The 29th chapter of Uttara Sthanam of Ashtanga Hridayam is named as ‘Granthi Arbuda Shlipada Apachi Nadi Vijnaniya’. This chapter deals with the explanation of ‘Knowledge of tumors-cancer-filariasis-Scrofula-Sinus ulcer’.

The topics covered in this chapter include –

• Granthi – Benign Tumor
• Vataja Granthi
• Pittaja Granthi
• Kaphaja Granthi
• Raktaja Granthi
• Mamsaja Granthi
• Medo Granthi
• Asthi Granthi
• Sira Granthi
• Vrana Granthi
• Curable and incurable Granthi
• Arbuda – malignant tumor / cancer
• Shonitarbuda
• Prognosis of arbuda
• Shlipada – filariasis
• Gandamala – Apachi(scrofula)
• Nadi Vrana – Sinus Ulcer

Pledge by the author(s)

अथातो ग्रन्थ्यर्बुदश्लीपदापचीनाडीविज्ञानीयं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Knowledge of tumors-cancer-filariasis-scrofula-sinus ulcer’. Thus, say (pledge) Atreya and other sages.

Granthi: Benign Tumor

कफप्रधानाः कुर्वन्ति मेदोमांसास्रगा मलाः ।
वृत्तोन्नतं यं श्वयथुं स ग्रन्थिर्ग्रथनात्स्मृतः ॥ १ ॥ दोषास्रमांसमेदोऽस्थिसिराव्रणभवा नव ।
Malas (doshas) of which Kapha is the predominant one, invading the fat, muscle and blood produce a round, raised swelling (new growth) known as Granthi; because of its knotty (lumpy) nature. It is of nine kinds viz, arising from each dosha, blood, from muscle tissue, fat tissue, bone, vein, and from ulcer.

Vataja Granthi

ते तत्र वातादायामतोदभेदान्वितोऽसितः ॥ २ ॥
स्थानात्स्थानान्तरगतिरकस्माद्धानिवृद्धिमान् ।
मृदुर्बस्तिरिवानद्धो विभिन्नोऽच्छं स्रवत्यसृक् ॥ ३ ॥
That arising from Vata, is broad, has pricking pain and cutting types of pain, black in color, shifts from place to place, undergoes increase or decrease in size without any reason, soft, bulged like a leather bag and exudes clear thin blood when pricked.

Pittaja Granthi

पित्तात्सदाहः पीताभो रक्तो वा पच्यते द्रुतम् ।
भिन्नोऽस्रमुष्णं स्रवति
That arising from Pitta, has burning sensation, yellow or red in color, ripens (suppurates) quickly; exudes warm blood when pricked.

Kaphaja Granthi

श्लेष्मणा नीरुजो घनः ॥ ४ ॥
शीतः सवर्णः कण्डूमान् पक्वः पूयं स्रवेद्घनम् ।
That arising from Kapha, is painless, hard, cold, of the same color of the skin, has itching; when ripens, exudes thick pus.

Raktaja Granthi

दोषैर्दुष्टेऽसृजि ग्रन्थिर्भवेन्मूर्छत्सु जन्तुषु ॥ ५ ॥
सिरामांसं च संश्रित्य सस्वापः पित्तलक्षणः ।
When the doshas get aggravated in the blood, a granthi (tumor) develops containing worms, which invade the veins and muscles, is accompanied with loss of tactile sensation and presence of symptoms of (aggravation of) Pitta.

Mamsaja Granthi

मांसलैर्दूषितं मांसमाहारैर्ग्रन्थिमावहेत् ॥ ६ ॥
स्निग्धं महान्तं कठिनं सिरानद्धं कफाकृतिम् ।
Muscle tissue, getting vitiated by indulgence in bad kind of meat as food, leads to formation of granthi which is unctuous, large in size, hard, studded with veins and having symptoms of aggravation of Kapha.

Medo Granthi

प्रवृद्धं मेदुरैर्मेदो नीतं मांसेऽथवा त्वचि ॥ ७ ॥
वायुना कुरुते ग्रन्थिं भृशं स्निग्धं मृदुं चलम् ।
श्लेष्मतुल्याकृतिं देहक्षयवृद्धिक्षयोदयम् ॥ ८ ॥
स विभिन्नो घनं मेदस्ताम्रासितसितं स्रवेत्
Fat tissue getting increased by indulgence in foods containing too much of fat, brought to the muscle or skin by Vata gives rise to granthi which is very unctuous, soft, movable, having symptoms of aggravation of Kapha, increasing and decreasing in size, with the increase or decrease of the body. It exudes coppery, black, or white, thick, fatty fluid when pricked.

Asthi Granthi

अस्थिभङ्गाभिघाताभ्यामुन्नतावनतं तु यत् ॥ ९ ॥
सोऽस्थिग्रन्थिः
Asthi granthi develops as a result of fractures, injuries causing upward or lower displacement (growth) of bones.

Sira Granthi

पदातेस्तु सहसाऽम्भोऽवगाहनात् ।
व्यायामाद्वा प्रतान्तस्य सिराजालं सशोणितम् ॥१०॥
वायुः सम्पीड्य सङ्कोच्य वक्रीकृत्य विशोष्य च ।
निःस्फुरं नीरुजं ग्रन्थिं कुरुते स सिराह्वयः ॥११॥
Foot soldiers entering into water suddenly or by fatigue after exertion, Vata getting aggravated along with blood, invades the network of veins causing pain, constriction, distortion, drying up and gives rise to the formation of granthi which is non- pulsating and painless. This is known as Siragranthi.

Vrana Granthi

अरूढे रूढमात्रे वा व्रणे सर्वरसाशिनः ।
सार्द्रे वा बन्धरहिते गात्रेऽश्माभिहतेऽथवा ॥१२॥
वातोऽस्रमस्रुतं दुष्टं संशोष्य ग्रथितं व्रणम् ।
कुर्यात्सदाहः कण्डूमान् व्रणग्रन्थिरयं स्मृतः ॥१३॥
If the patient indulgent in foods of all tastes without any control, when the ulcer has not healed or healed just then, or if it (ulcer) is not bandaged, when still moist, or the body is hit by stones etc., then Vata dries up the vitiated blood which has not gone out, causes a granthi in the ulcer associated with burning sensation and itching. This is known as Vrana Granthi.

Curable and incurable Granthi

साध्या दोषास्रमेदोजा न तु स्थूलखराश्चलाः ।
मर्मकण्ठोदरस्थाश्च
Those Granthi (tumors) arising from the doshas, rakta and medas are curable; those which are big, hard and moveable, those located on vital spots, throat and abdomen are not curable.

Arbuda: Malignant tumor / cancer

महत्तु ग्रन्थितोऽर्बुदम् ॥ १४ ॥
तल्लक्षणं च मेदोऽन्तैः षोढा दोषादिभिस्तु तत् ।
प्रायो मेदःकफाढ्यत्वात्स्थिरत्वाच्च न पच्यते ॥ १५ ॥
Large granthis are called Arbuda (malignant tumors). The (signs of) Arbuda are of six kinds, (three) caused by the doshas etc. and three ending with meda (rakta, mamsa and meda) because of predominance of medas (fat) and Kapha generally and due to deep rootedness, they do not ripen (suppurate).

Shonita Arbuda

सिरास्थं शोणितं दोषः सङ्कोच्यान्तः प्रपीड्य च ।
पाचयेत तदानद्धं सास्रावं मांसपिण्डितम् ॥ १६ ॥
मांसाङ्कुरैश्चितं याति वृद्धिं चाशु स्रवेत्ततः ।
अजस्रं दुष्टरुधिरं भूरि तच्छोणितार्बुदम् ॥ १७ ॥
Doshas getting aggravated, vitiate the blood present inside the veins, causing contractions, pain and ripening, with obstruction and discharges (blood) produce a growth of (tumor) muscle, studded with sprouts of muscle, the tumor develops fast and discharges vitiated blood constantly in large quantities, this is Shonitarbuda (caused due to vitiation of blood tissue).

Prognosis of Arbuda

तेष्वसृङ्मांसजे वर्ज्ये चत्वार्यन्यानि साधयेत् ।
Among these (Arbudas) those arising from blood (Shonitarbuda) and muscle tissue (Mamsarbuda) should be refused, the remaining four should be treated.

Shlipada: Filariasis
प्रस्थिता वङ्क्षणोर्वादिमधःकायं कफोल्बणाः ॥ १८ ॥
दोषा मांसास्रगाः पादौ कालेनाश्रित्य कुर्वते ।
शनैः शनैर्घनं शोफं श्लीपदं तत्प्रचक्षते ॥ १९ ॥
Doshas with the predominance of Kapha, getting aggravated invade the muscle and blood, commencing first in the groin and gradually with time descend to the thigh and other parts of the lower body and the feet, making it largely swollen, slowly and steadily, this disease is called filariasis.
परिपोटयुतं कृष्णमनिमित्तरुजं खरम् ।
रूक्षं च वातात्पित्तात्तु पीतं दाहज्वरान्वितम् ॥ २० ॥ कफाद्गुरु स्निग्धमरुक् चितं मांसाङ्कुरैर्बृहत् ।
In that caused by Vata, the leg is having small cracks in the skin, black in color, pain develops without any reason and (skin) is rough and dry; in Pitta, it is yellow, accompanied with burning sensation and fever; in that caused by Kapha the leg is heavy, unctuous, painless and studded with big sprouts of muscle fibres.
तत्त्यजेद्वत्सरातीतं सुमहत्सुपरिस्रुति ॥ २१ ॥
That which is more than one year old, very big and exuding heavily should be rejected.
पाणिनासौष्ठकर्णेषु वदन्त्येके तु पादवत् ।
श्लीपदं जायते तच्च देशेऽनूपे भृशं भृशम् ॥२२॥
Shlipada affects the hands, nose, lips and ears also like the feet, some (authorities) say so; and it is especially common in extremely marshy regions.

Gandamala: Apachi (Scrofula)

मेदस्थाः कण्ठमन्याक्षकक्षावङ्क्षणगा मलाः ।
सवर्णान् कठिनान् स्निग्धान् वार्ताकामलकाकृतीन् ॥२३॥
अवगाढान् बहून् गण्डांश्चिरपाकांश्च कुर्वते ।
पच्यन्तेऽल्परुजस्तेऽन्ये स्रवन्त्यन्येऽतिकण्डुराः ॥२४॥ नश्यन्त्यन्ये भवन्त्यन्ये दीर्घकालानुबन्धिनः ।
गण्डमालाऽपची चेयं दूर्वेव क्षयवृद्धिभाक् ॥२५॥
Doshas aggravated invading the medas (fat) present in the throat, neck, region of collar bone, axilla and groin, give rise to growth of hard, unctuous, deep rooted, multiple, small tumors of the same color as of the skin resembling vārtāka – Solanum melongena, āmalaka – Emblica officinalis (in size), causing delayed maturation (suppuration), ripening causing mild pain. Some others are exuding fluid and some others causing severe itching, some disappear and afresh the disease persists for long. This is known as Gandamala and Apachi and undergoes increase or decrease like the durva grass (Cynodon dactylon) (disappears in unsuitable climate and reappears in suitable climate).

Gandamala: Apachi (Scrofula) Prognosis

तां त्यजेत्सज्वरच्छर्दिपार्श्वरुक्कासपीनसाम् ।
That associated with fever, vomiting, pain in the flanks, cough and nasal catarrh should be refused treatment.

Nadi Vrana: Sinus Ulcer

अभेदात्पक्वशोफस्य व्रणे चापथ्यसेविनः ॥ २६ ॥
अनुप्रविश्य मांसादीन् दूरं पूयोऽभिधावति ।
गतिः सा दूरगमनान्नाडी नाडीव संस्रुतेः ॥ २७ ॥
नाड्येकानृजुरन्येषां सैवानेकगतिर्गतिः ।
Not cutting the ripened abscess (and draining out the pus) and the person indulging in unsuitable foods etc., the pus retained inside the ulcer entering into the muscles etc. and runs deep into them, produces that (channels / sinus) which go inside them for long distances are called gati, nadi is that in which there is exudation just like in a sieve, only one channel which is straight is called as Nadi (sinus); other one which has more than one channel and which are not straight (curved) is called as Gati- technically.

Types of Nadi Vrana

सा दोषैः पृथगेकस्थैः शल्यहेतुश्च पञ्चमी ॥ २८ ॥
It (Nadivrana) is of five kinds, from each dosha separately, from the combination of all of them and fifth from the foreign body.

Vataja Nadi Vrana (Sinus Ulcer)

वातात्सरुक् सूक्ष्ममुखी विवर्णा फेनिलोद्वमा ।
स्रवत्यभ्यधिकं रात्रौ
That caused by Vata has pain, small opening, discolored, exudes froth, more at nights.

Pittaja Nadi Vrana (Sinus Ulcer)

पित्तात्तृड्ज्वरदाहकृत् ॥ २९ ॥
पीतोष्णपूतिपूयस्रुद्दिवा चाति निषिञ्चति ।
That caused by Pitta has thirst, fever, burning sensation, exudes yellow, warm, foul-smelling pus, exudes more during the day.

Kaphaja Nadi Vrana (Sinus Ulcer)

घनपिच्छिलसंस्रावा कण्डूला कठिना कफात् ॥ ३० ॥
निशि चाभ्यधिकक्लेदा
That caused by Kapha has thick and slimy exudation, severe itching, hardness, exudation more at nights.

Tridoshaja Nadi Vrana (Sinus Ulcer)

सर्वैः सर्वाकृतिं त्यजेत् ॥ ३१अब् ॥
In that, caused by all the doshas, all the symptoms will be present, this should be rejected.

Nadi Vrana: Sinus Ulcer

अन्तःस्थितं शल्यमनाहृतं तु करोति नाडीं वहते च सास्य |
फेनानुविद्धं तनुमल्पमुष्णं सास्रं च पूयं सरुजं च नित्यम् ॥ ३१॥
The foreign body remaining inside the body, if not removed leads to nadi (sinus Ulcer); it exudes thin, little, warm, frothy blood and pus, along with pain, every day.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने ग्रन्थ्यर्बुदश्लीपदापचीनाडीविज्ञानीयं नामैकोनत्रिंशोऽध्याय: ॥ २९ ॥
Thus, ends the chapter- Granthi- Arbuda Shlipada Apachi-Nadi Vijnaniya- the twenty ninth in Uttara Sthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.