E-ISSN:2456-3110

Case Report

Ganglion cyst

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 8 September
Publisherwww.maharshicharaka.in

Effect of Apamarga (Achyranthes aspera) Ksharajala over Recurrent Ganglion Cyst of Great Toe - Case Report

Meghana A.1*, P Warma S.2, Gopikrishna B.3
DOI:

1* A M Meghana, Second Year Post Graduate Scholar, Department of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Shyam P Warma, Assistant Professor, Department of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 B J Gopikrishna, Professor & HOD, Department of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Ganglion cysts are cystic swelling occurring in relation to tendon sheath or synovial sheath or joint capsule containing clear gel like fluid. They usually occur at the dorsum of wrist (Near scaphoid-lunate articulation), flexor aspect of wrist and occasionally around ankle joint. Its occurrence in the great toe is rare. The condition is managed by injecting sclerosing agent like hyaluronidase or by excision. In Ayurveda, swellings are usually compared to Granthi but it is difficult to corelate ganglion cyst to a particular type of Granthi. In this case study, a 52-year-old male patient reported to the outpatient Department of Shalya Tantra SDMCAH, Hassan, with repeated complaints of swelling in plantar aspect of great toe with occasional tingling and numbness every month. The swelling was diagnosed as ganglion cyst. Excision of swelling followed by Apamarga Ksharajala was done. No reoccurrence of cyst along with relief in clinical manifestations was the outcome. Therefore, this case report proposes an innovative treatment modality for management of ganglion cyst and the observation made here would be useful for organizing future clinical trials.

Keywords: Ganglion cyst, Ayurveda, Granthi, Apamarga Ksharajala

Corresponding Author How to Cite this Article To Browse
A M Meghana, Second Year Post Graduate Scholar, Department of Shalya Tantra, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		A M Meghana, Shyam P Warma, B J Gopikrishna, Effect of Apamarga (Achyranthes aspera) Ksharajala over Recurrent Ganglion Cyst of Great Toe - Case Report. J Ayu Int Med Sci. 2022;7(8):149-152.
Available From
https://www.jaims.in/jaims/article/view/2038

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-01 2022-08-02 2022-08-09 2022-08-16 2022-08-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by A M Meghana, Shyam P Warma, B J Gopikrishnaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Meghana A et al: Apamarga Ksharajala over Recurrent Ganglion Cyst of Great Toe

Introduction

Ganglion cysts are non-cancerous tissues which commonly arise close to tendons or any joints. Although it occurs in various locations, it develops more frequently in the dorsal aspect of the wrist joints. Occurrence of ganglion cysts over plantar aspect of great toe is rare. These cyst cause pain and discomfort

on walking and are usually soft or undeviating and sizing up to 1 to 3 centimetre in diameter loosely attached to sheath of the tendon or joint capsules.

In modern science aspiration and excision are described measures to manage ganglion. Aspiration is commonly practiced treatment which resolves the cyst in a few and reoccurs in some others. The surgical management that is excision of ganglion is also known to cause reoccurrence.

To reduce the recurrence there is a need for a minimal invasive uncomplicated technique. In Ayurveda, Acharya Sushruta has explained Kshara Karma a parasurgical procedure which does Chedana (excision), Bhedana (incision) and Lekhana (scraping). It is a unique procedure which alleviates Tridosha and it is considered best among Shastra (surgical instruments) and Anushastra (parasurgical instruments).[1] Here in we report a case of a 52 years old patient of ganglion cyst over great toe managed by Apamarga Ksharajala.

Case Report

A male patient aged 52 years who is a known case of Type 2 diabetes mellitus approached Shalya Tantra OPD of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan with complaints of swelling in the plantar aspect of great toe with occasional tingling and numbness since 2 years. The patient had pain on walking but had no history of trauma.

2 years back when he approached with the same complains after thorough clinical examination the swelling was diagnosed as a ganglion cyst and the cyst was excised and the contents were sent for cytological study for the confirmation of diagnosis. Within two months the cyst reoccurred and it was managed by intralesional injection of hyaluronidase followed by fine needle aspiration.

jaims_2038_01.PNG

Fig. 1: Cytology report

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Fig. 2: X-ray of left foot


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Meghana A et al: Apamarga Ksharajala over Recurrent Ganglion Cyst of Great Toe

jaims_2038_03.PNGFig. 3: Excision of cyst

Apamarga Ksharajala Preparation[2]

Apamarga Kshara is an alkaline substance obtained from the ash of Apamarga. The dried pieces of Apamarga herb are put in an earthen pot and burnt to ash. After cooling the ash, the ash must be dissolved in 6 parts of water and stirred. This is then filtered through a piece of clean linen for 21 times till a clear liquid is obtained. This liquid is then taken in an iron vessel and heated over moderate fire till the water evaporates, leaving a solid salty white substance that is known as kshara. Ksharajala is the supernatant solution of Apamarga Kshara.

Management: Excision of the cyst was done using blade number 11 and a jelly like clear, thick, sticky, colourless material was seen. Later 0.5 ml of Pratisaraneeya Ksharajala was locally applied. Nimbu Swarasa (lemon juice) was applied in the area of Ksharajala injected and Pakwa Jambu Phala Varna was observed. Dressing was done with Ropanaghritha (medicated ghee).

jaims_2038_04.PNGFig. 4: Recurrence of cyst after excision.

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Fig. 5: Excision followed by Pratisaraneeya Apamarga Ksharajala application.

Observation

Features After Excision After excision followed by Prateesaraneeya Ksharajala
Collection of Fluid Present Absent
Fluctuation Present Absent
Pain Absent Absent

Follow-Up: Patient was called for follow-up every week. After a week there was no collection of fluid and wound was healing. After 30 days when it was observed there was no reoccurrence of cyst or collection of jelly like substance. The keratinized tissue was observed.

jaims_2038_06.PNG

Fig. 6: Post application of Pratisaraneeya Apamarga Ksharajala on 3rd day, 7th day and 1 month.

Discussion

In Ayurveda various types of Granthi can be correlated to swellings or lumps, however it is difficult to correlate ganglion cyst to a particular type of Granthi. Usually, Granthi are managed by Shastrakarma, Ksharakarma and Agnikarma.


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Meghana A et al: Apamarga Ksharajala over Recurrent Ganglion Cyst of Great Toe

To prevent reoccurrence of ganglion cyst, excision and local application Pratisaraneeya Apamarga Kshara Jala can be recommended. Kshara is the substance that removes vitiated material from skin, flesh etc. (Dusta Tvagmamsadi) or the substance which detoxifies the Dosha (bodily humour), Dhatu (tissues) and Mala (excreta) is known as Kshara.[3] Kshara possess caustic properties and helps in excision of unwanted tissues. It works locally as a sclerosing agent.[4] Kshara has properties of Chedhana, Bhedana and Lekhana and also Vrana Shodana (purification of wound) and Ropana (healing) properties. It is mentioned in the classics, that the diseases which are difficult to treat can be cured by Kshara therapy.

Conclusion

In the present case, as the patient had reoccurrence of complaints several times even after repeated excision, therefore para surgical procedure of Ksharakarma was adopted. The local application of Pratisaraneeya Apamarga Ksharajala was done. This treatment was found to be effective. The technique of local application of Apamarga Ksharajala can be practiced for further cases and to prevent recurrence of ganglion cyst.

Declaration of patient consent: The authors certify that they have obtained the appropriate patient consent form. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Reference

1. Sushruta, Sushruta samhita, Vaidya Jadavaji Trikamji Acharya and by Narayan Ram Acharya Kavyatirtha, editor. Edition reprint, Chaukhambha Prakashanapage 2014. P.45

2. Sushruta, Sushruta samhita, Vaidya Jadavaji Trikamji Acharya and by Narayan Ram Acharya Kavyatirtha, editor. Edition reprint, Chaukhambha Prakashanapage 2014. P.46,47.

3. Sushruta, Sushruta Samhita, English Commentary by Sharma P.V., Varanasi, Chaukhamba Bharati Academy,Reprint 2010, Sutra Sthana 11/4, pp. 113.

4. Gundeti, M. S., Reddy, R. G., & Muralidhar, J. V. (2014). Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series. Journal of Ayurveda and integrative medicine, 5(4), 236–240. https://doi.org/10.4103/0975-9476.146558


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