Sushruta Samhita Nidanasthana Chapter 11 Granthi Apaci Arbudam Galaganda Nidanam (Benign tumor – Cervical metastasis

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 known as Apaci.

Under talked about are the options of Apaci –

–        The granthi is immovable

–        It’s spherical, broad or unctuous

–        It’s related to delicate ache

–        They’ve the scale of seeds of Amalaka – gooseberry

–        They unfold just like the shoal of fish eggs

–        Have identical colour as that of the physique

–        Grows steadily

–        There’s itching and delicate ache

–        They disappear when pricked following which the brand new ones seem

On account of its gradual and regular progress, it’s known 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 might happen wherever within the physique. This illness is known as Arbuda by these individuals who’re realized in science. Arbuda manifests with the beneath talked about options –

–        Spherical in form

–        Immovable

–        Has delicate ache

–        Large in dimension

–        Is deep rooted

–        Grows slowly

–        Doesn’t ripen i.e. pus shouldn’t be shaped

Bheda – varieties

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 kinds 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 are aggravated will produce squeezing and contraction within the blood and veins. That is known as Rakta Arbuda – produced by blood. Under 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

–        Repeatedly discharges vitiated blood

This rakta arbuda is incurable. These affected by arbuda may have loads of issues and extreme lack of blood. On account of these, the individual 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 many others.

Pathogenesis – the muscle, on the place of the physique hit by fist and many others. will get vitiated. A swelling happens at that place. Under talked about are the options of the swelling –

–        Painless

–        Unctuous

–        Is of the physique colour

–        There is no such thing as a formation of pus

–        Has stone like consistency

–        Immovable

This primarily happens in individuals who’ve vitiated muscle mass and who repeatedly 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 varieties 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 is 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 is known as Dvirarbuda i.e. double tumors.

Each the above stated circumstances are stated 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 cause is because of the predominance of kapha and medas, stability of doshas and these being within the type of lumps or laborious 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 step by step and is related to the options of the respective doshas. This situation is 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 pink

–        It turns into very unctuous and painless with passage of time, when it combines with fats and grows in dimension

–        Typically it turns into coarse / tough, grows slowly and doesn’t bear suppuration

–        Typically it might additionally bear suppuration by accident or with none recognized trigger

–        It provides rise to dangerous 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 |

Under talked about are the options of Galaganda produced by predominant aggravation of kapha –

–        The tumor is immovable

–        It has the identical colour of the physique

–        Has slight ache

–        Has profound itching

–        Is chilly to the touch

–        Is huge in dimension

–        Grows slowly

–        Typically there may be formation of pus which takes place slowly

–        Is accompanied with delicate ache

–        There’s 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||

Under talked about are the options of Galaganda produced by predominance of fats –

–        The tumor is unctuous

–        It’s mushy, white in colour and has disagreeable odor

–        There’s absence of ache

–        There’s 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 dimension

–        There’s unctuousness of the mouth

–        There’s fixed manufacturing of second kind of voice which is all the time 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 problem in respiration

–        All of the elements of the physique change into mushy

–        Galaganda persisting for a couple of yr

–        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 free just like the scrotum,

–        Both huge or small in dimension

इति सुश्रुतसंहितायां निदानस्थाने गलगण्डगण्डमालापच्यर्बुदनिदानं नामैकादशोऽध्यायः ||११||
Thus ends the Eleventh chapter by title Granthi- Apaci- Arbuda- Galaganda Nidanam in Nidana sthana of Susruta Samhita.