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|title=Gulma Nidana

|title=Gulma Nidana

|type=article

|type=article

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<big>'''Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps '''</big>

<big>'''Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps '''</big>

{{Infobox

{{Infobox

|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|label6 = Translator and commentator

|label6 = Translator and commentator

|data6 = Sahu M., Fatmi U., Deole Y. S.

|data6 = Sahu M., Fatmi U., [[Yogesh Deole|Deole Y. S.]]

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Kar A.C., Gadgil D.

|data7  = Kar A.C., Gadgil D.

|label8 = Editors

|label8 = Editors

|data8  = Khandel S.K., Godatwar P., Deole Y.S., Basisht G.

|data8  = Khandel S.K., Godatwar P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication  

|label9 = Year of publication  

|data9 =  2020

|data9 =  2020

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

 

<p style="text-align:justify;">The third chapter describes the etiology, pathogenesis, clinical features and therapeutics of lumps in abdomen. Gulma, a (stable or transitory) growth that could occur anywhere in the body is primarily caused by a vitiated [[vata]]. The description given in the text cannot be correlated with any single entity of conventional medicine, but denotes localized intra-abdominal swellings of multiple origin in terms of their cause, site, features etc. In patients weakened by or recuperating from diseases or cleansing therapies ([[vamana]], etc.), or suffering from very stressful conditions, [[vata]] gets vitiated and enters the mahasrotas (gastrointestinal tract) causing the formation of gulma. Amongst the five types of gulma, sannipatika gulma is incurable whereas remaining can be managed according to [[dosha]] involvement. </p>

<div style="text-align:justify;">The third chapter describes the etiology, pathogenesis, clinical features and therapeutics of lumps in abdomen. Gulma, a (stable or transitory) growth that could occur anywhere in the body is primarily caused by a vitiated [[vata]]. The description given in the text cannot be correlated with any single entity of conventional medicine, but denotes localized intra-abdominal swellings of multiple origin in terms of their cause, site, features etc. In patients weakened by or recuperating from diseases or cleansing therapies ([[vamana]], etc.), or suffering from very stressful conditions, [[vata]] gets vitiated and enters the mahasrotas (gastrointestinal tract) causing the formation of gulma. Amongst the five types of gulma, sannipatika gulma is incurable whereas remaining can be managed according to [[dosha]] involvement. </div>

'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.  

'''Keywords''': ''Gulma, mahasrotas, koshtha, dhatukshaya, avarana'', abdominal lumps, intra-abdominal swellings, tumors.  

=== Location of ''gulma'' ===

=== Location of ''gulma'' ===

With respect to the ''adhishthana'' (location) of ''gulma'', five major sites have been mentioned [Cha.Sa. [[Chikitsa Sthana]] 5/8], including the ''hridaya, nabhi, basti,'' and ''parshwadwaya'' (flanks). In the context of this chapter, ''hridaya'' should be taken as the upper part of the abdominal cavity rather than the thoracic cage as described in [[Sharira Sthana]]. ''Vata gulma'' most commonly occurs in ''basti'', while ''pittagulma'' occurs most commonly in the ''nabhi'' region, and ''kaphagulma'' in the ''hridaya'' and ''parshwadwaya'' regions.<ref>Vagbhata. Sutra Sthana, Cha.11 Vidradivriddhigulmanidana verse 41. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. </ref> The ''yakrita gulma'' occurs in the region of ''hridaya, ashtheela gulma'' in the region of ''kukshi'' (hypogastrium), ''pleeha gulma'' in the ''madhya'' (central) region, ''chandravivardhaka gulma'' in the region of ''basti'' , and ''granthi gulma'' afflicts the region of ''nabhi''.<ref>Harita, Harita Samhita. Tritiya Sthana, Chap 4, Gulma Chikista, Verse 2-4, In: Harihariprasad Tripati, Editor. Harita Samhita. 2nd ed. Varanasi: Chaukhambha Krishnadas Academy; 2009</ref>  

With respect to the ''adhishthana'' (location) of ''gulma'', five major sites have been mentioned [Cha.Sa. [[Chikitsa Sthana]] 5/8], including the ''hridaya, nabhi, basti,'' and ''parshwadwaya'' (flanks). In the context of this chapter, ''hridaya'' should be taken as the upper part of the abdominal cavity rather than the thoracic cage as described in [[Sharira Sthana]]. ''[[Vata]] gulma'' most commonly occurs in ''basti'', while ''[[pitta]] gulma'' occurs most commonly in the ''nabhi'' region, and ''[[kapha]] gulma'' in the ''hridaya'' and ''parshwadwaya'' regions.<ref>Vagbhata. Sutra Sthana, Cha.11 Vidradivriddhigulmanidana verse 41. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000. </ref> The ''yakrita gulma'' occurs in the region of ''hridaya, ashtheela gulma'' in the region of ''kukshi'' (hypogastrium), ''pleeha gulma'' in the ''madhya'' (central) region, ''chandravivardhaka gulma'' in the region of ''basti'' , and ''granthi gulma'' afflicts the region of ''nabhi''.<ref>Harita, Harita Samhita. Tritiya Sthana, Chap 4, Gulma Chikista, Verse 2-4, In: Harihariprasad Tripati, Editor. Harita Samhita. 2nd ed. Varanasi: Chaukhambha Krishnadas Academy; 2009</ref>  

The pathogenesis of ''pittaja'' and ''kaphaja gulma'' takes place in ''amashaya'' that lies in the region between ''hridaya'' and ''basti'' [Chakrapani on Cha.Sa.[[Nidana Sthana]] 03]. Thus these two variants of ''gulma'' (i.e., ''pittaja'' and ''kaphaja'') cannot occur in ''basti''. The five sites of ''gulma'' can be mapped to the following anatomical sites of the abdomen:

The pathogenesis of ''pittaja'' and ''kaphaja gulma'' takes place in ''amashaya'' that lies in the region between ''hridaya'' and ''basti'' [Chakrapani on Cha.Sa.[[Nidana Sthana]] 03]. Thus these two variants of ''gulma'' (i.e., ''pittaja'' and ''kaphaja'') cannot occur in ''basti''. The five sites of ''gulma'' can be mapped to the following anatomical sites of the abdomen:

'''Prognosis''' –''Sannipatika gulma'' is incurable, rest four are curable when treated timely.  

'''Prognosis''' –''Sannipatika gulma'' is incurable, rest four are curable when treated timely.  

'''Management'''- All the four types of ''gulma'' can be managed according to the prevalent ''doshas''. In emergency conditions  if there is no time to diagnose the type of ''gulma, vata dosha'' should be managed first as it is prevalent in all types of ''gulma''.

'''Management'''- All the four types of ''gulma'' can be managed according to the prevalent ''[[dosha]]s''. In emergency conditions  if there is no time to diagnose the type of ''gulma, [[vata dosha]]'' should be managed first as it is prevalent in all types of ''gulma''.

Considering the various clinical features of ''gulma'' it can be said that the majority of ''gulmas'' are non-inflammatory and non-malignant intra-abdominal swellings. But some ''gulmas'' show indications of inflammatory swellings, some benign while some show the characteristics of malignant growths.

Considering the various clinical features of ''gulma'' it can be said that the majority of ''gulmas'' are non-inflammatory and non-malignant intra-abdominal swellings. But some ''gulmas'' show indications of inflammatory swellings, some benign while some show the characteristics of malignant growths.

* [[Gulma Chikitsa]]

* [[Gulma Chikitsa]]

== References ==

== References ==