Changes

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

• Gulma is a disease of the mahastrotas (gastro-intestinal tract/abdomen) and is caused due to predominance of vata. It is of five types depending upon its location (limited to the gastro-intestinal region between the heart and the bladder). Four types of gulma are common to both males and females while the fifth, raktaja gulma, is a condition limited to females.

*''Gulma'' is a disease of the ''mahastrotas'' (gastro-intestinal tract/abdomen) and is caused due to predominance of ''vata''. It is of five types depending upon its location (limited to the gastro-intestinal region between the heart and the bladder). Four types of ''gulma'' are common to both males and females while the fifth, ''raktaja gulma'', is a condition limited to females.

• Gulmas also vary by the vitiation of other doshas besides vata. The Sannipitak gulma, caused by vitiation of all three doshas, is said to be incurable.

*''Gulmas'' also vary by the vitiation of other doshas besides ''vata''. The ''sannipitaka gulma'', caused by vitiation of all three ''doshas'', is said to be incurable.

• A primary feature of gulma is obstruction to the path of vata, which can be due to causes like tumor, stricture, inflammation, tuberculosis, parasites, etc.

*A primary feature of ''gulma'' is obstruction to the path of ''vata'', which can be due to causes like tumor, stricture, inflammation, tuberculosis, parasites, etc.

• Gulma with acute symptoms should have urgent relief of vata obstruction.

*''Gulma'' with acute symptoms should have urgent relief of ''vata'' obstruction.

• Treatment of vata gulma includes vata-alleviating unction, fomentation, mild unctuous purgation, enema, and use of  sweet, sour and salty substances. If vata dosha is pacified in gulma disease, then other two dosha can also be controlled.  

*Treatment of ''vata gulma'' includes ''vata''-alleviating unction, fomentation, mild unctuous purgation, enema, and use of  sweet, sour and salty substances. If ''vata dosha'' is pacified in ''gulma'' disease, then other two ''dosha'' can also be controlled.  

Vidhi vimarsha:

 

=== ''Vidhi Vimarsha'' ===

 

A comprehensive effort has been made in Ayurveda to describe different types of swellings occurring in the body e.g. gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha, and vidradhi etc. They can be distinguished from each other according to their specific characteristics as written in different classics of Ayurveda. Generalized abdominal swellings have been described under the heading of udara roga (abdominal diseases including ascitis), while localized, non-suppurated swellings are gulmas. Other localized swellings, such as vriddhi roga (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region. Shopha is a localized inflammatory swelling. Vidradhi (abscess) are also  localized  but large suppurative lesions and are deep - rooted that may develop either from external  surfaces or  internal body cavities.  Granthi (cyst) and arbuda (tumor) are also localised, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and  are commonly known as neoplastic lesions.  

A comprehensive effort has been made in Ayurveda to describe different types of swellings occurring in the body e.g. gulma, udara roga, vriddhi roga, granthi, arbuddha, shopha, and vidradhi etc. They can be distinguished from each other according to their specific characteristics as written in different classics of Ayurveda. Generalized abdominal swellings have been described under the heading of udara roga (abdominal diseases including ascitis), while localized, non-suppurated swellings are gulmas. Other localized swellings, such as vriddhi roga (hernia and hydrocele), have also been described by ancient authors but such swellings are in regions other than the gastro-intestinal region, or in parts of the body such as the scrotal and inguinoscrotal region. Shopha is a localized inflammatory swelling. Vidradhi (abscess) are also  localized  but large suppurative lesions and are deep - rooted that may develop either from external  surfaces or  internal body cavities.  Granthi (cyst) and arbuda (tumor) are also localised, progressively increasing knotty lesions and are primarily non suppurative in nature. Such swellings may arise in any part of the body and  are commonly known as neoplastic lesions.  

Etiopathogenesis of gulma-

 

            In Caraka samhita, vitiated vata dosha is considered as major aetiological factor for the development of any type of gulma. . Amongst the five types of vata  mentioned in Charaka Samhita, vitiated apana and/or samana vata seem to be the primary etiological factors of gulma, since these are mainly responsible for the normal physiological functions of mahastrotas. The prodromal symptoms of gulma also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.  

==== Etiopathogenesis of gulma ====

In Chikitsasthana, 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.

 

In [[Charaka Samhita]], vitiated vata dosha is considered as major aetiological factor for the development of any type of gulma. . Amongst the five types of vata  mentioned in [[Charaka Samhita]], vitiated apana and/or samana vata seem to be the primary etiological factors of gulma, since these are mainly responsible for the normal physiological functions of mahastrotas. The prodromal symptoms of gulma also point towards these two e.g. aversion to food, anorexia, and diminished urge to pass flatus, urine and feces.  

 

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 analysing 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 Chikitsasthana, 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 pittagulma is not treated timely,  pitta dosha and rakta dhatu get aggravated (together or separately), and involves the deeper structure (kritmulam).  

While analysing 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 Chikitsasthana, 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 pittagulma is not treated timely,  pitta dosha and rakta dhatu get aggravated (together or separately), and involves the deeper structure (kritmulam).  

Shadkriyakala (lifecycle) of Gulma:

Shadkriyakala (lifecycle) of Gulma: