The eleventh chapter of Nidanasthana of Sushruta Samhita is known as as Granthi Apaci Arbudam Galaganda Nidanam. This chapter offers with Benign tumor – Cervical metastasis – Malignant tumor and cervical lymphadenitis.
अथातो ग्रन्थपच्यर्बुदगलगण्डानां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We are going to now expound Granthi (benign tumor) Apaci (cervical metastasis) Arbuda (Malignant tumor) and Galaganda Nidanam (cervical lymphadenitis) as revealed by the venerable Dhanvantari.
Samprapti- pathogenesis
वातादयो मांसमसृक् च दुष्टाः सन्दूष्य मेदश्च कफानुविद्धम् |
वृत्तोन्नतं विग्रथितं तु शोफं कुर्वन्त्यतो ग्रन्थिरिति प्रदिष्टः ||३||
Vata will get aggravated together with the opposite dosha i.e. pitta and get related to kapha. All these doshas vitiate the muscle, blood and fats tissues. Doing so, the produce a swelling which is spherical in form, elevated and cyst like. This swelling known as as Granthi – tumor.
Lakshanas – indicators and signs
Vataja Granthi
आयम्यते व्यथ्यत [१] एति तोदं प्रत्यस्यते कृत्यत [२] एति भेदम् |
कृष्णोऽमृदुर्बस्तिरिवाततश्च भिन्नः स्रवेच्चानिलजोऽस्रमच्छम् ||४||
Beneath talked about are the options of granthi produced by aggravated vata –
Nature of pains within the swelling –
– Increasing
– Hitting
– Pricking
– Reducing and so forth.
The swelling is –
– Black in shade
– Laborious on contact
– Enlarged just like the urinary bladder and
– Exudes clear blood when pricked / punctured
Pittaja Granthi
दन्दह्यते धूप्यति चूष्यते च पापच्यते प्रज्वलतीव चापि |
रक्तः सपीतोऽप्यथवाऽपि पित्ताद्भिन्नः स्रवेदुष्णमतीव चास्रम् ||५||
Beneath talked about are the options of granthi produced by aggravated pitta –
Nature of pains –
– Burning
– Very heat
– Feels as if smoke is being eradicated from the swelling
– Sucking ache
– Suppurates and feels as if being burnt by the hearth
The swelling is –
– Pink in ncolor,
– Barely yellowish
– Bursts open when pricked, discharge of enormous amount of heat blood
Kaphaja Granthi
शीतोऽविवर्णोऽल्परुजोऽतिकण्डूः पाषाणवत् संहननोपपन्नः |
चिराभिवृद्धिश्च कफप्रकोपाद्भिन्नः स्रवेच्छुक्लघनं च पूयम् ||६||
Beneath talked about are the options of granthi produced by aggravation of kapha –
The swelling is
– Chilly to the touch
– Not discolored
– Has slight ache
– Has extreme itching
– Has grown huge in measurement, like a stone
– Develops slowly
– Bursts open when pricked and there’s exudation of thick pus which is white in shade
Medoja Granthi
शरीरवृद्धिक्षयवृद्धिहानिः स्निग्धो महानल्परुजोऽतिकण्डूः |
मेदःकृतो गच्छति चात्र भिन्ने पिण्याकसर्पिःप्रतिमं तु मेदः ||७||
Beneath talked about are the options of the granthi produced by vitiated fats –
The swelling –
– Will increase or decreases in accordance with the rise or lower of the physique
– Is unctuous
– Very huge in measurement
– Has extreme itching
– Exudes fatty liquid which resembles the sesame paste or ghee
Siraja Granthi
व्यायामजातैरबलस्य तैस्तैराक्षिप्य वायुर्हि सिराप्रतानम् |
सम्पीड्य सङ्कोच्य विशोष्य चापि ग्रन्थिं करोत्युन्नतमाशु वृत्तम् ||८||
ग्रन्थिः सिराजः स तु कृच्छ्रसाध्यो भवेद्यदि स्यात् सरुजश्चलश्च |
अरुक् स एवाप्यचलो महांश्च मर्मोत्थितश्चापि विवर्जनीयः ||९||
इति ग्रन्थीनां निदानं समाप्तम् |
Vata will get aggravated in individuals who’re weak and indulge loads in additional bodily actions. The aggravated vata invades the community of veins and would squeeze, constrict and dry up these veins. Doing so, the vata offers rise to an elevated, rounded swelling of veins, which develops shortly. This situation turns into very painful and therefore will get very tough to treatment. It additionally strikes from one place to the opposite.
That swelling of veins which doesn’t transfer from one place to the opposite, is huge in measurement and located on the marmas – the important spots, shouldn’t be handled. They need to be rejected even when there’s absence of ache.
हन्वस्थिकक्षाक्षकबाहुसन्धिमन्यागलेषूपचितं तु मेदः |
ग्रन्थिं स्थिरं वृत्तमथायतं वा स्निग्धं कफश्चाल्परुजं करोति ||१०||
तं ग्रन्थिभिस्त्वामलकास्थिमात्रैर्मत्स्याण्डजालप्रतिमैस्तथाऽन्यैः |
अनन्यवर्णैरुपचीयमानं चयप्रकर्षादपचीं वदन्ति ||११||
कण्डूयुतास्तेऽल्परुजः प्रभिन्नाः स्रवन्ति नश्यन्ति भवन्ति चान्ये |
मेदःकफाभ्यां खलु रोग एष सुदुस्तरो वर्षगणानुबन्धी ||१२||
Medas – fats will get elevated together with kapha. These two collectively would give rise to granthi – tumor close to the decrease jaw, axilla / scapula, clavicle, shoulder joint, nape of the neck and entrance of the neck / throat.
They’re referred to as Apaci.
Beneath talked about are the options of Apaci –
– The granthi is immovable
– It’s spherical, broad or unctuous
– It’s related to gentle ache
– They’ve the scale of seeds of Amalaka – gooseberry
– They unfold just like the shoal of fish eggs
– Have identical shade as that of the physique
– Grows steadily
– There may be itching and gentle ache
– They disappear when pricked following which the brand new ones seem
As a consequence of its gradual and regular progress, it’s referred to as Apaci.
These produced by morbid fats and kapha are tough to treatment. These persist for a few years.
Samprapti – Pathogenesis
गात्रप्रदेशे क्वचिदेव दोषाः सम्मूर्च्छिता मांसमभिप्रदूष्य |
वृत्तं स्थिरं मन्दरुजं महान्तमनल्पमूलं चिरवृद्ध्यपाकम् ||१३||
कुर्वन्ति मांसोपचयं तु शोफं तमर्बुदं शास्त्रविदो वदन्ति |१४|
The doshas aggravated in any area of the physique will vitiate the muscle tissue and produce muscular swelling. This swelling could happen anyplace within the physique. This illness known as Arbuda by these individuals who’re realized in science. Arbuda manifests with the beneath talked about options –
– Spherical in form
– Immovable
– Has gentle ache
– Massive in measurement
– Is deep rooted
– Grows slowly
– Doesn’t ripen i.e. pus isn’t shaped
Bheda – sorts
वातेन पित्तेन कफेन चापि रक्तेन मांसेन च मेदसा च ||१४||
तज्जायते तस्य च लक्षणानि ग्रन्थेः समानानि सदा भवन्ति |१५|
Arbuda is produced by the beneath talked about –
– Vata
– Pitta
– Kapha
– Rakta
– Mamsa
– Medas
Signs of those Arbudas are much like these of corresponding forms of granthi.
Raktarbuda
दोषः प्रदुष्टो रुधिरं सिरास्तु सम्पीड्य सङ्कोच्य गतस्त्वपाकम् ||१५||
सास्रावमुन्नह्यति मांसपिण्डं मांसाङ्कुरैराचितमाशुवृद्धिम् |
स्रवत्यजस्रं रुधिरं प्रदुष्टमसाध्यमेतद्रुधिरात्मकं स्यात् ||१६||
रक्तक्षयोपद्रवपीडितत्वात् पाण्डुर्भवेत् सोऽर्बुदपीडितस्तु |१७|
The doshas which might be aggravated will produce squeezing and contraction within the blood and veins. That is referred to as Rakta Arbuda – produced by blood. Beneath talked about are the options of rakta arbuda that are brought on by aggravated doshas and blood –
– Undergoes suppuration – pus is shaped
– Formation of a ball of muscle
– Constantly discharges vitiated blood
This rakta arbuda is incurable. These affected by arbuda can have loads of problems and extreme lack of blood. As a consequence of these, the particular person turns into a sufferer of pandu roga – anemia.
Mamsarbuda
मुष्टिप्रहारादिभिरर्दितेऽङ्गे मांसं प्रदुष्टं प्रकरोति शोफम् ||१७||
अवेदनं स्निग्धमनन्यवर्णमपाकमश्मोपममप्रचाल्यम् |
प्रदुष्टमांसस्य नरस्य बाढमेतद्भवेन्मांसपरायणस्य ||१८||
मांसार्बुदं त्वेतदसाध्यमुक्तं… |१९|
Causes – Being hit by fist and so forth.
Pathogenesis – the muscle, on the place of the physique hit by fist and so forth. will get vitiated. A swelling happens at that place. Beneath talked about are the options of the swelling –
– Painless
– Unctuous
– Is of the physique shade
– There is no such thing as a formation of pus
– Has stone like consistency
– Immovable
This primarily happens in individuals who’ve vitiated muscle tissues and who often eat meat. This mamsa arbuda is incurable.
Adhyarbuda and Dvirarbuda
…साध्येष्वपीमानि विवर्जयेत्तु |
सम्प्रस्रुतं मर्मणि यच्च जातं स्रोतःसु वा यच्च भवेदचाल्यम् ||१९||
यज्जायतेऽन्यत् खलु पूर्वजाते ज्ञेयं तदध्यर्बुदमर्बुदज्ञैः |
यद्द्वन्द्वजातं युगपत् क्रमाद्वा द्विरर्बुदं तच्च भवेदसाध्यम् ||२०||
Even among the many curable ones, the next sorts are match to be rejected;
– That which flows excessively (has exudation, discharges),
– That which has developed over a marma (important spot),
– That which has manifested / developed in a srotas (channels of the physique) and
– That which is immovable (fastened)
Adhyarbuda – The arbuda which develops over an earlier (already current) arbuda known as as Adyarbuda by those that have good data of arbudas.
Dvirarbuda – Arbuda which is 2 in quantity proper from the start (two arbudas have developed proper from the start) or two arbudas (tumors) develop one after the opposite known as Dvirarbuda i.e. double tumors.
Each the above mentioned circumstances are mentioned to be incurable.
न पाकमायान्ति कफाधिकत्वान्मेदोबहुत्वाच्च विशेषतस्तु |
दोषस्थिरत्वाद्ग्रथनाच्च तेषां सर्वार्बुदान्येव निसर्गतस्तु ||२१||
By nature, there isn’t a formation of pus in all of the arbudas. The opposite motive is because of the predominance of kapha and medas, stability of doshas and these being within the type of lumps or exhausting plenty.
वातः कफश्चैव गले प्रवृद्धौ मन्ये तु संसृत्य तथैव मेदः |
कुर्वन्ति गण्डं क्रमशः स्वलिङ्गैः समन्वितं तं गलगण्डमाहुः ||२२||
A tumor is shaped within the sides of the neck because of the localization of vata and kapha collectively. This tumor develops regularly and is related to the options of the respective doshas. This situation known as as Galaganda.
Galaganda produced by predominance of vata
तोदान्वितः कृष्णसिरावनद्धः कृष्णोऽरुणो वा पवनात्मकस्तु |
मेदोन्वितश्चोपचितश्च कालाद्भवेदतिस्निग्धतरोऽरुजश्च [१] ||२३||
पारुष्ययुक्तश्चिरवृद्ध्यपाको यदृच्छया पाकमियात् कदाचित् वैरस्यमास्यस्य च तस्य जन्तोर्भवेत्तथा तालुगलप्रशोषः ||२४||
Options of Galaganda produced by predominant vitiation of Vata –
– Has pricking sensation
– Lined by community of black veins
– Shade of the tumor – black or slight purple
– It turns into very unctuous and painless with passage of time, when it combines with fats and grows in measurement
– Generally it turns into coarse / tough, grows slowly and doesn’t endure suppuration
– Generally it might additionally endure suppuration by chance or with none identified trigger
– It offers rise to unhealthy style within the mouth and extreme dryness of the palate and throat
Galaganda produced by predominance of kapha
स्थिरः सवर्णोऽल्परुगुग्रकण्डूः शीतो महांश्चापि कफात्मकस्तु |
चिराभिवृद्धिं कुरुते चिराच्च प्रपच्यते मन्दरुजः कदाचित् ||२५||
माधुर्यमास्यस्य च तस्य जन्तोर्भवेत्तथा तालुगलप्रलेपः |
Beneath talked about are the options of Galaganda produced by predominant aggravation of kapha –
– The tumor is immovable
– It has the identical shade of the physique
– Has slight ache
– Has profound itching
– Is chilly to the touch
– Is huge in measurement
– Grows slowly
– Generally there’s formation of pus which takes place slowly
– Is accompanied with gentle ache
– There may be candy style within the mouth and
– Coating of the palate and throat
Medoja Galaganda – Galaganda produced by predominance of fats
स्निग्धो मृदुः पाण्डुरनिष्टगन्धो मेदःकृतो नीरुगथातिकण्डूः ||२६||
प्रलम्बतेऽलाबुवदल्पमूलो देहानुरूपक्षयवृद्धियुक्तः |
स्निग्धास्यता तस्य भवेच्च जन्तोर्गलेऽनुशब्दं कुरुते च नित्यम् ||२७||
Beneath talked about are the options of Galaganda produced by predominance of fats –
– The tumor is unctuous
– It’s delicate, white in shade and has disagreeable scent
– There may be absence of ache
– There may be extreme itching
– The swelling hangs like a pitcher gourd with small base,
– The swelling will increase or decreases in accordance to the rise or lower of the physique measurement
– There may be unctuousness of the mouth
– There may be fixed manufacturing of second sort of voice which is at all times current and is unclear
Prognosis of Galaganda
कृच्छ्राच्छ्वसन्तं मृदुसर्वगात्रं संवत्सरातीतमरोचकार्तम् |
क्षीणं च वैद्यो गलगण्डिनं तु भिन्नस्वरं चैव विवर्जयेत्तु ||२८||
The doctor ought to reject the affected person of Galaganda within the presence of the beneath talked about indicators –
– The affected person has issue in respiration
– All of the elements of the physique turn out to be delicate
– Galaganda persisting for multiple 12 months
– The affected person is affected by lack of style
– He’s emaciated and likewise has
– Hoarseness of voice
Galaganda definition
निबद्धः श्वयथुर्यस्य मुष्कवल्लम्बते गले |
महान् वा यदि वा ह्रस्वो गलगण्डं तमादिशेत् ||२९||
Galaganda is the title given to a swelling which –
– Adheres firmly within the throat / neck,
– Hangs unfastened just like the scrotum,
– Both huge or small in measurement
इति सुश्रुतसंहितायां निदानस्थाने गलगण्डगण्डमालापच्यर्बुदनिदानं नामैकादशोऽध्यायः ||११||
Thus ends the Eleventh chapter by title Granthi- Apaci- Arbuda- Galaganda Nidanam in Nidana sthana of Susruta Samhita.
