Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Baker’s Cyst
A fluid stuffed swelling or bump shaped on the again of the knee is known as Baker’s Cyst. It is usually referred to as a popliteal cyst or synovial cyst. When harm happens to the knee joint or its surrounding tissues, extreme fluid drains into the knee joints and accumulates behind the joint and varieties a sac. That is referred to as Baker’s Cyst. These cysts trigger ache, discomfort or limit the actions within the joint, all of them can also happen.
Irritation, an infection or harm could trigger Baker’s cyst. A number of causes could also be causal.
To place it quick, ‘when the knee joint produces an extreme quantity of synovial fluid, it may possibly accumulate within the popliteal bursa, resulting in the formation of a Baker’s cyst’.
Baker’s Cyst: Ayurveda Understanding
Dosha connection
Overproduction and accumulation of synovial fluid within the popliteal bursa is the primary occasion behind formation of Baker’s Cyst. From an Ayurveda perspective we are able to think about this situation as extreme formation and accumulation of kapha within the knee joint.
Shleshaka Kapha is a subtype of kapha which is situated within the bony joints of the physique. In a state of stability, it lubricates the joints and facilitates straightforward motion of joints. When shleshaka kapha will increase past regular permissible limits inside and across the joints, it may possibly trigger swelling, both within the entrance or sides or again of the joints (knee joint on this context), impart strain on the joints and trigger signs like ache and heaviness.
Granthi / Kaphaja or Shlaishmika Granthi
Since Baker Cyst is a fluid stuffed lump, it may be thought-about as kaphaja / shlaishmika granthi. Since they’re benign growths, they can’t be categorised underneath arbuda.
These cysts are shaped because of the extreme vitiation of kapha. The signs induced on this situation are additionally resulting from kapha involvement.
On this situation, the cysts are chilly to the contact and are of the color of the pores and skin, have much less of ache and extreme itching, are stony onerous in consistency and develop very slowly in measurement. Once they break open, they discharge white colored pus.
If such a granthi is shaped behind the knee it may be thought-about as Baker’s cyst. Baker’s Cyst can also be induced resulting from an infection. When there may be an infection and suppuration, there will likely be discharge of pus. So, Kaphaja or Shlaishmika Granthi will be correlated with contaminated Baker’s Cyst or Baker’s cyst induced resulting from an infection.
Medoja Granthi
That is one other kind of granthi whose look and consistency resembles that of Baker’s Cyst.
The cyst herein is unctuous, massive in measurement and is related to itching and devoid of ache. When it breaks open, fatty discharge resembles the paste of sesame seeds or ghee.
The looks of discharge resembles that of synovial fluid. Medoja Granthi can happen anyplace within the physique however when it happens on the again of the knee joint, it resembles the medical presentation of Baker’s Cyst.
Shotha
Baker’s Cyst and the swelling occurring therein are both induced or triggered by an infection, irritation or harm. We have to have a look at this from the attitude of ‘Shotha’ defined in Ayurveda texts.
Shotha is a time period which encompasses varied kinds of swellings, inflammatory and non-inflammatory, every little thing.
With irritation being an vital occasion within the causation of this situation, pittaja shotha will be considered in its nearest correlation. Abhighataja shotha which is a swelling brought on by harm will be introduced into nearer correlation with Baker’s cyst induced resulting from harm.
Pittaja Shotha
The swelling brought on by vitiated pitta is clean in texture, emits particular scent, is black, yellow or crimson in color, related to giddiness, fever, extreme sweating, thirst, intoxication, burning kind of ache, has clear ache and redness of eyes. It presents with a extreme burning sensation and suppuration.
All these signs point out that the swelling is inflammatory in nature. Baker’s Cyst can also be brought on by irritation and might exhibit inflammatory signs.
Kaphaja Shotha
The swelling brought on by vitiated kapha is heavy, agency (mounted, motionless), pale in color and is related to anorexia, nausea, extreme sleep, vomiting and low digestion energy (fireplace). The looks and disappearance of this swelling could be very gradual. When pressed for just a few seconds and the strain launched, the swelling rises to the floor very slowly. The swelling is predominant through the night time time.
Abhighataja Shotha
The swelling brought on by exterior harm or contact of something which causes swelling will be thought-about as abhighataja shotha. It’s brought on by harm from sharp / blunt devices or weapons, contact of heavy breeze, snow, juice of Semecarpus anacardium or bristles of Mucuna pruriens and so on. These swellings are likely to unfold in all instructions, and will likely be related to rise in temperature, redness of the affected half and signs of pitta aggravation. This image seems much like inflammatory swelling or edema. Irritation and harm are the vital causes of Baker’s Cyst. Abhighataja Shotha, which reveals indicators of harm and irritation, when happens on the posterior area of the knee joint will be thought-about as Baker’s Cyst.
Sandhi Vikruti
Varied sorts of arthritis could cause Baker’s cyst – osteoarthritis, rheumatoid arthritis and gouty arthritis affecting the knee joint. Shotha is a component and parcel of sandhigata vata, amavata and vatashonita too, which correlates carefully with the above-mentioned situations respectively. Based on Ayurveda, all these situations additionally current with shula or Vedana – ache, and knee ache can also be defined amongst the signs of Baker’s cyst. Ache worsening with bodily exercise or extended standing in Baker’s Cyst is because of strain on nerves and surrounding tissues, which can occur resulting from extreme accumulation of shleshaka kapha or vata getting aggravated resulting from harm or pitta resulting from irritation. Rakta and ama might also be concerned within the pathogenesis as in vatarakta and amavata respectively. Stiffness and restricted mobility of the knee joint / joints can happen because of the affliction of the joint by morbid kapha, vata or each.
Kroshtuka Shirsha
It’s a swelling which happens on the centre of the knee joint (might also happen behind the knee as in Baker’s Cyst), brought on by mixed aggravation of vata and shonita (rakta, blood) and is related to extreme ache. The swollen knee joint seems like the pinnacle of kroshtuka / srugala – jackal and therefore the title Kroshtuka Shirsha.
Dhatu Connection
Since we’re talking in regards to the knee joint, janu sandhi – all constructions concerned in formation of the joint ought to be thought-about to be within the illness. The joint is made up of bones of thigh and leg. So asthi dhatu is the primary dhatu concerned. The rakta, mamsa and majja dhatu therein are additionally concerned within the illness course of.
Marma Connection
Janu Sandhi is a vital Marma and is situated within the janu sandhi – knee joint. It’s a ‘sandhi marma’. Mamsa – muscle groups, Sira – blood vessels, Snayu – ligaments and tendons, Asthi – bones and Sandhi – joints are the parts in every marma. The class to which it belongs depends upon which element is predominant in that marma. In Janu Marma, Sandhi element is predominant compared to the opposite parts and therefore is a Sandhi Marma.
It is usually a Vaikalyakara Marma – i.e. an important spot which causes deformity when injured.
When Baker’s Cyst progresses and entails the marma element because it will get persistent, and when not addressed by correct and well timed interventions, the prognosis turns into tough or regardless of correct remedy, the illness would go away its footprints and current within the type of frequent occurrences or relapses.
Ayurveda Therapy Ideas and Issues for Baker’s Cyst
Nidana Parivarjana
The principle strategy will likely be ‘avoiding’ the causative elements or triggers of the illness. They might be etiological elements inflicting or triggering the illness, illness inflicting doshas or each.
Panchakarma therapies
Vamana could also be ideally suited when there may be loads of fluid accumulation within the cyst, when there may be extreme vitiation of kapha afflicting the knee joint and there may be additionally systemic aggravation of kapha and the swelling is massive and related to heaviness, stiffness, onerous and actions restricted.
Virechana is good when irritation causes the swelling of the cyst, when there may be extreme vitiation of pitta afflicting the knee joint and there may be additionally systemic aggravation of pitta with widespread irritation, when there may be aggravation of rakta, or when the swelling is brought on by aggravated vata and rakta, as in vatarakta and when the swelling is related to different pitta signs like redness, burning sensation and raised heat across the swelling.
Exterior Therapies
Lepa Chikitsa – Software of medicinal pastes like Dashanga Lepa or Rasnadi (churna) Lepa that are hygroscopic in nature are efficient. As per dosha predominance, completely different medicinal powders can be utilized to organize lepas and apply on the jjoint / joints. Helpful powders embrace Kottamchukkadi Churna, Ellum Nishadi Churnam and Grihadhumadi Churnam.
Dhanyamla Dhara – shall be carried out in presence of inflammatory indicators across the swelling and if irritation can also be causal.
Pradhana Vyadhi Chikitsa
Baker’s Cyst could be a symptom of inflammatory ailments of the knee, harm or an infection as already mentioned. These causes or no matter causes them ought to be handled.
From Ayurveda perspective, Baker’s Cyst could also be handled on the ideas of treating the beneath talked about situations –
– Shotha – pittaja, kaphaja, abhighataja
– Granthi – kaphaja, medoja,
– Sandhi Vikriti / Roga – Amavata, Sandhigata Vata, Vatarakta, Kroshtuka Shirsha
Shastra Chiktsa
In excessive situations when the swelling / cyst must be lower open and the contents drained to guard the knee joint and when the medicinal approaches will not be yielding outcomes, surgical procedure ought to be most well-liked. Chedana – incision (indication – granthi), Bhedana (indication – vataja, pittaja and kaphaja granthi), Visravana – drainage (indication – eka deshaja shopha – inflammatory edema confined to 1 place or one a part of the physique and granthis) are the popular surgical procedures for Baker’s Cyst.
Helpful Formulations
– Dashamula Kashayam
– Punarnavadi Kashayam
– Rasnaerandadi Kashayam
– Patoladi Kashayam
– Guggulutiktakam Kashayam
– Varanadi Kashayam
– Brihahtyadi Kashayam
– Amavatari Kashayam
– Kokilaksham Kashayam
– Dashamularishtam
– Punarnavasavam
– Kanchanara Guggulu
– Kaishora Guggulu
– Simhanada Guggulu
– Triphala Guggulu
– Gokshuradi Guggulu
– Punarnavadi Guggulu
– Punarnavadi Mandura
– Shothari Mandura
