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Aggravated ''vata'', along with vitiated ''pitta'', gets (completely or partially) collected in the ''amashaya'' and produces the same types of pain as mentioned for ''vata gulma''. Due to aggravation of ''pitta'' in certain cases, the patient feels a burning sensation (with hyperacidity) in the belly, cardiac region, chest and throat while letting out smoky and sour eructations at the same time. In the location of ''gulma'', there is burning sensation, pain, sensations of fuming, sweating and moistening, laxity, tenderness and slight horripilation. The patient could exhibit symptoms such as fever, giddiness, burning pain, thirst, dryness of throat, palate and mouth, fainting and diarrhea, and develops greenish or yellowish discoloration of skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''pitta gulma''. [9]
 
Aggravated ''vata'', along with vitiated ''pitta'', gets (completely or partially) collected in the ''amashaya'' and produces the same types of pain as mentioned for ''vata gulma''. Due to aggravation of ''pitta'' in certain cases, the patient feels a burning sensation (with hyperacidity) in the belly, cardiac region, chest and throat while letting out smoky and sour eructations at the same time. In the location of ''gulma'', there is burning sensation, pain, sensations of fuming, sweating and moistening, laxity, tenderness and slight horripilation. The patient could exhibit symptoms such as fever, giddiness, burning pain, thirst, dryness of throat, palate and mouth, fainting and diarrhea, and develops greenish or yellowish discoloration of skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''pitta gulma''. [9]
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==== Kapha-dominant gulma ====
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==== ''Kapha''-dominant ''gulma'' ====
    
तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात्  
 
तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात्  
 
पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य  चातिप्रगाढमुदपानात्  
 
पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य  चातिप्रगाढमुदपानात्  
 
सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा  सह मारुतेन प्रकोपमापद्यते||१०||  
 
सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा  सह मारुतेन प्रकोपमापद्यते||१०||  
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tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhakṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||  
 
tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhakṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||  
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prakopamApadyate||10||
 
prakopamApadyate||10||
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If a person weakened by diseases or aforesaid factors (in verse 6) takes too much unctuous, heavy, sweet and cold things, habitually takes preparations of (rice) flour, sugarcane, milk, sesamum, black gram and coarse, unrefined sugar (jaggery), uses excessively immature curd, alcoholic drinks, salads, eats meat of marshy, aquatic and domesticated animals in excessive quantities, suppresses natural urges, drinks too much water when hungry, or is subjected to excessive shaking of the body (caused by travelling on rough roads, etc), his kapha along with vata gets vitiated or aggravated. (10)
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If a person weakened by diseases or aforesaid factors (in verse 6) takes too much unctuous, heavy, sweet and cold things, habitually takes preparations of (rice) flour, sugarcane, milk, sesame, black gram and coarse, unrefined sugar (jaggery), uses excessively immature curd, alcoholic drinks, salads, eats meat of marshy, aquatic and domesticated animals in excessive quantities, suppresses natural urges, drinks too much water when hungry, or is subjected to excessive shaking of the body (caused by travelling on rough roads, etc.), his ''kapha'' along with ''vata'' gets vitiated or aggravated. [10]
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तं प्रकुपितं  मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति  
 
तं प्रकुपितं  मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति  
 
य उक्ता वातगुल्मे; श्लेष्मा  त्वस्य  शीतज्वरारोचकाविपाकाङ्गमर्द हर्षहृद्रोगच्छर्दिनिद्रालस्यस्तैमित्यगौरवशिरोभितापानुपजनयति, अपि च गुल्मस्यस्थैर्यगौरवकाठिन्यावगाढसुप्तताः, तथाकासश्वासप्रतिश्यायान्  राजयक्ष्माणं चातिप्रवृद्धः, श्वैत्यं त्वङ्नखनयनवदनमूत्रपुरीषेषूपजनयति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्मगुल्मः||११||
 
य उक्ता वातगुल्मे; श्लेष्मा  त्वस्य  शीतज्वरारोचकाविपाकाङ्गमर्द हर्षहृद्रोगच्छर्दिनिद्रालस्यस्तैमित्यगौरवशिरोभितापानुपजनयति, अपि च गुल्मस्यस्थैर्यगौरवकाठिन्यावगाढसुप्तताः, तथाकासश्वासप्रतिश्यायान्  राजयक्ष्माणं चातिप्रवृद्धः, श्वैत्यं त्वङ्नखनयनवदनमूत्रपुरीषेषूपजनयति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत इति श्लेष्मगुल्मः||११||
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taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē; ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati, api ca gulmasyasthairyagauravakāṭhinyāvagāḍhasuptatāḥ, tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ, śvaityaṁtvaṅnakhanayanavadanamūtrapurīṣēṣūpajanayati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti ślēṣmagulmaḥ||11||
 
taṁ prakupitaṁ māruta āmāśayaikadēśē saṁvartya [18] tānēva vēdanāprakārānupajanayati ya uktā vātagulmē; ślēṣmā tvasyaśītajvarārōcakāvipākāṅgamardaharṣahr̥drōgacchardinidrālasyastaimityagauravaśirōbhitāpānupajanayati, api ca gulmasyasthairyagauravakāṭhinyāvagāḍhasuptatāḥ, tathā kāsaśvāsapratiśyāyān rājayakṣmāṇaṁ cātipravr̥ddhaḥ, śvaityaṁtvaṅnakhanayanavadanamūtrapurīṣēṣūpajanayati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti ślēṣmagulmaḥ||11||
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taM  prakupitaM mAruta AmAshayaikadeshe saMvartya tAneva vedanAprakArAnupajanayati ya uktA Vatagulme; shleShmA tvasya
 
taM  prakupitaM mAruta AmAshayaikadeshe saMvartya tAneva vedanAprakArAnupajanayati ya uktA Vatagulme; shleShmA tvasya
 
shItajvarArocakAvipAkA~ggamardaharShahRudrogacchardinidrAlasyastaimityagauravashirobhitApAnupajanayati, api ca gulmasya sthairyagauravakAThinyAvagADhasuptatAH,
 
shItajvarArocakAvipAkA~ggamardaharShahRudrogacchardinidrAlasyastaimityagauravashirobhitApAnupajanayati, api ca gulmasya sthairyagauravakAThinyAvagADhasuptatAH,
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viparItAni copasherata iti shleShmagulmaH||11||
 
viparItAni copasherata iti shleShmagulmaH||11||
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Such aggravated vata along with vitiated kapha, when accumulated in the amashaya (upper part of abdomen) region or a part of it, causes the same types of painful symptoms as mentioned for vatagulma. Kapha causes fever accompanied with cold sensation, anorexia, indigestion, bodyache, horripilation, heart disease, vomiting, excess sleep, lassitude, sweating, and a feeling of heaviness and distress in the head. In the region where the gulma is located, there is fixity, heaviness, hardness, and numbness. Complications could occur such as cough, dyspnoea, coryza and even tuberculosis in much advanced stages. In terms of physical appearance, the patient develops whiteness in skin, nails, face, urine and faeces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. . This variant of gulma is called kaphagulma. (11)
+
Such aggravated ''vata'' along with vitiated ''kapha'', when accumulated in the amashaya (upper part of abdomen) region or a part of it, causes the same types of painful symptoms as mentioned for vatagulma. Kapha causes fever accompanied with cold sensation, anorexia, indigestion, bodyache, horripilation, heart disease, vomiting, excess sleep, lassitude, sweating, and a feeling of heaviness and distress in the head. In the region where the gulma is located, there is fixity, heaviness, hardness, and numbness. Complications could occur such as cough, dyspnoea, coryza and even tuberculosis in much advanced stages. In terms of physical appearance, the patient develops whiteness in skin, nails, face, urine and faeces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. . This variant of gulma is called kaphagulma. [11]
Tridosha dominant gulma:
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==== ''Tridosha'' dominant ''gulma'' ====
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त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति  कुशलाः|  
 
त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति  कुशलाः|  
 
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
 
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||