Now we shall describe the characteristic features of internal abscesses (Antara- Vidradhi). The Váyu, Pittam and Kaphah of the body, deranged through eating heavy, incompatible and in-congenial (to the physical temperament of the eater) articles of food or of dry, putrid and decomposed substances, or by excessive coition and fatiguing physical exercise, or by voluntary repression of any natural urging of the body or through the eating of food which is followed by an acid reaction, either severally or collectively give rise to a tumour-like (Gulma), raised, or elevated abscess in the interior of the organism, which is often felt to be shaped like an ant-hill. 12-13.
They are generally found to be seated at the mouth (neck) of the bladder, or about the umbilicus, or in the sides, or in the Kukshi (inguinal regions), or on the Vrikkas, or on the liver, or in the heart, or on the Kloma, or on the spleen, or in the rectum. Their general characteristics are identical with those of the several types of external abscess. The symptoms of their suppurated or unsuppurated stages should be determined in the light of the chapter on Amapakvaishanyiam (Ch. XVII Sutra.). 14-15.
Now hear me describe the symptoms which specifically mark these internal abscesses according to their seats in the different regions of the organism. An abscess appearing in the rectum (Guda) is marked by the suppression of the flatus (Váta). Seated in the bladder, it gives rise to difficulty of urination and scantiness of urine. Appearing about the umbilicus it produces a distressing hic-cough and a rumbling sound (Atopa) in the intestines. Seated in either of the sides (Kukshi) it tends to aggravate inordinately the váyu of the body. Appearing in the inguinal region it gives rise to an extreme catching pain at the back and waist. Seated in either of the Vrikkas it brings about a contraction of the sides. Appearing on the spleen, it produces symptoms of difficult and obstructed respiration. Seated on the heart it gives rise to an excruciating and piercing pain within its cavity and a drawing pain (Graha) extending all over the body (D. R. - cough). Seated in the Liver its characteristic indications are thirst and difficult breathing (D. R. - hic-cough) whereas a sort of unquenchable thirst is the symptom which marks its seat on the Kloma. 16-17.
Prognosis: - An abscess appearing on any vital part (Marma) of the organism, whether large or small in size, suppurated or unsuppurated, should be deemed' as extremely hard to cure. Discharge from an abscess formed in the region of the organism above the umbilicus and (spontaneously bursting), will flow out through the mouth whereas similar secretions from down the umbilical region of (the abdomen), naturally find an outlet through the fissure of the anus. The case in which the secretions (pus etc.) find a downward channel and outlet may end in recovery of the patient, whereas the one in which the secretions take an upward course invariably proves fatal. An incision made by surgeon from the outside into an internal abscess, other than the one situated on the heart, or on the bladder or on the umbilicus may occasionally, prove successful, but the one, seated on any of the preceding vulnerable visceras (heart, bladder etc.) of the body and surgically opened invariably ends in death. 18-19.
A woman, who has miscarried or has been even safely delivered of a child at term, may be afflicted with a dreadful abscess in the event of her taking injudicious and unhwholesome food after parturition. The abscess in such a case, which is attended with extreme hyper-pyrexia (Dáhajvara) should be considered as having had its origin to the vitiated blood (Raktaja Vidradhi) accumulated in the organism. The abscess, which appears in the Kukshi (in the iliac region) of a safely delivered woman owing to the presence of the unexpelled blood-clots in those regions after childbirth, should be also diagnosed as a case of Raktaja abscess. The unexpelled blood is called Makkalla. Such an abscess, if not absorbed in the course of a week, is sure to suppurate. 20 - 21.