Granthi (cyst)

ayurvedic concepts of granthi

1. Granthi (Cyst) Dr. Alok Kumar PhD Shalya Tantra NEIAH Shillong

2. Definition वातादयो मांसमसृक् च दुष्टाः सन्दूष्य मेदश्च कफानुविद्धम् | वृत्तोन्नतं विग्रथितं तु शोफं कुर्वन्त्यतो ग्रन्थिरिति प्रदिष्टः || Su. Ni. 11/3 Due to vitiation of doshas these doshas involve mansha and rakta along with meda produces rounded, elevated shoph called granthi.

3. Types Vataj Pittaj Kaphaj Medoj Siraj

4. Vataj आयम्यते व्यथ्यत एति तोदं प्रत्यस्यते कृत्यत एति भेदम् | कृष्णोऽमृदुर्बस्तिरिवाततश्च भिन्नः स्रवेच्चानिलजोऽस्रमच्छम् ||४ || Pittaj दन्दह्यते धूप्यति चूष्यते [ १ ] च पापच्यते प्रज्वलतीव चापि | रक्तः सपीतोऽप्यथवाऽपि पित्ताद्भिन्नः स्रवेदुष्णमतीव चास्रम् ||५ | Kaphaj शीतोऽविवर्णोऽल्परुजोऽतिकण्डूः पाषाणवत् संहननोपपन्नः | चिराभिवृद्धिश्च कफप्रकोपाद्भिन्नः स्रवेच्छुक्लघनं च पूयम् ||६||

5. Medoj शरीरवृद्धिक्षयवृद्धिहानिः स्निग्धो महानल्परुजोऽतिकण्डूः | मेदःकृतो गच्छति चात्र भिन्ने पिण्याकसर्पिःप्रतिमं तु मेदः ||७|| Siraj व्यायामजातैरबलस्य तैस्तैराक्षिप्य वायुर्हि सिराप्रतानम् | सम्पीड्य सङ्कोच्य विशोष्य चापि ग्रन्थिं करोत्युन्नतमाशु वृत्तम् ||८|| ग्रन्थिः सिराजः स तु कृच्छ्रसाध्यो भवेद्यदि स्यात् सरुजश्चलश्च | अरुक् स एवाप्यचलो [ १ ] महांश्च मर्मोत्थितश्चापि विवर्जनीयः ||९||

6. Chikitsha sutra ग्रन्थिष्वथामेषु भिषग्विदध्याच्छोफक्रियां विस्तरशो विधिज्ञः | रक्षेद्बलं चापि नरस्य नित्यं तद्रक्षितं व्याधिबलं निहन्ति | Su Chi 18/3 अमर्मजातं शममप्रयान्तमपक्वमेवापहरेद्विदार्य | दहेत् स्थिते चासृजि सिद्धकर्मा सद्यःक्षतोक्तं च विधिं विदध्यात् | Su Chi 18/14

7. Definition A soft fluctuant swelling containing fluid or semisolid material in sac lined by epithelium or endothelium is called cyst.

8. Classification Classi . I True 2. False i . Exudation cyst ii. Degeneration cyst Classi . II Congenital Sequestration Dermoid Tubulo -dermoid Cyst of embryonic remnants Acquired Retention Distention Exudation D egeneration Traumatic Implantation Cystic tumor Parasitic

9. Clinical feature History Duration of swelling How did the swelling appear Pain Growth of cyst General health

10. Inspection Site Number Surface and margin

11. Palpation Surface and margin Consistency Fluctuation Translucency Fluid thrill

12. Pressure effects A cyst may press the neighboring structure specially the blood vessels to cause venous congestion and varicosity of vein. Cyst may press adjacent duct for e.g. choledochal cyst compress common bile duct.

13. Complications Infection Hemorrhage Torsion Calcification

14. Treatment Symptomatic cyst should excise immediately to avoid complication if cyst is small and asymptomatic then may leave for later.

15. Sebaceous cyst These cyst develops due to blockage of mouth of sebaceous gland, the gland become distended with it’s own secretions. As the sebaceous gland are present in skin so may be called as epidermal cyst. Cyst lined by superficial squamous cells. Common site Scalp Face Scrotum Back There are no sebaceous gland in palm and sole , so no sebaceous gland will never present on palm and sole.

16. Clinical feature These cysts are spherical in shape, always possess a small black spot in center called punctum (except in scalp and scrotum). Usually Mobile, non-tender only became tender if got infection. These cyst always fix to the skin, skin above swelling can not be lifted. Due to presence of sebum ( pultaceous material) along with fat and desquamated epithelial cell, inside the cyst, it’s consistency became cystic and indentation will be present. Trans-illumination test will be negative.

17. Treatment Total excision of cyst is treatment of choice. If cyst is inflamed due to infection give some conservative treatment and excise when it become asymptomatic. An elliptical incision should be made including punctum and dissect from surrounding tissue, take care while dissection to avoid rupture of cyst. Removal of complete cyst wall is essential to avoid recurrence. Before closing of wound with interrupted mattress suture heamostasis must be achieved. Followed by ASD If the cyst is infected and full of p us t hen do I&D under local anesthesia and treat like abscess. Leave the wound for healing with secondary intension.

18. Dermoid cyst This cyst lies in deep to the skin and lined by skin, may called as epidermal cyst. These cyst also contain pultaceous or tooth paste like material which contain desquamated epithelial cells. These cyst are lined by squamous epithelial cells. Dermoid cyst never has punctum. These are four types: Sequestration Dermoid Implantation Dermoid Tubulo Dermoid Teratomatous Dermoid

19. Sequestration Dermoid These cyst are congenital. These develops during embryonic development when epithelium buried at the line of fusion. So these are found in the line of fusion of two embryonic segments. These cyst are line by stratified epithelium with hair follicle, sebaceous gland and sweat gland. Collection is pultaceous contains hairs, sebum and desquamated cells. Common site Midline of body neck, Outer canthus of eye Post auricular area Skull Midline of face (root of nose)

20. Clinical feature Cysts are usually congenital, painless, slowly growing and cosmetic disfigurement is main complain. Hardly attain big size to give any kind of serious effect and hardly infected. O n palpation non-tender, mobile, free from skin (skin above swelling can be lift), smooth regular surfaces cystic swelling. Indentation present. No punctum. These cysts are neither compressible nor reducible. Trans illumination is negative.

21. Treatment Surgical excision of complete cyst is the choice of treatment. If the cyst is present on skull, so before excision X-ray must be done to confirm that cyst has not eroded skull bone. Excision method is same as sebaceous cyst. Complication Infection Suppuration Ulceration Pressure on adjacent organ.

22. Implantation Dermoid It is an acquired Dermoid arises from puncture injury on skin. Injury leads the penetration of epithelium beneath the skin. Commonly found in gardeners, tailors and women. Common site are Palm of hand Fingers specially tip/pulp. Sole.

23. Clinical feature Patients usually have history of pricking injury On examination an tense cystic swelling, often firm/hard in consistency, there may be scar of injury. Elicitation of fluctuation is difficult due to small size and tension. Treatment Complete excision is the choice of treatment Complication Infection Suppuration Bursting

24. Teratomatous dermoid This is a cystic swelling develops from the totipotent cells with ectodermal predominance. Usually these cyst contain mesodermal elements like bone, cartilage etc. Hairs are almost always present in cyst. So the usual content are bone, cartilage, tooth, hairs and cheesy materials. Example Ovarian cyst Testis-teratoma Mediastinal cyst Post anal Dermoid Retroperitoneal cyst Treatment Complete Excision Teratomatous dermoid

25. Tubulodermoid These cyst develops due to un-obliterated portion of congenital ectodermal duct or tube. The cyst form due to accumulation of secretions of the line of ectodermal cells of unobliterated portion of embryonic duct Example Thyroglossal cyst Post-anal Dermoid Ependymal cyst in brain. Treatment C omplete Excision Thyroglossal cyst