Gulma Nidana: Difference between revisions

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In [[Chikitsa Sthana]], Charaka states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction). The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.

While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (kritmulam).

While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').

''shadkriyakala'' (lifecycle) of ''gulma'':

a. Sanchaya- Vata accumulates in vatasthana (pakwashaya, or the intestines) with the consumption of vatika food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.

#'''''Sanchaya'''''- ''Vata'' accumulates in ''vatasthana'' (''pakwashaya'', or the intestines) with the consumption of ''vatika'' food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.

#'''''Prakopa'''''- Consumption of ''ruksha, khara'' and ''sheeta'' food for prolonged periods of time reduces the ''snigdha'' quality of ''strotas'' while stimulating excess ''vata'' to overflow from its ''sthana''.

#'''''Prasara'''''-In this stage aggravated ''vata'' dislodges from its accumulated site and spreads all over the body.

#'''''Sthanasanshraya'''''- This is the stage in which the ''dosha'' stays at a particular locus and comes in contact with ''dushya''. In case of ''gulma'', the ''mahastrotas'' are the principal loci, with an absence of ''dushya'' in their formation. The vitiated ''vata'' and other ''doshas'' have an affinity towards specific loci such as ''hridaya, nabhi, basti'' etc. to get lodged there. Prodromal symptoms of ''gulma'' such as anorexia, aversion for food, weakness etc. also become apparent at this stage.

#'''''Vyakti'''''- Clinical features of different types of ''gulma'' manifest at this stage so management can be done depending upon specific ''dosha'' characteristics.

#'''''Bheda'''''-When the ''gulma'' is not treated at the fourth and fifth stage, complications like ''bradhna roga'' (inguinal swelling), ''jwara'' (fever), ''vidbheda'' (loose stools/diarrhea), and suppuration (in case of ''pittaja gulma'' ) occur where surgical intervention could be necessary.

~~b. Prakopa- Consumption of ruksha, khara and sheeta food for prolonged periods of time reduces the snigdha quality of strotas while stimulating excess vata to overflow from its sthana.~~

~~c. Prasara-In this stage aggravated vata dislodges from its accumulated site and spreads all over the body.~~

d. Sthanasanshraya- This is the stage in which the dosha stays at a particular locus and comes in contact with dushya. In case of gulma, the mahastrotas are the principal loci, with an absence of dushya in their formation. The vitiated vata and other doshas have an affinity towards specific loci such as hridaya, nabhi, basti etc. to get lodged there. Prodromal symptoms of gulma such as anorexia, aversion for food, weakness etc. also become apparent at this stage.

~~e. Vyakti- Clinical features of different types of gulma manifest at this stage so management can be done depending upon specific dosha characteristics.~~

f. Bheda-When the gulma is not treated at the fourth and fifth stage, complications like bradhna roga (inguinal swellig), jwara (fever), vidbheda (loose stools/diarrhoea), and suppuration (in case of pittaja gulma ) occur where surgical intervention could be necessary.

==== Location of gulma ====

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 In [[Chikitsa Sthana]], Charaka states that ''vata'' gets vitiated by two basic means i.e. ''dhatukshaya'' (tissue wasting) and ''margavarana'' (obstruction). The etiology given in this chapter could also include excess consumption of food with ''ruksha guna'', trauma and faulty ''shodhana'' procedures, excessive loss of ''mala'' and ''dhatu'' responsible for ''dhatukshaya'' and various other factors that vitiate ''doshas'' and ''mala'' causing obstruction of different channels, further aggravating ''vata''.
-While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (kritmulam).
+While analyzing the definition given by various Acharyas regarding ''gulma'' it can be stated that it is the clinical condition in which only solidification of ''doshas'' give rise to ''gulma''. It is believed that, for the development of any other disease, vitiated ''dosha''(s), together with ''dushya'' need to accumulate at a specific site leading to development of the disease. Therefore for the development of any disease, a combination of ''dosha'' and ''dushya'' is critical. However for ''gulma'', only vitiated ''doshas'' are responsible and there is no involvement of ''dushya''. This is a unique feature of pathogenesis of ''gulma''. Sushruta has explained further that just as water bubbles appear and disappear when rain drops fall on water, ''gulmas'' appear and disappear. Also, in the absence of any ''dushya'' (''dhatu'' and ''mala''), these swellings are commonly non-suppurative in nature. There are, however, some cases where suppuration may take place. For example, in [[Chikitsa Sthana]], Charaka has mentioned that suppuration may takes place in ''pittaja'' ''gulma'' and further elaborates the various stages of suppuration of ''gulma'' i.e. ''ama'' (immature or initial stage), pachyamana (intermediary stage) and pakwa awastha (final mature stage) etc. similar to the stages seen in various suppurative conditions like ''vidradhi''. Chakrapani commented that when the ''pitta gulma'' is not treated timely, ''pitta dosha'' and ''rakta dhatu'' get aggravated (together or separately), and involves the deeper structure (''kritmulam'').
 ''shadkriyakala'' (lifecycle) of ''gulma'':
-a.	Sanchaya- Vata accumulates in vatasthana (pakwashaya, or the intestines) with the consumption of vatika food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.
+#'''''Sanchaya'''''- ''Vata'' accumulates in ''vatasthana'' (''pakwashaya'', or the intestines) with the consumption of ''vatika'' food and activities such as excessive exercise, suppressing emergent urges etc., further aggravating it.
+#'''''Prakopa'''''- Consumption of ''ruksha, khara'' and ''sheeta'' food for prolonged periods of time reduces the ''snigdha'' quality of ''strotas'' while stimulating excess ''vata'' to overflow from its ''sthana''.
+#'''''Prasara'''''-In this stage aggravated ''vata'' dislodges from its accumulated site and spreads all over the body.
+#'''''Sthanasanshraya'''''- This is the stage in which the ''dosha'' stays at a particular locus and comes in contact with ''dushya''. In case of ''gulma'', the ''mahastrotas'' are the principal loci, with an absence of ''dushya'' in their formation. The vitiated ''vata'' and other ''doshas'' have an affinity towards specific loci such as ''hridaya, nabhi, basti'' etc. to get lodged there. Prodromal symptoms of ''gulma'' such as anorexia, aversion for food, weakness etc. also become apparent at this stage.
+#'''''Vyakti'''''- Clinical features of different types of ''gulma'' manifest at this stage so management can be done depending upon specific ''dosha'' characteristics.
+#'''''Bheda'''''-When the ''gulma'' is not treated at the fourth and fifth stage, complications like ''bradhna roga'' (inguinal swelling), ''jwara'' (fever), ''vidbheda'' (loose stools/diarrhea), and suppuration (in case of ''pittaja gulma'' ) occur where surgical intervention could be necessary.
-b.	Prakopa- Consumption of ruksha, khara and sheeta food for prolonged periods of time reduces the snigdha quality of strotas while stimulating excess vata to overflow from its sthana.
-c.	Prasara-In this stage aggravated vata dislodges from its accumulated site and spreads all over the body.
-d.	Sthanasanshraya- This is the stage in which the dosha stays at a particular locus and comes in contact with dushya. In case of gulma, the  mahastrotas are the principal loci, with an absence of dushya in their formation.  The vitiated vata and other doshas have an affinity towards specific loci such as hridaya, nabhi, basti etc. to get lodged there. Prodromal symptoms of gulma such as anorexia, aversion for food, weakness etc. also become apparent at this stage.
-e.	Vyakti- Clinical features of different types of gulma manifest at this stage so management can be done depending upon specific dosha characteristics.
-f.	Bheda-When the gulma is not treated at the fourth and fifth stage, complications like bradhna roga (inguinal swellig), jwara (fever), vidbheda (loose stools/diarrhoea), and suppuration (in case of pittaja gulma ) occur where surgical intervention could be necessary.
 ==== Location of gulma ====