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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 140-144

Conservative management of a Galastha Vidradhi (~inflammatory neck swelling) through Ayurveda: a case report


Central Ayurveda Research Institute, Bhubaneswar, Odisha, India

Date of Submission06-May-2021
Date of Decision23-May-2021
Date of Acceptance31-May-2021
Date of Web Publication28-Jun-2021

Correspondence Address:
Dr. Krishna R Sathya
Central Ayurveda Research Institute, Bhubaneswar, Odisha.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_40_21

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  Abstract 

Neck swelling due to various causes is common across age groups, and invasive methods are usually done in its management. An inflammatory swelling is considered in Ayurveda as Vidradhi (~abscess) or Vranasopha (~inflammatory swelling). A 27-year-old male patient with a solitary inflammatory neck swelling was successfully treated in 21 days with noninvasive methods like internal medicines and external therapies. Internal medicine like Trayanthyadikwatha, Gopichandanadi tablet, Sudarsanam tablet, Septilin syrup, Varanadikwatha, and Abhayarista were given as per the disease progression. Therapies like medicated lukewarm gargles, Murivena, and egg white external application were also done as per the stage of inflammation. The patient had a complete recession of the swelling without any discoloration or any other complication. The results of the present case report suggested that proper evaluation of Dosha and intervention at the right time key in managing such types of swellings from suppuration and avoid surgical intervention.

Keywords: Ayurveda, Idradhichikitsa, inflammatory neck swelling, noninvasive management, Vrana Sopha


How to cite this article:
Sathya KR, Sabu I, Panda AK, Ratha KK, Rao MM. Conservative management of a Galastha Vidradhi (~inflammatory neck swelling) through Ayurveda: a case report. J Indian Sys Medicine 2021;9:140-4

How to cite this URL:
Sathya KR, Sabu I, Panda AK, Ratha KK, Rao MM. Conservative management of a Galastha Vidradhi (~inflammatory neck swelling) through Ayurveda: a case report. J Indian Sys Medicine [serial online] 2021 [cited 2021 Jul 26];9:140-4. Available from: https://www.joinsysmed.com/text.asp?2021/9/2/140/319466




  Introduction Top


The neck forms an important anatomical and surgical structure that connects the head with the rest of the body. It is like a junction where vital functional structures like nerves, arteries, veins and lymph vessels etc. meet and transit and hence an area to be managed with utmost care. Neck swelling is one of the common findings found in all age groups due to various causes, ranging from congenital to acquired, from cystic, inflammatory, and infective to neoplastic disease.[1] The differential diagnosis of neck swellings is also extensive. An abscess is a localized collection of pus or purulent fluid, which can be benign, potentially treated with antibiotics, and is also one of the commonest surgical conditions. In cases like subcutaneous and soft-tissue abscesses, incision and drainage (I and D) exclusive of primary closure are the treatment of choice with a significant drawback of delayed healing and pain and can leave ugly scars.[2]

In Ayurveda, the inflammatory swelling is correlated with Vidradhi.[3] It is a condition caused by vitiation of skin, muscle, fat tissue, bone, ligament, blood, and tendon, which leads to one or more swelling, either external or internal.[4]Bahyavidradhi (~external abscess) is a painful condition with all features of inflammation and tendency for suppuration,[5] and the Ama (~unripe stage), Pachyamana (~ripening stage), and Pakva (~ripened stage) are similar to that of Sopha (~inflammatory edema). Vidradhi is primarily managed in Ayurveda, in line with Sopha using internal medications and external therapies that prevent suppuration of the swelling, i.e., conservative management. If the condition proceeds toward suppurative changes, suitable surgical procedures like incision, drainage etc. are done in line with Vranachikitsa.

Cases of Vidradhi can be successfully prevented by proceeding to suppuration, and surgical procedures can be avoided if managed effectively using Ayurveda principles. Conservative management also avoids complications that can occur postsurgical procedures and reduce the time of hospital visit also. This is a case successfully managed conservatively purely on Ayurveda principles.


  Case Report Top


A 27-year-old (Reg No 6669) male patient, nonsmoker and nonalcoholic, presented with a tender solitary swelling in the right of the neck for two months, associated with a tingling sensation around the swelling and pain in major joints with morning stiffness [Figures 1 and 2]. On examination, the swelling measured 5cm × 7cm extending from the midline extending to the right side of the neck to the medial aspect of the sternocleidomastoid muscle. The swelling was smooth, soft, fluctuant, warm, and with grade 1 tenderness. On physical examination, the patient is afebrile and with a pulse of 72/min, a blood pressure of 130/80 mm Hg, respiratory rate of 12 breaths/min. Hematological investigation done on December 6, 2018 revealed that total white blood cells were 10,700 cells/cmm3, hemoglobin was 11.4g/dL, erythrocyte sedimentation rate (ESR) was 110 mm first hour, antistreptolysin “O” (ASO) was 927 IU/mL, C-reactive protein was 4.1 mg%, and PO2 was 98%.
Figure 1 and 2: Status of swelling on December 6, 2018 (day 1)

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History suggested that the complaint started as a small, hard pea-sized swelling without any tenderness on the right side of the neck and was hence neglected by the patient. There was no difficulty in swallowing and hoarseness of voice during this period. Gradually, over 15 days, he developed pain in swelling and took Homeopathic medicine for two weeks, but the size increased to almost three times, and he developed a fever. Then, he took allopathic medication for around three weeks, and the fever subsided, along with softening of the lump as though filled with fluid/pus. He took Ayurveda medicine from a practitioner, but the pain and swelling aggravated associated with pain in joints and difficulty in walking.

On the assessment of Ayurveda parameters using Astavidhapariksha (eight-fold of examination) were Nadi (~pulse): SarpaGati, Mutra (~urine): Avila Varna, Mala (~stool): Samanya (normal), Jivha (~tongue): Anupalepa (clear), Sabda (~sound): Samanya (~normal), Sparsa (~touch): Ushna (~warm), Druk (~appearance): Samanya (~normal), Akruti (~physical constitution): Samanya (~normal). The patient was found to be Vatapittaprakruthi (~constitution).


  Timeline Top


The condition was managed at the Outpatient Department level in lines of Apakva sopha (~nonsuppurative swelling) and Vidradhi (~abscess).[6] Internally, Trayanthyadikwatha[7] was administered along with Gopichandanadi tablet; Sudarsanam tablet, lukewarm gargle with Triphala[8]kwatha along with Tankanabhasma.[9] Septilin syrup was administered for a week. Externally, Murivennapichu was advised along with medication. On day 3, as the patient reported a change in consistency of the swelling to a fluid-filled one and increased redness [Figures 3 and 4], external application of egg white was advised, avoiding the most tender area, and Murivennapichu was stopped. On the next visit (day 5) [Figures 5 and 6], the internal medicine was revised to Varanadikwatha,[10] AYUSH 64, and Abhayarista.[11] External application of egg white and the gargle was advised to be continued for two weeks [Table 1]. The patient was not on any other medication during the treatment period.
Figure 3 and 4: Status of swelling on December 9, 2018 (day 4)

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Figure 5 and 6: Status of swelling on December 10, 2018 (day 5)

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Table 1: Timeline

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  Follow-up and Outcome Top


It was observed that the inflammatory swelling was successfully managed completely [Figure 7] by two courses of internal medications and external therapies only over a period of 16 days. The condition was treated with no other medication or surgical/parasurgical procedures like drainage and bloodletting.
Figure 7: Status after treatment on December 21, 2018 (day 16)

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  Discussion Top


According to Ayurveda, an inflammatory swelling if not managed properly by external and internal therapies or due to profound increase of dosha is prone to suppuration.[12] In this case, it was managed purely using the management principles of Vidradhi and Sopha. Based on the symptoms, the dushya was assessed to be Pitta-kapha. As the clinical presentation and hematological parameters like elevated ESR and ASO were evocative of an inflammatory pathology, with an aim to prevent suppuration, Thrayanthyadikashaya told in Vidradhichikitsa and Gopichandanadi tablet used in Jwarachikitsa were administered. Sudarsanam tablet mentioned in Jwarachikitsa also was given, aiming to prevent further suppuration due to its predominant Thikta rasa (bitter taste). The initial line was in pitta pacifying manner as the inflammatory markers were elevated and to prevent suppuration. Tripahalakwatha with Tankanabhasma for lukewarm gargle was advised to prevent any Kapha accumulation that can be a substrate for further infections. Aiming at arresting any probability of suppuration, Murivennataila was advised externally as Pichu. Septilin syrup was also administered during the visit as it has proven antagonisticability to suppress acute inflammation and wound healing.[13]

As there is a mild progression toward suppuration, the external Murivennapichu was stopped and advised application of egg white (for a time till it gets dried up on its own) owing to its slimy nature, avoiding most tender site for the purpose of Prapeedana (~pressing of a swelling).[14] The patient reported watery exudates from the swelling on the application of egg white, along with a reduction in symptoms like redness, size of the swelling, and warmth of the swelling. During the next visit, on day 5, as the signs of inflammation (Paithika symptoms) were absent, and the swelling was hard in consistency, the management focused on Kaphasamana. So, Varanadikwatha, which is Kaphahara and used in management of Abhyantaravidradhi (internal abscess) was administered. AYUSH-64 was administered after food as it is a common drug used in fever and inflammatory conditions.[15] As the patient reported mild constipation, Abhayarista was included twice daily after food aiming at Vataanulonama. The external application of egg white was advised to be continued for two weeks.

The complaints were completely cured at the follow-up after 21 days, which shows that a proper evaluation of Doshas and intervention at the right time can manage such swellings from suppuration and avoid surgical intervention.


  Conclusion Top


Inflammatory swellings can be effectively and safely managed by nonsurgical measures like internal medicines and external applications. The conservative management principles of Sopha, Vidradhi, and Vranachikitsa can be beneficial in other types of inflammatory and noninflammatory swelling. Conservative management of similar disease conditions prevents the postsurgical complications and considerably reduces the treatment cost involved.

Acknowledgement

The authors would like to thank Director General CCRAS and Deputy Director General CCRAS for the support and guidance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abraham SZ, Mathias M, Mapondella BK, Kahinga AA, Ntunaguzi D, Massawe RE. Prevalence and aetiology of neck masses among patients receiving surgical services at Muhimbili National Hospital, Tanzania. Med J Zambia 2019;46:54-60.  Back to cited text no. 1
    
2.
Singh A, Singh G, Sidhu DS, Bhalla M. Conventional incision and drainage versus incision and drainage with primary closure in acute abscess: A prospective study. Int Surg J 2018;5:281-5.  Back to cited text no. 2
    
3.
Shekokar AV, Borkar KM, Sapkal LU. A case control study of tilkalka (sesamum paste) Madhusarpivarti in the management of Vidradhi Bhedana and Vistravana (I&D). Int J Ayureda Pharma Res 2013;1:59-63.  Back to cited text no. 3
    
4.
Murthy SK, editor. Astagahridaya of Vagbhatta. NidanaSthana. Chapter 11, Verse 2. Varanasi: Chaukhamba Surbharati Prakasan; 2003. p. 100.  Back to cited text no. 4
    
5.
Murthy SK, editor. Astagahridaya of Vagbhatta. NidanaSthana. Chapter 11, Verse 4. Varanasi: Chaukhamba Surbharati Prakasan; 2003. p. 101.  Back to cited text no. 5
    
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Murthy SK, editor. Astagahridaya of Vagbhatta. ChikitsaSthana. Chapter 13, Verse 1. 5th ed. Varanasi: Chaukhamba Surbharati Prakasan; 2003. p. 391.  Back to cited text no. 6
    
7.
Murthy SK, editor. Astagahridaya of Vagbhatta. ChikitsaSthana. Chapter 13, Verse 11-13. 5th ed. Varanasi: Chaukhamba Surbharati Prakasan; 2003. p. 393.  Back to cited text no. 7
    
8.
Murthy SK, editor. Astagahridaya of Vagbhatta. Sutra Sthana. Chapter 6, Verse 159. 5th ed. Varanasi: Chaukhamba Surbharati Prakasan; 2004. p. 105.  Back to cited text no. 8
    
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Sharma S, editor. Ras Tarangini. Kshartrikvigyaneeyyatarang. Chapter 13, Verse 119. 11th ed. reprint. Varanasi: Motilal Banarasidas Publishers; 2012. p. 325.  Back to cited text no. 9
    
10.
Murthy SK, editor. Astagahridaya of Vagbhatta. Sutra Sthana. Chapter 15, Verse 21-22, 5th ed. Varanasi: Chaukhamba Surbharati Prakasan; 2004. p. 203.  Back to cited text no. 10
    
11.
Krishnanvaidyar KV, Gopalapillai S. Sahasrayogam. Aristayoga. 26th ed. Mullakkal: Vidyarambam Publications; 2006. p. 236.  Back to cited text no. 11
    
12.
Murthy SK, editor. Astagahridaya of Vagbhatta. Vol. 2. ChikitsaSthana. Chapter 13, Verse 26-27. 5th ed. Varanasi: Chaukhamba Surbharati Prakasan; 2003. p. 396.  Back to cited text no. 12
    
13.
Udupa AL, Rao SG, Kulkarni DR. Wound healing profile of septilin. Indian J Physiol Pharmacol 1989;33:39-42.  Back to cited text no. 13
    
14.
Dalhana A. Commentary NibandhaSangraha on Susruta Samhita of Sushruta. Chikitsasthana. Chapter 1, Verse 11 Dvivraniya. Varanasi: Chaukhamba Sanskrit Santhan; 2009. p. 481.  Back to cited text no. 14
    
15.
Gundeti MS, Bhurke LW, Mundada PS, Murudkar S, Surve A, Sharma R, et al. AYUSH 64, a polyherbal Ayurvedic formulation in influenza-like illness: Results of a pilot study. J Ayurveda Integr Med2020;S0975-9476(20)30025-5. doi: 10.1016/j.jaim.2020.05.010  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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