Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Baker’s Cyst
A fluid crammed swelling or bump shaped on the again of the knee is named Baker’s Cyst. It is usually referred to as a popliteal cyst or synovial cyst. When injury happens to the knee joint or its surrounding tissues, extreme fluid drains into the knee joints and accumulates behind the joint and kinds 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 damage could trigger Baker’s cyst. A number of causes could also be causal.
To place it brief, ‘when the knee joint produces an excessive amount of synovial fluid, it can accumulate in the popliteal bursa, leading to 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 principle occasion behind formation of Baker’s Cyst. From an Ayurveda perspective we are able to contemplate this situation as extreme formation and accumulation of kapha within the knee joint.
Shleshaka Kapha is a subtype of kapha which is positioned within the bony joints of the physique. In a state of steadiness, 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 could actually trigger swelling, both within the entrance or sides or again of the joints (knee joint on this context), impart stress on the joints and trigger signs like ache and heaviness.
Granthi / Kaphaja or Shlaishmika Granthi
Since Baker Cyst is a fluid crammed lump, it may be thought-about as kaphaja / shlaishmika granthi. Since they’re benign growths, they can’t be labeled below arbuda.
These cysts are shaped because of the extreme vitiation of kapha. The signs precipitated on this situation are additionally attributable to 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 arduous in consistency and develop very slowly in measurement. After 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 precipitated attributable to an infection. When there may be an infection and suppuration, there can be discharge of pus. So, Kaphaja or Shlaishmika Granthi might be correlated with contaminated Baker’s Cyst or Baker’s cyst precipitated attributable to 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, giant 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 precipitated or triggered by an infection, irritation or damage. We have to take 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, the whole lot.
With irritation being an essential occasion within the causation of this situation, pittaja shotha might be considered in its nearest correlation. Abhighataja shotha which is a swelling brought on by damage might be introduced into nearer correlation with Baker’s cyst precipitated attributable to damage.
Pittaja Shotha
The swelling brought on by vitiated pitta is easy in texture, emits particular odor, is black, yellow or pink 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 (fastened, motionless), pale in color and is related to anorexia, nausea, extreme sleep, vomiting and low digestion power (fireplace). The looks and disappearance of this swelling could be very sluggish. When pressed for just a few seconds and the stress launched, the swelling rises to the floor very slowly. The swelling is predominant throughout the evening time.
Abhighataja Shotha
The swelling brought on by exterior damage or contact of something which causes swelling might be thought-about as abhighataja shotha. It’s brought on by damage from sharp / blunt devices or weapons, contact of heavy breeze, snow, juice of Semecarpus anacardium or bristles of Mucuna pruriens and so forth. These swellings are inclined to unfold in all instructions, and can be related to rise in temperature, redness of the affected half and signs of pitta aggravation. This image seems just like inflammatory swelling or edema. Irritation and damage are the essential causes of Baker’s Cyst. Abhighataja Shotha, which reveals indicators of damage and irritation, when happens on the posterior area of the knee joint might be thought-about as Baker’s Cyst.
Sandhi Vikruti
Numerous sorts of arthritis could cause Baker’s cyst – osteoarthritis, rheumatoid arthritis and gouty arthritis affecting the knee joint. Shotha is part 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 stress on nerves and surrounding tissues, which can occur attributable to extreme accumulation of shleshaka kapha or vata getting aggravated attributable to damage or pitta attributable to irritation. Rakta and ama can 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 (can 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 identify Kroshtuka Shirsha.
Dhatu Connection
Since we’re talking in regards to the knee joint, janu sandhi – all buildings concerned in formation of the joint ought to be thought-about to be bothered within the illness. The joint is made up of bones of thigh and leg. So asthi dhatu is the principle 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 positioned within the janu sandhi – knee joint. It’s a ‘sandhi marma’. Mamsa – muscle tissue, 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 part is predominant in that marma. In Janu Marma, Sandhi part 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 includes the marma part because it will get persistent, and when not addressed by correct and well timed interventions, the prognosis turns into troublesome or despite correct therapy, the illness would go away its footprints and current within the type of frequent occurrences or relapses.
Ayurveda Therapy Rules and Issues for Baker’s Cyst
Nidana Parivarjana
The primary strategy can 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 ultimate 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 giant and related to heaviness, stiffness, arduous and actions restricted.
Virechana is right 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 – Utility of medicinal pastes like Dashanga Lepa or Rasnadi (churna) Lepa that are hygroscopic in nature are efficient. As per dosha predominance, totally different medicinal powders can be utilized to arrange lepas and apply on the bothered jjoint / joints. Helpful powders embrace Kottamchukkadi Churna, Ellum Nishadi Churnam and Grihadhumadi Churnam.
Dhanyamla Dhara – shall be completed in presence of inflammatory indicators across the swelling and if irritation can also be causal.
Pradhana Vyadhi Chikitsa
Baker’s Cyst is usually a symptom of inflammatory illnesses of the knee, damage or an infection as already stated. 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 aren’t yielding outcomes, surgical procedure ought to be most popular. Chedana – incision (indication – granthi), Bhedana (indication – vataja, pittaja and kaphaja granthi), Visravana – drainage (indication – eka deshaja shopha – inflammatory edema confined to at least one place or one a part of the physique and granthis) are the popular surgical procedures for Baker’s Cyst.
Useful 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
