That swelling which grows more and more, again and again is called as Apachi. Master Sushruta defines Apachi as – ‘That which gets aggregated in different forms in a unique way and also undergoes increase intensively is called as Apachi’.

ते ग्रन्थयः केचिदवाप्तपाकाः स्रवन्ति नश्यन्ति भवन्ति चान्ये || ९ ||

कालानुबन्धं चिरमादधाति सैवापचीति प्रवदन्ति तज्ज्ञः |

साध्याः स्मृताः पीनस – पार्श्वशूल – कास – ज्वर – च्छर्दियुतास्त्वसाध्याः || १० ||

Apachi has been compared to a condition called as Lymphadenitis. Since Ayurveda also has explained about its longer course and disease pertaining for longer duration, it can be compared to chronic lymphadenitis. This occurs due to inflammation of the lymph glands in different parts of the body.

Master Charaka has mentioned only Gandamala but not Apachi. On the contrary Sushruta has explained only Apachi and not Gandamala.

PATHOGENESIS, PROGNOSIS

Some of these cysts / glandular swellings get suppurated and break open. They also exhibit discharges. Some of them spontaneously get destroyed, some surface yet again and some get newly manifest. This disease keeps coming and going and stays for longer duration. These swellings are curable. But the Apachi associated with rhinitis, pain in flanks, cough, fever and vomiting is said to be incurable.

Master Bhoja explains Apachi as –

‘Aggravated vata, pitta and kapha along with abnormally increased fat tissue reach the tendons of calf muscles and get lodged therein. They then produce many cystic swellings of fish eggs shape in that region. The vata then takes the other doshas and moves in upward direction and get lodged in chest, axilla, nape of the neck and neck and produce many types of cystic swellings. These swellings are called as Apachi. The same Apachi when forms in the region of neck, heart and joints of the jaw in the form of garland of cystic swellings it will be called as Gandamala’. This explanation shows that Gandamala is a form of Apachi.

SYMPTOMS

Glandular swelling in –

• Legs / calves

• Chest

• Axilla

• Nape of the neck

• Neck

• Region of heart

• Joints of the jaw

TYPES

Master Sushruta has explained two stages of this disease –

Stage 1 – Here, the glandular swellings are manifested which do not undergo suppuration. There is presence of itching and mild pain. According to Master Charaka, this stage is nothing but Gandamala. Charaka has mentioned that Gandamala does occur only in the neck. Master Bhoja too has mentioned that Gandamala is a type of Apachi but according to his explanation this condition occurs at multiple places in the body and is not limited to the neck.

Stage 2 – In this stage the swellings get suppurated, break open and discharges occur.

TREATMENT

1. INTERNAL MEDICATION

A. CHANDANADI TAILA

B. Kanchanara Guggulu is highly effective in curing Apachi.

C. Alambusha Prayoga- Juice of tender leaves of Alambusha – Sphaeranthus indicus is consumed.

D. Pupalika Prayoga- Pupalika i.e. a kind of sweetened cake is prepared with roots of Vana Ka rpasika – wild cotton and rice ground together. This is consumed for the cure of apachi.

2. EXTERNAL MEDICATION

A. Shobhanjanadi Lepa

B. Sarshapadi Lepa

C. Ashvattadi Bhasma Lepa

D. Gunjadi Taila Abhyanga

3. NASAL INSTILLATION

A. Vyoshadi Taila

4. AGNIKARMA

The physician should make an incision of the shape of the egg of fish 12 angula (finger breadth) above in line with the heel, over the calf muscle, avoiding the Indrabasti Marma – a vital spot in the leg. He should remove carefully the networks from that region and burn it with fire.

5. REKHA TRAYA VIDHANA

Above the wrist joint, with a gap of 1 angula each, physician should make three lines by burning those areas. This is said to cure Apachi.

6. AUSHADHA DHARANA- Root of Sahadevi – Vernonia cinerea plucked on Pushya Nakshatra star constellation should be tied on the arm of the patient suffering from Apachi.

Alternatively root of Apamarga – Achyranthes aspera should be tied.

7. SIRAVEDHA

Two veins located on the under surface of tongue is cut and bloodletting done