൧൧. ഗ്രന്ഥ്യപച്യര്ബുദഗലഗണ്ഡനിദാനമ്

Meaning of the śloka

Now we shall explain the diagnosis of granthi, apacī, arbuda, and galagaṇḍa. Thus spoke the revered Dhanvantari.

Key terms

granthi

A classical category of localized knot-like swelling.

apacI (apacī)

A classical category of glandular or nodular swelling discussed later in the chapter.

arbuda

A classical category of substantial localized swelling or mass.

galagaNDa (galagaṇḍa)

A classical swelling in the neck or throat region.

nidAna (nidāna)

The account of causes, development, and diagnostic features.

Meaning of the śloka

The disturbed doṣas, together with affected muscle and blood, are said to further vitiate fat associated with kapha and produce a rounded, raised, densely knotted or very hard swelling. For this reason it is designated granthi.

Key terms

granthi

A knot-like swelling characterized here as round, raised, and very hard.

mAMsa (māṃsa)

Muscle or fleshy tissue affected in the classical account.

asRuk (asṛk)

Blood.

medas

Fat or adipose tissue in the classical tissue scheme.

kaphAnuviddha (kaphānuviddha)

Associated or intermixed with kapha.

vigrathita

Densely knotted or, according to the commentary, extremely hard.

Meaning of the śloka

A granthi attributed to vāta is described as becoming stretched or elongated, shifting or throbbing, producing pricking and splitting sensations, and seeming to be cast about, cut, or divided. It is dark, not soft but rough, and extended like a bladder. When opened, it discharges clear blood.

Key terms

vAtaja granthi (vātaja granthi)

Granthi attributed to vāta in the classical classification.

Ayamyate (āyamyate)

Becomes drawn out or elongated.

toda

A pricking or piercing sensation.

bheda

A splitting sensation.

amRudu (amṛdu)

Not soft; glossed as rough.

accha asra

Clear blood described as the discharge after opening.

Meaning of the śloka

A granthi attributed to pitta is described as intensely burning, producing a smoky heat sensation and a feeling of being sucked, undergoing marked suppuration, and seeming to blaze. It is red or yellowish-red, and when opened it releases very hot blood.

Key terms

pittaja granthi

Granthi attributed to pitta in the classical classification.

dandahyate

Feels intensely burning.

dhUpyati (dhūpyati)

Produces a smoky or excessive heat sensation.

cUShyate (cūṣyate)

Feels as if being sucked or drawn.

pApacyate (pāpacyate)

Seems to undergo intense suppuration.

uShNa asra (uṣṇa asra)

Blood described as very hot when discharged.

Meaning of the śloka

A granthi arising from aggravated kapha is described as cold, only slightly altered in colour, mildly painful, intensely itchy, stone-hard, large and compact, and slow to enlarge. When opened, it discharges thick white pus.

Key terms

kaphaja granthi

Granthi attributed to kapha in the classical classification.

avivarNa (avivarṇa)

Only slightly changed from the surrounding colour.

pAShANavat (pāṣāṇavat)

Stone-like, with hardness supplied by the commentary.

saMhananopapanna (saṃhananopapanna)

Compactly aggregated and large.

cirAbhivRuddhi (cirābhivṛddhi)

Slowly enlarging over time.

shuklaghana pUya (śukla-ghana pūya)

Thick white pus.

Meaning of the śloka

A granthi arising from medas is described as enlarging and diminishing as the body itself gains and loses bulk. It is unctuous or smooth, large, only mildly painful, and intensely itchy. When opened, fatty material resembling sesame paste or congealed ghee flows from it.

Key terms

medaHkRuta granthi (medaḥ-kṛta granthi)

Granthi attributed to medas, or fatty tissue, in the classical classification.

sharIravRuddhikShayavRuddhihAni (śarīra-vṛddhi-kṣaya-vṛddhi-hāni)

Increasing and decreasing along with gain and loss of body bulk.

snigdha

Unctuous, smooth, or oily in character.

piNyAka (piṇyāka)

Pressed sesame paste used as a comparison for the discharged material.

styAna ghRuta (styāna ghṛta)

Congealed or thickened ghee used as a comparison.

medas

Fatty material in the classical tissue scheme.

Meaning of the śloka

The passage says that repeated or strenuous exercise in a weak person may provoke vāyu, which draws, compresses, contracts, and dries the network of vessels and quickly produces a raised, round granthi. A vessel-origin granthi that is painful and mobile is considered difficult to treat. If it is painless, immobile, and large, or if it arises at a vital anatomical site, it is said to be unsuitable for curative treatment. This completes the diagnostic account of granthi.

Key terms

sirAja granthi (sirāja granthi)

A granthi described as arising from the network of vessels.

sirApratAna (sirā-pratāna)

The spread or network of vessels.

vyAyAmajAta (vyāyāma-jāta)

Repeated or grouped forms of exertion according to the commentary.

cala

Mobile or movable.

acala

Fixed or immobile.

marma

A vital anatomical site in the classical account.

vivarjanIya (vivarjanīya)

Historically regarded as unsuitable for curative treatment.

Meaning of the śloka

Accumulated medas together with kapha is said to form firm, smooth, round or elongated, mildly painful nodules around the jaw bone, axilla, upper chest or shoulder region, elbow, vessels at the back of the neck, and throat. When the original nodule becomes surrounded by other enlarging, skin-colored nodules about the size of an amalaka seed or resembling clusters of fish eggs, the condition is called apaci because of this marked accumulation. The nodules itch and hurt little; after breaking open they discharge and disappear while others arise. The disorder is described as very difficult to overcome and continuing for years.

Key terms

apacI (apaci)

A chronic classical disorder of multiple enlarging nodules in specified regions.

granthi

A firm, rounded or elongated nodule.

manyA (manya)

A vessel or structure at the back of the neck in the commentary.

amalakAsthimAtra (amalakasthimatra)

About the size of an amalaka seed or stone.

matsyANDajAlapratima (matsyandajalapratima)

Resembling a cluster of fish eggs.

gaNDamAlA (gandamala)

A chain or group of swellings discussed in the quoted authorities.

Meaning of the śloka

When aggravated doshas affect mamsa at any part of the body, they are said to produce a swelling that is round, fixed, mildly painful, large, deep-rooted, slow-growing, and non-suppurating, with an accumulation of flesh. Authorities call this arbuda.

Key terms

arbuda

A classical category of a large, fixed, slowly enlarging tissue swelling.

mAMsa (mamsa)

Flesh or muscle tissue affected in the classical account.

analpamUla (analpamula)

Having a substantial or broad root.

ciravRuddhi (chiravriddhi)

Slow or prolonged growth.

apAka (apaka)

Not undergoing suppuration.

mAMsopacaya (mamsopacaya)

An accumulation or mass of flesh.

Meaning of the śloka

Arbuda is said to arise from vata, pitta, kapha, rakta, mamsa, or medas. The signs of each type correspond to those of the granthi arising from the same factor.

Key terms

vAtaja arbuda (vataja arbuda)

An arbuda attributed to vata.

pittaja arbuda

An arbuda attributed to pitta.

kaphaja arbuda

An arbuda attributed to kapha.

raktaja arbuda

An arbuda attributed to rakta.

mAMsaja arbuda (mamsaja arbuda)

An arbuda attributed to mamsa.

medoja arbuda

An arbuda attributed to medas.

Meaning of the śloka

In the account of raktaja arbuda, an aggravated dosha enters the vessels, compresses and constricts the blood, and produces a slightly suppurating, discharging mass of flesh. The mass is covered with fleshy sprouts, grows rapidly, and continually releases altered blood. This blood-natured arbuda is called incurable. The affected person becomes pale because of blood loss and associated complications.

Key terms

raktaja arbuda

An arbuda attributed to rakta in the classical classification.

sirA (sira)

Vessels entered by the aggravated dosha in the account.

mAMsapiNDa (mamsapinda)

A mass of flesh.

mAMsA~gkura (mamsankura)

Fleshy sprout-like projections covering the mass.

AshuvRuddhi (ashuvriddhi)

Rapid growth.

raktakShaya (raktakshaya)

Loss or depletion of blood, linked here with pallor.

Meaning of the śloka

After a body part is struck by a fist or similar trauma, altered mamsa is said to produce a swelling. It is painless, smooth, the same color as the surrounding tissue, non-suppurating, stone-like, and immovable. The text says it occurs especially in a person whose mamsa is disturbed and who habitually eats meat, and calls this mamsarbuda incurable. The supplied verse then breaks off.

Key terms

mAMsArbuda (mamsarbuda)

An arbuda attributed to altered mamsa.

muShTiprahAra (mushtiprahara)

A blow with the fist in the received reading.

kAShThaprahAra (kashthaprahara)

A blow with wood in an alternative reading.

ashmopama

Stone-like in firmness.

apracAlya (aprachalya)

Immobile or fixed.

mAMsaparAyaNa (mamsaparayana)

Habitually devoted to eating meat, according to the commentary.

Meaning of the śloka

Even among arbuda types otherwise considered treatable, the text advises leaving aside one that has spread, arises at a marma or within channels, or is immovable. A second arbuda that develops upon a pre-existing one is known as adhyarbuda. Two arbudas arising as a pair, either simultaneously or in sequence, constitute dvirarbuda; both patterns are called incurable.

Key terms

samprasRuta (samprasrita)

Spread or extensively extended.

marma

A vital or vulnerable site in classical anatomy.

srotas

A bodily channel in the classical framework.

adhyarbuda

A second arbuda arising upon an existing one.

atyarbuda

An alternative reading for adhyarbuda.

dvirarbuda

Two arbudas occurring together or successively, above or beside one another.

Meaning of the śloka

Arbudas are said not to undergo suppuration because kapha is especially predominant, medas is abundant, the doshas remain stable, and their constituents are knotted together; by their very nature, all arbudas therefore do not mature into pus.

Key terms

arbuda

A classical category of persistent swelling or mass described here as generally non-suppurating.

pAka (paka)

Maturation into suppuration in this context.

medas

The classical fatty tissue constituent said to be abundant in arbuda.

doShasthiratva (doshasthiratva)

Stability or persistence of the involved doshas and their effect.

grathana

Knotting or binding into a mass-like form.

mAMsocchraya (mamsocchraya)

An elevation or overgrowth of flesh in the commentary's description.

Meaning of the śloka

When vata and kapha increase in the throat and medas likewise accumulates in the two manyas, they gradually produce a swelling with the characteristic signs of its cause; this is called galaganda.

Key terms

galagaNDa (galaganda)

A classical swelling of the neck or throat region.

manya

A paired region or structure at the sides of the neck in the classical anatomical context.

medas

The classical fatty tissue constituent said to accumulate in the neck region.

svali~gga (svalinga)

The characteristic signs of the causative factor.

samprApti (samprapti)

The classical account of how a disorder develops.

Meaning of the śloka

Vata-type galaganda has pricking pain, is covered by dark vessels, and is dark or reddish. With time it may accumulate medas, become enlarged, very unctuous, and painless. It is rough, grows slowly, usually does not suppurate but may occasionally do so without an evident regular cause, and is associated with an unpleasant taste and dryness of the palate and throat. Kapha-type galaganda is firm, of the surrounding skin color, mildly painful, intensely itchy, cool, and large. It enlarges slowly and may mature only after a long time with little pain; the mouth tastes sweet and the palate and throat feel coated. The medas-type is unctuous, soft, pale, unpleasant-smelling, painless, and intensely itchy. It hangs like a bottle gourd from a narrow base, decreases or increases along with the body, makes the mouth feel unctuous, and continually produces an echo-like sound in the throat.

Key terms

vAtaja galagaNDa (vataja galaganda)

The vata-classified neck swelling, marked here by pricking pain, dark vessels, and slow growth.

kaphaja galagaNDa (kaphaja galaganda)

The kapha-classified neck swelling, described as firm, cool, itchy, and slowly enlarging.

medoja galagaNDa (medoja galaganda)

The medas-classified neck swelling, described as soft, pendulous, pale, and changing with body size.

pAruShya (parushya)

Roughness.

alAbuvat (alabuvat)

Like a bottle gourd, describing the hanging shape.

anushabda

An echo or reverberating sound in the throat.

Meaning of the śloka

The physician is instructed to leave aside as incurable a person with galaganda who has difficult breathing, generalized softness or loss of firmness of the body, disease lasting beyond a year, loss of appetite, wasting, or an altered or broken voice.

Key terms

kRucchrAcchvasan (krichchhracchvasan)

Breathing with difficulty.

mRudusarvagAtra (mridusarvagatra)

Having generalized softness or loss of firmness of the body; the precise clinical implication is uncertain.

arocaka (arochaka)

Loss of appetite or aversion to food.

kShINa (kshina)

Wasted, depleted, or markedly weakened.

bhinnasvara

An altered, broken, or impaired voice.

vivarjayet

Should leave aside, expressing an unfavorable historical prognosis.

Meaning of the śloka

A firmly attached swelling that hangs from the neck like a scrotum or oval sac, whether large or small, is designated galaganda.

Key terms

nibaddha shvayathu

A firmly attached or fixed swelling.

muShkavat (mushkavat)

Like a scrotum or oval sac; the commentary also glosses it as egg-like.

gala

The throat or neck region.

galagaNDa (galaganda)

The classical neck-swelling category defined by the stated form.

Meaning of the śloka

Thus ends the eleventh chapter of the Nidanasthana in the Sushruta Samhita, entitled the diagnostic account of galaganda, gandamala, apachi, and arbuda.

Key terms

galagaNDa (galaganda)

A classical category of neck swelling.

gaNDamAlA (gandamala)

A classical category involving a chain or group of swellings.

apacI (apachi)

A classical swelling category named in the chapter title.

arbuda

A classical persistent mass category; it is not automatically equivalent to cancer.

nidAnasthAna (Nidanasthana)

The division concerned with causes and diagnostic descriptions.

nibandhasa~ggraha (Nibandhasangraha)

The title of Dalhana's commentary.