एकादशोऽध्यायः । अथातो ग्रन्थ्यपच्यर्बुदगलगण्डानां निदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरि: ।
Now we shall discourse on the Nidana of Granthi (Glands etc.), Apaci (Scrofula etc.), Arbuda (Tumours) and Galaganda (Goitre). 1
वातादयो मांसमसृक् च (प्र) दुष्टाः सन्दूष्य मेदश्च कफानुविद्धम् । वृत्तोन्नतं विग्रथितन्तु शोकं कुर्वन्त्यतो ग्रन्थिरिति प्रदिष्टः ॥ २॥
The deranged and unusually aggravated Vayu etc. (Pitta and Kapha), by vitiating the flesh, blood and fat mixed with the Kapha ( of any part of the organism), give rise to the formation of round, knotty, elevated swellings which are called Granthi (Glandular inflammation). 2
आयम्यते व्यथ्यत एति तोदं प्रत्यस्यते कृत्यत एति भेदम् । कृष्णोऽमृदुर्बस्तिरिवाततश्च भिन्नः स्त्रवेच्चाविलजोत्रमच्छम् ।।३।।
दन्दह्यते धूप्यति चातिमात्रं पापच्यते प्रज्वलतीव चापि । रक्तः सपीतोप्यथवाऽपि पित्ताद् भिन्नः स्त्रवेदुष्णमतीव चासम् ॥ ४ ॥
शीतोऽविवर्णोऽल्परुजोऽतिकण्डुः पाषाणवत् संहननोपपन्नः । चिराभिवृद्धिश्च कफप्रकोपाद् भिन्नः स्रवेच्छुक्लघनञ्च पूयम् ॥ ५॥
The Dosa-Origined Types : The swelling (Sopha) of the Vataja type seems as if it were drawn into and elevated or as if severed or pricked with a needle, cleft in two or drawn as under or as if cut in two or pierced. The knotty growth assumes a black colour, and is rough and elongated like a bladder. On bursting a granthi of this type exudes clear bright red blood. The Pittaja Granthi is characterised by heat and an excessive burning sensation (in its inside). A pain, like that of being boiled by an alkali or by fire, is felt in the inside. The knotty formation assumes a red or yellowish colour and exudes a flow of extremely hot blood on bursting. The Kaphaja Granthi is slightly discoloured and cold to the touch. It is characterised by a slight pain and excessive itching, and feels hard and compact as a stone. It is slow or tardy in its growth and exudes a secretion of thick white-coloured pus when it bursts. 3-5
शरीरवृद्धिक्षयवृद्धिहानिः स्निग्धो महानल्परुजोऽतिकण्डूः । मेदःकृतो गच्छति चात्र भिन्ने पिण्याकसर्पिः प्रतिमन्तु मेदः ।।६।।
The Medaja Type : The fat origined Granthi is large and glossy and gains or loses in size with the gain or loss of flesh by the patient. It is marked by a little pain and an excessive itching sensation and exudes a secretion of fat resembling clarified butter or a gruel, in colour and consistency, made of the levigated paste of sesamum on bursting. 6
व्यायामजातैरबलस्य तैस्तैराक्षिप्य वायुर्हि सिराप्रतानम् । संपीडच सङ्कोच्य विशोष्य चापि ग्रन्थिं करोत्युन्नतमाशु वृत्तम् ।।
ग्रन्थि: सिराजः स तु कृच्छसाध्यो भवेद् यदि स्यात् सरुजश्चलश्च । अरुक् स एवाप्यचलो महांश्च मर्मोत्थितश्चापि विवर्जनीयः ॥ ७॥
Sira-Granthi (aneurism or varicose veins): The bodily Vayu in weak and enfeebled persons, deranged by over-fatiguing physical exercises, straining or exertion or by pressure, presses on, contracts, dries or draws up the ramifications of veins (Sira) or arteries (of the affected locality), and speedily gives rise to a raised knotty formation which is called a Sira-Granthi. In the event of its being shifting and slightly painful, it can be cured only with the greatest difficulty. Whereas a case in which the knotty formation is painless, fixed, large and situated at any of the vital parts of the body (Marmas), should be deemed incurable.¹ 7
1. In several editions an additional line is to be found running as men well conversant with symptoms (of Granthi) recognise a type of Granthi due to the action of the deranged flesh and blood, which exhibits symptoms identical
मेदः । हन्वस्थिकक्षाक्षकबाहुसन्धि-मन्यागलेषूपचितन्तु ग्रन्थिं स्थिरं वृत्तमथायतं वा स्निग्धं कफश्चाल्परुजं करोति ।। ८ ।।
तं ग्रन्थिभिश्चामलकास्थिमात्रैर्मत्स्याण्डजाल प्रतिमैस्तथाऽन्यैः । वदन्ति ।। ९ ।। अनन्यवर्णैरुपचीयमानं चयप्रकर्षादपचीं
Apaci (Scrofula etc.) : The augmented and accumulated fat and Kapha give rise to string of hard glossy, painless, nodular, or elongated granthi swellings) about the joints of the jawbones, at the waist, joint, about the tendons of the neck, about the throat or about the region of the arm-pits. These glands (Granthis) resembling the stones of the Amalaka fruit or the spawn of fish in shape or like some other shape, are of the same colour as the surrounding skin; and a string or a large crop of such glandular knots, gradually growing is called Apaci¹ on account of the extensive nature of their growth. 8-9
कण्डूयुतास्तेऽल्परुजः प्रभिन्नाः स्त्रवन्ति नश्यन्ति भवन्ति चान्ये । मेद: कफाभ्यां खलु रोग एष सुदुस्तरो वर्षगणानुबन्धी ।। १० ।।
These knotty formations are characterised by itching and a slight pain. Some of them spontaneously burst exuding secretions while others are observed to vanish and re-appear (in succession ). Such vanishings, reappearances, or fresh formations continue for a considerable time. The disease undoubtedly owes its origin to the deranged fat and Kapha, and may only be made amenable (to medicine) with the greatest difficulty lasting for years at a time. 10
गात्रप्रदेशे क्वचिदेव दोषाः संमूर्च्छिता मांसमसृक्प्रदूष्य | वृत्तं स्थिरं मन्दरुजं महान्तमनल्पमूलं चिरवृद्धयपाकम् ।। ११ ।।
with those of a tumour (Mansira’srayam charvuda laskshanena tulyam hi drishtamath lakshanajani). But Jejjata has rejected it as of questionable authority.
1. These glandular formations appear about the root of the penis, about the sides. in the arm-pits and about the throat and the tendons of the neck. They resemble spawns of fish in shape and size and are due to the action of the deranged Vayu. Pitta and Kapha. The appearance of such glands in the upper part of the body should be attributed to the action of the deranged and aggravated Vayu. They are extremely hard to cure in as much as their growth (formation) involves the concerted action of the morbific principles (Dosas) of the body. –Bhoja. Charaka, who designates this disease as Gundamala, describes its location in regions about the jawbones alone.
कुर्वन्ति मांसोपचयञ्च शोकं तदर्बुदं शास्त्रविदो वदन्ति | वातेन पित्तेन कफेन चापि रक्तेन मांसेन च मेदसा च । तज्जायते तस्य च लक्षणानि ग्रन्थेः समानानि सदा भवन्ति ।। १२ ।।
Arbuda (tumour etc. ) : The large vegetation of flesh which appears at any part of the body, becomes slightly painful, rounded, immovable and deep-seated, and has its root sunk coniderably deep in the affected part, and which is due to the vitiation of the flesh and blood by the deranged and aggravated Dosas (Vayu, Pitta and Kapha) is called an Arbuda (tumour) by the learned physicians¹. The growth of an Arbuda is often found to be slow, and it seldom suppurates. The characteristic symptoms of an Arbuda which owes its origin to the deranged condition of the Vayu, Pitta, Kapha, flesh or fat, are respectively identical with those, which mark the cases of Granthis, brought about by the same deranged principles of the body. 11-12 दोषः प्रदुष्टो रुधिरं सिरास्तु संपीडय सङ्कोच्य गतस्तु पाकम् । सास्त्रावमुन्नहयति मांसपिण्डं मांसाङ्कुरैराचितमाशु वृद्धिम् ।।१३।। स्त्रवत्यजस्त्रं रुधिरं प्रदुष्टमसाध्यमेतद् रुधिरात्मकं स्यात् । रक्तक्षयोपद्रवपीडितत्वात् पाण्डुर्भवेदर्बुदपीडितस्तु ।। १४ ।।
Raktaja-Arbuda : The deranged Dosas (Vayu, Pitta and Kapha) contracting, compressing and drawing the vessels (Sira) and blood (of the affected part), raise a slightly suppurated and exuding tumour which is covered with small warts and fleshy tubercles and is called a Raktarbuda. This tumour is rapid in its growth and exudes a constant flow of (vitiated) blood. The omplexion of the patient owing to depletive actions and other concomitant evils of haemorrhage becomes pale and yellow. The type should be considered incurable on account of its having its origin in the blood.2 13-14
मुष्टिप्रहारादिभिरर्दितेऽङ्गे मांसं प्रदुष्टं प्रकरोति शोफम् । स्त्रिग्धमनन्यवर्णमपाकमश्मोपममप्रचाल्यम् ।। १५ ।। अवेदनं
1. That they having recourse to the flesh, produce deep-seated vegetations (of flesh) is the reading adopted by Gayadasa and others.
2. Although all types of Arbuda have their origin in the deranged flesh and blood, preponderant action of the deranged blood is found in Rakta-arbuda, while a dominant action of the deranged flesh marks the Mansarbuda type.
प्रदुष्टमांसस्य नरस्य बाढ मेतद् भवेन्मांसपरायणस्य मांसार्बुदन्त्वेतदसाध्यमुक्तं साध्येष्वपीमानि विवर्जयेत् तु ।। १६ ।।
Mansarbuda : The flesh of any part of the body hurt by an external blow etc. (hurting it with a log of wood–D.R.) and vitiated in consequence, gives rise to a sort of swelling (tumour) which is called Mansarbuda, which originates through the action of the deranged Vayu. It is glossy, painless, non-suppurating, hard as a stone, immobile, and of the same colour as the surrounding skin. Such a tumour appearing in a person addicted to meat diet becomes deep seated owing to the consequent vitiation of the bodily flesh and soon lapses into one of an incurable type. 15-16
संप्रस्त्रुतं मर्मणि यच्च जातं स्त्रोतःसु वा यच्च भवेदचाल्यम् । यज्जायतेऽन्यत् खलु पूर्वजाते ज्ञेयं तदध्यर्बुदमर्बुदज्ञैः ।।
यवन्द्वजातं युगपत् क्रमाद् वा द्विरर्बुदं तच्च भवेदसाध्यम् ।। १७ ।।
नपाकमायान्ति कफाधिकत्वान्मेदोऽधिकत्वाच्च विशेषतस्तु । दोषस्थिरत्वाद् ग्रथनाच्च तेषां सर्वार्बुदान्येव निसर्गतस्तु ।। १८ ।।
Prognosis Even of the aforesaid curable types (such as the Vataja, etc.), the following types of Arbuda ( tumours) should be likewise regarded as incurable, those which appear in the cavity of a Srota channel or an artery, or any vulnerable point of the body and are characterised by any sort of secretion and also immovable, should be deemed incurable. An Arbuda (tumour) cropping up on one existing from before is called Adhyarbuda, which should be likewise deemed as incurable. A couple of contiguous Arbuda (tumours) cropping up simultaneously or one after another is called Dviarbuda, which should be held as equally incurable (with one of the foregoing types). An Arbuda (tumour) of whatsoever type, never suppurates owing to the exuberance of the deranged Kapha and fat as well as in consequence of the immobility, condensation and compactness of the deranged Dosas (Vayu, Pitta and Kapha involved in the case, or out of a specific trait of its own nature. 17-18
वातः कफश्चैव गले प्रवृद्धौ मन्ये तु संसृत्य तथैव मेदः । कुर्वन्ति गण्डं क्रमशः स्वलिङ्गैः समन्वितं तं गलगण्डमाहुः ।। १९ ।।
Definition of Galaganda (Goitre): The deranged and aggravated Vayu in combination with the deranged and augmented Kapha and fat of the locality affects the two tendons of the neck (Manyas) and gradually gives rise to a swelling about that part of the neck characterised by the specific symptoms of the deranged Dosas (Vayu or Kapha) and principles involved in the case. The swelling is called Galganda (Goitre). 19
तोदान्वितः कृष्णसिरावनद्धः श्यावोऽरुणो वा पवनात्मकस्तु | मेदोऽन्वितश्चोपचितश्च कालाद् भवेत् प्रदिग्धे च गलेऽरुजश्च ।। २० ।।
पारुष्ययुक्तश्चिरवृद्धयपाको यदृच्छया पाकमियात् कदाचित् । वैरस्यमास्यस्य च तस्य जन्तोर्भवेत् तथा तालुगलप्रशोषः ।। २१ ।।
स्थिरः सवर्णोऽल्परुगुग्रकण्डूः शीतो महांश्चापि कफात्मकस्तु । चिराभिवृद्धिं कुरुते चिराद् वा प्रपच्यते मन्दरुजं कदाचित् । माधुर्यमास्यस्य च तस्य जन्तोर्भवेत् तथा तालुगलप्रलेपः || २२ ॥
Symptoms of the Dosa-origined Types: The swelling or tumour in the Vataja goitre is characterised by a pricking pain (in its inside) marked by the appearance of blue or dark coloured veins (Sira) on its surface. It assumes a vermilion or tawny brown hue. The goitre becomes united with the local fat in course of time, and gains in size, giving rise to a sense of burning in the throat, or is characterised by absence of any pain at all. A Vataja goitre is rough to the touch, slow in its growth, and never or but rarely suppurates. A sense of dryness in the throat and the palate as well as a bad taste in the mouth likewise marks this type. The swelling in the Kaphaja Type assumes a large shape and becomes hard, firm, cold and of the same colour ( white). There is but slight pain and the patient feels an irresistible inclination to scratch the part. It is slow in its progress and suppuration is rare and tardy. A sweet taste is felt in the mouth and the throat and the palate seem as if smeared with a sort of sticky mucous. 20-22
स्निग्धो मृदुः पाण्डुरनिष्टगन्धो मेदः कृतो नीरुगथातिकण्डूः । प्रलम्बतेलाsबुवदल्पमूलो देहानुरूपक्षयवृद्धियुक्तः ।
स्निग्धास्यता तस्य भवेच्च जन्तोर्गलेऽनुशब्दं कुरुते च नित्यम् ।। २३ । ।
Symptoms of the Medaja Type : The swelling is glossy, soft (heavy –D.R.) and pale-coloured. It emits a fetid smell and is characterised by excessive itching and an absence of pain. It is short at its root and hangs down from the neck in the shape of a pumpkin (Alabu), gradually gaining its full rotundity at the top. The size of the goitre is proportionate to the growth or loss of flesh of the body. The face of the patient looks as if it has been anointed with oil and a peculiar rumbling sound is constantly heard in the throat. 23
कृच्छ्रच्छ्रवसन्तं मृदुसर्वगात्रं संवत्सरातीतमरोचकार्त्तम् । क्षीणन्तु वैद्यो गलगण्डिनं तु भिन्नस्वरञ्चैव विवर्जयेत् तु || २४ ||
Prognosis: A case of goitre attended with difficult respiration, a softening of the whole body, weakness, a nonrelish for food, loss of voice as well as the one which is more than of a year’s duration should be abandoned by the physician as incurable. 24
निबद्धः श्वयथुर्यस्य मुष्कवल्लम्बते गले।
महान् वा यदि वा ह्रस्वस्तं गण्डमिति निर्दिशेत् ।। २५ ।।
Metrical Text: A pendent swelling whether large or small and occurring about the region of the throat and resembling the scrotum in shape is called a Gala – Ganda. 25
इति सुश्रुतसंहितायां निदानस्थाने ग्रन्थ्यपच्यर्बुदगलगण्डनिदानम् ।
Thus ends the eleventh Chapter of the Nidana Sthana in the Susruta Samhita which treats of the Nidana of Granthi, Scrofula, etc.
