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→Tridosha dominant gulma
त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|
त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||
tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ|
tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ|
sa vipratiṣiddhōpakramatvādasādhyō [19] nicayagulmaḥ||12||
sa vipratiṣiddhōpakramatvādasādhyō [19] nicayagulmaḥ||12||
Tu sAnnipAtikaM gulmamupadishanti kushalAH| sa vipratiShiddhopakramatvAdasAdhyo
Tu sAnnipAtikaM gulmamupadishanti kushalAH| sa vipratiShiddhopakramatvAdasAdhyo
nicayagulmaH||12||
nicayagulmaH||12||
When the symptoms of three doshas are exhibited, a gulma patient is said to be ailing from sannipatika gulma. This condition is incurable. (12)
Shonita gulma :
When the symptoms of three ''doshas'' are exhibited, a ''gulma'' patient is said to be ailing from ''sannipatika gulma''. This condition is incurable. [12]
==== ''Shonita gulma'' ====
शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्| पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा
शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्| पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा
वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||
वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||
śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|
pāratantryādavaiśāradyāt satatamupacārānurōdhādvā vēgānudīrṇānuparundhatyā āmagarbhē vā'pyacirapatitē'thavā'pyaciraprajātāyā r̥tau vāvātaprakōpaṇānyāsēvamānāyāḥ kṣipraṁ vātaḥ prakōpamāpadyatē||13||
pāratantryādavaiśāradyāt satatamupacārānurōdhādvā vēgānudīrṇānuparundhatyā āmagarbhē vā'pyacirapatitē'thavā'pyaciraprajātāyā r̥tau vāvātaprakōpaṇānyāsēvamānāyāḥ kṣipraṁ vātaḥ prakōpamāpadyatē||13||
khalu striyA eva bhavati na puruShasya, garbhakoShThArtavAgamanavaisheShyAt|
khalu striyA eva bhavati na puruShasya, garbhakoShThArtavAgamanavaisheShyAt|
pAratantryAdavaishAradyAt satatamupacArAnurodhAdvA vegAnudIrNAnuparundhatyA
pAratantryAdavaishAradyAt satatamupacArAnurodhAdvA vegAnudIrNAnuparundhatyA
VataprakopaNAnyAsevamAnAyAH kShipraM VataH prakopamApadyate||13||
VataprakopaNAnyAsevamAnAyAH kShipraM VataH prakopamApadyate||13||
Shonita/Raktagulma occurs specifically only in women and not in men because of presence of uterus and menstrual flow in the former. In woman, who suppress their natural urges because of dependence, ignorance or a constant attendance to service of others or uses vata aggravating substances soon after abortion, delivery or during menstruation, vata gets vitiated or aggravated quickly. (13)
''Shonita'' or ''raktagulma'' occurs specifically only in women and not in men because of presence of uterus and menstrual flow in the former. In woman, who suppress their natural urges because of dependence, ignorance or a constant attendance to service of others or uses ''vata'' aggravating substances soon after abortion, delivery or during menstruation, ''vata'' gets vitiated or aggravated quickly. [13]
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|
तस्याः शूलकासातीसारच्छर्द्यरोचकाविपाकाङ्गमर्दनिद्रालस्यस्तैमित्य कफप्रसेकाः समुपजायन्ते, स्तनयोश्च स्तन्यम्, ओष्ठयोः
तस्याः शूलकासातीसारच्छर्द्यरोचकाविपाकाङ्गमर्दनिद्रालस्यस्तैमित्य कफप्रसेकाः समुपजायन्ते, स्तनयोश्च स्तन्यम्, ओष्ठयोः
योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते,
योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते,
केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||
केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||
sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|
tasyāḥ śūlakāsātīsāracchardyarōcakāvipākāṅgamardanidrālasyastaimityakaphaprasēkāḥ samupajāyantē, stanayōśca stanyam, ōṣṭhayōḥ stanamaṇḍalayōścakārṣṇyam, atyarthaṁ glāniścakṣuṣōḥ, mūrcchā, hr̥llāsaḥ, dōhadaḥ, śvayathuśca pādayōḥ, īṣaccōdgamō rōmarājyāḥ, yōnyāścāṭālatvam, api ca yōnyādaurgandhyamāsrāvaścōpajāyatē, kēvalaścāsyā gulmaḥ piṇḍita ēva spandatē, tāmagarbhāṁ garbhiṇīmityāhurmūḍhāḥ||14||
tasyāḥ śūlakāsātīsāracchardyarōcakāvipākāṅgamardanidrālasyastaimityakaphaprasēkāḥ samupajāyantē, stanayōśca stanyam, ōṣṭhayōḥ stanamaṇḍalayōścakārṣṇyam, atyarthaṁ glāniścakṣuṣōḥ, mūrcchā, hr̥llāsaḥ, dōhadaḥ, śvayathuśca pādayōḥ, īṣaccōdgamō rōmarājyāḥ, yōnyāścāṭālatvam, api ca yōnyādaurgandhyamāsrāvaścōpajāyatē, kēvalaścāsyā gulmaḥ piṇḍita ēva spandatē, tāmagarbhāṁ garbhiṇīmityāhurmūḍhāḥ||14||
sa prakupito yonimukhamanupravishyArtavamuparuNaddhi, mAsi mAsi tadArtavamuparudhyamAnaM kukShimabhivardhayati| tasyAH
sa prakupito yonimukhamanupravishyArtavamuparuNaddhi, mAsi mAsi tadArtavamuparudhyamAnaM kukShimabhivardhayati| tasyAH
shUlakAsAtIsAracchardyarocakAvipAkA~ggamardanidrAlasyastaimityakaphaprasekAH
shUlakAsAtIsAracchardyarocakAvipAkA~ggamardanidrAlasyastaimityakaphaprasekAH
api ca yonyA daurgandhyamAsrAvashcopajAyate, kevalashcAsyA
api ca yonyA daurgandhyamAsrAvashcopajAyate, kevalashcAsyA
gulmaH piNDita eva spandate, tAmagarbhAM garbhiNImityAhurmo UDhAH||14||
gulmaH piNDita eva spandate, tAmagarbhAM garbhiNImityAhurmo UDhAH||14||
This vitiated vata gets into the cervico-vaginal canal and checks the menstrual flow. If this continues for a prolonged period, the menstrual blood being obstructed accumulates and enlarges the abdomen. The patient consequently suffers from pain, cough, diarrhoea, vomiting, anorexia, indigestion, bodyache, excess sleep, lassitude, dampness, and excessive salivation. There occurs appearance of milk in breasts, dark coloration of lips and areolar region, excessive heaviness in eyes, fainting, nausea, longing for certain food articles as seen during pregnancy, swelling in feet, dilatation of the vaginal orifice and foul smelling discharge from the vagina. There is pulsation in the entire mass of gulma, confusing the patient (or her attendants) into thinking that she is pregnant. (14)
Prodormal symptoms:
This vitiated ''vata'' gets into the cervico-vaginal canal and checks the menstrual flow. If this continues for a prolonged period, the menstrual blood being obstructed accumulates and enlarges the abdomen. The patient consequently suffers from pain, cough, diarrhea, vomiting, anorexia, indigestion, bodyache, excess sleep, lassitude, dampness, and excessive salivation. There occurs appearance of milk in breasts, dark coloration of lips and areolar region, excessive heaviness in eyes, fainting, nausea, longing for certain food articles as seen during pregnancy, swelling in feet, dilatation of the vaginal orifice and foul smelling discharge from the vagina. There is pulsation in the entire mass of ''gulma'', confusing the patient (or her attendants) into thinking that she is pregnant. [14]
==== Prodormal symptoms ====
एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि
एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि
पूर्वरूपाणि भवन्ति; तद्यथा-अनन्नाभिलषणम्, अरोचकाविपाकौ,
पूर्वरूपाणि भवन्ति; तद्यथा-अनन्नाभिलषणम्, अरोचकाविपाकौ,
अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः,
अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः,
अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||
अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||
ēṣāṁ tu khalu pañcānāṁ gulmānāṁ prāgabhinirvr̥ttērimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arōcakāvipākau, agnivaiṣamyaṁ, vidāhō bhuktasya,pākakālē cāyuktyā chardyudgārau, vātamūtrapurīṣavēgānāṁ cāprādurbhāvaḥ, prādurbhūtānāṁ cāpravr̥ttirīṣadāgamanaṁ vā,vātaśūlāṭōpāntrakūjanāpariharṣaṇātivr̥ttapurīṣatāḥ, abubhukṣā, daurbalyaṁ, sauhityasya cāsahatvamiti||15||
ēṣāṁ tu khalu pañcānāṁ gulmānāṁ prāgabhinirvr̥ttērimāni pūrvarūpāṇi bhavanti; tadyathā- anannābhilaṣaṇam, arōcakāvipākau, agnivaiṣamyaṁ, vidāhō bhuktasya,pākakālē cāyuktyā chardyudgārau, vātamūtrapurīṣavēgānāṁ cāprādurbhāvaḥ, prādurbhūtānāṁ cāpravr̥ttirīṣadāgamanaṁ vā,vātaśūlāṭōpāntrakūjanāpariharṣaṇātivr̥ttapurīṣatāḥ, abubhukṣā, daurbalyaṁ, sauhityasya cāsahatvamiti||15||
eShAM tu khalu pa~jcAnAM gulmanAM prAgabhinirvRutterimAni
eShAM tu khalu pa~jcAnAM gulmanAM prAgabhinirvRutterimAni
pUrvarUpANi bhavanti; tadyathA-anannAbhilaShaNam, arocakAvipAkau,
pUrvarUpANi bhavanti; tadyathA-anannAbhilaShaNam, arocakAvipAkau,
abubhukShA, daurbalyaM, sauhityasya cAsahatvamiti||15||
abubhukShA, daurbalyaM, sauhityasya cAsahatvamiti||15||
These five types of gulma have the following prodormal symptoms just prior to occurring: aversion to food, anorexia and indigestion, disturbed metabolism, burning sensation after taking meals, vomiting and unusual eructations, reduced urge for flatus, urine and bowel movements, pain, distension, gurgling sound, horripilation and diarrhoea due to vata, loss of appetite, debility, and inability to endure satiety. (15)
These five types of ''gulma'' have the following prodormal symptoms just prior to occurring: aversion to food, anorexia and indigestion, disturbed metabolism, burning sensation after taking meals, vomiting and unusual eructations, reduced urge for flatus, urine and bowel movements, pain, distension, gurgling sound, horripilation and diarrhea due to ''vata'', loss of appetite, debility, and inability to endure satiety. [15]
Prognosis and general principles of management:
==== Prognosis and general principles of management ====
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|
सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|
तेषां सान्निपातिकमसाध्यं ज्ञात्वा नैवोपक्रमेत,
तेषां सान्निपातिकमसाध्यं ज्ञात्वा नैवोपक्रमेत,
वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||
sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ|
sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ|
tēṣāṁ sānnipātikamasādhyaṁ jñātvā naivōpakramēta, ēkadōṣajē tu yathāsvamārambhaṁ praṇayēt, saṁsr̥ṣṭāṁstu sādhāraṇēna karmaṇōpacarēt|
tēṣāṁ sānnipātikamasādhyaṁ jñātvā naivōpakramēta, ēkadōṣajē tu yathāsvamārambhaṁ praṇayēt, saṁsr̥ṣṭāṁstu sādhāraṇēna karmaṇōpacarēt|
tvaramANastu visheShamanupalabhamAno gulmeShvAtyayike karmaNi VatacikitsitaM praNayet, snehasvedau Vataharau snehopasaMhitaM ca mRudu virecanaM bastIMshca; amlalavaNamadhurAMshca rasAn yuktyA~avacArayet| mArute hyupashAnte svalpenApi prayatnena shakyo~anyo~api doSho niyantuM gulmeShviti||16||
tvaramANastu visheShamanupalabhamAno gulmeShvAtyayike karmaNi VatacikitsitaM praNayet, snehasvedau Vataharau snehopasaMhitaM ca mRudu virecanaM bastIMshca; amlalavaNamadhurAMshca rasAn yuktyA~avacArayet| mArute hyupashAnte svalpenApi prayatnena shakyo~anyo~api doSho niyantuM gulmeShviti||16||
As is evident from the descriptions of gulma, no variant is caused without vitiation of vata. Amongst these variants, sannipatika gulma is incurable and should not be treated. The variant caused by just one dosha, should be treated with suitable therapeutics prescribed for respective dosha. Those caused by a combination of two doshas (vata – pitta or vata – kapha) should be managed with the general therapeutic measures applicable to dwidoshic ailments. The measures that are not contrary to the dosha can be applied according to severity of complications. In case of emergency situations, the measures applicable in treatment of vata gulma, such as vata-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances should be administered. If vata is pacified, then the disease can be cured even with little efforts and other types of gulma can also be treated. (16)
As is evident from the descriptions of gulma, no variant is caused without vitiation of vata. Amongst these variants, sannipatika gulma is incurable and should not be treated. The variant caused by just one dosha, should be treated with suitable therapeutics prescribed for respective dosha. Those caused by a combination of two doshas (vata – pitta or vata – kapha) should be managed with the general therapeutic measures applicable to dwidoshic ailments. The measures that are not contrary to the dosha can be applied according to severity of complications. In case of emergency situations, the measures applicable in treatment of vata gulma, such as vata-alleviating unction, fomentation, mild unctuous purgation, enema, and use of sweet, sour and salty substances should be administered. If vata is pacified, then the disease can be cured even with little efforts and other types of gulma can also be treated. [16]
भवति चात्र-
भवति चात्र-
गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|
गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|
मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā|
bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā|
mārutē hyavajitē'nyamudīrṇaṁ dōṣamalpamapi karma nihanyāt||17||
mārutē hyavajitē'nyamudīrṇaṁ dōṣamalpamapi karma nihanyāt||17||
bhavati cAtra-
bhavati cAtra-
gulminAmanilashAntirupAyaiH sarvasho vidhivadAcaritavyA| mArute
gulminAmanilashAntirupAyaiH sarvasho vidhivadAcaritavyA| mArute