Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, B.A.M.S
Granthi means a cyst or cystic swelling. Cysts are sac-like structures that can be filled with fluid, pus or other gaseous material. It is noncancerous. They are often caused by infection, clogging of sebaceous glands or around earrings.
वातादयो मांसम् असृक् प्रदुष्टाः संदूष्य मेदः च तथा सिरः च।
वृत्त उन्नतं विग्रथितं च शोथं कुर्वन्त्यतो ग्रन्थिः इति प्रदिष्टः॥(सु.नि.१३)
The Doshas (Vata, Pitta and Kapha) contaminated the mamsa (muscles) and asruk (blood), meda (fat) and siraa (vein, blood vessel) causes an elevated swelling which is rounded and knotted (clotted). Such swelling will be called as Granthi. When the cyst (granthi) occurs specifically in sira, it will be called sira granthi.
Granthi is of below mentioned types –
- Vataja – caused by morbid vata
- Pittaja – caused by vitiated pitta
- Kaphaja – caused by vitiated kapha
- Medaja – caused by vitiated meda or fat
- Siraja granthi – cystic swelling caused in the sira or veins
Vataja Granthi – If vata is predominant in the granthi, it will be associated with various types of pain like pulling (aayamyate), splitting (vrushchati), pricking (toda), churning (mathya), blasting (bhedana) etc. it will be having the shape of a smooth bladder, black in colour. When it breaks open, pure blood is discharged)
In Kaphaja Granthi – the granthi will be cold, has body color, associated with itching and less pain, hard like stone, grows to maximum size in a slow manner, when it breaks open it discharges white colored pus (infected).
शीतो विवर्णो अल्प रुजो अति पाण्डुः पाषाणवत् संहननोपपन्नः।
चिर अभिवृद्धिः च कफ प्रकोपाद् भिन्नः स्रवेत् शुक्ल घनं च पूयं॥ (यो.र.गलगण्डादि निदानम्.४)
Symptoms of Kaphaja Granthi –
- Sheeta – cold to touch
- Vivarna – disocloured
- Alpa ruk – associated with mild pain
- Ati pandu – pale appearance
- Paashaanavat – stone hard on touch
- Chira abhivruddham – develops slowly and gradually
- Bhinnaha sravet shukla ghanam cha pooyam – on opening thick, white, viscid pus gets discharged
व्यायाम जातैः अबलस्य तैः तैः आक्षिप्य वायुः तु सिरा प्रतानम्।
संकुच्य संपीड्य विशोष्य च अपि ग्रन्थिं करोति उन्नतम् आशु वृत्तम्॥
ग्रन्थिः सिराजः स तु कृच्छ्र साध्यो भवेद् यदि स्यात् स रुजः चलः च।
अरुक् स एव अपि अचलो महान् च मर्म उत्थितः च अपि विवर्जनीयः॥(सु.नि.११)
Vayu aggravated due to excessive exercises afflicts the siras, dries them up and cause narrowing in them (constriction, congestion) along with pain. In the process, the vitiated Vayu quickly causes rounded granthis in the siras. These siras are called Siraja Granthis. They are very difficult to cure especially when they are associated with severe pain and if the granthi is movable. The sira granthis which are devoid of pain and are immobile, large in size and are manifested in Marma sthanas (vital points, parts or organs of the body) should be considered as incurable.
In this, Sushruta has clearly explained the narrowing and congestion (pooling and collection of blood at one place) of siras or veins. This makes their valves incompetent enough to push the blood back towards the heart against gravitation (which is good when the veins are healthy and the valves are properly functioning). This causes enlargement or engorgement of siras (pampiniform plexus of veins in the scrotum in this case) and causes varicocele.
Treatment of Vataja Granthi –
Himsradi lepa – application of paste of Himsra (Solanum indicum), Katuki (Picrorhiza kurroa), Guduchi (Tinospora cordifolia), Bharangi (Clerodendrum serratum), shyonaka (Oroxylum indicum), Bilwa (Aegle marmelos), Aguru (Aquilaria agollocha), Shigru (drumstick), mixed in gomutra (urine of cow) should be applied over the granthi.
Apart from this other Vata alleviating measures and treatment of Vata shotha (explained later) should be followed.
Treatment of Kaphaja Granthi –
Shodhana – Body cleansing through Vamana (therapeutic emesis) and Virechana (therapeutic purgation)
Madhookadi Lepa – wound cleansing and healing (after patana) should be done by applying the paste prepared using Madhooka (Madhuca longifolia), Jambu (Syzygium cumini), Arjuna (Terminalia arjuna), and vetasa twak (bark of bamboo)
Formulations like Kanchanara Guggulu, Punarnava Kashaya, Triphala Guggulu etc are useful.
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