Sushruta Samhita Chikitsasthana Chapter 18 Granthi – Apaci – Arbuda

ग्रन्थिष्वथामेषुभिषग्विदध्याच्छोफक्रियांविस्तरशोविधिज्ञः।।
रक्षेद्वलंचापिनरस्यनित्यंतद्रक्षितंव्याधिबलंनिहन्ति।।३।।

Ama avastha is a stage of Granthi – benign tumours in which the tumours are unripe. In these conditions, the treatments indicated for sopha (inflammatory swelling) should be adopted in detail by the physician, according to procedure. Care should be taken to protect the strength of the patient constantly. The protected strength in turn controls the strength of the disease.

Vātaja grañthi cikitsā 

तैलंपिबेत्सर्पिरथोद्वयंवादत्त्वावसांवात्रिवृतंविदध्यात्।।
अपेहिवातादशमूलसिद्धंवैद्यश्चतुःस्नेहमथोद्वयंवा।।४।।

Vataja Granthi is a granthi which is produced by Vata. Those having Vataja Granthi should drink one of the below mentioned –

–        oil separately or

–        ghee separately or

–        oil and ghee together or

–        a mixture of three fats i.e. oil, ghee and muscle fat

The physician may administer a mixture of all four snehas (fats) or any two snehas along with Dasamula decoction, for mitigating Vata.

हिंस्राऽथरोहिण्यमृताऽथभार्गीश्योनाकबिल्वागुरुकृष्णगन्धाः।।
गोजीचपिष्टासहतालपत्र्याग्रन्थौविधेयोऽनिलजेप्रलेपः।।५।।
स्वेदोपनाहान्विविधांश्चकुर्यात्तथाप्रसिद्धानपरांश्चलेपान्।।
विदार्यवापक्वमपोह्यपूयंप्रक्षाल्यबिल्वार्कनरेन्द्रतोयैः।।६।।
तिलैःसपञ्चाङ्गलपत्रमित्रैःसंशोधयेत्सैन्धवसंप्रयुक्तः।।
शुद्धंव्रणंवाऽप्युपरोपयेत्तुतैलेनरास्नासरलान्वितेन।।७।।
विडङ्गयष्टीमधुकामृताभिःसिद्धेनवाक्षीरसमन्वितेन।।

Paste of the below mentioned ingredients should be prepared and applied on the granthi caused by vata –

–        Himsra,

–        Rohini (katukarohini),

–        Amrta,

–        Bharngi,

–        Syonāka,

–        Bilva,

–        Aguru,

–        Krsna gandha,

–        Goji (gojihvā) and

–        Tālapatra (musali)

The physician should apply different kinds of sweda – sudation, upanaha – poultice and lepa – pastes which are popular or otherwise.

Once the granthi becomes ripe, it should be cut open and the pus inside it shall be removed. Now, the ulcer is washed with decoction of Bilva, Arka and Narendra (Aragwadha). Next, the ulcer is purified by filling it with paste of tila, leaves of Pancangula and Saindhava.

Following this the wound should be made to heal by applying the oil prepared with the below mentioned ingredients –

–        Rasna,

–        Sarala,

–        Vidanga,

–        Yastimadhuka,

–        Amrta and

–        Ksira – milk

Pittaja grañthi cikitsa

जलौकसःपित्तकृतेहितास्तुक्षीरोदकाभ्यांपरिषेचनंच।।८।।
काकोलिवर्गस्यचशीतलानिपिबेत्कषायाणिसशर्कराणि।।
द्राक्षारसेनेक्षुरसेनवाऽपिचूर्णंपिबेच्चापिहरीतकीनाम्।।९।।
मधूकजम्ब्वर्जुनवेतसानांत्वग्भिःप्रदेहानवचारयेत।। 
सशर्करैर्वातृणशून्यकन्दैदिह्यादभीक्ष्णंमुचुलुन्दजैर्वा।।१०।।
विदार्यवापक्वमपोह्यपूर्यधावेत्कषायेणवनस्पतीनाम्।।
तिलैःसयष्टीमधुकैर्विशोध्यसर्पिःप्रयोज्यंमधुरैर्विपक्वम्।।११।।

In Pittaja Granthi i.e. granthi produced by pitta, bloodletting should be done using leeches.

For washing the granthi, a mixture of milk and water is beneficial.

For drinking purposes – decoction prepared using the herbs belonging to Kakolyadi Varga / Gana added with sugar and cooled is beneficial.

Haritaki – Terminalia chebula powder should be consumed along with juice of draksa – raisins or iksu – sugarcane.

Warm poultice prepared using the below mentioned ingredients should be applied over the granthi after mixing sugar with it –

–        barks of madhuka, jambu, arjuna and vetasa or

–        tubers of trnasanya (ketaki) or muculunda (kantakimadana)

Below mentioned treatments should be done for the ripened granthi –

–        it should be cut open and the pus drained,

–        the wound is then washed with decoction of bark of vanaspatis (Pancavalkala trees)

–        the wound / ulcer is then purified by filling paste of Tila and Yastimadhuka in it and

–        its healing is done by using ghee boiled and prepared with the herbs belonging to Madhura varga – sweet group of herbs

Kaphaja granthi chikitsa 

हृतेषुदोषेषुयथानुपूर्व्याग्रन्थौभिषक्श्लेष्मसमुत्थितेतु।।
स्विन्नस्यविम्लापनमेवकुर्यादङ्गुष्ठलोहोपलवेणुदण्डैः।।१२।।
विकङ्कतारवधकाकणन्तीकाकादनीतापसवक्षमूलैः।।
आलेपयेत्पिण्डफलाकभार्गीकरकालामदनैधविद्वान्।।१३।।
अमर्मजातशमयप्रयान्तमपक्वमेवापहरेविदार्थ।।
दहेत्स्थितेचासजिसिखकर्मासयक्षतोक्तंचविधिविदध्यात्।।१४।।

In kaphaja granthi i.e. tumour produced by kapha, removal of morbid doshas should be done in the usual manner as has been described earlier.

Following this, svedana – fomentation and vimplapana – kneading with thumb, iron rod, stone or bamboo should be done to the granthi.

After this, paste of the below mentioned ingredients should be applied on it –

–        Vikankata,

–        Aragvadha,

–        Kakananti,

–        Kakadani,

–        Bark of Täpasavrksa,

–        Pindaphala (tiktaalübü),

–        Arka, Bhärñgi, Karanja,

–        Kälä and

–        Madana

The granthi which is not present on marma sthana i.e. fatal spot or organ and that which is not going to become ripe i.e. that which does not suppurate should be excised in its unripe stage itself and removed.

Now, this site should be burnt by fire (cauterization). After the stoppage of bleeding, treatment advocated for fresh wounds should be adopted by the wise and successful physician.

यामांसकन्धःकठिनाबहत्यस्तास्वेषयोज्यक्षविधिविधिज्ञैः।।
शस्त्रेणवाऽऽपाट्यसुपक्वमाशुप्रक्षालयेत्पथ्यतमैःकषायैः।।१५।।
संशोधनैस्तंचविशोधयेत्तुक्षारोत्तरैःक्षौद्रगुडप्रगावैः।।
शुद्धेचतैलंत्ववचारणीयविडङ्गपाठारजनीविपक्वम्।।१६।।

The physicians conversant with treatment procedures should follow and conduct the same treatments for the muscular swellings which are hard and big.

Alternatively, ripe granthi may be excised using sharp instruments and later washed with decoction of appropriate herbs.

The granthi should be later cleansed with a mixture of alkalies, honey and jaggery.

After cleaning, oil processed and prepared with Vidanga, Patha and Rajani shall be used over them for healing.

Medograñthi chikitsa – treatment of fatty tumor

मेदःसमुत्थेतिलकल्कदिग्धंदत्त्वोपरिष्टादिद्वगुणंपटान्तम्।।
हुताशतप्तेनमुहुःप्रमृज्याल्लोहेनधीमानदहन्हिताय।।१७।।
प्रलिप्यदावीमथलाक्षयावाप्रतप्तयास्वेदनमस्यकार्यम्।।
निपात्यवाशस्त्रमपोह्यमेदोदहेत्सुपक्वंत्वथवाविदार्य।।१८।।
प्रक्षाल्यमूत्रेणतिलैःसुपिष्टैःसुवर्चिकाद्यैर्हरितालमित्रैः।।
ससैन्धवैःक्षौद्रघृतप्रगाढेःक्षारोत्तरैरेनमभिप्रशोध्य।।१९।।
तैलंविदधादिद्वकरञ्जगुञ्जावंशावलेखेङ्गुदमूत्रसिद्धम्।।

Paste of Tila – sesame should be kept in between two layers of cloth. This should be used to give a coating to the Medoja Granthi i.e. tumour produced by morbid fat which is in its unripe stage (ama avastha), as a first step in its treatment.

Next, the granthi should be burnt (cauterized) with a heated iron rod. Alternatively a wooden stick, the front tip of which is capped with laksa (lac) can be used.

Or, the fat of the medoja granthi should be removed by scraping it with a sharp instrument and then burnt.

After this, the burnt area should be washed. For this purpose, gomutra – urine of cows should be used.

Following this, the nice paste of the below mentioned ingredients should be put into the granthi so as to cleanse it –

–        Tila – sesame,

–        Suvarcika,

–        Haritala etc.

This combination should be added with more honey and ghee before putting it into the granthi.

According to Acharya Dalhana, Yavaksara, Saindhava and Haritala added with more honey and ghee should be used for filling into the granthi.

For healing the wound of granthi, oil prepared with the below mentioned ingredients should be used –

–        two kinds of Karanja,

–        Gunja,

–        Bark of Vamsa,

–        Inguda and

–        Gomutra

2. Apacī cikitsā – treatment of cervical lymphadenitis

जीमूतकैःकोशवतीफलैश्चदन्तीद्रवन्तीत्रिवृतासुचैव।।२०।।
सर्पिःकृतंहन्त्यपचीप्रवृद्धांद्विधाप्रवृत्तंतदुदारवीर्यम्।।
निर्गुण्डिजातीबरिहिष्ठयुक्तंजीमूतकंमाक्षिकसैन्धवाढ्यम्।।२१।।
अभिप्रतप्तंवमनंप्रगाढंदुष्टापचीषूत्तममादिशन्ति।।
कैडर्यबिम्बीकरवीरसिद्धंतैलंहितंमूर्धविरेचनंच।।२२।।
शाखोटकस्यस्वरसेनसिद्धंतैलंहितंनस्यविरेचनेषु।।
मधूकसारश्चहितोऽवपीडेफलानिशिग्रोःखरमञ्जरेर्वा।।२३।।

Medicated ghee should be prepared with the below mentioned ingredients –

–        Jimutaka,

–        Kosavati phala,

–        Danti,

–        Dravanti and

–        Trivrit

Benefits – Being a highly potent medicine, this ghee removes the morbid doshas in both ways i.e. through emesis and purgation. It also cures Apaci including the condition which has greatly increased (severe forms of apache).

Other recipes – Juice should be prepared from Nirgundi, Jati and Barihista (Valaka). It should be added with more honey and saindhava – rock salt. This should be made comfortably warm. When consumed, it produces vomiting. Therefore it is considered as the best recipe for Dusta Apaci (suppurative lymphadenitis).

Medicated oil is prepared with kaidarya, bimbī and karavīra. This oil is beneficial for producing purgation of the head.

Likewise, oil prepared with Sakhotaka juice is ideal as purgative and can also be used as nasal drops.

Also, the oil prepared with Madhūkasāra, fruits of Sigru, and Kharamañjari (apāmārga) is best for avapīda nasya (nasal drops).

ग्रन्थीनमर्मप्रभवानपक्वानुद्धृत्यचाग्निंविदधीतपश्चात्।।
क्षारेणवाऽपिप्रतिसारयेत्तुसंलिख्यशस्त्रेणयथोपदेशम्।।२४।।

Treatment for granthis which are not developed on marmas – vital spots and those which are in unripe stage include –

–        excision (cutting and removing them) and

–        burning the area with fire (cauterization with heated iron rod) or

–        smearing of caustic alkalies after scraping the area with sharp instruments as described earlier

पार्ष्णिप्रतिद्वेदशचाङ्गुलानिमित्वेन्द्रबस्तिपरिवय॑धीमान्।।
विदार्यमत्स्याण्डनिभानिवैद्योनिष्कृष्यजालान्यनलंविदध्यात्।।२५।।

The intelligent physician, should conduct the below mentioned procedures to cure apaci (cervical lymphadenitis) –

–        firstly he should cut open the foreleg of the patient of apaci, about twelve angula (24 cms) above the paarsni i.e. ankle / calcaneus, taking care to avoid injury to indrabasti marma (fatal spot in the middle of calf muscle)

–        then he should pull out (remove) the network of nodules located therein, resembling the shoal of fish eggs and

–        burn the area with fire (heated iron rod)

आगुल्फकर्णात्सुमितस्यजन्तोस्तस्याष्टभार्गखुडकाद्विभज्य।।
घोणर्जुवेधःसुरराजबस्तेहित्वाऽक्षिमात्रंत्वपरेवदन्ति।।२६।।

According to the opinion of some other scholars –

In patients of apaci, an area equal to one eighth of the length of foreleg, upwards from the ear like projections of ankle joints (portions of ankle joints projecting outwards and laterally – malleolus?) should be cut open.

While cutting, Suraraja Basti (Indrabasti) Marma located in the leg (calf muscle) should be avoided (not injured).

The incision should be straight like the ridge of the nose. It should be of the size (width) of the eye. Following this, the network of fatty nodes should be removed and the area is burnt with fire.

मणिबन्धोपरिष्टाद्वाकुर्याद्रखात्रयंभिषक्।।
अङ्गुल्यन्तरितंसम्यगपचीनांनिवृत्तये।।२७।।

Three lines of incisions should be made above the wrist joint. There should be a space of one angula (2 cm) between these lines. This would cure apaci.

चूर्णस्यकालेप्रचलाककाकगोधाहिकूर्मप्रभवांमसींतु।।
दद्याच्चतैलेनसहेङ्गुदीनांयद्वक्ष्यतेश्लीपदिनांचतैलम्।।२८।।
विरेचनंधूममुपाददीतभवेच्चनित्यंयवमुद्गभोजी।।

Below mentioned treatments should be done during the period of healing,

Below mentioned ingredients mixed in Ingudi Taila should be applied –

–        ash of feathers of peacock and cock

–        skin of iguana, snake and tortoise

Alternatively, medicated oils indicated for slipada (filariasis) may be applied.

Every day, Virecana Dhuma (inhalation of head purging medicated smoke) should be given.

Food prepared with yava – barley and mudga – green gram should be consumed by the patient.

2. 
   

     Arbuda Cikitsā – treatment of malignant tumour / carcinoma / cancer