Chapter XI - Diagnosis of glands, scrofula, tumors and goitre

Now we shall discourse on the Nidana of Granthi (Glands etc.), Apachi (Scrofula etc.), Arvudi (Tumours) and Galaganda (Goitre). 1.

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.

The Dosha-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 asunder 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.

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.

Shira-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 (Shira) or arteries (of the affected locality), and speedily gives rise to a raised knotty formation which is called a Shira-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.

Apachi (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 Apachi^[2] on account of the extensive nature of their growth. 8-9.

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.

Arvuda (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 considerably deep in the affected part, and which is due to the vitiation of the flesh and blood by the deranged and aggravated Doshas (Vayu, Pitta and Kapha) is called an Arvuda (tumour) by the learned physicians^[3]. The growth of an Arvuda is often found to be slow, and it seldom suppurates. The characteristic symptoms of an Arvuda 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.

Raktaja-Arvuda:—

The deranged Doshas (Vayu, Pitta and Kapha) contracting, compressing and drawing the vessels (Shira) 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 Raktarvuda. This tumour is rapid in its growth and exudes a constant flow of (vitiated) blood. The complexion of the patient owing to depletive actions and other concomitant evils of hemorrhage becomes pale and yellow. The type should be considered incurable on account of its having its origin in the blood^[4] 12—13.

 

 

Mansarvuda:—

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 Mansarvuda, 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. 14.

Prognosis:—

Even of the aforesaid curable types (such as the Vataja, etc.), the following types of Arvuda (tumours) should be likewise regarded as incurable, those which appear in the cavity of a Srota channel or an artery, or any vulnerable joint of the body and are characterised by any sort of secretion and also immovable, should be deemed incurable. An Arvuda (tumour) cropping up on one existing from before is called Adhyarvuda, which should be likewise deemed as incurable. A couple of contiguous Arvuda (tumours) cropping up simultaneously or one after another is called Dviarvuda (?), which should be held as equally incurable (with one of the foregoing types). An Arvuda (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 Doshas (Vayu, Pitta and Kapha involved in the case, or out of a specific trait of its own nature. 15-16.

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 tne neck (Manyas) and gradually gives rise to a swelling about that part of the neck characterised by the specific symptoms of the deranged Doshas (Vayu or Kapha) and principles involved in the case. The swelling is called Galganda (Goitre). 17.

Symptoms of the Dosha-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 Shira) 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 the 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. 18-20.

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 (Alavu), 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. 21.

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 standing should be abandoned by the physician as incurable. 22.

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. 23.

 

Thus ends the eleventh Chapter of the Nidana Sthana in the Susruta Samhita which treats of the Nidana of Granthi, Scrofula, etc.

Footnotes and references:

[1]:

In several editions an additional line is to be found running as men well conversant with symptoms (of Granthis) recognise a type of Granthi due to the action of the deranged flesh and blood, which exhibits symptoms identical with those of a tumour (Mansjra’srayam charvuda laskhanena (lakshanena?) tulyam hi drishtamath lakskanajanih). But Jejjata has rejected it as of questionable authority.

[2]:

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 extremdy hard to cure inasmuch as their growth (formation) involves the concerted action of the morbific principles (Doshas) of the body.—Bhoja.

Charaka, who designates this disease as Gandamala, describes its location in regions about the jawbones alone.

[3]:

That they having recourse to the flesh, produce deep-seated vegetations (of flesh) is the reading adopted by Gayadasa and others.

[4]:

Although all types of Arvuda have their origin in the deranged flesh and blood, preponderant action of the deranged blood is found in Rakta - arvuda, while a dominant action of the deranged flesh marks the Mansarvuda type.