Chapter 38 – Galaganda – Gandamala – Apachi – Granthi – Arbuda Nidanam

The 38th chapter of Madhava Nidana is Galaganda – Gandamala – Apachi – Granthi – Arbuda Nidanam which deals with Cervical Lymphadenoma, Scrofula – Tumors, Cancer. Cervical lymphadenopathy is abnormal enlargement of lymph nodes (LNs) in the head and neck usually >1 cm

Definition —

निबद्धः श्वयथुर्यस्य मुष्कवल्लम्बते गले |
महान् वा यदि वा हृस्वो गलगण्डं तमादिशेत् || १ ||

nibaddhaḥ śvayathuryasya muṣkavallambatē galē |
mahān vā yadi vā hr̥svō galagaṇḍaṁ tamādiśēt || 1 ||

A swelling in the neck, big or small hanging like the scrotum has been defined as Galaganda. 1

Pathogenesis —

वातः कफश्चापि गले प्रदुष्टो मन्ये च संश्रित्य तथैव भेदः |
कुर्वन्ति गण्डं क्रमशः स्वलिङ्गैः समन्वितं तं गलगण्डमाहुः || २ ||

vātaḥ kaphaścāpi galē praduṣṭō manyē ca sanśritya tathaiva bhēdaḥ |
kurvanti gaṇḍaṁ kramaśaḥ svaliṅgaiḥ samanvitaṁ taṁ galagaṇḍamāhuḥ || 2 ||

A morbid excess of Vata and kapha brings about changes in the fat (medas) and causes swellings in the neck and around it. In this morbidity, features of the vitiated doshas manifest gradually. This condition is known as Galaganda. 2

वैरस्यमास्यस्य च तस्य जन्तोर्भवेत्तथा तालु – गलप्रशोषः |

vairasyamāsyasya ca tasya jantōrbhavēttathā tālu – galapraśōṣaḥ |

Vataja Galaganda —

तोदान्वितः कृष्णसिरावनद्धः श्यावो अरुणो वा पवनात्मकस्तु |
पारुष्ययुक्तश्चिरवृद्द्यपाको यदृच्छया पाकमित्यात्कदाचित् || ३ ||

tōdānvitaḥ kr̥ṣṇasirāvanaddhaḥ śyāvō aruṇō vā pavanātmakastu |
pāruṣyayuktaściravr̥ddyapākō yadr̥cchayā pākamityātkadācit || 3 ||

Features of Vataja Galaganda include the following:

• Bad taste in the mouth,
• Dryness of the palate and throat,
• Swelling associated with a pricking pain,
• Presence of a network of black colored veins,
• Swelling that is blue or red in colour,
• Rough, and slow in growth.

It usually does not form pus. If pus is there, it comes out only occasionally. 3

Kaphaja Galaganda—

स्थिरः सवर्णो गुरुरुग्रकण्डूः शीतो महांश्चापि कफात्मकस्तु || ४ ||
चिराभिवृद्धिं भजते चिराद्वा प्रपच्यते मन्दरुजः कदाचित् |
माधुर्यमास्यस्य च तस्य जन्तोर्भवेत्तथा तालु – गलप्रलेपः || ५ || 

sthiraḥ savarṇō gururugrakaṇḍūḥ śītō mahānścāpi kaphātmakastu || 4 ||
cirābhivr̥ddhiṁ bhajatē cirādvā prapacyatē mandarujaḥ kadācit |
mādhuryamāsyasya ca tasya jantōrbhavēttathā tālu – galapralēpaḥ || 5 ||

Symptoms of Kaphaja Galaganda include the following:

• Swelling of the spots that are immovable and that have the same colour as the skin.
• The swelling is heavy, and is cold to touch, big in size, slow in growth.

In addition, there is a severe itching in it. It occasionally suppurates and is accompanied with a mild pain. Moreover, the patient has a sweetish taste in mouth and he feels as if his palate and throat are coated with phlegm. 4-5

Medaja Galaganda —

स्निग्धो गुरुः पाण्डुरनिष्टगन्धो मेदोभवः कण्डुयुतो अल्परुक् च |
प्रलम्बते अलाबुवदल्पमूलो देहानुरूपक्षयवृद्धियुक्तः || ६ ||
स्निग्धास्यता तस्य भवेच्च जन्तोर्गले अनुशब्दं कुरुते च नित्यम् |

snigdhō guruḥ pāṇḍuraniṣṭagandhō mēdōbhavaḥ kaṇḍuyutō alparuk ca |
pralambatē alābuvadalpamūlō dēhānurūpakṣayavr̥ddhiyuktaḥ || 6 ||
snigdhāsyatā tasya bhavēcca jantōrgalē anuśabdaṁ kurutē ca nityam |

Symptoms of Medaja Galaganda include the following:

• A swelling that is smooth, heavy, and yellowish – white in color.
• It emits unpleasant smell and produces itching and mild pain, it hangs as pitcher gourd (Alabu), it is attached very loosely, it is increased or decreased in accordance to condition of the body.
• He discharges copious salivation and makes a cooing sound in the throat.

These are the additional symptoms of the disease. 6

Prognosis —

कृच्छ्राच्छवसन्तं मृदुसर्वगात्रं संवत्सरातीतमरोचकार्तम् || ७ ||
क्षीणं च वैद्यो गलगण्डयुक्तं भिन्नस्वरं चापि विवर्जयेच्च | 

kr̥cchrācchavasantaṁ mr̥dusarvagātraṁ sanvatsarātītamarōcakārtam || 7 ||
kṣīṇaṁ ca vaidyō galagaṇḍayuktaṁ bhinnasvaraṁ cāpi vivarjayēcca |

The patients of Galaganda who are to be rejected or refused for treatment (as they are practically incurable) include the following:

• One who has difficulty in breathing,
• One having the disease in very soft parts,
• having it more than a year,
• the one who has lost appetite,
• has got emaciated and
• has developed a broken voice. 7

Gandamala (Lymphadenopathy) —

कर्कन्धु – कोलामलकप्रमाणैः कक्षांस – मन्या – गल – वङ्क्षणेषु || ८ ||
मेदः – कफाभ्यां चिर – मन्दपाकैः स्याद्गण्डमाला बहुभिश्च गण्डैः |

karkandhu – kōlāmalakapramāṇaiḥ kakṣānsa – manyā – gala – vaṅkṣaṇēṣu || 8 ||
mēdaḥ – kaphābhyāṁ cira – mandapākaiḥ syādgaṇḍamālā bahubhiśca gaṇḍaiḥ |

The Gandamala  signifies the condition in which more than one swelling (ganda) appears in the

• Axilla,
• Shoulders,
• Sides of the neck,
• Front of the neck, or the groin.

Varying in size from that of Karkandhu and fruit of Jujube (Kola) to that of goose berry, the fruit of plant Phyllanthus emblica (Aamalaka). It is also associated with the kapha and fat (medas) and there is suppuration in it after a long period. 8

Apachi (Suppurating Lymphadenitis) — 

ते ग्रन्थयः केचिदवाप्तपाकाः स्रवन्ति नश्यन्ति भवन्ति चान्ये || ९ ||
कालानुबन्धं चिरमादधाति सैवापचीति प्रवदन्ति तज्ज्ञः |
साध्याः स्मृताः पीनस – पार्श्वशूल – कास – ज्वर – च्छर्दियुतास्त्वसाध्याः || १० ||

tē granthayaḥ kēcidavāptapākāḥ sravanti naśyanti bhavanti cānyē || 9 ||
kālānubandhaṁ ciramādadhāti saivāpacīti pravadanti tajjñaḥ |
sādhyāḥ smr̥tāḥ pīnasa – pārśvaśūla – kāsa – jvara – cchardiyutāstvasādhyāḥ || 10 ||

Some of the above mentioned glandular swellings reach the stage of suppuration and start discharging and being destroyed on their own,while others are produced afresh and become chronic in due course of time. Such condition is termed as Apachi if it continues for a long period and it can be cured as well.
Nevertheless, if the patient has running of the nose, pain in the flanks, cough, fever, and vomiting then apachi cannot be cured. 9-10

Granthi (Cystic Swellings) Pathogenesis —

वातादयो मांसमसृक् प्रदुष्टाः सन्दूष्य मेदश्च तथा सिराश्च |
वृत्तोन्नतं विग्रथितं च शोथं कुर्वन्त्यतो ग्रन्थिरिति प्रदिष्टः || ११ ||

vātādayō mānsamasr̥k praduṣṭāḥ sandūṣya mēdaśca tathā sirāśca |
vr̥ttōnnataṁ vigrathitaṁ ca śōthaṁ kurvantyatō granthiriti pradiṣṭaḥ || 11 ||

In the case of Granthi, due to excess of Vata, and other doshas abnormalities in the blood (asrk), muscle (mamsa), fat (medas), and veins (siras) are produced, and this pathological condition in turn, generates roundly shaped and large lump of masses. 11

Vataja Granthi —

आयम्यते वृश्चयति तुध्यते च प्रत्यस्यते मथ्यति भिध्यते च |
कृष्णो मृदुर्बस्तिरिवाततश्च भिन्नः स्रवेच्चानिलजो अस्रमच्छं || १२ ||

āyamyatē vr̥ścayati tudhyatē ca pratyasyatē mathyati bhidhyatē ca |
kr̥ṣṇō mr̥durbastirivātataśca bhinnaḥ sravēccānilajō asramacchaṁ || 12 ||

Features of tumors (vataja granthi) include the following:

• Different types of pain such as expanding, tearing, pricking, pulling, churning, and cutting pains;
• the concerned mass of flesh turning black, and soft.
• It exudes thin and pure blood if pricked, and it resembles a water bag. 12

Pittaja Granthi —

दन्दह्यते धूप्यति वृश्चयते च पापच्यते प्रज्वलतीव चापि |
रक्तः सपीतो अप्यथवा अपि पित्ताद्भिन्नः स्रवेदुष्णमतीव चास्रं || १३ ||

dandahyatē dhūpyati vr̥ścayatē ca pāpacyatē prajvalatīva cāpi |
raktaḥ sapītō apyathavā api pittādbhinnaḥ sravēduṣṇamatīva cāsraṁ || 13 ||

Features of Pittaja granthi include the following:

• Severe burning sensation,
• A feeling as though being touched by fire or by strong alkalis;
• The concerned mass turns red or yellowish red, and a large amount of warm blood is discharged by it. 13

Kaphaja Granthi —

शीतो अविवर्णो अल्परुजो अतिकण्डुः पाषाणवत् संहननोपपन्नः |
चिराभिवृद्धश्च कफप्रकोपाद्भिन्नः स्रवेच्छुक्ल – घनं च पूयम् || १४ ||

śītō avivarṇō alparujō atikaṇḍuḥ pāṣāṇavat sanhananōpapannaḥ |
cirābhivr̥ddhaśca kaphaprakōpādbhinnaḥ sravēcchukla – ghanaṁ ca pūyam || 14 ||

Features of Kaphaja Granthi include the following:

• It is cold in touch,
• Is without any discoloration,
• Having mild pain but severe itching,
• Very hard like stone,
• Slow growth rate, and
• Discharge of thick white pus. 14

Medoja Granthi (lipoma) —

शरीरवृद्धि – क्षयवृद्धि – हानिः स्निग्धो महान् कण्डुयुतो अरुजश्च |
मेदःकृतो गच्छति चात्र भिन्ने पिण्याक – सर्पिः प्रतिमं तु मेदः || १५ ||

śarīravr̥ddhi – kṣayavr̥ddhi – hāniḥ snigdhō mahān kaṇḍuyutō arujaśca |
mēdaḥkr̥tō gacchati cātra bhinnē piṇyāka – sarpiḥ pratimaṁ tu mēdaḥ || 15 ||

According to the constitution of the body, the size of Medoja granthi is increased or decreased. The tumour thus developed is smooth, itching, and painless, , the lump produced by this pathological condition resembles the paste of sesame seeds, and a thick fatty material is released by it. 15

Siraja Granthi —

व्यायामजातैरबलस्य तैस्तैराक्षिप्य वायुस्तु सिराप्रतानम् |
सङ्कुच्य सम्पीड्य विशोष्य चापि ग्रन्थिं करोत्युन्नतमाशु वृत्तम् || १६ ||
ग्रन्थिः सिराजः स तु कृच्छ्रसाध्यो भवेध्यदि स्यात् सरुजश्चलश्च |
अरुक् स एवाप्यचलो महांश्च मर्मोत्थितश्चापि विवर्जनीयः || १७ ||

vyāyāmajātairabalasya taistairākṣipya vāyustu sirāpratānam |
saṅkucya sampīḍya viśōṣya cāpi granthiṁ karōtyunnatamāśu vr̥ttam || 16 ||
granthiḥ sirājaḥ sa tu kr̥cchrasādhyō bhavēdhyadi syāt sarujaścalaśca |
aruk sa ēvāpyacalō mahānśca marmōtthitaścāpi vivarjanīyaḥ || 17 ||

Vata is vitiated in those persons who are weak but who perform strenuous activity. Subsequently, the vitiated vata invades the network of veins, making them constricted, dried, and rolled into a round big mass known as tumor of veins. (Siraja Granthi)

It is generally incurable when it turns painful, and moving. It is incurable there even if it is painless and immobile. 16-17

Arbuda (Tumours)

Pathogenesis —

गात्रप्रदेशे क्वचिदेव दोषाः संमुर्च्छिता मांसमसृक् प्रदूष्य |
वृत्तं स्थिरं मन्दरुजं महान्तमनल्पमूलं चिरवृद्द्यपाकम् || १८ ||
कुर्वन्ति मांसोच्छ्रयमत्यगाधं तदर्बुदं शास्त्रविदो वदन्ति |
वातेन पित्तेन कफेन चापि रक्तेन मांसेन च मेदसा वा || १९ ||
तज्जायते तस्य च लक्षणानि ग्रन्थेः समानानि सदा भवन्ति |

gātrapradēśē kvacidēva dōṣāḥ sammurcchitā mānsamasr̥k pradūṣya |
vr̥ttaṁ sthiraṁ mandarujaṁ mahāntamanalpamūlaṁ ciravr̥ddyapākam || 18 ||
kurvanti mānsōcchrayamatyagādhaṁ tadarbudaṁ śāstravidō vadanti |
vātēna pittēna kaphēna cāpi raktēna mānsēna ca mēdasā vā || 19 ||
tajjāyatē tasya ca lakṣaṇāni granthēḥ samānāni sadā bhavanti |

The doshas when vitiated, invade the muscle and blood, and generate round, immovable, slightly painful, large, deep seated, slowly increasing, non suppurating tumours of muscular tissue, called by the learned as cancer (arbuda). There are six kinds of Arbuda:

• Vataja
• Pittaja
• Kaphaja
• Raktaja
• Mamsaja and
• Medaja.

All its features are similar to the symptoms of Granthis. 18-19

Rakta Arbuda —

दोषः प्रदुष्टो रुधिरं सिराश्च सङ्कुच्य संपिण्ड्य ततस्त्वपाकम् |
सास्रावमुन्नह्यति मांसपिण्डं मांसाङ्कुरैराचितमाशुवृद्धम् || २० ||
करोत्यजस्रं रुधिरप्रवृत्तिमसाध्यमेतद्रुधिरात्मकं तु |
रक्तक्षयोपद्रवपीडितत्वात् पाण्डुः भवेदर्बुदपीडितस्तु || २१ ||

dōṣaḥ praduṣṭō rudhiraṁ sirāśca saṅkucya sampiṇḍya tatastvapākam | 
sāsrāvamunnahyati mānsapiṇḍaṁ mānsāṅkurairācitamāśuvr̥ddham || 20 ||
karōtyajasraṁ rudhirapravr̥ttimasādhyamētadrudhirātmakaṁ tu |
raktakṣayōpadravapīḍitatvāt pāṇḍuḥ bhavēdarbudapīḍitastu || 21 ||

The doshas when vitiated invade the blood, and generate large – sized muscular tumours that exudate. They remain studded all over with sprouts, developing quickly, and discharging large amount of blood constantly. Because of the complication of loss of blood, the patient with this tumour becomes anaemic. This condition is known as Raktarbuda. 20-21

Mamsarbuda —

मुष्टिप्रहारादिभिरदिरर्दिते अङ्गे मांसं प्रदुष्टं जनयेद्धि शोथम् || २२ ||
अवेदनं स्निग्धमनन्यवर्णमपाकमश्मोपममप्रचाल्यम् |
प्रदुष्टमांसस्य नरस्य गाढमेतद्भवेन्मांसपरायणस्य || २३ ||
मांसार्बुदं त्वेतदसाध्यमुक्तं —-

muṣṭiprahārādibhiradirarditē aṅgē mānsaṁ praduṣṭaṁ janayēddhi śōtham || 22 ||
avēdanaṁ snigdhamananyavarṇamapākamaśmōpamamapracālyam |
praduṣṭamānsasya narasya gāḍhamētadbhavēnmānsaparāyaṇasya || 23 ||
mānsārbudaṁ tvētadasādhyamuktaṁ —-

Due to the assault on the body by fist, and the like; derangement in muscle tissues (mamsa) takes place, and it gives rise to tumour that is painless, smooth, and in colour similar to that of the skin, non suppurative, hard like stone, and immovable. This is considered more common in those who are fond of eating flesh. The ailment is known as Mamsarbuda, and it cannot be cured. 22-23

Prognosis —

—- साध्येष्वपीमानि तु वर्जयेच्च |
संप्रसृतं मर्मणि यच्च जातं स्रोतःसु वा यच्च भवेदचाल्यं || २४ ||

—- sādhyēṣvapīmāni tu varjayēcca |
samprasr̥taṁ marmaṇi yacca jātaṁ srōtaḥsu vā yacca bhavēdacālyaṁ || 24 ||

Even out of the curable ones, the following cases of Arbuda should be rejected:

• The arbuda that exudes heavily;
• that which is located in vital organs or channels,
• and that which have become fixed. 24

Adhyarbuda and Dvirarbuda (Multiple Tumours) —

यज्जायते अन्यत् खलु पूर्वजाते ज्ञेयं तदध्यर्बुदमर्बुदज्ञैः |
यद् द्वन्द्वजातं युगपत् क्रमाद्वा द्विरर्बुदं तच्च भवेदसाध्यम् || २५ ||

 yajjāyatē anyat khalu pūrvajātē jñēyaṁ tadadhyarbudamarbudajñaiḥ |
yad dvandvajātaṁ yugapat kramādvā dvirarbudaṁ tacca bhavēdasādhyam || 25 ||

After the course of the first arbuda, a second arbuda develops which is called as Adhyarbuda by the specialists of arbuda; while a second arbuda developing concurrently with the first one is called Dvirarbuda, and both of these are simply incurable ones. 25

Non – suppuration of tumours —

 न पाकमायान्ति कफाधिकत्वान्मेदोबहुत्वाच्च विशेषतस्तु |
दोषस्थिरत्वाद् ग्रथनाच्च तेषां सर्वार्बुदान्येव निसर्गतस्तु || २६ || 

na pākamāyānti kaphādhikatvānmēdōbahutvācca viśēṣatastu |
dōṣasthiratvād grathanācca tēṣāṁ sarvārbudānyēva nisargatastu || 26 ||

In view of predominance of Kapha, and medas, nature, and hardness of the doshas, arbudas do not suppurate. 26

इति श्रीमाधवकरविरचिते माधवनिदाने गलगण्ड – गण्डमालापचि – ग्रन्थ्यर्बुदनिदानं समाप्तम् || ३८ ||

iti śrīmādhavakaraviracitē mādhavanidānē galagaṇḍa – gaṇḍamālāpaci – granthyarbudanidānaṁ samāptam || 38 ||

Thus concludes the Chapter on Galaganda and the like.

Source — 

1. Cervical Lymphadenopathy