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Gulma Nidana (view source)

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{{#seo:

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|title=Gulma Nidana

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|titlemode=append

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|keywords=Gulma, mahasrotas, koshtha, dhatukshaya, avarana, abdominal lumps, intra-abdominal swellings, tumors

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|description=Nidana Sthana Chapter 3. Diagnosis and etio-pathogenesis of Abdominal lumps

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

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===Sanskrit Text, Transliteration and English Translation===

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अथातो गुल्मनिदानं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātō gulmanidānaṁ vyākhyāsyāmaḥ||1||

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Iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

Now I shall explain the chapter on etiopathogenesis of ''gulma''. Thus said Lord Atreya.[1-2]

==== Classification of ''gulma'' ====

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इह खलु पञ्च गुल्मा भवन्ति; तद्यथा- वातगुल्मः, पित्तगुल्मः,

श्लेष्मगुल्मो, निचयगुल्मः, शोणितगुल्म इति||३||

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iha khalu pañca gulmā bhavanti; tadyathā- vātagulmaḥ, pittagulmaḥ, ślēṣmagulmō, nicayagulmaḥ, śōṇitagulma iti||3||

Iha khalu pa~jca gulma bhavanti; tadyathA- VatagulmaH, pittagulmaH, shleShmagulmo, nicaya gulmaH, shoNitagulma iti||3||

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</div></div>

There are five types of ''gulma''- ''vata'' dominant ''gulma'', ''pitta'' dominant ''gulma'', ''shleshma''/''kapha'' dominant ''gulma'', ''nichaya'' (''tridosha'' dominant) ''gulma'', and ''shonita gulma''.[3]

==== Agnivesha’s question ====

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एवंवादिनं भगवन्तमात्रेयमग्निवेश उवाच- कथमिह भगवन् पञ्चानां गुल्मानां विशेषमभिजानीमहे; नह्यविशेषविद्रोगाणामौषधविदपि भिषक् प्रशमनसमर्थो भवतीति||४||

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ēvaṁvādinaṁ bhagavantamātrēyamagnivēśa uvāca- kathamiha bhagavan pañcānāṁ gulmānāṁ viśēṣamabhijānīmahē; nahyaviśēṣavidrōgāṇāmauṣadhavidapibhiṣak praśamanasamarthō bhavatīti||4||

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gulmanAM visheShamabhijAnImahe; nahyavisheShavidrogANAmauShadhavidapi bhiShak

prashamanasamartho bhavatIti||4||

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</div></div>

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After Lord Atreya said this, Agnivesha asked, “Sir, How can we know the specific characteristics of these five ''gulmas''? Because without this knowledge, such patients cannot be successfully treated by a physician even though he is well versed in the selection and usage of drugs.”[4]

</div>

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तमुवाच भगवानात्रेयः-

समुत्थानपूर्वरूपलिङ्गवेदनोपशयविशेषेभ्यो विशेषविज्ञानं गुल्मानां भवत्यन्येषां च रोगाणामग्निवेश! तत्तु खलु गुल्मेषूच्यमानं निबोध||५||

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tamuvāca bhagavānātrēyaḥ- samutthānapūrvarūpaliṅgavēdanōpaśayaviśēṣēbhyō viśēṣavijñānaṁ gulmānāṁ bhavatyanyēṣāṁ ca rōgāṇāmagnivēśa! tattu khalu [1]gulmēṣūcyamānaṁ nibōdha||5||

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samutthAnapUrvarUpali~ggavedanopashayavisheShebhyo visheShavij~jAnaM gulmanAM

bhavatyanyeShAM ca rogANAmagnivesha! Tattu khalu gulmeShUcyamAnaM nibodha||5||

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</div></div>

Lord Atreya replied, “Agnivesha! Specific characteristics of the five ''gulma'' as well as other diseases are defined on the basis of their etiology, prodromal symptoms, clinical features with various types of pains, and therapeutic applicability.”[5]

==== Etio-pathogenesis of ''vata''-dominant ''gulma'' ====

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यदा पुरुषो वातलो विशेषेण ज्वरवमनविरेचनातीसाराणामन्यतमेन

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अभिघातमृच्छति वा, विषमासनशयनस्थानचङ्क्रमणसेवी

वा भवति, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं व्यायामजातमारभते, तस्यापचाराद्वातः प्रकोपमापद्यते||६||

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yadā puruṣō vātalō viśēṣēṇa jvaravamanavirēcanātīsārāṇāmanyatamēna karśanēna karśitō vātalamāhāramāharati, śītaṁ vā viśēṣēṇātimātram [3] , asnēhapūrvē vāvamanavirēcanē pibati, anudīrṇāṁ vā chardimudīrayati, udīrṇān vātamūtrapurīṣavēgānniruṇaddhi, atyaśitō vā pibati navōdakamatimātram, atisaṅkṣōbhiṇā vā yānēnayāti, ativyavāyavyāyāmamadyaśōkarucirvā, abhighātamr̥cchati vā, viṣamāsanaśayanasthānacaṅkramaṇasēvī [4] vā bhavati, anyadvā kiñcidēvaṁvidhaṁviṣamamatimātraṁ vyāyāmajātamārabhatē, tasyāpacārādvātaḥ [5] prakōpamāpadyatē||6||

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anyadvA ki~jcidevaMvidhaM viShamamatimAtraM vyAyAmajAtamArabhate,

tasyApacArAdVataH prakopamApadyate||6||

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</div></div>

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When a person of ''vatika'' constitution, particularly emaciated due to one of the debilitating factors like fever, emesis, purgation and diarrhoea, consumes ''vata''- aggravating food or excessively cold food, in excessive quantities, or is administered emesis or purgation without prior unction, he vomits profusely and holds up impelling urges of flatus, urine, bowel movement. Or if such a person, after consuming a heavy meal, drinks a lot of fresh water or travels by an excessively jerking vehicle, indulges in excessive sexual intercourse, intensive physical exercise, or drinks alcoholic drinks, or suffers from excessive anxiety, or is subjected to injury or uses uneven postures in sitting, sleeping, standing and walking, or starts some other similar sort of irregular and excessive physical exercises -''vata'' gets vitiated or aggravated. [6]

</div>

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स प्रकुपितो वायुर्महास्रोतोऽनुप्रविश्य रौक्ष्यात्

कठिनीभूतमाप्लुत्य पिण्डितोऽवस्थानं करोति हृदि बस्तौ पार्श्वयोर्नाभ्यां वा; स शूलमुपजनयति ग्रन्थींश्चानेकविधान्,

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भवति, निदानोक्तानि चास्य नोपशेरते, विपरीतानि चोपशेरत

इति वातगुल्मः||७||

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sa prakupitō vāyurmahāsrōtō'nupraviśya raukṣyāt kaṭhinībhūtamāplutya [6] piṇḍitō'vasthānaṁ karōti hr̥di bastau pārśvayōrnābhyāṁ vā; sa śūlamupajanayatigranthīṁścānēkavidhān, piṇḍitaścāvatiṣṭhatē, sa piṇḍitatvād ‘gulma’ ityabhidhīyatē; sa muhurādhamati [7] , muhuralpatvamāpadyatē; aniyatavipulāṇuvēdanaścabhavati calatvādvāyōḥ, muhuḥ pipīlikāsampracāra ivāṅgēṣu, tōdabhēdasphuraṇāyāmasaṅkōcasuptiharṣapralayōdayabahulaḥ; tadāturaḥ sūcyēva śaṅkunēvacābhisaṁviddhamātmānaṁ manyatē, api ca divasāntē jvaryatē [8] , śuṣyati cāsyāsyam, ucchvāsaścōparudhyatē, hr̥ṣyanti cāsya rōmāṇi vēdanāyāḥ prādurbhāvē;plīhāṭōpāntrakūjanāvipākōdāvartāṅgamardamanyāśiraḥśaṅkhaśūlabradhnarōgāścainamupadravanti; kr̥ṣṇāruṇaparuṣatvaṅnakhanayanavadanamūtrapurīṣaścabhavati, nidānōktāni cāsya nōpaśēratē, viparītāni cōpaśērata iti vātagulmaḥ||7||

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plIhATopAntrakUjanAvipAkodAvartA~ggamardamanyAshiraHsha~gkhashUlabradhnarogAshcainamupadravanti; kRuShNAruNaparuShatva~gnakhanayanavadanamUtrapurIShashca

bhavati, nidAnoktAni cAsya nopasherate, viparItAni copasherata iti VatagulmaH||7||

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</div></div>

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Such vitiated ''vata'', on entering the ''mahasrotas'', hardens due to dryness forming a mass or swelling localised in the regions of heart, urinary bladder, sides and the navel. The condition, ''gulma'' (or ''vata gulma''), is painful and can take the shape of a single swelling or multiple nodules of various types. It sometimes gets aggravated and enlarged, sometimes diminished, and causes mild or severe pain due to instability of ''vayu''. Sometimes there are tingling sensations like ants crawling on body and frequent onset and diminution of various types of painful sensations such as piercing, breaking, twitching, extension, contraction, numbness, hyperaesthesia, etc. These sensations could be accompanied by a rise in temperature usually in the evenings, dryness of mouth, difficulty in expiration, horripilation at the onset of pain and complications such as spleen (enlargement), distension and gurgling sound in the abdomen, indigestion, ''udavarta'' (upward movement of ''vata''), bodyache, pain in the lateral side of the neck, head and temple regions and ''bradhana'' (swellings of the inguinal region) with appearance of blackness, reddishness and roughness in skin, nails, eyes, face, urine and feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. These are characteristic features of ''vata gulma''. [7]

</div>

==== ''Pitta''-dominant ''gulma'' ====

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तैरेव तु कर्शनैः कर्शितस्याम्ललवणकटुकक्षारोष्ण तीक्ष्ण शुक्तव्यापन्न मद्यहरितकफलाम्लानां विदाहिनां च शाकधान्य मांसादीनामुपयोगादजीर्णाध्यशनाद्रौक्ष्यानुगते चामाशये वमनमतिवेलं सन्धारणं वातातपौ चातिसेवमानस्य पित्तं सह मारुतेन प्रकोपमापद्यते||८||

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tairēva tu karśanaiḥ karśitasyāmlalavaṇakaṭukakṣārōṣṇatīkṣṇaśuktavyāpannamadyaharitakaphalāmlānāṁ vidāhināṁ caśākadhānyamāṁsādīnāmupayōgādajīrṇādhyaśanādraukṣyānugatē cāmāśayē vamanamativēlaṁ [10] sandhāraṇaṁ vātātapau cātisēvamānasya pittaṁ sahamārutēna prakōpamāpadyatē||8||

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Taireva tu karshanaiH karshitasyAmlalavaNa kaTukakShAroShNatIkShNashuktavy ApannamadyaharitakaphalAmlAnAM vidAhinAM ca shAkadhAnyamAMsAdIn AmupayogAdajIrNAdhyashanAdraukShyAnugate cAmAshaye vamanamativelaM

sandhAraNaM Vatatapau cAtisevamAnasya pittaM saha mArutena prakopamApadyate||8||

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</div></div>

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If a person, weakened by ailments or various etiological factors (as mentioned above in verse 6), uses sour, salty, pungent, and alkaline substances with hot and sharp potency, vinegar, improperly prepared or denatured alcoholic drinks, salads, sour fruits and acidic vegetables, grains, meat etc., takes food during indigestion, is administered emesis when ''amashaya'' is dry (or not properly oleated), suppresses natural urges for long, or is exposed excessively to the sun and wind, his ''pitta'' along with ''vata'' gets vitiated or aggravated. [8]

</div>

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तत् प्रकुपितं मारुत आमाशयैकदेशे संवर्त्य तानेव वेदनाप्रकारानुपजनयति,

य उक्ता वातगुल्मे; पित्तं त्वेनं विदहति कुक्षौ

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गुल्मावकाशश्चास्य दह्यते दूयते धूप्यते ऊष्मायते स्विद्यति क्लिद्यति शिथिल इव स्पर्शासहोऽल्परोमाञ्चश्च भवति; ज्वरभ्रमदवथुपिपासागलतालुमुखशोषप्रमोहविड्भेदाश्चैनमुपद्रवन्ति;

हरितहारिद्रत्वङ्नखनयनवदनमूत्रपुरीषश्च भवति; निदानोक्तानि चास्य नोपशेरते, विपरीतान्युपशेरत इति पित्तगुल्मः||९||

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tat prakupitaṁ māruta āmāśayaikadēśē saṁvartya [11] tānēva vēdanāprakārānupajanayati, ya uktā vātagulmē; pittaṁ tvēnaṁ vidahati kukṣau hr̥dyurasi kaṇṭhē ca; savidahyamānaḥ sadhūmamivōdgāramudgiratyamlānvitaṁ, gulmāvakāśaścāsya dahyatē dūyatē dhūpyatē [12] ūṣmāyatē svidyati klidyati śithila [13] ivasparśāsahō'lparōmāñcaśca [14] bhavati; jvarabhramadavathupipāsāgalatālumukhaśōṣapramōhaviḍbhēdāścainamupadravanti;haritahāridratvaṅnakhanayanavadanamūtrapurīṣaśca bhavati; nidānōktāni cāsya nōpaśēratē, viparītānyupaśērata iti pittagulmaḥ||9||

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haritahAridratva~gnakhanayanavadanamUtrapurIShashca bhavati; nidAnoktAni

cAsya nopasherate, viparItAnyupasherata iti pittagulmaH||9||

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</div></div>

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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]

</div>

==== ''Kapha''-dominant ''gulma'' ====

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तैरेव तु कर्शनैः कर्शितस्यात्यशनादतिस्निग्धगुरुमधुरशीताशनात्

पिष्टेक्षुक्षीरतिलमाषगुडविकृतिसेवनान्मन्दकमद्यातिपानाद्धरितकातिप्रणनयादानूपौदकग्राम्यमांसातिभक्षणात् सन्धारणादबुभुक्षस्य चातिप्रगाढमुदपानात्

सङ्क्षोभणाद्वा शरीरस्य श्लेष्मा सह मारुतेन प्रकोपमापद्यते||१०||

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tairēva tu karśanaiḥ karśitasyātyaśanādatisnigdhagurumadhuraśītāśanātpiṣṭēkṣukṣīratilamāṣaguḍavikr̥tisēvanānmandakamadyātipānāddharitakātipraṇanayādānūpaudakagrāmyamāṁsātibhak<br>ṣaṇāt [16] sandhāraṇādabubhukṣasya [17]cātipragāḍhamudapānāt saṅkṣōbhaṇādvā śarīrasya ślēṣmā saha mārutēna prakōpamāpadyatē||10||

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piShTekShukShIratilamAShaguDavikRutisevanAnmandakamadyAtipAnAddharitakAtipraNanayAdAnUpaudakagrAmyamAMsAtibhakShaNAt sandhAraNAdabubhukShasya cAtipragADhamudapAnAt sa~gkShobhaNAdvA sharIrasya shleShmA saha mArutena

prakopamApadyate||10||

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</div></div>

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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]

</div>

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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||

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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||

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tva~gnakhanayanavadanamUtrapurISheShUpajanayati, nidAnoktAni cAsya nopasherate,

viparItAni copasherata iti shleShmagulmaH||11||

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</div></div>

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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 ''vata gulma''. ''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 feces. The disease aggravates due to these etiological factors and pacifies due to opposite factors. This variant of ''gulma'' is called ''kapha gulma''. [11]

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==== ''Tridosha'' dominant ''gulma'' ====

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त्रिदोषहेतुलिङ्गसन्निपाते तु सान्निपातिकं गुल्ममुपदिशन्ति कुशलाः|

स विप्रतिषिद्धोपक्रमत्वादसाध्यो निचयगुल्मः||१२||

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tridōṣahētuliṅgasannipātē tu sānnipātikaṁ gulmamupadiśanti kuśalāḥ|

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Tu sAnnipAtikaM gulmamupadishanti kushalAH| sa vipratiShiddhopakramatvAdasAdhyo

nicayagulmaH||12||

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</div></div>

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'' ====

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शोणितगुल्मस्तु खलु स्त्रिया एव भवति न पुरुषस्य, गर्भकोष्ठार्तवागमन वैशेष्यात्| पारतन्त्र्यादवैशारद्यात् सततमुपचारानुरोधाद्वा

वेगानुदीर्णानुपरुन्धत्या आमगर्भे वाऽप्यचिरपतितेऽथवाऽप्यचिरप्रजाताया ऋतौ वा वातप्रकोपणान्यासेवमानायाः क्षिप्रंवातः प्रकोपमापद्यते||१३||

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śōṇitagulmastu khalu striyā ēva bhavati na puruṣasya, garbhakōṣṭhārtavāgamanavaiśēṣyāt|

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Amagarbhe vA~apyacirapatite~athavA~apyaciraprajAtAyA Rutau vA

VataprakopaNAnyAsevamAnAyAH kShipraM VataH prakopamApadyate||13||

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</div></div>

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''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]

</div>

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स प्रकुपितो योनिमुखमनुप्रविश्यार्तवमुपरुणद्धि, मासि मासि तदार्तवमुपरुध्यमानं |कुक्षिमभिवर्धयति|

तस्याः शूलकासातीसारच्छर्द्यरोचकाविपाकाङ्गमर्दनिद्रालस्यस्तैमित्य कफप्रसेकाः समुपजायन्ते, स्तनयोश्च स्तन्यम्, ओष्ठयोः

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योन्याश्चाटालत्वम्, अपि च योन्या दौर्गन्ध्यमास्रावश्चोपजायते,

केवलश्चास्या गुल्मः पिण्डित एव स्पन्दते, तामगर्भां गर्भिणीमित्याहुर्मूढाः||१४||

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sa prakupitō yōnimukhamanupraviśyārtavamuparuṇaddhi, māsi māsi tadārtavamuparudhyamānaṁ kukṣimabhivardhayati|

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api ca yonyA daurgandhyamAsrAvashcopajAyate, kevalashcAsyA

gulmaH piNDita eva spandate, tAmagarbhAM garbhiNImityAhurmo UDhAH||14||

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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]

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==== Prodormal symptoms ====

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एषां तु खलु पञ्चानां गुल्मानां प्रागभिनिर्वृत्तेरिमानि

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अग्निवैषम्यं, विदाहो भुक्तस्य, पाककाले चायुक्त्या छर्द्युद्गारौ, वातमूत्रपुरीषवेगानां चाप्रादुर्भावः, प्रादुर्भूतानां चाप्रवृत्तिरीषदागमनं वा, वातशूलाटोपान्त्रकूजनापरिहर्षणातिवृत्तपुरीषताः,

अबुभुक्षा, दौर्बल्यं,सौहित्यस्य चासहत्वमिति||१५||

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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||

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VatashUlATopAntrakUjanApariharShaNAtivRuttapurIShatAH,

abubhukShA, daurbalyaM, sauhityasya cAsahatvamiti||15||

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</div></div>

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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]

</div>

==== Prognosis and general principles of management ====

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सर्वेष्वपि खल्वेतेषु गुल्मेषु न कश्चिद्वातादृते सम्भवति गुल्मः|

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वातचिकित्सितं प्रणयेत्, स्नेहस्वेदौ वातहरौ स्नेहोपसंहितं च मृदु विरेचनं बस्तींश्च; अम्ललवणमधुरांश्च रसान् युक्त्याऽवचारयेत्|

मारुते ह्युपशान्ते स्वल्पेनापि प्रयत्नेन शक्योऽन्योऽपि दोषो नियन्तुं गुल्मेष्विति||१६||

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sarvēṣvapi khalvētēṣu gulmēṣu na kaścidvātādr̥tē sambhavati gulmaḥ|

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gurUnupadravAMstvaramANashcikitsejjaghanyamitarAn|

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||

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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]

</div>

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भवति चात्र-

गुल्मिनामनिलशान्तिरुपायैः सर्वशो विधिवदाचरितव्या|

मारुते ह्यवजितेऽन्यमुदीर्णं दोषमल्पमपि कर्म निहन्यात्||१७||

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bhavati cātra- gulmināmanilaśāntirupāyaiḥ sarvaśō vidhivadācaritavyā|

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gulminAmanilashAntirupAyaiH sarvasho vidhivadAcaritavyA| mArute

hyavajite~anyamudIrNaM doShamalpamapi karma nihanyAt||17||

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In the case of ''gulma'', all the measures for pacification of ''vata'' should be administered properly because after ''vayu'' is controlled over, other aggravated ''doshas'' can be alleviated even with small remedies. [17]

==== Summary ====

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तत्र श्लोकः-

सङ्ख्या निमित्तं रूपाणि पूर्वरूपमथापि च|

दिष्टं निदाने गुल्मानामेकदेशश्च कर्मणाम्||१८||

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tatra ślōkaḥ- saṅkhyā nimittaṁ rūpāṇi pūrvarūpamathāpi ca|

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sa~gkhyA nimittaM rUpANi pUrvarUpamathApi ca| diShTaM

nidAne gulmanAmekadeshashca karmaNAm||18||

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</div></div>

Now, to summarize:

In the chapter on diagnosis of ''gulma'' the number, causative factor, symptoms and prodromal symptoms along with a portion of treatment of ''gulmas'' have been described.[18]

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने गुल्मनिदानं

नाम तृतीयोऽध्यायः||३||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē nidānasthānē gulmanidānaṁ nāma tr̥tīyō'dhyāyaḥ||3||

ityagniveshakRute tantre tantre carakapratisaMskRute nidAnasthAne gulmanidAnaM nAma tRutIyo~adhyAyaH||3||

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Thus ends the third chapter on the diagnosis of ''gulma'' in the treatise composed by Agnivesha and redacted by Charak.

Agnivesha

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