STANA-VIDRADHI/ STANAROGA/ STANAKILAKA/ STANABAJRA

Reference in classics-

CS- no reference
SS, MN, BP- stanaroga under different entity
Vāg- short description of stanavidradhi under general abscess.
KS- stanavajra or stanakilaka

Except difference in etiology, the above three entities are identical.

Definition of stanavidradhi

Doshas vitiated due to their respective causes- reaches the breasts of lactating or non-
lactating women, especially in pregnant and puerperal women as they have dialated
dhamanis/ sirās/ nadis in the breasts- vitiate rakta and māmsa – produces five types of
vidradhi (except raktaja).

Classifications

05 types – Vātaja, pittaja, kaphaja, sannipātaja & abhighātaja (SS)/āgantuja (BP)

(note: Vāg in general described six types of vidradhi also occur in breast including
raktaja. Kāshyap not given any classification, however has described features of
stanakilaka due to V,P & K)

Nidāna (both stanavidradhi and stanakilaka)

a) Incidence- pregnant and puerperal lady, most commonly who are lactating. Though
it is written in classics that the disease is absent in virgins (kanyā) however in
practical field the incidence is seen much less.

b) Diet- excessive ushna, vidāhi, ruksha, sushka and stale foods and other factors
vitiate rakta.

c) Mode of life- sleeping over uneven bed, abnormal acts (vichesthā) etc

d) Trauma or foreign body cause āgantuja vidradhi.

According to Kāshyap, stanakila occurs due to ingestion of bajra by wetnurse. Here

by the meaning bajra refers to trina (grass), kita (insect), tusa, shuka (bristle),
makshikā (fly), losta (stone), kesa (hair), una (wool) & asthi (bone).

Lakshana

“lakshanāni samānāni bāhyavidradhi lakshnai”

Means lakshanas are similar to external vidradhi (abscess)

1) Vātaja-
Local features

Colour-krishna (dark) or aruna (dark reddish)

Touch- paursha (hard, rough or stiff)
Pain- severe, piercing or tearing type
Size and shape- the swelling is uneven or increase and decrease alternately
Suppuration- very slowly
Discharge- after bursting thin discharge (tanu srāva) comes out.
Pulsation (spandana)- present.

General features- bhrama (giddiness) and Ānāha (flatulence) According to Kāshyap

the stanakilaka due to vāta increases very fast.

2) Pittaja

Local features-

Colour- ripen fruit of udumbara (pakwaudumbarasankāsha)

Size and shape- as like of udumbara fruit
Suppuration-very fast
Discharge-after bursting pitasrāva (yellowish) comes out.
Pulsation (spandana)- present

General features-

Trishnā (thrist), moha (confusion), jwara (fever) & dāha (burning sensation)

It suppurates and bursts quickly (KS)

3) Kaphaja-

Local features

Colour- resembles an earthen pot, pāndu (yellowish white)

Touch- sheeta (cold), stabdha (stiff)
Pain- alpavedanā (mild)
Itching- present
Suppuration- gradually or lately
Discharge- white (sheetāsrāva) after rupture

General features-
utklesha (nausea), aruchi (anorexia), gaurava. Kaphaja stanakila troubles for longer
duration (KS) “kaphātchiram kleshayati”

4) Sannipātaja-

Local features

Colour- multiples colour “nānāvarnarujāsravo”

Pain- different types (piercing, burning, tearing etc)
 Size and shape-Vishama (irregular), mahāna (big)
Suppuration- Vishama (irregular) pāka
Discharge- nānāsrāvā (irregularity)
Vāg accept mixed symptoms

5) Abhighātaja/ Āgantuja/ Kshataja-

Similar to pittaja and raktaja types (in this all vāta, pitta and rakta all are vitiated).

6) Raktaja (only by Vāg)-

Is covered with black blisters and other features of pittaja (burning, fever etc).

Samprāpti (pathogenesis)

 General pathogenesis- of five types including raktaja except āgantuja as

described in the definition.
 Specific pathogenesis of āgantuja type- person consuming apathy (non-
congenial diet) while getting abhighāta or kshata (closed or open wound) due
to blow by wood, stone, rock etc concealed or revealed bleeding vāyu
aggravation this aggravated vāyu withholding the heat of injury (kshatoshmā)
travels all around and then vitiates rakta and pitta. Ultimately reaches the
channels of breast and producing vidradhi.
 According to Kāshyap pathogenesis of stanakila- if the wetnurse swallows
vajra (foreign body) neither digested nor metabolized gets moistened
circulates by vāyu via rasa dhātu reaches milk carrying channels of breast
produces stanakila (hard wedge/rod)

Correlation-

Exact correlation is difficult to made however on the basis of specific clinical features it may
be correlated as follows-

1) Vātaja- acute inflammatory stage of abscess

2) Pittaja- acute suppurative stage of abscess
3) Kaphaja- chronic stage of abscess
4) Sannipātaja- acute stage with necrosis
5) Abhighātaja- suppuration of accumulated blood by pyogenic bacteria
6) Raktaja- acute stage with very early stage of gangrene.

Treatment

Principles

1. Treatment of general ascess, vronasotha (inflammation) and vrona (ulcer) should be

prescribed according to their respective stages as follows-
 Apakkwāvasthā –
 Āmāvasthā vranasothavata chikitsa
  Pacchyāmānavasthā vidradhivata chikitsa
 Pakkwāvasthā and after bhedana (its rupture)- vranavata chikitsa.

2. Repeated squeezing (dohana) should be done in all stages.

3. Use of pittaghna and sheeta dravyas
4. Rakta mokshana with the help of leeches.

Treatment according to the different stages-

I. Āmāvasthā (before its suppuration)-

At this stage characterized by inflammation (sotha) so the treatment prescribed in

vranasotha (except upnāha/ poultice) should be used.
 Lepa (anointment) abhyanga (massage) pariseka (irrigation) raktamokshana
(venesection) in sequential orders. \
 During this stage constant sheetaupachāra (cold treatment) are given in the
form of lepa, pariseka etc.

Recipes-

1) Vātaja- irrigation with luke warm ghreeta, taila, mamsarasa and decoction of
Bhadradāru. Paste of devadāru, rāsna and agnimantha for lepa.
2) Pittaja/ raktaja/ abhighātaja- irrigation with milk, ghreeta, lukewarm
decoction of madhura group or ksheerivriksha (or cold decoction). Paste of
yashimadhu, chandana, ushira etc mixed with ghreeta.
3) Kaphaja- irrigation with gomutra, kshārodaka, surā, sukta or with decoction
(hot) of kaphaghna drugs. Paste of ajagandhā, ajasringi, manjisthā.

II. Pacchyamānāvasthā (stage of suppuration)-

This stage should be treated by vidradhivata chikitsa mentioned under general

abscess.

 Vātaja- thick lepa with vātaghna drugs mixed with ghreeta, taila and vasā.
Swedana with vesabār, krisharā, pāyasa, dugdha or shigrumool kwath.
Drink- decoction of dashamoola mixed with guggula and eranda taila.

 Pittaja- lepa with yasthimadhu, chandana, ushira, sārivā pasted with milk or
with ksheerivriksha pestled with ghreeta. Irrigation with jeevaniya ghreeta.
Drink- trivrit or triphala kwath (for purgation).

 Kaphaja- lepa with istikā (brick) bālukā cowdung cowurine. Swedana with
heated istikā, bālukā, losta (stone), loha, cowdung etc. drink dashamoola
kwath mixed with guggula and gomutra.

 Raktaja/ abhighātaja- treatment prescribed in pittaja type.

III. Pakkwāvasthā (after suppuration)-

According to sushruta in this stage bhedana (incision) followed by sravana (drainage) is done.
The bhedana of the suppurated abscess is done either medicinally or surgically.

1. Medicinal- the aim is to incise the suppurated abscess. The karma known as
dāranakarma. Mainly ushna and tikshna lepana are applied over the abscess for
bursting out the pus. Drugs used are- danti, dravanti, chitraka etc.

2. Surgical- bhedana and visrāvana (incision and drainage) by vriddhipatra (scalpel),

nakhashastra (nail cutter), mudrika shastra (finger knife) or utpal patra (lancet).

IV. Pacchāta karma/ treatment after rupture-

The treatment applied is as varanavata chikitsa. After proper drainage the wound should be
sterilized and washed out with vronasodhana drugs (medicaed oil, ghreeta, varti, rasakriya,
kwath etc.) and then application of ropana (healing) drugs to heal up the wound.

a. Irrigation- with decoction of panchamoola (V), ksheerivriksha (P), ārogvadhā (K)

b. Washing with neem or triphala kwath.
c. Ropana medications- karanjādi ghreeta/taila, jātyādi taila etc.

V. Pathya (congenial deeds)

 Before suppuration- Virehana, lepana, swedana, raktamokshana as diet- lasuna,

kulattha, punarnavā, chitraka etc.or the pathya mentioned in vronasotha.
 After suppuration- sashtrakriya As diet- old raktasāli, taila, ghreeta, yusha, vilepi,
māmsarasa.

STANAKILA

“sahānnapānena yadā dhātri bajra….” (KS)

Nidāna, lakshana and samprapti have been descried under stana vidradhi in reference to
Kashyap. Here only the specific lakshana and treatment will be discussing here.

Lakshana (clinical features)- of stanakilaka or peetabajrā (woman having ingested vajra)-

1. Mainly related to GIT- aruchi, kapha- utklesha, atisāra.

2. Parvabheda (joint pain), angamarda, angagraha (stiffness), shirashoola, kshvathu etc
3. Jwara, trishnā
4. Mutrasanga

Local clinical features in the breast-

1. Stambha (stiffness), srāva (discharge), sotha, shoola, rujā, dāha and tenderness.
2. Shirajāla (net of vessels) appears all around.

Treatment
Conservative
1. First of all ghreeta should be given orally (with this unction the srotas get softened,
thus vajra slips out or expelled out)
2. Careful dohana (milking) and mardana (massage)
3. Pariseka (irrigation) with cold medications
4. Pralepa (anointment) with cold medications
5. Purgation
6. Pathya sevana

Surgical

1. Apakkwa (before suppuration)- srāvana (drainage)

2. Pakkwa (after suppuration)- Pātana (incision)
3. Post operative management as that of vidradhi.

Correlation- thickened pus said as coming out of as kila or stanabajra by Kashyap.

 MODERN VIEW

Differences between BREAST TUMOUR and BREAST ABSCESS

Points BREAST TUMOUR BREAST ABSCESS

Definition A tumour is an Abscess is a closed
uncontrolled growth cavity containing
which has played no pus.
essential function. This
growth is organized by
‘oncogenes’
Nature Non-inflammatory Inflammatory, non-
swelling and power of malignant
metastases
(malignancy)
Transmission Malignant are invasive Absent
and metastatic (eg-duct
papilloma-benign to
duct CA)
Origin CA arise from the Segments / lobules
epithelium of the duct are involved
system
Classification Broadly benign and Clinically - pyogenic,
malignant Benign- pyaemic & cold
epithelial (duct types
papilloma, adenoma),
connective tissue Anatomically-
(neurofibroma, lipoma), sub areolar,
mixed (fibroadenoma) - intra mammary,
Malignant- Duct CA - retro mammary.
(commonest), lobular
CA, Tubular CA,
Colloid CA, Medullary
CA.
Etiology a. Predisposing Mastitis, weaning,
factors- retracted nipple or
heredity, a cracked nipple,
benign growth infection.
b. Causes-  Mastitis-
unknown, some infant,
carcinogens are bacterial,
responsible. Is mastitis from
common in milk
criteria as- engorgement
Geographical- western during
country weaning
Age- middle age  Retracted or
Genetic- family history cracked
of Breast CA nipple
Diet- saturated fatty  Infection
 acid, alcohol through
Endocrine- nullipara, baby’s mouth
obese, menopausal.  Blood born
Others- any infection
hyperestrogenic state, It is an infective
OCP, HRT, smoking condition mainly by
etc. staphylococcus
aureus.
Clinical features a. Painless hard lump a. All symptoms of
with retracted nipple acute inflammation
b. Involvement of the b. Tenderness
axillary and internal c. Fluctuation test
mammary lymph nodes may be positive
c. Symptoms of d. Systemic- fever,
metastases (bone, anorexia, malaise
viscera etc)
Prognosis Poor in case of Good
malignancy, which
depends on TNM
staging.
Investigations FNAC is most Mammography, USG
important and ducography.
Treatment Benign are treated 1. Rest to the breast
fruitfully by simple 2. Rest to the patient
excision along with 3. Broad spectrum
capsule. The malignant antibiotics
are either palliable or 4. Feeding of the
incurable. Depending affected breast is
upon clinical stage, restricted
TNM grading it can be 5. Emptying by
managed as- breast pump
1. Surgery 6. Local heat and
(mastectomy) fomentation
2. Radiotherapy 7. Analgesics for the
3. Chemotherapy relief of pain
4. Hormone therapy 8. Surgical I & D
5. Combined 9. If occur during
chemotherapy with lactation period- use
hormone therapy of anti lactative
6. Breast reconstructive hormones as
surgery (nipple Stilboestrol,
reconstruction, breast Bromocriptine,
prostheses etc) Cabergolin.
Surgery in breast abscess

For better cosmetic result a circum-areolar incision is preferred, otherwise a transverse or a

radial incision is done over the affected segment (as far as possible the areola should be
saved). Incision should be made through the skin and the superficial fascia. A long haemostat
(or closed artery forceps) is then inserted into the abscess cavity and every lobules should be
opened. Then the instrument is withdrawn and the finger is introduced and any remaining pus
pockets are to e disrupted. When an abscess cavity is found in lower quadrant of the breast, a
counter incision should be made at the most dependent part of the breast and a drainage tube
(corrugated tube) is inserted and kept for 2-3 days. After removing this tube the incision
(wound) should be sutured and treat the wound accordingly i.e proper dressing with all
antiseptic measures.