ayurvedic concepts of granthi

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

2. Definition
• वातादयो माांसमसृक् च दुष्ााः सन्दूषय मेदश्च कफानुविव्धमम् |
वृत्तोन्नतां विवग्रथितां तु शोफां कु ववन््यतो ग्रन्न्िरितित ्रदिदष्ाः || 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
1. Vataj
2. Pittaj
3. Kaphaj
4. Medoj
5. Siraj

4. Vataj
• आयम्यते व्यथ्यत एित तोदां ्रद्यस्यते कृ ्यत एित भेदम् |
कृ षणोऽमृदुर्वन्स्तरितवाततश्च भभन्नाः स्रवेच्चािनलजोऽस्रमच्छम् ||४||
Pittaj
दन्दह्यते धमूप्यित चूषयते [१] च पापच्यते ्रदज्वलतीव चाविप |
तक्ताः सपीतोऽप्यिवाऽविप विपत्ता्भभन्नाः स्रवेदुषणमतीव चास्रम ् ||५|
Kaphaj
शीतोऽविववणोऽल्परुजोऽितकण्ूाः पाषाणवत् सांहननोपपन्नाः |
थचताभभवृ्थधमश्च कफ्रदकोपा्भभन्नाः स्रवेच्छु क्लघनां च पूयम ् ||६||

5. Medoj
शतीतवृ्थधमक्षयवृ्थधमहािनाः न्स्नग्धमो महानल्परुजोऽितकण्ूाः |
मेदाःकृ तो गच्छित चात्र भभन्ने विपणयाकसविपवाः्रदितमां तु मेदाः ||७||
Siraj
व्यायामजातैतर्लस्य तैस्तैताक्षक्षप्य वायुिहव भसता्रदतानम् |
सम्पीड्य सङ्कोच्य विवशोषय चाविप ग्रन्न्िां कतो्युन्नतमाशु वृत्तम ् ||८||
ग्रन्न्िाः भसताजाः स तु कृ च्रसाध्यो भवे्यिद स्यात ् सरुजश्चलश्च |
अरुक् स एवाप्यचलो [१] महाांश्च ममोन््ितश्चाविप विववजवनीयाः ||९||

6. Chikitsha sutra
• ग्रन्न्िषविामेषु भभषन्ग्वदध्याच्छोफक्रियाां विवस्ततशो विवथधमज्ञाः |
तक्षे्र्लां चाविप नतस्य िन्यां
तद्रक्षक्षतां व्याथधमर्लां िनहन्न्त | Su Chi 18/3
• अममवजातां शमम्रदयान्तमपक्वमेवापहते्विवदायव |
दहेत् न्स्िते चासृन्ज भस्धमकमाव
स्याःक्षतोक्तां च विवथधमां विवदध्यात ् | 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
1.True
2. False
i. Exudation cyst
ii. Degeneration cyst
Classi. II
1. Congenital
1. Sequestration Dermoid
2. Tubulo-dermoid
3. Cyst of embryonic remnants
2. Acquired
1. Retention
2. Distention
3. Exudation
4. Degeneration
5. Traumatic
6. Implantation
7. Cystic tumor
8. 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.

18. 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 pus then do I&D under local
anesthesia and treat like abscess. Leave the wound for healing with
secondary intension.

20. 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

21. 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)

22. 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.
• On 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.

23. 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.

25. 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.

26. 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

27. 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

28. 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
• Complete Excision
Thyroglossal cyst