Madhava Nidana Chapter 38 Galaganda, Gandamala, Apachi, Granthi, Arbuda Nidanam

This article explains Madava nidana 38th chapter “Galaganda, Gandamala, Apachi, Granthi, Arbuda Nidanam”. Causes, pathology and symptoms of Galaganda, Gandamala, Apachi, Granthi and Arbuda are explained in this chapter.
Read – Acharya Madhavakara: His Work ‘Madhava Nidana’, Legacy, Amazing Facts

Galaganda Paribhasha

Word derivation and meaning of the term Galaganda
Galaganda is defined as a swelling (tumour) in the neck, big or small in size, and hanging like the scrotum. (1).

Galaganda Samprapti

Pathogenesis of galaganda
Vaata, kapha and medas (fat) get aggravated in the neck (throat) and reach manya (nape of the neck / side of the neck) and produce ganda i.e., a knot like swelling which grows in size gradually. This condition is called galaganda. In this the symptoms of the involved doshas would manifest (depending on their predominance in the disease). (2)
Read – Adhijihwa Throat Disorder (Epiglottitis) Causes, Symptoms, Treatment

Vataja Galaganda Symptoms

In Vataja Galaganda there will be pricking pain and the swelling will be surrounded by a network of black coloured veins, is blackish brown or golden-brown colour, rough on touch, which grows gradually and doesn’t undergo suppuration. By chance if suitable etiological factors are available the swelling may even go suppuration. The patient will also experience bad (opposite) tastes in his mouth and also dryness of the throat and palate. (3)

Kaphaja Galaganda Symptoms

In Kaphaja Galaganda, the swelling is immovable, having the same colour as the skin, is heavy, with severe itching, cold to touch, big in size, will grow slowly, will occasionally undergo suppuration slowly, and will be associated with mild pain. The person would experience a sweet taste in the mouth and coating (furring) of the palate and throat. (4-5)

Medoja Galaganda Symptoms

In Medoja Galaganda the swelling will be unctuous, heavy, pale (yellowish white), emit an unpleasant smell, associated with itching and mild pain (one will experience mild pain on scratching). The swelling hangs like an alabu (pitcher gourd) and is attached very loosely. It keeps undergoing increase and decrease (in size) in accordance to the body (health of the body). The inside of the mouth of the patient in this condition will be unctuous (will produce copious salivation) and the patient will make cooing sounds or indistinct sounds from the throat. (6-7)
Read – Alabu Avacharana – Bloodletting Method Using Bottle gourd

Symptoms of incurability of Galaganda

The patient of galaganda who has difficulty in breathing, very soft (looseness of) body parts, his swelling persisting for more than one year, is associated with loss of taste, emaciation and broken voice (hoarseness of voice) should be rejected treatment (should not be treated since this condition is incurable). (7-8)

Gandamala

More than one ganda (swelling) caused by kapha and medas (fat), appearing in the regions of axilla, shoulders (scapular region), sides of the neck (nape of the neck), front of neck or the groin, varying in size from that of karkandhu and kola (fruit of jujube) to that of amalaka (gooseberry), and undergoing suppuration after long period of time is known as Gandamala (chain of swellings). (8)

Apachi

Some of the swellings undergo suppuration, some more burst open and discharge their contents, some get destroyed or disappear, and some new ones appear. This process continues for a long time. Experts call such conditions as Apaci. This condition is curable. On the other hand, apaci associated with complications like running from the nose, pain in the flanks, cough, fever and vomiting will become incurable. (9-10)
Read – Apachi – Symptoms, Pathogenesis, Treatment

Granthi

Vāta and other two doșhas (pitta and kapha) undergoing increase, contaminate (bring about abnormalities in the) mamsa (muscles), asrk (blood), meda (fat) and siras (veins) produce round, elevated and cystic swelling. Therefore, these swellings (masses) are called granthi (cyst, tumour). (11)

Vatika Granthi

In vataja granthi different kinds of pains are manifested – like pulling / stretching, tearing, throbbing (pricking), pulling, churning, and splitting (cutting) types of pains. The cyst is black in colour, soft, resembles and bulged like a water bag and discharges thin, clear (thin) blood when pricked. (12)

Pittaja Granthi

The symptoms of pittaja granthi include severe burning sensation as if burnt by fire, feeling as if smoke is being eliminated from the swelling / body (raised temperature), pain as if that part of the body is excised, undergoes quick suppuration as if burnt by alkali, and feeling as if the body is burnt into ash. The colour of the cyst is either red or yellow in colour. When the cysts burst open (or pricked), they discharge (exude) large amounts of warm blood. (13)
Read – Granthi: Cystic Swelling, Types, Features, Ayurvedic Treatment

Kaphaja Granthi

In kaphaja granthi, the cyst is cold to touch, will not have any discolouration (or have slight discolouration), will have mild pain and severe itching. The cyst has stone like consistency (hard), grows slowly and when it breaks open it discharges thick and white coloured pus. (14)

Medoja Granthi

The cyst of medaja granthi (caused due to vitiated fat) will increase or decrease in size in accordance with that of the body. It is unctuous, big in size, is associated with itching and is painless. When pricked (bursts open), it will discharge thick fatty exudates which resembles the paste of sesame seeds or ghee. (15)

Siraja Granthi

In persons who are weakened but do excessive indulgence in various kinds of strenuous activities / exercises, vata undergoing increase invades the network of veins, making them constricted, condensed and dried and quickly rolls them into a round big mass. This is known as siraja granthi (cysts or tumours of veins). When there is pain and movement in these granthis it will become difficult to cure. If these cysts are bigger in size and appear on or around the vital organs of the body they are considered as incurable in spite of them   being devoid of pain and immobile (fixed). (16-17)

Arbuda

Pathogenesis of Arbuda – Doshas undergoing increase in any particular part of the body, invade and contaminate the muscle and blood and produce round, immobile, slightly painful, big, deep-seated, slowly increasing tumours which do not suppurate. They appear like balls of muscles (big muscular mass) and are termed by the learned experts as Arbuda (cancer).
Types of Arbuda – Arbuda is of six types. They are – Vataja, Pittaja, Kaphaja, Raktaja, Mamsaja and Medaja. Each of these arbudas will have the symptoms similar to the granthis (granthis formed by the same doshas respectively).
Example – Vataja arbuda will have symptoms similar to vataja granthi, pittaja arbuda will have symptoms similar to pittaja granthi etc. (18-19)
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Raktarbuda

The doshas which have undergone increase will contaminate (constrict) and compress the blood and veins. By doing so they would produce a big sized muscular mass (tumour) which does not undergo suppuration (or undergoes less suppuration), is surrounded by (studded all over) many muscular sprouts, grows quickly and has little discharges. Bleeding takes place constantly from such a mass. This is called as raktaja arbuda and it is incurable. Since there is excessive bleeding from the rakta arbuda there would occur severe loss of blood in this condition which would eventually lead to many complications. Due to this the person would quickly become victim of anaemia. (20-21)

Mamsa Arbuda 

Assault on the body by the fist, etc.; leads to contamination (derangement) of the muscles. This leads to causation of a swelling (tumour) which is painless, unctuous, has colour of the skin, does not undergo suppuration, is hard like a stone, and fixed. This condition is called mamsa arbuda. This condition occurs commonly in those who are accustomed and habituated to eating excessive (contaminated) meat (flesh) in their food. This condition should be considered as incurable. (22-23)

Incurability / prognosis of arbuda

Even among the curable forms of arbuda, the following are to be rejected –

• that which has heavy discharges (exudation)
• that occurring on or around the vital organs
• that occurring on or around the channels including nasal passage etc (and hence imparting pressure on them and obstructing their functioning)
• that which is immobile (24)
  Read – How To Make Prognosis Of Disease According To Ayurveda?

Adyarbuda / Dwirarbuda

Adyarbuda – A second arbuda developing over an already existing arbuda (superseding) or after the course of an earlier one (the earlier one being removed) is called Adhyarbuda by the specialists of arbuda.
Dwirarbuda – Arbuda developing alongside yet another arbuda simultaneously or after some time at the same place or at some other place of the body is called as Dvirarbuda.
Both these conditions are incurable. (25)

Why arbudas do not suppurate?
All arbudas do not suppurate when –

• there is predominance of kapha and medas (fat) in them
• by the hardness and immobility of doshas
• by the very nature of the disease (26)

Thus ends the chapter on Galaganda, Gandamala, Apachi, Granthi, Arbuda Nidanam in Madhava Nidana text written by Acharya Madhavakara.