The deranged and aggravated Vŕyu in combination with the deranged and augmented Kapham and fat of the locality affects the two tendons of the neck (Manyás) and gradually gives rise to a swelling about that part of the neck characterised by the specific symptoms of the deranged Doshas (Vŕyu or Kapham) and principles involved in the case. The swelling is called Galganda (Goitre). 17.
The swelling or tumour in the Vátajá goitre is characterised by a pricking pain (in its inside) marked by the appearance of blue or dark coloured veins Sirá) on its surface. It assumes a vermilion or tawny brown hue. The goitre becomes united with the local fat in course of time, and gains in size, giving rise to a sense of burning in the throat, or is characterised by the absence of any pain at all. A Vátaja goitre is rough to the touch, slow in its growth, and never or but rarely suppurates. A sense of dryness in the throat and the palate as well as a bad taste in the mouth likewise marks this type. The swelling in the Kaphaja Type assumes a large shape and becomes hard, firm, cold and of the same colour (white). There is but slight pain and the patient feels an irresistible inclination to scratch the part. It is slow in its progress and suppuration is rare and tardy. A sweet taste is felt in the mouth and the throat and the palate seem as if smeared with a sort of sticky mucous. 18-20.
The swelling is glossy, soft (heavy - D.R) and pale-coloured. It emits a fetid smell and is characterised by excessive itching and an absence of pain. It is short at its root and hangs down from the neck in the shape of a pumpkin (Alávu), gradually gaining its full rotundity at the top. The size of the goitre is proportionate to the growth or loss of flesh of the body. The face of the patient looks as if it has been anointed with oil and a peculiar rumbling sound is constantly heard in the throat. 21 .
Prognosis: - A case of goitre attended with difficult respiration, a softening of the whole body, weakness, a nonrelish for food, loss of voice as well as the one which is more than of a year's standing should be abandoned by the physician as incurable. 22.
A pendent swelling whether large or small and occurring about the region of the throat and resembling the scrotum in shape is called a Gala-Ganda. 23.
Thus ends the eleventh Chapter of the Nidána Sthánam in the Susrutá Samhitá which treats of the Nidánam of Granthi, Scrofula, etc.