The deranged and unusually aggravated Váyu etc. (Pittam and Kapham), by vitiating the flesh, blood and fat mixed with the Kapham (of any part of the organism), give rise to the formation of round, knotty, elevated swellings which are called Granthi (Glandular inflammation). 2.

The Dosha-Origined Types

The swelling (Sopha) of the Vátája type seems as if it were drawn into and elevated or as if severed or pricked with a needle, cleft in two or drawn asunder or as if cut in two or pierced. The knotty growth assumes a black colour, and is rough and elongated like a bladder. On bursting a granthi of this type exudes clear bright red blood. The Pittaja Granthi is characterised by heat and an excessive burning sensation (in its inside). A pain, like that of being boiled by an alkali or by fire, is felt in the inside. The knotty formation assumes a red or yellowish colour and exudes a flow of extremely hot blood on bursting. The Kaphaja Granthi is slightly discoloured and cold to the touch. It is characterised by a slight pain and excessive itching, and feels hard and compact as a stone It is slow or tardy in its growth and exudes a secretion of thick white-coloured pus when it bursts. 3-5.

The Medaja Type

The fat origined Granthi is large and glossy and gains or loses in size with the gain or loss of flesh by the patient. It is marked by a little pain and an excessive itching sensation and exudes a secretion of fat resembling clarified butter or a gruel, in colour and consistency, made of the levigated paste of sesamum on bursting. 6.

Sira-Granthi - (Aneurism Or Varicose Veins)

The bodily Vŕyu in weak and enfeebled persons, deranged by over-fatiguing physical exercises, straining or exertion or by pressure, presses on, contracts, dries or draws up the ramifications of veins (Sirŕ) or arteries (of the affected locality), and speedily gives rise to a raised knotty formation which is called a Sirá-Granthi. In the event of its being shifting and slightly painful, it can be cured only with the greatest difficulty. Whereas a case in which the knotty formation is painless, fixed, large and situated at any of the vital parts of the body (Marmas), should be deemed incurable.* 7.

Apachi - (Scrofula Etc.)

The augmented and accumulated fat and Kapham give rise to string of hard glossy, painless, nodular, or elongated granthi (swellings) about the joints of the jawbones, at the waist, joint, about the tendons of the neck, about the throat or about the region of the arm-pits. These glands (Granthis) resembling the stones of the Amalaka fruit or the spawn of fish in shape or like some other shape, are of the same colour as the surrounding skin; and a string or a large crop of such glandular knots, gradually growing is called Apachi † on account of the extensive nature of their growth. 8-9.

* In several editions an additional line is to be found running as men well conversant with symptoms (of Granthis) recognise a type of Granthi due 1o the action of the deranged flesh and blood, which exhibits symptoms identical with those of a tumour (Mansjrasrayam chárvuda laskhanena tvlyam hi drisktamath lakshanajanih). But Jejjata has rejected it as of questionable authority.

† These glandular formations appear about the root of the penis, about the sides, in the arm-pits and about the throat and the tendons of the neck.

These knotty formations are characterised by itching and a slight pain. Some of them spontaneously burst exuding secretions while others are observed to vanish and re-appear (in succession). Such vanishings, reappearances, or fresh formations continue for a considerable time. The disease undoubtedly owes its origin to the deranged fat and Kapham, and may only be made amenable (to medicine) with the greatest difficulty lasting for years at a time. 10.