN| poSagranthikarkaTa se visthAya yA uttarajAta vRddhiyA~ bahuta kama milatI haiN| poSagranthi meM arbuda hone ke kAraNa jo aneka lakSaNa dekhane meM Ate haiM unheM tIna samUhoM meM vibhakta kiyA jA sakatA hai 1. ve lakSaNa jo antaHkaroTIya pIr3anAdhikya ko prakaTa karate haiM para kyoMki poSagranthi ke arbuda bahuta bar3A AkAra nahIM le pAte isalie ye lakSaNa bahuta mahattvapUrNa nahIM hote| 2. antaHsrAvI lakSaNa ( endocrine symptoms )-ye lakSaNa poSagranthi kI paramakAryatA yA alpakAryatA ina donoM meM se kisI eka ko prakaTa karate haiM / paramakAryatA ( hyperpituitarism ) ke lakSaNoM meM bhI bheda ho sakatA hai kyoMki poSagranthi meM amlaraMjya (acidophil) pITharaMjya ( basophil ) aura abhiraMjya ( chromophil) tIna prakAra ke kozA hote haiN| inameM jo kozA bar3hatA hai vaise hI lakSaNa milate haiN| poSagranthi kI alpakAryatA ke sAtha kandAdharikabhAga ( hypothalamic part ) ke lakSaNa hote haiM, vizeSakara jaba abhiraMjya granthyarbuda ho| 3. samIpastha lakSaNa samIpa ke aMgoM para prabhAva hone ke kAraNa utpanna hote haiN| inameM andhatA eka aura bahuta bhayAnaka lakSaNa hai kyoMki arbuda kI sthiti ke kAraNa dRSTinAr3I para pIr3ana ho sakatA hai / isake kAraNa dRSTinAr3I kI prAthamika apuSTi (primary atrophy ) ho jAtI hai| yahA~ dvitIyaka apuSTi nahIM hotI jo anya mastiSkagata arbudoM meM dekhI jAtI hai aura jo dRSTinAr3IpAka ke uparAnta hotI hai / donoM ora bhItara ke dRSTinAr3I yojanikA ( optic chiasma) ke tantuoM para pIr3ana hone ke kAraNa donoM ora ke zaMkhakIya dRSTikSetrAoM kI andhatA ( bitemporal hemianopia) kA honA eka mahattva kA lakSaNa hai| cakravRtikA ( diaphragma sillae ) jaba khiMcatI hai to usake kAraNa atyadhika zIrSazUla hotA huA pAyA jAtA hai| yaha zUla jaba zAnta ho jAtA hai taba cakravRttikA phaTa jAtI hai| para Age cala kara antaHkaroTIya pIr3ana kI vRddhi ke sAtha ziraHzUla punaH hone lagatA hai| aura isa pIr3ana vRddhi kA antima pariNAma mRtyu hotA hai| (8) adhikkagranthi karkaTa (Cancers of the Adrenal glands ) adhivRkkagranthi ke do bhAga mukhya hote haiN| inameM eka majjaka kA aura dUsarA bAhyaka kaa| majjaka meM varNAtiraMjya karkaTa (chromaffin carcinoma) hotA hai tathA bAhyaka meM granthikarkaTa vA sAmAnya karkaTa milatA hai| nIce hama ina saba kA thor3A vicAra prastuta kareMge For Private and Personal Use Only

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arbuda prakaraNa 746. varNAtiraMjya karkaTa yA asitavarNIya karkaTa ( Pleochromocytoma ) -- yaha adhivRkkagranthi ke majjaka pradeza kA karkaTa hai jo bahuta hI kama dekhA jAtA hai aura jIvana ke uttarakAla meM utpanna hotA hai / yaha arbuda Arambha meM bahuta dhIre-dhIre utpanna hotA hai, sAdhAraNa ( apuSTa ) hotA hai tathA prAvarita hotA hai / isakA taba AkAra bhI choTA hotA hai / para jyoM hI yaha dvipArzvIya ( bilateral ) huA nahIM ki isameM duSTatA ke lakSaNa thor3e-thor3e dikhalAI dene lagate haiM / ye arbuda saghana vA koSTI, babhru varNa ke yA lAla raMga ke hote haiM ve bahubhujIya viSama kozAoM se banate haiM jo vargIya ( chromates ) dvArA abhiraMjita hote haiM / isI kAraNa isakA eka nAma varNA tiraMjyArbuda bhI hai ye kozA upavRkkI ( adrenaline ) banAte haiM / unakA nirmANa aniyantrita hotA hai jisake kAraNa nipIDAdhikya ( paroxysmal hypertension) ho jAtA hai / dhamanIdA bhI usI kAraNa hotA hai para kabhI upavRkkI ( eDrInalIna ) kI mAtrA itanI adhika rakta meM bhara jAtI hai ki sahasA mRtyu bhI ho sakatI hai / yadi karkaTa kA uccheda kara diyA gayA to ye koI lakSaNa nahIM rahate parantu zastrakarmottarIya sahasAgatastabdhatA ( shock ) ke kAraNa bhI mRtyu ho sakatI hai / yaha arbuda bahudhA to adhivRkka ke majjaka se banatA hai para vaha majjaka ke bAhara aura svatantra gaNDa ke parapragaNDIya varNAtiraMjya kozAoM meM yA adharA antra nibandhanI dhamanI ke udbhavasthala se jhukarakaiNDala ( zucker kandle ) ke aMga se jo navajAta zizu meM upasthita rahatA hai, se bhI utpanna hotA hai / mAtRkAgranthi ( carotid body ) ko varNAtiraMjya kozAoM kA ghara mAnA jAtA hai parantu usameM upavRkkI kI mAtrA bahuta kama rahatI hai / usake arbudoM meM bhI upavRkkI kama utpanna hotI hai / ve arbuda mArAtmaka nahIM hote yadyapi ve punaH punaH bhI ho sakate haiM tathA samIpa kI granthiyoM para AkramaNa bhI kara sakate haiM / adhika ho jAtA hai jaba varNAtiraMjya karkaTa hone ko hotA hai to udara meM zUla, vamana, bhrama, nAr3Idrautya aura kampAdi lakSaNa hone lagate haiM / kabhI-kabhI nipIr3Adhikya para bahudhA yaha sthAyI rUpa se nahIM bar3ha pAtA / arbuda ke na nikalane para rogI saMnyAsAvasthA meM hI samApta ho sakatA hai yA adhiraktIya hRdbheda ( congestive heart failure ) ke kAraNa bhI mRtyu ho sakatI hai / granthikarkaTa ( adrenal carcinoma ) - yaha adhivRkka ke bAhyaka kA karkaTa hai / yaha mRdu, pIta aura raktAstrAvIya pravRtti se yukta hotA hai / aNvIkSaNa para karkaTa ke kozA bAhya ke gucchakIya kaTibandha ( zona glomerulosa ) yA staMbhakozIya kaTibandha zona fasciculata ) ke banAne kA asaphala prayAsa karate haiM / dekha kozA vinyAsa viSama ho jAtA hai tathA astavyasta lagatA hai / kozA eka parivAhinya racanA meM anukramita ho jAte haiM kabhI-kabhI mahAkozA bahuta milate haiM / For Private and Personal Use Only

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750 vikRtivijJAna yaha karkaTa bahuta mAraka hotA hai / usake visthAya jaldI banate haiM aura ve sthAnika pracalana se vRkka meM pahu~cate haiM tathA adhivRkka pUrNatayA bhI vilupta ho sakatA hai / isa roga meM adhivRkka tathA vRkka kI sirAoM para prabhAva par3atA hai / isa karkaTa kA vistAra raktadhArA tathA lasavahA donoM se hotA hai / visthAya dUra-dUra hote haiM parantu phuphphusa, yakRt aura mastiSka isake visthAya ke pradhAnasthala haiM / kabhI-kabhI dUsarI ora kA vRkka bhI prabhAvita ho jAtA hai / pazca udaracchadIya, AntranibandhanIka aura phuphphusAntarAlIya lasagranthiyA~ bhI isameM bar3ha jAtI haiN| anumAna ke viparIta visthAya asthiyoM meM nahIM hote| isakA kAraNa yaha hai ki asthivisthAya vRkka meM karkaTa hone para bahudhA hote haiM / adhivRkka meM karkaTa hone kA una para koI pariNAma nahIM dekhane meM AtA / isa roga ke lakSaNoM se adhivRkka bAhyaka ke kAryoM kA patA laga jAtA hai / glina kA mata hai ki bAlakoM meM yaha arbuda lar3akiyoM meM lar3akoM kI apekSA pA~ca gunA hotA hai / vayaskoM meM barAbara-barAbara milatA hai / bAlakoM meM puMjananAGgoM meM vRddhi hone lagatI hai aura unameM puruSatva ke cihna bar3hane lagate haiM / adhivRkkajananAGgIya sahalakSaNa ( adreno genital syndrome) kahA jAtA hai / lar3akiyoM meM prathamanAta evaM uttarajAta donoM prakAra ke puruSatva ke lakSaNoM kA udaya hotA hai / unakI bhagazikSikA ( clitoris ) bar3ha jAtI hai / unake mu~ha aura zarIra para kezodgama hone lagatA hai / isa avasthA ko kezodgamana ( hirsuties ) kahate haiM / bAlakoM kA liMga bahuta adhika bar3ha jAtA hai para sAtha meM SaNDhatA bhI rahatI hai| striyoM meM prajananAGga apuSTa ho jAte haiM, anArtava aura medasvitA bar3ha jAtI hai, svara moTA ho jAtA hai, dAdI aura mU~cha khUba uga Ate haiM / ina lakSaNoM ko kyUziMga sahalakSaNa ( cushing syndrome ) tathA adhivRkkajananAGgIya sahalakSaNa meM vibhakta kara diyA gayA hai / kyUziMga sahalakSaNa poSagranthi ke pITharaMjya granthyarbuda se milatA-julatA hai / isameM pezI daurbalya, kezodgamana, anArtavatA, SANDya, tvacA kI apuSTi, asthivairalya ( osteoporosis ), kabhI-kabhI nipIDAdhikya tathA madhuvazi se bho na sudharane vAlA madhumeha Adi lakSaNa pAye jAte haiN| isake kAraNa poSagranthi pITharaMjya kozAoM meM kAcara parivartana ho jAtA hai tathA usake kaNa vilupta ho jAte haiM / adhivRkkajananAGgIya sahalakSaNa meM kezodgamana, puruSatva ( virilism ), pezyAdhikya hotA hai, madhumeha nahIM huA karatA / puruSoM meM parivartana bahuta kama dekhane meM Ate haiM / kabhI kahIM unameM strItva ke lakSaNa dekhe jAte haiM / aisI avasthA meM unake mUtra meM strIjanakatatva ( oestrogenic material ) milane lagatA hai / nipAdhikya bahudhA milatA hai para vaha daure ke sAtha hotA hai / vRkkoM meM vRkkANu ( nephrosclerosis ) mila sakatA hai / arbuda uccheda kara dene para puruSatva ke tathA anya saba lakSaNa cale jAte haiM aura nipIDAdhikya bhI nahIM rahatA / isase yaha patA lagatA hai gayA ki nipIDAdhikya kA eka prakAra adhivRkkIya bAhyaka kI atikriyA dvArA bhI utpanna hotA hai /

Page #827
arbuda prakaraNa (6) mUtrasaMsthAna ke karkaTa 1-vRkkakarkaTa ( Renal Carcinoma ) vRkka ke jIvitaka se utpanna hone vAle karkaToM ko ativRkkArbuda ( hyperneph. roma ) yA prAvitjhArbuda (Grawitz tumours ) kahA jAtA hai / grAvitjha nAmaka vaijJAnika ne sarvaprathama yaha batalAyA thA ki ina arbudoM ke upariSTha kozA adhivRkka ke bAhyaka se milate haiN| vRkkakarkaToM kA pratyakSa darzana eka viziSTa prakAra kA hotA hai| ye prAyaH bar3e aura raMga meM pIle hote haiN| unake Upara aneka UtinAza aura raktasrAvapradarzaka kSetra hote haiM / raktastrAvI kSetroM kA pAyA jAnA inakI bahuta mahattvapUrNa vizeSatA batalAI jAtI hai| kabhI-kabhI to rakta se bhare hue koSTha (cysts) bhI itastataH dekhe jA sakate haiN| karkaTa ke Upara eka prAvara jo paryApta puSTa hotA hai, car3hA rahatA hai jisakA nirmANa vRkka prAvara dvArA tathA pIr3ana ke kAraNa naSTa huI samIpastha UtiyoM tathA unake tantUtkarSa dvArA hotA hai| yaha prAvara hara sthala para eka barAbara dRr3ha nahIM hotA aura na usakI moTAI sarvatra eka sI rahatI, isI kAraNa kahIM-kahIM vaha chidrita bhI ho jAtA hai| vRkka ke bhItara karkaTa ke kozAoM kI bharamAra hone lagatI hai tathA vRkta Uti kA nAza bhI hone lagatA hai| isake kAraNa sampUrNa vRka anta meM eka arbuda kA hI rUpa dhAraNa kara letA hai| vRkka ke karkaTa usake uttarIya, madhyavartI yA dakSiNI dhruva meM kahIM bhI bana sakate haiN| vRkkamukha para AkramaNa kA honA aura gavInI kA avarodha hokara uvRkkoskarSa ( hydronephrosis ) kA bananA bhI eka svAbhAvika ghaTanA ho sakatI hai| bahudhA ye vRddhiyA~ eka hI vRkka meM milatI haiM para ve kabhI-kabhI donoM ora bhI pAI jA sakatI haiN| aisI avasthA meM eka meM karkaTa bahuta bar3A aura dUsare meM thor3A choTA dekhA jA sakatA hai / choTA karkaTa bar3e karkaTa kA visthAya jJAta hotA hai| vRkka ke karkaTa paryApta duSTa hote haiN| isa kAraNa ve paryApta hI visthAyoM ke janaka bhI hote haiN| adhivRkkIya karkaToM kI bhA~ti hI inakI pravRtti sirAoM ko AkrAnta karane kI bhI rahatI hai| isalie ve vRkkasirA ( renal vein) yA uttarA mahAsirA ke kinAroM para bhI dekhe jA sakate haiN| isake kAraNa visthAya lasavahAjanya na hokara raktavAhinIjanya huA karate haiN| inhIM sabakA pariNAma yaha hotA hai ki vRkka karkaTo ke uttarajAta visthAya phuphphusoM meM banate haiN| ye visthAya sUkSma bhI ho sakate haiM aura paryApta sthUla bhI / sUkSma vA sthUla, rakta dvArA ye asthiyoM taka jA sakate haiM aura vahA~ unakA punarupasarga kara sakate haiN| asthiyoM meM aparadana ho jAtA hai jisake kAraNa vaikArika asthibhanna utpanna ho jAte haiN| inhIM asthibhannoM dvArA vRkkIya karkaTa kI upasthiti kA bahudhA jJAna bhI huA karatA hai| asthi meM isa prakAra visthAya pragaNDAsthi ke UrdhvazIrSa meM yA kisI kazerukA meM hotA hai / yaha visthAya prAyaH eka hI milatA hai| For Private and Personal Use Only

Page #828
752 vikRtivijJAna Upara jo hamane citra upasthita kiyA hai vaha yadyapi vRkcha karkaTa kA sthUla aura eka sA svarUpa prakaTa karatA hai tadyapi aNvIkSaNa para vRkka karkaTa ke do bhinna prakAra dekhane meM Ate haiN| inameM eka prakAra aMkurIya (papillary) hotA hai / isake catuSkoNAbha kozA pravarddhanakoM meM dekhe jAte haiN| isa kozAoM kA prarasa kaNAtmaka hotA hai aura usameM snehavindu hote haiM kabhI-kabhI vaha atyanta svaccha kaNavirahita aura rasadhAnIyukta bhI dekhA jAtA hai / usa para koI varNa nahIM car3hatA parantu usameM madhujana kI mAtrA paryApta hotI hai| vRkka karkaTa ke dUsare prakAra meM kozA stambhoM meM yA staroM meM vinyasta rahate haiM, aMkura nahIM bnaate| ve catuSkoNAma na hokara bahubhujIya hote haiN| unakA kozAprarasa svaccha aura kaNarahita hotA hai| isa prakAra meM bahunyaSTIya vA mahAkozA bahudhA dekhe jAte haiM jo prathama prakAra meM nahIM milte| kahIM-kahIM vRkka nalikAe~ ugatI huI bhI dikhAI detI haiN| vRkka karkaTa nidarzaka lakSaNa bahuta kama milate haiM / yaha roga prauDhAvasthA meM utpanna hotA hai / isameM zUlarahita nirantara bhaura pracura parimANa meM raktameha (haematuria) pAyA jAtA hai| isa raktameha kA kAraNa hai vRktakarkaTIya kSetra se nalikAoM evaM vRkamukha ko rakta kA cyAvana honaa| parantu yaha lakSaNa sadaiva sthAyI rUpa se nahIM miltaa| jaba taka karkaTa choTe rUpa meM rahatA hai taba taka raktasrAva nahIM hotA aura hone para mUtra ke sAtha utsarga honA Avazyaka nhiiN| kisI-kisI meM sAtha-sAtha jvara A sakatA hai jo barAbara rahatA hai| ina do lakSaNoM ke atirikta anya lakSaNa nahIM milte| jaba asthi meM visthAya ke kAraNa asthibhanna hotA hai yA phuphphusa meM visthAya hone se raktaThIvana hotA hai taba vRktakarkaTa kA kucha AbhAsa milA karatA hai| isa roga meM vRkazUla nahIM yA bahuta hI kama pAyA jAtA hai| 2-bhrauNa granthikarkaTa ( Foetal adenocarcinoma ) __ vRkta ke jIvitaka zrauNa vizrAmasthala ( foetal rests ) kahIM-kahIM pAye jAte haiM arthAt vahA~ vRkka Uti paripakva na hokara apakva raha jAtI hai| ina vizrAmasthaloM se bhrauNika Uti kI utpatti huA karatI hai| isameM prArambhika (primitive ) prAvara ( capsules ) tathA nalikAe~ ( tubules ) banate haiM / yaha Uti apane sthAna para duSTa hotI hai aura vRkka kI paripakva Uti ko naSTa karatI hai| isake dvArA visthAyotpatti bahudhA hotI nahIM hai| prAyaH bhrauNa prakAra kA vRkka acchA banatA hai aura kozAoM kA vibhannana uccazreNI kA rahatA hai / 3-vRkkamukhIya adhicchadArbuda (Epithelioma of the renal pelvis) vRkkamukha para jo karkaTotpatti hotI hai vaha antarvartI ( transitional ) prakAra For Private and Personal Use Only

Page #829
arbuda prakaraNa 753 kI hotI hai| usameM zAGgaNa ( keratinization ) kozAkoTaranirmANa (formation of cell nests ) tathA adhicchadIya muktAoM kA abhAva hotA hai tathA zitAgrIyakozA (prickle cells ) aura unakI koNIya bahIrekhA tathA antaHkozIya tantviyA~ ( intercellular fibrils ) nahIM dikhAI detIM / vRkkIya adhicchadArbudoM meM aMkurAbuMdoM kI bhA~ti aMkura to hote haiM para ve unakI apekSA choTe aura adhika sUkSma hote haiN| inameM dauSTya apekSAkRta adhika hotA hai| inake dvArA kSetrIya lasagraMthakoM meM lasavahAoM dvArA visthAya banate haiN| dUrastha aMgoM meM visthAya raktadhArA ke kAraNa banate haiN| adhosthita mUtramArga meM mUtradhArA dvArA tathA saMvapana ( implantation ) dvArA visthAya banate haiN| isa roga meM gavInI avaruddha ho jAtI hai aura uvRkkotkarSa milatA hai| raktamehatA isakA bhI lakSaNa hotA hai| vRkkamukha para jaba nirantara prakSobha kA prabhAva par3atA rahatA hai to usakA antarvartI adhicchada, stRta vizalkIya adhicchada ( stratified squamous epithelium ) meM parivartita ho jAtA hai aura taba usase vizalkIya adhicchadArbuda bana jAtA hai jisameM zAGgaNa evaM kozAkoTara dekhe jA sakate haiM / 4-basti karkaTa ( Carcinoma of the bladder ) . vRkkamukha, gavInI tathA basti ina tInoM aMgoM kA eka dUsare se nikaTa kA sambandha hai kyoMki tInoM meM antavartI ( transitional ) adhicchada kA Astara rahatA hai / isa kAraNa inameM antavartI kozA karkaTa yA cirakAlIna prakSobha ke kAraNa parivartita hue vizalkIya adhicchada meM vizalkIya kozA karkaTa dekhane meM Ate haiN| ___ basti meM do prakAra ke karkaTa milA karate haiM jinameM eka niSaNNa ( sessile ) aura dUsarA vraNAtmaka ( ulcerative ) kahalAtA hai| niSaNNa karkaTa ke kAraNa mRdula, carmakIlavat (warty) padArtha bastiprAcIra se nikalatA hai| isake dharAtala se pracura parimANa meM raktasrAva hotA hai| bahudhA aMkurAbuMda dvArA yaha duSTarUpa taiyAra hotA hai| isake hI bhAga TUTa-TUTa kara aura saMvapita hokara basti ke vibhinna bhAgoM meM arbudika pravardhana rUpa meM dekhe jA sakate haiN| __ niSaNNa arbuda ke kozA bastiprAcIra meM bharamAra karate haiM aura kabhI-kabhI nahIM bhI karate / sAdhAraNa aMkurArbuda aura isameM antara AkRti, svarUpa, kozAoM ke raMjana kI prakRti meM vibhinnatA, paramavarNayukta nyaSTiyoM kI upasthiti aura vibhajanAGkoM kI prApti se kiyA jAtA hai| vraNAtmaka prakAra ko anAGkarIya karkaTa ( nonpapillary carcinoma) bhI kahA jAtA hai| isake sAtha paryApta saMdhArika pratikriyA hone se isameM tantUtkarSa paryApta hotA hai / isake kAraNa kevala eka, kAThinyayukta duSTa vraNa banatA hai| yaha karkaTa bastiprAcIra kI zleSmalakalA ke nIce-nIce paur3hatA hai aura usake kozAoM kI bharamAra For Private and Personal Use Only

Page #830
754 vikRtivijJAna kAphI gaharAI taka ho jAtI hai| usameM UtinAza tathA vaNana ho jAtA hai jisase eka karkaTIya vraNa bana jAtA hai| aNvIkSaNa meM dekhane se vaha azmopama yA majjakIya prakAra kA hotA hai| ina donoM prakAra ke karkaToM meM kozA aprArUpika ( atypical ) hote haiN| unakA vibhinnana nimna zreNI kA hotA hai parantu duSTatA bahuta ucca hotI hai| unase visthAya jaldI banate haiN| lasavahAoM dvArA jaghanastha lasagranthiyoM ( iliac lymph glands) tathA kaTistha ( lumbar) lasagranthiyoM taka prabhAva par3atA hai| raktadhArA dvArA phuphphusa, yakRt tathA kabhI-kabhI asthiyoM taka prabhAva par3a jAtA hai| jaba aMkurAbaMda karkaTa kA rUpa letA hai taba duSTatA nimna hotI hai tathA visthAya dera se banate haiN| pittAzmarI se jisa prakAra pittAzayika karkaTa kA sambandha hotA hai vaisA yahA~ nahIM hotaa| vinIlinIya ( snileinic ) saMyogoM ( compounds ) ke sAtha kArya karane vAle zramikoM ke mUtra meM vinIlI nikalatI hai isa kAraNa unako bastikarkaTa dekhe jAte haiN| ___ uttarajAta bastikarkaTa puruSoM meM aSThIlA granthi yA malAzayastha karkaTa ke dvArA tathA striyoM meM garbhAzayagrIvA evaM garbhAzayastha karkaTa dvArA banA karate haiN| basti meM karkaTotpatti ke tIna sthAna hote haiM / eka gavInImukhoM ke bAhara, dUsarA, bastigrIvA para aura tIsarA prakoSTha (vault) meN| gavInImukhoM para vRddhi hone se ye mukha banda ho jA sakate haiM / usa dazA meM uddhRkkoskarSa ho sakatA hai tathA upasarga ke chU jAne se bastipAka evaM vRkkapUyoskarSa (pyonephrosis ) ho sakatA hai| mRtyu kA kAraNa mUtraraktatA (uraemia) huA karatA hai| (10) puruSaprajananAGgIya karkaTa 1-puraHstha (aSThIlA) granthi karkaTa (Carcinoma of the Prostate) puraHstha granthi kA karkaTa bahudhA puraHstha granthi kI vRddhi ke sAtha-sAtha prauDhAvasthA meM pAyA jAtA hai para isa paramacaya aura karkaTa meM Apasa meM koI sambandha honA siddha nahIM kiyA jA sakA hai| isa granthi meM vRddhi kA utanA mahattva nahIM hai jitanA ki usake kAThinya kA hai / eka azmopama karkaTa kI bhA~ti yaha karakarAhaTa ke sAtha kaTatA hai| kaTA huA dharAtala zuSka hotA hai, usameM na to ubhAra hotA hai na gA~The hotI haiM aura na khaNDopakhaNDa hI pAye jAte haiN| karkaTIya kozAoM ke pIta dvIpasamUha isameM dekhane meM Ate haiM jaise ki stana ke azmopama karkaTa meM milA karate haiN| yahI saba vizeSatAe~ aSThIlA ke paramacaya se ise pRthaka karatI haiN| paramaghaTita aSTIlA kA jaba uccheda kiyA jAve to kaTe hue bhAga meM se eka cheda ( section ) lekara aNvIkSa ke nIce rakhanA cAhie aura dekhanA cAhie ki usameM kahIM dauSTya ke kSetra to nahIM bana gaye haiN| rica nAmaka vidvAn ne mRtyUttara parIkSaNa para yaha mAlUma kiyA ki 50 varSa se Upara marane vAloM kI aSThIlA granthiyoM meM se 14 pratizata meM karkaTIya kozA upasthita the| For Private and Personal Use Only

Page #831
arbuda prakaraNa aNvIkSaNa se isa karkaTa kA svarUpa azmopama karkaTa yA granthi karkaTa ke tulya pAyA jAtA hai| donoM meM azmopama hI adhika milatA hai| bvAyaDa kA kathana hai ki aNvIkSaNa para jaba vikRtivizArada ko dauSTya ( malignancy ) kA tanika bhI sandeha ho to samajhanA hogA ki aSThIlA meM avazya hI karkaTa hai / stanakarkaTa meM sandeha honA karkaTa ke sadaiva viruddha jAtA hai| kabhI-kabhI (para bahuta hI kama ) karkaTa kozA pIle meda se bharapUra hone ke kAraNa jhAgadAra dikhalAI dete haiM inheM pItakarkaTa (carcinoma xan thomatodes ) kahate haiN| ___ aSThIlA karkaTa se pIDita prANI bahuta hI kama bacate haiN| paramacaya ke lie hue zastrakarma meM yadi akasmAt karkaTa kozA mila jAveM taba bhI visthAyoM ke kAraNa yA punarutpatti dvArA mRtyu ho jAyA karatI hai| ____ isa karkaTa kA prasAra bhI bahuta mahattvapUrNa hotA hai| aSThIlA granthi ke pazca bhAga meM prAyaH karkaTika vRddhi huA karatI hai / vahA~ se zukraprasekinI (ejaculatory duct) kI dizA meM phailatI hai| usake pazcAt basti aura zukraprapA ke bIca meM gudaparIkSaNa para mAlUma kI jA sakatI hai| basti kA pharza aura usake samIpa kI tAntava racanAe~ phira AkrAnta ho sakatI haiN| isa karkaTa kA prasAra parivAtIya lasavahAoM (perineural lymphatics ) dvArA hotA hai jo isake prasAra ke mukhya sAdhana haiM aura jo karkaTa kozAoM se rUMdhI aura phUlI huI prAyaH dikhA karatI haiN| aSThIlA ke prAvara ke parivAtIya karkaTika AkramaNa kA honA sabase pahale parivartanoM meM se eka ghaTanA hai| mUla karkaTa cAhe kitanA hI choTA kyoM na ho prAvara taka AkramaNa ho sakatA hai aura vahA~ se Age basti, mUtramArga, zukraprapikA, malAzaya, basti gudAntarIya sthAlIpuTa (rectovesical pouch ) vapAvahana tathA asthIya zroNi taka AkramaNa mila sakatA hai| zroNIya aura kaTipradezIya lasagranthaka sarvaprathama AkrAnta hote haiN| vahA~ se Age graivika tathA adhiakSIya (supraclavicular ) lasagranthakoM taka upasarga jA sakatA hai / zukraprapikAoM (seminalis vesiculae) aura mUtramArga kA lasavahA sambandha vaMkSaNa pradezastha lasagranthakoM se hone ke kAraNa pandraha pratizata rogiyoM meM vaMkSaNa pradezIya lasagranthaka bhI AkrAnta milate haiN| kahane kA tAtparya yaha hai ki kadAcit hI koI eka lasagranthaka isase bacatA ho| aSThIlA granthi ke karkaTa ke visthAya (metastases) raktadhArA dvArA yakRt , phuphphusAdi sthaloM meM dekhe jAte haiN| parantu sarvAdhika mahattvapUrNa visthAya isake dvArA asthiyoM meM banAe jAte haiN| sattara pratizata mRtakoM meM asthIya visthAya dekhe jA cuke haiN| zroNi aura kaTistha kazerukoM meM ye visthAya pAye jAte haiN| vahA~ se Urvasthi aura pazukAoM taka bhI milate haiM / trika aura kaTipradeza meM upasarga kA kAraNa parivAtIya lasavahAe~ hotI haiM parantu bATasana ke mata meM sirAoM ke kazerukIya saMsthAna (vertebral system of veins ) dvArA upasarga jAtA hai / taba kisI vRddha vyakti ko asthi kA arbuda ho to usakI aSThIlA granthi meM karkaTa hone kA sandeha kiyA jA sakatA hai aura usake lie isa granthi kA parIkSaNa avazya karanA caahie| asthi meM aSThIlAgranthi karkaTa ke kAraNa For Private and Personal Use Only

Page #832
vikRtivijJAna bane visthAya kSakiraNa citra meM jaraThatAyukta ( sclerosing ) tathA anya kAraNoM se viralatAyukta ( rarefying ) dekhe jAte haiN| aSThIlA granthi ke karkaToM ke kAraNa asthIya visthAya 70% taka dekhe jAte haiN| avaTukA pranthi ke kAraNa 37%, stana karkaTa se 14% tathA anya kAraNoM se aura bhI kama milate haiN| __ aSThIlA ke cAroM ora tathA basti ke mUla meM sirAoM kA eka tagar3A pratAna (plexus) hotA hai| vahA~ se kucha rakta adhizroNikA sirA ( ileac vein ) meM jAtA hai jahA~ adharA mahAsirA meM hotA huA phuphphusa taka jAtA hai| kucha rakta mastiSkamAtRkA sirA ( vertebral vein ) dvArA karoTi evaM kazerukAoM taka jAtA hai| karkaTa ke kozA ina donoM hI mArgoM kA avalambana kara sakate haiN| bAda ke mArga se ve jAnA adhika pasanda karate haiN| pahale mArga se phuphphusa meM sUcama visthAya banate haiM vahA~ se karkaTa kozA rakta ke sAtha mila kara hRdaya meM jAte haiM jahA~ se ve pragaNDAsthi yA urvasthi ke zIrpa ko jAte haiN| jaGghAsthi yA pazukAoM taka meM visthAya aise hI banate haiM, dvitIya mArga dvArA zroNistha asthiyA~, kaTitrikastha kazerukA yA Urdhva graivika kazerukAvA karoTika asthiyA~ jaisA ki pahale likhA jA cukA hai visthAya ke sthala banatI haiN| tIsarA mArga vAtanADI kaMcukoM aura parivAtIya lasavahAoM kA hai jo pahale spaSTa kiyA jA cukA hai| ___ asthIya karkaTotkarSa ke sAtha-sAtha raktakSaya yA araktatA (anaemia) sadaiva milA karatI hai rakta ke citra meM RjuruhoM (normoblasts) tathA majjakAyANu (myelocytes) bahulatA se pAye jAte haiN| citra sitaraktarahIya araktatA ( leuco-erythroblastic anaemia) kA hotA hai| yadyapi vaikArika asthibhanna mila sakate haiM parantu asthi kI saghanatA ( jaraThatA) kA honA tathA raikliMgaADasana ke zabdoM meM use karkaTIya asthipAka (carcinomatous osteitis) kA honA aSThIlAgranthi karkaTa ke asthigata visthAya kA pramukha lakSaNa hai / naI asthi isameM banA karatI hai jo prAyaH AdhmAyita (chidriSTa-spongy ) hotI hai| jaba-taba vaha Thosa bhI ho sakatI hai| sAtha-sAtha asthi pracUSaNa ( resorption ) bhI hotA rahatA hai| kSa-citra dekhane se kabhI-kabhI paigeTAmaya ( Paget's disease ) kA bhrama ho jAtA hai parantu bhrama dUra karane meM rakta citra sahAyatA kara sakatA hai / aSThIlAgranthi karkaTa kyoMkara hotA hai isa para IviMga aura yaMga ke do paraspara virodhI mata haiN| IviMga kahatA hai ki paramacaya, paramaghaTana yA paramapuSTi ke kAraNa karkaTotpatti hotI hai| sAdhAraNa lagane vAlI puraHsthagranthi kI vRddhi bahudhA duSTa rUpa dhAraNa kara letI hai yA usameM dauSTaya ke sUkSma kSetra dekhe jA sakate haiN| yaMga kA kathana yaha hai ki karkaTa sadaiva aSThIlA ke pazca bhAga meM utpanna hotA hai| isa bhAga kI parama puSTi zAyada hI kabhI hotI ho ataH paramapuSTi karkaTotpAdaka mukhya kAraNa nahIM ho sakatI / IviMga ke mata se isa granthi ke karkaToM meM se 10 pratizata meM paramapuSTi milatI hai| tathA 19 pratizata paramapuSTi ke rugNoM meM adhika dhyAnapUrvaka dekhane se karkaTa mila sakatA hai| For Private and Personal Use Only

Page #833
arbuda prakaraNa Adhunika khoja isa tathya para pahu~cAtI hai ki aSThIlA granthi kI sAdhAraNa vRddhi antaHsrAvI graMthiyoM kI asantulita avasthA para nirbhara karatI hai| sAtha hI karkaTotpatti ke prakaraNa meM nyAsargIya abhikartAoM ( hormonal agents ) kA varNana karate hue hama yaha likha cuke haiM ki kAma sAndrAbhoM ( sex-steroids ) ke dvArA bhI karkaTotpatti ho sakatI hai / idhara hama yaha bhI dekhate haiM ki yadi kisI vyakti kA aNDAkarSaNa ( castration ) kara diyA jAve to usakI aSThIlAgraMthi meM utpanna hue karkaTa kI vRddhi ruka jAtI hai| agara isa granthi ke karkaTa se pIr3ita vyakti ko strIsAndrava (stilboesrtol) kA upayoga karAyA jAve to bhI karkaTa samApta ho jAtA hai| ina tathyoM se hama isa nirNaya para saralatA se pahu~ca sakate haiM ki puMsavIya asantulana ( andro. genous imbalance ) ke kAraNa saba nahIM to kucha avazya hI aSThIlAgranthikarkaToM kI utpatti hotI hai| yahI eka aisA karkaTa hai jo antaHsrAvI padArthoM ke dvArA cikitsya hai| haginsa aura usake sahakAriyoM ne bhAsveda ( phosphatase ) nAmaka vikara ( enzyme ) para parIkSaNa kiye haiN| yaha bhAsveda kSArIya aura Amlika karake do prakAra kA hotA hai| kSArIya bhAsveda asthirUhoM dvArA bar3hatI huI asthiyoM meM banatA hai| Amlika bhAsveda aSThIlAgraMthi meM bahutAyata se milatA hai / jaba aSThIlAgranthikarkaTa ke visthAya asthi taka pahu~cate haiM to bhAsveda kI mAtrA rakta meM bar3ha jAtI hai| Amlika bhAsveda ko aSThIlAgraMthi kA adhicchada banAtA hai tathA karkaTa utpanna hone para usakI mAtrA aura bhI bar3ha jAtI hai| asthi meM visthAya hone para raktarasa meM isakI mAtrA bahuta adhika bar3ha jAtI hai| ukta vidvAnoM kA kathana hai ki jaba 100 gha0 za. mA0 rakta meM 10 ekakoM se adhika Amlika bhAsveda bar3ha jAve to aSThIlAgranthikarkaTa kI sambhAvanA nizcita hI batalAI jA sakatI hai| para sadaiva hI yaha vRddhi ho yaha Avazyaka nhiiN| Amlika bhAsveda aSThIlAgranthi meM karkaTa karane kA na to hetu hI hai aura na usako pahacAnane kA pramukha sAdhana / kyoMki yaha to usI avasthA meM bar3hatA hai jaba asthi taka visthAya bar3ha gayA ho| jaba taka asthiyA~ AkrAnta nahIM hotI isakI vRddhi nahIM hotii| yaha karkaTa granthi ke pazcabhAga meM hotA hai isa kAraNa mUtramArga meM avarodha yA mUtrakRcchratA nahIM hotii| prArambha meM cupacApa vRddhi hotI hai| kaTipradezIya kazerukAoM yA sirAoM ke grasita hone se sabase pahalA lakSaNa kaTizUla kA milatA hai| vaikArika asthibhagna, UrvasthizIrSa yA pragaNDAsthizIrSa yA paryukA meM zUla mila sakatA hai ve sUja bhI sakatI haiN| bastimUla ke AkrAnta hone para bastipAka aura raktameha dekhA jA sakatA hai| grIna kA kathana hai ki jo vRddha puruSa kaTizUla, gRdhrasI, tAntavapAka yA sandhivAta ke zUla batalAte haiM unheM puraHsthagranthikarkaTa ho sakatA hai, ise na bhUlA jaave| For Private and Personal Use Only

Page #834
vikRtivijJAna - 2-zukrArbuda ( Seminoma) yaha eka prakAra kA karkaTa hai / ise IviMga eka prakAra kA bhrauNArbuda (teratoma) mAnatA hai aura kahatA hai ki isameM kozA bahuta nimna zreNI kA hone ke kAraNa vibhinnana prakaTa nahIM hotaa| phrAnsIsI vidvAn ise retasanAlikAoM (seminiferous tubules) ke bar3e-bar3e pUrvazukrakozAoM ( spermatoey tes ) dvArA banA huA arbuda mAnate haiM aura isalie ise vAstava meM vRSaNa karkaTa kahate haiN| donoM hI mata grAhya haiM kyoMki isa arbuda ke kozAoM kA vinyAsa kabhI-kabhI nAlikIya granthikAoM ke nirmANa kI ora nirdeza karatA hai aura bahuta sthAnoM para aisA vinyAsa nahIM dekhA jaataa| ataH donoM matoM meM se kisI eka ko abhI taka mAnyatA dene ke pUre pramANa upalabdha nahIM ho sake haiN| autikIya raSTi se yaha arbuda gola avibhinita kozAoM se banatA hai jisakI nyaSTiyA~ gaharI raMgI jA sakatI haiN| inameM kAyArasa adhika nahIM hotaa| vibhajanAGka paryApta hote haiN| kozAoM meM aGgAma vinyAsa na hokara ve stAroM yA stambhoM meM hote haiM jinheM tAntava saMdhAra kI svalpa mAtrA pRthaka karatI hai| saMdhAra meM lasIkozAoM aura laghujAlakAntazchadIya mahAkozAoM kI bharamAra dekhI jA sakatI hai| dekhane se aura kozIya vibhinnana kI kamI se saMkaTArbuda (sArkomA) kA bhrama ho sakatA hai parantu vAstava meM yaha karkaTa hai isameM koI sandeha nhiiN| zukrArbuda sadaiva bahuta data vega se bar3hate haiN| yadi unheM utpanna hote hI kATa kara na pheMka diyA gayA to unakI punarutpatti hI nahIM hotI ve sarvAGgINa (genera. lised) visthAya bhI utpanna kara sakate haiM / UtinAza aura raktAstrAva khUba hotA hai| yaha bar3e arbudoM meM bahuta dekhA jAtA hai| karkaTakozA aNDadharapuTaka ( tunica vaginalis ) taka bharamAra karate haiN| vRddhi ke sAtha udakamuSka ( hydrocele ) tathA zoNamuSka ( heamatocele ) bhI dekhe jA sakate haiM parantu unakI bhI eka maryAdA hotI hai kyoMki arbuda vRSaNa se saMsakta ( abhilagna ) hotA hai| 3-zizna karkaTa ( Carcinoma of the Penis ) ise adhicchadArbuda ( epithelioma ) bhI kahA jAtA hai| yaha bahuta adhika dekhA jAne vAlA roga hai| yaha zalkIya adhicchadArbuda hotA hai| Arambha meM karkaTa eka choTI carmakIlasama (warty ) vRddhi mAtra hotA hai| vaha zanaiH zanaiH ziznamuNDa para gobhI ke phUla kI taraha kavakAnvita piNDa (fungating mass ) bana kara phailatA calA jAtA hai| yaha ziznamuNDa ke kinAre ( corona ) para prAyaH banane lagatA hai| jo vyakti niruddhaprakaza ( cphimosis ) se kucha pIr3ita rahate haiM unako hI yaha vikAra adhika hotA hai isI kAraNa parikartita mer3hacarmiyoM ( circumcised ) ko yaha vikAra nahIM milA karatA / For Private and Personal Use Only

Page #835
arbuda prakaraNa aNvIkSaNa para ziznakarkaTa puSTa adhicchadArbuda prakaTa hotA hai| usameM kozAkoTara bane hote haiN| sAtha hI suspaSTa zAGgaga jaisA ki prathama zreNI ke karkaToM meM dekhA jAtA hai milatA hai| isake atirikta anya vibhinita prakAra bhI mila sakate haiN| ziznamuNDa kI svAbhAvika AkRti meM kitanA hI parivartana A jAne para bhI mUtratyAgaprakriyA yathAvat calatI rahatI hai| isake kAraNa uttarajAta vRddhiyA~ vaMkSaNIya lasagraMthakoM meM hotI haiM jo Age calakara anya sudUrastha aMgoM meM bhI dekhI jA sakatI haiN| 4-vRSaNa karkaTa yaha cimanI meM kAma karane vAle zramikoM meM ho jAtA hai| pairAphIna para kAma karane vAloM ko bhI ho sakatA hai| (11) strIprajananAGgIya karkaTa 1-bIjakozIya karkaTa (Ovarian Carcinoma) prathamajAta aura uttarajAta do prakAra ke bIjakozIya karkaTa hote haiN| ina donoM kA varNana hama nIce de rahe haiM : prathamajAta-bIjakoSoM kI adhikAMza vRddhiyA~ koSThIya (cystic ) hotI haiN| unameM bhI koSThagraMthikarkaTa (cystadeno carcinoma) pramukhatayA milatA hai| kyoMki koSThagraMthyarbuda meM duSTatA bahuta dUta vega se lagatI hai| jitane koSThIya karkaTa lasya koSThagraMthyarbuda se banA karate haiM utane kUTazleSa koSThagraMthyarbuda ( psuedomucinous cystadenoma ) se nahIM bnte| anya graMthiyoM meM jisa prakAra ke karkaTa banate haiM vaise hI yahA~ bhI banate haiN| graMthikarkaTa khAsa karake banatA hai| yaha koSThIya tathA aMkurIya (papillary ) donoM prakAra kA dekhA jAtA hai| isameM zleSAbha vihAsa bhI ho jAtA hai| sAdhAraNa karkaTa bahudhA koSThIya para kabhI-kabhI saghana bhI hotA hai| prasara karkaTa sadaiva saghana hotA hai| bIjakozIya karkaTa sadA 45 se 55 varSa kI Ayu taka hotA hai| kabhI-kabhI yaha bahuta pahale bhI dekhA jA sakatA hai| 50 pratizata rogiyoM meM bIjakozIya karkaTa donoM ora milatA hai| eka ora karkaTa utpanna hone para lasadhArA dvArA dUsarI ora visthAya hI sambhavataH isakA kAraNa hotA hai| sAtha hI sAtha prAyaH jalodara bhI rahatA hai jisameM tarala rakta varNa kA hotA hai / isa tarala meM karkaTa kozA bhI dekhe jA sakate haiN| jalodara kA kAraNa udaracchada meM visthAya bananA hai| 80 pratizata rogiyoM meM ye visthAya banate haiN| sAtha hI prasara udaracchadIya karkaTotkarSa (diffuse peritoneal carcinoma ) bhI dekhane meM AtI hai| granthIya visthAya pahale-pahala kaTipradezastha lasagranthakoM meM banate haiN| vahA~ se ve Upara yA nIce kI ora lasyazRMkhalA dvArA bar3hate haiN| raktadhArA dvArA Age visthAya yakRt aura phuphphusa taka cale jAte haiN| pratyakSa prasAra dvArA garbhAzaya nalikAoM meM bhI visthAya bana sakate haiN| garbhAzaya ke antazchada para bhI visthAya dekhe jA sakate haiN| For Private and Personal Use Only

Page #836
vikRtivijJAna aMkurIya koSTha granthyarbudoM se bahudhA utpanna hone ke kAraNa bIjakoSIya karkaToM ke kozA prakAra lasya vA kUTazleSi koSThoM jaise hote haiN| bheda itanA hI hotA hai ki ve sapakSma (ciliated ) nahIM hote haiN| adhikAMza karkaToM meM kozA stambhAkAra hote haiM tathA kevala kucha hI sthaloM para zAyada vizalkIya karkaTa kozA dekhane meM Ate haiN| vizalkIya karkaTa kozA kA prakAra nicarmAbha koSTha (dermoid cyst) meM milatA hai| karkaTa sadaiva rohiadhicchada (germinal epithelium) meM banA karatA hai| sAdhAraNa karkaTa meM kozAoM kA vibhinnana naSTa huA rahatA hai aura ve golAbha ho jAte haiN| isase gola yA kar3e azmopama karkaTa banate haiN| inameM kar3Apana saMdhAra ke anupAta para nirbhara karatA hai| uttarajAta-bIjakoSoM ke visthAya karkaTa bahudhA dekhe jAte haiM / ye do mukhya sthaloM se banate haiN| eka to ve jo garbhAzaya yA usakI nAlikAoM ke prathamajAta karkaToM se utpanna hote haiN| inake prasAra kA mukhya sAdhana lasadhArA hotA hai| dUsare ve jo AmAzaya vA bRhadantra yA mahAsrota ke anya bhArgoM dvArA utpanna hote haiN| mahAsrotottha karkaTa saghana hote haiN| ye raktadhArA dvArA Ate haiM yA pAraudarika vapana (transcoe. lomic inplantation) dvArA ise abhI nizciti se nahIM kahA jA sktaa| glauknara kA kathana yaha hai ki udara ke kisI sthala se karkaTa kozA nIce kI ora lur3haka kara Dagalasa kI jeba meM ekatra ho jAte haiN| vahA~ se ve bIja koSoM meM praveza karate haiM / yaha praveza yA to rohiantazchada dvArA hotA hai yA visphoTita kUpikAoM (ruptured follicles ) dvArA yaha nahIM kahA jA sakatA hai / parantu glauknara kA yaha mata adhika mAnya nahIM hai| 2-garbhAzaya karkaTa ( Carcinoma of the Uterus ) __ garbhAzaya ke karkaTa usakI grIvA tathA kAyA donoM sthaloM meM hote haiN| donoM kA varNana nIce diyA jAtA hai: garbhAzayagrIvA karkaTa ( Cervical Cancer )-garbhAzaya kAyA kI apekSA usakI grIvA meM karkaTa bahuta adhika milate haiN| kAyA aura grIvA meM hone vAle karkaTa Apasa meM itane bhinna hote haiM ki unheM do pRthak roga mAnanA adhika upayukta hai| grIvA kA karkaTa 35 varSa se lekara 60 varSa taka kI una striyoM meM adhika dekhA jAtA hai jo prajAvatI hotI haiN| 95 pratizata mAtAoM meM yaha roga hotA hai / parantu kyA isakA kAraNa nyAsargika ( hormonal ) hai ? nyAsargika kI apekSA grIvA kA prasava kAla meM vidIrNa honA adhika mahatvapUrNa hai| garbhAzaya grIvA kA AghAta adhikatama naidAni. kIya dRSTi se pUrNa haitukI hai| parantu Aja isa haitukI para bhI sandeha hotA hai kyoMki zarIra meM anyatra kisI bhI sthala para aisA nahIM dekhA jAtA ki AghAta karkaTajanaka huA ho yA hotA ho| hauphabauara kA kathana hai ki garbhAzayagrIvA kA anta For Private and Personal Use Only

Page #837
arbuda prakaraNa zchada sadaiva nyAsargika prabhAva meM rahatA hai aura nyAsargika prabhAva AghAtajanya prabhAva kI apekSA karkaTotpati meM adhika vajanI dikhAI par3atA hai| strIsAndrava ke prayoga se eka cUhe kI garbhAgrIvA meM karkaTa hote dekhA gayA hai| yaha bhI hauphabauara ke mata ko hI siddha karatA hai| jisa cuhiyA meM prayoga dvArA yaha karkaTa utpanna kiyA jAtA hai vaha stana karkaTa kI pratirodhI hotI hai| yaha karkaTa rajonivRttikAla ke uparAnta hotA hai| rajonivRtti kAla meM pItapiNDIya nyAsarga ( progesterone ) nahIM rahatA taba to strImadi (oestrin ) hI milatI hai| yaha karkaTa una striyoM meM bhI dekhA jAtA hai jinako prasava zastrakarma (sIseriyana saikzana ) dvArA karAyA jAtA hai arthAt jahA~ grIvA ke AghAta kA koI avasara hI nahIM aataa| bvAyaDa ne eka aisI strI meM bhI yaha karkaTa dekhA thA jisakA prasava zastrakarma dvArA 10 varSa pUrva huA thaa| ina saba pratyakSa udAharaNoM se yaha jJAta hotA hai ki nyAsarga isa karkaTa kI utpatti meM adhika aura mahattvapUrNa bhAga lete haiN| __ pratyakSa dekhane se garbhAzayagrIvAkarkaTa do prakAra kA milatA hai| eka aMkurIya prakAra aura dUsarA antarAbharita prakAra / aMkurIya prakAra ( papillary form ) meM eka bar3A kavakAnvita piNDa bana jAtA hai jo yoniguhA kI ora nikalA huA rahatA hai aura aisA lagatA hai mAno vaha garbhAzayagrIvA ke bAhya oSTa dvArA utpanna huA ho| isa prakAra kA karkaTa gaharAI meM nahIM hotaa| maithuna ke pazcAt raktasrAva isa roga kA mahattvapUrNa lakSaNa hai| antarAbharita prakAra (infiltrating form) kA karkaTa bahuta adhika pAyA jAtA hai / isameM dharAtala para uThI huI koI vRddhi nahIM dikhAI detI balki vRddhi gaharI ati meM ghusI huI aura antarauSTha ( internal os) kI ora adhika hotI hai| isase grIvA meM kaThinatA aura vRddhi ho jAtI hai| isa prakAra ke karkaTa meM paryAptakAla taka koI lakSaNa nahIM dikhAI dete| Age calakara UtinAza aura nirmocana (sloughing ) hone lagatA hai jisase grIvA vicIrita ( ragged ) ho jAtI hai aura usameM guhA bana jAtI hai| kabhI kabhI garbhAzaya kI kAnAla avaruddha ho jAtI hai jisase koI bhI srAva nIce kI ora nahIM ho pAtA aura garbhAzaya meM pUya bharane lagatA hai| isa avasthA ko pUyagarbhAzaya (pyometra) kahate haiN| lUgola ke tarala ( lugol's solution ) dvArA abhiraMjita karane para Rju antazchada kA raMga kAlababhru ( deep brown) ho jAtA hai jaba ki karkaTAnvita antazchada para koI raMga nahIM cddh'taa| ise zIlaraparIkSA ( Schiller test ) kahate haiN| parantu grIvA ke aparadana (erosion ) meM bhI koI raMga nahIM car3hA krtaa| isa kAraNa isa parIkSaNa dvArA bahuta adhika jJAna nahIM ho paataa| aNvIkSaNa kI parIkSA isa karkaTa ke zreNI vibhAjana karane ke sambandha meM kaI prakAra kI duvidhAe~ utpanna kara detI haiN| bAta yaha hai ki garbhAzayagrIvA meM do prakAra kA adhicchada pAyA jAtA hai| arthAt usake yoni bhAga (portio vaginalis ) meM For Private and Personal Use Only

Page #838
762 vikRtivijJAna stRta adhicchada hotA hai tathA graivika kAnAla meM stambhAkArI adhicchada kA eka stara cadA rahatA hai| ina do prakAra ke adhicchadoM ke hI AdhAra para do prakAra ke arbuda pAye jAte haiN| eka adhicarmAbha karkaTa jo bahudhA (96%) dekhane meM AtA hai tathA dUsarA granthikarkaTa jo bahuta kama (4%) pAyA jAtA hai| yaha bhI samajhanA bhUla hogI ki yonibhAga se adhicarmAbha tathA kAnAla bhAga se granthikarkaTa bne| kabhI-kabhI eka prakAra kA adhicchada dUsare ke andara taka praviSTa ho jAtA hai / usa dazA meM bhinna sthAna se bhinna prakAra kA karkaTa bhI dekhane meM AtA hai| aisA bahudhA milatA hai ki bAhyauSTha para karkaTa pahale bane / bAhyauSTha para aparadana ke kAraNa vizalkIya adhicchada kA sthAna stambhAkArI adhicchada le letA hai phira vahA~ dhIre-dhIre vizalkIya adhicchada AtA jAtA hai aura granthikarkaTa ke sthAna para adhicarmAbha karkaTa bana jAtA hai| karkaTa kozA gaharAI meM ugate cale jAte haiM aura unameM asaMkhya vibhajanAMka dekhane meM Ate haiN| vibhinnana kI mAtrA ke anusAra adhicarmAbha karkaTa ke tIna prakAra kie gaye haiN| eka praur3ha prakAra jisameM kozA bahuta adhika vibhinita hote haiN| isameM kadarIkaraNa aura mukAnirmiti bahuta hotI hai| yaha prakAra reDiyopratirodhI hotA hai| yaha prakAra 20 pratizata taka milatA hai / dUsarA prakAra pratAnarUpIya (plexiform) kahalAtA hai| isameM kozA vizalkIya rUpa kho baiThate haiM aura unameM thor3A sA anaghaTana hone lagatA hai / yaha prakAra 60 pratizata taka milatA hai| tIsarA prakAra anaghaTita hotA hai| isameM kozAoM meM vizalkIya lakSaNa koI nahIM milate, ve pUrNataH abhinita hote haiM aura paryApta AkrAnta hote haiM / yaha prakAra 20 pratizata taka milatA hai| isa tRtIya prakAra para reDiyo kiraNoM kA bahuta adhika prabhAva hotA huA pAyA jAtA hai, yadyapi ve sabase adhika duSTa hote haiM / zastrakarma dvArA cikitsA karane meM ina para sabase kama prabhAva par3atA hai| granthikarkaTa para reDiyo razmiyoM kA prabhAva bahuta kama hotA hai, yadyapi zastrakarma dvArA usameM paryApta saphalatA pAI jA sakatI hai| grIvA karkaTa kA prasAra ativedhana, lasadhArA tathA raktadhArA tInoM dvArA ho sakatA hai| ativedhana dvArA karkaTa kozA parAgarbhAzaya ( parametrium ) kI ora, basti kI dizA meM, malAzaya kI ora athavA nIce yoni kI ora jA sakate haiM / garbhAzaya kI ora karkaTa kozA nahIM jAte cAhe sampUrNa grIvA AkrAnta ho jaave| yaha Azcaryajanaka hai / lasadhArA dvArA adhizroNikIya ( iliac ), saMvAhinIya ( hypogastric ) tathA trikIya ( sacral ) lasagranthakoM meM karkaTa kozA pahu~cate haiN| garbhAzayagrIvAkarkaTa visthAya bahuta dera meM banAyA karatA hai / raktadhArA dvArA prasAra bahuta kama hotA hai aura vaha bhI taba jaba ki roga bahuta bar3ha gayA ho| adhicarmAbha kakaTa to niyamataH raktavAhiniyoM ko AkrAnta hI nahIM karatA aisA kahA jAtA hai| garbhAzayakAyA karkaTa (Cancer of the body of the uterus )--yaha bahuta kama hone vAlA karkaTa hai| garbhAzaya ke sampUrNa karkaToM meM 10 pratizata yaha dekhane For Private and Personal Use Only

Page #839
arbuda prakaraNa 763 meM AtA hai| yaha rajonivRttikAla meM utpanna hotA hai| jaba kisI rajonivRtta strI ke garbhAzaya se raktasrAva hone lage to garbhAzayakarkaTa kA bhI smaraNa A jAnA caahie| isakA grIvAkarkaTa ke barAbara antarAbharaNa nahIM hotaa| strI kA prajAvatI honA isa roga meM Avazyaka nahIM kyoMki yaha aprasavAoM ( nullipara ) meM jitanA milatA hai itanA bahuprasavAoM meM nhiiN| garbhAzayakAyAkarkaTa garbhAzaya ke antazchada meM utpanna hotA hai aura cAroM ora bahuta bar3e kSetra meM antazchada ke upariSTha bhAga meM hI phaila jAtA hai| isakA svarUpa aMkurIya hotA hai jisase yaha garbhAzaya guhA ke andara khUba jagaha lekara phailatA phUTatA hai| isake kAraNa garbhAzaya thor3A phUla jAtA hai| isameM grIvA para koI prabhAva nahIM par3atA / dhIre-dhIre vaha pezIya stara taka bhI pahu~ca jAtA hai| isa karkaTa meM parAgarbhAzaya prArambha meM AkrAnta nahIM hotA jaisA ki grevika karkaTa meM dekhane meM AtA hai| khuracana yA vilekhana ( curettage ) dvArA isa karkaTa kA patA lagatA hai| ____ aNvIkSaNa karane para jo citra milatA hai vaha granthikarkaTa kA citra hotA hai jisameM viSama duSTa nAlikAe~ pAI jAtI haiM jo pezIya bhAga meM dhaMsatI huI dekhI jAtI haiN| kabhI-kabhI sampUrNa racanAvihIna anaghaTita kvacit granthIya mAtra dekhA jAtA hai / kevala antazchadIya khuracana dvArA karkaTa kA pUrNa jJAna nahIM ho pAtA kyoM ki navIna duSTavRddhi antazchadIya paramacaya mAtra hotI hai / abhiraMjana kI viSamatA, vibhajanAMkoM kA bAhulya aura antarAbharaNa kA pramANa milane se hI ThIka-ThIka nidAna ho pAtA hai| yahA~ autikIya citra kI apekSA kozIya citrAnveSaNa dvArA roga kA ThIka patA calatA hai| yadi vaikArikIvizArada ko bhrama ho to nissandeha garbhAzaya karkaTa nahIM hai, aisA mAna lenA caahie| ___ isa roga kA prasAra pezIya prAcIra dvArA hotA hai / isake kAraNa chidraNa ho sakatA hai| karkaTa ke khaNDa garbhAzaya nAlikAoM meM hokara bIjakozoM taka ko AkrAnta kara sakate haiM / isIlie garbhAzaya kA uccheda karate samaya isa roga kI cikitsA meM vaijJAnika bIjakoSoM ko bhI nikAla dene kI salAha dete haiN| Age calakara lasadhArA dvArA parA kazerukIya lasagranthakoM tathA raktadhArA dvArA phuphphusoM tathA yakRt taka prabhAva ho sakatA hai| 3-jarAyvadhicchadArbuda (Chorionepithelioma ) yaha parama duSTArbuda hai| yaha bhrauNa Uti dvArA utpanna hotA hai, mAtR Uti dvArA nhiiN| kisI strI ko jaba garbhapAta ho jAtA hai to usake pazcAt yA kabhI-kabhI pUrNa prasava hone ke uparAnta bhI yaha dekhA jAtA hai| bahuta hI kama yaha bIjakoSoM tathA vRSaNoM meM bhI dekhA gayA hai| isakA nirmANa 30 pratizata rugNoM meM drAkSArUpIzUka (hydatidiformmole) ke dvArA hotA hai| drAkSArUpIzUka aura jarAyvadhicchadArbuda donoM usI dazA meM dekhe jAte haiM jaba ki pItapiNDa (corpus luteum) paryApta pravRddha ho| pItapiNDa aura ina donoM kA For Private and Personal Use Only

Page #840
764 vikRtivijJAna kyA sambandha hai yaha abhI sthira nahIM kiyA jA skaa| prasava ke turaMta bAda yA usake mahInoM yA varSo bAda yaha roga ho sakatA hai| garbha pradarzikA azcIma jhoMDaka kasauTI isameM bhI astyAtmaka rahatI hai / arbuda aparA kI ora garbhAzaya kAyA meM utpanna hotA hai / yaha atIva mRdula, lAla aura atyadhika raktasrAvI piNDa hotA hai jo garbhAzaya kI guhA ko bhara letA hai tathA jo pezIya bhAga meM bhI bharamAra karatA hai / uttarajAta vRddhiyA~ garbhAzaya ke nicale bhAgoM tathA yoni pradeza meM bhI milatI haiN| Age calakara arbuda garbhAzaya ke bAhya dharAtala para bhI dekhA jA sakatA hai / aNvIkSaNa para dekhane se yaha jJAta hotA hai ki yaha arbuda garbhAvasthA kI hI eka atirekAvasthA hai / aparA ke auauNa bhAga meM jarAyu ke aMkura ( chorionic villi ) hote haiM ina aMkuroM kA mahattvapUrNa bhAga poSarUha ( trophoblast ) kahalAtA hai / isa poSarUha kA mukhya kAryaM mAtRraktasrotasoM para AkramaNa karanA hotA hai / poSaruha meM do prakAra kA adhicchada hotA hai / inameM bhItara kI ora svaccha caukora kozA hotA hai jinameM bar3I pANDura nyaSTiyA~ hotI haiM / inheM leMgaheMsa kozA (langhans' cells) kahate haiM / bAhara kI ora bar3e kAle bahunyaSTIya kozApiNDa hote haiM jinheM saMkozakozA ( syn cytial cells ) kahate haiM / jarAyu ke adhicchadArbuda meM laiMga haiMsa ke kozA bahuta adhika hote haiM tathA dUsare prakAra ke kozA kucha kama hote haiM jo rakta ke sarovaroM meM par3e rahate haiN| isa arbuda meM leMga heMsa kozA bAhara ke saMkoza ( syneytial ) stara meM phUTa Ate haiM jo svAbhAvika kozA vinyAsa ke viruddha hotA hai / isa arbuda meM na to saMdhAra hotA hai aura na raktavAhiniyA~ | kyoMki isakA poSaNa usa rakta se hotA hai jise ki yaha AkrAnta karatA hai / kyoMki poSaruhIya kozA sadaiva aura isa arbuda kA prasAra raktadhArA dvArA hotA hai svabhAvatayA raktavAhiniyoM para hI AkramaNa karate haiM / garbhapAta hone ke pazcAt bahuta hI thor3e kAla meM phuphphusa meM isI arbuda ke visthAya dekhane ko milate haiM / uttarajAta arbudoM se bhI rakta kA srAva utane hI vega se hotA hai jitanA ki prathamajAta meM dekhA jAtA hai / yoni kI prAcIroM meM uttarajAta vRddhi dekhI jA sakatI hai jo vapana dvArA nahIM hotI kyoMki arbuda kozA vAhiniyoM ke bhItara pAye jAte haiM / jaba leMgaheMsa ke kozAoM ke sthAna para saMkozakozA ( syncytial cells ) kI vRddhi kA arbuda milatA hai to use saMkozArbuda ( syncytioma ) kahate haiM / yaha sAdhAraNa arbuda hotA hai / isameM na to visthAya hote haiM aura na raktadhAtu AkrAnta hotI hai / ( 12 ) stanakarkaTa (Carcinoma of the Breast) stana meM hone vAle sampUrNa arbudoM meM 75 pratizata karkaTa hI hote haiM / jisameM itane adhika karkaTa kI sambhAvanA ho sakatI hai vaha garbhAzaya hai / For Private and Personal Use Only anya aMga yaha prauDhA

Page #841
NER . . . stanakarkaTa pRSTha 764 HERST S isameM Upara kI ora karkaTa dikhalAyA gayA hai| nIce donoM ora pUrvakarkaTAvasthA prakaTa ho rahI hai| For Private and Personal Use Only

Page #842
arbuda prakaraNa vasthA meM hone vAlA roga hai magara bIsa varSa kI yuvatI se lekara nabbe varSa kI vRddhA taka ko bhI yaha roga dekhA jA sakatA hai| durbhAgyavaza strI jitanI hI adhika navayauvanA hogI, karkaTa bhI utanI hI ghAtakatApUrvaka usa para prahAra karatA hai / vAma stana meM yaha roga dakSiNa stana kI apekSA adhika hotA hai| stana ke Urdhva bAhya caturthAMza meM jitanA adhika yaha roga milatA hai utanA anya caturthAMzoM ( quadrants ) meM nahIM / usake pazcAt adhobAhya, UrdhvAntara tathA sabase kama adhontara caturthAMza AtA hai| yaha karkaTa bahuprasavAoM aura aprasavAoM meM eka barAbara milatA hai tathA zizu ke stanapAna kA roga para koI mahattva kA prabhAva nahIM par3hA krtaa| yadyapi mAtA se putrI meM aura putrI se pautrI meM yaha roga dekhA jA sakatA hai jisake udAharaNa DhUMDhanA koI bahuta kaThina kArya nahIM hai parantu phira bhI yaha roga kulaja pravRtti rakhane vAlA nahIM hai| yaha sadaiva smaraNa rakhanA hogA ki mahilA-zarIra meM stana eka aisA aMga hai jo usakI avasthA ke sAtha sahasA aura Atyantika parivartana kara sakatA hai| zaizava, yauvana, praur3hAvasthA aura vRddhAvasthA sabho meM usameM parivartana dekhe jAte haiN| tAruNya, RtukAla, sagarbhatA, stanyakAla aura rajonivRttikAla meM usameM parivartana Ate haiN| yahI kAraNa hai jo isake vistRta adhicchada meM karkaTotpatti itanI saralatA se ho jAtI hai| jaise anya karkaToM kA prasAra hotA hai ThIka usI taraha isakA bhI prasAra stana se zarIra ke anya bhAgoM taka huA karatA hai / yadyapi antaHzalyatA isa roga ke prasAra meM bahuta mahattva kA bhAga nahIM letI jitanA ki lasavahAoM kA ativedhana ( permeation ) jisameM karkaTa kozA eka saghana stambha ke rUpa meM lasanAliyoM meM utpanna hotA hai| yaha mUla karkaTa se kisI bhI dizA meM arthAt sarva dizAoM meM binA lasadhArA ke pravAha kI gati kA vicAra kie kahIM bhI ho sakatA hai| isa rUpa meM yaha kakSAstha lasagranthiyoM meM praveza kara sakatA hai jahA~ se phuphphusAntarAla meM vahA~ se udara aura yakRt meM hRdayAdharika pradeza ( epigastrium ) meM hokara jA sakatA hai| usake Age asthiyoM tathA anya dUrastha aMgoM taka isakA prabhAva dekhA jA sakatA hai| jo lasavahA prAvaraNI (fascia) taka jAtI hai aura vahA~ se tvacA ko usameM jaba ativedhana hotA hai taba tvacA bhI karkaTAkrAnta ho jAtI hai| lasavahAoM ke ativedhana se unameM tantUtkarSa bahuta hone lagatA hai| isameM vAhiniyA~ saMkocanazIla tAntavaUti ke rajju(strand) mAtra raha jAte haiN| isI kAraNa karkaTa ke cAroM ora vistRta valiyA~ (puckerings) milatI haiN| kahIM-kahIM karkaTa kozAoM kA pratyakSa antarAbharaNa peziyoM aura vakSaprAcIra meM ho jAtA hai, kahIM-kahIM lasadhArA aura raktadhArA donoM se karkaTa kozAoM kA gamana hotA hai| hRdayAdharika pradeza meM hokara eka bAra bhI jaba udaracchada taka karkaTa kozAoM kA AkramaNa ho jAtA hai to sampUrNa udaracchada meM karkaTakozA prasarita ho jAte haiM / isa prakAra phuphphusAntarAla ke jitanA samIpa prAthamika karkaTa hotA hai utanI hI zIghratA se phuphphusa meM uttarajAta vRddhiyA~ dekhI jAtI haiN| isI prakAra karkaTa hRdayAdharika For Private and Personal Use Only

Page #843
766 vikRtivijJAna pradeza ke jitane hI samIpa hotA hai utanI hI uttarajAta vRddhiyA~ udara meM pAI jAtI haiM / isa dRSTi se jo karkaTa stana ke AntarArddha ( inner half ) meM hote haiM ve sAdhyAsAdhyatA kI dRSTi se bAhyAI ke karkaToM se adhika gambhIra hote haiN| asthiyoM meM uttarajAta karkaTa isa roga meM prAyaH milate haiM / asthiyoM meM vakSa ke samIpa kI jaise parzaka, uraHphalaka aura kazerukA mahattvapUrNa haiN| ye hI pahale prabhAvita hotI haiM isake pazcAt dUrastha asthiyoM para prabhAva par3atA hai| yadi raktadhArA dvArA asthiyoM meM karkaTa kA gamana huA hotA to asthi kI poSikA raktavAhinI ke pAsa hI visthAya banatA jaisA ki nahIM dekhA jAtA, isase jJAta hotA hai ki visthAya kA kAraNa lasadhArA hai aisA haiNDale kA mata hai| stana meM sthita lasavahA snehAkta prAvaraNI ( fatty fascia) taka tvacA ke nIce jAtI haiN| yaha stara bahuta gambhIra rUpa dhAraNa karatA hai kyoMki karkaTa kozAoM kA prasAra isameM atyadhika hotA hai| ataH stanakarkaTa kA uccheda karate samaya isakA bhI paryApta uccheda kara denA Avazyaka hotA hai| stana karkaTa kI utpatti ke sambandha meM jo prayoga kiye gaye haiM unase tIna mukhya hetuoM kA jJAna hotA hai : (1) stana praNAliyoM meM aparyApta utsAraNa (drainage ), jisake kAraNa stanya kA rukanA tathA sar3anA (eddeyraadi)| (2) bIjakoSoM kA viSama vA anRju uttejana (laikAsegne Adi), tathA (3) mAtR dugdha ke sAtha prApta mAtRja prabhAva (biTanara) vakSIya dugdhotsAraNa kriyA meM bAdhA stanastha praNAliyoM (ducts ) meM gar3abar3a hone para par3atI hai| jaise praNAlI meM vizalkita kozAoM kA samUha utpanna hokara roka lagA sakatA hai| prAyaH stana karkaTotpatti una striyoM meM adhika hotI hai jinako koI baccA paidA nahIM huA hotA kyoMki unake stana apuSTa, choTe, kar3e, tanvita ( fibrosed ) karkaTa ke lie sukhadAyaka zaiyA kA kArya karate haiN| eDeyara kA kathana hai ki karkaTa kevala 8.5 pratizata prajAvatI striyoM meM pAyA jAtA hai| baiga ne eka aise varga ke cUhe kI stana praNAliyoM ko bA~dha diyA jisameM karkaTa bahuta kama hotA thaa| yaha kArya usakI sagarbhatA kA AdhA kAla bItane para kiyA thA aura usane dekhA ki use stanakarkaTa ho gyaa| usane cUhoM meM druta gati se kaI bAra garbhAvasthA utpanna karake tathA stanapAna roka kara karkaTotpatti kii| saMsAra meM gAya ke stana sarvAdhika zrama karate haiM aura usako kabhI stanakarkaTa nahIM dekhA jaataa| yaha prakaTa karatA hai ki stana praNAlikAoM meM koI bAdhA na par3e aura stanya kA pravAha nirantara calatA rahe to karkaTotpatti nahIM hotii| isake viparIta yadi stanya praNAlikAoM meM ruka gayA tathA sar3a gayA to karkaTotpatti kI sambhAvanA ho jAtI hai| isI kAraNa aprasavAoM meM yA jo mAtA apane baccoM ko dugdhapAna nahIM karAtI yA jinake stanoM meM bahuta adhika vidradhiyA~ utpanna hotI rahatI haiM unheM stanakarkaTa kA zikAra honA par3atA hai| For Private and Personal Use Only

Page #844
arbuda prakaraNa 767 bIjakoSoM kI uttejanA kA prabhAva bhI karkaTotpattikAraka ho sakatA hai / isakA prayoga karane ke lie bIjakopanyAsarga kA antaHkSepaNa karanA par3atA hai yA bIjakoSoM kA uccheda karanA par3atA hai / laikAsaigne kA kathana hai ki khImadi (oestrin ) kA antaHkSepaNa karane se cUhoM ( nara yA mAdA ) meM stanakarkaTotpatti kI jA sakatI hai| isameM pahale adhicchadIya paramapuSTi, praNAlikAoM kA visphAraNa, koSThoM kA nirmANa, aMkurIya pravarddhanoM kI utpatti aura golakozIya bharamAra hotI hai / isI prakAra jina varga ke cUhoM meM stanakarkaTotpatti adhika hotI hai unake zaizavAvasthA meM hI bIjakoSa nikAla diye jAyeM to niSkriya stanoM meM karkaTotpatti ruka jAtI hai / isase prakaTa hai ki strImadi karkaTajanaka padArtha hai / isakA doSa bIjakoSa meM svayaM hai aisA naha api tu vaha anya praNAlIhIna granthiyoM se sambandha rakhatA hai / kyoMki yaha koI pramANa upalabdha nahIM ki jina cUhoM meM stana karkaTa adhika banate haiM ve adhika strImadi utpAdanakarttA hote haiM / aisA kahA jAtA hai ki adhivRkka bAhyaka karkaTotpatti meM sahAyatA karatA hai jaba ki agrapoSaNikA ( anterior pituitary ) usakA virodha karatA hai / stanakarkaTa se pIr3ita jIvoM meM grIsa tathA anya vidvAnoM ne adhivRkka bAhyaka kI paramapuSTi kI sAkSI dI hai| isase siddha hai ki bIjakoSoM kI uttejanA se karkaTotpatti meM sahAyatA milatI hai tathA uttejanA aura karkaTotpatti meM anya praNAlIhIna granthiyoM kA bhI hAtha hai| karkaTotpatti meM kulaja pravRtti koI mahatva nahIM rakhatI aisA mata hama Upara de cuke haiN| isI sambandha meM biTanara kA mata bhI bahuta mahatvapUrNa hai / usakA kahanA hai ki pitryasUtrAtirikta ( extra chromosomal ) prabhAva mAtRdugdha meM pravAhita hotA rahatA hai / yadi atyadhika stanakarkaTotpAdaka varga ke zizu ko aise varga kI mAtA kA dugdha pilAyA jAya jise stanakarkaTotpatti atyalpa hotI ho to vaha zizu bar3A hone para stanakarkaTa se virahita ho jAtA hai / yaha prayoga yaha siddha karatA hai ki mAtRdugdha meM stanakarkaTakAraka koI tatva avazya pravAhita hotA hai| kabhI bhI baTanara ke uparyukta satya kA pUrNarUpeNa parIkSaNa nahIM ho pAyA / para yadi yaha siddha ho gayA to aneka anya rahasyoM kA bhI samaya rahate udghATana ho sakegA / biTanara ne to stanakarkaTotpAdakatatva ko mAtRdugdha se nikAla bhI liyA hai / aura jaba usane isa tatva ko una prANiyoM ko sevana karAyA jinameM stanakarkaTa 1% hI hotA thA to isake sevana se unameM yaha ghaTanA 67% pAI gii| koI karkaTajanaka viSANu ( virus ) usane khoja nikAlA jo pAvya ( filterable ) hai / uDa aura DArliMga ne eka aise kuTumba kA varNana kiyA hai jisameM cAra pIr3hI taka stanakarkaTa milaa| tIsarI pIr3hI meM tIna bahanoM ko stanakarkaTa milA / yaha stana karkaTa unhIM striyoM meM huA jinhoMne apanI mAtAoM kA stanapAna kiyA thA / yaha ghaTanA biTanara ke satya kA eka aura pramANa hai / isI AdhAra para yaha kahA jA rahA hai isase jJAta hotA hai ki hai For Private and Personal Use Only

Page #845
768 vikRtivijJAna ki una kuTumboM kI mAtAe~ jinameM duSTArbuda adhika hote haiM, apane baccoM ko apanA dugdha na pilAyA kreN| kucha logoM kA mata yaha bhI hai ki AghAta aura bAhya prakSobha kA stanakarkaTotpatti se gaharA sambandha hai parantu yaha mata mahattvahIna aura niHsAra hai| ____ stana karkaTa ke aneka prakAra granthoM meM varNita haiN| inameM kucha pratyakSa ke AdhAra para haiM, kucha aNvIkSaNa ke kAraNa haiM aura kucha naidAnika lakSaNoM ke anusAra kahe gaye haiN| bvAyaDa ne ina saba prakAroM ko pA~ca samUhoM meM vibhakta kara diyA hai: 1. azmopama karkaTa ( scirrhus cancer ), 2. majjakIya karkaTa ( medullary cancer ), 3. granthi karkaTa ( adeno carcinoma), 4. praNAlikIya karkaTa (duct carcinoma) tathA 5. paigaTAmaya ( paget's disease) / kabhI-kabhI roga itanA avibhinita hotA hai ki use uparyukta kisI samUha meM nahIM rakhA jA sakatA aura taba use anaghaTitarUpa (anaplastic form) nAma diyA jA sakatA hai / aba hama sarvaprathama uparyukta pA~coM samUhoM kA varNana kreNge| 1. azmopama karkaTa-yaha stana meM sarvAdhika hone vAlA karkaTa hai| yaha sadaiva stana ke Urdhva bAra caturthAMza meM utpanna hotA hai jise hathelI se dabAne se eka bahuta kar3A padArtha sA pratIta hotA hai| yaha pahale gambhIra prAvaraNI yA mAMsadharAkalA se abhilagna ho jAtA hai phira bAda meM tvacA se bhI saMlagna ho jAtA hai| yadi arbuda prAvaraNI aura tvacA ke bIca meM ho to use kucha samaya taka saralatApUrvaka hilAyA hulAyA jA sakatA hai| lasIya zotha ke kAraNa thor3A sA gartana ( dimpling ) ho jAtA hai| Age cala kara cUcuka sthira ho jAtA hai tathA bhItara kI ora khiMca jAtA hai| yaha taba hotA hai jaba bar3I stana praNAlI AkrAnta ho jAtI hai| stana choTA aura cipaTA ho jAtA hai / yaha kadApi na bhUlanA hogA ki Arambha kAla meM zastrasAdhya jaba taka roga rahatA hai taba taka karkaTa eka kaThina granthaka jaisA hotA hai| ataH karkaTakAlIna avasthA vAlI strI ke stana meM aisA kar3A golA ho to usakA parIkSaNa avilamba kiyA jAnA caahie| majjakIya karkaTa kI apekSA azmopama karkaTa bahuta dhIre-dhIre AtA hai parantu usase sAdhyAsAdhyatA meM koI antara nahIM AtA kyoMki sthAnika vRddhi dhIre-dhIre hone para bhI karkaTa kA viprathana ( dissemination) zIghra hotA hai| __ azmopama karkaTa kisI prAvara meM banda na hokara apane pravarddhana stana Uti meM itastataH bhejatA rahatA hai| koSThIya paramacaya kI apekSA yaha vaise nizcita rUpa se pari. likhita ( circumscribed ) hotA hai| isake kAraNa eka sunizcita vRddhi yA arbuda banatA hai| prasarAvasthA hone para use koSThIya paramacaya ( cystic hyperplasia) mAnanA caahie| yaha karkaTa bahuta hI kaThina hotA hai isI kAraNa ise azmopama For Private and Personal Use Only

Page #846
arbuda prakaraNa 766 ( azma = patthara ) nAma diyA jAtA hai / aMgrejI meM ise skirasa kahate haiM jisakA artha bhI 'kaThina' hotA hai / kaccI nAzapAtI ke kATane meM jo zabda hotA hai usI zabda ( karakarAhaTa grittiness ) sAtha yaha bhI kaTatA hai isI kAraNa cAkU ke arbuda ke andara praveza karate hI isakA nidAna ho jAtA hai / isakA kaTA huA dharAtala dhUsara ( gray ) hotA hai jo kahIM bhI eka sA yA samarasa (homogenous) nahIM huA krtaa| usameM pIlI yA dhUsara dhAriyA~ ( streaks ) par3I hotI haiM / kaTA huA tala nyubja ( natodara ) hotA hai aura sAdhAraNa tala se nIce pratyAkRSTa hotA hai / isake sAtha hI sAtha choTe-choTe koSTaka bhI rahate haiM / azmopama karkaTa kA sthUla darzana itanA spaSTa hotA hai ki binA kisI vaikArikI vizArada kI sahAyatA ke eka zalyavid usakI par3atAla bar3I saralatA se zastrakarma ke samaya kara sakatA hai / isa karkaTa kA aNvIkSIya citra bhI saralatA se pahacAnA jA sakatA hai / yaha karkaTa sadA kisI praNAlI ke adhicchada se utpanna hotA hai / thor3e hI samaya meM usakA granthI rUpa arbuda ke rUpa meM parivartita ho jAtA hai jisameM adhicchadIya kozApuJja saghana saMdhAra dvArA pRthak kie hue dikhate haiN| yaha saMdhAra itanA saghana hotA hai ki karkaTa kozA eka paMkti meM hI dikhate haiM aura ve lasAvakAza (lymphspaces ) meM hI par3e rahate haiM / ve choTe aura raMgane para gahare raMgate haiM / kahIM-kahIM to ve pUrNataH lupta bhI ho jAte haiM / ye kozA bahubhujIya aura vikhaNDita hote haiM / inameM vibhajanAMka bahuta kama milate haiM, kahIM-kahIM gola kozIya bharamAra mila jAtI hai / 2. majjakIya karkaTa / citra se - azmopama karkaTa kI apekSA yaha kama pAyA jAtA hai / vaise yaha usI kI thor3I badalI huI AkRti mAtra hotA hai jisa kAraNa se donoM ke bIca vibhedaka rekhA khIMcanA bahuta kaThina kArya hai donoM ke pratyakSa darzana se thor3e bahuta antara kA patA bhI calatA hai parantu aNvIkSIya vaisA jJAna kama ho pAtA hai / majjakIya karkaTa mastuluMgAbha ( encephaloid ) arthAt mastuluMga ( brain ) ke samAna hotA hai aura azmopama kI vizeSatA Upara batalA cuke haiM / adhika komala hone ke kAraNa majakIya karkaTa ko mastuluMgAbhIya karkaTa ( encephaloid carcinoma ) bhI kahane kA rivAja rahA hai para mastuluMga se yaha bilkula nahIM milatA / yaha karkaTa azmopama ke samAna gaharI prAvaraNI ke sAtha yA tvacA ke sAtha Arambha hI meM abhilagna utpanna nahIM karatA / yaha karkaTa mRdula aura tvarAvRddhikArI hotA hai / isake dvArA jo sthAnika vRddhi hotI hai vaha tvacA meM vraNa utpanna kara detI hai / uccheda karane para yaha komala tathA kSodya ( friable ) hotA hai / aNvIkSaNa karane para yaha bahuta adhika kozAvAn hotA hai aura isameM saMdhAra bahuta kama hotA hai jisake hI kAraNa yaha itanA komala hotA hai / kozA bar3e hote haiM / unameM aneka vibhajanAMka hote haiM aura ve gola dikhate haiM / ve bar3e-bar3e dravyoM meM kahIM-kahIM kisI avakAza ke cAroM ora ve isa prakAra lage hote haiM granthIya rUpa bhI dikhane lagatA hai / 65, 66 vi0 For Private and Personal Use Only ekatra rahate haiN| jisase unakA

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770 vikRtivijJAna majakIya karkaTa kA eka prakAra ugra ( acute ) hotA hai| isameM prasaraNazIlatA adhika hotI hai| ise dekhakara koI ise tIvra stanapAka mAtra ho samajhane kA bhrama kara sakatA hai| kyoMki isameM zUla, lAlI, sUjana, sparzAkSamatA tathA sitakozotkarSa Adi lakSaNa milate haiM / isakA viprathana tvarAgati se stana aura tvacA meM hotA hai / majakIya karkaTa kA ugra rUpa sadA stanapAna kAla meM hI prakaTa hotA hai| yaha kucha mAsa meM hI samApti kara detA hai| 3. granthikarkaTa-yaha stana meM bahuta hone vAlA karkaTa hai / yaha mRdula aura paryApta bhArI ( bulky ) ho sakatA hai| isakI vRddhi dhIre-dhIre hotI hai tathA mArAtmakatA ( malignancy ) bhI saumya svarUpa kI hotI hai| Age calakara yaha tvacA meM vraNana kara detA hai aura eka bahuta bar3A kavakAnvita ( fangating ) arbuda stana ke dharAtala para bana jAtA hai| kakSA ko lasagranthiyA~ thor3I sI phUla jAtI haiM aura una para koI adhika prabhAva nahIM par3A karatA / aNvIkSaNa para aisA mAlUma par3atA hai ki stambhAkArI adhicchada se ghire huI granthIya avakAza ho| stana meM praNAlikIya karkaTa (duct carcinoma) hotA hai jise granthikarkaTa ke nAma se le liyA jAtA hai |vaise graMthikarkaTa bahuta kama milatA hai| 4. praNAlikIya aMkurIya karkaTa-yaha karkaTa cUcuka ke pAsa kI kisI eka bar3I dugdhapraNAlI se nikalatA hai| ise praNAlIya karkaTa kahate haiM / karkaTa praNAlikIya aMkurAbuMda dvArA bhI uga sakatA hai| aMkurIya pravarddhanakoM ke mila jAne se granthi jaisI AkRti ho jAtI hai jisa kAraNa ise koSThagranthIya karkaTa (cystadenoma ) bhI kahA jAtA hai| yaha arbuda bahuta manda gati se AkramaNa karatA hai| isameM cUcukIya raktasrAva eka mukhya ghaTanA hotI hai| antaHpraNAlikIya karkaTa ( Intraduct carcinoma)-adhicchadIya paramacaya meM jaba mArAtmakatA yA duSTatA A jAtI hai to usa koSThIya khaNDIya paramacaya (oystic lobular hyperplasia) ko antaHpraNAlikIya karkaTa kaha dete haiN| isa nAma kA kAraNa yaha hai ki karkaTakozA isameM praNAlikAoM ke bhItara hI rahA karate haiN| yaha prasarita ( diffused ) ho jAtA hai| inameM se kucha ko blaDaguDa ne kAmIDo karkaTa ( Comedo carcinoma) bhI kahA hai kyoMki unheM kATane se kITasama nirmoka ( worm-like casts ) nikalate haiN| stana kA svedagraMthIya karkaTa-IviMga ne isakA nAmakaraNa kiyA hai aura ise khoja nikAlA hai| usakA kahanA hai ki yaha karkaTa tvacA aura kakSA meM utpanna hotA hai aura isakA udbhavasthala svedagranthiyA~ hotI haiN| ina granthiyoM meM jo adhicchada hotA hai use phrAMsIsI svedagraMthIya adhicchada nAma dete haiM tathA jarmana pANDura adhicchada kahate haiM parantu lAla raMgA jAne se bvAyaDa use uSisapriya adhicchada (eosinophilic epithelium ) kahatA hai| Dausana kA kathana hai ki yaha adhicchada raktagranthi se banatA hai| raktapranthi kI svAbhAvika avasthA meM yaha nahIM banatA balki jaba usase koSTa nirmANa For Private and Personal Use Only

Page #848
arbuda prakaraNa 771 hote haiM tabhI banatA hai / usa samaya adhicchada meM praguNana ke sAtha vihAsa hone se yaha rUpa AtA hai| parantu stana meM sAdhAraNataH svedagranthiyA~ hone meM abhI sandeha hone se isa karkaTa ke sambandha meM bhI koI nizcita mata nahIM bana paayaa| 5. paigaTAmaya-sara jemsa paigaTa nAmaka vidvAn ne san 1874 I0 meM isa roga ko prakaTa kiyA thaa| yaha cUcuka kA ukautA yA prapAmA ( eczema ) hai| isa roga ke hone ke kucha varSa pazcAt isI meM se stana karkaTa bana jAyA karatA hai| cUcuka meM yaha roga hone para vaha yA to AI aura sarasa ( weeping ) ho jAtA hai yA zuSka aura zalkIya ( sealy ) dikhatA hai| aNvIkSaNa karane para prabhAvagrasta kSetra kI tvacA meM adhicarmIya paramaduSTi dikhalAI detI hai| yaha puSTi vaNana hone ke pUrva hI ho letI hai / mahattva kI bAta yaha hai ki isa roga meM eka vicitra prakAra ke kozA pAye jAte haiM jinheM paigaTa kozA (Paget cells) kahate haiM / ye kozA bar3e, svaccha, rasadhAnIyukta hote haiM jinameM choTI sthUla (pyknotic) nyaSTiyA~ hotI haiN| ye adhicarma meM kaTe hue (paMca kie hue ) avakAzoM ke samAna lagate haiM / ye AdhAra ke staroM meM bahuta hote haiM parantu vaise ye adhicarma kI moTAI meM kahIM bhI mila sakate haiN| usake nIce ke carma ( dermis ) meM lasIkozAoM aura prarasakozAoM kI bharamAra hotI hai| Age calakara adhicameM meM vaNana ho jAtA hai| paigaTa ke kozA kyA haiM isa sambandha meM vibhinna mata haiM / kucha inheM zAGgakozAoM (prickle cells ) ke vihRSTa rUpa mAnate haiM aura unheM mArAtmaka (duSTa ) nahIM mAnA jAtA para adhika pracalita mata to yaha hai ki stana meM praNAlikAoM meM karkaTa ho jAtA hai usI se ye kozA banate haiN| aisA mAnA jAtA hai ki duSTa sthala se calakara ye kozA adhicarmIya stara meM vapita ho jAte haiN| kabhI-kabhI adhicarmIya stara ke sire para kozAoM ke bIca meM aisA citra bhI dekhA jAtA hai jisameM paigaTa kozA lasadhArA meM bharamAra kara rahe hoN| aisA hI dugdhapraNAlikAoM meM bhI dekhane meM AtA hai| haiNDale kA mata yaha hai ki stana kI dugdhapraNAlikAoM meM utpanna paigaTAmaya manthara gati se bar3hane vAlA eka karkaTa hai aura yaha jo prapAmIya ( eczematous ) sthiti dekhI jAtI hai vaha eka prakAra kA zotha hai jo lasadhArA ke avarodha ke kAraNa bana jAtA hai| yaha avarodha karkaTIya bharamAra ke kAraNa huA karatA hai| parantu IviMga kA kA mata haiNDale se mela nahIM khAtA hai kyoMki usane do vibhinna prakAra ke vikSata dekhe haiN| eka vaha jisameM koI arbuda milatA nahIM, pragati manda rahatI hai tathA roga sAdhya hotA hai tathA dUsarA vaha jisameM prasara prakAra kA tvarA utpanna hone vAlA karkaTa milatA hai aura jisakI bharamAra stana meM paryApta hotI hai / yaha asAdhya yA atikaSTasAdhya hotA hai aura isake visthAya bhI kaI sthaloM para banate haiN| stana karkaTa gartANuoM (acini ) se na nikala kara sabhI dugdhapraNAlikAoM kI AstaraNa kalA se nikalate haiN| zuddha gANvika karkaTa kabhI nahIM milatA hai| kabhI For Private and Personal Use Only

Page #849
772 vikRtivijJAna kabhI praNAlikA aura gartANu donoM hI dekhe jA sakate haiM / stanakarkaToM kA vargIkaraNa abhI taka asantoSajanaka hai / stana karkaTa kA prasAra stana karkaTa ke kozA bharamAra karake yA lasadhArA se yA raktadhArA se apanA prasAra kiyA karate haiM | bharamAra ke dvArA karkaTa kozA sampUrNa stana meM phailate haiM / ve Uti avakAzoM meM jo sneha kozAoM aura saMyojI Uti ke kozA puMjoM ke bIca meM rahate haiM bhara jAte haiM jaisA ki azmopama karkaTa meM dekhane meM AtA hai / isI ke kAraNa gambhIra prAvaraNI aura tvacA prabhAvita hotI hai / granthika karkaTa tathA praNAlikIya karkaTa adhika bharamAra nahIM karate / aNvI citra se sampUrNa stana kI gaharAI dekhane se jJAta hotA hai ki azyopama karkaTa Adhe se adhika logoM meM urazchadA pezI prabhAvita hotI hai yadyapi sthUla rUpa se yaha kahanA kaThina par3atA hai ki ye peziyA~ prabhAvita ho cukI haiM / isIlie zastra karma karate samaya isa pezI ko bhI adhika se adhika nikAla diyA jAtA hai / / ladhArA ke dvArA karkaTa kozA kucha dUra taka le jAye jAte haiM / yaha prasAra do prakAra se hotA hai / karkaTa kozA lasavahAoM ke kinAre-kinAre ugate haiM / isa paddhati ko lasya ativedhana (lymphatic permeation ) haiNDale kahatA hai / dUsarA DhaMga yaha hai ki antaHzalyoM ke rUpa meM arbuda kozA lasadhArA meM Ate haiN| aisA lagatA hai ki antaHzalyatA yahA~ ativedhana kI apekSA adhika saphalatA prApta karatI hai / pahale ativedhana ko pramukha sthAna diyA jAyA karatA thA parantu Aja vaisA sthAna pAne ke lie usake pAsa koI vizeSa kAraNa nahIM rahA / karkaTa kozA kakSAstha lasagranthakoM meM roga ke Arambhika kAla meM hI pahu~ca jAte haiM aisA azmopama karkaTa meM adhika dekhane meM AtA hai / zastrakarma ke samaya 60 pratizata rugNoM ke kakSAstha lasagranthaka prabhAvita isI kAraNa dekhe jAte haiM / phuphphusAntarAlIya lasagranthakoM meM bhI prabhAva kabhI-kabhI to kakSAstha granthakoM ke pUrva hI dekhane meM AtA hai| jaba ina granthakoM meM prabhAva ho jAtA hai| taba zalyazAstra usakI cikitsA karane meM apane ko pUrNataH asamartha anubhava karane lagatA hai / isI se isa roga kI sAdhyAsAdhyatA ina graMthakoM ke prabhAvita vA aprabhAvita hone para nirbhara karatI hai / graMthikarkaTa tathA praNAlikIya karkaToM meM lasagranthakIya prabhAva nahIM hotA para duHkha kI bAta to yaha hai ki ye donoM karkaTa bahuta kama milate haiM / gambhIra prAvaraNI ke Upara chAye hue lasavAhinIya cakra ( plexus of lymphatics) meM karkaTa kozA bhara jAte haiN| pezIya vitAna ( muscular apponeuroses ) tathA gambhIra prAvaraNI ke taloM ke madhya meM vakSIya karkaTa phailatA hai / zastrakarmoparAnta jo kucha gA~The carma meM dikhatI haiM unakA mUla isI kSetra meM hotA hai / gaharI lasavAhiniyoM meM jaba abhilopana ho jAtA hai to lasAvarodha ke kAraNa tvacA meM lasIya zopha ho jAtA hai / para adhicarma ( epidermis ) meM kahIM kezamUla hote haiM aura kahIM svedagranthiyA~ | isase yaha zopha sarvatra eka sA na hokara kahIM usameM garta par3a jAtA hai aura kahIM phUla jAtA hai / isase nAraMgI kA sA dRzya ( peau d' orange ) stana meM dekhane For Private and Personal Use Only

Page #850
arbuda prakaraNa 773 ko milatA hai| eka avasthA jise vakSatvagIya karkaTa ( cancer en cuirasse ) kahate haiM vaha bhI isa lasIya zopha ke dvArA banatI hai na ki tvacA meM karkaTa kozAoM kI bharamAra se / prAvaraNIya tathA vitAnIya taloM ke sAtha hI sAtha pariphuphphusIya tathA udaracchadIya avakAza bhI lasIya prasAra dvArA prabhAvita ho jAte haiN| zvasanikIya lasagranthakoM dvArA phuphphusa bhI prabhAvAnvita ho jAtA hai| yakRt ko ve lasavahA prabhAvita karatI haiM jo trikakukundarAsthi sandhAyinIsnAyu (falciform ligament) ko jAtI haiN| raktadhArA ke dvArA jo prasAra hotA hai vaha dUrastha aMgoM ko prabhAvita karatA hai| isake kAraNa phuphphusa tathA yakRt meM visthAya banate haiN| usake pazcAt adhivRkka, plIhA aura bIja granthiyoM meM visthAya banA karate haiN| saraktamajjA ( red marrow ) meM karkaTa kozA sthita rahA karate haiN| isIlie kazerukAoM, capaTI asthiyoM tathA pragaNDAsthi tathA aurvI asthiyoM ke samIpAntoM ( proximal ends ) para visthAya milate haiN| karoTi evaM kazerukAoM meM isa karkaTa kA vistAra kazerukIya sirAsaMsthAna ( set of vertebrsal veins ) dvArA hotA hai|| sAdhyAsAdhyatA stana karkaTa sAdhyAsAdhyatA kI dRSTi se utanA hI gambhIra roga hai jitane ki anya karkaTa / eka pIDitA strI isa roga se adhika se adhika tIna varSa taka jItI hai| reDiyama yA akiraNopacAra se jIvana 10 varSa taka adhika se adhika bar3ha sakatA hai, vaha bhI 85% meM / azmopama karkaTa aura majakIya stana karkaTa asAdhya hote haiM tathA anya kucha kama duSTa hote haiN| vikiraNa vikiraNa (radiation ) kA prabhAva bhinna prakAra ke stana karkaToM para bhinna-bhinna huA karatA hai / sAmAnyataH 20% para acchA par3atA hai, 20% para bilkula nahIM par3atA tathA 60% para madhyama hotA hai| yaha bhUlanA nahIM cAhie ki jo karkaTa jitanA hI adhika vikiraNa se prabhAvita hotA hai utanA hI kozAvAn ( cellular ) vaha huA karatA hai tathA jo karkaTa jitanA hI adhika kozAvAn hotA hai vaha utanA hI adhika ghAtaka bhI huA karatA hai / azmopama karkaTa bahuta adhika vikiraNa-pratirodhI hotA hai| majakIya para vikiraNa kA prabhAva khUba par3atA hai| granthikarkaTa tathA praNAlikIya karkaToM para bhI vikiraNa kA prabhAva paryApta par3a jAtA hai| tvarita utpanna hone vAle anaghaTita rUpa vAle karkaTa vikiraNa ke dvArA paryApta prabhAvita hone para bhI unameM asAdhyatA hI adhika hotI hai| puruSastanIya karkaTa yaha bahuta hI kama pAyA jAtA hai / phira bhI 1 pratizata stana karkaTa puruSoM meM dekhe jAte haiN| 50 varSa kI Ayu ke Upara yaha hotA hai vaise 30 varSa taka ke vyaktiyoM meM bhI yaha mila sakatA hai| yadyapi striyoM kI apekSA puruSoM meM stanakarkaTa kI gati bahuta manthara hotI hai phira bhI yaha tvacA meM unakI apekSA zIghra vraNana kara detA hai usakA For Private and Personal Use Only

Page #851
774 vikRtivijJAna kAraNa yahI hai ki puruSa meM stana Uti atyalpa hotI hai evaM raktavAhiniyA~ bhI kama rahatI haiN| kakSAstha lasagranthiyoM para prabhAva tathA visthAyotpatti strIstanIya karkaTa ke tulya hI hotI hai| adhicchadIya Uti ke sAdhAraNa arbuda adhicchadIya Uti ke duSTa arbuda karkaTa kA vistRta vivecana karane ke uparAnta aba hama isI uti ke sAdhAraNa arbudoM kA varNana upasthita karate haiN| adhicchadIya kozAoM se prakaTa hone vAle arbuda jitane spaSTa hote haiM utane saMyojI Utyuttha arbuda nahIM dekhe jAte / isakA mukhya kAraNa yaha hai ki unameM do UtiyoM ke ghaTaka mile rahate haiM / arthAt adhicchadIya arbudika kozA tathA saMyojI UtIya saMdhAra / yaha saMdhAra adhicchadIya kozAoM ko sAdhe rahatA hai tathA unako rakta pahu~cAtA hai| yahI kAraNa hai ki adhicchadIya arbudoM kA eka nizcita rUpa banatA hai jo unake adhika duSTa hone kI dazA meM hI bigar3atA hai anyathA nhiiN| sAdhAraNa adhicchadIyArbuda do prakAra ke hote haiM: 1. aGkurArbuda ( papilloma ) tathA 2. granthya rbuda ( adenoma.) / aba hama sabase pahale aGkurArbuda kA varNana prakaTa kareMge tatpazcAt granthyarbuda leNge| carmakIla yA aMkurArbuda ( Papilloma) aGkurArbuda eka prakAra kA sAdhAraNa arbuda hotA hai jisameM adhicchadIya kozA aMguli. samAna uge hue saMdhAra ke aMkuroM ko AcchAdita kie hue dekhe jAte haiN| yaha arbuda bAharI ( upariSTha) yA bhItarI (Antarika ) dharAtala se ugatA hai| aGkurArbuda kahane se sadaiva sAdhAraNa arbuda pratibhAsita hotA hai parantu malAzaya aura basti pradeza meM sthita aMkurArbuda duSTa rUpa bhI dhAraNa kara letA hai| dharAtalIya adhicchada se hI sadaiva yaha arbuda utpanna hotA hai| isakA nAma yaha isalie rakkhA gayA hai kyoMki yaha pravRddha aMkura ke samAna dikhalAI detA hai / isakA eka nAma carmakIla bhI hai / bAharI tala para utpanna aGkurAbaMda camakIla aura bhItarI tala para utpanna antazcarmakIla kahalAtA hai| pratyeka aMkurAbuMda meM eka kendriya tantuvAhinIya Antaraka (fibro vascular core ) hotA hai usI se dharAtala ke lie aneka aMgulisama aMkurIya pravardhanaka nikalate haiM jinameM se pratyeka raktavAhiniyoM ko sahArA detA hai ye raktavAhiniyA~ kezAlajAloM ( capillary network ) meM yA ekala pAza ( single loop ) meM samApta ho jAtI haiM aura yaha saba kA saba paramaghaTita adhicchada dvArA AvRta rahatA hai| ye adhicchadIya stara kitane hI sthUla kyoM na hoM ve eka svAbhAvika rUpa se prApta adhaHstRta kalA para sthita rahate haiN| yaha adhaHstRta kalA jahA~-jahA~ hotI hai vahA~-vahA~ ye stara usa para rahate haiN| yaha kalA unheM nIce kI anya utiyoM se pRthaka kara detI hai| sAdhAraNa aMkurAbUMdoM meM adhaHstRta kalA sadaiva asphuTita ( intact ) rahatI For Private and Personal Use Only

Page #852
arbuda prakaraNa 775 hai / isake viparIta duSTArbudoM meM vaha bharamAra karane vAle kozAoM ke dvArA chidrita ho jAtI hai| arbuda ke aGkura ( papillae ) choTe aura sAdhAraNa hote haiN| tvacA ke aGkurArbuda ( carmakIloM) meM unakA choTA aura sAdhAraNa rUpa spaSTataH prakaTa hotA huA dekhA jAtA hai / ye aGkura bastigata aGkurArbudoM meM khUba lambe, komala sazAkha aura asaMkhya hote haiM / svaggata aGkurArbudoM kA AcchAdaka adhicchada sthUla, kaThina starAnvita hotA hai aise arbuda kI carmakIla saMjJA yathArtha hI hotI hai / zleSmala dharAtala para utpanna aGkurArbuda meM patale vAhinImaya pravardhanaka mRdu adhicchada dvArA AcchAdita rahate haiM aura isa kAraNa ve zIghra hI cuTaila ho jAyA karate haiM / pratyeka aGkurArbuda ke sAtha raktasrAva, vraNatA tathA upasarga prAyaH milA karatA hai para unheM dvitIyaka parivartana nAmaka saMjJA nahIM dI jaatii| koI yadi mahattva kA parivartana dekhane meM AtA hai to vaha aGkurArbuda kI adhicchadIyArbuda meM pariNati hI hai / aGkuzarbuda meM cAhe tala kitanA hI viSama kyoM na ho sampUrNa adhicchada tala para hI rahatA hai / jyoM hI yaha adhicchada tala ke nIce jAne lagatA hai tyoM hI usakI saMjJA carmakIla yA aGkurArbuda na rahakara karkaTa ho jAtI hai / pratyakSa dekhane se carmakIla ( cutaneous papilloma) eka kaThina nokadAra uThA huA acchidIya piNDa hotA hai / isakI sataha viSama hotI hai jisameM kaI gaharI sItAe~ ( fissures ) banI hotI haiM / jaba adhicchada bahuta adhika hotA hai yA jaba aGkura choTe-choTe hote haiM to eka gola puJja ( rounded mass ) sA dikhane lagatA hai para jaba aGkura lambA hone lagatA hai aura adhicchada usa para patalAne lagatA hai taba pahale gobhI ke phUla kI sI AkRti banatI hai jo bAda meM rasAGkurIya ( villous ) ho jAtI hai / ye rasAGkurIya pravardhanaka bar3e komala hote haiM aura unase rakta svatantratayA aura cAhe jitanA nikalA karatA hai / zleSmalakalA se tathA granthiyoM kI praNA I / aGkurArbuda yA carmakIla sadaiva carma se, likAoM (ducts ) utpanna huA karate haiM ve sadA pahale se upasthita aGkuroM se hI phUTate haiM para kabhI-kabhI jahA~ pahale se koI bhI aGkura nahIM hotA vahA~ bhI banate hue dekhe jAte haiN| vahA~ ve upAdhicchadIya Uti se banate haiM / svarayantra tathA AmAzaya meM ye aise hI banate haiM / aGkura yA isa prakAra kI AkRti kA honA bhautika prabhAva ( physical effect ) ke kAraNa batalAyA jAtA hai / sthAnika adhicchadIya paramapuSTi jo kisI kAraNa vizeSa se sthAnika poSaNa meM badala hone ke kAraNa hotI hai tathA vAstavika aGkurArbuda meM paryApta antara hotA hai / upAdhicchadIya jIrNa pAka yA vraNazotha ke kAraNa prAyaH aisI paramapuSTiyA~ dekhane meM AtI haiM aura taba unheM purvaMgaka ( polyps ) nAma diyA jAtA hai jaba ve kisI zleSmala kalA meM utpanna hotI haiN| nAsA, bRhadantra aura garbhAzaya meM aise purvaMgaka milate rahate haiN| jaba ve tvacA se nikalatI haiM to unheM carmAGkura ( warts ) kahA jAtA hai / For Private and Personal Use Only

Page #853
776 vikRtivijJAna svacA meM zaizava kAla meM jo aneka vArTsa yA masse uga Ate haiM ve kisI viSANu kI kRpA ke phalasvarUpa hote haiM / dvitIyaka ( Abhyantara ) phiraMga ke dvArA utpanna phiraMgArza (condylomata) ko laiGgika carmAGkura ( venereal warts) nAma diyA jAtA hai / guptAGgoM para uSNavAta ( ganoriyA ) meM jaba aGkurIya paramapuSTiyA~ ho jAtI haiM to ve bhI laiGgika carmAra hI kahalAtI haiM / upAdhicchadIya vAhinyarbudoM ( angiomata ) ke Upara bhI paramapuSTi ho sakatI hai, aGkurIya arbuda bana sakate haiM aura anta meM jo nyaccha ( naevi ) nAma se prasiddha hote haiM / kucha upariSTha vAtatantvarbuda ( superficial neurofibromata ) kezoM kI atyadhika vRddhi ke kAraNa kisI eka sthAna para dekhe jA sakate haiM / vahA~ sthAnika adhicchadIya paramapuSTi bhI rahatI hai / gharSaNa aura pIDana dvArA kisI eka sthAna para paramapuSTi ho jAtI hai jise kiNa ( callosity ) kahate haiM / isI prakAra aGkurArbuda ke rUpa meM kadara ( corn ) bhI banatA hai para jyoMjyoM jUte se vaha dabatA hai adhicarma sthUla hotA jAtA hai aura vaha komala bhAgoM meM ghusa jAtA hai tathA usake aGkura apuSTa ho jAte haiM / I Ayurveda meM kadara, nyaccha, vyaGga, mazaka, carmakIla, padminIkaMTaka Adi zabdoM kA vyavahAra hotA hai / ye sabhI kSudra rogoM ke antargata Ate haiM / inakA varNana isa prakAra hai| : - kadara - zarkaronmathite pAde kSate vA kaNTakAdibhiH / medo raktAnugaizcaiva doSairvA jAyate nRNAm // sakIlakaThino granthirnimnamadhyonnato'pi vA / kolamAtraH saruksrAvI jAyate kadarastu saH // pA~va meM kaMkar3a lagane se yA kA~TA lagane se meda aura rakta kA Azraya karake doSa vyaktiyoM meM kIlayukta kaThina eka gA~Tha banAte haiM jo madhya meM nIcI yA uThI huI aura jharaberI bera ke samAna yA bar3e bera ke samAna hotI hai vaha pIDAyukta aura sAva karane vAlI ho sakatI hai / jatumaNi - nIrujaM samamutpannaM maNDalaM kapharaktajam / sahajaM raktamIpacca ilakSaNaM jatumaNiM viduH // zUlarahita, eka barAbara uThI huI, gola, kapharakta se banI, janma se hI thor3I lAla, cikanI jatumaNi kahalAtI hai / maSaka--avedanaM sthiraM caiva yasya gAtreSu dRzyate / mASavatkRSNamutsannamanilAnmaSakaM vadet / vedanArahita, sthira, kAle ur3ada ke samAna, uThA huA, kAlA, vAtadoSa ke kAraNa HSaka ( mazaka ) kahalAtA hai / tilakAlaka - kRSNAni tilamAtrANi nIrujAni samAni ca / vAtapittakaphodrekAttAn vidyAttilakAlakAn || kAle tilapramANa, zUlarahita, eka se ( non-elevated ), vAtapittakaphoka dvArA utpanna tilakAlaka hote haiM / padminIkaNTaka - kaNTakairAcitaM vRttaM kaNDUmat pANDumaNDalam / padminIkaNTakaprakhyaistadAkhyaM kaphavAtajam // For Private and Personal Use Only

Page #854
arbuda prakaraNa kamala ke kA~ToM ke samAna kaNTakayukta, gola, kaNDUyukta, pANDura varNa kA kaphavAtaja maNDala padminIkaNTaka kahA jAtA hai / nyaccha-- maNDalaM mahadalpaM vA zyAmaM vA yadi vA sitam / sahajaM nIrujaM gAtre nyacchamityabhidhIyate // 777 maNDalAkAra bar3e yA choTe, kAle vA zveta, sahaja aura nIruja cakattoM ko nyaccha kahate haiM / carmakIla - samutthAnanidAnAbhyAM carmakIlaM prakIrtitam / krodhAyAsaprakupito vAyuH pittena saMyutaH // sahasA mukhamAgatya maNDalaM visRjatyataH / krodha evaM zrama dvArA kupita vAyu pitta ke sAtha mila kara mukha vA dvArabhAga meM jo sahasA maNDalotpatti karatA hai vaha carmakIla kahalAtA hai / unake uThAna aura nidAna dvArA unakA jJAna hotA hai yahA~ jo carmakIla zabda AyA hai vaha carmAGkura ke sthAna para prayukta mAnanA caahie| tathA vyAnastu prakupitaH zleSmANaM parigRhya bahiH sthirANi kIlavadarzAsi nirvartayati tAni carmakIlAnyarzAsItyAcakSate / tathA / teSu kIleSu nistodo mArutenopajAyate / zleSmaNA tu savarNatvaM granthitvaM ca vinirdizet // pittazoNitajaM kRSNaraktatvaM snigdhatA tathA / samudIrNakharatvaM ca carmakIlasya lakSaNam // yaha jo arza prakaraNa ke carmakIla kA varNana hai vaha aGkurArbuda ke lie liyA jA sakatA hai| For Private and Personal Use Only naidAnikadRSTyA jaba taka eka aGkurArbuda sAdhAraNa yA apuSTa rahatA hai taba taka usakA pradhAna lakSaNa raktastrAva rahA karatA hai kyoMki sabhI aGkurArbuda rakta se bhare aura vAhiniyoM se yukta hote haiM / isa kAraNa thor3I sI coTa se hI ve rakta dene lagate haiM / basti meM utpanna aGkurArbuda gavInI ke bastIya chidra meM ghusa kara mUtrapravAha roka sakate haiM tathA eka ora ke vRkka ko pUrNataH kriyAbhraSTa kara sakate haiM, basti antarmukha ( internal_urinary meatus ) ko bhI banda kara sakate haiM / inake kAraNa raktameha ( haematuria ) prAyaH hotA huA dekhA jA sakatA hai| mUtramArgastha aGkurArbuda ke kozAoM ke puJja basti meM anyatra bhI uga A sakate haiM jaise ki bIja ugatA hai / ina uttarajAta vRddhiyoM se arbuda meM duSTatA A gaI aisA mAnane kA koI kAraNa nahIM / garbhAzaya ke antarbhAga meM aisI vRddhiyA~ sAdhAraNatayA dekhI jA sakatI haiM / Antra meM aGkurArbuda aneka ( multiple ) ho sakate yA huA karate haiM / ina arbudoM kA sarvAdhika bhayaprada lakSaNa hai inakA duSTa ( malignant ) banate jAnA / basti aura malAzayastha aGkurArbuda prAyaH duSTasva grahaNa kara lete haiM / duSTa hone para ye vRddhiyA~ bahuta vistRta ho jAtI haiM / isase pahale ki hama vividha sthaloM meM pAye jAne vAle aMkurArbudoM kA pRthak-pRthak aura kucha vistRta varNana kareM, hama aMkurArbudoM ke do pradhAna rUpoM kA kucha varNana prArambha karate haiM / isa rUpoM meM eka zalkIya aura dUsarA zleSmala hai kyoMki ve zalkIya athavA zleSmala inhIM do dharAtaloM se utpanna hote haiM /

Page #855
778 vikRtivijJAna zalkIya aMkurArbuda yA carmakIla-yaha svacA meM utpanna hone vAlA arbuda hai| svacA ke atirikta jahA~ kahIM anyatra stRtAdhicchada ( stratified epithelium) ho vahA~ jaise mukha, svarayantra yA anya kisI bhI guhA meM yaha bana sakatA hai| isakA AdhAra caur3A yA taMga kaisA hI ho sakatA hai| aneka aise roga hote haiM jo aMkurArbuda jaise dikhate haiM parantu vAstavika aMkurAbaMda meM zalkIyAdhicchada kA praguNana hone lagatA hai, adhicarma sthUla ho jAtA hai aura usameM se sthUla pravardhanaka nikala kara camar3I meM ghusa jAte haiN| pAdatala para jo camakIla (plantar warts ) milate haiM ve eka prakAra ke capaTe aMkurAbuMda hI hote haiN| inameM adhicarma kA atyadhika sthaulya dekhA jAtA hai aura dharAtala kA atyadhika kadarIkaraNa ho jAtA hai| sthUlita adhicchada vAtanADiyoM ke saMjJAvaha sUtroM ko pIDita kara detA hai jisase dabane para zUla hotA hai| pratyeka aMkurAbuMda meM eka tAntava Antaraka ( filrous core ) hotA hai| kahIM-kahIM to adhicchada kI vRddhi na hokara isI tAntava jati kI vRddhi hI hotI huI dekhI jAtI hai| zleSmala aGkarAcuda-yaha bRhadantra meM adhikatara milatA hai| isakA dUsarA udAharaNa basti hai| yaha aMkurArbuda kisI bhI zleSmalakalA meM utpanna ho sakatA hai / AmAzaya tathA antra meM aMkurArbuda purvaMgaka yA arza ( polypus) kahalAtA hai| yaha arza yA purvagaka aMkurAbuMda utanA nahIM hotA jitanA ki granthyarbuda hotA hai kyoMki yaha praguNita pranthiyoM ke dvArA nirmita hotA hai| AmAzaya aura antra meM purvaMgaka anekoM hote haiN| bRhadantra meM unakI saMkhyA saikar3oM meM hotI hai| bilhAjhiyA hImaiTobiyA kA upasarga hone para to basti evaM malAzaya meM aMkurotkarSa (papillomatosis ) hone lagatA hai| AmAzaya evaM bRhadantra ke purvagapha isalie bhI mahattvapUrNa haiM ki ve duSTatva ko bahuta zIghra prApta ho jAte haiN| aba Age zarIra ke vividha sthaloM para utpanna carmakIloM yA aMkurAbaMdoM kA hama varNana kreNge| 1-bastistha aGkurArbuda ( Papilloma of the Bladder ) basti meM aMkurArbuda bahudhA milane vAlA arbuda hai| ise aMkurIya basti arbuda ( villous bladder tumour ) kahate haiN| yadyapi yaha eka sAdhAraNa arbuda hai phira bhI yaha duSTatA kI sImA para hI rahatA hai jisake kAraNa kucha varSoM ke pazcAt yaha duSTa ho jAtA hai| yaha eka vRntayukta sAMkura, aMkurIya ( papilliferous ) zveta ja hotA hai jisameM se dhAge ke samAna pravardhanaka nikale rahate haiM jo mUtra meM tairA karate haiN| yaha basti kI zleSmalakalA se utpanna hotA hai| isakA udbhavasthala prAyaH basti kA trikoNa ( trigone ) huA karatA hai| kisI gavInI ke mukha ke pAsa bhI yaha utpanna ho sakatA hai| bahudhA eka bar3A arbuda hotA hai jisake samIpa aneka choTe For Private and Personal Use Only

Page #856
aGkurArbuda pRSTha 778 P YA SEAON SRCH yaha bastistha aGkurArbuda kA citra hai| For Private and Personal Use Only

Page #857
arbuda prakaraNa 776 choTe aMkurArbuda dekhe jAte haiN| kabhI-kabhI vRnta yA nAlarahita aMkurArbuda bhI dekhane ko milate haiN| yaha arbuda striyoM meM bahuta kama parantu puruSoM meM adhikatara dekhA jAtA hai| jarmanI meM yaha vinIlI raMga ke kArakhAnoM meM kArya karane vAle zramikoM meM bahutAyata se pAyA jAtA hai| bastistha aMkurArbuda kA nidAna karane meM zUlavihIna raktameha (painless hae. maturia) bahuta mahattvapUrNa hai| rakta camakIlA aura lAla (jIvarakta) hotA hai aura vaha mUtra ke sAtha mizrita hotA hai| raktameha nirantara calatA nahIM hai| kucha kAla taka Akara phira thor3e yA bahuta dinoM ke lie banda ho jAtA hai|muutr meM rakta sahasA hI AtA aura svayaM hI banda ho jAtA hai Age jaba arbuda kA AkAra bar3ha jAtA hai to raktasrAva kI mAtrA bhI bar3ha jAne se rogI bahuta durbala aura pANDura ho jAtA hai| isa roga meM mUtra tyAgane ke pazcAt rakta ko camakIlI bUMdeM pezAba ke bAda dekhI jA sakatI haiN| kucha kAla pazcAt basti meM pAkotpatti hone se kSobha hone lagatA hai| bastipAka hone para mUtra meM pUya aura zleSmA kA srAva bhI ho sakatA hai aura mUtra ke sAtha arbuda ke sUkSma khaNDa bhI dekhe jA sakate haiN| isa arbuda ke aMkura kabhI-kabhI gavInImukha ko banda karake jalIya vRkotkarSa ( hypernephrosis ) kara sakate haiN| kabhI ve mUtramArga meM Akara mUtrotsarga kriyA ko roka kara sahasA evaM capalagati se mer3ha meM zUlotpatti kara sakate haiN| jaba eka yA donoM gavInIdvAroM ko aMkurAbuMda ke pravardhanaka bhara dete haiM to udavRkkotkarSa ( hydro nephrosis ) taka hotA huA dekhane meM AtA hai| bastidarzaka yantra ( cystoscope ) dvArA isa roga kA pratyakSa jJAna huA karatA hai| jaba bhI zUlavihIna raktameha kA patA lage, rogI ko bastidarzaka mUtra kI sahAyatA se jA~canA caahie| dekhane para sAdhAraNa aMkurAbuMda zveta, jhallarIya ( frilled ), aMkurIya aura vRntayukta hotA hai| usake pravardhanaka tathA tantu mUtra ke Upara tairate rahate haiM / duSTa aMkurArbuda aMkuravihIna aura sapATa ( bald ) hote haiM / duSTatA kA pramANa inake vraNIbhavana se, bhAsvIyoM kI papar3I ( encrustation with phosphates ) se tathA bastipAka se bhI milatA hai| 2-svarayantrastha aGkurArbuda ( Papillomata of the Larynx) ___ sAdhAraNa arbudoM meM aMkurArbuda yA carmakIla vaha vRddhi hai jo svarayantra meM bahutAyata se tathA prAyazaH pAI jAtI hai / isa carmakIla kA AdhAra eka saMyojIUti kA banA hotA hai jisa para adhicchada kA eka stara usI prakAra car3hA rahatA hai jaisA ki anyatra dekhA jA sakatA hai| ye carmakIla akele yA bahuta se svarayantra meM banA karate haiN| ve vinAla yA sanAla kisI bhI prakAra ke ho sakate haiN| yadi eka carmakIla banA to vaha svaratantriyoM ke agrima do-tihAI bhAga meM banatA hai / para yadi kaI aMkurArbuda For Private and Personal Use Only

Page #858
780 vikRtivijJAna bane to ve svarayantrIya zle malakalA se kahIM bhI bana sakate haiN| jitanA hI rogI taruNa yA yuvA hotA hai usake svarayantra meM utane hI adhika aMkurArbuda banate hue dekhe jAte haiM / jaba svarayantradarzaka dvArA svarayantra dekhA jAtA hai to ve zveta varNa ke camakIle saralatayA pahacAne jA sakate haiM / jaba unakI saMkhyA bahuta adhika hotI hai to phira zleSmalakalA itanI ghira jAtI hai ki use phira dekhanA hI kaThina ho jAtA hai / Acharya Shri Kailassagarsuri Gyanmandir svarayantrIya aGkurArbuda sadaiva zalakIya arbuda hote haiM aura zalkAdhicchada dvArA hI banate haiM / ye baccoM, gAyakoM aura vaktAoM meM bahuta adhika dekhe jAte haiM / inakA uccheda kara dene para choTI avasthA ke rogiyoM meM ye punaH utpanna ho jAte haiM parantu rahate sAdhAraNa ( benign ) hI haiM tathA kabhI-kabhI jAdU kI taraha ThIka bhI ho jAte haiN| bar3oM meM ve duSTa hone kI pravRtti se yukta ho jAte haiM aura unakI punarutpatti choToM se kahIM adhika dekhI jAtI hai / svatantrI ke kinAre banA carmakIla kabhI-kabhI pUrNataH vAgzaktinAza ( aphonia ) kara detA hai / kabhI-kabhI aneka carmakIla rahane para bhI rogI kI vArazakti para koI prabhAva nahIM pdd'taa| baccoM meM bahuta se carmakIloM ke kAraNa itanA zvAsAvarodha hone lagatA hai ki kaNThanAlikoccheda ( tracheotomy ) taka karanI par3a sakatI hai| 3- tAlustha aGkurArbuda (Papillomata of the Palate ) jihvA aura kapoloM meM sthita carmakIla ke hI samAna tAlu meM aGkurArbuda banatA hai / tAlu meM yaha dantamAMsa se jAtA hai / isake sAtha svastha sitaghaTana ( leucoplakia ) bhI rahatA hai / 4--jihvAstha aGkurArbuda (Papillomata of the Tongue ) 1 sAdhAraNatayA jihvA para aduSTa yA sAdhAraNa arbuda nahIM rahA karate para jaba unakA pAyA jAnA sambhava hotA hai to unameM aMkurArbuda kA paryApta mahatva rahatA hai / jihvA para carmakIla usake dharAtala para kahIM bhI bana sakate haiN| kisI bhI avasthA meM bana sakate haiM / jo carmakIla yA aMkurArbuda banatA hai vaha vinAlayA sanAla kaisA hI ho sakatA hai 1 vaha zUla vihIna hotA hai aura usake kozAoM kI bharamAra yA kAThinya bhItarI bhAgoM meM bilkula nahIM hotA / na samIpastha granthiyA~ hI pravRddha hotI hai aura na usase rakta kA srAva hI hotA hai / aisA lagatA hai ki yaha carmakIla jihvAstha kisI chatrAGkura ( fungiform papillae ) se utpanna hotA hai / yaha duSTarUpa dhAraNa kara le sakatA hai ataH jihvA ke kucha aMza ke sAtha isakA uccheda karanA zalyavid ke lie eka atyAvazyaka ghaTanA rahanI cAhie / For Private and Personal Use Only

Page #859
arbuda prakaraNa 781 5-pittAzayastha aGkurArbuda ( Papillomata of the Gallbladder ) vaise pittAzaya meM sAdhAraNa arbuda sAdhAraNatayA kama utpanna hote haiM aura agara hote bhI haiM to unameM aGkurArbuda kI hI pradhAnatA rahatI hai / ye aMkurArbuda pittAzaya kI zleSmala kalA se eka sAtha kaI prakaTa hote haiM / jaba pittAzaya kI kalA cirakAla se zothayukta hotI hai to usameM aMkurIya puMja (papillary masses) bahuta dekhe jAte haiM / kabhI kabhI to sampUrNa zleSmalakalA meM aMkurIyotkarSa ( papillomatosis ) vyApta ho jAtA hai / parantu ina atIva kSudra aMkuroM ko arbuda mAneM yA arza vA purvaMga (polyhs ) yA vraNazotha yaha eka prazna hai / Age cala kara yahI duSTa ho jAte haiM aura granthikarkaTa ko janma dete haiM / Acharya Shri Kailassagarsuri Gyanmandir 6 - vRkkamukhastha aGkurArbuda ( Papilloma of the Renal pelvis ) yaha mRdu sAGkura aura ati komala arbuda hotA hai jo bastistha aGkurArbuda se milatA julatA hai / yaha vRkkamukha ke kisI bhI bhAga meM utpanna ho sakatA hai parantu sAdhAraNatayA yaha gavInI mukha ke samIpa yA gavInI ke Urdhva bhAga meM hI utpanna hotA hai / isake dvArA avarodha utpanna ho sakatA hai jisake kAraNa udavRkkotkarSa bana jA sakatA hai / vaise to aMkurArbuda ekala ( single ) hote haiM para kabhI kabhI ve aneka (multiple ) ho jAte haiM / usakA kAraNa yaha hai ki eka hI arbuda ke kucha sUtra TUTa kara zleSmala kalA meM dUsare dUsare sthAnoM para bastistha aMkurArbudoM kI taraha uga Ate haiM / isa prakAra se utpatti hote hote sampUrNa zleSmalakalA aisI ho jAtI hai jaisI ki bAloM se yukta bher3a kI khAla / yahIM se basti ko upasRSTa karane kA bhI upakrama cala sakatA hai / aMkurArbuda ati zIghra raktastrAvakArI hote haiM isa kAraNa vedanAvihIna raktameha isa roga kA pradhAna aura ekamAtra lakSaNa dekhA jAtA hai / jaba gavInI bhI rogAkrAnta ho jAtI hai to zUla bhI sAtha sAtha mila sakatA hai / usa dazA meM vRkkala eka ati kaSTadAyaka ghaTanA ke rUpa meM dekhA jA sakatA hai / sAdhAraNa aMkurArbuda kI duSTa arbuda meM pariNati vRkkoM se asambhava ghaTanA nahIM balki yaha to prAyazaH hone vAlI aura sthiti hai / 13 - ziznastha aGkurArbuda ( Papillomata of the Penis ) zizna meM arbuda prAyaH bahuta kama milate haiM / aduSTa yA sAdhAraNa arbudoM meM aMkurArbuda bhI pAyA jAtA hai jo adhika avasthA ke vyaktiyoM meM hotA hai / yaha prAyaH ziznamuNDa se nikalatA hai aura Age calakara karkaTa meM pariNata ho jAtA hai / karkaTa banane ke pUrva taka usameM vaMkSaNastha granthiyA~ phUlatI nahIM / jina logoM kI medUcarma ( foreskin ) bar3I aura gandI ho vahA~ tathA uSNavAta se pIDitoM meM zizna nemikA ( corona glandis ) ke pIche carmakIla ( warts ) bhI dekhe jAte haiM / For Private and Personal Use Only lekara basti taka koI dekhI jAne vAlI vastu

Page #860
782 vikRtivijJAna 8-antrastha aGkurArbuda ( Papilloma of Intestines ) vaise to aMkurArbuda antra ke kisI bhI bhAga meM prakaTa ho sakatA hai parantu sAdhAraNa tayA malAzaya (rectum ) athavA sthUlAntra usakA priya sthala hai| yahA~ para aneka aMkurArbuda banate haiM aura ugate haiM jinake kAraNa aneka arza (polyps ) zleSmala kalA meM dikhAI dete haiN| isa avasthA ko antra kI aMkurIyotkarSatA yA atkirSatA (poly. posis) kahate haiN| bAyaDa isa roga ko sahaja mAnatA hai| malAzayastha aMkurArbuda yA granthyarbuda sadaiva pUrva karkaTika ( precancerous ) huA karate haiN| yahA~ aMkurAbaMda kI racanA pranthika (glandular ) hotI hai aura usase granthikarkaTa kA udaya huA karatA hai| aMkurArbuda se karkaTa meM pariNati kabhI kabhI bahuta druta gati se huA karatI hai / pahale eka aMkurArbuda prabhAvita hotA hai phira dUsarA / yaha arbuda bahuta hI kama hone vAlA hai tathA bar3oM meM hI dekhA jAtA hai| isake kAraNa atyadhika raktasrAva huA karatA hai| dekhane se yaha aMkurIbhUta ( papilliferous ) vinAla, lAla puMja hotA hai jo malAzaya kI bahuta sI prAcIra ko ghere rahatA hai| ise dekha kara karkaTa kA bhrama ho sakatA hai| yahI bhrama Age calakara satya bana jAtA hai| isa roga ke sAtha sAtha sthUlAntra (colon) meM prasara granthyarbuda bhI milate haiN| atyadhika raktastrAva vA raktAtIsAra isakA pradhAna lakSaNa hotA hai| -zIrSastha aGkarArbuda ( Papilloma of the Scalp ) zIrSa para jaba kabhI aMkurArbuda banatA hai to vaha eka zRMga (sIMga) kA rUpa dhAraNa karatA hai / yaha eka kaThina carmakIla hotA hai / 10-stanastha praNAlikIya aGgurArbuda (Duct Papilloma of the Breast) isa avasthA ko granthikoSThArbuda (adenocystoma), aMkurIya koSThArbuda (papillary oystoma), antarkoSThIya aMkurArbuda ( intracystic papilloma) Adi nAmoM se vibhUSita kiyA jAtA hai| cUcuka ke samIpavartI kSetra kI kisI visphArita stanyapraNAlI ke bhItara aMkurArbuda utpanna honA Arambha karatA hai| choTI makoya jaisI isakI AkRti pahale dekhI jAtI hai jisa para aMkura uThe rahate haiN| bAda meM ye aMkura aura parta eka hokara tala cikanA ho jAtA hai aura arbuda eka Thosa rUpa dhAraNa kara letA hai| ___ aNvIkSaNa para isa arbuda meM asaMkhya aMkura ( villi ) dekhe jAte haiM jina para adhicchada car3hA hotA hai parantu jaba arbuda bar3hatA hai to aMkura saba eka dUsare se cipaka jAte haiM aura granthi ke samAna usameM avakAza ho jAte haiN| isI kAraNa ise granthIya yA koSThIya kaI nAmoM se smaraNa kiyA jAtA hai| isameM raktavAhiniyA~ aneka hotI haiN| unakI prAcIre bahuta patalI hotI haiM isa kAraNa unase raktasrAva hotA rahatA hai / isI For Private and Personal Use Only

Page #861
arbuda prakaraNa 783 kAraNa cUcuka se raktayukta stanya nikalanA isa roga kA mahatva kA lakSaNa hai| kabhI kabhI yahI praNAlikIya karkaTa meM pariNata ho jAtA hai| granthya rbuda ( Adenoma) granthyarbuda eka sAdhAraNa yA aduSTa adhicchadIya arbuda hotA hai jisakI sampUrNa racanA usa granthi ke samAna yA usa graMthi jaisI hotI hai jisase ki yaha utpanna huA karatA hai| parantu yaha jo varNana diyA gayA hai vaha pUrNa nahIM samajha lenA cAhie / bahuta se granthyarbuda arbuda na hokara sthAnikapUraka paramacaya ( localised com. pensatory hyperplasia) ke hI udAharaNa mAtra hote haiM jaise yakRt kA eka bhAga naSTa hone para jo naI Uti kA puMja utpanna hotA hai vaha dharAtala taka bar3ha AtA hai aura bhUla se use granthyarbuda samajha liyA jAtA hai para vAstava meM vaha pUraka paramacaya hI hotA hai| vAstavika granthyarbuda sadaiva prAvarita ( encapsulated ) huA karatA hai| racanA kI dRSTi se granthyabuMda asaMkhya nAlikAoM yA gartikAoM ( tubules or acini) se yukta hotA hai| ye nAlikAe~ yA gartikAe~ ThIka vaisI hI hotI haiM jaisI ki mUla granthi meM dekhI jAtI haiN| ina nAlikAoM aura gartikAoM ko Astarita karane vAle kozAoM meM kucha aMza taka paramacaya huA rahatA hai isa kAraNa una kozAoM kA ekAdhika stara vahA~ para prAyaH dekhA jAtA hai / aMkurAbaMda kI taraha granthyarbuda meM adhaHstRta kalA saMlagna ( intact ) hotI hai| saMyojI Uti ko mAtrA kahIM adhika aura kahIM kama dekhane meM AtI hai| jaba saMyojI Uti bahuta adhika hotI hai to arbuda ko granthyarbuda mAtra na kaha kara saMyojI granthyarbuda (fibroadenoma) kahA karate haiN| ___granthyarbuda prAyaH sadaiva una graMthiyoM se hI utpanna hote haiM jinakI sthiti pahale se hI tathA svAbhAvikatayA zarIra meM huA karatI hai / ve apanA vistAra zanaiH zanaiH karate haiN| unameM prAvaraNa aura mUlagranthi se pRthakatA spaSTatayA dikhalAI detI hai / isa prakAra ve sthAnika vraNazothAtmaka paramacayoM se bhinna hote haiM kyoMki ve mUlagranthi se pUrNataH sambaddha hote haiM aura unameM prAvaraNa nahIM huA krtaa| granthyarbuda jaba kisI zleSmalakalA se utpanna hote haiM to unakA svarUpa carmakIla se milatA-julatA hotA hai isa kAraNa koI mahattva kA antara carmakIla (aGkurArbuda) tathA graMthyarbuda meM nahIM pAyA jAtA / AmAzaya tathA antra meM sthita granthyarbudoM meM yaha dekhane ko milatA hai| __ granthyarbudoM meM kahIM-kahIM unake kozAoM meM udAsargI zakti (secreting power) pAI jAtI hai| jaise zleSmala graMnthiyoM ke granthyarbudoM ke kozAoM se zleSmA kA nAva hotA hai| isI prakAra praNAlIvihIna graMthiyoM dvArA jo nyAsarga nikalate haiM ve hI unake graMthyarbudoM se nikalate haiM jisake kAraNa antaHsrAvI santulana sampUrNa zarIra kA Ando. For Private and Personal Use Only

Page #862
784 vikRtivijJAna lita ho jAyA karatA hai| jo koI bhI srAva yA nyAsarga banatA hai vaha mUla graMthi meM pAye jAne vAle srAva yA nyAsarga ke samAna hI hotA hai aura abhI taka aisA koI udAharaNa nahIM pAyA gayA jahA~ mUla graMthi se viparItaguNayukta srAva yA nyAsarga milA ho| kabhI-kabhI puraHstha (aSThIlA) graMthi yA avaTukA pranthi ke sthAnika paramacayoM ko granthyarbuda samajha liyA jAtA hai jo nitAnta bhrama hai| isa bhrama kA mukhya kAraNa yaha hai ki paramacaya prAvarita (encapsulated ) huA karate haiM kyoMki unakA phailAva vistaraNa ( expansion ) se hotA hai| aisI dazA meM ina paramacayoM aura granthyarbudoM meM antara karane ke lie yaha samajha lenA cAhie ki paramacaya kI utpatti bahunAbhIya ( multifocal origin) hotI hai jaba ki granthyarbuda kI utpatti sadaiva eka nAbhi (single focus ) se hI hotI hai| sAtha hI yadi eka aMga meM ekAdhika granthyarbuda hoM to ve sabhI eka hI prAvara meM prAvarita nahIM hote jaisA ki paramacayoM meM dekhA jAtA hai| mUla granthi kI bhA~ti granthyarbudoM meM avakAza hote haiM jinheM hamane gatikA kaha kara likhA hai| ye gartikAe~ sadaiva niyamita ( regular ) rUpa vAlI hotI haiM aura unake cAroM ora ekAdhika stara meM kozA chAye rahate haiN| pezI prAcIra ke saMkocana ke phalasvarUpa AmAzaya evaM sthUlAntra meM granthyarbudoM meM eka vRnta (stalk) utpanna ho jAtA hai jisake kAraNa eka purvagaka yA arza (polypus) kI taraha granthyarbuda suSiraka meM laTakA rahatA hai| isa purvagaka ko loga aMkurArbuda kaha dete haiM yadyapi usakA zuddha nAma purvaMgakIya granthyarbuda ( polypoid adenoma ) athavA granthyarbudIya purvagaka ( adenomatous polypus ) honA caahie| granthyarbuda meM jo avakAza hote haiM unake kozAoM se cyAvita hokara rasa ikaTThA hotA calA jAtA hai jisake kAraNa ve tana jAte haiM aura taba koSTha (sisTa-cyst) kA nirmANa ho sakatA hai| isa vRddhi ko sakoSTha granthya buda ( cystadenoma) kahA jAtA hai| yaha bIja granthiyoM meM prAyaH dekhA jAtA hai jahA~ koSThoM kI prAcIroM meM lambe-lambe stambhAkArI kozA lage rahate haiM aura unase eka prakAra kA zleSmAbha padArtha cUtA rahatA hai| tarala ke pIDana ke kAraNa ye kozA kabhI-kabhI cipaTe ho jAte haiN| kabhI-kabhI ve koSThAvakAza meM pravarddhanakoM kI bhA~ti bar3ha bhI jAte haiM taba vaha sAMkura sakoSTha granthyarbuda ( papillary cystadenoma) kahalAtA hai| ___ yaha kahanA bahudhA kaThina hotA hai ki eka granthyarbudIya vRddhi sAdhAraNa hai yA duSTa ho gaI hai, kyoMki graMthikarkaTa meM bhI granthIya racanA lagAtAra pAI jAtI hai aura donoM meM taba taka koI patA nahIM laga pAtA jaba taka ki arbuda ke pariNAha se cheda lekara aNvIkSaNa na kreN| usa dazA meM sAdhAraNa arbuda meM eka sunizcita maryAdaka prAvara For Private and Personal Use Only

Page #863
satantumanyarbuda pRSTha 785 Acharya Shri Kailassagarsuri Gyanmandir yaha citra stana meM utpanna granthyarbuda kA hai| isameM tAntavaUti kI bahulatA dikhalAI de rahI hai / For Private and Personal Use Only

Page #864
arbuda prakaraNa ( limiting capsule ) hotA hai jaba ki mArAtmaka arbuda meM granthIya racanA samIpa kI UtiyoM meM AkramaNa karatI huI pAI jAtI hai / Acharya Shri Kailassagarsuri Gyanmandir *-- granthyarbuda ke prakAra granthyarbuda ke do mukhya prakAra batalAye jAte haiM: (1) satantu granthyarbuda ( fibro adenoma ) tathA ( 2 ) sakoSTha - granthyarbuda ( oystadenoma ) aNvIkSaNa karane para kaI prakAra ke granthyarbuda milA karate haiM / adhicchada ke prakAra para hI granthyarbuda kA prakAra nirbhara karatA hai / pratyakSa dekhane se bhI vibhinna adhicchada meM utpanna granthyarbuda vibhinna rUpa ke hote haiM / stambhakArIkozAyukta granthyarbuda tvacA, Antra, garbhAzaya aura bIjagranthiyoM meM pAye jAte haiN| zizuoM kI garbhanADI kA ucchedana karane ke bAda nAbhi meM bhI vaha utpanna ho sakatA hai / eka dUsarA varga golAbhakozIya granthyarbudoM kA hotA hai / bahuzAkhIya granthiyoM ke udAsargI adhicchada meM utpanna granthyarbudoM meM golAbha kozA pracura mAtrA meM dikhalAI par3ate haiM / stana, avaTukAgraMthi puraHstha graMthi meM yaha milatA hai / vaise adhivRkka granthi, poSaNikA granthi aura vRkkoM meM bhI yaha mila sakatA hai / Hbr satantunthyarbuda- yaha prakAra adhikatara stana meM pAyA jAtA hai / inameM jaba granthIya Uti adhika hotI hai to ve mRdula tathA mAMsala dekhe jAte haiM para jaba tAntaka tyAdhikya rahatA hai to ve kaThina hote haiN| ye arbuda prAvarita hote haiM / inakI AkRti golAbha, khaNDIya ( lobulated ) yA aNDAkAra hotI hai / stana meM ise hAtha se cAhe jidhara hilAyA jA sakatA hai / kATane para dharAtala kucha udubja ( convex ) milatA hai jaba ki azmopama meM nyubjatA ( concavity ) pAI jAtI hai / yaha arbuda dekhane se khaNDIya yA tAntavIya AbhAsita hotA hai athavA isameM ekavardhyakSIya ( racemose ) racanA pratyakSa dekhane AtI hai| For Private and Personal Use Only ye taruNI striyoM meM milane vAle arbuda haiM jo taruNoM meM bahuta kama milate haiM / kabhI-kabhI ye aneka bhI milate haiM / stana meM prApta hone vAle satantugranthyarbuda ko do prakAroM meM vibhakta kara sakate haiM jinameM eka parikulyakIya ( pericanalicular ) aura dUsarA antaHkulyakIya ( intra-canalicular ) kahalAtA hai / granthIyakulyAoM ke bAhara cAroM ora jaba tAntava Uti bar3hatI hai to parikulyakIya aura jaba kulyAoM ke sAtha-sAtha tAntavaUti adhicchada se Dha~kI huI andara hI andara bar3hatI hai to antaHkulyakIya nAma sArthaka hotA hai / cheda ( section ) lene para antaHkulyakIya granthyarbuda kI nAliyoM ke andara tAntavaUti bichI huI pAI jAtI hai / bahuta se satantu granthyarbudoM meM koSTha ( cyst) pAye jAte haiM / ye saMkhyA meM kaI bhI ho sakate haiM / inakA avakAza bahuta choTA sA bhI ho sakatA hai tathA itanA bar3A

Page #865
786 vikRtivijJAna bhI ho sakatA hai ki isameM kucha chaTAMka pItazleSmAbha tarala bharA huA ho / yaha tarala prakAra meM rakta ke milane se lAla yA babhru varNa kA bhI ho sakatA hai| sakoSTha-grandhyarbuda-yaha granthyarbuda koSThoM ke starIya kozAoM se banA karatA hai| bIjagranthi tathA stanagranthiyoM meM yaha bahudhA pAyA jAtA hai| koSTha ke starIyakozA ( lining cells ) praguNita hote haiM jisake kAraNa aMkurIya pravarddhanaka koSTha ke suSiraka meM bar3hane lagate haiN| ve yahA~ taka bar3ha sakate haiM ki sampUrNa koSThIya avakAza ko hI bhara leN| yahI sakoSTha granthyarbuda kahalAtA hai| yaha arbuda akelA bhI ho sakatA hai aura kabhI-kabhI kaI-kaI bhI ho sakate haiN| yadi kozA praguNana aMkurIya nahIM hai to grIna ko use arbuda kA vAstavika rUpa karake mAnane meM sandeha hai| zalkAdhicchadIya koSTha kabhI-kabhI tvacA ke nIce hI pAye jAte haiN| aisA aMguliyoM meM athavA anyatra dekhA jAtA hai| yaha tvaglava ke AdhAtika vapana ( traumatic implantation of a frag. ment of skin ) kA eka udAharaNa hai| yaha vapana nirantara vRddhiMgata hone para bhI saccA arbuda nahIM huA karatA / ise carmAbha vapana ( implantation dermoid) bhI kahate haiM parantu yataH vaha bhrauNArbudIya carmAbhoM ke sAtha golamAla kara sakatA hai ataH carmAbhavapana koI sundara nAmakaraNa nahIM ho sktaa| jahA~ para grIvA meM jalaklomadarI ( branchial cleft ) banda hotI haiM ThIka unhIM vinduoM para adhicarma kozAoM kA mizraNa dekhA jAtA hai| inake kAraNa klomajanaka koSTha ( branchiogenic cysts ) grIvA meM banate jAte haiM jo zalkAdhicchadAcchAdita hote haiN| kisI praNAlI ke mukha ke banda ho jAne se bhI avaruddha koSTha ( retention cyst ) bana jAte haiN| ina koSThoM meM taralIya vihAsa ( colliquative necrosis) hotI huI bhI mila sakatI hai| yakRt aura vRkkoM meM zarIranirmANa sambandhI doSa ke kAraNa anyatra bhI koSTha banate haiN| sakoSTha granthyarbuda dvArA raktasrAva karane kI pravRtti bahuta adhika dekhI jAtI hai| yahI nahIM, bahudhA ve duSTArbuda meM pariNata ho jA sakate haiN| usa samaya sakoSTha karkaTa unakI saMjJA dI jAtI hai| cUcuka ke samIpa kI bar3I-bar3I stanya praNAliyoM meM praNAlikIya aGkarAbuda (duct papilloma) nAmaka eka roga aura milatA hai| yaha satantu granthyarbuda kA aMkurIya prakAra pratIta hotA hai| yaha prajAvatI prauDhAoM ko 40 varSa kI vaya se Upara utpanna hotA hai / ye arbuda saralatA se AghAtagrasta ho jAte haiM aura inase paryApta rakta nikala jAtA hai| inake kAraNa inakI AkRti stanakarkaTa sarIkhI dekhI jAtI hai| jisa dugdha praNAlI meM ye banate haiM use caur3A kara dete haiM aura kabhI-kabhI druSTa rUpa bhI dhAraNa kara lete haiN| bIjagranthiyoM (ovaries) meM utpanna hone vAle granthyarbuda bhI bahudhA koSThIya (cystic) huA karate haiM / isa vRddhi ke adhicchadIya kozAoM kI utpatti do sthaloM se ho sakatI hai| inameM eka sthala bIjagranthi ke dharAtala para sthita rohi-adhicchada kA antaHbhAga hotA For Private and Personal Use Only

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arbuda prakaraNa hai aura dUsarA sthala madhyavRkka praNAlI ( wolffian duct ) ke adhicchadAvazeSoM (remnents of epithelium) hotA hai| usakA tAntava bhAga saMdhAra se nikalatA hai| kozA kA prakAra catuSkoNAbha yA stambhAkAra hotA hai| catuSkoNAbha prakAra choTe arbudoM meM jinameM eka hI avakAza hotA hai pAyA jAtA hai| usa avakAza meM svaccha lasya (serous) tarala bharA rahatA hai / ye rohi-adhicchadodbhUta mAne jAte haiM / stambhAkArI adhicchada bahukhaNDIya aMkurIya kUTazleSmIya ( pseudo mucinous ) granthyarbudoM meM dekhA jAtA hai jinakA AkAra bahuta bar3A hotA hai aura jo kabhI kabhI sampUrNa udaraguhA ko bhI bhara lete haiN| ye tAntava paTiyoM ( septa ) se vibhAjita rahate haiM inameM eka picchila (glairy) zleSmAbha tarala (picchA) bharA rahatA hai / ye kabhI-kabhI phaTa jAte haiM aura unake arbudIya kozA udaraguhA ke udaracchadIya dharAtala se cipaka jAte haiM isase aneka naye arbuda uttarajAta vapanakriyA ( process of secondary seeding ) dvArA utpanna ho jAte haiN| isameM atyadhika mAtrA meM zleSmA utpanna hotA hai / isa avasthA ko kUTa-zliSIyotkarSa udaracchadIya (pseudo-myxomatosis peritonei ) kahate haiM / ye duSTatA ko bhI grahaNa kara sakate haiN| granthyarbudoM ke uttarajAta parivartana vihAsAtmaka hote haiN| inase koSTa banate haiM jinameM raktasrAva huA rahatA hai / ve Upara kI tvacA meM vraNa karake upasarga ko sthAna de sakate haiM jisase utinAza aura nirmokotpatti bana sakatI hai| donoM Thosa athavA koSThIya granthyarbudoM meM duSTatA utpanna ho sakatI hai aura ve karkaTa meM rUpAntarita ho sakate haiN| kahIM-kahIM stana ke satantu-granthyarbuda meM saMyojI bhAga ke adhika prabhAvita hone se saMkaTArbuda bhI bana sakatA hai| aba hama vividha aMgoM meM utpanna hone vAle granthyarbudoM kA vibhAgazaH varNana upasthita kareMge 1-adhivRkka bAhyakIya granthya rbuda ( Cortical Adenoma ) adhivRkka ke bAhyaka ( cortex of the adrenals ) meM granthyarbuda kI utpatti bahuta kama dekhI jAtI hai| kabhI-kabhI praur3hAvasthA meM paramacaya ke nAbhyakSetra arbuda samAna racanA banA liyA karate haiM jinheM granthyarbuda saMjJA dI jAtI hai jo ucita nhiiN| adhivRkka meM jaba granthyarbudotpatti hotI hai to striyoM ke andara kaI prakAra ke kAma parivartana ( sexual changes ) mila jAyA karate haiN| granthyarbuda se granthikarkaTa (adeno. carcinoma ) bhI bana sakatA hai| ___ isa arbuda ke dvArA eka pItavarNa kA piMDa bana jAtA hai jo dharAtala ke Upara uThatA rahatA hai| isa piNDa kI racanA bAhyaka ke kabhI samAna hotI hai aura kabhI vicitra prakAra kI hotI hai / jaba usakA AkAra choTA hotA hai to use granthakIya paramacaya se pRthak karanA kaThina par3atA hai| For Private and Personal Use Only

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788 vikRtivijJAna 2 - stanastha granthyarbuda ( Adenoma of the Breast ) stana meM satantu granthyarbuda tathA karkaTa ye do prakAra kI vRddhiyA~ hI vizeSarUpa meM pAI jAtI haiM | satantu granthyarbuda sadaiva navayuvatiyoM meM tathA karkaTa rajonivRttikAlIna avasthA vAlI prauDhAoM meM pAyA jAtA hai / Acharya Shri Kailassagarsuri Gyanmandir satantu granthyarbuda stana kI stanyavahA praNAliyoM ke adhicchada tathA usake cAroM ora DhilAI se lagI saMyojIUti se sambaddha vyAdhi hai / strIsadi (oestrin ) ke dvArA uttejanA pAkara ye donoM UtiyA~ ( praNAlikIya adhicchada tathA saMyojI Uti ) hI adhika praguNita hotI haiM / isase vidita hai ki satantu granthyarbuda kI utpatti kI nirmiti meM strImadi kA eka mahatvapUrNa sthAna hai / komala granthyarbuda se lekara kaThina tantvarbuda taka ke sabhI prakAra isa satantu granthyarbuda meM dekhane ko mila jAte haiN| ye vRddhiyA~ Thosa, parilikhita ( circumscribed ), aGkurIya athavA koSThIya kisI bhI prakAra kI ho sakatI haiM / } ye vRddhiyA~ taruNa jIvana ke prabhAta kAla meM utpanna hotI haiM / inake Upara eka prAvara avazya car3hA hotA hai jo suspaSTa hote hue bhI bahudhA apUrNa milatA hai / grIna ne tIna prakAra ke satantu granthyarbudoM kA varNana kiyA hai: : ( 1 ) paripraNAlikIya granthyarbuda ( Pericanalicular filro-adenoma ) ( 2 ) antaH praNAlikIya granthyarbuda ( Intarcanalicular fibro-adenoma) (3) sAMkurakoSThIya granthyarbuda ( Papillary cystic fibro-adenoma ) / hama ina tInoM kA saMkSipta varNana upasthita karanA apanA karttavya mAnate haiM paripraNAlikIya granthyarbuda - yaha mantharagati se bar3hane vAlA AkAra meM bahuta choTA, atyanta kaThina arbuda hai / yaha stana meM hAtha se TaTolane para idhara udhara DulAyA jA sakatA hai tathA isake prAvara se ise saralatayA mukta kiyA jA sakatA hai / yaha kaThina, camakadAra aura zveta hotA hai aura cAkU se kaThinatA ke sAtha kaTatA hai / aNvIkSaNa karane para praNAlikAoM ke cAroM ora arbudika tAntava rajjupAza jo paryApta sthUla hotA hai, lipaTA huA dikhatA hai / praNAlikAe~ visphArita nahIM milatI haiM / unake Astaraka kozAoM kI saMkhyA bho bar3hI huI pAI jAtI hai / sAdhAraNa stana meM jitane gartANu hote haiM usase kucha adhika hI yahA~ hote haiM / antaHpraNAlikIya granthyarbuda - paripraNAlikIya granthyarbuda kI apekSA prArambha meM yaha vRddhi adhika mRdu hotI hai| isa para bhI prAvara car3hA hotA hai tathA ise bhI stana meM idhara udhara hAtha se bulAyA jA sakatA hai / Age cala kara yaha bahuta bar3A AkAra dhAraNa kara sakatA hai / yaha tvacA se saMlagna hokara use pIDita karake apuSTa kara sakatA hai / isa kAraNa tvacA meM vraNa ho sakatA hai aura usameM upasarga laga sakatA hai | tvacA meM se dekhane para arbuda karkaTa sA mAlUma par3ane lagatA hai / aNvIkSaNa karane para isa arbuda meM granthIya Uti kI apekSA tAntava Uti kI adhika vRddhi dekhI jAtI hai / For Private and Personal Use Only

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arbuda prakaraNa 789 tAntavaUti ke praNAlikIya adhicchada se AvRta pravarddhanaka praNAlikIya suSirakoM meM bar3hate hue dekhe jAte haiN| isake kAraNa praNAlikAeM visphArita hokara phaila jAtI haiN| yaha tAntava Uti bhauNikIya tAntava Uti se adhika milatI julatI hotI hai na ki sAdhAraNa saMdhArakIya tAntava Uti se / saMdhArakIya jati isa kArya meM bhAga nahIM liyA karatI / strI meM strImadIya ( oestrogenic) mAsika cakrakAla meM jo paramacaya dekhA jAtA hai usI kA vizAla rUpa idhara dekhane meM AtA hai| yadi isa vRddhi ke cheda ko lekara dekhA jAve to praNAliyoM ke suSirakoM meM adhicchada se DhaMkI tAntavaUti kI dvIpikAe~ ( islets ) dekhane meM AtI haiM aura una para punaH adhicchada kA eka stara aura car3ha jAtA hai| jIrNa tanvIyana yukta stanapAka ( chronic involutionary mastitis ) meM prAyaH bahuta se satantugranthyarbuda dekhane meM Ate haiM jo choTe-choTe aura kabhI-kabhI to zyAmAkasama hote haiN| kabhI-kabhI prasara granthyarbudAbha paramacaya jaisA milatA hai aura koI viziSTa arbuda nahIM dekhane meM aataa| isa paramacaya meM tathA stanapAka meM bheda karanA bahuta kaThina par3atA hai| sAMkurakoSThIya satantugranthyarbuda-isa vyAdhi ko praNAlikIya aGkarAbuda ( Duct papilloma ) bhI kahate haiM tathA sAGkurasakoSThapranthya rbuda ( Papillary cystadenoma ) bhii| yaha ThIka cUcuka ke nIce bar3I bar3I stanyavahAoM meM hone vAlA roga hai| yaha eka choTA sAMkura arbuda yA aMkurAbuMda sarIkhA dikhatA hai jo koSTha ke eka avakAza meM sthita rahatA hai aura usI kI prAcIra se ugatA ho| bahuta hI kama yaha stana ke gambhIra bhAga se bhI utpanna hotA huA pAyA jAtA hai| anya aMkurAbuMdoM kI taraha ise bhI tanuprAcIra vAlI raktavahAoM dvArA rakta pahuMcatA hai aura thor3e hI AghAta ke kAraNa isameM raktasrAva hotA huA dekhA jAtA hai| aNvIkSaNa karane para isa arbuda kI sAmAnya racanA eka aMkurAcaMda ke samAna hotI hai jisameM tantuvAhinya pravarddhanakoM para stambhAkAra adhicchada car3hA hotA hai / yaha arbuda zanaiH zanaiH apane AkAra meM vRddhi karatA hai| jisase praNAlikAoM kA visphAraNa hone lagatA hai / isake aMkurIya pravarddhanakoM ke Apasa meM antarvayana ( iuterlacing ) ke kAraNa granthisama avakAza chUTa jAte haiM jisake kAraNa isakA nAma sakoSThagranthyarbuda nikalA hai| anya antaH koSTIya aMkurAbaMdoM kI bhA~ti yaha bhI mArAtmaka rUpa dhAraNa kara sakatA hai / sAdhAraNataH yaha arbuda 40 varSa kI vaya meM puruSoM meM tathA bahu-prasavAoM meM pAyA jAtA hai / ___satantu granthyarbuda mArAtmaka rUpa dhAraNa kara liyA karatA hai| ve Thosa arbuda jinameM saMdhAra kA Adhipatya hotA hai saMkaTAbaMdIya rUpa dhAraNa karate haiM / sAdhAraNatayA tAkAra kozAoM se yukta saMkaTArbuda idhara banatA hai jisakI prArambhika nirmANAvasthA meM adhicchadIya Uti pAI jAtI hai para vaha Age cala kara tirohita ho jAtI hai| aMkurIya prakAra ke arbudoM kA karkaTa meM rUpAntara hotA hai aura duSTa praNAlikIya aMkurAbuda banate haiN| For Private and Personal Use Only

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760 vikRtivijJAna 3-lomanAla (zvAsanAlastha) granthyarbuda (Adenoma of the Bronchus) ___ zvAsanAladarzana ( bronohoscopy ) ke sudhAre hue sAdhanoM kI kRpA se nAtidUra kAla meM Aja hama zvAsanAlastha granthyarbuda kA vicAra karane ke lie samartha ho sake haiN| aneka bAra hone vAle raktaSThIvana yA Urdhvaga raktapitta kA Aja taka jo kAraNa ajJAta thA vaha aba granthyarbudIya purvagaka se prakaTa huA hai| ardhvaga raktapitta meM phuphphusoM dvArA prasUta rakta ke yakSmA ke atirikta aneka kAraNa ho sakate haiM jinameM granthyarbuda eka hai / bvAyaDa ne zvAsanAlIya granthyarbuda se pIDita eka aise rogI kA bhI varNana kiyA hai jisane vigata 25 varSa taka samaya samaya para mukha se vipula parimANa meM raktasrAva kiyaa| zvAsanAla meM jitane prakAra ke prathamajAta arbuda milate haiM unameM yaha 8 pratizata taka dekhA jAtA hai| puruSoM kI apekSA ye striyoM meM adhika pAye jAte haiN| ye 40 varSa kI Ayu ke pUrva hI hote haiN| __ granthyarbuda bar3e zvAsanAla meM eka purvaMgakIya vRddhi (polypoidal grow. th) ke rUpa meM ugatA aura zvAsanAla ke suSiraka meM poMr3hatA calA jAtA hai / yahA~ taka ki use yaha pUrNataH avaruddha kara letA hai / isa avarodha ke anantara phuphphusa kA avapAta (collapse ) ho jAtA hai aura usameM pUyajanaka upasarga kI sRSTi ho sakatI hai| isa arbuda kA vraNana kama hotA hai para yaha raktasrAvI adhika hotA hai| jisase kaI kaI bAra rakta kA srAva hotA huA dekhA jA sakatA hai| yaha arbuda ghanAkAra ( cubical ) kozAoM se banatA hai / ina kozAoM meM svaccha kAyArasa bharA rahatA hai| ye kozA kabhI kabhI avakAzikIya samUhoM ( alveolar groups ) meM yA kabhI kabhI eka sAMkura pravarddhanaka kI taraha vAhinyasaMdhAra meM vinyasta ( arranged ) rahate haiM / ye arbuda kahA~ utpanna hote haiM yaha abhI nizcita nahIM kiyA jA sakA hai / yaha to kadAcit satya hI hai ki ve pacamala ( ciliary ) adhicchada meM utpanna nahIM hote| vomaka aura grAhama ke vicAra se ve phuphphusa ke bhrauNa aMgArambha (foetal anlage) para nikalA karate haiM aura unakI tulanA lAlA granthiyoM ke arbudoM se kI jA sakatI hai| kucha logoM kA aisA vicAra hai ki ve zvAsanAla kI zlaiSmika kalA meM sthita zleSmagranthiyoM dvArA banate haiN| inameM kucha nizcita mArAtmakatA yA duSTatA rahatI hai| kATane para kucha to pUrNataH adraSTa yA sAdhAraNa pAye jAte haiM, kucha meM vinA kisI visthAya ko janma diye kevala sthAnika bharamAra hotI hai| tIsare prakAra meM visthAya bhI banate haiM para mArAtmakatA nimna koTi kI hI rahatI hai| yaha sambhava hai ki ye granthyarbuda zvAsanAlIya karkaTotpatti ke prArambha kartA hI hoM kyoMki ye 40 varSa kI Ayu ke uparAnta tathA strI ko puruSa kI apekSA adhika hotA huA dekhA jAtA hai| bahuta se to bAlakoM tathA taruNoM meM bhI yaha dekhA jA sakatA hai| bahudhA granthyarbudoM ko cAkU dvArA eka zalyavid nikAla sakatA hai para sAdhyAsAdhyatA arbuda kozAoM kI usa mAtrA para nirbhara karatI hai jo samIpa kI UtiyA~ meM bharamAra karatI haiN| For Private and Personal Use Only

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arbuda prakaraNa 761 zvAsadarzaka se dekhane para zvAsanAlastha granthyarbuda kA eka suspaSTa citra dikhalAI detA hai / aNvIkSaNa karane se isameM adhicchadIya kozA milate haiM jo samAna AkRti ke hote haiM aura ve eka garttANu ke kinAre kinAre vinyasta ( anukramita ) hote haiM / para kabhI kabhI ve Thosa puMja bhI banA lete haiM / 4 -- sthUlAntrastha granthyarbuda ( Adenoms of the Large Interties ) vAmabhAga meM sthita sthUlAntra tathA malAzaya ( rectum) ina do sthaloM meM aneka - vidha granyarbuda pAye jAte haiN| ye camakadAra lAla raMga ke tathA sanAla hote haiM aura atizIghra mArAtmaka banane kI pravRtti rakhate haiM / kucha kA yaha mata hai ki ve sahaja hote haiM aura strI athavA puruSa kisI ke bhI dvArA santAna meM jA sakate haiM / inameM hone vAle raktasrAva ke kAraNa athavA mArAtmakatA kI pravRtti hone se isase grasta parivAra naSTa ho jAyA karate haiM / 20 varSa se 40 varSa kI Ayu vAle vyaktiyoM ko ye hone lagate haiM / inake kAraNa tIvra atIsAra, aiMThana, sarakta aura sAma mala kA tyAga hotA huA pAyA jAtA hai / udara meM zUla rahatA hai aura rogI kA hai / sthUlAntradarzaka dvArA ina arbudoM ko dekhA jA sakatA hai prAcIra ko TaTolane para kucha bhI hAtha nahIM AtA / bhAra ghaTatA calA jAtA parantu Upara se udara sthUlAntra ke pakvAzaya yA avarohi bhAga meM granthyarbuda jitane hote haiM usase adhika malAzaya meM milate haiM / kabhI-kabhI to samasta sthUlAntra kI zleSmalakalA meM purvaMgakIya paramacaya hotA huA dekhA jAtA hai jisase asaMkhya choTe-choTe arbuda bana jAte haiM / aisA samraNa sthUlAntrapAka ( ulcerative colitis ) yA ugra atIsAra vA pravAhikA meM athavA sahaja rUpa meM dekhA jAtA hai| ina sanAla vRddhiyoM meM se bar3I saralatA se raktastrAva hotA hai / ye bAlakoM meM bahuta hotI haiN| bar3oM meM vinAla granthyarbuda milate haiM jina para sUkSma para lambI aMkuriyA~ ( villi ) car3hI hotI haiM jinase khUba raktasrAva hotA hai / ye vRddhiyA~ prAyaH bahuta hotI haiM aura ye adhikatara mArAtmaka ho jAtI haiM / ina arbudoM ke kAraNa antra kA avarodha ho sakatA hai tathA nirantara raktastrAva hone se raktAlpatA bhI dekhI jA sakatI hai / 5--yAkRta granthyarbuda ( Adenoma of the Liver ) yakRt kA granthyarbuda eka aisI vyAdhi hai jo bahuta hI kama dRSTigocara hotI hai / isake kAraNa eka Thosa aura lAla raMga kA prAvarita piNDa sA prakaTa hotA hai jo yakRt meM kahIM bhI pAyA jA sakatA hai aura kabhI-kabhI to yakRt ke nIce bhI milatA hai aura yakRt ke prAvara ko thor3A sA uThA detA hai / ye piNDa kabhI-kabhI akele hI hote haiM taba unakA AkAra kucha bar3A hotA hai / kabhI-kabhI ve anekoM hote haiM taba unakA AkAra choTA hotA hai / akele hone tathA dharAtala ke pAsa hone para unheM nikAlA jA sakatA hai / I For Private and Personal Use Only

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762 vikRtivijJAna isameM kozAoM ke viSama yA aniyamita stambha dekhane meM Ate haiM tathA yakRtkhaNDikA kI svAbhAvika racanA naSTa-bhraSTa ho jAtI hai / yakRddAlyutkarSa ke kAraNa yakRt meM milane vAle granthakoM ko bhramavaza kabhI-kabhI granthyarbuda samajha liyA jA sakatA hai jo anucita hai| 6-AmAzayastha grandhya rbuda ( Adenoma of the Stomach ) AmAzayika zleSmalakalA ke dharAtala para aneka purvagakIya vRddhiyA~ dekhI jAyA karatI haiN| inheM bahuvidha granthyarbuda ( multiple adenomata) yA prasara AmAzayika purvaMgakotkarSa ( diffuse gastric polyposis) kahA jAtA hai| isameM mRdula purvaMgakIya puMja yA to samUhoM meM yA kalA ke dharAtala para itastataH dekhe jAte haiN| aNvIkSaNa karane para ye granthyarbudIya racanA spaSTataH siddha hotI haiN| kabhI-kabhI unameM se ekAdha karkaTa rUpI bhI ho jAtA hai| granthyarbuda ke kAraNa bahuta adhika raktakSaya (anaemia) tathA AmAzayika anamlatA (achyliagastrica) milatI hai| granthipezyarbuda ( adenomyoma )-AmAzaya ke mudrikAdvAra ke samIpa yA kabhI-kabhI kSudrAntra meM yaha arbuda pAyA jA sakatA hai| AmAzaya meM yaha eka sthAnika pItavargIya piNDa ke rUpa meM dekhA jAtA hai aura ise dekhakara AmAzayika karkaTa kA sandeha ho sakatA hai| isameM mudrikAdvArIya yA grahaNIka granthiyA~ pAI jAtI haiN| sAtha meM sarvakiNvIya Uti lagI rahatI hai jisake cAroM ora anaicchika pezyAvaraNa rahatA hai| isa roga kA isalie bhI kucha mahattva hai ki isake kAraNa AmAzayika roga lakSaNa dekhe jA sakate haiN| 7-laiGgarahainsa dvIpIya granthya rbuda (Adenoma of the Islets of Langerhans yadyapi laiGgArahainsadvIpikAoM (sarvakiNviIyaantarAlitautIya kSetroM ) meM arbudotpatti bahuta kama hotI hai parantu jaba hotI hai to granthyarbuda bahudhA dekhA jAtA hai| jaba dvIpoM meM viziSTa kaNoM ( specific granules ) kI upasthiti pAI jAtI hai aura unake andara madhuvazi ( insulin ) ko upasthiti pAI jAtI hai to usa dazA ko granthyarbuda saMjJA dI jAtI hai| homsa Adi kA kathana hai ki ye vikSata granthyarbuda na hokara aGgavisthAnana ( heterotopia) mAtra haiM kyoMki unameM kabhI praNAlikIya racanA dekhI jAtI hai, kabhI prAvara kA abhAva rahatA hai tathA vRddhi kA AkrAmaka rUpa nahIM dekhA jAtA / kabhI-kabhI eka sthAnika granthyarbuda ke sthAna para dvIpikIya uti kI prasara parama puSTi sampUrNa sarvakiNvI meM dekhane meM AtI hai| ___ isa roga meM madhuvazi kI utpatti atyadhika hone ke kAraNa paramamadhuvazitA (hyper insulinism) tathA upamadhuraktatA ( hypoglycaemia) ke lakSaNa dekhane meM Ate haiN| bhojana ke pazcAt yadi dera taka punaH bhojana na mile to madhuvazi kI pracuratA ke kAraNa mUrchA A sakatI hai jo zarkarA ke upayoga se haTAI jA sakatI hai| yahA~ vAstava meM madhumeha kA viloma hotA hai| For Private and Personal Use Only

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arbuda prakaraNa 763 8- avaTukApranthistha granthyarbuda (Adenoma of the Thyroid Gland) kAloparAnta galagaNDa ( goiter ) granthakIya rUpa dhAraNa kara letA hai / ina granthakIya racanAoM ( nodular formations ) ko sAdhAraNatayA granthyarbuda nAma de diyA jAtA hai / kintu yahA~ isa zabda kA upayoga anucita hai kyoMki ye granthaka zuddha granyarbuda nahIM hote / manuSyoM meM granthi kA paramacaya sidhmoM (patches) meM hotA hai jisase sthAnika kSetra bana jAte haiM jinako avaTukA kI tAntava paTTiyA~ pRthak kara detI haiM tathA vAstavika arbuda kI taraha ina para bhI prAvara car3ha jAtA hai / paramacayAvasthA meM granthi sampUrNa rUpa se bar3hatI hai ataH ina granthakoM kA patA calatA nahIM para jaba vaha avasthA zAnta ho jAtI hai to granthaka prakaTa hote haiM / naidAnika dRSTi se ve kabhI nahIM dikhate para jaba granthi ko kATA jAtA hai to kaTe dharAtala para ve pAye jAte haiM / inakI saMkhyA avasthA para nirbhara hotI hai / do prakAra ke vikSata isa roga meM dekhane meM Ate haiM- eka ko lepAbha granthyarbuda ( colloid adenoma ) kahate haiM aura dUsare ko bhrauNa granthyarbuda ( foetal adenoma ) kahate haiM ina donoM ko pRthaka-pRthaka nAma se parantu hama ina donoM kA alaga-alaga. / lAne ke sambandha meM bhI mataikya nahIM hai / hI varNana karate haiM / zleSAbha granthyarbuda - ise lepAbhagranthakIya galagaNDa ( colloid nodular goiter ) bhI kaha sakate haiN| yaha uttara amerikA meM adhikatama pAyA jAne vAlA galagaNDa hai / granthaka ( nodule ) akelA bhI milatA hai parantu bahudhA ye kaI hote haiN| choTe-choTe aneka granthaka prasarita aura pravRddha avaTukAgranthi meM itastataH chitare rahate haiM / isa sthiti ko granthyarbudotkarSa ( adenomatosis ) kahA jAtA hai / kabhI-kabhI eka yA do granthaka bar3e ho jAte haiM aura granthi kI bahIrekhA ( outline) ko bigAr3a dete haiM | bar3e granthakoM para tAntava Uti kA prAvara car3hA hotA hai / granthaka kATane para usakA dharAtala granthi ke dharAtala ke hI samAna dikhalAI par3atA hai| sAtha hI dhIre-dhIre vihAsAtmaka parivartana hone lagate haiM jisake kAraNa granthakako mala ho jAtA hai, usameM koSThaka bana jAtA hai tathA raktasrAva bhI hone lagatA hai| koSThaka ke andara kA rasa svaccha hotA hai aura usameM paittava ( kolaisTaraula ) ke sphaTa camakate hue dekhe jAte haiM / purAnA ho jAne para rakta ke purAne par3a jAne se usakA varNa babhru ( brown ) ho jAtA hai / granthyarbuda yA koSThaka ke kendrabhAga meM cUrNIyana bahudhA dekhA jAtA hai / aNvIkSa se dekhane para granthi aura isameM koI antara nahIM pdd'taa| jo kucha antara dikhatA hai vaha eka tAntavapaTI (fibrous septum) kA hotA hai / isa vRddhi ke kAraNa granthaka ke bAhara ke garttANuoM para itanA dabAva par3a jAtA hai ki ve bahuta adhika saMkucita ho jAte haiM / granyarbuda meM paramacaya ke parivartana tabhI dikhalAI par3ate haiM jaba granthi ke anya bhAgoM meM bhI ye parivartana hone lagate haiM / kabhI-kabhI kevala granthyarbuda meM hI paramacayAdhikya pAyA jAtA hai aura taba yaha adhika kriyAzIlatA kA eka kendra bana jAtA hai / 67, 68 vi0 For Private and Personal Use Only

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764 vikRtivijJAna bhrauNa granthyabaMda-yaha nAma eka usa asvIkRta vAda para AdhArita hai jisake anusAra vikSatotpatti bhrauNa kozAkoTara ( foetal cell rests ) mAne jAte haiN| yaha taruNAI kA roga hai aura yauvanArambha ke sAtha-sAtha eka kaThina granthaka ke rUpa meM mRdu galagaNDa ke bIca meM rahatA hai| lUgola vilayana kA isa para koI prabhAva nahIM pdd'taa| arbuda akelA hotA hai aura vahI akelA avaTukA kA vikSata hotA hai| isake cAroM ora eka tAntava prAvara car3hA hotA hai / yaha avaTukA ko eka ora dhakela detA hai / aisA zleSAbha granthakoM meM nahIM dekhA jAtA / kaTA dharAtala saghana aura pratyAstha ( elastic) hotA hai / vaha pArAndha gulAbI yA dhUsara varNa kA hotA hai| usameM ati nAza kI pIlI rekhAe~ khiMcI rahatI haiN| bIca ke bhAga meM zveta tAntava Antaraka bahudhA milatA hai| inhIM saba kAraNoM se vikSata ko zleSAbha vikSatoM se pRthaka avaTukA kA hI eka vikSata mAna liyA gayA hai| isa vikSata meM koSThakotpatti, raktasrAva tathA cUrNIyana zleSAbha granthakoM se kahIM adhika milatI hai aura Age cala kara arbuda kA sthAna eka koSThaka ( cyst ) le letI hai jisakI prAcIreM cUrNIyita ( calcified ) hotI haiN| yadi vihrAsAtmaka parivartana isakI bar3I sImAoM ko naSTa na kara deM to aNvIkSIya citra zleSAbha granthakoM ke aNvIkSIya citra se bahuta pRthaka dikhalAI detA hai| isa arbuda meM choTechoTe gartANu (acini) hote haiM jinameM zlepAbha padArtha bahuta hI kama hotA hai yA bilkula hI nahIM hotA / purAne hone para unameM zleSAbha padArtha bar3hatA hai aura yaha zlepAbha granthaka kA rUpa le letA hai| granthi kI avakAzikAyeM (alveoli ) eka racanAvihIna kAcara saMdhAra ke dvArA bahuta dUra kara dI jAtI haiN| isa saMdhAra kI AkRti phUlI huI yA zleSAbha hotI hai| usameM aneka bar3I tanuprAcIrI vAhiniyA~ hotI haiM jinase bar3I saralatA se raktasrAva hotA hai| kucha ga Nu adhicchadIya kalikAoM kA rUpa le lete haiM jinase navIna gartANuoM kA nirmANa hotA hai| kabhI-kabhI arbuda Thosa puMjoM yA kozAdaNDikAoM ( trabeculae of cells) dvArA banatA hai| inase vAstavika arbuda kA AbhAsa milatA hai| -bIjagranthIya granthya rbuda ( Adenoma of Ovaries ) bIjagranthiyoM meM sAdhAraNa yA mArAtmaka kisI bhI prakAra ke adhicchadIya arbuda utpanna hoM, lagabhaga unameM se assI pratizata arbudoM meM granthyarbudAtmaka rUpa dekhA jAtA hai| yaha rUpa adhikatara koSThIya hI hotA hai| Thosa granthyarbuda to bahuta hI kama milA karate haiN| bIjagranthi ke koSThIya granthyarbudoM ke bhI do bheda hote haiM: (1) lasyasakoSTha granthyarbuda ( serous cystadenoma ) / (2) bahugahvarIya sakoSTha granthya rbuda ( multilocular systadenoma ) / lasya sakoSThagranthya rbuda-koSThaka ( cysts ) akele yA kaI mila sakate haiN| parantu tAntavapaTiyoM ke dvArA yahA~ ve adhika gahvarAnvita (loculated) nahIM hote| koSThaka meM jo tarala padArtha bharA rahatA hai vaha lasya hotA hai zleSmIya ( mucinous ) For Private and Personal Use Only

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arbuda prakaraNa 765 nahIM hotaa| isakA varNa pIta yA Ababhraharita hotA hai| isameM probhUjina kI mAtrA paryApta hotI hai| adhika vizalkita adhicchadIya kozAoM kI upasthiti hone para to yaha Avila ( turbid ) hotA hai aura jaba ve nahIM pAye jAte to svaccha ( clear ) hotA hai| bIjakoza kI adhicchada se granthyarbudAtmaka aMkurIya bahirvRddhiyA~ ( outgrowths ) nikalatI haiM jo ina koSThakoM meM pAI jAtI haiN| ye bahirvRddhiyA~ kabhI-kabhI to itanI adhika banatI haiM ki unake kAraNa koSThaka kA rikta sthala abhilupta ho jAtA hai aura vaha eka Thosa arbuda sarIkhA dikhane lagatA hai / koSThaka ke bahirdharAtala ke kozAoM kI pravRtti samIpa kI racanAoM meM antarbharaNa kI rahatI hai jo arbuda ke mArAtmaka rUpa ke paricAyaka hote haiN| isa arbuda meM kozA yA to ghanAkArI (cubical) hote haiM yA stambhAkArI ( cylindrical ) hote haiM jaise ki garbhAzaya praNAlI ( uterine tube ) meM pAye jAte haiN| kabhI-kabhI donoM prakAra ke kozAoM kI milAvaTa bhI pAI jAtI hai| lagabhaga do tihAI rugNoM meM ye arbuda donoM ora pAye jAte haiM / aMkurIya bahirvRddhiyoM se yukta dvipAIya adhikatara hote haiM tathA inakI pravRtti mArAtmakatA ( malignancy ) kI ora bahuta rahatI hai / yadyapi isa prakAra utpanna karkaTa meM mArakazakti bahuta kama pAI jAtI hai| dharAtalIya aMkuroM ke dvArA hI yaha arbuda phailatA hai yadyapi isakA autikIya rUpa sAdhAraNa rahatA hai / koSThaka ke phUTa jAne para aneka vRddhiyA~ udaracchada para bhI cipakI huI tathA banI huI pAI jAtI hai / dharAtalIya aMkuroM kI ragar3a se bhI udaracchada meM ye vRddhiyA~ bana jAtI haiM / udaracchada ke prabhAvita hone para jalodara kA bananA aura nirantara rahanA bhI sambhava ho sakatA hai| kUTazleSmIyasakoSTa granthyarbuda-lasya sakoSThagranthyarbuda kI apekSA ye koSTha adhikatara milate haiN| kAlAntara meM inakA AkAra bhI bahuta bar3ha jAtA hai| adhikatara ye eka ora hI hote haiM parantu milane ko donoM ora bhI mila jA sakate haiM / AnIla varNa ke anekoM aise koSThakoM ke dvArA isakA nirmANa hotA hai jinameM kUTazleSmIya zliSIya (gelatinous ) picchila (slimy ) padArtha bharA rahatA hai| pratyeka koSThaka ke cAroM ora eka paTa ( septum ) lagA hotA hai jisake bhItara yaha padArtha banda rahA karatA hai| bAhara kI ora yaha paTa cikanA aura camakadAra hotA hai isake sAtha koI abhilAga ( adhesions ) nahIM hote| bhItara kI ora koSThakIya avakAzoM meM ucca stambhAkArI zleSmasrAvI pakSmarahita ( non-ciliated ) adhicchada kA AstaraNa huA rahatA hai| caSakakozA (goblet cells) bhI usameM bahudhA milA karate haiN| lasya koSThakoM meM jaise aMkurIya pravarddhanaka milate haiM aise yahAM prAyazaH nahIM milA karate / sAtha hI adhicchadIya kozA bAhya prAcIroM ko phor3ane kA kArya bhI utanA yahA~ nahIM kiyA krte| kabhI kabhI koSThaka kA eka bhAga adhika Thosa, adhika zveta aura kama zliSIya dekhA jAyA karatA hai| inameM adhicchadIya Uti bahuta adhika milatI hai aura usameM mArAtmakatA (duSTatA) ke lakSaNa adhika dekhane meM Ate haiN| pA~ca pratizata ye granthyarbuda duSTa ho jAyA karate haiN| isako punarutpatti bhI For Private and Personal Use Only

Page #875
vikRtivijJAna ho jAtI hai aura isake bIja (seedling ) udaracchadakalA meM yA zastrakarma se banI vaNavastu meM punaH ugakara udaracchadakalA kI guhA ko zleSmAbha ( mucoid ) padArtha se bhara dete haiM / yaha avasthA kUTodaracchadIya zliSotkarSa (Pseudo myxomato. sis peritonei ) kahalAtI hai| Adhunika vicArakoM kA kathana hai ki yaha arbuda zrauNArbudika udbhava ( teratomatous origin ) vAle hote haiM tathA eka prakAra ke adhicchadIya kozA antra Uti kozAoM ko DhaMka dete haiN| yahI kAraNa hai ki eka bhrauNArbuda ke sAtha bhI kUTodaracchadIya zlipotkarSa dekhA jAtA hai| Antrapuccha kI zleSmavRddhi ( mucocele ) jo Antrika adhicchada dvArA utpanna hotI hai usake phaTane se bhI kuTodaracchadIya zliSotkarSa ho jA sakatA hai| isI kAraNa yaha kahA jAtA hai ki aise hI adhicchada meM bIjagranthi kA sakoSTa granthyarbuda utpanna hotA hai kyoMki usakI prakRti zrauNArbudika huA karatI hai / baeNnarArbuda (Brenner tumour) meM vihAsAtmaka parivartana dvArA bhI kucha bIjagranthIya arbudotpatti ho sakatI hai para aisA bahuta kama dekhA jAtA hai| 10-anya aMgoM ke granthyarbuda a-vRkkastha-vRkka ke bAhyaka meM granthyarbuda eka gA~Tha ke rUpa meM banatA hai| usameM vRkka nAlikAe~ ( tubules ) hotI haiN| kabhI kabhI ativRkArbuda (hypernephro. ma.) meM pAye jAne vAle kozA yahA~ milate haiN| kabhI kabhI vahA~ koSThakotpatti ho jAtI hai jisameM aMkurIya pravarddhanaka hote haiM aura isa kAraNa vAstava meM vaha sAMkura sakoSTha granthyarbuda ( papillary cystadenoma ) hI ho jAtA hai| A-poSaNikA granthistha-poSaNikAgranthi kA granthyarbuda tIna prakAra kA hotA hai| eka anAzuraMjya ( chromophobe ), dUsarA amlaraMjya tathA tIsarA pITharaMjya ( basophil) / arthAt yahI tIna prakAra ke kozA inameM pAye jAte haiM aura inhIM ke granthyarbuda bhI dekhane meM Ate haiN| ina tInoM meM anAzuraMjya kozAoM dvArA nirmita granthyarbuda bahutAyata se dekhane meM AtA hai| isake kozA aNDAkAra nyaSTi se yukta hote haiM / usakA kAyArasa kaNIya nahIM hotA isa kAraNa amla vA pITha kisI se bhI vaha raMgA nahIM jaataa| ina arbudika kozAoM se koI udAsarga pravAhita na hone se koI antarAsargIya lakSaNa (endocrine symptom) dekhane meM nahIM aataa| isa arbuda ke bhAra se anya prakAra ke kozAoM kI apuSTi ho sakatI hai| kandAdharika bhAga ( hypothalamus ) para bhAra par3ane se bahumUtra, medasvitA, atinidratA ( somnolence ) Adi roga ho jAte haiM / poSaNikA jisa para TikI hai usa asthi kA aparadana hone se bhedI ziraHzUla nirantara hotA huA pAyA jA sakatA hai| adhika strImadi (IsTrIna) kA antaHkSepa naraprANiyoM meM karake parIkSaNAtmaka rUpa se anAzuraMjya granthyarbuda vaijJAnikoM ne utpanna karake dikhAye haiM jo yaha siddha karatA hai ki yaha arbuda puruSoM meM bhI strImadi samavarta ( oestrin metabolism) kI gar3abar3I se hI hotA hogaa| For Private and Personal Use Only

Page #876
ativRkkArbuda yA grAvitjhArbuda pRSTha 797 LISA HAMPARAN iOE ANSH AirT ALSO SA ye donoM citra grAvitjhArbuda ke haiN| donoM meM bahubhujIya kozAoM ke stambha spaSTa dRggocara ho rahe haiN| pratyeka stambha tAntavaUti se pRthakkRta haiN| For Private and Personal Use Only

Page #877
767 arbuda prakaraNa amlaraMjya granthyarbuda ke kAraNa ina kozAoM kI vRddhi hone se pizAcaroga (giantism ) tathA ekromIgelI ( acromegaly ) nAmaka roga ho jAtA hai / pITharaMjya granthyarbuda ke kAraNa hone vAle lakSaNoM para abhI samucita prakAza nahIM par3A / uparyukta tInoM prakAra ke grandhyarbuda vihvaSTa hokara koSThIya bana jAte haiM taba unameM antarAsargI lakSaNa banda ho jAte haiN| parantu koSTha ke bhAra se poSaNikAgranthi ke kArya meM bAdhA par3a jAyA karatI hai| i-tAlustha-tAlu kI granthiyoM meM kabhI kabhI granthyarbuda utpanna ho jAyA karatA hai / yaha cikanA gulAbI makoya ke barAbara hotA hai / na isameM zUla hotA hai na vaNana / yaha dhIre-dhIre bar3hatA hai| I-ziraHstha-zira ( scalp ) para vizeSakara zaGkhapradeza para granthyarbuda ho jAtA hai / yaha prasvedagranthiyoM meM hotA hai aura lAla yA baiMganI raMga kA hotA hai / isa para camakadAra patalI tvacA car3hI hotI hai jisake kAraNa ise TamATo arbuda bhI kaha dete haiN| vaha kabhI vraNita aura kavakita ho jAtA hai, usase srAva nikalatA hai aura AkRti adhicchadIyArbuda se milatI julatI ho jAtI hai| (ga) adhicchadIya Uti ke anya arbuda yahAM hama tIna prakAra ke arbudoM kA varNana kareMge:(1) ativRkkArbuda ( Hypernephroma ) (2) jarAyvadhicchadArbuda ( Chorionepitheliona ) (3) dantAkAcArbuda ( Adamantinoma ) (1) ativRkArbuda ise paramavRkkArbuda athavA grAvitjhAda (Grawitz tumour ) bhI kahA jAtA hai / ye sabhI nAma bahuta purAne haiN| 1883 I0 meM grAvitjha nAmaka vidvAna ne ativRkkArbuda nAma se ise pukArA thaa| Aja yaha nAma lupta hotA jA rahA hai / grAvitna kA mUla vicAra yaha thA ki bhrUNa meM vRka ke andara adhivRkkagranthi ke bAhyaka ke kucha bhAga samA jAne se yaha arbuda banatA hai| para Aja isa vicAra ko koI protsAhana nahIM diyA jaataa| Aja to ativRkkAbuMda ko vRkkIya karkaTa mAnA jAtA hai aura usI nAma se hama isakA varNana pIche kara cuke haiN| isa nAma ke sambandha meM bvAyaDa likhatA hai ki-'As the old name is based on a wrong theory it should really be given up, but it is so firmly entrenched that it is almost impossible to uproot it.' arthAt prAcIna nAma eka galata mata para AdhArita hone se use vAstava meM tyAga denA hogA parantu isakA prayoga hama itanA adhika karate rahe haiM ki isakA mUloccheda lagabhaga asambhava sA ho gayA hai / grAvitjha kA tarka yaha hai ki yaha arbuda svaccha, rasadhAnIyukta. For Private and Personal Use Only

Page #878
768 vikRtivijJAna ( vacuolated ), medapUrNa ( lipoid-filled ) kozAoM se banA hotA hai jaisA - ki adhivRkka bAhyaka ( adrenal cortex ) meM dekhA jAtA hai / ataH bhrUNAvasthA meMauNa bAhyakIya aMza se hI isa arbuda kI utpatti huI hai ataH vRkka ke Upara sthita aisA arbuda kA nAma rahanA cAhie jise ativRkkArbuda na kahakara vRkkoparisthita arbuda se kahanA ucita hogA parantu ye sabhI nAma Aja bhrama haiM kyoMki yaha arbuda zuddha vRkka utpanna hai aura eka taraha kA karkaTa hai jisakA varNana pIche dekhA jA sakatA hai / vRkka kI nAlikAoM se bane granthyarbuda meM bhI aise hI kozA dekhane meM Ate haiM / ativRkkArbuda meM jo nAlikIya racanA dekhane meM AtI hai vaisI adhivRkkagranthi yA usake arbudoM meM kahIM nahIM milatI / adhivRkkagranthi ke arbudoM ke sAtha jo laiGgika parivartana sarvazarIra meM dekhane meM Ate haiM ve bhI yahA~ nahIM hote jisase yaha siddha hotA hai ki ativRkkArbuda adhivRkkagranthiyoM se koI sambandha nahIM ho sakatA / yaha arbuda vRkka ke eka yA dUsare sire meM hotA hai / vaha sirA dUsare sire kI apekSA bhArI aura sthUla ho jAne se vRkka apanI svAbhAvika AkRti meM rahatA nahIM / Arambha meM yaha prAvarita hokara bhI bAda meM prAvaravihIna aura AkramaNAtmaka rUpa dhAraNa kara letA hai / kaTe dharAtala kA varNa meda kI adhikatA ke kAraNa pIta hotA hai / kahIM-kahIM raktasrAva ke kAraNa lAla raMga bhI mila sakatA hai| choTe-bar3e koSTaka bhI isameM milate haiM inameM lasya yA zlaiSmika tarala bharA hotA hai| kisI-kisI meM UtinAza ke kAraNa rakta bharA milatA hai / arbuda ke bIca meM tAntavakendra ( fibrous cone ) bhI dekhane meM AtI hai| Arbudika bhAga meM svastha vRkkIyabhAga bahuta kama hotA hai / aNvIkSaNa karane para isakA citra kaI rUpa kA milatA hai | arbudakozA bar3e-bar3e, gola-gola svaccha yA rasadhAnIyukta kAyArasa se pUrNa milate haiM / yaha svacchatA meda ke kAraNa hotI hai / paittava sunyuda ( cholesterol esters ) isake pradhAna hetu haiM / madhujana kI upasthiti bhI isameM AMzika sahAyatA karatI hai / kabhI-kabhI arbuda meM asita ( dark ) kaNIya kozA pAye jAte haiM / yaha rUpa adhika duSTa huA karatA hai / kozAvinyAsa kaI prakAra kA ho sakatA hai- ( 1 ) zuddha nAlikIya vinyAsa, (2) koSTIya sAMkura rUpa jisameM aMkurita pravarddhanaka koSThakoM kI ora bar3hate hue milate haiM tathA (3) Thosa rajjuoM kA avakAzikIya vinyAsa jo patalI paTiyoM dvArA alaga-alaga rahatA hai / isameM saMdhAra alpa hotA hai parantu raktavAhiniyA~ khUba aura moTI hotI haiM / inakI prAcIreM arbudakozAoM se hI prAyaH banatI haiM isI se isa arbuda meM raktasrAva kI pravRtti paryApta hotI hai tathA isakA visthAyana raktadhArA dvArA hotA hai / zUlarahita raktameha jo isa prakAra ke rogI meM pAyA jAtA hai vaha bhI inhIM ke kAraNa hotA hai / inake phaTakara nAlikAoM meM pahu~cane se mUtra ke sAtha rakta jAtA hai / (2) jarAyvadhicchadArbuda Acharya Shri Kailassagarsuri Gyanmandir jarAvadhicchadArbuda se pIr3ita 50 rogiyoM meM 20 ko drAkSAsama koSTaka ( bydatidiform mole ), 10 ko Rju sagarbhatA aura 15 ko garbhapAta hotA For Private and Personal Use Only

Page #879
jarAdhicchadArbuda pRSTha 799 Acharya Shri Kailassagarsuri Gyanmandir yaha phuphphusa meM utpanna jarAyvadhicchadArbuda kA citra hai / For Private and Personal Use Only

Page #880
arbuda prakaraNa 766 huA pAyA jAtA hai aisA kucha tajjJoM kA anumAna hai| yaha arbuda bahudhA garbhapAta ke pazcAt utpanna huA karatA hai / kabhI-kabhI prasava ke pazcAt bhI dekhane meM AtA hai aura kabhI-kabhI yaha bIjagranthi yA vRSaNoM meM bhI milatA hai| isakA Ayu ke sAtha koI mahattva kA sambandha sthApita nahIM kiyA jAtA parantu itanA satya hai ki garbhAvasthAoM kA isa para avazya prabhAva par3atA hai| jo strI pA~ca bAra garbha dhAraNa kara cukI hotI hai usameM yaha aThagunA usa strI kI apekSA pAyA jAtA hai jo eka bAra hI garbhadhAraNa kara pAI ho / garbhAvasthA yA garbhapAta hone ke kucha hI saptAhoM pazcAt yaha arbuda prakaTa hone lagatA hai| kabhI-kabhI para bahuta kama yaha utpanna hone meM varSoM le letA hai / jaba garbhadhAraNa garbhAzayetara sthaloM meM hotA hai taba bhI yaha utpanna hotA hai aura taba usakI prathama sITa (sthAtra ) garbhAzayanAlI meM huA karatI hai| jarAyvadhicchadArbuda ke samaya bIjagranthiyoM meM eka ora yA donoM ora asAdhAraNa AkAraprApta pItapiNDa ( kArpasalyUTiyama ) dekhA jAtA hai| ina donoM meM koI kAryakAraNa kA sambandha dRSTigocara nahIM hotA balki aisA lagatA hai ki donoM hI garbhAzayavikAra ke pariNAma mAtra haiN| garbhatA nApane kA azcImajhaNDaka parIkSaNa yahA~ sadaiva astyAtmaka (positive) huA karatA hai| yaha arbuda mAtR UtiyoM meM na banakara garbha kI UtiyoM meM hI banA karatA hai / isakA Arambha garbhAzaya piNDa meM sarvaprathama aparA meM eka kinAre para hotA hai / isake kAraNa raktasrAvI, mRdula lAla raMga kA eka puMja garbhAzayaguhA meM uThane lagatA hai / vaha garbhAzaya ke pezIyabhAga para bhI apanA AkramaNa karatA hai| isake kAraNa yoni-prAcIra tathA garbhAzayagrIvA meM uttarajAta vRddhiyA~ banatI haiN| Age calakara garbhAzaya ke bAhya dharAtala taka roga pahu~ca jAtA hai| ___aNvIkSaNa karane para patA calatA hai ki jarAyvadhicchadArbuda sagarbhatA meM prApta avasthA kA hI eka atipravRddha rUpa mAtra hai| aparA ke zroNikabhAga meM jarAyu-aGkura ( chorionic villi ) hote haiN| ina aMkuroM kA mukhyabhAga poSaraha ( trophoblast ) hotA hai jisakA kArya hai mAtRraktasrotasoM ( maternal blood sinuses ) kA AkramaNa krnaa| ina poSarahoM meM do prakAra kA adhicchada huA karatA hai jisameM antaHstara svaccha ghanAkArI kozAoM se banatA hai jisameM bar3I aura pANDura varNa kI nyaSTiyA~ nivAsa karatI haiN| ina kozAoM ko laiGgAhainsIya kozA kahA jAtA hai tathA bAhara kI ora kAyANurasa kA eka asitavarNa kA bahunyaSTIya bar3A sA puMja hotA hai jise bhakSaka kozAstara ( syncitial cell layer ) kahA jAtA hai| jarAyvadhicchadArbuda meM mukhyarUpa se laiGgahainsIya kozA samUha rahatA hai tathA kucha bhakSaka kozApuJja rakta ke sarovaroM ke madhya meM sthita hotA hai| sAdhAraNatayA ina do kozAoM meM jo prakRta sambandha rahane cAhie ve rahate nahIM haiM aura pratyakSa meM laiGgahainsIya kozA bhakSakastara ke Upara hAvI ho jAte haiM / isa arbuda meM raktavAhiniyoM kA nAma bhI nahIM hotA kyoMki For Private and Personal Use Only

Page #881
500 vikRtivijJAna isa arbuda kA poSaNa to usa rakta se ho jAtA hai jisakI vAhiniyoM ko yaha barabasa pachAr3atA hai / na isameM saMdhAra hI hotA hai / Acharya Shri Kailassagarsuri Gyanmandir * isa arbuda ke prasAra kA eka mAtra sAdhana raktadhArA hai kyoMki poSarUha kozAoM kA raktavAhiniyoM para AkramaNa eka svAbhAvika ghaTanA hai / kabhI-kabhI isI rakta ke dvArA phuphphusa meM isake visthAya garbhapAta hone ke kucha hI kAla bAda dekhe jAte haiM / phuphphusAdi meM bane ye uttarajAta arbuda bhI mUla arbuda kI bhA~ti hI raktAsrAvI aura unameM aNvIkSIya citraNa bhI mUla arbuda jaisA hI milatA hai / laiGgahainsIya kozAoM kI jitanI adhika bahulatA hogI utanI hI duSTatA arbuda meM bar3hatI hai / kabhI-kabhI kozA garbhAzaya prAcIra ko itanA bhedate cale jAte haiM ki vaha chidrita taka ho jA sakatA hai / pezIya bhAga meM UtinAza ho jAyA karatA hai / arbuda ke duSTa kozAoM meM AkAra kI viSamatA tathA atimAtra raMgAyaNa (hyperchromasia ) jitanA milatA hai utanA vibhajanAGkana ( mitoses ) nahIM milte| isakA visthAyana phuphphusa tathA yoniprAcIra evaM bIjagranthiyoM taka meM milatA hai / yaha roga atyadhika mAraka hote hue bhI yadi garbhAzaya kI vRddhi ko turata zastrakarma dvArA ucchedita kara diyA jAve to prAgjJAna ( prognosis ) kucha sAdhya ho jA sakatA hai aura visthAya bhI tirohita ho jAte haiM / ( 3 ) dantAkAcArbuda yaha eka Thosa koSThIya adhicchadArbuda hai jo yA to dA~ta ke AkAca ( enamel) bhAga se banatA hai yA parAdanta ( paradental) bhAga se janma letA hai| isameM kaI guNa kRntaka vidradhi (roDeNTa alsara) sadRza hote haiM parantu yaha duSTa na hokara sAdhAraNa hotA hai aura isake kAraNa visthAya nahIM banA krte| yaha sthAnika vinAzaka aura dhIre-dhIre bharamAra karane vAlA hai / isameM paiThika kozIya karkaTa ( basal-cell carcinoma ) ke lakSaNa milate haiM jo ki kRntaka vidvadhi meM pAye jAte haiM / isakA itihAsa bar3A lambA hotA hai jo bIsa varSa taka jA sakatA hai jisameM yaha dhIre-dhIre Upara yA nIce ke hanu kI Uti meM bharamAra karatA hai / isameM zothotpatti hotI hai tathA asthi kA nAza hone lagatA hai / jaba yaha arbuda adhika andara ko hotA hai to usakA uccheda karanA kaThina hotA hai aura arbuda kI punarutpatti ho jA sakatI hai| usakI mArAtmakatA meM vRddhi ho jAtI hai / yahA~ taka ki anta meM visthAyana hone lagate haiM / isake kozA AkAcaruha ( enameloblast ) hote haiM jo velanAkAra hote haiN| ye kozA yA to kisI koSThaka kA stara banAte haiM yA ve Thosa paMktiyA~ banAte haiM jo tAntava saMdhAra dvArA pRthak rahatI haiN| ye kozA kahIM adhika ghanAkAra dikhalAI dete haiM aura kahIM adhika zalkIya | AkAcarUhoM dvArA isakA nirmANa hone se isakA eka nAma AkAcaruhArbuda ( enameloblastoma ) bhI kahA jAtA hai| poSaNikAgranthi tathA jaMghAsthi ( tibia ) ina do sthaloM meM bhI aise hI arbuda mila sakate haiM / aisA bvAyaDa kA kathana hai / For Private and Personal Use Only

Page #882
arbuda prakaraNa 801 isa prakAra adhicchadIya arbudoM kA varNana yathAvazyaka karake aba hama saMyojI uti ke arbudoM para Ate haiN| (2) saMyojI-Uti ke arbuda (Connective-tissue tumours ) (ka) duSTa arbuda / isa vibhAga meM do prakAra ke arbuda sammilita kie jAte haiM jinameM eka saGkaTAbaMda hai aura dUsarA pRSThamevarbuda hai| saMkaTAdhuMda (Sarcoma) aMgarejI kA sArkomA zabda grIka zabda sArksa yA sArka se banatA hai jisakA artha mAMsa hotA hai tathA omA arbuda ke lie vyavahRta kiyA jAtA hai / isa prakAra sArkomA ko mAMsArbada zabda se vyakta kara sakate haiN| parantu sArkomA mAMsa mAtra kA arbuda ho aisA nahIM hai| vaha to tAntava Uti, medasa Uti, asthi, basti, yakRt , phuphphusa, karNamUla granthiyA~, plIhA, vRkkAdi kisI bhI aMga meM aura Uti meM dekhA jA sakatA hai| lakhanaU meM kAzI ke mAnya vidvAn DA0 ghANekara mahodaya se vArtA huI thii| unhoMne kahA thA ki sArkomA ko mAMsAvuda aura mAyomA ko pezyarbuda karake likho| parantu mAMsArbuda aura pezyarbuda ina do nAmoM se do vibhinna viSayoM kA samAveza ThIka nahIM lgaa| idhara duSTa, caNDa aura mArAtmaka zabdoM kA prayoga mailigneNTa arbudoM ke lie pahale se hI prayukta thA ataH 'karkaTa' kaiMsara ke lie aura 'saMkaTa' sArkomA ke lie yuktiyukta mAna kara prayoga karanA Arambha kiyA hai| saMkaTArbuda kA prayoga pahale jitane vyApaka kSetra meM hotA thA Aja usakI vaha sthiti nahIM raha gii| pahale samaya meM kucha aise aneka arbudoM ko saMkaTArbuda kaha kara pukArA jAtA thA jo saMyojI Uti ke arbuda nahIM ye| kyoMki saMkaTArbuda eka saMyojI uti kA arbuda hai ataH lasyasaMkaTArbuda (lymphosarcoma ). kAlisaMkaTArbuda ( malanotic sarcoma ), yA pezyasaMkaTArbuda ( myosarcoma ) Adi zabda Aja vyartha ho gaye haiN| jIrNavraNazothAtmaka avasthAe~ jo Aja kaNArbuda (granulomas) kahalAtI haiM, pahale bhI saGkaTAvuda ke matthe mar3hI jAtI rahI haiN| isI prakAra rUpa meM bahuta kucha milane ke kAraNa anaghaTya karkaTa ( anaplastic cancer ) ko bhI saMkaTArbuda kaha diyA jAtA thA aura inameM vRSaNa karkaTa, bIjagranthi karkaTa athavA avaTukAgranthi karkaTa Ate the| ye saba bhI Aja saMkaTArbuda se koI pAsa yA dUra kA sambandha nahIM rakhate / itanA saba hone para bhI anaghaTyakarkaToM, kaNArbudoM tathA saGkaTArbudoM ke aNvIkSaNa se prApta citra meM koI mahattva kA bheda DhUMr3ha nikAlanA bahuta kaThina par3atA hai kyoMki For Private and Personal Use Only

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802 vikRtivijJAna kaNArbuda tathA tAkArI kozA vAle saMkaTArbuda tathA anaghaTya karkaTa tathA gola kozA vAle saMkaTArbuda eka dUsare se bahuta kucha milate haiM / vidyArthI aura vaidya donoM kA dharma hai ki vaha yaha samajha le ki karkaTa aura saMkaTa ye donoM hI mArAtmaka haiM parantu karkaTa kA bahuta bar3A aura paryApta vizAla kSetra hai jaba ki saMkaTa usakI tulanA meM bahuta saMkIrNa kSetra kA svAmI hai| saMkaTArbuda kI mArAtmakatA saMkaTArbuda kI mArAtmakatA yA duSTatA sadaiva eka sI nahIM rhtii| jisameM yaha bahuta ugra svarUpa kI hotI hai usameM to vaikArikIvid saralatApUrvaka kaha detA hai ki yaha arbuda mArAtmaka aura saMkaTArbuda hai| para jahA~ sAdhAraNa saMyojI Uti ke dvArA zanaiH zanaiH saMkaTAbaMdIya rUpa AtA hai vahA~ kucha bhI kahanA bahuta kaThina ho jAtA hai / jaba tantvarbuda ( fibroma ) mArAtmaka bananA Arambha karatA hai to aNvIkSaka ko eka ora vaha tanvarbuda dikhatA hai aura dUsarI ora kaNIya Uti / bvAyaDa kA kathana hai ki isa antara kA bheda eka anubhavI vyakti kI antarAtmA hI kara sakatI hai tathA use zabdoM meM vyakta nahIM kiyA jA sktaa| yadi utpanna hone ke turata bAda kisI arbuda kA uccheda hotA calA jAve to bhI usakI mArAtmakatA ke spaSTa lakSaNa prakaTa nahIM ho paate| saMkaTArbuda kA pratyakSadarzana eka saMkaTa dUsare saMkaTa se bahuta bhinna ho sakatA hai / itanA bhinna ki usako vyakta karanA kaThina ho jAtA hai| phira bhI unameM kucha sarvasAmAnya aise lakSaNa bhI pAye jAte haiM jinheM hama nIce vyakta karate haiM 1. dekhane meM eka saMkaTa mAMsa (sArka) sarIkhA lagatA hai isI se ise sArkomA yA mAMsArbuda kahane kA rivAja cala par3A mAlUma hotA hai| 2. isakA eka aisA prapuJja ( bulk ) banatA hai jaisA karkaTa kA bhI nahIM banatA jisake kAraNa yaha samIpa kI anya UtiyoM se bilkula pRthaka aura uThA huA dekhA jAtA hai| __3. jitanA hI adhika saMkaTa kozAvAn ( cellular ) hotA hai utanA hI vaha mastiSka ke mastuluMga yA zveta padArtha ke sadRza dikhAI detA hai| ___4. saMkaTa kI gADhatA ( consistency ) sadaiva eka sI nahIM milatI para vaha adhikAMza mastuluMga ke hI samAna prAyaH mRdula ( soft ) huA karatA hai| 5. saMkaTArbuda kA kaTA huA dharAtala sadaiva samarasa ( homogeneous ) hotA hai jo isakI eka mahattvapUrNa aura pramukha vizeSatA hai| para yataH isake sAtha vihAsoM kI zrRMkhalA sI lagI rahatI hai ataH vaha isakI samarasatA ko bigAr3a diyA karatI hai| For Private and Personal Use Only

Page #884
arbuda prakaraNa 803 6. saMkaTArbuda kI vRddhi kahIM kahIM itanI adhika ho jAtI hai ki usakI raktapUrti ko bhI pIche chor3a jAtI hai jisake kAraNa kaI prakAra ke RNAstraNa (infarction ) bana jAte haiN| 7. bahudhA saMkaTa ke sAtha UtimRtyu yA UtinAza ( necrosis ), zleSmAbha ( mucoid ) athavA zliSIya ( myxcmatous) mRdvana ( softening ) athavA vAstavika taralana ( liquefaction ) taka ho jA sakatA hai| 8. saMkaTArbuda ko sarvAdhika saMkaTagrasta karane vAlA hai isakI asaMkhya tanuprAcIrI raktavAhiniyoM ke dvArA hone vAlA raktasrAva / aNvIkSaNa aNvIkSa se dekhane para karkaTArbuda aura saMkaTAbaMda meM antara spaSTataH AtA hai jaisA ki adhicchada (ipIthIliyama) aura saMyojI Uti (kanaikTiva TizU) meM hotA hai| karkaTa ke kozA samUhoM meM vibhakta rahate haiM aura pratyeka kozA samUha ke bIca meM saMdhAra unheM pRthak karatA rahatA hai aura yaha saMdhAra karkaTa ke eka eka kozA ke bIca meM kadApi nahIM AtA / isa racanA ko avakAzikIya racanA ( alveolar arrangement ) kahA jAtA hai / saMkaTAbaMda meM aisI avakAzikIya racanA nahIM pAI jaatii| kozA eka barAbara vitarita rahate haiM aura pratyeka kozA ko saMdhAra pRthaka karatA hai| yaha racanA asthi ke saMkaTa meM bahuta spaSTa hotI hai parantu kahIM kahIM itanI aspaSTa hotI hai ki abhiraMjana (staining) ke viziSTa sAdhanoM ke prayoga se hI siddha ho pAtI hai| jo kama anabhinita saMkaTArbuda hote haiM unameM saMdhAra bahuta sUkSma aura kaThinAI se pahacAnA jA sakatA hai para jo adhika bhinnita ( differentiated ) saMkaTArbuda hote haiM unameM saMdhAra ( stroma ) pracura mAtrA meM pAyA jAtA hai jaisA ki asthisaMkaTa ( osteosarcoma) meM dekhA jAtA hai jahA~ saMkaTakozAoM ke bIca meM asthiti rahA karatI hai| saGkaTArbuda kozAoM meM madhyastarakArI ( mesoblastic) lakSaNa huA karate haiM / karkaTakozAoM kI apekSA inake kinAre adhika aspaSTa huA karate haiN| inake kAyANurasa kA vistAra antaHkozIya antavya banatA hai / jahA~ karkaTa ke kozAsamUhoM ke madhya meM sthita saMdhAra ke andara hokara raktavAhiniyA~ jAyA karatI haiM vahAM asaMkhya kozAoM aura srotAbhoM ( sinusoids ) ke dvArA sampUrNa saMkaTArbuda vedhita kiyA jAtA hai / isa kAraNa karkaTa meM UtinAza kI adhika sambhAvanA rahA karatI hai kyoMki raktavAhiniyoM kI vRddhi se kahIM adhika drutagati se karkaTakozAoM kI vRddhi hotI hai| raktavAhiniyoM ke DhA~ce para saMkaTArbuda vistRta hotA huA calA jAtA hai isa kAraNa yaha kama Azcaryajanaka nahIM hai ki yahA~ bhI raktastrAva bahudhA dekhane ko milatA hai| yojyUtikara ( saMyojI Uti dvArA bane-mesenchymal ) arbudoM meM sUtribhAjanAMka ( mitotic figures ) kI jitanI mahattA hai utanI karkaToM meM nhiiN| prapAkita adhicarma meM sUtribhAjanAta (vibhajanAGka) prAyaH dekhe jA sakate haiN| tanturuha, For Private and Personal Use Only

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804 vikRtivijJAna asthiruha, kA sthiruha yA anya isI prakAra ke kozAoM ke prakAra isameM pAye jAte haiN| adhika anabhinita hone para kozAprakAra kA patA lagAnA kaThina ho jAtA hai| usa avasthA meM tanturuha (fibroblast) Adi zabdoM kA prayoga na karake golakozIya saMkaTa (round-cell sarcoma ) taGakozIya saMkaTa (spindle cell sarcoma) Adi nAmoM se use pukArate haiM / ina arbudoM meM aneka bahurUpIya (polymorphic) yA bahuracanA vAle hote haiM, jinameM kaI prakAra ke kozA eka sAtha milate haiN| jo saMkaTa dratagati se bar3hate haiM unameM sUtribhAjanAGka bahuta adhika milate haiM para jo mandagati se vRddhi karate haiM unameM ve itane pramANa meM nahIM milte| kaNIya Uti bhI jaba bahuta tejI se bar3hatI hai to usameM bhI sUtribhAjanAGka adhika pAye jAte haiN| ina sUtribhAjanAGkoM ke bala para hI kozIya tanvarbuda aura saMkaTa meM vibheda kiyA jAtA hai| kyoMki tanvarbuda meM ve nahIM pAye jaate| atyadhika mArAtmaka prakAra ke saMkaTArbuda meM atikAyakozA yA mahAkozA (giant cells ) pAye jAte haiM / yadi kisI kAraNa se arbuda upasRSTa ho jAtA hai to ye mahAkozA anekoM sitakozAoM kA bhakSaNa kara lete haiN| saMkaTArbuda kA prasAra saMkaTArbuda kA vistAra hote hote vaha eka vizAlakAya puMja kA rUpa dhAraNa kara letA hai tathA sAtha hI yaha samIpastha UtiyoM meM bharamAra bhI karatA hai| isakI vRddhi kI gati bahuta adhika badalatI rahatI hai| yaha gati taba aura adhika bar3ha jAtI hai jaba saGkaTArbuda kA apUrNatayA uccheda kiyA jAtA hai| isalie yA to isakA pUrNataH uccheda kiyA jAnA cAhie athavA ise nahIM chUnA caahie| kabhI kabhI jaba saMkaTa ativega se bar3hane lagatA hai to kabhI kabhI apanI raktapUrti kA atikramaNa kara baiThatA hai / aisI dazA meM abuMda ekadama stabdha ho jAtA hai aura kabhI kabhI to pratIpagamana ( retrogress ) karane laga jAtA hai| aise avasara para tejAtu kiraNoM athavA dahAtujambeya ke prayogoM se usake AkAra ko aura bhI kama kiyA jA sakatA hai| samIpa kI UtiyoM meM saMkaTArbuda bharamAra kiyA karatA hai| usake kozAstarIya pRSTha ( fascial plane ) para pezI tantuoM ke madhya meM asthiyoM kI nikulyAoM Adi meM hokara bar3hate rahate haiM / isI pravRtti ke kAraNa inakA vinAza athavA uccheda sadaiva apUrNa raha jAtA hai aura inakI punarutpatti bahudhA dekhI jAtI hai| __saMkaTArbuda kA visthAyana yA dUragAmI prasAra (distant spread) raktavAhiniyoM ke dvArA hotA hai / isakA kAraNa yaha hai ki eka to raktavAhiniyA~ bahuta adhika hotI haiN| dUsare inakI prAcIreM bahuta tanu hotI haiM tIsare saMkaTakozA ina prAcIroM ko saralatA se pAra karane kI zakti rakhate haiN| isa kAraNa se raktavAhiniyoM meM ye kozA ghusa jAte haiN| sabase pahale phuphphusoM meM isake dvArA visthAya banatA hai / vaise phuphphusa meM hokara saMkaTakozA kisI bhI aMga ko pahu~ca kara vahA~ visthAyotpatti kara sakate haiM / For Private and Personal Use Only

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tantusaGkaTArbuda pRSTha 805 kA hai SALA COM ans STER yaha citra tarkukozIya ( spindle-celled ) saGkaTAbaMda kA hai| For Private and Personal Use Only

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arbuda prakaraNa isI kAraNa bvAyaDa kA kathana hai ki kitanA hI zastrasAdhya saMkaTArbuda ho, phephar3oM kA eksare avazya le lenA cAhie / 5- 10 pratizata rogiyoM meM lasadhArA dvArA bhI isakA prasAra hotA huA mila sakatA hai / 805 saMkArbuda yojI Uti meM utpanna hone vAlA arbuda hone ke kAraNa jahA~-jahA~ zarIra meM yojI Uti milatI hai vahIM vahIM isakI utpatti ko sadaiva sambhAvanA rahatI hai / asthi, upatvag Uti, mAMsadharAkalA aura pezI ye isakI utpatti ke mukhya sthala ( sites ) haiM / saMkArbuda kA vargIkaraNa tathA prakAra saMkaTa ke vargIkaraNa ke lie do vidhiyAM calatI haiM- - eka kauzikIya ( cytological ) aura dUsarI autikIya ( histological ) / kauzikIya vidhi meM Uti kA nAma usa kozA ke anusAra liyA jAtA hai jo use bhare rahatA hai / isI kAraNa golakozIya saMkaTa, mizrakozIya saMkaTa, tarkukozIya saMkaTa, mahAkozIya saMkaTa Adi nAmoM se isako pukArA jAtA hai / yaha vidhi to jaba koI cArA na cale taba prayojanIya hai ataH ise jahA~ taka ho kama prayukta karanA cAhie / autikIya vidhi meM arbuda kA nAmakaraNa usa Uti ke anusAra hotA hai jisameM vaha utpanna hotA hai / tantusaMkaTa, asthisaMkaTa, kAsthisaMkaTAdi isI dRSTi se rakhe gaye aura vyavahRta nAma haiM / autikIya hI kevala eka santoSajanaka rUpa hai / kyoMki antarAlita Uti adhika mahatvapUrNa hotI hai na ki kozA kA prakAra / nIce hama saMkaTArbuda ke autikIya prakAroM kA vivecana karate haiM jinake sAtha sAtha unake kauzikIya rUpa bhI yathAsambhava diye jA rahe haiM / For Private and Personal Use Only saMkaTa ke autikIya prakAra tantusaMka TArbuda (fibrosarcoma ) -- isakA mukhya kozA tanturuha ( fibroblast ) hotA hai / yaha eka prakAra kA tarkukozIya ( spindle-celled ) saMkArbuda hotA hai / yaha arbuda utanI adhikatA se nahIM hotA jitanA ki anumAna lagAyA jAtA rahA hai / pahale bahuta se mArAtmaka yojyUtIya arbudoM ko tantusaMkaTa mAna liyA jAtA thA para khoja se Aja ve pariNAhI vAtanADiyoM ( peripheral nerves ) ke dvArA utpanna cetAjanaka ( neurogenic yA vAtanADIjanya ) siddha hue haiM 1 sthUla aura sUkSma dRSTi se dekhane para yaha saMkaTa vividha lakSaNoM se yukta dekhA jAtA hai | anaghaTita (anaplastic) jitanA hI adhika yaha hotA hai utanA hI isake rUpa meM parivartana dekhane ko milatA hai / kabhI kabhI yaha anaghaTana itanA adhika hotA hai ki arbuda bahuta adhika mRdula banatA hai / usake kozAoM meM tarkurUpatA itanI kama hotI hai ki use golakozIya kahane kA bhrama utpanna ho jAtA hai / usake saMdhAra meM bhI bahuta bhinnatA ho jAyA karatI hai / vaha kabhI to bahuta adhika aura kabhI bahuta kama hotA hai / usameM kabhI to itane adhika tantuka ( fibrils ) hote haiM ki use

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806 vikRtivijJAna mRdu tantvarbuda kahane ko jI cAhatA hai| aisI avasthA meM sUtribhAjanAkoM kI khoja hI yogya mArga ko prakaTa karane meM sahAyatA karatI hai / vAtika yA vAtanADIya saMkaTa ( Neuro sarcoma or neurogenic sarcoma.)-yaha saMkaTa vAtanADI ke kaMcuka ( sheath) dvArA utpanna hotA hai| yaha vAtika tantvarbuda ( neurofibroma) kA mArAtmaka rUpa hai| yaha arbuda na bahuta kama milatA hai aura na bahuta adhik| yaha hAtha aura pairoM kI upatvak ati aura antazIya uti meM utpanna hotA hai| Arambha meM yaha laghukAya hotA hai tathA ise hilAyA dulAyA jA sakatA hai| usa samaya yaha itanA sAdhAraNa dikhatA hai ki ise thor3I visaMtatA dvArA cAkU se kATa diyA jAtA hai para kaTane ke bAda yaha apane asalI rUpa meM AtA hai aura ekadama bar3hane lagatA hai| kaI bAra isa prakAra usake kaTane ke bAda usake visthAya jaba phuphphusa meM pAye jAte haiM taba isakA vAstavika jJAna ho pAtA hai / yadi cAkU dvArA ise na kATA jAve to yaha bahuta dhIre dhIre bar3hatA hai| pahale to yaha sthAnika hotA hai para kaI bAra kaTane ke pazcAt yaha samIpa kI UtiyoM meM bharamAra karane lagatA hai| aNvIkSaNa se yaha tantusaMkaTa sarIkhA lagatA hai parantu lambotare kozA viziSTa gaTThoM ( interwining bundles ) pUloM ( fasciculi ) yA bhugmiyoM ( whorls ) meM hote haiM isI se isakI vAtika utpatti kA anumAna hotA hai parantu isakI mArAtmakatA kA patA lagAnA bar3A kaThina hotA hai kyoMki yaha eksereja ke lie bar3A pratirodhI hotA hai| isI tathya se isakA svarUpajJAna hotA bhI hai| __ asthisaMkaTa yA asthijanaka saMkaTa-yaha prAyazaH hone vAlA aura atyadhika mahattvapUrNa saGkaTAbaMda hai / isakA mukhya kozA asthiruha (osteoblast) hai / isa kozA kI apekSA isakA jJAna antarkozIya padArthakAsthi vA asthi dvArA prApta huA karatA hai| kAsthisaGkaTa (chondro-sarcoma )-sAdhAraNa kAsthiarbuda meM jaba mArAtmakatA utpanna ho jAtI hai taba usakI vRddhi druta ho jAtI hai, usake kozAoM ke AkAra aura svarUpa meM viSamatA A jAtI hai aura sUtribhAjanA khUba hone lagatI hai| isI avasthA ko kAsthisaMkaTa kahA jAtA hai| yaha uraHphalaka yA zroNi kI asthi meM utpanna hotA hai| isakA AkAra bahuta vizAla ho sakatA hai| yaha raktavAhiniyoM ko AkrAnta karake phuphphusa meM visthAyotpatti kara sakatA hai| kAsthiarbuda aura kAsthisaMkaTa meM antara karanA bahuta kaThina hai| isa bheda ko jAnane meM jitanA roganidAna aura lakSaNa lAbha detA hai utanA aNvIkSaNa nhiiN| zliSIya vihrAsa dvArA sandehotpatti hotI hai| vimedasaGkaTa ( Lipo-sarcoma) yaha bhI paryApta hotA hai / ise jJAta karane ke lie snaihika abhiraMjana Avazyaka hai| jahA~ bhI vimeda yA carbI hotI hai vahIM yaha ho sakatA hai parantu antargazIyaUti, sandhiyoM ke samIpa, pazcaudaracchada tathA padhavRkkakSetra meM yaha sarvAdhika milatA hai| yaha Arambha meM prAvarita hotA hai aisI avasthA meM For Private and Personal Use Only

Page #889
arbuda prakaraNa 807 jaba isakA uccheda kara diyA jAve to yaha punaH utpanna ho jAtA hai aura aba yaha anya UtiyoM meM antarAbharaNa karane lagatA hai / sAdhyAsAdhyatA kI dRSTi se yaha nikRSTa hai / aNvIkSa citra meM bahuta antara milatA hai| eka hI arbuda ke andara bhI antara pAyA jA sakatA hai / isameM tarkukozA tathA bRhat bahubhujIya kozA ye do pAye jAte haiM / kozArasa kaNIya hotA hai / usameM kabhI meda pAyA jAtA hai kabhI nahIM pAyA jaataa| ise jAnane ke lie snaihika abhiraJjana karanA caahie| bahubhujIya kozA sUje se aura pANDuravarNa ke hote haiM jo adhicchadIya kozAoM jaise dIkha par3ate haiM aura uttarajAta vRkkakarkaTa yA ativRkkArbuda kA bhrama utpanna karAte haiM / yaha bhrama jaba arbuda asthi meM ho taba vizeSa rUpa se ho sakatA hai| kozA bhrauNavimeda kozA se milate julate hote haiM tathA arbudIya mahAkozA bhI pAye jAte haiM zliSIya saGkaTa ( myxo-sarcoma ) - yaha saGkaTArbuda na hokara saGkaTArbuda afronta fagiu (myxomatous degeneration of sarcoma) hotA hai / kozIya saGkaTa ( Giant-cell sarcoma ) - yaha nAma bhramotpAdaka hai kyoMki yaha arbuda saGkaTArbuda jaisA vyavahAra nahIM karatA / isake kAraNa visthAyotpatti nahIM hotI / masUr3e ke nIce jabar3e meM athavA lambI asthiyoM ke siroM para yaha arbuda utpanna hotA hai / aisA hI eka arbuda kaNDarA kaJcuka ( tendon sheaths ) meM bhI milatA hai / isakA adhika varNana asthi ke mahAkozIya arbuda ke rUpa meM Age hogA / saGkaTArbuda ke bhautika lakSaNa saGkaTa ke ve bhAga jinameM koI uttarajAta parivartana nahIM hotA, adhikatara mRdula, arddhapArabhAsI, dhUsaravarNIya yA Apadma dhUsara raMga ke huA karate haiM / ye lakSaNa saGkaTa kI paridhi ke samIpa jahA~ drutagati se bar3hane vAle kozAoM kI paTTI saMkIrNa hotI hai, adhikatara pAye jAte haiN| vRddhiMgata kinArA viSamAkArI aura aspaSTa hotA hai / isI kAraNa samIpa ke bhAgoM tathA saGkaTa meM koI vibhedaka rekhA bhI nahIM khIMcI jA sakatI, kabhI kabhI jaba saGkaTa zanaiH zanaiH apanI vRddhi karatA hai to usake Upara jisa yojIta meM vaha hotA hai usI kA eka prAvara car3ha jAtA hai / saGkaTa ke uttarajAta parivartana saGkaTa meM snaihikavihrAsa aura usake pazcAt UtinAza mukhya uttarajAta parivartana haiN| adhikatara ye parivartana arbuda ke prAcIna bhAgoM meM banA karate haiM / inake kAraNa arbuda ke ve bhAga mRdula ho jAte haiM tathA kabhI kabhI unameM koSThaka yA guhA bhI bana jAtI haiM / raktapUrti kA kArya vAhinI meM ghanAsrotkarSa hone se yA usakI prAcIra meM kozAoM kI bharamAra hone ke kAraNa prAcIra ke phaTa jAne se aura raktasrAva ho jAne ke kAraNa banda ho jAtA hai / raktasrAva hone se raktapUrNa koSTha ( blood cyst ) bhI bana sakate haiM / cUrNIyana, asthIyana athavA zliSIya vihAsa bahuta kama dekhane meM Ate haiM / For Private and Personal Use Only

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88 vikRtivijJAna saGkaTa kI vRddhi aura aviSTAna kI rIti saGkaTArbuda sadaiva yojIUti se banatA hai ataH jahA~ jahA~ yojIUti hotI hai vahIM vahIM vaha pAyA bhI jAtA hai| yaha kahanA kaThina hai ki vaha pragalbha ati dvArA banatA hai yA Uti ke bhauNika prakAra se utpanna hotA hai| carma ke tila yA carmakIloM dvArA prauDhAvasthA meM inakA zrI gaNeza hotA hai| svacA, upatvam Uti, mAMsadharAkalA, paryastha, asthimajjA aura lasagranthiyA~ ye saGkaTa ke sAmAnya adhiSThAna haiN| saGkaTa ke naidAnika lakSaNa saGkaTArbuda sadaiva Arambhika aura madhyajIvana, zaizava yA prauDhAvasthA meM bahudhA utpanna hotA hai / yaha saba prakAra ke arbudoM meM sarvAdhika mArAtmaka yA duSTa arbuda mAnA jAtA hai| yaha apane sthAna para bahuta adhika vRddhi karatA hai tathA ucchedana karane para bar3e vega se aura pahale se adhika bar3hatA hai aura samIpa kI racanAoM meM antarAbharaNa karatA hai / yaha bahudhA sAmAnyita (generalised ) ho jAtA hai aura isake kAraNa phuphphusa meM visthAya bana jAte haiN| phuphphusa meM saGkaTa 3 visthAya hone ke kAraNa thUka meM rakta Ane lagatA hai ( rktsstthiivn)| viprathana ( dissemination) yA saGkaTakozAoM kA gamana sirAraktadhArA dvArA hotA hai| vaha vAhinI prAcIra ke apUrNa nirmANa ke kAraNa huA karatA hai| isa kAraNa karkaTa kI apekSA yahA~ viprathana adhika drutagati se hotA hai kyoMki karkaTa kA viprathana pahale lasaMdhArA dvArA hotA hai phira bAda meM raktadhArA dvArA hotA hai| kAsthisaGkaTArbuda tathA lasasaGkaTArbuda kA viprathana lasadhArA dvArA hI hotA hai| visthAya prathamajAta saGkaTa ke samAna hI banA karate haiN| vibhinna prakAra ke saGkaToM meM vibhinna prakAra kI duSTatA bhI pAI jAtI hai parantu jo saGkaTa jitanA adhika mRdu, jitanA adhika raktapUrNa aura jitanA adhika kama pragalbha yojIUti ke kozAoM ke dvArA banA huA hogA vaha utanA hI adhika duSTa hogaa| isa kAraNa mRdula tarkukozIya saGkaTa kaThina tarkukozIya saGkaTa kI apekSA adhika mArAtmaka hotA hai| kaI laghutarkakozA vAle saGkaTa uccheda hone ke bAda punaH utpanna nahIM hote jabaki anya bahuta se kaI bAra utpanna hote haiM aura vibhinna aGgoM meM visthAya utpanna karate haiN| grIna kA kathana hai ki tarkukozAoM ke AkAra kA bar3appana, unake kozArasa ke vibhinnana kI anupa. sthiti aura unameM se bahutoM meM ekAdhika nyaSTiyoM kI upasthiti ucca mArAtmakatA ke pramANa hote haiN| (1) asthi kA saGkaTArbuda __asthiracanA se sambaddha Uti meM jo mArAtmaka yA duSTa arbuda hote haiM ve saba asthi ke saGkaTAbuMdoM meM gine jAte haiN| inakA sambandha rakta banAne vAle asthimajjA ke bhAga se nahIM hotaa| asthi ke saGkaTArbuda do prakAra ke hote haiM: asthijanaka saGkaTa (osteogenic sarcoma ) tathA asthidalaka saGkaTa ( osteoclastoma ) For Private and Personal Use Only

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arbuda prakaraNa asthijanaka saGkaTa paryApta pAyA jAtA hai / yaha atyadhika mArAtmaka asthyarbuda hai jo sAdhAraNatayA yaha dasa varSa se tIsa varSa taka ke vyaktiyoM meM pAyA jAtA hai / pacAsa varSa kI avasthA vAle vyaktiyoM yaha kadAcit hI pAyA jAtA ho / yaha pairoM kI asthiyoM meM 70 pratizata aura zeSa meM 30 pratizata ke anupAta se utpanna hotA hai / jAnu sandhi kI nirmAtA aurvI asthi kA adhobhAga tathA jaMghAsthi kA UrdhvabhAga isa saGkaTa ke viziSTa adhiSThAna kahe jAte haiM / lambI asthiyoM ke siroM para isakI utpatti huA karatI hai / jina asthiyoM meM yaha jisa krama se adhika pAyA jAtA hai unameM aurvI pahalI, jaMghAsthi dUsarI, pragaNDAsthi tIsare nambara para, zroNi cauthe para aura anujaMghAsthi pA~caveM krama para AtI hai / agrabAhu meM isakI utpatti prAyaH karake nahIM milA karatI / asthi ke do tihAI adhobhAga taka asthijanaka saGkaTotpatti ho sakatI hai| asthijanaka saMkaTArbuda kI utpatti meM kaI kAraNa lie jA sakate haiN| inameM AghAta ( trauma ) eka hai / para arbuda aura AghAta ke sambandha ko spaSTataH jor3anA bar3A kaThina hotA hai / asthibhagnatA se kisI bhI asthIya arbuda kA sambandha nahIM jor3A jA sakatA / mArTalaiNDa ke anusAra asthijanaka saGkaTa una vyaktiyoM meM bhI bana sakatA hai jo tejovara ( radioactive ) padArthoM para kAma karate haiM / kucha lar3akiyA~ jo tejovara dravya kA lepa ghar3I ke DAyala para kara rahI thIM ve mara gaI / mRtyu ke uparAnta jA~ca se patA calA ki unameM 27 pratizata ko asthijanaka saMkaTa kA roga thA / bvAyaDa kahatA hai ki ina lar3akiyoM kI haDDiyA~ san 3491 I0 taka pratisekiNDa eka lAkha pacAsI hajAra elphA kaNa prakaTa karatI raheMgI aura ina karNo meM se pratyeka aThAraha hajAra mIla prati saikaNDa ke hisAba se yAtrA karatA huA hogA / For Private and Personal Use Only to asthika saMkaTa sadaiva asthiruhoM ke dvArA banatA hai / paryastha ke asthijanaka antarbhAga se yA asthi ke upariSTha antarasthi ( superficial endosteum ) se asthiruha ( osteoblast ) banatA hai / arbuda meM asthinirmANa kI gupta zakti hotI hai jise usake kozA prakaTa karake asthinirmANa kara bhI sakate haiM aura nahIM bhI / jaba ve asthinirmANa kArya karate haiM to arbuda meM asthikAyA ke samakoNa para apUrNa asthi ke zuka ( spicule ) taiyAra ho jAte haiM isa kAraNa arbuda apanA nijI kaMkAla (skeleton ) banAne lagatA hai jise eksare citra dvArA samajhA jA sakatA hai / isa arbuda meM tarkukozA hote haiM jo vibhinnita hokara asthyAbha ( osteoid ) Uti meM badala jAte nirmANa kara detI hai / kahIM haiM aura yaha Uti Age calakara cUrNIyita hokara asthi kA kahIM kAsthi kI dvIpikAe~ ( islets of cartilage ) bhI pAI jAtI haiM / yaha bhale prakAra samajha lenA hogA ki yaha arbuda asthi ke bhItara aura bAhara donoM ora bar3I sejI se bar3hatA hai parantu isameM haDDI kA vAstavika nirmANa bahuta adhika nahIM hotA raft asthi nirmANa kI zakti isameM paryApta rahatI hai /

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510 vikRtivijJAna ___ yaha eka sthUla arbuda hotA hai / yaha asthi ke daNDa ( shaft of a bone ) ko naSTa karake vaikArikIya asthibhanna ( pathological fracture) kA kAraNa banatA hai / asthi kA nirmANa bahuta karake nahIM ho pAtA / yaha asthidaNDa ke bhItara majakIya guhA kI ora bar3hatA hai tathA bAhara kI ora paryastha meM bar3ha kara mRdu bhAgoM taka AkramaNa karatA hai| paryastha ko AkrAnta karake tathA use naSTa bhraSTa karake yaha peziyoM aura mAMsadharAkalA ko vidAratA huA tvacA taka A jAtA hai aura eka vraNa banA detA hai|| paryastha para adhika dabAva par3ane se sarvaprathama isa roga meM zUla utpanna hotA hai jo asthiryoM ke UparI bhAga meM rahatA hai| yaha arbudotpatti se pUrva saptAhoM athavA mahInoM raha sakatA hai| jaba arbuda pUrNa pragalbhAvasthA meM A jAtA hai to usakA puMja asthi ke sire para tarkurUpa ( fusiform ) ho jAtA hai jo asthidaNDa kI ora ghaTatA jAtA hai| isake svarUpa ko bvAyaDa ne avimAMsala pAda (a leg of mutton) kaha kara pukArA hai / Arambha meM roga asthi se sambaddha hotA hai taba asthidaNDa, paryastha tathA asthi ke majakIya bhAga taka hI usakA sambandha AtA hai| Age calakara paryastha ko chor3a kara arbuda mRdu bhAgoM ko AkrAnta karatA hai| isa roga meM asthi kA zoSaNa aura nirmANa donoM eka sAtha dekhe jAte haiM jisake kAraNa mUla asthidaNDa to vilIna ho jAtA hai parantu upaparyastha bhAga meM asthijanaka arbudakozAoM ke dvArA arbudIya asthi kA nirmANa hone lagatA hai| yaha jAna kara Azcarya ho sakatA hai ki sAdhAraNa mahAkozIya arbuda (asthidalakArbuda) meM asthi kA nAza hotA hai aura mahAmArAtmaka asthijanakArbuda meM asthi kA nirmANa hotA hai| yaha asthinirmANa sidhmika ( patchy ) itastataH hI hotA hai isa kAraNa vaikArikIya asthibhagna Age kI avasthAoM meM bahudhA milatA hai| jaise jaise asthi ke Upara se paryastha uTatI jAtI hai vaise hI vaise asthi meM jAne vAlI raktavAhiniyA~ usake samAnAntara zAkhAe~ detI calI jAtI haiN| ye eka samAdhAra ( scaffolding ) kA kAma detI haiM / isI para naI asthi jamatI hai / asthizUkoM ko kSa-razmi citra meM dekhane se sUrya kI kiraNoM jaisA citra banatA hai| isa arbuda ko gAr3hatA isake andara banI asthi ke anupAta meM kama yA adhika hotI hai| arbuda bahuta mRdula aura mAMsala ho sakatA hai yA dRDha aura tAntava athavA kaThina aura asthIya ho sakatA hai| isakA sAdhAraNataH varNa dhUsara hotA hai parantu yaha arbuda atyadhika vAhinIya hone se aura raktastrAvAdhikya ke kAraNa raktapUrNa koSThaka isameM milate haiN| UtinAza aura mRdvIyana khUba milatA hai| aNvIkSaNa karane para yaha asAdhAraNatayA vividharUpI (varied) pAyA jAtA hai| isa kAraNa bhinna bhinna asthijanaka saMkaToM meM bahuta adhika antara ho jAtA hai| eka hI arbuda meM kaI prakAra ke rUpa pAye jAte haiM jaise ki mastiSka ke chidriSTaruhAbaMda ( spongioblastoma multiforme of the brain) meM milate haiN| isake kozA sadaiva asthiruha hote haiM / ina asthiruhoM ke tIna rUpa dekhane meM AyA karate haiN| pahalA rUpa vaha hai jisameM eka takakozA akelA rahatA hai aura usake andara parama varNa For Private and Personal Use Only

Page #893
arbuda prakaraNa 811 yukta nyaSTi rahatI hai / isakA kAyArasa alpa rahatA hai yahA~ taka ki yadi abhiraMjana ke lie prayukta padArtha alpa pramANa meM prayoga kiye gaye to vaha bilkula bhI prakaTa nahIM ho pAtA / isa kAraNa kozA nyaSTi mAtra ke dikhane se gola dikhAI dete haiN| para yaha sadaiva smaraNa rakhanA hogA ki asthijanakasaMkaTa ke kozA kabhI gola ho nahIM skte| dUsarA rUpa vaha hai jisameM kozA bar3e aura tAkArI hote haiM athavA bahubhujIya (polyhedral ) hote haiM / ina kozAoM meM sUtribhAjanA khUba milatI hai| tIsare rUpa meM mahAkozA (giant cells) pAye jAte haiM / ye yA to arbuda ke hI kozA hote haiM yA bAhya dravya (foreign body ) ke dvArA utpanna mahAkozA hote haiN| abaMdIya mahAkozAoM meM eka nyaSTIyatA hotI hai athavA kabhI kabhI thor3I saMkhyA meM bar3I bar3I nyaSTiyA~ milatI haiN| bAhyadravya mahAkozAoM kI apekSA ina kozAoM kI AkRti adhika viSama, asAdhAraNa aura arbudika ( neoplastic) hotI hai / bAhyadravya mahAkozA asthijanaka saMkaTa kA khojakArI (exploratory ) zastrakarma hone ke uparAnta athavA jaba asthi kA bahuta adhika vinAza ho cukA hai taba milate haiN| kozAoM kI bhA~ti antarkozIya padArtha ( intercellular substance ) bhI bahuta mahattva rakhatA hai| yaha kAcara yA tAntava, kAsthIya yA zliSIya, asthyAbha (osteoid ) yA asthIya ( osseous ) hotA hai / isa prakAra bhavudika asthi kI utpatti hone lagatI hai| yaha arbudika asthi asAdhAraNa aura kamajora hotI hai| yaha avaMda ke saMdhAra ke sAtha cipaka jAtI hai aura asthirahoM kI kinAre kI paMkti isameM nahIM miltii| zoNitajArali (hImaiTojAyalIna) dvArA raMgane se cUrNAtu apane asita nIlavarNa meM prakaTa hotI hai| jaba arbuda meM tAntava Uti kA Adhikya hotA hai taba yaha jaraThaprakArIya saMkaTa (sclerosing sarcoma) banatA hai tathA jaba usameM raktavAhiniyoM kI adhikatA hotI hai taba yaha agrasirAvisphArI ( telangiectotic ) prakAra kA kahalAtA hai| tanuprAcIrI sirAoM yA vAhiniyoM kA AkramaNa hone se arbudakozAoM dvArA vastutaH srotoM kI prAcIreM banA karatI haiM / isalie jisa bhAga meM yaha arbuda ho usa aMga ko bahuta sAvadhAnI se baratanA caahie| yaha sambhava hai ki zastrakarma ke hI avasara para visthAyotpatti ho jaave| ise rokane ke lie yadi pahale se hI usa para kSa-razmi dvArA vikiraNa karake vAhiniyoM ko banda kara diyA jAve to yaha bhaya bahuta kucha dUra ho jAtA hai| ___ asthijanaka saMkaTAbaMda kA prasAra mukhyatayA raktadhArA ke dvArA hI hotA hai / yahI vAstavika bhI ho sakatA hai kyoMki yaha raktavAhiniyoM kA AgAra rahatA hai aura tanuprAcIrI vAhiniyoM kI prAcIreM kozAoM ke lie saralatayA zreSTha hotI haiM jinase ho kara raktadhArA kabhI bhI dUSita kara dI jA sakatI hai| isake dvArA visthAya sabase pahale phuphphusoM meM banate haiM para yadi arbudika antaHzalya phauphphusika kozAoM ko pAra karane meM samartha ho jAte haiM to anya aMgoM meM bhI visthAya bana sakate haiN| yaha mahattvapUrNa tathya hai ki anya asthiyoM meM isake uttarajAta visthAya dekhane meM bahuta hI kama Ate haiN| jaba kaI asthiyoM meM arbuda baneM to vaha saMkaTAbaMda na hokara IviMga kA arbada bAlakoM For Private and Personal Use Only

Page #894
812 vikRtivijJAna meM tathA bahuvidha majjakArbuda ( multiple myeloma ) prauDhoM meM mAnanA caahie| kabhI kabhI lasatantuka bhI prabhAvita ho jAte haiM para unameM koI bhI jo vRddhi hotI hai| vaha vraNazothAtmaka hI hotI hai / isa roga meM sthAnika vikAra paryApta rahatA hai aura jaba saMkaTa paryastha ko phor3a detA hai to arbuda mRdu UtiyoM ko pAra karake tvacA taka saralatA se pahu~ca jAtA hai / isa roga kA prAgjJAna ( prognosis ) azubha hai / zastrakarma ke pA~ca varSa pazcAt 100 meM 80 rogI isa asAra saMsAra ko kole tathA pUla ke kathanAnusAra parityAga kara dete haiM / rogI jitanA hI alpAyu hogA utanA hI usakA maraNa isa roga meM zIghra sambhava hogA / isa dRSTi se 10 varSa kI Ayu vAlA bAlaka isa roga se bahuta jaldI maratA hai | jaba asthijanaka karkaTa ke sAtha sAtha paigaTAmaya bhI ho to mRtyu zIghra AtI hai / yadi mArAtmakatA halake darje kI ho aura arbuda pariNAhI ( peripheral ) kSetra meM ho to prAgjJAna kucha acchA rahA karatA hai / asthidalakArbuda yA mahAkozIya saGkaTa ( Osteoclastoma or Giant-cell Sarcoma ) mahAkozIya saMkaTArbuda, sAdhAraNa majjakAbha saMkaTArbuda ( benign myeloid sar. coma ), yA majjakAbha dantapuSpuTaka ( myeloid epulis ) Adi nAmoM se asthidalakArbuda pukArA jAtA hai / yaha arbuda sAdhAraNa tathA duSTa donoM prakAra kA ho sakatA hai| rogI jitanA hai alpAyu hotA hai arbuda utanA hI sAdhAraNa rahatA hai tathA rogI jitanI adhika Ara vAlA hotA hai arbuda utanA hI duSTa yA mArAtmaka hotA calA jAtA hai / arbuda me mahAkozA jitane hI kama hoMge utanA hI vaha adhika duSTa hogA aisA bhI kahA jAta hai / isake vicitra svabhAva ko dekhakara aisA kahA jA sakatA hai ki yaha arbuda tarka kozIya saMdhAra dvArA banatA hai aura jyoM jyoM usake mahAkozA ghaTate jAte haiM tyoM tyaM adhika mArAtmaka banatA calA jAtA hai / yaha arbuda vAstava meM eka arbu ( neoplasm ) hai yA kaNArbuda ( granuloma ) isakA bhI abhI taka nirNa nahIM ho pAyA / kaNArbuda ke pakSa meM isakA autikIya citra, visthAyotpatti kA prAyaza abhAva aura tantukoSTrIya asthiroga meM arbudasamapuMjoM kA vikAsa Adi Ate haiM / isa visthAya phuphphusa meM dekhe jA cuke haiM ataH ise arbuda jisakA rUpa kabhI bha mArAtmaka ho sakatA hai aisA mAna lenA par3atA hai / yaha arbuda bAlakoM aura taruNoM meM tIsa varSa kI Ayu ke pUrva hI utpanna hotA hai yaha mukhyataH lambI asthiyoM ke siroM para utpanna hotA hai / yaha bhI jAnusandhi ka asthiyoM meM adhika hotA hai vaise yaha kAsthi meM banane vAlI kisI bhI asthi pAyA jA sakatA hai / jo asthiyA~ kalAoM ( membranes ) meM banatI haiM jai karoTi kI asthiyA~ unameM yaha roga nahIM miltaa| isakA kAraNa jAnane meM dera naha For Private and Personal Use Only

Page #895
majjakArbuda pRSTha 812 Acharya Shri Kailassagarsuri Gyanmandir yaha hanvasthi ke majakArbuda kA citra hai / For Private and Personal Use Only

Page #896
arbuda prakaraNa 813 lagegI / isa roga meM asthi kA kendrabhAga phaila jAtA hai tathA bAhyaka to karpara ( shell ) mAtra raha jAtA hai isa kAraNa eka Akasmika asthibhanna ke kAraNa hI isa zUlarahita avasthA kA bodha sarvaprathama hotA hai / asthi meM itastataH koSThaka bana jAte haiM jo use sAbuna ke jhAga jaisA svarUpa ( soap bubble appearance ) pradAna karate haiN| aiksare (kSakiraNa) citra dvArA sthiti aura bhI suspaSTa ho jAtI hai| isase bar3I saralatApUrvaka nidAna ho jAyA karatA hai| isameM eka viralita bahukoSThIya yA bAhyaka bandhanIyukta ( trabeculated ) citra dekhA jAtA hai jo aisA mAlUma par3atA hai mAno bar3e bar3e babUloM ke dvArA vaha banAyA gayA ho, jisameM bAhyaka ( cortex ) patalI par3atI jAtI hai tathA jo samIpa ke asthibhAga tathA mRduUtiyoM se pRthak spaSTataH dikhatA hai| ___ sAdhAraNatayA dekhane se mRdula, asita lAla, raktasrAvI puMja ke rUpa meM jisameM kabhI kabhI pIta kSetra bhI hoM yaha dekhA jAtA hai / isa padArtha ko khuracA jA sakatA hai aura khuracanA hI isakA upacAra prAyaH mAnA jAtA hai| tejAtu vikiraNa kA kucha rogiyoM para prabhAva par3atA hai parantu kucha para nahIM par3a paataa| asthi kendrasthalI meM koSThotpatti ho sakatI hai tathA isa prakAra bane hue koSThaka meM rakta bhara sakatA hai| rogagrasta asthi kA sirA paryApta phaila jAyA karatA hai| . aNvIkSaNa karane para arbuda meM tIna prakAra ke kozA pAye jAte haiM / takarUpI kozA, golakozA tathA mhaakoshaa| jaba arbada kI vRddhi bahuta vega se hotI hai taba asaMkhya golakozA dekhane meM Ate haiN| para jaba vRddhi ruka jAtI hai taba takurUpa kozAoM kI adhikatA abaMda meM milatI hai| tarkurUpakozAdhikya arbuda ko sAdhyatA kI ora le jAtA hai| tAntava asthipAka ( osteitis fibrosa ) nAmaka roga meM bhI ye vikSata banate haiM / kazerukAoM meM bane ve mahAkozIyAbaMda yA asthidalakArbuda jo saralopacAra se bhI ThIka ho jAyA karate haiM unameM tarkarUpa kozA adhikatA se pAye jAte haiN| mahAkozA asthidala prakAra ke bahunyaSTIya kozA hote haiN| ve eka bhAga meM bahuta jamaghaTa kie hue raha sakate haiM tathA dUsare bhAga meM idhara udhara thor3e thor3e chiTake hue mila sakate haiN| kaNAva'doM ke mahAkozAoM aura asthidalakIya mahAkozAoM meM antara yaha hai ki yahA~ to kozA ke andara pAI jAne vAlI anekoM choTI nyaSTiyAM kozA ke kendra kI ora rahatI haiM java ki kaNAvaMda meM ve pariNAha kI ora pAI jAtI haiN| asthijanaka saMkaTa ke mahAkozAoM se bhI ye bahuta bhinna hotI haiM jinameM kucha bar3I viSamAkAra nyaSTiyA~ pAI jAtI haiM / yaha arbuda atyadhika vAhinIyukta hotA hai| (2) phuphphusa-saGkaTa (Sarcoma of the Lung) phuphphusa meM prathamajAta saGkaTAbaMda nahIM pAyA jaataa| vividha lakSaNoM ko dekhakara jo loga saGkaTa kA nirNaya karate haiM ve anaghaTita kozA vAle karkaTa (anaplastic For Private and Personal Use Only

Page #897
814 vikRtivijJAna cancer ) ko hI saMkaTArbuda mAna baiThate haiN| kabhI kabhI phuphphusa meM vraNazothAtmaka prakriyA hotI hai yA pUyoras ( empyema ) bana jAtA hai usako bhI bhramavaza saMkaTa ke lakSaNa mAna lete haiM jo sarvathaiva anucita hai | phauphphusika yakSmA se pIDita vyakti meM saMkaTa kA bhrama bahudhA ho sakatA hai / para ina bhramoM se dUra rahane para aura hara prakAra vicAra kara lene para yaha sambhava hai ki eka choTA sA samUha tarkurUpa yA golakozIya saMkaTa kA mila jaave| parantu vAstava meM phuphphusa meM prathamajAta saMkaTa yadA kadA hI hone vAlI sthiti mAtra hai / Acharya Shri Kailassagarsuri Gyanmandir uttarajAta saMkaTArbuda sarvaprathama phuphphusa meM hI pAyA jAyA karatA hai / isakA vicAra hama thor3A bahuta pIche kara Aye haiM / (3) lasAbhaUti yA jAlakAntazchadIya saMsthAna ke saMkaTa isa saMsthAna meM do prakAra ke arbuda pAye jAte haiM : 1. lasasaGkaTa ( Lympho-sarcoma ), tathA 2. jAlikAkozIya saGkaTa ( Reticulum-cell - sarcoma ) lasa-saGkaTa ( Lympho - Sarcoma ) kina kA roga yA hAja kinAmaya kA jJAna eka zatAbdI pUrva ho cukA thA para san 1893 I0 meM sarvaprathama anya lasArbudoM tathA isa lasasaMkaTa meM kuNDreTa nAmaka vidvAn ne antara batalAyA / lasasaMkaTa tathA hAja kinAmaya meM jo antara hai| use jAna lenA paramAvazyaka hai / lasasaMkaTa sabase pahale lasAbha tantukoM ke eka samUha meM yA lasAbha Uti ke eka bhAga meM utpanna hotA hai aura lasavAhiniyoM dvArA dUsare samUha yA bhAga meM pahu~catA hai / isakA prasAra saMtata ( continuous ) hotA hai jaba ki hAja kinAmaya meM prasAra asantata ( discontinuous ) hotA hai / yaha saMkaTa nimna sthaloM para utpanna hotA hai a -- graivika lasagranthiyA~, A---grasanikA, i--uras ( thorax ), I - mahAsrota, uplIhA, U-- asthimajjA aura e - yakRt / ina sthaloM meM jahA~ jahA~ lasagranthaka yA lasauti pAI jAtI hai vahIM lasasaGkaTotpatti kI sambhAvanA rahatI hai / jaise udarakSetra meM AntranibandhanI ke lasagranthakoM se yA AntraprAcIra kI upazleSmala lasakUpikAoM ( submucous follicles ) se yaha banatA hai / isa roga meM hAjakinAmaya ke kaI lakSaNa bhI mila sakate haiM / udAharaNa ke For Private and Personal Use Only

Page #898
arbuda prakaraNa 815 lie isa roga meM plIhAvRddhi pAI jA sakatI hai| plIhodara hAjakinAmaya kA eka mAnA huA lakSaNa hai| jvara bhI sAtha sAtha mila sakatA hai| lasIkozotkarSa tathA pravRddhizIla uttarajAta raktakSaya ke lakSaNa bhI mila sakate haiN| isa roga meM rakta citra parIkSA eka bahuta Avazyaka aMga rahanA caahie| kucha ko asitaratIya sitaraktatA ( aleukaemic leukaemia) mila sakatA hai| kueDreTa dvArA varNita zuddha lasasaGkaTa bahuta kama pAyA jAtA hai aisA Adhunika vidvAnoM kA mata hai| pratyakSa darzana karane se lasasaMkaTa aura hAjakinAmaya meM koI bheda prakaTa nahIM hotA parantu lasasaMkaTa meM lasagranthi ke prAvara ke phaTa jAne kI pravRtti adhika hotI hai aura samIpastha UtiyoM meM UtinAza aura AkramaNa karane kI bahuta bar3I kSamatA dekhI jAtI hai| dUsare se utinAza kama hotA hai aura vahA~ pIle sidhma nahIM pAye jAte / Antra kI lasamaya uti ke bahuta sUja jAne se usake bhItarI aMga meM gA~The bana jAtI haiN| udara athavA vakSaguhAyeM arbudapuMjoM se bhara jAtI haiM tathA phuphphusoM meM bahuta adhika bharamAra ho jAtI hai| eka citra lasasaMkaTa ke Antra lasagranthakoM meM utpanna hone kA diyA jA rahA hai| use dekhakara anumAna kiyA jA sakatA hai ki yaha saMkaTa kitanA bhayAnaka hotA hai| aNvIkSaNa karane para pUrNa pragalbha lasako zAoM ke sthAna para unase AkAra meM bar3e paramavarNika kozA pAye jAte haiM jinameM thor3A sA pITharaMjya kAyANurasa rahatA hai| sAtha hI eka gola yA aNDAkAra nyaSTi milatI hai jisake andara bar3I aura spaSTataH prakaTa hone vAlI eka ninyaSTi rahatI hai| isameM sUtribhAjanA milatI hai para usakI pahacAna karanA bahuta kaThina par3atA hai| isa roga meM kozAoM kI samAnatA eka atyanta mahattvapUrNa lakSaNa hai| hAjakinAmaya meM kozAoM kA nAnArUpatva pradhAna hotA hai| rajata abhiraJjanoM se dekhane para isameM jAlikA meM vRddhi nahIM pAI jaatii| jo bhI jAlikAtantu isameM pAye jAte haiM ve to mUla se hI lasagranthi meM pAye jAnevAle hote haiN| yadi kisI kSetra kA aNvIkSaNa kiyA jAve to / ina prAkRtika jAlikA tantuoM ke bIca bIca meM saGkaTakozA A jAte haiM jisake kAraNa inakI saMkhyA ghaTI sI mAlUma par3atI hai| kisI kisI roga meM apekSA isake ki eka kSetra meM lasagranthakoM meM vRddhi ho aura phira anya bhAgoM ko usakA viprathana ho, eka sAtha eka sAmAnyita vRddhi dekhI jAtI hai| aisI avasthA meM jo mUla racanA hotI hai usakA sthAna pragalbha lasIkozA le lete haiN| aisI avasthA meM lasIya sitaraktatA (lymphatic leukaemia) tathA isameM koI antara karanA bar3A kaThina ho jAtA hai| raktacitra hI eka mAtra pahacAna kA sAdhana hotA hai| isa avasthA ko lasakAyArbuda ( lymphocytoma) kahA jAtA hai| yaha anta meM lasIya sitaraktatA meM badala sakatA, hai aisA bvAyaDa mAnatA hai| For Private and Personal Use Only

Page #899
816 vikRtivijJAna jAlikAkozIya saGkaTa ( Reticulum-cell Sarcoma) ise jAlakIya saGkaTa ( retico sarcoma ) bhI kahA jAtA hai| jAlikAoM kI bahurUpatA (polymorphism) jo jAlikAntazchadIya saMsthAna meM pAI jAtI hai, ke kAraNa jaba isa saMsthAna meM koI saGkaTArbuda banatA hai to usakA rUpa kaI prakAra ke autakIya citra upasthita karatA hai| aise pA~ca rUpa raubasmitha ne batalAye haiN| inameM eka rUpa vaha hai jisameM ve arbuda Ate haiM jinake kozA avibhinnita rahate haiM tathA eka saMkozIya (bhakSaka)stAra (syncitial sheet) mAtra bana jAtI hai| dUsarA rUpa vaha hotA hai jisameM arbudakozA jAlaki ( reticulin) banAte haiM jisake kAraNa ve tanvIya ( fibrillary ) kahe jAte haiM; tIsare rUpa ke arbudoM ke kozA kisI eka yA dUsare zoNikakozA ( haemic cell ) meM vibhinita hote haiM; caturtha prakAra ke arbudoM meM autikIyarUpa mizrita ( mixed ) hotA hai tathA paJcama rUpa meM arbuda ke kozA velAtaTIya kozAoM ( littoral cells) se hI utpanna hote haiN| uparyukta raubasmithIya zreNI vibhAjana atyanta jaTila hotA hai para isase yaha spaSTa ho jAtA hai ki jAlikIya saGkaTa meM kitane kitane rUpa aura prakAra dekhane meM A sakate haiM aura isakI pahacAna meM autikIya nidAna kA Thoka ThIka samajha lenA kitanA Avazyaka hai| tRtIya varga ke saGkaTa sarvAdhika pramANa meM milate haiM jabaki antima paJcama varga ke saMkaTa bahuta kama pAye jAne haiN| isa arbuda ko lasasaMkaTa kA hI eka rUpa mAnakara isakA nAma jAlikA-lasasaMkaTa ( reticulum lympho sarcoma ) bhI kahA jAtA hai| yaha kaI avasthAoM meM mila sakatA hai| jisameM asthi bhI eka hai jahA~ yaha eka prakAra kA asthisaMkaTa utpanna karatA hai| ataH yahI acchA hai ki ise jAlikA saMkaTa nAma se hI pukArA jaave| yaha roga atyanta mAraka hai| rogI adhika se adhika do varSa jItA hai| lasasaMkaTa kI apekSA jAlikAkozIyasaMkaTa bahuta adhika milane vAlA lasatantukoM kA arbuda hai| isakA aNvIkSNa citra bahuta kSaNika hotA hai| yaha tabhI milatA hai jaba abhiraMjana dRDhatA se kiyA jaave| jAlikAkozAoM kA kAyANurasa bahuta adhika hotA hai aura svalpa amlaraMjya mAnA jAtA hai| jAlikAkozAoM kI nyaSTi lasakozAoM kI nyaSTi se dugunI hotI hai / vaha andara kI ora aise mur3I hotI hai ki usakI AkRti vRkkarUpI (reniform ) ho jAtI hai / ThIka prakAra sudRr3ha kiye citra meM kozArasa tathA nyaSTi donoM se nikale aura bar3he hue kUTapAda samapravardhana (pseudopodlike process) jo kAmarUpIya (amoeboid) kriyAzIlatA ko eka jIvita kozA meM vyakta karate haiM isakA eka bahuta mahatva kA lakSaNa hai / arbuda kozA-sirA-prAcIroM meM bharamAra karate hue bahudhA milate haiN| ve kabhI kabhI to sirA suSiraka ko pUrNataH bhara dete haiN| For Private and Personal Use Only

Page #900
arbuda karaNa 817 isa roga meM jAlikAtantu bar3hate bhI haiM aura sAtha hI arbuda kozA ko cAroM ora se ra bhI haiM / yadyapi sAdhAraNataH hAjakinAmaya, lasasaMkaTa aura jAlikAkozIya saMkaTa tInoM: eka dUsare se pUrNataH pRthak dekhe jAte haiM para viziSTa sthaloM para ina tInoM meM se koI do eka dUsare se mila bhI sakate haiN| isa kAraNa jaba ki jIvitAvasthA meM kozAparIkSaNa: se eka hI rUpa mile, mRtAvasthA meM parIkSaNa meM do rUpa mile hue bhI dekhe jA sakate haiN|. harbaTa aura usake sahayogiyoM kA aisA vizvAsa hai ki inameM do rAsAyanika padArtha rahatehaiM jinameM se eka majjAbha kozAoM kA praguNana karatA hai aura dUsarA lasAbha kozAoM kA praguNana karatA hai / hAja kinAmaya meM ye donoM padArtha mUtra meM eka barAbara rahate haiM / isa prakAra eka hI jAlikAkozA se tIna prakAra ke roga utpanna ho sakate haiM / raft jAlikAsaMkaTa jahA~ bhI jAlikAkozA ho vahIM utpanna ho sakatA hai parantu : vyavahAra meM lasagranthakoM meM sabase adhika, phira tuNDikAgranthiyoM nAsAgrasanI tathA. mahAsrota kI lAbha Uti meM, tatpazcAt asthimajjA meM tathA sabase kama yakRt tathA plIhA meM yaha milatA hai / vaise anyatra kahIM prAthamika vikSata banane para visthAya ke rUpa meM ina donoM sthaloM para bhI mila sakatA hai| anya mArAtmakArbudoM kI bhA~ti ye arbuda bhI sthAnika, AkrAmaka aura vinAzaka hote haiM tathA paryApta aura dUra taka visthAyotpatti karate haiM / inakA prasAra pahale lasagranthaka ( lymph node ) se hotA hai phira raktadhArA dvArA / kahIM-kahIM jaise asthi kI bahumajjakArbudotkarSa ( multiple myelomatosis of the bone ) meM vibhinna sthaloM para bahuta sI vRddhiyA~ utpanna ho jAtI haiM unheM uttarajAta yA prathamajAta aisA nirNaya karanA bar3A kaThina ho jAtA hai / ina sabhI kI mArAtmakatA bahuta adhika hotI hai / mRtyu kucha mahInoM meM bhI ho sakatI: hai / inameM teja kiraNoM kA bhI kucha prabhAva par3atA hai jisa kAraNa | vRddhi kucha dina avaruddha raha sakatI hai / karkaTa ke viparIta yahA~ vibhinnana kI mAtrA para mArAtmakatA kI vRddhi nahIM hotI / ataH yaha kahanA ki eka lasasaMkaTa se avibhinita saMkozIya stara atyadhika mArAtmaka hai sandehAspada hai / naidAnika dRSTi se ina arbudoM ke kAraNa jvara, dvitIyaka raktakSaya tathA kabhI kabhI bahunyaSTIya sitakozotkarSa mila sakatA hai / lasya syUna ( serous s809 ) para prabhAva par3ane se unameM pAye jAne vAle udAsargI: tarala meM raktavarNatA pAyI jAtI hai / bahurUpIya jAlikAsaGkaTa (Polymorphic Reticulo Sarcoma) yataH yaha hAja kinAmaya ( lasagranthyarbuda ) se bahuta kucha milatA julatA hotAhai / ataH isakA varNana karanA Avazyaka hai / isameM kaI bahunyaSTrIya kozA hote haiM jo AkAra aura sUtribhAjanA kI dRSTi se eka dUsare se bahuta antara rakhate haiM / yahA~ jAlikAntazchadIya kozAoM meM aviziSTa paramacayatA pAI jAyA karatI hai / yahA~ jAlikA ( reticulin ) kA nirmANa bar3ha jAtA hai sAtha meM zleSajanIya tantuka 66, 70 vi0 For Private and Personal Use Only

Page #901
28 vikRtivijJAna ( collagenous fibrils) bhI prakaTa hone lagate haiM jo lasapranthyarbuda meM tantUtkarSa kA anumAna karAte haiM bAda meM bahunyaSTi aura uSasipriya kozAoM ko bhI alpa saMkhyA meM dekhA jA sakatA hai| rogI meM raktAlpatA bar3hatI jAtI hai aura kabhI kabhI jvara Ane lagatA hai| roga ke citra ko dekhakara aisA lagatA hai ki vaha hAjakinAmaya hI hai / ise hAjakinIya saMkaTa ( Hodgkin's sarcoma) bhI pahale kaha kara pukArate the / arthAt lasagranthyarbuda meM duSTa lakSaNotpatti ho gaI ho aisA mAnate the| para aise udAharaNa nahIM milate jinameM hAjakinAmaya hI duSTa yA mArAtmaka bana gayA ho| isa roga kI prathamotpatti kisI lasagranthi meM hotI hai vahA~ se phira isakA AkramaNa yakRt , plIhA, phuphphusa tathA asthi-majA taka jA sakatA hai| roga kI dizA hAjakinAmaya se kahIM adhika duta huA karatI hai| isa kAraNa yaha kucha mahInoM kI apekSA kucha saptAhoM kA hI viSaya raha jAtA hai| isake raktacitra meM arbuda kozA nahIM pAye jAte haiN| (4) mahAsrotoya saGkaTArbuda mahAsrota ke vibhinna aMgoM meM saGkaTArbuda pAye jA sakate haiN| jihvA, tuNDikA, annapraNAlI ( oesophagus ), AmAzaya ( stomach ) tathA antra ( intestines ) mukhyatayA Ate haiM / aba hama inhIM kA saMkSipta vicAra kreNge| 1. jihvAstha saGkaTa-jIbha meM saMkaTArbuda bahuta hI kama milatA hai| yadi milatA bhI hai to bAlakoM meM adhikatara pAyA jAtA hai| yaha golakozIya, pezIya tantusaMkaTa ( round-celled muscular fibrosarcoma) hotA hai| yaha jihvA meM bahuta gaharAI para utpanna hokara eka dRr3ha, gola, pratyAstha zotha kA rUpa dhAraNa kara letA hai jo ati zIghra vraNita aura kavakAnvita ( fungating ) ho jAtA hai / pahale zUla atyalpa rahatA hai jo Age calakara paryApta bar3ha jAtA hai| nidAna meM phiraMgArbuda ( gumma) kA pahale bhrama hotA hai aura jaba taka isakA eka bhAga kATa kara aNvIkSa ke nIce na dekha liyA jAve taba taka yathArthatA kA bodha karanA kaThina rahatA hai| 2. tuNDikAstha saMkaTa-tuNDikA granthiyAM lasAbha Uti dvArA banatI haiM ataH isakA varNana usI ke sAtha mAna lenA cAhie para yataH mukha se guda taka mahAsrota kahalAtA hai aura isI mArga meM yaha pAyI jAtI hai ataH isakA varNana yahAM bhI kie dete haiM / yaha saMkaTa kisI bhI avasthA meM utpanna ho sakatA hai| lasasaMkaTa (lympho. sarcoma ) prakAra kA yaha hotA hai| isameM tuNDikA pravRddha asitAbha lAlavarNa kI bahIrekhA meM cikanI tathA gADhatA meM dRDha ho jAtI hai| Arambha meM yaha calanazIla hotA hai parantu Age jAkara sthira ho jAtA hai| isake kAraNa praivika lasagranthiyA~ taka pravRddha ho jAtI haiM / dutavega atyadhika vRddhi tathA bharamAra dvArA isakA nidAna hotA hai| For Private and Personal Use Only

Page #902
arbuda prakaraNa 816 3. annanalikAstha saGkaTa - annanalikA meM saGkaTArbuda bahuta kama hotA hai usakI apekSA karkaTa bahuta adhika pAyA jAtA hai / atyadhika mArAtmaka prathama zreNI ke anaghaTita prakAra ke duSTa arbuda ko annapraNAlI kA saMkaTa ( carcino sarcoma of the oesophagus ) kahA jAtA hai para vAstava meM karkaTArbuda hI hotA hai / 4. AmAzayastha saGkaTa - yaha bhI bahuta kama pAyA jAne vAlA arbuda hai / jaba yaha hotA hai to eka bahupAdIya puMja banA letA hai jo AmAzayaguhA meM vikSipta (projeoted ) rahatA hai / yaha bahudhA pezIsUtroM se utpanna hone ke kAraNa pezIya saMkaTa hotA hai jo lambe lambe pezI kozAoM se banatA hai / AmAzayika zleSmalakalAstha lasagranthiyoM para kabhI kabhI lasasaMkaTa yA hAjakinAmaya kA prabhAva dekhA jAyA karatA hai / AmAzaya kA saMkaTa usake karkaTa se milatA julatA hotA hai para yaha karkaTa kI apekSA kucha kama Ayu vAloM meM hotA hai / isameM karkaTa kI apekSA raktavamana ( haematemesis ) bhI adhika hotI hai / 5. AntrasaGkaTa - tudrAntra meM saGkaTArbuda aura karkaTArbuda donoM utpanna ho sakate haiM / donoM hI bahuta kama dekhe jAte haiM parantu karkaTa kI apekSA saGkaTa adhika milatA hai / prathama jAta saMkaTa antra kI upazleSmala kalA meM sthita lasAbha kUpikA ( lymphoid follicles ) meM utpanna hote haiM jisake kAraNa yaha lasasaGkaTa hotA hai / saGkaTa kA dUsarA udbhava sthala mAMsaprAcIra ho sakatI hai yA parivAhinIya yojI Uti bhI ho sakatI hai usa samaya yaha tarkukozIya saMkaTa banatA hai / donoM hI rUpa bAlakoM yA taruNoM meM pAye.. jAte haiM ye annra ke suSiraka meM bar3hate haiM / aura jIrNa AntrAvarodha ke kAraNa banate haiM / ye antra prAcIra kI bharamAra karate haiM jisase usameM kAThinya tathA kramasaMkocAbhAva ( loss of peristalsis ) ho jA sakatA hai| kabhI vRddhi udaracchada ko phAr3a kara ghusa jAtI hai jisase udaracchadapAka ho jAtA hai yA kisI anya AntrapAza (loop ) meM nAla ( fistula ) bana sakatI hai / (5) anya audarika saGkaTArbuda 1. pazvodaracchadIya saGkaTa - udara ke pazca bhAga meM sthita udaracchada ( retroperitoneum ) meM bhI saMkaTArbuda ho sakatA hai / yaha usakI kalA ( fascia ) se utpanna hotA hai / yaha tantusaMkaTa ( fibro- sarcoma ) hotA hai aura isameM tantusaMkaTa meM hone vAle sabhI lakSaNa milate haiM / .. 2. yakRt saMkaTa - yakRt meM prathamajAta saMkaTa itane kama hote haiM ki yadi unheM nahIM hote aisA mAna liyA jAya to bhI kucha anucita nahIM hai / yahA~ uttarajAta saMkaTa bahudhA pAye jAyA karate haiM / ye gola yA tarkukozIya huA karate haiM / I (6) mUtra - prajanana saMsthAnoya saGkaTArbuda 1. vilmIyArbuda ( Wilms' tumour ) - yaha eka zizuroga hai jo janma ke samaya bhI ho sakatA hai aura 3 varSa kI avasthA taka utpanna ho sakatA hai / yaha bahudhA For Private and Personal Use Only

Page #903
820 vikRtivijJAna 'ubhayapArzvIya ( bilateral ) huA karatA hai / sahaja hone para to isake kAraNa prasava hone meM bhI kaThinAI par3a sakatI hai / yadyapi yaha granthipezIya saMkaTa ( adenomyosarcoma ) hai para kaI vidvAn ise zrauNArbuda ( teratoma ) bhI mAnate haiM / ise vRkkya bhrUNArbuda ( renal embryoma ) bhI kahate haiM / yaha eka mizrita arbuda kA hI pukAra hotA hai jisameM granthikozA, eka avibhinita tAntava saMdhAra, sAmAnya yA rekhita pezItantu tathA kabhI kabhI kAsthi vA asthi taka pAI jA sakatI hai / yaha arbuda vRkka ke bAhyaka meM utpanna hotA hai / isakA varNa dhUsara hotA hai isakI AkRti saMkaTArbudIya hotI hai jo vRkka kI Uti para AkramaNa karake use naSTa karatI hai / isI kAraNa Age calakara UtinAza evaM raktasrAvI kSetra isameM bana jAte haiM / yaha arbuda madhyastarotpanna ( of mesodermal origin) hotA hai aura alpamArAtmaka saMkArbuda kI bhA~ti vyavahAra karatA hai / yaha ati zIghra bar3hakara samIpastha anya aMgoM para sIdhA AkramaNa karatA hai / isake kAraNa visthAya bahuta kama banate haiM / jitane bhI lakSaNa hote haiM ve isake puMja tathA AkAra ke kAraNa hote haiN| na to isameM zUla hotA hai aura na raktameha hI bahudhA pAyA jAtA hai / thor3A jvara sAtha meM raha sakatA hai | yaha teja hRSa ( radio-sensitive ) hotA hai / isa arbuda ke atirikta vRkka meM prathamajAta saGkaTa kA prAyazaH abhAva rahA karatA hai / 2. adhivRkka majjaka saMkaTa ( Sarcoma of the medula of the adre - nals ) - adhivRkka ke majjaka meM 3 prakAra ke arbuda utpanna hote haiM jinameM eka cetAruhArbuda yA vAtanADIruhArbuda ( neuroblastoma ) dUsarA, pragaNDacetArbuda ( ganglioneuroma ) aura tIsarA asita varNa kozArbuda ( pheochromocy toma yA chromaffinoma ) kahalAtA hai / cetAruhArbuda yA vAtanADIruhArbuda ko bAlakIya adhivRkka saMkaTArbuda ( adrenal sarcoma of the children ) bhI kaha diyA jAtA hai / jitane bhI bahuta pazvodaracchadIya arbuda banate haiM ve sabhI isI prakAra ke hote haiM aura ve audarika svatantra nAr3I pragaNDoM se utpanna hote haiM / arbuda meM avibhinita laghu gola kozA vAtanADIruha ( neuroblasts ) pAye jAte haiM, sAtha hI kucha apUrNa pragaNDa kozA aura tantuka bhI milate haiM / ye tantuka isa saMkaTa kA vizeSa lakSaNa prakaTa karate haiN| ye vAtanADIyatantuka ( cetAtantuka ) hote haiM / ve yA to anvAyAmI gaTToM ( longitudinal bundles ) meM ba~dhe hote haiM yA gola puMja banAte haiM jinake cAroM ora kozA lage rahate haiM aura eka pATalaka ( rosette ) banA lete haiM / ye pATalaka isa roga ke mahattvapUrNa prakaTAyaka lakSaNa hote haiM / kabhI kabhI inakA milanA bahuta kaThina hotA hai / isa arbuda ke prasAra se bahudhA karoTi ( skull ) meM visthAyotpatti ho jAtI hai / vizeSakara akSagolaka ( orbit ) meM / isake kAraNa netra ke samIpa eka raktasrAvI kSetra bana jAtA hai jisase Age calakara A~kha bAhara kI ora nikala AtI hai / jaba yaha For Private and Personal Use Only

Page #904
arbuda prakaraNa 821 lakSaNa ( proptosis ) mile to samajhanA cAhie ki adhivRkka meM koI navavRddhi ho rahI hai aura turata udara kI parIkSA karanI Avazyaka hai| karoTi ke atirikta anyA asthiyoM meM bhI yaha vikAra dekhA jA sakatA hai| karoTi kA prasAra sadA sirAoM ke pRSThavaMzIya saMsthAna ( vertebral system of the veins ) se huA karatA hai| asthiyoM ke prasAra ko haciMsanIya prakAra ( Hutchinson type ) kahate haiM / kucha rugNoM meM yakRt kI vRddhi adhika hone lagatI hai| yakRt kozAoM meM prasara bharamAra hone ke kAraNa usakI vRddhi eka sI hotI hai| ise paiparIya prakAra ( Pepper type ) kahA jAtA hai| haciMsanIya prakAra ke prasAra meM asthiyA~ aura paiparIya prakAra ke prasAra meM yakRt prabhAvita hotA hai yaha satya hai parantu isase yaha anumAna lagAnA ki pahale meM vAma adhivRkka aura dUsare meM dakSiNAdhivRkka rogagrasta hone se aisA hotA hai, pUrNataH satya nahIM hai| bvAyaDa kA kathana hai ki yadyapi vAtanADIruhArbuda bahuta duSTa arbuda hotA hai para yaha sadaiva mAraka ho aisA nahIM hai| pharbara kA vizvAsa hai ki sahasA yA vikiraNoparAnta yaha ThIka ho jA sakatA hai| 3. bastisaGkaTa-yaha bahuta kama pAyA jAne vAlA saGkaTa hai| yaha kabhI bhI aMkurIya (papillomatous ) nahIM hotA jaisA ki bastikarkaTa huA karatA hai| vaha bhI bAlakoM meM pAyA jAtA hai| yaha bahupAdIya, drAkSAsama (grape like ) yA aneka vRddhiyA~ utpanna karatA hai| yaha drutagati se bar3hatA hai aura thor3e hI dinoM meM eka bar3e gola arbuda ko janma detA hai jo lasagraMthiyoM taka bar3ha jAtA hai para niyamataH isameM zIghra vaNana nahIM huA krtaa| isameM raktameha hotA hai jisake sAtha bastiprakSobha bhI milatA hai jisase kaI-kaI bAra mUtra parityAga karanA par3atA hai| kabhI kabhI sahasA mUtrAvarodha bhI ho jAtA hai| yaha saGkaTa udara kI agraprAcIra para uThA huA yA donoM hAthoM se dabAkara TaTolA jA sakatA hai| isakA prAyaH zastrakarma dvArA apanayana sambhava nahIM hotaa| 4. puraHstha (aSThIlA) granthisaGkaTa-yaha bahuta viralAvasthA meM hI pAyA jAtA hai aura vizeSa karake zaizavakAla meM utpanna hotA hai| kabhI kabhI taruNavarga meM bhI mila sakatA hai| yaha bar3e vega se bar3hatA hai aura bar3hakara basti kI prAcIra para AkramaNa karatA hai / prauDhAvasthA meM jo mArAtmaka vRddhiyA~ pAI jAtI haiM ve prAyaH atyucca avibhinnita karkaTa hI hote haiM aisA mata vidvAnoM kA hai| 5. vRSaNasaGkaTa-yaha bahuta hI kama pAyA jAne vAlA arbuda hai| jo bhI namUne isake nAma para rakhe milate haiM ve yA to bhrauNArbuda ke hote haiM yA karkaTa ke| vRSaNasaGkaTa sadaiva zizuoM meM utpanna hotA hai| yaha bahudhA tarkukozAoM dvArA banatA hai| kabhI kabhI golakozA vAlA bhI pAyA jAtA hai| lasikAgraMthiyoM para isakA prabhAva viralatayA hI par3atA hai| isake visthAya phuphphusa meM banA karate haiN| For Private and Personal Use Only

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822 vikRtivijJAna 6. bIjagranthisaGkaTa ( Sarcoma of the ovary)-yaha bahuta kama hone vAlA saGkaTa hai / sampUrNa bIjagranthIya arbudoM kA 5 pratizata mAtra saGkaTArbuda huA karatA hai| yaha tAruNya ( puberty ) meM bahudhA milatA hai para rajonirodhakAla meM bhI dekhA jA sakatA hai| tanvarbuda kabhI kabhI bar3hakara saGkaTa kA rUpa dhAraNa kara liyA karate haiN| ye ta'kozIya hote haiN| saGkaTa ke kAraNa vRSaNa kI eka bar3I sthUla vRddhi ho jAtI hai jo bahuta duSTa hotI hai| isakA viprathana (dissemination) atizIghra hotA hai| prasara visthAya jo udaracchadaguhA meM pAye jAte haiM inake kAraNa jalodara bana sakatA hai aura jalodara meM jala ke sAtha sAtha rakta bhI pAyA jA sakatA hai| bahudhA bIjagranthisaGkaTa meM gola avibhinita kozA pAye jAte haiN| kabhI kabhI avibhinita karkaTa saGkaTa kA bhrama utpanna kara diyA karatA hai| 7. garbhAzayasaGkaTa-garbhAzaya kI kAyA athavA grIvA donoM meM se kisI eka sthala para saGkaTotpatti ho sakatI hai| garbhAzayIya saGkaTArbuda bahata virala (rare ) hote haiN| ye garbhAzaya ke pezyarbudoM ( myoma) athavA tantupezyarbudoM ( fibromyoma) se banA karate haiN| yaha rajonirodhakAlInaavasthA meM peMtAlIsa se pacAsa varSa kI avazthA taka utpanna hotA hai| pezyAdi arbuda sabhI saGkaTa meM parivartita hote hoM aisA nahIM hai kevala do pratizata ke lagabhaga garbhAzaya ke arbuda saGkaTArbuda meM pariNata hote haiN| garbhAzayika saGkaTa antarAlita ( interstitial) athavA prasara ( diffuse) ina donoM meM se kisI eka prakAra kA huA karatA hai| antarAlita saGkaTa sadaiva garbhAzayastha yojIUtiyoM ke abuMdoM se utpanna hotA hai aura Arambha meM unhIM ke prAvara ke andara bar3hatA hai| prasarasaGkaTa garbhAzaya kI antaHkalA (endometrium ) ke saMdhAra kozAoM se banatA hai ataH Arambha meM yaha upazleSmalastara para hI hotA hai| ___ antarAlitasaMkaTa tarkukozAoM dvArA banate haiM / ye garbhAzaya-prAcIra meM praur3hAvasthA meM utpanna hote haiN| ye anya arbudoM kI bhA~ti garbhAzaya prAcIra ke bAhara kI ora uTha kara upalasya arbuda ( subumcous tumour ) kA rUpa bhI le sakate haiM aura andara kI ora garbhAzayaguhA meM bhI bar3ha sakate haiN| taba eka purvaMgaka ( polyp ) ke samAna garbhAzaya grIvA meM laTake hue dekhe jA sakate haiN| inakA AkAra bahuta bar3A nahIM hotA / inakA raMga AdhUsara yA ApIta hotA hai| inake bhItara raktasrAvI tathA koSTIya vihAsa ( cystic degeneration ) ke kSetra pAye jAte haiN| ___prasarasaGkaTa antarkalA meM hotA hai| para yaha sampUrNa garbhAzaya ko bhI grasita kara le sakatA hai| garbhAzayaguhA bahupAdIya puoM se bhara jAtI hai aura ye puJja kabhI kabhI garbhagrIvA yA yoni ke mukha se bAhara bhI nikalane lagate haiN| yaha tAruNya meM utpanna hotA hai| isake kozA gola yA aNDAkAra hote haiM aura ve avibhinita bhI hote haiN| mArAtmakatA bahuta adhika hotI hai| For Private and Personal Use Only

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arbuda prakaraNa 823 kisa sthAna para garbhAzaya meM saGkaTotpatti huI hai isa para mArAtmakatA bahuta adhika nirbhara rahatI hai / jaba vaha kisI tankharbuda yA sAdhAraNa arbuda meM utpanna hotA hai taba Arambha meM mArAtmakatA kama rahatI hai / para jaba vRddhi garbhAzaya ke pezIyastara yA antaHstara se utpanna hotI hai to usameM mArAtmakatA bahuta prabala hotI hai| adhikatara garbhAzaya kI kramika vRddhi hotI hai jisake sAtha kabhI to yaunaraktastrAva hotA hai aura kabhI nahIM hotA / vilamba se yA zIghra garbhAzayasaGkaTa visthAyotpatti karatA hai / visthAya sadaiva raktadhArA dvArA banate haiN| isameM koSTotpatti ( cyst formation ) kI kAphI guMjAiza rahatI hai / pezIya yA tantupezIya garbhasaGkaTa kA aNvIkSaNa karane para vaha bRhad tarkurUpa kozAoM dvArA bane milate haiN| kabhI kabhI ve AkAra meM bar3e aura gola bhI ho sakate haiM / unakI nyaSTiyA~ paryApta bar3I aura vibhajanAGkoM se prAyaH yukta milatI haiN| isa avasthA meM yaha pahacAna karanA ki arbudakozA tanturUhoM se bane haiM yA pezItantuoM se, bahuta kaThina par3atA hai / antastara se utpanna garbhasaGkaTa meM tarkurUpa tathA golakozA aNvIkSaNa para pAye jAte haiN| jitanA hI yaha adhika mAraka hogA utane hI isameM vibhajanAGka yA sUtribhAjanAGka adhika mileMge / yaha udaracchada, prAdezika lasagranthiyA~ tathA anya dUrastha aGgoM taka jAtA hai / 8. stana saGkaTa --- mUtraprajananAGga se spaSTa sambaddha stana na hone para bhI prajanana ke sAtha inakA sadaiva sambandha rahatA hai / ataH hama stanasaGkaTa kA varNana isI prakaraNa meM karanA Avazyaka mAnate haiM / stanasaGkaTa bahuta kama hone vAlA roga hai / yaha kATane para machalI ke mAMsa ke sadRza samarasa dharAtala vAlA dIkha par3atA hai jisameM stana karkaTa ke samAna pIta UtinAzIya kSetra yA rekhana ( striation ) nahIM hotA / karkaTa jitanA hI kaThina hotA hai yaha utanA hI mRdula hotA hai isa kAraNa ise pratyakSa dekhakara bhI pahacAnA jA sakatA hai / stana meM jo saGkaTArbuda banatA hai vaha granthisaGkaTa ( adeno-sarcoma) kahalAtA hai jo tantugranthyarbuda ke dvArA banatA hai / tantugranthyarbuda sadaiva vayaskoM kA roga hai / isa kAraNa yaha bAlakoM meM nahIM pAyA jAtA / cAlIsa varSa kI praudAoM meM stanasaGkaTa saralatApUrvaka dekhA jA sakatA hai / stanasaGkaTa tarkukozA-saMkaTa kA hI eka rUpa hotA hai / isameM adhicchadIya kozAoM ke samUha milate haiM para unameM mArAtmaka guNa nahIM hotA aura anta meM ve lupta bhI ho jAte haiN| ye vAstava meM tantugranthyarbuda ke adhicchadIya avazeSa mAtra hote haiM / Arambha meM yaha saGkaTa prAvarita hotA hai para Age calakara bar3e vega se antarAbharita ho jAtA hai / yaha arbuda stanaUti ko cIra kara tvacA ko kATatA huA bar3hatA jAtA hai / isake dvArA kavakAnvita puMjoM kA nirmANa hotA hai jinameM vraNana, upasarga aura For Private and Personal Use Only

Page #907
824 vikRtivijJAna raktasrAva tInoM milate haiN| yaha saMkaTa Thosa vA koSThIya donoM prakAra kA ho sakatA hai / koSTI kA AkAra bahuta vizAla ho jAtA hai / isake visthAya raktadhArA dvArA banA karate haiM aura lasagranthakoM para kadAcit hI koI prabhAva par3a pAtA hai| jyoM hI saGkaTa drutavega se bar3hane lagatA hai ki phira mRtyu Ane meM bahuta samaya kI pratIkSA nahIM karanI pdd'tii| yadi isakA uccheda kara diyA jAve to isakI punarutpatti atizIghra ho jAtI hai / yaha nahIM bhUlanA ki jahA~ karkaTa stana kA pratyAkarSaNa karatA hai vahA~ saGkaTa ke kAraNa stana paryApta bar3hatA hai aura usakA cUcuka Age kI ora nikala par3atA hai / Upara jitane aMgoM ke saGkaTArbudoM kA varNana kiyA gayA hai unake atirikta avaTukAgranthi saGkaTa ( sarcoms of the thyroid gland) tathA svarayantra saGkaTa ( sarcoma_ of the larynx) aura hote haiM / ye donoM bahuta hI viralatA se kabhI kabhI hI milate haiM / kabhI kabhI to avibhinnita karkaTa ko vaikArikIvid bhUla se saGkaTa samajha liyA karate haiN| donoM meM tarkurUpa ( spindle-shaped ) kozAoM kI adhikatA hotI hai / saGkaTArbudoM kA varNana karane ke pazcAt hama yojIUti ke dUsare duSTa arbuda pRSThamervarbuda kA varNana kareMge / pRSTha mervarbuda ( Chordoma ) yaha arbuda bhrauNa pRSThameru ( notochord ) ke avazeSoM meM utpanna hotA hai / yaha bahuta viralatayA hone vAlA arbuda hai / yaha mArAtmakatA meM saumya hotA hai / pRSThameru ke UparI sire para poSaNikAkhAta tathA mahAchidra ke bIca meM tathA nIce ke sire para trika anutrikIya kSetra ( sacrococcygeal region ) meM utpanna hotA hai / yaha bharamAra dvArA apanA prasAra karatA hai aura apanI antima avasthA meM hI visthAya utpanna karane meM samartha ho pAtA hai / arbuda kA jaba AkAra bar3A ho jAtA hai taba usameM pratyAstha gADhatA ( elastic consistence) pAI jAtI hai sAtha hI pArabhAsaka pRSThameru Uti ke kSetra milate haiM jinheM raktasrAvI sidhma eka dUsare se pRthak karane kA yatna karate haiM / Na pRSThameru se hI pRSThavaMza yA pRSTameru yA kazerukAoM kA nirmANa hotA hai / yaha arbuda eka prakAra kA ghAtaka kAsthIya arbuda sarIkhA hotA hai / aNvIkSaNa se dekhane para isa arbuda meM bar3e bar3e svaccha kozA eka sthAna para bhare hue milate haiM jinake bIca meM koI anya padArtha nahIM hotA / kozA zliSIya padArtha se phUla jAte haiM isa kAraNa zliSIya karkaTa kA bhI ise dekhakara bhrama ho sakatA hai| kozArasa rasadhAnIyukta ( vacuolated ) hotA hai yahI isakI bahuta bar3I vizeSatA hai / For Private and Personal Use Only

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(1) tantvarbuda pRSTha 125 tantuti meM bane sAdhAraNa arbuda kA citra hai| (2) tantupezyarbuda Nalan yaha garbhAzayastha tanturUpa hai / varNana pRSTha 831 para dekhie| For Private and Personal Use Only

Page #909
arbuda prakaraNa (kha) sAdhAraNa arbuda isa vibhAga meM tantvarbuda, vimedArbuda, zleSmArbuda, kAsthyarbuda aura asthyarbuda kA varNana kiyA jAyagA / 825 tantvarbuda ( Fibroma ) yaha arbuda zvetAbha va Uti ke dvArA taiyAra huA karatA hai / isakI gAr3hatA prastarasama kAThinya se lekara ati mRdula taka dekhI jAtI hai / yataH sampUrNa zarIra meM tAntava Uti paryApta vipulatA ke sAtha upalabdha hotI hai isa kAraNa vizuddha tAntavArbuda kA milanA ati kaThina hotA hai yadyapi thor3I yA bahuta ( alpAdhika ) mAtrA meM pratyeka arbuda aura vraNazothAtmakAvasthA meM tAntavaUti yojIUtIya saMdhAra ke rUpa meM avazya pAI jAtI hai / sampUrNa tankharbuda mArAtmakarUpa dhAraNa karake saGkaTArbuda banane kA yatra karate haiM / vAstava meM tanvarbuda prathamataH eka sAdhAraNa prakAra kA nirdoSa arbuda hotA hai / yaha ' haNa ( firm ), prAvarita ( encapsulated ) vRddhi hotI hai jo Arambha meM samarasa (homogeneous ) hotI hai / isameM tantukozA ( fibrocyte ) yA tanturuha (fibroblast ) ina do meM se koI eka kozA pAyA jAtA hai / tantvarbudoM ko kaThina aura mRdula ina do zreNiyoM meM vibhAjita karane kA pracalana hai kaThina tantvarbuda ( hard fibroma ) - yaha camakIle zveta tAntava Uti ke khaNDikAmaya puoM ( lobulated masses ) ke dvArA nirmita hote haiM / inako kATa kara dekhane se ye puJja saMkendrita bhramiyoM ( concentric whorls ) meM vinyasta hote haiM / khaNDikAe~ vAhiniyoM se yukta saghana yA virala yojIUti ke dvArA ba~dhI hotI haiM / ye arbuda kisI bhI yojIUti meM utpanna ho sakate haiM / inakA dharAtala khaNDikAmaya ho sakatA hai / inakI AkRti vartulAkAra ( globular ) aura kaThina ho sakatI hai jo nizcita rUpa se parilikhita ( circumscribed ) huA karatI hai / para aisA prAvara nahIM car3hA hotA jaisA ki vimedArbuda meM milatA hai / ina arbudoM meM zleSajana kI mAtrA bahuta adhika hotI hai / inake kozA tantukozA ( fibrocytes ) hote haiM / ye arbuda jaisA ki nAma se vidita hai khUba kar3e aura dRr3ha tathA prAvarayukta hote haiM | kATakara dekhane se AdhUsara zveta, camakIlI tAntava AbhA usake dharAtala kI dikhalAI detI hai / 1 For Private and Personal Use Only ye kaThina tAntava arbuda zleSmaparyastha se sambandhita Urdhva aura agho hanuoM meM mila sakate haiM / vahA~ yA to ve asthikendra meM yA paryastha meM utpanna hote haiM aura dantapuSpuTa (epulis) utpanna karate haiM / inakI utpatti kA dUsarA sthala nAsAgrasanI ( nasopharynx ) hai / pariNAhI vAtanAr3iyoM ke kaMcukoM ( sheaths of peripheral nerves ) se bhI ye nikalate haiN| vahA~ ye Uti zUlayukta kaThina upasvagIya granthaka banA dete haiM / akele yA bahuta se hone para inake kAraNa jo avasthA banatI hai use vAtanADIyatanyarbudoskarSa yA cetAnyarbudotkarSa (neurofibromatosis ) kahate haiM /

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826 vikRtivijJAna ina kaThina tantvabuMdoM meM vihAsIya parivartana bahudhA dekhane ko milate haiM isa kAraNa arbuda ke andara zleSmAbha yA cUrNIya ( calcareous ) kSetra bana jAte haiN| isameM kabhI kabhI kucha upasarga laga jAne se Atmapacana (auto-digestion) bhI pAyA jA sakatA hai jise jaivika nAza ( necrobiosis) kahate haiN| sampUrNa puMja kATane para lAla aura sUjA huA dekhane meM AtA hai| yaha tantumAsArbuda meM jitanA milatA hai utanA zuddha tantvabuMda meM nhiiN| garbhAzaya ke prAcIna arbudoM meM pezItantu kI vRddhi na hone ke kAraNa ve zuddha tantvarbuda bana jAte haiM / bIjagranthiyoM meM bhI aise arbuda kabhI kabhI pAye jA sakate haiN| mRdula tantvarbuda (soft fibroma )-gAr3hatA kI dRSTi se ye bahuta pilapile hote haiN| inameM tAntava Uti DhIlIDhAlI aura kama saghana rahatI hai| inameM aneka vAhiniyA~ hone ke kAraNa thor3e bhI AghAta se inase bahuta adhika raktasrAva hone kI AzaMkA rahatI hai| inakI mRdulatA ke kAraNa inameM aura vimedArbuda meM antara karane meM paryApta bhrama hotA huA dekhA jA sakatA hai| dUsarI ora mRdula tanvarbuda aura saMkaTArbuda meM pharka karanA bhI kaThina ho jAtA hai kyoMki yaha arbuda bahudhA mArAtmaka rUpa dhAraNa kara liyA karatA hai| ye arbuda yA to sthAnIya yA prasara ina do rUpoM meM vAtanADI kaMcukoM para dekhe jAte haiN| yadi inakA AkAra bar3A huA to ve tvacA ke Upara vRntayukta (pedunculated) arbuda ke rUpa meM bana jAte haiM / inako mRdutantu ( molluseum fibrosum) kahate haiM / yaha vAtanADItantvavRMdotkarSa kA hI eka rUpa hotA hai| anya kaThina tantvaydoM kI bhA~ti mRdula tantvavaMdoM meM bhI vihAsAtmaka parivartana pAye jA sakate haiN| ve prAyaH kAcara (hyaline ) yA zleSmAbha prakAra ke hote haiN| kATane para dharAtala svaccha kSetra se yukta banatA hai jisa para itastataH raktasrAva dekhA jA sakatA hai| hoTaTauTa nitamba (Hottentot buttock ) isI prasara mRdula tantva. buMda kA eka udAharaNa hai| ___ ye arbuda tvacA yA zleSmalakalA ke nIce pAye jAte haiN| tvacA ke nIce bar3e bar3e vRnta yukta prAvaravihIna arbudoM kA nirmANa hotA hai| inheM utsedha (wen) kahate haiN| ye kabhI kaI hote haiN| kabhI kabhI tvacA athavA upatvagIya bhAgoM meM sthUlatA bar3ha jAtI hai / aisA nitamba, vaMkSaNa yA anya bhAgoM meM dekhA jAtA hai| ise zlopadika tanvarbuda (elephan. toid fibroma) nAma diyA jAtA hai| uparyukta prasara vRddhiyoM ke atirikta adhika parilikhita tathA prAvarita mRdula tAntavArbuda karoTi, vRSaNa, antapezIyapaTI (inter-muscular septum ), bhaga Adi anya sthaloM para bhI prakaTa ho sakate haiM / inameM se kucha to itane adhika kozAvAn hote haiM ki unako saMkaTArbuda se pRthak karanA eka samasyA bana jAtI hai kyoMki unameM vibhinnana kA nizcita rUpa se abhAva pAyA jAtA hai| zleSajana kI utpatti nahIM hotI aura kozA tanturuha prakAra kA hotA hai| For Private and Personal Use Only

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arbuda prakaraNa 827 vAtanADIya tantvarbuda - vAtanADiyoM ke tanvarbuda do prakAra ke hote haiM-eka jo upariSTha vAtanADiyoM meM banate haiM aura dUsare jo gambhIra vAtanAr3Iya skandhoM se nikalate haiN| ina arbudoM ko vAtanADIya tantvarbuda ( neurofibromata ) kahA jAtA hai| ___ upariSTha yA upatvagIya prakAra kA vAtanADIya tantvarbuda prAyaH akelA hI utpanna hotA hai / isase eka dRDha tathA bahudhA atyadhika sparzazUlI granthaka tvacA meM banatA hai| yaha arbuda vAtanADI kI saMyojI Uti kI kaMcuka meM banatA hai| jaba tvacA meM bahuta se vAtanADIya tantvarbuda utpanna ho jAte haiM taba unheM raikaliMgahAujanAmaya ( Recklinghausein's disease ) yA mRdutantu ( molluscum fibrosum) kahate haiM / isameM saikar3oM arbuda ho sakate haiN| ye upatvagIya vAtanADiyoM tathA tvacA ke mRdu granthakoM dvArA nikalate haiN| ve vaise gambhIra vAta nADiyoM se tathA zIrSaNyA nADiyoM se bhI utpanna ho sakate haiN| jaba inameM saMkaTArbudIya parivartana ho jAte haiM tabhI ve mRtyu kA kAraNa banate haiN| gambhIra vAtanADiyoM ke vAtanADIya tantvabaMda upatvagIya tathA gambhIra vAtanADI donoM se hI uga sakate haiN| yaha pahale prakAra kI apekSA kama pAye jAte haiM parantu isakI mahattA kA kAraNa hai isameM mArAtmakatA kI ora atizaya pravRtti kA pAyA jaanaa| isa viSaya ko hamane vAtanADIya saMkaTa yA vAtanADIjanya saMkaTa ke antargata bhalI prakAra batalAne kI ceSTA kI hai| pAThakoM ko vahIM dekhanA caahie| ___ kabhI kabhI vAtanADIya tantupaMja (endoneurium ) kI atyadhika prasaravRddhi ke kAraNa eka vAtanADIya arbuda bana jAtA hai jise pratAnarUpI vAtanADIya arbuda (plexiform neuroma) kahate haiN| yaha upatvagIya Uti ke andara huA karatA hai| yaha kuNDalIbhUta ( coiled ) yA sthUlita vAtanADIyakANDoM ( nerve trunks ) se banatA hai| inheM ucchedita kiyA jA sakatA hai| ye zira yA grIvA meM adhikatara milate haiN| / vraNavasturUpArbuda (Cheloid or keloid) yaha eka vAstavika arbuda nahIM hai api tu vraNavastu (scar tissue) kI atyadhika utpatti kA hI nAma vraNavasturUpArbuda yA kIlAiDa diyA jAtA hai / yaha aphrIkA ke habaziyoM meM prAyaH pAyA jAtA hai, kisI kisI meM isakI eka pravRtti hotI hai jisase vraNavastu kA nirmANa kahIM bhI ho yaha bana jAtA hai| pItArbuda (Xanthoma ) jaisA ki nAma se spaSTa hai yaha pIta varNa kA hotA hai / isakI sAdhAraNataH racanA eka tantvarbuda ke samAna hI hotI hai| isake pramukha prakAra pAye jA sakate haiM : 1. pItArbuda sarvAMgIya (xanthoma multiplex ) tathA isake pIle granthaka sampUrNa zarIra para kahIM bhI pAye jA sakate haiN| jaba zarIra meM paittava (cholesterol) kI adhikatA ho jAtI hai taba yaha adhika milatA hai| isa kAraNa madhumeha tathA For Private and Personal Use Only

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828 vikRtivijJAna avarodhAtmaka kAmalA ( obstructive jaundice ) meM yaha pAyA jAtA hai| pIle raMga kA kAraNa paittava hI hotA hai| ise madhumaihika pItArbuda ( xanthoma diabeticorum ) bhI kaha dete haiM / 2. pItapaTTikA ( xanthelasma ) yaha tInoM meM sarvAdhika pracalita prakAra hai / yaha koI vAstavika arbuda thor3e hI huA karatA hai balki vartmapeziyoM (muscles of the eyelids ) ke vihAsa se banatA hai / yaha prauDha puruSoM meM eka laghukAya pItagranthaka ke rUpa meM milatA hai / 3. bRhatpItArbuda ( large xanthoma ) ye bahuta kama milate haiM aura ve kaNDarA kaMcuka ( tendon sheaths ) meM pAye jAte haiM / ye mahAkozIya arbudoM se milate julate hote haiM / uparyukta tInoM prakAra ke arbudoM kA varNa camakIlA pIlA hotA hai / ye yojI Uti ke kozAoM dvArA banate haiM jinake andara vimedAbha vinduka ( paittava ) bhare rahate haiM jo usake varNa ko pIlA aura jhAgadAra ( foamy ) banA dete haiM / inake atirikta unameM tanturuha tathA apadravyahara mahAkozA bhI hote haiM / tathA inameM rakta ke raMgA ( pigments ) bhI kAphI pAye jAte haiN| kisI kisI meM ina arbudoM meM kabhI kabhI eka valayAkAra mudrikAvat nyaSTi rahatI hai jo kozA ke pariNAha meM hotI hai| ye mudrikAnyaSTiyA~ bahuta sI bhI ho sakatI haiN| ye vvAyaDa ke mata se anyatra nahIM dekhI jA sakIM / ina pItArbudoM kA kAraNa kabhI kabhI to vimedIya cayApacaya meM parivartana kA honA mAnA jAtA hai jisake sAtha atipaittavaraktatA (hypercholesterolaemia) rahatI hai / kahIM kahIM antaHkozIya gar3abar3I ise utpanna karatI hai jisameM jAlakAnta dIya saMsthAna ke katipaya kozA bhAga lete haiM / carmatantvarbuda ( dermato-fibroma ) - isakA yaha nAma hone para bhI ise tankharbuda kA vAstavika rUpa nahIM mAnA jA sakatA / yaha zAkhAoM para utpanna hotA hai / yaha laghu, kaThina, aprAvarita prakAra kA vikSata hai jo camar3I ( corium ) ke andara banatA hai / isake kozA kaI dizAoM meM calane vAle tarkurUpa, viSamAkAra aura bar3e bar3e hote haiM / isameM kabhI to bahuta se kozA hote haiM aura kabhI zleSajana bahuta adhika tathA kozA bahuta kama hote haiM / isakA eka mahattva kA lakSaNa hotA hai isakA aspaSTa kinArA jo samIpastha Uti meM bharamAra karatA huA hotA hai| ise dekhakara kAlyarbuda yA vAtanADIya tantvarbuda kA bhaya ho sakatA hai / isameM raktaraMgA mila sakatA hai / usa avasthA meM ise koI koI jaraThIya sirArbuda ( sclerosing haemangioma ) bhI kaha dete haiM / tantuprandhyarbuda ( fibro-adenoma ) - ye stana meM adhikatara utpanna hote haiN| ye mRdula mAMsala vRddhi se lekara kaThina tAntava puMja taka ho jA sakate haiM / mRdula rahane para inameM granthIya Uti aura kaThina hone para tAntava Uti kI inameM pradhAnatA rahatI For Private and Personal Use Only

Page #913
arbuda prakaraNa 826 1 hai / ye sabhI arbuda saprAvara hote haiM aura gola yA aNDAkAra yA khaNDikAyukta hote haiM aura ve stana meM itastataH calAye jA sakate haiM / kATane para inakA dharAtala thor3A udubja (convex) hotA hai vaha azmopama karkaTa kI bhAMti nyubja ( concave ) nahIM hotA / inakA adhika varNana hamane granthyarbuda ke sAtha kara diyA hai vahIM pAThakoM ko dekhanA cAhie / asthigata tantvarbud ( Fibroma of the bone ) asthi kA tankharbuda bahuta hI kama pAyA jAtA hai / yaha sadaiva paryastha ke bAhyastara se utpanna hotA hai / vizeSa karake Urdhvahanu athavA pazcanAsAgrasanI kI prAcIra meM yaha prakaTa hotA hai| vahAM yaha eka tAntava purvaMgaka banA letA hai / I asthi meM tatkharbuda na kevala paryastha ke nIce hI banatA hai apitu majjakIya kAnAla ( medullary_canal ) meM bhI kendra kI ora bana sakatA hai / mRdu hotA hai tathA Age calakara yaha saGkaTArbuda meM pariNata ho jAtA hai / yaha sadaiva stanagata tantvarbuda stana meM kabhI kabhI eka aisI vRddhi ho jAtI hai jo eka ora prAvarita aura dUsarI ora stana Uti se jur3I huI dekhI jAtI hai / jaba isameM kevala yojI Uti mAtra hI hotI hai to ise tankharbuda kahate haiM para bahudhA isameM granthIka bhAga bhI rahane se adhika upayukta nAma tantugranthyarbuda ( fibro-adenoma ) diyA jA sakatA hai / kyoMki stana meM tAntava tathA granthIka donoM prakAra kI UtiyoM meM paramacaya honA svAbhAvikatayA dekhA gayA hai / yaha stanIya tantugranthyarbuda navayuvatiyoM meM, jinheM koI prasava nahIM huA, dekhA jAtA hai / yaha do prakAra kA ho sakatA hai / eka ko antaHkAnAlIya ( intra canalicular ) aura dUsare ko parikAnAlIya ( pericanalicular) kahate haiM / inameM antaHkAnAlIya bahuta adhika hotA hai / yaha granthyarbuda utanA nahIM hotA jitanA ki tanvarbuda hotA hai / kyoMki isameM khaNDikAoM kI viziSTa Uti lagI hotI hai / yaha dekhane meM bhIMgA sA, prAvarita tathA mRdu hotA hai / ise kATane para isake kaTe kSetra meM choTe choTe praNAlikAoM ke kSetra dekhe jAte haiM jisake kAraNa isakI AkRti eka pustaka ke pRSThoM jaisI ho jAtI hai| kabhI-kabhI Uti ke choTe-choTe puMja choTe-choTe sthAnoM meM banda dekhe jA sakate haiM / yaha prAvaraNa yA bandI pUrNataH na hokara AMzika hotI hai| jisakA artha yaha hai ki arbuda eka ora stanaUti ke sAtha milA huA hotA hai aura zeSa bhAga meM prAvara se yukta hotA hai / aNvIkSaNa karane para abaddhayojI Uti kA bahuta praguNana dekhA jAtA hai / yaha khulI racanAoM ( open structures ) vAlI Uti hotI hai jo praNAlikAoM meM antarvalana ( invagination ) karatI hai / praNAlikAoM ke sudhirakoM meM yaha bahupAdIya puMja banA detI hai jisake kAraNa praNAlikAe~ bahuta visphArita ho jAtI haiM / unakI lambAI bhI bar3ha jAtI hai tathA ve vyAkRSTaH For Private and Personal Use Only

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830 vikRtivijJAna (distorted ) ho jAtI haiN| isa vRddhi meM stana kA sAdhAraNa saMdhAra koI bhAga nahIM letA / samIpastha Uti kI khaNDikAoM meM paramacaya dekhA jA sakatA hai| __ parikAnAlIya tantugranthyarbuda antaHkAnAlIya tantugranthyarbuda kI apekSA adhika kaThina hotA hai| yaha utanA bar3A bhI nahIM ho paataa| yaha pUrNataH prAvarita hotA hai aura kATane meM apane prAvara meM se saralatayA nikAlA bhI jA sakatA hai| sparza karane para isameM viziSTa caliSNutA ( mobility ) pAI jAtI hai| aNvIkSaNa karane para isameM granthIka aura tAntava donoM prakAra kI utiyoM kA praguNana pAyA jAtA hai| naI yojI Uti jo isa arbuda meM banatI hai vaha praNAlikAoM ke Upara hI hotI hai unake andara nahIM jAtI isI kAraNa isakA nAma parikAnAlIya rakkhA gayA hai / antaHkAnAlIya kI apekSA yaha kama kriyAzIla arbuda hotA hai| - parantu isakA artha yaha nahIM hai ki ye donoM vRddhiyA~ pRthaka-pRthaka hotI haiN| anta:kAnAlIya vRddhi ke andara kaI parikAnAlIya arbuda bhI dekhe yA DhU~Dhe jA sakate haiN| donoM meM jo prakAra adhika hotA hai usI ke nAma para nAmakaraNa kara diyA jAyA karatA hai| udaraprAcIrastha tantvarbuda udaraprAcIra meM udaradaNDikA pezI ke kaMcuka ( sheath ) meM tanvarbuda yA tantu. paTTArbuda ( desmoid tumour ) banatA hai| yaha kaMcuka se nikala kara pezI meM bharamAra karane lagatA hai| yaha bahuta kaThina hotA hai tathA tAntavaUti ke antarvayanakArI ( interlacing ) tantupaTTa kaTe hue kSetra meM sugamatA se dekhe jA sakate haiM / isI ke kAraNa ise tantupaTTArbuda bhI kahA jAtA hai| yaha arbuda bahuprasavA striyoM meM 80 pratizata taka dekhe vA pAye jAte haiN| anya 20 pratizata unameM milate haiM jinakI udaraprAcIra para koI AghAta kA itihAsa milatA ho| jo pezIsUtra andara arbuda ke sAtha banda ho jAte haiM ve mahAkozAoM kI taraha bahunyaSTIya saMkozotIya puMjoM (plasmodial masses ) meM parivartita ho jAte haiN| isa arbuda kI kabhIkabhI mArAtmakatA kI ora bhI pravRtti pAI jA sakatI hai| bIjakoSastha tantvarbuda bIjakoSoM (ovaries ) meM tanvarbuda do rUpoM meM pAyA jAtA hai| eka jo bahuta kama hotA hai use prAvarita tantvarbuda kahate haiM yaha eka hI ora hotA hai| dUsarA jo adhika hotA hai prasararUpIya hotA hai| yaha bahuta ubhayapAIya yA donoM ora milatA hai| yaha paryApta vizAlakAya ho sakatA hai / yaha dUsarA sazAkha hotA hai aura zAkhA para mur3a (twist) sakatA hai / yaha arbuda bahuta adhika kaThina hotA hai| isakA kaTA huA kSetra bar3A zveta hotA hai| isameM kAcara vihAsa ke kSetra aura taralana ke kAraNa koSThanirmANa pAyA jA sakatA hai| UtimRtyu, cUrNIyana tathA asthIyana taka mila sakatA hai| aNvIkSaNa karane para ye tantvabuMda hote haiM para kabhI-kabhI jinameM kozA pUrNataH pragalbha yA praur3ha nahIM hue rahate haiM ve tanturuhIya ( fibroblastic ) hote haiM aura For Private and Personal Use Only

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arbuda prakaraNa 831 tarkurUpa saMkaTArbuda kA AbhAsa karAte haiM / prAvarita vRddhi sadaiva sAdhAraNa rahatI hai aura prasararUpIya sadaiva saMkaTArbuda meM pariNata ho jAtI hai aisA vidvAnoM kA anubhava hai / garbhAzayastha tantupezyarbuda ( Fibromyoma of the Uterine Wall ) garbhAzaya prAcIra meM tantupezyarbudoM kI upasthiti strI ke navayauvanArambha se pUrva nahIM huA karatI / sAtha hI 20 varSa kI Ayu ke pUrva bhI nahIM hotI aisA kucha vidvAnoM kA mata hai / tIsa se lekara pacAsa varSa taka kI Ayu vAlI praur3hAoM meM ye bahudhA pAye jAte haiM / grIna kA kathana hai ki eka cauthAI strIsamAja isa vyAdhi se 1 pIDita rahA karatA hai / 92 pratizata tantupezyarbudoM kA utpattisthala garbhAzayapiNDa kI pezIya prAcIra hotA hai tathA 8 pratizata garbhAzayagrIvA ke kAnAla meM yaha udaya hote haiM / ye kSudra, zveta, kaThina, jvAra ke bIja jaise piNDoM meM kisI eka dhamanI se sambandhita prakaTa hote haiM aura vistAra ( expansion ) dvArA bar3hate haiM / ye svayaM prAvarita ho jAte haiM aura inakI raktapUrti bahuta kama hotI hai / isa kAraNa agara inakA AkAra adhika bar3ha jAtA hai to rakta kI kamI ke kAraNa inakA vihAsa ho jAtA hai| adhika bar3e AkAra ke arbuda kaThina yA haNa tathA pratyAstha ( elastic ) ho jAte haiM / aura jaba unheM kATA jAtA hai to pezIya aura tAntava Uti ke paTToM kA antarvalayita tathA camakatA huA rUpa dekhate hI banatA hai / pezI Uti kI mAtrA arbuda kI Ayu para nirbhara hotI hai / yadi arbuda nayA hai to usameM pezIya Uti paryApta hotI hai aura yadi vaha purAnA hai to usameM tAntavati kI mAtrA adhika bar3hatI calI jAtI hai / isI kAraNa navIna arbuda mRdula tathA aNvIkSaNa se kozIya hote haiM aura prAcIna kaThina I hote haiM / garbhAzaya ke tantupezyarbudoM ko tanturUpa ( fibroids) kahA jAtA hai / yaha tanturUpa garbhAzaya kI pezI meM gaharAI meM jaba banatA hai to yaha antaHprAcIrIya tanturUpa ( intramural fibroid ) kahalAtA hai / para jyoM jyoM yaha vRddhi bar3hatI jAtI hai usakI sthiti meM bhI parivartana hone lagatA hai kyoMki garbhAzaya meM saMkocanazIlatA hotI hai / usake kAraNa yA to yaha andara kI ora bar3hatA hai aura garbhAzaya ke antazchada ke nIce taka A jAtA hai taba use upazleSmala tanturUpa ( submucous fibroid ) kahate haiM aura yA kabhI kabhI yaha garbhAzaya ke bAharI dharAtala para udaracchada ke nIce bhI dekhA jA sakatA hai taba use upalasya tanturUpa ( Subserous fibroid ) kahA jAtA hai / antaHprAcIrIya yA antarAlita tanturUpa sabase naye arbuda hote haiM / ye kaI garbhAzaya prAcIra meM vyAkarSaNa paramacaya ke bhI kAraNa banate kaI eka sAtha banate haiN| apanI sthiti ke kAraNa ve ( distortion ) utpanna kara dete haiN| kabhI kabhI ve haiM / ve garbhAzaya ke kArya meM koI bAdhA vizeSa utpanna nahIM kiyA karate / naye hI hone ke kAraNa inameM vihAsa bhI nahIM huA karatA / For Private and Personal Use Only

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832 vikRtivijJAna uparalaiSmika tanturUpa garbhAzaya kI guhA meM hI antazchada ke nIce hone ke kAraNa garbhAzaya ke kAryoM meM paryApta vighna DAla sakate haiN| apanI isa sthiti meM ve akele hI hote haiM tathA garbhAzayasaMkocoM ke kAraNa nIce kI ora calane lagate haiM aura garbhAzayagrIvA kI suraMga taka A jAte haiN| yahI nahIM, inameM vRnta yA nAla bana jAte haiM jinake kAraNa suraMga meM hokara yoni ke andara taka laTaka jAte haiM / isa avasthA meM unako tanturUpa purvagaka ( fibroid polyp ) kahA jAtA hai| yoni meM Ane para zIghra yA vilamba se inameM upasarga laga jAtA hai jisake kAraNa Age calakara inameM vaNana tathA nirmocana (aloughing ) taka ho jAtA hai| isI ko AyurvedajJa yonikanda kahate haiMpUyazoNitasaMkAzaM nikucAkRtisaMnibham / janayanti yadA yonau nAmnA kandaH sa yonijaH / / jaba upazleSmala tanturUpa garbhAzaya guhA meM hote haiM taba unake Upara kA antazchada dabAva ke kAraNa apuSTa ho jAtA hai aura isa kAraNa upasRSTa bhI ho jAtA hai| tanturUpa ke kinAroM para vaha bahuta moTA aura paramapuSTa ho jAtA hai| isa kAraNa mAsikadharma ke samaya bahudhA adhika raktasrAva hotA hai tathA zeSakAla meM zveta raMga kA srAva hotA rahatA hai jise pradara ( leucorrhoea ) kahate haiM / ina parivartanoM se aisA jJAta hotA hai ki mAno strImadi bAhulya (excessive production of oestrogens) kA tanturUpotpatti se koI vizeSa sambandha ho| upalasya tanturUpa sadaiva bahuta se hote hai aura yataH ina para koI dabAva (pIDana) paDatA nahIM ataH inakA AkAra cAhe jitanA bar3ha sakatA hai / ye bhI savRnta (pedun. culated ) hote haiN| yadyapi avRnta bhI mila sakate haiN| inakI sthiti ke kAraNa inameM thor3A bahuta vimoTana (torsion ) ho sakatA hai| jisake kAraNa inakI raktapUrti meM bAdhA utpanna ho sakatI haiM aura inameM vihAsAtmaka parivartana mila sakate haiN| garbhAzaya kI grIvA kI prAcIra meM bahudhA akelA hI tanturUpa banA karatA hai| garbhAzaya grIvA prAyaH sthira hotI hai / tanturUpa upalasya yA antarAlita hotA hai| yaha grIvA suraMga ko vyAkRSTa kara sakatA hai tathA prasavakAla meM bAdhA utpanna kara sakatA hai| ____ santurUpoM ke kAraNa garbhadhAraNA meM nirantara bAdhAe~ utpanna hotI huI dekhI jAtI haiM / garbhAzaya kI AkAravRddhi hone se garbhAzayAntazchada para pIDanAdhikya ke kAraNa apuSTi hone se, tanturUpa meM upasarga ho jAne ke kAraNa vraNazothAtmaka udAsargoM ke dvArA bIja yA zukrANu ke naSTa ho jAne se, garbhAzaya ke vikarSaNa ( distortion ) se, yA garbhAzaya nAla ke phaila jAne se zukrANu aura bIjANu donoM kA sammelana nahIM hone pAne se garbhadhAraNA nahIM hotI hai| ___ yadi garbhadhAraNA ho bhI gaI to pratikSaNa garbhapAta kI AzaMkA banI rahatI hai| garbhapAta meM do mukhya kAraNa ho sakate haiM jinameM eka to arbudoM kI upasthiti ke For Private and Personal Use Only

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arbuda prakaraNa 833 kAraNa yathAvazyaka garbhAzaya ke prasAra meM bAdhA kA honA aura dUsarA garbhAzayAntazchada pAka kA utpanna ho jAnA hotA hai| agara garbhAzaya kI vRddhi yathAvazyaka hotI jAtI hai to zroNitaTa ke Upara tanturUpa kA jAnA nahIM ho pAtA aura phira garbhAzaya kA avabandha (incarceration) ho jAtA hai| garbhAzaya grIvAstha tanturUpa prasavakAla meM paryApta bAdhA utpanna kara dete haiN| prasava hone ke pazcAt aparApAtanArtha jitanA adhika garbhAzaya-saGkoca honA cAhie vaha nahIM ho pAne se prasavoparAnta raktastrAvAdhikya pAyA jAtA hai| prasavakAla meM kabhIkabhI tanturUpoM ko bhI AghAta pahu~ca sakatA hai / AdhAta ke pazcAt ve upasaSTa hokara aura bhI adhika hAni pahuMcA sakate haiM aura prasUtikAlIna rogANutA ( sepsis) utpanna ho jAyA karatI hai jisake pariNAma sadaiva gambhIra huA karate haiN| __tanturUpoM meM nimna vihAsAtmaka parivartana prAyazaH milA karate haiM kyoMki tanturUpoM meM raktapUrti bahuta kama hone se unameM vihrAsa saralatayA ho jAyA karatA hai| yaha vihAsa sAdhAraka apoSakSaya, kAcara vihAsa, zliSIya vihrAsa, cUrNIyana, lAla vihAsa yA mArAtmaka vihAsa meM se koI sA ho sakatA hai| sAdhAraNa apuSTi rajonirodhakAla meM jaba garbhAzaya kA bhI svarUpa choTA aura kSINa hone lagatA hai usa samaya dekhI jAtI hai| usake sAtha sAtha snaihika parivartana bhI milate haiM / kabhI kabhI ve punaH bar3hane lagate haiN| tanturUpoM meM kAcarIkaraNa bahuta karake dekhA jAtA hai| usake pazcAt zleSAbha vihAsa aura bAda meM taralana (liquefaction) huA karatA hai / isake Age koSThakotpatti hotI hai| koI bhI tanturUpa ina vihAsoM se virahita dekhA nahIM jaataa| kAca jaise kAcara vihAsagrasta bhAga bahudhA dekhane meM Ate haiN| kAcarIya vihAsa ke pazcAt cUrNIyana ( calcification ) bhI mila sakatA hai| yaha parivartana praudAoM tathA vRddhAoM ke tanturUpoM meM pAyA jAtA hai| taruNiyoM meM yaha bahuta kama milatA hai / cUIyana kA citra kSa-kiraNoM dvArA bhI prakaTa ho jAtA hai| lAla vihAsa (red degeneration) nAmaka parivartana inhIM tanturUpoM meM vizeSa karake pAyA jAtA hai| yaha Ama taura para garbhAvasthA athavA prasavakAla meM hotA hai, vaise aprasavAoM aura vandhyAoM ke tanturUpoM meM bhI yaha mila kakatA hai| isameM sahasA utinAza hotA hai| rugNA ko tIva zUla aura kabhI kabhI jvara bhI ho jAtA hai| tanturUpa kA sampUrNa yA aMzataH varNa lAla yA gaharA babhru ho jAtA hai, vaha bahuta mRdula bhI ho jAtA hai| yaha varNa rakta tathA UtiyoM ke Atmapacana kA pramANa hai / avarodhAtmaka zopha ke sAtha-sAtha sirAoM kA ghanAsrotkarSa pAyA jAtA hai| ye parivartana bahudhA tanturUpa ke kendriya bhAga meM Arambha hote haiM / yaha bhAga antarAlita Uti se banA hotA hai / isa kArya meM roga ke jIvANuoM kA koI bhAga rahatA ho isakA koI puSTa pramANa abhI taka upalabdha nahIM ho skaa| ataH kevala zoNa-vikSatoM ke dvArA hI yaha banatA hai aisA mAna lenA par3atA hai| garbhAvasthA meM garbhAzaya ke saMkoca hote rahate haiM jisake kAraNa tanturUpoM ko jAne vAlI raktavAhiniyA~ saMkucita ho jAtI haiM aura unameM hokara kendriya bhAga taka rakta For Private and Personal Use Only

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834 vikRtivijJAna kA pahu~canA ruka jAtA hai aura eka prakAra kI alparaktatA vahA~ A jAtI hai jo isa parivartana kI mukhya vidhAyikA mAnI jAtI hai / para yaha pramANa pUrNasantoSajanaka nahIM mAnA jA sakatA kyoMki garbhatA ke atirikta bhI to yaha milatA hai / sau meM do tanturUpa ( fibroids ) mArAtmaka rUpa dhAraNa karate hue pAye jAte haiM / tanturUpa yA to tantusaMkaTArbuda kA rUpa dhAraNa karatA hai athavA tarkurUpa saMkaTa banatA hai / mArAtmaka rUpa ke sAtha sAtha anya vihAsAtmaka svarUpa bhI dekhe jA sakate haiM / tankharbuda ke jitane sthAna abhI taka batalAye gaye haiM unake atirikta jahA~ bhI tAntava Uti pAI jAtI hai vahA~ hI yaha utpanna ho sakatA hai / mukhya sthaloM kA varNana kiyA jA cukA hai| gauNa sthaloM meM eka vRkkastha tantvarbuda hai / vRkka meM tanvarbuda tabhI hogA jaba usake svAbhAvika vikAsa meM hI koI maulika bAdhA utpanna ho jAvegI / isI kAraNa kucha loga ise tantvarbuda na kaha kara truTayarbuda ( haemartoma ) kahate haiM / yaha vRkka ke stUpa (pyramid ) yA piNDikA ( papilla ) meM choTe gola granthaka ke rUpa meM pAyA jAtA hai / annanalikA meM jo tantvarbuda banate haiM ve purvaMgaka kA rUpa dhAraNa kara lete haiM / A~toM ke andara bhI unakA purvaMgaka rUpa ( polypus ) ho jAtA hai / bAlakoM ke svarayantra meM nAlarahita zoNasaMyojI Uti kA tantvarbuda bana jAtA hai / vimedArbuda (Lipoma ) yaha eka prakAra kA sAdhAraNa, aduSTa, hAnirahita prakAra kA medasaMcAyikA yojI Uti se banane vAlA arbuda hai / ise medorbuda nAma se AyurvedajJa pukArate haiM / yaha dekhane meM svAbhAvika meda jaisA hI lagatA hai antara kevala yahI hotA hai ki yaha usase kucha zvetatara ( paler ) tathA khaNDikAoM meM vibhakta pAyA jAtA hai / ye khaNDikAe~ yojI aa dvArA nirmita hotI haiM / sampUrNa arbuda ke cAroM ora eka tAntava prAvara car3hA hotA hai jo paryApta saghana hotA hai / prAvara ke nIce eka komala patalI kalA kI cAdara chAI rahatI hai / prAvara samIpastha UtiyoM ke sAtha ghaniSThatA ke sAtha ba~dhA hotA hai para arbuda ke sAtha DhIlA sA lagAva rakhatA hai / isI kAraNa prAvara meM se yaha saralatayA ucchedita kiyA jA sakatA hai / prAvara meM hokara hAtha se arbuda ko idhara udhara hilAyA DulAyA bhI jA sakatA hai / yaha arbuda mArAtmaka kabhI nahIM hotA / isa arbuda kA saMdhAra tAntava hotA hai tathA isako rakta bahuta hI kama mila pAtA hai / rakta kI vAhiniyA~ prAvara meM se eka khAsa sthAna meM hokara pahu~catI haiN| vimedArbuda sadaiva upasvagIya snaihika Uti meM banA karate haiN| ve akele yA aneka donoM rUpoM meM pAye jAte haiM / upatvagIya Uti ke atirikta anya sthaloM meM bhI ye bana sakate haiN| sthiti ke anusAra inake 8 bheda bhI kiye gaye haiM- 1. upasvagIya vimedArbuda ( subcutaneous lipoma ) 2. upazlaiSmika vimedArbuda ( submucous lipoma ) 3. upalasya vimedArbuda ( subserous lipoma ) For Private and Personal Use Only

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arbuda prakaraNa 835 4. upasandhIya vimedArbuda ( subsynovial lipoma ) 5. upaparyastha vimedArbuda ( subperiosteal lipoma ) 6. parAsthIya vimedArbuda ( parosteal lipoma ) 7. antargazIya vimedArbuda (intramuscular lipoma ) 8. upastarIya vimedArbuda ( subfascial lipoma) racanA para vicAra karane se eka vimedAbaMda kozAoM se nirmita hotA hai| kozAoM ke andara sneha ( fat ) bharA hotA hai sAtha thor3I yA bahuta tAntava Uti rahA karatI hai| isake kozA vapAUti (adipose tissue) ke sadRza parantu usase kucha bar3e hote haiN| usakI nyaSTi aura prarasa kozAprAcIra meM dabe hue rahate haiM isa kAraNa bar3I kaThinAI se dekhe jA sakate haiN| jaisA ki pahale batAyA hai eka saMyojI Uti ke dvArA banI huI eka bahuta patalI kalA arbuda ke Upara car3hI rahatI hai| isI meM se kaI paTiyA~ (septa) nikala kara arbuda ko kaI khaNDikAoM meM vibhakta kara detI haiN| tAntava paTiyoM meM hokara hI raktavAhiniyA~ pahu~catI haiM jinake kinAre-kinAre arbudika Uti bar3hatI rahatI hai| pratyakSa dekhane se vimedArbuda kA varNa pIta hotA hai| vaha khaNDikAyukta ( lobulated ) hotA hai, usake cAroM ora tAntava prAvara car3hA hotA hai| jaba isake Upara kI tvacA ko hAtha se alaga karane kA yatna kiyA jAtA hai to usameM gaDhe ( dimple ) par3a jAte haiM jo yaha spaSTa karatA hai ki ve tvacA se sambaddha hote haiN| kATane para unakI AkRti vapauti jaisI hotI hai jinake bIca bIca meM tAntava paTiyA~ spaSTa dikhAI par3atI haiN| vimedAdhuMda kabhI vinAla aura kabhI sanAla dekhe jAte haiM / saMkSepa meM eka vimedArbuda mRdu, parilikhita ( cirumscribed ) khaNDikAyukta prAvarita arbuda hotA hai jise usake prAvara meM se saralatayA nikAlA jA sakatA hai / yaha bhItarI kalA ( deep fascia) se sambaddha nahIM rahatA para tvacA ko haTAne para tvacA meM gartikAoM kA par3anA usakI usase lagnatA prakaTa karatA hai| vimedAdhuMda yadyapi bahuta nirdoSa arbuda hai para jaba yaha pazcaudaracchadIya yA parivRkkIya hotA hai taba drutagati se vRddhi karake itastataH bharamAra kara sakatA aura hAni pahu~cA sakatA hai / aisI avasthA meM ise vimedasaMkaTa ( lipo-Sarcoma) kahA jAtA hai / vimedotkarSa ( lipomatosis ) tathA vimedArbuda meM paryApta antara hotA hai| vimedotkarSa eka poSaNikAgranthijanya roga hai jaba ki yaha eka arbuda hai jo eka sthAnavizeSa para hI sImita rahatA hai| vimedotkarSa meM grIvA athavA anya kisI aMga kI yojI Uti meM sneha kA saMcaya ho jAtA hai| yadi meda kA AhAra meM abhAva ho jAve to vimedotkarSa dvArA saMcita medabhaMDAra rikta ho jAtA hai parantu vimedAdhuMda meM saJcita sneha jyoM kA tyoM banA rahatA hai| peziyoM, kalAoM, kaNDarAoM, paryastha, udaracchada, sandhiyoM, mukha, grasanI, svarayantra, Antra Adi sthAnoM meM kahIM bhI vimedArbuda bana sakate haiN| A~toM meM inake kAraNa For Private and Personal Use Only

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836 vikRtivijJAna suSirakAvarodha hone se yA AntrAntrapraveza (intussusception-baddhagudodara) hokara ghAtaka pariNAma dekhe jA sakate haiN| do peziyoM ke madhya meM sthita kalA meM bhI yaha bana sakatA hai| AmAzaya tathA Antra kI upazlaiSmika Uti ke andara bhI yaha dekhA jAtA hai| sandhiyoM meM kabhI kabhI isakI utpatti se sampUrNa sandhi guhA bhara jAtI hai taba yaha sazAkha vimedAbaMda ( lipoma arborescens ) kahalAtA hai|| kisI bhI sthAna para vimedArbuda ho usakA varNana lagabhaga eka sA hI hotA hai| yadi aMga komala hai aura usa para arbuda kA bhAra par3a rahA hai to avazya vizeSa parivartana pAyA jAvegA anyathA koI khAsa antara dRSTigocara nahIM huA krtaa|| ____ asthi ke Upara aura paryastha ke nIce gaharAI meM kabhI kabhI vimedArbuda banatA hai| usake kAraNa parilikhita arddhauccAvacIya ( semifluctuant ) zotha ke rUpa meM yaha dikhalAI detA hai aura aisA prakaTa hotA hai ki mAno koI vidradhi bana rahI ho para jyoM hI zastrakarma kiyA jAtA hai isakA vAstavika rUpa prakaTa ho jAtA hai| prIvA meM medotkarSa ke kAraNa dvitIya hanu kA nirmANa ho jAtA hai| vaha jaisA ki pahale kahA hai vimedAdhuMda na hokara vimedotkarSa praivika ( lipomatosis colli ) kaha lAtA hai| grIvA meM yA kandhe meM jaba vimedArbuda banatA bhI hai to vaha gurutvAkarSaNa ke kAraNa nIce kI ora sarakatA calatA hai aura usa para eka prAvara car3hA rahatA hai| vimedotkarSa meM vaisA prAvara nahIM huA krtaa| kabhI kabhI puraH kapAlAsthi ( frontal bone ) ke Upara paryastha ke nIce bhAla para vimedArbuda bane hue dekhane meM Ate haiN| yaha upaparyasthIya hote haiN| asthi se sambaddha rahane ke kAraNa inameM uccAvacana prAyaH nahIM hotaa| jihvA ke padArtha ke bhItara gola mRdula zotha ke rUpa meM bhI vimedArbuda dekhA jA sakatA hai| vimedAvaMda ke 3 pramukha prakAra haiM / 1. tantu-vimedArbuda (fibro lipomata)-yahA~ vinedArbuda ke andara tAntavaUti kA Adhikya rahatA hai| 2. zliSa-vimedArbuda ( myxo lipomata)-yahA~ vimedArbuda meM zliSIyajati kA bhI saMyoga huA rahatA hai / ____3. bAhinya vimedArbuda ( naevo lipomata)-yahA~ vimedArbuda ke sAtha bAhinyarbudIya racanA bhI dekhI jAtI hai| zleSmArbuda ( Myxoma) yaha saMyojI Uti kA hI eka arbuda hai jisakI racanA garbhanAla sadRzna ( like umbilical cord ) hotI hai| yaha zuddha arbuda ke rUpa meM bahuta hI kama milatA hai| yojI UtiyoM meM zleSmAbha yA zliSIya vihAsa hone ke kAraNa hI yaha banatA For Private and Personal Use Only

Page #921
arbuda prakaraNa 837 hai / yaha sAdhAraNa aura duSTa donoM prakAra kA hotA hai / koI bhI nirdoSa arbuda jaba zliSIya vihAsa se yukta ho jAtA hai to usakA sadaiva artha usameM mArAtmakatA kI upasthiti meM hI kiyA jAtA hai / aNvIkSaNa karane para hArTanazleSmaka (wharton's (jelly) ke samAna isakI racanA dekhI jAtI hai / yojI Uti kI zAkhAe~ isa zleSmaka meM itastataH phailI huI pAI jAtI haiM / isa zleSmaka ko abhiraMjita bhI kiyA jA sakatA hai ' nAsA yA karNa ke dvArA vraNazodhAtmaka kaNanIya Uti kA jo strAva hotA hai, jo unake nIce kI asthiyoM meM pAka kA pariNAma hai, dekhane meM zleSmArbudIya padArtha sA hone para bhI pUrNataH bhinna vastu hai / isI prakAra kAcarIya vihAsa, zleSmAbha vihAsa athavA zlepAbha ( colloid ) vihAsa ke kAraNa bane padArtha bhI zleSmArbuda se bahuta hI bhinna hote haiM / racanA kI dRSTi se isake kozA koNIya tathA tArAkRtika ( stellate ) hote haiM jinake pravarddhanaka eka dUsare se milate hue hote haiM / kucha kozA svatantra bhI hote haiM / ve tarkurUpa, aNDAkAra, yA golAkRtika bhI dekhe jAte haiM / inakA antarkozIya padArtha pracura mAtrA meM hotA hai| vaha pUrNataH samarasa, mRdu, zliSIya, aura picchila ( viscid ) hotA hai aura usase bahulatA ke sAtha zleSmi ( mucin ) banatI haiN| isameM kitane hI kAmarUpAbha kozA pAye jAte haiM / isameM raktavAhiniyA~ bahuta nahIM hotIM ve saralatayA dekhI jA sakatI haiM aura pRthak kI jA sakatI haiN| kabhI kabhI pratyAstha kozA bhI dekhane meM Ate haiM / pratyakSa dekhane se zleSmArbuda zliSIya padArtha ke bane hote haiN| ve pANDura AdhUsara yA Arakta zveta varNa ke hote haiM / kaTe hue dharAtala se cipacipA lasadAra zleSmIya tarala nikalatA hai jisameM arbuda ke kozIya tatva pAye jAte haiM / zleSmArbuda samIpastha racanAoM se eka bahuta patale tAntava prAvara dvArA pRthak huA rahatA hai / isa prakAra se kaI paTiyA~ nikala kara ise kaI khaNDikAoM meM bA~Ta detI haiM / zleSmArbuda dhIre dhIre bar3hane vAlA eka nirdoSa arbuda hotA hai jo kAlAntara meM kAphI bar3A AkAra bhI dhAraNa kara letA hai / yaha prauDhAvasthA meM hone vAlI vRddhi hai / zleSmArbuda ke bheda anya arbudoM ke sAtha isake saMyoga ke AdhAra para banate haiM / sabase adhika milane vAlA zleSmavimedArbuda ( myxo-lipoma ) hotA hai / vaise zleSmasaMkaTArbuda, zleSmatanvarbuda, zleSmakAsthyarbuda aura zleSmagranthyarbuda bhI banate haiM / vizuddha zleSmArbuda bahudhA nahIM banatA / zleSmArbuda kI utpatti yojI Uti se hI hotI hai / vizeSa karake yaha upagIya yA upalasya sneha meM bahuta banate haiN| adhika upariSTha bhAgoM meM banane para ye sanAla ( pedunculated ) ho jAte haiM / upazleSmala athavA antarpezIya Uti meM bhI ye banate haiM / mastiSka meM bAlazleSa kI AkRti zleSmArbuda ke padArtha jaisI hI hotI hai| For Private and Personal Use Only

Page #922
838 vikRtivijJAna ataH kucha vyakti yahI samajhate the ki mastiSka meM jo bhI arbuda banate haiM ve sabhI zleSmArbuda hI hote haiM / aba aisA bhrama karane kA koI kAraNa nahIM hai| aisA hI eka bhrama karNa vA nAsA meM hue purvagakoM ke dvArA hotA rahA hai jisameM zaMkhAsthi yA jharjharAsthi meM jIrNa vraNazotha ke kAraNa utpanna kaNana Uti ko zleSmArbuda kA padArtha mAnA jAtA rahA hai| __ zleSmasaGkaTArbuda ke nAma se jo arbuda dekhe jAte haiM unameM vAstava meM saGkaTArbuda ke andara zliSIya vihrAsa (myxomatous degeneration) pAyA jAtA hai| kAsthya rbuda ( Chondroma ) kaMkAlIya uti (skeletal tissue ) se do prakAra ke arbuda banate haiM eka kAsthyarbuda jo kAsthi ke dvArA utpanna hotA hai aura dUsarA asthyarbuda jo asthi se banatA hai| jaba ve donoM mArAtmaka rUpa dhAraNa kara lete haiM to ve kAsthisaMkaTa ( chondro-sarooma ) athavA asthisaMkaTa (osteo-sarcoma) kahalAte haiN| kAsthyarbuda eka sAdhAraNa tathA nirdoSa prakAra kA arbuda hotA hai jo kAsthi ke dvArA banatA hai| yaha sparza meM kaThina raMga meM AnIla yA AnIladhUsara aura svAbhAvika kAcara ke samAna arddha pArabhAsaka hotA hai| yaha khaNDikAoM meM vibhakta aura prAvara se yukta hotA hai / yaha thor3A pratyAstha bhI ho sakatA hai| Upara se yaha cikanA hotA hai| isameM bahuta thor3I raktavAhiniyA~ pAI jAtI haiN| yaha pratyakSa dekhane se aisA lagatA hai ki mAno yA to yaha eka hI arbuda ho athavA kitane hI choTe choTe arbudoM ko eka jagaha milAkara eka banA diyA gayA ho| ise usake prAvara meM se saralatayA nikAlA jA sakatA hai| aNvIkSaNa karane para isameM aura kAcarakAsthi meM pharka yaha hotA hai ki isameM kozAoM kI AkRtiyA~ vividha hotI haiM aura ve eka eka karake viSamatayA vinyasta hote haiM jaba ki usameM ve jhuNDoM ke andara hote haiN| isake araktIya yA vAhinI. vihIna hone ke kAraNa isameM zliSIya bihAsa bahudhA laga jAyA karatA hai| prAyazaH yaha cUrNIyita bhI ho jAyA karatA hai| yaha arbuda taruNa vyaktiyoM kI lambI asthiyoM ke asthizirIya bhAgoM (epi. physeal ends ) kI kAsthiyoM se utpanna hotA hai| jaba asthi apanA bar3hanA banda kara detI hai tabhI kAsthi ke dvArA arbuda kA nirmANa bhI ruka jAtA hai usake bAda arbuda yA to cUrNIyita ho jAtA hai athavA asthIyita ho jAtA hai| ye arbuda hAthaparoM kI asthiyoM dvArA bhI bana sakate haiM / zroNi yA uraphalaka kI capaTI asthiyoM ke dvArA bhI inakA nirmANa hotA huA dekhA gayA hai| zroNi ke andara kAsthyarbuda apanA vizAlakAya rUpa dhAraNa kara le sakatA hai aura Age cala kara phira vaha saMkaTArbuda bhI bana jA sakatA hai| zrauNArbudoM ke andara yadyapi kAsthi mila sakatI hai parantu kAsthyarbuda aura isameM For Private and Personal Use Only

Page #923
kAsthyarbuda pRSTha 838 Acharya Shri Kailassagarsuri Gyanmandir isa citra meM kozAoM kI AkRtiyA~ viSama haiM tathA unakA vinyAsa viSama dikhalAI de rahA hai / For Private and Personal Use Only

Page #924
arbuda prakaraNa 836 bahuta antara hai / vRSaNoM ke athavA lAlAgranthiyoM ke bhrauNArbuda meM kAsthi pAI jAtI hai / ina kAsthyarbudoM meM vihAsAtmaka parivartana bahudhA pAye jAte haiN| ye parivartana mukhyatayA cUrNIyana tathA asthIyana ke hote haiM / ye parivartana itane adhika dekhane meM Ate haiM ki sampUrNa arbuda eka asthyarbuda yA cUrNIyita tantupezyarbuda sarIkhA lagatA hai / kabhI-kabhI taralIya UtinAza ho jAtA hai jisake kAraNa isameM koSTako - tpatti hotI huI dekhI jAtI hai / kAsthyarbuda bahuta karake saMkaTArbuda meM pariNata hote dekhe gaye haiM / jaba taka yaha pariNati nahIM hotI taba taka eka mahattva kI bAta yaha hotI hai ki jisa asthi meM kAsthyarbuda banatA hai usakI asthimajjA taka asthibheda karake vaha nahIM pahu~catA / saMkaTArbuda bana jAne para asthimajjA taka usakA prasAra ho jAtA hai tathA taba vaha apane rUpa meM bhI nahIM rahatA / " kAsthyarbuda kI sUkSma racanA para punarvicAra karane se aisA lagatA hai ki mAno isameM svAbhAvika kAsthi kA hI upayoga huA ho / usakA antarkozIya padArtha kAcara, tAntavayA zliSIya kaisA hI ho sakatA hai / bahudhA yaha kAcara kAsthIya hI ho hotA hai / antara itanA hI hai ki isake kozA alaga-alaga bikhare hue hote haiM jaba ki usake samUhoM meM milate haiM / kozA golA tarkurUpa, tArAkRtika kaisI hI AkRti ke ho sakate haiM / ve adhikasaMkhya bhI mila sakate haiM tathA alpa saMkhyA meM bhI vAye jA sakate haiM isakA koI niyama nahIM hai / tAntavarUpa meM to kozA choTe aura yojI Uti jaise hote haiM / kAcarIyarUpa meM ve bar3e tathA gola yA aNDAkAra hote haiM / zliSIya ( myxomatous ) rUpa hone para jo bahuta kama banatA hai ve tArAkRtika (stellate ) tathA zAkhAoM se yukta ( branched ) hote haiM / aise kozA una antarvartI kozAoM se adhika milate haiM jo sandhiyoM meM sandhAyI kAsthiyoM ke kinAre para jahA~ sandhikalA samApta hotI hai pAye jAte haiM / I kAsthyarbuda ke drutagAmI rUpoM meM zleSma kAsthyarbuda, asthikAsthyarbuda tathA kAsthisaMkaTAda adhika bar3e, adhika mRdula aura adhika raktavAn ( vascular ) hote haiM / ve sAdhAraNatayA zuddha kAsthi se bhinna rUpa ke bhI pratIta hote haiM / Upara hamane likhA hai ki cUrNIyana aura asthIyana ye do parivartana isa arbuda meM khAsa karake pAye jAte haiM / ina donoM meM cUrNIyana bahuta adhika hone vAlA dvitIyaka parivartana hai / yaha adhikatara kAsthyarbudoM ko prabhAvita karatA hai / aMguliparvAsthiyoM tathA hastazalAkAoM meM cUrNIyana hI hotA hai / yaha kaI kendroM se Arambha hotA hai / pahale yaha prAvara meM utpanna hokara phira antarkozIya padArtha ( inter-cellular substance ) taka calA jAtA hai / asthiyoM ke siroM para utpanna kAsthyarbudoM meM asthIyana adhika hotA hai / pAdAMguSTha ke nIce jo asthIyana pAyA jAtA hai vaha kisI tanvarbuda, kAsthyarbuda yA tantukAsthyarbuda meM hI hotA huA mAlUma par3atA hai / zleSmAbha mArdava For Private and Personal Use Only

Page #925
840 vikRtivijJAna aura koSThakotpatti kI ora iMgita hama kara hI cuke haiN| kabhI-kabhI kAsthyarbuda ke Upara kI tvacA sar3a jAtI hai aura eka kavakAnvita puMja bana jAtA hai| kAsthyarbudoM ke prakAra antarkozIya padArtha kI vividhatA para nirbhara karate haiN| yaha padArtha tAntava, kAcara, zliSIya kaisA hI ho sakatA hai| eka hI arbuda meM bhI ve tInoM eka sAtha pAye jA sakate haiM / niyama yaha hai ki jo asthimajjA ke pAsa se nikalate haiM ve kAcara aura zliSIya tathA anya sthiti meM utpanna hone vAle bahudhA tAntava hote haiN| jo tAntava prakAra zIghra bar3hatA hai yaha kAsthisaMkaTa (chondroisarcomata) banatA hai tathA jo zliSIya rUpa rakhatA hai vaha zleSmakAsthyarbuda (myxo-chondroma ) bana kara raha jAtA hai| kabhI-kabhI eka hI arbuda meM asthisaMkaTa tathA zleSmakAsthyarbuda donoM hI pAye jAte haiN| kAsthyarbudoM kA utpattisthala asthi hotI hai jo tIna cauthAI pramANa meM upalabdha hotI hai| asthi meM isake do sthAna haiN| eka kendra se jise antaHkAsthyarbuda (enchondroma ) aura dUsarA paryastha ke nIce se jise bahiHkAsthyarbuda ( ecchondroma) kahate haiN| __ asthiyoM meM jaba taka vRddhi karane kI kSamatA rahatI hai aura unameM pracura parimANa meM raktapUrti hotI rahatI hai, asthi padArtha ke bIca-bIca meM kAsthi kI dvIpikAe~ bichI rahatI haiN| inhIM kAsthi dvIpoM meM hI kAsthyarbuda kA vikAsa hotA hai|| kAsthyarbuda hAtha pairoM kI aMguliyoM, aurvI asthi ke nicale bhAga, pragaNDAsthi jaMghAsthi ke UparI siroM se adhikatara utpanna hotA hai / vaise paryukAoM tathA zroNi kI asthi meM bhI yaha banatA hai| naidAnika dRSTi se kAsthyarbuda ke do vibhAga kiye jAte haiM eka ko ekala prakAra kahate haiM jisameM bahiHkAsthyarbuda kA samAveza hotA hai, yaha lambI asthi kI kisI kAsthIya dvIpikA dvArA asthi ke upariSTa dharAtala para banatA hai, yaha asthi ke sire para yA paryukIya kAsthi (costal cartilage ) meM banatA hai| asthi yA pazukA donoM meM koI sambandha vizeSa nahIM rhtaa| isakI asthizirIya kAsthi se bhI koI sambandha nahIM hotaa| ye arbuda bar3e kaThina hote haiM tathA khaNDikAyukta hote haiN| ye asthi ke sAtha lage rahate haiM aura jaba taka kisI vAtanADI ke dabAne meM kAraNa baneM, sarvathA vedanAvihIna hote haiN| inakA AkAra bahuta bar3A ho sakatA hai| kabhI-kabhI to ve eka phuTabAla (pAdakanduka ) ke barAbara bhI bar3e dekhe jAte haiM, aisI avasthA meM dabAva ke dvArA aMga ko vikRta karanA, samIpastha UtiyoM yA racanA kI apuSTi karanA yA aMga ke hilane-Dulane meM kaThinAI karanA sambhava ho sakatA hai| ye sadaiva saMkaTArbuda kA rUpa dhAraNa kara liyA karate haiN|| dUsare ko bahuvidha ( mutiple ) prakAra kahate haiM isameM antaHkAsthyarbuda kA samAveza kiyA jA sakatA hai| ye sadaiva choTI hAtha pairoM kI asthiyoM meM hote haiM / arbuda asthi ke bhItara chidriSTha Uti ( cancellous tissue ) meM asthi zira ke For Private and Personal Use Only

Page #926
arbuda prakaraNa 841 samIpa banatA hai| isake kAraNa choTI-choTI haDDiyA~ apanI svAbhAvika AkRti chor3a kara gAjara yA mUlI ke samAna phUlI huI ho jAtI haiN| kAsthisaMkaTa ( chondro sarcoma)-kAsthyarbuda jaba badalakara saMkaTArbuda kA rUpa dhAraNa karatA hai to vaha kAsthisaMkaTa kahalAtA hai| yaha asthi ke dvArA yA kAsthi ke mArAtmaka vihAsa ke pariNAmasvarUpa banatA hai| yaha dratagati se bar3hatA hai aura bar3A kAsthIya puMja banatA hai jo prAyaH zlipIya hotA hai| isameM kAsthyarbuda kA AnIla varNa aura arddhapArabhAsakatA barAbara pAI jAtI hai| vAhinIyatA isameM adhika hotI hai| yaha sthAnika UtiyoM para AkramaNa karatA hai aura sirAoM taka pahu~ca jAtA hai jinameM hokara anya pradezoM ko vizeSa kara phuphphusoM ko visthAya pahu~ca jAte haiN| autikIya dRSTi se kAsthyarbuda aura kAsthisaMkaTa meM bahuta pharka nahIM hotaa| phira bhI kAsthisaMkaTa meM vAhiniyoM aura kozAoM kI kAsthyarbuda kI apekSA adhikatA pAI jAtI hai| asthi tathA stana ina do sthaloM meM kAsthyarbuda kA varNana vizeSakara AtA hai| asthi ke andara yA bAhara banane vAle kAsthyarbudoM kA varNana ThIka ThIka pIche kiyA jA cukA hai ki ve asthizirIya kAsthi se yA asthi kSetra meM vyApta kAsthibhAgoM meM banate haiM ve bAlakoM yA bar3oM meM taba taka banA karate haiM jaba taka unakI vRddhi, banda nahIM ho jaatii| ve hArthoM aura pairoM kI choTI asthiyoM meM bahutAyata se hote haiN| bar3e bar3e ekala kAsthyarbuda aMsaphalaka, zroNi phalaka, aurvI asthi kI grIvA Adi meM banate haiN| inameM zliSIya vihAsa aura koSThotpatti dekhI jA sakatI hai| inameM mArAtmaka parivartana hone se inakA kAsthisaMkaTa meM bhI rUpAntara dekhA jA sakatA hai| aise parivartana aNvIkSa kI apekSA zastrakarma se adhikatayA spaSTa ho sakate haiN| stana meM kAsthyarbuda bana sakatA hai para milatA bahuta kama hai| yaha smaraNIya hai ki svAbhAvika kAsthiyA~ zarIra meM vividha sthAnoM aura aMgoM meM milatI haiM para vahA~ unameM kAsthyarbudotpatti karane kI kSamatA dikhalAI nahIM detii| asthiyoM ke andara hI jo kAsthi ke kSetra apragalbha rUpa meM raha jAte haiM ve asthi ke rUpa meM parivartita honA bhUla kara kAsthirUpa meM hI bar3hane lagate haiN| yaha vRddhi amaryAdita aura zarIra ke svAbhAvika vikAsa ke viparIta hone se hAniprada hotI hai aura kAsthyarbuda ke nAma se pukArI jAtI hai| asthya buda ( Osteoma) asthyarbuda pUrNataH nirdoSa arbuda hote haiN| inakA nirmANa bhI kAsthyarbuda kI bhA~ti kaMkAlIya Uti dvArA hotA hai| ye sahaja ( hereditary ) aura bahuvidha bhI hote haiM aura taba ve bAlyakAla meM hI dRggocara ho jAte haiN| asthyarbuda asthi ke dvArA bane hote haiN| yA yoM kahie ki jahA~ kahIM kisI bhI uti kA asthIyana ho jAtA hai vaha asthyarbuda ke nAma se pukArI jAne lagatI hai| isI se navanirmita yojI Uti ke pariNAma kA nAma hI asthyarbuda hai aisA bhI vidvAnoM kA kathana hai| 71, 72 vi0 For Private and Personal Use Only

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842 . vikRtivijJAna asthyarbuda kA asthipadArtha donoM prakAra kA pAyA jA sakatA hai-eka jo saMghana ( compact ) yA hastidanta ( ivory ) ke samAna kahalAtA hai aura dUsarA jise chidriSTha ( cancellous ) kahA jAtA hai / inhIM do prakAroM ke AdhAra para asthyarbuda bhI do prakAra kA hI hotA hai| saMghana yA hastidanta asthyarbuda sadaiva asthi ko paryastha se utpanna hotA hai| yaha sAdhAraNatayA karoTi ( skull ) ke bAhya yA Antara dharAtala se prakaTa hotA hai| akSiguhA usakA eka priya sthala hai| inake atirikta aMsaphalaka, zroNiphalaka tathA Urdhva aura adho hanvasthiyoM meM bhI yaha mila sakatA hai| hanuoM meM yaha dantaparyastha se utpanna hotA hai aura dantAsthyarbuda ( dental osteoma) kahalAtA hai| saMghana asthyarbuda jisa asthi se utpanna hotA hai usase sAtatya rakhatA hai / yaha vistRta AdhAra yukta, golAI lie hue, kama U~cA aura cikanA hotA hai jisake Upara paryastha usI prakAra car3hI hotI hai jisa prakAra kisI anya asthi para car3hI ho| samIpa kI Uti kI apekSA yaha paryApta spaSTa hotA hai| aNvIkSaNa karane para eka hastidanta asthyarbuda ke asthipatra ( lamellae ) saMkendra vinyasta (concentrically arranged ) hote haiN| ye asthipatra arbudIya dharAtala ke samAnAntara hote haiN| isameM chidriSTha uti kA abhAva hotA hai aura haivarsiyana kAnAla choTe aura kama hote haiN| __chidriSTha asthya rbuda yaha asthyarbuda kA dUsarA prakAra hai| isakI racanA dekhane se aisA mAlUma hotA hai mAno kAsthyarbuda kA hI asthIyana ho gayA ho kyoMki isakI utpatti lambI asthiyoM ke asthizirIya bhAga tathA asthidaNDa ke saMgama se hotI hai| yaha aurvI asthi ke nicale bhAga meM yA pragaNDAsthi aura jaMghAsthi ke UparI bhAga meM vizeSa karake banatA hai| yaha paryApta Age ko nikalA huA thor3A yA bahuta sazAkha hotA hai aura jaba taka isameM bar3hane kI kSamatA rahatI hai taba taka isake Upara kAsthi kI eka TopI car3hI hotI hai| jaba yaha TopI bhI asthIyita ho jAtI hai tabhI isa arbuda kI vRddhi ruka jAtI hai| kaTe hue kSetra ko dekhane se patA lagatA hai ki yaha arbuda asthi ke usa bhAga se sAtatya rakhatA hai jahA~ se isakI utpatti hotI hai / yaha cAroM ora saMghanita asthi ke eka patale stara dvArA AvRta rahatA hai| usake bhItara ke majakIya avakAza meM bhrauNikIya, tAntava yA snaihika Uti kA vAsa rahatA hai| asthyarbuda meM tathA sAdhAraNa kAsthi ke svAbhAvika rUpa meM asthIyita ho jAne meM bahuta antara hotA hai| paryukIyakAsthi, svarayantrIya kAsthiyA~ Adi samaya pAkara asthIyita to ho jAtI haiM parantu ve asthyarbuda bana jAtI hoM aisA nhiiN| sandhipAka yA anya vraNazothAtmaka sthitiyoM meM kabhI kabhI sandhiguhA athavA asthiyoM meM asthIyana kA kSetra bar3ha jAtA hai| vaha bhI asthyarbuda se bhinna vastu hai aura usakA dhyAna pratyeka vaikArikI vizArada ko rakhanA Avazyaka hai| kahIM kahIM kisI kisI sthala kA cUrNIyana ho jAtA hai para asthi nahIM bntii| aisI dazAoM aura asthyarbuda meM bhI antara samajhe rahanA Avazyaka hotA hai| For Private and Personal Use Only

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arbuda prakaraNa 843 asthyarbuda kI vRddhi jaba bAhara kI ora hotI hai to vaha bahirasthyutkarSa (exostosis ), jaba andara kI ora hotI hai to antarasthyu tkarSa ( enostosis) aura jaba chidriSTha Uti ke andara hI asthyarbuda chipA rahatA hai to vaha kendriya asthyarbuda ( central osteomata ) kahalAtA hai| ___ asthyarbudoM meM vraNapAka bhI ho sakatA hai aura unameM atinAza bhI dekhA jA sakatA hai| saMghana bahirasthyutkapa meM azitAsthi ( carious bone) dekhI jA sakatI hai| asthyazana ke kAraNa asthyarbudIya bhAga pRthak ho jAtA hai aura ArAma ho jAtA hai| asthi ke paryastha bhAga, majakIyabhAga yA kAsthIya kSetra jo usameM pAye jAte haiM asthyarbuda ke lie prabhavasthala kA kArya karate haiN| kabhI kabhI yojI Uti ke anya arbuda bhI asthIyita hokara asthyarbuda banA dete haiN| pRSThavaMza kI kazerukAoM meM athavA karoTi meM asthyarbuda banate hue dekhe jAte haiN| karoTi meM saMghana prakAra bahuta adhika milatA hai para chidriSTha prakAra bhI mila jAtA hai| yaha adhohanu aura karoTimUla ( base of the skull ) meM milatA hai| saMghanAsthyabuMda kA nirmANa karoTi ke una bhAgoM meM bahuta karake hotA hai jo jJAnendriyoM ( sepecial sense organs) ke pAsa hote haiN| UparI dharAtala para yA nicale tala para kidhara hI asthyarbuda karoTi meM banA karatA hai| ye asthIyana kendroM ( centres of ossification ) ke pAsa prAyaH utpanna hote haiN| inakI vRddhi bahuta manthara gati se hotI hai| ve vedanAvirahita aura prastarasama kaThina aura cikane hote haiN| jaba ve andara kI ora ugate haiM to mastiSkaguhA meM pIDana ke kAraNa kSobha yA saMpIDana ( compression ) kara dete haiN| pIDana kA prabhAva zIrSaNyA nADiyoM para bhI par3a sakatA hai| (3) pezI-ti ke arbuda ( Muscle-Tissue Tumours ) pezyarbuda ( myoma ) sAdhAraNatayA do prakAra kA hotA hai| eka ko rekhita pezyarbuda (rhabdomyoma ) aura dUsare ko arekhita pezyarbuda ( Leomy. oma. ) kahA jAtA hai| rekhita pezyarbuda-yaha bahuta kama pAyA jAne vAlA arbuda hai| isameM rekhita pezI ke dvArA hI arbuda banatA hai jaisA ki AzA kI jAtI hai aicchika pezI meM yaha nahIM miltaa| eka vizuddha rekhita pezyarbuda kI utpatti hRdaya taka hI sImita rahatI huI. batalAI jAtI hai| sampUrNa arbuda ko dekha kara vaha pUrNa vikasita pezI ke dvArA hI banatA hai yaha kahanA bhI yuktiyukta nahIM dikhalAI detaa| arbuda ke bahuta se kozA to pUrNataH aparipakvAvasthA ( immature stage ) meM hote haiN| unheM pezIruha ( myo.. For Private and Personal Use Only

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844 vikRtivijJAna blasts ) kahate haiN| isI kAraNa ye arbuda bahudhA ghAtaka yA mArAtmaka rUpa dhAraNa kara lete haiM jinheM pezIruhArbuda ( myoblastoma ) kahate haiN| ina bahuta hI kama pAye jAne vAle arbudoM kI prApti mizritaarbudoM meM bahudhA pAI jAtI hai| vRkka tathA vRSaNoM meM prasavottarakAlIna bhrauNa padArthoM ke vikAsa ke sAtha rekhita pezI bhI bar3ha kara pezyarbuda kA rUpa le letI hai| hRtprAcIra meM eka sahaja pezyarbuda ke rUpa meM jaba kabhI bhI yaha utpanna hotA hai taba usakA sambandha adhivRkkIya arbudoM tathA mastiSka jAraThya ( cerebral sclerosis ) se ho jAtA hai| arekhitapezyarbuda-yaha cikanI pezI (smooth muscle) kA arbuda hai| yaha pezI zuddha rUpa meM kabhI arbuda kA nirmANa nahIM karatI api tu usameM bahuta sI yojI Uti bhI sammilita rahatI hai / yaha eka nirdoSa arbuda hotA hai| yaha arbuda garbhAzaya meM bahuta adhikatA se pAyA jAtA hai / isakA svarUpa tAntava hone ke kAraNa ise tanturUpa (fibroid ) kaha kara pukArA jAtA hai jisakA vistRta vivaraNa hama tantupezyarbuda ke rUpa meM tanvarbuda ke varNana ke sAtha kara cuke haiN| ye santAnotpatti kAla meM adhika hote haiN| isI kAraNa yauvanArambha se pUrva aura rajonivRttikAla ke pazcAt ve nahIM milate haiN| ve akele na hokara bahuta se eka sAtha hote haiN| yaha Azcaryajanaka hai ki arekhita. pezyarbuda zarIra ke anya bhAgoM meM jahA~ arekhita pezI paryApta hotI hai nahIM pAye jAte haiM / vaise ye bIjakoSa, garbhanAla, aura pakSabandhanI snAyu ( broad ligament ) meM banate haiN| mahAsrota meM ye bahupAdIya puMja ( polypoidal masses ) banA lete haiN| basti aura gavIniyoM ( ureters ) meM bhI ye bana sakate haiN| raktavAhiniyoM kI pezIprAcIra para inakA nirmANa nahIM hotaa| ___ arekhita pezyarbuda kA aNvIkSaNa karane para usameM arekhita pezI (plain musole) ke eka dUsare se baMdhe sUtra samUha dekhe jAte haiM jo tAntava Uti ke vividha padArtha dvArA pRthaka hue rahate haiN| tarkakozIya saGkaTArbuda tathA isake kozAoM meM antara karanA kaThina hotA hai phira bhI vibhajanAoM ke abhAva lambI daNDasama ( rod like ) nyaSTi se arekhita pezyarbuda pahacAnA jA sakatA hai| pratyakSadarzana yA sthUladRSTi se dekhane para arekhita pezyarbuda eka tanvarbudake samAna dikhalAI detA hai| isakA AkAra sadaiva eka sA nahIM rhtaa| vaha atyanta sUkSma bhI ho sakatA hai aura bahuta vizAla bhI dekhA jA sakatA hai / yaha kaThina aura dRr3ha hotA hai, cAroM ora se bhalIbhA~ti prAvarita hotA hai isa kAraNa AsAnI se ucchedya hotA hai / kaTe hue kSetra ko dekhane se eka viziSTa bhramipUrNa ( whorled ) sampUrNa dharAtala dRSTigocara hotA hai| isakA kAraNa yaha hai ki vibhinna dizAoM meM baMdhe tantu kaI pRSThoM (planes ) meM kaTa jAte haiM aura zramiyukta rUpa banA lete haiN| ___ isa arbuda meM vihAsAtmaka parivartana bahudhA hote haiN| inameM kAcarIya vihAsa, zleSmAbha ( mucoid ) vihAsa mRdulana aura kabhI kabhI pUrNa cUrNIyana isameM dekhA jAtA hai| For Private and Personal Use Only

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zoNavAhinyarbuda pRSTha 845 Acharya Shri Kailassagarsuri Gyanmandir yaha kezikIya zoNavAhinyarbuda kA citra hai / For Private and Personal Use Only

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arbuda prakaraNa 845 kabhI kabhI arbuda kA eka bhAga mArAtmaka svarUpa dhAraNa kara letA hai / use mArAtmaka pezyarbuda yA arekhita pezisaGkaTArbuda kahA jAtA hai / usakI nyaSTiyA~ adhika bar3I, kozA adhika sakriya aura vibhajanAGkoM se yukta milate haiM / ina arbudoM se visthAya kabhI nahIM banA karate tathA eka bAra ucchedita kara dene para unakI punarutpatti bhI hotI huI nahIM dekhI jAtI / pezIruhArbuda (myoblastoma ) -- isakA thor3A varNana hama rekhitapezIya arbuda ke samaya kara cuke haiN| isakA prAcInatama varNana san 1926 kA hai / usake bAda agale 8 varSoM meM 50 aura arbuda aise dekhe jA cuke haiN| isakI utpatti ke sAmAnya sthala jihvA, svarayantra aura tvacA rahate haiM / inake atirikta yaha oSTha, annapraNAlI ke UparI bhAga aura TA~ga meM bhI pAyA jA sakatA hai / isake kozA bahubhujIya hote haiM tathA isameM uccakaNIya kozArasa pAyA jAtA hai / kaNIya kozA rasa ( granular cytoplasm ) ke sAtha sAtha paTTikAvat saMkozapuMja ( ribbon-like syncitial masses ) bhI pAye jAte haiM / isameM anuprastha rekhana ( cross striation ) nahIM hotA / yaha bhI sandehAspada hai ki ye arbuda pUrvaja pezIruhoM dvArA banatA hai jaisA ki sarvasAdhAraNa mata Aja pracalita hai kyoMki jahA~ rekhita pezI kA nAma nizAna nahIM vahA~ bhI ye dekhe jAte haiM / dUsare ye bilkula nirdoSa hote haiM jaba ki arekhitapezi saMkaTArbuda ghAtaka prakAra kA arbuda hotA hai / ( 4 ) vAhinI arbuda ( Angioma ) kisI bhI vAhinI ke dvArA banA arbuda vAhinIya arbuda yA vAhinyarbuda kahalAtA hai / ye vAhinI zoNavAhinI yA raktavAhinI ( blood vessel ) bhI ho sakatI hai aura savAhinI (lymphatic ) bhI ho sakatI hai / zoNavAhiniyoM meM arbuda bana jAne para zoNavAhinyarbuda ( haemangioma ) kahalAtA hai tathA lasavAhinI meM savAhinyarbuda (lymphangioma ) kahalAtA hai / kezikAoM ke arbuda ko kezikAvAhinyarbuda ( capillary angioma ) kahA jA sakatA hai / zoNavAhinyarbuda ( haemangioma ) eka zoNa vAhinyarbuda kA artha raktavAhinI kI eka navIna racanA | yaha do prakAra kA hotA hai- 1. kezikIya aura 2 srotasIya vAhinyarbuda ( cavernous angioma) kezikIya vAhinyarbuda -- meM navanirmita raktapUrNa kezAloM kA jala bana jAtA hai / arbudavAhinI eka khaNDa para hI prabhAva DAlatA hai / usI khaNDa se antazchada kI kalikAe~ ugane lagatIM tathA kezAla vA kezikAoM kA nirmANa karane lagatI haiM / isa prakAra kezikAoM yA vAhiniyoM kA eka banda saMsthAna bana jAtA hai / eka bhAga kI vAhiniyoM kA visphAra ( telangiectasis ) isase sarvathA pRthak avasthA kA nAma hai / ye kezikA usa bhAga se nikalatI haiM jo eka alpavikasita vAhinIbhAga mAtra For Private and Personal Use Only

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vikRtivijJAna hotA hai| isa kAraNa jo puJja yA arbuda banatA hai usakA sArvadaihika raktaparibhramaNa se koI mahattva kA sambandha nahIM rahatA aura isa kAraNa usameM rakta kI mAtrA atyalpa hotI hai| isI se usake dvArA hone vAlA raktasrAva bhI koI bahuta mahattva kA yA gambhIra svarUpa kA nahIM hotaa| bvAyaDa kA kathana hai ki vikiraNa ke dvArA isa saMsthAna ko abhilupta kiyA jA sakatA hai kyoMki vikiraNa abhilopI dhamanI antazchadapAka ( obliterative endarteritis) utpanna kara detA hai| isameM antazchadIya kozA kAphI bar3e aura phUle hue hote haiM aura kaI stara gahare hote haiN| antazchadIya kozAoM kA praguNana kabhI kabhI to itanA adhika hotA hai ki vAhinI kA suSiraka avaruddha ho jAtA hai jisase kozAoM ke saghanapuMja banane lagate haiN| aisI avasthA ko zoNavAhinyantazchadArbuda ( haemangio-endothelioma ) kahate haiM yA kevala antazchadArbuda mAtra kaha dene se bhI kAma cala jAtA hai| naye kozA isameM bhramiyoM meM vinyasta hote haiN| kezikIya vAhinyarbuda tvacA meM bahadhA banate haiM aura isake kAraNa svagdharAtala para camakadAra lAlavarNa kA sidhma bana jAtA hai| yaha eka sahaja avasthA hotI hai jo janma ke sAtha sAtha utpanna hotI hai / yaha paryApta kSetra meM vyApta mila sakatI hai| mukha yA sira kI tvacA meM yaha prAyazaH milatA hai| vaise yaha kisI bhI aMga meM mila sakatA hai| mukha para yaha paJcamIzIrSaNyA nAr3I kI zAkhA prazAkhAoM kI dizAoM meM kevala eka hI ora phailA rahatA hai| ina tvagvAhinyarbudoM ko prasavakAlIna cihna mAnA jAtA hai| inako nyaccha' ( neavi ) bhI kahA jAtA hai| kezikIya vAhinyarbudoM kI utpatti zleSmala kalAoM para bhI dekhI jA sakatI hai| nAsA, dantamAMsa, oSTha, gudAdi kI zleSmalakalAoM meM jaba yaha utpanna ho jAtA hai to ina aMgoM se paryApta raktasrAva hone kI AzaMkA rahatI hai| inake mRdu baiMganI raMga ke saralatayA pahacAne jAne vAle sidhma bana jAte haiN| jihvA meM sthUlajihvatA ( macroglossia ) nAmaka avasthA bhI isI ke kAraNa bana jAtI hai / Antra meM aneka zoNavAhinyarbuda eka sAtha bana kara Antra se raktasrAva karA dete haiN| ___ vAhinyarbuda asthi tathA mastiSka meM bhI bana sakate haiN| asthi meM ve ativRkkArbuda se milate julate hote haiM / aiksare citraNa se asthi kA pracUSaNa dekhA jA sakatA hai| kucha vAhinyarbudoM meM pratIpagAmI parivartana dekhane meM Ate haiN| una parivartanoM kA mukhya kAraNa tantUtkarSa hotA hai| aisI dazA meM kezikAe~ abhilupta ho jAtI haiM para itastataH bikhare hue antazchadIya kozAoM ke samUha pAye jAte haiM / isake kAraNa bahane vAle rakta yA raktasrAva se prApta rakta ke dvArA bane vimedAbha padArtha ( lipoid material ) tathA zoNAyasi ( haemosiderin ) pAye jAte haiN| ye donoM padArtha bhakSi antazchadIya kozAoM ke garbha meM bhI dekhe jA sakate haiN| antazchadIya kozAoM ke 1. dekheM pRSTha 856 / For Private and Personal Use Only

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arbuda prakaraNa 847 sammUhana se bAhya padArtha mahAkozA ( foreign body giant cells ) bhI bana jA sakate haiN| tvacA ke arbudoM meM rakta ke raMgA kI adhikatA hone se ve kAlyarbuda karake bhI bhrama se lie jA sakate haiN| para cUMki kAlyarbuda ke kAli ke kaNa choTe gola aura adhika ekase hote haiM aura isake kaNa usakI apekSA adhika bar3e aura viSamAkRtika hote haiM isase donoM ko pahacAnane meM kAphI saralatA ho jAtI hai| srotasIya vAhinyarbuda-isa prakAra ke vAhinyarbuda bahuta hI kama pAye jAte haiN| ye rakta ke bar3e bar3e avakAzoM ( blood spaces ) ke dvArA banate haiM jinake bhItara antazchada kA staraNa huA rahatA hai / yakRt isa arbuda kI mukhya krIDAbhUmi hai| yakRt meM ve aneka ho sakate haiM para ve bar3e bahuta hI kama hote haiM / bvAyaDa eka aise rogI kA ullekha karatA hai jisake vAma yakRtkhaNDa meM eka bahuta bar3A srotasIya vAhinyabuMda thA jisakA pahale se koI jJAna nahIM hone se zastrakarma karate samaya vaha vidIrNa ho gayA aura rogI meja para kucha hI minaToM meM mara gyaa| yakRt ke atirikta oSTha, akSiguhA, plIhA, upasvagIya Uti aura pezI meM bhI yaha ho sakatA hai| ina srotasoM meM dhamaniyA~ sIdhI sIdhI bhI kabhI kabhI khulatI haiM aura unameM paryApta rakta bhara detI haiN| ye arbuda prasara yA parilekhita donoM prakAra ke mila sakate haiN| jaba yaha sahaja rUpa meM hote haiM jo liNDau ke roga ( Lindau's disease ) meM dekhe jAte haiM to ve sarvakiNvI, nimastiSka, dRSTipaTala ( retina ), suSumnA Adi aMgoM meM bhI srotasIya vAhinyarbuda banate haiN| ___ antazchadIya kozA vAhinyarbuda kA pramukha kozA huA karatA hai tathA usakI racanA kA ekaka koI raktavAhinI yA lasIkAvAhinI hotI hai| sAdhAraNatama vAhinyabuMda ke andara vAhinI khulI ( patent) hotI hai| isameM lasIkA vA rakta pAyA jAtA hai tathA antazchada kevala ekakozIya stara kA banA hotA hai| jaba antazchada meM paramacaya adhika hotA hai taba kaI kozA milakara suSiraka kA mukha ghera lete haiM jisake kAraNa supiraka khulA huA nahIM dikhalAI diyA krtaa| vAhiniyoM ke andara kahIM kahIM kozAoM ke aise samUha dekhe jA sakate haiN| inako kozIya vAhinyabudikA ( cellular angiomata) kahA jAtA hai| isa dazA meM zoNavAhinIya antazchadArbuda se lekara atimArAtmaka vAhinyaruhArbuda ( angioblastoma ) taka sabhI zreNI ke arbuda mila sakate haiN| kezikIya yA srotasIya donoM prakAra ke vAhinyarbuda bhrauNa dINoM ( embryonic clefts ) ke samIpa pAye jAte haiN| jaba ye dIrNa nahIM hote taba ye vAtanADiyoM ke vibhAjana ke mArga ke sAtha sAtha milate haiM / tvagIya vAhinyarbuda ( carmakIla yA nyaccha) paJcamI zIrSaNyA nADI kI eka zAkhA ke vibhajana ke sAtha sAtha pAyA jAtA hai| parantu grIna kA kathana hai ki anekoM sthaloM para vAhinyarbuda uparyukta niyamoM ko pAlana karane ke lie bAdhya nahIM kiyA jA sakatA aura bhrauNa dIreM yA nADI vibhAgoM ke atirikta bhI adhikAdhika saMkhyA meM dekhA jA sakatA hai| For Private and Personal Use Only

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848 vikRtivijJAna vAtavAhinyabaMda yA golArbuda (glomus tumour )-ye arbuda autikIya dRSTi se vAtanAr3I tantuoM tathA vAhinIya antazchadIya kozAoM dvArA banate haiN| kabhI kabhI unameM vAhinI kI racanA itanI bana jAtI hai ki unheM pahacAnA jA ske| ise 'glomeliomA' (glomangioma) bhI kahA jAtA hai| gloma gola ke lie eka laiTina zabda hai ataH ise golavAhinyarbuda ke nAma se bhI pukArA jA sakatA hai| ye choTe gola sAdhAraNa arbuda hote haiM / ye bahudhA zAkhAoM ( extremities ) meM hote haiN| ye atyanta vedanAdAyaka aura manthara gati se utpanna hone vAle granthaka hote haiN| kATane se vedanA jAtI rahatI hai| inakI punarutpatti nahIM huA krtii| inakI utpatti agrabAhu para adhikatara hotI hai / aMguliyoM meM nakhoM ke nIce ye bahudhA milate haiN| ye arbuda vAtanAr3I-vAhinIya usa kalAvinyAsa ( mechanism ) se utpanna hote haiM jo svacA meM raktapravAha kA niyantraNa karatA hai| ise dhamanIsirIyasaMgama (arterio-venous shunt) bhI kaha sakate haiN| isameM rakta dhamaniyoM se sIdhA sirA meM calA jAtA hai / yaha sthala bar3e bar3e adhicchadAbha gola (glomasa) kozAoM dvArA starita hotA hai / yahA~ anaicchika pezItantuoM kA bhI paryApta jamAva rahatA hai tathA bahuta se avimajikaMcuka (nonmedulated ) vAtanADI tantu kozAoM ke bIca se hokara jAte rahate haiN| adhicchadAbha kozA tarkurUpa anaicchika pezIka kozAoM se dhamanI yA sirA meM mila jAte haiN| ye jhimaramaina ke parikozAoM (pericy tes of Zimmer mann ) dvArA utpanna hote haiM jo sampUrNa zarIra meM kezikAoM ke cAroM ora lipaTe rahate haiM aura anaicchika pezIka tantuoM meM samApta ho jAte haiN| yaha sampUrNa kalAvinyAsa vAtanADI pezIya dhAmanika gole ko banAtA hai jo zAkhAoM meM rakta paribhramaNa kA niyantraNa karake sthAnika tApAMza ko maryAdita karatA rahatA hai| maisana ne 1922 I. meM isa kalAvinyAsa meM utpanna hone vAle ina arbudoM kI khoja kI thii| lasavAhinyarbuda ( Lymphangioma ) jitanA zoNavAhinyarbuda milatA hai usakI apekSA yaha bahuta kama pAyA jAtA hai| zoNavAhinyarbuda kI taraha yaha bhI eka sahaja ( congenital ) vyAdhi hotI hai| yaha arbuda sthAnika aura prasara donoM prakAra kA ho sakatA hai| vAhiniyA~ chudra bhI ho sakatI haiM aura srotasIya ( cavernous ) bhii| inameM rana ke sthAna para lasIkA bharI rahatI hai| isa kAraNa se zoNavAhinyarbuda ke varNa meM aura isake varNaM meM paryApta antara hotA hai| ye arbuda anRju bRhat lasIkAvAhiniyoM se yukta hote haiN| yaha kahanA sandehAspada hai ki eka lasavAhinyarbuda meM vRddhi kA kitanA aMza vAhinI ke visphAra se banA hai aura kitanA lasavAhiniyoM ke vAstavika navanirmANa dvArA bana sakA hai| isake bhI zoNavAhinyarbuda kI bhA~ti do prakAra kie jA sakate haiM eka kezikIya aura dUsarA srotasIya / isakA vyavahAra aura udgamasthala bhI zoNavAhinyarbuda se milate julate hI huA karate haiM / donoM meM kevala mukhya antara yahI rahatA hai ki zoNavAhinya For Private and Personal Use Only

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arbuda prakaraNa 846 buMda meM jahA~ rakta ke lAlakaNa ( red corpuscles) hote haiM vahA~ isameM lasIkA hotI hai aura raktakaNa nahIM hote| ye sahaja aura avApta (acquired) donoM prakAra ke mila jAte haiN| sahaja jihvA meM paramajihvatA ( macroglossia) ke rUpa meM oSTha meM paramoSThatA ( macro. cheilia) ke taura para aura bhagoSTha ( labium ) meM usakI ativRddhi rUpa meM pAye jAte haiN| tvacA meM anya sthaloM para bhI ve mila sakate haiN| grIvA meM unake dvArA eka avasthA utpanna hotI hai jise koSThika udakArbuda ( cystic hygroma ) kahA jAtA hai| jo arbuda upariSTha bhAgoM meM hote haiM ve upasRSTa bhI ho sakate haiM aura baNita bhii| avApta prakAra meM lasIkAvAhiniyoM kA visphAra tvacA aura upatvagIya uti meM huA karatA hai| vizeSa karake Uru aura urasa kSetra meM ina sthaloM meM upatvagIya Uti meM nAraMgI ke barAbara bar3e arbuda bhI bana jAyA karate haiN| ekAdha vAhinI ke vidIrNa hone se lasIkA srAva hokara bhayAnaka sthiti ko janma de sakatA hai| jina kSetroM se lasIkAvAhiniyA~ arbuda meM jAtI haiM unameM arbuda ke hI samAna sthUlana ( thicken. ing ) dekhA jA sakatA hai| yaha sthUlana tvacA meM camakIla ( wart ) kA rUpa bhI dhAraNa kara sakatA hai| vAhinIruhArbuda ( Angioblastoma ) vAhinIya antazchadArbuda se utpanna hone vAle mArAtmaka arbuda bahuta hI kama dekhane meM Ate haiN| parantu jaba bhI ve bana jAte haiM to ve unhIM niyamoM kA pAlana karate haiM jinakA anya vAhinyarbuda karate haiM aura unakI racanA meM apUrNatayA nirmita vAhiniyA~ dekhI jAtI haiN| inakA kozAprakAra, vAhinIya antazchadIya kozA hotA hai| ina kozAoM kA AkAra aura rUpa viSama hotA hai aura unameM vibhajanAGka vizeSa karake dekhe jAte haiN| ve lasavAhiniyoM yA raktavAhiniyoM donoM se bana sakate haiN| raktavAhiniyoM dvArA ve adhikatara banate haiM / isa kAraNa ve raktasrAvI hote haiM aura unakI pravRtti bhI raktasrAvAtmaka hotI hai| inakI mArAtmakatA bahuta kucha parivartanazIla hotI hai aura inakI racanA kI ekaka aviziSTa raktavAhinI ( atypical blood vessel ) huA karatI hai| vAhinyarbuda aura aGgavizeSa vAhinyarbuda bahudhA jihvA, yakRt , vRkkamukha asthi-oSTha aura stanoM meM pAye jA sakate haiN| jihvAstha vAhinyarbuda ( angiomata of the tongue ) eka sAdhAraNa prakAra kA abaMda hotA hai jo bAlakoM meM sahaja rUpa meM bahudhA banatA hai / zoNavAhinyabaMda camakIle lAla raMga kA atyadhika vAhinIyukta mantharagati se utpanna hone vAlA arbuda hotA hai| kabhI kabhI yaha bahuta bar3ha jAtA hai aura usase bahuta adhika raktasrAva hotA hai| lasIkA vAhinyabaMda ke kAraNa sthUlajihvatA ( macroglossia) ho jAtI hai| For Private and Personal Use Only

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850 vikRtivijJAna yakRt meM bAhinyadhuMda kA prakAra srotasIya hotA hai / yaha yakRt ke bahuta se kSetra meM prasarita ho jAtA hai / yaha prAvarita bahuta hI kama dekhA jAtA hai| __ vRkkamukhIya vAhinyarbuda ( Angioma of the renal pelvis ) yaha eka bahuta kama hone vAlA abaMda hai| jaba vedanA virahita raktameha ( painless haematuria) hotA hai aura jo eka sthAna vizeSa para hI dRSTigocara ho to isa arbuda kA sandeha kiyA jA sakatA hai| isameM raktasrAvAdhikya bahuta bhISaNa rUpa dhAraNa kara le sakatA hai| asthi meM bhI vAhinyabaMda kA honA batalAyA jAtA hai para yaha bahuta hI kama dekhane meM AtA hai aura adhika mahatvapUrNa nahIM hotaa| oSTha ke andara zoNavAhinyarbuda tathA lasIkAvAhinyarbuda donoM mila sakate haiN| sAdhAraNatayA bAlakoM meM sahaja rUpa meM yaha roga pAyA jAtA hai| inake kAraNa oSTha bahuta sthUla ho jAtA hai| zoNavAhinyarbuda kA varNa AnIla aura lasIkAvAhinyarbuda varNahIna hotA hai| stanoM meM bhI vAhinyarbuda ho sakatA hai| ( 5 ) antazchadAbuda ( Endothelioma ) antazchadArbuda nAmaka arbuda kA varga Aja luptaprAya ho rahA hai| isakA yaha kAraNa nahIM ki antazchada ke arbuda banate nahIM balki isalie ki isa nAma se jo bahuta se arbuda lie jAte the ve Aja anya nAmoM ke dvArA anya anya udgamasthaloM se utpanna mAna lie gaye haiN| Aja bhI isa nAma ke sAtha kina arbudoM ko liyA jAve isake bAre meM bahuta bar3A matabheda hai / isa matabheda kA mukhya kAraNa yaha hai ki antazchada kise pukArA jAve / tathA isa antazchada kA vikRtAvasthIya rUpa kyA hai isakA jJAna kaise ho / vAstavikatA yaha hai ki antazchadIyakozA adhicchadIya kozAoM tathA saMyojI UtikozAoM ke bIca ke mArga kA anusaraNa karate haiN| ye eka prakAra kA antarkozIya bandhaka dravya (intracellular cement substance ) utpanna karate haiM jisake kAraNa ve eka dUsare se bahuta adhika saTe hote haiM ve rajjuoM aura velanoM (cylinders ) ke rUpa meM utpanna hote haiM jinameM suSiraka ( lumen ) hote haiN| inakI nyaSTiyA~ choTI aura spaSTa hotI haiM jinake cAroM ora kozAprarasa kA svaccha AvaraNa car3hA hotA hai| inakI tulanA meM adhicchadIya kozAoM meM bar3I bar3I udravika ( vesicular ) nyaSTiyA~ hotI haiM aura unakA kozAprarasa kaNadAra hotA hai| vAhinyarbuda ( angiomas ) eka prakAra ke antazchadArbuda hI haiN| isI prakAra jAlakAntazchadIya saMsthAna ke antargata zoNotpAdaka UtiyoM ke arbuda bhI antazchadArbuda ke varga hI meM Ate haiN| inakA varNana yathAsthAna huA hai| bahuta se antazchadA. buMda saMkaTArbuda ke samAna hote haiM aura donoM meM bheda karanA bahuta kaThina hotA hai| hama For Private and Personal Use Only

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arbuda prakaraNa 851 isa viSaya ko adhika spaSTa aura vivAdAspada mAna kara yahIM chor3e dete haiM tAki pAThakagaNa isa viSaya ke anya ucca granthoM kA pArAyaNa kara sakeM aura apanA mata sthira kara skeN| (6) zoNotpAdaka UtiyoM ke arbuda ( Tumours of Haemopoietic tissues ) isa varga meM lasAbhaUti ( lymphoid tissue ) aura asthimajjA ( bone marrow ) ke arbuda sammilita kie jAte haiN| inameM lasasaMkaTArbuda, hAjakinAmaya, sitaraktatA, bahumajjakArbuda tathA lasArbuda lie jAte haiN| inameM se kucha vAstavika arbuda haiM para kucha jaise sitaraktatA ( leukaemia ) arbuda kI paribhASA ke anurUpa nahIM baiThatA / isI prakAra hAjakinAmaya bhI eka arbuda nahIM mAnA jA sktaa| ataH hama ina rogoM kA varNana jahA~ Avazyaka hogA vahA~ deNge| (7) vAtaUtIya arbuda ( Nervous-Tissue Tumours ) kendriya vAtanADIsaMsthAna kI utpatti bahiHstara se huI hai| yaha do bhAgoM meM punaH vibhAjita kiyA gayA hai-eka jIvitaka ati ( parenchymatous tissue ) jisameM vAtanADI kozA aura vAtanADIsUtra Ate haiM aura dUsarA AdhAra ati jisameM vAtanADIdhArI vAtazleSa ( neuroglia) AtA hai| jIvitaka Uti ke arbuda bahuta kama pAye jAte haiM parantu vAtazleSa uti ke arbuda bahutAyata ke sAtha pAye jAte haiM / vAtasaMsthAna arbudoM kA yadi punarvargIkaraNa kiyA jAve to jIvitaka Uti ke nimna arbuda mileMge: 1. vAtanADIkaMcuka ke arbuda ( tumours of nerve sheaths ), ye do haiM (1) vAtatantusaMkaTArbuda ( Neurofibrosarcoma) (2) vAtatantvarbuda ( Neurofibroma) 2. vAtanADIkandANuoM ke arbuda ( tumours of Neurons ), ye tIna haiM (1) vAtanADyarbuda ( Neuroma ) (2) nADIkandikArbuda (Ganglioneuroma) (3) vAtaruhArbuda ( neuroblastoma) 3. nADyagroM ke arbuda ( tumours of nerve endings ) ye tIna hI haiM (1) dRSTiruhArbuda ( Retinoblastoma) (2)nyaccha ( Naevus) (3) kAlyarbuda ( Melanoma ) ye grIna ke vargIkaraNa ke anusAra haiN| For Private and Personal Use Only

Page #938
852 vikRtivijJAna vAtazleSa yA cetAdhArI Uti ke arbuda ko zleSArbuda (glioma ) kahA jAtA hai / aba hama ina arbudoM kA saMkSipta varNana upasthita kareMge: vAtatantusaGkaTArbuda-vAtatantvarbuda-ye donoM vAtanADiyoM ke Upara car3hI saMyojI Uti kI kaMcukoM se banate haiM / inameM vAtatantusaMkaTAbaMda mArAtmaka tathA vAtatanvarbuda sAdhAraNa arbuda hai| ataH ye vAta uti se koI sambandha na rakha kara saMyojI Uti ke arbuda haiM ataH inakA varNana pIche tantvabaMda ke prakaraNa meM dekhA jA sakatA hai| vAtanADyarbuda-nADIkandANakArbuda vAtanADIkozAoM aura vAtanADIsUtroM se bananevAlA arbuda hai| pahale se upasthita vAtati se isakA udaya hotA hai yaha vimajji ( medullated ) nADItantuoM ke puMja dvArA banatA hai| racanA meM yaha mastiSka sauSumnika vAtanADiyoM dvArA banate haiN| asthiucchedAtmaka vAtanADyarbuda ( amputation neuroma ) kaTI haDDiyoM ke siroM para phailI huI piDikAoM ke rUpa meM milate haiM ve arbuda na hokara paristhitijanya rUpAntara kahe jA sakate haiN| vAtakandikArbada-vAta Uti kI kandikAoM (ganglia ) ke kozA aura vAtanADI sUtroM ke dvArA inakI utpatti hotI hai| ye prAyaH svatantra nADImaNDala ( sympathetic nervous system ) se nikalate haiM aura tvacA meM pAye jAte haiN| ve udara yA urasa meM svatantra nADImaNDala kI nADiyoM yA cakroM ke mArga kA anusaraNa karate hue bhI pAe jA sakate haiN| ye kabhI kabhI adhivRkkagranthiyoM meM bhI ho sakate haiN| vAtaruhArbuda-yaha arbuda cAra varSa se nIcI Ayu ke bAlakoM taka sImita rahatA hai| isakA rUpa saMkaTArbuda se milatA julatA hotA hai ataH bAlaadhivRkkIya saMkaTArbuda ( adrenal sarcoma of children ) ke nAma se bhI ise kahA jAtA hai / isakA varNana hama pIche saMkaTArbuda ke prakaraNa meM kara cuke haiN| yaha vAtakozAoM ke pUrvajoM ( primitive nerve cells) dvArA utpanna hotA hai jinheM hama vAtaruha ( neuroblasts ) kahate haiM aura adhivRkka granthiyoM kI majjaka meM banatA hai| yaha bahuta mArAtmaka hotA hai aura anekoM sthaloM para visthAyotpatti karatA hai / nADyanoM ke kucha arbuda raMgita arbuda prakaraNa meM jAveMge ataH yahA~ kevala dRSTiruhArbuda kA varNana kiyA jaavegaa| dRSTiruhArbuda-isa arbuda ko dRSTipaTala (retina ) kA vAtazleSArbuda (glioma of the retina) kahA jAtA hai| para sambhavataH yaha zuddha vAtaruhArbuda na hokara dRSTipaTalIya vAtanADIaoM kA arbuda hotA hai| ise vAtaruhArbuda yA vAta adhicchadArbuda kaha kara bhI pukArA jAtA hai| yaha zaizavakAlIna roga hai aura kauTumbika pravRtti rakhatA hai| dRSTipaTala ke bhrUNakAlIna kucha kozA jo bAda meM pragalbha na hokara apanA bhrauNika rUpa hI rakhate haiM unase yaha banatA hai isI kAraNa ise yaha nAma diyA gayA hai| yaha eka asAdhAraNa prakAra kA arbuda hai aura isameM tIna mukhyatAe~ bvAyaDa batalAtA hai: For Private and Personal Use Only

Page #939
vAtazleSArbuda pRSTa 853 SE ETRI E yaha vAtazleSa ( neuroglia ) dvArA nirmita arbuda kA aNvIkSa citra hai| For Private and Personal Use Only

Page #940
arbuda prakaraNa 853 1. ubhayapArthIyatA jo 30% rogiyoM meM milatI hai arthAt yaha donoM A~khoM meM pAyA jAtA hai| 2. zaizavakAlIna udgama 90% rogiyoM meM yaha 4 varSa kI avasthA pUrva hI utpanna hotA hai / jaisA ki adhivRkkIya vAtaruhArbuda meM dekhA jAtA hai| 3. kauTumbika pravRtti ( familial tendenoy ) eka hI kuTumba meM eka se dUsare meM yaha asAdhAraNatayA dekhA jAtA hai| bvAyaDa ke anusAra eka kuTumba ke 16 prANiyoM meM se 10 akele isa roga ke kAraNa hI samApta ho gye| ___ yaha arbuda sthAnika vinAza karatA hai| para Age calakara lasaka granthakoM meM tathA anya Antarika aMgoM meM isake visthAya banA karate haiN| aNvIkSaNa karane para yaha kSudra gola kozAoM dvArA nirmita hotA hai| ina kozAoM meM nAma mAtra kA kozAprarasa hotA hai tathA koI tantuka ( fibril ) bhI nahIM hotaa| isakI mukhya vizeSatA stambhAkAra kozIya vRttoM ( circles yA rosettes ) kI upasthiti mAnI jAtI hai| ye vRtta kabhI kabhI anupasthita bhI hote haiN| ye vRtta zAyada dRSTipaTala ke daNDazaMkuoM ( rods & cones ) ke antarbhAga meM sthita kozAoM ko prakaTa karate haiM / vAtazleSArbuda (Glioma )-isa viSaya para belI aura kyUziMga ne jo krAntikArI khojeM kI haiM unake prati cikitsaka samudAya paryApta kAla taka RNI rhegaa| mastiSka ke andara jitane bhI prakAra ke arbuda milate haiM ve sabhI vAtazleSa yA cetAdhArI ke hI hote haiM / mastiSka meM jo tIna prakAra kI antarAlita Uti pAI jAtI hai usameM se aNuzleSa ( microglia) tathA alpacelAlomazleSa (oligodendroglia) bahuta hI kama arbudotpatti karatI haiN| isa kAraNa sabhI prakAra ke vAtazleSArbuda yA glAyomA tArAkozAoM (astrocytes) dvArA hI banate haiM aisA uparyukta donoM vidvAnoM kA mata hai| antaHkaroTIya arbuda mArAtmaka aura sAdhAraNa do prakAra ke hote haiN| mArAtmakoM meM zleSaruhArbuda, majjakaruhArbada aura mastiSkIya tArAkozArbuda mukhya haiN| tathA. sAdhAraNa prakAra meM mastiSkacchadArbuda, zravaNanADyarbuda, poSaNika granthyarbuda, nimastikIya tArAkozArbuda, nilayastarArbuda, vAhinyarbuda aura sahaja arbuda Ate haiN| isake sAtha sAtha yaha bhI dhyAna meM rahanA cAhie ki vAtazleSArbuda meM se kaI to bahuta adhika duSTa aura mArAtmaka hote haiM parantu unase visthAyotpatti kadApi nahIM huA krtii| isakA eka kAraNa yaha bhI ho sakatA hai ki zarIra meM anya kisI bhI sthAna para vAtazleSa uti ko ugAyA ( transplant ) nahIM jA sktaa| 30 pratizata vAtazleSAbaMda ubhayapA/ya hote haiN| belI aura kyUziMga ne ina arbudoM ke aneka bhedoM kA bahuta vistArapUrvaka varNana kiyA hai jo apane grantha ke andara anAvazyaka hai| hama yahA~ vAtazleSArbuda ke pramukha nimna bhedoM kA varNana upasthita kareMge For Private and Personal Use Only

Page #941
854 vikRtivijJAna 1. bahurUpI zleSaruhArbuda (glioblastoma multitorme ) 2. tArAko zArbuda ( astrocy toma ) 3. vimajjiruhArbuda ( medulloblastoma ) 4. nilayastarArbuda ( ependymoma ) Acharya Shri Kailassagarsuri Gyanmandir bahurUpI zleSasahArbuda yaha bahuta adhika pAyA jAne vAlA aura sabase adhika duSTa arbuda hai / ise chidriSThahArbuda bahurUpI ( Spongioblastoma multiforme ) bhI kahA jAtA hai / isakA kozA chidriSTakRta ( spongioblast ) hotA hai / yaha eka na hokara aneka banate haiM / yaha bahurUpatA anya mArAtmaka arbudoM meM nahIM pAI jAtI / yadi isa arbuda kA yathocita upacAra na kiyA gayA to yaha mRtyu kA kAraNa bana jAtA hai / arbuda mRdula, dhUsara varNIya, asta vyasta ( ill-defined ), vAhinIyukta aura vihAsa se yukta hotA hai / vihAsa meM UtinAza, raktasrAva aura koSThotpatti pAI jAtI hai / yaha bahuta adhika AkrAntA arbuda hai / isake kendriya bhAga meM vihAsa hone se isake prAvarita hone kA mithyA AbhAsa milatA hai / isakI AkrAmaka zakti ke kAraNa zalyavid yaha nahIM jAna pAtA ki arbuda kahA~ para samApta hotA hai aura kahA~ se Rju mastiSka Uti Arambha hotI hai / isa arbuda kA aNvIkSaNIya citra bahuta adhika parivartanIya hotA hai / isa arbuda meM kozIyatA bahuta hotI hai aura kozA naikarUpIya ( pleomorphic ) hote haiM jo AkAra aura svarUpa meM bahuta adhika bhinnatA rakhate haiM / vaisA hI asthi ke asthijanaka saGkaTArbuda meM bhI dekhA jAtA hai / inhIM kAraNoM se ise bahurUpI saMjJA pradAna kI gaI hai / eka aura zleSaruhArbuda hotA hai jisameM kozAoM meM eka hI pravarddha ( process ) hotI hai / bahurUpI arbuda meM kucha kozA aNDAkAra kucha nAzapAtI ke AkAra ke aura kucha lambotare hote haiM / inhIM ke bIca bIca meM arbudika mahAkozA hote haiM jinameM kaI kaI yaSTiyA~ hotI haiN| kozAoM ke vibhajanAGka khUba milate haiM / ( glia fibres ) nahIM milte| kyoMki chidriSTaruha ina tantuoM kA hotA / vAhinI antazchada meM bahudhA praguNana hotA hai / isa kAraNa suSiraka kozAoM se bhara jAte haiM yaha parivartana to arbuda ke kSetra ke bAhara Rju Uti meM bhI dekhA jAtA hai / arbuda ke cAroM ora zleSotkarSa ( gliosis ) bahuta milatI hai / 1 isameM zleSa tantu nirmAtA nahIM vAhiniyoM ke tArAkozArbuda yaha pahale arbuda ko apekSA kucha sAdhAraNa hotA hai / kyUziMga ke anusAra isakA zastrakarma hone ke uparAnta rogI kI jIvanAyu 6 varSa paryanta aura rahatI hai / bahuta se rogI to pUrNataH upacArita aise lagane lagate haiM / samIpa kI svastha Uti ke sAtha arbuda itane ArAma se mila jAtA hai ki donoM kI bhedaka rekhA kA pAnA bahuta kaThina kArya ho jAtA hai | yaha mastiSka ke kisI bhI bhAga meM utpanna ho sakatA hai / bAlakoM meM sAdhAraNatayA nimastiSka (dhamillaka) meM yaha prakaTa hotA hai / isameM koSTotpatti hotI For Private and Personal Use Only

Page #942
arbuda prakaraNa 855 hai jisakI prAcIra meM arbuda laTakA rahatA hai| isameM kaI koSThaka bana sakate haiM / arbuda ke bAhara bar3e koSThakoM meM eka tarala ekatra ho jAtA hai jisake pracUSaNa ke uparAnta punaH tarala bhara jA sakatA hai / vayaskoM kA tArAkozArbuda adhika kozIya hotA hai aura kahIM kahIM to zleSa hArbuda kA rUpAntara mAtra pratIta hotA hai / para aNvIkSIya citra zleSa - hArbuda se bahuta alaga hotA hai isameM kozA kama para AkRti aura rUpa meM eka se hote haiM / kabhI kabhI vihAsAtmaka parivartanoM ke kAraNa kozAkAya meM sUjana aura kAcarIkaraNa mila jAtA hai aura usakI nyaSTi eka ora ko saraka jAtI hai / pramastiSka meM kozIyatA adhika aura vibhajanAGkopasthiti mila sakatI hai / kozA anekoM zleSakozAoM dvArA pRthak rahate haiM / arbudIya tArAkozA eka jagaha ikaTThe aura ghire rahane se anya svastha tArAkozAoM kI apekSA adhika lambe ho jAte haiM / inameM vAhinIya pAdapaTTa ( vascular foot plate ) bhI nahIM hotI / raktavAhiniyA~ isa arbuda meM asaMkhya hotI haiM / arbuda kI eka vizeSatA yaha hai ki isameM vAtanADI kozA arbuda kozAoM ke bIca bIca meM RjurUpa meM milate haiM / isakA kAraNa yahI ho sakatA hai ki arbuda kozAoM meM vinAzaka zakti bahuta adhika nahIM rahatI / cUrNIyana bhI mila sakatA hai jo kSarazmi-citraNa dvArA spaSTa ho sakatA hai / arbuda ke cAroM ora zleSotkarSa nahIM milatA / isa arbuda kI sImA kA nirdhAraNa bhI bahuta kaThina hotA hai / vimajjihArbuda dutavRddhizIla aura atiduSTa yaha arbuda bAlakoM meM utpanna hotA hai aura caturtha nilaya kI chata para nimastiSka kI madhyarekhA meM prakaTa hotA hai / yaha mRdula Arakta dhUsara piNDa kA nirmANa karatA hai jo caturtha nilaya ko bhara kara spaSTataH udaka mastiSkotpatti ( formation of hydrocephalus ) kara sakatA hai / jisa prakAra zleSaruhArbuda vayaskoM kI mRtyu bulAtA hai usI prakAra yaha bAlamRtyukArI hotI hai / yaha arbuda hI akelA aisA hai jo mRdutAnikA ( piamater ) bhedane kI zakti rakhatA hai tathA brahmodakulyA ( subarachnoid space taka phaila sakatA hai / aNvIkSIya citra pUrNatayA avibhinita hotA hai jaisA ki gola kozIya saMkaTArbuda meM milatA hai / yaha arbuda atikozIya aura tantuka virahita hotA hai / isake adhikAMza kozA gola aura kucha garjarAkRtika hote haiM / isake kozA raktavAhiniyoM ke kinAre kinAre samUhita rahate haiM aura kUTavRttikA ( pseudo rosette ) kA nirmANa karate haiM / ye nilayastarIyArbuda kI vRttikAoM se bhinna hotI haiM kyoMki inake kendra meM suSiraka nahIM hote / nilayastarArbuda yaha arbuda pUrvokta tInoM arbudoM se kama utpanna hotA hai / yaha vimajjiruhArbuda se do bAtoM meM milatA hai / eka to yaha ki yaha bAlakoM kA roga hai dUsare yaha bhI caturtha nilaya ke pharza yA chata para hotA hai| usase bhinnatA bhI do bAtoM meM hai jinameM eka isakA atyadhika vibhinita honA hai aura dUsarA usase kama mArAtmaka honA hai / yaha For Private and Personal Use Only

Page #943
vikRtivijJAna pramastiSka ( sairIbrama) meM tRtIya nilaya yA pArzva nilaya ke samIpa utpanna hotA hai yaha thor3A dRr3ha hotA hai aura kSakiraNa citra dvArA isameM cUrNIyana mila sakatA hai| ___ aNvIkSaNa karane para isa arbuda meM nilayastarIya kozA yA nilayastarIya chidriSTharuha milate haiM / chidriSTharuha lambotare hote haiM jinakI pU~cha lambI zizu meMDhaka ( tadpole ) sarIkhI hotI hai / nilayastarIya kozA sadaiva eka guhA kA AstaraNa karate haiM ataH kucha nilayastarIya kozA tudra kAnAloM ke cAroM ora samUhita milate haiN| ina samUhoM ko vRttikA ( rosette ) kahate haiM jaba ye vRttikAeM upasthita hotI haiM to nilayastarArbuda kI vikRtisUcaka AkRti ko batalAtI hai| kozAoM ke prarasa meM suSiraka aura nyaSTi ke bIca meM suSiraka ke kinAre kSudra daNDikA ( rod ) milatI haiM ye daNDikA ( blepharoplasten ) nilayastarIya kozAoM kI viziSTatA prakaTa karatI haiN| kyoMki ve padoM ( cilia ) ke AdhAra kI abhivarNi ( chromatin ) ke avaziSTa bhAga kI sUcikA hotI haiN| (8) raMgita arbuda (Pigmented Tumours ) raMgita arbudoM meM nyaccha aura kAlyarbuda ina donoM kA ullekha kiyA jAtA hai| nyaccha sAdhAraNa aura kAlyarbuda mArAtmaka prakAra kA hotA hai| mArAtmakatA ke vicAra meM use mArAtmaka kAlyarbuda yA kAlyarbudIya saMkaTArbuda bhI kaha kara pukArA jAtA hai| para kAlyarbudIya saMkaTAbaMda aisA prAcIna nAmakaraNa isa samaya prayukta nahIM hotA kyoMki kAlyarbuda saMkaTArbuda nahIM hotaa| varNa kA kAraNa kAli ( melanin ) hotI hai| donoM prakAra ke arbuda jaisA poche likha cuke haiM vAtanADyagroM ke arbuda haiN| nyaccha se kAlyarbuda sIdhA bhI bana sakatA hai aura svatantra bhI uga sakatA hai| aba hama ina donoM kA yathArtha varNana prastuta kreNge| nyaccha ( Naevus) AyurvedIya paribhASAkAroM ne isakA nimna lakSaNa kiyA hai:mahadvA yadi vA cAlpaM zyAvaM vA yadi vA'sitam / nIrujaM maNDalaM gAtre nyacchamityabhidhIyate // __ bahuta yA kama zyAva vA kRSNa varNa kA vedanA virahita gAtra para jo maNDala uga AtA hai vaha nyaccha kahalAtA hai| yadi yahI maNDala aura adhika kRSNa varNa kA hotA hai to vahI nIlikA kahalAne lagatA hai| Adhunika vicArakoM ke mata meM nyaccha kA artha janmacihna ( birth mark ) hotA hai| aura yaha do vikSoM ko batalAtA hai eka savarNa nyaccha (pigmented naevus ) aura dUsarA tvagIya vAhinyarbuda ina donoM ko kramazaH vAtanADIya nyaccha athavA nyaccha tathA kezAlIya nyaccha yA nIlikA kaha sakate haiN| yahA~ hama nyaccha zabda kA hI prayoga upayukta mAnate haiM aura isa prakaraNa meM usI kA upayoga kiyA jaavegaa| For Private and Personal Use Only

Page #944
nyaccha pRSTha 857 Acharya Shri Kailassagarsuri Gyanmandir nyaccha ke kozA nicarma ( dermis ) meM sthita haiM / adhicarma ( epidermis ) se unakA koI sambandha nahIM hotA yaha isa citra se spaSTa upalakSita hotA hai / For Private and Personal Use Only

Page #945
arbuda prakaraNa 857 nyaccha tila ( mole ) jaisA hotA hai| yaha bahudhA raMgita hotA hai| isakA varNa dhUsara se babhru aura atyadhika kRSNa taka ho sakatA hai| yaha bahudhA kezoM se AcchAdita aura tvacA se kucha uThA huA hotA hai / AkAra kI dRSTi se yaha kaI prakAra kA hotA hai| kabhI yaha bahuta choTA aura laghu rUpa meM milatA hai aura kabhI zarIra tvacA ke bahuta se bhAga meM phailA huA milatA hai / nyaccha pratyeka vyakti meM eka se lekara bIsa paccIsa taka pAye jA sakate haiM ye bahudhA mukhamaNDala, grIvA aura pRSTha para milate haiM parantu vaise kisI bhI aMga meM pAye jA sakate haiM / jaba ve tvacA se kucha U~ce uThe hote haiM aura unakA dharAtala carmakIlavat ( warty ) hotA hai to gharSaNAdi se prakSubdha hokara mArAtmakarUpa dhAraNa kara le sakate haiN| aisI avasthA meM unheM ucchedita kara dene se bar3hakara acchA mArga aura nahIM mila sktaa| kabhI-kabhI nyaccha netra ke kRSNa maNDala meM bhI dekhA jA sakatA hai| nyaccha eka sahajAvasthA hai para vayaska hone ke uparAnta kaI vyaktiyoM meM ye utpanna hote hue dekhe jA sakate haiM / nyaccha sadaiva eka mahattvahIna jIvana vyatIta karate aura apuSTa ho jAyA karate haiM para yadi kisI meM drutagati se vRddhi hone lage to avazya hI usameM mArAtmaka pravRtti kI pravRddhi kA vicAra kara lenA caahie| aNvIkSaNa karane para eka zAnta prasupta ( quiescent) nyaccha, svaccha, golIya, bahubhujIya kozAoM kA nicarma ( dermins ) meM saMcaya mAtra hotA hai| ye adhicarma ke nIce hI nIce rahate aura bar3hate haiN| inheM 'nyaccha kozA' ( naevus cells) kahA jAtA hai| nyaccha kozA bahuta pAsa pAsa saMveSTita hote haiM tathA eka viziSTa svarUpa se yukta hote haiN| ina nyaccha kozAoM ke kinAroM para kAlikaNoM se pUrNa tarkurUpa raMgita kozA hote haiM jinameM raMgA kI mAtrA bahuta adhika bhinnatA rakhatI hai| ina kAlikoM ( melanin ) ko kAliruha ( melanoblast ) kahate haiN| kAliruha ke kAraNa hI nyaccha meM raMga AtA hai| kabhI kabhI jaba ye nahIM hote to nyaccha varNahIna bhI dekhA jA sakatA hai| varNa zyAva ho yA asita usakI gaharAI kA mArAsmakatA ke anupAta se koI sambandha nahIM dekhA jaataa| kabhI kabhI nyaccha kA varNa zanaiH zanaiH ur3atA bhI calA jAtA hai aura vaha pUrNataH varNavihIna rUpa meM bhI dekhA jA sakatA hai| nyaccha kozAoM kI utpatti ke sambandha meM Adhunika zAstrajJoM ke matabhedoM ko mesana ne dUra kara diyA hai| usakA mata hai ki nyaccha vAtika roga hai| pahale ise adhicarma madhyaruhIya yA antazchadIya mAnA jAtA thA / mesana likhatA hai ki saMjJAvaha nAr3I tantuoM ke agra para sthita saMjJAjJApaka tvagAzrita vAtanADIya bhAga vizeSa meM yaha banatA hai vizeSa karake nicarma ke miznarIya kaNakozA ( cells of meissner's corpuscles ) ise banAte haiN| usane apane trivarNIya ( trichrome ) abhiraMjanA dvArA arbuda kozAoM meM vimajji aura avimagji vAtanADI sUtroM kI upasthiti pratyakSa For Private and Personal Use Only

Page #946
858 vikRtivijJAna dikhalA dI hai / mAdhavanidAna kI madhukozA TIkA bhI ise eka vAtaja roga mAnatI hai likhA hai: 'atra bhojavacanAt pittaraktAnvito vAyuH kAraNam / yadAha___ raktapittAnvito vAyustvakpradezAzrito yadA / janayenmaNDalaM kRSNaM zyAvaM vA nyacchamAdizet // ' rakta aura pitta se yukta vAyu jaba tvacA ke bhAga meM Azrita ho jAtI hai to vaha kAlA yA sA~valA nyaccha nAmaka maNDala utpanna kara detI hai| nyaccha meM jaisA ki abhI batalAyA hai do prakAra ke kozA hote haiN| eka nvaccha kozA jo raMgahIna aura vAtanADI agroM (nerve-endings) se yukta hote haiN| dUsare raMgIna jo vAtanADiyoM se virahita hote haiN| inheM kAliruha kAlikRt yA kAlighaTa kahate haiN| raMgIna kozA jitane adhika hote haiM utanA hI adhika nyaccha para varNa car3hatA hai| kAliruha kAli kA nirmANa karate haiN| tvacA meM vicarane vAle kucha raMgIna kozA hote haiM ( wandering pigmented cells ) ve svayaM varNotpatti nahIM karate api tu kAlirahoM dvArA nirmita varNa kA vahana mAtra karate haiM isI se inheM varNavAhaka (chromatophore ) yA kAlivAhaka ( melanophore ) saMjJA dI jAtI hai| ___ adhicarma bhI nyaccha nirmANa kA kArya kara sakatA hai para kriyAzIla kozA adhicchadIya na hokara vAtabahistarIya ( neuro-ectodermal) hote haiN| suSupta kAliruha aura nyaccha kozA donoM adhicarma meM bhI raha sakate haiM aura nyacchotpatti kara sakate haiN| nyaccha kI vAtika utpatti ise vAtatantvabaMdotkarpa ( neuro fibromatosis) jise phAna raikaliMgahAujanAmaya bhI kahate haiM se bhI sambandha kara detA hai| isa roga meM bhI raMgIna sidhma bahudhA dekhane meM Ate haiN| dUsare nyaccha kI adhikatA se aneka vAtatantvarbuda bhI utpanna hote dekhe jAte haiN| mArAtmakakAlyarbuda (Malignant Melanoma ) yaha arbuda kAlyarbuda athavA kAlyarbudIya ( Melanotic) saMkaTArbuda kahalAtA hai| yaha tvacA ke nyaccha dvArA yA A~kha ke raMgita paTala meM utpanna hotA hai A~kha meM isake pUrva kI avasthA nyaccha kI nahIM hotii| A~kha meM saba mArAtmaka kAlyarbudoM kI saMkhyA kA tRtIyAMza pAyA jAtA hai| koI tila jisapara gharSaNa yA prakSobha nirantara hotA rahatA hai| kAlyarbuda meM pariNata ho sakatA hai| pairoM ke talavoM yA nakhoM ke nIce yA strI ke bAhya guptAMgoM para ye svatantratayA dekhe jA sakate haiM yadyapi ina sthAnoM para nyacchotpatti bahuta hI kama hotI hai| kabhI-kabhI para bahuta hI kama aisI avasthAe~ AtI haiM jaba malAzaya, adhivRkka yA mRdutAnikA meM prAthamika vikSata bana jAne se tvacA para koI bhI kAlyarbuda nahIM dikhatA yA kevala usakA dvitIyakarUpa hI dekhane meM AtA hai| kAlyarbuda eka bahuta hI kama hone vAlA roga hai| For Private and Personal Use Only

Page #947
arbuda prakaraNa racanA kI dRSTi se vicAra karane para hama dekhate haiM ki jaba nyaccha mArAtmakarUpa dhAraNa karane lagatA hai to arbuda kozA gaharI UtiyoM kI ora pragati karane lagate haiM unakI prasuptAvasthA samApta ho jAtI hai| kozAoM kA AkAra bhI kucha bar3A ho jAtA hai unakI nyaSTi paramavarNika ho jAtI hai aura unameM vibhajanAGka pAye jAne lagate haiN| isa prakAra eka pUrNa pragalbha kAlyarbuda ke kozA bRhat , bahubhujIya aura avakAzikIya samUhana (alveolar grouping ) se saMyukta dekhe jAte haiN| inake samUhoM ke madhya meM bahuta sUkSma saMdhAra pAyA jAtA hai| isakA yaha svarUpa ise karkaTArbuda kA jAmA pahanA kara bhramotpatti kara sakatA hai / netra meM isake kozA adhika takarUpa hone se usakA rUpa tantu saMkaTa se milatA julatA ho jAtA hai| kAlyarbuda kI jitanI vibhinnatAe~ dekhI jAtI haiM utanI anya arbudoM kI bahuta kama dekhane meM AtI haiN| isa kAraNa karkeTa, saMkaTa, antazchadIyArbuda yA lasasaMkaTArbuda taka se milane vAle isake rUpa dekhe jA sakate haiN| kozAoM meM kAli kI upasthiti se pahacAna meM paryApta sahAyatA milA karatI hai para jaba kAlinirmAtA kozA prasupta rahate haiM to autikIya citra hI isakI pahacAna kA pramukha sAdhana hotA hai| arbuda dekhane meM kAle raMga kA hone para bhI antarkozIya raMga pIlA hotA hai| jaba araMgita kAlyarbuda milatA hai to usakI pahacAna DopA pratikriyA dvArA kI jA sakatI hai| dviudadarzalAsuvI ( dihydroxyphenylamie) eka jArakeda ( oxydase ) ke sAtha milakara raMgIya kSetroM ke kucha kozAoM ke sAtha kAli ke samAna eka asita padArtha taiyAra karatA hai| ise DopApratikriyA kahate haiN| yaha sacce kAliruhoM kI upasthiti mApane kA rAsAyanika parIkSaNa hai jise blauca ne batalAyA hai| kAliruha DopA astyAtmaka (dopa positive) aura varNavAhaka (chromatophores ) DopA nAsyAtmaka ( dopa negative ) hote haiN| kabhI-kabhI kAlyarbuda ke eka bhAga meM raMga hotA hai aura dUsarA bhAga varNa hIna hotA hai| raMga yukta kozAoM se raMga nikala par3atA hai aura use bhatikozA udarastha kara lete haiN| kAlyarbuda ke dvArA sthAnika koI vizeSa vikRti utpanna nahIM hotI api tu isake dvArA utpanna visthAya bahuta vistRta hote haiM aura prANanAza ke kAraNa hote haiM / arbuda kozAoM kA prasAra lasavahAoM dvArA hotA hai jahA~ se ve prAdezika lasagranthakoM ko jAte haiN| Age raktavAhiniyAM inakA prasAra karake inheM dUrastha sthAnoM taka pahu~cA detI haiN| netrIya kAlyarbuda kA prasAra lasavahAoM dvArA nahIM ho pAtA / lasavahAoM ke dvArA hI mukhyatayA isakA prasAra hone se usa kSetra kI lasagranthiyA~ bar3hane lagatI haiM / rakta ke dvArA prasAra kArya bAda meM hotA hai kabhI-kabhI to mRtyu hone taka vaha nahIM bhI hotaa| para jaba rakta dvArA prasAra hotA hai to yaha itanA vistRta hotA hai ki kadAcit hI koI aMga baca pAtA ho| svacA visthAyotpatti kI mukhya bhUmi hai| visthAya sarva For Private and Personal Use Only

Page #948
860 vikRtivijJAna prathama tvacA meM utpanna hote haiM / yadi tvacA meM aneka vRddhiyAM dekhane meM AveM cAhe ve raMgIna hoM yA nahIM to bhI kAlyarbuda kA sandeha kiyA jAnA caahie| yadi isa roga se eka netra naSTa ho jAya aura yakRt pravRddha ho to netrIya kAlyarbuda kI kalpanA kI jA sakatI hai| sAdhyAsAdhatA kI dRSTi se yaha roga mAraka hai para atyadhika ghAtaka ho aisA lekara nahIM calanA cAhie / isa roga se pIDita eka vyakti do se tIna varSa paryanta jI sakatA hai ( bvAyaDa) / yadi sthAnika vRddhi ke sAtha-sAtha hI samIpastha lasagranthiyA~ bhI prabhAva grasta hokara pravRddha ho jAveM to bhI unakA uccheda kara dene se prANarakSA kI jA sakatI hai aisA Adhunika vaijJAnika batalAte haiM / (6) saMyuktArbuda yA bhrauNArbuda ( Teratomas ) saMyuktArbuda yA bhrauNArbuda kA artha aneka UtiyoM se nirmita arbuda hotA hai isameM zarIra meM pAI jAne vAlI sabhI UtiyoM ke kozA kabhI-kabhI to mila sakate haiN| isake kAraNa anya arbudoM meM aura inameM bahuta bar3A antara ho jAtA hai jo yaha pragaTa karatA hai ki ye bhrUNa UtioM dvArA utpanna hote haiM / prasaMgoparAnta zukrArtava saMyoga ke bahuta alpakAloparAnta hI isa arbuda ke bIja buva jAte haiM aura garbhavikAsa kI bahuta prArambhikAvasthA se athavA usake pazcAt hI yaha arbuda Arambha karatA hai / vizvAmitra kI sRSTi racanA kI taraha aisA lagatA hai ki mAno bhauNArbuda ke rUpa meM eka navIna vyakti kI racanA kI jA rahI ho jisameM sAdhAraNataH zarIra meM pAI jAne vAlI sabhI UtiyoM ke bIja vidyamAna hote haiM / ye arbuda haiM bhI yA nahIM isameM bhI Aja paryApta sandeha hai tathA inakI utpatti ke hetu ko ThIka ThIka prakaTa karanA bhI Aja taka eka samasyA banA huA hai / kabhI-kabhI to yaha strI kI garbhAvasthA meM eka garbha ke sAtha jur3avA ke sthAna para milatA hai aura kahIM-kahIM yaha vyakti kI pragalbhAvasthA meM bhI utpanna hotA hai aura aisA jJAna hotA hai ki isa arbuda kI utpatti ke kAraNabhUta zraNa kozA prasuptAvasthA meM paryApta kAla taka par3e raha kara isa avasara para utpanna ho gaye haiM / 1 NArbuda zarIra kI madhyarekhA meM sAmane kI ora athavA pIche kI ora kahIM bhI pAyA jA sakatA hai yA laiGgika granthiyoM meM ( in sex glands ) milatA hai / jaba do mUDha garbha 'jur3avA utpanna hote haiM to unake yA to peTa aura chAtI eka dUsare se jur3e hue Ate haiM yA trike jur3I hotI haiM / inhIM sthaloM ( zarIra kI madhyarekhA athavA trikasthAnAdi ) meM NArbudotpatti hotI hai| isa kAraNa yadi koI yaha mata rakhe ki saMyuktArbuda do yamajoM ( twins ) kI utpatti kA asaphala prayAsa mAtra hai to adhika azuddha nahIM mAnA jA sakatA / bhrUNa Uti ko vidhivat rakhane vAlA aMzavizeSa jaba anupasthita rahatA hai tabhI aisA ho sakatA hai| isI se saba prakAra kI utiyA~ kisI na kisI prakAra milI huI utpanna ho jAtI haiM / kucha kA vicAra yaha bhI hai ki zukrArtava saMyogoparAnta jo yuktUtAvasthA ( morula stage ) AtI hai aura kozAoM kA vibhajana bar3hI drutagati se calatA rahatA hai to usa samaya kucha yuktAkhaNDa ( blastomere ) For Private and Personal Use Only

Page #949
saMyuktArbuda yA bhrauNArbuda pRSTha 860 ALSO PRATANERS yaha bhrauNArbuda vRSaNa meM utpanna huA hai isameM saMyojI Uti tathA adhicchadIya uti donoM hI dekhI jAsakatI haiN| For Private and Personal Use Only

Page #950
arbuda prakaraNa 861 sthAnacyuta hokara vikAsa roka dete haiM aura kAlAntara meM unameM punaH vRddhi hone lagatI hai aura usake phalasvarUpa saMyuktArbuda utpanna ho jAtA hai| inakI utpatti ke sambandha meM eka vAda yaha bhI pracalita hai ki bhrUNa ke utpAdaka kozA kAyabhAga ( soma.) se prajana bhAga (gonad ) kI ora pracalana kara dete haiM aura pracalita kozAoM meM se kucha apane patha se vicalita hokara pragalbha prajanAGga meM zrauNArbuda utpanna kara detA hai| bhrauNAbaMdotpatti prajananAMgoM meM hotI hai aura usakA mUlakAraNa pragalbha (adult) yA avikasita ( undeveloped ) rohikozA (germ cell ) huA karatA hai| __bhrauNArbuda sabhI sAdhAraNa arbuda ( benign growths ) huA karate haiM tathA inakI vRddhi zarIra kI sAdhAraNa zrauNika UtIya vRddhi ke samAna hI hotI hai| Age calakara unameM se kucha meM mArAtmaka guNa utpanna hotA huA dekhA jA sakatA hai / prajananAGgoM meM strI kI bIjagranthi meM jo bhrauNArbuda banate haiM ve sadA sAdhAraNa yA aduSTa tathA koSThIya ( cystic ) hote haiM para jo puruSa kI vRSaNagranthi meM banate haiM ve Thosa aura mArAtmaka dekhe jA sakate haiN| ___ kahane kA tAtparya yaha hai ki eka bhrauNArbuda meM sabhI prakAra jaTilatAeM pAI jA sakatI haiN| vaha eka parAzrita bhrUNa ( parasitic foetus ) kA rUpa bhI le sakatA hai athavA hRdaya virahita svAbhAvika garbha se sambaddha mUDha garbha ke rUpa meM bhI dekhA jA sakatA hai| use eka saMyukta puMja ke rUpa meM Urdhva hanu se saMlagna bhI dekhA jA sakatA hai aura trika pradeza meM bhI usI prakAra abhilagna pAyA jA sakatA hai| usakA eka puMjarUpa zarIra meM prajananAMgoM meM bhI bana sakatA hai| usameM eka yA do se lekara bahuta sI UtiyA~ bhI ho sakatI haiN| kahIM yaha koSThIyarUpa dhAraNa kara letA hai aura kahIM yaha Thosa rahatA hai| mAyA ke jisa prakAra vividharUpa hote haiM usI prakAra bhrauNArbuda ke bhI ho sakate haiM / prajananAMgoM ke bhrauNArbuda bahurUpatA ke lie suprasiddha haiM / nicarmAbha koSTha ( dermoid cyst ) ke andara jo bIjagranthi meM banatI hai bAla, tvacA, prasvedIya padArtha, dA~ta, mastiSka avaTukAdi aMga dekhe jA sakate haiM / vRSaNa ke zrauNArbuda meM taruNAsthi, pezI, mastiSka tathA maJjarikA ( choroid plexus ) taka pAyA jA sakatA hai| nicarmAbhakoSTha ( Dermoid cysts )-bIjagranthIya arbudoM kA eka dazAMza nicarmAbhIya koSThoM dvArA pUrNa huA karatA hai / prajananakAla (procreation period) meM ye utpanna hote haiN| ye prAyaH akele hI banate haiM kabhI usI para bahuta hI kama eka bIjagranthi meM do yA donoM ora kI bIjagranthiyoM meM eka eka bhI ye dekhe jA sakate haiM / koSTha dhIre dhIre utpanna hote haiM aura ve sAdhAraNa yA aduSTa hote haiM para Age cala kara unakA mArAtmaka svarUpa bIjakozIya adhicchadArbuda meM bhI badala jA sakatA hai| eka nicarmIya koSTha kA prAcIra tAntava Uti ke dvArA banakara taiyAra hotA hai jisake andara zalkAdhicchada kA AstaraNa rahatA hai| usake nIce bar3I bar3I vasA granthiyA~ ( sebaceous glands ) rahate haiM jinameM kezakUpikAe~ ( hair-follicles ) hotI For Private and Personal Use Only

Page #951
862 vikRtivijJAna haiM / koSThaka meM makkhana ke samAna pIlA vasAgranthiyA~ kA strAva hotA hai aura vizalkita adhicchadIya kozA pAye jAte haiN| isake andara keza utpanna hue rahate haiN| isa koSThaka ke eka sire para thor3A sthUlana hotA hai jise nicarmIya pravarddhanaka ( dermoid pro. cess ) kahate haiM isa pravarddhanaka se dA~ta yA dA~ta kA aMza sambaddha rahatA hai| isa pravarddhanaka kA cheda lene para usa meM anya aneka UtiyA~ pAI jAtI haiM jina meM asthi, taruNAsthi, avaTukA, lasagranthiyA~ Adi mukhya haiN| kabhI kabhI avaTukAgranthi ke dvArA bhI sampUrNa arbuda puMja banatA hai| ise bIjagranthIya galagaNDa (struma ovari ) kahate haiM / yaha bhauNikArbudIya tathA sAdhAraNa hotA hai| bhrauNArbudAbha yA mizrita arbuda (Teratoid or mixed tumours) ina arbudoM meM koI nizcita vinyAsapUrvaka UtIya kozA nahIM rakhe hote / ina meM sabhI prakAra kI UtiyA~ milatI haiN| kAsthi, asthi, granthIka Uti, zalkAdhicchadAdi ye sabhI aduSTa arbuda haiM aura UtIya kozA sabhI pUrNataH vibhinnita prakAra ( differentiated type ) ke hote haiN| prAyaH kabhI kabhI eka prakAra kI Uti adhika vRddhi karane lagatI hai jisake kAraNa usameM mArAtmakatA bhI pAI jA sakatI hai| jaba yojI Uti kI ati vRddhi hotI hai to saMkaTArbuda tathA jaba adhicchadIya Uti bar3hatI hai to karkaTArbuda utpanna hote dera nahIM lgtii| karkaTArbudotpatti saMkaTArbudotpatti kI apekSA adhika dekhI jAtI haiN| mArAtmakatA kI utpatti hone para inake visthAya svatantratayA milate haiM aura inakI duSTatA bahuta adhika pracaNDa rUpa dhAraNa kara letI hai| ye arbuda bahudhA vRSaNoM meM banate haiM aura prAyaH Thosa hote haiN| kabhI kabhI choTI choTI kaI koSThikAe~ bhI bana sakatI haiN| inhIM ke kAraNa inheM vRSaNa kA tantukoSThIya roga ( fibrocystic disease of the testis) bhI kaha kara pukArA jA cukA hai| inameM kabhI kabhI jarAdhadhicchadArbuda bhI milA hai| yadyapi jarAyu aMkuroM ke tatvoM ko bahudhA nahIM dekhA jA skaa| jarAyu Uti zrauNArbudIya hI hotI haiM aura isameM bhakSaNa zakti kI vipulatA ke pariNAmasvarUpa arbada meM anya dUsarI Uti nahIM mila paatii| For Private and Personal Use Only

Page #952
dvAdaza adhyAya rudhira vaikArikI dehasya rudhiraM mUlaM rudhireNaiva dhAryate / tasmAdyatnena saMrakSyaM raktaM jIca iti sthitiH // (suzrutaH) deha kA mUla rudhira hai| rudhira hI deha kA dhAraNa karatA hai ataH rakta yatnapUrvaka saMrakSaNIya hai / rakta hI jIva hai yaha sthiti hai / rudhira aura rakta donoM paryAyavAcI zabda haiN| eka se dUsare kA bodha hotA hai / Ayurveda tattvavettAoM ne rudhira yA rakta kI mahattA kA paryApta adhyayana kiyA thA aura usI ke pariNAmasvarUpa raktaM jIva iti sthitiH taka unakI pahu~ca huI thii| rakta kA nirmANa Ayurveda rasa se mAnatA hai-rasAdaktam / rasa kI paribhASA sazruta ne dete hue likhA hai tatra pAJcabhautikasya caturvidhasya SaDsasya dvividhavIryasyASTavidhavIryasya vA'nekaguNasyopayuktasyAhArasya samyakpariNatasya yastejobhUtaH sAraH paramasUkSmaH sa rasa ityucyate / ki pRthivyAdi paJcamahAbhUtAtmaka, peya, lehya, bhakSya, bhojya cAra prakAra ke svAdu, amla, lavaNa, tikta, kaTu, kaSAya ina cha rasoM se yukta zIta tathA uSNa ina do vIryoM se saMyukta; zItoSNa snigdha rUkSa, vizada, picchila, mRdu tIkSNa ina aSTavidha vIrya se ota prota tathA dravyaguNazAstra meM varNita guru-laghu, zItoSNa, snigdha-rUkSa, manda-tIcaNa, sthira-sara, mRdu-kaThina, vizada-picchila, zlakSNa-khara, sUkSma-sthUla, sAndra-drava, vikAzivyavAyi Adi anekoM guNoM vAlA AhAravidhividhAna ke anusAra kie gaye bhojana ke samyaktayA paca jAne para jo tejobhUta prasAda svarUpa paramasUkSma sAra banatA hai vahI rasa kahalAtA hai / isa rasa kA hRdaya sthAna mAnA gayA hai vahA~ se cala kara kRtsnaM zarIramaharahastarpayati vardhayati dhArayati yApayatisampUrNa zarIra kA nirantara tarpaNa, vardhana, dhAraNa aura yApana karatA hai| yaha isakA sampUrNa karma adRSTa hetukena karmaNA kisI adRSTa karma ke prabhAva se hotA hai / yaha Apya (jalarUpa) rasa yakRtplIhAnau prApya rAgamupaiti aura taba isakI saMjJA rakta ho jAtI hairaJjitAstejasA tvApaH zarIrasthena dehinAm / avyApannAH prasannena raktamityabhidhIyate // ( suzrutaH) zarIriyoM kI deha meM sthita rasa teja ke dvArA yaha Apyarasa yakRt plIhA meM raMgA jAkara prasAda rUpa rakta kahalAne lagatA hai| isase vidita hotA hai ki lAlakaNa rahita rakta kA sampUrNa tarala bhAva AyurvedIya AhAra kA tejobhUta sAra Apya rasa hai tathA lAlakoM ke mila jAne se aura varNa meM lAla ho jAne ke bAda isa rasa kI saMjJA rakta ho jAtI hai| . usI rasa ke sambandha meM nimnalikhita bhAvoM kI abhivyakti aura kI jAtI hai1. rasAdeva striyA raktaM rajaH saMjJaM pravartate / For Private and Personal Use Only

Page #953
864 vikRtivijJAna striyoM kA raja nAmaka rakta isI rasa se taiyAra hotA hai / 2. tatra rasa gatau dhAtuH, aharahargacchatItyato rasaH -- gati dhAtu se nirmita rasa zabda dina dina gamana karatA hai ataH rasa kahalAtA hai / 3. sa khalu trINi trINi kalAsahasrANi paJcadaza ca kalA ekaikasmindhAtvAvatiSThate, evaM mAsena rasaH zukrI bhavati strINAM cArtavam- vaha rasa eka eka dhAtu meM 3015 kalA taka ThaharatA hai / tathA eka mAsa meM vahI puruSa meM zukra aura strI meM bIja bana jAtA hai / tathA rasa se vIrya banane meM 18090 kalA kA samaya lagatA hai / 4. sa zabdAcirjalasantAnavadaNunA vizeSeNAnudhAvatyevaM zarIraM kevalam -- vaha Apyarasa zabda - teja-jala ke vistAra kI taraha zarIra meM kevala sUkSmarUpa se vizeSatayA gamana karatA hai / Acharya Shri Kailassagarsuri Gyanmandir 5. sa evAnnaraso vRddhAnAM paripakvazarIratvAdaprINano bhavati -- vRddhoM ke paripakka zarIra vAlA hone ke kAraNa vahI annarasa aprINana ( apuSTikAraka ) hotA hai / 6. rasaH prINayati raktapuSTa ca karoti rasa zarIra kA prINana tathA rakta kI puSTi karatA hai / 7. rasakSaye hRtpIDA kampaH zUnyatA tRSNA ca- rasa kA kSaya ho jAne para hRdaya meM pIDA hotI hai, zarIra meM kampana hotA hai, zUnyatA tathA pyAsa bar3ha jAtI hai / 8. raso'tivRddhau hRdayotkleda prasekaM cApAdayati- rasa kI adhika vRddhi hone para hRdaya meM utkleda aura mukha se pAnI nikalane lagatA hai / 9. tatra zleSmalAhArasevino'dhyazanazIlasyAvyAyAmino' manukrAmannatisnehAnmedo janayati / tadatisthaulyamApAdayati "evAnnaraso madhuratarazca zarIra zleSmala AhAra vihArAdi se annarasa madhuratara hokara adhika sneha se medotpatti karake sthUlatA kI vRddhi karatA hai 1 10. upazoSito rasadhAtuH zarIramananukrAmannalpatvAnna prINAti so'tikRzaH kSutpipAsAzItoSNavAtavarSabhArAdAneSvasahiSNurvAtarogaprAyo'lpaprANazca kriyAsu bhavati, zvAsakAsa zoSalIhodarAgnisAdagulma raktapittAnAmanyatamamasAdhya maraNamupayAti vAtalAhArasevI vyakti kI rasadhAtu jaba upazoSita ho jAtI hai to vaha dhAtuoM kA prINana zarIra meM nahIM kara pAtI hai jisake kAraNa rogI adhika kRza ho jAtA hai / kArya ke kAraNa kSudhAtRSNAdi meM asahiSNu ho jAkara vaha alpaprANa ho jAtA hai jisase vAsakAsAdika se grasita hokara mara taka jAtA 11. yathA svabhAvataH khAni mRNAleSu biseSu ca / dhamanInAM tathA khAni raso yairupacIyate - hai 1 For Private and Personal Use Only

Page #954
rudhira vaikArikI jisa prakAra se kamalanAloM aura kamalakandoM meM chidra svAbhAvika rUpa meM hote haiM usI prakAra svAbhAvika rUpa meM dhamaniyoM meM chidra hote haiM jinameM hokara rasa nirantara bahatA rahatA hai| uparyukta uddharaNoM se blaDa nAma se jisa dhAtu kA bodha Adhunika kiyA karate haiM vaha AyurvedIya raJjita rasadhAtu hai jo rakta yA rudhira nAma se sarvatra prasiddha hai / jIvarakta ke nAma se bhI isI kA bodha hotA hai-pAJcabhautikaM svapare jIvaraktamAhurAcAryAH / isa jIvarakta kI pAJcabhautikatA kI puSTi ke lie nimnalikhita zloka bar3e mahattva kA hai visratA dravatA rAgaH spandanaM laghutA tathA / bhUmyAdInAM guNA hyete dRzyante cAtra zoNite / / Amagandhi guNa pRthivI kA, dravatva jala kA, lAlI agni kA, spandana vAyu kA tathA halakApana AkAza kA guNa hotA hai aura ye pA~coM guNa rakta meM barAbara dikhAI dete haiN| tasya zarIramanusarato'numAnAdgatirupalakSayitavyA kssyvRddhivaikRtaiH| tasmin sarvazarIrAvayavadoSadhAtumalAzayAnusAriNirase jijJAsA-kimayaM saumyastaijasa iti / atrocyate -sa khalu dravAnusArI snehanajIvanatarpaNadhAraNAdibhirvizeSaiH saumya ityavagamyate / ( suzruta sUtra adhyAya 14) / uparyukta vAkya meM rasa ke sambandha meM jitanA bhI AcAryoM ko jJAna hai vaha anumAna nAmaka pramANa ke AdhAra para hai| rasa ke kSaya, vRddhi aura vikRtiyoM ke dvArA sarvazarIracArI rasa vA rakta kI gati kA jJAna anumAna dvArA hI kiyA gayA hai| yaha sampUrNa zarIra meM bahatA hai| zarIra ke saba avayava, saba doSa, sampUrNa dhAtue~, sAre mala aura Azaya sarvatra rasa vyApta hai| saumya yA taijasa isa prazna kA uttara dete hue kahA gayA hai ki rasa drava hai, bhramaNazIla hai, snehana, jIvana, tarpaNa, dhAraNAdi vizeSa guNoM ke kAraNa yaha saumya hI jJAta hotA hai| bhela ne samAzanaparidhanIya nAmaka gyArahaveM adhyAya meM rasa-rakta-vyApattija jo roga ginAe haiM unase bhI hamArI rasa-rakta-kalpanA ( conception ) ko eka AdhAra prApta ho jAtA haiannasya "ta ( bala ) tastejo raso nirvaya'te nRNAm / rasAdraktaM tato mAMsaM mAMsAnmedastato'sthi ca / / asthno majjA tataH zukra zukrAdgarbhasya smbhvH| evaM pUrvAtparaM yAti dhAturdhAtuM yathAkramam / / tatrApathyaM yathAbhuktaM rasasevyathavA punaH / kuryAdrogAnadIptAnI rasavyApattisambhavAn / zoNitAdyAtmatA gacchetpariNAmavazAt tadA / yasminvyApadyate dhAtau tasmin vyAdhIn karotyatha / / viSUcikAM sAlasakAM pittadAhaM vilambikAm / anyedyaSkaM satatakaM tRtIyakacaturthakam / / pittaM lohitapittaM ca raktAsi pralepakam / vipATikAMzca tAn vyAdhIn rasavyApattijAnviduH / / karcha carmadalaM pAmAM carmakIlaM vicarcikAm / viDjAn sattvAni kuSThAni raktavyApattijAnviduH / / Adhunika vicArakoM ke mata se rasa meM nilambita kozAoM se yukta tarala rudhira kahalAtA hai / yaha sampUrNa zarIra bhAra kA bIsavAM bhAga huA karatA hai / Ayurveda meM jise rasa ke nAma se sambodhita kiyA gayA hai vaha plAjmA ( plasma ) kahalAtA hai| plAjmA prAGgodeyoM, probhUjinoM, jAraka (auksIjana), snehoM, paittava tathA lavaNoM kA tarala saMmizraNa hotA hai jisameM jIvatiktiyA~ tathA nyAsarga ( hormones ) bhI sammilita hote haiM / inake atirikta cayApacaya meM UtiyoM meM bane apadravya (waste 73, 74 vi0 For Private and Personal Use Only

Page #955
866 vikRtivijJAna products ) bhI rahate haiM / lasIkA yA lasa (lymph) yaha plAjmA yA rasa kA hI eka tanu svarUpa hai| isameM rakta rasa yA anna rasa ke atirikta UtiyoM se prApta tarala ( tissue fluids ) bhI rahate haiN| yaha eka mAdhyama ( medium ) kA kArya karatA hai jisake eka ora rakta aura dUsarI ora Uti rahatI hai| rakta se poSaka dravyoM ko lasIkA UtiyoM meM pahu~cAtI hai aura UtiyoM meM cayApacaya kriyA dvArA bane apadravyoM ko rakta ko arpaNa karatI hai| sAdhAraNatayA svasthAvasthA meM rakta kI rAsAyanika, bhautika tathA kozIya sthiti sthira svarUpa kI hotI hai isalie rakta ke ghaTakoM yA paristhiti meM thor3A sA bhI antara usI samaya AyA karatA hai jaba zarIra ko koI roga satAve / jahA~ vikRtivizArada (paithAlaujisTa) apanI prayogazAlA meM rakta ke ghaTakoM kA jJAna prApta karake rogAvasthA kA jJAna karatA hai vahA~ eka prAcIna cikitsaka raktagati kA adhyayana nADI dvArA karake nidAna kA ThIka ThIka jJAna prApta karane kA prayatna karatA hai| nADI yA raktacitra meM antara jJAta hone para usakA rogavizeSa ke sAtha sambandha baiThAnA nidAnajJa ke lie eka gurutara kArya hotA hai| rudhirANu-inheM rakta ke lAlakaNa bhI kahate haiM / Adhunika bhASA meM raiDa blaDa kArpaskilsa (Red Blood Corpuscles) ke nAma se prasiddha haiM jinakA saMkSipta nAma Ara. bI. sI. (R. B. C.) kahA jAtA hai / vaijJAnika bhASA meM inheM erIthrosAiTsa (erythrocytes) atAfAIETA (normocytes), a41 HAIETA (chromo. cytes) ke nAma se pukArate haiM jinake paryAya kramazaH raktakAyANu, RjukAyANu tathA varNakAyANu isa pustaka meM prayukta hue haiM / stanadhArI jIvoM meM janma ke kucha kAla pazcAt ye rudhirANu nyaSTi rahita (non-nucleated) hote haiM / garbhAvasthA meM tathA prasava ke turata bAda inameM nyaSTi dekhI jA sakatI hai| inakI saMkhyA meM paryApta antara svasthAvasthA meM bhI dekhA jA sakatA hai| striyoM meM 40 lAkha se 50 lAkha pratighana milImITara tathA puruSoM meM 45 lAkha se 60 lAkha taka inakI svAbhAvika gaNanA mila sakatI hai| pratyeka rudhirANu kA ausata vyAsa 7.5 myU kA hotA hai| AkRti kI dRSTi se ubhaya. pArzva natodara ( biconcave ) hotA hai| nyaSTi kA abhAva hone ke kAraNa rudhirANu kA vibhajana nahIM ho sakatA hai| eka rudhirANu prAyazaH tIna saptAha taka jIvita rahA karatA hai| isakA artha yaha huA ki sAre zarIra ke rudhirANuoM kA tIsavA~ bhAga pratidina naSTa ho jAtA hai / ina naSTa hone vAle rudhirANuoM ko samApta karane kA kArya jAlakAntazchadIya saMsthAna kA hai| ___ yadyapi Ayurveda rudhirANuoM kA udbhavasthala yakRt tathA plIhA ko mAnatA hai| para dekhA yaha gayA hai ki jaba taka bAlaka garbhastha rahatA hai taba taka usake rudhirANuoM kA nirmANa yakRt plIhA bhale hI kareM para janmoparAnta yaha kArya lAla asthimajjA ( red bone narrow ) ke andara hI sambhava hotA hai| lAla asthimajjA sadaiva cipaTI asthiyoM meM hI pAI jAtI hai| isa kAraNa vayaskoM meM pRSThavaMza ke kIkasa, For Private and Personal Use Only

Page #956
rudhira vaikArikI uraHphalaka, pazukAe~, karoTi kI asthiyA~ , zroNi kI asthiyA~ Adi isake utpatti ke sthala hote haiM / bAlakoM meM prAyazaH sabhI asthiyA~ kevala lAla asthimajjA se hI bharI hone ke kAraNa rudhirANuoM kA nirmANa unake zarIra kI prAyaH sabhI asthiyoM meM huA karatA hai| sAtaveM varSa meM lAla asthimajjA meM pItaasthimajjA kA prAdurbhAva hone lagatA hai jo kevala aNvIkSaNa para hI spaSTa hotA hai| caudahaveM varSa meM lAla se pIlI majjA ke nirmANa ko svayaM dekhA jA sakatA hai tathA Age calakara bIsaveM varSa meM saba lambI haDDiyoM meM lAla ke sthAna para pIlI majjA hI zata pratizata dikhAI par3atI hai aura rakta ke lAla kaNoM kA nirmANa inameM pUrNataH banda ho jAtA hai| yaha parivartana sadaiva asthi ke dUrastha bhAga ( distal end ) meM Arambha hotA hai aura dhIre dhIre Upara kI ora calatA hai / sAtha hI ina asthiyoM ke samIpastha bhAga (proximal end ) Urvasthi, pragaNDAsthi tathA jaGghAsthi ke UrdhvazIrSoM para lAla asthimajjA kevala bIja rUpa meM raha jAtI hai| yahI kAraNa hai ki jaba Age calakara majjA kI kriyAzakti kA paramacaya hone lagatA hai to vaha inake samIpastha bhArgoM meM hI Arambha hotA hai jo bAda meM kahIM dUrastha bhAga kI ora taka pahu~catA hai| eka bAta aura hai ki jisa prakAra samIpastha bhAga meM lAlamajjA bAda meM tathA dUrastha bhAga ko pahale chor3a detI hai vaise hI una asthiyoM meM jo hRdaya kI dizA meM adhika pAsa hotI haiM unameM lAlimA adhika kAla taka rahatI hai| yahI kAraNa hai ki jaba javAsthi ( tibia ) pUrNataH pIlI majjA se bhara jAtI hai usa samaya bhI Urdhvasthi (femur ) meM lAla majjA paryApta pAI jAtI hai| yaha smaraNa rakhanA cAhie ki lAla majjA pIlI majjA kI apekSA bahuta adhika vAhinya ( vascular ) hotI hai| isI kAraNa uttarajAta karkaTa pragaNDAsthi ( humerus ) tathA Urvasthi meM jitanI adhika mAtrA meM pAyA jA sakatA hai utanA jaGghAsthi yA agrabAhu kI asthiyoM meM nahIM / AvazyakatA par3ane para jaba kriyAtmaka (functional ) paramacaya hotA hai taba una haDDiyoM meM jinameM pIlI majjA bharI hotI hai eka vistRta parivartana ho jAtA hai| unake samIpastha bhAgoM meM pahale tathA dUrastha bhAgoM meM bAda meM lAlamajjA bharane lagatI hai| yahI nahIM AvazyakatAnusAra haDDI kA asthIya bhAga bhI pracUSita hokara asthiguhA ko aura caur3A aura vistRta ho jAtA hai| yaha pIlI se lAla majjA kA parivartana do avasthAoM meM bahudhA milatA hai-eka to jaba vyakti araktatA (anImiyA) se pIDita ho jAtA hai tathA dUsare jaba use koI upasarga (inphaikzana) laga jAtA hai| upasarga ke kAraNa mRtyu jina rogiyoM kI hotI hai unakI lambI haDDiyA~ kabhI kabhI to pIlI ke sthAna para pUrNataH lAla majjA se bharI huI hI dekhI jAtI haiN| parantu anImiyA meM jo parivartana dekhe jAte haiM ve rudhirANANuruhika (erythroblastic ) hote haiM tathA inphaikzana meM zvetANuruhika (leucoblastic) huA karate haiN| : lAlamajjA ke andara kozAoM kI pahacAna bvAyaDa kI dRSTi meM eka kaThina kArya hai| For Private and Personal Use Only

Page #957
868 vikRtivijJAna asthimajjA meM gaNanA meM sabase adhika zvetakaNa pAye jAte haiN| ve rudhirANuoM kI apekSA tIna gune hote haiN| lAlamajjA meM rudhirANuoM kA nirmANa majjA kI antaHsrotasAbha kezAloM ke antazchadIya starakozAoM (endothelial lining cells of the intersinusoidalcapillaries of the red bone-marrow) se sUtribhAjaka vibhajana (mitotic division ) dvArA hotA hai / ina jAlakAntazchadIya kozAoM se sarvaprathama zoNakozaruha (haemocytoblasts) taiyAra hote haiN| unase phira prAthamika rudhiraruha (primary erythroblasts) banate haiN| ve phira vibhakta hokara dvitIyaka rudhiraruha (secondary erythroblasts) kI utpatti karate haiN| unase Age calakara Rjuruha (normoblasts) bana jAte haiM / RjurahoM se jAlakakAyANu (reticulocyte) utpanna hote haiM aura taba kahIM jAkara unase rudhirakAyANu yA rudhirANu ( erythrocyte) kA nirmANa hotA hai| prAthamika rudhiraruha kInyaSTi udvika (vesicular) hotI hai / kozA svayaM paryApta bar3e hote haiN| inakA kAyANurasa (cytoplasm) kSArapriya yA pITharajya (basophil) hotA hai| dvitIya rudhirarahoM meM nyaSTIlA gaharI raMgI jAsakatI hai, usakI AkRtibhI viSama ho jAtI hai tathA vaha AkAra meM kucha choTI bhI ho jAtI hai| ye kozA punarutpatti ke ayogya ho jAte haiM / ina kozAoM kA cidrasa paripakva ho jAtA hai, usameM zoNavartuli kA prAkaTya dekhA jAtA hai| unase phira Rjulhotpatti hotI hai RjuruhoM kI nyaSTiyA~ bhI viSamAkRtika hotI haiN| yaha nyaSTi jaba apajanita hone lagatI hai taba jAlakakozAoM kI jAlAkRtika nyaSTiyA~ banatI haiM / rudhirANuoMmeM nyaSTiyA~ nahIM huA karatI / yaha zarIra kriyA vijJAna kA pratyeka vidyArthI jAnatA hai| eka zoNakozAruha se anekoM rudhirANu banA karate haiM parantu isa kriyA ke yathAvat calane ke lie prAmalakAmla (viTAmIna sI), avaTukAsatva ( thyroxin ) tathA raktakSayAntaka yA raktAlpatAhara tatva (anti-anaemic factor ) kA honA paramAvazyaka hotA hai| jaba ina tInoM meM se kisI kI upalabdhi meM antara A jAtA hai to rudhirANuoM ke svastha nirmANa meM bAdhA par3a jAyA karatI hai| jaba yaha jAlakAntazchadIya kozA apane ko vibhakta karake Age kI avasthAoM meM jAne meM asamartha ho jAtA hai taba vaha AkAra meM thor3A aura bar3A ho jAtA hai aura taba use bRhadraktaruha ( megaloblast ) kahakara pukArA jAtA hai| Age calakara isakA kozArasa paripakva ho jAtA hai aura vaha zoNavartuli taiyAra kara detA hai sAtha hI usakI nyaSTi lupta ho jAtI hai jisake pariNAmasvarUpa jo kozA banatA hai vaha bRhadraktakozA ( megalocyte ) kahalAtA hai| yaha bRhadraktakozA eka prakAra se vikRta rudhirANu hI hotA hai| yaha rudhirANu se thor3A bar3A hotA hai| bRhadktakozA kI utpatti kA mukhya kAraNa hai raktakSayAntaka dravya kI kamI / ye bRhadraktakozA saMkhyA meM bhI kama hote haiN| isake kAraNa jo raktakSaya utpanna hotA hai usakA raktacitra dekhane se rudhirANuoM kI saMkhyA meM kamI tathA bRhadraktakozAoM kI upasthiti spaSTataH dikhAI detI hai jinameM zoNavartuli kI mAtrA radhirANuoM kI apekSA adhika hotI hai| isI se isa raktakSaya ko bRhatkAyANvika For Private and Personal Use Only

Page #958
afar vaikArikI paramavarNika ( macrocytic hyperchromic ) kahA jAtA hai / raktaruhoM ( erythroblasts ) ke kozArasa kI paripakkatA ke lie, tAki zoNavartula (hImoglobIna) kA nirmANa yathocita ho sake, ayas yA lohe kI upasthiti paramAvazyaka hotI hai / ayas rakta kAyA AyurvedIya paribhASA meM rasa kA abhiraJjana karane ke liye Avazyaka hotA hai| kozIya praguNana se usakA koI sarokAra nahIM hotaa| kyoMki kozIyapraguNana ayas kI kamI-bezI para nirbhara nahIM karatA, isa kAraNa ayas kA abhAva hone para bhI kozIya praguNana para usakA koI prabhAva nahIM par3atA ayas kA abhAva unheM varNahIna aura laghukAya kara sakatA hai / varNa kI kamI aura kozAkAyA kI laghutA ye do lakSaNa lohe ke abhAva se utpanna raktakSaya meM spaSTa dikhalAI dete haiM isI lie usako laghukAyika alpavarNika ( microcytic hypochromic ) raktakSaya kahA jAtA hai / / rudhirANuoM kI vikRtiyA~ rudhirANuoM meM kaI prakAra ke parivartana vikRtAvasthA meM pAye jAyA karate haiN| yathA1. rudhirANuoM kI zoNavartuli kI mAtrA ( haemoglobin content ) ke parivartana | 2. rudhirANuoM kI saMkhyA ( number ) meM parivartana, 3. rudhirANuoM ke AkAra ( size ) meM parivartana, 866 4. rudhirANuoM ke svarUpa ( shape ) meM parivartana, 5. abhiraJjana ( staining ) sambandhI parivartana, 6. raktadhArA meM nyaSTivAn rudhirANuoM kI upasthitijanya parivartana, 7. rudhirANuoM meM bhaMguratA ( fragility ) janya parivartana, 8. rudhirANuoM kA AtaJcana ( coagulation ) janya parivartana, 9. raktAvasAdanagati ( sedimentation rate ) janya parivartana, 10. zoNaprasamUhi ( haemaglutinin ) janya parivartana | aba hama Age inhIM 10 prakAra kI vikRtiyoM para saMkSiptarUpa se vicArArambha karate haiM tAki raktavikAroM ke vistRta vicAra ke samaya Avazyaka sahAyatA prApta ho sake / For Private and Personal Use Only zoNavatuli sambandhI parivartana - zoNavartuli eka sphaTIya ( crystallizable ), vartula nAmaka probhUjina (proTIna) tathA lohe ke eka yaugika (hImaiTIna) ke saMyoga sebanA karatI hai / zoNavartuli sadaiva rudhirANuoM meM rahatI huI raktarasa (plasma) andara utpanna hone vAlI amlatA ko dhvasta karatI rahatI hai / usake isa kArya ke kAraNa apratyakSarUpa meM raktarasa meM prAGgAradvijAreya ( kArbana DAI oNksAiDa ) ko adhika mAtrA meM grahaNa karane kI sAmarthya meM vRddhi ho jAyA karatI hai / rakta ko yadi sukhA liyA jAve to usameM 9/10 bhAga zoNavartula kA mila sakatA hai / zarIra meM jitanA lohA ( ayas ) milatA hai usakA 80 pratizata zoNavartuli ke andara pAyA jAtA hai /

Page #959
'870 vikRtivijJAna yaha mAna liyA gayA hai ki eka svastha vayaska meM zoNavartuli 100% hotI hai| usI anupAta se zoNavartuli kI saMkhyA anyoM meM nimna mAnI gaI hai svastha strI-90 se 95% / 6 varSIya bAlaka-70 se 85% / 100% kA artha hai 14.5 grAma zoNavartuli 100 ghana seNTImITara rakta meM upasthita hai| __ raMgadezanA (Colour index)--vyakti ke pratyeka rudhirANu meM upasthita zoNavartuli kI mAtrA kA svastha puruSa ke pratyeka rudhirANu meM upasthita zoNavartuli kI mAtrA ke sAtha jo anupAta hai vahI raMgadezanA kahalAtI hai| isake prApta karane ke lie vyakti kI zoNavartuli % ko, rudhirANu saMkhyA prati ghana milImITara ke prathama 2 aGkoM ke dugune se bhAga denA par3atA hai| jaise yadi vyakti meM 80% zoNavartuli hai tathA usakI rudhirANu saMkhyA 4500000 hai to usakI raMgadezanA 62 = yA 0.88 mAnI jaavegii| __ rudhirANu-vikRti hone para kaI rUpa zoNavartuli meM dekhe jAte haiM-sAdhAraNatayA jitanI zoNavartuli eka kozA meM Avazyaka hai usase kama dikhAI par3e yA kozA sAmAnyakozA kI apekSA bar3e AkAra kA hone ke kAraNa usameM zoNavartuli kI mAtrA adhika mile| zoNavartali kI kamI haridutkarSa ( chlorosis) meM milatI hai tathA zoNavartuli kA Adhikya ghAtaka raktakSaya ( pernicious anaemia) meM pAyA jA sakatA hai| zoNavartuli kI atyadhika kamI ke kAraNa rudhirANuoM kA kendrabhAga pUrNataH varNavihIna yA zvetAbha lAla varNa kA dikhalAI de sakatA hai| haridulkarSa meM isa avasthA kI utpatti huA karatI hai aura ise alpavarNatA (hypochromia ) kahA jAtA hai| __ yahA~ yaha smaraNa karanA bhI asaGgata na hogA ki rudhirANuoM ke nirmANa aura raMjana meM nimna padArthoM kI AvazyakatA zarIra ko par3A karatI hai lohA-sampUrNa zarIra meM 6 grAma lohA hai| yaha sabhI khAdya padArthoM dvArA zarIra ko prApta hotA hai| jaisA ki pahale kahA hai 70 se 80 pratizata yaha lohA rakta meM upasthita rahatA hai| tAmra-zoNavartuli ke nirmANa ke lie tathA ayasa (lohe)kA upayoga ThIka ThIka karane ke lie tAmra kI AvazyakatA ko Adhunika jahA~ aba svIkAra karane lage haiM vahA~ AyurvedajJoM ne hajAroM varSa pUrva usakI mahattA ko svIkAra kara liyA thaa| jIvatiktiga(viTAmIna sI) lohe ke pAcana meM sahAyatA karatI hai yaha AdhunikoM ne.bar3e vicAra se taya kiyA hai| AyurvedajJa apane lohe ko triphalA svarasa dvArA hI mArate Aye haiM tathA triphalA meM AmalA viTAmIna sI kA akSaya bhaNDAra hai / dhAtrI loha, triphalAmaNDUra Adi yogoM meM viTAmIna sI pracura mAtrA meM upasthita rahatI hI hai / yahI pholika esiDa tathA viTAmIna bI ko bhI hajama karane ke lie Avazyaka mAnI gaI hai| For Private and Personal Use Only

Page #960
rudhira vaikArikI 871 ketvAtu ( kobAlTa )-isa dhAtu kI sUkSmAMza meM rudhirANuoM kI utpatti aura raMjana ke lie AvazyakatA hotI hai / jIvatikti bI-zoNakozaruha (haemocytoblast) jinheM pUrvarudhiraruhANu (pro-erythroblast ) bhI kahA jA sakatA hai kI duSTi ke lie tAki usakA vibhajana ThIka ThIka ho sake viTAmIna bI kI AvazyakatA Aja anubhava meM A rahI hai| khoja kI AvazyakatA hai harItakI meM nihita viTAmIna bI aura usake asaMkhya tatvoM kii| __ patrikAmla (pholikAmla )-pholika esiDa bhI viTAmIna bI ke sAtha sAtha usakekArya meM sahAyatA dene ke lie Avazyaka mAnI gaI hai / AyurvedajJa pratyeka auSadhi ke sAtha jo tAjA patrasvarasa anupAna rUpa meM dete haiM vaha spaSTataH usakI mahattA ko Aja siddhakaratA hai kyoMki pattiyA~ pholika esiDa kI prApti kA naisargika AdhAra hotI haiN| agrapIyUSagranthi (anterior pitiutary gland) kA e. sI. TI. eca. ( adrenocorticotrophic hormone ) nAmaka hArmona bhI raktasaMjanana kriyA kA varddhaka hotA hai / akTukAgranthisatva ( thyroxine ) bhI raktasaMjanana meM cayApacaya kriyAoM kI vRddhi karake parokSatayA sahAyaka hotA hai / isa prakAra raktasaMjanana vA rasa ke raktarUpa meM pariNata hone ke lie, kozAoM meM lohA milAne ke lie tathA ucita vAtAvaraNotpAdana ke lie kaI vastuoM, tatvoM aura nyAsoM (hArmonsa) kI AvazyakatA par3atI hai| saMkhyA sambandhI parivartana-eka svastha puruSa meM 57 se 55 lAkha pratighana milImITara kI saMkhyA meM rudhirANu rahA karate haiN| yaha saMkhyA svastha striyoM meM kama huA karatI hai| koI 40-45 lAkha rudhirANu prati gha. mi. mI. unameM milate haiN| jaba kisI kAraNa se yaha saMkhyA aura bar3ha jAtI hai to usa avasthA ko bahukozAraktatA (polycythaemia) kahate haiN| yaha bahukozAraktatA jahA~ vAstavika ho sakatI hai vahA~ mithyA bhii| mithyA bahukozAraktatA kA udAharaNa hai jaba zarIra se jalIya bhAga zIghratA se zarIra se bAhara calA jAkara rakta gAr3hA ho jAtA hai tathA ugra jalAbhAva ( dehydration ) rugNa ko vyathita kie rahatA hai tathA usake raktacitra meM jisa bahukozAraktatA kA AbhAsa milatA hai vaha vAstavika na hokara mithyA hI huA karatA hai| visUcikA, haijA, atIsAra, grahaNI, pravAhikA Adi rogiyoM meM yaha mithyAbahukozAraktatA mila sakatI hai| jahA~ vyakti ko ucca parvatIya jIvana vyatIta karanA par3atA hai vahA~ rakta kI jAraNa kriyA (oxygenation ) kama ho jAtI hai vAtAvaraNastha auksIjana ke pIDana (praizara ) kI kamI ke kAraNa vahA~ bhI yaha ho sakatI hai| taba ise pUraka bahukozAraktatA ( compensatory polycy thaemia) kahA jAtA hai| jaba rogI nIce bhAgoM meM utara AtA hai to yaha pUrakabahukozAraktatA calI jAtI hai / For Private and Personal Use Only

Page #961
872 vikRtivijJAna ___ para jina rogoM meM phuphphusoM kA zvAsa lene kA kSetraphala ghaTa jAtA hai jisake kAraNa pUrI mAtrA meM auksIjana kI prApti nahIM ho pAtI vahA~ yaha vAstavika bahukozAraktatA ke rUpa meM milatI hai| jIrNazvAsanAla yA klomanAlapAka ( chronic bronchitis) tathA ( vAyukozA vistAra ) (emphysema ), tathA jIrNa phuphphusIya tantulkarSa ( chronic fibrosis of the lung ) meM yaha milatI hai| rakta ke sahaja phuphphusIya nirodhotkarSa (congenital pulmonary stenosis of the blood ) meM phuphphusoM ko svatantratApUrvaka rakta kA AvAgamana na ho sakane ke kAraNa rakta ko AksIjana kI mAtrA kI prApti kama hone se bhI vAstavika bahukozAraktatA mila sakatI hai| isI prakAra prAGgAraekajAreya viSatA (carbon mono-oxide poisoning) meM aura samazoNavartuliraktatA ( methaemoglobinaemia ) meM bhI rakta kI auksIjanagrAhaka zakti kA hrAsa hone se yaha avasthA utpanna ho jA sakatI hai| jina avasthaoM meM rudhirANuoM kI saMkhyA kama ho jAtI hai unheM raktakSaya, araktatA, alparaktatA Adi kaI nAmoM se pukArA jAtA hai aura jo 'enImiyA' nAma se prasiddha haiN| unakA varNana vistArapUrvaka Age hogA ataH yahA~ isa samaya isa viSaya kA vizeSa ullekha nahIM krte| __ AkArasambandhI parivartana-AkAra kI viSamatA bhI rudhirANuoM kA eka vikAra hai ise asamatotkarSa yA viSamakAyotkarSa (anisocytosis) bhI kahA jAtA hai / jo rudhirANu AkAra meM bar3e hote haiM tathA jinameM raktimA kama hotI hai, paramakozA yA maikro sAiTsa ( macrocytes ) kahalAte haiN| ye 10 se 18 (myU) ke AkAra ke hote haiN| isase aura bar3e kozA bRhadaktakozA ( megaloblasts ) kahalAte haiN| atyanta sUcanAkRtika (1 se 6 myU taka) rudhirANu laghukAyANu ( microcytes) halAte haiM / sAdhAraNa svastha rudhirANu kA AkAra 7.2 myU kA mAnA jAtA hai| isakI sImA 6 se 9 myU taka jA sakatI hai| __ prAisajonsavakratA (Price jones curve) ke dvArA viSamakAyotkarSa kA jJAna bhale prakAra ho jAtA hai| isake lie rakta kI eka patalI paTTI lekara sukhA kara jainara ke drava meM 2 minaTa ra~ga kara utanI hI dera upasi (iosIna) meM ra~gate haiN| ise eka vizeSa pAtra vikSepa sAdhitra ( projection apparatus) meM rakha kara aNvIkSa ke nIce dekhate haiN| isa pAtra kA rUpa aisA hotA hai ki vAstavika citra 1000 gunA bar3A lagatA hai tathA jisa kAgaja para yaha par3hA jAtA hai usa para 1 milI mITara AtA hai| isa prakAra citra paTTI para 1 myU taka lambAI kA jJAna ho jAtA hai| rudhirANuoM kI nApa phira isI se Arambha kI jAtI hai| isa prakAra 500 rakta kaNa nApa lie jAte haiN| eka ora grApha para inakI saMkhyA aura dUsarI ora unake vyAsa kI nApa (myU meM) ke dvArA jo vakra rekhA banatI hai vaha prAisajonsavakratA kahalAtI hai| yaha vakratA 7.2 myU para sarvocca zikhara svastha puruSoM meM banAtI hai / For Private and Personal Use Only

Page #962
rudhira vaikArikI 873 paramavarNika raktakSaya hone para yaha vakra rekhA dakSiNa kI ora saraka AtI hai| alpavarNika raktakSaya meM vaha vAmadizA kI ora saraka jAtI hai| isa vakratA ke dvArA bahuta thor3e hI parizrama se raktakSaya kA spaSTa citra prApta ho jAtA hai| svarUpasambandhI parivartana-yaha parivartana sAmAnyataH sabhI raktakSayoM meM milA karatA hai| isameM rudhirANu virUpAkRtika ho jAte haiM / isI ko trirUpakAyotkarSa (poikilocytosis ) kahA jAtA hai| isake kAraNa rudhirANu lambotare, nAzapAtI yA aMjIra kI zakala ke bana jAte haiN| virUpa bane kozAoM ko virUpakozA ( poikilocyte ) kahA jAtA hai / jaba virUpakozA rakta meM apanI upasthiti batalA deM to jAna lenA hogA ki rakta majjA ke andara punarjanana kriyA sakriya ho gaI hai| jina raktakSayoM meM yaha kriyA cAlU nahIM kI jA sakatI vahA~ virUpakozA kadApi nahIM milte| jaisA ki anaghaTita (acayika) raktakSaya (aplastic anaemia) meM ye virUpakozA nahIM hI milA karate / abhiraJjana sambandhI parivartana-yaha niyama hai ki svastha paripakva rudhirANuoM kA abhiraJjana kevala amla raMgoM dvArA hI hotA hai| upasi (iosina) eka prakAra kA amla raMga hone se isake sAtha ve bar3e maje se raMga jAte haiN| yadi ye aparipakva (immature ) hoM to inakA abhiraMjana amla aura kSAra donoM prakAra ke raMgoM se ho sakatA hai / aparipakka rudhirANuoM meM nyaSTi aneka sUkSma kaNoM meM vibhakta huI chitarI rahatI hai jo kSArIya varNa ko grahaNa kara liyA karatI hai / jaise rudhirANu nIla varNa dhAraNa kara lete haiN| isa vikRti ko bahuvarNatA ( polychromasia ) yA bahuvarNapriyatA (polychromatophilia) kahA jAtA hai| sAdhAraNatayA nyaSTivAn rudhirANu apane sAmAnya parivartanazIla prAkRtika vyApAra meM Age calakara nyaSTivirahita rudhirANuoM ko janma dete haiN| isa dRSTi se tIna parivartana unameM dekhe jAte haiM 1. nyaSTi kA saMkucita honA ( pyknosis-sthaulyotkrp)| 2. nyaSTi kA vizRGkhalita honA ( karyorrhexis-nyssttivishkhln)| 3. nyaSTi ke kaNoM kA kozA ke cidasa meM vilIna ho jAnA ( chromatolysisvarNAzana ) / kabhI kabhI jaba raktanirmANakArI aMgoM para atyadhika kAryabhAra par3a jAtA hai to kucha aise rudhirANu bhI rakta meM dekhe jAte haiM jinakI nyaSTi ke kaNa aMzataH cidrasa meM vilIna ho jAte haiN| eka yA do tIna nyaSTikaNa jo kSArIya abhiraMjana se ra~ge jA sakate haiM usa rudhirANu meM dikhAI dete haiM jo lagabhaga nyaSTivihIna ho cukA hai| isa kSArapriya puMja ko hauvela jaulI piNDa ( Howell-Jolly body ) kahA jAtA hai / kabhI-kabhI nyaSTi ke pUrNataH vilIna ho jAne para bhI usakA AvaraNa ( nuclear membrane) rudhirANu ke andara raha jAtA hai / ise kaiboTavalaya (Cabot ring) kahA jAtA hai| RjuruhoM ( normoblasts ) se rudhirANu banane kI svAbhAvika prakriyA ke madhya For Private and Personal Use Only

Page #963
8674 vikRtivijJAna eka prakAra jAlakakozAoM ( reticulocytes ) kA par3A karatA hai / inameM nyaSTi jAlikA meM pariNata ho jAtI hai jo kSArIya raMga se abhiraJjita ho jAtI hai / yaha jAlikA atyanta sUkSma rezoM se banI huI dikhalAI detI hai / ye jAlakakozA prakRta rakta meM nahIM milate muzkila meM 1000 rudhirANuoM ke pIche do kA ausata par3atA hai / para jaba raktanirmANakriyA asthimajjA meM asAmAnya paristhiti meM cala par3atI hai to unakI saMkhyAbhivRddhi ho jAtI hai / yahA~ taka ki ye sampUrNa rudhirANu saMkhyA kA 15 pratizata taka pahu~ca jA sakate haiN| kabhI-kabhI raktakSaya kI adhikatAvaza yA sIsa viSatA ( lead poisoning ) ho jAne para yahI kSAraraMjanazIla jAlaka kaNoM meM parivartita ho jAtA hai / ise vindukIya kSArapriyatA ( punctate basophilia ) yA kSArapriya sidhmana ( basophil stippling ) athavA kaNIya kSArapriya vihAsa ( granular basophilic degeneration ) kahA jAtA hai | nyaSTivAn rudhirANu -- hama Upara do prakAra ke nyaSTivAn ( nucleated ) rudhirANuoM kA nAmollekha kara cuke haiM - eka Rjuruha ( naurmoblAsTa ) tathA dUsare bRha - draruha ( maigAloblAsTa ) / inameM Rjuruha rudhirANu ke samAna AkAra vAle hote haiM / inake andara nyaSTi gola hotI hai jo kSArIya raMga se gaharI abhiraMjita hotI hai| usakA cidrasa amlaraMgoM ke prati adhika jhukAva rakhatA hai kyoMki usameM zoNavartulita upasthita rahatI hai / ina rUhoM kI AkRti meM bhI antara hotA hai / naye kozA purAnoM se bar3e hote haiM / para bRhadraktaruha RjuruhoM kI apekSA bahuta bar3e hote haiM / inake andara kI nyaSTi jAlakIya ( reticular ) hone se isa para kSArIya raMga acchA nahIM car3hatA tathA isakI AkRti bhI paryApta viSama hotI hai / Arambha meM inakA cidrasa zoNavartulivihIna hone ke kAraNa kSAra se abhiraMjita ho jA sakatA hai para Age calakara zoNavartula banane ke sAtha-sAtha amlAbhiraMjita hone lagatA hai / sAmAnyatayA yaha nyaSTi vilIna hotI jAtI hai, zoNavartula bar3hatI jAtI hai, usakA AkAra sAdhAraNa rudhirANuoM se bar3A hotA hai aura usameM bahuvarNatA ( polychromasia ) spaSTataH milatI hai / yahI bRhadraktakozA ( megalocyte ) kA rUpa hai / isameM paryApta mAtrA meM zoNavartuli rahane se tathA AkAra meM vizAlatA hone se ise sakriya AkArikIya pizAca ( functio. nal morphological giant ) kahate haiM / rudhirAgu aura bhaMguratA - samabalalavaNavilayana (isotonic salt solution) 0.85 grAma lavaNa 100 sI. sI. parisruta jala meM milA kara banAyA jAtA hai jisameM rudhirANu bar3e maje meM binA kisI vikRti ke ghaNToM par3e raha sakate haiN| yadi isa vilayana meM lavaNa kI mAtrA kramazaH kama karate cale jAya~ to jo vilayana taiyAra hoMge unameM se 0.44% ke vilayana se rudhirANuoM kA aMzana ( lysis ) Arambha ho jAtA hai / yaha zoNAMzana yA aMzana 0.34% ke vilayana meM pUrNa ho jAtA hai / pittavihIna (yA apittamehika) mUtrIya kAmalA ( acholuric jaundice ) meM rudhirANu bahuta bhaMgura ho jAne ke kAraNa unakA aMzana 0.7% para Arambha hokara 45% para pUrNa ho jAtA hai / I For Private and Personal Use Only

Page #964
rudhira vaikArikI 875 sirAoM ke andara rudhirANuoM kA aMzana kaI virSoM meM dekhA jAtA hai| ina virSoM meM mukhyatayA sarpa viSa ( snake venom) to rakta ke kaNoM ko rakta ke andara hI galAkara pheMka detA hai / sAlavarsana tathA mallayukta ( arseniuretted hydrogen ) tathA tribhUyavirAlaya ( trinitro-toluol ) bhI zoNAMzana kara dete haiN| kucha jIvANu jaise zoNAMzika mAlAgolANu ( streptococcus haemolyticus ) tathA vAtijana prAvara gadANu ( Cl. welchii ) bhI zoNAMzana kiyA karate haiN| kisI bhI zoNAMzika lasI ( haemolytic serum ) ke antaHkSepaNa se bhI prAyogika rUpa meM zoNAMzana kiyA jA sakatA hai| ( paroxysmal hamoglobinurea ) aura ( black. water fever ) meM zoNAMzana hotA hI hai| zoNAMzana kI pravRtti kucha rogoM meM bahuta ghaTa bhI jAtI hai / alpa varNika (hypochromic) raktakSaya tathA raktarahajanya raktakSayoM ( erythroblastic anae mias ) meM yaha pravRtti apane Apa kama ho jAtI hai tathA 0.36% taka zoNAMzana nahIM hotA / avarodhAtmaka kAmalA ( obstructive jaundice ) tathA ghAtaka raktakSaya meM bhI yaha ghaTa jAtI hai (grIna ) / AtaJcanajanya parivartana-sirA se rakta nikAla lene para vaha sAmAnyatayA 3 se 5 minaTa meM AtaJcita ho (jama) jAtA hai / prayukta vidhi kI vibhinnatA ke kAraNa 1-2 minaTa kA antara bhI dekhA jA sakatA hai| AtaJcana (coagulation) kA samaya yadi svAbhAvika gati se bar3hatA hai to vaha vikRti mAnI jAtI hai kyoMki aise vyakti kA raktasrAva hone para usakA rakta bahuta dera meM jamegA ataH paryApta mAtrA meM rakta bAhara calA jAvegA jo kabhI-kabhI jIvana ko bhI saGkaTa meM DAla de sakatA hai| zoNapriyatA ( hImophiliyA ), tantujana kI kamI ( fibrogen defficiency ) tathA jaba rakta meM koI AtaJcavirodhI (anticoagulant ) tatva pravAhita ho rahA hai / taba AtaJcana kAla meM vRddhi ho jAyA karatI hai| aneka gambhIra upasarga, mAdaka dravya tathA yakRdvikAroM meM bhI AtaJcana kAla bar3ha jAtA hai| raktAvasAdanagatijanya parivartana-saiDImeNTezanareTa yA raktAvasAdanagati ke jJAta karane ke lie kaTalara, vaisTaragrIna tathA viNTroba ne alaga-alaga paddhatiyA~ apanAI haiN| rudhirANuoM ke pratyAtaJcI padArtha (anticoagulant ) kI upasthiti meM pAtra kI talI meM baiThane kI gati ko avasAdanagati kahA jAtA hai| parIcaya rakta meM pratyAtacI padArtha milA kara eka lambI kA~ca kI nalI meM bhara dete haiM aura jisa gati se rudhirANu avasAdana karate haiM use noTa kara lete haiN| kucha vidvAn eka dUrI nizcita rakhate haiM aura usa taka pahu~cane meM jo samaya rudhirANuo ko lagatA hai use noTa karate haiN| isa samaya ko avasAdanakAla (sedimentation time) kahA jAtA hai / kucha vidvAn samaya nizcita rakhate haiM utane samaya meM rudhirANu kitanI dUrI taya kara pAye ise noTa karate haiM yahI avasAdana gati kahI jAtI hai / svastha puruSa meM svAbhAvika avasAdana gati 1 milImITara prati 5 minaTa kA ausata par3atA hai| rudhirANu kisa AkAra kA For Private and Personal Use Only

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876 vikRtivijJAna AtaJca yA samUha nirmANa karate haiM isa para raktAvasAdana kI gati nirbhara rahatI hai aura samUha yA AtaJcaka nirmANa rakta meM upasthita tantvijana kI mAtrA para nirbhara rahatA hai 1 avasAdana kI gati garbhAvasthA meM striyoM meM bar3ha jAtI hai / vaisragrIna kI paddhati kA anusaraNa karane para puruSoM meM svasthAvasthA meM avasAdana gati 3 milImITara prati ghaNTA rahanI cAhie / striyoM meM 10 milImITara prati ghaNTA taka svasthAvasthA meM hotI hai| puruSoM meM 8 mi. mI. prati ghaNTA taka sandehAtmaka ( doubtful ) paristhiti kA dyotaka hai / 8 se 12 mi. mI. prati ghaNTA taka zAyada roga hai aisA AbhAsa pradAna karatA hai para 12 mi. mI. prati ghaNTA se Upara kI gati strI aura puruSa donoM hI meM nizcayAtmaka rUpa se vikAra kI ora nirdeza karatI hai / nimnAGkita rogoM meM raktAvasAdana gati bar3ha jAtI hai 1. rAja yakSmA 2. kuSTha 3. kAlA AjAra 6. AmavAtAbha sandhipAka 5. tIvra vRkkapAka 8. karkaTArbuda 4. AmavAta jvara 7. Antra ke jIrNa vraNa 9. sitaraktatA ( leukaemia ) / 10. lasI yA masUrI ( vaccine ) kA antaH kSepaNa karane ke pazcAt / 11. dugdha yA anya bAhya probhUjina kA antaHkSepaNa karane ke pazcAt / 12. jIrNa viSaraktAvasthA ( chronic toxaemia ) / nimna rogoM meM raktAvasAdana gati para koI prabhAva nahIM par3A karatA1. zvagraha yA kukarakhA~sI jaba vaha anupadrava ho / 2. Arambhika uNDukapucchapAka ( early appendicitis ) / nimna rogoM meM raktAvasAdana gati ghaTa jAtI hai 1. adhiraktIya hRdbhedAvasthA ( congestive heart failure ) 2. bahukozAraktatA ( polycythaemia ) milegA / isa parIkSA kA vistRta varNana klInIkala paithAlojI kI pustakoM yaha parIkSaNa Ajakala yakSmA, AmavAta tathA kuSTha kI cikitsA ke pariNAmoM kA niyantraNa karane ke lie tathA sAdhyAsAdhyatA kA jJAna prApta karane ke lie kiyA jAtA hai / zoNaprasamUhijanya parivartana - yadi eka vyakti kA lasa (sIrama ) dUsare varga ke vyaktiyoM ke rudhirANuoM ke sAtha milAyA jAve to unameM se kucha ke rudhirANu eka dUsare se cipaTa jAveMge jise prasamUhana ( agglutination ) bhI kahA jA sakatA hai / isa prasamUhana kA dhyAna sadaiva una rogiyoM meM rakhanA par3atA hai jinheM anya vyaktiyoM kA rakta antaHkSepaNa dvArA pahu~cAnA paramAvazyaka hotA hai / yadi yaha rakta vyakti ke andara ke rakta ke sAtha milakara rudhirANuoM kA prasamUhana karane vAlA huA to rogI kI avasthA gambhIra ho jA sakatI hai aura raktAvasecana ( transfusion of blood) kA sampUrNa abhiprAya vyartha ho sakatA hai / isa dRSTi se adhyayana karane para jAnskI tathA mausa ne mAnavIya rakta ko 4 vargoM meM bA~Ta diyA hai / ina donoM vidvAnoM ke raktavargIkaraNa meM bheda hone se For Private and Personal Use Only

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I 11 IV rudhira vaikArikI laiNDasTInara ( 1901 I0) ne akSaranirdhAraNa karane kI nayI vidhi upasthita kI hai aura vahI Ajakala cAlU bhI hai| tInoM prakAra kA vargIkaraNa AdhunikoM ne jisa prakAra prakaTa kiyA hai vaha hama uddhRta karate haiN| rakta-varga lasa rudhirANu jAnskI mausa laiNDasTInara prasamUhi prasamUhijana IV A B o (kucha bhI nahIM) A tathA B II Ab A. III III Ba B 0 . tathA b 0 (kucha bhI nahIM) e bI varga ( mausa I) lasa meM koI prasamUhi nahIM hotI isalie vaha kisI bhI prakAra ke rudhirANu ke sAtha prasamUhana nahIM karatA hai| isIlie ise sarvagrAhaka (universal recipient ) kahate haiN| o varga ( mausa IV ) meM koI prasamUhijana (agglutinogen) nahIM rahatA hai isa kAraNa vaha kisI ke bhI lasa ke sAtha prasamUhana nahIM kara sakatA / isalie ise sarvapradAtA (universal donor ) kahA jAtA hai| isa kAraNa jahAM atyAvazyakatA par3a jAve aura grAhaka ke lasa tathA dAtA ke rudhirANuoM ko ekatra kara prasamUhana parIkSA ke lie samaya na ho tathA turata raktadAna karanA par3e vahAM isa sarvapradAtA kA upayoga binA kisI zaGkA ke kara liyA jA sakatA hai| isalie ovarga ke vyakti svarAraktAvasecanArtha sadaiva mahatvapUrNa siddha hote haiN| e (mausa II) varga ke vyakti e varga tathA o varga ke vyakti kA rakta le sakate haiN| bI varga (mausa III) ke vyakti bI varga tathA o varga ke vyakti kA rakta prayoga meM lA sakate haiM / tathA o varga (mausa IV) ke vyakti kevala apane o varga ke vyaktiyoM kA rakta hI kAma meM lA sakate haiM para unakA rakta anya sabhI vargoM ke kArya meM bhA sakatA hai| varga A B(mausa I) jaisA ki abhI kahA jA cukA hai kisI bhI varga ke vyakti ke rakta kA upayoga kara sakate haiN| raktAvasecana (TrAMsaphyUjana Ava blaDa) kA aneka bAra prayoga karane se jJAta yaha ho rahA hai ki ina 4 vargoM ke atirikta bhI kucha anya varga haiN| astu, uparyukta 4 vargoM ko parama vizvasanIya mAnakara calane meM bhI saGkaTopasthiti ho sakatI hai| ataH dAtA kA varga jJAta hone para bhI yaha paramAvazyaka hai ki grAhaka ke lasa ke sAtha dAtA ke kozAoM kA sammelana karake dekha liyA jaave| aura yadi donoM ke milane se prasamUhana na ho to raktAvasecana kiyA jAya / e aura bI varga kA parIkSaNArtha rakhA haA lasa samaya adhika ho jAne ke kAraNa athavA saMrakSaNa meM tApAMza kI vRddhi ho jAne para kharAba ho sakatA hai aura usake dvArA raktANuoM kA sammelana sarvathA galata pariNAma de sakatA hai ataH ina kisI para bhI vizvAsa na karake sIdhe sIdhe grAhaka ke lasa aura dAtA ke rudhirANuoM kA turata kiyA gayA sammelanapariNAma hI ekamAtra vizvAsa For Private and Personal Use Only

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878 vikRtivijJAna kI kasauTI mAnI jAnI caahie| yadi galata varga ke dAtA kA rakta kisI grAhaka ko mila bhI jAtA hai to vaha grAhaka raktAvasecana ke kucha ghaNToM bAda mara jAyagA athavA marane meM kucha dina le legaa| adhika gambhIra rugNoM meM tIvra tApAMza, kampa, raktameha tathA AkSepoM ke sAtha eka tIvra pratikriyA turanta utpanna ho jAtI hai| vRkkoM meM vikSata bana jAte haiM tathA mUtra kA ghAta bhI ho jA sakatA hai| aisI avasthA meM mRtyu kA ekamAtra kAraNa mUtra viSamayatA (yUrI miyA) huA karatA hai / sAdhAraNa pratikriyA hone para jvara ke sAtha thor3A kampa AtA hai aura mAraka rUpa nahIM bntaa| eka bAta aura bhI dhyAna meM rakhanI cAhie / raktAvasecana meM raktANu aura lasa ke vargIkaraNa ke atirikta yaha bhI dekhanA cAhie ke dAtA phiraMga yA viSamajvara se pIDita na ho anyathA grAhaka ko ye roga AsAnI se prApta jAveMge / ataH dAtA ke rakta kA phiraMgadRSTayA vAsaramena pratikriyA parIkSaNa karA lenA caahie| Adhunika kAla meM rakta kA saJcaya rakta baiMkoM (raktAdhikoSoM) dvArA karane kI prathA cala par3I hai| isa prathA ke kAraNa naI naI samasyAe~ aura unako nayA nayA samAdhAna Avazyaka ho gayA hai| jyoM jyoM mAnava mastiSka prakRti ke nirIkSaNa meM apanI sUkSma buddhi kA upayoga karatA jAtA hai, use naye naye dRzya milate cale jAte haiN| prakRta rakta ke pratijanIya guNoM ( antigenic properties of normal blood ) kI khojabIna taba se barAbara jArI huI hai jaba se raktAvasecana nimitta rakta kA saMgraha kArya cAlU haA hai| e prasamUhijana jaisA ki pahale vicAra thA eka pratijana (antigen ) nahIM hai balki isameM kaI upavarga bhI zAmila haiN| ye upavarga grAhaka ke lasa ke sAtha pUrA pUrA kabhI kabhI mela nahIM bhI khAte aura cintAjanaka sthiti kara de sakate haiN| eka tatva hIsasa phaikTara karake prasiddha hai / rakta ke navayugIya adhyayana ko usake binA adhUrA samajhA jAtA hai| hIsasa jAti ke vAnaroM ke rakta meM isa pratijana kI upasthiti prathama jJAta huI thii| usI se isakA yaha nAma vikhyAta huA hai / ise hakAraka (Rh-factor ) bhI kahate haiN| yaha kAraka 85% mAnavoM meM upasthita rahatA hai| kevala 15% isake binA hote haiN| isa 15 pratizata mAnavatA ko grAhaka mAna kara raktAvasecana karAyA jAve tathA o, e, bI, e-bI varga sammelana kA pUrA dhyAna rakhA jAve taba bhI gambhIra avasthA utpanna ho sakatI hai| 85% mAnava to ha-astyAtmaka ( Rh-positive ) mAne jAte haiM tathA 15% ha-nAsyAtmaka ( rh-negative) kahe jAte haiM / ina ha-nAratyAtmaka prANiyoM ko yadi ha-astyAtmaka prANiyoM ke rakta kA avasecana karA diyA gayA to hra-virodhI-prasamUhi grAhaka ke rakta meM banane lagegI aura yadi ha -astyAtmaka rakta kA praveza punaH kara diyA gayA to hAnikAraka lakSaNa avazya upasthita ho jaayeNge| eka sthiti rudhirarahotkarSabhrauNIya ( erythroblastosis foetalis ) kahI jAtI hai jisameM bhrUNa yA garbha mRta janma letA hai yA janma ke kucha kAloparAnta usake For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra pratikAya ( prasa mUhiyA~ tathA zoNAMziyA~ ) rudhira vaikArikI 87ha rakta meM tIvra zoNAMzIya raktakSaya kI utpatti ho jAtI hai jisake pariNAmasvarUpa vaha mara jAtA hai / isa sthiti kA Adhunika kAraNa yaha ha-kAraka hI mAnA gayA hai / isa sthiti kA yaha nAma isalie DAlA gayA hai kyoMki bAlaka ke rakta meM rudhiraruhoM kI adhikatA dekhI gaI hai jo raktotpAdaka saMsthAna kI atidruta kriyAzIlatA kI paricAyikA hai / isa sthiti kI utpatti kA rocaka itihAsa hai| bhrUNa -ha-astyAtmaka huA aura mAtA ha- nAstyAtmaka huI to bhrUNa ke rakta kA ha-kAraka aparA meM mAtA ke rakta meM milakara - pratijana taiyAra karatA hai / pratijana se mAtA ke rakta meM pratikAyotpatti ( antibody formation ) hokara vaha unake sAtha punaH bhrUNa rakta meM pahu~catA hai jisase bhrUNa ke rakta meM zoNAMzana hone lagatA hai / aura mRta zizu ke janma pitA hra + www.kobatirth.org bhrUNa hra + ( rudhirANu pratijana ) mAtA ha - 1 kA kAraNa banatA hai / kyoMki yaha pratijana kezAloM kI prAcIroM ko naSTa kara detI haiN| jisase bAlaka sarvAMgazotha ( hydrops foetalis) se pIDita ho jAtA hai / yadi jindA paidA huA to use sarvAMga meM kAmalA hotA hai tathA zoNAMzika raktakSaya paryApta milatA hai / jise navazizu kA gambhIra kAmalA ( icterus gravis neona torum ) kahA jAtA hai / yadi ina bAlakoM ko turata ha- nAstyAtmaka raktAvasecana karA diyA jAve to zoNAMzana ruka jA sakatA hai aura zizu kI prANarakSA kI jA sakatI hai parantu yaha bahudhA dekhA gayA hai ki ye bAlaka Age calakara pUrNa vikasita nahIM ho pAte / mandabuddhi, hatabhAgya, durbhaga, zlatha, rugNarUpa meM hI ve rahA karate haiM / buddhi vikAsa meM ha - kAraka kI upayogitA kA parIkSaNa yAnneTa tathA lIbaramena ne kiyA hai| isa ha - kAraka ke virodha ke pariNAmasvarUpa hI bahudhA mandabuddhi bAlakoM kI utpatti hotI hai aisA unhoMne siddha kiyA hai / mAtA aura zizu ina donoM kA buddhivikAsa kI dRSTi se kyA sambandha meM hai isake lie eka navIna mArga khula jAtA hai para yaha ha-kAraka bhI eka padArtha nahIM hai / isameM bhI 7 ghaTaka sammilita batalAye jAte haiN| Age ke vidvAn jaba inakI khojakara inake guNoM kA adhyayana kareMge to aneka naye tathya buddhivikRti ke sambandha meM prakaTa hoMge /

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80 vikRtivijJAna __ mAtA aura putra kI samapratikAritA (iso-immunisation ) ke kAraNa zizuoM ke anya zoNAMzika rogoM kA bhI patA lagAtA jA rahA hai| inameM e prasamUhi. jana ke sAtha ema tathA ena pratijanoM kI upasthita tathA e. bI. o varga meM antara Ane se mAtA aura garbha ke rakta meM pratikAyotpatti hokara ye zoNAMzika roga banate haiM para ha-kAraka kA sarvopari mahattva hai| grIna likhatA hai ki smitha ne 200 prathama prasavAoM kA adhyayana kiyA hai| inameM usane 154 meM mAtA aura usakI santAna ke ha-kAraka aura e. bI. o. varga ko eka samAna pAyA hai| inheM usane samAna vaiziSTaya sagarbhatA (homospecific pregnancies) nAma diyA hai| 46 meM usane donoM ke rakta meM antara pAyA hai unheM viSamavaiziSTaya sagarbhatA (heterospecific pregnancies) kahA gayA hai| isase jJAta hotA hai ki Arambhika garbhAvasthAoM meM samAna vaiziSTya pAyA jAtA hai para Age kI garbhAvasthAoM meM vipama vaiziSTya kI pradhAnatA rahatI hai isI se mAtA ke prathama zizu meM zoNAMzIya roga bahuta kama milate haiM jo Age kI garbhAvasthAoM meM bar3hate jAte haiM / isa viSaya para abhI paryApta anusandhAna apekSita hai| raktabimbANu ( Blood Platelets ) rudhirANuoM tathA zvetakAyANuoM kI taraha raktabimbANuoM kI utpatti bhI asthimajjA se hI hotI hai inheM ghanAstrakozA ( thrombocyte ) bhI kahate haiN| ye bRhannyaSTikozAoM ( megacaryocytes) ko tor3akara banate haiN| inameM kAyANurasa ( cytoplasm ) hotA hai para nyaSTi nahIM hotii| na inameM zoNavartuli pAI jAtI hai / ye gola yA aNDAbha bimba ( disc ) ke svarUpa ke hote haiN| svasthAvasthA meM inakI saMkhyA pratighana milImITara 3 lAkha hotI hai| vaise 2 // se 3 // lAkha milA karate haiN| inakA AkAra eka rudhirANu kA AdhA yA ekatihAI huA karatA hai| raktamajjA ke zoNakAyaruha ( haemocytoblast) se bRhannyaSTiruha ( mega. karyoblast ) banate haiN| unase pUrva bRhananyaSTikozA panapate haiM jinase bRhannyaSTikozA banate haiM aura unhIM se raktabimbANu taiyAra hote haiM (citra dekhie)| jaba kahIM raktastrAva hotA hai to ye bimbANu TUTakara dhaumboplAsTInojInez2a ( thromboplasti. nogenase ) ko unmukta kara dete haiM jo raktarasa meM nihita AtaMcaghaTitajana (thromboplAsTInojina) ko sakriya karake thromboplAsTIna (AtaJca ghaTita ) ko banA dete haiM / yaha AtaJcaghaTita kailziyama ayana kI upasthiti meM pUrvaAtaMci ko (prothrombIna) AtaMci (thrombIna ) meM pariNata karake raktAtaJcana kI kriyA kA zrIgaNeza karatA hai / isa prakAra bimbANu vAhinIprAcIra kI surakSA meM sadaiva tatpara rahate haiN| ye prAyaH 3-4 dinataka jIvita rahate haiM usake bAda naSTa ho jAte haiM aura unakA sthAna anya raktabimbANu le lete haiN| raktabimbANuoM kA mahattva isa prakAra raktastrAva rokane meM hotA hai| yadi inakI saMkhyA kisI kAraNa se ghaTa jAtI hai to sahasA kisI bhI sthAna se raktasrAva ho For Private and Personal Use Only

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rudhira vaikArikI 881 sakatA hai / thor3A AghAta lagane se tvacA ke nIce raktasrAva ( ecchymoses ) kA honA sAdhAraNa ghaTanA hai / isI prakAra zlaiSmika kalAoM meM bhI tanika AghAta raktasrAvotpatti kara sakatA hai / zarIra ke bhItarI aMgoM meM bhI raktasrAva kA kAraNa inakI kamI ho sakatI hai / yadyapi AtaJcanakAla jyoM kA tyoM rahatA hai / yadyapi rakta kA AtaJca yathApUrva banatA hai para AtaJca kA saMkoca yathApUrva na hone se raktasrAvI sthAna se rakta kA strAva jArI rahatA hai aura raktasrAva kAla ( bleading time ) lamba ho jAtA hai / kezAoM meM bhI pratirodhaka zakti ghaTa jAtI hai / isa kAraNa thor3I dera (2 minaTa) ke lie bhI yadi kisI aGga ko dabAkara usakA raktasaMvahana roka diyA jAya to AsapAsa raktastrAva ke dhabbe AsAnI se dekhe jA sakate haiM / isa upadrava ko nIlohA ( purpura ) kahA jAtA hai jisakA vistRta varNana Age yathAsthAna kiyA jAvegA / Acharya Shri Kailassagarsuri Gyanmandir sitakozA ( White Blood Corpuscles ) yadyapi sitakozAoM kA nAmasmaraNa hama isa pustaka meM pRSTha 14-15 para kara cuke haiM para yahA~ usa para eka bAra punarvicAra karanA Avazyaka hai / hama pahale kaha cuke haiM ki raktamajjA ke prArambhaka jAlaka jise zoNakozaruha ( hImo sAiToblASTa ) kahate haiM, ke dvArA rakta meM pAye jAne vAle sabhI kozAoM kA nirmANa hotA hai / raktabimbANu, rudhirANu donoM usI se bane haiN| usI se sitakozAoM (leucocytes) kA nirmANa bhI hotA hai / rakta ke bAhara ke prarasakozA ( plasma cells ) kA nirmANa bhI isI se hotA hai / yaha sArA varNana zarIravyApArazAstra ke antargata par3hA jA cukA hone se ati saMkSepa meM hama ise duharA rahe haiN| rakta ke ye zveta kaNa yA sitakozA 3 vargoM meM vibhakta kie jA sakate haiN| inameM eka ko kaNakAyANu (granulooytes) kahate haiM / ye sazAkha jAlaka kozAoM dvArA visphArita srotasoM ( dilated sinuses ) ke bAhara banate haiM / ye vibhakta ho hokara praguNana karate haiM aura unakI yaha zreNiyA~ bana jAtI haiM / inameM eka zreNI majjaruhoM (myeloblasts) kI hotI hai / ye kaNarahita, golanyaSTininyaSTiyukta hote haiM tathA inakA kAyANurasa cArapriya ( besophila ) hotA hai / inase banI dUsarI zreNI majjakozAoM ( myelocytes ) kI hotI hai jinameM kaNa hote haiM tathA tIsarI zreNI sitakozA ( leucocytes ) kI banatI hai jo nyUTrophila iosInophila ( upasipriya ) tathA besophila ( kSArapriya ) meM unake raMga grahaNa karane ke guNoM ke anusAra nAmakaraNa ho jAtA hai / isa prakAra - 1 zoNakozaruha 1 majjaruha krama banatA hai / majjakozA / sitakozA (bahunyaSTi, upasipriya, kSArapriya ) For Private and Personal Use Only

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882 vikRtivijJAna inakI nyaSTiyA~ Arambha meM vRkkAkArI hotI haiM jo phira ghor3e ke bAla ke samAna ho jAtI haiN| svasthAvasthA meM 50 se 65% ye nyUTrophila milate haiN| 1 se 4% upasipriya tathA 3 se 1% kSArapriya milate haiN| sakalagaNa 3 se 7 hajAra pra0 gha0 mi. mI. hotA hai| dUsarA varga sitakozAoM kA lasakAyANuoM kA hotA hai| yaha na kevala asthimajjA ke zoNakozaruha se hI banate haiM api tu zarIrastha sampUrNa lasadhAtu se kahIM bhI inakI utpatti sambhava hai| plIhA, thAyamasa, tuNDikerI tathA Antra ke peyarIya sidhmoM se inakA nirmANa vizeSarUpa se huA karatA hai| pahale jAlakAntazchadIya saMsthAna meM lasaruha (lymphoblast) kA nirmANa hotA hai| usase pUrva lasIkozA ( prelymphocyte ) banate haiM, unase bRhallasIkozA ( large lymphocytes ) banate haiM unhIM se paripakka lasIkozA taiyAra hote haiN| bar3e lasIkozA 13 myU ke tathA choTe 10 myU AkAra ke hote haiN| choTe 15 se 25% taka aura bar3e 5 se 10% taka pAye jAte haiN| zizuoM evaM bAlakoM meM bRhalasIkozA laghulasIkozAoM kI apekSA adhika milate haiN| bRhallasIkozA laghula0 ko0 se naye hote haiN| ina lasIkozAoM kA jIvana 12 se 20 ghaNToM taka calatA hai / svasthAvasthA meM sakalagaNana saMkhyA 2000 se 3000 prati ghana milImITara taka ho sakatI hai| ___ zoNakAyarahoM se prarasaruha ( plasmoblast ) banakara unase pUrva prarasakozA banate haiM jo anta meM prarasakozAoM meM badala jAte haiN| jo saMyojI UtiyoM meM bhI pAye jAte haiM tathA jinakA varNana sthAna-sthAna para isa grantha meM hotA AyA hai| sitakAyANuoM kA tIsarA varga ekakaNakozAoM ( monocytes ) kA banatA hai| ye bhI jAlakIya kozAoM se banate haiN| aMzataH plIhA se aura aMzataH asthimajjA se inakA nirmANa hotA hai / zoNakAyarahoM se pahale ekaruha banate haiM jinase pUrvekakAyANu ( premonocyte ) banate haiM jo anta meM ekakAyANuoM meM pariNata ho jAte haiM / ye 500 pratighana mi0 mITara kI saMkhyA meM prAyaH milate haiN| sitakozotkarSa-svasthAvasthA meM eka puruSa ke rakta meM 5000 se 10000 prati ghanamilImITara ke hisAba se sitakAyANu rahA karate haiM aura ausata 7500-8000 kA jAtA hai / yaha saMkhyA svAsthya kI dazA para nirbhara karatI hai aura jaise hI koI roga hotA hai to saMkhyA meM paryApta antara A jAtA hai| sitakAyANuoM kI saMkhyA meM vRddhi kA kAraNa vikRti aura prakRti donoM hI ho sakate haiN| kisa prakAra ke kozAoM kI vRddhi huI hai isakA jJAna bhI sadaiva Avazyaka rahatA hai| sitakAyANUtkarSa yA sitako. zotkarSa zabda kA prayoga karane ke sAtha hI kauna zvetakaNa adhika saMkhyA meM bar3hA hai isakA bhI dhyAna rakhanA hotA hai| jaise bahunyaSTi sitakozotkarSa kahane se zvetakAyANuoM kI vaha saMkhyAvRddhi jisameM bahvAkArI (polymorphonuclear cells) kI vRddhi huI hai| bahvAkAriyoM kI isa vRddhi ko pUrA na likhakara sitakozotkarSa mAtra For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra kaha dene se bhI vahI bodha hotA hai hI na ghoSita kara diyA gayA ho / www.kobatirth.org rudhira vaikArikI rUpare jaba taka ki anya zvetakAyANuoM kA spaSTa nAma 1. pUyana / 3. duSTa yA mArAtmaka roga 5. gambhIrazastrakarmottarakAlIna / Acharya Shri Kailassagarsuri Gyanmandir bakariyoM kA sitakozotkarSa unakI svAbhAvika maryAdA ke Upara 12 se 40 hajAra taka prati ghana milImITara kI vRddhi mAnA jAtA hai / yaha vRddhi pratizata meM 75% se 95% taka pahu~catI hai / prakRtAvasthA meM yaha sitakozotkarSa garbhAvasthA kI pUrNatA ke samaya meM strI ko tathA janma lete hue zizu ko milatA hai / bhojanoparAnta sAdhAraNa puruSoM meM bhI kucha sitakozotkarSa hotA huA dekhA jA sakatA hai / prasavakAlIna vedanA ke samaya se prasUtikAla taka strI ko sitakozotkarSa mila sakatA hai / nimna vikRtAvasthAoM meM yaha sitakozotkarSa mila sakatA hai : -- 2. tIvraviziSTajvarAvasthAeM / 4. gambhIra raktasrAvottarakAlIna / pUrAna ( suppuration ) ke kAraNa huA sitakozotkarSa rogI ke bala tathA roga kI gambhIratA para nirbhara karatA hai / choTA vikSata sitakozotkarSotpAdaka nahIM ho sakatA / kabhI-kabhI jaba upasarga atIva gambhIra ho aura mRtyu samIpa hI ho to aisI avasthA meM sitakozotkarSa na hokara sitakozApakarSa ( leucopenia ) hI dRSTigocara huA karatA hai / jina rogiyoM meM rogapratIkAritA zakti kI vRddhi rahatI hai aura upasarga bhI thor3A damadAra hotA hai to usa samaya nissandeha sitakozotkarSa huA karatA hai | kaI bAra raktaparIkSaNa para sitakozotkarSa kI prApti ho to samajha lenA cAhie ki zarIra meM kahIM na kahIM prayotpatti ho gaI hai aura vahI isakA kAraNa hai / Antrikajvara, viSANujanya upasarga, rAjayakSmA, zvagraha ( kukura khA~sI ), ( uudulant fever ) ina rogoM ko chor3akara zeSa sabhI viziSTa tIvra jvaroM meM sitakozotkarSa pAyA jAtA hai / mArAtmaka rogoM meM se unameM jinameM vraNana hotA hai tathA upasarga kA itihAsa milatA hai thor3A bahuta sitakozotkarSa mila jAtA hai / gambhIra raktasrAva tathA gambhIra zastrakarmoM ke uparAnta sitakozotkarSa hone para kucha kAla bAda raktacitra svAbhAvika ho jAyA karatA hai / kabhI-kabhI jaba kisI roga ke sambandha meM granthokta kAraNa pUrNatayA dekhane meM nahIM Ate taba raktacitra dekhane para sitakozotkarSa kI upasthiti kisI jIrNa yA tIvra pUyana ( sepsis ) kI sthiti kI ora iGgita karatI hai / phuphphusa khaNDoM ke bIca meM kabhI-kabhI prayotpatti ho jAtI hai / usakA koI anya lakSaNa bhI nahIM milatA tathA usake jJAna kA eka mAtra sAdhana yaha sitakozotkarSa hI hotA hai / 90% se Upara sitakozotkarSa kA artha uNDukapuccha meM hue pUyana kI ora iGgita hai ! For Private and Personal Use Only

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884 vikRtivijJAna udaracchadakalApAka tathA uNDakapuccha kA vidIrNa honA Adi bhI isI se jJAta hote haiN| aisI avasthA meM turata zastrakarma karane se bar3ha kara anya upAya zalyavid nahIM dekhatA / 80% lakSaNa itanI gambhIratA kI ora iGgita nahIM karatA aura rogI para dRSTi rakhane aura sthiti kA avalokana karate rahane ko AvazyakatA rahatI hai| jaba sitakozotkarSa sImA pAra karane lagatA hai to bahvAkAriyoM meM madhujana (glekojana) ke kaNa utpanna ho jAte haiN| unake sAtha apUrNa kozA bhI raktacitra meM mila jAte haiM jinameM pUrvasitakozA, majjakozA Adi hote haiM / jIrNa rogoM meM tathA jahA~ bahvAkAriyoM kA utkarSa kisI kAraNa se nahIM ho pAtA vahA~ lasakAyANUtkarSa milA karatA hai| jahA~ 5 pratizata se adhika uSasipriya rakta meM pAye jAte haiM vahA~ upasipriyotkarSa (iosInophiliyA) yA uSasipriya sitakozotkarSa mila sakatA hai| yaha sadaiva anurjA (alI) kI avasthAoM meM, udara meM kRmi hone para tathA kucha svacA ke rogoM meM bahudhA milatA hai / ye upasipriya kozA rakta ke atirikta utiyoM meM bhI mila sakate haiN| maleriyA aura TripAnosomiyAsisa Adi parajIvI jIvANuoM se hone vAle rogoM meM eka kAyANUtkarSa dekhA jAtA hai / zItalA, anya viSANujanya upasargoM, Antrika jvara tathA granthikajvara hone para yaha bahudhA milatA hai| sitakozApakarSa-sitakozAoM kI vizeSa karake bahvAkAriyoM kI saMkhyA meM kamI A jAne kI avasthA ko sitakozApakarSa kahA jAtA hai| Antrikajvara (motIjharA) meM yaha lakSaNa vizeSa karake isalie milatA hai ki Antrika jvara kA viSa asthimajjA meM bahvAkArI nirmANa karane vAle usake pUrvaja kozAoM ko hI yaha naSTa kara detA hai| yacamA meM, viSANujanya upasargoM meM, akaNakAyANakarSIya avasthAoM meM tathA mArAtmaka evaM acayika raktakSayoM meM sitakozApakarSa dekhA jAtA hai / __ akaNakAyANUtkarSa (agranulocytosis )-ise akaNakozIya mukhapAka (agranulocytic angina ) bhI kahate haiM / yaha roga jitanA Adhunika cikitsA ke putra rUpa meM prakaTa huA hai utanA anya nhiiN| isa roga meM kaNAtmaka ( granular ) sitakozAoM kA vinAza hone lagatA hai| kabhI kabhI to majjA meM unake pUrvaja banate haiM para unakA vibhajana kaNAtmaka sitakozAoM meM nahIM ho pAtA / kahIM majjA meM pUrvajoM ke nirmANa meM bhI bAdhA par3a jAtI hai jisake kAraNa majjA majjakAyANuoM ( myelocytes ) se rahita ho jAtI hai aura rakta bahvAkAriyoM se vihIna ho jAtA hai| a~garejI oSadhiyoM ke prati atihaSatA ( hypersenesitiveness) isa roga kI utpatti meM bahudhA mUla kAraNa kA kAma karatI hai / raktacitra dekhane para rakta meM sitakozAoM kI saMkhyA hajAroM meM na hokara saikar3oM meM raha jAtI hai| inameM bhI kaNAtmaka ( bahvAkArI) kozAoM para vizeSa prabhAva par3A karatA hai| lasIya sitakozAoM para utanA prabhAva nahIM hotA tathA rakta ke bimbANu isa vyAdhi meM bar3hate hue hI dekhe jAte haiN| For Private and Personal Use Only

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rudhira vaikArikI 885 Adhunika yuga meM isa vyAdhi kA hetu mukhyataH a~garejI davAiyoM kA andhAdhundha prayoga hai / vizeSa karake beMjInariMga (dhUpenya valaya) dvArA nirmita padArthoM kA prayoga jinameM pAirAmIDonavarga (pyramidon group ) kI oSadhiyA~ mukhya haiN| emIDopAirIna, espirIna, bArbITyUreTsa, salphonamAiDa tathA salphAvarga ke dravyoM kA atizaya prayoga yA una vyaktiyoM dvArA inakA atizaya prayoga jinheM unake prati atihRSatA meM hotI hai akaNakAyANUtkarSa dekhA jAtA hai| phiraMga se pIDita vyaktiyoM ko jaba Arsanika dravyoM ke sUcIvedha diye jAte haiM to unheM bhI atihapatA ke kAraNa yaha vyAdhi ho jA sakatI hai| bvAyaDa kA kathana hai ki akaNakAyANUtkarSa yA akaNa mukhapAka eka sarvathA nUtana roga hai yathA-Agranulocytosis, specially agrnanulocytic angina is new disease, for the first time was reported by Schulty in 1922 and the steady increase in the number of cases corres. ponds with the increase in the consumption of drugs containing the benzene ring. ____isa roga kI utpatti meM jahA~ oSadhiyoM ke dvArA anuhRSatA yA zarIra kA viSAkta honA pramANa hai vahA~ rogakAraka jIvANuoM ke dvArA utpanna viSa bho kaNIyasitakozAoM ko naSTa karane meM samartha ho sakate haiN| aisA patA cala cukA hai ki kucha pUyajanaka jIvANu eka sitakaNanAzakatatva (leucocidin) utpanna karane meM samartha hote haiM yaha tatva sitakozAoM ko naSTa kara detA hai vizeSa karake kaNAtmaka kozAoM para usakA atyadhika prabhAva par3atA hai / pUyajanaka jIvANuoM meM svarNaguccha golANu (staphylo. coccus aureus), zoNAMzI mAlAgolANu (streptococcus haemolyticus) tathA zoNaharita mAlAgolANu (streptococcus viridans) isa sitakozAnAzaka kArya meM sakriya bhAga lete haiM / Dainisa ne zoNaharita mAlAgolANu ko eka prakAra ke grAvaroM (kaipasUlsa ) meM banda karake zarIra kI Uti meM ve prAvara rakha diye| kucha kAla pazcAt eka prasaraNazIla viSi usameM se utpanna huI jo parIkSaNa karane para sitakozA ko nAza karane meM pUrNa samartha pAI gii| usa padArtha ko jaba sitakozAoM ke samparka meM rakhA gayA to bahvAkArI sitakozA eka eka kara vighaTita hone lage jaba ki lasIkozA aprabhAvita rahe jo yaha prakaTa karatA hai ki ina jIvANuoM se jo viSa nikalatA hai vaha kaNAtmaka sitakozAoM kA hI saMhAra kara sakatA hai| uparyukta pUyajanaka jIvANuoM se jo jo roga huA karate haiM una sabhI meM akaNakAyANUtkarSa pAyA jA sakatA hai / isI kAraNa zvasanaka (nyUmoniyA) meM yaha milatA hai| eka Azcaryajanaka bAta yaha bhI hai ki Antrika jvara meM sitakozApakarSa rahane para bhI akaNakAyANUtkarSa nahIM pAyA jAtA hai| isa prakAra hamane oSadhiprabhAvajanya akaNakAyANUtkarSa tathA jIvANujanya akaNa For Private and Personal Use Only

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856 vikRtivijJAna kAyANUtkarSa para vicAra prakaTa kiye haiM para eka tIsare prakAra se bhI yaha roga utpanna ho sakatA hai aura usameM na oSadhIya anuhRSatA aura na jIvANujanya viSatA hI kAraNa hotI hai| kyA yA kauna hetu usakI utpatti meM kAraNa hotA hai nahIM kahA jA sakatA use ajJAta hetujanya ( idiopathic ) akaNakAyANUtkarSa mAnanA caahie| __ yaha roga puruSoM kI apekSA striyoM meM adhika hotA hai kyoMki manodainya (nyUraisthIniyA) se ve hI adhikatara pIDita huA karatI haiN| striyoM ko prAyaH 40 varSa ke bAda yaha milatA hai| aba yaha jAnanA bhI parama lAbhaprada hai ki isa roga ke kyA lakSaNa hote haiN| lakSaNoM kI dRSTi se isake tIvra aura jIrNa do rUpa hote haiN| tIvra svarUpa hone para sajvara galapAka ( soreness of the throat with fever ) tathA glAni ( malaise ) pAI jAtI hai| roga drutavega se bar3hatA hai jisake kAraNa tuNDikeriyoM, galatoraNikAoM tathA mukha kI zleSmalakalA meM atyadhika vraNana ( ulceration ) ho jAtA hai| kabhI kabhI yoni aura bhagapradeza meM bhI vaNana milatA hai| mahAsrotIya zleSmalakalA meM bhI mukhya rUpa se malAzaya meM vaNana mila sakate haiN| rakta meM bahvAkAriyoM ( polymorphs) kI anupasthiti ke kAraNa koI bhI rogakArI jIvANu rugNa zarIra para apanA prabhAva dikhA sakatA hai| jisake kAraNa rogANuraktatA (septi. caemia ) dekhI jA sakatI hai / rogI atyanta durbala ho jAtA hai tathA thor3e samaya meM hI kAlakavalita ho jAtA hai| isa roga kA prabhAva kabhI kabhI mukha, kaNTha tathA hanvasthi para bhI par3a sakatA hai jisake kAraNa kothAtmaka (gangrenous) vikSatoM kA bhI nirmANa ho sakatA hai| jo vaNana Upara batalAyA gayA hai vaha roga kA hetu hai yA pariNAma isakI abhI puSTi nahIM ho sakI hai| ___ jIrNasvarUpa hone para jvara ke sAtha gale meM kabhI kabhI pAka hotA rahatA hai tathA glAni yA khinnatA banI rahatI hai striyoM meM mAsikadharma ke samaya bhI prAyaH ye lakSaNa prakaTa hote haiN| ___ asthimajA tIvra svarUpa ke roga meM kaNAtmaka sitakozAoM ke nirmANa meM asamartha ho jAtI hai / jisake kAraNa ve adhikatara vilupta ho jAte haiM unake pUrvaja kozAoM meM paramacaya huA rahatA hai| tatva isakA yaha hai ki ina pUrvaja kozAoM se prauDhana hokara kaNAtmaka kozAoM kI utpatti nahIM ho pAtI isa kAraNa ve raktapravAha meM Ane meM asamartha rahate haiN| isI ko bvAyaDa ne atizayatA meM daridratA ( poverty in plenty ) mAnA hai / yaha avasthA mArAtmaka yA ghAtaka raktakSaya meM khUba milatI hai| adhika dina bIta jAne para majakIya Uti meM alpacaya hone lagatA hai isa kAraNa usameM kaNAtmaka kozAoM kI nirmiti na hokara prarasakozA tathA lasIkozA adhika saMkhyA meM upalabdha hote haiM / rakta ke lAlakaNa (rudhirANu) isa roga meM yathAvat rahate haiM / yaha roga asAdhya svarUpa kA hotA hai phira bhI pezIvedha dvArA peNTanyUklioTAiDa For Private and Personal Use Only

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887 rudhira vaikArikI (pentnucleotide ) kA prayoga ise sAdhya banA detA hai| yaha oSadhi asthimajjA ko uttejita karake kaNAtmaka kozAoM ke nirmANa ke lie Avazyaka navajIvana pradAna karanevAlI siddha huI hai| araktatA, alparaktatA yA raktakSaya (Anaemia) rakta ke mukhya ghaTaka rudhirANu (red blood corpuscle ) meM kisI bhI prakAra kA vikAra Ane para zarIra meM jo vividha lakSaNotpatti hotI hai usI ko araktatA, alparaktatA yA raktakSaya ke nAma se cikitsaka pukArate Aye haiN| enImiyA ana tathA ImiyA do zabdoM se banA hai| ana kA artha alpatA yA sarvathA abhAva tathA ImiyA hImiyA kA rUpa hai jise raktatA kahA jAtA hai| astu enImiyA aura a yA alparaktatA eka dUsare ke paryAya haiN| raktakSaya eka anya pracalita zabda hai| raktadhAtu kA jaba kramAnukrama se kSaya hone lagatA hai to jo avasthA utpanna hotI hai vaha raktakSaya kahalAtI hai| isameM tvacA kI vivarNatA, zrama karane se thakAvaTa aura parizrama se zvAsakRcchratA pAI jAtI hai| rogI kA hRdaya dhakadhaka karatA huA use pratIta hotA hai| ina sAmAnya lakSaNoM ke atirikta kAmalA, mUrchA, zleSmalakalAoM meM kahIM se bhI raktasrAva, hRcchUla, agninAza, vibandha yA atIsAra, striyoM ke rajodharma meM kharAbI Adi sahalakSaNa bhI thor3e bahuta mila sakate haiN| sAmAnyatayA rudhirANuoM kA rUpa, AkAra aura abhiraMjanA zakti isa roga meM vikRta ho jAte haiM jisake pariNAmasvarUpa uparoktalakSaNa samUha pragaTa huA karatA hai / rudhirANuoM kA nirmANa jina zarIrastha varkazApoM meM hotA hai jaba taka unameM koI gar3abar3I nahIM hai taba taka rudhirANuoM meM kharAbI AnA prAyaH sambhava nahIM hai ataH rudhirANujanya vikRtiyoM kA varNana ina varkazApoM kI vikRti kA hI varNana ho sakatA hai| yaha smaraNIya hai ki raktakSaya meM rakta ke sitakozA ( leucocytes ) meM koI khAsa parivartana nahIM milA krtaa| isI adhyAya ke Arambha meM hama rudhirANuoM kI utpatti kI kathA AdyopAnta prastuta kara cuke haiM aura aba hama mAnavasamAja kI zakti kA hAma karake usakI zramajananazakti ko kama karake manuSya kI sAmarthya ko ghaTAne meM pramukha hetusvarUpa isa roga kA saMkSipta varNana upasthita karanA Avazyaka samajhate haiN| rakta ke nirmANa meM bAdhA par3ane se jahA~ raktakSaya ho sakatA hai vahA~ rakta ke bAhara baha jAne ke kAraNoM se bhI raktakSaya sambhava hai| prAcIna AcAryoM ne raktapitta ke prakaraNa meM jo usake pUrvarUpa rUpa yA upadrava likhe haiM ve AdhunikoM dvArA vyakta lakSaNAdi kathana ke lie sahAyatA kara sakate haiM / yathA___ tasyemAni pUrvarUpAgi bhvnti| tadyathA - anannAmilApo bhukasya vidAhaH zuktAmlagandharasa udgArazTa bhozAgamanaM charditasya bobhatsatA sara-do gAtrANAM sadanaM paridAho mUgvALUmAma iva loilohitamasyAmaganvitvamiva cAsyasya raktahatihAridratvamaGgAvayavazakRnmUtrasvedalAlAti For Private and Personal Use Only

Page #977
8 vikRtivijJAna kAsyakarNamalapiDakolikApiDakAnAm, aGgavedanA lohitanIlapItazyAvAnAmAciSmatAM duSTAnAJca rUpANAM svapne sandarzanamabhIkSNamiti lohitapitta pUrvarUpANi bhavanti / Acharya Shri Kailassagarsuri Gyanmandir anna kI abhilASA na honA, bhojana ke uparAnta jalana, sirake jaisI gandha aura rasa yukta DakAroM kA AnA, bAra-bAra vamana honA, rogI kA bIbhatsa ho jAnA, svarabheda, gAtroM meM avasAda, zarIra meM dAha honA, mukha se mAno ghU~A nikalatA ho, mukha se lohA, rakta, machalI jaisI yA Amagandha nikalanA, zarIrAGgAvayava - mala-mUtra-sveda - lAranAsAsrAva - mukhamala - karNamala - netramala tathA piDakAoM kA lAla nIla pIlA zyAva agni ke samAna camakadAra yA vikRta svarUpa vAlA ho jAnA tathA inakA svapna meM bAra-bAra dekhanA yaha raktapitta ke pUrvarUpa hote haiM / tathA upadravAstu khalu niyatAH daurbalyArocakAvipAkazvAsakAsajvarAtisAra zoSazothapANDurogAHsvarabhedazca / isa dRSTi se durbalatA, aruci, anna ke pAka meM kaSTa honA, zvAsaphUla jAnA, khA~sI ho jAnA, jvara - atIsAra zoSa, zotha pANDuroga aura svarabheda ye upadrava rUpa meM avazya milate haiM / suzruta ne inhIM ko nimna zlokoM dvArA vyakta kiyA hai -- daurbalyazvAsakAsajvaravamathumadAH pANDutA dAhamUrcchA bhukte ghoro vidAhastvadhRtirapi sadA hRdyatulyA ca pIDA / tRSNA kaNThasyabhedaH zirasi ca tapanaM pUtiniSThIvanaM ca / bhaktadveSo'vipAko vikRtirapi bhaved raktapittopasargAH // isa prakAra hama AcAryoM ke dvArA raktakSaya ke kAraka tatvoM dvArA utpanna lakSaNoM ko apratyakSatayA adhyayana kara sakate haiM / raktArza aura raktAtIsAra ke upadravoM ke rUpa meM AcAryoM ne jo lakSaNa ginAe haiM ve bhI isI koTi meM Ate haiM haste pAde mukhe nAbhyAM gude vRSaNayostathA / zotho hRtpArzvazUlaM ca yasyAsyAdhyo'rzaso hi saH // hRtpArzvazUlaM saMmoharachardiraGgasya rugjvaraH / tRSNA gudasya pAkazca nihanyurgudajAturam // kSapayanti hi // Adi tRSNArocakazUlArtamatiprasutazoNitam / zodhAtisArasaMyuktamarzAsi AcAryoM ne jo pANDuroga kA varNana kiyA hai vaha raktakSaya kA hI varNana hai / rakta kI kamI ke kAraNa mAnava zarIra kA varNa pANDuvarNa kA yA vivarNa ho jAtA hai usI ke anusAra yaha nAmakaraNa kiyA gayA hai| likhA bhI hai doSAH pittapradhAnazca yasya kupyantu dhAtuSu / zaithilyaM tasya dhAtUnAM gauravaJcopajAyate // tato varNabalasnehA ye cAnye'pyojaso guNAH / vrajanti kSayamatyarthaM doSadRSyapradUSaNAt // so'lparakto'lpamai darako niHsAraH zithilendriyaH / vaivarNya bhajate // tathA sa pANDuroga ityuktasya liGgaM bhaviSyataH / hRdayaspandanaM raukSyaM svedAbhAvaH zramastathA || sambhUte'smin bhavet sarvaH karNakSveDI hatAnalaH / durbalaH sadano'nnadviT zramabhramanipIDitaH // gAtrazUlajvarazvAsagauravArucimAn naraH / mRditairiva gAtraizva pIDitonmathitairiva // zUnAkSikUTo haritaH zIrNaromA hataprabhaH / kopanaH ziziradveSI nidrAluH ThIvano'lpavAk // piNDikodveSTaka TyUrupAdaruksadanAni 1 syuradhvArohaNAyAsaiH // uparokta varNana spaSTataH prAcInoM kI dIrghakAlIna nirIkSaNazakti kA prAgaTya karatA hai / ca For Private and Personal Use Only

Page #978
rudhira vaikArikI aba hama Age raktakSaya yA pANDuroga kA mADarna vargIkaraNa prastuta kreNge| enImiyA ke mADarna vargIkaraNa ko do vidvAnoM ne do dRSTiyoM se kiyA hai| inameM eka vieTroba hai aura dUsarA DaiviDasana / viNTroba ne jo vargIkaraNa prastuta kiyA hai vaha rudhirANuoM kI racanAvikRti kI dRSTi se kiyA hai / DeviDasana ne hetu kA dRSTikoNa apane samakSa rakha kara vargIkaraNa kiyA hai| ina donoM kA nAmollekha karake hama DaiviDasanIya paddhati kA avalambana isa grantha meM kareMge jisake sAtha-sAtha viNTroba dvArA nirdiSTa tathya bhI A jAveMge kyoMki yahI sulabha mArga bhI hai| DaiviDasananirdiSTa raktakSayika zreNIvibhAjana 1. AhArIya ayogajanya prAthamika ! - ghAtaka yA mArAtmaka raktakSaya amajakIya raktakSaya grahaNI (ka) raktotpattikaratatvavirahita sagarbhatA AmAzayAMzoccheda kRmi uttarajAta prAthamika (kha ) raktotpattikAraka dravyoM (lohatAmra jIvatiga avaTukAsatvAdi) ke abhAvajanya sAdhAraNa anIrodIya raktakSaya plUmara-vinsana sahalakSaNa zaizavIya poSaNika raktakSayaH haridutkarSa zaizavIya audarika roga anazana zliSIyazopha uttarajAta 2. asthimajakIya kriyA kA avasAda (ka) prAthamika anabhighaTya raktakSaya { vikiraNa (kSa-kiraNAdika se) (kha) uttarajAta 2 dhUpava / sIsaviSatA 3. raktasrAva (ka) tIna raktasrAva (kha) jIrNa raktasrAva 75,76 vi0 For Private and Personal Use Only

Page #979
Shri Mahavir Jain Aradhana Kendra 860 4. zoNAMzIya avasthAe~ 2. (kha) sadaiva upasthita avasthAe~ viSamajvara 1 ( ka ) tIvrAvasthAe~ < kAlajalajvara 1. paramakAyAvika raktakSaya RjukAyANvika raktakSaya www.kobatirth.org 3. sAdhAraNa sUkSmakAyANvika raktakSaya vikRtivijJAna viTro nirdiSTa raktakSayika zreNI vibhAjana [ ghAtaka raktakSaya amajjakIya raktakSaya 4. sUkSmakAyAzvika upavarNika raktakSaya rogANuraktatA apittamehika kAmalA kUlIyaraktakSaya phAnayakSaraktakSaya sIsaviSatA grahaNI zliSazopha Acharya Shri Kailassagarsuri Gyanmandir kRmi sagarbhatA kA ghAtaka raktakSaya anabhighaTyaraktakSaya tIvra anuraktasrAvIya viSamajvara jIrNa upasarga mArAtmaka roga raGga dezanA - 1.0 paramakozatA paramavarNatA raGgadezanA - For Private and Personal Use Only -0.9 RjukozatA RjuvarNatA raGgadezanA- -0.9 sUkSmako zatA RjuvarNatA sAdhAraNa anIrodIya raktakSaya raGgadezanA 0.9 kenIce blUmara - vinsanIya sahalakSaNa jIrNa anuraktasrAvIya haridurSa zaizavIya poSaNika raktakSaya aMkuza mukhakamyutkarSa sUkSmakozatA upavarNatA aba hama Adhunika dRSTi se upasthita kie gaye raktakSayoM kA yathAsambhava nAtivistRta varNana upasthita karate haiM / yaha varNana uparokta vargIkaraNa kA pUrNataH anukaraNa na karake vyAvahArika dRSTi kA vicAra sAmane rakha kara prastuta kiyA jA rahA hai / ( 1 ) AhArIya ayogajanya raktakSaya ( Nutritional Activity ) ( ka ) ve raktakSaya jinameM raktotpAdaka tatva kA abhAva rahatA hai /

Page #980
ghAtaka raktakSaya pRSTha 890 Shri Mahavir Jain Aradhana Kendra AAR isa citra meM AmAzayaprAcIra kA tulanAtmaka adhyayana prastuta kiyA gayA hai| A- svastha AmAzaya prAcIra kA citra hai| B-ghAtaka raktakSaya se pIDita AmAzayaprAcIra kA citra hai| Acharya Shri Kailassagarsuri Gyanmandir

Page #981
rudhira vaikArikI 861 ghAtaka raktakSaya ( Pernicious Anaemia ) ghAtakaraktakSaya meM asthimajjA kI svAbhAvika raktajanaka kriyAzakti raktotpattikara tatva ( haemopoitic principle ) ke abhAva meM naSTa ho jAtI hai| jisake kAraNa rudhirANuoM kI pragalbhatA ( maturation) apUrNa raha jAtA hai jisake pariNAma svarUpa asthimajA aparipakka kozAoM se bhara jAtI hai| sAtha hI ye aparipakka kozA bhI raktadhArA meM adhika saMkhyA meM praviSTa hone meM asamartha rahate haiN| bvAyaDa kA prAcurya meM dAridraya ( poverty in the midst of plenty ) yahA~ ThIka baiThatA hai| annapAcanakAla meM AmAzaya meM raktotpattikara tattva kA nirmANa hotA hai| phira isakA saMgraha yakRt meM hotA hai tathA AmAzaya evaM vRkkoM meM bhI yaha saMgrahIta rahatA hai| kaisila kI khojoM se yaha nizcita ho cukA hai ki raktotpattikara tatva do vastuoM se milakara banatA hai| eka anna kI probhUjina meM upasthita rahatA hai jise bAhyakAraka (extrinsic factor ) kahate haiM tathA isa bAhyakAraka para AmAzayika rasa se udbhUta AbhyantarikakAraka ( intrinsic factor ) nAmaka dUsare dravya kI kriyA hotI hai aura pariNAmasvarUpa raktotpattikaratattva ( haemopoitic principle ) kA. nirmANa ho jAtA hai| Abhyantara kAraka yA AmAzayika kAraka (gastric factor ) na to AmAzayika rasa kA amla bhAga hI hotA hai aura na pAci ( pepsin ) api tu ina donoM se pRthak eka viziSTa kAraka hotA hai jisakI prakRti kA pUrNa paricaya abhI taka nahIM ho sakA hai| isa Abhyantarika kAraka ke abhAva ke sAtha-sAtha anIrodakatA (achlorhydria) yA aglAbhAva pAyA jAtA hai / yaha varSoM rahatA hai jisake pazcAt raktakSaya kI utpatti dekhI jAtI hai| isa roga se pIDita hone vAloM ke parivAra meM payolasAbhAva (achylia) kA itihAsa bhI mila sakatA hai| jo isa kAraka kI kamI ke kulajavRtta kA paricAyaka hai| hotA yaha hai ki pahale rogI ke AmAzaya meM AmAzayika amla naSTa hone lagatA hai| kucha samaya pazcAt pAci (paipsIna ) bhI kama hone laga jAtI hai tatpazcAt zlaiSmika srAva ghaTane lagatA hai tadanantara AmAzayika kAraka kA abhAva dRSTigocara hotA hai| ina saba parivartanoM kA AdhAra eka zabda meM AmAzayika zleSmalakalA kA uttarottara apoSakSaya ( atrophy of the gastric mucosa ) ho sakatA hai| sTrAsa aura kaisila kA kathana hai ki bAhyakAraka prakRtitaH jIvatikti kha, (viTAmina bI,) hai / para abhItaka isa viSaya meM nirNAyaka vicAra nahIM ho pAyA hai| para itanA nirNIta hai ki yaha viTAmina bI varga kA hI padArtha hai| ___ yaha bhI na bhUlanA cAhie ki bAhya aura Abhyantara donoM kArakoM ke dvArA bane raktotpattikara tattva hone para bhI yadi Antrika zleSmalakalA se usakA pracUSaNa ThIka ThIka nahIM ho pAtA to bhI ghAtaka raktakSayotpatti dekhI jA sakatI hai| audarika roga For Private and Personal Use Only

Page #982
862 vikRtivijJAna ( coeliac disease ) tathA saMgrahaNI (sprue ) meM isa roga kI upasthiti kA yahI mukhya kAraNa dikhalAI detA hai| ___ hamane yaha dekhA ki bAhya yA Abhyantarika kAraka ke abhAva se raktotpattikara ( raktakSayAntaka ) tatva ke nirmANa meM bAdhA par3a sakatI hai tathA usake bana jAne para bhI usakA ThIkaThIka pracUSaNa na hone se bhI raktakSaya A upasthita hotA hai| Abhyantarika kAraka kA uttarottara abhAva anIrodatA, pAci kA abhAva, tudhAnAza, zlaiSmika srAvAlpatA Adi lakSaNa kara sakatA hai| yaha saba hameM AyurvedajJoM dvArA pratiSThita 'agni' kI kalpanA ko samajhane ke lie acchA avasara pradAna karatA hai| jise unhoMne 'agni' nAma se pragaTa kiyA hai vaha AbhyantarikakAraka ho sakatA hai jisake abhAva se raktotpatti meM pratyakSa bAdhA A sakatI hai aura aneka upadrava uTha khar3e hote haiN| AmAzaya ko agni kA adhiSThAna mAnA gayA hai / grahaNI bhI agni ke nirmANa aura sakriyatA se sambaddha hai| Adhunika vicAraka AmAzaya tathA grahaNI donoM meM hI raktotpattikara tattva kA nirmANa mAnate haiN| yadannaM deDhyAtvojobalavarNAdipoSakam / tatrAgnirheturAhArAnna hyapakkAda rsaadyH|| isameM anna ko jo varNapoSaka batalAyA hai vaha usameM nihita bAhyakAraka kI ora nirdeza hai| vinA usake raktanirmANa nahIM ho sakatA aura vinA raktanirmANa ke rogI ke varNa kA poSaNa bhI nahIM ho sktaa| phira usa anna ko paripakka karane kA hetu jATharAgni batalAI gaI hai| jaThara meM sthita agni jisake abhAva se pAci (paipsIna) tathA AmAzayika amla kA nirmANa aura utsarga nahIM ho pAtA vahI to agni hai aura vaha Abhyantarika kAraka kI ora spaSTa saMketa hai| isa agni ke zAnta ho jAne se manuSya jI nahIM sakatA ucita rUpa meM rahane se nirAmaya jI sakatA hai aura vikRta ho jAne se rogI ho jAtA hai zAnte'gnau mriyate yukte ciraMjIvatyanAmayaH / rogI syAda vikRte mUlamagnistasmAnnirucyate // jaikabasana kA kathana hai ki raktotpatti kriyA meM bAhya tathA Abhyantarika kArakoM kA sammelana AmAzaya ke ArjeNTAphina kozAoM ( argentaffin cells of the stomach ) meM hotA hai| ye kozA AmAzaya ke piNDa ( body ) meM nahIM pAye jAte api tu usake hArdika bhAga (cardiac part) tathA mudrikA bhAga (pyloric part) meM pAye jAte haiN| kahane kA tAtparya yaha hai ki agni kA pUrNa vinAza ghAtaka raktakSaya kA janaka hotA hai / agninAza ke kAraNa raktotpatti sambhava nahIM hotI rakta kI kabhI vAtakAraka hotI hai jisakA pariNAma vAta saMsthAna para par3atA hai| isIlie isa roga meM suSumnA meM vikSata pAye jAte haiM jinakA varNana Age yathAsthAna hama kreNge| ghAtaka raktakSaya kA svarUpa hameM isa roga ke sambandha meM nimnAMkita tathya milate haiM:1. yaha praur3hAvasthA meM hone vAlA roga hai jo strI puruSoM meM samAna rUpa se pAyA For Private and Personal Use Only

Page #983
afar vaikArikI 863 jAtA hai phira bhI striyoM ko puruSoM kI apekSA pahale roga kA AkramaNa hotA huA dekhA gayA hai| 2. rogI roga se itanI manda gati se AkrAnta hotA hai ki use yaha patA hI nahIM calatA ki roga use kaba se Arambha huA hai 1 3. roga ke bIca-bIca meM upazama kA bhI kAla calatA rahatA hai jisameM roga lakSaNa ThIka ho jAte haiM aura rakta kA citra bhI prakRta ho jAtA hai / 4. kevala asAdhAraNa avasthAoM meM kaI saptAhoM meM hI rudhirANugaNana 1 lAkha se 3 lAkha taka calA jA sakatA hai / 5. yakRcikitsA ke Agamana ke pUrva yaha eka atIva ghAtaka roga mAnA jAtA rahA hai / aura usase prANarakSA bahuta kaThina huI hai / 6. pANDutA ( pallor ), alpazvAsa, hRtspandanAnubhava ( palpitation of the heart ) tathA zopha Adi raktakSaya meM sarvasAdhAraNatayA pAye jAne vAle lakSaNa uttarottara vRddhiMgata rUpa meM pAye jAte haiM / 7. anIrodatA ( achlorhydria ) yA AmAzayika rasAbhAva ( achylia gastrica ) isa roga meM mukhyatayA pAyA jAtA hai| anIrodatA (anamlatA ) meM kevala AmAzayika amla kI uttarottara kamI hotI jAtI hai tathA rasAbhAva meM AmAzayika rasa jisameM amla tathA kaI vikara ( enzymes - pepsin rennin Adi) kama hote cale jAte haiM / isa roga meM pUrNa anIrodatA yA amlAbhAva dRSTigocara hotA hai / itanI anamlatA AmAzayika karkaTa meM bhI nahIM pAI jAtI jitanI ki ghAtaka raktakSaya meM dekhane. AtI hai| 8. AmAzaya meM amlAbhAva raktakSaya Arambha hone ke kaI saptAha pUrva hI utpanna ho jAtA hai| isake sAtha sAtha sudhAnAza ( loss of appetite ) eka dUsarA mukhya lakSaNa hai jo kabhI kabhI ghAtaka raktakSaya kI ora iGgita na karake AmAzayika karkaTa kA bhrama utpanna kara detA hai / 1 9. ghAtaka raktakSayI ke rakta ke citra meM parivartana hoM yA na hoM para kabhI-kabhI suSumnA kANDa meM kucha lakSaNa dekhe jAte haiM / inameM saMcAlanAbhAva ( ataxia ), saMjJAvikSobha ( sensory disturbances ), aMgagraha ( spasticity ) tathA TAMgoM kI asthiyoM meM AveSAbhAva ( loss of vibration sense in the bones of the legs ) mukhya haiM / ina lakSaNoM kA rakta ke citra se mela ho aisA Avazyaka nahIM hai| arthAt ye lakSaNa svatantratayA utpanna hote haiM / 10. uparokta lakSaNoM ke atirikta kucha sAdhAraNa vAtika lakSaNa bhI isa roga meM dekhane meM Ate haiM inameM hAtha pairoM meM saMjJAzUnyatA ( senselessness ), uttejanA ( tingling sensation ), para caitanya ( parasthesia ) Adi kA anubhava For Private and Personal Use Only

Page #984
864 vikRtivijJAna hotA hai / ye lakSaNa eka sAdhAraNa vAtanADIya zotha ( neuritis ) ke kAraNa hote haiM tathA inake sauSumnika vikSatoM se koI sambandha nahIM hotA hai| 11. roga ke bhAvegakAla ( exacerbation) meM jo raktacitra hotA hai vaha bAda meM koI khAsa parivartana nahIM kiyA krtaa| eka tIvasvarUpa ke ghAtaka raktakSaya meM raktacitra nimnalikhita hotA hai: a-rakta ke saba tatva saMkhyA meM ghaTa jAte haiM (i) rudhirANu kI saMkhyA adhika gambhIra rogiyoM meM 10,00000 yA usase bhI kama pratighana milImITara raha jAtI hai| jisa raktakSaya meM rudhirANu bIsa lAkha se kama ho usako ghAtaka raktakSaya kA lakSaNa samajhA jA sakatA hai para aisA anya raktakSayoM meM bhI mila sakatA hai| (ii) upazamakAla meM yaha saMkhyA 40 lAkha taka calI jAtI hai| (iii) zoNavartuli bhI isa roga meM kama ho jAtI hai para yaha kamI anupAta meM meM nahIM hotI isakAraNa raMgadezanA sadaiva 1 se Upara rahA karatI hai| kabhI kabhI 1.5 taka pahu~ca sakatI hai| (iv) adhikatara rudhirANu khUba raMge hue hote haiM isI kAraNa unheM paramavarNika ( hyperchromic ) saMjJA se abhibhUta kiyA gayA hai| (v) paramavarNatA se bhI bar3hakara isa roga meM rudhirANu kI AkAravRddhi hotI hai| yataH asthimajjA meM bRhadraktaruhIya ( megaloblastic ) parivartana isa roga meM dekhe jAte haiM jinake kAraNa bRhadraktakozIya ( megalocytic) parivartana rakta ke andara dekhane meM Ate haiM jinakA pariNAma rakta ke lAla kaNoM kI sthUlakAyatA ( macro. cytes) meM hotA hai| isa roga meM rudhirANu apane prakRta AkAra se sadaiva bar3e hote haiN| prAisajonsa kA kahanA hai ki lAlakaNa kA prakRta AkAra 7 // aNuma ( micron ) se 8 // aNuma taka calA jAtA hai| 6 se 9 aNuma ke prakRta parivartana ke sthAna para yahA~ 4 se 12 aNuma ke bIca meM AkAra parivartana dekhA jAtA hai / jisake kAraNa kitane hI raktakozA prakRta lAla kaNoM se choTe hote haiN| ise asamatotkarSa (anisocytosis) kaha sakate haiM / ye choTe kaNa raMga meM bhI halake hote haiN| (vi) rudhirANuoM ke rUpa meM bhI parivartana jise virUpatoSkarSa ( poikilocy. tosis ) kahate haiM, pAyA jA sakatA hai| isake kAraNa rudhirANuoM kA taraha taraha kA rUpa ho jAtA hai| unakA AkAra bahuta badala jAtA hai| ghAtaka raktakSaya kI pravRtti lAlakaNa ko usake bhroNarUpa (embryonic form) meM badalane kI rahatI hai kyoMki isa roga kA mukhya bhAva hI yaha hai ki asthimajjA ke lAlakoM meM zIghratA se pUrNa pragalbha hone kI kSamatA kA abhAva ho jAya / majjA kI bRhadaktaruhIya ( megaloblastic ) pratikriyA tathA raktakSaya kA sthUla kozIya For Private and Personal Use Only

Page #985
rudhira vaikArikI 865 honA usakA mukhya lakSaNa hai| usake aneko kozAoM meM bahuvarNapriyatA pAI jAtI hai| rakta kA lAlakaNa mUla se kSArapriya ( basophilic) huA karatA hai| jyoM jyoM usameM zoNavartuli kA praveza hone lagatA hai vaha amlapriya ( acidophilic) hone lagatI hai| yahA~ taka ki pUrNa pragalbha kozA pUrNatayA amlapriya ho jAtA hai| para isa roga meM zoNavartuli jaba AMzikarUpa se pragaTa hotI hai to kucha bhAga kSArapriyatA tathA kucha amlapriyatA prakaTa kiyA karate haiM jisase raMjana meM aneka varNatA dikhAI dene lagatI hai jise hama bahuvarNapriyatA (polychromatophilia) kahate haiN| isake sAtha-sAtha kSArapriya vindukatA (bosophilic stippling) pAI jA sakatI hai / jo eka prakAra se kaNanIya vihAsa (granular degeneration) hI hotA hai / isake sAtha sAtha jAlikIya kozA ( reticulocytes) kA bhI prAdurbhAva hotA hai jo svayaM raktakaNa ke apUrNa pragalbhana kI ora spaSTataH saMketa karatA hai| jaba ki sAdhAraNatayA kula eka pratizata jAlikIya kozA rakta meM pAye jAte haiM ghAtaka raktakSaya meM ve 5 pratizata taka dekhane meM Ate haiM / jAlikIya kozAoM kI raktacitra meM vRddhi sadaiva asthimajjA kI kriyAzIlatA kI ora spaSTa nirdeza hai| yakRccikitsA ke uparAnta yaha vRddhi aura bhI bar3ha jAyA karatI hai / anaghaTita raktakSaya (aplastic anaemia) meM jahA~ asthimajjA meM kriyAzIlatA kA sarvathA abhAva pAyA jAtA hai jAlikIya kozAoM kI anupasthiti hI prApta hotI hai| para yaha bhI nahIM bhUlanA cAhie ki jAlikIya kozoM kA darzana sAdhAraNa abhiraJjanoM meM sambhava na hokara viziSTa abhiraJjanoM kI AvazyakatA par3atI hai| sanyaSTi rudhirANuoM kI upasthiti bhI isa roga meM pAI jAtI hai jo rudhirANuoM kI apragalbhatA ( immaturity ) kA spaSTa pramANa hai / nyaSTiyukta lAlakaNa Rjuraha tathA bRhadrataruha donoM ho sakate haiN| para jahA~ Rjuruha (normoblasts ) kisI bhI tIvra raktakSaya meM AsAnI se dekhe jAte haiM bRhadraktaruha ( megaloblasts ) vizebatayA ghAtaka raktakSaya hI meM dekhane meM Ate haiN| RjuruhoM kI apekSA bRhadraktaruha hI adhika bar3A hotA hai| isakI nyaSTi bhI adhika bar3I aura khulI hotI hai| isakA kozAprarasa ( cytoplasm ) yA to bahuvarNapriya hotA hai yA vaha zuddha kSArapriya bhI dekhA jA sakatA hai| inakI nyaSTi meM vibhajana bhI milanA sambhava hai| eka bAta aura smaraNa rakhanI hogI ki bRhadraktarUhoM kI upasthiti rakta meM tabhI taka dekhI jAtI hai jaba lAlakaNoM kA gaNana 20 lAkha pratighana milImITara ke nIce rahatA hai| jaba yaha gaNana 25 lAkha para pahu~ca jAtA hai to phira inako khojanA bahuta kaThina ho jAtA hai| eka bAta aura / yataH ghAtaka raktakSaya meM rakta ke kaNa apragalbha rahate haiM isalie unakI bhiduratA yA bhaGguratA ( fragility ) kama ho jAtI hai| kyoMki purAne lAlakaNoM ko jaba upabala lavaNa vilayana ( hypotonic saline solution ) ke samparka meM lAyA jAtA hai to ve bahuta jaldI bhaGgura ho jAte haiN| For Private and Personal Use Only

Page #986
vikRtivijJAna vikRta zArIra-ghAtaka raktakSaya ke kucha vikSata to prathamajAta athavA roga ke sAtha Arambha se hI rahate haiM / tathA adhikAMza lakSaNa raktakSaya ke kAraNa athavA raktanAza ke kAraNa utpanna hote haiN| do lakSaNa jo pramukhatayA dekhe jAte haiM inameM eka asthimajjA meM bRhadraktaruhIya prakAra ke kozAoM kI saMkhyAvRddhi tathA dUsarA lohotkarSa (siderosis ) hotA hai | bvAyaDa ne vikSatoM ke anusAra nimnalikhita 5 samUha banAe haiM1. raktakSaya ke kAraNa bane hue vikSata jinameM snaihika vihAsa tathA raktasrAvAdi Ate haiN| 2. asthimajjA ke parivartana / 3. lohotkarSa jisake sAtha sAtha jAlakAntazchadIya saMsthAna ke kozAoM dvArA bhakSikozotkarSa (phagocytosis ) krnaa| 4. mahAsrotas ke vikSata, tathA 5. vAtanADI saMsthAna ke vittata / vividha aGgoM para prabhAva-ghAtaka raktakSayI kI tvacA kA varNa nIbuA ( lemonyellow) ho jAtA hai / jo pANDuratA ( pallor ) raktakSaya meM dekhI jAtI hai usakA yahA~ abhAva hI rahatA hai| usakA meda bhI nIbuA raMga kA pIlA tathA prabhUta mAtrA meM milatA hai isa kAraNa isa roga meM kArya (wasting ) nahIM hI miltaa| yakRccikitsA ke kAraNa Aja kala nIbuA raMga ke rogI dekhanA kaThina hai| peziyA~ khUba lAla raMga yA raktabaca ( reddish brown ) varNa kI aura yathAvat rahatI haiM unameM koI antara dekhane meM nahIM aataa| lasya kalAoM ( serous membranes) meM nIlohAMkIya raktasrAva (petechial haemorrhages) hote hue dekhe jA sakate haiN| sajIvAvasthA meM dRSTipaTala ( retina) meM aise raktasrAva kA pratyakSa darzana kiyA jA sakatA hai| uparokta parivartanoM kA mukhya kAraNa hotA hai snaihika vihrAsa ( fatty dege. neration ) tathA snaihika vihAsa banatA hai raktakSaya ke dvArA / yaha snaihika vihrAsa hRdaya meM khUba dekhA jAtA hai / isake kAraNa hRdaya pANDura aura zlatha ho jAtA hai / vAmanilaya kI prAcIra tathA mAMsastambhI peziyoM ( papillary muscles ) meM eka pItavarNa kA sidhmana (yellow speckling ) ho jAtA hai jise ,zabaisTa yA murajhAI huI pattI ( faded leaf ) kahate haiN| yaha lakSaNa atyadhika raktakSaya kI avasthA meM hI milatA hai| mRtyu yadi zIghra ho gaI to yaha kama milatA hai yA nahIM bhI pAyA jaataa| __yakRt meM bhI snaihika vihAsa tathA lohotkarSa ye do parivartana dekhane meM Ate haiN| snaihika vihAsa atyantAvasthA kA ho sakatA hai| yakRt khaNDikAoM ke bAhya do tihAI bhAga meM zoNAyasi ( haemosiderin ) ke pItakaNa saMgrahIta ho jAte haiM jinakI pratikriyA ( reaction ) ayazyAmanIla (prussian blue ) varNa kI huA For Private and Personal Use Only

Page #987
rudhira vaikArikI 867 karatI hai / kUphara kozAoM meM unakI upasthiti bahuta kama rahatI hai yA unakA sarvathA abhAva ho jAtA hai / yakRt meM majjAbha ( myeloid ) kSetra bhI mila sakate haiM / plIhA thor3I parivRddha ho jAtI hai / aNvIkSaNa karane para usake jAlikAntazchadIya kozAoM meM bhakSikozIya kriyAzIlatA meM vRddhi kA honA pAyA jAtA hai inhIM bhakSikozAoM meM raMgA tathA lAlakaNoM ke Tukar3e pAye jAte haiN| plIhA dekhane meM gaharI lAla tathA spaSTataH sUjI huI dRSTigocara hotI hai / roga ke punarAkramaNa ( relapse ) meM plIhA ke ye parivartana adhika bar3ha jAte haiM / ayas-raMgA kA saJcaya yahA~ hotA hai para lohotkarSaM ( siderosis ) utane parimANa meM nahIM milatA jaisA ki yakRt meM pAyA jAtA hai| isase eka bAta spaSTa ho jAtI hai ki yadyapi plIhA kA kArya raktANuoM kA vinAza karanA hai para lohe ke raMgA kA saJcaya plIhA kI apekSA yakRt meM kahIM adhika hotA hai / isameM majjakozA ( myelocytes ) tathA sanyaSTi raktANuoM ( nucleated red cells ) ke choTe choTe kSetra khUba pAye jAte haiM / yaha smaraNa rakhanA cAhie ki isa roga meM lasagranthakoM para koI mahatva kA prabhAva par3atA huA nahIM dekhA jAtA / vRkkoM meM bhI vahI do parivartana - snaihika vihAsa tathA lohotkarSa dekhane meM Ate haiM para yahA~ yakRt kI apekSA hAni kama pAI jAtI hai / anya aGgoM kI bhI sthiti thor3I yA bahuta isI prakAra kI rahA karatI hai / ghAtaka raktakSaya meM asthi majjA meM sakriyatA bahuta bar3ha jAtI hai| yahI nahIM lambI asthiyA~ jo pIta majA se bharI rahatI haiM unameM bhI raktanirmANa kA kArya cala par3atA hai aura unakI pItamajjA raktamajjA meM pariNata hone lagatI hai / yaha parivartana Urvasthi meM pahale aura jaMghAsthi meM bAda meM dekhA jAtA hai| yahI nahIM, pragaNDAsthi tathA Urvasthi ke UparI siroM para jahAM raktAbha majjA thor3I bahuta pAI jAyA karatI hai vahIM se majjA kA raktavarNIkaraNa Arambha hotA hai / para yaha raktavarNatA hara sthAna para eka sI nahIM calatI, aNvIkSaNa karane para eka sthAna khUba gaharA lAla dekhane meM AtA hai to dUsarA kucha kama tIsarA kSetra pUrNataH pIlA bhI ho sakatA hai / asthi ke andara yaha jo paramacaya kI kriyA calanI prArambha hotI hai usake pariNAmasvarUpa asthi majjA guhA kI daNDikAoM ( trabeculae of the medullary cavirty ) kA pracUSaNa hone lagatA hai jisase yaha guhA asthidaNDa ke mUlya para bar3hane lagatI hai / raktasrAva ke pazcAt jo kAryakArI paramacaya ( functional hyperplasia ) pAyA jAtA hai vaisA paramacaya isa samaya nahIM miltaa| kyoMki vaha pratikriyA RjuruhAtmaka hotI hai jabaki yahA~ para parivartana bRhadraktaruhAtmaka ( megaloblostic ) hotA hai / bRhadrakta kozA kA parivartana sIdhA bRhatkAyANvika kozAoM ( macrocytes ) meM ho jAtA hai / sAtha hI praguNana kA abhAva rahatA hai / kevala jaba yakRt ke andara raktotpAdaka tatva kA abhAva ho jAtA hai tabhI bRhadrakta kozAoM kA prAdurbhAva hotA hai vaise unakA koI mahatvapUrNa sthAna garbhottarakAlIna jIvana meM sAmAnya For Private and Personal Use Only

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568 vikRtivijJAna lAla kaNoM ke vikAsa meM nahIM mAnA jaataa| isase rakta ke pravAha meM lAla kaNoM ko saMkhyA meM kamI tathA apekSAkRta bahuta thor3e RjuruhoM kI upasthiti kA spaSTIkaraNa ho jAtA hai / yahI eka pratikriyA roga kI vikRti kI ora spaSTataH nirdeza karatI hai| jaba roga thama jAtA hai taba RjuruhAtmaka ( normoblastic ) pratikriyA lauTa AtI hai| yaha nahIM samajhanA cAhie ki paramacayika asthimajjA meM kevala bRhadraktaruha nAmaka kozA hI hote haiN| prArambhika zvetakozA-majjakozA tathA majjaruha ye donoM prakAra ke kozA bahuta dikhalAI dete haiN| eka bAta aura hai ina zvetakozApUrvajoM kI upasthiti ke sAtha-sAtha sitakozApakarSe ( leucopenia) bhI rahatA hai| isakA bhI eka hI uttara hai ki lAlakoM kI taraha zvetakaNa bhI pUrNa vikasita hone meM asaphala rahate haiM aura jabataka unakA pUrNa vikAsa yA pragalbhana nahIM ho jAtA tabataka ve rakta pravAha meM praviSTa hone meM bhI asaphala rahate haiN| isase aisA lagatA hai ki mAno koI eka tatva jo majjakozAoM ( myelocy tes ) ko bahvAkArI sitakozAoM meM badalatA hai usakA sarvathA abhAva ho jAtA hai| yahI kAraNa hai ki ghAtaka raktakSaya meM asthimajjA ke andara puSTa bahvAkAriyoM kI saMkhyA svasthavyakti kI raktamajjA meM pAI jAne vAlI saMkhyA se bahuta kama pAI jAtI hai / bRhannyaSTikozAoM ( megacaryocy tes ) kI saMkhyA bhI ghaTa jAtI hai| unameM jo bRhannyaSTi kozA dekhe bhI jAte haiM ve choTe evaM vihRSTa ( degeneratad ) hote haiM isI ke kAraNa bimbANvapakarSa ( thrombocytopenia ) ho jAtA hai / roga ke punarAgamana ( relapse ) ke samaya zoNAyasI yukta bhakSikozA yA rakta kAyANu khUba dekhe jA sakate haiN| uparokta varNana se yaha spaSTa ho gayA hogA ki ghAtaka raktakSaya meM sita kozAoM kI saMkhyA ghaTa jAtI hai aura sitakozApakarSa pragaTa ho jAtA hai| yaha apakarSa vizeSa karake bahvAkAriyoM meM hI hotA hai jisake kAraNa sApekSatayA lasIkozotkarSa kA AbhAsa hone lagatA hai arthAt bahvAkArI jo sadA rakta meM anya sitakozAoM se adhika rahA karate haiM unakI saMkhyA ghaTa jAtI hai jisase lasIkozA na bar3hane para bhI apekSayA adhika dekhane meM Ate haiM kyoMki unakI saMkhyA to isa roga meM ghaTatI nahIM hai| eka bAta aura, ghAtaka raktakSaya meM jo bhI bahvAkArI milate haiM ve anya raktakSayoM kI apekSA adhika khaNDita ( lobed ) hote haiN| vyAvahArika dRSTi se yaha bAta bahuta lAbhaprada hai| vAstavikatA to yaha hai ki raktakSaya ke lie jJAna prApta karane kI dRSTi se zveta kaNoM kA adhyayana jitanA lAbhaprada ho sakatA hai utanA lAlakoM kA nahIM (bvaaydd)| sitakozApakarSa ghAtaka raktakSaya meM itanA adhika dekhA jAtA hai ki yadi rogI tInopasarga se bhI pIDita ho jAya to bhI sitakozotkarSa ( leucocytosis ) ke darzana nahIM huA krte| isakA hetu yA doSa sadaiva asthimajjA meM nihita rahatA hai| asthi majjA majjakIya kozAoM se bhara jAtI hai| parantu majjakIya kozAoM meM pragalbhana honA ruka jAtA hai isa kAraNa bahvAkAriyoM kI utpatti bahuta hI kama hotI hai aura unakI saMkhyA rakta meM ghaTa jAtI hai| For Private and Personal Use Only

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rudhira vaikArikI 866 raktarasa ( plasma ) meM bhI vikRti AtI hI hai / usameM adhika rakta ke lAlakoM kA adhika vinAza hone ke kAraNa pittarakti kI mAtrA bar3hane lagatI hai jo usameM pIta varNa kI vRddhi kara detI hai / isI kAraNa prakRta kAmalA dezanA ( normal icterus index ) jo kevala 5 hotI hai vaha aba 5 se 15 taka pAI jA sakatI hai / mUtra meM bhI mUtrapittijana ( urobilinogen ) kI vRddhi hone se phAna Dainaba prati kriyA asatyAtmaka apratyakSa ( positive indirect ) ho jAtI hai / yaha saba jJAna vahA~ bahuta upAdeya siddha hotA hai jahA~ kozikIya citra ( cytological pictune ) anizcita rahane se nidAna kI nizciti meM kaThinAI kA anubhava hotA hai / asthimajjA ke bAhara raktanirmANa isa roga meM hotA huA dekhA jA sakatA hai / para vaha kitane parimANa meM hotA hai yaha jJAna karanA kaThina par3atA hai / yaha bAta satya hai ki garbhastha zizu meM paJcama mAsa ke pUrva rakta kA nirmANa yakRt tathA plIhA ke dvArA hotA hai / prAcIna AcAryoM ne isa tathya ko apane sAmane rakha kara tathA raktakSaya ke pIDitoM meM dekha kara - sa khalvApyo raso yakRtplIhAnau prApya rAgamupaiti / ( suzruta sUtra 14 ) aisA likha diyA hai / isI ko vAgbhaTa ne prabhavatyasRjaH sthAnAtplIhatI yakRtazca tat / kaha kara raktapittakAsanidAna meM spaSTa kiyA hai / suzruta ne zArIrasthAna 4 meM yadyapi medodharA kalA ke varNana meM sthUlAsthiSu vizeSeNa majjA tvabhyantarAzritaH / kaha kara - athetareSu sarveSu saraktaM meda ucyate / bhI kahA hai| usane choTI haDDiyoM meM saraktameda ke darzana kie haiM aura usakI dRSTi meM isa sarakta meda kA vicAra AyA bhI hai para raktotpatti meM saraktameda kI mahattA ko Adhunika vaijJAnikoM ne hI adhika spaSTa kiyA hai / astu, jaba zarIra meM rakta kI paramAvazyakatA ghAtaka raktakSaya meM A upasthita hotI hai to yakRt meM vizeSa karake evaM plIhA meM bhI majjAbha Uti kI dvIpikAe~ itastataH utpanna ho jAtI haiM aura unase bhI raktotpatti honA Arambha ho jAtA hai / parantu jahA~ zarIra kI sampUrNa majjA meM eka krAnti AI ho aura usakI pItatA saraktameda meM pariNata ho gaI ho vahA~ inakA kyA vizeSa mahattva ho sakatA hai ? para mahattA ho yA na ho, yakRt tathA plIhA bhI apane garbhakAlIna kArya meM punaH tatpara hokara raktotpatti kara sakate haiM / aba yaha prazna upasthita hotA hai ki jina AcAryoM ne itanI sUkSma dRSTi se yakRt tathA plIhA meM raktotpatti ke darzana kie unhoMne saraktabheda meM raktotpatti kA kyoM dhyAna nahIM diyA / hamAre vicAra se AcAryoM ne eka hI tatva ko pradhAnatA dI / vaha yaha ki unake mata meM yakRta aura plIhA meM eka sAtha yA alaga-alaga koI vikAra hone para raktotpatti meM vighna yA kharAbI dekhane meM AI isase unhoMne samajha liyA ki raktotpattikAraka bhAva yA tasva yakRt vA plIhA yA donoM meM nihita hai / vAstavikatA bhI yahI hai / raktotpatti For Private and Personal Use Only

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vikRtivijJAna kahA~ hotI hai yaha prazna nahIM hai| prazna to yaha hai ki kisakI AjJA se aura kisake saMcAlana meM yaha kriyA sampanna hotI hai| so to pUrNataH spaSTa hai ki yakRt meM saMgrahIta tatva jise raktotpattikaratatva ( haemopoitic factor ) yA jise raktakSayAntaka tatva ( anti anaemic factor) kahate haiM vahI isakA kartA hone se raktotpatti kA mUlasthAna yakRt hI baiThatA hai, jahA~ usakA saMcAlaka rahatA hai| usa saMcAlaka (raktotpattikara tatva ) kA nirmANakendra asthiyoM meM nihita avakAza meM sthita majjA hotI hai| majA gauNa aura yaha tatva pradhAna hai / Adhunika phijiyAlojI abhI taka pUrNa pragalbha nahIM ho pAI isalie nizciti se yaha nahIM kahA jA sakatA ki kevala yakRt hI raktotpatti ke saMcAlana kA saMcayakartA hai / sambhava hai kAlAntara meM kisI aise bhI tatva kA patA lage jisakI utpatti aura upasthiti plIhA meM nihita ho jo raktotpatti meM pratyakSa bhAga letA ho| kyoMki rakta ke lasyakoM kA vighaTana plIhA meM hotA hai| vighaTana kriyA jahA~ cala rahI ho vahA~ unake nirmANa ke lie sAtha-sAtha AhvAna na kiyA jA rahA ho, yaha asambhava hai kyoMki paramAtmA kI banAI sRSTi meM kriyA aura pratikriyA donoM eka sAtha utpanna hotI aura bar3hatI haiN| ____ mahAsrota meM pAye jAne vAle vikSata mukhyataH AmAzaya aura jihvA para prakaTa hote haiM / roga ke Arambha se hI vedanAvatI jihvA pAI jA sakatI hai| ghAtaka raktakSaya se marane vAle rogiyoM meM jihvApAka eka mukhya lakSaNa milatA hai| usakA varNa agni ke samAna lAla dekhA jAtA hai| jIrNa rugNoM meM jihvA apuSTa aura sapATa ho jAtI hai| usake Upara ke aMkura naSTa ho jAte haiN| zleSmalakalA tathA pezI bhI apuSTa hotI huI dekhI jAtI hai / jihvA ko jisa kaSTa kA sAmanA karanA par3atA hai vaisA hI kaSTa mAnavetara prANiyoM meM mAnavoM ne jina prakriyAoM dvArA prApta kiyA hai ve hI yahA~ bhI kAraNabhUta hoMgI aisA logoM kA mata hai| tadanusAra jihvA kI sArI ApadAe~ tabhI sambhava haiM jaba rogI ko pracura parimANa meM jIvadravya (vitamins) na mila skeN| astu, ghAtaka raktakSaya meM ajIvitiktyutkarSa (avitaminosis ) hI jihvArogoM kA janaka mAnA jAtA hai| isI prakAra AmAzaya kA Urdhva 3 bhAga durbala aura apuSTa hotA calA jAtA hai| vaha itanA patalA ho jAtA hai ki dekhane mAtra se hI saralatApUrvaka usakA bodha kara liyA jA sakatA hai| yaha apuSTi AmAzaya ke sabhI AvaraNoM meM pAI jA sakatI hai / isake kAraNa AmAzayika zleSmalakalA se amlajanaka kozA ( oxyntic cells) tathA pAcikozA ( peptic cells ) vilupta ho jAte haiN| AmAzaya piNDa aura mudrikIya zleSmalakalA jahA~ milatI haiM vahA~ sahasA parivartana milatA hai aura zleSmalakalA vahA~ Rju milatI hai| ina parivartanoM kA raktakSaya se maulika sambandha mAlUma par3atA hai / jo loga A~toM meM bhI ina apuSTa aura vraNAtmaka vikSatoM kI kalpanA karate haiM ve bhrama meM haiN| kyoMki yadi mRtyu ke turata bAda phArmelIna kA iMjekzana zava meM kara diyA jAve to phira ye parivartana A~toM meM nahIM milate jisase siddha yaha huA ki A~toM meM mRtyUttarakAlIna kriyAe~ unheM janma detI haiM, roga nahIM (bvaaydd)| For Private and Personal Use Only

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rudhira vaikArikI 601 suSumnAkANDajanya vikSata-prati bIsa rogI pIche eka rogI meM suSumnAkANDajanya vikSata pAye jAte haiM jinakA jJAna mRtyUttara parIkSaNoM meM prAyaH huA karatA hai| suSumnA ke mukhyataH pazca (posterior) aura sAdhAraNataH pArzva (lateral) bhAga meM anutIvra milita vihAsa ( subacute combined degeneration ) dekhA jAtA hai / suSumnA sUja jAtI hai| usameM pArAbhAsI kSetra sthAna sthAna para prakaTa hone lagate haiN| ye pahale pazca stambhoM ( lateral columns ) meM dikhalAI dete haiM phira pArzvastambhoM meM phailate haiM aura anta meM agra (anterior) stambhoM meM bhI dekhe jA sakate haiM / aNvIkSaNa karane para majavikaMcukoM ( medullary sheaths ) kA vinAza aura vihrAsa dekhA jAtA hai jisake uparAnta akSarambha vilupta hone lagate haiN| inhIM vikSatoM ke kAraNa asaMgati ( ataxia) tathA aMgagrahaNa (spasticity ) jo pahale kaha cuke haiM dekhane meM Ate haiN| eka bAta mukhya hai ki suSumnA ke vikSata raktakSaya kI tIvratA ke sAtha sambaddha nahIM hote / yahI nahIM, kabhI-kabhI to jaba raktakSaya ke hone meM bhI sandeha hotA hai taba bhI ye mila jAyA karate haiM / sAtha hI saMjJAzUnyatA ( numbness ), jhunajhunI ( tingling ) tathA paracaitanya (parasthesia) ke jo lakSaNa dekhane meM Ate haiM unake nirmANakartA bhI ye vikSata nahIM hote| ise sadA smaraNa rakhanA hogaa| anya paramakAyANvika raktakSaya (1) amajakIya raktakSaya (Achrestic anaemia)-yadyapi yaha raktakSaya ghAtaka prakAra ke raktakSaya jaisA hI hotA hai para isameM kaI antara bhI pAye jAte haiM jinameM 3 mukhya haiM : 1. anIrodatA ( achlorhydria) kA abhAva, 2. vAtika lakSaNoM ( nervous symptoms ) kA abhAva, tathA 3. yakRccikitsA se koI lAbha na honA yaha raktakSaya bahuta kama dekhA jAtA hai| aisA pratIta hotA hai ki asthimajjA raktakSayAntaka tatva kA upayoga karane meM asamartha ho gaI ho isa kAraNa yaha raktakSaya utpanna huA ho / kyoMki yakRt kA cikitsA kI dRSTi se prayoga karane se isa roga meM koI lAbha nahIM hotA / raktotpattikara tatva rogI ke zarIra meM upasthita rahatA hai| usakI koI kamI nahIM rahatI para usakA upayoga karake saraktamajjA kucha bhI kara nahIM pAtI / isa roga meM raktacitra tIvra bRhadktANujanya ( megalocytic ) paramavarNika raktakSaya kA milatA hai / rudhirANudhoM ke sakala gaNana kI dRSTi se unakI saMkhyA bIsa lAkha prati ghana milImITara se nIce rahatI hai| raMgadezanA 1 se Upara pAI jAtI hai| (2) grahaNI janya raktakSaya (Anaemia due to sprue)-grahaNI eka uSNakaTibandhIya Antrika vyAdhi hai jisameM AdhmAna kA pAyA jAnA, pracura parimANa meM medayukta purISa kA parityAga, jihvA kI apuSTi tathA Antrika zleSmalakalA kI apuSTi aura For Private and Personal Use Only

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602 vikRtivijJAna AmAzayika amlAbhAva (gastric anacidity ) mukhyatayA pAI jAtI hai / isakA raktacitra ghAtaka raktakSaya ke raktacitra ke samAna hI hotA hai / mAdhavakara ne saMgrahagrahaNI ke jo lakSaNa diye haiM ve sprU se bahuta kucha milate haiM antrakUjanamAlasyaM daurbalyaM sadanaM tathA / dravaM zItaM ghanaM snigdhaM sakaTIvedanaM zakRt // AmaM bahu sapacchilyaM sazabdaM mandavedanam / pakSAnmAsAddazAhAdvA nityaM vApyatha muJcati // divA prakopo bhavati rAtrau zAnti vrajecca yA / durvijJeyA duzcikitsyA cirakAlAnubandhinI // sA bhavedAmavAtena saMgrahagrahaNImatA // grahaNI janya raktakSaya ke sambandha meM harbarTa phreJca kA mata hai - Thus with gastric carcinoma after gastro-intestinal operations, and in sprue and allied diseases the anaemia is most often of post haemorrhagic or iron-deficiency type with low colour index but occasionally it is typical of a deficiency of the haemopoitic principle with a high colour index and large cells and sometimes it presents a picture which is a mixture of the two the colour index being low but the cell diamater increased. ki AmAzayika karkaTa meM AmAzayAntrika zastrakarmoparAnta tathA grahaNI aura anya sambandhita rogoM meM raktakSaya kA svarUpa bahudhA raktasrAvottarakAlIna yA ayasAbhAvI rahatA hai jisameM raMgadezanA 1 se nIce pAI jAtI hai / para prAyaH raktakSaya kA citra raktotpattikara tatva ke abhAva se hone vAle raktakSaya ke samAna dekhA jAtA hai| jisameM raMgadezanA 1 se Upara ho aura bRhadraktakozA pracuratA se pAye jAte haiM / kabhI kabhI ina donoM prakAroM kA mizrarUpa bhI dekhane meM AtA hai jaba raMgadezanA 5 se kama tathA rudhirANu kA AkAra bRhad milatA hai / yadyapi donoM prakAra ke raktakSaya spU meM milate haiM para hameM yahA~ paramavarNika bRhaskAyANvika raktakSaya kI dRSTi se pramukhatayA vicAra karanA hai / jaba yaha raktakSaya yahA~ milatA hai to usakA raktacitra tathA ghAtaka raktakSayajanya raktacitra karIba karIba eka sA hotA hai donoM meM antara karanA bahuta kaThina par3atA hai / raktakSaya bRhatkAyANvika ( macrocytic ) hotA hai tathA asthimajja kI pratikriyA bRhadraktaruhIya ( megaloblastic ) hotI hai / grahaNI yA saMgrahagrahaNI meM antra kI zleSmalakalA patalI par3atI jAtI hai tathA apuSTa hone lagatI hai aura yaha apuSTi barAbara bar3hatI calI jAtI hai yahA~ taka ki an kA adhicchada bilakula naSTa ho jAtA hai| jisake pariNAmasvarUpa raktotpattikara tasva ke pradUSaNa kA kArya jo mukhya hai itanA ghaTa jAtA hai ki isa tatva kA eka cirakAlIna abhAva anubhava meM Ane lagatA hai isakA pariNAma asthimajjA para vahI hotA hai jo ghAtaka yA mArAtmaka raktakSaya meM dekhA jAtA hai / For Private and Personal Use Only

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rudhira vaikArikI 603 isa tatva ke donoM ghaTakoM kI kamI yA unake yA isa tatva ke pracUSaNa ke abhAva ke kAraNa athavA yakRt meM saJcaya na ho sakane yA asthimajjA ke dvArA upayogakArI zakti ke abhAva se jo vividha raktakSaya A upasthita hote haiM unakA spaSTa jJAna saiki lIya nimna tAlikA se mila jAtA hai: - bAhyakAraka (AhAra) / uSNa kaTibandhIya poSaNika rakta kSayameM isakA abhAva ho jAtA hai| takSayAntaka yA rakkotpattikara tatva / ghAtaka raktakSaya meM yA AmAzayocchedakarma ke pazcAt isakA abhAva ho jAtA hai| AbhyantarakAraka(AmAzaya) AntradvArA pracUSaNa--> snehayukta atIsAra, jIrNa grahaNI, Antra meM hrasvaparipatha ( short circuit in bowel) faraa dvinAlazirakRmi ( diphyllobothrium latum) ke upasargoM meM abhAva ho jAtA hai| yakRt meM saJciti---> yakRddAlyutkarSa meM abhAva ho jAtA hai| asthimajjAdvArA upayoga- amajjakIya raktakSaya meM isakA upayoga banda ho jAtA hai| ataH spaSTa hai ki grahaNI meM raktakSaya kA kAraNa Antrika zlaiSmikakalA kI apuSTi ke pariNAmasvarUpa utpanna paristhiti meM raktotpattikara tatva ke pracUSaNa kA abhAva aura usake kAraNa uttarottara isa dravya kA asthimajjA ke lie abhAva hone se raktacitra meM ghAtaka raktakSaya ke sAdRzya kA honA hotA hai| isameM raMgadezanA 1 se Upara calI jAtI hai| rakta meM jo lAlakaNa dekhe jAte haiM unameM aneka bRhadraktakozA (maigAlo sAiTasa) hote haiM jinakI AkRti tathA rUpa meM vikRti hone ke kAraNa asamatotkarSa (anisocytosis) tathA virUpotkarSa (poikilocytosis) pAI jAtI hai| prAisajonsavakra bhI isameM ghAtaka raktakSaya jaisA hI hotA hai| sAtha meM bahuvarNatA ( polychromasia ) kSArapriya sidhmana ( basophilic stippling ) tathA kabhIkabhI RjuruhoM kI upasthiti dekhI jA sakatI hai| For Private and Personal Use Only

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604 vikRtivijJAna . caraka ne jo vividha grahaNiyoM meM hRtpIDA, kArya, daurbalya, balakSaya, Alasya, timira, karNasvana Adi lakSaNa ginAe haiM ve sabhI isI viziSTa raktakSaya ke kAraNa hote haiN| mRtyUttara parIkSA karane para isa kArya kA pramANa yahA~ taka milA hai ki peziyoM saba snehavirahita aura patalI, hRdaya kA AkAra choTA, audarika aMgoM ke AkAra ghaTe hue tathA mahAsrota bhI atyadhika apuSTa milA hai| anya bRhatkAyANvika raktakSayoM kA kAraNa AhAra meM bAhyakAraka kI kamI bhI dekhI jAtI hai jisake vinA raktotpattikara (raktakSayAntaka ) tatva kA nirmANa hI nahIM hotaa| (3) parNikAmlAbhAva (pholika esiDa kI kamI)-viTAmIna bI kampleksa parivAra kA eka sadasya parNikAmla patrikAmla yA pholika esiDa bhI hai| isa amla kI jaba kabhI kisI prayogika jantu meM kamI kara dI jAtI hai taba bRhatkAyANvika raktakSaya kI utpatti ho jAtI hai, sAtha hI kaNakozApakarSa ( granulocytopenia ) bhI ho jAtI hai| antra ke daNDANuoM ke dvArA yaha amla Antra meM nirmANa kiyA jAtA hai| yadi isa daNDANvika kriyA ko rokanA ho to saksInila salphAthiyAz2ola khilAnA Avazyaka hai / isa dravya ke khilAne se pholika esiDa kA prakRta nirmANakArya ruka jAtA hai jo bRhatkAyANvika raktakSaya ko utpanna kara detA hai| isI AdhAra para Ajakala raktakSayarodha meM pholika esiDa kA bhI mahattva bahuta adhika bar3ha gayA hai| isake upayoga se raktakSaya meM Azcaryajanaka lAbha dekhane meM AyA hai / / (4) vistRta dvinAlazirakRmi janya raktakSaya (anaemia due to diphyllobothrium latum ) bhI bRhatkAyANvika tathA paramavarNika hI hotA hai / dvinAlazira yaha eka parAzrayI kRmi hai jo machalI khAne vAloM meM milatA hai| ina matsyabhakSiyoM meM se thor3e se logoM meM aisA raktakSaya ho jAtA hai jo ghAtaka raktakSaya ke sAtha pUrNa samAnatA rakhatA hai| ina rogiyoM meM se 80 pratizata meM anIrodatA ( achlorhy. dria) yA anamlatA upasthita rahatI hai| isa raktakSaya ko do prakAra se dUra kiyA jAtA hai| inameM eka hai A~toM se kRmi kA niSkAsana aura dUsarA hai yakRccikitsA kA Arambha karake raktotpattikara tatva ko zarIra meM phuNcaanaa| kRmi ke naSTa ho jAne se jahA~ roga svataH dUra ho jAtA hai vahA~ kRmi ke rahate hue kevala yakRt kA cikitsAtmaka prayoga bhI raktakSaya ko dUra kara detA hai| isase bvAyaDa ko yaha zaka bar3ha gayA hai ki kRmi ke atirikta koI anya kAraka isa raktakSaya kA kartA hai tathA yaha kAraka raktakSayAntaka tatva kA sagotrIya hI hotA hai| isa sambandha meM eka mahattva kI bAta bhI smaraNa rakhanI caahie| yaha yaha ki jApAna meM machalI manuSyoM kA mukhya AhAra hone ke kAraNa matsya-dvinAlazirIya paTTa kRmi ( tapeworm) kA upasarga bahudhA dekhane meM AtA hai para vahA~ para yaha raktakSaya bilkula bhI nahIM pAyA jAtA / parantu phinalaiNDa meM jahA~ ke nivAsI bhI matsyabhakSI hote haiM yaha paTTa kRmi aura usake sAtha For Private and Personal Use Only

Page #995
rudhira vaikArikI 605 raktakSaya bahuta adhika milatA hai / ise vikRtivettAoMne viziSTa jAtijanya kAraNa ke antargata mAnA hai / kucha bhI ho yaha satya hai ki paTTa kRmi eka sthAna para raktakSaya utpanna karatA hai aura dUsare sthAna para nahIM / ( 5 ) sagarbhAvasthA meM bRhatkAyANvika raktakSaya ke bhI darzana ho sakate haiM aura bhAratavarSa meM sUkSma kAyANvika raktakSaya utanA dekhane meM nahIM AtA jitanA garbhiNI striyoM meM isa raktakSaya ke darzana ho jAyA karate haiM / ghAtaka raktakSaya se isakA citra bhale prakAra milatA hai / eka mahattva kI bAta jo isake sambandha meM samajha lenI cAhie vaha yaha hai ki bahudhA yaha raktakSaya garbhAvasthA kI samApti ke sAtha samApta ho jAtA hai aura isakI punarutpatti dUsarI sagarbhAvasthA ke abhAva meM prAyaH nahIM hotI / jaba ki vAstavika ghAtaka raktakSaya meM vaha pravRtti avazya pAI jAtI hai / vidvAnoM kA kathana to yaha hai ki yaha roga bhI unhIM kAraNoM hotA hai jinase vAstavika ghAtaka raktakSaya huA karatA hai / kucha vidvAnoM ke mata se prasavottarakAla meM bhI yaha raktakSaya banA raha sakatA hai tathA yakRccikitsA viTAmIna bI kamplaiksa kA upayoga aura lohe ke prayoga se ThIka ho jAyA karatA hai / 1 jisake pariNAma - ( 6 ) AmAzayoccheda ( gastrectomy ) janya raktakSaya - AmAzaya ke amlajanaka bhAga kA uccheda kara dene se bhI paramavarNika bRhatkAyANvika raktakSaya kI utpatti sambhava ho sakatI hai / isakA kAraNa spaSTa hai / raktotpattikAraka tatva ke nirmANa meM jo AbhyantarakAraka bhAga letA hai usakA janma hI AmAzaya meM hotA hai / AmAzaya ke abhAva meM isa kAraka kA bhI abhAva ho jAtA hai svarUpa raktotpattikara tatva kA nirmANa ruka jAtA hai jo anta meM prabhAva DAlakara ghAtaka raktakSaya ke samAna raktakSaya utpanna kara detA hai / isI prakAra AmAzayika karkaTa hone para anIrodatA hokara ghAtaka raktakSaya jaisA raktakSaya bana jAtA hai tathA ghAtaka raktakSaya evaM AmAzayika karkaTa meM aba vidvAn sambandha bhI jor3ane lage haiM / asthi-majjA para isI prakAra yakRt meM vikAra hone se raktotpattikara tatva kA saMcaya yakRt meM nahIM ho pAtA aura zarIra meM usakI kamI barAbara anubhava meM Ane lagatI hai aura paramavarNika bRhatkAyANvika raktakSaya kI utpatti meM sahAyaka hotI hai / ( kha ) ve raktakSaya jinameM raktotpattikAraka lohAdi dravyoM kA abhAva rahatA hai| upazayAtmaka cikitsA se jisameM lAbha ho vaha raktakSaya-kSetra yahA~ prakaTa kiyA gayA hai / arthAt lohe kI kamI se hone vAlA vaha raktakSaya hai jo lohe ke sevana se ThIka ho jAya yA anya kisI tatva kI kamI se hone vAlA raktakSaya jaba usa tatva kI prApti karake ThIka ho jAya vaha bhI isI ke antargata A sakatA hai usa dRSTi se ghAtaka raktakSaya bhI upazayAtmaka hai kyoMki vaha raktakSayAntaka tatva ke saMgrahasthala yakRt ke prayoga se zAnta hotA hai para usakA varNana ho cukA hai aura usake vividha For Private and Personal Use Only

Page #996
606 vikRtivijJAna lakSaNoM ko kahA jA cukA hai ataH isa sthala para lauhatAmrAdi ke abhAva se hone vAle raktakSayoM para prakAza DAlA jA rahA hai| pANDuroga kA varNana karate samaya pANDutvenopalakSito rogaH pANDurogaH aisA madhukozakAra ne vyakta kiyA hai| jisameM doSAH raktaM pradUSya tvacaM pANDuratAM nayanti vahI pANDuroga hai / AyurvedajJoM ne pANDuroga kA jo varNana kiyA hai use dekhakara tathA usakI cikitsA meM lohabhasma, maNDUrabhasma, kAntaloha, tIkSNaloha, tAmrabhasma Adi kA pracura mAtrA meM upayoga likhA hai jo prakaTa karatA hai ki isI varga ke raktakSaya ko pANDuroga se sambodhita kiyA gayA hai / raktakSayAntaka dravyAbhAvajanita raktakSaya kA ullekha pANDuroga ke sAtha nahIM hI dikhatA / raktapitta prakaraNa meM yakRdbhakSaNa kA suzruta vA vAgbhaTIya udAharaNa ghAtaka raktakSaya ke lie prayukta yakRt se bhinna hai usakI kalpanA vahA~ mUrtarUpa dhAraNa nahIM kara sakI hai| sambhava hai prAcIna kAla meM ghAtaka raktakSaya kI utpatti kA avasara hI na AyA ho| athavA isa raktakSaya ko ve vividha hare padArthoM jar3I bUTiyoM ke svarasa ke sAtha lohAdi ke prayoga se ThIka kara lete ho aura unheM raktakSayAntaka dravya kI kamI ko samajhane kA yA usakI khoja kA avasara hI na milA ho / kyoMki pANDuratvacA kaha denA eka upalakSaNa mAtra hai rUkSakRSNAruNAbhatA ( vAtika), pItAbhatA (paittika ) aura zuklatA (kaphaja ) ke dvArA unhoMne pANDu ke vargIkaraNa meM kisa-kisa kA grahaNa na kiyA hogA ise Aja kahanA AsAna nahIM hai| isa varga ke raktakSaya meM mukhya lakSaNa zoNavartuli ( hImoglobIna ) kI alpatA vA hInatA kA pAyA jAnA hai / rakta ke lAlakaNoM kI saMkhyA isa roga meM kama na hokara unake varNa meM phIkApana pAyA jAnA vizeSa mahattva kI bAta hai| zoNavartali kI kamI hone se lAlakaNa avazya upavarNika (phIke) par3a jAte haiN| raMgadezanA ( colour index ) 0.5 yA usase bhI nIce calI jAtA hai| jaba roga sAdhAraNa rahatA hai taba unake AkAra meM vizeSa parivartana nahIM bhI milatA para Age calakara lAla hokara choTe hone lagate haiM aura isIlie laghukAyANvika zabda kA prayoga kiyA jAtA hai| yaha to rahI rakta ke lAlakaNoM kI avasthA / rakta ke zvetakaNoM meM isa roga meM kAI mahattvapUrNa parivartana na dekhA jAne para bhI unakI saMkhyA meM kamI jise hamane sitakozApakarSa ( leucopenia) kaha kara pukArA hai, dekhI jAsakatI hai| isa raktakSaya kA mukhya kAraNa jaisA ki pahale batAyA jA cukA hai lohe kI kamI hai| isa kamI ke nimnAMkita kAraNa ho sakate hai: 1. atyadhika rktnaash| 2. AhAra meM lohayukta padArthoM kA sarvathA abhAva / 3. lohalaulya arthAt zarIra ko lohe kI itanI AvazyakatA par3e ki use pacAyA tathA pracUSita na kiyA jA sakatA ho| inameM atyadhika raktanAza ke dvArA hone vAlI lohe kI kamI pramukha hai| yaha sambhava hai ki kisI vyakti ke zarIra se rakta ke lohAMza kA bahuta bhAga naSTa ho jAya For Private and Personal Use Only

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afar vaikArikI aura zarIrastha lohasaJcaya sthaloM se vaha unakI pUrti bhI kara le para bhAge yadi aisA raktanAza huA to phira usakI pUrti na ho sakegI aura lohAbhAvI raktakSaya avazya upasthita ho jAvegA / raktasrAva kA nirantara honA lohAbhAvI raktakSaya kA jisa prakAra janaka hai usI prakAra asRgdara yA atyArtava bhI striyoM meM isa roga kA kartA hotA hai / AhAra meM lohe kI nirantara kamI bhI isa raktakSaya ko utpanna kara zizu prAyaH jo kevala dugdha kA hI sevana karate haiM aura kyoMki dUdha meM lohe bahuta kama rahatI hai prAyaH isa raktakSaya ke zikAra ho jAte haiM / jinake zarIra meM saJcita lohe kI AvazyakatA garbha ke nirmANa meM sakatI hai I kI mAtrA athavA garbhiNI striyAM 207 paryApta hotI hai aura tadanukUla mAtrA meM ve usako apane AhAra meM prApta karane meM asamartha rahatI haiM isa kAraNa bhI yaha raktakSaya unameM dekhA jAyA karatA hai| mAtAoM meM jo apanI santAna ko dUdha pilAtI haiM athavA garbhiNI striyoM meM isI kAraNa lohalaulya khUba hotA hai / do varSa taka zizu ko bhI laulya rahA karatA hai / usakI pUrti na hone para lohAbhAvI raktakSaya ke lakSaNa utpanna ho jAte haiM / mAtRstanya meM lohe kI mAtrA ThIka rahane se mAtRdugdhapAyI zizuoM meM lohAbhAvI raktakSaya na milakara unakI mAtAoM meM dekhA jAyA karatA hai tathA botalapAyI zizuoM ke dugdha meM lohe kA atyanta abhAva rahane se ina zizuoM meM hI raktakSaya ke darzana hote haiM / isI kAraNa upavarNika laghukAyANvika raktakSaya ( hypochromic microcytic anaemia ) sagarbhA striyoM, dhAyoM aura Upara kA dUdha pIne vAle baccoM meM bahudhA dekhA jAtA hai / AhAra meM lohayukta padArthoM kA sarvathA abhAva kaI kAraNoM se ho sakatA hai jinameM eka daridratA hai, dUsarA bhojana ke padArthoM meM saloha dravyoM ko na lenA hai / tIsarA zarIra ke andara lohe kA ThIka se pracUSaNa na honA hai / AmAzaya aura annapraNAlI ke rogoM meM bhI lohe kA upayoga ucita rUpa meM nahIM ho pAtA aura lohAbhAvI upavarNika sUkSmakAyANvika raktakSaya ke darzana ho jAyA karate haiM / For Private and Personal Use Only prAthamika upavarNika raktakSaya ( Primary hypochromic anaemia ) avasthA meM hotA hai / pradhAnatayA yaha eka strIroga hai jo 35 se 50 varSa kI sagarbhAvasthA meM yA sagarbhAvasthA ke bAda yaha Arambha hotA hai calatA hai | isake lakSaNa ghAtaka raktakSaya ke sAtha milate haiM hai / isameM tudhAnAza, apaca, vibandha, mAsikadharma ke upadrava, ziraHzUla, pANDuratA, daurbalya tathA raktakSaya ke anya lakSaNa milate haiM / isa roga meM jihvA paka jAtI hai| camakadAra ( glazed ) ho jAtI hai aura nigalane meM bahuta dikkata par3atI hai ( ina lakSaNoM ko plUmara. vinsana sahalakSaNa (Plummer Vinson syndrome kahate haiM ) / AmAzayika rasa meM amla alpatA ho jAne se anIrodatA ( achlorhydria ) ho jAtI hai / kabhI kabhI plIhodara bhI milatA hai / nakha bahuta bhidura ho jAte haiM | khuvAkRtika nakha ( cammacanumA nAkhUna - spoon-shaped nails ) isa roga kI vizeSatA hai / ise suSiranakhatA - koilonychia - kahate haiM / yaha suSira - aura kAphI dina taka para hotA yaha upavarNika

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608 vikRtivijJAna nakhatA ghAtaka raktakSaya meM bilkula bhI nahIM dekhI jAtI / bhujAoM aura TA~goM meM jhunajhunI ( parasthesia) milatI hai| nakhabhiduratA-suSiranakhatA tathA jihvA kI zleSmalakalA kI apuSTi isa roga ke pramukha lakSaNa haiN| AhAra meM doSa yA Antra dvArA lohe kA ThIka ThIka pracUSaNa na hone ke kAraNa yaha roga hotA hai isI kAraNa lohe kA pracura parimANa meM upayoga karane se isameM bar3A lAbha hotA hai / sagarbhatA tathA atyArtava se yaha bar3hatA hai| lakSaNoM meM sAdRzya hone para bhI raktajanya parivartana isa roga meM ghAtaka raktakSaya ke bilkula viparIta hote haiN| ghAtaka raktakSaya jahA~ parama varNika kahA gayA hai yaha avarNika ( achromic ) hai / ghAtaka raktakSaya meM asthi majjA bRhadraktaruhIya pratikriyA karatI hai para yahA~ vaha RjuruhIya pratikriyA kiyA karatI hai / rakta ke lAlakaNa na kevala saMkhyA meM hI ghaTa jAte haiM api tu zoNavartuli kI mAtrA to unameM aura bhI adhika kama ho jAtI hai| isI zoNavartuli ke abhAva se raMgadezanA nimna aura upavarNatA yA avarNatA adhika spaSTa ho jAtI hai| lAlakaNoM kA vyAsa unake prakRta vyAsa se ghaTA huA hone se ise sUcamakAyANvika raktakSaya nAma diyA jAtA hai| isa roga meM raMgadezanA 0.4 se 0.5 taka milatA hai| lAlakaNa kI AkRti tathA rUpa meM pharka ho jAtA hai ve pANDura (pale ) ho jAte haiM jo thor3e bar3e hote haiM unake bhItara kendra araJjita hotA hai tathA cAroM ora kozArasa raMjita ho jAtA hai| lAlakaNoM kI sUkSmatA ke bAre meM Upara likhA jA cukA hai ve prAyaH 6.2 se 6.7 aNuma ke vyAsa vAle hote haiN| eka lAlakaNa kA ausata Ayatana 78 kyUbika mAikraunsa tathA ausata zoNavartuli saMkendraNa 32 pratizata se nIce aura prAyaH 27 pratizata hotA hai| isa roga meM zvetakaNa aura raktabimbANu kI saMkhyA prakRta huA karatI hai jo kabhI kabhI ghaTa bhI jAyA karatI hai| isa roga meM zoNAMzana ( haemolysis ) nahIM milatA jaisA ki ghAtaka raktakSaya meM dekhA jAyA karatA hai| sitakozApakarSa hone para bhI thor3A lasIkozotkarSa (lymphocytosis) mila jAtA hai| bimbANuoM kI kamI se bimbANvapakarSa ( thrombcy topenia) hotA huA kabhI kabhI milatA hai| ___Akhira isa roga kA kyA kAraNa hai ? yaha prazna uThatA hai| usakA bahuta sundara uttara bvAyaDa ne diyA hai ki isa roga kA mukhya kAraNa zarIra meM lohe kI kamI hai jisake kAraNa 1. Rjuruha ( normoblasts ) vaha zakti nahIM pAte jisase unakA pragalbhana ( maturation ) ho jAya aura ve lAla kaNa meM pariNata ho ske| isalie ve zIghratA se lAla kaNoM meM pariNata na hokara RjuruhoM ke rUpa meM hI rakta meM bahudhA dekhane meM Ate haiN| 2. RjuruhoM meM bhI zoNa vartuli kA aNu ( molecule of the haemoglobin ) bhI ThIka se nirmita nahIM rhtaa| isake pariNAmasvarUpa asthimajjA RjuruhoM se For Private and Personal Use Only

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rudhira vaikArikI 1. bhara jAtI hai tathA lAla kaNoM kA ThIka-ThIka nirmANa nahIM ho pAtA / jo lAla kaNa banate bhI haiM unameM zoNa vartuli kA bahuta abhAva pAyA jAtA hai / rakta ke isa citra kA kAraNa lohA hai / lohA AmAzayika amla meM ghulanazIla hai| vaha vahAM ghulatA hai ghulakara rakta meM hokara asthimajjA taka jAtA hai / isakA upayoga asthimajjA kiyA karatI hai tathA RjurUhoM ko rudhirANuoM meM parivartita karatI rahatI hai / astu yadi AmAzaya meM agni kA abhAva hai arthAt anIrodatA yA anamlatA hai to lohe kA vilayana nahIM ho skegaa| eka bAta aura samajha lenI cAhie aura vaha yaha ki jaba svastha zarIra meM kula 4 mASA lohA rahatA hai phira itanI bar3I mAtrAoM meM lohe ke prayoga kA nirdeza kyoM kiyA jAtA hai ? usakA kAraNa yaha diyA jAtA hai ki lohe kI bar3I-bar3I mAtrAoM kI AmAzaya meM upasthiti usake gholane ke lie Amlika pratikriyA ko bahuta ugrakara detI hai aura paryApta mAtrA meM lohA zarIra meM ghula kara pahuMca jAtA hai / lohe ke sAtha thor3A tAmra bhI yadi cikitsA ke lie milA liyA jAve to upavarNika sUkSma kAyANvika raktakSaya meM usakA utanA hI prabhAva par3atA hai jitanA ki paramavarNika sthUla kAyANvika raktakSaya meM yakRccikitsA ( liver therapy ) kA par3atA hai / anya dhAtuoM ke upayoga kA bhI lAbhadAyaka AbhAsa milane lagA hai / uparyukta raktakSaya se pIDita puruSa kI Arthika sthiti kA avazya patA lagAnA caahie| strI ho to usake mAsika dharma athavA sagarbhatA ke sambandha meM vicAra kara lauhatAmra yogoM kA upayoga karane se isa raktakSaya se pUrNa rakSA ho sakatI hai / plUmara vinsana sahalakSaNa ( Plummer Vinson syndrome ) -- yaha eka lakSaNa samUha hai jisameM nigaraNa kRcchratA ( dysphagia ) ke sAtha-sAtha upavarNika sUkSma kAyANvika raktakSaya pAyA jAtA hai / jihvA aura grasanI kSetra kA adhicchada sapATa ( bald ) aura masRNa ( smooth ) yA rUkSa ho jAtA hai / sAtha meM anIrodatA yA agnimAndya rahatA hai / isa saha lakSaNa ke sAtha upavarNika raktakSaya adhika para parama varNika bhI dekhA jA sakatA hai / yaha prauDhA striyoM meM hone vAlA roga hai / mukha koNa para vidAra ( cracks ) milate haiM jinameM zUla hotA rahatA hai| plIhA kI vRddhi tathA nakhoM kI bhiduratA pAI jAtI hai / isa saha lakSaNa ke uparAnta upagrasanikIya kSetra meM karkaTa kI utpatti hone kI bahuta sambhAvanA rahatI hai / kabhI-kabhI to karkaTa kI pUrvAvasthA yaha sahalakSaNa hI le letA hai / loha prayoga isameM bahuta lAbhakArI siddha hotA hai / haridutkarSa (Chlorosis ) isa roga meM haripIta varNa kA rogI ho jAtA hai / isa lie ise hamane yaha saMjJA pradAna kI hai| isakA eka nAma grInasikanesa kA artha bhI harA roga hai / yaha roga dhIredhIre samApta ho rahA hai| yaha roga kevala striyoM meM adhika dekhA jAtA hai / yaha yuvatiyoM kA roga hai aura 15 se 25 varSa kI Ayu taka hotA hai / yaha lohe ke abhAva se utpanna hone vAlA roga hai jo AhAra meM lohe kI kamI se, mAsika dharma kAla meM Artava ke For Private and Personal Use Only

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610 vikRtivijJAna nAvAdhikya tathA anya kAraNoM se utpanna raktAbhAva se athavA vRddhiMgata tAruNyakAlIna lohe ke lie adhika mAMga bar3hane ke phalasvarUpa lohAbhAva kI sambhAvanA rahatI hai| aura ye hI kAraNa isa hare roga ke karttA bhI hote haiM / bvAyaDa kA kathana hai ki lar3akiyoM ke svAbhAvikatayA hone vAle parivartanoM kI atizayatA ( exaggeration ) kA hI paryAya haridutkarSa hai jo 10% lar3akiyoM meM bahudhA huA karate haiM / pAzcAtya vidvAn isa roga ke kramika hAsa kA kAraNa striyoM ke ArAmatalaba jIvana kA parityAga jo pazcima meM isa samaya striyoM kI sakriyatA se pramANita hotA hai, pAyA jAtA hai / aba isa roga kA eka saumya rUpa dRSTigocara hotA hai jise loha prayoga se saralatayA sudhArA jA sakatA hai / yaha roga yuddha pUrva kAla meM jahA~ hAsa ko prApta ho rahA thA vahA~ 1939 se 45 taka ke yuddha kAla meM punaH isakI vRddhi kA bhI jJAna milatA hai / isa roga meM rogI kI tvacA pItAbha yA svalpa haritAbhapIta ho jAtI hai / rakta rasa meM vRddhi hone ke kAraNa rakta kA Ayatana paryApta bar3ha jAtA hai / zoNa vartuli pracuratA ghaTa jAtI hai / vaha 40% taka ghaTa sakatI hai / kabhI-kabhI vaha 20% taka jA pahuMcatI hai| rakta ke lAu karNo kI saMkhyA vinA ghaTe hI yaha parivartana hone ke kAraNa raMgadezanA bahuta kama dekhI jAtI hai| zoNa vartuli kI kamI ke kAraNa zoNa vartula virahita valayAkAra lAlakaNa ( annular red corpuscles) bahudhA milate haiN| vaise thor3I sI unameM virUpatA tathA asamatA bhI mila sakatI hai / rakta ke varNa dravya kI kamI ke kAraNa daurbalya, parizrama para zvAsa kI vRddhi tathA hRdgati vaiSamya Adi lakSaNa ( cardiac arrhthmia ) pAye jAte haiM / hRdaya kI dhukadhukI bhI bar3ha jAtI hai / isa roga meM vibandha ( constipation ) milatA hai jisake sAtha parama nIrodatA ( hyperchlorhydria ) pAI jA sakatI hai jo Age AmAzayika vraNa meM pariNata ho sakatI hai / yaha roga sAdhya hai / sirAjanya ghanAsrotkarSa hone ke kAraNa hI mRtyu ho sakatI hai| audarika roga (Coeliac disease ), anazana aura miksIDimA meM bhI lohA bhAvI raktakSaya utpanna hotA huA dekhA jAtA hai / ( 2 ) asthimajjakIya kriyA kA avasAda (Depression of Bone-Marrow Activity) anaghaTita yA anabhighaTya raktakSaya ( Aplatic Anaemia ) asthimajjA kI puSTi ( aplasia ) ke sAtha yaha raktakSaya bahudhA dekhane meM AtA hai aisA vidvAnoM kA mata rahA hai / para rahoDsa, milara, thaumpasana tathA anyoM ke mata meM apuSTi na hokara paramapuSTi yA paramacaya ke kAraNa yaha raktakSaya utpanna hotA hai / 13 rugNoM meM apuSTi yA acaya ( aplasia ) ke kAraNa thompasana ko kevala 1 hI rogI milA / acaya yA apuSTi ke atirikta Arambhika avibhinita avasthA meM pragalbhana kA abhAva ( failure of maturation at an early undifferentiated For Private and Personal Use Only

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rudhira vaikArikI 611 stage ) vaha mahatvapUrNa parivartana hai jo isa roga meM vizeSatayA pAyA jAtA hai jisake kAraNa asthimajjA meM apuSTa apragalbha kozAoM kI bharamAra ho jAtI hai jo raktapravAha jAne se roka diye jAte haiN| yaha avasthA akaNakAyANUtkarSa (agranulocytosis) kI Arambhika avasthA ke samAna hI hotI hai aura ho sakatA hai ki donoM kI utpatti meM koI eka samAna kAraNa hI upasthita hotA ho| isa roga meM asthi kI lAla majA meM bahuta hI thor3e kozA dikhalAI par3ate haiM / rakta ke lAlakaNa, majjakAyANu ( myelocytes ) tathA bRhannyaSTikozA ( megacaryocytes ) sabhI vilupta ho jAte haiM / yakRt, vRkkAdi meM ugra raktakSaya ke pramANasvarUpa snaihika vihAsa ( fatty degeneration ) pAyA jAtA hai / isa roga meM zoNAMzika kriyA ( haemolytic activity ) kA koI vizeSa pramANa nahIM milatA hai para yakRt tathA asthimajjA meM paryApta zoNAyasyutkarSa ( haemosiderosis ) mila sakatA hai / vvAyaDa ke zabdoM meM jaba blaDphaikTarI apanA kArya banda kara detI hai taba anaghaTita raktakSaya kI utpatti hotI hai / asthimajjA dvArA kAmabandI nimnalikhita kAraNoM se sambhava hai: :--- 1. kaI prakAra kI viSAkta oSadhiyA~ asthimajjA para ghAtaka prabhAva DAla sakatI haiM jinameM dhUpa ( benzol ) tathA tribhUyavirAlava ( trinitrotoluol ) mukhya haiM / ArsInobeMz2ola, DAinAiTrophInola, salphonemAiDsa tathA svarNa rajata aura pArada ke yoga tathA sIsa ( lead ) bhI ise utpanna kara sakate haiM / 2. vikiraNa dvArA - tejAtu aura kSa-razmiyA~ / 3. kaI aupasargika rogoM kI vidhiyA~ ( toxins ) jaise-- pUyA ( sepsis ) tathA Antrika jvara (typhoid fever ) / 4. ghAtaka raktakSaya kI antima avasthA meM jaba acaya kA sthAna paramacaya le letA hai aura parizrAnta asthimajjA yuddha ekadama banda kara detI hai yadi isa samaya asthiyoM ko dekhA jAya to unakI guhAe~ sneha (phaiTa) se bharI huI pAI jAtI haiM jo eka vismayakAraka sthiti hotI hai / uparokta cAroM kAraNoM se honevAlA anaghaTita raktakSaya dvitIyaka yA uttarajAta kahalAtA hai / para usake atirikta prathamajAta raktakSaya bhI hotA hai jisakI utpatti ke kAraNoM para prakAza DAlanA sambhava nahIM hotA use ajJAta kAraNajanya (idiopathic) kahA jA sakatA hai / yaha roga yadyapi bAlakoM meM bhI mila sakatA hai / para mukhyatayA striyoM kA roga hai jo unake tAruNyakAla ( 15 se 30 varSa ) meM bahudhA dekhA jAtA hai / puruSoM meM yaha kama dekhane meM AtA hai / yaha roga bahuta hI umra hotA hai / isase pIDita prANI kucha saptAhoM meM hI asAra saMsAra se bidA lene ko bAdhya hote haiM / kabhI-kabhI yaha mahInoM taka raha sakatA hai / gambhIra raktakSaya ke atirikta raktasrAva aura nIlohika lakSaNa ( purpuric manifestations ) bhI milane lagate haiM aura taba tIvra raktastrAvI nIlohA ( acute For Private and Personal Use Only

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12 vikRtivijJAna purpura haemorrhagica ) se ise pRthak karanA lagabhaga asambhava yA ati kaThina ho jAtA hai / ghAtaka raktakSaya ( paranIzasa enImiyA ) meM raktastrAvI jo lakSaNa dekhe jAte haiM ve yahA~ nahIM milate arthAt svacA kA upakAmalika varNa ( subicteric tinge ) nahIM milatA rakta kI pittarakti ( bilirubin ) meM vRddhi nahIM hotI / tathA mUtra meM mUtrapitti ( urobilin ) anupasthita yA atyalpa pAI jAtI hai tathA suSumnA ke parivartana bhI nahIM milate / yaha nahIM bhUlanA cAhie ki isa raktakSaya meM asthimajjA rakta nirmANakArI tonoM tayva---raktakaNasaMjanaka ( erythropoietic ), zvekaNasaMjanaka ( leucopoietic ) tathA bimbANujanaka ( megacaryocytic ) hI apanA kArya banda kara dete haiM / para raktakaNasaMjanana kI utpatti meM bAdhA ke lie hI anabhighaTya raktakSaya zabda kA adhikatara prayoga hotA hai / akaNakAyAtkarSa zabda sitakozIyasaMjanana tathA mArAtmaka bimbANva - pakarSa ( malignant thrombocytopenia ) zabda bimbANusaMjanana kI kamI ke lie prayukta hotA hai| kyoMki isa roga meM bimbANuoM kI kamI ho jAtI hai ataH raktasrAva kI pravRtti barAbara pAI jAtI hai / sitakozApakarSa hone se vinAzaka vraNana necrotic ulceration ) mukha tathA antra meM pAye jAyA karate haiM / yakRtplIhA tathA lasaka granthiyoM meM mahattva kA parivartana nahIM hotA phira bhI rudhirANuoM kI TUTa phrUTa ke kAraNa zoNAyasyutkarSa ( haemosiderosis ) pAyA jAtA hai / plIhA tathA lasaka granthiyA~ isa roga meM kabhI phUlatI nahIM hai / I isa raktakSaya ke raktacitra meM saba prakAra ke kozAoM kI saMkhyA kA ghaTate cale jAnA mukhyatayA dekhA jAtA hai| lAlakaNa, zvetakaNa, bimbANu saba kama ho jAte haiM / yadyapi isa roga meM parimANAtmaka yA iyattAtmaka ( quantitative ) parivartana paryApta hotA hai para guNAtmaka yA tattAtmaka ( qualitative) parivartana nahIM hotA / isa kAraNa rakta ke lAlakarNIoM kI saMkhyA bIsa lAkha se dasa lAkha taka pAI jAne para bhI raMgadezanA 1 ke lagabhaga hI rahatI hai / phAnaDenabardhIya pratikriyA nAstyAtmaka hotI hai / zvetakaNa 3 se 4 hajAra pratighana milImITara pAye jAte haiM / mRtyu ke samaya ve 2 hajAra se nIce cale jAte haiM bahrAkAriyoM kI ghaTotarI ke kAraNa sApekSalasIkozotkarSa ho jAtA hai / asama, vidrUpa lAlakaNa, bRhatkAyANu, sanyaSTikozA tathA jAlakita ( reticulated ) kozA ina vividha lakSaNoM kI upasthiti kisI bhI raktakSaya meM milanA sambhava hai jo isa bAta kA pramANa hai ki asthimajjA zarIra kI AvazyakatAoM kI pUrti jI-jAna se kara rahI hai para anaghaTita raktakSaya meM ye saba parivartana nahIM hI milte| isI kAraNa yahA~ lAlaka kA svarUpa svAbhAvika hotA hai aura raMgadezanA 1 ke AsapAsa rahA karatI hai / bimbANuoM ke ghaTane se nIlohA ( purpura ) ke lakSaNa milane lagate haiM, zleSmala kalAoM se raktasrAva hotA hai / raktasrAvakAla ( bleeding time ) vilambita ( delayed ) ho jAtA hai / yadyapi AtaMcikAla ( clotting time ) svAbhAvika rahatA hai yadyapi AtaMca sikur3a nahIM pAtA / bimbANyapakarSajanita raktasrAvI nIlohA For Private and Personal Use Only

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613 rudhira vaikArikI ( thrombocytopenic purpura haemorrhagica ) meM bhI yahI citra dekhA jAtA hai jaisA ki Upara hamane iGgita kiyA hai / isase aisA AbhAsa hotA hai ki ina donoM rogoM meM koI na koI sambandha avazya hogaa| jo kAraNa asthimajjA kI kAmabandI kakke anaghaTita raktakSaya kI utpatti karatA hai vahI jaba kevala bimbANuoM para AkramaNa karatA hai to raktasrAvI nolohA utpanna karatA hai aisA pratIta hotA hai| ___yaha roga yakRccikitsA se ThIka na hone ke kAraNa ghAtaka raktakSaya se alaga kiyA jA sakatA hai / asitaratIya sitaraktatA (aleukaemic leukaemia) aura isa roga meM bheda karanA kaThina hone para bhI usameM plIhA yakRt aura lasagranthiyA~ jahA~ phUla jAtI haiM vahA~ isameM ve apanI svAbhAvika AkRti ko nahIM chodd'tiiN| anaghaTita raktakSaya ke nimnarUpa aura bhI mila sakate haiM: 1. majakSayika raktakSaya ( Myelophthisic anaemia)-yaha uttarajAta anaghaTita yA acayika raktakSaya kA hI eka prakAra hai| isameM asthimajA kI raktajanaka jati arbudika vRddhi ke dvArA parivartita ho jAtI hai| yaha prAthamika aura uttarajAta donoM rUpa kA dekhA jAtA hai / yUiMga (ewing) ke arbuda yA majjArbuda (myeloma) meM yaha prAthamika hotA hai tathA vakSa, vRkka, avaTukA, aSThIlA tathA phuphphusa ke karkaTArbudoM meM uttarajAtarUpa meM dekhA jAtA hai| 2. sitaraktatA (lyUkImiyA) meM raktajanaka Uti, sitaraktIya Uti (leukaemic. tissue ) se bhara jAtI hai| 3. asthijAraThya ( osteosclerosis) nAmaka roga meM asthi kA sthUlana Arambha ho jAne se asthigatamajjA ke lie bahuta thor3A sthAna raha jAtA hai| isake kAraNa eka raktakSaya utpanna ho jAtA hai jise asthijAraThika raktakSaya (osteosclerotic anaemia) nAma diyA jAtA hai| ___4. sarakta asthimajjA meM karkaTotkarSa ( carcinomatosis ) hone para sitaraktaruhIya raktakSaya ( leuco-erethroblastic anaemia ) utpanna ho jAtA hai jisake kAraNa raktakSaya thor3A hone para bhI rakta meM sanyaSTi rudhirANu ( nucleated red cells ) tathA majakAyANu ( myelocytes ) pAye jAte haiN| yahA~ raktakSaya zoNAMzika hotA hai| bvAyaDa kA kathana hai ki uparokta ina avasthAoM meM aura kAraNavihIna vAstavika anaghaTita raktakSaya meM mahattvapUrNa antara yaha hotA hai ki uparokta avasthAoM meM vikRta asthimajjA ke atirikta zeSa asthimajjA meM usakA paramacaya ho jAtA hai jisake kAraNa raktapravAha meM apragalbha lAlakaNa (sanyaSTirakta kozA tathA jAlakita lAla kozA) tathA apragalbha zvetakAyANu ( majjakAyANu) pAye jAte haiM / raktacitra ghAtaka raktakSaya se pUrNatayA milatA julatA hotA hai| Age calakara jaba majjA adhikAMzataH pratisthApita ( replaced ) ho jAtI hai to raktacitra anaghaTita yA acayika raktakSaya kA ho jAtA hai| 77, 78 vi0 For Private and Personal Use Only

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614 vikRtivijJAna raktastrAva tathA tajjanya raktakSaya ( The Post-haemorrhagic Anaemias) isa varga meM ve saba avasthAe~ sammilita haiM jinameM vAhinI ke dvArA rakta kA bAhara jAnA aura usake uparAnta raktakSaya kA honA avazyambhAvI ghaTanA hotI hai| kisa kAraNa se vAhinI kSatigrasta huI usakA vicAra karanA utanA Avazyaka nahIM hotA jitanA raktasrAva aura usakA pratiphala raktakSaya / ve avasthAe~ jinameM raktasrAva hotA hai adholikhita mukhya haiM 1. abhighAtajaraktasrAva / 2. jIrNavraNoM se hone vAlA raktasrAva / 2. phuphphusa se hone vAlA yakSmAjanyaraktastrAva / 4. kRmiyoM dvArA utpanna raktasrAva / 5. zoNapriyatA ( haemoplilia) tathA 6. nIlohA (purpura) / raktasrAva ke kAraNa raktacitra meM nimnAMkita vizeSatAe~ upalabdha hotI haiM: 1. raktasrAva ke svarUpa para rudhirANuoM kI saMkhyA nirbhara karatI hai| unakA kabhI kama, kabhI madhyama aura kabhI gambhIra hrAsa hotA huA dekhA jAtA hai| 2. virUpakAyotkarSa ( poikilocytosis ) pAyA jAtA hai jisake kAraNa lAla kaNoM kA rUpa vikRta ho jAtA hai| 3. lAlakaNoM kA asamatotkarSa ( anisocytosis) khUba milatA hai aura ve choTe bar3e dikhalAI dete haiN| 4. bahuvarNapriyatA ( polychromatophilia) mila sakatI hai para kama / 5. vindukIya tArapriyatA (punctate basophilia) bhI kama hI pAI jAtI hai para jaba atyadhika raktasrAva ho cukA ho taba avazya isameM vRddhi ho jAtI hai| 6. yadi asthimajjA meM rakta ke lAlakaNoM kA punarjanana tIvra gati se cala rahA ho to jAlaka kAyANuoM ( reticulocytes ) kI upasthiti bhI dekhI jA sakatI hai| 7. sanyaSTi raktakaNa adhika nahIM milate para jo milate haiM ve hote adhikatara Rjuruha ( normoblasts ) hI haiN| 8. lAlakaNa bahudhA upavarNika hote haiN| 9. lAlakaNoM kI AkRti sAmAnya rahate hue bhI unameM sUkSmakAyatA ( microcytosis ) kI hI pravRtti vizeSa pAI jAtI hai| 10. asthimajjA kI kriyAzIlatA khUba bar3ha jAtI hai jisakA pratyakSa darzana lambI asthiyoM meM hotA hai jahA~ pItamajA kA sthAna raktamajjA lekara raktanirmANa kArya Arambha kara detI hai| 11. rakta ke sitakaNoM kA nirmANa vegapUrvaka hone lagatA hai jisake kAraNa sitakAyotkarSa ( leucocytosis ) hone lagatA hai| For Private and Personal Use Only

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rudhira vaikArikI 615 12. rakta meM kucha majjakAyANu ( myelocytes ) bhI milate haiN| raktasrAva ke 2-3 dina bAda sAdhAraNatayA tIvra raktasrAva hone ke kitanI dera bAda raktacitra kA parIkSaNa kiyA jA rahA hai yaha bahuta mahatvapUrNa hotA hai| eka tIvra aura druta raktastrAva ke turata bAda raktacitra meM koI bhI parivartana na milanA pUrNatayA sambhava hai| kyoMki rakta kA ToTala Ayatana ghaTa jAne para bhI raktarasa aura lAlakaNa usI anupAta meM naSTa hue haiM jinameM unakA saMkendraNa ( concentration ) sAdhAraNatayA rahatA rahA hai / aura abhI taka koI upazayAtmaka ( reparative ) parivartana nahIM ho paate| kevala bimbANuoM kI saMkhyAvRddhi ho jAyA karatI hai aura AtaJcakAla (clotting period) ghaTa sakatA hai| ___ raktasrAva ke 2-3 dina pazcAt sabase pahale rakta meM usake drava yA tarala bhAga kI vRddhi hotI hai jisake pariNAmasvarUpa rakta manda ( dilute ) ho jAtA arthAt patalA par3a jAtA hai jisake kAraNa-1. kozAgaNana ( cell count ) tathA 2. raMgadezanA ( colour index ) ye donoM hI ghaTa jAte haiN| ___ Age cala kara kozAoM kI pUrti hotI hai| parantu naye kozAoM kI zoNavartuli kI pUrti pUrI-pUrI nahIM ho pAne se navakozAoM kI zoNavartuli mAtrA kama ho jAtI hai / ___ zoNavartuli kI kamI ke kAraNa lAlakoM ko saMkhyA bar3hane lagatI hai, raMgadezanA ghaTa jAtI hai tathA haridutkarSIya ( chlorotic ) ho jAtI hai| ___thor3e se Rjuruha utpanna ho jAte haiM aura raktamajjA kI sakriyatA ke pariNAmasvarUpa aneka bahunyaSTikozAoM kI utpatti ho jAtI hai thor3e se maja kAyANu bhI dekhane ko milA karate haiN| dhIre-dhIre zoNavartuli kI bhI pUrti hone lagatI hai| jabataka yaha pUrti nahIM ho pAtI taba taka zoNavartuli kI mAtrA kama rahane ke kAraNa paryApta kAla taka raMgadezanA meM bhI avasAda pAyA jAyA karatA hai| jIrNa raktasrAva meM AmAzayika yA grahaNIka vraNoM dvArA nirmita vikSatoM se mArAtmaka arbudoM se yA phauphusika yakSmAjanya phuphphusIya gahvaroM yA vraNoM se nirantara aura kAla se calane vAle raktastrAva meM raktakaNoM meM zoNavartuli kI mAtrA bahuta adhika ghaTa jAtI hai| isake kAraNa-1. raMgadezanA 0.5 ke nIce taka calI jAtI huI dekhI jAtI hai / 2. rakta ke zveta kaNoM kI saMkhyA ghaTa jAtI hai tathA sitakozApakarSa ( leucopenia ) isa roga meM niyamataH pAyA jAtA hai, yadi raktasrAva ko rokane kA yathocita prabandha na huA to| 3. majjA kA utsrAvaNa ( exhaustion ) ho sakatA hai tathA kozAoM kA punarjanana bilkula banda bhI ho sakatA hai| aisA lagatA hai mAno nirantara hone vAle raktastrAva ke kAraNa asthimajjA kI svAbhAvika pratikriyA daba jAtI hai jisase naye For Private and Personal Use Only

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616 vikRtivijJAna kozAoM kA nirmANa ruka jAtA hai tathA rakta ke andara navIna kaNoM kA sarvathA abhAva ho jAtA hai, sAtha hI upavarNatA bhI spaSTa dekhI jAtI hai / raktasrAvajanya raktakSaya ko bahudhA loga lohAbhAvI raktakSaya ke antargata lete haiM para yaha bhI smaraNa rakhanA hogA ki lohe kI kamI mahatvapUrNa hone para bhI UtiyoM ke dvArA zoNavartali ke probhUjinika bhAga ke nirmANa meM bhI bahuta bar3I kaThinAI par3atI hai vizeSakara yadi vikSatoM ko sthalI mahAsrota kA UrdhvabhAga hI svayaM ho to / ataH zoNavartula ke nirmANa meM bhAga lene vAle lohe ( zoNa ) aura probhUjina ( vartuli ) donoM kI kamI se hI yaha raktakSaya utpanna hotA hai / striyoM meM atyArtava, asRgdara, yonija raktasrAva tathA uSNakaTibandha meM aGkuzamukha kRmi ke kAraNa bhI yaha avasthA utpanna ho sakatI hai / nIlohA ( Purpura ) tvacA meM raktastrAva kA honA yA zleSmala kalAoM se rakta nikalanA athavA Antarika aMgoM meM raktacyAva honA jisa roga ke antargata Ate haiM use hama nIlohA yA parA kahate haiM / svacA meM kahIM raktasrAva huA vaha sthAna nIlalohita yA parapila par3a jAtA hai, isI varNa ke anusAra ise nIlohA yA paprcyUrA kahA jAtA hai / ke mukhya bheda prathamajAta ( primary ) tathA uttarajAta ( secondary) do hote haiM / prathamajAta ko bimbANvapakarSakIya nIlohA ( thrombocytopenic purpura ) kahate haiM / uttarajAta prakAra meM ve sabhI nIlohA sammilita haiM jo kisI tIvra upasarga athavA kisI vizeSa auSadhi ke prayoga ke kAraNa hote haiM / AmavAtIya nIlohA, zUnalInIya roga, hainakIya nIlohA tathA bAlanIlohA Adi bhI uttarajAtIya prakAra meM Ate haiM / prathamajAta aura uttarajAta na kahakara bimbANvapakarSajanya tathA abimbANvapakarSajanya ye do prakAra bhI isake kie jAte haiN| para donoM bhAga eka dUsare ke itane samAna hote haiM ki yaha bheda karanA vyartha ho jAtA hai / sAdhAraNatayA yA prAkRtika rUpa meM raktasthApana 2 bhAgoM meM sampanna hotA hai arthAt jahA~ raktastrAva ho rahA ho usa kezAla kA saMkoca honA jo kSatigrasta huA hai / dUsare vahA~ para ghanAtra kI utpatti honA / bimbANu yA abimbANujanya nIlohoM meM kSatigrasta kezAla ThIka ThIka yA pUrA pUrA saMkoca nahIM kara pAtA aura raktasravaNakAla (bleeding time ) bar3ha jAtA hai| zoNapriyatA meM kezAlasaMkoca to ThIka ThIka hotA hai para ghanAsrotpatti nahIM hotI isalie thor3I thor3I dera bAda raktasrAva hotA rahatA hai / astu lohA ko rakta kA roga na mAnakara kezAla kA roga mAnanA adhika upayukta hai / kezAla ke antazchada meM koI vikAra hone para rakta ke bimbANu ghanAsra banA liyA karate haiM para dekhA yaha gayA hai ki isa roga meM bimbANu bhI kama ho jAte haiN| mAnavazarIra meM ye bimbANu 2|| se 4 || lAkha pratighana mi. mI. hote haiM para nIlohA ke rogiyoM meM * inakI saMkhyA 40 hajAra prati ghana mi. mI. ke nIce pAI jAyA karatI hai / For Private and Personal Use Only

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rudhira vaikArikI pahale nIlohA ke nimna 4 vibhAga kie jAte the 1. sAdhAraNa nIlohA ( purpura simplex ) - yaha eka saumya prakAra kA hone vAlA ( pratyAvartI - recurrent ) roga hai / 617 2. raktasrAvI nIlohA ( purpura haemorrhagica ) - yaha gambhIra svarUpa kA hotA hai aura isake sAtha bimbANvapakarSa avazyameva pAyA jAtA hai / ise bhaumika prazItAda ( land scurvy ) bhI kahate haiM / 3. AmavAtika nIlohA ( purpura rheumatica ) - yadyapi AmavAta se isakA koI sambandha nahIM huA karatA para yataH kezAloM se raktasrAva sandhiyoM meM huA karatA hai ataH vahA~ zUla paryApta milatA hai isa kAraNa isakA yaha nAma DAlA gayA hai / sandhiyoM meM zUla ke sAtha jvara bhI mila jAyA karatA hai / 4. * hainakIya nIlohA ( Henoch's purpura ) - yaha zizuoM kA roga hai / Antra prAcIra meM raktastrAva hotA hai jisake sAtha sAtha Antra meM zotha, maror3a tathA udarazUla bhI hotA hai / mala sarakta AtA hai / ( dekho pRSTha 921 ) kAraNa dRSTi se isake 2 vibhAga aura bhI kie jAte haiM - 1. aupasargika vibhAga ( infective type ) 2. vaiSika vibhAga ( toxic type ) / aupasargika vibhAga - isameM - 1. tIvra viziSTa jvaroM ke sAtha nIlohA utpanna hotA hai / inameM raktasrAvI romAntikA ( haemorrhagic form of measles ) lohitajvara Adi rahate haiM jo sadaiva mAraka rUpa hI upasthita karate haiM / 2. tadrikajvara ( typhus ), zItalA, mastiSkasuSumnAjvara, jvarikAmalA ati kuntalANUkarSa ( leptospirochaetosis icter haemorrhagica ), 3. rogANuraktatA ( septicaemia ) vizeSa karake zoNAMzika mAlAgolANvika rogANuraktatA isI prakAra anya jIvANu bhI kArya kara sakate haiM / viSamajvara kA parAzrayI jIvANu tathA zyAmAkasama yakSmA kA yamadaNDANu / 4. mukhyataH sUkSma antaHzalyoM ke kAraNa tathA aMzataH upasarga ke kAraNa mArAtmaka hRdantazchadapAka meM nIlohA dekhA jAtA hai / vaiSika vibhAga - isameM 1. rogANvika viSiyAM ( bacterial toxins ) jisake sAtha dUSakanAbhi ( septic focus ) upasthita ho vizeSakara jaba rogANu zoNAMzika ho / 2. zarIra meM vAtarakta (gout ), pANDu ( jaundice ), madhumeha ( diabetes. mellitus ), jIrNa vRkkapAka meM antarjanita viSiyoM ( endogenous toxins ) kI upasthiti bhI nIlohotpAdaka ho sakatI hai / For Private and Personal Use Only 3. prativiSalasikA (antitoxic sera ) tathA sarpaviSa ( snake venom ) Adi bAhyaviSa bhI nIlohA utpanna karate haiM /

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618 vikRtivijJAna 4. anuhRSatAyukta prANiyoM meM sailIsileTsa, phinAsiTIna, eNTIpAirIna, kyUbebsa, kvinIna, AyoDAiDsa, phAsphorasa, markarI, alkohala, Arsenika, beMjola tathA salpho naimAiDa varga ke dravyoM ke kAraNa nIlohA utpanna ho sakatA hai| 5. rakta ke roga jaise sitaraktatA (lyUkImiyA) acayika yA anaghaTita raktakSaya, lasagranthyarbuda, ghAtaka raktakSaya, prathamajAta bimbANvapakarSa Adi rogoM meM bimbANu ghaTa jAte haiM para bimbANuoM ke atizaya hrAsa ke sAtha nIlohotpatti hotI ho yaha Avazyaka nahIM hai| ___Antarika dharAtaloM se bhI raktasrAva sambhava hai| vRkka, kaNThanAr3I, nAsA, mahAsrota tathA dRSTipaTala taka se raktasrAva hotA huA dekhA jAtA hai| tIna sitaraktatA ( lenkaemia) meM bhI nIlohA spaSTatayA milatA hai| anaghaTita yA acayika raktakSaya meM asthimajjA meM sitakAyANu aura rudhirANuoM kI nirmiti meM jahA~ bAdhA par3atI hai usI anusAra bimbANuoM kA bhI nirmANa nahIM ho pAtA / lasagranthyarbuda aura ghAtaka raktakSaya meM nIlohA adhika mahattvapUrNa lakSaNa ke rUpa meM nahIM prakaTa hotA hai phira bhI jaba kabhI utpanna ho bhI jAtA hai to yakRccikitsA ke uparAnta bimbANuoM kI saMkhyA bar3ha jAne para zAnta ho jAtA hai| prAthamika bimbANvapakarSajanita nIlohA-(Primary thrombocytopenic purpura ) ise valhauMphAmaya ( Werlhoff's disease yA Maculosus haemorrhagicus of Werlhofi ) yA kAraNavihIna raktasrAvInIlohA ( idiopathic purpura haemorrhagica ) kahate haiN| isa avasthA ke sAtha lAlakoM kI saMkhyA meM kamI kA lakSaNa avazya pAyA jAtA hai jo kisI na kisI aMga meM hue raktasrAva ke kAraNa utpanna hotA hai| usa samaya sitakAyANuoM kI saMkhyA avazya hI bar3hI huI hotI hai| isa roga meM rakta ke bimbANu (platelets ) bahuta hI kama ho jAte haiM / 50000 yA usase nIce unakI saMkhyA kA milanA eka sAdhAraNa ghaTanA hai| kabhI-kabhI to ve bilkula bhI nahIM hote / jo rahate bhI haiM ve bhI rUpa aura AkAra meM vikRta ho jAte haiN| yadi raktasrAva kAphI gambhIra huA to uttarajAta raktakSaya utpanna ho jAtA hai| para yaha raktakSaya sadA upasthita hI rahe tathA koI bahuta Avazyaka lakSaNa isa roga kA ho aisA bhI nahIM dekhA jAyA krtaa| bimbANuoM kI kamI ke kAraNa raktasravaNa kAla ( bleeding time) bar3ha jAtA hai para AtaJcikAla ( coagulation time ) vahI rahatA hai| para eka bAta yaha hotI hai ki jo AtaJca ( clot ) banatA hai vaha sikur3ane (pratyAkarSaNa-retraction) meM asamartha ho jAtA hai| isa roga meM raktasrAva kI pravRtti bahuta hotI hai| kabhI kabhI thor3A thor3A antara dekara bhI raktastrAva hotA hai| yaha antara rakta meM vimbANuoM kI kamI bezI para ghaTatA bar3hatA rahatA hai| isake mukhya lakSaNoM meM raktasrAva mukhya hai jo tvacA ke andara bahudhA milatA hai| For Private and Personal Use Only

Page #1009
rudhira vaikArikI 6.16 zleSmalakalAoM ( mucous membranes ) tathA lasyakalAoM (serous membranes ) meM bhI raktasrAva hotA hai| A~toM meM, mUtravahamArga meM, garbhAzaya meM raktasrAva ho sakatA hai| kabhI kabhI isa roga kA patA nahIM calatA hai aura thor3A sA AghAta yA zastrakarma raktasrAva ko Arambha kara detA hai| ___ isa roga meM raktacitra roga kI gambhIratA ke anusAra badalatA hai| sAtha hI bimbANuoM kI kamI ke atirikta anya kucha bhI mahattvapUrNa nahIM dekhA jAtA hai| isa roga ke tIvra aura jIrNa do rUpa milate haiN| jIrNa meM thor3I plIhA vRddhi bhI milatI hai| tIvra rUpa bahuta kama milatA hai para jaba yaha hotA hai to thor3e hI saptAhoM meM rogI kI jIvanalIlA samApta karane meM samartha ho jAtA hai| jIrNaroga mahInoM aura varSoM cala sakatA hai| vikAra ke kAraNa ke sambandha meM abhI pUrI khoja nahIM ho sakI hai| kucha vidvAnoM kA vicAra hai ki jisa prakAra ghAtaka raktakSaya meM rakta ke kaNoM ke nirmANa meM bAdhA par3atI hai usI prakAra isa roga meM bimbANuoM kI utpatti asvAbhAvika rUpa meM hotI hai aura ki jAlakAntazchadIya saMsthAna inakA vinAza kara detA hai| kucha vidvAnoM kA mata hai ki jAlakAntazchadIya saMsthAna ke dvArA bimbANuoM kA vinAza hI bimbANuoM ke apakarSa kA mukhya hetu hai| isakA pramANa ve dete haiM ki yadi rogI kA plIhoccheda ( splenectomy ) kara diyA jAya to bimbANuoM kI saMkhyA meM vRddhi hokara unakI saMkhyA prakRta ho jAtI hai| kisI kisI meM plIhoccheda ke pazcAt hone vAlA bimbAzUlkarSa svalpakAlika hotA hai aura thor3e samaya pazcAt punaH vaha apanI apakarSAvasthA grahaNa kara letA hai| para eka bAta mahattvapUrNa hotI hai ki raktasrAva kI pravRtti sadA ke lie ThIka ho jAtI hai (griin)| prAthamika yA uttarajAta donoM prakAra ke nIlohA meM kezAla prAcIra kI vRddhiMgata bhaMguratA ( increased fragility of the capillary walls ) mukhya hai| jisake kAraNa rakta unakI prAcIroM se cU jAtA hai| haisa ne isa bhaMguratA ko nApane ke lie eka parIkSA sthira kI hai jisake anusAra rogI kI bAhu meM TUrnIke bA~dhakara kasa dete haiM isameM upariSTha vAhiniyA~ to daba jAtI haiM para nAr3I calatI rahatI hai| kucha minaToM ke bAda dekhane meM AtA hai ki kezAla prAcIroM se raktasrAva unakI bhaMguratA kI koTi ke pramANa meM ho gayA hai| isa parIkSaNa se kezAla prAcIroM kI pratirodhaka zakti kA patA lagatA hai| taruNAI ke pUrva isa roga se pIDita 40% milate haiN| kizora aura kizoriyA~ donoM eka barAbara isase vyathita dekhe jAte haiM para tAruNyakAla aura usake pazcAt isa roga se pIDitoM meM yuvatiyA~ adhika pIDita dekhI jAtI haiN| mAsika dharma, garbhAvasthA meM antaHsrAvI granthiyoM kI kriyAzIlatA sambhavataH isakA kAraNa ho jisake sAtha sAtha avaTukaviSotkarSa ( thyrotoxicosis ) kA bhI sahavAsa ho sakatA hai| For Private and Personal Use Only

Page #1010
620 vikRtivijJAna isa roga meM plIhA ke mahattva ko samajhanA hogA / TrolaiNDa tathA lI ne plIhA meM eka aise tatva kA patA lagA liyA hai jisako yadi zazakoM meM antaHkSipta kara diyA jAve to bimbANu saMkhyA 90% taka ghaTa jAtI hai / yaha ghaTotarI sahasA hotI hai| tathA sahasA hI ve phira apanI prakRta saMkhyA meM A jAte haiM / bimbANuoM ke Akasmika hAsa ke kAraNa raktasravaNakAla to bar3ha jAtA hai para nIlohA kI utpatti nahIM hotI / isa tattva ko ve thrAmbosAiTopaina ( thrombocytopen ) kahate haiM | Acharya Shri Kailassagarsuri Gyanmandir isa roga meM jo lagAtAra raktasrAva hotA hai usakA kAraNa rakta meM bimbANuoM kI kamI mAnA jAnA cAhie / jo loga yaha samajhate haiM ki rakta ke rukane kA kAraNa AtaMcana ( coagulation ) hotA hai ve nIlohA kI dRSTi se bhUla karate haiM / kyoMki kucha aise bhI prANI haiM jinake rakta kA AtaMcana bilkula na hone para bhI unakA raktasrAva thor3e kAla bAda banda ho jAtA hai / yaha kaise sambhava hai ? jaba isa prazna para vicAra karate haiM to jJAta hotA hai ki raktavAhinI kI prAcIra se hI to rakta nikalatA hai / vAhinI prAcIroM meM jahA~ cheda ho gayA hai yadi ise banda kara diyA jAve taba bhI to raktasrAva ruka sakatA hai / yaha kArya bimbANu karate haiM / bimbANu usa cheda ko banda kara dete haiM vahA~ abhilagnakaNoM ( adhesive corpuscles ) ke rUpa kArya karate haiM / jaba ye bimbANu bAhya dravya ke samparka meM Ate haiM to unakI abhilagnatA bahuta bar3ha jAtI hai aura bimbANuoM kA samUha vahA~ ekatra ho jAtA hai jo eka choTe chidra ko saralatayA banda karane kA sAmarthya rakhatA hai / jaba bimbANuoM kI saMkhyA bahuta kama ho jAtI hai to yaha prasamUhana nahIM ho pAtA jisase raktasravaNakAla anAyAsa bar3ha jAtA hai aura yadi bAhya dharAtala para banA AtaMca rakta ke dvArA ghulatA calA jAya to vaha aura bhI bar3ha sakatA hai / ina bimbANuoM kA eka kArya thromboplAsTIna ( thromboplastin ) kA nirmANa karanA bhI hai jo AtaMca nirmANa prakriyA meM acchA bhAga letA hai / para isake banane ke lie bimbANuoM kI thor3I saMkhyA bhI paryApta kArya karatI hai isalie AtaMca kAla meM koI hAni nahIM ho pAtI / adhika saMkhyA meM jo bimbANu zeSa raha jAte haiM ve AtaMca ke pratyAkarSaNa meM bhAga lete haiM / yaha pratyAkarSaNa kaise hotA hai vaha to abhI nahIM kahA jA sakatA hai para usameM bimbANuoM kI AvazyakatA par3atI hai / para nIlohA meM bimbANu saMkhyA thor3I hone se AtaMca bana to jAtA hai para usakA pratyAkarSaNa karane ke lie Avazyaka saMkhyA meM bimbANuoM kI upasthiti na hone se usakA pratyAkarSaNa nahIM ho pAtA hai / isIlie vaha AtaMca mRdu aura zlatha rahatA hai / isa prakAra bimbANuoM kI saMkhyA kI kamI raktasravaNakAla kI vRddhi mRdu AtaMca kI utpatti aura AtaMca ke pratyAkarSaNa kA abhAva tInoM ko eka sAtha batalAne meM samartha hotI hai / para bimbANvalpatA ke dvArA yaha hotA hai aisA mata prakaTa karane ke lie bhI hama para koI mahattva kA pramANa nahIM hai kyoMki hama dekhate haiM ki plIhoccheda ke bAda bimbapakarSa lauTa Ane para bhI bimbANuoM kA guNa prasamUhana tathA pratyAkarSaNa prakRtarUpa prApta kara For Private and Personal Use Only

Page #1011
afar vaikArikI 21 letA hai / astu bvAyaDa ke mata meM yaha parivartana guNAtmaka ( qualitative ) tathA iyattAtmaka ( quantitative ) donoM prakAra kA hotA hai / eka aura kAraNa bhI isakA diyA jA sakatA hai| aisA mAlUma par3atA hai ki doSa vAhinI prAcIra meM rahatA hai| jisake kAraNa rakta kA vyAva usameM se hone lagatA hai / isa doSa ko dUra karane ke lie raktastha bimbANu sthAna sthAna para abhilAga utpanna kara dete haiM / aisA karane meM unakI saMkhyA bahuta ghaTa jAtI hai / kabhI kabhI to vAhinIprAcIra para AghAta itanA tIvra hotA hai ki sampUrNa bimbANuoM ke samApta ho jAne para bhI usakI pUrti nahIM ho pAtI aura raktasrAva hotA rahatA hai ataH koI bhI kriyA jisase bimbANuoM ( raktacakrikAoM ) kI vRddhi kI jA sake isa roga meM lAbhadAyaka siddha hotI hai / lohA ke anya rUpa yataH nIlohA eka roga bhI hai jaisA ki Upara varNana kiyA gayA hai aura dUsare yaha svayaM eka lakSaNa bhI hai jo vividha kAraNoM se kisI bhI roga meM bana sakatA hai| ataH isakA eka pUrNa santoSajanaka zreNIvibhAjana nahIM kiyA jA sakatA / Age hama nIlohA ke nimna anya rUpoM ko likhakara isa viSaya ko samApta karate haiM / nIlohA ke do mukhya rUpa dekhane meM Ate haiM : -- eka kAraNa vihIna sAdhAraNa / dUsarA dvitIyaka nIlohA / sAdhAraNa kAraNa vihIna nIlohA ( simple idiopathic purpura ) isa rUpa meM na to vaiSika aura na aupasargika hI kAraNa nIlohotpatti ke milate haiM / lakSaNoM kI bhinnatA ke kAraNa aisA jJAta hotA hai ki vividha roga vividha prakAra ke lakSaNoM ke sAtha nIlohA kA bhI eka lakSaNa lie hue hoM / isa varga ke nIlohoM meM nimna mukhya haiM 1. sAdhAraNa nIlohA ( purpura simplex ) - yaha eka saidha prakAra kI avasthA hai / isameM raktasrAva tvacA taka sImita rahatA hai aura 1-2 saptAha meM ThIka ho jAtA hai / 2. hainakIya nIlohA ( Henoch's purpura ) - yaha bhI eka bAla roga hI hai ise apratiSedhAbha nIlohA ( anaphylactoid purpura ), raktasrAvI kezAlaya viSatotkarSa ( haemorrhagic capillary toxicosis ) yA vaiSika lohA (toxic purpura ) bhI kahate haiM / yaha una nIlohoM ke varga kA roga hai jo avimbANvapakarSIya (non--thrombocytopenic ) kahe jAte haiM / inakI utpatti ke sambandha meM abhI taka koI dRDha mata sthira nahIM kiyA jA sakA hai / hainakIya lohA ke sAtha zItapitta ( urticaria ), zopha, sandhizopha tathA anya zarIrAMgIya For Private and Personal Use Only

Page #1012
622 vikRtivijJAna lakSaNa mile hote haiM / isI kA saumyarUpa sAdhAraNa nIlohA kahA jAtA hai / yaha eka kapharaktI yA alargika roga hai / aura bahurUpIya atiraktimA ( erythema multiforme ), granthIya atiraktimA ( erythema nodosum), vAhinyavAtIya zopha ( angioneurotic oedema ) tathA lasIroga ( serum sickness ) Adi alaga avasthAoM se sambandhita hotA hai / isa roga meM kezAlaprAcIreM itanI ativedhya yA pravezya ( permeable ) ho jAtI haiM ki unase raktarasa aura raktakaNa saralatA se bAhara calA jAtA hai / isakA karttA sadaiva eka nahIM rahatA / kabhI yaha kArya mAlAgolA karatA hai to kabhI AhAra ke prati vRddhiMgata anupatA yA asahiSNutA use karatI hai| tvacA meM raktasrAva kA honA, zItapitta ho jAnA, atiraktimA ( erythema ) ho jAnA Adi lakSaNa dekhe jAte haiM / nAsA tathA mahAsrotIya zleSmalakalA se bhI raktasrAva hotA huA dekhA jA sakatA hai / raktasrAva ke atirikta raktalasa kA itanA adhika pArayAtana ( transudation ) AmAzaya aura Antra se hotA hai ki ina aMgoM meM tIvra zUla utpanna ho jAtA hai vamana hone lagatA hai aura atIsAra ( diarrhoea) bhI utpanna ho jAtA hai / ina lakSaNoM ko lekara kitane hI zalya vizArada bhrama meM par3a jAte haiM / jvara tathA saumyarUpa kA sitakAyANUtkarSa bhI hokara nidAna ke samajhane meM paryApta kaThinAI DAla detA hai / yaha nidAna sambandhI samasyA taba aura jaTila ho jAtI hai jaba sAtha meM svaggata lakSaNa anupasthita ho haiM aura kevala mahAstrotIya lakSaNa hI pAye jAte haiM / isa roga ke sAtha sAtha AntrAntra praveza ( intussuception ) bhI milA karatA hai / zUla aura zotha bhI pAyA jA sakatA hai / bvAyaDa ko eka aisA rogI milA jaba isI roga se pIDita rogI ke vRkka se raktasrAva ho rahA thA rakta upasthita thA / vaha sAdhyAsAdhyatA kI dRSTi se ise sAdhya mAnatA hai / anya vidvAnoM kI dRSTi meM isa roga meM raktasrAva eka pramukha ghaTanA hai / jo ghrANAsrAva raktavamana, raktAtisAra yA raktameha ke rUpa meM eka hI vyakti meM vividha avasaroM para mila sakatA hai / yaha kabhI na bhUlanA cAhie ki isa roga meM bimbANuoM meM koI vikRti nahIM AtI unakI saMkhyA hI kama hotI hai hA~ kaI bAra yA bAra bAra raktasrAva hone se unakI saMkhyA Age calakara avazya ghaTa sakatI hai| raktasrAva ke sAtha alargika lakSaNoM kI upasthiti roga kI pahacAna meM vizeSa sahAyatA pradAna karatI hai / sandhiyoM meM bhI dekhane ko jisake mUtra ke sAtha svatantratayA 3 zUnalInIya nIlohA ( Schonlein's purpura ) isa roga ko nIlotkarSIya AmavAta ( Peliosis rheumatica ) yA AmavAtIya nIlohA ( Purpura rheumatica ) kahate haiM / aisA vizvAsa kiyA jAtA rahA hai ki yaha roga AmavAta ke kAraNa hotA hai isI ke kAraNa ye nAma ise diye gaye haiM / para yaha aba taka bhrama hI siddha huA hai AmavAta aura isa roga meM koI sAmya nahIM hai ise nizcita rUpa se AmavAta ke sAtha vAle nAmoM ke sAtha kadApi na jor3anA caahie| yaha bhI Upara ke roga kA hI dUsarA aura vidvAnoM kA mata hai ki For Private and Personal Use Only

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rudhira vaikArikI 23 rUpa hai yahA~ AkramaNa kA lakSya sandhiyA~ hotI haiM / bahusandhipAka ko dekhakara sandhAyI - kAsthi meM sthita AmavAta kA bhrama ho sakatA hai / usa bhrama ko jvara tathA gale kI kharAbI aura bhI puSTa kara detI hai / isa roga meM nIlohA ke sidhma TA~goM para banate haiM sAtha meM atiraktimA tathA zItapitta bhI rahatA hai / sandhipAka kA mukhya kAraNa sandhi meM lasya utsyanda kA honA hai / yaha roga aura hainakIya nIlohA donoM bhAI-bhAI haiM para yaha choTA bhAI mAnA jAvegA / Adhunika jJAna kA vicAra karane para patA calatA hai ki nIlohA ke sAtha isakA sambandha jor3anA eka prakAra se anyAya hai / Ajakala ise utsyanda pUrvI rogasthiti ( exudative diathesis ) kahate haiM / prAgvisthiti ke do rUpa haiM eka audarika jise hama hainakIya nIlohA kahate haiM aura dUsarA sandhipAkIya jise zUnalInIya lohA kahA jA rahA hai / dvitIyaka ( uttarajAta ) nIlohA ( Secondary purpuraa ) vAzrita raktasrAva ke aneka kAraNa ho sakate haiM aura unake pIche eka dUsare se pUrNataH bhinna kAraNa bhI dekhA jA sakatA hai / kitanI hI vaiSika aura aupasargika avasthAoM meM yaha dekhA jA sakatA hai / mastiSka golANvika mastiSkachadapAka meM, lohita jvara meM athavA tandrika jvara meM utkoTha ( rash ) ke sAtha tvaggataraktasrAva eka gambhIra ghaTanA hotI hai / kisI vaiSika kAraNa se kezAla- prAcIra ko kSati pahu~ca kara hI aisA sambhava hotA hai / rogANuraktatA ( septicaemia ) ke sAtha jo nIlohAGkIya raktasrAva pAyA jAtA hai usakA bhI hetu yahI diyA jA sakatA hai I asthimajjA ke roga ke kAraNa bimbANuoM kI kamI se bhI nIlohA utpanna hotA hai yaha eka abhyavarga meM liyA jA sakatA hai| yaha uttarajAta bimbANvapakarSa asthimajjA ke arbudoM meM, lasavAhinya sitaraktatA tathA ghAtaka raktakSaya meM ho jAtA hai / anaghaTita yA acayika raktakSaya hone para ye rakhtasrAva khUba milate haiM kyoMki vahA~ asthimajjA ke sabhI tatva kama ho jAte haiM jinameM bRhannyaSTikozA ( megakaryocytes ) bhI kama hote haiM jinase bimbANuoM kA nirmANa hotA hai / zoNapriyatA ( Haemophilia ) jisa roga meM thor3e se AghAta se raktasrAva Arambha ho jAve aura bar3I kaThinatA se rokA jA sake tathA jisake pIche pIDhI dara pIDhI roga ke mAtRka pAreSaNa ( hereditary transmision ) kA itihAsa mile vaha zoNapriyatA hI hai / isa roga meM vyAdhimAtA se putra meM jAtI hai / jitanI kulaja pravRtti isa roga meM dekhI jAtI hai anyatra kahIM nahIM milatI isI se ( the most hereditary of all hereditary ) zabda kA prayoga bvAyaDa ne isake lie kiyA hai / suprasiddha klIthairo parivAra meM yaha roga gata 200 varSa taka DhUMDhA jA sakatA hai / bulaka tathA philDe ne apanI khojoM se yaha pramANita kara diyA hai ki yaha roga kevala puruSoM meM hI hotA hai striyA~ For Private and Personal Use Only

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624 vikRtivijJAna isase achUtI rahatI haiM para yaha bhI utanA hI satya hai ki roga parivAra kI striyoM ke dvArA hI gamana karatA hai / auTo ne san 1803 I0 meM isa roga ke sambandha meM jo kathAnaka likhA hai use likhane kA moha saMvaraNa nahIM kiyA jA sakatA / usane kahA ki merIlaiNDa nAmaka sthAna para kisI pitA ko 6 bacce the / unameM se 4 putra thor3A khujAne se hue raktastrAva ke kAraNa samApta ho gaye inameM bhI antima putra kI tarjanI aMgulI ke nAkhUna para eka kaMkar3I gira gaI jisake kAraNa aMguli ke agra se itanA rakta nikalane lagA ki use koI roka na sakA aura taba taka rakta bahatA rahA jaba taka ki usakA zarIrAnta nahIM ho gayA / bace hue donoM putroM ke sambandha meM pitA hara kSaNa cintita rahatA hai ki kahIM kisI AghAta ke kAraNa raktasrAva hokara unakI bhI vahI dazA na ho jAve / inheM thor3I sI khursaTa Ane para bahuta adhika raktastrAva hone lagatA hai / para ina bhAiyoM kI eka bahina bhI hai use koI bhI Dara nahIM hai usako AghAtoM se raktasrAva nahIM hotA aura yadi hotA bhI hai to zIghra banda bhI ho jAtA hai / eka pitA ne yaha kathA mujhe sunAI para auTo kahatA hai ki mujhe usakA aura adhika vivaraNa jAnane kI koI AvazyakatA nahIM huI / zoNapriyatA eka bAla roga hai / zizu ke Arimbhaka pahale dUsare yA tIsare varSa taka raktasrAvI prakRti kA patA laga jAtA hai / yahI tIna Arambhika varSa zizu ke lie bahuta khataranAka huA bhI karate haiM / nIlohA meM jahA~ svaggataraktasrAva ke lie kisI bAhya kAraNa kI AvazyakatA nahIM hotI vahA~ zoNapriyatA meM raktasrAva ke pIche kisI AghAta kA, kSata kA, viddha kA yA zastra ke lagAne kA itihAsa avazya milatA hai / I zoNapriyatA meM mukhya parivartana rakta ke AtaMca kAla ( clotting or coagulation time ) meM vRddhi honA hai / sAmAnyatayA yaha AtaMca kAla 3-4 minaTa kA huA karatA hai para eka zoNapriyatA ke rogI meM vahI bar3ha kara ghaNToM kA ho jAtA hai| isameM rakta ke bimbANuoM kI saMkhyA prakRta rahatI hai / para thrombokIneja ( ghanAstrikara ) nAmaka vikara ( eJjAima ) kA abhAva ho jAtA hai / hovela tathA kekADA kA mata hai ki jaba kisI zoNapriya rogI ke zarIra se raktasrAva hotA hai to usake rakta ke bimbANu jyoM ke tyoM rahate haiM TUTate nahIM binA TUTe unake andara banda AtaMcI vikara mukta nahIM ho pAtA jisake binA mukta hue AtaMca banatA nahIM / AtaMca ke nirmANa meM phibrInojana ( tavijana ), prothrombIna ( pUrvaghanAstri ), thrombokIneja ( ghanAstrikara ) tathA cUrNAtu ( kailziyama ) kI AvazyakatA huA karatI hai / inameM tatvijana, pUrvaghanAstri tathA cUrNAtu rakta meM rahate haiM / ghanAstrikara AghAta prApta UtikozAoM tathA bimbANuoM se milatA hai / pUrvaghanAstikara mila kara ghanAstri ( aumbIna ) kA nirmANa karate haiM / yaha ghanAstri tanvijana se mila kara aa (phibIna ) paidA karatI hai / yaha to eka svAbhAvika kriyA hai jo AtaMca kI utpatti karatI hai / zoNapriya rogiyoM meM yaha AtaMca banane meM itane vilamba kA kAraNa For Private and Personal Use Only

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rudhira vaikArikI 625 hai rakta ke bimbANuoM se ghanAstrikara kA na niklnaa| yaha dhanAsrikara eka to zarIra kI kSatigrasta utiyoM meM banatA hai dUsare bimbANuoM ke andara rahatA hai| stanakArI jIvoM ke atirikta zudra jIvoMke rakta meM jahA~ bimbANu nahIM hote vahA~ AtaMcana kA kArya kSatigrasta utiyoM se nikale dhanAstrikara ke dvArA sampanna hotA hai| yadi kisI prakAra isa rakta ko kSatigrasta Uti ke samparka meM na Ane diyA jAve to rakta kA AtaMcana nahIM hI hotaa| sAdhAraNatayA mAnava zarIra kA rakta sUcI dvArA binA UtiyoM kA samparka lAye nikAla liyA jAve aura use pairAphIna lagI zIzI meM rakkhA jAve to thor3e samaya pazcAt bimbANu TUTane lagate haiM unase ghanAstrikara nikalane lagatA hai jo tantvijana, pUrvadhanAni aura cUrNAtu se milakara AtaMca kA nirmANa kara detA hai| yadi kisI zoNapriya kA rakta isI prakAra kI zIzI meM sUI ke dvArA sIdhA kAr3ha kara liyA jAya to 5.5 ghaNToM taka bimbANu jyoM ke tyoM dekhe jAte haiM TUTate nahIM haiM isa kAraNa unase ghanAsrikara ( thrombokinase )nikalatA nahIM hai / aura rakta bhI jama nahIM pAtA usameM AtaMca kA nirmANa ghaNToM nahIM hotaa| para jaba kucha ghaNToM ke bAda bimbANu TUTate haiM to turata rakta jama jAtA hai| ___ isase yaha nizcita ho jAtA hai ki putra ko mAtA ke rakta se aise bimbANu utpanna karane kI prApti hotI hai jo AsAnI se vighaTita honA yA TUTanA nahIM jAnate / yahI pravRtti ghanAsrikara kI prApti meM bahuta bar3I bAdhA bana kara khar3I ho jAtI hai aura apAra raktakSati kA kAraNa bana kara kAla ke karAla gAla taka meM praveza karA de sakatI hai| eka zoNapriya rogI kA sAdhAraNataH patA taba taka nahIM calatA jaba taka ki usakA dA~ta na ukhAr3A jAya yA use koI coTa jisameM upariSTha tvacA kaTa gayI ho, na laga jaay| upariSTha tvacA ke kaTane se yA dA~ta ukhAr3ane se rakta kA jo pravAha Arambha hotA hai vaha ghaNToM taka nahIM rukatA hai| suI se cubhone ke bAda zoNapriya ke rakta kA srAva bahuta dera na hone kA kAraNa hai samIpastha kSatigrasta UtiyoM se ghanAsrikara kI turata prApti ho jAnA tathA rogI kA rakta pravAha kAla bhI prakRta rahatA hai aura pAsa kI UtiyoM kI pratyAsthatA (sthiti sthApakatA-elasticity ) svAbhAvika rahane se jaldI hI sthAna banda (sIlDa) ho jAtA hai / gahare kaTAvoM se bhI zoNapriya kA raktasrAva bahuta kAla taka nahIM hotA kyoMki pAsa kI UtiyA~ itanI adhika kSatigrasta ho jAtI haiM ki unase pracura parimANa meM AtaMciyA~ ( coagulins ) bana jAtI haiM jo nikala nikala kara rakta meM mila AtaMcotpatti kara detI haiN| ataH kevala upariSTha kaTAvoM ( superficial cuts) hI zoNapriya meM raktasrAva ko avirala gati se bahAne meM samartha hote haiM aura vahA~ bar3I kaThinatA se rakta rokA jA sakatA hai| rakta kA jahA~ bahuta pravAha cala rahA ho to raktAvasecana ( blood transfusion ) turata karane se pUrvadhanAni acchI mAtrA meM pahu~ca jAtA hai aura rakta ke AtaMcana kA kAla ghaTa kara rakta banda kara detA hai| ataH For Private and Personal Use Only

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26 vikRtivijJAna cikitsaka kA yaha parama dharma hai vizeSakara zalya zAlAkya cikitsaka kA ki vaha yaha jAne rahe ki kauna vyakti zoNapriya hai kauna nahIM / eka bAta aura bhI samajhanI hai ki zizu ke jIvana ke Arambhika kAla meM 1-3 varSa taka yaha roga bhISaNa rUpa dhAraNa karatA hai para janma ke samaya garbhanAla se adhika rakta kA strAva nahIM hotA / para jaba sunnata ( circumcision ) karAyA jAtA hai to isakA rUpa prakaTa ho jAtA hai / zoNapriya meM rakta kI mAtrA adhika nahIM nikalatI para pravAha lagAtAra calatA rahatA hai jisakI pAnI kI TaGkI meM hue sUkSma chidra se tulanA kara sakate haiM jo dera meM hI sahI para sampUrNa TaGkI ko khAlI kara DAlane kI avazyakSamatA rakhatI hai / isa kAraNa Akasmika raktasrAva se zoNapriya kA kAlakavalita honA nahIM dekhA jAtA hai | raktasrAva zarIra ke bhItarI bhAgoM meM bhI hotA rahatA hai / inameM sandhiyoM kA raktasrAva bahuta mahattvapUrNa hai / jAnusandhi ( knee joint ) tathA kUrparasandhi ( elbow joint) meM yaha raktasrAva vizeSa karake hotA hai / anya kisI bhI sandhi meM bhI ho sakatA hai / isake kAraNa sandhiyAM phUla jAtI haiM / unameM khUba utsyandana hotA hai / aura khUba hI zUla aura vedanA bhI hotI hai / prabhAvita sandhi uSNasparzI, raktavarNa kI aura samIpastha UtiyA~ bhI phUlI huI dekhI jAtI haiM / jvara 101-102 phairenahAiTa taka ho jA sakatA hai / sandhi ke andara zuddha rakta milatA hai para jyoM-jyoM usakA pracUSaNa hotA jAtA hai vahA~ babhru varNa kA Avila drava bana jAtA hai aura vaha sandhizleSmala kalA ko bhI babhru kara detA hai / sandhAyokAsthi bhI babhru varNa se raMga jAtI hai / kabhI-kabhI yaha rakta zIghra pracUSita ho jAtA hai aura sandhi kI kriyA zakti yathAvat ho jAtI hai / para jaba pracUSaNa dhIre-dhIre hotA hai yA utsyanda nirantara hotA hai to sandhi mur3a sakatI hai yA usameM sthAyI sthairya ( ankylosis ) ho jA sakatI hai jisake kAraNa rogI AjIvana vikRtAMga ho jAtA hai / sandhiyoM meM raktasrAva ke kAraNa bahuta vinAza ho sakatA hai / unakI sandhAyIkAsthi naSTa ho sakatI haiM / snAyu barbAda ho sakate haiM jisake kAraNa asthiyA~ anAvRta ho jAtI haiM aura unameM asthi- sandhipAkavat ( osteoarthritic ) parivartana milane lagate haiM / atirikta asthivRddhi (osteophyte ) kA nirmANa yA asthIya sandhisthairya ho to sakatA hai para hotA adhika nahIM hai / para tAntava sandhisthairya ( fibrous ankylosis ) mila sakatI hai / una parivAroM meM jahA~ isa roga kA itihAsa milatA hai yadi santAnotpatti na hone dI jAve aura zoNapriya santati utpanna karake use jIvana bhara ke lie eka saMkaTa kA sAmanA karane ke lie bAdhya kiyA na jAve to bahuta sundara ho / nindita vivAha ke niSedha kA dharmazAstrIya upadeza bhI grAhya honA cAhie / aninditaiH strIvivAhairanindyA bhavati prajA / ninditairninditA nRNAM tasmAnnindyAnvivarjayet // anindita strI ke sAtha vivAha karane se santAna anindya hotI hai tathA ninditA ke sAtha puruSoM kA samAgama nindya santAnotpatti karatA hai ataH nindyoM kA parivarjana kare / For Private and Personal Use Only

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rudhira vaikArikI 627 zoNapriyatA nindya striyoM ke dvArA unake putroM meM jAtA hai ataH zoNapriya parivAra kI kanyAoM ko isa dRSTi se nindya zreNI meM ginanA cAhie aura yadi vaisI kanyA ke sAtha vivAha sambandha jur3a gayA hai to asantAnotpatti kAraka upAyoM kA pAlana karanA caahie| tIvra raktasrAva tIvra raktasrAva hone ke pazcAt rakta ke Ayatana meM jitanI kamI ho jAtI hai usakI pUrti yathAzIghra UtiyoM ke dvArA prApta tarala se ho jAtI hai isake kAraNa rakta thor3A tanu ho jAtA hai usake ghaTakoM meM kamI par3a jAtI hai aura raktakSaya kI sthiti spaSTa hone lagatI hai / ise hama jalAnvita rakta ( watered blood ) kI avasthA kaha sakate haiM / yadi rakta kI bahuta adhika mAtrA raktasrAva ke kAraNa nikala cukI hai to mRtyu taka ho sakatI hai para yadi vaisA nahIM hai to raktasrAva ke kAraNa asthiyantra meM kriyA zakti uttejita ho jAtI hai jisake kAraNa 8-10 dina meM rakta kI sArI kamI pUrI kara lI jAtI hai | yadi koI kAraNa asthimajjA kI isa uttejanA ko rokane kA yA virodha karane kA rahA to raktakSaya banA raha sakatA hai| aisA pratirodha na rahane para rakta strAva se yA rakta kA dAna karane se raktakSaya utpanna nahIM hotA jo hotA bhI hai vaha thor3e dinoM meM pUrNa ho jAtA hai / jIrNa raktasrAva yadi kisI ko eka tIvra raktasrAva ke pazcAt punaH punaH raktasrAva hone lagatA hai to raktakSaya bajAya ghaTane ke bar3hane lagatA hai / rakta ke lohAMza kI kamI ho sakatI hai jisake kAraNa raMgadezanA ghaTa sakatI hai aura raktakSaya ke gambhIra pariNAma sAmane A sakate haiM / aba Age hama zoNAMzika raktakSaya kA varNana karate haiM / 4 zoNAMzIya avasthAe~ ( Haemolytic conditions ) raktakSaya ke kaI rUpa sAmane A cuke haiM / aba jo rUpa sAmane A rahA hai vaha hai usa raktakSaya kA jo rakta ke lAla karNo ko galA detA hai / rudhirANuoM ke galane kI isa kriyA ko hama zoNAMzana ( haemolysis ) kahate haiM / sarpadaMza se sahasroM vyakti prativarSa marate haiM unakI mRtyu kA mukhya kAraNa sarpaviSa kA zarIrastha rakta ke sAtha mela karane para rudhirANuoM kA gala jAnA hotA hai / yaha aMzana ( galAva ) itanA druta hotA hai ki zarIra ke jAraNa aura prANavAyu ke upayoga meM bAdhA hokara manuSya tatkAla mara jAtA hai / lAlakoM kA antarvAhinIya vinAza ( intravascular destruction of red bloodcells) zoNAMzana kA mukhya kAraNa hotA hai / yaha zoNAMzana prathamajAta ( primary ) yA kAraNavihIna (idiopathic ) tathA uttarajAta ( secondary ) do prakAra kA ho sakatA hai| prAthamika yA prathamajAta zoNAMzIya raktakSaya meM nimnalikhita vyAdhiyA~ sammilita mAnI jAtI haiM ( 1 ) zoNAMzikaraktakSaya ( haemolytic jaundice ) (2) dAtrakozIyaraktakSaya ( sickle cell anaemia ) For Private and Personal Use Only

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628 vikRtivijJAna (3) raktarahIyaraktakSaya ( erythroblastic anaemia) (4) AvegayuktamAMjiSThameha ( paroxysmal haemoglobinuria) uttarajAta yA dvitIyaka zoNAMzIya raktakSaya meM nimnalikhita vyAdhiyA~ sammilita mAnI jAtI haiM 1. sarpadaMza ( snake bite ). 2. viSama jvara ( malaria). 3. zoNAMzIya mAlAgolANujanya upasarga (infection due to streptococcus haemolyticus ) tathA ghAtaka raktakSaya meM bhI eka mukhya lakSaNa ke rUpa meM zoNAMzIya raktakSaya upasthita rahA karatA hai|| zoNAMzIya raktakSayoM kA pRthak-pRthak varNana Arambha karane ke pUrva sabhI meM pAyI jAne vAlI vikRtiyoM kA kucha vicAra kara lenA paramAvazyaka hai| yadi rakta ke bahuta se lAlakaNa drutagati se TUTane lage to mUtra meM zoNavartuli (mAMjiSTameha) nikalane lagatA hai tathA pANDu (jaundice ) ke lakSaNa bhI paryApta milane lagate haiN| para yadi cirakAla se zoNAMzika raktakSaya cala rahA ho to jo bar3I Azcaryajanaka ghaTanA dikhAI detI hai vaha hai pANDuvarNatA kI kamI / raMgadezanA eka yA usake Asa-pAsa rahA karatI hai aura isakA parivartana asthimajjA kI pratikriyA para nirbhara karatA hai / yataH asthimajjA isa raktakSaya ko dUra karane ke lie atyadhika prayatnazIla hotI hai isalie rakta meM jAlakAyANuoM (reticulocytes ) kI saMkhyA paryApta hotI hai| tathA pariNAhI rakta (peripheral blood ) meM sanyaSTiraktakozA (nucleated blood cells) bhI pAye jA sakate haiN| rakta ke zvetakaNoM kA utkarSa isa roga kI tIvra avasthAoM meM dekhA jAtA hai jaba drutagati se aMzana huA karatA hai / usa avasthA meM apragalbha sitakAyANu bhI rakta meM pAye jA sakate haiN| jIrNa zoNAMzika raktakSaya kI avasthA hone para sitakozAoM ( leucocytes) kI saMkhyA prAyaH aprabhAvita rahatI hai para kabhI kabhI kucha thor3I ghaTa bhI jAtI hai| roga ke ArambhakAla meM rakta ke bimbANuoM kI saMkhyA ghaTa jAtI hai para Age jAkara phira jyoM kI tyoM ho jAyA karatI hai| zoNAMzana ke kAraNa yakRtplIhodara kA honA, lasagranthiyoM kI vRddhi tathA asthi majjA kA paramacaya tathA zoNAyasi kA utkarSa ( haemosiderosis ) ho sakatA hai| isa roga meM mahAsrota yA vAtanADIsaMsthAna Adi prakRta rahate haiN| unameM koI vikAra nahIM dekhA jAyA karatA hai| aba hama pahale prathamajAta zoNAMzIya raktakSaya kA varNana kreNge| zoNAMzika pANDu ( Haemolytic Jaundice ) isake do rUpa mukhyatayA dekhe jAte haiM-eka sahaja ( congenital ) tathA dUsarA avApta (acquired) inameM sahaja ko miGkAuskI cauphArDa TAipa For Private and Personal Use Only

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rudhira vaikArikI 626 ( Minkawski chauffard type ) tathA avApta ko hAyema viDAla TAipa (Hayem-Widal type) kahA jAtA hai| sahaja meM raktazoNAMziyoM ( heemolysis ) rahita hotA hai para avApta meM rakta meM zoNAMziyAM pAI jAyA karatI haiN| aba hama ina donoM kA varNana yathAmati upasthita karate haiN| apittamehikapANDu ( acholuric jaundice ) isako golakAyAraNUtkarSa (spherocytosis ), sahaja zoNAMzIya raktakSaya ( congenital haemolytical anaemia ), yA miGkA uskI cauphArDa prakAra kA raktakSaya Adi nAmoM se bhI pukArate haiN| ise apittamehika yaha nAma isalie diyA gayA hai kyoMki isa roga se pIDita hone para rogI kA varNa to pANDu ho jAtA hai para usake mUtra se pitta kA bilkula bhI srAva na hone se mUtra kA varNa pIlA kadApi nahIM hotaa| apittamehika pANDu sahaja aura kulaja ( familial ) roga hai| eka hI parivAra ke kaI sadasya eka sAtha isase pIDita ho jAte haiM tathA 3-4 pIDhiyoM taka isa roga kA itihAsa mila sakatA hai| yaha roga zizu ke janma ke sAtha rahane vAlA hote hue bhI isake lakSaNa zaizava, bAlapana tathA tAruNya taka meM dekhane meM nahIM Ate kabhI kabhI to jIvana bhara unakI spaSTatA nahIM dekhI jAtI / rakta meM koI vikRta zoNAMziyA~ nahIM dekhI jAtI aura na yahI siddha hotA hai ki zoNAMzana kA AdhAra plIhA meM upasthita koI prAthamika doSa ho| raktakSaya aura pANDuvarNatA jo isa roga meM pAI jAtI hai una donoM meM koI samIpa kA sambandha nahIM hotA hai| na eka dUsare para nirbhara hI rahatA hai / pittarakti ( bilirubin ) kI rakta meM sthita mAtrA na kevala zoNAMzana ke kramabandhana (grade ) para hI nirbhara karatI hai para vaha yakRrakozAoM ke utsarjana kI zakti para bhI nirbhara rahA karatI hai| ___isa roga ke kAraNa utpanna pANDu eka bAra hokara nirantara jIvana bhara dekhA jAtA hai| isI kAraNa bahuta se vyaktiyoM kI A~khoM tathA tvacA meM pIlApana nirantara eka-sA dekhane meM AtA hai svAsthya para roga kA koI vizeSa prabhAva nahIM dikhAI par3atA hai tathA yaha roga mAraka bhI nahIM hotA hai| paittika avarodha se utpanna pANDu tathA isa pANDu meM mukhya antara yaha hai ki avarodhajanya pANDu meM harApana vizeSa rahatA hai jo yahA~ nahIM miltaa| yahA~ para to raMga ekadama spaSTataH pIlA rahatA hai| dUsare avarodhajanya pANDu ( obstructive jaundice ) meM mRttikAvarNIya purISa (clay-coloured stool ) hotA hai| jaba ki zoNAMzika pANDu meM mUtra se pitta raMgA ( bile pigment ) khUba nikalatA hai para yaha raMgA mUtra dvArA kadApi prakaTa nahIM hotA isI se ise apitta mehika pANDu (acholuric jaundice) nAma diyA jAtA hai / mUtra se yadyapi pittarakti kA utsarga nahIM hotA para yUrobilIna (mUtrapitti ) pracura parimANa meM prakaTa hotI hai| isa roga meM kabhI kabhI plIhA yA yakRt pradeza meM zUla ke sAtha vamana kA daurA For Private and Personal Use Only

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630 vikRtivijJAna bhI par3A karatA hai / isake sAtha sAtha pANDuvarNa aura gaharA ho jAtA hai / ise isa roga kA dAruNyakAla ( period of crisis ) kaha sakate haiN| isa avasara para rakta ke lAlakaNoM kI saMkhyA drutagati se ghaTane lagatI hai kyoMki unakA vinAza kArya bar3ha jAtA hai tathA plIhA bhI bar3hane laga jAtI hai / isa roga meM plIhAbhivRddhi prAyaH dekhI jAtI hai| plIhA bar3hakara nAbhi taka pahu~ca jAtI hai / kabhI kabhI to vaha nAbhi ke nIce calI jAtI hai| aise bahuta kama rogI dekhe jAte haiM jinameM plIhAbhivRddhi na mile / isa roga meM pittAzmariyoM kI upasthiti bahuta mahatvapUrNa hai / pittAzmariyA~ ( gall stones ) lagabhaga 60 pratizata rogiyoM meM banA karate haiM / ye paittika zarkarA ( biliyarI graivila ) se banate haiM aura inameM pittarakti tathA cUrNAtu ( bilIrubIna evaM kailziyama ) hI hotA hai / paittava ( kolesTarola) nahIM pAyA jAtA hai / isa roga meM araktatA yA raktakSaya saumyasvarUpa kA rahatA hai jisake kAraNa rudhirANuoM kI saMkhyA 30 lAkha pratighana milImITara ke nIce prAyaH nahIM jAtI / para dAruNyakAla kI upasthiti para vaha 15 lAkha taka jAtI huI dekhI jAtI hai / rogakA gambhIra rUpa hone para ghAtaka raktakSaya se milatA julatA raktakSaya ho jAsakatA hai| ( bvAyaDa ) nigelI kA kathana hai ki isa roga meM rakta meM sUkSmagulikotkarSa ( microspherulosis ) pAyA jAtA hai| jisakA artha yaha hai ki rakta kA lAlakaNa apane dvinyubja svarUpa ( biconcave shape ) ko chor3a detA hai aura eka gulikA kI taraha gola ( spherical ) ho jAtA hai tathA sUkSmakAya ( microcyte ) ho jAtA hai| usake gola ho jAne se usakA vyAsa bar3ha jAtA hai / vyAsa meM vRddhi ho usakI vRddhiMgata bhaMguratA meM kAraNa banatI hai / aura yaha gulikotkarSa hI vaha maulika Antarika truTi hai jo isa roga ke AdhAra kA kAma karatI hai / ye gola kozA AsAnI se phaTa jAte haiN| gola hone ke kAraNa inakA abhiraMjana bhI gaharA hotA hai / para raMgadezanA svAbhAvika ke AsapAsa hI rahA karatI hai / asthimajjA meM sanyaSTi raktakaNoM kI kriyAzakti bar3ha jAtI hai / tathA jAlakita lAlakoM kI sakriyatA meM bhI paryApta vRddhi dekhI jAtI hai / yahI kAraNa hai ki isa roga meM rakta ke andara jitane jAlakakAyANu ( raiTIkyulosAiTsa ) milate haiM utane anya kisI roga meM nahIM dekhe jAte haiM / jAlakakAyANu svasthAvasthA meM 0.5 se 1 pratizata taka mila sakate haiM / ve ghAtaka raktakSaya meM 5% taka dekhe jA sakate haiM para isa apittamehika pANDuroga meM 10-20 pratizata milanA to sAdhAraNa bAta hai tathA yaha to rahI sahaja prakAra ke apittamehika pANDu kI bAta avAptarUpa apittamehika pANDu meM to yaha saMkhyA 50 pratizata taka pahu~ca jAtI hai / bairI ne eka rogI meM 92% taka inakA gaNana kiyA hai| kisI kisI rogI meM athavA eka hI rogI meM kabhI kabhI inakI saMkhyA itanI bar3ha jAtI hai ki rakta meM I vahI vahI dekhe jAte haiM / For Private and Personal Use Only

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rudhira vaikArikI 631 caudhArDa, bvAyaDa tathA bArakophTa ne alaga alaga rakta ke lAlakaNoM ki bhaMguratA ( fragility ) para kArya kiyA hai| sAdhAraNatayA svastha lAlakaNa 0.45 pratizata ke lavaNa ghola meM ghulane lagate haiM aura yaha ghulanazIlatA 0.3 pratizata ke lavaNa vilayana meM pUrNa ho jAtI hai| cauphArDa ne prathama bAra 1907 meM yaha pragaTa kiyA ki isa roga meM usa alpabala lavaNa vilayana meM bhI lAlakaNa ghulanA zurU kara dete haiM jisakA prakRta lAlakaNa para koI prabhAva nahIM par3atA hai| isI samaya se isa roga kA vAstavika rUpa vidvAnoM ko samajha meM Ane laga gayA hai| isa zoNAMzika pANDuroga meM 0.6 pratizata se lekara 0.4 pratizata taka lavaNajala bhaMguratA kI utpatti karane meM samartha hotA hai| bhaMguratA kI kriyA jitanI adhika gulikIya lAlakaNoM para dekhI jAtI hai utanI apragalbha lAlakaNoM para nahIM dekhI jaatii| isa kAraNa jaba rakta meM isa roga ke kAraNa jAlakIya kAyANuoM kI atyadhika vRddhi hone lagatI hai to isa bhaMguratA meM bhI kamI A jAyA karatI hai| raktapitti kI atyadhika upasthiti ke kAraNa raktarasa gaharA raMgA rahatA hai tathA phAnaDenabargha pratikriyA apratyakSa ( indirect ) milate haiN| avAptarUpa-isa roga kA avApta ( acquired ) rUpa sahaja rUpa kI apekSA bahuta kama milatA hai| isakA Arambha bAlyAvasthA meM na hokara 30 varSa ke pazcAt dekhA jAtA hai| isa rUpa kI pramukha vizeSatA hotI hai rakta meM zoNAMziyoM ( hImolA isInsa) kI upasthiti kii| ye zoNAMziyA~ sahajarUpa ke zoNAMzika pANDu meM nahIM milA krtiiN| avAptarUpa meM yaha roga bahuta bhayaMkara hotA hai tathA mAraka bhI hotA hai| rakta ke lAla kaNoM kI saMkhyA 20 lAkha tathA usase bhI nIce dekhI jAtI hai para zarIra kI pANDuvarNatA adhika prakaTa nahIM dekhI jaatii| isa rUpa meM dAruNya kI sthiti sahajarUpa se kahIM adhika dekhI jAtI hai| lAlakaNoM kI bhaMguratA bhI sahajarUpa jaisI idhara nahIM miltii| vikRti-zoNAMzika pANDu ke donoM rUpoM meM vaikArikIya parivartana prAyaH samAna hI hote haiM / jo mukhya vikRtijanya parivartana milate haiM nIce likhe jAte haiM: 1. plIhA paryApta bar3ha jAtI hai usakA osata bhAra 71 (prakRta bhAra 23 chaTaoNka) pAyA jAtA hai| isa bhAra kA mukhya kAraNa plIhA meM raktAdhikya kA ho jAnA hai| jaba rakta ko nicor3a diyA jAtA hai to plIhA kA AkAra bahuta choTA ho jAtA hai| plIhA meM dRDhatA ( firmness ) milatI hai| usakA kaTA huA dharAtala lAla hotA hai| plIhA para jo prAvara car3hA hotA hai vaha aura moTA ho jAtA hai| tathA mahAprAcIrA pezI ke sAtha usameM se abhilAga nikala kara mila jAte haiN| aNvIta citra dekhane se plIhA kA vAstavika svarUpa chipa jAtA hai aura usake sthAna para rakta hI rakta hara ora dikhAI detA hai / rakta kA vitaraNa bhI bahuta vicitra hotA hai| plIhA ke gorda (pulp ) meM rakta khUba bharA hotA hai para usake srotasa rakta se khAlI dekhe jAte haiN| unake starIkaraNa karane vAle kozAoM ( lining cells ) ko dekhane se aisA For Private and Personal Use Only

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32 vikRtivijJAna lagatA hai mAno ki ve kisI granthi ke adhicchada mAtra ho / plIhA kI lasakUpikAe~ (lymph follicles ) eka dUsare se itanI adhika alaga ho jAtI hai ki unakI saMkhyA kama ho gaI ho aisA AbhAsa hone lagatA hai / bvAyaDa likhatA hai ki eka rogI kI plIhA ke majjakIya bhAga ke bAhara rakta-saMjanana kriyA ( extramedullary haemopoiesis) spaSTataH usane dekhI hai / yaha kriyA usameM gambhIra svarUpa ko raktakSaya ke kAraNa dekhI gaI thI / plaiha srotasoM ke antazchadIya kozAoM meM eka prakAra kI pratikriyA vahA~ upasthita raGgA ke kAraNa dekhI jAyA karatI hai / jisake kAraNa vahA~ ke lohe kA upayoga hokara atyanta AvazyakatA par3ane para raktasaMjanana kriyA calA karatI hai / antazchadIya kozA cipaTApana chor3akara aNDAkAra hote hue dekhe jAte haiM / roga kI tIvrAvasthA meM jaba plIhA kA uccheda kiyA jAtA hai tabhI isa lohe kI upasthiti pAI jA sakatI hai / isa roga meM plIhA kI ( trabeculae ) tathA jAlaka ( reticulum ) sthUlita nahIM ho pAte yaha baiNTI ke roga meM sadaiva sthUlita ho jAyA karate haiM / dhamanikAoM ke coloM (media ) meM kAcarIya sthaulya ( hyaline thickening ) pAI jA sakatI hai / jAlakAntazchadIya kozAoM meM paramacaya tathA lAlakaNoM kA bhakSikAyotkarSa khUba hone para bhI saMdhAra kA tantUtkarSa dvArA sthUlana nahIM dekhA jAtA / plIhA meM RNAsa ( infarcts ) mila sakate haiN| AbabhruvarNa ke granthaka jinheM gaiNDIgaimnA granthaka (gandy-gamna nodules ) kahA jAtA hai pAye jAte haiM / ye granthaka choTe choTe plaihika raktasrAvoM ke rUpa meM prakaTa hote haiM jinake bAda rakta kA aMzana tathA tantUrakarSa huA karatA hai / zleSajana ( collagen ) ke phUle hue tantuka (fibrils ) lohe ke raMgA ke bhare hue pAye jAte haiM jinake cAroM ora bAhyakAya mahAkozA ( foreign body giant cells ) rahA karate haiM / 2. plIhA ke atirikta anya jAlakAntazchadIya saMsthAna ke aMgoM vizeSakara yakRt tathA asthimajjA meM zoNAMzika kriyA vizeSa ho jAtI hai| unameM rakta kA raMgA (blood pigment ) khUba pAyA jAtA hai / 3. vRkka aura yakRt ke jIvitaka kozA khUba raMgAnvita ho jAte haiN| thor3A sA yakRt bar3ha jAtA hai usameM lohotkarSa ( siderosis ) pAI jAtI hai / pittarakti ke azma pittAzaya meM bahuta hote haiM jo pittAzmarI ke lakSaNa utpanna kara dete haiM / 4. asthimajjA meM paramacaya khUba hotA hai / tathA rakta ke lAla kaNoM ke punarjanana ke lie kriyAe~ druta gati se calatI haiM / vaha gahare lAla raMga kI ho jAtI hai / yaha paramacaya RjuruhIya hotA hai bRhadraktaruhIya ( megaloblastic ) nahIM milatA / karoTi kI asthiyoM meM asthi vairalya ( rarefaction of skull bones ) khUba hotA hai usakA kAraNa majjA meM paramacaya kA honA tathA daNDikAoM (trabeculae) kA pracUSaNa hai / For Private and Personal Use Only

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rudhira vaikArikI Tarka ne bahuta sundara upamA dekara kahA hai ki yadi zoNAMzika rogoM ko putra mAneM to plIhA ko unakI mAtA mAnanA pdd'egaa| para inakA janaka eka hai yA aneka isakA koI patA abhI taka nahIM laga skaa| zoNAMzika pANDu meM mukhyatayA gulikotkarSa ( spherulocytosis ) hotA hai / isI gulikotkarSa ke kAraNa lAlakaNoM kI bhaMguratA bar3ha jAtI hai tathA usake kAraNa zoNAMzana kI pravRtti bar3ha jAtI hai| aba yadi plIhA ko zastrakarma dvArA nikAla diyA jAve to kucha hI dinoM meM pANDu naSTa ho jAtA hai jo phira kabhI bhI nahIM lauTatA / lAla kaNoM kI saMkhyA bar3hakara prAkRtika taka A jAtI hai| tathA mUtrapitti kA bahirgamana ruka jAtA hai| itanA saba hone para bhI lAlakaNoM kI bhaMguratA jahA~ kI tahA~ hI banI rahatI hai| Dausana ne 27 varSa pUrva jisakA plIhoccheda huA thA aise manuSya kA varNana karate hue likhA hai ki vaha pUrNa svastha thA para usake lAlakoM kI bhaMguratA abhI taka prakRta se Upara rahatI thii| isa bhaMguratA ke lie plIhA ko doSI nahIM ThaharAyA jA sktaa| adhika ugra lAlakoM ko usake antazchadIya kozA (jaba ve srotasoM se hokara gujarate haiM taba naSTa kara kara dete haiM / kauna unameM bhaMguratA kI vRddhi karatA hai yaha nahIM hI kahA jA sktaa| laiDararIya prakAra kA tIna zorNAzika raktakSaya ( Ledrer type acute haemolytic anaemia)-isakA jJAna 1925 meM laiMDarara ne kiyA thA isameM pANDuratA, pANDu, daurbalya, jvara, zoNAMzana druta gati se milatA hai jisake kAraNa khUba raktakSaya hotA hai sitakAyANUrakarSa milatA hai tathA raktarahoM kI saMkhyA bar3ha jAtI hai| isameM lohotkarSa upasthita rahatA hai| lAlakaNoM kI bhaMguratA prakRta pAI jAtI hai| isakA kAraNa ajJAta hai| raktAvasecana se isa ghAtaka roga meM paryApta lAbha hotA hai| dAtrakozIya raktakSaya ( Sickle cell anaemia) dAtra (ha~siyA) ke samAna arddhacandrAkAra rUdhirANuoM kI upasthiti jahA~ hotI hai vahA~ dAtrakozIya raktakSaya kI kalpanA karalI jAtI hai| dAtrakozIya raktakSaya kA kyA kAraNa hai isakA patA nahIM laga sakA hai| sAdhAraNa rudhirANu kA yadi havA tathA AksIjana se samparka kama kara diyA jAya aura vAtAvaraNa amla banatA calA jAve to ve apanI prakRta AkRti ko khone lagate haiM aura arddhacandrAkRtika hote cale jAte haiN| dAtrakozIya raktakSaya se pIDita meM aisA kyoM hotA hai isakA pUrA pUrA patA abhI taka nahIM laga sakA hai| __yaha na kevala kauTumbika ( familial ) api tu eka jAtigata (racial ) roga hai| aura aphrIkA ke habaziyoM meM hI pAyA jAtA hai| isakA sarvaprathama varNana hairika ne 1910 meM kiyA thaa| yaha bAlakoM ke zoNAMzika raktakSaya tathA zoNAMzika pANDu se paryApta milatA hai| yaha eka sahaja prakAra kA roga hai jo janma ke samaya bhI upasthita rahatA hai| yaha paitRka ( hereditary) tathA kauTumbika ( familial) hotA hai| For Private and Personal Use Only

Page #1024
634 vikRtivijJAna dAtrakozIya raktakSaya meM nimnalikhita lakSaNa milA karate haiM1. raktakSaya tathA pAMDu kI upasthiti rahatI hai| 2. asthiyoM tathA asthisandhiyoM meM zUla rahatA hai| eksare se asthisuSiratA ( osteo porosis ) pAI jAtI hai / 3. zoNAMzika kAmalA mRdu svarUpa kA pAyA jAtA hai| 4. jvara samaya samaya para bar3hA karatA hai| 5. plIhAbhivRddhi huI rahatI hai| isa roga meM plIhoccheda se koI lAbha nahIM huA krtaa| sAtha hI rogI ke rakta kA citra bhI sadaiva eka samAna nahIM rahA karatA hai| kabhI kabhI raktakSaya bahuta prabala ho jAtA hai| raktakaNoM meM asamatotkarSa (anisocytosis) tathA bahuvarNatA ( polychromasia ) pAI jAtI hai| sitakozotkarSa pAyA jAtA hai| sitakozAoM meM bRhadratakozA milate haiM Rjuruha paryApta hote haiM tathA jAlakIya kozIya gaNana paryApta ucca rahatA hai| zizuoM tathA navajAtoM ke raktakSaya zoNarahotkarSa zaizavIya-navajAta zizu meM prAyaH milane vAlA para gambhIra svarUpa kA jo raktakSaya pAyA jAtA hai vaha zaizavIya zoNaruhotkarSa ( erythroblastosis foetalis) ke sAtha milatI hai| yaha avasthA garbhAzaya meM bhI bhrUNa ko kaSTa pahu~cA sakatI hai tathA kabhI kabhI zizu ke janma lene ke bAda taka apanA rUpa pragaTa nahIM krtii| yaha eka prakAra kA gambhIra svarUpa kA raktakSaya hotA hai jo paramavarNika athavA sUkSmavarNika kisI bhI prakAra kA ho sakatA hai| isa roga meM raktasrAva kI durdamanIya pravRtti antra yA anya zleSmalakalA se hotI huI dekhI jAtI hai| ina raktasrAvoM ke rokane kA ekamAtra sAdhana raktAvasecana hI hotA hai| isa roga ke sAtha sAtha zoNAMzika pANDu bhI mila sakatA hai jisake kAraNa janma ke samaya jo zizu ke zarIra para lepa (vernix caseosa) car3hA hotA hai vaha sunaharI raMga kA hotA hai| isa roga ke tIna rUpa dekhe jA sakate haiM: 1. zaizavIya sahajodakatA ( congenital hydrops foetalis ) isa avasthA meM mRtagarbha (still birth) kA janma hotA hai tathA usakI sampUrNa lasyaguhAoM meM zophIya tarala bharA huA hotA hai| yakRt parivRddha hotA hai isake srotasAbhoM meM sakriya raktasaMjananakriyA calatI huI pAI jAtI hai| aparA prakRta AkAra se bar3A aura zothayukta hotA hai| 2. navajAtIya gambhIra kAmalA (icterus gravis neonatorum)isameM janma ke samaya yA usake thor3e samaya bAda bAlaka ko gaharA zogAMzika raktakSaya pAyA jAtA hai| jisake kAraNa jIvana ke prathama saptAha meM hI prAyaH bAlaka kAlakavalita For Private and Personal Use Only

Page #1025
afar vaikArikI 635 1 ho jAtA hai / isameM bhI aparA prakRta AkAra se bar3A hotA hai tathA garbha kA lepa pIlA pAyA jAtA hai / raktakSaya paramavarNika hotA hai / asthisauSirya, yakRvRddhi, plaihika vRddhi tathA majjA ke bAhara samasaMjanana kriyA khUba hotI huI dekhI jAtI hai / 3. navajAtIya zoNAMzika raktakSaya ( haemolytic anaemia of the new born ) - yaha jIvana ke Arambhika saptAhoM meM dekhA jAtA hai / isameM mRdu svarUpa kA raktakSaya pAyA jAtA hai jisake sAtha pANDu sadA upasthita nahIM rahA karatA / yaha raktakSaya paramavarNika hotA hai / lAlakaNa 10 lAkha pra. gha. mi. mI. taka raha jA sakate haiN| rakta meM sanyaSTikozAoM tathA jAlakIya kozAoM kI upasthiti isakA pramANa hai ki raktasaMjanana kendra pUre vega ke sAtha kArya kara rahe haiM / plIhAbhivRddhi tathA mUtra meM mUtrapittijana tathA mUtrapitti kA khUba utsarga dekhA jAtA hai / ina tInoM rUpoM kA sambandha kAraka ( rh factor ) se hai jisakA varNana vistAra ke sAtha pahale ho cukA hai| phAnayakSIya raktakSaya ( Von Jaksch's anaemia ) - ise zizuoM kA plaihika raktakSaya ( splenic anaemia of the infants ) bhI kahA jAtA hai / yaha eka prakAra kA raktakSaya hai jo zizuoM meM 2 varSa kI avasthA taka pAyA jAtA hai / sAtha meM yakRt bar3hA huA hotA hai tathA rakta meM sitakozotkarSa bhI pAyA jAtA hai / isa roga meM rakta ke lAlakarNo kI saMkhyA pratighana milImITara 10 lAkha yA usase bhI kama ho jAtI hai / unake AkAra tathA rUpa meM parivartana ho jAtA hai abhiraMjanA meM bhI antara A jAtA hai / rakta meM Rjuruha tathA jAlakakAyANu pracura saMkhyA meM milate haiM / kabhI kabhI bRhadraktaruha ( megaloblasts ) bhI mila jAte haiM / / rakta ke zvetakaNoM kA gaNana 50000 pratighana milImITara yA usase bhI adhika calA jAtA hai / inameM bhI bahunyaSTikozAoM meM mukhyatayA vRddhi hotI hai / usake bAda lasakAyANuoM kI saMkhyA bhI bar3hI huI hotI hai / majjakozA ( myelocytes ) bhI dekhe jAte haiM / isa roga meM zoNAMzika prakAra kA raktakSaya pAyA jAyA karatA hai / phAnaDena barSIya pratikriyA apratyakSa milatI hai / plIhA kI AkAra meM aura usakI dRDhatA meM vRddhi isa roga meM dekhI jAtI hai / plIhoccheda karane para rakta meM sanyaSTikozAoM kI vRddhi hone lagatI hai aura bAlaka kI avasthA meM sudhAra hone lagatA hai / jina zizuoM ko yaha raktakSaya dekhA jAtA hai unake andara anya rogoM kI upasthiti kA bhI dhyAna rakhanA caahie| kisI ko phakka, kisI ko yakSmA athavA kisI ko sahaja phiraMga kI upasthiti dekhI jA sakatI hai / inhIM rogoM ke kAraNa rakta meM ye saba parivartana hote haiM aisA bhI bahutoM kA anumAna hai / raktacitra sitaraktatA (lyUkImiyA ) se milatA julatA hone ke kAraNa nidAna meM kabhI kabhI kaThinAI A sakatI hai para vAstavika sitaraktatA zizuoM meM kabhI For Private and Personal Use Only

Page #1026
36 vikRtivijJAna pAyI nahIM jAtI isalie isa roga ke nidAna meM kaThinAI nahIM par3anI cAhie / isa roga meM raMgadezanA 0.6 taka ho jAtI hai| nAsA tathA masUr3oM se raktasrAva kI pravRtti bhI prAyaH pAI jAtI hai / kUlIya raktakSaya ( Cooley's anaemia ) jise sitaraktaruhIya ( leuco-erythroblastic anaemia ) kahate haiM jo ki eka prakAra kA bhUmadhyasAgara ina kSetroM meM basI huI jAtiyoM meM bahudhA milatA hai isameM bhI phAna jakSIya raktakSaya se milate julate lakSaNa pAye jAte haiM / isameM plIhAbhivRddhi, asthimajjA meM paramacaya ke sAtha asthi sauSurya ( osteoporosis ) khUba pAyA jAtA hai / yaha paramavarNika tathA sUkSmavargika donoM prakAra kA hotA hai isameM rakta ke zvetakaNa tathA lAlaka donoM hI kama ho jAte haiM isI se ise sitaraktaruhIya nAma diyA gayA hai| lAlakaNa Rjuruha yA raktaruha hote haiM tathA zvetakaNa majjakozA milate haiM / isa roga meM asthiyoM para vizeSa prabhAva par3atA hai jo barAbara supira hotI calI jAtI haiM / Acharya Shri Kailassagarsuri Gyanmandir plaihika raktakSaya yA baiNTIyAmaya (Splenic anaemia or Banti's disease) isakA kAraNa abhI taka ajJAta hai / yaha bAlakoM aura vayaskoM donoM meM milatA hai para prauDhoM meM prAyaH dekhane meM nahIM AtA hai / isa roga meM itane lakSaNa mahatva ke milate haiM 1. dhIre dhIre roga kI pragati / 2. mahAsrota ke kisI bhI bhAga se raktasrAva / 3. plIhA kI uttarottara vRddhi / 4. upavargika raktakSaya kA zanaiH zanaiH utkarSa / 5. yakRt tathA plIhA meM tantUtkarSa / 6. jalodara | isa roga meM dhIre dhIre bar3ha kara plIhA bahuta bar3I ho jAtI hai / raktakSaya sUkSmakAyika upavarNika hotA hai / dezanA 0.5 se 0.7 taka milatI haiM / rakta ke lAlakaNoM meM Arambha meM thor3I kamI AtI hai para Antrika tIvra raktasrAva ke uparAnta yA mRtyu ke pUrva lAlakaNa gaNana paryApta kama ho jAtA hai / mahAsrota meM sthita kisI sirA ke phaTane se raktasrAva ho sakatA hai yA vahA~ kI raktavAhiniyoM meM se thor3A thor3A rakta cUtA rahatA hai jisake kAraNa raktavamana yA raktAtisAra kI sthiti barAbara pAI jAtI hai / mala meM jIvarakta ( occult blood) pAyA jAyA karatA hai / isa roga meM raktacitra meM sanyaSTi kozA kama milate haiM jo milate haiM ve Rjuruha hI hote haiM / jAlaka kozAoM kA sarvathA abhAva dikhAI detA hai / rakta-kozIya punarjanana kI sakriyatA kA koI pramANa isa roga meM nahIM hI milatA hai / For Private and Personal Use Only

Page #1027
rudhira vaikArikI 637. I sitakozApakarSa ( leucopenia ) isa roga kA mukhya lakSaNa hai / sitakozA 3000 prati gha0 mi0 mI0 taka kama ho jAte haiM / bahvAkArI aura lasakozA donoM meM hI kamI AtI hai| isameM phAnaDena barSIya pratikriyA apratyakSa aura assyAtmaka ( positive indirect ) hotI hai / rakta ke bimbANu prAyaH prakRta saMkhyA meM rahate haiM para kabhI kabhI unakI saMkhyA bhI ghaTI huI dekhI jAyA karatI hai / isa roga meM zoNAMzana ke kAraNa kA patA nahIM calatA / isa roga meM plIhA kI atizaya vRddhi huA karatI hai / para vRddhi ke sAtha usakA svarUpa bigar3atA nahIM hai / usake tAntava saMdhAra meM vRddhi hotI hai| plIhA ke srotasAbha khUba caur3e ho jAte haiM jinameM antazchadIya stara andara ko nikalA huA hotA hai| mAlapIghiya kAryoM kI dhamaniyoM ke cAroM ora kucha raktasrAva milatA hai aura apittamehika pANDu kI taraha inase sambandhita gaiNDIgaimnAgranthaka pAye jAte haiM / plIhA ke bAda yakRt bar3hatA hai / Age calakara yaha choTA hone lagatA hai usameM granthaka utpanna hone lagate haiM aura vaha yakRddAlyUtkarSIya ( cirrhotic ) rUpa dhAraNa kara letA hai / laihika sirA ( splenic vein ) bhI kAphI visphArita aura sthUlita ho jAtI hai / usameM jIrNa zotha pAyA jAtA hai tathA usameM ghanAstrotkarSa bhI ho sakatA hai / yaha jIrNa zotha kezikA bhAjisirA tathA usakI zAkhA prazAkhAoM taka ko prabhAvita kara letA hai jisake kAraNa vahA~ bhI ghanAsrotkarSa mila sakatA hai / Age calakara yakRt meM tantUtkarSa ke hone aura kezikA bhAji ( pratihAriNI ) sirA ke prabhAvita hone se sirAvarodha ( portal obstruction ) ho jAtA hai isa kAraNa anya kI nizceSTa adhiraktatA utpanna ho jAtI hai jo jalodara ( ascites ) kA kAraNa banatI hai / jahA~ para sAMsthAnika ( systemic ) tathA kezikA bhAji ( portal ) sirAoM kA antarmela ( anastomosis ) hotA hai vahA~ sirotphulla ( varices ) banate haiM aura phaTa jAyA karate haiM / isa roga meM plIhoccheda se paryApta lAbha hotA hai aisA kahA jAtA hai / sIsaviSatA, maleriyA, blaika vATara phIvara aura saipTIsimiyA dvArA zoNAMzana kI pravRtti ke sambandha meM sambandhita sthaloM para vicAra kiyA jAyagA / bahuko raktatA ( Polycythaemia Rubra ) ise plIha vRddhijanya bahukozAraktatA ( splenomegalic polycythaemia) atizayaraktatA ( erythraemia) athavA vAkveja kA roga (vaquez's disease) Adi kaI nAmoM se pukArate haiM / ise eka prakAra kA jAlakoskarSa ( reticulosis ) mAnA jAtA hai aura rakta ke lAlakaNoM kI saMkhyA isa roga meM bahuta adhika bar3ha jAtI hai / eka ghana milImiTara meM 1 karor3a 30 lAkha taka lAlakaNa pAye jA sakate haiM / lAlakarNI ke itanA bar3ha jAne para bhI zoNavartuli kI mAtrA meM koI vRddhi nahIM hotI 76, 80 vi0 For Private and Personal Use Only

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138 vikRtivijJAna isa kAraNa isa roga meM raMgadezanA bahudhA 1 se nIce hI rahA karatA hai| isa roga kA dUsarA mahattvapUrNa lakSaNa hotA hai sitakozotkarSa kA / rakta meM sitakozAoM kI saMkhyA 25000 pratighana milImITara taka dekhI jA sakatI hai| isa roga kA tIsarA mukhya lakSaNa hotA hai plIhAbhivRddhi kaa| rakta majjA meM lAlakaNa nirmANa kA kArya drutagati se huA karatA hai tathA mRtyUttara parIkSaNa para ise saralatA se pramANita bhI kiyA jA sakatA hai| rogI ke zarIra meM rakta kA Ayatana ( total blood volume) bhI bahuta bar3ha jAtA hai| zarIra kI sirAe~ khUba visphArita hotI huI dekhI jAtI haiN| unameM khUba rakta bharA rahatA hai| adhika rakta ke kAraNa rogI kA varNa zyAva par3a jAtA hai| zyAvatA kA mukhya kAraNa hotA hai rakta pravAha kI gati meM mandatA kA honA / rakta meM kozAoM kI adhikatA hone se rakta ke Alagatva (viscosity ) meM vRddhi ho jAtI hai| isa roga ke kAraNa kA patA nahIM lagatA para yataH isameM asthimajjA kA paramacaya hotA hai tathA plIhA kI abhivRddhi dekhI jAtI hai aura eka prakAra ke ho kozA kI atizaya vRddhi hotI hai isase ise jAlakotkarSa ( reticulosis) kahA jA sakatA hai| isa roga meM aGgaliyoM ke agrabhAga sthUla ho jAte haiM ( clubbing of the fingures ) yadi isa roga se pIDita rogI kA kAna umeTha diyA jAya to sthAnIya sirAe~ phaTa kara unase kAle raMga kA rakta bahane lagatA hai| __paramabala bahukozAraktatA ( Polycy thaemia hypertonica ) eka dUsarA prakAra hai ise gAyasbauka kA roga ( Gaisbock's disease ) kahA karate haiN| isameM uparyukta roga ke saba lakSaNa milate haiM para palIhAbhivRddhi nahIM hotI sAtha hI isa roga meM rakta pIDana ( blood pressure ) kAphI bar3ha jAtA hai| isase dhamanI jAraThya ( arterio-sclerosis) bhI milatA hai| isa roga kA pariNAma hRdabheda, maskiSkagataraktasrAva athavA ghanAsrotkarSa meM hone ke kAraNa 6 varSa meM mRtyu ho jAtI hai| sitaraktatA ( Leukaemia) ise sitotkarSa ( leucosis ) athavA sitakozIya raktatA ( leucocythaemia) ina do nAmoM se bhI pukArA jAtA hai| isa roga ke andara una vikAroM kA samAveza kiyA jAtA hai jo rakta aura raktotpAdaka aGgoM kI vikRti se utpanna hote haiN| inase pIDita manuSya kA zarIra kRza hotA calA jAtA hai vaha uttarottara durbala hotA huA dekhA jAtA hai tathA raktasrAva se pIDita rahatA hai| saba prakAra kI sitaraktatAoM meM kucha lakSaNa samAna hote haiN| jAlakAntazchadIya For Private and Personal Use Only

Page #1029
rudhira vaikArikI 636 saMsthAna meM paramacaya anivAryataH pAyA jAtA hai jisake kAraNa plIhA, yakRt tathA lasIkA pranthiyoM meM parivRddhi pAI jAyA karatI hai| asthimajjA ke sitarahIya kozAoM kA paramacaya ( hyperplasia of the leucoblastic cells of the bone manow ) bhI mahattvapUrNa hai jisake kAraNa asthi kI majjA kA sthAna vistRta ho jAtA hai aura asthi kI suSiratA bar3hatI jAtI hai| jisake kAraNa asthiyoM meM zUlotpatti bhI pAI jAyA karatI hai| ina sitarahIya UtiyoM kI atizaya kriyAzIlatA ke kAraNa raktapravAha meM apragalbha yA aprakRta (artificial) zvetakozA bahuta bar3I saMkhyA meM prakaTa hone lagate haiN| rakta ke andara bahuta bar3I saMkhyA meM zvetakaNoM yA zvetakoM ke pUrvajoM kI upasthiti kA nAma hI lyUkImiyA yA sitaraktatA diyA jA rahA hai| sitaraktatA ke sAtha sAtha raktakSaya bhI pAyA jAtA hai jo kucha gambhIra svarUpa kA hotA hai| jisake kAraNa hRtpezI kA ajArakIya (anoxaemic ) snaihika vihAsa taka kara detA hai jisake kAraNa zvAsakRcchratA (dyspnoea) tathA hRkampa ( heart palpitation ) utpanna ho jAtA hai| yakRt tathA vRkkoM meM bhI snaihika parivartana usake kAraNa dekhe jA sakate haiN| sitaraktatA ke sAtha raktasrAva kI paramparA bhI jur3I rahatI hai| yaha raktasrAva zleSmala kalAoM meM yA lasyakalAoM meM hotA hai| nAka se bAra bAra nakasIra phUTane para aise rogI ke rakta kI parIkSA karake dekhanA cAhie ki kahIM vaha sitaraktatA se to pIDita nahIM hai| aise rogiyoM meM jo durvala aura kRza hote cale jAte haiM kisI bhI upasarga se pIDita hone kI unameM sadaiva AzaGkA banI rahA karatI hai| jvara bhI isa roga meM mila sakatA hai vaha tIvrasitaraktatA meM vizeSarUpa se pAyA jAtA hai aura anyatra bhI milatA hai / rakta ke kozAoM kI atyadhika TUTa phUTa ke kAraNa rakta kI tathA mUtra kI mihikAmla rAzi (uric acid content) meM kAphI vRddhi dekhI jAyA karatI hai| kabhI kabhI maNDAbhavihrAsa bhI dekhA jAyA karatA hai| sitaraktatA tIna prakAra ke sitakozAoM kI bahudhA milA karatI hai1. kaNAtmakasitakozAjanya / 2. lasIya sitakozAjanya, tathA 3. ekakAyANu sitakozAjanya / uparokta tInoM prakAra kI sitaraktatAoM ke tIvra aura jIrNa donoM hI svarUpa dekhane meM Ate haiN| kaNIya sitakozAoM kA janma asthimajjA se hotA hai| lasakAyANu kI utpatti lasagranthiyoM evaM zarIrastha lasAbha Uti se hotI hai tathA eka kAyANuoM kI utpatti jAlakAntazchadIya saMsthAna se huA karatI hai| aba hama vividha sitaraktatAoM kA varNana saMkSepa meM isalie karate haiM ki pAThaka unase paricita ho sakeM majjAjanya sitaraktatA (Myelogenous Leukaemia ) yaha tIvra aura jIrNa donoM rUpoM meM ho sakatA hai para tIvra rUpa bahuta hI kama milatA hai| tIvra rUpa eka yA do mAsa taka rahatA hai isameM raktasrAvIya pravRtti bahuta For Private and Personal Use Only

Page #1030
140 vikRtivijJAna adhika hotI hai| isameM sitakAyANu 90% majjaruha ( myeloblast ) huA karate haiM / tIvra svarUpa meM lAlakaNoM kI saMkhyA bahuta ghaTa jAtI hai| Adhunika khoja se patA calA hai ki tIvra sitaraktatA ke jo rogI lasakozIya sitaraktatA ke mAne jAte the ve bhI majjAjanya sitaraktatA ke hI hote haiM yadyapi unameM Arambha meM lasIya sitakozAoM kA Adhikya rahatA hai| __ majjAjanya sitaraktatA kA jIrNa svarUpa prAyazaH dekhA jAtA hai aura milatA bhI bahuta hai| isa roga meM kaNAtmaka sitakozA (granular leucocytes ) kI saMkhyA bahuta adhika bar3ha jAtI hai| kaNAtmaka sitakozA apane pUrvaja ( primitive) tathA vayaska ( adult ) donoM rUpoM meM pAye jAte haiN| ina donoM prakAra ke sitakozAoM meM bahvAkArI, upasipriya tathA kSArapriya tInoM hI kaNAtmaka kozA meM se koI bhI pAye jA sakate haiN| roga ke Arambha meM bahvAkArI agaNita saMkhyA meM milA karate haiN| parantu Age cala kara majjAkozA ( myelocytes ) bar3hane lagate haiM aura sakala gaNana kA 50 pratizata inhIM majjakozAoM kA dekhA jAtA hai| majjakozA ke sambandha meM likhA haiMyelocyte is a large cell about double the size of a polymorphonuclear with a lobed or indented nucleus and plenty of cytoplasm containing granules which may be fine and neutrophil or coarse and eosinophil or basophil ki majakozA eka bar3e AkAra kA kozA hotA hai jo eka bahvAkArI sitakozA se dugunA bar3A hotA hai| usakI nyaSTi khaNDoM meM vibhakta yA dantura hotI hai jisameM prabhUta mAtrA meM kozArasa pAyA jAtA hai jinameM kaNa hote haiM ye kaNa sUkSma kIbarajya (nyUTrophila) yA rUkSa upasiraMjya athavA pITharaJjya hote haiN| majakozAoM ke bhI pUrvaja jinheM majaruha ( myeloblast ) kahate haiM ve isa roga ke tIvrarUpa meM yA jaba rogI kA antakAla nikaTa AtA hai taba dekhe jAyA karate haiN| uparokta sitakAyANuoM kA sakalagaNana 50 sahasra se lekara 10 lAkha taka ho sakatA hai / majAbha uti ke saba ghaTaka isa apriya anRju kriyA meM bhAga lete haiM / jise hama majjotkarSa ( myelosis ) kaha sakate haiN| lAlakaNoM ke pUrvaja bhI isa roga meM rakta meM paryApta saMkhyA meM dekhe jA sakate haiN| RjuruhoM kI saMkhyA isa roga meM ghAtaka raktakSaya kI apekSA bahuta adhika milA karatI hai| kabhI-kabhI paramakAyANu ( macrocytes ) tathA bRhadraktaruha ( megaloblasts ) paryApta saMkhyA meM dRggocara hone lagate haiM / jaisA ki abhI batalAyA hai isa roga ke Arambha meM bahvAkArI sitakozA aura usake pUrvaja majakozA bar3he hue milate haiN| Age cala kara upasipriya tathA pITharaJjya sitakozA aura unake pUrvajoM kI saMkhyA bar3hane lagatI hai aura ve raktapravAha meM prakaTa hone lagate haiN| For Private and Personal Use Only

Page #1031
rudhira vaikArikI 641 rogArambha meM rakta ke lAlakaNoM kI saMkhyA meM koI mahattva kI kamI prakaTa nahIM hotI para Age cala kara uttarottara lAlakaNoM kI kamI hone lagatI hai aura raktakSaya bar3hane lagatA hai| usakA kAraNa yaha hai ki lAlakaNa saMjanaka Uti meM majAbha kozAoM kI bhIr3a laga jAtI hai jo usake prakRta kArya meM paryApta aura sthAyI bAdhA DAlate haiN| kama hote-hote lAlakaNoM kI saMkhyA 10 lAkha pratighana milImITara taka jA sakatI hai| isa majjotkarSa meM bRhannyaSTikozA (megacarycytes ) bhI khUba bhAga lete haiM / jisake kAraNa rakta meM bimbANuoM kI saMkhyA meM khUba vRddhi hotI hai| rakta meM ye vRhannyaSTikozA bhI upasthita dekhe jA sakate haiN| inakI saMkhyA 10 se 20 lAkha taka pahu~ca jAtI hai| ___ kalpanA kIjie eka aise rakta citra kI jisameM 10 lAkha lAlakaNa ho 10 lAkha zvetakaNa hoM tathA 10 lAkha hI bimbANu ho !! kitanA bhayAnaka hogA vaha dRzya / para isa roga meM yaha bhI sambhava hai| yataH lasakAyANu asthimajA dvArA nahIM banate isalie isa roga meM unakA pratizata gaNana bahuta kama ho jAtA hai| uparokta vivaraNa ke prakAza meM yadi hama vividha aMgoM kA dhyAna deM to patA calegA ki roga kA mukhya aura ekamAtra AdhAra majjAbha UtiyoM kI sitaruhIya kriyAzIlatA kI atimAtra vRddhi hai| isameM asthi kI lAlamajjA apragalbha sitakozAoM se DaTakara bhara jAtI hai / asthi kI pItamajjA bhI apanI niSkriyatA kA parityAga karake sakriyarUpa meM ina sitakozA pUrvajoM kI utpatti meM paramavega se saMlagna ho jAtI hai| pItamajjA samaya-samaya para raMga badalA karatI hai / kabhI vaha dhUsara varNa dhAraNa karatI hai to kabhI babhra to kabhI laal| asthimajjA meM yadyapi mukhyatayA klIbaraMjya bahvAkArI sitakozA aura usake pUrvaja majakozA pAye jAte haiM para upasipriya tathA kSArapriya yA pITharaMjya sitakozA aura unake pUrvajoM kI upasthiti bhI kama nahIM hotii| roga kI antima avasthA meM akaNAtmaka majakozA pracura saMkhyA meM rakta meM praveza karate hue pAye jAte haiN| plIhA isa roga meM AkAza pAtAla eka kara detI hai| DhAI chaTaoNka ke prakRta bhAra vAlI plIhA sampUrNa udara kSetra ko bhara detI hai| usakA bhAra 10 sera taka jA sakatA hai / isakA goda aura saMdhAra khUba bar3hatA hai jinameM mAlapiSiyana kAyAe~ (malpighian bodies ) aspaSTatayA dikhalAI par3atI haiN| usakA gorda saba prakAra ke kaNAtmaka sitakozAoM se TuMsakara bharA hotA hai| plIhA kI kSudra vAhiniyoM meM sitakozIya ghanAsroM ke dvArA anekoM RNAstra ( infarcts ) bana jAte haiM aura unake ApIta kSetra itastataH dekhane meM Ate haiN| plIhA kA varNa asita (dark ) ho jAtA hai| aNvIkSaNa karane para plIhA se lasAbhaUti tirohita ho jAtI hai| tathA plIhA ke goda kA tathA asthimajjA kI racanA lagabhaga eka ho jAtI hai kyoMki donoM hI majAbha kozAoM se bhare rahate haiM unameM Rjuruha ( normoblasts) bhI pAye jAte haiN| jahA~ yaha satya hai ki plIhA ina sitakozAoM ko rokakara unheM naSTa karane kA asaphala prayAsa karatI For Private and Personal Use Only

Page #1032
642 vikRtivijJAna hai vahA~ yaha bhI satya mAnanA cAhie ki isa roga meM plIhA apanI asaliyata para utara AtI hai arthAt garbhAvasthA meM rakta nirmANa kA jo kArya vaha karatI thI vahI kArya punaH Arambha kara detI hai aura sitakozAoM kI vRddhi meM sakriya bhAga letI hai| yaha kATane meM bahuta kar3I ho jAtI hai aura kaTA huA bhAga gahare lAla raMga kA dikhalAI detA hai jisake bIca-bIca meM zveta varNa ke sidhma itastataH phaile hue rahate haiN| loha raMgA bhI svalpa mAtrA meM plIhA ke andara upasthita rahatA hai| anya lasagranthiyoM meM bhI isI prakAra kA autikIya citra dekhA jA sakatA hai aura ye granthiyA~ apane AkAra se kucha bar3I ho jAtI haiN| zarIra ke sabhI aMga pratyaMgoM meM ina sitakozAoM kI bharamAra dekhI jA sakatI hai| hRdaya tathA vRkkoM meM ina kozAoM ke kAraNa zveta arbuda jaise puMja ( white tumour like masses ) dekhe jAte haiN| yakRt bhI thor3A bar3A ho jAtA hai aura usameM ina kaNAtmaka sitakozAoM kI khUba bharamAra pAI jAtI hai| hRdaya, yakRt aura vRkka tInoM meM sneha kA saMcaya hone lagatA hai| sitakozAoM ke bharamAra ke kAraNa yakRt kozAoM meM paryApta apuSTi bhI dekhI jA sakatI hai| hRtpezI, yakRt tathA vRkkoM meM snaihika vihvAsa ke lakSaNa dekhe jA sakate haiM / kabhI kabhI ina aMgoM kA maNDAbha vihAsa bhI hotA huA dekhA jAtA hai| yakRt . kI AkAravRddhi kA kAraNa yakRt ke andara sthAna sthAna para majAbha kozAoM kI bharamAra hotI hai| yaha bharamAra bAhara se na hokara kucha vidvAnoM ke mata meM Antarika ghaTanA kI hI prakAzikA hai| garbha meM yakRt dvArA raktasaMjanana kA kArya hI punaH cAlU ho gayA to usakA pramANa ise mAnA gayA hai| vAhiniyoM meM majjAbhakozA bhara jAte haiM aura unake bAhara bhI nikala kara UtiyoM taka isa prakAra vyApta ho jAte haiM jaise kisI arbudika vRddhi ke kozA ho| isI se sitaraktatA ko arbudika vRddhi bhI mAnA jAtA hai| __ isa roga se pIDita vyakti tIna se dasa varSa taka jI sakatA hai| nAsA se raktasrAva kA honA isa roga meM pramukhatayA pAyA jAtA hai jaisA ki pahale bhI kahA jA cukA hai sAtha hI dRSTipaTala, tvacA, garbhAzaya, AmAzaya, Antra, vRkka tathA phuphphusoM se bhI raktastrAva hotA huA dekhA jA sakatA hai| sitakozAoM ke atyadhika vighaTana ke kAraNa rakta tathA mUtra meM mihikAmla (uric acid ) kI mAtrA meM vRddhi huI bhI pAI jAtI hai| isa roga meM rakta kA raMga gulAbI ( pinkinch ) ho jAtA hai tathA raMgadezanA 0.5 se 0.7 taka pAI jAtI hai| lAlakoM kI kamI ke kAraNa isa roga ko sitAraktatA ( leukanaemia) bhI kaha dete haiN| bahuvarNapriyatA tathA vindukIya kSIrapriyatA ( punctate basophilia) yahA~ khUba milate haiN| isa roga ke kabhI kabhI daure par3A karate haiM jaba rakta ke lAlakoM kI saMkhyA aura bhI kama ho jAyA karatI hai| For Private and Personal Use Only

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rudhira vaikArikI 43 jIrNa sakozIya sitaraktatA ( Chronic lymphatic leukaemia ) hama yahA~ pahale jIrNa sakozIya sitaraktatA kA hI varNana upasthita kareMge aura tIvra sitaraktatA kA varNana usake pazcAt diyA jAyagA / yaha prauDhAvasthA kA roga hai aura 40 varSa kI Ayu ke pazcAt prAyaH dekhane meM AtA hai / jIrNa sakozIya sitaraktatA meM lasIya sitakozA aura unake pUrvajoM kI atyadhika vRddhi hotI hai / inakI janmabhUmi zarIrastha sampUrNa lAbha Uti (lymp* hoid tissue) hai / astu, jina jina aMgoM meM yaha Uti pAI jAtI hai aba unakI khUba vRddhi hotI hai isa kAraNa isa roga kI mukhya vizeSatA milatI hai lasIkA granthiyoM plIhA tathA Antra kI lasIkA kUpikAoM ( lymphatic follicles of the intestinal tract ) kI paryApta vRddhi meM aMga khUba phUlate haiM / para plIhA kI vRddhi utanI nahIM hotI jitanI majjAjanya sitaraktatA meM pAI jA cukI hai / uttarottara daurbalya, raktakSaya, zleSmala kalAoM se raktasrAva kI atizaya pravRtti ke lakSaNa isa sitaraktatA meM bhI khUba pAye jAte haiM / lasakozIya sitaraktatA meM lasAbha kozAoM (lymphoid cells) kI pracuratA ke sAtha vRddhi dekhI jAtI hai / yaha vRddhi itanI taka ho sakatI hai ki zvetakaNoM ke sApekSa gaNana karane para 99% taka ve mila sakate haiN| vaise sAmAnyatayA 90% to ve isa roga meM bar3he hue dekhe hI jAte haiM / sakala gaNana karane para 50 sahasra se 1 lAkha taka inakI saMkhyA pratighana milImITara pAI jAtI hai / yaha saMkhyA majjAjanya sitaraktatA kI apekSA kama rahatI hai / isa saMkhyA meM 90% lasIkozAoM kA rahatA hai 1 lasIkozAoM meM bhI kSudra lasIkozA ( small lymphocytes ) mukhyatayA pAye jAte haiM / isa roga meM kSudra lasIkozA hI vizeSa karake bhAga letA hai / lasIruha ( lymphoblasts ) tathA majjakozA ( myelocytes ) Age calakara bar3hane lagate haiN| isa roga meM rakta ke lAlakarNI kI saMkhyA ghaTane lagatI hai / unake ghaTane se jo raktakSaya banatA hai vaha upavarNika prakAra kA hI hotA hai / yahA~ RjurUhoM kI thor3I sI saMkhyA pAI to jAtI hai para majjAjanya sitaraktatA kI apekSA bahuta kama rahatI hai / rakta ke lAlakaNa ghaTate ghaTate 10 lAkha pratighana milImITara taka raha jA sakate haiM / zleSmalakalAoM, masUr3oM, tvacA tathA anya aMgoM se raktastrAva hotA rahatA hai jisake kAraNa prazItAda ( scurvy ) kI zaMkA cikitsaka ko ho sakatI hai para raktaparIkSaNa karane para roga kI asaliyata kA patA laga jAtA hai / lasIkozAoM kA adhyayana karane para jJAta hotA hai ki unameM kozArasa ( cytoplam ) bahuta kama hotA hai jisake kAraNa aNvIkSaNa karane para kevala nagna nyaSTimAtra dikhalAI detI hai tathA kozArasa meM arajjyakaNa ( azurophil granules ) bhI prAyaH nahIM milA karate haiM / grIna ne eka mahattva kI bAta ina kSudra sitakozAoM ke bAre meM yaha batalAI hai ki rakta citra kA aNvIkSaNa yA avalokana karane para bahuta se kSudra lasIkozA mRtavat dikhalAI dete haiM inheM sitacihna ( smudge ) kaha kara usane For Private and Personal Use Only

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644 vikRtivijJAna pukArA hai / pUrvamajjAbha kozAoM kI utpatti bAda meM hotI hai yaha pahale hI kahA jA cukA hai / usakA mukhya kAraNa vaha uttejanA hai jo asthimajjA lasIkozAoM dvArA bharamAra karane se prApta karatI hai / asthimajjA ke svAbhAvika kArya meM bAdhA par3ane ke hI kAraNa raktasaMjananakriyA meM kamI Ane lagatI hai jo raktakSaya kA kAraNa banatI hai / para yaha bAdhA majjAjanya sitaraktatA ke barAbara nahIM hotI isa kAraNa yahA~ RjurUhoM kA nirmANa usakI apekSA bahuta kama dekhA jAtA hai / majjA kI prAkRtika kriyA meM bAdhA isa roga meM kucha dera meM hotI hai isa kAraNa vilambapUrvaka hI rakta ke bimbANuoM kI bhI saMkhyA yahA~ ghaTane lagatI hai / isake kAraNa raktasrAvI pravRtti aura bhI bar3ha jAtI hai / kabhI kabhI to ye bimbANu pUrNataH rakta se lupta ho jAte haiM / isI vicAra ke AdhAra para majjAjanya sitaraktatA tathA lasIkozIya sitaraktatA kA antara samajhane kA bhI acchA avasara hAtha lagA karatA hai / majjAjanya sitaraktatA meM raktakSaya jitanA adhika prakaTa hotA hai utanA lasIkozIya sitaraktatA meM nahIM vahA~ bRhadraktaruha bhI rakta meM khUba pAye jAte haiM tathA Rjuruha ( normoblasts ) bhI lasIkozIya sitaraktatAjanya raktakSaya meM ye kozA bahuta kama milate haiN| para raktabivANuoM kI kamI ke kAraNa tvacA meM raktasrAvI sidhma ( petechial ) bana jAte haiM / mala ke sAtha rakta AtA hai aura upavarNika raktakSaya kA Age calakara pUrNarUpa vikasita ho jAyA karatA hai / aba vividha aMgoM kA avalokana karane para asthimajjA meM isa roga ke Arambha meM jaba lasIkozAoM kA vahA~ jamAva hone lagatA hai to usameM Arambha meM itastataH lAbha Uti kI dvIpikAe~ ( islands of lymphoid tissue ) dekhane meM AtI haiM / Age calakara zanaiH zanaiH asthi kI pIta aura donoM prakAra kI majjA kA sthAna yaha lAbha Uti hI le letI hai / sthUla dRSTyA isakA svarUpa majjAjanya sitarakkatA se milatA julatA ho jAtA hai / lasIkozIya sitarakkatA meM plIhA kI sAmAnya vRddhi hotI hai para adhika jIrNa ho jAne para plIhA utanI hI bar3I ho jAtI hai jitanI ki majjAjanya sitaraktatA meM pAI jAtI hai| plIhA ke gorda meM lasIkozA bhara jAte haiM / lasI kUpikAe~ (lymph follicles ) paramacaya ko prApta ho jAtI haiM / mAlapoghiyana kAyAe~ isa roga meM surakSita rahatI haiM tathA kucha bar3ha bhI jAtI haiM / anya aMgoM meM bhI lasIkozA bhara jAte haiM vAhiniyA~ isase khUba bharI rahatI haiM / vAhiniyoM ke bAhara bhI kucha kozA jAkara usI prakAra bharamAra karate haiM jaise kisI arbuda ke kozA / isIlie sitaraktatA ko kucha loga zvetakaNoM kA arbuda hI mAnate haiM / yakRt ke pratihAriNIya mArgoM meM choTe choTe lasIkozIya granthaka bana jAte haiM / yakRt kI vAhiniyoM ke bAhara bhI bahuta se kozA bharamAra kie hote haiM kucha vidvAnoM kA kathana hai ki yaha bharamAra na hokara garbhakAlIna raktanirmANa prakriyA ko phira se For Private and Personal Use Only

Page #1035
rudhira vaikArikI 645 isa roga meM yakRt Arambha karatA hai usI kA pramANa yakRt Uti meM itastataH lasIkozAoM kI upasthiti hai / aura aneka apragalbha kozA jo yakRt meM pAye jAte haiM ve vahIM nirmita hote haiM / isa sabake kAraNa yakRt kI bhI vRddhi ho jAtI hai para vaha plIhA kI apekSA kama rahatI hai / vRkkoM, hRdaya, phuphphusa tathA anya aMgoM meM bhI lasIkozA itastataH bikhare hue aura bharamAra karate hue dekhe jAte haiM / santare ke svacA ke sagranthiyA~ bar3hakara arbudoM kI mAlA sI banA letI haiM aura eka barAbara taka bar3I aura alaga alaga rahatI huI dekhI jAtI haiM / ve na to sAtha abhilagna hotI haiM aura na unameM TUTa phUTa yA pUyana hI dekhA jAtA hai / isa roga meM upariSTha lasagranthiyA~ tathA Abhyantara lasagranthiyA~ donoM hI prabhAvita hotI haiM / granthiyA~ kucha apane prakRta rUpa se adhika mRdu ho jAtI haiM aura unakA varNa AdhUsara gulAbI ( greyish pink ) ho jAtA hai / aNvIkSaNadRSTyA parIkSaNa karane para unakI prakRta racanA naSTa huI dekhI jAtI hai / unake andara tulasIkozA tathA kucha bar3e pITharajya kozA bhare rahate haiM / lasagranthaka isa roga meM bahuta bar3ha jAte haiN| vizeSakara udarastha lasagranthakoM kI bahuta vRddhi hotI hai ve bar3hakara supArI ke AkAra taka pahu~ca jA sakate haiM / unake andara lasIkozAoM kI khUba bharamAra hotI hai jo unakI racanA ko bhI vikRta kara dete haiM / aNvIkSaNa karane para citra lasIsaMkaTArbuda jaisA hotA hai / vividha lasI UtiyoM meM vRddhi isa roga kI sAdhAraNa ghaTanA hai / tIvra sitaraktatA ( Acute Leukaemia ) ise sitaruhika sitaraktatA ( leucoblastic leukaemia ) bhI kahA jAtA hai / eka majjajanya tIvra sitaraktatA tathA lasIkozAjanya tIvra sitaraktatA meM AdarzayA bheda kiyA jA sakatA hai para vyavahAra meM inameM itanA kama antara hotA hai ki tIvra sitaraktatA ke nAma se donoM kA bodha hotA hai / aura donoM ko eka hI roga mAnakara unakA varNana bhI kiyA jAtA hai / isa roga kA Arambha sahasA tathA jvara ke Avega ke sAtha huA karatA hai / jvara prakampa ( rigor ) yA AkSepa ( convulsions) ke sAtha car3hatA hai aura aisA lagatA hai ki mAno rogANuraktatA ( septicaemia ) ho gaI ho| isameM itane lakSaNa saralatayA dekhe jA sakate haiM : 1. zleSmakalAoM se raktasrAva kI pravRtti / 2. tvacA meM raktasrAva tathA nIlohika simoM (purpuric spots) kI upasthiti / 3. lasagranthiyoM kI vRddhi / 4. tuNDikerI, yauvana lupta granthi ( thymus ) tathA Antra kI lasakUpikAoM kI parivRddhi / For Private and Personal Use Only

Page #1036
646 vikRtivijJAna 5. sandhiyoM meM shuul| 6. mAMsapeziyoM meM zUla / uparyukta lakSaNoM se aisA lagatA hai mAnoM kisI rogANu dvArA upasarga laga gayA ho aura usakI avasthA sAmane AI ho| rogI kA zarIra pIlA par3a jAtA hai use raktakSaya ke sabhI lakSaNa dikhane lagate haiN| yaha roga eka bAla roga hai aura 10 varSa taka ke bAlakoM meM yaha pAyA jAtA hai| jvarAvasthA ke kAraNa unakA rakta parIkSaNa bhI kaThinAI se karane diyA jAtA hai parantu rakta parIkSaNa karanA parama Avazyaka hotA hai| roga mAraka aura asAdhya hotA hai tathA mRtyu kucha saptAhoM meM hI ho jAyA karatI hai| tIvra vitaraktatA meM Arambha meM sitakozA gaNana vahuta adhika nahIM rahatA ise upasitarattyAvasthA ( subleukaemia) yA asitaraktIya (aleukaemic ) kahA jA sakatA hai / kozAoM kI saMkhyA 30000 pratighana milImITara se nIce hI rahatI hai| Arambhika kozA kA svarUpa dekhane se isa roga meM bRhallasIkozA ( large lymphocytes ) hI prakaTa hote haiM isa kAraNa isa roga ko lasIkozIya sita raktatA kI tIvrAvasthA ghoSita kiyA jAtA thaa| para adhika sUkSma vivecana karane para patA calatA hai ki ye kozA majjAbha ( myeloid ) hI hote hai aura ve majjAbhastambhIyakozA ( myeloid stem cells ) kahalAte haiN| majjarahoM tathA lasIrahoM kI pahacAna karanA sAdhAraNa prayogazAlIya kAryakartA kA kArya nahIM hai / majaruhoM ke sAtha majakozA aura kucha bahvAkArI upasthita hoNge| yadi vaha lasIruha hai to usake sAtha lasIkozA mila sakate haiN| ve lasI kozA kAphI bRhat bhI ho sakate haiN| rica biNTroba aura lyUisa ne isa ora kArya kiyA hai aura unhoMne dekhA hai ki vizeSa saMvardhana ke sAtha rakhane para majaruha eka peca kI taraha mur3e hue kIr3e kI taraha vyavahAra karate haiM / lasIruha eka hastaka lage hue darpaNa kI taraha eka ora gola aura eka ora pUMcha jaise dekhe jAte haiM aura eka sthira gati karate hue pAye jAte haiN| ekakozIya kozA kaI kUTa pAdoM ( pseudopodia ) se yukta dekhe jAte haiN| unake kUTa pAda kisI bhI dizA kI ora bar3hate hue milate haiN| ___ uparyukta varNana se eka bAta spaSTa ho jAnI cAhie ki isa roga meM jo sitakozA rakta meM upasthita hote haiM ve jIrNa sitaraktatAoM meM upasthita pUrNa pragalbha sitakozA na hokara bhrauNika ( embryonic ) prakAra ke sitakozA hote haiN| mukhyakozA jo isameM milatA hai vaha bRhad pITharaJjya ( basophil ) hotA hai| usameM kevala eka hI tathA gola nyaSTi hotI hai| isa roga meM kula sitakozA 1 lAkha se Upara nahIM jAte / jinameM 80 se 99 pratizata taka eka nyaSTIya ( mononuclear) kozA hI hote haiN| bahunyaSTIya ( polynuclear ) kozA bahuta kama ho jAte haiM aura ve sakalagaNana kA adhika se adhika 10 pratizata taka kA nirmANa karate haiN| ve sabhI klIbarajya ( neutrophils ) hote haiM / kabhI-kabhI bRhallasIkozA jinako rAiDarakozA For Private and Personal Use Only

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rudhira vaikArikI 647 ( rieder's cells ) kahate haiM ve pAye jAte haiM jo lasIkozIya sitaraktatA kI ora iMgita karate haiM para ve sadaiva upasthita nahIM rahA karate / isa roga meM raktakSaya bahuta adhika hotA hai / raMgadezanA ghaTa jAtI hai aura lAlakaNa gaNana 10 lAkha yA usase bhI kama dekhA jA sakatA hai / bRhadraktaruha ( maigAloblAsTa ) bhI milate haiM para sanyaSTi rudhirANu bahuta kama hI dekhane meM Ate haiM / I isa roga meM stambhIkozAoM kI upasthiti ko punaH eka bAra yAda dilAnA paramAvazyaka hai / ye kozA sadaiva pITharanjya hote haiM inameM apekSAkRta bar3I nyaSTi hotI hai aura nyaSTi kA vizeSa prakAra hotA hai / lasIkozA kI nyaSTi meM jahA~ koI ninyaSTi nahIM dekhI jAtI aura nyaSTiya abhivarNi ( nuclear chromatine) eka rUkSa prakAra prakaTa karatI hai jisameM bhArI kSetra ( heavy blocks ) milate haiM eka stambhIya lasIkozA kI nyaSTi meM eka yA kaI ninyaSTiyA~ dekhI jAtI haiM aura usakI nyaSTIya abhivarNa meM ati sUkSma dhAriyA~ pAI jAtI haiM / siraktatA meM asthimajjA lAla aura paramacayika ho jAtI hai aura apragalbha kozAoM se bhara jAtI hai / usameM pUrNa pragalbha sitakozA bahuta kama hI dekhane ko milate haiM / rakta ke lAla kaNoM kA nirmANa bhI kama hotA huA dekhA jAtA hai / usameM majjAruhoM ( myeloblasts ) khUba bhare hote haiM thor3e se majjakozA ( myelocytes ) milate haiM aura thor3e se hI rudhirANu pAye jAte haiM arthAt rudhirANu nirmANakartrI Uti yahA~ pUrNataH visthApita ho jAtI hai / hA isa roga meM bar3hane kA prayatna bhara karatI hai / usakI paryApta vRddhi hone ke pUrva rogI isa asAra saMsAra kA parityAga kara detA hai / jitanA hI roga adhika tIvra hogA plIhA utanI hI kama bar3hegI / yahA~ taka ki atIva gambhIra rogAvasthA meM yaha bilkula bhI nahIM bar3hatI / aNvIkSaNa karane para isake andara apragalbha sitakozAoM kI khUba bharamAra dekhI jAtI hai / lasagranthaka majjaruhoM se bhare hue hote haiM tathA kucha phUla jAte haiM / sampUrNa zarIra kI sagranthiyA~ utanI nahIM phUlatIM / kisI-kisI aMga meM ve adhika phUla sakatI haiM / unameM raktasrAvI pravRtti aura mArdava mila sakatA hai jo arbuda yA pUyA ( sepsis ) kI ora iGgita karatA hai / hRtpezI meM raktastrAva ke sAtha-sAtha snaihika vihrAsa mila sakatA hai / yaha vihAsa ajArakI ( anoxaemia ) prakAra kA hI hotA hai / yakRt tathA vRkkoM meM bhI yaha mila sakatA hai / raktakSaya tathA snaihika parivartanoM ke kAraNa zarIra rogoM kA varNa pANDura ho jAtA hai / lakSya ( serious) kalAoM tathA zlaiSmika mucous ) kalAoM meM raktasrAva hotA huA mila sakatA hai / hRtpezI meM upahRdantaHbhAga tathA upaparihRt bhAga meM raktastrAva ke kAraNa khUba dhabbe milate haiM aura vaha atyadhika pANDura ho jAtI hai / ekakozIyasitaraktatA ( Monocytic leukaemia ) ise eka kAyika sitaraktatA bhI kahate haiM / para isa roga meM eka kozIya sitakozA For Private and Personal Use Only

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648 vikRtivijJAna mukhyatayA bhAga letA hai jisakI ghor3e ke nAla (horse shoe ) jaisI nyaSTi saralatA pahacAna lI jA sakatI hai| adhika ugrarUpa dhAraNa karane para ekakAyakozAoM ke sthAna para ekaruha (monoblast ) kozA bhI mila sakate haiM / para ekaruha majjaruhoM ke itane samAna svarUpa ke hote haiM ki donoM meM pRthakkaraNa karanA atyanta kaThina pAyA jAtA hai / raktadhArA meM ekakAyika kozA tathA ekaruha kozA bahuta bar3I saMkhyA meM isa roga meM prakaTa hone lagate haiM / kucha logoM kA kathana hai ki yataH ekaruha aura majjaruhoM meM antara karanA kaThina hai ataH ekaruhIya na hokara majjaruhIya sitaraktatA hI yaha bhI hotA hai kyoMki majjAbha sitaraktatA ke sAtha ekakozotkarSa bhI prAyaH milatA hai / isa roga meM kozA bRhat, pITharanjya hote haiM jinapara raMga bahuta halakA car3hA hai 1 unakI nyaSTi viSama tathA bahubhujIya hotI hai / sitakozAoM kI saMkhyA 50000 taka bar3hatI hai / kabhI-kabhI inakI saMkhyA prakRtagaNana se adhika nahIM hotI para usameM bhI ekakAyikasitakozA 50% taka pAye jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir yaha prauDhAvasthA kA roga hai isameM bhI lasya aura zleSmalakalAoM se raktasrAva hotA huA dekhA jAtA hai / isa roga meM uttarottara raktakSaya hotA huA dekhA jAtA hai / yaha roga tIvrasvarUpa kA hotA hai jisake sAtha sAtha plIhAbhivRddhi, jvara, lasagranthiyoM kI vRddhi, yakRvRddhi pAyI jAtI hai / isa roga meM jAlakAntazchadIya paramacaya ke jAlakAntazchadIya saMsthAna meM kisI arbudotpatti ke lakSaNa pAye jAte haiM / kabhI kabhI sAtha-sAtha bhI yaha avasthA dekhane AtI hai| grIna kA kathana hai ki ekakozIya sitaraktatA kA vibheda granthIyajvara (glandular fever ) tathA lisTrailA upasargoM se avazya karanA caahie| inameM granthIyajvara jise ekanyaSTIyotkarSa (mononucleosis ) kahate haiM taruNoM kA roga hai isameM mRdujvara, galapAka ke sAtha upariSTha lasI granthakoM kI vRddhi aura rakta meM ekanyaSTIyotkarSa milatA hai / yaha 2 - 3 saptAha meM ThIka ho jAtA hai / rakta meM sitakozA 15 se 20 sahasra taka milate haiM / lasagranthiyoM meM thor3A paramacaya hone ke atirikta koI vizeSa parivartana nahIM milatA / baisIlasalisTaraillA monosAiTojinisa ke upasarga meM ekakAyANUkarSa 96 se 120 ghaNToM meM apane zikhara para pahu~ca jAtA hai isameM 30% taka sakala gaNana meM ekakozIya kozA milate haiM / Uti meM tIvra vraNazotha hokara nAbhya nAza pAyA jAtA hai / vikSatoM ke samIpa ekakAyANu khUba milate haiM aura eka prakAra kI yamikA banA lete haiM / yaha kSudra jIvoM kA roga hai para manuSya bhI isase prabhAvita hote haiN| vizeSa kara bAlaka isake caMgula meM phaMsate haiM aura unheM mastiSkacchadapAka taka ho jAtA hai / ekakozIya sitaraktatA ke sAtha-sAtha viMsenTa ke jIvANuoM ke dvArA gale meM upasarga bhI dekhA jA sakatA hai / sabalasAbha UtiyoM meM jAlakIya praguNana ke sAtha yakRt aura vRkkoM meM bhI ekakozIya kozAoM kI bharamAra dekhI jAtI hai / For Private and Personal Use Only

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rudhira vaikArikI asitarakkIya sitaraktatA ( Aleukaemic Leukaemia ) ise kUTasitaraktatA ( pseudo leukaemia ) bhI kahate haiM / kabhI-kabhI zarIrastha UtiyoM meM to sitakozAoM kA praguNana joroM se jArI rahatA hai para raktadhArA meM usakA pramANa upasthita nahIM hotA / isa avasthA ko atiraktIya sitarakkatA kahA jAtA hai / ise asitaraktIya majjotkarSa (aleukaemic myelosis) yA asitarakkIya lasagranthyutkarSa ( aleukaemic lymphadenosis ) yA asita raktIya jAlakAntazchadIyotkarSa ( aleukaemic endotheliosis ) nAma denA Sales kI dRSTi se adhika upayukta hai / arthAt jo sitaruhIya Uti prabhAvita ho rahI ho usI ke anurUpa nAmakaraNa karanA adhika vaidhAnika hogA aisA usakA kahanA hai / ise pRthak roga ginanA ucita nahIM hai / yaha to sitaraktatA kA pUrvarUpa mAtra hotA hai jo zIghra yA vilamba se sitaraktatA meM pariNata huA karatA hai aura rakta meM agaNita sitakozA avazya praveza karate haiM / yaha sthiti Ane ke pUrva bhI yadyapi rakta kA sitakozA sakala gaNana nahIM bar3hatA phira bhI usameM vividha prakAra ke apUrNa yA apragalbha zvetakozA milane lagate haiM / isa roga meM jitanA lasAbha Uti meM praguNana milatA hai| utanA kaNakozIya Uti meM nahIM milatA / isameM eka sthAnIya yA sarvAMgINa lasAbha UtIya paramacaya dekhA jAtA hai jise kUTa sitakozIya lasadhAtUtkarSa ( pseudo leuk. aemic lymphomatosis ) kahA jAtA hai isameM eka sthAna vizeSa kI lasagranthiyA~ yA kSetravizeSa kI lasagranthiyA~ athavA Antra kI lasIya Uti kI abhivRddhi hone lagatI hai | ise dekhakara lasIya saMkaTArbuda ( lymphosarcoma ) aura isameM antara karanA bahuta kaThina ho jAtA hai / kyoMki lasoya saMkaTArbuda bhI anta meM sitarakkIya citra upasthita kara sakatA hai / For Private and Personal Use Only 646 isa atiraktIya sitaraktatA meM plIhA meM bhI sAmAnya vRddhi dekhI jAtI hai / aura yataH yaha avasthA kevala mukhya vyAdhi kA pUrvarUpa mAtra hai ataH dhIre-dhIre sitaraktatAoM meM prApta hone vAlI sabhI vikRtiyA~ isameM apane prArambhika rUpa meM upasthita rahA karatI haiM / uraHphalaka se majjA lekara usakA parIkSaNa karane para isa roga kA ThIka-ThIka nidAna kiyA jA sakatA hai /

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trayodaza adhyAya agni vaikArikI AyurvedIya dRSTi se rogoM kI vaikAriko jAnane ke lie agni viSayaka AyurvedIya kalpanA ko pratyeka vikRti zAstra ke vidyArthI ko samajhanA hogaa| mahAsrotIyasaMsthAna ke pramukha-pramukha rogoM kI utpatti meM agni kI vikRti mukhya kAraNa hai| atIsAra, grahaNI aura arza ye tIna vikAra mukhyarUpa se agni kI vikRti se hI utpanna mAne gaye haiN| isa prakaraNa meM hama ina tIna vyAdhiyoM ko mukhyarUpa se likhanA cAhate haiM / use likhane ke pUrva agni ke sambandha meM sarvasAmAnya jJAna upasthita karanA paramAvazyaka hai / caraka ne saba agniyoM meM jATharAgni kI mahattA svIkAra karate hue likhA haiannasya paktA sarveSAM paktRNAmadhipo mtH| tanmUlAste hi tavRddhikSayavRddhikSayAtmakAH // anna ko pacAne vAlI agni saba agniyoM kA adhipati karake prasiddha hai / zeSa agniyoM kI vRddhi tathA kSaya meM jATharAgni kI vRddhi yA kSaya hI pramukha kAraNa mAnA gayA hai| jATharAgni ke kAraNa anna kA pAcana hotA hai| anna para prasAdAtmaka pariNAma se vAta pitta kapha kA svastha nirmANa hotA hai aura kiTTa bhAga se mala rUpa tridoSoM kA janma hotA hai| annarasa jisase zeSa saba zarIrastha dhAtuoM kA poSaNa hotA hai usakA nirmANa jATharAgni dvArA anna para kI gaI svastha pAcana kriyA para hI avalambita hotA hai ataH ise zarIrastha sampUrNa dhAtvagniyoM, mahAbhUtAniyoM kA adhipati mAnA jAve to koI atizayokti nahIM hai| isI dehAgni yA jATharAgni kI prazaMsA karate hue caraka ne nimnAMkita vAkyoM kA aura prayoga karake agni kI mahattA kA samIcIna citraNa upasthita kiyA hai1. AyurvarNo balaM svAsthyamutsAhopacayau prbhaa| ojastejo'gnayaH prANAzcoktA dehAgnihetukAH / / 2. zAnte'gnau mriyate yukte ciraM jovatyanAmayaH / rogI syAd vikRte mUlamagnistasmAnnirucyate // 3. yadannaM dehadhAtvojobalavarNAdipoSakam / tatrAgnirheturAhArAna hyapakkAd rsaadyH|| ____ Ayu, varNa, bala, svAsthya, utsAha, upacaya, prabhA, oja, teja, agniyA~ tathA prANa ina 11 kA hetu dehAgni hotI hai| usake zAnta ho jAne se prANI mara jAtA hai| yuktAvasthA meM rahane se vaha nIroga hokara dIrghAyuSya prApta karatA hai usake vikRta ho jAne se prANI rugNa ho jAtA hai isIlie AyurAdika kA mUla dehAgni ko kahA jAtA hai| jisa anna ko deha, dhAtu, oja, bala-varNAdikA poSaka mAnA hai usake ina guNoM kA bhI Adi kAraNa Ayurveda agni ko hI mAnatA hai| kyoMki binA agni ke dvArA AhArAdi ke paripAka ke rasAdi kA nirmANa sambhava nahIM aura vinA paripakva anna rasa se zeSa dhAtuoM kA poSaNa tarpaNa aura prINana nahIM ho sktaa| isalie agni kA For Private and Personal Use Only

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agni vaikArikI mahattva samajhanA pratyeka vikRti vizArada ke lie paramAvazyaka mAnA jAtA hai| yaha vivaraNa upasthita karane ke pUrva hama eka bAra AhAra aura usake niyamana para vihaMgama dRSTipAta kreNge| AhAra vidhi AcAryoM ne AhAra vidhi para paryApta prakAza DAlate hue batalAyA hai ki prakRti, karaNa, saMyoga, rAzi, deza, kAla, upayogasaMsthA aura upayoktA / ina ATha kAraNoM kA vizeSa vicAra karanA caahie| prakRti kA artha kisI bhI vastu kA apanA nizcita svabhAva hotA hai| mASa prakRtyA guru aura mudga prakRtyA laghu hai| karaNa kA artha vastu para kiyA gayA saMskAra vizeSa hai| saMskAra ke kAraNa tattat vastu meM vizeSa guNAdhAna hotA hai| yaha guNAdhAna vastu ke jala vA agni kA samparka lAne se, usakA zodhana karane se, manthana karane se, deza vizeSa meM utpatti hone se yA kisI sthAna vizeSa meM rakhane se aucitya se adhika kAla bItane para vastu ke guNa meM kSINatA AtI hai kyoMki usameM bhAvanA dene se yA kisI sugandhAdi dravya meM basAne se, kAlaprakarSa arthAt itane dina pazcAt vastu kA upayoga ho aisA niyamana karane se, bhAjana vizeSa meM rakhane se vizeSa vizeSa saMskAra hokara mUla vastu kI prakRti meM antara le AyA jA sakatA hai| saMyoga jaba kisI vizeSa naye rAsAyanika saMgaThana kA nirmANa do vastuoM ke milAne se ho jAtA hai to bhI vastu ke guNa meM antara A jAtA hai| madhu, matsya aura dugdha kA saMyoga hAniprada hai| rAzi bhI apanA prabhAva DAlatI hai| kitanI mAtrA meM kauna dravya lenA hai| amAtra, alpamAtra aura atimAtra dravya sevana kA pRthaka-pRthaka prabhAva hotA hai| deza kA punarvicAra bhI karanA hotA hai| kisI deza meM kucha sAtmya hai dUsare deza meM vaha asAtmya hai tathA kahIM kisI kI utpatti hai kahIM kisI kA pracAra hai isakA bhI bahuta prabhAva par3atA hai / kAla isI prakAra nityaga aura Avasthika hotA hai| eka Rtu sAtmyApekSI hotA hai aura dUsarA avasthA kA dyotaka hai| inakA bhI bahuta upayoga hai| kisa avasthA ke vyakti ko kyA denA hai tathA kisa Rtu meM kyA denA hai isa para dhyAna denA hI par3egA upayoga saMsthA padArtha ke jIrNAjIrNa svarUpa ke vinizcayIkaraNa ke niyamAdi ko kahA jAtA hai| upayoktA ke lie kauna padArtha okasAtmya hai| kisa rUpa meM aura mAtrA meM vyakti grahaNa kara sakatA hai yaha jo vyakti vizeSa ke lie vizeSa niyama banAne par3ate haiM ve saba upayoktA kI prakRti para nirbhara karate haiN| bhojya sAdguNya ina aSTa AhAra vidhiyoM kA ucita dhyAna dene se zubha anyathA azubha phaloM kI prApti hotI hai| isake pazcAt bhojana karane meM kucha bhojya sAdguNyoM kI ora bhI dRSTi nikSepa kiyA gayA hai1. uSNamaznIyAt 2. snigdhamaznIyAt 3. mAtrAvadaznIyAt 4. jIrNe'znIyAt For Private and Personal Use Only

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652 vikRtivijJAna 5. vIryAviruddhamanIyAt 6. iSTe deze ceSTasarvopakaraNaJcAznIyAt 7. nAtidvatamaznIyAt 8. nAtivilambitamaznIyAt 9. ajalpannahasan tanmanA bhuJjIta 10. AtmAnamabhisamIcaya bhuJjIta / AhAra aura mAtrA phira Age calakara kukSi ko 3 bhAgoM meM vibhakta karane kA Adeza hai jisameM se eka bhAga mUrta AhAroM ke lie dUsarA jala ke lie aura tIsarA vAtapittazleSma ke liye khAlI rakhane ke lie iGgita kiyA gayA hai| pratyeka vyakti ko apanI kukSi kA dhyAna rakhakara AhArAdi kI mAtrA kA isI dRSTi se niyamana aura niyantraNa karanA caahie| isa mAtrAvat AhAra se Ayurveda nimnAGkita lAbha dekhatA hai 1. kukSeraprapIDanam AhAreNa / 2. hRdysyaanvrodhH| 3. pArzvayoravipATanam / 4. nAtigauravaM udrsy| 5. prINana mindriyANAm / 6. kssutpipaasoprmH| 7. sthAnAsanazayanagamanocvAsaprazvAsahAsyasaMkathAsu sukhAnuvRttiH / 8. sAyaM prAtazca sukhena prinnmnm| 9. balavarNopacayakaratvam / hIna mAtrA meM lI gaI AhArarAzi nimnalikhita hAni karatI hai| 1. balavarNopacayakSayakaram / 2. atRptikaram / 3. udAvartakaram / 4. anAyuSyamavRSyamanaujasyam 5. zarIramanobuddhIndriyopaghAtakaram / 6. saarvidhmnm| 7. aladamyAvaham / 8. azItezca vAtajAnAM vikArANAmAyatanam / atimAtra AhArarAzi ke sambandha meM caraka vimAna dvitIya adhyAya meM nimna gadyAMza milatA hai atimAtraM punaH sarvadoSaprakopaNamicchanti kushlaaH| yo hi mUrtAnAmAhArajAtAnAM sauhityaM gatvA drvstRptimaapdyte| bhUyastasyAmAzayagatAvAtapittazleSmANo'pavahAreNAtimAtreNAtiprapIDyamAnAH sarve yugapat prakopamApadyante / te prakupitAstamevAhArarAzim apariNatamAvizya kukSyekadeza. mAzritAH viSTambhayantaH sahasA vApyuttarAdharAbhyAM mArgAbhyAM pracyAvayantaH pRthak pRthagimAn vikArAn abhinivrtyntytimaatrbhoktuH| tatra vAtaH zUlAnAhAGgamardamukhazoSamUbhrimAgnivapamyasirAkuJcanasaMstambhanAni karoti, pittaM punavarAtisArAntardAhatRSNAmadabhramapralapanAni zleSmA tu cchrockaavipaakshiitjvraalsygaatrgaurvaanni| uparyukta vAkyoM meM vividha vikAroM kI utpatti ke AdikAraNa para prakAza DAlA gayA hai| Ayurveda vikAroM kI utpatti meM pramukha kAraNa vAta-pitta-kapha doSatrayI kI sAmyAvasthA meM vaiSamya mAnatA hai| yaha vaiSamya kisa prakAra AhAra ko yathA mAtrA sevana na karane se honA sambhava hai isa ora iGgita kiyA gayA hai| hamArA sampUrNa vijJAna doSasAmya aura usake pariNAmasvarUpa dhAtusAmya kI kalpanA se svAsthya kI For Private and Personal Use Only

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agni vaikArikI 653 kAmanA kiyA karatA hai| AyurvedIya vaikArikI kA isa pRSThabhUmi ko binA samajhe samajhanA nitAnta bhramotpAdaka hai| atyadhika mAtrA meM bhojana karanA yaha sarva doSa prakopaka mAnA gayA hai| jo vyakti tRptipUrvaka Thosa padArthoM kA sevana karake phira Upara se dravoM ko AkaNTha pI letA hai to usake AmAzayagata vAta-pitta-kapha atyadhika bhojana kara lene ke kAraNa pIr3ita hokara yugapat ( ekasAtha) prakupita ho jAte haiN| usa adhika bhojana kie hue prANI ke andara ve prakupita hue doSa kukSi ke eka deza meM praveza karake usa apakka anna ko vidagdha yA viSTabdha kara dete haiN| athavA use sahasA uttara mArga se (mukha dvArA) yA adhomArga se (guda dvArA) nikAla dete haiM aura ina vikAroM kI utpatti karate haiMvAtavikAra-zUla, AnAha, aGgamada, mukhazoSa, mUrchA, bhrama, agnivaiSamya, sirAkuJcana, saMstambhana / paittikavikAra-jvara, atisAra, antardAha, tRSNA, mada, bhrama, pralapana / zlaiSmikavikAra-chardi, arocaka, avipAka, zItajvara, Alasya, gAtragaurava / AmadoSa aura unake guNa aSTavidha AhAravizeSAyatanoM, AhArasAdguNyoM tathA anya AhArasambandhI niyamoM kA pAlana na karane aura atimAtra bhojana karane se AhAra kA pAcana nahIM ho paataa| vaha apakkAvasthA meM hI raha jAtA hai| isI ko AmAvasthA kahate haiN| AhAra kA AmadoSa hI agninAza kA mukhya kAraNa huA karatA hai| atimAtra AhAra ke atirikta anya kAraNa bhI isa AmadoSa ke kAraNa caraka ne likhe haiM: na khalu kevalamatimAtramevAhArarAzimAtrapradoSakAlamicchanti / api tu khalu gururUkSazItazukaviSTambhividAhyAzuciviruddhAnAm akAle'nnapAnAnAmupasevanam kAmakropalobhamoheAhIzokamAnodvegabhayopataptamanasA vA yadannapAnamupayujyate tadapyAmameva pradUSayati / ina kAraNoM meM jahA~ usane bhArI, rUkhe, ThaNDe, bAsI, sUkhe, kabja karane vAle, jalana utpanna karane vAle, pavitratA se rahita, parasparavirodhI annoM ke sevana se AmadoSa kI utpatti siddha kI hai vahA~ usane akAla meM bhojya karane se bhI AmadoSa utpanna huA mAnA hai aura manovaijJAnika sthitiyoM ko bhI isa ora bar3hane meM mukhya kAraNa mAnA hai| kAma-krodha-lobha-moha-IrSyA-lajjA-zoka-mAna-udvega-bhaya Adi se mana ke upatapta ho jAne se bhI AmadoSa ho sakatA hai| manovega vikArapUrNa hoM to phira sampUrNa AhArIya niyamana ke siddhAnta pAlana karane para bhI rogotpatti yA Amotpatti nahIM rukatI mAtrayApyabhyavahRtaM pathyaJcAnnaM na joryati / cintaashokbhykossduHkhmohprjaagraiH|| kevala eka bAra adhika bhojana karane se yA niyamoM ke tor3ane se AmadoSotpatti nahIM hotii| usake lie AmadoSakara paristhitiyA~ barAbara banatI rahatI haiM aura pariNAmasvarUpa agni manda hone lagatI hai| jisakI agni samAvasthA para hai vaha to For Private and Personal Use Only

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654 vikRtivijJAna do eka bAra kI gar3abar3I ko bardAzta kara letA hai / para nirantara gar3abar3a agni kI samAvasthA ko bigAr3a detI hai astu tasmAt taM vidhivaddyuktairannapAnendhanairhitaiH / pAlayet prayatastasya sthitau tvAyurbalasthitiH // agni ke dUSita hone ke nimna anya kAraNa diye gaye haiM - abhojanAdajIrNAMtibhojanAdviSamAzanAt / asAtmyaguruzotAtirUkSasanduSTabhojanAt // virekavamanasnehavibhramAd vyApikarSaNAt / dezakAlartuvaiSamyAd vegAnAM ca vidhAraNAt // duSyatyagniH sa duSTo'nnaM na tat pacati labhyapi / apacyamAnaM zuktatvaM yAtyannaM viSatAJca tat // apaka aura zuktatA ko prApta anna AmaviSa ke lakSaNa utpanna karane meM samartha ho jAtA hai / caturvidha jATharAgni -- caraka ne jina cAra prakAra kI agniyoM kA varNana kiyA hai vaha isa prakAra hai( 1 ) viSamo dhAtuvaiSamyaM karoti viSamaM pacan / tIkSNo mandendhano dhAtUn vizoSayati pAvakaH // yuktaM bhuktavato yukto dhAtusAmyaM samaM pacan / durbalo vidatyannaM tad yAtyUrdhvamadho'pi vA // isI ko anyatra nimnalikhita zabdoM meM vyakta kiyA hai ( 2 ) agniSu tu zArIreSu caturvidho vizeSo balabhedena bhavati tadyathA - tIkSNo mandaH samo viSama iti / tatra tIkSNo'gniH sarvApacArasahaH, tadviparItalakSaNo mandaH samastu khalvapacArato vikRtimApadyate'napacAratastu prakRtAvavatiSThate, samalakSaNaviparItalakSaNastu viSamaH ityete caturvidhA bhavantyagnayazcaturvidhAnAmeva puruSANAm // viSamo vAtajAn rogA~stIkSNaH pittanimittajAn / karotyagnistathA mando vikArAn kaphasambhavAn // samA samAgnerazitA mAtrA samyagvipacyate / svalpA'pi naiva mandAgnerviSamAgnestu dehinaH // kadAcitpacyate samyakkadAcinna vipacyate / mAtrA'timAtrA'pyazitA sukhaM yasya vipacyate // tIkSNAgniriti taM vidyAt samAgniH zreSTha ucyate // arthAt balabheda se vaha agni cAra prakAra kI hotI hai viSamAgni - yaha samAgni ke viparIta lakSaNa vAlI hotI hai dhAtuoM ke sAmya ko dUra karake viSamatA utpanna karatI huI viSamatayA AhAra kA pAcana karatI tathA isake kAraNa vAtakAraka roga hote haiN| viSamAgni kabhI to bhojana ko pacA detI hai aura kabhI nahIM pacAyA karatI / sahane vAlI hotI hai| IMdhana ko bhasmIbhUta zarIrastha dhAtuoM ko tIkSNAgni- yaha sarvApacArasaha arthAt saba apathyoM ko bhukta AhAra ko usI prakAra pakA detI hai jaise tIkSNa agni kara DAlatI hai / jaba bhukta anna paca jAtA hai to phira vaha jalAne lagatI haiM jisake kAraNa zarIra durbala hotA huA calA jAtA hai / tIcNAgni pittakAraka hotI hai aura paittika rogoM kI kartrI mAnI jAtI hai / yaha kitanA hI bhojana kiyA ho sabako pacA DAlatI hai / samAgniyA yuktAgni - sadaiva zreSTha mAnI jAtI hai / yaha apathya se bigar3atI aura pathyapUrvaka rahane para ThIka rahatI hai yaha bhuktAnna ko ThIka ThIka pacA kara dhAtu For Private and Personal Use Only

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agni vaikArikI 655 sAmyAvasthA rakhakara svasthAvasthA kI janayitrI hotI hai| hara cikitsaka agni kI samAvasthA lAne kA yatna karatA hai| jaba taka yaha samAgni nahIM jAgatI taba taka zarIra nirantara roga se vyApta rahatA hai| phira mandAgni yA durbalAgni kA vicAra AtA hai / jo tIkSNAgni ke viparIta lakSaNa vAlI hotI hai| bhukta anna agni kI mandatA ke kAraNa vidagdhAvasthA ko prApta ho jAtA hai / thor3A sA bhI AhAra binA pace UrdhvabhAga se yA adhobhAga se nikala jAtA hai yA vahIM rahakara annaviSatA utpanna karatA hai| samAgni kI zreSThatA samAgniH zreSTha ucyate yaha zAstrakAroM kA kathana hai| svastha ke lakSaNoM kA varNana karate samaya bhagavAn dhanvantari ne samadoSaH ke sAtha samAgnizca bhI kahA hai| ataH samAgni kA zarIra ke svAsthya se mahattvapUrNa sambandha hai| samAgni kI paribhASA likhate hue madhukoSakAra likhate haiM __ samA ucitA, mAtrA AhArasya, samyagyasya vipacyate sa samAgniH / isI ko dUsare zabdoM meM___ atimAtramajIrNe'pi guruM cAnnamathAznataH / divA'pi svapato yasya pacyate so'gniruttamaH // kahA gayA hai| vahI agni isa padyakAra ne uttama mAnI hai jo adhika mAtrA meM bhojana kare, ajIrNa meM bhI khAya, bhArI anna khAyA jAya aura divAsvapna karane para bhI jo saba khAnA pacA de| suzrutAdika jATharAgni ke prakAra / prAgabhihito'gnirannasya pAcakaH / sa caturvidho bhavati-doSAnabhipanna ekaH, vikriyAmApannastrividho bhavati viSamo vAtena, tIkSNaH pittena, mandaH zleSmaNA, caturthaH samaH sarvasAmyAditi / (suzruta sU. a. 35) arthAt pUrva hI yaha kahA jA cukA hai ki pAcaka agni anna kA pAcaka hai| vaha cAra prakAra kI hotI hai-eka doSarahita aura tIna vikAra yukta / savikAra tIna prakAroM meM vAta se viSamAgni pitta se tIkSNAgni aura zleSmA se mandAgni / cauthI doSarahita agni samAgni kahalAtI hai jo doSoM kI sAmyAvasthA ke dvArA utpanna hotI hai| Upara jo 4 prakAra kI jATharAgniyoM kA nAmollekha AyA hai unhIM ke lakSaNoM kA varNana karate hue likhA gayA hai ki: tatra yo yathAkAlamupayuktamannaM samyak pacati sa samaH, samairdoSaiH, ya kadAcit samyak pacati kadAcidAdhmAnazUlodAvartAtisArajaTharagauravAntrakUjanapravAhaNAni kRtvA sa viSamaH, yaH prabhUtamapyupa 1. taccAdRSTahetukena vizeSega pakkAmAzayamadhyasthaM pittaM caturvidhamannapAnaM pacati vivecayati ca doSarasamUtrapurISANi tatrasthameva cAtmazaktyA zeSANAM pittasthAnAnAM zarIrasya cAgnikarmaNA'nugrahaM karoti tasmin pitte pAcako'gniriti saMjJA / (su. sU. sthA. a. 21) For Private and Personal Use Only

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656 vikRtivijJAna yuktamannamAzu pacati sa tIkSNaH, sa evAbhivardhamAno'tyagnirityAbhASyate, sa muhurmuhuH prabhUtamapyupayuktamannamAzutaraM pacati, pAkAnte ca galatAlvoSThazoSadAhasantApAJjanayati, yastvalpamapyupayuktamudara zirogauravakAsazvAsaprasekacchadiMgAtrasadanAni kRtvA mahatA kAlena pacati sa mndH| (su. sU. sthA. a. 35-38) uparyukta vAkyoM meM AyurvedIya kalpanA kA AdhAra caturvidha jATharAgni kA jo bhavya rUpa prakaTa kiyA gayA hai vaha viSaya ko dina ke samAna spaSTa kara detA hai| arthAt samAgni vaha hai jo ThIka samaya para sevana kie hue anna ko ThIka-ThIka pakA de| samAgni kI yaha avasthA doSasAmya se utpanna hotI hai| viSamAgni kA kAraNa vAtika doSa kI adhikatA hotI hai| viSamAgni vAle vyakti kA sevana kiyA huA bhojana kabhI ThIka paca jAtA hai aura kabhI vaha sAdhAraNatayA pacatA nahIM api tu pAcanakriyA ke sAtha-sAtha kaI prakAra ke audarika vikAra dekhe jAte haiM jaise : AdhmAna (tympanites ) zUla ( intestinal colic) udAvarta ( misperistalsis) atisAra ( diarrhoea) udaragaurava ( heaviness in abdomen ) AntrakUjana (intestinal sounds) pravAhaNa (griping) kahanA nahIM hogA ki sAtoM vikAra Antra meM vAyu ke prakupita hone ke pariNAmasvarUpa utpanna hote haiN| vAyu ke dvArA pAcakAgni kI viSamatA utpanna hotI hai| yathAyogya pAcanakriyA karane ke lie pAcakAgni asamartha ho jAtI hai jisase kabhI adhika aura kabhI kama vega ke sAtha pAcanakriyA calatI hai| adhika calane se pravAhaNa (kunthana ) AntrakUjanAdi vikAra hote haiM kama calane se udara gaurava udAvartAdi vikAra utpanna hote haiN| tIkSNAgni kA kAraNa pitta kA prakopa hai| jaba zarIra meM pittAdhikya ho jAtA hai to pAcakapitta kA srAva paryApta mAtrA meM hotA hai| isI kAraNa se isa agni kA rUpa tIkSNa ho jAtA hai jisake kAraNa bahutAyata se khAye hue anna ko bhI pacAne meM yaha agni samartha ho jAtI hai| jaba yaha agni bahuta adhika bar3ha jAtI hai taba yahI atyagni kahalAtI hai| bAra-bAra prabhUta (pracura ) mAtrA meM sevana kie anna ko atizIghra pacA detI hai pAcana ke uparAnta galazoSa ( dry throat) galadAha ( hot or infilammed throat) tAluzoSa (dry palate ) tAludAha ( inflammed palate ) oSThazoSa ( dry lips) oSThadAha (inflammed lips) Arang ( rise in temperature ) ye lakSaNa utpanna ho jAte haiN| ye sabhI lakSaNa pittAdhikya ke pratyakSa pariNAma haiN| khAne aura pacAne meM pAcana kriyA kI ati ho jAtI hai jisase saMsthAna atyanta For Private and Personal Use Only

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agni vaikArikI uSNa ho jAtA hai jisake kAraNa dAha kA bodha hotA hai| yaha dAha oSTha, tAlu aura kaNTha meM zoSa athavA dAha ke rUpa meM vyakta hotA hai| vRndamAdhava tathA anya kaI AcAryoM ne atyagni ko bhasmakAkhya agni yA bhasmaka roga nAma diyA hai| a-vardhamAno bhavettIkSNo bhasmakAkhyo mahAnalaH (vRnda) A-bhuktaM kSaNAdbhasma karoti yasmAttasmAdayaM bhasmakasaMzako'bhUt / -( yo0 ra0) i-tAmatyagniM-bhasmakAkhyam-( aruNadatta) mandAgni kaphAdhikya ke kAraNa pAcakAgni kI eka aisI vikRtAvasthA hai jisameM thor3A sA bhI bhojana kara lene para vaha bahuta manda gati se bar3I dera meM paca pAtA hai / bhojana ke vilamba karake pacane se zarIra ko poSaka tatvoM kI prApti utanI saralatA se nahIM ho pAtI jitanI ki samAgni hone para hotI hai ataH rasa nAmaka dhAtu kI utpatti kama ho jAtI hai jisa para ki zeSa dhAtuoM kI utpatti vA poSaNa kA bhAra rahatA hai| isakA pariNAma yaha hotA hai ki mandAgni ke sAtha-sAtha hI: 1. zirogaurava ( heaviness in head or slow headache ) 2. kAsa ( cough) 3. zvAsa ( asthmatic attack ) 4. praseka ( catarrh) 5. chardi ( vomiting) 6. gAtrasadana ( depression) uparyukta chaH lakSaNa bar3he hue kapha ke pratyakSa pariNAma haiN| agnimAndya pittAlpatA kA pramANa hai agniguNabhUyiSTha pitta kI kamI somaguNabhUyiSTha kapha kI vRddhi meM hI dekhI jAtI hai ataH kaphavRddhi se mandAgni aura mandAgni se kaphavRddhi kA eka duzcakra nirantara bana jAtA hai| __ hamane jo niSkarSa nikAlA hai usI ko suzrutAcArya nimna zloka meM pahale se hI rakha cuke haiM : viSamo vAtajAn rogAMtIkSNaH pittanimittajAn / karotyagnistathA mando vikArAn kaphasambhavAn // ___arthAt viSamAgni vAtaja, tIkSaNAgni, pittaja aura mandAgni kaphaja vikAroM ko utpanna kiyA karatI hai| pAcakAgni kI mahattA sArametaccikitsAyAH paramagnezca pAlanam / tasmAdyatnena karttavyaM vahvestupratipAlanam / / astu dopazataM kruddhaM santu vyAvizatAni ca / kAyAgnimeva matimAn rakSan rakSati jIvitam // sampUrNa cikitsA kA sAra paramagni yA jATharAgni kA paripAlana hone se usakI rakSA karanI caahie| saikar3oM doSoM ke kupita ho jAne aura saikar3oM rogoM se ghira jAne para kAyAgni kI rakSA karatA huA buddhimAn vaidya jIvana kI rakSA kara letA hai| jATharo bhagavAnagnirIzvaro'nasya pAcakaH / saumyAdrasAnAdadAno vivektaM naiva zakyate / prANApAnasamAnastu sarvataH pavanastribhiH / dhyAyate pAcyate cApi sve sve sthAne vyvsthite|| -suzruta sU0 35 For Private and Personal Use Only

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vikRtivijJAna annapAcaka bhagavAn jATharAgni Izvara hai yaha rasa ko grahaNa karatA hai aura bahuta sUkSma hone ke kAraNa isakA vivecana karanA sambhava nahIM hai| agni, prANa, apAna aura samAna nAmaka tIna prakAra kI vAyuoM dvArA isakA prajvalana aura paripAlana hotA hai| suzruta ne jATharAgni kI mahattA batalAte hue do mahatva ko bAteM kaha dI haiN| eka to yaha ki yaha ati sUkSma hai isakI lau jalatI huI nahIM dekhI jA sakatI jaisI ki laukika agni meM dekhI jAtI hai ataH yaha eka aisI zakti hai jo anna ko pakAtI hai jaise ki anyatra pAcanakArya yA agnikArya calatA hai para isakA rUpa parama sUkSma hai / isake kArya se hI isakI upasthiti kA bodha hotA hai / dUsarA yaha ki yaha svayaM prANa, samAna aura apAna ina tIna vAtoM ke dvArA niyamita rahatI hai| yaha svayaM agniyoM kA Iza hote hue bhI isakA Izvara vAyu hai arthAt isakI utpatti aura kriyA zakti narvasa kaNTrola ke antargata rahatI hai| prakRtidRSTayA agnivicAra carakane adholikhita vAkya meM prakRtidRSTyA agni vicAra prastuta kiyA hai tatra samavAtapittazleSmaNAM prakRtisthAnAM samA bhavantyagnayaH, vAtalAnAM tu vAtAbhibhUte'gnyadhiSThAne viSamA bhavantyagnayaH, pittalAnAM tu pittAbhibhUte'gnyadhiSThAne tIkSNA bhavantyagnayaH, zleSmalAnAM tu zleSmAbhibhUte hyagnyaviSThAne mandA bhvntygnyH|| jina puruSoM ke prakRtistha vAta, pitta, kapha ye tInoM doSa samAvasthA ko prApta hote haiM unameM agniyA~ prAyaH sama rahatI haiN| vAtalaprakRti ke manuSyoM meM agnyadhiSThAna ke vAtA. bhibhUta hone ke kAraNa ve viSama rahatI haiN| pittala vyaktiyoM meM agnyadhiSThAna ke pitta se abhibhUta hone se agniyA~ tIkSNa milatI haiN| zlaiSmika prakRti vAloM meM agnyadhiSThAna ke zleSmA se AkrAnta rahane ke kAraNa agniyA~ manda rahatI haiN| vikRti vivecanA ke lie prakRtiyoM se paricaya bhI paramAvazyaka hai| loka meM hama kisI ko adhika kisI ko thor3A aura kisI ko viSamatayA bhakSaNa karate hue dekhate haiN| unakI vibhinna prakRtiyA~ hI isakA hetu haiN| jaba hama kisI kI agni samA. vasthA para lAnA cAhate haiM to usakA tAtparya hI yaha hai ki jisa prakRti kA yaha hai usI ke anurUpa usakI agni prakRtistha kara dI jAve / agni kA nivAsa sthAna isa agni kA nivAsa sthAna AmAzaya nAma se stanoM tathA nAbhi ke madhya meM sthita batalAyA gayA hai| yahA~ AmAzaya sampUrNa pacanasaMsthAna kA dyotaka hai jahA~ para anna kA paripAka hotA hai nAbhistanAntaraM jantorAmAzaya iti smRtaH / azitaM khAditaM pItaM lIDhaM cAtra prapacyate / / AmAzayagataH pAkamAhAraHprApya kevalam / pakvaH sarvAzayaM pazcAd dhamanIbhiHprapadyate / / (caraka vi 2) ina do sUtroM meM pacanasaMsthAna kI pUrI kalpanA dI gaI hai| kisa prakAra saba prakAra kA AhAra AmAzaya meM jAkara pahale pAka ko prApta hotA hai phira paripakva annarasa For Private and Personal Use Only

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65E agni vaikArikI dhamaniyoM ke dvArA sampUrNa zarIra ke andara pahu~catA hai| caraka cikitsA a0 15 meM isake pacane kI sampUrNa kriyA kA ullekha kiyA gayA hai| agnimAndya aura Ama doSa jise caraka ne Ama doSa mAnA hai aura vividha lakSaNa aura prakAra diye haiM usI ko itara vidvAnoM ne agnimAndya yA ajIrNa ke nAma se prakAzita kiyA hai| ajINaM ke sambandha meM likhA haianAtmavantaH pazuvadbhaJjate ye'pramANataH / rogAnIkasya te mUlamajIrNa prApnuvanti hi // (bhAvaprakAza) jo mUrkha pazuoM ke samAna binA pramANa ke andhAdhundha bhojana karate haiM ve aneka rogoM ke mUla ajIrNa ko prApta hote haiN| __ajIrNa ke kAraNoM meM bhojana ke kaI prakAra vizeSa bhI apanA hAtha rakhate haiN| yathA: 1. samazana-hitAhitakArI dravyoM ko milAkara sevana karanA / 2. adhyayana-pUrva kiye bhojana ke pUrNatayA pacane ke pahale punaH bhojana karanA / 3. pramRtAzana-bhUkha aura pyAsa ke pUrNatayA naSTa ho jAne para aura agni ke zAnta ho jAne para bhojana krnaa| 4. viSamAzana-sAtmyakrama ke viparIta aura saMskArita guNoM ke virodha meM bhojana karanA athavA kabhI thor3A, kabhI bahuta, kabhI kisI kAla meM aura kabhI kisI kAla meM bhojana krnaa| 5. viruddhAzana-do viparIta guNa sampanna padArthoM kA eka sAtha sevana jaise guDa aura mUlI athavA dUdha aura mchlii| 6. ajIrNAzana-ajIrNa hone para bhI bhojana karanA / 7. atyazana-atimAtra bhojana karanA / ___ ajIrNa lakSaNa caraka ne likhA haitasya liGgamajINesya viSTambhaH sadanaM tathA / ziroruka caiva mUrchA ca bhramaH pRsstthkttiigrhH|| jambhAGgamardastRSNA ca jvarazchardipravAhaNam / arocakAvipAkau ca ghoramannaM viSaJca tat // pittena saha saMsRSTaM dAhatRSNAmukhAmayAn / janayatyamlapittaM ca pittajAMzcAparAn gadAn // yakSmapInasamehAdIn kaphajAn kaphasaGgatam / karoti vAtasaMsRSTaM vAtajAMzcAparAn gadAn // mUtrarogAMzca mUtrasthaM kukSirogAn zakRdgatam / rasAdibhizca saMsRSTaM kuryAdrogAn rasAdijAn // ajIrNa ke lakSaNa kitane vyApaka ho sakate haiM isakA jJAna hameM saralatayA caraka ne diyA hai| viSTambha, avasAda, ziraHzUla, mUrchA, bhrama, pRSThagraha, kaTigraha, jRmbhAdhikya, aGgamarda, tRSNA, jvara, vamana, pravAhikA, aruci, avipAka ye sabhI isake andara samAviSTa haiM / vaha AmarUpa ghora annaviSa jaba pitta ke sAtha mila jAtA hai to pitta kA prakopa karake dAha, tRSNA, mukha ke vividha roga, amlapitta tathA anya aneka paittika vikAroM For Private and Personal Use Only

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vikRtivijJAna kA kartA hotA hai| amlapitta kI utpatti meM pramukha kAraNa durbalAgni hai| aba jo hamAre bandhu AyurvedIya agni ko udanIrikAmla (hAiDroklorika esiDa) mAtra mAnakara calate haiM ve kahA~ Tikate haiN| yadi AmAzayastha amlamAtra agni hotA to usakI kamI (durbalAmi) amlapitta kA janaka kaise hotA ? kyoMki amlapitta meM to AmAzayika amlatA bar3hatI hI hai| ataH agni kI hamArI kalpanA isase bhinna hai| pitta kI vidagdhAvasthA hI amlapitta kI jananI hai aura pitta vidagdha hotA hai agni ke durbala karane vAle kAraNoM kI upasthiti meN| kapha kI vidagdhAvasthA ke kAraNa bhI kaI roga utpanna hote haiM aura unameM bhI jATharAgni kI mandatA kA bahuta mahattva hotA hai| yakSmA, pratizyAya aura pramehAdi kI utpatti meM kapha kI vidagdhAvasthA mukhya hai| yakSmA meM agni kI durbalatA eka mahatva kA lakSaNa hotA hai| ataH agnimAndya hI yakSmA ke taiyAra karane meM pradhAna kAraNa mAnA jA sakatA hai / yuktAgni vyakti jo ThIka khAkara pacA letA hai aura jisake doSa. duSyoM kI avasthA agni kI yuktatA ke kAraNa sama rahatI hai kyA yakSmA se upasRSTa hotA hai ? yakSmA kA daNDANu to hara samaya vAyumaNDala meM rahatA hai yA raha sakatA hai para sabhI usase pIDita nahIM hote| pIDita hoMge durbalAgni ho gaI hai jinakI ve / ataH yadi hindU jIvana meM khAna-pAna ke viSaya meM vizeSa niyantraNa aura caukA ke jaTila niyama banA diye gaye haiM to ve kahA~ Adhunika vaijJAnika yuga ke viparIta par3ate haiM ? unakA akSarazaH pAlana karane vAlA vyakti durbalAgni se kadApi pIDita nahIM hogA aura isIlie hamAre yahA~ anuloma yakSmA na milakara pratiloma yakSmA milatI rahI hai / rAjAoM dvArA adhika zukranAza janita daurbalya ke prabhAva se utpanna ymaa| khAna-pAna ke niyamoM meM upekSA baratane ke kAraNa hI deza meM yakSmA bar3hI hai| durbalAgnivAle yuvaka abhI abhI hI adhika bar3he haiN| pacAsa varSa pUrva aisA nahIM thaa| vAtasaMsRSTa annaviSa vAta ko vidagdha karake aneka vAtavyAdhiyoM kI utpatti kiyA karatA hai / bahudhA jina vyaktiyoM ko ekAGga, addhAMga, sarvAMgavAta milatI hai ve sabhI durbalAgni hote haiN| vRddha prAyaH pakSAghAta se pIDita hote haiM aura vAkya durbalAgni kA prabala dyotaka hai| jina buDDhoM kI agni dIpta rahatI hai unheM vAtavikAra adhika kaSTa pradAna nahIM krte| annaviSa kA samparka mUtra ke sAtha hokara mUtragata vikAra banate haiN| mala ke sAtha samparka Ane para kukSi ke roga banate haiN| rasaraktAdi dhAtuoM ke sAtha jaba yaha annaviSa calatA hai to vividha dhAtuoM meM vikAra utpanna ho jAte haiN| ___agni ke vikAra kA prabhAva kisa aMga para nahIM par3atA? kauna dhAtu isake prabhAva se bacI hai aura doSa to mAno isake kor3e ke nIce nAcate rahate haiN| ataH agni kI mahattA ko AyurvedIya vaikArikI kA adhyayana karane vAloM ko bhale prakAra hRdayaMgama For Private and Personal Use Only

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agni vaikArikI 661 kara hI lenA hogaa| AcAryoM ne jo ajIrNa ke kAraNa likhe haiM unakA nAma smaraNa karanA yahA~ yuktiyukta hI hai| ajIrNa ke kAraNa kAzyapasaMhitA ke bhojyopakramaNIya nAmaka adhyAya meM ajIrNa vA apacana ke nimna kAraNa diye gaye haiM: atisnigdhAtizuSkANAM gurUNAM cAtisevanAt / jantoratyambupAnAcca vAtaviNmUtradhAraNAt // rAtrI jAgaraNAt svapnAddivA viSamabhojanAt / asAtmyasevanAccaiva na samyak paripacyate // suzrutasaMhitA meM isa para nimna vAkya milate haiM: atyambupAnAdviSamAzanAdvA sandhAraNAtsvapnaviparyayAcca / kAle'pi sAtmyaM lavu cApi bhuktamannaM na pAkaM bhajate narasya / IrSyAbhayakrodhaparikSatena lubdhena rugdainyanipIDitena / pradveSayuktena ca saivyamAnamantraM na samyak paripAkameti // atyantasnigdha padArthoM ke adhika sevana se ajorNa usI prakAra utpanna hotA hai jaise bahuta adhika ghRta ko agni para u~Dela dene se vaha bujha jAtI hai| kaI vyakti jo bahuta mAtrA meM maisUra pAka yA sUjI kA halavA khA lete haiM unakI bhUkha mArI jAtI hai| ___adhika sUkhe padArthoM ke sevana se vAyu bar3ha kara pAcana kriyA meM vaiSamya utpanna kara detI hai jisase bhojana kA paripAka yathAvat nahIM hone paataa| guru dravyoM kA upayoga karanA vizeSa kara una logoM ko jo roga se pIDita haiM yA jo roga se abhI-abhI hI chUTe haiM yA jinheM viSTambha Adi rahatA hai sadaiva ajIrNa kAraka hotA hai| atisevana cAhe phira kitanA hI halakA padArtha kyoM na ho ajIrNakAraka huA karatA hai| atyambupAna arthAt bahuta adhika jala pInA usI prakAra ajIrNakAraka hotA hai jaise bahuta sA jala DAlanA agni ko bujhAne meM saphala hotA hai| vegarodha se vAyu prakupita hotI hai| vAta kA prakopa sadaiva pAcanakriyA meM vaiSamya utpanna karake ajIrNotpatti kara detI hai| rAtrijAgaraNa vAtakAraka hai viSamabhojana zarIra kI zaktiyoM ke sAmaJjasya ke. lie vighaTanAtmaka siddha hotA hai| asAtmya padArthoM kA prayoga karane se zarIra use grahaNa karane meM asamartha rahatA hai| divA svapna athavA rAtrijAgaraNa rUpa svapnaviparyaya kI eka aisI avasthA hai ki kitanA hI sAmya aura laghu bhojana kiyA jAve vaha ThIka-ThIka jIrNa nahIM ho pAtA / vegasaMdhAraNa se bhI yaha ho sakatA hai| ____ AhAra ke pacana meM mana kA anivAryatayA sthAyI bhAga rahatA hai| sabhI jAnate haiM ki pUrNa svAdiSTa aura rasapUrNa padArtha bane hone para tanika sI bhI anabana hone para khinnamanA bAlaka yA taruNa bhojana nahIM kara sakatA aura yadi bar3oM kI DaoNTa phaTakAra para 81,82 vi0 For Private and Personal Use Only

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vikRtivijJAna bhojana le bhI letA hai to ajIrNa ho jAtA hai vamana ho jAtI hai yA peTa meM darda ho jAtA hai| isa mAnasika susthiti kI anivAryatA para suzruta ne likhA hai zabdarUparasAn gandhAn sparzAzcamanasaH priyAn / bhuktavAnupaseveta tenAnnaM sAdhu tiSThati / / ki bhojana karane ke bAda mana ko priya aise zabda sune, rUpa dekhe, rasa cakhe, gandha saMdhe aura sparzadAyaka padArthAdi chue to usakA anna ThIka prakAra se pacatA hai| AcArya ghANekara AkAzavANI (reDiyo) ke prayoga kI mantraNA isI AdhAra para dete haiN| IrSyA, bhaya, saGkoca, krodha, lobha, cintA, roga, dInatA, dveSa, AghAtAdika ina sabhI meM se kisI se bhI mana kA santulana naSTa ho sakatA hai ataH bhojana ke pazcAt ina mAnasika vikAroM meM se kisI ke bhI adhika ugra hone se vyakti ajIrNa se pIDita ho sakatA hai / caraka ne vimAnasthAna meM isI kI puSTi kI hai mAtrayA'bhyavahRtaM pathyaM cAnnaM na jIryati / cintAzokabhayakrodhaduHkhazaiyA prjaagraiH|| anna kA samyaktayA paripAka na hone se Ama kI utpatti hotI hai| jahA~-jahA~ Ama kA saMcaya ho jAtA hai usI-usI jagaha vikArotpatti hotI hai sAtha hI usakA anyatra bhI prabhAva par3atA haiyatrasthamAmaM virujettameva dezaM vizeSeNa vikaarjaatH| dopeNa yenAvatataM zarIraM tallakSaNerAmasamudbhavaizca / / arthAt AmadoSa zarIra ke jisa vizeSa aMga meM sthita ho jAtA hai usa aMga ko avazyameva rogAkrAnta kara detA hai aura jisa prakAra ke doSa se AmadoSa kA samparka AtA hai usa aMga meM tathA ( etenAnyadeze'pi kiMcadrujaM karotIti se anyatra bhI) usa-usa doSa ke dvArA hone vAle prakopaka lakSaNoM ko bhI vahA~ utpanna kara detA hai| aura isa ajIrNa kI utpatti meM AhAra vaiSamya pradhAna kAraNa mAnA gayA hai| yaha ajIrNa hI rogoM kA utpAdaka hai| yadi ajIrNa ko naSTa karake agni ko samAvasthA para adhiSThita karane vAlI cikitsA kI jAya to roga bhI naSTa ho hI jAte haiM prAyeNAhAravaiSamyAdajIrNa jAyate nRNAm / tanmUlo rogasaMghAtastadvinAzAdvinazyati / / ajIrNa naSTa karane ke pazcAt jIrNAhAra kI kalpanA sAkAra karate hue likhA gayA haiudgArazuddhirutsAho vegotsargo ythocitH| laghutA kSutpipAsA ca jIrNAhArasya lakSaNam // ___ ajIrNa aura usake prakAra suzruta ne AmAjIrNa, vidagdhAjIrNa, viSTabdhAjIrNa tathA rasazeSAjIrNa karake ajIrNa ke cAra bheda svIkAra kie haiN| mAdhavakara dinapAkI ajIrNa tathA prAkRta ajIrNa isa prakAra do aura bheda milAkara kula 6 bheda ajIrNa ke mAnate haiM AmaM vidagdhaM viSTabdhaM kphpittaanilaistribhiH| ajIrNa kecidicchanti caturtha rasazeSataH / / ajIrNa paJcamaM kecinnirdoSa dinapAki ca / vadanti SaSThaM cAjINaM prAkRtaM prativAsaram / / kahanA nahIM hogA ki ajIrNa ke ina bhedoM ke pragaTa karane meM bahuta bar3I buddhimAnI kA paricaya diyA gayA hai| isameM Arambhika AmadoSa kI vyApti se AmAjIrNa kI For Private and Personal Use Only

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agni vaikArikI 663 kalpanA kI hai jo kaphajanita upadravoM kA kartA bhI hai / anna kI AmAvasthA ke pazcAt vidagdhAvasthA AtI hai vaha pittadoSavardhaka hai tathA pazcAt viSTabdhAvasthA ana kI AtI hai jo Ama aura vidagdha hue anna ko viSTambhayukta karake vAtika vikAroM kI utpatti kA kAraNa banatI hai / ajIrNa kI ye eka ke bAda dUsarI kramika avasthAeM bhI ho sakatI haiM aura svatantra avasthAe~ bhI / Ayurveda ne sampUrNa pacanasaMsthAna ke andara durbalAgni kI kalpanA kI hai| jaba vaha zleSmasthAna ( AmAzaya ) meM adhika durbalatA ko prApta huI hai to AmAjIrNa kI avasthA banegI / pacyamAnAzaya pittakAraka vidagdhAjIrNa kA rUpa lAvegA tathA pakvAzaya viSTabdhAjIrNa banAvegA / para agnidaurbalya sampUrNa pacanasaMsthAna meM vyApta hai ataH AmAjIrNa, vidagdhAjIrNa aura viSTabdhAjIrNa kI avasthAe~ eka ke bAda dUsarI Arambha meM banakara tInoM yugapat bhI raha sakatI haiM para vyakti kI prakRti, deza, kAlAdi kI dRSTi se inameM koI eka prabala aura zeSa gauNa rUpa meM dekhI jA sakatI hai / mukhyataH yahI tIna ajIrNa hote bhI haiN| zeSa rasazeSAjIrNa, dinapAkI aura prAkRta ajIrNAvasthA vizeSa mahattva kI nahIM haiM / rasazeSa ajIrNa meM AhAra dvArA rasa banane ke bAda AhAra kA kucha aparipakka aMza raha jAtA hai vaha jabataka pUrNatayA paripakva nahIM hotA usase pUrva hI DakAreM Akara sUcanA kara detI haiM ki saba paca gayA para yathArtha meM pAcanakriyA zeSa rahatI hai / isI lie ise rasAya zeSo rasazeSa aisA mAnA isameM sampUrNa bhojana kA ThIka-ThIka paripAka nahIM hone se rogI durbala hotA aura nAgArjuna ke zabdoM meM-- gayA hai / jAtA hai| udgAre'pi vizuddhatAmupagate kAMkSA na bhaktAdiSu / snigdhatvaM vadanasya sandhiSu rujA kRtvA zirogauravam / / mandAjIrNarase tu lakSaNamidaM tatrAtivRddhe punaH / hRllAsajvara mUrcchanAdi ca bhavet sarvAmayakSobhaNam // eka spaSTataH vizeSa roga kA paricAyaka hotA hai / isa para gadAdharAdi ne bhI UhApoha kiyA hai / gadAdhara ne rase zeSo rasazeSaH, AhArajanite rase zepa AhArAvayavo'nupraviSTo'lakSyamANaH kSIrenIramivAzeSaH / kaha kara bar3e hI sUkSmabheda kI ora iGgita kiyA hai / zarIra meM paripakka rasa dhAtu kI nirmANa svasthAvasthA kA dyotaka hai para yaha bhI sambhava hai ki AhAra kA kucha rasa pUrNa paripakka ho aura kucha apakka hI zarIra meM saMcaraNa ke lie cala pdd'e| isI apakkaMza meM jaba bAta apakka rahatI hai to vAtika, pittAMza apaka rahatA hai to paittika tathA kaphAMza apaka rahane para kaphaja vyAdhiyA~ zarIra meM vyApta ho jAtI haiN| rasazeSAjIrNa suzruta dvArA mAnya nahIM hai / usane to Ama, vidagdha aura viSTabdha ajIrNa meM hI ise samAviSTa kara liyA hai para anyoM kA mata usane de diyA hai / vijayarakSita ne AmAdi ko anna aura rasazeSa ko AhAra rasaja aise do bheda kie haiN| para yathArthatA kucha aura hI hai / AmAjIrNa meM rasazeSAjIrNa rahatA hI hai / kyoMki kapha ke kopa ke kAraNa AhAra kA kaphaja aMza kucha paka aura kucha aparipakka rUpa meM anna rasa meM mila rahA hai / yahI dazA anya ajINoM meM anya doSoM kI hai / For Private and Personal Use Only

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164 vikRtivijJAna sarvamajINaM tridoSajam kA jo nArA lagAte haiM ve hamAre mata kI puSTi hI karate haiM ki agni kI durbalatA hI ajIrNa hai| agni durbala hone para tInoM hI doSoM kA dhAturUpa pAcana pUrA-pUrA na hokara kucha dhAturUpa aura kucha malarUpa pAcana hotA hai jisake kAraNa tridoSaja lakSaNa hI ajIrNa meM hote haiM para ____eka doSa vypdeshstuutkttaikdosslinggtven| alaga-alaga doSoM ke taratama bheda se vibhinna nAma diye jAte haiN| dinapAkI ajIrNa vaha avasthA hai jaba eka nizcita kAla meM anna kA pAka na hokara adhika kAla vaha letA hai| dinapAki cetyahorAtreNAhAraH pacyata ityutsargaH yatra tu mAtrAkAlAsAtmyAdidoSAdaparadine pacyate tddinpaaki-vijyrkssit| yaha nirdoSa mAnA gayA hai| agni kucha-kucha manda hai aura zarIra meM doSadRSya sAmya kI sthiti kisI taraha DhakelI jA rahI hai yahI isase prakaTa hotA hai| prAkRta ajIrNa eka vyartha kA doSAropaNa mAtra hai| bhojana karane ke bAda samAgni bhI kucha kAla cAhatI hai jisameM usakA paripAka honA hai| isa kAla ke pUrNatayA bItane se pahale prAkRta ajIrNa kA hI kAla hotA hai| jIrNAhAra ke lakSaNa jo udgAra zuddhi utsAhAdi Upara kaha Aye haiM ve bhojana khAne ke turata bAda nahIM hote| jabataka ve nahIM hoMge hama jIrNAhAra nahIM kaha sakate ataH bhojana grahaNa karane ke bAda ina lakSaNoM ke prAkaTya taka prAkRta ajINaM kA samaya rahatA hai| mAdhavakara ne ina ajIrNoM ke lakSaNa batAne ke lie adholikhita sUtra diye haiMtatrAme gurutotkledaH zotho gnnddaakssikuuttgH| udgArazca yathAmuktamavidagdhaH pravartate // vidagdhe bhramatRNmUrchAH pittAcca vividhA rujaH / udgArazca sadhUmAmlaH svedo dAhazca jaayte|| viSTabdhe zUlamAdhmAnaM vividhA vaatvednaaH| malavAtApravRttizca stambho moho'GgapIDanam / / rasazeSe'nna vidveSo hRdayAzuddhi gaurve| inhIM kA suzruta ne nimna vAkyoM meM prakaTIkaraNa kiyA hai mAdhuryamannaM gatamAtrasaMjJaM vidagdhasaMjJaM gatamamlabhAvam / kiJcidvipakkaM bhRzatodazUlaM viSTabdhamAbaddhaviruddhavAtam / / udgAra zuddhAvapi bhaktakAGkSA najAyate hRdgurutA ca yasya / rasAvazeSeNa tu saprasekaM caturthametat pravadantyajIrNam / / aba AmAjIrNa meM anna meM mAdhurya bhAva kI vRddhi to hotI hai para usakA paripAka ThIka nahIM hone se ajIrNa bana jAtA hai| kapha doSa kI dUSakatA kA yahA~ mahattva hai| usake kAraNa gaurava, utkleza, akSikUTa tathA gaNDapradeza meM zotha tathA jaisA bhojana kiyA ho tadanukUla DakAreM AyA karatI haiN| ye DakAreM bhojana kI avidagdhAvasthA meM binA pace hue hI AtI haiN| vidagdhAjINa meM sampUrNa AhAra apakka rahane kI sAtha-sAtha amla bhAva ko prApta hone ke kAraNa paittikopadravoM kI utpatti karatA hai jinameM bhrama, tRSNA, mUrchA, khaTTI DakAreM, dhuA~sA nikalatA huA, svedAdhikya, dAha tathA anya aneka For Private and Personal Use Only

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agni vaikArikI 165 paittika roga dekhe jAte haiN| viSTabdhAjIrNa meM sampUrNa apakka anna kaTubhAva ko prApta ho jAtA hai jo udara meM zUla, AdhmAna, aneka vAtika vedanAe~, mala aura vAta kI apravRtti, stambha, moha aura aMgapIDana utpanna kara detA hai| rasazeSAjINa meM udgAra zuddhi hone para bhI bhojana kI icchA kA na honA hRdayapradeza meM gaurava ke sAtha-sAtha praseka kA lakSaNa bhI dekhA jAtA hai| visUcI, alasaka tathA vilambikA ___ ajIrNa kA itanA vicAra karane ke bAda Age usakA kyA rUpa hotA hai use bhI jAnanA caahie| caraka ne jahA~ vividha kukSIya vimAna meM durbalAgni kA citraNa upasthita karake AmadoSa kA jikra kiyA hai vahA~ taM dvividhamAmapradoSamAcakSate bhiSajo visUcikAmalasaJca / ke dvArA visUcI aura alasaka kA varNana Arambha kara diyA hai / suzruta ne uttaratantra meM ajIrNamAmaM viSTabdhaM vidagdhaJca yadIritam / visUcyalasakau tasmAt bhaveccApi vilambikA / / ke dvArA visUcI, alasaka tathA vilambikA ina tInoM kA varNana kiyA hai| inameM bhI AmAjIrNa kA rUpAntara visUcikA meM, viSTabdhAjIrNa kA rUpAntara alasaka meM, tathA vidagdhAjIrNa kA rUpAntara vilambikA meM spaSTataH kahA hai| isa para kArtikakuNDa ne isI vyavasthA ko ThIka mAnA hai__ AmaviSTabdhavidagdhepu triSu visUcyalasakavilambikA yathAsaMkhyaM bhavanti / DalhaNa ne bhI yadyapi vilambikA bAhulyena vidagdhAjIrNAjjAyate, vidagdhAjIrNAcca pittaM duSTaM na vAyurduSTo bhavati na vA zleSmA tathApi pittaduSTayA itarayorapi duSTiH tasmAt kaphamArutAbhyAM duSTamityuktam / para bakulakara ne isameM eka pakSArtha zaMkA kA yaha upasthita kI hai ki vidagdhAjIrNa amlabhAva se utpanna paittika vyAdhi hai usase kaphavAtaja vilambikA kI utpatti kaise sambhava hai___ 'tanna' iti bahulakAH yathAsaMkhye hi vilambikA vidagdhAt prApnoti, tAM ca kaphavAtAbhyAM paThiSyati / tasyA trividhAjIrNAdyathAsambhavaM visUcyAdInAmutpAda iti yuktam / uktaM hi-ajIrNAtpavanAdInAM vibhramo balavAn bhavet iti // isa prakAra tInoM prakAra ke ajIrNo se hI ina tInoM rogoM kI utpatti sambhava hai. yaha mata adhika yuktisammata hai / isa dRSTi se 1. kaphaja visUcI kaphaja alasaka AmAjIrNa se kaphaja vilambikA 2. pittaja visUcI pittaja alasaka vidagdhAjIrNa se tathA pittaja vilambikA For Private and Personal Use Only

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666 vikRtivijJAna 3. vAtaja visUcI vAtaja alasaka viSTabdhAjIrNa se vAtaja vilambikA utpanna ho sakate haiM yaha kalpanA bhI dRSTipatha para pratyeka cikitsaka ko rakhanA cAhie / aba hama ina tInoM kI vikRti kA varNana karate haiN| visUcI yA visUcikA 1. tatra visUcikAmUrdhvaJcAdhazca pravRttAmadoSA yathoktarUpAM vidyAt / ( caraka) 2. sUcIbhiriva gAtrANi tudan saMtiSThate'nilaH / yatrAjIrNana sA vaidyairvisUcIti nigadyate // na tAM parimitAhArA labhante viditAgamAH / mUDhAratAmajitAtmAno labhante'zanalolupAH / / mUrchA'tisAro vamathuH pipAsA zUlo bhramodveSTanaz2ambhadAhAH / / vaivarNyakampau hRdaye rujazca bhavanti tasyAM zirasazca bhedaH // ( suzruta ) 3. vividhairvedanAbhedairvAyvAde zakopataH / sUcIbhiriva gAtrANi bhinattIti visUcikA // (mAdhavakara) ajIrNottha visUcikA meM AmadoSa Urdhva aura adhomArgoM se pravRtta hote haiN| isa roga meM zarIra meM sUcI (suI ) jaisI cubhana vAyu utpanna karatA hai| yaha roga parimita mAtrA meM AhAra sevana karane vAloM meM nahIM hotA para jo mUDha-asaMyamI hote haiM aura bhojanabhaTTa karake prasiddha haiM ve hI ise prApta karate haiN| isameM mUrchA, atisAra, vamana, tRSNA, zUla, bhrama, udveSTana, jambhA, dAha, vaivarNya, kampa, hRcchUla tathA ziraHzUla ye lakSaNa milate haiM / yaha roga AmadoSottha hone para bhI isameM vAyu kA vizeSa prakopa hotA hai aura vamana atIsArAdi ke atirikta udara meM tathA sarvAGga meM tIvra zUla hotA huA milatA hai| __ Adhunika dRSTi se visUcI daNDANu ( cholera bacillus ) dvArA hone vAle roga ko visUcikA mAnA jAtA hai / para gaNanAthasena sarasvatI ne apane siddhAnta nidAna meM likhA hai ki sUcIbhiriva gAtrANi todanI yA visuucikaa| prAcAM sA syAdajIrNotthA prAyaH prAgaharI na sA / / prAcInoM dvArA ajIrNottha visUcikA jisameM gAtra meM sUcIvata yA todanayukta zUla rahatA hai prANahArI nahIM hotA kyoMki usameM visUcI daNDANu nahIM pAyA jaataa| visUcIdaNDANujanya yA ajIrNajanya visUcI donoM meM AmadoSa kI vyApti ko asvIkAra nahIM kiyA jA sktaa| jaba taka AmAzaya kI sthiti vikArayukta nahIM hai taba taka svastha AmAzaya meM visUcIdaNDANu koI bhI prabhAva nahIM ddaaltaa| isa roga meM jitanI bhayAnakatA dekhI jAtI hai usake anupAta meM vikSata nahIM bnte| isameM kSudra aura bRhadantra donoM hI prabhAvagrasta hote haiM para unake adhicchada kA upariSTha bhAga hI prabhAvita hotA hai| usameM raktAdhikya tathA nirmokana ( congestion and sloughing ) milate haiM / bhItarI ati pUrNataH svastha vA aprabhAvita dekhI jAtI hai| For Private and Personal Use Only

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agni vaikArikI 667 AntranibandhIka granthiyoM meM vraNazotha ho jAtA hai| rogakAraka daNDANu meM AkrAmaka zakti utanI nahIM hotI para isakI vibhISikA kA kAraNa hotA hai usake dvArA utpanna viSaraktatA tathA vamana aura atIsAra ke kAraNa hone vAlA jalAbhAva / atIsAra ke rUpa meM cAvala ke maNDa ke varNa ke dasta calate rahate haiN| mRtyUttara parIkSaNa para peziyoM meM vidaraNa tathA AkuMcana, UtiyoM meM jalAbhAva tathA dakSiNa hRtalinda meM arddha AtaMcita rakta kI upasthiti milatI hai| yakRt meM raktAdhikya milatA hai| pittAzaya meM pittAdhikya ke kAraNa vistAra bar3ha jAtA hai| A~ta kI zleSmalakalA lAla ho jAtI hai usake andara maNDasadRza padArtha bharA hotA hai| jisameM asaMkhya visUcI daNDANu mila sakate haiN| ye jIvANu rakta se, vRkkoM se tathA plIhA se bhI prApta kie jA sakate haiN| alasaka alasakamupadekSyAmaH durbalasyAlpAgnebahuzleSmaNo vAtamUtrapurISavegavidhAriNaH sthiragurubahurUkSazItazuSkAnnasevinaH tadannapAnamanilaprapIDitaM zleSmaNA ca nibaddhamArgamatimAtrapralInam alasatvAnna bahirmukhI bhavati / tatazchadyatIsAra varjAnyAmapradoSaliMgAni abhisandarzayatyatimAtrANi / atimAtrapraduSTAzca dopAH praduSTAmabaddhamArgAstiryag gacchantaH kadAcideva kevalamasya zarIraM daNDavat stambhayanti atastamalasakamasAdhyaM bruvate / viruddhAdhyazanAjIrNAzanazIlinaH punareva doSam AmaviSamityAcakSate bhipajo vipasadRpaliGgatvAt / tat paramaasAdhyamAzukAritvAt viruddhopkrmtvaacceti| caraka / 2-kukSirAnahyate'tyartha pratAmyati vikUjati / niruddho mArutazcApi kukSAvuparidhAvati // __vAtava!nirodhazca kukSau yasya bhRzaM bhavet / tasyAlasakamAcaSTe tRSNodgArAvarodhakau // (suzruta u. taM. 56) caraka ne alasaka kA varNana karate hue punaH eka bAra usa paristhiti kA spaSTIkaraNa kara diyA hai jisameM alasaka taiyAra hotA hai| arthAt jo vyakti durbala hote haiM, jinakI agni manda ho gaI rahatI hai tathA jinameM kaphAdhikya yA kapha kA atisaMcaya pAyA jAtA hai, jo vAta ke, mUtra ke, malatyAga ke vegoM ko rokA karate haiM; jo sthira, bhArI, bahutasA, rUkhA, ThaNDA, sUkhA anna sevana karate rahate haiM unakA udarastha annapAna vAyu dvArA pIDita kiyA jAtA hai| kapha usake Upara yA nIce jAne ke mArga ko roka detA hai jisase annAdika andara hI andara lIna hone lagatA hai aura tIvra viSaraktatA kI utpatti karane meM samartha hotA hai vaha (vamana yA atIsAra ke rUpa meM) bahirmakha nahIM ho paataa| isake kAraNa vamana aura atIsAra ko chor3akara AmadoSajanya anya saba lakSaNa khUba hI dekhane meM Ate haiN| isa prakAra khUba hI praduSTa hue doSa praduSTa Ama se baddhamArga ke kAraNa tiryaka gati karake kabhI kabhI sampUrNa zarIra ko hI daNDa ke samAna stambhita kara dete haiM / jise daNDAlasaka kahA jAtA hai| ____alasaka meM kukSi khUba phUla jAtI hai, rogI ko mUrchA A jAtI hai, vaha khUba cillAtA hai, vAyu rukane ke kAraNa kukSi ke UparI bhAgoM (hRdaya kaNTha) taka ghUmatA hai / isa prakAra jisameM vAyu aura mala kA atyanta nirodha hotA hai, jisameM DakAreM aura pyAsa khUba milatI hai vaha alasaka kahalAtA hai| For Private and Personal Use Only

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168 vikRtivijJAna visUcikA kA eka rUpa kAlerA sikkA ( cholera sicoa ) kahalAtA hai| isameM na vamana hotA hai na atIsAra, para rogI tIvra viSaraktatA se pIDita hokara zIghra mara jAtA hai / alasaka usI kA paryAya mAlUma par3atA hai aura jaba kAlerA sikkA kA varNana visUcI ke turata bAda hai to visUcI ke dvArA bhI prAcInoM dvArA kAlerA kA hI varNana kiyA gayA hai isameM sandeha kI koI guJjAiza nahIM rhtii| gaNanAthasena ne jo ajIrNottha visUcI ko mAraka nahIM mAnA hai vaha yathArtha nahIM hai| ajIrNa ke hI kAraNa visUcI daNDANu jisa vyathA ko karatA hai vaha visUcikA yA kAlerA hai| annaviSa prakaraNa meM jo chardi aura pravAhaNa diyA hai jisameM vamana aura atisAra hotA hai vaha svayaM ajIrNa yA annaviSatA hai vaha mAraka nahIM hai| AmaviSa caraka ne AmaviSa ke spaSTa lakSaNa dekara ise aura bhI puSTa kara diyA haiviruddhAdhyazanajIrNAzanazIlinaH punarevaM doSaM AmaviSamityAcakSate bhiSajo viSasadRzaliGgatvAt / tat paramaasAdhyamAzukAritvAt viruddhopakramatvAcceti / viruddhAzana, adhyazana, ajIrNAzana ke kAraNa jo AmadoSa bhayAnaka rUpa dhAraNa karatA hai vaha AmaviSa kahalAtA hai, isameM viSa jaise lakSaNa hote haiM vaha atIva asAdhya hotA hai kyoMki usameM upakrama viruddha par3atA hai (viSa kI zIta cikitsA Ama kI uSNa cikitsA hone se ) vaha AzukArI (sadyomAraka ) hotA hai| AmaviSa zabda viSaraktatA ( toxaemia) ke lie prAcIna tathA upayukta zabda hai / vilambikA duSTaM tu yuktaM kaphamArutAbhyAM pravartate nordhvamadhazca yasya / vilambikAM tAM bhRzaduzcikitsyAmAcakSate zAstravidaH purANAH // (su. u. taM. 55 ) kapha aura vAyu ina donoM se dUSita huA bhuktAnna na nIce jAtA hai aura na Upara, ise prAcIna zAstrakAroM ne vilambikA batalAyA hai tathA yaha duzcikitsya hotI hai| alasaka meM bhI vahI hotA hai ataH caraka ne vilambikA nAma se koI pRthaka roga nahIM diyA / daNDAlasaka nAma se jo tantrAntara meM likhA gayA hai vaha isI kA paryAya DalhaNa mAnatA hai| ___ajIrNa visUcI alasakAdi meM AmadoSa pradhAna hone ke kAraNa hI nirAmAvasthA lAne ke lie apatarpaNaja cikitsA kA spaSTa vidhAna diyA gayA hai AmapradoSajAnAM punarvikArANAmapatarpaNanaivoparamo bhavati / aba hama agni ke pratyakSa vikAra se utpanna hone vAle atisAra grahaNI tathA arza kA varNana kreNge| atosAra ArSagranthoM meM atIsAra kI utpatti 'gomAMsabhakSaNa ke kAraNa huI aisA kahA gayA hai| caraka saMhitA meM pRSadhra rAjA ke yajJa meM govadha se utpatti kisa prakAra huI usakA upasaMhAra karate hue likhA hai For Private and Personal Use Only

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ani vaikArikI 66 atazca pratyavarakAlaM pRSatreNa dIrghasatreNa yajatA pazUnAmalAbhAdgavAmAlambhaH pravartitaH, taM dRSTvA pravyathitA bhUtagaNAH teSAM copayogAdupAkRtAnAM gavAM gauravAdauSNyAdasAtmyatvAdazastopayogAtsvAdU payogAccopahatAgnInAmupahatamanasAM cAtIsAraH pUrvamutpanna pRSadhayajJe / zAstrakAroM ne atIsAra ke hone meM nimna kAraNoM ko batalAyA hai: -- 1. guru, bhArI kabja karane vAle padArthoM kA sevana / 2. atyadhika cikanAI se yukta tela, ghI yA ghAsaleTa ke bane padArthoM kA sevana / 3. cikanAI se zUnya rUkhe padArthoM kA sevana / 4. atyanta uSNavIrya dravyoM kA sevana / 5. atyanta patale padArthoM kA sevana athavA peya padArthoM kA sevana yA kevala jala kA hI bahuta prayoga / 6. atyanta sthUla prakRti padArtha jaise pIThI ke padArtha, laDDU, khuramA Adi kA sevana / 7. atyanta zItala padArthoM kA sevana jaise barpha- soDA Adi kA pInA / 8. zAstra meM jo viruddha bhojana kahe haiM jinameM kucha saMyoga viruddha haiM jaise dUdha aura machalI, kucha deza viruddha haiM, kucha kAla viruddha haiM aura kucha mAtrA se viruddha kahe gaye haiM unakA prayoga | Acharya Shri Kailassagarsuri Gyanmandir 9. adhyazana karanA arthAt pahale bhojana ke pUrNatayA pacane se pahale hI dubArA bhojana kara lenA / hIna yoga karanA / 13. viSa kA prayoga / 10. ajIrNa yA apakka anna kA sevana | 11. viSamAzana arthAt akAla bhojana / 12. snehana yA snehapAna kA adhika mAtrA meM karAnA, vamana, virecana, anuvAsana, nirUhaNAdi karmoM kA atyadhika upayoga karanA athavA mithyA yoga karanA vA 14. bhaya karanA / 15. zoka karanA / 16. dUSita jala vA duSTa dugdha kA sevana / 17. atyadhika madya kA sevana / 18. sAtmya viparyaya dravyoM kA sevana, sUkhe durbala mAMsa kA prayoga / 19. Rtu viparyaya dravyoM kA sevana / 20. jala meM adhika kAla taka ramaNa karanA / 21. vegoM kA vighAta | 22. udara kRmi athavA arza kA honA / -- uparyukta kAraNoM ko pradarzita karane vAle kucha sUtra suzruta ne isa prakAra diye haiM: gurvatisnigdharUkSoSNadravasthUlAtizItalaiH / viruddhAdhyazanAjANairviSamaizcApi bhojanaiH // snehAdyairatiyuktaizca mithyAyuktairviSairbhayaiH / zokA duSTAmbumadyAtipAnaiH sAtmyartuparyayaiH // jalAbhiramaNairvegavighAtairRmidoSataH / nRNAM bhavatyatIsAraH" ...... **********11 For Private and Personal Use Only

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vikRtivijJAna hArIta ne nimna zabdoM meM ina kAraNoM ko vyakta kiyA haisnigdhAtizItaguruzItalapicchilAnnaM duSTAzanAtiviSamAzanapAnabhakSyam / adyAdajIrNamathazokaviSairbhayairvA zokArtiduSTapayasA tu viparyayeSu // vAgbhaTa ke mata se atIsArotpatti ke nimna kAraNa hai ...'sa sutarAM jAyate'tyambupAnataH / kRSazuSkAmiSAsAtmyatilapiSTa virUDhakaiH // madyarUkSAtimAtrAnnairoMbhiH snehavibhramAt / kRmibhyo vegrodhaacc'......| atIsAra kI nirukti karate hue DalhaNa likhatA hai atiratyarthavacane saratirgati karmaNi, tasmAdatyantasaraNAdatIsAra iti smRtaH / / ki atIsAra do zabdoM ke dvArA banatA hai| ati aura saraNa / ati kA artha bahuta tathA saraNa kA artha gati karanA arthAt jisameM atyanta gati ho halacala ho vaha atisAra kahalAtA hai| atIsAra meM A~toM meM bahuta halacala macatI hai| bAra-bAra TaTTI AtI hai, bAra-bAra malAzaya se mala kA saraNa hotA rahatA hai ataH ise atIsAra nAmaka saMjJA dI gaI hai| atIsAra kI samprApti ke sambandha meM zAstrakAroM ke nimna vAkya pramANa haiM1. saMzamyApAM dhAturantaH kuzAnuM varcI mizro mArutena praNunnaH / vRddho'tIvAdhaH saratyeva yasmAdvayAdhi ghorantaM tvatIsAramAhuH // ekaikazaH sarvazazcApi doSaiH zokenAnyaH SaSTha Amena coktaH / kecit prAhurnekarUpa prakAraM naivetyevaM kAzirAjastvavocat // doSAvasthAstasya naikaprakArAH kAle kAle vyAdhitasyodbhavanti / / (suzruta) 2. daurbalyatAM viSamabhojanakena cApsu saMbhidyate malamajIrNa ninti cAgniH / saJjAyate hi manujasya tadAtisAro hatvodarAgniM manujasya tadAtisAraH / / sajAyate sa tu punarbahalo malena syAtpaJcadhA nigadito munibhividhijnyaiH|| (hArIta ) 3.""""tadvivaiH kupito'nilaH / visransayatyadho'bdhAtuM hatvA tenaiva cAnalam / / vyApadyAnuzakRtkoSThaM purIpaM dravatAM nayan / prakalpate tisArAya ........ / (aSTAGgahRdaya ) 4. doSAH sannicitA yasya vidgdhaahaarmuucchitaaH| atIsArAya kalpante..."( caraka ) ina pramANita vAkyoM ko dRSTipatha meM rakha kara calane se hama nimna AyurvedIya tathyoM ko prApta karate haiM:1. apAdhAtu se kAyadrava zleSmapittarakta (DalhaNa ) tathA rasa jala mUtra sveda medaH kapha pitta raktAdi (mAdhavakara ) liye jAte haiN| 2. yaha apAdhAtu gurvatisnigdhAdi kAraNoM se bar3hA karatI hai| 3. apAdhAtu zarIrastha jATharAgni ko manda kara detI hai| 4. apAdhAtu svayaM mala ke sAtha mila kara use patalA karatI hai / 5. yaha patalA mala vAyu ke dvArA adhobhAga kI ora prerita kiyA jAtA hai / 6. patale mala kA bAra-bAra vAyu ke dvArA nikAlanA yahI atIsAra kA rUpa hai| 7. atIsAra eka ghora vyAdhi mAnI jAtI hai| For Private and Personal Use Only

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agni vaikArikI 671 8. suzruta ke mata se vAtika, paittika, zlaiSmika, sAnnipAtika, zokajanya aura Amajanya ye 6 atIsAra ke prakAra hote haiM isI ko kaI zAstrakAra kaI prakAra vAlA bhI batalAte haiM jise kAzirAja svIkAra nahIM krte| doSAvasthAnusAra samaya samaya para atIsAra ke vividha rUpa dekhe jAte haiN| eka hI prakAra ke atIsAra meM AmAvasthA, pakvAvasthA aura raktAtIsArAvasthA ye tIna avasthAe~ banA karatI haiM vAstava meM mUla prakAra doSAnusAra hI rahate haiN| yA yoM kahie ki atIsAraH paTaprakAra eva, yAzca Amapakka raktAnyadoSAnubandhAdyAstatrAnekaprakArA avasthAstA dossaannaamevetyrthH-ttlhnnH| 9. hArIta ne inhIM tathyoM ko apane rUpa meM rakhate hue likhA hai ki vyakti durbala ho, viSamatayA bhojana kara cukA ho to use ajIrNa ho jAtA hai jisake kAraNa mala apakka raha jAtA hai, jo jala ke sAtha mila kara agni ko naSTa kara detA hai / isa prakAra udara kI agni ke zAnta hone ke kAraNa manuSya ko atIsArotpatti ho jAtI hai| 50. vAgbhaTa kahatA hai ki atIsAra kA pradhAna kAraNa atyadhika jala pInA hai| kRzazupkAmiSa, asAtmya, tila, piSTa, virUDhaka, madya, rukSAnna, atimAtrAhAra, arza, sneha vibhrama, kRmi, vegarodha Adi kAraNoM se vAtadoSa prakupita hotA hai / vaha abdhAtu ko nIce kI ora khIMcatA hai aura jATharAgni ko naSTa kara detA hai| yaha abdhAtu malAzaya ke pAsa taka A jAtI hai aura vahA~ para sthita purIpa ko patalA banA detI hai| 11. caraka aura vAgbhaTa donoM ne hI yaha bhI mAnA hai ki vyakti ke zarIra meM AhAra ke vidagdha hone ke kAraNa bar3he hue doSa atIsArotpatti meM kAraNa hote haiN| saMkSepa meM hama itanA kaha sakate haiM ki bAra-bAra patale dastoM kA honA Ayurvedika paribhASA meM atIsAra kahalAtA hai| patalA dasta yAnI pAnI ( abdhAtu) se yukta mala hai| sAdhAraNatayA mala eka viziSTa AkAra kA kele ko gaira ke samAna banatA hai| vibhinna prANiyoM meM usakI AkRti bhinna bhinna hotI hai| ajAzakRt jahA~ gandhaka vaTI golI se kucha bar3A hotA hai vahA~ U~Ta kA zakRt yA azvazakRt viziSTAkAra meM gola geMdoM jaisA milatA hai| para zakRt kI yaha AkRti adhika jala milane se bigar3a jAtI hai / yaha jala abdhAtu kahA gayA hai| dhAturUpa jala arthAt vaha poSaka jala jo zarIra meM bala kA kAraNa hotA hai| A~toM kI prAcIroM ke dvArA isakA atimAtrA meM utsarjana tabhI honA sambhava hai jaba peTa meM pAcana kriyA zithila par3a gaI ho aura vaha agni sarvathA zAnta ho gaI ho jisake kAraNa Ata meM AyA huA jalIyAMza pracUSita ho jAtA hai| agni ke manda ho jAne ke kAraNa A~toM kI prAcIroM kA bhI jalIyAMza A~toM meM ekatra hokara mala ko patalA karane meM sahAyaka hotA hai| ajIrNa yA agni kI mandatA kA uttararUpa dasta ke patale hone meM prakaTa hotA hai| yaha patalA mala eka bAra nahIM aneka bAra jo nikalatA hai usameM mukhya kAraNa vAyu hai| vAyu A~toM kI kriyA ko aniyamita kara detA hai| isake kAraNa bAra-bAra vyakti ko malatyAga karane ko bAdhya For Private and Personal Use Only

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172 vikRtivijJAna honA par3atA hai| agni ko manda karane kA kArya AhAra kA viSamatayA grahaNa, kRmi Adi aneka kAraNa haiM jinheM hama pahale hI spaSTa kara cuke haiN| ___Upara hamane atIsAra kI samprApti saMkSepa meM parantu spaSTataH likha dI hai| isakI Adhunika vijJAna se kahA~ taka saGgati baiThatI hai yaha batalAnA yahA~ anAvazyaka hai| __ atIsAra ke pUrvarUpa ke sambandha meM suzruta kA nimna zloka prasiddha hai : hRnnAbhipAyUdarakukSitodagAtrAvasAdAnilasannirodhAH / viTsaGgaAdhmAnamathA vipAko bhaviSyatastasya puraHsarANi / / isakA abhiprAya yaha hai ki atIsAra hone ke pahale hRdaya, nAbhi, guda, udara, kukSi ina saba sthAnoM meM yA kucha meM toda utpanna ho jAtA hai| zarIra meM avasAda A jAtA hai aura vAyu tathA mala kI rukAvaTa ke sAtha AdhmAna aura avipAka ho jAtA hai| isa prakAra 10 prAgrUpa pAye jA sakate haiN| ye lakSaNa kisI atIsAra meM adhika aura kisI meM kama hote haiN| ___ todo hRdgudakoTheSu gAtrasAdo malagrahaH / AdhmAnamavipAkazca lakSaNaM tasya bhAvinaH // ke dvArA aSTAMgahRdayakAra ne bhI inhIM kI puSTi kI hai| aba hama pratyeka atIsAra ke sambandha meM kucha varNana karate haiM: (1) vAtaja atIsAra athAvarakAlaM vAtalasya vAtAtapavyAyAmAtimAtraniSevaNo rUkSAlpapramitAzinastIkSNamadyavyavAyanityasyodAvartayatazca vegAn vAyuH prakopamAdyate paktA copahanyate sa vAyuH kupito'gnAvupahate mUtra svedau purISAzayamupahRtya tAbhyAM purISaM dravIkRtya atIsArAya prakalpate / (caraka) avarakAla meM arthAt pRSadhra ke gomedha yajJa ke pazcAt ke kAla meM vAtalavyakti vAyu, dhUpa, vyAyAmAdi kA atyadhika sevana karane para yA rUkSa padArtha sevana karane para, alpamAtrA meM bhojana karane para yA tIkSNa madya pIne para, bahuta maithuna karane para athavA vegoM ke rokane se vAyu prakupita ho jAtA hai| prakupita hokara vaha paktA arthAt jATharAgni kA apahanana kara detA hai / vaha vAyu kupita hokara agni ko naSTa karake sveda tathA mUtra arthAt jalIyAMza ko malAzaya meM lAkara usase mala ko patalA banAkara atIsAra kI utpatti kara detA hai| vAtaja atIsAra ke lakSaNoM ke sambandha meM nimna sAhitya milatA hai 1. tasya rUpANi-vijjalamAmaviplutamavasAdi rUkSaM dravaM sazUlamAmagandhaM sazabdamISacchabdaM vA vibaddhamUtravAtamatisAryate purISaM vAyuzcAntaHkoSThe sazabdazUlastiryak carati vibaddha ityAmAtisArIvAtAt , pakvaM vibaddhamalpAlpaM sazabdaM sazUlaphenapicchAparikartikaM hRSTaromAviniHzvasan zuSkamukhaH kaTyUrutrikajAnupRSThapArzvazUlI bhraSTagudo muhurmuhurvigrathitamupavezyate purISaM vAtAt , tamAhuranugrathitamityeke, vAtAnugrathitavarcastvAt / ( caraka) 2. zUlAviSTaH saktamUtro'ntrakUjI srastApAnaH sannakaTyUrujaGghaH / va_muJcatyalpamalpaM saphenaM rUkSaM zyAvaM sAnilaM mArutena // (suzruta) 3.................................."tatra vAtena viDjalam / alpAlpaM zabdazUlADhyaM vibaddhamupavezyate / rUkSaM saphenamacchaM ca grathitaM vA muhurmuhuH / / For Private and Personal Use Only

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agni vaikArikI 673 tathAdagdhaguDAbhAsaM spicchaaprikrtikm| zuSkAsyo bhraSTapAyuzca hRSTaromA viniSTanan / / (aSTAGgahRdaya) 4. aruNaM phenilaM rUkSamalpamalpaM muhurmuhuH| zakRdAmaM sarukzabdaM mArutenAtisAryate // (mAdhavakara ) 5. aruNaM phenilaM rUkSamalpamalpaM muhurmuhuH / sAmaM sazUla zabdazca sAro vAtAtpravartate // (siddhasaMgraha) 6. saphenilaM picchalameva rUkSamalpaM zakRdAmasazabdazUlam / kRSNaM bhavedgAtraviceSTanaJca vAtAtisAre pravadanti tajjJAH / / ( hArItasaMhitA) 7. rUkSaM phenilamalpamalpamaruNaM sAmaM sazabdaM saruk / viTzyAvaM kaThinaM vibaddhamasakRdvAtAtisAre bhavet / / (vaidyavinoda) NaM vAtAta............................ (aJjananidAn ) 9. zUlAnvitomalamapAnarujApragADhaM, yastoyaphenasahitaM sarujaM sazabdam / rUkSaM sRjatyatimuhurmuhuralpamalpaM, vAtAtisAra iti taM munayo vadanti ||(klyaannkaark) uparyukta uddharaNoM kA vicAra karane para hama isa niSkarSa para pahu~cate haiM ki vAtika atIsAra ke sambandha meM nimnAGkita lakSaNoM ko adhikAMza svIkAra karate haiM: 1. mala rUkSa hotA hai aura usameM snehAMza nahIM pAyA jaataa| 2. mala thor3A thor3A karake bAra bAra AtA hai| 3. mala meM jhAga hote haiN| 4. mala tyAgate samaya peTa meM parikartanavat pIr3A hotI hai| 5. malatyAga kI kriyA sazabda hotI hai aura sAtha meM zUla bhI hotA hai| 6. kucha loga mala ko dekhakara usakA varNa aruNa nizcita kara dete haiM kucha use zyAva aura kucha kRSNa bhI kahate haiN| aSTAGgasaMgrahakAra use jale gur3a kI AbhAvAlA mAnatA hai| 7. mala DhIlA DhIlA, ga~ThIlA, pAnIyukta, prasaraNazIla, drava, Amagandhi Adi rUpa kA batAyA jAtA hai| 8. malatyAga ke samaya A~toM meM kuMthana yA kUjana aura guDaguDa zabda hotA hai, zarIra para roMgaTe khar3e ho jAte haiM, mukha zuSka ho jAtA hai| 9. malatyAga ke bAda kaTi, Uru, trika, pArzva, pRSTha, jAnu Adi aMgoM meM vedanAe~ aura gAtra kA viceSTA karanA dekhA jAtA hai| 10. TaTTI karate karate kaiyoM kI kA~ca bAhara A jAtI hai| yaha smaraNa rakhane yogya hai ki caraka ne vijala se lekara vibaddha taka vAtotpanna AmAtisAra kA varNana kiyA hai; pakka ke dvArA vAtika pakvAtisAra kA vicAra kiyA hai| isa pakkavAtAtisAra ko kucha anugrathita atIsAra bhI kahate haiM yaha prakaTa kiyA gayA hai| zeSa AcAryoM ne isa prakAra varNana nahIM kiyA / (2) pittaja atIsAra pittaja atIsAra ke sambandha meM nimna lakSaNa sAhitya upalabdha hotA hai: 1. tasyarUpANi-hAridraM haritaM nIlaM raktapittopagatamatidurgandhamatisAryate purISaM tRSNAdAhasvedamUrchAzUlabadhnasantApapAkaparIta iti pittAtisAraH / (caraka ) For Private and Personal Use Only

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674 vikRtivijJAna 2. durgandhyuSNaM vegavanmAMsatoyaprakhyaM bhinnaM svinndeho'tirugrH| pittAtpItaM nIlamAlohitaM vA tRSNAmUrchAdAhapAkajvarAtaH // ( suzruta ) 3. pittena pItamasitaM hAridraM zAdalaprabham / saraktamatidurgandhaM tRNamUsveidadAhavAn / / sazUlaM pAyusantApapAkavAn.............. ( aSTAGgahRdaya ) 4. aruNaM haritaM potaM nIlaM durgandhasaMyutam / zUlasantApapAkAzca tApazca karapAdayoH / / mUsveidapipAsAzca pittAtIsAralakSaNam / (cikitsAsArasiddhasaMgraha) 5. tenAruNaM pItamathAtinIlaM durgandhazoSajvarapANDuyuktam / bhramAttimUrchA ca tuSAGgadAhaH pittAtisArasya ca lakSaNAni / / (hArIta ) 6. pittAtpItamathoSNanIlamaruNaM durgandhitIkSNaM zakRt / svinnAGge visRjetsadAhamasakRttaDdAhapAkAnvitaH // (vaidyavinoda ) 7. pittAtpItAruNAsitam / (aananidAna) 8. pItasaraktamahimaM haritaM sadAhaM, mU.tRSAjvaravipAkamadairupetam / __ zIghraM sRjatyativibhinnapurISamacchaM pittAtisAra iti taM munayo vadanti / / (kalyANakAraka) uparyukta uddharaNoM kA vicAra karane para hama isa niSkarSa para pahu~cate haiM ki paittika atIsAra ke sambandha meM nimnAGkita lakSaNoM ko adhikAMza svIkAra karate haiM:1. paittika atIsAra meM mala kA varNa haldI kA sA, harA yA nIlA hotA hai| kAlA yA asita tathA aruNa varNa kA bhI mila sakatA hai| 2. mala atyanta durgandhita hotA hai| 3. mala phaTA phaTA hotA hai| 4. mala bahuta uSNa hotA hai| 5. malatyAga bar3e vega se hotA hai| 6. mala meM rakta bhI ho sakatA hai| 7. mala mAMsatoya yA zAhala jaisA hotA hai| 8. pittAtIsAra meM pyAsa kA laganA eka pramukha lakSaNa hai| 9. pittAtIsArI ko dAha bahuta satAtA hai aura hAtha pairoM meM jalana par3atI hai| 10. sveda kA AnA bhI isa roga meM Avazyaka hai| 11. atIsAra ke mala meM pitta kI tIkSNatA ke kAraNa gudA meM hara samaya dAha aura pAka kA banA rahanA eka aisA lakSaNa hai jo isI roga meM pAyA jAtA hai| 12. udara meM zUla aura malatyAga ke samaya kuMthana bhI hotA huA dekhA jA sakatA hai| 13. kisI kisI rogI ko jvara bhI ho jAtA hai| 14. pANDu, zoSa, avipAka aura mada ina cAra meM se bhI koI lakSaNa kabhI-kabhI pAyA jA sakatA hai| para pittAtIsAra kI vikRti se inakA vizeSa sambandha na hokara svatantra vyAdhi ke anubandha ke rUpa meM hI inakA astitva huA karatA hai| (3) kaphaja atIsAra kaphaja atIsAra ke lakSaNoM meM nimna sAhitya milatA hai 1. tasya rUpANi-snigdhe zvetaM picchilaM tantumadAmaM guru durgandhaM zleSmopahitamanubaddhazUlamalpA. lpamabhIkSNamatisAryate sapravAhikaM gurUdaragudavastivaNadezaH kRto'pyakRtasaMjJaH salomaharSaH sotklezo nidrAlasyaparItaH sadano'nnadveSI ceti zleSmAtisAraH / (caraka) For Private and Personal Use Only

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agni vaikArikI 675 2. tandrAnidrAgauravotklezasAdI vegAzaGkI sRSTaviTako'pi bhuuyH| zuklaM sAndraM zleSmaNAzleSmayuktaM bhaktadveSI niHsvanaM hRSTaromA / / (suzruta ) 3. ............ zleSmaNA dhanam / picchilaM tantumacchavetaM snigdhamAtraM kaphAnvitam // abhIkSNaM guru durgandhaM vibaddhamanubaddharuk / nidrAluralaso'nnadviDalpAlpaM sapravAhikam // saromaharSaH sotklezo gurubastigudodaram / kRte'pyakRtasaMjJazca................... ||(assttaangghRdy) 4. zuklaM sAndraM zleSmaNA zleSmayuktaM visraM zItaM hRSTaromA manuSyaH / / (mAdhavakara ) 5. tena zleSmA zuSkabhedAruciH syAtsAndraM visraM jADyatA romhrssH| mandAgnitvaM mandavego viziSTaH sAlasyo'pi viddhisAraH kaphotthaH // ( hArItasaMhitA) 6. zvetaM balAsabahuto bahula suzItaM shiitaarditaatigurushiitlgaatryssttiH| ___ kRtsnaM malaM sRjati mandamanalpamalpaM zleSmAtisAra iti taM munayo vadanti // ( kalyANakAraka) 7. sAndraM sitaM zleSmavimizritaM syAt zleSmAtisAre bhRzagandhi zItam / / (vaidyavinoda) 8. kaphAtsAndraM zvetahimaM varcaH // ( aJjananidAna) uparyukta uddharaNoM kA vicAra karane para hama isa niSkarSa para pahu~cate haiM ki kaphaja atIsAra ke sambandha meM nimnAGkita lakSaNoM ko adhikAMza svIkAra karate haiM: 1. kaphaja atIsAra meM mala kA varNa zveta rahatA hai| 2. mala snigdha, picchila aura tantuoM se yukta hotA haiM / 3. mala vibaddha (baMdhA huA) aura anubaddha ( lagna = lagA huA) AtA hai| 4. mala vistra yA AmagandhI ataH durgandhita hotA hai| 5. mala meM zleSmA pracura mAtrA meM rahatA hai| 6. mala sAndra aura bahuta hote hue bhI usakI gati alpAlpa saraNa kI hotI hai| 7. mala binA kisI zabda ke nikalatA hai| 8. mala ke sAtha pravAhikA hotI hai| 9. mahattva kI bAta yaha hai ki malatyAga kara lene para bhI mana meM aisA lagA rahatA hai ki abhI aura malatyAga karanA hai / 10. mala zItala hotA hai| 11. kaphaja atIsAra se pIDita rogI kA udara, basti aura vaMkSaNa pradeza bhArI yA bhare hue pAye jAte haiN| 12. rogI meM Alasya tathA nidrAlutA kI mAtrA bar3ha jAtI hai| 13. rogI zithila sA par3A rahatA hai| 14. rogI ko bhUkha nahIM lagatI aura vaha anna se dveSa karatA hai| 15. malatyAga karate samaya sAre zarIra para romAJca kA ho jAnA eka aisA lakSaNa hai jise prAyaH sabhI AcAryoM ne svIkAra kiyA hai| 16. kisI kisI rogI ko utkleza (matalI) bhI ho jAtA hai| (4) sAnnipAtika atIsAra isake sambandha meM nimna lakSaNasAhitya prApta hotA hai1. tatra zoNitAdipu dhAtuSvatipraduSTeSu' hAridraharitanIlamAJjiSThamAMsadhAvanasaGkAzaM raktaM 1. tatra zoNitAdiSu dhAtupu nAtipraduSTeSu / ( gaMgAdhara ) For Private and Personal Use Only

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676 buphalasadRzaM sannipAtaH ( hArIta) vikRtivijJAna kRSNaM zvetaM vA varAhamedaH sadRzamanubaddhavedanamavedanaM vA samAsavyatyAsAdupavezyate zakRdgrathitamAma sakRdapi vA pakkamanatikSINamAMsazoNitabalo mandAgnirvihatamukharasazca, tAdRzamAturaM kRcchrasAdhyaM vidyAt / (caraka) 2. tandrAyukto mohasAdAsyazoSI varcaH kuryAnnaikavarNa tRSArtaH / ___ sarvodbhUtaM sarvaliGgopapattiH kRcchrazcAyaM baalvRddhessvsaadhyH|| ( suzruta ) 3. sarvAtmA sarvalakSaNaH ( aSTAMgahRdaya) 4. varAhasnehamAMsAmbusadRzaM sarvarUpiNam / kRcchasAdhyamatIsAraM vidyAddoSatrayodbhavam // (mAdhavakara) 5. varAhavAsAsadRzaM tilAbhaM mAMsadhAvanAbhAtam pakvajambUphalasadRzaM sannipAtaH pravahatAm / / 6. sarvAtmakaM sakaladoSavizeSayuktaM vicchinnamacchamatisikthamasikthakaM vA / ( ugrAdityAcArya) 7. vArAhamAMsAmbu samaM tridoSAdvidhAdatIsAramanekarUpam / tandrAtRSAdAhamadAsya zoSabhramAnvito mohasamanvito vA / / (vaidyavinoda ) 8. sarvaistu sarvaruka- (aJjananidAna) sAnipAtika atisAra ke sambandha meM jisane bhI apanI lekhanI calAI hai unameM caraka ne jitanI yogyatApUrvaka viSaya kA pratipAdana kiyA hai vaisA anyatra nahIM dikhalAI detA / suzruta, vAgbhaTa, aJjananidAnakAroM ne sarvalakSaNayukta aisA mAnakara chor3a diyA hai / uparyukta sAhitya ko par3hakara hama nimna pariNAma para pahu~cate haiM : 1. sAnnipAtika atisAra ke mala ke sambandha meM kucha bhI spaSTa nahIM kiyA jA sktaa| usakI upamA suara kI carbI, mAMsajala, tila yA pakI jAmuna ke sAtha dI jA sakatI hai| pIlA, harA, nIlA, majIThiyA, lAla, kAlA, sapheda sabhI prakAra ke varNa mila sakate haiM / sannipAtAtIsAra kA mala itane varSoM se yukta ho yaha Avazyaka nahIM / vividha rogiyoM kA parIkSaNa karane para kisI meM lAla raMga, kisI meM majIThiyA aura kisI meM mAMsa ke dhovana ke samAna yA zUkara vasA ke sadRza milA karatA hai / kabhI kabhI eka hI rogI meM eka bAra ke mala meM hI kaI varNa mila sakate haiN| mala baMdhA huA prAyaH hotA hai / kabhI kabhI vaha vicchinna bhI ho sakatA hai| kabhI usameM siktha (kaNa) milate haiM, kabhI nahIM bhI milate, kabhI vaha bilkula svaccha bhI ho sakatA hai| 2. mala baMdhA huA yA gAMThadAra ho sakatA hai| 3. mala karate samaya kisI ko vedanA hotI hai kisI ko nahIM bhI hotii| 4. rogI ko tandrA A jAtI hai| 5. use pyAsa bahuta lagatI hai| 6. usakA mukha sUkha jAtA hai| 7. vaha moha se grasita rahatA hai| 8. dAha bhI pAyA jA sakatA hai| 9. mada yA bhrama bhI raha sakatA hai| (5) AmAtIsAra tathA pakkAtIsAra atIsAra ke 2 rUpa aura bhI haiM jinameM sAma aura nirAma atIsAra Ate haiN| suzruta ne isa sambandha meM nimnalikhita sAhitya pradAna kiyA hai: annAjIrNAt pradrutAH kSobhayantaH koSTha doSA dhAtusaMdhAnyalAMzca / nAnAvaNe naikazaH sArayanti zUlopetaM SaSThamenaM vadanti // For Private and Personal Use Only

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agni vaikArikI 677 saMsRSTamebhirdoSaistu nyastamapsvavasIdati / purISaM bhRzadurgandhi vicchinnabAmasaMzitam // etAnyeva tu liGgAni viparItAni yasya tu| lAghavaJca manuSyasya tasya pakaM vinirdizet // anna yA Ama ke ajIrNa se kSubdha aura vimArgagAmI doSa dhAtusaMgha (raktAdika) aura maloM ko koSTha meM le jAkara nAnA varNa ke tathA bAra-bAra zUla ke sAtha jisa atIsAra ko janma dete haiM vahI AmAtIsAra hai| ina doSoM se vyApta jo mala pAnI meM DAlane para DUba jAya, jisameM bahuta durgandha ho aura jo chinna bhinna yA picchila ho to vaha Ama kahalAtA hai| inase viparIta lakSaNa vAlA lAghava mala vAlA atIsAra pakkAtIsAra mAnA jAvegA para kaphAtpakko'pi majati kahakara aSTAGgahRdayakAra ne jala meM mala ke duSane kA kAraNa kapha ko bhI batalAyA hai| ____ sAnipAtika atIsAra ke varNana ke sAtha hI AmAtIsAra aura pakkAtIsAra kA bhI kaI zAstrakAra varNana kara dete haiN| durgandhamapsvapi nimagnamamedhyamAm kahakara aisA mala jo durgandhita ho, pAnI meM DAlane se DUba jAve aura dekhane meM kharAba lage vaha AmAtIsAra hai aura isake viparIta lakSaNoM vAlA pakkAtIsAra ho jAtA hai| mAdhavakara ne inhIM tathyoM ko sAmane rakhakara suzruta kA nimna uddharaNa upasthita kiyA hai: saMsRSTamebhirdo paistu nyastamapsvavasIdati / purISa bhRzadurgandhi picchilaM cAmasaMjJitam / / etAnyeva tu liGgAni viparItAni yasya vai / lAghavaM ca vizeSeNa tasya pakkaM vinirdizet // __ asAdhya lakSaNa sAnnipAtika atIsAra sadaiva kaSTasAdhya huA karatA hai para bahudhA vaha asAdhya bhI ho jA sakatA hai| usa avasthA meM isake jo jo lakSaNa sambhava haiM unakA saMgraha suzruta ne nimna rUpoM meM kara diyA hai: pakkajAmbavasaGkAzaM yakRtkhaNDanibhaM tanu / ghRtatailabasAmajAvezavArapayodadhi / mAMsadhAvanatoyAbhaM kRSNaM nIlAruNaprabham / mecakaM snigdhakapUraM candrakopagataM dhanam / / kuNapaM mastuluGgAbhaM sugandhi kuthitaM bahu / tRSNAdAhatamaHzvAsahikkApAGasthizUlinam / / saMmUrchAratisaMmohayuktapakkavalIgudam / pralApayuktaM ca bhiSagvarjayedatisAriNam / / asaMvRtagudaM kSINaM duuraadhmaatmupdrutm| gude pakkaM gatoSmANamatisArakiNaM tyajet // aura bhI zvAsazUlapipAsAta kSINaM jvaranipIDitam / vizeSeNa naraM vRddhamatIsAro vinAzayet / / atIsAra ke upadravoM kI dRSTi se usakI asAdhyatA ko vyakta karate hue likhA gayA zothaM zUlaM jvaraM tRSNAM kAsaM zvAsamarocakam / chardi mUrchA ca hikkAJca dRSTvAtIsAriNaM tyajet // ugrAditya ne atIsAra kI asAdhyatA para nimna vacana kahe haiM: 1. zokAdatiprabalazoNitamizramuSNamAdhmAnazUlasahitaM malamutsRjantam / tRSNAdyupadravasametamarocakAta kukSyAmayaH kSapayati kSapitasvaraM vA // 2. bAlAtivRddhakRzadurbalazoSiNAM ca kRcchrAtisAra iti taM parivarjayet / sarpiplIhAmadhuvasAyakRtAsamAnaM tailAmbudugdhadadhitakrasamaM savantam / / For Private and Personal Use Only

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678 vikRtivijJAna arthAt atizoka ke kAraNa utpanna, atyadhika raktamizrita, atyuSNa mala se yukta AdhmAna, zUlayukta malatyAga kA honA tRSNAdi upadrava aura aruci se grasta aura kSINa svarI rogI ko atIsAra naSTa kara detA hai| __ bAlaka, atizaya vRddha, atyanta kRza, durbala aura sUkhe hue rogI ko atisAra sadaiva kaSTakAraka mAnA gayA hai tathA aisA rogI vaidya ko chor3a denA cAhie / isI prakAra jisa atIsArI kA mala ghRta, plIhA, zahada, vasA, yakRt , taila, jala, dugdha, dahI yA taka ke samAna AtA ho unakA bhI parityAga hI kara denA caahie| (6) zokAtIsAra zoka ke kAraNa utpanna atIsAra kA varNana suzruta ne bar3e sundara zabdoM meM kiyA hai taistai vaiH zocato'lpAzanasya bASpoSmA vai vahnimAvizya jantoH / koSThaM gatvA kSobhayettasya raktaM taccAdhastAtkAkaNantI prakAzam // nirgacche? viDvimizraM hyaviDvA nirgandhaM vA gandhavadvAtisAraH / zokotpanno duzcikitsyo'timAtraM rogo vaidhaiH kaSTa eSa pradiSTaH / / arthAt dhana, bandhu, priya janoM ke nAza ke kAraNa zoka karane se, bahuta thor3A bhojana karane vAle ke netra-nAsA-gala-sthAnAdi se nikalanevAle jala se utpanna USmA vyakti ko vyAkula karake koSTha meM jAkara usake rakta ko prakSubdha kara detI hai| usake kAraNa gudamArga se kAkaNantI (guJjA) sadRza varNa kA mala ke sAtha milakara durgandhayukta yA gandharahita atIsAra cala par3atA hai| yaha zokotpanna atisAra adhika hone para duzcikitsya yA kaSTasAdhya kahA jAtA hai| kyoMki zokotpanna roga zoka ke kAraNa dUra hone para hI jA sakatA hai| sAdhAraNataH oSadhiyA~ adhika kArya nahIM krtiiN| (7) bhayaja atIsAra zokAtisAra tathA bhayaja atisAra ye donoM Agantuja atIsAra kahalAte haiM aura donoM kA sambandha mana se kahA gayA hai : Agantu dvAvatIsArau mAnasau bhyshokjau| tattayorlakSaNaM vAyoryadatIsAralakSaNam / / arthAt do bhaya-zokaja atIsAra mAnasa haiM aura Agantuja atIsAra ke nAma se vikhyAta haiN| unakA lakSaNa vAtAtIsAra ke samAna batalAyA gayA hai| ___ aSTAGgasaMgrahakAra ne bhayaja atIsAra ko vAtapittasama mAnA hai aura tadvat zokaja atIsAra ko kahA hai bhayena kSobhite citte sapitto drAvayecchakRt / vAyustato'tisAryeta kSipramuSNaM dravaM plavam / / vAtapittasamaM liGgairAhuH tadvacca zokataH // tathA dUsare do rUpa saraktaatIsAra yA raktAtIsAra tathA nirasra atIsAra ke bhI kahe gaye haiN| (8) raktAtIsAra raktAtIsAra pittAtIsArI ko hI hotA hai aura vaha bhI taba jaba vaha pittavarddhaka anna-pAnAdika kA hI sevana karatA hai| isake sambandha meM carakasaMhitA meM likhA hai For Private and Personal Use Only

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ani vaikArikI pittAtisArI yastvetAM kriyAM muktvA niSevate / pittalAnyannapAnAni tasya pittaM mahAbalam // raktAtisAraM kurute raktamAzu pradUSayat / tRSNA zUlaM vidAhaM ca gudapAkaM ca dAruNam // ( carakasaMhitA ci. sthA. a. 19 ) jo pittAtisAra se pIDita vyakti yogya upacAra ko chor3a kara pittala anna pAnAdika sevana karatA hai usakA mahAbalavAn huA pitta rakta ko turata dUSita karake raktAtIsArako utpanna kara detA hai / isameM tRSNA, zUla, dAha aura dAruNa gudapAka ke upadrava dekhe jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir mAdhavakara ne bhI isI kA samarthana nimna sUtra dvArA kiyA hai pittakRnti yadA'tyarthaM dravyANyaznAti paittike / tadopajAyate'bhIkSNaM raktAtIsAra ulbaNaH // pracura mAtrA meM pittakAraka padArthoM kA nirantara sevana hI raktAtIsArakAraka hai / ataH raktAtIsAra ko koI alaga atIsAra nahIM mAnanA cAhie vaha to pittAtIsAra kA hI eka rUpa hai | vibhinna atIsAroM kI samprAptiyoM para saMkSipta vicAra caraka ne vAtika, paittika aura zlaiSmika tInoM prakAra ke atIsAroM kI utpatti meM vividha vAtakAraka, pittakAraka athavA zleSmAvarddhaka padArthoM kA atyadhika sevana mahattva - pUrNa mAnA hai / vaha kahatA hai ki jaba vyakti vAtAtapavyAyAmAdi kA adhika sevana karatA hai, rUkSAlpapramitAzI hokara vAtakAraka tIkSNa madya vyavAyAdi kA nitya prayoga karatA hai aura vegoM ko rokatA hai taba ina sabhI vAtakAraka kAraNoM se vAyu kupita hokara nimna kArya karatA hai 1. dravatvAdUSmANamupahtya-- tarala hone se pAcakAgni kA nAza karake / 676 9. sarvaprathama vAyu rogI kI pAcakAgni ko naSTa kara detA hai / 2. mUtra aura sveda ko malAzaya taka lAkara mala ko patalA kara detA hai / mUtra aura sveda ke dvArA jo jalIyAMza zarIra se bAhara jAtA thA vaha kriyA banda yA kama ho jAtI hai tathA sampUrNa jala mala ko patalA karane meM laga jAtA hai / 3. malake patalA hone aura pAcakAgni kI kriyA zAnta hone se vAtika atIsArotpatti ho jAtI hai / paittika atIsAra kI utpatti meM amla lavaNa - kaTuka- kSArIya, uSNa, tIkSNa padArthoM kA ati mAtrA meM sevana, agni-sUryasantApa yA lU kA zarIra para bahuta adhika prabhAva honA; adhika krodha, IrSyA Adi karane se pitta prakupita ho jAtA hai / pitta ko tarala padArtha mAnA gayA hai ataH - 3. atIsArAya kalpate paittika atIsArotpatti karatA hai / 2. auSNyAt, dravatvAt saratvAcca purISAzayamAzritya bhittvA purISam - pitta apanI uSNatA, taralatA tathA saratA ke guNoM se yukta hone se malAzaya meM jAkara mala kA bhedana karake - patalA banAkara / For Private and Personal Use Only

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680 vikRtivijJAna zlaiSmika yA kaphaja atIsAra kI utpatti kA kAraNa vyakti kA guru, madhura, zIta, snigdha padArthoM kA upasevana, paryApta bhojana karanA, cintArahita jIvana vyatIta karanA, dina meM sonA tathA Alasya meM par3e rahanA ina saba kAraNoM se kapha prakupita ho jAtA hai| yaha kupita kapha apane svabhAva ke kAraNa (guru, madhura, zIta, snigdha, zithila hone se) 1. pAcakAgni ko naSTa karatA hai| 2. saumyasvabhAvAt purIzAyamupahatyopakledyasoma yAnI jalaguNabhUyiSTha hone se malAzaya meM pahu~ca kara mala ko patalA banAtA hai tathA 3. kaphaja atIsAra ko utpanna kara detA hai| sarvaliGgaja sAnipAtika atIsAra meM bhI isI prakAra aneka kAraNa( atizItasnigdharUkSoSNagurukharakaThinaviSamaviruddhAsAtmyabhojanAdabhojanAt , kAlAtItabho. janAd yatkicidabhyavaharaNAt praduSTamadyapAnIyapAnAdatimadyapAnIyapAnAd asaMzodhanAt pratikarmaNAM viSamagamanAt , anupacArAt , jvalanAt upavanasalilAtisevanAd , asvapnAd , atisvapnAt vegavidhAraNAt , RtuviparyayAt , ayathAbalamArambhAt , bhayazokacintodvegAtiyogAt , kRmizoSajvarArzavikAropakarSaNAt ) / hone se tInoM doSa prakupita ho jAte haiM jo 1. pAcakAgni ko naSTa karate haiN| 2. malAzaya meM praveza karake mala ko patalA karate haiN| 3. aura sAnnipAtika atIsAra ko utpanna kara dete haiN| raktAdi dhAtu ko adhika dUSita karane se raktAtIsArAdi banate haiN| kahane kA tAtparya yaha hai ki bhatIsAra meM prakupita doSa pahale pAcakAgni kI kriyA meM vighna DAlate haiM phira mala ko patalA karate haiN| isa prakAra AmAzaya se lekara malAzaya taka sampUrNa mahAsrota meM eka prakAra kA tIvra kSobha vyApta rahatA hai jo vividha prakAra ke atIsAroM ko janma detA hai| pravAhikA atIsAra kA hI eka prakAra pravAhikA kahalAtA hai| yaha malatyAga ke vikRta rUpa kI ora aGgulinirdeza karatA hai| suzruta uttaratantra meM isakA varNana nimna prakAra diyA gayA hai vAyuH pravRddho nicitaM balAsaM nudatyadhastAdahitAzanasya / pravAhato'lpaM bahuzo malAktaM pravAhikAM tAM pravadanti tajjJAH / / pravAhikA vAtakRtA sazUlA pittAt sadAhA sakaphA kaphAcca / sazoNitA zoNitasambhavA ca tAH sneharUkSaprabhavA matAstu / / tAsAmatIsAravadAdizecca liGgaM kramaM cAmavipakkatA ca / ahita seviyoM ke vAyu ke duSTa hone para vaha saJcita hue kapha ko nIce kI ora DhakelatA hai jisase bAra bAra vaha kapha mala se yukta hokara thor3A thor3A pravAhita hotA rahatA hai| isI ko vidvajana pravAhikA kahate haiN| For Private and Personal Use Only

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agni vaikArikI 181 jaba yaha vAtika hotI hai to isake sAtha zUla hotA hai, paittika meM dAha pAyA jAtA hai tathA kaphaja meM kapha AtA hai / raktaja pravAhikA meM mala ke sAtha rakta jAtA hai| yaha snehaprabhavA, rUhaprabhavA tathA tu zabda se madhukoza vyAkhyAkAra ke mata se tIkSNoSNaprabhavA hotI hai| snehaprabhavA meM kapha kA, rUkSaprabhavA meM vAta kA aura tIkSNoSNaprabhavA meM pitta athavA tathA rakta kA bAhulya hotA hai| isake lakSaNa, cikitsAkrama, pakkApakvatA sabhI atIsAra ke anusAra hote haiN| vAstavikatA yaha hai ki atIsAra kA vaha rUpa pravAhikA nAma se prasiddha hai jisameM bAra bAra aiMThana ke sAtha thor3A thor3A mala AtA hai / phira cAhe doSAnusAra usameM zUla, dAha, kaphAdhikya, pittAdhikya yA raktopasthiti ho yA na ho / mukhyataH isakA kAraNa vAtika ( nervous ) hai aura kaphadoSa vAta ke iGgitoM para nAcane ko bAdhya hokara hI yaha sthiti paidA kara detA hai| grahaNI atisAre nivRtte'pi mandAgnerahitAzinaH / bhUyaH sandUSito vahnirgrahaNImabhidUSayet // mandAgni se pIDita, ahita dravyoM ke sevana meM tallIna rogI ke atisAra ke nivRtta ho jAne para yA svatantratayA bhI athavA atisAra calatA huA rahe taba bhI usakI pAcakAgni atyadhika dUSita hokara grahaNI ko dUpita kara detI hai aura grahaNI yA saMgrahaNI roga kA kAraNa banatI hai| __ agni kI mahattA grahaNI roga agni ke dUSita hone se hI banatA hai / yaha agni 11 kI hetu caraka ne batalAyI hai AyurvarNo balaM svAsthyamutsAhopacayau prabhA / ojastejognayaH prANAzcoktA dehAgnihetukAH // 1. Ayu (cetanAnuvRtti) 2. varNa (gaurakRSNAdi) 3. bala (zakti) 4. svAsthya (samadoSAdijanya) 5. utsAha (duSkara kArya meM bhI adhyavasAya kI pravRtti) 6. upacaya (dehapuSTi) 7. prabhA (kAnti) 8. oja ( sarvadhAtusAra) 9. teja (zukra) 10. paJcabhUtAgniyA~ tathA 11. paJcavAyu (prANApAnAdi) uparyukta 11 zarIrastha pAcakAgni ke dvArA ghaTane-bar3hane vAle haiN| dhyAna dene kI bAta yaha hai ki agnisandIpaka oSadhiyogoM kA yahA~ ullekha na karake mAnavazarIra meM hI nihita ina sthitiyoM kI ora iGgita kiyA gayA hai jo zarIrAgni ke vAstavika kAraNa haiN| yaha nitya ke dekhane kI bAta hai ki jisakA svAsthya ThIka hai usakI agni bhI prabala hai| tejasvI tathA ojasvI vyakti adhika bhojana karatA hai aura usakA bhojana saralatayA paca jAtA hai| utsAha se paripUrNa vyakti kI agni adhika prabala hotI hai / paJcabhUtAgniyA~ tathA saptadhAtvagniyA~ bhI dehAdi kI samAvasthA ke lie kAraNabhUta hotI haiM tathA vAyu ke binA agni panapa hI nahIM sakatI, For Private and Personal Use Only

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682 vikRtivijJAna yaha Adhunika vaijJAnikoM dvArA siddha tatva hai ataH uparyukta gyAraha kI yaha hetu hai yaha ucita aura vijJAnasammata hI hai| agni kI mahattA kA pratiSThApaka sUtra nIce diyA jAtA hai__ zAnte'gnau mriyate yukte ciraMjIvatyanAmayaH / rogI syAd vikRte muulmgnistsmaannirucyte|| ki jaba dehAgni zAnta ho jAtI hai to prANI mara jAtA hai| jaba vaha samarUpa meM rahatI hai to vaha varSoM nIroga hokara jItA hai| jaba vaha vikRta ho jAtI hai taba vaha rogI ho jAtA hai ataH agni hI Ayu Adi kA mUlakAraNa hai arthAt svAsthya kA mUlAdhAra agni hai| jo anna dehadhAtvAdi kA poSaka kahA jAtA hai vahA~ bhI agni hI usakA hetu hai kyoMki apakva anna se rasAdi dhAtuoM kA poSaNa nahIM ho sakatA hai| isakA vistAra karate hue caraka ne anna ke pAcana ke sambandha meM nimna sUtra diye haiM annamAdAnakarmA tu prANaH koSThaM prakarSati / tadvaibhinnasaMghAtaM snehena mRdutAM gatam / / samAnenAvadhUto'gnirudIryaH pavanena tu / kAle bhuktaM samaM samyak pacatyAyurvivRddhaye // evaM rasamalAyAnnamAzayasthamadhaHsthitaH / pacatyagniryathA sthAlyAmodana yAmbutaNDulam / / annasya bhuktamAtrasya SaDrasasya prapAkataH / madhurarAkhyAt kapho bhAvAt phenabhAva udIryate // parantu pacyamAnasya vidgdhsyaamlbhaavtH| AzayAccyavamAnasya pittamacchamudIryate / / pakkAzayantu prAptasya zoSyamANasya vahninA / paripiNDitapakkasya vAyuH syAtkaTubhAvataH / / anna ke pAcana meM nimna kriyAe~ hotI haiM: 1. AdAnakarma vAlA prANavAyu hai arthAt usakA kArya pAnAhArAdika ko apanI ora khIMcanA hai| vaha jisa anna ko hama khAte haiM use mukha dvArA koSTha ke bhItara le jAtA hai| 2. vahA~ para sthita dravabhAga usa anna ke eka eka avayava ko zithila kara detA hai / arthAt jaise roTI ko pAnI meM DAlane se thor3I dera bAda usakA eka eka kaNa bikhara jAtA hai usI prakAra AmAzaya meM sthita kledaka kapha nAmaka tarala se sampUrNa khAdita anna apane saMgaThana ko chor3a chinna bhinna ho jAtA hai| 3. avayavazaithilya ke sAtha sAtha AmAzaya meM sthita snehAMza use mRdu banA detA hai| 4. aba samAnavAyu jo AmAzaya meM nivAsa karatI hai aura jisakA kArya hI anna kA pacAnA hai vaha samaya pAkara arthAt jaba vyakti ko bhUkha lagatI hai taba udarasthita agni ko uThA detI hai| 5. yaha jATharAgni yadi apane samayoga yA avikRtAvasthA meM hai to AyuvarddhanAya usa anna ko bhale prakAra pacA detI hai| isa prakAra AhArapAcana meM AmAzayastha drava, snehAMza, samAnavAyu, kAla aura agni kA samayoga paramAvazyaka hotA hai| jATharAgni usI prakAra rasa aura kiTTabhAga ke lie udarastha anna kA pAcana karatI hai jisa prakAra bhAta banAne ke lie cUlhe kI agni / SaDUsa-anna ke mukha meM grahaNa karate hI usakA madhurarasapradhAna bhAga sarvaprathama For Private and Personal Use Only

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agni vaikArikI 653 pacatA hai| usake pacane se pahale pahala phenabhUta kaphotpatti hotI hai| kapha nAmaka dhAtu kI utpatti AhAra ke usI aMza se hotI hai jo guru-zIta-snigdhAdi guNoM se yukta hotA hai / mukha kA lAlArasa use apane meM ghola kara kapha dhAtu ko utpanna karatA hai| ____ AmAzaya ke Age kapha ke bana jAne para jo annAMza baca jAtA hai vaha apanI pacyamAnAvasthA meM pittakAraka dravyoM ke dvArA dhAturUpa pitta ko utpanna karatA hai / grahaNI aura tudrAntra meM tathA kucha AmAzaya meM bhI amlabhAva ke kAraNa vidagdha huA anna pittotpatti kA kAraNa banatA hai| ___ amlabhAva ke Age cudAntra meM kaTubhAva kI upasthiti hone se anna kA yaha zeSAMza piNDIbhUta ho jAtA aura sUkha jAtA hai aura usase vAyu nAmaka dhAtu kI utpatti hotI hai| mukha kA lAlArasa, AmAzaya kA pAcaka amla aura grahaNI kA kaTu pAcakapitta ye kramazaH madhura, amla aura kaTurasabhUyiSTha hote haiN| unase kramAnusAra kapha, pitta aura vAyu ke prasAda bhAga kI utpatti hotI hai| prasAda bhAga ke hI sAtha sAtha mala bhAga kI bhI utpatti hotI hai / isa prakAra doSa aura dhAturUpa tridoSa kI utpatti anna kI Ama, pacyamAna aura pakvAvasthA meM anna kI prApti, ucita kAla, agni ke samayoga, vAyu, dravatva, snehopasthiti Adi kAraNoM se huA karatI hai| caraka ne pArthivAdi paJcabhUtAgniyoM ko bhI spaSTa kiyA hai-- maumApyAgneyavAyavyAH paJcoSmANaH sanAbhasAH / paJcAhAraguNAnsvAnsvAnpArthivAdInpacanti hi // ki bhauma, Apya, Agneya, vAyavya aura nAbhasa ye pA~ca agniyA~ paJcabhUtAtmaka AhAra ke pRthvI, jala, agni, vAyu aura AkAza se bane aMza meM rahatI haiN| peTa meM jaba yaha paJcabhUtAtmaka anna pahu~ca jAtA hai to jATharAgni kI kriyA se ye pA~coM bhUtAgniyA~ prabala ho uThatI haiM aura anna ke apane apane aMza kA pAcana karatI haiN| arthAt anna kA paripAka kapha, vAta aura pittarUpa meM na hokara pA~coM bhUtoM ke rUpa meM hotA hai aura ye paripakva hue prasAda rUpa bhUta paJcabhUtAtmaka zarIra meM apane apane aMza ko prApta ho jAte haiN| zarIra ke pArthiva aMza ke sAtha anna kA bhaumAgni dvArA paripakva kiyA gayA bhAga mila jAtA hai| ApyAgni dvArA paripakva tatva zarIrastha jalIyAMza meM vilIna ho jAtA hai| AgneyAMza AgneyAMza meM, vAyavya vAyavya meM aura nAbhasa nAbhasa meM calA jAtA hai| anna ke paripAka se zarIra meM sAta prakAra kI dhAtue~ taiyAra hotI haiN| rasa, rakta, mAMsa, medas , asthi, majA aura zukra ina dhAtuoM meM bhI apanI apanI agni vyApta rahatI hai / ye agniyA~ unakA barAbara paripAka karatI huI prasAda aura kiTTa bhAga utpanna karatI rahatI haiM:___ saptabhirdehadhAtAro dhAtavo dvividhaM punaH / yathA svamagnibhiH pAkaM yAnti kidRprasAdataH / / .. zarIra meM gaye hue anna kA eka eka aMza prasAdarUpa vAta pitta kapha rasAdi sapta dhAtuoM taka pahuMcatA hai| dhAtue~ apane apane sthAnoM para apanI apanI agniyoM dvArA vizeSa vizeSa For Private and Personal Use Only

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684 vikRtivijJAna padArthoM ko taiyAra karatI rahatI haiN| isa taiyArI meM kucha jo kharAba baca jAtA hai vaha kiTTabhAga mala kahalAtA hai| ___ anna se banI rasadhAtu svayaM apanA tarpaNa karatI hai| usakI agni kucha rakta tatva banAtI hai aura kucha doSarUpa kapha nAmaka mala kI utpatti karatI hai| rakta nAmaka dhAtu ke nirmANa meM rasadhAtu paryApta kArya karatI hai aura kiTTarUpa meM pittadoSotpatti hotI hai| rakta kA prasAdaka rUpa mAMsa bar3hAtA hai| mAMsa kA prasAdaka bhAga medas dhAtu banAtA hai aura kiTTa se kAna nAka Adi se nikalane vAlA mala banatA hai| medodhAtu kA prasAda bhAga asthitatva taiyAra karatA hai aura kiTTa bhAga se svedotpatti hotI hai| asthi dhAtu apanI USmA se annastha tatvoM kA grahaNa karatI hai phira apane prasAda bhAga se majjA aura kiTTabhAga se keza aura loma taiyAra hote haiN| majA kA prasAda bhAga zukra banAtA hai aura kiTTa bhAga se tvacA meM vyApta snehAMza aura netroM kA kIcar3a bana jAtA hai| kucha dhAtue~ apanI upadhAtue~ bhI banAtI haiN| rasa se striyoM meM stanya aura Arttava tathA rakta se kaNDarA aura sirA mAMsa se vasA tathA 6 tvacA aura medasa se snAyuoM kI utpatti kahI gaI hai| yathArasAtstanyaM striyA raktamasRjaH kaNDarA sirAH / mAMsAdasA tvacaH SaT ca medasaH snAyusambhavaH / / (ca. ci. sthA. a. 15) pAcakAgni saba agniyoM meM pradhAna mAnI gaI hai usakI vRddhi para hI bhautika aura dhAtvagniyA~ vRddhi ko prApta hotI haiM tathA usake kSINa hone ke sAtha hI sAtha ve bhI kSINa ho jAtI haiN| carakAcArya kA kahanA hai ki:tasmAttaM vidhivdyuktairnnpaanendhnaihitaiH| pAlayetprayatastasya sthitau hyAyurvalasthitiH // isalie hitakArI annapAna rUpa IMdhana dvArA usa pAcakAgni ko jo annasya paktA sarveSAM paktRNAmadhipo mataH hai vidhipUrvaka aura prayatnapUrvaka pAlana karanA cAhie kyoMki zarIra ke Ayu aura balAdika kI sampUrNa sthiti isI pAcakAgni para hai| ___ isa pAcakAgni ke dUSita hone kA phala grahaNI roga ke hone meM hotA hai| grahaNI roga ke varNana ko samajhane ke pUrva pAcakAgni kI mahattA ko jAnanA par3egA tabhI isakI AyurvedIya vicAradhArA ke sAtha tAdAtmya sthira kiyA jA sakatA hai| grahaNI kA rogI atyanta kRza, sudhA se rahita aura udara rogoM se yukta isIlie dekhA jAtA hai ki usakI pAcakAgni atyanta dUSita ho jAne ke kAraNa rasa, rakta, mAMsa, medas , asthi majA aura zukrAdi dhAtuoM kA nirmANa ThIka se hotA nhiiN| suzruta ne likhA hai ___ atIsAre nivRtte'pi mandAgnerahitAzinaH / bhUyaH sandUSito vahnirgrahaNImabhidUpayet // ki atIsAra se chuTakArA pAne para bhI agnimAndya se pIDita aura apathyakara dravya sevI kI pAcakAgni khUba dUSita ho jAtI hai aura vaha grahaNI ko bhI dUSita kara detI hai / atIsAra ke pazcAt aura atIsAra ke vinA bhI agni ke bigar3a jAne se grahaNI ke dUSita hone kI pUrNa AzaGkA raha sakatI hai| For Private and Personal Use Only

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ami vaikArikI 685 grahaNI roga kI utpatti meM agni kA kyA mahattva hai ise A~kane ke lie yadi hama bhela saMhitA kI prati ko uThA leM to vahA~ AcArya bhela kI nimna paMktiyA~ anAyAsa hI dRSTi patha para A virAjeMgI anirvAyurmanuSyANAM prANAstatra pratiSThitAH / balamArogyamAyuzca sukhaH duHkhaM tadAzrayam // mriyate hyapazAnte'gnau yukte coSmaNi jIvati / tasmAtprANAyuSI vidyAdagnimUle zarIriNAm || sognirasamucitaM bhuktaM rasAya vitanotyadhaH / tenendriyabalaM puSTiM varNaM ca labhate naraH // catuvidhaM pacatyagniH samaM tIkSNaM tathA mRduH / viSamaM ceti teSAM tu yassamo'gnissa zasyate // bhajatAM guru rUkSaM ca divAsvamaJca nityazaH / rAtrau sadAraM svapatAM tathA vegavidhAriNAm // atyanatAmajIrNena atisnehavirekiNAm / jvarAnmadyaprasaGgAcca tathA'sAtmyaniSevaNAt // madhurakSIranityAnAM tathA jalavihAriNAm / piSTAnnadavizAkAnAmahRdyAnAM niSevaNAt // IdRzairgrahaNI jantordUSyate'ti niSevitaiH / mandAtitIkSNAviSamA trividhaM sA prakupyati // manuSyoM ke prANoM kI pratiSThA, bala, Arogya, Ayu, sukha, duHkha Adi zarIrastha agni tathA vAyu ke Azrita hote haiM / agni ke zAnta hone para prANI mara jAtA hai aura yogya pramANa meM rahane para jIvita rahatA hai| ataH zarIriyoM ke prANa aura AyuSya kA mUla agni hI hai / usa agni ke lie samucita padArtha sevana karane se rasAdidhAtuoM kA paripAka ucita hokara indriyabala, puSTi, varNa vyakti prApta karatA hai / sama, tIkSNa, I mRdu aura viSama cAra prakAra se agni pacAtI hai / inameM samAgni bahuta prazasta kI jAtI hai / jo guru rUkSa padArthoM kA sevana karate haiM, nitya dina meM sote haiM, rAtri meM strI ke sAtha soyA karate haiM, jina vegoM ko nahIM rokanA cAhi eunako rokate haiM, ajIrNa hone para bhI bahuta khA jAte haiM, atyadhika snigdha virecana lete haiM, jvaroM meM madya aura maithuna sevana karate haiM, asAmyoM kA sevana nitya madhura aura kSIra se bane bhArI padArtha lete rahate haiM, jala meM vihAra karate haiM, pIThI ke padArtha, dahI, zAka aura ahRdya dravyoM kA sevana karate haiM ina sabake ati sevana se jantu kI grahaNI dUSita ho jAtI hai aura vaha manda, atitIkSNa aura ativiSama ina tInoM rUpoM meM prakupita ho jAtI hai / vAgbhaTa ne grahaNI roga kI utpatti ke do rUpa batalAye haiM- atIsAreSu yo nAtiyatnavAn grahaNIgadaH / tasya syAdagnividhvaMsakarairanyasya sevitaiH // eka vaha jisameM atIsAra se pIDita rogI apane roga kI upekSA kara detA hai / dUsarA vaha jisameM agni ko naSTa karane vAle anya kAraNa sammilita haiM / grahaNI aura atIsAra meM kyA antara hai ise jitanA spaSTa vAgbhaTa ne aSTAGgahRdaya meM kiyA hai vaha anyatra nahIM milatA / atIsAra kyA hai isa para vaha likhatA hai:sAmaM zakunnirAmaM vA jIrNe yenAtisAryate / so'tisAro'tisaraNAdAzukArI svabhAvataH // -- ki atisAra 1. AhAra ke jIrNa hone para utpanna hotA hai / 2. isameM mala, sAma yA nirAma koI sA bhI mila sakatA hai / 3. mala kA atisaraNa yA bAra bAra bahirnirgamana mahattvapUrNa hai tathA 83, 84 vi0 For Private and Personal Use Only

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186 vikRtivijJAna 4. svabhAva se hI atisAra AzukArI hotA hai| grahaNI ke sambandha meM vaha likhatA haisAma sAnnamajIrNe'nne jIrNe pakkaM tu naiva vA / akasmAdvA muhurbaddhamakasmAcchithilaM muhuH / / cirakRd grahaNIdoSaH saJcayAccopavezayet / ki grahaNI-1. AhAra ke jIrNa na hone kI avasthA meM aura kabhI-kabhI jIrNa hone para bhI utpanna hotI hai| 2. isameM mala sAnna, sAma athavA pakka rUpa meM yA apakva nikalatA hai| 3. mala akasmAt ba~dhA huA bAra bAra AtA hai aura kabhI akasmAt bAra-bAra DhIlA hotA hai| 4. grahaNI roga cirakArI hotA hai aura doSoM ke saJcaya ke dvArA utpanna hotA hai| 5. grahaNI roga kI utpatti bahudhA atIsAra ke uparAnta hotI hai aura isameM agni ko vidhvaMsa karane vAle padArthoM kA sevana karanA mukhyatayA mahattvapUrNa hotA hai| caraka ne grahaNI roga kA svarUpa nimna pakSiyoM meM vyakta kiyA hai: adhastu pakkamAmaM vA pravRttaM grahaNIgadaH / ucyate sarvamevAnnaM prAyo hyasya vidahyate / / adhomArga se kacce yA pakke mala kI pravRtti ko grahaNI roga kahate haiN| isa roga meM khAyA huA sampUrNa anna prAyaH karake vidAha ko prApta ho jAtA hai| caraka ne grahaNI ke sthAna kA spaSTa nirdeza karate hue usake kAryoM kA bhI vivecana kiyA hai: agnyadhiSThAnamannasya grahaNAt grahaNI matA / nAbherupari sA hyagnibalopastambhabRMhitA / / apakvaM dhArayatyanna pakvaM sRjati paarshvtH| duIlAgnibalADhuSTA tvAmameva vimuJcati / / grahaNI agni kA adhiSThAna hai| anna kA vaha grahaNa karatI hai / ataH vaha grahaNI kahalAtI hai| yaha nAbhi se Upara hotI hai aura agni ke bala rUpa upastambha se puSTa ho kara eka pArzva se kaccA anna grahaNa karake dUsare pArzva se use paripakka karake nikAla detI hai| yadi usakI agni durbala ho gaI hai aura usake kAraNa vaha duSTa ho cukI hai to phira yaha Ama rUpa meM usako nikAlatI hai| suzruta ne SaSThI pittadharA kalA ko grahaNI mAnA hai aura agni bala usake Azrita kiyA hai:__SaSThI pittadharA nAma yA kalA prikiirtitaa| pakkAmAzayamadhyasthA grahaNI sA prakIrtitA / / grahaNyA balamagnihi sa cApi grhnniishritH| tasmAtsandUSite vahnau grahaNI sampraduSyati / / nAbhi ke Upara pakvAzaya aura AmAzaya ke bIca meM agni ke adhiSThAna jisa avayava ko grahaNI nAma diyA hai vaha tudAntra kA UparI bhAga hai jahA~ kaI prakAra ke rasa Akara ekatra hote haiM aura anna kA pAcana karate haiM yaha sthala DuoDInama kahalAtA hai| yahI grahaNI nAma se prasiddha bhI hai| ajIrNa aura agni kI vikRti ke kAraNa grahaNI dUSita ho jAtI hai aura grahaNI nAmaka roga loka meM milatA hai isa kAraNa For Private and Personal Use Only

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agni vaikArikI 687 grahaNImAzritaM doSamajIrNavadupAcaret / ( vAgbhaTa ) jo kahA gayA hai vaha bhI sArthaka aura tarka para DaTane vAlA satya hai / ___ grahaNI se jisa roga kI ora iGgita kiyA gayA hai usake prAgrUpa vAgbhaTa ne nimna zabdoM meM diye haiM:prAgrUpaM tasya sadanaM cirAtpacanamamlakaH / praseko vaktravarasyamarucistRT klamo bhrmH|| ___AnaddhodaratAchardiH karNakSveDo'ntrakUjanam / avasAda, dera se pacanA, khaTTI DakAreM, praseka, mukha kI virasatA, aruci, tRSNA, klama, bhrama, peTa phUlanA, vamI, karNaveDa aura annakUjana ye usake pUrva rUpa haiM / hArIta ne grahaNI roga kI vyAkhyA bar3e hI bhavya bhAva se kI hai yadalpamalpaM kramazo niSevitaM malaM bhagAdhAragataM ca nityam / hatvAntarAgniM kurute narasya vikAramAhurgrahaNIti saMjJAm / / nirvRtte cAtisAre zamayati dahanaM bhUyasA doSito'pi / bhuktvA nAzyamalAMzaM bahudinamanizaM saJcayitvA nisati / / vAraM vAraM vigRhya sahajamasaralaM pakkamAnaM dhanaM vA / durvyAdhi|rarUpo manuja rujakaraH syAttathA grahaNIti // grahaNI ke sarva sAmAnya lakSaNa sAmAnya lakSaNaM kAyaM dhUmakastamako jvrH| mUrchA zirorugviSTambhaH zvayathuH karapAdayoH / / kRzatA, dhuMA sA uThanA, aMdhakAra kA honA, jvara, mUrchA, ziraHzUla, malAvarodha tathA hAtha, pairoM meM zothotpatti ye grahaNI ke sAmAnya lakSaNa haiN| prakAra sa caturthA pRthagdoSaiH sannipAtAcca jAyate / vAtika, paittika, zlaiSmika aura sAnnipAtika isa prakAra grahaNI cAra prakAra kI batalAI jAtI hai / hama unakA varNana nIce eka-eka karake karate haiN| vAtika grahaNI kaTutikta kaSAyAtirUkSazItAlpabhojanaiH / pramitAnazanAtyadhvaveganigrahamaithunaiH / / mArutaH kupito vahni saMchAdya kurute gadAn / ( caraka ci. sthA. a. 15) kaTu rasa pradhAna, tikta rasa pradhAna, kaSAya rasa pradhAna, atyanta rUkSa, atyanta zItala aura alpa mAtrA meM bhojana karane se, mAtrA hIna bhojana se, anazana se, atyadhika mArga taya karane yA paidala yAtrA karane se, vergoM ke rokane se tathA maithuna meM atizaya pravRtta hone para (svatantra rUpa meM yA atIsAra ke pazcAt ) vAyu kupita ho kara agni ko AcchAdita karake rogoM ko utpanna karatA hai| jo roga vAtika kAraNoM aura agni ke naSTa hone se hote haiM unameM vAtika grahaNI kA eka apanA sthAna rahA karatA hai| vAtika grahaNI ke nimnalikhita lakSaNa vividha zAstrakAroM ne svIkAra kiye haiM : For Private and Personal Use Only

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665 vikRtivijJAna 1. tasyAnnaM pacyate duHkhaM zuktapAkaM kharAGgatA / kaNThAsya zoSaH kSuttRSNA timiraM karNayoH svanaH // pArzvoruvaMkSaNagrIvA rujo'bhIkSNaM visUcikA / hRtpIDAkAryadaurbalyaM vairasya parikartikA // gRddhiH sarvarasAnAJca manasaH sadanaM tathA // jIrNe jIryati cAdhmAnaM bhuktesvAsthyamupaiti ca / sa vAtagulmahRdrogI plIhAzaGkI ca mAnavaH // cirAduHkhaM dravaM zuSkaM tanvAmaM zabdaphenavat / punaH punaH sRjedvarcaH kAsazvAsArdito'nilAt // ( caraka ) 2. vAtAcchUlAthikaiH pAyuhatpArzvodara mastakaiH / ( suzruta ) 3. tatrAnilAttAluzoSastimiraM karNayoH svanaH / pArzvoravaMkSaNagrIvArujA'bhIkSNaM visUcikA // raseSu gRddhiH sarveSu kSuttRSNAparikartikA / jIrNe jIryati cAdhmAnaM bhuMkte svAsthya samaznute // bAtahRdrogagulmArza: plIhapANDutvazaGkitaH / cirAduHkhaM dravaM zuSkaM tanvAmaM zabdaphenavat // punaH punaH sRjedvarcaH pAyurukzvAsakAsavAn / ( vAgbhaTa ) 4. kaNThazoSazca hRtpIDA tRSNAkAsaviSUcike / anne jIrNe sadA dhyAnaM mukte rujaM kSaNe bhavet // cirAdukhaM dravaM zuSkaM tanvAmaM zabdaphenavat / punaH punaH sRjedvarcaH kAsazvAsamajIrNatA || grahaNI vAtajA jJeyA dIpanaistAmupAcaret / ( siddhavidyAbhUH ) 5. citraM sazabdaM sRjate'tra varcaH zopho'nilo varcamatIvarUkSam / I hokara agni kA zvAsArtiyuktaM tanuzaithilaM ca srAvo grahaNyAnilakopataH syAt // ( hArIta ) 6. vAtAdadhastAdvisRjeddhivacaizcireNa duHkhaM dravazuSkamAmam // ( vaidyavinoda ) vividha kAraNoM se jisa rogI kI vAta dhAtu atyanta prakupita AcchAdana kara letI hai usakA anna bar3e kaSTa ke sAtha pacatA hai / anna kA pAka zuktamaya ( khaTTA ) hotA hai aura zarIra khara ( rUkhA ) ho jAtA hai / mukha, tAlu aura kaNTha meM zoSa, sudhA tathA tRSA kI vRddhi, A~khoM ke sAmane a~dherA honA, kAnoM meM sanasanAhaTa rahanA, pArzva, Uru, vaMkSaNa aura grIvApradeza meM nirantara zUla rahanA, visUcikA, hRdaya meM zUla, kArya, daurbalya, mukha kI virasatA, koSTha meM kartanavat pIr3A, sabhI prakAra ke rasoM ke prati atyadhika icchA honA, citta meM avasAda / rogI kA bhojana kI jIryamANAvasthA hone para AdhmAna hotA hai para kucha khA lene para vaha zAnta ho jAtA hai tathA punaH bhojana ke jIrNa ho jAne para AdhmAna ho jAtA hai / ina lakSaNoM ko dekhakara rogI ko zaGkA hotI hai ki kahIM use vAta gulma, arza, hRdroga, plIhodara, pANDu Adi meM se koI to nahIM ho gayA hai / vAyu ke kAraNa hue isa grahaNI roga meM gudA, hRdaya, pArzva, udara aura zira meM zUla kA honA suzruta bhI svIkAra karatA hai 1 vAtika grahaNI ke sarva sAmAnya lakSaNa nimnalikhita hote haiM 1. rogI bahuta dera karake malatyAga karatA hai / 2. mala tyAgakAla meM use bahuta pIr3A hotI hai / 3. rogI kA mala kabhI drava yA tarala rUpa meM rahatA hai aura kabhI sUkhA utaratA hai / 4. mala patalA aura usameM Ama rahatI hai / 5. mala tyAga ke samaya vicitra zabda hotA hai / 6. mala meM jhAga hotA hai / rogI ko bAra bAra mala tyAga karane jAnA par3atA hai / 7. 8. kisI-kisI dina rogI ko mala utaratA hI nahIM aura pUrNa koSThabaddhatA rahatA hai| For Private and Personal Use Only

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6 agni vaikArikI 9. rogI kI gudA meM zUla hotA hai / 10. use vAtika kopa ke anya lakSaNa jaise zoSa, zvAsa yA kAsa bhI milate haiN| paittika grahaNI isake nimnalikhita lakSaNa vividha zAstrakAroM ne svIkAra kiye haiM : 1. kaTvajIrNavidAhyamlakSArAdyaiH pittamulbaNam / agnimAplAvayaddhanti jalaM taptamivAnalam / so'jIrNa nIlapItAbhaM pItAbhaH sAryate dravam / pUtyamlodArahRtkaNThadAhArucitRDarditaH // (caraka) 2. pittAt sdaahaiH| ( suzruta ) 3. pittena nIlapItAbhaM pItAbhaH sRjati dravam / puutymlodgaarhRtknntthdaahaarucitRddditH|| / ( vAgbhaTa ) 4. pUtyamlodgArahRtkaNThadAhAstRTchvAsarukklamAH / ajIrNaM pItanIlAbhaM pittAdvai sravati dravam // (siddhavidyAbhUH) 5. vidAhi zIrNa sarujaM tRpAttaM durgandhapItAruNanIlakAlam / saMsRjyate yasya malo vimizraH pittodbhavA sA grahaNIti saMjJA // ( hArIta ) 6. pItaM bhRzoSNaM bahugandhi pittAt / (vaidyavinoda ) ___kaTu, ajIrNakAraka, vidAhotpattikAraka jaise Adhe pake bhune cAvalAdi, amla dravya, kSAra jaise yavakSAra, lavaNa, tIkSNa padArthoM ke prayoga karane se pitta prakupita ho jAtA hai jo svayaM tarala hone ke kAraNa jATharAgni ko AplAvita karake usI prakAra naSTa kara detA hai jisa prakAra taptajala A~ca ke a~gAre ko AplAvita karake bujhA detA hai, na ki tapta jala kI garmI se aMgAre meM garmI AtI hai| isa prakAra pitta ke kopa se yukta jATharAgni jisakI bujhI huI par3I hai aise rogI ko paittika grahaNI ghera letI hai| isa paittika grahaNI ke nimna lakSaNa dekhane meM Ate haiM 1. paittika grahaNI se pIDita rogI kA varNa pIlA par3a jAtA hai| 2. vaha ajIrNa arthAt kaccA mala nikAlatA hai| 3. vahImala pIlA, nIlA, aruNa athavA nIla kAlA (baiMganI) ina cAra varSoM meM se kisI bhI prakAra kA ho sakatA hai / vaise to pItAbhAvAlA mala hI AtA hai para pIta nIlAbha donoM prakAra kA pRthaka pRthak yA milakara bhI A sakatA hai| gulAbI baiMganI yA raMga lie hue bhI mala A sakatA hai, cAroM varNa vimizrita bhI ho sakate haiN| 4. mala patalA (dravarUpa) hotA hai| 5. paittika grahaNI se pIDita rogI ko durgandhiyukta khaTTI DakAreM AtI haiN| 6. usake hRdayapradeza aura kaNTha meM dAha rahA karatA hai| 7. use bhojana meM aruci pAI jAtI hai| 8. use pyAsa bahuta satAtI hai| 9. kabhI kabhI use zvAsa kI gati bhI bar3hI huI pAI jAtI hai| 10. rogI ko eka prakAra kA Alasya yA thakAvaTa jise klama kahate haiM ghere raha sakatA hai| 11. rogI kA mala atyanta uSNa hotA hai ! For Private and Personal Use Only

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660 vikRtivijJAna 12. mala meM atyadhika durgandha AtI hai, yaha gandha kaI prakAra kI ho sakatI hai / paittika grahaNI meM grahaNI ke mala ke jo sAdhAraNatayA cihna aura lakSaNa batalAye ye haiM ve to sabhI yathAvat milA hI karate haiM para sAtha meM mala kA pIlApana lie nIlA honA, rogI ko dAhAdhikya milanA, use pyAsa adhika laganA, mala patalA badabUdAra honA tathA pittolbaNatA ke zarIraMgata anya lakSaNa milate jaise pUtyaklodvArAdi mahattvapUrNa haiM / isa roga meM anna kI sampUrNa zleSmalakalA vraNazothAtmaka ( inflammed ) ho jAtI hai ise nahIM bhUlanA cAhie / zlaiSmika grahaNI gurvatisnigdhazItAdibhojanAdatibhojanAt / bhuktamAtrasya ca svapnAddhantyagniM kupitaH kaphaH // Upara ke sUtra meM caraka ne kapha ke prakopa ke kucha kAraNoM para prakAza DAlA hai jinameM bhArI padArthoM kA sevana, adhika cikanAI se yukta vastuoM kA grahaNa karanA, zItala, drava, picchila padArthoM kA lenA, atyadhika bhojana karanA, aura bhojana karake so jAnA ina kaI kaphakAraka kAraNoM se kaphadhAtu prakupita hokara agni ko naSTa kara detI hai / agni kA nAza grahaNI kA sarvaprathama ekamAtra aura mUla kAraNa hai / agninAza ke sAtha grahaNI ke anya lakSaNoM kA udaya honA tattaddoSajanya grahaNI kI utpatti meM kAraNa banate haiM / yahA~ agninAza kA kAraNa kaphakAraka avasthAe~ haiM isa kAraNa jo grahaNI vyAdhi utpanna hogI vaha kaphaja grahaNI kahalAvegI / jahA~ paittika yA vAtika avasthAe~ agninAza meM kAraNa banatI haiM vahA~ paittika athavA vAtika grahaNI kI utpatti banatI hai / tasyAnnaM pacyate duHkhaM hallAsacchardharocakAH / AsyopadehamAdhurya kAsaSThIvanapInasAH // hRdayaM manyate styAnamudaraM stimitaM guru / duSTo madhura udgAraH sadanaM strISvaharSaNam // uparyukta kaphakAraka kAraNoM ke dvArA naSTa huI jATharAgnivAle rogI ke anna kA pAka duHkhapUrvaka hotA hai use matalI aura vamana AtI haiM aura arocaka rahatA hai / mukha lipA sA mIThA-mIThA hotA hai / use khA~sI, dhukadhukI, jukAma hotA hai vaha hRdaya ko sAndra yA ghanA ( bhArI ) sA mAnatA hai / udara nizcala aura baddha sA tathA gaurava se yukta milatA hai / mukha se bure mIThe mIThe DakAra Ate haiM, cittAvasAda rahatA hai aura rogI strI ko dekhakara usameM rati karane ke lie apane ko asamartha pAtA hai / ye sabhI lakSaNa kaphajagrahaNI ke sAtha-sAtha mila sakate haiN| aba hama Age vividha zAstroM meM varNita mukhya lakSaNoM kI ora pAThaka kA dhyAna AkRSTa karate haiM-- / 1. bhinnAmazleSmabhUyiSThaguruvarcaH pravarttanam / akRzasyApi daurbalyamAlasyaJca kaphAtmake || (caraka) 2. gurubhiH kaphAt - ( suzruta ) 3. bhinnAmazleSmasaMsRSTaguruvarcaH pravartanam / akRzasyApi daurbalyam // ( vAgbhaTa ) 4. kAsaniSThIvanaM chardiH madhurAsyamarocakam / bhinnAmaileSmamizraM ca sAryate codakaM guru // duSTo madhura udgAraH pInasazca kaphAdhike / akRzasyApi daurbalyamAlasyaJca kaphAtmake // (siddhavidyAbhUH ) Acharya Shri Kailassagarsuri Gyanmandir 5. hallAsachada zvasanaM ca zophaH kAso jaDatvaM ca sa zItatA ca / vairasyamAsye gurugAtratA syAt arocakaM zaMkhazakRdagrahastu || ( hArIta ) 6. snigdhaM sitaM zleSmayutaM kaphAcca / ( vaidyavinoda ) For Private and Personal Use Only

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ani vaikArikI 661 661 saMkSepa meM kaphaja grahaNI meM adholikhita lakSaNa batalAye haiM1. rogI kA mala phaTA-phaTA ( bhinna) hotA hai| 2. rogI ke mala me Ama milI rahatI hai| 3. mala kapha se yukta hotA hai| 4. mala bhArI hotA hai / yaha bhArIpana usameM jala milA hone para dekhA jAtA hai| 5. mala dekhane meM cikanA aura zaMkhavat zveta ho jA sakatA hai| 6. rogI akRza hote hue bhI daurbalya kA anubhava karatA hai arthAt kaphaja grahaNI se pIDita vyakti mAMsopacita paripuSTa zarIravAlA hone para bhI usase sAdhAraNa sA kArya karanA sambhava nahIM hotA / vaha atyanta durbala apane ko mAnane lagatA hai| 7. rogI ko zIta bahuta vyApatA hai| 8. rogI ko pInasa, hRllAsa, vamana, zvAsopadrava, zopha, kAsa, jar3atA raha sakatI hai| 9. usakA mukha mIThA aura mIThI hI DakAra AtI rahatI hai| 10. rogI meM Alasya kI mAtrA bahuta adhika bar3ha jAtI hai, jise kucha zAstrakAra gurugAtratA ke nAma se pukArate haiN| sAnnipAtika grahaNI sAnnipAtika grahaNI ke sambandha meM caraka ne nimna sUtra dekara apanA piNDa chur3A liyA hai: pRthagvAtAdinirdiSTahetuliGgasamAgame / tridoSaM nirdizedevaM teSAM vakSvAmi bheSajam // vAtika, paittika aura zlaiSmika grahaNI ke pRthaka, pRthak jo lakSaNa batAye haiM aura jo ina tInoM ke hetu kahe gaye haiM unhIM kA samAgama (eka sthala para saJcaya) hI sAnnipAtika grahaNI banAtA hai| isI ko vAgbhaTa ne sarvaje sarvasaGkaraH kahA hai| sarveSAM lakSaNAnAM saGkaro mizratvaM yatra vartate sa sAnnipAtikaM grahaNIgadambhavati / isI ko hArIta ne bar3I sundaratA se aGkita kiyA hai tribhiH sametaM gaditaM ca cihnametasya kopo madhurAsyatA vA / dAho'tha mUrchA zvasanaM jaDatvaM sa sannipAtagrahaNIgadaH syAt / / vasavarAjIyakAra ne tridoSaja ke sAtha dvandvaja grahaNI bhI svIkArI hai mizrite dvandvajA jJeyA tridoSe sarvarUpiNI / saMgrahagrahaNI ghaTIyantragrahaNI yA AmavAtagrahaNI mAdhavakara tathA vasavarAjIyakAra ne eka saMgrahagrahaNI yA ghaTIyantragrahaNI nAmaka asAdhya kahe jAnevAle roga kA bar3A sundara citraNa nimna zabdoM meM kiyA hai: antrakUjanamAlasyaM daurbalyaM sadanaM tathA / dravaM zItaM dhanaM snigdhaM sakaTIvedanaM zakRt / / AmaM bahu sapaicchilyaM sazabdaM mandavedanam / pakSAnmAsAddazAhAdvA nityaM vApyatha muJcati / / divA prakopo bhavati rAtrau zAnti vrajecca sA / durvijJeyA duzcikitsyA cirakAlAnubandhinI / / sA bhavedAmavAtena saMgrahagrahaNI matA / svapataH pArzvayoH zUlaM gljjlghttiidhvniH| taM vadanti ghaTIyantramasAdhyaM grahaNIgadam / / (mAdhavakara) For Private and Personal Use Only

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662 vikRtivijJAna suptiH pArdhAtitA yasya gljjlghttdhvniH| pravartate ghaTIyantrAtsazabdaM mandavedanam // dvAtriMzadivasAdvApi pakSAnmAsAcca vAsarAt / AmasrAvaH saphenazca snigdhaM zuddhaM ghanaM sravet / / divAkopo nizAzAntiHzuSkakampAGgakRdbhavet / grahaNI hyAmavAtena duzcikitsyA bhissgvraiH|| (basavarAjIya) saMgrahagrahaNI tathA ghaTIyantragrahaNI ina donoM kA jo Upara varNana kiyA gayA hai vaha spaSTa batalAtA hai ki saMgrahagrahaNI durvijJeyA, duzcikitsyA tathA cirakAlAnubandhinI hotI hai tathA ghaTIyantrAkhyagrahaNI asAdhyA mAnI gaI hai| basavarAjIyakAra ne ina donoM ko milAkara eka kara diyA hai jise duzcikitsya kahA gayA hai| saMgrahagrahaNI ke nimna lakSaNa haiM 1. A~toM meM kUjane kA zabda honA, yaha zabda paryApta dUra se bhI sunA jA sakatA hai| yaha hara samaya bhI ho sakatA hai para kabhI adhika aura kabhI zAnta rahatA hai| 2. Alasya, avasAda aura daurbalya pramukhatayA milate haiN| 3. isa roga meM mala kA vizeSa lakSaNa yaha hotA hai ki vaha bahuta sI Ama lie hue (kacce anna ke sAtha) picchila (cipacipA), drava, zItala, saghana, snigdha (carabIyukta) saphena aura mAtrA meM bahuta sA dekhA jAtA hai / mala kA yaha rUpa jisameM Ama kA srAva hotA hai jo phenayukta, zuddha snehayukta athavA saghana hotA hai pratidina, saptAha yA pakSa meM eka bAra yA 30-32 dina bAda dikhalAI par3atA hai| aisA mala AmavikAra kA dyotaka hai| 4. malatyAga ke samaya manda manda vedanA hotI hai| 5. isa roga kA prakopa dina meM khAsa kara prAtaHkAla huA karatA hai tathA rAtri. kAla meM zAnti milatI hai| 6. yaha roga zuSkatA aura kampAGgatA utpanna kara sakatA hai| ye donoM lakSaNa vAtika vikAra ke dyotaka haiN| ghaTIyantragrahaNI ke nimna lakSaNa kahe jAte haiM1. rogI ko sote samaya pasaliyoM meM pIr3A rahatI hai| 2. udara se prati samaya surAhI se pAnI u~Delate samaya jaisA gaTa gaTa zabda hotA hai vaisA malatyAga ke samaya hotA rahatA hai| yaha zabda malatyAga ke atirikta kucha kucha kAloparAnta sunAI par3a sakatA hai jo saMgrahagrahaNI kI antrakUjanAvasthA kA aura spaSTa rUpa hai| Adhunika vicArakoM kI dRSTi meM grahaNI yA DiseMdrI antrakI eka vraNazothAvasthA hai jisameM A~toM meM vraNIbhavana hotA hai tathA antra kI zleSmalakalA kA vistRta kSetra naSTa-bhraSTa ho jAtA hai jisake kAraNa mala ke sAtha rakta aura Ama ( mucus ) paryApta mAtrA meM nikalatI hai| yaha tIvra aura cirakAlAnubandhI donoM hI rUpoM meM pAI jA sakatI hai| jIrNa rUpa meM yaha mahInoM aura varSoM raha sakatI hai| grahaNI kA roga eka mahAmArI ke rUpa meM bhI A sakatA hai tathA sthAnika bhI pAyA jA sakatA hai| yaha roga sadaiva vAhakoM dvArA eka For Private and Personal Use Only

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663 agni vaikArikI sthAna yA rogI se dUsare sthAna yA rogI taka pahu~catA hai| yadyapi grahaNI kisI bhI kAla meM mila sakatI hai para isakI bahulatA uSNArdratA yukta Rtu jaise varSA meM adhika pAI jAtI hai| bhAratavarSa meM 3 prakAra kI DiseMTrI bahudhA milatI haiN| inameM eka amIbAjanya amIbika DiseMdrI, dUsarI baikTIriyAjanya baisIlarI DiseMTI tathA tIsarI proTojuAjanya baileMTIDiyala ddiseNttrii| tInoM meM prathama do bahutAyata se dekhI jAtI haiM / hama aba ina tInoM kA varNana saMkSepa meM kareMge Ama grahaNI yA amIbika DiseMTrI ( Amoebic Dysentery) yaha vyAdhi eNTAmIbA hisToliTIkA (AmakArI antaHkAmarUpI) nAmaka jIvANu ke dvArA utpanna hotI hai| yaha jIvANu sthUlAntra ke upazleSmala AvaraNa para kriyA karatA hai jisase vahA~ vraNa utpanna ho jAte haiM ye vraNa isa roga ko tIvra yA cirakAlAnubandhi kisI bhI rUpa meM rakha sakate haiN| isa roga ke dvArA amIbika yakRtpAka yA yakRdvidadhi hone kI pUrNa sambhAvanA rahA karatI hai| ____ aba hama thor3A isa AmakArI jIvANu ke sambandha meM vicAra kreNge| yaha jIvANu A~toM meM 3 pramukha rUpoM meM milatA hai: 1. vAnaspatikarUpa yA tIvrarUpa ( vegetative or acute form), 2. granthipUrvIrUpa ( precystic form ), tathA 3. granthIyarUpa ( cystic form ) tIvra rUpa kA eNTAmIbA hisTolITikA sAma aura sarakta zakRt ke andara dekhane meM AtA hai / isakA rUpa utiyoM meM praveza pAne aura una para AkramaNa karane meM samartha hotA hai / isake kAraNa bRhadantra meM vaNana hotA hai| yaha svaccha, ISat harita, pAradarzI tathA vyAsa meM 20 se 30 myU taka hotA hai| jaba yaha apanI vikArakAriNI sthiti meM hotA hai taba isameM se kAcarIya kUTapAda (hyaline pseudopodia) nikala nikala kara bar3I tejI se gati karate haiM, bAhya bhAga svaccha aura antarbhAga kaNadAra hotA hai / yaha apane kUTapAdoM ke dvArA rakta ke zveta lAlakoM tathA Uti ke aMzoM ko hajama karatA rahatA hai| tarala bhAga kA zoSaNa yaha AsRti ( osmosis) dvArA karatA hai / isakA praguNana dvikhaNDana ( binary fission) dvArA hotA hai| zakRt meM yaha puMja yA jhuNDoM ke rUpa meM milatA hai| zarIra ke bAhara isakA jIvana kucha ghaNToM kA hI hotA hai| uSNAvasthA isakI utpatti ke lie tathA isakI gatiyoM ke lie lAbhaprada siddha huI hai| UtiyoM para AkramaNa karanevAle AmakArI kAmarUpI pUrvagranthIyarUpa kA nirmANa karate haiN| sakriya amIbA vibhakta hokara choTe choTe amIbAoM kI utpatti ke kAraNa banate haiN| ye AMtoM ke andara se AhAra ko sampUrNatayA nikAla dete haiN| ye gola, 5 se 20 myU taka AkAra vAle mandagatimaya aura rasadhAnIvihIna kozAprarasayukta hote haiN| pUrvagranthIya rUpa amIbA ke dvArA eka patalI kalA yA granthi kI prAcIra kA nirmANa hotA hai| For Private and Personal Use Only

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664 vikRtivijJAna granthIya rUpa meM amIbA gola, cakrAkAra rogI ke mala ke andara milate haiM / inakA AkAra 7 se 9 myU taka hotA hai / koI koI 15 se 20 myU taka bhI bar3e hote haiM / usakI yaSTi eka se do ho jAtI hai aura do se cAra taka kA rUpa dhAraNa kara letI hai / isa prakAra caturnyaSTika granthi ( quadrinucleate oyot) bahudhA mila jAtI haiM / ina nyaSTiyoM meM vartanazIla varNAbhapiNDa ( refractile chromatoid bodies) rahate haiM tathA glAikojana kA AyoDIna dvArA abhiraJjita hone yogya bhAga rahatA hai / granthirUpa amIbA A~ta meM nahIM pakate balki eka prANI ko chor3a jaba ve dUsare prANI meM praveza karate haiM to vahA~ bhI AmAzayika rasa kA una para koI asara nahIM hotA para jaba vaha agnyAzayarasa ke samparka meM Ate haiM taba vaha khula jAte haiM aura catuSTiyukta amIbA kI utpatti hotI hai / eka granthi meM 10 dina taka yaha zakti rahatI hai / cAra nyaSTiyoM kA jaba dvikhaNDana hotA hai to usase 8 amIbA taiyAra ho jAte haiM / Acharya Shri Kailassagarsuri Gyanmandir AmajagrahaNI yA AmAtisAra kA vaikArikIya jJAna eka bahuta bar3A mahattva rakhatA hai / AmakArI kAmarUpI Antra ke suSiraka meM prAyaH par3A rahatA hai aura Antra kI zleSmakalA ke Upara vaha par3A rahakara Antrastha padArtha, jIvANuoM, zvetasAra ( sTArca) ke karNo aura mala ko khAtA rahatA hai / mAnavIya Antra meM unako puSTikAraka bhojana na milane se vaha durbala rahatA hai / jina vyaktiyoM ke mala se amIbA kI sisTeM nikalA karatI haiM unameM kaI to isI prakAra ke nirApada ( harmless ) rUpa vAle amIbAoM se yukta hote haiM / jaba antra svastha hotI hai aura ba~dhA huA mala visarjana kiyA jAtA hai taba amIbika upasarga hai itanA hI patA malaparIkSaNa dvArA ho jA sakatA hai / para jaba mala DhIlA utaratA hai to inakA AkAra bar3ha jAtA hai aura inake udara meM grasita daNDANuoM yA zAkANuoM kA bhI patA cala jAtA hai / AmakArI amIbA jo sisTotpatti karatA hai bahudhA eka sahabhojI ( commensal ) ke rUpa meM apane mitra manuSya ke sAtha nivAsa karatA hai / para jaba isa mitra kI antra kI zleSmalakalA ko koI AghAta pahu~ca jAtA hai jo roga jIvANuoM dvArA sadaiva sambhava hai to phira maitrI sambandha TUTa jAtA hai aura vaha eka ugrarUpa dhAraNa karake AntraprAcIra para AkramaNa kara detA hai / isa avasthA meM amIbA zleSmalakalA se cipaka jAtA hai aura eka prakAra kA kozAMzi padArtha ( cytolysin ) utpanna karatA hai / yaha kozAMzi AntrakozAoM ko naSTa karate hue upazleSmalakalA (submucosa ) taka amIbA ko pahu~cA detA hai / isake kAraNa sthAnika UtinAza hotA hai / vidradhi kI utpatti hotI hai aura eka palighakRtika ( flask-shaped ) vraNa bana jAtA hai / yahA~ pUrvagraMthIya rUpa taiyAra hote haiM usake pazcAt sisTeM banatI haiM jo mala ke sAtha sAtha nikalA karatI haiM / sthUlAntra, uNDuka, sthUlAntra ke yakRt nikaTastha bhAga ( hepatic flexure ), malAzaya plIhanikaTastha bhAga ( splenic flexure ) kSudrAntra kA nicalA bhAga bahuta kama prabhAvita huA karatA hai / sthUlAntra kA UrdhvAdha For Private and Personal Use Only

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abhi vaikArikI 665 jitanA prabhAvita hotA hai utanA malAzayAdi nicale bhAga nahIM / raktavAhiniyoM ko dekhane se unameM ghanAsrotkarSa tathA atipUrNatA ( engorgement ) pAI jAtI hai / vraNoM ke bIca bIca kI zleSmalakalA svastha hotI hai| jaba vraNa kA upazama hotA hai to sleTI raMga kI carmapatrIya vraNavastu ( parchment soar ) banatI hai / isa roga ke vraNa AkAra meM choTe bar3e kaI prakAra ke hote haiM ve malAzaya se gudadvAra taka phaila sakate haiM / unameM kAle raMga ke nirmoka ( sloughs ) bhare rahate haiM inheM 'sIenImona 'alsarsa' kahA jAtA hai / isa sabake kAraNa antra kA paramacaya tathA sthaulya dekhA jA sakatA hai kahIM kahIM para AntraprAcIra meM gar3he bana jAte haiM aura kahIM vraNa vastu janya saMkocana ( cicatrical contractions ) bhI mila jAte haiN| gaharI raktavAhiniyoM kA ghanAtrotkarSa, ghanAtra meM amIbA kI utpatti, AntraprAcIra kA kotha tathA raktasrAva ye sabhI pAye jA sakate haiM / vraNoM ke phaTa jAne se udaracchadapAka yA sthAnika paristhUlAntra vidradhi ( peri colic abscess ) bhI bana sakate haiM / uNDukapuccha kA amIbA dvArA phaTanA yA chidraNa bhI pAyA jA cukA hai / yaha dvitIyaka pUyika upasarga laga gayA to zleSmalakalA kA kothIya vinAza bhI dekhA jA sakatA hai / karkaTArbuda se milatA julatA amIbika kaNArbuda ( amoebic granulomata ) bhI prAyazaH mila jA sakate haiM ( mAnsana bahara ) / Upara jo likhA gayA hai use dekhane se jJAta hotA hai ki amIbika DiseMTrI kA atyanta mahattvapUrNa vikSata sthUlAntra ke upazleSmala AvaraNa ke bhItara eka vraNazothIya utsyanda ( iuflammatory exudation ) kA honA hai jo Age cala kara zleSmala kalA ko kSatigrasta kara detA hai aura vraNana kA kAraNa banatA hai / isa vaikArikIya svarUpa kI itanI bhinnatAe~ dekhane meM AtI haiM ki kabhI kabhI Antrika prAcIra kI kaI iJca taka sampUrNa paridhi vraNIbhUta ho jAtI hai jisase usa ke AvaraNa atyanta sthUla ho jAte haiM aura turata mAraka rUpa se lekara uNDuka meM lakSaNoM se bhI virahita kucha vraNa mAtra taka ke rUpa dekhe jA sakate haiM / ataH pahale prArambhika vikSatoM kI utpatti para hama punaH prakAza DAla kara kaise unakA rUpa ugra ho jAtA hai use batalAveMge / amIbA dvArA nirmita prathama vikSata lAla binduoM yA adhiraktatA ke kSudra simoM ( small petches of congestion ) ke rUpa meM zleSmala kalA para udaya hote haiN| jisake sAtha upazleSmala AvaraNa meM svalpa sthaulya bhI milatA hai / samIpastha bhAgoM meMdra gola unnata pIta kSetra milate haiM jinheM tIvra adhiraktatA kA eka gulAbI valaya ghere rahatA hai / ye sidhma svastha zleSmala kalA se kAphI uThe hue hote haiM / yaha AkRti upazleSmala AvaraNa meM gahare pIle ( tawny yellow) kAcarIya ( gelatinous) padArtha kI sthAnika bharamAra ke pariNAmasvarUpa AtI hai / isake kendra bhAga kI zleSmala kalA ke adhicchadI bhAga naSTa ho cuke hote haiM jaba ki usake AsapAsa kI zleSmala kalA sazotha valaya kA rUpa dhAraNa kara letI hai / eka dUsarI avasthA antra ke dUsare bhAgoM meM milatI hai jaba ki zleSmalakalA kI anuprastha valiyoM ( transeversefolds For Private and Personal Use Only

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646 vikRtivijJAna of mucous membrane ) kI dizA meM unnata vraNa lambe lambe bane hote haiM / ina vikSatoM ke bIca kI zleSmalakalA pUrNataH svastha hotI hai| isa prakAra ina vikSatoM ko dekha kara hama kaha sakate haiM ki ve antra kI svastha prAcIra para eka baTana ke samAna bane hote haiM jaba ki daNDANujanya grahaNI ( bacillary dysentery ) meM ThIka isake viparIta sthiti hotI hai| vahA~ abanatagarta jaise vraNa banate haiM jinake cAroM ora kI zleSmalakalA prAyaH moTI aura sUjI huI hotI hai| apanI prArambhika avasthA meM amIbika DiseMTarI ke vikSata sthUlAntra ke nicala bhAga kI apekSA Upara ke bhAga meM ve adhika saMkhyA aura adhika prauDha hote haiM inakI apekSA nicale bhAga meM ve thor3e aura naye hote haiN| yadi vikSata kI thor3I khurcana ( scraping ) kA parIkSaNa kiyA jAve to patA lagegA ki kitane hI AmakArI kAmarUpI sakriya rUpa se vahA~ kArya kara rahe haiN| Upara amobika DiseMTrI ke jina vikSatoM kA varNana kiyA gayA hai unake sAtha yadi Antrastha padArthoM ke jIvANuoM kA dvitIyaka upasarga aura laga jAve to unameM aura adhika kharAbI Akara jo avasthA banA karatI hai vaha tIvra nirmocanI AmagrahaNI (Acute sloughing amoebic Dysentery ) kI sthiti kahalAtI hai / isa avasthA meM amIbAoM dvArA nikalane vAlA srAva bar3ha jAtA hai| tathA sAdhAraNatayA jo upazleSmala AntrAvaraNa srAva patalA rahA karatA thA vaha sthUlarUpa dhAraNa karane lagatA hai yahA~ taka ki usakI moTAI Antra prAcIra kI sAdhAraNa moTAI se bhI kaI gunA bar3ha jA sakatI hai jisake kAraNa bAhara se TaTolane se A~ta aisI lagatI hai mAno AntrAntra praveza ( intussusception ) jaisA puJja bana gayA ho / aisI avasthA Ane para srAva apanA mArga Antra ke pezyAvaraNa ko cIra kara upaudaracchadastara ( subperitoneal layer ) taka calA jAtA hai| isake kAraNa Antra Upara se picchila lasa se sana jAtI hai jisameM sakriya amIbA dekhe jA sakate haiN| yaha sthiti vinA Antra ko vidIrNa kie hI banA karatI hai / isa kAla meM Antra ke bhItara jo vraNa bane hote haiM ve kaI varga iJcoM meM phaila jAte haiM aura unake kinAroM se kuthita zleSmalakalA ke nirmokita Tukar3e laTake hue dekhe jA sakate haiN| AntraprAcIra sthAna-sthAna para itanI mRdu ho jAtI hai ki vaha rojarsa aura maigo ke zabdoM meM eka gIle sokhte (zoSaka patra ) ke samAna mAlUma par3atI hai aura mRtyUttara parIkSaNa kAla meM use vinA pUrNataH vidIrNa kie nikAlA nahIM jA sktaa| para santoSa kI bAta yaha hai ki Upara jisa bhayaGkara vyAdhi kA svarUpa pragaTa kiyA gayA hai vaha bahuta hI kama dekhI jAyA karatI hai so bhI varSoM meM ekAdha bAra / atidurbala upekSita rogI hI isake zikAra banA karate haiN| isa samaya yadi yakRt ko dekhA jAve to jJAta hogA ki usameM asaMkhya choTI-choTI vidradhiyA~ banI huI haiN| isa bIca sampUrNa sthUlAntra amIbika vraNoM meM bhara jAtI hai| iliyosIkalavAlva ke Upara tudAntra meM isa roga kA eka bhI vraNa nahIM dekhA jAtA jo bahuta Azcaryajanaka ghaTanA hai| sAtha hI yaha bhI AzcaryakAraka hai ki A~ta meM asaMkhya bar3e-bar3e vraNa hone para bhI do vraNoM ke madhya kI bhUmi pUrNataH svastha pAI jAtI hai| For Private and Personal Use Only

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agni vaikArikI 667 yaha to rahI roga kI tIvrAvasthA kI carama sImA jidhara pAThaka ne dRSTipAta abhI abhI kiyA thA aba hama krAnika ( kAlika) amIbika DiseMTrI (AmagrahaNI) kI ora usakA dhyAna AkRSTa karate haiN| jIrNa AmagrahaNI meM upazleSmalAvaraNIya strAva ke bAhara nikala jAme athavA parizuSka ho jAne se antra meM choTe avanata vraNa raha jAte haiM jinake kinAre uThe hue rahate haiM jinameM tAntava Uti kI saghanatA pAI jAto hai| inameM bahuta thor3e amIbA pAye jAte haiM / ina vraNoM kI dIvAle ghane tAntava bhAga se hI banatI haiN| inake sire eka dUsare se cipake hue hote haiN| ina vraNoM kI vAstavika prakRti unheM dekha kara nahIM oNkI jA sakatI para Antra kI zleSmalakalA meM amIbika DiseMTrI ke rUpadarzaka spaSTa vraNa bhI dekhe jA sakate haiN| eka hI antra meM isa roga kI pratyeka avasthA ArAma se dekhI jA sakatI hai prArambhika kSudra vraNa kI avasthA, nirmocanI avasthA, tathA jIrNAvasthA ina tInoM ke svarUpa vahA~ saralatayA dekhe jA sakate haiN| ucita upacAra ke abhAva meM yaha roga varSoM taka mila sakatA hai| gahare vraNoM ke kAraNa antra kA chidraNa bhI adhika jIrNa rugNoM meM mila sakatA hai| jIvANujanya aura amIbAjanya grahaNiyoM meM antara grahaNI ke mukhya lakSaNa atIsAra tathA mala ke sAtha rakta, Ama tathA pUya kA jAnA yaha to donoM prakAra kI grahaNiyoM meM eka sA milatA hai| ina donoM kA antara jAnane kA eka upAya mala parIkSA karanA hai jisameM vikSatoM meM jo pharka pAyA jAtA hai use spaSTatayA jAnA jA sakatA hai| UtinAza 3 prakAra kA prAyazaH huA karatA hai jinameM eka aMzana ( lysis ) kahalAtA hai, dUsarA sAndratotkarSa ( pyknosis) kahA jAtA hai aura tIsarA sUtraNa ( karyorrhexis) kahalAtA hai| jIvANujanya upasargoM meM kozIya aMzana bahuta dekhA jAtA hai jinake kAraNa mahAbhakSiyoM se rAkSasa kozA (ghost cells ) aura vahunyaSTiyoM se balayanyaSTiyA~ ( ring nuclei ) taiyAra hote haiM / 90 pratizata kozA bahunyaSTi hote haiN| para yaha parIkSaNa apanA sArA mahattva isa lie kho baiThatA hai ki dvitIyaka upasarga se abhibhUta amIbika DiseMTrI se pIr3ita rogI kA mala bhI sapUya ho sakatA hai / atyanta mahatvapUrNa yadi koI hai to vaha hai mahAbhati kozA ( macrophages ) aura usake rAkSasa kozA / para durbhAgyavaza inakI prakRti amIbA se milatI julatI hone ke kAraNa bhrama ho sakatA hai| aura donoM meM pRthakkaraNa vinA atyanta dakSa vikRti vizArada ke karanA asambhava ho jAtA hai| zuddha amIbika DiseMTrI se bane mala meM kozAoM kI saMkhyA bahuta kama hotI hai aura ekakozIya kozAoM kI bahulatA dekhI jAtI hai| kozAprarasa para vikaroM kA pariNAma hone se unakI AkRti AkhudaSTa ( mouse-eaten ) jaisI ho jAtI hai yA unakI nyaSTiyoM se sAndrakAya ( pyknuotic bodies ) bana jAtI haiN| amIbA ke atirikta rakta ke lAla kaNa bahuta bar3I saMkhyA meM mala meM dekhe jAte haiN| cArkaTa leDina krisTala ( char For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 668 vikRtivijJAna cot-leyden crystals) kA pAyA jAnA bhI amIbika DiseMTrI kA hI pramANa hotA hai baisIlarI kA nahIM / bvAyaDa ne saMkSepa meM ina donoM kI vibhedaka eka tAlikA dI hai jise hama nIce de rahe haiM: -- www.kobatirth.org 1. vikSatIya prakAra 2. vraNa gAmbhIrya 3. vraNa taTa 4. madhyavartI zleSmalakalA 5. vikSatIya jIvANu 6. malIya kozA vijJAna 7. daNDAvika grahaNI pUyAtmaka svalpa tIkSNa zotha pUrNa grahaNI daNDANu bahuSTiko bahuta kama Acharya Shri Kailassagarsuri Gyanmandir kAmarUpIya grahaNI UtinAzAtmaka atyadhika kuNThita avanata For Private and Personal Use Only prakRta AmakArI antaHkAmarUpI ekanyaSTi kozA prAyazaH dvidradhi daNDAvika grahaNI yA baisIlarI DiseMTrI ( Bacillary Dysentry ) 4 amIbika tathA daNDANvika grahaNiyA~ donoM pUrNataH pRthak roga haiM tathA inako eka sthAna para rakhanA aura eka sAtha inakA vicAra karanA asaGgata aura paramparAgata hai aisA kaI vidvAn mAnate aura samajhate haiM / isa roga kI utpatti kisI bhI deza meM ho sakatI hai / jaise amIbika grahaNI kI utpatti uSNa kaTibandha meM sImita hai vaisA isake lie nahIM / ghane base hue bhAgoM meM isakI mahAmAriyA~ phailA karatI haiM jo 1-2 mA raha kara calI jAtI haiM / Antrika aura upAntrika jvara jaise vAhakoM dvArA pracArita hotA hai| ThIka vaise hI daNDAvika grahaNI bhI vAhakoM dvArA hI pracAra pAtA hai / yaha roga jIrNa rUpa bhI dhAraNa kara liyA karatA hai / isa roga meM jvara, aniyantrita atIsAra aura mala meM rakta aura pUya ye mukhya lakSaNa milA karate haiM / daNDAvika grahaNI ke pramukha pracAraka tIna prakAra ke daNDANu hote haiM - 1. bI DiseMTarI zIgI (B. dysenteriae shigae ) 2. bI DiseMTarI phlekjanerI (B. dysenteriae flexneri ) tathA 3. bI DiseMTarI saumI ( B. dyserteriae Sonni) ina tInoM meM zIgA daNDANu dvArA atighora rUpa kI grahaNI pAI jAtI hai / phlekjanara madhyama aura sona alpatama kaSTadAyaka rUpa lekara AtI hai / isa roga meM rogakAraka daNDANu sthAnAzrita rahA karate haiN| na to UtiyoM meM hI praviSTa hote haiM aura na raktadhArA ko hI AkrAnta karate haiM ve sthAnika UtinAza ( local neorosis ) karate haiM tathA eka prakAra ke bahirviSa ( exotoxin ) ko taiyAra karate haiM jo sArvadehika prabhAva DAlatA hai / isa roga kA prathama vikSata sthUlAntra kI zleSmalakalA para banatA hai / yataH isakA AkramaNa rakta kI dhArA para nahIM hotA ataH Antrika jvara kI taraha yahA~ zvetakaNApakarSa na hokara zveta kaNotkarSa milatA hai / isa roga ke karttA daNDANu ko Antra nibandhinI kI granthiyoM meM dekhA jA sakatA hai para anya granthiyoM meM niyamataH yaha nahIM

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agni vaikArika exe milA karatA / isa roga ke kAraNa na kevala sampUrNa sthUlAntra api tu zeSAntra (ileum) kA 2 phITa bhAga bhI rogAkrAnta ho sakatA hai / prArambhika avasthA meM choTe choTe pIle raMga ke sidhma banate haiM jinake Upara eka tanvimat pUyika srAva ( fibrinopurulent exudation) kA AvaraNa car3ha jAtA hai / isa saba ke kAraNa sampUrNa zleSmalakalA vraNazotha se yukta ho jAtI hai aura eka tIvrasvarUpa kA raktasrAvIya zopha ( haemorrhagic oedema ) utpanna ho jAtA hai jisake kAraNa zleSmalakalA khUba moTI ho jAtI hai / jyoM jyoM yaha prakriyA calatI rahatI hai naSTa huI Uti kA bhAga nirmocita hokara mala meM pragaTa hone lagatA hai| aura jahA~ se nirmoka giratA hai vahA~ zleSmalakalA meM eka sarpAkRtika ( serpiginous) vraNa bana jAtA hai jo Antra ke dharAtala se thor3A nIcA hotA hai jisake kinAre cithar3e cithar3e ( ragged ) hote haiM aura jisakA tala vraNazothavAn hotA hai / yaha vraNana amIbika grahaNI kI apekSA bahuta uthalA hotA hai tathA vraNa ke kinAre spaSTataH kaTe hue hote haiM jhuke hue nahIM / vraNa ke dharAtala para vraNazothIya utsyanda ke kAraNa eka picchila, tanvi tathA bahunyaSTiyoM dvArA nirmita eka AvaraNa car3ha jAtA hai / yaha AvaraNa apane nIce ke UtinAza dvArA prApta padArtha ke dvArA eka aisI kUTakalA ( false membrane ) kA nirmANa kara letA hai jaisI ki DiphthIriyA (rohiNI) meM dekhI jAtI hai / AntraprAcIra ke pezIya bhAga taka ye vraNa bahuta kama pahu~cate haiN| kara bar3hane kI pravRtti inakI nahIM hotI / para kabhI kabhI lasyAvaraNa taka pahu~ce hue aura antra kA chidraNa karate hue bhI pAye gaye haiN| choTe choTe kaI braNa bhI ho sakate haiM aura ve saba mila kara eka bar3A vraNa bhI banA sakate haiM / do vraNoM ke madhya kI zleSmakalA sazotha tathA aMkurIyita (pabillomatous ) hotI hai / yezIya bhAga ko cIra ye aNvIkSaNa karane para AntraprAcIra bahunyaSTi kozAoM se paripUrNa pAI jAtI hai / upazleSmala bhAga meM bhI paryApta zopha aura sthUlana milatA hai / vraNa ke tala meM daNDANu bahuta bar3I saMkhyA meM pAye jAte haiN| jaba ina vraNoM kA upazama kaNana Uti dvArA huA karatA hai jisameM granthi virahita eka sAdhAraNa adhicchada use Dha~ke rahatA hai / jaba taka vraNana upariSTha bhAga meM rahatA hai vraNavastu kA nirmANa bahuta kama hotA hai / para gahare aNoM meM vraNavastu adhika bana jAtI hai aura jo Antra kI gati ke sthairya ( stenosis ) kA kAraNa banatI hai 1 Antra ke ye vikSata iGgita karate haiM ki inakI utpatti daNDANvIya bahirviSa kI kRpA kA pariNAma hai / yaha bahirviSa sthUla Antra kI zleSmala kalA dvArA nikalatA rahatA hai / isameM UtinAza kI paryApta pravRtti rahatI hai / naidAnika dRSTi se roga eka tIvra viSaraktatA ( acute toxaemia ) kahalAtA hai / zIgA ke bahirviSa kA parIkSaNa karane se patA lagatA hai ki vaha eka aisA viSa hai jo sthUlAntrIya zleSmalakalA ko bahuta cAhatA hai / usake sAtha hI eka vAtanADI viSa bhI nikalatA hai jisake kAraNa parisarIya vAtanAr3I pAka ( peripheral neuritis ) ho jAtA hai / isa roga meM For Private and Personal Use Only

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1000 vikRtivijJAna rogANuraktatA (septicaemia) nahIM hotii| na isameM yakRdvidradhi hI banatI hai / para jaba kabhI yakRd meM vidradhi dekhI jAtI hai to vaha eka na ho kara kaI hotI haiM aura unameM pUya bharA hotA hai| yadyapi AntrachidraNa aura lasyAvaraNa kA sambandha isa roga meM nahIM AtA para jaba A jAtA hai to eka abhighaTya udaracchadapAka :( plastic peritonitis) bhI mila sakatA hai jisameM antra apane Asa pAsa kI racanAoM vA aMgoM se cipaka jAtI hai| isa kAraNa chidraNa ( perforation ) kabhI nahIM hotaa| jIrNa daNDANvika grahaNI meM sthUlAntra ke nicale Adhe bhAga meM roga pAyA jAtA hai / bar3e bar3e viSamAkRtika nimnita ( depressed ) vraNa jo eka se dUsare jAkara mila jAte haiM, pAye jAte haiM jinheM dekhakara aisA lagatA hai mAno kITadaSTa A~ta ho / Antra zleSmalakalA ke vistIrNa bhAga pUrNatayA naSTa hue milate haiM unakI madhyavartI zleSmalakalA paramapuSTa ho jAtI hai aura usameM zleSmIya pUrvagaka ( mucous polyps) bana jAte haiN| vraNoM ke taloM meM ekanyaSTiyoM kI bharamAra ho jAtI hai aura jIrNa vraNazotha kI avasthA prakaTa hotI hai| AntraprAcIra meM tantUkarpa khUba ho jAtA hai jisase Antra-sthairya athavA AntrAvarodha (intestinal obstruction ) bhI ho jA sakatA hai| isa roga meM mRtyu sabase pahale tIvra viSaraktatA ke kAraNa ho sakatI hai| rogI bahuta jalda kucha hI dinoM meM mara jAtA hai| mRtyUttara parIkSaNa karane para aise zavoM kI AntraprAcIra meM adhika vraNa nahIM mila paate| para kabhI-kabhI eka hI saptAha meM roga kI sampUrNa avasthAe~ samApta hokara rogI bhalA caMgA bhI ho jA sakatA hai / vraNa bharane gate haiM aura kucha bhI pIche ko nahIM bctaa| phlekzanara rUpa meM aisA hI hotA hai| zIgA rUpa meM roga jIrNasvarUpa bhI dhAraNa kara le sakatA hai| rogI ko varSoM atIsAra calatA hai vaha durbala hotA jAtA hai aura duSpoSaNa ke pariNAmasvarUpa isa loka ko chor3a paraloka sidhAra jAtA hai| isa rUpa meM thor3e se hI apathya se roga kA tInAkramaNa bIca-bIca meM kaI bAra bhI dekhA jA sakatA hai| roga se pUrNa mukti milane para bhI rogI ke mala meM grahaNI daNDANu kI eka phauja chUTa sakatI hai / vaha isa prakAra eka vAhaka kA rUpa lekara samAja ke lie abhizApa bana jA sakatA hai| kITANu grahaNI yA baileMTIDiyala DiseMTrI ( Balantidial Dysentery ) isakA kartA eka kITANu (protozoon ) hotA hai jise baileMTIDiyama kolAya ( ballantidium coli ) kahA karate haiN| yaha Ama grahaNI se bahuta milatA julatA roga hai| isakA kITANu upazleSmala AvaraNa meM pAyA jAtA hai| pezIya AvaraNa, rakta vAhiniyoM, lasIkA vAhiniyoM tathA Antra nibandhinI kI granthiyoM meM bhI vaha mila sakatA hai| mala parIkSaNa karane para kITANu bahuta kama pAyA jAtA hai para jhuNDa ke rUpa meM milA karatA hai| For Private and Personal Use Only

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agni vaikArikI 1001 TrApIkala spU ( Tropical Sprue ) yadyapi yaha poSaNa kI kamI se utpanna hone vAlA roga hai para isake lakSaNa saMgraha grahaNI se paryApta milate haiM khAsakara divA prakopo bhavati rAtrau zAnti vrajecca sA ke kAraNa TrApIkala spU aura saMgraha grahaNI bahuta nikaTa A sake haiN| spU ko silosisa ( Psilosis ) yA sIlona soramAutha ( laMkAmukhapAka ) Adi nAma bhI diye jAte haiN| yaha roga bhArata, brahmA, laGkA, dakSiNa cIna meM adhika dekhane meM AtA hai| isa roga meM cudAntra kI zleSmalakalA kI AhAra pracUSiNI zakti (absorptive power ) kama ho jAtI hai| khAsa karake snehoM kA pracUSaNa nahIM hone paataa| yaha roga jorNa rUpa dhAraNa kie vinA mAnatA nahIM hai| isa roga ke tIna pramukha lakSaNa, jihvA pAka ( glossitis ), AdhmAna ( meteorism ) aura snehAtIsAra (steatorhoea) pAye jAte haiM / atIsAra prabhAta meM adhika kaSTa detA hai rAtri meM nhiiN| AdhmAna bhojanoparAnta athavA rAtri meM adhika banatA hai| jihvApAka meM jIbha sUja jAtI hai, lAra bahuta TapakatI hai aura sAtha-sAtha mukhapAka ( stomatitis ) bhI ho jAtA hai| jihvA para amla padArtha yA lavaNa sparza karAte hI ghora kaSTa kA anubhava rogI karane lagatA hai| jihvApAka kA lakSaNa bahudhA atIsAra Arambha hone ke pUrva hI dekhA jAtA hai / atIsAra Arambha meM tIvra svarUpa kA hotA hai yaha sadrava, jhAgayukta, mAtrA meM bahuta aura tIvra gandhayukta hotA hai arthAt usameM saMgraha grahaNI ke dravaM zItaM dhanaM snigdhaM sakaTI vedanaM zakRt / AmaM bahu sapaicchilyaM sazabdaM mandavedanam // lakSaNa yathArthataH mila jAte haiN| mala meM bhojana ke binA pace kaNa, raMga kI kamI, sneha bahulatA, pittopasthiti pAI jAtI hai| sAdhAraNa avasthA meM rogI jitanA mala nikAlatA thA usase 5 gunA taka mala eka bAra meM aura prabhAtakAla meM vaha nikAla detA hai| nyUTrala phaiTa kI apekSA phaiTI aisiDsa mAtrA meM tIna gunI nikalatI haiN| aNvIkSaNa karane para phaiTI aisiDsa ke sphaTa tathA sneha ke vinduka saralatayA dekhe jA sakate haiN| yaha isa bAta kA pramANa hai ki agnirasa kI kriyA yathAvat hotI hai arthAt snigdhAMza kA pAcana ThIka ThIka ho jAtA hai para usakA zoSaNa nahIM hone pAtA isake kAraNa rakta meM sneha kI kamI ho jAtI hai| arthAt jahA~ svAbhAvika svastha rakta meM 600 mi.grA. pratizata sneha milatA thA vahA~ vaha syU meM 412.8 mi. grA. pratizata hI dekhane meM AtA hai| AmAzayika rasa meM lavaNAmla kA abhAva bhI isa roga meM vizeSa karake dekhane ko milatA hai| AmAzaya kI zleSmalakalA dekhane para apuSTa mila sakatI hai| mUtra meM roga kI tIvAvasthA meM mUtrapitti (urobilin) pAI jA sakatI hai| mUtra meM nIlarUpatA ( coproporphyrinuria) yA nIlamehatA (indicanuria) pAI jAsakatI hai| raktako dekhane se anImiyA kA lakSaNa adhika milatA hai| isameM mahAkozAdhikya jisameM kozA viSamAkRtika aura paramavarNika hote haiM, pAyA jAtA hai| parama For Private and Personal Use Only

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1002 vikRtivijJAna pittaraktiraktatA ( hyperbilirubinaemia ) pAI jAtI hai para vaha itanI ugratA lie hue nahIM hotI jitanI pelAgrA meM pAI jAtI hai| rakta meM kailziyama kI bhI kamI pAI jAtI hai / ( 11 ke sthAna para 8 yA 9 pratizata hI hotI hai ) / upapaittika raktatA ( hypocholesterolaemia ) bhI milatI hai / 1 vaikArikI dRSTi se dekhane se nimna lakSaNa milate haiM: -- 1. svacA rUkSa, khuradarI, nimbUka varNIya hotI hai / 2. durbalatA bahuta hotI hai tathA Alasya aura aMgAvasAda bahuta milatA hai / 3. rogI kI carbI ghaTatI calI jAtI hai / peTa kI toMda pacaka jAtI hai aura TApA ghaTa jAtA hai / 4. yakRt meM apuSTi aura kabhI kabhI snaihika vihAsa bhI pAyA jAtA hai / 5. hRdaya babhruvarNIya apuSTi ( brown atrophy ) mila sakatI hai / 6. kSudrAntra meM vAyu bharane se vaha phUla jAtI hai / antra ke aMkura ( villi ) sikur3a jAte haiM, apuSTa ho jAte haiM unameM anutIvra vraNazotha ke lakSaNa dekhe jA sakate haiN| aura kabhI kabhI unameM vraNana bhI hotA hai / AntranibandhinI kI granthiyoM kI kabhI kabhI AkAra vRddhi ho jAtI hai / aura ve tantvika ( fibrotic ) ho jAtI haiM / 1 7. asthimajjA paramacayita ho jAtI hai / mRtyu kA kAraNa Antrika apuSTi, araktatA athavA zeSAntra kA chidraNa ho sakatA hai| prU kA eka rogI dUsare se mukhapAka, AdhmAna aura atIsAra ina tIna lakSaNoM ke atirikta anya prakAra se mile hI yaha Avazyaka nahIM hai / varNavihIna mala, snehazoSaNa kA abhAva aura phaTI phaTI vraNita jihvA ke sAtha paramavarNika araktatA, isa roga ke sAtha prAyaH pAyI jAtI hai| rogI kA mala dhIre dhIre apanA raMga khone lagatA hai vaha mAtrA meM bahuta adhika hagatA hai, mala meM jhAga aura gaisa bahuta milatI hai, mala mRdu aura pesTa (leI ) jaisA hotA hai / mala meM snehAMza aura apacita anna ke kaNa khUba milate haiM / isa prakAra zarIra ke poSakatattvoM kA nirantara mala dvAra se bAhara jAne ke pariNAmasvarUpa zarIra durbala aura kSINa ( emaciated ) hotA calA jAtA hai / jaba rogI kI parAvaTukA granthiyA~ thaka kara khAlI ho jAtI haiM aura rakta meM kailziyama kI paryApta kamI hone lagatI hai to apatAnikA ( TiTainI - totany ) nAmaka roga bhI ho jA sakatA hai / kiraNa darzana se jo beriyama AhAra ke bAda antra kara liyA jAtA hai grahaNI aura ladhvantra meM jo svabhAvataH pakSAkAra ( feathery ) svarUpa hotA hai vaha samApta ho jAtA hai jo Antra jhallaroM ( valvulae conniventes ) kI apuSTi se yA unake sapATa ho jAne se hotA hai| isake kAraNa Antrika zleSmalakalA kI pracUSikA bhUmi kama ho jAtI hai / A~toM ke andara snaihika amloM (fatty acids ) tathA klIba snehoM (neutral fats ) kA jo anupAta svasthAvasthA meM rahatA hai vaha For Private and Personal Use Only

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agni vaikArikI 1003 / badala jAtA hai / svasthAvasthA meM 2 amla aura 1 se 4 klIba sneha rahatA hai jo haTakara 1 yA 5 amla aura 1 klIba sneha aisA ho jAtA hai ( thaumsanAdi ) / sneha ke pracUSaNa ke abhAva kA eka pramANa yaha hai mala ko dAba kara usase snehAMza nikAlA jAve to vaha 25 se 50% taka nikalatA hai AhAra ke uparAnta sadaiva raktastha snehArbho ( lipoid ) kI vRddhi rogI meM nahIM dekhI jAtI jo snehapracUSaNa kI karatI hai / para jaba do cAra bAra yakRt kA pracUSaNI zakti bar3hatI huI dekhI jAtI hai| utaratA / isase bArkara tathA rahoDsa ne yaha niSkarSa nikAlA hai ki sneha ke pracUSaNa kA abhAva hI sprU meM atIsAra yA snehAtIsAra ( steatorrhoea ) kA mUlabhUta kAraNa hai| jo sprU se pIDita pakSa meM hI matadAna antaH nikSepaNa kara diyA jAtA hai to yaha adhika mAtrA meM nahIM sAtha hI mala bhI adhika snehapUrNa hai ho jAyA karatI kriyA na hone ke AhataparIkSA se yakRt kA manda kSetra ( area of dulness ) ghaTA huA milatA hai isake do kAraNa haiN| eka to yaha ki yakRt meM kucha apuSTi ho jAne ke kAraNa yakRt kA AkAra kucha ghaTa jAtA hai dUsare udara meM vAyu ke adhika ekatra ho jAne se udara phUlA phUlA rahane lagatA hai jisase mandatA kI puSTi nahIM ho pAtI / 1 pratyeka sprU ke rogI ke sAtha enImiyA yA araktatA kA rahanA eka sarvasAdhAraNa ghaTanA hai / prauDha vyaktiyoM meM jaba yaha upadrava sAtha sAtha ho jAtA hai to mRtyu kucha saptAhoM meM hI ho jA sakatI hai| aise rugNoM meM rakta meM Rjuruha (normoblasts) bar3ha jAte haiM / mArAtmaka araktatA ( pernicious anaemia ) meM rakta kA jo svarUpa banatA hai vaisA hI smU meM bhI bana jAtA hai / arthAt zoNavartula dezanA ( haemoglobin index ) bahuta ucca rahatI hai / ghAtaka yA mArAtmaka araktatA se isameM yahI bheda hotA hai ki yahA~ araktatA azoNAMzika vRhadraktIya prakAra ( nonhaemolytic megalocytic type ) kI hotI hai / aura alpa phAnaDena par3hA jAtA hai tathA raktakaNa ke AkAra meM vRddhi huI rahatI hai / arnitha gaNanA meM bahuta hI thor3A antara A pAtA hai / Upara atIsAra aura grahaNI sambandhI mahattvapUrNa tathyoM kA ullekha karake agnivikAra se pratyakSa sambaddha aba hama arza kA vicAra kareMge / arza prakaraNa (Haemorrhoids) arza kA abhAratIya nAma hImora hauiDsa yA pAilsa athavA bavAsIra hai / yaha eka avasthA hai jaba atyalpa AdhAravAlI arzakArI sirAe~ praphullita yA apasphIta ( varicose ) tathA paramapuSTa ( hypertrophied ) ho jAtI haiM / antarAza ( internal piles ), malAzaya ( reotum ) ke bhItara aura zleSmalakalA ke nIce uttarIya guda sirAoM ( superiorhaemorroidal veins ) ke dvArA banate haiM aura bahirarza (external piles) adharagudasirAoM ( inferior haemorrhoi For Private and Personal Use Only

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1004 vikRtivijJAna dal veins) tvacA se DhaMke aura guda ke nicale bhAga meM banate haiN| Adhunika dRSTi se inake kAraNa kendriya tathA sthAnika do prakAra ke kahe gaye haiN| kendriya kAraNoM meM yakRhAlyutkarSa aura hRdaurbalya mukhya haiM / sthAnika hetuoM meM gudakarkaTa ( carcinoma of the rectum) garbhAzaya kA bhAra, aSThIlA granthi kI vRddhi tathA mala kA viSTambha mukhya haiN| ___ arza meM atyadhika visphArita sirAoM ke samUha hote haiM aura unheM dekhakara eka bar3e vAhinyarbuda kA bhAsa ho sakatA hai| yaha zleSmalakalA athavA tvacA se DhaMkA hotA hai / sirApAka athavA dhanAtrotkarSa ke sAtha isako bahudhA koI upasarga lA sakatA hai jisase arza kA sahasA daurA hotA huA dekhA jAtA hai| ghanAstra tantvit (fibrosed ) ho jA sakatA hai| jisake kAraNa turata lAbha ho jA sakatA hai| kabhI kabhI upasarga grasita ghanAstra TUTa TUTa kara antaHzalyoM kA nirmANa karatA hai jo yakRt meM jAkara vidradhi nirmANa kara sakate haiN| arza ke masse ke cAroM ora kI tvacA ke kozA jIrNa vraNazotha se pIDita raha sakate haiM ghanAstra sirApAkAvasthA ke atirikta raktastrAva arza kA eka pramukha lakSaNa hai jisake kAraNa dvitIyaka araktatA ho sakatI hai| jahA~ AdhunikoM ne Antarika aura bAhya ina-do vibhedoM ko karake arza kA varNana kiyA hai vahA~ Ayurveda ke vidvAnoM ne ise 6 prakAra kA mAnA hai : pRthagdoSaiH samastaizca zoNitAtsahajAni ca / arzAsi paTa prakArANi vidyAdgudavalitraye / / arthAt vAtika, paittika, zlaiSmika, sAnnipAtika, raktajanya aura sahaja isa prakAra guda kI valitrayI meM 6 prakAra ke arza hote haiN| pRthaka pRthaka doSoM ke jaise arza hote haiM vaise hI dvandvaja arza bhI samhAle jAve to arzoM kI saMkhyA aura bhI bar3ha sakatI hai| sahaja arza aura tridoSaja arza ke lakSaNa eka se hote haiN| doSajanya arzI ke nidAna ( aetiology ) ke sambandha meM caraka ke nimna sUtra bahuta mahattva ke kahe gaye haiM : vAtArza-kaSAyakaTutiktAni rUkSazItalavUni ca / pramitAlpAzanaM tIkSNaM madyaM maithunasevanam / laMghanaM dezakAlau ca zItau vyAyAmakarma ca / zoko vAtAtapasparzI heturvAtArzasAM mataH / / pittArza-kaTavamlalavaNoSNAni vyAyAmAgnyAtapaprabhAH / dezakAlAvazizirau krodho madhamasUyanam / / vidAhi tIkSNamuSNaM ca sarva pAnAnnabheSajam / pittolvaNAnAM vijJeyaH prakope hetura zaMsAm / / kaphArza-madhurasnigdhazItAni lavaNAmlagurUNi ca / avyAyAmo divAsvapnaHzayyA''sanasukhe ratiH / / prAgvAtasevA zItau ca dezakAlAvacintanam / zlaiSmikANAM samuddiSTametatkAraNamarzasAm / / (caraka cikitsAdhyAya 14 ) bhela ne arza ke sarva sAmAnya nimitta batalAte hue nimna sUtra prakaTa kiye haiM:vidAhi gururUkSANAM AnUpodakasevinAm / dadhidugdhaguDAdInAM pizitAnAM ca bhojinAm / / yAnAnAmudakAnAM ca duSTAnAmupacAraNAt / nityAjIrNabhujAM cApi vegAnAM ca vidhAraNAt / / pravAhaNAccAtimAtraM maithunasyAtisevanAt / duSTapAnaprasaGgAna kaThinAtpRSThapIDanAt // nirUhasyAtiyogAcca vastinAM vibhramAdapi / snehapAke ca vibhrAntAt madhadoSAzrayAtkSayAt // For Private and Personal Use Only

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avaikArikI 11 ebhiH prakupitA koSA vAtapittakaphAstrayaH / ekazassarvazo vAtaH dvandvazaH zoNitena vA gudAbhiSyandamevAzu kurvanti gudamAzritAH / 1005 uparyukta ina sampUrNa kAraNoM ke dekhane se yaha spaSTa hai ki arzotpatti meM AhAra vihAra aura pAna kA viparyaya mahattvapUrNa bhAga letA hai / svAdvamlalavaNatiktoSaNa kaSAyarasasampanna vividha padArthoM meM se koI bhI atimAtra sevana karane se arzakAraka sthiti utpanna kara de sakatA hai / rUkSa, zItala, laghu dravya hoM yA vidAhI, tIkSNa, uSNa padArtha hoM athavA snigdha, uSNa guru vastue~ hoM arzotpattikAraka avasthA utpanna karane meM ve sabhI samartha ho sakate haiN| zoka, krodha, cintA se tInoM mAnasika avasthAe~ arza kI utpatti meM athavA usake vegoM ko bulAne meM sadaiva mahattvapUrNa abhinaya karate haiM / vyAyAma kA karanA yA na karanA donoM hI arzotpAdaka bana sakate haiM / madya sevana arzakAraka kahA gayA hai / dadhi, dugdha, guDa, mAMsAdika kA prayoga, duSTa jala kA upayoga, pravAhaNa, maithunAdhikya, vegavidhAraNa, ajIrNa bhojana, adhika savAriyoM meM baiThanA, kaThina pITha vAle pazuoM kI pITha para car3hate rahanA, vasti meM vyatikrama, snehapAna vibhrAnti Adi aneka aise kAraNa haiM jo doSoM kA prakopa gudasthAna meM karake vyakti ko arza se pIDita kara dete haiM / vegoM kA vidhAraNa karanA ghaNToM TaTTI kI hAjata ko mAranA yA mUtratyAga meM atyadhika vilamba karanA athavA apAna vAyu ke nissaraNa ko rokane kA yatna choMka ko rokanA Adi sabhI gudasthAna para atyadhika dabAva mahattvapUrNa yoga dete haiM / DAlakara arza ko utpanna karane meM arza ke pUrva rUpoM kA nimna varNana caraka ne kiyA hai-- viSTambho'nnasya daurbalyaM kukSerATopa eva ca / kAryamudgAra bAhulyaM sakthisAdo'lpavikatA // grahaNadoSapANDvarte rAzaGkA codarasya ca / pUrvarUpANi nirdiSTadhanyarzasAmabhivRddhaye // anna kA viSTambha arthAt anna ke pAcana kI gati meM rukAvaTa, durbalatA, kukSi meM vAyu ke kAraNa ATopa, kRzatA, adhika DakAroM kA AnA, TA~goM meM zaithilya, mala kI kamI, grahaNI kA dUSita honA, pANDu roga yA udara roga kI zaGkA honA ye sabhI arza ke pahale dekhe jAte haiM / arza kI utpatti ke samaya pRthak-pRthak eka-eka doSa yadyapi hamane prakupita huA batalAyA hai parantu paJcAtmA mArutaH pittaM kapho gudavalitrayam / sarva eva prakupyanti gudajAnAM samudbhave // ki pA~coM vAyu, pA~coM pitta aura pA~coM kapha ye sabhI guda kI valitrayI meM arza hone se prakupita ho jAte haiM / isI kAraNa - tasmAdarzAsi duHkhAni bahuvyAdhikarANi ca / sarvadehopatApIni prAyaH kRcchratamAni ca // kahe jAte rahe haiM / For Private and Personal Use Only kI nirukti Adi arivatprANino mAMsakIlakA vizasanti yat / arzAsi tasmAducyante gudamArganirodhataH // doSAstvaGmAMsamedAMsi sandRSya vividhAkRtIn / mAMsAGkurAnapAnAdau kurvantyazasi tAn jaguH //

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1006 vikRtivijJAna mAM ke kIlaka ari ke samAna jaba prANiyoM ko kaSTa dete haiM taba ve arza kahalAte haiN| ye kIlaka gudamArga ke avarodha ke kAraNa hI utpanna hote haiN| inakI utpatti meM pradhAna uttaradAyittva doSoM kA rahatA hai / vAtAdika doSa tvacA, mAMsa athavA medo dhAtu ko dUSita karake vividha rUpavAle mAMsAGkura yA mAMsa kIlaka apAnAdi bhAgoM meM utpanna kara dete haiM | Adi zabda se karNa aura nAsAgata arza liye jAte haiM / vAgbhaTa ne arza ke bhedoM kA eka sundara vivecana kiyA hai| usane arza ko pahale do bhedoM meM bA~TA hai Acharya Shri Kailassagarsuri Gyanmandir 1. sahaja arza jo janma se hI sAtha Ate haiM / tathA 2. janmottara arza jo vyakti ko bAda meM utpanna hote haiM / usake bAda 2 bheda aura bhI kie haiM : -- 1. zuSka arza tathA 2. srAvi arza / zuSkA sadaiva sUkhe aura sazUla hote haiM srAvI arzoM se raktasrAva hotA rahatA hai / arza kI dRSTi se zArIra kA varNana vAgbhaTa ne bahuta soca samajha kara kiyA hai gudaH sthUlAntrasaMzrayaH // ardhapaJcAGgulastasmistisro'bhyardhAGgulAH sthitaH / valyaH pravAhiNI tAsAmantarmadhye visarjanI || bAhyA saMvaraNI tasyA gudauSTho bahiraGgule / yavAdhyardhaH pramANena romANyatra tataH param // bRhadantra ke Azrita aura usakA antima bhAga guda kahalAtA hai / isa guda meM tIna valiyA~ hotI haiM jinameM sabase bhItarI vali pravAhaNI kahalAtI hai jo mala kA nIce kI ora pravAhaNa karatI hai / dUsarI bIca kI jo mala kA visarjana karatI hai visarjanI bali kahalAtI hai / tIsarI sabase bAhara kI ora sthita vali saMvaraNI kaha lAtI hai jo mala ko yathA icchA rokA karatI hai / sampUrNa guda kA pramANa ardha paJcAGgula yAne sArddhacaturaGgula ( 4 // aMgula ) batalAyA jAtA hai guda ke isa 4 // aMgula bhAga meM adhyardhAGgula (1 // - 1 // aMgula ) kI dUrI para tInoM valiyA~ pratiSThita haiN| eka-eka vali 1 // aMgula meM samAtI hai / romAvali se 13 yava Upara gudoSTha hotA hai usase 1 aMgula Upara prathama vali saMvaraNI hotI hai / ye valiyA~ zaGkhAvarta ke samAna eka ke Upara dUsarI sthita rahatI haiM varNa se ye hAthI ke tAlu ke samAna hotI haiM zaGkhAvarttaninAzcApi uparyupari saMsthitAH / gajatAlunibhAzcApi varNataH samprakIrtitAH // sahaja arza AyurvedajJa isameM pUrNataH vizvAsa karate haiM ki arza mAtA-pitA ke apacAra se utpanna hone vAlA eka paitrika roga hai / isakA pramANa jAnane ke lie dUra jAne kI AvazyakatA nahIM hai / kisI bhI arza rogI kA itihAsa jAnakara yaha patA sahaja hI lagAyA jA sakatA hai ki usake pitA, mAtA, dAdI, dAdA, nAnI yA nAnA ko yaha roga rahA ki nhiiN| sAtha hI saba arza se pIDita vyaktiyoM ke mAtApitAdiko arza For Private and Personal Use Only

Page #1097
agni vaikArikI 1007 hotI yaha bhI Avazyaka nahIM hai / isI kAraNa jAtasyottarakAlaja arza kA bhI varNana kiyA gayA hai| sahaja arzI ke AkAra kI spaSTa kalpanA caraka ne nimna zabdoM meM kI hai: tatra sahajAnyAsi kAnicidaNUni kAnicinmahAnti kAniciddI;Ni kAnicidadhrasvAni, kAnicivRttAni, kAnicidviSamavisRtAni, kAnicidantaHkuTilAni, kAnicibahiHkuTilAni kAnicijjaTilAni, kAnicidantarmukhAni yathAsvaM doSAnubandhavarNAni / aNu, mahAn , dIrgha, hasva, vRtta, viSamavisRta, antaHkuTila, bahi kuTila, jaTila, antarmukha ina rUpoM meM sahajArza milate haiN| tathA varNa kA nAnAvidhatva doSAnubandha ke kAraNa hotA hai| sahajArzI kA satyacitraNa karane meM caraka kI lekhanI ko jo siddhahastatA prApta huI hai vaha anyatra milatI hI nahIM tairupahato janmaprabhRti bhavatyatikRzo vivarNaH kSAmo dInaH pracuravibaddhavAtamUtrapurISaH zArkarI cAzmarI vA tathA'niyatavibaddhamuktapakkAmazuSkabhinnavarcA antarAntarA zvetapANDuharitapItaraktAruNatanusAndrapicchilakuNapagandhAmapurISopakezI nAbhivastivaMkSaNoddeze pracuraparikartikAnvitaH sagudazUlapravAhikApariharSapramohaprasaktaviSTambhAntrakUjodAvartahRdayendriyopalepaH pracuravibaddhatiktAmlodgAraH sudurbalo sudurghalAgnirapazukraH krodhanoduHkhopacArazIla: kAsazvAsatamakatRSNAhRllAsacchardivarocakAvipAkapInasakSavathuparItastaimirikaH ziraHzUlI kSAmabhinnasannasaktajarjarasvaraH karNarogI zUnapANipAdabadanAkSikUTaH sajvaraH sAGgamardaH sarvapasthizUlIcAntarAntarA pArzvakukSibastihRdayapRSThatrikagrahopataptaH pradhAnaparaH paramAlasazceti / (ca. saM. ci. sthA. a. 14) __janmaprabhRtasya gudajairAvRto mArgoparodhAdvAyurapAnaH pratyArohansamAnavyAnaprANodAnAnpittazleSmaNau ca prakopayati, te prakupitAH paJcavAtAH pittazleSmANau cArzasamabhidravanta etAn vikArAnupajanayantItyuktAni shjaanyiisi| sahajArza se pIDita vyakti apane janma kAla se hI atyanta kRza, vivarNa, kSAma, dIna, vAta-mUtra-purISa ko adhika mAtrA meM aura vibaddha nikAlatA hai, usake mUtra meM zarkarA kA honA athavA mUtra mArga meM azmariyoM kI upasthiti pAI jA sakatI hai| aniyata, vibaddha, mukta, pakva, apakka, zuSka yA bhinnasvarUpa kA mala pAyA jAtA hai| mala kA svarUpa zveta, pANDa, harita, pIta, rakta, aruNa meM se koI bhI ho sakatA hai| vaha mala tanu, sAndra, picchila Ama athavA kuNapagandhI ho sakatA hai| nAbhibasti tathA vaMkSaNa pradeza meM parikartikA pAI jA sakatI hai| gudazUla, pravAhikA, romaharSa, moha, nirantara viSTambha ( habitual constipation) AntrakUjana, udAvata, hRdayopalepa, indriyopalepa pracura vibaddha tiktodgAra tathA amlodvAra Ate haiN| rogI atyanta durbala hotA hai usakI agni manda hotI hai vaha alpazukrI hotA hai| krodhI tathA duHkha adhika mAnane vAlA hotA hai, kAsa, tamaka, zvAsatRSNA, hRllAsa, vamana, aruci, avipAka, pInasa, kSavathu se yukta, timiraroga, ziraHzUla se pIDita ho sakatA hai / usakA svara kSINa, phaTA huA, avasAdayukta, ruka rukakara hone vAlA tathA jarjara hotA hai / vaha karNaroga se bhI pIDita ho sakatA hai / usake hAtha paira mukha netrakUTa sUje hue pAye jA sakate haiM, vaha sajvara, sAGgamarda, sarvaparvAsthizUlayukta, samaya samaya For Private and Personal Use Only

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1008 vikRtivijJAna para pArzva-kukSi basti, hRdaya, pRSTha, trika kI jakar3ana kA bhI anubhava kara sakatA hai / vaha dhyAna vA cintAparAyaNa tathA atyanta AlasI hotA hai / uparyukta citraNa yaha spaSTa kara detA hai ki sahajArzI kA pahacAnanA koI ati kaThina bAta nahIM phira bhI kabhI kabhI uparyukta sampUrNa lakSaNa nahIM milA krte| kisI ko koI lakSaNa milatA hai aura dUsaroM ko koI / ataH nidAna meM bar3I sAvadhAnI kI AvazyakatA par3atI hai / sahajA ke upadravoM kI samprApti batalAte hue caraka ne likhA hai ki sahajArI se pIDita kA gudamArga AvRta rahatA hai / mArgIyarodha ke kAraNa apAnavAyu pratyAroha karake samAna, vyAna, prANa aura udAna nAmaka doSa cAra vAyuoM ko tathA pitta aura leSmAko sandUSita karake prakupita kara detI hai / ye pA~coM vAta aura pitta tathA kapha sabhI prakupita hokara una upadrava vA vikAroM ko utpanna kara dete haiM jinakA varNana pahale kiyA jA cukA hai / jAtasyottarakAlaja arza caraka ne hetu aura samprApti kA sarvasAmAnyanirUpaNa karane ke lie nimna vAkya likhe haiM guru madhurazItAbhiSyandividA hiviruddhAjIrNapramitAzanAsAtmya bhojnaadgvymaatsyvaaraahmaahiss| jAvikapizitabhakSaNAtkRzazuSkapUtimAMsa paiSTika para mAnnakSora modakadadhitilaguDavikRtisevanAcca, mASayUSekSurasapiNyAkapiNDAlukazuSkazAkazuktalazunakilATa krapiNDakavi samRNAlazAlakakauJcAdanakazerukazRGgATakatarUTavirUDhanavadhAnyAmamUlakopayogAdguruphalazAkarAgaharitaka kAsamardakavasAziraspadapayUpitapUrtizItasaGkIrNAnnAbhyavaharaNAnamandakAtikrAntamadyapAnAd vyApannagurusalilapAnAdatisnehapAnAda saMzodhanAstikarmavibhramAd vyavAyAddivAsvapnAtsukhazayanAsanopasevanAccopahatAgnermalopacayo bhavatyatimAtraM tathotkaTukaviSamakaThinAsanasevanAdudubhrAntayAnoSTryAnAdativyavAyAdvastinetrAsamyak praNidhAnAd gudakSaNanAdabhIkSNaM zItAmbu saMsparzAccelaloSTratRSNAdigharSaNAd pratatanirvAhaNAd vAtamUtrapurISavegodIraNAt samudIrNavegavinigrahAt strINAM cAmagarbhabhraMzAd garbhotpIDanAdbahuvipamaprasUtibhizca prakupitovAyurapAnastaM malamupacitamadhogatamAsAdyagudabaliSvAdhatte, tatastAsvarzAsi prAdurbhavanti / uparyukta vividha kAraNoM se apAna vAyu prakupita ho jAtA hai jo adhogata saJcita mala ko prApta karake use gudavalitraya meM dhAraNa kara detA hai aura azoM kI utpatti kara detA hai | ataH arzotpatti meM mukhya kArya apAna vAyu hI karatA hai aura jaba taka yaha apanI svAbhAvika avasthA ko prApta nahIM ho jAtA arzaroga se mukti nahIM mila sakatI / hArIta ne bhI isI mata kI puSTi kI hai anazanalaghu rUkSAhArasaMsevanena kaTulavaNavidAheH sevayA vAtarodhAt / bhavati satatavIpsA viSTareNaiva hInA kupitamarutavegAdarzasAM bhUtirAsIt // anazanopaviSTasya malamUtrAvadhAraNe / zItasaMsevanenApi gudajaH samprakupyati // lavaNakaTukaSAyAtiktasaMsevanena amitavilaghubhojyAcchItalenAtirodhAt kupitamalinanAmApAnamArgeSvapAne sRjati rudhiravAto'pAnamArge marutsu // (hA. sthA. tR. sthA. a. 11 ). aba hama jAtasyottarakAlaja vividha arzoM kA saMkSipta varNana prakAzita karate haiM / For Private and Personal Use Only

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ani vaikArikI vAtArza Acharya Shri Kailassagarsuri Gyanmandir 1 - zItatvatodaM paruSaM vinidrA gulmodarASThIlaviSUcikA vA / zophavubhau kRSNanakhasya netre liGgAni vAtaprabhavArzasAnAm // ( hArIta ) 1006. 2 - gudAGkurA bahvanilAH zuSkAzcimacimAnvitAH / glAnAH zyAvAruNAH stabdhA vizadAH paruSAH kharAH // mitho bisadRzA vakrAstIkSNA visphuTitAnanAH / bimbIkharjUrakarkandhu kArpAsIphalasannibhAH // kecit kadambapuSpAbhAH kecitsiddhArthakopamAH / ziraH pArzvAsakaccUruvacaNAdyadhikavyathAH // kSavathUdgAraviSTambhahRda grahArocakapradAH / kAsazvAsAgnivaiSamya karNanAdabhramAvahAH // tairAta grathitaM stokaM sazabdaM sa pravAhikam / rukphenapicchAnugataM vibaddhamupavezyate // kRSNatvaGnakhaviNmUtranetravaktrazca jaayte| gulmaplIhodarASThIlA sambhavastata eva ca // ( mAdhavanidAna ) 3 - tatra mArutAt parizuSkAruNavarNAni viSamamadhyAni kadambapuSpatuNDikerI nADImukhasUcI mukhAkRtIni ca bhavanti / tairupahataH sazUlaM saMhatamupavezyate / kaTIpRSThapAzrvamedgudanAbhipradezeSu cAsya vedanA gulmASThIlA plIhodarANi cAsya tannimittAnyeva bhavanti / kRSNatvaGnakhanayanavadanamUtrapurISazca puruSo bhavati / (su. ni. a. 2 ) 4- teSAmayaM vizeSaH - zuSkamlAnakaThina paruSarUkSazyAvAni tIkSNAgrANi vakrANi sphuTitamukhAni viSamavistRtAni zUlAkSepatodasphuraNacimicima saMharSaparItAni snigdhoSNopazayAni pravAhikAdhmAna ziznavRSaNabastivaGkSaNahRd grahAGgamarda hRdayadravaprabalAni pratatavivaddhavAtamUtravacasi kaThinavacasyUrukaTipRSThatrikapArzvakukSibastizUlaziro'bhitApakSavathUgArapratizyAyakAsodAvartAyAsazoSazothamUrcchArocakamukhavairasya taibhiryakaNDUnAsAkarNazaGkhazUla svaropaghAtakarANi zyAvAruNaparuSanakhanayanavadanatvamUtrapurISasya vAtolvaNAnyasIti vidyAt / (ca. saM. ci. sthA. a. 14 ) uparyukta uddharaNa isa bAta ke pramANa haiM ki prAcInAcAryoM ko vAtolbaNa arza kA ThIka-ThIka jJAna thA athavA yoM kahie ki kina-kina lakSaNa samUhoM kA ekatrIkaraNa vAtArza ke lie paramAvazyaka hai use ve bhale prakAra se jAnate the / unake vicAra se vArtika arza meM jo masse yA kIlaka milate haiM ve sUkhe, malina, kaThina, paruSa, rUkSa aura zyAva raMga ke hote haiN| unake agrabhAga nukIle aura mukha phUTe hue hote haiM / ve viSamatayA phaile hote haiM / unameM khUba darda hotA hai sAtha hI toda aura AkSepa, cimacimAnA, sphuranA tathA romaharSa hotA rahatA hai / basavarAjIyakAra inake varNa ke viSaya meM likhatA hai - For Private and Personal Use Only jAyante hyaGkaraiH zyAmaiH zuSkAzasi ca mArutAt / sUkhe aura kAle raMga ke aMkuroM kA honA vAtArza meM mahatvapUrNa hai / ina kIlakoM yA aGkuroM kI upamA vividha pustakakAroM ne vibhinnatayA dI hai| basavarAjIyakAra use nIma ke bIja, sarasoM yA binaule ke bIja ke samAna mAnatA hai / hArIta inheM paruSA viSamA dIrghA vAtena gudajA matAH kahatA hai / mAdhavakara bimbIkharjUrakarkandhukArpAsIphalasannibhAH kahatA hai / kadambapuSpAbhAH aura siddhArthakopamAH bhI inheM vaha mAnatA hai / suzruta kA nADImukha sUcImukha kahanA bhI yathArtha hai / uparyukta lakSaNoM ke sAtha-sAtha kucha anya lakSaNa bhI diye haiM jinakA sambandha sampUrNa zarIra se AtA hai / ye lakSaNa 85, 86 vi0

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vikRtivijJAna vividha zAstrakAroM ne apanI-apanI dRSTi se likhe haiN| mala kA lakSaNa sabhI ne lagabhaga eka sA diyA hai ki vaha sapravAhikA hotA haiM grathita, stoka, picchAnugata, vibaddha, sazUla, saphena tathA sazabda hotA hai / hArIta dvArA vinidratA kA jo lakSaNa diyA huA hai vaha anubhava ke AdhAra para aura ucita hai| vAtArza ke massoM meM itane zUlAkSepAdi rahate haiM ki rogI so nahIM sakatA tathA zizna vRSaNa basti vaMkSaNa aura hRdayadeza meM grahatA yA jakar3ana pAI jAtI hai kaTi, pRSTha, trika, pArzva, kukSi, basti meM zUla, zira meM abhitApa, chIMkoM kA AnA, DakArAdhikya Adi lakSaNa bhI milate haiM / vAgbhaTa kA kRSNatvanakhanayanavadanamalAzca bhI atyanta mahattvapUrNa hai| gulma, udararoga, aSThIlA, visUcikA, zopha Adi roga bhI upadrava svarUpa mila jAte haiN| pittArza 1. dAhazramau jvarapipAsi zarArato vA mUruicirnayanadantamukhAni yasya / ___ pItacchavirbhavati vA viTabhedanaM ca pittana jAtagudajasya ca lakSaNAni // ( hArIta ) 2. pittottarA nIlamukhA raktapItA sitprbhaaH| tanvasrasAviNo visrAstanavo mRdavaH ilthaaH|| zukajihvA yakRtkhaNDa jalaukovaktrasannimaH / daahpaakjvrsvedtRnnmuurchaa'rucimohdaaH|| soSmANo drvniilossnnpiitrktaa'bhvrcsH| yavamadhyA hrittpiithaaridrtvngnkhaadyH|| (mAdhavanidAna) 3. pittAnnIlAgraNI tanUni visarpANi pItAvabhAsAni yakRtprakAzAni zukrajivhAsaMsthAnAni yavamadhyAni jalaukovaktrasadRzAni praklinnAni c| tairupahataH sadAhaM sarudhiramatisAryate, jvaradAhapipAsAmUzciopadravA bhavanti pItatvaGnakhanayanadazanavadanamUtrapurISazca puruSo bhavati / ( suzruta ) 4. tatra yAni mRduzithilasukumArANi sparzAsahAni raktapItanIlakRSNAni svedopakledabahulAni visragandhIni tanupItaraktasrAvINi rudhiravahANi dAhakaNDazUlanistodapAkavanti ziziropazayAni sambhinnaH pItaharitavAsi pItavisragandhipracuraviNmUtrANi pipAsAjvaratamakasammohabhojanadveSakarANi pItanakhanayanatvamUtrapurISasya pittolbaNAnyIsIti vidyAt / (caraka ) 5. sajvaraM piTakaM tRSNA tIkSNavegaM sazoNitam / uSNadravaM sadAhaM ca pittAzassUpalakSyate / / pANDuvarNazca bhavati pItAbhAsaJca lakSyate // ( bhela ) pittArza meM pitta ke aneka lakSaNa prakaTa hote haiN| hArIta ne unakA svarUpa varNana karate hue likhA hai sadAhAzca vicitrAzca pItAnIlAvabhAsikAH / lohitaM sravate soSNaM pittena gudajA matAH / / ki pittaja arza dAha karane vAle vicitra prakAra ke pIle vA nIlI AbhA vAle hote haiM unase garma rakta nikalA karatA hai| caraka ne sAtha hI unameM mRdutA, zithilatA, sukumAratA, sparza na sahane kI pravRtti, lAla, pIle, nIle vA kAle raMga ke batalAye haiM jo sveda tathA upakleda se yukta hote haiN| ve Amagandhi aura jinase patalA pIlA yA raktamizrita srAva hotA hai| sAtha meM jinake dAhakaNDUzUla, toda aura pAka jaisI vedanA hotI hai| pittAzoM kA svarUpa zuka (tote) kI jihvA jaisA yA yakRt ke Tukar3e jaisA athavA jalaukA ke mukha ke sadRza humA karatA hai vaha yavamadhya ke samAna bIca meM moTA For Private and Personal Use Only

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afrat 1011 tathA AsapAsa patalA hotA hai / zArIrika anya lakSaNoM meM dAha, pAka, jvara, svedAdhikya, tRSNA, mUrchA, aruci aura mohAdi pittajanaka lakSaNa prakaTa hote haiM / jo mala hotA hai vaha patalA, nIlA, garama, pIlA, haldI ke varNa kA, raktayukta yA Amayukta hotA hai / tvacA, nakha, netra, mukha, dA~ta Adi meM pIlI, harI, nIlI athavA lAla AbhA pAI jAtI hai / bhela ke anusAra pANDuvarNatA tathA pItAbha ye do lakSaNa pittArzI meM pAye jA sakate haiM / pittArzo se patalA rakta nikalatA hai jo visragrandhI ( AmagandhI ) hotA hai aura jo uSNa kahalAtA hai vaha dAha ke sAtha nikalatA hai / zleSmArza 1. nidrA ca jADyadhanamandarujA ca zophA zUlAtigulmagudabhaGgurakAstathA syuH / viTbandhatodamarucirgatimandatA ca leSmodbhavA gudarujaH khalu bheSajajJaH // ( hArIta ) 2. zleSmolbaNA mahAmUlA ghanA mandarujaH sitAH / ucchUnopacitAH snigdhAH stabdhavRttagurusthirAH // picchilAH stimitAH lakSaNAH kaNDvADhyAH sparzanapriyAH / karIrapanasAsthyAbhAstathA gostanasannimAH " vaGkSaNAnAhinaH pAyubastinAbhivikartinaH / sakAsazvAsahRllAsaprasekArucipInasAH || mehakRcchazirojADya zizirajvarakAriNaH / kunyAgnimArdavacchudirAmaprAyavikAradAH // sapravAhikAH / navati na bhidyante pANDusnigdhatvagAdayaH // ( vAgbhaTa ) vasAbhasakaphaprAjyapurISAH 3. zleSmajAni zvetAni mahAmUlAni sthirANi vRttAni snigdhAni pANDUni karIra panasAsthigostanAkArANi na bhidyante na sravanti kaNDUbahulAni ca bhavanti / tairupahataH sazleSmANamanalpaM mAMsadhAvanaprakAzamatisAryate, zodhazItajvarArocakAvipAkazirogauravANi cAsyatannimittAnyeva bhavanti / zukutvaGnakhanayanadazanavadanamUtrapurISazca puruSo bhavanti / ( suzruta ) 4. tatra yAni pramANavantyupacitAni kSNAni sparzasahAni zvetapANDupicchilAni stabdhAni gurUNi stimitAni suptasuptAni sthirazvayathUni kaNDUbahulAni pratatapiarazvetaraktapicchasrAvINi gurupicchilazvetamUtrapurISANi rUkSoSNopazayAni pravAhikAtimAtrotthAnavaGkSaNAnAhavanti parikartikA - hRlAsaniprIvikAkAsArocakapratizyAyagauravacchardimUtrakRcchrazoSazothapANDurogazItajvarAzmarIzarkarA hRdayendriyAsyopalepAsya mAdhurya pramehakarANi dIrghakAlAnuzayAnyatimAtramagnimArdavaklaibyakaraNyAma vikArapravalAni ca zukuna khanayanavadanatvaGmUtrapurISasya ileSmolbaNAnyarzAsIti vidyAt / ( caraka ) 5. dahyate ca gudo'tyarthaM gudapAkazca jAyate / kSeSmaleSvapi cArzassu picchilaM zukla saplavam // purISaM sakaphaM yAti stokaM stokaM savedanam / upaviSTazciraM cAste nisvanaM copavezyate // zIryate medUvRSaNaM vastizca guda eva ca / arucizcAvipAkazca na ca pakka viricyate // zvayathu vizatyainaM vizeSeNAkSikRTayoH / satat zleSmasamutthAnamarzasAM rUpamucyate // (mela) lagAtAra aura dera taka baiThe rahane se meDhU vRSaNa basti aura gudapradeza meM kaSTa hone se tathA anya zleSmakAraka kAraNa banane se kapholbaNa arza banate haiM / inakI AkRti karIra kI TeMTI yA kaTahala ke bIja yA phUle hue munakke ke samAna huA karatI hai / inakI mUla bar3I hotI hai, varNa meM ye zveta hote haiM U~ce uThe hue hAtha phirAne para cikane, gola, bhArI, sthira aura stabdhatA lie hue hote haiM / inakI utpatti ke samaya bhela kaM mata se gudapradeza meM atyadhika dAha hotA hai aura vaha paka jAtA hai / jo mala utaratA For Private and Personal Use Only

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1012 vikRtivijJAna hai vaha sapheda thor3A thor3A aura zUla ke sAtha utaratA hai| zleSmolSaNa arza ke masse sparzasaha hote haiM / picchila srAva se DhaMke rahate haiM ye supta se hote haiN| ye sthiratayA sUje hue hote haiN| inameM khujalI bahuta hotI hai| inase nirantara zveta ApIta (piJjaravarNa), zveta, yA raktavarNa kA picchA jharatA rahatA hai| vAgbhaTa ke mata meM na sravanti na bhidyante kA pATha hai ki inase raktAdika kucha bhI jharatA nahIM aura na ye phaTate haiM / toDara na sravanti se rakta kA na jharanA letA hai picchAsnAva ke sambandha meM virodha nahIM karatA / picchAsrAva suzruta aura caraka donoM svIkAra karate haiN| zarIra ke anya vibhinna lakSaNoM kI dRSTi se akSikUTa meM vizeSa zotha ( bhela), aruci, avipAka, (bhela), apakva malatyAga (bhela), pAyubasti nAbhi meM parivartikAvat zUla ( vAgbhaTa) vaMkSaNa meM AnAha (vAgbhaTa), viDbandha, toda, gatimandatA ( hArIta ) zvAsa, kAsa, hRllAsa, praseka, pInasa, mUtrakRcchU, ziraHzUla, zItajvara, klaibya, agnimAnya, chardi, AmajadoSa, parikartikA, niSThIvana, pratizyAya, gaurava, zopa, zotha, pANDuroga, azmarI, zarkarA, hRdayopalepa, indriyopalepa, mukhopalepa, mukhamAdhurya, prameha, Adi meM se koI sA yA kaI yA sabhI vikAra ho sakate haiN| mala meM vasAbha kapha kA jAnA ( vAgbhaTa) yA sazleSma bahuta mAtrA meM mAMsadhAvana sadRza mala kA AnA (suzruta ) athavA gurupicchila zveta varNa kA malamUtra pAyA jAnA (caraka) yaha bhI kaphArza kI vizeSatAoM meM se hI haiM / nakha, nayana, dazana, vadana mUtra purISAdi kA zveta varNayukta ho jAnA bhI isa roga meM pAyA jA sakatA hai| dvandvaja arza __hetulakSaNasaMsargAdvidyAdvandvolbaNAni ca / nidAna aura lakSaNoM ke mela se vAtapaittika, pittazlaiSmika athavA vAtazlaiSmika nAma dvandvaja arza bhI mila sakate haiN| mizritaM dvandvajaM jJeyam kahakara bhI inakA ullekha mAtra kiyA gayA hai| basavarAjIyakAra ne dvandvajArzoM ko yApya tathA kaSTasAdhya mAnA hai dvandvajaM yApyakaM caiva kRcchrasAdhyaM bhiSagvaraiH / suzrutasaMhitA meM yadyapi SaDAsi bhavanti vAtapittakaphazoNitasannipAtaiH sahajAni ceti / ke dvArA nidAnasthAna adhyAya 2 meM vAtika, paittika, zlaiSmika, raktaja, sannipAtaja aura sahaja ina 6 arza prakAroM kI gaNanA kI gaI hai parantu usI adhyAya meM dvandvaja arza ke sambandha meM itanA aura likhA gayA hai arzaH tu dRzyate rUpaM yadA doSadvayasya tu / saMsarga taM vijAnIyAt saMsargaH sa ca SaDvidhaH // ___ jaba arza do doSoM ke mela se banate haiM to usa mela ko doSasaMsarga mAnanA caahie| yaha doSasaMsarga 6 prakAra kA hotA hai| DalhaNAcArya ne ina 6 kA nAma nimnalikhita diyA hai1. vAtapaittika 2. vAtazlaiSmika 3. pittazlaiSmika 4. vAtaraktajanya 5. pittaraktajanya 6. kapharaktajanya For Private and Personal Use Only

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agni vaikArikI 1013 sAdhyAsAdhyatA kI dRSTi se suzruta ne bahuta spaSTa ghoSaNA kI hai dvandvajAni dvitIyAyAM valau yAnyAzritAni c| kRcchrasAdhyAni tAnyAhuH parisaMvatsarANi ca // ki dvitIyavali meM Azrita eka varSa purAne dvandvaja arza kRcchrasAdhya hote haiN| tridoSajArza ( sannipAtajArza) sannipAtajAni sarvadoSalakSaNayuktAni-suzruta saba doSoM ke lakSaNoM se yukta arza sannipAtaja arza hote haiM / caraka ne ___ sarvo hetustridoSANAM sahajairlakSaNaM samam / kaha kara sarva doSoM se utpanna tridoSaja arza ko mAnA hai tathA usake lakSaNa sahajAoM ke samAna jAnane ke lie spaSTa nirdeza kiyA hai| __madhukozavyAkhyAkAra ne trayo doSA janakatvenaiSAM santIti tridoSajAni / Adi likha kara phira eka vivAda kA samAdhAna kiyA hai| dvavyamekarasaM nAsti na rogopyekadoSajaH / yo'dhikastena nidezaH kriyate rasadoSayoH / ke dvArA rasa vA doSa kisake nAma se kisa padArtha ke rasa vA kisI roga ke doSa kA nAmasaMskAra kareM isakI ora lakSya kiyA gayA hai| caraka ne vAtapittazleSmA ina tInoM se hI nirmita saba zarIradhAriyoM ko batalAyA hai| isa vacana se yadyapi dhAsvAdi eka doSa se dUSita hone para bhI usa doSa ke andara vyApta anya donoM doSa bhI kucha na kucha duSTi karate hoNge| aura bhI apane kAraNa se varddhita vAta zaitya ke dvArA zleSmA ko tathA lAghava ke dvArA tejorUpa pitta ko uttejita karane kI zakti rakhatI hai| pitta kaTu hone se vAta, dravasvaguNa ke kAraNa zleSmA ko prakupita kara sakatA hai| kapha isI prakAra nijazItalatA se vAyu aura dravatva ke kAraNa pitta kA varddhana kara sakatA hai| ____ ataH na rogo'pyekadoSajaH kA siddhAnta prAyaH pramANita kiyA jA sakatA hai| isI se ekaH prakupito doSaH sarvAneva prakopayet kA dUsarA siddhAnta bhI puSTa hotA hai| para jaba apane-apane spaSTa kAraNoM se tInoM hI doSa prakupita ho gaye hoM to vahA~ tridoSajanya vyAdhi vizeSatayA abhilakSita hotI hai| caraka ne uparokta siddhAntoM kI puSTi karate hue nimnalikhita zloka likhA hai :arzAsi khalu jAyante naasnniptitaistribhiH| doSairdoSavizeSastu vizeSaH kalpyate'rzasAm / / jisakA Azaya yaha hai ki koI bhI arza vAta, pitta aura kapha ina tInoM ke asannipAta se utpanna nahIM hotaa| parantu jisa vizeSa doSa kI vizeSatA yA ulbaNatA hotI hai usI ke nAma se usakA nAmakaraNa kiyA jAtA hai| cakrapANi ne isI ko aura bhI spaSTa karate hue likhA hai__ yadyapi sannipatitairityukte trayANAM melako labhyate, tathApi tribhiriti padaM trayANAmapyatra anubandhtvasya tathA ca hiinpaadsyopdrshnaarthkH| doSavizeSAditi ulbaNarUpAdivizeSAt / vizeSa iti vAtajo'yaM ityAdiko vishessH| 1. sarvadehacarAstu vAtapittazleSmANaH / For Private and Personal Use Only

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1014 vikRtivijJAna raktArza (1) raktajAni nyagrodhaprarohavidrumakAkaNantikAphalasadRzAni pittalakSaNAni ca, yadA'vagADhapurISa (pravRtti ) pIDitAni bhavanti tadA'tyarthaM duSTamanalpamasRk sahasA visRjanti, tasya cAtipravRttau zoNitAtiyogopadravA bhavanti // (su0 ni0 sthA0 a0 2-13) (2) raktolbaNA gude kIlAH pittaakRtismnvitaaH| vaTaprarohasadRzA guaavidrumsnnibhaaH|| te'tyarthaM duSTamuSNaM ca gaaddhvittprtipiidditaaH| sravanti sahasA raktaM tasya cAtipravRttitaH / / bhekAbhaH pIDyate duHkhaiH shonnitkssysmbhvaiH| hInavarNabalotsAho hataujAH kalupendriyaH / / (a. ha. ni. sthA. a. 7) ( 3 ) ............."raktajAtaM tu pittotthArzaH plakSaprarohapratimamatha samaM coccaTAvidrumAbhyAm / bhekAbhaM pIDyate sasratibhiratitarAmuSNaviTakaH sakaSTaM vApi ghrANAsyaliGgeSvapi bhavati ca tadraktajaM raktavAhi // (vaidyacandrodaya) ( 4 ) raktolbaNagude kIlAH pittaakRtismnvitaaH| zRGgAyaiH zoNitasrAvo hyadhovAyurna gacchati // (bheSajakalpa ) Upara raktaja arzI ke sambandha meM kucha vAkya uddhRta kiye gaye haiM jo yaha spaSTa karate haiM ki raktaja arza pittaja arza ke hI samAna hote haiN| inakA raMga pilakhuna yA baragada kI koMpala, pravAla (ma~gA) athavA guJjAphala (rattI) ke samAna lAla hotA hai / ve kabja ke kAraNa kaThina mala ke dvArA pIDita kiye jAne para garma-garma kAlA (duSTa) rakta ekadama adhika mAtrA meM girA dete haiN| adhika rakta ke girate rahane ke kAraNa rogI meM raktakSaya bar3hane lagatA hai vaha meMDhaka sA pIlA par3a jAtA hai raktakSaya ke kAraNa vAyu kA prakopa adhika hone se use adhika pIr3A hotI hai aura vaha bala, varNa, utsAha se hIna, oja se hata aura durbala indriya ho jAtA hai| raktaja arza na kevala gudamArga meM hI banate haiM apitu nAsA, mukha, karNAdi sthaloM meM bhI bana sakate haiN| sIMgI dvArA inase sAdhAraNatayA bhI rakta kA srAva karAyA jA sakatA hai| raktajArza meM raktasrAva usI avasthA meM prAyaH dekhA jAtA hai jaba vAyu ke adhogamana meM rukAvaTa ho jAtI hai jo kabja meM prAyazaH dekhI jAtI hai| raktArza meM vAta aura kapha kA anubandha bhI ho sakatA hai| usake lakSaNa zAstra meM nimna diye gaye haiM: tatrAnubanyo dvividhaH zleSmaNo mArutasya ca / viTzyAvaM kaThinaM rUkSamadhovAyunaM vartate // tanu cAruNavarNaM ca phenilaM cAsRgarzasAm / kaTyarugudazUlaM ca daurbalyaM yadi cAdhikam // tatrAnubandho vAtasya heturyadi ca rUkSaNam / zithilaM zvetapItaJca vinigdhaM guruzItalam / / yadhazastaM dhanaM cosaka tantumat pANDupicchilam / gudaM sapicchaM stimitaM gurusnigdhe ca kAraNam / ileSmAnubandho vizeyastatra raktArzasAM budhaiH / / sahajArza pIche hamane tridoSajArza ko sahajArza ke tulya ThaharAyA hai| sahajArza kA vivecana vividha AcAryoM ne nimnalikhita zabdoM meM kiyA hai: (1) sahajAni duSTazoNitazukranimittAni, teSAM doSata eva prasAdhanaM karttavyaM, vizeSatazcaitAni durdarzanAni paruSANi pANDUni dAruNAnyantarmukhAni, tairupadrutaH kRzo'lpabhuk sirAsantatagAtro'lpaprajaH For Private and Personal Use Only

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1015 agni vaikArikI kSINaretAH kSAmasvaraH krodhano'lyAgnirghANaziro'kSizravaNarogavAn, satatamantrakUjATopahRdayopalepArocakaprabhRtibhiH pIDyate / ( suzruta ) (2) tatra sahajAnyarzAsi kAnicidaNUni kAnicinmahAnti kAniciddI;Ni kAniciddhasvAni kAnicivRttAni kAnicidviSamavistRtAni kAnicidantaHkuTilAni kAnicidvahiHkuTilAni kAnicijjaTilAni kAnicidantarmukhAni yathAsvaM doSAnubandhavarNAni / / tairupahato janmaprabhRti bhavatyatikRzo vivarNaH kSAmo dInaH pracuravivaddhavAtamUtrapurISaH zArI cAimarI vA tathA'niyatavibaddhamuktapakkAmazuSkabhinnavarcA antarAntarA zvetapANDuharitapItaraktAruNa tanusAndrapicchilakuNapagandhAmapurISopavezI nAbhibastivaMkSaNoddeze pracuraparikartikAnvitaH sagudazUlapravAhikApariharSapramohaprasaktaviSTambhAntrakUjodAvartahRdindriyopalepaH pracuravibaddhazuktAmlodgAraH sudurbalaH sudurbalAgniH krodhanaH svalpazukro duHkhopacAra zIlaH kAsazvAsatamakatRSNAhRllAsacchargharocakAvipAkapInasakSavathuparItastaimirikaH ziraHzUlI kSAmabhinnasaMsaktajarjarasvaraH karNarogo zUnapANipAdavadanAkSikUTaH sajvaraH sAGgamardaH sarvapasthizUlI cAntarAntarA pArthakukSibastihRdayapRSThatrikagrahopataptaH pradhmAnaparaH paramalazceti // janmaprabhRtyasya hi gudamArgoparodhAd vAyurapAnaH pratyArohan samAnodAnaprANavyAnapittazleSmadoSAn prakopayati / ete sarve eva kupitAH paJcavAyavaH pittazleSmANau cArzasam abhidravantastAn vikArAn janayanti / ityuktAni sahajAnyarzAsi // ( caraka ) (3) sahajAni vizeSeNa rUkSadurdarzanAni ca / antarmukhAni pANDUni dAruNopadravANi ca / / (a. hR.) sahaja arza mAtA ke duSTa rakta athavA pitA ke duSTa zukra ke kAraNa utpanna hote haiN| inakA vargIkaraNa doSAnusAra hI karanA caahie| yathA-vAtika sahajArza, paittika sahajArza, zlaiSmika sahajArza Adi janmottarakAlIna arthoM kI apekSA sahajArza dekhane meM kurUpa, paruSa, pANDavIya, dAruNa, antarmukhI, koI itanA choTA jaise aNu, koI bar3A, koI dIrgha, koI hasva, koI gola, koI viSamatayA phaile hue, kucha andara se kuTila, kucha bAhara se kuTila, koI jaTila aura apane-apane doSa ke anusAra varNavAle yathA vAyu se kRSNAruNa, pitta se nIlAbha yA pItAbha tathA zleSmA se zveta hote haiN| vAgbhaTa ne sahajAoM ko vizeSa rUpa se rUkSa mAnA hai tathA dAruNa upadravoM se yukta likhakara chor3a diyA hai| caraka ne ina upadravoM kA sAGgopAGga citraNa kiyA hai| suzruta ne sahajArzI ko kRza, thor3A khAnevAlA, zarIra para sirAoM kA prakaTa honA, thor3A santAnavAlA, kSINavIrya, durbalasvara, krodhI, agnimAnya se pIr3ita, nAsA, A~kha, kAna aura zirorogoM se pIr3ita jisakI A~toM meM barAbara kUjana hotA rahatA hai, jo ATopa, hRdayopalepa, aruci Adi se pIr3ita aisA svIkAra kiyA hai| caraka ne sahajArzI para eka pUrA nibandha likhA hai| usane sabhI pahaluoM ko sAGgopAGga citrita kiyA hai / usake anusAra eka sahaja arza se pIr3ita rogI: 1. atyantakRza hotA hai usakI mAMsapeziyA~ apuSTa hotI haiN| 2. usakA varNa camakadAra nahIM hotaa| 3. vaha kSINa aura dIna hotA hai| 4. vaha vAta, mUtra aura mala pracuramAtrA meM aura vibaddha rUpa meM utsarjita karatA hai / For Private and Personal Use Only

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1016 vikRtivijJAna 5. usake mUtra meM zarkarA A sakatI hai aura vaha azmarI se bhI pIr3ita ho sakatA 1 6. use aniyata samaya para, ba~dhA huA yA patalA, pakA yA kaccA, sUkhA yA phaTA-phaTA mala tyAga hotA hai / 7. bIca-bIca meM usake mala kA varNa zveta, pANDura, harA, pIlA, lAla yA aruNa inameM se koI bhI ho jA sakatA hai / mala patalA, gAr3hA, cipacipA athavA kuNapa ( zava ) gandhavAlA bhI ho sakatA hai / 8. usake nAbhipradeza meM, basti meM athavA vaMkSaNapradeza meM kATane jaisI pIr3A mila sakatI hai / 9. gudapradeza meM zUla kA honA, pravAhikA, romaharSa, moha, viSTambha kA nirantara rahanA, AntrakUjana, udAvarta aura hRdaya tathA indriyoM meM kriyAzIlatA kI kamI ye lakSaNa bahudhA thor3e yA bahuta, saba yA kucha barAbara milA karate haiM / 10. bahuta ruke hue se ( vibaddha ) tikta vA zukta jaisI khaTTI DakAroM kA AnA bhI pAyA jAyA karatA hai / 11. rogI prAyaH durbala hotA hai / usakI agni manda hone ke kAraNa bahuta kama padArtha khAtA vA pacAne meM samartha hotA hai / durbalatA kA pratyakSa pariNAma svabhAva ke cir3acir3e hone meM hotA hai tathA mana meM atyanta dukha kA anubhava karatA rahatA hai / 12. khAMsI tamaka zvAsa ( damA ), pyAsa, matalI AnA, vamana honA, aruci, avipAka, chIMka AnA, jukAma jaldI jaldI honA athavA timira roga kA honA aura use turata turata sira darda se pIDita honA ye lakSaNa bhI milA karate haiM / 13. usakA svara kSINa, phaTA phaTA, rukA rukA sA aura jarjarita hotA hai / 14. kAna meM bhI usake roga mila sakatA hai / 15. usake hAtha, paira, mukha akSikUTa sUje hue mila sakate haiM / 16. use jvara banA raha sakatA hai / 17. aGgamarda honA, asthiyoM ke sabhI parvoM meM zUla kA anubhava karanA, tathA bIca bIca meM pArzvakukSi, basti, hRdaya, pRSTha, trika kA jakar3a jAnA yA garma ho jAnA bhI dekhA jAtA hai / 18. vaha dhyAnamagna yA cintAzIla aura AlasI hotA hai / uparyukta lakSaNoM meM se bahuta se sahajaphiraMgI mAtA pitA se utpanna hue bAlakoM meM phiraMgaja arza ( condylomata ) ke sAtha pAye jA sakate haiN| ho sakatA hai Atreya bhagavAn ne phiraMga pIDita sahajArzI kA hI isa prakAra citraNa kiyA ho / sahajArzI kI samprApti bahuta hI saralarUpa meM carakAcArya ne likha dI hai unakA kathana hai ki janma se hI arza se pIDita hone ke kAraNa apAnavAyu adhomArgagAmI na hokara pratyArohaNa ( Urdhvagamana) karane lagatI hai / isa apAnavAyujanya vikRti kA For Private and Personal Use Only

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agni vaikArikI 1017 pariNAma zeSa cAroM bAtoM tathA donoM doSoM para bhI par3atA hai jisake kAraNa samAnodAnaprANavyAnapittazleSmadoSa kupita ho jAte haiN| inake kopa ke kAraNa hI Upara likhe 18 paricchedoM meM prakaTa upadravoM ko utpanna karane meM ve samartha hote haiN| arza kA sthAna (1) sarveSAM cArzasA kSetraM-gudasyArdhapaJcamAGgule'vakAze tribhAgAntarAstisro gudavalayaH, kSetramiti dezaH / kecitta bhUyAMsameva dezamupadizantyazaMsAM ziznamapatyapathaM galamukhanAsikAkarNAkSivAni tvak ca / tadastyadhimAMsadezatayA gudavalijAnAM tvarzAsIti saMjJA tantre'smin / (caraka ) (2) tatra sthUlAntraprativaddhamardhapaJcAGgulaM gudamAhuH, tasmin valayastisro'dhyardhAkulAntarasambhUtAH pravAhaNI visarjanI saMvaraNI ceti // caturaGgulAyatAH srvaastirygekaanggulocchritaaH| zaGkhAvartanibhAzcApi uparyupari sNsthitaaH|| gajatAlunibhAzcApi varNataH samprakIrtitAH / romAntebhyo yavAdhya? gudauSThaH parikIrtitaH // prathamA tu gudauSThAdaGgulamAtre / / (suzruta) sabhI azoM kA kSetra guda ke nicale 4 // aGgula meM samAnAntara para rakhI huI pravAhaNI, visarjanI tathA saMvaraNI nAmaka 3 gudavar3iyA~ haiN| sthUlAntra kA sabase nicalA dvAra guda kahalAtA hai| isa guda meM 1 // -1 // aGgula ke antara se eka eka bali rakhI huI hai| pratyeka bali kI lambAI tirachI 4 aGgula hai pratyeka kI U~cAI 1 aGgula pramANa hai| tInoM valiyA~ eka dUsare ke Upara zaGkhAvarta yA peca ke samAna rakhI huI haiM / inakA varNa gajatAlu ke samAna lAla hotA hai| guda ke kinAre jahA~ bAla yA roma hote haiM vahA~ ( romAnta ) se 13 yava bhItara kI ora guda ke mukha ko gudauSTha kahA jAtA hai / isa gudauSTha se 1 aGgula Upara prathama vali hotI hai| valiyoM meM sabase nIce saMvaraNI hotI hai| usake Upara 13 aGgula dUra visarjanI aura usake 13 aGgula Upara pravAhaNI tRtIya gudavali hotI hai| gudauSTha se 1 aGgula para prathama 13 aGgula para dvitIya aura 13 hI aGgula para tRtIya vali hone se tInoM valiyA~ 4 aGgula ke bhItara hI A par3atI haiM / yahI 4 aGgula arthotpAdaka kSetra yA sthAna jAnanA caahie| isI kAraNa arzIyantra kI lambAI 4 aGgula kI kahI gaI hai| __ arzasAM gostanAkAraM yantrakaM caturaGgulam / ( a. hR.) DA0 ghANekara kA kathana hai-yahA~ guda kA jo varNana milatA hai vaha Adhunika zArIra varNana ke sAtha ThIka ThIka milatA hai / isa cAra aGgula ke sthAna meM jo sirAe~ hotI haiM ve racanA vizeSatA ke kAraNa vikRta ho jAtI haiM aura arza utpanna hotA hai| __carakasaMhitA meM jaisA ki Upara varNita hai kaI anya vidvAnoM ke matoM kA ullekha karake guda ke atirikta zizna, yoni, galA, mukha, nAsA, kAna, A~khoM ke palaka aura svacA ko bhI arza sthAnasvIkAra kiyA gayA hai| suzruta ne ina sthAnoM para hone vAle jina arzI kA varNana kiyA hai vaha karkaTArbudotpatti kI ora AyurvedIya vicAra ko jitanA prakaTa karatA hai arza kI ora nahIM / sambhavataH karkaTa se nikalane vAle raktasrAva ko dekha kara unheM raktaja arza kA sandeha huA ho / nIce hama suzrutokta gudetarakSetrIya For Private and Personal Use Only

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1018 vikRtivijJAna arthotpatti ( hamAre zabdoM meM karkaTotpatti) ko avikala rUpa meM utkRta kie dete haiM : prakupitAstu doSA mer3hamabhiprapannA mAMsazoNite pradUSya kaNDUjanayanti, tataH kaNDUyanAt kSata samupajAyate, tasmiMzca kSate duSTamAMsajAH prarohAH picchilarucirasrAviNo jAyante kUrcakino'bhyantaramupariSTAdvA, te tu zepho vinAzayantyupadhnanti ca puMstvaM, yonimabhiprapannAH sukumArAn durgandhAn picchilarudhirasrAviNazchatrAkArAn karIrAjanayanti te tu yonimupanantyAvazca / nAbhimabhiprapannA sukumArAn durgandhAn picchilAn gaNDapadamukhasadRzAn karIrAn janayanti ta evordhvamAgatAH zrotrAkSighrANavadaneSvarzAsyupanivartayanti; tatra karNajeSu bAdhiya zUlaM pUtikarNatA ca, netrajeSu vavirodho vedanAsrAvo darzananAzazca, ghrANajepu pratizyAyo'timAtraM kSavathuH kRcyocchavA satA pUtinasyaM sAnunAsikavAkyatvaM ziroduHkhaM ca, vaktrajeSu kaNThoSThatAlUnAmanyatamasmistairgadgada vAkyatA rasAzAnaM mukharogAzca bhavanti / ___ vyAnastu prakupitaH ileSmANaM parigRhya bahiH sthirANi kIlavadarzAsi nivartayati tAni carmakIlAnyAsItyAcakSate / saMkSepa meM prakupita doSa zizna ke mAMsa aura rakta meM khujalI karate haiM khujalAne se tata banatA hai kSata se praroha banate haiM jinase cipacipA rakta nikalatA hai| praroha kUrcakavat bana jAte haiM jo zizna ko naSTa kara vyakti ko napuMsaka banA dete haiN| yoni meM chatraka ke samAna (karkaTArbuda kA svarUpa bhI chatraka jaisA hotA hai) rudhira srAvI karIra vA aGkara banate haiM ve yoni kA vinAza kara dete haiN| nAbhi ke karIra gaNDUpada mukha sadRza hote haiN| kAna, netra, nAsA aura mukha meM utpanna hue karIra tattat sthAna se sambaddha vAdhirya, karNazUla, pUtikarNa, varmAvarodha, netrazUla, srAva, dRSTinAza, pratizyAya, kSavathu Adhikya kRcchrocAsatA, pUtinasya, gadgadavAkyatA, rasAjJAnAdi vikAroM kA utpAdana karate haiN| vyAnavAyu sarva zarIra meM vicaraNa karane vAlA hone se kaphadoSa ke sAtha milakara tvacA para carmakIla taiyAra karatA hai| kahane kA tAtparya yaha ki arza ke sthAna guda aura guda valitraya to mukhyatayA hai hI suzruta vidyAlaya ke mAnane vAle gudetara karNanAsAziznayonyAdi aMgoM meM bhI arthotpatti svIkAra karate haiN| sAdhyAsAdhyatA kI dRSTi se vicAra karane para jo arza nicalI yA bAhya do valiyoM meM hote haiM ve sAdhya mAne jAte haiM / bhItarI vali (pravAhaNI vali ) meM hone vAlA arza asAdhya batalAyA gayA hai ataHbAhyamadhyavalisthAnAM pratikuryAdbhiSagvaraH / antarvalisamutthAnAM pratyAkhyAyAcaret kriyAm // ( suzruta) aura bhii| bAhyAyAM tu valau jAtAnyekadoSolbaNAni ca / asi sukhasAdhyAni na cirotpatitAni ca / / dvandvajAni dvitIyAyAM valau yAnyAzritAni ca / kRcchrasAdhyAni tAnyAhuH parisaMvatsarANi ca // sahajAni tridoSANi yAni cAbhyantarAM vlim| jAyante'rzAsi saMzritya tAnyasAdhyAni nirdizet / / (caraka) For Private and Personal Use Only

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ani vaikArikI arza samprApti paJcAtmA mArutaH pittaM kapho gudavalitrayam / sarva eva prakupyanti gudajAnAM samudbhave // 1016 ( ca. ci. sthA a. 14-55 ) arzotpattikAla meM prANodAnasamAnavyAnAdAnapaJcAtmaka vAtadoSa, pAcakara akasAdhakAlo cakabhrAjaka paJcAtmaka pittadoSa, kledakAvalambaka bodha katarpakazleSaka paJcAtmaka kaphadoSa aura guda kI saMvaraNI, visarjanI aura pravAhaNI tInoM valiyA~ ye sabhI prakupita hote haiM / isI ke kAraNa arza atyanta kaSTadAyaka, aneka vyAdhiyoM ke karane vAle sampUrNa zarIra ko upatapta karane vAle aura kaSTasAdhyoM meM sarvAdhika kaSTakAraka mAne jAte haiM / guruzItAbhiSyandividAhiviruddhAjIrNapramitAsAtmya bhojana karane se, atisneha pAna vA asaMzodhana se, vastikarmavibhrama se, avyAyAma, ativyavAya divAsvama, sukhAsanAdi se, vegoM ke dhAraNa se, mala yA garbha kA dabAva par3ane se bahu viSama prasUtiyoM se, guda meM kSata hone se tathA anya zAstravihita kAraNoM se jaba apAnavAyu adhogata saJcita mala ko guda valitraya meM dhAraNa karatA hai taba arza utpanna hotA hai prakupito vAyurapAnasthamalamupacitamadhogamAsAdya gudavaliSvAdhatte, tatastu tAsvarzAMsi prAdurbhavanti / isI ko vAgbhaTa ne apanI lalita vANI meM nimna zabdoM meM vyakta kiyA hai:doSaprakopa hetustu prAguktastena sAdite / agnau, male'tinicite, punazcAtivyavAyataH // yAnasaMkSobhaviSamakaThinotkaTakAsanAt / vastinetrAzmaloSThovatalacailAdighaTTanAt // bhRzaM zItAmbusaMsparzAtpratatAtipravAhaNAt / vAtamUtrazakRdvegadhAraNAntadudIraNAt // jvaragulmAtisArAmagrahaNIzophapANDubhiH / karzanAdviSamAbhyazca ceSTAbhyo yoSitAM punaH // AmagarbhaprapatanAdgarbhaMvRddhiprapIDanAt / IdRzaizcApare vayurapAnaH kupito malam // pAyorvISu taM dhatte tAsvabhiSaNNamartiSu / jAyante'rzAsi 11 arzoM kA vargIkaraNa arzoM ke sambandha meM yadyapi pIche paryApta likhA jA cukA hai para isake vargIkaraNa ke kaI rUpa pAThakoM ke samakSa nahIM A sake / For Private and Personal Use Only vAtale molvaNAnyAhuH zuSkANyarzAsi tadvidaH / prasrAvINi tathA''rdrANi raktapittolvaNAni ca // vAtika aura zlaiSmika arza zuSkArza kahalAte haiM kyoM ki unase kisI bhI prakAra kA strAva nahIM hotA tathA raktaja athavA pittaja arza ArdrArza kahalAte haiM kyoMki eka se rakta kA aura dUsare se tanupItaraktasrAva hotA rahatA hai I arza kA eka vargIkaraNa sahaja aura janmottara do anya rUpoM se bhI kiyA jAtA hai / sahaja arza kI utpatti meM bhI 2 kAraNa haiM- -eka mAtA pitA kA apacAra aura dUsarA pUrvakRta karma / janmottarakAlIna arza ke doSAnusAra vAtika, paittika, zlaiSmika, dvandvaja, sannipAta raktaja Adi rUpa hote haiM / sahaja arza meM bhI ye bheda mila sakate haiM para vaha

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1020 vikRtivijJAna sannipAtaja, janmottara arza se adhika sAdRzya rakhatA hai / raktaja arza meM bhI vAtika, paittika Adi doSaja rUpa mila sakate haiN| usake 6 prakAra hama pIche de cuke haiN| Acharya Shri Kailassagarsuri Gyanmandir arzAdi meM agnibala kA mahattva trayovikArAH prAyeNa ye parasparahetavaH / arzAsi cAtisArazca grahaNIdoSa eva ca // eSAmagnibale hIne vRddhivRddhe parikSayaH / tasmAdagnibalaM rakSyameSu triSu vizeSataH || caraka ke uparyukta donoM sUtra atyanta mahatvapUrNa haiM jaba Adhurika risarcara adhika gaveSaNA karegA to use kAlAntara meM arza, atisAra aura grahaNI ina tInoM rogoM ke eka dUsare ko utpanna karane kI sAmarthya kA jJAna hogaa| tInoM hI zarIrastha pAcakAgni ke hIna hone se bar3hate aura vRddhiMgata hone se naSTa ho jAte haiM ataH ina tInoM rogoM meM agni bala kI rakSA karane kI vizeSa AvazyakatA hai / yahI kAraNa hai ki AyurvedajJoM ne arza, atIsAra vA grahaNI roga nAzaka jo bhI cikitsA likhI hai usameM agnisandIpaka padArthoM ke upayoga kI ora satarka hokara iGgita kiyA hai / pathya kA sUtra arza rogI ko batalAte samaya hI caraka isa mahattvapUrNa bhAva ko vyakta karane se cUke nahIM haiMyadvAyorAnulomyAya yadagnibalavRddhaye / annapAnauSadhaM dravyaM tatsevyaM nityamarzasaiH // Musex For Private and Personal Use Only

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caturdaza adhyAya rogApaharaNasAmarthya Ayurveda meM jo aGga rasAyanatantra kahalAtA hai usakA aura rogapratIkAritA ( Immunity )kA pUrA-pUrA sAmaJjasya hotA hai| AcAryoM ne rasAyanatantra kA artha batalAte hue likhA hai rasAyanatantraM nAma vayaHsthApanamAyudhAbalakaraM rogApaharaNasamarthaM ca / arthAt jisa zAstra ke dvArA Ayu kI sthApanA, buddhi kI tIvratA, bala kI vRddhi tathA rogoM ke apaharaNa kI sAmarthya AtI hai vaha rasAyanatantra kahalAtA hai| Ajakala rasAyanatantra meM kucha balavarddhaka yogoM kA varNana AtA hai parantu rogApaharaNasAmarthya nAmaka jisa sadguNa kA nAmollekha kiyA gayA hai vaha zarIra meM hI nihita hotA hai use vividha AyuSya aura medhya dravyoM ke prayoga se bar3hAyA jA sakatA hai tathA usakI bar3hotarI aneka sadvyavahAroM ke dvArA bhI kI jAtI hai jinheM AcAryoM ne AcArarasAyana nAma se saMbodhita kiyA hai| nIce hama AcArarasAyana ke sambandhI sUtroM kA ullekha kareMge aura unase yaha spaSTatayA dekha sakeMge ki yadi manuSya unakA vidhivat sevana kare aura apanA vyavahAra yogya banAve to vividha upasargoM se zarIra kI rakSA karanevAlI vijayavAhinI zakti jise kSamatA yA pratIkAritA kahate haiM, kA udaya hokara vyakti zataJjIvI banAyA jA sakatA hai|praaciin zAstrakAroM ne kSamatA ke vibhinna bhedoM kA pRthakkaraNa karake unakA adhyayana nahIM kiyA isIlie kSamatA vA rogApaharaNasAmarthya ke bheda, unake bar3hAne aura ghaTAne ke prakAra tathA vividha rogoM ke jIvANuoM para kSamatA ke camatkAroM kA varNana nahIM kiyaa| yaha bhI vismaraNa na karanA cAhie ki kSamatA zarIra meM nihita rogakara hetuoM se pratirodha karane vAlI eka zakti hai tathA rasAyana usa zakti ko vRddhiMgata karane ke sAdhanoM kA nAma hai| 'yajjarAvyAdhividhvaMsi bheSajaM tad rasAyanam' arthAt jo jarA (vRddhatva ) aura vyAdhi (roga) kA vidhvaMsa kara sakatI hai usa bheSaja kA nAma rasAyana hai|bhessj kA artha rogApanayana ke lie cikitsakoM dvArA prayukta jo bhI ho vaha saba hotA hai| yaha bheSaja 2 prakAra kI kahI gaI hai-eka svasthasyaujaskara (jo oja Adi kI vRddhi karake svAsthya kA saMrakSaNa kare ) tathA dUsarI-Artasya roganut (jo rugNa ke roga kA nAza kare) ataH rasAyana se 'svasthasyaujaskara' tathA Artasya roganut' nAmaka oSadhiyoM vA kriyAoM kA grahaNa kiyA jAtA hai jo jarAvyAdhi ko naSTa kara vyakti ko pUrNAyu kara sakeM / svasthasyaujaskara bheSaja vA zakti ko prAkRtika For Private and Personal Use Only

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1022 vikRtivijJAna kSamatA ( natural immunity ) kahA jAtA hai / tathA bharttasya roganut bheSaja vA zakti ko kRtrima yA kSamatA ( acquired immunity ) kahate haiM / rasAyana ke dvArA hone vAle lAbhoM ko AcArya caraka ne nimna sUtroM dvArA vyakta kiyA hai : :-- dIrghamAyuH smRti medhAmArogyaM taruNaM vayaH / prabhAvarNasvaraudAryadehendriyabalaM param // vAksiddhiM prati kAnti labhate nA rasAyanAt / lAbhopAyo hi zastAnAM rasAdInAM rasAyanam // AcAra rasAyana ke sambandha meM caraka ke nimna sUtra smaraNa rakhane hoMgesatyavAdinamakrodhaM nivRttaM madyamaithunAt / ahiMsakamanAyAsaM prazAntaM priyavAdinam // japazaucaparaM dhIraM dAnanityaM tapasvinam / devagobrAhmaNAcAryaguruvRddhArcane ratam // AnRzaMsyaparaM nityaM nityaM kAruNya vedinam / samajAgaraNasvapnaM nityaM kSIraghRtAzinam // dezakAlapramANajJaM yuktijJamanahaGkRtam / zastAcAramasaGkIrNamadhyAtmapravalendriyam // upAsitAraM vRddhAnAmAstikAnAM jitAtmanAm / dharmazAstraparaM vidyAnnaraM nityarasAyanam // guNairetaiH samuditaiH prayuGkte yo rasAyanam / rasAyanaguNAn sarvAn yathoktAn sa samaznute // arthAt satyavAdI, krodharahita, madya aura maithuna na sevana karane vAlA, mana-vacana-karma se ahiMsaka, adhika AyAsa ( zrama ) na karane vAlA, zAntacitta, priyabhASI, japa karane vAlA, zauca ( pavitratA ) rakhane vAlA, dhairyavAn, nitya dAna karane vAlA, tapasvI, devagobrAhmaNAcArya aura guru kI arcanA karane vAlA, krUratArahita, nitya dayAdRSTi rakhane vAlA, nidrA aura jAgaraNa sama vA yukta mAtrA meM sevana karane vAlA, nitya dugdha aura ghRta sevana karane vAlA, deza-kAla aura pramANa kA jJAtA, yuktijJa, anahaGkArI, sadAcArI, udAra, adhyAtma meM indriya jisakI pravRtta hoM, vRddha-Astika-jitAtmAoM kA upAsaka, dharmazAstra ke anusAra AcaraNa rakhanevAle vyakti ko rasAyanasevI hI jAnanA cAhie / ukta AcAra rasAyana ke guNa spaSTatayA yaha udghoSita karate haiM ki uttama prakAra se jIvanacaryA rakhane se zarIra meM kSamatAzakti bar3ha kara use na kevala nIroga kintu dIrghajIvI bhI banA detI hai / prAcInakAla meM kyoMki janatA ina guNoM kA adhika se adhika pAlana karatI thI isI kAraNa isa kSamatAzakti ke viSaya meM pRthaka se UhApoha karane kI AvazyakatA nahIM thI / jaise kisI eka roga kI sarala cikitsA jJAta ho jisase vaha turata zAnta ho jAtA hai to phira bahuta adhika vistAra se use jAnane kI AvazyakatA nahIM rahatI / jaba usakI cikitsA kaThina hotI hai to phira usakA nidAna, pUrvarUpa, rUpa, samprApti, upazayAdi ke jJAna kI AvazyakatA par3atI hai / aba cU~ki vyaktiyoM kA dRSTikoNa badala gayA hai aura ukta guNoM meM se ekAdha bhI kahIM kahIM dRSTigocara hotA hai / isa rogApaharaNa sAmarthya yA kSamatAzakti ke sambandha meM adhika se adhika jJAna prApta karane kI AvazyakatA bhI pratIta huI hai / kSamatA ke do prakAra kSamatA do prakAra kI hotI hai| eka ko prAkRtakSamatA (natural immuinty) kahate haiM tathA dUsarI ko avAptakSamatA ( acuired immuinty ) kahA jAtA hai / Age inakA varNana kiyA jAtA hai : : For Private and Personal Use Only

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rogApaharaNasAmarthya prAkRtakSamatA prAkRtakSamatA Abhyantarazakti kA nAma hai / yaha eka prakAra kI ucca pratirodhAtmaka zakti hai jo kisI prajAti ( race ) yA vyakti (individual) yA jAti (species) meM svataH hI pAI jAtI hai / kucha jAtiyoM ke prANiyoM meM eka roga nahIM hotA para dUsarI jAtiyoM meM milatA hai| prathama jAtiyoM meM usa roga ke prati kSamatA hai parantu dvitIya jAtiyA~ una rogoM ko grahaNa karatI haiM / udAharaNa ke lie rAjayakSmA zUkara- vassoM aura gAryo, meM to hotI hai para Avi, ajA, azva aura gardabhoM meM prAyaH rAjayakSmA nahIM pAI jAtI / jAtiyoM ko yakSmA - grAhya ( susceptible to tuberculosis ) tathA itara jAtiyoM ko yacmAkSama ( Immune to tuberculosis ) kahA jAtA hai / prathama kucha mAnavIya prajAtiyA~ ( human races ) kucha rogoM ke lie tama hotI haiN| udAharaNa ke lie nigrA pItajvara ke lie kSama hote haiM parantu zvetaprajAtiyA~ pItajvara grAhya hotI haiM / 1023 isI prakAra kucha vyakti vizeSa kisI eka roga ke lie kSama aura kucha grAhya hote haiM / katipaya baMgAlIjana viSamajvara ke lie jitane kSama hote haiM utane vahAM para pravAsa karane vAle itarapradezIyajana nahIM / For Private and Personal Use Only avAptakSamatA avAkSamatA do prakAra kI hotI hai| inameM eka saceSTa avAptakSamatA ( active acquired immunity ) tathA dUsarI nizceSTa kSamatA ( passive acuqired inmmunity ) kahalAtI hai / saceSTa avAptakSamatA --- yadi kisI vyakti ko eka bAra phuphphusapAka (nyUmoniyA) ho jAve to Age bhI use jitane bAra roga kA saMkramaNa hogA, phuphphusapAka ho sakatA hai / parantu yadi usI vyakti ko eka bAra masUrikA ho jAve to phira jIvana meM dUsarI bAra masUrikA se pIDita hone kA use avasara nahIM AvegA / usa udAharaNa se usa vyakti meM masUrikA ke lie avAptakSamatA kA udaya huA aisA kahA jAyagA / pratyakSa roga ke kAraNa vA roga ke kucha jIvANuoM kA zarIra meM praveza karake usa roga ke prati jo pratirodhAtmaka zakti zarIra meM utpanna ho jAtI hai yA kI jAtI hai vaha saceSTa avAtakSamatA kahalAtI hai / masUrIkaraNa ( vaccination ) dvArA masUrikA ke viSANu at faSTa karake bAlakoM meM jisa avAptakSamatA ko utpanna kiyA jAtA hai vaha bhI saceSTa avAtakSamatA hI hai / vidvAnoM kA kathana hai ki vayaskoM kI adhikAMza prAkRta kSamatA vAstava meM eka prakAra kI saceSTa avAptakSamatA hI hai kyoMki roga ke vividha jIvANu alpAlpa mAtrA meM acenatA meM ( unconsciously ) manuSya meM praveza karate rahate haiM / roga ke jIvANu ananta haiM, unase bacanA sambhava nahIM hotA ataH zarIra ke vividha koSAoM para mukha, nAsA, netra, guda, upastha, tvacA, zvAsa Adi dvArA unakA AghAta hotA rahatA hai / zarIra ke kozA unase paricaya kara unakA pratirodha karane kI kSamatA

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1024 vikRtivijJAna sahaja hI utpanna kara lete haiN| isakA eka prasiddha udAharaNa rAjayakSmA kA hai / yakSmA kA jIvANu pratyeka bAlaka ko 2-3 varSa kI avasthA meM hI grasa letA hai parantu usakI pratirodhakazakti ( pratIkAritA) itanI unnata rahatI hai ki bAlyAvasthA se lekara AjIvana yakSmA usakA kucha bhI nahIM bigAr3a paatii| jaba kinhIM hetuvizeSa ke kAraNa yaha zakti naSTa ho jAtI hai taba roga kA AkramaNa hotA hai / manuSya jIvana ke prathama varSa meM hI aneka rogoM ke AkramaNa hote haiN| roga ke jIvANu sajIva vA mRta zarIrastha dhAtuoM meM praviSTa hote hI zarIra ke dvArA mAre jAte haiM aura unake viruddha prativiSa yA kSamatA taiyAra ho jAtI hai / rohiNI ( diphtheria ) kA roga prathama varSa ke bAlakoM meM 90 pratizata taka dekhA jAtA hai| jabaki vayaskoM meM vaha 12 pratizata se adhika nahIM hotA / yaha udAharaNa hI ukta tathya ko puSTa karane ke lie paryApta hai / saMkSepataH saceSTa avAptakSamatA vaha pratirodhaka zakti hai jo kisI roga ke dvArA prANI ke grasita hone athavA roga ke jIvANuoM kI masUrI ( vaccine ) kA TIkA lagAne ke pazcAt hue roga ke lakSaNoM para saphalatApUrvaka vijaya prApta kara lene ke uparAnta usa prANI meM raha jAtI hai jisake kAraNa dUsarI bAra yadi usI roga kA AkramaNa ho to vaha prANI usa roga se pIr3ita na ho yA yadi pIr3ita bhI ho to usakA pariNAma koI vizeSa na ho / yaha saceSTakSamatA pratyeka roga meM vibhinna samaya taka rahane vAlI hotI hai / nizceSTa avAptakSamatA - nizceSTa avAptakSamatA kI prApti garbha ko aparA dvArA gaye mAtA ke rakta meM upasthita padArthoM se yA mAtA ke dugdha meM upasthita padArthoM dvArA stanapAyI zizu ko hotI hai / yahI kAraNa hai ki navajAta zizu rohiNI ke lie kSama hotA hai / ye vidhiyA~ prAkRtika vidhiyA~ haiM jinake dvArA nizceSTa avAptakSamatA prApta karAI jA sakatI hai / anya vidhiyA~ kRtrima hotI haiM parantu ye bahuta mahattvapUrNa haiN| yadi kisI prANI ke zarIra meM vizeSa jIvANu yA usakA viSa praviSTa kara diyA jAve to usake rakta meM sakriya avAtakSamatA A jAtI hai / phira usa viSa vA jIvANu se kSama rakta kI lasIkA ( serum ) ko lekara usakA sUcIvedha manuSya meM kara diyA jAve to manuSya ke zarIra meM usa jIvANu vA viSa ko naSTa karane vAle tatva praviSTa hokara ukta roga vA viSa ke AkramaNa se usakI rakSA kara lete haiM / isa paddhati ko nizceSTa vAtakSamatA ( passive acquired immunity ) prApti kI paddhati kahate haiM / yadi koI manuSya kisI eka roga se pIr3ita hokara punaH aura yadi usake zarIra meM saceSTakSamatA kA nirmANa usa roga ke prati ho cukA ho to jaba koI dUsarA rogI usI roga meM grasta ho jAve to isa svastha vyakti kI lasIkA ko antarvedha dvArA pahu~cA dene se bhI nizceSTakSamatA yA nizceSTa avApta kSamatA utpanna kI jA sakatI hai| rakSAtmaka padArtha jitanI mAtrA meM rogI ke zarIra meM jAte haiM rogI kI usa roga ke prati rogApaharaNasAmarthya bhI usI anupAta meM hotI hai| isakA artha yaha hai ki rogI kI dhAtue~ rogapratIkAraka padArthoM ko utpanna karane meM isa kAla meM nizceSTa vA akarmaNya rahatI haiM / isI se yaha nAma isa kSamatA ko diyA jAtA hai / svAsthya lAbha kara cukA ho For Private and Personal Use Only

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rogApaharaNasAmarthya 1025 tIvra saMkrAmaka avasthAoM meM nizceSTakSamatA (passive immunisation ) kI AvazyakatA par3atI hai| kyoMki isa avasthA meM rogI svayaM prArambhika rogApahAraka padArthoM ke nirmANa meM samartha nahIM hotA hai kyoMki rogakArI jIvANu use vaisA karane meM asamartha banA dete haiM / isa prakAra prApta nizceSTa avAptakSamatA alpakAlika hotI hai kintu to bhI yaha upasarga kI vibhISikA ko manda karatI hai tathA roga ke ugrasvarUpa ko saumya banA detI hai| kisI bhI prakAra kI kSamatA ho pratyeka roga ke lie viziSTa prakAra kI (specific to each disease ) nizcita hotI hai| yahI kAraNa hai ki jaba eka roga vyakti ko ho jAtA hai to use dUra karane ke lie usameM saceSTa kSamatA kA nirmANa ho jAtA hai parantu vaha kSamatA usI roga ke lie nizcita hai kyoMki usa roga ke pazcAt dUsarA roga ho sakatA hai aura usake lie alaga se kSamatA utpanna hotI hai| isI prakAra kRtrima kSamatA bhI unhIM jIvANuoM ke prati utpanna kI jA sakatI hai jina jIvANuoM kA ki prayoga kiyA jAtA hai| Ajakala kSamatA yA rogApaharaNasAmarthya nAmaka viSaya kI gaveSaNA bahuta bar3e pramANa meM ho rahI hai / usake kAraNa bahuta adhika lAbha huA hai / prArambha meM isa viSaya ko lekara do mata pracalita the-eka mecinIkopha kA, jo yaha kahatA thA ki kSamatA kA kAraNa zarIrastha kozAoM (vizeSakara zvetakoM) kI kriyA hai| dUsarA mata naTTala, buknara aura phlugge Adi kA thA jo kahate the ki rogoM kI pratIkArakazakti zarIrastha vividha taraloM ( vizeSakara rakta kI lasIkA) ke dvArA avApta vizeSa guNoM para nirbhara karatI hai| prathama kozIyamata (Cellular theory) aura dUsarI taralIyamata ( Humoral theory ) kahalAtI thii| ina donoM matoM ke pratipAdaka eka dUsare ke samIpa kadApi AnA pasanda nahIM karate the| para Aja yaha spaSTataH svIkAra kiyA jAtA hai ki kSamatA kI pratikriyAoM ko sampanna karane meM kozA tathA tarala donoM hI sammilita haiM / koSA bhakSikAyANUtkarSa (phagocytosis ) dvArA tathA tarala kozIya kriyA dvArA nirmita saMrakSaka padArthoM ke dvArA kSamatA utpanna karate haiM / sarvasAmAnyatayA zarIra kI saMrakSaka pratikriyAe~ 2 bhAgoM meM vibhakta kI jA sakatI haiN| eka bhAga vaha jisake dvArA jIvANuoM ke virSoM kA nirviSIkaraNa (neutralisation of the bacterial toxins ) hotA hai tathA dUsarA bhAga vaha jisake dvArA jIvANuoM kI kAyA kA vinAza kiyA jAtA hai| prathama bhAga ke dvArA viSaprativirSoM ( toxin-antitoxin ) kA jJAna hotA hai aura dUsare bhAga se prasamUhana (agglutination), kAyAMzana ( cytolysis ), bhakSikAyANUkarSa (phagocy. tosis ) kA varNana AtA hai / hama Age ina saba prakriyAoM kA varNana kreNge| rogANuoM ke vividha viSa ( Types of the Bacterial Poisons ) rogotpAdaka jIvANuoM ko rogANu ( bacteria) kahate haiN| ye rogANu aneka For Private and Personal Use Only

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1026 vikRtivijJAna prakAra ke hote haiN| kevala zarIra meM kisI eka rogANu kI upasthiti mAtra se hI roga nahIM ho jAtA balki roga kA mukhya kAraNa una rogANuoM dvArA viSaile dravyoM kA nirmANa ho hokara usa dravya kA vyakti ke zarIra meM pahu~canA hotA hai| ve dravya zarIra-dhAtuoM ko AghAta pahu~cAte haiM / AghAta pahu~cAne kI aneka vidhiyA~ ho sakatI haiN| eka to yahI ki kabhI kabhI ve rakta meM upasthita roganAzaka zvetakaNoM ko naSTa karate haiM aura kabhI kabhI bhakSikAyANuoM (phagocytes ) kI utpatti hI roka dete haiM / ataH zarIra ke lie ghAtaka dravyoM vA virSoM kA (jinheM rogANu utpanna karate haiM ), jJAna karanA bhI Avazyaka hai / ye ghAtaka dravya vA viSa 5 prakAra ke hote haiM: 1. bahirviSa ( Exotoxins ) 2. antarviSa ( Endotoxins ) 3. vyaMziyA~ ( Lysins) 4. agrApakAri ( Aggressins ) 5. zavikakSArAma ( Ptomaines ) / bahirviSa-rogANuoM kI kAyA se vAstava meM nissaraNa karane vAlA yaha eka ghAtaka padArtha hai jo usake zarIra se svatantra hokara svatantratApUrvaka rakta meM bhramaNa karatA hai| inheM kRtrima rUpa se bhI taiyAra kiyA jA sakatA hai| vividha rogANuoM ke bahirviSoM meM bhI antara hotA hai| parantu ve asthAyI svarUpa ke padArtha hote haiM jo kucha samaya taka ubAlane se yA sUrya kI dhUpa dikhAne mAtra se hI vighaTita ho jAte haiN| yadi bahirviSoM ko saJcita kiyA jAve to bhI ve vighaTita ho jAte haiM tathA rAsAyanika padArthoM ke saMyojana se unheM kucha kama viSaile viSAbhoM ( toxoids ) meM pariNata kara dete haiM / ina bahirviSoM kA vibhinna prANiyoM meM antarvedhana karake prativiSoM (antitoxins ) kA nirmANa karate haiN| kabhI kabhI viSoM kA prayoga na karake viSAbhoM kA prayoga karate haiM jo kama viSaile hone para bhI prativipa vaise hI utpanna karane kI sAmarthya rakhate haiM / rohiNI, dhanurvAta, boTayUlijma ( botulism ), vAtika kotha (gas-gangrene ) ke rogANuoM ke bahirviSa pramukha haiN| inameM prathama tIna bahirviSoM kA prabhAva vAtanAr3IsaMsthAna para bahuta ugra hotA hai| mAlA aura stabaka golANuoM ( strepto & staphylococci ) ke kucha prakAra (strains ) bhI bahirviSa utpanna karate haiM / ina bahirviSoM ke vividha ghaTakoM ( components ) kA bhI jJAna aba prApta ho cukA hai / ina ghaTakoM meM rudhirajanaka kAraka (erythrogenic factor) Atabheda ( coagulase ) tanvyaM zi ( fibrolysin ) prasaraNa kAraka ( spreading factor ) pramukha haiN| antaviSa-kucha rogANu jaba taka sajIvAvasthA meM rahate haiM unase koI vizeSa hAni hotI huI nahIM dekhI jAtI parantu jaba ve naSTa ho jAte vA mara jAte haiM to unake zarIra kA viSa nikala kara mAnava zarIra para bar3A bhayaGkara pariNAmakAraka ho jAtA hai jo yaha prakaTa karatA hai ki rogANu aura viSAkta padArtha ye donoM sajIvAvasthA meM eka sAtha rahate haiM aura rogANu ke marate hI viSa svatantra ho jAtA hai| kyoMki yaha viSa rogANu ke marane ke bAda prApta hotA hai ataH antarviSa kahalAtA hai| ina antarviSoM ke For Private and Personal Use Only

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rogApaharaNasAmarthya 1027 prakaTa hone meM kauna-kauna kAraNa ho sakate haiM isa para vicAra karane se patA calatA hai ki rogANu sajIvAvasthA meM aise aneka padArtha utpanna karate rahate haiM jo svayaM unake lie hI hAniprada ho sakate haiM jinake kAraNa una rogANuoM kI mRtyu ho jAtI hai| mRta rogANuoM ke zarIra se kiNva nikalate haiM jo unakA vilayana karate haiN| isa AtmAMzana (autolysis ) vidhA ke dvArA bhI antarviSoM kI utpati hotI hai| antarviSakAraka rogANu se upasRSTa prANI ke zarIra meM unakI mRtyu hotI rahatI hai jisake kAraNa prANI ke bhItara antarviSa banatA aura pracUSita hotA rahatA hai| antarviSa utpAdaka rogANuoM kA sabase adhika mahattva kA udAharaNa hai visUcikA (cholera) kA vakrANu / dUsarA hai Antrajvara (typhoid) kA daNDANu aura tIsarA udAharaNa mastiSkagolANuja mastiSkacchadapAka ( meningococcal meningitis) kA diyA jA sakatA hai| rogANuoM ke antarviSoM aura bahirviSoM kI yadi tulanA kI jAve to jJAta hogA ki 1-jahA~ bahirviSa ati zIghra thor3I garmI yA sUryadhUpa meM naSTa kie jA sakate haiM vahA~ antarvipa dera taka garmI ko saha sakate haiM ( tApasaha )|2-sNgrh karane para bahirviSa jitane zIghra vighaTita ho jAte haiM utane zIghra antarviSa vighaTita nahIM hote|3-bhirvissoN ko jahA~ pAvitaghola (filtrate)meM DhUMDhA jA sakatA hai vahA~ antarviSa anupasthita milate haiN| 4-bahirviSa para rAsAyanika padArthoM kI kriyA dvArA unheM viSAbhoM (toxoids) meM parivartita kara sakate haiM parantu antarviSoM se viSAbha banate hI nhiiN| 5-jahA~ bahirviSa ke antarvedha se prANI ke zarIra meM prativiSa banane lagatA hai, vahA~ antarviSa ke antarvedha dvArA praveza karane se bhI koI prativiSa banatA hogA isameM bahuta sandeha hai| ina thor3e se bhedoM se hI ina donoM prakAra ke mahAbhayAnaka padArthoM kI vibhinnatA kA paryApta bodha ho cukA hogaa| ___vyaMziyA~-una padArthoM ko vyaMzi kahA jAtA hai jo zarIradhAtuoM (UtiyoMtissues ) ke paramANuoM (kozAoM-cells) kA pAcana kara lete haiN| ye bahirvirSoM kI bahaneM haiN| bahirviSa to kozAoM kA nAza hI karate haiM parantu ye Age bar3hakara kozAoM kA nAza kara unakA pAcana bhI kara letI haiN| saMracanA kI dRSTi se vyaMziyoM kI tulanA vikaroM ( enzymes ) se kI jA sakatI hai| vyaMziyoM ke nAmakaraNa kI do paddhatiyA~ pracalita haiN| eka paddhati ke anusAra jisa jIvANu ke dvArA vaha banAI jAtI haiM usake nAma para nAma par3a sakatA hai jaise puMjavyaMzi (Staphylolysin ) / dUsarI paddhati usa dehadhAtu ke nAma para nAma DAlanA hai jisako vaha naSTa karake bhakSaNa kara letI hai jaise zoNavyaMzi yA zoNAMzi ( haemolysin ) / ___ agrApakAri (aggressins )--yaha vaha padArtha hai jo kevala prANiyoM ke zarIra meM hI prakaTa hotA hai| ye rogANuoM ke dvArA hI utsRSTa hotI haiN| ye viSAkta hotI haiN| inakA parakhanalI meM saMvardhana ( culture ) nahIM kiyA jA sktaa| aisA prasiddha hai ki ve bhakSikAyANuoM kI vRddhi ko roka letI haiM tathA unakI kriyA ko bhI manda kara detI haiM / ho sakatA hai ki unakA yaha kArya antarviSajanya hI koI ghaTanA ho / yadi For Private and Personal Use Only

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1028 vikRtivijJAna kisI upasRSTa prANI ke dhAturasa ko kisI aise prANI meM antarvedha dvArA praviSTa karAyA jAve jise kisI rogANu dvArA upasRSTa karA diyA gayA ho to isa dhAturasake andara vyApta agrApakAri ke kAraNa usa rogANu kI vikArazakti bahuta tIvra ho jAtI hai| zavikakSArAbha-ye rogANuoM dvArA udAsRSTa padArtha nahIM haiM / ye to ve viSAkta padArtha haiM jinheM rogANuoM dvArA probhUjinoM ke vighaTana se prApta kiyA jAtA hai| ye vAnaspatika kSArAbhoM ke sadRza lagate haiM / zavikakSArAbhoM meM 2 mukhya haiM-zavI ( cadaverin) tathA pUtigandhi (putrescin) / inheM tApa ke dvArA naSTa nahIM kiyA jA sktaa| zavikakSArAbhoM ke dvArA viSatA bahuta kama dekhI jAtI hai / zavI aura pUtigandhi dvArA viSatA na hokara ina zavikakSArAbhoM ke nirmANakartA rogANuoM ke dvArA vaha hotI hai| rogANavika AkramaNa evaM zArIrika pratirakSA jaba kabhI koI rogANu apane zarIra para AkramaNa karatA hai to usase pratirakSaNa ke lie zarIra kucha sAmAnya (general ) athavA aviziSTa ( non-specific ) tathA kucha asAmAnya yA viziSTa ( specific ) upAyoM kA avalambana karatA hai / hama nIce ina saba upAryoM kA saMkSipta varNana dete haiM / zarIra pratirakSA ke sAmAnya upAya-(1) ina upAyoM meM sarvaprathama avidIrNa svastha tvacA hai jo kisI bhI jIvANu ke zarIra-praveza ko rokatI hai| zleSmalakalA svastha hote hue bhI pratirakSA kI dRSTi se bahuta adhika vizvAsa kI vastu nhiiN| pramehANu ke dvArA usakA saralatA se bhedA jAnA isa bAta kA spaSTa pramANa hai| (2) zarIradhAtuoM aura taraloM kI amlatA bhI pratirakSA meM mahattva kA kArya karatI hai| yoni kI zleSmala kalA se aglasrAva kA honA, AmAzayika srAva meM amlatva kI upasthiti tathA mUtra kI svAbhAvika amlatA ke kAraNa inameM vaikArika jIvANuoM kI vRddhi prAyazaH ruka jAtI hai / (3) zArIrika tarala jaise A~sU inake dvArA eka viziSTa sthAna para upasthita rogANuoM ko zarIra svayaM dho detA hai| (4) pakSma aura unakI gatiyoM dvArA zvAsa nalikA meM sthita anAvazyakatatva bAhara pheMka diye jAte haiN| (5) mastiSka kA tApa-niyantA-kendra rogakAraka jIvANuoM kI upasthiti kI pratikriyA santApa bar3hAkara karatA hai| santApa kA bar3hanA jahA~ rogANuoM ke lie hAnikara siddha hotA hai vahA~ vaha nAr3I kI gati ko tIna karake rudhira-saMvahana kriyA ko uttejita karake saba dhAtuoM kA zodhana kara detA hai tAki sveda Akara viSa bAhara ho jAtA hai| isase samajhA jA sakatA hai ki rogANavika upasarga kAla meM jvara eka pratirakSAtmaka lAbhaprada vidhAna hai hAnikara nhiiN| (6) zvetakaNa apanI rogANubhakSi-kriyA dvArA pratirakSAtmaka kArya karate haiN| upasarga hote hI asthimajjA meM zvetakaNotpatti pracuratA ke sAtha hone lagatI hai aura zvetakaNa upasarga ke sthala para pahu~cakara vahIM use rokate yA naSTa karate haiN| (7) pUraka ( complement ) nAmaka padArtha For Private and Personal Use Only

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rogApaharaNasAmarthya 1026 pratyeka stanadhArI jIvadhArI ke abhinava rudhira meM prAyaH milatA hai| yaha bhI eka sAmAnya padArtha hai / isakI AvazyakatA kucha viziSTa pratIkAraka padArthoM ( Specific-immune substances ) ke lie Avazyaka hotI hai jinakA varNana Age hogaa| yaha tatva 56deg taka 10 minaTa tapAne se naSTa ho jAtA hai / (8) vyaMza-vikara ( Lysozyme)yaha nAma 1922 meM phlemiGga nAmaka vaijJAnika ne diyA hai| vaha kahatA hai ki prANiyoM ke nAsAsrAva aura azruoM meM tathA anya vAnaspatika padArthoM meM bhI rogANuoM ko gholane vAlA yaha padArtha rahatA hai| zarIrapratirakSA ke viziSTa upAya-yadi prayogazAlA ke kisI prANI meM kisI rogANu ko yA rogANu viSa ko antarvedha dvArA pahuMcA diyA jAya to usa prANI meM ina bAharI viSAkta vastuoM se bhir3ane ke lie usake jAlikAntazchadIya-saMsthAna (reticulo-endothelial system) meM eka viziSTa tatva utpanna hone lagatA hai| ina tatvoM ko pratidravya ( Antibodies ) kahate haiN| jina padArthoM ke antaH praveza se jo pratidravya banate haiM unheM pratidravyajana yA saMkSepa meM pratijana ( Antigen) kahate haiN| jisa prakAra prayogazAlA ke prANI meM kisI pratijana ke antaHniHkSepa se pratidravya taiyAra kie jAte haiM vaise hI mAnava zarIra meM jaba koI rogANu yA rogANu viSa pahu~ca jAtA hai yA koI pratijana pahu~cAyA jAtA hai taba bhI ye pratidravya vahA~ vanane lagate haiN| ye pratidravya pratyeka roga ke lie pRthaka-pRthaka hote haiN| kisI vyakti ko Antrajvara hone ke kAraNa eka vizeSa prakAra kA pratidravya usake zarIra meM taiyAra hogA jo Antrajvara para vijaya prApta kregaa| vaha pratidravya usa vyakti kI plega yA visUcikA se rakSA karane meM samartha nahIM ho sktaa| pratidravyotpAdana meM jina pratijanoM kA prayoga kiyA jAtA hai unakI saMracanA bar3I jaTila hotI hai, ve probhUjinasvarUpa kI hotI haiM tathA adhikAMza meM probhUjina tathA puruzarkareya kA mizra hotA hai| ina donoM tatvoM meM bhI puruzarkareyatasva ( polysaccharide ) prativyakAraka hotA hai| viziSTa pratidravya 3 prakAra ke hote haiM:1. prativipika pratidravya ( antitoxic antibodies ) ise prativipi (antitoxin ) bhI kahate haiN| 2. pratirogANvIya pratidravya (antibacterial antibodies) 3. prativiSANvIya prativya ( antiviral antibodies ) prativiSi eka prakAra kA pratidravya hotA hai jo bahirviSa kA klIbana ( neutralise ) kara detA hai| rakta meM jaba koI bahirviSa kisI rogANu ke kAraNa upasthita ho gayA ho jaise rohiNI meM dekhA jAtA hai to use naSTa karane ke lie prativiSi utpanna hotA hai / rakta kI lasI jisameM yaha pratidravya yA prativiSi taiyAra ho jAtI hai, bhI vizeSa viSa ko mArane kI dRSTi se viziSTa ho jAtI hai aura vaha prativiSika lasI ( antitoxic serum ) kahalAtI hai| For Private and Personal Use Only

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1030 vikRtivijJAna pratirogANvIya pratidravyoM kI utpatti rogANuoM aura unake antarviSoM ke anta. - niHkSepaNa ke kAraNa hotI hai| inakA vargIkaraNa inakI usa kriyA ke AdhAra para hotA hai jisako ve pratijana ke milane para prakaTa karatI haiN| udAharaNa ke lie yadi inake dvArA jIvANuoM kA samUhana hotA hai inheM prasamUhi (agglutinin ) kahate haiM / prasamUhIkaraNa karane vAlI pratijana bhI prasamUhijana (agglutinogen) kahalAtI hai prasamUhana kI pratikriyAoM ke dvArA kaI rogoM kA nidAna saralatA se ho jAtA hai / Annrajvara, adhyAnnrajvara ( Paratyphoid), jvarAtIsAra ( Bacillary dysentery ). visUcikA kA jJAna prasamUhana ke kAraNa hI hotA hai| rakta kI lasI meM prasamUhiyA~ kabhI to roga hote hI prakaTa ho jAtI haiM aura kabhI kucha vilamba se prakaTa hotI haiM / ataH jaba taka ve utpanna na ho jAya~ taba taka prasamUhana dvArA parIkSA saphala nahIM hotI / Acharya Shri Kailassagarsuri Gyanmandir jaba pratirogANvIya pratidravyayukta kisI pratilasI ko kisI rogANu ke saMvardha ko chAnakara usa tarala meM milAyA jAve aura aisA karane se vaha tarala jama jAya yA nissAdita ( precipiteted ) ho jAya taba vaha pratidravya nissAdi ( preoipitin ) kahalAvegA / prasamUhiyA~ tathA nissAdiyA~ yadyapi eka nahIM haiM parantu phira bhI ve Apasa meM eka dUsare se paryApta samAnatA rakhatI haiN| kyoMki jina rogoM meM prasamUhanaparIkSA sambhava hai unhIM meM nissAdana bhI sambhava hai / kabhI kabhI anya jIvANuoM kI upasthiti ke kAraNa jaba prasamUhana nahIM ho pAtA usa samaya nissAdana saralatA se ho jAtA hai| rogANuoM ko chor3a anya probhUjina utpAdoM para bhI nissAdana kriyA kI jA sakatI hai / jaise rakta ke sUkhe hue dhabbe kI parIkSA nissAdana dvArA sambhava hotI hai| 1 kucha pratidravya pratijanoM kA aMzana kara dete haiM, arthAt unheM ghulA DAlate haiM / inheM vyaMzi (lysins) kahate haiM / vyaMziyA~ probhUjina ko ghulAne vAlI hotI haiM / inheM zAkANvaMziyA~ ( bacteriolysins ), zoNAMziyA~ ( heemolysins ) athavA kozAMziyA~ ( cytolysins ) Adi nAmoM se pukArate haiM / jitane bhI rogANu hote haiM unake zarIra kisI na kisI probhUjina dvArA banate haiM / ye probhUjina apane zarIra kI dRSTi se videzIya hote haiM ataH inako bulAne ke lie zarIra meM vividha vyaMziyoM kI utpatti hotI hai / jaba kabhI eka prANI ko dUsare prANI kA rakta diyA jAtA hai to rakta ke lAla karNo kI probhUjina yadi dUsare prANI ke lie videzIya huI to unakA aMzana prArambha ho jAtA hai / vyaMzi kI kriyA sadaiva aviziSTa pUraka ( non-speeific complement ) para hI hotI hai| binA aviziSTa pUraka kI upasthiti ke pratijana para isakI koI kriyA nahIM dekhI jAtI / usakA kAraNa yaha hai ki vyaMzi sadaiva do vastuoM kI eka sAtha AkAMkSA karatI hai- eka pratijana aura dUsarI pUraka / vyaMziyoM ko dvigrAhI ( amboceptor ) varga kA mAnA jAtA hai / yaha varga sadaiva viziSTa hotA hai| aura 56deg taka tapAne se bhI naSTa nahIM hotA / vyaMziyoM se kaI rogoM kA nidAna kiyA jAtA hai jinameM phiraMga mukhya hai / For Private and Personal Use Only

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rogApaharaNasAmarthya 1031 pratijana meM sthita pUraka ke sthirIkaraNa kI kriyA karane vAle vyaMziyoM ke hI samAna pUrakabandhaka ( complement fixers) bhI hote haiN| pratijana, vyaMzi aura pUraka ina tInoM ko sthirIkRta karake svatantratayA pUraka kI upasthiti ko aprakaTa karane vAle ye huA karate haiN| pratijana ke zarIra meM praviSTa hote hI bhakSikAyANu unakA bhakSa karane lagate haiN| yadi ina bhakSikAyANuoM ko dho diyA jAve to ve phira bhakSaNa karane meM asamartha ho jAte haiM / yadi isa samaya prAkRtika raktalasI usameM girA dI jAve to phira ve bar3e cAva se bhakSaNa kArya kara uThate haiN| isa prakriyA se yaha jJAta hotA hai ki pratijana ko susvAdu banAne vAlI koI vastu avazya hai jisake ghula jAne se pratijana arucikara ho jAtI hai| isa vastu ko hama susvAdi ( opsonin ) nAma dete haiN| susvAdiyA~ bhI 2 prakAra kI hotI haiM-eka USmahat ( thermolabile ) aura dUsarI UpmasthAyI ( thermostable ) USmahat 56 za0 para naSTa ho jAtI hai / ise pUraka se pRthak pahacAnanA kaThina hai aura yaha aviziSTa hotI hai| dUsarI uSmasthAyI susvAdi ko rogANvAvarti ( bacteriotropin ) kahate haiM / yaha pUraka kI upasthiti meM acchA kArya karatI hai| prativiSANvIya pratidravya pratirogANvIya pratidravyoM ke samAna hI hote haiN| abhI taka baikTIriyA ke lie hamane rogANu kA prayoga kiyA hai para ve zAkavarga ke vAnaspatika tatva haiM ataH unake lie yogya zabda zAkANu hai| isI prakAra rogANvIya ke sthAna para zAkANvIya Adi aavegaa| jahA~ rogajanaka sarvasAmAnya aNuoM kA vicAra hogA vahA~ rogANu tathA jahA~ vizeSa varga kA varNana hogA vahA~ zAkANu clegaa| __ sthAnika pratIkAritA kucha zarIra dhAtue~ kisI vizeSa jIvANuoM ke dvArA rogAkrAnta hone kI pravRtti rakhatI haiN| yadi unheM hama samartha ( immune ) kara deM to sampUrNa zarIra usa roga se pratIkArI banAyA jA sakatA hai| aisA baiTeDakA nAmaka vidvAn kA mata hai| udAharaNa ke lie kAlasphoTa ( enthrAksa ) kA jIvANu tvacA para tathA Antrajvara kA jIvANu Antra para apanA prabhAva karatA hai| yadi hama vaNTamUSa kI tvacA chIlakara usa para mRdu banAe kAlasphoTa daNDANu kA gharSaNa kareM to svacA meM sthAnika pratIkAritA utpanna ho jAtI hai jisake kAraNa yadi bAda meM ati tIkSNa mAtrA ko sUcIvedha dvArA usakI tvacA meM praviSTa kareM to bhI vaNTamUSa maratA nhiiN| yadi kisI prANI kI khacA ke nIce kAlasphoTa daNDANu praviSTa kareM to kucha nahIM hotA para yadi tvacA meM praveza kara deM to turata mRtyu ho jAtI hai| ye saba bairoDkA ke vicAra ko vyakta karate haiN| kAlasphoTa ke lie pratIkAritA yaha sthAnIya dhAtu-tvacA kA kArya hai| isI prakAra yadi mRta Antrajvara daNDANu mukha dvArA khilAe jAveM tA Antra meM pratIkAritA utpanna ho jAvegI jisake kAraNa Age calakara Antrajvara kA prabhAva na ho skegaa| parantu yahA~ For Private and Personal Use Only

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1032 vikRtivijJAna sthAnika pratIkAritA ke atirikta rakta meM bhI prasamUhiyA~ banatI haiN| jvarAtisAra aura visUcikA meM bhI sthAnika pratIkAritA utpanna kI jA sakatI hai| puMjagolANuoM ke mAMsarasasaMvardha ( broth culture ) pAvita ( filtrate )meM aise padArtha hote haiM jinheM tvacA para lagAne se puMjagolANu upasarga tvacA para nahIM ho paataa| isa pAvita ko prativiSANu (antivirus) kahate haiN| prativiSANu sAdhAraNa mAMsarasa ( broth) se adhika prabhAvita ho sakatA hai isakA koI pramANa nahIM / rogApaharaNasAmarthya ke vividha siddhAnta kSamatA zabda immyUniTI ke lie prayoga kiyA gayA hai| isake lie dUsarA adhika upAdeya zabda rogapratIkAritA yA pratIkAritA hai jise hamane rogApaharaNasAmarthya kahA hai / pratIkAritA zabda kA prayoga isa dizA meM vaidyakIya abhinava granthoM meM kama calatA hai, kSamatA adhika / isI kAraNa hamane use apanAyA hai parantu pratIkAritA zabda ke lene se aMgrejI dRSTi se jo immyUniTI se aneka zabda banate haiM unheM hindI meM vyakta karanA sarala hogA ataH aba hama pratIkAritA ko kSamatA ke sthAna para prayukta kreNge| pratIkAritA ke jo vAda Aja taka prakaTa hue haiM unameM nimna mahattva ke haiM1. aharlika kA pArzva zRGkhalA vAda 2. arhIniyasa tathA madasena kA vAda 3. borDe kA vAda 4. sAmparIkSa avalokana 5. Adhunika vAda hama nIce inhIM pA~coM kA kucha prakAza kareMge / aharlikIya pArzvazRGalA vAda (Side chain theory of Eherlich)aharlika kA aisA vizvAsa thA ki kozA ke prarasIya vyUhANu meM eka sthira nyaSThIlA hotI hai tathA usakI cayApacayika kriyAe~ usake pArzva meM sambaddha vibhinna paramANusamUhoM ke dvArA sampanna hotI haiM jinheM 'pArzva zRGkhalA' nAma diyA jA sakatA hai| ye pAva zRGkhalAe~ anya mUloM se milane kI zakti rakhatI haiN| isa sammilana kSamatA ke kAraNa unheM AdAtA (Receptors ) nAma diyA jA sakatA hai| AdAtAoM ke dvArA eka kozA kA sambandha Asa-pAsa ke vibhinna padArthoM se ho sakatA hai| inhIM ke dvArA kozA ko khAdya sAmagrI pahu~catI hai jo vahIM para kozA ke anurUpa parivartita hokara kozA ke dvArA grahaNa kI jAtI hai| koI bhI hAniprada padArtha jaba taka vaha kozA ke ina AdAtAoM se apanA sambandha nahIM jor3a letA taba taka kozA kI koI hAni nahIM ho paatii| yadi koI viSa adhika mAtrA meM ekatra hokara kozA ke saba AdAtAoM se sambaddha ho jAtA hai aura khAdya pahu~cAne kA koI mArga nahIM raha jAtA taba kozA naSTa ho jAtA hai tathA usakI mRtyu ho jAtI hai| para yadi hAniprada padArtha kI svalpa mAraka For Private and Personal Use Only

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rogApaharaNa sAmarthya 1033 mAtrA kA praveza kiyA jAve to kozA ke saba AdAtA usase AkrAnta na hokara kucha hI ho pAte haiM, zeSa AdAtA kozA kA jIvana kAyama rakhate haiN| viSAkrAnta kozAoM kI pUrti karane ke lie kozA anya kaI AdAtAoM ko prakaTa kara detA hai| ye atirikta AdAtA svAbhAvikatayA kozA se pRthaka hokara zArIrika taraloM meM prativiSa ke rUpa meM prakaTa ho jAte haiN| pratijana-prativiSa pratikriyA kA pUrNa digdarzana karAne ke lie aharlika ne bhAdA. tAoM ke 3 gaNa ( orders ) mAna lie haiM-prathama gaNa, dvitIya gaNa tathA tRtIya gaNa / pratyeka AdAtA ke pAsa eka saMyojana samUha (combining group) kA honA bhI isane mAna liyA hai| isa saMyojana samUha ko usane lAMgaladhara yA haipTophora (hapto. phore ) nAma diyA hai| yadi milate ho kevala klIbana ho gayA to AdAtA prathama gaNa kA mAna liyA jAvegA / aisA viSa aura prativiSa donoM ke saMyoga ke kAraNa hI ho sakatA hai| para viSAbha nirmiti ko spaSTa karane ke lie viSa vyUhANu ke sAtha viSadhara yA Tokjophora ( toxophore ) samUha kI upasthiti bhI mAna lenI par3I jisakA dAyitva viSailI kriyA karanA hai| yahI Toknophora samUha parivartita hokara viSAbha ( toxoid ) bana jAtA hai tathA haipTophora samUha aparivartita raha kara kozIya AdAtA se milane ke lie svatantra rahatA hai yA prativiSa vyUhANu rUpa meM ( mukta AdAtA) rakta meM saMvahita hotA rahatA hai| aharlika ke dvitIya gaNa ke AdAtA prasamUhana tathA nissAdana ina donoM kriyAoM ko kisa prakAra karate haiM ise spaSTa kiyA gayA hai| dvitIya gaNa ke AdAtAoM meM eka aisA parivartana mAnA gayA hai aura usameM eka anya samUha kA bhAva samajhA gayA hai jisake kAraNa pratijana meM eka bhautika parivartana A jAtA hai jyoM hI usake haipTophora samUha ke sAtha pratidravya bana jAtA hai| isI anyakriyAkara samUha ko argophora ( ergophor ) samUha nAma diyA gayA hai| tRtIya gaNa dvArA pUraka pratibandhana ( complement-fixation ) kI ghaTanA spaSTa hotI hai| isake lie yaha mAna liyA gayA hai ki eka aura AdAtA hotA hai jo svayaM to niSkriya rahatA hai para jo pratijana ko anya kriyAvAn padArtha pUraka (complement) ke sAtha saMyukta kara detA hai / tRtIya gaNa ke AdAtAoM ke pAsa do haipTophora samUha hote hue mAna lie gaye haiM jinameM eka pratijana ke sAtha mila jAtA hai jise kozApriya ( cytophilic ) AdAtA kahate haiM aura dUsarA pUraka ke sAtha mila jAtA hai jo pUraka priya (complementophilic) AdAtA kahalAtA hai| tRtIya gaNa ke isa AdAtA ko hI embosaipTara (amboceptor) yA dvigrAhI kahate haiM kyoMki isameM donoM samUha haipTophora prakAra ke hote haiN| saMkSepa meM tInoM gaNoM ke sambandha meM nimna sUtra upayogI hoMge 87, 88 vi0 For Private and Personal Use Only

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2034 vikRtivijJAna pratijana pratidravya pratikriyA prathama gaNa : kevala haipTophora samUha : viSa-prativiSa dvitIya gaNa: haipTophora tathA irgophora : prasamUhana, nissAdana tRtIya gaNa : do haipTophora : pUraka-prati bandhana,aMzana ___aharlikavAda pratidravya nirmANa ke sambandha meM yogya vicAra prakaTa karatA hai aura pratijana-pratidravya pratikriyAoM kA pakSapAtI hai| isameM yadyapi Ajataka parivartana hote cale gaye haiM tathA isako AdhAra mAna kara prayogazAlAoM meM pratIkAritA kI samasyAoM ke sambandha meM gaveSaNAe~ kI gaI haiN| aharlika kI apane vAda ke sambandha kI bahuta sI dhAraNAe~ galata siddha huI haiN| udAharaNa ke lie viSa-prativiSa kA klIbana tIkSNa amla aura tIkSNa kSArIya prakAra kA aura anutkrAmya ( nonreversible) hotA hai, aisA vaha mAnatA thA jo Age vyavahAra meM siddha nahIM ho sakA / pratijana-pratidravya saMyojana sambandhI usake mata bhI Aja mAnya nahIM haiN| aIniyasa aura madasenavAda pratijana-pratidravya saMyoga asthAyI tathA AsAnI se viyAvya ( dissociable ) hotA hai ataH ina do vidvAnoM ne yaha sujhAva rakhA ki inakI kriyA utkrAmya svarUpa kI hai aura aisI hai ki jaisI manda amla aura suSava ( alcohol ) meM pralavaNa ( ester ) banAne meM hotI hai| viSa aura prativiSa ke kisI bhI mizra meM pratikriyAkara padArthoM ke saMketaNa kI mAtrA ke anurUpa hI svatantra viSa, prativiSa aura viSa-prativiSa milate haiN| borDavAda borDa kA vizvAsa yaha rahA hai ki pratijanapratidravya saMyoga ke lie rasAyana zAstra ke sarvasAdhAraNa niyamoM se kArya nahIM cala sktaa| usake anusAra yaha pratikriyA pRSTa aura antaHsImA ke zleSAbhIya adhicUSaNa ( colloidal adsorption ) svarUpa kI hai| yaha vAda bhI bahuta dUra nahIM le jAtA kyoMki isake dvArA vaiziSTya (specificity ) ke mahattvapUrNa bhAva ko prakaTa karane kA koI AdhAra nhiiN| sAMparIkSa-avalokana aba hama saMparIkSA ( experiments ) ke AdhAra para vicAra karate haiM / jisake bala para vividha vAdoM kA janma huA aura viSa-prativiSa-pratikriyA ko AdhAra banAkara jisase nirNaya lie gye| viSa aura prativiSa donoM ko jaivika AdhAra para prabhAvita kara liyA jAtA hai| ahalika ne apanI parIkSAoM meM nyUnatama mAraka mAtrA (nyU. mA. mA.) kA ullekha karate hue usa mAtrA ko liyA hai jo 250 dhAnya bhAra ke vaNTa mUSa (guinea pig) ko upatvakvedha ke pazcAt cAra dina meM mAra DAle / usane prativiSa ke ekaka (unit) kI paribhASA karate hue batalAyA ki jo nyUnatama mAtrA viSa kI 100 nyU. mA. mA. kA klIbana kara sake vaha eka prativiSa ekaka hogA / kisI viSa kA pramApana karane For Private and Personal Use Only

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rogApaharaNa sAmarthya 1035 kI aharlika dvArA prayukta vidhi yaha thI ki eka ekaka prativiSa ke sAtha viSa kI vibhinna mAtrAe~ milA dI jAveM tathA vaNTamUSa meM vedha dvArA usa mAtrA kA jJAna kiyA jAve jisake kAraNa usa para koI hAnikara prabhAva na par3a ske| aise mizra (mikzcara) meM viSa kI jo mAtrA eka ekaka prativiSa dvArA klIba kara dI gaI vaha viSa kI mA0 (zUnya mAtrA) mAna lI gaI para mA0 kA ThIka ThIka nirdhAraNa karanA asambhava thA isa kAraNa usane eka anya pramApana vidhi nikAlI jise viSa kI mA0 mAtrA kahA gyaa| mA0 + nyUnatama vipa kI vaha mAtrA hai jise eka ekaka prativiSa 'se milAkara sUcIvedha dvArA praveza karane para eka 250 dhAnyabhAra kA vaNTamUSa 4 dina meM mara jAtA hai| isa paribhASA ke anusAra mA + mAtrA - mA0 mAtrA1 nyU0 mA0 mA0 hogii| parantu vyavahAra meM yaha galata niklaa| nyU. mA. mA. 1 se sadaiva adhika Ardra aura kabhI kabhI to yaha mAtrA 50 gunI taka ho gii| isa ghaTanA ko ahalikIya ghaTanA ( Ehrlich's phenomenon) kahA jAtA hai| Ajakala isa ghaTanA kA prayoga na hokara jaivika pramApana kArya sAMkhyikIya AdhAra (statistical basis ) para kiyA jAtA hai| apanI ghaTanA ko apane mata se spaSTa karane ke lie pratijanaprativiSa saMyoga ke sambandha meM aharlika ne jabardastI prativiSa ke prati bandhusvabhAva rakhane vAle saMjaTila viSAbhoM kI kalpanA kara lI thii| ina viSAbhoM kI upasthiti Aja svIkAra nahIM kI jaatii| ghaTanA kA artha bovAda yA arhIniyasavAda dvArA kiyA jAtA hai| saMparIkSA yaha siddha karatI hai ki parIkSaNakAla meM viSa aura prativiSa donoM ko eka sAtha milAne se viSa ko prativiSa naSTa nahIM krtaa| donoM kA saMyoga saralatA se utkrAmya ( reversible) ho sakatA hai yadi mizra ko manda ( dilute) kara diyA jAya, garma kara diyA jAya, jamA diyA jAya yA una para tanu amloM kA prayoga kiyA jAya / isI kAraNa viSa prativiSa mizraNa jamA dene para atyanta viSAkta ho jAtA hai / eka tathya yaha bhI smaraNIya hai ki viSa aura prativiSa donoM kA saMyoga aura dRDha ho jA sakatA hai yadi donoM kA sammilana samaya paryApta bar3hA diyA jaave| para atyadhika samaya hone para donoM kA viyavana ( dissociation ) hone lagatA hai| ye sabhI tathya aharlikavAda ke viruddha haiM tathA pratikriyA manda aura utkrAmya hai jaba ki ahaliMka use tIkSNa aura anutkrAmya mAnatA AyA hai| eka aura tathya hai jo aharlika tathA ahIMniyasa evaM madasena ke vAdoM ko vicUrNa karatA hai| use Dainiza ghaTanA ( Danysz phenomenon ) kahate haiM / Dainiza ne patA lagAyA thA ki yadi nizcita mAtrA meM viSa ke sAtha prativiSa kI nizcita mAtrA milA dI jAve to viSa ke klIbana kI mAtrA prativiSa ko mizrita karane ke DhaMga para nirbhara hogii| yadi prativiSa ekadama bahuta sA milA diyA jAvegA to viSa kI adhika mAtrA klIba hA jAvegI para yadi thor3I-thor3I mAtrA meM Thahara-Thahara kara prativiSa ko viSa meM milAyA jAvegA to viSa kA klIbana bahuta kama hogaa| isa ghaTanA ko borDavAda dvArA samajhAyA jA sakatA hai| For Private and Personal Use Only

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1036 vikRtivijJAna Adhunika vAda Upara jo tIna vAda diye gaye haiM una tInoM ke samajhaute ko AdhunikavAda nAma diyA jA sakatA hai / isa vAda meM tInoM vAdoM kA samanvaya hotA hai / Adhunika rogApaharaNa sAmarthya kI samasyAe~ yaha prakaTa karatI haiM ki unakA svarUpa rAsAyanika evaM bhautika hai isalie vyUhANu kI racanA tathA zleSAbhIya ghaTanA kA sambandha pratidravyotpatti tathA pratijana - pratidravya-saMyoga donoM ke sAtha rahatA hai / ahardika kA mata jisameM vaha vaiziSTya para adhika jora detA hai maulikatayA ThIka jJAta hotA hai / parantu usane jo 3 gaNa banAe haiM unakI AvazyakatA isalie nahIM rahatI ki spaSTa dRggocara honevAlI prasamUhana aura nissAdana kriyA adRSTa viSa prativiSa saMyoga yA saMpUraka pratibandhana saba pratikriyAvAn padArthoM kI bhautika avasthA ke dvArA anuzAsita hote haiM / pratijana aura pratidravyoM ke saba saMyoga eka se hote haiN| Adhunika dRSTi se borDebAda ko isa prakAra liyA jA sakatA hai ki pratijana - pratidravya saMyoga vividha anupAtoM meM huA karatA hai / ahaniyasa aura madasena kA vAda isa dRSTi se grAhya hai ki pratijana - pratidravya saMyoga Taran sambhava hai / Acharya Shri Kailassagarsuri Gyanmandir jitane bhI rAsAyanika pramANa haiM ve batalAte haiM ki pratidravya lasIkAvartuliyA~ ( serum globulins ) haiM jinake viziSTa rAsAyanika samUha hote haiM jo apane-apane pratijanoM ke sAtha milane kI sAmarthya rakhate haiM / pratijana - pratidravya saMyogoM meM adhicUSaNa ghaTanA bhI mahatva kA bhAga letI hai / eka vyUhANu ko dUsarA vyUhANu pakar3a kara bhinna-bhinna saMyogoM kI racanA kiyA karatA hai yaha kArya adhicUSaNa ghaTanA ke AdhAra para hotA hai / adhika kAla taka viSa prativiSa kA milana unheM dRr3hatA se saMyukta kara detA hai / usakA kucha to kAraNa yaha hai ki unameM sAmUhika kriyA ( mass action ) hotI hai aura kucha yaha ki jaba antaH vyUhANuzakti dvArA prArambhika sammilana ho jAtA hai| to antaH vyUhANuzakti apanI kriyA karake saMyoga meM dRr3hatA lA detI hai / jAnapadika pratIkAritA ( Herd Immunity ) aneka saMparIkSaNa aura kitane hI sAMkhyikIya adhyayana yaha jAnane ke lie hue haiM ki janapadoddhvaMsa ( epidemic ) kA kyA kAraNa hai aura usake banda hone meM bhI kauna hetu dekhe jAte haiM / yaha sambhava hai ki koI deza yA pradeza kucha yantravat kAraNoM ke hone mAtra se hI kisI roga vizeSa ke prati pratIkArI ho isakA sarvasAdhAraNa udAharaNa 'iGgalaiNDa hai jahA~ plega aura visUcikA nahIM hote / usakA kAraNa yaha kadApi nahIM ki vahA~ ke logoM meM inake prati janmajAta pratIkAritA pAI jAtI hai / api tu usakA pradhAna kAraNa hai bandaragAhoM meM svacchatA, jala kI pavitratA tathA manuSya yA janasaMkhyA ko rogAkrAnta jIvajantu se na milane dene kA svAsthya vibhAga kA saphala prayatna / isI ko yantravat ( mechanical ) kAraNa kahA jAtA hai| kisI roga kA upasarga 1 For Private and Personal Use Only

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rogApaharaNa sAmarthya 1037 ( infection) kisI jAti vA samUha meM kabhI-kabhI isalie bhI nahIM hotA ki prAkRtika rUpa meM usa roga ke lie vaha pratIkArI hai / anya kAraNoM se bhI pratIkAritA usameM A sakatI hai| yadi kisI janapada meM koI roga saMcArita ho jAve jisake lie vaha janapada anuhRSa (susceptible) hai to thor3e hI kAla meM vaha roga janapadoddhvaMsa kA rUpa dhAraNa kara letA hai / vaha vizvavyApI bhI bana sakatA hai| sAdhAraNatayA eka janapada meM vividha aMza meM pratIkAritA lie hue vyakti rahate haiN| usa janapada meM sthAnika rUpa se koI saMcArI roga raha sakatA hai jo samaya-samaya para vyApaka rUpa dhAraNa kara le sakatA hai / isa parivartana kA kAraNa rogakAraka jIvANu kI tIvratA yA mandatA utanI nahIM hai jitanI ki janapadastha nivAsiyoM kI usa roga ke prati anuhRSatA ( susceptibility ) mahatvapUrNa hai| jo anuhaSa vyaktiyoM kA anupAta ucca hotA hai roga mahAmArI kA rUpa dhAraNa kara letA hai aura yaha ugratA taba taka rahatI hai jaba taka ki anuhRSa vyaktiyoM kI saMkhyA punaH svalpa hokara sthAnika svarUpa kA roga kA vyApa nahIM ho jaataa| saMparIkSA ke lie janapada meM saMcArita rogoM ke kAraNa anubhava yaha AyA hai ki mahAmArI kA jaba anta Ane ko hotA hai taba rogANvika saMkhyA meM parivartana AtA hai para yaha parivartana roga kI saMcAra zakti (infectivity) para adhika prabhAva DAlatA hai na ki roga kI ugratA ( virulence ) pr| janapadodhvaMsa kA jJAna pIDita rugNoM ke dekhane se tathA lakSaNa virahita rugNoM ke dvArA hotA hai / yadi lakSaNavirahita rugNoM ke pahacAnane meM dera kI to mahAmArI phailatI hai kyoMki bahuta se svastha prANI aise hote haiM jo roga ke vAhaka (carriers ) kA kArya karate haiM para svayaM bImAra nahIM par3ate aura unameM se adhikAMza ko vaha roga naidAnika lakSaNoM se rahita aura kAlika evaM gupta svarUpa kA hotA hai / sthAnika roga ( endemic disease ) kA kAraNa bhI ye vAhaka hote haiN| janapadodhvaMsa AcAryoM ne mahAmAriyoM ko janapadodhvaMsa nAma diyA hai aura inake kAraNa ke sambandha meM bhagavAn Atreya se agniveza ne prazna kiyA hai api ca khalu janapadoddhvaMsanabhekenaiva vyAdhinA yugapadasamAnaprakRtyAhAradehabalasAtmyasattva vayasAM manuSyANAM kasmAd bhavatIti ? arthAt eka hI vyAdhi ke dvArA eka hI kAla meM bhinna prakRtivAle, bhinna-bhinna bhojana sevana karane vAle, bhinna dehabala yukta, pRthak sAtmya, pRthak mana, bhinna Ayu ke hote hue kisa prakAra manuSya ko AkrAnta kiyA jAtA hai| isakA bahuta sarala aura Adhunika vijJAna se svIkRta nimna uttara AtreyajI dete haiM___ tamuvAca bhgvaanaatreyH| evamasAmAnyavatAmapyebhiragniveza ! prakRtyAdibhirbhAvairmanuSyANAM ye'nye bhAvAH sAmAnyAstadvaiguNyAt samAnakAlAH samAnaliGgAzca vyAdhayo'bhinivartamAnA janapadaM uddhvaMsayanti / te tu khalvime bhAvAH sAmAnyA janapadeSu bhavanti, tadyathA-vAyurudakaM dezaH kAla iti / tatra vAtamevaMvidhamanArogyakara vidyAt / tadyathA-yathartuviSamamatistimitamaticalamatiparuSamati For Private and Personal Use Only

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1038 vikRtivijJAna zItamatyuSNamatirUkSamatyabhiSyandinamatibhairavArAvamatipratihataparasparagatimatikuNDalinamasAtmyagandhabASpasikatApAMzudhUmopahatamiti / udakantu khalvatyarthavikRtagandhavarNarasasparzavat kledabahulam apakrAntajalacaravihaGgamupakSINajalAzayamaprItikaramapagataguNaM vidyAt / dezaM punaH prakRtivikRtavarNagandhara sasparza kledabahulamupasRSTaM sarIsRpavyAla-mazaka-zalabha-makSikAmUSikolUka-imAzAnikazakunijambUkAdibhiH tRNolUpopavanavantaM pratAnAdibahulaM apUrvavada vapatita zuSkanaSTazasyaM dhUmrapavanaM ca pradhmAtapatatrigaNam utkRSTazvagaNamadbhrAntavyathitavividhamRgapakSisaMgham utsRSTanaSTadharmasatyalajjAcArazIlaguNajanapadaM zazvatkSubhitodIrNasalilAzayaM pratatolkApAtanirghAtabhUmikampaJca pratibhayAvArarUpam rUkSatAmrAruNasitAbhrajAlasaMvRtArkacandratArakamabhIkSNaM sambhramodvegamiva satrAsaruditamiva satamaskamiva guhyakAcaritam ivAkranditazabdabahulaJca ahitaM vidyAt / kAlantu khalu yathartuliGgamatiliGgahInaliGgaJcAhitameva vyavasyet / imAnevaM doSayuktAn caturo bhAvAn janapadoddhvaMsakarAn vadanti kushlaaH| bahuta saMkSepa meM parantu mahAmArI ke hone ke sampUrNa kAraNoM para jisa vaiziSTaya ke sAtha maharSi ne likhA hai vaha pUrNataH mAnanIya hai| ve kahate haiM ki he agniveza yaha maiM mAnatA hU~ ki manuSyoM kI prakRti, AhAra, dehabala, sAtmya, satva tathA Ayu bhinna-bhinna haiM parantu kucha aise bhI bhAva haiM jo sabake lie samAna haiN| jaba ina bhAvoM meM viguNatA AtI hai to eka hI samaya meM eka se lakSaNoM vAlI vyAdhiyA~ utpanna hokara janapadoM kA nAza karatI haiN| janapadoM meM vAyu, jala, deza aura kAla ye samAna hote haiM / vAta meM vaiguNya Ane se Rtu viparIta, atyanta nizcala, atyadhika calAyamAna, atikarkaza, ati zItala, atyuSNa, atirUkSa, atyadhika kledaka, atyadhika bhISaNa zabda karane vAlI, vibhinna dizAoM se uThakara paraspara TakarAne vAlI, bavaNura yA kuNDalI rUpa meM uThane vAlI, asAtmyagandhavAlI bASpa, bAlU, reta aura dhue~ se yukta ho jAtI hai| jala bhI atyanta vikRta gandha yukta, vikRta varNa yukta, vikRta rasa vAlA, sparza meM vikRta, sar3AMdavAlA, jalacara aura panI jise chor3a cuke hoM, jalAzaya kA jala sUkha kara thor3A rahA ho, pIne meM apriya aura guNa rahita ho jAtA hai| deza kA varNa bigar3a jAtA hai, gandha kharAba AtI hai, rasa aura sparza bekAra ho jAtA hai| saDAMda uThatI hai, sA~pa-hiMsrajantu-macchara-pataMgA-makkhiyA~-mUSaka ( cUhe ) ullU-gRddha-gIdar3Adi se yukta ho jAtA hai| tRNa, dhAsa bahuta utpanna ho jAtI hai, beleM aura pratAna bahuta ho jAte haiM, dhAnya pahale sA na hokara bIca meM hI sUkha jAtA hai, vAyu dhUmra varNa kI dikhAI detI hai, pakSI bhadde zabda karate haiM, kutte rote haiM, pazupakSI itastataH dukha se bhAgate haiM,dharma, satya, lajjA, AcAra, zIla aura guNoM se rahita nAgarika dekhe jAte haiM, jalAzaya kSubdha haiM, ulkApAta, bhUkampa hote haiN| unake bhayAvaha zabda sunAI par3ate haiM, candramA aura tArAgaNa rUkSa, tAmravarNa, aruNa, zveta bAdaloM meM chipe se dikhate haiM, saMbhrama, trAsa, rudana, tama, devoM dvArA AkrAnta, zabdabahula deza dikhalAI aura sunAI par3atA hai| For Private and Personal Use Only

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rogApaharaNa sAmarthya 1036 jaba kAla bigar3atA hai to Rtu viparIta kama yA adhika lakSaNoM yukta ho jAtA hai| ina cAroM bhAvoM ke viparIta hone para ve janapada-nAzaka hote haiM / yaha prAcIna fara kA mata hai| vAta kI viguNatA kA yadi hama vyApaka arthaleM to Adhunika rogasaJcArI jIvANuoM se dUSita vAyu bhI usameM samAviSTa ho jAvegI / dUSita jala ko bhI vikArI jIvANuoM dvArA hI adhika vikRta kara diyA jAtA hai jisake pariNAmasvarUpa visUcikA AntrajvarAdi roga phailate haiN| deza kI vikRti ke kAraNa mUse bar3hate haiM, plega phailatI hai, kAla kI vikRti ke kAraNa jagata bhara meM roga dekhe jAte haiN| deza ke sambandha meM batAte hue anya kaI viziSTa bhAvoM kI ora AcArya ne iGgita kiyA hai jo kauna kaha sakatA hai ki nikaTa bhaviSya meM hI vaijJAnikoM dvArA nahIM svIkAra kara lie jAveMge / kauna vikRta bhAva se kauna vikRta bhAva mahattvapUrNa hai isake lie vicAra adholikhita sUtroM meM kiyA gayA hai vaiguNyamupapannAna dezakAlA nilAmbhasAm / garIyastvaM vizeSeNa hetumatsampracakSate // vAtAjjalaM jalAd dezaM dezAtkAlaM svabhAvataH / vidyAdaparihAryatvAdgarIyaH paramArthavit // deza, kAla, vAta aura jala inake viguNa ho jAne para kisakI gurutA vizeSa hai isakA vicAra karane para vAta se jala, jala se deza tathA deza se kAla svabhAvataH aparihArya jAnanA caahie| isa kramAnusAra vAyu se jala garIba hai / jala se deza garIya hai tathA sabase adhika garIya kAla hai kyoMki prathama tIna se bacane kA upAya bhI ho sakatA hai para kAla to sarvathA aparihArya hai / For Private and Personal Use Only

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paJcadaza adhyAya samprAptivimarza isa grantha ke antima adhyAya meM AcAryoM ke dvArA vikRti ke sambandha meM jo sUkSmAtisUkSma vivecana kiyA gayA hai jisake yathAvat jJAnamAtra se vikAra kA yAthAtathya bodha ho jAtA hai, jisakA yathAvat jAna lenA hI mAno AyurvedIya nidAnazAstra ke gUr3ha tatva kA vivecana hai tathA jisake vidhivat parijJAna ke binA koI na to Ayurveda kA paNDita hI kahA jA sakatA hai aura na saphalacikitsaka hI ho sakatA hai evaM jisake viSaya meM atizaya andhakAra ke prasAra ke kAraNa hI vaidyavarga meM Avazyaka cetanA kA abhAva haggocara ho rahA hai tathA jisake lie anusandhAna mahArathiyoM ko tatpara hokara kArya karanA parama Avazyaka hai / usa 'samprApti' ke sambandha meM Avazyaka sAhitya kA nAtivistRta vimarza yahA~ upasthita kiyA jA rahA hai / kisI bhI vyakti ko apasmAra ho gayA, jvara A gayA, zvAsa kA daurA par3a gayA yaha kahane se jahA~ sAdhAraNa vyakti ko kramazaH eka mUrcchAgrasta rogI kA, jalate hue zarIra vAle kA athavA hA~phate hue prANI kA citra svayaM upasthita ho jAtA hai vahA~ eka cikitsaka ke mastiSka meM ina tInoM prakAra ke rogiyoM ke viSaya meM tIna nimnalikhita kalpanAe~ AtI haiM 1 - vividha kAraNoM ke kupita hue vAtAdi doSa hRdaya ke srotasoM meM sthita hokara smRti kA apadhvaMsa karake apasmAra nAmaka roga ko utpanna karane meM samartha hue haiM / 2 - mithyA AhAra vihArAdi ke kAraNa dUSita hue vAtAdika doSoM ne AmAzaya meM pahu~cakara rasavahasrotasoM kA mArga grahaNa kiyA hai tathA koSThAmi ko bAhara nikAla kara jvara utpanna kara diyA hai / tathA 3 - kupita vAyu ne kapha ke sAtha prANacAhI srotasoM kA avarodha kara diyA hai aura phira vaha phuphphusoM meM sarvatra vicaraNa karatA huA zvAsa roga ko utpanna kara rahA hai / yahI nahIM, phira ina tInoM vyAdhiyoM meM prakAra jJAna karanA, doSoM ke kopa kI ThIka-ThIka sthiti kA patA lagAnA, kauna doSa svatantrarUpa se aura kauna paratantra hokara rogotpatti meM bhAga le rahA hai ise samajhanA, roga kitanI zakti ke sAtha zarIra meM sthita hai ise khojanA tathA tadrogoM ke kAraka doSoM kA prakopa kisa kAla meM adhika vA kama hotA hai tathA doSa kI jIrNatA vA nUtanatA kA paricaya pAnA Adi kucha aura mahatva ke tatra haiM jinako bhI sAtha hI jAnanA Avazyaka hotA hai / uparyukta sampUrNa jJAna vyaktivizeSa ke zarIra meM hone vAlI vyAdhi kA pUrA-pUrA citra cikitsaka ke samakSa upasthita kara detA hai jise jAnakara vaha rogI kI cikitsA kA, sAdhyAsAdhyatA kA tathA pathya kA vicAra saralatayA kara letA hai 1 doSoM kI prakupita avasthA kA ThIka-ThIka paricaya, zarIra ke aGgoM, pratyaGgoM aura avayavoM kI yatheccha jAnakArI ye sabhI isake lie paramAvazyaka hotI haiM / jisa prakAra mADarna cikitsAzAstra kA vidyArthI paithAlojI kA parijJAna karane ke lie kriyAzArIra (phijiyAlojI) evaM racanAzArIra ( enATomI ) kA jJAna anivAryatayA Avazyaka For Private and Personal Use Only

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samprAptivimarza 1041 mAnatA hai usI prakAra Ayurveda ke samprAptizAstra kI samyak jJAnopalabdhi ke lie doSoM kI sAmyAvasthA, doSoM ke prAkRtika sthAna, doSoM ke prAkRtika kArya, dhAtuoM kI samAvasthA, ani ke bheda, sirA, snAyu, kaNDarA srotasAdi AyurvedIya zArIra tathA doSa dhAtumalAdi vijJAna se paricita honA bhI nitAnta Avazyaka hotA hai / astu, samprApti samajhane ke lie zArIrarahasya jAnanA bhI apekSita hai / hRdayastha srotasoM ke jJAna ke binA apasmAra, prANavAhI srotasoM ke jAne vinA zvAsa kA tathA rasavAhI srotasa evaM koSTAni kI kalpanA ke sAkAra citra ko vinA hRdayaGgama kie jvara kA bodha nahIM ho sakatA / AyurvedIya pUrNatA kA spaSTa citra hameM usake svatantra zArIra aura svatantra samprApti vijJAna se milatA hai eka-eka roga ko lekara phira AcAryoM ne usake sambandha meM jo samprApti sambandhI vimarza diyA hai usako samajha kara yadi Adhunika vijJAna meM niSNAta bhAratIya vidvAn baiMTheM to bahuta kucha maulika prApta kara le sakate haiM / hamane grantha ke anta meM isa prakaraNa ko isalie diyA hai ki Adhunika paithAlojI ke tatvoM se paricita hone para samprApti ke sambandha meM upasthita varNana ko surucipUrvaka par3hA jA sakegA aura AcAryoM kA usase kyA abhiprAya hai usa para saralatayA pahu~cA jA sakegA / samprApti-paryAya samprApti, Agati aura jAti ye tIna zabda paryAya rUpa meM prayukta kie jAte haiM / isI ko nivRtti aura niSpatti bhI kahate haiM / gaGgAdhara kavirAja ne apanI jalpakalpataru TIkA meM, cakrapANidatta ne AyurvedadIpikAkhya vyAkhyA meM tathA indu ne aSTAGgasaMgraha kI zazilekhA nAmaka TippaNI meM samprApti kA yathocita bodha karAne kI bharasaka ceSTA kI hai / madhukozavyAkhyAkAra vijayarakSita tathA aruNadatta ne sarvAGgasundarI evaM hemAdri ne AyurvedarasAyana meM isa viSaya kA acchA jJAna pradarzita kiyA hai| hama nIce yaha saba avikala uddhRta karate haiM tAki isa sambandha meM jo Age hameM niSkarSa nikAlane haiM unameM sahAyatA mila sake gaGgAdhara kavirAja - eSa upazayaH pUrvarUpe prayukto bhaviSyad vyAdhiM bodhayati / utpanne vyAdhau prayukto varttamAnaM vyAdhiM bodhayati / jAyamAnantu vyAdhiM kiM bodhayati na vA'tha cedbodhayati kadA-kadA prayukto bodhayatItyataH samprAptimAha- samprAptirityAdi / samprAptirAgatirjAtirityanarthAntaraM vyAdheH iti / samprAptiriti ktic / jAtirityapi janerbhAve ktic / Agatirityapi Agame bhAve ktic / ya evArtho janeH sa evArthaH samprAbhyAmApeH sa eva AGpUrvaM bherityanarthAntaramityuktam / janI prAdurbhAve iti sattAnukUlavyApAro janidhAtvarthaH / janyarthasvarUpo bAhyabhAvaH / ktic pratyayArthaH / sa ca santAnukUlavyApArasvarUpaH / saditi / yataH sa sattA sadbhAvaH prakRtibhUtakAraNAnAM kalpAntareNa abhiniSpannAnAmanuvRttihetuH / utpanno yenottarakAlaM varttate sa svakAraNasamavAya patra sattA / sA sAmAnyaM vizeSazca / ArambhakaH dravyANAM svasvakriyAjanya punaH punaH saMyogavibhAgAbhyAM vikriyamANAnAM rUpAntareNa samAnaprasavAtmikA sattA sAmAnyaM jAtirucyate / yathA brAhmaNAnAM nikhilAnAM samAna eva prasavaH / asamAnaprasavAtmikA sattA pratyekazo jAtiH sAmAnyajanmanoriti sAmAnyajAtilakSaNam vizeSajAtistu pratirogaM vakSyate / utpannAnAM bhAvAnAM samavAyikAraNa samavAyo yAvantaM kAlaM varttante tAvantaM kAlaM teSAmutpatteranu pazcAdvattirityanuvRtterhetuH samavAyaH sattocyate / tasyAzca sattAyA anukUlavyApAraH prakRtibhUtadravyANAM svasvakriyAbhiH parasparaM punaH punaH saMyogavibhAgau janayitvA niSpAdyate tattat kAryANAM svarUpaniSpattau sarvAvayavasamavAya iti / zArIravyAdhyutpattau tu svakAraNaiH duSTAnAM doSANAM duSTihudhA, saMgraheNa dvidhA prAkRtI vaikRtI ca / prAkRtI yathA svalakSaNarttukasaMvatsarAddorAtra bhuktAMzakAlakRtacayaprakopau / vaikRtI For Private and Personal Use Only

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1042 vikRtivijJAna duSTiH punaH RtUnAM yathA svalakSaNahInAtiviparyayega yA duSTiniMdAnasevAbhizca sA ca dvidhA duSTirekazI dvizaH sarvazca / vRddhau kSaye ca / rajastamasozcaivaM duSTireko dvizazca / tatra zArIradoSANAM sAMsargikI duSTividhA prakRtisamaviSamasamavAyAbhyAM bhavati / tatra samasamavAyAt SaT paJcAzat , ekazaH SaDiti, vRddhikssyossissttidhaa| viSamasamavAyAt tu niyamo nAsti / evaM duSTo svabhAvAd yasmin vyAdhau yAvato duSTistAvatI saMkhyA tasya vyAdheH sarvaza iti sattAnukUlA saMkhyA vyaapaarvishessH| AgantujeSvapi saMkhyA sattAnukUlA vyApArabheda eva / doSANAM tathaiva duSTAnAM dvizo bahUnAJca prAdhAnyamaprAdhAnyaJca vyaapaarvishessH| prakArazca vyaapaarbhedH| nidAnasvabhAvena yAdRzasvabhAvo doSo bhavati sa tasya prkaarH| yAvatAMzena yasya doSasya cayaprakopau tatkalpanA ca vyaapaarbhedH| balakAlazca doSANAM vyaapaarbhedH| ityete doSANAM dRSyasaMyoge svasvakriyeva vyApArAstAnAha-sA saMkhyAprAdhAnyavidhivikalpabalakAlavizeSairbhidyate / iti / sa sattAnukUlA kriyAsamprAptiH saGkhyAdibhiH paJcabhirbhedarbhidyate / cakRpANidatta-yadyapi samprAptyanantaraM liGgaprAdurbhAvaH, tathApi samprAptairnirUpaNaM prati alpaprayojanAccheSataH smpraaptimaah-smpraaptirityaadi| jAtirjanma, samprAptyA gatijAtizabdai. ryo'rtho'bhidhIyate vyAdheH, sA samprAptirityarthaH / atraike vyAdhijanmamAtramantyakAraNavyApArajanyaM samprAptimAhuH / iyaJca samprAptiryadyapi nidAnAdivavyAdhibodhikA na bhavati, tathApi nAnutpannasya vyAdhelakSaNaM bhavatIti kRtvA utpatteAdhyupalambhakatvaM varNayanti / etaccAnye na manyante / yataH navaM sati samprAptitaH kazcid vizeSo vyAdheradhigamyate, na cA'yaM niyamaH yadutpanna eva paraM vyAdhirupalabhyate / yataH nidAnapUrvarUpAbhyAmanutpanno vyAdhi vitvena budhyate / tasmAdvayAdhijanakadoSavyApAravizeSayuktaM vyAvijanmeha smpraaptiH| paryAye 'AgatiH' ityuktam / AgatihiM utpAdakAraNasya vyAdhijananaparyantaM gamanam / iyaJca samprAptiAdhivizeSaM bodhayatyeva, yathA-jvare 'sa yadA prakupitaH pravizyAmAzayam' ityArabhya 'tadAjvaramabhinivartayati' ityantena yA samprAptirucyate tathA jvarasyAmAzayadUSakatvamagnyupadhAtakarasadUSakatvAdayo dharmAH pratIyante / na ca vAcyam-doSANAmayamAmAzayadUdhakatvAdidharmaH, tatazca kAraNadharmANAM nidAnagrahaNenaiva bhvtiiti| yataH kAraNadharmo'pyayaM vyAdhijanakadoSavyApArarUpaH samprAptizabdena vizeSabodhanArtha pRthak kRtvocyate / yathA-liGgatvAvizeSe'pi bhAvivyAdhibodhakatvavizeSAt pUrvarUpaM pRthagucyate / ataeva vAgbhaTe'pyevameva samprAptilakSaNamuktamyathA duSTena doSeNa yathA cAnuvisarpatA / nirvRttirAmayasyAsau samprAptirjAtirAgatiH / / iti / samprati samprAptaH prativyAdhivyaktibhinnAyAH sarvatra vyAdhau tatprayojanAbhAvAnna bhedo vaktavyA, yastUpayukto bhavati samprAptivizeSaH, tamabhidhAsyatyeva, sa yadA prakupitaH pravizyAmAzayam ityAdinA granthena, ataH sarvasamprAptyanabhidhAnAt nyUnatAdoSaparihArArthaM sarvavyAdhisAdhAraNAn samprAptibhedAnAha-sA saMkhyetyAdi / sA samprAptiH saMkhyAdibhibhidyate iti saMkhyAdibhinne vyAdhau bhinna bhavatItyarthaH, yataH na bhinnAnAM bhAvAnAmaminnotpattirbhavati, kiM tahiM bhinnaiva bhavati, yadyapi ca prativyAdhivyaktayapi samprAptibhinnaiva bhavati, tathApi sa bhedaH samprApteriha prayojanAbhAvAnnocyate; yataH saMkhyAprAdhAnyavidhyAditulyAsu jvaravyaktiSu eka rUpanidAnaliGgacikitsitAsu bhedapratipAdane na kiJcit prayojanamasti, saMkhyAdibhinne tu jarAdau nidAnaliGgacikitsAbhedo'sti, ataH saMkhyAdibhedajanikAyAH samprApta dakathanamucitameva / indu-atha kadAcinnidAnAdIni sAdhAraNatvAvyAmohAdanyato'pi vA nimittAdAtaGkasya svarUpamasamathitAni pradarzayituM tataH samprAptyA vyAdhivizeSaM bhiSagavagacchet / atha kA punariyaM samprAptirnAma bhavatIti yA hi janAnAM paddhatiriva gadAnAM nidAnAdibhiradhigatAnAmapi sarveNa prakAreNa svarUpaniHzeSanirAkAGakSatAmAvahati / iyamucyate-evaM duSTodoSastena caivamAragdho vyAdhi ityAdinA / For Private and Personal Use Only

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samprAptivimarza 1043 evamityanena prakAreNa prakArazcAhitavizeSasevanAdbahurUpaH / tathA ca tadevaikaM dravyaM tameva cai svakAryabhUtamanyatamaM doSaM prakRtyAdInAM nAnAvidhavizeSApekSayA kadAcillAghavena kopayati kadAcidraukSyeNa / kadAcit kAThinyena, kadAcidajIrNana, kadAciddoSAntaraprakopeNa, kadAcicchaityena, kadAcidanyena vA yathAsambhavaguNavizeSeNeti / tathA vizcidravyamUrdhvabhAgikaM bhavati tadanyathA doSaM kopayati / kiJcidadhobhAgikaM tadanyathA anyadubhayabhAgikaM tadrUpAntareNa / etasmAcca kAryavizeSAdevaM duSTo doSa iti jJAyate-na hi maricasya raukSyeNa yo duSTo vAyuryazca tasyaiva lAghavena tAvekarUpau bhavitumarhataH / rokSyeNa hi kupito raukSyamevAtmaguNamupabRMhayaMstadanuguNAnyeva kAryANi kAThinyopazoSaNAdIni kurute| lAghavena ca kupitaH pavano rUpamanuvardhayan lAghavAdInyeva pradarzayati / evaM sarvamapyUhyam / saMmoha, bhayAdvistareNa na pratanyate / tathA ca idameva tAvadRzyatAm / iha hi prAbhaanaprakopakAraNaM tiktakaTukaSAyarUkSalaghuzItaviSTambhivirUDhakatRNadhAnyAdi bahuvidhaM nirdiSTam / yatra yastiktarasena dravyeNa kopaH sa eva kiM kaTukenAnyena vA virUDhakAdinA bhavati / dravyANAmanekakAraNArabdhatvAt / tathA yo'pi paTolAta kopaH sa eva na trAyantIvAlakAdipratyayatAmupayAti / na caivamekaM dravyamekasyaiva doSasyAyatana bhavati / yatastadravyamanucitena mAtrAdivizeSeNa prayuktaM sadyathoktena guNena kiJcit kopayati / tathA guNAntareNa / sadRzeNa vilakSaNena vaa| prabhAvAdibhirvAtameva doSAntarameva vA prakopayitaM kiM bandhuvargeNa kAritazapatham / tenaikasminnapi doghe kupite vyAdhikAriNi cAnyo doSo hetvAdyapekSaM kadAcinmAtrayA tasya vyAdheH samutthAnatAmaprApto'pi vikAravizeSamApanno bhavatyeva / tathA ca tantreSu dRzyate / jvaracikitsite tAvat 'kapAyapAnapathyAnnairdazAha iti lavite / sarpirdadyAt kaphe mande vAtapittottare jvare / pakkeSu dopeSvamRtaM tadviSopamamanyathA / dazAhe syAdatIte'pi baropadvavRddhikRt / laGghanAdikramaM tatra kuryAdAkaphasaMkSayAt' // (aM. saM. ci. aM. 1 ) 'dehadhAtvabalatvAcca jvaro jiirnno'nuvrtte| rUkSaM hi tejo jvarakRt tejasA rakSitasya ca / vmnsvedkaalaambukssaaylghubhojnaiH| yaH syAdatibalodhAtuH sahacArI sadAgatiH // (aM. saM. ci. aM.2) ityAdi / idameva tAvadvicAryatAM kiM tridoSajameva jvaramadhikRtyetaducyate / AhosvitsAmAnyena / yadi tridoSajAdhikAreNetyucyate tanna / AprakaraNamavizeSapAThAdyathoktAsambhavAcca / athavA sAmAnyena / tatraikadoSAbhimatarogapakSe kathaM yathoktasambhavaH ? yato jvarakAraNe kaphe vamanAdibhiH kSINe tatkAryaJca jvaro'pi kathaM na kSIyate |anpcito'pi vA kimiti svakAraNadoSaviparItadoSAntarakAraNatAmekadaivAsAdayati / uktaM caitat 'prayogaH zamaye vyAdhi yo'nyamanyamudIrayet / nA'sau vizuddhaH zuddhastu zamayedyo na kopayet // ' (ca. ni. 8-23 a. saM. sU 21 iti) tasmAnnApi kriyApAdahAnau vyAmUDhakacikitsakaviSaye caitaducyate anavasthAprasaGgAt / evamekedoSajeSvapi rogepu doSAntaraM samprAptyabhimukhaM bhavatyeva kAlAdikaM sahAyamAsAdya nAnAvidhavikArakaraNAya viz2ambhata iti / na cAnekamapi dravyamekenaiva rUpeNaikasya doSasya kAraNaM bhavati / tasmAdanena prakAreNa duSTo doSa iti jnyaayte| kathamanena duSTenA'pi satA vyAdhirArabhyata iti viklpyte| tasmAd duSTo doSo doSakAraNa vizeSavazAdanyathA cAnyathA ca vikArahetutAmanugRhNAti / tathA sa eva doSaH sakalaM zarIramanusaran viziSTabheva rogamabhinivarttayati / ekatrAvasthito'pi viziSTadoSAntareNa bihataprasaro'nyaM doSAntaramanugatonyamityevamAdinaiko'pi doSo nAnAvidhavikAra karaH sampadyate yena sa evaM vAyuH kadAcit jvaramabhinivartayati kadAcitkuSThAdikamiti / eSA samprAptI rogavizeSAdhigame For Private and Personal Use Only

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1044 vikRtivijJAna hetuH| yasmAdyadaivaM jJAyate yathA'nena nidAnavizeSeNa yo doSaH kupitaH sa ca kAraNavazAdasmin dehesvata evaM vyApAro'nenAnugatazca vartate / evaM vidhazcAsya rogavizeSasya samprAptivizeSaH pradarzitastadAvazya. mevA'dhigamyate, ayaM roga utpanna iti / etAni nidAnAdIni paJca parasparasamanvitAni vyAdhivizepAdhigamane nirAkAGkSatAmanubadhnanti / / vijaya rakSita-nAnAvidhA hi doSANAM duSTiH / prAkRtI vaikRtI vA anubandhyarUpA anubandharUpA vA, ekazo dvizo vA samastA vA, raukSyAdibhiH sarvairbhAvairalpairvA evamAdiduSTiduSTena doSeNa yA Amayasya rogasya nirvRttirutpattiH sA samprAptirucyate / yathA caanuvisrpteti| anekadhA doSANAM visarpaNaM gatirUvA'dhastiryagAdibhedena tathA visarpatA / samprAptiparyAyAvAha zAstre vyavahArArtha lakSaNArtha ca jAtirAgatiriti / jAtyAdibhiH zabdo'bhidhIyate sA samprAptiriti / jAtirAgAti janmApi jJAnakAraNam , ajAtasya jJAnAbhAvAt / ityAha bhttttaarhricdrH| etenaitaduktaM bhavati-na hi nidAnAdivadvodhakatvena jJAnakAraNatvaM kintu bodhaviSayatvena / tanna / ityanye, AlokacakSurAderiva evaM vidhsmpraaptishcikitsaayaamnupyogaat| na cAsti niyamo jAtameva vijJAyata iti, ajAtasya vyAdheniMdAnapUrvarUpAbhyAM vRSTayAderiva meghAdinA zAyamAnatvAt / atha jAtamiti janmAvacchinnamucyate, vRSTayAdikaM ca bhaviSyajanmAvacchinnameva, yasya tu kAlatraye'pi janma nAsti tanna jJAyata eva; tathA'pi na vyAdhijanma samprAptiH, janmAdAlokAccakSurAde'pi vAcyatvAyattaH, tairapi vinA jJAnAbhAvAt / tasmAddopetikartavyatopalakSitaM vyAdhijanmasamprAptiH na tu kevalaM janmeti bhttttaarhricndraabhipraayH| vAgbhaTenA'pi 'yathA duSTana ityAdi vadatA viziSTameva vyAdhijanmasamprAptiruktAH, tathA ca sati kriyAvizeSo labhyate; yathA-jvare AmAzayadUSaNAgnihananAdibodhe laGganapAcanasvedAdikaraNamiti / samprAptizcaivaM vidha yadyapi doSANAmavAntaravyApAratvena doSagrahaNenaiva prApyate tathA'pi cikitsAvizeSArthameva pRthaka kriyate, yathA--jJApakatvAvizeSe'pi pUrvarUpameva rUpAt pRthagiti / tasmAddoSetikartavyatopalakSitaM vyAdhijanma samprAptirityeva lakSaNam // ___ aruNadatta-yena prakAreNa duSTaH-kupito, vAtAdyanyatamo doSo yathAduSTaH, tena yathA duSTana doSeNa yathAcAnuvisarpatA-dehamanudhAvatA sannivezavizeSeNa gacchatA, pratyAmayaM vA nivRttiH-niSpattirudbhava iti yAvat, nirdiSTA sA smpraaptiH| sA ca jAtirAgatizca kathyate / yathA jvara sya-'malAstatra (hR. ni. a. 2 / 3 ) ityAdi lkssnnlkssitaa| tatra tatra malAnAmAzayapravezanena, tathA''mAnugamanena, tathA srotorodhena, tathA paktisthAnAjjvalananirasanena, tathA tenaiva jAThareNa vahninA teSAmabhisarpagena, tathA sakaladehatApena, gAtraM cAtyuSNaM kurvatA, evaM vidhayA samprAptyA jvaro'yamiti nishciiyte| evaM raktapittAdiSvapi cintyA smpraaptiH|| hemAdri-samprApti lakSaNamAha-yathA duSTeneti / yathA yena prakAreNa nivRttiH asau prakAraH samprAptiH / sa ca prakAro duSTatvena (saM) calitatvena ca / rUpahAnirvA rUpavRddhiA rUpAntaraM vetyAdi dusstttvprkaarH| saMcalitatvena vA vegena vA mArgAntareNa vA gatirityAdi saJcalitatvaprakAraH samprApteH paryAyau jAtirAgatizca / gaMgAdhara kavirAja ne-samprAptirjAtirAgatidityanAntaraM vyAdhe : sA saMkhyAprAdhAnyavidhivikalpabalakAlavizeSaibhiMdyate // nAmaka caraka nidAnasthAna adhyAya 1 ke paJcamasUtra kI vyAkhyA karate hue nimna vicAra samprAptiparaka prakaTa kie haiM____-upazaya pUrvarUpa meM prayukta kiyA jAne para bhaviSyatkAlIna vyAdhi kA jJAna detA hai| vyAdhi ke utpanna ho jAne para prayukta karane para vartamAna vyAdhi kA bodha karAtA hai| parantu jAyamAna (utpanna hone kI kriyA meM saMlagna) vyAdhi kA kauna jJAna karAtA hai ? bodha kA koI sAdhana hai ? hai bhI yA nahIM hai ? aura yadi usakA jJAna hotA bhI hai to kaba For Private and Personal Use Only

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samprAptavimarza 1045 prayukta karane para hotA hai ? isI prazna kA samAdhAna samprApti se hotA hai / ataH samprApti kA varNana caraka meM kiyA gayA hai / 2 - samprApti Agati * jAti ye tInoM vyAdhi ke anarthAntara ( paryAya ) ko spaSTa karate haiM / samprApti bhAve ktic, jAti janerbhAve ktic Agati AgamerbhAve ktic se banate haiM / jana kA jo artha vahI ApakA bhAva hai aura vahI gama kA tAtparya hai / jana prAdurbhUta hone ke liye prayukta hotA hai / jana meM ktica lagAne se jAti zabda banatA hai / gama meM AG upasarga lagAkara ktica pratyaya se Agati banatA hai Agama kA artha AnA hai / samprApti meM saM upasarga aura ktica pratyaya Apa meM jor3anA par3atA hai / Apa kA tAtparya pahu~canA yA vyApta honA hai / astu tInoM kA bhAva eka hI hai / 3 - janI prAdurbhAve se jani dhAtu kA artha sattAnukUlavyApAra mAnanA cAhie / prAdurbhAva arthAt bAhyabhAva bAhara kI ora Ane kI preraNA aisA spaSTa hotA hai / ataH samprApti sattAnukUlavyApAra kA svarUpa hotA hai| zarIra meM roga hone para jo sattA doSoM kI hai usake anukUla AcaraNa kA prAkaTya hI samprApti mAnA jA sakatA hai| kyoMki prakRtibhUtakAraNoM kI abhiniSpatti ke rUpAntara mAtra se sadbhAvarUpa satata hetu banatA hai / utpanna huI jinase bAda meM vaha svakAraNasamavAyarUpasattA hotI hai / yaha samavAyarUpasattA sAmAnya sattA aura viziSTa sattA ina do rUpoM meM prakaTa hotI hai / ArambhakarttA padArthoM se unakI apanI-apanI kriyA se utpanna unake bAra-bAra saMyoga vA vibhAga se anya anya rUpa meM utpanna hone vAlI samAnaprasavAtmikA sattA sAmAnyajAti kahalAtI hai / prakRta kAraNa jinakI prakRti samAna hotI hai unake milane aura pRthaka hone ke paunaH punya se jo samAnaprasavarUpa kriyA hotI hai usame sAmAnyajAti kA nirmANa hotA hai / jaise sampUrNa brAhmaNavarga samAna prasavAtmaka hone se sAmAnya jAtirUpa meM kahA jAtA hai | asamAnaprasavAtmika sattA pratyeka vyakti ke janma kA bodha karAtI hai / jaise eka-eka brAhmaNa kA janma alaga-alaga hotA hai / sAmAnyajanmanA jAti kahI jAtI hai / yaha sAmAnya jAtilakSaNa huA / vizeSa jAti pratiroga ko kahA jAvegA / utpanna hue bhAvoM kA samavAyikAraNa samavAya jitane kAla taka rahatA hai usa kAlataka unakI utpatti rahatI hai / pazcAdvartI anuvRtti kA kAraNa samavAya hai jise sattA kahate haiM / usa sattA ke anukUla vyApAra prakRtibhUta Fort kI apanI-apanI kriyAoM se paraspara bAra-bAra saMyoga-vibhAga utpanna karake karAyA jAtA hai / una-una kAryoM ke svarUpanirmANa meM sarva avayavajanya samavAya hI mukhya hai / 4- zArIrika vyAdhi kI utpatti nija nija kAraNoM se duSTa hue doSoM kI duSTi se hI bahudhA hotI hai / vahI saMgraha se prAkRta tathA vaikRta do prakAra kI hotI hai / prAkRta duSTi R varSa dina, rAtri, bhuktAMza kAla ke dvArA kiye gaye prakRta apane lakSaNoM se utpanna saMcaya aura prakopa kI svAbhAvika avasthA vaikRta dRSTi se tAtparya usa asvAbhAvika avasthA se hai jo Rtu Adi ke apane svAbhAvika lakSaNoM ke hIna viparyaya, ati viparyaya vA mithyA viparyaya se athavA duSTa nidAnake sevana se banatI hai / yaha vaikRtI duSTi bhI punaH do prakAra kI hotI hai| eka-eka, do yA saba uparokta kAraNoM ke kSaya vA vRddhi se utpanna aura dUsarI - raja va tama ke akele yA donoM ke sammilana se utpanna hotI hai / 6- zArIrika doSoM ke saMsarga se utpanna huI yaha duSTi bhI do prakAra kI hotI hai eka For Private and Personal Use Only

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1048 vikRtivijJAna gamana karanevAlA hone se usa prakAra se kArya karatA hai / isa prakAra kArya vizeSa se duSTa hue doSa kA jJAna kiyA jAtA hai / marica ke raukSya se jo duSTa huA vAyu aura jo usake hI lAghava se ve donoM eka rUpa ko nahIM prApta hote haiM / raudaya se kupita raukSya apane hI ke guNavAle se upabRMhita hotA hai aura kAThinya, upazoSaNAdi kArya karatA hai| lAghava dvArA kupita huA pavana lakSaNoM ko bar3hAtA huA lAghavAdika dvArA hI pradarzita hotA hai / isI prakAra sabhI kI kalpanA kara lenI cAhie / isI prakAra aura bhI dekheM / 4 - yahA~ jo vAyukopakAraka tikta-kaTu-kaSAya- rUkSa- laghu-zIta-viSTambhi- virUDha tRNadhAnyAdi kA bahuta-sA varNana kiyA gayA hai vahA~ jo tiktarasapradhAna dravya se kopa utpanna huA hai vaha kaTu ke yA anya ke dvArA kaise ho sakatA hai ? kyoMki dravyoM kI kAraNArabdhakatA aneka prakAra kI hotI hai / isI prakAra jo paTola ke kAraNa vAyu kopa hai vaha trAyamANa- bAlakAdika ke dvArA kAraNatA nahIM prApta karatA hai / 5 :- aura na eka dravya eka hI doSa kI utpatti kA Ayatana hotA hai / ataH kisI dravya kA anucita mAtrA meM upayoga karane para jaisA guNa usakA likhA hotA hai tadanusAra thor3A kopa karatA hai usI prakAra usameM guNAntara hone se, sAdRzya se, vilakSaNatA hone se athavA prabhAva ke kAraNa vahI doSAntaroM meM prakopa karane ke lie apane bandhuvarga meM usane koI zapatha thor3e hI khA rakhI hai| isa prakAra eka meM bhI doSa kA kopa hone se vyAdhikAraka anya doSa nidAnAdi kI apekSA karake kisI na kisI mAtrA meM kama yA adhika usa vyAdhi ke samutthAna ( utpatti ) kI aprApti hone para bhI vikAra- vizeSa ko vyApti ho jAtI hai / tantroM meM aisA hI dikhalAI detA hai / tathA'kaSAyapAna pathyAnnairdazAha iti laGghitaM' Adi / 'dehadhAtvabalatvAcca jvarojIrNo'nuvartate' Adi / 6--yaha bhI taba taka vicAraNIya hai ki kyoM tridoSajajvara ko lekara aisA kahA gayA hai / yadi tridoSajAdhikAra ke kAraNa yaha kahA hai so nahIM hai / prakaraNa ke anusAra avizeSa pATha tathA yathokta ke asambhava hone ke kAraNa athavA sAmAnya se bhI yaha siddha hotA hai / vahA~ to ekadoSAnusAra rogotpatti batalAI gaI hai phira yathokta kaise sambhava hai ? ataH jvara ke kAraNarUpa kapha ke vamanAdika dvArA kSINa ho jAne para bhI usakA jvara kyoM kSINa nahIM hotA ? anapacita hone para bhI svakAraNadoSa ke viruddha doSAntarakAraNatA utpanna hotI hai| jisake lie 'prayogaH zamayed vyAdhiH' kA udAharaNa diyA gayA hai| usase cikitsApAda kI hAni nahIM hai / vaha to vyAmUDhaka cikitsA ke viSaya meM kahA gayA hai| anavasthA prasaGga Ane se / 7 - eka hI doSa ke dvArA utpanna rogoM meM doSAntara samprApti kI ora abhimukha karatA hai vahI kAlAdika kI sahAyatA ko prApta karake nAnA prakAra ke vikAroM ko utpanna karatA hai aura na anekoM dravya ekarUpa dhAraNa karake eka hI doSa kA kAraNa hotA hai / ataH isa prakAra duSTa hue doSa kA jJAna karanA cAhie ki kisa prakAra isa doSa kI duSTi se rogArambha huA hai / isa taraha duSTa huA doSa doSakAraNavizeSa ke vaza meM hokara anya anya vikArahetutA ko grahaNa karatA hai aura vahI doSa sampUrNa zarIra kA anusaraNa karatA huA viziSTa roga ko utpanna kara detA hai / 8 - eka sthAna para avasthita hone para bhI viziSTa doSAntara hone para prasArita hokara anya doSAntara meM jAkara aneka doSa bhI nAnAvidha vikAra utpanna kara detA hai / vahI vAyu kabhI jvara kabhI kuSThAdi utpanna kara dete haiM / For Private and Personal Use Only

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samprAptivimarza 1046 yaha samprApti rogAdhigama kA hetu hai| isIlie ise adaivajanya jAnanA caahie| yathA isa nidAnavizeSa se jo doSa kupita huA hai vahI kAraNavaza isa deha meM svataH vyApAra se isake andara pAyA jAtA hai| isa prakAra rogavizeSa kI samprApti vizeSa pradarzita hotI hai / usI se yaha roga utpanna huaa| ye paJcanidAna paraspara samanvita hokara vyAdhivizeSa ke jJAna meM nirAkAMkSatA utpanna kara dete haiN| vijaya rakSita-madhukozavyAkhyAkAra zrI vijayarakSita ne yathA duSTena doSeNa yathA cAnuvisarpatA, nivRttirAmayasyAsau smpraaptirjaatiraagtiH| kI vyAkhyA karate hue nimna tathyoM kA udghATana kiyA hai 1-vividha doSoM kI prAkRti aura vaikRtI yaha do prakAra kI duSTi huA karatI hai| vaha anubandha tathA anubandhya karake do rUpoM meM dRSTigocara huA karatI hai| vaha eka, do yA saba doSoM se bhI utpanna hotI hai tathA rUkSAdi sampUrNa bhAvoM ko vyApta karake yA kucha thor3e bhAvoM ko lekara calatI hai| isa prakAra ina Adi duSTiyoM se dUSita doSoM ke dvArA jo roga kI nivRtti yA utpatti hotI hai vahI samprApti kahalAtI hai| 2-dooM kA visarpaNa bhI kaI prakAra kA hotA hai| yaha unakI gati hai jo UrdhvaadhaH athavA tiryaka dizA avalambinI hotI hai| 3-zAstravyavahAra ke lie athavA lakSaNajJAna ke lie isa samprApti ke anya paryAya bhI calate haiM / jaise-jAti tathA aagti| jAti aura Agati abdoM se jo prakAra upalakSita hotA hai use hI samprApti mAnanA cAhie / ___4-bhaTTAraharicandra-janma ho cukA hai jisa vastu kA usako bhI jJAna meM kAraNa mAnate haiM kyoMki jo utpanna nahIM huA usake viSaya meM ajJAna hone se| isa dRSTi se jisa roga kA janma ho cukA hai| vahI jJAna kA kAraNa hai vahI samprApti hai aisA unakA kathana hai| isase yaha upalakSita hotA hai ki nidAna se isa prakAra jo avabodha hotA hai vaha jJAnakAraNatva nahIM hai balki bodha viSaya kI spaSTa upasthiti vA janma hI usakA kAraNa hai| 5-ise anya AcArya nahIM mAnate / unakA kathana hai ki netra aura prakAza bhI vyAdhijJAna ke kAraNa hone para bhI cikitsAdRSTi se unakI upAdeyatA zUnya hai / isI prakAra cikitsA meM samprApti kevala jJAna ke lie hI apekSita hai| cikitsA meM usakA koI upayoga nahIM hai| aura yaha bhI koI niyama nahIM hai ki utpanna vastu kA jJAna bhI ho ske| dUsarI ora AkAza meM meghAdika ke ghira jAne se jaise honevAlI varSA kA jJAna hotA hai usI prakAra nidAna aura pUrvarUpAdi se bhAvI vyAdhi kA jJAna ho jAtA hai| isIlie jAta arthAt janmAvacchinna (janma liyA huA) kahA jAtA hai| varSA Adika bhaviSyajanmAvacchinna hote haiN| 6-jisakA ki tInoM kAloM meM bhI janma nahIM honA use nahIM jAnA jA sktaa| phira bhI vyAdhijanma mAtra samprApti nahIM hai / janma ke samAna prakAza cakSu Adi ke vAcyatva meM Apatti hone ke kaarnn| unase bhI vinA jJAna ke abhAva ke kAraNa athavA jAta isa vijJAna ke abhAva se| isalie doSoM kI karttavyatA se upalakSita vyAdhi kA janma hI samprApti mAnA hai| bhaTTAraharicandra kI taraha janmamAtra samprApti kI kalpanA amAnya hai| For Private and Personal Use Only

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2050 vikRtivijJAna __7-vAgbhaTa ne bhI 'yathA duSTena doSeNa ke dvArA viziSTa vyAdhi ke janma ko hI samprApti svIkAra kiyA hai| aura vaha vyApAravizeSa dvArA hI sUcita hotI hai| jaise jvara meM AmA. zaya dUSaNa, agnihahana Adi jJAna se laMghana, pAcana, svedAdi kAryoM kI vyavasthA kI jAtI hai| 8-isa prakAra doSoM ke avAntara vyApAra se doSa grahaNamAtra se samprApti kI prApti ho jAtI hai tathApi cikitsA vizeSa ke lie isakA pRthaka vicAra bhI kiyA jAtA hai| jaise pUrvarUpa aura rUpa donoM ho vyAdhi kA jJAna karAnevAle hone se samAna haiM phira bhI cikitsA vizeSa kI dRSTi se unakA alaga-alaga nirdeza kiyA jAtA hai| kyoMki vyAdhi kI pUrvarUpAvasthA meM jo cikitsA kI jAtI hai vaha rUpAvasthA kI cikitsA se avazya kucha bhinna hotI hai| isalie vijaya rakSita ne doSetikartavyatopalakSita vyAdhijanma ko hI samprApti mAnA hai| aruNadatta-ne bhI 'yathA duSTena doSeNa' para apanA mata prakaTa karate hue likhA hai kijisa bhI prakAra se kupita huA vAtAdi anyatama doSa duSTa hokara zarIra meM vizeSatayA praveza karake anugamana karatA hai to usake dvArA jo rogotpatti hotI hai arthAt doSa praveza se rogotpatti paryanta yAvatI jo bhI kriyA hotI hai vaha samprApti kahalAtI hai| jaise ki jvara meM mala (doSa)AmAzaya meM praveza karake, Antra meM anugamana karake tathA srotorodha se evaM paktisthAna meM sthita agni ko nikAlakara sampUrNa zarIra meM usako prasarpaNakara sakala deha ko taptakara gAtra kI atyuSNatA karate haiM yaha jvara kI samprApti kahI jAtI hai| isI prakAra raktapittAdika kI bhI kahI jA sakatI hai| hemAdri-jisa prakAra se roga kI nivRtti ( utpatti ) hotI hai usI ko samprApti mAnatA hai / usa vidhi se duSTa doSoM ke saMcalana se lakSaNahAni athavA lakSaNavRddhi athavA rUpAntara hotA hai| vega se duSTa doSa kA zarIra meM saMcalana yA mArgAntara gati hI samprApti hai| ina saba vidvajanoM ke dvArA kie gaye sUkSmAtisUkSma vivecana se zAstrIya sUtra kA kyA artha hai isakA bodha ho jAtA hai| mUla tatva eka hI hai ki duSTa hue doSa zarIra meM jisa prakAra anusarpaNa karate haiM aura roga kI utpatti meM samartha hote haiM doSoM ke usa calacitra vA sthiti ko samprApti mAnA jAtA hai| samprApti ke bhedoM ke sambandha meM likhA haisaGkhyAvikalpaprAdhAnyabalakAlavizeSataH / sA bhidyate, yathA'traiva vakSyante'STau barA iti // doSANAM samavetAnAM vikalpoM'zAMzakalpanA / svAtantryapAratantryAbhyAM vyAdheH prAdhAnyamAdizet // hetvAdikAtyAvayavairbalAbalavizeSaNam / naktaMdinartubhuktAMzAdhikAlo yathA malam // -a. hR. ni. sthA. 1 isake sambandha meM madhukoza vyAkhyA tathA usa para jo vimarza caukhambA saMskRta pustakAlaya dvArA prakAzita zrI paNDita sudarzana zAstrI dvArA likhita aura AcArya paM0 yadunandanajI upAdhyAya dvArA sampAdita mAdhavanidAna meM diyA gayA hai use bhI avikala prakaTa karanA abhISTa hai tasyA aupAdhikabhedamAha-saMkhyetyAdinA sA midyata ityantena / atra ca prAdhAnyopAdAnAdaprAdhAnyaM ca tatpratiyogitayA boddhavyam , ata eva ca vivaraNe svAtantryapAratantryAbhyAmiti vakSyati / evaM bale'pi vyAkhyeyam saMkhyAdikameva vivRnnoti-ythetyaadi| aSTau jvarA iti saMkhyAvivaraNam / aSTatvaM ca vAtAdikAraNabhedAt ; ekajAstrayo, dvandvajAstrayaH, sannipAtaja eka, Agantu For Private and Personal Use Only

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samprAptivimarza 1051 caika iti / yadyapi vRddhairdoSaiH sannipAtAtrayodaza, yaduktaM carakeNa - 'dvayalbuNaikolbaNaiH SaT syuhIna - madhyAdhikaizca SaT / samaizcaiko vikArAste sannipAtAtrayodaza' ( ca. sU. a. 17 ) iti tathA'pyatra tridoSajatvasAmAnyAt sAnnipAtika ekatvena gaNitaH / evaM kAmazokabhayAdyanekakAraNajo'pyAgantuja AgantujatvasAmAnyAdekatvena nirdiSTa ityaSTau jvarA iti / vikalpaM vivRNoti - doSANAmityAdi / samavetAnAM parasparasaMbaddhAnAM tena dvandvasannipAtayorgrahaNam / aMzAMzakalpaneti - aMzA vAtAdigataraukSyAdayaH tairekadvivyAdibhiH samastairvA vAtAdikopAvadhAraNakalpanA : yaduktaM suzrute - 'sarvairbhAvaistribhirvA'pi dvAbhyAmekena vA punaH / sasarge kupitaH kruddhaM doSaM doSo'nudhAvati -' iti ( su. sU. a. 21 ) / evaMvidhaJca dopakopo nidAnavaicitryAdbhavati / tadyathA - vAtasya raukSyazaityalAghavavaizadyAdiguNasya evaMguNaH kaSAyarasaH kalAyaca sarvairbhAvairvardhakaH, raukSyazaityalAghavaistaNDulIyakaH, raukSyazaityAbhyAM kANDekSuH, zaikSyega sIdhuH; tathA pittasya sarvairbhAvaivardhakaH kaTuko raso madyaM ca, hiGgu kaTUSNatIkSNatvaiH, dIpyakastaiupayoSNyAbhyAm, auSNyena tilAH; tathA ileSmaNaH sarvairbhAvairvardhako madhuro raso mAhiSaM ca payaH, snehagauravamAdhurye rAjAdanaphalaM kazeruH zaityagauravAbhyAM zaityena kSIriNAM phalAnIti / aparaguNodAha prakArA jejjaragadAdhara vApya candravyAkhyAvizeSAzca vistaratvApattaratra na likhitAH / prAdhAnyaM vivRgoti-svAtantrya pAratantryAbhyAmiti / anubandhyAnubandha bhAvenetyarthaH / atrApi 'doSANAM samavetAnAm ' ityanuvartanIyam / 'aprAdhAnyaM ca' iti zeSaH, gamyamAnatvAnnopadazitam / tena svAtantryAt prAdhAnyaM, pAratantryAdaprAdhAnyamiti sidhyati / valaM vivRNoti - hetvAdItyAdi / hetupUrvarUparUpANAM sAkalyAdvayAdherbalavattvaM teSAmavayavenaikadezenAbalavattvam / kAlaM vivRNoti - naktamityAdi / naktaM rAtriH, dinamahaH, Rtavo vasantAdayaH, bhuktamAhAraH, eSAmaMzairekadezaiH; vyAdhikAlo vyAdhivRddhihAnihetuH kAlaH / atra, RtoraMzAH katipayAnyahorAtrANi, yadAha vAgbhaTaH - 'RtvorantyAdisaptAhAvRtusaMviriti smRtaH iti ( vA. sU. a. 3 ); saMvatsararUpasya kAlasya RturUpoM'zaH RtvaMza ityevamapi yojyaM, natvekasya RtordinAdivadAdimadhyAntA RtvaMzAH, RtoH samuditasya tatra kAraNatvenotatvAt / yathAmala yathAdoSaM; tadyathA - rAtrerAdau zleSmA, madhye pittaM, zeSe vAyuH evaM dinasya; vasante kaphasya, zaradi pittasya, varSAsu vAyoH evaM bhuktAdau bhuktamAtre kaphasya, madhye pacyamAnAvasthAyAM pittasya, ante samyakpariNate bhukte vAyo prakopa iti / taduktaM vAgbhaTenaiva - 'te vyApino'pi hannA - bhyoradhomadhyordhvasaMzrayAH / vayo'horAtribhuktAnAM te'ntamadhyAdigAH kramAt' iti ( vA. sU. a. 1 ) / atra te iti krameNa vAtapittazleSmANaH / nanu, saMprAptibhede carakeNa saMkhyAdivadvidhirapyuktaH; yathA'dvividhA vyAdhayo nijAgantubhedena' (ca. ni. a. 1 ); 'trividhaM raktapittam' ( ca. sU. a. 19 ) ityAdi; tat kuto'tra vidhirnoktaH ? ucyate, saMkhyAgrahaNena vidheravarodhaH, tasyAvyabhicaritasaMkhyAyogitvAt / vidhisaMkhyayozcAyaM bhedaH - vidhirhi prakAraH, sa cAbhinnajAtIyAnAmeva kasyaciddharmAntarasyAnvayAdbhavati, yathA- raktapittatvAvizeSe'pyUrdhvagAdiprakAro bhavatiH saMkhyA tu bhinnatvamAtre'pi; yathA - catvAro ghaTAH, aSTau jvarA iti / atraiva vidhirhi prakAraH, sa ca bhinneSu na yuktaH, ataH saMkhyAdibhinneSu vyAdhiSu kAraNadharmAnugataH prakAro yujyate / tathA ca nyAyavido bruvate - 'samAnena dharmeNa parigraho bhedAnAM yatra kriyate sa vidhiH, saMkhyA tu bhedamAtram' iti; vaiyAkaraNA apivyAcakSate - 'anvayavAn prakAraH, niranvayo bhedaH' iti vApyacandro likhitavAn / nanu yathAM'zAMzavikalpanAdinA jvaro jJAyate na tathA saMkhyayA / ucyate - saMkhyA bhedena vyAdherdoSabhedo jJAyate, yato jvarAdikaM svarUpato jJAtvA cikitsArthaM vizeSo jijJAsyaH, katamo'yaM jvaraH ? iti tasmin jJAte vizeSo bhavatIti paraMparayA kAraNatvaM saMkhyAyAH / tatra yadyutpadyamAna evAsau doSabhedAdbhinno jA (jJA ) tastato yuktamasya paryeSaNaM - katamo'yamiti / kutaH ? cikitsAvizeSArtham / iti saMprAptilakSaNam // 11-13 // saMkhyA, vikalpa, prAdhAnya, bala aura kAla kI vizeSatAoM ke AdhAra para samprApti ke bheda kiye jAte haiM / jaise Age ( jvaranidAna meM ) kaheMge ki jvara ATha hote haiM / ( yaha For Private and Personal Use Only

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1052 vikRtivijJAna saMkhyAsamprApti huI ), rogotpatti meM kAraNabhUta doSoM kI aMzAMkalpanA (nyUnAdhikya Adi vivecana)vikalpa samprApti, svatantratA aura paratantratA dvArA doSoM kA prAdhAnya yA aprAdhAnya vivecana prAdhAnya samprApti, hetu, pUrvarUpa aura rUpa kI sampUrNatA yA alpatA ke dvArA bala yA abala kA vivecana balasamprApti aura doSAnusAra rAtri, dina Rtu evaM bhojana (ke paripAka) ke aMza (Adi, madhya aura anta ) dvArA rogakAla kA jJAna kAlasamprApti sama. jhanA caahie| vimarzaH-saMkhyA, vikalpa prAdhAnya, bala tathA kAla bheda se samprApti kA bheda hotA hai| Age kramazaH unake lakSaNa evaM udAharaNa diye jAte haiM 1. saMkhyA samprAptiH-jisake dvArA rogoM ke bhedoM kI gaNanA kI jAtI hai usako saMkhyA samprApti kahate haiM / yathA-Age kahA jAyagA ki jvara ATha prakAra ke hote haiN| caraka ne bhI kahA hai'saMkhyA tAvadyathA-aSTaujvarAH, paJcagulmAH sapta kuSThAnyevamAdiH (ca0 ni0 1112) 2. vikalpasamprAptiH-vyAdhi meM samaveta (paraspara sambaddha) doSoM kI aMzAMkalpanA ko vikalpa samprApti kahate haiN| vAta Adi doSa meM rahane vAle rUkSatA Adi pratyeka dharma aMza hai| amuka doSa itane aMzoM se prakupita huA hai isake nirdhAraNa ko hI aMzAMzakalpanA kahate haiM / vikalpa kA vivecana karate hue caraka ne kahA'samavetAnAM punardoSANAmaMzAMzabalavikalpo'sminnarthe' ( ca. ni. 1 / 15) arthAt saba (eka, do yA tInoM) doSoM kA utkarSApakarSarUpa aMzAMzabala ko vikalpa kahate haiN| 3. prAdhAnya samprAptiH-prAdhAnya ke kathana se aprAdhAnya kA bhI bodha ho jAtA hai| vyAdhi meM sambaddha doSoM kI svatantratA evaM paratantratA ke bala para vyAdhi kI prAdhAnya yA aprAdhAnya samprApti kA nirdeza karanA caahie|(1)arthaat vyAdhyutpAdaka doSoM kI svatantratA kA jisake dvArA jJAna ho use usa vyAdhi kI prAdhAnya samprApti aura jisake dvArA doSoM kI paratantratA kA jJAna ho use usa vyAdhi kI aprAdhAnyasamprApti kahate haiN| jvara, atisAra Adi dvandvaja yA tridoSaja rogoM meM jisa doSa kI pradhAnatA hogI, prAdhAnya samprApti bhI usI ke nAma se vyavahRta hogii| cikitsA krama kA nirdhAraNa bhI mukhyataH usake anusAra hI kiyA jaaygaa| isake viparIta aprAdhAnya samprApti hotI hai / carakokta prAdhAnya samprApti kA varNana bhI vAgbhaTa ke samAna hI hai / unhoMne kahA hai 'prAdhAnyaM punardoSANAM taratamAbhyAmupalabhyate tatra dvayostara stripu tama iti (ca. ni. 1113 ) 4. balasamprAptiH-nidAna; pUrvarUpa aura rUpoM kI sampUrNatA yA alpatA ke kAraNa vyAdhi ke balAbala kA jJAna jisase hotA hai use balarUpa samprApti kahate haiM / arthAt hetu, pUrvarUpa aura rUpa kI adhikatA vAlI vyAdhi ko sabala samajhanA cAhiye isake viparIta hetu Adi kI aMzataH upasthiti rahane para vyAdhi ko nirbala samajhanA caahie| caraka ne balasamprApti ko pRthaka na mAnakara kAlasamprApti se hI usakA sambandha kara tathA vidhi kA bhI pRthaka ullekha kara pAMca prakAra kI hI samprApti mAnI hai| 5. kAlasamprAptiH-jisa samprApti ke dvArA doSoM ke anusAra rAtri, dina. Rtu evaM bhojana ke aMzoM (Adi, madhya evaM anta) se vyAdhi kI vRddhi tathA hAni kA nirdhAraNa hotA hai use kAla rUpa samprApti kahate haiM / rAtri Adi cAroM ke tInoM bhAgoM meM kramazaH kapha, pitta For Private and Personal Use Only

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samprAptivimarza 1053 tathA vAta kA prakopa hotA hai| kAla vizeSa meM hone se kAla samprApti kahate haiN| caraka isake sAtha bala ko bhI saMyukta karake nimna prakAra se lakSaNa karate haiM-'valakAlavizeSaH punayAdhInAmRtvahorAtrakAlavidhiniyato bhvti'| (ca. ni. 1 / 16) aba saMkhyA Adi kA kramazaH pRthak pRthak varNana vistAra se karate haiM saMkhyA samprApti vAta Adi kAraNa bheda se jvara ATha prakAra ke hote haiM yaha saMkhyA samprApti kA udAharaNa hai| vAta Adi pratyeka se tIna, dvandvaja tona, sannipAtaja eka tathA Agantuja eka isa prakAra jvara ke ATha bheda hote haiM / yadyapi vRddha doSoM se sannipAta ke teraha bheda haiM jaisA ki caraka ne kahA bhI hai-'dvayulbaNai' rityAdi-arthAt do ulbaNa aura ekolbaNa hone se cha bheda, hIna, madhya tathA adhika se chai bheda, samadoSoM se eka bheda isa prakAra sannipAta ke teraha bheda hote haiM, tathApi sabhI tridoSaja haiM ataH tridoSaja jAti ke kAraNa ye teraha prakAra eka meM hI antarbhUta ho jAte haiN| nimna koSTaka ke dvArA inakA spaSTa jJAna ho sakatA hai dvayalbaNaikolbarNaH SaT syuH vRddha vRddha vRddhatara vRddhatara vAta kapha pitta / / / vAta dvayalbaNa pitta kapha vAta kapha pitta kapha vAta pitta kapha vAta pitta ekolbaNa kapha vAta hInamadhyAdhikaizca SaTa vRddha vRddhatara vRddhatama vAta vAta pitta pitta pitta kapha kapa kapha pitta vAta vAta kapha / hIna-madhya || aura adhika kapha vAta pitta vAta samaizcaikaH vRddha vRddha sama. kula saMkhyA 13 vRddha pitta ___vAta kapha isI prakAra kAma, zoka, bhaya Adi aneka kAraNoM se utpanna hone vAle sabhI jvara Agantukatva sAmAnya ke kAraNa Agantuja bheda meM hI antarbhUta hone se eka hI kahe jAte hai| isa prakAra ATha For Private and Personal Use Only

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1054 vikRtivijJAna vikalpa samaveta doSoM kI aMzAMzakalpanA ko vikalpa kahate haiN| vAta Adi ke rUkSatA Adi guNoM ko aMza kahate haiN| isa guNasamUha ke eka, do, tIna yA samasta aMzoM se vAta Adi ke prakopa kA nizcaya karanA hI aMzAMzakalpanA hai| arthAt kitane prakopaka guNoM se doSa kA prakopa huA hai isakA sUkSma vivecana karanA hI vikalpa yA aMzAMzakalpanA kahalAtA hai| suzruta ne bhI kahA hai ki-'rocya Adi sampUrNa, tIna, do yA eka guNa se bhI saMsarga meM kupita doSa dUsare kupita doSa kA anugamana karatA hai| isa prakAra kA doSaprakopa nidAna kI vicitratA kA hI phala hai / dravya aura unake rasoM meM doSoM ke hI samAna guNa rahate haiN| ataH prakopa rasa yA dravya meM doSaprakopa jitane aMza rahate haiM unase hI doSoM kA prakopa hotA hai / yathA kaSAyarasa tathA kalAya (maTarabheda khisArI) rUkSatA Adi saba guNoM se yukta hone ke kAraNa raupya, zaitya, lAghava, vaizadya Adi guNoM se yukta vAta ko sabhI aMzoM se bar3hAtA hai| taNDulIyaka (caurAI) rUkSatA, zItatA tathA lAghava ina tIna guNoM se bAta kA vardhaka hai| kANDeca rUkSatA aura zItatA guNoM se hI vAtako bar3hAtA hai| sIdhu (zarAbabheda) kevala rUkSatA guNa se hI vAta kA vardhaka hai| ___ kaTu rasa tathA madya meM pittavardhaka sabhI aMza vidyamAna haiM ataH vaha pitta kA sarvAMzavardhaka hai / hiMgu kaTu, tIkSNa evaM uSNa ina tInoM guNoM se pitta ko bar3hAtA hai ajavAina tIkSNatA tathA uSNatA guNa se aura tila kevala uSNatA ke kAraNa hI pitta ke vardhaka haiN| __ madhura rasa evaM bhaiMsa kA dUdha zleSmavardhaka sampUrNa aMzoM se kapha kA vardhana karate haiM / sneha, gaurava aura mAdhurya se khiranI kapha kA prakopa karAtI hai| kazerU zaitya aura gaurava ke kAraNa tathA kevala zaitya guNa ke kAraNa kSIrI vRkSoM ke phala kapha ke vardhaka hote haiM / guNoM ke anya udAharaNa jejaTa, gadAdhara aura vApyacandra kI TIkAoM meM likhita haiM unakA ullekha vistAra bhaya se yahA~ nahIM kiyA jA rahA hai| rAtri ke prathama bhAga meM kapha, madhya meM pitta evaM anta meM vAta kA prakopa hotA hai| isI prakAra dina ke tIna bhAga aura bhojana ke Ama, pacyamAna aura pakka avasthA athavA pAcana ke Adi, madhya aura anta meM kramazaH kapha, pitta aura vAyu kI vRddhi yA prakopa hotA hai tathA vasanta, zarada aura varSA RtuoM meM bhI yahI krama rahatA hai / Rtu ke katipaya dinoM ko RtvaMza kahate haiN| isIliye vAgbhaTa ne kahA hai-pahalI Rtu ke antima aura dUsarI ke prathama saptAha ko Rtu sandhi kahate haiN| athavA varSarUpa kAla kA Rtu bhI eka aMza hai, yaha artha bhI ucita hai| eka hI Rtu ke Adi, madhya aura anta kI kalpanA karanA anucita hai; kyoMki sampUrNa Rtu ko hI doSa prakopa kA kAraNa kahA gayA hai usake aMza ko nhiiN| saMkhyA aura vidhi caraka ne 'samprAptiAtirAgatirityanAntaraM vyAdheH, sA saMkhyAprAdhAnyavidhivikalpabalakAlavizeSabhidyate' isa samprApti lakSaNa tathA usake bhedoM ke nirUpaNa meM saMkhyA Adi ke samAna 'vidhi' bheda kA bhI ullekha karate hue 'vidhirnAma--dvividhA vyAdhayo nijAgantubhedena, trividhA stridoSabhedena, caturvidhAH sAdhyAsAdhyamRdudAruNabhedena' sUtra ke dvArA usake pRthaka udAharaNoM kA bhI spaSTa nirUpaNa kiyA hai| kintu vAgbhaTa ne isa bheda kI pUrNataH upekSA karake sandeha utpanna kara diyA hai| vijayarakSita 'ucyate' Adi ke dvArA isakA uttara dete haiM-saMkhyA For Private and Personal Use Only

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1055 samprAptivimarza ke grahaNa se vidhi kA bhI grahaNa ho jAtA hai| usakA pRthak pATha karane kI AvazvakatA nahIM, kyoMki vidhi kA saMkhyA se niyamita sambandha hai| vidhiprayukta dvividha, trividha Adi zabdoM meM niyamataH saMkhyA kA hI prayoga hotA hai| isa prakAra vidhi saMkhyA se atirikta nahIM hai ataH pRthaka vivecana bhI anAvazyaka hai| zAstra aura loka meM kvacit vidhi zabda prayoga ke anekoM udAharaNa upalabdha hote haiN| ina donoM ke ucita artha kSetra kI maryAdA kA jJAna karanA bhI paramAvazyaka hai| isakA hI nirUpaNa vApyacandra jI ke matAnusAra Age 'vidhisaMkhyayozcAyaM bhedaH' ityAdi ke dvArA kiyA gayA hai| vidhi aura saMkhyA meM bheda kevala itanA hai ki-vidhi kA artha prakAra hai aura usakA prayoga avAntara dharma bheda ke sambandha se eka hI jAti kI do yA usase adhika vyaktiyoM meM bheda pradarzita karane ke liye kiyA jAtA hai| gathA-trividhaM raktapittam-tiryagUrvAdhogabhedAt / yahA~ para Urdhvaga aura adhoga meM raktapittattva jAti samAna rahane para bhI Urdhvaga aura adhoga svarUpa dharmabheda ko mAnakara raktapitta meM saMkhyA ke sAtha-sAtha vidhi zabda kA bhI prayoga kiyA gayA hai| kintu saMkhyA kA prayoga avAntara dharma nirapekSa vyakti bheda kI gaNanA mAtra meM hotA hai| arthAt aneka vastuoM kI gaNanA, vinA kisI viziSTa avAntara dharma kA vicAra ke hI karanA saMkhyA hai| saMkhyA kA prayoga sarvatra kiyA jA sakatA hai| 'yathA catvAro ghaTAH, aSTo jvarAH, paJca gulmAH, sapta kuSThAni' yahA~ para ghaTa tathA jvara Adi kI sAmAnya gaNanA ke liye saMkhyA kA prayoga kiyA gayA hai| yahA~ yaha apekSA nahIM hai ki ghaTa kisa-kisa dhAtu ke bane haiM evaM jvara kisa dharma vizeSa se yukta haiM, kintu paraspara bhinna avazya haiM, kevala isI kA nirdeza saMkhyA ke dvArA kiyA gayA hai| prakRti meM vidhi zabda kA artha prakAra kahA gayA hai, aura usakA prayoga bhinna jAti ke vyaktiyoM meM nahIM kiyA jA sktaa| yathA gotva gau meM hI raha sakatA hai azva meM nhiiN| ataH yaha ucita hai ki saMkhyA, vikalpa Adi ke dvArA bheda karane para bhI avAntarabhedaka kAraNa ke dharma ke anurUpa prakAra yA vidhi zabda kA prayoga kiyA jaave| tAtparya yaha hai ki saMkhyA Adi ke dvArA rogoM kA bheda kara dene para bhI dharmabheda ke pratipAdanArtha 'vidhi' kA kathana avazya karanA caahie| __isa viSaya meM naiyAyikoM kA bhI mata hai ki jahAM vibhinna bhedoM kA nirNaya samAna dharma se kiyA jAtA hai vahAM vidhi zabda kA prayoga karanA caahie| kevala bheda pradarzita karane ke lie saMkhyA kA prayoga karanA ucita hai| isameM jAti kI samAnatA yA asamAnatA kI apekSA nahIM ha / vaiyAkaraNoM kA bhI kahanA hai ki (6)samAna jAti meM hI avAntara dharma ke sambandha se bheda ko prakAra (vidhi) evaM samAna yA asamAna jAti meM bhedamAtrasUcaka saMkhyA kA prayoga kiyA jAtA hai| yathA kAlI aura zveta do prakAra kI gAya haiMyahAM para bheda zvetatva evaM kRSNatva ke sambandha se samAna jAti meM hI kiyA gayA hai ataH prakAra zabda prayukta huaa| isI prakAra cAra pazu yaha kahane se gAya, bhaiMsa Adi sabakA bodha ho sakatA ha ataH yahAM vijAtIya hone ke kAraNa bheda mAtra kA hI jJAna hotA hai jisase kevala saMkhyA kA prayoga kiyA gayA hai| vidhi evaM saMkhyA kA bheda nirUpaNa karate hue zrI paNDita gaGgAdhara kavirAja jI kA kathana hai-'atra vidhistu prakAraH, saMkhyA tu bhedamAtram , sajAtIya-vijAtIyeSu :paJca braahmnnksstriyaaH| prakArastu sajAtIyeSu minneSu dharmAntareNa uppttiH'| isakA tAtparya yaha hai ki vizeSaNa yA dharma vizeSa ko mAnakara bheda karane para vidhi zabda kA prayoga kiyA jAtA hai| 'nijAgantuvibhAgena tatra rogA dvidhA smRtA' yahAM para roga vizeSya hai evaM nija aura Agantu For Private and Personal Use Only

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1056 vikRtivijJAna vizeSaNa / ina do vizeSaNoM ko hI AdhAra mAnakara roga ke bheda kiye gaye haiM, ata eva yahAM para vidhi zabda kA hI prayoga kiyA gyaa| isI prakAra'mandastIkSNo'tha viSamaH samazceti caturvidhaH / kaphapittAnilAdhikyAttatsAmyAjATharo'nalaH // ' yahAM para manda Adi cAra vizeSaNoM dvArA vizeSyabhUta agni ke cAra bheda pratipAdita kiye gaye haiM ataH yahAM bhI vizeSaNa ke AdhAra para hI vidhizabda kA prayoga kiyA gayA hai| kintu jahAM bhedamAtra abhISTa hai vahAM kevala saMkhyA kA hI prayoga karate haiN| yathAaSTau jvarAH, paJca gulmAH, sapta kuSThAni / ina saboM meM bheda kA nirdeza jvara Adi vizeSya ko mAnakara kiyA gayA hai ataH yahAM saMkhyA prayukta huI hai| 'paJca brAhyaNakSatriyAH' yahAM para saMkhyA kA prayoga vizeSya prayukta hI hai / kvacit saMkhyA aura vidhi donoM kA ekatra prayoga bhI ho sakatA hai / yathA-trayo raktAH, dvau zvetau, paJca lohamayAH kumbhAH, iti trividhAH aSTau ca kumbhAH' yahAM para kumbharUpa vizeSya ke AdhAra para saMkhyA kA tathA unake viziSTa dharmoM ke AdhAra para vidhi zabda kA ekatra prayoga karane para bhI koI doSa nahIM aataa| isa prakAra vidhi ko saMkhyA se bhinna hI mAnanA caahie| yadi donoM ko eka hI mAnA jAya to trividha ke sAtha ATha kahanA asaMgata pratIta hogaa| isake atirikta vidhirUpa samprApti kA pariNAma bhI saMkhyA rUpa samprApti se nitAnta bhinna hai| yathA Urdhvagaraktapitta meM adhomArga se haraNa karane para hI zAnti hotI hai| UrdhvaharaNa se nhiiN| adhoga raktapitta meM UrdhvamArga se doSa nirharaNa karAne se lAbha hotA hai adhoniharaNa se nhiiN| isa prakAra vAgbhaTa tathA unakA anukaraNa karane vAle mAdhavakara ne jo vidhi kA antarbhAva saMkhyA meM hI kiyA hai vaha bhramapUrNa hai| kyoMki vidhi ke kSetra meM kevala saMkhyA kA prayoga karanA anupayukta hai / cakrapANi ne bhI kahA hai ki 'saMkhyAdyagRhIte vyAdhiprakAre'yaM vidhizabdo vartanIyaH' arthAt saMkhyA Adi meM antarbhAva na hone yogya vyAdhi ke viziSTa bhedoM kA nirUpaNa karane ke liye vidhi zabda kA upayoga karanA caahie| __ aba yaha prazna ho sakatA hai ki aMzAMza kalpanA Adi bhedoM ke dvArA jvara Adi vyAdhi kA jisa prakAra vizeSa jJAna hotA hai vaise saMkhyA se nahIM, punaH saMkhyA kA pATha kyoM kiyA gayA? isake liye kahate haiM saMkhyA bheda se vyAdhi kA doSa bheda jAnA jAtA hai| arthAt doSa bheda hone ke kAraNa unheM jAnane ke liye hI saMkhyA kA prayoga karanA par3A hai| ataH jvara Adi vyAdhi ko svarUpa se jAnakara bhI cikitsA ke liye jvara ke vAtika Adi vizeSa bhedoM ko jAnane kI AvazyakatA par3atI hai ina bhedoM ko jAnane ke pazcAt hI cikitsA meM vaiziSTya kiyA jA sakatA hai| isa prakAra saMkhyA meM paramparayA kAraNatA hai| kisI bhI kAraNa se utpanna roga tatkAla doSabheda se viziSTa rUpoM ko dhAraNa kara sakatA hai, ataH cikitsA vizeSa ke liye usa bheda ko jAnanA paramAvazyaka hai| yaha bheda saMkhyA ke prayoga se hI jJAta ho sakatA hai / ataH saMkhyA kA prayoga avazya karanA caahie| isa prakAra hama dekhate haiM ki rogoM ke samyak jJAna ke lie jahA~ nidAna, pUrvarUpa, rUpa tathA upazaya kA vicAra kiyA jAtA hai vahA~ para hI samprApti kA bhI dhyAna diyA jAtA hai| nidAna una hetuoM kI ora iGgita karatA hai jo zarIrastha vikRti ke kAraNasvarUpa hote haiN| pUrvarUpa vikAra ke bhAvI svarUpa kI ora iGgita karatA hai| rUpa, vikRtijanya zarIra para hue pariNAma kA prakAzaka hai| upazaya nidAna aura cikitsA donoM ke jJAna meM sahAyaka AdhAra svarUpa hotA hai| parantu samprApti zarIra ke aGga vA Azaya vizeSa meM For Private and Personal Use Only

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samprAptivimarza 1057 prakupita yA kSINa hue doSoM ke dvArA huI usa vAstavika kSati kI ora iGgita karatI hai jisake pariNAmasvarUpa roga ke vividha lakSaNa prakaTa hote haiM isake sambandha meM vividha vicArakoM kI sammatiyoM ke AdhAra para hama isa niSkarSa para pahu~cate haiM ki AcAryoM ne vAstavika vikRti kA citraNa samprApti ke antargata kiyA hai| yataH doSa hI zarIra meM kisI bhI roga kA kartA hotA hai cAhe phira usa roga kA kAraka koI bAhya jIvANu ho athavA koI anya rAsAyanika vA bhautika AdhAra ho| vividha kAraNoM se zarIra ke aMga yA dhAtu vizeSa (dRSyoM) meM sthita doSoM kI samAvasthA meM kitanA bigAr3a hotA hai| doSa usa kSetra meM kitanA prasarpaNa karate haiN| unameM kitanI duSTi samAtI hai| ye saba samprApti ke antargata Ate haiN| isI kAraNa samprApti ke nimna bheda svIkAra kiye gaye haiM5-saMkhyA samprApti, 2-vikalpa samprApti, 3-prAdhAnya samprApti, 4-bala samprApti tathA 5-kAla samprApti jinake sambandha meM Upara bahuta likhA jA cukA hai| AcAryoM ne yatnapUrvaka vividha rogoM kI samprApti prakaTa kI hai| prAcIna vaidya isI samprApti ke dvArA roga vijJAna samajhane aura cikitsA cAlU karane kA upakrama karate the| roga kA kauna lakSaNa hai isa ora ve dhyAna na dekara isa lakSaNa ke mUla meM kauna doSa mukhyatayA vikAra kA yaha rUpa upasthita kara rahA hai isake lie cikitsA karate the| isakA pramANa hai ziraHzUla ke rogI ko vibandhanAzaka aura vAtazAmaka cikitsA dvArA ThIka karane ke lie jahA~ vaidya prakaTa hotA aura Adara pAtA hai vahA~ Adhunika cikitsaka pratyakSazUlazAmaka esprIna bArbITayUreTsa Adi kA upayoga kara zUla ko tatkSaNa kucha kAla ke lie bandakara rogI kA vizvAsa pAne meM saphala hotA hai| isI se Ayurveda roga kA samUla nAza karatA hai tathA DAkTarI roga meM kSaNika zAnti pradAna karatI hai aisI kiMvadantI loka meM kahIM bhI sunane ko mila jAtI hai| vividha vikAra aura unakI samprApti aba hama AyurvedIya zAstroM meM varNita vividha rogoM kI samprApti ke sAra mAtra kA noce ullekha kareMge tAki unake sambandha kI kalpanA yathArtha rUpa se samajhI jA ske| yahA~ vikalpAMzakalpanA aura duSTa doSa kI sthiti ko mukhya rUpa se hI likhA jA rahA hai| saMkhyA, samprApti Adi nidAna kA pratyakSa viSaya hone se chor3A jA rahA hai| -atIsAra-saMzamyApAM dhAtu raniM pravRddhaH zakunmizro vAyunAthaH prnnunnH| saratyatIvAtisAraM tamAhuAdhiM ghoraM SaDavidhaM taM vadanti / / (suzruta u. taM.) agni ko naSTa karake bar3hI huI jalIya dhAtu mala ke sAtha milakara vAyu ke dvArA adhomArga kI ora prerita kI jAtI hai| mala ke bAra-bAra saraNa karane se isa ghora vyAdhi ko atIsAra kahate haiN| use 6 prakAra kA vidvajjana batalAyA karate haiN| 2-antarvidadhitaistairbhAvairabhihate kSate vaapthysevinH| kSatoSmA vAyuvisRtaH saraktaM pittamIrayet / / jvarastRSNAca dAhazca jAyate tasya dehinaH / eSa vidrapirAgantuH pittvidrdhilkssnnH|| (suzruta ci. sthA. a. 9) 86 vi0 For Private and Personal Use Only

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vikRtivijJAna apathyasevana karane vAloM ko abhighAta yA kSata lagane se Ahata sthAna kI USmA vAyu dvArA vistAra pAkara rakta ke sAtha pitta ko bhI vahA~ prakupita kara detI hai jisake kAraNa jvara, tRSNA tathA dAha usa vyakti ko utpanna ho jAte haiN| yahI antarvidadhi hai jisake lakSaNa paittika vidhi ke samAna hote haiN| 3-antarAyAmasamastadhamanIgataprakupito'nilaH ileSmaNA / sa daNDadhanurAkRtiM tanumihAtanotyAyatAm // sa eva bahirantaraGgadhamanIgato'pyuddhato / bahirbahirihAntarAntaradhikaM naraM nAmayet // (ka. kA. vA. 16) sampUrNa dhamaniyoM meM vyApta vAyu zleSmA ke sAtha milakara zarIra ko daNDa tathA dhanuSa ke rUpa meM jhukA detA hai / bAhya dhamanIgata hone para vahirAyAma tathA Abhyantara dhamanI meM sthita hone para antarAyAma kAraka hotA hai| 4-anyedhuSkajvara-anyedyuH punarahorAtratya sakRdekavAraM vegaM karoti / tasmindoSA mAMsavahA nADIrAzritAH / ( a. saM. zazilekhA vyAkhyA ) anyedyaSkajvara meM kupita doSa mAMsavahA nADiyoM ke andara rahate haiM tathA dina-rAtri meM kevala eka bAra jvara kA daurA hotA hai| 5-apacIvAtapittakaphavRddhA medazcApi samAcitam / jaGghayoH kaNDarAH prApya matsyANDasadRzAn bahUn / kurvanti prathitAstebhyaH punaH prakupito'nilaH / tAn doSAnUlago vakSaH kkssaamnyaaglaashritH|| nAnAprakArAn kurute granthIn sA tvapacI smRtA / cyAmizradoSajAtasya kRcchrasAdhyA prakIrtitA / (bhoja) __vAta, pitta aura kapha meda ke sAtha milakara javAoM kI kaNDarAoM meM machalI ke aNDe jaisI aneka gA~The banA detI haiN| unameM phira vAyu kupita hokara UrdhvagAmI hokara vakSa, kakSA, manyA tathA gale meM nAnA prakAra kI gA~The utpanna kara detA hai| ye apacI kahalAtI haiN| milita doSoM se utpatti hone se yaha kaSTasAdhya samajhI jAtI hai| 6-apatantrakabAyurUrvaM vrajetsthAnAt kupito hRdayaM shirH| zaGkhau ca pIDayatyaGgAnyAkSipennamayecca sH|| nimIlitAkSo nizceSTaH stabdhAkSo vA'pi kUjati / nirucchvAso'thavA kRcchAducchvasyAnnaSTacetanaH // sasthaH syAddhRdaye mukte hyAvRte ca pramuhyati / kaphAnvitena vAtena jJeya eSo'patantrakaH // (su. ni. sthA. a. 1) prakupita vAyu apane sthAna ko chor3a detA hai tathA hRdaya, zira aura donoM zaMkhoM ko pIDita karatA hai| aMgoM meM AkSepa karatA hai tathA unako jhukA detA hai| netrabanda, ceSTAhIna, netrastabdha rogI kUjane lagatA hai yA ucchavAsa letA hI nahIM yA kaSTapUrvaka ucchavAsa letA hai| usakI cetanAzakti naSTa ho jAtI hai| usakA hRdaya jaba prakupita vAyu se mukta ho jAtA hai to svastha aura yadi AvRta rahA to mohayukta rogI ho jAtA hai| vAyu ke sAtha kapha kA anubandha rahatA hai / ise apatantraka jAnanA caahie| 7-apatAnaka-dekho AkSepaka 18 8-apasmAra-cintAzokAdibhirdoSAH kruddhA hRtsrotasi sthitAH / kRtvA smRterapadhvaMsamapasmAraM prakurvate // (mAdhavanidAna) For Private and Personal Use Only

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samprAptivimarza 1054 cintAzokAdi mAnasika kAraNoM se kupita hue doSa hRdaya ke srotoM meM sthita hokara smRti ko vinaSTa karake apasmAra roga karate haiN| 9-abhighAtajajvara-zramAcca tasmin pavanaH prAyo raktaM pradUSayan / / savyathAzophavaivayaM sarujaM kurute jvaram // (a. saM. ni.sthA. a. 2) abhighAtAdika ke kAraNa vAyu prAyazaH rakta ko dUSita karatA huA vyathA ke sAtha zopha, vivarNatA tathA zUla ke sAtha jvara utpanna kara detA hai| 10-arditauccaiAharato'tyartha khAdataH kaThinAni vA / hasato jRmbhato vA'pi bhArAdviSamazAyinaH / / zironAsauSThacibukalalATekSaNasandhigaH / ardayatyanilo vaktramarditaM janayatyataH // vakrIbhavati vaktrArdhe grIvA cApyapavartate / zirazcalati vAksaGgo netrAdInAM ca vaikRtam // grIvAcibukadantAnAM tasminpArzve ca vedanA / yasyAgrajo romaharSI vepathurnetramAvilam / / vAyurUrvaM tvaci svApastodo manyAhanugrahaH / tamarditamiti prAhuAdhi vyAdhivicakSaNAH // (suzruta vi. sthA.) atyadhika cillAne se, kaThina padArtha (jaise bAdAma) khAne se, atyadhika hasane se, adhika mu~ha phAr3akara jamhAI lene se, adhika bhAra Dhone se, viSamatayA ,sone se, sira, nAsikA, oSTha, gAla, mAthA tathA netroM kI sandhiyoM meM gamana karanevAlI vAyu mukhamaNDala ko vyathita karake ardita ko utpanna kara detI hai| isake kAraNa cehare kA AdhA bhAga Ter3hA ho jAtA hai| grIvA bhI Ter3hI ho jAtI hai| sira meM kampana, vANI kA avaruddha honA, netra Adi meM vikRti ho jAtI hai, grIvA, cibuka tathA dA~toM ke pArzva meM zUla hotA hai| isake sAtha romaharSa, vepathu, netroM kI AvilatA, tvacA kI sunnatA, manyAgraha tathA hanugraha hotA hai| vAyu ke kAraNa utpanna isa vyAdhi ko vikRtizAstravizArada ardita kahate haiN| 11-ardhAvabhedaka ruukssaashnaatydhyshnpraagvaataavshymaithunaiH| vegasandhAraNAyAsavyAyAmaiH kupito'nilaH // kevala: sakapho vA'dha gRhItvA ziraso balI / manyAbhrazaGkhakarNAkSilalATArthe'ti vedanAm / / zastrAraNinimAM kuryAttIvrAM so'rdhAvabhedakaH / nayanaM vA'thavA zrotramativRddho vinAzayet // (mAdhava ni.) rUkSabhojanAdika vividha zlokokta athavA usI prakAra ke anya kAraNoM se prakupita huA balavAn vAta akelA yA kapha ke sAtha Adhe sira ko jakar3akara manyA, bhra, zaMkha, karNa, netra aura lalATa ke Adhe bhAga meM zastraccheda jaisI yA agni se jalane ke samAna tIvra aura atyadhika vedanA kara detA hai| yaha zUla kabhI-kabhI itanA tIvra ho jAtA hai ki netra kI dekhane ko tathA kAnoM kI sunane kI zakti bhI naSTa ho jAtI hai| 12-arbuda-gAtrapradeze kacideva doSAH sammUrchitA mAMsamasRk pradUSya / vRttaM sthiraM mandarujaM mahAntamanalpamUlaM ciravRddhayapAkam // kurvanti mAMsocchyamatyagAdhaM tadarbudaM zAstravido vadanti / vAtena pittena kaphena cApi raktana mAMsena ca medasA vaa|| tajjAyate tasya ca lakSaNAni granthe samAnAni sadA bhvnti| (suzruta ni. stha.) dRSyasaMsRSTa pravRddha doSa zarIra ke kisI bhI bhAga meM rakta tathA mAMsa dhAtu ko dUSita karake golAkAra, kaThina, bahuta kama zUla yukta, bar3e, jinakI jar3a gaharI hai, jinakI vRddhi tathA pAka vilamba se hotA hai, jo mAMsa ke eka U~ce saMghAta ke rUpa meM zopha karate haiM, use For Private and Personal Use Only

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1060 vikRtivijJAna zAstravid arbuda kahate haiN| ve vAta, pitta, kapha, rakta, mAMsa athavA meda kisI se bhI banate haiM unake lakSaNa granthi ke samAna hote haiN| 13-arza-doSAstvaGmAMsamedAMsi sandUSya vividhAkRtIn / ___ mAMsAGkurAnapAnAdau kurvantyAsi tAn jaguH // ( aSTAGgahRdaya nidAna sthAna ) vAtAdi kupita doSa jaba apAna ke kSetra meM sthita mAMsa, meda, tvacA bhAdi ko dUSita karake vividha prakAra ke jina mAsAMkuroM ko utpanna karate haiM unheM arza jAnanA caahie| 14-azmarIyadA vAyurmukhaM basterAvRtya parizoSayet / mUtraM sapittaM sakarpha sazukra vA tadA kramAt // saJjAyate'zmarI ghorA pittAdgoriva rocnaa| ileSmAzrayA ca sarvA syAt / / (a. hR. ni. sthA.) jisa samaya vAyu kupita hokara basti mukha ko avaruddha karake mUtra kA zoSaNa karatA hai taba pitta ke sAtha pittAzmarI jo gorocana ke samAna varNa kI hotI hai, kapha ke sAtha zleSmAzmarI tathA zukra ke sAtha zukrAzmarI utpanna hotI hai| ye krama se ghora, ghoratara aura ghoratama hotI haiN| ina sabhI azmariyoM kA AdhAra zleSmA hotA hai| 15-asRgdara-zokopavAsAdatimaithunAcca vidAhi bhizcAsramatova duSTam / pravartate yoniSu nAdazAli hyasRgdaraM taM prabalaM hi vidyAt / / (basavarAjIyam ) zoka, vrata, atimaithuna, vidAhI padArthoM ke prayogAdi se jaba atIva duSTa rakta yoni mArga se pravartita hotA hai use asRgdara kahate haiN| 16-AmavAtaviruddhAhAraceSTasya mandAgnenizcalasya ca / snigdhaM bhuktavato hyannaM vyAyAma kurvatastathA // vAyunA prerito hyAmaH zleSmasthAnaM pradhAvati / tenAtyartha vidagdho'sau dhamanIH pratipadyate // vAtapittakaphairbhUyo dUSitaH so'nnajo rasaH / srotAMsyabhiSyandayati nAnAvarNo'ti picchilH|| janayatyAzu daurbalyaM gauravaM hRdayasya ca / vyAdhInAmAzrayo hyeSa AmasaMzo'tidAruNaH / / yugptkupitaavntstriksndhiprveshko| stabdhaM ca kurute gAtramAmavAtaH sa ucyate // (mAdhavanidAna) viruddha AhAra; viruddha ceSTA karanevAle agnimAnya se pIr3ita, nizcala ora snigdha dravyoM kA adhika sevana karanevAle, khAne ke bAda turata vyAyAma karane vAle kA Amarasa vAyu ke dvArA preraNA pAkara zleSmA ke sthAnoM meM daur3a jAtA hai / vahI Ama usa kupita vAta se vidagdha hokara dhamaniyoM meM gamana karatA hai| vahA~ vAta, pitta aura kapha ke dvArA vaha annarasa khUba dUSita hokara aneka varNa kA aura picchilatAyukta hokara srotasoM ko bhara detA hai jisake kAraNa hRdaya meM durbalatA tathA gaurava kA turata anubhava hotA hai / isI ko dAruNa AmavAta kahA jAtA hai| kyoMki isameM doSa aura Amarasa eka sAtha kupita hokara zarIrastha sampUrNa sandhiyoM tathA trika pradeza meM praveza karate haiM isase sArA zarIra stabdha ho jAtA hai| 17-AkSepakajvara-pUrvoktahetoruditaM viSaM hi mastiSkamUle manujasya yasya / prAyeNa nUnaM paritaH suSumnAkANDaM ca tacchAdikalAntarAle / kramAllasIkAmatipUyatulyAM saMhatya dopAnnikhilAtprakopya / ceSTAvahanADikAvrajAnAmatyuttejanahetuto janAnAm / vAkSipadaGgakAni zAkhAH saMkocya praNihanti cetanAM ca / / For Private and Personal Use Only

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samprAptivimarza 1061 AkSepakagadasyaiSA samprAptirvaidyanizcitA / prAyeNAtra nRNAM loke jIvitaM durlabhaM bhavet / / __ -mAdhavanidAna ( caukhambA) jIvANuoM dvArA utpanna viSa mAnavIya mastiSka mUla, suSumnAkANDa inako AcchAdita karanevAlI kalA ke antarAla meM sthita lasIkA ko pUyAbha banAkara sampUrNa doSoM ko prakupita karake tatrastha ceSTAvaha nAr3iyoM meM pahuMcakara unako atyadhika uttejita kara detA hai jisase zarIrAMga khUba AkSepa karate haiM / zAkhAe~ saMkoca karato haiM aura cetanA naSTa ho jAtI hai / rogI kA jIvana durlabha ho jAtA hai| 18-AkSepakayadA tu dhamanIH sarvAH kupito'bhyeti maarutH| tadAkSipatyAzu muhurmuhurdehaM muhushcrH|| muhurmuhustadAkSepAdAkSepaka iti smRtH| so'patAnakasaMjJo yaH pAtayatyantarAntarA // kaphAnvito bhRzaM vAyustAsveva yadi tiSThati / sa daNDavat stambhayati kRcchro daNDApatAnakaH / / hanugrahastadAtyartha so'nne kRcchaannissetrte| kaphapittAnvito vAyurvAyureva ca kevalaH // kuryAdAkSepakantvanyaM caturthamabhighAtajam / garbhapAtanimittazca na zoNitAtisravAcca yaH / / abhighAtanimittazca na sidhyatyapatAnakaH // jaba prakupita vAyu zarIrastha sampUrNa dhamaniyoM meM hokara calatA hai to bAra-bAra zIghrazIghra rogI kA zarIra AkSepa karatA hai / bAra-bAra usameM gati hotI hai / bAra-bAra ke AkSepa ke kAraNa yaha roga AkSepaka kahalAtA hai| para jaba yahI AkSepa paryApta antara se Ate haiM to use apatAnaka kahA jAtA hai| gayadAsAcArya ke anusAra yena apatAmyata-tathA yena vAyunA kartRbhUtena hetubhUtena vA pumAn apatAmyate tamo dRzyate mohyate iti yAvat so'patAnaka iti / sa evApatAnakaH hRdisthamano'dhiSThAnena sakaphena vAyunA janyata iti / arthAt jo apatAmyatA karatA hai andherA kara detA hai vaha apatAnaka hai| vAyu ke kAraNa jaba manuSya andhakAra ko dekhatA tathA mUcchita ho jAtA hai to vaha apatAnaka kahalAtA hai| yaha hRdaya meM jo mana se adhiSThita hai vahA~ kapha ke sAtha kupita vAyu dvArA utpanna roga hai / yahI jaba daNDa ke samAna zarIra ko stambhita kara detA hai to daNDApatAnaka kahalAtA hai| isa roga meM hanugraha ( trismus ) hone se anna kA nigalanA kaThina ho jAtA hai| ____ yaha AkSepaka cAra prakAra kA hotA hai| eka kapha se yukta vAta dvArA jise saMsRSTAkSepaka kahA jAtA hai| dUsarA pitta se yukta vAta dvArA jo apatAnaka kahalAtA hai| tIsarA kevala vAta dvArA jo kevalAkSepaka kahalAtA hai| cauthA abhighAtaja AkSepa kahalAtA hai| yaha garbhapAtajanya yA atizaya raktasrAva ke kAraNa hotA hai| yaha caturtha sAdhya nahIM mAnA hai| 19-udararoga-UrdhvAdho dhAtavo ruddhvA vAhinIrambuvAhinIH / prANAgnyapAnAnsandUSya kuryustvngmaaNssndhigaaH|| AdhmApya kukSimudaramaSTadhA tacca bhidyate / pRthagdoSaiH samastaizca plIhavaddhakSatodaH // (aSTAMgahRdaya ni. sthA.) Urdhva aura adho bhAga meM vAtAdi doSa jalavAhI srotasoM ko avaruddha karake tathA prANavAyu, jATharAgni tathA apAnavAyu ko dUSita karake tvacA aura mAMsa kI sandhiyoM meM praveza karake kukSi tathA udara ko phulAkara udara roga utpanna karate hai| usake ATha bheda kie jAte haiM-bAtodara, pittodara, kaphodara, sannipAtodara, plIhodara, baddhagudodara, kSatodara tathA jlodr| For Private and Personal Use Only

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1062 vikRtivijJAna 20 - udAvarta tAdInAM vegasandhAraNAdyaH sarvendrAzanyagnizastropamAnaH / kruddho'pAnapyUrdhvamutpadya tIvrodAnavyAptaH syAdudAvartarogaH // kalyANakAraka Arambha meM vAtAdi vegoM ke sandhAraNa karane se sarpa, vajra, agni tathA zastra ke samAna bhayaGkara huA apAna vAyu UrdhvagAmI hokara udAna vAyu ko tIvragati se vyApta kara letA hai taba udAvarta roga hotA hai / 2:- unmAda - tairalpasattvasya malAH praduSTA buddhernivAsaM hRdayaM pradUSya / strotAMsyadhiSThAya manovahAni pramohayantyAzu narasya cetaH // ( caraka saMhitA ci. sthA. ) vividha kAraNoM se durbalamanA vyaktiyoM ke duSTa hue doSa buddhi ke nivAsa hRdaya ko dUSita karake manovaha srotasoM meM vyApta hokara manuSya kI cetanA ko mohita karake unmAda kI utpatti karate haiM / 22--unmArgI bhagandara - mUDhena mAMsalubdhena yadasthizalyamannena sahAbhyavahRtaM yadAvagADhapurISonmizramapAnenAdhaH preritamasamyagAgataM gudaM kSiNoti, tatra kSatanimittaH kotha upajAyate, tasmiMzca kSate pUyarudhirAvakIrNamAMsakothe bhUmAviva jalapraklinnAyAM krimayaH saJjAyante, te bhakSayanto gudamanekadhA pArzvato dArayanti, tairmArgeH kRmikRtavAtamUtrapurISaretAMsyAbhiniHsaranti; taM bhagandarasumArgiNamityAcakSate / ( suzruta ) mAMsa kA lobhI koI mUDha jaba anna ke sAtha kisI asthizalya ko bhI khA jAtA hai taba vaha asthizalya purISa ke andara sAtha meM milakara apAna ke dvArA prerita hokara guda ko kATatA hai / vahA~ eka kSata bana jAtA hai usase kotha kI utpatti hotI hai / usa kSata ke pUya-rakta-mAMsa janita kotha meM jisa prakAra bhUmi para dekhA jAtA hai kRmi utpanna ho jAte haiN| ve kRmi guda ke pArzvabhAga ko aneka sthAnoM para kATate haiM / una mArgoM se kRmiyoM ke sAtha vAtamUtrapurISa-retasAdi nikalA karate haiM isa bhagandara ko unmArgI bhagandara kahA jAtA hai I 22 - upAntrazotha -- upAntrasya bhittau yadA ileSmaNo vA kalAyAM prakuryu hi kITAH prazotham / tato mandabhAvena vRddhaH sa zoyo vraNasya svarUpaM tu nUnaM sudadhyAt // ( mA. ni. cau. ) upAntra (uNDukapuccha) kI prAcIra meM yA usakI zleSmalakalA meM jaba jIvANu zodhotpatti karate haiM taba zanaiH-zanaiH bar3hatA huA vaha zotha vraNa kA rUpa dhAraNa kara letA hai / 24-uraHkSata tathA'nyaiH karmabhiH krUrairbhRzamabhyAhatasya vA / vikSate vakSasi vyAdhirbalavAn samudIryate // strISu cAtiprasaktasya rUkSAtpapramitAzinaH / uro vibhajyate'tyarthaM bhidyate'tha virujyate // prapIDyate tataH pArzve zuSyatyaGga pravepate / kramAdvIryaM balaM varNoM ruciragnizca hIyate // jvaro vyathA manodainyaM vibhedAgnivadhAvapi / duSTaH zyAvaH sudurgandhaH pIto vigrathito bahuH // kAsamAnasya cAbhIkSNaM kaphaH sAsRk pravartate / sa kSatI kSIyate'tyartha tathA zukrojasoH kSayAt // ( bhA. pra . ) atyadhika sAhasika kArya karane se athavA bahuta coTa lagane se chAtI meM ghAva ho jAne para uraHkSata nAmaka eka balavatI vyAdhi utpanna ho jAtI hai / rUkSa, thor3A aura parimita bhojana karane athavA atyadhika strI ke sAtha sahavAsa karane se uraHsthala bahuta adhika kSatigrasta ho jAtA hai usameM bhedana tathA zUla hotA hai / usake kAraNa pArzva meM khUba pIr3A hotI hai, zarIra sUkhatA jAtA hai tathA kampana hotA hai| dhIre-dhIre usakA vIrya, bala, varNa, ruci aura abhi saba kama hone lagatI hai / jvara, zUla, manodainya ( neurasthenia ) For Private and Personal Use Only

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samprAptivimarza 1063 atisAra, agnimAndya ke sAtha duSTa, zyAva, durgandhapUrNa, pIlA, ga~ThIlA bahuta sA kapha rakta ke sAtha khA~sI Ane para bAra-bAra nikalatA hai / vaha urasvatI zukra aura oja ke kSaya se aura bhI kSINa hotA calA jAtA hai| 25-urastoya-urastoyanAmAmaye prAyazo'sminnurasyekapAzrve'thavA pArzvayoH / bhavet saJcayoddhA jalIyasya dhAtorapi prANahRt pUrNatoyaH pradiSTaH / / (-upAdhyAya) urastoya nAma ke isa roga meM prAyaH pArzva ke eka athavA donoM pAzcauM meM jalIya dhAtu kA saMcaya ho jAtA hai / ise pUrNataH prANanAzaka batalAyA jAtA hai| 26-uSNavAta-rajasvalAyAM bahubhuktavatyAM tathA''tayonau madanAturo yH| prayAtu mohAd yadi ko'pi tarhi dhruvaM gadaM dAruNametumetu // yA mUtranADyantarasaMsthitA tvaka zleSmAvahA sA vraNitA satItu / kledaM gade'trAharati prakAmaM tato bhiSagbhivraNameha uktH|| (-upAdhyAya) rajasvalA, atizaya bhojana kI huI tathA jinakI yoni meM yaha roga lagA huA hai unameM kAmadeva ke prabhAvase andhA hokara jo koI bhI sahavAsa karatA hai use yaha dAruNa roga avazya mila jAtA hai| isameM mUtranADI kI AbhyantarIya zleSmalakalA vraNita ho jAtI hai jisase vahA~ paryApta dAha tathA pUyasrAva hotA hai / isIse ise vraNameha bhI kahate haiN| 27-UrddhavAta-adhaHpratihato vAyuH zleSmaNA mArutena vA / ___ karotyudgArabAhulyamUrdhvavAtaH sa ucyate // kapha se yA svayaM apane Apa vAyu nIce gamana karane meM asamartha kara dI jAtI hai to pratiloma gativAlI vaha vAyu bahuta bAra DakAre utpanna kara detI hai| vahI UrdhvAta kahalAtI hai| 28-kaphaja chardinandrAsyamAdhuryakaphaprasekasantoSanidrArucigauravArtaH / snigdhaM ghanaM svAdu karpha vizuddhaM salomaharSo'lparujaM yamettu // (ca. ci. sthA. 20) tandrA, mukhakI madhuratA, kaphapraseka, bhojana karane kI anicchA, nidrA, aruci aura gaurava ke kAraNa snigdha, Thosa, madhurasvAda vAle jisa kapha kA vamana hotA hai, jisake sAtha romaharSa hotA hai tathA adhika kaSTa bhI nahIM hotA use kaphaja chardi mAnanA caahie| 29-kphodr-avyaayaamdivaasvpnsvaatisnigdhpicchilaiH| dadhidugdhodakAnUpamAMsaizcApyatisevitaiH // kraddhena zleSmaNA srotaH svAvRteSvAvRto'nilaH / tameva pIDayan kuryAdudaraM bahirantaram // (ca. ci. sthA. 13) avyAyAmAdi kaphavarddhaka kAraNoM se kupita hue kapha se bhare srotoM ke dvArA vAyu AvRta ho jAtA hai kapha ko andara bAhara se pIDA pahu~cA kara kaphodara ko utpanna kara detA hai| 30-karNamUlika jvara pUrva bhavedekatare hi pArthe karNasya zotho jvrkRdrujaavaan| tato dvitIye'nupadaM bhiSagvarairgadaH sa ukto bhuvi karNamUlikaH // ayaM jvaro vAtakaphodbhavastathA vizeSato jAnapadaH pradRzyate / Arambha meM kAna ke eka pArzva meM zotha hotA hai jisameM zUla hotA hai tathA jvara rahatA hai phira dUsare pArzva meM bhI sazUla zotha ho jAtA hai| yaha vAtakaphAtmaka jvara hai jo janapada (jile bhara) ke nivAsI bAlakoM meM vizeSakara ke dekhA jA sakatA hai| For Private and Personal Use Only

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1064 vikRtivijJAna 31-kardamavisarpakaphapittAjjvaraH stambho tandrA nidrA shirorujH| aGgAvasAdavikSepapralApArocakabhramAH / / mUrchAgnihAnirbhedo'sthnAM pipAsendriya gaurvm| AmopavezanaM lepaH srotasAM sa ca sarpati / / prAyeNAmAzaye gRhNannekadezaM na caatiruk| pittkairvkiirnne'tibhiitlohitpaanndduraiH|| mecakAmo'sitaH snigdhomalinaH zophavAna guruH| gambhIrapAkaH prAjyoSmA spRSTaH klinno'vdoryte|| paGkavacchIrNamAMsazca spaSTasnAyusirAgaNaH / zavagandhI ca vIsarpaH kardamAkhyamuzanti tam // (a. saM. a. 13) kapha aura pitta ke kAraNa jvara-stambha-tandrA-nidrA-ziraHzUla-aMgAvasAda-vikSepapralApa-aruci-bhrama-mUrchA-agnimAndya-asthizUla-tRSNA-indriyagaurava-Amamala kA tyAgasrotoM meM avarodha ke sAtha vaha visarpa AmAzaya meM ekade zIyarUpa meM sthita ho jAtA hai / pIDA adhika nahIM rhtii| pIlI-lAla-pANDuravarNa kI piTikAeM phailI rahatI haiM / vaha visarpa mecaka (kRSNa kapila) kRSNa, snigdha, malina, zophayukta, guru, gambhIrapAka aura atyanta uSNa hotA hai / chUne mAtra se phaTatA hai| usameM klinnatA hotI hai| mAMsa ke zIrNa hone se kIcar3a ke samAna usa visarpa meM snAyu tathA sirAe~ spaSTatayA dikhalAI detI haiN| isameM zava ke samAna gandha AtI hai| isa visarpa ko kardama kahate haiN| 32-kAmalApANDurogI tu yotyartha pittalAni niSevate / tasya pittamasRGamAMsaM dagdhvA rogAya kalpate // kAmalA bahupittaiSA koSThazAkhAzrayA matA // (ca.ci. a. 16) atyadhika pittavarddhaka padArthoM kA jo pANDurogI sevana karatA hai usakA pitta, rakta aura mAMsa ko bhI dUSita karake kAmalA kI utpatti karatA hai| yaha atyadhika pitta se utpanna roga hai jo koSTAzrita tathA zAkhAzrita do prakAra kA hotA hai| 33-kAlajvara jIvANavastvasya gadasya nUnaM majjAntrayormuSkajakozamadhye / adhyantrabhittyasthnyadhiphuphphusaM vai prAyo yakRtplIhagatA vasanti / / plIhAyakRccaidhata evaM nUnamanArataM te kSubhite vizeSAt / syAtAM ca te sautrikatantuyukte jvarAmaye'sminnanu kAlasaMze // ( upAdhyAya ) isa roga ke jIvANu asthimajA, antra, aNDakoza, Antrabhitti, asthi, phuphphusa, yakRt tathA plIhA meM prAyaH nivAsa karate haiN| inake kAraNa yakRt tathA plIhA meM vizeSa kSobha hotA hai, ve bar3ha jAte haiM aura tAntava utkarSa se yukta dekhe jAte haiN| yaha kAlasaMjJaka jvara (kAlAjAra ) hai| 34-kAsaadhaH pratihato vAyurUva'srotaH smaashritH| udAnabhAvamApannaH kaNThe saktastathorasi / / Avizya zirasaH khAni sarvANi pratipUrayan / AbhaannAkSipan dehaM hanumanye tathAkSiNI // netrapRSThamuraH pArve nirbhujya stambhayaMstataH / zuddho vA sakapho vApi kAsanAt kAsa ucyate // pratighAtavizeSeNa tasya vAyoH srNhsH| vedanAzabdavaizeSyaM kAsAnAmupajAyate / / (ca. ci. sthA. a.18) kisI kAraNavizeSa se athavA svayameva jaba vAyu kA adhogamana ruka jAtA hai taba vaha UrdhvasrotoM ke Azrita hokara udAnabhAva ko prApta ho jAtA hai| jisake kAraNa kaNTha aura chAtI meM saMlagna ho jAtA hai| sira ke samasta chidroM (srotoM) meM pahu~cakara unheM For Private and Personal Use Only

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samprApti vimarza 1065 bharatA huA zarIra tathA hanu-manyA tathA netroM ko bhagna evaM AkSepapUrNa karatA huA netra-pRSTha-urasa-pArzva ko Ter3hA karake stabdha karatA huA zuddha, sUkhA yA kapha se yukta banA kAsa kI utpatti karatA hai| khA~sane se use kAsa kahate haiN| usa vAyu ke vegapUrNa pratighAta kI bhinnatA ke kAraNa kAsoM meM vedanA tathA zabda kI bhI bhinnatA dekhI jAtI hai| suzruta ne isI rUpaka ko saMkSepa meM adholikhita zabdoM meM vyakta kara diyA hai prANo hyudAnAnugataH praduSTaH sabhinnakAMsyasvanatulyaghoSaH / nireti vaktrAt sahasA sadoSo manISibhiH kAsa iti pradiSTaH // (su. u. ta.) yahA~ prANavAyu udAnAnugata hone se praduSTa huI kAsa kA kAraNa hotI hai| 35-kuSTha AcArato'pathyanimittato vA, duSTo'nilaH kupitapittakaphau vigRhya / yatra kSipatyucchritadopabhedAttatraiva kuSThamatikaSTataraM karoti // ( kalyANakAraka) AcAra meM dauSTaya Ane se athavA pathya meM truTi hone se dUSita vAyu kupita kapha aura pitta donoM kopakar3a kara jahA~ pheMka detA hai usI sthAna para udvikta doSoM ke anusAra atyanta kaSTadAyaka kuSTha ko utpanna kara detA hai| 36-gaNDamAlA karkandhukolAmalakapramANaiH kakSAsamanyAgalavaMkSaNeSu : bhedaH kaphAbhyAM ciramandapAkaiH syAdgaNDamAlA bahubhizcagaNDaiH / / kakSA, aMsa, manyA, kaNTha vaMkSaNa pradeza meM meda tathA kapha ke dvArA dhore dhIre pakane vAlI vividha AkAra prakAra kI gA~The gaNDamAlA kahalAtI haiN| 37-galagaNDa vAtaH kaphazcaiva gale pravRddhau manye tu saMsRtya tathaiva bhedaH / kurvanti gaNDaM kramazaH svaliGga samanvitaM taM galagaNDamAhuH / / gale meM vAta aura kapha prakupita hokara manyA kA saMzraya karake aura meda ko sAtha lekara kramAnusAra vAtika aura kaphaja gaNDa kI utpatti karate haiM yahI galagaNDa kahalAtA hai| 38-gulma vAtapradhAnAH kupitA doSAH pRthak saMsRSTAH samastAH saraktA vA mahAsroto'nupravizyAvRtyordhvamadhazca mArgamavazyaM zUlamupajanayanto gulmamabhinirvartayanti / ( a. saM. ni. 11) vividha granthokta kAraNoM se kupita hue vAtapradhAna doSa alaga alaga, do-do yA saba milakara yA rakta ke sAtha milakara mahAsrota meM praveza kara Urdhva aura adhomArgoM ko AvRta karake zUla utpanna karate hue granthirUpa gulma banAte haiN| 39-grahaNIatIsAre nivRtte'pi mandAgne rahitAzinaH / bhUyaH sandUpito vahnirgrahaNImabhidUSayet // ekaikazaH sarvazazca doSairatyarthamUcchitaiH / sA duSTA bahuzo bhuktamAmameva vimuJcati // pakkaM vA sarujaM pUti muhurbaddhaM muhuIvam / grahaNIrogamAhustamAyurvedavido janAH // (su. u. ta. a. 40) atisAra kI samApti para yA svatantratayA bhI apathyakara bhojana karane vAle mandAgni se pIDita vyaktiyoM kI grahaNI ko vAta Adi doSoM meM se eka eka se yA sabase duSTa huI jATharAgni khUba dUSita kara detI hai| duSTa huI vaha grahaNI khAye hue anna ko pUrNataH Ama athavA kucha pakka rUpa meM bAra-bAra tyAgatI rahatI hai| jisake kAraNa kabhI baddha kabhI patalA zUla ke sAtha pAkhAnA utaratA rahatA hai / isI ko grahaNI yA saMgrahaNI kahA jAtA hai| For Private and Personal Use Only

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1066 vikRtivijJAna 40-camakIlavyAno gRhItvA zleSmANaM karotyarzastvaco bhiH| kIlopamaM sthirakharaM carmakIlaM tu taM viduH|| vAtena todaH pAruSyaM pittaadsitrkttaa| zleSmaNA snigdhatA tasya grathitatvaM savarNatA // (a. hR. ni a.7) kIla ke samAna sthira aura khara bAhya tvacA para nikale hue arza jo vyAna vAyu ke dvArA zleSmA ko grahaNa karake banate haiM carmakIla kahalAte haiM unameM vAta se toda aura paruSatA, pitta se gaharA lAla varNa aura kapha se unakA gAMThadAra, savarNa aura snigdha honA pAyA jAtA hai| 41-cippanakhamAMsamadhiSThAya vAyuH pittaM ca dehinAm / kurvAte dAhapAkau ca taM vyAdhi cippamAdizet // (su. ni. 13) nakha meM sthita mAMsa meM adhiSThita hokara java manuSyoM ke vAyu aura pitta dAha evaM pAka kI utpatti karate haiM to usa vyAdhi ko cippa kahA jAtA hai| 42-chardidoSAnudIrayan vRddhAnudAno vyaansnggtH| UrdhvamAgacchati bhRzaM viruddhAhAra sevanAt // ( suzruta ) atizaya viruddhAhAra sevana karane se prakupita hue doSoM ko jaba vyAna vAyu ke sAtha udAna vAyu Upara kI ora tejI se le AtI hai to yaha avasthA vamana kahalAtI hai| 43-jalodarasnehapItasya bhandAgneH kSINasyAtikRzasya c| atyambupAnAnnaSTe'gnau mArutaH klomnyavasthitaH / / srotaHsu ruddhamArgeNa kaphazcodakamUcchitaH / varddhayetAM tadevAmbu svasthAnAdudarAyatau // atyanta kSINa aura kRza mandAgni se vyathita sneha kA jisane prayoga kiyA huA hai usake atyadhika drava padArthoM ke sevana se jaba agni naSTa ho jAtI hai taba klomasthita vAyu kupita hokara srotasoM aura mAgoM kA avarodha karake kapha jalIyAMza ko mUchita karake ve donoM apane sthAna se udara roga ke lie bar3hA dete haiN| isa prakAra udara roga kI utpatti meM rogI ke snehana karma kA bigar3anA, agni kA manda honA, rogI kA kRza ho jAnA, tarala dravyoM kA atizaya sevana tathA vAyu aura kapha ke dvArA udakavaha srotasoM kA avaruddha kiyA jAnA mukhyatayA dekhA jAtA hai| 44-jvarasaMsRSTAH sannipatitAH pRthaga vA kupitA mlaaH| rasAkhyaM dhAtumanvetya paktiM sthAnAnirasya ca / / svena tenoSmaNA caiva kRtvA dehoSmaNo balam / srotAMsi ruddhvA saMyAtAH kelaM dehamulvagAH / / santApamadhikaM dehe janayanti narastadA / bhaktyatyuSNasarvAGgo jvaritastena cocyte| srotasAM saMvibaddhatvAt svedaM nA nAdhigacchati / svasthAnAt pracyute cAgnau prAyazastaruNe jvare / prakupita hue vAtapitta kapha ye tInoM doSa akele-akele, do-do milakara athavA tInatIna ekatra hokara rasa nAmaka dhAtvAhAra pariNAmarUpa Adya dhAtu kA anugamana karake usakI agni (rasastha rasAgni rUpa jATharAgni) ko apane sthAna se nikAlakara bAhara kI ora utkSipta kara dete haiN| usa bAhara pheMkI huI USmA ke sAtha dehoSmA milakara aura bhI uttapta ho jAtI hai| dUsarA kArya ye kupita doSa srotoM (purISa-mUtra-svedAdivAhI srotasoM) ke avarodha kA karate haiN| jisake kAraNa zarIra meM santApa ( Temperature ) bar3ha jAtA hai tathA adhika dera taka sthAyI rUpa meM bar3hA huA rahatA hai| sarvAGga ke isa prakAra atyuSaNa For Private and Personal Use Only

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samprAptivimarza 1067 hone kI saMjJA jvara kahI jAtI hai / svasthAna se cyuta huI agni se tathA yataH srotovarodha huA karatA hai / ataH taruNa jvara se grasita rogI ko prAyaH pasInA nahIM AtA / / 45 - tRSNA vAtAtpittakaphAttRSNA sannipAtAdrarukSayAt / SaSThIsyAdupasargAcca vAtapitte tu kAraNam // sarvAsu tatprakopo hi saumyadhAtu prazoSaNAt / sarva deha bhramantApadAhamohakRt // jihvAmUlagaraklomA lutonavAH sirAH / saMzodhya tRSNA jAyante " (aSTAGgahRdaya ) tRSNA vAta se, pitta se, kapha se, sannipAta se, rasa ke kSINa ho jAne se tathA chaThI upasarga ke kAraNa utpanna hotI hai / ina chahoM prakAra kI tRSNAoM kI utpatti meM mukhya kAraNa vAta aura pitta hote haiN| vAyu-zoSaNa dvArA aura pitta USmA dvArA zuSka karake somayukta dhAtuoM kA prazoSaNa karake tRSNA ko utpanna karate haiN| isake kAraNa sampUrNa zarIra meM bhrama, kampa, tApa, tRSA, dAha aura moha utpanna ho jAtA hai / jihvAmUlagata, galastha, klomastha, tAlustha jalavahA sirAoM kA zoSaNa karake tRSNA paidA huA karatI hai / 46--dAha tvacaM prAptaH sa pAnomA pittaraktAbhimUcchitaH / dAhaM prakurute ghoraM pittavattatra bheSajam // kRtsnaM dehAnugaM raktamudriktaM dahati dhruvam / sa uSyate tRSyate ca tAmrAbhastAmralocanaH // lohagandhAGgavadano vahninevAvakIryate / pittajvarasamaH pittAtsa cApyasya vidhiH smRtaH // tRSNA nirodhAdanyAtau kSINe tejaH samuddhatam / savAhyAbhyantaraM dehaM pradahenmandacetasaH // saMzuSka galatAatur jihvAM niSkRSya vepate / asRjaH pUrNakoSThasya dAho'nyaH syAtsuduHsahaH // dhAtukSayotyo yo dAhastena mUcchAtRDarditaH / kSAmasvaraH kriyAhInaH sa sIded bhRzapIDitaH // kSatajo'naznatazcAnnaM zocato vA'pyanekadhA / tenAntardahyatetyarthaM tRSNAmUrcchApralApavAn // marmAbhighAtajapyasti so'sAdhyaH saptamo mataH / sarva eva ca varjyAH syuH zItagAtrasya dehinaH // AcAryoM ne dAha ke 7 kAraNa likhe haiM-madya, raktapitta, tRSNAnirodha, dhAtukSaya, kSata tathA marmAbhighAta / madyapAna se zarIrastha USmA pitta aura rakta se milakara ghora dAtta karatI hai / sampUrNa zarIracArI rakta ke prakupita ho jAne se bhI sArA zarIra dahaka uThatA hai / pitta ke prakupita ho jAne se pittajvara ke lakSaNoM se yukta paittikadAha utpanna hotA hai | tRSNA kA nigraha kara lene se jaladhAtu ke kSINa hone se zarIra bhara meM teja dIpta ho jAtA hai jisase bAhara aura bhItara sarvatra zarIra jala uThatA hai, gala tAlu bhoSTha sUkha jAte haiN| dhAtukSaya se jisameM raktapUrNakoSThatA ( raktasrAva sammilita hai, ati duHsaha dAha utpanna kara detA hai / kSataja dAha meM tathA raktasrAva dAha kA pramukha kAraNa hotA hai / marmAbhighAta ke kAraNa bhayaMkara mAnA jAtA hai / Abhyantarika ) bhI mAnasika avasAda utpanna dAha sabase 47- pakSAghAta adhogatAH satiryagA dhamanIrUdUrdhvadehagAH / yadA prakupito'tyarthaM mAtarizvA prapadyate // tadAnyatarapakSasya sandhibandhAn vimokSayan / hanti pakSaM tamAhurhi pakSAghAtaM bhiSagvarAH // yasya kRtsnaM zarIrArdhamakarmaNyamacetanam / tataH patatyasUn vApi jahAtyanilapIDitaH // suzruta adhogAmI, tiryaggAmI athavA UrdhvagAmI dhamaniyoM ko jaba karatA hai taba jisa ora yaha kopa karatA hai usake dUsarI ora ke ko (pezIya kriyAoM ko ) vimocita karatA huA usa pakSa ko naSTa bhiSagvara pakSAghAta kahate haiM / isake kAraNa usakA sampUrNa zarIra, AdhA zarIra yA eka kara detA hai / isI ko For Private and Personal Use Only kupita huA vAyu prApta eka pakSa ke sandhibandhoM

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1068 vikRtivijJAna (aSTADa hadaya) aMga akarmaNya ho jAtA hai aura usakI cetatA zakti naSTa yA kama ho jAtI hai| vaha vAtavyAdhi se pIDita vyakti adhika gambhIrAvasthA hone para yA Age calakara prANoM ko bhI tyAga detA hai| 48-pANDurogapittapradhAnAH kupitA yathoktaiH kopanarmalAH / tatrAnilena balinA kSiptaM pittaM hRdi sthitam // dhamanIrdazasamprApya vyApnuvatsakalAM tanum / zleSmatvagraktamAMsAni pradUSyAntaramAzritam // tvaGmAMsayostatkurute tvaci varNAn pRthgvidhaan| pANDUhAridraharitAn pANDutvaM teSu cAdhikam / / yato'taH pANDurityuktaH sa rogH-| pradhAnatayA pitta se yukta doSa yathokta doSa kopaka hetuoM ke dvArA kupita hote haiN| saba doSoM meM vAyu adhika balavAn sadA hI rahane ke kAraNa vaha isa pravRddha pitta ko jo hRdaya meM sthita hai dazoM dhamaniyoM meM pheMka detA hai / isa kAraNa vaha sampUrNa zarIra meM (malamUtra svedAdika meM bhI) vyApta ho jAtA hai / zleSmA, tvacA, rakta tathA mAMsa ko duSTa karatA huA vaha pitta tvacA aura mAMsa ke antara meM sthita hokara tvacA ko vividha varNa kA banA detA hai| pANDu-hAridra-haridvarNa kA kara detA hai| pANDutva kI adhikatA hone se ise pANDuroga kahA jAtA hai| 49-pratizyAya cayaM gatA mUrddhani mArutAdayaH pRthak samastAzca tathaiva zoNitam / prakopyamANA vividhaiH prakopaNairnRNAM pratizyAyakarA bhavanti hi // (suzruta u. taM.) vAtAdika doSa jaba zira ke bhItara akele-akele athavA milakara saMcita ho jAte haiM isI prakAra raktadoSa kA bhI jaba saMcaya ho jAtA hai to ve hI vividha prakopaka kAraNoM kI upasthiti hone para manuSyoM ko pratizyAya utpanna kara dete haiN| 50-prameha medazca mAMsaJca zarIrajaJca kledaM kapho vastigataM pradRSya / karoti mahAn samudIrNamuSNaistAneva pittaM paridRSya cApi // kSINeSu doSeSvavakRSya bastau dhAtUn pramehAn kurute'nilazca / doSo hi basti samupetya mUtraM sandUSya mehAn kurute yathAsvam // (caraka ci. sthA.) vividha kAraNoM se kupita kaphadoSa bastigata meda , mAMsa tathA zarIrastha kleda ko dUSita karake kaphaja prameha ko, pittadoSa jo uSNa padArthoM ke sevana se kupita huA hai bastistha meda, mAMsa aura zarIraja kleda ko dUSita karake pittaja prameha ko tathA pitta aura kapha ke kSINa hone para vAyu dhAtuoM ko basti meM khIMcakara vAtaja prameha ko utpanna karatA hai| isa prakAra kupita doSa basti meM pahu~cakara mUtra ko dUSita rUpa meM utpanna karake hI vividha prakAra ke pramehoM ko utpanna karate haiN| 51-plIhodaraatyAzitasya saMkSobhAd yaanaayaanaaticessttitaiH| ativyvaaybhaaraadhvvmnvyaadhikrssnnaiH|| vAmapArthAzritaH plIhA cyutaH sthAnAt pravarddhate / zoNitaM vA rasAdibhyo vivRddhaM taM vivarddhayet // (caraka ci. sthA.) atyanta khAye hue manuSya kA savArI dvArA yA anya kisI prakAra se zarIra ko adhika hilAne, atyanta maithuna karanA, bhAra DhonA, paidala calanA, vamana aura rogoM ke dvArA kRza hone se bhI vAmapArzvastha plIhA cyuta hokara bar3hane lagatI hai| binA cyuta hue bhI plIhA kI vRddhi kA kAraNa usameM rakta athavA rasadhAtu kI vRddhi honA hotA hai| For Private and Personal Use Only

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samprAptivimarza 1066 52-baddhagudodara yasyAntramannarupalepibhirvA bAlAzmabhirvA sahitaiH pRthagvA / saJcIyate tatra malaH sadoSaH krameNa nADyAmiva saGkaro hi // nirudhyate cAsya gude purISaM nireti kRcchAdapi cAlpamalpam / hRnnAbhimadhye parivRddhimeti yaccodaraM viTsamagandhikaJca / pracchardanaM baddhaguDhI vibhaavyH......................|| (su. ni. sthA.) picchila annAdika se, bAloM se, patthara ke Tukar3oM se yA anya eka vA aneka kAraNoM se jaba antra kA nirodha ho jAtA jisake kAraNa vahA~ nAlI meM kUr3e ke samAna duSTa purISa ekatra hone lagatA hai| Antra nirodha se thor3I-thor3I mAtrA meM gudamArga para bar3e kaSTa se mala nikalatA hai / hRdaya aura nAbhi ke madhya kA udara bahuta phUla jAtA hai| purISa ke samAna gandhavAlI vamana bhI hone lagatI hai| yaha roga baddhagudodara jAnanA caahie| 53-bastikuNDaladrutAdhvalaMghanAyAsaira bhighAtAtprapIDanAt / svasthAnAdvastiruvRttaH sthUlastiSThati garbhavat / zUlaspandanadAhA" bindu bindu sravatyapi / pIDitastusRjeddhArAM saMstambhodveSTanAtimAn / / bastikuNDalamAhustaM ghoraM zastraviSopamam / pavanaprabalaM prAyo durnivaarmbuddhibhiH| vividha kAraNoM se basti apane sthAna se haTakara sthUla garbhavat dikhalAI par3atI hai| usameM zUla spandanAdi ke sAtha sAtha bindu-bindu bhUtra hara samaya giratA hai| dabAne se dhArA nikalatI hai / udveSTana tathA stabdhatA barAbara milatI hai / isa ghora vyAdhi ko basti kuNDala kahate haiM / yaha sAdhAraNa cikitsakoM se ThIka nahIM hotaa| yaha vAyu ke kopa se utpanna hotA hai| 54-bhrama-pittaprabhaJjanabhavaM bhramameva puMsAm / ( hArIta ) manuSyoM ko pitta aura vAta ke prakopa se bhrama kI utpatti hotI hai| 55-madAtyayaviSasya ye guNA dRSTAH snnipaatprkopkaaH| ta eva madye dRzyante viSe tu blvttraaH|| hantyAzu hi viSaM kiJcit kizcidrogAya kalpate / yathAviSaM tathaivAntyo zeyo madyakRto mdH|| tasmAt tridoSajaM liGgaM sarvatrApi madAtyaye / dRzyate rUpavaizeSyAt pRthaktvaJcApi lakSyate / / (ca ci. sthA.) jo guNa viSa ke batalAye gaye haiM ve hI sannipAtakopaka guNa madya ke hote haiN| viSa madya se adhika balavAn hotA hai| koI viSa mAra detA hai, koI kucha roga mAtra kara detA hai| usI prakAra madya kI tRtIyAvasthA mAraka hotI hai| ataH madAtyaya meM sarvatra tInoM doSoM kA prakopa huA karatA hai / lakSaNabheda se usake alaga-alaga prakAra batalAye gaye haiN| 56-mantharajvaramalamUtrasvedajAtadoSasaMsargadUSitaiH, bhakSyapeyAdibhirdravyairnAnAsaMkramakAraNaiH / kITANavaH saMkramaNaM prakurvanti vizeSataH, kRtvA saMkramaNaM nRNAmAdAvantraM prayAnti te // tatpazcAdanyabhittisthAn granthIn zothasamanvitAn , kRtvA sadyo rasaM raktaM doSAn saGkopayantyapi / tataH kSudrAnvAntyabhAgAJcchanaiHkurvanti sakSatAn , pazcAdAntrakSatAnAM ca vRddhiH saJjAyate kramAt / / tayA kSudrAntrabhAgasthaM kSataM tatpAragaM bhavet , tataH zothatvamApnoti codarasthA kalA dhruvam / evaM rItyA kSate vRddhe purISotsarjane kvacit , lakSyeta yadi raktasya srAvo bhinnAntratA tdaa| jJAtavyA bhiSajA cApi nUnaM tasyApyasAdhyatA // rogiyoM ke mala-mUtrAdi ke saMsarga se duSTa hue bhakSyapeyAdi ke dvArA mantharajvara ke kITANuoM kA praveza manuSya kI A~toM meM ho jAtA hai| Antra kI prAcIra meM sthita zleSmala granthiyoM ko ve zothayukta kara dete haiM jisake kAraNa rasa-rakta dhAtue~ tathA vAtapittAdi doSa 60vi0 For Private and Personal Use Only

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1070 vikRtivijJAna prakupita ho jAte haiM / tudAntra ke antima bhAga meM kSata ho jAte haiN| dhIre-dhIre ye kSata prAcIra ke andara bar3hate jAte haiM aura kabhI-kabhI prAcIra ko bhedakara pAra cale jAte haiM jisake kAraNa udarasthA kalA udaracchadA zotha ko prApta ho jAtI hai| isa prakAra kSatoM ke bar3hane para mala ke sAtha yadi rakta kA srAva bhI mile to Antra kA bhedana huA hai aisA jJAna ho jAtA hai / yaha avasthA nizcaya hI asAdhya jAnanI caahie| 57-mUtrakRcchU pRthamalAH svaiH kupitA nidAnaiH sarve'thavA kopamupetya bastau / mUtrasya mArga paripIDayanti yadA tadA mUtrayatIha kRcchrAt / / (ca. ci. sthA.) __ apane-apane hetuoM se prakupita hue vAtAdika doSa pRthaka-pRthak athavA saba milakara basti meM kopa utpanna karake mUtra ke mArga ko paripIDita kara dete haiM jisake kAraNa rogI jaba taba kaSTapUrvaka mUtra tyAga karatA hai| 58-mUtrakSayarUkSasya klAntadehasya bastisthau pittamArutau / mUtrakSayaM sarugdAhaM janayetAM tadAhvayam // ( sa. u. ta.) ___ rUkSa aura klAnta dehavAle rogI ke basti meM sthita pitta aura vAta nAmaka prakupita doSa mUtra kA nirmANa naSTa karake pIr3A aura dAha ke sAtha mUtrakSaya nAmavAle roga ko utpanna kara dete haiN| 59-mUtragranthi yA raktagranthiraktaM vAtakaphAdRSTaM vastidvAre sudAruNam / granthi kuryAt sa kRcchreNa sRjenmUtraM tadAvRtam / / azmarIsamazUlaM taM mUtragranthi pracakSate // basti ke dvAra para vAta aura kapha se duSTa huA rakta eka prakAra kI dAruNa granthi banA detA hai| usase AvRta mArga hone se kaSTa ke sAtha mUtra nikalatA hai| usameM azmarI jaisA zUla hotA hai| yaha raktagranthi yA mUtragranthi kahalAtI hai| 60-mUtrajaTharamUtrasya vege'bhihate tadudAvartahetukaH / apAnaH kupito vAyurudaraM pUrayed bhRzam / / nAbheravastAdAdhmAnaM janayettIvravedanam / tanmUtrajaTharaM vidyAdadhobastinirodhanam // (su. u. ta.) mUtra ke vega ke roka dene se mUtranirodhakArI udAvarta ke phalasvarUpa apAna vAyu kupita hokara udara ko khUba bhara detA hai jisake kAraNa nAbhi ke nIce khUba phUla jAtA hai| khUba vedanA hotI hai| yaha basti ke adhobhAga ke nirodha se utpanna hotA hai| 61-mUtrazukramUtritasya striyaM yAto vAyunA zukramuddhatam / sthAnAcyutaM mUtrayataH prAk pazcADhA pravartate // bhasmodakapratIkAzaM mUtrazukraM taducyate / (su. u. taM.) mUtra ke vega ko dhAraNakara strI ke sAtha maithuna meM pravRtta vyakti kA pravRddha zukra jaba vAyu dvArA apane sthAna se cyuta kiyA jAtA hai to vaha mUtratyAga ke pUrva yA pazcAt nikalatA hai| yaha bhasma mile jala yA cUnA mile jala ke samAna hotA hai| 62-mUDhagarbhasarvAvayavasampUrNo manobuddhayAdisaMyutaH / viguNApAnasaMmUDho mUDhagarbho'bhidhIyate // (mAdhava ni.) saba avayavoM se yukta manobuddhayAdi se pUrNa jaba garbha apAnavAyu kI viguNatA se saMmUDha hokara anyAnya vikRta AsanoM ko grahaNa karatA hai to use mUDhagarbha kahA jAtA hai| 63-mUtrasAdapittaM kapho dvAvapi vA saMhanyete'nilena cet / kRcchAnmUtraM tadA pItaM zveta raktaM dhanaM sRjet // sadAhaM rocanAzaMkhacUrNavarNaM bhavetu tat / zuSkaM samastavarNa vA mUtrasAdaM vadanti tam // ( a. ha. ni.) For Private and Personal Use Only

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samprAptivimarza 1071 pitta aura kapha donoM athavA alaga-alaga vAyu ke dvArA jaba saMghanana ko prApta hote haiM to mUtra pIlA, sapheda athavA lAla tathA ghanarUpa meM dAhapUrvaka gorocana yA zaMkhacUrNa rUpa meM zuSka yA samasta varNa kA ho jAtA hai / yahI mUtrasAda kahalAtA hai| 64-mUtrAtItaciraM dhArayato mUtraM tvarayA na pravartate / mehamAnasya mandaM vA mUtrAtItaH sa ucyate // ( su. u. taM.) dera taka rokA gayA mUtra jaba tyAgane para turata na nikalakara manda manda gati se giratA hai to yaha avasthA mUtrAtIta kahalAtI hai| 65-mUtrotsaGga bastau vA'pyathavA nAle maNau vA yasya dehinaH / mUtraM pravRttaM sajjeta saraktaM vA prvaahtH|| sravecchanairalpamalpaM sarujaM vA'tha nIrujam / viguNAnilajo nyAdhiH sa mUtrotsaGgasaMzitaH ||(s. u. taM.) vAyu kI viguNatA ke kAraNa basti, nAla (mUtramArga) athavA maNi meM pravRtta huA mUtra alpa-alpa yA rakta ke sAtha, zUlapUrvaka yA vinA zUla pravAhita hotA hai to yaha avasthA mUtrotsarga kahalAtI hai| 66-mUcrchAkSINasya bahudoSasya viruddhAhArasevinaH / vegAghAtAdamISAlAddhInasattyasya vA punH|| karaNAyataneSUgrA bAhyeSvAbhyantareSu ca / nivizante yadA doSAstadA mUrcchanti mAnavAH / / saMjJAbahAma nADIpu pihitAsvanilAdibhiH / tamo'bhyupaiti sahasA sukhaduHkhavyayohakRt / / sukhaduHkhavyapohAcca naraH patati kASThavat / moho mUrcchati tAM prAhuH SaDvidhA sA prkiirtitaa|| vAtAdibhiH zoNitena nadyena ca viSeNa ca / paTsvapyetAsu pittaM hi prabhutvenAvaniSThate / / vividha kAraNoM se prakupita hue doSa jaba bAhya karmendriyoM tathA Abhyantarika manobuddhi-jJAnendriyAdika meM praveza kara jAte haiM tabhI prANI mUrchita ho jAtA hai / ina prakupita vAtAdika doSoM se jaba saMjJAvahasrota bhara jAte haiM to sahasA tama kA Agamana ho jAne se sukha-duHkha kA nAza ho jAtA hai, jisake kAraNa vyakti kASTha ke samAna gira jAtA hai, use moha yA mUrchA kahA jAtA hai / yaha vAtika, paittika, zlaiSmika, raktaja, madyaja tathA viSaja 6 prakAra kI mAnI jAtI hai| 67-yonikandadivAsvapnAdatikrodhAd vyAyAmAdatimaithunAt / kSatAcca nakhadantAdyairvAtAcAH kupitA ydaa|| pUyazoNitasaMkAzaM nikucA kRtisaMnibham / janayanti yadA yonau nAmnA kandaH sayonijaH // (su. u. taM.) divAsvapnAdi kAraNoM se kupita vAtAdidoSayoni meM pUyaraktayukta bar3ahala kI AkRti ke jisa kanda ko utpanna karate haiM vaha yonikanda kahalAtA hai| 68-yonivyApatpravRddhaliGga puruSaM yAtyarthamupasevate / rUkSadurbalabAlAyAstasyA vAyuH prakupyati / / sa duSTo yonimAsAdya yonirogAya klpte| trayANAmapi doSANAM yathAsvaM lakSaNena tu // vizatiApadoyonenirdiSTA rogasaMgrahe / mithyAcAreNa yAHstrINAMpraduSTenAtavena ca // jAyante bIjadoSAcca devAcca zRNutAH pRthaka / / ( su. u. taM.) rUkSa durbala jo strI puruSa ke atilambamAna mehana kA upasevana barAbara karatI hai usakA vAta doSa kupita hokara yoni meM pahu~cakara yonirogoM ko utpanna kara detA hai| yahI vAyu pitta aura kapha ko duSTa karake tInoM doSoM ke anusAra yoniroga utpanna kara detA hai| isa prakAra 20 prakAra ke yonibyApat zAstra meM varNita haiN| striyoM ke mithyAcAra se, ArtavaduSTi se, bIjadoSa se athavA daivAt bhI inakI utpatti sambhava hai| For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 1072 www.kobatirth.org ******** vikRtivijJAna 69 - raktapitta atidharmatayA vApi tIkSNoSNakaTusevanAt / kSArAmlasevanAdvApi madyapAnAdisevanAt // ativyavAyAcchItena zuSkazAkAdisevanAt / etaistu kupitaM pittaM raktena saha mUcchitam // * "yenaiva kupyate pittaM raktaM tenaiva kupyate // tAvatprakupite koSThe vAyurdArayate bhRzam / UrdhvaM ca nayate prANazcApAno'pAnamIrati // madhye samAnaH kurute raktapittasya kopanam / evaM yugapatpittaca raktena saha kupyati // ( hArIta tR. sthA. ) / prakupita pitta aneka prakAra ke uparyukta kAraNoM se pitta kA atyadhika kopa hotA hai rakta ke sAtha mUrcchita ( mizrita ) ho jAtA hai| jina kAraNoM se pitta kA kopa sambhava hai unhIM se rakta bhI kupita huA karatA hai / pitta taralaguNabhUyiSTha hone se rakta ko aura patalA kara detA hai / isa kupita pitta ke dvArA vAyu bhI bahuta adhika kupita kara dI jAtI hai / vaha koSTha ko yA una sabhI sthAnoM ko phAr3a detI hai jahA~ pittamizrita rakta prakopa kie rahate haiM / Urdhva bhAga meM prANa vAyu, madhya meM samAna vAyu tathA adhobhAga meM apAna vAyu raktapitta kA prakopaNa karane meM samartha hotI haiN| isa prakAra eka sAtha hI sthAna-sthAna para rakta ke sAtha pitta kA prakopa huA karatA hai / 70 - rAjayacamA Acharya Shri Kailassagarsuri Gyanmandir malajala gatirodhAnmaithunAdravighAtAdazanavirasabhAvAcchleSmarodhAtsirAsu / kupitasakalado pairvyApta dehasya jantorbhavati viSamazoSavyAdhirepo'tikaSTaH // ( ka. kA. ) malamUtrAdika vega ke nirodha se, atyadhika maithuna karane se, sAhasAdika kAryoM se vighAta hone para, sirAoM meM zleSmA kA avarodha hone se sampUrNa doSa prakupita hokara manuSya 'ke zarIra meM vyApta hone se yaha atova kaSTadAyaka bhayaGkara rAjayacamA roga huA karatA hai | yaha sAnnipAtika mAnI jAtI hai / 71 - vAtakuNDalikA - svajala vegavighAtavidUSitazciravirUkSavazAdapi vastija M zcarati mUtrayuto marudutkaTaH prabalavedanayA saha sarvadA / sRjati mUtramasau sarujaJcirAnnaravarolpamatolpamativyathaH pavanakuNDalikAkhya mahAmayo bhavati ghorataro'nilakopataH // (kalyANakAraka) mUtraveganirodha, cirakAla taka rUkSa vAtakAraka padArthoM kA prakopa karAtA hai / vaha utkaTa vAyu mUtra ke sAtha sampUrNa vasti meM nirantara ghUmatI hai / rogI bar3e kaSTa se thor3A-thor3A mUtra karatA hai / isa ghoratara vAta kopa se utpanna hue mahAroga ko vAtakuNDalikA kahA jAtA hai / sevana vAyu kA utkaTa prabala vedanA karatI huI T 72 - vAtarakta-- hastyazvoSTraprayAtasya ca bhavati vidAhyaznato'nnaM samastam / raktaM duSTaM viduSTena ca yutamanileneti tadvAtaraktam // ( vaidya candrodaya ) hAthI, ghor3A, UMTa Adi savAriyoM para car3hane se tathA vidAhakAraka annAdika kA sevana karane se sampUrNa rakta vidagdha ho jAtA hai| yahI vAyu ke sAtha milakara vAtarakta ko utpanna karane meM samartha hotA hai / 73 - vAtavyAdhirUkSazItAlpaladhvannavyavAyAtiprajAgaraiH H / laGghanaplavanAtyadhvavyAyAmAdiviceSTitaiH / dhAtUnAM viSamAdupacArAcca doSAsakasravaNAdapi 11 saMkSayAccintAzoka rogAtikarSaNAt // marmAbAdhAdgajoSTrAzva zIghrayAnApataMsanAt // vegasandhAraNAdA mAdabhighAtAdabhojanAt / dehe srotAMsi riktAni pUrayitvA'nilo balI / karoti vividhAn vyAdhIn sarvAGgaikAGgasaMzrayAn // ( caraka ci. sthA. ) For Private and Personal Use Only

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samprAptivimarza 1073 dhAtukSayakarairvAyuH kupyatyatiniSevitaiH / caran srotaHsu rikteSu bhRzaM tAnyeva pUrayan / tebhyo'nyadoSapUrNebhyaH prApya vAssvaraNaM balI // ( a. saMgraha ni. sthA. ) dhAtu kSINa karane vAle rUtta-zItAdi AhAra-vihArAdika kAraNoM se manuSya ke zarIra meM vAtadoSa prakupita ho jAtA hai / dhAtuoM kI kSINatA ke kAraNa unameM sthita srotas rikta ho jAte haiM / unako yaha kupita vAyu khUba bhara detA hai| isa kAraNa vAyu ke vividha roga ho jAte haiM / kabhI kabhI jaba srotas anya doSoM se pUrNa hote haiM taba kupita vAyu unameM pravezakara AvaraNa prApta karake bhI vividha vAtika vyAdhiyoM ko utpanna karane meM samartha ho jAtA hai / svataH vAtakopa se yA AvRta huI vAta se donoM meM se kisI eka prakAra se hI vAta roga hote hue dekhe jAte haiM / 74- vAtAlikA-- RtuvyApattisamaye janamAraH pravartate / tatropavAsI dhRtimAn viprAbhivAdana // tvaramANazcikitseta pravRddhA mArayettvaram / pittazleSmasamutthAnA vAtazoNitamUcchitA // mantrauSadhayazcApi janamArAtpramucyate / vAtAliketi tAmAhuH yatravAMstatra jIvati // ( bhelasaMhitA) asAtmyagandhamAdAya vAto yatrAtiricyate / tatra martyeSu sAmAnyaH pratizyAyaH pravartate / / tathA vAtAlikAnAntu piTIkA cAsya jAyate / kakSAdhaH UrumUle ca pANipAdataleSu ca // kaNThe vA zrotramAzritya vastau vA hRdaye'pi vA / vAtAlikA eka prakAra kA janamAra ( epidemic ) hai / upavAsa, dhIratA, vidvajjanasevA, mantra, auSadha Adi mArga dvArA isase rakSA hotI hai / pahale pratizyAya hotA hai phira kakSA vaMkSaNAdi pradezoM meM, kaNTha, zrotra, basti, hRdayastha kSetrIya lasIkA granthiyA~ sUja jAtI haiN| turata cikitsA na hone se mAra detA hai| kevala yatnavAn hI jItA hai / yaha vyAdhi pitta aura kapha se utpanna vyAdhi hai isameM vAta aura rakta mUcchita rahate haiM 75 - vAtASTIlA - zakRnmArgasya vastazca vAyurantaramAzritaH / aSThIlAbaddhanaM granthi karotyacalamunnatam // viNmUtrAnilasaGgazca tatrAdhmAnaJca jAyate / vedanA ca parA bastau vAtASThIleti tAM viduH // (su. u. taM.) mala aura mUtra mArga ke madhya meM sthita aSTIlA nAmaka baddha granthi meM kupita huA vAyu sthita hokara use acala aura unnata kara detA hai jisake kAraNa mala-mUtra aura vAyu kA avarodha hotA hai, AdhmAna utpanna hotA hai tathA basti meM vedanA hotI hai / 76 - vidradhi-- tvagraktamAMsamedAMsi pradUSyAsthisamAzritAH / doSAH zophaM zanairghoraM janayantyucchritA bhRzam // mahAmUlaM rujAvantaM vRttaJcApyathavAyatam / tamAhurvidradhiM dhIrA vijJeyaH sa ca SaDvidhaH // ( su. u. taM.) tvacA, rakta, mAMsa, meda aura asthi ina dUSyoM ko Azrita karake kupita doSa dhIre dhIre eka ghora zopha ko utpanna karate haiM jo gola yA caur3A, mahAmUlavAlA aura zUlayukta hotA hai isI ko dhIra puruSa vidradhi kahate haiM / 77 - viSamajvara doSo'lpo'hitasambhUto jvarotsRSTasya vA punaH / dhAtumanyatamaM prApya karoti viSamajvaram // alpa doSa ahitakara AhAra vihAra ke kAraNa kAlavizeSa meM labdhabala hokara jisakA jvara abhI-abhI hI chUTA hai use punaH rasaraktAdika dhAtuoM meM pahu~ca pahu~cakara jvara utpanna kara dete haiM / yahI viSamajvara kahalAtA hai / 78 - visarpa raktaM lasIkA tvaGmAMsaM dUSyaM doSAstrayo malAH / visarpANAM samutpattau vijJeyAH saptadhAtavaH // (ca. ci. sthA. ) For Private and Personal Use Only

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1074 vikRtivijJAna rakta- lasIkA - tvacA - mAMsa Adi dUSya tathA tInoM doSa milakara saptadhAtuoM meM prasarpaNakArI jisa roga ko utpatti karate haiM vaha visarpa kahalAtA hai / 79:- visUcI vividhairvedanAbhedervAyvAderbhRzakopataH / sUcIbhiriva gAtrANi bhinattIti visUcikA // ( madhukoza ) pravaratIrujAtu visUcikA bhavati gauriva yo'tti nirantaram / bahutarAnnamajIrNamato'sya tat // ( kalyANakAraka ) gAya ke samAna nirantara bahuta sA anna bhakSaNa karane se utpanna ajIrNa ke kAraNa vAtAdika doSoM ke kupita hone se vividha tIvra vedanAoM se yukta sUcI ke samAna bhedanavat pIDA utpanna karane ke kAraNa visUcikA kahalAtI hai / 80- - visphoTa tvacamAzritya te raktamAMsAsthIni pradUSya ca / ghorAn kurvanti visphoTAn sarvAn jvarapuraHsarAn // ( mAdhava ) duSTa hue doSa tvacA meM Azrita hokara rakta, mAMsa, asthyAdika dhAtuoM ko dUSita karake jvarapUrvaka ghora visphoToM kI utpatti karate haiM / 81 - vRddhi - atha pravRtto'nyatamo'nilAdiSu praduSTadoSaH phalakozavAddinIm / samAzrito'sau pavanaH samantataH karoti zophaM phalakozayoriva // ( kalyANakAraka ) kramAcca doSai rudhireNa maidasA prabhUtamUtrAntranimittato'pi vA / sanAmadheyA vRSaNAbhivRddhayo bhavanti puMsAmiha saptasaMkhyayA // vAtAdika meM se koI bhI eka doSa prakupita hokara aNDakoza ko jAnevAlI vAhinI ko vAyu ke sahAre Azraya karatA hai to jo donoM kozoM meM zopha utpanna ho jAtA hai vaha tusvRddhi kahalAtI hai vAta, pitta, kapha, rakta, meda, mUtra athavA antra ke kAraNa kramAnukrama se puruSoM meM sAta prakAra kI vaha vRSaNavRddhi huA karatI hai / 82 - zataponaka- tatrApathyasevinAM vAyuH prakupitaH sannivRttaH sthirIbhUto gudamabhito'Ggule dvayaGgule vA mAMsazoNite pradUSyAruNavarNI piDakAM janayati / sA'sya todAdIn vedanAvizeSAn janayati, apratikriyamANA ca pAkamupaiti, mUtrAzayAbhyAsagatatvAcca vraNaH praklinnaH zataponaka badaNumukhairichadrairApUryate tAni ca chidrANi ajasraM phenAnuviddhaM adhikamAsrAvaM sravanti, vraNazca tADyate bhidyate chidyate sUcIbhiriva nistudyate gudadbhAvadIryate, upekSite ca vAtamUtrapurISaretasAmapyagamazca tairevacchidrairbhavati taM bhagandaraM zataponakamityAcakSate / (su. ni. sthA. ) I kupathya sevana karanevAloM kI kupita huI vAyu nikalate samaya guda ke eka yA do aMgula ke mAMsarakta ke kSetra meM sthira hokara use dUSita karatI huI piDakA utpanna karatI hai / jisake kAraNa todAdi vedanA utpanna hotI hai / isa piDakA kI cikitsA yadi na kI gaI to vaha paka jAtI hai mUtrAzaya se kledAMza prAptakara vaha vraNa praklinna ho jAtA hai / usameM zataponaka ke samAna kaI sUkSma chidra utpanna ho jAte haiM una chidroM se dhArArUpa phenayukta khUba AsrAva ( discharge ) nikalatA hai / isa vraNa meM vividha prakAra kI pIr3A hotI hai / yaha gudapradeza ko vidIrNa kara detA hai| adhika upekSA karane se isI chidra ke dvArA vAta, mUtra, purISa tathA zukra nikalane lagatA hai / yaha zataponaka nAmaka bhagandara kahalAtA hai / 83 - zambUkAvarta - vAyuH prakupitaH prakupitau pittazleSmANau parigRhyAdhogatvA pUrvavadavasthitaH pAdAGguSThapramANAM For Private and Personal Use Only

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samprAptivimarza 1075 sarvaliGgAM piDakAM janayati / sAsya todadAhakaNDvAdIn vedanAvizeSAn janayati, apratikriyamANA ca pAkamupaiti vraNazca nAnAvidhavarNamAtrAvaM sravati pUrNanadIzambUkAvarttava chAtra samuttiSThanti vedanAvizeSAH taM bhagandaraM zambUkAvarttamityAcakSate / (su. ni. sthA. ) na kevala vAyu hI api tu jaba pitta aura zleSmA bhI prakupita hokara guda pradeza meM pAnA kuThapramANa kI sarvalakSaNayukta piDakA utpanna kara dete haiM jisake kAraNa usameM vividha vedanAe~ hotI haiM / cikitsA na karane se usameM pAka ho jAtA hai / vraNa se nAnAvidha srAva hotA hai nadI meM sthita zaMkha ke AvartoM ke samAna isameM Avarta bana jAte haiM / isa vedanA viziSTa bhagandara ko zambUkAvarta kahate haiM / 84 - zUla vAyuH kupitaH prakaroti zUlam 1 hRtkaNThapArzve sakaphaH sapittaH hRnnAbhimadhye kaphapittazUlaH / tau ca nAbhau prakaroti pIDAM dehe'khile yaH sa tu vAtapittAt // ( hA. tU. sthA. ) sAdhAraNatayA vAyuzUla kA kAraNa mAnA gayA hai / kapha ke kAraNa hRdaya-kaNTha-pArzva pradeza meM zUla hotA hai| pitta se, hRdaya se nAbhi taka madhya bhAga meM zUla utpanna hotA hai / kapha aura pitta milakara basti tathA nAbhi meM zUla karate haiM / tathA sarvAMga zarIra meM zUla kI utpatti vAta aura pitta se hotI hai / 85-- zotha yA zopha raktapittakaphAn vAyurduSTo duSTAn bahiH sirAH / nItvA ruddhagatistairhi kuryAttvamAMsasaMzrayam // utsedhaM saMhataM zophaM tamAhuniMcayAdataH // ( a.hR. ni. ) doSa prakopaka kAraNoM se, abhighAta se yA viSa laga jAne se duSTa huA vAyu rakta, pitta aura kapha ko bAharI sirAoM meM le jAkara aura unase avaruddha hokara tvacA aura mAMsa meM Azrita hokara sabake saJcita hone se utsedhayukta zotha ko utpanna karatA hai / isI ko dUsare zabdoM meM caraka ne isa prakAra vyakta kiyA hai bAhyAH sirAH prApya yadA kaphAsRpittAni sandUSayatIha vAyuH / tairbaddhamArgaH sa tadA visarpannutseddhaliGgaM zvayathuM karoti // 86- zlIpada kupitAstu doSA vAtapittazleSmANo'dhaH prapannA vaGkSaNorujAnujaGghAsvavatiSThamAnAH kAlAntarega pAdamAzritya zanaiH zophaM janayanti taM zlIpadamityAcakSate / (su. ni. sthA. ) vAtapittakapha tInoM doSa prakupita hokara nIce kI ora vaMkSaNa, Uru, jAnu, jaGghA meM sthita hokara ora phira kAlAntara meM zanaiH zanaiH paira ko Azraya banA jisa zopha ko utpanna karate haiM usako zlIpada kahA jAtA hai / 87- zvAsa yadA strotAMsi saMrudhya mArutaH kaphapUrvakaH / viSvagvrajati saMruddhastadA zvAsAn karoti saH // (su. u. taM.) jaba prANodAnavAhI srotoM kA saMkoca karake kaphayukta kupita vAta doSa avaruddha hokara itastataH cAroM ora (phuphphusoM meM ) ghUmatA hai taba vaha zvAsa ko utpanna kara detA hai / 88 - zvitra-- kuSThaikasambhava zvitraM kilAsaM cAruNaM ca tat / nirdiSTamaparisrAvi tridhAtUdbhavasaMzrayam // ( a. saM. ni. ) kuSTha ke hI sadRza zvitra yA kilAsa ko utpatti hotI hai / vaha aruNavarNa kA, khAvarahita aura tridhAtu se utpanna hotA hai / tridhAtu se vAta pitta kapha tInoM doSa tathA raktamAMsa meda tInoM dUSya lie jAne cAhie / 89 - satatajvara doSo raktAzrayaH prAyaH karoti satatajvaram / ahorAtrasya sa dviH syAt // ( a. saM. ni. sthA. ) For Private and Personal Use Only

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1076 vikRtivijJAna raktadhAtu meM Azraya pAkara kupita vAtAdi doSa prAyazaH satata jvara ke kAraNa banate haiM / yaha 24 ghaNToM meM do bAra car3hatA hai / 90- saMnyAsa Acharya Shri Kailassagarsuri Gyanmandir vAgdehamanasAM ceSTAmAkSipyAtibalA malAH / sannyAsaM sannipatitAH prANAyatanasaMzrayAH // kurvanti tena puruSAH kASThI bhUto mRtopamaH / mriyeta zIghraM zIghraM ceccikitsA na prayujyate // (a.saM.ni.sthA.) eka kAryodyata vAta, pitta aura kapha ati prabala hokara prANavAhI srotoM kA Azraya lekara jaba vANI, zarIra aura mana kI ceSTAoM ko AkSipta kara dete haiM taba vyakti kASTha ke samAna mRta jaisA ho jAtA hai / yadi usakI turata cikitsA na prArambha kara dI jAve to usake marane kI bahuta sambhAvanA rahatI hai| ise sannyAsa kahate haiM / 91 - sirAjagranthi - vyAyAmajAtairabalasya taistairAkSipya vAyuhiM sirApratAnam / sampIDya saGkocya vizoSya cApi granthi karotyunnatamAzuvRttam // granthiH sirAjaH sa tu kRcchrasAdhyo bhaved yadi syAt sarujazcalazca / aruk sa evApyacalo mahAMzca mammatthitazvApi vivarjanIyaH // ( su. ni. sthA. ) durbala ke dvArA vyAyAma kiyA jAne para kupita vAyu usake sirA pratAna kA AkSepa karake usakA pIr3ana karake, saGkucita karake tathA sukhA kara eka unnatavRttAkArI granthi ko zIghra banA detA hai / yaha sirAja granthi zUlayukta aura spandanayukta hone para kaSTasAdhya hotI hai / zUla rahita, acala, bar3I aura marma meM utpanna bhI varjanIya hai / 92 - stanaroga sakSIrau vA'pyadugdhauvA prApya doSaH stanau striyAH / pradUSya mAMsarudhiraM stanarogAyaka lpate // ( mA.ni.) dugdha hone para yA vinA dugdha ke jaba kupita doSa strI ke stanoM meM prApta ho jAte haiM to ve vahA~ para rudhira aura mAMsa ko dUSita karake stanaroga ( stanapAka ) utpanna kara dete haiM / 93 - svarabheda - atyuccabhASaNaviSAdhyayanAbhighAtasandUSaNaiH prakupitAH pavanAdayastu / srotaHsu te svaravaheSu gatAH pratiSThAM hanyuH svaraM bhavati cApi hi SaDvidhaH saH / / (su.u.taM ) ucca svara se bhASaNa dene se, viSa ke prabhAva se, ucca svara se par3hane se, coTa se ina saba dUSaNakartA kAraNoM se kupita hue vAtAdika doSa svaravAhI srotoM meM sthita hokara svara naSTa kara dete haiM / yaha svara bheda 6 prakAra kA hotA hai / 94- -hikkA mArutaH prANavAhIni srotAMsyAvizya kupyati / urastaH kaphamuddhya hikkA zvAsAn karotyatha // / (ca. ci. sthA. ) ghorAn prANoparodhaJca prANinAM paJca paJca ca vAyu jaba prANavAhI srotoM ko prApta kara kupita hotI hai aura ura meM sthita kapha ko Upara ko lAtI hai to vaha hikkA aura zvAsa ke ghora prANoM kA uparodha karane meM samartha pA~capA~ca prakAra vAle rogoM ko prANiyoM meM utpanna kara detI hai / isa prakAra zvAsa tathA hikkA kI eka hI samprApti AcAryoM ne likhI hai / 95 - hRdroga dUSayitvA rasaM doSA viguNA hRdayaM gatAH / hRdi bAdhAM prakurvanti hRdrogaM taM pracakSate // (su.u. ta.) vividha kAraNoM se viguNita hue doSa jaba hRdaya meM pahu~cakara rasa ko dUSita karake hRdaya meM sthita kArya meM bAdhA utpanna karate haiM taba usako hRdroga kahA jAtA hai I -~ For Private and Personal Use Only

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akArAdirogAnukramasUcI viSaya 978 392 963 pRSTha | viSaya pRSTha | viSaya / pRSTha aMgaghAta adhoceSTacetaka 218 | aGkurotkarSa rUkSaprasara 134 / atIsAra kAraNa 960 - avasthAe~ aGgamarda 310 - pakka 976 - laiNDrIya ArohI , aGguliparvasthipAka - pittaja 973 -- zlatha yakSma 523 - pUrvarUpa 972 aMsapIDana 359 ajArakatA 264 akaNakAyANUtkarSa 884 ajIrNa Ama 963, 964 vAtaja 972 akSAnti hitopadezeSu 313 - aura usake vibhinna kI akSipAta 405 . prakAra 962 samprAptiyoM para agni 892 - ke kAraNa 961 saMkSipta vicAra 979 - kA nivAsa sthAna 958 - dinapA kI 963,964 zokaja 978 -kI mahattA 991 prAkRta 963 - samprApti 971,1057 -pAMcabhautika 983 rasazeSa 963 - sAnnipAtika 975 -mAndya tathA lakSaNa 959 atyagni 956 AmadoSa 959 - vidagdha 963 atyaGga-sAda 405 - mArdava - viSTabdha atyazana 959 - vicAra prakRti - azana adhicchadArbuda 709,715 dRSTayA 958 aNuzleSa 183 -- jarAyu 763,798 - vaikArikI 950 atighaTana 300 - vRkamukhIya 752 - saptadhAtustha 983 - nidratA 398 adhiraktatA sAmAnya agrApakAri 1027 - pAka nizceSTa 279 aGkurArbuda - raktatA adhivRSaNikApAka 162 774 - antrastha 782 -nizceSTa 279 -- yakSma jihvAstha -- yakRt kI adhyazana 959 - tAlustha - plIhA 282 anaghaTana pittAzayastha - phuphusa ko 283 anannAbhilASI 398 bastistha 778 - saceSTa 278 anIrodakatA 891 vRkkamukhastha 781 - roSa 386 anIrodatA yA AmA. zalkIya 778 - vAka 410 zayika rasAbhAva 893 ziznastha - vRkkArbuda 753, 791 anuhaSatA tathA pratIkA - zIrSastha 782 - zayaraktatA 937 ritA (karkaTotpattimeM) 692 - zleSmala atIsAra 968, 382 antaHkaroTIya - stanastha - asAdhyalakSaNa 977 nipIDAdhikyakAraNa 200 praNAlikIya 782 - -- 976 antaHgarbhAzayapAka - svarayantrastha 779 kaphaja yakSama 571 282 778 For Private and Personal Use Only

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1078 vikRtivijJAna 268 845 viSaya pRSTha | viSaya pRSTha viSaya pRSTha antaHgravapAka 156 ardhAvabheda samApti 1059 arbuda bruka kA 715 - dhamanIpAka arbuda-adhicchadIya - bhrauNa 860 __ abhilopI 72 Uti ke 706 - bhaugAma 862 - pUyatA - adhicchadIya - mizrita pittAzayakI 135 atike anya 797 - raMgita - zalyatA - adhicchadIya - lasIkAdhicchadIya 717 - arbudika Utike sAdhAraNa 704 - vargIkaraNa 7.4 kozAdvArA 668 - asitavarNa kozA820 - AyurvedadRSTayA 705 - zalyatA - asthi 841 - vAta UtIya 851 jIvANujanya 273 - upazamakIprakriyA700 - vAtatantu 852 - zalyatA pariNAma270 - kriyAzUnyatA 667 - vAtanAr3Iruha 820 - vAta 272 - gola 848 - vAtazleSa - sneha 273 - cetAsaha 820 - vAhinIya - zalyaracanAke -chidriSTaruha - vAhinIruha 849 pariNAma 272 mastiSka kA 810 - vimajiruha 855 antarAyAma samprApti1058 - tArAkozA 854 - vilmIya 819 antardAha 410 - tejohRSatA kI --- vraNa vasturUpa 827 antarvidradhi samprApti 1057 dRSTise 3 zreNiyA~ 803 -- zukrIya 758 antazchadArbuda 850 - duSTa tathA sAdhAraNa - zoNotpAdaka annapAcanameM kriyAeM 982 / meM antara 673 UtiyoM ke 851 annadveSa 381 / - dRSTiruha 852 - saMyukta 860 annapraNAlIsirAviskAra 127 / - dauSTaya ko aMzAMza -- saMyojIUti ke 801 - rasakheda kalpanA 676 - - duSTa " - annaviSa 960 - nADIkandikA - samprApti 1059 anyedviSkajvara ___yA vAtakandikA 852 - -ke sAdhAraNa82 samprApti 1058 nilayastara - hRSatA 701 855 apacI 77, 1058 --- naidAnikaprakAra 671 abuMdIya racanA 664 apatantraka 1058 - paribhASA 660 - vistAra 667 apatAnaka - pAka na hone kA arza - sthAna 1017 - samprApti 1061 kAraNa 660 - nirukti 1005 aparadana graivika 172 -pIta 827 - jAtasyottara apasmAra samprApti 1058 - punaH ropaNa 670 kAlaja 1008 apraharSa 313 pRSTameru 824 - tridoSaja amIbika DiseNTrI 993 --pezI-Uti ke 843 (sannipAtaja) 1013 ayeA kA roga 73 prakaraNa -dvandvaja 1012 araktatA (dekhoraktakSaya) - pragaNDa cetA - pUrvarUpa 1005 arati 309, 386 - pratIpagAmI -- prakaraNa 1003 aruci310,381,382,441 parivartana 666 vargIkaraNa 1019 arocaka 367 prabhAva 677 vAgbhaTokta ardita samprApti 159 | - pravikiraNa 698 / arza bheda 1006 820 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra viSaya pRSTha arza samprApti 1019, 1060 sahaja 1008, 1014 arzAdi agnibala kA arzoyantra alasaka alAsa mahatva 1020 102 alpAcetAlomazleSa 182 311 alpaprANatA alparaktatA (dekho raktakSaya ) alpazophatA avaTuviSatotkarSa avasAda avasAdanakAla gati avasthA niHsrAvakA w samprApti 1017 967 riNI 31 31 - praguNanAtmaka avAptakSamatA nizceSTa 1024 saceSTa 1023 avipAka 310,405, 368 aviziSTa pUraka 1030 azmarI 257 asthipAka 16 745 386 875 876 tAntava azvagranthi azraddhA 368 asamatotkarSa 903 asitavarNakozArbuda 820 asUyA 313 asRgdara samprApti 1060 1060 654 rearegranthi 58 asthikAsahaja phiraGga 600 dalakIya gartikIya punaryUSaNa 37 asthi paryasthapAka prasara phiraGgika 603 36,41 813 akArAdirogAnukramasUcI www.kobatirth.org viSaya asthimajjakIya kriyA - kA avasAda 910 asthimajjApAka 38 asthinAzake 3 kAraNa39 asthimajjA pAkakAraNa 38 tIvrasapUya 37 yakSma vividha rogANuoM ke dvArA utpanna hotA hai 40 lakSaNa 41 520 asthiyamA asthiyoM para yakSma daNDANukA prabhAva 520 asthi racanA 35 vraNazotha kA asthifar asthizirapAka - asthisandhi vraNazotha asthyarbuda pariNAma 35 44 41 42 anutIvra jIrNa 42 AkSepaka pRSTha AghAta 520 kA pariNAma 42 841 843 842 842 841 hastidanta asthyazanAsAdhAraNI 523 aharlikIya ghaTanA 1035 pArzvazRMkhalAvAda 1032 kendriya chidriSTha saMghana 1061 jvara samprApti 1060 3 ( karkaTotpatti AcAra rasAyana AtaMcin nAza AdAtA AdAruNa meM hetu ) 694 1022 234 1032 653 pRSTha viSaya AdhmAna 364, 370, 443 Antra para yacamA kA AntrapAka Gl prabhAva 556 109 110 AntrayacamA w 1076 kalAvata tIvra 109 painasa yA prasekI 110 samagrasthAnika 110 556 lakSaNa vikSata sambandha 560 Antrikajvara asthigata parivartana 491 asthimajjAgata parivartana 491 Antragata vikRti 488 cAra avasthAe~ 481 pittAzayagata pari vartana 490 plIhAgata parivartana 480 yakRtgata parivartana 490 raktagata parivartana 492 hRdgata tathA anya pezIgata parivartana 491 Ama * utpatti 962 Ama vAtaja udbheda 62 - hRcchotha 58 1 - vAtanIlorakarSIya 922 viSa 968 AmavAta samprApti 1060 AmAtIsAra tathA pakkAtIsAra 976 AmAzayakopa samagra 106 AmAzaya carmakUpIya 712 106 735 107 106 107 109 AmAzayapAka - abhighaTita - jIrNa tIvra - tIvra sapUya AmAzayAntrapAka

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1080 vikRtivijJAna WWW 380 viSaya pRSTha viSaya viSaya Ayu (karkaTotpatti meM)692 upavRkkagranthi kA kaTigraha 359 Alarka 221 __bAhyakanyAsarga 140 kaTibhannatA -paNDi 224 upavRkkagranthiyoM para kaTukAsyatA Alasya 309 yakSmA kA prabhAva 563 kaNakAyANu 881 Asyavarasya 309, 365 upazaya aura samaMgI. kaNanIyAbuda 639 AhAra aura mAlA 952 karaNa meM bheda 90 kaNArbuda -vidhi 951 upazamAvasthA 90 - bAhyadravya 657 icchA-dveSa-zItavAtAta- upasarga bahistAnikIya kaNArbudikIyavyAdhiyA~ pAdi meM 311 mastiSkagolAnvika 198 anya viziSTa 639 uNDukapAka upAntrazotha samprApti 1063 kaNThakRcchratA 457 uNDukapucchapAka 113 ukSata samprApti 1062 kadara 334 uNDukapucchapAka jIrNa 115 urastota samprApti 1063 kanapheDa 104 uNDukapucchapAka urobhispandana 404 kaJjampazana 493 - tIvra uSNavAta samprApti 1063 kaphajachardi samprApti 1063 - sakotha 114 uSNAbhiprAyatA 370,405 kaphajvara dekho jvara utkoTha atiraktimA upasipriyakaNa vRddhi 402 kaphodara samprApti 1063 yukta 465 upasipriyatA 15 karkaTa adhicarmAbha725,729 utkoTha anna bhinna 466 uSmaNastIvabhAvaH 374 - adhivRkkagranthi 748 utkle da 395 utinAza 3 mukhya - anADarIya 753 utkleza 395 kAraNa 230 - antarvartIkozIya718 utsyanda sandhiyoM meM 47 UtimRtyu prakAra 234 - annapraNAlIya 733 udaracchadakalApAka 115 UtimRtyu meM kyA - avaTukAgranthiya745 tIvra hotA hai ? 233 - azmopama 711 jIrNa 119 Uti mRtyuyA yama 561 UtinAza 230 (stana karkaTa) 768 udaracchadasthUlAntrapAka 17 UtiyAM-mRta 3 Antra 829 udara niSpIDana 360 UrusAda 359 / - AmAzayika 734 - roga samprApti 1061 UrdhavAta samprApti 1063 - uttarajAtaparivartana712 - zUla dekho zUla Rjuruha 874 - udaracchadIya 740 udyakRdutkarSa 745 RNAsrapradeza 274 - oSTha 729 udarda 404 RNAstra phuphphusa 276 karkakaTa sannipAta udAvarta samprApti 1062 - mastiSka 278 4 avasthAe~ 87 udveSTana 312 277 - kAraka hetu usaJcaya 135 mAnavIya 69 - lAla 275 unmAda samprApti 1062 kA vistAra 713 - zveta 275 unmArgIya bhagandara - hRdaya 278 kI racanA 707 samprApti 1063 ekanyaSTIyotkarSa 948 naidAnikalakSaNa 714 upakuza 101 oja 403 ke prakAra 709 upadaMza oSThasthaulya 729 kozIya dRSTi se upamadhuraktatA 792 | autikIya vibheda 23 vicAra 714 yakRt For Private and Personal Use Only

Page #1169
Shri Mahavir Jain Aradhana Kendra 760 viSaya karkaTa garbhAzaya garbhAzayakAyA 762 garbhAzayagrIvA 760 golAbhakozIya 719 granthi 710, 719 granthi - - - - - - - ( stana karkaTa ) 770 grasanI 732 738 grahaNI janakaabhikarttA 684 tantu 712 pittapraNAlIka 742 pittAzayika 743 puraHstha (aSThIlA) granthi 854 puruSaprajananAGgIya 754 puruSastanIya 773 paiThikakozIya 715 poSaNika granthi 741 praNAlikIya aMkurIya ( stanakarkaTa) 770 prAyogika gaveSaNA 682 722 phuphphusa pRSTha avakAzi kIya 724 prasara 724 vRntIya 724 753 basti 759 armaadhivRkka 749 bIjakozIya majjakIya majjakIya 711 ( stana karkaTa ) 769 mastuluGgAbha mahAsrotIya 729 711 yA karkaTArbuda 707 741 731 varNAtiranjya 749 61, 62 vi0 yAkRta rasanA akArAdirogAnumaRsUcI www.kobatirth.org viSaya pRSTha karkaTa vividha aGgake 720 751 vRka zalkakozIya 714 zana 758 zleSAbha 720 zvasanasaMsthAna 721 saMdhAra kI vizeSatAeM 708 sarvavIya 744 * sAMparIkSa bhrauNikI 784 sAdhAraNa 711 stana 764 stana kA sveda granthIya - stana prasAra vikiraNa karkaTArbuda karkaTotpatti --- kA prabhAva 773 sAdhyAsAdhyatA 773 stambhakozIya 718 strIprajananAGgIya759 svarayantrIya 721 707 670 tathA tArakola 685 tathA prakSobhaka 683 nyAsargika abhikarttA 688 104 770 772 karNamUla granthipAka zodha (dekho karNamUlagranthipAka ) karNamUlakajvarasamprApti 163 kardama visarpasamprApti 1064 kalA mAMsadharA 54, 55 aas - praveza ke 3mArga 648 roga 646 roga kiraNa 647 651 365 516 247 sakArbuda kaSAyAsyatA kAka ghaTanA kAcara vihAsa pRSTha viSaya kAcarIkaraNa vRkkoM meM 149 781 kAma parivartana kAmalA gambhIra nava jAtIya 934 : kAmalA jAnapadika w sukuntalAnvika 638 kAmalA prasekI. 131 1064 samprApti kAraka Abhyantarika 891 bAhya 891 kAlajvara samprApti 1064 are aur 1038 658 kAlasphoTa kAlivAhaka 858 kAyarbuda mArAtmaka 858 kAsa 400 1081 kAsa zuSka samprApti kAsthi saMkaTa kAraNa ( phuphphusa yakSmA meM ) 555 366 1064 80 841 838 840 kAsthisaGkaTa kAsthyarbuda ekala tathA zrauNArbuda meM antara 838 kAsthyarbuda bahuvidha 840 kilATIyana (yakSmA ) 511 kilATIyanAza 235 kI sapAka virUpakara 53 kukSibandha 360 kumachidusannirodho - tkarSa 60 575 kuntalANu kuntalApUrakarSa 636 kulajapravRtti ( karkaTotpatti meM ) 691 kuSTha mahAkuSTha bhI dekho -- upasarga kA mArga 642 kI autikI 645

Page #1170
1082 vikRtivijJAna 'viSaya 591 ketvAtu 871 493 pRSTha | viSaya pRSTha | viSaya pRSTha kuSTha kI aupasargikatA 641 kozA mRtyu pariNAha- garbhAzayAntaHpAka - granthikIya 643 pradezIya 121 jIrNa sapUya 71 - nizceta 643 - -prasara 121 galagaNDa zleSAbha-mizritarUpa 644 - madhyapradezIya " granthakIya 793 - yaha nAma kyoM - laghulasI 15 - samprApti 1065 par3A? 640 koSTakadrAkSAsama 798 galatkuSTha dekho mahAkuSTha -samprApti 1065 -nicarmAbha 861 galazopha 637 kUTa kAlyutkarSa koSThAgni 305 gavInIpAka 155 kRSNatA 364 koSThikAe~ bAhyadaiva 173 gAvaraucaya 363 562 kRSNa maNDalapAka krauna roga guru gAtratA 389, 391 (phiraGgaja) klama geNDIgemnA granthaka 932 kluptIbhAva mala golakAyANUtkarSa 929 kezodgamana 750 mUtrAdika kA 363 golArbuda 848 kaipTenaAphaDaitha kvekainsTeTa cihna 187 gaurava 310,397 keboTavalaya 893 granthikarkaTa 710 kSamatA 1021 granthikarkaTa bhrauNa 752 koTarapAka sapUyavAyu 83 -avApta 1023 kotha 259 -ke do prakAra 602 1022 granthikA paryastha - antaHzAlyika 261 -prAkRta 1023 granthipezyarbuda 792 - Adra 260 496 kSaya granthiyA~ moreNTa - upasargajanya 261 - anuloma 493 bekara kI 43 granthisaGkaTa - jIvANvika -pratiloma 823 115 495 kSArapriyatA vindukIya 874 granthisirAja - naidAnikIya 609 kSArapriya vindukatA 895 granthyarbuda dRSTi se bheda 261 783 kSArapriya sidhmana 874 - antaHpraNA- madhumehajanita 262 tArAtupratidhAraNa 141 likIya 788 -vAti 262 kSudhA - adhivRkka bAhyakIya787 - vArdhakya janya 262 gaNDamAlA samprApti 1065 - anya aMgoM ke 796 -zuSka 259 gatiskhalana 314 - AmAzayastha 792 kozA upasiranjya 15 gatisthairya kUTa - avaTukAgranthistha 793 - ekanyaSTIya 14 gammA yA gamaiTA 595 - klomanAlastha -caSaka garbhAzaya ke pAka 168 yA zvAsanAlastha 790 -nAza garbhAzayagrIvApAka 16 tantu 828 ---purukhaNDanyaSTIya garbhAzayapAka 165 tAlustha 791 (bahvAkArI) 12 garbhAzayapezIpAka - paripraNAlikIya 788 -pracalana 286 jIrNa - purvaMgakIya 784 -prarasa 15 garbhAzayasaGkaTa bIjagranthIya 794 - mRtyu kendriya 121 antarAlita 822 - - kUTazle-mRtyu khaNDikIya garbhAzayasaGkaTa prasara 822 mIya sakoSTha 795 yA prAdezika 120 garbhAzayAntaHpAka - - lasyasakoSTha 794 -mRtyu nAmyakSetriya 120 uSNavAtIya 165 - bhauNa 794 / 795 233 / / / / / / / / For Private and Personal Use Only

Page #1171
Shri Mahavir Jain Aradhana Kendra viSaya granthyarbuda yA kRta poSaNikA - -- - -- - B granyarbuda grasanIkarkaTa pAka grahaNI granthistha 796 laiGgaransa dvIpIya 792 796 791 793 783 koSTha 786 sakoSTha sAGkura 784 satantu 785 - vRkkastha zirastha zleSAbha saMyojI Wid - Ama ww kIya 788 sAGkurakoSTI 7899 * satantu 78 - 788 791 793 732 105 981 stanastha sthUlAnnrastha paripraNAli - Adhunika vicArakoM - --- pRSTha 791 kI dRSTi meM 992 - kyA hai ? ghaTIyantra - - jIvANujanya tathA amIvAjanya meM utpatti meM agni kA mahatva 985 - kITANu (bailiNTI Diyala ) 1000 986 992 993, 996 tathA atIsAra antara 991 - daNDANvika - paittika * vAtika - zlaiSmika saGgraha kA bheda 985 998 989 981 990 992 akArAdirogAnukramasUcI www.kobatirth.org viSaya pRSTha grahaNI samprApti 1065 991 - sAnnipAtika grAvijhArbuda 799, 751 graiva aparadana pAka jIrNa ghanAtra antima - - aura AtaMca ghanAsratA parivartana 267 263 267 267 kandukIya kAcara tanvi 267 263 263 kyoM hotI hai paJcatvaprApti 267 lakSaNa aura ghanA strotkarSa gharmecchA carmakIla prakAra yA arbuda samprApti dharmatantvarbuda carmAra cAturthika jvara viparyaya cArkaTa sandhi cippa samprApti cUrNIyana 172 abhimadhya kA jJAna ke sthAna ( yacamA) visthAyika 265 dare 370 777 774 1066 828 775 330 338 51, 604 1066 255 255 256 256 514 257 cUNoMrakarSa 257 181 cUSakapAda cetAtantvarbudoskarSa 825 cetApAka dekho vAtanADI pAka 226 cetAlomabhakSikozo tkarSa 184 viSaya chardi zuSka jatumaNi janapadoddhvaMsa jarAvadhicchadA --- samprApti saMcaya kAraNa santrAsa sandhi jalodara An - rbuda 798, 763 1030 17 jAgaraNa jaTharAgni kI yakSmA meM 561 samprApti 128, 1066363 - 108 mahattA 305, 950 jaTharAgni ke prakAra pRSTha 366 1066 776 1037 955 ( suzrutokta ) jATharAgni caturvidha 954 jADya 397 868 jAlakakAyANu jAlakAntazchadIyoskarSa jihAkaNTaka pAka 221 45 atiraktIya 949. 938 jAlakotkarSa jAlakAntazchadIyasaMsthAna para vraNazotha kA pariNAma 75 102 1001, 102 jIrNa jIvittaka 103 jIrNa bAhya 102 891 870 871 865 3 204 310, 410 3679 jIvatikti kha2 jIvatikti ga bIdara jIvarakta jIvANu jIvitaka vikSata jRmbhA jRmbhAtyarthaM

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2054 vikRtivijJAna viSaya viSaya pRSTha | viSaya pRSTha jvara 302 jvara cAturthaka 330 / jvara phuphphusayakSmA meM 554 - antarvega 37 - - tridoSaja hai 366 - bahirvega 317 anyedhuSka 329, 34 - - paittika 337 majjAgata 351 apagama 415 -- - vAtika 666 marumakSikA 468 avirAma 460 - - zlaiSmika , mAMsagata 348 aSTavidha 354 tandrika 464, 469 - mAnasa 316 asAdhya 321 taraGga yA - mUSikadaMzaja asthigata 350 UrmimAn 473 - medogata 350 Agama 415 tANDava 62 - raktagata 346 Agantu 316, 452 tRtIyaka 330 - rasagata 345 Agneya 317 -doSadRSTayA vAta 355 Antrika 481 bheda 335 --USmAvaiSamya 357 - Antrika (dekho - tRtIyaka vAtakapho. - jvara bhI) lbaNa tridoSayukta 336 --- cArakAla 360 - Avartaka 471 - tRtIyaka vAtapitto- -- doSAnusAra - utpattikA kAraNa lbaNatridoSayukta 336 lakSaNa 412 rasa kI virasatA 413 - daNDaka 467 vAtapittaja 25 - utpatti kI - dvandvaja 406 lakSaNa 408 kahAnI 388 - -doSa vaiSamyAdi --viSamArambha 357 - uSNAbhiprAya 316 kI krameNotpatti 415 --vedanAvaiSamya 357 -- prakRtisama -viSama 323,398,471 ekarUpa - kapha - kI tridoSAsamavAyArabdha 406 386 - - vikRti viSama tmakatA 339 - 389 - kAla - - parivartanIya - kAsa 400 samavAyArabdha 406 - - nidrA aura - dvividha 316 paristhitiyA~ 339 tandrA vivecana vaikRta - nAjIrNena vinA 13 398 318 - nija zArIra 316 - kapha pitta lakSaNa - paJcavidha tAlikA 415 - zItAbhiprAya 323 - pitta 371 -- zukragata - kapha pratizyAya 400 - - utpattikAla 375 - zleSma pitta - - zvAsa 400 --ghrANamukhakaNThoSTa zvasanaka - - samprAti 387 tAlupAka 378 * satata kAla 474 - - pitta lakSaNa 372 santata 324 - kAlabheda 485 - pIta 468 - utpatti 325 kI saMkhyA - punarAvartana kA -aura samprApti 315 AdhAra 335 apatarpaNa 328 - kI samprApti 303 - pUrvarUpa - dIrghakA- ke sambandha meM - pratyAvartI 636 lAnubandhitA 327 Adhunika vicAra 454 - pralepaka 366 - doSoM kA - granthIya 948 ! - prAkRta 318 / gamana 326 316 413 328 For Private and Personal Use Only

Page #1173
tama 343 828 akArAdirogAnukramasUcI 1085 viSaya pRSTha / viSaya pRSTha / viSaya pRSTha jvara santata prazamana yA tanvIyana (karkaTotpatti doSa cirapAka 450 hanana kA rahasya 326 __meM hetu) 696 drAvaNa nAza jvara santata maryAdA 325 dvandvaja jvara dekho jvara--suduHsahatA 326 tApa 381 dvandvaja dvigrAhI 1030 - sannipAta 416 tAmra 870 dvirabaMda 706 - saptavidha tArAzleSa 181 dhamanikIyajAravya 255 - samprApti 1066 - kArya 182 dhamaniyoM para vraNa. - sAdhya 321 tilakAlaka 776 zotha kA pariNAma 70 - asaumya tIkSNAgni 956 dhamanIjAravya 255 jhunajhunI 908 tovapItApuSTi 121 - pAka tIvra TeratA 199 tuNDikApAka 83 aupasargika 70 Taukjophora 1033 tuNDikerIpAka - pAka phiraGgika 608 DIDe mahAzaya tRT 377 racanA 68 niyama 589 tRtIyaka jvara 330 sirAsaMgama 848 DopA pratikriyA 859 tRtIyadravya dhamanyantazchadapAka tantugraMthyabuda (kajAla) 180 yama 529 tantupezyarbuda tRSA 314, 377 dhavalAkSimalAnanatva 402 garbhAzayastha 831 -tRSNA 377, 410 dhAtvagniyA~ 983 tanturUpa 831 - samprApti 1067 dhUsara yakRtIbhavana kI - antaHprAcIrIya 831 yuTyarbuda 834 avasthA 88 upalasya 831 svaksavarNatA 16 - savanAvasthA 88 -- upazleSmala 831 tvagvaivarNya nakhasvAkRtika 9.7 vihAsajanaka thAyasisa 493 nayanaplava 309 parivartana 833 zrAmbosAiTopaina 920 nADIkandANupAka tantu saMkaTAbaMda dekho zrAmboplAsTIna 920 tIvra aupasargika 228 saMkaTAbuda daNDAlasaka 967 nAtyuSNagAtratA 391 tantUtkarSa (yakSmA)512 / dadu (kavakajanita) 653 nAbhyanAza tantvabuda 825 dantakAcAbuda 800 nAsAkalApAka - asthigata 829 danta puppuTa 825 acayika 82 - udaraprAcIrastha 830 - puppuTaka 100 - kalApAka jIrNa kaThina 825 - mUla yA danta- paramacayika pUyIya 81 mAMsapAka 100 - kalApAka rohiNIya83 bIjakoSastha 830 veSTa 100 - bIjANUtkarSa 658 - mRdula 826 - harSa 370 - vRddhi 655 - vAtanADoya 827 17,410 - prAvara vetrANu 655 - zlIpadika 826 - karapAda 374 zoSa stanagata 829 - samprApti 1067 - strAva 401 tanvAbha jAravya 593, 594 / - sarvAGga 374 nAsikApAka tantvimaya vraNazotha 27 durgandhatA zvAsa kI 386 niHzvAsa vaigandhya 386 tandrA 398 / deza vaiguNya 1038 / nijaroga 409 carma 828 82 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 1086 viSaya nidAna parivarjana nidrA nidrAdhikya nidrAnAza - nidrAlutA 398 nindita vivAha 926, 410 nissAdi nIlohA -- kI kamI kSati pRSTha 388 397 386 366 398 362 1030 916 apratiSedhAbha 921 ambApakarSa 921 AmavAtika AmavAtIya aupafrgaka vibhAga 917 nIlohA kAraNavihIna raktasrAvI 918 --- - nIlohA kAraNavihIna sAdhAraNa 921 nIlohA ke anya rUpa 921 dvitIyaka (uttarajAta ) 923 - bimbANvapakarSa 917 922 janita prAthamika 928 raktasrAvI 911 vaiSika - 921 922 vibhAga 917 zUnalInIya sAdhAraNa 917, 921 hainikIya "" 921 paMcabhUtAniyAM patrikAmla padminI kaNTaka nyaccha 856, 773,777 nyaSTIlA nAza 233 nyupadaMza (paraMga) 638 nyUmonAiTisa pakkavraNaliGga 97 18 pakSAghAta - samprApti 1067 983 971 776 viSaya pRSTha paraGga (nyupadeza ) 638 paramani -------- www.kobatirth.org 955 paramajihvatA 849 148 vikRtivijJAna paittavaraktatA madhuvazitA raktatA parikSaya 410 paricertakIya upagraha 182 pariNAmazUla 137 paridara 101 71 paridhamanIpAka paribIjakoSapAka 163 pariyakRtpAka 132 parilasagranthipAka 75 parilasIkapAka 75 sandhAyIstaratAntava parisirA zotha parisrAvI vraNazotha parihRcchadapAka parihRtpAka yakSma sapUya paryasthapAka pAka paryAvaraNa parvabheda pazcakA - phiraMgaja yA pracalanAsaGgati 625 279 21 * rakta 21 pAcakAni kI mahattA 957 pANDu apittamehika 929 ati Edit - 792 278 pAka 49 263 25 pANDuroga 57 529 58 36 591 519 410 nirukti samprApti pANDuzoNAMzika avAptarUpa 931 vikRti 931 sahaja rUpa 929 888 906 1068 928 viSaya pArayAtana pArkinsonIyatA pArzvagamana purukhaNDanyaSTi kozAoMkA 12 259 104 pArzvarujA pASANagardabha piGga 376 404 piTikA zIta piNDikodveSTana 312, 349 pittajvara dekho jvara-pitta hI motIjharA hai 386 pittArza pittAzaya para vraNa 1010 zotha kA prabhAva pittAzaya pAka jIrNa tIvra pitrAgati pIDA aMsapArzva meM - pItapaTTikA pItAbha pItArbuda sarvAMgI puJjanyaMzi puTaka pAka punarnimANa pUtinAsA pUya paribhASA pRSTha 281 209 pUyaraktatA kezikA bhAjIya pUyasandhi pUraka pratibandhana bandhana asthikA puraHstha granthi pAka puruSa prajananAMgoM para vraNazotha kA pariNAma 161 purvaMgaka granyarbudIya pRSThatoda pRSTha mervarbuda 131 134 132 519 495 828 376 827 827 1027 54 285 295 161 775 784 82 17 125 45 1033 1031 359 824

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pRSTha pRSTha bAhya akArAdirogAnukramasUcI 1087 viSaya viSaya pRSTha | viSaya pRSThIya kArya 599 pratIkAritAsthAnika 1031 -phiraMga aura sagarbhA 580 pekriyAjako sarvakiNvI prabhAva zleSmalakalA - sahaja 579 ___ kyoM kahate haiM ? 135 vraNazotha kA 28 - aura hRdaya 618 pezIpAka 56 pramRtAzana 959 - kI caturthAvasthA 599 - asthikara 56 prameha samprApti 1068 - garbhAzaya para prabhAva 621 - pragAmItantukara 56 pralapana - cAra avasthA 578 pezIruhArbuda 844, 845 pralApa 370, 383, 410, - dvitIyAvasthA pezyarbuda arekhita 844 pralepaka jvara 366 (vizeSatAe~) 591 - mArAtmaka 845 pravAhikA 980 - nAsA para prabhAva 617 - rekhita 843 pravikiraNa kA karkaTa- - prakaraNa 575 paigaTAmaya(stanakarkaTa)781 kozAoM para prabhAva 694 - plIhA paraprabhAva 612 paittava 238 - raktavahAoM para - phuphphusa para prabhAva 612 - vRddhikI dazAeM 238 prabhAva 700 585 poSaNa meM bAdhA 220 prasamUhi 1030 --smaraNIyatathya 589 pauTAmaya 523 prasamUhijana 2030 - bahirantarbhava 593 prakSobhajIrNa (karkaTo- praseka 367, 393 - bhAvamizra ke tpatti meM) 694 prAisajonsavakratA 872 __ mata se avasthAe~ 579 prakRtisamasamavA prItyamlapaTUSaNe 313 - mastiSka suSumnA 622 yArabdha 406 plAhA phiraGga kA - mukha para prabhAva 614 pracalana kozA 286 prabhAva 612 - yakRt para prabhAva 656 -protikozAoM kA 289 / plIhA zoNAMzika - raktavAhiniyoM para pracalanAsaGgati 627 rogoMkI jananI 933 prabhAva 605 - (pazca yA pRSTha kAya) plIhotkarSa 125 - lasamanyioM para lakSaNoM ke 7 samUha 628 plIhodara samprApti 1068 prabhAva 611 pratidravya viziSTa 1029 plega yA vAtAlikA 471 - vAtanADIsaMsthAna pratirakSA viziSTa plaihikasirA kA uttara para prabhAva 621 upAya 1029 jAta pAka 125 - vRkkapAka 619 - sAmAnya upAya 1028 phalgu - vRSaNoM para prabhAva 620 prativiSi 1029 phAnagI roga 246 - vyutpatti 575 pratizyAya 80,401 phiraGga avaThukA granthi - saGkramaNa ke -kahA~ kahA~ para prabhAva 618 cAra prakAra 577 hotA hai? 401 - avApta 585 - sandhija 603 --- asthi kA 602 - svarayaMtra para prabhAva 612 -samprApti 1068 - asthi 600 phiraGgArbuda kilATIya pratIkAritA 1021 - Abhyantara 590 yacamAma 596 - ahIMniyasa eNDa - oSTha para prabhAva 614 - dhyAna dene madasena vAda 1034 - aura AmAzaya 618 yogya bAteM 598 - AdhunikavAda 1036 - - upadaMza meM bheda575 phiraGgArbuda 593, 295 -- jAnapadika 1036 --jihvA 614 / phiraGgArza 591, 592 1034 | - - mahAsrota 615 / phuphphusa atiraktatA 283 426 For Private and Personal Use Only

Page #1176
Shri Mahavir Jain Aradhana Kendra 1088 viSaya pRSTha phusphusa karkaTa prasAra 726 lakSaNa 727 3 zreNiyA~ 724 - phuphphusapAka Adya avizeSa - SEAS para yamadaNDANu kA prabhAva upasthAyIya khaNDakhaNDIya AGA Papusata khaNDikIya yugapacalitarUpa 95 85 khaNDIya austra khaNDikIya meM antara 92 tailIya 97 (dekho zvasanaka) niHzvAsajanya visthAyI zastrakarmottarakAlIna96 hRdaya para prabhAva 91 612 phuphphusa phiraGga phuphphusa yakSmA 532 85 97 97 85 92 kA prabhAva 612 phauphphusika yakSmA prAthamika upasarga 535 96 97 prasAravidhi 533 lakSaNa vikSata sambandha phlegmiziyA elbA Dolensa phuphphusAntarAlapAka 58 phroyana lakSaNa 190 phlemiMga 74 1029 652 badarANu roga baddhagudodara samprApti 1069 424 babhru bastikuNDala samprApti 1069 bahirarSa 843 bahukoza raktA 937 paramabala 938 www.kobatirth.org vikRtivijJAna viSaya 871 bahukozA pUraka plIha vRddhijanya 937 bahudhamanIpAka sagaNDa 79 bahunidratA 312 bahumakArbudokarSa 817 139 bahumUtratA 93 pUraka bahulasI kalApAka 119 bahuvarNatA 873 bahuvarNapriyatA 873, 895 bastipare 157 - tIvra yakSma sapUya bAhubheda bojakoSapAka jIrNa tIvra bIjavAhinIpAka pRSTha bIjavAhinI sapUya sazoNa sodaka burgavyAdhi bRhadraktakoza ma 158 569 155 359 163 164 166 uSNavAtIya granthikIya 571 pUyajanaka 168 570 yakSma saMyogasthalIya baiDakA brAiTAmaya brAkTa vAkTara piNDa kAryada 99 39 gaNDa 168 166 168 167 71 868 936 baisIlasa kAksa inphekzana baisIlasa lisTarallA monosAiTojinisa 948 1031 140 64 717 493 viSaya bharamAra aura apa bhallu bhojya sadguNya bhrama 433,370,384,410 janana meM hetu 241 426 954 samprApti aNa sarvAMgazotha zrauNArbuda zrauNikIya avazeSa (karkaTotpatti meM hetu ) 696 425 37 makarI majjaparIpAka majjaruha Hate karSa - asita raktIya maNDAbhakAya maNDAbha vihAsa ( dekho vihAsa ) matalI pRSTha manda vahni - * vedanA mandAgni -- 1069 879 860 - 395 384 410 mada madAtyaya samprApti 1069 madurApAda madhyakarNa pAka 651 191 madhujanIya antarA maraNa 246 manodaurbalya 68 mantharajvara samprApti 1069 392 16 881 949 249 mandoSNatA mandoSmatA mala apravartana kI apravRtti stabdhatA 399 malAzayapAka yakSma 561 maSaka 776 mastiSka golANvika 193 rogANutA 198 chadapAka 192 957 392 16 363 ""

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Shri Mahavir Jain Aradhana Kendra viSaya mastiSkadapAka -- phuphphusa golANvika - arogANuka 198 -- golANvika manthara mAlA mastiSka pAka kha tAnikIya lasottarIya 201 yacama 572 lasya 189 210 vyApaka zilDara kA pAkottarIya kampavAta tathA suSumnAdhUsara dravya pAka ke vikSatoM meM phira Ggika 623 pRSTha - vyApaka mahAkuSTa 200 199 >7 tulanA 205 mastiSka suSumnA jala 186 pAka 201 211 tapasargika 210 mastiSko vividha vikAroM meM parivartana 189 mahAgada mahAdhamanI sirAja 209 mastiSka pAka meM 206 639 kaise phailatA hai 641 vikRta zArIra 643 137 granthiyA~ 609 mahAdhamanIpAka Halfve mahAsrota para vraNa zodha kA pariNAma 98 phiraMgika 605 101 www.kobatirth.org akArAdirogAnukramasUcI viSaya mAMsatAna mAMsadharAkalApAka mAMsadhAtu para vraNa zotha kA pariNAma mAMsAbuda bhArAtmaka araktatA mikUlikja lakSaNa mithyA vihAra mithyAhAra kI kalpanA303 miharaktatA - jIrNa mukha kI madhuratA kyoM mukhatiktatA mukhapAka kiNvaja zveta pRSTha 722 56 kotha 54 706 109 104 304 hotI hai ? 394 380 98 mUtrazukra samprApti mUtrasAda mUtrAtIta mUtrotsaMga mUrcchA 104 151 mRdutantu mRdvagnitA 651 mAdhurya 393 mUDhagarbha samprApti 1070 mUtrakRcchra samprApti 39 mUtrakSaya mUtragranthi mUtrajAra mUtranAlapAka 99 "" 33 kahA~ kahA~ dekhI 37 95 tIvra mUtraprajananasaMsthAna para yakSmA kA prabhAva 567 159 164 1070 "3 " 1071 93 370, 410 jAtI hai ? 685 827 392 236 meghasamazotha meghAbhagaNDa kI atyantA vasthA 238 viSaya meghAbhazotha sArbuda motIjharA 706 386 moreNTakara kI granthiyA~ 43 414 111 kA prabhAva yakRtpAka upasargA moha yakRcchotha yakRt jIrNanizceSTA. tiraktatA 282 yakRt para vraNazotha 1086 yakRdarbuda yaddayutkarSa - tmaka 131 jIrNavaiSika 123 tIvra vaiSika 120 741 pRSTha 236 upasargAtmaka paittika apoSakSayajanya 196 avarodhAtmaka paittika 129 199 130 eka khaNDIya 129 kUTa 133 kendrAbhiga 133 kezikA bhAji 123 -- paramacayika pattika 129 bahukhaNDI kA prabhAva raMgA vaiSika hi huNDI meM vikRti 125 130 113 126 121 127 hajjanya haiTa kA paramacayika 130 yakRdvRddhi viSamajvara janya 481 makavANu 496 yamadaNDANu prakAra 535

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/ / 1060 vikRtivijJAna viSaya pRSTha | viSaya pRSTha / ghiSaya pRSTha yamapurasthagranthipAka 569 yuktAgni 954 zroNAMzika bRhatkAyAyamapUyavRkANUtkarSa 568 yugakavakaroga 652 ___NvikaparamavarNika 868 yakSamA 493 yonikanda samprApti 1071 - bRhatkAyANvika - anuhRSatA tathA yoninyApada - " mlAyAvajanya904 pratIkAritA 515 raMgadezanA 870 - majakSayika 913 yakSmA asthi 520 raktakoThodgama 385 -miGkAuskI Antra 556 raktakSaya 887 cauphArDa prakAra 929 uNDakIya 562 - anaghaTita anabhi -lohAbhAvI 905 - utsyandI prati -viNTrobanirdiSTa ghaTya 910 kriyA 543 zreNIvibhAjana 890 - amajakIya 901 upasarga kA --- asthi jAraThika913 -vistRta dvinAla prasAra 505 - AmAzayoccheda zirakRmijanya 904 autikIya janya 905 raktakSaya zizuoM tathA pratikriyA 506 AhArIya nava jAtoM ke 934 kazerukIya 523 ayogajanya 890 - sagarbhAvasthA meM905 - ke prabhavasthala 497 - sitaraktaruhIya 913 -ke sahAyaka kAraNa 518 - kA mADarna vargI - saivilIya tAlikA 903 karaNa 889 -konigagranthika kUlIya 936 -sahaja zoNAMzIya 929 sandhikalIya 525 grahaNIjanya 901 raktakSayAntaka tatva 892 - klomanAlIya 554 raktagraMthi samprApti 1070 ghAtaka 891 - jIrNa prasarita 553 raktanetratA 410 -kAsvarUpa899 - tantukilATIya 548 - - vikRta -parivahana kI - tIvrazyAmAkasama 552 vikRtiyA~ 258 - tIvra sarvAGgINa 517 zArIra 8962 - - vividha -pAka - daNDANuraktatA 534 aMgoM para prabhAva 869 -pitta pUrvarUpa 887 -paramapuSTika 562 - yakSmA praveza ke mArga499 - DaiviDasana nirdiSTa -~-samprApti 128,1072 -bimvANu zreNIvibhAjana 88 -prasAra ke sAdhana 498 880 - meha zUla vihIna 779 -phuphphusa - tIna laiDarIya 532 377 - varNatA - phauphphusika zoNAMzika 933 532 433 -vikRtazArIra 546 - dAyakozIya 933 -vraNAtmaka -kAraNa phuphphusa 567 - nava jAtIya yakSmA zoNAMzika -zastra meM 935 518 155 -sandhi - paramakAyANvika901 524 -saMvahana sirAgata ke uddezya 280 yacimakA - prAthamika 494 -nirmANa tathA vikAsa54 upavarNika 901 - srAva ke 2-3 dina 915 -parivartana 510 - prAthamika --jIrNa 915 -pIta upavaNika kAraNa 908 -tathA tajjanya yakSmikAstha kozAoM - plaihika 936 raktakSaya 914 kA prabhavasthala 510 - phAnayakSINa 935 / -tIvra / / / -ThIvana 927 For Private and Personal Use Only

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akArAdirogAnukramasUcI 1061 viSaya pRSTha | viSaya pRSTha / viSaya pRSTha - avasthAe~ jinameM reno kA roga 231, 262 -saghanAvasthA sambhava hai 914 raikaliMgahAujanAmaya 827 -strAva 393 raktAbharaNa sthAnika raiklasa vyAdhi 174 lomaharSa 409 nizceSTa 283 rogarATa 493 lohA 870 raktAbuMda 705 rogANavika AkramaNa evaM vakSa prAjanana 360 - oSThakA 730 zArIrika pratirakSA1028 vamathu 410 raktArza 1014 rogANu 3 vamana 380 raktotpattikara tattva 891 rogANvAvarti 1031 voM robina avakAza rasa kI paribhASA 862 rogANvika viSiyAM 232 186, 203 - ke sambandha meM rogApaharaNasAmarthya 1021 varNa vAhaka 858 vividha bhAva 863 - ke vividha siddhAMta 1032 vophAmaya 918 rasanAkarkaTa 731 ropaNa asthi 295 , vAkveja kA roga 937 rasa se rakta kI utpatti 863 -upazamana dvArA 294 __ vAtakuNDalikA rasAyana paribhASA 1021 -kaNana dvArA 298 samprApti 1072 rAjayakSmA samprApti 1072 -punarjanana dvArA 293 vAtatantu saGkaTArbuda 852 rAsAyanika dravya 3 -prati ropaNa kA vAtanADIya tantvabuMdo- viSa tathA bhautika mahattva 298 skarSa 825 ___abhikartA 232 ropaNa prathama 287 vAtanADI raMgAdika rUkSagAtratA -samagIkaraNa dvArA 291 parivartana 179 rucirviramatA 393 romaharSa312,409,405,369 - saMsthAna rugalpatva 405 romodma 312 upasarga ke mArga 185 racirviramatA 393 laGkAmukhapAka 1001 - saMsthAna para rudhiraruhotkarSa bhrauNIya 878 lavaNAsyatA 394,396 yacamA kA prabhAva 572 rudhiravaikArikI 866 lasakaNArbuda 656, 815 - saMsthAna rudhirANu 866 lasagranthipAka 592 vikAsa 184 - AkAra sambandhI - yakSma 530 vAtanADyarbuda 852 parivartana 872 -phiraGgakA prabhAva 611 vAtaphiraMga 622 - AtaJcanajanya lasagraMthiyA~ racanA 69 vAtanADIpAka 226 parivartana 875 lasadhAtUtkarSa kUTa sita- - antarAlita 227 - aura bhaGguratA 874 kozIya 949 -jIvitaka - nyaSTivAn 874 lasavAhinyarbuda vAtarakta samprApti 1072 -zoNa prasamUhijanya lasasaGkaTa 814 vAtaruhArbuda 852 parivartana 876 lasIkA graMthipAka 75 vAtavAhinyarbuda 848 -raktAvasAdana-jIrNa vAta vaiguNya 1038 gatijanya parivartana 875 -tIvra vAtavyAdhi samprApti 1072 -vikRtiyA~ 869 lasIkAdhicchadArbuda vAtArza 1009 -saMkhyA sambandhI lasIkApAka 74 vAtAlikA 471 parivartana 871 lasIkA saMsthAna 69 - samprApti 2073 - svarUpa sambandhI lasya utsyanda 29 / vAtASThIlA- " parivartana 873' lAla kaNa bahirgamana 281 ' vAzaramaina pratikriyA 589 848 76 75 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 2062 viSaya pRSTha vAhinI prAcIra ke roga264 181 849 845 pAdapaTTa hArbuda visphAra vAhinya parivartana ( yakSmA ) 514 vAhinyarbuda oSTha 850 * aura aMga vizeSa 849 849 - - - parivartana 846 850 850 848 vAta 848 - zoNa 845 vAhinyarbudikA kozIya847 vikRtabhAva aura unakI mahattA 1039 vikRtiviSamasamavAya 406 vikSata pUrvakarkaTa 697 visa 382 vidradhi abhighAtaja 379 - samprApti 1073 114 * uNDukapucchIya - upamahAprAcIrika 115 715 102 - - parituNDakIya 83,649 115 995 649 572 379 --- - lasa -- - -- jihvAstha * pratIpagAmI ----- - parivRkka yakRt vRkka mukha * kRntaka - jihvA - * paristhUlAntra * pazcagrasanI pazvastanIya - pittaja - phuphphusa 95 vIjakoSa vAhinya 163 - brauDIya 40 190 mastiSka kI sakala, mastiSkakI 18 sUcamazyAmAkasama 185 www.kobatirth.org viSaya vinamana vinAma vikRtivijJAna vinidratA vibhinnana vibhu vimedaraktatA vimedArbuda - - tantu - vAhinya - zliS vimedAbha sneha virasatA viruddhAzana virupotkarSa vilambikA vilasana kA roga vilmIyArbuda vivarNatA vivAditA vi-vibhinnana viziSTa pratIkAraka - vizoNatA viSa antaH viSaNNatA viSatotkarSa raktasrAvI pRSTha 212 368 363 702 424 245 834 836 836 836 padArtha 1029 258 1026 368 kezAlaya 921 viSa prativiSa saMyoga 1035 viSa bahiH viSamajvara (dekho jvaraviSama) 1026 238 309 959 903 968 125 819 309 383 663 - samprApti - viSamAni viSamAzana raktagata parivartana 483 1073 953 959 viSa rogANuoM ke vividha viSAditA visaMjJatA visarpa samprApti 1025 368 433 1073 viSaya pRSTha visUcikA ajIrNajanya 966 visUcI daNDANujanya 966 visUcI asaka aura vilambikA 965 visUcIyA visUcikA966 - samprApti -- -- visphoTa vihAsa www 236 kaNIya kSArapriya 874 vihrAsa kAcaravindu 142 238 - ---- - dhamanI * duSTa 249 maNDAma maNDAbha ke pariNAma 254 plIhA kA 251 * mahAsrotaskA 254 -- jalamaya lAla - vAlarIya vimedAbhIya - zleSAbha - zliSIya - snaihika -- - -- - vihvalatA vIlaroga 1074 yakRt kA 242 vRkkoM kA 245 * hRdaya kA snaihika 243 386 638 99 vRkka uttara jAta yakRt kA 253 vRkkoM kA 252 833 177 246 247 838 238, 240 mAMsa pezI kA244 -- - kaNAtmaka 255 697 saMkucita 151 151 'kSudra rakta yA zveta 151 -pAka 140 - anutItrAvasthA 142 antaHzAliyaka 65 * jIrNa antarAlita 151

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viSaya 288 / / / / pRSTha vRka jUTIya 140 -tIvranAbhya 65 --- nAbhya jUTikIya 150 -nAbhya lakSaNa 153 - -sapUya 154 -prasara aura nAbhya meM antara 141 --jUTikIya anu tIvrAvasthA 144 - kezAla bAhya prakAra14 -kezAlAntaHprakAra 145 -prasara jUTikIya tIvAvasthA 143 --sapUya 153, 154 -phiraGgika 619 - yakSma 567 -vRkkamukha 154,155 -sapUya 153 - pUyarattIya 2535 -mukha pAka 154, 156 -vimaji 145, 246 -zalya 154 -zveta bRhat 145 vRkkoskarSa ud 779 -parama 779 vRkkotkarSa sapUya 154 vRkkoM para vraNa zotha __ kA pariNAma 137 vRNazotha vRkya 140 vRddhi samprApti 1074 vRSaNapAka vedanAe~ 18 vepathu vaikArika vicyuti vaidarbha 101 vyaMza vikAra 1028 vyaMziyA~ 1027 vyUhANvIyanAza 236 vraNa upadaMzaja tathA phiraGgaja (vyavacchedaka koSThaka) 588 akArAdirogAnukramasUcI 1063 viSaya pRSTha / viSaya pRSTha vraNa upastha - puruSa prajananAMgoM -ke sthAna para pariNAma 161 -kRntaka dekho vidradhi - prakAra, naidAnikIya 26 kRntaka - pragrahaNa 23 vraNana 236 - prasAra 22 vraNa mRdUpastha 587 - mahAsrota para -mekhalAkAra pariNAma 98 -ropaNa - mAMsadhAtu kA -vasturUpAbaMda 827 pariNAma 54 - zotha - meM kyA hotA hai ? 8 - anutIvrAvasthA 25 - rakta tathA lasavAhi- abhighavya 29 niyoM para pariNAma 68 - asthidhAtu para vraNa - lasya 29 zotha kA pariNAma35 - lasya kalAoM kA 29 - AmAvasthA 16 - vargIkaraNa - utpatti meM rakta - vAtanADIsaMsthAna kA kArya 8 para pariNAma 176 - aura zAtha meM bheda 1,2 | - vividha zarIrAGgoM - kI prAcIna kalpanA16 __ para prabhAva 33 -- ke kAraNa AyurvedIya -- vizeSa lakSaNa 6 - ke kAraNa kSetrIya - vizuSka 29 parivartana 21 vRkkoM para pariNAma137 - jala saMcaya kyoM zleSmala kalA ke 26 hotA hai 10 sapUya 30 - jAlikAntazchadIya - sarva kiNvI para ___ saMsthAna para pariNAma75 prabhAva 135 - jIrNa - strI prajananAMgoM pr| - jIrNAvasthA 25 : pariNAma 163 - tantimaya 27. - hRdaya para pariNAma57 -- tantvimaya 26, 27 / - hetu 3 - tIvAvasthA 24 - samyagUDhAvasthA 288 - doSa tathA dUSya 19 / - sAmAnya liMga 5 - doSa sambandha 2 vraNazothAtmaka pratikriyA 8 - nAsA kA vraNazothAvasthA kI - pacyamAnAvasthA __AThagha TanAe~ 16 - pakkAvasthA vraNazothotpatti tathA - paribhASA zArIra kozAe~ 12 paritrAvI zaMkha nistoda 362 - pittAzaya para zataponaka samprApti 1074 prabhAva 133 / zambUkAvarta samprApti , / / / / / / For Private and Personal Use Only

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1064 vikRtivijJAna 600 zoSa 493 viSaya pRSTha | viSaya pRSTha | viSaya pRSTha zavikakSArAma 1028 zoNAMzi 1027 zvasanaka yakSmakilATIya551 zimailbuzAmaya 174 zoNAMzIya avasthAeM 927 -saMsthAna para vraNa ziraH zUla zotha Agantuja 4,5 zotha kA pariNAma 77 ziro'rti 386,387 - dekho vraNa zotha zvasanIpAka abhighaTana zizirapriyatA -nija 4 tanvimat 85 zizu vRkkapAka 156 -samprApti 1075 zvAsa zIghrakAri 425 -sAMga vRkkIya 147 -tamaka 402 zIta 313 zopha Agantu -samprApti 1075 zItaka 412 -dvandvaja zvitra samprApti zIta mAtratA 429 -paribhASA zveta jihvatA -pitta 412 -paittika -pAda 74, 267 - zoNa prasamUhi - raktaja zvaitya 402 --- zophatA 16 - vAtika SThIva 498 zItAda 100 -viSaja saMkaTa agrasirAvisphArI811 zItAbhiprAyatA 379,386 - zlaiSmika - adhivRkka majjaka 820 zItecchA -samprApti 1075 - annanalikAstha 819 zIlavikRti 314 - sAnnipAtika - asthijanaka 809 zukrAbuda 758 - sthUla 146 - asthi dalaka 812 zuklatA akSaNoH 402 - asthi yA asthi zuklamUtra purISatva 402 -mukhatAlukaNTha 364 janaka 806 zUla udara 364, 737 zauklyam 402 -Antra -samprApti 1075 zauSira 101 -AmAzayastha 819 zeSAntrakapAka zrama --kAsthi 841 zaitya 369,401 zrutirodha 405 - garbhAzaya 822 zaiyAvraNa zlIpada samprApti 1075 zaizavIyAGgaghAta 212 zleSaka - jaraTha prakArIya 811 zokAtIsAra 978 zleSaruhArbuda bahurUpI 854 - jAlakAntazchadIya zoNa kozaruha 868 zleSma-vibhedArbuda 837 ___saMsthAna ke 814 -priyatA 923 - jAlikA kozIya 816 - ruhotkarSa zaizavIya 934 zleSmArza 1011 - - bahurUpIya 87 - vartuli sambandhI zvasanikApAka -jihvAstha 818 parivartana 869 zvasana - tuNDikAstha 818 zvasanaka jvara dekho -vAhinyantazchadArbuda846 - pazcodaracchadIya 819 phuphphusa pAka tathA - vAhinyarbuda -puraHstha ( aSTIlA) karkaTaka sannipAta kezikIya 845 zvasanaka nIreya saMcaya 91 granthi 821 prAgjJAna 812 -srotasIya 846 -pratizyAya zoNa - basti - vyaMzi 1027 priyANu janya 95 -bIja granthi 822 - sandhitA | -pratizyAyAtmaka 95 - mahAkozIya 812 zoNAMzana 927 / -mAlAgolANuja 94 / - yakRt 819 819 -granthi zleSmArbuda 250 For Private and Personal Use Only

Page #1183
821 438 akArAdirogAnukramasUcI viSaya pRSTha viSaya pRSTha / viSaya pRSTa saMkaTa lasAbha Uti ke 814 satatajvara samprApti 1075 sannipAta antaka 440,436 - vRSaNa satatajvara dekho jvara satata - antardAha 440 -stana 823 satantu granthyarbuda granthya- - abhinyAsa 451, 434 saMkaTArbuda 801 buMda ke antargata dekhie - aiNIdAha 440 - aNvIkSaNa 803 santApa 315 - kaNThakubja 438 - anya audarika 819 sandhikalA pAka jIrNa -kapholbaNa 423 - arekhita pezIya 845 lasya 45 - karkaTaka 86, 428 - asthi kA 808 sandhi kI antaH pUyatA45 -karNika - uttarajAta parivartana807 / -gata yakSmA -kumbhIpAka 439 - kA prasAda 804 parivartana 526 krakaca 428 - kA vargIkaraNa tathA -pAka 41 -cittabhrama 437 sa prakAra 805 sandhipAka asthi 51 -jihvaka 434 -kAsthi 806 - Antrika jvara janya49 - jvara dekho jvara-sanni -kI mArAtmakatA 802 - AmavAta janya 49 pAta tathA sannipAta -ke autikIya prakAra805 -AmavAtAbha 51 - tandrika - tantu 805 -grahaNI janya - daNDapAta 440 -nAmakaraNa kAkAraNa801 -ghora pAkala 427 --- naidAnika lakSaNa 808 - ghora Ayurvedokta 46 -pittakapholbaNa 426 -pratyakSa darzana 802 -jIrNa -pittolbaNa karara -phuphphusa kA 813 -prakAra 46 -13 prakAra - phuphphusAntarAla kA -pramehANu janita 48 pralApI 439 __ yavakozIya 725 - phuphphusa golANu -pralApaka - bhautika lakSaNa 807 __ janita 18 -proNunAva 439 - mahAkozIya 807 -lasI antaH nikSepa - bhunanetra - mahAsrotIya 818 janya 50 - bhUtahAsa -mUtra prajanana ~ vAta nADI vikSata - bheda darzaka tAlikA418 saMsthAnIya 819 janya 51 - bhAlukI tantrokta 814 - vAtaraktajanya 50 varNana 417 -vAtika yA vAta -virUpakara 53, 51 - yantrApIDa 441 nADIya 806 -vividha 47 yAmya 427 -vimeda 806 sandhi bandhana 399 raktaSTIcI 432 -vRddhi aura adhiSThAna - yacmA 3 avasthAeM527 rugdAha kI rIti 808 -para yacama daNDANu -lakSaNa sAmAnya 442 - zliSIya 807 kA prabhAva 524 -vAtakapholbaNa 425 -saMkaTa bhI dekho -vizleSa 359 -vAtapittolbaNa 424 saMjJAnAza 433 -zleSmadharAkalApAka 47 - vAtolbaNa 420 saMnyAsa sarva kiNvIya 135 -zleSmA 73 - -tulanAtmaka - samprApti 1075 - saMkSipta vivaraNa 42 tAlikA 421 saMyuktArbuda 860 -sthairya kUTa 49 -vikRtiviSamasama sakIla yakRt 126, 124 / sannipAta ajaghoSa 440 / / vAya lakSaNa 416 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra 1066 viSaya vikRti vaidArika - - - zItAGga saMnyAsa - saMmohaka - saMzoSi - sandhiga - sAdhyAsAdhyatA kI tAlikA 444 - hataujasa 451 440 - hAridraka sapUya zrutimUlazotha 105 samaGgIkaraNa 90 - samazana samAni 959 954 955 kI zreSThatA samprApti aSTavidha jvaroM kI saMkSepa meM 454 avan - sAmAnya lakSaNoM - - aruNadatta kA mata 1044 indu gaMgAdhara " 1042 " 1044 cakrapANidatta " 1042 vijayarakSita " 1044 1040 paryAya hemAdrikA mata 1044 1050 1040 1053 aura vidhi 1054 "3 bheda vimarza saMkhyA -- pRSTha 428 429 441 427 441 435 441 vikalpa raktapitta vividha vikAra aura unakI sarpo oSThIya kanInikIya prajananAMgIya viziSTa sajvara 72 1057 226 "" - gauNa lAkSaNika sarpo225 226 224 226 www.kobatirth.org viSaya pRSTha sarpI sAmAnya 226 sarva kiNvanAza tIvra 135 - para vraNa zodha kA prabhAva vikRtivijJAna sarva grAhaka pradAtA sarvasara B pAka jIrNa tIvra 135 tIvra raktasrAvI 135 sakotha 135 877 877 98 99 100 - janya parisrAvI ( pAradIya ) zlaiSmika 99 savaNa 100 100 sopha sarvAGgaghAta aunmAdika 599 - unmattasya 632 632 sarvAGga vAta sahaja phiraGga 579 - asthigata vikRtiyAM601 3 vibhAga 583 mahajodakatA zaizavIya934 saha lakSaNa plUmara vinsana 901,989 - 135 136 sAkura gudapAka 113 sAmparIkSa avalokana 1034 sAtrAkulAkSitA 309 sIlona soramAutha 1001 592 901 207 sukuntalANu suSiranakhatA suSupti suSumnAdhUsara dravyapAka tIvra agra 242 suSumnApAka 220 1031 susvAdi - USma sthAyI 1031 USmahat 1031 sUkSma kavaka janyaroga 653 viSaya sUjana sitakozA - 1 -- ----- pRSTha 9 881 kozAoM ke AkarSaNa kA kAraNa 13 kozA- kauna kauna vraNa sthAna meM pahu~catA hai 13 * kozApakarSa 884 kozIya raktatA 938 kozotkarSa 882 938, 942 -- raktatA -- w - asita raktIya 815,913,949 raktatA eka kozIya947 949 - kUTa jIrNa sitotkarSa sirAjagranthi lasakozIya 943 - tIvra 945 majjAjanya 939 - lasIbha 815 sita ruhika 945 938 609 611 611 1076 610 cyAva tarkurUpa samprApti syUnAkAra sirApAka -- calAyamAna racanA 263 zotha samagra sirosisa kA artha 123 silosisa 1001 73 73 79 359 52 skandha mathana sTila kI vyAdhi sToka Adama roga sTrampala merI siNDroma 54 stana karkaTa 5 prakAra 68 banAtA hai 768 stanaroga samprApti 1076 stanapAka 173

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Shri Mahavir Jain Aradhana Kendra viSaya stanapAka utpAdI - jIrNa g -- wd -- - antarAlita UtIya tIvra - yadama stanasya tantukoSThIya kA vraNazotha se koI saMbaMdha nahIM hai 175 jIrNakoSThIya 174 * tanvIyana yukta789 praguNanAtmaka 174 173 571 sthUlAntrapAka pRSTa sthairya 175 174 stambha stimitovegaH staimitya strI prajananAGgoM para vraNa zotha kA pariNAma 163 sthiratva 399 111 175 jIrNa prasekI tIvra prasekI savaNa roga 174 399 396 396 112 16 akArAdirogAnukramasUcI www.kobatirth.org viSaya snigdhagAtratA naihikanAza nipAvana vihAsa dekho vihAsa s 'TrApIkala 902 1001 386 405 83 bheda samprApti 1076 yakSma 531 phiraGga kA prabhAva 612 383 412 909 1076 433 203 370 sphoTakAH sroto rodha svarayantrapAka - sveda svedApravartanam haridurSa hikkA samprApti hicakI hijAvakAza himApri yatvam hatkapATapAka hRtpAka Ama vAtaja pRSTha 397 235 240 Am 62 karttA kauna ? 61 * pariNAma 61 viSaya hatpezIpAka - jAMrNa - 67 antarAlIya 61 67. jIvitaka tantvAbha tIvra jIvANvIya vaiSika hRdantazchadapAka kapATIya 67 67 76 62 62 anutIvra jIvANvIya 63 jIrNa 66 tIvra jIvANvIya 65 62 366 - prakoSThIya 1067 hRdayagraha hRdayopalepa hRdroga samprApti hallAsa hallepa haipTophora pRSTha 66 hauja kinAmaya hauTeMTauTa nitamba hauvela - jaulI piNDa sasa phaikTara 396 1076 394 396 1033 656 826 873 878

Page #1186
INDEX 40 185 95 995 791 115 793 647 Abscess appendicular 114 Adenoma of ovaries 794 brodie's - (of ovaries ) mutilomiliary cular cyst 795 of lung of pituitary glands 796 of the brain 190 of palate 797 pericolic of scalp 797 ferinephric 115 of breast 788 peritonsillar of brouchus 790 periurethral 164 ot islets of Langarretromammary 572 hans 722 - solitary of brain 185 of large intestines sub diaphragmatic of liver 791 - tongue 102 Adenomatosis - tubo-ovarian 163, 167 Adenomyoma 792 Achlorhydria 891, 898 Adeno-sarcoma 823 Achylia gastrica 893 | Age factor in carcinogenesis 1692 Actinomycosis Agglutinin 1030 Adamantinoma 800 Agglutinogen 1030 Addison's disease Aggressins 1027 Adenocarcinoma Agranulocytosis 464,884 Adenocarcinoma foetal Amboceptor 1030 Adenoma 783 Amyloid bodies 249 colloid degenaration see degecortical 787 neration cyst 786 Anaemias post haemorrhagic 984 embryomic 704 Anaemia 887 fibro 785, 828 - achrestic 901 of kidney 796 --- acute haemolytic - papillar cyst 784 Ledrer type 993 polypoid - aplastic 910 fibro-papillary cystic 789 - congenital haemolytical 929 fibro 783 Anaemia-Cooley's fibro-intracanalicular 788 due to defficiency of iron 905 fibro pericanalicular 788 - due to diphyllobothrium (of ovaris) serous cyst 794 latum 904 of the thyroid gland 793 due to gastrectomy 905 of the stomach 792 - - Sprue 901 563 90 752 II! 784 For Private and Personal Use Only

Page #1187
Shri Mahavir Jain Aradhana Kendra Anaemia haemolytic of the new myelophthisic osteosclerotic pernicious born 935 905 in pregnency leucoerythroblastic macrocytic hyperchromic 868 913 modern classification 889 913 -- Anaplasia Anasarca general renal Aneurysm fusiform leaking of aorta Saccular Angina Vincent's von jaksch's hyperchromic Angioblastoma Angioma -- Angiomata cellular tomy 896 sickle cell 933 splenic 936 primary hypochromic 901 935 morbid ana of lip, of Liver of Renal pelivs Anisocytosis Ankylosis false Anoxaemia of the tongue www.kobatirth.org Anthrax Antibodies specific Antitoxin Aortitis Syphilitie Apoplexy panrcreatic Appedicitis acute chronic [ 1099 ] dw 109, 891 901 301 147 611 19 27 13 847 849 903 49 264 658 1929 1029 605 135 113 114 115 Appedicitis gangrenous Arteriosclerosis Arterio-venous shunt Acharya Shri Kailassagarsuri Gyanmandir Arteritis syphilitic Arthritis Acute Ascites acute infective chronic deformans dysenteric gonococcal gouty neuropathic pneumococcal Astrocytoma 609 Ayerza's disease 610 Azotemia 637 Bacillaemia tuberculosis 849 Bacterial toxins 845 Bacteriotropin 850 rheumatic rheumatoid serum typhoid in intestinal T. B, Banti's deseare Basophil stippling Basoplilia punctate Bedsore Blastomycosis Blood circulation pathological Bracht Wacter bodies Bright's disease Bronchiolitis Bronchitis fibrinous For Private and Personal Use Only Blood platelets Bone-marrow activity depressi plastic Broncho pneumonia 114 255 848 608 45 70 51 51, 53 49 854 73 140 534 232 1031 936 874, 895 874 263 652 disorders of 258 880 48 50 51 48 49 51 50 49 128 on of 910 64 55 " 92 85 85

Page #1188
[ 1100 ] 753 257 514 708 707 707 Buerger's disease 71 | Carcinoma of the bile duct 742 Bursitis - of the bladder Button hole stenosis 60 of the boy of the Cahot ring 873 uterus 762 Calcinosis of the breast 764 Calcification 255 adeno(T. B.) carcinoma 770 appearance of 256 duct media! 255 carcinoma 770 metastatic 257 meduseats of 256 Ilary cancer 769 Cancer characteristics of stroma - scirrhus 768 experimental 684 of the female genital its formation system 759 its varieties 709 of the gall-bladder 743 or carcinoma of the gastro-intestiCancrum oris 101 nal tract 729 Cancer see carcinoma of the intestines 739 Carcinogenesis 679 of the liver 741 Carcinoma 797 of the lungs 722 adeno 709 - spread 726 adrenal 749 of the male breast and their cells 714 of the male genital basal-cells 715 system 754 cervical of the pancreas 744 clinical symptoms of the penis colloid of the pharynx 783 columnar-called of the pituitary body 747 duodenal 738 of the prostate encephaloid 711 of the thyroid gland epidermoid 715, of the tongue fibro 712 of the urinary System 751 its extension 713 of the uterus medullary 711 Ovarian 758 mucinoid scirrhus non papillary secondary changes oesophageal simple 711 of larynx 721 squamous-celled 714 of peritoneum 740 transitional-celled 718 of respiratory system 721 | Carditis rheumatic of the adrenal glands 748 Carise sicca IIII!! 760 714 758 754 !!!!!!!!!!!! 731 760 712 733 58 523 For Private and Personal Use Only

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[ 1101 ] 795 133 130 portal pseudo 165 Caseation (T. B.) 511 | Cirrhosis alcoholic 124, 126 Cell eosinophil 15 atrophic 123, >> - goblet centripetal - lymphocyte small hanot's hypertrophic 130 Cellular response hypertrophic Biliary 129 Cells mononuclear infective biliary 130 Cell plasma laenuec's 124,126 Cells polymorphonuclear miltilobylar 123 Cerebro-spinal fluid 186 --- effect of 127 Cerebro-spinal fluid changes obstructive biliary 129 in various diseases 189 of spleen 125 Cerebro-spinal fluid in encepha pigment litis lethargica 206 123 Cervical erosion 172 133 Cervicitis toxic 123 1 chronic 172 unipolenpar 129 Ceylon sore-mouth 1001 Cloudy swelling 236 Chanere hard 586 Cobalt $70 - soft 575, 587 Coccidioidomycosis 939 Chancroid 575 Cold haemoglutinins Charcot's Joint 51, 604 Colitis 111 Cheloid - acutec atarrhal 112 Chemical poisons & physical - chroniccatarrhal agents 232 - ulcerative Chlorosis 909 Colour index 870 Cholecystitis Acute 123 Comparision between encephalitis - chronic 134 & Poliomyelitis 205 Cholesterol 238 Complement fixation 1033 -- factors responsible Complement fixers 1031 for its increase 238 - nonspecific 1030 Chondroma Corcretion multiple solitary 840 Condylomata 591, 592 Chondro-Sarcoma 841 Congenital hydrops foetalis 934 Chorea Congestion general passive 279 Chordoma 824 local passive 283 Chorion eptithelioma 763 - passive 279 Chorionepithelioma see under Cortical hormone of Adrenal 140 epitheleoma Crohn's disease 562 Chromaffinoma 820 Cystadenoma see under adenoma Chromatophone 858 cyst dermoid 861 Cireulation venous, 2 functions 280 Morant Baker's 43 827 8:38 257 62 For Private and Personal Use Only

Page #1190
( 1102 ] 155 30 696 45 Cystitis 157 | Effects of inflammation of mucous - Acute 158 membranes 22 - Suppurative Effect of inflammation of serous Cystitis tuberculous 560 membranes Cysts Nabothian 173 Effusion in joints Dactilitis syphilitic 602 Embolism 268 Dactylitis tuberculous 523 Enteritis catarrhal 110 De-differentiation 663 Embolism due to clumping of Degeneration 236 bacteria Degeneration amyloid 249 due to tumour cells 668 - effects of 254 effects & consequences 272 - of elimentary fat 273 canal gas 272 - of kidneys 252 | Embryonic rests in carcinoge- of liver 253 nesis - of spleen 551 | Empyema of the joint arterial 555 Empyema of cystic duct 135 granular basophilic 874 Encephalitis B. 210 hyaline 47 epidemic 201 hyaline droplet 142 lethargica 201 hydropic 238 meningeal syphilitic 623 238, 240 post vaccinal 210 - of heart Schilder's periaxialis - of tidvry 245 diffusa 211 - of liver 243 Encephalomyelitis Acute - of muscles 244 infective 210 lipoidal Endarteritis tuberculous 929 malignant 697 Endocarditis mucoid 247 acute bacterial myxmatous 838 chronic mural Wallerian 177 subacute bacterial Dendrophagocytosis valvular Differentiation Endocervitis 165 Dopa reaction 859 Endometritis chronic suppurative Dysentery Amoebic 993 gonococcal 165 Dysentery Bacillary 998 Endothelioma 850 Dysentery Balantidial 1000 Endotheliosis aleukaemic 949 Dysentery difference in bacillary Endotoxin 1026 & amoebic 997 Enteritis 109 Dysentery modern view acute IIIIIIIIIIIIIII faty 246 62 red 62 702 9921 For Private and Personal Use Only

Page #1191
[ 1103 ] 468 8 ) : 729 172 843 of ovary 827 Enteritis localised phlegmonous 110 Fever typhus 469 - membranous u - undulant 473 Eosinophilia 15 -- yellow Ependymoma Fibro adenoma 828 Epididymitis tuberculous 570, 162 - adenoma see under adenoma Epiphysis 44 Fibroid degenerative changes 833 Epipliysitis 41 - intramural 831 - syphilitic 601 Fibroids Epithelioma 709, 715 Fibroid subserous chorion 763, 798 - submucous Lympho 717 Fibroma of the lip dermato 828 of the renal pelvis 752 elephantoid 826 Epulis 825 hard 825 Erosion cervical of abdominal wall 830 Erythema 465 of bone $29 Erythroblastosis foetalis 878, 934 of mammary 828 Exostosis 830 Factor anti-anaemic 892 soft 825 gastric 091 Fibromata neuro intrinsic " Fibro-myoma of the uterine extrinsic Fatigue 308 Fibro sarcoma see under sarcoma Fatty degeneration see degeneration | Fibrosis (T. B. ) 512 Fatty infiltration Fibrotic disease of the breast 174 Favus 653 Fibrositis Fever 302 Folic acid black water 485 Foot & mouth disease 102 continued 160 Gangrene 259 dengue 467 bacterial 115 due to allergy 412 dry 259 eight kinds of 354 diabetic five types 323 due to infection 261 glandular 948 embolic 261 intermittent 329 gas 262 prodromal symptoms 308 - senile Rat bite 460 varieties clinical 261 relapsing 478 636 wet 260 sandily 468 Gandy-gamna nodales 931 seven kinds of 343 Ganglioneuroma 825 typhoid 487 | Gastritis 106 wall 831 240 56 871 262 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra Gastritis acute Glioma Glossitis 106 106 106 106 109 632 100 101 1-0 654 854 853 102, 1001 acute parenchymauous 102 acute phlegmatous suppurative Gastro enteritis General paresis Gingivitis chronic Glanders Glioblastoma multiforme ---- endamoeba suppurative superficial chronic superficial mercurial Goitre colloid nodular Granulocyte Granuloma foreign body Gum boil Gumma caseous tuberculoid of syphilis Haemangio endothelioma capillary cavernous Haemarthrus Haemartoma Haemato salpinx Haemocytoblost Haemoglobin changes in Haemolysis Haemolytic condition Haemolysin Haemophilia www.kobatirth.org Haemophyious of Ducrey Haemopoitic principle Haemoptysis Haemorrhage acute chronic [1104] 27 103 102 793 881 639, 801 655 100 596 593, 595 845 23 33 1026 923 587 Haemorrhoids Haptophore Healing by first intention by granulation by organisation by regeneration by resolution - - Hepatitis Acharya Shri Kailassagarsuri Gyanmandir acute infective chronic toxic Heredity in carcinogenesis Herpes cornealis febrilis genitalis labialis Hirsuties Hobnail liver Hodgkin's disease Hottentot buttock Howell-jolly body H. Substance 847 45 Hydrophobia 834 Hydrops articuli 168 Hydrops foetalis 868 Hydrosalpinx 869 927 Hyalinisation in kidneys Hydrarthrosis Hydrohepatosis Hyperaemia Hyperaemia active secondary symptomatic 225 simplex 526 Zoster 224 of the lungs of the spleen passive Hypercholesterinaemia For Private and Personal Use Only 1003 1033 281 891 733 927 Hyperinsulinism Hypernephroma 239 291 293 294 chronic passive of the liver 120 123 691 226 226 33 * 750 124, 126 656 826 873 9 149 45 745 221 45 879 16 278 278 282 283 282 279 148 798 751, 797

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( 1105 ] 792 77 80 276 Hypoglycaemia Icterus gravis neonatorum 934 Ileitis regional 111 Immunity 1021 Immunity acquired active 1023 - passive 1024 Immunity arhenius & Madsen's theory 1034 Immunity Bordet's Theory 1034 herd 1036 local 1031 modern theory 1036 natural 1023 various theories 1032 Induration simple fibroid 563, 594 Infantile pyelitis 156 Infarction 274 Infarction of brain of heart - liver 277 lungs Infarct red 275 - white Infection Bacillus Koch's 493 - extrameningeal meningococcal Infiltration glycogen Inflammation aetiology and blood and body cells arrest of 23 catarrhal 26 changes in tissue cells 21 chronic chronic stage classification 7 clinical types of definition dry 29 eifect on arte:ie. 70 13 vi0 gall bladder 133 gastro intestinal tract 98 heart 57 blood and lymph vessels 68 kidney 737 liver 119 male genital organs 161 nervous system 176 pancreas 135 -respiratory system 77 -reticuloendothelial system 75 --- various body.tissues 33 Abrinous 26, 27 general symptoms 5 nasal of bone 35 of mucous membrane 26 of serous membranes 29 Inflammations of uterus 168 Inflammation plastic 29 renal sero-purulent special symptoms spread subacute stage variation in histology 23 Intracranial pressure increaes in 200 Interference with nutrition 230 Involutionary changes in carcinogenesis 696 Iritis 591 Irritation chronic ( incarcinogenesis ) Ischaemia 258 Jaundice acholuric 929 - catarrhal 131, 463 epidemic spirochaetal 638 heamolytic 928 140 G 12 o 696 Nos For Private and Personal Use Only

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[ 1106 ) 151 246 Joints infflammation of 42 | Lipoma Kala azar 474 - arborescence Keloid 827 Lipomata fibro Kidney granular - myxo large, white 145 - naevo myelin Liver chronic passive congestion 282 pyaemic 153 Liver enlargement due to malaria 481 secondary contracted 151 Locomoter ataxia 625 small red or white (tabes dorsalis) surgical 154 - seven groups of symptoms 628 myelin Lymphadenitis 75, 592 Klebsiella rhinoscleromatis 655 tuberculous 530 Koch's phenomenon 516 aleukaemic 949 Koilonychia 907 Lymphangitis Laryngitis 83 | Lymphangioma 848 - tuberculous 531 Lymphocytom: 815 Leucopenia 884 Lymphogranuloma 656 Leucocytosis 882 Lymphomatosis pseudo leukaemic949 Leucocythaemia Lympho sarcoma see under sarcoma Leucosis Lysins 1027 Leucotaxine 913 Lysozyme 1029 Leprosy 639 Macroglossia 849 anaesthetic 643 Maculosus haeinorrhagicus of mixed form Werlhoff 918 nodular 643 Madura foot 651 - pathology of Maladie de Reclas 164 Lesion precancerous 697 Malaria 744 Leukanaemia 942 - blood changes 483 Leukaemia 938 Margination acute Mastitis 173 aleukaemic 815, 913, 948 acute chronic lymphatic 943 chronic interstitial 175 leucoblastic 945 - involutionary 789 Leucoplakia lingual 630 - cystic 175 Leukaemia lymphatic 815 - proliferative monocytic 947 productive 868 myelogenous - tuberculous 561 - pseudo Mediastinitis 58 Linitis plastica 712, 735 | Medulloblostoma Lipaemia Megaloblast Lipoids 238 | Megalocyte 643 645 945 174 mvela 938 949 855 245 868 For Private and Personal Use Only

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( 1107 ) . 192 198 201 cell 300 234 fat - 265 121 234 Melanoma malignant 858 : Miyositis Melanophore - ossificans Meningitis - progressive fibrosing aseptic Naevus 856 pneumococcal 200 Nail spoon-shaped 907 streptococcal Necrosis acute pancreatic 135 tardi 199 caseous 235 tuberculous 572 233 Meningococcal sepsis 198 central 121 Meta plasia coagulative 234 Metritis 165 colliquative - chronic 162 diffuse 151 Microglia 183 235 Migration of cell 286 focal 120, 234 - of histiocytes lobulor or zonal 120 Mole hydatidiform 798 - midzonal 121 Mononucleosis 464, 948 - molecular 236 Molluscum fibrosum 827 Necrosis of nucleus 233 Morant Baker's cyst 43 Necrosis peripheral Moulds 653 - varieties of Multiple myelomatosis of the Negri bodies 224 hone 817 Nephritis 140 Mumps 104 - acute focal Muscle effect of inflammation 54 chronic interstitial 151 Mycetoma 051 - diffuse glomerulo nephr. Mycobacterium tuberculosis 496 itis Acute stage 143 Mycoses 646 Nephritis diffuse glomerulo subMyelitis 220 acute stage 144 Myeloblast 881 Extra capillarytype 145 Myelosis aleukaemic 949 Intra capillary type >> Myoblastoma diffuse suppurative 153 Myocarditis acute bacterial embolic 65 acute toxic focal glomerulo 150 chronic focal suppurative 154 chronic interstitial focal symptoms fibroid glomerulo nephritis 140 parenchymatous 67 subacute stage 142 Myoma leo 844 syphilitic 619 - rhabdo 843 suppurative Myxo-lipoma 837 Nephrosis hydro 779 Myxoma 836! - hydro 779 65 153 153 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra Neuritis Neuroglia interstitial Parenchymatous Neuroma Neuroblastoma Neurofibroma Neurofibromata Neurofibromatosis functions Oedema gross Oedema in inflammation cause Oesophageal varix Oligodendroglia Oophoritis w Opsonin 827 825 Neuronitis acute infective 228 Neuro syphilis 622 184 Nervous system development sources of infection 185 Node periosteal in syphilis Normoblast Nutritional activity acute - thermostable Thermolabile Orchitis Organisation Osteo Arthritis Osteitis fibrosa www.kobatirth.org 820,, Osteoclastic lacunar resorption Osteoclastonia Osteoma [ 1108 ] 126 Osteoperiostitis syphilitic 227 Other specific granulomatous 227 diseases 181 Otitis media 182 Ozena 852 Paget's disease (carcinoma of the breast) Pancreatitis acute 33 602 874 890 146 10 127 51 36, 41 813 37 812 841 cancellous 842 central 843 compact 842 842 ivory Osteomyelitis acute suppurative 57 41 symptoms tuberculous 520 Panphlebitis Papilloma Acharya Shri Kailassagarsuri Gyanmandir acute haemorrhagic chronic gangrenous - mucous 136 135 263 774 778 of intestines 782 of the bladder 778 duct of the breast 782 Papillomata of the gall-bladder 781 of the laryux 779 781 780 781 782 Papillamata of the tongue Papilloma stratified of the penis of the palate 182 163 Papilloma of the renal pelvis of the scalp 163 1031 1031 1031 Papillomatosis shaggy diffuse Paralysis flaccid type 218 161 90 Paralysis general of insane 599, 632 infantile 212 lower motor type of 3 stages Parastheia Parenchymatous lesions Parkinsonism Parotitis For Private and Personal Use Only 603 suppurative Pathological dislocation Pathology of blood Peliosis rheumatica Periadenitis 639 191 82 771 135 33 neurone 780 778 134 218 218 908 204 209 104 104 51 862 922 76

Page #1197
[ 1109 ) 94 903 182 938 119 Periarteritis 71 Pneumonia metastatic Periarticular fibrozitis 49 post operative Pericarditis primary atypical 96 - suppurative 58 streptococcal tuberculous 529 Pneumonitis 97 Pericolitis 111 Poikilocytosis Perihepatitis Poisons bacterial types of 1025 Perilymphangitis 75 Poliomyelitis acute anterior 212 Perineuronal satellite Polychromasia 837 Periooploritis 163 Polychromatophilia $73, 895 Periostits 591 Polycythaemia compensatory 871 36 hypertonica Periphlebitis 26: rubra 937 Peritonitis 115 Polycythaemia splenomegalic acute 117 Polyps 775 chronic Polypus adenomatous 784 tuberculous 561 Polyserositis 119 Pharyngitis 105 Polyurea 139 Phenomenon Ehrlich's 1035 - compensatory Pheochromocytoma 820 Post encephalitic Parkinsonism 209 Phlebitis Pot's disease 523 -- migrans Precipitin 103 Phlegmasia alba dolens Price jones curve 872 Phlegmasia alba dolens 267 Prostitis Piles bleeding 1014 Proctitis polypose 113 - congenital Prostatis tuberculous 569 - dry 1009 Proctitis 561 Pigmentary changes 179 Pseudo melanosis 116 Plague 471 | Psilosis 1001 Pleochromocytoma 749 Ptomains 1028 Pneumonia haemophylous cata- Pulmonary tuberculosis 232 rrhalis 95 Purpura 916 Pneumonia-broncho confluent anaphylactoid form haemorrhagica 917 tuberculous caseous 545 idiopathic 918 Pneumonia hypostatic Henoch's 921 influenzal infective type 917 inhalation non-thrombocytopenic 921 Jipoidal rheumatica 917, 922 lobar schonlein's 922 lobular 92 - secondary 923 co 161 821 For Private and Personal Use Only

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82 805 cells [ 1110} Purpura simplex 917, 921 | Rhinitis diphtheritic - simple idiopathic - purulent - thrombocytopenic 918 - sicca - toxic 917, 921 Rhinoscleroma 655 Pus definition 17 Rhinosporiodiosis 658 Pyaemia portal 115 Ringworm due to trichoplaytous 653 Pyarthrosis 45 Salpingitis 164 Pyelitis 156 gonococcal 166 Pyonephrosis tuberculous 568 istlunica nodosa 168, 571 Pyorrhoea alveolaris 100 pyogenic 168 Pyosalpinx 166 tuberculous 570 Queekenstedt sign 187 Sarcoma 801 Rabies 221 adeno 823 Radiation effect on blood vessels 700 chondro 876 - itseffect on tumour classification of 698 clinical signs 808 Ranaud's diseasb 231, 262 ! fibro 805 R. B. C. & their fragility 874 giant-cell 807, 812 R. B. C. change in number 871 histological type of 805 - changes in shape 873 lipo 806 changes in sedimenta ly ho 814 tion rate 875 macroscopical examinachanges in size 872 802 coagulation changes 875 malignancy of diapedesis mediastinal oat-celled 725 - haemaglutinin changes 876 microscopical examina- nucleated 874 tion 807 Receptor 132 myxo Neuro fibro 827 Recklinghausein's disease 852 Red blood corpuscle 866 neuro or neurogenic 806 Repair 285 of gastro-intestinal tract 818 - by transplantation of yenito-urinary system 819 of the bone 295 of intestines Retentions odium of lymphoid tissue Reticulocyte of prostate Reticulo-sarcoma polymorphic 817 of reticulo-endothelial Reticulosis 938 system 814 Retinoblastoma of retroperitoneum Rh-factor 878 of bladder 821 Rhinitis of bone 808 - atrophic 32 - of liver 819 tion 281 803 298 147 868 852 819 For Private and Personal Use Only

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[ 1111 ] 536 53 0 0 I!!!!!!!!!! OD 52 Sarcoma of lung 813 Spirochaetosis of medulla of the litis Deformans adrenals 820 Spongioblastoma multiforma of. of mammary gland 823 the brain 810 of muscle 845 | Spongy gums 101 of oesophagus Sprue 902 of ovary - tropical 1001 of stomach Sputum 498 of testis Stage of congestion S7 of tongue - of grey hepatisation 88 of tonsil - of red hepatisation of uterus 822 of resolution - diffuse Staphylolysin 1027 - interstitial Still's disease osteoclastoma 812 Stoke adam's syndrome osteogenic 809 Stomach-leather bottle 712 physical signs 807 Stomatitis prognosis 812 - aphthous reticulo polymorphic 817 catarrhal rericulum cell 816 gangrenous sclerosing 811 mercurial 100 secondary changes Strabismus 199 spread of 804 Strumpel Marie syndrome telangiectotic Suoker foot 181 Schimmelbuschi's disease 174 Suppuration 17 Scurvy 100 Susceptibility & imunity in carSecondary phlebitis of splenic vein123 cinogensis 692 Sedimentation rate 876 Swelling cloudy 236 time 875 Syndrome Froin Seminoma 758 Micklicz Serous effusion Plumner hypochromic 907 Serum globulin 1036 Plumner Vinson 909 Sexual changes 787 Synovitis chronic serous Side chain theory of Eherlich i032 Syphilis 576 Sinusitis suppurative 83 acquired 585 Sorethroat 457 and stomach 618 Space of His 203 cerebro spinal Specific immune substances 1029 congenital 579 Spherocytosis 929 effect on thyroid 618 Spirochacta 575 effect on uterus 621 - pallida 392 of larynx 612 807 54 811 29 45 622 For Private and Personal Use Only

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[ 1112 ] 83 621 617 556 Syphilis of lungs 612 of lymph glands 611 of nervous system of spleen 612 of blood vessels 605 of bone 600 of gastro-intestinal tract 615 of heart 615 of joints 603 of lip 614 of liver 616 of mouth 614 of nose of testis 620 of tongue 614 primary 585 quaternary stage of 599 secondary 590 - tertiary stage 593 Syphilomata 596 Tabes dorsalis 599 or locomotor ataxia 625 Telangiectasis 845 Temperature rise of 315 Teratomas 860 Thrombocytopenia Thromboplastin 920 Thrombosis - causation 263 Thrombus & clot ball 267 characters of fibrinous 267 final changes hyaline organisation Thrush 99 - due to oidium albicans 651 Thyrotoxicosis 745 Tisue nerosis 230 changes in Tisue necrosis 3 main causes 230 Tonsillitis Toxicosis haemorrhagic capillary 921 Toxophore 1033 Trauma and carcinogenesis 694 Transudation 281 Tropical eosinophilia 404 Tubercle 494 - formation 5.13 yellow 509 Tuberculosis 493 acute generalised 517 acute miliary 552 bronchial 554 chronic disseminated 553 fibrocaseous 548 hypertrophic 592 intestinal konig's nodular synovial 523 pathology 5.16 pulmonary 532 surgical 518 susceptibility 515 tissue reaction 506 Tuberculosis of bone 520 - of caecum 562 of genito-urinary system 567 - of nervous system 572 - of suprarenal glands 563 of joints 524 vertebral 523 Tumour brook's 715 clinical types of 671 glomus 813 grawitz 797 Tumours 660 classitications of simple, of epithelial tissue 774 - mixed 862 263 265 704 233 For Private and Personal Use Only

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Shri Mahavir Jain Aradhana Kendra Tumours of connective tissue benign malignant w of epithelial tissue of haemopoietic tissues of muscle-tissue of nervous tissue pigmented radiation sensitivity teratoid structure of wilon's Typhoid-four stages Uraemia chronic Ulcer girdle Ulceration Ulcer Rodent Universal donor Urethritis recipient acute Urticaria Valvulitis www.kobatirth.org [ 1113 ] 801 825 706 851 843 851 856 698 701 862 664 819 487 151 558 236 877 32 1 Van Gierke disease Vaquerz's disease Vascular changes ( foot plate Vegetations rheumatic Vessel wall diseases of the Acharya Shri Kailassagarsuri Gyanmandir Vincent's angina Virchow Robin space Vitamine B 2 B 12 C Xanthelasma Xanthoma Warts Wasserman's reaction Weil's diseas Werlhoff's disease White blood corpuscles Wilm's tumour 100705001 (Tb.) 159 164 412 Yaws 62 Yellow atrophy acute For Private and Personal Use Only large multiplex 246 937 514 181 62 264 100 186, 203 891 871 870 775 589 463, 638 911 881 819 828 827 828 827 638 121

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navIna vaijJAnika cikitsA granthaH1 abhinava zarIrakriyA vijJAna / ( sacitra ) zrI priyavrata zarmA 7 // ) 2 abhinava bUTIdarpaNa / sacitra 1-2 bhAga 3 aSTAMgahRdaya / 'vidyotinI' bhASA TIkA vaktavya pariziSTa sahita 4 aSTAMgasaMgraha / 'arthaprakAzikA' bhASATIkA vaktavya sahita / sUtrasthAna 8) 5 zrAyurvedapradIpa (Ayurvedika-elopethika gAiDa) rAjakumAra dvivedI 10) 6 AyurvedIya-paribhASA / prakAzikA-hindI TIkA pariziSTa sahita 11) 7 kAzyapasaMhitA / 'vidyotinI' bhASA TIkA saM0 hindI upodghAta sahita 16) 8 kaumArabhRtya (navya-vAlaroga sahita ) raghuvIra prasAda trivedI 9) 9 cakradatta / bhAvArthasandIpinI' bhASA TIkA pariziSTa sahita 10) 10 dravyaguNavijJAna / zrI priyavratazarmA prathamabhAga 5 // ) dvitIya-tRtIyabhAga 12 // ) 11 prasUti vijJAna (scitr)| DA. ramAnAtha dvivedI 12 bhAvaprakAzaH / 'vidyotinI' hindI TIkA pariziSTa sahita saMpUrNa 30) 13 bhaiSajyaratnAvalo / navIna vaijJAnika 'vidyotinI' bhASATIkA, vimarza, TippaNI tathA vividha pariziSTa sahita / TIkAkAra-ambikAdatta zAstrI 15) 14 mAdhavanidAna / 'madhukoSa' saMskRta tathA 'vidyotinI' hindI TIkA, navIna vaijJAnika vimarza sahita / sampAdaka zrI yadunandana upAdhyAya 13) 15. mAdhavanidAna / 'madhukoSa' saMskRta tathA 'manoramA' hindI TIkA sahita 6) 16 yakRt ke roga aura unako cikitsA / zrI sabhAkAnta mA 2) 17 yogacikitsA / lekhaka-atrideva gupta / 3 // ) 18 yogaratnAkara / mUla saTippaNa 6) vidyotinI bhASA TIkA sahita 18) 19 rscikitsaa| kavirAja prabhAkara caTopAdhyAya 20 rasaratnasamuccaya / 'suratnojjvalA' bhASA TIkA vimarza pariziSTa sahita 10) 21 rasendrasArasaMgraha / 'rasacandrikA' bhASA TIkA vimarza pariziSTa sahita 6) 22 rAjakIya zroSadhiyoga saMgraha / zrI raghuvIra prasAda trivedI 23 rASTriyacikitsA siddhayogasaMgraha / raghuvIra prasAda trivedI 24 vaidyajIvana / sudhA hindI TIkA sahita 25 vaidyaka paribhASA pradIpa / pradIpikA hindITIkA sahita 26 zAlAkyatantra (nimitntr)| DA0 ramAnAtha dvivedI 27 shaanggdhrsNhitaa| 'subodhinI' bhASA TIkA vimarza pariziSTa sahita 28 siddha-bheSaja-saMgraha / saMpAdaka-zrI gaMgAsahAya pANDeya 29 suzrutasaMhitA-sUtra-nidAna-zarIrasthAna / DA. kavirAja ambikAdatta evaM DA0 ghANekarajI kRta hindITIkA saMcalita 1-2 bhAga 15) 30 sauvatI / DA. ramAnAtha dvivedI sulabha saMskaraNa 7 // ) uttama saMskaraNa 8 // ) Cx prAptisthAna-caukhambA vidyA bhavana, cauka, banArasa-1 For Private and Personal Use Only

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vikRtivijJAna-pRSTha 411 (ka) sannipAta | sandhika tandrika pralApa cittavibhrama jihaka kaNika rugdAha antaka bhugmanetra lakSaNa tIvra jvara ke sAtha zarIra kI pamukha lakSaNa sandhiyoM meM zodha tIna vara ke sAtha tIna jvara ke sAtha atyadhika tandrA pralApa bahulatA tathA atyadhika vedanA tIvra jvara ke sAra gAyana, nartana hAsya aura pralA tIvra jvara ke tIvra jvara ke sAtha sAtha karNamUlajilA kaThina kaNTakoM grandhi meM zotha se AvRta aura aura vedanA bAhulya tIbra jvara ke sAtha tIvra jvara ke sAtha atyadhika dAha, nirantara ziravidhUhanumanyA aura kaMTha nana yA zirakampa | tIna jvara ke sAtha vakradRSTitA bahalatA usake kAraNa makatA meM ativyathA doSotvaNatA vAtakapha bAtakapha vAtakapha vAtakapha bAtakapha bAtakapha pitta pitta vAtapitta tRSNA +++++ ++++++ dAha ++ +++ + ++++++ zvAsa +++++ +++++++++++ +++++ ++ +++++ kAsa ++++++ ++++ ++ ++++ hikA ++++++ pralApa ++++++++++++ +++++++++++ + ++++++ kampa ++++++ + + +++++ tandrA + nidrA jAgaraNa zrama kuma +++++ +++ +++ +++++ vamana ++ atIsAra +++++ mada ++++ +++++ +++++++++++ +++ mULa vikalatA +++ +++++ ++ bedanA +++++ +++ + + + + +++ saMjJAnAza +++++ AdhmAna balakSaya ++++ tApa ++++ ++ ++++++ +++++ +++++ +++ zaitya aGgazaithilya kaNTharuka ++++ ++++ ++++++ ra-zyAmA sa-zUkAvRta nA-kaThinA ++++ ++++ ++++ ++++ karNazUla ++++ ++++++ ++ ++++ vikRtanetra +++++ ++++++ jaDatA prasveda + + praseka +++ agnimAndha For Private and Personal Use Only

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-sannipAtabhedapradarzikAtAlikA bhugnanenna kaNThakuja raktaSThIcI zItAGga abhinyAsa phalgu zIghrakArI makarI visphuraka bhAlukitantriya sannipAta vizeSa 1112 tIna jvara ke sAtha tIvra jvara ke sAtha . tIvra jvara ke sAtha vra jvara ke sAtha ziraHzUla tathA raktaSThIvana aura tIna jvara ho yA na hai| vakradRSTitA zUkAvRta kaMTha aura tvacA para lAla para hima ke samAna va zItala zarIramakatA snigdhamuSNatA galarodha hanustambha atIva moha yA jvara aGgamada nidratA ceSTAnAza tAluzoSa zItajvara kSudhA jvara, glAni, para jvara antardAha pArzvanigraha ziro- pArzvazUla, dRSTikSaya, antaHvara parvabheda zI vahiHzIta dakSiNa gauraba Alasya piNDikodveSTana aba | gaurava nAbhipArzvapArzvatoda urograha manyAstambha kaTi- sAda saraktaviNmUtra mUla svinnAzupra zUla svinnAzupratA ziraHzUla kaNDa vastizUla gudabastizUla / vRddhi srotoM meM rakta kA pravartana kaphapitta kaphavAta bAta pitta cakatte vAtapitta bAtapitta pittavAta vAtapitta tridotra vAtapitta +++++ +++ +++ +++ +++ +++ ++++++ ++ +++ + ++ + ++ -++++ + + +++++ +++++ +++++ ++ + ++ + ++++ ++ + + ++++ + +++++ + + + + + I +++++++++++ ++ +++ / +++++ +++++ +++ 1 + + + + +++++ +++ ++++ +++++ ++++++ + ++ + |++++ +++ +++ +++++ + + + +++ +++++ +++++ +++ +++ + + + +++++ ++++ +++++ +++ +++ ++++ ++++ ++ + +++++ +++ +++ ++++ +++ +++ +++ ++++++ +++ +++ ++++ - For Private and Personal Use Only

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zIghrakArI kaphphaNa kUTapAlaka sammoha karkaTa pAlaka yAmya kaca vaidArika vasavarAjIyakAra ke dvArA kathita sannipAta vizeSa antardAha vizeSa manyAstambha ziro- hRddAha yakRtplI raktamukhamaNDala kaTitoda alpazUla graha humyAthA chidroM hAntraphuphphusapAka pArzvazUla kapotavata ziro bastimanyA se raktasrAva saMrakta pUyaraktanirgama manyAstambha kUjana ileSmApUrNa | hRdaya vAkrujaH stabdhanetratA zIrNadantatA zuSka raktakoSThatAlu karNamUlapiDakA hatvAka raktaSThIvana pittavAta pittakapha vAtapitta kaphavAta kaphapitta jvaraghora bahijvara antaHjvara parvabheda zIta jvara gaurava gaurava nAbhipArzva- Alasya arocaka stabdhAGga ekapakSAmizUla svinnAzupra- tRpti hRdgrahaSThIvana stabdhanetratA vRddhi srotoM meM rakta mukhamAdhurya kA pravartana - - - - -- kapha tridoSa vAtapitta ghAta pitta +++ ++ + +++ +++ +++ +++ +++ +++ ++ + +++ +++ +++ +++ +++ +++ +++ +++ ++ + +++ +++ +++ + + + +++ +++ +++ ++ + + + + +++ +++ +++ ++ + +++ + + + +++ +++ ++ + +++ + + + +++ +++ ++ +++ +++ +++ +++ +++ + + + + + 4 . +++ +++ +++ +++ +++ +++ +++ + ++ +++ For Private and Personal Use Only

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