StanaRoga in Ayurveda with modern concepts of breast tumour and abscess

Stanaroga or Breast diseases in Ayurveda

1. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 1

STANA-VIDRADHI/ STANAROGA/ STANAKILAKA/ STANABAJRA
Reference in classics-
CS- no reference
SS, MN, BP- stanaroga under different entity
Vāg- short description of stanavidradhi under general abscess.
KS- stanavajra or stanakilaka
Except difference in etiology, the above three entities are identical.
Definition of stanavidradhi
Doshas vitiated due to their respective causes- reaches the breasts of lactating or non-lactating
women, especially in pregnant and puerperal women as they have dialated dhamanis/ sirās/
nadis in the breasts- vitiate rakta and māmsa – produces five types of vidradhi (except raktaja).
Classifications
05 types – Vātaja, pittaja, kaphaja, sannipātaja & abhighātaja (SS)/āgantuja (BP)
(note: Vāg in general described six types of vidradhi also occur in breast including raktaja.
Kāshyap not given any classification, however has described features of stanakilaka due to V,P
& K)
Nidāna (both stanavidradhi and stanakilaka)
a) Incidence- pregnant and puerperal lady, most commonly who are lactating. Though it is
written in classics that the disease is absent in virgins (kanyā) however in practical field
the incidence is seen much less.
b) Diet- excessive ushna, vidāhi, ruksha, sushka and stale foods and other factors vitiate
rakta.
c) Mode of life- sleeping over uneven bed, abnormal acts (vichesthā) etc
d) Trauma or foreign body cause āgantuja vidradhi.
According to Kāshyap, stanakila occurs due to ingestion of bajra by wetnurse. Here by the
meaning bajra refers to trina (grass), kita (insect), tusa, shuka (bristle), makshikā (fly), losta
(stone), kesa (hair), una (wool) & asthi (bone).
Lakshana
“lakshanāni samānāni bāhyavidradhi lakshnai”
Means lakshanas are similar to external vidradhi (abscess)
1) Vātaja-

2. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 2

Local features
Colour-krishna (dark) or aruna (dark reddish)
Touch- paursha (hard, rough or stiff)
Pain- severe, piercing or tearing type
Size and shape- the swelling is uneven or increase and decrease alternately
Suppuration- very slowly
Discharge- after bursting thin discharge (tanu srāva) comes out.
Pulsation (spandana)- present.
General features- bhrama (giddiness) and Ānāha (flatulence)
According to Kāshyap the stanakilaka due to vāta increases very fast.
2) Pittaja
Local features-
Colour- ripen fruit of udumbara (pakwaudumbarasankāsha)
Size and shape- as like of udumbara fruit
Suppuration-very fast
Discharge-after bursting pitasrāva (yellowish) comes out.
General features- trishnā (thrist), moha (confusion), jwara (fever) & dāha (burning
sensation)
It suppurates and bursts quickly (KS)
3) Kaphaja-
Local features
Colour- resembles an earthen pot, pāndu (yellowish white)
Touch- sheeta (cold), stabdha (stiff)
Pain- alpavedanā (mild)
Itching- present
Suppuration- gradually or lately
Discharge- white (sheetāsrāva) after rupture
General features- utklesha (nausea), aruchi (anorexia), gaurava.
Kaphaja stanakila troubles for longer duration (KS) “kaphātchiram kleshayati”

3. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 3

4) Sannipātaja-
Local features
Colour- multiples colour “nānāvarnarujāsravo”
Pain- different types (piercing, burning, tearing etc)
Size and shape-Vishama (irregular), mahāna (big)
Suppuration- Vishama (irregular) pāka
Discharge- nānāsrāvā (irregularity)
Vāg accept mixed symptoms
5) Abhighātaja/ Āgantuja/ Kshataja- similar to pittaja and raktaja types (in this all vāta,
pitta and rakta all are vitiated).
6) Raktaja (only by Vāg)- is covered with black blisters and other features of pittaja
(burning, fever etc).
Samprāpti (pathogenesis)
 General pathogenesis- of five types including raktaja except āgantuja as described in the
definition.
 Specific pathogenesis of āgantuja type- person consuming apathy (non-congenial diet)
while getting abhighāta or kshata (closed or open wound) due to blow by wood, stone,
rock etc concealed or revealed bleeding vāyu aggravation this aggravated vāyu
withholding the heat of injury (kshatoshmā) travels all around and then vitiates rakta
and pitta. Ultimately reaches the channels of breast and producing vidradhi.
 According to Kāshyap pathogenesis of stanakila- if the wetnurse swallows vajra (foreign
body) neither digested nor metabolized gets moistened circulates by vāyu via
rasa dhātu reaches milk carrying channels of breast produces stanakila (hard
wedge/rod)
Correlation- exact correlation is difficult to made however on the basis of specific clinical
features it may be correlated as follows-
1) Vātaja- acute inflammatory stage of abscess
2) Pittaja- acute suppurative stage of abscess
3) Kaphaja- chronic stage of abscess
4) Sannipātaja- acute stage with necrosis
5) Abhighātaja- suppuration of accumulated blood by pyogenic bacteria

4. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 4

6) Raktaja- acute stage with very early stage of gangrene.
Treatment
Principles
1. Treatment of general ascess, vronasotha (inflammation) and vrona (ulcer) should be
prescribed according to their respective stages as follows-
Apakkwāvasthā
- Āmāvasthā vranasothavata chikitsa
- Pacchyāmānavasthā vidradhivata chikitsa
Pakkwāvasthā and after bhedana (its rupture)- vranavata chikitsa.
2. Repeated squeezing (dohana) should be done in all stages.
3. Use of pittaghna and sheeta dravyas
4. Rakta mokshana with the help of leeches.

Treatment according to the different stages-

I. Āmāvasthā (before its suppuration)- at this stage characterized by inflammation (sotha)
so the treatment prescribed in vranasotha (except upnāha/ poultice) should be used.
o Lepa (anointment) abhyanga (massage) pariseka (irrigation)
raktamokshana (venesection) in sequential orders.
o During this stage constant sheetaupachāra (cold treatment) are given in
the form of lepa, pariseka etc.
Recipes-
Vātaja- irrigation with luke warm ghreeta, taila, mamsarasa and decoction of
Bhadradāru. Paste of devadāru, rāsna and agnimantha for lepa.
Pittaja/ raktaja/ abhighātaja- irrigation with milk, ghreeta, lukewarm decoction
of madhura group or ksheerivriksha (or cold decoction). Paste of yashimadhu,
chandana, ushira etc mixed with ghreeta.
Kaphaja- irrigation with gomutra, kshārodaka, surā, sukta or with decoction (hot)
of kaphaghna drugs. Paste of ajagandhā, ajasringi, manjisthā.

II. Pacchyamānāvasthā (stage of suppuration)- This stage should be treated by vidradhivata
chikitsa mentioned under general abscess.
Vātaja- thick lepa with vātaghna drugs mixed with ghreeta, taila and vasā.
Swedana with vesabār, krisharā, pāyasa, dugdha or shigrumool kwath. Drink-
decoction of dashamoola mixed with guggula and eranda taila.
Pittaja- lepa with yasthimadhu, chandana, ushira, sārivā pasted with milk or with
ksheerivriksha pestled with ghreeta. Irrigation with jeevaniya ghreeta. Drink-
trivrit or triphala kwath (for purgation).

5. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 5

Kaphaja- lepa with istikā (brick) bālukā cowdung cowurine. Swedana
with heated istikā, bālukā, losta (stone), loha, cowdung etc. drink dashamoola
kwath mixed with guggula and gomutra.
Raktaja/ abhighātaja- treatment prescribed in pittaja type.

III. Pakkwāvasthā (after suppuration)- according to sushruta in this stage bhedana (incision)
followed by sravana (drainage) is done. The bhedana of the suppurated abscess is done
either medicinally or surgically.
 Medicinal- the aim is to incise the suppurated abscess. The karma known as
dāranakarma. Mainly ushna and tikshna lepana are applied over the abscess for bursting
out the pus. Drugs used are- danti, dravanti, chitraka etc.
 Surgical- bhedana and visrāvana (incision and drainage) by vriddhipatra (scalpel),
nakhashastra (nail cutter), mudrika shastra (finger knife) or utpal patra (lancet)

IV. Pacchāta karma/ treatment after rupture- the treatment applied is as varanavata chikitsa.
After proper drainage the wound should be sterilized and washed out with vronasodhana
drugs (medicaed oil, ghreeta, varti, rasakriya, kwath etc.) and then application of ropana
(healing) drugs to heal up the wound.
a. Irrigation- with decoction of panchamoola (V), ksheerivriksha (P), ārogvadhā (K)
b. Washing with neem or triphala kwath.
c. Ropana medications- karanjādi ghreeta/taila, jātyādi taila etc.

V. Pathya (congenial deeds)
 Before suppuration- Virehana, lepana, swedana, raktamokshana as diet- lasuna,
kulattha, punarnavā, chitraka etc.or the pathya mentioned in vronasotha.
 After suppuration- sashtrakriya
As diet- old raktasāli, taila, ghreeta, yusha, vilepi, māmsarasa.

STANAKILA
“sahānnapānena yadā dhātri bajra….” (KS)
Nidāna, lakshana and samprapti have been descried under stana vidradhi in reference to
Kashyap. Here only the specific lakshana and treatment will be discussing here.
Lakshana (clinical features)- of stanakilaka or peetabajrā (woman having ingested vajra)-
 Mainly related to GIT- aruchi, kapha- utklesha, atisāra.
 Parvabheda (joint pain), angamarda, angagraha (stiffness), shirashoola, kshvathu etc
 Jwara, trishnā.
 Mutrasanga.

6. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 6

Local clinical features in the breast-
 Stambha (stiffness), srāva (discharge), sotha, shoola, rujā, dāha and tenderness.
 Shirajāla (net of vessels) appears all around.
Treatment
Conservative
 First of all ghreeta should be given orally (with this unction the srotas get softened, thus
vajra slips out or expelled out)
 Careful dohana (milking) and mardana (massage)
 Pariseka (irrigation) with cold medications
 Pralepa (anointment) with cold medications
 Purgation
 Pathya sevana.
Surgical
 Apakkwa (before suppuration)- srāvana (drainage)
 Pakkwa (after suppuration)- Pātana (incision)
 Post operative management as that of vidradhi.
Correlation- thickened pus said as coming out of as kila or stanabajra by Kashyap.
Abbreviations
 CS- Charak Samhita
 SS- Sushrut Samhita
 MN- Madhava Nidan
 BP- Bhava Prakash
 Vāg- Vagbhata (Astanga Hridaya)
 KS- kashyapa Samhita
 V- Vata
 P- Pitta
 K- Kapha

7. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 7

MODERN VIEW
Differences between BREAST TUMOUR and BREAST ABSCESS
Points BREAST TUMOUR BREAST ABSCESS

Definition A tumour is an uncontrolled growth
which has played no essential
function. This growth is organized by
‘oncogenes’
Abscess is a closed cavity containing
pus.
Nature Non-inflammatory swelling and
power of metastases (malignancy)
Inflammatory, non-malignant

Transmission Malignant are invasive and metastatic
(eg-duct papilloma-benign to duct
CA)
Absent
Origin CA arise from the epithelium of the
duct system
Segments / lobules are involved
Classification Broadly benign and malignant
Benign- epithelial (duct papilloma,
adenoma), connective tissue
(neurofibroma, lipoma), mixed
(fibroadenoma)
Malignant- Duct CA (commonest),
lobular CA, Tubular CA, Colloid CA,
Medullary CA.
Clinically - pyogenic, pyaemic & cold
types
Anatomically- sub areolar,
- intra mammary,
- retro mammary.
Etiology a. Predisposing factors- heredity,
a benign growth
b. Causes- unknown, some
carcinogens are responsible. Is
common in criteria as-
Geographical- western country
Age- middle age
Genetic- family history of Breast CA
Diet- saturated fatty acid, alcohol
Endocrine- nullipara, obese,
menopausal.
Others- any hyperestrogenic state,
OCP, HRT, smoking etc.
Mastitis, weaning, retracted nipple or
cracked nipple, infection.
 Mastitis- infant, bacterial,
mastitis from milk engorgement
during weaning
 Retracted or cracked nipple
 Infection through baby’s mouth
 Blood born infection
It is an infective condition mainly by
staphylococcus aureus.
Clinical
features
a. Painless hard lump with
retracted nipple
b. Involvement of the axillary
and internal mammary lymph
nodes
c. Symptoms of metastases
(bone, viscera etc)

a. All symptoms of acute
inflammation
b. Tenderness
c. Fluctuation test may be positive
d. Systemic- fever, anorexia,
malaise

8. Stanaroga, Dr. Anuradha Roy, PT, Ay, BHU Page 8

Prognosis Poor in case of malignancy, which
depends on TNM staging.

Good
Investigations FNAC is most important Mammography, USG and ducography.

Treatment Benign are treated fruitfully by simple
excision along with capsule. The
malignant are either palliable or
incurable. Depending upon clinical
stage, TNM grading it can be
managed as-
1. Surgery (mastectomy)
2. Radiotherapy
3. Chemotherapy
4. Hormone therapy
5. Combined chemotherapy with
hormone therapy
6. Breast reconstructive surgery
(nipple reconstruction, breast
prostheses etc)
1. Rest to the breast
2. Rest to the patient
3. Broad spectrum antibiotics
4. Feeding of the affected breast is
restricted
5. Emptying by breast pump
6. Local heat and fomentation
7. Analgesics for the relief of pain
8. Surgical I & D
9. If occur during lactation period-
use of anti lactative hormones as
Stilboestrol, Bromocriptine,
Cabergolin.

Surgery in breast abscess
For better cosmetic result a circum-areolar incision is preferred, otherwise a transverse or a radial
incision is done over the affected segment (as far as possible the areola should be saved).
Incision should be made through the skin and the superficial fascia. A long haemostat (or closed
artery forceps) is then inserted into the abscess cavity and every lobules should be opened. Then
the instrument is withdrawn and the finger is introduced and any remaining pus pockets are to e
disrupted. When an abscess cavity is found in lower quadrant of the breast, a counter incision
should be made at the most dependent part of the breast and a drainage tube (corrugated tube) is
inserted and kept for 2-3 days. After removing this tube the incision (wound) should be sutured
and treat the wound accordingly i.e proper dressing with all antiseptic measures.






Haemostat
Drainage tube
Counter incision